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Health 2023年第2期15卷 177-185页

作者： Glenn Melnick june o’leary Sol Price School of Public Policy University of Southern California Los Angeles CA USA

The topic of the long-term effects of CoVID-19, so-called “long-CoVID”, has gained increased attention. The US federal government announced plans to develop an interagency national research action plan to uncover more insights into the long-term effects of CoVID-19. This study contributes to our understanding of the long-term effects of CoVID-19 by quantifying patterns of healthcare utilization up to 360 days after an initial CoVID-19 diagnosis occurring during the beginning of the pandemic (March-August 2020) in a very large nationally representative population of insured adults. We quantify actual CoVID-19-related utilization (as opposed to reported symptoms) by accessing claims data to calculate average medical visits per patient per month by type of encounter (e.g. inpatient stay, physician visit). In contrast to many recent reports in the media, our results show that CoVID-19-related utilization declines substantially after the first-month post-diagnosis and continues to decline throughout the study period to very low levels.

关键词： CoVID-19 Utilization Long-CoVID Utilization

The Evolving Structure of Multi-Hospital Systems in the US: Focus on California

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Health 2021年第7期13卷 757-765页

作者： Glenn Melnick june F. o’leary Sol Price School of Public Policy University of Southern California Los Angeles CA USA

objectives: Hospital consolidation and the growth of multi-hospital systems are generating media headlines in the US. While there is a growing literature on the role of multi-hospital systems in the US health care sys... 详细信息

ong>objectives:ong> Hospital consolidation and the growth of multi-hospital systems are generating media headlines in the US. While there is a growing literature on the role of multi-hospital systems in the US health care system, it is still quite limited. This study helps fill the gap by documenting and describing the structure and evolution of multi-hospital systems in California over a recent 18-year period. ong>Methods:ong> Descriptive analysis of a hospital level longitudinal database covering the period 2002-2019 in California. ong>Results:ong> The total number of hospitals declined by 40 hospitals, from 445 to 405, over the study period and the total number of multi-hospital systems increased substantially from 14 systems in 2002 to 30 systems in 2019. As a result, the number and proportion of all California hospitals that were part of a multi-hospital system grew—from 177 in 2002 to 238 in 2019. By 2019, 59% of all hospitals were part of systems (compared to 40% in 2002). The size distribution of multi-hospital systems in California changed substantially over time. In the early period, larger systems dominated the system landscape. Now, half of all systems have 5 or fewer hospitals compared to 29% in 2002, while the percentage of systems with 25 or more members has declined from 25% to just 7%. Interestingly, the clinical service mix of hospital systems has changed substantially. In 2002, all 14 systems were largely acute care focused. By 2019, less than half of systems had acute care as their only and primary focus. ong>Conclusions: ong>Combined, these findings provide insight into the development, evolution and growing role of hospitals systems in our health care system and identify new areas for further research.

关键词： Hospital Systems Consolidation Multi-Hospital Systems

Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes

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Health 2018年第2期10卷 171-180页

作者： june F. o’leary Janelle Howe Jeremy Rich Glenn Melnick Sol Price School of Public Policy University of Southern California Los Angeles CA USA DaVita HealthCare Partners Medical Group El Segundo CA USA HealthCare Partners Institute for Applied Research and Education El Segundo CA USA

objectives: While the value of glycemic control to minimize adverse health outcomes among patients with diabetes is clear, achieving hemoglobin A1c (A1c) goals remain a challenge. We evaluated the use of financial incentives to increase enrollment and improve glycemic control among patients invited to participate in a monthly diabetes group appointment (DGA) as part of their enrollment in DaVita HealthCare Partners, a large southern California managed care organization. Methods: Adult diabetes patients (≥18 years) with a currently uncontrolled hemoglobin A1c level (>8.0% if 9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater Los Angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. on average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, -1.2%) versus non-incentive DGA (9.7% to 9.0%, -0.7%) versus no DGA group (9.1% to 8.7%, -0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under “real-world” conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications.

关键词： Diabetes Glycemic Control Financial Incentives Behavioral Economics Group Appointments

A pipeline to characterize p53 effectors by integrative cistrome and transcriptome analysis in a genetically-defined organoid model

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Genes & Diseases 2024年第2期11卷 512-515页

作者： june-Ha Shin Hwa-Ryeon Kim Jae-Seok Roe Department of Biochemistry College of Life Science and BiotechnologyYonsei UniversitySeoul 120-749Republic of Korea

Tumor-protein 53(p53)is a transcription factor(TF)encoded by TP53(Trp53 in mice)and is a master regulator of tumor-suppressive programs'.Importantly,TP53 is the most frequently mutated gene in human cancer,and its loss of function contributes to tumor development,exemplified by variable p53 mutations detected in 50%-75%of pancreatic cancers.2 From these perceptions,a number of targets transcribed by p53 that confer tumor suppression have been ***,our understanding of how p53 prevents normal cells from initiating tumorigenesis is still *** complement this limitation,herein,we established a new approach to identify underlying effectors transcribed by p53 in normal physiology.

