The Relationship between Burnout and Sense of School Belonging among the Resident Physicians in the Standardization Training in China.

BACKGROUND: As an important part in medical training in graduate school, 33-month medical residency training could be a stressful period inducing burnout (i.e. emotional exhaustion, depersonalization, and low personal accomplishment). Despite that existing literature has found that sense of belonging may have merits for residents' well-being, it has remained unclear how sense of school belonging affects burnout and the potential moderators. To address this question, a cross-sectional survey has been conducted among the residents of the physicians standardized residency training program in China. METHODS: Seven hundred (N = 700) resident physicians from different majors (i.e. clinical medicine, clinical Stomatology, and Chinese medicine) and grades have participated in the survey. Resident's sense of school belonging was assessed with the psychological sense of school membership scale (PSSM, mean = 45.12, SD = 11.14). Burnout was measured by the 22-item Maslach Burnout Inventory (MBI-HSS, mean = 65.80, SD = 15.89), including three subscales of emotional exhaustion, depersonalization, and personal accomplishment. RESULTS: The results showed that over 80% of the residents reported moderate or high level of emotional exhaustion and reduced personal accomplishment during residency training. Meanwhile, higher level of sense of school belonging was associated with lower overall burnout (B = -0.722, p < 0.001), less emotional exhaustion, reduced depersonalization, and higher personal accomplishment. In particular, the benefits of sense of belonging seem more pronounced among female and those at earlier stage of residency. No interaction effect was found between sense of belonging and major, while those from Chinese medicine reported lower scores in overall burnout and the three dimensions. CONCLUSIONS: Burnout was a prevalent issue among the resident physicians, and our findings confirmed the protective effects of sense of school belonging against burnout. Therefore, support service should be developed to cultivate resident's sense of school belonging and social connections, particularly for female and those at earlier stage of residency.

Control of N-nitrosodimethylamine (NDMA) formation from N,N-dimethylhydrazine compounds by ozone-based advanced oxidation processes.

N-nitrosodimethylamine (NDMA) is formed during ozonation of model compounds with dimethylhydrazine groups, such as daminozide (DMZ) and 2-furaldehyde 2,2-dimethylhydrazone (2-F-DMH) at pH 7 with yields of 100 % and 87 %, respectively. In this study, ozone/hydrogen peroxide (O3/H2O2) and ozone/peroxymonosulfate (O3/PMS) were investigated to control NDMA formation, and O3/PMS (50-65 %) was more effective than O3/H2O2 (10-25 %) with a ratio of H2O2 or PMS to O3 of 8:1. The reaction of PMS or H2O2 to decompose ozone could not compete with the ozonation of model compound because of the high second-order rate constants of the ozonation of DMZ (5 ×105 M-1 s-1) or 2-F-DMH (1.6 ×107 M-1 s-1). The Rct value of the sulfate radical (SO4•-) showed a linear relationship with NDMA formation, indicating that SO4•- significantly contributed to its control. NDMA formation could be further controlled by injecting small quantities of ozone numerous times to minimize the dissolved ozone concentration. The effects of tannic acid, bromide and bicarbonate on NDMA formation were also investigated during ozonation, O3/H2O2, and O3/PMS processes. Bromate formation was more pronounced in the O3/PMS process than in the O3/H2O2 process. Therefore, in practical applications of O3/H2O2 or O3/PMS processes, the generation of NDMA and bromate should be detected.

Breast Amide Proton Transfer Imaging at 3 T: Diagnostic Performance and Association With Pathologic Characteristics.

