Intrinsic capacity assessment using World Health Organization Integrated Care for Older People Step 1, and the association with frailty in community dwelling older adults.

AIM: This study aimed to investigate the association between intrinsic capacity (IC) and frailty in community-dwelling older adults. Specifically, we examined the utility of the World Health Organization's Integrated Care for Older People Step 1 screen for identifying frail older persons in the community. METHODS: This is a cross-sectional analysis of a community frailty screening initiative. IC loss was ascertained using the World Health Organization's Integrated Care for Older People Step 1 questions. The Clinical Frailty Scale was used to categorize participants as robust (Clinical Frailty Scale S1-3) or frail (Clinical Frailty Scale ≥4). Logistic regression was used to analyze the association of individual and cumulative IC losses with frailty, adjusting for confounders. Additionally, the diagnostic performance of using cumulative IC losses to identify frailty was assessed. RESULTS: This study included 1164 participants (28.2% frail). Loss in locomotion (adjusted odds ratio [AOR] 1.47, 95% CI 1.07-2.02), vitality (AOR 1.58, 95% CI 1.04-2.39), sensory (AOR 1.99, 95% CI 1.51-2.64) and psychological capacities (AOR 1.92, 95% CI 1.45-2.56) were significantly associated with frailty. Loss in more than three IC domains was associated with frailty. Using loss in at least three ICs identifies frailty, with sensitivity of 38.6%, specificity of 83.5% and positive predictive value of 47.4%. Using loss in at least four ICs improved specificity to 96.9%, and is associated with the highest positive predictive value of 57.6% and highest positive likelihood ratio of 3.55 for frailty among all cut-off values. The area under the receiver operating characteristic curve was 0.64 (95% CI 0.61-0.68). CONCLUSIONS: IC loss as identified through World Health Organization's Integrated Care for Older People Step 1 is associated with frailty community-dwelling older adults. Geriatr Gerontol Int 2024; 24: 457-463.

High-Suspicion Subcentimeter Thyroid Nodules: Cost Effectiveness of Active Surveillance versus Fine Needle Aspiration.

PURPOSE: To compare the cost-benefit of active surveillance (AS) against immediate fine needle aspiration (FNA) of sonographically suspicious subcentimeter thyroid nodules. MATERIALS AND METHODS: A Markov model was constructed to compare the cost-benefit of 3 strategies from the point of discovery until death: (a) Surveillance of all nodules, (b) Surveillance of nodules with positive cytology, and (c) Surgery of nodules with positive cytology. The reference case was a 40-year-old woman with a sonographically suspicious subcentimeter thyroid nodule. Transition probabilities, costs, and health state utilities were derived from the literature. Sensitivity analyses were performed to evaluate model uncertainty. Willingness-to-pay threshold was set at $100,000/quality-adjusted life year. RESULTS: Surveillance of nodules with positive cytology dominated in the reference scenario and was cost-beneficial over Surveillance of all nodules, independent of the utility of AS. Surveillance of all nodules was cost-beneficial only at a life expectancy of <2.6 years or surveillance duration of <4 years. CONCLUSIONS: While current guidelines recommend AS of sonographically suspicious subcentimeter nodules, the results of this study suggest that immediate FNA (Surveillance of nodules with positive cytology) is more cost-beneficial than AS (Surveillance of all nodules). Patients with positive cytology on FNA may subsequently opt for AS (Surveillance of nodules with positive cytology) or surgery (Surgery of nodules with positive cytology) according to their level of comfort (ie, utility) with AS.

The predictive value of patient-reported outcomes on the impact of breast cancer treatment-related quality of life.

