Early use of PCSK9 inhibitors in the prognosis of patients with acute coronary syndrome by protecting vascular endothelial function.

INTRODUCTION: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has a protective effect on acute coronary syndrome (ACS). However, most studies have shown that this protective effect is based on a decrease in low-density lipoprotein cholesterol (LDL-C), while other mechanisms remain limited. This study aimed to determine whether PCSK9i can improve the prognosis of ACS patients by protecting endothelial function. METHODS: A total of 113 ACS patients were enrolled and randomly assigned to PCSK9i group (PCSK9i combined with statins) and control group (statins only). Blood lipids and endothelial function indicators were measured and analyzed 6 weeks before and after treatment. The effect of PCSK9i on the expression and secretion of endothelial function indicators in vascular endothelial cells were studied by cell experiments. RESULTS: After 6 weeks of treatment, endothelial function indicators such as NO, TM, ICAM-1, ET-1, and flow-mediated vasodilation (FMD) were significantly improved in PCSK9i group compared with control group. Only the changes of NO and vWF were associated with blood lipid levels, whereas the changes of other endothelial function indicators were not significantly associated with blood lipid levels. PCSK9i reduced the incidence of MACEs in patients with ACS compared to those in the control group. In cell experiments, PCSK9i treatment significantly ameliorated LPS induced endothelial injury in HUVECs. CONCLUSION: PCSK9i can protect vascular endothelial function partly independently of its lipid-lowering effect and ameliorate the prognosis of patients with ACS within 6 weeks. This mechanism may involve HSF1/HSPs related signaling pathways. Early use of PCSK9i in patients with ACS should be strongly considered in clinical practice.

Ultra-Wideband Ranging Error Mitigation with Novel Channel Impulse Response Feature Parameters and Two-Step Non-Line-of-Sight Identification.

The effective identification and mitigation of non-line-of-sight (NLOS) ranging errors are essential for achieving high-precision positioning and navigation with ultra-wideband (UWB) technology in harsh indoor environments. In this paper, an efficient UWB ranging-error mitigation strategy that uses novel channel impulse response parameters based on the results of a two-step NLOS identification, composed of a decision tree and feedforward neural network, is proposed to realize indoor locations. NLOS ranging errors are classified into three types, and corresponding mitigation strategies and recall mechanisms are developed, which are also extended to partial line-of-sight (LOS) errors. Extensive experiments involving three obstacles (humans, walls, and glass) and two sites show an average NLOS identification accuracy of 95.05%, with LOS/NLOS recall rates of 95.72%/94.15%. The mitigated LOS errors are reduced by 50.4%, while the average improvement in the accuracy of the three types of NLOS ranging errors is 61.8%, reaching up to 76.84%. Overall, this method achieves a reduction in LOS and NLOS ranging errors of 25.19% and 69.85%, respectively, resulting in a 54.46% enhancement in positioning accuracy. This performance surpasses that of state-of-the-art techniques, such as the convolutional neural network (CNN), long short-term memory-extended Kalman filter (LSTM-EKF), least-squares-support vector machine (LS-SVM), and k-nearest neighbor (K-NN) algorithms.

The Improved Method for Indoor 3D Pedestrian Positioning Based on Dual Foot-Mounted IMU System.

Micro-Electro-Mechanical System (MEMS) inertial sensors, characterized by their small size, low cost, and low power consumption, are commonly used in foot-mounted wearable pedestrian autonomous positioning systems. However, they also have drawbacks such as heading drift and poor repeatability. To address these issues, this paper proposes an improved pedestrian autonomous 3D positioning algorithm based on dual-foot motion characteristic constraints. Two sets of small-sized Inertial Measurement Units (IMU) are worn on the left and right feet of pedestrians to form an autonomous positioning system, each integrated with low-cost, low-power micro-inertial sensor chips. On the one hand, an improved adaptive zero-velocity detection algorithm is employed to enhance discrimination accuracy under different step-speed conditions. On the other hand, considering the dual-foot gait characteristics and the height difference feature during stair ascent and descent, horizontal position update algorithms based on dual-foot motion trajectory constraints and height update algorithms based on dual-foot height differences are, respectively, designed. These algorithms aim to re-correct the pedestrian position information updated at zero velocity in both horizontal and vertical directions. The experimental results indicate that in a laboratory environment, the 3D positioning error is reduced by 93.9% compared to unconstrained conditions. Simultaneously, the proposed approach enhances the accuracy, continuity, and repeatability of the foot-mounted IMU positioning system without the need for additional power consumption.

Defending the city's cleanliness with their lives? A study of road traffic collisions involving sanitation workers in China over five years.

