Health-related social needs, medical financial hardship, and mortality risk among cancer survivors.

BACKGROUND: Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health-related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. METHODS: Adult cancer survivors were identified from the 2013-2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2-3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. RESULTS: Among cancer survivors 18-64 years old (n = 5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65-79 years old (n = 5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18-64 years old, severe HRSNs was associated with increased mortality risk (hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36-2.93, p < .001; reference = minor/none) in adjusted analyses. Among cancer survivors 65-79 years old, 2-3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13-2.20, p = .007; reference = 0 domain). CONCLUSIONS: HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer.

The long-term spatio-temporal trends in burden and attributable risk factors of major depressive disorder at global, regional and national levels during 1990-2019: a systematic analysis for GBD 2019.

AIMS: Caused by multiple risk factors, heavy burden of major depressive disorder (MDD) poses serious challenges to public health worldwide over the past 30 years. Yet the burden and attributable risk factors of MDD were not systematically known. We aimed to reveal the long-term spatio-temporal trends in the burden and attributable risk factors of MDD at global, regional and national levels during 1990-2019. METHODS: We obtained MDD and attributable risk factors data from Global Burden of Disease Study 2019. We used joinpoint regression model to assess the temporal trend in MDD burden, and age-period-cohort model to measure the effects of age, period and birth cohort on MDD incidence rate. We utilized population attributable fractions (PAFs) to estimate the specific proportions of MDD burden attributed to given risk factors. RESULTS: During 1990-2019, the global number of MDD incident cases, prevalent cases and disability-adjusted life years (DALYs) increased by 59.10%, 59.57% and 58.57%, respectively. Whereas the global age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR) and age-standardized DALYs rate (ASDR) of MDD decreased during 1990-2019. The ASIR, ASPR and ASDR in women were 1.62, 1.62 and 1.60 times as that in men in 2019, respectively. The highest age-specific incidence, prevalence and DALYs rate occurred at the age of 60-64 in women, and at the age of 75-84 in men, but the maximum increasing trends in these age-specific rates occurred at the age of 5-9. Population living during 2000-2004 had higher risk of MDD. MDD burden varied by socio-demographic index (SDI), regions and nations. In 2019, low-SDI region, Central sub-Saharan Africa and Uganda had the highest ASIR, ASPR and ASDR. The global PAFs of intimate partner violence (IPV), childhood sexual abuse (CSA) and bullying victimization (BV) were 8.43%, 5.46% and 4.86% in 2019, respectively. CONCLUSIONS: Over the past 30 years, the global ASIR, ASPR and ASDR of MDD had decreased trends, while the burden of MDD was still serious, and multiple disparities in MDD burden remarkably existed. Women, elderly and populations living during 2000-2004 and in low-SDI regions, had more severe burden of MDD. Children were more susceptible to MDD. Up to 18.75% of global MDD burden would be eliminated through early preventing against IPV, CSA and BV. Tailored strategies-and-measures in different regions and demographic groups based on findings in this studywould be urgently needed to eliminate the impacts of modifiable risk factors on MDD, and then mitigate the burden of MDD.

A predictive model for patent ductus arteriosus seven days postpartum in preterm infants: an ultrasound-based assessment of ductus arteriosus intimal thickness within 24†h after birth.

Objectives: To develop a predictive model for patent ductus arteriosus (PDA) in preterm infants at seven days postpartum. The model employs ultrasound measurements of the ductus arteriosus (DA) intimal thickness (IT) obtained within 24 h after birth. Methods: One hundred and five preterm infants with gestational ages ranging from 27.0 to 36.7 weeks admitted within 24 h following birth were prospectively enrolled. Echocardiographic assessments were performed to measure DA IT within 24 h after birth, and DA status was evaluated through echocardiography on the seventh day postpartum. Potential predictors were considered, including traditional clinical risk factors, M-mode ultrasound parameters, lumen diameter of the DA (LD), and DA flow metrics. A final prediction model was formulated through bidirectional stepwise regression analysis and subsequently subjected to internal validation. The model's discriminative ability, calibration, and clinical applicability were also assessed. Results: The final predictive model included birth weight, application of mechanical ventilation, left ventricular end-diastolic diameter (LVEDd), LD, and the logarithm of IT (logIT). The receiver operating characteristic (ROC) curve for the model, predicated on logIT, exhibited excellent discriminative power with an area under the curve (AUC) of 0.985 (95% CI: 0.966-1.000), sensitivity of 1.000, and specificity of 0.909. Moreover, the model demonstrated robust calibration and goodness-of-fit (χ2 value = 0.560, p > 0.05), as well as strong reproducibility (accuracy: 0.935, Kappa: 0.773), as evidenced by 10-fold cross-validation. A decision curve analysis confirmed the model's broad clinical utility. Conclusions: Our study successfully establishes a predictive model for PDA in preterm infants at seven days postpartum, leveraging the measurement of DA IT. This model enables identifying, within the first 24 h of life, infants who are likely to benefit from timely DA closure, thereby informing treatment decisions.

