Relative Bioavailability of Cadmium in Rice: Assessment, Modeling, and Application for Risk Assessment.

Rice consumption is the primary route of cadmium (Cd) exposure to the populations with rice as the staple food. To accurately assess the potential health risks of Cd exposure via rice consumption, determination of Cd relative bioavailability (RBA) in rice is necessary. However, large variations exist in Cd-RBA, hindering the application of source-specific Cd-RBA values to different rice samples. In this study, we collected 14 rice samples from Cd contaminated areas and determined both rice compositions and Cd-RBA using in vivo mouse bioassay. Total Cd concentration varied from 0.19 to 2.54 mg/kg in the 14 rice samples, while Cd-RBA in rice ranged from 42.10% to 76.29%. Cadmium-RBA in rice correlated positively with calcium (Ca) (R = 0.76) and amylose content (R = 0.75) but negatively with the concentrations of sulfur (R = -0.85), phosphorus (R = -0.73), phytic acid (R = -0.68), and crude protein (R = -0.53). Cd-RBA in rice can be predicted by Ca and phytic acid concentrations in a regression model (R2 = 0.80). Based on the total and bioavailable Cd concentrations in rice, weekly dietary Cd intake for adults was estimated to be 4.84-64.88 and 2.04-42.29 µg/kg bw/week, respectively. This work demonstrates the possibility of Cd-RBA prediction based on rice compositions and provides valuable suggestions for health risk assessment with consideration of Cd-RBA.

Assessment of a Text Message-Based Smoking Cessation Intervention for Adult Smokers in China: A Randomized Clinical Trial.

Importance: Successful smoking cessation strategies are an important part of reducing tobacco use. However, providing universal smoking cessation support can be a challenge for most countries because it requires sufficient resources. One way to expand access is to use mobile technologies to provide cessation support. Objective: To assess the efficacy of a behavior change theory-based smoking cessation intervention using personalized text messages. Design, Setting, and Participants: This study was a 2-arm double-blind randomized clinical trial conducted in 5 cities in China. Daily or weekly smokers 18 years or older were eligible for inclusion if they owned a mobile phone and used the WeChat social media app. A total of 722 participants were randomized to the intervention or control group between April 1 and July 27, 2021. Interventions: Intervention group participants received a personalized text message-based smoking cessation intervention that was based on the transtheoretical model and protection motivation theory and developed by this study's investigators. Control group participants received a nonpersonalized text message-based smoking cessation intervention developed by the US National Cancer Institute. Both groups received 1 to 2 text messages per day for 3 months through the app. Main Outcomes and Measures: The primary outcome was the biochemically verified 6-month sustained abstinence rate, defined as the self-report of no smoking of any cigarettes after the designated quit date, which was validated biochemically by an expired air carbon monoxide level of less than 6 ppm at each follow-up point. Results: A total of 722 participants (mean [SD] age, 41.5 [12.7] years; 716 men [99.2%]; all of Chinese ethnicity) were randomly assigned to the intervention group (360 participants) or the control group (362 participants). Biochemically verified continuous abstinence at 6 months was 6.9% in the intervention group and 3.0% in the control group (odds ratio [OR], 2.66; 95% CI, 1.21-5.83). Among smokers with low nicotine dependence, the intervention group had significantly better abstinence rates for most of the indicators after adjusting for covariates (eg, biochemically verified 24-hour point prevalence of abstinence at 1 month: adjusted OR, 2.15; 95% CI, 1.05-4.38). Among smokers with moderate and high nicotine dependence, only the biochemically verified 24-hour point prevalence of abstinence at 6 months was statistically significant (adjusted OR, 4.17; 95% CI, 1.34-3.00). The pattern was similar for quitting intention, and the personalized text message-based intervention was more effective for smokers who had strong quitting intention than for those who had weak quitting intention. Conclusions and Relevance: In this study, the behavior change theory-based smoking cessation intervention using personalized text messages was more effective than an intervention using nonpersonalized text messages. The intervention was most effective among smokers with low nicotine dependence and strong quitting intention. This study's findings also provide further evidence regarding the potential benefits of mobile health interventions for other behaviors. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2100041942.

