Reliability and validity assessment of the Chinese version of the Intrahospital Transport Safety Scale (IHTSS) in intensive care units.

BACKGROUND: Intrahospital transport of critically ill patients is a common practice in intensive care units (ICUs), where patients' safety is constantly challenged in high-intensity and dynamic environments. While Intrahospital Transport Safety Scale (IHTSS) is widely used internationally to evaluate the intrahospital transport safety, it has not been introduced in China. OBJECTIVES: This study aimed to assess the reliability and validity of the Chinese version of the IHTSS scale among critical care nurses in China. METHODS: A cross-sectional study was conducted using a cluster sampling method. A total of 544 critical care nurses from 25 ICUs in 10 tertiary hospitals were recruited. We employed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the questionnaire's underlying factor structure, ensuring construct validity. Additionally, internal consistency was assessed using Cronbach's alpha coefficient, test-retest reliability, and corrected item-total correlation. RESULTS: The Chinese version of the scale displayed robust psychometric properties, with a Cronbach's α coefficient of 0.976, a split-half reliability of 0.906, and a test-retest reliability of 0.856. EFA revealed a robust four-factor model that accounted for 75.970% of the variance, with the factor loadings of the items ranging from 0.433 to 0.951. CFA indicated a strong model fit, with a chi-square to degrees of freedom ratio (CMIN/DF) of 2.765, comparative fit index (CFI) of 0.943, incremental fit index (IFI) of 0.943, and goodness-of-fit index (GFI) of 0.845, supporting the efficacy of the four-factor model in assessing intrahospital transport safety for critically ill patients. CONCLUSION: The Chinese version of the IHTSS demonstrated favourable reliability and validity among critical care nurses in China, making it a suitable tool for measuring the level of intrahospital transport safety for critically ill patients.

Navigating the landscape of global sustainable livelihood research: past insights and future trajectory.

Sustainable livelihoods (SL) have emerged as a crucial area of focus in global environmental change research, aligning with the Sustainable Development Goals (SDGs). This field is rapidly gaining prominence in sustainability science and has become one of the primary research paradigms. In our study, we conducted scientometrics analysis using the ISI Web of Science core collection database to examine research patterns and frontier areas in SL research. We selected 6441 papers and 265,759 references related to SL published from 1991 to 2020. To achieve this, we employed advanced quantitative analysis tools such as CiteSpace and VOSviewer to quantitatively analyze and visualize the evolution of literature in the SL research field. Our overarching objectives were to understand historical research characteristics, identify the knowledge base, and determine future research trends. The results revealed an exponential increase in SL research documentation since 1991, with the Consortium of International Agricultural Research Center (CGIAR) contributing the highest volume of research documents and citations. Key journals in this field included World Development, Global Environmental Change, Ecological Economics, and Ecology and Society. Notably, Singh RK and Shackleton CM emerged as prolific authors in SL research. Through our analysis, we identified six primary clusters of research areas: livelihoods, conservation, food security, management, climate change, and ecosystem services. Additionally, we found that tags such as rural household, agricultural intensification, cultural intensification, and livelihoods vulnerability remained relevant and represented active research hotspots. By analyzing keyword score relevance, we identified frontier areas in SL research, including mass tourism, solar home systems, artisanal and small-scale mining, forest quality, marine-protected areas, agricultural sustainability, sustainable rangeland management, and indigenous knowledge. These findings provide valuable insights to stakeholders regarding the historical, current, and future trends in SL research, offering strategic opportunities to enhance the sustainability of livelihoods for farmers and rural communities in alignment with the SDGs.

Antibiotic resistance genes in constructed wetlands: Driving indicators and risk assessment.

