Ultrasound imaging for preoperative assessment of extensor tendon tear following distal radius fracture.

Open reduction with internal fixation is a common approach for treating distal radius fractures. However, complications such as extensor tendon rupture can occur following this procedure. In this case report, we present a patient who experienced extensor tendon rupture following volar plate fixation of a distal radius fracture. The rupture was diagnosed preoperatively using ultrasound. We highlight the potential usefulness of ultrasound as a convenient and sensitive tool for diagnosing tendon injuries in patients with suspected complications following internal fixation of distal radius fractures. Furthermore, we discuss how ultrasound images can aid in localizing the site of tendon rupture and guide surgical incisions for smaller postoperative wound care, resulting in improved cosmetic outcomes.

Facile preparation of environmental benign LED white light active humic acid nanolayer coated titanium dioxide photocatalyst for bisphenol A degradation.

Natural organic matter is a mixture of microbial decomposition products widely found in surface and groundwater. These organic materials have great potential as carbon-based precursors for chemical synthesis. This work demonstrated the development of a green photocatalyst via a facile adsorption process that combined colloidal titanium dioxide (TiO2) with humic acid. The resulting photocatalyst was visible light active and able to completely degrade 5 mg/L of BPA within 6 h under the irradiation of energy-efficient LED white light. The first-order kinetic rate constant of the reaction was determined to be 1.7 × 10-2 min-1. The enhanced photocatalytic activity was attributed to the decreased band gap energy and effective charge separation that limits the photogenerated electron-hole recombination. The outcome of this research opened an opportunity for the development of sustainable functional materials using natural organic matter.

Enhancement of bicycle exercise capacity in patients with chronotropic incompetence through closed-loop stimulation: a randomized crossover trial.

AIMS: This study aimed to investigate the effectiveness of closed-loop stimulation (CLS) pacing compared with the traditional DDD mode in patients with chronotropic incompetence (CI) using bicycle-based cardiopulmonary exercise testing (CPET). METHODS AND RESULTS: This single-centre, randomized crossover trial involved 40 patients with CI. Patients were randomized to receive either DDD-CLS or DDD mode pacing for 2 months, followed by a crossover to the alternative mode for an additional 2 months. Bicycling-based CPET was conducted at the 3- and 5-month follow-up visits to assess exercise capacity. Other cardiopulmonary exercise outcome measures and health-related quality of life (QoL) were also assessed. DDD-CLS mode pacing significantly improved exercise capacity, resulting in a peak oxygen uptake (14.8 ± 4.0 vs. 12.0 ± 3.6 mL/kg/min, P < 0.001) and oxygen uptake at the ventilatory threshold (10.0 ± 2.2 vs. 8.7 ± 1.8 mL/kg/min, P < 0.001) higher than those of the DDD mode. However, there were no significant differences in other cardiopulmonary exercise outcome measures such as ventilatory efficiency of carbon dioxide production slope, oxygen uptake efficiency slope, and end-tidal carbon dioxide between the two modes. Patients in the DDD-CLS group reported a better QoL, and 97.5% expressed a preference for the DDD-CLS mode. CONCLUSION: DDD-CLS mode pacing demonstrated improved exercise capacity and QoL in patients with CI, highlighting its potential as an effective pacing strategy for this patient population.

[Concept Analysis of Fusion Leadership].

Important concepts in leadership management related to the field of medical care management include servant leadership, charismatic leadership, and transformational leadership. Since the 2020 emergence of the coronavirus pandemic, the world has faced the immediate challenges of epidemic prevention and control. Although national government and medical system officials as well as scholars have weighed in on this issue, their leadership does not appear to line up the core ideas of leadership. Daft and Lengel (2000) examined the influence of fusion leadership on individuals and organizations. The fusion of many nuclei of leadership intentions will produce great power and influence. To elucidate the concept of integrated leadership for individuals and organizations in the post-pandemic healthcare system, this paper summarizes the defining characteristics of fusion leadership based on the conceptual analysis method of Walker and Avant (2019). Concurrently, we confirm the antecedents and consequences of fusion leadership, use different cases to illustrate the analysis, and share the reference indicators and measurements of fusion leadership to provide a reference for healthcare system administrators.

