Concentrations, compositional profiles, and health risks of benzophenones among the Taiwanese population based on analysis of 23 daily consumed foods.

In this study, we analyzed the occurrence and distribution of 11 benzophenone-type ultraviolet filters (BPs) in 893 food samples spanning 7 food categories in Taiwan. We conducted a Monte Carlo simulation to determine the carcinogenic and noncarcinogenic risks of BPs. The results indicated that cornflakes had the highest mean level of BPs (103 ng/g), followed by bread (101 ng/g) and pastries (59 ng/g). BP was the most prevalent category, followed by 4-methylbenzophenone (4-MBP), 2-hydroxybenzophenone, and benzophenone-3. Estimation of the lifetime cancer risk (LTCR) of BP (average life expectancy of 80 years) placed them in the 50th and 97.5th percentiles [P50 (P97.5)] LTCR of 1.9 × 10-7 (5.7 × 10-6), indicating that BP in food poses a low renal hazard to the Taiwanese population. The noncarcinogenic risk of BPs was evaluated using a hazard quotient and combined margin of exposure (MOET), revealing a P50 (P97.5) hazard index of < 1 for BP, 4-MBP, and methyl-2-benzoylbenzoate. Although the P50 MOET values for all age groups were within the moderate range of concern, with a more conservative extreme (P2.5), the MOET values for the 0-3, 3-6, and 6-12 age groups fell below 100, indicating a high concern for renal degeneration and hyperplasia.

Dietary risk assessment of benzophenone derivatives using bread consumption estimates in a Taiwanese population.

Listed as endocrine-disrupting chemicals, benzophenone (BP) and its nine analogues (BPs) are an emerging group of contaminants. The migration of BPs from ultraviolet inks to food has been investigated in many studies; however, few studies have investigated BPs in foods and the risks of human exposure to BPs. We validated a trace and multi-residue method for simultaneously determining 10 BPs, including BP, BP-1, BP-2, BP-3, BP-8, 4-MBP, 2-OHBP, 4-OHBP, M2BB, and PBZ. Eighty-one bread samples were analyzed using stable isotope labeling and ultrahigh-performance liquid chromatography-electrospray ionization tandem mass spectrometry with solid-liquid extraction. We determined the estimated daily intake of BPs, non-cancer risks, and lifetime cancer risks (LTCRs) from daily bread consumption for seven age groups using a Monte Carlo simulation. The method demonstrated robust linearity (R2 ≥ 0.991), low limits of detection (0.04-2 ng/g), and satisfactory precision. The intra- and interday relative standard deviation ranges were 0.6%-9% and 3%-20%, respectively. BP, 4-MBP, 2-OHBP, BP-1, and BP-3 were detected in 97%, 67%, 59%, 24%, and 23% of the samples, respectively. 2-OHBP had the highest mean (range) value of 18.3 (

Comprehensive assessment of pretreatment sarcopenia impacts on patients with EGFR-mutated NSCLC treated with afatinib.

BACKGROUND: This study aimed to comprehensively evaluate the efficacy and toxicity of afatinib in patients with sarcopenia, an important prognostic factor for treatment efficacy and toxicity in patients with cancer. METHODS: The clinical features of patients with advanced NSCLC treated with frontline afatinib between 2014 and 2018 at a medical center in Taiwan were retrospectively reviewed. Sarcopenia was evaluated based on the total cross-sectional area of skeletal muscles assessed by computed tomography (CT) imaging at the L3 level. Baseline characteristics, response rates, survival rates, and adverse events (AEs) were compared between sarcopenic and nonsarcopenic patients. RESULTS: A total of 176 patients evaluated for sarcopenia by CT and treated with afatinib were enrolled in the current study. Sarcopenia was significantly associated with good performance status, low body mass index (BMI), low body surface area (BSA), and low total mass area (TMA). Sarcopenia did not influence the response rate (69.2% vs. 72.0%, p = 0.299), progression-free survival (median 15.9 vs. 14.9 months, p = 0.791), or overall survival (median 26.5 vs. 27.2 months, p = 0.441). However, BSA ≤ 1.7 and the 40 mg afatinib dose were associated with dose reduction. TMA was the only independent factor for afatinib discontinuation due to AEs. CONCLUSION: Sarcopenia was not associated with treatment efficacy or toxicity among patients with NSCLC harboring common mutations treated with afatinib, indicating sarcopenic patients should not be excluded from afatinib treatment. Other factors, such as BSA and TMA, were associated with dose reduction and afatinib discontinuation, respectively, which may require additional evaluations in future studies.

