Detoxification of tetracycline and synthetic dyes by a newly characterized Lentinula edodes laccase, and safety assessment using proteomic analysis.

Fungal laccase has strong ability in detoxification of many environmental contaminants. A putative laccase gene, LeLac12, from Lentinula edodes was screened by secretome approach. LeLac12 was heterogeneously expressed and purified to characterize its enzymatic properties to evaluate its potential use in bioremediation. This study showed that the extracellular fungal laccase from L. edodes could effectively degrade tetracycline (TET) and the synthetic dye Acid Green 25 (AG). The growth inhibition of Escherichia coli and Bacillus subtilis by TET revealed that the antimicrobial activity was significantly reduced after treatment with the laccase-HBT system. 16 transformation products of TET were identified by UPLC-MS-TOF during the laccase-HBT oxidation process. Gas chromatography-mass spectrometry (GC-MS) analysis revealed that LeLac12 could completely mineralize ring-cleavage products. LeLac12 completely catalyzed 50 mg/L TET within 4 h by adding AG (200 mg/L), while the degradation of AG was above 96% even in the co-contamination system. Proteomic analysis revealed that central carbon metabolism, energy metabolism, and DNA replication/repair were affected by TET treatment and the latter system could contribute to the formation of multidrug-resistant strains. The results demonstrate that LeLac12 is an efficient and environmentally method for the removal of antibiotics and dyes in the complex polluted wastewater.

Are disparities in mental health care for Medicaid beneficiaries lower in managed care?

BACKGROUND: There are large and persistent racial and ethnic disparities in the use of mental health care in the United States. Medicaid managed care plans have the potential to reduce racial and ethnic disparities in use of mental health care through monitoring of need and active management of use of services across the populations they cover. This study compares racial and ethnic disparities among Medicaid beneficiaries in managed care with those not in managed care. METHODS: We compared Medicaid beneficiaries enrolled health maintenance organizations (HMOs) with those in fee-for-service (FFS) using data from the 2007-2015 Medical Expenditure Panel Survey (N = 26,113). We specified two-part propensity score adjusted models to estimate differences in mental health related emergency department visits, hospital stays, prescription fills, and outpatient visits overall and by race/ethnicity. RESULTS: HMO enrollment was associated with lower odds of having a mental health prescription (OR = 0.86, 95 % CI 0.78-0.96) or outpatient visit (OR = 0.82 95 % CI 0.73-0.92). These differences were similar across racial and ethnic groups or larger among Non-Hispanic Black and Hispanic beneficiaries than among Non-Hispanic White beneficiaries. CONCLUSIONS: Medicaid managed care has not improved the inequitable allocation of mental health care across racial and ethnic groups. Explicit attention to monitoring of racial and ethnic differences in use of mental health care in Medicaid managed care is warranted. IMPLICATIONS: Improvement in racial and ethnic disparities in mental health care in Medicaid manage care is unlikely to occur without targeted accountability mechanisms, such as required reporting or other contracting requirements.

County-level disparities in care for patients with glioblastoma.

