Prevalence of cardiometabolic risk and health factors among Puerto Rican young adults in the Boricua Youth Study - Health Assessment.

We describe and compare the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY. As part of the Boricua Youth Study - Health Assessment, (mean age 23 ± 0.1 years) objective anthropometric, blood pressure and blood samples were collected. Information on diet, physical activity and sleep were collected via surveys. Life's Essential 8 metrics were characterized as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion. The prevalence of cardiometabolic risk factors was high for obesity (35% in NY, 19% in PR) and diabetes (17% NY, 20% PR). In this ethnically homogenous population, we found low levels of ideal CVH that varied across study site, suggesting differences by sociocultural context. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

A rapid multispectral endoscopic imaging system for in vivo assessment of the morphological and physiological characteristics of mouse intestines.

Accurate assessment of blood content in biological tissues is critical for the diagnosis and monitoring of various diseases, including cardiovascular disease, tumors, trauma, and the success rate of organ transplants. In this study, a multispectral endoscopic imaging system was built for capturing tissue reflection optical images in 18 bands across the wavelength range from 400 nm to 760 nm, non-invasively. The system was characterized by six tri-channel narrowband filters installed in front of the light source to achieve spectral separation and was equipped with a specially designed color CCD for achieving a speed of 24 multispectral imaging cubes per second. A method based on linear matrix inversion was proposed to calibrate the CCD spectral response overlaps, while a spectral analysis algorithm was developed for evaluating blood content and detecting tissue composition. The developed system was implemented in an in vivo mouse model for illustrating the blood volume, blood oxygen saturation index, and scattering particle size of the intestinal wall mucosa. The observations not only helped us to understand the blood supply situation in the intestinal mucosa, but also further testified the feasibility of our presented system. Meanwhile, the developed system could provide critical non-invasive optical information for intracavitary cancer diagnosis, surgery guidance, and treatment assessment.

The "Trinity" smart hospital construction policy promotes the development of hospitals and health management in China.

Recently, in order to comprehensively promote the development of medical institutions and solve the nationwide problems in the healthcare fields, the government of China developed an innovative national policy of "Trinity" smart hospital construction, which includes "smart medicine," "smart services," and "smart management". The prototype of the evaluation system has been established, and a large number of construction achievements have emerged in many hospitals. In this article, the summary of this field was performed to provide a reference for medical workers, managers of hospitals, and policymakers.

Angiography-based index of microcirculatory resistance (AccuIMR) for the assessment of microvascular dysfunction in acute coronary syndrome and chronic coronary syndrome.

Background: To assess the diagnostic accuracy of AccuIMR, a newly proposed, pressure wire-free index, in identifying coronary microvascular dysfunction (CMD) among patients with acute coronary syndrome [including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI)] and chronic coronary syndrome (CCS). Methods: A total of 163 consecutive patients (43 with STEMI, 59 with NSTEMI, and 61 with CCS), who underwent invasive coronary angiography (ICA) and for whom the index of microcirculatory resistance (IMR) was measured, were retrospectively enrolled at a single center. IMR measurements were made in 232 vessels. The AccuIMR based on computational fluid dynamics (CFD) was calculated from coronary angiography. The diagnostic performance of AccuIMR was assessed using wire-based IMR as a reference standard. Results: AccuIMR correlated well with IMR (overall r=0.76, P<0.001; STEMI r=0.78, P<0.001; NSTEMI r=0.78, P<0.001; CCS r=0.75, P<0.001) and had good diagnostic performance in detecting abnormal IMR [overall diagnostic accuracy, sensitivity, and specificity were 94.83% (91.14% to 97.30%), 92.11% (78.62% to 98.34%), and 95.36% (91.38% to 97.86%), respectively]. Using a cutoff value of IMR >40 U for AccuIMR in STEMI and IMR >25 U in NSTEMI and CCS, the area under the receiver operating characteristic (ROC) curve (AUC) of AccuIMR for predicting abnormal IMR value was 0.917 (0.874 to 0.949) in all patients, 1.000 (0.937 to 1.000) in patients with STEMI, 0.941 (0.867 to 0.980) in patients with NSTEMI, and 0.918 (0.841 to 0.966) in patients with CCS. Conclusions: The use of AccuIMR in the evaluation of microvascular diseases could provide valuable information and potentially increase the application of physiological assessment for microcirculation in patients with ischemic heart disease.

