RESUMO
BACKGROUND: The global population of adults aged 60 and above surpassed 1 billion in 2020, constituting 13.5% of the global populace. Projections indicate a rise to 2.1 billion by 2050. While Hospital-at-Home (HaH) programs have emerged as a promising alternative to traditional routine hospital care, showing initial benefits in metrics such as lower mortality rates, reduced readmission rates, shorter treatment durations, and improved mental and functional status among older individuals, the robustness and magnitude of these effects relative to conventional hospital settings call for further validation through a comprehensive meta-analysis. METHODS: A comprehensive literature search was executed during April-June 2023, across PubMed, MEDLINE, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) to include both RCT and non-RCT HaH studies. Statistical analyses were conducted using Review Manager (version 5.4), with Forest plots and I2 statistics employed to detect inter-study heterogeneity. For I2 > 50%, indicative of substantial heterogeneity among the included studies, we employed the random-effects model to account for the variability. For I2 ≤ 50%, we used the fixed effects model. Subgroup analyses were conducted in patients with different health conditions, including cancer, acute medical conditions, chronic medical conditions, orthopedic issues, and medically complex conditions. RESULTS: Fifteen trials were included in this systematic review, including 7 RCTs and 8 non-RCTs. Outcome measures include mortality, readmission rates, treatment duration, functional status (measured by the Barthel index), and mental status (measured by MMSE). Results suggest that early discharge HaH is linked to decreased mortality, albeit supported by low-certainty evidence across 13 studies. It also shortens the length of treatment, corroborated by seven trials. However, its impact on readmission rates and mental status remains inconclusive, supported by nine and two trials respectively. Functional status, gauged by the Barthel index, indicated potential decline with early discharge HaH, according to four trials. Subgroup analyses reveal similar trends. CONCLUSIONS: While early discharge HaH shows promise in specific metrics like mortality and treatment duration, its utility is ambiguous in the contexts of readmission, mental status, and functional status, necessitating cautious interpretation of findings.
Assuntos
Alta do Paciente , Humanos , Idoso , Readmissão do Paciente/estatística & dados numéricos , Serviços Hospitalares de Assistência Domiciliar , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Many people who have a positive hepatitis C virus (HCV) antibody (Ab) test never receive a confirmatory HCV RNA viral load (VL) test. Reflex VL testing may help address this problem. We undertook a systematic review to evaluate the effectiveness of reflex VL testing compared with standard nonreflex approaches on outcomes across the HCV care cascade. METHODS: We searched 4 databases for studies that examined laboratory-based reflex or clinic-based reflex VL testing approaches, with or without a nonreflex comparator, and had data on the uptake of HCV RNA VL test and treatment initiation and turnaround time between Ab and VL testing. Both laboratory- and clinic-based reflex VL testing involve only a single clinic visit. Summary estimates were calculated using random-effects meta-analyses. RESULTS: Fifty-one studies were included (32 laboratory-based and 19 clinic-based reflex VL testing). Laboratory-based reflex VL testing increased HCV VL test uptake versus nonreflex testing (RR: 1.35; 95% CI: 1.16-1.58) and may improve linkage to care among people with a positive HCV RNA test (RR: 1.47; 95% CI: .81-2.67) and HCV treatment initiation (RR: 1.03; 95% CI: .46-2.32). The median time between Ab and VL test was <1 day for all laboratory-based reflex studies and 0-5 days for 13 clinic-based reflex testing. CONCLUSIONS: Laboratory-based and clinic-based HCV reflex VL testing increased uptake and reduced time to HCV VL testing and may increase HCV linkage to care. The World Health Organization now recommends reflex VL testing as an additional strategy to promote access to HCV VL testing and treatment. CLINICAL TRIALS REGISTRATION: PROSPERO CRD42021283822.
Assuntos
Hepatite C , Humanos , Hepatite C/diagnóstico , Hepacivirus/genética , Carga Viral , Reflexo , RNARESUMO
Blockchain-smart contracts have emerged as a new value proposition in improving certain aspects of sustainability in projects. However, there is little knowledge on how smart contracts can be leveraged to stimulate sustainable project performance from the integrated perspective. This study aims to capture the latest research development and applications of smart contracts for sustainable outcomes throughout the project lifecycle. Bibliometric and content analyses were conducted to critically review smart contracts and sustainable project performance. The results show that various new applications of smart contracts for sustainability have become more popular in the architecture, engineering, construction, and operation (AECO) industry. A smart contracts-sustainable project performance framework has been developed to fill up the research gaps for improving each dimension of sustainability and the integrated dimensions of sustainability during the project lifecycle. This study renders important implications for promoting sustainable project performance in the context of the engineering, construction, and operation industry, particularly for the required interdisciplinary research and practice in smart contracts.