OBJECTIVE: Racial and socioeconomic disparities in neuro-oncological care for patients with brain tumors remain underexplored. This study aimed to analyze county-level disparities in glioblastoma (GBM) care in the United States, focusing on access to surgery and the use of adjuvant temozolomide chemotherapy and radiation therapy. METHODS: Using repeated cross-sectional data from the Surveillance, Epidemiology, and End Results 17 database; the Area Health Resources File; and the American Community Survey, from 2010 to 2019, the authors performed multivariate regression analyses to understand the associations between county-level racial and socioeconomic characteristics, as well as the rates of surgery performed, delays in surgery, and use of adjuvant chemotherapy and radiation therapy for newly diagnosed GBM. RESULTS: In total, 29,609 GBM patients from 602 different US counties over a decade were included in this study. Counties with lower rates of surgery for GBM were associated with a higher percentage of Black residents (coefficient [CE] -0.001, 95% CI -0.002 to 0; p < 0.05) and being located in the Midwest (CE -0.132, 95% CI -0.195 to -0.069; p < 0.001) or West (CE -0.127, 95% CI -0.189 to -0.065; p < 0.001) relative to the Northeast. Counties with delayed surgical treatment were more likely to lack neurosurgeons (adjusted OR [aOR] 2.52, 95% CI 1.77-3.60; p < 0.001), have a higher percentage of Black residents (aOR 1.011, 95% CI 1.00-1.02; p < 0.05), and be located in the Midwest (aOR 3.042, 95% CI 1.12-8.24; p < 0.05) or West (aOR 3.175, 95% CI 1.12-8.97 p < 0.05). Counties with high rates of adjuvant radiation therapy were less likely to have higher percentages of Black residents (aOR 0.987, 95% CI 0.980-0.995; p < 0.01) and uninsured individuals (aOR 0.962, 95% CI 0.937-0.987; p < 0.01). CONCLUSIONS: Counties without neurosurgeons and those with a higher percentage of Black patients have delays in surgical care and demonstrate lower overall rates of surgery and adjuvant therapy for GBM. This study underscores the need for targeted interventions and policies that address structural barriers in healthcare access, improve equitable distribution of the neurosurgery workforce, and ensure timely and comprehensive GBM care to all populations.

Regional and temporal trends of falls and injurious falls among Chinese older adults: results from China Health and Retirement Longitudinal Study, 2011-2018.

OBJECTIVE: This study aimed to investigate temporal trends and regional differences of both falls and injurious falls among Chinese older adults and identify the associated risk factors. METHODS: We conducted a retrospective analysis using the 2011, 2013, 2015 and 2018 waves of China Health and Retirement Longitudinal Study. Our sample included 35 613 people aged 60 years or above. We analysed two binary outcome variables that were collected at each wave, including whether a respondent had any falls in the last 2 or 3 years, and if so, whether a respondent experienced any injurious falls that warranted seeking medical treatment. The explanatory variables included individual-level sociodemographic characteristics, physical function and health status. We conducted both descriptive and multivariate logistic analyses. RESULTS: We found no significant trend for falls after adjusting for individual-level factors, while significant regional variations in falls existed with higher fall prevalence in the central and western areas, compared with the eastern area. We detected a significant descending trend of injurious falls between 2011 and 2018 and identified the northeastern region with the lowest rates of injurious falls during the study period. Our study also revealed significant risk factors for falls and injurious falls, such as chronic conditions and function limitations. CONCLUSIONS: Our results indicated no temporal trend of falls, a declined trend of injurious falls, and significant regional variations in the prevalence of falls and injurious falls in 2011-2018. These findings have important implications for prioritising areas and subpopulations to prevent falls and injuries among China's elderly population.

The Pediatrician Workforce in the United States and China.

ABSTRACT: From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.

First-Principles Assessment of CdTe as a Tunnel Barrier at the α-Sn/InSb Interface.

Majorana zero modes, with prospective applications in topological quantum computing, are expected to arise in superconductor/semiconductor interfaces, such as ß-Sn and InSb. However, proximity to the superconductor may also adversely affect the semiconductor's local properties. A tunnel barrier inserted at the interface could resolve this issue. We assess the wide band gap semiconductor, CdTe, as a candidate material to mediate the coupling at the lattice-matched interface between α-Sn and InSb. To this end, we use density functional theory (DFT) with Hubbard U corrections, whose values are machine-learned via Bayesian optimization (BO) [ npj Computational Materials 2020, 6, 180]. The results of DFT+U(BO) are validated against angle resolved photoemission spectroscopy (ARPES) experiments for α-Sn and CdTe. For CdTe, the z-unfolding method [ Advanced Quantum Technologies 2022, 5, 2100033] is used to resolve the contributions of different kz values to the ARPES. We then study the band offsets and the penetration depth of metal-induced gap states (MIGS) in bilayer interfaces of InSb/α-Sn, InSb/CdTe, and CdTe/α-Sn, as well as in trilayer interfaces of InSb/CdTe/α-Sn with increasing thickness of CdTe. We find that 16 atomic layers (3.5 nm) of CdTe can serve as a tunnel barrier, effectively shielding the InSb from MIGS from the α-Sn. This may guide the choice of dimensions of the CdTe barrier to mediate the coupling in semiconductor-superconductor devices in future Majorana zero modes experiments.

