Caregiver burden among parents of school-age children with asthma: a cross-sectional study.

Objective: To investigate the caregiver burden of parents of school-age children with asthma and analyze the factors influencing their caregiver burden. Methods: A convenience sampling method was used to select 366 parents of school-age children with asthma who visited the outpatient departments of three tertiary hospitals in Sichuan Province, China, from January 2021 to July 2021. A general information questionnaire and the Caregiver Burden Inventory (CBI) were used to assess the current caregiver burden and analyze the influencing factors. Results: The caregiver burden score of parents of school-age children with asthma was 27 (17, 39), with 40.43% of parents experiencing moderate to high levels of burden. Detailed results of univariate analysis showed that there were significant differences in caregiver burden scores based on parents' gender, highest education level, number of children, occupation, family history of asthma, monthly family income, annual medical expenses for the child, child's gender, whether the child had undergone lung function tests, number of emergency visits due to asthma exacerbation in the past 3 months, and whether the child had missed school due to asthma exacerbation in the past 3 months (p < 0.1). Detailed results of multivariate analysis showed that parents' gender, occupation, family history of asthma, monthly family income, annual medical expenses for the child, number of emergency visits due to asthma exacerbation in the past 3 months, and whether the child had missed school due to asthma exacerbation in the past 3 months were independent risk factors for caregiver burden in parents of school-age children with asthma (p < 0.05). Conclusion: Parents of school-age children with asthma experience a certain level of caregiver burden, with over one-third of parents experiencing moderate to high levels of burden. Being a mother, being a worker, having no family history of asthma, having low monthly family income, having high annual medical expenses for the child, having frequent emergency visits due to asthma exacerbation in the past 3 months, and having missed school due to asthma exacerbation in the past 3 months are independent risk factors for caregiver burden in parents of school-age children with asthma, healthcare providers should develop feasible coping strategies, such as paying attention to caregivers' psychological condition to reduce the burden of caring for parents of school-age children with asthma. The entire society should also make efforts in improving social support and strengthening healthcare coverage in order to achieve the aforementioned goals.

Simulating ozone degradation of deoxynivalenol and its bio-safety assessment by mouse model.

Deoxynivalenol (DON), a trichothecene mycotoxin, is one of the most prevalent mycotoxins globally, primarily produced by Fusarium species. DON exposure could cause a range of symptoms, including nausea, vomiting, gastroenteritis, growth retardation, immunosuppression, and intestinal flora disorders in both humans and animals. Recently, ozone degradation technology has been applied for DON control. However, the safety of the contaminated grain after degradation was often ignored. Therefore, the implementation technology for assessing the safety of DON-contaminated grain degradation is of great significance for food safety. In this study, based on previous degradation result of DON, we further studied and assessed the toxicity of corn contaminated with ozone-degrading DON by animal experiments in mice. We simulated feed made from corn contaminated with DON produced by inoculated Fusarium graminearum, which was treated with an ozone aqueous solution. DON treated by ozone could effectively increase the expression of total protein in mice and improve the immune system efficacy. Meanwhile, compared with DON directly-exposed mice, the corn with degrading DON could effectively maintain the level of liver and kidney immune function, and improved growth performance, enterohepatic circulation, and energy metabolism. Our study indicated that the toxicity of fed corn contaminated with degrading-DON decreased significantly after ozone degradation, resulting in a much lower toxicity compared to the DON group, or nontoxicity to some extent. Therefore, we hope that this mouse model could be used as a promising approach for assessing the risk of fungal toxins on metabolism, immunity, and intestinal health.

Assessment of beneficial effects and identification of host adaptation-associated genes of Ligilactobacillus salivarius isolated from badgers.

