Trauma Program Value Assessment at an Academic Health Network System Over 12 Years.

BACKGROUND: Trauma is a leading cause of global death, with 200 000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System. METHODS: Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS <15) and severe cases (ISS >15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index (RI) were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS. RESULTS: 41,927 trauma evaluations were performed, leading to 16 044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7 Kg/m2, respectively, P < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively (P < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC (P < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages. CONCLUSIONS: The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.

Assessment of the response characteristics of pollution load in Huntai Basin under climate change.

This study establishes a calibrated SWAT (Soil and Water Assessment Tool) model for the Huntai Basin, driven by SSP126, SSP245, SSP585, and multi-model ensemble (MME) models in CMIP6 (Coupled Model Intercomparison Project-6), to investigate the effects of climate change on hydrological processes and pollution load in the Huntai Basin. The results show that the annual mean temperature and the annual precipitation will gradually increase. The nitrogen and phosphorus pollution loads in the basin exhibit a trend of decreasing-increasing-decreasing. The correlation between the nitrogen-phosphorus pollution load and the hydrological process strengthens with increasing radiative forcing. In the four scenarios, CO2 is a primary driving factor that contributes greatly to nitrogen and phosphorus pollution. The main differences are in the total driving factors, and SSP126 and SSP245 are less than those of other models. The total phosphorus and total nitrogen pollution in different climate models were higher than the average level during the benchmark period, except for ammonia nitrogen pollution, which was lower. The nitrogen and phosphorus pollution in SSP126 and SSP245 modes will reach the maximum in 2040s, and the pollution in other periods will be lower than that in SSP585 and MME scenarios. In the long run, the development state between SSP126 and SSP245 may be better appropriate for the Huntai Basin's future sustainable development. This paper analyzes the occurrence and influencing factors of nitrogen and phosphorus pollution under climate change to provide reference to the protection of water environment under changing environments.

Risk-based detection as a cost-effective strategy to reduce foodborne illness due to salmonella.

Background: Salmonella, a widespread pathogen, poses a significant threat to global food safety, leading to foodborne diseases and substantial economic losses. The timely and accurate detection of foodborne pathogens is pivotal for averting food contamination and outbreaks across the food production chain. This study assesses the cost-effectiveness of traditional culture-based methods versus risk-based approaches, incorporating polymerase chain reaction (PCR) for Salmonella detection. Methods: We employed a stochastic scenario tree model to simulate scenarios based on the sampling inspection plan for raw aquatic products conducted by the Guangzhou Center for Disease Control and Prevention from 2018 to 2020. Various detection methods (culture or PCR) were applied to these aquatic products based on their categorized risk level. Sensitivity values were derived from published data, and incremental cost-effectiveness ratios were used to compare the different scenarios against the traditional culture method. Results: A total of 360 samples were collected for analysis. The cost of culture-based detection alone amounted to 125,423.20 Chinese Yuan (CNY) and yielded nine instances of positive Salmonella detections. The risk-based detection strategy, which combined the more sensitive PCR method with high-risk sample characteristics, while employing the culture method for the remaining combinations, imposed a total cost of 128,775.83 CNY and yielded ten positive detections. This approach cost approximately 3391.74 CNY per additional positive sample detected compared to the culture method alone. Meanwhile, PCR-only detection imposed a total cost of 62,960.03 CNY. Conclusions: In comparison to traditional culture-based methods, both the risk-based detection strategy and the PCR-only approach demonstrated superior capabilities with respect to detecting contaminated aquatic products. Implementing risk-based detection strategies can enhance cost-effectiveness, not only ensuring food safety but also reducing the incidence and economic burden of foodborne diseases.

Structural Uncertainty Analysis of High-Temperature Strain Gauge Based on Monte Carlo Stochastic Finite Element Method.

