Development and reliability testing of a risk factor and risk outcome assessment scale for nurses in "internet + nursing services" for the elderly.

BACKGROUND: China is experiencing an aging population, leading to a significant demand for "Internet + nursing services" tailored for elderly individuals. However, there are many risk problems in the process of nurse service, which hinder the development of the service, and a scale is needed to assess the risk problems faced by nurses in "Internet + nursing services" for the elderly. OBJECTIVE: The purpose of this study is to develop an assessment scale for risk factors and outcomes related to nurses' involvement in the "Internet + Nursing Service" for the elderly and to assess its reliability and validity. METHODS: Based on literature analysis, focus group, the Delphi method, and a presurvey, we designed an initial scale. The initial scale comprised two sections: risk factors and risk outcomes for nurses. In January and February of 2023, nurses engaged in "Internet + nursing services" for the elderly in Shanxi Province were chosen through a convenience sampling technique for a questionnaire survey. Subsequently, item analysis and exploratory factor analysis were employed to refine and develop a test version of the scale further. A follow-up questionnaire survey was carried out in March and April 2023 using a similar approach. The reliability and validity of the scale were assessed through confirmatory factor analysis, culminating in the formation of the final scale. RESULTS: The initial survey yielded 244 valid responses. The cumulative variance contributions of the two segments from the exploratory factor analysis were 84.584% and 90.089%, respectively. A subsequent survey garnered 220 valid responses. The confirmatory factor analysis results indicated: χ2/df = 2.086, comparative fit index (CFI) = 0.918, normative fit index (NLI) = 0.855, root mean square of residuals (RMR) = 0.045, and root mean square of error of approximation (RMSEA) = 0.070. These results demonstrate good structural, convergent, and discriminant validity. The content validity index at the item level (I-CVI) ranged between 0.875 and 1.000, while the content validity index at the scale level (S-CVI/Ave) was 0.941. Cronbach's alpha coefficient for the entire scale stood at 0.970. Moreover, the scale exhibited a split-half reliability of 0.876 and a retest reliability of 0.980 (p < 0.01). CONCLUSION: The risk factors and risk outcomes associated with nurses involved in "Internet + nursing services" for elderly individuals, as developed in this study, demonstrate strong reliability and validity. They are well suited to the Chinese national context.

Temporal trends of sepsis-related mortality in China, 2006-2020: a population-based study.

BACKGROUND: The scarcity of sepsis epidemiologic data from most low- and middle-income countries (LMICs) hampered estimation of regional and global burden of the disease, and provided limited guidance for policy makers. We aimed to characterize and analyze the temporal trends of sepsis-related mortality in China, by population groups, underlying causes of death, geographic regions, and sociodemographic index (SDI) levels. METHODS: Sepsis-related deaths were identified from the National Mortality Surveillance System (NMSS) of China from 2006 to 2020. Trends of sepsis-related mortality and years of life lost (YLLs), stratified by age, sex, underlying diseases, and regions were analyzed using the Jointpoint regression analysis. We investigated the association of SDI with trends of sepsis-related mortality. RESULTS: In 2020, sepsis was estimated to be responsible for 986,929 deaths and 17.1 million YLLs in China. Age-standardized sepsis-related mortality significantly declined from 130.2 (95%CI, 129.4-131) per 100,000 population in 2006 to 76.6 (76.3-76.9) in 2020. Age-standardized YLLs decreased from 2172.7 (2169.4-2176) per 100,000 population in 2006 to 1271 (1269.8-1272.2) in 2020. Substantial variations of sepsis-related mortality and YLLs were observed between population groups and regions, with higher burden in males, the elderly, and western China. An inverse relation was noted between SDI and sepsis-related mortality or YLLs. CONCLUSIONS: Despite declining trends of age-standardized mortality and YLLs of sepsis in China, significant disparities between population groups and regions highlight a need for targeted policies and measures to close the gaps and improve the outcome of sepsis.

[Pollution Characteristics and Risk Assessment of Antibiotics in Beiyun River Basin in Beijing].

