Evaluation on the Effect of Ward-Noise Reduction Management Combined with Monitoring-Training-Planning Management Mode in Hospitalized Patients with Heart Failure.

BACKGROUND: Noise from medical institutions such as hospitals usually exceeds the level recommended by the World Health Organization. This study aimed to explore the application effect of ward-noise reduction management combined with monitoring-training-planning (MTP) management mode in hospitalized patients with heart failure. MATERIALS AND METHODS: Among the 168 research objects, 55 patients with heart failure receiving ward-noise reduction management combined with MTP management mode from April 2022 to March 2023 were included in group A, 52 patients with heart failure who underwent MTP management mode from March 2021 to March 2022 were selected as group B, and 61 patients who underwent routine management measures from March 2020 to February 2021 served as the control group. The vital signs, Self-rating Anxiety Scale (SAS) scores, Self-rating Depression Scale (SDS) scores, physical function indices, sleep quality score, and satisfaction degree of patients in the three groups were compared before and after management. RESULTS: After 1 month of management, group A had lower heart rate, diastolic blood pressure, systolic blood pressure, and respiratory rate compared to group B and the control group (P < 0.001). The SAS score, SDS score, and Pittsburgh Sleep Quality Index score after management in group A were lower than those in group B and the control group (P < 0.001). Group A had a higher 6-Minute Walk Distance than group B and the control group (P < 0.001). Group A had a higher satisfaction degree after management compared to group B (P < 0.01) and the control group (P < 0.001). Group A had lower noise level than group B and the control group (P < 0.001), and there was no significant difference in noise level between group B and the control group (P > 0.05). CONCLUSION: Ward-noise reduction management combined with MTP management mode can reduce the noise level in the ward and improve the psychological state and sleep quality of patients with heart failure.

Influential factors on disease activity in Crohn's disease and their Roc curve evaluation: a cross-sectional study.

OBJECTIVE: This study aims to investigate the factors influencing disease activity in patients with Crohn's disease (CD) and provide insights and references for the management and prevention of CD. METHODS: We recruited CD patients who met the inclusion and exclusion criteria and were treated at the First Affiliated Hospital of Soochow University from November 2022 to June 2023. Generalized linear mixed models were used to analyze the factors affecting disease activity in CD patients. Receiver operating characteristic (ROC) curve analysis was employed to assess the predictive value of these factors for disease activity. RESULTS: A total of 268 CD participants aged 18 to 65 were included in the study, with over 68% of them in remission or experiencing mild disease activity, indicating relatively good disease control. The results of the generalized linear mixed models showed that older age, absence of diabetes, high levels of physical activity, and a low dietary inflammatory index (DII) were protective factors for lower disease activity in CD patients (p < 0.05). ROC curve analysis demonstrated that physical activity level, age, and DII all had ROC areas greater than 0.6 in predicting disease activity in CD patients (p < 0.05). CONCLUSION: The factors influencing the disease activity of CD patients are numerous and should be given attention. CD patients who are younger, have low levels of physical activity, high DII, and have diabetes are at a higher risk of increased disease activity. By reducing or avoiding the mentioned risk factors and leveraging protective factors, it is possible to mitigate the disease activity of CD to some extent.

Global burden of depression or depressive symptoms in children and adolescents: A systematic review and meta-analysis.