BACKGROUND: Amide proton transfer (APT) imaging has been increasingly applied in tumor characterization. However, its value in evaluating breast cancer remains undetermined. PURPOSE: To assess the diagnostic performance of APT imaging in breast cancer and its association with prognostic histopathologic characteristics. STUDY TYPE: Prospective. SUBJECTS: Eighty-four patients with breast lesions. FIELD STRENGTH/SEQUENCE: A 3.0 T/single-shot fast spin echo APT imaging. ASSESSMENT: APTw signal in breast lesion was quantified. Lesion malignancy, T stage, grades, Ki-67 index, molecular biomarkers (estrogen receptor [ER] expression, progesterone receptor [PR] expression, human epidermal growth factor receptor [HER-2] expression), molecular subtypes (luminal A, luminal B, triple negative, and HER-2 enriched) were determined. STATISTICAL TESTS: Student t-test, one-way analysis of variance, receiver operating characteristic analysis, and Pearson's correlation with P < 0.05 as statistical significance. RESULTS: APTw signal was significantly higher in malignant lesions (1.55% ± 1.24%) than in benign lesions (0.54% ± 1.13%), and in grade III lesions than in grade II lesions (1.65% ± 0.84% vs. 0.96% ± 0.96%), and in T2- (1.57% ± 0.64%) and T3-stage lesions (1.54% ± 0.63%) than in T1-stage lesions (0.81% ± 0.64%) for invasive breast carcinoma of no special type. APTw signal significantly correlated with Ki-67 index (r = 0.364) but showed no significant difference in groups of ER (P = 0.069), PR (P = 0.069), HER-2 (P = 0.961), and among molecular subtypes (P = 0.073). DATA CONCLUSION: APT imaging shows potential in differentiating breast lesion malignancy and associates with prognosis-related tumor grade, T stage, and proliferative activity. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

Mechanism of catalytic ozonation in expanded graphite aqueous suspension for the degradation of organic acids.

In this study, expanded graphite (EG) was prepared by the oxidation and intercalation of the natural flake graphite using perchloric acid and potassium permanganate at different expansion temperatures (300, 400, 500, and 600°C), and were characterized by scanning electron microscope (SEM) and X-ray photoelectron spectroscopy (XPS). EG prepared at 500°C was found to be highly effective for the mineralization of oxalic acid aqueous solution during ozonation at pH 3, which was ascribed to the formation of hydroxyl radicals from the surface reaction of surface hydroxyl groups on EG with ozone. The performance of expanded graphite in this catalytic system was basically unchanged after three repeated use. The presence of Cl-, SO42-, HPO42-/H2PO4- and NO3- could inhibit the degradation of oxalic acid in catalytic ozonation with EG. Degradations of oxamic acid and pyruvic acid in catalytic ozonation with EG were pH-dependent, which were lower than that of oxalic acid. The degradations of oxalic acid and oxamic acid were identified as mineralization process by the determination of TOC, while pyruvic acid may transform into organic products such as acetic acid by O3/EG. Manganese ion (Mn2+) could promote the degradation of oxalic acid by O3/EG at pH 3 because permanganate was produced by O3/EG in oxalic acid solution and then reacted with oxalic acid readily at acidic pH. Catalytic ozonation by EG exhibited great application potential for the destruction of refractory organic compounds.

Airborne Lidar Measurements of XCO2 in Synoptically Active Environment and Associated Comparisons With Numerical Simulations.

Frontal boundaries have been shown to cause large changes in CO2 mole-fractions, but clouds and the complex vertical structure of fronts make these gradients difficult to observe. It remains unclear how the column average CO2 dry air mole-fraction (XCO2) changes spatially across fronts, and how well airborne lidar observations, data assimilation systems, and numerical models without assimilation capture XCO2 frontal contrasts (ΔXCO2, i.e., warm minus cold sector average of XCO2). We demonstrated the potential of airborne Multifunctional Fiber Laser Lidar (MFLL) measurements in heterogeneous weather conditions (i.e., frontal environment) to investigate the ΔXCO2 during four seasonal field campaigns of the Atmospheric Carbon and Transport-America (ACT-America) mission. Most frontal cases in summer (winter) reveal higher (lower) XCO2 in the warm (cold) sector than in the cold (warm) sector. During the transitional seasons (spring and fall), no clear signal in ΔXCO2 was observed. Intercomparison among the MFLL, assimilated fields from NASA's Global Modeling and Assimilation Office (GMAO), and simulations from the Weather Research and Forecasting--Chemistry (WRF-Chem) showed that (a) all products had a similar sign of ΔXCO2 though with different levels of agreement in ΔXCO2 magnitudes among seasons; (b) ΔXCO2 in summer decreases with altitude; and (c) significant challenges remain in observing and simulating XCO2 frontal contrasts. A linear regression analyses between ΔXCO2 for MFLL versus GMAO, and MFLL versus WRF-Chem for summer-2016 cases yielded a correlation coefficient of 0.95 and 0.88, respectively. The reported ΔXCO2 variability among four seasons provide guidance to the spatial structures of XCO2 transport errors in models and satellite measurements of XCO2 in synoptically-active weather systems.

