Unveiling facial kinship: The BioKinVis dataset for facial kinship verification and genetic association studies.

Facial image-based kinship verification represents a burgeoning frontier within the realms of computer vision and biomedicine. Recent genome-wide association studies have underscored the heritability of human facial morphology, revealing its predictability based on genetic information. These revelations form a robust foundation for advancing facial image-based kinship verification. Despite strides in computer vision, there remains a discernible gap between the biomedical and computer vision domains. Notably, the absence of family photo datasets established through biological paternity testing methods poses a significant challenge. This study addresses this gap by introducing the biological kinship visualization dataset, encompassing 5773 individuals from 2412 families with biologically confirmed kinship. Our analysis delves into the distribution and influencing factors of facial similarity among parent-child pairs, probing the potential association between forensic short tandem repeat polymorphisms and facial similarity. Additionally, we have developed a machine learning model for facial image-based kinship verification, achieving an accuracy of 0.80 in the dataset. To facilitate further exploration, we have established an online tool and database, accessible at http://120.55.161.230:88/.

Genome-wide association studies combined with k-fold cross-validation identify rs17822931 as an ancestry-informative marker in Han Chinese population.

DNA-based ancestry inference has long been a research hot spot in forensic science. The differentiation of Han Chinese population, such as the northern-to-southern substructure, would benefit forensic practice. In the present study, we enrolled participants from northern and southern China, each participant was genotyped at ∼400 K single-nucleotide polymorphisms (SNPs) and data of CHB and CHS from 1000 Genomes Project were used to perform genome-wide association analyses. Meanwhile, a new method combining genome-wide association study (GWAS) analyses with k-fold cross-validation in a small sample size was introduced. As a result, one SNP rs17822931 emerged with a p-value of 7.51E - 6. We also simulated a huge dataset to verify whether k-fold cross-validation could reduce the false-negative rate of GWAS. The identified ABCC11 rs17822931 has been reported to have allele frequencies varied with the geographical gradient distribution in humans. We also found a great difference in the allele frequency distributions of rs17822931 among five different cohorts of the Chinese population. In conclusion, our study demonstrated that even small-scale GWAS can also have potential to identify effective loci with implemented k-fold cross-validation method and shed light on the potential maker of rs17822931 in differentiating the north-to-south substructure of the Han Chinese population.

The Effects of APP-Based Intervention for Depression Among Community-Dwelling Individuals With Spinal Cord Injury: A Randomized Controlled Trial.

OBJECTIVE: To assess the effect of a self-management intervention delivered by mobile application (APP) for depression among community-dwelling individuals with spinal cord injury (SCI). DESIGN: Randomized controlled trial. SETTINGS: General communities in China. PARTICIPANTS: Community-dwelling individuals with SCI who were diagnosed within 2 years were recruited in this study (N=98). It was a convenience sample with an average age of 41.71, 82.7% participants were men. INTERVENTIONS: Participants in the intervention group (n=49) received 5 sessions on self-management training provided by nurse-led multidisciplinary team via APP at the second, fourth, sixth, eighth, and 12th weeks, respectively, after they discharge from hospitals. Participants in the control group (n=49) received routine telephone counselling provided by follow-up nurses at the 12th week after they discharge. OUTCOME MEASURE: The outcome of this study is depression, which is not the primary outcomes in the registration of this program. Depression was measured by version 2 of Beck Depression Inventory at discharge (T0), the 12th week after discharge from hospitals (T1), and the 24th week after discharge from hospitals (T2). RESULTS: There were 98 participants (49 in the intervention group and 49 in the control group) completing the intervention and data collection. Compared with the control group, the intervention group had lower level of depression at T2 (B=-5.76; 95% CI=-9.97, -1.54; P=.007). Small to moderate effect sizes on depression favoring the intervention were demonstrated at T1 (Cohen's d=-.178) and T2 (Cohen's d=-.535). CONCLUSIONS: APP-based self-management support can be a potential intervention to reduce depression among community-dwelling individuals with SCI.