Performance of feeding black soldier fly (Hermetia illucens) larvae on shrimp carcasses: A green technology for aquaculture waste management and circular economy.

Over 944 thousand tonnes of shrimp carcasses are produced worldwide during the shrimp production cycle, and black soldier fly larvae (BSFL) are a potential solution for this shrimp carcass accumulation. In this study, we evaluated the performance of BSFL feeding on shrimp carcasses. Six combinations of wheat bran and shrimp carcass powder (with replacement increments of 20 %) and one whole shrimp carcasses treatment were tested. The bioconversion rate (27.15 ± 3.66 %; p = 0.001), crude protein (55.34 ± 1.27 %; p < 0.001), and crude lipid (14.37 ± 1.86 %; p = 0.007) values of BSFL reared on whole shrimp carcasses were significantly higher than those of BSFL reared on wheat bran. Increasing the shrimp carcass amount in the feeding media resulted in significant increases in BSFL docosahexaenoic acid (with the highest value occurring for BSFL reared on whole shrimp carcasses; 1.46 ± 0.09 %; p < 0.001). Conversely, BSFL docosahexaenoic acid was not detected for BSFL reared on wheat bran. The detected heavy metal concentrations in BSFL were below the limits of the published international guidelines for animal feed. In the obtained BSFL, Salmonella was not detected, and the mould count was <10 CFU/g. The total bacterial count (Lg transformation) of obtained BSFL ranged from 7.88 to 8.07 CFU/g, and no significant differences among all treatments (p = 0.424). Overall, this study demonstrates that BSFL-based bioconversion presents a resource recovery technology for converting shrimp carcasses into high-value nutritional biomass.

Surface property and in vitro toxicity effect of insoluble particles given by protein corona: Implication for PM cytotoxicity assessment.

In vitro toxicological assessment helps explore key fractions of particulate matter (PM) in association with the toxic mechanism. Previous studies mainly discussed the toxicity effects of the water-soluble and organic-soluble fractions of PM. However, the toxicity of insoluble fractions is relatively poorly understood, and the adsorption of proteins is rarely considered. In this work, the formation of protein corona on the surface of insoluble particles during incubation in a culture medium was investigated. It was found that highly abundant proteins in fetal bovine serum were the main components of the protein corona. The adsorbed proteins increased the dispersion stability of insoluble particles. Meanwhile, the leaching concentrations of some metal elements (e.g., Cu, Zn, and Pb) from PM increased in the presence of proteins. The toxicity effects and potential mechanisms of the PM insoluble particle-protein corona complex on macrophage cells RAW264.7 were discussed. The results revealed that the PM insoluble particle-protein corona complex could influence the phagosome pathway in RAW264.7 cells. Thus, it promoted the intracellular reactive oxygen species generation and induced a greater degree of cell differentiation, significantly altering cell morphology. Consequently, this work sheds new light on the combination of insoluble particles and protein corona in terms of PM cytotoxicity assessment.

US Medicare Hospice and Palliative Medicine Physician Workforce and Service Delivery in 2008-2020.

