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In response to the coronavirus diseases 2019 (COVID-19) pandemic, the Japanese government declared a state of emergency on April 7, 2020. Six days earlier, the Japan Surgical Society had recommended postponing elective surgical procedures. Along with the growing public fear of COVID-19, hospital visits in Japan decreased.

Using claims data from the Quality Indicator/Improvement Project (QIP) database, this study aimed to clarify the impact of the first wave of the pandemic, considered to be from March to May 2020, on case volume and claimed hospital charges in acute care hospitals during this period. To make year-over-year comparisons, we considered cases from July 2018 to June 2020.

A total of 2,739,878 inpatient and 53,479,658 outpatient cases from 195 hospitals were included. In the year-over-year comparisons, total claimed hospital charges decreased in April, May, June 2020 by 7%, 14%, and 5%, respectively, compared to the same months in 2019. Our results also showed that per-case hospital charges increased during this period, possibly to compensate for the reduced case volumes. Regression results indicated that the hospital charges in April and May 2020 decreased by 6.3% for hospitals without COVID-19 patients. For hospitals with COVID-19 patients, there was an additional decrease in proportion with the length of hospital stay of COVID-19 patients including suspected cases. The mean additional decrease per COVID-19 patient was estimated to 5.5 million JPY.

It is suggested that the hospitals treating COVID-19 patients were negatively incentivized.

It is suggested that the hospitals treating COVID-19 patients were negatively incentivized.

Accurate and timely diagnosis of breast carcinoma is very crucial because of its high incidence and high morbidity. Screening can improve overall prognosis by detecting the disease early. Biopsy remains as the gold standard for pathological confirmation of malignancy and tumour grading. The development of diagnostic imaging techniques as an alternative for the rapid and accurate characterization of breast masses is necessitated. Quantitative ultrasound (QUS) spectroscopy is a modality well suited for this purpose. This study was carried out to evaluate different texture analysis methods applied on QUS spectral parametric images for the characterization of breast lesions.

Parametric images of mid-band-fit (MBF), spectral-slope (SS), spectral-intercept (SI), average scatterer diameter (ASD), and average acoustic concentration (AAC) were determined using QUS spectroscopy from 193 patients with breast lesions. Texture methods were used to quantify heterogeneities of the parametric images. Three statistical-bacificity, 91% accuracy, 0.95 AUC using QUS parameters and their GLSZM texture features.

A QUS-based framework and texture analysis methods enabled classification of breast lesions with >90% accuracy. The results suggest that optimizing method for extracting discriminative textural features from QUS spectral parametric images can improve classification performance. Evaluation of the proposed technique on a larger cohort of patients with proper validation technique demonstrated the robustness and generalization of the approach.

90% accuracy. The results suggest that optimizing method for extracting discriminative textural features from QUS spectral parametric images can improve classification performance. Evaluation of the proposed technique on a larger cohort of patients with proper validation technique demonstrated the robustness and generalization of the approach.Drug resistance (DR) remains a major challenge for tuberculosis (TB) control. Whole-genome sequencing (WGS) provides the highest genetic resolution for genotypic drug-susceptibility tests (DST). We compared DST profiles of 60 Mycobacterium tuberculosis isolates which were drug resistant according to agar proportion tests (one poly DR-TB, 34 multidrug-resistant TB and 25 extensively drug-resistant TB). We additionally performed minimum inhibitory concentration (MIC) tests using Sensititre MYCOTBI plates (MYCOTB) and a WGS-based DST. Agreement between WGS-based DST and MYCOTB was high for all drugs except ethambutol (65%) and ethionamide (62%). Isolates harboring the -15 c/t inhA promoter mutation had a significantly lower MIC for isoniazid than did isolates with the katG Ser315Thr mutation (p less then 0.001). Similar patterns were seen for ethambutol (embB Gly406Asp vs. embB Met306Ile), streptomycin (gid Gly73Ala vs. rpsL Lys43Arg), moxifloxacin (gyrA Ala90Val vs. gyrA Asp94Gly) and rifabutin (rpoB Asp435Phe/Tyr/Val vs. rpoB Ser450Leu). For genotypic heteroresistance, isolates with lower proportion of mapped read tended to has lower MIC of anti-TB drugs than those with higher proportion. These results emphasize the high applicability of WGS for determination of DR-TB and the association of particular mutations with MIC levels.

With the emergence of new health information technologies, health information can be shared across networks, with or without patients' awareness and/or their consent. It is often argued that there can be an ethical obligation to participate in biomedical research, motivated by altruism, particularly when risks are low. In this study, we explore whether altruism contributes to the belief that there is an ethical obligation to share information about one's health as well as how other health care experiences, perceptions, and concerns might be related to belief in such an obligation.