Occurrence, controlling factors and noncarcinogenic risk assessment based on Monte Carlo simulation of fluoride in mid-layer groundwater of Huaibei mining area, North China.

Fluoride groundwater pollution is a major challenge to ensuring a safe groundwater supply for the global community. This study emphasized mid-layer groundwater (MG) as the main water supply source in the Huaibei mining area, North China. A total of 74 groundwater samples were taken to determine the hydrochemistry, source provenance, driving forces of high-fluoride groundwater, and associated probabilistic health risk using Monte Carlo simulation. The fluoride concentration in 55.56 % of the MG samples exceeded the Chinese drinking water permissible limit of 1 mg/L. In addition, MG is characterized by the hydrochemical faces of HCO3- type and Na+ type, lower Ca2+ and higher TDS concentration. Fluoride enrichment was predominantly controlled by the geogenic sources of fluorite dissolution, silicate weathering and lateral supply from the Carboniferous Taiyuan Formation limestone aquifer (CLA). In addition, the driving forces of high-fluoride groundwater were an alkaline environment, low Ca2+ concentration, high Na+ and HCO3- concentration, cation exchange between Ca2+ and Na+ on the surface of clay minerals, and competitive adsorption of HCO3-. The health risk assessment of F- for noncarcinogenic risk showed that the HQ values of 28.16 % of groundwater samples exceeded the safety limit of 1 for infants, followed by 2.1 % for children and 0 % for both adult females and males. Infants and children are more prone to the impact of excessive F-. The findings of this study will provide new insights into the geochemical behavior of F- and the safety of drinking water.

Quantifying nitrate pollution sources of shallow groundwater and related health risks based on deterministic and Monte Carlo models: A study in Huaibei mining area, Huaibei coalfield, China.

Nitrate pollution in groundwater is a global environmental concern. As a result, accurate identification of potential sources for such pollution is of critical significance to the effective control of groundwater quality. In this study, forty-nine shallow groundwater samples were collected from the Huaibei mining area. Hydro-chemical characterization, geospatial analysis technique, dual nitrate isotopes (δ15N-NO3- and δ18O-NO3-), Bayesian model and health risk assessment model were adopted for exploring the conditions, sources, proportion, and potential health risks of nitrate pollution for the first time in the study area. The results showed that the nitrate concentration ranged from 0.00 to 293.21 mg/L, and that 18.37% groundwater samples exceeded the standard of drinking water in China (GB 5749-2006). Based on the dual isotopic values of nitrate, it could be concluded that nitrification was dominated migration and transformation process of nitrogen. The results of Bayesian model showed that the proportional contributions of the potential nitrate pollution sources in shallow groundwater were manure and sewage (M&S) (39.54 %), NH4+ in fertilizer and precipitation (NHF&P) (34.93 %), soil nitrogen (SN) (14.89 %), and NO3- in atmospheric deposition (NAD) (10.64 %). The health risk assessment indicated that non-carcinogenic risks posed by NO3--N was higher for children than adults. The primary exposure pathway was oral ingestion. Monte Carlo simulation were applied to evaluate model uncertainty. The probabilities of non-carcinogenic risks were up to 12.54 % for children and 5.22 % for adults. In order to protect water quality and drinking water safety, it was suggested that effective nitrate reduction strategies and better management practices can be implemented.

Investigating patients' preferences for new anti-diabetic drugs to inform public health insurance coverage decisions: a discrete choice experiment in China.

