Human health risk assessment of 6:2 Cl-PFESA through quantitative in vitro to in vivo extrapolation by integrating cell-based assays, an epigenetic key event, and physiologically based pharmacokinetic modeling.

Human health risk assessment of chemicals is essential but often relies on time-consuming and animal and labor-extensive procedures. Here, we develop a population-based, quantitative in vitro to in vivo extrapolation (QIVIVE) approach which depended on cellular effects monitored by in vitro assays, considered chemical internal concentration determined by LC-MS/MS, extrapolated into in vivo target tissue concentration through physiologically based pharmacokinetic (PBPK) modelling, and assessed populational health risk using in silico modelling. By applying this QIVIVE approach to 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA), as a representative of the emerging pollutants, we find that 6:2 Cl-PFESA disturbed lipid homeostasis in HepG2 cells through enhancement of lipid accumulation and fatty acid ß-oxidation, during which miR-93-5p served as a key event towards toxicity and thus, could serve as an efficient toxicity marker for risk assessment; further, the disruption potency of lipid homeostasis of 6:2 Cl-PFESA for the most of studied populations in China might be of moderate concern. Together, our approach improved the reliability of QIVIVE during human health risk assessment, which can readily be used for other chemicals.

Binding, activity and risk assessment of bisphenols toward farnesoid X receptor pathway: In vitro and in silico study.

Bisphenols have been identified as emerging environmental pollutants of high concern with potential adverse effects through interactions with receptor-mediated pathways. However, their potential mechanism of action and health risks through the farnesoid X receptor (FXR) pathway remain poorly understood. In the present study, we aimed to explore the potential disruption mechanism of bisphenols through the FXR signalling pathway. Receptor binding assays showed that bisphenols bound to FXR directly, with tetrabromobisphenol A (TBBPA; 34-fold), tetrachlorobisphenol A (TCBPA; 8.7-fold), bisphenol AF (BPAF; 2.0-fold), and bisphenol B (BPB; 1.9-fold) showing a significantly stronger binding potency than bisphenol A (BPA). In receptor transcriptional activity assays, bisphenols showed agonistic activity toward FXR, with BPAF, BPB, and bisphenol F (BPF) exhibiting higher activity than BPA, but TBBPA and TCBPA showing significantly weaker activity than BPA. Molecular docking results indicated that the number of hydrogen bonds dictated their binding strength. Intracellular concentrations of bisphenols were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS) in receptor activity assays, and it was found that the intracellular concentrations of TBBPA and TCBPA were 40-fold lower than those of BPA. Using the bioactivity concentrations in the FXR receptor activity assay, the liver concentrations of bisphenols were estimated using physiologically-based pharmacokinetic (PBPK) models through their serum concentrations, and the hazard quotient (HQ) values were calculated. The results suggest a potentially high concern for the risk of activating the FXR pathway for some populations with high exposure. Overall, these results indicate that bisphenols can bind to and activate FXR receptors, and that the activation mechanism is dependent on cellular uptake and binding strength. This study provides important information regarding the exposure risk of bisphenols, which can promote the development of environmentally friendly bisphenols.

Health risk assessment of cadmium exposure by integration of an in silico physiologically based toxicokinetic model and in vitro tests.

Cadmium (Cd) is a common environmental pollutant that can damage multiple organs, including the kidney. To prevent renal effects, international authorities have set health-based guidance values of Cd from epidemiological studies. To explore the health risk of Cd exposure and whether human equivalent doses (HEDs) derived from in vitro tests match the current guidance values, we integrated renal tubular epithelial cell-based assays with a physiologically based toxicokinetic model combined with the Monte Carlo method. For females, the HEDs (µg/kg/week) derived from KE2 (DNA damage), KE3 (cell cycle arrest), and KE4 (apoptosis) were 0.20 (2.5th-97.5th percentiles: 0.09-0.48), 0.52 (0.24-1.26), and 2.73 (1.27-6.57), respectively; for males the respective HEDs were 0.23 (0.10-0.49), 0.60 (0.27-1.30), and 3.11 (1.39-6.78). Among them, HEDKE4 (female) was close to the tolerable weekly intake (2.5 µg/kg/week) set by the European Food Safety Authority. The margin of exposure (MOE) derived from HEDKE4 (female) indicated that risks of renal toxicity for populations living in cadmium-contaminated regions should be of concern. This study provided a new approach methodology (NAM) for environmental chemical risk assessment using in silico and in vitro methods.

