Metabolism-based category formation for the prioritisation of genotoxicity hazard assessment for plant protection product residues (Part 4): α-Chloroacetamides.

In dietary risk assessment of plant protection products, residues of active ingredients and their metabolites need to be evaluated for their genotoxic potential. The European Food Safety Authority recommend a tiered approach focussing assessment and testing on classes of similar chemicals. To characterise similarity, in terms of metabolism, a metabolic similarity profiling scheme has been developed from an analysis of 69 α-chloroacetamide herbicides for which either Ames, chromosomal aberration or micronucleus test results are publicly available. A set of structural space alerts were defined, each linked to a key metabolic transformation present in the α-chloroacetamide metabolic space. The structural space alerts were combined with covalent chemistry profiling to develop categories suitable for chemical prioritisation via read-across. The method is a robust and reproducible approach to such read-across predictions, with the potential to reduce unnecessary testing. The key challenge in the approach was identified as being the need for metabolism data individual groups of plant protection products as the basis for the development of the structural space alerts.

A review of real-world evidence on preemptive pharmacogenomic testing for preventing adverse drug reactions: a reality for future health care.

Adverse drug reactions (ADRs) are a significant public health concern and a leading cause of hospitalization; they are estimated to be the fourth leading cause of death and increasing healthcare costs worldwide. Carrying a genetic variant could alter the efficacy and increase the risk of ADRs associated with a drug in a target population for commonly prescribed drugs. The use of pre-emptive pharmacogenetic/omic (PGx) testing can improve drug therapeutic efficacy, safety, and compliance by guiding the selection of drugs and/or dosages. In the present narrative review, we examined the current evidence of pre-emptive PGx testing-based treatment for the prevention of ADRs incidence and hospitalization or emergency department visits due to serious ADRs, thus improving patient safety. We then shared our perspective on the importance of preemptive PGx testing in clinical practice for the safe use of medicines and decreasing healthcare costs.

Vesical Imaging-Reporting and Data System (VI-RADS) as a grouping imaging biomarker combined with a decision-tree mode to preoperatively predict the pathological grade of bladder cancer.

AIM: To investigate whether the Vesical Imaging-Reporting and Data System (VI-RADS) could be used to develop a new non-invasive preoperative grade-prediction system to partially predict high-grade bladder cancer (HG-BC). MATERIALS AND METHODS: The present study enrolled 89 primary BC patients prospectively from March 2022 to June 2023. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of VI-RADS for predicting HG-BC and muscle-invasive bladder cancer (MIBC) in the entire group. In the low VI-RADS (≤2) group, the decision tree-based method was used to obtain significant predictors and construct the decision-tree model (DT model). The performance of the DT model and low VI-RADS scores for predicting HG-BC was determined using ROC, calibration, and decision curve analyses. RESULTS: At a cut-off of ≥3, the specificity and positive predictive value of VI-RADS for predicting HG-BC in the entire group was 100%, and the area under the ROC curve (AUC) was 0.697. Among 65 patients with low VI-RADS scores, the DT model showed an AUC of 0.884 in predicting HG-BC compared to 0.506 for low VI-RADS scores. Calibration and decision curve analyses showed that the DT model performed better than the low VI-RADS scores. CONCLUSION: Most VI-RADS scores ≥3 correspond to HG-BCs. VI-RADS could be used as a grouping imaging biomarker for a pathological grade-prediction procedure, which in combination with the DT model for low VI-RADS (≤2) populations, would provide a potential preoperative non-invasive method of predicting HG-BC.

Metabolism-based category formation for the prioritisation of genotoxicity hazard assessment for plant protection product residues (part 3): Strobilurins.

In dietary risk assessment of plant protection products, residues of active ingredients and their metabolites need to be evaluated for their genotoxic potential. The European Food Safety Authority recommend a tiered approach focussing assessment and testing on classes of similar chemicals. To characterise similarity, in terms of metabolism, a metabolic similarity profiling scheme has been developed from an analysis of 46 chemicals of strobilurin fungicides and their metabolites for which either Ames, chromosomal aberration or micronucleus test results are publicly available. This profiling scheme consists of a set of ten sub-structures, each linked to a key metabolic transformation present in the strobilurin metabolic space. This metabolic similarity profiling scheme was combined with covalent chemistry profiling and physico-chemistry properties to develop chemical categories suitable for chemical prioritisation via read-across. The method is a robust and reproducible approach to such read-across predictions, with the potential to reduce unnecessary testing. The key challenge in the approach was identified as being the need for metabolism data and individual groups of plant protection products as the basis for the development of such profiling schemes.

