Transurethral En Bloc Resection Versus Standard Resection of Bladder Tumour: A Randomised, Multicentre, Phase 3 Trial.

BACKGROUND: Conventionally, standard resection (SR) is performed by resecting the bladder tumour in a piecemeal manner. En bloc resection of the bladder tumour (ERBT) has been proposed as an alternative technique in treating non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE: To investigate whether ERBT could improve the 1-yr recurrence rate of NMIBC, as compared with SR. DESIGN, SETTING, AND PARTICIPANTS: A multicentre, randomised, phase 3 trial was conducted in Hong Kong. Adults with bladder tumour(s) of ≤3 cm were enrolled from April 2017 to December 2020, and followed up until 1 yr after surgery. INTERVENTION: Patients were randomly assigned to receive either ERBT or SR in a 1:1 ratio. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was 1-yr recurrence rate. A modified intention-to-treat analysis on patients with histologically confirmed NMIBC was performed. The main secondary outcomes included detrusor muscle sampling rate, operative time, hospital stay, 30-d complications, any residual or upstaging of disease upon second-look transurethral resection, and 1-yr progression rate. RESULTS AND LIMITATIONS: A total of 350 patients underwent randomisation, and 276 patients were histologically confirmed to have NMIBC. At 1 yr, 31 patients in the ERBT group and 46 in the SR group developed recurrence; the Kaplan-Meier estimate of 1-yr recurrence rates were 29% (95% confidence interval, 18-37) in the ERBT group and 38% (95% confidence interval, 28-46) in the SR group (p = 0.007). Upon a subgroup analysis, patients with 1-3 cm tumour, single tumour, Ta disease, or intermediate-risk NMIBC had a significant benefit from ERBT. None of the patients in the ERBT group and three patients in the SR group developed progression to muscle-invasive bladder cancer; the Kaplan-Meier estimates of 1-yr progression rates were 0% in the ERBT group and 2.6% (95% confidence interval, 0-5.5) in the SR group (p = 0.065). The median operative time was 28 min (interquartile range, 20-45) in the ERBT group and 22 min (interquartile range, 15-30) in the SR group (p < 0.001). All other secondary outcomes were similar in the two groups. CONCLUSIONS: In patients with NMIBC of ≤3 cm, ERBT resulted in a significant reduction in the 1-yr recurrence rate when compared with SR (funded by GRF/ECS, RGC, reference no.: 24116518; ClinicalTrials.gov number, NCT02993211). PATIENT SUMMARY: Conventionally, non-muscle-invasive bladder cancer is treated by resecting the bladder tumour in a piecemeal manner. In this study, we found that en bloc resection, that is, removal of the bladder tumour in one piece, could reduce the 1-yr recurrence rate of non-muscle-invasive bladder cancer.

Velocity field and turbulence structure of the meandering flow produced by alternating deflectors.

Meandering flow can be formed during the advance of natural rivers by the scouring of river banks. However, this phenomenon is not common in artificial cement channels. This study used experimental scouring terrain data for a numerical simulation to study the meandering flow pattern formed between double alternating deflectors in a straight channel. The numerical results showed that the path of the accelerated flow generated by the upstream deflector was changed by installing a downstream deflector while the flow rate remained unchanged. Thus, a meandering flow formed, and a stable, narrow, high-speed zone formed in the downstream area. The accelerated flow between the two deflectors hit the channel bank soon after its direction changed. Then, a strong downward flow formed in this area, which may have produced an elliptical scour hole. A large-scale vortex structure was formed in the elliptical scour hole, which was influenced by the horseshoe vortex system before the downstream deflector.

Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide.

BACKGROUND: Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. METHODS: A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. RESULTS: Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60 ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59 ml/PD. CONCLUSION: Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.

Effectiveness of interventions on sedentary behaviors in office workers: a systematic review and meta-analysis.