The high-temperature strain gauge is a sensor for strain measurement in high-temperature environments. The measurement results often have a certain divergence, so the uncertainty of the high-temperature strain gauge system is analyzed theoretically. Firstly, in the conducted research, a deterministic finite element analysis of the temperature field of the strain gauge is carried out using MATLAB software. Then, the primary sub-model method is used to model the system; an equivalent thermal load and force are loaded onto the model. The thermal response of the grid wire is calculated by the finite element method (FEM). Thermal-mechanical coupling analysis is carried out by ANSYS, and the MATLAB program is verified. Finally, the stochastic finite element method (SFEM) combined with the Monte Carlo method (MCM) is used to analyze the effects of the physical parameters, geometric parameters, and load uncertainties on the thermal response of the grid wire. The results show that the difference of temperature and strain calculated by ANSYS and MATLAB is 1.34% and 0.64%, respectively. The calculation program is accurate and effective. The primary sub-model method is suitable for the finite element modeling of strain gauge systems, and the number of elements is reduced effectively. The stochastic uncertainty analysis of the thermal response on the grid wire of a high-temperature strain gauge provides a theoretical basis for the dispersion of the measurement results of the strain gauge.

Preoperative Frailty Assessment Predicts Postoperative Mortality, Delirium and Pneumonia in Elderly Lung Cancer Patients: A Retrospective Cohort Study.

BACKGROUND: The purpose of this study was to investigate the predictive value of the 5-factor modified frailty index (mFI-5) for postoperative mortality, delirium and pneumonia in patients over 65 years of age undergoing elective lung cancer surgery. METHODS: Data were collected from a single-center retrospective cohort study conducted in a general tertiary hospital from January 2017 to August 2019. In total, the study included 1372 elderly patients aged over 65 who underwent elective lung cancer surgery. They were divided into frail group (mFI-5, 2-5), prefrail group (mFI-5, 1) and robust group (mFI-5, 0) on the basis of mFI-5 classification. The primary outcome was postoperative 1-year all-cause mortality. Secondary outcomes were postoperative pneumonia and postoperative delirium. RESULTS: Frailty group had the highest incidence of postoperative delirium (frailty 31.2% versus prefrailty 1.6% versus robust 1.5%, p < 0.001), postoperative pneumonia (frailty 23.5% versus prefrailty 7.2% versus robust 7.7%, p < 0.001), and postoperative 1-year mortality (frailty 7.0% versus prefrailty 2.2% versus robust 1.9%. p < 0.001). Frail patients have significantly longer length of hospitalization than those in the robust group and prefrail patients (p < 0.001). Multivariate analysis showed a clear link between frailty and increased risk of postoperative delirium (aOR 2.775, 95% CI 1.776-5.417, p < 0.001), postoperative pneumonia (aOR 3.291, 95% CI 2.169-4.993, p < 0.001) and postoperative 1-year mortality (aOR 3.364, 95% CI, 1.516-7.464, p = 0.003). CONCLUSIONS: mFI-5 has potential clinical utility in predicting postoperative death, delirium and pneumonia incidence in elderly patients undergoing radical lung cancer surgery. Frailty screening of patients (mFI-5) may provide benefits in risk stratification, targeted intervention efforts, and assist physicians in clinical decision-making.

Identification of Factors that May Predict Career Trajectory Among Neuro-Ophthalmology Fellows.

BACKGROUND: There is modest literature regarding fellowship applicant factors that may predict future career achievement. We aim to characterize neuro-ophthalmology fellows and identify and analyze characteristics that may predict future career trajectory. METHODS: Data, including demographic information, academic background, scholarly activities, and practice information, were collected using publicly available sources, on individuals who completed neuro-ophthalmology fellowships from 2015 to 2021. Summary statistics describing the cohort were calculated. Prefellowship characteristics were compared with postfellowship characteristics to evaluate which prefellowship characteristics may predict postfellowship academic productivity and career achievement. RESULTS: Data were collected on 174 individuals (41.6% men, 58.4% women). Sixty-five percent were residency-trained in ophthalmology, 31% neurology, 1.7% both, and 1.7% pediatric neurology. Fifty-eight percent completed residency in the US, 8% in Canada, 32% internationally, and 2% in multiple locations. Among those practicing in the US/Canada, 63.8% practice at academic centers, 35.3% private practice, and 0.9% at both. Thirty-one percent completed additional subspecialty training and 17.8% additional graduate degrees. Completion of additional fellowship training or graduate degrees, and publication of more papers before fellowship, correlated with later academic productivity. There were no significant correlations between completion of an additional fellowship or graduate degree with current practice environment or attainment of leadership roles. There were no significant correlations between total publishing productivity prefellowship and practice environment or leadership roles postfellowship. CONCLUSIONS: Additional graduate degrees/subspecialty training, and prefellowship academic productivity, correlated with later academic productivity among neuro-ophthalmologists, suggesting that these metrics may be helpful in predicting future academic performance among fellowship applicants.

