Are ulcers a marker for invasive carcinoma in barrett's esophagus? data from a diagnostic variability study with clinical follow-up

We correlated follow-up information from 138 patients with Barrett's esophagus and varying degrees of dysplasia with the presence of ulcers. Methods A group of pathologist participants were asked to contribute patients’ initial biopsy slides showing Barrett's esophagus (BE) without dysplasia and with epithelial changes indefinite for dysplasia, low grade dysplasia (LGD), high grade dysplasia (HGD), and adenocarcinoma. From the initial 250 cases used for a diagnostic reproducibility study, follow-up information was available for 138 patients. Results There were 44 cases submitted as BE, 22 as BE with epithelial changes indefinite for dysplasia, 26 as BE with LGD, 33 as BE with HGD, and 13 as BE with adenocarcinoma. Ulcers were present in 35/138 cases (25%), including 3/44 cases of BE without dysplasia (7%), 2/22 cases of BE with epithelial changes indefinite for dysplasia (9%), 0/26 cases of BE with LGD (0%), 10/33 cases of BE with HGD (30%), and 7/13 cases of BE with adenocarcinoma (54%). On follow-up, there were no invasive carcinomas detected among the BE without dysplasia group (median follow-up = 38.5 months). Adenocarcinomas were detected in 4/22 cases (18%) submitted as BE with epithelial changes indefinite for dysplasia at 19, 55, 60, and 62 months and in 4/26 cases (15%) of BE with LGD at 9, 9, 11, and 60 months. None of these carcinomas occurred in cases in which an ulcer was present in the initial biopsy specimen. Among the 33 HGD cases, 20 (60%) were found to have adenocarcinoma on subsequent resection specimens. The presence of an ulcer with HGD increased the likelihood of finding carcinoma in the resection specimen, as 8/10 biopsies (80%) of HGD patients with ulcers had carcinoma, compared to 12/23 biopsies (52%) of HGD patients without ulcers. All of the cases interpreted as adenocarcinomas on biopsy were found either to have invasive carcinoma on esophageal resection or to have metastases that were demonstrated in unresectable patients. Conclusion If an ulcer accompanies HGD in a biopsy specimen from a patient with BE, it is likely that invasive carcinoma is also present at that time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75186/1/j.1572-0241.2002.05420.x.pd

Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Readmission Rates: Implications for the Hospital Readmissions Reduction Program

Under the Hospital Readmissions Reduction Program (HRRP) of the Centers for Medicare & Medicaid Services (CMS), hospitals with excess readmissions for select conditions and procedures are penalized. However, readmission rates are not risk adjusted for socioeconomic status (SES) or race/ethnicity. We examined how adding SES and race/ethnicity to the CMS risk-adjustment algorithm would affect hospitals’ excess readmission ratios and potential penalties under the HRRP. For each HRRP measure, we compared excess readmission ratios with and without SES and race/ethnicity included in the CMS standard risk-adjustment algorithm and estimated the resulting effects on overall penalties across a number of hospital characteristics. For the 5 HRRP measures (heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and total hip or knee arthroplasty), we used data from the Healthcare Cost and Utilization Project’s State Inpatient Databases for 2011-2012 to calculate the excess readmission ratio with and without SES and race/ethnicity included in the model. With these ratios, we estimated the impact on HRRP penalties and found that risk adjusting for SES and race/ethnicity would affect Medicare payments for 83.8% of hospitals. The effect on the size of HRRP penalties ranged from −14.4% to 25.6%, but the impact on overall Medicare base payments was small—ranging from −0.09% to 0.06%. Including SES and race/ethnicity in the calculation had a disproportionately favorable effect on safety-net and rural hospitals. Any financial effects on hospitals and on the Medicare program of adding SES and race/ethnicity to the HRRP risk-adjustment calculation likely would be small

Imaging of zinc oxide nanoparticle penetration in human skin in vitro and in vivo

Zinc oxide (ZnO-nano) and titanium dioxide nanoparticles (20 to 30 nm) are widely used in several topical skin care products, such as sunscreens. However, relatively few studies have addressed the subdermal absorption of these nanoparticles in vivo. We report on investigation of the distribution of topically applied ZnO in excised and in vivo human skin, using multiphoton microscopy (MPM) imaging with a combination of scanning electron microscopy (SEM) and an energy-dispersive x-ray (EDX) technique to determine the level of penetration of nanoparticles into the sub-dermal layers of the skin. The good visualization of ZnO in skin achieved appeared to result from two factors. First, the ZnO principal photoluminescence at 385 nm is in the "quiet" spectral band of skin autofluorescence dominated by the endogenous skin fluorophores, i. e., NAD[P]H and FAD. Second, the two-photon action cross section of ZnO-nano [sigma((TPEF))(ZnO) similar to 0.26 GM; diameter, 18 nm] is high: similar to 500-fold of that inferred from its bulk third-order nonlinear susceptibility [Im chi((3))(ZnO)], and is favorably compared to that of NAD[P]H and FAD. The overall outcome from MPM, SEM, and EDX studies was that, in humans in vivo, ZnO nanoparticles stayed in the stratum corneum (SC) and accumulated into skin folds and/or hair follicle roots of human skin. Given the lack of penetration of these nanoparticles past the SC and that the outermost layers of SC have a good turnover rate, these data suggest that the form of ZnO-nano studied here is unlikely to result in safety concerns. (c) 2008 Society of Photo-Optical Instrumentation Engineers. [DOI: 10.1117/1.3041492

