Obtaining EQ-5D-3L utility index from the health status scale of traditional Chinese medicine (TCM-HSS) based on a mapping study.

BACKGROUND: Almost all traditional Chinese medicine (TCM) quality of life measures are non-preference-based measures (non-PBMs), which do not provide utilities for cost-utility analysis in pharmacoeconomic evaluation. Whereas the mapping has become a new instrument to obtain utilities, which builds a bridge between non-PBMs and PBMs. PURPOSE: To develop mapping algorithms from the health status scale of traditional Chinese medicine (TCM-HSS) onto the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L). METHODS: The cross-sectional data were collected by questionnaire survey from a tertiary hospital visit population and community residents in China, and randomly divided into training and validation set by 2:1. Based on the training set, direct and indirect mapping methods (7 regression methods and 4 model specifications) were conducted to establish alternative models, which were comprehensively evaluated based on the validation set by mean absolute error, root mean square error, and Spearman correlation coefficient between predicted and observed values. Based on the whole sample, the preferred mapping algorithm was developed. RESULTS: A total of 639 samples were included, with an average age of 45.24 years and 61.66% of respondents were female. The mean EQ-5D-3L index was 0.9225 [SD = 0.1458], and the mean TCM-HSS index was 3.4144 [SD = 3.1154]. The final mapping algorithm was a two-part regression model including the TCM-HSS subscales, interaction terms, and demographic covariates (age and gender). The prediction performance was good. The mean error was 0.0003, the mean absolute error was 0.0566, the root mean square error was 0.1039, and 83.10% of the prediction errors were within 0.1; the Spearman correlation coefficient between predicted and observed EQ-5D-3L values was 0.6479. CONCLUSION: It is the first study to develop a mapping algorithm between the TCM-HSS and EQ-5D-3L, which demonstrates excellent prediction accuracy and estimates utility value for economic evaluation from TCM quality of life measures.

Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization.

The COVID-19 pandemic, climate change-related events, protracted conflicts, economic stressors and other health challenges, call for strong public health orientation and leadership in health system strengthening and policies. Applying the essential public health functions (EPHFs) represents a holistic operational approach to public health, which is considered to be an integrated, sustainable, and cost-effective means for supporting universal health coverage, health security and improved population health and wellbeing. As a core component of the Primary Health Care (PHC) Operational Framework, EPHFs also support the continuum of health services from health promotion and protection, disease prevention to treatment, rehabilitation, and palliative services. Comprehensive delivery of EPHFs through PHC-oriented health systems with multisectoral participation is therefore vital to meet population health needs, tackle public health threats and build resilience. In this perspective, we present a renewed EPHF list consisting of twelve functions as a reference to foster country-level operationalisation, based on available authoritative lists and global practices. EPHFs are presented as a conceptual bridge between prevailing siloed efforts in health systems and allied sectors. We also highlight key enablers to support effective implementation of EPHFs, including high-level political commitment, clear national structures for institutional stewardship on EPHFs, multisectoral accountability and systematic assessment. As countries seek to transform health systems in the context of recovery from COVID-19 and other public health emergencies, the renewed EPHF list and enablers can inform public health reform, PHC strengthening, and more integrated recovery efforts to build resilient health systems capable of managing complex health challenges for all people.

Do Narcotic Use, Physical Therapy Location, or Payer Type Predict Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction?

BACKGROUND: Opioid use and public insurance have been correlated with worse outcomes in a number of orthopaedic surgeries. These factors have not been investigated with anterior cruciate ligament reconstruction (ACLR). PURPOSE/HYPOTHESIS: To evaluate if narcotic use, physical therapy location, and insurance type are predictors of patient-reported outcomes after ACLR. It was hypothesized that at 1 year postsurgically, increased postoperative narcotic use would be associated with worse outcomes, physical therapy obtained within the authors' integrated health care system would lead to better outcomes, and public insurance would lead to worse outcomes and athletic activity. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: All patients undergoing unilateral, primary ACLR between January 2015 and February 2016 at a large health system were enrolled in a standard-of-care prospective cohort. Knee injury and Osteoarthritis Score (KOOS) and the Hospital for Special Surgery Pediatric-Functional Activity Brief Scale (HSS Pedi-FABS) were collected before surgery and at 1 year postoperatively. Concomitant knee pathology was assessed arthroscopically and electronically captured. Patient records were analyzed to determine physical therapy location, insurance status, and narcotic use. Multivariable regression analyses were used to identify significant predictors of the KOOS and HSS Pedi-FABS score. RESULTS: A total of 258 patients were included in the analysis (mean age, 25.8; 51.2% women). In multivariable regression analysis, narcotic use, physical therapy location, and insurance type were not independent predictors of any KOOS subscales. Public insurance was associated with a lower HSS Pedi-FABS score (-4.551, P = .047) in multivariable analysis. Narcotic use or physical therapy location was not associated with the HSS Pedi-FABS score. CONCLUSION: Increased narcotic use surrounding surgery, physical therapy location within the authors' health care system, and public versus private insurance were not associated with disease-specific KOOS subscale scores. Patients with public insurance had worse HSS Pedi-FABS activity scores compared with patients with private insurance, but neither narcotic use nor physical therapy location was associated with activity scores. Physical therapy location did not influence outcomes, suggesting that patients be given a choice in the location they received physical therapy (as long as a standardized protocol is followed) to maximize compliance.