BACKGROUND: With increasing urbanization in developing countries, sanitation workers are frequently involved in road traffic collisions. Our purpose was to study specific collisions involving sanitation workers and provide decision-making suggestions and reference measures for the sanitation industry and urban managers to reduce the occurrence of collisions. METHODS: We obtained online news data about sanitation worker road traffic collisions in China between 2013 and 2017 and analyzed occurrence time and location, victim characteristics, and causes of collisions. RESULTS: In China, between 2013 and 2017, 511 road traffic collisions were reported, with the fewest in February and July. Most occurred around 5:00 a.m. in Eastern regions and in urban areas. Victims were mainly over 50 years old, with more females than males. Collisions usually resulted in death at the scene. The ambiguity of laws, the exploitation of workers through industry outsourcing, and the difficulty of processing claims may be the main factors preventing victims from obtaining legal compensation. CONCLUSIONS: The most common cause of collisions was drivers' speeding, but workers also regularly risk death by crossing the road in pursuit of their duties. The absence of legal controls for environmental protection, the excessive pursuit of efficiency in urban governance, and the lack of basic education of sanitation workers are underlying causes of collisions. Raising awareness about sanitation worker road traffic collisions will help protect the work safety rights of this vulnerable group.

Extent and risk factors of psychological violence towards physicians and Standardised Residency Training physicians: a Northern China experience.

PURPOSE: Physicians and Standardised Residency Training physicians (SRTPs) have relatively high exposure to psychological violence. Its adverse effects are far greater than those of physical violence. However, no previous research has paid attention to the problem of psychological violence among them. This study aims to evaluate the extent, characteristics, and risk factors of psychological violence among SRTPs in comparison to physicians, and also to highlight the psychological violence experienced by SRTPs and suggest preventive measures. METHODS: A cross-sectional survey was conducted in northern China. 884 physicians and 537 SRTPs completed a questionnaire which compiled by the ILO, ICN, WHO and PSI in 2003 to measure violence in the workplace. Descriptive statistics and logistic regression analysis were used to analyse results. RESULTS: The effective response rates of physicians and SRTPs were 63.1%(884/1400) and 86.3%(537/622) respectively. 73.0%(645/884) of physicians and 24.8%(133/537) of SRTPs suffered psychological violence in the past year. Compared to physicians (29/645, 4.5%), SRTPs (42/133, 31.6%) experience more internal violence. Further, after experiencing psychological violence, physicians are willing to talk to family and friends, but SRTPs generally take no action. Shift work was a risk factor for both physicians (OR 1.440, 95% CI 1.014-2.203) and SRTPs (OR 1.851, 95% CI 1.217-2.815) suffering from psychological violence. In contrast, no anxiety symptoms protected physicians (OR 0.406, 95% CI 0.209-0.789) and SRTPs (OR 0.404, 95% CI 0.170-0.959) against psychological violence. CONCLUSIONS: SRTPs and physicians in northern China have a high risk of experiencing psychological violence, and physicians experience more. Meanwhile, there are obvious differences in responses to psychological violence and risk factors between them. Therefore, medical institutions should pay more attention to psychological violence, especially among SRTPs, such as supporting the reporting of psychological violence, strengthening team relationships, and providing psychological comfort and counselling. Trial registration number (Project Identification Code: HMUIRB20160014), Registered May 10, 2016.

What is the impact of restricted access policy on workplace violence in general hospital? A before-after study in a CHINESE tertiary hospital.

BACKGROUND: To evaluate the impact of a restricted access policy on workplace violence in a healthcare setting. METHODS: We surveyed healthcare workers before and after the implementation of a restricted-access policy at a tertiary hospital in north-eastern China. Data were collected in April 2017 and January 2019. Fisher's exact test were used to compare the difference in workplace violence prevalence between responses to two surveys. Survey 1 (S1) collected data from 345 healthcare professionals who had worked in the inpatient ward for at least 12 months. Survey 2 (S2) included 338 healthcare workers from the same ward who had been employed for more than two years. The effective response rates for the two studies was 79.31 and 83.25%, respectively. All 18 female security guards were included in the investigation in S2. RESULTS: The prevalence of psychological violence was 62.03% in S1 and 34.62% in S2, the difference in prevalence showing statistical significance (P = 0.000), while the prevalence of physical violence was 3.77 and 4.73% respectively, showing no statistical significance (P = 0.573). The change in the rate of injury caused by physical violence was also statistically significant at 76.92 and 31.25% (P = 0.025), respectively. Security guards were at high risk of workplace violence under the policy. Most healthcare professionals thought this policy ameliorated treatment order, the sense of security, anxiety about workplace violence, and so forth, but one-third of the respondents thought that it caused patient dissatisfaction. CONCLUSION: While the restricted access policy may be effective for healthcare professionals in avoiding or dealing with violence, such policy could contribute to new problems regarding the safety of security guards and the potential dissatisfaction of patients. The policy should be further developed to alleviate this phenomenon.

