Changes in Medicare Reimbursement for Common Gastroenterology Services Over 15 Years: 2007-2022.

INTRODUCTION: We evaluated trends in Medicare reimbursement for common gastrointestinal (GI) services from 2007 to 2022. METHODS: Top GI procedures and office/inpatient visits were identified. The Physician Fee Schedule Look-Up Tool from Centers for Medicare & Medicaid Services was queried to extract reimbursement data. Reimbursement trends were analyzed, accounting for inflation. RESULTS: GI procedures exhibited an average decrease in unadjusted and adjusted reimbursement of 7.0% and 33.0%, respectively. Reimbursement for patient visits exhibited an inflation-adjusted decrease of 4.9%. DISCUSSION: The analysis revealed a steady decline in adjusted reimbursement for both GI procedures and patient visits in the past 15 years.

Methyl Internal Rotation in Fruit Esters: Chain-Length Effect Observed in the Microwave Spectrum of Methyl Hexanoate.

The gas-phase structures of the fruit ester methyl hexanoate, CH3-O-(C=O)-C5H11, have been determined using a combination of molecular jet Fourier-transform microwave spectroscopy and quantum chemistry. The microwave spectrum was measured in the frequency range of 3 to 23 GHz. Two conformers were assigned, one with Cs symmetry and the other with C1 symmetry where the γ-carbon atom of the hexyl chain is in a gauche orientation in relation to the carbonyl bond. Splittings of all rotational lines into doublets were observed due to internal rotation of the methoxy methyl group CH3-O, from which torsional barriers of 417 cm-1 and 415 cm-1, respectively, could be deduced. Rotational constants obtained from geometry optimizations at various levels of theory were compared to the experimental values, confirming the soft degree of freedom of the (C=O)-C bond observed for the C1 conformer of shorter methyl alkynoates like methyl butyrate and methyl valerate. Comparison of the barriers to methyl internal rotation of methyl hexanoate to those of other CH3-O-(C=O)-R molecules leads to the conclusion that though the barrier height is relatively constant at about 420 cm-1, it decreases in molecules with longer R.

Perovskite Photocatalytic CO2 Reduction or Photoredox Organic Transformation?

Metal-halide perovskites have been explored as photocatalysts for CO2 reduction. We report that perovskite photocatalytic CO2 reduction in organic solvents is likely problematic. Instead, the detected products (i.e., CO) likely result from a photoredox organic transformation involving the solvent. Our observations have been validated using isotopic labeling experiments, band energy analysis, and new control experiments. We designed a typical perovskite photocatalytic setup in organic solvents that led to CO production of up to ≈1000 µmol g-1 h-1 . CO2 reduction in organic solvents must be studied with extra care because photoredox organic transformations can produce orders of magnitude higher rate of CO or CH4 than is typical for CO2 reduction routes. Though CO2 reduction is not likely to occur, in situ CO generation is extremely fast. Hence a suitable system can be established for challenging organic reactions that use CO as a feedstock but exploit the solvent as a CO surrogate.

Multi-Sensor Data Fusion in A Real-Time Support System for On-Duty Firefighters.

While working on fire ground, firefighters risk their well-being in a state where any incident might cause not only injuries, but also fatality. They may be incapacitated by unpredicted falls due to floor cracks, holes, structure failure, gas explosion, exposure to toxic gases, or being stuck in narrow path, etc. Having acknowledged this need, in this study, we focus on developing an efficient portable system to detect firefighter's falls, loss of physical performance, and alert high CO level by using a microcontroller carried by a firefighter with data fusion from a 3-DOF (degrees of freedom) accelerometer, 3-DOF gyroscope, 3-DOF magnetometer, barometer, and a MQ7 sensor using our proposed fall detection, loss of physical performance detection, and CO monitoring algorithms. By the combination of five sensors and highly efficient data fusion algorithms to observe the fall event, loss of physical performance, and detect high CO level, we can distinguish among falling, loss of physical performance, and the other on-duty activities (ODAs) such as standing, walking, running, jogging, crawling, climbing up/down stairs, and moving up/down in elevators. Signals from these sensors are sent to the microcontroller to detect fall, loss of physical performance, and alert high CO level. The proposed algorithms can achieve 100% of accuracy, specificity, and sensitivity in our experimental datasets and 97.96%, 100%, and 95.89% in public datasets in distinguishing between falls and ODAs activities, respectively. Furthermore, the proposed algorithm perfectly distinguishes between loss of physical performance and up/down movement in the elevator based on barometric data fusion. If a firefighter is unconscious following the fall or loss of physical performance, an alert message will be sent to their incident commander (IC) via the nRF224L01 module.

Highly Accurate Step Counting at Various Walking States Using Low-Cost Inertial Measurement Unit Support Indoor Positioning System.