Health Utilities of Bilateral Severe-to-Profound Hearing Loss with Assistive Devices.

Hearing loss is a common sensory disorder in newborns. Early intervention with assistive devices benefits children's auditory and speech performance. This study aimed to measure the health utilities of children with bilateral severe-to-profound hearing impairment with different assistive devices. The descriptions of four hypothetical health states were developed, and their utility values were obtained from healthcare professionals via the visual analogue scale (VAS) and time trade-off (TTO) methods. Thirty-seven healthcare professionals completed the TTO interview and were included in the analysis. The mean utility scores obtained via VAS were 0.31 for no assistive devices, 0.41 for bilateral hearing aids, 0.63 for bimodal hearing, and 0.82 for bilateral cochlear implants. As for the utility scores obtained via TTO, mean values were 0.60, 0.69, 0.81, and 0.90, respectively. None of the four groups had the same VAS- or TTO-elicited utility (p < 0.001). The post hoc test results showed that the difference was significant between any two groups (all p < 0.05). In conclusion, this study elicited health utility of bilateral hearing impairment with different assistive devices using the VAS and TTO methods. The utility values obtained provide critical data for future cost-utility analysis and health technology assessment.

Survival benefits and disparities in radiation therapy for elderly patients with pancreatic ductal adenocarcinoma.

BACKGROUND: Older patients represent a unique subgroup of the cancer patient population, for which the role of cancer therapy requires special consideration. However, the outcomes of radiation therapy (RT) in elderly patients with pancreatic ductal adenocarcinoma (PDAC) are not well-defined in the literature. AIM: To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice. METHODS: Data from patients with PDAC aged ≥ 65 years between 2004 and 2018 were collected from the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was performed to determine factors associated with RT administration. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS. Propensity score matching (PSM) was applied to balance the baseline characteristics between the RT and non-RT groups. Subgroup analyses were performed based on clinical characteristics. RESULTS: A total of 12245 patients met the inclusion criteria, of whom 2551 (20.8%) were treated with RT and 9694 (79.2%) were not. The odds of receiving RT increased with younger age, diagnosis in an earlier period, primary site in the head, localized disease, greater tumor size, and receiving chemotherapy (all P < 0.05). Before PSM, the RT group had better outcomes than did the non-RT group [median OS, 14.0 vs 6.0 mo; hazard ratio (HR) for OS: 0.862, 95% confidence interval (CI): 0.819-0.908, P < 0.001; and HR for CSS: 0.867, 95%CI: 0.823-0.914, P < 0.001]. After PSM, the survival benefit associated with RT remained comparable (median OS: 14.0 vs 11.0 mo; HR for OS: 0.818, 95%CI: 0.768-0.872, P < 0.001; and HR for CSS: 0.816, 95%CI: 0.765-0.871, P < 0.001). Subgroup analysis revealed that the survival benefits (OS and CSS) of RT were more significant in patients aged 65 to 80 years, in regional and distant stages, with no surgery, and receiving chemotherapy. CONCLUSION: RT improved the outcome of elderly patients with PDAC, particularly those aged 65 to 80 years, in regional and distant stages, with no surgery, and who received chemotherapy. Further prospective studies are warranted to validate our results.

Contribution of insurance status to the association between marital status and cancer-specific survival: a mediation analysis.