Dynamic Scenario Analysis of Science and Technology Innovation to Support Chinese Cities in Achieving the "Double Carbon" Goal: A Case Study of Xi'an City.

Since the Chinese government proclaimed the "double carbon" goal in 2020, carbon emissions reduction has become an important task for the Chinese government. Cities generate more than 60% of carbon emissions. There are many challenges in achieving the "double carbon" goal for the cities of China. Science and technology innovation (STI) provides a feasible path, and the mechanism of STI influencing carbon emissions is analyzed. The STI factors, economic factors, energy factors, and population factors are studied based on the generalized Divisia index method. According to the decomposing results, science and technology innovation investment is the most important increasing factor in carbon emissions, and technology innovation investment efficiency is the most important decreasing factor, respectively. Three scenarios are set up and simulated with Monte Carlo technology evaluating the city of Xi'an in China. Under the baseline development scenario, it cannot achieve the carbon peak goal, and the uncertainty of carbon emissions increases. Under the green development scenario, it will peak in 2051, with a 95% confidence interval of 6668.47-7756.90 × 104 tons. Under the technology breakthrough scenario, the lower and median boundaries of carbon emissions peak at 4703.94 × 104 tons and 4852.39 × 104 tons in 2026, and the upper boundary peaks at 5042.15 × 104 tons in 2030. According to the Environmental Kuznets Curve theory, it will peak between 2028 and 2029 with a GDP per capita of CNY 153,223.85. However, it will fail to achieve the carbon neutrality goal by 2060, and should rely on the national carbon trading market of China to achieve the goal with a trading volume of 2524.61-3007.01 × 104 tons.

Does CSR performance improve corporate immunity to the COVID-19 pandemic? Evidence from China's stock market.

This paper studies the role of corporate social responsibility (CSR) performance on corporate financial performance during the COVID-19 by examining a sample of Chinese listed firms. Based on the PSM-DID methodology, we find that the pandemic-induced decline in stock returns is stronger with more CSR engagement. The results remain robust even after the dynamic effect test and placebo test. It means CSR performance does not improve Chinese corporate immunity to the pandemic. This inadequate response of CSR could be due to the "relatively few good things effect". Furthermore, our study indicates that increasing awareness of responsible investment and improving the quality of CSR disclosure could facilitate CSR engagement in China.

[Risk assessment, safe medication and scientific supervision of traditional Chinese medicine containing aristolochic acids--toxicity is different among aristolochic acids, and detection and control of aristolochic acid â /â ¡ is critical].

The safety problem of traditional Chinese medicine containing aristolochic acid is of great concern in China and abraod, which poses a challenge in clinical application and supervision. There are many types of aristolochic acid analogues(AAAs) and 178 have been reported. According to the structure, they are classified into aristolochic acids(AAs) and aristololactams(ALs). The toxi-city is remarkably different among AAAs of different types. For example, AA-Ⅰ has strong nephrotoxicity and carcinogenicity, and the toxicity of AA-Ⅱ is lower than that of AA-Ⅰ. Besides, AA-Ⅳa and AA-Ⅰa are considered to have no obvious nephrotoxicity and carcinogenicity. The types and content of AAAs are significantly different among traditional Chinese medicines derived from different Aristolochiaceae species. For example, Asari Radix et Rhizoma and Aristolochiae Herba mainly consist of AAAs without obvious toxicity(such as AA-Ⅳa). The content of AAAs in compound preparations is related to the proportions of the medicinals and the processing method. The content of AA-Ⅰ in some compound preparations is very low or below the detection limit. Therefore, the author concludes that AAAs of different types have different toxicity, but not all AAAs has nephrotoxicity and carcinogenicity. Moreover, the toxicity of traditional Chinese medicines containing AAAs should not be generalized and AA-Ⅰ and AA-Ⅱ should be emphasized. In this paper, it is suggested that traditional Chinese medicine containing AAAs should be used rationally and research, analysis, and toxicological study of AAAs species and content should be strengthened. In addition, limit standards of AA-Ⅰ and AA-Ⅱ should be formulated and science-based supervision should be performed.

