How to adjust the expected waiting time to improve patient's satisfaction?

BACKGROUND: Long waiting time in hospital leads to patient's low satisfaction. In addition to reducing the actual waiting time (AWT), we can also improve satisfaction by adjusting the expected waiting time (EWT). Then how much can the EWT be adjusted to attribute a higher satisfaction? METHODS: This study was conducted though experimental with hypothetical scenarios. A total of 303 patients who were treated by the same doctor from August 2021 to April 2022 voluntarily participated in this study. The patients were randomly divided into six groups: a control group (n = 52) and five experimental groups (n = 245). In the control group, the patients were asked their satisfaction degree regarding a communicated EWT (T0) and AWT (Ta) under a hypothetical situation. In the experimental groups, in addition to the same T0 and Ta as the control group, the patients were also asked about their satisfaction degree with the extended communicated EWT (T1). Patients in five experimental groups were given T1 values with 70, 80, 90, 100, and 110 min respectively. Patients in both control and experiment groups were asked to indicate their initial EWT, after given unfavorable information (UI) in a hypothetical situation, the experiment groups were asked to indicate their extended EWT. Each participant only participated in filling out one hypothetical scenario. 297 valid hypothetical scenarios were obtained from the 303 hypothetical scenarios given. RESULTS: The experimental groups had significant differences between the initial indicated EWT and extended indicated EWT under the effect of UI (20 [10, 30] vs. 30 [10, 50], Z = -4.086, P < 0.001). There was no significant difference in gender, age, education level and hospital visit history (χ2 = 3.198, P = 0.270; χ2 = 2.177, P = 0.903; χ2 = 3.988, P = 0.678; χ2 = 3.979, P = 0.264) in extended indicated EWT. As for patient's satisfaction, compared with the control group, significant differences were found when T1 = 80 min (χ2 = 13.511, P = 0.004), T1 = 90 min (χ2 = 12.207, P = 0.007) and T1 = 100 min (χ2 = 12.941, P = 0.005). When T1 = 90 min, which is equal to the Ta, 69.4% (34/49) of the patients felt "very satisfied", this proportion is not only significantly higher than that of the control group (34/ 49 vs. 19/52, χ2 = 10.916, P = 0.001), but also the highest among all groups. When T1 = 100 min (10 min longer than Ta), 62.5% (30/48) of the patients felt "very satisfied", it is significantly higher than that of the control group (30/ 48 vs. 19/52, χ2 = 6.732, P = 0.009). When T1 = 80 min (10 min shorter than Ta), 64.8% (35/54) of the patients felt "satisfied", it is significantly higher than that of the control group (35/ 54 vs. 17/52, χ2 = 10.938, P = 0.001). However, no significant difference was found when T1 = 70 min (χ2 = 7.747, P = 0.052) and T1 = 110 min (χ2 = 4.382, P = 0.223). CONCLUSIONS: Providing UI prompts can extend the EWT. When the extended EWT is closer to the AWT, the patient's satisfaction level can be improved higher. Therefore, medical institutions can adjust the EWT of patient's through UI release according to the AWT of hospitals to improve patient's satisfaction.

Alkali-Induced In Situ Formation of Amorphous NixFe1-x(OH)2 from a Linear [M3(COO)6]-Based MOF Template for Overall Electrochemical Water Splitting.

