A Self-Healing PVA-Linked Phytic Acid Hydrogel-Based Electrolyte for High-Performance Flexible Supercapacitors.

Flexible supercapacitors can be ideal flexible power sources for wearable electronics due to their ultra-high power density and high cycle life. In daily applications, wearable devices will inevitably cause damage or short circuit during bending, stretching, and compression. Therefore, it is necessary to develop proper energy storage devices to meet the requirements of various wearable electronic devices. Herein, Poly(vinyl alcohol) linked various content of phytic acid (PVA-PAx) hydrogels are synthesized with high transparency and high toughness by a one-step freeze-thaw method. The effects of different raw material ratios and agents on the ionic conductivity and mechanical properties of the hydrogel electrolyte are investigated. The PVA-PA21% with 2 M H2SO4 solution (PVA-PA21%-2 M H2SO4) shows a high ionic conductivity of 62.75 mS cm-1. Based on this, flexible supercapacitors fabricated with PVA-PA21%-2 M H2SO4 hydrogel present a high specific capacitance at 1 A g-1 after bending at 90° (64.8 F g-1) and for 30 times (67.3 F g-1), respectively. Moreover, the device shows energy densities of 13.5 Wh kg-1 and 14.0 Wh kg-1 at a power density of 300 W kg-1 after bending at 90° and for 30 times during 10,000 cycles. It provides inspiration for the design and development of electrolytes for related energy electrochemical devices.

Surgical procedures and plasma exchange for ovarian teratoma-associated anti-N-methyl D-aspartate receptor encephalitis: a case report and review of literature.

We reported a case of ovarian teratoma-associated Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis with recurrent epileptic seizures and disturbance of consciousness. Although surgical excision of the tumor remains the established standard of care, unlike other reported cases, the patient exhibited limited response to early oophorocystectomy, as well as IVIG and steroid therapy; however, a favorable response was observed with Plasma exchange (PE) initiated on postoperative day 12. Literature review revealed no definite recommended surgical extent for ovarian teratomas, and outstanding improvement in patients with anti-NMDAR encephalitis following PE. Our case raises the question regarding the optimal surgical extent for tumor resection, necessitating careful consideration when deciding between oophorectomy and adnexectomy as the preferred surgical procedure for anti-NMDAR encephalitis in female teens and adults. Furthermore, for refractory patients who fail to respond following tumor resection, PE can be performed early instead of immediately initiating second-line therapy.

Postmyomectomy uterocutaneous fistula: a case report and literature review.

BACKGROUND: Uterocutaneous fistula (UCF) is an uncommon clinical entity. The aetiology and optimal treatment strategy of UCF are still not clear. GnRHa (gonadotropin-releasing hormone agonist) treatment as an option for conservative hormone therapy for UCF has diverse clinical outcomes. The true status of hormone receptors in UCF lesions and its relationship with the therapeutic effect of GnRHa treatment have not yet been studied. CASE PRESENTATION AND REVIEW OF THE LITERATURE: A 39-year-old woman underwent an uneventful myomectomy during her initial visit to our centre. The patient returned to our centre with complaints of fluid oozing from her abdominal wound. Misdiagnosed with poor wound healing, the patient received a secondary closure. Consequent blood-stained drainage from the wound during menstruation and imaging tests confirmed the diagnosis of UCF. Surgical repair and excision of the fistula tract were performed. Histopathological analysis revealed fistulization and a negative status of hormone receptors in the fistula. Considering the controversial role of GnRHa treatment in UCF and the negative oestrogen receptor (ER) and progesterone receptor (PR) status in the current case, we further systematically reviewed the literature for GnRHa treatment for UCF, with the results showing that GnRHa manipulation as a conservative hormone therapeutic schedule is effective in 2 (50%) of the 4 patients in which it was attempted. CONCLUSION: UCF is a rare entity and tends to be misdiagnosed. GnRHa as a conservative therapy for UCF has different clinical outcomes. The current finding of a negative hormone receptor status in the fistula may provide new clues for further exploration of the mechanisms of the diverse therapeutic effects of GnRHa on UCF.

Evidence of Construct Validity of Computer-Based Tests for Clinical Reasoning: Instrument Validation Study.

BACKGROUND: Clinical reasoning (CR) is a fundamental skill for all medical students. In our medical education system, however, there are shortcomings in the conventional methods of teaching CR. New technology is needed to enhance our CR teaching, especially as we are facing an influx of new health trainees. China Medical University (CMU), in response to this need, has developed a computer-based CR training system (CMU-CBCRT). OBJECTIVE: We aimed to find evidence of construct validity of the CMU-CBCRT. METHODS: We recruited 385 students from fifth year undergraduates to postgraduate year (PGY) 3 to complete the test on CMU-CBCRT. The known-groups technique was used to evaluate the construct validity of the CBCRT by comparing the test scores among 4 training levels (fifth year MD, PGY-1, PGY-2, and PGY-3). RESULTS: We found that test scores increased with years of training. Significant differences were found in the test scores on information collection, diagnosis, and treatment and total scores among different training years of participants. However, significant results were not found for treatment errors. CONCLUSIONS: We provided evidence of construct validity of the CMU-CBCRT, which could determine the CR skills of medical students at varying early stage in their careers.

