LiverRisk score: An accurate, cost-effective tool to predict fibrosis, liver-related, and diabetes-related mortality in the general population.

BACKGROUND: Noninvasive and early assessment of liver fibrosis is of great significance and is challenging. We aimed to evaluate the predictive performance and cost-effectiveness of the LiverRisk score for liver fibrosis and liver-related and diabetes-related mortality in the general population. METHODS: The general population from the NHANES 2017-March 2020, NHANES 1999-2018, and UK Biobank 2006-2010 were included in the cross-sectional cohort (n = 3,770), along with the NHANES follow-up cohort (n = 25,317) and the UK Biobank follow-up cohort (n = 17,259). The cost-effectiveness analysis was performed using TreeAge Pro software. Liver stiffness measurements ≥10 kPa were defined as compensated advanced chronic liver disease (cACLD). FINDINGS: Compared to conventional scores, the LiverRisk score had significantly better accuracy and calibration in predicting liver fibrosis, with an area under the receiver operating characteristic curve (AUC) of 0.76 (0.72-0.79) for cACLD. According to the updated thresholds of LiverRisk score (6 and 10), we reclassified the population into three groups: low, medium, and high risk. The AUCs of LiverRisk score for predicting liver-related and diabetes-related mortality at 5, 10, and 15 years were all above 0.8, with better performance than the Fibrosis-4 score. Furthermore, compared to the low-risk group, the medium-risk and high-risk groups in the two follow-up cohorts had a significantly higher risk of liver-related and diabetes-related mortality. Finally, the cost-effectiveness analysis showed that the incremental cost-effectiveness ratio for LiverRisk score compared to FIB-4 was USD $18,170 per additional quality-adjusted life-year (QALY) gained, below the willingness-to-pay threshold of $50,000/QALY. CONCLUSIONS: The LiverRisk score is an accurate, cost-effective tool to predict liver fibrosis and liver-related and diabetes-related mortality in the general population. FUNDING: The National Natural Science Foundation of China (nos. 82330060, 92059202, and 92359304); the Key Research and Development Program of Jiangsu Province (BE2023767a); the Fundamental Research Fund of Southeast University (3290002303A2); Changjiang Scholars Talent Cultivation Project of Zhongda Hospital of Southeast University (2023YJXYYRCPY03); and the Research Personnel Cultivation Program of Zhongda Hospital Southeast University (CZXM-GSP-RC125).

Cost-effectiveness evaluation of different control strategies for Clonorchis sinensis infection in a high endemic area of China: A modelling study.

Clonorchiasis is an important food-borne parasitic disease caused by Clonorchis sinensis infection. The evaluation of long-term cost-effectiveness of control strategies is important for disease control and prevention. The present study aimed to assess the cost-effectiveness of the three recommended strategies (i.e., WHO, Chinese and Guangdong strategies) and different combinations of commonly used measures (i.e., preventive chemotherapy, information, education, and communication (IEC) and environmental improvement) on clonorchiasis. The study area, Fusha town in Guangdong Province, was a typical high endemic area in China. The analysis was based on a multi-group transmission model of C. sinensis infection. We set the intervention duration for 10 years and post-intervention period for 50 years. The corresponding costs and DALYs were estimated. Strategies with incremental cost-effectiveness ratios (ICERs) less than 1/5 of the willingness-to-pay threshold were identified as highly cost-effective strategies. The optimal control strategy was obtained using the next best comparator method. The ICERs of Guangdong strategy were $172 (95% CI: $143-$230) US for praziquantel and $106 (95% CI: $85-$143) US for albendazole, suggesting the highest cost-effectiveness among the three recommended strategies. For praziquantel, 470 sets of control strategies were identified as highly cost-effective strategies for achieving infection control (prevalence<5%). The optimal strategy consisted of chemotherapy targeted on at-risk population, IEC and environmental improvement, with coverages all being 100%, and with the ICER of $202 (95% CI: $168-$271) US. The results for transmission control (prevalence<1%) and albendazole were obtained with the same procedures. The findings may help to develop control policies for C. sinensis infection in high endemic areas. Moreover, the method adopted is applicable for assessment of optimal strategies in other endemic areas.

