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Eating disorders are characterized by significant disturbances in eating patterns associated with negative attitudes toward one's body, weight, and shape. They are associated with an increased risk of mortality and morbidity as well as significant health, economic, and psychosocial burdens. Additionally, individuals with eating disorders often hesitate to seek treatment and symptoms may be difficult to ascertain without structured assessment. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders aims to enhance knowledge and increase the appropriate use of interventions for eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with eating disorders. This practice assessment activity can also be used in fulfillment of Continuing Medical Education and ABPN Continuing Certification, Improvement in Medical Practice.
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Previous studies have shown contradictory results regarding the association between vegetable and fruit consumption and the risk of sarcopenia. We aimed to evaluate this association using a meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, EMBASE, and the Cochrane Library through July 2023 using related keywords. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated based on the random-effects model. We included 14 observational studies with 11 cross-sectional and three cohort studies involving 6436 sarcopenias among 33,801 participants. Vegetable and fruit consumption were significantly associated with reduced sarcopenia risk (OR, 0.61; 95% CI, 0.48 to 0.79; I2 = 59.8%). The association was significant in cross-sectional studies (OR, 0.64; 95% CI, 0.49 to 0.84; I2 = 56.3%; n = 11) but not in cohort studies (OR, 0.50; 95% CI, 0.22 to 1.11; I2 = 76.4%; n = 3). Moreover, the association was significant in age ≥60 (OR, 0.64; 95% CI, 0.49 to 0.83; I2 = 58.0%; n = 10). This meta-analysis suggests that eating vegetables and fruit reduces sarcopenia risk. However, as cohort studies provide a higher level of evidence than case-control studies, further prospective cohort studies should be conducted.
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Dieta , Frutas , Sarcopenia , Verduras , Humanos , Sarcopenia/prevención & control , Masculino , Persona de Mediana Edad , Femenino , Anciano , Estudios Transversales , Factores de RiesgoRESUMEN
Background: Previous observational epidemiological studies such as case-control studies and cohort studies have reported inconsistent results regarding the associations between seafood intake and the risk of thyroid cancer. Materials and methods: We searched PubMed and EMBASE in August 2021 using keywords related to seafood intake and thyroid cancer. A pooled odds ratio (OR) or relative risk (RR) with its 95% confidence interval (CI) was calculated. Results: We included 17 observational studies with 13 case-control studies and 4 cohort studies, which included 4,309 thyroid cancer patients among 599,161 participants. In the random effects model meta-analysis of all 17 studies, we found that there was no significant association between seafood intake (highest vs. lowest intake) and the risk of thyroid cancer (OR or RR, 1.01; 95% CI: 0.86 to 1.19; I2=51.4%). Although the associations were not statistically significant, subgroup meta-analyses by study design showed opposite findings: seafood intake decreased the risk of thyroid cancer in case-control studies (OR or RR, 0.94; 95% CI: 0.74 to 1.19; I2=60.6%; n=13) but increased in cohort studies (OR or RR, 1.14; 95% CI: 0.97 to 1.35; I2=0.0%; n=4). Conclusion: The current meta-analysis of observational epidemiological studies found that that overall, there was no significant association between seafood intake and the risk of thyroid cancer. However, given that cohort studies give us a higher level of evidence than case-control studies, further prospective cohort studies are warranted to confirm the association between them.
