Physician financial incentives to reduce unplanned hospital readmissions: A propensity score weighted cohort study.

BACKGROUND: Unplanned hospital readmissions are associated with adverse patient outcomes and substantial healthcare costs. It remains unknown whether physician financial incentives for enhanced discharge planning can reduce readmission risk. METHODS: In 2012, policymakers in British Columbia, Canada, introduced a $75 fee-for-service physician payment to incentivize enhanced discharge planning (the 'G78717' fee code). We used population-based administrative health data to compare outcomes among G78717-exposed and G78717-unexposed patients. We identified all non-elective hospitalizations potentially eligible for the incentive over a five-year study interval. We examined the composite risk of unplanned readmission or death and total direct healthcare costs accrued within 30 days of discharge. Propensity score overlap weights and adjustment were used to account for differences between exposed and unexposed patients. RESULTS: A total of 5262 of 24,787 G78717-exposed and 28,096 of 136,541 unexposed patients experienced subsequent unplanned readmission or death, suggesting exposure to the G78717 incentive did not reduce the risk of adverse outcomes after discharge (crude percent, 21.1% vs 20.6%; adjusted odds ratio, 0.97; 95%CI, 0.93-1.01; p=0.23). Mean direct healthcare costs within 30 days of discharge were $3082 and $2993, respectively (adjusted cost ratio, 1.00; 95%CI, 0.95-1.05; p=0.93). CONCLUSIONS: A physician financial incentive that encouraged enhanced hospital discharge planning did not reduced the risk of readmission or death, and did not significantly increase or decrease direct healthcare costs. Policymakers should consider the baseline prevalence and effectiveness of enhanced discharge planning, the magnitude and design of financial incentives, and whether auditing of incentivized activities is required when implementing similar incentives elsewhere. TRIAL REGISTRATION: ClinicalTrials.gov ID, NCT03256734.

Causal association of sleep traits with the risk of thyroid cancer: A mendelian randomization study.

BACKGROUND: This study was to explore the causal associations of sleep traits including sleep duration, snoring, chronotype, sleep disorders, getting up in the morning, sleeplessness/insomnia and nap during day with the risk of thyroid cancer based on Mendelian randomization (MR) analysis. METHOD: Summary single nucleotide polymorphism (SNP)-phenotype association data were obtained from published genome-wide association studies (GWASs) using the FinnGen and UK Biobank databases. A series of screening processes were performed to select qualified SNPs strongly related to exposure. We applied the inverse variance weighted (IVW), the Mendelian Randomization robust adjusted profile score (MR-RAPS), the Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO), and the Weighted Median to estimate the causal links between sleep traits and the risk of thyroid cancer. Odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS: The IVW results showed that getting up in the morning (OR = 0.055, 95%CI: 0.004-0.741) and napping during day (OR = 0.031, 95%CI: 0.002-0.462) were associated with decreased risk of thyroid cancer in the Italian population. A 1.30-h decrease of sleep duration was associated with 7.307-fold of thyroid cancer risk in the Finnish population (OR = 7.307, 95%CI: 1.642-32.519). Cronotype could decrease the risk of thyroid cancer in the Finnish population (OR = 0.282, 95%CI: 0.085-0.939). Sleep disorders increased the risk of thyroid cancer in the Finnish population (OR = 2.298, 95%CI: 1.194-4.422). The combined results revealed that sleep duration was correlated with increased risk of thyroid cancer (OR = 5.600, 95%CI: 1.458-21.486). CONCLUSION: Decreased sleep duration was associated with increased risk of thyroid cancer, which indicated the importance of adequate sleep for the prevention of thyroid cancer.

Complete biodegradation of tetrabromobisphenol A through sequential anaerobic reductive dehalogenation and aerobic oxidation.

