Homeownership Matters: Impact of Homeownership on the Prevalence of Chronic Health Conditions in the United States.

Introduction: Homeownership is crucial for stability and healthy life. We examined the role of homeownership in predicting the prevalence of common chronic health conditions in the United States. Methods: We used 2020 Behavioral Risk Factor Surveillance System data (N = 401,958) to assess the association between homeownership and self-reported diagnosed diabetes, asthma, cancer, coronary heart disease (CHD), stroke, and kidney disease. We analyzed data by using logistic regression, adjusting for age, sex, race and ethnicity, education, employment, and income and computed odds ratios (ORs) and corresponding 95% CIs. Results: Most survey participants (66.8%) owned their residences. Age, marital status, education, and income significantly influenced homeownership. Odds of homeownership progressively increased with age, reaching a peak at 17.45 (95% CI, 16.21-18.79) for adults aged 65 years or older, and non-Hispanic White adults had the highest odds (OR = 3.34; 95% CI, 3.18-3.52). Compared with renters, homeowners generally had lower prevalence of chronic health conditions, especially among those aged 45 to 64 years. After adjusting for age, sex, and race and ethnicity, the odds of having chronic health conditions among renters were higher than those of homeowners: CHD, 1.39 (1.27-1.52); diabetes, 1.27 (1.20-1.35); asthma, 1.29 (1.23-1.36); stroke, 1.89 (1.71-2.09); and kidney disease, 1.59 (1.44-1.77). Conclusion: Homeownership can be used to predict the prevalence of several chronic health conditions. Considering its significant influence, public health initiatives should focus on housing-related interventions to improve population health.

Dynamic Repositioning of Aerial Base Stations for Enhanced User Experience in 5G and Beyond.

The ultra-dense deployment (UDD) of small cells in 5G and beyond to enhance capacity and data rate is promising, but since user densities continually change, the static deployment of small cells can lead to wastes of capital, the underutilization of resources, and user dissatisfaction. This work proposes the use of Aerial Base Stations (ABSs) wherein small cells are mounted on Unmanned Aerial Vehicles (UAVs), which can be deployed to a set of candidate locations. Furthermore, based on the current user densities, this work studies the optimal placement of the ABSs, at a subset of potential candidate positions, to maximize the total received power and signal-to-interference ratio. The problems of the optimal placement for increasing received power and signal-to-interference ratio are formulated, and optimal placement solutions are designed. The proposed solutions compute the optimal candidate locations for the ABSs based on the current user densities. When the user densities change significantly, the proposed solutions can be re-executed to re-compute the optimal candidate locations for the ABSs, and hence the ABSs can be moved to their new candidate locations. Simulation results show that a 22% or more increase in the total received power can be achieved through the optimal placement of the Aerial BSs and that more than 60% users have more than 80% chance to have their individual received power increased.

Dynamic analysis of the determinants of long-term microfinance interest rates: Macro and micro factors.

Introduction: A recent increase in interest rates has raised doubts about the stability of micro-finance institutions (MFI) A recent increase in interest rates has raised doubts about the stability of MFI in many countries. This has compelled governments to consider some MFI practices unethical. Methods: This paper studies the MFI interest rates by using a dynamic panel method to identify the determining factors of the viability, financial, and social execution of microfinance firms. The research shows that the long-term interest rate evolution depends on the anticipation of loan loss rates (LLR), profit, or macroeconomic factors like inflation and the short-term current interest rate. The Study used database of 897 microfinance institutions in 106 countries and six geographic regions with a representative sample size of 5,075 observations between 2008 and 2020. The external factors considered are the market structure (Competition), economics (inflation), cultural and technological political conditions, and banking regulations in effect (regulation). Financial costs, operational costs, the write-off rate, and the average size of the loan are the most important determinant factors in MFI interest rate fluctuations. Results: The research find that other factors like gender, legal status, and regulations also contribute to the MFI interest rate variation. The research also discovered that there is a threshold effect in the relationship between women borrowers (WB) and the interest rate. Another important finding of this study is that MFIs do not anticipate inflation in the definition of the interest rate. Discussion: From an institutional point of view, it is necessary to promote competition, as the study shows that well-regulated competition helps to keep interest rates at a reasonable level.