OBJECTIVES: To evaluate the extent to which marriage influences cancer-specific survival (CSS) by influencing the insurance status among patients with common solid cancers and the feasibility of reducing the survival gap caused by marriage by increasing private insurance coverage for unmarried patients. SETTING: A retrospective cohort study with patients retrieved from the Surveillance, Epidemiology and End Results programme. PARTICIPANTS: Patients with nine common solid cancers diagnosed between 2007 and 2016 were included. Patients were excluded if their marital status, insurance status, socioeconomical status, stage or cause of death was unavailable, if survival time was less than 1 month, or if they were younger than 18 years at the time of diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was CSS, which was compared between married and unmarried individuals. Mediation analyses were conducted to determine the contribution of insurance status to the association between marriage and CSS. RESULTS: Married patients had better CSS than those unmarried (time ratio 1.778; 95% CI 1.758 to 1.797). Private health insurance was a key factor mediating the association between marital status and CSS (proportion mediated (PM), 17%; 95% CI 17% to 17.1%). The PM ranges from 10.7% in prostate cancer to 20% in kidney cancer. The contribution of private insurance to the association between marital status and CSS was greater among women than among men (PM 18.5% vs 16.7%). The mediating effect of private insurance was the greatest for the comparison between married and separated individuals (PM 25.6%; 95% CI 25.3% to 25.8%) and smallest for the comparison between married and widowed individuals (PM 11.0%; 95% CI 10.9% to 11.1%). CONCLUSIONS: 17% of the marital disparities in CSS are mediated by private insurance coverage. Increasing private insurance coverage for unmarried patients may reduce the survival gap related to marital status and sex. However, it is unclear whether better publicly funded insurance would have the same effect.

Liquid biopsy posttreatment surveillance in endemic nasopharyngeal carcinoma: a cost-effective strategy to integrate circulating cell-free Epstein-Barr virus DNA.

BACKGROUND: The optimal posttreatment surveillance strategy for nasopharyngeal carcinoma (NPC) remains unclear. Circulating cell-free Epstein-Barr virus (cfEBV) DNA has been recognized as a promising biomarker to facilitate early detection of NPC recurrence. Therefore, we aim to determine whether integrating circulating cfEBV DNA into NPC follow-up is cost-effective. METHODS: For each stage of asymptomatic nonmetastatic NPC patients after complete remission to primary NPC treatment, we developed a Markov model to compare the cost-effectiveness of the following surveillance strategies: routine follow-up strategy, i.e., (1) routine clinical physical examination; routine imaging strategies, including (2) routine magnetic resonance imaging plus computed tomography plus bone scintigraphy (MRI + CT + BS); and (3) routine 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT); cfEBV DNA-guided imaging strategies, including (4) cfEBV DNA-guided MRI + CT + BS and (5) cfEBV DNA-guided PET/CT. Clinical probabilities, utilities, and costs were derived from published studies or databases. Sensitivity analyses were performed. RESULTS: For all disease stages, cfEBV DNA-guided imaging strategies demonstrated similar survival benefits but were considerably more economical than routine imaging strategies. They only required approximately one quarter of the number of imaging studies compared with routine imaging strategies to detect one recurrence. Specifically, cfEBV DNA-guided MRI + CT + BS was most cost-effective for stage II (incremental cost-effectiveness ratio [ICER] $57,308/quality-adjusted life-year [QALY]) and stage III ($46,860/QALY) patients, while cfEBV DNA-guided PET/CT was most cost-effective for stage IV patients ($62,269/QALY). However, routine follow-up was adequate for stage I patients due to their low recurrence risk. CONCLUSIONS: The cfEBV DNA-guided imaging strategies are effective and cost-effective follow-up methods in NPC. These liquid biopsy-based strategies offer evidence-based, stage-specific surveillance modalities for clinicians and reduce disease burden for patients.

Genetically engineered microbial remediation of soils co-contaminated by heavy metals and polycyclic aromatic hydrocarbons: Advances and ecological risk assessment.

Soils contaminated with heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) have been becoming a worldwide concerned environmental problem because of threatening public healthy via food chain exposure. Thus soils polluted by HMs and PAHs need to be remediated urgently. Physical and chemical remediation methods usually have some disadvantages, e.g., cost-expensiveness and incomplete removal, easily causing secondary pollution, which are hence not environmental-friendly. Conventional microbial approaches are mostly used to treat a single contaminant in soils and lack high efficiency and specificity for combined contaminants. Genetically engineered microorganisms (GEMs) have emerged as a desired requirement of higher bioremediation efficiency for soils polluted with HMs and PAHs and environmental sustainability, which can provide a more eco-friendly and cost-effective strategy in comparison with some conventional techniques. This review comments the recent advances about successful bioremediation techniques and approaches for soil contaminated with HMs and/or PAHs by GEMs, and discusses some challenges in the simultaneous removal of HMs and PAHs from soil by designing multi-functional genetic engineering microorganisms (MFGEMs), such as improvement of higher efficiency, strict environmental conditions, and possible ecological risks. Also, the modern biotechnological techniques and approaches in improving the ability of microbial enzymes to effectively degrade combined contaminants at a faster rate are introduced, such as reasonable gene editing, metabolic pathway modification, and protoplast fusion. Although MFGEMs are more potent than the native microbes and can quickly adapt to combined contaminants in soils, the ecological risk of MFGEMs needs to be evaluated under a regulatory, safety, or costs benefit-driving system in a way of stratified regulation. Nevertheless, the innovation of genetic engineering to produce MFGEMs should be inspired for the welfare of successful bioremediation for soils contaminated with HMs and PAHs but it must be supervised by the public, authorities, and laws.