BACKGROUND: Ligilactobacillus salivarius has been frequently isolated from the gut microbiota of humans and domesticated animals and has been studied as a candidate probiotic. Badger (Meles meles) is known as a "generalist" species that consumes complex foods and exhibits tolerance and resistance to certain pathogens, which can be partly attributed to the beneficial microbes such as L. salivarius in the gut microbiota. However, our understanding of the beneficial traits and genomic features of badger-originated L. salivarius remains elusive. RESULTS: In this study, nine L. salivarius strains were isolated from wild badgers' feces, one of which exhibited good probiotic properties. Complete genomes of the nine L. salivarius strains were generated, and comparative genomic analysis was performed with the publicly available complete genomes of L. salivarius obtained from humans and domesticated animals. The strains originating from badgers harbored a larger genome, a higher number of protein-coding sequences, and functionally annotated genes than those originating from humans and chickens. The pan-genome phylogenetic tree demonstrated that the strains originating from badgers formed a separate clade, and totally 412 gene families (12.6% of the total gene families in the pan-genome) were identified as genes gained by the last common ancestor of the badger group. The badger group harbored significantly more gene families responsible for the degradation of complex carbohydrate substrates and production of polysaccharides than strains from other hosts; many of these were acquired by gene gain events. CONCLUSIONS: A candidate probiotic and nine L. salivarius complete genomes were obtained from the badgers' gut microbiome, and several beneficial genes were identified to be specifically present in the badger-originated strains that were gained in the evolution. Our study provides novel insights into the adaptation of L. salivarius to the intestinal habitat of wild badgers and provides valuable strain and genome resources for the development of L. salivarius as a probiotic.

Impacts of the zero mark-up policy on hospitalization expenses of T2DM and cholecystolithiasis inpatients in SC province, western China: an interrupted time series analysis.

Background: Since 2009, a series of ambitious health system reforms have been launched in China, including the zero mark-up drug policy (ZMDP); the policy was intended to reduce substantial medicine expenses for patients by abolishing the 15% mark-up on drugs. This study aims to evaluate the impacts of ZMDP on medical expenditures from the perspective of disease burden disparities in western China. Method: Two typical diseases including Type 2 diabetes mellitus (T2DM) in internal medicine and cholecystolithiasis (CS) in surgery were selected from medical records in a large tertiary level-A hospital in SC Province. The monthly average medical expenses of patients from May 2015 to August 2018 were extracted to construct an interrupted time series (ITS) model to evaluate the impact of policy implementation on the economic burden. Results: A total of 5,764 cases were enrolled in our study. The medicine expenses for T2DM patients maintained a negative trend both before and after the intervention of ZMDP. It had declined by 74.3 CNY (P < 0.001) per month on average in the pre-policy period and subsequently dropped to 704.4 CNY (P = 0.028) immediately after the policy. The level change of hospitalization expenses was insignificant (P = 0.197), with a reduction of 677.7 CNY after the policy, while the post-policy long-term trend was significantly increased by 97.7 CNY (P = 0.035) per month contrasted with the pre-policy period. In addition, the anesthesia expenses of T2DM patients had a significant increase in the level under the impact of the policy. In comparison, the medicine expenses of CS patients significantly decreased by 1,014.2 CNY (P < 0.001) after the policy, while the total hospitalization expenses had no significant change in level and slope under the influence of ZMDP. Furthermore, the expenses of surgery and anesthesia for CS patients significantly increased by 320.9 CNY and 331.4 CNY immediately after the policy intervention. Conclusion: Our study indicated that the ZMDP has been an effective intervention to reduce the excessive medicine expenses for both researched medical and surgical diseases, but failed to show any long-term advantage. Moreover, the policy has no significant impact on relieving the overall hospitalization burden for either condition.

The Predicament and Outlet of Environmental Impact Assessment Mechanism from the Perspective of Risk Society: Taking Japan's Accident-Type Nuclear Sewage Disposal as a Cut-In.

As an important yardstick of social modernization, nuclear technology not only promotes the in-depth development of the national economy but also hangs a sword of Damocles in the field of the risk society. Against the background of the unrest of the nuclear leakage disaster at the Fukushima nuclear power plant, the Japanese government has announced its unilateral decision to discharge nuclear sewage into the sea, undoubtedly putting at least the Pacific Rim countries at huge potential risks. In order to maximize risk reduction and focus on preventive construction in advance, Japan's measures to discharge accident nuclear sewage into the sea have a legitimate basis for the application of an environmental impact assessment system. At the same time, in the process of operation, there are numerous risk dilemmas, such as lack of safety treatment standards, long follow-up disposal cycle and negative domestic supervision system, which need to be broken through one by one. The effective application of the environmental impact assessment system in the Japanese nuclear accident not only helps to reduce the environmental crisis caused by accidental nuclear effluent discharge to the sea but also has a positive and far-reaching international demonstration significance, which helps to better build a foundation of international trust and preventive guarantee system in advance for the possible accidental nuclear effluent treatment in the future.

