Systems modelling as an approach for eliciting the mechanisms for hip fracture recovery among older adults in a participatory stakeholder engagement setting.

Introduction: Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, psychological, and social factors often affects the recovery trajectories of older adults with hip fractures, often complicating the recovery process. Methods: This research aims to actively engage stakeholders (including doctors, physiotherapists, hip fracture patients, and caregivers) using the systems modeling methodology of Group Model Building (GMB) to elicit the factors that promote or inhibit hip fracture recovery, incorporating a feedback perspective to inform system-wide interventions. Hip fracture stakeholder engagement was facilitated through the Group Model Building approach in a two-half-day workshop of 25 stakeholders. This approach combined different techniques to develop a comprehensive qualitative whole-system view model of the factors that promote or inhibit hip fracture recovery. Results: A conceptual, qualitative model of the dynamics of hip fracture recovery was developed that draws on stakeholders' personal experiences through a moderated interaction. Stakeholders identified four domains (i.e., expectation formation, rehabilitation, affordability/availability, and resilience building) that play a significant role in the hip fracture recovery journey.. Discussion: The insight that recovery of loss of function due to hip fracture is attributed to (a) the recognition of a gap between pre-fracture physical function and current physical function; and (b) the marshaling of psychological resilience to respond promptly to a physical functional loss via uptake of rehabilitation services is supported by findings and has several policy implications.

Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system.

BACKGROUND: Small bowel obstruction (SBO) still imposes a substantial burden on the health care system. Traditional evaluation systems for SBO outcomes only focus on a single element. The comprehensive evaluation of outcomes for patients with SBO remains poorly studied. Early intensive clinical care would effectively improve the short-term outcomes for SBO, however, the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined. AIM: We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status. METHODS: Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO (SiBO) group and the strangulated SBO (StBO) group. A principal component (PC) analysis was applied for data simplification and the extraction of patient characteristics, followed by separation of the high PC score group and the low PC score group. We identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management outcomes. Receiver operating characteristic curves were drawn, and the areas under the curve (AUCs) were calculated to assess the effectiveness of the predictive models. RESULTS: Of the 281 patients, 45 patients (16.0%) were found to have StBO, whereas 236 patients (84.0%) had SiBO. Regarding standardized length of stay (LOS), total hospital cost and the presence of severe adverse events (SAEs), a novel principal component was extracted (PC score = 0.429 × LOS + 0.444 × total hospital cost + 0.291 × SAE). In the multivariate analysis, risk statuses related to poor results for SiBO patients, including a low lymphocyte to monocyte ratio (OR = 0.656), radiological features of a lack of small bowel feces signs (OR = 0.316) and mural thickening (OR = 1.338), were identified as risk factors. For the StBO group, higher BUN levels (OR = 1.478) and lower lymphocytes levels (OR = 0.071) were observed. The AUCs of the predictive models for poor outcomes were 0.715 (95%CI: 0.635-0.795) and 0.874 (95%CI: 0.762-0.986) for SiBO and StBO stratification, respectively. CONCLUSION: The novel PC indicator provided a comprehensive scoring system for evaluating SBO outcomes on the foundation of complication-cost burden. According to the relative risk factors, early tailored intervention would improve the short-term outcomes.

A Causal View of the Role and Potential Limitations of Capitation in Promoting Whole Health System Performance.

For several decades, health systems in developed countries have faced rapidly rising healthcare costs without concomitant improvements in health outcomes. Fee for service (FFS) reimbursement mechanisms (RMs), where health systems are paid based on volume, contribute to this trend. In Singapore, the public health service is trying to curb rising healthcare costs by transitioning from a volume-based RM to a capitated payment for a population within a geographical catchment area. To provide insight into the implications of this transition, we developed a causal loop diagram (CLD) to represent a causal hypothesis of the complex relationship between RM and health system performance. The CLD was developed with input from government policymakers, healthcare institution administrators, and healthcare providers. This work highlights that the causal relationships between government, provider organizations, and physicians involve numerous feedback loops that drive the mix of health services. The CLD clarifies that a FFS RM incentivizes high margin services irrespective of their health benefits. While capitation has the potential to mitigate this reinforcing phenomenon, it is not sufficient to promote service value. This suggests the need to establish robust mechanisms to govern common pool resources while minimizing adverse secondary effects.