Perceived Susceptibility to Illness in Ethnic Minority Men

History would show that ethnic minority communities’ health concerns often go unknown to the masses. Men in particular are a mystery to healthcare providers as well. Women are more likely to disclose information thus being more willing to participate in a study, let alone explore health concerns. Pair up being a male with being ethnic minority and you will have health topics that may not have been explored prior come to surface. The study is a community-based project with a purpose to acquire knowledge of men\u27s beliefs about certain health concerns. Participation in the study are exclusive to ethnic minority men over the age of 18. Studies are currently being conducted in the metro Atlanta area. Although it is a very diverse area, challenges in data collection rise being that the study focuses on a skeptic population. Incomplete surveys, non-disclosure to demographics, and time have served as the source to these methodological challenges. Conclusions will include levels of agreement on statements about health issues as well as nonidentifiable demographic questions for analyzation. The anticipated results could lead to the overall betterment in representation for ethnic minority men in healthcare. Due to this study being an expansion of past research on this topic, expected results hold that men will be most concerned with getting diabetes and high blood pressure. Still, keeping in mind their perspectives on these health topics, new ways to raise awareness, educate, and treat could surface

Introduction to the Special Issue on Machine Translation for Low-Resource Languages

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Concentration-Dependent Photocatalytic Upcycling of Poly(ethylene terephthalate) Plastic Waste

Photocatalytic plastic waste upcycling into value-added feedstock is a promising way to mitigate the environmental issues caused by the nondegradable nature of plastic waste. Here, we developed a MoS2/g-C3N4 photocatalyst that can efficiently upcycle poly(ethylene terephthalate) (PET) into valuable organic chemicals. Interestingly, the conversion mechanism is concentration-dependent. For instance, at a low ethylene glycol (EG) concentration (7.96 mM), acetate is the main product. Unexpectedly, the conversion of PET water bottle hydrolysate with only 7.96 mM ethylene glycol (EG) can produce a 4 times higher amount of acetate (704.59 nmol) than the conversion of 300 mM EG (174.50 nmol), while at a higher EG concentration (300 mM), formate is the dominant product. Herein, a 40 times higher EG concentration (300 mM compared to 7.96 mM) would produce only ∼3 times more formate (179 nmol compared to 51.86 nmol). In addition, under natural sunlight conditions, comparable amounts of liquid and gaseous products are produced when commercial PET plastics are employed. Overall, the photocatalytic PET conversion process is quite efficient under a low concentration of EG in PET hydrolysate, indicating the enormous potential of this photocatalysis strategy for real plastics upcycling

Zinc Single Atom Confinement Effects on Catalysis in 1T-Phase Molybdenum Disulfide

Active sites are atomic sites within catalysts that drive reactions and are essential for catalysis. Spatially confining guest metals within active site microenvironments has been predicted to improve catalytic activity by altering the electronic states of active sites. Using the hydrogen evolution reaction (HER) as a model reaction, we show that intercalating zinc single atoms between layers of 1T-MoS2 (Zn SAs/1T-MoS2) enhances HER performance by decreasing the overpotential, charge transfer resistance, and kinetic barrier. The confined Zn atoms tetrahedrally coordinate to basal sulfur (S) atoms and expand the interlayer spacing of 1T-MoS2 by ∼3.4%. Under confinement, the Zn SAs donate electrons to coordinated S atoms, which lowers the free energy barrier of H* adsorption-desorption and enhances HER kinetics. In this work, which is applicable to all types of catalytic reactions and layered materials, HER performance is enhanced by controlling the coordination geometry and electronic states of transition metals confined within active-site microenvironments

Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Readmission Rates

Under the Hospital Readmissions Reduction Program (HRRP) of the Centers for Medicare & Medicaid Services (CMS), hospitals with excess readmissions for select conditions and procedures are penalized. However, readmission rates are not risk adjusted for socioeconomic status (SES) or race/ethnicity. We examined how adding SES and race/ethnicity to the CMS risk-adjustment algorithm would affect hospitals’ excess readmission ratios and potential penalties under the HRRP. For each HRRP measure, we compared excess readmission ratios with and without SES and race/ethnicity included in the CMS standard risk-adjustment algorithm and estimated the resulting effects on overall penalties across a number of hospital characteristics. For the 5 HRRP measures (heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and total hip or knee arthroplasty), we used data from the Healthcare Cost and Utilization Project’s State Inpatient Databases for 2011-2012 to calculate the excess readmission ratio with and without SES and race/ethnicity included in the model. With these ratios, we estimated the impact on HRRP penalties and found that risk adjusting for SES and race/ethnicity would affect Medicare payments for 83.8% of hospitals. The effect on the size of HRRP penalties ranged from −14.4% to 25.6%, but the impact on overall Medicare base payments was small—ranging from −0.09% to 0.06%. Including SES and race/ethnicity in the calculation had a disproportionately favorable effect on safety-net and rural hospitals. Any financial effects on hospitals and on the Medicare program of adding SES and race/ethnicity to the HRRP risk-adjustment calculation likely would be small