A comprehensive analysis of patients with cerebral arteriovenous malformation with headache: assessment of risk factors and treatment effectiveness.

BACKGROUND: Due to the high mortality and disability rate of intracranial hemorrhage, headache is not the main focus of research on cerebral arteriovenous malformation (AVM), so research on headaches in AVM is still scarce, and the clinical understanding is shallow. This study aims to delineate the risk factors associated with headaches in AVM and to compare the effectiveness of various intervention treatments versus conservative treatment in alleviating headache symptoms. METHODS: This study conducted a retrospective analysis of AVMs who were treated in our institution from August 2011 to December 2021. Multivariable logistic regression analysis was employed to assess the risk factors for headaches in AVMs with unruptured, non-epileptic. Additionally, the effectiveness of different intervention treatments compared to conservative management in alleviating headaches was evaluated through propensity score matching (PSM). RESULTS: A total of 946 patients were included in the analysis of risk factors for headaches. Multivariate logistic regression analysis identified that female (OR 1.532, 95% CI 1.173-2.001, p = 0.002), supply artery dilatation (OR 1.423, 95% CI 1.082-1.872, p = 0.012), and occipital lobe (OR 1.785, 95% CI 1.307-2.439, p < 0.001) as independent risk factors for the occurrence of headaches. There were 443 AVMs with headache symptoms. After propensity score matching, the microsurgery group (OR 7.27, 95% CI 2.82-18.7 p < 0.001), stereotactic radiosurgery group(OR 9.46, 95% CI 2.26-39.6, p = 0.002), and multimodality treatment group (OR 8.34 95% CI 2.87-24.3, p < 0.001) demonstrate significant headache relief compared to the conservative group. However, there was no significant difference between the embolization group (OR 2.24 95% CI 0.88-5.69, p = 0.091) and the conservative group. CONCLUSIONS: This study identified potential risk factors for headaches in AVMs and found that microsurgery, stereotactic radiosurgery, and multimodal therapy had significant benefits in headache relief compared to conservative treatment. These findings provide important guidance for clinicians when developing treatment options that can help improve overall treatment outcomes and quality of life for patients.

The impact of dual VA-Medicare use on a data-driven clinical management tool for older Veterans with multimorbidity.

BACKGROUND: Healthcare systems are increasingly turning to data-driven approaches, such as clustering techniques, to inform interventions for medically complex older adults. However, patients seeking care in multiple healthcare systems may have missing diagnoses across systems, leading to misclassification of resulting groups. We evaluated the impact of multi-system use on the accuracy and composition of multimorbidity groups among older adults in the Veterans Health Administration (VA). METHODS: Eligible patients were VA primary care users aged ≥65 years and in the top decile of predicted 1-year hospitalization risk in 2018 (n = 558,864). Diagnoses of 26 chronic conditions were coded using a 24-month lookback period and input into latent class analysis (LCA) models. In a random 10% sample (n = 56,008), we compared the resulting model fit, class profiles, and patient assignments from models using only VA system data versus VA with Medicare data. RESULTS: LCA identified six patient comorbidity groups using VA system data. We labeled groups based on diagnoses with higher within-group prevalence relative to the average: Substance Use Disorders (7% of patients), Mental Health (15%), Heart Disease (22%), Diabetes (16%), Tumor (14%), and High Complexity (10%). VA with Medicare data showed improved model fit and assigned more patients with high accuracy. Over 70% of patients assigned to the Substance, Mental Health, High Complexity, and Tumor groups using VA data were assigned to the same group in VA with Medicare data. However, 41.9% of the Heart Disease group and 14.7% of the Diabetes group were reassigned to a new group characterized by multiple cardiometabolic conditions. CONCLUSIONS: The addition of Medicare data to VA data for older high-risk adults improved clustering model accuracy and altered the clinical profiles of groups. Accessing or accounting for multi-system data is key to the success of interventions based on empiric grouping in populations with dual-system use.

Taoism and digital inclusive finance.

