Assessment of progression of pulmonary fibrosis based on metabonomics and analysis of intestinal microbiota.

The main purpose of this study was to explore the changes of biomarkers in different developmental stages of bleomycin-induced pulmonary fibrosis (PF) in rats via comprehensive pathophysiology, UPLC-QTOF/MS metabonomic technology, and 16S rRNA gene sequencing of intestinal microbiota. The rats were randomly divided into normal control and 1-, 2- and 4-week model group. The rat model of PF was established by one-time intratracheal instillation of bleomycin. The levels of inflammatory and fibrosis-related factors such as hydroxyproline (HYP), type III procollagen (COL-III), type IV collagen (COL-IV), hyaluronidase (HA), laminin (LN), interleukin (IL)-1ß, IL-6, malondialdehyde (MDA) increased and superoxide dismutase (SOD) decreased as the PF cycle progressed. In the 1-, 2- and 4-week model group, 2, 19 and 18 potential metabolic biomarkers and 3, 16 and 12 potential microbial biomarkers were detected, respectively, which were significantly correlated. Glycerophospholipid metabolism pathway was observed to be an important pathway affecting PF at 1, 2 and 4 weeks; arginine and proline metabolism pathways significantly affected PF at 2 weeks. Linoleic acid metabolism pathway exhibited clear metabolic abnormalities at 2 and 4 weeks of PF, and alpha-linolenic acid metabolism pathway significantly affected PF at 4 weeks.

In this study, metabolomics technology and intestinal microbiota 16S rRNA gene sequencing were used to search for biomarkers with significant differences in each stage of pulmonary fibrosis. Finally, the variation characteristics of each stage of the disease were discussed. The hope is to provide new insights into the development of diagnostic biomarkers and potential therapeutic targets at all stages.

Assessment of occurrence, partitioning and ecological risk for 144 steroid hormones in Taihu Lake using UPLC-MS/MS with machine learning model.

Steroid hormones (SHs) have attracted mounting attention due to their endocrine-disrupting effects on humans and aquatic organisms. However, the lack of analytical methods and toxicity data for a large number of SHs has limited the effective management of SH contamination in the water-sediment systems. In this study, we developed a highly sensitive analytical method for the simultaneous quantification of 144 SHs to investigate their occurrence, spatial distribution and partitioning in the water and sediment in Taihu Lake. The results showed that the total concentrations of SHs in water and sediment were 366.88-998.23 ng/L (mean: 612.84 ng/L) and 17.46-150.20 ng/g (mean: 63.41 ng/g), respectively. The spatial distribution of SHs in Taihu Lake might be simultaneously influenced by the pollution sources, lake hydrodynamics, and sediment properties. The sediment-water partitioning result implied that 28 SHs were in dynamic equilibrium at the water-water interface. In addition, 22 and 12 SHs tended to spread to water and settle into sediment, respectively. To assess the ecological risk of all SHs, a robust random forest model (R2 = 0.801) was developed to predict the acute toxicity of SHs for which toxicity data were not available from publications. Risk assessment showed that SHs posed a high ecological risk throughout Taihu Lake, with the highest risk in the northwestern areas. Estrone, 17ß-estradiol and 17α-ethynylestradiol were the dominant risk contributors and were therefore recommended as the priority SHs in Taihu Lake. This work provided a valuable dataset for Taihu Lake, which would help to provide guidance and suggestions for future studies and be useful for the government to develop the mitigation and management measures.

Dissipation Dynamic, Residue Distribution and Risk Assessment of Emamectin Benzoate in Longan by High-Performance Liquid Chromatography with Fluorescence Detection.