Development and validation of a Modified Patient-Generated Subjective Global Assessment as a nutritional assessment tool in cancer patients.

BACKGROUND: Completing Patient-Generated Subjective Global Assessment (PG-SGA) questionnaires is time consuming. This study aimed to develop and validate an easy-to-use modified PG-SGA (mPG-SGA) for cancer patients. METHODS: Seventy professionals assessed the content validity, comprehensibility, and difficulty of the full PG-SGA. A survey including the PG-SGA and other questionnaires was completed by 34 071 adult hospitalized cancer patients with first cancer diagnosis or recurrent disease with any tumour comorbidities from the INSCOC study. Among them, 1558 patients were followed for 5 years after admission. Reliability and rank correlation were estimated to assess the consistency between PG-SGA items and to select mPG-SGA items. The external and internal validity, test-retest reliability, and predictive validity were tested for the mPG-SGA via comparison with both the PG-SGA and abridged PG-SGA (abPG-SGA). RESULTS: After deleting items that more than 50% of professionals considered difficult to evaluate (Worksheet 4) and items with an item-total correlation <0.1, the mPG-SGA was constructed. Nutritional status was categorized using mPG-SGA scores as well-nourished (0 points) or mildly (1-2 points), moderately (3-6 points), or severely malnourished (≥7 points) based on the area under curve (0.962, 0.989, and 0.985) and maximal sensitivity (0.924, 0.918, and 0.945) and specificity (1.000, 1.000, and 0.938) of the cut-off scores. The external and internal validity and test-retest reliability were good. Significant median overall survival differences were found among nutritional status groups categorized by the mPG-SGA: 24, 18, 14, and 10 months for well-nourished, mildly malnourished, moderately malnourished, and severely malnourished, respectively (all Ps < 0.05). Neither the PG-SGA nor the abridged PG-SGA could discriminate the median overall survival differences between the well-nourished and mildly malnourished groups. CONCLUSIONS: We systematically developed and validated the mPG-SGA as an easier-to-use nutritional assessment tool for cancer patients. The mPG-SGA appears to have better predictive validity for survival than the PG-SGA and abridged PG-SGA.

[Impact of Enclosure Culture on Heavy Metal Content in Surface Sediments of Hongze Lake and Ecological Risk Assessment].

In order to explore the concentrations of heavy metals and the influence of fencing on Hongze lake, the content, source, and spatial distribution characteristics of heavy metals in surface sediments and ecological risks were analyzed in 2018 after part of the fence around Hongze Lake was removed. The results showed that the average contents of Cr, Ni, Cu, Zn, As, Cd, and Pb in the surface sediments in Hongze Lake were 66.78, 33.89, 25.35, 74.77, 16.55, 0.23, and 27.20 mg·kg-1, respectively. Cr, Ni, Cu, Zn, and Pb contents were at non-polluting levels, with As and Cd at the lowest level, based on the accumulation index evaluation. Except for Cd, all the elements showed low potential ecological risk. The results showed that the heavy metal content in the fenced, dismantled, and peripheral areas increased and accumulated towards the center of the lake. The removal of the fence did not significantly reduce the heavy metal content in the short-term. Overall, Hongze Lake presented a state of low ecological risk. In the future, environmental policies should include surface sediment accumulation areas and fencing culture in the north and northeast of Hongze Lake.

Global Leadership Initiative on Malnutrition criteria as a nutrition assessment tool for patients with cancer.

