Liver transplantation and resection in patients with hepatocellular cancer and portal vein tumor thrombosis: Feasible and effective?

Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy,have given some hope to prolong survival in them.This review summarized recent evidence in literature regarding the possible role of liver resection(LR)and liver transplantation(LT)in patients with locally advanced HCC and PVTT with no extrahepatic disease.Downstaging therapies have helped make curative resection or LT a reality in selected patients.This review emphasizes on the key points to focus on when considering surgery in these patients,who are usually relegated to palliative systemic therapy alone.Meticulous patient selection based on tumor biology,documented downstaging based on imaging and decrease in tumor marker levels,and an adequate waiting period to demonstrate stable disease,may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.

Development and validation of a prediction model for early screening of people at high risk for colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.

The impact of the Rural Minimum Living Standard Guarantee(Rural Dibao)Program on child nutrition outcomes

The Rural Minimum Living Standard Guarantee(Rural Dibao)is an important unconditional cash transfer program to alleviate poverty in rural China.Despite the importance of children’s nutrition in breaking poverty cycles,little is known about the impact of Rural Dibao on child nutrition outcomes.Using China Family Panel Studies(CFPS),this paper examines the effects of Rural Dibao on child nutrition outcomes and investigates potential pathways and heterogeneous effects.We exploit propensity score matching and difference-in-differences techniques to evaluate the effects of the Rural Dibao program on child nutrition outcomes.Our results suggest that Rural Dibao significantly impacts the nutrition outcomes of children up to 15 years of age.Specifically,our results suggest that Rural Dibao improves child height-to-age z-scores by 1.05 standard deviations and lowers the probability of stunting by 11.9 percentage points.Additional analyses suggest that increased protein intake is the main pathway through which Rural Dibao participation contributes to better nutrition outcomes.We also find that the effect of the program is more pronounced among girls,children who are non-left-behind or live with highly educated mothers,and those from low-income families and poor areas.Our findings suggest that Rural Dibao participation helps improve child nutrition outcomes through improving diet quality.

Establishing delivery route-dependent safety and efficacy of living biodrug mesenchymal stem cells in heart failure patients

BACKGROUND Mesenchymal stem cells(MSCs)as living biopharmaceuticals with unique properties,i.e.,stemness,viability,phenotypes,paracrine activity,etc.,need to be administered such that they reach the target site,maintaining these properties unchanged and are retained at the injury site to participate in the repair process.Route of delivery(RoD)remains one of the critical determinants of safety and efficacy.This study elucidates the safety and effectiveness of different RoDs of MSC treatment in heart failure(HF)based on phase II randomized clinical trials(RCTs).We hypothesize that the RoD modulates the safety and efficacy of MSCbased therapy and determines the outcome of the intervention.AIM To investigate the effect of RoD of MSCs on safety and efficacy in HF patients.METHODS RCTs were retrieved from six databases.Safety endpoints included mortality and serious adverse events(SAEs),while efficacy outcomes encompassed changes in left ventricular ejection fraction(LVEF),6-minute walk distance(6MWD),and pro-B-type natriuretic peptide(pro-BNP).Subgroup analyses on RoD were performed for all study endpoints.RESULTS Twelve RCTs were included.Overall,MSC therapy demonstrated a significant decrease in mortality[relative risk(RR):0.55,95%confidence interval(95%CI):0.33-0.92,P=0.02]compared to control,while SAE outcomes showed no significant difference(RR:0.84,95%CI:0.66-1.05,P=0.11).RoD subgroup analysis revealed a significant difference in SAE among the transendocardial(TESI)injection subgroup(RR=0.71,95%CI:0.54-0.95,P=0.04).The pooled weighted mean difference(WMD)demonstrated an overall significant improvement of LVEF by 2.44%(WMD:2.44%,95%CI:0.80-4.29,P value≤0.001),with only intracoronary(IC)subgroup showing significant improvement(WMD:7.26%,95%CI:5.61-8.92,P≤0.001).Furthermore,the IC delivery route significantly improved 6MWD by 115 m(WMD=114.99 m,95%CI:91.48-138.50),respectively.In biochemical efficacy outcomes,only the IC subgroup showed a significant reduction in pro-BNP by-860.64 pg/mL(WMD:-860.64 pg/Ml,95%CI:-944.02 to-777.26,P=0.001).CONCLUSION Our study concluded that all delivery methods of MSC-based therapy are safe.Despite the overall benefits in efficacy,the TESI and IC routes provided better outcomes than other methods.Larger-scale trials are warranted before implementing MSC-based therapy in routine clinical practice.

