Utilization Rate Research Articles

Changes in the nutritional, flavor, and phytochemical properties of Citrus reticulata Blanco cv. ‘Dahongpao’ whole fruits during enzymatic hydrolysis and fermentation

IntroductionCurrently, the large-scale consumption of fresh citrus fruits in the form of juices, jams, and purees results in significant quantities of waste consisting of citrus peels, pulp, and seeds.MethodsTo improve the utilization rate of whole citrus fruits and reduce the generation of processing waste, the best pre-optimized enzymatic fermentation conditions were used to treat whole citrus fruits and to analyse the changes in nutritional and active components (Enzymatic: pectinase, cellulase, hemicellulase added at a ratio of 1:1:1 for 63.326 min at a temperature of 60°C, with 0.506% of each enzyme added; Fermentation: Lacticaseibacillus rhamnosus TR08, Lactiplantibacillus plantarum subsp. Plantarum CICC 6257, and Limosilactobacillus fermentum CCFM1139 were added at a ratio of 1:1:1 for 30 h, with the concentration was 108 CFU/mL, and the total amount added was 6%).ResultsResults showed that after enzymatic hydrolysis, the mineral elements (Nitrogen, phosphorus), total amino acid, vitamin C, and organic acid content increased. For soluble sugars, the contents of fructose and glucose increased, whereas the sucrose content decreased. Fermentation had a minimal effect on the mineral content; however, the total amino acid, vitamin C, and soluble sugar contents decreased. Additionally, when comparing the samples after enzymatic fermentation to those after enzymatic hydrolysis alone, the total phenols, total flavonoids, carotenoids and antioxidant activities were significantly increased by 1.39, 1.49, 1.21 and 3.79 folds, respectively.DiscussionThis study addresses the challenges of utilizing fruit residue in the current market, including high treatment costs and environmental pollution, by providing a novel perspective on the enzymatic hydrolysis and fermentation of whole red oranges. Furthermore, it aims to improve the nutritional, functional, and health benefits of citrus fruit products.

Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates.

Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with severe mental illness (SMI). Effective care delivery models are needed to address this mortality gap. This study examines the impact of an enhanced primary care (PC) program that specializes in the treatment of patients with SMI, called Medicine in Psychiatry Service-Primary Care (MIPS-PC). Using multipayer claims data in Western New York from January 1, 2016 to December 31, 2021, patients with SMI and CVD were identified using International Classification of Diseases, Tenth Revision codes. National Provider Identification numbers of MIPS-PC providers were then used to identify those patients who were treated by MIPS-PC during the period. These MIPS-PC-treated patients were compared against a cohort of one-to-one propensity score matched contemporaneous comparison group (ie, patients receiving PC from providers unaffiliated with MIPS-PC). A difference-in-difference approach was used to identify the treatment effects of MIPS-PC on all-cause emergency department (ED) visits and hospitalization rates. The MIPS-PC group was associated with a downtrend in the acute care utilization rates over a 3-year period following the index date (ie, date of first MIPS-PC or other PC provider encounter), specifically a lower hospitalization rate in the first year since the index date (25%; P < 0.001). ED visit rate reduction was significant in the third-year period (18%; P = 0.021). In summary, MIPS-PC treatment is associated with a decreasing trend in acute care utilization. Prospective studies are needed to validate this effect of enhanced PC in patients with SMI and CVD.

An efficient CNN accelerator for pattern-compressed sparse neural networks on FPGA

Currently, the sparsity of weights and activations are mainly utilized to improve the energy efficiency and computational performance of CNN accelerators. However, the irregular sparsity of weights and activations can lead to problems such as mapping access conflict and imbalanced workload, which poses great challenges to the efficient computation of sparse networks. To address those problems, this paper proposes a CNN accelerator for pattern-compressed sparse neural networks on FPGA to achieve efficient inference acceleration. It mainly includes three parts: first, we propose a convolutional kernel grouping fusion method to achieve a balanced workload of weights. Second, we propose an activation hash mapping conflict reduction method to drastically reduce the mapping access conflict rate. Finally, we further propose a hierarchical mapping computing architecture to achieve efficient processing of mapping access conflicts and balanced adaptation of weight loads. To verify the effectiveness of the method proposed in this paper, our accelerator is designed and implemented on the Zynq UltraScale+ MPSoC ZCU102 evaluation board and evaluated by running VGG16 and ResNet50 networks. The experimental results show that the method proposed in this paper can reduce the mapping conflicts by more than 97 % and improve the utilization rate of processing element (PE) by 1.67×. Furthermore, the accelerator implemented in this paper can achieve 393.2 GOPs throughput, 1.40–3.25× computational performance, and 1.11–7.34× energy efficiency improvement.

