Given that the presence of insurance may affect the risk of suicide mortality in cancer patients, we aimed to examine the association in a population-based study using the Surveillance, ...Epidemiologic, and End Results (SEER) database.
A retrospective analysis of data from the SEER database.
We conducted a retrospective study using the SEER database. Hazard ratios (HRs), adjusted HRs (aHRs), and 95% confidence intervals (95% CIs) of suicide death were calculated using Cox proportional hazard models to evaluate the risk of suicide mortality among the cohorts.
Multivariable analysis revealed that cancer patients without insurance had an increased risk of suicide death compared with patients with private insurance (aHR, 1.37; 95% CI, 1.01–1.72), whereas no significant result was observed in patients with any Medicaid (aHR, 1.10; 95% CI, 0.93–1.30; P = 0.27). In addition, the stratified analysis indicated that the risk of suicide death in patients in the uninsured and Medicaid groups presented with localized stage of disease (aHR, 1.32; 95% CI, 1.02, 1.69), White (aHR, 1.34; 95% CI, 1.05, 1.71), and American Indian/Alaska Native and Asian/Pacific Islander (aHR, 1.89; 95% CI, 1.08, 3.30) were greater than insured patients.
Overall, our results indicated that insurance status was a statistically significant predictor of suicide death in patients with cancer. Healthcare providers should identify those patients at high risk of suicide and provide appropriate mental health and psychosocial oncology services in time.
Real-world data regarding patient factors associated with the occurrence of spinal cord compression (SCC) or pathological fracture (PF), or need for bone surgery (BS), or use of radiation therapy ...(RAD) (i.e. skeletal complications and radiation therapy; SCRT) are limited for women with metastatic breast cancer (BCa). Given the substantial clinical and economic burden of these events in advanced BCa, we conducted the present study to understand the prevalence and identify the risk factors associated with these events among elderly women presenting with de novo metastatic BCa.
Using linked Surveillance, Epidemiology, and End Results and Medicare data, we identified women with incident metastatic BCa diagnosed during 2005-2009. Associations between patient demographics and select clinically relevant factors, and SCRT were examined using the Cox proportional hazards model, accounting for death as a competing risk.
Of 3,731 Medicare beneficiaries with incident metastatic BCa, 1,808 (48.5%) experienced at least one SCRT event during a median follow-up of 13.2 months; a majority (69%) experienced a subsequent SCRT event. The proportions of women who had RAD, PF, BS, and SCC were: 32%, 28%, 8%, and 4%. Older women (80+ years), or those with more comorbid conditions (CCI≥2) had a statistically significant lower risk of SCRT (HR 0.78 CI: 0.67-0.92, p<0.01; HR 0.77 CI: 0.67-0.89, p<0.01, respectively), primarily due to lower frequency of radiotherapy (p<0.01). Compared to Caucasians, African Americans had lower risk of SCRT (HR 0.70 CI: 0.60-0.82, p<0.01), as well as all SCRT subtypes defining this group except for SCC, which was the same for both race groups.
This study highlights that certain patient characteristics and clinical factors are associated with the risk of spinal cord compression or pathologic fractures, or need for bone surgery or radiation among women with metastatic BCa. In future studies, it will also be important to consider the clinical and economic burden based on these components of skeletal complications and radiation therapy use in order to guide and improve the management of women with advanced BCa.
How Can AI Help Improve Food Safety? Qian, C; Murphy, S I; Orsi, R H ...
Annual review of food science and technology,
03/2023, Volume:
14
Journal Article
Peer reviewed
Open access
With advances in artificial intelligence (AI) technologies, the development and implementation of digital food systems are becoming increasingly possible. There is tremendous interest in using ...different AI applications, such as machine learning models, natural language processing, and computer vision to improve food safety. Possible AI applications are broad and include, but are not limited to, (
) food safety risk prediction and monitoring as well as food safety optimization throughout the supply chain, (
) improved public health systems (e.g., by providing early warning of outbreaks and source attribution), and (
) detection, identification, and characterization of foodborne pathogens. However, AI technologies in food safety lag behind in commercial development because of obstacles such as limited data sharing and limited collaborative research and development efforts. Future actions should be directed toward applying data privacy protection methods, improving data standardization, and developing a collaborative ecosystem to drive innovations in AI applications to food safety.
Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient ...benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.
We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.
Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 95% CI - 0.71 to - 0.09; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 95% CI 0.44 to 1.67; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% 95% CI - 4.3% to 1.2%; P = 0.42) between groups.
In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.
ISRCTN, ISRCTN12233792 . Registered November 20th, 2017.
The goal of this study was to compare two approaches for MR-based PET patient attenuation correction (AC) in whole-body FDG-PET imaging using a tri-modality PET/CT and MR setup. Sixteen clinical ...whole-body FDG patients were included in this study. Mean standard uptake values (SUVs) were measured for liver and lung volumes-of-interest for comparison. Maximum SUVs were measured in 18 FDG-avid features in 10 of the patients. The AC methods compared to gold-standard CT-based AC were segmentation of the CT (air, lung, fat, water), MR image segmentation with four tissue classes (air, lung, fat, water), and segmentation with air, lung and a continuous fat/water method. Results show that magnitude differences of the uptake values induced by CT-based image segmentation were similar but lower on average than those found using MR-derived AC methods. The average liver SUV difference as compared to using CTAC was 1.3%, 10.4%, and 5.7% for 4-class segmented CT, 4-class MRAC, and continuous fat/water MRAC methods, respectively. The average FDG-avid feature SUVmax difference was -0.5%, 1.7%, and -1.6% for 4-class segmented CT, 4-class MRAC, and continuous fat/water MRAC methods, respectively. The results demonstrated that both 4-class and continuous fat/water AC methods provided adequate quantitation in the body, and that the continuous fat/water method was within 5.7% on average for SUVmean in liver and 1.6% on average for SUVmax for FDG-avid features.
