Pregnant women with chronic hepatitis B virus infection at the assessment of tenofovir disoproxil fumarate prescription: Baseline characteristics of a prospective cohort study in Vietnam.

Objectives: We aimed to determine epidemiological characteristics and serologic markers among chronically hepatitis B virus (HBV)-infected pregnant women during the assessment of tenofovir disoproxil fumarate (TDF) prescription in Vietnam. Methods: We consecutively recruited 375 pregnant women with chronic HBV (cHBV) infection at week 25±2 of pregnancy, at which time they were assessed for TDF use as pre-prophylaxis and/or pre-treatment at the Hospital for Tropical Diseases in southern Vietnam during December 2019-April 2021. Demographic characteristics, serological biomarkers, and prenatal liver ultrasounds were obtained through interviews and reviews of medical records. Results: The median age of pregnant women was 29 years (interquartile range: 26-32). More than half of pregnant women (208/375; 55.5%) started TDF for prevention of mother-to-child transmission of HBV and/or treatment of chronic hepatitis B (CHB). Among the pregnant women initiating TDF, 96.1% (198/206) tested positive for hepatitis B e antigen, and 21.6% (45/208) had quantitative hepatitis B surface antigen (qHBsAg) ≤104 IU/mL. A relatively strong correlation between qHBsAg and HBV deoxyribonucleic acid (DNA) (r = 0.81; 95% CI: 0.76-0.85) was observed in pregnant women starting TDF. Conclusions: Our results demonstrate the high need for TDF prescription for prevention and/or treatment purposes in pregnant women with cHBV infection. Pregnant women with qHBsAg levels ≤104 IU/mL may prioritize HBV DNA testing over qHBsAg to decide on TDF prescription.

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer.

OBJECTIVES: This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients. METHODS: This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking. RESULTS: The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT. CONCLUSIONS: FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.

Validation of the COmprehensive Score for Financial Toxicity (COST) in Vietnamese patients with cancer.

INTRODUCTION: The COmprehensive Score for Financial Toxicity (COST) has proven to be a reliable tool for quantifying the impact of financial toxicity (FT) in patients with cancer in clinical and public health settings. However, the COST has not yet been validated in Vietnam. Therefore, we aimed to evaluate its reliability and validity among Vietnamese patients with cancer. METHODS: A cross-sectional study was conducted in a sample of 300 patients with cancer aged 27-95 years (mean: 58.5±11.2) in a tertiary hospital. The COST was translated into Vietnamese and English and adjusted to suit the local culture. Reliability was evaluated using Cronbach's alpha and McDonald's omega coefficients. The construct and convergent validities were also assessed. RESULTS: The COST demonstrated good internal consistency and reliability (Cronbach's alpha = 0.913; McDonald's omega = 0.915). The exploratory factor analysis revealed two factors that explained 64.9% of the variance. The adjusted fit indices indicated a good fit of the model (χ2 (39) = 67.78, p = 0.003; standardized root mean squared residual = 0.042; Tucker-Lewis index = 0.971; comparative fit index = 0.979; root mean square error of approximation = 0.061, 90% confidence interval = 0.035-0084). Higher COST scores were significantly correlated with higher health-related quality of life (EQ-5D-5L utility score: r = 0.21, p = 0.002; EQ VAS: r = 0.28, p < 0.001). Multivariate quantile regression analysis revealed that female sex, rural residence, and unstable job/unemployment were associated with lower COST scores. There was no statistically significant difference in other factors, including clinical factors (types of cancer, staging, and treatment modalities). CONCLUSIONS: The COST is reliable and valid, making it suitable for assessing FT severity in Vietnamese patients with cancer.

Willingness to Pay for a Quality-Adjusted Life Year among Gastrointestinal Cancer Patients at a Tertiary Hospital of Vietnam, 2022.