The path via pathway-based approaches towards safety assessment: A concise review.

For decades, chemical safety assessment has been proposed to shift from animal testing to in vitro testing systems in response to the call for the 3R. In Europe, the answer was to combine various information sources in integrated testing strategies (ITS); In the US, it was in 2007 when the landmark report by the National Research Council put forward a vision of in vitro toxicity testing paradigm. Since then, efforts to develop pathway-based assessment framework have been on the track. In 2010, systems biology brought out a conceptual framework called adverse outcome pathway (AOP), which took one step further from toxicity pathway to regulatory toxicology. Computational modeling, high-throughput screening, high-content omics have all been approached to facilitate this progress. This paper briefly reviewed the achievement of pathway-based chemical assessment since 2007, discussed potential pitfalls and challenges that mechanism-driven chemical assessment may undergo, and presented future perspectives of safety assessment that is to be based on computational system biology.

[Pollution Characteristics and Health Risk Assessment of Perfluorinated Compounds in PM2.5 in Zhejiang Province].

As typical new pollutants, perfluorinated compounds (PFCs) have been widely concerned by environmental workers in recent years. This study was carried out to investigate the pollution characteristics of perfluorinated compounds in atmospheric particulate matter (PM2.5) in Zhejiang Province. The chemical extraction of PM2.5 was performed using the accelerated solvent extraction (ASE) method with mixed dichloromethane and acetone (2:1). The chemical analysis was implemented by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The results showed that the daily average concentration of the sum of 12 PFCs (Σ12 PFCs) ranged from 131.63 pg·m-3 to 578.53 pg·m-3, which was slightly higher in winter compared to that in autumn. The concentrations of perfluorosulfonic acids (PFSAs) were much lower than those of perfluorocarboxylic acids (PFCAs). PFOS was the primary contaminant among PFASs, with an average concentration of 12.90 pg·m-3. The content of PFCAs exhibited a trend of PFOA>PFHxA>PFHpA, and the detection rate of long-chain PFCs was much lower than that of short-chain PFCs. The hysplit-4 model was used to calculate the QZ air mass transport trajectory. The results indicated that the backward trajectory of this point was significantly different along time, and the source of air mass rarely affected the concentration. The forward trajectory confirmed that PFCs can be transmitted over long distances in the atmosphere in a short time. The correlation coefficient between PFUdA and PFTeDA was evaluated to be 0.68, and that between PFHxS and PFOS was 0.66, suggesting the same sources of these chemicals. The content of PFCs was positively correlated with PM2.5, indicating that people might suffer from higher health risks on haze days. The risk quotient estimation implied no health risk of PFCs in PM2.5 in Zhejiang Province.

The application of instant evaluation based on information technology in anatomy teaching from China / Aplicación de evaluación instantánea basada en tecnología de la información en la enseñanza de la anatomía en China

SUMMARY: The information technology (IT) based "instant evaluation" is supported by IT, which allows instant evaluation of teaching phenomena based on certain evaluation criteria and provides instant feedback. In anatomy teaching, we explored and practiced the application of instant evaluation based on a platform called "Rain classroom." We found that IT-based instant evaluation had higher practicability and better student satisfaction, which could improve teaching efficiency during class time, help students improve learning methods, and promote knowledge mastery. Additionally, instant evaluation positively impacted teachers' evaluation ability and teaching skills.