A Note on the Hierarchy of Quantum Measurement Incompatibilities.

The quantum measurement incompatibility is a distinctive feature of quantum mechanics. We investigate the incompatibility of a set of general measurements and classify the incompatibility by the hierarchy of compatibilities of its subsets. By using the approach of adding noises to measurement operators, we present a complete classification of the incompatibility of a given measurement assemblage with n members. Detailed examples are given for the incompatibility of unbiased qubit measurements based on a semidefinite program.

Application of latent class analysis in assessing the competency of physicians in China.

BACKGROUND: The physicians' competency is an important public health issue around the world. Several international organizations have taken the lead in examining the competencies required to be a physician. The purpose of this study is to identify subgroups of physicians' competency based upon the importance results of competency evaluation and provide a scientific basis for the qualitative research of the competency of physicians. METHODS: A cross-sectional study was conducted on a large population-based sample in 31 provinces, autonomous regions and municipalities directly under the central government in China. The latent class analysis was performed to identify patterns of physicians' competency using M-plus software. RESULTS: In this study, the latent class analysis was adopted to identify the appropriate number of distinct latent classes of physicians' competency based on eight competency dimensions, and a four-class model best fit the data, which are excellent competency group, lack of professionalism competency group, individual competency driven group, and lack of competency cognitive group. Therefore, 6247 physicians can be divided into four latent classes based on the importance results of competency evaluation, and the number of each class is 5684, 284, 215 and 64, respectively. CONCLUSION: These findings suggested that latent class analysis can be used to study the competency of physicians, and four distinct subgroups were identified. Therefore, we can effectively understand the patterns of physicians' competency, and the health administrative departments could utilize more specific measures according to their different competency subgroups, and providing individualized training schemes in the future training and management of physicians.

On Local Unitary Equivalence of Two and Three-qubit States.

We study the local unitary equivalence for two and three-qubit mixed states by investigating the invariants under local unitary transformations. For two-qubit system, we prove that the determination of the local unitary equivalence of 2-qubits states only needs 14 or less invariants for arbitrary two-qubit states. Using the same method, we construct invariants for three-qubit mixed states. We prove that these invariants are sufficient to guarantee the LU equivalence of certain kind of three-qubit states. Also, we make a comparison with earlier works.

A Competency Model for Clinical Physicians in China: A Cross-Sectional Survey.

BACKGROUND: Around the world, regulatory bodies have taken the lead in determining the competencies required to become a physician. As a first step in addressing this project, it was decided to develop a set of core competencies that were unique to China and that might serve as a basis for medical education. The purpose of this paper was to construct a competency model for clinical physicians in China. METHODS: Data was collected using a cross-sectional survey of 6247 clinicians from seven administrative regions (31 provinces, autonomous regions and municipalities directly under the central government) in China. The total sample was randomly divided into two sub-samples, an initial sample (Sample 1) and a replication sample (Sample 2). Independent exploratory factor analysis was conducted in each sample and the results were compared to determine the stability. After that the confirmatory factor analysis was used to ascertain the competency model for physicians. The reliability, convergent and discriminant validity of competency-based instrument were also examined. RESULTS: 76 items with 8 dimensions were identified, accounting for 68.41% of the construct's total variance in the initial sample and 67.47% in the replication sample. For the two samples, the overall scale reliability (Cronbach's alpha) was both 0.985 with dimensions from 0.905 to 0.954 for the initial sample and from 0.902 to 0.955 for the replication sample after deleting the items. In confirmatory factor analysis, the result showed that all items had acceptable goodness of fit index. RMSEA and SRMR were less than 0.08 (RMSEA = 0.046, SRMR = 0.040), while GFI, NFI, IFI, and CFI were higher than 0.9 (GFI = 0.905, NFI = 0.903, IFI = 0.909, CFI = 0.909), leading to acceptable construct validity. All construct reliability values of the factors were higher than 0.70, and all average variance extracted values exceeded 0.50. Thus, we considered the reliability and validity of the 8 dimensions were acceptable. CONCLUSIONS: The instrument was shown to be both valid and reliable for measuring clinical physicians' competency in China. The results of the competency-based instrument can be used by ministry of health and administrators of hospitals to assess physicians' competencies, encourage and guide them to modify their behaviors according to the evaluation criteria, and also cultivate physicians with strong clinical practice, innovation and independent scientific research ability. Through these measurements and understandings, the overall level of clinical physicians will be increased in China.