OBJECTIVES: Since the launch of Global Leadership Initiative on Malnutrition (GLIM), there has been an urgent need to validate the new criteria, especially in patients with cancer. The aim of this study was to evaluate and validate the use of the GLIM criteria in patients with cancer. METHOD: This multicenter cohort study compared the GLIM with the scored Patient-Generated Subjective Global Assessment (sPG-SGA). The 1-y survival rate, multivariate Cox regression analysis, κ-value, sensitivity, specificity, receiver operating characteristic (ROC) curve, and time-dependent ROC analysis were applied to identify the performance of the GLIM. RESULTS: Among the 3777 patients in the study, 50.9% versus 49.1% or 36.3% versus 63.7% of the patients were defined as well-nourished and malnourished by GLIM or sPG-SGA, respectively. GLIM presented moderate consistency (κ = 0.54, P < 0.001), fair sensitivity and specificity (70.5 and 88.3%) compared with sPG-SGA. There was no difference in the 1-y survival rate in malnourished patients (76.9 versus 76.4%, P = 0.711), but it was significantly different in well-nourished patients (85.8 versus 90.3%, P < 0.001) between GLIM and sPG-SGA. The above difference was eliminated after omitted nutritional risk screening (NRS)-2002 screening before GLIM (88.1 versus 90.3%, P = 0.078). Omitting NRS-2002 screening before GLIM did not change the 1-y survival rate in well-nourished or malnourished patients by GLIM with NRS-2002 screening (76.9 versus 78.9%, P = 0.099; 85.8% versus 88.1%, P = 0.092) although it significantly raised the rate of malnutrition to 72.5%. The combination of "weight loss and cancer" showed better performance than other combinations. CONCLUSIONS: GLIM could be a convenient alternative to sPG-SGA in nutrition assessment for patients with cancer. The combination of "weight loss and cancer" was better than other combinations. Considering the higher risk for malnutrition in patients with cancer, NRS-2002 screening may not be needed before GLIM.

The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients.

BACKGROUND & AIMS: Elderly cancer patients are at particularly high risk for malnutrition because both the disease and the old age threaten their nutritional status. The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing and grading malnutrition, but the validation of these criteria in elderly cancer population is not well documented. Our objective was to investigate the application of the GLIM criteria in nutrition assessment and survival prediction in elderly cancer patients. METHODS: This retrospective cohort analysis was conducted on a primary cohort of 1192 cancer patients aged 65 years or older enrolled from a multi-institutional registry, and a validation cohort of 300 elderly cancer patients treated at the First Affiliated Hospital of Sun Yat-sen University. Patients considered at-risk for malnutrition based on the NRS-2002 were assessed using the GLIM criteria. The association between the nutritional status and patients' overall survival (OS) was then analyzed by the Kaplan-Meier method and a Cox model. A nomogram was also established that included additional independent clinical prognostic variables. To determine the predictive accuracy and discriminatory capacity of the nomogram, the C-index, receiver operating characteristic (ROC) curve and calibration curve were evaluated. RESULTS: The percentage of patients considered "at-risk" for malnutrition was 64.8% and 67.3% for the primary and validation cohorts, respectively. GLIM-defined malnutrition was diagnosed in 48.4% of patients in the primary cohort and 46.0% in the validation cohort. In the primary cohort, patients at risk of malnutrition (NRS-2002 ≥ 3) showed a worse OS than those with a NRS-2002 < 3 (HR 1.34, 1.10-1.64; p = 0.003). Additionally, patients with GLIM-defined severe malnutrition (HR1.71, 1.37-2.14; p < 0.001) or moderate malnutrition (HR1.35, 1.09-1.66; p = 0.006) showed a significantly shorter OS compared to those without malnutrition. The nomogram incorporating the domains of the GLIM with other variables was accurate, especially for predicting the 1- and 2-year overall survival rates. CONCLUSIONS: The GLIM criteria can be used in elderly cancer patients not only to assess malnutrition, but also to predict survival outcome. The nomogram developed based on the GLIM domains can provide a more accurate prediction of the prognosis than existing systems.

Eliciting women's preference for prenatal testing in China: a discrete choice experiment.

BACKGROUND: Pregnancy tests can be used for the early diagnosis of fetal problems and can prevent abnormal birth in pregnancies. Yet, testing preferences among Chinese women are poorly investigated. METHODS: We developed a Discrete Choice Experiment with 5 attributes: test procedure, detection rate, miscarriage rate, time to wait for result, and test cost. By studying the choices that the women make in the hypothetical scenarios and comparing the attributes and levels, we can analyze the women's preference of prenatal testing in China. RESULTS: Ninety-two women completed the study. Respondents considered the test procedure as the most important attribute, followed by detection rate, miscarriage rate, wait time for result, and test cost, respectively. The estimated preference weight for the non-invasive procedure was 0.928 (P < 0.0001). All other attributes being equal, the odds of choosing a non-invasive testing procedure over an invasive one was 2.53 (95% confidence interval, 2.42-2.64; P < 0.001). Participants were willing to pay up to RMB$28,810 (approximately US$4610) for a non-invasive test, RMB$6061(US$970) to reduce the miscarriage rate by 1% and up to RMB$3356 (US$537) to increase the detection rate by 1%. Compared to other DCE (Discrete Choice Experiment) studies regarding Down's syndrome screening, women in our study place relatively less emphasis on test safety. CONCLUSIONS: The present study has shown that Chinese women place more emphasis on detection rate than test safety. Chinese women place great preference on noninvasive prenatal testing, which indicate a popular need of incorporating noninvasive prenatal testing into the health insurance coverage in China. This study provided valuable evidence for the decision makers in the Chinese government.