A Wearable Diagnostic Assessment System vs. SNAP-IV for the auxiliary diagnosis of ADHD: a diagnostic test.

OBJECTIVE: We design a diagnostic test to evaluate the effectiveness and accuracy of A non-intrusive Wearable Diagnostic Assessment System versus SNAP-IV for auxiliary diagnosis of children with ADHD. METHODS: This study included 55 children aged 6-16 years who were clinically diagnosed with ADHD by DSM-5, and 55 healthy children (typically developing). Each subject completes 10 tasks on the WeDA system (Wearable Diagnostic Assessment System) and Parents of each subject complete the SNAP-IV scale. We will calculate the validity indexes, including sensitivity, specificity, Youden's index, likelihood ratio, and other indexes including predictive value, diagnostic odds ratio, diagnostic accuracy and area under the curve [AUC] to assess the effectiveness of the WeDA system as well as the SNAP-IV. RESULTS: The sensitivity (94.55% vs. 76.36%) and the specificity (98.18% vs. 80.36%) of the WeDA system were significantly higher than the SNAP-IV. The AUC of the WeDA system (0.964) was higher than the SNAP-IV (0.907). There is non-statistically significant difference between groups (p = 0.068), and both of them have high diagnostic accuracy. In addition, the diagnostic efficacy of the WeDA system was higher than that of SNAP-IV in terms of the Youden index, diagnostic accuracy, likelihood ratio, diagnostic odds ratio and predictive value. CONCLUSION: The advantages of the WeDA system in terms of diagnostic objectivity, scientific design and ease of operation make it a promising system for widespread use in clinical practice.

Muscle Energy Technique plus Neurac Method in Stroke Patients with Hemiplegia Complicated by Diabetes Mellitus and Assessment of Quality of Life.

Objective: To analyze the role of muscle energy technique (MET) plus Neurac method in stroke patients with hemiplegia complicated by diabetes mellitus and the impact on quality of life. Methods: From January 2021 to December 2021, 100 stroke patients with hemiplegia complicated by diabetes mellitus treated in our institution and assessed for eligibility were recruited and randomly assigned (1 : 3) via the random sampling method to either the conventional rehabilitation group or the experimental group. The patients in the experimental group were randomized (1 : 1 : 1) into either the MET group (receives MET), the Neurac group (receives Neurac), or the joint group (receives MET plus Neurac). The primary endpoint is the clinical efficacy, and the second endpoint is the quality of life. Results: The eligible patients had similar pretreatment Barthel index scores, Visual Analogue Scale (VAS) scores, Berg balance scale (BBS) scores, Tinetti scores, Fugl-Meyer scores, and quality of life (QoL) scores (P > 0.05). The treatment herein achieved significant improvements in Barthel index scores, VAS scores (2.71 ± 0.28), BBS scores, Tinetti scores, Fugl-Meyer scores, and QoL scores (99.67 ± 10.62), and MET plus Neurac method obtained the best results versus both the conventional rehabilitation and monotherapy of either MET or Neurac (P < 0.05). Conclusion: Neurac method plus MET improves the independent mobility of stroke patients with hemiplegia and diabetes, relieves pain, enhances balance and stability, mitigates limb dysfunction, and boosts patients' quality of life, so it is worthy of clinical application.

Analysis on carbon emissions efficiency differences and optimization evolution of China's industrial system: An input-output analysis.

