The emergence of community-associated methicillin-resistant S. aureus was associated with dramatically increased skin and soft tissue infection (SSTI) incidence in the first few years of the 21st century in the U.S. However, subsequent trends are poorly understood. We examined ambulatory and inpatient data of over 48 million persons years aged 0–64 years from the HealthCore Integrated Research Database (HIRD) between 2005 and 2010. Data were extracted from medical, pharmacy, and eligibility databases. We quantified SSTI incidence, type, and complications and comparative incidence trends for urinary tract infections (UTIs) and pneumonia. A total of 2,301,803 SSTIs were identified. Most SSTIs (95 %) were treated in the ambulatory setting and most (60 %) were categorized as abscesses or cellulitis. During the study period, SSTI incidence remained relatively stable from 47.9 (95 % CI: 47.8–48.1) cases/1,000 PY in 2005 to 48.5 cases/1,000 PY (95 % CI: 48.3–48.6) in 2010). Persons aged 45–64 years had the highest incidence of both ambulatory-treated and inpatient-treated SSTIs (51.2 (95 % CI: 51.1–51.3) and 3.87 (95 % CI: 3.84–3.90) cases/1,000 PY, respectively). SSTI complications such as myositis, gangrene, and sepsis occurred in 0.93 % (95 % CI: 0.92–0.94 %) and 16.92 % (95 % CI: 16.87–16.97 %) of ambulatory-treated and inpatient-treated patients, respectively. SSTI incidence was approximately twice that of UTIs and tenfold of that of pneumonia. Among our large, diverse population of persons less than 65 years, SSTI incidence 2005 through 2010 has remained relatively constant at approximately 4.8 SSTIs per 100 person years, suggesting that previously observed increases in SSTI incidence remain sustained.

Background: Dental caries is the most common chronic childhood infectious disease and is a serious public health problem affecting both developing and industrialized countries, yet it is preventable in most cases. This study evaluated the potential of screening for dental caries among children using a machine learning algorithm applied to parent perceptions of their child’s oral health assessed by survey. Methods: The sample consisted of 182 parents/caregivers and their children 2–7 years of age living in Los Angeles County. Random forest (a machine learning algorithm) was used to identify survey items that were predictors of active caries and caries experience. We applied a three-fold cross-validation method. A threshold was determined by maximizing the sum of sensitivity and specificity conditional on the sensitivity of at least 70%. The importance of survey items to classifying active caries and caries experience was measured using mean decreased Gini (MDG) and mean decreased accuracy (MDA) coefficients. Results: Survey items that were strong predictors of active caries included parent’s age (MDG = 0.84; MDA = 1.97), unmet needs (MDG = 0.71; MDA = 2.06) and the child being African American (MDG = 0.38; MDA = 1.92). Survey items that were strong predictors of caries experience included parent’s age (MDG = 2.97; MDA = 4.74), child had an oral health problem in the past 12 months (MDG = 2.20; MDA = 4.04) and child had a tooth that hurt (MDG = 1.65; MDA = 3.84). Conclusion: Our findings demonstrate the potential of screening for active caries and caries experience among children using surveys answered by their parents.

Background: Stress is a known causative factor in modulating cognitive health, which overall well-being and quality of life are dependent on. Long-term stress has been shown to disrupt the balance of the hypothalamic–pituitary–adrenal (HPA) axis. Adaptogens, such as Withania somnifera (ashwagandha), are commonly used in Ayurvedic medicine for stress relief and ameliorating HPA-axis dysfunction. The aim of this study was to support the role of a root and leaf water-extracted ashwagandha extract (WS) in stress reduction by confirming the lowest clinically validated dose for stress management (125 mg/day) in a dose-dependent clinical study in adults with self-reported high stress. Methods: An 8-week, randomized, double-blinded, placebo-controlled study to compare the effects of three different WS extract doses (125, 250 and 500 mg) was performed. A total of 131 adults were enrolled, and 98 were included in the final analysis. Attenuation of chronic stress was measured using the 14-item Perceived Stress Scale (PSS) and biochemical-related stress parameters. Results: We have shown that aqueous WS extract (roots and leaves) safely reduces mild to moderate chronic stress at doses of 125 mg, 250 mg, and 500 mg/day for 8 weeks. Conclusions: Our findings demonstrate the stress-reduction capabilities of this well-characterized aqueous extract of WS (root and leaf) at the low dose of 125 mg/day, in a dose-dependent manner, via the modulation of the HPA axis. Trial registration: This study was registered with the Clinical Trials Registry—India (CTRI) with the registration number: CTRI/2019/11/022100.