[Distribution and Risk Assessment of OCPs in Surface Water, Sediments, and Fish from Lake Gucheng and Inflow and Outflow Rivers].

To investigate the distribution, source, and ecological risk of organochlorine pesticides (OCPs) residues in Lake Gucheng, surface water, sediment, and biological samples were collected from 12 sampling sites of Lake Gucheng and its inlets and outlets during summer and winter, and the concentrations of 19 OCPs were analyzed. The results showed that the concentration (dry weight) of OCPs in Lake Gucheng ranged from 26.74 to 48.12 ng·L-1 in surface water, 9.01 to 35.34 ng·g-1 in sediment, and 13.39 to 124.29 ng·g-1 in organisms. The pollution characteristics of OCPs in surface water showed that the concentration was much higher in summer than in winter, and much higher at inflow and outflow rivers than in farming ponds and the central region of Lake Gucheng; the seasonal pollution characteristics in sediment were not obvious. All 19 kinds of OCPs in water, sediment, and organisms were detected in different degrees, and the dominant contaminants were HCHs and DDTs. α-HCH was the main pollutant at all sites in both surface water and sediment, with 21% to 42% of total HCHs in two seasons. p,p'-DDD was the main pollutant in surface water with 30% to 76% of total DDTs, whereas p,p'-DDT was the main pollutant in sediment with 68% to 93% of total DDTs in two seasons. Source analysis based on ratios of HCHs isomers and DDTs isomers indicated that there was a new input of OCPs under anaerobic conditions in the study area. The ecological risk assessment showed that the OCPs in surface water did not lead to significant health risks, but the OCPs in sediments might pose ecological risks to the Lake Gucheng ecosystem. The organisms were within the acceptable potential carcinogenic risk range.

Opioid Use and Outcomes in Hospitalized Older Patients With Heart Failure Receiving and Not Receiving Hospice Referrals.

BACKGROUND: The use of opioids is associated with poor outcomes. Less is known about this association in patients with heart failure (HF) and whether it varies by the receipt of hospice care. METHODS: Of the 7467 patients hospitalized for HF without previous opioid use, 124 received discharge opioids. We matched 123 of these patients with 123 not receiving opioids based on their propensity scores for opioid use, thus assembling a matched cohort of 246 patients balanced on 30 baseline characteristics (mean age, 76 years, 60% women, and 11% African American). We repeated the process in hospice (n = 155; 20 received opioids) and nonhospice (n = 7298; 104 received opioids) subgroups, thus assembling 2 matched cohorts of 22 and 208 patients, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) associated with opioid use were estimated from matched cohorts. RESULTS: During 8.6 (median, 1.4) years of follow-up, all-cause mortality occurred in 80% and 68% of matched patients in the opioid and nonopioid groups, respectively (HR, 1.49; 95% CI, 1.11-1.99; P = 0.008). There was evidence of heterogeneity in this association between hospice and nonhospice patients (P for interaction, 0.027). Among matched hospice and nonhospice patients, HRs (95% CIs) for mortality were 6.37 (2.06-19.69; P = 0.001) and 1.42 (1.03-1.96; P = 0.035), respectively. HRs (95% CIs) for 30-day and 1-year mortality were 1.98 (1.06-3.70; P = 0.033) and 1.72 (1.18-2.49; P = 0.004), respectively. HRs (95% CIs) for all-cause, HF, and non-HF readmissions were 1.31 (0.97-1.76; P = 0.079), 1.03 (0.71-1.49; P = 0.866), and 1.75 (1.05-2.91; P = 0.031), respectively. Readmission associations were similar among matched nonhospice patients. There was no readmission among matched hospice patients receiving opioids. CONCLUSIONS: In older patients with HF, opioid use is associated with a higher risk of mortality, which is greater in the hospice subgroup, and a higher risk of non-HF readmission in the nonhospice subgroup.