Amorphous and bifunctional electrocatalysts based on 3d transition metals tend to exhibit better performance than their crystalline counterparts and are a promising choice for efficient overall water splitting yet far from being well explored. A 3,6-net metal-organic framework (MOF) of [Ni3(bpt)2(DMF)2(H2O)2]·1.5DMF (Ni-MOF), based on linear [Ni3(COO)6] as a node and [1,1'-biphenyl]-3,4',5-tricarboxylic acid (H3bpt) as a linker, was conveniently prepared via a hydrothermal reaction. Benefitting from the wide compatibility of the octahedral coordination geometry in Ni-MOF for different 3d metal ions, the molecular level and controllable metal doping facilitates the production of the desired Ni/Fe bimetallic MOF. A high-concentration alkali solution of 1 M KOH induced the in situ transformation of the MOF as a precursor to new amorphous electrocatalysts of [Ni(OH)2(H2O)0.6]·H2O [a-Ni(OH)2] and its metal-doped derivatives of a-Ni0.77Fe0.23(OH)2 and a-Ni0.65Fe0.35(OH)2. In particular, the costly organic ligand H3bpt was fully dissolved in the alkaline solution and can be recovered for cyclic utilization by subsequent acidification. The obtained amorphous hydroxide was deduced to be loose and defective layers containing both coordinated and lattice water based on combined characterizations of TG, IR, Raman, XPS, and sorption analysis. As opposed to the crystalline counterpart of Ni(OH)2 with stacked packing layers and an absent lattice water, the abundant catalytic active sites of the amorphous electrocatalyst endow good performance in both oxygen evolution reaction (OER) and hydrogen evolution reaction (HER). The bifunctional a-Ni0.65Fe0.35(OH)2 coated on nickel foam realizes small overpotentials of 247 and 99 mV for OER and HER, respectively, under a current density of 10 mA cm-2, which can work with a cell voltage of merely 1.60 V for overall water splitting. This study provides an efficient strategy for widely screening and preparing new functional amorphous materials for electrocatalytic application.

Color-Tuning and Near-Sunlight White Emission in Highly Stable Rod-Spacer MOFs with Defective Dicubane Based Lead(II)-Carboxyl Chains.

The active lone pair electron effect and highly flexible coordination geometry of Pb2+ prevented the rational construction of metal-organic frameworks (MOFs) but promoted excellent fluorescence tuning. The regulation on organic and alkali templates facilitated the assemblies of three new Pb-MOFs: [Pb2(pia)2(DMA)]·DMA (1), [Pb2(pia)2(DMF)]·1.5DMF (2), and [Pb2(pia)2(DMF)]·NEt3 (3). They were rigid rod-spacer and double-walls frameworks, which possess defective dicubane [Pb4O6] based metal-carboxyl chains constructed from both semidirected and holodirected Pb2+ ions. These MOFs exhibited thermal stability up to 370 °C and unprecedented chemical stability in H2O and acidic (pH 2) and alkaline (pH 12) aqueous solutions, found for the first time in Pb-MOFs. A single-phase and rare-earth-free white-emitting phosphor, 1, was screen out, which showed a near-sunlight and human-vision-friendly broadband spectrum covering the full visible region, possessing the close-to-pure-white chromaticity coordinates of (0.332, 0.347), a near-daylight color temperature of 5696 K, and a high color rendering index of 95. The replacement of DMF as apical ligand and guest in 2 resulted in an intrinsic single and narrow emission at 562 nm with yellow color. The convenient yellow-and-blue color-tuning until white for 2 was realized by either solution or solid blending with blue-emissive H2pia, benefited from their highly matched excitation spectra. Using large NEt3 as template guest induced great framework distortion for 3 and led to white emission with chromaticity coordinates of (0.302, 0.294), stemming from nonequivalent dual emission at 450 and 545 nm. In-depth structure analysis revealed intra-/interchain Pb···Pb interactions in the lead(II)-carboxyl chains greatly affected the photochemical output.

Near sunlight continuous broadband white-light emission by single-phase Zn(ii)-1,3,5-benzenetricarboxylate MOFs.

A new white light MOF was constructed from low-cost 1,3,5-benzenetricarboxylate and nontoxic Zinc(ii) ions. The compound possessed the most sophisticated crystallographic asymmetric unit containing sixteen metal ions and twelve ligands. Near sunlight and human eye friendly white-light emission under a wide ultraviolet radiation range of 300 to 390 nm was observed for this photoemitter, without the use of expensive rare earth and complicated organic ligands.

Improving outpatient satisfaction by extending expected waiting time.

