Search

Background: Hepatitis C virus (HCV) transmission has been epidemiologically linked to healthcare settings, particularly out-of-hospital settings such as endoscopy clinics and hemodialysis clinics. These have been largely attributed to lapses in infection prevention and control practices (IPAC). Objective: To describe the public health response to an outbreak of HCV that was detected among patients of a colonoscopy clinic in Ontario, and to highlight the risks of using multi-dose vials and the need for improved IPAC practices in out-of-hospital settings. Methods: Screening for HCV was conducted on patients and staff who attended or worked at the clinic within the same timeframe as the index case’s procedure. Blood samples from positive cases underwent viral sequencing. Inspections of the clinic assessed IPAC practices, and a chart review was done to identify plausible mechanisms for transmission. Outcome: A total of 38% of patients who underwent procedures at the clinic on the same day as the index case tested positive for HCV. Genetic sequencing showed a high degree of similarity in the HCV genetic sequence among the samples positive for HCV. Chart review and clinic inspection identified use of multi-dose vials of anesthesia medication across multiple patients as the plausible mechanism for transmission. Conclusion: Healthcare workers, especially those in out-of-hospital procedural/surgical premises, should be vigilant in following IPAC best practices, including those related to the use of multi-dose vials, to prevent the transmission of bloodborne infections in healthcare settings.

Contexte : La transmission du virus de l’hépatite C (VHC) a été épidémiologiquement liée aux établissements de santé, en particulier aux établissements de soins externes, tels que les cliniques d’endoscopie et d’hémodialyse. Celles-ci ont été largement attribuées à des manquements concernant la prévention et le contrôle des infections. Objectif : Décrire les mesures de santé publique face à une épidémie du VHC détectée parmi les patients d’une clinique de coloscopie en Ontario, et souligner les risques liés à l’utilisation de flacons à doses multiples et la nécessité d’améliorer les pratiques de prévention et le contrôle des infections dans les établissements de soins externes. Méthodes : Le dépistage du VHC a été effectué chez les patients et le personnel qui ont fréquenté la clinique ou y ont travaillé en même temps que l’intervention du cas indexé. Les échantillons de sang des cas positifs ont été soumis à un séquençage viral. Des inspections de la clinique ont permis d’évaluer les pratiques de prévention et le contrôle des infections, et un examen des dossiers a été effectué pour cerner les mécanismes plausibles de transmission. Résultat : Au total, 38 % des patients qui ont subi des interventions à la clinique le même jour que le cas indexé a reçu un résultat positif pour le VHC. Le séquençage génétique a montré un haut degré de similarité dans la séquence génétique du VHC parmi les échantillons positifs pour le VHC. L’examen des dossiers et l’inspection des cliniques ont permis de désigner l’utilisation de flacons à doses multiples de médicaments d’anesthésie chez plusieurs patients comme mécanisme plausible de transmission. Conclusion : Les travailleurs de la santé, en particulier ceux qui se trouvent dans des établissements d’intervention ou chirurgicaux externes, devraient être vigilants et s’en tenir aux pratiques exemplaires de prévention et le contrôle des infections, notamment celles liées à l’utilisation de flacons à doses multiples, afin de prévenir la transmission d’infections hématogènes dans les établissements de soins de santé.

The findings of this article suggest that both Internet-based synchronous and asynchronous teaching modes can significantly improve students’ academic performance compared to traditional face-to-face teaching. Moreover, internet-based asynchronous teaching seems to be more effective in enhancing students’ learning outcomes than synchronous teaching. This could be due to the flexibility and convenience of asynchronous learning, allowing students to learn at their own pace and time. Additionally, this article highlights the importance of remote education and management in supporting online education, especially in the context of increasing user numbers and demands within schools. Schools need to invest in high-quality remote education systems and effective management to ensure the success of online education and stay competitive in the market. Overall, the development prospects of web-based remote translation teaching mode are promising, and online education is expected to become the main trend worldwide. This highlights the need for educators and institutions to embrace technology and explore innovative teaching methods that can provide high-quality education to students anytime, anywhere.

