Potential Effects of Long-Term Exposure to Air Pollution on Dementia: A Longitudinal Analysis in American Indians Aged 55 Years and Older.

(1) Background: American Indians are disproportionately affected by air pollution, an important risk factor for dementia. However, few studies have investigated the effects of air pollution on the risk of dementia among American Indians. (2) Methods: This retrospective cohort study included a total of 26,871 American Indians who were 55+ years old in 2007, with an average follow-up of 3.67 years. County-level average air pollution data were downloaded from land-use regression models. All-cause dementia was identified using ICD-9 diagnostic codes from the Indian Health Service's (IHS) National Data Warehouse and related administrative databases. Cox models were employed to examine the association of air pollution with dementia incidence, adjusting for co-exposures and potential confounders. (3) Results: The average PM2.5 levels in the IHS counties were lower than those in all US counties, while the mean O3 levels in the IHS counties were higher than the US counties. Multivariable Cox regressions revealed a positive association between dementia and county-level O3 with a hazard ratio of 1.24 (95% CI: 1.02-1.50) per 1 ppb standardized O3. PM2.5 and NO2 were not associated with dementia risk after adjusting for all covariates. (4) Conclusions: O3 is associated with a higher risk of dementia among American Indians.

Risk of sleep apnea associated with higher blood pressure among Chinese and Korean Americans.

OBJECTIVE: This study examines associations between sleep apnea risk and hypertension in a sample of immigrant Chinese and Korean Americans. DESIGN: The dataset included Chinese and Korean patients ages 50-75 recruited from primary care physicians' offices from April 2018 to June 2020 in the Baltimore-Washington DC Metropolitan Area (n = 394). Hypertension risk was determined using a combination of blood pressure measurements, self-reported diagnosis of hypertension by a medical professional, and/or self-reported use of antihypertensive medications. Linear regression models examined the associations between sleep apnea risk and blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). Poisson regression models examined associations sleep apnea risk and hypertension. Models controlled for body mass index (BMI), demographic, and socioeconomic risk factors. We further examined models for potential effect modification by age, gender, Asian subgroup, and obesity, as well as effect modification of daytime sleepiness on the association between snoring and hypertension risk. RESULTS: High risk of sleep apnea appeared to be associated positively with SBP (ß = 6.77, 95% CI: 0.00-13.53), but not with DBP. The association was positive for hypertension, but it was not statistically significant (PR = 1.11, 95% CI: 0.87-1.41). We did not find effect modification of the associations between sleep apnea and hypertension risk, but we did find that daytime sleepiness moderated the effect of snoring on SBP. Snoring was associated with higher SBP, primarily in the presence of daytime sleepiness, such that predicted SBP was 133.27 mmHg (95% CI: 126.52, 140.02) for someone with both snoring and daytime sleepiness, compared to 123.37 mmHg (95% CI: 120.40, 126.34) for someone neither snoring nor daytime sleepiness. CONCLUSION: Chinese and Korean immigrants living in the U.S. who are at high risk of sleep apnea have higher SBP on average, even after accounting for sociodemographic characteristics and BMI. CLINICAL TRAIL REGISTRATION: : NCT03481296, date of registration: 3/29/2018.

Distress, multimorbidity, and complex multimorbidity among Chinese and Korean American older adults.