Marketing mental health services: a mixed-methods analysis of racially and ethnically diverse college students’ engagement with and perspectives on U.S. university mental health clinics’ websites

BackgroundThe United States (U.S.) faces a significant mental health crisis, with around 52.9 million adults experiencing mental health disorders, with young adults (18–25 years old), such as college students, having the highest prevalence and lowest service utilization rates. While efforts to expand mental health services through “push” strategies are in place (e.g., training therapists in evidence-based therapies), limited initial engagement suggests a need for “pull strategies” and targeted marketing that make services attractive to college students and increase demand. This mixed-methods study identifies U.S. university mental health clinic websites and website characteristics that are attractive and engaging to college students interested in seeking mental health services (i.e., students were considering or actively looking for mental health support).MethodsEleven U.S. university websites were chosen (10 randomly and one from the university where students were attending) from a pool of 44 Psychological Clinical Science Accreditation System training clinics websites. Fifty-seven college students (Mage = 20.95, SD = 2.97; 81% female; 68% racial/ethnic minority) were videorecorded engaging with two U.S. university mental health clinic websites, completed self-report engagement measures, and gave detailed feedback about websites through semi-structured interviews.ResultsLikert scale scores revealed moderate engagement with all websites (e.g., they were interesting and helpful). Qualitative results indicated that websites that provided important and easily understood information about key features of services (e.g., types, evidence-base, and cost), therapist backgrounds, psychoeducation, used lay language, and had an appealing website layout (e.g., color, font, images, organization, and interactive components) generated greater consumer interest and trust in their mental health services.ConclusionsThis study emphasizes the importance of using marketing strategies to enhance college students’ engagement through mental health service websites. Salient features, psychoeducation, and effective promotional strategies (e.g., how information is presented) were identified as crucial for website engagement and subsequent mental health service uptake. Using marketing strategies, such as tailoring language to consumer literacy levels, describing the evidence-base of services, and improving website design may address college students’ needs and enhance initial mental health service engagement.

A Survey to Determine Health Utility States After a Traumatic Brain Injury (TBI): Influence of a History of TBI on Disability Perceptions.

Background The Glasgow Outcome Scale-Extended (GOSE) has emerged as one of the most widely used outcome instruments for evaluating ongoing disability and recovery after traumatic brain injury (TBI). The influence of a personal history of TBI on disability perception and quality of life is not well understood. This study aimed to assess changes in health utility states using the GOSE among individuals with severe TBI and their caregivers compared to a general population group. We hypothesized that individuals with a history of TBI, either as patients or caregivers, would recognize health utility associated with a more severe disability than the general population group. Methodology This cross-sectional, observational study included 300 individuals with a history of severe TBI, 300 designated primary caregivers or family members, with 1:1 participation for each subject with severe TBI, and 300 participants from the general population. A computer-based survey was developed based on the GOSE. Participants assessed hypothetical scenarios representing one-year post-TBI outcomes using a standard gamble approach. The main measure for this study was participants' perceptions of health-related quality of life and preferences for different GOSE health states following TBI. Results Of the 900 initial participants, 10 were excluded. Among the remaining 890 participants, lower GOSE states were rated to have lower health utilities. The general population group exhibited a notable decrease in health utility ratings from GOSE4 to GOSE3. Individuals with a history of severe TBI and their caregivers or family members experienced the most substantial decline in health utility ratings between GOSE3 and GOSE2. TBI and caregiver/family member status correlated with higher health utility ratings. Conclusions This study validated the use of the GOSE as a health utility metric and emphasized the subjective nature of acceptable outcomes. These findings underscore the need for considering personal experiences and preferences in decision-making regarding TBI care.