Effect of solvent on the initiation mechanism of living anionic polymerization of styrene:A computational study

For living anionic polymerization(LAP),solvent has a great influence on both reaction mechanism and kinetics.In this work,by using the classical butyl lithium-styrene polymerization as a model system,the effect of solvent on the mechanism and kinetics of LAP was revealed through a strategy combining density functional theory(DFT)calculations and kinetic modeling.In terms of mechanism,it is found that the stronger the solvent polarity,the more electrons transfer from initiator to solvent through detailed energy decomposition analysis of electrostatic interactions between initiator and solvent molecules.Furthermore,we also found that the stronger the solvent polarity,the higher the monomer initiation energy barrier and the smaller the initiation rate coefficient.Counterintuitively,initiation is more favorable at lower temperatures based on the calculated results ofΔG_(TS).Finally,the kinetic characteristics in different solvents were further examined by kinetic modeling.It is found that in benzene and n-pentane,the polymerization rate exhibits first-order kinetics.While,slow initiation and fast propagation were observed in tetrahydrofuran(THF)due to the slow free ion formation rate,leading to a deviation from first-order kinetics.

Recent advances in living cell nucleic acid probes based on nanomaterials for early cancer diagnosis

The early diagnosis of cancer is vital for effective treatment and improved prognosis. Tumor biomarkers, which can be used for the early diagnosis, treatment, and prognostic evaluation of cancer, have emerged as a topic of intense research interest in recent years. Nucleic acid, as a type of tumor biomarker, contains vital genetic information, which is of great significance for the occurrence and development of cancer. Currently, living cell nucleic acid probes, which enable the in situ imaging and dynamic monitoring of nucleic acids, have become a rapidly developing field. This review focuses on living cell nucleic acid probes that can be used for the early diagnosis of tumors. We describe the fundamental design of the probe in terms of three units and focus on the roles of different nanomaterials in probe delivery.

Relationship Between Individuals’Epidemic Risk Perception Within Living Space and Subjective Well-Being:Empirical Evidence from China after the First Wave of COVID-19

It is common to observe the epidemic risk perception(ERP)and a decline in subjective well-being(SWB)in the context of public health events,such as Corona Virus Disease 2019(COVID-19).However,there have been few studies exploring the impact of individuals’ERP within living space on their SWB,especially from a geographical and daily activity perspective after the resumption of work and other activities following a wave of the pandemic.In this paper,we conducted a study with 789 participants in urban China,measuring their ERP within living space and examining its influence on their SWB using path analysis.The results indicated that individuals’ERP within their living space had a significant negative effect on their SWB.The density of certain types of facilities within their living space,such as bus stops,subway stations,restaurants,fast food shops,convenience shops,hospitals,and public toilets,had a significantly negative impact on their SWB,mediated by their ERP within living space.Additionally,participation in out-of-home work and other activities not only increased individuals’ERP within living space,but also strengthened its negative effect on their SWB.

Individual alcohol consumption by the population of Russia versus regional living conditions

