Personal mastery and quality of life in patients with atrial fibrillation after radiofrequency ablation: The mediating role of health promoting behavior.

BACKGROUND: Improving quality of life is vital for patients with atrial fibrillation (AF) after radiofrequency ablation. Quality of life can be affected not only by personal mastery but also by health promoting behavior as previously studied. However, it remains unclear whether health promoting behavior mediates the relationship between personal mastery and quality of life. OBJECTIVES: To explore whether health promoting behavior mediates the relationship between personal mastery and quality of life in patients with AF after radiofrequency ablation. METHODS: A cross-sectional design and convenience sampling were conducted at a tertiary hospital in China. Self-reported questionnaires were used to assess personal mastery, health promoting behavior and quality of life. SPSS and AMOS software were used for statistical analysis. RESULTS: A total of 202 patients with AF after radiofrequency ablation were enrolled (mean age 58.28 ± 12.70 years). The scores for personal mastery and quality of life were 22.52 ± 2.53 points and 62.58 ± 8.59 points, respectively, indicating a limited level. The health promoting behavior exhibited a moderate level, with scores averaging 103.82 ± 8.47 points. There was a positive correlation between the three variables (all P < 0.05). Health promoting behavior played a partial mediating role in the relationship between personal mastery and quality of life in patients with AF after radiofrequency ablation, accounting for 44.79 % of the total effect. CONCLUSIONS: In order to improve quality of life and prognosis, it is necessary to consider enhancing personal mastery and increasing patient compliance with health promoting behavior, which are important ways to improve their quality of life.

[Carbon Reduction Analysis of Life Cycle Prediction Assessment of Hydrogen Fuel Cell Vehicles：Considering Regional Features and Vehicle Type Differences].

As one of the important paths for China to achieve the "dual carbon" strategy， developing hydrogen fuel cell vehicles is currently being promoted in various regions across the country， including passenger cars， coaches， and heavy-duty trucks. Quantifying the carbon reduction potential of hydrogen fuel cell vehicles for different vehicle types and regions has become a hot research topic. Using a life cycle assessment method that considers future vehicle fuel economy， power generation carbon emission factors， hydrogen production carbon emission factors， and regional differences in the scale and hydrogen production methods， this study quantitatively evaluated the life cycle carbon emissions of different types of vehicles， including fuel cell vehicles （FCV）， traditional fuel vehicles （ICEV）， and battery electric vehicles （BEV）. We compared and analyzed the carbon reduction potential of hydrogen fuel cell vehicles at different times and in different regions and conducted an uncertainty analysis on hydrogen consumption per hundred kilometers. The results showed that by 2025， the life cycle carbon emissions of hydrogen fuel cell coaches would decrease by 36.0% compared to that of traditional fuel coaches， but the reduction in carbon emissions for hydrogen fuel cell heavy-duty trucks was not significant. By 2035， as the hydrogen energy source structure in China continues to improve， the life cycle carbon emissions of hydrogen fuel cell heavy-duty trucks were predicted to decrease by 36.5% compared to that of traditional fuel heavy-duty trucks. The decarbonization potential was most significant for heavy-duty trucks compared to that of passenger cars and coaches. Taking the Beijing-Tianjin-Hebei demonstration group as an example in 2035， as the hydrogen consumption per hundred kilometers decreases by 20%， the carbon reduction potential of FCV passenger cars， coaches， and heavy-duty trucks would increase by 7.29%， 9.93%， and 19.57%， respectively. Therefore， it is recommended to prioritize the promotion of hydrogen fuel cell coaches in the short term， heavy-duty trucks in the long term， and passenger cars as a supplement. Promoting hydrogen fuel cell vehicles in different regions and stages will help advance the low-carbon development of the automotive industry in China.

Individual-level socioeconomic status and cataract-induced visual disability among older adults in China: the overview and urban-rural difference.

