A real-world data validation of the value of early-stage SIR modelling to public health.

Performance of Susceptible-Infected-Recovered (SIR) model in the early stage of a novel epidemic may be hindered by data availability. Additionally, the traditional SIR model may oversimplify the disease progress, and knowledge about the virus and transmission is limited early in the epidemic, resulting in a greater uncertainty of such modelling. We aimed to investigate the impact of model inputs on the early-stage SIR projection using COVID-19 as an illustration to evaluate the application of early infection models. We constructed a modified SIR model using discrete-time Markov chain to simulate daily epidemic dynamics and estimate the number of beds needed in Wuhan in the early stage of COVID-19 epidemic. We compared eight scenarios of SIR projection to the real-world data (RWD) and used root mean square error (RMSE) to assess model performance. According to the National Health Commission, the number of beds occupied in isolation wards and ICUs due to COVID-19 in Wuhan peaked at 37,746. In our model, as the epidemic developed, we observed an increasing daily new case rate, and decreasing daily removal rate and ICU rate. This change in rates contributed to the growth in the needs of bed in both isolation wards and ICUs. Assuming a 50% diagnosis rate and 70% public health efficacy, the model based on parameters estimated using data from the day reaching 3200 to the day reaching 6400 cases returned a lowest RMSE. This model predicted 22,613 beds needed in isolation ward and ICU as on the day of RWD peak. Very early SIR model predictions based on early cumulative case data initially underestimated the number of beds needed, but the RMSEs tended to decline as more updated data were used. Very-early-stage SIR model, although simple but convenient and relatively accurate, is a useful tool to provide decisive information for the public health system and predict the trend of an epidemic of novel infectious disease in the very early stage, thus, avoiding the issue of delay-decision and extra deaths.

[Research status on efficacy enhancement and toxicity reduction of Chinese medicine in treatment of malignant tumors: a review of projects supported by National Natural Science Foundation of China].

Through a retrospective analysis of the projects supported by the National Natural Science Foundation of China in the past ten years in the field of Chinese medicine for the treatment of malignant tumors, this article systematically summarized the main research contents and hotspots of Chinese medicine in efficacy enhancement and toxicity reduction. The efficacy enhancement of Chinese medicine mainly included the mitigation of molecule-targeted drug resistance, multidrug resistance, and chemotherapy resistance, synergistic efficacy enhancement, and radiotherapy sensitization. The toxicity reduction is mainly reflected in the alleviation of the side effects of radiotherapy and chemotherapy. In addition, Chinese medicine has advantages in reducing serious adverse reactions of malignant tumors, providing more options for the adjuvant treatment of tumors.

Analysis of a mathematical model with nonlinear susceptibles-guided interventions.

In this paper, we considered a mathematical model describing the nonlinear susceptibles-guided vaccination and isolation strategies, incorporating the continuously saturated treatment. In this strategy, we find that the disease-free periodic solution can always exist, and consequently the control reproduction number can be defined through analyzing the stability of the disease-free periodic solution. Also, we discussed the existence and stability of the positive order-1 periodic solution from two points of view. Initially, we investigated the transcritical and pitchfork bifurcation of the Poincaré map with respect to key parameters, and proved the existence of a stable or an unstable positive order-1 periodic solution near the disease-free periodic solution. For another aspect, by studying the properties of the Poincaré map, we verified the existence of the positive order-1 periodic solution in a large range of the control parameters, especially, we verified the co-existence of finite or infinite countable different positive order-1 periodic solutions. Furthermore, numerical simulations show that the unstable order-1 periodic solution can co-exist with the stable order-1, or order-2, or order-3 periodic solution. The finding implies that the nonlinear susceptibles-triggered feedback control strategy can induce much rich dynamics, which suggests us to carefully choose key parameters to ensure the stability of the disease-free periodic solution, indicating that infectious diseases die out.

A Chinese version of the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale: Reliability and validity assessment in chronically ill patients.

AIMS AND OBJECTIVES: To translate the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale (PPPNBS) into Chinese and to psychometrically test the Chinese version of PPPNBS (PPPNBS-C) in chronically ill patients. BACKGROUND: The growing prevalence and burden of chronic illnesses became the driving force for the need of empowerment as an approach to engage patients in self-management. The PPPNBS was developed to assess patient perceptions of the process of empowerment during hospitalisation. Extending its application to different clinical context and ethnicities is worth pursuing. DESIGN: A cross-sectional survey. METHODS: The PPPNBS was translated according to Brislin's translation guidelines and was culturally adapted. A questionnaire survey was carried out to determine the reliability and validity of the PPPNBS-C among a total of 517 hospitalised patients with chronic illnesses. RESULTS: The content validity was found to be good with a content validity index of 0.94. Exploratory factor analysis identified six factors explaining 68.56% of the total variance and confirmatory factor analysis confirmed this six-factor structure. The hypothesised differences were demonstrated through contrasted group comparisons by time since diagnosis and length of hospital stay. The score of the PPPNBS-C was significantly and positively associated with that of the Client Satisfaction Questionnaire, as was the Self-Efficacy for Managing Chronic Disease 6-Item Scale score, providing evidence of convergent validity. The Cronbach's alpha coefficient was 0.960 and the intraclass correlation coefficient was 0.86 for the total scale, explaining good internal consistency and time stability. CONCLUSIONS: The PPPNBS-C has preliminary verification of the validity and reliability and could be useful in measuring patient perceptions of patient-empowering nurse behaviours. RELEVANCE TO CLINICAL PRACTICE: The PPPNBS-C can be applied to chronically ill patients as a metric of the implementation status of patient-empowering nurse behaviours and can be used as a guide to encourage nurse's intentional utilisation of empowering behaviours.