Background:There are substantial regional differences in drinking alcohol in Russia,both at the population and individual levels.However,the causes of these differences have not been studied yet.Objective:The goal of our study was to examine the effect of regional living conditions on individual alcohol consumption by the population of Russia.Methods:For the analysis,we used data from a cross-sectional epidemiological study conducted in 2013-2014.The final analytical sample included 18,130 people aged 25-64 years.We conducted the interviews face to face,based on which any drinking in the last year,as well as alcohol abuse,were considered as a response.Alcohol abuse was recorded when the respondent consumed 5.75 or more grams of pure ethanol per day(75th percentile of average daily alcohol consumption among alcohol drinkers).The assessment of the regional living conditions was accomplished via integral indexing,which was previously performed based on publicly available data for 2010-2014.Associations were assessed using generalized scoring equations with unchanging standard errors.The associations were expressed by odds ratios(OR)and 95%confidence intervals(C).Results:Deterioration of social conditions and increase in demographic depression in the region of residence increased the odds of any drinking(OR 1.51,95%CI:1.33 to 1.72,P<0.001 and OR 1.22,95%CI:1.05 to 1.41,P=0.oo9,respectively).The odds of alcohol abuse increased with the deterioration of social living conditions and the growth of the industrial development in the region:OR 1.35,95%CI:1.14 to 1.59,P<0.001 and OR 1.16,95%CI:1.05 to 1.28,P=0.002,respectively.Conclusion:Our analysis allowed assessing the impact of the regional living conditions on individual drinking alcohol in the population of Russia.

Assessing the role of forest resources in improving rural livelihoods in West Bengal of India

Forest resources play a vital role in supporting the livelihoods of rural communities residing in forest-rich areas.In India,a forest-rich country,a significant proportion of non-timber forest products(NTFPs)is consumed locally,supporting numerous rural communities relying on forests for essential resources,such as firewood,timber,and NTFPs.This study focuses on two forest-dominant districts in West Bengal of India,namely,Jhargram District and Paschim Medinipur District.Furthermore,this study aims to enhance the understanding of forest-dependent communities by comparing the standard of living among different village classes.Thus,we categorized villages into three classes based on the distance from home to forests,including inner villages,fringe villages,and outer villages.Through focus group discussions and household surveys,we explored the sources of local economy,income sources of household,and reasons for economic diversification in different village classes.The study findings confirm that substantial variations existed in the income sources and the standard of living in these villages.Forest income varied dramatically among the three village classes,with inner villages having greater forest income than fringe villages and outer villages.Meanwhile,households in outer villages depended on forests and engaged in diverse economic activities for their livelihoods.Compared with inner and fringe villages,households in outer villages derived a significant portion of their income from livestock.This discrepancy can be attributed to challenges,such as inadequate transportation,communication,and underdeveloped market chains in inner villages.Moreover,these findings emphasize the need to develop sustainable forest management practices,create alternative income-generation opportunities,and improve infrastructure and market access in inner villages,as well as promote economic diversification in outer villages.Through targeted policy measures,these forest-rich regions can achieve improved livelihoods,enhanced standard of living,and increased resilience for their communities.

Personalized and continuous care intervention affects rehabilitation,living quality,and negative emotions of patients with breast cancer

BACKGROUND Breast cancer is among the most common malignancies worldwide.With progress in treatment methods and levels,the overall survival period has been prolonged,and the demand for quality care has increased.AIM To investigate the effect of individualized and continuous care intervention in patients with breast cancer.METHODS Two hundred patients with breast cancer who received systemic therapy at The First Affiliated Hospital of Hebei North University(January 2021 to July 2023)were retrospectively selected as research participants.Among them,134 received routine care intervention(routing group)and 66 received personalized and continuous care(intervention group).Self-rating anxiety scale(SAS),self-rating depression scale(SDS),and Functional Assessment of Cancer Therapy-Breast(FACT-B)scores,including limb shoulder joint activity,complication rate,and care satisfaction,were compared between both groups after care.RESULTS SAS and SDS scores were lower in the intervention group than in the routing group at one and three months after care.The total FACT-B scores and five dimensions in the intervention group were higher than those in the routing group at three months of care.The range of motion of shoulder anteflexion,posterior extension,abduction,internal rotation,and external rotation in the intervention group was higher than that in the routing group one month after care.The incidence of postoperative complications was 18.18%lower in the intervention group than in the routing group(34.33%;P<0.05).Satisfaction with care was 90.91% higher in the intervention group than in the routing group(78.36%;P<0.05).CONCLUSION Personalized and continuous care can alleviate negative emotions in patients with breast cancer,quicken rehabilitation of limb function,decrease the incidence of complications,and improve living quality and care satisfaction.

