Pediatric Residents' Procedural Competency Requirements: A National Needs Assessment of Program Directors and Chief Residents.

BACKGROUND: There is increased learner competition for a shrinking pool of procedural training opportunities and indications in pediatrics. This study aimed to describe pediatric residency program directors' (PDs) and chief residents' (CRs) perspectives about whether procedural requirements for pediatric residents should be reformed and individualized. METHODS: This was a survey-based, mixed methods study of PDs and CRs affiliated with the Association of Pediatric Program Directors (APPD). We used descriptive statistics to analyze demographics and perspectives, logistic regressions to examine individual and program factors, and thematic analysis for qualitative data. RESULTS: Forty-seven percent (95/203) of PDs and 16% (64/392) of CRs responded, representing APPD membership across program setting, size, and region (average standard mean deviation 0.28). Ninety-one percent of PD respondents considered one or more of the current Accreditation Council for Graduate Medical Education (ACGME) required procedures nonessential; 74% favored individualizing procedural training. CR responses mirrored PD responses. Program size, setting, and access to procedural teams did not significantly associate with likelihood to favor individualization. CONCLUSIONS: The majority of PD and CR respondents believe that current ACGME procedures should be reformed and individualized to future career goals. This change could allow maximization of limited time in residency in this era of decreased opportunity.

Cost-effectiveness analysis of tumor-infiltrating lymphocytes biomarkers guiding chemotherapy de-escalation in early triple-negative breast cancer.

BACKGROUND: To accelerate the clinical translation of tumor-infiltrating lymphocytes (TILs) biomarkers for guiding chemotherapy de-escalation in early-stage triple-negative breast cancer (TNBC), cost-effectiveness evidence is essential but has not been investigated. We intend to evaluate the cost-effectiveness of using TILs to guiding chemotherapy de-escalation in patients with early-stage TNBC from the perspective of the Chinese health service system. METHODS: The hybrid decision-tree-Markov model was designed to compare the cost-effectiveness of cytotoxic chemotherapy guided by whether TILs assay was performed in 50-year-old female patients with early-stage TNBC over a lifetime horizon. In Strategy (1), if TILs testing was performed, patients with TILs values exceeding 30% could be spared from chemotherapy. In Strategy (2), where no TILs testing was performed, all patients were administered chemotherapy following China's clinical practices. Based on the algorithm built by Guyot, the individual patient data were reconstructed from the published Kaplan-Meier curves, and the survival functions were calculated by parametric methods. Cost estimates were valued in Chinese yuan (as per rates in 2022). RESULTS: In 50-year-old female patients with early-stage TNBC, Strategy (1), which employs TILs testing to guide cytotoxic chemotherapy yielded an additional 0.47 quality-adjusted life years (QALYs) and saved 40,976 yuan, with an incremental cost-effectiveness ratio (ICER) of -87,182.98 yuan per QALY gained compared with Strategy (2). This indicates that compared with Strategy (2), Strategy (1) is the dominant scheme. The results were sensitive to utility parameters, discount rates, and treatment costs after relapse. At a willingness-to-pay threshold of 85,700 yuan (based on GDP per capita) per QALY, the probability of TILs being cost-effective was almost 100%. CONCLUSIONS: The application of biomarkers (TILs) to guide decisions for chemotherapy de-escalation is a cost-effective strategy for early-stage TNBC patients and deserves to be widely promoted in clinical practice.

Multi-scale analysis of the impacts of meteorology and emissions on PM2.5 and O3 trends at various regions in China from 2013 to 2020 3. Mechanism assessment of O3 trends by a model.