Using Pre-stimulus EEG to Predict Driver Reaction Time To Road Events.

The ability to predict a driver's reaction time to road events could be used in driver safety assistance systems, allowing for autonomous control when a driver may be about to react with sup-optimal performance. In this paper, we evaluate a number of machine learning and feature engineering strategies that we use to predict the reaction time(s) of 24 drivers to road events using EEG (Electroencephalography) captured in an immersive driving simulator. Subject-independent models are trained and evaluated using EEG features extracted from time periods that precede the road events that we predict the reaction times for. Our paper has two contributions: 1) we predict the reaction times corresponding to individual road events using EEG spectral features from a time period before the onset of the road event, i.e. we take EEG data from 2 seconds before the event, and 2) we predict whether a subject will be a slow or fast responder compared to other drivers.

Investigating Inclusive Leadership and Pro-Social Rule Breaking in Hospitality Industry: Important Role of Psychological Safety and Leadership Identification.

This study aims to empirically examine the mediating effects of psychological safety and leadership identification on the relationship between inclusive leadership and pro-social rule breaking among hospitality employees. This study analyzes the survey data collected in three waves from 589 employees working in different hotels and restaurants operating in the Northern areas of Khyber Pakhtunkhwa, Pakistan. The scale validity, composite reliability, and hypotheses were assessed through PLS-SEM. The study found that inclusive leadership significantly impacts employees' pro-social rule-breaking. The study also found that leadership identification and psychological safety partially mediate the relationship between inclusive leadership and pro-social rule-breaking. Hospitality leaders can practice inclusive leadership characteristics because it may significantly enhance employee engagement in pro-social rule-breaking. Through their inclusive features, hospitality leaders can improve employees' psychological safety and leadership identification, enhancing frontline employees' pro-social rule-breaking.

A Case Control Study of the Seroprevalence of Helicobacter pylori Proteins and Their Association with Pancreatic Cancer Risk.

Background: The association between Helicobacter pylori (H. pylori) infection and pancreatic cancer (PC) risk remains inconclusive. We examined the association between H. pylori antibodies and PC risk in a case-control study at a comprehensive cancer center. Methods: Multiplex serology using a glutathione S-transferase capture immunosorbent assay in conjunction with fluorescent bead technology was used to measure antibodies to 15 H. pylori proteins in serum or plasma from 131 incident cases with PC or a PC precursor and 131 healthy controls. Reactivity to ≥4 H. pylori proteins was defined as the overall seroprevalence. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for age at diagnosis/interview, gender, and race. Results: The majority of the sample was 50 years or older, and from the white race group. Half of the sample were women. Seroprevalence ≥4 of H. pylori proteins was 11.1%. Overall, H. pylori seroprevalence was not associated with PC risk (OR: 0.59; 95% CI: 0.25-1.40). The prevalence of several H. pylori-specific proteins HP537 (OR: 1.78; 95% CI: 0.30-10.51), HP305 (OR: 1.38; 95% CI: 0.61-3.16), and HP410 (OR: 1.31; 95% CI: 0.44-3.96) increased the odds of PC. Similarly, H. pylori-specific proteins HP522 (OR: 0.25; 95% CI: 0.04-1.66), HyuA (OR: 0.49; 95% CI: 0.21-1.14), and HP1564 (OR: 0.63; 95% CI: 0.27-1.51) decreased the odds of PC. However, these findings were not statistically significant at α = 0.05. Conclusions: Our findings do not support an association between H. pylori and PC risk. Further evaluation of this lack of association is recommended.

Seroprevalence of Chlamydia trachomatis, herpes simplex 2, Epstein-Barr virus, hepatitis C and associated factors among a cohort of men ages 18-70 years from three countries.