BACKGROUND: Depression is the leading cause of health-related disability. A proportion of depression cases begin in childhood and increase dramatically during adolescence. This systematic review and meta-analysis aimed to estimate the global prevalence of depression or depressive symptoms in children and adolescents and explore the temporal and regional distribution of depression or depressive symptoms. METHODS: This systematic review and meta-analysis identified peer-reviewed literature published through April 8, 2023, using the MEDLINE, Embase and APA PsycINFO databases, supplemented by reverse reference searches. Observational studies published in English and based on validated instruments with prevalence data on depression or depressive symptoms in children and adolescents aged ≤18 years were eligible. Random-effects meta-analysis and meta-regression analysis were performed using R software. RESULTS: This systematic review and meta-analysis included a total of 96 studies (29 countries, 528,293 participants) published between 1989 and 2022. The pooled prevalence of mild-to-severe, moderate-to-severe, and major depression were 21.3 % (95%CI, 16.7 %-26.7 %), 18.9 % (95%CI, 14.6 %-24.2 %), and 3.7 % (95%CI, 2.7 %-5.1 %) respectively. Meta-regression analysis showed that from 1989 to 2022, the prevalence of mild-to-severe and moderate-to-severe depression increased over time (P = 0.002, P = 0.034, respectively), but the prevalence of major depression did not change significantly (P = 0.636). LIMITATIONS: Only English articles were included. There was significant heterogeneity across the included studies. The studies included were mostly based on self-report scales to assess depressive symptoms. CONCLUSION: In this systematic review, about one in five children and adolescents globally suffered from depression or had depressive symptoms, and this proportion was increasing over time.

Attitude and influencing factors on exercise in patients with moderately to severely active inflammatory bowel disease: a qualitative study.

OBJECTIVES: To explore the attitudes towards exercise, factors influencing exercise and exercise-related needs of patients with moderately to severely active inflammatory bowel disease. DESIGN: A qualitative phenomenological research. SETTING: The study was conducted at a comprehensive tertiary hospital in Suzhou, China, which is a secondary care facility. PARTICIPANTS: The study included 17 participants who met specific inclusion criteria: aged between 16 and 70 years, diagnosed with inflammatory bowel disease and in a state of moderate to severe disease activity. Participants were required to be capable of clear self-expression and provide voluntary consent. Exclusion criteria included the presence of cancer or severe physical illness, cognitive impairment or mental illness. INTERVENTIONS: Semistructured interviews were used to collect data. RESULTS: The exercise experiences of participants with moderate to severe inflammatory bowel disease yielded three themes: attitudes towards exercise, factors influencing exercise and exercise-related needs. CONCLUSION: The majority of participants had negative attitudes towards exercise during periods of moderate to severe activity, largely influenced by disease activity, symptom management, inadequate knowledge of exercise and uncertainty about the value of exercise. Of particular note, professional guidance was generally recognised as stimulating a willingness to exercise positively, and participants demonstrated a strong need for professional guidance. Therefore, it is recommended that clear exercise guidelines for inflammatory bowel disease be constructed to ensure that patients receive safe and effective guidance to develop a healthy lifestyle in order to maximise the benefits of exercise.

Perceived knowledge, attitudes and practices regarding the medical consortium among medical staff in Sichuan, China: a cross-sectional survey.

BACKGROUND: In China, fragmented and inefficient health care systems are common while quality resources are limited. To promote an organized, efficient system, the government launched a medical consortium policy to vertically integrate health care through the collaboration of different levels of medical care. Logically, medical staff's knowledge, attitudes and practices (KAP) regarding the consortium are critical for its development. The objective of this study was to explore the KAP regarding the medical consortium among medical staff in a medical consortium in Sichuan Province, China. METHODS: A cross-sectional survey was conducted. In total, 690 medical staff members in 3 cities of Sichuan Province, China, were interviewed from November 2018 to December 2018. The questionnaire consisted of 18 items, including 4 items related to perceived knowledge, 4 items related to attitudes and 2 items related to practices, and was rated on a 5-point Likert scale (one = strongly disagree/do not know, five = strongly agree/know). RESULTS: The effective response sample was 640 copies of the questionnaire, and most medical staff members (92.50%) knew about the cooperation with other hospitals in the medical consortium. Medical staff scored differently on each item in the questionnaire, with the highest score being the item 'agreeing with the ward rounds and clinical teaching and training organized by the leading hospital' (4.54 ± 0.76), and the lowest score being the item 'frequency in participating in ward rounds and clinical teaching organized by the leading hospital' (2.83 ± 1.36). In addition, the effect of demographic characteristics on KAP was evaluated by stepwise multiple regression analysis, and a significant positive correlation was found between all the studied variables by Spearman's correlation (p < 0.05). CONCLUSIONS: This study showed that the attitudes toward and knowledge of the medical consortium significantly contribute to practices, satisfaction with the support work performed by the leading hospital and agreement of improvement after joining the medical consortium. Thus, to improve medical staff's KAP and satisfaction, publicity and educational programs in medical consortia are necessary, and the leading hospital should attach importance to the informatization construction and demand of different medical staff members. CLINICAL TRIAL REGISTRATION: There are no clinical trials in this study.