Purpose: Patient-reported outcomes (PROs) have been widely used to measure breast cancer (BC) treatment outcomes. However, evidence is still limited on using routinely PROs to personalize treatment decision-making, including or not chemotherapy, targeted therapy, and radiotherapy. Using patient baseline PRO scores, we aimed to use PROs before treatment initiation to predict improvement or decline in health-related quality of life (HRQoL) due to treatment that they receive. Methods: In two French cancer sites, women with non-metastatic BC completed the EORTC QLQ-C30 and QLQ-BR23 and BREAST-Q questionnaires to assess their PROs at baseline and again at 6 months. The outcome measured was post-operative change in PROs with minimal important difference for QLQ-C30 domains. We performed multivariate ordinal logistic regression to estimate the incremental probability of post-operative PRO improvements and deteriorations depending upon treatment options and baseline HRQoL. Results: One hundred twenty-seven women completed questionnaires. Chemotherapy had significant negative impacts on Global health status (GHS) and on physical and social functioning. Chemotherapy and radiotherapy increased patient fatigue scores after adjusting for clinical factors (p< 0.01 and p< 0.05, respectively). The incremental probability of GHS deteriorations for chemotherapy was +0.3, +0.5, and +0.34 for patients with baseline GHS scores of 40, 70, and 100, respectively. This showed that different pre-treatment PROs might predict differential effects of chemotherapy on women change in HRQoL. Conclusion: Patients with different baseline PRO scores may experience dissimilar impacts from BC treatments on post-operative PROs in terms of improvements and deteriorations. Oncologists might decide to adapt the treatment option based on a given level of the negative impact. Future studies should concentrate on incorporating this information into routine clinical decision-making strategies to optimize the treatment benefit for patients.

Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis.

BACKGROUND: Left atrial appendage occlusion (LAAO) is a potential alternative to oral anticoagulants in selected patients with atrial fibrillation (AF). Compared with anticoagulants, LAAO decreases major bleeding risk, but there is uncertainty regarding the risk for ischemic stroke compared with anticoagulation. OBJECTIVE: To determine the optimal strategy for stroke prevention conditional on a patient's individual risks for ischemic stroke and bleeding. DESIGN: Decision analysis with a Markov model. DATA SOURCES: Evidence from the published literature informed model inputs. TARGET POPULATION: Women and men with nonvalvular AF and without prior stroke. TIME HORIZON: Lifetime. PERSPECTIVE: Clinical. INTERVENTION: LAAO versus warfarin or direct oral anticoagulants (DOACs). OUTCOME MEASURES: The primary end point was clinical benefit measured in quality-adjusted life-years. RESULTS OF BASE-CASE ANALYSIS: The baseline risks for stroke and bleeding determined whether LAAO was preferred over anticoagulants in patients with AF. The combined risks favored LAAO for higher bleeding risk, but that benefit became less certain at higher stroke risks. For example, at a HAS-BLED score of 5, LAAO was favored in more than 80% of model simulations for CHA2DS2-VASc scores between 2 and 5. The probability of LAAO benefit in QALYs (>80%) at lower bleeding risks (HAS-BLED score of 0 to 1) was limited to patients with lower stroke risks (CHA2DS2-VASc score of 2). Because DOACs carry lower bleeding risks than warfarin, the net benefit of LAAO is less certain than that of DOACs. RESULTS OF SENSITIVITY ANALYSIS: Results were consistent using the ORBIT bleeding score instead of the HAS-BLED score, as well as alternative sources for LAAO clinical effectiveness data. LIMITATION: Clinical effectiveness data were drawn primarily from studies on the Watchman device. CONCLUSION: Although LAAO could be an alternative to anticoagulants for stroke prevention in patients with AF and high bleeding risk, the overall benefit from LAAO depends on the combination of stroke and bleeding risks in individual patients. These results suggest the need for a sufficiently low stroke risk for LAAO to be beneficial. The authors believe that these results could improve shared decision making when selecting patients for LAAO. PRIMARY FUNDING SOURCE: None.

Physical Literacy Assessment Tools: A Systematic Literature Review for Why, What, Who, and How.

