Nurses' preferences for interventions to improve infection prevention and control behaviors based on systems engineering initiative to patient safety model: a discrete choice experiment.

BACKGROUND: The evidence of preferences for infection prevention and control (IPC) intervention from system perspective was lacked. This study aimed to elicit nurses' preferences for the intervention designed to improve IPC behaviors based on the Systems Engineering Initiative to Patient Safety (SEIPS) model using Discrete Choice Experiment (DCE). METHODS: A DCE was conducted among nurses who were on active duty and willing to participate from July 5th to 10th, 2021 in a tertiary hospital in Ganzhou City, Jiangxi Province, using convenience sampling. A self-administered questionnaire included scenarios formed by six attributes with varying levels based on SEIPS model: person, organization, tools and technology, tasks, internal environment and external environment. A conditional logit and latent class logit model were performed to analyze the data. RESULTS: A total of 257 valid questionnaires were analyzed among nurses. The results from the latent class logit model show that nurses' preferences can be divided into three classes. For nurses in multifaceted-aspect-preferred class (41.9%), positive coefficients were obtained in those six attributes. For person-preferred class (19.7%), only person was positively significant. For environment-preferred class (36.4%), the most important attribute were tasks, tools and technology, internal environment and external environment. CONCLUSIONS: This finding suggest that nurses have three latent-class preferences for interventions. Multifaceted interventions to improve IPC behaviors based on the SEIPS model are preferred by most nurses. Moreover, relevant measured should be performed targeted the latent class of person-preferred and external-environment-preferred nurses.

The impacts of knowledge and attitude on behavior of antibiotic use for the common cold among the public and identifying the critical behavioral stage: based on an expanding KAP model.

BACKGROUND: This study aims to explore the impacts of knowledge and attitude on the behavior of antibiotic use during the treatment of the common cold based on the expanding KAP model, and then identify the critical behavioral stage. METHODS: A cross-sectional study was conducted on 815 public from 21 community health centers (CHCs) in Chongqing, China. Based on the expanding KAP model, a self-administered questionnaire was designed to measure knowledge, attitude, multi-stage behavior, and perceived threat, in which multi-stage behavior was divided into pre-use antibiotic behavior, during-use antibiotic behavior, and post-use antibiotic behavior. A structural equation model was used to examine the model fit and the direct, indirect, mediating effects, and moderating effect of the variables. RESULTS: The expanding KAP showed good model fit indices with χ²/df = 0.537, RMSEA = 0.033, CFI = 0.973, GFI = 0.971, NFI = 0.934, TLI = 0.979. Knowledge had a positive effect on attitude (ß = 0.503, p < 0.05), pre-use antibiotic behavior (ß = 0.348, p < 0.05), during-use antibiotic behavior (ß = 0.461, p < 0.001), and post-use antibiotic behavior (ß = 0.547, p < 0.001). Attitude had a positive effect on during-use antibiotic behavior (ß = 0.296, p < 0.001), and post-use antibiotic behavior (ß = 0.747, p < 0.001). The mediating effect of attitude was positive among knowledge, during-use antibiotic behavior (ß = 0.149, p < 0.05), and post-use antibiotic behavior (ß = 0.376, p < 0.001). Perceived threat also had a positive moderating effect between knowledge and post-use antibiotic behavior (ß = 0.021, p < 0.001). CONCLUSIONS: Knowledge, attitude and perceived threat had different effects on different stages of antibiotic behavior. The critical behavioral stage prioritized the post-use antibiotic behavior and during-use antibiotic behavior over pre-use antibiotic behavior.

The pre-analytical process management status and influencing factors of laboratory test before prescribing antimicrobial in developing country.