BACKGROUND: Studies suggest that distress is associated with various health conditions such as hypertension, asthma, diabetes, and coronary heart disease. However, only few studies focused on Asian Americans and little is known about the association with multiple comorbidity. METHODS: We conducted a cross-sectional analysis among 400 Chinese and Korean American participants (aged 50-75 years) of the STOP CRC randomized controlled trial. Perceived distress was assessed using the distress thermometer scale (range 0-10). Disease diagnosis was self-reported by the participants. Multimorbidity (MM) was defined as having ≥2 chronic conditions. Complex multimorbidity (CMM) was defined as having ≥3 of the following body system disorders: circulation disorder, endocrine-metabolic disorder, cancer, anxiety or depression, breathing problem, and other health problems. We performed logistic regression for CMM and Poisson regression with robust error variance for MM to estimate associations with distress, adjusting for potential confounders. RESULTS: The mean age was 58.4 years and mean distress score was 3.65. One-unit increase in distress score was associated with a 1.22-fold increase in the odds of having CMM (95% CI: 1.04-1.42). The magnitude of association slightly increased after additional adjustment for socioeconomic factors and health insurance status (OR: 1.29; 95% CI: 1.10-1.52). Higher distress score was positively associated with MM but the association was only marginally significant (PR: 1.04; 95% CI: 0.99-1.10), adjusting for socioeconomic factors and health insurance status. CONCLUSION: Our data suggest that higher perceived distress may be associated with simultaneous dysfunction of multiple distinct body systems among Chinese and Korean American older adults.

Long-term in vivo chimeric cells tracking in non-human primate.

Non-human primates (NHPs) are increasingly used in preclinical trials to test the safety and efficacy of biotechnology therapies. Nonetheless, given the ethical issues and costs associated with this model, it would be highly advantageous to use NHP cellular models in clinical studies. However, developing and maintaining the naïve state of primate pluripotent stem cells (PSCs) remains difficult as does in vivo detection of PSCs, thus limiting biotechnology application in the cynomolgus monkey. Here, we report a chemically defined, xeno-free culture system for culturing and deriving monkey PSCs in vitro. The cells display global gene expression and genome-wide hypomethylation patterns distinct from monkey-primed cells. We also found expression of signaling pathways components that may increase the potential for chimera formation. Crucially for biomedical applications, we were also able to integrate bioluminescent reporter genes into monkey PSCs and track them in chimeric embryos in vivo and in vitro. The engineered cells retained embryonic and extra-embryonic developmental potential. Meanwhile, we generated a chimeric monkey carrying bioluminescent cells, which were able to track chimeric cells for more than 2 years in living animals. Our study could have broad utility in primate stem cell engineering and in utilizing chimeric monkey models for clinical studies.

Sparse Logistic Regression-Based EEG Channel Optimization Algorithm for Improved Universality across Participants.

Electroencephalogram (EEG) channel optimization can reduce redundant information and improve EEG decoding accuracy by selecting the most informative channels. This article aims to investigate the universality regarding EEG channel optimization in terms of how well the selected EEG channels can be generalized to different participants. In particular, this study proposes a sparse logistic regression (SLR)-based EEG channel optimization algorithm using a non-zero model parameter ranking method. The proposed channel optimization algorithm was evaluated in both individual analysis and group analysis using the raw EEG data, compared with the conventional channel selection method based on the correlation coefficients (CCS). The experimental results demonstrate that the SLR-based EEG channel optimization algorithm not only filters out most redundant channels (filters 75-96.9% of channels) with a 1.65-5.1% increase in decoding accuracy, but it can also achieve a satisfactory level of decoding accuracy in the group analysis by employing only a few (2-15) common EEG electrodes, even for different participants. The proposed channel optimization algorithm can realize better universality for EEG decoding, which can reduce the burden of EEG data acquisition and enhance the real-world application of EEG-based brain-computer interface (BCI).

Correntropy-Based Logistic Regression With Automatic Relevance Determination for Robust Sparse Brain Activity Decoding.