Associations of PNPLA3 and LEP genetic polymorphisms with metabolic-associated fatty liver disease in Thai people living with human immunodeficiency virus

BACKGROUND The prevalence of metabolic-associated fatty liver disease(MAFLD)is a growing public health issue in people living with human immunodeficiency virus(PLWH).However,the pathophysiology of MAFLD is still unknown,and the role of genetic variables is only now becoming evident.AIM To evaluate the associations of gene-polymorphism-related MAFLD in PLWH.METHODS The study employed transient elastography with a controlled attenuation parameter≥248 dB/m to identify MAFLD in patients from a Super Tertiary Hospital in central Thailand.Candidate single-nucleotide polymorphisms(SNPs)were genotyped using TaqMan®MGB probe 5'nuclease assays for seven MAFLD-related genes.Statistical analyses included SNP frequency analysis,Fisher's Exact and Chi-square tests,odds ratio calculations,and multivariable logistic regression.RESULTS The G-allele carriers of PNPLA3(rs738409)exhibited a two-fold rise in MAFLD,increasing by 2.5 times in MAFLD with human immunodeficiency virus infection.The clinical features and genetic patterns imply that LEP rs7799039 A-allele carriers had a nine times(P=0.001)more significant chance of developing aberrant triglyceride among PLWH.CONCLUSION The current study shows an association between PNPLA3 rs738409 and LEP rs7799039 with MAFLD in PLWH.

Hepatitis C virus eradication in people living with human immunodeficiency virus:Where are we now?

Hepatitis C virus(HCV)/human immunodeficiency virus(HIV)co-infection still involves 2.3 million patients worldwide of the estimated 37.7 million living with HIV,according to World Health Organization.People living with HIV(PLWH)are six times greater affected by HCV,compared to HIV negative ones;the greater prevalence is encountered among people who inject drugs and men who have sex with men:the risk of HCV transmission through sexual contact in this setting can be increased by HIV infection.These patients experience a high rate of chronic hepatitis,which if left untreated progresses to end-stage liver disease and hepato-cellular carcinoma(HCC)HIV infection increases the risk of mother to child vertical transmission of HCV.No vaccination against both infections is still available.There is an interplay between HIV and HCV infections.Treatment of HCV is nowadays based on direct acting antivirals(DAAs),HCV treatment plays a key role in limiting the progression of liver disease and reducing the risk of HCC development in mono-and coinfected individuals,especially when used at an early stage of fibrosis,reducing liver disease mortality and morbidity.Since the sustained virological response at week 12 rates were observed in PLWH after HCV eradication,the AASLD has revised its simplified HCV treatment algorithm to also include individuals living with HIV.HCV eradication can determine dyslipidemia,since HCV promotes changes in serum lipid profiles and may influence lipid metabolism.In addition to these apparent detrimental effects on the lipid profile,the efficacy of DAA in HCV/HIV patients needs to be considered in light of its effects on glucose metabolism mediated by improvements in liver function.The aim of the present editorial is to describe the advancement in HCV treatment among PLWH.

Launching Ceremony of the International Living Water Project Held in Nairobi,Kenya

Jointly hosted by Jiangsu People's Association for Friendship with Foreign Countries and the Amity Foundation,the launching ceremony of the International Living Water Project was held in Nairobi,Kenya on the afternoon of April 18.Ma Xin,member of the Standing Committee of the CPC Jiangsu Provincial Committee and Executive Vice-Governor,and Pasalis,member of the Kenyan National Assembly,attended the event and delivered speeches.

Socio-Demographic and Occupational Aspects of HIV-HBV Co-Infection in Bangui, Central African Republic (CAR): Hospital-Based Cross-Sectional Study

