Exploring non-linear effects of walking accessibility on well-being in rural older adults of Jintang County: a random forest analysis.

Objective: The global concern surrounding the aging population has brought the well-being of older individuals to the forefront of societal attention. Unfortunately, studies focusing on the well-being of older people residing in rural areas are frequently overshadowed by the developmental disparities between rural and urban regions. Thus, this study aims to delve into the non-linear impact of walking accessibility on the subjective well-being of rural older adults. The goal is to gain a comprehensive understanding of this relationship, ultimately contributing to an improved quality of life and health for older adults in rural areas. Methods: In this study, the Random Forest algorithm was employed to explore the non-linear effects of demographic variables, perceived safety, subjective built environment (including perceptions and preferences of the built environment), and walking accessibility on the subjective well-being of older adults. Results: The findings of this study underscore the pivotal role of walking accessibility in influencing the well-being of older adults, particularly in terms of access to bazaars and health centers, where non-linear and threshold effects are evident. Furthermore, community safety, road conditions, and walking preferences were identified as positive influencers on the well-being of older adults. Well-being trends varied with age, revealing noteworthy non-linear relationships for certain variables. Conclusion: The insights gained from this study provide crucial theoretical guidance for the development of policies tailored to the unique context of rural aging. By taking into account factors such as walking accessibility, community safety, health support, and social interaction, we can create an improved living environment for rural older adults, ultimately enhancing their happiness and overall quality of life.

A Two-Dimensional Eight-Node Quadrilateral Inverse Element for Shape Sensing and Structural Health Monitoring.

The inverse finite element method (iFEM) is a powerful tool for shape sensing and structural health monitoring and has several advantages with respect to some other existing approaches. In this study, a two-dimensional eight-node quadrilateral inverse finite element formulation is presented. The element is suitable for thin structures under in-plane loading conditions. To validate the accuracy and demonstrate the capability of the inverse element, four different numerical cases are considered for different loading and boundary conditions. iFEM analysis results are compared with regular finite element analysis results as the reference solution and very good agreement is observed between the two solutions, demonstrating the capability of the iFEM approach.

A high-sensitivity fiber Bragg grating sensor for displacement measurement in structural health monitoring.

Displacement measurement is of great significance to monitor the crack variation and ensure the health of building structures. Aiming at the problems of low sensitivity and high temperature error of fiber Bragg grating (FBG) displacement sensors in displacement monitoring, this paper presents an adjustable cantilever beam displacement sensor with the FBGs as the sensing element. The sensor adds double FBGs on the relative surfaces of the equal-strength cantilever beam, which increases the bending deformation on the FBG of the beam surface to improve the sensitivity and realize the temperature compensation of the sensor. By adding an adjustable external rod structure between a flexible spring and a fixed foot stand, the sensor can regulate the range of initial crack width for different occasions. A theoretical analysis of the displacement sensor is performed, and the simulation analysis and optimization design for the structural parameters of the cantilever beam elastic sensitive element are implemented by adopting SolidWorks and ANSYS software. Finally, a displacement testing platform is constructed to test its performance. Experimental results show that this design has a high sensitivity coefficient of 39.47 pm/mm and a temperature coefficient of 1.04 pm/°C in the range of initial crack width from 0 to 110 mm or from 0 to 130 mm depending on different monitoring situations. Furthermore, good linearity, hysteresis delay, repeatability, and temperature compensation performance have also been demonstrated.

The Interval of Two-Stage Bilateral Total Hip Arthroplasty under Enhanced Recovery Affects Perioperative Complications and Cost of Hospitalization: A Retrospective Study.

