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Objective: To evaluate the association between patient-provider race concordance and the likelihood of being screened for suicide risk in Veterans Health Administration (VA) primary care settings., Study Setting and Design: In November 2020, the VA expanded its national suicide risk identification strategy to include an annual universal suicide screening requirement. This study examined VA primary care visits from 2021 to 2022, where provider race and ethnicity could be identified. We examined the association between patient-provider race concordance and the probability of being screened for suicide risk, adjusting for patient and visit characteristics. Importantly, we also adjusted for provider fixed effects, which allowed us to estimate the effect of race concordant vs. non-concordant patient interactions for the same provider. We additionally conducted analyses stratified by provider race and ethnicity., Data Sources and Analytic Sample: Patient visit data were extracted from the VA Corporate Data Warehouse. The analytic sample comprised 219,673 primary care visits and 196,968 unique patients., Principal Findings: Sixty-two percent of all patients due for a screening were screened. Black patients had the lowest unadjusted screening rate of 58%. In adjusted analyses, we found that Black patients were 1.2 percentage points less likely to be screened compared to White patients (95% CI: -0.016, -0.008). Patient-provider race concordance was associated with a 0.4 percentage points higher likelihood of suicide screening (95% CI: 0.0002, 0.008). This small effect size represents 880 suicide screens and 33% of the Black-White screening gap. In separate analyses stratified by provider race and ethnicity, White providers were less likely to screen racially minoritized patients, and Hispanic and Asian providers were less likely to screen Black patients compared to White patients., Conclusions: Patient-provider race concordance was associated with increased suicide screens. Despite the small absolute increase in screening, health systems should consider the role of race concordance in patient-provider interactions when developing strategies to aid nationwide efforts to prevent suicides., (Published 2025. This article is a U.S. Government work and is in the public domain in the USA. Health Services Research published by Wiley Periodicals LLC.)

Background: o-Aminophenol derivatives are of particular interest for their di-verse biological activities and potential therapeutic applications. Such as, antioxidant, an-tibacterial, and cytotoxic activities., Objective: This study aimed to design and synthesize a series of novel o-aminophenol de-rivatives through an efficient multi-step process, characterize them using modern spectro-scopic techniques, and evaluate their antimicrobial, antioxidant, and cytotoxic activities., Methods: A series of novel derivatives of o-aminophenol have been successfully synthe-sized with very high efficiency through a simple six-step process using readily available chemicals and straightforward reactions. The structures of all products were accurately de-termined using modern spectroscopic methods such as 1D and 2D NMR, as well as IR, MS spectroscopy, and X-ray methods. The antimicrobial activities of eight o-nitrophenol derivatives were assessed against Gram (-) and Gram (+) bacteria as well as fungi. In comparison, antioxidant activities were tested for two o-nitrophenol and 11 o-aminophenol derivatives using SC50 and EC50 assays. Cytotoxicity was evaluated on KB, HepG2, A549, and MCF7 cancer cell lines., Results: Six synthesized compounds 5b, 5c, 5g, 6b, 6c, 6g exhibited unusual doublet sig-nals in the H8 region of the 1H NMR spectrum, attributed to atropisomer formation. Eight o-nitrophenol derivatives demonstrated weak antimicrobial activity, with MIC values ranging from 100 to 200 μg/mL. Compound 5g showed activity against all tested bacterial and fungal strains. In antioxidant testing, eight o-aminophenol derivatives 6a, 6b, 6c, 6e, 6f, 6h, 6i, and 12b displayed excellent activity, with SC50 values between 18.95 and 34.26 μg/mL, approaching ascorbic acid's SC50 value of 12.60 μg/mL. Three derivatives 6d, 6g, and 12a showed superior antioxidant activity with EC50 values between 4.00 and 11.25 μg/mL, surpassing quercetin's standard of 9.8 μg/mL. Cytotoxicity assays revealed that o-aminophenol derivatives 6b, 6c, 6f, 6i, and 12b exhibited moderate inhibitory effects on KB cell lines with IC50 values from 32 to 74.94 μg/mL. Compound 6i demonstrated mod-erate cytotoxic activity against HepG2, A549, and MCF7 cell lines, with IC50 values of 29.46, 71.29, and 80.02 μg/mL, respectively., Conclusion: Design, synthesis, antimicrobial activity, DPPH Radical Scavenging, Cyto-toxic activity, Evaluation of H8 signal anomalies in certain compounds, and Single crystal X-ray diffraction analysis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: Unused medical appointments affect both patient care and clinic operations, and the frequency of cancellations due to clinic reasons is underreported. The prevalence of these unused appointments in primary care in the Veterans Affairs Health Care System (VA) is unknown. This study examined the prevalence of unused primary care appointments and compared the relative frequency of cancellations and no-shows for patient and clinic reasons., Study Design: In this retrospective, observational study, we collected all in-person and virtual VA primary care appointments from October 1, 2018, to April 1, 2024., Methods: We examined the proportion of appointments canceled on the same day as the appointment and classified these into canceled by patient, canceled by clinic, and no-show., Results: Of more than 90 million in-person and nearly 24 million virtual primary care appointments, 11.9 million (10.87%) were canceled on the day of the appointment. For in-person care cancellations, the most common reasons were canceled by the patient (3.92%; n = 3,531,016), no-show (3.87%; n = 3,487,944), and clinic cancellation (3.08%; n = 2,780,259)., Conclusions: Although this study shows that same-day cancellations of primary care appointments in the VA are common, comparisons with other providers and health care systems indicate similar or lower levels of unused appointments in the VA.

We report the preparation of poly(ionic) polymer-wrapped single-walled carbon nanotube dispersions for chemiresistive methane (CH 4 ) sensors with improved humidity tolerance. Single-walled CNTs (SWCNTs) were noncovalently functionalized by poly(4-vinylpyridine) (P4VP) with varied amounts of a poly(ethylene glycol) (PEG) moiety bearing a Br and terminal azide group (Br-R 1 ). The quaternization of P4VP with Br-R 1 was performed using continuous flow chemistry and Bayesian optimization-guided reaction selection. Polymers (PyBrR 1 ) with different degrees of functionalization were used to disperse SWCNTs and subsequently incorporated into sensors containing a platinum complex as an aerobic oxidative catalyst with a polyoxometalate (POM) redox mediator to facilitate room-temperature CH 4 sensing. As the degree of quaternization in the PyBrR 1 -CNT composites increased, improvements in response magnitude were observed, with nominally 10% quaternized PyBrR 1 giving the largest response. Incorporation of PEG improved sensor stability at relative humidities between 57-90% versus sensors fabricated from CNT dispersions with unfunctionalized P4VP. Devices fabricated with these dispersions outperformed those prepared in situ under dry conditions, and exhibited greater stability at elevated humidities. The influence of Keggin-type POM character was also evaluated to identify alternative POMs for enhanced sensor performance at high humidity. In an effort to identify areas for further improvement in algorithm performance for polymer functionalization, a kinetically informed machine learning model was explored as a route to predict reactivity of pyridine units and alkyl bromides under flow conditions.

