Ultrasound evaluation of intraluminal magnets in an ex vivo model.

PURPOSE: The management of foreign body ingestion proves to be a challenge. Magnets pose a unique set of risks when ingested due to their attractive forces and subsequent risk of adherence, pressure necrosis, and perforation complications. Radiographs only provide a limited snapshot in the setting of multiple magnet ingestion when the risk of complication is highest. We hypothesize that abdominal ultrasound (US) has the potential to supplement radiographs in assessing ingested magnets by determining the presence of bowel loop entrapment and of any extraluminal fluid. METHODS: We recreated various scenarios of magnet configurations using animal cadaveric bowel models. X-ray and US images were obtained in various bowel-magnet orientations. RESULTS: We identified several key US features to suggest bowel wall tethering. These include direct visualization of bowel wall entrapment between magnets (what we term the "dangerous V sign"), anti-dependent positions of the magnets, and inability to separate loops of bowel with compression. CONCLUSION: These findings could potentially provide valuable information when directing the urgency of intervention in foreign body ingestion. Ultrasound may supplement and improve the current guidelines in management of magnet ingestion.

Web-Based Patient Recommender Systems for Preventive Care: Protocol for Empirical Research Propositions.

BACKGROUND: Preventive care helps patients identify and address medical issues early when they are easy to treat. The internet offers vast information about preventive measures, but the sheer volume of data can be overwhelming for individuals to process. To help individuals navigate this information, recommender systems filter and recommend relevant information to specific users. Despite their popularity in other fields, such as e-commerce, recommender systems have yet to be extensively studied as tools to support the implementation of prevention strategies in health care. This underexplored area presents an opportunity for recommender systems to serve as a complementary tool for medical professionals to enhance patient-centered decision-making and for patients to access health information. Thus, these systems can potentially improve the delivery of preventive care. OBJECTIVE: This study proposes practical, evidence-based propositions. It aims to identify the key factors influencing patients' use of recommender systems and outlines a study design, methods for creating a survey, and techniques for conducting an analysis. METHODS: This study proposes a 6-stage approach to examine user perceptions of the factors that may influence the use of recommender systems for preventive care. First, we formulate 6 research propositions that can be developed later into hypotheses for empirical testing. Second, we will create a survey instrument by collecting items from extant literature and then verify their relevance using expert analysis. This stage will continue with content and face validity testing to ensure the robustness of the selected items. Using Qualtrics (Qualtrics), the survey can be customized and prepared for deployment on Amazon Mechanical Turk. Third, we will obtain institutional review board approval because this is a human subject study. In the fourth stage, we propose using the survey to collect data from approximately 600 participants on Amazon Mechanical Turk and then using R to analyze the research model. This platform will serve as a recruitment tool and the method of obtaining informed consent. In our fifth stage, we will perform principal component analysis, Harman Single Factor test, exploratory factor analysis, and correlational analysis; examine the reliability and convergent validity of individual items; test if multicollinearity exists; and complete a confirmatory factor analysis. RESULTS: Data collection and analysis will begin after institutional review board approval is obtained. CONCLUSIONS: In pursuit of better health outcomes, low costs, and improved patient and provider experiences, the integration of recommender systems with health care services can extend the reach and scale of preventive care. Examining recommender systems for preventive care can be vital in achieving the quadruple aims by advancing the steps toward precision medicine and applying best practices. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/43316.

Thermoconformational Behavior of Cellulose Nanofiber Films as a Device Substrate and Their Superior Flexibility and Durability to Glass.

The design and high-throughput manufacturing of thin renewable energy devices with high structural and atomic configurational stability are crucial for the fabrication of green electronics. Yet, this concept is still in its infancy. In this work, we report the extraordinary durability of thin molecular interlayered organic flexible energy devices based on chemically tuned cellulose nanofiber transparent films that outperform glass by decreasing the substrate weight by 50%. The nanofabricated flexible thin film has an exceptionally low thermal coefficient of expansion of 1.8 ppm/K and a stable atomic configuration under a harsh fabrication condition (over 190 °C for an extended period of 5 h). A flexible optoelectronic device using the same renewable cellulose nanofiber film substrate was found to be functionally operational over a life span of 5 years under an intermittent operating condition. The success of this device's stability opens up an entirely new frontier of applications of flexible electronics.

Hepatitis B Surface Antigen Levels Are Related to Spontaneous Hepatitis B Surface Antigen Seroconversion in Inactive Hepatitis B Carriers.