RESUMEN: La "evaluación instantánea" basada en la tecnología de la información (TI) está respaldada por ésta y permite la evaluación instantánea de los fenómenos de enseñanza en función de ciertos criterios de evaluación proporcionando retroalimentación instantánea. En la enseñanza de la anatomía, exploramos y practicamos la aplicación de la evaluación instantánea basada en una plataforma llamada "Aula de lluvia" o Rain Classroom. Descubrimos que la evaluación instantánea basada en TI tenía una mayor practicidad y una mejor satisfacción de los estudiantes, lo que podría mejorar la eficiencia de la enseñanza durante el tiempo de clase, ayudar a los estudiantes a mejorar los métodos de aprendizaje y promover el dominio del conocimiento. Además, la evaluación instantánea tuvo un impacto positivo en la capacidad de evaluación y las habilidades de enseñanza de los maestros.

[Critical quality attribute assessment of big brand traditional Chinese medicine: modular identification of Tongren Niuhuang Qingxin Pills based on efficacy with chemical properties].

Identification of critical quality attribute(CQA) is crucial in quality control of Tongren Niuhuang Qingxin Pills(TRNHQXP). In this study, 661 active components in TRNHQXP were selected by liquid chromatography-mass spectrometry(LC-MS) and network pharmacology based on reported data and TCMSP, BATMAN-TCM, and TCMID databases, as well as mass spectrometry data, and 1 413 targets of the active components were obtained through SwissTargetPrediction. The 152 potential targets obtained from the intersection of predicted targets with 456 stroke targets underwent functional enrichment analysis by Metascape. The 27 Chinese medicinals in TRNHQXP were divided into four sets according to efficacies. Thirty-seven key targets in the blood-activating and stasis-resolving set and 41 in the tonifying set were screened out. On the basis of these potential key targets, 137 potential key CQA of TRNHQXP for stroke were reversely predicted. This study revealed the possible mechanism of TRNHQXP in treating stroke and established a modular identification method for the potential CQA of big brand traditional Chinese medicine(TCM) based on efficacies and chemical properties. Consequently, the CQA of TRNHQXP were identified by this method, which has provided a reference for the following experimental studies of CQA.

[Criticalquality attribute assessment of big brand traditional Chinese medicine: visualization method for quality control of Ginkgo Leaves Tablets based on spatial distribution uniformity].

Spatial distribution uniformity is the critical quality attribute(CQA) of Ginkgo Leaves Tablets, a variety of big brand traditional Chinese medicine. The evaluation of the spatial distribution uniformity of active pharmaceutical ingredients(APIs) in Ginkgo Leaves Tablets is important in ensuring their stable and controllable quality. In this study, hyperspectral imaging technology was used to construct the spatial distribution map of API concentration based on three prediction models, further to realize the visualization research on the spatial distribution uniformity of Ginkgo Leaves Tablets. The region of interest(ROI) was selected from each Ginkgo Leaves Tablet, with length and width of 50 pixels, and a total of 2 500 pixels. Each pixel had 288 spectral channels, and the number of content prediction data could reach 1×10~5 for a single sample. The results of the three models showed that the Partial Least Squares(PLS) model had the highest prediction accuracy, with calibration set determination coefficient R_(pre)~2 of 0.987, prediction set determination coefficient R_(pre)~2 of 0.942, root mean square error of calibration(RMSEC) of 0.160%, and root mean square error of prediction(RMSEP) of 0.588%. The classical least-squares(CLS) model had a greater prediction error, with the RMSEP of 0.867%. Multivariate Curve Resolution-Alternating Least Square(MCR-ALS) model showed the worst predictive ability among the three models, and it couldn't realize content prediction. Based on the prediction results of PLS and CLS models, the spatial distribution map of APIs concentration was obtained through three-dimensional data reconstruction. Furthermore, histogram method was used to evaluate the spatial distribution uniformity of API. The data showed that the spatial distribution of APIs in Ginkgo Leaves Tablets was relatively uniform. The study explored the feasibility of visualization of spatial distribution of Ginkgo Leaves Tablets based on three models. The results showed that PLS model had the highest prediction accuracy, and MCR-ALS model had the lowest prediction accuracy. The research results could provide a new strategy for the visualization method of quality control of Ginkgo Leaves Tablets.