Objective: To investigate the prevalence of cataract-induced visual disability and its association with individual-level socioeconomic status (SES) among older adults in China. Methods: Using the data of 354,743 older adults (60 years and older) from the Second China National Sample Survey on Disability in 2006. Cross-sectional study design was applied. The differences in visual disability prevalence of cataracts among sociodemographic subgroups were analyzed by the chi-square test, and the association between individual-level SES and cataract-induced visual disability was investigated by the multivariate logistic regression model. Results: The weighted visual disability prevalence of cataracts was 4.84% in 2006. Older people with a higher household income per capita (OR = 0.83, 95% CI: 0.81-0.85), higher education level (primary school vs. illiteracy: OR = 0.80, 95% CI: 0.76-0.83; ≥undergraduate college vs. illiteracy: OR = 0.31, 95% CI: 0.25-0.39), and occupation (OR = 0.53, 95% CI: 0.50-0.56) were less likely to suffer from cataract-induced visual disability. Household income per capita and education level increase played a greater role in decreasing the risk of visual disability caused by cataracts in urban areas, while having occupation contributed more to reducing the risk of disability in rural areas. Conclusion: The gap in individual-level SES is closely related to the visual health inequities among older Chinese people and there are two distinct mechanisms in rural and urban areas. Strategies to promote collaborative healthcare development regionally, strengthen safeguards for disadvantaged groups, and increase public awareness of visual disability prevention are warranted.

An early screening model for preeclampsia: utilizing zero-cost maternal predictors exclusively.

To provide a reliable, low-cost screening model for preeclampsia, this study developed an early screening model in a retrospective cohort (25,709 pregnancies) and validated in a validation cohort (1760 pregnancies). A data augmentation method (α-inverse weighted-GMM + RUS) was applied to a retrospective cohort before 10 machine learning models were simultaneously trained on augmented data, and the optimal model was chosen via sensitivity (at a false positive rate of 10%). The AdaBoost model, utilizing 16 predictors, was chosen as the final model, achieving a performance beyond acceptable with Area Under the Receiver Operating Characteristic Curve of 0.8008 and sensitivity of 0.5190. All predictors were derived from clinical characteristics, some of which were previously unreported (such as nausea and vomiting in pregnancy and menstrual cycle irregularity). Compared to previous studies, our model demonstrated superior performance, exhibiting at least a 50% improvement in sensitivity over checklist-based approaches, and a minimum of 28% increase over multivariable models that solely utilized maternal predictors. We validated an effective approach for preeclampsia early screening incorporating zero-cost predictors, which demonstrates superior performance in comparison to similar studies. We believe the application of the approach in combination with high performance approaches could substantially increase screening participation rate among pregnancies. Machine learning model for early preeclampsia screening, using 16 zero-cost predictors derived from clinical characteristics, was built on a 10-year Chinese cohort. The model outperforms similar research by at least 28%; validated on an independent cohort.

Recycling alkali lignin-derived biochar with adsorbed cadmium into cost-effective CdS/C photocatalyst for methylene blue removal.

Cadmium (Cd)-enriched adsorbents wastes possess great environmental risk due to their large-scale accumulation and toxicity in the natural environment. Recycling spent Cd-enriched adsorbents into efficient catalysts for advanced applications could address the environmental issues and attain the carbon neutral goal. Herein, a facile strategy is developed for the first time to reutilize the alkali lignin (AL)-derived biochar (ALB) absorbed with Cd into cadmium sulphide (CdS)/C composite for the efficient methylene blue (MB) removal. The ALB is initially treated with Cd-containing solution, then the recycling ALB samples with adsorbed Cd are converted to the final CdS/C composite using NaS2 as the sulphurizing reagent for vulcanization reaction. The optimal ALB400 demonstrates a high adsorption capacity of 576.0 mg g-1 for Cd removal. Then the converted CdS/C composite shows an efficient MB removal efficiency of 94%. The photodegradation mechanism is mainly attributed to carbon components in the CdS/C composite as electron acceptor promoting the separation of photoelectrons/holes and slowing down the abrasion of CdS particles. The enhanced charge transfer and contact between the carrier and the active site thus improves the removal performance and reusability. This work not only develops a method for removing Cd from wastewater effectively and achieving the waste resource utilization but also further offers a significant guidance to use other kinds of spent heavy metal removal adsorbents for the construction of low-cost and high value-added functional materials.

How does the location of high-speed railway stations affect the emission reduction effect of industrial structure upgrading?