OBJECTIVES: Perioperative enhanced recovery after surgery (ERAS) protocols can improve the quality of healthcare and reduce hospitalization for patients who underwent total hip arthroplasty (THA). The interval of staged bilateral THA under ERAS is still unclear. We attempt to ascertain the optimal interval of staged bilateral THA for reducing the perioperative complications and the cost of hospitalization. METHODS: We retrospectively reviewed patients who received staged bilateral THA under ERAS performed at West China Hospital of Sichuan University from 2018 to 2021. The staged time was divided into two groups using four different cutoff points: (1) ≤3 months versus >3 months, (2) ≤4 months versus >4 months, (3) ≤5 months versus >5 months and (4) ≤6 months versus >6 months. Primary outcomes included the rate of perioperative complications and the cost of hospitalization. The secondary outcomes were the length of hospital stay (LOS), the rates of transfusion and albumin (Alb) administration, hemoglobin (Hb) decrease and serum Alb decrease. The categorical variables were compared using chi-squared and/or two-tailed Fisher's exact tests, whereas continuous variables were compared using two-tailed independent t-tests, the continuous variables which were asymmetrical distributions used a Kruskal-Wallis test. RESULTS: With the application of ERAS, the rate of perioperative complications in the >5 months group was significantly lower than that in the ≤5 months group (13/195 vs. 45/307, p < 0.05). Concerning the cost of hospitalization, the >5 monthly intervals spent significantly less than the ≤5 monthly intervals ($ 8695.91 vs. $ 8919.71, p < 0.05). However, no significant difference was found for secondary outcomes such as the rate of transfusions and Alb administrations or decreases of Hb and Alb in the 5 months threshold. CONCLUSIONS: More than 5 months maybe a reasonable period to perform the first contralateral THA under ERAS regarding the rate of perioperative complications and the cost of hospitalization. However, more high-quality research will include a larger sample size in the future to validate the appropriate time of staged bilateral THA.

Statistical Assessment of High-Performance Scaled Double-Gate Transistors from Monolayer WS2.

Scaling of monolayer transition metal dichalcogenide (TMD) field-effect transistors (FETs) is an important step toward evaluating the application space of TMD materials. Although some work on ultrashort channel monolayer (ML) TMD FETs has been published, there exist no comprehensive studies that assess their performance in a statistically relevant manner, providing critical insights into the impact of the device geometry. Part of the reason for the absence of such a study is the substantial variability of TMD devices when processes are not carefully controlled. In this work, we show a statistical study of ultrashort channel double-gated ML WS2 FETs exhibiting excellent device performance and limited device-to-device variations. From a detailed analysis of cross-sectional scanning transmission electron microscopy (STEM) images and careful technology computer aided design (TCAD) simulations, we evaluated, in particular, an unexpected deterioration of the subthreshold characteristics for our shortest devices. Two potential candidates for the observed behavior were identified, i.e., buckling of the TMD on the substrate and loss of gate control due to the source geometry and the high-k dielectric between the metal gate and the metal source electrode.

Has the Volume-Based Drug Purchasing Approach Achieved Equilibrium among Various Stakeholders? Evidence from China.

Volume-based drug purchasing by China's health insurance system currently represents the largest group purchasing organization worldwide. After exchanging the market that accounted for nearly half of the volume of the healthcare system for the ultra-low-price supply of limited drugs, what are the effects on patient and funding burdens, drug accessibility, and clinical efficacy? We aimed to verify the effectiveness of the policy, explore the reasons behind the problem and identify regulatory priorities and collaborative measures. We used literature and reported data from 2019 to 2021 to conduct a stakeholder analysis and health impact assessment, presenting the benefit and risk share for various dimensions. The analysis method was a multidimensional scaling model, which visualized problematic associations. Seventy-nine papers (61 publications and 18 other resources) were included in the study, with 22 effects and 36 problems identified. The results indicated favorable affordability and poor accessibility of drugs, as well as high risk of reduced drug quality and drug-use rationality. The drug-use demand of patients was guaranteed; the prescription rights of doctors regarding clinical drug use were limited; unreasonable evaluation indicators limited the transformation of public hospitals to value- and service-oriented organizations; the sustainability of health insurance funds and policy promotion were at risk; and innovation by pharmaceutical companies was accelerated. The problems associated with high co-occurrence frequencies were divided into the following clusters: cost control, drug accessibility, system rationality, policy fairness, drug quality, and moral hazards. These findings suggested that China has achieved short-term success in reducing the burden on patients and reducing fund expenditure. However, there were still deficiencies in guaranteed supply, quality control, and efficacy tracking. The study offers critical lessons for China and other low- and middle-income countries.

Sigma metrics application for validated and non-validated detecting systems performance assessment.