[Critical quality attribute assessment of big brand traditional Chinese medicine: quality control method of Huangjing Zanyu Capsules based on chemical properties of characteristic components].

The chemical properties of characteristic components are significant to the manufacturing quality control of big brand traditional Chinese medicine. In this study, the Huangjing Zanyu Capsules were used as the research carrier to determine the content of five characteristic components including icraiin, emodin, schisandrin A, 2,3,5,4'-tetrahydroxystilbene-2-O-ß-D-glucoside, and osthole simultaneously by high-performance liquid chromatography(HPLC). The results showed that the chemical properties of five cha-racteristic components had a good linear relationship(r>0.999 9) within the quantitative range; the relative standard deviations(RSD) was 0.11%-2.0% and 0.25%-2.8% respectively for intra-day and inter-day precision; the RSD of repeatability was 1.8%-2.6%; the RSD of stability within 48 hours was 0.19%-2.8%, and the average recovery rate was 95.52%-100.1%, all meeting the requirements of pharmaceutical quantitative analysis. Additionally, the interval estimation method was used to directly reflect the distribution of samples with abnormal chemical properties of characteristic components, and the results showed ten samples were detected beyound the 95% control line of confidence level. Multivariate statistical process control(MSPC) method was used to monitor the abnormal samples of Huangjing Zanyu Capsules collectively, and the results showed that two samples were beyond the 95% control line of Hotelling's T~2 and three samples beyond the 95% control line of squared prediction error(SPE), indicating consistent quality control of Huangjing Zanyu Capsules. In conclusion, the proposed method is not only accurate and efficient but also a compensation for the traditional single-component quality control method, providing a scientific basis for the quality control in manufacturing process of Huangjing Zanyu Capsules. Furthermore, it could also serve as a reference method for the quality control in manufacturing big brand traditional Chinese medicine.

Blood lead levels of Chinese children from 1991 to 2020: Based on Monte Carlo simulation.

Chinese children have been exposed to high level of lead due to polluted air, dust, contaminated foods and water, etc. In this research, we investigated published blood lead levels (BLLs) reflecting 1,057,832 Chinese children aged at 0-12 and teenagers aged at 13-18 in the past 30 years (1991-2020). The data mining and estimation were performed innovatively by Monte Carlo simulation to remedy the skewed distribution-induced bias. The temporal trend of Chinese children's BLLs showed an obvious decrease in the past decades from 88.74 µg/L (Geometric SD = 4.09) during 1991-1995 to 27.32 µg/L (Geometric SD = 4.18) during 2016-2020. This study also indicated that children's BLLs of Yunnan, Guizhou, Shanxi were at relatively high levels and most provinces showed a downward trend. Chinese boys aged at 1-18 years old had higher BLLs (GM: 44.03 µg/L) compared to girls (GM: 41.32 µg/L) (p < 0.001). At different age groups, Chinese children's BLLs were 42.04 µg/L (1-3 years old), 52.88 µg/L (4-6 years old), 50.49 µg/L (7 and above years old), respectively. Although the BLLs of Chinese children exhibited a continuous declined trend in the past 30 years, it was still higher than that in developed countries, which indicated that more efforts are needed in children's BLLs control.

Model-informed risk assessment for Zika virus outbreaks in the Asia-Pacific regions.

Recently, Zika virus (ZIKV) has been recognized as a significant threat to global public health. The disease was present in large parts of the Americas, the Caribbean, and also the western Pacific area with southern Asia during 2015 and 2016. However, little is known about the factors affecting the transmission of ZIKV. We used Gradient Boosted Regression Tree models to investigate the effects of various potential explanatory variables on the spread of ZIKV, and used current with historical information from a range of sources to assess the risks of future ZIKV outbreaks. Our results indicated that the probability of ZIKV outbreaks increases with vapor pressure, the occurrence of Dengue virus, and population density but decreases as health expenditure, GDP, and numbers of travelers. The predictive results revealed the potential risk countries of ZIKV infection in the Asia-Pacific regions between October 2016 and January 2017. We believe that the high-risk conditions would continue in South Asia and Australia over this period. By integrating information on eco-environmental, social-economical, and ZIKV-related niche factors, this study estimated the probability for locally acquired mosquito-borne ZIKV infections in the Asia-Pacific region and improves the ability to forecast, and possibly even prevent, future outbreaks of ZIKV.

