Fracture toughness and brittleness of novel CAD/CAM resin composite block.

OBJECTIVES: To evaluate the fracture toughness and brittleness of a newly developed CAD/CAM resin composite block and compare it with five other resin composite blocks and one polymer-infiltrated ceramic block. METHODS: Fracture toughness was determined through single-edge notched beam (SENB) method according to ASTM D5045-14. Parallelepiped specimens (thickness × width × length = 1.8 × 3.6 × âˆ¼18 mm) with a V notch (length = âˆ¼1.8 mm) (n = 10) were made from block materials using a low-speed water-cooled diamond precision saw and razor blade. Brittleness index (BI) was calculated from Vickers hardness and fracture toughness. Data were analyzed using one-way ANOVA and post-hoc Tukey tests (p ≤ 0.05). RESULTS: The experimental block showed significantly higher fracture toughness than all commercial block materials (p < 0.001) and has a brittleness index similar to most commercial blocks (p > 0.05) which have significantly lower brittleness index than Vita Enamic (p < 0.001). A moderate or strong correlation was observed between fracture toughness and flexural strength (Pearson's correlation coefficient R = 0.66) or diametral tensile strength (R = 0.86) or filler loading (R = 0.66), and between brittleness and Vickers hardness (R = 0.87). SIGNIFICANCE: The new composite block exhibited significantly higher fracture toughness and lower brittleness among the commercial CAD/CAM composite block materials tested, indicating a lower tendency to fracture and marginal chipping, and better machinability. The new composite block with higher fracture toughness and lower brittleness is suitable to use in the fabrication of CAD/CAM indirect restorations with potential long-term clinical success.

A Phenomenological Study on the Positive and Negative Experiences of Chinese International University Students From Hong Kong Studying in the U.K. and U.S. in the Early Stage of the COVID-19 Pandemic.

Background: The COVID-19 pandemic has caused distress in students globally. The mental health of international students studying abroad has been neglected during the COVID-19 pandemic, especially Chinese students who have been unfairly targeted. Objective: To explore and document the positive and negative experiences of a group of Hong Kong Chinese international students studying in the U.K. and U.S. from an insider perspective in the early stage of the COVID-19 pandemic. Methods: The qualitative study used four 1.5-h online focus group interviews of 20 Chinese international students from Hong Kong aged 18 or older studying in universities in the United Kingdom or the United States, from 3 May to 12 May 2020. A framework approach with a semi-structured interview guide was used to reflect students' stressors, cognitive appraisals, coping, and outcomes (negative impacts and positive gains), in the early stages of COVID-19. Different strategies were used to ensure the credibility, dependability, confirmability, and transferability of the study. Transcripts were analyzed using qualitative thematic content analysis. Results: Twenty full-time international University students (60% female, 90% aged 18-25 years and 65% undergraduates) were recruited. Students reported (i) stress from personal (e.g., worries about health and academic attainment), interpersonal (e.g., perceived prejudice and lack of social support), and environmental factors (e.g., uncertainties about academic programme and unclear COVID-19-related information); (ii) significant differences in culture and cognitive appraisal in the levels of perceived susceptibility and severity; (iii) positive thinking and using alternative measures in meeting challenges, which included effective emotion and problem coping strategies, and the importance of support from family, friends and schools; and (iv) negative psychological impact (e.g., worries and stress) and positive personal growth in crisis management and gains in family relationships. Conclusions: With the rise in sinophobia and uncertain developments of the pandemic, proactive support from government and academic institutions are urgently needed to reduce stress and promote the well-being of international students, especially Chinese students in the U.K. and U.S. Clear information, public education and policies related to the pandemic, appropriate academic arrangements from universities and strong support systems play important roles in maintaining students' psychological health. Clinical Trial Registration: The study was registered with the National Institutes of Health (https://clinicaltrials.gov/, identifier: NCT04365361).

Facemask Wearing Among Chinese International Students From Hong Kong Studying in United Kingdom Universities During COVID-19: A Mixed Method Study.

