Comparing the Impact of Food Insecurity, Access to Exercise Opportunities, and County Classification on Obesity Rates in Ohio

Objective: We completed a study to determine how food insecurity, access to exercise opportunities, and county classification (rural or urban) impacted obesity rates in Ohio. We hypothesized that the county classification impacted obesity the most followed by food insecurity and access to exercise opportunities. Methods: We obtained data on food insecurity, access to exercise opportunities, and obesity from County Health Rankings and county classification data from the United States Department of Agriculture Census. We analyzed correlations between obesity and food insecurity and obesity and access to exercise opportunities in both county types. We also analyzed changes in obesity rates in both county types during 2016 and 2022. Furthermore, we developed a regression model to measure how each factor contributes to obesity. Results: Correlations between food insecurity and obesity were significant in both county types in 2022. However, the correlation between access to exercise opportunities and obesity was only significant in urban communities in 2022. In 2016, the correlation between food insecurity and obesity was not statistically significant in both county types. Similarly to 2022, the correlation between access to exercise opportunities and obesity was statistically significant. Overall, obesity significantly increased from 2016 and 2022 in both county types. This increase is despite significant decreases in food insecurity. However, this increase matches the fact that access to exercise opportunities decreased significantly from 2016 and 2022. Our linear regression model showed that in 2022, food insecurity and access to exercise opportunities were significant predictors of obesity. In 2016, however, only food insecurity was a significant predictor of obesity. Conclusion: The results of our study highlight how county classification, food insecurity, and access to exercise opportunities contribute to obesity in Ohio. Interestingly, these factors only contribute to 27% of current obesity rates, indicating that there are various contributing factors. Regardless, targeting these factors through healthcare intervention and policy can still alleviate a large contributor to obesity rates

Analytical Comparison of RSA and RSA with Chinese Remainder Theorem

RSA encryption algorithm is one of the most powerful public key encryption algorithm. The problem with RSA algorithm is that RSA decryption is relatively slow in comparison to RSA encryption. Chinese Remainder Theorem (CRT), a modulo based mathematical theorem, is proposed by researchers as a way to enhance the performance of decryption. CRT minimizes the mathematical computation to large extent, thus improving the speed. CRT is well known for improving RSA’s decryption speed, but it has some drawbacks which limits its usage. The problem is that the limitations or drawbacks of CRT are not highlighted. The goal of this research paper is to address disadvantages of CRT when used for RSA decryption. Apart from the social and economic impacts, this paper covers the effects of research on current cryptographic protocols used by different browsers as well as organizations. In order to achieve goal, we are comparing several factors between RSA decryption with RSA-CRT decryption. We are using JAVA programming language to analyze the decryption algorithms. The significance of this research paper is to serve as the foundation for further research on RSA-CRT decryption. In addition, this paper addresses situations where CRT decryption is faster and beneficial to use by stating its advantages and disadvantages

Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients.  Methods: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression.  Results: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0-33), median 0.5 hospitalizations (range 0-8), and 0 overdoses (range 0-3), vs median one ED visit (range 0-8), median 0 hospitalizations (range 0-4), and median 0 overdoses (range 0-3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07.  Conclusion: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients

Self-assembly modulation in star block copolymers by amphiphilic diol: A scattering insight

The present study offers a better insight into the alteration in the aggregation characteristics of ethylene oxide-propylene oxide (EO-PO)-based star block copolymers Tetronics® T1304 and T1307 induced by an amphiphilic diol Surfynol® 104 (hereafter C$_{14}$ diol) using scattering (dynamic light scattering and small angle neutron scattering) with complementary physical property measurement viz. solution viscosity and cloud point (CP). It is the hydrophobic interaction that drives C$_{14}$ diol molecules to penetrate inside copolymer micelles resulting in dehydration that lowered the CP and markedly increase in solution viscosity. Quite interestingly, initial lowering in CP is followed by sudden increase at higher level of solubilization. A significant increase in the apparent hydrodynamic diameter (D$_h$) divulges the growth of micelles which is equally supported by SANS measurements. The micellar parameters obtained from SANS analysis for T1304 and T1307 in the presence of C$_{14}$ diol are described. The preferential partitioning of C$_{14}$ diol into the copolymer micelles is the driving force for morphological changes from spherical to unilamellar vesicles. Also, the effect of temperature and NaCl was examined with the aim to observe various micellar transitions. The observed changes are clarified in terms of the hydrophobic interaction of C$_{14}$ diol with Tetronic® micelles and HLB value of copolymers. The perception of C$_{14}$ diol stabilised Tetronic® micelles is anticipated and correlated with optimal parameters obtained from computational simulation approach, providing a clear understanding of the correlation between the molecular orbital energy levels of Tetronic® and C$_{14}$ diol. The present manuscript thus sheds light on C$_{14}$ diol induced dehydration causing the micelle growth for both Tetronics® with varied hydrophobicity. Such hydrophobic diol-induced spherical to vesicular transition is observed for the first time in Tetronic®-diol mixed system

Cost Effectiveness of Intensive Lipid-Lowering Treatment for Patients with Congestive Heart Failure and Coronary Heart Disease in the US

