A 20-year Follow-up of the International Early Lung Cancer Action Program (I-ELCAP).

Background The low-dose CT (≤3 mGy) screening report of 1000 Early Lung Cancer Action Program (ELCAP) participants in 1999 led to the International ELCAP (I-ELCAP) collaboration, which enrolled 31 567 participants in annual low-dose CT screening between 1992 and 2005. In 2006, I-ELCAP investigators reported the 10-year lung cancer-specific survival of 80% for 484 participants diagnosed with a first primary lung cancer through annual screening, with a high frequency of clinical stage I lung cancer (85%). Purpose To update the cure rate by determining the 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening in the expanded I-ELCAP cohort. Materials and Methods For participants enrolled in the HIPAA-compliant prospective I-ELCAP cohort between 1992 and 2022 and observed until December 30, 2022, Kaplan-Meier survival analysis was used to determine the 10- and 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening. Eligible participants were aged at least 40 years and had current or former cigarette use or had never smoked but had been exposed to secondhand tobacco smoke. Results Among 89 404 I-ELCAP participants, 1257 (1.4%) were diagnosed with a first primary lung cancer (684 male, 573 female; median age, 66 years; IQR, 61-72), with a median smoking history of 43.0 pack-years (IQR, 29.0-60.0). Median follow-up duration was 105 months (IQR, 41-182). The frequency of clinical stage I at pretreatment CT was 81% (1017 of 1257). The 10-year lung cancer-specific survival of 1257 participants was 81% (95% CI: 79, 84) and the 20-year lung cancer-specific survival was 81% (95% CI: 78, 83), and it was 95% (95% CI: 91, 98) for 181 participants with pathologic T1aN0M0 lung cancer. Conclusion The 10-year lung cancer-specific survival of 80% reported in 2006 for I-ELCAP participants enrolled in annual low-dose CT screening and diagnosed with a first primary lung cancer has persisted, as shown by the updated 20-year lung cancer-specific survival for the expanded I-ELCAP cohort. © RSNA, 2023 See also the editorials by Grenier and by Sequist and Olazagasti in this issue.

Pathway complexity in fibre assembly: from liquid crystals to hyper-helical gelmorphs.

Pathway complexity results in unique materials from the same components according to the assembly conditions. Here a chiral acyl-semicarbazide gelator forms three different gels of contrasting fibre morphology (termed 'gelmorphs') as well as lyotropic liquid crystalline droplets depending on the assembly pathway. The gels have morphologies that are either hyperhelical (HH-Gel), tape-fibre (TF-Gel) or thin fibril derived from the liquid crystalline phase (LC-Gels) and exhibit very different rheological properties. The gelator exists as three slowly interconverting conformers in solution. All three gels are comprised of an unsymmetrical, intramolecular hydrogen bonded conformer. The kinetics show that formation of the remarkable HH-Gel is cooperative and is postulated to involve association of the growing fibril with a non-gelling conformer. This single molecule dynamic conformational library shows how very different materials with different morphology and hence very contrasting materials properties can arise from pathway complexity as a result of emergent interactions during the assembly process.

Understanding the Effects of Widowhood on Health in China: Mechanisms and Heterogeneity.

This paper analyzes the impact of widowhood on the health of mid-aged and older individuals in China using data from the China Health and Retirement Longitudinal Study (CHARLS) data. Our results show that widowhood significantly increases the risk of depression, chronic diseases, and body pain while reducing cognitive function, sleeping time, and daily activity functions. The effects on depression and daily functions are immediate, that on chronic diseases is lagged, and the effects on cognitive function and sleeping hours persist over time. We find that rural widows are particularly vulnerable to negative health outcomes due to their weaker economic positions, for whom widowhood leads to more grandchild care responsibility and corresponding workforce and social withdrawals. Moreover, rural widows' income loss is not compensated by children, either by co-residence or financial transfers, leading to reduced living standards. Overall, our findings suggest that China needs to strengthen economic security for older people, especially among rural women, in order to avoid significant negative consequences of widowhood.

Bayesian Methods in Human Drug and Biological Products Development in CDER and CBER.

The Center for Drug Evaluation and Research (CDER) and the Center for Biologics Evaluation and Research (CBER) of the U.S. Food and Drug Administration (FDA) have been leaders in protecting and promoting the U.S. public health by helping to ensure that safe and effective drugs and biological products are available in the United States for those who need them. The null hypothesis significance testing approach, along with other considerations, is typically used to demonstrate the effectiveness of a drug or biological product. The Bayesian framework presents an alternative approach to demonstrate the effectiveness of a treatment. This article discusses the Bayesian framework for drug and biological product development, highlights key settings in which Bayesian approaches may be appropriate, and provides recent examples of the use of Bayesian approaches within CDER and CBER.

