Contradictions in human-nature relationships threaten coastal resilience and sustainability in the Bohai Rim Region, China.

Under the challenge of global environmental change and rapid development, tremendous risks brought about by natural disasters and human activities have increased environmental pressures for sustainable development. How to improve coastal resilience in the process of urban development has become an important topic in academia. In this study, a variable fuzzy recognition model was used to measure the level of coastal resilience in 17 cities in the Bohai Rim region, and then the kernel density, thiel index, and random forest model were used to explore the spatiotemporal characteristics and influencing factors of coastal resilience. The results show that (1) The overall resilience level of the Bohai Rim region is increasing over time, but at a relatively slow rate. (2) Coastal resilience has significant spatial unevenness, with high-level cities dominated by Tianjin, Qingdao, Yantai, etc. and low-level cities dominated by Cangzhou, Panjin, Yingkou, Binzhou, etc. (3) The influence of economic development, infrastructure, innovation ability, technology investment, and government regulation on coastal resilience decreases in order. Based on the research findings, the study can not only make suggestions for the actual regulation strategy but also provide empirical and theoretical experience for other coastal countries.

Why Ecological Momentary Assessment Surveys Go Incomplete: When It Happens and How It Impacts Data.

BACKGROUND: Ecological momentary assessment (EMA) often requires respondents to complete surveys in the moment to report real-time experiences. Because EMA may seem disruptive or intrusive, respondents may not complete surveys as directed in certain circumstances. PURPOSE: This article aims to determine the effect of environmental characteristics on the likelihood of instances where respondents do not complete EMA surveys (referred to as survey incompletion), and to estimate the impact of survey incompletion on EMA self-report data. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Ten adults hearing aid (HA) users. DATA COLLECTION AND ANALYSIS: Experienced, bilateral HA users were recruited and fit with study HAs. The study HAs were equipped with real-time data loggers, an algorithm that logged the data generated by HAs (e.g., overall sound level, environment classification, and feature status including microphone mode and amount of gain reduction). The study HAs were also connected via Bluetooth to a smartphone app, which collected the real-time data logging data as well as presented the participants with EMA surveys about their listening environments and experiences. The participants were sent out to wear the HAs and complete surveys for 1 week. Real-time data logging was triggered when participants completed surveys and when participants ignored or snoozed surveys. Data logging data were used to estimate the effect of environmental characteristics on the likelihood of survey incompletion, and to predict participants' responses to survey questions in the instances of survey incompletion. RESULTS: Across the 10 participants, 715 surveys were completed and survey incompletion occurred 228 times. Mixed effects logistic regression models indicated that survey incompletion was more likely to happen in the environments that were less quiet and contained more speech, noise, and machine sounds, and in the environments wherein directional microphones and noise reduction algorithms were enabled. The results of survey response prediction further indicated that the participants could have reported more challenging environments and more listening difficulty in the instances of survey incompletion. However, the difference in the distribution of survey responses between the observed responses and the combined observed and predicted responses was small. CONCLUSION: The present study indicates that EMA survey incompletion occurs systematically. Although survey incompletion could bias EMA self-report data, the impact is likely to be small.

Using Smartphone-Based Ecological Momentary Assessment in Audiology Research: The Participants' Perspective.

Purpose The article's purpose was to examine participants' impressions and experiences with smartphone-based ecological momentary assessment (EMA) to inform future EMA study design. Method Adults with hearing impairment (HI, n = 9) and with normal hearing (NH, n = 10) participated in a study using a smartphone-based EMA system to measure their auditory lifestyles. A 14-item survey was scheduled to deliver every 45 min by an EMA app. After a 1-week trial, participants were interviewed regarding their study experiences. The app log files were analyzed to understand how the participants interacted with the app. Results Across the two groups, 1,295 surveys were completed (compliance rate 74.4%). On average, HI participants completed 10.0 and NH participants completed 9.1 surveys per day. The mean survey completion time for HI and NH groups were 72 s and 51 s, respectively. For both groups, about 90% of the participants reported the app as easy to use; about 60% of the participants reported that repetitive surveys interrupted or somewhat interrupted their activities. Participants reported surveys disrupting situations, for example, working, driving, and social events, and that they were more likely to skip surveys in these situations. Additionally, 50% of NH and 30% of HI participants indicated that the survey was not delivered too frequently and none indicated that the survey was too long. Conclusion Overall, the app and EMA design seem to be appropriate. Insights from this study can help researchers design their studies to adequately assess listeners' experience in the field with optimal compliance and data quality.