OBJECTIVES: To estimate the seroprevalence of Chlamydia trachomatis (CT), herpes simplex type-2 (HSV2), hepatitis C (HCV), Epstein-Barr virus (EBV) and nine human papilloma virus (HPV) types, and investigated factors associated with the seropositivity among men from three countries (Brazil, Mexico and U.S). METHODS: Archived serum specimens collected at enrollment for n = 600 men were tested for antibodies against CT, HSV2, HCV, EBV, and 9-valent HPV vaccine types (6/11/16/18/31/33/45/52/58) using multiplex serologic assays. Socio-demographic, lifestyle and sexual behavior data at enrollment were collected through a questionnaire. RESULTS: Overall, 39.3% of the men were seropositive for CT, 25.4% for HSV2, 1.3% for HCV, 97.3% for EBV, 14.0% for at least one of the seven oncogenic HPV (types: 16/18/31/33/45/52/58), and 17.4% for HPV 6/11. In the unadjusted models, age, race, smoking, sexual behavior variables, and seropositivity for high-risk HPV were significantly associated with the seropositivity for CT. In multivariable analyses, self-reported black race, higher numbers of lifetime female/male sexual partners, current smoking, and seropositivity to high-risk HPV were significantly associated with increased odds of CT seropositivity. Odds of HSV2 seroprevalence were elevated among older men and those seropositive for high risk HPV. CONCLUSION: Exposure to STIs is common among men. Prevention and screening programs should target high-risk groups to reduce the disease burden among men, and to interrupt the disease transmission to sexual partners.

Chronic disease and socioeconomic factors among uninsured patients: A retrospective study.

OBJECTIVES: Uninsured patients represent an understudied population. The current study aimed to estimate the burden of 10 common chronic conditions and to investigate the associated factors among patients who use free clinics for their health care needs. METHODS: Patient charts from four free clinics were reviewed from January to December of 2015. Proportion of prevalence, adjusted odds ratios (AOR), and 95% confidence intervals (CI) for associations between participant characteristics and chronic conditions are reported. RESULTS: Prevalence of hypertension and hyperlipidemia significantly differed by clinic, age, gender, race, and marital status. Compared to age 15-44 years, older patients (45-64 years, and ≥65) were 5-10 times more likely to suffer from hypertension. Compared to women, men; compared to White, African-Americans; and compared to single, married patients had higher prevalences of hypertension. Older patients were 5-8 times more likely to suffer from hyperlipidemia. Asians, and married patients were also more likely to experience hyperlipidemia. Prevalence of diabetes, depression and arthritis significantly differed by age and race. Prevalence of coronary artery disease and chronic obstructive pulmonary disease increased 6-13 folds among older patients. DISCUSSION: Patients of free clinics suffer from high burden of chronic conditions. Patients who frequent free clinics are primarily older, unemployed, women, minorities, and are of low income.

Methylation of HPV 16 and EPB41L3 in oral gargles: Associations with oropharyngeal cancer detection and tumor characteristics.

Oropharyngeal cancer (OPC) incidence is increasing significantly among men and often requires intensive therapy causing significant morbidity. Early detection of OPC is needed, when monotherapy can be safely delivered with less treatment-associated morbidity, while maintaining high cure rates. We conducted a study of 101 pretreatment male OPC cases matched 1:1 to 101 disease-free controls for age and smoking history. Oral gargles were collected from cases and controls with additional biopsies or aspirates from cases. The HPV SPF10 -LiPA25 PCR assay was utilized for HPV genotyping. Methylation of three CpG sites (438, 427 and 425) in the EPB41L3 gene and methylation status of the L1 (6,367, 6,389), L2 (4,257, 4,262, 4,266, 4,269, 4,275, 4,282) and E2 (3,412, 3,415, 3,417, 3,433, 3,436) CpG sites of HPV 16 positive specimens was assessed by pyrosequencing. Significant correlations were observed between tumor and oral specimens for all methylation biomarkers (p < 0.01). EPB41L3 and HPV 16 L1, L2 and E2 methylation were significantly (p < 0.0001) higher among cases than controls, regardless of early vs. late disease. When HPV 16 genes and EPB41L3 methylation status were combined in a logistic regression analysis, a sensitivity of 70.3% and a specificity of 90.9% were observed for the detection of OPC from an oral gargle. Our data suggest that methylation biomarkers measured in oral gargles may have utility in identifying OPC early. Future studies are needed to replicate these findings and to inform additional biomarkers that can maximize specificity and sensitivity for early OPC detection.

Exploring the critical determinants of environmentally oriented public procurement using the DEMATEL method.