The opening of high-speed railway (HSR) has accelerated the reorganization and reallocation of regional production elements, and constantly promoted the adjustment and upgrading of industrial structure. The cleaner production effect produced by industrial structure upgrading is of great significance to industrial pollution reduction. As a bridge connecting resources within the city and elements outside the city, the location of HSR stations has become an important factor affecting the structural emission reduction effect. Based on the data of 285 prefecture level and above cities in China from 2004 to 2018, this paper investigates the structural emission reduction effects of HSR opening and the impact of HSR station location on it by employing difference-in-differences (DID) model combined with mediation effect method. The results demonstrate that the opening of HSR has significant structural emission reduction effect, and the upgrading of inter-industry structure and the intra-industry structure are important mechanisms for HSR to achieve industrial emission reduction. The structural emission reduction effect of HSR opening is closely related to the location of HSR stations. With the increase of the distance between HSR station and city center, the industrial structure upgrading effect will continue to weaken, thus inhibiting the exertion of structural emission reduction effect, of which 10 km away from the city center is the optimal site strategy for the HSR service to give full play to the structural emission reduction effect, and exceeding 50 km will be significantly detrimental to its role in promoting industrial structure upgrading.

Low-dose decitabine for previously untreated acute myeloid leukemia ineligible for intensive chemotherapy aged 65 years or older: a prospective study based on comprehensive geriatric assessment.

Background: The outcome of patients with acute myeloid leukemia (AML) aged ⩾65 years is poor. Effective treatment options are limited for patients with AML who cannot tolerate intensive chemotherapy. Objectives: We aimed to evaluate the efficacy of low-dose decitabine in previously untreated patients with AML aged ⩾65 years who were ineligible for intensive chemotherapy based on a comprehensive geriatric assessment. Design: We performed a prospective, multicenter, open-label, and non-randomized study. Methods: Patients were enrolled at four centers in Beijing between 1 January 2017 and 31 December 2020. They were treated with decitabine at a dose of 6 mg/m2 for 10 days. The treatment was repeated every 28 days for one cycle for a total of six cycles. The primary endpoint of our study was overall survival (OS) at the end of the first year after enrolment. The secondary endpoints included overall response rate, leukemia-free survival, relapse rate, treatment-related mortality (TRM), quality of life, safety, and transfusion dependence. Patients were continuously monitored for toxicity. Results: Overall, 47 patients (30 males and 17 females) participated in this study. The median age of the enrolled patients was 78 (range, 65-90) years. The median follow-up time was 22.2 (range, 4.6-38.8) months. Fifteen (31.9%) patients achieved complete remission (CR), 11 (23.4%) patients achieved partial remission, 3 (6.4%) patients achieved hematological improvement only, and 18 (38.3%) patients did not achieve remission. The median time to obtain CR was 2 months. The median CR was 8.5 months. Of the patients, 36 (76.6%) patients completed six cycles of treatment with low-dose decitabine, and the 1-year OS was 36.1%. According to instrumental activities of daily living scales, age, comorbidities, and albumin (IACA) scores, the median survival was 11.2 months in the unfit group and 6 months in the frail group. The 1-year OS rates in the unfit and frail groups were 49.2% and 23.4%, respectively. Grade ⩾3 non-hematological toxicity was observed in 70.2% (33/47) of the patients. TRM occurred in three patients. No early deaths occurred after treatment. Conclusion: In newly diagnosed older patients with AML whose IACA assessment was unfit or frail for standard chemotherapy, treatment with low-dose decitabine demonstrated clinical activity and good security in our study.

[Life Cycle Prediction Assessment of Energy Saving and New Energy Vehicles for 2035].