INTRODUCTION: The results of laboratory testing are crucial basis for clinicians to prescribe antimicrobial. Laboratory testing is a highly complex process, and increasing evidence suggests that errors and obstacles in the pre-analytical process (PP) will affect reasonable antimicrobial use. However, PP was an easily neglected link in hospital infection management and the current situation of it and the influencing factors of management are not clear. METHODS: A cross-sectional survey was conducted in the department of clinical, specimen collection, transportation, and inspection in 109 secondary and tertiary hospitals in Central China. The rate of antimicrobial susceptibility test request (AST) and related indexes of above departments were calculated to describe the situation. Management characteristics (frequency of training etc.) were described as proportions and fractional probit regression analysis was used to determine the influencing factors. RESULTS: The average rate of non restricted-use antimicrobial was 63%, the restricted-use was 86%, the special-use was 95%. The zero obstacle rate of specimen collection was 27.3%, of specimen transportation was 19.4% and of inspection feedback was 61.7%. There was a difference between the secondary and tertiary hospitals on non restricted-use (X2 = 22.968, P < 0.001); restricted-use (X2 = 29.466, P < 0.001); special-use (X2 = 27.317, P < 0.001). Taking non restricted-use as an example, training (OR = 0.312, 95%CI: 0.148,0.429), low-frequency appraisal (OR = 0.153, 95%CI: 0.082,0.224), guidance (OR = 0.32, 95%CI: 0.237,0.403) and information technology (OR = 0.104, 95%CI: 0.009,0.199) were positive factors. CONCLUSIONS: There were substantial differences in the rate of AST request in clinical department between secondary and tertiary hospitals. The zero obstacle rate in collection, transportation and inspection department were still low. In most departments, training and performance appraisal were positive factors, guidance and information technology were positive supporting factors.

Factors Influencing Clinicians' Use of Hospital Information Systems for Infection Prevention and Control: Cross-Sectional Study Based on the Extended DeLone and McLean Model.

BACKGROUND: Healthcare-associated infections have become a serious public health problem. Various types of information systems have begun to be applied in hospital infection prevention and control (IPC) practice. Clinicians are the key users of these systems, but few studies have assessed the use of infection prevention and control information systems (IPCISs) from their perspective. OBJECTIVE: This study aimed to (1) apply the extended DeLone and McLean Information Systems Success model (D&M model) that incorporates IPC culture to examine how technical factors like information quality, system quality, and service quality, as well as organizational culture factors affect clinicians' use intention, satisfaction, and perceived net benefits, and (2) identify which factors are the most important for clinicians' use intention. METHODS: A total of 12,317 clinicians from secondary and tertiary hospitals were surveyed online. Data were analyzed using partial least squares-structural equation modeling and the importance-performance matrix analysis. RESULTS: Among the technical factors, system quality (ß=.089-.252; P<.001), information quality (ß=.294-.102; P<.001), and service quality (ß=.126-.411; P<.001) were significantly related to user satisfaction (R2=0.833), use intention (R2=0.821), and perceived net benefits (communication benefits [R2=0.676], decision-making benefits [R2=0.624], and organizational benefits [R2=0.656]). IPC culture had an effect on use intention (ß=.059; P<.001), and it also indirectly affected perceived net benefits (ß=.461-.474; P<.001). In the importance-performance matrix analysis, the attributes of service quality (providing user training) and information quality (readability) were present in the fourth quadrant, indicating their high importance and low performance. CONCLUSIONS: This study provides valuable insights into IPCIS usage among clinicians from the perspectives of technology and organization culture factors. It found that technical factors (system quality, information quality, and service quality) and hospital IPC culture have an impact on the successful use of IPCISs after evaluating the application of IPCISs based on the extended D&M model. Furthermore, service quality and information quality showed higher importance and lower performance for use intention. These findings provide empirical evidence and specific practical directions for further improving the construction of IPCISs.

The impact of clinical pharmacist-physician communication on reducing drug-related problems: a mixed study design in a tertiary teaching Hospital in Xinjiang, China.