Conventional papillary thyroid carcinoma with intraglandular lymphatic dissemination shows more aggressive features.

OBJECTIVE: To investigate the invasive capability and other clinicopathological features of conventional papillary thyroid carcinoma (CVPTC) with intraglandular lymphatic dissemination. METHODS: Seventy-three conventional papillary thyroid carcinoma patients receiving total thyroidectomy were analyzed in this study. The expression of BRAF-V600E, D2-40 and CD31 in all thyroid samples was detected by immunohistochemical staining. The results were evaluated by two pathologists and were statistically analyzed. The rate of positive BRAF-V600E expression and the clinical invasiveness of CVPTC with intraglandular dissemination, multifocal non-intraglandular dissemination-CVPTC and single focus-CVPTC were evaluated. The correlation between BRAF-V600E expression, lymphatic vessel density, microvessel density and the clinicopathological characteristics of conventional papillary thyroid carcinoma were assessed. RESULTS: Twenty-five intraglandular dissemination-CVPTC, 17 multifocal non-intraglandular dissemination-CVPTC and 31 single focus-CVPTC cases were included in this study. The results showed that BRAF-V600E expression was independently correlated with intraglandular dissemination, age and pN staging (P < 0.05). The lymphatic vessel density in the intraglandular dissemination-CVPTC group was higher than that in the non-intraglandular dissemination-CVPTC group (P < 0.05). Compared with cases without intraglandular dissemination, intraglandular dissemination-CVPTC was associated with a younger age, higher lymph node metastasis rate, pN staging, the expression of BRAF-V600E and increased Capsule invasion and lymphovascular tumor thrombus (P < 0.05). During the follow-up of 30 months (median 15 months), two patients in the intraglandular dissemination-CVPTC group had cervical lymph node metastasis after the first operation. CONCLUSIONS: Intraglandular dissemination-CVPTC shows more aggressive features, and intraglandular lymphatic dissemination may be a potential biological indicator of poor prognosis.

Exploring the situational motivation of medical students through clinical medicine level test: a cross-sectional study.

China's Clinical Medicine Level Test (CMLT) was designed to evaluate the key factors that affect the learning outcome of medical students prior to entering clinical practice. In this study, we systemically analyzed the performance of a cohort of medical students at Jinan University School of Medicine participating in the recent CMLT. The analytical results of the medical students' written and objective structured clinical examination (OSCE) scores showed that their academic performance was predominantly associated with students' internship allocations, although other demographic characteristics such as sex, age, geographical origin of students, and grade point average (GPA) might be sporadically related to the students' OSCE performance at different OSCE stations. To explore the inherent reasons behind this, a survey was implemented among the medical students who participated in the examination to further interpret the factors influencing the students' learning outcome. The findings of this questionnaire manifested that intrinsic motivation and identified regulation acted as the major motivational profiles for the medical students from three different internship sites, whereas external regulation emerged as the crucial factor to make the students perform well academically in the CMLT. The result of this study suggested that strengthening the quality control of the clinical learning environment and improving medical administration may still be the most effective approaches to ensure the quality of clinical medical education.

Formation mechanism and control strategies of N-nitrosodimethylamine (NDMA) formation during ozonation.

This review summarizes major findings over the last decade related to N-nitrosodimethylamine (NDMA) formed upon ozonation, which was regarded as highly toxic and carcinogenic disinfection by-products. The reaction kinetics, chemical yields and mechanisms were assessed for the ozonation of potential precursors including dimethylamine (DMA), N,N-dimethylsulfamide, hydrazines, N-containing water and wastewater polymers, dyes containing a dimethylamino function, N-functionalized carbon nanotubes, guanidine, and phenylurea. The effects of bromide on the NDMA formation during ozonation of different types of precursors were also discussed. The mechanism for NDMA formation during ozonation of DMA was re-summarized and new perspectives were proposed to assess on this mechanism. Effect of hydroxyl radicals (•OH) on NDMA formation during ozonation was also discussed due to the noticeable oxidation of NDMA by •OH. Surrogate parameters including nitrate formation and UV254 after ozonation may be useful parameters to estimate NDMA formation for practical application. The strategies for NDMA formation control were proposed through improving the ozonation process such as ozone/hydrogen peroxide, ozone/peroxymonosulfate and catalytic ozonation process based on membrane pores aeration (MEMBRO3X).