Estimating willingness-to-pay for neonicotinoid-free plants: Incorporating pro-environmental behavior in hypothetical and non-hypothetical experiments.

This study investigates the extent to which individuals' perceptions and attitudes toward pesticides and pollinator related labeling influence their preferences for eco-labeled products. An incentive compatible second-price auction and a hypothetical discrete choice experiment were used to elicit individual preferences for ornamental plants grown with or without controversial (neonicotinoid) pesticides. Positive attitudes toward pollinators, neonicotinoid labeling regulations, and labeling of sustainable production methods were found to be significant predictors of individual choice behavior. Individuals with attitudes expressing concern for pollinators and agreement with mandatory labeling and disclosure of neonicotinoids, showed a stronger preference for neonicotinoid-free plants. Our results suggest that both hypothetical and non-hypothetical experiments are consistent in predicting the general direction of consumer preferences despite the elicitation mechanism. Implications for relevant stakeholders are discussed.

Assessment of Talaromyces Marneffei Infection of the Intestine in Three Patients and a Systematic Review of Case Reports.

BACKGROUND: Hematogenous dissemination of Talaromyces marneffei can result in multiorgan involvement (skin, lung, and reticuloendothelial system involvement); however, few studies have reported intestinal T marneffei infections. We investigated clinical features, management, and patient outcomes concerning Talaromyces-related intestinal infections. METHODS: Patients with Talaromycosis between August 2012 and April 2019 at The First Affiliated Hospital of Guangxi Medical University, China, were retrospectively analyzed. Patients presenting with intestinal Talaromycosis and endoscopy-confirmed diagnoses were investigated. We also undertook a systematic review of the relevant English and Chinese literature. RESULTS: Of 175 patients diagnosed with Talaromycosis, 33 presented with gastrointestinal symptoms, and 31 underwent stool cultures, 1 of which tested positive. Three patients had gastrointestinal symptoms and negative stool cultures, and endoscopic tissue biopsy confirmed a pathological diagnosis. A systematic review of 14 reports on human Talaromycosis identified an additional 16 patients. Fever, weight loss, and anemia were the most common symptoms, along with abdominal pain, diarrhea, and bloody stools. Abdominal computed tomography showed intestinal wall edema and thickening and/or abdominal lymphadenopathy. Endoscopy showed erosion, hyperemia, edema, and multiple intestinal mucosal ulcers. Of the 19 patients, 16 received antifungal therapy, 14 of whom recovered and 2 died. Three patients received no therapy and died. CONCLUSIONS: Gastrointestinal disseminated Talaromycosis is not rare and can affect the stomach, duodenum, and colon, and may involve the entire digestive tract. Colon is the most common site. Endoscopy is needed for patients presenting with gastrointestinal symptoms in T marneffei-infected endemic areas. Systemic application of effective antifungal therapy can improve the prognosis.

Longitudinal behavioral and fMRI-based assessment of inhibitory control in heroin addicts on methadone maintenance treatment.

The objective of the present study was to determine whether methadone maintenance treatment (MMT) in heroin-dependent patients affects inhibitory control, whether any MMT-induced changes correlate with methadone dose and MMT duration, and whether these changes depend on the psychological characteristics of patients, such as depression, anxiety and impulsivity. Response inhibition in the GO/NO-GO test was combined with functional magnetic resonance imaging (fMRI) scanning data to examine whether MMT affects inhibitory control in 21 heroin-addicted patients who had already undergone at least three months of MMT. Patients were evaluated one year prior to and after the MMT period. Participants exhibited no difference in their GO/NO-GO reaction time and accuracy rate, or in their false alarm rate under NO-GO conditions. However, increased activation was detected in numerous brain regions in their 12-month fMRI scans, although these were not in the frontal-striatal loop. Increased fMRI activation in the left precentral gyrus and superior temporal gyrus were negatively correlated with the daily methadone dose and total methadone dose during the one-year study period. In conclusion, these results suggested that MMT over one year does not significantly change the behavioral indicators of inhibitory control function in heroin-dependent patients. The increase in activation leads to the hypothesis that MMT over one year may increase cognitive inhibitory control, which may be the result of the combined negative effect of methadone and the positive effect of functional recovery after withdrawal of heroin.