[S073]-The impact of interval appendectomy timing on follow-up adverse outcomes.

OBJECTIVE: This study aims to compare the timing of interval appendectomy (IA) and its impact on post-operative outcomes. METHODS: A retrospective analysis was performed for adult patients diagnosed with appendicitis between 2006 and 2017. IA was defined as a follow-up appendectomy > 1 week and < 2 years after the initial presentation. Time intervals were divided into 4 groups based on patient quartiles: 1-6 weeks, 7-9 weeks, 10-15 weeks, and > 15 weeks. The primary outcome measure was length of stay (LOS). Secondary outcomes included 30-day readmission and IA post-operative complications. Tertiary outcomes included 30-day mortality and colonoscopy suggesting neoplasm or Inflammatory Bowel Disease. RESULTS: A total of 5069 patients' records whose interval appendectomy fell > 1 week and < 2 years after initial presentation were analyzed. Among them, 1006 (19.85%) underwent an initial percutaneous abscess drainage at diagnosis. The median timing for IA was 9.2 weeks. Patients with IA at 1-6 weeks were more likely to have longer LOS when compared to 7-9 weeks (ratio 1.33, 95% CI 1.2-1.48) and 10-15 weeks (ratio 1.38, 95% CI 1.25-1.52). IA between 7 and 9 weeks (ratio 0.81, 95% CI 0.73-0.89) and 10-15 weeks (ratio 0.78, 95% CI 0.71-0.86) was associated with significantly shorter LOS compared to those receiving the operation after 15 weeks. Further, patients requiring abscess drainage (ratio 1.2, 95% CI 1.13-1.34) or those with comorbidities (ratio 1.51, 95% CI 1.39-1.63) were more likely to have longer LOS at IA. Socioeconomic and demographic differences including Black, Hispanic, and those with Medicare and Medicaid insurance had a greater LOS after their IA. CONCLUSION: LOS remains lowest among patients undergoing IA between 7-9 weeks and 10-15 weeks after initial appendicitis presentation. Patients with lower socioeconomic status or from racial minorities had a longer LOS after IA.

An interval two-stage fuzzy fractional programming model for planning water resources management in the coastal region - A case study of Shenzhen, China.

In this study, an interval two-stage fuzzy fractional programming (TFFP) method is developed to facilitate collaborative governance of economy and water resources. Methods of interval programming, fuzzy programming, two-stage programming, and fractional programming are integrated within a general system optimization framework. The main contribution of TFFP is simultaneously addressing various uncertainties and tackling trade-offs between environmental and economic objectives in the optimized schemes for water resources allocation. A case study of a highly urbanized coastal city (i.e., Shenzhen) in China is provided as an example for demonstrating the proposed approach. According to the results, industrial sectors should receive 34.8% of total water supply, while agricultural sectors should receive 1.5%. For the spatial allocation of water resources, Bao An, Long Gang, and Fu Tian districts should be allocated 21.6%, 20.5%, and 14.8% water to promote the economic development. The discharge analysis indicates that chemical oxygen demand (CODcr) and total phosphorus (TP) would be key pollutants. Moreover, the optimized seawater desalination volume would be negligibly influenced by price, while the upper bounds of desalination would be increased with the raising acceptable credibility levels in the period of 2031-2035. Analysis of desalination prices also reveals that the decision-makers should increase the scale of desalination in the period of 2021-2025. In addition, the effectiveness and applicability of TFFP would be evaluated under economic maximization scenarios. The result showed that the economic maximization scenario could obtain higher economic benefits, but it would be accompanied by a larger number of pollutant discharges. It is expected that this study will provide solid bases for planning water resources management systems in coastal regions.