Identifying the competencies of doctors in China.

BACKGROUND: China adopted a Flexnerian model as its medical institutions developed over the recent past but the political, social, and economic environment has changed significantly since then. This has generated the need for educational reform, which in other countries, has largely been driven by competencies-oriented models such as those developed in Canada, and the United States. Our study sought to establish the competencies model, relevant to China, which will support educational reform efforts. METHODS: Data was collected using a cross-sectional survey of 1776 doctors from seven provinces in China. The surveys were translated and adapted from the Occupational Information Network General Work Activity questionnaire (O*NET-GWA) and Work Style questionnaire (O*NET-WS) developed under the auspices of the US Department of Labor. Exploratory factor analysis and confirmatory factor analysis ascertained the latent dimensions of the questionnaires, as well as the factor structures of the competencies model for the Chinese doctors. RESULTS: In exploratory factor analysis, the questionnaires were able to account for 64.25 % of total variance. All responses had high internal consistency and reliability. In confirmatory factor analysis, the loadings of six constructs were between 0.53 ~ 0.89 and were significant, Construct reliability (CR) were between 0.79 ~ 0.93 respectively. The results showed good convergent validity. The resultant models fit the data well (GFI was 0.92, RMSEA was 0.07) and the six-factor competencies framework for Chinese doctors emerged. CONCLUSIONS: The Chinese doctors' competencies framework includes six elements: (a) technical procedural skills; (b) diagnosis and management; (c) teamwork and administration; (d) communication; (e) professional behavior; and (f) professional values. These findings are relevant to China, consistent with its current situation, and similar to those developed in other countries.

Internal and External Factors Related to Burnout among Iron and Steel Workers: A Cross-Sectional Study in Anshan, China.

BACKGROUND: Burnout is a syndrome of emotional exhaustion, cynicism and reduced professional efficacy, which can result from long-term work stress. Although the burnout level is high among iron and steel workers, little is known concerning burnout among iron and steel worker. This study aimed to evaluate the burnout and to explore its associated internal and external factors in iron and steel workers. METHODS: A cross-sectional survey was conducted in iron and steel workers at the Anshan iron-steel complex in Anshan, northeast China. Self-administered questionnaires were distributed to 1,600 workers, and finally 1,300 questionnaires were returned. Burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS). Effort-reward imbalance (ERI), perceived organizational support (POS), and psychological capital (PsyCap) were measured anonymously. A hierarchical regression model was applied to explore the internal and external factors associated with burnout. RESULTS: Mean MBI-GS scores were 13.11±8.06 for emotional exhaustion, 6.64±6.44 for cynicism, and 28.96±10.39 for professional efficacy. Hierarchical linear regression analysis showed that ERI and POS were the most powerful predictors for emotional exhaustion and cynicism, and PsyCap was the most robust predictor for high professional efficacy. CONCLUSIONS: Chinese iron and steel workers have a high level of burnout. Burnout might be associated with internal and external factors, including ERI, POS, and PsyCap. Further studies are recommended to develop an integrated model including both internal and external factors, to reduce the level of ERI, and improve POS and workers' PsyCap, thereby alleviating the level of burnout among iron and steel workers.

Transformation of the education of health professionals in China: progress and challenges.

In this Review we examine the progress and challenges of China's ambitious 1998 reform of the world's largest health professional educational system. The reforms merged training institutions into universities and greatly expanded enrolment of health professionals. Positive achievements include an increase in the number of graduates to address human resources shortages, acceleration of production of diploma nurses to correct skill-mix imbalance, and priority for general practitioner training, especially of rural primary care workers. These developments have been accompanied by concerns: rapid expansion of the number of students without commensurate faculty strengthening, worries about dilution effect on quality, outdated curricular content, and ethical professionalism challenged by narrow technical training and growing admissions of students who did not express medicine as their first career choice. In this Review we underscore the importance of rebalance of the roles of health sciences institutions and government in educational policies and implementation. The imperative for reform is shown by a looming crisis of violence against health workers hypothesised as a result of many factors including deficient educational preparation and harmful profit-driven clinical practices.

Survey and analysis of the current state of residency training in medical-school-affiliated hospitals in China.