Assessment of the characteristics and quality of life of patients with uremic peripheral neuropathy
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OBJECTIVES: This study seeks to examine the characteristics and health-related quality of life (HRQL) of patients with uremic peripheral neuropathy. METHODS: Uremic patients undergoing maintenance hemodialysis (MHD) at our hospital were enrolled in this study. Data collection began in January 2011 and ended in June 2011. The patients were divided into two groups, the lesion group (110 cases) and the non-lesion group (168 cases), based on the presence or absence of peripheral neuropathy. To examine continuous changes in signs and symptoms in the lesion group, electromyography (EMG) was performed to measure sensory nerve conduction velocity (SCV), motor nerve conduction velocity (MCV), and distal latency (DL). Furthermore, HRQL was analyzed using the generic Short Form-36 (SF-36) questionnaire. RESULTS: Numbness and a burning sensation in the distal limbs were observed in the lesion group; in particular, these phenomena occurred in the upper limbs and the lower limbs in 3.6% (4/110) and 48.2% (53/110) of patients, respectively. With respect to motor symptoms, upper and lower limb weakness was observed in 1.8% (2/110) and 11.8% (13/110) of patients, respectively. Changes in physical signs were mainly evidenced by tendon reflexes, for example, areflexia, or tendon reflex loss was detected in the upper extremities, the knee tendon, and the Achilles tendon in 9.09% (10/110), 55.45% (61/110), and 35.5% (39/110) of patients, respectively. Relative to the non-lesion group, the lesion group had significantly slower average SCV and MCV as well as a longer average DL (p < 0.01 for all comparisons). Based on a clinical statistical analysis of SF-36 reports, scores on each scale were lower in the lesion group than in the non-lesion group. However, compared with the non-lesion group, the lesion group did not significantly differ with respect to overall SF-36 score (t = 1.896, p = 0.060) but did significantly differ with respect to bodily pain score (t = 5.301, p < 0.001). CONCLUSIONS: Typical symptoms of uremic peripheral neuropathy include numbness of the limbs and changes in tendon reflexes. In this study, sensory nerves were damaged more severely than motor nerves, and lower extremity lesions were more frequent than upper limb lesions. Clinicians should devote greater attention to patients with uremic peripheral neuropathy and strive to continuously improve these patients' quality of life.
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Perceptions and attitudes of health professionals in kenya on national health care resource allocation mechanisms: a structural equation modeling.

BACKGROUND: Health care resource allocation is key towards attaining equity in the health system. However, health professionals' perceived impact and attitude towards health care resource allocation in Sub-Saharan Africa is unknown; furthermore, they occupy a position which makes them notice the impact of different policies in their health system. This study explored perceptions and attitudes of health professionals in Kenya on health care resource allocation mechanism. METHOD: We conducted a survey of a representative sample of 341 health professionals in Moi Teaching and Referral Hospital from February to April 2012, consisting of over 3000 employees. We assessed health professionals' perceived impact and attitudes on health care resource allocation mechanism in Kenya. We used structural equation modeling and applied a Confirmatory Factor Analysis using Robust Maximum Likelihood estimation procedure to test the hypothesized model. RESULTS: We found that the allocation mechanism was negatively associated with their perceived positive impact (-1.04, p < .001), health professionals' satisfaction (-0.24, p < .01), and professionals' attitudes (-1.55, p < .001) while it was positively associated with perceived negative impact (1.14, p < .001). Perceived positive impact of the allocation mechanism was negatively associated with their overall satisfaction (-0.08) and attitude (-0.98) at p < .001, respectively. Furthermore, overall satisfaction was negatively associated with attitude (-1.10, p <.001). On the other hand, perceived negative impact of the allocation was positively associated with overall satisfaction (0.29, p <.001) but was not associated with attitude. CONCLUSION: The result suggests that health care resource allocation mechanism has a negative effect towards perceptions, attitudes and overall satisfaction of health professionals who are at the frontline in health care. These findings can serve as a crucial reference for policymakers as the Kenyan health system move towards devolving the system of governance.