BACKGROUND: Gastrointestinal (GI) cancer burden in Asia is increasing, and Vietnam is no exception. Assessing the affordability of achieving a quality-adjusted life year (QALY) in gastrointestinal cancer patients Vietnam, as well as identifying predictors of willingness to pay (WTP) per QALY, is crucial to decision-making around medical intervention prioritization and performing medical technology assessments for these cancers. OBJECTIVES: Our study aimed to estimate WTP/QALY gained and associated factors among patients diagnosed with GI cancer at a tertiary hospital in Hue, Vietnam. METHODS: A cross-sectional descriptive study, using contingent valuation methodology was conducted among 231 patients at tertiary hospital in 2022. A double limited dichotomous choice and the EQ-5D-5L were utilised to estimate WTP and QALY, respectively. Quantile regression was applied to determine predictors of WTP/QALY. RESULTS: The mean and median maximum WTP/QALY gained among GI patients was $15,165.6 (42,239.6) and $4,365.6 (IQR: 1,586.5-14,552.0), respectively, which was equal to 3.68 times the 2022 gross domestic product (GDP) per capita in Vietnam.  Additionally, cancer severity was found to have a significant impact  on WTP per QALY gained, with a higher amount identified among patients with earlier stages of GI cancer. Furthermore, living in an urban dwelling and patients' treatment modalities were significantly associated with WTP/QALY. CONCLUSION: Evidence from our study can be used to inform how decision-makers in Vietnam to determine the cost-effectiveness of GI cancer interventions.

Applications of engineered biochar in remediation of heavy metal(loid)s pollution from wastewater: Current perspectives toward sustainable development goals.

Environmental pollution of heavy metal(loid)s (HMs) caused adverse impacts, has become one of the emerging concerns and challenges worldwide. Metal(loid)s can pose significant threats to living organisms even when present in trace levels within environmental matrices. Extended exposure to these substances can lead to adverse health consequences in humans. Removing HM-contaminated water and moving toward sustainable development goals (SDGs) is critical. In this mission, biochar has recently gained attention in the environmental sector as a green and alternative material for wastewater removal. This work provides a comprehensive analysis of the remediation of typical HMs by biochars, associated with an understanding of remediation mechanisms, and gives practical solutions for ecologically sustainable. Applying engineered biochar in various fields, especially with nanoscale biochar-aided wastewater treatment approaches, can eliminate hazardous metal(loid) contaminants, highlighting an environmentally friendly and low-cost method. Surface modification of engineered biochar with nanomaterials is a potential strategy that positively influences its sorption capacity to remove contaminants. The research findings highlighted the biochars' ability to adsorb HM ions based on increased specific surface area (SSA), heightened porosity, and forming inner-sphere complexes with oxygen-rich groups. Utilizing biochar modification emerged as a viable approach for addressing lead (Pb), cadmium (Cd), arsenic (As), mercury (Hg), and chromium (Cr) pollution in aqueous environments. Most biochars investigated demonstrated a removal efficiency >90 % (Cd, As, Hg) and can reach an impressive 99 % (Pb and Cr). Furthermore, biochar and advanced engineered applications are also considered alternative solutions based on the circular economy.

Shaping a greener future: The role of geopolitical risk, renewable energy and financial development on environmental sustainability using the LCC hypothesis.

The recent progress report of Sustainable Development Goals (SDG) 2023 highlighted the extreme reactions of environmental degradation. This report also shows that the current efforts for achieving environmental sustainability (SDG 13) are inadequate and a comprehensive policy agenda is needed. However, the present literature has highlighted several determinants of environmental degradation but the influence of geopolitical risk on environmental quality (EQ) is relatively ignored. To fill this research gap and propose a inclusive policy structure for achieving the sustainable development goals. This study is the earliest attempt that delve into the effects o of geopolitical risk (GPR), financial development (FD), and renewable energy consumption (REC) on load capacity factor (LCF) under the framework of load capacity curve (LCC) hypothesis for selected Asian countries during 1990-2020. In this regard, we use several preliminary sensitivity tests to check the features and reliability of the dataset. Similarly, we use panel quantile regression for investigating long-run relationships. The factual results affirm the existence of the LCC hypothesis in selected Asian countries. Our findings also show that geopolitical risk reduces environmental quality whereas financial development and REC increase environmental quality. Drawing from the empirical findings, this study suggests a holistic policy approach for achieving the targets of SDG 13 (climate change).

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews.

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Review on fate, transport, toxicity and health risk of nanoparticles in natural ecosystems: Emerging challenges in the modern age and solutions toward a sustainable environment.