This research investigates the empirical effects of the laser land leveling (LLL) adoption on irrigation water and water efficiency in paddy production in the Mekong Delta region (MDR), using the randomized controlled trial (RCT) approach incorporated into input demand function models. The descriptive analysis highlights the potential for water reuse through farmers' drainage practices. However, the dependence on experiential methods for applying technology in paddy production poses challenges that could compromise long-term sustainability. The regression results indicate that the LLL treatment leads to savings of 1975 m 3  ha -1 and 1299.35 m 3  ha -1 in irrigation water and net water use in paddy production, respectively, compared to the control. These savings account for 20.52% of total irrigation water use and 28.64% of net water use. The projected savings on average are 375.51 and 247.05 million m 3 , respectively, for irrigation water and net water use with 5% implementation of the technology in the MDR. The research highlights the environmental benefits of the LLL technology and underscores the need for its promotion to achieve water conservation in paddy production, offering policymakers insights to enhance sustainable agriculture amid climate change and water scarcity. The study addresses significant gaps in the existing literature by providing an in-depth analysis of LLL technology's impact on irrigation water and efficiency by extending the drainage performance within the paddy mono-cropping context and employing RCT methodology combined with input demand function models to comprehensively evaluate its impact on irrigation water usage., Competing Interests: Declarations: All authors have read, understood, and have complied as applicable with the statement on “Ethical responsibilities of Authors” as found in the Instructions for Authors. Ethics approval: The study was approved by the Scientific Council of the School of Economics, College of Economics, Law and Government, UEH University in Ho Chi Minh City, Vietnam. Consent to participate: Not applicable. Consent for publication: The participants, as co-authors, have consented to the submission of the manuscript to the journal. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Ambulatory care settings are at high risk for errors when identifying patients and matching them to their intended care., Objective: The objective of this project was to improve correct and consistent patient identification and matching to their intended care by nurses in ambulatory care settings., Methods: The seven-phase JBI Evidence Implementation Framework was used to guide this project. JBI tools were used to audit current practices and implement best practices in four ambulatory care units. The implementation plan included a baseline audit and two follow-up audits. Feedback was obtained through interviews with ambulatory care nursing staff, educational sessions were conducted for nursing staff, and unit guidelines were developed., Results: In the baseline audit, compliance with best practice criteria for patient matching and identification was below 62% for 7/13 criteria. After conducting education sessions and other strategies, 1/3 pre- and post-clinical intervention criteria improved in compliance, while 2 were unchanged. For blood product administration criteria, 2/5 improved, 1 was unchanged, and 2 were lower than baseline. Nurses' education in patient identification procedures improved (1/1) and knowing where to access relevant policies remained unchanged at 100%. Criteria for patients knowing the importance of patient identification (2/2) and the identification band following national standards (1/1) improved from baseline., Conclusions: The results support the use of education sessions and infrastructure changes to promote and sustain change in evidence-based practice in ambulatory care units. Not all criteria improved, and the audit team identified strategies to improve the implementation of evidence-based practice in ambulatory care units., Spanish Abstract: http://links.lww.com/IJEBH/A275., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 JBI. Unauthorized reproduction of this article is prohibited.)

Background: Lack of health insurance is a public health crisis, leading to foregone care and financial strain. Hospital Presumptive Eligibility (HPE) is a hospital-based emergency Medicaid program that provides temporary (up to 60 d) coverage, with the goal that hospitals will assist patients in applying for ongoing Medicaid coverage. It is unclear whether HPE is associated with successful longer-term Medicaid enrollment., Objective: To characterize Medicaid enrollment 6 months after initiation of HPE and determine sociodemographic, clinical, and geographic factors associated with Medicaid enrollment., Design: This was a cohort study of all HPE approved inpatients in California, using claims data from the California Department of Healthcare Services., Setting: The study was conducted across all HPE-participating hospitals within California between January 1, 2016 and December 31, 2017., Participants: We studied California adult hospitalized inpatients, who were uninsured at the time of hospitalization and approved for HPE emergency Medicaid. Using multivariable logistic regression models, we compared HPE-approved patients who enrolled in Medicaid by 6 months versus those who did not., Exposures: HPE emergency Medicaid approval at the time of hospitalization., Main Outcomes and Measures: The primary outcome was full-scope Medicaid enrollment by 6 months after the hospital's presumptive eligibility approval., Results: Among 71,335 inpatient HPE recipients, a total of 45,817 (64.2%) enrolled in Medicaid by 6 months. There was variability in Medicaid enrollment across counties in California (33%-100%). In adjusted analyses, Spanish-preferred-language patients were less likely to enroll in Medicaid (aOR 0.77, P <0.001). Surgical intervention (aOR 1.10, P <0.001) and discharge to another inpatient facility or a long-term care facility increased the odds of Medicaid enrollment (vs. routine discharge home: aOR 2.24 and aOR 1.96, P <0.001)., Conclusion: California patients who enroll in HPE often enroll in Medicaid coverage by 6 months, particularly among patients requiring surgical intervention, repeated health care visits, and ongoing access to care. Future opportunities include prospective evaluation of HPE recipients to understand the impact that Medicaid enrollment has on health care utilization and financial solvency., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: The aim of this paper is to investigate the incorporation of visual narratives, such as comics and graphics, into nursing education using Generative Artificial Intelligence (GAI) models like DALL-E., Background: Visual narratives serve as a powerful method for communicating intricate concepts in nursing education. Despite their advantages, challenges in creating effective educational comics persist due to the need for expertise in graphic design and the associated time and resource constraints., Design: This study examines existing literature that highlights the efficacy of visual narratives in education and demonstrates the potential of GAI models, specifically DALL-E, in creating visual narratives for nursing education., Methods: We analyze the potential of GAI models, specifically DALL-E, to create visual narratives for educational purposes. This was demonstrated through illustrative examples addressing sensitive topics, illustrating research methodology and designing recruitment posters for clinical trials. Additionally, we discussed the necessity of reviewing and editing the text generated by DALL-E to ensure its accuracy and relevance in educational contexts. The method also considered legal concerns related to copyright and ownership of the generated content, highlighting the evolving legal landscape in this domain., Results: The study found that GAI, specifically DALL-E, has significant potential to bridge the gap in creating visual narratives for nursing education. While offering cost-effectiveness and accessibility, GAI tools require careful consideration of challenges such as text-related errors, misinterpretation of user prompts and legal concerns., Conclusions: GAI models like DALL-E offer promising solutions for enhancing visual storytelling in nursing education. However, their effective integration requires a collaborative approach, where educators engage with these tools as co-pilots, leveraging their capabilities while mitigating potential drawbacks. By doing so, educators can harness the full potential of GAI to enrich the educational experience for learners through compelling visual narratives., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

As thin films of semiconducting covalent organic frameworks (COFs) are demonstrating utility for ambipolar electronics, channel materials in organic electrochemical transistors (OECTs), and broadband photodetectors, control and modulation of their thin film properties is paramount. In this work, an interfacial growth technique is utilized to synthesize imine TAPB-PDA COF films at both the liquid-liquid interface as well as at the liquid-solid interface on a Si/SiO 2 substrate. The concentration of acetic acid catalyst in the aqueous phase is shown to significantly influence the thin film morphology of the liquid-solid growth, with concentrations below 1 M resulting in no film nucleation, concentrations of 1-4 M enabling smooth film formation, and concentrations greater than 4 M resulting in films with a higher density of particulates on the surface. Importantly, while the films grown at the liquid-liquid interface are mixed-orientation, those grown directly at the liquid-solid interface on the Si/SiO 2 surface have highly oriented COF layers aligned parallel to the substrate surface. Moreover, this liquid-solid growth process affords TAPB-PDA COF thin films with p-type charge transport having a transconductance of 10 μS at a gate voltage of -0.9 V in an OECT device structure.