Using HRMS fingerprinting to explore micropollutant contamination in soil and vegetables caused by swine wastewater irrigation.

Livestock wastewater has been reused for agricultural irrigation to save water and fertilise the soil. However, micropollutants excreted by livestock animals may contaminate the soil and crops through livestock wastewater irrigation. This study employed high-resolution mass spectrometry (HRMS) to facilitate broad-scope suspect screening of soil and vegetables and identify changes in micropollutant fingerprints caused by swine wastewater irrigation. Field trials were performed to simulate the practical cultivation of small leafy vegetables. Soil and pak choi were irrigated with groundwater, a reasonable amount of swine wastewater, and excessive swine wastewater (three times the reasonable amount) and were sampled at three time points. The samples were extracted using organic solvents and analysed with a liquid chromatography-quadrupole-time-of-flight HRMS system. The molecular features were compared to over 3000 micropollutants in commercial libraries. The relative concentrations of suspect micropollutants among the irrigation groups were compared using multivariate and univariate analyses. The marker micropollutants that increased with swine wastewater irrigation were rigorously identified based on the MS/MS spectra. Fifty-three micropollutants were frequently found in the soil (n = 54) and 36 in the pak choi (n = 53). Partial least squares discriminant analysis (PLS-DA) models revealed significant differences in the micropollutant fingerprints in the soil among the three irrigation groups, but not in the pak choi. Eight micropollutants with variable importance in projection scores above 1.0 in the PLS-DA model and significantly higher relative concentrations (p < 0.05) in the soil irrigated with swine wastewater were confirmed as markers. Besides veterinary drugs and their metabolites, cinnamic acid and phenylalanine were the markers relevant to swine feed that were not previously reported. Nevertheless, accumulations of micropollutants in the soil or contamination of the pak choi due to swine wastewater irrigation were not found under the trial conditions.

[Prevention and treatment of non-alcoholic fatty liver disease by regulation of mitochondrial function with Chinese medicine].

Non-alcoholic fatty liver disease(NAFLD), as a metabolic stress liver injury disease, is one of the most common chronic liver diseases, which seriously threatens people's health. The pathogenesis of NAFLD is very complex. A large number of studies show that the hepatic mitochondrial dysfunction leads to the disorder of hepatic glucose and lipid metabolism, oxidative stress, and inflammation, thus inducing hepatocyte apoptosis, which plays an important role in the progression of NAFLD. In recent years, researchers have begun to focus on developing drugs that slowed the progression of NAFLD by regulating the hepatic mitochondrial function. Chinese medicine has a good curative effect on the treatment of NAFLD, with the advantages of high safety and few side effects. Various studies have shown that Chinese medicine prevented and treated NAFLD by regulating the mitochondrial function. Therefore, this paper summarized the relationship between NAFLD and mitochondria, and the mechanism of Chinese medicine(single Chinese medicine, Chinese medicine monomer, and Chinese medicine compound prescription) in the prevention and treatment of NAFLD by regulating mitochondrial function. This paper is expected to provide references for clinical application of traditional Chinese medicine in the treatment of NAFLD by regulating mitochondrial function.

The NORMAN Suspect List Exchange (NORMAN-SLE): facilitating European and worldwide collaboration on suspect screening in high resolution mass spectrometry.