Objective: HIV-HBV co-infection is a major public health problem that has not been sufficiently explored in the Central African workplace. The aim of this study was to assess the frequency of HIV-HBV co-infection among people who living with HIV (PLHIV) in the infectious and tropical diseases department of the Centre Hospitalier Universitaire de lAmiti Sino-Centrafricaine in Bangui. Methods: A retrospective study was carried out from January 1, 2010 to December 31, 2021 in the Infectious and Tropical Diseases Department at the Amiti Sino-Centrafricaine University Hospital. It included the files of all PLHIV, which included the results of HBV serology. A standardized form was used to collect socio-demographic and professional data by documentary review. Data was analysed using Epi-Info 7 software. Means, proportions were calculated as well as Chi square witch was significant if p-value was below 0.05. Results: The study included 265 patients, 188 were women (70.1%) and 77 men (29.1%), giving a sex ratio of 0.45. Mean age was 35.8 years, higher in men (40 years) than in women (35.8 years) (p 0.0001). The age groups 25 to 34 (37.7%) and 35 to 44 (33.6%) were in the majority (71.3%). The majority of PLHIV were unemployed (57.1%), including housewives (43.0%). HBV prevalence was 14.3%, including 7.2% among the unemployed, who account for half of all co-infections. The search for associations between HIV-HBV co-infection and all socio-demographic characteristics (age, sex, marital status) and socio-professional categories showed no significant difference (p 0.05). Conclusion: PLHIV were predominantly young adults, female, and unemployed;no occupation was significantly associated with co-infection. The vast majority of co-infected people were not covered by the occupational health system (unemployed or informal sector). Urgent action is needed to improve workers access to occupational medicine in CAR.

Assessing the relationship between health literacy intervention and hypertension self-management:A 7-year systematic review from January 2016 to December 2022

Hypertension(HTN)is one of the most common chronic diseases affecting over 30%of the adult population globally,with a growing incidence rate.This review assesses the relationship between health literacy(HL)intervention and hypertension(HTN)self-management among people with HTN.The study design was a systematic review of empirical research articles using a well-defined strategy.Online journals were accessed through databases such as PubMed,CINAHL,Google Scholar,ProQuest,Global Health,WHOLIS,Embase,and EbscoHost,spanning from January 2016 to December 2022 as the scope of the study.Articles selected for inclusion were those published in English during the specified time frame and adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Sample,Phenomenon of Interest,Design,Evaluation,Research Type framework for systematic review,focusing on criteria related to the sample,the phenomenon of interest,study design,evaluation,and research type.Out of 180 studies initially identified in the database search,20 studies were ultimately included in the review.The findings were reported based on these five emerging themes:Relationship between HL and HTN self-management;Effect of HL intervention on HTN self-management;Factors predicting self-care behaviors among HTN patients with low HL;Effect of HL and self-management efficacy on health-related quality of life(HRQoL);and level of self-care practices.This review highlights a relationship between HL,self-efficacy,self-care,and HRQoL,underscoring the necessity for further well-designed intervention studies focused on enhancing HL in individuals with HTN in Nigeria to enhance their quality of life.

Evaluation of the Living Conditions and Health Perceptions of Waste Electrical and Electronic Equipment Handlers in the Informal Sector in Dakar

Electrical and electronic devices are becoming an increasingly important part of our society. In Africa, and in Senegal in particular, the handling and management of electronic and electrical equipment (EEE) that has reached the end of its life is mainly informal. This professional environment is characterized by the disintegration of the sector and the social heterogeneity that can be found there. The objective of this study is to assess the standard of living of electrical and electronic equipment waste handlers in the Dakar region, as well as their perception of their health. A survey was used to obtain information on sociodemographic background, living arrangements, perception of health status, and good practices to be implemented in case of work-related health problems. Life style, perception of general health and health problems were ranged as excellent, very good, good, average and poor. Informal recyclers in the Dakar region lived mainly in rooms and buildings as tenants (49.1%), or in family homes (48.4%) before starting this activity, and 51.2% continue to live in rooms and buildings as tenants compared to 41.4% who still live in a family home. The perception of health status ranged from poor to excellent, and 4.9% believe that they are limited in work due to a disability or health problem. Informal work is a heterogeneous phenomenon that makes research and policymaking particularly complex. There are several external factors within informal WEEE re-cyclers that can cause health problems or functional disability. However, the living conditions and the perception they have of their state of health are contradictory to the working conditions and the social environment to which they belong. A biomedical approach would consolidate these achievements by confirming or invalidating them.

