Seeking a United Front

IN most parts of Africa today, you cannot communicate officially unless you address yourself in English, Arabic, Portuguese or French languages brought either by migrants from the Middle East or colonialists from the West.

Assessment of Wet Season Precipitation in the Central United States by the Regional Climate Simulation of the WRFG Member in NARCCAP and Its Relationship with Large-Scale Circulation Biases

Assessment of past-climate simulations of regional climate models(RCMs)is important for understanding the reliability of RCMs when used to project future regional climate.Here,we assess the performance and discuss possible causes of biases in a WRF-based RCM with a grid spacing of 50 km,named WRFG,from the North American Regional Climate Change Assessment Program(NARCCAP)in simulating wet season precipitation over the Central United States for a period when observational data are available.The RCM reproduces key features of the precipitation distribution characteristics during late spring to early summer,although it tends to underestimate the magnitude of precipitation.This dry bias is partially due to the model’s lack of skill in simulating nocturnal precipitation related to the lack of eastward propagating convective systems in the simulation.Inaccuracy in reproducing large-scale circulation and environmental conditions is another contributing factor.The too weak simulated pressure gradient between the Rocky Mountains and the Gulf of Mexico results in weaker southerly winds in between,leading to a reduction of warm moist air transport from the Gulf to the Central Great Plains.The simulated low-level horizontal convergence fields are less favorable for upward motion than in the NARR and hence,for the development of moist convection as well.Therefore,a careful examination of an RCM’s deficiencies and the identification of the source of errors are important when using the RCM to project precipitation changes in future climate scenarios.

Temporal Variability of Tropospheric NO_(2) over Cities in the United States,Western Europe and China from 2005 to 2022

Anthropogenic Nitrogen oxides(NO_(x)=NO_(2)+NO)emissions are highly concentrated in urban area,and the weekly cycles,seasonal patterns and long-term trends of tropospheric NO_(2) columns over cities differ from region to region due to different emission sectoral compositions and human activities.In this study,we used satellite observed tropospheric NO_(2) column data to compare the longand short-term NO_(2) column density time series over cities in the United Sates(the U.S.),western Europe and China.The results showed that in all the targeted cities,the outbreak of the Corona Virus Disease in 2019(COVID-19)moved the December peak of the city-level NO_(2)columns forward to November and October or even earlier in 2020 and 2021.On weekly level,cities in the U.S.show the lowest NO_(2) columns ratio on weekend/work day,then come the western European cities,and a weak weekly pattern is seen in Chinese cities.For all the cites,we find a higher weekend/work day NO_(2) ratio in cold seasons than in warm seasons,indicating a higher contribution from NOx emission sectors of residential,industry and power plants in the warm seasons.In the long-term,NO_(2) columns over the U.S.and western European cities declined by a fraction twice that of the regional mean level from 2004 to 2021.In China,NO_(2) columns started to decrease since 2012,at a similar rate between the city and regional level.This work confirms the importance to quantify and control NOx emissions from cities.

Geologic characteristics,exploration and production progress of shale oil and gas in the United States:An overview

We present a systematic summary of the geological characteristics,exploration and development history and current state of shale oil and gas in the United States.The hydrocarbon-rich shales in the major shale basins of the United States are mainly developed in six geological periods:Middle Ordovician,Middle-Late Devonian,Early Carboniferous(Middle-Late Mississippi),Early Permian,Late Jurassic,and Late Cretaceous(Cenomanian-Turonian).Depositional environments for these shales include intra-cratonic basins,foreland basins,and passive continental margins.Paleozoic hydrocarbon-rich shales are mainly developed in six basins,including the Appalachian Basin(Utica and Marcellus shales),Anadarko Basin(Woodford Shale),Williston Basin(Bakken Shale),Arkoma Basin(Fayetteville Shale),Fort Worth Basin(Barnett Shale),and the Wolfcamp and Leonardian Spraberry/Bone Springs shale plays of the Permian Basin.The Mesozoic hydrocarbon-rich shales are mainly developed on the margins of the Gulf of Mexico Basin(Haynesville and Eagle Ford)or in various Rocky Mountain basins(Niobrara Formation,mainly in the Denver and Powder River basins).The detailed analysis of shale plays reveals that the shales are different in facies and mineral components,and"shale reservoirs"are often not shale at all.The United States is abundant in shale oil and gas,with the in-place resources exceeding 0.246×10^(12)t and 290×10^(12)m^(3),respectively.Before the emergence of horizontal well hydraulic fracturing technology to kick off the"shale revolution",the United States had experienced two decades of exploration and production practices,as well as theory and technology development.In 2007-2023,shale oil and gas production in the United States increased from approximately 11.2×10^(4)tons of oil equivalent per day(toe/d)to over 300.0×10^(4)toe/d.In 2017,the shale oil and gas production exceeded the conventional oil and gas production in the country.In 2023,the contribution from shale plays to the total U.S.oil and gas production remained above 60%.The development of shale oil and gas has largely been driven by improvements in drilling and completion technologies,with much of the recent effort focused on“cube development”or“co-development”.Other efforts to improve productivity and efficiency include refracturing,enhanced oil recovery,and drilling of“U-shaped”wells.Given the significant resources base and continued technological improvements,shale oil and gas production will continue to contribute significant volumes to total U.S.hydrocarbon production.