Constructed wetlands (CWs) were responsible for the in-depth purification of wastewater, providing an ideal environment for the transport, acquisition, and dissemination of antibiotic resistance genes (ARGs). A better understanding of influencing factors and risks of ARGs in CWs was deemed indispensable. In this research, the abundance of ARGs and mobile genetic elements (MGEs) was determined to be higher in summer and spring, ranging from 53.7 to 8.51 × 106 and 30.9-6.02 × 106 copies/mL, respectively. Seasonal variation significantly influenced the abundance of ARGs and MGEs, as well as the co-occurrence patterns among ARGs, MGEs and bacteria. However, the environmental gradients, from the influent (CW01) to the effluent (CW10), did not impose significant effects on the abundance of ARGs and MGEs. Furthermore, the ratios of pathogenic bacteria to ARG hosts and ARG risks index decreased by 50.4% and 88.54% along with the environmental gradients, indicating that CWs could act as barriers to the transfer of ARGs. Partial least squares-path modeling (PLSPM) revealed that temperature was the main driving factor of ARGs, followed by MGEs, stable and differential bacteria. This finding effectively and innovatively explored the driving indicators for the variations and risks of ARGs caused by spatial-temporal variations, providing new insights into the evaluation and control of ARGs in CWs.

An Exploratory Study on a New Method for Nutritional Status Assessment in Patients with Chronic Kidney Disease.

Malnutrition is a risk factor for disease progression and poor prognosis in chronic kidney disease (CKD). However, the complexity of nutritional status assessment limits its clinical application. This study explored a new method of nutritional assessment in CKD (stage 1-5) patients using the Subjective Global Assessment (SGA) as the gold standard and evaluated its applicability. The kappa test was used to analyze the consistency of the Renal Inpatient Nutrition Screening Tool (Renal iNUT) with SGA and protein-energy wasting. Logistic regression analysis was used to analyze the risk factors of CKD malnutrition and calculate the prediction probability of multiple indicators combined for the diagnosis of CKD malnutrition. The receiver operating characteristic curve of the prediction probability was drawn to evaluate its diagnostic efficiency. A total of 161 CKD patients were included in this study. The prevalence of malnutrition according to SGA was 19.9%. The results showed that Renal iNUT had a moderate consistency with SGA and a general consistency with protein-energy wasting. Age > 60 years (odds ratio, OR = 6.78), neutrophil-lymphocyte ratio > 2.62 (OR = 3.862), transferrin < 200 mg/dL (OR = 4.222), phase angle < 4.5° (OR = 7.478), and body fat percentage < 10% (OR = 19.119) were risk factors for malnutrition in patients with CKD. The area under the receiver operating characteristic curve of multiple indicators for the diagnosis of CKD malnutrition was 0.89 (95% confidence interval: 0.834-0.946, p < 0.001). This study demonstrated that Renal iNUT has good specificity as a new tool for the nutrition screening of CKD patients, but its sensitivity needs to be optimized. Advanced age, high neutrophil-lymphocyte ratio, low transferrin level, low phase angle, and low body fat percentage are risk factors for malnutrition in patients with CKD. The combination of the above indicators has high diagnostic efficiency in the diagnosis of CKD malnutrition, which may be an objective, simple, and reliable method to evaluate the nutritional status of patients with CKD.

Global occurrence, drivers, and environmental risks of microplastics in marine environments.

With an increasing quantity of plastic waste being discharged into the oceans, marine microplastic (MP) pollution has received widespread attention. However, the global occurrence characteristics, environmental risks, driving factors, and source-sink relationships remain unclear. In this study, we conducted a meta-analysis based on 165 articles about marine MP pollution. It was found that the global marine MP abundance displayed a significant spatial heterogeneity, and the distribution pattern was influenced by offshore distance, population density, and economic development. The morphological characteristics of MPs showed a significant difference between seawater and marine sediment, and small-size MPs (<1 mm) accounted for the majority of all MPs in the marine environment. The environmental risk assessment revealed that most of the marine MP pollution still remains at low concentrations in the global context, with the Polyurethane (PU), Polyacrylonitrile (PAN), and Polyvinyl chloride (PVC) types of MPs showing high environmental-risk contributions. In addition, land-based waste and marine operations, which were considered to be the dominant sources of marine MPs, primarily aggregated at nearshore submarine areas, in the water column, and in the deep-sea bottom environment. This study suggested that the combination of a meta-analysis and Monte Carlo simulation can provide much valuable information regarding the global occurrence characteristics and environmental risks of marine MPs.

An Intelligent Motor Assessment Method Utilizing a Bi-Lateral Virtual-Reality Task for Stroke Rehabilitation on Upper Extremity.