Study on Distribution of Four Pseudomonas Species in Living Environment Using Multiplex PCR

Purpose: The genus Pseudomonas is a ubiquitous microorganism frequently detected from immunocompromised patients. The inherent resistance to numerous antimicrobial agents contributes to the opportunistic character of this pathogen exhaustive monitoring of this pathogen is considered of critical importance to public health organizations. The reliable identification method able to distinguish genetic close Pseudomonas species is needed, because these organisms are difficult to differentiate by phenotypic or biochemical methods. The purpose of the present study was to design species-specific primers in order to identify and detect four Pseudomonas species which are frequently detected from the human oral cavities, and to investigate the distribution of these organisms in the living environment using a multiplex PCR. Methods: Polymerase chain reaction (PCR) primers were designed based on partial sequences of the rpoD gene of four Pseudomonas species. Swab samples were collected from fifty washstands, and the distribution of Pseudomonas species was investigated using a conventional PCR at genus level and a multiplex PCR at species level. Results: Multiplex PCR method developed in this study was able to distinguish four Pseudomonas species clearly. The genus Pseudomonas was detected from all samples (100%), whereas P. putida, P, aeruginosa, P. stutzeri and P. fluorescens were detected at 44%, 8%, 4% and 2% in fifty swab samples, respectively. Conclusion: Our developed one-step multiplex PCR method is accurate, specific, cost-effective, time-saving, and works without requiring DNA extraction. It was indicated that washstands were the uninhabitable environment for P. putida, P, aeruginosa, P. stutzeri and P. fluorescens.

基于Living Lab理念的体验式教学设计与应用研究——以“高等数学”课程为例

针对传统“高等数学”课程教学存在抽象理论难以理解、实践应用环节欠缺、学习兴趣普遍不高和教学质量效果不佳等问题,提出采用Living Lab理念的体验式教学方法作为课堂教学的补充和改进方案。Living Lab理念强调在真实环境中进行学习和研究,以实地考察、实践操作和数学建模等活动为载体,将抽象的数学理论与实际生活和工程问题相结合,促进学生对数学知识的理解和应用。Living Lab理念的体验式教学为改进高等数学课程教学提供了新思路和新方法,有助于提高教学质量和激发学生的学习动力。

Improvement of Activities of Daily Living (ADL) for Patients Treated in Skilled Nursing Facilities (SNFs)

Background: Self-care tasks or activities of daily living (ADL)’s performance are often disrupted after an older adult sustains an injury or illness, which can be a determining factor for discharge placement after hospitalization, or it can determine the level of assistance required after discharge from a skilled nursing facility (SNF). We believe that comprehensive rehabilitation can improve a patient’s overall functioning during their short term stay in SNFs. The purpose of this study is to determine if an individual’s level of independence improved after admission to a skilled nursing facility and procurement of rehabilitation services. Methods: This study retrospectively reviewed 4612 nursing home patients in California who underwent rehabilitative services at skilled nursing facilities to determine how the patients responded to their environments, therapy interventions, and any other additional supportive measures. The records of patients who were admitted for short-term rehabilitation were reviewed in a blinded fashion, looking specifically at Section GG of the Minimum Data Set (MDS). Self-Care Section GG scores recorded by rehabilitative staff provide objective data and measure patients’ levels of assistance that were required. Each activity is scored from 1, being completely dependent, to 6, being entirely independent, with varying levels of assistance with scores in between. The admission scores versus the discharge scores can be compared to determine if a patient improved their level of functioning upon discharge. Results: Utilizing the Pearson’s correlation coefficient, a strong correlation of improvement in ADL performance on Section GG between the admission and discharge scores was identified, implying significant improvement in functional independence upon discharge. The average percent improvement for Managed Care patients was ~35.4% and ~39.4% for Medicare patients. Conclusions: The results support the benefits of rehabilitation services in skilled nursing facilities, and the data suggests that admission scores can be used as a predictive tool for functional outcomes.

Jonathan Livingston Seagull (Excerpt)

It was morning,and the new sun sparkled gold across the ripples of a gentle sea.A mile from shore a fishing boat chummed the water and the word for Breakfast Flock flashed through the air,till a crowd of a thousand seagulls came to dodge and fight for bits of food.It was another busy day beginning.