RESUMO
BACKGROUND: Digital network-based methods may enhance peer distribution of HIV self-testing (HIVST) kits, but interventions that can optimize this approach are needed. We aimed to assess whether monetary incentives and peer referral could improve a secondary distribution program for HIVST among men who have sex with men (MSM) in China. METHODS AND FINDINGS: Between October 21, 2019 and September 14, 2020, a 3-arm randomized controlled, single-blinded trial was conducted online among 309 individuals (defined as index participants) who were assigned male at birth, aged 18 years or older, ever had male-to-male sex, willing to order HIVST kits online, and consented to take surveys online. We randomly assigned index participants into one of the 3 arms: (1) standard secondary distribution (control) group (n = 102); (2) secondary distribution with monetary incentives (SD-M) group (n = 103); and (3) secondary distribution with monetary incentives plus peer referral (SD-M-PR) group (n = 104). Index participants in 3 groups were encouraged to order HIVST kits online and distribute to members within their social networks. Members who received kits directly from index participants or through peer referral links from index MSM were defined as alters. Index participants in the 2 intervention groups could receive a fixed incentive ($3 USD) online for the verified test result uploaded to the digital platform by each unique alter. Index participants in the SD-M-PR group could additionally have a personalized peer referral link for alters to order kits online. Both index participants and alters needed to pay a refundable deposit ($15 USD) for ordering a kit. All index participants were assigned an online 3-month follow-up survey after ordering kits. The primary outcomes were the mean number of alters motivated by index participants in each arm and the mean number of newly tested alters motivated by index participants in each arm. These were assessed using zero-inflated negative binomial regression to determine the group differences in the mean number of alters and the mean number of newly tested alters motivated by index participants. Analyses were performed on an intention-to-treat basis. We also conducted an economic evaluation using microcosting from a health provider perspective with a 3-month time horizon. The mean number of unique tested alters motivated by index participants was 0.57 ± 0.96 (mean ± standard deviation [SD]) in the control group, compared with 0.98 ± 1.38 in the SD-M group (mean difference [MD] = 0.41),and 1.78 ± 2.05 in the SD-M-PR group (MD = 1.21). The mean number of newly tested alters motivated by index participants was 0.16 ± 0.39 (mean ± SD) in the control group, compared with 0.41 ± 0.73 in the SD-M group (MD = 0.25) and 0.57 ± 0.91 in the SD-M-PR group (MD = 0.41), respectively. Results indicated that index participants in intervention arms were more likely to motivate unique tested alters (control versus SD-M: incidence rate ratio [IRR = 2.98, 95% CI = 1.82 to 4.89, p-value < 0.001; control versus SD-M-PR: IRR = 3.26, 95% CI = 2.29 to 4.63, p-value < 0.001) and newly tested alters (control versus SD-M: IRR = 4.22, 95% CI = 1.93 to 9.23, p-value < 0.001; control versus SD-M-PR: IRR = 3.49, 95% CI = 1.92 to 6.37, p-value < 0.001) to conduct HIVST. The proportion of newly tested testers among alters was 28% in the control group, 42% in the SD-M group, and 32% in the SD-M-PR group. A total of 18 testers (3 index participants and 15 alters) tested as HIV positive, and the HIV reactive rates for alters were similar between the 3 groups. The total costs were $19,485.97 for 794 testers, including 450 index participants and 344 alter testers. Overall, the average cost per tester was $24.54, and the average cost per alter tester was $56.65. Monetary incentives alone (SD-M group) were more cost-effective than monetary incentives with peer referral (SD-M-PR group) on average in terms of alters tested and newly tested alters, despite SD-M-PR having larger effects. Compared to the control group, the cost for one more alter tester in the SD-M group was $14.90 and $16.61 in the SD-M-PR group. For newly tested alters, the cost of one more alter in the SD-M group was $24.65 and $49.07 in the SD-M-PR group. No study-related adverse events were reported during the study. Limitations include the digital network approach might neglect individuals who lack internet access. CONCLUSIONS: Monetary incentives alone and the combined intervention of monetary incentives and peer referral can promote the secondary distribution of HIVST among MSM. Monetary incentives can also expand HIV testing by encouraging first-time testing through secondary distribution by MSM. This social network-based digital approach can be expanded to other public health research, especially in the era of the Coronavirus Disease 2019 (COVID-19). TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR) ChiCTR1900025433.