In today's era, nanoparticles (NPs) have become an integral part of human life, finding extensive applications in various fields of science, pharmacy, medicine, industry, electronics, and communication. The increasing popularity of NP usage worldwide is a testament to their tremendous potential. However, the widespread deployment of NPs unavoidably leads to their release into the environmental matrices, resulting in persistence in ecosystems and bioaccumulation in organisms. Understanding the environmental behavior of NPs poses a significant challenge due to their nanoscale size. Given the current environmental releases of NPs, known negative consequences, and the limited knowledge available for risk management, comprehending the toxicity of NPs in ecosystems is both awaiting and crucial. The present review aims to unravel the potential environmental influences of nano-scaled materials, and provides in-depth inferences of the current knowledge and understanding in this field. The review comprehensively summarizes the sources, fate, transport, toxicity, health risks, and remediation solutions associated with NP pollution in aquatic and soil ecosystems. Furthermore, it addresses the knowledge gaps and outlines further investigation priorities for the sustainable control of NP pollution in these environments. By gaining a holistic understanding of these aspects, we can work toward ensuring the responsible and sustainable use of NPs in today's fast-growing world.

RP-HPLC-Based Flavonoid Profiling Accompanied with Multivariate Analysis: An Efficient Approach for Quality Assessment of Houttuynia cordata Thunb Leaves and Their Commercial Products.

Chemical profiling for quality monitoring and evaluation of medicinal plants is gaining attention. This study aims to develop an HPLC method followed by multivariate analysis to obtain HPLC profiles of five specific flavonoids, including rutin (1), hyperin (2), isoquercitrin (3), quercitrin (4), and quercetin (5) from Houttuynia cordata leaves and powder products and assess the quality of H. cordata samples. Eventually, we successfully established HPLC-based flavonoid profiles and quantified the contents of 32 H. cordata fresh leave samples and four powder products. The study also quantified the contents of those five essential flavonoids using an optimized RP-HPLC method. Peak areas of samples were then investigated with principal component analysis (PCA) and hierarchical cluster analysis (HCA) to evaluate the similarity and variance. Principal components in PCA strongly influenced by hyperin and quercetin showed that the samples were clustered into subgroups, demonstrating H. cordata samples' quality. The results of HCA showed the similarity and divided the samples into seven subgroups. In conclusion, we have successfully developed a practical methodology that combined the HPLC-based flavonoid profiling and multivariate analysis for the quantification and quality control of H. cordata samples from fresh leaves and powder products. For further studies, we will consider various environmental factors, including climate and soil factors, to investigate their effects on the flavonoid contents of H. cordata.

Multi-level assessment of the origin, feeding area and organohalogen contamination on salmon from the Baltic Sea.

The Atlantic salmon (Salmo salar) population in the Baltic Sea consists of wild and hatchery-reared fish that have been released into the sea to support salmon stocks. During feeding migration, salmon migrate to different parts of the Baltic Sea and are exposed to various biotic and abiotic stressors, such as organohalogen compounds (OHCs). The effects of salmon origin (wild or hatchery-reared), feeding area (Baltic Main Basin, Bothnian Sea, and Gulf of Finland), and OHC concentration on the differences in hepatic proteome of salmon were investigated. Multi-level analysis of the OHC concentration, transcriptome, proteome, and oxidative stress biomarkers measured from the same salmon individuals were performed to find the key variables (origin, feeding area, OHC concentrations, and oxidative stress) that best account for the differences in the transcriptome and proteome between the salmon groups. When comparing wild and hatchery-reared salmon, differences were found in xenobiotic and amino acid metabolism-related pathways. When comparing salmon from different feeding areas, the amino acid and carbohydrate metabolic pathways were notably different. Several proteins found in these pathways are correlated with the concentrations of polychlorinated biphenyls (PCBs). The multi-level analysis also revealed amino acid metabolic pathways in connection with PCBs and oxidative stress variables related to glutathione metabolism. Other pathways found in the multi-level analysis included genetic information processes related to ribosomes, signaling and cellular processes related to the cytoskeleton, and the immune system, which were connected mainly to the concentrations of Polychlorinated biphenyls and Dichlorodiphenyltrichloroethane and their metabolites. These results suggest that the hepatic proteome of salmon in the Baltic Sea, together with the transcriptome, is more affected by the OHC concentrations and oxidative stress of the feeding area than the origin of the salmon.

Looking beyond workforce parity: addressing gender inequity in pathology.

While women pathologists have made up over one-third of pathologists in the Australian workforce for over 15 years and at least 50% since 2019, they are under-represented in senior leadership roles, scientific publications, grant recipients, editorial boards, key presentations, and professional awards. This is not unique to pathology and is seen in the broader medical and academic community. Barriers to gender equity and equality in pathology, medicine and academia include gender stereotypes, gender-based discrimination, structural and organisational barriers as well as broader social and cultural barriers. A diverse leadership reflective of the whole professional body and the broader community is important for optimal health outcomes. It is the responsibility and moral duty of individuals and organisations to address any gender disparities, inequities, and inequalities by monitoring, identifying, and acting on gender biases and systemic barriers that hinder appropriate levels of representation by women.