BACKGROUND: Sigma metrics provide an objective and quantitative methodology for analytical quality evaluation of clinical laboratory. This study investigated the testing performance of validated systems and non-validated systems based on sigma metrics, and explored the major parameters affecting the system performance. METHODS: Sigma metrics were evaluated by six biochemistry assays based on Beckman and Mindray validated and non-validated systems through crossing the reagents and analyzers. Imprecision and bias were assessed for all assays based on trueness programs organized by National Centre for Clinical Laboratory. Total error allowance obtained from the Chinese Ministry of Health Clinical Laboratory Centre Industry Standard (WS/T403-2012). RESULTS: The imprecision for all systems meets the quality specifications except TP assay (2.19%) detected by Mindray non-validated system, and the bias for four assays measured by non-validated systems cannot fulfill the criterion, including lactate dehydrogenase (LDH), total protein (TP), triglycerides (TG), and glucose (GLU). Higher biases were detected in six assays at different levels among non-validated and validated systems. Systems performed poorly or unacceptably for TP assay with sigma metrics lower than 3 except Mindray non-validated system. The sigma metrics for other assays with four systems were greater than 3 except the LDH evaluated on Mindray non-validated systems. CONCLUSION: Non-validated systems may introduce performance uncertainty compared with validated systems based on sigma metrics evaluation, and lower bias was provided by validated systems. The performance of non-validated systems should be evaluated thoroughly in the clinical laboratory before they were adopted for routine use.

Temperature-dependent optical constants of monolayer [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]: spectroscopic ellipsometry and first-principles calculations.

The temperature-dependent ([Formula: see text]) optical constants of monolayer [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] were investigated through spectroscopic ellipsometry over the spectral range of 0.73-6.42 eV. At room temperature, the spectra of refractive index exhibited several anomalous dispersion features below 800 nm and approached a constant value of 3.5-4.0 in the near-infrared frequency range. With a decrease in temperature, the refractive indices decreased monotonically in the near-infrared region due to the temperature-dependent optical band gap. The thermo-optic coefficients at room temperature had values from [Formula: see text] to [Formula: see text] for monolayer transition metal dichalcogenides at a wavelength of 1200 nm below the optical band gap. The optical band gap increased with a decrease in temperature due to the suppression of electron-phonon interactions. On the basis of first-principles calculations, the observed optical excitations at 4.5 K were appropriately assigned. These results provide basic information for the technological development of monolayer transition metal dichalcogenides-based photonic devices at various temperatures.

Development and assessment of an individualized nomogram to predict colorectal cancer liver metastases.

BACKGROUND: This article aims to develop and assess the radiomics paradigm for predicting colorectal cancer liver metastasis (CRLM) from the primary tumor. METHODS: This retrospective study included 100 patients from the First Hospital of Jilin University from June 2017 to December 2017. The 100 patients comprised 50 patients with and 50 without CRLM. The maximum-level enhanced computed tomography (CT) image of primary cancer in the portal venous phase of each patient was selected as the original image data. To automatically implement radiomics-related paradigms, we developed a toolkit called Radiomics Intelligent Analysis Toolkit (RIAT). RESULTS: With RIAT, the model based on logistic regression (LR) using both the radiomics and clinical information signatures showed the maximum net benefit. The area under the curve (AUC) value was 0.90±0.02 (sensitivity =0.85±0.02, specificity =0.79±0.04) for the training set, 0.86±0.11 (sensitivity =0.85±0.09, specificity =0.75±0.19) for the verification set, 0.906 (95% CI, 0.840-0.971; sensitivity =0.81, specificity =0.84) for the cross-validation set, and 0.899 (95% CI, 0.761-1.000; sensitivity =0.78, specificity =0.91) for the test set. CONCLUSIONS: The radiomics nomogram-based LR with clinical risk and radiomics features allows for a more accurate classification of CRLM using CT images with RIAT.

Risk assessment of the total testing process based on quality indicators with the Sigma metrics.

Background Evidence-based evaluation of laboratory performances including pre-analytical, analytical and post-analytical stages of the total testing process (TTP) is crucial to ensure patients receiving safe, efficient and effective care. To conduct risk assessment, quality management tools such as Failure Mode and Effect Analysis (FMEA) and the Failure Reporting and Corrective Action System (FRACAS) were constantly used for proactive or reactive analysis, respectively. However, FMEA and FRACAS faced big challenges in determining the scoring scales and failure prioritization in the assessment of real-world cases. Here, we developed a novel strategy, by incorporating Sigma metrics into risk assessment based on quality indicators (QIs) data, to provide a more objective assessment of risks in TTP. Methods QI data was collected for 1 year and FRACAS was applied to produce the risk rating based on three variables: (1) Sigma metrics for the frequency of defects; (2) possible consequence; (3) detection method. The risk priority number (RPN) of each QI was calculated by a 5-point scale score, where a value of RPN > 50 was rated as high-risk. Results The RPNs of two QIs in post-analytical phase (TAT of Stat biochemistry analyte and Timely critical values notification) were above 50 which required rigorous monitoring and corrective actions to eliminate the high risks. Nine QIs (RPNs between 25 and 50) required further investigation and monitoring. After 3 months of corrective action the two identified high-risk processes were successfully reduced. Conclusions The strategy can be implemented to reduce identified risk and assuring patient safety.