Physical literacy (PL) has been acknowledged to be an individual journey, in view of this contention, objective assessment of such a developing construct has become a debatable issue for the last couple of decades apart from physical domain of observable domain. The purpose of this systematic review was to scrutinise what is currently known regarding the PL assessment tools-the existing PL assessment tools, their pioneers and year of publication, the philosophy behind their initiation, what they have been assessing (assessment domains), the category of population being assessed in relation to their age group, validity of the tools, other scholars notes, as well as the approaches being used, whether assessment for, as or of learning during physical activity participation. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to undertake a comprehensive search from six electronic databases-ScienceDirect, Scopus, Eric, PubMed, Google Scholar, and SportDiscus retrieved 52 research articles and review papers, whereby only 22 articles were included after identification, screening, and eligibility selection criteria process. The study established that the majority-70%-of PL assessment tools were developed to promote either fundamental movement skills, athlete development or long-term health and well-being, instead of lifelong participation in physical activity. It was also ascertained that only 30% of PL assessment tools address both three domains comprising PL. Of a particular concern, it was explored that only the International Physical Literacy Association (IPLA) PL matrix takes into account everyone of any age group, while the rest of the others segregate participants falling in a specific age groups to be based on. Afterward, the majority of PL assessment tools were identified at 70% to adopt assessment for learning or at a certain time combination with assessment as learning while assessing individuals' PL progress. The conclusion was therefore drawn that the overall purpose of PL- to value and take responsibility of engaging in physical activity for life is still largely absent among the majority of existing PL assessment tools and both the ideal of what to assess and who to be assessed are far less to be met, while the effective PL assessment approaches remain critical. After all, in light of this conclusion future agenda has been suggested in view of designing PL assessment tools effective enough to promote PL for all.

Systemic inequalities in indoor air pollution exposure in London, UK.

Deprived communities in many cities are exposed to higher levels of outdoor air pollution, and there is increasing evidence of similar disparities for indoor air pollution exposure. There is a need to understand the drivers for this exposure disparity in order to develop effective interventions aimed at improving population health and reducing health inequities. With a focus on London, UK, this paper assembles evidence to examine why indoor exposure to PM2.5, NOx and CO may disproportionately impact low-income groups. In particular, five factors are explored, namely: housing location and ambient outdoor levels of pollution; housing characteristics, including ventilation properties and internal sources of pollution; occupant behaviours; time spent indoors; and underlying health conditions. Evidence is drawn from various sources, including building physics models, modelled outdoor air pollution levels, time-activity surveys, housing stock surveys, geographical data, and peer-reviewed research. A systems framework is then proposed to integrate these factors, highlighting how exposure to high levels of indoor air pollution in low-income homes is in large part due to factors beyond the control of occupants, and is therefore an area of systemic inequality. POLICY RELEVANCE: There is increasing public and political awareness of the impact of air pollution on public health. Strong scientific evidence links exposure to air pollution with morbidity and mortality. Deprived communities may be more affected, however, with limited evidence on how deprivation may influence their personal exposure to air pollution, both outdoors and indoors. This paper describes different factors that may lead to low-income households being exposed to higher levels of indoor air pollution than the general population, using available data and models for London (i.e. living in areas of higher outdoor air pollution, in poor-quality housing, undertaking more pollution-generating activities indoors and spending more time indoors). A systems approach is used to show how these factors lead to systemic exposure inequalities, with low-income households having limited opportunities to improve their indoor air quality. This paper can inform actions and public policies to reduce environmental health inequalities, considering both indoor and outdoor air.

The Cost of Impression Management to Life Satisfaction: Sense of Control and Loneliness as Mediators.

PURPOSE: Impression management, or self-presentation, prevails in our daily lives. However, whether it enhances or reduces individuals' well-being remains underexplored. To fill this gap, the research proposed and tested the following hypotheses. Impression management is negatively related to life satisfaction. Impression management is negatively related to sense of control. Impression management is positively related to loneliness. Sense of control and loneliness mediate the relationship between impression management and life satisfaction. METHODS: Data were collected from an online survey of 243 Chinese adults drawn from a national sampling frame. We used LISREL8.8 to perform a series of CFAs to verify the distinctiveness of variables and conducted SEM modeling to test hypotheses. To further test the mediation hypotheses, we used bootstrapping procedures that generated a sample size of 5000. RESULTS: We found a negative association between impression management and life satisfaction. In addition, the association was fully mediated by sense of control and loneliness. CONCLUSION: These results reveal that impression management is a negative indicator of life satisfaction because impression management impedes personal sense of control and elevates loneliness.