A review of biosensor for environmental monitoring: principle, application, and corresponding achievement of sustainable development goals.

Human health/socioeconomic development is closely correlated to environmental pollution, highlighting the need to monitor contaminants in the real environment with reliable devices such as biosensors. Recently, variety of biosensors gained high attention and employed as in-situ application, in real-time, and cost-effective analytical tools for healthy environment. For continuous environmental monitoring, it is necessary for portable, cost-effective, quick, and flexible biosensing devices. These benefits of the biosensor strategy are related to the Sustainable Development Goals (SDGs) established by the United Nations (UN), especially with reference to clean water and sources of energy. However, the relationship between SDGs and biosensor application for environmental monitoring is not well understood. In addition, some limitations and challenges might hinder the biosensor application on environmental monitoring. Herein, we reviewed the different types of biosensors, principle and applications, and their correlation with SDG 6, 12, 13, 14, and 15 as a reference for related authorities and administrators to consider. In this review, biosensors for different pollutants such as heavy metals and organics were documented. The present study highlights the application of biosensor for achieving SDGs. Current advantages and future research aspects are summarized in this paper.Abbreviations: ATP: Adenosine triphosphate; BOD: Biological oxygen demand; COD: Chemical oxygen demand; Cu-TCPP: Cu-porphyrin; DNA: Deoxyribonucleic acid; EDCs: Endocrine disrupting chemicals; EPA: U.S. Environmental Protection Agency; Fc-HPNs: Ferrocene (Fc)-based hollow polymeric nanospheres; Fe3O4@3D-GO: Fe3O4@three-dimensional graphene oxide; GC: Gas chromatography; GCE: Glassy carbon electrode; GFP: Green fluorescent protein; GHGs: Greenhouse gases; HPLC: High performance liquid chromatography; ICP-MS: Inductively coupled plasma mass spectrometry; ITO: Indium tin oxide; LAS: Linear alkylbenzene sulfonate; LIG: Laser-induced graphene; LOD: Limit of detection; ME: Magnetoelastic; MFC: Microbial fuel cell; MIP: Molecular imprinting polymers; MWCNT: Multi-walled carbon nanotube; MXC: Microbial electrochemical cell-based; NA: Nucleic acid; OBP: Odorant binding protein; OPs: Organophosphorus; PAHs: Polycyclic aromatic hydrocarbons; PBBs: Polybrominated biphenyls; PBDEs: Polybrominated diphenyl ethers; PCBs: Polychlorinated biphenyls; PGE: Polycrystalline gold electrode; photoMFC: photosynthetic MFC; POPs: Persistent organic pollutants; rGO: Reduced graphene oxide; RNA: Ribonucleic acid; SDGs: Sustainable Development Goals; SERS: Surface enhancement Raman spectrum; SPGE: Screen-printed gold electrode; SPR: Surface plasmon resonance; SWCNTs: single-walled carbon nanotubes; TCPP: Tetrakis (4-carboxyphenyl) porphyrin; TIRF: Total internal reflection fluorescence; TIRF: Total internal reflection fluorescence; TOL: Toluene-catabolic; TPHs: Total petroleum hydrocarbons; UN: United Nations; VOCs: Volatile organic compounds.

Longitudinal Assessment of Cerebral Blood Volume Variation in Human Neonates Using Ultrafast Power Doppler and Diverging Waves.

Longitudinal assessment of brain perfusion is a critical parameter for neurodevelopmental outcome of neonates undergoing cardiopulmonary bypass procedure. In this study, we aim to measure the variations of cerebral blood volume (CBV) in human neonates during cardiac surgery, using Ultrafast Power Doppler and freehand scanning. To be clinically relevant, this method must satisfy three criteria: being able to image a wide field of view in the brain, show significant longitudinal CBV variations, and present reproducible results. To address the first point, we performed for the first time transfontanellar Ultrafast Power Doppler using a hand-held phased-array transducer with diverging waves. This increased the field of view more than threefold compared to previous studies using linear transducers and plane waves. We were able to image vessels in the cortical areas as well as the deep grey matter and temporal lobes. Second, we measured the longitudinal variations of CBV on human neonates undergoing cardiopulmonary bypass. When compared to a pre-operative baseline acquisition, the CBV exhibited significant variation during bypass: on average, + 20±3 % in the mid-sagittal full sector ( [Formula: see text]), - 11±3 % in the cortical regions ( [Formula: see text]) and - 10±4 % in the basal ganglia ( [Formula: see text]). Third, a trained operator performing identical scans was able to reproduce CBV estimates with a variability of 4% to 7.5% depending on the regions considered. We also investigated whether vessel segmentation could further improve reproducibility, but found that it actually introduced greater variability in the results. Overall, this study demonstrates the clinical translation of ultrafast power Doppler with diverging-waves and freehand scanning.

