Association between heatwaves and risk and economic burden of injury related hospitalizations in China.

BACKGROUND: Public health is greatly affected by heatwaves, especially as a result of climate change. It is unclear whether heatwaves affect injury hospitalization, especially as developing countries facing the impact of climate change. OBJECTIVES: To assess the impact of heatwaves on injury-related hospitalization and the economic burden. METHODS: The daily hospitalizations and meteorological data from 2014 to 2019 were collected from 23 study sites in 11 meteorological geographic zones in China. We conducted a two-stage time series analysis based on a time-stratified case-crossover design, combined with DLNM to assess the association between heatwaves and daily injury hospitalization, and to further assess the regional and national economic losses resulting from hospitalization by calculating excess hospitalization costs (direct economic losses) and labor losses (indirect economic losses). To determine the vulnerable groups and areas, we also carried out stratified analyses by age, sex, and region. RESULTS: We found that 6.542% (95%CI: 3.939%, 9.008 %) of injury hospitalization were attributable to heatwaves during warm season (May to September) from 2014 to 2019. Approximately 361,447 injury hospitalizations were attributed to heatwaves each year in China, leading to an excess economic loss of 5.173 (95%CI: 3.104, 7.196) billion CNY, of which 3.114 (95%CI: 1.454, 4.720) billion CNY for males and 4.785 (95%CI: 3.203, 6.321) billion CNY for people aged 15-64 years. The attributable fraction (AF) of injury hospitalizations due to heatwaves was the highest in the plateau mountain climate zone, followed by the subtropical monsoon climate zone and the temperate monsoon climate zone. CONCLUSIONS: Heatwaves significantly increase the disease and economic burden of injury hospitalizations, and vary across populations and regions. Our findings implicate the necessity for targeted measures, including raising public awareness, improving healthcare infrastructure, and developing climate resilience policies, to reduce the threat of heatwaves to vulnerable populations and the associated disease and economic burden.

Assessment and management of constipation in post-operative patients in the spinal surgery ward: a best practice implementation project.

INTRODUCTION AND OBJECTIVE: Constipation is a common complication following spinal surgery that can result in distension, abdominal pain, infection, and even intestinal perforation. This study reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards. METHODS: The project was conducted in the spinal surgery ward of a general tertiary hospital in Changsha City, China, from March to August 2022. We used the JBI Implementation Framework and the JBI Model of Evidence-Based Healthcare for audits and feedback. Data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. Seven audit criteria were developed based on the best practice recommendations summarized by JBI. A baseline audit was conducted with 20 nurses and 50 patients in the spinal surgery ward, and a follow-up audit was conducted using the same sample size and setting. RESULTS: The baseline audit revealed compliance below 46% for five of the seven criteria. Strategies developed to address poor compliance included educating nurses and patients, developing a post-operative constipation risk assessment sheet, organizing stakeholder focus group meetings, establishing a constipation management routine, and effective empowerment of nurses. The follow-up audit showed positive compliance results, with the highest rate for Criterion 7 (100%) and the greatest increase for Criterion 2 (from 0% to 78%). Furthermore, the incidence of post-operative constipation decreased from 48% to 16%. CONCLUSION: The project improved compliance with audit criteria, reduced the incidence of constipation, and enhanced the efficiency of quality management in the spinal surgery ward. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A186.

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Alien invasive plants have been found in the semi-arid region of Northeast China for a long time, but the overall invasion situation is rarely reported. In this study, we established a database of alien invasive plants in the semi-arid area of Northeast China through field investigation, specimen collection, research of specimen online information platform and literature. The results showed that there were 34 species of alien invasive plants belonging to 26 genera and 10 families in the semi-arid area of Northeast China, among which the Composite family had the largest number of richness, with 9 genera (34.6%) and 11 species (32.4%). There were 15 species (44.1%) in 11 genera (42.3%) of Legumes, Solanaceae and Gramineae. In all the alien invasive plants, 33 species were herbaceous plants, being overwhelmingly dominant (97.1%). There were both 7 species of countrywide invasive plants with invasive grade 1 and 2, each accounting for 20.6% of the total. The number of species with invasive grade 4 was the largest, 17 species, accounting for 50% of the total. The invasive plants originated in North America and Europe was the most, accounting for 64.7%, while those from South America, Asia and Africa accounted for 35.3%. Totally, 44.1% of all the invasive alien plants were intentionally introduced, while 55.9% were unintentionally introduced. In the semi-arid area of Northeast China, 81.3% of the counties (cities) had the distribution of alien invasive plants, and the invasion situation was very serious.