To help investors understand the profound impact of Taoism in society, this study systematically evaluates its impact on digital inclusive finance and its mechanisms. Based on theoretical analysis, this study makes an empirical analysis based on Chinese city-level data from 2011 to 2019, in which the core explanatory variable "Taoism" encompasses the Taoist places of religious activity in each city, and the explained variable "digital inclusive finance" is measured using the Peking University digital inclusive finance index. The results of this study show that (1) the Taoist concept of inaction requires people to put aside selfishness and prejudice, and treat others fairly, rationally, and leniently, which is conducive to the development of digital inclusive finance; (2) the dialectical wisdom of Taoism inspires positive psychological capital, which is conducive to digital and traditional technological innovations and the development of digital inclusive finance; and (3) further research indicates that Taoism encourages Chinese-listed enterprises to actively fulfill their social responsibilities by promoting the development of digital inclusive finance. This study can help global investors understand China's traditional culture and capital markets and serve as the first step in exploring Taoist economics.

Distribution and risk assessment of microplastics in Liujiaxia Reservoir on the upper Yellow River.

Microplastics (MPSs) distribution in global freshwater systems is extensively reported, but the distribution of MPSs in reservoirs of the Yellow River has rarely been studied. To fill in this gap, we systematically investigated the distribution of MPSs in surface water and bank sediments gleaned from Liujiaxia Reservoir of the upper Yellow River for the first time and conducted an ecological risk assessment in succession in this work. The results showed that the main polymer types of MPSs in the surface water and bank sediments of Liujiaxia Reservoir were polyethylene terephthalate (PET), polystyrene (PS), and polypropylene (PP), and the abundance of MPSs in the reservoir surface water and bank sediments ranged from 4.48 to 12.09 item/L and 447.27 to 1543.80 item/kg (dry weight), respectively. Further physical morphology analysis of MPSs in the samples revealed that MPSs in the surface water and bank sediments of Liujiaxia Reservoir were predominantly fibrous with small particle sizes (<1 mm), and there was abundant color, mainly exhibiting transparent, black, and blue. The results of the MPS pollution load index (PLI>1) and the hazard ranking of MPSs (HZone = 10.20 for surface water and HZone = 14.06 for bank sediments) yielded a hazard class II for MPS pollution in Liujiaxia Reservoir, the combined pollution risk index (PRIZone = 17.05 for surface water and PRIZone = 31.25 for bank sediments) stated clearly the potential ecological risk in the Liujiaxia Reservoir. Briefly, this study supplemented and enriched the data on the distribution of MPSs in the reservoirs of the Yellow River basin, and provide a benchmark for future pollution control and management in the reservoir area.

Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study.

BACKGROUND: Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system. METHODS: We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model. RESULTS: The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation. CONCLUSIONS: A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.

Land use∖cover change and influencing factors inside the urban development boundary of different level cities: A case study in Hubei Province, China.

Cities are divided into different levels around the world, which is manifested as cities are managed according to the urban administrative level system in China, urban development boundary (UDB) has always been an spatial policy to limit the scope of urban sprawl. There is a lack of comparative studies on LUCC and influencing factors inside the UDBs of different level cities. Based on the methods of descriptive statistical analysis, transition matrix analysis, Pearson's correlation analysis, and OLS regression, this paper takes Hubei Province, China as an example to study the statistical regularities of LUCC and its influencing factors within the UDBs of different level cities from 2006 to 2020. The results showed that LUCC is different within the UDBs of different level cities, economic and social factors are related to major types of LUCC at the level of PGHP city, correlations between economic and social factors and major types of LUCC is small at the level of PGPL city, and the influence of environmental governance on LUCC is increasing at the level of PGPL city. differentiated control should be carried out according to the level of city in the process of formulating and implementing the policies of land use management.

Sequential Organ Failure Assessment (SOFA) and 90-day mortality in patients with kidney transplant status at first ICU admission: a cohort study of 428 patients.