Skin self-management of community-dwelling patients with spinal cord injury: A cross-sectional study.

BACKGROUND: community-acquired pressure injury is one of the most common and troublesome complications of discharged patients with spinal cord injury. Previous studies have shown that pressure injury can not only increase the financial burden and care burden of patients, but also seriously affect their quality of life. AIM: To evaluate the skin self-management of community-dwelling patients with spinal cord injury and to explore the related independent influencing factors. METHODS: This was a cross-sectional survey study. A convenience sample of 110 community-dwelling patients with spinal cord injury recruited from three rehabilitation centers in Guangzhou and Chengdu in China completed the survey from September 2020 to June 2021. They were asked about their demographic data, skin self-management, knowledge about skin self-management, attitude to skin self-management, self-efficacy, and functional independence. Univariate analysis and multiple linear regression were performed to isolate the most important relationships. RESULTS: The skin self-management of community-dwelling patients with spinal cord injury was relatively low, and they also performed poorly in the three categories of: skin check, preventing pressure ulcer, and preventing wounds. Skin self-management was found to be most often associated with level of knowledge about skin self-management, higher reimbursement and self-efficacy. CONCLUSION: Community-dwelling patients with spinal cord injury with lower level of knowledge about skin self-management, with lower self-efficacy, and those with higher reimbursement have worse skin self-management.

Translation and validation of the Chinese version of the Spinal Cord Independence Measure (SCIM III) Self-Report.

STUDY DESIGN: A cross-sectional psychometric study. OBJECTIVE: To translate, culturally adapt and validate the Chinese version of the Spinal Cord Independence Measure III-Self Report (SCIM-SR). SETTING: Four rehabilitation centers in Guangzhou, Chengdu, and Shiyan, China. METHODS: Translation and cultural adaptation of the Chinese version of the SCIM-SR was conducted according to Brislin guidelines. A total of 147 spinal cord injury patients self-rated their functional independence using translated instrument. The psychometric properties of content validity, criterion-related validity, internal consistency reliability, and test-retest reliability were examined. RESULTS: The content validity index of the new scale was 0.99. The intraclass correlation coefficient between the total SCIM-SR and SCIM III scores was 0.935, and the coefficients for its three subscales were 0.899, 0.760, and 0.942. Bland-Altman analysis showed that the mean difference between the total SCIM-SR and SCIM III scores was 2.35 (95% confidence interval -0.58 to 5.28), and differences for the three subscales were 0.75 (-0.51-2.01), 1.30 (-0.63-3.23), and 0.30 (-0.80-1.40). The Cronbach's α coefficients for the total scale, the self-care subscale, and the mobility subscale were 0.908, 0.913, and 0.895, respectively. The α for the respiration and sphincter management subscale was 0.581. Test-retest reliability after 2 weeks yielded a Spearman coefficient for the total scale of and subscale values all above 0.73. CONCLUSIONS: Our results indicate acceptable validity and reliability of the Chinese version of SCIM-SR. It may facilitate long-term evaluations of independence in Chinese spinal cord injury patients in the community and at home.

Medical legal dispute in hospitals of different grades: a retrospective study on 206 cases..

OBJECTIVE: To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute. METHODS: A total of 206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part, and degree of causality in the treatment. RESULTS: Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology. CONCLUSION: The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.

Analysis of the current status of community nurses' spiritual care competencies and the factors: A descriptive cross-sectional analysis.

AIM: To examine and analyze the level of spiritual care competency among community nurses. DESIGN: The study employed a cross-sectional design. METHODS: From May to July 2022, 442 nurses from community health clinics were chosen as survey respondents using the convenience sample method. The General Information Questionnaire, the version in Chinese of the Nurses' Spiritual Caregiving Awareness Scale and the Chinese version of the Spiritual Caregiving Competence Scale were used in the survey. There were 442 questionnaires distributed, 422 were collected, and the response rate was 95.4%. RESULTS: The amount of spiritual care competencies of community nurses was positively correlated with the level of spiritual awareness. Simultaneously, their level of education, religious beliefs, marital status and the degree of knowledge of spirituality were all influenced.