Engineering rare earth metal Ce-N coordination as catalyst for high redox kinetics in lithium-sulfur batteries

Lithium-sulfur (Li-S) batteries are a key area of research in energy storage due to their high theoretical energy density, low cost, and environmental friendliness. However, the shuttle effect caused by lithium polysulfides (LiPSs) intermediates often results in poor cycling stability. Therefore, constructing rational cathode structures to achieve fast reaction kinetics in adsorbing and catalyzing LiPSs is the key to obtain high-performance Li-S batteries. Metallic single-atom catalysts (SACs), known for their 100 % atomic utilization rate and low cost, have demonstrated excellent catalytic activity and selectivity in the redox reactions of Li-S batteries, positioning them as one of the most promising catalysts in this field. Rare earth metallic SACs with versatile oxidation states, diverse coordination chemistry and environmentally friendly are rarely investigated in Li-S system. Herein, we fabricate a rare earth metal-based single-atom catalyst (CeSAs) supported on a three-dimensional porous N-doped carbon (3DCeSA-N-WS), and systematically study its performance in Li-S batteries. Benefitting from the atomic dispersion and versatile oxidation states (Ce3+/Ce4+), the 3DCeSA-N-WS demonstrates excellent performance in anchoring and catalyzing LiPSs, significantly enhancing the redox reaction kinetics. Consequently, the prepared sulfur cathode exhibits exceptional electrochemical performance, with a high initial specific discharge capacity of 1225 mAh g−1 at 0.2 C and a capacity retention of 76.1 % after 160 cycles. The assembled 100 mAh-level pouch cellmaintains a high specific discharge capacity of 877 mAh g−1 after 50 cycles at 0.5 C. This work provides new insights into the design of sulfur cathode catalysts, thereby contributing to the realization of high-performance Li-S batteries.

Efficient catalysis for acidic methanol oxidation: Exploration of a Low-Platinum quaternary alloy catalyst via a Two-Step method

The quest for platinum-based catalysts with enhanced catalytic efficacy and durability during the methanol oxidation reaction (MOR) has been a focal point in energy conversion science. Traditional platinum-based catalysts are often constrained by their high platinum content, which escalates economic costs and complicates experimental protocols. In this study, we introduce a low-platinum-loaded catalyst synthesized via a two-step method, which incorporates a four-component alloy. This innovative approach significantly reduces platinum content while maintaining superior catalytic performance through precise control over the alloy’s composition and structure. The two-step synthesis methodology streamlines the conventional multi-step processes, enhancing the catalyst preparation’s efficiency and reproducibility. The resulting PtCoSnCu/N-C alloy catalyst exhibits remarkable catalytic activity in methanol solution, with mass activity and specific activity that are 9.73 and 9.75 times higher, respectively, than those of commercial platinum on carbon (Pt/C) catalysts. Notably, the optimized PtCoSnCu/N-C alloy catalyst demonstrates exceptional long-term stability, outperforming Pt/C in aging and extended stability tests. Density functional theory (DFT) calculations elucidate the optimization of the electronic structure and the synergistic effect of surface atoms in the PtCoSnCu/N-C catalyst, which mitigates the adsorption energy of CO molecules and enhances the utilization rate of active sites during the oxidation process. This research presents a paradigm-shifting low-platinum catalyst strategy for methanol fuel cells, establishing a theoretical foundation for catalyst design and optimization.

The current diagnosis and treatment situation of rare disease in the pediatric intensive care unit

