Coupling phytotoxicity and human health risk assessment to refine the soil quality standard for As in farmlands.

In the present study, a field experiment was conducted to investigate arsenic (As) concentrations in soils and in grains of 15 rice varieties in a contaminated site in Taiwan. The studied site was divided into two experimental units, namely plot A and plot B. The results showed that mean total As concentrations were 70.94 and 61.80 mg kg-1 in plot A and plot B, respectively, and thus greater than or approximate to the soil quality standard for total As in Taiwan (60 mg kg-1). The As levels in rhizosphere soil in plot A (19.71-32.33 mg kg-1) were much higher than in plot B (6.41-8.60 mg kg-1); however, As accumulation in brown rice did not significantly differ between the plots. These results implied that a significant variation in the bioconcentration factor (BCF) value of As existed among different rice genotypes, and a negative correlation was observed between BCF value and rhizosphere As level in the soil. In phytotoxicity, the median values of the ecological risk indicator were 104.85 and 103.89 in plot A and plot B, respectively, indicating considerable risk. In human health risk assessment, the median and 97.5%-tile values for cancer risk for both male and female residents were markedly higher than the acceptable risk (1 × 10-4). Furthermore, non-cancer and cancer risks were higher for males than females, mainly due to the greater rice ingestion rate of males. Sensitivity analysis showed that total As concentration in soil was the main factor affecting health risks, suggesting that priority should be given to the reduction of soil As levels. To better manage the phytotoxicity of As on rice, as well as the health risk to residents resulting from exposure to As-contaminated soils, the soil quality standard for As in farmland soils should be set between 5 and 10 mg kg-1. The methodology developed in this study could also be applied to provide the basis for refining and revising the soil quality standard for heavy metals in farmland in other regions and countries.

Assessment of the clinical benefits of prenatal screening for toxoplasmosis in southern Taiwan.

OBJECTIVE: The present study aimed to investigate the seroprevalence and risk factors for toxoplasmosis among pregnant women in southern Taiwan and to determine the clinical benefits of screening for the same. MATERIALS AND METHODS: The current study included 458 pregnant women who received prenatal care from the first trimester at the Kaohsiung and Chiayi Chang Gung Memorial Hospitals during the time period from 2014 to 2015. Serological tests performed to detect the presence of Toxoplasma IgG and IgM antibodies. Amniocentesis was scheduled and real-time polymerase chain reaction (PCR) was employed to detect Toxoplasma DNA. Moreover, the maternal characteristics and risk factors, perinatal outcomes related to the seropositivity for Toxoplasma infection were analyzed. RESULTS: Among the pregnant patients included in the current study, 39/458 (8.5%) were IgG+ and 2/458 (0.6%) were IgM+. The present study analyzed the maternal characteristics and risk factors, perinatal outcome pertaining to the IgG seropositive group by means of the multiple logistic regression analysis revealed a female predominance (10.8%), compared to the males (6.4%), (adjusted OR = 0.48 (95%, 0.24-0.98), P = 0.043∗). The number cases with gestational age above 37 weeks at the time of delivery was significantly lower, compared to the cases below 37 weeks (adjusted OR = 0.32 (0.12-0.94), P = 0.038∗). Among one case with low avidity cannot exclude recent infection, the amniocentesis did not show any evidence of vertical transmission. CONCLUSION: The scenario may not warrant general screening and the results will not influence the clinical decisions. Although the present study failed to identify the maternal risk factors related to Toxoplasma infection, the results imply that health education is essential, owing to the slightly higher rate of preterm delivery in the IgG seropositive group.

Is Positive Affect Related to Meaning in Life Differently in Younger and Older Adults? A Time Sampling Study.

OBJECTIVES: Prior studies have found that as people age, they value low-arousal positive affect (LAP) to a greater extent and high-arousal positive affect (HAP) to a lower extent. We aimed to investigate whether actually achieving those ideal affects was related to better well-being outcomes, measured in terms of meaning in life. METHODS: Using a time sampling design across 14 days (N = 162), we investigated whether the experience of LAP and HAP was related to the experience of meaning in life and how these associations differed across younger and older adults in Hong Kong. RESULTS: Both LAP and HAP contributed to the experience of meaning in life for both younger and older adults. The global effect of LAP on meaning in life was stronger for older than younger adults, whereas the momentary effect of HAP on meaning in life was stronger for younger adults than older adults. DISCUSSION: Findings suggest that achieving ideal affect is related to better eudaimonic well-being outcomes. People of different age groups know how they want to feel. Actually achieving the feelings endorsed by one's age group is associated with higher meaningfulness of life.