Evaluation of a SNP-STR haplotype panel for forensic genotype imputation.

Short tandem repeat polymorphism (STR)-based individual identification is a popular and reliable method in many forensic applications. However, STRs still frequently fail to find any matched records. In such cases, if known STRs could provide more information, it would be very helpful to solve specific problems. Genotype imputation has long been used in the study of single nucleotide polymorphisms (SNPs) and has recently been introduced into forensic fields. The idea is that, through a reference haplotype panel containing SNPs and STRs, we can obtain unknown genetic information through genotype imputation based on known STR or SNP genotypes. Several recent studies have already demonstrated this exciting idea, and a 1000 Genomes SNP-STR haplotype panel has also been released. To further study the performance of genotype imputation in forensic fields, we collected STR, microhaplotype (MH) and SNP array genotypes from Chinese Han population individuals and then performed genotype imputation analysis based on the released reference panel. As a result, the average locus imputation accuracy was ∼83 % (or ∼70 %) when SNPs in the SNP array (or MH SNPs) were imputed from STRs, and was ∼30 % when highly polymorphic markers (STRs and MHs) were imputed from each other. When STRs were imputed from SNP array, the average locus imputation accuracy increased to ∼48 %. After analyzing the match scores between real STRs and the STRs imputed from SNPs, ∼80 % of studied STR records can be connected to corresponding SNP records, which may help for individual identification. Our results indicate that genotype imputation has great potential for forensic applications.

Polycyclic aromatic hydrocarbons in seawater, surface sediment, and marine organisms of Haizhou Bay in Yellow Sea, China: Distribution, source apportionment, and health risk assessment.

The pollution status of polycyclic aromatic hydrocarbons (PAHs) in seawater, surface sediment, and marine organisms was investigated in Haizhou Bay, which is a traditional marine fish farming region in China. The total concentrations of PAHs in seawater, surface sediment, and marine organisms were 12.4-40.3 ng/L (average 24.8 ng/L), 183.2-496.6 ng/g (average 293.5 ng/g), and 228.1-679.9 ng/g (average 392.6 ng/g), respectively. Source analysis results showed that the PAH sources for seawater and marine organisms were coal and biomass combustion (66.53%), petroleum (28.94%), and traffic (4.52%), while those for the surface sediment were traffic (48.14%), coal and biomass combustion (40.56%). The lifetime cancer risk increment (ILCR) values of marine organisms in the Haizhou Bay were less than 10-6, indicating no carcinogenic risk. In the future, this study can be used as a reference to understand the distribution and interrelation of PAHs in other semi-enclosed bays in the world.

Cross-cultural and psychometric property assessment of the Moorong Self-Efficacy Scale in Chinese patients with spinal cord injury.

PURPOSE: To translate the Moorong Self-Efficacy Scale (MSES) into Chinese and to examine its reliability and validity in patients with spinal cord injury (SCI). METHODS: A cross-sectional study design was employed. The MSES was translated into Chinese by forward- and back-translation and its psychometric properties were examined among 176 patients with SCI recruited from four rehabilitation centers in China using convenience sampling. RESULTS: In this study, all 176 patients were aged from 18 to 90 years old with an average of 39.51 ± 14.07. The content validity index of the scale was 0.99. Principal components analysis with varimax orthogonal rotation was used. Three factors were extracted accounting for 39.083%, 11.149%, and 8.391% of the total variance and labeled as general self-efficacy (eight items), social self-efficacy (five items), and self-management self-efficacy (three items). Confirmatory factor analysis showed acceptable fit compared with previous studies. Pearson's correlation coefficient between the total scores of the MSES and the General Self-Efficacy Scale was 0.660 (p < 0.001). Cronbach's α coefficient was 0.892 for total items and 0.862, 0.817, and 0.739 for the three factors. The interclass correlation coefficients between the pretest and retest were 0.859 (0.733-0.925) for the total score. CONCLUSIONS: The Chinese version of the MSES is reliable and valid, suggesting that it is suitable for evaluating self-efficacy of Chinese patients with SCI.Implications for rehabilitationThe satisfactory reliability and validity of the Chinese version of the Moorong Self-Efficacy Scale (MSES) confirmed its suitability as a tool to measure self-efficacy among Chinese patients with spinal cord injury (SCI).The Chinese version of the MSES could be used to reflect the important and specific aspects of self-efficacy in patients with SCI such as self-care, social interaction, and daily activities, and to help medical stuff giving more targeted intervention.