The excessive carbon emissions not only intensify the global climate change, but also seriously restrict the sustainable development of social economy. However, improving industrial carbon emissions efficiency is the most directly effective way to reduce emissions. Therefore, accurate measurement and analysis of carbon emissions efficiency and evolution characteristics of China's industrial system is the basis for China to improve carbon emissions efficiency. Based on this, we adopted energy consumption method and input-output method to calculate and analyze the industrial carbon emissions efficiency and evolution characteristics of China from 2002 to 2015. The results show that (1) If carbon emissions from cement production are ignored and only energy-related carbon emissions are considered, the calculation results of carbon emissions efficiency of heavy industry will be overestimated about 30%. (2) Compared with 2002, China's industrial carbon emissions efficiency increased by about twice in 2015. Specifically, the optimization of carbon emissions efficiency in agriculture, construction, light industry and service industry is very obvious, which has increased by 5.65, 5.00, 4.69 and 4.68 times respectively; The optimization of carbon emissions efficiency in power sector, heavy industry, transportation and chemical industry was obvious, which increased by 2.55, 2.01, 1.86 and 1.47 times respectively; The carbon emissions efficiency of the fossil energy sector has decreased by 0.36 times. (3) The carbon emissions efficiency of various industries has significant differences. Among them, agriculture, service industry, light industry and construction industry are generally industries with higher carbon emissions efficiency, while power sector, fossil energy sector, transportation industry, chemical industry and heavy industry are generally industries with lower carbon emissions efficiency, especially power and fossil energy sectors. Based on these, this paper provides policy implications and scientific evidence for accurately improving carbon emissions efficiency from the perspective of carbon emissions efficiency.

Ultralow-cost portable device for cesium detection via perovskite fluorescence.

Public anxiety and concern from cesium pollution in oceans have been back on the agenda since tons of nuclear waste water were announced to be poured into oceans. Cesium ion can easily enter organisms and bioaccumulate in animals and plants, thus its harm is chronic to humans through food chains. Here we showed a kind of hybrid ionic liquid membrane (HILM) for detection of cesium ion in seawater through CsPbBr3 perovskite fluorescence. With sustainability in mind, HILM was built frugally. The lowest cost of HILM is below 3 cents per piece. The HILM can detect cesium ion quickly with eye-readable fluorescence signal. Ultracheap, portable, easy-to-use on-site detection device could offer benefit for personal security and applications in environment science and ecology in the future decades.

Normal pancreatic volume assessment using abdominal computed tomography volumetry.

ABSTRACT: To determine the normal range of pancreatic volume (PV) in Chinese adults using computed tomography (CT) volumetry. To assess the relationships of PV with patient demographics and clinical parameters. To analyze the degree of correlation between PV values determined by manual segmentation and those calculated by formulas.A total of 240 adults (120 women, 120 men) between the ages of 18 and 79 years were reviewed. There were 6 groups of patients, with 40 patients in each decade regarding age. PV was segmented manually on computed tomography images slice by slice for each patient, and 2 formulas were used to calculate PV∗ and PV#.The mean PV was 77.44 ±â€Š19.11 cm3 (range from 28.55-138.15 cm3). PV was significantly correlated with height (r = 0.427, P < .001), weight (r = 0.525, P < .001), body mass index (r = 0.377, P < .001), the width of the first lumbar vertebral body (r = 0.166, P = .01), the transverse abdominal diameter (r = 0.455, P < .001), and the sagittal abdominal diameter (r = 0.456, P < .001). There was a negative correlation between PV and age (r = -0.209, P = .001). The correlation coefficients between PV and PV∗ and PV# were 0.676 and 0.376, respectively, with both P < .001.PV associated with patient demographics and clinical parameters. A more accurate and simpler formula should be used in the future to calculate and monitor changes in PV.

Gender and Socioeconomic Disparities in Global Burden of Epilepsy: An Analysis of Time Trends From 1990 to 2017.