To investigate the pollution characteristics and risk levels of antibiotics in water of the Beiyun River Basin in Beijing, the concentration of antibiotics was analyzed by using the solid-phase extraction and high-performance liquid chromatography-tandem mass spectrometry (SPE-HPLC-MS/MS) method. The results showed that seven types of four categories of antibiotics were detected in the samples from 12 sampling points; the total concentration of antibiotics including sulfapyridine, clarithromycin, azithromycin, roxithromycin, erythromycin, ofloxacin, and lincomycin ranged from 59.19 to 703.44 ng·L-1. Among these antibiotics, the detection rate of clarithromycin, azithromycin, roxithromycin, ofloxacin, and lincomycin was 100%; that of erythromycin was 41.67%; and that of sulfapyridine was 33.33%. Compared with that in some rivers in China, the Azithromycin, Erythromycin, and Clarithromycin in the Beiyun River Basin were at a relatively high level. The ecological risk assessment results showed that the most sensitive species was algae. The health risk quotients indicated that sulfapyridine, lincomycin, roxithromycin, azithromycin, and erythromycin presented no risk for every age group, whereas the health risk of clarithromycin was at a low level.

Socioeconomic factors, perceived stress, and social support effect on neonatal nurse burnout in China: a cross-sectional study.

BACKGROUND: Neonatal nurses' working environments are highly stressful, and burnout is common. This study examines the effect of socioeconomic factors, perceived stress, and social support on neonatal nurse burnout. METHODS: A total of 311 neonatal nurses participated in this study. They were administered a validated Maslach Burnout Inventory. The study employed a 14-item perceived stress scale (PSS-14) and a social support rate scale (SSRS) to examine stress, socioeconomic factors, and lifestyles. RESULTS: Of the neonatal nurses, 40.19% had burnout, 89.60% had mild burnout, and 10.40% had moderate burnout; no neonatal nurse experienced severe burnout. Young nurses and those with low technical skills, poor interpersonal relationships, irregular diet, and insufficient rest were exposed to burnout (all p < 0.05).Most burnout nurses experienced moderate-severe perceived stress, and their PSS-14 scores were higher (all p < 0.05).The scores for objective social support, subjective social support, utilization of social support, total SSRS scores, and the level of social support were all lower in burnout nurses (all p < 0.05). Perceived stress was correlated positively and significantly with emotional exhaustion and personal accomplishment (all p < 0.05). Social support correlated significantly with and reduced personal accomplishments (p < 0.05). Age, poor interpersonal relationships, perceived stress, and social support were all independent factors associated with neonatal nurse burnout (all p < 0.05). CONCLUSION: The prevalence of burnout in neonatal nurses was higher than average. Socioeconomic factors, higher perceived stress, and lower social support contribute to neonatal nurse burnout. Nursing managers should pay attention to socioeconomic factors, perceived stress, and social support among neonatal nurses and employ strategies to reduce neonatal nurse burnout.

Dual task cost in adults with persistent concussion symptoms.

BACKGROUND: Persistent concussion symptoms (PCS) negatively affects common activities of daily living including deficits in both single and dual-task (DT) gait. DT gait deficits are present post-concussion; however, task prioritization and the effects of differing cognitive challenge remain unexplored in the PCS population. RESEARCH QUESTION: The purpose of this study was to investigate single and dual-task gait performance in individuals with persistent concussion symptoms and to identify task priorization strategies during DT trials. METHODS: Fifteen adults with PCS (age: 43.9+11.7 y.o.) and 23 healthy control participants (age: 42.1+10.3 y.o.) completed five trials of single task gait followed by fifteen trials of dual task gait along a 10-m walkway. The cognitive challenges consisted of five trials each of visual stroop, verbal fluency, and working memory cognitive challenges. Groups were compared on DT cost stepping characteristics with independent samples t-test or Mann-Whitney U tests. RESULTS: There were significant overall gait Dual Task Cost (DTC)difference between groups for gait speed (p = 0.009, d=0.92) and step length (p = 0.023, d=0.76). Specific to each DT challenge, PCS participants were slower during Verbal Fluency (0.98 + 0.15 m/s and 1.12 + 0.12 m/s, p = 0.008; d=1.03), Visual Stroop (1.06 + 0.19 m/s and 1.20 + 0.12 m/s, p = 0.012, d=0.88), and Working Memory (1.02 + 0.15 m/s and 1.16 + 0.14 m/s, p = 0.006, d=0.96). There were significant cognitive DTC differences between groups for WM accuracy (p = 0.008, d=0.96), but not for VS accuracy (p = 0.841, d=0.061) or VF total words (p = 0.112, d=0.56). SIGNIFICANCE: The PCS participants displayed a posture-second strategy whereby gait performance generally decreased in the absence of cognitive changes. However, during the Working Memory DT, PCS participants had a mutual interference response whereby both motor and cognitive performance decreased suggesting the cognitive task plays a key role in the DT gait performance of PCS patients.

Comparative Oncology Assessment of a Novel Inhibitor of Valosin-Containing Protein in Tumor-Bearing Dogs.