Background: The NORMAN Association (https://www.norman-network.com/) initiated the NORMAN Suspect List Exchange (NORMAN-SLE; https://www.norman-network.com/nds/SLE/) in 2015, following the NORMAN collaborative trial on non-target screening of environmental water samples by mass spectrometry. Since then, this exchange of information on chemicals that are expected to occur in the environment, along with the accompanying expert knowledge and references, has become a valuable knowledge base for "suspect screening" lists. The NORMAN-SLE now serves as a FAIR (Findable, Accessible, Interoperable, Reusable) chemical information resource worldwide. Results: The NORMAN-SLE contains 99 separate suspect list collections (as of May 2022) from over 70 contributors around the world, totalling over 100,000 unique substances. The substance classes include per- and polyfluoroalkyl substances (PFAS), pharmaceuticals, pesticides, natural toxins, high production volume substances covered under the European REACH regulation (EC: 1272/2008), priority contaminants of emerging concern (CECs) and regulatory lists from NORMAN partners. Several lists focus on transformation products (TPs) and complex features detected in the environment with various levels of provenance and structural information. Each list is available for separate download. The merged, curated collection is also available as the NORMAN Substance Database (NORMAN SusDat). Both the NORMAN-SLE and NORMAN SusDat are integrated within the NORMAN Database System (NDS). The individual NORMAN-SLE lists receive digital object identifiers (DOIs) and traceable versioning via a Zenodo community (https://zenodo.org/communities/norman-sle), with a total of > 40,000 unique views, > 50,000 unique downloads and 40 citations (May 2022). NORMAN-SLE content is progressively integrated into large open chemical databases such as PubChem (https://pubchem.ncbi.nlm.nih.gov/) and the US EPA's CompTox Chemicals Dashboard (https://comptox.epa.gov/dashboard/), enabling further access to these lists, along with the additional functionality and calculated properties these resources offer. PubChem has also integrated significant annotation content from the NORMAN-SLE, including a classification browser (https://pubchem.ncbi.nlm.nih.gov/classification/#hid=101). Conclusions: The NORMAN-SLE offers a specialized service for hosting suspect screening lists of relevance for the environmental community in an open, FAIR manner that allows integration with other major chemical resources. These efforts foster the exchange of information between scientists and regulators, supporting the paradigm shift to the "one substance, one assessment" approach. New submissions are welcome via the contacts provided on the NORMAN-SLE website (https://www.norman-network.com/nds/SLE/). Supplementary Information: The online version contains supplementary material available at 10.1186/s12302-022-00680-6.

The determinants of patient care manager role and the implementation of COVID-19 clinical pathway: a cross-sectional study.

Objective: This study aims to determine the factors associated with patient care manager role and the implementation of the clinical pathway among nurses in private hospitals. Methods: This study was conducted from January-July 2021 using the cross-sectional approach. The sample consisted of 168 nurses working in a private hospital in Surabaya City, East Java, Indonesia. Meanwhile, the data were collected using the Patient Care Manager Role Scale (PCMRS) and analyzed by multiple logistic regression to find the correlation between the variables. Results: A higher percentage of nurses namely 64.3% had compliance in COVID-19 clinical pathways with an average PCMRS score of 27.81 ± 2.43. Nurses with a high-level patient care manager role level had a significant compliance risk with odds ratio [OR] 440.137, 95% confidence interval [CI] [51.850-3736.184], and p-value = 0.000 compared to those with a low role. Conclusion: The role of patient care manager and compliance with COVID-19 clinical pathways correlated significantly. Based on the results, several actions are needed for the early identification of patient service managers' roles to ensure compliance with COVID-19 clinical pathways and reduce the number of cases in Indonesia.

A metagenomics study of hexabromocyclododecane degradation with a soil microbial community.

Hexabromocyclododecanes (HBCDs) are globally prevalent and persistent organic pollutants (POPs) listed by the Stockholm Convention in 2013. They have been detected in many environmental media from waterbodies to Plantae and even in the human body. Due to their highly bioaccumulative characterization, they pose an urgent public health issue. Here, we demonstrate that the indigenous microbial community in the agricultural soil in Taiwan could decompose HBCDs with no additional carbon source incentive. The degradation kinetics reached 0.173 day-1 after the first treatment and 0.104 day-1 after second exposure. With additional C-sources, the rate constants decreased to 0.054-0.097 day-1. The hydroxylic debromination metabolites and ring cleavage long-chain alkane metabolites were identified to support the potential metabolic pathways utilized by the soil microbial communities. The metagenome established by Nanopore sequencing showed significant compositional alteration in the soil microbial community after the HBCD treatment. After ranking, comparing relative abundances, and performing network analyses, several novel bacterial taxa were identified to contribute to HBCD biotransformation, including Herbaspirillum, Sphingomonas, Brevundimonas, Azospirillum, Caulobacter, and Microvirga, through halogenated / aromatic compound degradation, glutathione-S-transferase, and hydrolase activity. We present a compelling and applicable approach combining metagenomics research, degradation kinetics, and metabolomics strategies, which allowed us to decipher the natural attenuation and remediation mechanisms of HBCDs.