A Secondary Data Analysis of Technology Access as a Determinant of Health and Impediment in Social Needs Screening and Referral Processes.

Introduction: Although health systems increasingly integrate social needs screening and referrals into routine care, the effectiveness of these interventions and for whom they work remains unclear. Methods: Patients (N=4,608) seen in the emergency department were screened for social needs (e.g., transportation, housing, food) and offered an opportunity to receive outreach from community service specialists. Results: Among 453 patients with 1 or more social needs who requested assistance, outreach specialists connected with 95 (21.0%). Patients preferred to be contacted through their telephone (n=21, 60.2%), email (n=126, 28.0%), someone else's telephone (n=30, 6.7%), or first by telephone followed by email (n=23, 5.1%). Preferred contact method varied by patient age; endorsement of unmet transportation, housing, and utility needs; receipt of service outreach; and differences in emergency department utilization from the 6 months before the index visit to the 6 months after. Conclusions: Because limited access to a stable telephone or internet connection may prevent patients from connecting with resource referrals, social needs interventions may not benefit the most underserved populations who are at the highest risk of negative health outcomes. Future research should investigate whether communication preferences are an important indicator of needs and how to adapt social needs screening and referral processes so that they are more accessible to populations who may experience more frequent disruptions in methods utilized for digital communication.

[Pollution Characteristics and Risk Assessment of PAHs in the Soil of Wild Forsythia Suspensa in Shanxi].

Shanxi is one of the main producing areas of Forsythia suspensa in China. In order to explore the safety of the soil in the areas where Forsythia suspensa grows,70 surface (0-25 cm) soil samples were collected from the main growing areas of F. suspensa in the eastsouth of Shanxi Province in July 2017. The concentration and composition characteristics of 16 polycyclic aromatic hydrocarbons (PAHs) in the sample soils were analyzed using chemical extraction and gas chromatography-mass spectrometry (GC-MS). The diagnostic ratio method was used to determine the source of PAHs in the areas. The potential ecological risk was assessed by using the method of calculating the equivalent carcinogenic concentration of benzo[a]pyrene. The results showed that the average concentration of total PAHs (Σ16PAHs) in all of the soil samples was 1.85 µg·g-1, which was dominated by three ring number PAHs, accounting for 76.7% of the total PAHs. The detection rates of phenanthrene (Phe) and anthracene (Ant) were both 100% of all the sample sites. The soil PAHs in the wild F. suspensa growing areas mainly originated from coal, biomass burning, and motor vehicle exhaust emissions, which resulted from air transport and sedimentation pathways. In all of the sample sites, the concentration of Σ16PAHs the limit standard level (0.2 µg·g-1) of Maliszewska-Kordybach for agricultural soil pollution and exceeded the soil heavy pollution level limit value (1.0 µg·g-1) in 41.4% of the sample sites. The concentration of BaP was above the risk control standard for soil contamination of agricultural land (0.55 µg·g-1) in 10% of all the soil samples. A total of 11.4% of the sample soil ΣBaPeq16PAHs and ΣBaPeq8BPAHs exceeded the agricultural soil screening value (0.55 µg·g-1). These results indicate that the contamination of PAHs was at a detectable level in the soil of wild F. suspensa growing in Shanxi, and thus their potential ecological risks should not be ignored. It is necessary to enhance the research regarding these areas to ensure the safe production of medicinal plants.