Author Correction: Near-real-time monitoring of global CO2 emissions reveals the effects of the COVID-19 pandemic.

A Correction to this paper has been published: https://doi.org/10.1038/s41467-020-20254-5.

Near-real-time monitoring of global CO2 emissions reveals the effects of the COVID-19 pandemic.

The COVID-19 pandemic is impacting human activities, and in turn energy use and carbon dioxide (CO2) emissions. Here we present daily estimates of country-level CO2 emissions for different sectors based on near-real-time activity data. The key result is an abrupt 8.8% decrease in global CO2 emissions (-1551 Mt CO2) in the first half of 2020 compared to the same period in 2019. The magnitude of this decrease is larger than during previous economic downturns or World War II. The timing of emissions decreases corresponds to lockdown measures in each country. By July 1st, the pandemic's effects on global emissions diminished as lockdown restrictions relaxed and some economic activities restarted, especially in China and several European countries, but substantial differences persist between countries, with continuing emission declines in the U.S. where coronavirus cases are still increasing substantially.

Prediction model of the response to neoadjuvant chemotherapy in breast cancers by a Naive Bayes algorithm.

BACKGROUND AND OBJECTIVE: Chemotherapy is useful to many breast cancer patients, however, it is not therapeutic for some patients. Pathologic complete response (pCR) is an indicator to good response in Neoadjuvant chemotherapy (NAC). In this study, we aimed to develop a way to predict pCR before NAC. METHODS: We retrospectively collected 287 stage II-III breast cancer cases either to a training set (N = 197) or to a test set (N = 90). Fourteen candidate genes were selected from four public microarray data sets. A prediction model was built, by using these fourteen candidate genes and three reference genes expression which were tested by TaqMan probe-based quantitative polymerase chain reaction, after selecting a better algorithm. RESULTS: The Naive Bayes algorithm had a relatively higher predictive value, compared with random forest, support vector machine (SVM), and k-nearest neighbor (knn) algorithms (P < 0.05). This 17-gene prediction model showed a high positive correlation with pCR (odds ratio, 8.914, 95% confidence interval, 4.430-17.934, P < 0.001). By using this model, the enrolled patients were classified into sensitive (SE) and insensitive (INS) groups. The pCR rates between the SE and INS groups were highly different (42.3% vs.7.6%, P < 0.001). The sensitivity and specificity of this prediction model were 84.5% and 62.0%. CONCLUSIONS: Instead of whole transcriptome-based technologies, panel gene expression with tens of essential genes implemented in a machine learning model has predictive potential for chemosensitivity in breast cancers.

(-)-Epigallocatechin-3-gallate protects PC12 cells against corticosterone-induced neurotoxicity via the hedgehog signaling pathway.

It has been acknowledged that environmental stress is a risk factor for developing mental disorders. Chronic stress may contribute to the hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis and a sustained rise in the levels of glucocorticoids (GCs). A high concentration of corticosterone (CORT) damages neuronal PC12 cells. It has been reported that (-)-Epigallocatechin-3-gallate (EGCG), a major component of green tea, exhibits neuroprotective activity. However, the protective effect of EGCG on neuronal cells injured by CORT remains to be elucidated. The present study aimed to identify the effects of EGCG on CORT-injured neuronal PC12 cells and its associated mechanisms of action. CORT-injured PC12 cells were pretreated with EGCG with or without cyclopamine. Cell viability was assessed using an MTT assay, changes in cell morphology were observed using phase-contrast microscopy, cellular apoptosis was assessed by Hoechst 33342 staining, cell proliferation was measured using a cell counting kit-8 assay, mRNA levels were measured by reverse transcription-quantitative polymerase chain reaction and protein expression was assessed using western blot analysis. The current study demonstrated that exposure to high concentrations of CORT induced cytotoxicity and downregulated the Sonic hedgehog pathway (Shh) in PC12 cells. These effects were attenuated by EGCG. However, the EGCG-mediated neuroprotective effects, as well as upregulation of the Shh pathway were all attenuated by the Shh signaling inhibitor cyclopamine. These results indicate that EGCG protects PC12 cells from CORT-induced neurotoxicity via activation of the Shh signaling pathway.