Objectives: Evaluating children’s oral health status and treatment needs is challenging. We aim to build oral health assessment toolkits to predict Children’s Oral Health Status Index (COHSI) score and referral for treatment needs (RFTN) of oral health. Parent and Child toolkits consist of short-form survey items (12 for children and 8 for parents) with and without children’s demographic information (7 questions) to predict the child’s oral health status and need for treatment. Methods: Data were collected from 12 dental practices in Los Angeles County from 2015 to 2016. We predicted COHSI score and RFTN using random Bootstrap samples with manually introduced Gaussian noise together with machine learning algorithms, such as Extreme Gradient Boosting and Naive Bayesian algorithms (using R). The toolkits predicted the probability of treatment needs and the COHSI score with percentile (ranking). The performance of the toolkits was evaluated internally and externally by residual mean square error (RMSE), correlation, sensitivity and specificity. Results: The toolkits were developed based on survey responses from 545 families with children aged 2 to 17 y. The sensitivity and specificity for predicting RFTN were 93% and 49% respectively with the external data. The correlation(s) between predicted and clinically determined COHSI was 0.88 (and 0.91 for its percentile). The RMSEs of the COHSI toolkit were 4.2 for COHSI (and 1.3 for its percentile). Conclusions: Survey responses from children and their parents/guardians are predictive for clinical outcomes. The toolkits can be used by oral health programs at baseline among school populations. The toolkits can also be used to quantify differences between pre- and post-dental care program implementation. The toolkits’ predicted oral health scores can be used to stratify samples in oral health research. Knowledge Transfer Statement: This study creates the oral health toolkits that combine self- and proxy- reported short forms with children’s demographic characteristics to predict children’s oral health and treatment needs using Machine Learning algorithms. The toolkits can be used by oral health programs at baseline among school populations to quantify differences between pre and post dental care program implementation. The toolkits can also be used to stratify samples according to the treatment needs and oral health status.

HIV testing continues to be a challenge among the young population in Tanzania. As of 2017, only 30% of 15–19-year-olds reported getting tested and receiving their results. This study will examine the demographic and socio-behavioral characteristics associated with HIV testing among adolescents and young adults in Tanzania. Interview data from the 2016–2017 Tanzania HIV Impact Survey (THIS) were analyzed on 10,128 adolescents and young adults 15–24 years of age, representing 10.5 million youth in Tanzania. Weighted logistic regression was used to model the relationship of HIV testing with demographic and socio-behavioral characteristics. Half (50%) of respondents reported ever having been tested for HIV. HIV testing was significantly lower among males compared with females (AOR = 0.5;95% confidence interval [CI] = 0.5–0.6; p<0.001), 15–19 year olds compared with 20–24 year olds (AOR = 0.4;95% CI = 0.4–0.5; p<0.001), no education compared with secondary or post-secondary education (AOR = 0.4;95% CI = 0.3–0.6; p<0.001), rural residents compared with urban residents (AOR = 0.7;95% CI = 0.6–0.9; p<0.001) and those who don’t use condoms during sexual intercourse compared with those who do (AOR = 0.6;95% CI = 0.5–0.8; p<0.001). Among HIV-infected youth, younger age group, rural residents, education less than primary, single, high income, and sex workers were significantly associated with never testing for HIV. This study highlights the majority of characteristics affecting HIV testing among young people in Tanzania have not changed over the years, thus it is necessary to re-examine the current approaches to HIV testing. The COVID-19 pandemic will add to this challenge as it collides with the ongoing HIV epidemic and competes for needed medical supplies and health care provider resources. In light of this current situation, intensified and targeted HIV testing programs for at risk young populations in Tanzania should be prioritized.

Co-encapsulated antiretrovirals (ARVs) with ingestible sensor (IS) has the capacity to monitor adherence in real-time using a sensor patch, a mobile device, and supporting software. We evaluated the acceptability, effectiveness, and sustainability of the IS system with real-time text reminders. Participants were recruited from HIV clinics in Los Angeles and were randomised 1:1 to IS or usual care (UC) group. Adherence to ARVs (primary outcome) was measured by IS system (IS group only), plasma ARV concentration, and self-report. IS-measured adherence was clustered by group-based trajectory model and was validated by ARV concentration summarized by integrated pharmacokinetic adherence measure (IPAM) score. HIV RNA viral load (VL) was compared between IS and UC group. A total of 112 (IS = 54, UC = 58) participants who completed baseline with at least one follow-up data collection were included in analyses. Overall satisfaction rate for the IS system was >90%. The IPAM score was higher (0.018, 95% CI: −0.098–0.134, p = 0.75) and VL decayed faster (−0.020, 95% CI: −0.042–0.002, p = 0.08) in the IS group compared with the UC group. The ingestible sensor system was well tolerated by study participants. The IS system was well accepted by participants and its use was associated with improved adherence and lower HIV RNA VL. The findings provide a potentially effective strategy for improving adherence. This work was supported by grant R01-MH110056 from the National Institute of Mental Health (NIMH)/ 10.13039/100000002 National Institutes of Health (NIH). Y. Wang was in part supported by the NIMH/NIH award T32MH080634. E. Daar was in part supported by the National Center for Advancing Translational Sciences through 10.13039/100007185 UCLA 10.13039/100006975 CTSI Grant UL1TR001881. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.