Tetrabromobisphenol A (TBBPA), a common brominated flame retardant and a notorious pollutant in anaerobic environments, resists aerobic degradation but can undergo reductive dehalogenation to produce bisphenol A (BPA), an endocrine disruptor. Conversely, BPA is resistant to anaerobic biodegradation but susceptible to aerobic degradation. Microbial degradation of TBBPA via anoxic/oxic processes is scarcely documented. We established an anaerobic microcosm for TBBPA dehalogenation to BPA facilitated by humin. Dehalobacter species increased with a growth yield of 1.5 × 108 cells per µmol Br- released, suggesting their role in TBBPA dehalogenation. We innovatively achieved complete and sustainable biodegradation of TBBPA in sand/soil columns columns, synergizing TBBPA reductive dehalogenation by anaerobic functional microbiota and BPA aerobic oxidation by Sphingomonas sp. strain TTNP3. Over 42 days, 95.11 % of the injected TBBPA in three batches was debrominated to BPA. Following injection of strain TTNP3 cells, 85.57 % of BPA was aerobically degraded. Aerobic BPA degradation column experiments also indicated that aeration and cell colonization significantly increased degradation rates. This treatment strategy provides valuable technical insights for complete TBBPA biodegradation and analogous contaminants.

[Characterization of Reductive Dechlorination of Chlorinated Ethylenes by Anaerobic Consortium].

Tetrachloroethylene （PCE） and trichloroethylene （TCE） are typical volatile halogenated organic compounds in groundwater that pose serious threats to the ecological environment and human health. To obtain an anaerobic microbial consortium capable of efficiently dechlorinating PCE and TCE to a non-toxic end product and to explore its potential in treating contaminated groundwater， an anaerobic microbial consortium W-1 that completely dechlorinated PCE and TCE to ethylene was obtained by repeatedly feeding PCE or TCE into the contaminated groundwater collected from an industrial site. The dechlorination rates of PCE and TCE were （120.1 ±4.9） µmol·ï¼ˆL·d）-1 and （172.4 ±21.8） µmol·ï¼ˆL·d）-1 in W-1， respectively. 16S rRNA gene amplicon sequencing and quantitative PCR （qPCR） showed that the relative abundance of Dehalobacter increased from 1.9% to 57.1%， with the gene copy number increasing by 1.7×107 copies per 1 µmol Cl- released when 98.3 µmol of PCE was dechlorinated to cis-1，2-dichloroethylene （cis-1，2-DCE）. The relative abundance of Dehalococcoides increased from 1.1% to 53.8% when cis-1，2-DCE was reductively dechlorinated to ethylene. The growth yield of Dehalococcoides gene copy number increased by 1.7×108 copies per 1 µmol Cl- released for the complete reductive dechlorination of PCE to ethylene. The results indicated that Dehalobacter and Dehalococcoides cooperated to completely detoxify PCE. When TCE was used as the only electron acceptor， the relative abundance of Dehalococcoides increased from （29.1 ±2.4）% to （7.7 ±0.2）%， and gene copy number increased by （1.9 ±0.4）×108 copies per 1 µmol Cl- released， after dechlorinating 222.8 µmol of TCE to ethylene. The 16S rRNA gene sequence of Dehalococcoides LWT1， the main functional dehalogenating bacterium in enrichment culture W-1， was obtained using PCR and Sanger sequencing， and it showed 100% similarity with the 16S rRNA gene sequence of D. mccartyi strain 195. The anaerobic microbial consortium W-1 was also bioaugmented into the groundwater contaminated by TCE at a concentration of 418.7 µmol·L-1. The results showed that （69.2 ±9.8）% of TCE could be completely detoxified to ethylene within 28 days with a dechlorination rate of （10.3 ±1.5） µmol·ï¼ˆL·d）-1. This study can provide the microbial resource and theoretical guidance for the anaerobic microbial remediation in PCE or TCE-contaminated groundwater.

Shared Decision Making in Hallux Valgus Surgery: A Prospective Observational Study.

Patient-physician communication has the potential to improve outcomes and satisfaction through the shared decision-making process (SDM). This study aims to assess the relationship between perception of SDM and demographic, clinical, and patient-reported outcomes in patients undergoing Hallux Valgus (HV) correction. A prospective analysis of 306 patients scheduled for HV surgery was completed. The CollaboRATE score was used to measure SDM. Multivariable linear regression model was used to assess whether SDM scores were associated with preoperative characteristics or postoperative outcome scores. The mean CollaboRATE score was 2.9 (SD 0.9) and did not differ by age, socioeconomic status, or sex. Lower CollaboRATE scores were associated with more symptoms of depression, lower socioeconomic status, and lower general health scores (p-value < 0.05). There was no association between SDM scores and postoperative outcome scores. In this study, patients with depressive symptoms and lower socioeconomic status had worse perceptions of SDM. There was no difference in postoperative outcomes among participants based on SDM scores. Level of Evidence: Level III, prospective observational study.