Virtual reality (VR) has been widely adopted by therapists to provide rich motor training tasks. Time series data of motion trajectory accompanied with the interaction of VR system may contain important clues in regard to the assessment of motor function, however, clinical evaluation scales such as Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and Test D'évaluation Des Membres Supérieurs Des Personnes Âgées (TEMPA) are highly depended in clinic. Further, there is not yet an assessment method that simultaneously consider motion trajectory and clinical evaluation scales. The objective of this study is to establish an evidence-based assessment model by machine-learning method that integrated motion trajectory of a VR task with clinical evaluation scales. In this study, a VR system for upper-limb motor training was proposed for stroke rehabilitation. Clinical trials with 20 stroke patients were performed. A variety of motor indicators that derived via motion trajectory were proposed. The correlations between motor indicators and clinical evaluation scales were examined. Further, motor indicators were integrated with evaluation scales to develop a machine-learning based model that represents an evidence-based motor assessment approach. Clinical evaluation scales, FMA, TEMPA and WMFT, were significantly progressed. A few motor indicators were found significantly correlated with clinical evaluation scales. The accuracy of machine-learning based assessment model was up to 86%. The proposed VR system is validated to be effective in motor rehabilitation. Motor indicators derived from motor trajectory were with potential for clinical motor assessment. Machine learning could be a promising tool to perform automatic assessment. Clinical and Translational Impact Statement-A VR task for motor rehabilitation was exanimated via clinical trials. Integrating motor indices with clinical assessment, a machine-learning model with accuracy of 86% was developed to evaluate motor function.

The effects of environmental tax reform on urban air pollution: A quasi-natural experiment based on the Environmental Protection Tax Law.

Air pollution significantly impacts sustainable development and public health. Taking the implementation of China's Environmental Protection Tax Law in China as a quasi-natural experiment, this paper employs the difference-in-differences (DID) and spatial DID models to evaluate the effects of environmental tax reform on urban air pollution. The findings are as follows. (1) Environmental tax reform can significantly reduce urban air pollution, and a series of robustness tests have also been conducted to provide further evidence. (2) Green technology innovation and industrial structure upgrading from a vital transmission mechanism for environmental tax reform to improve air quality. (3) Environmental tax reform significantly inhibits urban air pollution in cities located north of the Qinling-Huaihe line and big cities. (4) Moreover, environmental tax reform not only promotes the improvement of local air quality but also has a significant negative spatial spillover effect, reducing air pollution in neighboring cities. The research conclusions provide theoretical support and policy suggestions for promoting sustainable economic development, rationally optimizing environmental protection tax policies and improving urban air quality.

Deep Reinforcement Learning-Based Resource Allocation for Cellular Vehicular Network Mode 3 with Underlay Approach.

Vehicle-to-vehicle (V2V) communication has attracted increasing attention since it can improve road safety and traffic efficiency. In the underlay approach of mode 3, the V2V links need to reuse the spectrum resources preoccupied with vehicle-to-infrastructure (V2I) links, which will interfere with the V2I links. Therefore, how to allocate wireless resources flexibly and improve the throughput of the V2I links while meeting the low latency requirements of the V2V links needs to be determined. This paper proposes a V2V resource allocation framework based on deep reinforcement learning. The base station (BS) uses a double deep Q network to allocate resources intelligently. In particular, to reduce the signaling overhead for the BS to acquire channel state information (CSI) in mode 3, the BS optimizes the resource allocation strategy based on partial CSI in the framework of this article. The simulation results indicate that the proposed scheme can meet the low latency requirements of V2V links while increasing the capacity of the V2I links compared with the other methods. In addition, the proposed partial CSI design has comparable performance to complete CSI.

[Pollution status and exposure assessment of lead, cadmium, total mercury and total arsenic in grains on sale from Shaanxi Province, 2002-2018].