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Neoplasias de la Tiroides , Humanos , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/etiología , Estudios de Cohortes , Estudios de Casos y Controles , Alimentos Marinos , Factores de RiesgoRESUMEN
Sarcopenia is a common disease defined as the loss of skeletal muscle mass, strength, and physical performance. Alcohol consumption is an uncertain risk factor for sarcopenia. Previous observational epidemiological studies have reported inconsistent results regarding the association between alcohol consumption and sarcopenia risk. This study aimed to investigate the association between alcohol consumption and sarcopenia. A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, and the Cochrane Library through April 2022 using keywords related to alcohol consumption and sarcopenia. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using a random effects model meta-analysis. The risk of bias of the studies was assessed using the Newcastle−Ottawa scale. Nineteen observational studies that reported 3826 sarcopenia patients among 422,870 participants were included in the qualitative analysis. Alcohol consumption was not significantly associated with sarcopenia risk (OR, 1.00; 95% CI, 0.83 to 1.20; I2 = 60.6%). Alcohol consumption resulted in a non-significant decrease in the risk of sarcopenia in men (OR, 0.70; 95% CI, 0.46 to 1.07; I2 = 0.0%) and in women (OR, 1.20; 95% CI, 0.63 to 2.30; I2 = 75.8%). The subgroup analyses by age and alcohol consumption were significantly associated with an increased the risk of sarcopenia in <65 years (OR, 2.62; 95% CI, 1.22 to 5.62; I2 = 100%). This meta-analysis of observational studies indicated that alcohol consumption was not significantly associated with sarcopenia risk. However, there are factors influencing the association between alcohol consumption and sarcopenia, such as smoking and dietary patterns. Additional study of these confounding factors is needed for the systematic analysis of the association of alcohol consumption with sarcopenia in future studies.
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Sarcopenia , Consumo de Bebidas Alcohólicas/efectos adversos , Femenino , Humanos , Masculino , Músculo Esquelético , Estudios Observacionales como Asunto , Oportunidad Relativa , Factores de Riesgo , Sarcopenia/epidemiología , Sarcopenia/etiologíaRESUMEN
Despite innovative advances in stent technology, restenosis remains a crucial issue for the clinical implantation of stents. Reactive oxygen species (ROS) are known to potentially accelerate re-endothelialization and lower the risk of restenosis by selectively controlling endothelial cells and smooth muscle cells. Recently, several studies have been conducted to develop biodegradable polymeric stents. As biodegradable polymers are not electrically conductive, double metallic layers are required to constitute a galvanic couple for ROS generation. Here, we report a new biodegradable hybrid material composed of a biodegradable polymer substrate and double anodic/cathodic metallic layers for enhancing re-endothelialization and suppressing restenosis. Pure Zn and Mg films (3 µm thick) were deposited onto poly-l-lactic acid (PLLA) substrates by DC magnetron sputtering, and a long-term immersion test using biodegradable hybrid materials was performed in phosphate-buffered solution (PBS) for 2 weeks. The concentrations of superoxide anions and hydrogen peroxide generated by the corrosion of biodegradable metallic films were monitored every 1 or 2 days. Both superoxide anions and hydrogen peroxide were seamlessly generated even after the complete consumption of the anodic Mg layer. It was confirmed that the superoxide anions and hydrogen peroxide were formed not only by the galvanic corrosion between the anode and cathode layers but also by the corrosion of a single Mg or Zn layer. The corrosion products of the Mg and Zn films in PBS were phosphate, oxide, or chloride of the biodegradable metals. Thus, it is concluded that ROS generation by the corrosion of PLLA-based hybrid materials can be sustained until the exhaustion of the cathode metal layer.
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Células Endoteliales , Peróxido de Hidrógeno , Materiales Biocompatibles , Corrosión , Ensayo de Materiales , Metales , Fosfatos , Polímeros , Especies Reactivas de Oxígeno , Stents , SuperóxidosRESUMEN
This work investigates the applicability of thermally treated calcium-rich minerals (CRMs), such as sepiolite (SPL), attapulgite (ATT), and dolomite (DLM) to hinder the nitrogen (N) and phosphorus (P) release from river sediments. A non-woven fabric mat (NWFM) or a sand layer were also capped as armor layers, i.e., placed over CRMs to investigate the capping impact on the N/P release. The capping efficiency was evaluated in a cylindrical reactor, consisting of CRMs, armor layers, sediments, and sampled water. We monitored N/P concentrations, dissolved oxygen (DO), oxidation reduction potential, pH, and electric conductivity in overlying water over 70 days. The DO concentrations in the uncapped and capped conditions were preserved for 30 days and 70 days (until the end of experiment duration), respectively. ATT showed higher efficiency for NH4-N and T-N than the other two materials, and the capping efficiency of NH4-N was measured as 96.4%, 93.7%, and 61.6% when capped with 2-cm sand layer, 1-cm sand layer, and NWFM layer, respectively. DLM showed a superior rejection capability of PO4-P to ATT and SPL, reported as 97.2% when capped with 2-cm sand armor. The content of weakly adsorbed-P was lower in the uncapped condition than in the capping condition. It can be concluded that ATT and DLM can be used as capping agents to deactivate N and P, respectively, to reduce water contamination from sediments of the eutrophic river.