Assessment of post-traumatic stress disorder (PTSD) in elderly survivors of the Wenchuan earthquake: A cross-sectional study.

OBJECTIVE: Post-traumatic stress disorder (PTSD) is a prevalent condition characterized by prolonged psychological distress following traumatic events encompassing serious health threats, domestic abuse, and natural disasters. The onset and persistence of PTSD can be attributed to advanced age. This study aimed to explore the occurrence and influencing factors of enduring post-traumatic stress disorder (PTSD) in survivors aged 60 years and over in the main area of the 2008 Wenchuan earthquake 10 years after the disaster. METHODS: Data were collected using a multistage sampling method from individuals aged 60 years and older living in the main impacted areas of Wenchuan 10 years after the Wenchuan earthquake. The PTSD Checklist-Civilian Version (PCL-C) was used to evaluate PTSD symptoms. We evaluated participants based on their PTSD symptoms: those exhibiting and those without. The latter group was four times the size of the former and was matched based on gender and age (within ± 2 years). Conditional logistic regression was used to discern the risk factors. RESULTS: Out of the total, 56 participants were recognized as having probable PTSD as per the PCL-C checklist, leading to a rate of 9.4% (56/588). The univariate conditional logistic regression values showed that playing Mahjong/poker (odds ratio (OR) = 0.394, 95% confidence interval (CI) = 0.171-0.911) and displacement (OR = 0.446, 95% CI = 0.220-0.907) were protective factors for the long-term mental health of survivors in the hard-hit areas, while the presence of a 2-week illness (OR = 3.605, 95% CI = 1.751-7.424), possessing insurance (OR = 0.250, 95% CI = 0.072-0.864), suffering from a chronic ailment (OR = 3.132, 95% CI = 1.2-8.174), and having an injured family member (OR = 2.26, 95% CI = 1.136-4.496) emerged as risk factors for PTSD symptoms. Multivariate analysis indicated that the absence of insurance and prevalence of 2-week illness correlated with increased PTSD symptoms. CONCLUSIONS: Ten years after the Wenchuan earthquake, the prevalence of probable PTSD remained significantly high in the elderly population. The major risk factors were the absence of insurance and the occurrence of a 2-week illness. Policymakers should incorporate these findings when devising strategies for aging societies.

High-resolution mapping of regional VOCs using the enhanced space-time extreme gradient boosting machine (XGBoost) in Shanghai.

The accurate estimation of highly spatiotemporal volatile organic compounds (VOCs) is of great significance to establish advanced early warning systems and regulate air pollution control. However, the estimation of high spatiotemporal VOCs remains incomplete. Here, the space-time extreme gradient boost model (STXGB) was enhanced by integrating spatiotemporal information to obtain the spatial resolution and overall accuracy of VOCs. To this end, meteorological, topographical and pollutant emissions, was input to the STXGB model, and regional hourly 300 m VOCs maps for 2020 in Shanghai were produced. Our results show that the STXGB model achieve good hourly VOCs estimations performance (R2 = 0.73). A further analysis of SHapley Additive exPlanation (SHAP) regression indicate that local interpretations of the STXGB models demonstrate the strong contribution of emissions on mapping VOCs estimations, while acknowledging the important contribution of space and time term. The proposed approach outperforms many traditional machine learning models with a lower computational burden in terms of speed and memory.

Abrupt exacerbation in air quality over Europe after the outbreak of Russia-Ukraine war.