Public's Health Risk Awareness on Urban Air Pollution in Chinese Megacities: The Cases of Shanghai, Wuhan and Nanchang.

This study assessed the public's health risk awareness of urban air pollution triggered by three megacities in China, and the data are the responses from a sample size of 3868 megacity inhabitants from Shanghai, Nanchang and Wuhan. Descriptive analyses were used to summarize the respondents' demographics, perceived health risks from air pollution and sources of health-related knowledge on urban air pollution. Chi-square tests were used to examine if participants' demographics were associated with participant's general attitudes towards current air quality and the three perceived highest health risks due to urban air pollution. We found low rate of satisfaction of current urban air quality as well as poor knowledge of air pollution related indicator. Participants' gender, age and travel experience were found to be associated with the satisfaction of current air quality. The knowledge of air pollution related indicator was significantly affected by respondents' education, monthly income, health status, and sites of study. As many as 46.23% of the participants expressed their feelings of anxiety when exposed to polluted air, especially females, older adults and those with poor health conditions. Most participants believed that coughs/colds, eye problems and skin allergies were the three highest health risks due to urban air pollution based on public education through television/radio, internet and newspaper/magazine. Further public health education is needed to improve public awareness of air pollution and its effects.

Scum sludge as a potential feedstock for biodiesel production from wastewater treatment plants.

The main goal of this study was to compare the component and yield of biodiesel obtained by different methods from different sludge in a wastewater treatment plant. Biodiesel was produced by ex-situ and in-situ transesterification of scum, primary and secondary sludge respectively. Results showed that scum sludge had a higher calorific value and neutral lipid than that of primary and secondary sludge. The lipid yield accounted for one-third of the dried scum sludge and the maximum yield attained 22.7% under in-situ transesterification. Furthermore the gas chromatography analysis of fatty acid methyl esters (FAMEs) revealed that all sludge contained a significant amount of palmitic acid (C16:0) and oleic acid (C18:1) regardless of extraction solvents and sludge types used. However, the difference lay in that oleic acid methyl ester was the dominant component in FAMEs produced from scum sludge while palmitic acid methyl ester was the dominant component in FAMEs from primary and secondary sludge. In addition, the percentage of unsaturated fatty acid ester in FAMEs from scum sludge accounted for 57.5-64.1% of the total esters, which was higher than the equivalent derived from primary and secondary sludge. In brief, scum sludge is a potential feedstock for the production of biodiesel and more work is needed in the future.

[Protective effect of paeoniflorin on the hippocampus in rats with cerebral ischemia-reperfusion through activating cannabinoid receptor 2].

OBJECTIVE: To investigate the protective effect of paeoniflorin on hippocampal neurons in rats subjected to cerebral ischemia and reperfusion through activating cannabinoid receptor 2 (CBR2). METHODS: A total of 144 male SD rats were randomly divided into sham-operation group, cerebral ischemia-reperfusion model group, menstruum group, 10 and 40 mg/kg paeoniflorin groups, 3 mg/kg CBR2 selective antagonist AM630 group, 40 mg/kg paeoniflorin combined with 3 mg/kg AM630 group, and 3 mg/kg CBR2 selective agonist HU308 treatment group. Focal cerebral ischemia-reperfusion models were made by inserting a monofilament suture into internal carotid artery. The neurological scores, infarction volume and cerebral edema were detected carefully to find out the effect of paeoniflorin on neurons. Pathological changes were observed by HE staining. The expressions of caspase-3 and cyclooxygenase 2 (COX-2) in hippocampal CA1 region were determined by immunohistochemistry. RESULTS: Paeoniflorin significantly decreased the neurological scores, infarction volume and cerebral edema. In addition, paeoniflorin relieved the pathological changes and inhibited the expressions of caspase-3 and COX-2 in hippocampus CA1 area. But injecting AM630 in advance obviously counteracted the neuroprotective effect of paeoniflorin. CONCLUSION: CBR2 may participate in the protective effect of paeoniflorin on hippocampal neurons of cerebral ischemia-reperfusion rat models.