OBJECTIVE: To investigate the pollution status of lead, cadmium, total mercury and total arsenic in grains sold in Shaanxi Province, and to analyze the potential risk of dietary exposure. METHODS: A total of 1873 samples of wheat, wheat flour, rice, maize and their products were randomly collected in circulation. The contents of lead and cadmium were determined by atomic absorption spectrophotometry and inductively coupled plasma mass spectrometry, and total mercury and arsenic were determined by atomic fluorescence spectrometry. The pollution status of four elements in grains was evaluated by single factor pollution index method, margin of exposure(MOE) was used to assess lead exposure, cadmium exposure was assessed by the ratio of estimated monthly intake(EMI) to provisional tolerable monthly intake(PTMI), and exposure to mercury and arsenic was assessed using the ratio of estimated weekly intake(EWI) to provisional tolerable weekly intake(PTWI). RESULTS: The average values of lead, cadmium, total mercury and total arsenic in grains sold in Shaanxi Province were 0.070, 0.022, 0.0079 and 0.030 mg/kg. The over-standard rates of lead, cadmium and total mercury were 6.30%, 1.39% and 4.43%. The average single factor pollution index of lead, cadmium, total mercury and total arsenic was less than 0.7; The MOE value of lead in grains was 0.99-18.41, the intake of cadmium in grains accounted for 19.08% of PTMI, and the intake of mercury and arsenic accounted for 10.28% and 10.67% of PTWI. CONCLUSION: Lead, cadmium, total mercury and total arsenic in all kinds of cereals sold in Shaanxi Province from 2002 to 2018 were less polluted and their intake was within the safe range.

An Assessment of Serological Assays for SARS-CoV-2 as Surrogates for Authentic Virus Neutralization.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in late 2019 and has since caused a global pandemic resulting in millions of cases and deaths. Diagnostic tools and serological assays are critical for controlling the outbreak, especially assays designed to quantitate neutralizing antibody levels, considered the best correlate of protection. As vaccines become increasingly available, it is important to identify reliable methods for measuring neutralizing antibody responses that correlate with authentic virus neutralization but can be performed outside biosafety level 3 (BSL3) laboratories. While many neutralizing assays using pseudotyped virus have been developed, there have been few studies comparing the different assays to each other as surrogates for authentic virus neutralization. Here, we characterized three enzyme-linked immunosorbent assays (ELISAs) and three pseudotyped vesicular stomatitis virus (VSV) neutralization assays and assessed their concordance with authentic virus neutralization. The most accurate assays for predicting authentic virus neutralization were luciferase- and secreted embryonic alkaline phosphatase (SEAP)-expressing pseudotyped virus neutralizations, followed by green fluorescent protein (GFP)-expressing pseudotyped virus neutralization, and then the ELISAs. IMPORTANCE The ongoing COVID-19 pandemic is caused by infection with severe acute respiratory syndrome virus 2 (SARS-CoV-2). Prior infection or vaccination can be detected by the presence of antibodies in the blood. Antibodies in the blood are also considered to be protective against future infections from the same virus. The "gold standard" assay for detecting protective antibodies against SARS-CoV-2 is neutralization of authentic SARS-CoV-2 virus. However, this assay can only be performed under highly restrictive biocontainment conditions. We therefore characterized six antibody-detecting assays for their correlation with authentic virus neutralization. The significance of our research is in outlining the advantages and disadvantages of the different assays and identifying the optimal surrogate assay for authentic virus neutralization. This will allow for more accurate assessments of protective immunity against SARS-CoV-2 following infection and vaccination.

The impact of socio-economic institutional change on agricultural carbon dioxide emission reduction in China.

With the change of social economic system and the rapid growth of agricultural economy in China, the amount of agricultural energy consumption and carbon dioxide emissions has increased dramatically. Based on the estimation of agricultural carbon dioxide emissions from 1991 to 2018 in China, this paper uses EKC model to analyze economic growth and agricultural carbon dioxide emissions. The Kaya method is used to decompose the factors affecting agricultural carbon dioxide emissions. The experimental results show that there is a co-integration relationship between economic growth and the total intensity of agricultural carbon emissions, and between economic growth and the intensity of carbon emissions caused by five types of carbon sources: fertilizer, pesticide, agricultural film, agricultural diesel oil and tillage. Economic growth is the main driving factor of agricultural carbon dioxide emissions. In addition, technological progress has a strong role in promoting carbon emission reduction, but it has a certain randomness. However, the impact of energy consumption structure and population size on carbon emissions is not obvious.