Translation of the Gothenburg Trismus Questionnaire-2 into Telugu and its Validation for use in Indian Patients.

Trismus refers to restriction in the ability to open the mouth. Comprehensive evaluation of trismus and its treatment outcomes needs a multidimensional, self-administered, trismus specific tool. In the present scenario, Gothenburg trismus questionnaire is the only reliable instrument to quantify trismus. Translation of this questionnaire helps in providing standardized documentation of trismus related problems and to obtain a patient's perspective on treatment outcomes within various populations. The aim of this study was to translate the Gothenburg trismus questionnaire-2 (GTQ 2) into Telugu (one of the Indian Languages) and validation of the translation for its effective use in regional Telugu speaking patients. The GTQ 2 was translated according to the guidelines framed by the International Society for Pharmacoeconomics and Outcomes Research: (1) forward translation, (2) reconciliation and back translation, (3) cognitive debriefing, and (4) pilot testing. The psychometric properties of the translated version were evaluated by testing its internal consistency, construct validity, known-group validity and floor and ceiling effects. Patients who reported with or without trismus to the Head and Neck Oncology outpatient clinic were enrolled for the study. Comparison of the GTQ scores was done using Mann-Whitney U-test. The Pearson correlation coefficient was used for assessing convergent and divergent validity. Internal Consistency was calculated using Cronbach's alpha coefficient. The translated version of the GTQ 2 was administered to 60 patients (30 trismus patients and 30 non-trismus patients). GTQ 2 was successfully translated without any significant issues. Construct validity of the translated version was confirmed and it has a good internal consistency (α > 0.7). The translated instrument can differentiate between those with and without trismus (p < 0.0005). A valid and reliable Telugu version of the Gothenburg Trismus Questionnaire-2 is now available for the benefit of Indian patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-021-01369-7.

Sub-structure-based category formation for the prioritisation of genotoxicity hazard assessment for pesticide residues: Sulphonyl ureas.

In dietary risk assessment, residues of pesticidal ingredients or their metabolites need to be evaluated for their genotoxic potential. The European Food Safety Authority recommend a tiered approach focussing assessment and testing on classes of similar chemicals. To characterise similarity and to identify structural alerts associated with genotoxic concern, a set of chemical sub-structures was derived for an example dataset of 74 sulphonyl urea agrochemicals for which either Ames, chromosomal aberration or micronucleus test results are publicly available. This analysis resulted in a set of seven structural alerts that define the chemical space, in terms of the common parent and metabolic scaffolds, associated with the sulphonyl urea chemical class. An analysis of the available profiling schemes for DNA and protein reactivity shows the importance of investigating the predictivity of such schemes within a well-defined area of structural space. Structural space alerts, covalent chemistry profiling and physico-chemistry properties were combined to develop chemical categories suitable for chemical prioritisation. The method is a robust and reproducible approach to such read-across predictions, with the potential to reduce unnecessary testing. The key challenge in the approach was identified as being the need for pesticide-class specific metabolism data as the basis for structural space alert development.

Trace level detection of explosives and pesticides using robust, low-cost, free-standing silver nanoparticles decorated porous silicon.

We report results from our extensive studies on the fabrication of ultra-thin, flexible, and cost-effective Ag nanoparticle (NP) coated free-standing porous silicon (FS-pSi) for superior molecular sensing. The FS-pSi has been prepared by adopting a simple wet-etching method. The deposition time of AgNO3 has been increased to improve the number of hot-spot regions, thereby the sensing abilities are improved efficiently. FESEM images illustrated the morphology of uniformly distributed AgNPs on the pSi surface. Initially, a dye molecule [methylene blue (MB)] was used as a probe to evaluate the sensing capabilities of the substrate using the surface-enhanced Raman scattering (SERS) technique. The detection was later extended towards the sensing of two important explosive molecules [ammonium nitrate (AN), picric acid (PA)], and a pesticide molecule (thiram) clearly demonstrating the versatility of the investigated substrates. The sensitivity was confirmed by estimating the analytical enhancement factor (AEF), which was ∼107 for MB and ∼104 for explosives and pesticides. We have also evaluated the limit of detection (LOD) values in each case, which were found to be 50 nM, 1 µM, 2 µM, and 1 µM, respectively, for MB, PA, AN, and thiram. Undeniably, our detailed SERS results established excellent reproducibility with a low RSD (relative standard deviation). Furthermore, we also demonstrate the reasonable stability of AgNPs decorated pSi by inspecting and studying their SERS performance over a period of 90 days. The overall cost of these substrates is attractive for practical applications on account of the above-mentioned superior qualities.

