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Objective To develop a basic competency assessment scale for generalist nurse in palliative care and test its reliability and validity. Methods The pre-test scale items pool was formed after literature review, internal discussion in the group, consultation with experts and small sample pre-survey. From January to March 2021, the pre-test scale was used to investigate 1 000 nurses in various wards including internal medicine, surgery, emergency, obstetrics and gynaecology, and intensive care units. The results were analyzed by SPSS software and AMOS software to undertake item analysis, exploratory factor analysis and confirmatory factor analysis to develop the final scale. Results The pre-test scale items pool was formed after literature review, internal discussion in the group, consultation with experts and small sample pre-survey. From January to March 2021, the pre-test scale was used to investigate 1 000 nurses in various wards including internal medicine, surgery, emergency, obstetrics and gynaecology, and intensive care units. The results were analyzed by SPSS software and AMOS software to undertake item analysis, exploratory factor analysis and confirmatory factor analysis to develop the final scale. Conclusion Our developed basic competency assessment scale for generalist nurse in palliative care has good reliability and validity, and can be used to evaluate the basic competency of palliative care for generalist nurses.

Background Metabolism-associated fatty liver disease (MAFLD) is considered as a major cause of increased morbidity and mortality from liver disease, type 2 diabetes mellitus (T2DM) is a driving factor in the progression of MAFLD. Estimated glucose processing rate (eGDR) is a simple evaluation indicator of insulin resistance in patients with T2DM, while its relationship with MAFLD has been rarely studied. Objective To investigate the correlation between eGDR and MAFLD in type 2 Diabetes and its predictive value. Methods A total of 1 434 patients with T2DM who were hospitalized in Hebei Provincial People's Hospital from 2019-01-01 to 2019-12-31 were selected as the study subjects. baseline data of the patients was collected, with their venous blood from the elbow collected for laboratory examination, and liver condition examined by abdominal ultrasound. According to the results of abdominal ultrasonography, T2DM patients were divided into MAFLD group (n=734) and non-MAFLD group (n=700). The subjects were divided into T1 group (eGDR≤5.09, n=477), T2 group (5.097.11, n=479) according to the eGDR tertiles. Spearman rank correlation analysis was used to explore the correlation between eGDR and baseline data. Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of combined MAFLD. The multiplicative interactions of eGDR with gender, age, hypertension, glycated hemoglobin A1c (HbA1c), BMI and glutamyl transferase (GGT) were evaluated. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of combined prediction model, FBG and HbA1c for MAFLD in T2DM and areas under curve (AUC) were calculated and compared by Delong test. Results Age, disease course, HDL-C and eGDR of MAFLD group were lower than non-MAFLD group. BMI, alcohol consumption, proportions of hypertension and smoking, fasting blood glucose (FBG), uric acid (UA), total cholesterol (TC), TG, low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), GGT and ALB were higher than non-MAFLD group (P

