How context links to best practice use in long-term care homes: a mixed methods study.

BACKGROUND: Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. METHODS: In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. RESULTS: Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. CONCLUSIONS: Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.

Effect of Face Masks on Voice Quality Associated with Young and Older Chinese Adult Speakers.

OBJECTIVES: Face masks have become important after the pandemic, but the change in voice when wearing a face mask is still unclear. The study investigated the effect of face masks on the acoustic and perceptual characteristics of voice quality associated with young and older Chinese adults. METHODS: Voice samples of the sustained vowel /a/ and continuous speech produced by 44 older and 61 young adults with and without an ASTM level-3 surgical face mask were recorded and analyzed. Perceptual and acoustic parameters including mean fundamental frequency (F0) and intensity, perturbation measures (jitter and shimmer), harmonic-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), and long-term average spectrum (LTAS) measures were obtained and compared. RESULTS: When comparing masked to unmasked voices, for both male and female speakers, F0 and intensity showed no significant changes, except for F0 of continuous speech, which increased significantly. Meanwhile, perturbation measures such as jitter and shimmer were reduced, while HNR and CPPs increased. In addition, LTAS measures included low-frequency mean spectral energy (MSE), high-frequency MSE, and spectral tilt (ST), which were different. For perceptual measures, the overall grade of dysphonia, and roughness were reduced, except for the breathiness among older male speakers, while the other vocal qualities were not changed. Between young and older speakers, significant differences in shimmer, CPPs, and perceived breathiness among male speakers, and low-frequency MSE among female speakers were found. CONCLUSION: Wearing a surgical mask appeared to change the perceived voice quality. This is supported by the change in perturbation and LTAS measures, and HNR and CPPs values. In addition, some differences between young and older adults were observed. Oral Communication effectiveness may be affected when wearing surgical masks due to changes in voice quality. Additionally, clinicians need to exercise hightened caution in evaluating the voice quality of clients when wearing face masks.

Pb(II) and chlortetracycline immobilization and economy of biologically amended coastal soil.

To study the pollutants immobilization and economy of biologically amended coastal soil, Alternanthera philoxeroides biomass (Bm), biochar (Bc), and dodecyldimethyl betaine (BS) modified Bc (BS-Bc) were used to amend coastal soil from Jialing, Fu, and Qu River. A runoff experiment was used to simulate the longitudinal migration and morphological changes of Pb(II) and chlortetracycline (CTC) in each amended coastal soil, and the economy of pollutants immobilization by different amended coastal soil were compared. The equilibrium time of Pb(II) and CTC in each amended coastal soil ranked in the order of BS-Bc-amended > Bc-amended > Bm-amended > unamended coastal soil. The average Pb(II) and CTC flow rate in different amended coastal soils presented an opposite trend with the equilibrium time. Pb(II) and CTC content all reduced with the increasing runoff length. Under the same soils, the content changes presented Bm and Bc amended > unamended > BS-Bc amended. CEC and clay content of coastal soils were the key factors affecting Pb(II) and CTC immobilization. The immobilization mechanisms were electrostatic attraction, ion exchange, surface precipitation, and complexation to Pb(II) and ion exchange and complexation to CTC. The economy of Pb(II) and CTC immobilization ranged from 0.5 to 9.0 and from 1.0 to 5.4 mg/¥, and coastal soil amended by BS-Bc had practical application value and high economy.

The Association of Nursing Homes' Organizational Context With Care Aide Empowerment: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. RESEARCH DESIGN AND METHODS: This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. RESULTS: Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). DISCUSSION AND IMPLICATIONS: In this study, modifiable elements of organizational context (i.e., culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care.

Health literacy in patients with gout: A latent profile analysis.

OBJECTIVES: Understanding the health literacy status of patients with gout diagnosis is essential for improving the health of this population. Our study aimed to investigate the latent profiles of health literacy in patients with gout and to analyze differences in characteristics across potential profiles. METHODS: This was a cross-sectional study. Eligible participants attended the Shandong Gout Medical Center, from March 2023 to May 2023 and self-reported gout diagnosis. We used the Health Literacy Scale for Patients with Gout designed and validated by our team. The scale had good reliability and validity among patients with gout. 243 patients completed the Demographic Information Questionnaire and the Health Literacy Scale for Patients with Gout. We used latent profile analysis to identify the latent profiles of gout patients' health literacy. We used Chi-square tests with Bonferroni correction to analyze differences in demographics and illness characteristics across identified profiles. RESULTS: Three profiles of patients with gout emerged (prevalence): the low literacy-low critical group (21.81%), the moderate literacy group (42.79%), and the high literacy-stable group (35.39%). The three groups differed in age, education level, monthly income, disease duration, and place of residence (P<0.01). CONCLUSIONS: The health literacy of patients with gout was heterogeneous. Healthcare professionals should adopt targeted interventions based on the characteristics of each latent health literacy profile to improve the health literacy level of patients with gout.