PURPOSE: We investigated the prognostic accuracy of scores of SOFA for 90-day mortality in patients with kidney transplant status identified from the public Medical Information Mart for Intensive Care III databank. METHODS: A total of 428 participants with kidney transplant status who were admitted for the first time to the ICU were included. The target-independent and target-dependent variables were the SOFA scores in the first 3 days of ICU admission and 90-day mortality, respectively. RESULTS: Fully adjusted binary logistic regression indicated that the day-2 and day-3 SOFA scores were positively associated with a risk of 90-day mortality after adjustment for confounders (odds ratio: 1.196, 95% confidence interval: 1.052-1.360; odds ratio: 1.233, 95% confidence interval: 1.062-1.432). The receiver operating characteristic curve showed areas under the curve for the prediction of 90-day mortality from SOFA scores on days 1, 2 and 3 were 0.524, 0.654, and 0.727, respectively. Further analysis using Kaplan-Meier survival curves and multivariate regression models of 90-day survival showed that patients with low SOFA scores survived longer than those with high scores. CONCLUSION: The SOFA scores in the early days of ICU admission were positively associated with 90-day outcomes although the first-day score showed no significant correlation.

Medical and Social Factors Associated With Referral for Elder Abuse Services in a National Health Care System.

BACKGROUND: Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national U.S. health care system. METHODS: We conducted a national case-control study in U.S. Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010 and 2018. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models. RESULTS: Of 5 567 664 Veterans meeting eligibility criteria during the study period, 15 752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (adjusted odds ratio; 95% confidence interval), age ≥ 85 (3.56 vs age 60-64; 3.24-3.91), female sex (1.96; 1.76-2.21), child as next-of-kin (1.70 vs spouse; 1.57-1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15-1.21), dementia diagnosis (3.01; 2.77-3.28), and receiving a VA pension (1.34; 1.23-1.46) were associated with receiving EA services. CONCLUSION: In the largest cohort of patients receiving EA-related health care services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in health care-based EA surveillance and detection.

Explaining the longevity characteristics in China from a geographical perspective: A multi-scale geographically weighted regression analysis.

Longevity is a near-universal human aspiration that can affect moral progress and economic development at the social level. In rapidly developing China, questions about the geographical distribution and environmental factors of longevity phenomenon need to be answered more clearly. This study calculated the longevity index (LI), longevity index for females (LIF) and longevity index for males (LIM) based on the percentage of the long-lived population among the total number of elderly people to investigate regional and gender characteristics at the county level in China. A new multi-scale geographically weighted regression (MGWR) model and four possible geographical environmental factors were applied to explore environmental effects. The results indicate that the LIs of 2838 counties ranged from 1.3% to 16.3%, and the distribution showed obvious regional and gender differences. In general, the LI was high in the East and low in the West, and the LIF was higher than the LIM in 2614 counties (92.1%). The MGWR model performed well explaining that geographical environmental factors, including topographic features, vegetation conditions, human social activity and air pollution factors have a variable influence on longevity at different spatial scales and in different regions. These findings enrich our understanding of the spatial distribution, gender differences and geographical environmental effects on longevity in China, which provides an important reference for people interested in the variations in the associations between different geographical factors.

Exploring the eco-efficiency of cultivated land utilization and its influencing factors in China's Yangtze River Economic Belt, 2001-2018.

Rapid urbanization in China has worsened the sustainable utilization of limited cultivated land resources, which seriously threatens food security and ecological security. To realize maximum benefits and minimize environmental pollution, the eco-efficiency of cultivated land utilization (ECLU) is becoming a vital indicator in weighing the rationality of regional land use. However, conceptualization of the ECLU remains lacking, while assessments of this indicator are still incomplete. This lack of information may inhibit planning guideline for the sustainable development of cultivated land resources. Thus, this study attempts to fill this gap by customizing a new conceptual index system for the ECLU and measuring it using the slack-based measure with undesirable output (SBM-Undesirable) model in the Yangtze River Economic Belt (YREB) during the period 2001-2018. Spatial econometric models were used to further analyze the influencing factors of the ECLU. The average ECLU value in the YREB declined from 2001 to 2004, and then rapidly trended upward in 2005-2018. The lower reaches had the highest efficiency, followed by the middle and upper reaches, with respective values of 0.494, 0.628, and 0.683. The spatial-temporal pattern of the ECLU reveals that the number of areas with low and medium-low efficiency decreased gradually, while the number of areas with medium-high and high efficiency increased continuously. The magnitude and direction of influencing factors indicates that socioeconomic development level, agricultural science and technology investments, carbon emission reducing, and agricultural pollution control could effectively improve the ECLU. These findings have important implications for promoting high-efficient, low-carbon utilization of cultivated land resources and sustainable regional development in China.