Characteristics of patients with Wilson disease in the United States: An insurance claims database study

BACKGROUND Wilson disease(WD)is a progressive,potentially fatal degenerative disease affecting the liver and central nervous system.Given its low prevalence,collecting data on large cohorts of patients with WD is challenging.Comprehensive insur-ance claims databases provide powerful tools to collect retrospective data on large numbers of patients with rare diseases.AIM To describe patients with WD in the United States,their treatment and clinical outcome,using a large insurance claims database.METHODS This retrospective,longitudinal study was performed in the Clarivate Real-World Data Product database.All patients with≥2 claims associated with an Interna-tional Classification of Diseases 10(ICD-10)diagnostic code for WD(E83.01)between 2016 and 2021 were included and followed until death or study end.Patients were divided into two groups by whether or not they were documented to have received a specific treatment for WD.Clinical manifestations,hospital-isations,liver transplantation and death were documented.RESULTS Overall,5376 patients with an ICD-10 diagnostic code for WD were identified.The mean age at inclusion was 41.2 years and 52.0%were men.A specific WD treatment was documented for 885 patients(15.1%),although the number of patients taking zinc salts may be underestimated due to over the counter purchase.At inclusion,the mean age of patients with a documented treatment was 36.6±17.8 years vs 42.2±19.6 years in those without a documented treatment.During follow-up,273 patients(5.1%)died.Compared with the American general population,the standardised mortality ratio was 2.19.The proportion of patients with a documented WD-specific treatment who died during follow-up was 4.0%and the mean age at death 52.7 years.CONCLUSION Patients treated for WD in the United States had an excess early mortality compared with the American population.These findings indicate that there is a significant unmet need for effective treatment for WD in the United States.

Travel-Limiting Disabilities in the United States: Why Accessibility Matters?

This study evaluates the distribution of travel-limiting disabilities across genders and geographic locations in the United States. This study aims to describe and compare the socioeconomic and demographic variables of the people with and without travel-limiting disabilities across geographic locations and gender. The study further evaluates the trip purpose and impact of Covid-19 fourth wave pandemic on the use of public transit and travel to physical workplace for the people with and without travel-limiting disabilities across gender and geographic locations. The study uses the 2022 weighted National Household Travel Survey dataset and employs descriptive statistics. Results reaffirm the findings from previous literature that there are more people with travel-limiting disabilities in urban areas and among women. Over 50 percent of people aged 65 and above have a form of travel-limiting disabilities. The most trip for people with travel-limiting disabilities is made for shopping and medical purposes. Across all categories, rural areas, urban areas, male and female for the people without travel-limiting disabilities, COVID-19 fourth wave did not change the pattern of trips made to physical workplace as pre-COVID-19 era. This pattern is also observable for the people with travel-limiting disabilities in rural and urban areas. Females with travel-limiting disabilities reported making less trips to physical workplaces while male reported doing the same as before COVID-19 era. The study concludes that the quantification of travel-limiting disabilities across geographic location and gender is vital in disability study and could drive policy implementation for improved accessibility for the vulnerable population.

The Enforcement of Occupational Safety and Health Requirements in Public and Private Sectors in the Emirate of Abu Dhabi, the United Arab Emirates

Research Problem: In Abu Dhabi, limited implementation of OSH Regulations contributes to the general unawareness among employees and workers about occupational hazards and safety measures, resulting in slow responsiveness toward enforcement measures and a lack of self-regulatory approaches within companies. Purpose: The purpose of this study is to examine the implementation methods practised in Abu Dhabi with those in developed countries with established OSH regulatory bodies. Methodology: Qualitative and quantitative research methods were employed to gather primary research data. Workers from various industries in Abu Dhabi were sampled on purpose and asked to respond to questionnaires and interviews on OSH protocol awareness and implementation, and circumstances of workplace incidence. Results: The findings of this study showed that the enforcement of OSH requirements in UAE positively correlated to a reduction in the rate of work-related injury and improved business performance. The quantitative research data showed that the energy sector had the highest score (15) while the tourism sector had the lowest score (5.3) in occupational health systems and improvements in business efficiency and productivity. Implications: The outcomes of this study shed light on the importance of implementing OSH Guidelines for companies to empower their safety managers to fully enforce OSH requirements in their organisations. In conclusion, effective OSH enforcement requires cooperation between general workers and OSH managers and facilitation from business owners.