The development of energy saving and new energy vehicles is an important technology path to reduce carbon emissions for the transportation industry. To quantitatively predict the life cycle carbon emissions of energy saving and new energy vehicles, this study used the life cycle assessment method and selected the fuel economy level, lightweight level, carbon emission factor of electricity structure, and carbon emission factor of hydrogen production as key performance parameters to establish inventories of internal combustion engine vehicles (ICEV), mild hybrid electrical vehicles (MHEV), heavy hybrid electrical vehicles (HEV), battery electrical vehicles (BEV), and fuel cell vehicles (FCV) based on automotive-related policy and technical routes. The sensitivity of carbon emission factors of electricity structure and different hydrogen production methods were analyzed and discussed. The results showed that the current life cycle carbon emissions (CO2 equivalent) of ICEV, MHEV, HEV, BEV, and FCV were 207.8, 195.2, 149.9, 113.3, and 204.7 g·km-1, respectively. By 2035, BEV and FCV were predicted to have a significant reduction of 69.1% and 49.3%, respectively, compared with ICEV. The carbon emission factor of electricity structure had the most significant influence on BEV life cycle carbon emissions. In terms of different hydrogen production methods of FCV, hydrogen demand should be mainly supplied by industrial hydrogen by-product purification in the short-term future, whereas hydrogen energy production by water electrolysis and hydrogen production from fossil energy combined with carbon capture, utilization, and storage technology should be used to meet the hydrogen demand of FCV in the long-term future, so as to achieve a significant improvement in the life cycle carbon reduction benefits of FCV.

Derivation of copper water quality criteria in Bohai Bay for the protection of local aquatic life and the ecological risk assessment.

Developing effective marine water quality criteria (WQC) is crucial for controlling marine contamination and protecting marine life. The WQC for copper is urgently needed due to the toxicity and widespread of copper contamination. In this work, both short-term water quality criteria (SWQC) and long-term water quality criteria (LWQC) under 10 % effect endpoints were derived by using the model averaging of species sensitivity distribution (SSD10) method for Bohai Bay. The WQC values were obtained directly from the hazardous concentration for 5 % of species (HC5) values, which removes the influence of arbitrary assessment factor (AF). Modifications to the acute-chronic ratio (ACR) strategies and the inclusion of the test toxicity data of local species also improved the accuracy and applicability of the WQC values. The derived SWQC and LWQC were 2.21 and 0.45 µg/L, respectively. Furthermore, the overall risk level of copper in Bohai Bay was evaluated by using the risk quotient (RQ) method, and the results showed it was at a moderate-low level. This study provides a new approach for the derivation of the WQC for Cu and the risk assessment of Bohai Bay, which is essential for the protection of local aquatic life and provides guidance to the establishment of the national WQC.

Transthoracic echocardiographic assessment of cardiac valves in patients with Behçet's disease.

The main objectives of the current study are to investigate valvular involvement in patients with cardiac Behçet's disease (BD) and find out the risk factors of valvular involvement in cardiac BD. We retrospectively assessed the clinical and echocardiographic data in the medical records of 121 patients with BD admitted to Beijing Anzhen Hospital from January 2015 to January 2022. We evaluated the valvular structure and function mainly by echocardiography. A total of 77 BD patients (77/121, 63.64%) had cardiac valvular involvement. Valvular lesions occurred more frequently in males (p = 0.022). Aortic regurgitation (AR) (62/77, 80.52%) was the most common finding and severe AR occupied 80.65% (50/62). The most common manifestations of BD patients with severe AR was aortic valve prolapse (25/50, 50%), followed by echo-free spaces within the aortic annulus (11/50, 22%), vegetation-like lesions (10/50, 20%), and aortic root aneurysm (10/50, 20%). The incidence of paravalvular leaks (PVL) in BD patients was 14.29% (7/49). The diameter of the sinus of Valsalva and proximal ascending aorta, and total cholesterol (TCHO) were the independent risk factors of moderate-severe aortic valvular regurgitation (p < 0.01). Left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) were significantly associated with moderate-severe mitral valvular regurgitation (p < 0.01). The most common valvular abnormality in BD is AR. Echocardiography has great value in the comprehensive evaluation and accurate diagnosis of valvular involvement in BD patients.

Does basic medical insurance promote public health? Evidence from China family panel study.