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Arena , Contaminantes Químicos del Agua , Calcio , Sedimentos Geológicos/química , Minerales , Fósforo/química , Ríos , Agua , Contaminantes Químicos del Agua/análisisRESUMEN
Decellularization to produce bioscaffolds composed of the extracellular matrix (ECM) uses enzymatic, chemical and physical methods to remove antigens and cellular components from tissues. Effective decellularization methods depend on the characteristics of tissues, and in particular, tissues with dense, complex structure and abundant lipid content are difficult to completely decellularize. Our study enables future research on the development of methods and treatments for fabricating bioscaffolds via decellularization of complex and rigid skin tissues, which are not commonly considered for decellularization to date as their structural and functional characteristics could not be preserved after severe decellularization. In this study, decellularization of human dermal tissue was done by a combination of both chemical (0.05% trypsin-EDTA, 2% SDS and 1% Triton X-100) and physical methods (electroporation and sonication). After decellularization, the content of DNA remaining in the tissue was quantitatively confirmed, and the structural change of the tissue and the retention and distribution of ECM components were evaluated through histological and histochemical analysis, respectively. Conditions of the chemical pretreatment that increase the efficiency of physical stimulation as well as decellularization, and conditions for electroporation and sonication without the use of detergents, unlike the methods performed in previous studies, were established to enable the complete decellularization of the skin tissue. The combinatorial decellularization treatment formed micropores in the lipid bilayers of the skin tissues while removing all cell and cellular residues without affecting the ECM properties. Therefore, this procedure can be widely used to fabricate bioscaffolds by decellularizing biological tissues with dense and complex structures.
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Electrical stimulation is a well-known strategy for regulating cell behavior, both in pathological and physiological processes such as wound healing, tissue regeneration, and embryonic development. Electrotaxis is the directional migration of cells toward the cathode or anode when subjected to electrical stimulation. In this study, we investigated the conditions for enhanced directional migration of electrically stimulated adipose-derived stem cells (ADSCs) during prolonged culture, using a customized agar-salt electrotaxis chamber. Exposure of ADSCs to a 1200 µA electric current for 3 h, followed by cessation of stimulation for 6 h and resumed stimulation for a further 3 h, increased directional cell migration toward the anode without inducing cell death. Moreover, Golgi polarization maintained the direction of polarity parallel to the direction of cell movement. Herein, we demonstrated that a pulsed electric current is sufficient to trigger directional migration of ADSCs in long-term culture while maintaining cell viability.
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Tejido Adiposo/citología , Movimiento Celular , Células Madre/citología , Supervivencia Celular , Estimulación Eléctrica , Aparato de Golgi/metabolismo , HumanosRESUMEN
Despite the development of advanced tissue engineering substitutes, inflammation is still a significant problem that can arise from inflamed burn injuries, chronic wounds, or microbial diseases. Although topical wound dressing accelerates healing by minimizing or preventing the consequences of skin inflammation, there remains a need for the development of a novel substitute scaffold that can effectively eliminate immoderate inflammation and infection in the initial phase of the healing meachanism. In this study, an artificial skin substitute scaffold fabricated with asiaticoside (AS) and epsilon-poly-L-lysine (εPLL) was prepared. Upon the release of these bioactive compounds, they accelerate wound healing and inhibit any bacterial infection at the wound site. We determined whether AS and εPLL exhibit anti-inflammatory and bactericidal effects through different mechanisms. Collectively, the collagen-AS/εPLL artificial skin substitute could be a significant therapeutic agent for scar-less rapid wound healing (without infection and inflammation) of initially-inflamed full-thickness wounds.