Could routine forensic STR genotyping data leak personal phenotypic information?

The application of forensic genetic markers must comply with privacy rights and legal policies on a premise that the markers do not expose phenotypic information. The most widely-used short tandem repeats (STRs) are generally viewed as 'junk' DNA because most STRs are located in non-coding regions and therefore refrain from leaking phenotypic traits. But with a deepening understanding of phenotypes and underlying genetic structure, whether STRs could potentially reflect any phenotypic information may need re-examining. Therefore, we performed the following analyses. First, we analyzed the association between 15 STRs and three facial characteristics (single or double eyelid, with or without epicanthus, unattached or attached earlobe) on 721 unrelated Han Chinese individuals. Then, we collected 27199 individuals' STRs and geographic data from the literature to investigate the association between STRs and bio-geographic information, and predict geographic information by STRs on additional 1993 unrelated individuals. We found that there was scarcely any association between STRs with studied facial characteristics. Although allele19 in D2S1338 and allele 18 in FGA (P = 0.0032, P = 0.0030, respectively after Bonferroni correction) showed statistical significance, the prediction effectiveness was very low. For the STRs and bio-geographic information, the principal component analysis showed the first three components could explain 87.7% of the variance, but the prediction accuracy only reached 25.2%. We demonstrated that the forensic phenotypes are usually complex traits, it is hardly possible to uncover phenotypic information by testing only dozens of STR loci.

A highly polymorphic panel of 40-plex microhaplotypes for the Chinese Han population and its application in estimating the number of contributors in DNA mixtures.

Microhaplotypes (MHs) have great potential in multiple forensic applications and have proven to be promising markers in complex DNA mixture analysis. In this study, we developed a multiplex panel of 40 highly polymorphic MHs for the Chinese Han population, evaluated its forensic values, and explored its application in predicting the number of contributors (NOCs) in DNA mixtures. The panel consisted of 20 newly proposed loci and 20 previously reported loci with lengths spanning less than 120 bp. The average effective number of alleles (Ae) was 3.77, and the cumulative matching probability (CMP) and the cumulative power of exclusion (CPE) reached 1.2E-37 and 1-2.1E-12, respectively, in the Chinese Han population from the 1000 Genomes Project. Further validation on 150 Chinese Han individuals showed that Ae ranged from 2.62 to 4.41 with a mean value of 3.61, and CMP and CPE were 3.61E-36 and 1-1.84E-12, respectively, indicating that this panel was informative for personal identification and paternity testing in the studied population. To estimate NOC in DNA mixtures, we developed a machine learning model based on this panel. As a result, the accuracies in artificial DNA mixtures reached 95.24% for 2- to 4-person mixtures and 83.33% for 2- to 6-person mixtures. Furthermore, the NOC estimation on simulated profiles with allele dropout showed that this panel was still robust under slight dropout. In conclusion, this panel has value for forensic identification and NOC estimation of DNA mixtures.

Effects of App-Based Transitional Care on the Self-Efficacy and Quality of Life of Patients With Spinal Cord Injury in China: Randomized Controlled Trial.