Assessment of the statistical optimization strategies and clinical evaluation of an artificial intelligence-based automated diagnostic system for thyroid nodule screening.

Background: Thyroid cancer is the most common endocrine cancer in the world. Accurately distinguishing between benign and malignant thyroid nodules is particularly important for the early diagnosis and treatment of thyroid cancer. This study aimed to investigate the best possible optimization strategies for an already-trained artificial intelligence (AI)-based automated diagnostic system for thyroid nodule screening and, in addition, to scrutinize the clinically relevant limitations using stratified analysis to better standardize the application in clinical workflows. Methods: We retrospectively reviewed a total of 1,092 ultrasound images associated with 397 thyroid nodules collected from 287 patients between April 2019 and January 2021, applying postoperative pathology as the gold standard. We applied different statistical approaches, including averages, maximums, and percentiles, to estimate per-nodule-based malignancy scores from the malignancy scores per image predicted by AI-SONIC Thyroid v. 5.3.0.2 (Demetics Medical Technology Ltd., Hangzhou, China) system, and we assessed its diagnostic efficacy on nodules of different sizes or tumor types with per-nodule analysis using performance metrics. Results: Of the 397 thyroid nodules, 272 thyroid nodules were overrepresented by malignant nodules according to the results of the surgical pathological examinations. Taking the median of the malignancy scores per image to estimate the nodule-based score with a cutoff value of 0.56 optimized for the means of sensitivity and specificity, the AI-based automated detection system demonstrated slightly lower sensitivity, significantly higher specificity (almost independent of nodule size), and similar accuracy to that of the senior radiologist. Both the AI system and the senior radiologist demonstrated higher sensitivity in diagnosing smaller nodules (≤25 mm) and comparable diagnostic performances for larger nodules. The mean diagnostic time per nodule of the AI system was 0.146 s, which was in sharp contrast to the 2.8 to 4.5 min of the radiologists. Conclusions: Using our optimization strategy to achieve nodule-based diagnosis, the AI-SONIC Thyroid automated diagnostic system demonstrated an overall diagnostic accuracy equivalent to that of senior radiologists. Thus, it is expected that it can be used as a reliable auxiliary diagnostic method by radiologists for the screening and preoperative evaluation of malignant thyroid nodules.

Cost-effectiveness of pneumococcal vaccines among adults aged 65 years and older in China: A comparative study.

We aimed to assess the cost-effectiveness and health benefits of 23-valent pneumococcal polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjunctive vaccine (PCV13), and PCV13-PPSV23 sequential vaccination strategies in preventing pneumonia and other pneumococcal diseases among the senior citizens (≥ 65 years) in China. The cost-effectiveness of pneumococcal vaccines compared to no vaccination was estimated using a decision-tree Markov model from a societal perspective. Parameters including epidemiological data, vaccine efficacy and cost data were obtained from previous studies. Cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) were presented as outcomes. Sensitivity analyses were performed to explore the uncertainty in the model. In the base-case analysis, compared with no pneumococcal vaccination, the ICERs of PPSV23, PCV13 and PCV13-PPSV23 are US$10,776.7/QALY, $9,193.2/QALY, and $15,080.0/QALY, respectively. PCV13 is the most cost-effective strategy and the only cost-effective strategy based on a threshold of the one-time national GDP per capita, whereas PPSV23 vaccine strategy is provided with the lowest cost, and PCV13-PPSV23 demonstrates the greatest impact on pneumococcal disease burden. Sensitivity analyses reveal that the results are greatly influenced by serotype coverage, vaccine efficacy, CAP incidence and vaccine prices. The PCV13 vaccination for Chinese seniors is more cost-effective than PPSV23 vaccination and PCV13-PPSV23 sequential vaccination.

Offering transportation services to economically disadvantaged patients at a family health center: a case study.