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Lisina , Cicatrización de Heridas , Antiinflamatorios/farmacología , Colágeno , TriterpenosRESUMEN
A terminal sterilization process for tissue engineering products, such as allografts and biomaterials is necessary to ensure complete removal of pathogenic microorganisms such as the bacteria, fungi, and viruses. However, it can be difficult to sterilize allografts and artificial tissue models packaged in wet conditions without deformation. In this study, we investigated the sterilization effects of electrical stimulation (ES) and assessed its suitability by evaluating sterility assurance levels in pouches at a constant current. Stability of polyvinylidene fluoride pouches was determined by a sterility test performed after exposure to five microorganisms (Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans) for 5 days; the sterility test was also performed with decellularized human dermal tissues inoculated with the five microorganisms. Sterilization using ES inactivated microorganisms both inside and outside of sealed pouches and caused no damage to the packaged tissue. Our results support the development of a novel system that involves ES sterilization for packaging of implantable biomaterials and human derived materials.
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Polivinilos , Esterilización , Bacillus subtilis , Estimulación Eléctrica , HumanosRESUMEN
Herein, pyrolysis of cattle manure was conducted to synthesize an effective material for removing heavy metals (e.g., selenium) from water environments. To remove selenate from aqueous solution, iron-impregnated cattle manure biochar (Fe/CM-biochar) was synthesized. The Fe-impregnation was performed by pre-treating cattle manure before its pyrolysis. The pretreatment increased the biochar yield. Influence of various factors such as contacting time, initial selenate concentration, reaction temperature, pH, and presence of coexisting anions were explored by performing batch adsorption experiments. The selenate adsorption reached equilibrium within 15 min. The Langmuir model was better fitted to equilibrium adsorption data than the Freundlich model. The maximum adsorption capacity of Fe/CM-biochar was calculated to be 52.56 mg-Se/g, which is superior to other adsorbents reported in the literature. As the reaction temperature increased in the range (15-35) °C, selenate adsorption on Fe/CM-biochar showed an endothermic and nonspontaneous reaction. The enthalpy change during selenate adsorption was 18.44 kJ/mol, which ranges in physical adsorption. The increase of solution pH (3-11) reduced the selenate adsorption (46.4-37.7 mg-Se/g). The extent of co-existing anion impact on selenate adsorption followed an order of HPO42- > HCO3- > SO42- > NO3-. These results indicate that Fe/CM-biochar is an effective functional material for the removal of selenate from wastewater.
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Aguas Residuales , Contaminantes Químicos del Agua , Adsorción , Animales , Bovinos , Carbón Orgánico , Cinética , Estiércol , Ácido Selénico , Contaminantes Químicos del Agua/análisisRESUMEN
Reactive oxygen species (ROS) are byproducts of cellular metabolism; they play a significant role as secondary messengers in cell signaling. In cells, high concentrations of ROS induce apoptosis, senescence, and contact inhibition, while low concentrations of ROS result in angiogenesis, proliferation, and cytoskeleton remodeling. Thus, controlling ROS generation is an important factor in cell biology. We designed a chlorin e6 (Ce6)-immobilized polyethylene terephthalate (PET) film (Ce6-PET) to produce extracellular ROS under red-light irradiation. The application of Ce6-PET films can regulate the generation of ROS by altering the intensity of light-emitting diode sources. We confirmed that the Ce6-PET film could effectively promote cell growth under irradiation at 500 µW/cm2 for 30 min in human umbilical vein endothelial cells. We also found that the Ce6-PET film is more efficient in generating ROS than a Ce6-incorporated polyurethane film under the same conditions. Ce6-PET fabrication shows promise for improving the localized delivery of extracellular ROS and regulating ROS formation through the optimization of irradiation intensity.