Spanish oncology nurses: Assessment and relationship between resilience and emotional labour status.

OBJECTIVE: To investigate nurses' resilience and emotional labour (EL) status in the oncology context as well as to examine the relationship between resilience and EL status. METHODS: Cross-sectional, correlational quantitative design. The selected setting is the oncology centre at a referral and teaching hospital in northern Spain. One hundred and two oncology nurses were included. Socio-demographic data were obtained from a questionnaire. Data for resilience and EL status were drawn from validated Spanish questionnaires. RESULTS: Oncology nurses reported a moderate to high level of resilience and experienced less intense EL. Professional rank was the only factor identified that influenced resilience (p < .05). Gender, educational level, shift work, work department, and oncology work experience were statistically significant when correlated with the EL of oncology nurses (p < .05). There was a positive correlation between resilience and two EL factors (p < .05). CONCLUSIONS: The information gained from this study may raise awareness of the importance of resilience and EL in the nursing profession. It would be important to develop a programme of resilience training and emotional regulation and integrate these programmes into educational systems in order to help enhance nursing students' and clinical nurses' resilience and emotional competency.

A Fuzzy-Based Risk Assessment Framework for Autonomous Underwater Vehicle Under-Ice Missions.

The use of autonomous underwater vehicles (AUVs) for various scientific, commercial, and military applications has become more common with maturing technology and improved accessibility. One relatively new development lies in the use of AUVs for under-ice marine science research in the Antarctic. The extreme environment, ice cover, and inaccessibility as compared to open-water missions can result in a higher risk of loss. Therefore, having an effective assessment of risks before undertaking any Antarctic under-ice missions is crucial to ensure an AUV's survival. Existing risk assessment approaches predominantly focused on the use of historical fault log data of an AUV and elicitation of experts' opinions for probabilistic quantification. However, an AUV program in its early phases lacks historical data and any assessment of risk may be vague and ambiguous. In this article, a fuzzy-based risk assessment framework is proposed for quantifying the risk of AUV loss under ice. The framework uses the knowledge, prior experience of available subject matter experts, and the widely used semiquantitative risk assessment matrix, albeit in a new form. A well-developed example based on an upcoming mission by an ISE-explorer class AUV is presented to demonstrate the application and effectiveness of the proposed framework. The example demonstrates that the proposed fuzzy-based risk assessment framework is pragmatically useful for future under-ice AUV deployments. Sensitivity analysis demonstrates the validity of the proposed method.

Head to Head Comparison of Two Point-of-care Platelet Function Tests Used for Assessment of On-clopidogrel Platelet Reactivity in Chinese Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention.

BACKGROUND: Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy. In China, the thromboelastography (TEG) test has been well accepted in clinics, whereas VerifyNow, mainly used for scientific research, has not been used in routine clinical practice. The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI). METHODS: A total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study. On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist. Based on the previous reports, an inhibition of platelet aggregation (IPA) <30% for TEG or a P2Y12 reaction unit (PRU) >230 for VerifyNow was defined as high on-clopidogrel platelet reactivity (HPR). An IPA >70% or a PRU <178 was defined as low on-clopidogrel platelet reactivity (LPR). Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient (r) and kappa value (κ), respectively. RESULTS: Our results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity (r = -0.511). A significant although poor agreement (κ = 0.225) in identifying HPR and a significantly moderate agreement in identifying LPR (κ = 0.412) were observed between TEG and VerifyNow. By using TEG as the reference for comparison, the cutoff values of VerifyNow for the Chinese patients in this study were identified as PRU >205 for HPR and PRU <169 for LPR. CONCLUSIONS: By comparing VerifyNow to TEG which has been widely used in clinics, VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.

Impact of Hearing Aid Technology on Outcomes in Daily Life I: The Patients' Perspective.