Preoperative depression and anxiety associated with younger age and receipt of immediate breast reconstruction.

BACKGROUND: As survivorship for breast cancer continues to improve, emphasis of care falls upon improving patients' quality of life. Understanding physical and mental health in the preoperative period is needed to aid surgical decision making and improve patient experience. METHODS: Consecutive patients awaiting total mastectomy (TM), TM with immediate breast reconstruction (IBR) and breast conserving surgery (BCS) were prospectively recruited. Scores for PHQ-9, GAD-7, Breast-Q, EQ5D(5L), PEG were collected preoperatively. Association was measured with multivariate analyses. RESULTS: 477 participants (374 BSC, 46 â€‹TM, 84 IBR) were included. Younger patients and those choosing IBR reported worse depression and anxiety symptoms. Clinical tumor features did not affect patient reported outcomes. Higher Breast-Q scores were seen with BCS and lower scores with TM. CONCLUSIONS: Patients scheduled for IBR and younger patients reported worse symptoms of depression and anxiety, regardless of clinical features. This will help with surgical decision making and identify patients in need for additional perioperative supports.

An examination of rectal prolapse surgery patients' quality of life and symptoms using patient-reported outcome instruments: A prospective cohort study.

BACKGROUND: We measured changes in self-reported health and symptoms attributable to rectal prolapse surgery using patient-reported outcome (PRO) measures. METHODS: A prospectively recruited cohort of patients scheduled for rectal prolapse repair in Vancouver, Canada between 2013 and 2021 were surveyed before and 6-months after surgery using seven PROs: the EuroQol Five-Dimension Instrument (EQ-5D-5L), Generalized Anxiety Disorder Scale (GAD-7), Pain Intensity, Interference with Enjoyment of Life and General Activity (PEG), Patient Health Questionnaire (PHQ-9), Fecal Incontinence Severity Index (FISI), Gastrointestinal Quality of Life Index (GIQLI), and the Fecal Incontinence Quality of Life Scale (FIQL). RESULTS: We included 46 participants who reported improvements in health status (EQ-5D-5L; p â€‹< â€‹0.01), pain interference (PEG; p â€‹< â€‹0.01), depressive symptoms (PHQ-9; p â€‹= â€‹0.01), fecal incontinence severity (FISI; p â€‹< â€‹0.01), gastrointestinal quality of life (GIQLI; p â€‹< â€‹0.01), and fecal incontinence quality of life (FIQL) related to lifestyle (p â€‹= â€‹0.02), coping and behaviour (p â€‹= â€‹0.02) and depression and self-perception (p â€‹= â€‹0.01). CONCLUSION: Surgical repair of rectal prolapse improved patients' quality of life with meaningful improvements in fecal incontinence severity and pain, and symptom interference with daily activities.

A systematic review of studies on stress during the COVID-19 pandemic by visualizing their structure through COOC, VOS viewer, and Cite Space software.

Background: The COVID-19 epidemic generated different forms of stress. From this period, there has been a remarkable increase in the quantity of studies on stress conducted by scholars. However, few used bibliometric analyses to focus on overall trends in the field. Purpose: This study sought to understand the current status and trends in stress development during COVID-19, as well as the main research drives and themes in this field. Methods: 2719 publications from the Web of Science(WOS) core repository on stress during COVID-19 were analyzed by utilizing Co-Occurrence (COOC), VOS viewer, and Cite Space bibliometric software. The overall features of research on stress during COVID-19 were concluded by analyzing the quantity of publications, keywords, countries, and institutions. Results: The results indicated that the United States had the largest number of publications and collaborated closely with other countries with each other. University of Toronto was the most prolific institution worldwide. Visualization and analysis demonstrated that the influence of stress during COVID-19 on the work, life, mental and spiritual dimensions is a hot research topic. Among other things, the frequency of each keyword in research on stress during COVID-19 increased from 2021 to 2022, and the researchers expanded their scope and study population; the range of subjects included children, nurses, and college students, as well as studies focusing on different types of stress, and emphasizing the handling of stress. Conclusion: Our findings reveal that the heat of stress research during COVID-19 has declined, and the main research forces come from the United States and China. Additionally, subsequent research should concern more on coping methods with stress, while using more quantitative and qualitative studies in the future.