Objective: The objective of the study is to investigate the gender and socioeconomic disparities in the global burden of epilepsy by prevalence and disability-adjusted life-years (DALYs). Methods: The global, regional, and national gender-specific prevalence and DALYs caused by epilepsy by year and age were extracted from the Global Burden of Disease (GBD) Study 2017. The Gini coefficient and concentration index (CI) were calculated to demonstrate the trends in between-country inequality in the epilepsy burden from 1990 to 2017. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to analyze the association of gender disparity in epilepsy and socio-demographic index (SDI). Results: The DALYs number of epilepsies increased from 1990 to 2017 by 13.8%, whereas age-standardized DALY rates showed a substantial reduction (16.1%). Men had a higher epilepsy burden than women of the same period. The epilepsy burden appeared to be higher in countries with lower socioeconomic development (CI < 0). The Gini coefficient decreased from 0.273 in 1995 to 0.259 in 2017, representing a decline in the between-country gap. Age-standardized prevalence and DALY rates of men were higher than those of women in each SDI-based country group (p < 0.0001). Male-minus-female difference (r = -0.5100, p < 0.0001) and male-to-female ratio (r = -0.3087, p < 0.0001) of age-standardized DALY rates were negatively correlated with SDI. Conclusion: Although global health care of epilepsy is in progress, the epilepsy burden was concentrated in males and developing countries. Our findings highlight the importance of formulating gender-sensitive health policies and providing more services in developing countries.

Occurrences, congener group profiles, and risk assessment of short- and medium-chain chlorinated paraffins in cup instant noodles from China.

Dietary intake is an important route of human exposure to chlorinated paraffins (CPs). Cup instant noodles are widely popular food and millions packet of instant noodles are consumed every year. To investigate the levels, congener groups, and health risk of SCCPs and MCCPs in each component of cup instant noodles, samples of nine common brands were collected and analyzed by comprehensive two dimensional gas chromatography coupled with mass spectrometry. The mean concentrations in the noodles were 1.2 × 103 ng/g wet weight (ww) (SCCPs) and 1.2 × 102 ng/g ww (MCCPs), the mean concentrations in the seasoning were 1.4 × 103 ng/g ww (SCCPs) and 1.3 × 102 ng/g ww (MCCPs), and the mean concentrations in the soup were 5.6 × 102 ng/L (SCCPs) and 5.4 × 102 ng/L (MCCPs). The SCCP to MCCP ratio were similar in the soup and soup container, which means CPs in the soup might be migrated from the soup container. Seasoning and noodles from the same brands have similar congener profiles of SCCPs and MCCPs, which may be raised from the manufacturing process or food packaging materials. The dominant SCCP congener groups were C10-11Cl6-7 in noodles and seasoning, and C10,13Cl6-7 in soup. The dominant MCCP congener groups were C14-15Cl6-7 in noodles and seasoning, and C14-15Cl6-7 in soup. A preliminary health risk assessment indicated that the current intakes of SCCPs and MCCPs through cup instant noodles in China did not pose a significant risk to human health.

[Levels and Risk Assessment of Short and Medium-Chain Chlorinated Paraffins in Soil from Paper Mill Area].

Short-chain chlorinated paraffins are persistent organic pollutants, and chlorinated paraffins were widely used as sizing agent in the paper industry. In order to investigate the levels and risk assessment of short-chain and medium-chain chlorinated paraffins in the paper mill plant, the surface soil and soil of different depths were collected.The concentrations, congener group profiles of short-chain chlorinated paraffins (SCCPs) and medium-chain chlorinated paraffins (MCCPs) in soil were determined by two-dimensional gas chromatography coupled with electron capture-negative ion mass spectrometry. The SCCPs and MCCPs concentrations were 42-3853 ng·g-1 and 34-2091 ng·g-1. The chlorine contents were 59.9%-61.9% and 48.7%-52.8%. The concentrations of SCCPs and MCCPs were different in the soil collected in different sampling site. The concentration of SCCPs and MCCPs were relatively higher in soil of sewage treatment area and coating area. The CP levels in soil from the paper mill plant were at a high level compared with those in other regions. C10Cl6-7 and C14-15Cl5 were the main congener groups in most soil samples. The results of principal component analysis showed that the CP52 commercial products may be sources of SCCPs and MCCPs in the soil. The risk quotient (RQ) for SCCPs and MCCPs were assessed in soil of paper mill plant. The results showed that the RQ values for SCCPs in soil ranged from 0.01 to 0.73 which are the medium risk, and the RQ values for MCCPs in soil ranged from 0 to 0.07, which are the low risk. The human exposure values of children and adults are lower than TDI[10 µg·(kg·d)-1] in both cases. The health risks caused by non-dietary exposure under paper mill area are low.