This study explores the critical determinants of environmentally oriented public procurement in Singapore, and investigates the causal relationships among the determinants that influence this procurement. Using the extant literature and basing our examination on natural-resource-based theory, we develop a conceptual framework for the implementation of environmentally oriented public procurement using three high-level dimensions and ten determinants. Sixteen interviews were conducted with 16 senior executives working in various ministries and statutory boards in Singapore who are closely involved in the public-procurement process. The decision-making trial and evaluation laboratory (DEMATEL) method, which is a multicriteria decision-making tool, is employed to analyse the interview data and information. The results of the analysis reveal that the two most critical determinants for environmentally oriented public procurement in Singapore are energy-efficiency strategy and environmental standards. These two determinants were also found to be the primary drivers of the implementation of environmentally oriented public procurement in Singapore. Through further analysis using the level of influence, a cognition map is developed to illustrate the relationships among the ten determinants. Understanding the dynamic nature of public procurement through these causal relationships is essential for the formulation of environmentally oriented public procurement implementation strategies.

Burden of Chronic Conditions among Patients from Free Clinics: A Retrospective Chart Review of 2015.

INTRODUCTION: There is limited research about the poor and uninsured patients who visit free clinics. METHODS: We conducted a retrospective chart review of uninsured adult patients in four free clinics seen between January and December 2015. Prevalence of chronic conditions and their association with socioeconomic factors were investigated. RESULTS: In 2015, 3,196 adult patients with chronic conditions were managed in four free clinics. Many of these patients were women (60.8%) and Hispanic (44.7%); the group had a mean age of 47.9 years (SD=14.1) and a median income of $14,400. The top five prevalent conditions were hypertension (33.6%), hyperlipidemia (20.7%), diabetes (14%), major depression (11.7%), and arthritis (8.7%). In the multivariable analysis, clinic site, age, marital status, employment status, and household size were significantly associated with the Disease Burden Index. DISCUSSION: Public health prevention programs should focus on uninsured patients of free clinics who are mainly low-income, sicker, and unemployed, and often women and Hispanics.

Maximising the resolving power of the scanning tunneling microscope.

The usual way to present images from a scanning tunneling microscope (STM) is to take multiple images of the same area, to then manually select the one that appears to be of the highest quality, and then to discard the other almost identical images. This is in contrast to most other disciplines where the signal to noise ratio (SNR) of a data set is improved by taking repeated measurements and averaging them. Data averaging can be routinely performed for 1D spectra, where their alignment is straightforward. However, for serial-acquired 2D STM images the nature and variety of image distortions can severely complicate accurate registration. Here, we demonstrate how a significant improvement in the resolving power of the STM can be achieved through automated distortion correction and multi-frame averaging (MFA) and we demonstrate the broad utility of this approach with three examples. First, we show a sixfold enhancement of the SNR of the Si(111)-(7 × 7) reconstruction. Next, we demonstrate that images with sub-picometre height precision can be routinely obtained and show this for a monolayer of Ti2O3 on Au(111). Last, we demonstrate the automated classification of the two chiral variants of the surface unit cells of the (4 × 4) reconstructed SrTiO3(111) surface. Our new approach to STM imaging will allow a wealth of structural and electronic information from surfaces to be extracted that was previously buried in noise.

Cutaneous HPV and alpha-mucosal 9-valent HPV sero-status associations.

Seroepidemiology of human papillomaviruses (HPV) among men is poorly understood. We examined the association between seropositivity to cutaneous HPV and 9-valent HPV (9vHPV) types. Six hundred men were randomly selected from the HPV Infection in Men (HIM) Study. Archived serum specimens were tested for antibodies against 9vHPV types [low-risk (6/11) and high-risk (16/18/31/33/45/52/58)], and 14 cutaneous types, including ß-types 5/8/12/14/17/22/23/24/38/47, α-type-27, γ-type-4, µ-type-1, and ν-type-41, using a GST L1-based multiplex serology assay. Risk factor data were collected through questionnaires. Logistic regression was used to evaluate associations between mucosal and cutaneous HPV types. Approximately 21% of men were positive for ≥ 1 cutaneous HPV type, and ≥ 1 nine-valent HPV vaccine type at the same time. Men who were seropositive for any-cutaneous HPV were nearly twice as likely to be seropositive for 9vHPV (adjusted odds ratio (AOR) = 1.97, 95% confidence interval (CI): 1.30-2.99), high-risk (AOR = 1.83; 95% CI: 1.04-3.20), low-risk (AOR = 1.92; 95% CI: 1.16-3.18), and four-valent, 4vHPV, (AOR = 2.01; 95% CI: 1.25-3.21). Type-specific cutaneous HPV seropositivity (types: 8/14/17/23/38/27/4/1) was also positively associated with seropositivity to 9vHPV, high-risk, and low-risk categories. These data indicate that exposure to cutaneous HPV and 9vHPV types is common. Future longitudinal studies are needed to assess the temporality of these associations.