Importance: Recently passed legislation aimed at improving access to care has considerably expanded options for veterans to receive emergency care in community, or non-Veterans Affairs (VA) settings. However, national trends in community emergency department (ED) use by veterans are unknown., Objective: To examine national, temporal trends in the frequencies and types of ED visits provided in community settings and explore the association between facilities' purchase of community care with facility and regional characteristics., Design, Setting, and Participants: Retrospective, observational cross-sectional study of ED visits over fiscal years (FY) 2016 to 2022. VA and community ED encounter data were obtained from the VA Corporate Data Warehouse and the Office of Integrated Veteran Care. Participants were veterans receiving ED care at VA facilities or paid for by the VA in the community. Data were analyzed from June to September 2023., Main Outcomes and Measures: The primary outcome measures included community ED visit volume, disposition, and payments over time. Also, the most common and costly ED visits were assessed. Negative binomial regression analysis examined associations between facility and regional characteristics and the rate of ED visits purchased in community settings relative to all ED visits., Results: There were 19 787 056 ED visits, predominantly at VA facilities (14 532 261 visits [73.4%]), made by 3 972 503 unique veterans from FY 2016 to 2022. The majority of ED users were male (3 576 120 individuals [90.0%]), and the median (IQR) age was 63 (48-73) years. The proportion of community ED visits increased in absolute terms from 18% in FY 2016 to 37% in FY 2022. Total community ED payments, adjusted to 2021 dollars, were $1.18 billion in FY 2016 and over $6.14 billion in FY 2022. The most common reasons for ED visits in the community were for nonspecific chest pain (305 082 visits [6%]), abdominal pain (174 836 visits [3%]), and septicemia (149 968 visits [3%]). The average proportion of ED visits purchased by a VA facility increased from 14% in FY 2016 to 32% by FY 2022. In multivariable analyses, facilities with greater ED volume and low-complexity facilities had higher expected rates of community emergency care than lower volume and high-complexity facilities, respectively., Conclusions and Relevance: As veterans increasingly use community EDs for acute, unscheduled needs, attention to factors associated with veterans' use of acute care services in different settings are important to identify access barriers and to ensure veterans' health care needs are met.

Background: Globally, heart failure (HF) affects more than 64 million people, and attempts to reduce its social and economic burden are a public health priority. Interventions to support people with HF to self-manage have been shown to reduce hospitalizations, improve quality of life, and reduce mortality rates. Understanding how people self-manage is imperative to improve future interventions; however, most approaches to date, have used self-report methods to achieve this. Wearable cameras provide a unique tool to understand the lived experiences of people with HF and the daily activities they undertake, which could lead to more effective interventions. However, their potential for understanding chronic conditions such as HF is unclear., Objective: This study aimed to determine the potential utility of wearable cameras to better understand the activities of daily living in people living with HF., Methods: The "Seeing is Believing (SIB)" study involved 30 patients with HF who wore wearable cameras for a maximum of 30 days. We used the E-Myscéal web-based lifelog retrieval system to process and analyze the wearable camera image data set. Search terms for 7 daily activities (physical activity, gardening, shopping, screen time, drinking, eating, and medication intake) were developed and used for image retrieval. Sensitivity analysis was conducted to compare the number of images retrieved using different search terms. Temporal patterns in daily activities were examined, and differences before and after hospitalization were assessed., Results: E-Myscéal exhibited sensitivity to specific search terms, leading to significant variations in the number of images retrieved for each activity. The highest number of images returned were related to eating and drinking, with fewer images for physical activity, screen time, and taking medication. The majority of captured activities occurred before midday. Notably, temporal differences in daily activity patterns were observed for participants hospitalized during this study. The number of medication images increased after hospital discharge, while screen time images decreased., Conclusions: Wearable cameras offer valuable insights into daily activities and self-management in people living with HF. E-Myscéal efficiently retrieves relevant images, but search term sensitivity underscores the need for careful selection., (©Teketo Kassaw Tegegne, Ly-Duyen Tran, Rebecca Nourse, Cathal Gurrin, Ralph Maddison. Originally published in JMIR Formative Research (https://formative.jmir.org), 21.02.2024.)

Introduction: Hospital Presumptive Eligibility (HPE) is a temporary Medicaid insurance at hospitalization, which can offset patient costs of care, increase access to postdischarge resources, and provide a path to sustain coverage through Medicaid. Less is known about the implications of HPE programs on trauma centers (TCs). We aimed to describe the association with HPE and hospital Medicaid reimbursement and characterize incentives for HPE participation among hospitals and TCs. We hypothesized that there would be financial, operational, and mission-based incentives., Methods: We performed a convergent mixed methods study of HPE hospitals in California (including all verified TCs). We analyzed Annual Financial Disclosure Reports from California's Department of Health Care Access and Information (2005-2021). Our primary outcome was Medicaid net revenue. We also conducted thematic analysis of semistructured interviews with hospital stakeholders to understand incentives for HPE participation (n = 8)., Results: Among 367 California hospitals analyzed, 285 (77.7%) participate in HPE, 77 (21%) of which are TCs. As of early 2015, 100% of TCs had elected to enroll in HPE. There is a significant positive association between HPE participation and net Medicaid revenue. The highest Medicaid revenues are in HPE level I and level II TCs. Controlling for changes associated with the Affordable Care Act, HPE enrollment is associated with increased net patient Medicaid revenue ( b = 6.74, p < 0.001) and decreased uncompensated care costs ( b = -2.22, p < 0.05). Stakeholder interviewees' explanatory incentives for HPE participation included reduction of hospital bad debt, improved patient satisfaction, and community benefit in access to care., Conclusion: Hospital Presumptive Eligibility programs not only are a promising pathway for long-term insurance coverage for trauma patients but also play a role in TC viability. Future interventions will target streamlining the HPE Medicaid enrollment process to reduce resource burden on participating hospitals and ensure ongoing patient engagement in the program., Level of Evidence: Economic And Value Based Evaluations; Level II., (Copyright © 2023 American Association for the Surgery of Trauma.)

Instant access to clinicians through virtual care is designed to allow patients to receive care they need while avoiding high-cost visits in acute-care settings. This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the emergency department (ED) following calls to a medical advice line. We used a staggered rollout design to assess the effects of implementing this program on key outcomes among Veterans Affairs enrollees. Analyzing over 1 million calls from 2019 to 2022, we found that access to a provider reduced the proportion of patients who subsequently visited the ED compared with those with access to the standard medical advice line (38% vs 36%). There was no significant difference observed in subsequent inpatient admissions or 30-day mortality. We found that a majority of callers (65%) achieved issue resolution or were directed to lower acuity settings for further evaluation. Although substantial direct cost savings were not evident, our findings demonstrate that on-demand access to a virtual provider can effectively decrease ED visits., Competing Interests: Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials., (Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc. 2023.)

Background: The study was to evaluate the effectiveness of dose distribution of four-dimensional computed tomography (4DCT) simulation., Materials and Methods: The gross tumor volume (GTV) and clinical target volume (CTV) were contoured in all 10 respiratory phases of 4DCT in 30 patients with non-small cell lung cancer (NSCLC). Both 3D and 4D treatment plans were made individually for each patient using the planning volume (PTV). The PTV3D was taken from a single CTV plus the recommended margin, and the PTV4D was taken from the 4D internal target volume, including all 10 CTVs plus the setup margins., Results: The mean PTV was 460 ± 179 (69-820) cm 3 for 3DCT and 401 ± 167 (127-854) cm 3 for 4DCT (p = 0.0018). The dose distribution (DD) of organs at risk, especially the lungs, was lower for the 4DCT simulation. The V5%, V10%, and V20% of the total lung dose for 4DCT were significantly lower for the 3DCT. However, lung V30% the heart, esophagus, and spinal cord were not significantly different. In addition, the conformity index and the dose heterogeneity index of the PTV were not significantly different. The normal tissue complication probability (NTCP) of the lung and heart was significantly lower for 4DCT than for 3DCT., Conclusions: The 4DCT simulation gives better results on the NTCP. The organs at risk, especially the lungs, receive a significantly lower DD compared with the 3DCT. The conformity index (CI), heterogeneity index (HI) and the DD to the heart, spinal cord, and esophagus were not significantly different between the two techniques., Competing Interests: Conflict of interests None declared., (© 2023 Greater Poland Cancer Centre.)