Impact of Land Urbanization on Carbon Emissions in Urban Agglomerations of the Middle Reaches of the Yangtze River.

The urban agglomerations in the middle reaches of the Yangtze River (MYR-UA) are facing a severe challenge in reducing carbon emissions while maintaining stable economic growth and prioritizing ecological protection. The energy consumption related to land urbanization makes an important contribution to the increase in carbon emissions. In this study, an IPAT/Kaya identity model is used to understand how land urbanization affected carbon emissions in Wuhan, Changsha, and Nanchang, the three major cities in the middle reaches of the Yangtze River, from 2000 to 2017. Following the core idea of the Kaya identity model, sources of carbon emissions are decomposed into eight factors: urban expansion, economic level, industrialization, population structure, land use, population density, energy intensity, and carbon emission intensity. Furthermore, using the Logarithmic Mean Divisia Index (LMDI), we analyze how the different time periods and time series driving forces, especially land urbanization, affect regional carbon emissions. The results indicate that the total area of construction land and the total carbon emissions increased from 2000 to 2017, whereas the growth in carbon emissions decreased later in the period. Energy intensity is the biggest factor in restraining carbon emissions, followed by population density. Urban expansion is more significant than economic growth in promoting carbon emissions, especially in Nanchang. In contrast, the carbon emission intensity has little influence on carbon emissions. Changes in population structure, industrial level, and land use vary regionally and temporally over the different time period.

Spatial-Temporal Characteristics of Illegal Land Use and Its Driving Factors in China from 2004 to 2017.

The scientific analysis of spatial-temporal differentiation characteristics and driving factors of illegal land use is of great significance for the formulation and optimization of policies to control the emergence of illegal land use. This paper establishes two variable systems of illegal land use and its driving factors, defined the multidimensional characteristic variables of illegal land use and analyzes the relationships among them by the Pearson's correlation coefficient; In addition, the spatial-temporal characteristics of each variable of illegal land use from 2004 to 2017 are described by the spatial autocorrelation analysis; Finally, based on the geographical detectors, the influence direction and degree of the factors of economic structure, social structure and land market behavior on the characteristics of different illegal land use are studied. The results show that the spatial agglomeration of different characteristics of illegal land use had been weakening from 2004 to 2017, but the rate of weakening was different, and L-L agglomeration changed between Xinjiang and other central-western provinces, H-H agglomeration changed in the coastal regions of the central-eastern of China, the level and ability of the central government and local governments to govern illegal land use is constantly improving on the whole; the compositional factors of economic development structure, social development structure, and land market behavior of driving factors had different influence in the degree, the location or the direction of different characteristics of illegal land use. According to the spatial-temporal characteristics and the differences of driving factors, managers can formulate differentiated illegal land use control policies, which will help to control the occurrence of illegal land use and help the settlement of illegal land use cases, and ultimately achieve sustainable development.

Tracking implementation strategies in the randomized rollout of a Veterans Affairs national opioid risk management initiative.

BACKGROUND: In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete "case reviews" for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids. Half of the facilities were randomly assigned to a Notice version including additional oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates. METHODS: Facility points of contact completed a survey assessing their facility's use of 68 implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. We collected respondent demographic information, facility-level characteristics, and case review completion rates (percentage of high-risk patients who received a case review). We used Kruskal-Wallis tests and negative binomial regression to assess strategy use and factors associated with case reviews. RESULTS: Contacts at 89 of 140 facilities completed the survey (64%) and reported using a median of 23 (IQR 16-31) strategies. The median case review completion rate was 71% (IQR 48-95%). Neither the number or types of strategies nor completion rates differed by randomization arm. The most common strategies were using the STORM dashboard (97%), working with local opinion leaders (80%), and recruiting local partners (80%). Characteristics associated with case review completion rates included respondents being ≤ 35 years old (incidence rate ratio, IRR 1.35, 95% CI 1.09-1.67) and having < 5 years in their primary role (IRR 1.23; 95% CI 1.01-1.51), and facilities having more prior academic detailing around pain and opioid safety (IRR 1.40, 95% CI 1.12-1.75). Controlling for these characteristics, implementation strategies associated with higher completion rates included (1) monitoring and adjusting practices (adjusted IRR (AIRR) 1.40, 95% CI 1.11-1.77), (2) identifying adaptations while maintaining core components (AIRR 1.28, 95% CI 1.03-1.60), (3) conducting initial training (AIRR 1.16, 95% CI 1.02-1.50), and (4) regularly sharing lessons learned (AIRR 1.32, 95% CI 1.09-1.59). CONCLUSIONS: In this national evaluation of strategies used to implement case reviews of patients at high risk of opioid-related adverse events, point of contact age and tenure in the current role, prior pain-related academic detailing at the facility, and four specific implementation strategies were associated with case review completion rates, while randomization to additional centralized oversight was not. TRIAL REGISTRATION: This project is registered at the ISRCTN Registry with number ISRCTN16012111. The trial was first registered on May 3, 2017.

