<h3>Importance</h3><p>Evidence supports using antiplatelet therapy in patients with acute ischemic stroke. However, neurological deterioration remains common under the currently recommended antiplatelet regimen, leading to poor clinical outcomes.</p><h3>Objective</h3><p>To determine whether intravenous tirofiban administered within 24 hours of stroke onset prevents early neurological deterioration in patients with acute noncardioembolic stroke compared with oral aspirin.</p><h3>Design, Setting, and Participants</h3><p>This investigator-initiated, multicenter, open-label, randomized clinical trial with blinded end-point assessment was conducted at 10 comprehensive stroke centers in China between September 2020 and March 2023. Eligible patients were aged 18 to 80 years with acute noncardioembolic stroke within 24 hours of onset and had a National Institutes of Health Stroke Scale (NIHSS) score of 4 to 20.</p><h3>Intervention</h3><p>Patients were assigned randomly (1:1) to receive intravenous tirofiban or oral aspirin for 72 hours using a central, web-based, computer-generated randomization schedule; all patients then received oral aspirin.</p><h3>Main Outcome</h3><p>The primary efficacy outcome was early neurological deterioration (increase in NIHSS score ≥4 points) within 72 hours after randomization. The primary safety outcome was symptomatic intracerebral hemorrhage within 72 hours after randomization.</p><h3>Results</h3><p>A total of 425 patients were included in the intravenous tirofiban (n = 213) or oral aspirin (n = 212) groups. Median (IQR) age was 64.0 years (56.0-71.0); 124 patients (29.2%) were female, and 301 (70.8%) were male. Early neurological deterioration occurred in 9 patients (4.2%) in the tirofiban group and 28 patients (13.2%) in the aspirin group (adjusted relative risk, 0.32; 95% CI, 0.16-0.65;<i>P</i> = .002). No patients in the tirofiban group experienced intracerebral hemorrhage. At 90-day follow-up, 3 patients (1.3%) in the tirofiban group and 3 (1.5%) in the aspirin group died (adjusted RR, 1.15; 95% CI, 0.27-8.54;<i>P</i> = .63), and the median (IQR) modified Rankin scale scores were 1.0 (0-1.25) and 1.0 (0-2), respectively (adjusted odds ratio, 1.28; 95% CI, 0.90-1.83;<i>P</i> = .17).</p><h3>Conclusions and Relevance</h3><p>In patients with noncardioembolic stroke who were seen within 24 hours of symptom onset, tirofiban decreased the risk of early neurological deterioration but did not increase the risk of symptomatic intracerebral hemorrhage or systematic bleeding.</p><h3>Trial Registration</h3><p>ClinicalTrials.gov Identifier:NCT04491695</p>

Marginal-based methods achieve promising performance in the synthetic data competition hosted by the National Institute of Standards and Technology (NIST). To deal with high-dimensional data, the distribution of synthetic data is represented by a probabilistic graphical model (e.g., a Bayesian network), while the raw data distribution is approximated by a collection of low-dimensional marginals. Differential privacy (DP) is guaranteed by introducing random noise to each low-dimensional marginal distribution. Despite its promising performance in practice, the statistical properties of marginal-based methods are rarely studied in the literature. In this paper, we study DP data synthesis algorithms based on Bayesian networks (BN) from a statistical perspective. We establish a rigorous accuracy guarantee for BN-based algorithms, where the errors are measured by the total variation (TV) distance or the L 2 distance. Related to downstream machine learning tasks, an upper bound for the utility error of the DP synthetic data is also derived. To complete the picture, we establish a lower bound for TV accuracy that holds for every ǫ-DP synthetic data generator.