Comprehensive single-cell analysis deciphered microenvironmental dynamics and immune regulator olfactomedin 4 in pathogenesis of gallbladder cancer.

OBJECTIVE: Elucidating complex ecosystems and molecular features of gallbladder cancer (GBC) and benign gallbladder diseases is pivotal to proactive cancer prevention and optimal therapeutic intervention. DESIGN: We performed single-cell transcriptome analysis on 230 737 cells from 15 GBCs, 4 cholecystitis samples, 3 gallbladder polyps, 5 gallbladder adenomas and 16 adjacent normal tissues. Findings were validated through large-scale histological assays, digital spatial profiler multiplexed immunofluorescence (GeoMx), etc. Further molecular mechanism was demonstrated with in vitro and in vivo studies. RESULTS: The cell atlas unveiled an altered immune landscape across different pathological states of gallbladder diseases. GBC featured a more suppressive immune microenvironment with distinct T-cell proliferation patterns and macrophage attributions in different GBC subtypes. Notably, mutual exclusivity between stromal and immune cells was identified and remarkable stromal ecosystem (SC) heterogeneity during GBC progression was unveiled. Specifically, SC1 demonstrated active interaction between Fibro-iCAF and Endo-Tip cells, correlating with poor prognosis. Moreover, epithelium genetic variations within adenocarcinoma (AC) indicated an evolutionary similarity between adenoma and AC. Importantly, our study identified elevated olfactomedin 4 (OLFM4) in epithelial cells as a central player in GBC progression. OLFM4 was related to T-cell malfunction and tumour-associated macrophage infiltration, leading to a worse prognosis in GBC. Further investigations revealed that OLFM4 upregulated programmed death-ligand 1 (PD-L1) expression through the MAPK-AP1 axis, facilitating tumour cell immune evasion. CONCLUSION: These findings offer a valuable resource for understanding the pathogenesis of gallbladder diseases and indicate OLFM4 as a potential biomarker and therapeutic target for GBC.

Organizational Context and Facilitation Interactions on Delirium Risk in Long-Term Care: A Cross-Sectional Study.

OBJECTIVES: Organizational context (eg, leadership) and facilitation (eg, coaching behaviors) are thought to interact and influence staff best practices in long-term care (LTC), including the management of delirium. Our objective was to assess if organizational context and facilitation-individually, and their interactions-were associated with delirium in LTC. DESIGN: Retrospective cross-sectional analysis of secondary data. SETTING AND PARTICIPANTS: We included 8755 residents from 281 care units in 86 LTC facilities in 3 Canadian provinces. METHODS: Delirium (present/absent) was assessed using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS 2.0). The Alberta Context Tool (ACT) measured 10 modifiable features of care unit organizational context. We measured the care unit's total care hours per resident day and the proportion of care hours that care aides contributed (staffing mix). Facilitation included the facility manager's perception of RAI-MDS reports' adequacy and pharmacist availability. We included unit managers' change-oriented organizational citizenship behavior (OCB) and an item reflecting how often care aides recommended policy changes. Associations of organizational context, facilitation, and their interactions with delirium were analyzed using mixed-effects logistic regressions, controlling for covariates. RESULTS: Delirium symptoms were prevalent in 17.4% of residents (n = 1527). Manager-perceived adequacy of RAI-MDS reports was linked to reduced delirium symptoms [odds ratio (OR) = 0.63]. Higher care hours per resident day (OR = 1.2) and an available pharmacist in the facility (OR = 1.5) were associated with increased delirium symptoms. ACT elements showed no direct association with delirium. However, on care units with low social capital scores (context), increased unit managers' OCB decreased delirium symptoms. On care units with high vs low evaluation scores (context), increased staffing mix reduces delirium symptoms more substantially. CONCLUSIONS AND IMPLICATIONS: Unit-level interactions between organizational context and facilitation call for targeted quality improvement interventions based on specific contextual factors, as effectiveness may vary across contexts.