Background: To promote common prosperity, China government has devoted much financial resources to the basic medical insurance system, it is of great significance to improve the health level of the insured groups to prevent them from returning to poverty due to illness. Whether or not the basic medical insurance can improve health status is an important policy issue after China has win the absolute poverty alleviation movement. Methods: Based on the data of China Family Panel Studies this paper constructs a strong balanced panel data with two levels information, which including variables from family level and personal level. This paper uses the panel data fixed effect model and propensity score matching model to analysis. Results: This paper finds that after controlling the family and personal confounding variables, the basic medical insurance has positive effect toward health status. With propensity score matching model, this paper finds that there is causality between basic medical insurance and public health. Conclusion: Basic medical insurance has a significant health effect, that is, basic medical insurance has a significant positive impact on individual self-rated health. Participating in basic medical insurance can significantly improve the ability of families to face risk shocks, promote the accumulation of health capital in families, promote the diversification of livelihood strategies, and effectively prevent the occurrence of returning to poverty due to illness.

Complex ecological and socioeconomic impacts on medicinal plant diversity.

Medicinal plant diversity (MPD) is an important component of plant diversity. Over-collection based on medicinal and economic value has the potential to damage the stability of the regional ecosystem. It is important to understand the current distribution of MPD and the factors influencing it. However, it is still unclear whether environmental and socioeconomic conditions have an impact on their distribution. We selected the Inner Mongolia as a representative study area which covers a wide area, accounting for 12.29% of China's national land area and 0.79% of the world's land area. At the same time, the region is a long-standing traditional medicinal area for Mongolians in China. Therefore, the region is significantly influenced by changes in environmental factors and socio-economic factors. We used 9-years field survey of the distribution of medicinal plants in Inner Mongolia for assessing the distribution of MPD as influenced by environmental and socioeconomic activities by combining spatial analyses, species distribution models, and generalized additive models. The results from the spatial analysis show that the western region of Inner Mongolia is the main cold spot area of the MPD, and the central-eastern and northeastern regions of Inner Mongolia are the main hot spot areas of the MPD. At the same time, the distribution of cold spots and hot spots of MPD is more obvious at large spatial scales, and with the refinement of spatial scales, the cold spots in scattered areas are gradually revealed, which is indicative for the conservation and development of MPD at different spatial scales. Under the future climate change of shared socioeconomic pathways (SSP), areas with high habitat suitability for medicinal plants remain mainly dominated by the Yellow River, Yin Mountains, and Greater Khingan Range. Notably, the SSP245 development pathway remains the most significant concern in either long- or short-term development. The nonlinear relationship between the driving factors of MPD at different spatial scales shows that temperature, precipitation and socioeconomic development do have complex effects on MPD. The presence of a certain temperature, altitude, and precipitation range has an optimal facilitation effect on MPD, rather than a single facilitation effect. This complex nonlinear correlation provides a reference for further studies on plant diversity and sustainable development and management. In this study, the spatial distribution of medicinal plant resources and the extent to which they are driven by ecological and socioeconomic factors were analyzed through a macroscopic approach. This provides a reference for larger-scale studies on the environmental and socioeconomic influences on the distribution of plant resources.

Economic Evaluation of Transcatheter Aortic Valve Replacement Compared to Surgical Aortic Valve Replacement in Chinese Intermediate-Risk Patients.

Background: Aortic stenosis (AS) is a severe disease that causes heart failure and sudden death. Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are both recommended for patients with intermediate surgical risk, but the cost-effectiveness of TAVR compared to SAVR in China has not been investigated. Methods: A combined decision tree and Markov model were conducted to compare the cost-effectiveness of TAVR versus SAVR with a 5-year simulation. The primary outcome was the incremental cost-effectiveness ratio (ICER), a ratio of incremental costs to incremental quality-adjusted life-year (QALY). One-way sensitive analysis and probabilistic sensitivity analysis (PSA) were conducted to test the robustness of the model. Results: After a simulation of 5 years, the costs of TAVR and SAVR were 54,573 and 35,002 USD, respectively, and the corresponding effectiveness was 2.826 versus 2.712 QALY, respectively. The ICER for the TAVR versus SAVR comparison was 170,056 USD/QALY, which was three times higher than the per capita gross domestic product (GDP) in China. One-way sensitive analysis showed that the cost of the TAVR device impacted the ICER. The TAVR could be cost-effective only in the case where its cost is lowered to 29,766 USD. Conclusion: TAVR is currently not cost-effective in China, but it could be cost-effective with a reduction of costs to 29,766 USD, which is approximately 65% of the current price.