Population-Based Trends in Complexity of Hospital Inpatients.

Importance: Clinical experience suggests that hospital inpatients have become more complex over time, but few studies have evaluated this impression. Objective: To assess whether there has been an increase in measures of hospital inpatient complexity over a 15-year period. Design, Setting and Participants: This cohort study used population-based administrative health data from nonelective hospitalizations from April 1, 2002, to January 31, 2017, to describe trends in the complexity of inpatients in British Columbia, Canada. Hospitalizations were included for individuals 18 years and older and for which the most responsible diagnosis did not correspond to pregnancy, childbirth, the puerperal period, or the perinatal period. Data analysis was performed from July to November 2023. Exposure: The passage of time (15-year study interval). Main Outcomes and Measures: Measures of complexity included patient characteristics at the time of admission (eg, advanced age, multimorbidity, polypharmacy, recent hospitalization), features of the index hospitalization (eg, admission via the emergency department, multiple acute medical problems, use of intensive care, prolonged length of stay, in-hospital adverse events, in-hospital death), and 30-day outcomes after hospital discharge (eg, unplanned readmission, all-cause mortality). Logistic regression was used to estimate the relative change in each measure of complexity over the entire 15-year study interval. Results: The final study cohort included 3 367 463 nonelective acute care hospital admissions occurring among 1 272 444 unique individuals (median [IQR] age, 66 [48-79] years; 49.1% female and 50.8% male individuals). Relative to the beginning of the study interval, inpatients at the end of the study interval were more likely to have been admitted via the emergency department (odds ratio [OR], 2.74; 95% CI, 2.71-2.77), to have multimorbidity (OR, 1.50; 95% CI, 1.47-1.53) and polypharmacy (OR, 1.82; 95% CI, 1.78-1.85) at presentation, to receive treatment for 5 or more acute medical issues (OR, 2.06; 95% CI, 2.02-2.09), and to experience an in-hospital adverse event (OR, 1.20; 95% CI, 1.19-1.22). The likelihood of an intensive care unit stay and of in-hospital death declined over the study interval (OR, 0.96; 95% CI, 0.95-0.97, and OR, 0.81; 95% CI, 0.80-0.83, respectively), but the risks of unplanned readmission and death in the 30 days after discharge increased (OR, 1.14; 95% CI, 1.12-1.16, and OR, 1.28; 95% CI, 1.25-1.31, respectively). Conclusions and Relevance: By most measures, hospital inpatients have become more complex over time. Health system planning should account for these trends.

Genome-Centric Metatranscriptomic Characterization of a Humin-Facilitated Anaerobic Tetrabromobisphenol A-Dehalogenating Consortium.

Tetrabromobisphenol A (TBBPA), a widely used brominated flame retardant in electronics manufacturing, has caused global contamination due to improper e-waste disposal. Its persistence, bioaccumulation, and potential carcinogenicity drive studies of its transformation and underlying (a)biotic interactions. This study achieved an anaerobic enrichment culture capable of reductively dehalogenating TBBPA to the more bioavailable bisphenol A. 16S rRNA gene amplicon sequencing and quantitative PCR confirmed that successive dehalogenation of four bromide ions from TBBPA was coupled with the growth of both Dehalobacter sp. and Dehalococcoides sp. with growth yields of 5.0 ± 0.4 × 108 and 8.6 ± 4.6 × 108 cells per µmol Br- released (N = 3), respectively. TBBPA dehalogenation was facilitated by solid humin and reduced humin, which possessed the highest organic radical signal intensity and reducing groups -NH2, and maintained the highest dehalogenation rate and dehalogenator copies. Genome-centric metatranscriptomic analyses revealed upregulated putative TBBPA-dehalogenating rdhA (reductive dehalogenase) genes with humin amendment, cprA-like Dhb_rdhA1 gene in Dehalobacter species, and Dhc_rdhA1/Dhc_rdhA2 genes in Dehalococcoides species. The upregulated genes of lactate fermentation, de novo corrinoid biosynthesis, and extracellular electron transport in the humin amended treatment also stimulated TBBPA dehalogenation. This study provided a comprehensive understanding of humin-facilitated organohalide respiration.