Seroprevalence of cutaneous human papillomaviruses (HPVs) among men in the multinational HPV Infection in Men study.

Data on cutaneous human papillomavirus (HPV) seroprevalence are primarily derived from skin cancer case-control studies. Few studies have reported the seroprevalence of cutaneous HPV among healthy men. This study investigated the seroprevalence of cutaneous HPV types and associated risk factors among men residing in Brazil, Mexico and the USA. Six hundred men were randomly selected from the HPV Infection in Men study. Archived serum specimens were tested for antibodies against 14 cutaneous HPV genotypes, ß-HPV types (5/8/12/14/17/22/23/24/38/48), α-HPV 27, γ-HPV 4, µ-HPV1 and ν-HPV 41 using a glutathione S-transferase L1-based multiplex serology assay. Risk factor data were collected by a questionnaire. Binomial proportions were used to estimate seroprevalence, and logistic regression to examine factors associated with seropositivity. Overall, 65.4 % of men were seropositive to ≥1 of the 14 cutaneous HPV types, and 39.0 % were positive for ≥1 ß-HPV types. Seroprevalence was 8.9, 30.9, 28.6 and 9.4 % for α-HPV 27, γ-HPV 4, µ-HPV 1 and ν-HPV 41, respectively. In multivariate analyses, seropositivity for any cutaneous HPV type was associated with higher education [adjusted odds ratio (AOR) 1.75; 95 % confidence interval (CI) 1.08-2.83], and seropositivity of any ß-HPV type was significantly associated with increasing age (AOR 1.72; 95 % CI 1.12-2.63, for men aged 31-44 years vs men aged 18-30 years). Other factors associated with various type-specific cutaneous HPV seropositivity included country, circumcision and lifetime number of male sexual partners. These data indicate that exposure to cutaneous HPV is common. Future studies are needed to assess the role of cutaneous HPV in diseases.

Seroprevalence and Associated Factors of 9-Valent Human Papillomavirus (HPV) Types among Men in the Multinational HIM Study.

BACKGROUND: Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Recently a 9-valent HPV (9vHPV) prophylactic vaccine was licensed. Seroprevalence prior to vaccine dissemination is needed for monitoring vaccine effectiveness over time. Few studies have assessed the seroprevalence of 9vHPV types in men. OBJECTIVES: To investigate the seroprevalence of 9vHPV vaccine types and associated risk factors among men residing in Brazil, Mexico, and the United States. METHODS: Six hundred men were randomly selected from the HPV Infection in Men (HIM) Study. Archived serum specimens collected at enrollment were tested for antibodies against nine HPV types (6, 11, 16, 18, 31, 33, 45, 52 and 58) using a glutathione S-transferase (GST) L1-based multiplex serologic assay. Socio-demographic, lifestyle and sexual behavior data at enrollment were collected through a questionnaire. Binomial proportions were used to estimate seroprevalence and logistic regression was used to examine factors associated with seropositivity of type-specific and grouped (i.e. 9vHPV, high-risk 9vHPV, low risk 9vHPV, and five-additional) HPV types. RESULTS: Overall, 28.3% of men were seropositive for at least one of the 9vHPV vaccine types, 14.0% for at least one of the seven high-risk types (16, 18, 31, 33, 45, 52 and 58) and 11.2% for at least one of the five high-risk types (31, 33, 45, 52 and 58) not included in the quadrivalent HPV vaccine, and 17.4% for at least one of the low-risk types (6/11). In multivariate analyses, odds ratios adjusted (AOR) for country of residence, age, marital status, smoking, number of anal sex lifetime partners, compared to men with no anal sex lifetime partners, men with ≥2 partners were more likely to be seropositive for grouped HPV [(9vHPV: AOR 2.52; 95% confidence interval (CI) 1.40-4.54), (high-risk 9vHPV: AOR 2.18; 95%CI: 1.05-4.50) and (low-risk 9vHPV: AOR 2.12; 95%CI: 1.12-4.03)], and individual HPV types 6, 16, 33 and 58 with AORs ranging from 2.19 to 7.36. Compared to men aged 18-30 years, men older than 30 years were significantly more likely to be seropositive for any high-risk 9vHPV, in addition to individual types 18 and 45; and compared to never smokers, current smokers were more likely to be seropositive to 9vHPV, low-risk 9vHPV and HPV 6. In contrast, married men were less likely to be seropositive to any high-risk 9vHPV and individual HPV types 18 and 31 when compared to single men. CONCLUSIONS: These data indicate that exposure to the nine HPV types included in the 9vHPV vaccine is common in men and that seropositivity to 9vHPV vaccine types is associated with older age and the lifetime number of anal sex partners. Nine valent HPV vaccination of males and females has the potential to prevent HPV related diseases and transmission in both sexes.