It has been established that high no-show rates of publicly supported health systems in economically depressed areas are largely due to a lack of inexpensive, reliable transportation. The purpose of this paper is to determine the financial feasibility of offering transportation and investigate the net cost savings by reducing no-show rates. The approach starts with a data analysis on 636 patients at the Family Health Center (FHC) in San Antonio, Texas, followed by logistic regression to determine the impact of various transportation factors on cancellations/no-shows and late arrivals. We then investigate the costs savings that could be realised by reducing the no-show rate from 24.3% by up to 60%. Finally, we analyse the expenses that would be incurred should the FHC provide transportation. The full analysis indicates a cost reduction of more than $15,000 per month can be achieved when the no-show rate is reduced by 25% down to 18.2%.

Associated factors with patient-reported unmet food needs among emergency department adult patients - A social need perspective.

Food insecurity is a complex problem affected by a number of factors from individual to societal. While individual-level demographic information and population-level social determinants of health (SDoH) are commonly used to identify patients at risk of food insecurity and to direct resources, a more comprehensive understanding of food insecurity requires integrating multi-level data. Our goal is to identify factors associated with food insecurity using patient, health system, and population level data. Between January 2019 and April 2020, we screened adult patients visiting an academic health sciences emergency department in Utah using a 10-item social needs screener. Patients' demographic data were linked to their screener responses. ZIP Code-level food-related SDoH such as accessibility to food providers, measured by geographic information systems methods, were assigned to patients. We then applied multilevel logistic regression modeling to identify factors associated with unmet food needs at two different levels-individual and ZIP Code. Unmet food needs were identified by asking patients if they felt there was not enough money for food in the last month, which grossly represents food insecurity. On a sample of 2,290 patients, 21.61% reported unmet food needs. Patient-reported housing, medical care, and utility needs along with Supplemental Nutrition Assistance Program participation and primary care provider utilization were highly associated with unmet food needs. Our efforts to identify the population at risk of food insecurity should be centered around patient-reported social needs. Our results suggest that addressing food insecurity in health care settings should include assessing social needs in primary care.

Quantitative assessment of changes in skeletal muscle injury by computer-aided analysis based on two-dimensional ultrasonography combined with contrast-enhanced ultrasonography and estimated by a modified semi-quantitative scoring system: An experimental study in a contusion model.

The aim of this study was to investigate the potential application of computer-aided analysis in the quantitative assessment of changes in skeletal muscle injury in the rabbit contusion model. Forty healthy rabbits were randomly divided into control (n = 5) and contusion (n = 35) groups. Rabbits in the contusion group were used to construct a muscle contusion model induced by a hammer hitting the right gastrocnemius, while the muscles of rabbits in the control group were non-injured. Two-dimensional ultrasound (2D US) and contrast-enhanced ultrasonography (CEUS) were performed on the rabbits that had received skeletal muscle contusion injury at 1 h, and 1, 3, 7, 14, 21 and 28 days after injury. Afterwards, a multiscale blob feature (MBF) method was used to extract the textural features from the 2D US, and the muscle injuries were quantitatively evaluated. The eight textural parameters of skeletal muscle analysed by MBF at 1 h, and 1, 3 and 7 days post-injury were found to be significantly higher in the contusion group than in the control group (p < .05). On Day 14, the textural parameters (e.g., greyscale mean [Mean], greyscale standard deviation [SDev], number of blobs, average size of blobs, homogeneity of distribution, periodicity of distribution [POD] and irregularity) were also evidently higher in the contusion group than in the control group (p < .05). On Day 28, Mean, SDev and POD in the contusion group were markedly higher (p < .05). After that, the microcirculation in the injured areas increased from Day 7 to Day 21 after injury, but decreased on Day 28 after injury. Thus the quantitative assessment of changes in skeletal muscle injury (SMI) using computer-aided analysis allowed us to describe the geometric features of injured muscle fibres and the microperfusion changes estimated by the modified semi-quantitative scoring system. This provides a scientific basis for the development of a novel approach for the evaluation of SMI and rehabilitation process.

Quality assessment and nutrient uptake and utilization in Luohan pine (Podocarpus macrophyllus) seedlings raised by chitosan spraying in varied LED spectra.