Accurate step counting is essential for indoor positioning, health monitoring systems, and other indoor positioning services. There are several publications and commercial applications in step counting. Nevertheless, over-counting, under-counting, and false walking problems are still encountered in these methods. In this paper, we propose to develop a highly accurate step counting method to solve these limitations by proposing four features: Minimal peak distance, minimal peak prominence, dynamic thresholding, and vibration elimination, and these features are adaptive with the user's states. Our proposed features are combined with periodicity and similarity features to solve false walking problem. The proposed method shows a significant improvement of 99.42% and 96.47% of the average of accuracy in free walking and false walking problems, respectively, on our datasets. Furthermore, our proposed method also achieves the average accuracy of 97.04% on public datasets and better accuracy in comparison with three commercial step counting applications: Pedometer and Weight Loss Coach installed on Lenovo P780, Health apps in iPhone 5s (iOS 10.3.3), and S-health in Samsung Galaxy S5 (Android 6.01).

Naloxone Online Information Exceeds the Recommended Reading Level for Patient Education Materials.

OBJECTIVE: The opioid epidemic claimed 68,630 lives in 2020 in the United States. It reached record levels during the COVID-19 pandemic. Public comprehension of naloxone, the reversal agent for opioid overdoses, is necessary for its broad uptake and the prevention of opioid-related deaths. This study assesses whether online patient education materials for naloxone meet national readability guidelines. It further compares the readability of naloxone materials to that of cardiopulmonary resuscitation (CPR) materials, given that the latter is an established and widespread life-saving procedure. METHOD: We searched Google in March 2022 for three terms: "naloxone," "Narcan," and "CPR." The top 15 websites for each term were retrieved, processed, and inputted into a readability calculator to generate six validated reading scale scores. Statistical analyses were performed to compare the readability of naloxone/Narcan online information against national standards and the readability of CPR online information. RESULTS: The average readability of naloxone/Narcan websites was grade 11.2 ± 2.3, and none of the websites met the recommended sixth-grade reading level for patient education materials. In comparison, the average readability of CPR websites was 7.8 ± 1.5. Of the naloxone/Narcan websites, only 17% (4/24) had a readability at or below the eighth-grade level, the average reading level of U.S. adults. In comparison, 80% (12/15) of the CPR websites had a readability at or below the eighth-grade level. CONCLUSIONS: Naloxone online information exceeds the recommended reading level and that of CPR materials. Online information about naloxone should be simplified to broaden educational access to this life-saving medication.

Concordance and Discordance Between Patient-reported Remission, Patient-reported Outcomes, and Physician Global Assessment.

BACKGROUND: Although validated patient-reported outcome (PRO) measurements can categorize patients with inflammatory bowel disease (IBD) into clinical remission or active disease, patients may have different definitions of remission. The purpose of this study was to compare patient-defined remission to remission based on PRO measures and physician global assessment (PGA) and to understand the clinical and demographic factors associated with disagreements. METHODS: We retrospectively analyzed 3257 de-identified surveys from 2004 IBD patients who consented to participate in the Crohn's and Colitis Foundation's IBD Qorus Learning Health System between September 2019 and February 2021. We used logistic regression models with generalized estimating equations to analyze the clinical and demographic factors (eg, age, disease duration, health confidence) associated with discordance between patient-defined remission (yes/no) and PRO-defined remission for ulcerative colitis (UC; PRO2: stool frequency, rectal bleeding) and Crohn's disease (CD; PRO-3: average number of liquid stools, abdominal pain, well-being). RESULTS: Among patients with UC, overall concordance was 79% between patient self-report and PRO2-defined remission and 49% between patient self-report and PGA-defined remission. Among patients with CD, overall concordance was 69% between patient self-report and PRO3-defined remission and 54% between patient self-report and PGA-defined remission. Patients in PRO-defined remission were more likely to report active disease if they had IBD <5 years and low health confidence. Patients with PRO-defined active disease were more likely to report remission if they were not using prednisone and had high health confidence. CONCLUSION: Discordance exists between how remission is defined by patients, PRO measures, and PGA.

Discordance between patients' self-reported remission and remission defined based on patient-reported outcomes was observed in 31% of Crohn's disease visits and 21% of ulcerative colitis visits. Disease duration and health confidence were associated with discordance.

Biliary fascioliasis - A rare differential diagnosis of biliary obstruction.

Fascioliasis is a zoonotic disease caused by Fasciola hepatica or F. gigantica. There are two phases of Fasciola infection. In the acute phase, the patient has a wide spectrum of clinical manifestations while the later phase of infection is usually related to inflammatory changes in the bile duct and the mechanical effects of the worm, which can lead to biliary obstruction. The presence of Fasciola inside the biliary system has rarely been reported in the literature. In this report, we presented a case of bile duct obstruction in a 36-year-old male patient undergoing cholecystectomy for gallstones and with a history of worsening jaundice for one month. Extensive laboratory testing failed to clarify the cause of jaundice. Three living liver flukes were subsequently retrieved from the right hepatic duct and later confirmed as F. gigantica by morphology and internal transcribed spacer (ITS2) sequence analysis.

Perforated Acute Appendicitis in a Six-Day-Old Neonate: A Rare Differential Diagnosis of Neonatal Peritonitis.