Urban Flood Risk Assessment Based on Dynamic Population Distribution and Fuzzy Comprehensive Evaluation.

Floods are one of the most common natural disasters that can cause considerable economic damage and loss of life in many regions of the world. Urban flood risk assessment is important for urban flood control, disaster reduction, and risk management. In this study, a novel approach for assessing urban flood risk was proposed based on the dynamic population distribution, improved entropy weight method, fuzzy comprehensive evaluation method, and the principle of maximum membership, and the spatial distribution of flood risk in four different sessions or daily time segments (TS1-TS4) in the northern part of the Shenzhen River Basin (China) was assessed using geographic information system technology. Results indicated that risk levels varied with population movement. The areas of highest risk were largest in TS1 and TS3, accounting for 7.03% and 7.07% of the total area, respectively. The areas of higher risk were largest in TS2 and TS4, accounting for 4.54% and 4.64% of the total area, respectively. The findings of this study could provide a theoretical basis for assessing urban flood risk management measures in Shenzhen (and even throughout China), and a scientific basis for development of disaster prevention and reduction strategies by flood control departments.

Construction and validation of a revised satisfaction index model for the Chinese urban and rural resident-based basic medical insurance scheme.

BACKGROUND: Quality is the most important factor in satisfaction. However, the existing satisfaction index model of urban and rural resident-based basic medical insurance scheme (SIM_URRBMI) lacks the segmentation of perceived quality elements, it couldn't provide a reference for quality improvement and satisfaction promotion. This study aims to construct a revised SIM_URRBMI that can accurately and detailly measure perceived quality and provide feasible and scientific suggestions for improving the satisfaction of urban and rural residents' basic medical insurance scheme (URRBMI) in China. METHODS: Based on the theoretical framework of the American Customer Satisfaction Index, the elements of perceived quality were refined through literature review and expert consultation, and a pool of alternative measurement variables was formed. A three-stage randomized stratified cluster sampling was adopted. The main decision makers of URRBMI in the families of primary school students in 8 primary schools in Changsha were selected. Both the classic test theory and the item response theory were used for measurement variables selection. The reliability and validity of the model were tested by partial least squares (PLS)-related methods. RESULTS: A total of 1909 respondents who had URRBMI for their children were investigated. The SIM_URRBMI1.0 consists of 11 latent variables and 28 measurement variables with good reliability and validity. Among the three explanatory variables of public satisfaction, perceived quality had the largest total effect (path coefficient) (0.737). The variable with the greatest effect among the five first-order latent variables on perceived quality was the quality of the medical insurance policy (0.472). CONCLUSIONS: The SIM_URRBMI1.0 consists of 28 measurement variables and 11 latent variables. It is a reliable, valid, and standard satisfaction measurement tool for URRBMI with good prediction ability for public satisfaction. In addition, the model provides an accurate evaluation of the perceived quality, which will greatly help with performance improvement diagnosis. The most critical aspects of satisfaction improvement are optimizing the scope and proportion of reimbursement as well as setting appropriate level of deductible and capitation of URRBMI.

Prediction Model Risk-of-Bias Assessment Tool for coronary artery lesions in Kawasaki disease.

Objective: To review and critically appraise articles on prediction models for coronary artery lesions (CALs) in Kawasaki disease included in PubMed, Embase, and Web of Science databases from January 1, 1980, to December 23, 2021. Materials and methods: Study screening, data extraction, and quality assessment were performed by two independent reviewers, with a statistics expert resolving discrepancies. Articles that developed or validated a prediction model for CALs in Kawasaki disease were included. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist was used to extract data from different articles, and Prediction Model Risk-of-Bias Assessment Tool (PROBAST) was used to assess the bias risk in different prediction models. We screened 19 studies from a pool of 881 articles. Results: The studies included 73-5,151 patients. In most studies, univariable logistic regression was used to develop prediction models. In two studies, external data were used to validate the developing model. The most commonly included predictors were C-reactive protein (CRP) level, male sex, and fever duration. All studies had a high bias risk, mostly because of small sample size, improper handling of missing data, and inappropriate descriptions of model performance and the evaluation model. Conclusion: The prediction models were suitable for the subjects included in the studies, but were poorly effective in other populations. The phenomenon may partly be due to the bias risk in prediction models. Future models should address these problems and PROBAST should be used to guide study design.