Backyard poultry farming for sustained production and enhanced nutritional and livelihood security with special reference to India: a review.

A comprehensive review on backyard poultry farming (BYPF) was carried out with respect to history, status, production systems, management practices, role in socio-economic development, etc., considering the Indian scenario in particular. Backyard poultry is an age-old traditional practice where small numbers of native chickens are reared with or without inputs under the free-range scavenging conditions. Currently, BYPF contributes about 17.8% (18.41 billion) of the total egg production (103.32 billion) of India. The introduction of high yielding chicken varieties, which resemble the native chicken, transformed the BYPF into a highly remunerative farming activity. The BYPF has a proven potential to alleviate poverty, eradicate malnutrition, empower women, and provide subsidiary income, and gainful employment in rural and tribal areas. In India, four types of backyard poultry farming are practiced, i.e., traditional, small-scale rural, small-scale intensive, and native chicken farming. The aspects of breeding and nutritional strategies in the nursery, and free-range conditions, besides the housing and health care practices that are followed in India, are discussed in detail. Backyard poultry farming has huge potential for further expansion as the produce from this system is preferred across the country.

The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM trial.

OBJECTIVES: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. DESIGN: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. SETTING: Forty-eight UK NHS early pregnancy units. POPULATION: Four thousand one hundred and fifty-three women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. METHODS: An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. MAIN OUTCOME MEASURES: Cost per additional live birth at ≥34 weeks of gestation. RESULTS: Progesterone intervention led to an effect difference of 0.022 (95% CI -0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI -£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014-0.096) and this was associated with a cost saving of £322 (95% CI -£1318 to £673). CONCLUSIONS: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). TWEETABLE ABSTRACT: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.

Robust and cost-effective silver dendritic nanostructures for SERS-based trace detection of RDX and ammonium nitrate.

We report the fabrication and performance evaluation of cost-effective, reproducible silver nanodendrite (AgND) substrates, possessing high-density trunks and branches, achieved by a simple electroless etching process and subsequently utilized them for the trace detection of 1,3,5-trinitroperhydro-1,3,5-triazine (Research Development Explosive, RDX) and Ammonium Nitrate (AN). The intricate structural features in AgNDs offer high-density hotspots for effective molecular detection based on the surface enhanced Raman scattering (SERS) technique. The active SERS-substrate was initially tested with standard Rhodamine 6G (R6G) molecules at 1 nM concentration, which established an effective enhancement factor (EF) of ∼108. The AgNDs were subsequently utilized in the detection of the explosives RDX and AN, down to concentrations of 1 µM. The typical EF achieved in the case of RDX and AN was ∼104. The sensitivity of 1 µM R6G was further enhanced by two-fold through the deposition of Au nanoparticles on the AgNDs. The reproducibility of the low-cost substrate was also demonstrated, with a ∼9% RSD value in the measurements.

Uncertainty quantification in reconstruction of sparse water quality time series: Implications for watershed health and risk-based TMDL assessment.

Despite the plethora of methods available for uncertainty quantification, their use has been limited in the practice of water quality (WQ) modeling. In this paper, a decision support tool (DST) that yields a continuous time series of WQ loads from sparse data using streamflows as predictor variables is presented. The DST estimates uncertainty by analyzing residual errors using a relevance vector machine. To highlight the importance of uncertainty quantification, two applications enabled within the DST are discussed. The DST computes (i) probability distributions of four measures of WQ risk analysis- reliability, resilience, vulnerability, and watershed health- as opposed to single deterministic values and (ii) concentration/load reduction required in a WQ constituent to meet total maximum daily load (TMDL) targets along with the associated risk of failure. Accounting for uncertainty reveals that a deterministic analysis may mislead about the WQ risk and the level of compliance attained with established TMDLs.