CONTEXT: Despite clinical benefits of early palliative care, little is known about Medicare physician workforce specialized in Hospice and Palliative Medicine (HPM) and their service delivery settings. OBJECTIVES: To examine changes in Medicare HPM physician workforce and their service delivery settings in 2008-2020. METHODS: Using the Medicare Data on Provider Practice and Specialty from 2008 to 2020, we identified 2375 unique Medicare Fee-For-Service (FFS) physicians (15,565 physician-year observations) with self-reported specialty in "Palliative Care and Hospice". We examined changes in the annual number of HPM physicians, average number of Medicare services overall and by care setting, total number of Medicare FFS beneficiaries, and total Medicare allowed charges billed by the physician. RESULTS: The number of Medicare HPM physicians increased 2.32 times from 771 in 2008 to 1790 in 2020. The percent of HPM physicians practicing in metropolitan areas increased from 90% to 96% in 2008-2020. Faster growth was also observed in female physicians (52.4% to 60.1%). Between 2008 and 2020, we observed decreased average annual Medicare FFS beneficiaries (170 to 123), number of FFS services (467 to 335), and Medicare allowed charges billed by the physician ($47,230 to $37,323). The share of palliative care delivered in inpatient settings increased from 47% to 68% in 2008-2020; whereas the share of services delivered in outpatient settings decreased from 37% to 19%. CONCLUSION: Despite growth in Medicare HPM physician workforce, access is disproportionately concentrated in metropolitan and inpatient settings. This may limit receipt of early outpatient specialized palliative care, especially in nonmetropolitan areas.

Role of automated functional imaging and myocardial work in assessment of cardiac function in children with obstructive sleep apnea.

BACKGROUND: Early identification of abnormal left ventricular function in children with obstructive sleep apnea (OSA) is difficult using conventional echocardiographic indices and commonly used clinical markers of myocardial damage. We sought to investigate the value of automatic function imaging and myocardial work parameters in predicting early cardiac impairment in children having OSA with preserved left heart function and thereby identifying an optimal index for assessment. PATIENTS AND METHODS: Fifty-two children who presented with symptoms of nocturnal sleep snoring and open-mouth breathing and 34 healthy controls were enrolled in this study. Clinical characteristics and conventional echocardiographic data were collected, and image analysis was performed using two-dimensional speckle-tracking echocardiography to obtain left ventricular global longitudinal strain (GLS), post-systolic index, peak strain dispersion, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. RESULTS: Children with OSA had significantly lower GLS, GWI, and GCW than those without (P < 0.05). Additionally, GWI (ß = -32.87, 95% CI: -53.47 to -12.27), and GCW (ß = -35.09, 95% CI: -55.35 to -14.84) were found to correlate with the disease severity in the multiple linear regression mode, with worsening values observed as the severity of the disease increased. ROC curve analysis revealed that GCW was the best predictor of myocardial dysfunction, with an AUC of 0.809 (P < 0.001), and the best cutoff point for diagnosing myocardial damage in children with OSA was 1965.5 mmHg%, with a sensitivity of 92.5% and a specificity of 58.7%. CONCLUSIONS: GLS, GWI, and GCW were identified as predictors of myocardial dysfunction in children with OSA, with GCW being the best predictor.

Rapid inverse radiative transfer solver for multiparameter spectrophotometry without integrating sphere.

Significance: Multiparameter spectrophotometry (MPS) provides a powerful tool for accurate characterization of turbid materials in applications such as analysis of material compositions, assay of biological tissues for clinical diagnosis and food safety monitoring. Aim: This work is aimed at development and validation of a rapid inverse solver based on a particle swarm optimization (PSO) algorithm to retrieve the radiative transfer (RT) parameters of absorption coefficient, scattering coefficient and anisotropy factor of a turbid sample. Approach: Monte Carlo (MC) simulations were performed to obtain calculated signals for comparison to the measured ones of diffuse reflectance, diffuse transmittance and forward transmittance. An objective function has been derived and combined with the PSO algorithm to iterate MC simulations for MPS. Results: We have shown that the objective function can significantly reduce the variance in calculated signals by local averaging of an inverse squared error sum function between measured and calculated signals in RT parameter space. For validation of the new objective function for PSO based inverse solver, the RT parameters of 20% Intralipid solutions have been determined from 520 to 1000 nm which took about 2.7 minutes on average to complete signal measurement and inverse calculation per wavelength. Conclusion: The rapid solver enables MPS to be translated into easy-to-use and cost-effective instruments without integrating sphere for material characterization by separating and revealing compositional profiles at the molecular and particulate scales.