Opportunity Reboot: A Community-Based Evaluation Focused on Opportunity Youth.

The number of young people living in the margins of society reflects one of the most pressing social inequities of our time. Opportunity youth often face many complex challenges perpetrated by a range of systemic issues. These trajectories can be positively disrupted by surrounding youth with a cohesive web of relational and instrumental supports and spaces where their strengths and potential are seen. Opportunity Reboot, a technical assistance and program enhancement model, was developed to leverage the existing capacity and strengths of community programs to more effectively create pathways to school, career, and life success for opportunity youth. The impact of Opportunity Reboot was tested using a single-group, non-experimental design and a quasi-experimental design with propensity score matching. Findings established associations between opportunity youths' experiences of three core Opportunity Reboot features and growth in select positive identity, social-emotional competencies, and skills for systems navigation outcomes. Opportunity Reboot youth were also more likely, on average, than comparison youth to be employed in the four quarters after endline data collection; this finding was even stronger when comparing youth of color in the Opportunity Reboot and comparison groups. This evaluation strengthens the evidence that program enhancement models like Opportunity Reboot hold promise for positively disrupting the lives of opportunity youth.

Development of an in vitro model to simulate migration of organic contaminants from pad products to human sweat and enhance dermal exposure risk assessment.

Dermal sorption is an important route for human exposure to organic chemicals embedded in consumer products, but the related chemical migration from consumer products to sweats was often overlooked in assessing skin exposure risk. To address this issue, the present study selected polycyclic aromatic hydrocarbons (PAHs), phthalic acid esters (PAEs), and benzothiazoles (BTs) as the target compounds and developed an in vitro simulation model with two artificial sweats (i.e., acidic and alkaline), a sorbent, and a PVC standard material. An appropriate biological inhibitor (ampicillin) and incubation time of 20 d for assessing the maximum migration efficiency of chemicals were selected. The mass balance of the target compounds during the in vitro incubation was verified. The established in vitro simulation model was used to determine the migration ratios of PAEs and BTs in three types of mouse pads. The maximum migration ratios of DBP, DIBP, DEHP, and BT from leather pad to both sweats were less than those for silicone and rubber pads. Key controlling parameters in migration ratios should be examined in subsequent investigations. Risk assessment showed that the daily exposure doses of PAEs and BTs in mouse pads were higher than the literature data. The hazard index of PAEs in leather pad exceed 1, indicating that PAEs could induce non-carcinogenic effects to human health through hand contact. Overall, the established in vitro simulation model provides a feasible alternative for assessing the potential risk for dermal exposure to consumer products.

Assessment of Modifiable Factors for the Association of Marital Status With Cancer-Specific Survival.