Background: A recent study found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-dose versus low-dose statin therapy. Objective: To examine the cost effectiveness of high-dose versus low-dose statin therapy in CHF patients. Methods: Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A10) in patients with both CHF and coronary heart disease (CHD) [CHF/CHD], using a lifetime Markov model. The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based on clinical trial data. The quality of life and costs were literature based. Measures included costs per life-year saved (LYS) and QALY gained. Health consequences and costs were discounted at 3.0% annually. Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values. Results: Literature-based mortality estimates (base case) increased life-years and QALYs for A80 compared with A10 (incremental cost-effectiveness ratios [ICERs]: $US9600 per LYS; $US13 600 per QALY). At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 80% of simulations. A10 dominated A80 when using trial-based mortality estimates (alternative scenario). At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations. Conclusions: Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US, due to projected gains in life expectancy and health-related quality of life. However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A10 dominates A80.

The Influence of the Microbiome on Urological Malignancies: A Systematic Review

The microbiome, once considered peripheral, is emerging as a relevant player in the intricate web of factors contributing to cancer development and progression. These often overlooked microorganisms, in the context of urological malignancies, have been investigated primarily focusing on the gut microbiome, while exploration of urogenital microorganisms remains limited. Considering this, our systematic review delves into the complex role of these understudied actors in various neoplastic conditions, including prostate, bladder, kidney, penile, and testicular cancers. Our analysis found a total of 37 studies (prostate cancer 12, bladder cancer 20, kidney cancer 4, penile/testicular cancer 1), revealing distinct associations specific to each condition and hinting at potential therapeutic avenues and future biomarker discoveries. It becomes evident that further research is imperative to unravel the complexities of this domain and provide a more comprehensive understanding

GRADE AND VOLUME PROGRESSION AND ITS ASSOCIATION WITH THE DECIPHER GENOMIC CLASSIFIER USING PATIENTS ENROLLED IN A PROSPECTIVE ACTIVE SURVEILLANCE PROTOCOL

The progression of prostate cancer through serial biopsies in patients on active surveillance is a multifaceted process, with grade and volume progression offering unique perspectives on disease advancement. The Decipher genomic classifier has been recognized as a valuable tool for predicting disease progression. This study examines the relationship between the Decipher score, and other GRID signatures and pathways, and grade and volume progression in prostate cancer patients, utilizing data collected prospectively from the Miami Active Surveillance Trial (MAST). We scrutinized 224 baseline samples from 124 unique patients participating in the MAST database. Progression was categorized into grade progression, volume progression, and no progression. For patients with multiple samples, the sample with the highest Decipher score was selected. We also evaluate the association between 11 prognostic signatures, including the Decipher score and an average genomic risk score combining the 11 signatures and 20 pathways available from the Decipher GRID. Out of the baseline samples, 60 demonstrated grade progression, 51 volume progression, and 113 showed no progression. We found that the Decipher was not associated to our trial definition of progression, that combined grade and volume progression however we did find a statistically significant difference in Decipher scores from patients who experience grade progression (p=0.0005) as compared to volume progression (p=0.92) when comparing them with patients with no progression(Figure 1). A heat map evaluating prognostic signatures and pathways available on the Decipher grid found that the majority of prognostic signatures including the Decipher score and the average risk model were more associated with grade progression compared to volume or no progression. (Figure 2) Our findings suggest that the Decipher score has a stronger correlation with grade progression than volume progression in prostate cancer patients. This highlights the potential of genomic classifiers like Decipher in enhancing our understanding of disease progression and in tailoring personalized treatment strategies. Further prospective studies are required to validate these findings

Gastrointestinal Manifestations of Coronavirus Disease 2019 Across the United States: A Multicenter Cohort Study.

Background and aimsGastrointestinal (GI) symptoms occur among patients diagnosed with coronavirus disease 2019 (COVID-19), and there is clear evidence that SARS-CoV-2, the causative pathogen, infects the GI tract. In this large, multicenter cohort study, we evaluated variations in gastrointestinal and hepatic manifestations of COVID-19 throughout the United States (US).MethodsPatients hospitalized with a positive COVID-19 test prior to October 2020 were identified at 7 US academic centers. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were abstracted. Descriptive and regression analyses were used to evaluate GI manifestations and their potential predictors.ResultsAmong 2031 hospitalized patients with COVID-19, GI symptoms were present in 18.9%; diarrhea was the most common (15.2%), followed by nausea and/or vomiting (12.6%) and abdominal pain (6.0%). GI symptoms were less common in the Western cohort (16.0%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. Compared to nonintensive care unit (ICU) patients, ICU patients had a higher prevalence of abnormal aspartate aminotransferase (58.1% vs 37.3%; P < .01), alanine aminotransferase (37.5% vs 29.3%; P = .01), and total bilirubin (12.7% vs 9.0%; P < .01). ICU patients also had a higher mortality rate (22.7% vs 4.7%; P < .01). Chronic liver disease was associated with the development of GI symptoms. Abnormal aspartate aminotransferase or alanine aminotransferase was associated with an increased risk of ICU admission.ConclusionWe present the largest multicenter cohort of patients with COVID-19 across the United States. GI manifestations were common among patients hospitalized with COVID-19, although there was significant variability in prevalence and predictors across the United States