Improving the estimation of rice above-ground biomass based on spatio-temporal UAV imagery and phenological stages.

Introduction: Unmanned aerial vehicles (UAVs) equipped with visible and multispectral cameras provide reliable and efficient methods for remote crop monitoring and above-ground biomass (AGB) estimation in rice fields. However, existing research predominantly focuses on AGB estimation based on canopy spectral features or by incorporating plant height (PH) as a parameter. Insufficient consideration has been given to the spatial structure and the phenological stages of rice in these studies. In this study, a novel method was introduced by fully considering the three-dimensional growth dynamics of rice, integrating both horizontal (canopy cover, CC) and vertical (PH) aspects of canopy development, and accounting for the growing days of rice. Methods: To investigate the synergistic effects of combining spectral, spatial and temporal parameters, both small-scale plot experiments and large-scale field testing were conducted in Jiangsu Province, China from 2021 to 2022. Twenty vegetation indices (VIs) were used as spectral features, PH and CC as spatial parameters, and days after transplanting (DAT) as a temporal parameter. AGB estimation models were built with five regression methods (MSR, ENet, PLSR, RF and SVR), using the derived data from six feature combinations (VIs, PH+CC, PH+CC+DAT, VIs+PH +CC, VIs+DAT, VIs+PH+CC+DAT). Results: The results showed a strong correlation between extracted and ground-measured PH (R2 = 0.89, RMSE=5.08 cm). Furthermore, VIs, PH and CC exhibit strong correlations with AGB during the mid-tillering to flowering stages. The optimal AGB estimation results during the mid-tillering to flowering stages on plot data were from the PLSR model with VIs and DAT as inputs (R 2 = 0.88, RMSE=1111kg/ha, NRMSE=9.76%), and with VIs, PH, CC, and DAT all as inputs (R 2 = 0.88, RMSE=1131 kg/ha, NRMSE=9.94%). For the field sampling data, the ENet model combined with different feature inputs had the best estimation results (%error=0.6%-13.5%), demonstrating excellent practical applicability. Discussion: Model evaluation and feature importance ranking demonstrated that augmenting VIs with temporal and spatial parameters significantly enhanced the AGB estimation accuracy. In summary, the fusion of spectral and spatio-temporal features enhanced the actual physical significance of the AGB estimation models and showed great potential for accurate rice AGB estimation during the main phenological stages.

RT-SRTS: Angle-agnostic real-time simultaneous 3D reconstruction and tumor segmentation from single X-ray projection.

Radiotherapy is one of the primary treatment methods for tumors, but the organ movement caused by respiration limits its accuracy. Recently, 3D imaging from a single X-ray projection has received extensive attention as a promising approach to address this issue. However, current methods can only reconstruct 3D images without directly locating the tumor and are only validated for fixed-angle imaging, which fails to fully meet the requirements of motion control in radiotherapy. In this study, a novel imaging method RT-SRTS is proposed which integrates 3D imaging and tumor segmentation into one network based on multi-task learning (MTL) and achieves real-time simultaneous 3D reconstruction and tumor segmentation from a single X-ray projection at any angle. Furthermore, the attention enhanced calibrator (AEC) and uncertain-region elaboration (URE) modules have been proposed to aid feature extraction and improve segmentation accuracy. The proposed method was evaluated on fifteen patient cases and compared with three state-of-the-art methods. It not only delivers superior 3D reconstruction but also demonstrates commendable tumor segmentation results. Simultaneous reconstruction and segmentation can be completed in approximately 70 ms, significantly faster than the required time threshold for real-time tumor tracking. The efficacies of both AEC and URE have also been validated in ablation studies. The code of work is available at https://github.com/ZywooSimple/RT-SRTS.

National assessment of obstetrics and gynecology and family medicine residents' experiences with CenteringPregnancy group prenatal care.