Adverse events in Chinese human immunodeficiency virus (HIV) patients receiving first line antiretroviral therapy.

BACKGROUND: Although the global human immunodeficiency virus (HIV) epidemic has improved significantly due to antiretroviral treatment (ART), ART-related adverse events (AEs) remain an issue. Therefore, investigating the factors associated with ART-related AEs may provide vital information for monitoring risks. METHODS: A prospective cohort study was conducted among adult patients (aged 18 years or older) with HIV who received Tenofovir (TDF) + Lamivudine (3TC) + Efavirenz (EFV) as first-line ART regimens. All AEs during the first 12 months of therapy were recorded. Logistic regression analysis was used to identify variables associated with AEs. RESULTS: Four hundred seventy-four patients receiving TDF+ 3TC+ EFV ART regimens between March 2017 and October 2017 were included in the study analysis. Among them, 472 (99.6%) experienced at least one AE, 436 (92.0%) patients experienced at least one AE within 1 month of treatment, 33 (7.0%) between one and 3 months of treatment, and three (0.6%) patients after 3 months of treatment. The most commonly reported AE was nervous system (95.6%) related, followed by dyslipidemia (79.3%), and impaired liver function (48.1%). Patients with baseline body mass index (BMI) greater than 24 kg/m2 (adjusted OR 1.77, 95%CI 1.03-3.02), pre-existing multiple AEs (adjusted OR 2.72, 95%CI 1.59-4.64), and pre-existing severe AEs (adjusted OR 5.58, 95%CI 2.65-11.73) were at increased odds of developing a severe AE. Patients with baseline BMI greater than 24 kg/m2 (adjusted OR 2.72, 95%CI 1.25-5.89) were more likely to develop multiple AEs. CONCLUSION: The incidence of ART-related adverse events over a 12-month period in China was high. Baseline BMI greater than 24 kg/m2, pre-existing multiple AEs, and pre-existing severe AEs were shown to be independent risk factors for developing a severe AE.

Membrane fouling reduction in a cost-effective integrated system of microbial fuel cell and membrane bioreactor.

Microbial fuel cells (MFC) and membrane bioreactors (MBR) are promising technologies for wastewater treatment. However, both of them have some drawbacks and application limitations. A cost-effective hybrid system (EMBR) integrating MFC with MBR was evaluated in terms of treatment performance and membrane fouling. In this paper, two electric field directions with a membrane module in the middle were applied to explore the mechanism of membrane fouling mitigation in EMBRs. In both configurations of EMBRs, microbial activity and degradation ability of activated sludge for chemical oxygen demand and NH4+-N removals could be enhanced compared with those for the controlled MBR. In addition, the irreversible resistance significantly decreased, especially in the EMBR(-) with a longer operation time. Furthermore, two critical factors, namely enhanced bioflocculation and electrophoresis forces, were compared based on key parameters (zeta potential, particle size distribution and extracellular polymeric substances). The electrophoresis forces made a greater contribution to fouling alleviation than that conducted by the enhanced bioflocculation. The results suggested that EMBR, as a promising wastewater treatment technology, improved effluent quality and reduced energy consumption.

