Large language models to identify social determinants of health in electronic health records.

Social determinants of health (SDoH) play a critical role in patient outcomes, yet their documentation is often missing or incomplete in the structured data of electronic health records (EHRs). Large language models (LLMs) could enable high-throughput extraction of SDoH from the EHR to support research and clinical care. However, class imbalance and data limitations present challenges for this sparsely documented yet critical information. Here, we investigated the optimal methods for using LLMs to extract six SDoH categories from narrative text in the EHR: employment, housing, transportation, parental status, relationship, and social support. The best-performing models were fine-tuned Flan-T5 XL for any SDoH mentions (macro-F1 0.71), and Flan-T5 XXL for adverse SDoH mentions (macro-F1 0.70). Adding LLM-generated synthetic data to training varied across models and architecture, but improved the performance of smaller Flan-T5 models (delta F1 + 0.12 to +0.23). Our best-fine-tuned models outperformed zero- and few-shot performance of ChatGPT-family models in the zero- and few-shot setting, except GPT4 with 10-shot prompting for adverse SDoH. Fine-tuned models were less likely than ChatGPT to change their prediction when race/ethnicity and gender descriptors were added to the text, suggesting less algorithmic bias (p < 0.05). Our models identified 93.8% of patients with adverse SDoH, while ICD-10 codes captured 2.0%. These results demonstrate the potential of LLMs in improving real-world evidence on SDoH and assisting in identifying patients who could benefit from resource support.

Global, regional, and national prevalence of hearing loss from 1990 to 2019: A trend and health inequality analyses based on the Global Burden of Disease Study 2019.

As a severe public health issue, hearing loss has caused an increasingly disease burden, especially in the elderly population. Hearing loss may inevitably induce asymmetric hearing, which makes it difficult for elderly individuals to locate sound sources, therefore resulting in increased postural instability and falling risk. To emphasize the public health emergence of hearing loss, we investigated the temporal trend of prevalence of hearing loss over the last 30 years and further predicted its changes in the next 20 years, decomposed the trend according to demographic factors and epidemiological changes, and quantified the cross-country healthy inequalities, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. In 2019, there were more than 140 million cases of hearing loss worldwide, a 93.89% increase from 70 million cases in 1990. The age-standardized rate (ASR) also increased with an estimated annual percentage change of 0.08% per year. Population growth and aging are the major drivers contributing to the changes, accounting for 60.83% and 35.35%. Of note, the contribution of aging varies showing a gradual increasing trend with sociodemographic index (SDI) elevating. Also notable, there were significant health inequalities across 204 countries and territories, with slope index of inequality rising over time. Projection of the global burden of hearing loss from 2020 to 2040 indicated progressive increases in both case number and ASR. These reflect the heavy disease burden of hearing loss that needed more targeted and efficient strategies in its prevention and management.

Dynamic Prediction of Internet Financial Market Based on Deep Learning.

P2P lending is an important part of Internet finance, which is popular among users because of its efficiency, low cost, wide range, and ease of operation. The problem of predicting loan defaults is affected by many factors, such as the linear and nonlinear nature of the data itself and time dependence and multiple external factors, which have not been well captured in the previous work. In this paper, we propose a multiattention mechanism to capture the different effects of various time slices and various external factors on the results, introduce ARIMA and LSTM to capture the linear and nonlinear characteristics of the lending data respectively, and establish a Time Series Multiattention Prediction Model (MAT-ALSTM) based on LSTM and ARIMA. This paper uses the Lending Club dataset from the United States to prove that our model is superior to ANN, SVM, LSTM, GRU, and ARIMA models in the prediction effect of MAE, RMSE, and DA.

Cav3.1-driven bursting firing in ventromedial hypothalamic neurons exerts dual control of anxiety-like behavior and energy expenditure.

The central nervous system has evolved to coordinate the regulation of both the behavior response to the external environment and homeostasis of energy expenditure. Recent studies have indicated the dorsomedial ventromedial hypothalamus (dmVMH) as an important hub that regulates both innate behavior and energy homeostasis for coping stress. However, how dmVMH neurons control neuronal firing pattern to regulate chronic stress-induced anxiety and energy expenditure remains poorly understood. Here, we found enhanced neuronal activity in VMH after chronic stress, which is mainly induced by increased proportion of burst firing neurons. This enhancement of VMH burst firing is predominantly mediated by Cav3.1 expression. Optogenetically evoked burst firing of dmVMH neurons induced anxiety-like behavior, shifted the respiratory exchange ratio toward fat oxidation, and decreased food intake, while knockdown of Cav3.1 in the dmVMH had the opposite effects, suggested that Cav 3.1 as a crucial regulator. Interestingly, we found that fluoxetine (anxiolytics) could block the increase of Cav3.1 expression to inhibit the burst firing, and then rescued the anxiety-like behaviors and energy expenditure changes. Collectively, our study first revealed an important role of Cav3.1-driven bursting firing of dmVMH neurons in the control of anxiety-like behavior and energy expenditure, and provided potential therapeutic targets for treating the chronic stress-induced emotional malfunction and metabolism disorders.