OBJECTIVES: Various interventions have sought to break sedentariness among office workers, but their pooled effect on sitting time reduction remains unknown. Also, it is essential to compare the effectiveness of different intervention types. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A literature search was conducted in the PubMed, EMBASE, Scopus, Web of Science, MEDLINE (via EBSCO), PsycINFO, and Cochrane Library databases from inception to May 2, 2023. Two independent reviewers screened eligibility, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Randomized controlled trials aiming to reduce sitting at work were included. The primary outcome was sitting time at work per day. The secondary outcomes included cardiometabolic risk factors, psychological well-being, and work engagement. A random effects model was performed to synthesize continuous data as mean differences with 95% confidence intervals (95% CIs). RESULTS: Twenty-four studies with 3169 participants were included. All intervention types in combination significantly reduced workplace sitting by 38 min per workday (95% CI: -47.32 to -28.72; P < 0.001; I2 = 49.78%). Interventions using environmental support (ES), motivational strategies (MS), or multiple components (multi) had all shown a significant reduction in work-time sedentary behavior (SB) relative to control groups. Regarding secondary outcomes, no significant effects were observed in physical or psychological outcomes besides high-density lipoprotein. CONCLUSIONS: Findings suggest that SB reduction interventions are generally effective for reducing workplace sitting. Multi interventions with both ES and MS are recommended for future clinical applications. Future studies should aim not only to reduce SB but also to attain the benefits of SB reduction interventions on physical and psychological well-being.

Impact of Environment on Pain among the Working Poor: Making Use of Random Forest-Based Stratification Tool to Study the Socioecology of Pain Interference.

Pain interferes with one's work and social life and, at a personal level, daily activities, mood, and sleep quality. However, little research has been conducted on pain interference and its socioecological determinants among the working poor. Noting the clinical/policy decision needs and the technical challenges of isolating the intricately interrelated socioecological factors' unique contributions to pain interference and quantifying the relative contributions of each factor in an interpretable manner to inform clinical and policy decision-making, we deployed a novel random forest algorithm to model and quantify the unique contribution of a diverse ensemble of environmental, sociodemographic, and clinical factors to pain interference. Our analyses revealed that features representing the internal built environment of the working poor, such as the size of the living space, air quality, access to light, architectural design conducive to social connection, and age of the building, were assigned greater statistical importance than other more commonly examined predisposing factors for pain interference, such as age, occupation, the severity and locations of pain, BMI, serum blood sugar, and blood pressure. The findings were discussed in the context of their benefit in informing community pain screening to target residential areas whose built environment contributed most to pain interference and informing the design of intervention programs to minimize pain interference among those who suffered from chronic pain and showed specific characteristics. The findings support the call for good architecture to provide the spirit and value of buildings in city development.

A Qualitative Inquiry into the Challenges in Overcoming Heroin Addiction Among Chinese Individuals Who Experience Voluntary Rehabilitation.

This study explores the intentions and experiences of individuals seeking abstinence from heroin use through voluntary rehabilitation, as well as challenges to achieving a positive outcome. This study used semi-structured interviews with 37 individuals (22 female) who used heroin and utilized rational choice theory to guide data analysis. This study found that participants tried both medical and non-medical treatment methods but faced structural and personal barriers that hindered their efforts. While ceasing heroin use would presumably benefit their health and family relationships, individuals perceived the physical, psychological, and social costs of abstinence as outweighing the potential benefits and ultimately resumed heroin use. More targeted voluntary rehabilitation programs addressing specific structural and personal barriers are therefore recommended to benefit Chinese people seeking abstinence from drug use.

Evaluating the Hounsfield unit assignment and dose differences between CT-based standard and deep learning-based synthetic CT images for MRI-only radiation therapy of the head and neck.

