Mixed methods examination of risk perception on vaccination intentions: The perspective of doctor-patient communication.

AIM: From the perspective of doctor-patient communication, this research used multiple methods combined natural language processing (NLP), a cross-sectional survey and an online experiment to investigated how risk perception influenced people's vaccination intention. METHODS: In Study 1, we used Python to crawl 335,045 comments about COVID-19 vaccine published in a social media platform Sina Weibo (equivalent of Twitter in China) from 31 December 2020 to 31 December 2021. Text analysis and sentiment analysis was used to examine how vaccination intention, as measured by linguistic features from the LIWC dictionary, changed with individuals' perceptions of pandemic risk. In Study 2, we adopted a cross-sectional questionnaire survey to further test the relation of risk perception, vaccination intention, trust in physicians, and perceived medical recommendations in a Chinese sample (n = 386). In Study 3, we conducted an online experiment where we recruited 127 participants with high trust in physicians and 127 participants with low trust, and subsequently randomly allocated them into one of three conditions: control, rational recommendation, or perceptual recommendation. RESULTS: Text and sentiment analysis revealed that the use of negative words towards COVID-19 vaccine had a significant decrease at high (vs. low) risk perception level time (Study 1). Trust in physicians mediated the effect of risk perception on vaccination intention and this effect was reinforced for participants with low (vs. high) level of perceived medical recommendation (Study 2), especially for the rational (vs. perceptual) recommendation condition (Study 3). CONCLUSION: Risk perception increased vaccination intention through the mediating effect of trust in physicians and the moderating effect of perceived medical recommendations. Rational (vs. perceptual) recommendation is more effective in increasing intention to get vaccinated in people with low trust in physicians.

Prediction of Medical Disputes Between Health Care Workers and Patients in Terms of Hospital Legal Construction Using Machine Learning Techniques: Externally Validated Cross-Sectional Study.

BACKGROUND: Medical disputes are a global public health issue that is receiving increasing attention. However, studies investigating the relationship between hospital legal construction and medical disputes are scarce. The development of a multicenter model incorporating machine learning (ML) techniques for the individualized prediction of medical disputes would be beneficial for medical workers. OBJECTIVE: This study aimed to identify predictors related to medical disputes from the perspective of hospital legal construction and the use of ML techniques to build models for predicting the risk of medical disputes. METHODS: This study enrolled 38,053 medical workers from 130 tertiary hospitals in Hunan province, China. The participants were randomly divided into a training cohort (34,286/38,053, 90.1%) and an internal validation cohort (3767/38,053, 9.9%). Medical workers from 87 tertiary hospitals in Beijing were included in an external validation cohort (26,285/26,285, 100%). This study used logistic regression and 5 ML techniques: decision tree, random forest, support vector machine, gradient boosting decision tree (GBDT), and deep neural network. In total, 12 metrics, including discrimination and calibration, were used for performance evaluation. A scoring system was developed to select the optimal model. Shapley additive explanations was used to generate the importance coefficients for characteristics. To promote the clinical practice of our proposed optimal model, reclassification of patients was performed, and a web-based app for medical dispute prediction was created, which can be easily accessed by the public. RESULTS: Medical disputes occurred among 46.06% (17,527/38,053) of the medical workers in Hunan province, China. Among the 26 clinical characteristics, multivariate analysis demonstrated that 18 characteristics were significantly associated with medical disputes, and these characteristics were used for ML model development. Among the ML techniques, GBDT was identified as the optimal model, demonstrating the lowest Brier score (0.205), highest area under the receiver operating characteristic curve (0.738, 95% CI 0.722-0.754), and the largest discrimination slope (0.172) and Youden index (1.355). In addition, it achieved the highest metrics score (63 points), followed by deep neural network (46 points) and random forest (45 points), in the internal validation set. In the external validation set, GBDT still performed comparably, achieving the second highest metrics score (52 points). The high-risk group had more than twice the odds of experiencing medical disputes compared with the low-risk group. CONCLUSIONS: We established a prediction model to stratify medical workers into different risk groups for encountering medical disputes. Among the 5 ML models, GBDT demonstrated the optimal comprehensive performance and was used to construct the web-based app. Our proposed model can serve as a useful tool for identifying medical workers at high risk of medical disputes. We believe that preventive strategies should be implemented for the high-risk group.