Patterns of service utilization among youth with substance use service need: a cohort study.

BACKGROUND: Integrated youth services (IYS) are vital to addressing the needs of youth who use substances. Evidence on the characteristics of youths accessing these services and the types of services accessed have been limited. The objectives were to identify sociodemographic, self-reported health and mental health, patterns of service utilization (service type and frequency of visits) among youths with different levels of substance use service needs (low, moderate, and high), and to estimate the extent to which substance use service needs, self-reported health and mental health influenced the frequency of visits and types of service utilized. METHODS: Data were collected from youth (12-24 years) accessing IYS centres in Canada. Information on socio-demographic factors, substance use in the last month, self-rated health measures, number of service visits, and type of services utilized were included. Poisson regression was used to estimate the relationship between substance use needs and number of service visits and the different type of services utilized. RESULTS: Of 6181 youths, 48.0% were categorized as low substance use service needs, 30.6% had moderate needs and 21.4% had high needs, with higher proportion of men in the high needs group. Mental health and substance use (MHSU) services were utilized the most across all three groups, followed by counseling. The median number of visits was 4 for the low and moderate needs group and 5 in the high needs group. People with high service needs had 10% higher rate of service visits and utilized 10% more services than people with low service needs (service visits: RR = 1.1 (95%CI: 1.1-1.2); service type: RR = 1.1 (95%CI:1.0-1.1)). The rate of service visits increased by 30 to 50% and the number of services increased by 10-20% for people who rated their health good/fair/poor. Similarly, the rate of service visits increased by 40 to 60% and the number of services increased by 20% for people who rated their mental health good/fair/poor. CONCLUSIONS AND IMPACTS: Our study highlighted that regardless of service needs, youth who use alcohol and drugs have complex intersecting needs that present once they access integrated youth services.

Case mix-based changes in health status: A prospective study of elective surgery patients in Vancouver, Canada.

INTRODUCTION: Hospital activity is often measured using diagnosis-related groups, or case mix groups, but this information does not represent important aspects of patients' health outcomes. This study reports on case mix-based changes in health status of elective (planned) surgery patients in Vancouver, Canada. DATA AND METHODS: We used a prospectively recruited cohort of consecutive patients scheduled for planned inpatient or outpatient surgery in six acute care hospitals in Vancouver. All participants completed the EQ-5D(5L) preoperatively and 6 months postoperatively, collected from October 2015 to September 2020 and linked with hospital discharge data. The main outcome was whether patients' self-reported health status improved among different inpatient and outpatient case mix groups. RESULTS: The study included 1665 participants with completed EQ-5D(5L) preoperatively and postoperatively, representing a 44.8% participation rate across eight inpatient and outpatient surgical case mix categories. All case mix categories were associated with a statistically significant gain in health status (p < .01 or lower) as measured by the utility value and visual analogue scale score. Foot and ankle surgery patients had the lowest preoperative health status (mean utility value: 0.6103), while bariatric surgery patients reported the largest improvements in health status (mean gain in utility value: 0.1515). CONCLUSIONS: This study provides evidence that it was feasible to compare patient-reported outcomes across case mix categories of surgical patients in a consistent manner across a system of hospitals in one province in Canada. Reporting changes in health status of operative case mix categories identifies characteristics of patients more likely to experience significant gains in health.

Associations between perceptions of shared decision making and health among hysterectomy patients: A prospective observational study.

OBJECTIVE: To investigate patient and clinical factors that are associated with perceptions of shared decision making between hysterectomy patients and surgeons and to evaluate associations between shared decision making and postoperative health. METHODS: This study is based on a prospective cohort scheduled for hysterectomy for benign conditions in Vancouver, Canada. Validated patient-reported outcomes assessed shared decision making, pelvic health, depression, and pain. Regression analyses measured the association between perceptions of shared decision making with patient and clinical factors. Then, associations between shared decision making with postoperative pelvic health, pain and depression were evaluated using regression analysis and adjusted for patient and clinical factors. RESULTS: In this study, 308 participants completed preoperative measures, and a subset of 146 participants also completed the postoperative measures. More than 50% of participants reported less than optimal shared decision making scores. No significant associations were identified between patients' perceptions of shared decision making with patients' age, comorbidities, socioeconomic factors, indication for surgery, or preoperative depression and pain. Regression analyses found that higher/better self-reported shared decision making scores were associated with fewer postoperative pelvic organ symptoms (P = 0.01). CONCLUSION: Many patients' reporting lower than optimal scores on the shared decision making instrument highlight the opportunity to improve surgeon-patient communication in this surgical cohort. Strengthening shared decision making between surgeons and their patients may be associated with improved self-reported postoperative health.