Assuntos
Infecções por HIV/diagnóstico , Teste de HIV/instrumentação , Homossexualidade Masculina , Reembolso de Incentivo , Autoteste , Minorias Sexuais e de Gênero , Adulto , China , Custos e Análise de Custo , Teste de HIV/economia , Teste de HIV/métodos , Humanos , MasculinoRESUMO
Human immunodeficiency virus self-testing (HIVST) is an innovative and effective strategy important to the expansion of HIV testing coverage. Several innovative implementations of HIVST have been developed and piloted among some HIV high-risk populations like men who have sex with men (MSM) to meet the global testing target. One innovative strategy is the secondary distribution of HIVST, in which individuals (defined as indexes) were given multiple testing kits for both self-use (i.e.self-testing) and distribution to other people in their MSM social network (defined as alters). Studies about secondary HIVST distribution have mainly concentrated on developing new intervention approaches to further increase the effectiveness of this relatively new strategy from the perspective of traditional public health discipline. There are many points of HIVST secondary distribution in which mathematical modelling can play an important role. In this study, we considered secondary HIVST kits distribution in a resource-constrained situation and proposed two data-driven integer linear programming models to maximize the overall economic benefits of secondary HIVST kits distribution based on our present implementation data from Chinese MSM. The objective function took expansion of normal alters and detection of positive and newly-tested 'alters' into account. Based on solutions from solvers, we developed greedy algorithms to find final solutions for our linear programming models. Results showed that our proposed data-driven approach could improve the total health economic benefit of HIVST secondary distribution. This article is part of the theme issue 'Data science approaches to infectious disease surveillance'.
Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , China , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Alocação de Recursos , AutotesteRESUMO
BACKGROUND: Social network approaches to testing allow individuals (indexes) to distribute tests to social networks (alters). This quasi-experimental study compared two social network-based testing strategies in promoting human immunodeficiency virus (HIV) testing among Chinese gay, bisexual, and other men who have sex with men (GBMSM). METHODS: GBMSM aged ≥18years were recruited from Guangzhou, China. From May to September 2019, indexes could distribute blood-based HIV/syphilis dual self-testing kits to people within their social network. Indexes recruited from October 2019 to January 2020 could send HIV testing cards to their social networks for free facility-based tests. Alters were encouraged to upload a photo verification of test results. Indexes and alters received incentives during both periods. RESULTS: There were 245 participants who were assessed for eligibility and 208/245 (84.9%) were eligible. 106 and 102 indexes were recruited in the secondary distribution and testing card arms respectively. 154/208 (74.0%) completed follow up at 1 month. 92 indexes in the secondary distribution arm self-reported distributions to 179 unique alters, and 62 in the testing card arm to 26 unique alters. An average of 1.95 (standard deviation [s.d.]=1.90) HIV/syphilis dual self-tests and 0.42 (s.d.=0.78) HIV testing cards were distributed, generating a risk difference of 1.53 (95% confidence interval [CI] 1.09, 1.96). Indexes self-identifying as gay (P =0.007) or having previously tested (P =0.02) distributed more tests. Secondary distribution cost less per alter tested (USD120 vs USD9408). CONCLUSIONS: Secondary distribution engaged more GBMSM to distribute tests and reached more GBMSM to test compared to referral cards, suggesting advantage in facilitating testing uptake among Chinese GBMSM.
Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Sífilis , China , Infecções por HIV/diagnóstico , Teste de HIV , Homossexualidade Masculina , Humanos , Masculino , Encaminhamento e Consulta , Autoteste , Sífilis/diagnósticoRESUMO
High-temperature polymer electrolyte membrane fuel cells (HT-PEMFCs) are gaining more and more attention due to their higher efficiency than low-temperature ones. Polybenzimidazole (PBI) membranes are the most popular membranes used in HT-PEMFCs. However, their chemical stability and chemical degradation mechanisms, which directly affect the lifetime of fuel cells, have been hardly reported. We applied the density functional theory and used ABPBI as an example membrane to investigate the chemical degradation mechanisms of PBI membranes. The possible degradation mechanisms that occurred on eight sites have been proposed, where sites 2 and 3 located on the phenyl ring are determined as two weak sites toward OH radical and oxygen molecule attack. When the terminal is the H atom at site 7, it is also weak under OH radical attack. Regarding these, the substituent effect on the chemical stability of polymers has been studied. By introducing four -C2F5 or -CN groups, the barrier heights of the corresponding degradation reactions are increased; thus, the chemical stabilities of related membranes are improved. The selection of terminal atoms was also explored for alleviating the chemical degradation of the membrane. The investigated proton transfer properties of nine model compounds revealed that introducing four -C2F5 or -CN groups improves the proton dissociation properties occurring at the cathode. The increase of phosphoric acid concentration is helpful for the proton transfer at both the membrane and the cathode. This work may hopefully help the design and synthesis of HT-PEMFCs with good stability and high efficiency.