BACKGROUND: Long waiting times result in low satisfaction. Although several methods are used to shorten the actual waiting time (AWT) in large hospitals of China, the outpatients still have a long actual waiting time. This study aimed to explore whether satisfaction could be improved by extending the expected waiting time (EWT) instead of shortening the AWT. METHODS: In October 2016, 257 students in grade one voluntarily participated in this study. They came from 6 classes, which were randomly divided into two groups: 3 classes comprised the control group (n = 125) and 3 classes comprised the experimental group (n = 132). Unfavorable information (UI) was given to the experimental group alone. Six distinct questionnaires were designed to explore the effects of UI on EWT and the effects of an extended EWT on satisfaction. Satisfaction scores ranged from 0 to 100: 0-25, very dissatisfied; 26-50, dissatisfied; 51-75, satisfied; 76-100, very satisfied. Each participant finished one of the 6 questionnaires online. Of the 257 questionnaires, 233 were valid. RESULTS: Before UI was given, the initial EWT (T0) was similar between the control and experimental groups (Z = -1.924, P = 0.054). Under the effects of UI, individuals in the experimental group extended their EWT (T1) from 121.0 to 180.0 min (Z = -6.367, P < 0.001). Females prolonged their EWT longer than males did (Z = -2.239, P = 0.025). Then, this study defined T0 = 1.5 h and T1 = 2.5 h, and compared the satisfaction scores between the control and experimental groups: a significant difference was found when AWT =2.0 h (t = - 3.568, P = 0.001), but not when AWT =3.0 h (t = - 0.718, P = 0.475) or when AWT =1.0 h (t = - 1.088, P = 0.280). When AWT =3.0 h, fewer individuals felt "very dissatisfied" in the experimental group (21.2%) than in the control group (44.7%) (χ2 = 4.368, P = 0.037). CONCLUSIONS: EWT was found to be extended greatly by UI. An extended EWT could improve satisfaction scores.

Development of a New RT-PCR with Multiple Primers for Detecting Southern African Territories Foot-and-mouth Disease Viruses.

INTRODUCTION: The extremely high genetic variation and the continuously emerging variants of foot-and-mouth disease virus (FMDV) of Southern African Territory (SAT) serotypes including SAT1, SAT2, and SAT3 make it necessary to develop a new RT-PCR for general use for monitoring viruses based on the updated genome information. MATERIAL AND METHODS: A FMDV SAT-D8 one-step RT-PCR was established based on the 1D2A2B genes of the SAT serotype viruses with a multiplex primer set. FMDV A, O, C, and Asia 1 serotypes, other vesicular disease viruses, inactivated SAT viruses, and 125 bovine, ovine, caprine and porcine tissue samples collected from the Chinese mainland were included for evaluating the assay. RESULTS: The new RT-PCR was proven to be specific without cross-reactions with Eurasian FMDV, swine vesicular disease virus (SVDV), Seneca valley virus (SVV), or other common viral pathogens of cattle, sheep, goat, and pig. An around 257 bp-sized amplicon clearly appeared when the inactivated SAT viruses were detected. However, all 125 samples collected from FMDV-susceptible animals from the Chinese mainland which has not known SAT epidemics showed negative results. CONCLUSIONS: A FMDV SAT-D8 one-step RT-PCR is a promising method for primary screening for FMDV SAT serotypes.

Construction of a chloroplast protein interaction network and functional mining of photosynthetic proteins in Arabidopsis thaliana.

Chloroplast is a typical plant cell organelle where photosynthesis takes place. In this study, a total of 1,808 chloroplast core proteins in Arabidopsis thaliana were reliably identified by combining the results of previously published studies and our own predictions. We then constructed a chloroplast protein interaction network primarily based on these core protein interactions. The network had 22,925 protein interaction pairs which involved 2,214 proteins. A total of 160 previously uncharacterized proteins were annotated in this network. The subunits of the photosynthetic complexes were modularized, and the functional relationships among photosystem I (PSI), photosystem II (PSII), light harvesting complex of photosystem I (LHC I) and light harvesting complex of photosystem I (LHC II) could be deduced from the predicted protein interactions in this network. We further confirmed an interaction between an unknown protein AT1G52220 and a photosynthetic subunit PSI-D2 by yeast two-hybrid analysis. Our chloroplast protein interaction network should be useful for functional mining of photosynthetic proteins and investigation of chloroplast-related functions at the systems biology level in Arabidopsis.