A derivatization method combined with high-performance liquid chromatography-fluorescence detection (HPLC-FLD) was used to evaluate the dissipation, residue distribution and risk assessment of emamectin benzoate in whole longan and pulp. The average recoveries were 82-111% with relative standard deviation (RSD) less than 11%. The limit of quantification (LOQ) was 0.001 mg/kg in longan and pulp. The half-lives were 3.3-4.2 days. The terminal residues in whole longan were <0.001-0.025 mg/kg applied two and three times at two levels of dosage with PHIs of 10, 14, and 21 days. The residues in whole longan had a higher quantity than those in the pulp, and the terminal residues of pulp were all lower than LOQ (0.001 mg/kg). The chronic risk of emamectin benzoate was not negligible to humans depending on ADI% value, which was higher than 1; and the acute risk was acceptable to the consumer. This study could provide guidance for the safe use of emamectin benzoate in longan and serve as a reference for the establishment of maximum residue limits (MRLs) in China.

Improving the High-Temperature Gate Bias Instabilities by a Low Thermal Budget Gate-First Process in p-GaN Gate HEMTs.

In this study, we report a low ohmic contact resistance process on a 650 V E-mode p-GaN gate HEMT structure. An amorphous silicon (a-Si) assisted layer was inserted in between the ohmic contact and GaN. The fabricated device exhibits a lower contact resistance of about 0.6 Ω-mm after annealing at 550 °C. In addition, the threshold voltage shifting of the device was reduced from -0.85 V to -0.74 V after applying a high gate bias stress at 150 °C for 10-2 s. The measured time to failure (TTF) of the device shows that a low thermal budget process can improve the device's reliability. A 100-fold improvement in HTGB TTF was clearly demonstrated. The study shows a viable method for CMOS-compatible GaN power device fabrication.

Establishment of a Method for the Detection of Indaziflam, Spirotetramat, Cyantraniliprole, and Their Metabolites and Application for Fruit and Vegetable Risk Assessment.

The presence of pesticides in foodstuffs has received increasing amount of attention worldwide. In this study, an efficient and sensitive QuEChERS/HPLC-MS/MS-based method was established for the simultaneous detection of indaziflam, cyantraniliprole, spirotetramat, and their metabolites on fruits and vegetables. The purification procedure and detection condition parameters were optimized. Good precision and reproducibility were found for the method, and the average recoveries of the target analytes ranged from 71 to 118%, with the relative standard deviation ranging from 2 to 12%. The limits of quantification and the limits of detection were 1-5 and 0.3-1.5 µg kg-1, respectively. The proposed method was used to detect three pesticides and their metabolites in fruit and vegetable samples collected from China's major producing regions. Furthermore, the dietary risk posed by the pesticide residues on fruits and vegetables was evaluated by risk quotients (RQs) and risk probabilities (RPs). The RQ and RP values were less than 100% for Chinese consumers. This study not only provides a reliable analytical method for monitoring purposes but also serves as a significant guide for food safety and export.

Multiple Risk Assessment of Heavy Metals in Surface Water and Sediment in Taihu Lake, China.

Taihu Lake is the third-largest freshwater lake in eastern China. The contamination of heavy metals (HMs) in Taihu Lake resulting from rapid economic development and population growth has raised significant concerns in recent years. In this study, the contents and spatial distributions of eight typical HMs (Hg, Cr(VI), As, Cd, Cu, Ni, Pb, and Zn) in the fresh surface water and sediments from Taihu Lake were investigated. The potential ecological and health risks posed by HMs were evaluated using multiple assessment methods. Risk quotients were used to assess the ecological risks of HMs, and chronic risk quotients of Cu, Ni, and Pb (>1.0) were found in the surface water of Taihu Lake. According to the geo-accumulation index (Igeo) and pollution load index (PLI) values, the lake sediments exhibited moderate risks of Cd and Hg. In general, the sediments were moderately contaminated by HMs based on the average risk index (RI < 300). Spatially, a high ecological risk posed by the HMs existed in the sediments of northern Taihu Lake (RI > 300), while the sediments in the southwestern and eastern regions had moderate risk levels. The non-carcinogenic risk levels of Hg, Cd, Cu, and Zn were acceptable based on the exposure characteristics of residents living around Taihu Lake. The carcinogenic risk levels of Cr(VI), As, Pb, and Ni through drinking water were acceptable. However, the ingestion of Cr(VI), As, and Ni through drinking water and fish consumption may pose certain health risks. Therefore, the levels of toxic metals, in particular, Cr(VI), As, and Ni, in edible organisms should be monitored periodically and controlled to alleviate the potential carcinogenic risks through food ingestion. Our work provides valuable information concerning the ecological risk distribution of HMs in Taihu Lake, which is essential for protecting the safety of aquatic organisms and human health and minimizing HM pollution in the lake.