Estimate of the annual burden of foodborne illness in nondeployed active duty US Army Service Members: five major pathogens, 2010-2015.

In this study, we estimate the burden of foodborne illness (FBI) caused by five major pathogens among nondeployed US Army service members. The US Army is a unique population that is globally distributed, has its own food procurement system and a food protection system dedicated to the prevention of both unintentional and intentional contamination of food. To our knowledge, the burden of FBI caused by specific pathogens among the US Army population has not been determined. We used data from a 2015 US Army population survey, a 2015 US Army laboratory survey and data from FoodNet to create inputs for two model structures. Model type 1 scaled up case counts of Campylobacter jejuni, Shigella spp., Salmonella enterica non-typhoidal and STEC non-O157 ascertained from the Disease Reporting System internet database from 2010 to 2015. Model type 2 scaled down cases of self-reported acute gastrointestinal illness (AGI) to estimate the annual burden of Norovirus illness. We estimate that these five pathogens caused 45 600 (5%-95% range, 30 300-64 000) annual illnesses among nondeployed active duty US Army Service members. Of these pathogens, Norovirus, Campylobacter jejuni and Salmonella enterica non-typhoidal were responsible for the most illness. There is a tremendous burden of AGI and FBI caused by five major pathogens among US Army Soldiers, which can have a tremendous impact on readiness of the force. The US Army has a robust food protection program in place, but without a specific active FBI surveillance system across the Department of Defence, we will never have the ability to measure the effectiveness of modern, targeted, interventions aimed at the reduction of specific foodborne pathogens.

Qualitative risk assessment for the transmission of African swine fever to Thailand from Italy, 2015.

African swine fever (ASF) is a highly contagious disease that infects porcine species and has a major impact on the pig industry. Thailand imported approximately4 million kilograms of pig products from Italy in 2015 during the same time as an ASF outbreak was occurring on the island of Sardinia in Italy, thereby posing a potential risk of introduction of ASF virus (ASFV) into Thailand. To estimate whether or not importing pig products from Italy is a risk for Thailand and to identify gaps in control and prevention measures, risk analysis was performed. The objective of this study was to estimate the risk of the introduction of ASFV through imported pig products from Italy into Thailand in 2015, using qualitative risk assessment approaches, with the aim to define specific control and preventive measures. The framework used to analyse risk in this study was composed of hazard identification, qualitative risk assessment and risk mitigation. Qualitative risk assessment revealed that the likelihood of introduction of ASFV into Thailand was negligible, while the level of consequence of virus introduction was high. The overall risk was determined to be negligible. Risk mitigation recommendations were framed to minimise the risk. In addition, this study provided a baseline qualitative risk of ASFV introduction and a systematic approach to a qualitative risk analysis.

La peste porcine africaine (PPA) est une maladie extrêmement contagieuse affectant les suidés et dont l'impact sur la filière porcine est considérable. En2015, la Thaïlande a importé d'Italie environ quatre mille tonnes de produits issus de porcs, alors même qu'un foyer de PPA se déclarait sur l'île de Sardaigne (Italie), entraînant un risque potentiel d'introduction du virus de la peste porcine africaine (VPPA) en Thaïlande. Une analyse des risques a été conduite afin de déterminer si l'importation de produits issus de porcs provenant d'Italie représentait ou non un risque pour la Thaïlande et d'identifier d'éventuelles lacunes dans les mesures de contrôle et de prévention. Les auteurs présentent les résultats d'une étude visant à évaluer le risque que le VPPA ait pu être introduit en Thaïlande en 2015 via l'importation de produits d'origine porcine en provenance d'Italie ; pour ce faire, des méthodes qualitatives d'évaluation du risque ont été appliquées, destinées à définir par la suite des mesures de contrôle et de prévention adaptées. Le cadre d'analyse comportait un volet d'identification des dangers, un volet d'évaluation qualitative du risque et un volet d'atténuation du risque. L'évaluation qualitative du risque a fait apparaître que la probabilité d'introduction du VPPA en Thaïlande était négligeable, tandis que les conséquences d'une telle introduction étaient d'un niveau élevé. Le risque global a été caractérisé comme négligeable. Des recommandations en termes d'atténuation du risque ont été proposées afin de minimiser le risque. En outre, cette étude a fourni une définition qualitative de référence du risque d'introduction du VPPA ainsi qu'une méthode systématique pour effectuer une analyse qualitative du risque.