The frequency of assessment tools in arthroscopic training: a systematic review.

BACKGROUND: Multiple assessment tools are used in arthroscopic training and play an important role in feedback. However, it is not fully recognized as to the standard way to apply these tools. Our study aimed to investigate the use of assessment tools in arthroscopic training and determine whether there is an optimal way to apply various assessment tools in arthroscopic training. METHODS: A search was performed using PubMed, Embase and Cochrane Library electronic databases for articles published in English from January 2000 to July 2021. Eligible for inclusion were primary research articles related to using assessment tools for the evaluation of arthroscopic skills and training environments. Studies that focussed only on therapeutic cases, did not report outcome measures of technical skills, or did not mention arthroscopic skills training were excluded. RESULTS: A total of 28 studies were included for review. Multiple assessment tools were used in arthroscopic training. The most common objective metric was completion time, reported in 21 studies. Technical parameters based on simulator or external equipment, such as instrument path length, hand movement, visual parameters and injury, were also widely used. Subjective assessment tools included checklists and global rating scales (GRS). Among these, the most commonly used GRS was the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Most of the studies combined objective metrics and subjective assessment scales in the evaluation of arthroscopic skill training. CONCLUSIONS: Overall, both subjective and objective assessment tools can be used as feedback for basic arthroscopic skill training, but there are still differences in the frequency of application in different contexts. Despite this, combined use of subjective and objective assessment tools can be applied to more situations and skills and can be the optimal way for assessment. LEVEL OF EVIDENCE: Level III, systematic review of level I to III studies. Key messagesBoth subjective and objective assessment tools can be used as feedback for basic arthroscopic skill training.Combined use of subjective and objective assessment tools can be applied to more situations and skills and can be the optimal way for assessment.

Propensity score weighted associations between financial strain and subsequent inflammatory biomarkers of aging among a representative sample of U.S. older adults.

BACKGROUND: Despite known socioeconomic disparities in aging-related outcomes, the underlying physiologic mechanisms are understudied. This study applied propensity score weighting to estimate the effect of financial strain on inflammation-related aging biomarkers among a national sample of older adults. METHODS: Financial strain severe enough to lack money for housing, utilities, medical/prescription bills or food was measured among 4,593 community-dwelling National Health and Aging Trends Study participants aged ≥ 65 years in 2016. Inverse probability propensity score weights were generated based on 2015 background characteristics, including age, gender, race/ethnicity, income to poverty ratio, education, occupation, home ownership, retirement, Sect. 8 housing, Medicaid, food/energy assistance, childhood health, marital status, and U.S. region. Sampling weights additionally accounted for study design and non-response. RESULTS: In propensity score-weighted analyses adjusting for age, gender, race/ethnicity, 2017 income to poverty ratio and education, those with 2016 financial strain had 15% higher IL-6 (p = 0.026) and 20% higher CRP levels (p = 0.002) in 2017 than those who were not strained, but did not differ with regard to hemoglobin A1c or CMV. In weighted comparisons, those with financial strain did not differ from those without with regard any 2015 background characteristics. CONCLUSIONS: These results strengthen the etiologic evidence suggesting that financial strain increases inflammatory biomarkers among older adults. Importantly, inflammation is likely a key physiologic pathway contributing to socioeconomic disparities. Therefore, research is needed to address financial strain.

Probabilistic risk assessment of heavy metals in urban farmland soils of a typical oasis city in northwest China.