Changes in targeted metabolomics in lung tissue of chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) is a common chronic lung disease and its incidence is steadily increasing. COPD patients and mouse models of COPD share some similarities in lung pathology and physiology. We performed this study to explore the potential metabolic pathways involved in the pathogenesis of COPD and to discover the COPD-associated biomarkers. Furthermore, we aimed to examine how much the mouse model of COPD was similar and different to human COPD in terms of the altered metabolites and pathways. Methods: Twenty human lung tissue samples (ten COPD and ten controls) and twelve mice lung tissue samples (six COPD and six controls) were analyzed by targeted HM350 metabolomics, and multivariate and pathway analysis were performed by Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Results: The counts of many metabolites such as amino acids, carbohydrates and carnitines were changed in both COPD patients and mice compared to controls, respectively. While lipid metabolism was changed only in COPD mice. After KEGG analysis, we found these altered metabolites involved in COPD through aging, apoptosis, oxidative stress and inflammation pathways. Conclusions: The expressions of metabolites changed in both COPD patients and cigarette smoke exposed (CS-exposed) mice. And there were also some differences between COPD patients and mouse models due to the differences between species. Our study suggested the dysregulation in amino acid metabolism, energy production pathway and perhaps lipid metabolism may be significantly related to the pathogenesis of COPD.

Recent research advances on corrosion mechanism and protection, and novel coating materials of magnesium alloys: a review.

Magnesium alloys have achieved a good balance between biocompatibility and mechanical properties, and have great potential for clinical application, and their performance as implant materials has been continuously improved in recent years. However, a high degradation rate of Mg alloys in a physiological environment remains a major limitation before clinical application. In this review, according to the human body's intake of elements, the current mainstream implanted magnesium alloy system is classified and discussed, and the corrosion mechanism of magnesium alloy in vivo and in vitro is described, including general corrosion, localized corrosion, pitting corrosion, and degradation of body fluid environment impact etc. The introduction of methods to improve the mechanical properties and biocorrosion resistance of magnesium alloys is divided into two parts: the alloying part mainly discusses the strengthening mechanisms of alloying elements, including grain refinement strengthening, solid solution strengthening, dislocation strengthening and precipitation strengthening etc.; the surface modification part introduces the ideas and applications of novel materials with excellent properties such as graphene and biomimetic materials in the development of functional coatings. Finally, the existing problems are summarized, and the future development direction is prospected.

Role of Mitophagy in Cigarette Smoke-induced Lung Epithelial Cell Injury In Vitro.

BACKGROUND: Mitochondria mediate airway inflammatory responses to cigarette smoke (CS). Removal of damaged or defective mitochondrial (mitophagy) may prevent the detrimental impact of CS extract (CSE) on airway and lung epithelial cells. METHODS: We studied the effect of a mitophagy activator (Urolithin A, UA) and a mitophagy inhibitor (Liensinine diperchlorate, Ld) on CSE-exposed alveolar (A549) and airway (BEAS-2B) epithelial cell proliferation, intracellular and mitochondrial ROS, inflammatory response, mitochondrial membrane potential (Δψm), mitochondrial morphology, mitochondrial complex activities, and protein levels of mitochondrial fission (DRP1, MFF) and mitophagy (SQSTM1/p62, LC3B). In both cell types, CSE exposure led to increased intracellular and mitochondrial oxidative stress, decreased Δψm and resulted in structural disruption of the mitochondrial network. CSE increased the expression of DRP1, MFF and SQSTM1/p62 while decreasing LC3B-II/I protein expression ratio. CSE also increased inflammatory (IL-1ß, IL-6, IL-18, CXCL1, CXCL8) and necroptosis factors (RIPK1, RIPK3, MLKL) mRNA expression. RESULTS: Pre-treatment with UA attenuated CSE-induced oxidative stress, inflammatory and necroptosis gene expression and restored mitochondrial structure and function. UA also prevented CSE-evoked increases in DRP1, MFF and SQSTM1/p62 protein expression and increased LC3B-II/I ratio. Conversely, pre-treatment with Ld aggravated CSE-induced cellular and mitochondrial responses. CONCLUSION: In conclusion, mitophagy mediates CSE-induced damage and inflammation of lung epithelial cells and may represent a therapeutic target in CS-driven diseases.

Association between hospital legal constructions and medical disputes: A multi-center analysis of 130 tertiary hospitals in Hunan Province, China.