关键词： incomplete initiating herein

Fortifying Smart Grids: A Holistic Assessment Strategy against Cyber Attacks and Physical Threats for Intelligent Electronic Devices

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Computers, Materials & Continua 2024年第8期80卷 2579-2609页

作者： Yangrong Chen june Li Yu Xia Ruiwen Zhang Lingling Li Xiaoyu Li Lin Ge School of Computer Science Zhengzhou University of AeronauticsZhengzhou450046China Henan Xin’an Century Technology Co. Ltd.Henan Data Security Engineering Technology Research CenterZhengzhou450046China Key Laboratory of Aerospace Information Security and Trusted Computing Ministry of EducationSchool of Cyber Science and EngineeringWuhan UniversityWuhan430072China

Intelligent electronic devices(IEDs)are interconnected via communication networks and play pivotal roles in transmitting grid-related operational data and executing control *** the context of the heightened security challenges within smart grids,IEDs pose significant risks due to inherent hardware and software vulner-abilities,as well as the openness and vulnerability of communication *** grid security,distinct from traditional internet security,mainly relies on monitoring network security events at the platform layer,lacking an effective assessment mechanism for ***,we incorporate considerations for both cyber-attacks and physical faults,presenting security assessment indicators and methods specifically tailored for ***,we outline the security monitoring technology for IEDs,considering the necessary data sources for their security ***,we classify IEDs and establish a comprehensive security monitoring index system,incorporating factors such as running states,network traffic,and abnormal *** index system contains 18 indicators in 3 ***,we elucidate quantitative methods for various indicators and propose a hybrid security assessment method known as GRCW-hybrid,combining grey relational analysis(GRA),analytic hierarchy process(AHP),and entropy weight method(EWM).According to the proposed assessment method,the security risk level of IEDs can be graded into 6 levels,namely 0,1,2,3,4,and *** higher the level,the greater the security ***,we assess and simulate 15 scenarios in 3 categories,which are based on monitoring indicators and real-world situations encountered by *** results show that calculated security risk level based on the proposed assessment method are consistent with actual ***,the reasonableness and effectiveness of the proposed index system and assessment method are validated.

关键词： Smart grid intelligent electronic device security assessment abnormal behaviors network traffic running states

[001]-texturing of(K,Na)Nbo_(3)-based piezoceramics with a pseudocubic structure and their application to piezoelectric devices

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Journal of Materiomics 2024年第3期10卷 632-642页

作者： Su-Hwan Go Seok-Jung Park Seung-Hyun Kim Seok-june Chae Eun-Ji Kim Geun-Su Lee Sahn Nahm Department of Materials Science and Engineering Korea UniversitySeoul02841Republic of Korea

0.96(K_(0.5)Na_(0.5-z)Li_(z))(Nb_(0.92)Sb_(0.08))o_(3)-0.04(Ca_(0.5)Sr_(0.5))Zro_(3)[(KN_(0.5-z)L_(z))NS-CSZ]piezoceramics(0≤z≤0.04)were aligned in the[001]orientation using 3%(in mole)NaNbo_(3)templates with a large Lotgering factor(>97%).Their crystal structures transformed from the orthorhombic-pseudocubic(o-P)structure to the orthorhombic-tetragonal-pseudocubic(o-T-P)structure with an increasing *** P structure was interpreted as a rhombohedral R3m *** piezoelectricity of the compositions increased after[001]-texturing,and the enhancement was proportional to the o phase *** composition(z=0.03)exhibited the highest piezoelectric constant(d_(33);670 pC/N)and electromechanical coupling factor(k_(p);0.56).Piezoelectric energy harvesters were produced using the untextured and textured samples(z=0.03).The textured harvester delivered a large power density of 26.6 mW/mm^(3),which was larger than that of the untextured harvester owing to the enhanced kp and d_(33)×g_(33) of the textured piezoceramic.A multilayer actuator was produced using the textured sample(z=0.03),and it exhibited a large acceleration(44.2 G)and displacement(±3,730 mm)at±25 ***,the[001]-textured(KN_(0.47)L_(0.03))NS-CSZ piezoceramic is suitable for piezoelectric energy harvesters and actuators.