There is a growing need for degradable polymers for applications in sustainable plastics and medical implants. To enhance the utility of degradable polymers, both better understanding of the factors that influence their degradation and new tools to modulate degradation are needed. We report the C-H xanthylation of poly(caprolactone), a biodegradable polyester, which results in changes in materials properties even at small incorporations. Despite the functionalized materials exhibiting a decrease in crystallinity and hydrophobicity, xanthylated poly(caprolactone) degrades more slowly than its unfunctionalized counterpart. To understand this rate difference, kinetic studies with a small-molecule surrogate were performed and demonstrated that functionalization adjacent to the hydrolyzable ester functional group led to slower degradation. This study illustrates how the interplay between molecular and materials characteristics can impact degradation., Competing Interests: The authors declare no competing financial interest. A preprint that reported a portion of the work included in this manuscript was published on ChemRxiv (10.26434/chemrxiv-2022-z7qlt).

Objectives: Research examining emergency department (ED) admission practices within the Department of Veterans Affairs (VA) is limited. This study investigates facility-level variation in risk-standardized admission rates (RSARs) for emergency care-sensitive conditions (ECSCs) among older (≥65 years) and younger (<65 years) Veterans across VA EDs., Methods: Veterans presenting to a VA ED for an ECSC between October 1, 2016 and September 30, 2019 were identified and the 10 most common ECSCs established. ECSC-specific RSARs were calculated using hierarchical generalized linear models, adjusting for Veteran and encounter characteristics. The interquartile range ratio (IQR ratio) and coefficient of variation were measures of dispersion for each condition and were stratified by age group. Associations with facility characteristics were also examined in condition-specific multivariable models., Results: The overall cohort included 651,336 ED visits across 110 VA facilities for the 10 most common ECSCs-chronic obstructive pulmonary disease (COPD), heart failure, pneumonia, volume depletion, tachyarrhythmias, acute diabetes mellitus, gastrointestinal (GI) bleeding, asthma, sepsis, and myocardial infarction (MI). After adjusting for case mix, the ECSCs with the greatest variation (IQR ratio, coefficient of variation) in RSARs were asthma (1.43, 32.12), COPD (1.39, 24.64), volume depletion (1.38, 23.67), and acute diabetes mellitus (1.28, 17.52), whereas those with the least variation were MI (1.01, 0.87) and sepsis (1.02, 2.41). Condition-specific RSARs were not qualitatively different between age subgroups. Association with facility characteristics varied across ECSCs and within condition-specific age subgroups., Conclusions: We identified unexplained facility-level variation in RSARs for Veterans presenting with the 10 most common ECSCs to VA EDs. The magnitude of variation did not appear to be qualitatively different between older and younger Veteran subgroups. Variation in RSARs for ECSCs may be an important target for systems-based levers to improve value in VA emergency care., (© 2023 Society for Academic Emergency Medicine. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background: Hospital Presumptive Eligibility (HPE) is a temporary Medicaid insurance at hospitalization that offsets costs of care, increases access to postdischarge resources, and provides patients with a path to sustain coverage through Medicaid. Because HPE only lasts up to 60 days, we aimed to determine Medicaid insurance status 6 months after injury among HPE-approved trauma patients and identify factors associated with successful sustainment., Methods: Using a customized longitudinal claims data set for HPE-approved patients from the California Department of Health Care Services, we analyzed adults with a primary trauma diagnosis (International Classification of Diseases version 10) who were HPE approved in 2016 and 2017. Our primary outcome was Medicaid sustainment at 6 months. Univariate and multivariate analyses were performed., Results: A total of 9,749 trauma patients with HPE were analyzed; 6,795 (69.7%) sustained Medicaid at 6 months. Compared with patients who did not sustain, those who sustained had higher Injury Severity Score (ISS > 15: 73.5% vs. 68.7%, p < 0.001), more frequent surgical intervention (74.8% vs. 64.5%, p < 0.001), and were more likely to be discharged to postacute services (23.9% vs. 10.4%, p < 0.001). Medicaid sustainment was high among patients who identified as White (86.7%), Hispanic (86.7%), Black (84.3%), and Asian (83.7%). Medicaid sustainment was low among the 2,505 patients (25.7%) who declined to report race, ethnicity, or preferred language (14.8% sustainment). In adjusted analyses, major injuries (ISS > 16) (vs. ISS < 15: adjusted odds ratio [aOR], 1.51; p = 0.02) and surgery (aOR, 1.85; p < 0.001) were associated with increased likelihood of Medicaid sustainment. Declining to disclose race, ethnicity, or language (aOR, 0.05; p < 0.001) decreased the likelihood of Medicaid sustainment., Conclusion: Hospital Presumptive Eligibility programs are a promising pathway for securing long-term insurance coverage for trauma patients, particularly among the severely injured who likely require ongoing access to health care services. Patient and provider interviews would help to elucidate barriers for patients who do not sustain., Level of Evidence: Prognostic and Epidemiological; Level IV., (Copyright © 2022 American Association for the Surgery of Trauma.)

The significant drop in estrogen levels during menopause increases the cardiovascular risks, one of which is cerebrovascular atherosclerosis. Research on rheoencephalography (REG) parameters for the early diagnosis of cerebrovascular atherosclerotic lesions is of great interest to scientists because of its ease of implementation, low cost, and non-invasiveness. The objectives of study are to evaluate the vascular tone, cerebral circulation flow in each hemisphere of the brain of menopausal women, and some associated factors through waveform characteristics and parameters in REG. A controlled cross-sectional descriptive study was conducted on a group of patients including 80 menopausal women and a control group of 46 menstruating women. All patients were measured REG in the frontal-occipital leads by VasoScreen 5000 impedance REG meter. In menopausal women, the percentage of sharp waves, the percentage of clear side waves, and the average REG were all lower than in the control group (p<0.01). The mean conduction time and mean slope ratio was lower than the control group (p<0.001). The mean peak time was higher than the control group (p<0.01). The mean elasticity index (alpha/T) was higher than the control group (p<0.001). Menopausal women have increased vascular tone, the highest in the group of women 50-60 years old, menopause <5 years, having a habit of eating red meat; and decreased blood flow intensity, the highest in the group of women <50 years old. However, the difference was statistically significant only in the left hemisphere (p<0.05). Vascular hypertonia in menopausal women with central obesity was higher than in the non-obese group in both hemispheres (p<0.05). In conclusion, menopausal women had atherosclerosis in both hemispheres of the brain, which was clearly shown in the rate of increased vascular tone. Central obesity may increase the risk of vascular hypertonia 3.75 times in the right and 5.44 times in the left hemisphere., Competing Interests: Conflict of interest The authors state no conflict of interest., (© 2022 Tin Hoang Nguyen, Kien Trung Nguyen, Long Duc Tran, An Thi Thuy Le, Thu Minh Phung, Truc Thi Ngoc Banh, Trang Thi Vo, Michael Bodo, published by Sciendo.)