Potential genotoxicity and risk assessment of a chlorinated flame retardant, Dechlorane Plus.

Dechlorane Plus (DP) is a chlorinated flame retardants that is globally ubiquitous. It is a potentially persistent organic pollutant (POPs) and an environmental toxin. However, the toxicity data is still limited and cannot provide a comprehensive environmental ecological risk assessment for DP. In this study, luminous bacteria, Vicia faba and Tetrahymena thermophila were chosen as testing organisms to investigate the acute toxicity and mutagenicity of DP. The concentration gradient of DP used in this study was chosen based on its environmental levels (experiments of luminous bacteria: 0.591, 2.95, 14.8, 73.8, 369 µg L(-1); micronucleus tests: 2.4, 12, 60, 300, 1500 µg L(-1); comet assay: 2.4, 12, 60, 300, 1500 µg L(-1)). For luminous bacteria, the relative luminosities were around 100% in treated groups, which suggested that there is no acute toxicity to luminous bacteria under the studied DP concentrations. The micronucleus test showed no significant difference between treatment and control groups, indicating no genotoxicity of DP. However the comet assay conducted with T. thermophila was relatively sensitive as there was a significant increase in DNA damage when the concentrations of DP increased from 300 to 1500 µg L(-1), while the lower concentrations failed to show any treatment-related differences. Therefore, DP may pose a potential risk at concentration⩾300 µg L(-1). The results provide scientific information on the ecological risk assessment of DP.

Assessment of immune cells and function of the residual spleen after subtotal splenectomy due to splenomegaly in cirrhotic patients.

BACKGROUND: The spleen is thought to be central in regulating the immune system, a metabolic asset involved in endocrine function. Overwhelming postsplenectomy infection leads to a mortality rate of up to 50%. However, there is still controversy on performing subtotal splenectomy as treatment of splenomegaly due to portal hypertension in cirrhotic patients. In the present study, immunocytes and the indexes of splenic size, hemodynamics, hematology and immunology in the residual spleen were analyzed to support subtotal splenectomy due to splenomegaly. RESULTS: In residual spleen, T lymphocytes mainly were focal aggregation in the periarterial lymphatic sheath. While B lymphocytes densely distributed in splenic corpuscle. In red pulp, macrophages were equally distributed in the xsplenic cord and adhered to the wall of splenic sinus with high density. The number of unit area T and B lymphocytes of splenic corpuscle and marginal zone as well as macrophages of red pulp were obviously increased in the residual spleen, while the number of macrophages didn't be changed among the three groups in white pulp. While there were some beneficial changes (i.e., Counts of platelet and leucocyte as well as serum proportion of CD3+ T cells, CD4+ T cells, CD8+ T cells were increased markedly; serum levels of M-CSF and GM-CSF were decreased significantly; The proportion of granulocyte, erythrocyte, megakaryocyte in bone marrow were changed obviously; But serum IgA, IgM, IgG, Tuftsin level, there was no significant difference; splenic artery flow volume, portal venous diameter and portal venous flow volume, a significant difference was observed in residual spleen) in the clinical indices. CONCLUSION: After subtotal splenectomy with splenomegaly due to portal hypertension in cirrhotic patients, the number of unit area T and B lymphocytes, and MØ in red pulp of residual spleen increased significantly. However, whether increase of T, B lymphocytes and MØs in residual splenic tissue can enhance the immune function of the spleen, still need further research to confirm.

[Role of socio-economy and management in sustainable transmission control of schistosomiasis in Taoyuan County, Hunan Province, China].