The flow index provides a comprehensive assessment of erectile dysfunction by combining blood flow velocity and vascular diameter.

Dynamic duplex sonography (DUS) is not comprehensive in the evaluation of arteriogenic erectile dysfunction (ED). We introduced a new parameter, the flow index (FI), into the assessment of arteriogenic ED. A retrospective review of a prospective database was conducted. Patients undergoing DUS and pelvic computed tomography angiography for the evaluation of ED were included. The FI was calculated from peak systolic velocity (PSV) and the percentages of pelvic arterial (PLA) stenosis. Correlations between PSV, PLA stenosis, the FI, and erectile function were calculated. Eighty-three patients were included. Compared with PSV, the FI had better correlations with the erection hardness score (EHS) (rs = 0.405, P < 0.001 for FI; rs = 0.294, P = 0.007 for PSV). For EHS < 3, the areas under the ROC curve of FI and PSV were 0.759 and 0.700, respectively. In patients with normal DUS but EHS < 3, PLA stenosis was more severe (62.5% vs. 10.0%, P = 0.015), and the FI was lower (8.35 vs. 57.78, P = 0.006), while PSV was not different. The FI is better than PSV in the evaluation of arteriogenic ED. On the other hand, assessment of the pelvic arterial system should be included in the evaluation of ED.

Preclinical safety evaluation of Macleaya Cordata extract: A re-assessment of general toxicity and genotoxicity properties in rodents.

Macleaya cordata extract (MCE) is widely used for its diverse pharmacological actions and beneficial effects on farm animals. Modern pharmacological studies have shown that it has anti-inflammatory, anti-cancer, and anti-bacterial activities, and is gradually becoming a long-term additive veterinary drug used to improve animal intestinal health and growth performance. Although some evidence points to the DNA mutagenic potential of sanguinarine (SAN), a major component of MCE, there is a lack of sufficient basic toxicological information on the oral route, posing a potential safety risk for human consumption of food of animal origin. In this study, we assessed the acute oral toxicity, repeated 90-day oral toxicity and 180-day chronic toxicity of MCE in rats and mice and re-evaluated the genotoxicity of MCE using a standard combined in vivo and ex vivo assay. In the oral acute toxicity test, the LD50 for MCE in rats and mice was 1,564.55 mg/kg (95% confidence interval 1,386.97-1,764.95 mg/kg) and 1,024.33 mg/kg (95% confidence interval 964.27-1,087.30 mg/kg), respectively. The dose range tested had no significant effect on hematology, clinical chemistry, and histopathological findings in rodents in the long-term toxicity assessment. The results of the bacterial reverse mutation, sperm abnormality and micronucleus test showed negative results and lack of mutagenicity and teratogenicity; the results of the rat teratogenicity test showed no significant reproductive or embryotoxicity. The results indicate that MCE was safe in the dose range tested in this preclinical safety assessment. This study provides data to support the further development of maximum residue limits (MRLs) for MCE.

Safety assessment of MPTA: An oral acute and 90-day sub-chronic toxicity study in Sprague-Dawley rats.

MPTA is a novel extract product derived from Macleaya cordata (Willd.) R. Br., which has good anti-inflammatory and antioxidant activity. The aim of this study was to investigate the acute oral toxicity and 90-day sub-chronic oral toxicity of MPTA. In the acute toxicity study, 50 SD rats of both sexes were randomly divided into 5 groups and dosed in a gradient from 197.53 mg/kg to 1000.00 mg/kg bw. Toxic effects were observed up to 14 days and LD50 was calculated. In a subchronic toxicity test, male and female SD rats were orally dosed repeatedly with 96.40, 19.28, 3.86 mg/kg bw of MPTA for 90 days. In addition, a control group was set up in the subchronic study. The acute toxicity test showed that the oral LD50 of MPTA was 481.99 mg/kg with a 95% confidence interval of 404.24-574.70 mg/kg. MPTA did not appear to induce toxic effects in the longer term in terms of food and water consumption, weight gain, haematological and clinical biochemical parameters and pathological examination. The first data on the potential toxicity of MPTA was provided to highlight the safety of short-term to longer-term oral administration of MPTA, and the experimental results yield and establish a NOEAL of 96.40 mg/kg/d for MPTA.