Turbofan Engine Health Assessment Based on Spatial-Temporal Similarity Calculation.

Aiming at the problem of the remaining useful life prediction accuracy being too low due to the complex operating conditions of the aviation turbofan engine data set and the original noise of the sensor, a residual useful life prediction method based on spatial-temporal similarity calculation is proposed. The first stage is adaptive sequence matching, which uses the constructed spatial-temporal trajectory sequence to match the sequence to find the optimal matching sample and calculate the similarity between the two spatial-temporal trajectory sequences. In the second stage, the weights of each part are assigned by the two weight allocation algorithms of the weight training module, and then the final similarity is calculated by the similarity calculation formula of the life prediction module, and the final predicted remaining useful life is determined according to the size of the similarity and the corresponding remaining life. Compared with a single model, the proposed method emphasizes the consistency of the test set and the training set, increases the similarity between samples by sequence matching with other spatial-temporal trajectories, and further calculates the final similarity and predicts the remaining use through the weight allocation module and the life prediction module. The experimental results show that compared with other methods, the root mean square error (RMSE) index and the remaining useful life health score (Score) index are reduced by 12.6% and 14.8%, respectively, on the FD004 dataset, and the RMSE index is similar to that in other datasets; the Score index is reduced by about 10%, which improves the prediction accuracy of the remaining useful life and can provide favorable support for the operation and maintenance decision of turbofan engines.

Automatic segmentation of the female pelvic floor muscles on MRI for pelvic floor function assessment.

Background: Pelvic organ prolapse (POP) is a pelvic floor dysfunction disease which affects females. The volume of pelvic floor muscle, especially the levator ani muscle (LAM), is an important indicator of pelvic floor function. However, muscle volume measurements depend on manual segmentation, which is clinically time-consuming. In this work, we present an efficient automatic segmentation model of pelvic floor muscles with magnetic resonance imaging (MRI) based on DenseUnet, to achieve muscle volume calculation and provide a reference for the assessment of pelvic floor function. Methods: A total of 49 female pelvic floor magnetic resonance (MR) series were retrospectively enrolled from the First Affiliated Hospital of Army Military Medical University between 2013 and 2021, including 21 normal participants and 28 patients with stage 1-4 POP. The LAM, internal obturator muscle (IOM), and external anal sphincter (EAS) were manually segmented. An improved DenseUnet was proposed for automatic segmentation of these 3 muscles. The Dice similarity coefficient (DSC), Hausdorff distance (HD), and average symmetrical surface distance (ASSD) were used to evaluate segmentation results. The segmentation performance of the improved DenseUnet was compared with those of standard DenseUnet, ResUnet, Unet++, and Unet. Results: The improved DenseUnet showed a good performance. The average DSC and standard deviation of the LAM, IOM, and EAS was 0.758±0.151, 0.716±0.173, and 0.810±0.147, respectively. The average HD was 22.41, 19.00, and 36.01 mm, respectively; and the average ASSD was 3.66, 3.80, and 5.23 mm, respectively. The average DSC and standard deviation of the normal group and POP group was 0.779±0.166 and 0.757±0.154, respectively. There was no significant difference between the muscle volume of the improved DenseUnet and manual segmentation (all P values >0.05). The average total segmentation time for 1 case was 10.18 s on our setup, which is much lower than the manual segmentation time of 45 minutes. Conclusions: The improved DenseUnet segments the pelvic floor muscles in MRI quickly and efficiently, with good precision and faster speed than those of manual segmentation. This can assist doctors in quickly segmenting pelvic floor muscles, calculating muscle volume, and further evaluating pelvic floor function.

Recovery of bio­sulfur and metal resources from mine wastewater by sulfide biological oxidation-alkali flocculation: A pilot-scale study.