Importance: Married patients with cancer have better cancer-specific survival than unmarried patients. Increasing the early diagnosis and definitive treatment of cancer among unmarried patients may reduce the survival gap. Objectives: To evaluate the extent to which marriage is associated with cancer-specific survival, stage at diagnosis, and treatment among patients with 9 common solid cancers and to recommend methods for reducing the survival gap. Design, Setting, and Participants: This retrospective, population-based cohort study included patients older than 18 years who were diagnosed with 1 of 9 common cancers between January 1, 2007, and December 31, 2016. Patient data were retrieved from the Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed from August 1 to October 1, 2020. Exposures: Marital status, classified as married and unmarried (including single, separated, divorced, widowed, and unmarried patients or domestic partners). Main Outcomes and Measures: The primary outcome was the time ratio (TR) of cancer-specific survival (married vs unmarried). Mediation analyses were conducted to determine the extent to which the association of marriage with cancer-specific survival was mediated by stage at diagnosis and treatment. Results: This study included 1 733 906 patients (894 379 [51.6%] women; 1 067 726 [61.6%] married; mean [SD] age, 63.76 [12.60] years). Multivariate analyses found that those who were married were associated with better cancer-specific survival than unmarried patients (TR, 1.36; 95% CI, 1.35-1.37). Early diagnosis in breast cancer, colorectal cancer, endometrial cancer, and melanoma mediated the association between marital status and cancer-specific survival (breast cancer: proportion mediated [PM], 11.4%; 95% CI, 11.2%-11.6%; colorectal cancer: PM, 10.9%; 95% CI, 10.7%-11.2%; endometrial cancer: PM, 12.9%; 95% CI, 12.5%-13.3%; melanoma: PM, 12.0%; 95% CI, 11.7-12.4%). Surgery mediated the association between marital status and cancer-specific survival in lung (PM, 52.2%; 95% CI, 51.9%-52.4%), pancreatic (PM, 28.9%; 95% CI, 28.6%-29.3%), and prostate (PM, 39.3%; 95% CI, 39.0%-39.6%) cancers. Chemotherapy mediated the association of marital status with cancer-specific survival in lung (PM, 37.7%; 95% CI, 37.6%-37.9%) and pancreatic (PM, 28.6%; 95% CI, 28.4%-28.9%) cancers. Improved cancer-specific survival associated with marriage was greater among men than women (men: TR, 1.27; 95% CI, 1.25-1.28; women: TR, 1.20; 95% CI, 1.19-1.21). The contribution of receiving an early diagnosis and treatment with surgery or chemotherapy to the association between marital status and cancer-specific survival was greater among men than women (early diagnosis: PM, 21.7% [95% CI, 21.5%-21.9%] vs PM, 20.3% [95% CI, 20.2%-20.4%]; surgery: PM, 26.6% [95% CI, 26.4%-26.7%] vs PM, 11.1% [95% CI, 11.0%-11.2%]; chemotherapy: PM, 6.8% [95% CI, 6.7%-6.8%] vs PM, 5.1% [95% CI, 5.0%-5.2%]). Conclusions and Relevance: In this study, survival disparities associated with marital status were attributable to early diagnosis in breast, colorectal, and endometrial cancers as well as melanoma and to treatment-related variables in lung, pancreatic, and prostate cancers. The findings also suggest that marriage may play a greater protective role in the cancer-specific survival of men than of women.

Optimized MRI Assessment for Clinically Significant Prostate Cancer: A STARD-Compliant Two-Center Study.

BACKGROUND: There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC). PURPOSE: To evaluate an optimized (Op)-MRI compared with biparametric (Bp)-MRI and multiparametric (Mp)-MRI for the diagnosis of CSPC. STUDY TYPE: Two-center, retrospective. SUBJECTS: A total of 346 patients from center 1 and 292 patients from center 2. FIELD STRENGTH/SEQUENCE: 3.0T scanners, T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging. ASSESSMENT: Four radiologists interpreted the Bp-MRI (T2 WI and DWI) and Mp-MRI (T2 WI, DWI, and DCE) independently according to the Prostate Imaging Reporting and Data System (PI-RADS). For Op-MRI, two radiologists used an adjusted decision rule on Bp-MRI-assessed PI-RADS 3 lesions by determining early enhancement of DCE. Pathologies at biopsy and/or prostatectomy specimens were used as standard references. STATISTICAL TESTS: Performance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability. RESULTS: Interreader agreement was excellent for all three MRI assessments (all κ values >0.80). Op-MRI had comparable sensitivity (senior/junior: 90.9% [261/287] / 91.6% [263/287]) and higher specificity (78.1% [274/351] /74.4% [261/351]) compared with Mp-MRI (sensitivity: 92.3% [265/287] / 93.7% [269/287]; specificity: 67.8% [238/351] / 68.1% [239/351]) and Bp-MRI (sensitivity: 91.6% [263/287] / 93.4% [268/287]; specificity: 71.2% [250/351] / 70.1% [246/351]) for the diagnosis of CSPC. Compared to Mp-MRI, Op-MRI spared biopsy in 80.7% (515/638) of DCE scans with similar performance accuracy. Compared to Bp-MRI, Op-MRI downgraded 25.2% (31/123) of lesions at a cost of missing 6.5% (3/46) of malignancies, and upgraded 45.5% (56/123) of lesions with a positive predictive value of 62.5% (35/56) in 123 equivocal findings. DATA CONCLUSION: The Op-MRI, using an adjusted PI-RADS decision rule, did not compromise diagnostic accuracy with sparing biopsy in 80.7% of DCE scans compared to Mp-MRI, and outperformed Bp-MRI by regrading PI-RADS lesions. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.