Pet dogs with naturally occurring cancers play an important role in studies of cancer biology and drug development. We assessed tolerability, efficacy, and pharmacokinetic/pharmacodynamic relationships with a first-in-class small molecule inhibitor of valosin-containing protein (VCP/p97), CB-5339, administered to 24 tumor-bearing pet dogs. Tumor types assessed included solid malignancies, lymphomas, and multiple myeloma. Through a stepwise dose and schedule escalation schema, we determined the maximum tolerated dose to be 7.5 mg/kg when administered orally on a 4 days on, 3 days off schedule per week for 3 consecutive weeks. Adverse events were minimal and mainly related to the gastrointestinal system. Pharmacokinetic/pharmacodynamic data suggest a relationship between exposure and modulation of targets related to induction of the unfolded protein response, but not to tolerability of the agent. An efficacy signal was detected in 33% (2/6) of dogs with multiple myeloma, consistent with a mechanism of action relating to induction of proteotoxic stress in a tumor type with abundant protein production. Clinical trials of CB-5339 in humans with acute myelogenous leukemia and multiple myeloma are ongoing.

Lifestyle and Social Factors Exacerbated on the Prevalence of Mood Disorders and Functional Dyspepsia Among Neonatal Nurses in China.

Background: Nursing is a high-stress occupation that can have an impact on mental health, particularly for neonatal nurses. Job-related stress factors and work-related behaviors have played a critical role in nurses' mental health. This study aimed to explore the prevalence of mood disorders and the impact of social factors, lifestyle on mood disorders among neonatal nurses. Methods: A total of 260 participants comprising neonatal nurses and nurses who work in neonatal intensive care units (NICU) were recruited. Data were collected using a validated generalized anxiety disorder questionnaire, patient health questionnaire-9, Pittsburgh sleep quality index, and social factors and lifestyle assessments. Results: In total, 49.23% of neonatal nurses exhibited mood disorders, particularly a combination of depression and anxiety. Female, poor interpersonal relationships and unhappy marital status, preference for smoking, alcohol, irregular diet, and poor sleep were common in neonatology nurses who exhibited mood disorders; preference for coffee and tea were lower in neonatology nurses without mood disorders (all P < 0.05). Interpersonal relationships, marital status, irregular diet, and poor sleep were independent factors associated with mood disorders among neonatal nurses (all P < 0.05). Mood disorders presented as functional dyspepsia (FD) among 50.78% of the participants (P < 0.05). Poor sleep and preference for smoking were common among neonatal nurses who had FD with mood disorders (all P < 0.05). Furthermore, the preference for sugary beverages was lower in participants with FD and mood disorders (P < 0.05). Poor sleep was independently associated with FD with mood disorders in neonatology nurses (P < 0.05). Conclusion: Prevalence of anxiety and depression was higher among neonatal nurses. Furthermore, most cases of mood disorders presented as FD. Thus, social factors and lifestyle have an impact on mood disorders which can manifest through somatic symptoms.

Construction and application of comprehensive drought monitoring model considering the influence of terrain factors: a case study of southwest Yunnan, China.

Droughts in winter and spring are one of the most prominent natural disasters in the Yunnan Province in China. They occur frequently, with long durations and have a wide range of damage, which has a serious impact on social and economic development, as well as agricultural production and, therefore, strongly impacts the lives of the people living in the region. The traditional drought monitoring model does not take terrain into consideration, thereby affecting the comparative nature of results, as baseline conditions are not the same. Therefore, this study proposed a comprehensive drought monitoring model considering the influence of terrain factors to improve the evaluation effect. Firstly, based on NASA's Moderate Resolution Imaging Spectroradiometer (MODIS) and Tropical Rainfall Measurement Mission (TRMM 3B43) data, vegetation condition index (VCI), temperature condition index (TCI), precipitation condition index (TRCI), and three terrain factors ground elevation (DEM), slope (SLOPE), aspect (ASPECT) were selected as model parameters. Then, a comprehensive drought monitoring model without considering terrain factors (Model A) and a comprehensive drought monitoring model of considering terrain factors (Model B) were constructed by using multiple linear regression models. Finally, the effects of the two models were evaluated by using standardized precipitation evapotranspiration index (SPEI) in southwest Yunnan Province, China, and model B was used to analyze the drought in winter and spring in the study area from 2008 to 2019. The results showed that (1) the correlation coefficient of model B was higher than that of model A in winter and spring and the standard error of model B was lower than that of model A. (2) The grade consistency rate of Model A and SPEI was 0.92 in winter and 0.33 in spring; the grade consistency between model B and SPEI was 0.83 in winter and 0.75 in spring, and therefore the monitoring effect of model B was more stable. (3) There were periodic droughts during the study period, and the degree of drought in spring was less than in winter. Medium and severe droughts were observed in winter. Thus, this study concluded that the effect of terrain has an important influence on the evaluation of droughts. The comprehensive drought monitoring model which considers topographic factors can effectively identify the occurrence of drought, and therefore provide significant input with regards to disaster prevention and mitigation policies in southwest Yunnan.