Mine wastewater treatment using bio-sulfate reduction technology forms sulfur-containing wastewater that comprises sulfides (HS- and S2-) and metal ions. Bio­sulfur generated by sulfur-oxidizing bacteria in such wastewater is usually negatively charged hydrocolloidal particles. However, bio­sulfur and metal resource recovery are difficult using traditional methods. In this study, the sulfide biological oxidation-alkali flocculation (SBO-AF) method was investigated to recover the above resources, and to provide a technical reference for mine wastewater resource recovery and heavy metal pollution control. Specifically, the performance of SBO in forming bio­sulfur and the key parameters of SBO-AF were explored and then applied in a pilot-scale process to recover resources from wastewater. Results show that partial sulfide oxidation was achieved under a sulfide loading rate of 5.08 ± 0.39 kg/m3·d, dissolved oxygen of 2.9-3.5 mg/L and temperature of 27-30 °C. The average sulfide oxidation rate and sulfur selectivity ratio were 92.86 % and 90.22 %, respectively. At pH 10, metal hydroxide and bio­sulfur colloids co-precipitated through the precipitation catching and adsorption charge neutralization effect. The average manganese, magnesium and aluminum concentrations and turbidity in the wastewater were 53.93 mg/L, 522.97 mg/L, 34.20 mg/L and 505 NTU, respectively, and decreased to 0.49 mg/L, 80.65 mg/L, 1.00 mg/L and 23.33 NTU, respectively, after treatment. The recovered precipitate mainly contained sulfur, along with metal hydroxides. The average sulfur, manganese, magnesium and aluminum contents were 45.6 %, 29.5 %, 15.1 % and 6.5 %, respectively. Economic feasibility analysis and the above results show that SBO-AF has obvious technical and economic advantages in the recovery resources from mine wastewater.

The effect of cancer exemption in mandatory-access prescription drug monitoring programs among oncologists.

To address the opioid epidemic, some states mandate that prescribers review a state-run prescription drug monitoring program (PDMP) database before prescribing opioids. We used Medicare Part D prescriber data from 2013 (baseline) to 2019 to examine the association between state mandatory-access PDMPs, with and without a cancer exemption, and changes in the percent of oncologists' patients with any opioid fill per year, stratified by oncologists' baseline prescribing volume. Among 9746 medical or hematologic oncologists, the proportion of patients prescribed opioids declined after states implemented mandatory-access PDMPs without a cancer exemption overall (-0.49 percentage point, 95% confidence interval = -0.78 to -0.20 percentage point) and among those with above-median baseline prescribing, but not in states with a cancer exemption (-0.16 percentage point, 95% confidence interval = -0.50 to 0.18 percentage point) or with below-median baseline prescribing. Carefully designed mandatory-access PDMPs with cancer exemptions minimize unnecessary reductions in prescription opioid treatments among oncology patients in need of pain management.

Suicide Risk Among Individuals Diagnosed With Cancer in the US, 2000-2016.