Metabolomic assessment of mechanisms underlying anti-renal fibrosis properties of petroleum ether extract from Amygdalus mongolica.

CONTEXT: The petroleum ether extract (PET) of Amygdalus mongolica (Maxim.) Ricker (Rosaceae) has an ameliorative effect on renal fibrosis (RF). OBJECTIVE: To evaluate the antifibrotic effects of A. mongolica seeds PET on RF by serum metabolomics, biochemical and histopathological analyses. MATERIALS AND METHODS: Sixty male Sprague-Dawley rats were randomly divided into the sham-operated, RF model, benazepril hydrochloride-treated model (1.5 mg/kg) and PET-treated (1.75, 1.25, 0.75 g/kg) groups, and the respective drugs were administered intragastrically for 21 days. Biochemical indicators including BUN, Scr, HYP, SOD, and MDA were measured. Haematoxylin and eosin and Masson staining were used for histological examination. The serum metabolomic profiles were determined by UPLC-Q-TOF/MS and metabolism network analysis. Acute toxicity test was performed to validate biosafety. RESULTS: The PET LD50 was >23.9 g/kg in rats. PET significantly alleviated fibrosis by reducing the levels of Scr (from 34.02 to 32.02), HYP (from 403.67 to 303.17) and MDA (from 1.84 to 1.73), and increasing that of SOD (from 256.42 to 271.85). Metabolomic profiling identified 10 potential biomarkers, of which three key markers were significantly associated with RF-related pathways including phenylalanine, tyrosine and tryptophan biosynthesis, amino sugar and nucleotide sugar metabolism and tyrosine metabolism. In addition, three key biomarkers were restored to baseline levels following PET treatment, with the medium dose showing optimal effect. CONCLUSIONS: These findings revealed the mechanism of A. mongolica PET antifibrotic effects for RF rats on metabolic activity and provided the experimental basis for the clinical application.

Physician-Nurse Communication Surrounding Computerized Physician Order Entry Systems From Social and Technical Perspective: An Ethnographic Study.

Although computerized physician order entry systems improve order transmission and patient safety, overdependence on these systems can impede users' communication. This ethnographic study explored physician-nurse communication surrounding computerized physician order entry systems using a sociotechnical framework. Fieldwork conducted in a tertiary teaching hospital comprised 89 hours of participant observation, and individual semistructured interviews were held with seven nurses and five physicians. In addition, documents and artifacts were collected. Three core themes emerged. First, computerized physician order entry quality-related issues undermined the work efficiency of physicians and nurses. Specifically, usability was error prone because of cognitive overload, and the system was unable to perform relevant traces and raise alerts, demonstrating poor interoperability. Second, social factors, including insufficient training, unclear responsibilities, and a lack of awareness concerning interdisciplinary communication, compounded communication problems. Last, environmental factors, including noncoterminous spaces and times and insufficient technical support, impeded the resolution of communication problems. Technical and social contextual factors relating to computerized physician order entry systems jointly affected physician-nurse communication. Cognitive issues and insufficient alerts impacted work efficiency the most and were compounded by contextual individual- and team-related factors and environmental factors. Therefore, improved functions of computerized physician order entry systems and interprofessional communication training are required to optimize technical and social aspects of physician-nurse communication.

Upper Limb Proprioceptive Acuity Assessment Based on Three-Dimensional Position Measurement Systems.