Long-term Healthcare Utilization by Medicaid Enrolled Children with Neonatal Abstinence Syndrome.

OBJECTIVE: To evaluate healthcare utilization in Medicaid enrolled children with neonatal abstinence syndrome (NAS) in the first 2 years of life. STUDY DESIGN: A retrospective, longitudinal cohort study evaluating Medicaid enrolled children born in New York (1999-2011) and Texas (1999-2010) was performed. Healthcare utilization, including inpatient days, emergency department and outpatient visits, and filled prescriptions in children after birth hospitalization was assessed. A tapered propensity-matching methodology was used, matching each child with NAS with 5 children without NAS, first on demographics, then on both demographics and clinical covariates (clinical diagnoses and congenital anomalies at birth). Poisson and negative binomial regression were used to calculate healthcare utilization ratios (HUR). RESULTS: In the first 2 years of life, children with NAS (n = 3799) had increased healthcare utilization with more inpatient days and emergency department visits than demographically similar children without NAS. This increased utilization however did not persist after matching on clinical covariates and performing multiple comparisons adjustment (inpatient days [HUR, 1.01; 95% CI, 0.88-1.16; P = .89], total emergency department visits [HUR, 1.06; 95% CI, 1.01-1.11; P = .02]). Children with NAS conversely had 9% fewer outpatient office visits (HUR, 0.91; 95% CI, 0.87-0.95; P < .0001). CONCLUSIONS: A diagnosis of NAS does not appear to be an independent predictor of increased healthcare utilization in the first 2 years of life. These results differ from some other published studies, but may suggest that the increased healthcare utilization observed in children with NAS is due to higher incidences of perinatal complications and congenital anomalies in children with prenatal drug exposures.

Unilateral Versus Bilateral Percutaneous Pedicle Screw Fixation in Oblique Lumbar Interbody Fusion.

OBJECTIVE: To compare clinical and radiologic outcomes of unilateral pedicle screw (UPS) and bilateral pedicle screw (BPS) fixations after single-level oblique lateral interbody fusion procedures. METHODS: This retrospective study included 74 patients receiving single-level oblique lateral interbody fusion at L3-4 or L4-5 (June 2014 to June 2017). These patients were divided into BPS (n = 36) and UPS (n = 38) groups. Perioperative outcomes included operative time, blood loss, medical expenses, and complication rates. Radiologic outcomes included fusion rates and cage subsidence rates. Clinical outcomes included disability measured by the Oswestry Disability Index and pain measured by the visual analog scale. RESULTS: The operative time was significantly shorter in the UPS group (76.2 ± 4.4 minutes) compared with the BPS group (127.0 ± 5.6 minutes, P < 0.001). There was a significant between-group difference in medical expenses ($11,044.8 ± $470.7 in UPS group vs. $15,018.4 ± $547.1 in BPS, P < 0.001). Blood loss and hospital stay did not differ between groups. Oswestry Disability Index and visual analog scale scores significantly decreased in both groups at different time points postoperatively compared with preoperatively. The UPS group had lower Oswestry Disability Index and visual analog scale scores than the BPS group at 7 days postoperatively, but no between-group difference was found after 1-month follow-up. Fusion rate was 86.8% in UPS group and 91.7% in BPS group (P > 0.05). Cage subsidence rates did not differ between groups. CONCLUSIONS: Oblique lateral interbody fusion with UPS fixation is an effective and reliable option for single-level lumbar diseases. Compared with BPS fixation, it resulted in less blood loss, required less operative time, and had comparable effects on radiologic and clinical outcomes.

Assessment of heavy metal contamination in surface sediments from the nearshore zone, southern Jiangsu Province, China.