BACKGROUND: Diabetes is a major public health concern with a considerable impact on healthcare expenditures. Deciding on health insurance coverage for new drugs that meet patient needs is a challenge facing policymakers. Our study aimed to assess patients' preferences for public health insurance coverage of new anti-diabetic drugs in China. METHODS: We identified six attributes of new anti-diabetic drugs and used the Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). The DCE was conducted in consecutive samples of type 2 diabetes patients in Jiangsu Province. The mixed logit regression model was applied to estimate patient-reported preferences for each attribute. The interaction model was used to investigate preference heterogeneity. RESULTS: Data from 639 patients were available for analysis. On average, the most valued attribute was the improvement in health-related quality of life (HRQoL) (ß = 1.383, p < 0.001), followed by positive effects on extending life years (ß = 0.787, p < 0.001), and well-controlled glycated haemoglobin (ß = 0.724, p < 0.001). The out-of-pocket cost was a negative predictor of their preferences (ß = -0.138, p < 0.001). Elderly patients showed stronger preferences for drugs with a lower incidence of serious side effects (p < 0.01) and less out-of-pocket costs (p < 0.01). Patients with diabetes complications favored more in the length of extended life (p < 0.01), improvement in HRQoL (p < 0.05), and less out-of-pocket costs (p < 0.001). CONCLUSION: The new anti-diabetic drugs with significant clinical effectiveness and long-term health benefits should become the priority for public health insurance. The findings also highlight the value of accounting for preference heterogeneity in insurance policy-making.

State Mandatory Paid Sick Leave Associated With A Decline In Emergency Department Use In The US, 2011-19.

Paid sick leave provides workers with job-protected paid time off to address short-term illnesses or seek preventive care for themselves and their family members. We studied the impact of mandatory paid sick leave at the state level on emergency department (ED) visit rates, using all-payer, longitudinal ED data from the Healthcare Cost and Utilization Project for the period 2011-19. We found that state implementation of paid sick leave mandates was associated with a 5.6 percent reduction in the total ED visit rate relative to the baseline, equivalent to 23 fewer visits per 1,000 population per year. The reduction was concentrated in Medicaid patients. Some of the largest reductions were ED visits related to adult dental conditions, adult mental health or substance use disorders, and pediatric asthma. Mandatory paid sick leave may be an effective policy lever to reduce excess ED use and costs.

Development and validation of quantitative optical index of skin blood content.

SIGNIFICANCE: We present an approach to estimate with simple instrumentation the amount of red blood cells in the skin microvasculature, designated as parameter LRBC. Variations of parameter LRBC are shown to reflect local changes in the quantity of skin red blood cells during a venous occlusion challenge. AIM: To validate a simple algebraic model of light transport in skin using the Monte Carlo method and to develop a measure of the red blood cell content in skin microvessels using the Monte Carlo predictions; to guide the development of an instrument to measure experimentally variations of the amount of red blood cells in the skin. APPROACH: Monte Carlo simulations were carried out in a multilayer model of the skin to compute remitted light intensities as a function of distance from the illumination locus for different values of the skin blood content. The simulation results were used to compute parameter LRBC and its variations with local skin blood content. An experimental setup was developed to measure parameter LRBC in human volunteers in whom skin blood content of the forearm increased during temporary interruption of the venous outflow. RESULTS: In the simulations, parameter LRBC was ∼16 µm in baseline conditions, and it increased in near proportion with the blood content of the skin layers. Measuring the diffusely reflected light intensity 0.5 to 1.2 mm away from the illumination locus was optimal to detect appreciable changes of the reflected light intensity as skin blood content was altered. Parameter LRBC measured experimentally on the human forearm was 17 ± 2 µm in baseline conditions it increased at a rate of 4 ± 2 µm / min when venous outflow was temporarily interrupted. CONCLUSION: Parameter LRBC derived experimentally with a two-wavelength diffuse reflectometer can be used to measure local variations of the amount of red blood cells in skin microvessels.

A Low-Cost AI Buoy System for Monitoring Water Quality at Offshore Aquaculture Cages.