Differences in Hospital Risk-standardized Mortality Rates for Acute Myocardial Infarction When Assessed Using Transferred and Nontransferred Patients.

BACKGROUND: One in 5 patients with acute myocardial infarction (AMI) are transferred between hospitals. However, current hospital performance measures based on AMI mortality exclude these patients from the evaluation of referral hospitals. OBJECTIVE: To determine the relationship between risk-standardized mortality for transferred and nontransferred patients at referral hospitals. RESEARCH DESIGN: This is a retrospective cohort study. SUBJECTS: Fee-for-service Medicare claims from 2011 for patients hospitalized with a primary diagnosis of AMI, at hospitals admitting at least 15 patients in transfer. MEASURES: Hospital-specific risk-standardized 30-day mortality rates (RSMRs) for 2 groups of patients: those admitted through transfer from another hospital, and those natively admitted without a preceding or subsequent interhospital transfer. RESULTS: There were 304 hospitals admitting at least 15 patients in transfer. These hospitals cared for 77,711 natively admitted patients (median, 254; interquartile range, 162-321), and 11,829 patients admitted in transfer (median, 26; interquartile range, 19-46). Risk-standardized mortality rates were higher for natively admitted patients than for those admitted in transfer (mean, 11.5%±1.2% vs. 7.2%±1.1%). There was weak correlation between hospital performance as assessed by RSMR for patients natively admitted versus those admitted in transfer (Pearson r=0.24, P<0.001); when performance was arrayed by quartile, 102 hospitals (33.6%) differed at least 2 quartiles of performance across the 2 patient groups. CONCLUSIONS: For Medicare patients with AMI, hospital-specific RSMRs for natively admitted patients are only weakly associated with RSMRs for patients transferred in from another hospital. Current AMI performance metrics may fail to provide guidance about hospital quality for transferred patients.

The effect of non-small cell lung cancer histology on survival as measured by the graded prognostic assessment in patients with brain metastases treated by hypofractionated stereotactic radiotherapy.

BACKGROUND: The purpose of this study was to investigate the impact of histology on survival stratified by the Graded Prognostic Assessment (GPA) for non-small cell lung cancer (NSCLC) in a group of selected patients treated recently. METHODS: A total of 171 NSCLC patients with brain metastases treated by hypofractionated stereotactic radiotherapy with or without whole-brain radiotherapy between 2001 and 2011 were included. The GPA score was calculated for each patient. Tumor histologies were categorized into adenocarcinoma (ADCA) and non-ADCA. Median survival time (MST, in months) was calculated using the Kaplan-Meier method. The log-rank test was used to determine statistical differences. RESULTS: MSTs by histology were: ADCA 15 (n = 92) and non-ADCA 10 (n = 79) (p < 0.001). For all patients, the MSTs by GPA score were: GPA 3.5-4, 24; GPA 2.5-3, 15; GPA 1.5-2, 9 and GPA 0-1, 6 (p < 0.001). The histology of ADCA showed a statistically significant higher MST than non-ADCA for patients with GPA 2.5-4. For GPA 2.5-3, MSTs were: ADCA 18, non-ADCA 10 (p = 0.007); for GPA 3.5-4, MSTs were: ADCA 30, non-ADCA 17 (p = 0.046). For GPA 0-2, MSTs did not differ significantly by histology. For GPA 0-1, MSTs were: ADCA 8, non-ADCA 4 (p = 0.146); GPA 1.5-2, MSTs were: ADCA 10, non-ADCA 8 (p = 0.291). We further found that non-ADCA in upper GPA class (3.5-4) had similar survival with ADCA in lower GPA class (2.5-3) (MSTs were 17 and 18, respectively, p = 0.775). This phenomenon also happened between patients of non-ADCA in upper GPA class (2.5-3) and those of ADCA in lower GPA class (1.5-2) (MSTs were both 10, p = 0.724). CONCLUSIONS: We confirmed that the histology of NSCLC had effect on the GPA in these selected patients treated recently. ADCA showed a statistically significant higher MST than non-ADCA with GPA 2.5-4. The non-ADCA in upper GPA classes (3.5-4 and 2.5-3) had similar survival to ADCA in lower GPA classes (2.5-3 and 1.5-2, respectively). The histology as a new factor should be added to the original GPA for NSCLC.