Talent cultivation in health technology assessment: an expert survey.

BACKGROUND: Health technology assessment (HTA) has become essential in many countries over the past few years, and the demand for HTA professionals has increased in academia, governments, and industries. This study aimed to examine which courses are most important and which training activities are most helpful for the development of HTA proficiency as perceived by HTA experts. METHODS: The survey questionnaire was developed by literature review and expert opinion. Convenience sampling was used to survey HTA experts from the industrial sector, academic/research units, and government/independent assessment organizations using an online survey tool, SurveyCake. We collected respondents' demographic information and asked them to assess the importance of each course included in an HTA program on a 5-point Likert Scale (1 = least important; 5 = highly important). In addition, respondents were asked to assess the extent to which various activities are helpful for HTA proficiency development. RESULTS: A total of 158 domestic and overseas experts in HTA-related fields were invited to participate in the survey and 68 completed the questionnaire. Among the respondents, the majority were female (57.4%) and working in academia (44.1%). The mean ± standard deviation of respondents' age and number of years spent in HTA-related fields were 43.2 ± 11.0 years and 11.3 ± 9.9 years, respectively. The course that was rated the most important was "Pharmacoeconomics/Cost-effectiveness analysis" with a score of 4.8 ± 0.4 points, followed by "Health economics" at 4.7 ± 0.7 points. Moreover, internships at HTA-related institutions were perceived to be the most helpful training activity for HTA proficiency development. CONCLUSIONS: Our study findings provide a better understanding of the requirements for developing HTA proficiency and can serve as a reference for the modification of current HTA education and training programs.

Response of cyanobacterial bloom risk to nitrogen and phosphorus concentrations in large shallow lakes determined through geographical detector: A case study of Taihu Lake, China.

Understanding the sensitivity of the response of chlorophyll (Chla) to nutrients (e.g., nitrogen and phosphorus) concentrations is important for predicting cyanobacterial bloom risk. However, the processes by which nutrients in lake that affect cyanobacterial growth and outbreaks are nonlinear, gradual and spatially and temporally heterogeneous, and the single response thresholds of concentrations between nutrients and the Chla proposed in current studies maybe hardly reflect these characteristics. Due to three decades of rapid regional socio-economic development, the eutrophication in Taihu Lake of China is serious and there are cyanobacterial blooms every year. In this study, we quantified the interaction effects of different forms of nitrogen and phosphorus on Chla concentrations in lake water and sediment pore water. And a refined response threshold range with continuous variation was proposed to characterize the relationship between the Chla concentration and the NH4-N, total nitrogen (TN) and total phosphorus (TP) concentrations. The results showed that TP was the dominant factor influencing the spatial variation of cyanobacteria blooms in most areas of Taihu Lake, followed by TN. TP should therefore be the highest priority for future pollution load reduction in Taihu Lake. The effects of the interactions between the pollution factors were greater than the sum of them individually. NH4-N and dissolved inorganic phosphorus (DIP) are likely to be preferentially consumed by algae for growth and should be the focus of nutrient control efforts in Taihu Lake. For cyanobacterial risk prediction, prevention and control, NH4-N, TN and TP concentrations of 0.06 mg/L, 2.89 mg/L and 0.06 mg/L, respectively, can be used to indicate the beginning of cyanobacterial blooms in Taihu Lake, and concentrations of 0.34 mg/L, 4.67 mg/L and 0.11 mg/L, respectively, can be used as reference thresholds to indicate serious cyanobacterial blooms.

[Quality of life assessment after endoscopic and microscopic myringoplasty using Chinese version of the Zurich chronic middle ear inventory].