Objective: To analyze the diagnosis and treatment of children with rare diseases in the pediatric intensive care unit (PICU), the distribution of disease types and populations, clinical characteristics, and the use of orphan drugs. Methods: A retrospective case summary was conducted. Data were collected from 105 children aged 29 days to <18 years with a confirmed diagnosis of rare diseases according to the "First Batch of Rare Disease Catalogue in China" who were admitted to the PICU of Beijing Children's Hospital, Capital Medical University from January 2020 to December 2022. Data including general information, auxiliary examinations, and treatment details for each patient were collected from the hospital's electronic medical record system. Patients were divided into age groups: infancy (29 days to<1 year), early childhood (1 to <3 years), preschool age (3 to<7 years), school age (7 to<13 years), and adolescence (13 to<18 years). The chi-square test was used to compare gender distribution differences among various rare diseases. Results: A total of 105 patients with 130 cases meeting the diagnostic criteria were included, accounting for 4.7% (130/2 754) of the total admissions to the PICU. The age at PICU admission was 5.3 (0.8, 9.5) years and there were 81 cases in male. The 3 most common types of diseases were endocrine, nutritional, and metabolic diseases (37 cases); followed by neurological disorders(32 cases); and congenital malformations, deformities, and chromosomal abnormalities(17 cases). The 5 most common rare diseases were methylmalonic acidemia (14 cases), mitochondrial encephalomyopathy (14 cases), atypical hemolytic uremic syndrome (12 cases), autoimmune encephalitis (12 cases), and idiopathic cardiomyopathy (9 cases). The distributions of common rare diseases varied among different age groups. In infants, atypical hemolytic uremic syndrome was most common (6 children). There was no statistically significant difference regarding gender among children with mitochondrial encephalomyopathy (13.6% (11/81) vs. 6.1% (3/49), χ2=1.77, P=0.184). Respiratory failure (36 cases) was the primary reason for rare diseases children to be admitted to the PICU. A total of 95 cases underwent mechanical ventilation, 39 cases received multidisciplinary collaborative diagnosis and treatment, and only 6 children received orphan drug therapy during their stay in the PICU. Conclusions: Rare diseases are not uncommon in PICU. Endocrine, nutritional and metabolic disorders, neurological disorders, congenital malformations, deformities, and chromosomal abnormalities were common. Methylmalonic acidemia, mitochondrial encephalomyopathy, atypical hemolytic uremic syndrome and autoimmune encephalitis have higher cases. Many children with rare diseases in the PICU have complex conditions those are challenging to treat, requiring multidisciplinary collaboration. The utilization rate of orphan drugs among children with rare diseases in PICU needs to be improved.

International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

Oil-based drilling cutting pyrolysis residues- phosphogypsum foamed ceramics: Basic properties, microsintering mechanism and heavy metals solidification

Oil-based drilling cutting pyrolysis residues(ODPR) and phosphogypsum(PG) are typical types of industrial solid waste in China, characterized by low utilization rate and high output. The large amount of untreated accumulation will release heavy metals(HMs) and other pollutants, posing risks to the environment. Therefore, there is an urgent need to develop a high value-added building material product that can reduce environmental hazards while improving utilization rate. Based on this background, this study uses ODPR and PG as raw materials to explore their potential applications in the field of foamed ceramics. Research has shown that different sintering processes have a significant impact on the appearance and performance of products. By adjusting the preparation process, foamed ceramic products with excellent performance can be prepared. When the sintering temperature is 925℃, the foaming agent dosage is 3 %, and the raw material ratio ODPR:PG:Borax=35:45:20, a foamed ceramic product with a porosity of 60.95 %, water absorption rate of 3.4 %, compressive strength of 4.8 MPa, thermal conductivity of 0.8016 W/(m·k), and acid and alkali resistance of 98.57 % and 99.44 % can be prepared. The product meets the relevant requirements of “Fired heat preservation brick and block (GB/T 26538)” and “ General Specification for porous ceramic products (GB/T 16533)”. The HMs content test showed that the Ni and Pb contents in the pre-sintered blanks were the highest, at 0.6308 mg/kg and 0.3182 mg/kg, respectively. However, after high-temperature calcination, the solidification rate of HMs could reach up to 98.93 %, and the leaching amount was significantly reduced. The three further evaluation methods indicate that HMs in the pre-sintered blanks and foamed ceramic products do not pose significant ecological risks. The research results provide a green inorganic insulation material in the field of solid waste control and building materials.

Variable Capital Utilization and Indeterminacy

Variable capital utilization has been widely used in business cycle research based on the observation that utilization rate is variable over time. The common assumption is that capital depreciates faster when it is utilized more extensively. This paper shows analytically that variable capital utilization makes it easier for indeterminacy to arise. In particular, when both capital utilization and labor supply become infinitely elastic, the required degree of external increasing returns can be arbitrarily small.

Race/ethnicity and human epidermal growth hormone receptor 2–targeted therapy for breast cancer.