Sustained detoxification of 1,2-dichloroethane to ethylene by a symbiotic consortium containing Dehalococcoides species.

1,2-Dichloroethane (1,2-DCA) is a ubiquitous volatile halogenated organic pollutant in groundwater and soil, which poses a serious threat to the ecosystem and human health. Microbial reductive dechlorination has been recognized as an environmentally-friendly strategy for the remediation of sites contaminated with 1,2-DCA. In this study, we obtained an anaerobic microbiota derived from 1,2-DCA contaminated groundwater, which was able to sustainably convert 1,2-DCA into non-toxic ethylene with an average dechlorination rate of 30.70 ± 11.06 µM d-1 (N = 6). The microbial community profile demonstrated that the relative abundance of Dehalococcoides species increased from 0.53 ± 0.08% to 44.68 ± 3.61% in parallel with the dechlorination of 1,2-DCA. Quantitative PCR results showed that the Dehalococcoides species 16S rRNA gene increased from 2.40 ± 1.71 × 108 copies∙mL-1 culture to 4.07 ± 2.45 × 108 copies∙mL-1 culture after dechlorinating 110.69 ± 30.61 µmol of 1,2-DCA with a growth yield of 1.55 ± 0.93 × 108 cells per µmol Cl- released (N = 6), suggesting that Dehalococcoides species used 1,2-DCA for organohalide respiration to maintain cell growth. Notably, the relative abundances of Methanobacterium sp. (p = 0.0618) and Desulfovibrio sp. (p = 0.0001995) also increased significantly during the dechlorination of 1,2-DCA and were clustered in the same module with Dehalococcoides species in the co-occurrence network. These results hinted that Dehalococcoides species, the obligate organohalide-respiring bacterium, exhibited potential symbiotic relationships with Methanobacterium and Desulfovibrio species. This study illustrates the importance of microbial interactions within functional microbiota and provides a promising microbial resource for in situ bioremediation in sites contaminated with 1,2-DCA.

Physician Financial Incentives for Use of Outpatient Intravenous Antimicrobial Therapy: An Interrupted Time Series Analysis.

BACKGROUND: In 2011, policymakers in British Columbia introduced a fee-for-service payment to incentivize infectious diseases physicians to supervise outpatient parenteral antimicrobial therapy (OPAT). Whether this policy increased use of OPAT remains uncertain. METHODS: We conducted a retrospective cohort study using population-based administrative data over a 14-year period (2004-2018). We focused on infections that required intravenous antimicrobials for ≥10 days (eg, osteomyelitis, joint infection, endocarditis) and used the monthly proportion of index hospitalizations with a length of stay shorter than the guideline-recommended "usual duration of intravenous antimicrobials" (LOS < UDIVA) as a surrogate for population-level OPAT use. We used interrupted time series analysis to determine whether policy introduction increased the proportion of hospitalizations with LOS < UDIVA. RESULTS: We identified 18 513 eligible hospitalizations. In the pre-policy period, 82.3% of hospitalizations exhibited LOS < UDIVA. Introduction of the incentive was not associated with a change in the proportion of hospitalizations with LOS < UDIVA, suggesting that the policy intervention did not increase OPAT use (step change, -0.06%; 95% confidence interval [CI], -2.69% to 2.58%; P = .97 and slope change, -0.001% per month; 95% CI, -.056% to .055%; P = .98). CONCLUSIONS: The introduction of a financial incentive for physicians did not appear to increase OPAT use. Policymakers should consider modifying the incentive design or addressing organizational barriers to expanded OPAT use.

A comparison of patient-reported outcomes among Canadian women having hysterectomies.