La peste porcina africana (PPA) es una enfermedad muy contagiosa que infecta a las especies porcinas y tiene repercusiones muy importantes en el sector porcino. En 2015 Tailandia importó cerca de 4 millones de kilogramos de productos porcinos de Italia, a la vez que un brote de PPA asolaba la isla italiana de Cerdeña, cosa que entrañaba el eventual riesgo de introducción del virus de la PPA en Tailandia. Con el fin de determinar si la importación de productos porcinos procedentes de Italia suponía o no un riesgo para Tailandia y detectar eventuales deficiencias en los dispositivos de control y prevención, se llevó a cabo un análisis del riesgo. Los autores describen ese estudio, destinado a estimar el riesgo de introducción del virus de la PPA a través de productos porcinos importados de Italia a Tailandia en 2015. Para ello se emplearon métodos de evaluación cualitativa del riesgo, con el objetivo último de definir medidas específicas de control y prevención. El método de análisis del riesgo utilizado en el estudio constaba de varios procedimientos: determinación de los peligros, evaluación cualitativa del riesgo y mitigación del riesgo. La evaluación cualitativa puso de manifiesto que la probabilidad de introducción del virus de la PPA en Tailandia era ínfima, pero también que tal introducción tendría consecuencias de gran calado. A la postre se concluyó que el riesgo global era insignificante. A fin de reducir al mínimo el riesgo se formularon una serie de recomendaciones encaminadas a mitigarlo. Además, el estudio dejó sentado un nivel de referencia del riesgo cualitativo de introducción del virus de la PPA y sirvió para instaurar un método sistemático de análisis cualitativo del riesgo.

Esophageal function testing: Billing and coding update.

BACKGROUND AND PURPOSE: Esophageal function testing is being increasingly utilized in diagnosis and management of esophageal disorders. There have been several recent technological advances in the field to allow practitioners the ability to more accurately assess and treat such conditions, but there has been a relative lack of education in the literature regarding the associated Common Procedural Terminology (CPT) codes and methods of reimbursement. This review, commissioned and supported by the American Neurogastroenterology and Motility Society Council, aims to summarize each of the CPT codes for esophageal function testing and show the trends of associated reimbursement, as well as recommend coding methods in a practical context. We also aim to encourage many of these codes to be reviewed on a gastrointestinal (GI) societal level, by providing evidence of both discrepancies in coding definitions and inadequate reimbursement in this new era of esophageal function testing.

Development, content validity, and cross-cultural adaptation of a patient-reported outcome measure for real-time symptom assessment in irritable bowel syndrome.

BACKGROUND: End-of-day questionnaires, which are considered the gold standard for assessing abdominal pain and other gastrointestinal (GI) symptoms in irritable bowel syndrome (IBS), are influenced by recall and ecological bias. The experience sampling method (ESM) is characterized by random and repeated assessments in the natural state and environment of a subject, and herewith overcomes these limitations. This report describes the development of a patient-reported outcome measure (PROM) based on the ESM principle, taking into account content validity and cross-cultural adaptation. METHODS: Focus group interviews with IBS patients and expert meetings with international experts in the fields of neurogastroenterology & motility and pain were performed in order to select the items for the PROM. Forward-and-back translation and cognitive interviews were performed to adapt the instrument for the use in different countries and to assure on patients' understanding with the final items. KEY RESULTS: Focus group interviews revealed 42 items, categorized into five domains: physical status, defecation, mood and psychological factors, context and environment, and nutrition and drug use. Experts reduced the number of items to 32 and cognitive interviewing after translation resulted in a few slight adjustments regarding linguistic issues, but not regarding content of the items. CONCLUSIONS AND INFERENCES: An ESM-based PROM, suitable for momentary assessment of IBS symptom patterns was developed, taking into account content validity and cross-cultural adaptation. This PROM will be implemented in a specifically designed smartphone application and further validation in a multicenter setting will follow.

Blood service in the Tibetan regions of Garzê and Aba, China: a longitudinal survey.