Previous studies lacked quantitative evaluation studies of the probability of ecology and human health risks from soil heavy metals. This study assessed heavy metal risk level by collecting topsoil samples from a typical oasis city (Wuwei) in northwest China and then quantitatively evaluating the ecological risk from heavy metals by incorporating the uncertainty of health risk model parameters into the risk assessment. This study found that anthropogenic activities have influenced the accumulation of heavy metals in the study area and that the risk of contamination of soil heavy metals was characterized as light to moderate contamination and low ecological risk. On this basis, the species sensitivity distribution curves of heavy metals were constructed using species acute toxicity data, the predicted no effect concentrations of heavy metals were derived, and a probabilistic ecological risk evaluation was conducted. The results show that the current soil environmental quality standards in China are not effective in protecting species diversity. In addition, the probability of ecological risk for Cr, Ni and As in the study area was 63.3%, 23.8% and 7.1%, however, traditional pollution assessment methods underestimate the hazard of Cr. Monte Carlo simulations have shown that the probability of the carcinogenic risk of Cr (adults: 79.4%; children: 94.5%) and As (adults: 78.9%; children: 94.0%) is high, the probability of the total carcinogenic risk exceeding 1E-06 is 99.0%, the probability of the non-carcinogenic risk is low, and the slope factor and reference dose can significantly affect the evaluation of human health risks.

The feasibility of 18F-FDG gated positron emission tomography (PET) for left ventricular dyssynchrony assessment in comparison with 99mTc-MIBI gated single-photon emission computed tomography (SPECT) among patients with prior myocardial infarction.

Background: Phase analysis by 99mTc-MIBI gated single-photon emission computed tomography (GSPECT) has been considered to be an adequate method in the validation of left ventricular (LV) dyssynchrony. Compared with GSPECT, prior myocardial infarction patients with myocardial perfusion defects but myocardial viability usually show preserved uptake of 18F-FDG, and extensive myocardium is detected by 18F-FDG gated positron emission tomography (GPET). Thus, theoretically, it should be more accurate. The aim of this study was to investigate the feasibility of GPET for LV dyssynchrony assessment in comparison with GSPECT among infarction patients. Methods: A total of 146 patients with infarction underwent 2 consecutive days of GSPECT and GPET examinations. Quantitative gated SPECT-derived LV phase analysis was applied to GPET and GSPECT data to assess the presence of LV dyssynchrony via histogram bandwidth (BW) and phase standard deviation (SD). The correlation and agreement of BW and SD between GSPECT and GPET were examined. Factors (i.e., total perfusion defect, scar and mismatch) related to the discrepancies of LV dyssynchrony (i.e., BW and SD) in GPET and GSPECT were assessed by univariate and multivariate regression analysis. Results: A moderate correlation between GPET and GSPECT was found in the measurements of BW (r=0.554) and SD (r=0.537). Bland-Altman analysis revealed that GPET overestimated both BW and SD (20.5° and 9.5°, respectively). In addition, the BW and SD measured by GPET were still overestimated after subgroup analysis. Between GPET and GSPECT, multivariate regression analysis revealed that total perfusion defects were related to the difference in BW measurement (P<0.001), and mismatch was associated with the difference in SD measurement (P<0.01). Conclusions: In patients with infarction, GPET moderately correlated with GSPECT in assessing LV dyssynchrony. GPET overestimated both BW and SD, so these analyses should not be interchangeable in individual patients.

External Exposure to BTEX, Internal Biomarker Response, and Health Risk Assessment of Nonoccupational Populations near a Coking Plant in Southwest China.

Benzene, toluene, ethylbenzene and xylene isomers (BTEX) have raised increasing concern due to their adverse effects on human health. In this study, a coking factory and four communities nearby were selected as the research area. Atmospheric BTEX samples were collected and determined by a preconcentrator GC-MS method. Four biomarkers in the morning urine samples of 174 participants from the communities were measured by LC-MS. The health risks of BTEX exposure via inhalation were estimated. This study aimed to investigate the influence of external BTEX exposure on the internal biomarker levels and quantitatively evaluate the health risk of populations near the coking industry. The results showed that the average total BTEX concentration in residential area was 7.17 ± 7.24 µg m-3. Trans,trans-muconic acid (T,T-MA) was the urinary biomarker with the greatest average level (127 ± 285 µg g-1 crt). Similar spatial trends can be observed between atmospheric benzene concentration and internal biomarker levels. The mean values of the LCR for male and female residents were 2.15 × 10-5 and 2.05 × 10-5, respectively. The results of the risk assessment indicated that special attention was required for the non-occupational residents around the area.