Target seedling cultivation pursues high quality and nutrient utilization instead of increasing growth and size. Exposure to light-emitting diode (LED) spectra is a well-known approach that can accelerate growing speed in tree seedlings, but it is still unknown whether seedling quality and nutrient utilization would be further improved with exogeneous polymer additives. Luohan pine (Podocarpus macrophyllus) seedlings were exposed to red (red-green-blue lights, 71.7%-13.7%-14.6%), green (26.2%-56.4%-17.4%), and blue (17.8%-33.7%-48.5%) LED-light spectra with half receiving leaf spray by chitosan oligosaccharides (Cos) at a rate of 2 ppm (w/w) and the other half receiving only water. The red-light spectrum promoted height, biomass, nutrient utilization, and quality assessment (DQI) in water-sprayed seedlings. The Cos spray enhanced fine-root growth, protein, and chlorophyll-b contents with elevated nutrient utilization and quality in seedlings in the green-light spectrum. DQI was found to have a positive relationship with phosphorus utilization. In conclusion, although the red-light LED spectrum can promote seedling growth, green light combined with Cos spray is recommended with the aim of maintaining seedling quality and increasing P utilization in Luohan pine seedlings.

Assessment of efficacy and safety of UV-based therapy for psoriasis: a network meta-analysis of randomized controlled trials.

BACKGROUND: Previous studies have proven that ultraviolet (UV)-based phototherapy, including UVB or psoralen UVA (PUVA), and their combination therapies, is effective for psoriasis treatment. OBJECTIVE: To compare the clinical efficacy and adverse events (AEs) of different UV-based phototherapy in psoriasis. METHODS: PubMed, Cochrane Library, Scopus and Embase were systematically searched. A random-effect model network meta-analysis with frequentist framework was performed, and results were reported as risk ratios (RRs) with 95% CI. The main variable for assessing effectiveness and safety are PASI 75 response and withdrawal due to AEs. Ranking effects were calculated by surface under the cumulative ranking analysis (SUCRA). RESULTS: Thirty-two studies involving a total of 2120 psoriasis patients were included in this network meta-analysis. Overall, no significant difference was reported with respect to withdrawal due to AEs or incidence of erythema. The relatively safest strategy was combined adjuvant therapy with PUVA (cPUVA), especially PUVA combined with calcium/vitamin D derivatives (RR 0.98, 95% CI [0.30-3.17], SUCRA = 80.8%). Both cPUVA (RR 1.39, 95% CI [1.00- 1.94]) and combined adjuvant therapy with UVB (cUVB) (RR 1.27, 95% CI [1.03-1.57]) showed a superior effect than the monotherapy of UVA or UVB, respectively. PUVA combined with vitamin D and its derivatives (PAVD) ranked highest concerning clinical effect and safety (clusterank value = 7393.2). CONCLUSIONS: The efficacy of all the combination therapy regimens was significantly superior to that of UV monotherapy, without significant differences in tolerability and safety. cUVB and cPUVA, and particularly the combination of UVA with calcium/vitamin D derivatives, was ranked as the overall safest and most effective phototherapy method.

Feasibility, usability, and acceptability of personalized web-based assessment of social network and daily social support interactions over time.

PURPOSE: The purpose of this study was to test the feasibility, usability, and acceptability of implementing a web-based method for collecting social network and longitudinal daily interaction data from cancer survivors and their caregivers. METHODS: Young adult and sexual/gender minority cancer survivors and their informal caregivers were recruited as dyads. Feasibility data, including enrollment and retention, were captured. Individual social network data were collected at baseline and used to individualize daily electronically delivered surveys assessing characteristics of daily social support-related interactions with identified network members for 14 days. Follow-up questionnaires assessing usability and exit interviews assessing acceptability were completed at the end of the 2-week study period. RESULTS: Fourteen survivor-caregiver dyads (28 individual participants) were enrolled and completed all baseline and final measures. Participants completed 85.2% of daily diary reports and reported excellent usability ratings. Acceptability was also high. In qualitative interviews, participants reported enjoying the daily reflection on social support facilitated by our methods. CONCLUSIONS: Our method has been shown to be highly feasible, usable, and acceptable. IMPLICATIONS FOR CANCER SURVIVORS: Developing better data collection tools can lead to better understanding of the social support cancer survivors and their caregivers receive, and how the social network structure facilitates or creates barriers to accessing this support.