An optimal posttreatment surveillance strategy for cancer survivors based on an individualized risk-based approach.

The optimal post-treatment surveillance strategy that can detect early recurrence of a cancer within limited visits remains unexplored. Here we adopt nasopharyngeal carcinoma as the study model to establish an approach to surveillance that balances the effectiveness of disease detection versus costs. A total of 7,043 newly-diagnosed patients are grouped according to a clinic-molecular risk grouping system. We use a random survival forest model to simulate the monthly probability of disease recurrence, and thereby establish risk-based surveillance arrangements that can maximize the efficacy of recurrence detection per visit. Markov decision-analytic models further validate that the risk-based surveillance outperforms the control strategies and is the most cost-effective. These results are confirmed in an external validation cohort. Finally, we recommend the risk-based surveillance arrangement which requires 10, 11, 13 and 14 visits for group I to IV. Our surveillance strategies might pave the way for individualized and economic surveillance for cancer survivors.

Illustrating the patient journey through the care continuum: Leveraging structured primary care electronic medical record (EMR) data in Ontario, Canada using chronic obstructive pulmonary disease as a case study.

BACKGROUND: Although barriers exist to secondary use of primary care electronic medical record (EMR) data, the Alliance for Healthier Communities (the Alliance) in Ontario, Canada has successfully created one of the largest structured primary care EMR datasets in Canada. In 2018, the Alliance and the Canadian Institute for Health Information (CIHI), an organization that provides comparable and actionable data to accelerate improvements in health across Canada, entered into a partnership to share EMR data. In this paper, we describe (i) the processes that enabled the collection of structured EMR data by the Alliance; (ii) how CIHI connected with the Alliance to share data and assess its quality; and, (iii) demonstrate the value of linking structured EMR data to administrative acute care data in illustrating the patient journey through the care continuum, using COPD as a case study. METHODS: CIHI and the Alliance entered into a formal data sharing agreement that enabled the sharing of linkable structured EMR data by the Alliance's 75 community health centres (CHCs) with CIHI. By leveraging the Alliance's Business Intelligence Reporting Tool, 3 years of EMR data containing patient-level clinical data were shared with CIHI. CIHI assessed the EMR data quality using its Data Source Assessment Tool to ensure fitness for analytical use. By linking the patient level EMR records with hospital records (CIHI's discharge abstract database (DAD) and the national ambulatory care reporting system (NACRS)), we examined aspects of COPD patient management in primary care and followed their journey through the health care continuum, including follow-up in primary care after hospital discharge. RESULTS: Alliance EMR data representing approximately 570,000 patients and 8.5 million primary care encounters between April 1, 2015 and March 31, 2018 were shared with CIHI. A data quality assessment, centered on completeness and concordance, confirmed that the data was fit for analytical purposes. Overall, 13,023 enrolled primary care patients were identified as having COPD, representing an overall crude prevalence of 8.7%. The average age of COPD patients was 64 years and equally affected males and females. Patients were most likely to have completed high school education or equivalent, speak English, live alone, and have a household income less than $15,000. They most commonly had between 10-19 primary care encounters a year with a range of providers where they most commonly sought services for health advice/ instructions, to discuss their treatment plans and for medication renewals. By linking the EMR data to CIHI's NACRS and DAD, we found that 74.1% of COPD patients had at least one ED visit and that 34.4% of COPD patients had at least one acute care hospitalization during the study period. Further, 16.2% of ED visits resulted in an acute care hospital admission. Of those hospitalized, the majority of COPD patients were discharged home (81.6%) and received timely follow-up in primary care (81.0% within 30 days). CONCLUSION: Structured and linkable EMR data provides opportunities to examine the patient journey through the care continuum in an innovative way. Using structured EMR data from the Alliance, linked with CIHI's NACRS and DAD databases, we were able to generate a cohort of patients with COPD, explore the complexities of their primary care encounters and follow them through the continuum of care, namely emergency department visits and hospitalizations. It is hoped that the partnership between the Alliance and CIHI will help drive future efforts on addressing the gap in comparable EMR data in Canada, and internationally.