[Early Assessment of Myocardial Fibrosis of Hypertrophic Cardiomyopathy with Native-T1-Mapping-Based Deep Learning: A Preliminary Study].

OBJECTIVE: To explore the diagnostic performance of deep learning (DL) model in early detection of the interstitial myocardial fibrosis using native T1 maps of hypertrophic cardiomyopathy (HCM) without late gadolinium enhancement (LGE). METHODS: Sixty HCM patients and 44 healthy volunteers who underwent cardiac magnetic resonance were enrolled in this study. Each native T1 map was labeled according to its LGE status. Then, native T1 maps of LGE (-) and those of the controls were preprocessed and entered in the SE-ResNext-50 model as the matrix for the DL model for training, validation and testing. RESULTS: A total of 241 native T1 maps were entered in the SE-ResNext-50 model. The model achieved a specificity of 0.87, sensitivity of 0.79, and area under curve ( AUC) of 0.83 ( P<0.05) in distinguishing native T1 maps of LGE (-) from those of the controls in the testing set. CONCLUSION: The DL model based on SE-ResNext-50 could be used for identifying native T1 maps of LGE (-) with relatively high accuracy. It is a promising approach for early detection of myocardial fibrosis in HCM without the use of contrast agent.

Residential Street Block Disorder and Biological Markers of Aging in Older Adults: The National Health and Aging Trends Study.

BACKGROUND: Residential environments are associated with older adults' health, but underlying physiologic causal mechanisms are not well understood. As adults age, street blocks are likely more relevant to their health than the larger neighborhood environment. This study examined the effects of adverse street block conditions on aging biomarkers among older adults. METHODS: We included community-dwelling Medicare beneficiaries aged 67 and older with 2017 biomarker data from the nationally representative National Health and Aging Trends Study (n = 4357). Street block disorder in 2016 was measured using interviewer report of any trash/glass/litter, graffiti, or vacant buildings on participants' blocks. Propensity score models were used to create balanced groups with regard to multiple 2015 participant characteristics, including demographic, socioeconomic, residence, and early-life characteristics. Linear regressions modeled street block disorder as a predictor of 4 aging biomarkers, hemoglobin A1C, high-sensitivity C-reactive protein, interleukin-6, and cytomegalovirus antibodies, before and after applying propensity score weighting. RESULTS: Adjusting for participant sociodemographic characteristics and applying propensity score weights, living on a block with any disorder was associated with 2% higher mean hemoglobin A1C levels (95% confidence interval [CI]: 0.002-0.03), 13% higher C-reactive protein (95% CI: 0.03-0.23), 10% higher interleukin-6 (95% CI: 0.02-0.19), and 19% more cytomegalovirus antibodies (95% CI: 0.09-0.29) compared to living on a block with no disorder. CONCLUSIONS: Street block disorder predicted subsequent aging biomarkers after applying a propensity score approach to account for confounding among a national sample of older adults. Targeting street-level residential contexts for intervention may reduce the risk for poor health in older adults.

Assessment of chronic disease self-management in patients with chronic heart failure based on the MCID of patient-reported outcomes by the multilevel model.