RESUMO
Aqueous zinc-ion batteries are emerging as promising sustainable energy-storage devices. However, their cyclic stability is still a great challenge due to the inevitable parasitic reaction and dendrite growth induced by water. Herein, a cosolvent strategy based on competitive effect is proposed to address the aforementioned challenges. Ethanol with a higher Gutmann donor number demonstrates lower polarity and better wettability on the Zn surface compared with water, which endows ethanol with the ability of minimizing water activity by weakening H bonds and preferentially adsorbing on the Zn electrode. The above competitive advantages synergistically contribute to inhibiting the decomposition of free water and dendrite growth. Besides, an organic-inorganic hybrid solid-electrolyte interphase layer is in situ built based on ethanol additives, where organic matrix suppresses water corrosion while inorganic fillers promote fast Zn2+ diffusion. Consequently, the electrolyte with ethanol additives boosts a high reversibility of Zn deposition, long-term durability, as well as superior Zn2+ diffusibility in both Zn half-cells (Zn||Cu and Zn||Zn batteries) and Zn full cells (Zn||PTCDA and Zn||VO2 batteries). This work sheds light on a universal strategy to design a high-reversible and dendrite-free Zn anode for stable aqueous batteries.
RESUMO
Background: Occupational burnout is a type of psychological syndrome. It can lead to serious mental and physical disorders if not treated in time. However, individuals tend to conceal their genuine feelings of occupational burnout because such disclosures may elicit bias from superiors. This study aims to explore a novel method for estimating occupational burnout by elucidating its links with social, lifestyle, and health status factors. Methods: In this study 5,794 participants were included. Associations between occupational burnout and a set of features from a survey was analyzed using Chi-squared test and Wilcoxon rank sum test. Variables that are significantly related to occupational burnout were grouped into four categories: demographic, work-related, health status, and lifestyle. Then, from a network science perspective, we inferred the colleague's social network of all participants based on these variables. In this inferred social network, an exponential random graph model (ERGM) was used to analyze how occupational burnout may affect the edge in the network. Results: For demographic variables, age (p < 0.01) and educational background (p < 0.01) were significantly associated with occupational burnout. For work-related variables, type of position (p < 0.01) was a significant factor as well. For health and chronic diseases variables, self-rated health status, hospitalization history in the last 3 years, arthritis, cardiovascular diseases, high blood lipid, breast diseases, and other chronic diseases were all associated with occupational burnout significantly (p < 0.01). Breakfast frequency, dairy consumption, salt-limiting tool usage, oil-limiting tool usage, vegetable consumption, pedometer (step counter) usage, consuming various types of food (in the previous year), fresh fruit and vegetable consumption (in the previous year), physical exercise participation (in the previous year), limit salt consumption, limit oil consumption, and maintain weight were also significant factors (p < 0.01). Based on the inferred social network among all airport workers, ERGM showed that if two employees were both in the same occupational burnout status, they were more likely to share an edge (p < 0.0001). Limitation: The major limitation of this work is that the social network for occupational burnout ERGM analysis was inferred based on associated factors, such as demographics, work-related conditions, health and chronic diseases, and behaviors. Though these factors have been proven to be associated with occupational burnout, the results inferred by this social network cannot be warranted for accuracy. Conclusion: This work demonstrated the feasibility of identifying people at risk of occupational burnout through an inferred colleague's social network. Encouraging staff with lower occupational burnout status to communicate with others may reduce the risk of burnout for other staff in the network.