Development and assessment of the efficacy and safety of human lung-targeting liposomal methylprednisolone crosslinked with nanobody.

Glucocorticoid (GC) hormone has been commonly used to treat systemic inflammation and immune disorders. However, the side effects associated with long-term use of high-dose GC hormone limit its clinical application seriously. GC hormone that can specifically target the lung might decrease the effective dosage and thus reduce GC-associated side effects. In this study, we successfully prepared human lung-targeting liposomal methylprednisolone crosslinked with nanobody (MPS-NSSLs-SPANb). Our findings indicate that MPS-NSSLs-SPANb may reduce the effective therapeutic dosage of MPS, achieve better efficacy, and reduce GC-associated side effects. In addition, MPS-NSSLs-SPANb showed higher efficacy and lower toxicity than conventional MPS.

Underground Pipeline Leakage Risk Assessment in an Urban City.

Underground pipeline safety is a concern among civilians in populated urban cities. Due to the potential for considerable damage from underground pipeline leakages, it is critical to identify potential risk areas. This study developed a simplified risk value using risk assessment software (ALOHA) and geography information systems (SuperGIS and Surfer) to produce potential risk maps for underground pipeline leakage in a major urban city. A risk assessment of areas affected by underground pipeline leakage was performed for vapor diffusion, thermal radiation from combustion, and overpressure from an explosion. The results are applicable to disaster management departments and agencies in highly populated cities.

Health risk assessment of heavy metal and its mitigation by glomalin-related soil protein in sediments along the South China coast.

Knowledge regarding the exposure risk of heavy metals in estuarine wetland is important for people (especially fishermen and consumers of local fish) living in the coastal area and the coastal reclamation. Here, we assessed the ecological and human health risks of sediment-associated metals in the large-scale estuary area based on different sediment textures (Mud, Mud-Sand, and Sand). To investigate the potential impact of terrestrial material on the contamination risks, glomalin-related soil protein (GRSP), a recalcitrant soil protein fraction, was used. Results showed that the estuarine sediment texture played a rather important role in the heavy metal distribution, risk assessment, and the metal sequestration capacity of the land-derived GRSP fraction. We found arsenic, Pb, Cd, and Cr had the highest enrichment in the estuarine wetlands by calculating multiple contamination indices, and that confirmed similar findings of heavy metal contents, except Cd. The average pollution load index (PLI) was 1.67 in all the estuarine sediments, indicating multi-element contamination, with the Muddy sediments (PLI = 2.07) significantly higher than the Mud-Sand mixed sediments (PLI = 1.85), and the lowest (0.78 < 1) in the Sandy sediments. The health risk assessment suggested that the potential cancer risk occurred (>1.00E-6) but no obvious non-carcinogenic effects occurred (<1). Arsenic was found to be the primary contributor to non-carcinogenic risk, accounting for 44.2% of hazard index, while Ni is the primary control metal for carcinogenic risk (except arsenic in the Sandy sediments). As a proxy of terrestrial organic matter, GRSP fraction possessed a high sequestration capacity for heavy metal, especially in the Sandy sediments, and it was significantly associated with the mitigation of ecological and health risks, which may provide new insights into the in situ remediation of anoxic estuarine wetlands.

[Distribution and Pollution Assessment of Nutrients and Heavy Metals in Surface Sediments from Shibalianwei Wetland in Hefei, Anhui Province, China].

Shibalianwei is a large constructed wetland formed at the estuary of the Nanfei River adjoining Lake Chaohu. To investigate the distribution and pollution characteristics of nutrients and heavy metals in surface sediments of Shibalianwei Wetland, sediment samples were collected from 72 sites in July 2018. The source of the pollution was analyzed. Our results showed that the average contents of total nitrogen (TN), total phosphorus (TP), and organic matter (OM) in surface sediments of Shibalianwei were 2108.87 mg·kg-1, 1448.82 mg·kg-1, and 86.2 g·kg-1, respectively; in the external water system of the wetland, they were 2305.81 mg·kg-1, 1268.46 mg·kg-1, and 59.9 g·kg-1, respectively. The average contents of heavy metals of Mn, Cr, Cu, Pb, Cd, As, and Hg in Shibalianwei were 462.58, 42.12, 21.69, 18.05, 0.63, 5.67, and 0.059 mg·kg-1, respectively; in the external water bodies, they were 381.61, 36.85, 24.74, 30.70, 2.49, 6.47, and 0.035 mg·kg-1, respectively. In the assessments of nutrient pollution of internal water bodies of Shibalianwei, TN was at mild to moderate pollution levels, TP was at a heavy pollution level, and the comprehensive pollution index (FF) indicated that nutrients in Shibalianwei were at moderate to heavy pollution levels. The assessment results of the organic pollution index (OI) were consistent with the FF. The potential ecological risk assessments of heavy metals showed that both Cd and Hg reached certain ecological risks, which were indicated by RI and Eri. For external water bodies, the nutrient levels were also high and heavy metal pollution was relatively serious, indicating high ecological risks.