BACKGROUND: The cure for hepatitis B is defined as the hepatitis B surface antigen (HBsAg) seroclearance and/or seroconversion. Predictors of spontaneous seroconversion are not well described. The objective of this study is to identify predictors of spontaneous HBsAg seroconversion from community practice. METHODS: We performed a matched analysis of patients who HBsAg seroconverted (cases) and patients who did not HBsAg seroconvert (control) in a 1:5 ratio according to date of clinic visit between 2014 and 2019 in a large community practice situated in Los Angeles area. Baseline laboratory and clinical data were collected. Univariate analysis and 2-sided t tests were performed, χ test for proportions, and logistic regression. RESULTS: We identified 14 cases and 70 controls. The mean (±SD) ages of the cases and controls were 53.6 (±12.2) and 49.5 (±13.1), respectively (P=0.45). Most patients were women, and all patients were of Asian descent. There were statistically significant mean (±SD) baseline differences between cases and controls in HBsAg titers (459.8±311.0 and 782.0±393.3 IU/mL, P=0.01) and alanine aminotransferase (ALT) values (17.6±4.4 and 25.1±16.7 IU/mL, P<0.01), respectively. Baseline hepatitis B virus DNA and other pertinent laboratory values did not differ between cases and controls. Eleven of 14 cases (79%) and 11 of 70 controls (16%) baseline HBsAg titers were <1000 IU/mL (P<0.01). The results of a logistic regression demonstrated that HBsAg titers and ALT values were predictor variables for HBsAg seroconversion (P=0.01 and <0.01, respectively). CONCLUSIONS: Spontaneous HBsAg seroclearance and seroconversion is an uncommon event in patients with chronic hepatitis B. The most important predictors of seroconversion are HBsAg titers<1000 IU/mL and low baseline ALT values.

Decrease of Alpha-fetoprotein in Patients with Cirrhosis Treated with Direct-acting Antivirals.

Background and Aims: The lack of specificity has limited the role of serum alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) screening among patients with cirrhosis related to hepatitis C virus (HCV) infection. We sought to examine whether AFP may decrease after achieving a sustained virological response (SVR) in patients with HCV-related cirrhosis. Methods: We performed a retrospective study of patients with HCV-related cirrhosis who were cured with direct-acting antiviral (DAA) therapy at the University of California, Los Angeles. Laboratory values, including serum AFP, were measured before and after completing the DAA treatment. Results: Fifty-six patients met the inclusion criteria, with median (interquartile range [IQR]) age of 67 (58-69) years and with 51.8% being male. All patients received DAA therapy without interferon. AFP decreased from median (IQR) 7.2 (4.2-13.4) ng/mL before DAAs to 4.2 (2.7-6.3) ng/mL at the end of treatment and 4.2 (2.9-6.8) ng/mL at 12 weeks after treatment (p < 0.001). Model for end-stage liver disease (MELD), fibrosis-4 (FIB4), and aspartate transaminase (AST) to platelet ratio index (APRI) scores at baseline were not significantly associated with AFP reduction. On multivariate analysis, platelet count, AST and total bilirubin at baseline were significantly correlated to AFP reduction (p = 0.04, 0.009 and 0.04, respectively). The higher the baseline AFP, the greater the reduction in AFP. There was no statistically significant correlation between baseline AFP and MELD, FIB4 or APRI scores. Conclusion: There was a significant decrease in AFP in patients with cirrhosis who achieved a SVR with DAAs. Given a reduction in AFP after DAA treatment, AFP should be further studied as a screening modality for HCC in patients with cirrhosis.

Accessibility to Oral Antiviral Therapy for Patients with Chronic Hepatitis C in the United States.

Background : Hepatitis C (HCV) direct acting antiviral agents (DAAs) are safe, effective, and tolerable. Most contraindications to interferon-based treatment are no long applicable. The aims of this study were to understand the predictors of approval to drug accessibility. Methods : We studied all consecutive patients with HCV prescribed DAAs between October 2014 and July 2015. Data on demographic, socio-economic status, comorbidities, baseline laboratory values, and assessment of liver disease severity, insurance, and specialty pharmacy type were collected. Multivariate analyses were performed to identify predictors of prescription approval. Results : In total, 410 patients were prescribed DAAs between October 2014 and July 2015. Of those, 332 (81%) patients were insurance approved for therapy. Of the 332 patients accepted, 251 were accepted after the first prescription attempt, and 38 were accepted after the second and third attempts. The number of attempts for the other 43 approved patients was unknown. Older age (p = 0.001), employment (p = 0.001), lack of comorbidities (p = 0.02), liver transplantation (p = 0.018), and advanced liver disease (p = 0.001) were more likely associated with obtaining approval. Household income was not associated with insurance approval. In the multivariate analysis, Medicare insurance (odds ratio [OR]) 2.67, 95% confidence interval [CI] 0.96-7.20), lack of nonliver comorbidities (OR 2.72, 95% CI 1.35-5.43), and the presence of advanced liver disease (OR 1.82, 95% CI 1.04-3.24) independently predicted drug approval. Conclusion : Despite the availability of DAAs for HCV, barriers from insurance carriers continue to impair widespread use. Patients with advanced liver disease, Medicare, and without comorbidities are most likely to be insurance approved for DAAs.