OBJECTIVE: To examine family medicine (FM) and obstetrician-gynecologist (OB/GYN) residents' experiences with CenteringPregnancy (CP) group prenatal care (GPNC) as a correlate to perceived likelihood of implementing CP in future practice, as well as knowledge, level of support, and perceived barriers to implementation. METHODS: We conducted a repeated cross-sectional study annually from 2017 to 2019 with FM and OB/GYN residents from residency programs in the United States licensed to operate CP. We applied adjusted logistic regression models to identify predictors of intentions to engage with CP in future practice. RESULTS: Of 212 FM and 176 OB/GYN residents included in analysis, 67.01% of respondents intended to participate as a facilitator in CP in future practice and 51.80% of respondents were willing to talk to decision makers about establishing CP. Both FM and OB/GYN residents who spent more than 15 h engaged with CP and who expressed support towards CP were more likely to participate as a facilitator. FM residents who received residency-based training on CP and who were more familiar with CP reported higher intention to participate as a facilitator, while OB/GYN residents who had higher levels of engagement with CP were more likely to report an intention to participate as a facilitator. CONCLUSION: Engagement with and support towards CP during residency are key factors in residents' intention to practice CP in the future. To encourage future adoption of CP among residents, consider maximizing resident engagement with the model in hours of exposure and level of engagement, including hosting residency-based trainings on CP for FM residents.

[Pelvic floor muscle rehabilitation training combined with psychological nursing intervention in the treatment of type â ¢B prostatitis].

OBJECTIVE: To investigate the clinical effect of pelvic floor muscle rehabilitation training combined with psychological nursing intervention in the treatment of intractable type ⅢB prostatitis. METHODS: We retrospectively analyzed the clinical data on 51 cases of intractable type ⅢB prostatitis treated from October 2020 to October 2022, which were randomly assigned to receive Tamsulosin medication (the control group, n = 24) or pelvic floor muscle rehabilitation training and psychological nursing in addition (the intervention group, n = 27), all for 8 weeks. We obtained NIH-CPSI, IIEF-5, Self-Rating Anxiety Scale (SAS) scores, Self-Rating Depression Scale (SDS) scores, the level of lecithin and the count of leukocytes in the prostatic fluid and the incidence of adverse events, and compared them between the two groups of patients before and after treatment. RESULTS: The total effectiveness rate was significantly higher in the intervention than in the control group (88.9% vs 62.5%, P < 0.05). Compared with the baseline, the NIH-CPSI, IIEF-5, SAS and SDS scores and the lecithin level were remarkably increased in both groups after treatment (P < 0.05), even more significantly in the intervention group than in the control (P < 0.05). No statistically significant difference was observed in the count of leukocytes before and after treatment (P > 0.05). CONCLUSION: On the basis of Tamsulosin medication, the application of pelvic floor rehabilitation training combined with psychological care can significantly enhance the therapeutic effect on type IIIB prostatitis, effectively relieve prostatitis pain, improve erectile function, lessen anxiety and depression symptoms, increase the level of lecithosomes and promote the recovery of prostatic function.

Gradient Channel Segmentation in Covalent Organic Framework Membranes with Highly Oriented Nanochannels.

Covalent organic frameworks (COFs) offer an exceptional platform for constructing membrane nanochannels with tunable pore sizes and tailored functionalities, making them promising candidates for separation, catalysis, and sensing applications. However, the synthesis of COF membranes with highly oriented nanochannels remains challenging, and there is a lack of systematic studies on the influence of postsynthetic modification reactions on functionality distribution along the nanochannels. Herein, we introduced a "prenucleation and slow growth" approach to synthesize a COF membrane featuring highly oriented mesoporous channels and a high Brunauer-Emmett-Teller surface area of 2230 m2 g-1. Functional moieties were anchored to the pore walls via "click" reactions and coordinated with Cu ions to serve as segmentation functions. This led to a remarkable H2/CO2 separation performance that surpassed the Robeson upper bound. Moreover, we found that the functionalities distributed along the nanochannels could be influenced by functionality flexibility and postsynthetic reaction rate. This strategy paved the way for the accurate design and construction of COF-based artificial solid-state nanochannels with high orientation and precisely controlled channel environments.

