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This study examines the quality of outpatient preventive care in a large, ethnically diverse cohort of outpatients with cirrhosis at a high‐volume tertiary liver transplant center. Receipt of evidence‐based quality indicators, including preventive processes for ascites, esophageal varices, hepatic encephalopathy, hepatocellular carcinoma, liver transplantation, and general cirrhosis care, was variable and overall low. These findings suggest that larger system redesign efforts are needed to improve the quality of care, beyond just improving access to specialty providers., We sought to identify specific gaps in preventive care provided to outpatients with cirrhosis and to determine factors associated with high quality of care (QOC), to guide quality improvement efforts. Outpatients with cirrhosis who received care at a large, academic tertiary health care system in the United States were included. Twelve quality indicators (QIs), including preventive care processes for ascites, esophageal varices, hepatic encephalopathy, hepatocellular carcinoma (HCC), and general cirrhosis care, were measured. QI pass rates were calculated as the proportion of patients eligible for a QI who received that QI during the study period. We performed logistic regression to determine predictors of high QOC (≥ 75% of eligible QIs) and receipt of HCC surveillance. Of the 439 patients, the median age was 63 years, 59% were male, and 19% were Hispanic. The median Model for End‐Stage Liver Disease–Sodium score was 11, 64% were compensated, and 32% had hepatitis C virus. QI pass rates varied by individual QIs, but were overall low. For example, 24% received appropriate HCC surveillance, 32% received an index endoscopy for varices screening, and 21% received secondary prophylaxis for spontaneous bacterial peritonitis. In multivariable analyses, Asian race (odds ratio [OR]: 3.7, 95% confidence interval [CI]: 1.3‐10.2) was associated with higher QOC, and both Asian race (OR: 3.3, 95% CI: 1.2‐9.0) and decompensated status (OR: 2.1, 95% CI: 1.1‐4.2) were associated with receipt of HCC surveillance. A greater number of specialty care visits was not associated with higher QOC. Conclusion: Receipt of outpatient preventive cirrhosis QIs was variable and overall low in a diverse cohort of patients with cirrhosis. Variation in care by race/ethnicity and illness trajectory should prompt further inquiry into identifying modifiable factors to standardize care delivery and to improve QOC.

A flexible and wearable microsensor array is described for simultaneous multiplexed monitoring of heavy metals in human body fluids. Zn, Cd, Pb, Cu, and Hg ions are chosen as target analytes for detection via electrochemical square wave anodic stripping voltammetry (SWASV) on Au and Bi microelectrodes. The oxidation peaks of these metals are calibrated and compensated by incorporating a skin temperature sensor. High selectivity, repeatability, and flexibility of the sensor arrays are presented. Human sweat and urine samples are collected for heavy metal analysis, and measured results from the microsensors are validated through inductively coupled plasma mass spectrometry (ICP-MS). Real-time on-body evaluation of heavy metal (e.g., zinc and copper) levels in sweat of human subjects by cycling is performed to examine the change in concentrations with time. This platform is anticipated to provide insightful information about an individual's health state such as heavy metal exposure and aid the related clinical investigations.

In this paper we present the REQS package which is an interface between the R environment of statistical computing and the EQS software for structural equation modeling. The package consists of three main functions that read EQS script files and import the results into R, call EQS script �files from R, and, �finally, run EQS script �files from R and, again, import the results after EQS computation. The components a user needs are R and EQS. We give a short introduction to R and EQS, elaborate the functionalities of the package, and show how to use the package by means of several examples with special emphasis on simulations.