BACKGROUND: Garzê and Aba form the second largest Tibetan-inhabited area of China. Blood services have never been reported for this region before. OBJECTIVE: To assess the current situation and analyse whether a safe and adequate blood supply has been developed in both Garzê and Aba. METHODS: We conducted a longitudinal survey covering the period 2011-2016. The subjects of interest were recruited from non-remunerated voluntary donation, blood testing, clinical transfusion practices and infrastructure of local blood service systems. RESULTS: The donation rate and blood collection volume were below the average levels of both the Sichuan Province and mainland China. Component therapy was widely used, but inappropriate usage of whole blood existed. A lack of national specific standards for people on the plateaus led to local blood transfusions being conducted without full clinical assessment. Endemic and frequently occurring disease, such as hydatid disease and gastrointestinal disease, were inevitable risks for blood utilisation and safety. The potential influence of religious belief and traditions, like 'male-leaving marriages', of Tibetans on donor recruitment and blood safety requires further research. CONCLUSIONS: A relatively safe and complete blood service system has been developed in this region. However, there is still an urgent need for comprehensive and effective support from the government in terms of policies and finance. As an epidemic area of hydatid disease and sexually transmitted disease, this region needs to emphasise public health measures, such as blood safety and inappropriate usage of blood products.

HDQLIFE: development and assessment of health-related quality of life in Huntington disease (HD).

PURPOSE: Huntington disease (HD) is a chronic, debilitating genetic disease that affects physical, emotional, cognitive, and social health. Existing patient-reported outcomes (PROs) of health-related quality of life (HRQOL) used in HD are neither comprehensive, nor do they adequately account for clinically meaningful changes in function. While new PROs examining HRQOL (i.e., Neuro-QoL-Quality of Life in Neurological Disorders and PROMIS-Patient-Reported Outcomes Measurement Information System) offer solutions to many of these shortcomings, they do not include HD-specific content, nor have they been validated in HD. HDQLIFE addresses this by validating 12 PROMIS/Neuro-QoL domains in individuals with HD and by using established PROMIS methodology to develop new, HD-specific content. METHODS: New item pools were developed using cognitive debriefing with individuals with HD, and expert, literacy, and translatability reviews. Existing item banks and new item pools were field tested in 536 individuals with prodromal, early-, or late-stage HD. RESULTS: Moderate to strong relationships between Neuro-QoL/PROMIS measures and generic self-report measures of HRQOL, and moderate relationships between Neuro-QoL/PROMIS and clinician-rated measures of similar constructs supported the validity of Neuro-QoL/PROMIS in individuals with HD. Exploratory and confirmatory factor analysis, item response theory, and differential item functioning analyses were utilized to develop new item banks for Chorea, Speech Difficulties, Swallowing Difficulties, and Concern with Death and Dying, with corresponding six-item short forms. A four-item short form was developed for Meaning and Purpose. CONCLUSIONS: HDQLIFE encompasses both validated Neuro-QoL/PROMIS measures, as well as five new scales in order to provide a comprehensive assessment of HRQOL in HD.

Enhancing the photovoltaic performance and stability of QDSSCs using surface reinforced Pt nanostructures with controllable morphology and superior electrocatalysis via cost-effective chemical bath deposition.

To make quantum-dot sensitized solar cells (QDSSCs) competitive, photovoltaic parameters such as the power conversion efficiency (PCE) and fill factor (FF) must become comparable to those of other emerging solar cell technologies. In the present study, a novel strategy has been successfully developed for a highly efficient surface-modified platinum (Pt) counter electrode (CE) with high catalytic activity and long-term stability in a polysulfide redox electrolyte. The reinforcement of the Pt surface was performed using a thin passivating layer of CuS, NiS, or CoS by simple chemical bath deposition techniques. This method was a more efficient method for reducing the electron recombination in QDSSCs. The optimized Pt/CuS CE shows a very low charge transfer resistance of 37.01 Ω, which is an order of magnitude lower than those of bare Pt (86.32 Ω), Pt/NiS (53.83 Ω), and Pt/CoS (73.51 Ω) CEs. Therefore, the Pt/CuS CEs show much greater catalytic activity in the polysulfide redox electrolyte than Pt, Pt/NiS and Pt/CoS CEs. As a result, under one-sun illumination (AM 1.5G, 100 mW cm(-2)), the Pt/CuS CE exhibits a PCE of 4.32%, which is higher than the values of 1.77%, 2.95%, and 3.25% obtained with bare Pt, Pt/CoS, and Pt/NiS CEs, respectively. The performance of the Pt/CuS CE was enhanced by the improved current density, Cu vacancies with increased S composition, and surface morphology, which enable rapid electron transport and lower the electron recombination rate for the polysulfide electrolyte redox couple. Electrochemical impedance spectroscopy and Tafel polarization revealed that the hybrid CEs reduce interfacial recombination and exhibit better electrochemical and photovoltaic performance compared with a bare Pt CE. The Pt/CuS CE also shows superior stability in the polysulfide electrolyte in a working state for over 10 h, resulting in a long-term electrode stability than Pt CE.