Analysis of the incidence of falls and related factors in elderly patients based on comprehensive geriatric assessment.

Objective: To investigate the incidence of falls in elderly aged 65 years and above among outpatients and inpatients, and to analyze its related factors and identify prevention strategies. Methods: A retrospective analysis was conducted on 451 patients aged 65 years and above who received comprehensive geriatric assessment in outpatients and inpatients from the Department of Geriatrics in the Second Xiangya Hospital from March 2021 to March 2022. According to whether there had been at least one fall in the past year, the patients were divided into a fall group and a non-fall group. Data were collected from the We-Chat applet of comprehensive geriatric assessment. A t test and chi-square test were performed to compare the difference between the two groups. Logistic regression analysis was then conducted to identify factors associated with falls. Results: (1) The incidence of falls among the outpatient and inpatient was 28.8%. (2) The rate of light, moderate, and heavy dependence on daily living ability and decreased mobile balance ability were higher in the fall group than those in the non-fall group. The average calf circumference in the fall group was significantly lower than that in the non-fall group. (3) The prevalence of diabetes and eye diseases in the fall group was significantly higher than that in the non-fall group. (4) The percentage of insomnia and suspicious insomnia cases in the fall group was higher than that in the non-fall group. The mean scores for dysphagia, frailty, and incontinence were higher and the mean malnutrition score was lower in the fall group than in the non-fall group. (5) Multiple logistic regression analysis showed that frailty, insomnia, and malnutrition were independent influencing factors of fall (OR = 1.955, 1.652, 10.719, P = 0.044, 0.041, 0.025, respectively). Conclusions: The incidence of falls among outpatients and inpatients aged 65 years and above is high. Frailty, insomnia, and malnutrition are the main factors influencing falls in these patients.

Co-infusion of CAR T cells with aAPCs expressing chemokines and costimulatory ligands enhances the anti-tumor efficacy in mice.

Chimeric antigen receptor-modified T (CAR-T) cell therapy has shown curable efficacy for treating hematological malignancies, while in solid tumors, the immunosuppressive microenvironment causes poor activation, expansion and survival of CAR-T cells, accounting mainly for the unsatisfactory efficacy. The artificial antigen-presenting cells (aAPCs) have been used for ex vivo expansion and manufacturing of CAR-T cells. Here, we constructed a K562 cell-based aAPCs expressing human epithelial cell adhesion molecule (EpCAM), chemokines (CCL19 and CCL21) and co-stimulatory molecular ligands (CD80 and 4-1BBL). Our data demonstrated that the novel aAPCs enhanced the expansion, and increased the immune memory phenotype and cytotoxicity of CAR-T cells recognizing EpCAM, in vitro. Of note, co-infusion CAR-T and aAPC enhances the infiltration of CAR-T cells in solid tumors, which has certain potential for the treatment of solid tumors Moreover, IL-2-9-21, a cytokine cocktail, prevents CAR-T cells from entering the state of exhaustion prematurely after continuous antigen engagement and boosts the anti-tumor activity of CAR-T cells co-infused with aAPCs. These data provide a new strategy to enhance the therapeutic potential of CAR-T cell therapy for the treatment of solid tumors.

Public Surveillance of Social Media for Suicide Using Advanced Deep Learning Models in Japan: Time Series Study From 2012 to 2022.