BACKGROUND: The incidence of drug-related problems (DRPs) has caused serious health hazards and economic burdens among polymedicine patients. Effective communication between clinical pharmacists and physicians has a significant impact on reducing DRPs, but the evidence is poor. This study aimed to explore the impact of communication between clinical pharmacists and physicians on reducing DRPs. METHODS: A semistructured interview was conducted to explore the communication mode between clinical pharmacists and physicians based on the interprofessional approach of the shared decision-making model and relational coordination theory. A randomized controlled trial (RCT) was used to explore the effects of communication intervention on reducing DRPs. Logistic regression analysis was used to identify the influencing factors of communication. RESULTS: The mode of communication is driven by clinical pharmacists between clinical pharmacists and physicians and selectively based on different DRP types. Normally, the communication contents only cover two (33.8%) types of DRP contents or fewer (35.1%). The communication time averaged 5.8 minutes. The communication way is predominantly face-to-face (91.3%), but telephone or other online means (such as WeChat) may be preferred for urgent tasks or long physical distances. Among the 367 participants, 44 patients had DRPs. The RCT results indicated a significant difference in DRP incidence between the control group and the intervention group after the communication intervention (p = 0.02), and the incidence of DRPs in the intervention group was significantly reduced (15.6% vs. 0.07%). Regression analysis showed that communication time had a negative impact on DRP incidence (OR = 13.22, p < 0.001). CONCLUSION: The communication mode based on the interprofessional approach of the shared decision-making between clinical pharmacists and physicians in medication decision-making could significantly reduce the incidence of DRPs, and the length of communication time is a significant factor. The longer the communication time is, the fewer DRPs that occur. TRIAL REGISTRATION: This trial was approved by the ethics committee of The First Affiliated Hospital of Medical College of Xinjiang Shihezi University Hospital (kj2020-087-03) and registered in the China clinical trial registry (https://www.chictr.org.cn , number ChiCTR2000035321 date: 08/08/2020).

Communication openness and nosocomial infection reporting: the mediating role of team cohesion.

BACKGROUND: The states of IPC (Infection Prevention and Control) is serious under the COVID-19 pandemic. Nosocomial infection reporting is of great significance to transparent management of IPC in regard to the COVID-19 pandemic. We aimed to explore the relationship between communication openness and nosocomial infection reporting, explore the mediating effect of team cohesion in the two, and provide evidence-based organizational perspective for improving IPC management in the hospitals. METHOD: A questionnaire was used to collect data on communication openness, team cohesion and nosocomial infection reporting in 3512 medical staff from 239 hospitals in Hubei, China. Structural Equation Model (SEM) was conducted to examine the hypothetical model. RESULT: Communication openness was positively related to nosocomial infection reporting (ß = 0.540, p < 0.001), and was positively related to team cohesion (ß = 0.887, p < 0.001). Team cohesion was positively related to nosocomial infection reporting (ß = 0.328, p < 0.001). The partial mediating effect of team cohesion was significant (ß = 0.291, SE = 0.055, 95% CI = [ 0.178,0.392 ]), making up 35.02% of total effect. CONCLUSION: Communication openness was not only positively related to nosocomial infection reporting. Team cohesion can be regarded as a mediator between communication openness and nosocomial infection reporting. It implies that strengthening communication openness and team cohesion is the strategy to promote IPC management from the new organizational perspective.

[Association of MDR1 gene polymorphisms with refractory epilepsy in children].

OBJECTIVE: To assess the association of single nucleotide polymorphisms of multidrug resistance gene 1 (MDR1) with refractory epilepsy in children. METHODS: Peripheral blood samples were collected from 200 children with epilepsy and 100 healthy controls. Genomic DNA was extracted and subjected to PCR amplification, agarose gel electrophoresis and target site sequencing. Genotypes of rs1922242, rs2235048, rs10808072, rs868755 and rs1202184 loci of the MDR1 gene were analyzed. RESULTS: No significant difference was found in genotypic distribution and allelic frequencies of the rs1922242, rs2235048, rs10808072 and rs868755 loci between the drug-resistant and drug-sensitive groups. For the rs1202184 locus, a significant difference in genotypic distribution was found (P=0.008). No significant difference was found in the frequencies of various haplotypes between the two groups. CONCLUSION: Genotypes of the rs1202184 locus of the MDR1 gene are associated with refractory epilepsy in children, for which the AA genotype plays a dominant role.

RNA Aptamer-Mediated Gene Activation Systems for Inducible Transgene Expression in Animal Cells.

RNA expression analyses can be used to obtain various information from inside cells, such as physical conditions, the chemical environment, and endogenous signals. For detecting RNA, the system regulating intracellular gene expression has the potential for monitoring RNA expression levels in real time within living cells. Synthetic biology provides powerful tools for detecting and analyzing RNA inside cells. Here, we devised an RNA aptamer-mediated gene activation system, RAMGA, to induce RNA-triggered gene expression activation by employing an inducible complex formation strategy grounded in synthetic biology. This methodology connects DNA-binding domains and transactivators through target RNA using RNA-binding domains, including phage coat proteins. MS2 bacteriophage coat protein fused with a transcriptional activator and PP7 bacteriophage coat protein fused with the tetracycline repressor (tetR) can be bridged by target RNA encoding MS2 and PP7 stem-loops, resulting in transcriptional activation. We generated recombinant CHO cells containing an inducible GFP expression module governed by a minimal promoter with a tetR-responsive element. Cells carrying the trigger RNA exhibited robust reporter gene expression, whereas cells lacking it exhibited no expression. GFP expression was upregulated over 200-fold compared with that in cells without a target RNA expression vector. Moreover, this system can detect the expression of mRNA tagged with aptamer tags and modulate reporter gene expression based on the target mRNA level without affecting the expression of the original mRNA-encoding gene. The RNA-triggered gene expression systems developed in this study have potential as a new platform for establishing gene circuits, evaluating endogenous gene expression, and developing novel RNA detectors.