Spatial distribution, source analysis, and ecological risk assessment of PBDEs in river sediment around Taihu Lake, China.

The distribution and composition of organic pollutants in sediment are affected by the source and regional environment. To understand the characteristics and risk of polybrominated diphenyl ethers (PBDEs) in the area around Taihu Lake, composite sediment samples (n = 41) were collected in rivers around Taihu Lake to explore the level, spatial distribution, and source of PBDEs. The results showed that the most abundant BDE congener in river sediment was BDE209, followed by BDE99 and BDE47, with median values of 48.7, 2.17, and 1.52 ng g-1, respectively. Concentrations of PBDEs in sediments from northern rivers were significantly higher than those from other areas, but the overall risk was at a moderate-lower level compared with research results in other references. Results of principle component analysis (PCA) and source characteristics analysis revealed that most of PBDEs in river sediments around Taihu Lake were mixture of multiple sources, which mainly originated from atmospheric deposition, industrial wastewater, and municipal sewage. TOC showed good correlations with most PBDEs, which implied that PBDE components were influenced by sediment organic matter. Meanwhile, the risk of PBDEs in river sediments in this study area is a moderate-lower level.

Clinical significance of autoantibodies in the assessment and treatment of idiopathic membranous nephropathy.

The present study aimed to explore the correlation between the dynamic serum levels of phospholipase A2 receptor (PLA2R), aldose reductase (AR) and superoxide dismutase 2(SOD2) antibodies with disease activity and treatment response in patients with idiopathic membranous nephropathy (IMN). The present study included 56 patients with IMN who were diagnosed through a renal biopsy and presenting with nephrotic syndrome. The patients were divided into two treatment groups: One treated with cyclophosphamide (CTX) and one with tacrolimus (FK506). Serum was collected prior to treatment, and at 1, 3, 6, 9 and 12 months after the start of the 12-month-long therapy. Samples were tested by ELISA to measure anti-PLA2R, anti-AR and anti-SOD2 antibody titers. In addition, urinary protein excretion, serum albumin (Alb) and other blood biochemical indexes were measured. Theanti-PLA2R antibody positivity rate was 71.43% in the patients prior to treatment. After 12 months of treatment, proteinuria and PLA2R antibody levels were decreased, whereas serum Alb was increased. There was no significant difference of remission rates between the CTX and FK506 groups. In conclusion, the results of the present study indicate that the anti-PLA2R antibody level is correlated with the severity of IMN, whereas anti-AR and anti-SOD2 antibody levels are not. In addition, there was no significant difference between the CTX and FK506 groups in regards to the remission rates of patients with IMN.

Factors Associated with Health Care Professionals' Attitude Toward the Presumed Consent System.

OBJECTIVES: This paper explores health care professionals' potential attitude toward organ donation if the presumed consent system were to be implemented in Malaysia, as well as factors associated with this attitude. MATERIALS AND METHODS: We used self-administered questionnaires to investigate the attitude of 382 health care professionals from the University of Malaya Medical Center between January and February 2014. The responses were analyzed using logistic regression. RESULTS: Of the 382 respondents, 175 (45.8%) stated that they would officially object to organ donation if the presumed consent system were to be implemented, whereas the remaining 207 (54.2%) stated that they would not object. The logistic regression showed that health care professionals from the Malay ethnic group were more likely to object than those from Chinese (adjusted odds ratio of 0.342; P = .001) and Indian and other (adjusted odds ratio of 0.341; P = .003) ethnic groups. Health care professionals earning 3000 Malaysian Ringgit or below were more likely to object than those earning above 3000 Malaysian Ringgit (adjusted odds ratio of 1.919; P = .006). Moreover, respondents who were initially unwilling to donate organs, regardless of the donation system, were more likely to object under the presumed consent system than those who were initially willing to donate (adjusted odds ratio of 2.765; P < .001). CONCLUSIONS: Health care professionals in Malaysia have a relatively negative attitude toward the presumed consent system, which does not encourage the implementation of this system in the country at present. To pave the way for a successful implementation of the presumed consent system, efforts should be initiated to enhance the attitude of health care professionals toward this system. In particular, these efforts should at most target the health care professionals who are Malay, earn a low income, and have a negative default attitude toward deceased donation.