BACKGROUND: Magnetic resonance image only (MRI-only) simulation for head and neck (H&N) radiotherapy (RT) could allow for single-image modality planning with excellent soft tissue contrast. In the MRI-only simulation workflow, synthetic computed tomography (sCT) is generated from MRI to provide electron density information for dose calculation. Bone/air regions produce little MRI signal which could lead to electron density misclassification in sCT. Establishing the dosimetric impact of this error could inform quality assurance (QA) procedures using MRI-only RT planning or compensatory methods for accurate dosimetric calculation. PURPOSE: The aim of this study was to investigate if Hounsfield unit (HU) voxel misassignments from sCT images result in dosimetric errors in clinical treatment plans. METHODS: Fourteen H&N cancer patients undergoing same-day CT and 3T MRI simulation were retrospectively identified. MRI was deformed to the CT using multimodal deformable image registration. sCTs were generated from T1w DIXON MRIs using a commercially available deep learning-based generator (MRIplanner, Spectronic Medical AB, Helsingborg, Sweden). Tissue voxel assignment was quantified by creating a CT-derived HU threshold contour. CT/sCT HU differences for anatomical/target contours and tissue classification regions including air (<250 HU), adipose tissue (-250 HU to -51 HU), soft tissue (-50 HU to 199 HU), spongy (200 HU to 499 HU) and cortical bone (>500 HU) were quantified. t-test was used to determine if sCT/CT HU differences were significant. The frequency of structures that had a HU difference > 80 HU (the CT window-width setting for intra-cranial structures) was computed to establish structure classification accuracy. Clinical intensity modulated radiation therapy (IMRT) treatment plans created on CT were retrospectively recalculated on sCT images and compared using the gamma metric. RESULTS: The mean ratio of sCT HUs relative to CT for air, adipose tissue, soft tissue, spongy and cortical bone were 1.7 ± 0.3, 1.1 ± 0.1, 1.0 ± 0.1, 0.9 ± 0.1 and 0.8 ± 0.1 (value of 1 indicates perfect agreement). T-tests (significance set at t = 0.05) identified differences in HU values for air, spongy and cortical bone in sCT images compared to CT. The structures with sCT/CT HU differences > 80 HU of note were the left and right (L/R) cochlea and mandible (>79% of the tested cohort), the oral cavity (for 57% of the tested cohort), the epiglottis (for 43% of the tested cohort) and the L/R TM joints (occurring > 29% of the cohort). In the case of the cochlea and TM joints, these structures contain dense bone/air interfaces. In the case of the oral cavity and mandible, these structures suffer the additional challenge of being positionally altered in CT versus MRI simulation (due to a non-MR safe immobilizing bite block requiring absence of bite block in MR). Finally, the epiglottis HU assignment suffers from its small size and unstable positionality. Plans recalculated on sCT yielded global/local gamma pass rates of 95.5% ± 2% (3 mm, 3%) and 92.7% ± 2.1% (2 mm, 2%). The largest mean differences in D95, Dmean , D50 dose volume histogram (DVH) metrics for organ-at-risk (OAR) and planning tumor volumes (PTVs) were 2.3% ± 3.0% and 0.7% ± 1.9% respectively. CONCLUSIONS: In this cohort, HU differences of CT and sCT were observed but did not translate into a reduction in gamma pass rates or differences in average PTV/OAR dose metrics greater than 3%. For sites such as the H&N where there are many tissue interfaces we did not observe large scale dose deviations but further studies using larger retrospective cohorts are merited to establish the variation in sCT dosimetric accuracy which could help to inform QA limits on clinical sCT usage.

COVID-19 hip fracture outcomes: The role of Ct values and D-dimer levels?