Importance: Individuals diagnosed with cancer have elevated suicide risks compared with the general population. National estimates of suicide risks among individuals with cancer are lacking in the US, and knowledge about risk factors is limited. Objective: To provide contemporary estimates of suicide risks associated with cancer and to identify sociodemographic and clinical factors associated with suicide risks among individuals diagnosed with cancer. Design, Setting, and Participants: A population-based cohort of individuals diagnosed with cancer from January 1, 2000, to December 31, 2016, from 43 states in the US were followed up through December 31, 2016. Standardized mortality ratios (SMRs) were calculated adjusting for attained age at death, sex, and race and ethnicity groups to compare suicide risks in the cancer cohort vs the general US population. Cox proportional hazards regression models were fitted to identify cancer-specific risk factors of suicide among the cancer cohort. Analyses were conducted from October 27, 2020, to May 13, 2022. Main Outcomes and Measures: The main outcomes were risk of suicide death compared with the general population, measured by the standardized mortality ratio; and risk of suicide death associated with sociodemographic and clinical factors among individuals with cancer. Exposure: Diagnosis of cancer. Results: Among a total of 16 771 397 individuals with cancer, 8 536 814 (50.9%) were 65 years or older at cancer diagnosis, 8 645 631 (51.5%) were male, 13 149 273 (78.4%) were non-Hispanic White, and 20 792 (0.1%) died from suicide. The overall SMR for suicide was 1.26 (95% CI, 1.24-1.28), with a decreasing trend (from an SMR of 1.67 [95% CI, 1.47-1.88] in 2000 to 1.16 [95% CI, 1.11-1.21] in 2016). Compared with the general population, elevated suicide risks were observed in the cancer cohort across all sociodemographic groups, with particularly high SMRs among Hispanic individuals (SMR, 1.48; 95% CI, 1.38-1.58), Medicaid-insured individuals (SMR, 1.72; 95% CI, 1.61-1.84), Medicare-insured individuals 64 years or younger (SMR, 1.94; 95% CI, 1.80-2.07), or uninsured individuals (SMR, 1.66; 95% CI, 1.53-1.80). Moreover, the highest SMR was observed in the first 6 months after the cancer diagnosis (SMR, 7.19; 95% CI, 6.97-7.41). Among individuals diagnosed with cancer, relatively higher suicide risks (ie, hazard ratios) were observed for cancer types with a poor prognosis and high symptom burden in the first 2 years after diagnosis, including cancers of oral cavity and pharynx, esophagus, stomach, brain and other nervous system, pancreas, and lung. After 2 years, individuals with cancers subject to long-term quality-of-life impairments, such as oral cavity and pharynx, leukemia, female breast, uterine, and bladder, had higher suicide risks. Conclusions and Relevance: In this cohort study of individuals with cancer, elevated suicide risks remained despite a decreasing trend during the past 2 decades. Suicide risks varied by sociodemographic and clinical factors. Timely symptom management and targeted psychosocial interventions are warranted for suicide prevention in individuals diagnosed with cancer.

Vertical integration of oncologists and cancer outcomes and costs in metastatic castration-resistant prostate cancer.

BACKGROUND: The share of oncology practices owned by hospitals (ie, vertically integrated) nearly doubled from 2007 to 2017. We examined how integration between hospitals and oncologists affected care quality, outcomes, and spending among metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS: Using Surveillance, Epidemiology, and End Results-Medicare linked data and the Medicare Data on Provider Practice and Specialty, we identified Medicare beneficiaries who initiated systemic therapy for mCRPC between 2008 and 2017 (n = 9172). Primary outcomes included 1) bone-modifying agents (BMA) use, 2) time on systemic therapy, 3) survival, and 4) Medicare spending for the first 3 months following therapy initiation. We used a differences-in-differences approach to estimate the impact of vertical integration on outcomes, adjusting for patient and provider characteristics. RESULTS: The proportion of patients treated by integrated oncologists increased from 28% to 55% from 2008 to 2017. Vertical integration was associated with an 11.7 percentage point (95% confidence interval [CI] = 4.2 to 19.1) increased likelihood of BMA use. There were no satistically significant changes in time on systemic therapy, survival, or total per-patient Medicare spending. Further decomposition showed an increase in outpatient payment ($5190, 95% CI = $1451 to $8930) and decrease in professional service payment (-$4757, 95% CI = -$7644 to -$1870) but no statistically significant changes for other service types (eg, inpatient and prescription drugs). CONCLUSIONS: Vertical integration was associated with statistically significant increased BMA use but not with other cancer outcomes among mCRPC patients. For oncologists who switched service billing from physician offices to outpatient departments, there was no statistically significant change in overall Medicare spending in the first 3 months of therapy initiation. Future studies should extend the investigation to other cancer types and patient outcomes.

Self-interest is intuitive during opportunity (in)equity: Evidence from multivariate pattern analysis of electroencephalography data.

Fairness is a remarkable preference for human society, involving both outcome and opportunity equity. Most previous studies have explored whether fairness itself or self-interest is intuitive during outcome (in)equity. However, intuition during outcome (in)equity can be affected by both fairness level and actual payoff. Since opportunity (in)equity is only affected by the fairness level, we explored only intuition during fairness by measuring event-related potential responses to opportunity (in)equity. Participants played a social non-competitive two-person choice game with advantage opportunity inequity (AI), opportunity equity (OE), and disadvantage opportunity inequity (DI). The behavioral results suggested an opportunity inequity bias, with greater feelings of fairness and pleasantness during OE than during AI and DI. However, multivariate pattern analysis of the event-related potential (ERP) data suggested that AI, OE, and DI can be significantly distinguished from each other in relatively early windows overlapping with early positive negativity (EPN), and AI and DI can be significantly further distinguished during a relatively late window overlapping with late positive potential (LPP). Moreover, the conventional ERP analysis found that EPN amplitudes were more negative for AI than for OE and DI, as well as for OE than for DI, suggesting a pleasure bias for increased self-interest. LPP amplitudes were greater for DI than for AI and OE, suggesting enhanced sensitivity to DI. These results suggest that self-interest is intuitive during opportunity (in)equity.

Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act.

Despite advances toward universal health insurance coverage for children, coverage gaps remain. Using a nationwide sample of pediatric and adolescent cancer patients from the National Cancer Database, we examined effects of the Affordable Care Act (ACA) implementation in 2014 with multinomial logistic regressions to evaluate insurance changes between 2010-2013 (pre-ACA) and 2014-2017 (post-ACA) in patients aged younger than 18 years (n = 63 377). All statistical tests were 2-sided. Following the ACA, the overall percentage of Medicaid and Children's Health Insurance Program-covered patients increased (from 35.1% to 36.9%; adjusted absolute percentage change [APC] = 2.01 percentage points [ppt], 95% confidence interval [CI] = 1.31 to 2.71; P < .001), partly offset by declined percentage of privately insured (from 62.7% to 61.2%; adjusted APC = -1.67 ppt, 95% CI = -2.37 to -0.97; P < .001), leading to a reduction by 15% in uninsured status (from 2.2% to 1.9%; adjusted APC = -0.34 ppt, 95% CI = -0.56 to -0.12 ppt; P = .003). The largest declines in uninsured status were observed among Hispanic patients (by 23%; adjusted APC = -0.95 ppt, 95% CI = -1.67 to -0.23 ppt; P = .009) and patients residing in low-income areas (by 35%; adjusted APC = -1.22 ppt, 95% CI = -2.22 to -0.21 ppt; P = .02). We showed nationwide insurance gains among pediatric and adolescent cancer patients following ACA implementation, with greater gains in racial and ethnic minorities and those living in low-income areas.

Echocardiographic assessment of intimal thickness growth of patent ductus arteriosus in neonates and analysis of influencing factors.

The spontaneous closure rate of patent ductus arteriosus (PDA) is high, and the necessity of early intervention is debated. Quantitative echocardiographic assessment of the intima in PDA has not been reported. This study evaluated intimal thickness growth in neonatal cases of PDA via echocardiography and investigated its correlation with clinical factors. Seventy-three neonates were enrolled, and echocardiography was performed three times: within 24 h post-birth (first echo), 48 h after the first echo (second echo), and before discharge (third echo). According to PDA outcome, the neonates were divided into the PDA-open group (n = 18 cases), PDA-closure at second echo group (n = 32 cases), and non-PDA at first echo group (n = 23 cases). We measured the intimal thickness (IT1 and IT2 at first and second echo, respectively), lumen diameter of ductus arteriosus (D1 and D2 at first and second echo, respectively), IT1/D1 ratio, and intimal thickness growth rate (V). Correlations between echocardiographic indicators, perinatal factors, and clinical treatment were analyzed. On first echo, the PDA-open group showed a significantly lower IT1/D1 than the combined PDA-closure group (P < 0.05). On second echo, the PDA-open group showed a significantly lower IT2 and V than the PDA-closure group as well as a significantly higher D2 (P < 0.05). Smaller gestational age correlated with a larger D2 but smaller IT2 and V (P < 0.05) and a higher level of respiratory support within 72 h post-birth correlated with a larger D2 and smaller IT 2 (P < 0.05). Increasing oxygen demand within 72 h of birth correlated with a larger D1 and D2 (P < 0.05). Echocardiographic assessment of intimal thickness growth in PDA may provide an approach for predicting spontaneous PDA closure, thereby guiding decision-making regarding early intervention.

Value assessment for the restoration of industrial relics based on analytic hierarchy process: a case study of Shaanxi Steel Factory in Xi'an, China.