[Conducting clinical studies during the epidemics of communicable diseases: perspectives of methodology and health economics].

In the setting of epidemics of communicable diseases, early initiation of epidemiological and clinical data collection and analysis and conducting relevant researches are essential to the success of epidemic containment. The coronavirus disease 2019 (COVID-19), starting initially as an epidemic in China in late 2019 and now becoming a pandemic globally, poses grave challenges to the global health care systems while also provides an opportunity for studying infectious diseases in the perspective of methodology. The authors propose the evaluation methods for case reports, randomized controlled trials (RCTs), real-world evidence studies and health economics researches during an epidemic. Case reports, which are of important value for health care workers during outbreaks of infectious diseases, should be written in standard format and style and published following a strict peer review process. RCTs provides the gold standard for evaluating the effectiveness of a given treatment for the patients from the outbreaks. We review the potential challenges faced in conducting RCTs during the outbreaks. The real-world data collected from the cases in designated hospitals allow the verification of the safety and effectiveness of the intervention measures. The data from health economics research also provide important support for optimizing communicable disease prevention and control strategies. Herein we summarize the health economics research methods, study design, and technical points during the outbreaks. We recommend that clinical research and health economics research be incorporated into the prevention and control plan and measures be taken to ensure both the standards and feasibility of these studies to improve the response capacity against outbreaks of communicable diseases.

Gaze Tracking and Point Estimation Using Low-Cost Head-Mounted Devices.

In this study, a head-mounted device was developed to track the gaze of the eyes and estimate the gaze point on the user's visual plane. To provide a cost-effective vision tracking solution, this head-mounted device is combined with a sized endoscope camera, infrared light, and mobile phone; the devices are also implemented via 3D printing to reduce costs. Based on the proposed image pre-processing techniques, the system can efficiently extract and estimate the pupil ellipse from the camera module. A 3D eye model was also developed to effectively locate eye gaze points from extracted eye images. In the experimental results, average accuracy, precision, and recall rates of the proposed system can achieve an average of over 97%, which can demonstrate the efficiency of the proposed system. This study can be widely used in the Internet of Things, virtual reality, assistive devices, and human-computer interaction applications.

Crosssectional Assessment of Bone Mass Density in Adults with Hepatitis B Virus and Hepatitis C Virus Infection.

Osteoporosis is one of the major complications in chronic hepatitis B virus (HBV) and hepatitis C (HCV) infection. However, few studies had examined the relationship between hepatic viral infection with bone loss. Our aim was to investigate the association between hepatic viral infection with bone mineral density (BMD) in a cross-sectional study. Participants who attended the health examinations at the Tri-Service General Hospital (TSGH), Taiwan, were enrolled in the study. Diagnosis of viral hepatitis was confirmed by the serum viral markers of hepatitis B surface antigen (HBsAg) and anti-HCV, and BMD measurement was performed by the bone densitometry. Subjects were divided into four groups by the presence of viral markers. The association between hepatic viral infection and BMD was examined by a multivariate linear regression model. HBV infection was inversely associated with BMD after full adjusting with ß values of -0.17 (95% CI: -0.29, -0.05) (p < 0.05). The relationship remained significant in males (ß = -0.16, 95% CI = -0.31, -0.01) (p < 0.05). In subjects with body mass index less than 30 HBV infection was associated with reduced BMD (ß = -0.16, 95% CI = -0.29, -0.02) (p < 0.05). However, HCV infection was only associated with an increase in BMD in patients with BMI less than 30 (ß = 0.17, 95% CI = 0.21, 0.32) (p < 0.05). Chronic HBV infection was significantly associated with reduced BMD in males. The impact of viral hepatitis on bone health deserves further investigation for the potential pathophysiological mechanisms.

Pilot simulation-based research for evaluation, training and assessment of holistic nursing at four intensive care unit sites.