Intraprocedural contrast-enhanced ultrasound-CT/MR fusion imaging assessment in HCC thermal ablation to reduce local tumor progression: compared with routine contrast-enhanced ultrasound.

Purpose: To evaluate whether local tumor progression (LTP) would be further reduced when contrast-enhanced ultrasound (CEUS)-CT/MR fusion imaging was used as intraprocedural assessment method in hepatocellular carcinoma (HCC) thermal ablation compared with routine CEUS. Materials and methods: This prospective non-randomized study was conducted from December 2010 to July 2012. CEUS-CT/MR fusion imaging and routine CEUS were used for treatment response assessment in the ablation procedure of 146 HCCs and 122 HCCs, respectively. Supplementary ablations were performed immediately if necessary. The primary technique efficacy rate, LTP rate and overall survival (OS) rate were calculated. Results: For CEUS-CT/MR fusion imaging and routine CEUS, the technical success rate, technique efficacy rate and supplementary ablation rate were 86.3% (126/146) and 98.4% (120/122) (p = .000), 99.2% (125/126) and 94.2% (113/120) (p = .032), and 14.3% (18/126) and 4.2% (5/120) (p = .006), respectively. The cumulative LTP rate and OS rate were not significantly different between fusion imaging group and routine CEUS group. However, for lesions that were larger than 3 cm or close to major vessels (41 lesions in fusion imaging group and 44 lesions in routine CEUS group, who received transcatheter arterial chemoembolization before ablation), the cumulative LTP rate was significantly lower in fusion imaging group than in routine CEUS group (p = .032). Conclusion: Although intraprocedural CEUS-CT/MR fusion imaging has certain limitations in application, it might provide a potential more efficient method compared with routine CEUS in reducing LTP in HCC thermal ablation, especially for difficult ablation lesions.

The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: An economic evaluation.

OBJECTIVES: To estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain. PERSPECTIVE: VA healthcare system. METHODS: We used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans' medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes. RESULTS: We identified 30,634 younger Veterans with chronic MSD pain as using CIH and 195,424 with no CIH use. CIH users differed from nonusers across all baseline covariates except the Charlson comorbidity index. They also differed on annual pre-CIH-start healthcare costs ($10,729 versus $5,818), pain (4.33 versus 3.76), and opioid use (66.6% versus 54.0%). The HLM results indicated lower annual healthcare costs (-$637; 95% CI: -$1,023, -$247), lower pain (-0.34; -0.40, -0.27), and slightly higher (less than a percentage point) opioid use (0.8; 0.6, 0.9) for CIH users in the year after CIH start. Sensitivity analyses indicated similar results for three most-used CIH approaches (acupuncture, chiropractic care, and massage), but higher costs for those with eight or more CIH visits. CONCLUSIONS: On average CIH use appears associated with lower healthcare costs and pain and slightly higher opioid use in this population of younger Veterans with chronic musculoskeletal pain. Given the VA's growing interest in the use of CIH, further, more detailed analyses of its impacts are warranted.

2018 Salary Survey of AMIA Members: Factors Associated with Higher Salaries.

Greater transparency in salaries overall and in factors associated with differing salaries can help students and professionals plan their careers, discover biases and obstacles, and help advance professional disciplines broadly. In March 2018, we conducted the first salary survey of American Medical Informatics Association members. Our goal was to summarize salary information and provide a nuanced view pertaining to the diverse biomedical informatics community. To identify factors associated with higher salaries, we reviewed average salaries for different groups (physician status, academic status, and different leadership positions) by gender. We also fitted multiple linear regression models for all participants (N = 201) and for gender, physician- and academic-status subgroup. The mean (standard deviation) salary was $181,774 ($99,566). Men earned more than women on average, and especially among professionals from academic settings. More years working in informatics and full-time employment were two factors that were consistently associated with higher salary.

[Spatial Interpolation Methods and Pollution Assessment of Heavy Metals of Soil in Typical Areas].