A cost-effective tsCUT&Tag method for profiling transcription factor binding landscape.

Knowledge of the transcription factor binding landscape (TFBL) is necessary to analyze gene regulatory networks for important agronomic traits. However, a low-cost and high-throughput in vivo chromatin profiling method is still lacking in plants. Here, we developed a transient and simplified cleavage under targets and tagmentation (tsCUT&Tag) that combines transient expression of transcription factor proteins in protoplasts with a simplified CUT&Tag without nucleus extraction. Our tsCUT&Tag method provided higher data quality and signal resolution with lower sequencing depth compared with traditional ChIP-seq. Furthermore, we developed a strategy combining tsCUT&Tag with machine learning, which has great potential for profiling the TFBL across plant development.

Occurrence, fate and risk assessment of per- and polyfluoroalkyl substances in wastewater treatment plants in Shaanxi, China.

Wastewater treatment plants (WWTPs) are considered as major sinks for per- and polyfluoroalkyl substances (PFASs). However, conventional WWTPs with low efficiency are also a secondary point source of PFASs entering the environment. Herein, a large-scale investigation of PFASs was conducted in 44 WWTPs throughout Shaanxi Province in the transitional zone between North and South China. The composition profiles of target PFASs differed between wastewater and sludge samples. Perfluorobutanoic acid was dominant in wastewater influent and effluent samples, with maximum concentrations of 59.8 and 11.4 ng/L, respectively. Perfluorooctane sulfonic acid occurred predominantly in sludge samples, with a maximum concentration of 73.2 ng/g. Through wastewater treatment, short-chain PFASs with an even number of carbon atoms were mostly removed, whereas short-chain PFASs with an odd number of carbon atoms were primarily discharged into receiving water. Long-chain PFASs (perfluoroalkyl carboxylic acids: C ≥ 8; perfluoroalkane sulfonic acids: C ≥ 6) were not removed efficiently and secondary production might occur during treatment. Based on the risk quotient, PFASs residues in wastewater effluent posed minimal ecological risk, but the residues in sludge posed low to high potential risk. The mass loadings of PFASs discharged through wastewater and sludge were 15.5 and 3.74 kg/year, respectively, from all WWTPs in Shaanxi Province.

Spatial distribution and risk assessment of certain antibiotics in 51 urban wastewater treatment plants in the transition zone between North and South China.

The release of antibiotics from WWTPs into the environment has raised increasing concern worldwide. The monitoring of antibiotics in WWTPs throughout a region is crucial for emerging pollutant management. A large-scale survey of the occurrence, distribution, and ecological risk of seven antibiotics in 51 WWTPs was conducted in Shaanxi Province, China. Norfloxacin and ofloxacin had the highest detection concentrations of 474.2 and 656.18 ng L-1, respectively. Antibiotic residues in effluents were decreased by 5.88-94.16 % after different treatment processes. In particular, A2O or mixed processes performed well in removing target antibiotic compounds simultaneously. The ecological risk posed by antibiotic compounds detected in effluents was calculated using the risk quotient (RQ). Norfloxacin, ofloxacin, tetracycline, and roxithromycin posed different levels of potential ecotoxicological risk (RQ = 0.02-7.59). Based on the sum of the RQ values of individual antibiotic compounds, each investigated WWTP showed potential ecological risk. WWTPs with high risk levels were mainly found in the central region, while those in the southern region exhibited low risk levels, and those in the northern region showed risk levels between medium and high. This comprehensive investigation provides promising results to support the safe use and control of antibiotics in the study area.

