Notes

Mathematical analysis of a most cancers design with time-delay throughout tumor-immune conversation along with activation techniques.
Importance Use of effective contraception decreases unintended pregnancy. It is not known whether Medicaid expansion under the Affordable Care Act increased use of contraception for women who are underserved in the US health care safety net. Objective To evaluate the association of Medicaid expansion under the Affordable Care Act with changes in use of contraception among patients at risk of pregnancy at US community health centers, with the hypothesis that Medicaid expansion would be associated with increases in use of the most effective contraceptive methods (long-acting reversible contraception). Design, setting, and participants This was a participant-level retrospective cross-sectional study comparing receipt of contraception before (2013) vs immediately after (2014) and a longer time after (2016) Medicaid expansion. Electronic health record data from a clinical research network of community health centers across 24 states were included. The sample included all female patients ages 15 to 44 years at risk larger, particularly in the longer term (2014 vs 2013 absolute difference-in-difference, 0.80 [95% CI, 0.30-1.30] percentage points; 2016 vs 2013 absolute difference, 1.79 [95% CI, 0.88-2.70] percentage points). Women from expansion states who received care at a Title X clinic had the highest percentage of women receiving most effective contraceptive methods compared with non-Title X clinics and nonexpansion states. Conclusions and relevance In this study, Medicaid expansion was associated with an increase in use of long-acting reversible contraceptive methods among women at risk of pregnancy seeking care in the US safety net system, and gains were greatest among adolescents.Importance Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood. Objective To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents. Design, setting, and participants A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019. CP-690550 chemical structure Exposures Possible internet addiction and internet addiction. Main outcomes and measures Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation. Results A total of 15 623 students (8043 male [51.5%] and 75SSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47). Conclusion and relevance Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI.Importance Findings suggest that the efficacy of D-cycloserine (DCS) for enhancing exposure therapy may be strongest when administered after sessions marked by low fear at the conclusion of exposure practice. These findings have prompted investigation of DCS dosing tailored to results of exposure sessions. Objective To compare tailored postsession DCS administration with presession DCS administration, postsession DCS administration, and placebo augmentation of exposure therapy for social anxiety disorder. Design, setting, and participants This double-blind randomized clinical trial involved adults with social anxiety disorder enrolled at 3 US university centers. Symptom severity was assessed at baseline, weekly during treatment, and at 1-week and 3-month follow-up. Data analysis was performed from September 2019 to March 2020. Interventions Participants completed a 5-session treatment and received pills commensurate with their condition assignment at sessions 2 through 5, which emphasized exposure practice. M008; d = 0.72) and lower symptom severity (b = -0.44, 95% CI, -0.73 to -0.14; P = .004; d = 0.64; and b = -0.41, 95% CI, -0.72 to -0.11; P = .008; d = 0.61) at 3-month follow-up. Conclusions and relevance Administration of DCS enhanced exposure therapy for social anxiety disorder when given before or after the exposure session. However, the study failed to achieve the aim to develop a tailored clinical application. Trial registration ClinicalTrials.gov Identifier NCT02066792.Importance Predicting chronic disease incidence for the population provides a comprehensive picture to health policy makers of their jurisdictions' overall future chronic disease burden. However, no population-based risk algorithm exists for estimating the risk of first major chronic disease. Objective To develop and validate the Chronic Disease Population Risk Tool (CDPoRT), a population risk algorithm that predicts the 10-year incidence of the first major chronic disease in the adult population. Design, setting, and participants In this cohort study, CDPoRT was developed and validated with 6 cycles of the Canadian Community Health Survey, linked to administrative data from January 2000 to December 2014. Development and internal validation (bootstrap and split sample) of CDPoRT occurred in Ontario, Canada, from June 2018 to April 2019 followed by external validation in Manitoba from May 2019 to July 2019. The study cohorts included 133 991 adults (≥20 years) representative of the Ontario and Manitoba populatss index (26.9 [5.1] vs 27.7 [5.4]) than the Manitoba cohort (n = 13 244). During development, the full and parsimonious CDPoRT models had similar Brier scores (women, 0.087; men, 0.091), Harrell C index values (women, 0.779; men, 0.783), and calibration curves. A simple version consisting of cigarette smoking, age, and body mass index performed slightly worse than the other versions (eg, Brier score for women, 0.088; for men, 0.092). Internal validation showed consistent performance across models, and CDPoRT performed well during external validation. For example, the female parsimonious version had C index values for bootstrap, split sample, and external validation of 0.778, 0.776, and 0.752, respectively. Conclusions and relevance In this study, CDPoRT provided accurate, population-based risk estimates for the first major chronic disease.
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