The Reliability of DNA Sequences in Public Databases Belonging to the Most Economically Important Shiitake Culinary-Medicinal Mushroom Lentinus edodes (Agaricomycetes) in Asia.

Large numbers of DNA sequences deposited in the International Nucleotide Sequence Databases (INSD) are erroneously annotated. The erroneous information may lead to misleading conclusions or cause great economic losses to farmers. Lentinus edodes (= Lentinula edodes (Berk.) Pegler) is one of the most important and popular culinary-medicinal mushrooms with a high nutritional value. In this study, experimental and in silico methods were used to correct the sequences annotated as L. edodes in the INSD. A total of 3,426 nucleotide entries were retrieved from public databases, including 140 different types of genetic sequences. Excluding 1,893 genome sequences, the most abundant signatures represented by ITS (258) and IGS1 (259) sequences accounted for 33.23% of the total entries. A total of 3,058 sequences were annotated correctly, 350 were indeterminate, and 18 were annotated erroneously based on the two methods. Correction of sequences will be beneficial for species identification and annotation. Phylogenic analysis based on ITS sequences suggested that L. edodes segregate in four clades in the tree based on ITS sequences. The isolates from China were distributed into two clades. In L. edodes, the intraspecific variation of the ITS2 sequences was much higher than that of the ITS1 sequences. In addition, the genetic diversity of the L. edodes sequences from China was much higher than that of any other regions included in this study. The northwest and southwest regions of China were L. edodes diversity centers.

Ultrasonic/CT image fusion guidance facilitating percutaneous catheter drainage in treatment of acute pancreatitis complicated with infected walled-off necrosis.

BACKGROUND: As the firs-line treatment for acute pancreatitis (AP) related infectious walled-off necrosis (WON), percutaneous catheter drainage (PCD) are usually accomplished under CT or US guidance, either of which has certain disadvantages. It is necessary to verify the clinical effects of using US and CT images fusion as guidance of PCD. METHODS: The total 94 consecutive AP patients with infected WON from January of 2013 to January of 2017 were included. Among these patients with infected WON, 48 received PCD under simple US guidance (US-PCD) and 46 under US/CT images fusion guidance (US/CT-PCD). The clinical data consisting of puncture data, drainage effectiveness indicators, intervention complications were collected. RESULTS: The demographic characteristics and disease related characteristics of two groups were comparable. After 48 h of PCD treatment, the US/CT-PCD group achieved a significantly higher imaging effective rate, and significantly lower inflammatory response indexes and severity score, than the US-PCD group (P < 0.05). The US/CT-PCD group required fewer puncture times and drainage tubes and lower rate of advanced treatment, showing higher operational success rate than the US-PCD group (P < 0.05). Moreover, the US/CT-PCD group exhibited significantly fewer puncture related complications, lower hospital stay, intubation time, and hospitalization expenses than the US-PCD group (P < 0.05). CONCLUSION: PCD treatment under the US/CT images fusion guidance is a reliable intervention with definite clinical effects for AP complicated with infected WON.

Assessment of synchronous neural activities revealed by regional homogeneity in individuals with acute eye pain: a resting-state functional magnetic resonance imaging study.

OBJECTIVE: Previous neuroimaging studies have demonstrated that pain-related diseases are associated with brain function and anatomical abnormalities, whereas altered synchronous neural activity in acute eye pain (EP) patients has not been investigated. The purpose of this study was to explore whether or not synchronous neural activity changes were measured with the regional homogeneity (ReHo) method in acute EP patients. METHODS: A total of 20 patients (15 males and 5 females) with EP and 20 healthy controls (HCs) consisting of 15 and 5 age-, sex-, and education-matched males and females, respectively, underwent resting-state functional magnetic resonance imaging. The ReHo method was applied to assess synchronous neural activity changes. RESULTS: Compared with HCs, acute EP patients had significantly lower ReHo values in the left precentral/postcentral gyrus (Brodmann area [BA]3/4), right precentral/postcentral gyrus (BA3/4), and left middle frontal gyrus (BA6). In contrast, higher ReHo values in acute EP patients were observed in the left superior frontal gyrus (BA11), right inferior parietal lobule (BA39/40), and left precuneus (BA7). However, no relationship was found between the mean ReHo signal values of the different areas and clinical manifestations, which included both the duration and degree of pain in EP patients. CONCLUSION: Our study highlighted that acute EP patients showed altered synchronous neural activities in many brain regions, including somatosensory regions. These findings might provide useful information for exploration of the neural mechanisms underlying acute EP.