BACKGROUND: Social media platforms have been increasingly used to express suicidal thoughts, feelings, and acts, raising public concerns over time. A large body of literature has explored the suicide risks identified by people's expressions on social media. However, there is not enough evidence to conclude that social media provides public surveillance for suicide without aligning suicide risks detected on social media with actual suicidal behaviors. Corroborating this alignment is a crucial foundation for suicide prevention and intervention through social media and for estimating and predicting suicide in countries with no reliable suicide statistics. OBJECTIVE: This study aimed to corroborate whether the suicide risks identified on social media align with actual suicidal behaviors. This aim was achieved by tracking suicide risks detected by 62 million tweets posted in Japan over a 10-year period and assessing the locational and temporal alignment of such suicide risks with actual suicide behaviors recorded in national suicide statistics. METHODS: This study used a human-in-the-loop approach to identify suicide-risk tweets posted in Japan from January 2013 to December 2022. This approach involved keyword-filtered data mining, data scanning by human efforts, and data refinement via an advanced natural language processing model termed Bidirectional Encoder Representations from Transformers. The tweet-identified suicide risks were then compared with actual suicide records in both temporal and spatial dimensions to validate if they were statistically correlated. RESULTS: Twitter-identified suicide risks and actual suicide records were temporally correlated by month in the 10 years from 2013 to 2022 (correlation coefficient=0.533; P<.001); this correlation coefficient is higher at 0.652 when we advanced the Twitter-identified suicide risks 1 month earlier to compare with the actual suicide records. These 2 indicators were also spatially correlated by city with a correlation coefficient of 0.699 (P<.001) for the 10-year period. Among the 267 cities with the top quintile of suicide risks identified from both tweets and actual suicide records, 73.5% (n=196) of cities overlapped. In addition, Twitter-identified suicide risks were at a relatively lower level after midnight compared to a higher level in the afternoon, as well as a higher level on Sundays and Saturdays compared to weekdays. CONCLUSIONS: Social media platforms provide an anonymous space where people express their suicidal thoughts, ideation, and acts. Such expressions can serve as an alternative source to estimating and predicting suicide in countries without reliable suicide statistics. It can also provide real-time tracking of suicide risks, serving as an early warning for suicide. The identification of areas where suicide risks are highly concentrated is crucial for location-based mental health planning, enabling suicide prevention and intervention through social media in a spatially and temporally explicit manner.

Older people's attitudes towards emerging technologies: A systematic literature review.

Public attitudes towards technology have been studied extensively for decades, but older people were not largely involved in early studies. In recent years, with the trend of digitalisation and the rapid growth of the older population around the world, the attitudes of older people towards emerging technologies have attracted the attention of researchers. This article is a systematic review of 83 relevant studies, to summarise the factors that impact older adults' attitudes towards adopting and using technology. It is found that older people's attitudes are influenced by their personal characteristics, technology-related factors and the social context of technology adoption. The complex relationship between older people and technology is interpreted by researchers with the framing of older people's identity, the role of technology, the interaction of the above factors and the opportunity for older adults to act as co-designers.

[Efficient production of L-asparaginase in Bacillus licheniformis by optimizing expression elements and host].

L-asparaginase (L-ASN) is widely applied in the treatment of malignant tumor and low-acrylamide food production, however, the low expression level hampers its application. Heterologous expression is an effective strategy to increase the expression level of target enzymes, and Bacillus is generally used as the host for efficient production of enzymes. In this study, the expression level of L-asparaginase in Bacillus was enhanced through optimization of expression element and host. Firstly, five signal peptides (SPSacC, SPAmyL, SPAprE, SPYwbN and SPWapA) were screened, among which SPSacC showed the best performance, reaching an activity of 157.61 U/mL. Subsequently, four strong promoters (P43, PykzA-P43, PUbay and PbacA) from Bacillus were screened, and tandem promoter PykzA-P43 showed the highest yield of L-asparaginase, which was 52.94% higher than that of control strain. Finally, three Bacillus expression hosts (B. licheniformis Δ0F3 and BL10, B. subtilis WB800) were investigated, and the maximum L-asparaginase activity, 438.3 U/mL, was reached by B. licheniformis BL10, which was an 81.83% increase compared with that of the control. This is also the highest level of L-asparaginase in shake flask reported to date. Taken together, this study constructed a B. licheniformis strain BL10/PykzA-P43-SPSacC-ansZ capable of efficiently producing L-asparaginase, which laid the foundation for industrial production of L-asparaginase.

Paid caregivers' experiences of falls prevention and care in China's senior care facilities: A phenomenological study.