Concomitant with the promotion of industrial transformation, sustainable development strategies, and accelerated urbanization, there has been an increase in the number of industrial relic restoration projects. However, there are many disputes over the value and development of such industrial relic restoration projects. In this work, we identified three evaluation indicators based on a study of 106 industrial relic restoration projects in China. A value assessment model composed of five parts combining the Delphi method and analytic hierarchy process was established. The results show that an effective assessment of the value of industrial relic restoration projects can enable the effective use of green technology, reduce construction costs, protect industrial heritage, and inherit historical culture. In addition, there are many uncertain factors in developing these projects, such as brownfield pollution and dilapidated buildings, and appropriate renewal strategies can reduce safety risks as well as maximize the heritage value. As there is limited research assessing the value of industrial relic restoration projects in China, our study can serve as a reference for the value assessment of existing building restoration projects including historical blocks and livable villages.

Heavy Metals in Indoor Dust Across China: Occurrence, Sources and Health Risk Assessment.

In this study, the occurrence of heavy metals including cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb), and zinc (Zn) was investigated in indoor dust samples collected from 33 urban and rural areas in 11 provinces, China. The concentrations of the selected heavy metals were determined by an inductively coupled plasma mass spectrometry. The mean concentrations of Zn (166 mg kg-1), Pb (40.7 mg kg-1), Cr (19.8 mg kg-1), Cu (16.9 mg kg-1), and Cd (2.29 mg kg-1) in indoor dust are in low or moderate levels compared with other countries or regions. Cd was significantly enriched with the highest enrichment factor of 23.7, followed by Zn, Pb, Cu, and Cr, which were all lower than 3. The concentrations of Pb from Northern China (61.4 mg kg-1) were significantly higher than those from Southern China (8.88 mg kg-1). The concentrations of heavy metals in indoor dusts from rural areas were higher than those from urban areas except for Cu. The multivariate analysis of variance revealed that wall cover, fuel types, and air conditioning were dominant factors influencing the levels of heavy metals in indoor dust. Principal component analysis showed that outdoor dust and wall paint were main factors for the high concentrations of Cd, Pb, and Cr, accounting for 40.6% of the total contribution; traffic sources contributed to the high levels of Cu and Zn explained 20.6% of the total variance. The hazard indexes of selected heavy metals were less than 1 and carcinogenic risk value of Cr were between 1.01 × 10-6 and 1 × 10-4, indicating minor noncarcinogenic and carcinogenic risks from heavy metals in indoor dust for residents in China. Pb contributed 72.0% and 86.9% to the sum of noncarcinogenic risk values of selected heavy metals for adults and children, respectively. The carcinogenic risk value of Cr was approximately 13-fold higher than that of Cd for both adults and children. Children endured higher risks from heavy metals in indoor dust compared with adults.

A 10-Year Prevalence Survey and Clinical Features Analysis of Pressure Injury in a Tertiary Hospital in China, 2009-2018.

OBJECTIVE: To describe the 10-year prevalence of pressure injury (PI) in a tertiary hospital in China and determine the clinical characteristics of inpatients with PI. METHODS: The authors performed a retrospective analysis of PI cases extracted from the electronic health record of a tertiary hospital. The trend of PI prevalence over 10 years was described by estimating the average percent change (EAPC). Comorbidities were described with the Charlson Comorbidity Index (CCI). The clinical characteristics of PI were described using the number of cases and composition ratio. RESULTS: The overall prevalence of PI was 0.59% (5,838/986,404). From 2009 to 2018, the rate increased from 0.19% to 1.00% (EAPC = 22.46%). When stage I PIs were excluded, the prevalence of PI ranged from 0.15% to 0.79% (EAPC = 21.90%). The prevalence of hospital-acquired PI was 0.13%. Prevalence increased with age (Ptrend < .001) and was significantly higher in men than women (P < .001). Patients with PI were more widely distributed in the ICU (20.58%), vasculocardiology department (11.73%), gastroenterology department (10.18%), and OR (8.29%). Of patients with PI, 71.3% had a CCI score 4 or higher. CONCLUSIONS: The PI prevalence in the study facility increased rapidly over the study period. Pressure injuries among patients in the gastroenterology department and in the community deserve more attention. The CCI may be a good indicator for PI risk assessment.