Seroprevalence of Cutaneous Human Papillomaviruses and the Risk of External Genital Lesions in Men: A Nested Case-Control Study.

BACKGROUND: A variety of cutaneous human papillomaviruses (HPV) are detectable in genital epithelial lesions in men and non-melanoma skin cancer patients. It remains unclear whether these viruses are associated causally with skin lesions. To date, no study has prospectively examined the association between cutaneous HPV seropositivity and development of external genital lesions (EGLs) in men. OBJECTIVES: To examine the association between seropositivity to cutaneous HPV types and the risk of subsequent development of EGLs. METHODS: A nested case-control study including 163 incident EGL cases and 352 EGL-free controls in the HPV Infection in Men (HIM) Study cohort was conducted. Cases were ascertained at each of up to 10 biannual clinical visits and verified through biopsy and pathological diagnoses. EGLs were categorized as condyloma, suggestive of condyloma, penile intraepithelial neoplasia (PeIN), and other EGLs. Archived serum specimens collected at baseline were tested for antibodies against 14 cutaneous HPV types (ß types (5, 8, 12, 14, 17, 22, 23, 24, 38, and 47), α type 27, γ type 4, µ type 1, and ν type 41) using a GST L1-based multiplex serology assay. Socio-demographic and sexual behavior data were collected through a questionnaire. Using logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated. RESULTS: Overall, seropositivity to ≥1 cutaneous HPV type (any-HPV) and ≥1 ß types (any-ß) was 58.3% and 37.5% among other EGL cases, 71.6% and 46.8% among condyloma, 66.8% and 50.0% among PeIN, and 71.9% and 38.4% among controls, respectively. Type-specific seropositivity was most common for ɤ-HPV 4, µ-HPV 1, and ß-HPV 8. No statistically significant association was observed between any-HPV, any-ß, and type-specific HPV seropositivity and subsequent development of EGLs across all pathological diagnoses. CONCLUSIONS: Overall, seropositivity to cutaneous HPV was common among men; however, it appears that cutaneous HPV is not associated with the development of genital lesions in men.

Prevalence, knowledge, and practices of hookah smoking among university students, Florida, 2012.

INTRODUCTION: Although hookah smoking is becoming a source of tobacco use among college students in the United States, little is known of the students' knowledge, attitudes, and practices regarding hookah use. This cross-sectional study was aimed at determining the prevalence of hookah use and describing social and behavioral factors associated with hookah smoking among university students in a large urban university in Florida. METHODS: A convenience sample of 478 undergraduate and graduate students was recruited. Lifetime use and current use was evaluated. Logistic regression modeling was used to assess the independent association between study covariates and hookah use. RESULTS: Prevalence among students of having ever used hookah during their lifetime was 54.4%. Hookah use within the past 30 days was 16.3%. Hookah use was significantly associated with cigarette smoking (odds ratio [OR], 4.52; 95% confidence interval [CI], 2.13-9.60) and hookah ownership (OR, 10.67; 95% CI, 4.83-23.66) but not with alcohol use (OR, 1.73; 95% CI, 0.74-4.04). Findings also suggest hookah is perceived as a safer alternative to cigarette smoking. Almost 30% of those who never smoked hookah reported they would consider smoking hookah in the future. CONCLUSION: Hookah smoking is popular among college students. Misperceptions associated with hookah use indicate a starting point for developing health behavior change interventions. Future studies should investigate social and behavioral determinants of hookah use and determine the incidence of hookah use among college and high school students. Tobacco control activities should include prevention of hookah tobacco use in university settings.