Background: In China, as population aging accelerates, senior care facilities have gradually become a mainstream option. According to the World Health Organization (WHO), the annual rate of falls has increased from 30 to 50% in senior care facilities. A study found that older adults who live in senior care facilities are three times more likely to fall than those who live in the community. The quality of care is highly related to the occurrence of falls. Therefore, exploring paid caregivers' experiences is very important to prevent falls in senior care facilities. Objective: The aim of this study was to explore paid caregivers' experiences of fall prevention and care in China's senior care facilities. Furthermore, we discussed the situation and provided suggestions. Design: This is a phenomenological study using face-to-face, in-depth, semi-structured interviews. Setting: The study was conducted at four senior care facilities in Changsha, Hunan, China. Participants: Fourteen paid caregivers in four senior care facilities, including nursing assistants and senior nurses, participated in this study. Methods: A purposive sample method was used to select 14 nursing assistants and senior nurses from four different senior care facilities in Changsha from March to April 2022. Every participant individually completed a face-to-face, in-depth, semi-structured interview. Based on the phenomenological research methodology, the thematic analysis method and the Colaizzi analysis method were used for data analysis and theme extraction. Results: Based on interview data, a total of seven themes were distilled: (1) paid caregivers' professional requirements; (2) paid caregivers' attitude toward falls; (3) paid caregivers' fall training and education; (4) paid caregivers' knowledge about falls; (5) paid caregivers' fall risk assessment; (6) paid caregivers' fall prevention; and (7) paid caregivers' fall treatment. Conclusion: In China's senior care facilities, paid caregivers to need to be responsible and pay appropriate attention to older adults. First, senior nurses and nursing assistants need to enhance communication and cooperation. Second, they must learn about deficiencies in fall risk assessment and try their best to improve their capability. Third, they must adopt appropriate education methods to improve fall prevention capability. Finally, the protection of privacy should be taken seriously.

A global portrait of expressed mental health signals towards COVID-19 in social media space.

Globally, the COVID-19 pandemic has induced a mental health crisis. Social media data offer a unique opportunity to track the mental health signals of a given population and quantify their negativity towards COVID-19. To date, however, we know little about how negative sentiments differ across countries and how these relate to the shifting policy landscape experienced through the pandemic. Using 2.1 billion individual-level geotagged tweets posted between 1 February 2020 and 31 March 2021, we track, monitor and map the shifts in negativity across 217 countries and unpack its relationship with COVID-19 policies. Findings reveal that there are important geographic, demographic, and socioeconomic disparities of negativity across continents, different levels of a nation's income, population density, and the level of COVID-19 infection. Countries with more stringent policies were associated with lower levels of negativity, a relationship that weakened in later phases of the pandemic. This study provides the first global and multilingual evaluation of the public's real-time mental health signals to COVID-19 at a large spatial and temporal scale. We offer an empirical framework to monitor mental health signals globally, helping international authorizations, including the United Nations and World Health Organization, to design smart country-specific mental health initiatives in response to the ongoing pandemic and future public emergencies.

COVID-19 Infection and Contact Tracing Among Refugees in the United States, 2020-2021.

Refugees in the United States are believed to be at high risk of COVID-19. A cross-sectional study design was utilized to collect anonymous, online surveys from refugee communities in the United States during December 2020 to January 2021. We invited bilingual community leaders to share the survey link with other refugees aged ≥18 years. We identified factors associated with COVID-19 infection and measured the distribution of contact tracing among those who tested positive. Of 435 refugees who completed the survey, 26.4% reported testing positive for COVID-19. COVID-19 infection was associated with having an infected family member and knowing people in one's immediate social environment who were infected. Among respondents who tested positive, 84.4% reported that they had been contacted for contact tracing. To prepare for future pandemics, public health authorities should continue partner with refugee community leaders and organizations to ensure efficient programs are inclusive of refugee communities.

Injectable and photocurable CAR-T cell formulation enhances the anti-tumor activity to melanoma in mice.