Workplace violence against healthcare professionals in a multiethnic area: a cross-sectional study in southwest China.

OBJECTIVE: The purpose of this study is to examine workplace violence (WPV) towards healthcare professionals in a multiethnic area in China, including prevalence, influencing factors, healthcare professionals' response to WPV, expected antiviolence training measures and content, and evaluation of WPV interventions. DESIGN: A cross-sectional study. SETTING: A grade III, class A hospital in the capital of Yunnan Province, which is the province with the most diverse ethnic minority groups in China. PARTICIPANTS: In total, 2036 healthcare professionals participated, with a response rate of 83.79%. RESULTS: The prevalence of physical and psychological violence was 5.5% and 43.7%, respectively. Healthcare professionals of ethnic minority were more likely to experience psychological violence (OR=1.54, 95% CI 1.16 to 2.05). Stratified by gender, male healthcare professionals of ethnic minority suffered from more physical violence (OR=3.31, 95% CI 1.12 to 9.79), while female healthcare professionals suffered from psychological violence (OR=1.71, 95% CI 1.24 to 2.36). We also found a unique work situation in China: overtime duty on-call work (18:00-07:00) was a risk factor for psychological violence (OR=1.40, 95% CI 1.02 to 1.93). Healthcare professionals of ethnic minority are less likely to order perpetrators to stop or to report to superiors when faced with psychological violence. They are also more interested in receiving training in force skills and self-defence. Both Han and ethnic minority participants considered security measures as the most useful intervention, while changing the time of shift the most useless one. CONCLUSION: Our study comprehensively described WPV towards healthcare professionals in a multiethnic minority area. More research on WPV conducted in multiethnic areas is needed.

Willingness and beliefs associated with reporting travel history to high-risk coronavirus disease 2019 epidemic regions among the Chinese public: a cross-sectional study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) that first occurred in Wuhan, China, is currently spreading throughout China. The majority of infected patients either traveled to Wuhan or came into contact with an infected person from Wuhan. Investigating members of the public with a travel history to Wuhan became the primary focus of the Chinese government's epidemic prevention and control measures, but several instances of withheld histories were uncovered as localized clusters of infections broke out. This study investigated the public's willingness and beliefs associated with reporting travel history to high-risk epidemic regions, to provide effective suggestions and measures for encouraging travel reporting. METHODS: A cross-sectional study was conducted online between February 12 and 19, 2020. Descriptive analysis, chi-squared test, and Fisher's exact test were used to identify socio-demographic factors and beliefs associated with reporting, as well as their impact on the willingness to report on travel history to high-risk epidemic regions. RESULTS: Of the 1344 respondents, 91 (6.77%) expressed an inclination to deliberately withhold travel history. Those who understood the benefits of reporting and the legal consequences for deliberately withholding information, showed greater willingness to report their history (P < 0.05); conversely, those who believed reporting would stigmatize them and feared being quarantined after reporting showed less willingness to report (P < 0.05). CONCLUSIONS: As any incident of withheld history can have unpredictable outcomes, the proportion of people who deliberately withhold information deserves attention. Appropriate public risk communication and public advocacy strategies should be implemented to strengthen the understanding that reporting on travel history facilitates infection screening and prompt treatment, and to decrease the fear of potentially becoming quarantined after reporting. Additionally, social support and policies should be established, and measures should be taken to alleviate stigmatization and discrimination against potential patients and reporters of travel history. Reinforcing the legal accountability of withholding travel history and strengthening systematic community monitoring are the measures that China is currently taking to encourage reporting on travel history to high-risk epidemic regions. These non-pharmaceutical interventions are relevant for countries that are currently facing the spread of the epidemic and those at risk of its potential spread.

RTK/Pseudolite/LAHDE/IMU-PDR Integrated Pedestrian Navigation System for Urban and Indoor Environments.

This paper presents an evaluation of real-time kinematic (RTK)/Pseudolite/landmarks assistance heuristic drift elimination (LAHDE)/inertial measurement unit-based personal dead reckoning systems (IMU-PDR) integrated pedestrian navigation system for urban and indoor environments. Real-time kinematic (RTK) technique is widely used for high-precision positioning and can provide periodic correction to inertial measurement unit (IMU)-based personal dead reckoning systems (PDR) outdoors. However, indoors, where global positioning system (GPS) signals are not available, RTK fails to achieve high-precision positioning. Pseudolite can provide satellite-like navigation signals for user receivers to achieve positioning in indoor environments. However, there are some problems in pseudolite positioning field, such as complex multipath effect in indoor environments and integer ambiguity of carrier phase. In order to avoid the limitation of these factors, a local search method based on carrier phase difference with the assistance of IMU-PDR is proposed in this paper, which can achieve higher positioning accuracy. Besides, heuristic drift elimination algorithm with the assistance of manmade landmarks (LAHDE) is introduced to eliminate the accumulated error in headings derived by IMU-PDR in indoor corridors. An algorithm verification system was developed to carry out real experiments in a cooperation scene. Results show that, although the proposed pedestrian navigation system has to use human behavior to switch the positioning algorithm according to different scenarios, it is still effective in controlling the IMU-PDR drift error in multiscenarios including outdoor, indoor corridor, and indoor room for different people.