Diffusion kurtosis imaging assessment of the response to radiotherapy in a VX2 bone tumor model: an animal study.

BACKGROUND: Neoadjuvant radiotherapy plays a vital role in the treatment of malignant bone tumors, and non-invasive imaging methods are needed to evaluate the response to treatment. PURPOSE: To assess the value of diffusion kurtosis imaging (DKI) for monitoring early response to radiotherapy in malignant bone tumors. MATERIAL AND METHODS: Treatment response was evaluated in a rabbit VX2 bone tumor model (n = 35) using magnetic resonance imaging (MRI), DKI, and histopathologic examinations. Subjects were divided into three groups: pre-treatment, post-treatment, and control groups. The post-treatment group was subclassified into good response and poor response groups according to the results of histopathologic examination. Apparent diffusion coefficient (ADC) and DKI parameters (mean diffusion coefficient [MD] and mean kurtosis [MK]) were recorded. The relationship between ADC, DKI parameters, and histopathologic changes after radiotherapy was determined using Pearson's correlation coefficient. The diagnostic performance of these parameters was assessed using receiver operating characteristic analysis. RESULTS: MD in the good response group was higher after treatment than before treatment (P < 0.001) and higher than that in the poor response group (P = 0.009). MD was highly correlated with tumor cell density and apoptosis rate (r = -0.771, P < 0.001 and r = 0.625, P < 0.001, respectively). MD was superior to other parameters for determining the curative effect of radiotherapy, with a sensitivity of 75.0%, specificity of 100.0%, and area under the curve of 0.917 (P < 0.001). CONCLUSION: The correlations between MD, tumor cell density, and apoptosis suggest that MD could be useful for assessing the early response to radiotherapy in rabbit VX2 malignant bone tumors.

Psychometric Evaluation of the Screener for Intensifying Community Referrals for Health.

This study examined the psychometric properties of the Screener for Intensifying Community Referrals for Health (SINCERE), a 10-item, low literacy screening tool developed to elicit social needs (e.g., transportation, housing) impacting patients' ability to engage in health-related activities. Patients seeking care in a tertiary care emergency department (ED) were invited to complete the SINCERE as part of registration processes, and were asked about their desire for follow-up by a partnering service provider offering low- and no-cost community resource referrals. A total of 5,081 patients completed screenings were included in this sample. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) identified and verified one-factor structure, suggesting that the SINCERE's 10-items are homogenous and measure one construct. The reliability of Cronbach's α and McDonald's ω were 0.89. Item Response Theory (IRT) suggested the SINCERE can effectively identify patients wishing referrals, or who have social needs. Moreover, patients who had two or more social needs were those willing to receive referrals after discharge. The SINCERE is a valid and reliable tool for measuring social needs for health, and should be considered as a screening option for practice interventions seeking to address social needs.

Automatic Volumetric Quality Assessment of Diffusion MR Images via Convolutional Neural Network Classifiers.

Diffusion Tensor Imaging (DTI) is widely used to find brain biomarkers for various stages of brain structural and neuronal development. Processing DTI data requires a detailed Quality Assessment (QA) to detect artifactual volumes amongst a large pool of data. Since large cohorts of brain DTI data are often used in different studies, manual QA of such images is very labor-intensive. In this paper, a deep learning-based tool is developed for quick automatic QA of 3D raw diffusion MR images. We propose a 2-step framework to automate the process of binary (i.e., 'good' vs 'poor') quality classification of diffusion MR images. In the first step, using two separately trained 3D convolutional neural networks with different input sizes, quality labels for individual Regions of Interest (ROIs) sampled from whole DTI volumes are predicted. In the second step, two distinct novel voting systems are designed and fine-tuned to predict the quality label of whole brain DTI volumes using the individual ROI labels predicted in the previous step. Our results demonstrate the validity and practicality of our tool. Specifically, using a balanced dataset of 6,940 manually-labeled 3D DTI volumes from 85 unique subjects for training, validation, and testing, our model achieves 100% accuracy via one voting system, and 98% accuracy via another voting system on the same test set.