Microplastics in 48 wastewater treatment plants reveal regional differences in physical characteristics and shape-dependent removal in the transition zone between North and South China.

This study investigated the physical characteristics and removal efficiency of microplastics in wastewater from regions with different climatic conditions and economic development levels. Microplastics with different shapes and sizes were analyzed from the influent and effluent of 48 wastewater treatment plants in three regions of Shaanxi Province (China). Results indicated that the abundance of microplastics in the influent samples was higher in the region with less regional water resources. However, the per capita microplastics emissions was higher in the region with higher economic development level. There were less fibers and more foams and beads in the more developed region. The removal efficiency of microplastics was related to their shape and size. Particularly, the removal efficiency showed a significant negative correlation with the percentage of foams, while it had a significant positive relationship with the proportions of films and fibers. The highest removal efficiency was obtained when the size of microplastics was ranged from 0.5 to 1.0 mm. This study suggests, compared to improving the removal efficiency of microplastics, that reducing the input at source is a more scientific and promising method.

Modeling of ultraviolet propagation from air to human epidermis with wavelength range of 200-300 nm.

Ultraviolet (UV) technology plays an important role in the fields of sterilization, disinfection, and short-range wireless optical communications. In this Letter, a theoretical model to determine the UV radiation intensity (UVRI) on human skin is put forward based on the Monte Carlo method, where the UV wavelength ranges from 200 to 300 nm. Meanwhile, the UVRI evaluation algorithm is provided to reproduce the simulation results. Furthermore, the penetration depth of UV radiation in the human epidermis is investigated, which can be used to assess whether UV radiation causes damage to human health. Simulation results coincide with the existing experimental results that the 222-nm UV radiation is harmless to humans at the given dose of 1.7 mJ/cm2. This work provides theoretical guidelines for the power control of a UV system when humans are in the vicinity.

Ultrasonographic assessment of preoperative gastric volume in patients with dyspepsia: a prospective observational study.

BACKGROUND: Patients undergoing gastroenteroscopy during sedation are prone to aspiration, and most patients with dyspepsia have delayed gastric emptying. This study aimed to investigate the feasibility of measuring the gastric antrum cross-sectional area (CSA) to supply a novel clinical diagnostic reference value in patients with dyspepsia. METHODS: Patients with dyspepsia undergoing elective gastroscopy were included. The Perlas qualitative 0-2 grading scale score was determined before the operation. The anteroposterior diameter (D1) and craniocaudal diameter (D2) between gastric antrum serosal surfaces were measured perpendicular to each other in the supine and right lateral decubitus (RLD) positions. CSA values in the supine position and RLD position were determined. Gastric contents were endoscopically suctioned with the volumes measured and noted as actual gastric volume. Multiple regression analysis was used to fit a mathematical model for estimating the gastric volume. Receiver operating characteristic (ROC) curves were constructed to determine the accuracy of RLD CSA to detect gastric volumes of > 0.8 ml/kg. RESULTS: A total of 117 patients were enrolled and divided into a functional dyspepsia (FD) group and an organic dyspepsia group according to gastroscopy findings. For a gastric volume of > 0.8 ml/kg, cut-off values for FD and organic dyspepsia were 6.7 cm2 and 10.0 cm2, respectively. Two new modified mathematical models were derived to predict an estimated gastric volume for FD and organic dyspepsia: volume = 3.93 × RLD CSA - 0.47 × age; and volume = 6.15 × RLD CSA - 0.61 × age. CONCLUSION: We used the cut-off value of the antral area for the fast diagnosis of gastric volumes in patients with dyspepsia, which may assist clinicians in identifying patients at risk of aspiration. TRIAL REGISTRATION: www.chictr.org.cn ( CHICTR-DDD-17010871 ); registered 15 March 2017.

The Global Burden of Disease attributable to low physical activity and its trends from 1990 to 2019: An analysis of the Global Burden of Disease study.