Near-Suicide Phenomenon: An Investigation into the Psychology of Patients with Serious Illnesses Withdrawing from Treatment.

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon "near-suicide". This study attempted to explore this phenomenon by examining how the seriousness of the patient's illness or injury and the subjective evaluation of the patient's and family's financial situation after paying treatment fees affect the final decision on the treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families' financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost-benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients' likelihood of making "near-suicide" decisions and improve social equality in the healthcare system.

Shorter Time to Treatment Is Associated With Improved Survival in Rural Patients With Breast Cancer Despite Other Adverse Socioeconomic Factors.

BACKGROUND: Cancer care in rural areas poses unique challenges, including access and proximity to care. This study examined differences in time to treatment initiation (TTI), a potential surrogate for access, and predictors of overall survival (OS) between rural and nonrural patients with breast cancer. METHODS: Women with stage I to III breast cancer diagnosed between 2004 and 2012 in facilities accredited by the National Cancer Database of Commission on Cancer (CoC) were included. Differences between rural and nonrural patients in demographics, disease and treatment characteristics, socioeconomic factors, and TTI were assessed by χ2 test. The effects on OS of age, insurance status, cancer center type, community median income, percentage of the community who had not graduated from high school, and TTI were assessed using Cox models. RESULTS: The study population was composed of 1,205,031 patients, 18,417 (2%) of whom were rural. Compared with nonrural patients, rural patients were more likely to be older, to be White, to receive care at nonacademic centers, to have government insurance or annual income less than $38,000, and to be less educated (P < .0001). Rural patients also had shorter median TTI (3 vs 4 weeks; P < .0001), which was associated with improved OS (P < .0001), and were more likely to have TTI less than 4 weeks and less than 8 weeks (P < .0001 for both). Shorter TTI (both <4 weeks vs 8 weeks and 4-8 weeks vs >8 weeks) was also associated with improved OS (P < .0001 for both). After adjusting for disease stage and demographic-, socioeconomic-, and treatment-related factors, rural status was associated with improved OS compared with nonrural status (HR, 0.92; 95% CI, 0.89-0.96; P < .0001). CONCLUSIONS: Despite several adverse demographic and socioeconomic factors, rural patients with breast cancer with access to CoC-accredited facilities had significantly shorter TTI and better OS compared with nonrural patients. The clinical significance of this is undetermined; however, these data suggest that improving TTI can mitigate disparities in rural cancer care.

Impact of Ventricular Geometric Characteristics on Myocardial Stiffness Assessment Using Shear-Wave Velocity in Healthy Children and Young Adults.

BACKGROUND: Diastolic myocardial stiffness (MS) can serve as a key diagnostic parameter for congenital or acquired heart diseases. Using shear modulus and shear-wave velocity (SWV), shear-wave elastography (SWE) is an emerging ultrasound-based technique that can allow noninvasive assessment of MS. However, MS extrinsic parameters such as left ventricular geometric characteristics could affect shear-wave propagation. The aims of this study were to determine a range of normal values of MS using SWE in age groups of healthy children and young adults and to explore the impact of left ventricular geometric characteristics on SWE. METHODS: Sixty healthy volunteers were recruited in the study and divided into 2 groups: neonates (0-1 months old, n = 15) and >1 month old (1 month to 45 years of age, n = 45). SWE was performed using the Verasonics Vantage systems with a phased-array ultrasound probe. The anteroseptal basal segment was assessed in two views. SWE was electrocardiographically triggered during the end-diastolic phase. Conventional echocardiography was performed to assess ventricular function and anatomy. Results are presented as stiffness values along with mean velocity measurements and SDs. Simple and multivariate linear regression analyses were performed. RESULTS: For neonates, mean MS was 1.87 ± 0.79 kPa (range, 0.59-2.91 kPa; mean SWV, 1.37 ± 0.57 m/sec), with high variability and no correlation with age (P = .239). For this age group, no statistically significant correlation was found between MS and any demographic or echocardiographic parameters (P > .05). For the >1 month old group, a mean MS value of 1.67 ± 0.53 kPa was observed (range, 0.6-3 kPa; mean SWV, 1.29 ± 0.49 m/sec) for healthy volunteers. When paired for age, no sex-related difference was observed (P = .55). In univariate linear regression analysis, age (r = 0.83, P < .01), diastolic interventricular septal thickness (r = 0.72, P < .01), and left ventricular end-diastolic diameter (r = 0.67, P < .01) were the parameters with the highest correlation coefficients with MS. In a multiple linear regression analysis incorporating these three parameters as cofounding factors, age was the only statistically significant parameters (r = 0.81, P = .02). CONCLUSION: Diastolic MS increases linearly in children and young adults. Diastolic MS correlates more robustly with age than with myocardial and left ventricular geometric characteristics. However, the geometry affects SWV, implying the need to determine well-established boundaries in future studies for the clinical application of SWE.