P2-Na0.67 Alx Mn1-x O2 : Cost-Effective, Stable and High-Rate Sodium Electrodes by Suppressing Phase Transitions and Enhancing Sodium Cation Mobility.

Sodium layered P2-stacking Na0.67 MnO2 materials have shown great promise for sodium-ion batteries. However, the undesired Jahn-Teller effect of the Mn4+ /Mn3+ redox couple and multiple biphasic structural transitions during charge/discharge of the materials lead to anisotropic structure expansion and rapid capacity decay. Herein, by introducing abundant Al into the transition-metal layers to decrease the number of Mn3+ , we obtain the low cost pure P2-type Na0.67 Alx Mn1-x O2 (x=0.05, 0.1 and 0.2) materials with high structural stability and promising performance. The Al-doping effect on the long/short range structural evolutions and electrochemical performances is further investigated by combining in situ synchrotron XRD and solid-state NMR techniques. Our results reveal that Al-doping alleviates the phase transformations thus giving rise to better cycling life, and leads to a larger spacing of Na+ layer thus producing a remarkable rate capability of 96 mAh g-1 at 1200 mA g-1 .

The alternative splicing of SKU5-Similar3 in Arabidopsis.

Alternative splicing largely enhanced the diversity of transcriptome and proteome in eukaryas. Along with technological development, more and more genes are reported to be alternatively spliced during mRNA maturation. Here, I report the alternative splicing of SKU5-Similar 3 (SKS3) and its special splicing site in Arabidopsis. SKS3 was predicted to be alternatively transcribed into two variants, SKS3.1 and SKS3.2, which encoded a GPI-anchored protein and a soluble secretory protein, respectively. But, according to experimental data, instead of SKS3.2, a novel variant, SKS3.3, which encodes a protein with a transmembrane region at its C-terminus, was demonstrated. Interestingly, it exhibites a different organ-specific expression pattern with SKS3.1, and an unusual intron splicing site not following 'GT-AG' rule or any reported rule.

Competitive Adsorption of Methanol-Acetone on Surface Functionalization (-COOH, -OH, -NH2, and -SO3H): Grand Canonical Monte Carlo and Density Functional Theory Simulations.

The capture and separation properties of surface-functionalized activated carbons (AC-Rs, R= -COOH, -OH, -NH2, and -SO3H) for the methanol-acetone mixture were investigated for the first time by grand canonical Monte Carlo simulation (GCMC) and density functional theory (DFT). The effects of surface functional groups and structural characteristics of AC-Rs on the adsorption and separation behaviors of methanol and acetone were clarified. The surface functional group with strong electron-donating or electron-accepting capacity (i.e., -NH2, -OH, and -SO3H) was a crucial factor for the methanol-acetone capture and separation performance at the lower pressure range, and the accessible surface area was found to be another determinative factor. AC-NH2 with the relatively large accessible surface area (4497 m2/g) exhibited an efficient capture performance for the single component (15.7 mol/kg for methanol and 6.7 mol/kg for acetone) and the highest methanol/acetone selectivity (∼23) at 0.02 kPa. At high pressures, the surface functionalization and available pore volume of AC-Rs played pivotal roles in the adsorptive separation process. This study provided mechanistic insights on how the surface functional groups affected the capture and separation properties of ACs, which would further provide a rational alternative strategy in the preparation and synthesis of ACs for the effective gas mixture separation.

Impact of subsidies on cancer genetic testing uptake in Singapore.