Objective: This cross-sectional study investigated the knowledge, attitudes, and practices (KAP) of Vietnamese university students regarding COVID-19., Methods: A validated questionnaire (Cronbach's alpha = 0.71) was used to survey 1,025 students. A convenience sampling method was used for recruiting students from April to May 2022. The Wilcoxon rank-sum test and the Kruskal-Wallis rank-sum test/Dunn test for multiple comparisons were employed to compare students' KAP scores between two groups and among three groups or more, respectively. Factors associated with students' COVID-19 KAP scores were determined via univariate and multivariate linear regression models. Variables in the multivariate linear regression models were chosen using the Bayesian Model Averaging method in R software version 4.2.0., Results: A majority of students had good knowledge (75.61%), positive attitudes (98.24%), and good practices toward COVID-19 (94.93%). Regarding the COVID-19 knowledge, the proportions of students who knew that mosquito bites and exposure to/eating wild animals would not lead to COVID-19 infection were not high (47.22 and 34.34%, respectively). More importantly, 70.34% of students thought that vitamins and minerals could help prevent or cure COVID-19. Antibiotics were the first choice for COVID-19 treatment of 438 students (42.73%). Nearly half of students (48.0%) bought antibiotics to keep at home in case of COVID-19 infection. The average KAP scores of medical students (19.97 ± 3.99, 45.10 ± 3.94, 9.72 ± 1.78) and females (18.67 ± 4.44, 44.79 ± 3.79, 9.36 ± 1.84) were significantly higher than those of non-medical students (16.48 ± 4.37, 43.33 ± 4.03, 8.68 ± 1.87) and males (17.01 ± 4.55, 42.79 ± 4.39, 8.77 ± 1.97), respectively (p &lt; 0.001). Older students were more likely to have good knowledge and practices than the younger ones (p &lt; 0.001). In addition, students using websites of the World Health Organization/the Ministry of Health and scientific articles to seek COVID-19 information were significantly associated with higher KAP scores when compared with those not using these sources (p &lt; 0.001, p &lt; 0.001, and p = 0.00139, respectively)., Conclusion: Students' KAP scores significantly varied by age, sex, major, and sources of COVID-19 information. Although many students had sufficient knowledge, positive attitudes, and good preventive practices toward COVID-19, additional education and training strategies are paramount, especially for non-medical students and males., (© 2022. The Author(s).)

Organic/inorganic heterostructures present a versatile platform for creating materials with new functionalities and hybrid properties. In particular, junctions between two dimensional materials have demonstrated utility in next generation electronic, optical, and optoelectronic devices. This work pioneers a microwave facilitated synthesis process to readily incorporate few-layer covalent organic framework (COF) films onto monolayer transition metal dichalcogenides (TMDC). Preferential microwave excitation of the monolayer TMDC flakes result in selective attachment of COFs onto the van der Waals surface with film thicknesses between 1 and 4 nm. The flexible process is extended to multiple TMDCs (MoS 2 , MoSe 2 , MoSSe) and several well-known COFs (TAPA-PDA COF, TPT-TFA-COF, and COF-5). Photoluminescence studies reveal a power-dependent defect formation in the TMDC layer, which facilitates electronic coupling between the materials at higher TMDC defect densities. This coupling results in a shift in the A-exciton peak location of MoSe 2 , with a red or blue shift of 50 or 19 meV, respectively, depending upon the electron donating character of the few-layer COF films. Moreover, optoelectronic devices fabricated from the COF-5/TMDC heterostructure present an opportunity to tune the PL intensity and control the interaction dynamics within inorganic/organic heterostructures.

We report a case of a 2-year-old female presenting with cyanosis since birth and having rare cardiac anatomy of visceral situs inversus, dextrocardia, discordant atrioventricular connections with double outlet right ventricle, atrial communication, subaortic interventricular communication, anteriorly leftward aorta with right aortic arch, single coronary artery with a branch crossing right ventricle outflow tract, pulmonary stenosis, and bilateral superior vena cava. Corrective repair with atrial switch (Senning technique), intracardiac baffle, and right ventricle outflow reconstruction was successfully performed with challenges from altered anatomical location and orientation of the heart and abnormal coronary artery.

The Video Browser Showdown addresses difficult video search challenges through an annual interactive evaluation campaign attracting research teams focusing on interactive video retrieval. The campaign aims to provide insights into the performance of participating interactive video retrieval systems, tested by selected search tasks on large video collections. For the first time in its ten year history, the Video Browser Showdown 2021 was organized in a fully remote setting and hosted a record number of sixteen scoring systems. In this paper, we describe the competition setting, tasks and results and give an overview of state-of-the-art methods used by the competing systems. By looking at query result logs provided by ten systems, we analyze differences in retrieval model performances and browsing times before a correct submission. Through advances in data gathering methodology and tools, we provide a comprehensive analysis of ad-hoc video search tasks, discuss results, task design and methodological challenges. We highlight that almost all top performing systems utilize some sort of joint embedding for text-image retrieval and enable specification of temporal context in queries for known-item search. Whereas a combination of these techniques drive the currently top performing systems, we identify several future challenges for interactive video search engines and the Video Browser Showdown competition itself., (© The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2022.)

Objectives: Mobile colistin resistance (mcr) genes are widely distributed around the world. To date, ten major variants of mcr genes are known (mcr-1 to mcr-10). However, only a few instances of Enterobacterales isolates harbouring mcr genes other than mcr-1 have been reported in Vietnam. The aim of this study was to investigate mcr-harbouring antimicrobial-resistant Enterobacterales isolates in Vietnam., Methods: Two mcr-9-harbouring Enterobacter hormaechei clinical isolates (NIHE14-1904 and MH17-539M) were obtained from medical institutions in Hanoi, Vietnam, in 2014 and 2017, respectively. Their genomes and plasmid sequences were analysed by short-read and long-read sequencing. Subsequently, comparative sequence analysis of their mcr-9-carrying plasmids was performed., Results: Strains NIHE14-1904 and MH17-539M belonged to sequence types ST916 and ST66, respectively, according to the Enterobacter cloacae multilocus sequence typing (MLST) scheme. NIHE14-1904 and MH17-539M harboured the mcr-9 gene on similar IncHI2 plasmids, namely pNIHE14-1904-mcr9 (373.1 kb) and pMH17-539M-mcr9 (289.3 kb), respectively. These plasmids were also highly identical to widespread IncHI2 plasmids that are often associated with mcr genes., Conclusion: For the first time, mcr-9-harbouring Enterobacterales isolates were detected in Vietnam, which carried mcr-9 on IncHI2 plasmids. The prevalence of such plasmids needs to be monitored in the future owing to their high dissemination., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The use of naturally occurring materials with antibacterial properties has gained a great interest in infected wound management. Despite being an abundant resource in Vietnam, chitosan and its derivatives have not yet been intensively explored for their potential in such application. Here, we utilized a local chitosan source to synthesize chitosan oligomers (OCS) using hydrogen peroxide (H 2 O 2 ) oxidation under the microwave irradiation method. The effects of H 2 O 2 concentration on the physicochemical properties of OCS were investigated through molecular weight, degree of deacetylation, and heavy metal contamination for optimization of OCS formulation. Then, the antibacterial inhibition was examined; the minimum inhibitory concentration and minimum bactericidal concentration (MIC and MBC) of OCS-based materials were determined against common skin-inhabitant pathogens. The results show that the local Vietnamese chitosan and its derivative OCS possessed high-yield purification while the molecular weight of OCS was inversely proportional and proportional to the concentration of H 2 O 2 , respectively. Further, the MIC and MBC of OCS ranged from 3.75 to less than 15 mg/mL and 7.5-15 mg/mL, respectively. Thus, OCS-based materials induce excellent antimicrobial properties and can be attractive for wound dressings and require further investigation.