OBJECTIVE: Recent studies have used sparse classifications to predict categorical variables from high-dimensional brain activity signals to expose human's mental states and intentions, selecting the relevant features automatically in the model training process. However, existing sparse classification models will likely be prone to the performance degradation which is caused by the noise inherent in the brain recordings. To address this issue, we aim to propose a new robust and sparse classification algorithm in this study. METHODS: To this end, we introduce the correntropy learning framework into the automatic relevance determination based sparse classification model, proposing a new correntropy-based robust sparse logistic regression algorithm. To demonstrate the superior brain activity decoding performance of the proposed algorithm, we evaluate it on a synthetic dataset, an electroencephalogram (EEG) dataset, and a functional magnetic resonance imaging (fMRI) dataset. RESULTS: The extensive experimental results confirm that not only the proposed method can achieve higher classification accuracy in a noisy and high-dimensional classification task, but also it would select those more informative features for the decoding tasks. CONCLUSION: Integrating the correntropy learning approach with the automatic relevance determination technique will significantly improve the robustness with respect to the noise, leading to more adequate robust sparse brain decoding algorithm. SIGNIFICANCE: It provides a more powerful approach in the real-world brain activity decoding and the brain-computer interfaces.

The Mediating Role of Sleep Disturbance on the Association Between Stress and Self-Rated Health Among Chinese and Korean Immigrant Americans.

INTRODUCTION: Disturbed sleep may be a factor that links stress with poor health, especially among groups experiencing high levels of stress caused by racial and ethnic minority and nativity status. The objective of this study was to describe the potential mediating role of sleep disturbance in the associations between various types of stress and self-rated health among Chinese and Korean Americans. METHODS: Our cross-sectional study consisted of 400 Chinese and Korean immigrants aged 50 to 75 years recruited from August 2018 through June 2020 from physicians' clinics in the Baltimore-Washington, DC, metropolitan area. We used the Patient Reported Outcomes Measurement Information System (PROMIS) short-form questionnaire to measure sleep disturbance. Linear regression analyses examined associations between 3 types of stress (acculturative stress, perceived stress, and distress) and self-rated health, accounting for demographic, socioeconomic, and health insurance factors. The Karlson-Holm-Breen method was used to estimate the total and direct effects of stresses on self-rated health and the indirect effects of stresses on health through sleep disturbance. RESULTS: Greater acculturative stress (ß = 0.08; 95% CI, 0.01-0.14), perceived stress (ß = 0.05; 95% CI, 0.03-0.08), and distress (ß = 0.09; 95% CI, 0.05-0.13) were all associated with poorer self-rated health. Sleep disturbance was a partial mediator, with sleep disturbance accounting for 21.7%, 14.9%, and 18.7% of the associations between acculturative stress, perceived stress, and distress and self-rated health, respectively. CONCLUSION: Because sleep disturbance partially mediates the associations between stress and poor self-rated health, future interventions and research may consider mitigating sleep disturbances and stress among racial and ethnic minority populations to address health disparities.

Acculturation and Cardiometabolic Abnormalities Among Chinese and Korean Americans.

BACKGROUND: Studies generally show that higher acculturation is associated with greater cardiovascular disease (CVD) risk among immigrants in the United States (US). However, few studies have compared how proxies of acculturation are differentially associated with metabolic abnormalities measured using objective biomarkers, self-reported diagnosis, and medication use, particularly among East Asian Americans. METHODS: Survey data and biomarker measurements collected from random (non-fasting) blood samples of Chinese and Korean immigrants in the US (n = 328) were used to examine the associations between two proxies for acculturation (years living in the US and English speaking proficiency) with three cardiometabolic abnormalities (high triglyceride levels, diabetes, and hypercholesterolemia). Poisson regression models estimated prevalence ratios adjusted for demographic characteristics, socioeconomic factors, and body mass index. Gender, Asian subgroup, and household income were tested as potential effect modifiers. RESULTS: Living longer in the US was associated with greater likelihood of having high triglycerides. In addition, living longer in the US was associated with greater likelihood of diabetes for people with lower household income and greater likelihood of hypercholesterolemia for people with higher household income. Higher level of English proficiency was less consistently associated with higher cardiometabolic risk, although there was a significant association with greater likelihood of hypercholesterolemia. CONCLUSIONS: Longer time lived in the US is associated with higher risk of cardiometabolic abnormalities among Chinese and Korean Americans. Future studies of acculturation and cardiometabolic risk should carefully consider potential mechanisms and what proxy measures of acculturation capture. TRIAL REGISTRATION NUMBER: NCT03481296, date of registration: 3/29/2018.