In this research, the 600 MPa acid resistant steel was used as flash butt welding base material, to study the effect of different upset allowance on the microstructure and mechanical properties of the joints. The results can be obtained as follows: with the increase of the upset allowance, it has a significant effect on the elongation, the ferrite content in the heat affected zone increases, and the joint strength first increases and then slowly decreases. When the upset allowance is bigger than 4mm, there are wide and large bainitic ferrites in the coarse grained zone, the joint strength deteriorates sharply. When the upset allowance is 3-4mm, the mechanical properties of the welded sample are the best, the tensile strength is 686-708MPa, the yield strength is 610-636MPa, the elongation is higher than 13.77%. The steel matrix can be strengthened effectively by forming grain refinement and dispersed granular bainite with proper upset allowance. The different hardness distributions of welded joints to display the difference of microstructure in different regions.

Background: Total knee arthroplasty (TKA) is a commonly performed procedure, primarily when knee joints have been damaged by progressive arthritis; however, over 20% of surgical patients develop persistent postsurgical pain (PPSP). We plan to conduct a systematic review and meta-analysis of factors associated with the development of PPSP following TKA. Methods: We will include peer-reviewed cohort or case–control studies that explore, in an adjusted model, factors associated with the development of PPSP after TKA. We will identify eligible studies, in any language, by a systematic search of MEDLINE, EMBASE, CINAHL, AMED, Scopus, SPORTDiscus, and PsycINFO, from inception of each database. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible studies, and extract information from eligible studies. When possible, we will pool estimates of association for all independent variables reported by more than one study and report both an adjusted odds ratio and the absolute risk increase and associated 95% confidence intervals (Cis). We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to summarize the quality of evidence for all meta-analyses as high, moderate, low, or very low. Discussion: Our results will facilitate identification of patients at risk for the development of PPSP following TKA, highlight promising predictors for further study, and help guide the design of interventional studies to improve prognosis of high-risk patients.

Introduction/Aim: Peripheral neuropathy is a common cause of chronic pain among patients with diabetes, and acupuncture has been suggested as a therapeutic option. To determine the effectiveness of acupuncture for chronic diabetic peripheral neuropathy (DPN). Methods: We searched MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, PsychINFO, trial registries, and reference lists of relevant articles up to February 2017. Pairs of reviewers, independently and in duplicate, screened articles for inclusion, assessed risk of bias and extracted data. We conducted meta-analyses when possible and used the GRADE approach to assess the quality of evidence. Results: Among 4443 potentially eligible studies 4 with 244 patients proved eligible to be included for review.1 Overall all four studies were at high risk of bias. Compared to sham acupuncture, we found very low quality evidence that acupuncture reduces pain (weighted mean difference [WMD] −1.95cm on a 10cm visual analogue scale, 95% CI −3.27 to −0.64; minimally important difference [MID] 1cm; risk difference (RD) for achieving the MID 52%; 95% CI 19% to 63%) and improves physical functioning (WMD 3.68 points on the short form-36 [SF-36] physical component summary score; 95% CI 1.66 to 5.70; MID is 5-points; RD for achieving the MID 8%, 95% CI 3% to 18%), but does not affect emotional functioning (WMD 1.26 points on the SF-36 mental component summary score, 95% CI: −1.13 to 3.66). Conclusions: Very low-quality evidence suggests that acupuncture reduces pain and improves physical functioning in patients with chronic DPN but does not affect emotional functioning.

Introduction/Aim: Each year 67,000 Canadians undergo total knee arthroplasty (TKA) and approximately 20% develop persistent post-surgical pain (PPSP). A complaint associated with functional limitations, reduced quality of life, and increased care-seeking. We systematically reviewed observational studies to explore factors associated with PPSP after TKA. Methods: We searched Medline, EMBASE, Cochrane CENTRAL, AMED, PsycINFO, SCOPUS and SPORTDiscuss from inception to October 31, 2018. When possible, we pooled estimates of association for all independent variables reported by more than one study. Random effects models were used for all meta-analysis. We assessed certainty in evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: Twenty-five studies, involving 44,069 participants, were eligible for review. Mean age of enrolled patients was 68.56 ± 8.77 years and 76% were female. Eligible studies reported the association of 56 predictors with PPSP after TKA, which clustered into 6 groups: (1) patient characteristics, (2) clinical findings, (3) genetic factors, (4) surgical approach, (5) radiographic findings, and (6) peri-operative management. Low and very-low quality evidence showed that higher preoperative pain (OR = 3.82, 95%CI 1.27 to 11.47) and female sex (OR = 1.23, 95%CI 1.08 to 1.4) were significantly associate with PSPP after TKA. Neither older age (OR = 0.97, 95%CI 0.88 to 1.07), higher BMI (OR = 1.07, 95%CI 1.00 to 1.13), or mood disorders (OR = 1.14, 95%CI 1.0 to 1.3) were predictors of PPSP following TKA. Discussion/Conclusions: Addressing high peri-operative pain may be important in reducing PPSP after TKA.