PURPOSE: The minimal clinically important difference (MCID) of a patient-reported outcome (PRO) represents the threshold value of the change in the score for that PRO. It is deemed to have an important implication in clinical management. This study was performed to evaluate the clinical significance of chronic disease self-management (CDSM) for patients with chronic heart failure based on the MCID of the chronic heart failure-PRO measure (CHF-PROM). METHODS: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from July 2018. Advice of CDSM was provided in written form at discharge to all patients. Information regarding CHF-PROM and CDSM were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of CDSM for CHF-PROM scores, as well as its physical and psychological domains. MCID changes of the PRO were introduced and compared with ß values of CDSM obtained from the multi-level models to further evaluate the clinical significance. The STROBE checklist is shown in Additional file 1. RESULTS: Scores for CHF-PROM improved significantly after discharge. The multilevel models showed that a regular schedule, avoidance of over-eating, a low-sodium diet and exercise increased scores on CHF-PROM. Compared with the MCID, avoidance of over-eating (12.39 vs. 9.75) and maintenance of a regular schedule often (10.98 vs. 9.75), and exercise almost every day (11.36 vs. 9.75) reached clinical significance for the overall summary. Avoidance of over-eating (5.88 vs. 4.79) and a regular schedule almost every day (4.96 vs. 4.79) reached clinical significance for the physical scores. Avoidance of over-eating half of the time (5.26 vs. 4.87) and a regular schedule almost every day (5.84 vs. 4.87) demonstrated clinical significance for the psychological scores. CONCLUSIONS: This study observed an association of avoidance of over-eating and maintenance of a regular schedule with the improvement of CHF-PROM. It provides further evidence for management of heart failure. TRIAL REGISTRATION: Current Prospective Trials NCT02878811; registered August 25, 2016; https://clinicaltrials.gov/ct2/show/NCT02878811?term=NCT02878811&draw=2&rank=1 .

Modeling analysis of COVID-19 based on morbidity data in Anhui, China.

Since the first case of coronavirus disease (COVID-19) in Wuhan Hubei, China, was reported in December 2019, COVID-19 has spread rapidly across the country and overseas. The first case in Anhui, a province of China, was reported on January 10, 2020. In the field of infectious diseases, modeling, evaluating and predicting the rate of disease transmission is very important for epidemic prevention and control. Different intervention measures have been implemented starting from different time nodes in the country and Anhui, the epidemic may be divided into three stages for January 10 to February 11, 2020, namely. We adopted interrupted time series method and develop an SEI/QR model to analyse the data. Our results displayed that the lockdown of Wuhan implemented on January 23, 2020 reduced the contact rate of epidemic transmission in Anhui province by 48.37%, and centralized quarantine management policy for close contacts in Anhui reduced the contact rate by an additional 36.97%. At the same time, the estimated basic reproduction number gradually decreased from the initial 2.9764 to 0.8667 and then to 0.5725. We conclude that the Wuhan lockdown and the centralized quarantine management policy in Anhui played a crucial role in the timely and effective mitigation of the epidemic in Anhui. One merit of this work is the adoption of morbidity data which may reflect the epidemic more accurately and promptly. Our estimated parameters are largely in line with the World Health Organization estimates and previous studies.

Simulation-Based Arthroscopic Skills Using a Spaced Retraining Schedule Reduces Short-Term Task Completion Time and Camera Path Length.

PURPOSE: To investigate whether acquiring basic knee arthroscopic skills via a spaced retraining schedule could prevent skills deterioration and achieve further skills improvement. METHODS: In the learning phase, 16 residents with no previous hands-on experience in practicing arthroscopic skills were asked to perform basic arthroscopic tasks on a simulator until they attained perfect scores in each task. Immediately after completing the learning phase, a pretest was performed to assess their performance. Next, they were randomly assigned into 2 groups. The spaced retraining group, which undertook a spaced repetitive training phase with a fixed-time interval, returned on days 2, 4 and 6 to repeat the same tasks for 20 minutes per day, whereas the control group did nothing. On day 7, all participants performed a posttest. A 2 × 2 mixed analysis of variance model was used for statistical analysis. RESULTS: Significant differences between the 2 groups were found in task completion time (P = .003) and camera path length (P = .043) but not cartilage injury (P = .186). Residents in the spaced retraining group decreased their task completion time (163.2 ± 23.9 seconds) whereas the task time in the control group increased (351.3 ± 25.5 seconds). The same pattern was found with the camera path length. CONCLUSIONS: Implementing a spaced retraining schedule in 1 week resulted in a reduced task completion time and camera path length but no significant reduction in cartilage injury. It appears that introducing a spaced retraining schedule to retain arthroscopic skills acquired through massed learning may be advantageous. CLINICAL RELEVANCE: In consideration of the training time available to residents and the trend toward massed learning, this spaced retraining schedule may offer a cost-effective and convenient way for residents to maintain and improve their basic arthroscopic skills with no significant increase in time invested.