The Impact of Social Participation on Frailty among Older Adults: The Mediating Role of Loneliness and Sleep Quality.

BACKGROUND: Frailty has become a common health issue among older adults, imposing a burden on both society and individuals. The relationship between social participation and frailty has received widespread attention, but the mechanism remains to be explored. The aim of this study is to explore the impact of social participation on frailty among older adults and to analyze the mediating role of loneliness and sleep quality, providing suggestions to alleviate frailty. METHODS: Data related to social participation, loneliness, sleep quality, and frailty from 7779 older adults were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018). The chain mediation model was conducted to explore the relationship between variables, and the Bootstrap method was used to examine the path coefficients. RESULTS: Social participation negatively affected frailty (ß = -0.00391049, 95% CI = [-0.042296, -0.035465]); the indirect effect of social participation on frailty mediated by loneliness was -0.0019505 (95% CI = [-0.002551, -0.001371]); the indirect effect of social participation on frailty mediated by sleep quality was -0.0011104 (95%CI = [-0.001692, -0.000557]); the effect mediated by both loneliness and sleep quality was -0.0004263 (95% CI = [-0.000593, -0.000304]). CONCLUSIONS: Social participation negatively affected frailty. Loneliness and sleep quality not only mediated independently, but also played a chain mediating role. This suggested that encouraging older adults to engage in more social participation, reducing loneliness, and improving sleep quality are feasible measures to improve frailty.

Toward a Sustainable Approach for Durably Hydrophilic and UV Protective PET Fabric through Surface Activation and Immobilization Integrating Epigallocatechin Gallate and Citric Acid.

Enhancing the hydrophilicity and UV protective property of poly(ethylene terephthalate) (PET) fabric are two significant ways to upgrade its quality and enlarge the applicable area. Biobased finishes are greatly welcomed for the fabrication of sustainable textiles; however, their application on PET fabric is still challenging compared with the case of natural fabric. This study presents a strategy that immobilizes epigallocatechin gallate (EGCG) onto PET fabric using citric acid (CA) for durably hydrophilic and UV-proof properties with negligible color change. A controllable surface-activating method integrating alkaline and deep eutectic solvent (DES) is customized for the PET fabric to promote the reactions among PET, CA, and EGCG. The hydrophilic, antistatic, and UV protective properties of functionalized PET fabric were explored. Results show that the hydrophilicity of the PET fabric after direct EGCG treatment increases but drops sharply after first-round washing due to weak interactions. The combined alkaline/DES pretreatment increases the number of hydrophilic groups and the roughness of PET fibers. After EGCG modification, the moisture regain (MR) of PET fabric increases from 0.41 to 0.64%. The contact angle and electrostatic charge half-life (T1/2) decreases from >120 to 23°, and from >60 to 0.13 s, respectively. The MR and T1/2 are well retained after a 10-cycle washing. In addition, the UV protective factor of the PET fabric increases from 18 to 36. A very slight yellowing phenomenon occurs on the PET fabric after the treatment. In all, this research attempts to integrate a biobased finishing agent and an eco-friendly cross-linker on synthetic fiber for durable functions, which is transferrable to the sustainable fabrication of other polymeric materials such as fibers or films.

Breast Cancer Classification From Digital Pathology Images via Connectivity-Aware Graph Transformer.