Assessment of metabolic perturbations associated with exposure to phthalates among pregnant African American women.

BACKGROUND: Phthalates have been linked with numerous harmful health effects. Limited data are available on the molecular mechanism underlying phthalate toxicity on human health. In this study, we measured urinary phthalate metabolites and used high-resolution metabolomics (HRM) to identify biological perturbations associated with phthalate exposures among pregnant African American (AA) women, who are disproportionately exposed to high phthalates levels. METHODS: We used untargeted HRM profiling to characterize serum samples collected during early (8-14 weeks gestation) and late (24-30 weeks gestation) pregnancy from 73 participants from the Atlanta AA Maternal-Child cohort. We measured eight urinary phthalate metabolites in early and late pregnancy, including Monoethyl phthalate (MEP), Mono(2-ethlyhexyl) phthalate (MEHP), and Mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), to assess maternal exposures to phthalates. Metabolite and metabolic pathway perturbation were evaluated using an untargeted HRM workflow. RESULTS: Geometric mean creatinine-adjusted levels of urinary MEP, MEHP, and MEHHP were 67.3, 1.4, and 4.1 µg/g creatinine, respectively, with MEP and MEHP higher than the mean levels of non-Hispanic blacks in the general US population (2015-2016). There were 73 and 1435 metabolic features significantly associated with at least one phthalate metabolite during early and late pregnancy (p < 0.005), respectively. Pathway enrichment analysis revealed perturbations in four inflammation- and oxidative-stress-related pathways associated with phthalate metabolite levels during both early and late pregnancy, including glycerophospholipid, urea cycle, arginine, and tyrosine metabolism. We confirmed 10 metabolites with level-1 evidence, which are associated with urinary phthalates, including thyroxine and thiamine, which were negatively associated with MEP, as well as tyramine and phenethylamine, which were positively associated with MEHP and MEHHP. CONCLUSION: Our results demonstrated that urinary phthalate levels were associated with perturbations in biological pathways connected with inflammation, oxidative stress, and endocrine disruption. The findings support future targeted investigations on molecular mechanisms underlying the impact of maternal phthalates exposure on adverse health outcomes.

Prioritizing sponge city sites in rapidly urbanizing watersheds using multi-criteria decision model.

Spatial planning is crucial for sponge city (SC) construction; however, prioritizing SC sites at the watershed scale has not been fully explored. In this study, a multi-criteria decision model, considering demand and suitability of SC construction, was established by monitoring, model simulation, and index calculation. This new model was then tested in a rapidly urbanizing watershed, Beijing, China, and the priority of SC construction at both grid scale (1km×1km) and subwatershed scale was ranked. The results showed that the highest priority was found in emerging regions where urbanization is ongoing and followed by urban core areas. In addition, six indexes were identified by clustering heatmaps as key factors affecting the priority of SC planning, including topographic index, water pollution index, pollution rate based on the state standard of surface water environment quality, urbanization planning, urban levels, and vegetation index, which could guide SC planning in data-lacking regions. The approach and findings in this study cannot only provide helpful references for watershed managers and urban planners but also can be easily used in other regions.

A factorial emission-focused general equilibrium model for investigating composite effects of multiple environmental policies.