Introduction: The COVID-19 pandemic has caused high mortality rates in hip fracture patients, but data for Asian patients are lacking. Whilst Cycle threshold (Ct) values and D-dimer have been reported as predictors of mortality in COVID-19 patients, their prognostic roles in those with concomitant hip fracture remain unknown. The objectives of this study were to i) assess the clinical outcomes of COVID-19 hip fractures patients in the Chinese population, ii) identify risk factors of mortality and complications, and iii) determine the prognostic roles of Ct values and D-dimer levels. Methodology: This cohort study was conducted during the 5th wave of the COVID-19 pandemic. Inclusion criteria were 1) hip fracture 2) â€‹≥ â€‹60 years old 3) low-energy trauma. Outcomes were 90-day all-cause mortality, complications, length of stay, discharge destination and mobility status. Logistic regression analysis was performed to identify risk factors for mortality and complications. Subgroup analysis was performed for patients with Ct â€‹< â€‹30 and Ct â€‹> â€‹30, comparing their outcomes of operations performed within 48 â€‹h vs beyond 48 â€‹h. Results: 159 hip fracture patients were included, 42 patients were COVID-19 positive. COVID-19 group had significantly higher 90-day mortality rates (21.4% vs 9.4%), complication rates (45.2% vs 28.2%) and longer length of stay (17.06 vs 10.84 nights). COVID-19 was an independent risk factor for mortality and complications. Amongst the COVID-19 group, risk factors for poor outcomes were advanced age, steroids use, conservative treatment and American Society of Anaesthesiologists (ASA) score ≥ 3. Conservative treatment was associated with higher mortality (OR â€‹= â€‹16.00; p â€‹= â€‹0.025) in COVID-19 hip fracture patients. There was no significant difference between Ct values â€‹< â€‹30 and >30 regarding mortality and complication rate. D-dimer and timing to operation did not affect outcomes. Conclusions: Patients with concomitant COVID-19 and hip fracture are at high risk of mortality and complications. Ct values and D-dimer levels have no prognostic roles for hip fracture outcomes. Early operative treatment is recommended as soon as patients are medically fit.

Cadaver Study on Transoral Thyroid Chondrolaryngoplasty and Transoral Sistrunk Operation, Possibility from Transoral Thyroidectomy.

OBJECTIVE: Transoral approaches in surgery are gaining global popularity. Transoral endoscopic and robotic thyroidectomies are well established due to the benefit of being truly scarless. Thyroid chondrolaryngoplasty reduces protrusion of the thyroid notch in transgender patients. The Sistrunk operation involves removal of the thyroglossal cyst and the central portion of the hyoid bone. In this cadaveric study, we developed a transoral thyroidectomy approach and assessed the feasibility of applying this technique to thyroid chondrolaryngoplasty and Sistrunk operation with the proper usage of a special endoscopic burr. METHODS: We performed surgery using the transoral vestibular approach with 13 fresh-frozen human cadavers. Unlike transoral thyroid surgery, which requires high-resolution detailed anatomical view, this technique uses a 5-mm 30-degree endoscope with a 5-mm central port. A smaller central port can reduce the risk of mental nerve paresthesia. A special endoscopic burr for functional endoscopic sinus surgery is used to thin the thyroid notch cartilage and cut the central portion of the hyoid bone. RESULTS: We successfully performed transoral thyroid chondrolaryngoplasty and transoral Sistrunk operation in 13 cadavers. CONCLUSION: Transoral chondrolaryngoplasty and transoral Sistrunk operation are feasible for transgender or thyroglossal cyst patients. It offers the additional benefit of being a scarless surgery and could play a promising role in minimally invasive thyroid surgeries. Proper use of an endoscopic drilling burr to thin thyroid notch cartilage and cutting the central portion of the hyoid bone can make transoral thyroid chondrolaryngoplasty and transoral Sistrunk operation safe and feasible .

Carbapenem resistance among Gram-negative isolates collected from patients in ICU and non-ICU hospital wards in Hong Kong: SMART 2017-2020.