Integrating social determinants of health screening and referral during routine emergency department care: evaluation of reach and implementation challenges.

BACKGROUND: Despite the importance of social determinants in health outcomes, little is known about the best practices for screening and referral during clinical encounters. This study aimed to implement universal social needs screening and community service referrals in an academic emergency department (ED), evaluating for feasibility, reach, and stakeholder perspectives. METHODS: Between January 2019 and February 2020, ED registration staff screened patients for social needs using a 10-item, low-literacy, English-Spanish screener on touchscreens that generated automatic referrals to community service outreach specialists and data linkages. The RE-AIM framework, specifically the constructs of reach and adoption, guided the evaluation. Reach was estimated through a number of approaches, completed screenings, and receipt of community service referrals. Adoption was addressed qualitatively via content analysis and qualitative coding techniques from (1) meetings, clinical interactions, and semi-structured interviews with ED staff and (2) an iterative "engagement studio" with an advisory group composed of ED patients representing diverse communities. RESULTS: Overall, 4608 participants were approached, and 61% completed the screener. The most common reason for non-completion was patient refusal (43%). Forty-seven percent of patients with completed screeners communicated one or more needs, 34% of whom agreed to follow-up by resource specialists. Of the 482 participants referred, 20% were reached by outreach specialists and referred to community agencies. Only 7% of patients completed the full process from screening to community service referral; older, male, non-White, and Hispanic patients were more likely to complete the referral process. Iterative staff (n = 8) observations and interviews demonstrated that, despite instruction for universal screening, patient presentation (e.g., appearance, insurance status) drove screening decisions. The staff communicated discomfort with, and questioned the usefulness of, screening. Patients (n = 10) communicated a desire for improved understanding of their unmet needs, but had concerns about stigmatization and privacy, and communicated how receptivity of screenings and outreach are influenced by the perceived sincerity of screening staff. CONCLUSIONS: Despite the limited time and technical barriers, few patients with social needs ultimately received service referrals. Perspectives of staff and patients suggest that social needs screening during clinical encounters should incorporate structure for facilitating patient-staff relatedness and competence, and address patient vulnerability by ensuring universal, private screenings with clear intent. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04630041 .

Phthalate metabolites: Characterization, toxicities, global distribution, and exposure assessment.

Phthalates are plasticizers in various products and regarded as endocrine disruptors due to their anti-androgen effects. Environmental occurrence and toxicities of parent phthalates have been widely reported, while the current state of knowledge on their metabolites is rarely summarized. Based on the available literature, the present review mainly aims to 1) characterize the potential metabolites of phthalates (mPAEs) using the pharmacokinetics evidences acquired via animal or human models; 2) examine the molecular and cellular mechanism involved in toxicity for mPAEs; 3) investigate the exposure levels of mPAEs in different human specimens (e.g., urine, blood, seminal fluid, breast milk, amniotic fluid and others) across the globe; 4) discuss the models and related parameters for phthalate exposure assessment. We suggest there is subtle difference in toxic mechanisms for mPAEs compared to their parent phthalates due to their alternative chemical structures. Human monitoring studies performed in Asia, America and Europe have provided the population exposure baseline levels for typical phthalates in different regions. Urine is the preferred matrix than other specimens for phthalate exposure study. Among ten urinary mPAEs, the largest proportions of di-(2-ethylhexyl) phthalate (DEHP) metabolites (40%), monoethyl phthalate (mEP) (43%) and DEHP metabolites/mEP (both 29%) were observed in Asia, America and Europe respectively, and mono-5-carboxy-2-ethypentyl phthalate was the most abundant compounds among DEHP metabolites. Daily intakes of phthalates can be accurately calculated via urinary mPAEs if the proper exposure parameters were determined. Further work should focus on combining epidemiological and biological evidences to establish links between phthalates exposure and biological phenotypes. More accurate molar fractions (FUE) of the urinary excreted monoester related to the ingested diesters should be collected in epidemiological or pharmacokinetic studies for different population.