91 Background: Breast cancer is the most common cancer in the US. Up to 25% of breast cancers are classified as human epidermal growth factor receptor 2 (HER2)-positive and associated with an aggressive tumor burden. HER2-targeting monoclonal antibodies improves survival in patients with HER2-positive breast cancer. Prior work has demonstrated disparities in access to oncologic therapies among older women. Our study seeks to examine racial/ethnic disparities in receiving HER2-targeted therapies for patients with HER2-positive breast cancer and trends in use over time. Methods: In the Surveillance, Epidemiology and End Results (SEER) Medicare-linked database we identified women diagnosed with breast cancer from 2010 to 2019. We included those &gt;66 years old who survived 12 months after diagnosis, were enrolled in Medicare Parts A/B for 12 months pre and post-diagnosis, and had local or regional stage HER2-positive cancer. Our primary outcome was receipt of HER2-targeted therapies in the 12 months after diagnosis. Our independent variable was race/ethnicity as measured by the validated Research Triangle Institute race/ethnicity codes in Medicare. Due to small sample sizes, we focus our analysis on White, Black, or Hispanic women. We used multivariable Modified Poisson regression to evaluate changes in the probability of HER2-targeted therapy receipt by race/ethnicity over time, adjusted for sociodemographics, cancer factors, and medical comorbidities. Results: Our cohort comprised 13,887 patients including 8.7% Black, 7.5% Hispanic, and 83.8% White (mean age 74.9). Overall, 7,351 (52.9%) received HER2-targeted therapies in the 12 months post-diagnosis, with use increasing over time in all racial/ethnic groups (Table). Compared with White patients, Black and Hispanic patients had a 19% (adjusted risk ratio [aRR] 0.81, 95% CI:0.69-0.96) and 27% (aRR 0.73, 95% CI 0.61-0.89) lower likelihood, respectively, of receiving HER2-targeted therapies from 2010-2011 (Table). By 2018-2019, no significant differences in receiving HER2-targeted therapies were observed across racial/ethnic groups. Conclusions: In a national cohort of Medicare enrollees with HER2-positive breast cancer, we observed significant racial/ethnic disparities which narrowed over time. Overall utilization rates were low. Future work is needed to understand how improved access to breast cancer treatments impact downstream outcomes. Use of human epidermal growth hormone receptor 2–targeted therapy from 2010-2011 and 2018-2019 by race/ethnicity. Race and Ethnicity Unadjusted Rates Adjusted Risk Ratios (95% CI)* 2010-2011 2018-2019 2010-2011 2018-2019 Black 36% 62% 0.81 (0.69-0.96) 0.97 (0.87-1.08) Hispanic 31% 68% 0.73 (0.61-0.89) 1.01 (0.92-1.12) White 42% 64% Reference Reference *Adjusted for age, marital status, region, breast cancer stage and year of diagnosis, and medical comorbidities.

Factors affecting problem-solving court team decisions about medications for opioid use disorder

BackgroundProblem-solving courts (PSCs) provide alternatives to prosecution and incarceration for drug-related crimes and offer integrated support for people who have lost custody of children due to drug use. Methadone and buprenorphine are lifesaving medications for opioid use disorder (MOUD) but are underused by PSC clients. Even when PSCs lack a court-level prohibition against MOUD, court staff still make individualized decisions about whether a court client can use MOUD. Therefore, we sought to identify factors involved in such individualized PSC court decisions about clients' use of MOUD. MethodsWe conducted semi-structured interviews and focus groups between Summer and Fall 2022 with a convenience sample of 54 PSC staff members from 33 courts across four states. Data were analyzed using iterative categorization. ResultsInterviewees indicated that their courts had eliminated blanket prohibitions against MOUD due to federal and state policy funding requirements, widespread dissemination of voluntary best practice standards, fear of lawsuits, and MOUD education targeting courts. Courts allowed MOUD if the court client accessed it through a treatment provider with whom the court collaborates. Some courts only allowed court clients to access MOUD from non-partnering treatment providers after a court-led “vetting” process of the proposed MOUD provider. MOUD provider characteristics considered during the vetting process included the provider's willingness to communicate with the court, frequent drug testing, adjustments of medication or dosage in response to aberrant results, offering of counseling, and acceptance of Medicaid or sliding scale payments. PSC staff were least comfortable with court clients using methadone treatment. ConclusionsThe presence (or lack of) a PSC-MOUD partnership is a key factor involved in court staff decisions when a court client desires MOUD. Therefore, increasing the number of partnerships between PSCs and MOUD providers could lead to higher rates of MOUD utilization. It is unclear whether court-led vetting processes for non-partnering MOUD treatment providers are necessary or appropriate, and such vetting processes could reduce treatment choice or access in communities with few MOUD providers.

Physiological and behavioural implications of the portosystemic shunt in C57Bl/6J mice.