The aim of the current work was to verify three-dimensional directional effects on the reproduction error precision of the human upper limb position. Thirty male subjects without history of upper limb pathology were recruited from Renmin University of China. A three-dimensional position reproduction task in six directions (up, down, left, right, far, and near) was performed by each subject. The results suggested that the proprioceptive sense of upper limb position depends on the direction, with smaller absolute errors in Directions 4 (right) and 5 (far) than in Directions 1 (up), 2 (down), 3 (left), and 6 (near). Proprioception near the end of the elbow joint range of motion may be more reliable and sensitive. Subjects reproduced fewer ranges in the horizontal plane (Directions 3, 5, and 6) and they overshot the target position along the z-axis (vertical direction) except for Direction 6. Overestimations of position in the z-axis may be caused by overestimations of force.

A Population-Based Survey of the Workplace Costs for Caregivers of Persons With Treatment-Resistant Depression Compared With Other Health Conditions.

OBJECTIVE: To describe caregiving work outcomes and related indirect (ie, productivity) and direct (ie, caregiving hours and expenses) costs. METHODS: A national, population-based survey to identify employed caregivers assisting a person with treatment-resistant depression (TRD) and a comparison group of employed caregivers assisting others (No TRD). RESULTS: Screening identified 169 TRD caregivers and 1070 No TRD caregivers providing 23.3 and 14.6 mean weekly caregiving hours, respectively. Adjusted annual indirect cost estimates were $11,121 for caregivers of TRD and $7761 for caregivers in the No TRD group (P ≤ 0.0001). At-work productivity loss (presenteeism) was the largest component. Adjusted annual direct cost estimates were $29,805 for caregivers of TRD and $20,642 for caregivers in the No TRD group (P ≤ 0.0001). CONCLUSIONS: TRD exacts a toll on caregivers and their employers exceeding that for other caregivers.

Single-Grain Gate-All-Around Si Nanowire FET Using Low-Thermal-Budget Processes for Monolithic Three-Dimensional Integrated Circuits.

We introduce a single-grain gate-all-around (GAA) Si nanowire (NW) FET using the location-controlled-grain technique and several innovative low-thermal budget processes, including green nanosecond laser crystallization, far-infrared laser annealing, and hybrid laser-assisted salicidation, that keep the substrate temperature (Tsub) lower than 400 °C for monolithic three-dimensional integrated circuits (3D-ICs). The detailed process verification of a low-defect GAA nanowire and electrical characteristics were investigated in this article. The GAA Si NW FETs, which were intentionally fabricated within the controlled Si grain, exhibit a steeper subthreshold swing (S.S.) of about 65 mV/dec., higher driving currents of 327 µA/µm (n-type) and 297 µA/µm (p-type) @ Vth ± 0.8 V, and higher Ion/Ioff (>105 @|Vd| = 1 V) and have a narrower electrical property distribution. In addition, the proposed Si NW FETs with a GAA structure were found to be less sensitive to Vth roll-off and S.S. degradation compared to the omega(Ω)-gate Si FETs. It enables ultrahigh-density sequentially stackable integrated circuits with superior performance and low power consumption for future mobile and neuromorphic applications.

Occurrence, spatial distribution and risk assessment of organophosphate esters in surface water from the lower Yangtze River Basin.

Organophosphate esters (OPEs) are extensively used as flame retardants and plasticizers in China; however, their potential carcinogenicity causes great concern. To date, their environmental distribution in water samples from the lower Yangtze River Basin still remains uncharacterized. This study systematically investigated the occurrence and spatial distribution of 13 OPEs, as well as their associated potential risks, in water samples from the lower Yangtze River and its 88 major inflowing rivers. The total OPE (ΣOPEs) concentrations ranged from 55.6 to 5071 ng/L, with a median of 144 ng/L. Among them, halogenated OPEs were the dominant group with an average of 61.6%, and tris(1-chloro-2-propyl) phosphate (12.6-450 ng/L, median: 53.38 ng/L) and tris(2-choroethyl) phosphate (11.0-1202 ng/L, median: 36.4 ng/L) were the most abundant OPEs. Significantly different concentrations were found with spatial variations (p < 0.01), and were higher in southern cities than in northern cities of the lower Yangtze River Basin. Principal component analysis with multiple linear regression and Spearman correlations showed that the main sources were likely emission of vehicular and marine traffic. Ecological risk analysis showed that the risk quotient (RQ) values of samples remained below 1, but the percentage of 0.1 < RQ ≤ 1 was 26.9%, indicating a medium risk of OPEs in water samples. Moreover, ethylhexyl diphenyl phosphate predominantly contributed to the ecological risk, accounting for >89.2% of the total ecological risk of ΣOPEs. However, the total non-carcinogenic and carcinogenic risks of ΣOPEs were negligible at the detected concentrations, even in a high exposure scenario. The risks from major inflowing rivers of the lower Yangtze River were almost one order of magnitude higher than those of the mainstream lower Yangtze River.