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In this study, the use of eggshells was suggested as an adsorbent for fluoride removal, and their mechanism of fluoride removal was investigated. The eggshells underwent thermal treatment to improve their adsorption capacity; 800 °C was found to be the optimal temperature for treatment. Eggshells thermally treated at 800 °C (ES-800) were mainly composed of Ca (82.4%) and C (15.9%), and the peaks of ES-800 obtained from X-ray diffraction (XRD) corresponded to calcite, portlandite, and lime. Fluorine adsorption by ES-800 reached 70% of the equilibrium adsorption amount within 15 min and gradually increased until 24 h. The maximum adsorption capacity of ES-800 at pH 7 and 25 °C was 258.28 mg/g, which is 18 times larger than that of activated alumina; this is classified as the best available technology by the United States Environmental Protection Agency. Both enthalpy and entropy increased in the process of fluoride adsorption onto ES-800. Fluoride adsorption of ES-800 decreased from 59.16 to 11.85 mg/g with an increase in pH from 3 to 11. Fluoride adsorption decreased in the presence of anions, whose impact follows the order: HPO43- > HCO3- >> SO42- > Cl-. XRD, and X-ray photoelectron spectroscopy analysis revealed that fluoride removal was achieved by the formation of calcium fluorite (CaF2). Thus, it can be concluded that eggshells can function as highly efficient adsorbents for fluoride removal, replacing bone char and activated alumina; further, their adsorption capacity can be improved by thermal treatment.
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Contaminantes Químicos del Agua , Purificación del Agua , Adsorción , Animales , Cáscara de Huevo , Fluoruros , Concentración de Iones de Hidrógeno , CinéticaRESUMEN
Inflammation is a significant clinical problem that can arise from full-thickness wounds or burn injuries or microbial disease. Although topical wound healing substances could promote rapid wound healing by preventing or reducing the consequences of inflammation, there still remains a need for the development of novel substances that can effectively reduce infection and inflammation in initial wound healing phase. In this study, collagen was combined with asiaticoside (AS) and ε-poly-l-lysine (εPLL). This complex was then applied to in vitro models of infection and inflammation. Collagen-AS coatings inhibited the initial inflammatory response to LPS through a sustained release of AS, and a bilayer coating-εPLL showed a notable antimicrobial effect using microbial infection test. In this study, we determined whether asiaticoside and εPLL have anti-inflammatory and antibacterial effects through different mechanisms. Collectively, the collagen-AS/εPLL complex indicated great therapeutic potentials for accelerate wound healing and the complex may be considered as a artificial scaffold substitute product to full-thickness wound healing.
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Polilisina , Triterpenos , Colágeno , Polilisina/farmacología , Cicatrización de HeridasRESUMEN
We evaluated Mytilus coruscus shells (MCS) as an adsorbent for fluoride removal. Its removal efficiency was enhanced by thermal treatment and MCS at 800 °C (MCS-800) increased significantly its fluoride adsorption capacity from 0 to 12.28 mg/g. While raw MCS is mainly composed of calcium carbonate (CaCO3), MCS-800 consisted of 56.9% of CaCO3 and 43.1% of calcium hydroxide (Ca(OH)2). The superior adsorption capacity of MCS-800 compared to untreated MCS can be also explained by its larger specific surface area and less negative charge after the thermal treatment. X-ray photoelectron spectroscopy and X-ray diffraction analysis revealed that the fluoride adsorption of MCS-800 occurred via the formation of calcium fluorite (CaF2). Fluoride adsorption of MCS-800 approached equilibrium within 6 h and this kinetic adsorption was well-described by a pseudo-second-order model. The Langmuir model was suitable for describing the fluoride adsorption of MCS-800 under different initial concentrations. The maximum fluoride adsorption amount of MCS-800 was 82.93 mg/g, which was superior to those of other adsorbents derived from industrial byproducts. The enthalpy change of fluoride adsorption was 78.75 kJ/mol and the negative sign of free energy indicated that this phenomenon was spontaneous. The increase of pH from 3.0 to 11.0 slightly decreased the fluoride adsorption capacity of MCS-800. The adsorption was inhibited in the presence of anions and their impact increased with following trend: chloride < sulfate < carbonate < phosphate. The fluoride adsorption capacities of MCS-800 after washing with deionized water and 0.1 M NaOH were reduced by 31.5% and 57.4%, respectively.