Exploration of dynamic human activity gives significant insights into understanding the urban environment and can help to reinforce scientific urban management strategies. Lots of studies are arising regarding the significant human activity changes in global metropolises and regions affected by COVID-19 containment policies. However, the variations of human activity dynamics amid different phases divided by the non-pharmaceutical intervention policies (e.g., stay-at-home, lockdown) have not been investigated across urban areas in space and time and discussed with the urban characteristic determinants. In this study, we aim to explore the influence of different restriction phases on dynamic human activity through sensing human activity zones (HAZs) and their dominated urban characteristics. Herein, we proposed an explainable analysis framework to explore the HAZ variations consisting of three parts, i.e., footfall detection, HAZs delineation and the identification of relationships between urban characteristics and HAZs. In our study area of Greater London, United Kingdom, we first utilised the footfall detection method to extract human activity metrics (footfalls) counted by visits/stays at space and time from the anonymous mobile phone GPS trajectories. Then, we characterised HAZs based on the homogeneity of daily human footfalls at census output areas (OAs) during the predefined restriction phases in the UK. Lastly, we examined the feature importance of explanatory variables as the metric of the relationship between human activity and urban characteristics using machine learning classifiers. The results show that dynamic human activity exhibits statistically significant differences in terms of the HAZ distributions across restriction phases and is strongly associated with urban characteristics (e.g., specific land use types) during the COVID-19 pandemic. These findings can improve the understanding of the variation of human activity patterns during the pandemic and offer insights into city management resource allocation in urban areas concerning dynamic human activity.

Existing studies often use the association between sector sizes to test the supplementary and complementary models of government–nonprofit relations, assuming that one mode of government–nonprofit ...

Since the New Public Management Movement, privatization has become a popular approach for delivering public services. However, few studies empirically assess the relationship between privatization ...

between 15e17-years old had stopped gender-affirming medications compared with 10.6% of patients who started GnRHa between 9e14-years, though this difference did not reach statistical significance. Insurance sponsor's rank (family income), birth-assigned sex, and the presence of mood disorders were not associated with cessation rates. Within 2 years of starting GnRHa, 83.2% (95%CI: 70.2 e 94.4%) of patients had started gender-affirming hormones; within 8 years of starting GnRHa, this number increased to 91.6% (95%CI 81.6 e100%). Younger patients had a greater delay in starting gender-affirming hormones. Insurance sponsor's rank, birth-assigned sex, and the presence of mood disorders were not associated with initiation of gender-affirming hormones. Conclusions: Contrary to concerns, GnRHa use did not inevitably lead to use of gender-affirming hormones. One out of twelve TGD adolescents who started GnRHa to address gender dysphoria subsequently stopped treatment. Sources of Support: None. Purpose: StRONG was a multicenter randomized clinical trial of refeeding in hospitalized adolescents and young adults with malnutrition secondary to anorexia nervosa (AN) and atypical anorexia nervosa (AAN) (ClinicalTrials.gov #NCT02488109). At end-of-treatment, higher calorie refeeding (HCR) was more efficacious and less costly than lower calorie refeeding (LCR). Here we compare efficacy of HCR in AAN vs. AN. Methods: Participants were N¼120, 12-24 yr-olds with > 60% median Body Mass Index (%mBMI) and medical instability. AAN was defined as %mBMI >85% at baseline. Meal-based HCR began 2000 calories/day (kcal/d) and advanced 200 kcal/d; LCR began 1400 kcal/d and advanced 200 kcal every other day (no tube feeding). Efficacy was defined as time to restore a 6-point Medical Stability Index (MSI): heart rate (HR) 45 bpm; systolic blood pressure (SBP) 90 mmHg, temperature 35.6 C, orthostatic increase in HR 35 bpm and decrease SBP 20 mmHg, and 75% median BMI (%mBMI). Main outcome was days to restore MSI, compared between groups with unpaired t-test. Exploratory moderator analyses examined the interaction between refeeding treatment and diagnosis on key outcomes (time to recover heart rate and weight gain). Weight gain was defined as change in %mBMI. Results: Modified intention to treat analyses included N¼111. Mean age was 16.5 (2.5) yrs, 43% had AAN. Upon admission, %mBMI was 95.2 (9) in AAN vs. 76.5 (5.9) in AN, p<.001. Upon discharge, %mBMI was 98.3 (8.9) in AAN vs. 82.2 (5.3) in AN, p<.001. MSI was restored fastest in patients with AN refed by HCR [7.1 (5.4) days], whereas medical stability required three additional days to restore in patients with AAN [10.1 (5.3) days, p<0.01]. Diagnosis (AAN or AN) and treatment (HCR or LCR) interacted to weaken the effect of refeeding on HR recovery [B¼3.76 (.572,6.95), p¼0.021] and weight gain [B¼039 (.006,072), p¼0.021], which was 0.3% mBMI per day slower (p¼0.005) and 2.6% mBMI less overall (p¼0.009) in AAN than AN. Conclusions: While HCR is more efficacious than LCR for refeeding in AN, it may contribute to underfeeding in AAN. source) and four family variables (family functioning , parental connection, parental monitoring, and parental psychological control). The outcome, UWCB (e.g. fasting, vomiting, laxative use), was self-reported by young adults eight years later. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) of UWCB for four weight stigma predictors and four family predictors. Models were adjusted for sociodemographic characteristics, baseline UWCB, and baseline BMI percentile, and predictors were modeled separately. Results: In analyses adjusted for sociodemographic characteristics, all weight stigma and family variables during adolescence longitudinally predicted significantly higher odds of UWCB eight years later. After additionally adjusting for baseline UWCB and baseline BMI percentile, two weight stigma variables (weight teasing from family [OR: 1.42, 95% CI: 1.08, 1.87] and hurtful weight-related comments from family [OR: 1.34, 95% CI: 1.06, 1.70]) and one family variable (poor family functioning [OR: 1.44, 95% CI: 1.14, 1.81]) remained significantly associated with subsequent UWCB. Conclusions: Findings indicate that there are long-term consequences , across major development periods, of weight teasing from family, hurtful weight-related comments from family, and low family 2022 SAHM Annual Meeting / Journal of Adolescent Health 70 (2022) S1eS32 S11