Assessment of the efficacy of Chinese patent medicine on treating pain caused by prostate cancer: A protocol for systematic review and meta analysis.

INTRODUCTION: With the development of economy and the acceleration of population aging, Prostate cancer (PCa) has presented a situation of high morbidity and mortality worldwide. The recent studies have shown that Chinese patent medicine combined with endocrine therapy in the treatment of prostate cancer not only plays a synergistic role in enhancing the efficacy. This review hopes to adopt meta-analysis to evaluate the efficacy and safety of Chinese patent medicine in the treatment of pain caused by prostate cancer and provides evidence for its application in clinical practice. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to June 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of pain caused by prostate cancer. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of Chinese patent medicine for pain caused by prostate cancer. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019131544.

Impact of Computer-Based and Pharmacist-Assisted Medication Review Initiated in the Emergency Department.

OBJECTIVES: Whether early medication reconciliation and integration can reduce polypharmacy and potentially inappropriate medication (PIM) in the emergency department (ED) remains unclear. Polypharmacy and PIM have been recognized as significant causes of adverse drug events in older adults. Therefore, this pilot study was conducted to delineate this issue. DESIGN: An interventional study. SETTING: A medical center in Taiwan. PARTICIPANTS: Older ED patients (aged ≥65 years) awaiting hospitalization between December 1, 2017, and October 31, 2018 were recruited in this study. A multidisciplinary team and a computer-based and pharmacist-assisted medication reconciliation and integration system were implemented. MEASUREMENTS: The reduced proportions of major polypharmacy (≥10 medications) and PIM at hospital discharge were compared with those on admission to the ED between pre- and post-intervention periods. RESULTS: A total of 911 patients (pre-intervention = 243 vs post-intervention = 668) were recruited. The proportions of major polypharmacy and PIM were lower in the post-intervention than in the pre-intervention period (-79.4% vs -65.3%; P < .001, and - 67.5% vs -49.1%; P < .001, respectively). The number of medications was reduced from 12.5 ± 2.7 to 6.9 ± 3.0 in the post-intervention period in patients with major polypharmacy (P < .001). CONCLUSION: Early initiation of computer-based and pharmacist-assisted intervention in the ED for reducing major polypharmacy and PIM is a promising method for improving geriatric care and reducing medical expenditures. J Am Geriatr Soc 67:2298-2304, 2019.

The impact of patient-centered medical homes on safety net clinics.

OBJECTIVES: To evaluate the impact of moving to a patient-centered medical home (PCMH) model in safety net clinics in a managed Medicaid plan. STUDY DESIGN: Quasi-experimental, difference-in-differences design. METHODS: The study examined whether the PCMH model reduced emergency department (ED) use and whether the growth in the seniors and people with disabilities (SPDs) population crowds out lower-cost populations. The study compared 7 PCMH safety net clinics (22,870 members) in late 2011 in the greater Los Angeles area with 110 general safety net clinics (143,530 members) between January 2011 and December 2013. During the time from 2011 to 2012, California began transitioning SPDs from fee-for-service Medicaid into managed care systems under a federal waiver. RESULTS: Among clinics with less than 10% SPD membership, a PCMH model was associated with more office visits and less ED use. In particular, PCMH clinics-relative to non-PCMH clinics-reduced ED visits by an average of 70 visits per 1000 members per year (PTMPY) and reduced avoidable ED visits by 20 visits PTMPY. Neither the change in office visits nor ED visits was evident in clinics with SPD membership greater than 10%. CONCLUSIONS: Adopting a PCMH model in safety net practices can effectively reduce ED use and increase the use of office visits among Medicaid patients. However, the beneficial effects of the PCMH model can be muted by a sudden influx of high-need users.

The effects of cultural values on mental health among the Taiwanese people: mediating of attitudes toward emotional expression.

Empirical evidence has demonstrated that an individual's cultural values can influence his or her mental health. This study extends previous research by proposing and testing a model that examines mediating processes underlying the relationship between individuals' cultural values and their mental health. This 2-stage study used data collected from 208 (at time 1) and 159 (at time 2) full-time staff employed by private enterprises in Taiwan. The author tested hypotheses through the use of hierarchical multiple regression. The results showed that under horizontal individualism and vertical collectivism, the predictors of negative mental health (ie, somatic symptoms, anxiety and insomnia, social dysfunction and/or severe depression) were partially and almost completely achieved through the mediating effect of the negative attitudes toward emotional expression.