Introduction: Low physical activity (LPA) is associated with several major non-communicable diseases (NCDs) and premature mortality. In this study, we aimed to assess the global burden and trends in disease attributable to LPA (DALPA) from 1990 to 2019. Methods: Annual age-standardized disability-adjusted life years (DALYs) and death rates of DALPA [all-cause and five specific causes (ischaemic heart disease, diabetes mellitus, stroke, colon and rectal cancer, and breast cancer)] by sex, age, geographical region and social deprivation index (SDI) score from 1990 to 2019 were available from the Global Burden of Disease (GBD) study 2019. The estimated annual percentage changes (EAPCs) were calculated to quantify the changing trend. A generalized linear model (GLM) was used to explore the relationship between DALYs/death rates of DALPA and sociodemographic factors. Results: Globally, in 2019, the age-standardized DALYs and death rates of DALPA were 198.42/100,000 (95% UI: 108.16/100,000-360.32/100,000) and 11.10/100,000 (95% UI: 5.66/100,000-19.51/100,000), respectively. There were 15.74 million (8.51-28.61) DALYs and 0.83 million (0.43-1.47) deaths attributable to LPA. Overall, age-standardized DALYs and death rates presented significant downward trends with EAPCs [-0.68% (95% CI: -0.85- -0.50%) for DALYs and -1.00% (95% CI: -1.13- -0.86%) for deaths] from 1990 to 2019. However, age-standardized DALYs and death rates of diabetes mellitus attributable to LPA were substantially increased [EAPC: 0.76% (95% CI: 0.70-0.82%) for DALYs and 0.33% (95% CI: 0.21-0.51%) for deaths]. In the 15-49 age group, DALPA presented significant upward trends [EAPC: 0.74% (95% CI: 0.58-0.91%) for DALYs and 0.31% (95% CI: 0.1-0.51%) for deaths]. The GLM revealed that higher gross domestic product and current health expenditure (% of GDP) were negatively associated with DALYs and death rates of DALPA. Conclusion: Although global age-standardized DALYs and death rates of DALPA presented downward trends, they still cause a heavy burden worldwide. These rates showed upward trends in the diabetic and 15-49 age groups, which need more attention and health interventions.

Feasibility study of cumulative sum (CUSUM) analysis as a competency assessment tool for ultrasound-guided venous access procedures.

PURPOSE: Typically, physician training programs use a self-reported case-log competency assessment that does not measure procedure success or objectively assess competency. Cumulative sum (CUSUM) analysis could provide objective assessments of competency and progress over the training period. Our study objective was to determine the feasibility of CUSUM analysis to assess competency of ultrasound-guided peripheral intravenous (USG-PIV) line placement in pediatric anesthesiology fellows. METHODS: We applied a CUSUM analysis to assess competency in USG-PIV placement in three consecutive pediatric anesthesia fellowship classes. After a didactic and hands-on training session, fellows placed a USG-PIV line and self-reported the outcomes via a web-based application. Fellows were deemed competent if the CUSUM curve crossed two consecutive boundary lines from above. RESULTS: Twenty-nine fellows reported 1,388 USG-PIV attempts, with 74% success. Most fellows (26/29; 90%) achieved competency by the end of the fellowship. Two fellows identified in the mid-year CUSUM as not progressing towards competency achieved competency after targeted interventions. Fellows achieving competency (11/29 vs 25/29; odds ratio, 15; 95% confidence interval [CI], 1.98 to 113.56; P = 0.01) and attempts needed to achieve competency (19 vs 11; mean difference, 8.5; 95% CI, 3.3 to 13.7; P = 0.002) were significantly lower in younger patients and significantly higher in older patients. CONCLUSION: Our study showed that CUSUM can be used to assess competence in USG-PIV procedures performed by pediatric anesthesia fellows and to identify learners not progressing toward competency in procedural skills. Ultrasound-guided venous access required more attempts to achieve competency in younger patients.