The chimeric antigen receptor-T cells (CAR-T) therapy, as a novel personalized immunotherapy, has shown prominent clinical efficacy in the treatment of B-cell malignancies. However, the progress in solid tumors was hindered by multiple elements in the tumor immunosuppressive microenvironment. In this study, an injectable and photocurable Gelatin Methacryloyl (GelMA) hydrogel was applied to be a depot of CAR-T cells, thus forming an injectable CAR-T Gelatin Methacryloyl hydrogels Delivery (i-GMD) system. According to our results, CAR-T cells in this system could be normally amplified, sustained released, and play an anti-tumor role in vitro. When compared with local or intravenously injection of CAR-T solution, injection of i-GMD matrix around tumor demonstrated enhanced anti-tumor effect and markedly extended survival of mice. Our research outcomes indicated that this therapeutic strategy might hopefully provide a treatment for patients with unresectable tumors.

Unleashing the potential of noncanonical amino acid biosynthesis to create cells with precision tyrosine sulfation.

Despite the great promise of genetic code expansion technology to modulate structures and functions of proteins, external addition of ncAAs is required in most cases and it often limits the utility of genetic code expansion technology, especially to noncanonical amino acids (ncAAs) with poor membrane internalization. Here, we report the creation of autonomous cells, both prokaryotic and eukaryotic, with the ability to biosynthesize and genetically encode sulfotyrosine (sTyr), an important protein post-translational modification with low membrane permeability. These engineered cells can produce site-specifically sulfated proteins at a higher yield than cells fed exogenously with the highest level of sTyr reported in the literature. We use these autonomous cells to prepare highly potent thrombin inhibitors with site-specific sulfation. By enhancing ncAA incorporation efficiency, this added ability of cells to biosynthesize ncAAs and genetically incorporate them into proteins greatly extends the utility of genetic code expansion methods.

Social media mining under the COVID-19 context: Progress, challenges, and opportunities.

Social media platforms allow users worldwide to create and share information, forging vast sensing networks that allow information on certain topics to be collected, stored, mined, and analyzed in a rapid manner. During the COVID-19 pandemic, extensive social media mining efforts have been undertaken to tackle COVID-19 challenges from various perspectives. This review summarizes the progress of social media data mining studies in the COVID-19 contexts and categorizes them into six major domains, including early warning and detection, human mobility monitoring, communication and information conveying, public attitudes and emotions, infodemic and misinformation, and hatred and violence. We further document essential features of publicly available COVID-19 related social media data archives that will benefit research communities in conducting replicable and reproducible studies. In addition, we discuss seven challenges in social media analytics associated with their potential impacts on derived COVID-19 findings, followed by our visions for the possible paths forward in regard to social media-based COVID-19 investigations. This review serves as a valuable reference that recaps social media mining efforts in COVID-19 related studies and provides future directions along which the information harnessed from social media can be used to address public health emergencies.

Urban-rural disparity of social vulnerability to natural hazards in Australia.

Assessing vulnerability to natural hazards is at the heart of hazard risk reduction. However, many countries such as Australia lack measuring systems to quantity vulnerability for hazard risk evaluation. Drawing on 41 indicators from multiple data sources at the finest spatial unit of the Australian census, we re-forged the Cutter's classic vulnerability measuring framework by involving the '4D' quantification of built environment (diversity, design, density and distance), and constructed the first nationwide fine-grained measures of vulnerability for urban and rural locales, respectively. Our measures of vulnerability include five themes-(1) socioeconomic status; (2) demographics and disability; (3) minority and languages; (4) housing characteristics; and (5) built environment-that were further used to assess the inequality of vulnerability to three widely affected natural hazards in Australia (wildfires, floods, and earthquakes). We found the inequality of vulnerability in the affected areas of the three hazards in eight capital cities are more significant than that of their rural counterparts. The most vulnerable areas in capital cities were peri-urban locales which must be prioritised for hazard adaptation. Our findings contribute to the risk profiling and sustainable urban-rural development in Australia, and the broad understanding of place-based risk reduction in South Hemisphere.

Exploring the spatial disparity of home-dwelling time patterns in the USA during the COVID-19 pandemic via Bayesian inference.