Automated classification of breast cancer subtypes from digital pathology images has been an extremely challenging task due to the complicated spatial patterns of cells in the tissue micro-environment. While newly proposed graph transformers are able to capture more long-range dependencies to enhance accuracy, they largely ignore the topological connectivity between graph nodes, which is nevertheless critical to extract more representative features to address this difficult task. In this paper, we propose a novel connectivity-aware graph transformer (CGT) for phenotyping the topology connectivity of the tissue graph constructed from digital pathology images for breast cancer classification. Our CGT seamlessly integrates connectivity embedding to node feature at every graph transformer layer by using local connectivity aggregation, in order to yield more comprehensive graph representations to distinguish different breast cancer subtypes. In light of the realistic intercellular communication mode, we then encode the spatial distance between two arbitrary nodes as connectivity bias in self-attention calculation, thereby allowing the CGT to distinctively harness the connectivity embedding based on the distance of two nodes. We extensively evaluate the proposed CGT on a large cohort of breast carcinoma digital pathology images stained by Haematoxylin & Eosin. Experimental results demonstrate the effectiveness of our CGT, which outperforms state-of-the-art methods by a large margin. Codes are released on https://github.com/wang-kang-6/CGT.

Associations between self-leadership and self-reported execution of infection prevention and control among physicians and nurses.

BACKGROUND: There is poor self-reported (SR) execution of infection prevention and control (IPC) among physicians and nurses. Self-leadership is considered an important factor to enhance IPC SR-execution. This study aims to explore the associations between self-leadership and IPC SR-execution among physicians and nurses. METHODS: A cross-sectional study of 26,252 physicians and nurses was conducted in all secondary and tertiary hospitals in Hubei province, China. A questionnaire was designed to measure physicians' and nurses' self-leadership, which includes positive traits and negative traits, and IPC SR-execution, which includes motivation, process, and outcome. RESULTS: Positive traits and negative traits of self-leadership had significant positive associations with SR-execution motivation (ß = .582, P < .001) (ß = .026, P < .001), SR-execution process (ß = .642, P < .001) (ß = .017, P < .001), and SR-execution outcome (ß = .675, P < .001) (ß = .013, P < .001). CONCLUSIONS: This study recommends that health care institutions should focus on cultivating positive traits of self-leadership among physicians and nurses. Although negative traits of self-leadership can also promote IPC SR-execution, the association is limited and may lead to risks.

Construction of millimeter-scale vascularized engineered myocardial tissue using a mixed gel.

Engineering myocardium has shown great clinal potential for repairing permanent myocardial injury. However, the lack of perfusing blood vessels and difficulties in preparing a thick-engineered myocardium result in its limited clinical use. We prepared a mixed gel containing fibrin (5 mg/ml) and collagen I (0.2 mg/ml) and verified that human umbilical vein endothelial cells (HUVECs) and human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) could form microvascular lumens and myocardial cell clusters by harnessing the low-hardness and hyperelastic characteristics of fibrin. hiPSC-CMs and HUVECs in the mixed gel formed self-organized cell clusters, which were then cultured in different media using a three-phase approach. The successfully constructed vascularized engineered myocardial tissue had a spherical structure and final diameter of 1-2 mm. The tissue exhibited autonomous beats that occurred at a frequency similar to a normal human heart rate. The internal microvascular lumen could be maintained for 6 weeks and showed good results during preliminary surface re-vascularization in vitro and vascular remodeling in vivo. In summary, we propose a simple method for constructing vascularized engineered myocardial tissue, through phased cultivation that does not rely on high-end manufacturing equipment and cutting-edge preparation techniques. The constructed tissue has potential value for clinical use after preliminary evaluation.

High-Level Production of scFv-Fc Antibody Using an Artificial Promoter System with Transcriptional Positive Feedback Loop of Transactivator in CHO Cells.

With the increasing demand for therapeutic antibodies, CHO cells have become the de facto standard as producer host cells for biopharmaceutical production. High production yields are required for antibody production, and developing a high-titer production system is increasingly crucial. This study was established to develop a high-production system using a synthetic biology approach by designing a gene expression system based on an artificial transcription factor that can strongly induce the high expression of target genes in CHO cells. To demonstrate the functionality of this artificial gene expression system and its ability to induce the high expression of target genes in CHO cells, a model antibody (scFv-Fc) was produced using this system. Excellent results were obtained with the plate scale, and when attempting continuous production in semi-continuous cultures using bioreactor tubes with high-cell-density suspension culture using a serum-free medium, high-titer antibody production at the gram-per-liter level was achieved. Shifting the culture temperature to a low temperature of 33 °C achieved scFv-Fc concentrations of up to 5.5 g/L with a specific production rate of 262 pg/(cell∙day). This artificial gene expression system should be a powerful tool for CHO cell engineering aimed at constructing high-yield production systems.

Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study.

BACKGROUND: Chronic pain, sleep disorders, and depression are major global health concerns. Recent studies have revealed a strong link between sleep disorders and pain, and each of them is bidirectionally correlated with depressive symptoms, suggesting a complex relationship between these conditions. Social participation has been identified as a potential moderator in this complex relationship, with implications for treatment. However, the complex interplay among sleep disorders, pain, depressive symptoms, and social participation in middle- and old-aged Asians remains unclear. OBJECTIVE: This study aimed to examine the bidirectional relationship between sleep disorders and pain in middle- and old-aged Chinese and measure the role of depression as a mediator and social participation as a moderator in this bidirectional relationship through a dynamic cohort study. METHODS: We used data from the China Health and Retirement Longitudinal Study across 5 years and included a total of 7998 middle- and old-aged people (≥45 years old) with complete data in 2011 (T1), 2015 (T2), and 2018 (T3). The cross-lag model was used to assess the interplay among sleep disorders, pain, depressive symptoms, and social participation. Depressive symptoms were assessed by the 10-item Centre for Epidemiological Studies Depression scale. Sleep disorders were assessed by a single-item sleep quality scale and nighttime sleep duration. The pain score was the sum of all pain locations reported. Social participation was measured using self-reported activity. RESULTS: Our results showed significant cross-lagged effects of previous sleep disorders on subsequent pain at T2 (ß=.141; P<.001) and T3 (ß=.117; P<.001) and previous pain on subsequent poor sleep at T2 (ß=.080; P<.001) and T3 (ß=.093; P<.001). The indirect effects of previous sleep disorders on pain through depressive symptoms (ß=.020; SE 0.004; P<.001; effect size 21.98%), as well as previous pain on sleep disorders through depressive symptoms (ß=.012; SE 0.002; P<.001; effect size 20.69%), were significant across the 3 time intervals. Among participants with high levels of social participation, there were no statistically significant effects of previous sleep disorders on subsequent pain at T2 (ß=.048; P=.15) and T3 (ß=.085; P=.02), nor were there statistically significant effects of previous pain on subsequent sleep disorders at T2 (ß=.037; P=.15) and T3 (ß=.039; P=.24). Additionally, the mediating effects of depressive symptoms on the sleep disorders-to-pain pathway (P=.14) and the pain-to-sleep disorders pathway (P=.02) were no longer statistically significant. CONCLUSIONS: There is a bidirectional relationship between sleep disorders and pain in middle- and old-aged Asians; depression plays a longitudinal mediating role in the bidirectional relationship between them; and social participation moderates the bidirectional relationship between them directly and indirectly by affecting depression. Future interventions may consider the complex relationship between these conditions and adopt a comprehensive treatment regime.

Effects of the Implementation of Transport-Driven Poverty Alleviation Policy on Health Care-Seeking Behavior and Medical Expenditure Among Older People in Rural Areas: Quasi-Experimental Study.

BACKGROUND: Improving the rural residents' accessibility to and affordability of health care is recognized as a common target globally. The Health in All Policies approach, from the Declaration of Helsinki to the United Nations' Decade Of Healthy Ageing, strengthened the far-reaching effect of large-scale public policies on health care-seeking behavior; however, the effects of national transport policy on health care-seeking behavior is unclear. OBJECTIVE: This quasi-experimental study aimed to examine the effects of the implementation of transport-driven poverty alleviation (TPA) policy on health care-seeking behavior and medical expenditure among older adults in rural areas and the mechanism underlying these effects. METHODS: We designed a quasi-experiment to estimate the effects of TPA policy implementation on health care-seeking behavior and medical expenditure among older adults in rural areas through a difference-in-differences (DID) analysis based on data from the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. The underlying mechanism was analyzed and effect modification patterns were further investigated by poor households, health status, and age. RESULTS: Our findings validated a positive contribution of TPA policy on health care-seeking behavior among older adults in rural areas. After the implementation of TPA policy, the number of inpatient visits increased by annually 0.35 times per person, outpatient medical expenditure increased by 192% per month, and inpatient medical expenditure increased by 57% annually compared with those of older adults in rural areas without the implementation of TPA policy. Further, there was a significant modification effect, with a positive effect among poor households, healthier older adults, and those aged 60-80 years. Additionally, the policy improved the patients' capabilities to seek long-distance care (ß=23.16, 95% CI -0.99 to 45.31) and high-level hospitals (ß=.08, 95% CI -0.02 to 0.13), and increased individual income to acquire more medical services (ß=4.57, 95% CI -4.46 to 4.68). CONCLUSIONS: These findings validate the positive contribution of TPA policy on health care-seeking behavior among older adults in rural areas; however, the medical expenditure incurred was also high. Concerted efforts are needed to address health care-seeking dilemmas in rural areas, and attention must be paid to curbing medical expenditure growth for older adults in rural areas during TPA policy implementation.