How would China achieve WHO's target of eliminating HCV by 2030?

Introduction: Hepatitis C virus (HCV) infection is a major global health concern on the rise, prompting unprecedented efforts by the World Health Organization (WHO) to eliminate this epidemic by 2030. Being the country with the largest HCV-infected population in the world, China has been faced with a general lack of awareness for HCV, low treatment uptake and subpar collaborations among healthcare providers and stakeholders. Areas covered: This review discusses the epidemiological situations of HCV infection and the challenges in HCV management in China. This review also explores micro-elimination strategies in China, identifying potential sub-populations for concerted efforts in eliminating HCV. As DAAs are increasingly recognized as a more effective alternative to traditional regimens, the cost-effectiveness and budget impacts of bringing more DAAs into the reimbursement lists are also addressed. Several small-scale targeted literature searches were conducted in PubMed for various topics covered in the article, and hand searching was performed to fill any data gaps. More recent data were used wherever possible. Expert opinion: Considering the unique socioeconomical landscape of China, micro-elimination strategies might be more effective and should be targeted at high-risk populations. Varying regional needs in HCV care across the country necessitate decentralized approaches in research and policy-making.

Has the High-Tech Industry along the Belt and Road in China Achieved Green Growth with Technological Innovation Efficiency and Environmental Sustainability?

From the perspective of green growth, which seeks to coordinate and make sustainable the development of resources, the environment, and the economy, this study's aim was to find out whether the high-tech industry along the Belt and Road (B&R) is sustainable and effective in using resources, reducing environmental pollution, and increasing performance. This study used panel data covering 16 provinces (municipalities) along the B&R in China between 2009 and 2016. This study used the directional distance function (DDF) and the global Malmquist-Luenberger (GML) index model to analyze the technological innovation efficiency (TIE) of the high-tech industry (HTI) while considering the undesirable output (environmental pollution). Further, supplemented by ArcGIS geographical analysis, this study carried out a comparative analysis of the TIE and its decomposition in the HTI along the B&R from geographical and time-series dimensions. Moreover, the panel Tobit regression model was used to analyze the influencing factors of TIE. The results show that the direct financial support of the government has no impact on the improvement of TIE in the HTI, the government's regulation of environmental pollution can significantly affect the improvement of the TIE, the intensity of R&D has a significantly negative impact on the TIE, a higher level of R&D personnel in the HTI can be helpful in improving TIE, and increasing the import and export trade volumes of the HTI can promote TIE.

Claims data-driven modeling of hospital time-to-readmission risk with latent heterogeneity.

Hospital readmission risk modeling is of great interest to both hospital administrators and health care policy makers, for reducing preventable readmission and advancing care service quality. To accommodate the needs of both stakeholders, a readmission risk model is preferable if it (i) exhibits superior prediction performance; (ii) identifies risk factors to help target the most at-risk individuals; and (iii) constructs composite metrics to evaluate multiple hospitals, hospital networks, and geographic regions. Existing work mainly addressed the first two features and it is challenging to address the third one because available medical data are fragmented across hospitals. To simultaneously address all three features, this paper proposes readmission risk models with incorporation of latent heterogeneity, and takes advantage of administrative claims data, which is less fragmented and involves larger patient cohorts. Different levels of latent heterogeneity are considered to quantify the effects of unobserved factors, provide composite measures for performance evaluation at various aggregate levels, and compensate less informative claims data. To demonstrate the prediction performances of the proposed models, a real case study is considered on a state-wide heart failure patient cohort. A systematic comparison study is then carried out to evaluate the performances of 49 risk models and their variants.

Blood loss and cost-effectiveness of oral vs intravenous tranexamic acid in primary total hip arthroplasty: A randomized clinical trial.