The ocean resources have been rapidly depleted in the recent decade, and the complementary role of aquaculture to food security has become more critical than ever before. Water quality is one of the key factors in determining the success of aquaculture and real-time water quality monitoring is an important process for aquaculture. This paper proposes a low-cost and easy-to-build artificial intelligence (AI) buoy system that autonomously measures the related water quality data and instantly forwards them via wireless channels to the shore server. Furthermore, the data provide aquaculture staff with real-time water quality information and also assists server-side AI programs in implementing machine learning techniques to further provide short-term water quality predictions. In particular, we aim to provide a low-cost design by combining simple electronic devices and server-side AI programs for the proposed buoy system to measure water velocity. As a result, the cost for the practical implementation is approximately USD 2015 only to facilitate the proposed AI buoy system to measure the real-time data of dissolved oxygen, salinity, water temperature, and velocity. In addition, the AI buoy system also offers short-term estimations of water temperature and velocity, with mean square errors of 0.021 °C and 0.92 cm/s, respectively. Furthermore, we replaced the use of expensive current meters with a flow sensor tube of only USD 100 to measure water velocity.

Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians.

BACKGROUND: It is well-documented that the Affordable Care Act Medicaid expansion increased health care utilization by low-income Americans. Emerging studies also found that the expansion changed the geographical distribution of new physicians. However, the effect of the expansion on physician compensation has not been studied. OBJECTIVES: We aimed to assess how the Medicaid expansion affected the compensation of new primary care physicians (PCPs) and whether the effect differed by specialty, gender, and geography. RESEARCH DESIGN: We used a quasiexperimental difference-in-differences design to assess changes in compensation for new PCPs from before to after the Medicaid expansion in states that expanded Medicaid compared with states that did not expand. SUBJECTS: Our study included 2003 new PCPs who responded to the Survey of Residents Completing Training in New York between 2009 and 2018. MEASURES: Our primary outcome was respondents' self-reported starting salary for their first year of practice. Our secondary outcomes were respondents' self-reported additional anticipated income and incentives they received for accepting the job offer. RESULTS: We found that starting salaries for new PCPs, especially new general internists and family physicians, grew faster in expansion states than in nonexpansion states. In addition, we found that the expansion was associated with a statistically significant increase in receiving additional anticipated income as part of the compensation package for new PCPs practicing in rural areas.

Chief Financial Officer Functional Diversity and the Timeliness of Annual Reports: A Comparative Study of Firms With Different Ownership Types.

Functional diversity is related to functional areas in which CFOs are experienced. It reflects their number of general managerial skills or social ties to some extent. In this paper, we try to examine whether there is an association between CFO functional diversity and the timeliness of annual reports. Using data on Chinese listed firms from 2009 to 2017, we found that in state-owned enterprises, there is a negative relationship between this diversity and timeliness. However, the promotion incentive of CFOs with functionally diverse experience can weaken this negative relationship. We also found that there is a positive relationship between the two factors in private enterprises whose offices are headquartered in regions with a low degree of marketization. We use difference-in-differences method to test the hypotheses again. The conclusions remain robust.

Seasonal changes of heavy metals and health risk assessment based on Monte Carlo simulation in alternate water sources of the Xinbian River in Suzhou City, Huaibei Plain, China.