Much attention has been paid to the world economy and social situations in response to the outbreak of war between Russia and Ukraine in the context of COVID-19. However, much less attention has been paid to the detrimental effect of war on the atmospheric environment. Here, we used an extended deweathered-detrended technique to quantitatively evaluate changes in ambient NO2, O3, and PM2.5 AQI levels arising from emission changes (due to pandemic-driven lockdowns and war-related activities) in European cities. Results show pandemic-induced lockdowns mitigated regional air pollution in Europe, but the war activities led to an average increase of approximately 9.78% in PM2.5 and 10.07% in NO2, along with an average decrease of about 7.93% in O3 levels in cities near the war zones. Moreover, the regional air pollution exacerbated by the war activities has offset the improvements in air quality observed during the COVID-19 pandemic. The potential mechanism analysis show that the increase in atmospheric pollutant emissions driven by the war activities led to the complexity of chemical reactions in the mixed atmospheric system, which posed a huge challenge to the alleviation of air pollution in the region. This study highlights the urgent need for a ceasefire from an environmental perspective.

Unraveling the O3-NOX-VOCs relationships induced by anomalous ozone in industrial regions during COVID-19 in Shanghai.

The COVID-19 pandemic promoted strict restrictions to human activities in China, which led to an unexpected increase in ozone (O3) regarding to nitrogen oxides (NOx) and volatile organic compounds (VOCs) co-abatement in urban China. However, providing a quantitative assessment of the photochemistry that leads to O3 increase is still challenging. Here, we evaluated changes in O3 arising from photochemical production with precursors (NOX and VOCS) in industrial regions in Shanghai during the COVID-19 lockdowns by using machine learning models and box models. The changes of air pollutants (O3, NOX, VOCs) during the COVID-19 lockdowns were analyzed by deweathering and detrending machine learning models with regard to meteorological and emission effects. After accounting for effects of meteorological variability, we find increase in O3 concentration (49.5%). Except for meteorological effects, model results of detrending the business-as-usual changes indicate much smaller reduction (-0.6%), highlighting the O3 increase attributable to complex photochemistry mechanism and the upward trends of O3 due to clear air policy in Shanghai. We then used box models to assess the photochemistry mechanism and identify key factors that control O3 production during lockdowns. It was found that empirical evidence for a link between efficient radical propagation and the optimized O3 production efficiency of NOX under the VOC-limited conditions. Simulations with box models also indicate that priority should be given to controlling industrial emissions and vehicle exhaust while the VOCs and NOX should be managed at a proper ratio in order to control O3 in winter. While lockdown is not a condition that could ever be continued indefinitely, findings of this study offer theoretical support for formulating refined O3 management in industrial regions in Shanghai, especially in winter.

Virus-induced breath biomarkers: A new perspective to study the metabolic responses of COVID-19 vaccinees.

Coronavirus disease 2019 (COVID-19) vaccines can protect people from the infection; however, the action mechanism of vaccine-mediated metabolism remains unclear. Herein, we performed breath tests in COVID-19 vaccinees that revealed metabolic reprogramming induced by protective immune responses. In total, 204 breath samples were obtained from COVID-19 vaccinees and non-vaccinated controls, wherein numerous volatile organic compounds (VOCs) were detected by comprehensive two-dimensional gas chromatography and time-of-flight mass spectrometry system. Subsequently, 12 VOCs were selected as biomarkers to construct a signature panel using alveolar gradients and machine learning-based procedure. The signature panel could distinguish vaccinees from control group with a high prediction performance (AUC, 0.9953; accuracy, 94.42%). The metabolic pathways of these biomarkers indicated that the host-pathogen interactions enhanced enzymatic activity and microbial metabolism in the liver, lung, and gut, potentially constituting the dominant action mechanism of vaccine-driven metabolic regulation. Thus, our findings of this study highlight the potential of measuring exhaled VOCs as rapid, non-invasive biomarkers of viral infections. Furthermore, breathomics appears as an alternative for safety evaluation of biological agents and disease diagnosis.