Reliability and Validity of the Repeatable Battery for Assessment of Neuropsychological Status Scale in Evaluation of Vascular Cognitive Impairment in Elderly Han Population.

Introduction: Vascular cognitive impairment (VCI) and Alzheimer's disease are the most common cognitive impairment diseases in the elderly. This study aimed to apply the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) scale to evaluate VCI in elderly patients and analyze its reliability and validity. Methods: We enrolled 278 VCI patients admitted to our hospital, from June 2017 to June 2018. The basic clinical information of each patient was documented, and the Mini-Mental State Examination (MMSE) and the RBANS scales were suggested to complete. Results: We found significant correlations between the RBANS total score and age, diabetes, hypertension, coronary heart disease and years of education. The internal consistency of the RBANS scale Cronbach αsuggested a good agreement with the total score and the single score at two time points. Moreover, the RBANS total score and the score of each dimension in the RBANS scale were positively correlated with the MMSE immediate memory, calculation ability, delayed memory, commanding ability, reading comprehension ability, command execution, sentence making, and pattern duplicating ability. Conclusion: In conclusion, the RBANS has good reliability and validity for the assessment of cognitive dysfunction in elderly VCI patients. It can be used as a routine clinical and research tool, for the simplicity in operation and superior acceptance.

The burden and trend of gastric cancer and possible risk factors in five Asian countries from 1990 to 2019.

The burdens and trends of gastric cancer are poorly understood, especially in high-prevalence countries. Based on the Global Burden of Disease Study 2019, we analyzed the incidence, death, and possible risk factors of gastric cancer in five Asian countries, in relation to year, age, sex, and sociodemographic index. The annual percentage change was calculated to estimate the trends in age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR). The highest ASIR per 100,000 person-years in 2019 was in Mongolia [44 (95% uncertainty interval (UI), 34 to 55)], while the lowest was in the Democratic People's Republic of Korea (DPRK) [23 (95% UI, 19 to 29)]. The highest ASDR per 100,000 person-years was in Mongolia [46 (95% UI, 37 to 57)], while the lowest was in Japan [14 (95% UI, 12 to 15)]. Despite the increase in the absolute number of cases and deaths from 1990 to 2019, the ASIRs and ASDRs in all five countries decreased with time and improved sociodemographic index but increased with age. Smoking and a high-sodium diet were two possible risk factors for gastric cancer. In 2019, the proportion of age-standardized disability-adjusted life-years attributable to smoking was highest in Japan [23% (95% UI, 19 to 28%)], and the proportions attributable to a high-sodium diet were highest in China [8.8% (95% UI, 0.21 to 33%)], DPRK, and the Republic of Korea. There are substantial variations in the incidence and death of gastric cancer in the five studied Asian countries. This study may be crucial in helping policymakers to make better decisions and allocate appropriate resources.

Use of Mobile Apps for Visual Acuity Assessment: Systematic Review and Meta-analysis.

BACKGROUND: Vision impairments (VIs) and blindness are major global public health issues. A visual acuity (VA) test is one of the most crucial standard psychophysical tests of visual function and has been widely used in a broad range of health care domains, especially in many clinical settings. In recent years, there has been increasing research on mobile app-based VA assessment designed to allow people to test their VA at any time and any location. OBJECTIVE: The goal of the review was to assess the accuracy and reliability of using mobile VA measurement apps. METHODS: We searched PubMed, Embase, Cochrane Library, and Google Scholar for relevant articles on mobile apps for VA assessment published between January 1, 2008, and July 1, 2020. Two researchers independently inspected and selected relevant studies. Eventually, we included 22 studies that assessed tablet or smartphone apps for VA measurement. We then analyzed sensitivity, specificity, and accuracy in the 6 papers we found through a meta-analysis. RESULTS: Most of the 22 selected studies can be considered of high quality based on the Quality Assessment of Diagnostic Accuracy Studies-2. In a meta-analysis of 6 studies involving 24,284 participants, we categorized the studies based on the age groups of the study participants (ie, aged 3-5 years, aged 6-22 years, and aged 55 years and older), examiner (ie, professional and nonprofessional examiners), and the type of mobile devices (ie, smartphone, iPad). In the group aged 3 to 5 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.87 (95% CI 0.79-0.93; P=.39), and the pooled specificity was 0.78 (95% CI 0.70-0.85; P=.37). In the group aged 6 to 22 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (95% CI 0.84-0.87; P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (95% CI 0.90-0.91; P=.27). In the group aged 55 years and older, the pooled sensitivity for VA app tests versus clinical VA tests was 0.85 (95% CI 0.55-0.98), and the pooled specificity for VA app tests versus clinical VA tests was 0.98 (95% CI 0.95-0.99). We found that the nonprofessional examiner group (AUC 0.93) had higher accuracy than the professional examiner group (AUC 0.87). In the iPad-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86, and the pooled specificity was 0.79. In the smartphone-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (P<.001). CONCLUSIONS: In this study, we conducted a comprehensive review of the research on existing mobile apps for VA tests to investigate their diagnostic value and limitations. Evidence gained from this study suggests that mobile app-based VA tests can be useful for on-demand VI detection.