Evaluation of perioperative prophylaxis with fosfomycin tromethamine in ureteroscopic stone removal: an investigator-driven prospective, multicenter, randomized, controlled study.

PURPOSE: To compare efficacy, safety, and cost-effectiveness of fosfomycin tromethamine with other standard-of-care antibiotics in patients undergoing ureteroscopic lithotripsy. METHODS: This study was a prospective, multicenter, randomized, controlled trial. Eligible patients scheduled for ureteroscopic lithotripsy were randomly assigned to receive either fosfomycin (fosfomycin group, N = 101 patients) or standard-of-care antibiotic therapy as prophylaxis (control group, N = 115 patients). The incidence of infectious complications and adverse events was analyzed between the two groups, as well as the cost-benefit analysis. RESULTS: The incidence of infections following lithotripsy was 3.0% in the fosfomycin group and 6.1% in the control group (p > 0.05). Only asymptomatic bacteriuria was reported in fosfomycin group. In the control group was reported asymptomatic bacteriuria (3.5%), fever (0.9%), bacteremia (0.9%), and genitourinary infection (0.9%). The rate of adverse events was very low, with no adverse event reported in the fosfomycin group and only one in the control group (forearm phlebitis). The average cost per patient of antibiotic therapy with fosfomycin was 151.45 ± 8.62 yuan (22.7 ± 1.3 USD), significantly lower compared to the average cost per patient of antibiotics used in the control group 305.10 ± 245.95 yuan (45.7 ± 36.9 USD; p < 0.001). CONCLUSIONS: Two oral doses of 3 g fosfomycin tromethamine showed good efficacy and safety and low cost in perioperative prophylaxis of infections following ureteroscopic stone removal.

Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure.

BACKGROUND: Patients with functional single ventricles after the Fontan procedure have abnormal cardiac mechanics. The aims of this study were to determine factors that influence diastolic function and to describe associations of diastolic function with current clinical status. METHODS: Echocardiograms were obtained as part of the Pediatric Heart Network Fontan Cross-Sectional Study. Diastolic function grade (DFG) was assessed as normal (grade 0), impaired relaxation (grade 1), pseudonymization (grade 2), or restrictive (grade 3). Studies were also classified dichotomously (restrictive pattern present or absent). Relationships between DFG and pre-Fontan variables (e.g., ventricular morphology, age at Fontan, history of volume-unloading surgery) and current status (e.g., systolic function, valvar regurgitation, exercise performance) were explored. RESULTS: DFG was calculable in 326 of 546 subjects (60%) (mean age, 11.7 ± 3.3 years). Overall, 32% of patients had grade 0, 9% grade 1, 37% grade 2, and 22% grade 3 diastolic function. Although there was no association between ventricular morphology and DFG, there was an association between ventricular morphology and E', which was lowest in those with right ventricular morphology (P < .001); this association remained significant when using Z scores adjusted for age (P < .001). DFG was associated with achieving maximal effort on exercise testing (P = .004); the majority (64%) of those not achieving maximal effort had DFG 2 or 3. No additional significant associations of DFG with laboratory or clinical measures were identified. CONCLUSIONS: Assessment of diastolic function by current algorithms results in a high percentage of patients with abnormal DFG, but few clinically or statistically significant associations were found. This may imply a lack of impact of abnormal diastolic function on clinical outcomes in this cohort, or it may indicate that the methodology may not be applicable to pediatric patients with functional single ventricles.

Economic burden and its associated factors of hospitalized patients infected with A (H7N9) virus: a retrospective study in Eastern China, 2013-2014.