Maternal Mortality Rates among Im/Migrant Populations in the United States

Introduction: Maternal mortality rates have more than doubled in the U.S over the last two decades, making it one of the few places in the world where maternal mortality is increasing. Differences in maternal mortality among certain races and ethnicities are known but few studies examine maternal mortality among immigrants. Since immigrants represent 13.7% of the U.S. population, it is essential to examine immigrant subsets to understand maternal mortality among this vulnerable population. Methods: A literature search identified 318 articles on maternal mortality and immigrants, with 12 articles from the U.S. The keywords included maternal mortality, United States, migrants, asylum seekers, immigrants, and disparities. Maternal mortality statistics were obtained from the World Health Organization and Center for Disease Control. Results: Studies analyzed in this review found an overall lower maternal mortality rate among immigrant women compared to U.S.-born women, except for Hispanic immigrant women. Black women had the highest maternal mortality rate, regardless of immigration status. Conclusion: Although the literature points to lower maternal mortality among immigrants, the data is still somewhat mixed, making it challenging to draw comprehensive conclusions. Additional research examining maternal mortality among Im/migrants in the U.S. is needed to guide future training among healthcare professionals and policymakers.

Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States

BACKGROUND There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit(NICU)to the pediatric intensive care unit(PICU)without an interim discharge home.These infants are often medically complex and have higher mortality relative to NICU or PICUonly admissions.Given an absence of data surrounding practice patterns for nonemergent NICU to PICU transfers,we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.AIM To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers’evaluations of their effectiveness.METHODS A cross-sectional survey was drafted,piloted,and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children’s Hospital Association.The survey was administered via internet(REDCap).Analysis was performed using STATA,primarily consisting of descriptive statistics,though logistic regressions were run examining the relationship between specific transfer steps,hospital characteristics,and effectiveness of transfer.RESULTS One PICU attending from each of 81 institutions in the United States completed the survey(overall 70%response rate).Over half(52%)indicated their hospital transfers patients without using set clinical criteria,and only 33%indicated that their hospital has a standardized protocol to facilitate non-emergent transfer.Fewer than half of respondents reported that their institution’s nonemergent NICU to PICU transfer practices were effective for clinicians(47%)or patient families(38%).Respondents evaluated their centers’transfers as less effective when they lacked any transfer criteria(P=0.027)or set transfer protocols(P=0.007).Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.CONCLUSION Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers.More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.

Coping with the Impact of Climate Change: A Dive into Precision Agriculture in the United States

With the continued increase in the number of people that are food insecure globally, which could be increasing because of the ongoing Ukraine-Russia war, leading to reduction in international agribusinesses, coupled with drastic climate change exacerbating the problem of food insecurity, there is a constant need to come up with innovative approaches to solve this global issue. In this article, we articulated how precision agriculture can be a tool for ensuring food security in the United States. This study aims to reiterate the significance of precision agriculture in solving global food insecurity.

Comparison of the Evolution of Genetically Modified Food Safety Policies between the United States and the European Union

With the research on and development of Genetically Modified Food （GMF）, people＇s attitude toward GMF may fall into two divergent categories, typical- ly represented by the United States（US） and the European Union（EU）, respectively. The former follows a ＂sound science principle＂ and firmly objects to the precautionary principle, namely a permissive policy of positive support of and voluntary labelling on GMF; while the latter adopts a cautiously precautionary principle, requiring mandatory labelling and traceability. From the standpoint of regulatory principles, together with corresponding supervisory measures and relevant provisions, this paper compared the execution of directives and provisions on GMF from the initial policies enacted by the US and EU to current situation combined with the track and analysis of latest polic ies issued.

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot program.Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes.If proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients.AIM To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care.METHODS The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.RESULTS The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach.The coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient complexity.The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of care to be replicated.