Hematologic toxicity assessment in solid tumor patients treated with cetuximab: a pooled analysis of 18 randomized controlled trials.

The role of cetuximab in treatment-related hematologic toxicity is not clear. We performed a meta-analysis of published randomized controlled trials (RCTs) to determine the overall risk of ≥grade 3 hematologic toxicity events (HTEs) associated with cetuximab. PubMed, EMBASE, and Web of Knowledge databases as well as abstracts presented at American Society of Clinical Oncology conferences and ClinicalTrials.gov were searched to identify relevant studies. Eligible studies included RCTs in which cetuximab in combination with chemotherapy or chemoradiotherapy was compared with chemotherapy or chemoradiotherapy alone. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. A total of 11,234 patients with a variety of advanced solid tumors from 18 RCTs were included in the meta-analysis. Compared with chemotherapy alone, the addition of cetuximab was associated with increased risks of ≥grade 3 leucopenia/neutropenia and anemia events in colorectal cancer, with RRs of 1.16 (95% CI 1.05-1.27, p=0.002; incidence, 21.0 vs. 18.0%) and 2.67 (95% CI 1.53-4.65, p=0.01; incidence, 4.0 vs. 2.0%), respectively. Cetuximab was also associated with an increased risk of leucopenia/neutropenia in nonsmall cell lung cancer (NSCLC) (RR: 1.15; 95% CI 1.08-1.22, p<0.01). Additionally, K-ras wild type in the case of colorectal cancer patients was more vulnerable to ≥grade 3 leucopenia or neutropenia events in cetuximab group (RR: 1.31; 95% CI 1.11-1.54, p=0.001). With present evidence, cetuximab in conjunction with chemotherapy or chemoradiotherapy, compared with chemotherapy or chemoradiotherapy alone, was associated with increased slight risk of ≥grade 3 HTEs, especially in colorectal cancer and NSCLC.

Acute colonic diverticulitis: diagnostic evidence, demographic and clinical features in three practice settings.

BACKGROUND AND AIMS: Diverticulitis is often diagnosed in outpatients, yet little evidence exists on diagnostic evidence and demographic/clinical features in various practice settings. We assessed variation in clinical characteristics and diagnostic evidence in inpatients, outpatients, and emergency department cases and effects of demographic and clinical variables on presentation features. METHODS: In a retrospective cohort study of 1749 patients in an integrated health care system, we compared presenting features and computed tomography findings by practice setting and assessed independent effects of demographic and clinical factors on presenting features. RESULTS: Inpatients were older and more often underweight/normal weight and lacked a diverticulitis past history and had more comorbidities than other patients. Outpatients were most often Hispanic/Latino. The classical triad (abdominal pain, fever, leukocytosis) occurred in 78 (38.6%) inpatients, 29 (5.2%) outpatients and 34 (10.7%) emergency department cases. Computed tomography was performed on 196 (94.4%) inpatients, 110 (9.2%) outpatients and 296 (87.6%) emergency department cases and was diagnostic in 153 (78.6%) inpatients, 62 (56.4%) outpatients and 243 (82.1%) emergency department cases. Multiple variables affected presenting features. Notably, female sex had lower odds for the presence of the triad features (odds ratio [95% CI], 0.65 [0.45-0.94], P<0.05) and increased odds of vomiting (1.78 [1.26-2.53], P<0.01). Patients in age group 56 to 65 and 66 or older had decreased odds of fever (0.67 [0.46-0.98], P<0.05) and 0.46 [0.26-0.81], P<0.01), respectively, while > / =1 co-morbidity increased the odds of observing the triad (1.88 [1.26-2.81], P<0.01). CONCLUSION: There was little objective evidence for physician-diagnosed diverticulitis in most outpatients. Demographic and clinical characteristics vary among settings and independently affect presenting features.

Impact of mental health comorbidities on health care utilization and expenditure in a large US managed care adult population with ADHD.