Chemical drivers of ozone change in extreme temperatures in eastern China.

Surface ozone pollution has become the biggest issue in China's air pollution since particulate matters have been improved in the atmosphere. Compared with normal winter/summer, extremely cold/hot weather sustained several days and nights by unfavorable meteorology is more impactful in this regard. However, ozone changes in extreme temperatures and their driving processes remain rarely understood. Here, we combine comprehensive observational data analysis and 0-D box models to quantify the contributions of different chemical processes and precursors to ozone change in these unique environments. Analyses of radical cycling indicate that temperature accelerates OH-HO2-RO2, optimizing ozone production efficiency in higher temperatures. The HO2 + NO → OH + NO2 reaction was the most influenced by temperature change, followed by OH + VOCs → HO2/RO2. Although most reactions in ozone formation increased with temperature, the increase in ozone production rates was greater than the rate of ozone loss, leading to a fast net ozone accumulation in heat waves. Our results also show that the ozone sensitivity regime is VOC-limited in extreme temperatures, highlighting the significance of volatile organic compound (VOC) control (particularly the control of alkenes and aromatics). In the context of global warming and climate change, this study helps us deeply understand ozone formation in extreme environments and design abatement policies for ozone pollution in such conditions.

[Guideline for clinical comprehensive evaluation of Chinese patent medicine (2022 version)].

Currently,the research or publications related to the clinical comprehensive evaluation of Chinese patent medicine are increasing,which attracts the broad attention of all circles. According to the completed clinical evaluation report on Chinese patent medicine,there are still practical problems and technical difficulties such as unclear responsibility of the evaluation organization,unclear evaluation subject,miscellaneous evaluation objects,and incomplete and nonstandard evaluation process. In terms of evaluation standards and specifications,there are different types of specifications or guidelines with different emphases issued by different academic groups or relevant institutions. The professional guideline is required to guide the standardized and efficient clinical comprehensive evaluation of Chinese patent medicine and further improve the authority and quality of evaluation. In combination with the characteristics of Chinese patent medicine and the latest research achievement at home and abroad,the detailed specifications were formulated from six aspects including design,theme selection,content and index,outcome,application and appraisal,and quality control. The guideline was developed based on the guideline development requirements of China Assoication of Chinese medicine. After several rounds of expert consensus and public consultation,the current version of the guideline has been developed.

The impact of informal caregivers' preparedness on short-term outcomes of heart failure patients with insufficient self-care.

AIMS: Even though self-care is essential in the long-term management of heart failure (HF), it is often not performed adequately in HF populations. Mobilizing informal caregivers may be one way to help patients perform self-care, support individual needs, and maintain health. However, informal caregivers often face insufficient preparation for providing long-term care. This insufficient caregiver preparedness may lead to a decline in caregiver contributions and affect the outcomes of care in patients with HF. This study aimed to explore whether informal caregivers' preparedness is a predictor that influences short-term outcomes of HF patients; to analyse whether caregiver contribution to self-care of HF (CC-SCHF) plays a mediating role between informal caregivers' preparedness and HF short-term outcomes. METHODS AND RESULTS: A prospective observational study was conducted in China. After controlling for covariates, higher levels of informal caregivers' preparedness were significantly associated with lower 3-month mortality [odds ratio (OR) = 0.919, 95% confidence interval (CI) = (0.855-0.988), P = 0.022] and 3-month readmission rate [OR = 0.883, 95% CI = (0.811-0.961), P = 0.004] and shorter length of hospital stay (ß = -0.071, P < 0.001). The informal caregiver's preparedness was positively associated with CC-SCHF maintenance (r = 0.708, P < 0.01), CC-SCHF management (r = 0.431, P < 0.01), and CC-SCHF confidence (r = 0.671, P < 0.01). The CC-SCHF management was a mediator in the relationship between informal caregivers' preparedness and 3-month readmission rate [effect 95% CI = (-0.054 to -0.001)] and length of hospital stay [effect 95% CI = (-0.235 to -0.042)]. CONCLUSION: A higher level of informal caregivers' preparedness is associated with better short-term outcomes of HF patients with insufficient self-care.