OBJECTIVE: To clarify the role of socio-economy and management in the sustainable schistosomiasis-control in Taoyuan County, an endemic area in hilly region, Hunan Province, China. METHODS: From 1996 to 2011, the data of socio-economy, the management of schistosomiasis control organizations, environment, and the changes in schistosomiasis prevalence were collected in Taoyuan County where schistosomiasis transmission had been controlled since 2008. A sampling survey of schistosomiasis prevalence of human and bovine was performed in 2011 to verify the current status of schistosomiasis transmission. All the data were analyzed statistically to evaluate the role of socio-economy and management in the sustainable schistosomiasis control. RESULTS: During the period from 1998 to 2012, the socio-economy including the residents' productive mode and daily life in Taoyuan County improved dramatically, but the recurrence risk of schistosomiasis endemic still existed due to the retuning of out-going workers and the migrating population. Moreover, the introduction of exotic species of plants and animals may increase the risk. The low running cost of schistosomiasis control organization as well as the efficient and adequate resource allocation in the county was in line with the national requirement to strengthen the rural grass-roots public health system. CONCLUSION: The harmonious development of socio-economy and the scientific and efficient health system in Taoyuan County are the key factors for the sustainable transmission control of schistosomiasis.

Time-scheduled delivery of computer health animations: "Installing" healthy habits of computer use.

The development of modern technology brings convenience to our lives but removes physical activity from our daily routines, thereby putting our lives at risk. Extended computer use may contribute to symptoms such as visual impairment and musculoskeletal disorders. To help reduce the risk of physical inactivity and promote healthier computer use, this study developed a time-scheduled delivery of health-related animations for users sitting in front of computers for prolonged periods. In addition, we examined the effects that the program had on the computer-related health behavior intentions and actions of participants. Two waves of questionnaires were implemented for data collection before and after intervention. The results showed that the animation program indeed had a positive effect on participants' healthy computer use actions in terms of breathtaking, body massages, and body stretches. It also helped to bridge the intention-action gap of the health behaviors. The development and evaluation were documented, and users' experiences/suggestions were discussed at the end.

How can activity-based costing methodology be performed as a powerful tool to calculate costs and secure appropriate patient care?

Previous studies have shown the advantages of using activity-based costing (ABC) methodology in the health care industry. The potential values of ABC methodology in health care are derived from the more accurate cost calculation compared to the traditional step-down costing, and the potentials to evaluate quality or effectiveness of health care based on health care activities. This project used ABC methodology to profile the cost structure of inpatients with surgical procedures at the Department of Colorectal Surgery in a public teaching hospital, and to identify the missing or inappropriate clinical procedures. We found that ABC methodology was able to accurately calculate costs and to identify several missing pre- and post-surgical nursing education activities in the course of treatment.

A structural equation modeling approach to examining the predictive power of determinants of individuals' health expenditures.

Understanding the determinants of health expenditures is essential for a fair and effective utilization profiling, particularly in the setting of capitation rates in risk-adjustment models. The objective of the study was to examine the relative importance of determinants in predicting future health expenditures, using structural equation modeling. Based on Andersen's behavioral system model, individual determinants along with prior utilization and measures of health status from 1994 are evaluated in a longitudinal design for theirpredictive powerfor health expenditures in 1995. A total of 4,255 policy-holders enrolled in three health plans at Trigon BlueCross/BlueShield of Virginia who responded to a mail survey were included for analysis. Person-level annual charges for health services utilization were used as the dependent variable. Five health scales were excerpted from Health Survey SF-36 to represent an individual's health status. Excluding prior utilization in 1994, health status (gamma = -0.19, p < 0.001) and having diabetes (gamma = 0.08, p < 0.001) are two statistically significant predictors of health expenditures in 1995. Including prior utilization, both health status (gamma = -0.15, p < 0.001) and prior utilization (gamma = 0.15, p < 0.001) are the most important predictors, followed by having diabetes (gamma = 0.08, p < 0.001). Health status is a powerful predictor offuture health expenditures, even when prior utilization is controlled.