OBJECTIVE: To estimate the health resource use (HRU) and expenditure of adult patients with attention deficit/hyperactivity disorder (ADHD) subsequently diagnosed with one or more mental health (MH) comorbidities. METHODS: Using Kaiser Permanente Southern California electronic medical records (January 1, 2006, to December 31, 2009), we identified adults with at least one ADHD diagnosis and at least two subsequent prescriptions fills for ADHD medication. The date of first MH comorbidity diagnosis after the index ADHD diagnosis was defined as the index transition date. Continuous eligibility 12 months before and after the index transition date was required. For patients with multiple transitions (≥2), the post-transition period reflected the 12 months after the second transition. HRU for all-cause inpatient, outpatient, emergency department, behavioral therapy, overall prescription fill counts, and ADHD-specific prescription fill counts and mean patient expenditure (2010 US $) were estimated. Generalized estimating equations were used to evaluate differences in HRU and expenditure between the pre- and post-transition periods, respectively. RESULTS: Of the 3809 patients with ADHD identified, 989 (26%) had at least one transition (n = 357 single and n = 632 multiple). From the pre- to the post-transition period, for single transition cohort, all HRU increased significantly except for behavioral therapy. In the multiple transition cohort, all HRU increased significantly. Total expenditure increased by mean ± SE of $1822 ± $306 and $4432 ± $301 (both P < 0.0001) in the single and multiple transition cohorts, respectively. CONCLUSIONS: Twenty-six percent of patients with ADHD transitioned to MH comorbid diagnoses. Increased HRU and expenditure were associated with MH transitions. Identifying of patients with ADHD at risk for MH comorbidities may help to improve their outcomes.

Prevalence and incidence of adult attention deficit/hyperactivity disorder in a large managed care population.

OBJECTIVES: To estimate longitudinal trends in prevalence and incidence rates of adult ADHD 2006-2009. RESEARCH DESIGN AND METHODS: Kaiser Permanente Southern California (KPSC) electronic medical records were analyzed to assess prevalence and incidence rates for adult ADHD. Trends over time were estimated and compared using three case definitions (ADHD diagnosis only [DX], ADHD DX and ≥2 FDA-approved ADHD prescriptions [DX + RX], and ADHD DX and ≥1 behavioral therapy visit [DX + BT]). MAIN OUTCOME MEASURES: Prevalence and incidence rates of adult ADHD. RESULTS: Prevalence ranged from 151 (DX + RX) to 312 (DX) cases per 100,000 members in 2006, increasing to 239 (DX + RX) and 415 (DX) cases in 2009. Prevalence based on DX + BT declined from 185 in 2006 to 94 cases per 100,000 in 2009. In 2006, incidence ranged from 15 (DX + BT) to 68 (DX) cases per 100,000 person-years. Incidence rates remained stable throughout the study period. Stratified analyses based on DX + RX revealed only slight variations by gender, but sharp differences by age, with younger adults demonstrating a higher prevalence overall as well as dramatic increases over the study period. Prevalence was highest among Caucasians, increasing substantially across all race groups over time. LIMITATIONS: A limitation of this study is that incidence rates may not be representative of new cases if diagnoses existed prior to enrollment in KPSC. Similarly, prevalence rates may be affected if patients sought care outside of the health plan. CONCLUSIONS: Adult ADHD prevalence in this managed care organization appears low, but showed increasing prevalence and incidence rates over time.

Mediating toxic emotions in the workplace--the impact of abusive supervision.

AIM: This study explores whether abusive supervision can effectively predict employees' counterproductive work behaviour (CWB) and organisational citizenship behaviour (OCB) and the role of toxic emotions at work as a potential mediator of these relationships in nursing settings. BACKGROUND: Workplace bullying is widespread in nursing. Despite the growing literature on abusive supervision and employees' counterproductive work behaviour and organisational citizenship behaviour, few studies have examined the relationships between abusive supervision and these work behaviours from the viewpoint of the victimed employee's emotion process. METHODS: This study adopted a two-stage survey of 212 nurses, all of whom were employed by hospitals in Taiwan. Hypotheses were tested through the use of hierarchical multiple regression. RESULTS: The results showed that abusive supervision was positively associated with toxic emotions. Moreover, toxic emotions could effectively predict nurses' counterproductive work behaviour and organisational citizenship behaviour. Finally, it was found that toxic emotions partially mediated the negative effects of abusive supervision on both work behaviours. CONCLUSION: Toxic emotions at work are a critical mediating variable between abusive supervision and both counterproductive work behaviour and organisational citizenship behaviour. Hospital administrators can implement policies designed to manage events effectively that can spark toxic emotions in their employees. IMPLICATIONS FOR NURSING MANAGEMENT: Work empowerment may be an effective way to reduce counterproductive work behaviour and to enhance organisational citizenship behaviour among nurses when supervisors do not promote a healthy work environment for them.