PURPOSE: Many indications for hysterectomy can negatively affect patients' quality of life. This study uses patient-reported outcomes to measure changes in self-reported health among hysterectomy patients. METHOD: A prospective cohort of 294 hysterectomy patients completed patient-reported outcomes preoperatively and six months postoperatively in Vancouver, Canada. Patient-reported outcomes measured pelvic health, sexual function, pain, and depression. Changes in health were compared with paired t-tests, and multi-variable regression analysis measured associations between patient and clinical factors with postoperative outcomes RESULTS: Many patients reported improvements in health. Unadjusted analysis found that 65% of participants reported less pelvic distress, 55% reported less pain, and 47% reported less depression symptoms postoperatively. Multivariable regression analysis found that poorer preoperative health was associated with poorer postoperative outcomes in all domains of health measured (p-value < 0.01). Postoperative pain scores were lower (less pain) by 0.78 among residents of the most affluent neighborhoods (p-value = 0.02) compared to those in less affluent neighborhoods. Postoperative depression scores were 1.58 points worse among participants with endometriosis (p-value = 0.03) and 1.02 points worse among participants having abdominal surgery (p-value = 0.02). CONCLUSION: Many participants reported improvements in pelvic symptoms, pain, and depression after hysterectomy. Lower socioeconomic status patients may be at risk for reporting higher pain after surgery, and endometriosis patients may report higher depression. Further investigation is needed to determine effective interventions for the higher postoperative pain observed in this study for residents of less affluent neighborhoods.

Impact of the COVID-19 pandemic on alcohol or drug use symptoms and service need among youth: a cross-sectional sample from British Columbia, Canada.

BACKGROUND: Concerns about youth alcohol and drug use have risen since the declaration of the global COVID-19 pandemic due to the pandemic's impact on known risk and protective factors for substance use. However, the pandemic's immediate and long-term impact on youths' substance use patterns has been less clear. Thus, this study sought to determine how the COVID-19 pandemic impacted alcohol or drug use and its risk and protective factors among youth accessing integrated youth services. METHODS: We conducted a repeated cross-sectional study of patient-reported outcomes data collected between May 2018 and February 2022 among youth (n = 6022) ages 10-24 accessing a provincial network of integrated youth services in Canada. The main exposure of interest was the COVID-19 pandemic (March 2020 - February 2022) compared with a pre-pandemic period (May 2018 - February 2020). As measured by the Global Appraisal of Individual Needs - Short Screener, outcomes included the average number of past month alcohol or drug use symptoms and past month likelihood of service need for alcohol/drug use (moderate/high vs. low need). Interrupted time series (ITS) examined change in average monthly alcohol/drug use symptoms between the pre- and pandemic periods. Stratified multivariable logistic regression investigated how the pandemic modified the effects of established risk/protective factors on likelihood of alcohol/drug use service need. RESULTS: Fifty-percent of youth met the criteria for moderate/high likelihood of alcohol/drug use service need, with the odds being 2.39 times (95% confidence interval = 2.04, 2.80) greater during the pandemic compared to the pre-pandemic period. Results from the ITS indicated significant immediate effects of the pandemic on monthly substance use symptoms (p = 0.01). Significant risk/protective factors for service need included exposure to violence, engagement in meaningful activities, and self-rated physical and mental health; and the direction of their effects remained consistent across pandemic and pre-pandemic periods. CONCLUSIONS: This study demonstrated that the COVID-19 pandemic corresponded with increased alcohol or drug use among youth accessing integrated services. This signals an urgent need for increased clinical capacity in existing youth services and policies that can respond to risk/protective factors for substance use earlier.

Observations of Atmospheric Tides in the Middle and Upper Atmosphere of Mars From MAVEN and MRO.

Variability in the Martian upper atmosphere is strongly linked to the lower atmosphere and much of it can be attributed to vertical wave propagation. Atmospheric tides in particular are a well-known phenomenon in the Martian atmosphere that play a key role in the transport of energy as they propagate to higher altitudes. Previous theoretical predictions and observations suggest that tides producing wavenumber-2 and wavenumber-3 patterns are strongest in a fixed local time at high altitudes, however, the energy they carry and the region of deposition are not well characterized. Given the availability of atmospheric observations from several spacecraft at the same time, in this paper, the nature and behavior of tides are studied concurrently at several altitudes. Here, six intervals are identified focused at fixed low latitudes utilizing simultaneous observations of the middle and upper atmosphere from in situ and remote sensing instruments on different spacecraft. In the middle atmosphere, strong wavenumber-2 signatures are identified in the intervals north of the equator whereas, in the south, wavenumber-3 signatures are strongest. Wave signatures observed in the upper atmosphere seem to be dominated by a mix of wavenumbers-2 and -3. Seasonal variation is observed in the northern intervals, with very little interannual variability in all intervals considered. Estimates of energy based on dominant wavenumber amplitude suggest that most of the energy dissipates below ∼90 km. Furthermore, model sampled output captures the dominant wavenumbers observed in the middle atmosphere as well as the energy dissipation characteristics.