Generic prediction of exocytosis rate constants by size-based surface energies of nanoparticles and cells.

Nanotechnology brings benefits in fields such as biomedicine but nanoparticles (NPs) may also have adverse health effects. The effects of surface-modified NPs at the cellular level have major implications for both medicine and toxicology. Semi-empirical and mechanism-based models aid to understand the cellular transport of various NPs and its implications for quantitatively biological exposure while avoiding large-scale experiments. We hypothesized relationships between NPs-cellular elimination, surface functionality and elimination pathways by cells. Surface free energy components were used to characterize the transport of NPs onto membranes and with lipid vesicles, covering both influences by size and hydrophobicity of NPs. The model was built based on properties of neutral NPs and cells, defining Van de Waals forces, electrostatic forces and Lewis acid-base (polar) interactions between NPs and vesicles as well as between vesicles and cell membranes. We yielded a generic model for estimating exocytosis rate constants of various neutral NPs by cells based on the vesicle-transported exocytosis pathways. Our results indicate that most models are well fitted (R2 ranging from 0.61 to 0.98) and may provide good predictions of exocytosis rate constants for NPs with differing surface functionalities (prediction errors are within 2 times for macrophages). Exocytosis rates differ between cancerous cells with metastatic potential and non-cancerous cells. Our model provides a reference for cellular elimination of NPs, and intends for medical applications and risk assessment.

Oxidative potential induced by metal-organic interaction from PM2.5 in simulated biological fluids.

The oxidative potential (OP) of fine particulate matter (PM2.5) has recently been proposed as a metric that may prove more indicative of human health effects than the routinely measured PM2.5 concentration. Observations of exposure to PM2.5 show most OP are originated from the contribution of transition metals and organics, but the pertinent coupling mechanisms are unclear. Here, we report laboratory observations in four simulated biological fluids (i.e., simulated saliva, surrogate lung fluid, artificial lysosomal fluid, and synthetic serum) that reveal OP of PM2.5 are significantly induced by prevalent metal complexes formed with nitrogen- and oxygen-containing compounds in low acid environments. Analyses of mass spectra and interaction factors indicate that organic-metal mixture effect in PM2.5, leading to synergistic, additive to antagonistic effects, which may serve as the dominant mechanism for this OP formation. A metal-organic mixtures origin for OP could explain why PM2.5 emission controls should emphasize the reduction of key toxic components, rather than just PM2.5 mass concentration control. SYNOPSIS: This study has investigated the oxidative potential of inhaled atmospheric particulate matter (PM) in four simulated biological fluids, which highlight the importance of metal-organic complexes to the formation of oxidative potential (OP).

Efficacy and Safety of Modified Yupingfeng Nasal Spray in Controlling the Recurrence of Persistent and Moderate-Severe Allergic Rhinitis: Study Protocol for a Multicenter, Open-Label, Randomized, and Parallel-Arm Trial.

Background: Recurrent episode of allergic rhinitis (AR) is one of the leading illnesses that affects patients. However, there is little research evidence to support pharmacotherapy for AR recurrence. Therefore, this study was designed to explore the efficacy of pharmacotherapy in the control of the recurrence of AR. Methods: In this study, a multicenter, open-label, randomized, and parallel-arm trial will be conducted at three study centers. A total of 190 subjects aged 18-65 with persistent and moderate-severe AR (Qi deficiency and blood stasis syndrome) will be randomly assigned to receive the modified Yupingfeng nasal spray or mometasone furoate aqueous nasal spray. When subjects' rhinitis control assessment test (RCAT) score is >21 for two weeks, they will stop taking the medication and enter the follow-up. Once a relapse occurs, the time point will be recorded, and the follow-up stops. The primary outcome is the six-month recurrence rate of AR after intervention withdrawal. The secondary outcomes are the one-month recurrence rate of AR, the RCAT score, the duration of follow-up, the duration of medication, the nasal endoscopic results, and questionnaires to evaluate symptoms, signs, and quality of life. The mechanism outcomes include some indicators that may be associated with AR recurrence. In addition, electrocardiograms and other safety indicators will be applied to evaluate the drug's safety. Discussion. This is the first study to explore the efficacy of traditional Chinese medicine nasal spray on AR from the perspective of controlling recurrence. The results of this trial may provide valuable clinical evidence for controlling the recurrence of this disease by pharmacotherapy. Trial Registration. This study was registered with registration number ChiCTR2100047053 (Chinese Clinical Trial Registry, https://www.chictr.org.cn/showproj.aspx?proj=127432 on June 7, 2021).