PURPOSE: Previous reports cite high costs of clinical cancer genetic testing as main barriers to patient's willingness to test. We report findings of a pilot study that evaluates how different subsidy schemes impact genetic testing uptake and total cost of cancer management. METHODS: We included all patients who attended the Cancer Genetics Service at the National Cancer Centre Singapore (January 2014-May 2016). Two subsidy schemes, the blanket scheme (100% subsidy to all eligible patients), and the varied scheme (patients received 50%-100% subsidy dependent on financial status) were compared. We estimated total spending on cancer management from government's perspective using a decision model. RESULTS: 445 patients were included. Contrasting against the blanket scheme, the varied scheme observed a higher attendance of patients (34 vs 8 patients per month), of which a higher proportion underwent genetic testing (5% vs 38%), while lowering subsidy spending per person (S$1098 vs S$1161). The varied scheme may potentially save cost by reducing unnecessary cancer surveillance when first-degree relatives uptake rate is above 36%. FINDINGS: Provision of subsidy leads to a considerable increase in genetic testing uptake rate. From the government's perspective, subsidising genetic testing may potentially reduce total costs on cancer management.

Cost-effectiveness analysis of apatinib treatment for chemotherapy-refractory advanced gastric cancer.

BACKGROUND: Apatinib, a third-line or later treatment for advanced gastric cancer (aGC), was shown to improve overall survival and progression-free survival (PFS) compared with placebo in the phase III trial. Given the modest benefit with high costs, we further evaluated the cost-effectiveness of apatinib for patients with chemotherapy-refractory aGC. METHODS: A Markov model was developed to simulate the disease process of aGC (PFS, progressive disease, and death) and estimate the incremental cost-effectiveness ratio (ICER) of apatinib to placebo. The health outcomes and utility scores were derived from the phase III trial and previously published sources, respectively. Total costs were calculated from the perspective of the Chinese health-care payer. Sensitivity analysis was used to explore model uncertainties. RESULTS: Treatment with apatinib was estimated to provide an incremental 0.09 quality-adjusted life years (QALYs) at an incremental cost of $8113.86 compared with placebo, which resulted in an ICER of $90,154.00 per QALY. Sensitivity analysis showed that across the wide variation of parameters, the ICER exceeded the willingness-to-pay threshold of $23,700.00 per QALY which was three times the Gross Domestic Product per Capita in China. CONCLUSIONS: Apatinib is not a cost-effective option for patients with aGC who experienced failure of at least two lines chemotherapy in China. However, for its positive clinical value and subliminal demand, apatinib can provide a new therapeutic option.

Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic.

PURPOSE: To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. METHODS: Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. RESULTS: Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. CONCLUSION: This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery.

Cost Effectiveness of Universal Hepatitis B Virus Screening in Patients Beginning Chemotherapy for Sarcomas or GI Stromal Tumors.

PURPOSE: The value of screening for hepatitis B virus (HBV) infection before chemotherapy for nonhematopoietic solid tumors remains unsettled. We evaluated the cost effectiveness of universal screening before systemic therapy for sarcomas, including GI stromal tumors (GISTs). PATIENTS AND METHODS: Drawing from the National Cancer Centre Singapore database of 1,039 patients with sarcomas, we analyzed the clinical records of 485 patients who received systemic therapy. Using a Markov model, we compared the cost effectiveness of a screen-all versus screen-none strategy in this population. RESULTS: A total of 237 patients were screened for HBV infection. No patients developed HBV reactivation during chemotherapy. The incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) of offering HBV screening to all patients with sarcomas and patients with GISTs exceeded the cost-effectiveness threshold of SG$100,000 per QALY. This result was robust in one-way sensitivity analysis. Our results show that only changes in mortality rate secondary to HBV reactivation could make the incremental cost-effectiveness ratio cross the cost-effectiveness threshold. CONCLUSION: Universal HBV screening in patients with sarcomas or GISTs undergoing chemotherapy is not cost effective at a willingness to pay of SG$100,000 per QALY and may not be required.

Detecting Germline PTEN Mutations Among At-Risk Patients With Cancer: An Age- and Sex-Specific Cost-Effectiveness Analysis.