Assessment of temporal and spatial distribution patterns of aerosol produced by air-puff non-contact tonometer.

PURPOSE: To assess the distribution pattern of aerosol in the aspect of time and direction during the intraocular pressure (IOP) measurement by air-puff non-contact tonometer (NCT) and further offer references for protection from coronavirus disease-19 (COVID-19) in the routine ophthalmic examination. METHOD: A single-center observational study was conducted in the ophthalmology clinics of Peking University Third Hospital. Two air quality detectors were equipped to assess the generated particulate matter (PM) concentration simultaneously within 30 s after IOP measurement in the outpatient hall. Detector A was fixed next to the NCT as a reference, while Detector B was fixed 1 meter away. The participants were divided into two groups depending on the position of Detector B. The generation of aerosol was compared within different groups and time intervals. RESULTS: 144 participants were enrolled in the final analysis. At a 1 m distance from the NCT, the PM2.5 concentration significantly increased at the 30 s (Z = 2.898, Bonferroni-corrected P = 0.038) while the PM10 concentration increased immediately after the IOP measurement (Z = 2.967, Bonferroni-corrected P = 0.030). The PM2.5 and PM10 concentrations at 1 m were significantly higher immediately (Z = -2.183, P = 0.029; Z = -2.502, P = 0.012) and 30 s (Z = -2.021, P = 0.043; Z = -2.071, P = 0.038) after the IOP measurements when the Detector B was vertical to the air jet on the lateral side. CONCLUSIONS: NCT may produce aerosol after the IOP measurement by air-puff. The generated PM2.5 had a prolonged existence compared with PM10 at a 1 m distance. The lateral side of the air-puff direction may be of higher exposure risk to aerosol.

Assessment of kidney function in chronic kidney disease by combining diffusion tensor imaging and total kidney volume.

OBJECTIVE: This study aimed to investigate the value and feasibility of combining fractional anisotropy (FA) values from diffusion tensor imaging (DTI) and total kidney volume (TKV) for the assessment of kidney function in chronic kidney disease (CKD). MATERIALS AND METHODS: Fifty-one patients were included in this study. All MRI examinations were performed with a 3.0 T scanner. DTI was used to measure FA values, and TKV was obtained from DTI and T2-weighted imaging (T2WI). Patients were divided into three groups (mild, moderate, severe) according to eGFR, which was calculated with serum creatinine. Differences in the FA values of the cortex and medulla were analysed among the three groups, and the relationships of FA values, TKV, and the product of the FA values and TKV with eGFR were analysed. Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficiency of the FA values, TKV, and the product of the FA values and TKV for kidney function in different CKD stages. RESULTS: Medullary FA values (m-FA), TKV, and the product of the m-FA values and TKV (m-FA-TKV) were significantly correlated with eGFR (r = 0.653, 0.685, and 0.797, respectively; all P < 0.001). ROC curve analysis showed that m-FA-TKV exhibited better diagnostic performance than m-FA values (P = 0.022). CONCLUSION: m-FA-TKV obtained by DTI significantly improves the accuracy of kidney function assessment in CKD patients.