Timing of Antiviral Therapy in Candidates for Liver Transplant for Hepatitis C and Hepatocellular Carcinoma.

OBJECTIVES: Hepatitis C virus infection is the most common underlying reason for hepatocellular carcinoma and indication for liver transplant. The increased availability of non-interferon-based therapy has expanded the number of treatment-eligible patients. MATERIALS AND METHODS: We used a decision analysis model to compare 2 strategies of treating hepatitis C virus. Included patients were followed for 1 year after liver transplant. The probabilities and costs were obtained from a literature review, an expert panel, and our institution's experience. Sensitivity analyses were performed on all variables. RESULTS: Our model demonstrated that it would be less costly to treat patients after liver transplant than to treat patients while they wait for transplant. When we compared baseline values, the cost difference between the 2 strategies was $25,011 per patient and $41,535 per sustained viral response. Overall survival was 60.1% for both strategies. Our model was robust across most of the variables tested in the sensitivity analysis. CONCLUSIONS: Our results indicated that there is no substantial pharmacoeconomic or survival advantage of treating hepatitis C virus in patients with compensated cirrhosis and hepatocellular carcinoma before liver transplant versus after transplant.

Kidney transplantation threshold in patients with hepatitis C: a decision analysis model.

BACKGROUND: There are no standard guidelines for the permissible degree of liver fibrosis in patients with chronic hepatitis C virus prohibiting cadaveric renal transplantation (CRT). METHODS: A decision analysis model was constructed to compare 5-year patient survival using three strategies for patients on hemodialysis. The probabilities of pretransplant and posttransplant survival, progression of liver fibrosis, CRT, and sustained viral response were obtained from a systematic review of the literature. Sensitivity analyses were performed. RESULTS: Kidney transplantation was associated with improved 5-year survival for patients with fibrosis stages 1 to 3, but not stage 4 (cirrhosis). Antiviral therapy was associated with improvement in survival in patients with stage 3 fibrosis. The 5-year survival was similar for patients with stage 4 irrespective of the option of antiviral therapy. The model was sensitive to varying the probability of both pretransplant and posttransplant survival. CONCLUSION: There appears to be no overall 5-year survival benefit in treating S1 and S2 fibrosis patients with hepatitis C virus antiviral therapy before CRT. There is no benefit in overall 5-year survival in patients with cirrhosis and thus should not be candidates for CRT.

Quality of life of mental health consumers in Hong Kong: Analysis of service perceptions.

OBJECTIVES: Successful psychiatric rehabilitation entails fostering overall quality of life of individuals recovering from severe mental illnesses. Understanding how service-related perceptions may be related to quality of life can be useful in improving the effectiveness of community-based care. This study investigated the quality of life of mental health consumers using a service-oriented paradigm. METHODS: 162 mental health consumers from community-based psychiatric rehabilitation centers were interviewed. Analyses were conducted to investigate the relationships between service perceptions (perceived treatment coercion, rehabilitation needs, and continuity of care) and quality of life. RESULTS: Physical health quality was negatively related to rehabilitation needs. Mental health quality was negatively related to both rehabilitation needs and poorer continuity of service. Life satisfaction was negatively related to poorer continuity of service and higher perceived treatment coercion. CONCLUSIONS: This study highlighted the significance of service perceptions in the well-being of individuals with severe mental illness.

Cognitive insight and causal attribution in the development of self-stigma among individuals with schizophrenia.

OBJECTIVE: Stigma has dampening effects on the overall rehabilitation of individuals given a diagnosis of schizophrenia. This study was an initial attempt to understand the relationship between cognitive insight and attribution in the development of self-stigma among this group of mental health consumers. METHODS: In a cross-sectional design, the investigators interviewed 162 mental health consumers with broad diagnoses of schizophrenia from 15 community-based psychiatric rehabilitation centers in Hong Kong. After controlling for the effects of demographic and illness-related factors, the authors used hierarchical multiple regression analysis to investigate the effects of cognitive insight and causal attribution on self-stigma. RESULTS: Better cognitive insight and attribution of personal responsibility to the cause of the illness were significantly associated with higher levels of self-stigma. CONCLUSIONS: Given that awareness and interpretation of participants' illness were related to self-stigma, cognitive restructuring is needed to alleviate self-stigma among individuals with schizophrenia.