PURPOSE: Cowden syndrome (CS) is an autosomal dominant disorder characterized by benign and malignant tumors. One-quarter of patients who are diagnosed with CS have pathogenic germline PTEN mutations, which increase the risk of the development of breast, thyroid, uterine, renal, and other cancers. PTEN testing and regular, intensive cancer surveillance allow for early detection and treatment of these cancers for mutation-positive patients and their relatives. Individual CS-related features, however, occur commonly in the general population, making it challenging for clinicians to identify CS-like patients to offer PTEN testing. PATIENTS AND METHODS: We calculated the cost per mutation detected and analyzed the cost-effectiveness of performing selected PTEN testing among CS-like patients using a semi-quantitative score (the PTEN Cleveland Clinic [CC] score) compared with existing diagnostic criteria. In our model, first-degree relatives of the patients with detected PTEN mutations are offered PTEN testing. All individuals with detected PTEN mutations are offered cancer surveillance. RESULTS: CC score at a threshold of 15 (CC15) costs from $3,720 to $4,573 to detect one PTEN mutation, which is the most inexpensive among the different strategies. At base-case, CC10 is the most cost-effective strategy for female patients who are younger than 40 years, and CC15 is the most cost-effective strategy for female patients who are between 40 and 60 years of age and male patients of all ages. In sensitivity analyses, CC15 is robustly the most cost-effective strategy for probands who are younger than 60 years. CONCLUSION: Use of the CC score as a clinical risk calculator is a cost-effective prescreening method to identify CS-like patients for PTEN germline testing.

Optimal management of Riata leads with no known electrical abnormalities or externalization: a decision analysis.

INTRODUCTION: Riata and Riata ST implantable cardioverter-defibrillator (ICD) leads (St. Jude Medical, Sylmar, CA, USA) can develop conductor cable externalization and/or electrical failure. Optimal management of these leads remains unknown. METHODS AND RESULTS: A Markov model compared 4 lead management strategies: (1) routine device interrogation for electrical failure, (2) systematic yearly fluoroscopic screening and routine device interrogation, (3) implantation of new ICD lead with capping of the in situ lead, and (4) implantation of new ICD lead with extraction of the in situ lead. The base case was a 64-year-old primary prevention ICD patient. Modeling demonstrated average life expectancies as follows: capping with new lead implanted at 134.5 months, extraction with new lead implanted at 134.0 months, fluoroscopy with routine interrogation at 133.9 months, and routine interrogation at 133.5 months. One-way sensitivity analyses identified capping as the preferred strategy with only one parameter having a threshold value: when risk of nonarrhythmic death associated with lead abandonment is greater than 0.05% per year, lead extraction is preferred over capping. A second-order Monte Carlo simulation (n = 10,000), as a probabilistic sensitivity analysis, found that lead revision was favored with 100% certainty (extraction 76% and capping 24%). CONCLUSIONS: Overall there were minimal differences in survival with monitoring versus active lead management approaches. There is no evidence to support fluoroscopic screening for externalization of Riata or Riata ST leads.

[Mice cope with parabiosis − assessment of their physiological changes of life].

The purpose of this study was to establish a parabiotic mice model and assess the physiological changes of the mice under the parabiotic state. Thirteen pairs of isogenic partners were studied. The model was created by preparing a bridge of skin and subcutaneous tissues between the two mice starting distal of the elbow joint along the humerus along the lateral costal region until the end of the waist line. Physiological, social and affective qualities of life were studied in the mice through behavioural observations for 120 days following the parabiotic surgery. During the first 2-3 days following the operation, the animals suffered from severe pain and distress. During the following days and weeks, the physiological system began to recover and the animals displayed behavioral adaptations to the parabiotic condition. All animals survived at day 120. At three days post operation, the body weight began to decrease. Following this, the animals experienced a continual body weight recovery and reached pre-surgical measures at about 30 days post op. Forty-eight h post op., faecal corticosterone-metabolites were extremely elevated, but their levels returned to two to four times of levels in control females within 72 hours post op. The faecal corticosterone-metabolite levels decreased near to control values on day 75. Out of the 13 pairs, the blood exchange rate of three parabiotic partners was tested, with the result being normal post op. After 12 weeks, the total blood exchange between both partners needed 63 or 46 or 107 min, respectively. These results demonstrated that the animals could adapt behaviourally to the parabiotic situation. Therefore, this parabiosis mouse model may provide useful insights in many research areas, such as transplantation immunity, hematological system and metabolism, etc.

