[Effect of sleep quality on day cycle fatigue in ward nurses].

OBJECTIVE: To explore the effect of sleep quality on day cycle work fatigue in ward nurses. METHODS: Through a cluster sampling of three hospitals, 479 clinical frontline nurses were investigated in Hangzhou, Zhejiang, China. Using Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality; Using self-reported work-related fatigue symptom scale to evaluate day cycle fatigue status; common information was also collected. RESULTS: The sleep quality of ward nurses is generally poor, with total PSQI score 7.31 +/- 3.45. 41.75% ward nurses have total PSQI score over 7, the total PSQI score showed a negative linear correlation with educational background (r = -0.11, P = 0.01), educational background also represented a negative correlation with sleep quality, sleep latency and sleep duration; there are no correlation between sleep and marriage, work age, professional title and duty. Work-related fatigue was closely correlated with sleep quality: Total PSQI score showed a positive correlation with four daytime points fatigue in the next day (r = 0.42, r = 0.34, r = 0.25, r = 0.33, P < 0.01). Total PSQI score is also related to five fatigue factors in four daytime points. There are significant correlation between seven factors of sleep and fatigue levels of four time points. Multiple regression analysis showed that Sleep quality, day function; sleep disturbance and drug use pay important part in work fatigue. There is no correlation between sleep quality and delayed off-work (r = 0.06, P = 0.17). CONCLUSION: Managers should think highly of sleep quality of ward nurses, acknowledge its degree of work fatigue and apply evidence based methods arrange work responsibility and follow sheet, then rationalize human resources management, emphasize sleep hygiene education, improve sleep quality and reduce work fatigue.

[Impact of Tourism on Bacterial Communities of Karst Underground River: A Case Study from Two Caves in Fengdu, Chongqing].

In this research, the bacterial community compositions of underground water in a tourist and pristine cave were studied. Xueyu Cave and Shuiming Cave are tourist and pristine caves, respectively, in the same karst cave system located in Chongqing, southwest China. To understand the impact of tourism on bacterial community compositions in underground water that flows through the caves, filtered materials from water were collected, and 16S rDNA gene sequences were obtained by high-throughput sequencing. The Shuiming Cave (the pristine cave) had less diversity than Xueyu Cave (the tourist cave) based on the Shannon's diversity index according to Illumina operational taxonomic units (OTUs). Proteobacteria, represented mostly by γ-Proteobacterium and Bacteroidetes, dominated both systems. OTUs from Shuiming Cave were dominated by 38% Proteobacteria, 24% Chlorobi, and 19% Bacteroidetes. In the Xueyu Cave, OTUs from upstream samples were comprised of 62% Proteobacteria but comprised 64% in the downstream samples. In the Xueyu Cave, Bacteroidetes accounted for 11% of the total OTUs in the upstream sample and 16% in the downstream. Among the γ-Proteobacterium and Bacteroidetes, Acinetobacter, Pseudomonas spp., and Flavobacteriaceae, which are related to potentially pathogenic species, were prevalent in the Xueyu Cave, while Methylococcaceae-uncultured, Methylomonas spp., and Methylobacter, all methane-oxidizing bacteria, had high relative abundances in the Shuiming Cave. These results revealed that potentially more pathogenic bacteria are present in the stream waters from the tourist cave, which has important implications for the protection of tourist caves. The RDA analysis of the environmental factor and bacteria community in groundwater showed that the distribution of pathogenic bacteria was positively correlated with the cave air CO2, and the Spearman correlation analysis of the two environmental factors indicated that the influence of the number of tourists on the structure of the bacterial community in the groundwater was more obvious and led to the disappearance of a large number of native bacteria. We proposed that tourist caves control the number of daily tourists and that they enter in batches and increase the import and export of closed devices to avoid the cave air exchange inside and outside. In addition, it was recommended that they increase the import and export of sterilization devices to reduce tourists with bacteria and organic matter, and avoid leaving garbage in the hole to avoid cave microbial exchange inside and outside. A reduction in the fixed lighting inside caves should be required to reduce long exposure, since the tourists can bring individual source lighting.

[Impacts of Land Use on the Source of Dissolved Fatty Acids in Epikarst Spring During Rainy Season].