OBJECTIVES: One of the challenges facing hearing care providers when recommending hearing aids is the choice of device technology level. Major manufacturers market families of hearing aids that are described as spanning the range from basic technology to premium technology. Premium technology hearing aids include acoustical processing capabilities (features) that are not found in basic technology instruments. These premium features are intended to yield improved hearing in daily life compared with basic-feature devices. However, independent research that establishes the incremental effectiveness of premium-feature devices compared with basic-feature devices is lacking. This research was designed to explore reported differences in hearing abilities for adults using premium- and basic-feature hearing aids in their daily lives. DESIGN: This was a single-blinded, repeated, crossover trial in which the participants were blinded. All procedures were carefully controlled to limit researcher bias. Forty-five participants used carefully fitted bilateral hearing aids for 1 month and then provided data to describe the hearing improvements or deficiencies noted in daily life. Typical participants were 70 years old with mild to moderate adult-onset hearing loss bilaterally. Each participant used four pairs of hearing aids: premium- and basic-feature devices from brands marketed by each of two major manufacturers. Participants were blinded about the devices they used and about the research questions. RESULTS: All of the outcomes were designed to capture the participant's point of view about the benefits of the hearing aids. Three types of data were collected: change in hearing-related quality of life, extent of agreement with six positively worded statements about everyday hearing with the hearing aids, and reported preferences between the premium- and basic-feature devices from each brand as well as across all four research hearing aids combined. None of these measures yielded a statistically significant difference in outcomes between premium- and basic-feature devices. Participants did not report better outcomes with premium processing with any measure. CONCLUSIONS: It could reasonably be asserted that the patient's perspective is the gold standard for hearing aid effectiveness. While the acoustical processing provided by premium features can potentially improve scores on tests conducted in contrived conditions in a laboratory, or on specific items in a questionnaire, this does not ensure that the processing will be of noteworthy benefit when the hearing aid is used in the real world challenges faced by the patient. If evidence suggests the patient cannot detect that premium features yield improvements over basic features in daily life, what is the responsibility of the provider in recommending hearing aid technology level? In the present research, there was no evidence to suggest that premium-feature devices yielded better outcomes than basic-feature devices from the patient's point of view. All of the research hearing aids were substantially, but equally, helpful. Further research is needed on this topic with other hearing aids and other manufacturers. In the meantime, providers should insist on scientifically credible independent evidence to support effectiveness claims for any hearing help devices.

[Fraction distribution and risk assessment of heavy metals in stream sediments from a typical nonferrous metals mining city].

A modified Tessier's sequential extraction procedure was used to investigate the fraction of seven types of heavy metals (Cd, Cr, Cu, Zn, Ni, Pb, As) in the surface sediments from Huixi Stream in Tongling City, a typical nonferrous metals mining city, China. Based on speciation distribution analysis of these metals, contamination degree and ecological risk assessment of heavy metals were conducted by means of risk assessment code (RAC) and mean sediment quality guideline quotient (SQG-Q). The results show that: (1) Cr and As are major composed with residual fractions, Zn, Ni and Pb are mainly constituted of residual and bound to iron and manganese oxides fractions, and Cu is dominated by bounding to organic matter, while Cd exists in approximate mass fractions of exchangeable, bound to carbonates, bound to iron and manganese oxides, and residue. (2) Carbonate and exchangeable mass fractions of Cd, Cr, Cu, Zn, Ni, Pb and As reach 46.48%, 4.62%, 4.05%, 4.12%, 9.17%, 0.97% and 0.03%, respectively. According to the RAC, Cd is of high risk to the environment, Cr, Cu, Zn and Ni are of low risk to the environment, while Pb and As pose extreme low risk to the environment. (3) The SQG index, calculated with SQG-Q, is 10.42, which is far higher than the threshold value 1.0, indicating that the sediment in Huixi Stream has a very high potential for biological toxicity effect. The PEL-Q indexes corresponding to Cd, Cr, Cu, Zn, Ni, Pb and As approach 4.23, 1.14, 20.75, 6.04, 2.33, 4.58 and 41.71, respectively, suggesting that all these metals have great potentials for biological toxicity and the adverse effects will frequently occur.

Need and challenges of refractive correction in urban Chinese school children.