Accumulating evidence suggests that maternal exposure to objectively stressful events and subjective distress during pregnancy may have intergenerational impacts on children’s mental health, yet evidence is limited. In a multisite longitudinal cohort (N = 454), we used multi-variable linear regression models to evaluate the predictive value of exposure to stressful events and perceived distress in pregnancy for children’s internalizing problems, externalizing problems, and adaptive skills at age 4. We also explored two- and three-way interactions between stressful events, distress, and child sex. Both objective and subjective maternal stress independently predicted children’s behavior, with more stressful events and higher distress predicting more internalizing and externalizing problems and worse adaptability; stress types did not significantly interact. There was some evidence that more stressful events predicted higher externalizing behaviors only for girls. Three-way interactions were not significant. The current findings highlight the importance of considering the type of stress measurement being used (e.g., counts of objective event exposure or subjective perceptions), suggest prenatal stress effects may be transdiagnostic, and meet calls for rigor and reproducibility by confirming these independent main effects in a relatively large group of families across multiple U.S. regions. Results point to adversity prevention having a two-generation impact and that pre- and postnatal family-focused intervention targets may help curb the rising rates of children’s mental health problems.

Tobacco and alcohol use are heritable behaviours associated with 15% and 5.3% of worldwide deaths, respectively, due largely to broad increased risk for disease and injury1–4. These substances are used across the globe, yet genome-wide association studies have focused largely on individuals of European ancestries5. Here we leveraged global genetic diversity across 3.4 million individuals from four major clines of global ancestry (approximately 21% non-European) to power the discovery and fine-mapping of genomic loci associated with tobacco and alcohol use, to inform function of these loci via ancestry-aware transcriptome-wide association studies, and to evaluate the genetic architecture and predictive power of polygenic risk within and across populations. We found that increases in sample size and genetic diversity improved locus identification and fine-mapping resolution, and that a large majority of the 3,823 associated variants (from 2,143 loci) showed consistent effect sizes across ancestry dimensions. However, polygenic risk scores developed in one ancestry performed poorly in others, highlighting the continued need to increase sample sizes of diverse ancestries to realize any potential benefit of polygenic prediction. A multi-ancestry meta-regression study analyses diverse genome-wide association studies and genome loci associated with tobacco and alcohol use.