Enhanced Heuristic Drift Elimination with Adaptive Zero-Velocity Detection and Heading Correction Algorithms for Pedestrian Navigation.

As pedestrian dead-reckoning (PDR), based on foot-mounted inertial sensors, suffers from accumulated error in velocity and heading, an improved heuristic drift elimination (iHDE) with a zero-velocity update (ZUPT) algorithm was proposed for simultaneously reducing the error in heading and velocity in complex paths, i.e., with pathways oriented at 45°, curved corridors, and wide areas. However, the iHDE algorithm does not consider the changes in pedestrian movement modes, and it can deteriorate when a pedestrian walks along a straight path without a pre-defined dominant direction. To solve these two problems, we propose enhanced heuristic drift elimination (eHDE) with an adaptive zero-velocity update (AZUPT) algorithm and novel heading correction algorithm. The relationships between the magnitude peaks of the y-axis angular rate and the detection thresholds were established only using the readings of the three-axis accelerometer and the three-axis gyroscopic, and a mechanism for constructing temporary dominant directions in real time was introduced. Real experiments were performed and the results showed that the proposed algorithm can improve the still-phase detection accuracy of a pedestrian at different movement motions and outperforms the iHDE algorithm in complex paths with many straight features.

A cross-sectional survey on patient safety culture in secondary hospitals of Northeast China.

OBJECTIVES: This study aims to investigate patient safety culture in secondary hospitals of Heilongjiang, Northeast China, and explore the implications of patient safety culture and practices through the perspectives of various healthcare workers. METHODS: A cross-sectional survey using the Safety Attitude Questionnaire (SAQ) was conducted to ascertain the status of patient safety culture in nine secondary hospitals across the six dimensions of the SAQ. Among the 900 staff members who were invited to participate, 665 completed the questionnaire. Descriptive statistics were used to calculate the general means and standard deviations of the patient safety culture dimensions and other numerical variables, and F-test and a multivariate regression analysis were used to statistically analyze the differences in perceptions of safety culture considering the differences in demographic characteristics. All statistical analyses were performed using SPSS v. 22.0. RESULTS: The respondents rated job satisfaction as the highest among all six dimensions of the SAQ, followed in order by teamwork climate, working conditions, and stress recognition (the lowest). There were significant differences among the dimensions of patient safety culture and other factors, such as gender, age, job position, and education. Compared with previous studies, teamwork climate and working conditions scores were quite high, while stress recognition score was very low. We also found differences in patient safety culture by demographic characteristics. CONCLUSIONS: The findings revealed the patient safety culture attitudes of healthcare workers in secondary hospitals of Heilongjiang, and provided baseline data for related future research. This evidence may also help government health policymakers and hospital administrators understand related challenges and develop strategies to improve patient safety culture in secondary hospitals of China and perhaps also in other developing countries.

Perceptions of patient safety culture among medical students: a cross-sectional investigation in Heilongjiang Province, China.

OBJECTIVES: Medical school education plays an important role in promoting patient safety. In this study, we assess medical students' perceptions of patient safety culture, identify their educational needs and provide evidence on the most important content relating to patient safety for the medical school curriculum. METHOD: This cross-sectional study was conducted in four medical universities in Heilongjiang province. Medical students in the first through five years completed an anonymous questionnaire-the Attitudes toward Patient Safety Questionnaire III. We analysed the differences in responses across the four universities and their cohorts. RESULTS: The overall perceptions of patient safety culture across the four medical universities were positive. The highest positive response rate was for 'I have a good understanding of patient safety issues as a result of my undergraduate medical training' (range: 58.4%-99.8%), whereas the lowest positive response rate was for 'medical errors are a sign of incompetence' (14.7%-47.9%). Respondents in the earlier years of school tended to have more positive responses for items concerning working hours and team work; however, fourth and fifth year students had more positive responses for error inevitability. Items with the lowest positive response rates across the cohorts included items related to 'professional incompetence as a cause of error' and 'disclosure responsibility'. CONCLUSIONS: While students generally had positive views of patient safety culture, none of them had been exposed to any formal curriculum content on patient safety. Policymakers should focus more on how educational needs vary across schools and cohorts in order to establish appropriate curricula.