Fatty acids were quantitatively analyzed by gas chromatography-mass spectrometer (GC-MS). Dissolved fatty acids were collected from Nanchuan epikarst spring. The results of BQ, LQ, HQ showed that the average contents of fatty acids were 14870, 12912 and 8801 ng·L-1 from May to July, respectively, and followed the order of SFA> MUFA> BrFA> PUFA. The monomers with highest content were C16:0 and C18:0. From May to July, the fatty acid content increased in BQ , LQ, HQ. The differences in vegetation coverage and bedrock bare rate, as well as the interaction of the dilution effect and soil transfer increase, led to the changes in content and the composition of the fatty acids. Based on the molecular characteristic indices of fatty acids, like H/L, CPIh, TARFA about BQ, LQ, HQ, and contents of fatty acids which were mainly originated from bacteria, phytoplankton or terrigenous higher plant, it was indicated that fatty acids were mainly originated from higher plant in LQ in May, from phytoplankton input in HQ in July, while from bacteria in the other months in LQ, HQ and from May to July in BQ.

[Modeling the Influencing Factors of Karstification and Karst Carbon Cycle in Laboratory].

To analyze the influencing factors of karstification and karst carbon cycle, a simulation experiment was carried out and 6 soil columns were designed. The results showed that the content of H2O4, hydrodynamic condition and thickness of the soil had important influence on karstification and karst carbon cycle. For the soil columns which were covered by the same thickness of soil, the concentrations of Ca2+ + Mg2+ and SO4(2-) followed the order of B20-2 > B20-1 > B20-3, B50-2 > B50-1 > B50-3. This meant that input of H2SO4 enhanced the karstification and increasing infiltration water had significant dilution effect on the chemical properties. For the soil columns with different thickness of soil but with the same slag pile and hydrodynamic conditions, the concentrations of Ca2+ + Mg2+ and SO4(2-) followed the order of B50-1 > B20-1, B50-2 > B20-2, B50-3 > B20-3. It was demonstrated that more carbonate rock was dissolved under the thick soil columns. In addition, the net consumption of CO2 mainly depended on the content of H2SO4 in this experiment due to slight contribution of H2CO3 to carbonate rock dissolution. More content of H2SO4 brought about less net consumption of C02, but B50-2 was an exception. Organic matter and other nutrients might be input into deep soil with the slag pile, and they promoted the production of soil C)2. Therefore, more CO2 was consumed due to the increased contribution of H2CO to karstification.

[Influencing Factors for Hydrochemistry and δ13CDIC of Karst Springs].

To gain more knowledge on the change of karst spring and its influencing factors, the hydrochemistry and δ13CDIC of Baishuwan spring, Lanhuagou spring and Hougou spring were monitored in rainy season (from June 2014 to October 2014) and contrasted with the results obtained in dry season. The results showed that more carbonate rock was dissolved and less CO2 was consumed in rainy season. And for Lanhuagou spring and Hougou spring, the CO2 consumption was less than the production. Compared to other months in rainy season, the least carbonate rock dissolution and the most CO2 consumption were observed in July 2014. Influenced by hydrodynamic condition, carbonate rock dissolved by HNO3 and H2SO4 increased while that dissolved by H2CO3 decreased during the rainy season. The δ13CDIC increased due to the HNO3 and H2SO4 dissolution of carbonate rock and the dehydration of HCO3-. Therefore, δ13CDIC correlated negatively to HCO3- concentration and positively to NO3- + SO(4)2- concentration. It was indicated that the hydrochemistry and δ13CDIC of karst springs were affected by the HNO3, H2SO4 and hydrodynamic condition.

A stewardship intervention program for safe medication management and use of antidiabetic drugs.