The impact of the new cooperative medical scheme on financial burden of tuberculosis patients: evidence from six counties in China.

BACKGROUND: Tuberculosis (TB) patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China's health insurance systems affect the alleviation of this burden under the integrated approach. This study aimed to measure reimbursement for TB services under the New Cooperative Medical Scheme (NCMS) in rural China and to evaluate changes in catastrophic health expenditure (CHE) caused by the reimbursement policies. METHODS: Reimbursement data were obtained from routine data systems for the NCMS in Yichang (YC) and Hanzhong (HZ). 1884 TB inpatients reimbursed by NCMS from 2010 to 2012 were included. Household surveys were conducted. A total of 494 TB patients under the NCMS were selected in this paper. 12 Focus Group Discussions (FGDs) were held. We measured the impact of the NCMS by counterfactual analysis, which analyzed the financial burden alleviation. Equity was assessed by Concentration Index (CI), and disaggregated by project sites. RESULTS: TB inpatients were reimbursed with an effective reimbursement rate of 57.3 %. Average out-of-pocket (OOP) payments for outpatient and inpatient services after diagnosis were 1413 yuan and 430 yuan, and 3572 yuan and 3013 yuan in YC and HZ, respectively. The reimbursement level for TB outpatient care after diagnosis was very low due to a limited outpatient quota. TB patients in HZ incurred higher effective reimbursement rates, but the incidence of CHE remained higher. The reduction of CHE incidence after the NCMS showed no difference statistically (P > 0.05). The severity of CHE was alleviated slightly. CIs after reimbursement were all below zero and their absolute values were higher than those before reimbursement. CONCLUSIONS: Low reimbursement for TB patients could lead to heavy financial burden. Poor TB patients incurred high rates of CHE. The NCMS was found to be a protective factor for CHE, but the impact was modest and the equity of CHE did not improve. The NCMS reimbursement policies should be improved in the future to include a more comprehensive coverage of care. Supplemental programs may be necessary to expand coverage for TB care.

Development and psychometric properties of an informant assessment scale of theory of mind for adults with traumatic brain injury.

Impairment of theory of mind (ToM) is a common phenomenon following traumatic brain injury (TBI) that has clear effects on patients' social functioning. A growing body of research has focused on this area, and several methods have been developed to assess ToM deficiency. Although an informant assessment scale would be useful for examining individuals with TBI, very few studies have adopted this approach. The purpose of the present study was to develop an informant assessment scale of ToM for adults with traumatic brain injury (IASToM-aTBI) and to test its reliability and validity with 196 adults with TBI and 80 normal adults. A 44-item scale was developed following a literature review, interviews with patient informants, consultations with experts, item analysis, and exploratory factor analysis (EFA). The following three common factors were extracted: social interaction, understanding of beliefs, and understanding of emotions. The psychometric analyses indicate that the scale has good internal consistency reliability, split-half reliability, test-retest reliability, inter-rater reliability, structural validity, discriminate validity and criterion validity. These results provide preliminary evidence that supports the reliability and validity of the IASToM-aTBI as a ToM assessment tool for adults with TBI.

Evaluation of energy-distribution of a hybrid microbial fuel cell-membrane bioreactor (MFC-MBR) for cost-effective wastewater treatment.

A low-cost hybrid system integrating a membrane-less microbial fuel cell (MFC) with an anoxic/oxic membrane bioreactor (MBR) was studied for fouling mitigation. The appended electric field in the MBR was supplied by the MFC with continuous flow. Supernatant from an anaerobic reactor with low dissolved oxygen was used as feed to the MFC in order to enhance its performance compared with that fed with synthetic wastewater. The voltage output of MFC maintained at 0.52±0.02V with 1000Ω resister. The electric field intensity could reach to 0.114Vcm(-1). Compared with the conventional MBR (CMBR), the contents rather than the components of foulants on the cake layer of fouled MFC-MBR system was significantly reduced. Although only 0.5% of the feed COD was translated into electricity and applied to MBR, the hybrid system showed great feasibility without additional consumption but extracting energy from waste water and significantly enhancing the membrane filterability.