Current state of stem cell research in non-human primates: an overview.

The remarkable similarity between non-human primates (NHPs) and humans establishes them as essential models for understanding human biology and diseases, as well as for developing novel therapeutic strategies, thereby providing more comprehensive reference data for clinical treatment. Pluripotent stem cells such as embryonic stem cells and induced pluripotent stem cells provide unprecedented opportunities for cell therapies against intractable diseases and injuries. As continue to harness the potential of these biotechnological therapies, NHPs are increasingly being employed in preclinical trials, serving as a pivotal tool to evaluate the safety and efficacy of these interventions. Here, we review the recent advancements in the fundamental research of stem cells and the progress made in studies involving NHPs.

Acculturation and self-rated health among Chinese and Korean immigrants aged 49 to 75.

Background: Given the rapidly growing Asian populations in the U.S. due to immigration, and the aging demographic of Asian immigrants, it is crucial to understand how acculturation shapes health among older adult Asian immigrants. We study the relationship between acculturation and self-rated health (SRH) and moderating roles of age and Asian subgroup. Methods: Our cross-sectional study consisted of 200 Chinese and 200 Korean immigrants aged 49-75 living in Baltimore-Washington DC metropolitan area, who were recruited from primary care physicians' clinics in Maryland and Northern Virginia. The participants completed the survey either in-person or by phone in their preferred language. Multidimensional proxies were used to measure acculturation: years living in the U.S. (≥23 years, <23 years), English proficiency (fluently/well, so-so, poorly/not at all), and ethnic identity (very Asian, mostly Asian, bicultural/westernized). SRH was measured using the question "How would you rate your general health?" (excellent/very good/good, fair/poor). Poisson regression models with robust error variance examined associations between acculturation and SRH, accounting for socioeconomic and health insurance factors. Results: Speaking English so-so and fluently/well had 0.73 (95% confidence intervals (CI): 0.55-0.97) and 0.51 (95% CI: 0.30-0.87) times the prevalence of having fair or poor SRH compared to speaking English poorly/not at all, respectively. The magnitudes and statistical significance of these associations were stronger among Chinese participants than Korean participants. Moreover, individuals who self-identified as bicultural/westernized had 0.63 times the prevalence of having fair or poor SRH (95% CI: 0.43-0.92) as those who self-identified as very Asian. The association was more pronounced among older participants (≥58) compared to younger participants (<58). Conclusion: Further research should identify the possible mechanisms linking acculturation with health to find effective strategies to enhance health among aging Asian immigrant populations.

Associations between sleep apnea risk and cardiovascular disease indicators among Chinese and Korean Americans.

Study objectives: While sleep apnea has been associated with cardiovascular disease (CVD) risk factors in white individuals in the U.S., these associations in Chinese and Korean Americans are less well-understood, particularly how these associations vary by age, gender, Asian origin, obesity, chronic conditions, and daytime sleepiness. Methods: We used a sample of Chinese and Korean Americans ages 50-75 (n = 394) from the Baltimore-Washington DC Metropolitan Area to examine the associations of high risk (HR) sleep apnea with diagnoseable hypercholesterolemia and diabetes, as well as the following biomarkers: total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio, triglycerides, and glucose (non-fasting). Poisson models included demographic factors, socioeconomic status, and body mass index (BMI). We tested for potential effect modifiers. Results: HR-sleep apnea was associated with higher LDL-C level (ß = 14.56, p < 0.05) and higher total cholesterol/HDL ratio (ß = 0.64, p < 0.01). Younger respondents had higher levels of triglycerides associated with HR-sleep apnea than older respondents. For men, HR-sleep apnea was associated with higher total cholesterol, total cholesterol/HDL-C ratio, and triglycerides. Obese and overweight respondents had positive associations between HR-sleep apnea and total cholesterol, total cholesterol/HDL ratio, and triglycerides, while underweight/normal weight individuals did not. The interactions between snoring and daytime sleepiness were associated with hypercholesterolemia and diabetes. Conclusions: This study demonstrates associations between sleep apnea risk and dyslipidemia among Chinese and Korean Americans. Associations were particularly pronounced among younger, male, overweight/obese, and sicker individuals. Future research should examine how to improve sleep health in Asian American populations to improve CVD risk.