It is important to choose the best spatial interpolation method to reflect spatial distribution features and evaluate soil heavy metal pollution. The spatial distribution of arsenic (As) and cadmium (Cd) concentrations in top soil samples from Hubei Province were studied by four frequently-used spatial interpolation methods, including inverse distance weighted (IDW), radial basis function (RBF), local polynomial interpolation (LPI) and ordinary kriging (OK). The interpolation precision and effect of the spatial distribution of the four methods were compared with the results of cross validation and spatial distribution, and the pollution was assessed by the geoaccumulative index (Igeo) and indicator kriging (IK). The results showed that the four interpolation methods had small prediction errors, but that the interpolation effects were quite different. Among them, LPI had the most serious smoothing effect, followed by OK. The IDW and RBF best retained the extreme value information for element concentrations, and interpolation results were more detailed-and so to accurately understand the distribution of soil heavy metals, IDW or RBF methods were recommended. Taking the arithmetic mean of heavy metal concentrations in deep soil of Hubei Province as the background value, the evaluation result of geo-cumulative index pollution allowed exceedance percentages for As and Cd accounted for 5.5% and 99.0% respectively. The soils of the study areas were heavily contaminated with Cd. The pollution evaluation result from IK showed that high probability contaminated areas, with moderate-heavy contamination levels, were mainly located in the central part of the study area. The authors concluded that development of agriculture in the research area should include attention to Cd pollution and that soils there required the effective treatment and restoration of Cd levels.

Quantitative Assessment of Airway Pathology in Subjects With COPD Using Low-Dose High-Resolution Computed Tomography.

BACKGROUND: The purpose of this study was to correlate airway parameters of COPD determined by low-dose high-resolution computed tomography (HRCT) with pulmonary function testing (PFT) results. METHODS: PFT data were collected for subjects with COPD and healthy controls. All subjects received inspiratory and expiratory phase low-dose HRCT. Bronchi in the apical segment of the right upper lobe (RB1), posterior segment of the right lower lobe (RB6), and lower lingual segment of the left upper lobe (LB5) were the target bronchi. Software automatically calculated airway wall area, inner area, and airway wall area percentage (percentage wall area for bronchial external area). RESULTS: A total of 75 COPD and 20 control subjects were included. The subjects with COPD were classified according to COPD stage, with 20 grade I, II, and III subjects, respectively, and 15 grade IV subjects. In COPD grade II, residual volume/total lung capacity was negatively correlated with airway wall area in LB5 (r = -0.51). In COPD grade III, FVC was negatively correlated with airway wall area percentage in LB5 (r = -0.49) but positively correlated with airway wall area in RB6 (r = 0.52); percent-of-predicted FEV1 was negatively correlated with airway wall area percentage in RB1 (r = -0.49); residual volume was negatively correlated with airway wall area (r = -0.47), and total lung capacity was negatively correlated with airway wall area in RB1 (r = -0.52) (all, P < .001). CONCLUSIONS: The results of this study suggest that airway parameters in different COPD grades have no uniform tendency of correlation with PFT, but some HRCT parameters are correlated to some PFT parameters.

Generic ledipasvir-sofosbuvir for patients with chronic hepatitis C: A real-life observational study.