A multiscale analysis of meteorological trends was carried out to investigate the impacts of the large-scale circulation types as well as the local-scale key weather elements on the complex air pollutants, i.e., PM2.5 and O3 in China. Following accompanying papers on synoptic circulation impact and key weather elements and emission contributions (Gong et al., 2022a; Gong et al., 2022b), an emission-driven Observation-based Box Model (e-OBM) was developed to study the impact mechanisms on O3 trend and quantitatively assess the effects of variation in the emissions control over 2013-2020 for Beijing, Chengdu, Guangzhou and Shanghai. Compared with the original OBM, the e-OBM not only improves the performance to simulate the hourly O3 peak concentration in daytime, but also reasonably reproduces the maximum daily 8-hour average (MDA8) O3 concentrations in the four cities. Based upon the sensitivity experiments, it is found that the meteorology is the dominant driver for the MDA8 O3 trend, contributing from about 32 % to 139 % to the variations. From the mechanistic point of view, the variations of meteorology lead to the enhancement of atmospheric oxidation capacity and the acceleration of O3 production. Further evaluation to the emission changes in four cities shows that the O3-precursors relationships of the four cities have been changed from the VOC-limited regime in 2013 to the transition regime or near-transition regime in 2020. Though the NOx/VOCs ratios have been obviously decreased, the emission reductions up to 2020 were still not enough to mitigate O3 pollution in these cities. It is emphasized in this study that the strengthened control measures with maintaining a certain ratio of NOx and VOCs should be implemented to further curb the increasing trend of O3 in urban areas.

Utility estimations of different health states of patients with type I, II, and III spinal muscular atrophy in China: A mixed approach study with patient and proxy-reported data.

Introduction: Spinal muscular atrophy (SMA) is a rare autosomal-recessive neuromuscular disease. Health state utility values (HSUV) are used in health economic evaluation regarding the desirability of health outcomes such as a certain health state or change in health states over time. There is no utility data of Chinese patients with SMA. Materials and methods: Vignettes were developed for 10 pediatric neurologists to value the utility of Chinese patients with Type I SMA. A mixed patient/proxy derived approach using EQ-5D-Y-3L, EQ-5D-3L, and CHU9D was adopted to estimate the HSUV data of patients with Type II and III SMA, including 112 patients and 301 caregivers. Result: The utility of Type I SMA patients ranged from 0.19 to 0.72 with the health state improved from "permanent ventilation" to "walking". The utility of children patients with Type II and III SMA derived from EQ-5D-Y-3L ranged from 0.33 to 0.82 while that derived from CHU9D ranged from 0.46 to 0.75. The utility of adult patients with Type II and III SMA measured by EQ-5D-3L ranged from 0.30 to 0.83. Conclusion: The better health states the patients with SMA were in, the higher were the HSUV. The utilities derived from population with different age and disease subtypes were not statistically different when patients with SMA were in the same health states. We recommend further studies on the Chinese specific value set for EQ-5D-Y-3L and other PBMs for children to derive more robust utility data.

Assessment of the antimicrobial effects of sodium hypochlorite on Enterococcus faecalis by D2O-labeled single-cell Raman micro-spectroscopy.

OBJECTIVES: To systematically evaluate the feasibility of D2O-labeled single-cell Raman micro-spectroscopy in drug resistance research and test the susceptibility of Enterococcus faecalis (E. faecalis)to sodium hypochlorite. METHODS: 1) The growth of E. faecalis in different doses of D2O and the regularity of D2O intake were evaluated through absorbance measurement and D2O-labeled single-cell Raman micro-spectroscopy to examine the universality of D2O-labeled single-cell Raman micro-spectroscopy in bacterial resistance research. 2) Broth dilution method and absorbance measurement were performed to determine the minimum inhibitory concentration (MIC) of NaClO against E. faecalis and the MIC based on metabolic activity (MIC-MA) in vitro via D2O-labeled single-cell raman micro-spectroscopy. RESULTS: 1) The growth of E. faecalis was not significantly inhibited by ≤40% D2O in the medium. E. faecalis could actively metabolize D2O and exhibit a C-D ratio in specific areas of Raman micro-spectroscopy results. The C-D ratio of E. faecalis at the stationary phase was positively correlated with D2O concentration. 2) The MIC and MIC-MA of NaClO against E. faecalis were 0.45 and 0.9 g·L-1, respectively. The concentration of MIC-MA was twice that of MIC. CONCLUSIONS: D2O-labeled single-cell Raman micro-spectroscopy is important in screening antimicrobial agents and evaluating the efficacy of antimicrobial agents. It is suitable for evaluating the effect of drugs on bacterial metabolic activities. NaClO showed an effective antimicrobial activity against E. faecalis. E. faecalis ceased propagation yet remained highly metabolically active when it was exposed to NaClO at the MIC level. The metabolic activity of most cells was inhibited only when they were exposed to NaClO at the MIC-MA level.

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis.