Introduction: Uninsured trauma patients are at higher risk of mortality, limited access to postdischarge resources, and catastrophic health expenditure. Hospital Presumptive Eligibility (HPE), enacted with the 2014 Affordable Care Act, enables uninsured patients to be screened and acquired emergency Medicaid at the time of hospitalization. We sought to identify factors associated with successful acquisition of HPE insurance at the time of injury, hypothesizing that patients with higher Injury Severity Score (ISS) (ISS >15) would be more likely to be approved for HPE., Methods: We identified Medicaid and uninsured patients aged 18 to 64 years with a primary trauma diagnosis (International Classification of Diseases, Tenth Revision) in a large level I trauma center between 2015 and 2019. We combined trauma registry data with review of electronic medical records, to determine our primary outcome, HPE acquisition. Descriptive and multivariate analyses were performed., Results: Among 2,320 trauma patients, 1,374 (59%) were already enrolled in Medicaid at the time of hospitalization. Among those uninsured at arrival, 386 (40.8%) acquired HPE before discharge, and 560 (59.2%) remained uninsured. Hospital Presumptive Eligibility patients had higher ISS (ISS >15, 14.8% vs. 5.7%; p < 0.001), longer median length of stay (2 days [interquartile range, 0-5 days] vs. 0 [0-1] days, p < 0.001), were more frequently admitted as inpatients (64.5% vs. 33.6%, p < 0.001), and discharged to postacute services (11.9% vs. 0.9%, p < 0.001). Patient, hospital, and policy factors contributed to HPE nonapproval. In adjusted analyses, Hispanic ethnicity (vs. non-Hispanic Whites: aOR, 1.58; p = 0.02) and increasing ISS (p ≤ 0.001) were associated with increased likelihood of HPE approval., Conclusion: The time of hospitalization due to injury is an underused opportunity for intervention, whereby uninsured patients can acquire sustainable insurance coverage. Opportunities to increase HPE acquisition merit further study nationally across trauma centers. As administrative and trauma registries do not capture information to compare HPE and traditional Medicaid patients, prospective insurance data collection would help to identify targets for intervention., Level of Evidence: Economic, level IV., (Copyright © 2021 American Association for the Surgery of Trauma.)

Objective: To determine whether delayed or canceled elective procedures due to COVID-19 resulted in higher rates of ED utilization and/or increased mortality., Summary of Background Data: On March 15, 2020, the VA issued a nationwide order to temporarily pause elective cases due to COVID-19. The effects of this disruption on patient outcomes are not yet known., Methods: This retrospective cohort study used data from the VA Corporate Data Warehouse. Surgical procedures canceled due to COVID-19 in 2020 (n = 3326) were matched to similar completed procedures in 2018 (n = 151,863) and 2019 (n = 146,582). Outcome measures included 30- and 90-day VA ED use and mortality in the period following the completed or canceled procedure. We used exact matching on surgical procedure category and nearest neighbor matching on patient characteristics, procedure year, and facility., Results: Patients with elective surgical procedures canceled due to COVID-19 were no more likely to have an ED visit in the 30- [Difference: -4.3% pts; 95% confidence interval (CI): -0.078, -0.007] and 90 days (-0.9% pts; 95% CI: -0.068, 0.05) following the expected case date. Patients with cancellations had no difference in 30- (Difference: 0.1% pts; 95% CI: -0.008, 0.01) and 90-day (Difference: -0.4% pts; 95% CI: -0.016, 0.009) mortality rates when compared to similar patients with similar procedures that were completed in previous years., Conclusions: The pause in elective surgical cases was not associated with short-term adverse outcomes in VA hospitals, suggesting appropriate surgical case triage and management. Further study will be essential to determine if the delayed cases were associated with longer-term effects., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Given the limitations and side effects of many synthetic drugs, natural products are an important alternative source for drugs and medications for many diseases. Icariin (ICA), one of the main flavonoids from plants of the Epimedium genus, has been shown to ameliorate osteoporosis and improve bone health in preclinical studies. Those studies have used different in vivo models, mostly rodents, but the underlying mechanisms remain unclear. The present study shows, for the first time, that ICA reduces bone damage in a Rankl-induced medaka fish (Oryzias latipes), a non-rodent osteoporosis model. Live imaging was previously performed in this model to characterize antiresorptive and bone-anabolic properties of drugs. Here, a new quantification method (I M ) was established based on the length of mineralized neural arches to quantify levels of bone mineralization damage and protection in early post-embryonic fish. This method was validated by quantification of three levels of bone damage in three independent Rankl fish lines, and by the determination of different degrees of severity of osteoporosis-like phenotypes in one Rankl line exposed to variable Rankl induction schemes. I M was also used to quantify the efficacy of alendronate and etidronate, two common anti-osteoporotic bisphosphonates, and revealed comparable bone protective effects for ICA and alendronate in this fish osteoporosis model. This study's data support the value of the medaka fish model for bone research and establish a method to screen for novel osteoprotective compounds., (© 2019 The Fisheries Society of the British Isles.)

Wound dressings are typically used to provide a favorable environment supporting the intricate process of wound healing. This research aims to fabricate and evaluate an electrospun polycaprolactone (EsPCL) membrane coated with various densities of chitosan oligomers (COS) - a biological agent - for application as bioactive wound dressing. Weight calculation was employed to investigate the density of COS coated onto the electrospun PCL membrane. Physicochemical characteristics of the prepared membranes, such as hydrophilicity and mechanical properties were demonstrated and evaluated through standard experimental methods. In vitro assays and mice model were used to investigate the antibacterial activities, cytocompatibility, hemostasis and the in vivo interaction of the membranes. The results showed that COS was coated successfully on the surface of the polymeric membrane, altering its morphology and associated characteristics. The greater concentration of COS led to an increase in the thickness of the membrane, which resulted in stronger antibacterial activities. Moreover, the increase of chitosan oligomers density in the membrane induced faster hemostasis and affected the re-epithelialization and wound healing in mice. Thus, the membrane as a whole and particularly chitosan oligomers were shown to be potential for further studies regarding wound dressing., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction and Objectives: Analysis of cancer biomarkers is an important tool in developing targeted-therapy and in modulating chemoresistance. Here, we analyze the relevance of CD90, a marker of cancer stem cells (CSC) in hepatocellular carcinoma (HCC) and its correlation with autophagy., Materials and Methods: For in vivo study, 86 specimens were collected from 43 patients undergoing liver resections. In each patient, HCC nodule (HCC) and surrounding non-tumor (SNT) were collected. For in vitro study, HCC cells JHH6 subpopulations expressing CD90+ and CD90- were isolated using magnetic-sorter and confirmed by flow-cytometry. Upon doxorubicin treatment, autophagy turn-over was analyzed by RTqPCR for mRNA expression, Western blot for protein expression, and autophagosome staining for autophagy-flux. Cytotoxicity test was performed by MTT assay. Gene and protein analysis were performed in clinical samples together with immunohistostaining., Results: CD90 mRNA expression was higher in HCC than in SNT for 8-fold (p < 0.001). LC3-II protein was up-regulated in the HCC in comparison with the SNT (p < 0.05). In vitro model showed that CD90+ and CD90- cells had diverse expressions of autophagy-related genes. Upon doxorubicin treatment, autophagy was activated in both cells by increasing LC3-II protein expression, autophagic vacuoles, and dysregulation of autophagy-related mRNAs. A differential autophagic capacity was noticed between two subpopulations and it was correlated with cellular toxicity assay., Conclusions: We demonstrated the relevance of differential autophagy capacity of CD90+ cells in HCC. Autophagy was involved in cancer-defense mechanism against doxorubicin. Cancer promoting function of autophagy in CD90+ cells was also related to cancer environment., (Copyright © 2020 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Hospital Presumptive Eligibility (HPE) is a national policy stemming from the Affordable Care Act that allows qualified hospitals, working with state officials, to enroll eligible patients for temporary Medicaid coverage. Although all states are required to operate an HPE program, hospital participation is elective and variable. It is unclear which hospitals choose to participate in HPE and how participation affects hospital utilization and revenue., Objective: We examined hospital factors associated with HPE participation in the state of California and assessed pre and post changes in hospital revenue and utilization for HPE and non-HPE hospitals., Research Design: We performed a logistic regression to identify hospital attributes associated with HPE participation. We then used a difference in differences methodology with a hospital fixed effect to test whether HPE enrollment was associated with changes in annual revenues by payer source, uncompensated care costs, outpatient visits, and/or discharges., Results: Three quarters (76%) of qualified hospitals elected to participate in HPE by the end of 2018. Hospitals with 100 or more beds had over 10 times greater odds of participating in HPE compared with smaller hospitals. Hospitals that did not provide outpatient care were significantly less likely to participate. Among hospitals included in trend analyses, enrollment in HPE was associated with increased annual net patient Medicaid revenue and decreased uncompensated care charges. We predicted that HPE enrollment was associated with an average of 9.7% (95% confidence interval: 3.4%-16.4%) increase in annual net patient Medicaid revenue. As of 2018, ∼33,000 adults and children were enrolled in California's HPE program per month., Conclusion: Hospital enrollment in the HPE program shifted costs from uncompensated care to Medicaid.