BACKGROUND: Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of SCI patients and the current community care system. With the prevalence of mobile terminals, the usage of mobile health apps has the potential to fill this gap by extending qualified medical resources to the families of SCI patients. Our team developed the app Together for the transitional care of home-dwelling SCI patients in China. OBJECTIVE: This study aimed to evaluate the effects of app-based transitional care on the self-efficacy and QOL of SCI patients. METHODS: Through a three-round Delphi process, an Android app was designed. Both medical staff and patients could access the app. Medical staff used it for providing remote transitional care to SCI patients. Patients used it to view transitional care time and send messages to medical staff. Thereafter, a multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who had SCI and lived at home following discharge were recruited and randomly assigned to a study group (n=49) and control group (n=49) using a randomized number list in four research centers. Patients in both groups received systematic discharge education before discharge. The study group received five follow-ups conducted by trained nurses through the app, which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction, at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-Efficacy Scale (MSES) and 36-item Short-Form Health Survey (SF-36) scores. Data were collected before discharge (T0) and at weeks 12 (T1) and 24 following discharge (T2). Differences between the groups were tested by repeated measures analysis of variance and simple effect analysis. RESULTS: After the follow-up, the total MSES scores in the study group improved over time (T0=67.80, T1=71.90, and T2=76.29) and were higher than those in the control group (T2=64.49) at 24 weeks following discharge (simple effect analysis: F1=8.506, P=.004). Regarding the total SF-36 score, although it was higher in patients from the study group (T2=65.36) than those from the control group (T2=58.77) at 24 weeks following discharge, only time effects were significant (F2,95=6.671, P=.002) and neither the group effects nor the interaction effects influenced the change in QOL (group effects: F1,96=0.082, P=.78; interaction effects: F2,95=3.059, P=.052). CONCLUSIONS: This study confirmed that app-based transitional care improves the self-efficacy of SCI patients. Nevertheless, QOL improvement is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-17012317; http://www.chictr.org.cn/showproj.aspx?proj=19828.

Outcome indicators in the transitional care of people with spinal cord injury in China: a Delphi survey based on the International Classification of Functioning, Disability and Health.

Objective: To identify the categories of the International Classification of Functioning, Disability and Health most suitable as outcome indicators in the transitional care for people with spinal cord injury in China.Methods: A three-round Delphi survey was conducted surveying 37 experts selected through purposive sampling. In the first round, each expert was required to suggest the most useful indicators in the transitional care for spinal cord injury patients. Categories of the International Classification of Functioning, Disability and Health were linked with the concepts extracted from the responses. In the second round, the experts were asked to make a yes/no judgment about the utility of those categories as outcome indicators and to rate their importance from 1 to 10. In the third round, the experts were asked to re-judge and re-rate the importance considering the second-round results.Results: Forty-one categories, seven personal factors, and three concepts not covered in the International Classification of Functioning, Disability and Health were identified. They generated agreement percentages over 80% in the third round. The means of the importance ratings ranged from 5.15 to 9.52.Conclusions: A set of categories and concepts was identified in the Delphi survey based on the International Classification of Functioning, Disability and Health. They provided a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.Implications for rehabilitationIn China, the people with spinal cord injury who live at home after discharge urgently need professional transitional care which can be extended from medical institutions to families.The categories and concepts identified by the Delphi survey based on the International Classification of Functioning, Disability and Health reflect the focuses in the transitional care of people with spinal cord injury in China.Those categories and concepts provide a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.

Using a Mobile App-Based International Classification of Functioning, Disability, and Health Set to Assess the Functioning of Spinal Cord Injury Patients: Rasch Analysis.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) is a unified system of functioning terminology that has been used to develop electronic health records and assessment instruments. Its application has been limited, however, by its complex terminology, numerous categories, uncertain operationalization, and the training required to use it well. Together is a mobile health app designed to extend medical support to the families of spinal cord injury (SCI) patients in China. The app's core framework is a set of only 31 ICF categories. The app also provides rating guidelines and automatically transforms routine assessment results to the terms of the ICF qualifiers. OBJECTIVE: The goal of the research is to examine the suitability of the ICF set used in the app Together for use as an instrument for assessing the functioning of SCI patients. METHODS: A cross-sectional study was conducted including 112 SCI patients recruited before discharge from four rehabilitation centers in China between May 2018 and October 2019. Nurses used the app to assess patient functioning in face-to-face interviews. The resulting data were then subjected to Rasch analysis. RESULTS: After deleting two categories (family relationships and socializing) and one personal factor (knowledge about spinal cord injury) that did not fit the Rasch model, the body functions and body structures, activities and participation, and contextual factors components of the ICF exhibited adequate fit to the Rasch model. All three demonstrated acceptable person separation indices. The 28 categories retained in the set were free of differential item functioning by gender, age, education level, or etiology. CONCLUSIONS: Together overcomes some of the obstacles to practical application of the ICF. The app is a reliable assessment tool for assessing functioning after spinal cord injury.