Quantitative assessment of the effect of LRRK2 exonic variants on the risk of Parkinson's disease: a meta-analysis.

Leucine-rich repeat kinase 2 (LRRK2, PARK8) gene has attracted considerable attention since the variants in this gene are recognized as the most common cause of Parkinson's disease (PD) so far. A number of association studies concerning variants of LRRK2 gene and PD susceptibility have been conducted in various populations. However, some results were inconclusive. To derive a more precise estimation of the relationship between LRRK2 and genetic risk of PD, we performed a comprehensive meta-analysis which included 27,363 cases and 29,741 controls from 61 published case-control studies. Totally, the effect of five LRRK2 variants all within the coding regions, i.e. G2019S, G2385R, R1628P, P755L and A419V, were evaluated in the meta-analysis using fixed effect model or random effects model if heterogeneity existed. There were genetic associations between four variants (G2019S, G2385R, R1628P and A419V) and increased PD risk, while there was no evidence of statistically significant association between P755L and PD. Publication bias and heterogeneity were absent in most analyses. Within its limitations, this meta-analysis demonstrated that the G2019S, G2385R, R1628P and A419V variations are risk factors associated with increased PD susceptibility. However, these associations vary in different ethnicities.

Knowledge, attitudes, and behaviour regarding breast cancer screening among women from different socio-economic regions in southwest China: a cross-sectional study.

BACKGROUND: In most developed countries, breast cancer screening (BCS) is a well-established practice which is widely accepted by women. In contrast, national BCS projects in China were only launched in the last two years, so little is known about their public response. METHODS: We surveyed 1,162 Chinese women from different socio-economic regions in Sichuan Province to assess participants' knowledge, attitudes, and behaviour regarding BCS. ANOVA/t-test, Chi-square test, SNK test, and covariance analyses were used to compare subgroups and a multinomial logistic regression model was adopted to examine factors associated with BCS attendance. RESULTS: Statistically significant differences in scores of BCS knowledge were seen across regions. Most women from all four regions were interested in knowing the risk factors for (1,053, 90.6%) and means of prevention (912, 78.5%) of breast cancer. Eight hundred thirty-seven (72.0%) women expressed willingness to pay extra insurance fees when young in exchange for reimbursement for cancer screening when they reached the age at which screening is recommended. Approval of primary medical institutions was generally low. Regional socio-economic level, work status, and education were strong predictors of BCS attendance. CONCLUSION: To eliminate geographic disparities and raise the participation rate of BCS, future health education should be adjusted to local conditions and strengthened for women in under-developed regions. Incorporating BCS into a regular program of community-based prevention of chronic non-communicable diseases, and increasing medical insurance funds to cover BCS, especially in rural areas, may be effective means to increase BCS attendance.

[Establishment and application of eco-environmental risk assessment system of highway: a case study from G315 Yitunbulake-Qiemo section of Xinjiang].

The eco-environmental risk assessment system of highway, based on the Analytic Hierarchy Process and specialists' ideas, is set up. To give prominence to the spatial attribute of each assessment index the weight values were determined by the magnitude of special range that was influenced by assessment index. By translating relative maps using GIS the influenced range of environmental factors, the area occupied, was gotten. The lengths impacted by disaster factors were measured by the route reconnaissance and design. The results of applying the assessment system to evaluate the eco-environmental risk assessment of G315 Yitunbulake-Qiemo section of Xinjiang show that the eco-environmental risk indices of the road region, eco-environmental risk assessment (ERA) were between 1.55-3.23. According to the heterogeneity of the ecoenvironmental vulnerability indices (sigma x(i)w(i)) and disasters indices (sigma y(i)w(j)) included in ERA, 4 risk ranks to assess the eight units of landscape ecology in the Yitunbulake-Qiemo section of G315 highway were carried out, which factually reflects the characteristics of the eco-environmental risk for the highway.