Background: The mental health of international students studying abroad has been neglected during the COVID-19 pandemic. Objective: This mixed-method study examined perceived public attitudes, personal beliefs, practice and stress toward facemask wearing as a preventive measure against COVID-19 among international University students from Hong Kong studying in the United Kingdom (UK) in the early stage (January-March 2020) of the pandemic. Methods: Our study included 2 parts: (i) an exponential, non-discriminative snowball sampling strategy was used to recruit 91 Chinese students studying in the UK to complete an online questionnaire survey, and (ii) online Zoom focus group interviews were conducted with 16 students who completed the online survey to gain an in-depth understanding of their experiences and coping methods during the pandemic. Results: Of the 91 students, 92.3% reported the UK public did not view facemask wearing as a preventive measure. 98.9% believed facemask wearing was an effective preventive measure, but 56% wore facemasks more than half of the time when out in public. 50.5% had internal conflicts of stress both when wearing and not wearing facemasks, which was more common in females than males [(62.5 vs. 31.5%), P = 0.004, Relative Risk (RR): 1.99 (1.17, 3.38)]. 61.5% reported public prejudiced attitudes against facemask wearing, also more common in females than males (71.4 vs. 45.7%), P = 0.02, RR: 1.56 (1.05, 2.32). The qualitative findings corroborated with the quantitative findings and reported that peer and family support were important for them to face such difficulties, and positive thinking and adaptability were effective methods on stress management. Conclusions: Since the outbreak of COVID-19, Chinese international students have been faced with a difficult, confusing, and sensitive situation. Owing to the ongoing pandemic, rising xenophobia and racist behaviors and the resumption of students' studies studies in the U.K., support from global communities are needed in their pursuit of quality education overseas. Our findings have significant implications on the proactive roles that governments should have, and the need for clear and accurate public health messaging to change public attitudes and mitigate prejudice. Academic institutions and mental health professionals need to proactively provide additional support to Chinese international students.

Mental Health Impacts of the COVID-19 Pandemic on International University Students, Related Stressors, and Coping Strategies.

Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted university teaching globally. The mental health impacts on international university students have been overlooked. Aims: This study examined the differences in COVID-19-related stressors and mental health impacts between international university students studying in the UK or USA who returned to their home country or region (returnees) and those who stayed in their institution country (stayers), and identified COVID-19-related stressors and coping strategies that were predictors of mental health. Method: An online questionnaire survey was conducted from April 28 through May 12, 2020 using an exponential, non-discriminative snowball sampling strategy (registered at the National Institutes of Health: NCT04365361). Results: A total of 124 full-time international university students (36.3% male) were included: 75.8% had returned to their home country or region for reasons related to COVID-19; 77.4% were pursuing a bachelor's program, and 53.2% were in programs with practicum component. 84.7% of all students had moderate-to-high perceived stress, 12.1% had moderate-to-severe symptoms of anxiety and depression, and 17.7% had moderate-to-severe symptoms of insomnia. Compared with returnees, stayers had significantly higher stress from COVID-19-related stressors such as personal health and lack of social support (Cohen's d: 0.57-1.11), higher perceived stress [10-item Perceived Stress Scale (PSS-10)] {22.6 ± 6.2 vs. 19.1 ± 6.1, ß [95% confidence interval (CI)]: 4.039 (0.816, 7.261), Cohen's d: 0.52}, and more severe insomnia symptoms [Insomnia Severity Index (ISI)] [11.8 ± 6.1 vs. 7.6 ± 5.2, ß (95% CI): 3.087 (0.262, 5.912), Cohen's d: 0.45], with moderate-to-large effect sizes. Compared with males, females reported significantly higher stress from uncertainties about academic program (Cohen's d: 0.45) with a small effect size. In the total sample, stress related to academics (e.g., personal attainment, uncertainties about academic program, and changes in teaching/learning format), health (including personal health and health of family and friends), availability of reliable COVID-19-related information, and lack of social support predicted more negative mental health impacts. Resilience, positive thinking, and exercise were predictors of less severe mental health impacts. Conclusions: Stayers experienced more adverse mental health impacts than returnees. We call on educators and mental health professionals to provide appropriate support for international students, particularly the stayers, during the pandemic.

Nurses' perceptions of and barriers to the optimal end-of-life care in hospitals: A cross-sectional study.

AIMS AND OBJECTIVES: To assess nurses' perceptions of what constitutes optimal end-of-life (EOL) care in hospital and evaluate nurses' perceived barriers to EOL care delivery. BACKGROUND: Care of dying patients is common in hospitals. However, little is known about the important elements of and barriers to optimal EOL care from key service providers' perspective, which is crucial for quality EOL care in hospital settings. METHOD: This is a cross-sectional survey. Nurses practising in hospitals recruited by convenience sampling completed self-report survey questionnaires. STROBE checklist was used in study reporting. RESULTS: One hundred and-seventy-five nurses participated in the survey. The majority (70%) had experience in caring for dying patients. The five most highly perceived factors constituting optimal EOL care included the following: "families know and follow patient's EOL wishes"; "patients emotional concerns identified and managed well"; "patients participating in decision-making"; "EOL care documents stored well and easily accessed"; and "provide private rooms and unlimited visiting hours for families of dying patients". Top five barriers were "doctors are too busy"; "nurses are too busy"; "insufficient private room/space"; "nurses have limited training in EOL care"; and "families have unrealistic expectations of patient's prognosis." Multivariate regression analysis identified that nurses without experience in caring for dying patients reported a significantly higher number of perceived barriers towards EOL care (p = .012). Those with postgraduate degree training reported significantly fewer perceived barriers (p = .007). CONCLUSION: Findings identified essential elements for optimal hospital EOL care not only involving patients and families in EOL decision and care, but also documentation and environmental issues in the healthcare system level and the needs for strengthening manpower and expertise at palliative care policy level. RELEVANCE TO CLINICAL PRACTICE: This study revealed quantitative data to inform health service managers and policy makers in terms of training and service development/ re-design for EOL care in hospital settings.