BACKGROUND: To assess the blood loss and cost-effectiveness of the oral and intravenous (IV) administration of tranexamic acid (TXA) for the treatment of primary total hip arthroplasty (THA). METHODS: From January 2017 to August 2017, 100 patients undergoing primary THA were enrolled and randomly divided into two groups. In the oral TXA group (N = 50), 1 g of TXA (2 tablets of 500 mg) was given 2 h before the incision, and the same dose was repeated 3 h and 6 h postoperatively. In the IV TXA group (N = 50), 1 g of TXA was administered 10 min before the incision, and the same dose was repeated 3 h and 6 h postoperatively. The total follow-up period was 6 months. RESULTS: There were no statistically significant differences in total blood loss (863.3 ±â€¯272.5 mL and 886.1 ±â€¯200.2 mL, P = 0.66), maximum Hb drop (2.9 ±â€¯0.6 g/dl and 3.1 ±â€¯0.8 g/dl, P = 0.17), maximum Hct drop (7.4 ±â€¯2.1% and 7.7 ±â€¯1.8%, P = 0.48), transfusion rates (1 and 2, P = 1.00) and transfusion units (1.5 u and 3 u, P = 0.56) between the two groups. However, the costs of TXA in the oral group were significantly lower than those in the IV TXA group (¥600 and ¥3150, P < 0.01). There was no difference in the Hb levels on postoperative days 1 and 3. No significant differences were found for operating time, hospital length of stay, DVT and/or PE, and wound complications in the postoperative follow-up. CONCLUSIONS: The study demonstrated that the oral and IV administration of TXA in patients undergoing THA was proved to be an equivalent and effective method in reducing blood loss and transfusion rates. However, oral TXA is more cost-effectiveness than IV TXA, and it may be an alternative to the IV form.

Risk analysis and assessment based on Sigma metrics and intended use.

INTRODUCTION: In order to ensure the quality in clinical laboratories and meet the low risk requirements of patients and clinicians, a risk analysis and assessment model based on Sigma metrics and intended use was constructed, based on which differential sigma performance (σ) expectations of 42 analytes were developed. MATERIALS AND METHODS: Failure mode and effects analysis was applied to produce an analytic risk rating based on three factors, each test of which was graded as follows: 1) Sigma metrics; 2) the severity of harm; 3) intended use. By multiplying the score of Sigma metrics by the score of severity of harm by the score of intended use, each was assigned a typical risk priority number (RPN), with RPN ≤ 25 rated as low risk. Low risk was defined as acceptable standards; the sigma performance expectations were calculated. RESULTS: Among the 42 analytes, tests with σ ≥ 6, 5 ≤ σ < 6, 4 ≤ σ < 5, 3 ≤ σ < 4, σ < 3 were 21, 5, 5, 6, and 5, respectively; there were 7 high-risk tests, 8 of them medium risk tests. According to the risk assessment conclusion, 13 tests had sigma performance expectations ≥ 6; 15 test items had sigma performance expectations ≥ 5, while 3 test items had sigma performance expectations ≥ 4; 11 test items had sigma performance expectations ≥ 3. CONCLUSIONS: Constructing the risk analysis and assessment model based on Sigma metrics and intended use will help clinical laboratories to identify the high-risk tests more objectively and comprehensively. Such model can also be used to establish the sigma performance expectations and meet the low risk requirements of patients and clinicians.

How to apply SHA 2011 at a subnational level in China's practical situation: take children health expenditure as an example.

BACKGROUND: System of Health Accounts 2011 (SHA 2011) is a new health care accounts system, revised from SHA 1.0 by the Organisation for Economic Co-operation and Development (OECD), the World Health Organization (WHO) and Eurostat. It keeps the former tri-axial relationship and develops three analytical interfaces, in order to fix the existing shortcomings and make it more convenient for analysis and comparison across countries. SHA 2011 was introduced in China in 2014, and little about its application in China has been reported. This study takes children as an example to study how to apply SHA 2011 at the subnational level in the practical situation of China's health system. METHODS: Multistage random sampling method was applied and 3 532 517 samples from 252 institutions were included in the study. Official yearbooks and account reports helped the estimation of provincial data. The formula to calculate Current Health Expenditure (CHE) was introduced step-by-step. STATA 10.0 was used for statistics. RESULTS: Under the frame of SHA 2011, the CHE for children in Liaoning was calculated as US$ 0.74 billion in 2014; 98.56% of the expenditure was spent in hospital and the allocation to primary health care institutions was insufficient. Infection, maternal and prenatal diseases cost the most in terms of Global Burden of Disease (GBD), and respiratory system diseases took the leading place in terms of International Classification of Disease Tenth Revision (ICD-10). In addition, medical income contributed most to the health financing. CONCLUSIONS: The method to apply SHA 2011 at the subnational level is feasible in China. It makes health accounts more adaptable to rapidly developing health systems and makes the financing data more readily available for analytical use. SHA 2011 is a better health expenditure accounts system to reveal the actual burden on residents and deserves further promotion in China as well as around the world.

How great is the medical burden of disease on the aged? Research based on "System of Health Account 2011".