Galvanic Vestibular Stimulation-Based Prediction Error Decoding and Channel Optimization.

A significant problem in brain-computer interface (BCI) research is decoding - obtaining required information from very weak noisy electroencephalograph signals and extracting considerable information from limited data. Traditional intention decoding methods, which obtain information from induced or spontaneous brain activity, have shortcomings in terms of performance, computational expense and usage burden. Here, a new methodology called prediction error decoding was used for motor imagery (MI) detection and compared with direct intention decoding. Galvanic vestibular stimulation (GVS) was used to induce subliminal sensory feedback between the forehead and mastoids without any burden. Prediction errors were generated between the GVS-induced sensory feedback and the MI direction. The corresponding prediction error decoding of the front/back MI task was validated. A test decoding accuracy of 77.83-78.86% (median) was achieved during GVS for every 100[Formula: see text]ms interval. A nonzero weight parameter-based channel screening (WPS) method was proposed to select channels individually and commonly during GVS. When the WPS common-selected mode was compared with the WPS individual-selected mode and a classical channel selection method based on correlation coefficients (CCS), a satisfactory decoding performance of the selected channels was observed. The results indicated the positive impact of measuring common specific channels of the BCI.

Comparison of Consumer Rankings With Centers for Medicare & Medicaid Services Five-Star Rankings of Nursing Homes.

Importance: The Centers for Medicare & Medicaid Services (CMS) Five-Star measure for nursing homes is designed with input from expert panels about the importance of multiple quality indicators. Consumers may assign different values to these indicators, creating different 5-star ratings. Objective: To compare nursing homes' rankings based on the CMS Five-Star measure with rankings based on consumers' judgment about the importance of the same quality indicators. Design, Setting, and Participants: In this quality improvement study, CMS Five-Star data were linked with a measure calculated from CMS quality indicators and consumer values obtained from a national survey. Data covered the last quarter of 2016 and the first three quarters of 2017. The study included 10 676 nursing homes, comprising 69.8% of those with reported Five-Star measures. The national survey included adults, either nursing home residents or their family members who reported being familiar with the quality of care their relative received. Data analysis was performed from January 2019 to February 2020. Main Outcomes and Measures: The contingent valuation method was administered via the survey to obtain consumers' relative values of the quality indicators, and statistical analyses were used to create the contingent valuation measure. Agreement in nursing home rankings was assessed using the Five-Star measure, which is based on weights developed by expert panels, compared with rankings based on the contingent valuation measure. Results: Among 10 676 study nursing homes with a mean (SD) of 119.4 (59.4) beds, 7845 (73.5%) were for profit, 6424 (61.8%) were part of a chain, and 8009 (75.0%) were urban. The 4310 survey respondents (mean [SD] age, 39.9 [15.6] years; 1143 [26.5%] men; 3448 [80%] white) included mostly family members (3879 participants [90.0%]). The Pearson correlation coefficient (0.65) and weighted κ statistics (0.48) indicated only moderate agreement between ranking of nursing homes' performance by the 2 measures and disagreement on ranking for approximately one-half of the nursing homes. Conclusions and Relevance: Current nursing home report cards might not reflect consumers' values and the relative importance consumers place on each of the quality indicators that compose the overall Five-Star measure. Quality report cards might be more relevant to consumers by augmenting the Five-Star measure with a measure reflecting consumers' preferences. It is unknown whether these conclusions are generalizable to other report cards, such as Hospital and Home Health Compare, without conducting similar studies for these report cards.