This article was migrated. The article was marked as recommended. Background: Holistic nursing of intensive care unit (ICU) patients encompasses diverse challenges requiring regular in situ evaluation, training and assessment. Simulation has been adopted as a research and training tool in medicine; however, evidence for its use in enhancing holistic care at multi-sites is limited. Objective: This study aims to conduct a simulation-based research (SBR) at four ICU for standardized training of holistic nursing. Methods: There are stages of evaluating, training+in-training assessment and post-course assessment in this SBR. Specifically, the curriculum-mapped scenarios were developed according to the deficiency of each site after evaluating stage. At the training stage, the first simulation by team was defined as preparation step and the in-training assessment was undertaken at the second simulation. Results: From January 2017 to October 2018, sixty-four ICU nurses (16 teams, 4 teams in each site) at RCU, PICU, NICU and GYN ICU, attend 8 similar courses (2 courses at each site) over 20 months. In comparison with baseline performance, in-training assessments revealed the significant improvement of attendee's skills of holistic nursing. Attendees commented that simulation was a valuable training modality to enhance skills of holistic care including history taking, physical examination, communication and teamwork that are rarely taught among ICU nurses. Post-course workplace assessment by senior nurses revealed the high frequency of clinical application of holistic nursing by attendees. Additionally, post-course self assessment revealed a high attendee's confidence of holistic approaching in ICU. Conclusion: This pilot SBR demonstrated the feasibility of a standardized holistic care simulation program across four ICUs. In situ simulation and post-course workplace assessment affords situational learning without compromising patient safety and is an exciting and novel training of holistic nursing for ICU that could be integrated into regular intervention.

Radiation dose for pediatric scoliosis patients undergoing whole spine radiography: Effect of the radiographic length in an auto-stitching digital radiography system.

OBJECTIVE: This study investigated the influence of spatial overlap and radiographic length (RL) on the effective dose (ED) and organ dose for pediatric patients undergoing whole spine radiography using an auto-stitching digital radiography (DR) system. METHODS: First, the system parameters were tested on a 10-year-old pediatric anthropomorphic phantom with a Shimadzu DR system, and the effects of the spatial overlap and RL on radiation doses were validated. The ED and organ dose were calculated on the basis of a Monte Carlo simulation program. Subsequently, 82 patients with adolescent idiopathic scoliosis were recruited. The spatial overlap and RL for each patient were modified to further investigate the dose reduction feasibility. RESULTS: RL and ED were appropriately correlated on the basis of patients' height. For a patient measuring 158 cm, the Shimadzu DR system was equipped with a 17-inch detector with a cut-off RL of 75 cm. The phantom simulations indicated that ED was reduced to a minimum value of 0.188 ± 0.001 mSv with a high RL for RL < 75 cm. The minimum value increased to 0.300 ± 0.002 mSv for an RL of 75 cm and dropped to 0.222 ± 0.001 mSv for the maximum RL. By employing optimized RLs for patients, EDs were significantly reduced (p < 0.05). Moreover, ED reductions were higher when longer RLs were employed. CONCLUSION: A decrease in the spatial overlap and number of radiographic acquisitions by adjusting RLs when possible could reduce ED and almost all organ doses. This study emphasized the effects of RL on the radiation dose and provided useful guidance for modifying the RL for patients to reduce the whole spine radiography dose using a modern auto-stitching DR system.

In vitro inhalation bioaccessibility for particle-bound hydrophobic organic chemicals: Method development, effects of particle size and hydrophobicity, and risk assessment.

Bioaccessibility of particle-bound hydrophobic organic contaminants and related particle size effects are significant for assessing the potential human health risk via inhalation exposure, but have not been clearly evaluated. To fill this knowledge gap, the present study developed an in vitro method to estimate the inhalation bioaccessibility of particulate polycyclic aromatic hydrocarbons (PAHs) using simulated human lung fluids, i.e., a modified Gamble's solution (MGS) and artificial lysosomal fluid (ALF) with Tenax as the absorption media. Assay parameters, namely incubation time (10 d) and influence of filter use, were optimized for establishing the in vitro method. The results showed that the bioaccessibility of PAHs increased with increasing particle size, but other factors, such as total organic carbon and chemical hydrophobicity, also played a large role in the fate of these compounds. The results from this portion of the present study were then used to evaluate human health risk, which showed that the risk of these particle-bound PAHs by incorporating size-dependent PAHs bioaccessibility and deposition efficiency in the human respiratory tract into inhalation exposure risk calculations was reduced by >90% when compared to using total concentration. This suggested that the inhalation bioaccessibility and deposition efficiency of hydrophobic organic chemicals should be included in human health risk assessment.