There are five distinct core structures in the lipopolysaccharides of Escherichia coli and at least two in Salmonella isolates, which vary principally in the outer core oligosaccharide. Six outer ...core glycosyltransferases, E. coli K-12 WaaG, WaaB, and WaaO and Salmonella typhimurium WaaI, WaaJ, and WaaK, were cloned, overexpressed, and purified. A novel substrate for WaaG was isolated from ΔwaaG E. coli overexpressing the lipid A phosphatase lpxE and the lipid A late acyltransferase lpxM. The action of lpxE and lpxM in the ΔwaaG background yielded heptose2-1-dephospho Kdo2-lipid A, a 1-dephosphorylated hexa-acylated lipid A with the inner core sugars that is easily isolated by organic extraction. Using this structurally defined acceptor and commercially available sugar nucleotides, each outer core glycosyltransferases was assayed in vitro. We show that WaaG and WaaB add a glucose and galactose sequentially to heptose2-1-dephospho Kdo2-lipid A. E. coli K-12 WaaO and S. typhimurium WaaI add a galactose to the WaaG/WaaB product but can also add a galactose to the WaaG product directly without the branched core sugar added by WaaB. Both WaaI and WaaO require divalent metal ions for optimal activity; however, WaaO, unlike WaaI, can add several glucose residues to its lipid acceptor. Using the product of WaaG, WaaB, and WaaI, we show that S. typhimurium WaaJ and WaaK transfer a glucose and N-acetylglucosamine, respectively, to yield the full outer core. This is the first demonstration of the in vitro assembly of the outer core of the lipopolysaccharide using defined lipid A-oligosaccharide acceptors and sugar donors.
The numerical geometrical configuration and cooling performances of parallel wire geometry have been investigated in one-dimensional active magnetic regenerator. Based on the actual regenerator, the ...wires in geometries were primarily arranged in square and triangular array, and worked in cross and parallel flow patterns. Regenerators containing wire bundles with three geometries were evaluated by varying utilization at fixed temperature spans between hot and cold reservoirs. The effects of geometrical parameters on heat transfer performance and friction factor of regenerator were firstly discussed here. Two materials, gadolinium and La(Fe,Mn,Si)13Hy, have been used for simulating the cooling performance of wire geometry. The numerical results showed that the arrangement of wires did not have influence on the cooling power greatly and the wire geometry could provide a higher coefficient of performance in parallel flow. After optimization, the desirable parallel wire geometry had a porosity of 0.40 and wire diameter of 0.15 mm. When the frequency was 2 Hz and temperature span was 10 K, the maximum cooling power could reach 158.40 W and 100.3 W for Gd and La(Fe,Mn,Si)13Hy wire geometries, whose coefficients of performance were as high as 13.46 and 14.96 respectively. Comparatively, the cooling powers of commonly used Gd and La(Fe,Mn,Si)13Hy packed bed were one third lower than those of optimized wire geometriesand the coefficients of performance were lower half.
Sublethal ischemic preconditioning (IPC) is a powerful inducer of ischemic brain tolerance. However, its underlying mechanisms are still not well understood. In this study, we chose four different ...IPC paradigms, namely 5 min (5 min duration), 5×5 min (5 min duration, 2 episodes, 15-min interval), 5×5×5 min (5 min duration, 3 episodes, 15-min intervals), and 15 min (15 min duration), and demonstrated that three episodes of 5 min IPC activated autophagy to the greatest extent 24 h after IPC, as evidenced by Beclin expression and LC3-I/II conversion. Autophagic activation was mediated by the tuberous sclerosis type 1 (TSC1)-mTor signal pathway as IPC increased TSC1 but decreased mTor phosphorylation. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and hematoxylin and eosin staining confirmed that IPC protected against cerebral ischemic/reperfusion (I/R) injury. Critically, 3-methyladenine, an inhibitor of autophagy, abolished the neuroprotection of IPC and, by contrast, rapamycin, an autophagy inducer, potentiated it. Cleaved caspase-3 expression, neurological scores, and infarct volume in different groups further confirmed the protection of IPC against I/R injury. Taken together, our data indicate that autophagy activation might underlie the protection of IPC against ischemic injury by inhibiting apoptosis.
Six interface models are constructed and used to find out the cohesion properties of W-ZrC interfaces through first principles calculations. It is revealed that interface orientation has an important ...effect on heat of formation and interface strength of W-ZrC interfaces, i.e., the W(110)-ZrC(111) interfaces with the Kurdjumov-Sachs (KS) relationship are not only energetically more favorable with more positive heats of formation, but also possess higher work of separation. Electronic structure calculations also show that the W-C bond fundamentally determines the magnitude of the interface cohesion between W and ZrC. The derived results are in good agreement with experimental observations in the literature, and could provide a deep understanding of cohesion properties of W-ZrC interfaces.
•Six interface models are constructed to reveal cohesion properties of W-ZrC.•W-ZrC interface with KS relationship is energetically more favorable.•W-ZrC interface with KS relationship has higher interface strength.•W-C bond determines the magnitude of interface cohesion of W-ZrC.•Electronic structures provide deep understanding of interface cohesion.
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