关键词： KNN-Based piezoceramic Lead-free Energy harvester Actuator Reactive template grain growth

Etanercept-synthesizing adipose-derived stem cell secretome:A promising therapeutic option for inflammatory bowel disease

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 882-892页

作者： Say-june Kim ok-Hee Kim Ha-Eun Hong Ji Hyeon Ju Do Sang Lee Department of Surgery Seoul St.Mary’s HospitalCollege of Medicinethe Catholic University of KoreaSeoul 06591South Korea Catholic Central Laboratory of Surgery Institute of Biomedical IndustryCollege of Medicinethe Catholic University of KoreaSeoul 06591South Korea Division of Rheumatology Department of Internal MedicineSeoul St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 06591South Korea

BACKGRoUND Inflammatory bowel disease(IBD)is a chronic inflammatory condition of the gastrointestinal tract,with tumor necrosis factor(TNF)-αplaying a key role in its ***,a decoy receptor for TNF,is used to treat inflammatory *** secretome derived from adipose-derived stem cells(ASCs)has anti-inflammatory effects,making it a promising therapeutic option for *** To investigate the anti-inflammatory effects of the secretome obtained from ASCs synthesizing etanercept on colon cells and in a dextran sulfate sodium(DSS)-induced IBD mouse *** ASCs were transfected with etanercept-encoding mini-circle plasmids to create etanercept-producing *** secretory material from these cells was then tested for anti-inflammatory effects both in vitro and in a DSS-induced IBD mouse *** This study revealed promising results indicating that the group treated with the secretome derived from etanercept-synthesizing ASCs[Etanercept-Secretome(Et-Sec)group]had significantly lower expression levels of inflammatory mediators,such as interleukin-6,Monocyte Chemoattractant Protein-1,and TNF-α,when compared to the control secretome(Ct-Sec).Moreover,the Et-Sec group exhibited a marked therapeutic effect in terms of preserving the architecture of intestinal tissue compared to the *** These results suggest that the secretome derived from ASCs that synthesize etanercept has potential as a therapeutic agent for the treatment of IBD,potentially enhancing treatment efficacy by merging the anti-inflam-matory qualities of the ASC secretome with etanercept's targeted approach to better address the multifaceted pathophysiology of IBD.

关键词： Adipose-derived stem cells Etanercept Inflammatory bowel disease Secretome Tumor necrosis factor-α

Desialylated Platelet Clearance in the Liver is a Novel Mechanism of Systemic Immunosuppression

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Research 2024年第3期2023卷 35-50页

作者： june Li Danielle Karakas Feng Xue Yingyu Chen Guangheng Zhu Yeni H.Yucel Sonya A.MacParland Haibo Zhang John W.Semple John Freedman Qizhen Shi Heyu Ni Department of Laboratory Medicine and Pathobiology University of TorontoTorontoONCanada Toronto Platelet Immunobiology Group TorontoONCanada Keenan Research Centre for Biomedical Science of St.Michael's Hospital TorontoONCanada Canadian Blood Services Centre for Innovation TorontoONCanada Departments of Pediatrics Medical College of WisconsinMilwaukeeWIUSA Blood Research Institute Versiti WisconsinMilwaukeeWIUSA Departments of ophthalmology and Vision Sciences Medicine University of TorontoTorontoONCanada Faculty of Engineering and Architectural Science Ryerson UniversityTorontoONCanada Multi-organ Transplant Program Toronto General Hospital Research InstituteTorontoONCanada Department of Immunology University of TorontoTorontoONCanada Critical Care Medicine Department ofAnesthesiology and PainUniversity of TorontoTorontoONCanada Department of Physiology University of TorontoTorontoONCanada Department of Pharmacology University of TorontoTorontoONCanada. Division of Hematology and Transfusion Medicine Lund UniversityLundSweden clinical Immunology and Transfusion Medicine Ofice of Medical ServicesRegion SkaneLundSweden Department of Medicine University of TorontoTorontoONCanada Children's Research Institute Children's WisconsinWauwatosaWIUSA Midwest Athletes Against Childhood Cancer Fund Research Center MilwaukeeWIUSA.