Floralozone regulates MiR-7a-5p expression through AMPKα2 activation to improve cognitive dysfunction in vascular dementia.

BACKGROUND: The pathogenesis of vascular dementia (VD) is complex, and currently, no effective treatments have been recommended. Floralozone is a colorless liquid first discovered in Lagotis Gaertn. Recently, its medicinal value has been increasingly recognized. Our previous study has demonstrated that Floralozone can improve cognitive dysfunction in rats with VD by regulating the transient receptor potential melastatin 2 (TRPM2) and N-methyl-D-aspartate receptor (NMDAR) signaling pathways. However, the mechanism by which Floralozone regulates TRPM2 and NMDAR to improve VD remains unclear. AMP-activated protein kinase (AMPK) is an energy regulator in vivo; however, its role of AMPK activation in stroke remains controversial. MiR-7a-5p has been identified to be closely related to neuronal function. PURPOSE: To explore whether Floralozone can regulate the miR-7a-5p level in vivo through AMPKα2 activation, affect the TRPM2 and NR2B expression levels, and improve VD symptoms. METHODS: The VD model was established by a modified bilateral occlusion of the common carotid arteries (2-VO) of Sprague-Dawley (SD) rats and AMPKα2 KO transgenic (AMPKα2-/-) mice. Primary hippocampal neurons were modeled using oxygen and glucose deprivation (OGD). Morris water maze (MWM) test, hematoxylin-eosin staining (HE staining), and TUNEL staining were used to investigate the effects of Floralozone on behavior and hippocampal morphology in rats. Minichromosome maintenance complex component 2(MCM2) positive cells were used to investigate the effect of Floralozone on neurogenesis. Immunofluorescence staining, qRT-PCR, and western blot analysis were used to investigate the effect of Floralozone on the expression levels of AMPKα2, miR-7a-5p, TRPM2, and NR2B. RESULTS: The SD rat experiment revealed that Floralozone improved spatial learning and memory, improved the morphology and structure of hippocampal neurons, reduced apoptosis of hippocampal neurons and promoted neurogenesis in VD rats. Floralozone could increase the miR-7a-5p expression level, activate AMPKα2 and NR2B expressions, and inhibit TRPM2 expression in hippocampal neurons of VD rats. The AMPKα2 KO transgenic (AMPKα2-/-) mice experiment demonstrated that Floralozone could regulate miR-7a-5p, TRPM2, and NR2B expression levels through AMPKα2 activation. The cell experiment revealed that the TRPM2 and NR2B expression levels were regulated by miR-7a-5p, whereas the AMPKα2 expression level was not. CONCLUSION: Floralozone could regulate miR-7a-5p expression level by activating the protein expression of AMPKα2, control the protein expression of TRPM2 and NR2B, improve the morphology and structure of hippocampus neurons, reduce the apoptosis of hippocampus neurons, promote neurogenesis and improve the cognitive dysfunction.

Radical-driven selective oxidation of benzyl alcohol on MnCoOx catalysts with no oxidant other than air in reactor.

Mn reinforced Co3O4 catalysts (MnCoOx) were prepared by a facile solid phase mixed foaming method with an in-situ heating enhancement for the formation of spinel phase mixed oxide species, and studied in the selective oxidation of benzyl alcohol just the air in reactor as oxygen donor. It was found that the MnCoOx catalysts are composed of relatively minimal spinel MnCo2O4 mixed oxide and massive Co3O4 to form MnCo2O4-Co3O4 oxide pair. The micro-domains of MnCo2O4-Co3O4 oxide pair present two redox couples of Mn3+/Mn2+ and Co3+/Co2+ instead of the single one of Co3+/Co2+ in Co3O4, and then dramatically enhance the formation of superoxide radicals (•O2-) species from the O2 in air, which can efficiently initiate the conversion of benzyl alcohol to benzaldehyde in a Fenton-like processes. With no oxidant other than air in reactor, the interaction between MnCo2O4 and Co3O4 in MnCoOx catalysts leads to a benzyl alcohol conversion up to 98 % with a 100 % benzaldehyde selectivity at atmospheric pressure while single component Co3O4 can only present a benzyl alcohol conversion at 37 %. This embodiment of highly efficient heterogeneous selective oxidation just with air as oxidant provides a probability for developing a low-cost and super-facile radical-induced selective oxidation process for alcohols.