Background: Medical disputes are common in hospitals and a major challenge for the operations of medical institutions. However, few studies have looked into the association between medical disputes and hospital legal constructions. The purpose of the study was to investigate the relationship between hospital legal constructions and medical disputes, and it also aimed to develop a nomogram to estimate the likelihood of medical disputes. Methods: Between July and September 2021, 2,716 administrators from 130 hospitals were enrolled for analysis. The study collected seventeen variables for examination. To establish a nomogram, administrators were randomly split into a training group (n = 1,358) and a validation group (n = 1,358) with a 50:50 ratio. The nomogram was developed using data from participants in the training group, and it was validated in the validation group. The nomogram contained significant variables that were linked to medical disputes and were identified by multivariate analysis. The nomogram's predictive performance was assessed utilizing discriminative and calibrating ability. A web calculator was developed to be conducive to model utility. Results: Medical disputes were observed in 41.53% (1,128/2,716) of participants. Five characteristics, including male gender, higher professional ranks, longer length of service, worse understanding of the hospital charters, and worse construction status of hospital rule of law, were significantly associated with more medical disputes based on the multivariate analysis. As a result, these variables were included in the nomogram development. The AUROC was 0.67 [95% confident interval (CI): 0.64-0.70] in the training group and 0.68 (95% CI: 0.66-0.71) in the validation group. The corresponding calibration slopes were 1.00 and 1.05, respectively, and intercepts were 0.00 and -0.06, respectively. Three risk groups were created among the participants: Those in the high-risk group experienced medical disputes 2.83 times more frequently than those in the low-risk group (P < 0.001). Conclusion: Medical dispute is prevailing among hospital administrators, and it can be reduced by the effective constructions of hospital rule of law. This study proposes a novel nomogram to estimate the likelihood of medical disputes specifically among administrators in tertiary hospitals, and a web calculator can be available at https://ymgarden.shinyapps.io/Predictionofmedicaldisputes/.

Role of TRPA1/TRPV1 in acute ozone exposure induced murine model of airway inflammation and bronchial hyperresponsiveness.

Background: Transient receptor potential (TRP) ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1) mediate the development of lung injury and inflammation. This study investigated the role and mechanism of the TRPA1/TRPV1 pathway in airway inflammation and bronchial hyperresponsiveness (BHR) induced by acute ozone exposure. Methods: C57BL/6 mice (8-10 weeks) were intraperitoneally injected with phosphate buffered saline (PBS), A967079 (TRPA1 inhibitor) or AMG9810 (TRPV1 inhibitor) 1 h before or after ozone exposure (2.5 ppm, 3 h). BHR, cell counts in bronchoalveolar lavage (BAL) fluid, oxidative stress biomarkers, inflammatory cytokines, TRPA1 and TPRV1 protein levels, mitochondrial dynamics- and mitophagy-related protein levels, and activities of mitochondrial respiratory chain (MRC) in lung were measured. Results: The preventive treatment effect was similar to the therapeutic treatment effect. Both A967079 and AMG9810 intervention suppressed BHR, inflammatory cytokines, total BAL fluid cells, malondialdehyde (MDA) levels and inflammatory cytokines mRNA including Substance P (SP), Keratinocyte-Derived Chemokine (KC), interleukin-18 (IL-18) and chemokine (C-X-C motif) ligand 8 (CXCL8) expression, and enhanced reduced glutathione (GSH)/oxidized glutathione (GSSG) levels compared with ozone-exposed mice. A967079 and AMG9810 intervention inhibited dynamin-related protein (DRP1), mitochondrial fission factor (MFF), Parkinson protein 2 E3 ubiquitin protein ligase (PARK2) and Sequestosome 1 (SQSTM1)/p62 expression, increased Optic atrophy 1 (OPA1), mitofusin 2 (MFN2) and PTEN-induced putative kinase 1 (PINK1) expression, and up-regulated the activities of MRC complex III and V in lung tissue. Conclusions: The results show that both TRPA1 and TRPV1 pathways are involved in acute ozone exposure-induced airway inflammation and BHR and influence oxidative stress, mitochondrial quality control and MRC activity, which could be a potential target for clinical therapy of respiratory diseases.

Integrated analysis reveals lung fibrinogen gamma chain as a biomarker for chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable airway disease. This study aimed to identify key genes related to COPD pathogenesis through an integrated transcriptomic and proteomic analysis of lung tissue from COPD subjects undergoing lung resection for malignancy. METHODS: We performed RNA sequencing, gene expression analysis, and gene set enrichment analysis (GSEA) on lung tissue in 13 non-smokers, 16 smokers, and 16 COPD patients. Key genes were verified by RT-qPCR, immunohistochemistry and Western blot in human lung tissues, cigarette smoke extract (CSE)-exposed human bronchial epithelial cell line (BEAS-2B cells), and a cigarette smoke (CS)-induced mouse model. RESULTS: There were 521 differentially expressed genes between non-smokers and smokers, 57 genes between smokers and COPD patients, and 860 genes between non-smokers and COPD patients. Fibrinogen gamma chain (FGG) was highly expressed in COPD patients versus smokers and in COPD patients versus healthy controls. GSEA of the COPD patients with the highest FGG expression were enriched in the B cell receptor signaling pathway, pantothenate and CoA biosynthesis, Fc epsilon RI signaling pathway, and the Toll-like receptor (TLR) signaling pathway. RT-PCR analysis confirmed enhanced FGG mRNA levels in the lungs of both smokers and COPD patients compared to non-smokers and in CSE-exposed cells compared to control cells. FGG protein levels were elevated in the lungs of COPD patients and smokers compared to non-smokers and in the lungs of CS-exposed mice compared to control mice. CONCLUSIONS: FGG may serve as a biomarker for COPD and may play an important role in its pathogenesis.