Gamma-glutamyl transferase 5 overexpression in cerebrovascular endothelial cells improves brain pathology,cognition,and behavior in APP/PS1 mice

In patients with Alzheimer’s disease,gamma-glutamyl transferase 5(GGT5)expression has been observed to be downregulated in cerebrovascular endothelial cells.However,the functional role of GGT5 in the development of Alzheimer’s disease remains unclear.This study aimed to explore the effect of GGT5 on cognitive function and brain pathology in an APP/PS1 mouse model of Alzheimer’s disease,as well as the underlying mechanism.We observed a significant reduction in GGT5 expression in two in vitro models of Alzheimer’s disease(Aβ_(1-42)-treated hCMEC/D3 and bEnd.3 cells),as well as in the APP/PS1 mouse model.Additionally,injection of APP/PS1 mice with an adeno-associated virus encoding GGT5 enhanced hippocampal synaptic plasticity and mitigated cognitive deficits.Interestingly,increasing GGT5 expression in cerebrovascular endothelial cells reduced levels of both soluble and insoluble amyloid-βin the brains of APP/PS1 mice.This effect may be attributable to inhibition of the expression ofβ-site APP cleaving enzyme 1,which is mediated by nuclear factor-kappa B.Our findings demonstrate that GGT5 expression in cerebrovascular endothelial cells is inversely associated with Alzheimer’s disease pathogenesis,and that GGT5 upregulation mitigates cognitive deficits in APP/PS1 mice.These findings suggest that GGT5 expression in cerebrovascular endothelial cells is a potential therapeutic target and biomarker for Alzheimer’s disease.

Effect of external and internal cues on core muscle activation during the Sahrmann five-level core stability test

BACKGROUND Pain in the back or pelvis or fear of back pain may affect the timing or cocontraction of the core muscles.In both static and dynamic movements,the Sahrmann core stability test provides an assessment of core muscle activation and a person's ability to stabilize the lumbopelvic complex.Preparatory cues and images can be used to increase the activation of these muscles.To attain optimal movement patterns,it will be necessary to determine what cueing will give the most effective results for core stability.AIM To investigate the effects of external and internal cues on core muscle activation during the Sahrmann five-level core stability test.METHODS Total 68 participants(21.83±3.47 years)were randomly allocated to an external(n=35)or internal cue group(n=33).Participants performed the Sahrmann fivelevel core stability test without a cue as baseline and the five-level stability exercises with an internal or external cue.External cue group received a pressure biofeedback unit(PBU),and the internal cue group received an audio cue.A Delsys Trigno^(TM)surface electromyography unit was used for muscle activation from the rectus abdominis,external oblique,and transverse abdominis/internal oblique muscles.RESULTS Linear mixed effects model analysis showed that cueing had a significant effect on core muscle activation(P=0.001);however,there was no significant difference between cue types(internal or external)(P=0.130).CONCLUSION Both external and internal cueing have significant effects on core muscle activation during the Sahrmann five-level core stability test and the PBU does not create higher muscle activation than internal cueing.

A Comparative Study of the Value Orientations of Foreign Language Education Policies in China and the United States in the 21st Century

Since the 21 st century, both Chinese Mainland and the United States have formulated foreign language education policiesbased on their national needs. This paper makes a comparative study of the value orientations of foreign language education poli-cies in Chinese Mainland and the United States in the 21 st century and finds that both China and the United States have regardedtheir national interests as the essential value orientation of their foreign language education policies. To be specific,the core valueorientation of foreign language education policies in China is to enhance its cultural soft power.In contrast,the core value orienta-tion of foreign language education policies in the United States is to safeguard its national security. Through the comparison of thedifferent value orientations of foreign language education policies of the two countries, the paper provides some reference for the for-eign language education policy-making in Chinese Mainland.

The 2 ℃ Global Temperature Target and the Evolution of the Long-TermGoal of Addressing Climate Change-From the United Nations FrameworkConvention on Climate Change to the Paris Agreement

The Paris Agreement proposed to keep the increase in global average temperature to well below 2 ℃ abovepre-industrial levels and to pursue efforts to limit the temperature increase to 1.5 ℃ above pre-industriallevels. It was thus the first international treaty to endow the 2 ℃ global temperature target with legal effect.The qualitative expression of the ultimate objective in Article 2 of the United Nations Framework Conventionon Climate Change （UNFCCC） has now evolved into the numerical temperature rise target in Article 2 of theParis Agreement. Starting with the Second Assessment Report （SAR） of the Intergovernmental Panel on Cli-mate Change （IPCC）, an important task for subsequent assessments has been to provide scientific informa-tion to help determine the quantified long-term goal for UNFCCC negotiation. However, due to involvementin the value judgment within the scope of non-scientific assessment, the IPCC has never scientifically af-firmed the unacceptable extent of global temperature rise. The setting of the long-term goal for addressingclimate change has been a long process, and the 2 ℃ global temperature target is the political consensuson the basis of scientific assessment. This article analyzes the evolution of the long-term global goal foraddressing climate change and its impact on scientific assessment, negotiation processes, and global low-carbon development, from aspects of the origin of the target, the series of assessments carried out by the 1PCCfocusing on Article 2 of the UNFCCC, and the promotion of the global temperature goal at the political level.

Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: Evidence on health outcomes and antidiabetic treatment in United States adults

AIMTo examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Fileson prescribed medicines for patients with DM were used to test the research questions. χ 2, Poisson and Cox’s regression models were applied in data analysis.RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD= 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI:1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM,respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations,specifically for metformin use, show a protective effect against all-cause and CVD mortalities.

Pretreatment of Crude Oil by Ultrasonic-electric United Desalting and Dewatering

A technology of ultrasonic-electric united desalting and dewatering of crude oil is studied. The ultrasonic setup is designed to form a standing-wave field, which is more efficient for agglomeration of water particles. The desalting and dewatering results of the ultrasonic-electric united process are compared with those of the electric process. For high salt-contenting crude oil （40-70 mg·L ^-1）, the salt content is still above 10.0 mg·L^-1 after crude oil has been treated by two-stage electric desalting process in refinery, which cannot meet the need of refinery. Ultrasonic-electric united process is a novel technology for treating the high salt-contenting oil. On the optimal operating conditions of the ultrasonic-electric united process, the salt content of crude oil can be reduced from 67 5 mg·L^-1 to 3.97 mg·L ^-1 by one-stage ultrasonic-electric united process, and the water content falls below 0.3% （by volume）. The results show that the ultrasonic-electric united process is more effective than the electric process in high salt-contenting oil desalting. This technology should be useful in the refinery process.

Prevalence of anal fistula in the United Kingdom

BACKGROUND Anal fistula is a pathological connection between the anal canal and perianal skin, which most commonly develops from an infected anal crypt. While the majority of anal fistulas are idiopathic, they are also associated with Crohn’s disease (CD) and other inflammatory conditions. The prevalence of anal fistula is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated. AIM To assess the prevalence of anal fistula and relevant comorbidities, with and without CD in the United Kingdom and Europe. METHODS A retrospective population-representative observational cohort study was performed in The Health Improvement Network (THIN), a United Kingdom primary care database. Mid-year point prevalence of anal fistula was calculated on the first of July for each year between 2014 and 2017. Estimates were calculated for anal fistula overall and by CD status and standardized to the United Kingdom and European population. Prevalence of relevant comorbidities including lymphogranuloma venereum, hidradenitis suppurativa, anal presentation of sexually transmitted diseases, diabetes mellitus, and radiation in the pelvic area was reported. RESULTS The United Kingdom-standardized overall point prevalence of anal fistula was 1.80 (95%CI: 1.65-1.94) per 10000 patients in 2017, while the Europe standardized estimate was 1.83 (95%CI: 1.68-1.98) per 10000 patients. Both these standardized point prevalence estimates ranged from 1.89 to 2.36 between 2014-2016. The United Kingdom-standardized point prevalence of anal fistula without CD was 1.35 (95%CI: 1.23-1.48) per 10000 patients, while the Europe-standardized estimate was 1.39 (95%CI: 1.26-1.52) per 10000 patients. In contrast, the standardized point prevalence estimate of anal fistula with CD was lower for both United Kingdom and Europe (0.44;95%CI United Kingdom: 0.37-0.52, 95%CI Europe: 0.37-0.51) per 10000 patients in 2017. In 2017, 19% of anal fistula patients without CD and 13% of anal fistula patients with CD had at least one relevant comorbidity. These results show that anal fistulas are infrequent in the general population. 24.5% of prevalent anal fistulas are associated with CD, but other potentially etiological comorbidities are rare. CONCLUSION This real-world evidence study estimated the United Kingdom-standardized prevalence of anal fistula was 1.80 per 10000 patients in 2017. Approximately 25% of cases may be associated with CD, while other comorbidities are rare.

Dr. Ralph Coan: a hero in establishing acupuncture as a profession in the United States

1 Introduction Dr. Ralph Coan is not well known to the general public. Originally, we had wanted to interview him as he was the medical director of the first acupuncture center in the United States that opened in the early 1970s. We wanted to know more about that center＇s history. Prior to visiting Dr. Coan, we found an article written by Dr. Sherman Cohn that mentioned Dr. Coan. The article noted that Dr. Coan was the founder of the American Association of Acupuncture and Oriental Medicine, which is the national association of acupuncturists and Chinese medicine practitioners in the United States.