[Establishment of a colloid gold-immunochromatography assay for detection of type Asia I foot-and-mouth disease virus].

AIM: To establish a colloid gold-immunochromatography assay (GICA) for detecting type Asia I foot-and-mouth disease virus (FMDV). METHODS: Colloidal gold was obtained by reducing the gold chloride with sodium citrate and then it was coupled with the purified anti-FMDV type Asia I antibody.The purified anti-FMDV type Asia I antibody and the goat anti-Guinea pig IgG were wrapped onto the nitrocellulose membrane as test line (T line) and control line (C line). The GICA strip was assembled with the purified antibody labelled with colloidal gold and the nitrocellulose containing antibody. The sensitivity, specificity and stability of GICA strip were evaluated in the diagnosis of FMD viral antigen from clinical samples. RESULTS: The strip was highly sensitive to FMDV type Asia I(0.116 mg/L) and it had the same result for positive specimens tested thrice. Cross tests proved no cross reaction was found with other serotype FMDV and Swine vesicular disease (SVD) antigen.The corresponding rate of GICA with RIHA was 96.87% for detecting the field sample. The stably test found the strip could be stored for 12 months. CONCLUSION: The GICA strip is a simple and rapid immunochromatographic test strip for the detection of FMDV type Asia I with high sensitivity and specificity.

[Distribution of hepatitis B virus genotypes in patients with chronic hepatitis B virus infection among 12 cities in China].

OBJECTIVE: To investigate the distribution of hepatitis B virus (HBV) genotypes in patients with chronic HBV infection among 11 cities of China. METHODS: A total of 1214 serum samples from patients with chronic HBV infection were collected in 11 cities of China, including Beijing, Qingyuan, Shenzhen, Shijiazhuang, Hanchuan, Nanjing, Changchun, Liaocheng, Jinan, Ningbo and Wenzhou. Genotypes of the 1214 HBV strains were identified by PCR method with type specific primers. Parts of the results were confirmed by direct sequencing analysis of PCR products. RESULTS: Among the 1214 patients with chronic HBV infection, 0.7% (9/1214)were genotype A, 28.4% (345/1214)genotype B, 58.4% (709/1214) genotype C, and 12.4% (151/1214) genotype B and genotype C mixed infection. No other genotypes were found. Genotype C was predominant in the northern part of China, such as Changchun, Beijing, Shijiazhuang,while genotype B was more commonly seen in south of China. 71.4% (20/28) for patients from Qingyuan and 63.6% (70/110) from Shenzhen were infected with genotype B. CONCLUSION: HBV genotypes had distinct geographic distribution. Genotype B and C the predominant strains in patients with chronic HBV infection in China. Genotype C was predominantly identified in the northern part of China versus genotype B the south.

[State transition of the photosynthetic apparatus in plant].

State transition of the photosynthetic apparatus in plants is a short-term adaptation mediated mainly by the reversible phosphorylation of the main light-harvesting complex protein (LHCII) and its migration between photosystem I (PSI) and photosystem II (PSII). In higher plants and Chlamydomonas, LHCII phosphorylation is mainly controlled by the redox state of plastoquinone pool and cytochrome b(6)f complex, while salt could induce a redox-independent LHCII phosphorylation via transient changes in ion concentrations in Dunaliella. State transition can balance the distribution of excitation energy between PSII and PSI by changes in light absorption cross section and excitation energy spillover between the two photosystems. The preliminary results got in the studies of green algae reveal that state transition can also balance the ATP supply and demand.

[Distribution and clinical significance of hepatitis B virus (HBV) genotypes and subtypes in HBV-infected patients].