Multi-Gbit/s phosphor-based white-light and blue-filter-free visible light communication and lighting system with practical transmission distance.

High speed visible light communication (VLC) is a technology with great potential for future mobile and wireless communication. Here, we report and demonstrate a 2.705 Gbit/s white-light VLC and illumination system supporting indoor transmission distance of 1.5 m, corresponding a illumination of 545 lux. We also study the performance tolerance offset ranges in both x- and y-directions.

Tricolor visible-light laser diodes based visible light communication operated at 40.665 Gbit/s and 2 m free-space transmission.

Visible light communication (VLC) can provide a dedicated, secure, and high data rate wireless transmission link. It has gained considerable attentions recently, and is considered as one of the promising technologies for beyond 5G mobile and wireless communications. In this work, we demonstrate a VLC system with a recorded data rate of 40.665 Gbit/s using tricolor red, green and blue (RGB) laser diodes (LDs) and polarization multiplexing. 2 m free-space transmission distance is achieved. The implementation of bit-loading, power-loading, and polarization multiplexing are discussed. Experimental bit-error-ratio (BER) results show that each of the 6 polarization and wavelength de-multiplexed channels can achieve the forward-error-correction (FEC) requirement.

Establishment of a Quantitative Medical Technology Evaluation System and Indicators within Medical Institutions.

BACKGROUND: The development and application of medical technologies reflect the medical quality and clinical capacity of a hospital. It is also an effective approach in upgrading medical service and core competitiveness among medical institutions. This study aimed to build a quantitative medical technology evaluation system through questionnaire survey within medical institutions to perform an assessment to medical technologies more objectively and accurately, and promote the management of medical quality technologies and ensure the medical safety of various operations among the hospitals. METHODS: A two-leveled quantitative medical technology evaluation system was built through a two-round questionnaire survey of chosen experts. The Delphi method was applied in identifying the structure of evaluation system and indicators. The judgment of the experts on the indicators was adopted in building the matrix so that the weight coefficient and maximum eigenvalue (λ max), consistency index (CI), and random consistency ratio (CR) could be obtained and collected. The results were verified through consistency tests, and the index weight coefficient of each indicator was conducted and calculated through analytical hierarchy process. RESULTS: Twenty-six experts of different medical fields were involved in the questionnaire survey, 25 of whom successfully responded to the two-round research. Altogether, 4 primary indicators (safety, effectiveness, innovativeness, and benefits), as well as 13 secondary indicators, were included in the evaluation system. The matrix is built to conduct the λ max, CI, and CR of each expert in the survey, and the index weight coefficients of primary indicators were 0.33, 0.28, 0.27, and 0.12, respectively, and the index weight coefficients of secondary indicators were conducted and calculated accordingly. CONCLUSIONS: As the two-round questionnaire survey of experts and statistical analysis were performed and credibility of the results was verified through consistency evaluation test, the study established a quantitative medical technology evaluation system model and assessment indicators within medical institutions based on the Delphi method and analytical hierarchy process. Moreover, further verifications, adjustments, and optimizations of the system and indicators will be performed in follow-up studies.

Cost Analysis of Cervical Cancer Patients with Different Medical Payment Modes Based on Gamma Model within a Grade A Tertiary Hospital.