Objective:To assess and compare therapeutic effects and quality of life after endoscopic and microscopic myringoplasty using Chinese version of the Zurich chronic middle ear inventory（ZCMEI）. Methods:Patients with chronic suppurative otitis media underwent myringoplasty at the Third Hospital of Peking University from October 2018 to September 2019 were included in this study and divided into two groups: endoscopic tympanoplasty group（n=40） and microscopic tympanoplasty group（n=57）. ZCMEI survey and pure tone audiometry were conducted preoperatively and 3-9 months postoperatively. The operation time, intraoperative blood loss, length of hospital, graft success rate, complication rate, hearing improvement and quality of life improvement were compared. Results:①The operation time, length of hospital and intraoperative blood loss of endoscopic group were significantly lower（P<0.05）. ②The graft success rate was 92.5% and 98.2%, respectively（P>0.05）. The difference between the complication rate in two groups was not significant, but patients in endoscopic group had no symptoms of wound numbness or pain. ③Air conduction threshold（AC） and air-bone gap（ABG） were significantly lower after surgery in endoscopic group（n=33） and microscopic group（n=43）. The analyzed result of generalized linear model indicated surgical approach had no influence on postoperative AC and ABG（P>0.05）. ④The total scores of ZCMEI were significantly improved in endoscopic group（n=32） and microscopic group（n=48） postoperatively, as well as the scores of ear symptoms, hearing and psychosocial impact（P<0.05）. Preoperative and postoperative scores of medical resources were not significantly different in either groups（P>0.05）. Controlling the course of disease, the total ZCMEI results and scores of each subscale in patients with single ear involved（n=71） had no significant difference between two groups. Conclusion:Endoscopic myringoplasty has the advantages of minimal invasiveness, short operation time, and quick recovery evaluated from subjective and objective aspects. Audiometry improvement, graft success rate, complication rate and quality of life improvements are comparable between endoscopic tympanoplasty and conventional microscopic tympanoplasty. The assessment of the quality of life is of great significance in efficacy evaluation of otitis media. Doctors should comprehensively consider patient's subjective experience and the objective improvement to obtain the best clinical efficacy.

Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment.

BACKGROUND: Recently, a percutaneous spinal endoscopy unilateral posterior interlaminar approach to perform bilateral decompression has been proposed for use in treatment of lumbar spinal stenosis, As a development and supplement to traditional surgery, its advantages regarding therapeutic effects and prognosis, such as minor soft tissue damage, little intraoperative blood loss, and a quick return to daily life. However, there are few analyses of this surgery with a follow-up of more than 1 year,we conducted this study in order to quantitatively investigate radiographic and clinical efficacies of this surgery for central lumbar spinal stenosis. MATERIALS AND METHODS: Forty-six patients with central lumbar spinal stenosis were enrolled from January 2017 to July 2018. The visual analog scale (VAS) for back pain and leg pain, Oswestry disability index (ODI), modified MacNab criteria were used to evaluate clinical efficiency at preoperative and postoperative time points. The intervertebral height index (IHI), cross-sectional area of the spinal canal (CSAC), calibrated disc signal (CDS) and spinal stability were examined to assess radiographic decompression efficiency via magnetic resonance imaging and X-ray at preoperative and postoperative time points. RESULTS: The VAS score for lower back pain and leg pain improved from 7.50 ± 0.78 to 1.70 ± 0.66 and from 7.30 ± 0.79 to 1.74 ± 0.68, respectively, and the ODI improved from 72.35 ± 8.15 to 16.15 ± 4.51. In terms of modified MacNab criteria, 91.3% of the patients achieved good or excellent outcomes. Furthermore, significant changes after surgery were observed for the percentage of CSAC, increasing from 125.3 ± 53.9 to 201.4 ± 78 mm2; however, no significant differences were observed for the remaining measurement indicators. CONCLUSIONS: The clinical and radiographic efficacies of this surgery for central lumbar spinal stenosis were good in short-term follow-up, and this surgery did not cause meaningful changes in IHI, CDS, and spine stability in short-term follow-up. The effect of long-term follow-up needs further investigation.

Cost-effectiveness analyses of sacubitril-valsartan for heart failure.