The "Magic Linker": Highly Effective Gelation from Sterically Awkward Packing.

Bis(urea)s based on the 4,4'-methylenebis(2,6-diethylphenylene) (4,4'-MDEP) spacer are highly effective low molecular weight gelators, and the first single crystal structure of a bis(urea) based on this spacer is reported. The structure is a conformational isomorph with eight crystallographically independent molecules (Z' = 8) arranged in four tennis-ball type dimers with the 2,6-diethylphenylene units adopting five different conformations in the ratio 4:5:3:2:2. The awkward shape and conformational promiscuity arising from the orientations of the ethyl groups in this system is linked to its gelation behavior. A total of seven 4,4'-MDEP derivatives have been prepared, and six are versatile gelators, confirming the particularly effective nature of the MDEP spacer. Only the nitrophenyl derivative does not form gels, likely because of intramolecular CH···O hydrogen bonding arising from the electron-withdrawing nature of the nitro substituent and hence inhibition of the urea α-tape hydrogen-bonded motif.

Adult Children's Education and Older Parents' Chronic Illnesses in Aging China.

Although intergenerational transmission from parents to children has been widely studied, less is known about human capital spillover from children to parents. Utilizing nationally representative data on both doctor diagnosis and biomarkers, as well as exploiting variations in the implementation of China's Compulsory Education Law, we examine the effects of adult children's education on the prevalence of chronic cardiovascular illnesses among older parents in China and explore potential mechanisms. Instrumental variable estimates indicate that additional years of schooling among adult children decrease the prevalence of hypertension among older parents, whereas no evidence indicates a significant impact on the prevalence of diabetes among the same group. Sons and daughters differentially impact their mothers and fathers. Compared with fathers, mothers benefit more from adult children's education. Although no significant differences are observed in the effects of sons' and daughters' education in urban China, sons' education is more beneficial for parents' health in rural China. Further analyses show that financial support and health support (e.g., diagnosis and management of chronic illnesses and maintenance of health behaviors) are critical pathways for older parents to benefit from their adult children's education.

Single-electron spin resonance in a nanoelectronic device using a global field.

Spin-based silicon quantum electronic circuits offer a scalable platform for quantum computation, combining the manufacturability of semiconductor devices with the long coherence times afforded by spins in silicon. Advancing from current few-qubit devices to silicon quantum processors with upward of a million qubits, as required for fault-tolerant operation, presents several unique challenges, one of the most demanding being the ability to deliver microwave signals for large-scale qubit control. Here, we demonstrate a potential solution to this problem by using a three-dimensional dielectric resonator to broadcast a global microwave signal across a quantum nanoelectronic circuit. Critically, this technique uses only a single microwave source and is capable of delivering control signals to millions of qubits simultaneously. We show that the global field can be used to perform spin resonance of single electrons confined in a silicon double quantum dot device, establishing the feasibility of this approach for scalable spin qubit control.

The Citizenship Advantage in Psychological Well-being: An Examination of the Hukou System in China.

Given that Chinese migrants with rural hukou status are not considered full citizens in their urban destinations, rural-urban hukou conversion signifies full citizenship attainment in urban China. We assess causal effects of three major types of urban hukou attainment-merit-, policy-, and family-based hukou conversion-on migrants' psychological well-being in middle- and later-life. We further examine how hukou matters-how periods and hukou destinations alter the values of specific urban hukou and their psychological health implications for individuals. We use the China Health and Retirement Longitudinal Study (2015 data) and life history data (for 2014) for analysis. To assess the extent to which the salmon effect contributes to estimation bias for migrants, we compare results from a sample with current migrants and one with current and returned migrants. To address for selection into hukou conversion, we adopt inverse probability-weighted regression adjustment methods. We show that the salmon bias significantly dampened causal estimates. Merit- and policy-based hukou conversion has protective effects on psychological well-being. Policy-based converters have better psychological health than other types of converters. Hukou conversion in the pre-1978 period conveys greater psychological benefits than that in the post-1998 period, when economic and social values of urban hukou have decreased. Hukou converters in the cities with the most resources enjoy better psychological well-being than their counterparts in other cities. Our study joins the emerging literature in investigating how citizenship conveys advantage in health and well-being. We discuss these results in the global context as well as the context of China's decades of evolution of hukou policy and the urbanization process.