Electron acceptors determine the BTEX degradation capacity of anaerobic microbiota via regulating the microbial community.

Anaerobic degradation is the major pathway for microbial degradation of benzene, toluene, ethylbenzene, and xylenes (BTEX) under electron acceptor lacking conditions. However, how exogenous electron acceptors modulate BTEX degradation through shaping the microbial community structure remains poorly understood. Here, we investigated the effect of various exogenous electron acceptors on BTEX degradation as well as methane production in anaerobic microbiota, which were enriched from the same contaminated soil. It was found that the BTEX degradation capacities of the anaerobic microbiota gradually increased along with the increasing redox potentials of the exogenous electron acceptors supplemented (WE: Without exogenous electron acceptors < SS: Sulfate supplement < FS: Ferric iron supplement < NS: Nitrate supplement), while the complexity of the co-occurring networks (e.g., avgK and links) of the microbiota gradually decreased, showing that microbiota supplemented with higher redox potential electron acceptors were less dependent on the formation of complex microbial interactions to perform BTEX degradation. Microbiota NS showed the highest degrading capacity and the broadest substrate-spectrum for BTEX, and it could metabolize BTEX through multiple modules which not only contained fewer species but also different key microbial taxa (eg. Petrimonas, Achromobacter and Comamonas). Microbiota WE and FS, with the highest methanogenic capacities, shared common core species such as Sedimentibacter, Acetobacterium, Methanobacterium and Smithella/Syntrophus, which cooperated with Geobacter (microbiota WE) or Desulfoprunum (microbiota FS) to perform BTEX degradation and methane production. This study demonstrates that electron acceptors may alter microbial function by reshaping microbial community structure and regulating microbial interactions and provides guidelines for electron acceptor selection for bioremediation of aromatic pollutant-contaminated anaerobic sites.

Complete Reductive Dechlorination of 4-Hydroxy-chlorothalonil by Dehalogenimonas Populations.

Chlorothalonil (2,4,5,6-tetrachloroisophthalonitrile, TePN) is one of the most widely used fungicides all over the world. Its major environmental transformation product 4-hydroxy-chlorothalonil (4-hydroxy-2,5,6-trichloroisophthalonitrile, 4-OH-TPN) is more persistent, mobile, and toxic and is frequently detected at a higher concentration in various habitats compared to its parent compound TePN. Further microbial transformation of 4-OH-TPN has never been reported. In this study, we demonstrated that 4-OH-TPN underwent complete microbial reductive dehalogenation to 4-hydroxy-isophthalonitrile via 4-hydroxy-dichloroisophthalonitrile and 4-hydroxy-monochloroisophthalonitrile. 16S rRNA gene amplicon sequencing demonstrated that Dehalogenimonas species was enriched from 6% to 17-22% after reductive dechlorination of 77.24 µmol of 4-OH-TPN. Meanwhile, Dehalogenimonas copies increased by one order of magnitude and obtained a yield of 1.78 ± 1.47 × 108 cells per µmol Cl- released (N = 6), indicating that 4-OH-TPN served as the terminal electron acceptor for organohalide respiration of Dehalogenimonas species. A draft genome of Dehalogenimonas species was assembled through metagenomic sequencing, which harbors 30 putative reductive dehalogenase genes. Syntrophobacter, Acetobacterium, and Methanosarcina spp. were found to be the major non-dechlorinating populations in the microbial community, who might play important roles in the reductive dechlorination of 4-OH-TPN by the Dehalogenimonas species. This study first reports that Dehalogenimonas sp. can also respire on the seemingly dead-end product of TePN, paving the way to complete biotransformation of the widely present TePN and broadening the substrate spectrum of Dehalogenimonas sp. to polychlorinated hydroxy-benzonitrile.