PURPOSE: Uncorrected refractive error is recognized as the principal cause of visual impairment in school-aged children. Although correction of refractive error is easy, safe, and effective, many children are without the necessary spectacles. Empiric research on barriers to refractive correction remains limited, precluding the formulation of effective remedial actions. The aims of this study were to characterize parental awareness and other barriers to spectacle use among children considered to be in need of refractive correction and to determine the proportion undercorrected for those already with spectacles. METHODS: A population-based sample of children 5 to 15 years of age was examined in Guangzhou, China. Visual acuity was measured followed by cycloplegic refraction and best-corrected vision. Parental awareness of the child's vision difficulties, spectacle use, and frequency of vision checkups were collected by questionnaire. Associations between these variables and demographic and socioeconomic characteristics were investigated with multiple logistic regression. RESULTS: Among the 4359 examined children, 919 (21.1%) were found to be in need of refractive correction. Need was defined as uncorrected visual acuity < or = 0.50 in both eyes correctable by at least two lines in the better eye. Parental awareness was apparent for 85% of cases; 74% had spectacles. Awareness of vision difficulties was associated with older child age, greater visual impairment, and higher parental education. The purchase of spectacles was associated with greater visual impairment; the child's age, gender, parental education, and family income were not significant factors. Undercorrection by two lines or more in the better eye was found in 30% of those already with spectacles; undercorrection was associated with greater visual impairment and less frequent refraction checkups. CONCLUSIONS: Half of the children in need of first-time or updated spectacles are without them, an unacceptably high proportion. Younger children with moderate visual impairment are at particular risk for uncorrected refractive error. Parental education and enhanced school-based screening programs may be necessary to address the unfilled need for refractive correction among school-aged children.

[Quality of life assessment of cataract surgery in elderly population of Doumen County, Guangzhou Province].

OBJECTIVE: To evaluate the outcome of cataract surgery in elderly population in Doumen County, Guangdong Province by assessment of subjective visual function and quality of life. METHODS: All the cataract postoperative subjects were identified in the population-level. Visual Function and Quality of Life (VF/QOL) questionnaire developed by National Eye Institute, USA in developing countries was used as the instrument. This Questionnaire was administered by four trained-interviewers in all subjects with visual acuity less than 0.1 in either eye (treated as visual impairment cases), One in every 20 persons with visual acuity better than 0.3 (treated as normal control cases) in both eyes (un-operated group) and all cataract postoperative cases (operated group). RESULTS: In 5 342 cross-sectional examined persons, individuals who could be successfully interviewed included 99 (90.8%) cataract postoperative cases, 535 (85.5%) visual impairment cases and 119 normal control ones. On a 0 - 100 scale, medium total scores of VF and QOL diminished from 92 to 2 and from 100 to 19 respectively along with visual status from normal to severe blindness in the un-operated group. Similar findings on visual status and VF/QOL scores were found in the operated group. The overall scores of VF and QOL were 40 and 56 for operated one and 56 and 72 for un-operated one. After adjusted the confounding effect of visual status, age, sex and education by multivariate regression model, the difference of QOL scores between un-operated and operated group was significant (P = 0.015), while no significant difference (P = 0.199) was found in VF scores. CONCLUSIONS: The scores of VF and QOL are significantly correlated with the visual status. Subjective visual function and quality of life could not be significantly improved after cataract surgery in this target population. Concerns should be paid in postoperative follow-up, aphakic correction and social-psychological rehabilitation.

Rapid assessment of trachoma in Hainan Province, China: validation of the new World Health Organization methodology.

This study was undertaken to validate a WHO methodology for the rapid assessment of trachoma. Fourteen villages were chosen by random sampling in two counties in Hainan Province, China. For the rapid assessment, trichiasis patients were identified, 50 children ages 1-10 years were examined for active trachoma, and information was collected on community access to services and community risk factors. To validate the methodology, a prevalence survey was undertaken simultaneously in the same villages. For the prevalence survey, 2428 people from 1606 households in the 14 villages were chosen by random sampling. Very little active trachoma was found by either method, although the rates of trichiasis were more substantial. Ranking of the villages by the two methods for trichiasis was highly correlated (Spearman's correlation coefficient = 0.60, p = 0.02). For active trachoma, the Spearman's correlation coefficient for the ranking of villages by the two methods was 0.40 and not significant (p = 0.14), suggesting that a correlation this close may have been seen by chance alone. The observational data showed all the villages to be at risk of active trachoma (due to poor environmental hygiene conditions), suggesting that this aspect of the WHO methodology overestimates the risk for active trachoma. We conclude that, with the exception of the community assessment of risk, this rapid assessment methodology is a valid tool for the assessment of trichiasis and possibly of active trachoma in rural communities, although the level of active trachoma in this study was too low to effectively validate that aspect of the methodology.