BACKGROUND: H7N9 continues to cause human infections and remains a pandemic concern. Understanding the economic impacts of this novel disease is important for making decisions on health resource allocation, including infectious disease prevention and control investment. However, there are limited data on such impacts. METHODS: Hospitalized laboratory-confirmed H7N9 patients or their families in Jiangsu Province of China were interviewed. Patients' direct medical costs of hospitalization were derived from their hospital bills. A generalized linear model was employed to estimate the mean direct medical costs of patients with different characteristics. RESULTS: The mean direct cost of hospitalization for H7N9 was estimated to be ¥ 71 060 (95 % CI, 48 180-104 820), i.e., US$ 10 996 (95 % CI, 7 455-16 220), and was ¥12 060 (US$ 1 861), ¥136 120 (US$ 21 001) and ¥218 610 (US$ 33 728) for those who had mild or severe symptoms or who died, respectively. The principal components of the total fees differed among patients with different disease severity, although medication fees were always the largest contributors. Disease severity, proportion of reimbursement and family member monthly average income were identified as the key factors that contributed to a patient's direct medical cost of hospitalization. CONCLUSIONS: The direct medical costs of hospitalized patients with H7N9 are significant, and far surpass the annual per capita income of Jiangsu Province, China. The influencing factors identified should be taken into account when developing related health insurance policies and making health resource allocation. TRIAL REGISTRATION: Not applicable. This is a survey study with no health care intervention implemented on human participants.

Rounded Cu2ZnSnS4 nanosheet networks as a cost-effective counter electrode for high-efficiency dye-sensitized solar cells.

Semi-transparent rounded Cu2ZnSnS4 (CZTS) nanosheet networks were in situ grown on a FTO glass substrate, via an effective solution method, without any post-treatments. An improved power conversion efficiency of 6.24% was obtained by applying CZTS nanosheet networks as a counter electrode for dye-sensitized solar cells. When assisted by a mirror reflection, the PCE increased to 7.12%.

Assessment of risk of late rectal bleeding for patients with prostate cancer started on anticoagulation before or after radiation treatment.

AIM: To evaluate the risk of late rectal bleeding and its association with the timing and type of anticoagulation use in patients receiving dose-escalated radiation therapy (RT) (≥ 7,560 cGy) for prostate cancer. PATIENTS AND METHODS: Between 2003-2010, 465 patients were treated at our Institution with dose-escalated RT and included in this analysis. Patients were placed into the following categories: no anticoagulation use, aspirin during RT, clopidogrel/warfarin during RT, aspirin after completion of RT, clopidogrel/warfarin after completion of RT. RESULTS: The overall bleeding rate was 7.5%. For those on aspirin during RT, the 4-year freedom from rectal bleeding (FFBS) rate was 91%, compared to 94.7% for patients who were never on anticoagulation (p=0.16). For those on warfarin/clopidogrel during RT the 4-year FFBS rate was 78.2%, compared to 94.7% in those never on anticoagulation (p<0.001). On multivariate analysis, use of warfarin/clopidogrel during radiation treatment were strongly associated with an increased risk of rectal bleeding (multivariate HR=4.84, 95% CI=1.84-12.68, p=0.001). However, initiation of anticoagulation after completion of radiation treatment did not significantly increase the risk of rectal bleeding (multivariate HR=0.78, 95% CI=0.21-2.91, p=0.71). CONCLUSION: The use of clopidogrel or warfarin during radiation is associated with significantly increased risk of rectal bleeding. However, initiation of these medications after completion of radiation does not appear to impact such risk.

Racial and socioeconomic disparities in the selection of prostate brachytherapy.

PURPOSE: To utilize the surveillance, epidemiology, and end results database to analyze whether there are racial or socioeconomic disparities associated with the selection of prostate brachytherapy. MATERIAL AND METHODS: We selected patients who were diagnosed with localized prostate cancer between 2004-2006 and who underwent treatment with radiation. Data regarding race and estimates of socioeconomic status were also obtained by analyzing the average reported cost of living adjusted income in the SEER county from which the patient was treated, and dividing these results into quartiles. Multivariate logistic regression analysis was used to determine whether there were any disparities associated with brachytherapy use. RESULTS: A total of 38 704 patients were included in the analysis. Most patients (57%) received EBRT alone, while the remaining 43% of patients had brachytherapy as a component of their treatment, either alone (30.2%) or in combination with EBRT (12.2%). On multivariate logistic regression, prostate brachytherapy use was less likely in African American patients with an odds ratio of 0.89 (95% CI: 0.84-0.95, p < 0.001), and was more likely to be used in those with higher socioeconomic status. Regarding socioeconomic status, the odds ratio for receiving brachytherapy was 1.65 (95% CI: 1.55-1.75) for the 25-50% quartile, 1.92 (95% CI: 1.81-2.04) for the 50-75% quartile, and 2.05 (95% CI: 1.93-2.18) for the 75-100% quartile, respectively (p < 0.001). CONCLUSIONS: There do appear to be socioeconomic and racial disparities in the selection of prostate brachytherapy. These findings may have both significant equality of care as well as cost of care implications.