Rapid quantitation of multiple ions released from HeLa cells during emodin induced apoptosis by low-cost capillary electrophoresis with capacitively coupled contactless conductivity detection.

Change in cation concentration, including that of potassium and sodium, is characteristic of apoptosis, therefore it is significant to detect cation concentration changes. In this work a rapid, sensitive, and practical method was developed for the determination of Na+ and K+ concentration in HeLa cells during emodin induced apoptosis by a low-cost capillary electrophoresis device with capacitively coupled contactless conductivity detection (CE-C4D). Under the optimized conditions, both ions were baseline separated in 4 min with 40 mM MES/40 mM His containing 1 mM 18-crown-6 as the separation buffer at pH 6.0. The limit of detections (LODs) and limit of quantifications (LOQs) were 0.47-1.15 µM and 1.58-3.86 µM, respectively. The precision for migration times and peak areas was below 0.56% and 3.74%, respectively. The data proved that the concentration of cations in cells can be accurately quantified. It was found that the K+ concentration decreased from 82.2 µM to 52.7 µM, and the Na+ concentration increased from 62.4 µM to 127.2 µM during the process of apoptosis when the cell density was 1 × 105 cells per mL. The low-cost CE-C4D provides a convenient way to decipher the interaction of Na+ and K+ in the regulation of cell apoptosis.

[Spatial Distribution Characteristics and Source Analysis of Dissolved Organic Matter in Beiyun River].

Dissolved organic matter (DOM) in aquatic ecosystems has gained wide concern because of its influence on the light attenuation, nutrient availability and contaminant transport. Human activities strongly influence the DOM of rivers in different ways, including increased agricultural activities and industrial and domestic emissions. However, recent socio-economic development with rapid urban development has significantly enhanced the discharge of sewage, and has caused high loads of DOM, which in turn pose a great risk to aquatic ecosystems. To effectively guide water management for protecting aquatic ecosystem health, it is very critical to investigate the distribution and source of dissolved organic matter in urban rivers. In this study, the distribution and source analysis of DOM in Beiyun River were evaluated, where covers the most populated area with a population of 14 million, representing the most urbanized watershed of Beijing. Since the main receiving source of the river is treated and untreated wastewater in Beijing City, the water quality is highly polluted by anthropogenic inputs. However, information on DOM of Beiyun river has not been reported. Therefore, this study can not only reveal the biogeochemistry of DOM in Beiyu River, but also provide useful implications of pollution control for similar urban rivers. The fingerprint features were extracted from the Excitation-Emission Matrix Spectrum of fluorescent dissolved organic matter (FDOM) in 23 sampling sites of Beiyun river during November 2013. Three separate fluorescent components were identified by Parallel factor analysis (PARAFAC) model, including two humic-like components (C1: 240, 300/385 nm; C2: 255, 350/400 nm) and one protein-like component (C3: 230, 280/340 nm). The results indicated that humic-like materials were generally the dominated component of FDOM, accounting for 76.18% of the average total fluorescence intensity. Positive relationships were found between the fluorescence intensity and the concentrations of some water quality indicators, such as total nitrogen, ammonia nitrogen and total phosphorus, indicating the same sources of these components. Thus, the migration and transformation of nitrogen & phosphorus could also influence the level of FDOM. The distribution of total fluorescence intensity showed a distinctly different spatial pattern. The fluorescence intensity decreased firstly along the upstream to midstream continuum, and then increased from the midstream to downstream. The FDOM in the upstream could be attributed to the industrial effluent and agricultural runoff inputs. Among the upstream to downstream continuum, the content of FDOM in the midstream was the lowest. Limited domestic pollution was suggested as the major source. In the downstream, the sources of FDOM could be interpreted as industrial, agricultural wastewater and livestock wastewater discharge. The relative abundance of protein-like materials was markedly increased in this area, indicating the sources of DOM was highly impacted by human activities. In addition, our study also concluded that the removal efficiency of DOM in wastewater plants is not very desirable, which implied that stronger support for DOM removal in sewage system is needed to alleviate DOM pollution and improve water quality.