INFLUENCE OF PERCEIVED RISK OF SMOKING AND SECOND-HAND SMOKE ON SELF-REGULATORY BEHAVIOR AMONG PREGNANT TAIWANESE WOMEN.

Tobacco use is a global health problem, including in Taiwan. The present study evaluated the perceived risk of smoking and second-hand smoke among pregnant Taiwanese women using a questionnaire. Seven hundred twenty-four pregnant Taiwanese women were recruited from an online parenting community using convenience sampling in 2013. Pregnant smokers and non-smokers had significantly different perceptions regarding risk of smoking and second-hand smoke during pregnancy. Pregnant non-smokers adopted more behaviors to avoid second-hand smoke both at home and in public than pregnant smokers. We conclude that perceived fetal health risks from smoking and second-hand smoke influenced maternal behavior during pregnancy. Pregnant women's perceptions of the risk of tobacco smoke depended on whether their focus in the decision-making process was on prevention or promotion. Understanding the risk factors associated with smoking and exposure to second-hand smoke during pregnancy may help in developing strategies to reduce such exposure.

Tobacco use and environmental smoke exposure among Taiwanese pregnant smokers and recent quitters: risk perception, attitude, and avoidance behavior.

In this study, we conducted an empirical survey of the avoidance behaviors and risk perceptions of active and passive smoking pregnant smokers and recent quitters. We employed an online questionnaire survey by recruiting 166 voluntary participants from an online parenting community in Taiwan. The results of the empirical survey revealed that three-fourths of smokers quit smoking during pregnancy and one-fourth continued smoking. All pregnant women who continued smoking had partners or lived with relatives who smoked. Current smokers and quitters differed significantly in their risk perceptions and attitudes toward smoking during pregnancy. Most pregnant smokers and quitters adopted passive smoking avoidance behaviors at home and in public. Nevertheless, one-fifth of pregnant women chose not to avoid passive smoking. We concluded that most women stop smoking during pregnancy; however, most women continue to be exposed to passive-smoking environments. Perceived fetal health risks and attitudes toward smoking during pregnancy are critical predictors of the anti-smoking behaviors of pregnant women.

Effects of an avidin-biotin binding system on Schwann cells attachment, proliferation, and gene expressions onto electrospun scaffolds.

Effective Schwann cells (SCs) attachment is a prerequisite for the successful construction of tissue-engineered nerve. The present study aimed to investigate the role of an avidin-biotin binding system (ABBS) for neural tissue engineering. The attachment, proliferation, and morphology of biotinylated SCs on avidin-treated scaffolds were examined, and the effects of avidin, biotin, and the avidin-biotin binding system on SCs gene expressions were also studied. The results indicated that the attachment of biotinylated SCs onto avidin-treated scaffolds was promoted obviously within a short time (10 min). Meanwhile, there were no great differences in terms of proliferation and morphology of SCs between the two groups after cultivation for 14 days. The gene expressions of S100, GDNF, BDNF, NGF, CNTF, and PMP22 were up-regulated significantly by biotin rather than aligned scaffolds or avidin. The present study demonstrated that ABBS enhanced the attachment and maturation of SCs onto the electrospun scaffolds without adverse effects on the proliferation of SCs in the long term, suggesting the potential application of ABBS in the neural tissue engineering.

On-line clean-up and screening of oxacillin and cloxacillin in human urine and plasma with a weak ion exchange monolithic column.

A weak ion exchange monolithic column prepared by modifying the GMA-MAA-EDMA (glycidyl methacrylate-methacrylic acid-ethylene glycol dimethacrylate) monoliths with ethylenediamine was applied to remove matrix compounds in biological fluid. Using this monolithic column, on-line clean-up and screening of oxacillin and cloxacillin in human urine and plasma samples had been investigated. Chromatography was performed by reversed-phase HPLC on a C(18) column with ultraviolet detection at 225 nm. Results showed that the ion exchange monolithic column could be used for deproteinization and retaining oxacillin and cloxacillin in human urine and plasma, which provided a simple and fast method for assaying drugs in human urine and plasma.