Na2S-Mediated One-Pot Selective Deoxygenation of α-Hydroxyl Carbonyl Compounds including Natural Products.

A practical method for the deoxygenation of α-hydroxyl carbonyl compounds under mild reaction conditions is reported here. The use of cheap and easy-to-handle Na2S·9H2O as the reductant in the presence of PPh3 and N-chlorosuccinimide (NCS) enables the selective dehydroxylation of α-hydroxyl carbonyl compounds, including ketones, esters, amides, imides and nitrile groups. The synthetic utility is demonstrated by the late-stage deoxygenation of bioactive molecule and complex natural products.

Assessment of clinical competency among TCM medical students using standardized patients of traditional Chinese medicine: A 5-year prospective randomized study.

BACKGROUND: Some Western medicine schools in China established standardized patient (SP) programs for medical education. However, SP programs are rarely applied to the education of traditional Chinese medicine (TCM). In this study, we evaluated the effectiveness of using standardized patient traditional Chinese medicine (SP-TCM) to improve clinical competency among TCM medical students. METHODS: This study was a prospective, 2-group, parallel-training randomized trial over the course of 5 years. Data were collected from September 2016 to December 2020. Participants in each year were randomly allocated into the traditional-method training group or the SP-TCM training group (1:1) for a 3-month curriculum. Measurement of clinical competency among all trainees was based on a standardized examination composed of scores of medical record documentation, scores of TCM syndrome differentiation and therapeutic regimen, and checklist assessment from both SP-TCMs and TCM professionals. Feedback was collected using semi-constructive questionnaires from both groups. RESULTS: Compared with those assigned to traditional-method training, those assigned to SP-TCM training demonstrated significantly greater post-training improvement in medical record documentation and TCM syndrome differentiation and therapeutic regimen. Moreover, SP-TCM trainees outscored those assigned to traditional training in the assessment for encounter performance given by independent SP-TCMs and TCM professionals. The SP-TCM method gained higher satisfaction of training efficacy and test performance than the traditional method. CONCLUSION: This SP-TCM program demonstrated great benefits for improving clinical competency among TCM medical students.

Attributing Increases in Ozone to Accelerated Oxidation of Volatile Organic Compounds at Reduced Nitrogen Oxides Concentrations.

Surface ozone (O3) is an important secondary pollutant affecting climate change and air quality in the atmosphere. Observations during the COVID-19 lockdown in urban China show that the co-abatement of nitrogen oxides (NOx) and volatile organic compounds (VOCs) caused winter ground-level O3 increases, but the chemical mechanisms involved are unclear. Here we report field observations in the Shanghai lockdown that reveals increasing photochemical formation of O3 from VOC oxidation with decreasing NOx. Analyses of the VOC profiles and NO/NO2 indicate that the O3 increases by the NOx reduction counteracted the O3 decreases through the VOC emission reduction in the VOC-limited region, and this may have been the main mechanism for this net O3 increase. The mechanism may have involved accelerated OH-HO2-RO2 radical cycling. The NOx reductions for increasing O3 production could explain why O3 increased from 2014 to 2020 in response to NOx emission reduction even as VOC emissions have essentially remained unchanged. Model simulations suggest that aggressive VOC abatement, particularly for alkenes and aromatics, should help reverse the long-term O3 increase under current NOx abatement conditions.