Background: A previous study has shown that 81% of the COVID-19 patients had mild or moderate symptoms. However, most studies on the sequelae in COVID-19 patients focused on severe cases and the long-term follow-up studies on the health consequences in non-severe cases are limited. The current study aimed to assess the sequelae of COVID-19 in patients nearly 1 year after diagnosis with a particular focus on the recovery of patients with non-severe COVID-19. Methods: We enrolled 120 patients infected with SARS-CoV-2 discharged from Wuhan Union hospital west district (designated hospital for COVID-19) and Fangcang shelter hospitals between January 29, 2020 and April 1, 2020. All participants were asked to complete a series of questionnaires to assess their symptoms and quality of life and for psychological evaluation. Also, pulmonary function test, chest CT, 6-min walking test (6MWT), routine blood test, liver and kidney function tests, fasting blood glucose test, lipid test, and immunoglobulin G antibody test were performed to evaluate their health. Results: The mean age of the study population was 51.6 ± 10.8 years. Of the 120 patients, 104 (86.7%) were cases of non-severe COVID-19. The follow-up study was performed between November 23, 2020 and January 11, 2021, and the median time between the diagnosis and the follow-up was 314.5 (IQR, 296-338) days. Sleep difficulties, shortness of breath, fatigue, and joint pain were common symptoms observed during follow-up and nearly one-third of the non-severe cases had these symptoms. A total of 50 (41.7%) and 45 (37.5%) patients reported anxiety and depression, respectively. And 18.3% of the patients showed negative results in the IgG test at the follow-up, which correlated with the severity of the infection (R = 0.203, p = 0.026), and the proportion of IgG negative cases in non-severe COVID-19 patients was higher than that in the severe cases (20.2 vs. 6.3%). Pulmonary diffusion impairment was reported in 30 (26.1%) out of 115 patients, and 24 (24.2%) out of the 99 non-severe cases. The values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, vital capacity (VC), total lung capacity (TLC), and residual volume (RV) were less than the normal range in 1.7, 8.6, 0.9, 11.2, 7.0, and 0.9% of the patients, respectively. A total of 55 (56.7%) out of the 97 patients showed abnormal CT findings, including ground-glass opacities (GGO), bronchiectasis, nodules, lines and bands, and fibrosis. Furthermore, there was a correlation between all the SF-36-domain scores and the duration of hospitalization, pulmonary function, and a 6MWT. Conclusions: At the nearly 1-year follow-up, COVID-19 survivors still had multi-system issues, including those in the respiratory functioning, radiography, quality of life, and anxiety and depression. Moreover, non-severe cases also showed some sequelae and the proportion of IgG negative cases in the non-severe patients was higher than that in severe cases. Therefore, conducting follow-ups and preventing the reinfection of SARS-CoV-2 in this group is necessary.

Correlation Between Ophthalmology Market Saturation and Medicare Utilization Rates.

PURPOSE: To characterize usage of ophthalmologic services by Medicare Fee-For-Service (FFS) beneficiaries relative to geography-specific market saturation, demographics, and contextual factors DESIGN: Cross-sectional study METHODS: Data sets from Centers for Medicare & Medicaid Services, US Census Bureau, US Department of Agriculture, and Housing and Urban Development, were used to calculate county- and state-level ophthalmologic service usage, market saturation, and demographic characteristics. Negative binomial regression models were used to evaluate the association between results and demographic or population-specific variables. RESULTS: Ophthalmologic service usage ranged from 58.2% to 15.2%, whereas saturation ranged from 21,763 to 91.4 FFS beneficiaries per registered ophthalmologist. Usage was significantly associated with demographic characteristics in each geography: lower proportion of African American (P = .009), Hispanic (P < .001), and other race beneficiaries (P < .001), relative to white beneficiaries; a higher proportion of female (P < .001) relative to male; a higher proportion of adults having completed an associate degree or some college (P = .001), or holding a bachelor's degree or higher (P < .001), relative to a high school diploma; a lower proportion of adults in each geography experiencing poverty (P = .009), geographies with lower Multidimensional Deprivation Index (P < .001); a higher urban-influence code (P < .001). There was no significant correlation between the usage of ophthalmologic services and the geographic market saturation of ophthalmologists (Spearman rho, -0.030, P = .227). CONCLUSIONS AND RELEVANCE: Ophthalmologic service usage is significantly influenced by population demographics; however, increased provider density alone appears insufficient to promote the usage of eye care services.