A study on biofuel produced by catalytic cracking of mustard and castor oil using porous Hß and AlMCM-41 catalysts.

Biofuel is the only novel solution to the increase in the greenhouse effect and bursting energy demand. The catalytic cracking of non-edible vegetable oils, namely castor and mustard was studied to yield gasoline range (C5-C9) hydrocarbons. Hß (Microporous; pore size <2 nm) and AlMCM-41 (Mesoporous; pore size 2 nm-50 nm) materials with different Si/Al ratios were used as catalysts for cracking purposes. Characterization of these catalysts was done by X-ray diffraction, Surface area analyzer, nitrogen sorption studies, TPD and inductively coupled plasma techniques. Used mustard oil was cracked over AlMCM-41 catalysts in a fixed bed catalytic cracking unit at optimized reaction condition (400 °C, 4.6 h-1) obtained over Hß. The liquid and gaseous products were analyzed using gas chromatograph (Shimadzu GC-9A). Among the mesoporous catalysts AlMCM-41 (27) was able to convert 75% of mustard oil into 48% of bioliquid and 30.4% selectivity towards BG. Pongamia, neem, castor, fresh coconut and used coconut oil was also cracked using AlMCM-41 (27) catalyst. The major products of cracking reactions were Castor Bioliquid (CBL) comprising of bio gasoline (BG), bio kerosene (BK) and bio diesel (BD) with less yield of gaseous products. AlMCM-41 converted 98% of castor oil into 85% of CBL and it was tested with ASTM 6751 standard procedures for its calorific value, viscosity and flash point. The sulphur emission from CBL run engine reached lower index. The results exhibited the commercial utility of the CBL in the near future.

Health risk assessment for pediatric population associated with ethanol and selected residual solvents in herbal based products.

In this study, 48 herbal based products (41 for the pediatric population) were analyzed for the presence of ethanol and residual solvents. Ethanol was not detected in only 12% of the products designed for infants or toddlers aged under 2, and not quantified in only 5 of 14 'alcohol free' products. Actual content was higher than labeled in six out of 11 samples with specified ethanol quantity. WHO proposed requirement for ethanol content in products intended for use in children under the age of 6 (<0.5%) was not met by as many as 26 samples. Furthermore, calculated blood alcohol levels in children exceeded the relevant toxicological levels for nine samples following a single dose, and for one sample in case of accidental poisoning with the entire package. Regarding the residual solvents, acetone, 1-propanol and 1-butanol were not quantified, 2-propanol was found in two samples in low concentrations, whereas methanol intake via one of the samples exceeded the permitted level for children. The obtained results revealed a significant health concern for the pediatric population due to ethanol intake via herbal based products, calling for the establishment of strict guidelines for ethanol content and labeling.

The role and the interventions of the Hospital Social Service (HSS) for the integration of the health and social activities: a comparative survey between 2008 and 2014 in the Social Service of the "Azienda Ospedaliera Universitaria Policlinico Umberto I" in Rome, Italy.