Establishment and comparison of different procedures for modeling intrauterine adhesion in rats: A preliminary study.

The establishment of a stable animal model for intrauterine adhesion (IUA) can significantly enhance research on the pathogenesis and pathological changes of this disease, as well as on the development of innovative therapeutic approaches. In this study, three different modeling methods, including phenol mucilage combined mechanical scraping, ethanol combined mechanical scraping and ethanol modeling alone were designed. The morphological characteristics of the models were evaluated. The underlying mechanisms and fertility capacity of the ethanol modeling group were analyzed and compared to those of the sham surgery group. All three methods resulted in severe intrauterine adhesions, with ethanol being identified as a reliable modeling agent and was subsequently subjected to further evaluation. Immunohistochemistry and RT-PCR results indicated that the ethanol modeling group exhibited an increase in the degree of fibrosis and inflammation, as well as a significant reduction in endometrial thickness, gland number, vascularization, and endometrial receptivity, ultimately resulting in the loss of fertility capacity. The aforementioned findings indicate that the intrauterine perfusion of 95 % ethanol is efficacious in inducing the development of intrauterine adhesions in rats. Given its cost-effectiveness, efficacy, and stability in IUA formation, the use of 95 % ethanol intrauterine perfusion may serve as a novel platform for evaluating innovative anti-adhesion materials and bioengineered therapies.

Efficacy of antibiotic prophylaxis for reducing capsular contracture in prosthesis-based breast surgery: a systemic review and meta-analysis.

Antibiotics Prophylaxis to prevent capsular contracture in prosthesis-based breast surgery is common in clinical practice. However, there is currently a dearth of high-quality evidence concerning the effectiveness of antibiotic usage in this field. To identify all pertinent studies prior to January 2023, a comprehensive literature search was conducted in the PubMed, Embase, Web of Science, Cochrane Library, and Medline databases. The extracted data was then subjected to meta-analysis. Fourteen studies were retained in the analysis. According to the results, perioperative antibiotic prophylaxis did not reduce the risk of capsular contracture (RR 1.15, 95% CI 0.82-1.59, p = 0.55) or surgical-site infection (RD 0.01, 95% CI - 0.01 to 0.03, p = 0.59) compared to nonantibiotic prophylaxis. There was no statistically significant difference between extended antibiotic prophylaxis and perioperative antibiotic prophylaxis in terms of preventing capsular contracture, whether calculated by patient numbers (RD 0.01, 95% CI - 0.01 to 0.02, p = 0.87) or by total procedures (RD 0.00, 95% CI - 0.00 to 0.01, p = 0.88), or controlling surgical-site infection (RR 1.05, 95% CI 0.77-1.44, p = 0.27). Additionally, topical antibiotic irrigation did not decrease the risk of infection (RR 0.61, 95% CI 0.34-1.08, p = 0.29) and capsular contracture, regardless of patient number (RR 0.41, 95% CI 0.27-0.63, p = 0.18) or total number of procedures (RR 1.29, 95% CI 0.73-2.28, p < 0.01). Current evidence revealed that both systemic and topical antibiotic prophylaxis may not provide benefits in preventing capsular contracture in prosthesis-based breast surgery. When the occurrence of surgical-site infections is minimized to the greatest extent, the administration of additional antibiotics for reducing capsular contracture should be carefully and judiciously considered.

Extracellular Vesicles from Urine-Derived Stem Cell for Tissue Engineering and Regenerative Medicine.

The potential of urine-derived stem cells (USCs) for tissue engineering and regenerative medicine has attracted much attention during the last few decades. However, it has been suggested that the effects of the USCs may be endowed by their paracrine extracellular vesicles (EVs) rather than their differentiation. Compared with the USCs, the USC-EVs can cross the barriers more easily and safely, and their inclusions may mediate intercellular communication and promote the tissue repair. This article has summarized the current knowledge and applications about the USC-EVs in tissue engineering and regenerative medicine, and discussed the prospects and challenges for using them as an alternative to cell therapy. Impact statement Urine-derived stem cells (USCs) represent a newly discovered type of stem cells, and studies have proved that the beneficial effects of the USCs may be manifested through their paracrine extracellular vesicles (EVs) rather than through their own differentiation, which opens up new avenues for tissue engineering and regenerative medicine strategies. Therefore, this review aims to summarize the latest research progress and potential clinical applications of the USC-EVs, highlighting the promising potential of the USC-EVs as a therapeutic option in kidney regeneration, genital regeneration, nerve regeneration, bone and cartilage regeneration, and wound healing.