We conducted an online survey using the National Opinion Research Center's (NORC) probability-based, nationally representative sample of U.S. adults. Our final analytic sample included complete responses from 2069 participants. We used multivariable logistic regression to examine how altruism, together with other knowledge, attitudes, and experiences contribute to the belief in an ethical obligation to allow health information t used for research is shaped by altruism and by one's experience with, and perceptions of, health care and by general concerns about the use of personal information. Altruism cannot be assumed and researchers must recognize the ways encounters with the health care system influence (un)willingness to share one's health information.

The use of severity of illness scoring systems such as the Acute Physiology and Chronic Health Evaluation in lower-middle income settings comes with important limitations, primarily due to data burden, missingness of key variables and lack of resources. To overcome these challenges, in Asia, a simplified model, designated as e-TropICS was previously developed. We sought to externally validate this model using data from a multi-centre critical care registry in India.

Seven ICUs from the Indian Registry of IntenSive care(IRIS) contributed data to this study. Patients > 18 years of age with an ICU length of stay > 6 hours were included. Data including age, gender, co-morbidity, diagnostic category, type of admission, vital signs, laboratory measurements and outcomes were collected for all admissions. e-TropICS was calculated as per original methods. The area under the receiver operator characteristic curve was used to express the model's power to discriminate between survivors and non-survivors. For alent of calibration in larger datasets from India and across the South-East Asia region will help in improving model performance.

e-TropICS has utility in the care of critically unwell patients in the South Asia region with good discriminative capacity. Further refinement of calibration in larger datasets from India and across the South-East Asia region will help in improving model performance.Grassroots have received more attention than the traditional method as soil reinforcement materials, especially the use of vetiver and other vegetation protection methods to treat expansive soil slope, have been tried and applied. To study the influence of grassroots on the strength properties of expansive soil, the laws of vetiver root growth over time and its vertical distribution of root content(δ) were firstly investigated by the experiment of planting vetiver. Then different δ and depth of planted soil were obtained. Simultaneously different δ and water content(ω) of grafted soil were made. With the direct shear test, the shear strength parameters of root-soil with different δ were analyzed. The shear test on root-soil composites with different δ was carried out to compare the strength characteristics of planted and grafted soil. The results showed that the δ of vetiver decreased with the increase of depth, and the δ of each layer increased with the growth period. The δ of 180d was 70.5% higher than that of 90d. The cohesion(c) of root-soil can be increased by more than 97%, and internal friction angle(φ) can be increased by more than 15.4% after 180 days. Necrostatin 2 purchase The c of 90 d vetiver root system can be increased by more than 18%, and the φ can be increased by more than 1.5%. At each depth, the c and φ of composite soil increases with the increase of δ, and the increment of cohesion (Δc) and the increment of internal friction angle (Δφ) increase with the increment of δ. But the increase in the ω will weaken the shear strength parameters of root-soil. Under the condition of the planted root system and grafted root system, the influence degree of δ on strength parameter of root-soil is different, and the law of strength parameters versus δ of grafted soil of 365d is similar to that of planted soil of 90d. And the root reinforcement of grafted soil is weaker than planted soil. Hence the grafted soil can´t accurately reflect the root-soil interaction of the existing root system.Imbalances in thyroid-stimulating hormone (TSH) levels are associated with metabolic syndrome (MetS), and the underlying mechanism is partly in alignment with that of lead exposure causing MetS. Many studies have reported the association between lead exposure and MetS, but no study has considered the possibility of TSH mediating lead's effect on MetS. Therefore, we aimed to examine the association between lead exposure and MetS considering TSH as a partial mediator. The data of 1,688 adults (age ≥19 years) from the Korea National Health and Nutrition Examination Survey in 2013 were analyzed. The prevalence of MetS in the Korean population was 21.9%, and the geometric mean of blood lead and serum TSH levels were 1.96 μg/dL and 2.17 μIU/mL, respectively. The associations between blood lead levels, serum TSH levels, and MetS were determined through a multiple logistic regression analysis. Blood lead levels were positively associated with high TSH levels (upper 25%) with an odds ratio (OR) and 95% confidence interval (CI) of 1.79 (1.24, 2.58) per doubled lead levels. The increase in blood lead and serum TSH levels both positively increased the odds of developing MetS. The OR of MetS per doubling of blood lead level was 1.53 (1.00, 2.35), and was not attenuated after adjusting for TSH levels. These findings suggest that higher levels of blood lead are positively associated with serum TSH levels and MetS. By exploring the role of TSH as a partial mediator between lead and MetS, we verified that lead exposure has an independent relationship with MetS, regardless of TSH levels.