Racial/ethnic differences in the use of biologic disease-modifying antirheumatic drugs among California Medicaid rheumatoid arthritis patients.

OBJECTIVE: To assess racial/ethnic differences in the use of biologic disease-modifying antirheumatic drugs (DMARDs) among California Medicaid (Medi-Cal) rheumatoid arthritis (RA) patients. METHODS: Medi-Cal patient level data for 5,385 DMARD recipients between ages 18 and 100 years with at least 1 diagnosis of RA (International Classification of Disease, Ninth Revision, Clinical Modification code 714.xx) and the use of 1 DMARD between January 1, 1998 and December 31, 2005 were collected. The outcome of interest was the choice of either standard DMARDs (methotrexate, lefluonomide, hydroxychloroquine, and sulfasalazine) or biologic DMARDs (adalimumab, etanercept, anakinra, and infliximab). A univariate analysis and logistic regression model were applied to examine the association of the choice of DMARD among different racial/ethnic groups. RESULTS: In the univariate analysis, biologic DMARD use was significantly associated with race/ethnicity (P < 0.001). In the multivariate logistic regression model, after adjusting for age, sex, insurance coverage, 12 comorbid conditions, RA-related drug prescription, RA-related inpatient stay, and rehabilitation visits, African Americans had 53% lower odds of receiving biologic DMARDs as compared to whites, whereas Hispanics had 36% increased odds of receiving biologic DMARDs as compared to whites. CONCLUSION: In this Medi-Cal population, with its racial diversity and relatively homogenous socioeconomic status and health care benefits, racial/ethnic differences were found in RA patients receiving biologic DMARDs.

Toxicity reduction in an industrial nitro-aromatic wastewater plant: an assessment and a proposed improvement.

In this study, the performance of a typical Chinese industrial nitro-aromatic wastewater project (operational capacity: 3,000 m(3)d(-1)) was evaluated using chemical properties and toxicity data. Additionally, the relationship between the removal of organic pollutants and toxicity reduction was investigated throughout the whole-process wastewater treatment. Current advanced treatment reduced the dissolved organic carbon by 40% compared with biologically treated wastewater effluent (BTWE), but the acute toxicity and early life-stage toxicity increased significantly. For instance, the acute toxicity of the current advanced treated wastewater was 450% greater than that of the untreated BTWE. With the aim of effectively decreasing the toxicity of the effluent, several efficient adsorption technologies were assessed and compared for further treatment of BTWE. Coagulation and/or oxidation coupled with activated carbon adsorption, hypercrosslinked resin adsorption, or MIEX(®) technology was helpful for improving chemical indices and reducing toxicity. Among these adsorption treatment technologies, hypercrosslinked resin adsorption was more effective at removing most of the toxicants than MIEX(®) technology, and it also had better regeneration efficiency and mechanical properties compared with activated carbon. Therefore, hypercrosslinked resin adsorption may be a promising technology for enhancing organic pollutant removal and toxicity reduction of BTWE from nitro-aromatic factories.

Rapid determination of aristolochic acids I and II in herbal products and biological samples by ultra-high-pressure liquid chromatography-tandem mass spectrometry.

Aristolochic acids (AAs) are a mixture of structural-related compounds, in which aristolochic acid I (AA I) and aristolochic acid II (AA II) are reported to be correlated with Aristolochic acid nephropathy (AAN). In this work, a rapid and sensitive ultra-high-pressure liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method was developed to determine AA I and AA II in herbal products and biological fluids. By using gradient elution with a mobile phase composed of a mixture of 10mM ammonium formate buffer (pH 3.0) and acetonitrile, AAs could be determined within 10 min. Under optimum UHPLC-MS/MS conditions, the limit of detections was 0.14 and 0.26 ng mL(-1) for AA I and AA II, respectively. Run-to-run repeatability and intermediate precision of peak area for AA I and AA II were less than 5.74% relative standard deviation (RSD). Accuracy was tested by spiking 10, 100 and 1000 ng mL(-1) in rat serum and the recoveries were within 76.5-92.9%. Matrix effects were within 78.8-127.7%. The developed method was successfully applied to determine AA I and AA II in several herbal products and to investigate their pharmacokinetic behavior in female Wister rats. The result shows that the developed UHPLC-MS/MS method is efficient, sensitive, and accurate for the determination of AA I and AA II in herbal products and biological samples.