Discrimination of Atlantic salmon origins using untargeted chemical fingerprinting.

Mislabelling the geographic origin of same-species aquaculture products is difficult to identify. This study applied untargeted small-molecule fingerprinting to discriminating between Atlantic salmon originating from Chile and Norway. The acquired liquid chromatography-high-resolution mass spectrometry data from Chilean (n = 32) and Norwegian (n = 29) salmon were chemometrically processed. The partial least squares discriminant analysis (PLS-DA) models successfully discriminated between Chilean and Norwegian salmon at both positive and negative ionisation modes (R2 > 0.96, Q2 > 0.81). Univariate analyses facilitated the selection of approximately 100 candidate markers with high statistical confidence (> 95%). Of these, 37 confirmed markers of Chilean and Norwegian salmon were primarily associated with feed formulations, including lipid derivatives and feed additives. None of the markers were residues or contaminants of potential food safety concern.

A salicylaldehyde benzoyl hydrazone based near-infrared probe for copper(ii) and its bioimaging applications.

Developing highly sensitive and selective methods for Cu2+ detection in living systems is of great significance in clinical copper-related disease diagnosis. In this work, a near infrared (NIR) fluorescent probe, CySBH, with a salicylaldehyde benzoyl hydrazone group as a selective and sensitive receptor for Cu2+ was designed and synthesized. The specific coordination of the salicylaldehyde benzoyl hydrazone group in CySBH with Cu2+ can induce a distinct quench of the fluorescence intensity, allowing for real-time tracking of Cu2+. We have demonstrated that CySBH could rapidly recognize Cu2+ with good selectivity and high sensitivity. Moreover, on the basis of low cell cytotoxicity, the probe was used to visualize Cu2+ in two cell lines by fluorescence imaging. Furthermore, CySBH can also be used to monitor Cu2+ in vivo due to its NIR emission properties. These overall results illustrate that the NIR fluorescent probe CySBH provides a novel approach for the selective and sensitive monitoring of Cu2+ in living systems.

Change in the Oligomeric State of α-Synuclein Variants in Living Cells.

The accumulation of ß-sheet-rich α-synuclein (α-Syn) protein in human brain cells is a pathological hallmark of Parkinson's disease (PD). Moreover, it has been reported that familial PD mutations (A30P, E46K, H50Q, G51D, and A53T) accumulate at an accelerated rate both in vivo and in vitro. In addition, accumulations of various C-terminal α-Syn truncations, such as C-terminal-truncated N103 α-synuclein (N103), were found in an aggregated form in the brain tissue of PD patients. Fluorescent protein-tagged wild-type α-Syn, A30P, E46K, H50Q, G51D, A53T, and N103 were transfected into HEK293T and SHSY5Y cells, and their diffusion behaviors were investigated with a custom-built fluorescence microscope system. Based on our experimental results, the oligomerization of α-Syn is a time-dependent process in both HEK293T and SHSY5Y cells, and the oligomer state approaches a plateau after 48 h of transfection. The change in the oligomeric state of E46K, H50Q, and G51D exhibited a similar trend to the wild type at a lower concentration but became intense at a higher concentration. A53T and N103 possess smaller diffusion coefficients than wild-type α-synuclein and other family PD mutations, indicating that these two mutants could form higher oligomeric states or stronger interactions in HEK293T and SHSY5Y cells. In contrast, the smallest oligomer and the lowest intracellular interaction among all investigated α-Syn variants were found for A30P. These phenomena indicated the presence of different pathogeneses among familial PD mutants and C-terminal α-Syn truncations.