The objective of this study was to evaluate the pharmacoeconomic value of sacubitril-valsartan for the treatment of heart failure (HF). PubMed, Embase, Cochrane Library, ScienceDirect, Scopus, CNKI, Wanfang, and VIP databases were searched systematically and the retrieval time ended in August 2019. According to the criteria of inclusion and exclusion, the quality of studies included was evaluated as per the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) scale, and the results were extracted and analyzed systematically. The total of 11 cost-effectiveness studies was identified, 10 were performed in the developed countries and 1 in Thailand. All the patients in the studies had chronic heart failure with reduced ejection fraction (HFrEF). Totally, the quality of all the 11 studies was reported to be of an average score of 20.5. Study perspective and time horizons were described in the 11 studies. All included studies discounted the cost or effectiveness. Only 1 study estimated direct and indirect costs; 10 studies evaluated direct cost. The incremental cost-effectiveness ratio (ICER) of sacubitril-valsartan treating HFrEF was $13,150 per quality-adjusted life-years (QALY) in Thailand and $86,735 in Singapore. In European countries, the ICER was from $21,786 to $34,576 per QALY and mean value was $25,410.6 per QALY. In the USA, ICER values ranged from $47,099 to $143,891 per QALY, and mean value was $73,383.5 per QALY; ICER was $30,090 per QALY in Colombia. With the exception of Thailand and Singapore, the ICER of other countries in the included literature was below the implemented country-specific thresholds. Based on existing literatures, with the exception of Thailand and Singapore, sacubitril-valsartan for the treatment of HFrEF is a better cost-effective therapy with ICER basically below the implemented country-specific thresholds. Sacubitril-valsartan was not considered a cost-effective treatment for heart failure with reduced ejection fraction in Thailand and Singapore with the current economic evaluation evidences, but with the willingness-to-pay (WTP) of other counties, sacubitril-valsartan was found to be a cost-effective treatment compared with comparator. Drug cost, time horizon, and hospitalization were the most influential variables across studies. Four studies indicated that with the longer time horizon, the lower ICER value would gain. Further studies are warranted to better evaluate comprehensive utility value of sacubitril-valsartan on heart failure.

Deep learning: To better understand how human activities affect the value of ecosystem services-A case study of Nanjing.

The value of ecosystem services is affected by increasing human activities. However, the anthropogenic driving mechanisms of ecosystem services are poorly understood. Here, we established a deep learning model to approximate the ecosystem service value (ESV) of Nanjing City using 23 socioeconomic factors. A multi-view analysis was then conducted on feasible impact mechanisms using model disassembly. The results indicated that certain factors had their own significant and independent effects on ESV, such as the proportion of water areas in the land-use structure and the output value of the secondary industry. The proportion of ecological water should be increased as much as possible, whereas the output value of the secondary industry should be reasonably controlled in Nanjing. Other intrinsically related factors were likely to be composited together to affect ESV, such as industrial water consumption and industrial electricity consumption. In Nanjing, simultaneously optimizing socio-economic factors related to city size, resources, and energy use efficiency likely represents an effective management strategy for maintaining and enhancing regional ecological service capabilities. The results of this work suggest that deep learning is an effective method of deepening studies on the prediction of ESV trends and human-driven mechanisms.

Medical students' motivation and academic performance: the mediating roles of self-efficacy and learning engagement.

Background: Motivation matters in medical students' academic performance. However, few studies have specifically examined how motivation and external environmental factors (e.g., institutions) affect medical students' performance with large-scale data sets. The roles of self-efficacy and learning engagement in the mechanisms that govern how motivation affects academic performance are still unclear.Objective: This study aims to advance a comprehensive understanding about the relationships between medical students' motivation, self-efficacy, learning engagement, and academic performance in a nationwide survey, taking students' demographic factors and sociocultural environments into consideration.Design: We collected data from 1930 medical students in China. We probed the relations between studying variables. We then performed structural equation model (SEM) analysis to examine the mediating roles of self-efficacy and learning engagement on the relationship between motivation and academic performance. We further carried out multiple-group SEM analyses to compare differences between males and females, and between students in key universities and colleges (KUCs) and non-key universities and colleges (NKUCs).Results: Medical students in KUCs demonstrated significantly higher intrinsic motivation, better academic performance and lower extrinsic motivation than those in NKUCs. Male students reported higher intrinsic motivation but surprisingly lower academic performance than females. The total effect of intrinsic motivation on academic performance was larger than that of extrinsic motivation. There were significant indirect effects of either intrinsic or extrinsic motivation on academic performance through learning engagement. Besides, both intrinsic motivation and extrinsic motivation predicted self-efficacy; however, the direct effect of self-efficacy on academic performance was not significant.Conclusions: This study provided researchers with a holistic picture of students' types of motivation in relation to academic performance. Findings from this study can help in rethinking the role of self-efficacy in medicine, in finding more effective interventions for promoting medical students' levels of motivation, and in developing motivation-related counselling methods for different groups of medical students.

Monpa, memory, and change: an ethnobotanical study of plant use in Mêdog County, South-east Tibet, China.