BACKGROUND & AIMS: Few patients from developing countries can afford brand name direct-acting antiviral agents for treating hepatitis C virus (HCV) infection, and controversy regarding the bioequivalence of generics exists. This study aimed to observe the safety and efficacy of 8 or 12weeks of generic ledipasvir-sofosbuvir with or without ribavirin for Chinese genotype 1b HCV-infected patients. METHODS: In this open-labelled observational study, 63 cirrhotic (group 1) and 65 non-cirrhotic (group 2) patients were administered generic ledipasvir-sofosbuvir plus 1000-1200mg of ribavirin daily for 12 and 8weeks, respectively; and 64 non-cirrhotic patients (group 3) received ledipasvir-sofosbuvir for 8weeks. The primary efficacy endpoint was undetectable HCV RNA at week 12 (SVR12) after cessation of therapy. Safety and pharmacokinetic data were collected. RESULTS: One hundred and eighty-seven patients completed treatment, and the latest undetectable HCV RNA was observed in three patients with cirrhosis at week 5 during treatment. Intention-to-treat analysis revealed 96.8% (61/63), 96.9% (63/65), and 96.9% (62/64) of SVR12 rates in groups 1, 2, and 3, respectively. One patient in group 3 relapsed at post-treatment week 4. The regimens were generally well-tolerated. The most common adverse events were fatigue (17.8%), diarrhea (10.9%), and headache (9.9%). Four patients discontinued therapy due to diarrhea and vomiting. One patient from group 2 discontinued treatment on day 29 because of drug-unaffordability; fortunately, she achieved SVR12. CONCLUSION: This study demonstrated that 8 or 12weeks of generic ledipasvir-sofosbuvir with or without ribavirin are safe and effective for patients with genotype 1b HCV infection. LAY SUMMARY: The price of Harvoni® has led to restrictions and access limitations in many developing and even developed countries with limited healthcare budgets. Gilead approved generic ledipasvir-sofosbuvir costs far less than Harvoni® and presents a similar cure rate for patients with chronic hepatitis C.

Doodle Health: A Crowdsourcing Game for the Co-design and Testing of Pictographs to Reduce Disparities in Healthcare Communication.

Supplementing patient education content with pictographs can improve the comprehension and recall of information, especially patients with low health literacy. Pictograph design and testing, however, are costly and time consuming. We created a Web-based game, Doodle Health, for crowdsourcing the drawing and validation of pictographs. The objective of this pilot study was to test the usability of the game and its appeal to healthcare consumers. The chief purpose of the game is to involve a diverse population in the co-design and evaluation of pictographs. We conducted a community-based focus group to inform the game design. Game designers, health sciences librarians, informatics researchers, clinicians, and community members participated in two Design Box meetings. The results of the meetings were used to create the Doodle Health crowdsourcing game. The game was presented and tested at two public fairs. Initial testing indicates crowdsourcing is a promising approach to pictograph development and testing for relevancy and comprehension. Over 596 drawings were collected and 1,758 guesses were performed to date with 70-90% accuracies, which are satisfactorily high.

Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure.

BACKGROUND: Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score-matched study of hospitalized patients with heart failure. METHODS: Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30 days after discharge, 1519 had a 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without a 30-day all-cause readmission, balanced on 34 baseline characteristics (mean age 75 years, 56% women, 24% African American). RESULTS: During 2-12 months of follow-up after discharge from index hospitalization, all-cause mortality occurred in 41% and 27% of matched patients with and without a 30-day all-cause readmission, respectively (hazard ratio 1.68; 95% confidence interval 1.48-1.90; P <.001). This harmful association of 30-day all-cause readmission with mortality persisted during an average follow-up of 3.1 (maximum, 8.7) years (hazard ratio 1.33; 95% confidence interval 1.22-1.45; P <.001). Patients with a 30-day all-cause readmission had higher cumulative all-cause readmission (mean, 6.9 vs 5.1; P <.001), a longer cumulative length of stay (mean, 51 vs 43 days; P <.001), and a higher cumulative cost (mean, $38,972 vs $34,025; P = .001) during 8.7 years of follow-up. CONCLUSIONS: Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost.

[Influence of the river-lake relation change on the distribution of heavy metal and ecological risk assessment in the surface sediment of Poyang Lake].