BACKGROUND: The aging of population and the burden of disease among the aged have become one of the hot topics in the international health, and also brought tremendous pressure in the development of health service. METHODS: A total of 1,377,681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and "System of Health Account 2011" was conducted to analyze the expenditure of disease for the elderly. Influencing factors were performed using multiple stepwise regression analysis. RESULTS: The curative care expenditure for the aged was 233.18 billion RMB. Most of the expenditure for the old people was in hospital. Moreover, by the disease, the highest expenditure was incurred by non-communicable diseases. The financing scheme of the aged was concentrated on social health insurance and family health expenditure. Hospitalization expenditure was significantly associated with length of stay, operation, etc. CONCLUSIONS: This study intends to capture large data from various medical institutions with a new accounting system. The finding illustrates that the burden of old people is still heavy.

Tumor invasion depth is a useful pathologic assessment for predicting outcomes in cervical squamous cell carcinoma after neoadjuvant radiotherapy.

BACKGROUND: To evaluate whether tumor invasion depth can be a reliable and easily applicable pathologic assessment strategy to predict outcomes using surgically resected cervical squamous cell carcinoma specimens from patients who have received neoadjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). METHODS: We included 173 patients with cervical squamous cell carcinoma who received neoadjuvant CCRT (n = 125) or RT (n = 48) and underwent subsequent radical hysterectomy. Data for the pre-operative clinical International Federation of Gynecology and Obstetrics (FIGO) stage, post-operative pathologic FIGO stage, World Health Organization (WHO) double diameter measurement evaluation, response evaluation criteria in solid tumors (RECIST 1.1) criteria, tumor necrosis rate (TNR), and tumor regression grade (TRG) were investigated to identify correlations with outcomes related to distant metastasis and survival. The tumor invasion depth (TID) and the tumor invasion depth with cytokeratin immunostaining correction (TIDC) at the cervical internal surface were measured to assess their relations to patients' outcomes. RESULTS: Based on measurements taken via transvaginal ultrasound, the pre-operative clinical and post-operative pathologic FIGO staging as well as the WHO double diameter measurement evaluation and RECIST 1.1 criteria were predictive of distant metastasis and survival-related outcomes. Also, lymph node involvement was found to be an independent prognostic factor for recurrence and distant metastasis. Finally, univariate analysis showed both the TID and TIDC were highly related to distant metastasis, overall survival, and progression-free survival, irrespective of the clinical stage of carcinomas. CONCLUSION: The TID or TIDC measured at the cervical internal surface is a useful and easily applied pathologic prognostic factor for distant metastasis and survival outcomes in patients with cervical squamous cell carcinoma treated with neoadjuvant RT or CCRT.

The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice.

BACKGROUND: There is growing awareness of the role of information technology in evidence-based practice. The purpose of this study was to investigate the role of organizational context and nurse characteristics in explaining variation in nurses' use of personal digital assistants (PDAs) and mobile Tablet PCs for accessing evidence-based information. The Promoting Action on Research Implementation in Health Services (PARIHS) model provided the framework for studying the impact of providing nurses with PDA-supported, evidence-based practice resources, and for studying the organizational, technological, and human resource variables that impact nurses' use patterns. METHODS: A survey design was used, involving baseline and follow-up questionnaires. The setting included 24 organizations representing three sectors: hospitals, long-term care (LTC) facilities, and community organizations (home care and public health). The sample consisted of 710 participants (response rate 58%) at Time 1, and 469 for whom both Time 1 and Time 2 follow-up data were obtained (response rate 66%). A hierarchical regression model (HLM) was used to evaluate the effect of predictors from all levels simultaneously. RESULTS: The Chi square result indicated PDA users reported using their device more frequently than Tablet PC users (p = 0.001). Frequency of device use was explained by 'breadth of device functions' and PDA versus Tablet PC. Frequency of Best Practice Guideline use was explained by 'willingness to implement research,' 'structural and electronic resources,' 'organizational slack time,' 'breadth of device functions' (positive effects), and 'slack staff' (negative effect). Frequency of Nursing Plus database use was explained by 'culture,' 'structural and electronic resources,' and 'breadth of device functions' (positive effects), and 'slack staff' (negative). 'Organizational culture' (positive), 'breadth of device functions' (positive), and 'slack staff '(negative) were associated with frequency of Lexi/PEPID drug dictionary use. CONCLUSION: Access to PDAs and Tablet PCs supported nurses' self-reported use of information resources. Several of the organizational context variables and one individual nurse variable explained variation in the frequency of information resource use.