OBJECTIVE: To study hepatitis B virus (HBV) genotype and subtype distribution and its clinical significance in HBV-infected patients. METHODS: We used type/subtype-specific primers and PCR to detect HBV genotype and subtype of 445 HBV-infected patients from Beijing, Changchun, Hanchuan Shenzhen, Qingyuan and Nanjing, including 7 acute hepatitis (AH), 36 asymptomatic HBV carriers (ASC), 352 chronic hepatitis (CH), 28 liver cirrhosis (LC), and 22 hepatocellular carcinoma (HCC) cases. Genotyping results were confirmed by PCR product sequencing. RESULTS: Among 445 HBV-infected patients, the proportions of genotype B, C, and B/C were 32.6% (145/445), 53.7% (239/445), and 13.7% (61/445), respectively. In genotype C, 13 (5.4%) were subtype C1, 135 (56.5%) were subtype C2, and the remaining 91 (38.1%) were neither C1 nor C2. In genotype B, 100 (69.0%) were subtype Ba, 25 (17.2%) subtype Bj, and the other 20 (13.8%) were neither Ba nor Bj. In genotype B/C, 15 (24.6%) were Ba/C2, 8 (13.1%) Bj/C2, 6 (9.8%) Ba/C1, 3 (4.9%) Bj/C1, 11 (18.0%) Ba/neither C1 nor C2, 7 (11.5%) Bj/neither C1 nor C2, and 6 (9.8%) neither Ba nor Bj/neither C1 nor C2, 2 (3.3%) neither Ba nor Bj/C1, 3 (4.9%) neither Ba nor Bj/C2. The HBV genotype and subtype distribution we found exhibited significant differences in the various clinical types of HBV infection tested, and showed that genotype C was predominant among patients with liver cirrhosis (78.6%) and hepatocellular carcinoma (86.4%) while genotype B was predominant in asymptomatic carriers (72.2%). In addition, genotype and subtype distribution showed no significant differences between male and female patients, but genotype and subtype distribution showed significant differences in patients positive or negative with HBeAg. CONCLUSION: Subtypes Ba and C2 are predominant in patients with hepatitis B from these 6 cities, and genotype C may be associated with the development of liver cirrhosis and hepatocellular carcinoma.

Demographic, clinical, and virological characteristics of hepatocellular carcinoma in Asia: survey of 414 patients from four countries.

Demographic, etiological, clinical characteristics and treatment of hepatocellular carcinoma (HCC) were surveyed in 414 patients in Asia, including 107 from China, 15 from India, 101 from Indonesia and 191 from Japan. Males predominated in all countries, accounting for up to 75%. The mean +/- SD age at the development of HCC was about 10 years older for the patients from Japan (63.8 +/- 9.5, P < 0.001) and India (63.1 +/- 11.2, P < 0.05) than those from China (54.0 +/- 13.7) and Indonesia (53.7 +/- 14.2). Hepatitis B surface antigen (HBsAg) in serum was detected in 67% of patients from China who were tested, 27% from India, 21% from Indonesia and 18% from Japan, whereas antibody to hepatitis C virus was detected in 4%, 53%, 40% and 70%, respectively; co-occurrence of hepatitis B and C infections was seen only in 7%, 0%, 2%, and 1%, leaving an etiology other than hepatitis viruses in 22%, 20%, 36% and 11%. HCC was diagnosed primarily by ultrasonography in China (43%) and Japan (52%), and on physical examination in India (60%) and Indonesia (52%). The size of the largest tumor exceeded 5.0 cm in diameter only in 24% of the patients from Japan, much less often than in 67%, 87%, and 71%, respectively, of those from China, India and Indonesia (P < 0.001). The most favored treatment was chemolipidolization in China (81%) and Japan (81%), whereas it was transarterial embolization in India (13%) and Indonesia (26%). These results highlight common as well as distinct characteristics of HCC in Asia, and warrant the need for close cooperation toward early diagnosis and effective treatment of HCC.