Analysis of Pollution of Phthalates in Pork and Chicken in Taiwan Using Liquid Chromatography-Tandem Mass Spectrometry and Assessment of Health Risk.

Phthalates are widely used plasticizers that can cause endocrine disruption, mutagenicity, and carcinogenic effects and can contaminate food through various pathways. Investigations are scanty on phthalate pollution of livestock and poultry meat and their dietary exposure to humans. The present study assessed residual levels of phthalates in unpackaged pork (30 samples) and unpackaged chicken (30 samples) and their relevance to meat consumption and health risks in the Taiwanese population. Phthalate quantity was assessed by liquid chromatography-tandem mass spectrometry; the materials included diisononyl phthalate, diisodecyl phthalate, benzyl butyl phthalate, di-2-ethylhexyl phthalate (DEHP), and di-n-butyl phthalate. The Taiwan Food and Drug Administration (TFDA) has established values of tolerable daily intake (TDI) for the five phthalates. The major compound detected was DEHP, which ranged from 0.62 to 0.80 mg/kg in two pork samples, and 0.42-0.45 mg/kg in three chicken samples. Collectively, 8.33% of the phthalate-residue-containing samples tested positive for DEHP. The concentrations of DEHP were lower than the screening value of 1.0 mg/kg, as defined by the TFDA. Health risk was calculated as the estimated daily intake (DI) for any likely adverse effects; the DI of DEHP residues was <1% of the TDI value. The estimated risk was insignificant and considered to be safe, indicating that there is no risk to the health of Taiwanese population due to meat consumption. However, it is suggested that a phthalate monitoring program in meat should be instituted for any possible effects in future on human health.

Phthalates and organophosphorus insecticide residues in shrimp determined by liquid/gas chromatography-Tandem mass spectrometry and a health risk assessment.

Shrimps are the most widely and increasingly cultured crustaceans in land-based ponds in Taiwan. However, few studies have investigated the phthalate contamination of and insecticide residues in shrimp. In this study, we applied a validated method to analyze the phthalate and 18 insecticides residues in shrimp. A total of 46 samples of whiteleg, grass, or giant river shrimp were collected from aquafarms and production areas in Taiwan. We detected 0.02-0.70 mg/kg of di-2-ethylhexyl phthalate (DEHP) in three shrimps; 0.02-0.03 mg/kg of chlorpyrifos in three shrimps, and 0.03 mg/kg of trichlorfon in one shrimp, indicating that 6.52% and 8.70% of the samples contained phthalate and insecticide residues, respectively. Furthermore, the assessed risk was negligible and indicated no immediate health risk associated with shrimp consumption. Continual monitoring of the residues in shrimps is critical for further assessment of possible effects on human health.

Mobile phone application for self-assessment of acute stroke patients: A tool for extended care and follow-up.