Introduction/Aim: Persistent post-surgical pain (PPSP) is a common complication after breast cancer surgery; but reported prevalence rates range from 10% to 69%. We conducted a systematic review to address this uncertainty. Methods: We searched MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2018, to identify observational studies that reported the prevalence and intensity of PPSP after breast cancer surgery. We performed random effects meta-analysis with Freeman-Tukey transformation for overall, moderate and severe PPSP prevalence, and pooled pain intensity after converting all pain scales to the 10cm VAS. Results: We included 188 observational studies with 300,025 patients. The overall prevalence of any PPSP was 34.5% (95%CI 30.1% to 39.2%). The pooled prevalence of moderate and severe pain was 14.9% (95%CI 11.5% to 18.7%) and 4% (95%CI 2.7% to 5.5%) respectively. The average pain intensity on a 10cm VAS was 2.7 (95%CI 2.2 to 3.1). We are completing analyses to inform PPSP prevalence and intensity at 3 years, and prevalence of neuropathic pain. We will also perform subgroup analyses for risk of bias, any pain vs. specific pain, axillary lymph nodes dissection and radiotherapy, and meta-regression for the association between PPSP and length of follow-up and proportion of loss to follow-up. Discussion/Conclusions: PPSP after breast surgery is common and affects approximately 1 in 3 women undergoing this procedure. Of those who develop persistent pain, 43% will report at least moderate pain and 12% will experience severe pain although the average pain is mild.

In response to the requirements of new engineering construction and reform, the new experimental teaching mode of the comprehensive practice link of computer-aided engineering analysis course was explored, and the “finite element analysis of the lateral stabilizer bar of new energy bus” was introduced into the comprehensive practice of the course to train students’ autonomy learning ability. At the same time, it has improved students’ scientific research and teamwork ability, and used project-based teaching as a link to open up the separation between undergraduate teaching and postgraduate teaching, cultivated students’ ability to continue learning, strengthened the combination of theoretical knowledge and engineering application, and improved student in solving the ability of the problem. It provides a reference for the curriculum reform under the background of “new engineering”.

Based on the idea of establishing urban visual orders, this paper aims to explore the demonstration form of Shenyang commercial signboard font designs under the influence of the visual order establishment and to handle problems currently existing on streets of Shenyang and major cities, including the chaos in words on commercial signboards that exerts an influence on the visual order. Method The innovative design plan is finally completed via on-site theoretical and survey research. Conclusion The design of commercial signboard fonts is an important element exerting an influence on the overall visual order of one street and even of a city. Two necessary methods of improving urban and regional visual environments are as follows: to fully consider the coordination between commercial signboard fonts and corresponding surrounding environments; and to well control such variables of commercial signboard fonts as forms, colors and materials.

A Mg(II) complex, [MgL·(H2O)3]·2H2O (H2L = 2,6-pyridinedicarboxylic acid), has been synthesized and characterized by elemental analysis, IR and X-ray single crystal diffraction analysis. The Mg(II) complex belongs to monoclinic, space group P21/n with a = 8.9318(18) Å, b = 10.002(2) Å, c = 13.290(3) Å, β = 96.86(3)º, V= 1178.8(4) Å3, Z = 4, Dc = 1.575 mg·m-3, μ = 0.192 mm-1, F(000) = 584, and final R1 = 0.0349, ωR2 = 0.1212. Structural analysis shows that the Mg(II) center is six-coordination with a NO5 distorted octahedral coordination environment. The Mg(II) complex forms 1D chain structure by the interaction of hydrogen bonds and π-π stacking.

In industrial design teaching, the laboratory is an important teaching space for cultivating students' innovative spirit, practical and creative ability. Laboratory space construction, teaching link design, service and management mechanism directly determine the quality of teaching. The paper explores how to redesign laboratory teaching of industrial design professional through the concept and method of service, which enhances the service experience on the service contact and uses participatory service design tools in the teaching process to improve the teaching process and quality.