OBJECTIVES: The aim of this study was to estimate carbapenem resistance in Pseudomonas aeruginosa and Enterobacterales isolated from infected patients in intensive care unit (ICU) and non-ICU hospital wards in Hong Kong. METHODS: Isolates of Pseudomonas aeruginosa (ICU, n = 35; non-ICU, n = 264) and Enterobacterales (ICU, n = 129; non-ICU, n = 1390) were collected in four Hong Kong hospitals in 2017-2020. Clinical and Laboratory Standards Institute broth microdilution minimum inhibitory concentrations (MICs) were interpreted according to Clinical and Laboratory Standards Institute 2021 M100 breakpoints. ß-lactamase genes were identified in imipenem-, imipenem/relebactam-, and ceftolozane/tazobactam-nonsusceptible isolates. RESULTS: Ceftolozane/tazobactam demonstrated potent in vitro activity against both P. aeruginosa (ICU, 88.6%; non-ICU, 98.5%) and Enterobacterales (96.1%; 97.1%). Percent susceptible values for P. aeruginosa isolates from ICU and non-ICU patients, respectively, were as follows: meropenem (ICU, 74.3%; non-ICU, 84.1%) and imipenem (68.6%; 73.1%). Only 1 of 77 isolates tested for ß-lactamase genes carried a carbapenemase (VIM-2). Percent susceptible values for Enterobacterales isolates from ICU and non-ICU patients were as follows: meropenem (100%; 99.4%), ertapenem (100%; 98.0%), and imipenem (88.4%; 88.6%). A total of 62 Enterobacterales isolates were tested for ß-lactamase genes. Only three isolates carried a carbapenemase gene; two (both Escherichia coli) were metallo-ß-lactamase-positive (both NDM-5), and one (Klebsiella pneumoniae) was OXA-48-like-positive. CONCLUSIONS: Carbapenem-nonsusceptible isolates of P. aeruginosa were common (>15% of isolates). P. aeruginosa percent susceptible values for ceftolozane/tazobactam (97.3% susceptible overall) were ≥14% higher than those for carbapenems in both ICU and non-ICU isolates. Carbapenemases were rare among both P. aeruginosa (one isolate) and Enterobacterales (three isolates). Most Enterobacterales isolates tested from ICU and non-ICU patients in Hong Kong hospitals in 2017-2020 were susceptible to meropenem and ertapenem (≥98%); imipenem was less active (89% susceptible).

A latent profile analysis of child maltreatment among at-risk youth gang members: Associations with violent delinquency, non-violent delinquency, and gang organizational structures.

BACKGROUND: The relationship between child maltreatment and later delinquency is an enduring concern worldwide. However, the maltreatment-delinquency relationship is relatively underexplored in youth gang populations. Consequently, to date, studies have not examined typologies of maltreatment and their associations with violent delinquency, non-violent delinquency, and gang organizational structures. OBJECTIVE: First, to identify the characteristics of subgroups of youth gang members who varied in abuse type and severity within type. Second, to determine in what ways the profiles differed in terms of gang organizational structures, violent delinquency, and non-violent delinquency. PARTICIPANTS AND SETTINGS: A sample of 161 youth gang members (mean age: 16.8; range: 12-24) were recruited and surveyed by outreach social workers in Hong Kong. METHODS: Latent profile analysis was first used to examine heterogeneity in victimization experiences (physical abuse, sexual abuse, emotional abuse, and neglect). Thereafter, non-parametric tests and post-hoc analyses were conducted to examine associations between the yielded typologies of maltreatment and gang organizational structures, violent delinquency, and non-violent delinquency. RESULTS: Poly-victimization was prevalent in the sample, with 148 respondents (91.9 %) reporting at least two types of past abuses. Three profiles of maltreatment emerged, varying in abuse types and severity within types: 'Minimally maltreated', 'Moderately maltreated, except sexual abuse', and 'Severely maltreated'. In comparison to the 'Minimal' maltreatment profile, the 'Moderate' and 'Severe' profiles were associated with greater delinquent behaviors and being in gangs that encouraged congregate illegal behaviors. CONCLUSIONS: There was a relationship between typologies of maltreatment and gang organizational structures, violent delinquency, and non-violent delinquency in the sample of youth gang members. Implications for practice and future research are discussed.

Trans-Sclera Electrical Stimulation Improves Retinal Function in a Mouse Model of Retinitis Pigmentosa.