Acute appendicitis is a rare diagnosis of acute abdomen in neonates which is associated with high mortality due to late diagnosis. Here, we presented a case of acute neonatal appendicitis in a 6-year-old full-term infant with Down syndrome and pulmonary atresia with ventricular septal defect. The patient underwent surgery and postoperative critical care. However, he died on postoperative day 5 due to worsening sepsis and decompensated hemodynamic instability.

Hepatectomy with Takasaki's Technique Using SonaStar Ultrasonic Aspiration System: An Experience from 58 Cases.

OBJECTIVE: This study aims to explore the short-term results of hepatectomy with Takasaki's technique using Sonastar ultrasonic aspiration system. MATERIALS AND METHODS: We retrospectively examined data of 58 patients who underwent hepatectomy with Takasaki's technique using Sonastar ultrasonic aspiration system at Hue Central Hospital from 01/2018 to 02/2021. RESULTS: The mean age was 60.7 ± 10.5 years (25-80) and the male/female ratio was 6:1. Patients with solitary tumor accounted for 79%; 68.4% had tumor size greater than 5 cm. Pringle maneuver was used in 57.9%, while selective right or left Glissonean pedicle occlusion was used in 69.0% and 32.8%, respectively. Final transection surface reinforcement was achieved by Surgicel and BioGlue in 78.9% and 21.5% of cases, respectively. Major liver resection accounted for 73.7%. The mean parenchymal transection time was 50 (45-110) minutes, while mean total operative time was 125 (90-280) minutes. Mean operative blood loss was 250 (150-650) mL. Mean post-operative hospital stay was 8 days (7-23). Post-operative complication rate was 15.9% and mortality rate was 1.7%. CONCLUSION: Hepatectomy using Takasaki technique with Sonastar ultrasonic aspiration system is safe, effective, allowing an anatomical resection with sufficient safety margin and resulting in low complication rates (liver failure, biliary leakage) and good survival outcomes.

Adaptive Tuning Curve Widths Improve Sample Efficient Learning.

Natural brains perform miraculously well in learning new tasks from a small number of samples, whereas sample efficient learning is still a major open problem in the field of machine learning. Here, we raise the question, how the neural coding scheme affects sample efficiency, and make first progress on this question by proposing and analyzing a learning algorithm that uses a simple reinforce-type plasticity mechanism and does not require any gradients to learn low dimensional mappings. It harnesses three bio-plausible mechanisms, namely, population codes with bell shaped tuning curves, continous attractor mechanisms and probabilistic synapses, to achieve sample efficient learning. We show both theoretically and by simulations that population codes with broadly tuned neurons lead to high sample efficiency, whereas codes with sharply tuned neurons account for high final precision. Moreover, a dynamic adaptation of the tuning width during learning gives rise to both, high sample efficiency and high final precision. We prove a sample efficiency guarantee for our algorithm that lies within a logarithmic factor from the information theoretical optimum. Our simulations show that for low dimensional mappings, our learning algorithm achieves comparable sample efficiency to multi-layer perceptrons trained by gradient descent, although it does not use any gradients. Furthermore, it achieves competitive sample efficiency in low dimensional reinforcement learning tasks. From a machine learning perspective, these findings may inspire novel approaches to improve sample efficiency. From a neuroscience perspective, these findings suggest sample efficiency as a yet unstudied functional role of adaptive tuning curve width.

Predictive Factors of Inactive Patient Participation in an Inflammatory Bowel Disease Learning Health System: A Longitudinal Cohort Study.

Patient participation is crucial to learning health systems that leverage patient data to improve care practices. Age, history of anxiety or depression, and frequency of clinic visits were associated with inactive participation in an inflammatory bowel disease learning health system.

High cortisol and cortisone levels are associated with breast milk dioxin concentrations in Vietnamese women.

OBJECTIVE: Dioxin (polychlorinated dibenzodioxins+polychlorinated dibenzofurans) is one of the most toxic chemical substances known. Although it is suspected to cause endocrine disruption, very few epidemiological studies have been carried out on its effects on human steroid hormones. The aim of this study was to elucidate the association of dioxin exposure with steroid hormone levels in the saliva and serum of Vietnamese women. STUDY DESIGN: Two areas, namely Phu Cat (hot spot) and Kim Bang (nonexposed area), were selected for the study. The study subjects consisted of 51 and 58 women respectively. Saliva, blood, and breast milk samples were collected from the subjects in both the areas. METHODS: Cortisol, cortisone, DHEA, androstenedione, estrone, and estradiol levels in serum and saliva were determined by liquid chromatography-tandem mass spectrometry; dioxin concentrations in breast milk were measured by gas chromatography-mass spectrometry. RESULTS: Dioxin concentrations in the breast milk of women from the dioxin hot spot were three to four times higher than those in the breast milk of women from the nonexposed area. Good correlations were found between the levels of six steroid hormones in saliva and those in serum respectively. Salivary and serum cortisol and cortisone levels in women from the dioxin hot spot were significantly higher than those in women from the nonexposed area (P<0.001) and those in all the subjects were positively associated with dioxin concentrations in Vietnamese women (P<0.01). CONCLUSION: These results suggest that dioxin influences steroidogenesis in humans. Saliva samples can be used for hormone analysis and are therefore excellent specimens in epidemiological studies.