Ecological operation of cascade hydropower stations is one of the most important methods for the ecological restoration of a river system. In order to balance the benefits between power generation and ecology of Qingjiang cascade hydropower station, an optimal equilibrium operation method is proposed in this paper. Firstly, the range of ecological flow of the Qingjiang cascade is calculated by using ten-day frequency calculation method. Secondly, an optimal equilibrium operation model by considering the balance between power generation and ecology is established. And then, in order to solve this complex model, a particle swarm optimization based model solution method is proposed, and the evaluation index system of operation schemes is established. Finally, through operation calculation in 2008-2010 years, the results show that compared with the operation scheme considering only power generation benefit, the optimal equilibrium operation scheme increases the runoff ecological dispersion coefficient by 6.90%，reduces the cascade ecological overflow by 7.739 billion m3 and the cascade ecological water shortage by 130 million m3, while the cascade power generation decreases slightly by 1.83%. This study provides an effective scientific method for the optimal operation of Qingjiang cascade under the background of Yangtze River protection.

The new electricity system reform has brought power generation companies into the market, and the scheduling target of cascade hydropower stations has been transformed from maximizing power generation to maximizing revenue. Market rules require hydropower generators to pay assessment fees for the power generation deviation. Therefore, in order to obtain the desired revenue, power generators should not only obtain more power generation indicators and higher power prices, but also control the power generation deviation and avoid being assessed. In response to the current market environment, the new requirements of the new electricity system reform for hydropower scheduling were analyzed. And based on regional market rules, a scheduling model for cascade hydropower stations with the goal of minimizing generation deviation was established, taking the example of eight cascade hydropower stations in the downstream of Dadu River in Sichuan province as an example, the effectiveness and applicability of the model were verified. The results show that the deviation in each period can be controlled within 1% and meet the basic requirements of market rules.

The traditional economy has transformed into a new economy led by innovation and entrepreneurship, deepened the reform of engineering education and pushed forward the development of "new engineering" as a trend. In the face of "new economy" and "neo-engineering", the applied field of design science is rapidly rising and widening, and the paradigm of design science, teaching idea, intension and talent training mode should be changed. Carrying out the study of the practical cross curriculum system of the major of products design from the perspective of "new engineering", it is mainly discussed from the aspects of curriculum reform, innovation and entrepreneurship education, and directional personnel training between schools and enterprises.

A network selection algorithm based on Decision Tree is proposed to solve the problem. Users can select the appropriate network according to their service characteristics and requirements when they decide which network to access. First, we get the training data under the Interactive Class service from the synergetic algorithm which can be used for training set. The network attributes are used for attribute set. And then we can choose the attribute with the largest information gain as the division attribute after the discretization of continuous features by the bisection method. Keep going this step recursively, we can finally get a decision tree with high generalization ability by which we can make the network selection. Simulation results show that the algorithm we proposed is simple and effective and demonstrate the effectiveness of our scheme in improving the quality of service according to the user requirements under the Interactive Class service.

Objective: There has been a trend toward increasing antidepressant (AD) use in recent decades. We used data from the National Population Health Survey (NPHS) to determine whether this trend is continuing and to provide updated estimates of the frequency of use. Methods: The NPHS is a longitudinal general health survey that began collecting data in 1994. The NPHS evaluates past-year major depressive episodes (MDEs) using a brief diagnostic instrument. At each biannual interview (from 1994 to 2006) current medication use is recorded. We estimated the frequency with which ADs were taken by respondents (aged 12 years and older) with and without past-year MDEs. These frequencies were cross-tabulated by sex, year of interview, and the reported duration of symptoms. Results: ADs are taken by about 5.4% of the household population at any point in time. Most respondents taking ADs did not report past-year MDEs but 63.9% of respondents taking ADs in the absence of past-year episodes reported previous episodes or being diagnosed by a health professional with depression. This pattern is consistent with long-term treatment for relapse prevention. The overall frequency of use of ADs is increasing only in respondents without past-year episodes. Conclusions: AD use among community residents with past-year MDEs is no longer increasing. The continued increase in the overall frequency of use may point toward broadening indications for AD treatment and may indicate that people are taking these medications for longer periods of time. [ABSTRACT FROM AUTHOR]