Building a Program Theory of Implementation Using Process Evaluation of a Complex Quality Improvement Trial in Nursing Homes.

BACKGROUND AND OBJECTIVES: Significant quality problems exist in long-term care (LTC). Interventions to improve care are complex and often have limited success. Implementation remains a black box. We developed a program theory explaining how implementation of a complex intervention occurs in LTC settings-examining mechanisms of impact, effects of context on implementation, and implementation outcomes such as fidelity. RESEARCH DESIGN AND METHODS: Concurrent process evaluation of Safer Care for Older Persons in residential Environments (SCOPE)-a frontline worker (care aide) led improvement trial in 31 Canadian LTC homes. Using a mixed-methods exploratory sequential design, qualitative data were analyzed using grounded theory to develop a conceptual model illustrating how teams implemented the intervention and how it produced change. Quantitative analyses (mixed-effects regression) tested aspects of the program theory. RESULTS: Implementation fidelity was moderate. Implementation is facilitated by (a) care aide engagement with core intervention components; (b) supportive leadership (internal facilitation) to create positive team dynamics and help negotiate competing workplace priorities; (c) shifts in care aide role perceptions and power differentials. Mixed-effects model results suggest intervention acceptability, perceived intervention benefits, and leadership support predict implementation fidelity. When leadership support is high, fidelity is high regardless of intervention acceptability or perceived benefits. DISCUSSION AND IMPLICATIONS: Our program theory addresses important knowledge gaps regarding implementation of complex interventions in nursing homes. Results can guide scaling of complex interventions and future research.

Photosynthetic and biochemical responses of four subtropical tree seedlings to reduced dry season and increased wet season precipitation and variable N deposition.

Interspecific variations in phenotypic plasticity of trees that are affected by climate change may alter the ecosystem function of forests. Seedlings of four common tree species (Castanopsis fissa, Michelia macclurei, Dalbergia odorifera and Ormosia pinnata) in subtropical plantations of southern China were grown in the field under rainout shelters and subjected to changing precipitation (48 L of water every 4 days in the dry season, 83 L of water every 1 day in the wet season; 4 g m-2 year-1 of nitrogen (N)), low N deposition (48 L of water every 2 days in the dry season, 71 L of water every 1 day in the wet season; 8 g m-2 year-1 N), high N deposition (48 L of water every 2 days in the dry season, 71 L of water every 1 day in the wet season; 10 g m-2 year-1 N) and their interactive effects. We found that the changes in seasonal precipitation reduced the light-saturated photosynthetic rate (Asat) for C. fissa due to declining area-based foliar N concentrations (Na). However, we also found that the interactive effects of changing precipitation and N deposition enhanced Asat for C. fissa by increasing foliar Na concentrations, suggesting that N deposition could alleviate N limitations associated with changing precipitation. Altered precipitation and high N deposition reduced Asat for D. odorifera by decreasing the maximum electron transport rate for RuBP regeneration (Jmax) and maximum rate of carboxylation of Rubisco (Vcmax). Ormosia pinnata under high N deposition exhibited increasing Asat due to higher stomatal conductance and Vcmax. The growth of D. odorifera might be inhibited by changes in seasonal precipitation and N deposition, while O. pinnata may benefit from increasing N deposition in future climates. Our study provides an important insight into the selection of tree species with high capacity to tolerate changing precipitation and N deposition in subtropical plantations.

Changes in Health and Well-Being of Care Aides in Nursing Homes From a Pre-Pandemic Baseline in February 2020 to December 2021.

Nursing homes were profoundly affected by the COVID-19 pandemic, influencing work outcomes of care aides who provide the most direct care. We compared care aides' quality of work life by conducting a repeated cross-sectional analysis of data collected in February 2020 and December 2021 from a stratified random sample of urban nursing homes in two Canadian provinces. We used two-level random-intercept repeated-measures regression models, adjusting for demographics and nursing home characteristics. 2348 and 1116 care aides completed the survey in February 2020 and December 2021, respectively. The 2021 sample had higher odds of reporting worked short-staffed daily to weekly in the previous month than the 2020 sample. The 2021 sample also had a small but significant drop in professional efficacy and mental health. Despite the worsening changes, our findings suggest that this workforce may have withstood the pandemic better than might be expected.