BACKGROUND: Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team's integrated endeavors to enhance safe medication management and use of antidiabetic drugs. METHODS: A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People's Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually. RESULTS: The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly "look-alike" and "sound-alike" NovoMix 30(®) (biphasic insulin aspart) and NovoRapid(®) (insulin aspart) has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011) to 96% (fourth quarter 2011) (P<0.05). The number of medication administration errors related to insulin continuously decreased from 20 (2011) to six (2014). The occurrence rate of hypoglycemia in non-endocrinology ward diabetes inpatients during 2011-2013 was significantly less than that in 2010 (5.03%-5.53% versus 8.27%) (P<0.01). Percentage of correct management of hypoglycemia by nurses increased from 41.5% (April 2014) to 67.2% (August 2014) (P<0.01). The percentage of outpatient diabetes patients receiving standard insulin injection education increased from 80% (April 2012) to 95.2% (October 2012) (P<0.05). Insulin injection techniques among diabetes outpatients who started to receive insulin were better than indicated in data from two questionnaire surveys in the literature, including the percentage checking injection sites prior to injection (85.6%), priming before injection (98.1%), rotation of injecting sites (98.1%), remixing before use (94.5%), keeping the pen needle under the skin for >10 seconds (99.4%), and using the pen needle only once (88.7%). On-site inspection indicated of great improvement in the percentage of drug-related problems in the antidiabetes regimen between the first and second quarter of 2014 (1.08% versus 0.28%) (P<0.05). CONCLUSION: Quality improvements in safe medication management and use of antidiabetic drugs can be achieved by multidisciplinary collaboration among pharmacists, nurses, physicians, and information engineers.

[Difference of Karst Carbon Sink Under Different Land Use and Land Cover Areas in Dry Season].

In order to identify the distinction of soil CO2 consumed by carbonate rock dissolution, Baishuwan spring, Lanhuagou spring and Hougou spring were selected as objects to monitor the hydrochemistry from November 2013 to May 2014. The results showed that the highest HCO3- concentration was observed in Baishuwan spring which is covered by pine forest, while the lowest HCO3- concentration was observed in Hougou spring which is mainly covered by cultivated land. In Baishuwan spring, HCO3- was mainly derived from carbonic acid dissolving carbonate rock and the molar ratio between Ca(2+) + Mg2+ and HCO3- was close to 0. 5; while the molar ratio between Ca(2+) + Mg2+ and HCO3- exceeded 0.5 because the carbonate rock in Lanhuagou spring and Hougou spring was mainly dissolved by nitric acid and sulfuric acid. Because of the input of litter and the fact that gas-permeability of soil was limited in Baishuwan spring catchment, most of soil CO2 was dissolved in infiltrated water and reacted with bedrock. However, in Lanhuagou spring catchment and Hougou spring catchment, porous soil made soil CO2 easier to return to the atmosphere in the form of soil respiration. Therefore, in order to accurately estimate karst carbon sink, it was required to clarify the distinction of CO2 consumption by carbonate rock dissolution under different land use and land cover areas.

[Influences of Biological Processes on Geochemical Characteristics: An Example of a Mountain Karst Pool in Spring Season].

Karst hydrologic system is quite sensitive to the surrounding environment, which leads to changes in the quality of karst water within diel, hours even minutes. Many surface water undergoes changes of pH value, dissolved gas, trace elements, nutrition and other hydrochemical parameters in a daily timescale. The Shuifang spring and its draining pool are located in Jinfo Mountain in Chongqing, the middle karst mountain belonging to temperate climate with an elevation of about 2050 m a. s. l. Diel cycles of geochemistry were measured for three days and nights to investigate the influence of biological processes on the geochemistry of the karst pool. Results showed that the geochemistry of Shuifang spring didn't exhibit diel variations, while the pool water appeared diurnal change, even if the variation amplitudes of water temperature, pH value, dissolved oxygen and specific conductance were slight. Under different weather conditions, variation amplitude of the geochemical parameters in the pool appeared discriminatory. pCO2 and concentrations of Ca2+, dissolved inorganic carbon (DIC) decreased during the day time and increased in night, while calcite saturation index (SIc) showed an inverse trend. Those phenomena might be attributed to water temperature change, calcite precipitation or dissolution and the process of metabolism by the aquatic plants in the pool. It was found that the influence of water temperature change on pCO2 accounted for only 0.79% to 10.01% by means of calculation of Henry constants. DIC loss contributed by physical factors, such as temperature and calcite precipitation, accounted for 39%, whereas the metabolism of aquatic plants accounted for 61%.