Psychometric properties of the International Classification of Functioning, Disability and Health set for spinal cord injury nursing based on Rasch analysis.

OBJECTIVE: To examine the psychometric properties of the International Classification of Functioning, Disability and Health (ICF) set for spinal cord injury nursing (ICF-SCIN) using Rasch analysis. METHODS: A total of 140 spinal cord injury patients were recruited between December 2013 and March 2014 through convenience sampling. Nurses used the components body functions (BF), body structures (BS), and activities and participation (AP) of the ICF-SCIN to rate the patients' functioning. Rasch analysis was performed using RUMM 2030 software. RESULTS: In each component, categories were rescored from 01234 to 01112 because of reversed thresholds. Nine testlets were created to overcome local dependency. Four categories which fit to the Rasch model poorly were deleted. After modification, the components BF, BS, and AP showed good fit to the Rasch model with a Bonferroni-adjusted significant level (χ2 = 86.29, p = 0.006; χ2 = 22.44, p = 0.130; χ2 = 39.92, p = 0.159). The person separation indices (PSIs) for the three components were 0.80, 0.54, and 0.97, respectively. No differential item functioning (DIF) was detected across age, gender, or educational level. CONCLUSIONS: The fit properties of the ICF set were satisfactory after modifications. The ICF-SCIN has the potential as a nursing assessment instrument for measuring the functioning of patients with spinal cord injury. Implications for rehabilitation The International Classification of Functioning, Disability and Health (ICF) set for spinal cord injury nursing contains a group of categories which can reflect the functioning of spinal cord injury patients from the perspective of nurses. The components body functions (BF), body structures (BS), and activities and participation (AP) of the ICF set for spinal cord injury achieved the fit to the Rasch model through rescoring, generating testlets, and deleting categories with poor fit. The ICF set for spinal cord injury nursing (ICF-SCIN) has the potential to be used as a clinical nursing assessment tool in measuring the functioning of patients with spinal cord injury.

The inter-rater reliability of the International Classification of Functioning, Disability and Health set for spinal cord injury nursing.

The International Classification of Functioning, Disability and Health (ICF) has potential to be used as a clinical assessment instrument directly. However, difficulty in operationalizing the ICF qualifiers has led to unsatisfactory inter-rater reliability of ICF instruments in previous studies. The ICF set for spinal cord injury (SCI) nursing contains a group of categories that can reflect the functioning of SCI patients from the perspective of nurses. The aim of this study was to explore the inter-rater reliability of the ICF set for SCI nursing. Detailed measuring guidelines were prepared for each category of the ICF set. Two trained nurses then used the ICF set to independently rate 40 SCI patients within the first 3 days after their admission. The results showed that the percentage of the observed agreement between the nurses ranged from 42.5 to 100% (median 75%, interquartile range 62.5-87.5%). The weighted κ ranged from -0.03 to 1.00 (median 0.68, interquartile range 0.45-0.84). A total of 50 categories (79.4%) showed weighted κ greater than 0.4 and 39 categories (61.9%) had weighted κ greater than 0.6. The medians of the weighted κ for the body functions, body structures, activity and participation and environmental factors components were 0.6, 0.64, 0.84, and 0.11, respectively. This study indicated that the inter-rater reliability of the ICF set for SCI nursing was acceptable. Establishment of detailed measuring guidelines could help reduce the differences between raters. Simpler and clearer measuring guidelines are recommended and the definitions of some categories need to be clarified in future studies.