We aimed to assess the accuracy of self-assessment for acute stroke patients via mobile phone application-based scales and determine the value and prospect of clinical use.A cross-sectional study was designed and acute stroke patients were enrolled. We pushed the modified Rankin scale (mRS) and activities of daily living (ADL) scale to patients via mobile phone application for self-assessment on the day before they were out of hospital. We compared the results from nurse assessment and self-assessment.Around 50 patients with the average age 51.72 ±â€Š12.40 completed the self-assessment. A total of 27 patients self-assessed the scales, while caregivers of other 23 patients completed the assessment. In comparison with patient assessment and nurse assessment, significant difference was found in ADL score (P = .004), but was not found in mRS score (P > .05). When comparing caregiver assessment with nurse assessment, no significant difference could be found either in ADL score (P > .05) or in mRS score (P > .05). The kappa value for self-assessment and nurse agreement of ADL was 0.720 (P = .000), with sensitivity 96.8% and specificity 82.0%. The kappa value for self-assessment and nurse agreement of mRS was 0.718 (P = .000), with sensitivity 97.6% and specificity 92.4%.In summary, mobile phone application-based scales are generally accurate, economical and convenient for self-assessment of acute stroke patients with acceptable reliability in our small scale study. Caregivers can serve as the proper assessor when patients are out of hospital. Therefore, it is promising but still need to be further confirmed how practical to use this application in extended care and follow-up.

Breast Cancer Incidence and Predictors of Surgical Outcome: a Nationwide Longitudinal Study in Taiwan.

AIMS: Despite the huge and growing global burden of patients who require breast cancer surgery, high-quality population-based studies of breast cancer trends and outcomes are scarce. The purpose of this study was to explore the incidence of breast cancer and predictors of hospital resource utilisation, mortality and recurrence in a nationwide population of patients who have received surgery. MATERIALS AND METHODS: This retrospective study analysed trends and outcomes in a Taiwan population of 77 971 patients after breast cancer surgery during 1996-2010. The Cox proportional hazards model was used for multivariate assessment of both mortality and recurrence predictors. RESULTS: The data analysis indicated that, during this period, the estimated mean hospital treatment cost and mean length of stay increased by 16.3% and 53.4%, respectively. The estimated mean overall survival time was 138.9 months (standard deviation 0.3 months) and the overall 1, 3, 5 and 10 year survival rates were 97.3, 89.2, 82.2 and 70.1%, respectively. The estimated mean overall recurrence time was 10.8 months (standard deviation 0.2 months) and the overall 1, 3, 5 and 10 year recurrence rates were 0.1, 18.8, 26.6 and 36.0%, respectively. Outcomes were significantly associated with age, Deyo-Charlson comorbidity index score, surgeon seniority, hospital volume, surgeon volume, surgery type, hospital level and baseline comorbidities (P<0.001). CONCLUSIONS: Analyses of these population-based data revealed simultaneous increases in the standard incidence of breast cancer surgery and its associated medical resource utilisation. Notably, healthcare providers and patients should recognise that both patient attributes and hospital attributes may affect breast cancer surgery outcomes.

Development of Short-Form Versions of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study.

BACKGROUND: The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item questionnaire designed to assess risk of aberrant medication-related behaviors in chronic pain patients. The introduction of short forms of the SOAPP-R may save time and increase utilization by practitioners. OBJECTIVE: To develop and evaluate candidate SOAPP-R short forms. DESIGN: Retrospective study. SETTING: Pain centers. SUBJECTS: Four hundred and twenty-eight patients with chronic noncancer pain. METHODS: Subjects had previously been administered the full-length version of the SOAPP-R and been categorized as positive or negative for aberrant medication-related behaviors via the Aberrant Drug Behavior Index (ADBI). Short forms of the SOAPP-R were developed using lasso logistic regression. Sensitivity, specificity, and area under the curve (AUC) of all forms were calculated with respect to the ADBI using the complete data set, training-test analysis, and 10-fold cross-validation. The coefficient alpha of each form was also calculated. An external set of 12 pain practitioners reviewed the forms for content. RESULTS: In the complete data set analysis, a form of 12 items exhibited sensitivity, specificity, and AUC greater than or equal to those of the full-length SOAPP-R (which were 0.74, 0.67, and 0.76, respectively). The short form had a coefficient alpha of 0.76. In the training-test analysis and 10-fold cross-validation, it exhibited an AUC value within 0.01 of that of the full-length SOAPP-R. The majority of external practitioners reported a preference for this short form. CONCLUSIONS: The 12-item version of the SOAPP-R has potential as a short risk screener and should be tested prospectively.