BACKGROUND: Due to their relative isolation, the previous studies of Monpa plant use were only conducted in north-east India. In October 2013, Mêdog County was no longer remote, thanks to completion of a highway into the county. This study of plant species used by the Monpa had three research objectives. These were (i) to identify and record local names and uses of plants in Mêdog County, (ii) to assess which of these were uses of endemic or near-endemic species within this part of the Indo-Burma biodiversity hotspot, and (iii) to assess how plant uses reflect socio-economic change in Mêdog County? METHODS: Field surveys were conducted in 12 villages of four townships in Mêdog County, Tibet, China. Two field visits were made. The first field trip was in November 2017 and the second field trip was in May 2018. We interviewed 64 key informants between 21 and 84 years old. Most of them were the village leaders and other local people who are knowledgeable about plants. After transect walks with knowledgeable local people, we used free listing, key informant interviews, and semi-structured interviews during the field work. Plants traditionally used by the Monpa were documented. Utilization frequency was used to assess the significance of each species, and the Cultural Importance index was used to estimate the cultural significance of the species in common. We also used the informant consensus factor (FIC) to determine the homogeneity of the informants' knowledge of medicinal plants. RESULTS: One hundred ninety-four plant species belonging to 82 families and 158 genera were recorded and collected. One hundred twenty-two species, primarily fruits, were food plants. Forty-five species were used as traditional medicines. This included highly valued species collected in alpine areas (Paris polyphylla) and brought to villages in Mêdog, which are at a lower altitude (between 728 and 1759 m a.s.l). Seven edible plant species were also used as herbal medicines. We also recorded 39 species used for other purposes in Monpa daily life. These included nine species that were used to make agricultural tools, five species for dyes and mordants, four species for timber, three species for fuelwood, four species for religious ritual use, three species for washing, two species for incense, two species for thatching, two species for fiber (rope and paper), two "calendar plants" were used to indicate seasons for agricultural purposes, two fish poison plant species, and one species were used as a tobacco substitute. Based on taxonomic insights and from studies elsewhere, we suggested that fiber species were under-reported (c. 14 species were used vs. one species reported used). Even though these plant species are rich and diverse, the use of endemic or near-endemic species was rarely recorded in previous studies. These species included Arenga micrantha (used for starch), Hornstedtia tibetica (fruits), Castanopsis clarkei (edible nuts) and Gnetum pendulum (edible nuts), Ophiorrhiza medogensis (vegetables), Derris scabricaulis (fish poison), Radermachera yunnanensis (agricultural tools), Litsea tibetana (seed oil), Dendrocalamus tibeticus (wine strainers and implements for administering medicine), Zanthoxylum motuoense (spices), Cinnamomum contractum (tobacco substitutes), Morus wittiorum (medicines), and Garcinia nujiangensis (funeral rituals). Despite the absence of roads until 2013 and the impression of "isolation," Monpa knowledge of plant use reflects three categories of change. Firstly, oral histories of plants used in Bhutan were also encountered by Monpa people after their migration from Bhutan to south-eastern Tibet. Secondly, a "slow change" through centuries of exchange of knowledge (for example of Chinese and Tibetan medical systems), seeds of introduced crops (finger millet (indigenous to Africa), maize (from Meso-America)), and experimentation and use of introduced medicinal plants (such as Datura stramonium, which originates from North America). Thirdly, "fast change" over the past decade. This is reflected in changes in traditional architecture and in rising commercial trade in selected plant resources such as Dendrobium orchid stems and Paris polyphylla rhizomes which are in demand in China's Traditional Chinese Medicine (TCM) markets). CONCLUSIONS: Monpa people in the south-eastern Tibet have detailed knowledge of the diverse plant resources. But that traditional knowledge is now faced with a crisis because of the modern socio-economic change. In addition, Monpa knowledge of plants reflects slower changes in knowledge as well. For example, Monpa ethnomedicine has been influenced by traditional Tibetan and Chinese medicine over a longer period in time. Overall, this study provides a deeper understanding of the Monpa peoples' knowledge on wild plants, including endemic and near-endemic species whose uses have not been previously recorded. Several of these narrowly distributed species, such as the fish poison Derris scabricaulis, could be the focus of further studies. Some wild edible plants may also have interesting dietary constituents which need in-depth studies. These detailed studies could enable the Monpa people to benefit from the use of their traditional plant-derived culture and therefore support the biodiversity conservation.

Cost-effectiveness analysis of low-dose direct oral anticoagulant (DOAC) for the prevention of cancer-associated thrombosis in the United States.