Organizational Context and Quality Indicators in Nursing Homes: A Microsystem Look.

The association of organizational context with quality of care in nursing homes is not well understood at the clinical microsystem (care unit) level. This cross-sectional study examined the associations of unit-level context with 10 unit-level quality indicators derived from the Minimum Data Set 2.0. Study settings comprised 262 care units within 91 Canadian nursing homes. We assessed context using unit-aggregated care-aide-reported scores on the 10 scales of the Alberta Context Tool. Mixed-effects regression analysis showed that structural resources were negatively associated with antipsychotics use (B = -.06; p = .001) and worsened late-loss activities of daily living (B = -.03, p = .04). Organizational slack in time was negatively associated with worsened pain (B = -.04, p = .01). Social capital was positively associated with delirium symptoms (B = .12, p = .02) and worsened depressive symptoms (B = .10, p = .01). The findings suggested that targeting interventions to modifiable contextual elements and unit-level quality improvement will be promising.

Promotion of uterine reconstruction by a tissue-engineered uterus with biomimetic structure and extracellular matrix microenvironment.

The recurrence rate for severe intrauterine adhesions is as high as 60%, and there is still lack of effective prevention and treatment. Inspired by the nature of uterus, we have developed a bilayer scaffold (ECM-SPS) with biomimetic heterogeneous features and extracellular matrix (ECM) microenvironment of the uterus. As proved by subtotal uterine reconstruction experiments, the mechanical and antiadhesion properties of the bilayer scaffold could meet the requirement for uterine repair. With the modification with tissue-specific cell-derived ECM, the ECM-SPS had the ECM microenvironment signatures of both the endometrium and myometrium and exhibited the property of inducing stem cell-directed differentiation. Furthermore, the ECM-SPS has recruited more endogenous stem cells to promote endometrial regeneration at the initial stage of repair, which was accompanied by more smooth muscle regeneration and a higher pregnancy rate. The reconstructed uterus could also sustain normal pregnancy and live birth. The ECM-SPS may thereby provide a potential treatment for women with severe intrauterine adhesions.

Novel biomarker genes for the prediction of post-hepatectomy survival of patients with NAFLD-related hepatocellular carcinoma.

BACKGROUND: The incidence and prevalence of nonalcoholic fatty liver disease related hepatocellular carcinoma (NAFLD-HCC) are rapidly increasing worldwide. This study aimed to identify biomarker genes for prognostic prediction model of NAFLD-HCC hepatectomy by integrating text-mining, clinical follow-up information, transcriptomic data and experimental validation. METHODS: The tumor and adjacent normal liver samples collected from 13 NAFLD-HCC and 12 HBV-HCC patients were sequenced using RNA-Seq. A novel text-mining strategy, explainable gene ontology fingerprint approach, was utilized to screen NAFLD-HCC featured gene sets and cell types, and the results were validated through a series of lab experiments. A risk score calculated by the multivariate Cox regression model using discovered key genes was established and evaluated based on 47 patients' follow-up information. RESULTS: Differentially expressed genes associated with NAFLD-HCC specific tumor microenvironment were screened, of which FABP4 and VWF were featured by previous reports. A risk prediction model consisting of FABP4, VWF, gender and TNM stage were then established based on 47 samples. The model showed that overall survival in the high-risk score group was lower compared with that in the low-risk score group (p = 0.0095). CONCLUSIONS: This study provided the landscape of NAFLD-HCC transcriptome, and elucidated that our model could predict hepatectomy prognosis with high accuracy.

Evaluation of measurement accuracy of wearable devices for heart rate variability.

This paper proposed a method based on heart rate variability (HRV) for evaluating the accuracy of wearable devices in measuring heart rate. HRV refers to the variation in time intervals between successive heartbeats, widely used in many fields such as clinical and sports fields. Wearable devices such as Electrocardiogram (ECG) electrode patches have gained popularity due to their portability and ease of use. However, they can be prone to measurement interference caused by environmental noise, human respiration, etc. The proposed method consists of four main components: selection of "gold standard measurement devices", identification of HRV measurement metrics, construction of an HRV evaluation framework, and quantification of measurement errors. The method is validated through simulated experiments using ECG patches. The evaluation framework and quantification model established in this method have significant implications in establishment of industry standards and diagnosis of diseases in clinical practice.