We determined the heavy metal concentrations and evaluated the pollution status of 213 surface sediment samples collected from the nearshore zone of southern Jiangsu Province, China. The distributions of lead (Pb) and zinc (Zn) were similar, and their concentrations were highest in tidal creeks dominated by fine-grained sediments, such as the Dawanhong and Wangcanghong creeks and the outer part of Lanshayang Creek. The spatial distributions of chromium (Cr) and cadmium (Cd) were similar, with high concentrations south of Yangkou Port and Haozhi Port. Copper (Cu) concentrations were high off the coast of Rudong. The sediments were not polluted by Cu, but were weakly polluted by Cd, Cr, Pb, and Zn. The results of principal component analysis indicated that Pb and Zn were mainly from natural sources, Cd and Cr were from anthropogenic sources, and Cu was from a mixture of natural and anthropogenic sources.

Causes of Emergency Department Overcrowding and Blockage of Access to Critical Services in Beijing: A 2-Year Study.

BACKGROUND: Emergency department (ED) overcrowding is a serious issue worldwide. OBJECTIVES: This study was done to evaluate the degree of overcrowding in local "teaching hospitals" in Beijing, and to ascertain the apparent root causes for the pervasive degree of overcrowding in these EDs. METHODS: This is a multicenter cross-sectional study. The studied population included all ED patients from 18 metropolitan teaching hospital EDs in Beijing for calendar years 2013 and 2014. Patient characteristics, and the primary reasons that these patients sought care in these EDs, are described. RESULTS: The total numbers of annual emergency visits were 1,554,387 and 1,615,571 in 2013 and 2014, respectively. High acuity cases accounted for 4.6% and 5.5% of the total annual emergency visits in 2013 and 2014, respectively. The percentage of patients placed into "Observation" beds, which were created to accommodate patients deemed to have problems too complex to be treated in an inpatient bed, or to accommodate patients simply needing chronic care, was 11.9% and 13.1% in 2013 and 2014, respectively. The ED-boarded patients accounted for 2.71% and 2.6% of the total annual emergency visits in 2013 and 2014, respectively. The average waiting time to admit the ED-boarded patients was 37.1 h and 36.2 h in 2013 and 2014, respectively. Respiratory symptoms were the most common presenting complaints, and an upper respiratory infection was the most common ED diagnosis. Patients who had pneumonia or various manifestations of end-stage diseases, such as advanced dementia or multiple organ dysfunction, were the most common characteristics of patients who had stays in "Observation" units. CONCLUSIONS: One principal reason for ED crowding in Beijing lies in the large numbers of patients who persist in the expectation of receiving ongoing care in the ED for minor illnesses. However, as is true in many nations, one of the other most important root causes of ED crowding is "access block," the inability to promptly move patients deemed by emergency physicians to need inpatient care to an inpatient bed for that care. However, in our system, another challenge, not widely described as a contributor to crowding in other nations, is that doctors assigned to inpatient services have been empowered to refuse to admit patients perceived to have overly "complex" needs. Further, patients with multisystem illnesses or end-stage status, who need ongoing chronic care to manage activities of daily living, have begun to populate Beijing EDs in increasing numbers. This is an issue with various root causes.

Cross-country Association of Press Freedom and LGBT freedom with prevalence of persons living with HIV: implication for global strategy against HIV/AIDS.