Chinese version of the clinical supervision self-assessment tool: Assessment of reliability and validity.

BACKGROUND: Cultivating the professional knowledge and professional identity of nursing students is important for nursing education. The degree of professional identity of nursing students will directly affect their career options and work performance after graduation. Clinical practice is a learning process of combining the knowledge and the practical techniques of nursing. It is the important way to cultivate the students' comprehensive ability, professional attitude and professional emotion. Effective clinical supervision during the clinical practice plays an important role in guaranteeing clinial practice quality and cultivating professional nursing students. Active teaching supervision is helpful to achieve the expected learning effect. Therefore, it is vital to evaluate the clinical supervision ability of the clinical nursing teachers. However, there is no special assessment instrument available in China. OBJECTIVES: To assess the validity and reliability of the Chinese version of the modified Clinical Supervision Self-Assessment Tool (mCAST). DESIGN: A cross sectional survey design with a convenience sample was used in this study. This cross-sectional psychometric instrumental study determined the reliability and validity of the Chinese version of the modified Clinical Supervision Self-Assessment Tool (mCAST). SETTINGS: Twelve hospitals in Tianjin, China. PARTICIPANTS: A total of 350 registered nurses who perform teaching tasks in clinical practice were recruited. METHODS: The Chinese version of the mCSAT was translated and tested by obtaining the authorization of the developer of the mCAST using Brislin's model (that is, translation, back translation, cultural adaptation and pilot study). A total of 350 registered nurses who perform teaching tasks in clinical practice were recruited by convenience sampling for the assessment of construct validity using exploratory factor analysis (EFA). Moreover, item analysis, internal correlation coefficients, Cronbach's alpha coefficients, test-retest realibility and split-half reliability were conducted to test the psychometric properties of the Chinese version of the mCSAT. RESULTS: The Chinese version of the mCSAT contained 2 subscales, namely, mCSAT-Knowledge and mCSAT-Skills. Exploratory factor analysis of the knowledge and skills subscales explained 63.26% and 63.60% of the total variances, respectively. The mCSAT-Knowledge subscale contains 3 dimensions, namely, evaluating learning (10 items), facilitating learning (9 items) and problem solving (10 items); the mCSAT-Skills subscale contains 3 dimensions, namely, evaluating learning (10 items), facilitating learning (9 items) and problem solving (10 items). The Cronbach's α coefficients of the mCSAT-Knowledge and mCSAT-Skills subscales were both 0.95. The split-half reliability of the mCSAT-Knowledge and mCSAT-Skills subscales were 0.88 and 0.89, respectively. CONCLUSION: The Chinese version of the mCSAT was reliable and valid in the evaluation of the knowledge and skills for the clinical supervision of registered nurses. Further validation of the Chinese version of the mCSAT requires a more representative and larger sample. Also, the confirmatory factor analysis should be conducted in future study.

Quantitative assessment of left ventricular myocardial work in chronic kidney disease patients by a novel non-invasive pressure-strain loop analysis method.

This study aimed to quantitatively evaluate myocardial work (MW) in advanced stage 3-5 chronic kidney disease (CKD) by a novel non-invasive left ventricular (LV) Pressure-strain loop analysis (PSL). 144 patients with CKD were included (68 with stage 3 CKD group, 76 with stage 4/5 CKD group), and 48 healthy patients were recruited as the control group. All subjects had undergone transthoracic echocardiography. LV myocardial work and efficiency were estimated from LV PSL analysis. There was a significant progressive increase in global work waste (GWW) and reduction in global work efficiency (GWE) in CKD compared to normal controls. No difference in global work index (GWI) and global constructive work (GCW) was observed among the three groups. Subdivided analysis according to systolic blood pressure (SBP) and LV geometry discovered that increased GWW seems to be present frequently in CKD patients with elevated SBP or LV hypertrophy (LVH). Multivariate analysis showed increased peak strain dispersion (PSD), SBP, LV mass index (LVMI), and decreased estimated glomerular filtration rate (eGFR) were significantly associated with increased GWW. The decline of renal function followed by impaired paralleled myocardial energy exploitation. Moreover, increased PSD, SBP, LVMI, and decreased eGFR might be potential drivers of increased GWW.