Retinitis pigmentosa (RP) is a photoreceptor-degenerating disease with no effective treatment. Trans-corneal electrical stimulation has neuroprotective effects in degenerating retinas, but repeated applications cause corneal injury. To avoid the risk of corneal damage, here we tested whether repetitive trans-sclera electrical stimulation (TsES) protects degenerating retinas in rd10 mice, a model of RP. At postnatal day 20 (P20), the right eyes of rd10 mice were exposed to 30 min of TsES daily or every other day till P25, at the amplitude of 50 or 100 µA, with zero current as the sham. Immunostaining, multi-electrode-array (MEA) recording, and a black-and-white transition box were applied to examine the morphological and functional changes of the treated retina. Functionally, TsES modified the retinal light responses. It also reduced the high spontaneous firing of retinal ganglion cells. TsES at 100 µA but not 50 µA increased the light sensitivities of ganglion cells as well as their signal-to-noise ratios. TsES at 100 µA increased the survival of photoreceptors without improving the visual behavior of rd10 mice. Our data suggest that repetitive TsES improves the retinal function of rd10 mice at the early degenerating stage, therefore, it might be an effective long-term strategy to delay retinal degeneration in RP patients.

Types of Community Support Services and Self-Efficacy for Continuous Community Living among Individuals with Disabilities and Caregivers.

This study explored the impacts of five types of community support services (i.e., center-based care, home-based care, respite care, caregiver assistance, and financial subsidies) on self-efficacy for continuous community living among individuals with disabilities and caregivers. DESIGN: Cross-sectional. METHOD: The sample consisted of a group of individuals with disabilities (n = 948) and a group of caregivers (n = 522). A mixed ANOVA was applied to explore the differences in the perceived importance of improvements to community support services between the groups. Logistic regression analyses were conducted to examine the perceived importance of improvements to types of community support services for self-efficacy for continuous community living. RESULTS: Caregivers perceived higher levels of importance for improvements to community support services than individuals with disabilities. Both groups reported that financial subsidies were the most important area for improvement. The greater importance of improvements to financial subsidies reported by caregivers predicted greater odds for self-efficacy for continuous community living. The greater importance of improvements to center-based services reported by individuals with disabilities predicted greater odds for self-efficacy for continuous community living. CONCLUSIONS: The findings suggested that financial subsidies for caregivers and center-based services for individuals with disabilities could improve self-efficacy for continuous community living.

Mental Health during the Early Stage of the COVID-19 Pandemic: A Hong Kong Study.

This study addressed the impact on mental health and wellbeing in relation to views of the self, the world, and the future during the early stage of the global novel coronavirus (COVID-19) pandemic outbreak. An online survey battery included the 21-item Depression Anxiety and Stress Scale (DASS-21), Subjective Happiness Scale, Self-Compassion Scale, Adult Hope Scale, and two specifically-written items measuring the valence quality and quantity of the impact of the pandemic. A total of 345 Hong Kong residents (54% females) responded; 17.1%, 24.7%, and 19.7% reported elevated levels of depression, anxiety, and stress, respectively. The prevalence of these issues was lower in this Hong Kong sample than reported in other COVID-19 studies, possibly due to the past experience of the severe acute respiratory syndrome (SARS) outbreak in Hong Kong in promoting the voluntary wearing of masks in public places and introducing social distancing measures during the early first wave of the pandemic. Correlational analyses showed associations between positive views about the self (higher self-compassion), the world (higher positive valence), and the future (more hope) and better mental health and psychological wellbeing (fewer depression, anxiety, and stress symptoms; more happiness). Regression analyses indicated a differential predicting power of the three views on the four selected mental health and psychological wellbeing indicators. Intervention programs to alleviate distress and/or promote better wellbeing should be matched to the specific problems encountered by the sufferers.

Increased Stability of SARS-CoV-2 Omicron Variant over Ancestral Strain.

As of April 2022, the Omicron BA.1 variant of concern of SARS-CoV-2 was spreading quickly around the world and outcompeting other circulating strains. We examined its stability on various surfaces and found that this Omicron variant is more stable than its ancestral strain on smooth and porous surfaces.

Activation of the viral sensor oligoadenylate synthetase 2 (Oas2) prevents pregnancy-driven mammary cancer metastases.