Effective photocatalytic degradation of sulfamethoxazole using tunable CaCu3Ti4O7 perovskite.

Sulfamethoxazole (SMX) is largely prescribed for bacterial infections but raises a major concern over generation of antibiotic-resistant bacteria in the environment. This study employed various perovskite-type photocatalysts, made by two-step synthesis procedures, to remove SMX. The as-synthesized CaCu3Ti4O7 (CCTO) perovskites were characterized by XRD, SEM-EDX, and DLS. Complete degradation (∼99%; kobs = 0.0279 min-1) of SMX was recorded under UV-light irradiation for 90 min in the presence of CCTO. SMX removal rate was investigated under various reaction conditions including pH, catalyst dose, electrolyte (NaCl and NaBr). The astonishing rate of SMX removal (kobs = 0.0614 min-1) was observed with the addition of 50 mM NaBr electrolytes in the reaction, which might imply that the appearance of halogen reactive species. CCTO-MS particles were aggregated in traces when the electrolytes concentration increases, resulting in reduced rate of SMX. The SMX concentration abatement and the formation of possible intermediates during photocatalytic reaction were analyzed. The upshot of this study reveals that the inexpensive and environmentally benign CCTO perovskite photocatalyst could be applied for the treatments of emerging contaminants in the future.

Astragalus mongholicus Bunge Water Extract Exhibits Anti-inflammatory Effects in Human Neutrophils and Alleviates Imiquimod-Induced Psoriasis-Like Skin Inflammation in Mice.

Neutrophils are the primary immune cells in innate immunity, which are related to various inflammatory diseases. Astragalus mongholicus Bunge is a Chinese medicinal herb used to treat various oxidative stress-related inflammatory diseases. However, there are limited studies that elucidate the effects of Astragalus mongholicus Bunge in human neutrophils. In this study, we used isolated human neutrophils activated by various stimulants to investigate the anti-inflammatory effects of Astragalus mongholicus Bunge water extract (AWE). Cell-free assays were used to examine free radicals scavenging capabilities on superoxide anion, reactive oxygen species (ROS), and nitrogen-centered radicals. Imiquimod (IMQ) induced psoriasis-like skin inflammation mouse model was used for investigating anti-psoriatic effects. We found that AWE inhibited superoxide anion production, ROS generation, and elastase release in human neutrophils, which exhibiting a direct anti-neutrophil effect. Moreover, AWE exerted a ROS scavenging ability in the 2,2'-Azobis (2-amidinopropane) dihydrochloride assay, but not superoxide anion in the xanthine/xanthine oxidase assay, suggesting that AWE exhibited anti-oxidation and anti-inflammatory capabilities by both scavenging ROS and by directly inhibiting neutrophil activation. AWE also reduced CD11b expression and adhesion to endothelial cells in activated human neutrophils. Meanwhile, in mice with psoriasis-like skin inflammation, administration of topical AWE reduced both the affected area and the severity index score. It inhibited neutrophil infiltration, myeloperoxidase release, ROS-induced damage, and skin proliferation. In summary, AWE exhibited direct anti-inflammatory effects by inhibiting neutrophil activation and anti-psoriatic effects in mice with IMQ-induced psoriasis-like skin inflammation. Therefore, AWE could potentially be a pharmaceutical Chinese herbal medicine to inhibit neutrophilic inflammation for anti-psoriasis.

Lipid changes in extrapulmonary organs and serum of rats after chronic exposure to ambient fine particulate matter.