In this study, we aim to reveal hidden patterns and confounders associated with policy implementation and adherence by investigating the home-dwelling stages from a data-driven perspective via Bayesian inference with weakly informative priors and by examining how home-dwelling stages in the USA varied geographically, using fine-grained, spatial-explicit home-dwelling time records from a multi-scale perspective. At the U.S. national level, two changepoints are identified, with the former corresponding to March 22, 2020 (9 days after the White House declared the National Emergency on March 13) and the latter corresponding to May 17, 2020. Inspections at U.S. state and county level reveal notable spatial disparity in home-dwelling stage-related variables. A pilot study in the Atlanta Metropolitan area at the Census Tract level reveals that the self-quarantine duration and increase in home-dwelling time are strongly correlated with the median household income, echoing existing efforts that document the economic inequity exposed by the U.S. stay-at-home orders. To our best knowledge, our work marks a pioneering effort to explore multi-scale home-dwelling patterns in the USA from a purely data-driven perspective and in a statistically robust manner.

Dietary Intake and Nutritional Status among Refugees in Host Countries: A Systematic Review.

Refugees remain vulnerable to acute food insecurity, malnutrition, and critically inadequate food and nutrient intake after migration, regardless of the economic level of the host country. We conducted this systematic review to summarize and evaluate the dietary intake and nutritional status among refugees resettled in non-camp settings worldwide. We searched PubMed and Web of Science databases to review relevant studies published between 2009 and 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We also conducted an additional manual search through PubMed and Google Scholar. Studies that evaluated both dietary intake and nutritional status of refugees in host countries were included. A total of 15 articles from 10 countries were included and assessed for study quality and outcomes. Poor dietary diversity and insufficient intake of specific food groups were reported. In addition to these dietary patterns, a high prevalence of stunting, underweight, and anemia was reported, particularly among children. A double burden of malnutrition was also observed across and within studies. Post-resettlement dietary intake and nutritional status of refugees are both influenced by factors at the pre- and post-resettlement stages as refugees transition to their host countries. Those factors, including pre-resettlement experiences, host country resources, socioeconomic status, acculturation, and food security, were summarized and presented in a conceptual model. There is a need for comprehensive dietary and health screening as well as culturally appropriate and sustainable nutrition education resources and interventions for refugees to improve their diet and nutrition. Longitudinal studies and novel methodological approaches are also suggested to measure changes in refugees' food intake and nutritional status as well as to further investigate factors associated with these 2 components.

Cost-effectiveness of enfortumab vedotin in previously treated advanced urothelial carcinoma.

BACKGROUND: Antibody-drug conjugates have recently been introduced as a treatment for advanced urothelial carcinoma. The EV-301 study demonstrated that enfortumab vedotin (EV) improved overall survival compared with conventional chemotherapy. To assess the cost-effectiveness of EV for the treatment of advanced urothelial carcinoma (UC) from a payer perspective in middle- and high-income countries. METHODS: A decision analysis model was developed to assess the efficacy and economic viability of EV as a subsequent-line treatment following disease progression in patients with advanced urothelial carcinoma already treated with PD-1 or PD-L1 inhibitors. Clinical and utility values were obtained from the published literature and available databases. Cost data were obtained from payer perspectives in the United States, United Kingdom, and China. Quality-adjusted life-years (QALYs) were used to measure health outcomes, and incremental cost-effectiveness ratios (ICERs) used to evaluate cost-effectiveness in comparison to willingness-to-pay in the United States, United Kingdom, and China. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model. RESULTS: Compared with chemotherapy, EV increased the benefit by 0.16-0.17 QALYs, resulting in ICERs of $2,168,746.71, $2,164,494.38, and $1,775,576.56 per QALY in the United States, United Kingdom, and China, respectively. One-way sensitivity analysis indicated that the largest effect on outcome was the utility value for progression-free survival. Probabilistic sensitivity analysis demonstrated that the probability of EV being cost-effective was 0%. CONCLUSIONS: EV provides an additional health benefit over chemotherapy for patients with advanced urothelial carcinoma but is not cost-effective from a payer perspective in the United States, United Kingdom, or China.