BACKGROUND: The interferon response can influence the primary and metastatic activity of breast cancers and can interact with checkpoint immunotherapy to modulate its effects. Using N-ethyl-N-nitrosourea mutagenesis, we found a mouse with an activating mutation in oligoadenylate synthetase 2 (Oas2), a sensor of viral double stranded RNA, that resulted in an interferon response and prevented lactation in otherwise healthy mice. METHODS: To determine if sole activation of Oas2 could alter the course of mammary cancer, we combined the Oas2 mutation with the MMTV-PyMT oncogene model of breast cancer and examined disease progression and the effects of checkpoint immunotherapy using Kaplan-Meier survival analysis with immunohistochemistry and flow cytometry. RESULTS: Oas2 mutation prevented pregnancy from increasing metastases to lung. Checkpoint immunotherapy with antibodies against programmed death-ligand 1 was more effective when the Oas2 mutation was present. CONCLUSIONS: These data establish OAS2 as a therapeutic target for agents designed to reduce metastases and increase the effectiveness of checkpoint immunotherapy.

Activity of ceftolozane/tazobactam against Gram-negative isolates among different infections in Hong Kong: SMART 2017-2019.

Introduction. Ceftolozane/tazobactam was approved by the Drug Office, Department of Health, Government of the Hong Kong Special Administrative Region in 2017.Hypothesis/Gap Statement. Currently the in vitro activity of ceftolozane/tazobactam against Gram-negative pathogens isolated from patients in Hong Kong is undocumented. It would be prudent to document the activity of ceftolozane/tazobactam against Pseudomonas aeruginosa and Enterobacterales isolated from hospitalized patients in Hong Kong.Aim. To describe the in vitro susceptibility of recent clinical isolates of P. aeruginosa and the two most common Enterobacterales species (Klebsiella pneumoniae, Escherichia coli) cultured from respiratory tract, intra-abdominal, urinary tract and bloodstream infection samples to ceftolozane/tazobactam and other commonly used antimicrobial agents.Methodology. CLSI-defined broth microdilution MICs were determined and interpreted for Gram-negative isolates collected in Hong Kong from 2017 to 2019 by the SMART surveillance programme.Results. For P. aeruginosa, 96.7 % of isolates (n=210) were susceptible to ceftolozane/tazobactam, while susceptibility rates were ≥14 % lower to meropenem (82.9 % susceptible), cefepime (82.4 %), ceftazidime (81.4 %), piperacillin/tazobactam (76.7 %) and levofloxacin (79.5 %). Ceftolozane/tazobactam inhibited 85.7 % of piperacillin/tazobactam-nonsusceptible isolates, 80.6-82.1 % of cefepime-, ceftazidime- or meropenem-nonsusceptible isolates, and 75.9 % of multidrug-resistant (MDR) isolates of P. aeruginosa. For K. pneumoniae, 96.1 % of isolates (n=308) were susceptible to ceftolozane/tazobactam compared with meropenem (99.0 % susceptible), piperacillin/tazobactam (93.8 %), cefepime (85.7 %) and ceftazidime (85.4 %). The majority (88.3 %) of ESBL (extended-spectrum ß-lactamase) non-CRE (carbapenem-resistant Enterobacterales) phenotype isolates of K. pneumoniae were susceptible to ceftolozane/tazobactam, comparable to piperacillin/tazobactam (85.0 %) but lower than meropenem (100 %). For E. coli, 98.5 % of isolates (n=609) were susceptible to ceftolozane/tazobactam compared to meropenem (99.3 % susceptible), piperacillin/tazobactam (96.7 %), ceftazidime (82.3 %) and cefepime (76.5 %). The majority (96.7 %) of ESBL non-CRE phenotype isolates of E. coli were susceptible to ceftolozane/tazobactam, similar to both meropenem (100 %) and piperacillin/tazobactam (94.5 %).Conclusions. Overall, >96 % of clinical isolates of P. aeruginosa, K. pneumoniae and E. coli collected in Hong Kong in 2017-2019 were susceptible to ceftolozane/tazobactam, while the activity of several commonly prescribed ß-lactams was reduced, especially for P. aeruginosa. Continued surveillance of ceftolozane/tazobactam and other agents is warranted.