International differences in interspousal health correlations.

Using objective measures of lung function, we document strong positive associations in health within couples in all European countries but large and significant differences in this correlation within broad European regions, with Southern Europe having by far stronger correlations than elsewhere. We analyze potential explanations for such differences, investigating the role of measures capturing current and past health behaviors, early life circumstances of each spouse, and measures capturing assortative mating in multiple dimensions. We show that marital sorting patterns by dimensions of early life health and socioeconomic position, as well as by geographical subregion within countries, are key to understanding the empirical patterns observed.

Unbalanced sex ratios in Germany caused by World War II and their effect on fertility: A life cycle perspective.

This paper analyzes the effects of permanently unbalanced sex ratios in Germany caused by World War II on fertility outcomes over the life cycle. Using Census records linked with individual biography data, our analysis confirms the commonly found short-term pattern of decreased fertility rates due to a stark imbalance of the sex ratio. Yet, the long-term effects of such an imbalance crucially depend on when in the life cycle fertility is evaluated. We find that female cohorts with low sex ratios have fewer children at younger ages and a larger fraction remains childless. While childlessness remains higher throughout their life cycle, mothers from affected cohorts catch up and even overcompensate at later ages with respect to the number of children. Our preferred reading of this result is that with low sex ratios women select themselves into late motherhood according to their fertility preferences. This interpretation is consistent with the finding that women from affected cohorts expand their childbearing period and accept lower quality matches in the marriage market. Our findings have important implications for understanding the long-term consequences of large population shocks.

Early-life Deprivation and Health Outcomes in Adulthood: Evidence from Childhood Hunger Episodes of Middle-aged and Elderly Chinese.

This paper examines long-term health consequences of early-life food deprivation across late-life health indicators. Our analysis relies on retrospective data of hunger drawn from CHARLS - a nationally representative survey of residents ages 45 and over in Continental China. The survey accurately measured hunger episodes in childhood. Exposure to hunger early in life is found to increase the probability of being overweight, having difficulty with ADLs/IADLs and depression in old age. The adverse cognitive impacts of hunger are confined to women due to gender disparity in nutrition and educational opportunities. We find gender-specific interaction effect between hunger episodes and sibling sex composition.

Retirement Effect on Health Status and Health Behaviors in Urban China.

This paper analyzes the causal impact of retirement in China on Body Mass Index (BMI) and weight, which are a good gauge of the risk for some diseases. Many middle income developing countries are aging very rapidly and may have to adjust the retirement age to have financially feasible government budgets. It is important to know and understand any plausible health consequences of raising the retirement age in developing countries, and which sub-populations within these countries may be most affected. By using 2011, 2013 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS), our identification strategy uses variation in China's mandatory retirement age with a fuzzy discontinuity design to examine an exogenous shock to retirement behavior. Our study finds that retirement will increase weight and BMI among men. This effect is much larger for men with low education. The channel may be that men with low education drink more and take less vigorous exercises after they get retired. Retirement does not affect weight and BMI for women. These effects are robust with different definitions of retirement, narrow retirement bandwidth for samples as well as dropping samples with rural Hukou.

Supplemental income program design: A cluster-randomized controlled trial to examine the health and wellbeing effects on older adults by gender, duration, and payment frequency.

BACKGROUND: We documented results from a cluster-randomized controlled trial we designed to supplement incomes in poor towns among adults 70 or older. We analyzed effects on health by gender, persistence over time, and variation by payment frequency. METHODS: We compared supplemental income effects over an 18-month period for two towns in Yucatan, Mexico: Valladolid, where eligible individuals received a monthly income supplement over the entire analysis period, and Motul, a demographically matched control town, where eligible individuals received a bimonthly income supplement over the last 12 months of the analysis period. While differing in frequency of payment, supplements provided similar levels of income. We conducted three surveys of recipients: (1) at baseline, (2) six months after baseline, and (3) 18 months after baseline. RESULTS: The primary outcomes we examined were peak expiratory flow, hemoglobin level, and verbal recall. The secondary outcomes were health care use and food availability. We found health benefits persisted for at least eighteen months for the monthly income supplement, with both males and females benefiting. Bimonthly income supplements had smaller health benefits. CONCLUSIONS: Older people in the developing world who lack social security benefits and health care may benefit most from monthly income programs. The greater payment frequency of monthly programs may influence how household resources are allocated. Supplemental income programs are common in low- and middle-income countries; hence, our results have implications for program design in many nations.