A significant fraction of the popular inbred C57Bl/6J mice show structural and biochemical features of the congenital portosystemic shunt (PSS). How this hepatic abnormality affects physiological and behavioural parameters has not been explored in detail. Here, we confirmed the frequent occurrence of the PSS in C57Bl/6J mice by three different methods. We screened a cohort of 119 C57Bl/6J mice for total bile acids (TBA) in plasma, identified 11 animals (9.2%) with high TBA (>11µm; 171.1 ± 76.8µm), and confirmed PSS presence in that subset by magnetic resonance angiography and 1H-magnetic resonance spectroscopy of brain metabolites in the hippocampal area. In addition to the high glutamine and low myo-inositol levels, we detected lower levels of several neurotransmitters and metabolites in the hippocampus, higher brain weight and volume, as well as enhanced brain glucose utilisation in the PSS mice. We also observed differences in peripheral organ weights, haematological cell counts and clinical chemistry parameters in C57Bl/6J mice with and without PSS. Animals with PSS were slightly hyperlocomotive, had better balance on the rotarod, showed altered gait properties, and displayed attenuated fear memory in the fear conditioning test. Furthermore, we revealed a significant alteration of the pharmacokinetic profile of diazepam in C57Bl/6J mice with PSS. Our data support previous reports of hepatic disturbances and demonstrate an altered neurobiological phenotype in C57Bl/6J mice with PSS. Such congenital differences between inbred C57Bl/6J littermates may significantly distort experimental outcomes of pharmacological, behavioural and genetic studies. KEY POINTS: A significant proportion of C57Bl/6J mice, an inbred strain popular in preclinical research, have congenital portosystemic shunts (PSS) that allow venous blood to enter systemic circulation bypassing the liver. In this study, we extended existing knowledge of PSS consequences, particularly with respect to the effects on brain structure and function. We demonstrated that C57Bl/6J mice with PSS differ from their normal counterparts in brain size and contents of several neuroactive substances, as well as in peripheral organ weights, rate of glucose utilisation, blood cell counts and blood clinical chemistry parameters. C57Bl/6J mice with PSS showed altered locomotor behaviour, performed worse in a memory test and had abnormal blood pharmacokinetics of a benzodiazepine drug after a single administration. PSS presence may significantly complicate the interpretation of experiments in C57Bl/6J mice; therefore, we propose that before their use in biomedical studies, these mice should be screened with a simple blood test.

Utilization patterns of glucagon like Peptide-1 receptor agonists prior to bariatric and metabolic surgery: a multicenter study

BackgroundGlucagon-like-peptide-1 receptor agonists (G1RA) have gained popularity as a treatment for weight loss in patients who are overweight or obese, but their utilization patterns and impact on candidates for metabolic and bariatric surgery (MBS) remain understudied. ObjectiveWe aimed to investigate the prevalence, characteristics, and outcomes of patients with a history of G1RA utilization among MBS candidates. SettingFive high-volume MBS centers in Israel. MethodsData were collected retrospectively from February 1st, 2023, to September 30th, 2023. Demographic, clinical, and treatment data were analyzed to assess a history of G1RA use, associated factors, adverse events, and treatment outcomes. ResultsFour hundred thirty-four MBS candidates were included in the study. A history of G1RA utilization was obtained in 275 (63%) MBS candidates, with Liraglutide and Semaglutide being the most commonly used agents. Younger age, type 2 diabetes mellitus, dyslipidemia, and no previous MBS history were associated with a higher rate of G1RA utilization. With these medications, median maximal weight loss was 5.38 kg, and mean duration of use was 19 weeks. Patients using G1RA for ≥6 weeks experienced significantly greater weight loss compared to those using it for shorter periods (6.3 ± 6.43 vs 1.65 ± 1.69; P < .001). GI-related adverse events were reported in 57.8% of patients. Over 95% of patients discontinued G1RA due to insufficient weight loss and/or adverse effects. Patients reaching the maximal recommended dose exhibited significantly greater weight loss versus patients who did not reach it for both Liraglutide (5.9 ± 4.98 kg vs. 3.9 ± 5.53 kg; P = .03) and Semaglutide (6.5 ± 7.8 kg vs. 2.5 ± 3.8 kg; P = .016). ConclusionPre-MBS G1RA utilization and failure are prevalent among MBS candidates. Our study underscores the need for further research to understand the role of G1RA therapy in obesity management and the development of guidelines for its appropriate use in MBS candidates.