The urban alternate water source (AWS) is of great significance to the sustainable development of the city, the pollution degree, and source of heavy metals (HMs) in AWS, and whether it will adversely affect human health has received widespread attention. In this study, the urban AWS of Xinbian River in Suzhou City, Huaibei Plain, China, was used as the research object to study the seasonal changes of HMs (As, Cr, Cu, Cd, Pb, and Zn), quantitative identification of pollution sources, and human health risks (HHR). Research results show that the contents of those HMs, except As, are less than the drinking standards limit set by the World Health Organization (WHO), and the contents of As, Cr, and Zn are the largest in summer. The multivariate statistical analysis combined with positive matrix factorization (PMF) model analysis revealed that industrial sources accounted for 44.83%, and agricultural sources accounted for 55.17%. HHR assessment based on Monte Carlo simulation shows that the noncarcinogenic risks of adults and children are in the acceptable range (hazardous ingestion (HI) < 1), and the probability of carcinogenic risk values of children and adults are 95.03% and 38.96%, respectively, which are exceed the acceptable range (1 × 10-4) recommended by the United States Environment Protection Agency (USEPA). Approximately 30.75% of the carcinogenic risk value of agricultural source HMs to children exceeds the acceptable range (1 × 10-4). The above research results indicate that the effect of agricultural non-point source pollution on AWS should be prevented.

The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists.

BACKGROUND: A recent study found that states that expanded Medicaid under the Affordable Care Act (ACA) gained new general internists who were establishing their first practices, whereas nonexpansion states lost them. OBJECTIVE: The objective of this study was to examine the level of social disadvantage of the areas of expansion states that gained new physicians and the areas of nonexpansion states that lost them. RESEARCH DESIGN: We used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. Using 2009-2019 data from the AMA Physician Masterfile and information on states' Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following the expansion to where they located during the 5 years preceding the expansion. SUBJECTS: A total of 32,102 new general internists. RESULTS: Compared with preexpansion patterns, new general internists were more likely to locate in expansion states after the expansion, a finding that held for high, medium, and low disadvantage areas. We estimated that, between 2014 and 2019, nonexpansion states lost 371 new general internists (95% confidence interval, 203-540) to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas even though these areas only accounted for 17.9% of the population of nonexpansion states. CONCLUSIONS: States that opted not to expand Medicaid lost new general internists to expansion states. A highly disproportionate share of the physicians lost by nonexpansion states were lost from high disadvantage areas, potentially compromising access for all residents irrespective of insurance coverage.

A safety assessment of a 300-meter saturation dive at sea by mental ability and performance efficacy.

High pressure is an environmental characteristic of the deep sea that may exert critical effects on the physiology and mental abilities of divers. In this study we evaluated the performance efficacy and mental ability of four divers during a 300-meter helium-oxygen saturation dive at sea. Spatial memory, 2D/3D mental rotation functioning, grip strength, and hand-eye coordination ability were examined for four divers during the pre-dive, compression, decompression, and post-dive phases. The results showed that both the reaction time and the correct responses for the mental rotation and hand-eye coordination were slightly fluctuated. In addition, there was a significant decline in the grip strength of the left hand. It is concluded that the performance efficacy and mental ability of divers were virtually unaffected during 300-meter helium-oxygen saturation diving at sea.

Validation of a three-dimensional printed dry lab pancreaticojejunostomy model in surgical assessment: a cross-sectional study.

OBJECTIVES: Until now, there have been few tools to evaluate whether a surgeon was technically ready to perform a safe pancreaticojejunostomy (PJ). In the current study, we aimed to evaluate whether a three-dimensional model could mimic a real surgical situation and distinguish between surgeons of different levels of experiences. DESIGN: A three-dimensional PJ dry laboratory model was printed. Eight experienced pancreatic surgeons were tasked to evaluate the appearance and tactile sensation of the model. Proficiency was scored based on 15 surgeons with various levels of pancreatic experience performing a PJ on the three-dimensional model. Additionally, the time of manipulation and NASA Task Load Index (NASA-TLX) scores were recorded for each operation. SETTING: Our study was conducted in multimedical centre in China. RESULTS: Compared with real surgical situations, this model had similar appearance (3.96±0.55 out of five points) and tactile sensation (3.85±0.46 out of five points) according to the expert evaluation. Additionally, the chief surgeon group scored the best in proficiency (based on NASA-TLX scores and operative time), and there were statistical differences for performances among surgeons of various levels (p<0.05). CONCLUSION: The three-dimensional PJ model could mimic a real surgical situation and can distinguish between surgeons of different levels of experiences.