Free GP care and psychological health: Quasi-experimental evidence from Ireland.

There is considerable ambiguity in the literature on the effect of health insurance on health. While the majority of previous analyses have examined physical health outcomes, analyses of the broader dimensions of health such as psychological health and wellbeing have been less frequent. Using data from the Irish Longitudinal Study on Ageing (TILDA) and a difference-in-differences research design, we examine the impact of free general practitioner (GP) care on psychological health among the older population and explore potential mechanisms. While we find no impact of public health insurance expansions on quality of life, life satisfaction, depression, and worry, the removal of GP fees for all those 70+ leads to a significantly lower level of perceived stress. The impact is mainly driven by poorer, sicker and single individuals. Further analyses show that removing GP fees leads to greater access to GP services and lower levels of financial stress.

The Long-Term Economic Impact of Criminalization in American Childhoods.

This article documents arrest and conviction histories before age 26 years of Panel Study of Income Dynamics (PSID) respondents using a retrospective module that I designed. I find strong positive cohort effects in rising probabilities of arrest for all demographic subgroups. This increased contact with the criminal justice system across birth cohorts was at a more rapid rate over time among Whites and women. These rising rates of arrests and convictions are associated with lower probabilities of being married, lower weeks worked, lower hourly wages, and lower family incomes during the adult years. The size of the estimated associations is quite large.

Hukou system, mechanisms, and health stratification across the life course in rural and urban China.

The literature on rural-urban health disparities have mostly focused on de facto rural/urban differences, and its intersections with de jure rural-urban divide are less understood. This research provides a comprehensive investigation of how the intersection of rural\urban residence and rural\urban household registration (hukou) status is associated with a range of health outcomes in later life. We investigate major mechanisms in accounting for these health disparities across the life span. Results show that rural hukouers in rural areas were exposed to highest level of hardships and adversities throughout life and are disadvantaged in a variety of health measures. In urban areas, those who have obtained urban hukou are better off than rural hukouers in psychological well-being but have higher risks of diabetes. These differences are mainly explained by disparities in socioeconomic status between the two groups. We discuss these results in a life course perspective and in the context of China's unique social, economic, and political settings.

The value of education to health: Evidence from Ireland.

Does education have a causal impact on health? The existing literature presents mixed results. More evidence is required from contexts that have not been explored in the literature, and using clinically-measured health outcomes. Using data from the Irish Longitudinal Study on Ageing (TILDA), and exploiting a policy change in the 1960s that eliminated public secondary school fees, we investigate whether additional years of schooling for those with lower socio-economic status (SES) have a causal effect on the prevalence of cardiovascular disease in later life. We find significant sizable effects of education on the prevalence of both hypertension and diabetes. An additional year of schooling decreases the probability of having hypertension by approximately 3% points, and decreases the probability of having diabetes by approximately 1% point, effects that are large given existing prevalence. Further analysis of possible mechanisms shows that additional schooling increases the probability of engaging in high levels of physical activity and refraining from smoking. In the context of an increasing focus on strategies to prevent chronic disease, evidence such as this provides important insights for policymakers tasked with designing public health interventions targeting risk factors for chronic disease.

What they say and what they do: comparing physical activity across the USA, England and the Netherlands.

BACKGROUND: Physical activity (PA) is important for maintaining health, but there are fundamental unanswered questions on how best it should be measured. METHODS: We measured PA in the Netherlands (n=748), the USA (n=540) and England (n=254), both by a 7 day wrist-worn accelerometer and by self-reports. The self-reports included a global self-report on PA and a report on the frequency of vigorous, moderate and mild activity. RESULTS: The self-reported data showed only minor differences across countries and across groups within countries (such as different age groups or working vs non-working respondents). The accelerometer data, however, showed large differences; the Dutch and English appeared to be much more physically active than Americans h (For instance, among respondents aged 50 years or older 38% of Americans are in the lowest activity quintile of the Dutch distribution). In addition, accelerometer data showed a sharp decline of PA with age, while no such pattern was observed in self-reports. The differences between objective measures and self-reports occurred for both types of self-reports. CONCLUSION: It is clear that self-reports and objective measures tell vastly different stories, suggesting that across countries people use different response scales when answering questions about how physically active they are.