The mediating role of incentives in association between leadership attention and self-perceived continuous improvement in infection prevention and control among medical staff: A cross-sectional survey.

Objectives: Promoting improvement in Infection Prevention and Control (IPC) is an important part of improving the quality of care. The influence of leadership attention and incentives on the self-perceived continuous improvement in IPC has drawn a lot of attention, but relevant academic research is still lacking. The objective of this study is to explore the effect of leadership attention on self-perceived continuous improvement in IPC among medical staff and its underlying mechanisms. Method: The 3,512 medical staff from 239 health facilities in Hubei, China, were surveyed online during September 2020. Data on leadership attention, incentives, and improvement in Infection Prevention and Control were collected using self-administered questionnaires. Correlation analysis was used to analyze the relationship between leadership attention, incentives, and improvement in Infection Prevention and Control. Amos 24.0 was used to analyze the mediating role. Results: The scores of leadership attention, incentives and self-perceived continuous improvement in Infection Prevention and Control were all high. The score of leadership attention was the highest (4.67 ± 0.59), followed by self-perceived continuous improvement (4.62 ± 0.59) and incentives in Infection Prevention and Control (4.12 ± 0.83). Leadership attention positively affected self-perceived continuous improvement in Infection Prevention and Control (ß = 0.85, 95% CI = [0.83, 0.87]). Moreover, incentives partially mediated the effect of leadership attention on self-perceived continuous improvement in Infection Prevention and Control among medical staff (ß = 0.13, 95% CI = [0.12, 0.15]). Conclusion: Leadership attention positively affects self-perceived continuous improvement in Infection Prevention and Control among medical staff, and incentives mediates this relationship. The present study has valuable implications for self-perceived continuous improvement in Infection Prevention and Control from the perspective of leadership attention and incentives.

Ultrasonic-Aided Co-Precipitation of Tannins and Chitosan Ammonium Salt on Cotton Fabric for Antimicrobial and Ultraviolet-Shielding Properties: An Efficient, Colourless, and Eco-Finishing Strategy.

Sustainable fabrication of protective cotton, using bio-extracts, is becoming increasingly attractive. However, many shortcomings­including the introduction of potentially hazardous mordants or modifiers to cotton, annoying colour changes after finishing, and low processing efficiency­require further melioration. Therefore, an efficient ultrasonic-assisted colourless finishing process was developed in this study, to fabricate ultraviolet-proof and antimicrobial cotton. A pair of oppositely charged bio-based substances, i.e., tannin acid (TA) and hydroxypropyltrimethyl ammonium chloride chitosan (HACC) were introduced during the ultrasonic process. The results reveal that cationic HACC significantly promotes the adsorption of TA to cotton. The apparent colour of the cotton remained almost unchanged after finishing. Based on Pesudo first-/second-order kinetic models, chemisorption was verified as the dominant mechanism. Efficiency under ultrasound was enhanced by 5.3% (70 °C) and 27% (90 °C), respectively. A mathematical modelling study established the factors to be in the following order of significance: concentration > pH > temperature. Under optimal conditions, a theoretical maximum UPF of 380.8 was achieved. TA (8 g/L)-treated cotton deactivated up to 98% of Escherichia coli, and also provided excellent UV-shielding performance. In general, the ultrasonic-assisted eco-dyeing and finishing process for cotton was explored in depth from practical and theoretical perspectives, which should push forward the development of the sustainable textile industry.

Clinicians' Intention to Submit Microbiological Pathogenic Test Before Antibiotics Use and Its Influencing Factors: New Evidence from the Perspective of Hospital Management.

