Geospatial analysis of suicidal bridge jumping in the Metro Vancouver Regional District from 2006 to 2014

In the past decade, there have been many structural changes implemented to Vancouver's largest bridges as a means of deterring criminogenic and suicidal behaviors. Guided by an environmental criminology theoretical framework, this research examines the patterns and trends of 201 cases of successful suicide jumping in the Metro Vancouver Regional District (MVRD) of British Columbia, Canada from 2006 to 2014. To evaluate these trends and to bolster the existing literature on deterrence measures through environmental design, this research will examine the spatial relationship between preferential bridge jumping locations and the home addresses of the deceased. Network analysis of 145 bridge jumpers suggests that suicidal people are willing to travel greater distances to jump from more iconic bridges than those closest to their home. Beyond mere aesthetic or practical functions, symbolic significance may impact which bridges become suicide hotspots over other convenient locations. Dwelling types, demographic profiles, and regional prevalence in the MVRD have also been aggregated and explored in this study.     

基于网络药理学的大果木姜子油治疗心力衰竭作用机制研究

目的:揭示大果木姜子油治疗心力衰竭的作用机制。方法:首先从动物药理学实验验证疗效,采用异丙肾上腺素(ISO)诱导复制心力衰竭大鼠模型,造模成功后应用大果木姜子油治疗4周,监测血流动力学指标,分析血清BNP水平和心肌组织形态学变化;然后基于文献检索和TCMSP数据库获取大果木姜子油活性成分及作用靶点,从CTD和Drugbank数据库筛选心力衰竭的已知治疗靶点,将疾病治疗靶点与大果木姜子油活性成分作用靶点进行Venn分析,运用SYBYL软件进行分子对接验证,运用STRING数据库分析蛋白互作关系,再利用DAVID数据库进行GO分子功能和KEGG通路富集分析。结果:大果木姜子油可显著升高ISO诱导的心衰大鼠LVSP、±dp/dtmax,降低LVEDP和BNP水平,改善心肌组织形态学变化;获得大果木姜子油20个活性成分,其中7个活性成分(沉香螺旋醇、芳樟醇、萜品烯-4-醇等)可能通过调控一个蛋白互作网络治疗心力衰竭,该网络中的靶点有PTGS1、PTGS2、NOS2、NOS3、GSK3B;由蛋白富集分析发现,这些靶点与前列腺素内过氧化物合酶活性和一氧化氮合酶活性有关。结论:大果木姜子油可改善心衰大鼠的血流动力学紊乱及心肌组织形态学变化;其治疗心力衰竭的机制可能与调控前列腺素内过氧化物合酶活性和一氧化氮合酶活性有关。     

Network analysis of human diseases using Korean nationwide claims data

ObjectiveTo investigate disease–disease associations by conducting a network analysis using Korean nationwide claims data.MethodsWe used the claims data from the Health Insurance Review and Assessment Service-National Patient Sample for the year 2011. Among the 2049 disease codes in the claims data, 1154 specific disease codes were used and combined into 795 representative disease codes. We analyzed for 381 representative codes, which had a prevalence of >0.1%. For disease code pairs of a combination of 381 representative disease codes, P values were calculated by using the χ² test and the degrees of associations were expressed as odds ratios (ORs).ResultsFor 5515 (7.62%) statistically significant disease–disease associations with a large effect size (OR > 5), we constructed a human disease network consisting of 369 nodes and 5515 edges. The human disease network shows the distribution of diseases in the disease network and the relationships between diseases or disease groups, demonstrating that diseases are associated with each other, forming a complex disease network. We reviewed 5515 disease–disease associations and classified them according to underlying mechanisms. Several disease–disease associations were identified, but the evidence of these associations is not sufficient and the mechanisms underlying these associations have not been clarified yet. Further research studies are needed to investigate these associations and their underlying mechanisms.ConclusionHuman disease network analysis using claims data enriches the understanding of human diseases and provides new insights into disease–disease associations that can be useful in future research.     

Impact of the HITECH financial incentives on EHR adoption in small,physician-owned practices