Fine particulate matter (PM2.5) is able to pass through the respiratory barrier to enter the circulatory system and can consequently spread to the whole body to cause toxicity. Although our previous studies have revealed significantly altered levels of phosphorylcholine-containing lipids in the lungs of rats after chronic inhalation exposure to PM2.5, the effects of PM2.5 on phosphorylcholine-containing lipids in the extrapulmonary organs have not yet been elucidated. In this study, we examined the lipid effects of chronic PM2.5 exposure on various organs and serum by using a rat inhalation model followed by a mass spectrometry-based lipidomic approach. Male Sprague-Dawley rats were continuously exposed at the whole body level to nonfiltered and nonconcentrated ambient air from the outside environment of Taipei city for 8 months, while the control rats inhaled filtered air simultaneously. After exposure, serum samples and various organs, including the testis, pancreas, heart, liver, kidney, spleen, and epididymis, were collected for lipid extraction and analysis to examine the changes in phosphorylcholine-containing lipids after exposure. The results from the partial least squares discriminant analysis models demonstrated that the lipid profiles in the PM2.5 exposure group were different from those in the control group in the rat testis, pancreas, heart, liver, kidney and serum. The greatest PM2.5-induced lipid effects were observed in the testes. Decreased lyso-phosphatidylcholines (PCs) as well as increased unsaturated diacyl-PCs and sphingomyelins in the testes may be related to maintaining the membrane integrity of spermatozoa, antioxidation, and cell signaling. Additionally, our results showed that decreased PC(16:0/18:1) was observed in both the serum and testes. In conclusion, exposure to chronic environmental concentrations of PM2.5 caused lipid perturbation, especially in the testes of rats. This study highlighted the susceptibility of the testes and suggested possible molecular events for future study.

New insights of metal free 2D graphitic carbon nitride for photocatalytic degradation of bisphenol A.

Polymeric oxygen rich exfoliated graphitic carbon nitride (exfoliated GCN, EGCN) was synthesized by the acid treatment of bulk GCN. The photocatalyst was characterized using X-ray diffraction, scanning electron microscopy, X-ray photoelectron spectroscopy, Fourier transform infrared spectroscopy, and point of zero charge. EGCN shows high valance band hole transfer under short-time visible light (λ > 420 nm) exposure for photocatalytic mineralization of bisphenol A (BPA). Enhanced BPA removal was achieved by EGCN (99 %) due to formation of OH● radicals (H2O/hVB+ →OH●/H+). Major factors affecting BPA degradation including catalyst dose, wide pH range, and pollutant concentration were optimized. Repeated cycles of BPA degradation were performed with negligible rate decreased from 0.045 to 0.029 min-1. The degradation profile and plausible reaction mechanism of BPA was established and well justified by the byproducts identified by mass analysis HR-ESI-MS. Therefore, the as-synthesized metal free EGCN, active under visible light, offers a new platform for complete mineralization of byproducts of halogenated organic contaminants.

Wide-scope screening for pharmaceutically active substances in a leafy vegetable cultivated under biogas slurry irrigation.

The use of livestock waste for the production of biogas and the application of biogas slurry to agricultural soil can resolve livestock waste problems and reduce synthetic fertiliser use. However, the migration of veterinary drugs to land and crops resulting from biogas slurry irrigation is a potential food safety concern. This study employed an ultra-performance liquid chromatography coupled with quadrupole-time of flight high-resolution mass spectrometry system for wide-scope suspect screening of pharmaceutically active substances on crop cultivated under biogas slurry irrigation. Briefly, a total of 22 pak choi samples were obtained from a greenhouse farmed in tropical south Taiwan between March 2019 and March 2020. Molecular spectra and fragmented ions (between m/z 70 and 1100) were acquired. Ion features were searched and matched with a library consisting of 1068 compounds. The matrixes in the crop production environment including soil, livestock wastewater, biogas slurry, and groundwater were included in this study to elucidate potential sources of the pharmaceutically active substances. Results demonstrated 23 suspects were matched with high mass accuracy (mass error within ±5.0 ppm) in pak choi. The detection of both bufexamac and nandrolone were confirmed using standards, where a new system of identification points was applied. Nandrolone was detected throughout the pak choi samples as well as livestock wastewater. Tetracycline, macrolide, and sulfonamide antibiotics were presented in biogas slurry and soil but not pak choi. This is the first study to reveal the presence of multiclass pharmaceutically active substances in a crop supplied as food. Such findings suggest that anabolics and antibiotics should be closely monitored in the corps irrigated by biogas slurry in future.