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Mytilus , Contaminantes Químicos del Agua , Purificación del Agua , Adsorción , Animales , Fluoruros , Concentración de Iones de Hidrógeno , CinéticaRESUMEN
Bottom ash generated by the combustion of cattle manure (BA-CCM) was investigated as an adsorbent for the removal of heavy metals such as Cd(II), Cu(II), Pb(II), and Ni(II) from aqueous solutions. When cattle manure was used as fuel, the thermal efficiency of the boiler was 88.7%, and the CO and CO2 concentrations in the exhaust gas were 2.3 ppm and 12.1%, respectively. The percentage of remaining solids was 31 wt.% after combustion at 900 °C. X-ray fluorescence analyses showed that the elemental composition of the BA-CCM was mainly CaO (43.3%), SiO2 (15.8%), CO2 (13.0%), and P2O5 (10.3%). The kinetic adsorption of Cd(II), Cu(II), Pb(II), and Ni(II) by BA-CCM reached equilibrium after 12 h, and the pseudo-second-order model fitted the experimental data well. The maximum amount of Cd(II), Cu(II), Pb(II), and Ni(II) adsorbed by the bottom ash was 5.4, 72.6, 88.2, and 24.6 mg/g, respectively. The equilibrium adsorption of metals onto BA-CCM was well-described by the Freundlich model. Thermodynamic analysis showed that the adsorption onto the bottom ash was endothermic and that the Gibbs free energy decreased as the temperature increased. The presence of cations such as Na+, Ca2+, and Al3+ was found to reduce the amount of metals adsorbed onto the BA-CCM, and Cd(II) adsorption was found to be more dependent on ionic strength than adsorption of Cu(II), Pb(II), and Ni(II). This study demonstrates the feasibility of producing heat energy by burning cattle manure and removing heavy metals from aqueous solutions using the generated bottom ash as an adsorbent.
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Ceniza del Carbón , Metales Pesados , Adsorción , Animales , Cadmio , Bovinos , Concentración de Iones de Hidrógeno , Cinética , Plomo , Estiércol , Dióxido de SilicioRESUMEN
Biochar derived from food waste was modified with Fe to enhance its adsorption capacity for As(III), which is the most toxic form of As. The synthesis of Fe-impregnated food waste biochar (Fe-FWB) was optimized using response surface methodology (RSM), and the pyrolysis time (1.0, 2.5, and 4.0 h), temperature (300, 450, and 600 °C), and Fe concentration (0.1, 0.3, and 0.5 M) were set as independent variables. The pyrolysis temperature and Fe concentration significantly influenced the As(III) removal, but the effect of pyrolysis time was insignificant. The optimum conditions for the synthesis of Fe-FWB were 1 h and 300 °C with a 0.42-M Fe concentration. Both physical and chemical properties of the optimized Fe-FWB were studied. They were also used for kinetic, equilibrium, thermodynamic, pH, and competing anion studies. Kinetic adsorption experiments demonstrated that the pseudo-second-order model had a superior fit for As(III) adsorption than the pseudo-first-order model. The maximum adsorption capacity derived from the Langmuir model was 119.5 mg/g, which surpassed that of other adsorbents published in the literature. Maximum As(III) adsorption occurred at an elevated pH in the range from 3 to 11 owing to the presence of As(III) as H2AsO3- above a pH of 9.2. A slight reduction in As(III) adsorption was observed in the existence of bicarbonate, hydrogen phosphate, nitrate, and sulfate even at a high concentration of 10 mM. This study demonstrates that aqueous solutions can be treated using Fe-FWB, which is an affordable and readily available resource for As(III) removal.
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Eliminación de Residuos , Contaminantes Químicos del Agua , Adsorción , Carbón Orgánico , Alimentos , Concentración de Iones de Hidrógeno , Cinética , Contaminantes Químicos del Agua/análisisRESUMEN
Schizophrenia is associated with significant health, social, occupational, and economic burdens, including increased mortality. Despite extensive and robust research on the treatment of individuals with schizophrenia, many individuals with the illness do not currently receive evidence-based pharmacological and nonpharmacological treatments. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, aims to enhance knowledge and increase the appropriate use of interventions for schizophrenia, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with schizophrenia. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and Maintenance of Certification, part IV, requirements, which can also satisfy requirements for the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System program.
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(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).