RéSUMé: OBJECTIF: En règle générale, les programmes de formation des médecins se fondent sur une évaluation autodéclarée des compétences dans un registre des cas qui ne mesure pas la réussite de l'intervention et n'évalue pas objectivement la compétence. L'analyse du cumul des écarts (CUSUM - pour CUmulative SUM) pourrait fournir des évaluations objectives des compétences et des progrès au cours de la période de formation. L'objectif de notre étude était de déterminer la faisabilité d'une analyse CUSUM pour évaluer la compétence pour le positionnement du cathéter intraveineux périphérique échoguidé (CIP-écho) des fellows en anesthésiologie pédiatrique. MéTHODE: Nous avons appliqué une analyse CUSUM pour évaluer la compétence pour le positionnement du CIP-écho de trois classes consécutives de fellows en anesthésie pédiatrique. Après une séance de formation didactique et pratique, les fellows ont placé un cathéter CIP-écho et ont déclaré eux-même les résultats via une application Web. Les fellows étaient jugés compétents si la courbe CUSUM franchissait deux lignes de démarcation consécutives à partir du haut. RéSULTATS: Vingt-neuf fellows ont rapporté 1388 tentatives de CIP-écho, avec un taux de réussite de 74 %. La plupart des fellows (26/29; 90 %) ont acquis la compétence à la fin de leur fellowship. Deux fellows identifiés dans l'analyse CUSUM de mi-année comme ne progressant pas vers la compétence sont parvenus à l'acquérir après des interventions ciblées. Les fellows acquérant cette compétence (11/29 vs 25/29; rapport de cotes, 15; intervalle de confiance [IC] à 95 %, 1,98 à 113,56; P = 0,01) et les tentatives nécessaires pour acquérir la compétence (19 vs 11; différence moyenne, 8,5; IC 95 %, 3,3 à 13,7; P = 0,002) étaient significativement plus basses avec des patients plus jeunes et significativement plus élevés chez les patients plus âgés. CONCLUSION: Notre étude a montré qu'une analyse CUSUM pouvait être utilisée pour évaluer la compétence pour les procédures de CIP-écho réalisées par des fellows en anesthésie pédiatrique et pour identifier les apprenants qui ne progressent pas vers la compétence en habiletés opératoires. L'accès veineux échoguidé a nécessité davantage de tentatives pour atteindre la compétence chez les patients plus jeunes.

Assessment of the antimicrobial effects of sodium hypochlorite on Enterococcus faecalis by D2O-labeled single-cell Raman micro-spectroscopy.

OBJECTIVES: To systematically evaluate the feasibility of D2O-labeled single-cell Raman micro-spectroscopy in drug resistance research and test the susceptibility of Enterococcus faecalis (E. faecalis)to sodium hypochlorite. METHODS: 1) The growth of E. faecalis in different doses of D2O and the regularity of D2O intake were evaluated through absorbance measurement and D2O-labeled single-cell Raman micro-spectroscopy to examine the universality of D2O-labeled single-cell Raman micro-spectroscopy in bacterial resistance research. 2) Broth dilution method and absorbance measurement were performed to determine the minimum inhibitory concentration (MIC) of NaClO against E. faecalis and the MIC based on metabolic activity (MIC-MA) in vitro via D2O-labeled single-cell raman micro-spectroscopy. RESULTS: 1) The growth of E. faecalis was not significantly inhibited by ≤40% D2O in the medium. E. faecalis could actively metabolize D2O and exhibit a C-D ratio in specific areas of Raman micro-spectroscopy results. The C-D ratio of E. faecalis at the stationary phase was positively correlated with D2O concentration. 2) The MIC and MIC-MA of NaClO against E. faecalis were 0.45 and 0.9 g·L-1, respectively. The concentration of MIC-MA was twice that of MIC. CONCLUSIONS: D2O-labeled single-cell Raman micro-spectroscopy is important in screening antimicrobial agents and evaluating the efficacy of antimicrobial agents. It is suitable for evaluating the effect of drugs on bacterial metabolic activities. NaClO showed an effective antimicrobial activity against E. faecalis. E. faecalis ceased propagation yet remained highly metabolically active when it was exposed to NaClO at the MIC level. The metabolic activity of most cells was inhibited only when they were exposed to NaClO at the MIC-MA level.

Recycling diagnostic MRI for empowering brain morphometric research - Critical & practical assessment on learning-based image super-resolution.