RESUMO
BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most prevalent type of scoliosis affecting children between the ages of 10-16 years. However, risk factors for AIS, particularly the modifiable ones, are still largely unknown. This study aims to investigate the associations of lifestyle and social environment factors with AIS in Chinese schoolchildren. METHODS: This is a matched case-control study based on survey data collected from school-based scoliosis screening program. We used conditional logistic regression models to describe the relative risk of AIS incidence for each variable in the analyses. To examine the independent effect of each factor on developing AIS, a multivariate conditional logistic regression was conducted and odds ratios (ORs) were adjusted for age and other significant variables. RESULTS: Overall, 2538 participants from 49 schools were included in this study, comprising 1269 AIS cases and 1269 controls. Mean age of the study population was 13.4 years ± 1.06 (range 10-18). One thousand five hundred and fifty (61.1%) of the study subjects were girls. After adjusting for other significant factors, inappropriate desk heights, either too low (OR = 1.40, 95% CI 1.04-1.90) or too high (OR = 1.61, 95% CI 1.09-2.38), standing with anterior pelvic tilt (OR = 2.73, 95% CI 1.41-5.28), and sleeping on the right side (OR = 1.38, 95% CI 1.00-1.91), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.69 (95% CI 0.50-0.96) for sitting normally, and 0.72 (95% CI 0.53-0.98) for sitting positions change. CONCLUSIONS: This is the first study to address the associations between desk heights and AIS and showed inappropriate desk heights were related to increased AIS risks. To protect school children from developing AIS, stakeholders are advised to consider introducing height-adjustable desks in the class, changing students' sitting positions in the classroom on a regular basis, and implementing educational programs to help students maintain correct sitting postures.
Assuntos
Cifose , Escoliose , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos de Casos e Controles , China/epidemiologia , Hábitos , Cifose/complicações , Estilo de Vida , Escoliose/etiologia , Escoliose/complicaçõesRESUMO
We present the synthesis and catalytic properties of two novel telluroniobates {Te15Nb21} and {Te10Nb14}. {Te15Nb21} is the first trimeric telluroniobate with the largest number of tellurium atoms in the Te-Nb system. Besides, both clusters exhibit excellent catalytic activity in the amidation reactions of anhydrides and amines, and cyclic imides and bi-amides can be controllably synthesized, which represents a breakthrough in the catalysis of polyoxoniobates.
RESUMO
Perfluorocarboxylic acids (PFCAs) are an emerging class of persistent organic pollutants. During the fabrication process, it is unavoidable to form PFCA homologs or isomers which exhibit distinct occurrence, bioaccumulation, and toxicity. The precision measurement of PFCAs is therefore of significant importance. However, the existing characterization techniques, such as LC-MS/MS, cannot fully meet the requirement of isomer-specific analysis, largely due to the lack of authentic standards. Single-molecule sensors (SMSs) based on nanopore electrochemistry may be a feasible solution for PFCAs determination, thanks to their ultra-high spatiotemporal resolutions. Hence, as a first step, this work was to elucidate the influence of electrolyte concentration on the four most critical indicators of nanopore measurements, and furthermore, performance of nanopore SMSs. More specifically, three of the most representative short-chain PFCAs, perfluoropentanoic acid (PFPeA), perfluorohexanoic acid (PFHxA) and perfluoroheptanoic acid (PFHpA), were adopted as the target analytes, aerolysin nanopore was employed as the sensing interface, and 2, 3 and 4 M KCl solutions were used as electrolytes. It was found that, when the concentration of KCl solution increased from 2 to 4 M, the conductance of aerolysin nanopore increased almost linearly at a rate of 0.5 nS per molar KCl within the whole voltage range, the current blockade of PFPeA at -50 mV increased from 61.74 to 66.57% owing to the enhanced steric exclusion effect, the maximum dwell time was more than doubled from 14.5 to 31.5 ms, and the barrier limited capture rate increased by 8.3 times from 0.46 to 3.85 Hz. As a result, when using 4 M KCl as the electrolyte, over 90% of the PFPeA, PFHxA and PFHpA were accurately identified from a mixed sample, and the calculated limit of detection of PFPeA reached 320 nM, more than 24 times lower than in 2 M KCl. It was thus clear that tuning the electrolyte concentration was a simple but very effective approach to improve the performance of nanopore SMSs for PFCAs determination.
RESUMO
We present a single molecular polyoxometalate cluster (K41[(P2W12Nb6O62)6{Mn3(OH)3(H2O)6}4{Mn3Na(H2O)16}]·26H2O) with controllable release of a large number of protons (â¼40 per molecule) in its aqueous solution upon addition of a base. The deprotonation/protonation process is reversible with the clusters remaining intact. This molecule can also absorb up to 11 protons per cluster when an acid, HCl, was added to its original aqueous solution. To the best of our knowledge, such large proton absorption/release capacity along with excellent stability is unprecedented.