High Charlson Comorbidity Index Score is associated with early fracture-related complication for internal fixation of neck of femur fractures.

The incidence of geriatric hip fractures continues to rise in our aging population and has become a major public health concern globally. The primary outcome of this study was to determine whether Age-adjusted Charlson Comorbidity Index (ACCI) is associated with increased fracture-related complications in neck of femur fractures treated by internal fixation. This was a cohort study between January 2014 to June 2018. All patients ≥ 50 years old with an acute neck of femur fracture after low-energy trauma fixed with cannulated hip screws were included and followed-up for 1 year at a tertiary centre. Primary outcome was to determine whether ACCI was associated with increased fracture-related complications. Secondary outcomes were revision rate, mortality, and function after surgery. Further analysis were performed within a "younger" group (age 50-65) and "elder" group (age > 65), as displaced fractures (Garden Type III/IV) were in "younger" group. 233 hip fractures (68 males; 165 females) with a mean age of 73.04 ± 12.89 were included in the study. Surgical outcomes showed that the complication rate of hip screw fixation for all patients was 21.5% (50 patients) at 1 year. ACCI was significantly higher in all patients with complications (p = 0.000). Analysis within "younger" (p = 0.000) and "elder" groups (p = 0.006) both showed significance. Stepwise logistic regression modelling showed ACCI had positive correlation with complications with ACCI = 6 (OR 4.27, p = 0.02). R2 values were comparatively better after controlled by Garden Type III/IV at ACCI = 4 (OR 6.42 (1.70, 24.25), p = 0.01). The authors recommend that for patients with a Garden Type I/II and ACCI ≥ 6 or a Garden Type III/IV and ACCI ≥ 4, a direct arthroplasty surgery should be considered.

Using Illicit Drugs to Lose Weight among Recovering Female Drug Users in China: An Exploratory Qualitative Study.

The population of female drug users has been growing in China, and these women have been found to care deeply about their weight. Against this backdrop, this study examines the relationship between Chinese women's illicit drug use and their intentions to lose weight, keep fit, and maintain a slim body shape. The participants of this study were 29 women who all had experience with illicit drug use for weight control. These women were drawn from a female compulsory drug treatment center located in eastern China. Semi-structured interviews with these 29 participants were conducted between 2013 and 2016. Expectations of losing weight and pursuing their ideal slim body shape were found to be an important reason for the study participants' initiation of drug use, its maintenance, and failures to achieve abstinence. These Chinese female drug users were generally satisfied with weight loss outcomes subsequent to drug consumption. A fuller appreciation of Chinese women's weight-loss-related illicit drug use patterns is much needed to help devise strategies and policies to deal with this growing problem. These include changing the dominant aesthetic cultural preference for thinness, paying particular attention to the functional use of illicit drugs in drug treatment programs, and having special interventions for women who interact with drug users within their social networks.

Double Disadvantage of Carers with a Disability: A Cross-Sectional Study of Care Duration and Perceived Importance for Service Improvement in Hong Kong, China.

OBJECTIVES: this study examined (i) the relationships between the care duration of carers and their perceptions of the importance of service improvement by types of service, and (ii) whether carers had a disability that moderated the impacts of care duration on these perceptions. DESIGN: survey data for cross-sectional analyses. METHOD: The sample consisted of carers without disability (n = 625) and carers with a disability (n = 77). Hierarchical multiple regression was applied to examine the unique contribution of care duration. The interaction effects of the disability status of the carer was also estimated. RESULTS: Longer care duration was associated with a greater perception of the importance of service improvement for certain services by carers. The positive relationships between care duration and perception of the importance of caregiver assistances and financial subsidy improvement were stronger for carers with disabilities compared to carers without disability. CONCLUSIONS: Long-term carers with disabilities face a potential double disadvantage of service improvement needs with more years of caregiving. Policy makers should consider prioritizing caregiver assistances or financial subsidy service improvements for long-term carers who themselves have a disability.