Preliminary studies have shown the feasibility of deep learning (DL)-based super-resolution (SR) technique for reconstructing thick-slice/gap diagnostic MR images into high-resolution isotropic data, which would be of great significance for brain research field if the vast amount of diagnostic MRI data could be successively put into brain morphometric study. However, less evidence has addressed the practicability of the strategy, because lack of a large-sample available real data for constructing DL model. In this work, we employed a large cohort (n = 2052) of peculiar data with both low through-plane resolution diagnostic and high-resolution isotropic brain MR images from identical subjects. By leveraging a series of SR approaches, including a proposed novel DL algorithm of Structure Constrained Super Resolution Network (SCSRN), the diagnostic images were transformed to high-resolution isotropic data to meet the criteria of brain research in voxel-based and surface-based morphometric analyses. We comprehensively assessed image quality and the practicability of the reconstructed data in a variety of morphometric analysis scenarios. We further compared the performance of SR approaches to the ground truth high-resolution isotropic data. The results showed (i) DL-based SR algorithms generally improve the quality of diagnostic images and render morphometric analysis more accurate, especially, with the most superior performance of the novel approach of SCSRN. (ii) Accuracies vary across brain structures and methods, and (iii) performance increases were higher for voxel than for surface based approaches. This study supports that DL-based image super-resolution potentially recycle huge amount of routine diagnostic brain MRI deposited in sleeping state, and turning them into useful data for neurometric research.

Functional photoacoustic/ultrasound imaging for the assessment of breast intraductal lesions: preliminary clinical findings.

This study aimed to identify features of breast intraductal lesions in photoacoustic/ultrasound (PA/US) imaging and compare PA/US with color Doppler flow/ultrasound (CDFI/US) in the evaluation of breast intraductal lesions. In the nine patients with 10 breast intraductal lesions and 8 patients with 8 benign lesions, total vessel scores evaluated from PA/US are significantly greater than those from CDFI/US (p=0.005). PA internal vessel scores and oxygen saturation (SO2) score are significantly increased in breast intraductal lesions than in benign lesions (p=0.016, p=0.006). With a cutoff PA score (sum of PA internal vessel score and SO2 score) of 2.5, we obtained a sensitivity of 90% and a specificity of 87.5% in differentiation of two groups. PA/US upgraded 40% of breast intraductal lesions, and downgraded 50% of benign lesions from the Breast Imaging Reporting and Data System grading results based on CDFI/US. PA/US functional imaging has the potential in differentiating breast intraductal lesions.

Use of a gentamicin-citrate lock leads to lower catheter-related bloodstream infection rates and reduced cost of care in hemodialysis patients.

INTRODUCTION: Central venous catheters (CVC) are a major contributor to infections in hemodialysis (HD) patients, leading to high morbidity and mortality. Gentamicin-citrate (GC) lock is used as standard of care at centers belonging to a mid-size dialysis organization. Four outpatient HD centers acquired by the organization continued to use heparin for catheter locks for a period of time before converting to the provider's standard of using GC lock. METHODS: In this retrospective observational study, we included patients receiving HD by CVC at these four centers. We report rates of CVC-related bloodstream infections (CVC-BSI) during the heparin lock and the GC lock periods; crude rate ratios and adjusted rate ratios using Cox survival analyses adjusting for potential confounders; microbiology patterns; safety signals (gentamicin resistance, hospitalizations and deaths); and financial impact on payer. FINDINGS: A total of 220 and 281 patients used tunneled CVCs, accounting for 25,245 and 44,550 catheter days in the heparin and the GC lock periods, respectively. CVC-BSI event rates were 66% lower in the GC lock period (CVC-BSI event rate: 0.20 per 1000 catheter-days) than the heparin lock period (rate: 0.59 per 1000 catheter days); rate ratio 0.34 (95% confidence interval (CI) 0.15-0.78, P = 0.01). In the fully adjusted multivariable Cox model, use of GC lock was associated with 70% reduction in CVC-BSI events (HR 0.30, 95% CI 0.12-0.72, P = 0.01). No increased risk of gentamicin resistance, hospitalizations, or death associated with use of GC lock were observed. Use of GC lock was associated with an estimated saving of $1533 (95% CI: $259-$4882) per patient per year. DISCUSSION: Use of GC lock led to significant reductions in CVC-BSIs with no signal for harm, and is associated with significant cost savings in dialysis care.