Government-nonprofit partnerships outside the contracting relationship have become an increasingly important mechanism in financing and supporting public service provision. However, the relationship between these partnerships and public funding allocation remains unclear. We articulate two competing mechanisms-the substitution mechanism and the exchange mechanism-and empirically test them with a unique geocoded dataset of public park capital projects allocation in New York City. Our findings indicate that parks units supported by government-nonprofit partnerships are likely to receive more public capital project funding, which supports the exchange mechanism. In addition, larger parks with a more populous community surrounding them get more public capital funding allocation. As governments at all levels are seeking new ways to finance and manage public service provision, many more empirical studies in other service subsectors, time periods, and geographical contexts are required to draw more general conclusions about how government-nonprofit partnerships may influence public funding allocation and how such dynamics may compromise or promote equitable public service provision. Yuan (Daniel) Cheng and Zhengyan Li contributed equally to this study.

Background Low: syphilis testing uptake is a major public health issue among : men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. Methods and findings An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win U S$15: if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% : CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US $26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing.

We categorized levels of self-reported stress, anxiety, worry, and sleep among US college and university students during the COVID-19 pandemic.We conducted an anonymous online survey between May 7 ...

Existing studies assume that the value of political connections is homogeneous to different types of nonprofits and seldom consider their interplay with other accountability mechanisms. Based on a multilevel analysis of 2,085 foundations in China, this study builds and tests a theoretical framework of the contingent value of political connections to nonprofits, treating transparency as a moderator for the relationship between political connections and donations. Our findings suggest that while transparency is positively associated with the amount of donations obtained by foundations, political connections can help foundations obtain more donations only when their transparency score is higher than a certain threshold.

This paper explores the link between nonprofit financial support and the service quality of city park systems. Specifically, this research constructs a longitudinal dataset and utilizes the fixed effects model to empirically investigate the relationship between nonprofit financial support for major US city parks and service quality. The findings show that the level of nonprofit financial support to city parks has a positive relationship with two major indicators of city park service quality: the size of parkland and the public access to parks. However, a small statistically significant relationship is found for the number of playgrounds in parks and the level of nonprofit financial support. This research contributes to the theoretical understanding of government–nonprofit relationships which heavily emphasize the resource flow from park-supporting charities to governments. It also improves our empirical knowledge of the general associations between public service provision and nonprofit organizations in urban areas.

Background: Men who have sex with men (MSM) bear a high burden of syphilis infection. Expanding syphilis testing to improve timely diagnosis and treatment is critical to improve syphilis control. However, syphilis testing rates remain low among MSM, particularly in low-and middle-income countries. We describe the protocol for a randomised controlled trial (RCT) to assess whether provision of syphilis self-testing services can increase the uptake of syphilis testing among MSM in China.

This article argues for a fuller and more integrated application of coproduction theory into explanations for social and voluntary sector activity around the globe. Coproduction also has potential value for understanding some aspects of an emerging and somewhat turbulent Chinese nonprofit sector. This article uses a literature review of voluntary sector theories to first offer three reasons for more emphasis on coproduction research to explain social sector behavior: its consumer- and systems-oriented perspective, its emphasis on citizen initiative, and its temporal flexibility. We then demonstrate the value of the coproduction theory for Chinese governance by employing a systematic literature review of Chinese coproduction and related collaboration scholarship. The articles produced, although quite limited in number, offer promising examples of all three of these ways in which the concept of coproduction has been used to date in Chinese contexts. We conclude with some suggestions for future China-oriented research to better integrate coproduction theory into voluntary sector theories.

Thus, let me recommend that the bridging of gulf between the analysis of private activities apart from those of government agencies needs to be high on the agenda of development theorists and activ...

The growing phenomenon of government-supporting charities prompts the question of whether these institutions help or hinder public values of equity in service access. Logit and tobit regression analysis using multiple data sources from the California and Florida state parks systems compares public parks with and without supporting “friends” groups. The results suggest that while parks philanthropy has produced real benefits in rallying citizen support for improved public spaces, it also introduces some distributional consequences that policy makers should not ignore. Namely, a philanthropic failure hypothesis is supported whereby wealthier Florida counties with greater income inequality are more likely to benefit from a charity supporting a nearby state park. Finding no similar result in California, the authors conclude that the association between community wealth and park charity presence may also depend on state characteristics such as the funding structure of each state park system, not just community wealth differences.