BackgroundPhysicians in small physician-owned practices in the United States have been slower to adopt EHRs than physicians in large practices or practices owned by large organizations. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 included provisions intended to address many of the potential barriers to EHR adoption cited in the literature, including a financial incentives program that has paid physicians and other professionals $13 billion through December 2015.ObjectiveGiven the range of factors that may be influencing physicians’ decisions on whether to adopt an EHR, and given the level of HITECH expenditures to date, there is significant policy value in assessing whether the HITECH incentives have actually had an impact on EHR adoption decisions among U.S. physicians in small, physician-owned practices. This study addresses this question by analyzing physicians’ own views on the influence of the HITECH incentives as well as other potential considerations in their decision-making on whether to adopt an EHR.MethodsUsing data from a national survey of physicians, five composite scales were created from groups of survey items to reflect physician views on different potential facilitators and barriers for EHR adoption as of 2011, after the launch of the HITECH incentives program. Multinomial and binary logistic regression models were specified to test which of these physician-reported considerations have a significant relationship with EHR adoption status among 1043 physicians working in physician-owned practices with no more than 10 physicians.ResultsPhysicians’ views on the importance of the HITECH financial incentives are strongly associated with EHR adoption during the first three years of the HITECH period (2010–2012). In the study’s primary model, a one-point increase on a three-point scale for physician-reported influence of the HITECH financial incentives increases the relative risk of being in the process of adoption in 2011, compared to the risk of remaining a non-adopter, by a factor of 4.02 (p < 0.001, 95% CI of 2.06–7.85). In a second model which excludes pre-HITECH adopters from the data, a one-point increase on the incentives scale increases the relative risk of having become a new EHR user in 2010 or 2011, compared to the risk of remaining a non-adopter, by a factor of 3.98 (p < 0.01, 95% CI of 1.48–10.68) and also increases the relative risk of being in the process of adoption in 2011 by a factor of 5.73 (p < 0.001, 95% CI of 2.57–12.76), compared to the risk of remaining a non-adopter in 2011. In contrast, a composite scale that reflects whether physicians viewed choosing a specific EHR vendor as challenging is not associated with adoption status.ConclusionsThis study’s principal finding is that the HITECH financial incentives were influential in accelerating EHR adoption among small, physician-owned practices in the United States. A second finding is that physician decision-making on EHR adoption in the United States has not matched what would be predicted by the literature on network effects. The market’s failure to converge on a dominant design in the absence of interoperability means it will be difficult to achieve widespread exchange of patients’ clinical information among different health care provider organizations.     

Garcinia cambogia,Either Alone or in Combination With Green Tea,Causes Moderate to Severe Liver Injury

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The association between hepatitis C infection and survival after orthotopic liver transplantation

BACKGROUND & AIMS: The effect of hepatitis C viral (HCV) infection on patient and allograft survival after orthotopic liver transplantation is controversial. Hepatitis C recurrence after transplant is inevitable, but studies to date have not found a survival difference between recipients with and without HCV. METHODS: Using data from the United Network for Organ Sharing, we performed a retrospective cohort study of 11,036 patients who underwent 11,791 liver transplants between 1992 and 1998. The hazard rates of patient and allograft survival for patients who were HCV-positive as compared with patients who were HCV-negative were assessed by proportional-hazards analysis, with adjustment for potential confounding variables, including donor, recipient, and transplant center characteristics. RESULTS: Liver transplantation in HCV-positive recipients was associated with an increased rate of death (hazard ratio, 1.23; 95% confidence interval [CI], 1.12-1.35) and allograft failure (hazard ratio, 1.30; 95% CI, 1.21-1.39), as compared with transplantation in HCV-negative recipients. This reduction in survival persisted after adjusting for potential confounders. There was an interaction between HCV and sex (P < 0.001) with the effect of HCV on survival being most pronounced in female recipients (patient survival hazard ratio, 1.56; 95% CI, 1.35-1.81; allograft survival hazard ratio, 1.51; 95% CI, 1.34-1.70). CONCLUSIONS: HCV infection significantly impairs patient and allograft survival after liver transplantation.     

Fisetin for COVID-19 in skilled nursing facilities: Senolytic trials in the COVID era

The burden of senescent cells (SnCs), which do not divide but are metabolically active and resistant to death by apoptosis, is increased in older adults and those with chronic diseases. These individuals are also at the greatest risk for morbidity and mortality from SARS-CoV-2 infection. SARS-CoV-2 complications include cytokine storm and multiorgan failure mediated by the same factors as often produced by SnCs through their senescence-associated secretory phenotype (SASP). The SASP can be amplified by infection-related pathogen-associated molecular profile factors. Senolytic agents, such as Fisetin, selectively eliminate SnCs and delay, prevent, or alleviate multiple disorders in aged experimental animals and animal models of human chronic diseases, including obesity, diabetes, and respiratory diseases. Senolytics are now in clinical trials for multiple conditions linked to SnCs, including frailty; obesity/diabetes; osteoporosis; and cardiovascular, kidney, and lung diseases, which are also risk factors for SARS-CoV-2 morbidity and mortality. A clinical trial is underway to test if senolytics decrease SARS-CoV-2 progression and morbidity in hospitalized older adults. We describe here a National Institutes of Health-funded, multicenter, placebo-controlled clinical trial of Fisetin for older adult skilled nursing facility (SNF) residents who have been, or become, SARS-CoV-2 rtPCR-positive, including the rationale for targeting fundamental aging mechanisms in such patients. We consider logistic challenges of conducting trials in long-term care settings in the SARS-CoV-2 era, including restricted access, consent procedures, methods for obtaining biospecimens and clinical data, staffing, investigational product administration issues, and potential solutions for these challenges. We propose developing a national network of SNFs engaged in interventional clinical trials.