With the rapid growth of the economy, there are increasing conflicts between economic development and environmental protection. Among these conflicts, the wastewater emission management as one of the significant ways to alleviate water scarcity has been paid increasing attention across the developing countries, such as China. It is thus essential to comprehensively investigate the enviro-economic effects induced by wastewater-related policies. In this study, a factorial emission-focused general equilibrium model (FEGE) is first developed to facilitate examine the composite enviro-economic effects of multiple policy scenarios with regards to wastewater-related environmental taxes and the related subsides. A special case study for the Municipality of Chongqing, China, is conducted to illustrate the potential benefits of its use in the formulation of wastewater-related policies. It is found that the impacts of various wastewater-related policies (i.e., environmental taxes and the related subside) on GDP are different. In detail, green tax policies on GDP are negative, while wastewater emission intensity (WEI) improvement policies on GDP are positive. When green tax reaches 14 yuan/tonne, which is the maximum proposed by the Chinese government, the GDP will drop by 0.37%, which would be deemed acceptable for the Municipality of Chongqing. In addition, the impacts on rural households' consumption are greater than those on urban households' consumption whichever the application of wastewater-related policies; it is because the rural households in the Municipality of Chongqing have a relatively unitary income source. It is thus recommended that the rural household in Chongqing should be paid more attention. For example, some extra allowances could be considered to the rural household to help them cope with the negative economic impacts induced by a new environmental policy. It is expected that the outputs would provide bases for formulating desired wastewater-related policies.

Evaluating readmissions following laparoscopic cholecystectomy in the state of New York.

INTRODUCTION: Hospital readmissions constitute an important component of associated costs of a disease and can contribute a significant burden to healthcare. The majority of studies evaluating readmissions following laparoscopic cholecystectomy (LC) comprise of single center studies and thus can underestimate the actual incidence of readmission. We sought to examine the rate and causes of readmissions following LC using a large longitudinal database. METHODS: The New York SPARCS database was used to identify all adult patients undergoing laparoscopic cholecystectomy for benign biliary disease between 2000 and 2016. Due to the presence of a unique identifier, patients with readmission to any New York hospital were evaluated. Planned versus unplanned readmission rates were compared. Following univariate analysis, multivariable logistic regression model was used to identify risk factors for unplanned readmissions after accounting for baseline characteristics, comorbidities and complications. RESULTS: There were 591,627 patients who underwent LC during the studied time period. Overall 30-day readmission rate was 4.94% (n = 29,245) and unplanned 30-days readmission rate was 4.58% (n = 27,084). Female patients were less likely to have 30-day unplanned readmissions. Patients with age older than 65 or younger than 29 were more likely to have 30-day unplanned readmissions compared to patients with age 30-44 or 45-64. Insurance status was also significant, as patients with Medicaid/Medicare were more likely to have unplanned readmissions compared to commercial insurance. In addition, variables such as Black race, presence of any comorbidity, postoperative complication, and prolonged initial hospital length of stay were associated with subsequent readmission. CONCLUSION: This data show that readmissions rates following LC are relatively low; however, majority of readmissions are unplanned. Most common reason for unplanned readmissions was associated with complications of the procedure or medical care. By identifying certain risk groups, unplanned readmissions may be prevented.

Portable, Non-Invasive Fall Risk Assessment in End Stage Renal Disease Patients on Hemodialysis.

Patients with end stage renal diseases (ESRD) on hemodialysis (HD) have high morbidity and mortality due to multiple causes, one of which is dramatically higher fall rates than the general population. The mobility mechanisms that contribute to falls in this population must be understood if adequate interventions for fall prevention are to be achieved. This study utilizes emerging non-invasive, portable gait, posture, strength, and stability assessment technologies to extract various mobility parameters that research has shown to be predictive of fall risk in the general population. As part of an ongoing human subjects study, mobility measures such as postural and locomotion profiles were obtained from five (5) ESRD patients undergoing HD treatments. To assess the effects of post-HD-fatigue on fall risk, both the pre- and post-HD measurements were obtained. Additionally, the effects of inter-HD periods (two days vs. three days) were investigated using the non-invasive, wireless, body-worn motion capture technology and novel signal processing algorithms. The results indicated that HD treatment influenced strength and mobility (i.e., weaker and slower after the dialysis, increasing the susceptibility to falls while returning home) and inter-dialysis period influenced pre-HD profiles (increasing the susceptibility to falls before they come in for a HD treatment). Methodology for early detection of increased fall risk - before a fall event occurs - using the portable mobility assessment technology for out-patient monitoring is further explored, including targeting interventions to identified individuals for fall prevention.