Using contingent valuation to develop consumer-based weights for health quality report cards.

OBJECTIVE: The current 5-Star composite measure for nursing homes uses expert-driven weights to combine elements of quality into a single score. We assessed the feasibility of using the contingent valuation method (CVM) to derive consumers' preference-based weights for the Nursing Home Compare report card as a potential alternative approach. DATA SOURCES: Survey of 4310 adults with nursing home experience (residents or family members of a resident) administered between September 25 and October 9, 2017. STUDY DESIGN: Contingent valuation method based on respondents' answers to questions about willingness-to-trade (WTT) visit travel time for better quality in seven quantitative indices included in Nursing Home Compare. We calculated WTT amounts per standard deviation change in quantitative indices to derive weights. DATA COLLECTION METHODS: Web-based survey. PRINCIPAL FINDINGS: Contingent valuation method results are consistent with respondents making economically rational trade-offs between quality and travel time. Estimates of mean WTT vary across quantitative quality indices. They also vary in terms of respondent status and behavioral factors. Weights based on mean WTT per standard deviation vary substantially across indices, with the largest weights for inspections and staffing. CONCLUSIONS: Contingent valuation method has promise as a method for deriving weights for use in summary measures that incorporate consumer preferences.

Examination of the New Short-Stay Nursing Home Quality Measures: Rehospitalizations, Emergency Department Visits, and Successful Returns to the Community.

In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced 3 new quality measures (QMs) to its report card, Nursing Home Compare (NHC). These measures-rehospitalizations, emergency department visits, and successful discharges to the community-focus on short-stay residents. We offer a first analysis of nursing homes' performance in terms of these new measures. We examined their properties and distribution across nursing homes using descriptive statistics and regression models. We found that, similar to other QMs, performance varies across the country, and that there is very minimal correlation between these 3 new QMs as well as between these QMs and other NHC QMs. Regression models reveal that better performance on these QMs tends to be associated with fewer deficiencies, higher staffing and more skilled staffing, nonprofit ownership, and lower proportion of Medicaid residents. Other characteristics are associated with better performance for some but not all 3 QMs. We also found improvement in all 3 QMs in the second year of publication. This study contributes to the validity of these measures by demonstrating their relationship to these structural QMs. It also suggests that these QMs are important by demonstrating their large variation across the country, suggesting substantial room for improvement, and finding that nursing homes are already responding to the incentives created by publication of these QMs.

CeO2 /Bi2 WO6 Heterostructured Microsphere with Excellent Visible-light-driven Photocatalytic Performance for Degradation of Tetracycline Hydrochloride.

CeO2 /Bi2 WO6 heterostructured microsphere with excellent and stable photocatalytic activity for degradation tetracyclines was successfully synthesized via a facile solvothermal route. The photocatalytic experiments indicated that CeO2 /Bi2 WO6 heterostructured microspheres exhibited enhanced photocatalytic activity compared to pure Bi2 WO6 in both the degradation of tetracycline hydrochloride (TCH) and rhodamine B (RhB) under visible-light irradiation. The 1CeO2 /2Bi2 WO6 exhibited the best photocatalytic activity for degradation of TCH, reaching 91% after 60 min reaction. The results suggested that the particular morphological conformation of the microspheres resulted in smaller size and more uniform morphology so as to increase the specific surface area. Meanwhile, the heterojunction was formed by coupling CeO2 and Bi2 WO6 in the as-prepared microspheres, so that the separation efficiency of photogenerated electrons and holes was dramatically improved and the lifetimes of charge carriers were prolonged. Hence, introduction of CeO2 could significantly enhance the photocatalytic activity of CeO2 /Bi2 WO6 heterostructured microspheres and facilitate the degradation of TCH. This work provided not only a principle method to synthesize CeO2 /Bi2 WO6 with the excellent photocatalytic performance for actual produce, but also a excellent property of the photocatalyst for potential application in photocatalytic treatment of tetracyclines wastewater from pharmaceutical factory.