Effects of river (Yangtze River)-lake (Poyang Lake) relation on the distribution and potential ecological risk of Cu, Pb, Zn, Cr and Cd were investigated in surface sediment of Poyang Lake under different waterregimens. The results indicated: (1) the sediments of Poyang Lake were polluted by various concentrations of heavy metals mainly originated from particulates of Yangtze River, and Cu and Pb were the main pollution factors. The pollution level of determined heavy metals followed the order of Cu > Pb > Zn > Cr >Cd. The concentration ranges of Cu, Pb, Zn, Cr and Cd in the sediment of Poyang Lake were 13.1-108.1 mg.kg-1 , 37-119.1 mg.kg-1, 29.9-129.9 mgkg-1, 13.3-98.6 mgkg-1 and 0. 19-2.77 mg.kg-1 during the wet period, and 3.05-69.7 mg.kg-1, 27.5-105 mgkg-1, 18.8-95.4 mg.kg-1, 7.34-70 mg.kg- and 0.033-0.406 mg.kg-1 during the dry period respectively. The region with the highest heavy metal concentrations was located in water input area of the " Five River" and water output area of " Hukou" ; (2)The regions with high risk of heavy metals in sediment were mainly located in the area of the trail of "Five Rivers" during the wet period; while during the dry period, the area with high risk of heavy metals in sediment enlarged, which was not only limited in the area of the trail of "Five Rivers", but also enlarged northwards. The potential ecological risk of "Hukou" was relatively high, however, the potential ecological risk of the sediment in the whole lake during the dry period was lower than that during the wet period. (3) With the change of river-lake relation, water level rose, the maintaining time was shortened during the wet period, the dry season appeared ahead of schedule, the transformation course of Poyang Lake from "Lake morphology" to " River morphology" increased, and the typical river properties were enhanced, which resulted in the decreased potential ecological risk of heavy metals in sediment of the whole lake, however, the area of high risk-region was enlarged northwards.

[Pollution distribution and potential ecological risk assessment of heavy metals in sediments from the different eastern dredging regions of Lake Taihu].

In order to investigate the distribution characteristics of nutrients and heavy metals in sediments from different eastern dredging regions of Lake Taihu, the surface and core sediment samples at 5 sites (in East Taihu Lake and Xukou Bay) were collected in 2012. Contents of nutrients (TOC, TN and TP) and heavy metals (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) in the sediments were measured and the pollution degrees of heavy metals were evaluated with the potential ecological risk method. The results showed that the heavy metal contents in Xukou Bay were generally higher than those in East Taihu Lake, whereas the nutrients contents showed the reverse trend. There were significant differences between the phytoplankton-dominated and culture lake regions. The concentrations of both nutrients and heavy metals decreased with increasing profile depth. Moreover, the contents of nutrients and heavy metals in the sediments of all dredged areas were lower than those in the un-dredged areas, suggesting that dredging may be a useful approach for decreasing nutrients and heavy metals loading in sediments, but its effectiveness decreased with time. Significant positive correlations were found among different heavy metals and nutrients, indicating that they were from the same pollution source. The Hakanson potential ecological risk index was applied for assessing the status of sediment heavy metal enrichment and the result indicated that sediment dredging could reduce the extent of potential ecological risk. The risk index in different sites followed the order: X1 > D1 > D3 > X2 > D2, while the risk index in site X1 of Xukou Bay was higher than that in site D1 of East Taihu Lake. And the comprehensive ecological risk grades in sites X1 and D1 were in the moderate range, while the sites D2, D3 and X2 were low.

[Hydroacoustic assessment of fish resources in reservoirs with different fishery management].

By using Biosonics DT-X echosounder (208 kHz), a hydroacoustic investigation was conducted on the fish resources in three mesotrophic reservoirs (Daxi Reservoir, Shahe Reservoir, and Jinniushan Reservoir) with different fishery management in late autumn and early winter 2011, and a GIS model was constructed to assess the fish resource distribution in the reservoirs. No significant difference was observed in the average size of fish in the three reservoirs, but the distribution curves of fish target strength (TS) showed that the fish size distribution proportion was different, and had close correlation with fishery management. The fish density in Daxi Reservoir (averagely 0.0183 ind x m(-3)) had no significant difference with that in Shahe Reservoir (averagely 0.0124 ind x m(-3)), but the fish density in Jinniushan Reservoir (averagely 0.0085 ind x m(-3)) was significantly lower than that in Daxi and Shahe reservoirs. There was no significant correlation between the horizontal distribution of fish density and the water depth in the three reservoirs. The fish in the three reservoirs were in group distribution, and fish aggregation was found in Daxi and Shahe reservoirs. In the three reservoirs, the fish biomass was the highest in downstream, and there was a greater biomass near the dam, except in Shahe Reservoir which was affected by fish catch activity. Based on the raster data obtained from GIS fish distribution model and the surface water area of each grid, the total amount of fish resources with the TS > -60 dB in the Daxi, Shahe and Jinniushan reservoirs was estimated as about 480000, 610000 and 520000 individuals, and that with the TS > -40 dB was about 50400, 52900 and 90700 individuals, respectively.