Impact of respiratory syncytial virus infection among patients with hematological cancer in the era of post-coronavirus pandemic.

400 Background: Two vaccine is recently approved for elderly patient with compromised immunity. Despite the recommendation by Center for Disease Control and Prevention (CDC), RSV vaccination is remains low among patient with hematological malignancy, when compare to influenza vaccination. Thus, we conducted an observational study to estimate the impact of RSV infection among patients with hematological malignancy. Methods: We conducted a population-based retrospective cohort utilized the TritNetx dataset, which consist of patients across 63 U.S. healthcare organization. This study included patient who had respiratory viral infection after a diagnosis of hematological malignancy during 6/1/2022 - 4/1/2022. Hematological malignancy was identified using ICD-10 codes. CPT code and ICD-10 code were used to identify diagnosis of respiratory viral infection after respiratory pathogen panel testing. Patient who was diagnosed with RSV, influenza or COVID-19 were paired based on the following variable, including demographics, body mass index, comorbidities, and anti-neoplastic therapy. Hazard ratio (HR) was estimated by Cox proportional hazard regression models and log-rank test. Risk ratio (RR) was calculated by logistic regression. Results: A total of 6,088 patients with hematological malignancy contracted RSV, influenza or COVID during the observation period. When compare to influenza, patients with RSV infection were associate with high healthcare utilization, including emergency visit (HR: 1.20, 95% CI:[1.00-1.41]), and hospitalization (HR: 1.29, 95% CI:[1.06-1.57]). RSV infection was also resulted in higher acuity including viral pneumonia (HR: 15.42, 95% CI:[9.26-25.68]), use of antibiotics (HR: 1.54, 95% CI:[1.28-1.86]), renal replacement therapy (HR: 2.09, 95% CI:[1.10-3.96]), and acute respiratory failure (HR: 1.54, 95% CI:[1.14-2.07]). When compare to COVID-19, RSV infection showed similar trend including more frequent emergency visit (HR: 1.30, 95% CI:[1.10-1.54]), and high risk of developing viral pneumonia (HR 23.48, 95% CI: [12.79-43.09]). Interestingly, the intubation rate, 28 days all-cause mortality and 90 days all-cause mortality were similar between the three cohort. Conclusions: RSV infection was associated with higher rate of pneumonia and healthcare utilization. RSV vaccination should be considered to prevent RSV-associated morbidity among patients with hematological malignancy.

Mitigating Risk of Acute Kidney Injury Among Children With Methicillin-resistant Staphylococcus aureus Osteomyelitis.

Children with acute hematogenous osteomyelitis (AHO) from methicillin-resistant Staphylococcus aureus (MRSA) are treated with vancomycin despite the risk of acute kidney injury (AKI). This study evaluates the rate of AKI and resource utilization for children with or without AKI when vancomycin is used in this setting. Children with MRSA AHO treated with vancomycin were retrospectively studied. AKI was assessed by clinical diagnosis and Kidney Disease Improving Global Outcomes (KDIGO) criteria. Cohorts of children with or without AKI were compared for differences in treatment, resource utilization, and outcomes. Multivariate logistic regression analysis assessed factors associated with risk for AKI. Cost analysis was performed using the Pediatric Health Information System and Healthcare Cost and Utilization Project databases. Among 85 children studied, 14 (16.5%) had chart-diagnosed AKI and 24 (28.2%) met KDIGO criteria. Children with AKI had more febrile days and higher thrombosis rates. They had longer vancomycin treatment (8 vs 5d), higher troughs (27.8 vs 17.5mg/L), and prolonged hospitalization (19.9 vs 11.1d). Multivariate analysis found a maximum vancomycin trough level (odds ratio: 1.05, P = 0.003) with a cutoff of 21.7mg/L predicted AKI.Only 2 of 20 (10%) children who had MRSA isolates with a minimum inhibitory concentration of 2 achieved therapeutic vancomycin levels. Pediatric Health Information System data of 3133 children with AHO treated with vancomycin identified 75 (2.4%) with AKI who had significantly longer lengths of stay (13 vs 7d) and higher billed charges ($117K vs $51K) than children without AKI. Chart documentation of AKI (16.5%) grossly underestimated KDIGO-defined occurrence (28.2%). This study showed that vancomycin-associated AKI required substantially greater resource utilization and higher health care costs. Lowering the targeted trough range, shortening the duration of vancomycin therapy, and considering alternative antibiotics when minimum inhibitory concentration ≥2 will reduce the risk and cost of AKI among children with MRSA AHO. Level III-retrospective comparative therapeutic study.