Clinical parameters of wound healing in patients with advanced illness.

BACKGROUND: Pressure injury is a common clinical parameter of patient care outcome. Various risk factors increase the risk of palliative care patients to pressure injuries and difficult wound healing. Healthcare professionals are aware that wound healing is difficult, but they still focus on this process instead of providing the needs of patients with unhealed wounds. METHODS: This study aims to identify the clinical parameters of pressure injuries in relation to patients with advanced illness. A retrospective analysis of the records of patients with pressure injuries admitted over 18 months was performed. Descriptive analysis and Spearman's correlation coefficient were used. RESULTS: A total of 127 clinical records were reviewed. The study revealed that patients of old age, high creatinine level, advanced wound age, reduced palliative performance scale (PPS) and low Norton scores are prone to suffer from unhealed wounds. CONCLUSIONS: Pressure injuries are prone to non-healing in patients with old age, high creatinine level, advanced wound stage, low PPS and low Norton scores. Further studies involving patients in earlier stage can be considered.

Superior mesenteric artery (SMA) syndrome: an unusual cause of intestinal obstruction in palliative care.

Superior mesenteric artery (SMA) syndrome is an uncommon cause of intestinal obstruction and seldom been mentioned in palliative care. Hereby, we reported a case of SMA syndrome who presented with symptoms of upper intestinal obstruction in a 68-year-old patient; subsequent CT findings were classical of SMA syndrome. The patient's history of poliomyelitis and recent significant weight loss were the predisposing factors for SMA syndrome. It also highlights the importance of monitoring signs and symptoms of intestinal obstruction in such patients before considering switching to oral feeding.

Palliative care for a patient with Lambert-Eaton myasthenic syndrome: role of 3,4-diaminopyridine.

Lambert-Eaton myasthenic syndrome (LEMS) is an uncommon autoimmune idiopathic or paraneoplastic syndrome producing antibodies against voltage presynaptic calcium channels. According to previous studies, many patients with LEMS experience remission in both the clinical symptoms of muscle weakness and the electrophysiologic abnormalities after successful treatment of lung SCC. However, some patients might not respond to conventional therapy and eventually require palliative care. Hereby, we reported a LEMS patient with advanced lung malignancy was referred for palliative care. He was benefited from multidisciplinary approach even with limited survival. In this case, use of 3,4-diaminopyridine (3,4-DAP) had other roles apart from symptomatic treatment.

Quality-of-life concerns of Chinese patients with advanced cancer.

This study aimed to examine the quality of life (QOL) of patients with advanced cancer in Hong Kong. Ninety participants were recruited from the oncology ward of the study hospital. They responded to a 28-item, 8-subscale multidimensional questionnaire and a single-item scale that measured QOL in a face-to-face interview. Participation in health care decisions, food-related concerns, and existential distress were some QOL concerns that require health care professionals' attention. Walking ability predicted the level of QOL in certain QOL domains that surfaces patients' need for rehabilitation. That the QOL domain value of life was the most important domain that predicted overall QOL calls for meaning-of-life interventions for palliative care.

The meaning of life intervention for patients with advanced-stage cancer: development and pilot study.

PURPOSE/OBJECTIVES: To develop the Meaning of Life Intervention in response to the need for brief and meaning-focused interventions in palliative care and to establish potential effect sizes for future full-scale randomized, controlled trials. DESIGN: A randomized, controlled trial conducted to pilot test the Meaning of Life Intervention. SETTING: A 68-bed oncology inpatient ward in an urban acute general hospital in Hong Kong. SAMPLE: 84 patients with advanced-stage cancer. Fifty-eight completed the study. METHODS: Assessments of outcome variables were conducted at baseline and one day and two weeks after the intervention. Patients were randomly allocated to the intervention group or the control group. Repeated measures analysis of covariance were conducted to assess the impact of the Meaning of Life Intervention on participants' quality of life. MAIN RESEARCH VARIABLES: The primary outcome was quality of life and was measured by the Quality-of-Life Concerns in the End-of-Life (QOLC-E) questionnaire and with a single-item scale on global quality of life. The eight subscales of the QOLC-E served as secondary outcomes. FINDINGS: Statistically significant main effects were noted for the group in the QOLC-E questionnaire total score, the single-item scale on global quality of life, and the existential distress subscale of the QOLC-E questionnaire. The effects represented a medium effect size. CONCLUSIONS: The results of this pilot study show that the Meaning of Life Intervention can improve quality of life, particularly existential distress. IMPLICATIONS FOR NURSING: The Meaning of Life Intervention represents a potentially effective and efficient intervention that is feasible for implementation by nursing staff for patients with advanced-stage cancer in a palliative care setting.