BACKGROUND: Cervical cancer shows a growing incidence and medical cost in recent years that has increased severe financial pressure on patients and medical insurance institutions. This study aimed to investigate the medical economic characteristics of cervical cancer patients with different payment modes within a Grade A tertiary hospital to provide evidence and suggestions for inpatient cost control and to verify the application of Gamma model in medical cost analysis. METHODS: The basic and cost information of cervical cancer cases within a Grade A tertiary hospital in the year 2011-2016 were collected. The Gamma model was adopted to analyze the differences in each cost item between medical insured patient and uninsured patients. Meanwhile, the marginal means of different cost items were calculated to estimate the influence of payment modes toward different medical cost items among cervical cancer patients in the study. RESULTS:: A total of 1321 inpatients with cervical cancer between the 2011 and 2016 were collected through the medical records system. Of the 1321 cases, 65.9% accounted for medical insured patients and 34.1% were uninsured patients. The total inpatient medical expenditure of insured patients was RMB 29,509.1 Yuan and uninsured patients was RMB 22,114.3 Yuan, respectively. Payment modes, therapeutic options as well as the recurrence and metastasis of tumor toward the inpatient medical expenditures between the two groups were statistically significant. To the specifics, drug costs accounted for 37.7% and 33.8% of the total, surgery costs accounted for 21.5% and 25.5%, treatment costs accounted for 18.7% and 16.4%, whereas the costs of imaging and laboratory examinations accounted for 16.4% and 15.2% for the insured patient and uninsured patients, respectively. As the effects of covariates were controlled, the total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs showed statistical significance. The total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs of insured patient were 1.33, 1.42, 1.52, and 1.44 times of uninsured patients. CONCLUSIONS: The analysis of different payment modes toward the medical economic characteristics based on Gamma model is basically rational. Medical payment modes are having certain influence toward the hospitalization expenses of cervical cancer patients in an extent, as drug costs, treatment costs, and examination costs appear to be the main causes.

Using a Single VCSEL Source Employing OFDM Downstream Signal and Remodulated OOK Upstream Signal for Bi-directional Visible Light Communications.

In this work, we propose and demonstrate for the first time up to our knowledge, using a 682 nm visible vertical-cavity surface-emitting laser (VCSEL) applied in a bi-directional wavelength remodulated VLC system with a free space transmission distance of 3 m. To achieve a high VLC downstream traffic, spectral efficient orthogonal-frequency-division-multiplexing quadrature-amplitude-modulation (OFDM-QAM) with bit and power loading algorithms are applied on the VCSEL in the central office (CO). The OFDM downstream wavelength is remodulated by an acousto-optic modulator (AOM) with OOK modulation to produce the upstream traffic in the client side. Hence, only a single VCSEL laser is needed for the proposed bi-directional VLC system, achieving 10.6 Gbit/s OFDM downstream and 2 Mbit/s remodulated OOK upstream simultaneously. For the proposed system, as a single laser source with wavelength remodulation is used, the laser wavelength and temperature managements at the client side are not needed; and the whole system could be cost effective and energy efficient.

Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center.

BACKGROUND: With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. METHODS: Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital (China) whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure, and decision tree method was adopted to establish the model of DRGs grouping combinations. RESULTS: The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications (CCs) of the disease, and the 3933 cases were divided into ten DRGs by four factors: age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant (P < 0.001, by Kruskal-Wallis test), with R2 = 0.53 and coefficient of variation (CV) = 0.524. CONCLUSIONS: The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

Long distance non-line-of-sight (NLOS) visible light signal detection based on rolling-shutter-patterning of mobile-phone camera.

We propose and demonstrate a long distance non-line-of-sight (NLOS) visible light signal detection based on the rolling shutter patterning using commercial mobile phone camera. By using our improved rolling shutter pattern demodulation algorithm, such as the background compensation (BC) blooming mitigation, extinction-ratio (ER) enhancement and Bradley adaptive thresholding, a 1.5 m NLOS visible signal (at low illumination of 145 lux) can be retrieved.

Research on 2041 Cases of High Inpatient Expenditure and Influence Factors during 3 Years in a Single Center.

BACKGROUND: The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles, thus identifying the major influence factors for high medical expenditure to develop further research. METHODS: We retrospectively studied 2041 inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015. We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure. All the data and materials were collected from medical record system, and the statistical methods included t-test, variance of analysis, and multivariate linear regression. RESULTS: The average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs, which respectively accounted for 33.03% and 32.32% of the total cost; and the average length of hospital stay was 28.39 days/person. Diseases of skeletal and muscular system, circulatory system, and tumor were the top three disease categories of high inpatient expenditure, which accounted for 39.00%, 33.46%, and 18.03%, respectively. Complications, criticality of the disease, gender of the patients, the occurrence of death, and the excessive length of hospital stay all had great impacts on average medical expenditure, while age, hospital infection, and surgery showed no significant impact on average medical cost. CONCLUSIONS: The main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials, lacking cost control measures within the hospital, the excessive length of hospital stay for inpatients, and the unnecessary treatment for the patients.