A multicenter randomized control trial: Point-of-care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness.

Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point-of-care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self-isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization. We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self-isolation plans, diagnostic confidence, and overall antibiotic utilization. Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4%vs. 42.4%, p<0.001) on day of treatment, more likely to resume normal activities sooner (83.3%vs. 69.4%, p=0.039), and more confident in their illness cause (60.7%vs. 29.6%, p<0.001); however, the rate of antibiotic utilization did not differ (33.5%vs. 26%, p=1.0). In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient-centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings.

Downstream Emergency Department and Hospital Utilization Comparably Low Following In-Person Versus Telemedicine Primary Care for High-Risk Conditions.

Telemedicine use expanded greatly during the COVID-19 pandemic. More data is needed to understand how this shift may impact other venues of acute care delivery. We evaluate the association of visit modality (telephone, video, or office) and downstream emergency department (ED) and hospital visits among primary care visits for acute, time-sensitive conditions. Observational study of patient-scheduled primary care telemedicine and office visits for acute conditions (cardiac, gastrointestinal, neurologic, musculoskeletal, and head and neck) in a large, integrated healthcare delivery system. Adults with a new self-booked primary care appointment for an eligible acute condition from January 1, 2022, to December 31, 2022 (with no primary care, ED, or hospital visits in prior 30 days). Visit modality, including office, video, or telephone. Seven-day ED and hospital utilization, adjusted for patient and visit characteristics. Among 258,958 primary care visits by 239,240 adult patients, 57.7% were telemedicine visits; of these, 72.4% were telephone and 27.6% were video. Telephone visits were the timeliest, with over 70% of visits scheduled within 1 day of booking. Rates of 7-day ED utilization were low, and varied by condition group, with cardiac visits having the highest rates (4.8%) and musculoskeletal visits having the lowest (0.8%). There was less than a 1% absolute difference in ED use by visit modality for all condition types; however, telephone visits were associated with slightly higher rates than video visits. The 7-day hospitalization rate was less than 1% and observed between visit type differences varied by clinical condition. Among office, telephone, and video visits in primary care for potentially high-risk, time-sensitive conditions, downstream ED and hospital use were uncommon. ED utilization was lower for video visits than telephone visits, although telephone visits were timelier and may offer a safe and accessible option for acute care.

Innovative synthesis of ternary heterojunction CuInS2/BiOI/Bi2MoO6 for 2,4-DCP degradation and its dechlorination performance

This study focuses on a novel ternary heterojunction catalyst for the removal of 2,4-dichlorophenol (2,4-DCP), an organic pollutant that is difficult to degrade. An efficient CuInS2/BiOI/Bi2MoO6 ternary heterojunction photocatalyst was formed by constructing a CuInS2/BiOI composite layer on a Bi2MoO6 substrate using an in-situ growth technique. The microstructure and photoelectric conversion properties of the catalysts were comprehensively resolved by systematic material characterization, including scanning electron microscopy (SEM) observation, X-ray photoelectron spectroscopy (XPS) analysis and photoelectrochemical testing. The experimental results showed that the optimized catalyst at a loading of 2.0 g/L exhibited excellent photocatalytic degradation efficiency against 20 mg/L concentration of 2,4-DCP at neutral pH, reaching 80.3 % degradation rate in 120 min. This high performance was mainly attributed to the enhanced charge-carrier separation mechanism at the heterojunction interface, which effectively enhanced the utilization and transfer rate of photogenerated electron-hole pairs and enhanced the photocatalytic activity of the catalyst. In addition, the study also deeply explored the conversion pathway of elemental chlorine in the photocatalytic system, elucidated the mechanism of 2,4-DCP degradation and dechlorination, and provided a theoretical basis for further improving the environmental adaptability and dechlorination efficiency of the catalyst. Overall, the CuInS2/BiOI/Bi2MoO6 ternary heterojunction photocatalysts proposed in this study demonstrate a broad application prospect in the purification of 2,4-DCP and other organic pollutants, and open up a new way to solve the problems of industrial wastewater treatment, which is of great environmental significance and scientific value.