Platelets are small, versatile blood cells that are critical for hemostasis/thrombosis. Local platelet accumulation is a known contributor to proinflammation in various disease states. However, the anti-inflammatory/immunosuppressive potential of platelets has been poorly explored. Here, we uncovered, unexpectedly, desialylated platelets (dPLTs) down-regulated immune responses against both platelet-associated and -independent antigen challenges. Utilizing multispectral photoacoustic tomography, we tracked dPLT trafficking to gut vasculature and an exclusive Kupffer cell-mediated dPLT clearance in the liver, a process that we identified to be synergistically dependent on platelet glycoprotein Ibα and hepatic Ashwell–Morell receptor. Mechanistically, Kupffer cell clearance of dPLT potentiated a systemic immunosuppressive state with increased anti-inflammatory cytokines and circulating CD4+ regulatory T cells, abolishable by Kupffer cell depletion. Last, in a clinically relevant model of hemophilia A, presensitization with dPLT attenuated anti-factor VIII antibody production after factor VIII ( infusion. As platelet desialylation commonly occurs in daily-aged and activated platelets, these findings open new avenues toward understanding immune homeostasis and potentiate the therapeutic potential of dPLT and engineered dPLT transfusions in controlling autoimmune and alloimmune diseases.

关键词： Platelet transfusion homeostasis

Is a Mini-Screen for Fetal Alcohol Spectrum Disorder Feasible?

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open Journal of Pediatrics 2024年第4期14卷 767-781页

作者： Tyler Mueller Devin Evavold june-Yung Kim Marilyn G. Klug Larry Burd School of Medicine and Health Sciences University of North Dakota Grand Forks USA Department of Social Work University of North Dakota Grand Forks USA

Background: Fetal Alcohol Spectrum Disorders (FASDs) are a global public health concern with lifelong consequences for affected individuals. Recent prevalence studies suggest FASD prevalence rates range from 1-5% among school age children. Most people with FASD are not correctly diagnosed and inadequate screening to identify patients with increased risk may contribute to under-diagnosis. This study developed a 10-item screening tool for FASD and examined its feasibility. Methods: The sample consisted of 355 children who had been evaluated at an FASD clinic. Data from the 33-item Alcohol Related Neurodevelopmental Disorder Behavioral Checklist was used to develop a brief FASD screen by comparing the changes in Cronbach’s alpha for different combinations of items. The validity of the brief scale was then further examined using receiving operating characteristic analyses. Results: The 10-item screen demonstrated acceptable sensitivity, specificity, and accuracy to identify children at high risk for FASD. The percentage correctly classified was 91.3 and the area under the receiving operating characteristic curve was 0.971. Conclusions: This feasibility study demonstrated that a screen for FASD consisting of 10 items with yes or no responses can be completed in 3 - 4 minutes. The tool is brief, with a low administration burden and has acceptable epidemiologic performance characteristics including accuracy. Future research should examine the performance of this tool when used in larger, community-based populations where screening for FASD would be appropriate.

关键词： Fetal Alcohol Spectrum Disorders (FASDs) Children Screening Prevalence

Immune remodulation in pediatric inherited metabolic liver diseases

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World Journal of Hepatology 2024年第9期16卷 1258-1268页

作者： Yi-Chi Wu Xue-Lin Xiang june-Kong Yong Meng Li Lin-Man Li Zi-Cheng Lv Yi Zhou Xi-Cheng Sun Zi-Jie Zhang Huan Tong Xiao-Ying He Qiang Xia Hao Feng Department of Liver Surgery Renji Hospital(Punan Branch)School of MedicineShanghai Jiao Tong UniversityShanghai 200127China Department of Liver Surgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200127China Department of Liver Surgery Renji Hospital Affiliated to Shanghai Jiao Tong UniversityShanghai Institute of TransplantationShanghai Engineering Research Center of Transplantation and ImmunologyShanghai 200127China Department of Gynecology Shanghai First Maternity and Infant HospitalShanghai 200012China

Inherited metabolic liver diseases arise from genetic mutations that lead to dis-ruptions in liver metabolic pathways and are predominantly observed in pedia-tric *** spectrum of genetic metabolic liver disorders is diverse,encompassing a range of conditions associated with aberrations in iron,copper,carbohydrate,lipid,protein,and amino acid ***,research in the domain of genetic metabolic liver diseases has predominantly concentrated on hepatic parenchymal cell ***,emerging studies suggest that inherited metabolic liver diseases exert significant influences on the immune microenvironment,both within the liver and *** review endeavors to encapsulate the immunological features of genetic metabolic liver diseases,aiming to expand the horizons of researchers in this discipline,and to elucidate the underlying pathophysiological mechanisms pertinent to hereditary metabolic liver diseases and to propose innovative therapeutic approaches.

关键词： Liver transplantation Inherited metabolic liver diseases Immune microen-vironment Genetic metabolic liver diseases Immunotherapy