Effect of body mass index in patients undergoing resection for gastric cancer: a single center US experience.

INTRODUCTION: With rising obesity in the USA, the impact of body mass index (BMI) on survival in gastric cancer remains unclear. METHODS: An institutional database of patients undergoing surgical evaluation for gastric cancer was reviewed. Patients were stratified by the following BMI: <18.5, 18.5-25, 25.1-30, and >30. Clinicopathologic factors and overall survival (OS) were analyzed. RESULTS: From 1997 to 2012, 222 patients underwent exploration for gastric adenocarcinoma. 186 (84%) had BMI recorded: nine (5%) <18.5, 72 (39%) 18.5-25, 62 (33%) 25.1-30, and 43 (23%) >30. One hundred thirty-five (73%) ultimately underwent resection. Although American Society of Anesthesiology score and blood loss were not associated with increasing BMI, operative time was longer, p = 0.02. Proximal location, perineural invasion, lymphovascular invasion, positive surgical margins, and positive lymph nodes (LN+) were all associated with worse OS but not with increased BMI. Although increased BMI was associated with a lower lymph node count, p = 0.004, the number of LN + and final pathologic stage were not associated with BMI. Additionally, use of neoadjuvant or adjuvant chemotherapy was not associated with BMI. Median OS was 22 months. Median OS was improved with increased BMI: 21 months for <18.5, 13 months 18.5-25, 28 months 25-30, and 34 months >30, p = 0.02. Disease-free survival (DFS) was similar: 2 months for <18.5, 7 months 18.5-25, 15 months 25.1-30, and 15 months >30, p = 0.02. CONCLUSION: Although BMI may impact the technical difficulty of resection for gastric cancer, increasing BMI is not associated with more advanced disease. In this experience, increased BMI does not adversely impact OS or DFS.

RFID-enabled process reengineering of closed-loop supply chains in the healthcare industry of Singapore.

Due to an increasing global awareness of the need for sustainable development in academia and business, closed-loop supply chains in hospitals have become an important area of focus. Process reengineering in purchasing, materials management, work practices, and waste management can reduce environmental hazards and contain costs at the healthcare facilities. This paper demonstrates an application of the RFID-enabled process reengineering in sustainable healthcare system design, and presents a case study in the linens division of central sterilization services department at a Singaporean hospital using ARENA simulation.

Prognostic impact of lymph node retrieval and ratio in gastric cancer: a U.S. single center experience.

INTRODUCTION: Increased lymph node (LN) retrieval for gastric cancer has been associated with improved overall survival (OS). This study examines the impact of number of examined LN (eLN) and lymph node ratio. METHODS: Patients referred for surgical care of gastric cancer were stratified by number of eLN, positive LNs (LN+), and lymph node ratio (LN+/eLN). Clinicopathologic factors were compared; OS and disease-free survival (DFS) were the primary endpoints. RESULTS: From 1997 to 2012, 222 patients, median age 67 (range, 17-92) years, were analyzed. Of 220 (99 %) explored, 164 (74 %) underwent resection. Median OS was 22 (range, 0.3-140) months. Perineural and lymphovascular invasion and poor differentiation adversely affected OS, p < 0.05. A median 14 eLN (range, 0-45), with median 1 LN+ (range, 0-31), was observed. There were no OS or DFS differences when comparing the eLN groups. Both OS and DFS were impacted by LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months (0) to 37 months (0.01-0.2), 27 months (0.21-0.5), and 12 months (>0.5), p < 0.0001. DFS was similar: 35 months (0), decreasing to 22 months (0.01-0.2), 13 months (0.21-0.5), and 7 months (>0.5), p < 0.0001. CONCLUSION: Number of eLN did not impact survival, while LN+ adversely affected survival. Lymph node ratio may predict prognosis better than number of eLN or LN+ in gastric cancer.