Objective: To estimate the net effect of living in a gentrified neighborhood on probability of having serious psychological distress., Data Sources: We pooled 5 years of secondary data from the California Health Interview Survey (2011-2015) and focused on southern California residents., Study Design: We compared adults (n = 43 815) living in low-income and gentrified, low-income and not gentrified, middle- to high-income and upscaled, and middle- to high-income and not upscaled neighborhoods. We performed a probit regression to test whether living in a gentrified neighborhood increased residents' probabilities of having serious psychological distress in the past year and stratified analyses by neighborhood tenure, homeownership status, and low-income status. Instrumental variables estimation and propensity scores were applied to reduce bias arising from residential selection and simultaneity. An endogenous treatment effects model was also applied in sensitivity analyses., Data Collection/extraction Methods: Adults who completed the survey on their own and lived in urban neighborhoods with 500 or more residents were selected for analyses. Survey respondents who scored 13 and above on the Kessler 6 were categorized as having serious psychological distress in the past year. We used eight neighborhood change measures to classify respondents' neighborhoods., Principal Findings: Living in a gentrified and upscaled neighborhood was associated with increased likelihood of serious psychological distress relative to living in a low-income and not gentrified neighborhood. The average treatment effect was 0.0141 (standard error = 0.007), which indicates that the prevalence of serious psychological distress would have been 1.4 percentage points less if none of the respondents lived in gentrified neighborhoods. Gentrification appears to have a negative impact on the mental health of renters, low-income residents, and long-term residents. This effect was not observed among homeowners, higher-income residents, and recent residents., Conclusions: Gentrification levies mental health costs on financially vulnerable community members and can worsen mental health inequities., (© Health Research and Educational Trust.)

The objective of this study was to develop a simple, inexpensive prototype device for rapid detection of hepatitis B virus (HBV). The device was able to simultaneously amplify, detect and quantify the target HBV DNA. The system was fabricated from a custom-made electrochemical set-up of which the temperature was thermostatically controlled by a water bath. Real-time monitoring of HBV DNA was accomplished by measuring the response of redox indicator in the reaction mixture. Concentration of HBV DNA in the samples was determined from the peak high ratio (PHR) and threshold time relationship. The signal was processed by sigmoidal model fitting to enhance the accuracy of the results. Key parameters including concentrations of redox indicator and reaction temperatures were optimized. Sensitivity and specificity of the method toward HBV DNA were evaluated. The prototype was capable of real-time amplification and detection of HBV DNA with concentration as low as 6.18 fg μl -1 . The test showed high specificity against HBV DNA. The system was also able to detect HBV positive serum directly with simple thermal pretreatment instead of tedious DNA extraction. The electrochemical set-up was compatible with microfluidic platforms and can be readily adapted for efficient and high throughput point-of-care (POC) diagnosis of HBV., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Objective: This study examined specialty behavioral health treatment patterns among employer-insured adults in same- and different-gender domestic partnerships and marriages., Methods: The study used behavioral health service claims (2008-2013) from Optum to estimate gender-stratified penetration rates of behavioral health service use by couple type and partnership status among partnered adults ages 18-64 (N=12,727,292 person-years) and levels of use among those with any use (conditional analyses). Least-squares, logistic, and zero-truncated negative binomial regression analyses adjusted for age, employer and plan characteristics, and provider supply and for sociodemographic factors in sensitivity analyses. Generalized estimating equations were used to address within-group correlation of adults clustered in employer groups., Results: Both women and men in same-gender marriages or domestic partnerships had higher rates of behavioral health service use, particularly diagnostic evaluation, individual psychotherapy, and medication management, and those in treatment had, on average, more psychotherapy visits than those in different-gender marriages. Behavioral health treatment patterns were similar between women in same-gender domestic partnerships and same-gender marriages, but they diverged between men in same-gender domestic partnerships and same-gender marriages. Moderation analysis results indicated that adults with same-gender partners living in states with fewer legal protections for lesbian, gay, bisexual, and transgender persons were less likely than adults with same-gender partners in LGBT-friendly states to receive behavioral health treatment. Sensitivity analyses did not affect findings., Conclusions: Behavioral health treatment patterns varied by couple type, partnership status, and gender. Results highlight the importance of increasing service acceptability and delivering inclusive, culturally relevant behavioral health treatment for lesbian, gay, and bisexual persons.

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

Background: Timely and appropriate treatment could help reduce the burden of mental illness., Purpose: This study describes mental health services use among Californians with mental health need, highlights underserved populations, and discusses policy opportunities., Methods: Four years of California Health Interview Survey data (2011, 2012, 2013, 2014) were pooled and weighted to the 2013 population to estimate mental health need and unmet need (n=82,706). Adults with mental health need had "unmet need" if they did not use prescription medication and did not have at least four or more mental health visits in the past year. Multivariable logistic regression analysis was performed to predict the probability adults with mental health need did not receive past-year treatment (n=5,315)., Results: Seventy-seven percent of Californians with mental health need received no or inadequate mental health treatment in 2013. Men, Latinos, Asians, young people, older adults, people with less education, uninsured adults, and individuals with limited English proficiency were significantly more likely to have unmet need. Cost of treatment and mental health stigma were common reasons for lack of care., Conclusion: Unmet mental health need is predominant in California. Policy recommendations include continued expansion of mental health coverage, early identification, and ensuring that treatment is culturally and linguistically appropriate.

A difference-in-difference approach was used to compare the effects of same-sex domestic partnership, civil union, and marriage policies on same- and different-sex partners who could have benefitted from their partners' employer-based insurance (EBI) coverage. Same-sex partners had 78% lower odds (Marginal Effect = -21%) of having EBI compared with different-sex partners, adjusting for socioeconomic and health-related factors. Same-sex partners living in states that recognized same-sex marriage or domestic partnership had 89% greater odds of having EBI compared with those in states that did not recognize same-sex unions (ME = 5%). The impact of same-sex legislation on increasing take-up of dependent EBI coverage among lesbians, gay men, and bisexual individuals was modest, and domestic partnership legislation was equally as effective as same-sex marriage in increasing same-sex partner EBI coverage. Extending dependent EBI coverage to same-sex partners can mitigate gaps in coverage for a segment of the lesbians, gay men, and bisexual population but will not eliminate them., (© The Author(s) 2016.)