BACKGROUND: Randomized controlled trials (RCTs) have demonstrated that low-dose direct oral anticoagulants (DOACs), including rivaroxaban and apixaban, may help reduce the incidence of cancer-associated venous thromboembolism (VTE). METHODS: A cost-utility analysis was performed from the health sector perspective using a Markov state-transition model in patients with cancer who are at intermediate-to-high risk for VTE. Transition probability, relative risk, cost, and utility inputs were obtained from a meta-analysis of the RCTs and relevant epidemiology studies. Differences in cost, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) per patient were calculated over a lifetime horizon. One-way, probabilistic, and scenario sensitivity analyses were conducted. RESULTS: In patients with cancer at intermediate-to-high risk for VTE, treatment with low-dose DOAC thromboprophylaxis for 6 months, compared with placebo, was associated with 32 per 1000 fewer VTE and 11 per 1000 more major bleeding episodes over a lifetime. The incremental cost and QALY increases were $1445 and 0.12, respectively, with an ICER of $11,947 per QALY gained. Key drivers of ICER variations included the relative risks of VTE and bleeding as well as drug cost. This strategy was 94% cost effective at the threshold of $50,000 per QALY. The selection of patients with Khorana scores ≥3 yielded the greatest value, with an ICER of $5794 per QALY gained. CONCLUSIONS: Low-dose DOAC thromboprophylaxis for 6 months appears to be cost-effective in patients with cancer who are at intermediate-to-high risk for VTE. The implementation of this strategy in patients with Khorana scores ≥3 may lead to the highest cost-benefit ratio.

Scholastic achievement among children enrolled in the Seychelles Child Development Study.

The Seychelles Child Development Study is a longitudinal cohort study following a group of 779 children exposed prenatally to methyl mercury (MeHg) through a maternal diet high in fish. The cohort has been examined six times beginning in infancy with no consistent evidence of adverse effects. In fact, their performance resembles what would be expected from normal children of comparable ages growing up in western cultures. During a neurodevelopment assessment at 66 months, the children were tested for scholastic achievement using the Woodcock Johnson Tests of Achievement. Their reading scores were depressed relative to US norms while arithmetic scores were within normal limits. This disparity was not evident at 107 months; in fact, reading achievement scores far exceeded expected performance relative to US norms, with over 75% of the cohort obtaining scores at or above the 90th percentile. This study reports a secondary analysis of the scholastic achievement data to test the hypothesis that the results obtained in the primary analysis were probably due to the onset of the primary school curriculum between the first and second testing, and not to inherent cognitive deficits among the children at 66 months. The results suggest that a combination of reading instruction and characteristically consistent letter-sound relationships in Creole, the language spoken at home by the majority of Seychellois families, probably accounted for the high achievement scores at 107 months.

Solidification of electroplating sludge with alkali-activated fly ash to prepare a non-burnt brick and its risk assessment.

Electroplating sludge (ES), a byproduct of the electroplating industry, is considered as hazardous waste because of the presence of several kinds of toxic heavy metals (HMs, i.e., Cr, Ni, Cu and Zn). The improper treatment of ES has resulted in the contamination of the environment and is ultimately harmful to the living biota. Solidification/stabilization is regarded as a promising technique to deal with hazardous wastes with the use of a geopolymer, an excellent material, in this technique. In this research, ES was solidified using fly ash (FA) and ordinary Portland cement together so that non-burnt bricks (NBBs) could be prepared. The risk assessment of these bricks was carried out in a homemade experimental device by simulating rainfall. The results showed that the compressive strength of NBBs was up to 15 MPa; hence, it could be used for construction purposes. The hazard quotient (HQ) of HMs (including Zn, Ni and Cu) was much less than the limit value, while both the HQ and cancer risk of Cr were over the corresponding limit values.

A comparison of Lyse-It to other cellular sample preparation, bacterial lysing, and DNA fragmentation technologies.

The ability for safe and rapid pathogenic sample transportation and subsequent detection is an increasing challenge throughout the world. Herein, we describe and use bead-beating, vortex, sonication, 903 protein saver cards, and Lyse-It methods, aiming to inactivate Gram-positive and -negative bacteria with subsequent genome DNA (quantitative Polymerase Chain Reaction) qPCR detection. The basic concepts behind the four chosen technologies is their versatility, cost, and ease of use in developed and underdeveloped countries. The four methods target the testing of bacterial resilience, cellular extraction from general and complex media and subsequent DNA extraction for qPCR detection and amplification. These results demonstrate that conventional high temperature heating, 903 protein saver cards, and Lyse-It are all viable options for inactivating bacterial growth for safe shipping. Additionally, Lyse-It was found to be particularly useful as this technology can inactivate bacteria, extract cells from 903 protein saver cards, lyse bacterial cells, and additionally keep genomic DNA viable for qPCR detection.