The Effects of Biofeedback Training and Smartphone-Delivered Biofeedback Training on Resilience, Occupational Stress, and Depressive Symptoms among Abused Psychiatric Nurses.

Psychiatric ward (PW) nurses are at a higher risk to encounter workplace violence than are other healthcare providers, and many interventions have been developed to improve their mental health. We compared the effectiveness of biofeedback training (BT) and smartphone-delivered BT (SDBT) interventions on occupational stress, depressive symptoms, resilience, heart rate variability, and respiration rate in a sample of abused PW nurses. This was a quasi-experimental study. Structured questionnaires were administered before and six weeks after the intervention. Data were collected from April 2017 to October 2017. A total of 159 abused PW nurses were randomly assigned to BT, SDBT, and control groups, and 135 of them completed all processes of our protocol, with the study consisting of 119 females (88.1%) and 16 males (11.9%) and their age range being from 22 to 59 with the mean age of 35.61 and a standard deviation of 8.16. Compared to the controls, both the BT and the SDBT intervention groups experienced significant improvements in depressive symptoms, resilience, and respiration rate; and the SDBT group experienced significant reductions in occupational stress. Considering the cost, accessibility, restrictions time and space, SDBT be used as an effective intervention in people with resilience or occupational stress.

[A Nursing Experience Enhancing the Resilience Capacity of a Patient With Chronic Schizophrenia].

The article describes the author's nursing experience providing psychiatric homecare to a patient with chronic schizophrenia using the concept of resilience. Holistic nursing assessments were conducted via clinical observations during home visits every two weeks from May 24th to September 20th, 2018. Through these assessments, the main health problems of the patient were defined as ineffective self-health management, ineffective coping skills, and insufficient resilience. The nursing interventions implemented were designed to establish the patient's capacity to effectively and correctly self-manage health status, achieve emotional accommodation, and reduce parent-child conflicts. In order to enhance the resilience of the patient, the patient was guided to review important support resources over the course of illness, to detect the barriers of returning society, to apply the beneficial skills of health management, and then extend the status of employment and to enhance self-fulfillment.

Targeted profiling of chlorinated transformation products and the parent micropollutants in the aquatic environment: A comparison between two coastal cities.

This study investigated chlorinated transformation products (TPs) and their parent micropollutants, aromatic pharmaceuticals and personal care products (PPCPs) in the urban water bodies of two metropolitan cities. Nine PPCPs and 16 TPs were quantitatively or semi-quantitatively determined using isotope dilution techniques and liquid chromatography-tandem mass spectrometry. TPs and most PPCPs were effectively removed by conventional wastewater treatments in a wastewater treatment plant (WWTP). Chlorinated parabens and all PPCPs (at concentrations below 1000 ng/L) were present in the waters receiving treated wastewater. By contrast, the waters receiving untreated wastewater contained higher levels of PPCPs (up to 9400 ng/L) and more species of chlorinated TPs including chlorinated parabens, triclosan, diclofenac, and bisphenol A. The very different chemical profiles between the water bodies of the two cities of similar geographical and climatic properties may be attributed to their respective uses of chemicals and policies of wastewater management. No apparent increase in the number of species or abundances of TPs was observed in either the chlorinated wastewater or the seawater rich in halogens. This is the first study to elucidate and compare the profiles of multiple TPs and their parent PPCPs in the water bodies of coastal cities from tropical islands. Our findings suggest that chlorinated derivatives of bisphenol A, diclofenac, triclosan, and parabens in the surface water originate from sources other than wastewater disinfection or marine chlorination. Although further studies are needed to identify the origins, conventional wastewater treatments may protect natural water bodies against contamination by those chlorinated substances.