The design, synthesis, and properties of the new microporous coordination polymer UMCM-310 are described. The unique electronic character of the perylene-based linker enables selective interaction with electron-poor aromatics leading to efficient separation of nitroaromatics. UMCM-310 possesses high surface area and large pore size and thus permits the separation of large organic molecules based on adsorption rather than size exclusion., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Data from the California Health Interview Survey (CHIS) from 2011--2013 showed approximately 90,000 veterans had mental health needs and 200,000 reported serious thoughts of suicide during the 12 months prior to participating in CHIS. Although the proportion of veterans reporting mental health need or serious psychological distress was no higher than the general population, California veterans were more likely to report lifetime suicide ideation. This policy brief uses CHIS data to examine the mental health status, needs, and barriers to care among veterans in California. Veterans were more likely to receive mental health or substance use treatment than nonveterans, yet three of four veterans with mental health needs received either inadequate or no mental health care. Integrating mental and physical health services, increasing access to care, retaining veterans who seek mental health treatment, and reducing stigma are among the strategies that might improve the mental health of California's veterans.

Data from the 2011 to 2013 California Health Interview Survey (CHIS) were pooled to estimate prevalence of mental health need (serious psychological distress and impairment in one or more life domains), minimally adequate treatment (having four or more visits with a health professional in the past 12 months and use of prescription medication for mental health problems in the past 12 months), and suicide ideation among veterans living in California. Numbers and percentages were weighted to the CA population using a large sample size (N=6,952), and for comparison purposes, veterans and nonveterans were standardized to the age and gender distribution of veterans in the sample. Although differences in mental health need were similar between veterans and nonveterans after adjustment, over three-quarters of veterans did not receive minimally adequate treatment needed to address their mental health needs. Suicide ideation was significantly higher among veterans than nonveterans. Male veterans at all ages were more vulnerable to thinking about suicide compared to their nonveteran counterparts.

Objectives: Emergency medicine (EM) is rapidly developing as a specialty in Vietnam. Point of care ultrasound (POCUS) is currently taught as part of formal EM curriculums though limited literature exists to describe current POCUS usage in EDs in Vietnam. A survey was developed to understand current POCUS utilisation and guide future training efforts., Methods: A survey was administered to 104 Vietnamese physicians attending a national emergency medicine symposium regarding POCUS utilisation, access, training and preference. Data were analysed using multiple logistic regression to identify independent variables associated with POCUS usage., Results: Increased access to ultrasound machines was significantly associated with increased POCUS usage, with 'all the time' access (OR = 92.9, 95% CI 7.15-1207.6, P = 0.001) being more strongly associated than 'sometimes' access (OR = 41.4, 95% CI 4.08-419.8, P = 0.002). Formal training did not significantly increase POCUS usage and 50.0% of respondents who regularly used POCUS had no formal training. There was no significant difference in physician preference or comfort for any single application of POCUS. There were 98.0% of trainees and 96.3% of independently practising physicians who reported a desire for additional POCUS training., Conclusions: Regular access to ultrasound machines increases the frequency of POCUS usage in EDs in Vietnam. POCUS training was not as clearly associated with POCUS usage as those without formal training were equally likely to use POCUS as those with formal training. No single POCUS application stood out as strongly preferred by physicians in this survey., (© 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: To assess the effectiveness of supreme laryngeal mask airway (SLMA) over face mask ventilation for preventing need for endotracheal intubation at birth., Study Design: We report a prospective, randomized, parallel 1:1, unblinded, controlled trial. After a short-term educational intervention on SLMA use, infants ≥34-week gestation and/or expected birth weight ≥1500 g requiring positive pressure ventilation (PPV) at birth were randomized to resuscitation by SLMA or face mask. The primary outcome was the success rate of the resuscitation devices (SLMA or face mask) defined as the achievement of an effective PPV preventing the need for endotracheal intubation., Results: We enrolled 142 patients (71 in SLMA and 71 in face mask group, respectively). Successful resuscitation rate was significantly higher with the SLMA compared with face mask ventilation (91.5% vs 78.9%; P = .03). Apgar score at 5 minutes was significantly higher in SLMA than in face mask group (P = .02). Neonatal intensive care unit admission rate was significantly lower in SLMA than in face mask group (P = .02). No complications related to the procedure occurred., Conclusions: In newborns with gestational age ≥34 weeks and/or expected birth weight ≥1500 g needing PPV at birth, the SLMA is more effective than face mask to prevent endotracheal intubation. The SLMA is effective in clinical practice after a short-term educational intervention., Trial Registration: Registered with ClinicalTrials.gov: NCT01963936., (Copyright © 2015 Elsevier Inc. All rights reserved.)

In recent years, carbon-hydrogen bond functionalization has evolved from an organometallic curiosity to a tool used in mainstream applications in the synthesis of complex natural products and drugs. The use of C-H bonds as a transformable functional group is advantageous because these bonds are the most abundant functionality in organic molecules. One-step conversion of these bonds to the desired functionality shortens synthetic pathways, saving reagents, solvents, and labor. Less chemical waste is generated as well, showing that this chemistry is environmentally beneficial. This Account describes the development and use of bidentate, monoanionic auxiliaries for transition-metal-catalyzed C-H bond functionalization reactions. The chemistry was initially developed to overcome the limitations with palladium-catalyzed C-H bond functionalization assisted by monodentate directing groups. By the use of electron-rich bidentate directing groups, functionalization of unactivated sp(3) C-H bonds under palladium catalysis has been developed. Furthermore, a number of abundant base-metal complexes catalyze functionalization of sp(2) C-H bonds. At this point, aminoquinoline, picolinic acid, and related compounds are among the most used and versatile directing moieties in C-H bond functionalization chemistry. These groups facilitate catalytic functionalization of sp(2) and sp(3) C-H bonds by iron, cobalt, nickel, copper, ruthenium, rhodium, and palladium complexes. Exceptionally general reactivity is observed, enabling, among other transformations, direct arylation, alkylation, fluorination, sulfenylation, amination, etherification, carbonylation, and alkenylation of carbon-hydrogen bonds. The versatility of these auxilaries can be attributed to the following factors. First, they are capable of stabilizing high oxidation states of transition metals, thereby facilitating the C-H bond functionalization step. Second, the directing groups can be removed, enabling their use in synthesis and functionalization of natural products and medicinally relevant substances. While the development of these directing groups presents a significant advance, several limitations of this methodology are apparent. The use of expensive second-row transition metal catalysts is still required for efficient sp(3) C-H bond functionalization. Furthermore, the need to install and subsequently remove the relatively expensive directing group is a disadvantage.

A strategy that allows the tuning of pore size in microporous coordination polymers (MCPs) through modification of their organic linkers is presented. When large substituents are introduced onto the linker, these pendent groups partially occupy the pores, thus reducing pore size while serving as additional adsorption sites for gases. The approach takes advantage of the fact that, for methane storage materials, small pores (0.4-0.8 nm in diameter) are more desirable than large pores since small pores promote optimal volumetric capacity. This method was demonstrated with IRMOF-8, a MCP constructed from Zn4O metal clusters and 2,6-naphthalenedicarboxylate (NDC) linkers. The NDC was functionalized through the addition of substituents including tert-butylethynyl or phenylethynyl groups. High pressure methane uptake demonstrates that the IRMOF-8 derivatives have significantly better performance than the unfunctionalized material in terms of both excess volumetric uptake and deliverable capacity. Moreover, IRMOF-8 derivatives also give rise to stronger interactions with methane molecules as shown by higher heat of adsorption values.