BACKGROUND: Since the global standards for postgraduate medical education (PGME) were published in January 2003, they have gained worldwide attention. The current state of residency training programs in medical-school-affiliated hospitals throughout China was assessed in this study. METHODS: Based on the internationally recognized global standards for PGME, residents undergoing residency training at that time and the relevant residency training instructors and management personnel from 15 medical-school-affiliated hospitals throughout China were recruited and surveyed regarding the current state of residency training programs. A total of 938 questionnaire surveys were distributed between June 30, 2006 and July 30, 2006; of 892 surveys collected, 841 were valid. RESULTS: For six items, the total proportions of "basically meets standards" and "completely meets standards" were <70% for the basic standards. These items were identified in the fields of "training settings and educational resources", "evaluation of training process", and "trainees". In all fields other than "continuous updates", the average scores of the western regions were significantly lower than those of the eastern regions for both the basic and target standards. Specifically, the average scores for the basic standards on as many as 25 of the 38 items in the nine fields were significantly lower in the western regions. There were significant differences in the basic standards scores on 13 of the 38 items among trainees, instructors, and managers. CONCLUSIONS: The residency training programs have achieved satisfactory outcomes in the hospitals affiliated with various medical schools in China. However, overall, the programs remain inadequate in certain areas. For the governments, organizations, and institutions responsible for PGME, such global standards for PGME are a very useful self-assessment tool and can help identify problems, promote reform, and ultimately standardize PGME.

Psychometric characteristics of the 360° feedback scales in professionalism and interpersonal and communication skills assessment of surgery residents in China.

AIMS: The aim of the study was to test the psychometric characteristics of the 360° evaluation instrument for assessing residents' competency in professionalism, interpersonal and communication skills, and develop a feasible, valid, and reliable multisource feedback (MSF) program for surgery residents to address this gap. METHODS: We carried out an MSF assessment of 149 surgery residents at 19 hospitals all over China. MSF assessment includes 6 surveys with 21, 21, 21, 26, 14, and 15 items and these surveys were developed to assess surgery residents by attending doctor, resident self, peer, nurse, patient, and office staff, respectively, using a 5-point agreement scale with an "unable-to-evaluate" category. Reliability was assessed by Cronbach alpha. Exploratory factor analysis was used to assess validity and determine which items grouped together into scales. RESULTS: A total of 2384 questionnaires were analyzed in this study. The internal consistency reliability of the instruments was a Cronbach alpha of 0.932, 0.936, 0.914, 0.916, 0.939, and 0.903 for attending doctor, resident self, nurse, patient, resident peer, and office staff surveys, respectively. On the attending, resident self, resident peer, nurse, office staff, and patient surveys, the factor analysis identified 2 factors of professionalism and interpersonal and communication skills accounting for 75.62%, 74.81%, 72.65%, 73.38%, 76.11%, and 63.89% of the variance, respectively. Some items, such as Demonstrates respect for my "Sexual Orientation," "Religion," and "Disability," in different surveys had high unable-to-evaluate rates (more than 10%). CONCLUSIONS: The data suggest that these instruments developed to assess surgery residents are feasible to administer and provide valid and reliable evidence. Some items in survey need to be adjusted keeping in mind the Chinese culture.

Assessment of resident physicians in professionalism, interpersonal and communication skills: a multisource feedback.

OBJECTIVE: To assess the internal validity and reliability of a multisource feedback (MSF) program by China Medical Board for resident physicians in China. METHOD: Multisource feedback was used to assess professionalism, interpersonal and communication skills. 258 resident physicians were assessed by attending doctors, self-evaluation, resident peers, nurses, office staffs, and patients who completed a sealed questionnaire at 19 hospitals in China. Cronbach's alpha coefficient was used to assess reliability. Validity was assessed by exploratory factor analyses and by profile ratings. RESULTS: 4128 questionnaires were collected from this study. All responses had high internal consistency and reliability (Cronbach's α > 0.90), which suggests that both questions and form data were internally consistent. The exploratory factor analysis with varimax rotation for the evaluators' questionnaires was able to account for 70 to 74% of the total variance. CONCLUSION: The current MSF assessment tools are internally valid and reliable for assessing resident physician professionalism and interpersonal and communication skills in China.

Evaluation of residents in professionalism and communication skills in south China.

OBJECTIVE: To evaluate the resident doctors' competency in professionalism and communication skills in south China. METHODS: We conducted this cross-sectional study in 8 hospitals, in 4 provinces of southern China from October to December 2007. The evaluation included 148 resident doctors. A 360-degree instrument from Education Outcomes Service Group (EOS group) of the Arizona Medical Education Consortium was developed and used by the attending physicians, residents, and their peers, nurses, patients, and office staff in this study. All data were entered into a computerized database and analyzed using the Statistical Package for Social Sciences version 13.0( SPSS Inc., Chicago, IL, USA) for Windows®. RESULTS: Our results indicated that the instruments are internally consistent (Cronbach's alpha >0.90). The principal components analysis with varimax rotation for the attending-, resident self-evaluation, nurse-, patient-, office staff- and resident peer-rated questionnaires explained 70.68%, 76.13%, 77.02%, 76.37%, 75.51%, and 72.05% of the total variance. Significant differences (p<0.05) were found among different evaluators. CONCLUSION: The 360-degree instrument appears to be reliable in evaluating a residents' competency in professionalism and communication skills. Information from the assessment may provide feedback to residents.