Evaluation of a fever-management algorithm in a pediatric cancer center in a low-resource setting.

BACKGROUND: In low- and middle-income countries (LMICs), inconsistent or delayed management of fever contributes to poor outcomes among pediatric patients with cancer. We hypothesized that standardizing practice with a clinical algorithm adapted to local resources would improve outcomes. Therefore, we developed a resource-specific algorithm for fever management in Davao City, Philippines. The primary objective of this study was to evaluate adherence to the algorithm. PROCEDURE: This was a prospective cohort study of algorithm adherence to assess the types of deviation, reasons for deviation, and pathogens isolated. All pediatric oncology patients who were admitted with fever (defined as an axillary temperature >37.7°C on one occasion or ≥37.4°C on two occasions 1 hr apart) or who developed fever within 48 hr of admission were included. Univariate and multiple linear regression analyses were used to determine the relation between clinical predictors and length of hospitalization. RESULTS: During the study, 93 patients had 141 qualifying febrile episodes. Even though the algorithm was designed locally, deviations occurred in 70 (50%) of 141 febrile episodes on day 0, reflecting implementation barriers at the patient, provider, and institutional levels. There were 259 deviations during the first 7 days of admission in 92 (65%) of 141 patient episodes. Failure to identify high-risk patients, missed antimicrobial doses, and pathogen isolation were associated with prolonged hospitalization. CONCLUSIONS: Monitoring algorithm adherence helps in assessing the quality of pediatric oncology care in LMICs and identifying opportunities for improvement. Measures that decrease high-frequency/high-impact algorithm deviations may shorten hospitalizations and improve healthcare use in LMICs.

Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial.

BACKGROUND: This cluster randomised controlled trial aimed to determine if a 6- month home-based intervention could improve the physical activity and dietary behaviours of adults aged 60 to 80 years living in retirement villages located in Perth, Western Australia. METHODS: Participants (n = 363) from 38 retirement villages were recruited into the trial and allocated to the intervention (n = 197: 17 sites) or control (n = 166: 21 sites) group and were blinded. Previously validated instruments-Fat and Fibre Barometer and International Physical Activity Questionnaire, along with anthropometric measures (weight, height, waist and hip circumferences) and blood pressure were collected at baseline and 6 ï»¿-month time period. Comparisons between intervention and control groups were undertaken pre- and post- intervention using univariate chi-square and t-tests. Multi-level mixed regression analyses were then conducted to ascertain the effects of the intervention on changes in the outcome variables over time and between groups. RESULTS: A total of 139 (70.5%) intervention and 141 (84.9%) control group participants completed the program and post-test assessments. The intervention group demonstrated significant increases in time (80 min more per week on average) devoted to moderate-intensity physical activity, engagement in strength exercises (from 23.7% to 48.2%), frequency of fruit consumed as well as fat avoidance and fibre intake scores, in addition to a 0.5 kg mean reduction in weight post program, whereas no apparent changes were observed in the control group. Mixed regression results further confirmed statistically significant improvements in weight loss (p < 0.05), engagement in strength exercises (p < 0.001) and fruit intake (p = 0.012) by the intervention participants at post-test relative to their controls. CONCLUSIONS: Retirement offers a time to reassess lifestyle, and adopt positive health enhancing physical activity and dietary behaviours. This intervention was successful in improving weight, engagement in strength exercises, increasing levels of moderate-intensity physical activity and consumption of fruit among retirement village residents. Further investigation is needed on how to better engage retirement village managers in such programs. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry (ACTRN12612001168842) registered November 2, 2012.