Financial burden on the families of patients with hepatitis B virus-related liver diseases and the role of public health insurance in Yunnan province of China.

OBJECTIVE: To investigate the financial burden of patients who had various stages of hepatitis B virus-related diseases and the level of alleviation from financial burden by health insurance schemes in Yunnan province of China. STUDY DESIGN: A cross-sectional survey. METHODS: Patients' information was consecutively recorded at the First Affiliated Hospital of Kunming Medical University, from December 2012 to June 2013. Consecutive cases of hepatitis B virus (HBV) (520), compensated cirrhosis (91), decompensated cirrhosis (198) and hepatocellular carcinoma (HCC) (131) were recruited from the outpatient and inpatient departments. The total direct costs, hospital charge, outpatient costs, hospitalization fees being reimbursed and household catastrophic health expenditure were estimated for each disease group. RESULTS: The average annual direct costs for each disease group were 19,496 RMB for HBV, 28,466 RMB in compensated cirrhosis, 46,061 RMB for decompensated cirrhosis, and 33,044 RMB for HCC patients. Catastrophic health expenditure occurred in all four groups. Health insurance reimbursement released the financial burden incurred by medical expenses of patients under a high level of household economic status. Public health insurance schemes helped the patients to various extents. CONCLUSIONS: Among these patient groups, direct costs represent a significant economic burden. Health expenditure and financing systems must be considered to prevent the increase of household catastrophe, particularly among the poor.

Enhanced photovoltaic performance and time varied controllable growth of a CuS nanoplatelet structured thin film and its application as an efficient counter electrode for quantum dot-sensitized solar cells via a cost-effective chemical bath deposition.

For the first time we report a simple synthetic strategy to prepare copper sulfide counter electrodes on fluorine-doped tin oxide (FTO) substrates using the inexpensive chemical bath deposition method in the presence of hydrochloric acid (HCl) at different deposition times. CuS nanoplatelet structures were uniformly grown on the FTO substrate with a good dispersion and optimized conditions. The growth process of the CuS nanoplatelets can be controlled by changing the deposition time in the presence of HCl. HCl acts as a complexing agent as well as improving S(2-) concentration against S atoms in this one-step preparation. The photovoltaic performance was significantly improved in terms of the power conversion efficiency (PCE), short-circuit density (J(sc)), open-circuit voltage (V(oc)), and the fill factor (FF). The optimized deposition time of CuS 60 min resulted in a higher PCE of 4.06%, J(sc) of 12.92 mA cm(-2), V(oc) of 0.60 V, and a FF of 0.52 compared to CuS 50 min, CuS 70 min, and a Pt CE. The superior performance of the 60 min sample is due to the greater electrocatalytic activity and low charge transfer resistance at the interface of the CE and the polysulfide electrolyte. The concentration of Cu/S also had an important role in the formation of the CuS nanoplatelet structures. The optical bandgaps for the CuS with different morphologies were measured to be in the range of 1.98-2.28 eV. This improved photovoltaic performance is mainly attributed to the greater number of active reaction sites created by the CuS layer on the FTO substrate, which results large specific surface, superior electrical conductivity, low charge transfer resistance, and faster electron transport in the presence of HCl. Cyclic voltammetry, electrochemical impedance spectroscopy and Tafel-polarization measurements were used to investigate the electrocatalytic activity of the CuS and Pt CEs. This synthetic procedure not only provides high electrocatalytic activity for QDSSCs but could also be a cost-effective way to fabricate flexible electrodes in dye-sensitized solar cells or supercapacitor applications.