BACKGROUND: Human behaviors are affected by attitudes and beliefs, which in turn are shaped by higher-level values to which we have ascribed. In this study, we explore the relationship between two higher-level values, press freedom and LGBT freedom, and HIV infection with national data at the population level. METHODS: Data were the number of persons living with HIV (PLWH, n = 35,468,911) for 148 countries during 2011-15, press freedom index (PFI) determined by the Reporters Without Borders, and LGBT freedom index (LGBT-FI) based on laws regulating same-sex relationships and expression. PLWH prevalence (1/1000), PFI and LGBT-FI were mapped first. Multiple regression was thus used to associate the logarithm of PLWH prevalence with PFI, LGBT-FI and PFI × LGBT-FI interaction, controlling for per capita GDP and weighted by population size. RESULTS: Global prevalence of PLWH during 2011-15 was 0.51 per 1000 population. The prevalence showed a geographic pattern moving from high at the south and west ends of the world map to low at the north and east. Both PFI and LGBT-FI were positively associated with PLWH prevalence with a negative interaction between the two. CONCLUSIONS: More people are infected with HIV in countries with higher press freedom and higher LGBT freedom. Furthermore, press freedom can attenuate the positive association between levels of LGBT freedom and risk of HIV infection. This study demonstrated the urgency for and provided data supporting further research to investigate potential cultural and socioecological mechanisms underpinning the complex relationship among press freedom, LGBT freedom and HIV infection, with data collected at the individual level.

PRESAGE: PRivacy-preserving gEnetic testing via SoftwAre Guard Extension.

BACKGROUND: Advances in DNA sequencing technologies have prompted a wide range of genomic applications to improve healthcare and facilitate biomedical research. However, privacy and security concerns have emerged as a challenge for utilizing cloud computing to handle sensitive genomic data. METHODS: We present one of the first implementations of Software Guard Extension (SGX) based securely outsourced genetic testing framework, which leverages multiple cryptographic protocols and minimal perfect hash scheme to enable efficient and secure data storage and computation outsourcing. RESULTS: We compared the performance of the proposed PRESAGE framework with the state-of-the-art homomorphic encryption scheme, as well as the plaintext implementation. The experimental results demonstrated significant performance over the homomorphic encryption methods and a small computational overhead in comparison to plaintext implementation. CONCLUSIONS: The proposed PRESAGE provides an alternative solution for secure and efficient genomic data outsourcing in an untrusted cloud by using a hybrid framework that combines secure hardware and multiple crypto protocols.

Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes.

AIM: To date, few studies have focused on the nutritional status of elderly hospitalized patients with diabetes. Our aims were to explore the prevalence of malnutrition among elderly diabetes patients admitted to the hospital, and to explore the relationships between malnutrition and geriatric syndromes, diabetic complications, and clinical outcomes. METHODS: A prospective, observational study including diabetes patients aged ≥65 years was carried out in a central hospital in Western China. Nutritional status was assessed using the Mini Nutritional Assessment incorporated into a comprehensive geriatric assessment. Follow up was carried out for ≤2.8 years. RESULTS: Of 302 participants, the prevalence of malnutrition, risk of malnutrition, and normal nutrition was 18.5%, 33.1% and 48.3%, respectively. In multivariate analysis, incontinence (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.08-9.36), diabetic microvascular complications (OR 2.22, 95% CI 1.06-4.61) and activities of daily living (ADL) dependence (OR 11.6, 95% CI 5.10-26.5) were independently associated with malnutrition. Malnourished patients had longer hospital stays (P = 0.003) and higher mortality rates (P < 0.001) than patients either at risk of malnutrition or with a normal nutritional status. Multivariate analysis also showed that malnutrition was independently associated with an increased risk of death (OR 2.86, 95% CI 1.30-6.28). CONCLUSIONS: The present study showed a high prevalence of malnutrition among elderly diabetes patients hospitalized for geriatric care. Considering the negative impact of malnutrition on hospital stay and mortality, adequate nutritional care should be emphasized for each elderly patient with diabetes, regardless of body mass index. Geriatr Gerontol Int 2017; 17: 2485-2492.

Twelve tips for medical teaching in low-resource settings.

Teaching in a low-resource setting comes with its own challenges and pitfalls. Many concepts, ideas and strategies can be transferred but need to be adapted to the different environment. This article highlights some of the challenges and obstacles that healthcare professionals working in this setting might encounter when setting up an educational intervention. The following twelve specific tips are aimed toward individual healthcare workers, independent charities, and smaller non-governmental organizations (NGOs) who wish to initiate small-scale teaching projects or larger educational ventures. The article covers general matters to consider prior to embarking on this journey and includes cultural, educational, linguistic, and social aspects.