Purpose: Antimicrobial resistance (AR) is a global public health problem, improving clinicians' intention to submit microbiological pathogenic test (submission intention) can effectively increase the value for rational use antibiotics to curb AR. However, there are few studies on the factors influencing improvement of the submission intention, especially from the perspective of hospital management. This study will fill the gap and provide evidence that can continuously support improvement of antibiotics prescribing rationally. Patients and Methods: A cross-sectional survey of clinicians was conducted in all public hospitals in Hubei, China. Dependent variables were submission intention of non-restricted-use, restricted-use and special-use antibiotics which were measured submission, not sure submission, no submission. Independent variables were frequency of training and publicity on submission, and hospital with or without submission performance assessment, guideline, information decision system and laboratory items, including bacterial culture item, fungal culture item and so on. Clinicians' demographics were applied as control variables. Multinomial logistic regression was performed to model independent variables influencing submission intention. Results: For non-restricted-use antibiotics, guideline (OR = 0.263; 95% CI = [0.188, 0.369]) (OR = 0.526; 95% CI = [0.375, 0.738]) and bacterial culture item (OR = 0.141; 95% CI = [0.074, 0.268]) (OR = 0.520; 95% CI = [0.292, 0.927]) are key factors that positively affect clinicians' intention on submission and not sure submission; For restricted-use and special-use antibiotics, training frequency and bacterial culture item (OR = 0.155; 95% CI = [0.076, 0.315]) (OR = 0.092; 95% CI = [0.036, 0.232]) (OR = 0.106; 95% CI = [0.046, 0.248]) (OR = 0.027; 95% CI = [0.006, 0.117]) are key factors that positively affect clinicians' intention on submission and not sure submission. Conclusion: This study found that bacterial culture item, guideline, and training frequency are key factors that affect clinicians' intention on submission and not sure submission, but various factors exist different effects level on different types of antibiotics. Consequently, a focus should be placed on the construction and implementation of management factors, as well as reformation of antimicrobial stewardship in hospitals according to the types of antibiotics.

The Sample Error Pre-Antimicrobial Susceptibility Testing and Its Influencing Factors from the Perspective of Hospital Management: A Cross-Sectional Study.

The overuse of antibiotics remains serious and has led to a dramatic increase in antimicrobial resistance, which poses a significant threat to global public health, although much action has been taken by World Health Organization and countries. As the direct evidence to guide the prescribing of antibiotics, the Antimicrobial Susceptibility Testing (AST) results were biased by sample errors, which was urgent and poorly explored in quality management. This study aimed to analyze sample errors pre-AST and its influencing factors from the perspective of hospital management, to provide evidence for promoting rational antibiotic use and antimicrobial stewardship. A cross-sectional survey of 5963 clinical nurses involved in pathogenic sample collection was conducted in 118 public hospitals in Hubei province, China. Dependent variables were sample errors attributed to resources and technology-oriented, capability-oriented, and attitude-oriented errors, which were measured by times per week. Independent variables were sample management information such as guidelines, record after collection, performance appraisal, training, and publicity activities, in which guidelines, record time, and record method were dummy variables, with 1 indicating having and 0 not. Others were continuous variables ranging from 0 to 4 times per month. Ordinary Least Square regression models were performed to analyze influencing factors on sample error times. The averages of sample errors on resource and technology-oriented, capability-oriented, and attitude-oriented were 1.48, 1.35, and 1.36 times per week, and their proportion were 25.3%, 38.9%, and 35.8%, respectively. The results showed that recording timeliness (r = −0.354, p < 0.01), record using both paper and digital methods(r = −0.060, p < 0.01), performance appraisal(r = −0.188, p < 0.01), and publicity activities (r = −0.186, p < 0.01) significantly reduced times of resource and technology-oriented errors. Performance appraisals(r = −0.171, p < 0.01) and training activities (r = −0.208, p < 0.01) had a positive impact on the reduction of capability-oriented error times. The times of attitude-oriented error decreased significantly when recording timeliness (r = −0.299, p < 0.01), implementing performance appraisal (r = −0.164, p < 0.01), and training activities (r = −0.188, p < 0.01). This study found that there was a high frequency of sample errors in quality management, especially capability-oriented and attitude-oriented errors. Sample information management, performance appraisal, training, and publicity activities were associated with the quality of samples valuable for the rational use of antibiotics.