Contributions and achievements on schistosomiasis control and elimination in China by NIPD-CTDR.

Being a zoonotic parasitic disease, schistosomiasis was widely spread in 12 provinces of Southern China in the 1950s, severly harming human health and hindering economic development. The National Institute of Parasitic Diseases at the Chinese Center for Diseases Control and Prevention, and Chinese Center for Tropical Diseases Research (NIPD-CTDR), as the only professional institution focussing on parasitic diseases at the national level, has played an important role in schistosomiasis control in the country. In this article, we look back at the changes of schistosomiasis endemicity and the contribution of NIPD-CTDR to the national schistosomiasis control programme. We review NIPD-CTDR's activities, including field investigations, design of control strategies and measures, development of diagnostics and drugs, surveillance-response of endemic situation, and monitoring & evaluation of the programme. The NIPD-CTDR has mastered the transmission status of schistosomiasis, mapped the snail distribution, and explored strategies and measures suitable for different types of endemic areas in China. With a good understanding of the life cycle of Schistosoma japonicum and transmission patterns of the disease, advanced research carried out in the NIPD-CTDR based on genomics and modern technology has made it possible to explore highly efficient and soft therapeutic drugs and molluscicides, making it possible to develop new diagnostic tools and produce vaccine candidates. In the field, epidemiological studies, updated strategies and targeted intervention measures developed by scientists from the NIPD-CTDR have contributed significantly to the national schistosomiasis control programme. This all adds up to a strong foundation for eliminating schistosomiasis in China in the near future, and recommendations have been put forward how to reach this goal.

Implementing a Social Determinants Screening and Referral Infrastructure During Routine Emergency Department Visits, Utah, 2017-2018.

PURPOSE AND OBJECTIVES: Emergency departments see a disproportionate share of low-income and uninsured patients. We developed and evaluated a process for identifying social needs among emergency department patients, for facilitating access to community-based resources, and for integrating clinical and community-based data. INTERVENTION APPROACH: We leveraged an academic-community partnership to develop a social needs screening tool and referral process. EVALUATION METHODS: In a 25-day feasibility trial incorporating rapid improvement cycles, emergency department staff screened 210 patients for social needs. Observational and interview notes were analyzed, and data were linked from patient screenings, the United Way of Salt Lake 2-1-1 consumer information system, and electronic health records. RESULTS: Domains uncovered during pilot testing included screening based on appearance or insurance; discomfort asking stigmatizing questions; and lack of clarity regarding the screening's purpose. During the trial, 61% (n = 129) of patients reported 1 or more need, 52% (n = 67) of whom wanted follow-up. Of the 65 patients with complete data who wanted referrals, 49% (n = 32) were ultimately reached by 2-1-1, which provided an average of 4 community referrals (eg, pharmacy programs, utility assistance). Service usage 3 months before versus 3 months after emergency department index dates demonstrated that patients with social needs experienced a significant increase in emergency department use compared with those without needs (1.07 vs 1.36, P = .03), while patients with no needs experienced increases in primary care visits compared with those patients with unmet needs (0.24 vs 0.56, P = .03). IMPLICATIONS FOR PUBLIC HEALTH: We demonstrated the ability to systematically screen and refer for emergency department patients' unmet social needs by using existing resources and to link screening results, service referral details, and health service data. However, our experiences demonstrate that widespread implementation efforts should thoughtfully address staff perceptions and patient communication challenges.