Intraoperative Ergonomic Assessment of Exoscopes versus Conventional DIEP Flap.

BACKGROUND: This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics. METHODS: Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected. RESULTS: The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the "surgeon at abdomen" showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the "surgeon at chest" showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference. CONCLUSION: Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.

Occurrence, emission sources, and risk assessment of polybrominated diphenyl ethers and current-use brominated flame retardants in settled dust from end-of-life vehicle processing, urban, and rural areas, northern Vietnam.

Settled dust samples from Vietnamese end-of-life vehicle (ELV) processing, urban, and rural areas were analyzed for polybrominated diphenyl ethers (PBDEs) and other current-use brominated flame retardants (BFRs). PBDE levels found in dust samples collected from ELV workshops (median 390; range 120-520 ng/g) and nearby living areas (110; 36-650 ng/g) were generally higher than those in common house dust (25-170 ng/g). BDE-209 was the most predominant congener detected in almost all the samples, indicating extensive application of products containing deca-BDE mixtures. The dust samples from ELV workplaces showed a more abundance of lower brominated congeners (e.g., tetra- to hexa-BDEs) that may originate from car interior materials treated by penta-BDE formulations. Concentrations of other BFRs decreased in the order urban > rural > ELV dust, reflecting the current use of these compounds in new consumer products. Decabromodiphenyl ethane (DBDPE) and 1,2-bis(2,4,6-tribromophenoxy)ethane (BTBPE) were the major alternative BFRs. Daily intake doses and hazard indexes of PBDEs and some other BFRs through dust ingestion were estimated and showed acceptable levels of risk. However, more comprehensive risk assessment considering multiple exposure pathways should be performed, especially for ELV workers and children in the ELV processing and urban areas.

Building eco-surplus culture among urban residents as a novel strategy to improve finance for conservation in protected areas.

The rapidly declining biosphere integrity, representing one of the core planetary boundaries, is alarming. In particular, the global numbers of mammals, birds, fishes, and plants declined by 68% from 1970 to 2016. One of the most widely accepted measures to halt the rate of biodiversity loss is to maintain and expand protected areas that are effectively managed. However, doing so requires substantial finance derived from nature-based tourism, specifically visitors from urban areas. Using the Bayesian Mindsponge Framework (BMF) for conducting analysis on 535 Vietnamese urban residents, the current study examined how their biodiversity loss perceptions can affect their willingness to pay for the entrance fee and conservation in protected areas. We found that perceived environmental degradation, loss of economic growth, loss of nature-based recreation opportunities, and loss of knowledge as consequences of biodiversity loss indirectly affect the willingness to pay through the mediation of the attitude towards conservation. Notably, perceived knowledge loss also has a direct positive influence on the willingness to pay for the entrance fee and conservation. In contrast, perceived loss of health is negatively associated with the attitude towards conservation. Based on these findings, we suggest that building an eco-surplus culture among urban residents by stimulating their subjective cost-benefit judgments towards biodiversity loss can be a promising way to generate more finance from nature-based tourism for conservation in protected areas and ease the domestic government's and international organizations' funding allocation problems. Eco-surplus culture is a set of pro-environmental attitudes, values, beliefs, and behaviors shared by a group of people to reduce negative anthropogenic impacts on the environment and conserve and restore nature.