Parent-child separation: the relationship between separation and psychological adjustment among Chinese rural children.

PURPOSE: The current study aimed to explore the characteristics of psychological adjustment among Chinese left-behind children (LBC) in rural areas, and to examine the association between separation duration from parent/parents (SDP) and children's psychological adjustment and the extent to which personality mediates this hypothesized link. METHODS: We surveyed 534 rural children and adolescents aged 10-17 years at school (440 LBC and 94 non-LBC) in 2013, who were selected for participation using stratified cluster sampling from two counties in Chongqing, China. Measures used included socio-demographic variables, age at the commencement and end of the separation from parents, the revised Chinese Juvenile Eysenck Personality Questionnaire, and the Adolescent Psychological Adaptability Scale. RESULTS: Most children (82.4%) had experienced separation from parents. t test results showed a marginally significant difference (p = .08) in psychological adjustment between LBC (mean = 64.44, SD = 8.62) and non-LBC (mean = 66.16, SD = 9.26). LBC's mean SDP was 5.64 years (SD = 3.90). Correlation analysis showed that children's SDP was negatively associated with psychological adjustment. Structural equation modeling showed that neuroticism, but not extraversion or psychoticism, fully mediated the link between children's SDP and psychological adjustment. CONCLUSION: Personality (neuroticism) is one of the mediating pathways through which long-term SDP may predict poor psychological adjustment among children. Given the detrimental impact of long-term SDP, interventions should target the mediating pathway to buffer against the negative impact of parental separation on the affected rural children and to improve their mental health.

Assessment of phytotoxicity grade during composting based on EEM/PARAFAC combined with projection pursuit regression.

Improper treatment of organic waste may result in environmental pollution and harm to plant growth due to the high concentration of phytotoxin. Composting has widely been used for recycling organic waste and reducing phytotoxin to improve soil properties. Assessing the phytotoxicity grades of compost products is essential for achieving high quality compost to guarantee its marketability. In this study, a technique combined parallel factor (PARAFAC) of excitation-emission matrices (EEMs) spectroscopy with projection pursuit regression (PPR) was applied to improve the sensitivity of phytotoxicity assessment during composting. Results showed that composting reduced the concentration of phytotoxin, and increased the germination index (GI). Composts were divided into four grades based on GI values. Five components containing simple DOM (component C1 and C2) and complex DOM (component C3-C5) were successfully developed by PARAFAC. Correlation analysis between phytotoxicity, chemical indices and fluorescence components demonstrated that C1, C4, complex DOM, and the ratio of simple/complex DOM components were more suitable to assess phytotoxicity of composting products. These results revealed that PARAFAC/PPR enabled a rapid and accurate method to assess the phytotoxicity of compost materials for composting plant.

Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy.

BACKGROUND: The roadmap approach is recommended to guide chronic hepatitis B treatment. We evaluated the cost-effectiveness of various treatment strategies in the global market. METHODS: Lamivudine and telbivudine were tested in roadmap models with switch-to tenofovir if HBV was detectable at week 24 or add-on tenofovir if resistance developed at year 1. Tenofovir and entecavir were tested as continuous monotherapy. In the reference arm, lamivudine was used with add-on tenofovir if resistance developed at year 1. The primary measure of effectiveness was undetectable HBV DNA at year 2. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) in US dollars against the reference arm. RESULTS: In the US and Germany, costs of the reference arms were US $14,486 and US $9,998 for hepatitis B e antigen (HBeAg)-positive and US $11,398 and US $7,531 for HBeAg-negative patients, respectively. In HBeAg-positive patients, the lamivudine roadmap was most cost-effective (ICER US $15,260 in the US and US $29,113 in Germany) with comparable effectiveness (75.1%) to other strategies. In HBeAg-negative patients, tenofovir and entecavir monotherapies were most effective (91-96%) and cost-effective (ICER US $31,297-43,387 in the US and US $53,976-59,822 in Germany). In Asia, where telbivudine cost was lower, both telbivudine and lamivudine roadmaps were cost-effective in HBeAg-positive patients. Tenofovir would be most cost-effective in HBeAg-negative patients if its cost equaled that of telbivudine in Asia. CONCLUSIONS: In HBeAg-positive patients, lamivudine roadmap was most cost-effective; in Asia, telbivudine roadmap had comparable cost-effectiveness to lamivudine roadmap because of the relatively low price of telbivudine. In HBeAg-negative patients, entecavir and tenofovir monotherapies were more cost-effective than the roadmap models.