INTRODUCTION: In the Azienda Ospedaliera Universitaria Policlinico Umberto I in Rome, the Hospital Social Services (HSS) is located within the Directorate of Health, reporting directly to the Chief Medical Officer, providing counselling and supporting clinical services. The HSS is part of a network with its own technical, professional and assessment independence. It often serves as liaison between the hospital and the territory, facilitating the development of services and contributing to public health recovery and maintenance, therefore improving the citizens' standard of living thanks to aid projects and specific interventions. METHODS: The present Report is based on two different studies carried out in 2008 and 2014, both examining the work of the Hospital Social Service in the "Azienda Ospedaliera Universitaria Policlinico Umberto I" in Rome. The purpose is to compare these surveys and work out the results. The data collection is based on a number of social records from the HSS archives (814 records in 2008 and 790 in 2014). The research project followed subsequent stages: planning a draft of the research, where ethnomethodology was used as empirical evaluation technique; collecting data from the HSS's paper and file archives (biographical, clinical and social data); revising, analysing and elaborating the data which showed relevant changes leading to interesting conclusions. RESULTS AND CONCLUSIONS: The comparative analysis of data showed a higher demand of HSS healthcare services, despite a smaller number of beds and hospitalisations available in standard regime. Also, it indicated an increase of patients below 18 years and a decrease of the over-65s age group. As for the geographical origin of patients reported to the HSS, there was a decrease in the percentage of Italian citizens, while the percentage of irregular non-EU and EU patients increased by over 5%. Significant results were found comparing the days between the report to the HSS and patient discharge. Data concerning the 'more than 7 days' group was steady over the years, being more consistent for both the variables considered and increasing in 2014. In the comparative analysis, the interventions with more significant differences were those aimed at promoting homecare and entering sheltered housing. In the former cases, a considerable decrease was observed, if compared to the activation of the integrated health and social homecare services, while there were more requests for homecare assistance; in the latter ones the analysis highlighted a sharp decrease in the percentage of the variable called "assessment to enter Extended Care Units". The causes of these changes are remarkable and have to be found in the political, historical and cultural scenario: - a first factor is the increase in the more recent migratory flow from non-EU countries to Italy, which could explain the rising percentage of foreigners taken over by the HSS; - regional policies, economic cuts imposed on healthcare and higher income limits in order to calculate the patient's economic participation in the costs of institutionalisation have affected the above-mentioned changes; - the innovations in the regulatory field of Latium Region have brought structural changes in long-term care facilities and in the level of care in Extended Care Units (ECU).

The anti-hyperplasia of mammary gland effect of protein extract HSS from Tegillarca granosa.

Tegillarca granosa Linnaeus, possesses various biological functions and has been used a Chinese traditional medicine more than one century, but there is no report about anti-hyperplasia of mammary gland (HMG) activity of drugs from T. granosa. In this study, we investigated the anti-HMG effect of protein extract named HSS from T. granosa. The HMG model of virgin female Sprague Dawley rats was prepared by injecting estrogen in the thigh muscle of the rats and progestogen consecutively. HMG rats were treated with either HSS or positive control drug by i.g. for 35 consecutive days. In order to evaluate anti-HMG activity of HSS, Changes of nipple height and diameter, serum sex hormones levels, organ indexes and pathologic changes of mammary gland were performed. Body weight, food intake, pathomorphology examination of organs (heart, liver, spleen, lung, kidney), hematological and biochemical analysis were performed to evaluate the toxicity of HSS. HSS could significantly reduce nipples height and diameter, increase P concentration of HMG rat serum, spleen and thymus index, decrease uterus index, and has therapeutic effect on rat HMG and no toxicity at 500mg/kg/day. The anti-HMG mechanism of HSS may be related to AP-2α and P53. HSS has protective and therapeutic effects on HMG rats, and may be a promising agent for treating hyperplasia of mammary glands.

The effect of high speed shearing on disaggregation and degradation of pectin from creeping fig seeds.

The effect of high speed shearing (HSS) on disaggregation and degradation of pectin from creeping fig seeds was investigated. It was found that disaggregation and degradation occurred during the whole shearing process. When pectin solution was sheared at 24,000 rpm for less than 8h, degradation happened but disaggregation was dominant during this period. After 8h, degradation became obvious, however, a small amount of aggregates remained even after 24h treatment, indicating that HSS may not eliminate aggregates efficiently. The presence of aggregates is one of the most probable causes for the inaccurate determination of molecular weight of pectin. A new method was proposed for calculating more accurately the molecular weight based on the change of the reducing sugar content and the variation of molecular weight. Determination of unsaturated uronide and FT-IR spectra analysis indicated that neither ß-elimination nor demethoxylation occurred during the HSS, and no new functional group was formed during the HSS process.