Background The incidence rate of nonalcoholic fatty liver disease is increasing year by year, but there is still no effective cure. Clinical and basic studies show that a type of hypoglycemic drug, namely glucagon-like peptide-1 (GLP-1) receptor agonists can improve liver lipid deposition, but the specific mechanism is unknown. Objective To explore the mechanism of GLP-1 receptor agonists improving liver lipid deposition in a rat model of insulin resistance induced by high-fructose diet. Methods This experiment was carried out from January to April 2016. Thirty-six Wistar rats were randomly divided into a control group (ND) receiving a normal diet and a model group receiving a high-fructose diet. After 8 weeks, a hyperinsulinemic-euglycemic clamp test was performed in the model group to verify the formation of insulin resistance. The rats in the model group were further randomized into a high-fructose (HFD) subgroup and a high fructose with exenatide (HFD+Ex) subgroup. The changes of glucose and lipid levels, insulin resistance, liver lipid deposition, the expression and nuclear translocation of β-catenin and lipid synthesis pathway related factors were observed in HFD+Ex subgroup at four weeks after receiving subcutaneous abdominal injection of exenatide injection. Further changes in cell lipid deposition and lipid synthesis pathway related factors were observed after inhibiting the expression of β-catenin with small interfering RNA (siRNA) by transfection techniques in HepG2 cells. HepG2 cells were treated with 25 mmol/L fructose, 100 nmol/L exendin-4, and non-transfected HepG2 cells were used as controls. ALL of the cells were divided into normal control group (Con) , high-fructose (HF) group, high fructose with exendin-4 (HF+Ex4) group, high fructose with exendin-4 and control siRNA (HF+Ex4+Si-control) group, and high fructose with exendin-4 and β-catenin siRNA (HF+Ex4+Si-β-catenin) group. After the experiment, the rats' weight and liver index, serum concentrations of triglyceride (TG) , total cholesterol (TC) , free fatty acid (FFA) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , fasting blood glucose (FBG) , fasting insulin (FINS) and liver TG concentration were measured, and the area under the plasma glucose curve (AUCglu) , and glucose infusion rate (GIR) were calculated, and lipid droplets in liver tissues were observed using Oil Red O staining. The protein expression levels of sterol regulatory element binding protein 1 (SREBP-1) and the key enzymes for downstream lipid synthesis, fatty acid synthase (FAS) , acetyl coenzyme A carboxylase (ACC) , stearoyl-CoA desaturase 1 (SCD-1) and β-catenin of liver tissues and HepG2 cells were also measured. Results (1) After 8-week high-fructose feeding, the model group had significantly higher weight, liver index and liver TG concentration, and lower GIR than the ND group (P

Progression of chronic disease is often manifested by repeated occurrences of disease-related events over time. Delineating the heterogeneity in the risk of such recurrent events can provide valuable scientific insight for guiding customized disease management. In this paper, we propose a new sensible measure of individual risk of recurrent events and present a dynamic modeling framework thereof, which accounts for both observed covariates and unobservable frailty. The proposed modeling requires no distributional specification of the unobservable frailty, while permitting the exploration of dynamic effects of the observed covariates. We develop estimation and inference procedures for the proposed model through a novel adaptation of the principle of conditional score. The asymptotic properties of the proposed estimator, including the uniform consistency and weak convergence, are established. Extensive simulation studies demonstrate satisfactory finite-sample performance of the proposed method. We illustrate the practical utility of the new method via an application to a diabetes clinical trial that explores the risk patterns of hypoglycemia in Type 2 diabetes patients.

Achondroplasia is a rare disease leading to growth and developmental disorders in children, mainly manifested as skeletal dysplasia and disproportionate short stature, which can lead to respiratory abnormalities, hearing loss, spinal involvement, limb joint deformity and other problems, thus making patients encounter a variety of treatment and rehabilitation issues throughout their life, with greatly impaired quality of life. However, the clinical treatment and care pathways of achondroplasia are still not completely unified. To facilitate the standardization of clinical treatment of achondroplasia, the International Consensus Statement on the Diagnosis, Multidisciplinary Management and Lifelong Care of Individuals with Achondroplasia was developed by a group of international experts. We interpreted the key points of the consensus, mainly involving lifelong care and multidisciplinary clinical management, aiming to promote the standardization of care for individuals with achondroplasia in order to improve their clinical outcomes and quality of life as well as reduce their mortality.

Pre-strengthening hot/warm forming (PHF) technology can effectively shorten the microstructure evolution process of aluminium alloy deformation and heat treatment, and has a broad application prospect. In this paper, the process parameters in PHF are abstracted into sequence data, which is used as the input of long short-term memory neural network (LSTM) model to predict mechanical properties of aluminium alloy components after PHF process. Besides, the prediction models based on Random Forest (RF), Support Vector Regression (SVR) and Back Propagation Neural Network (BPNN) are established and compared with LSTM model. In addition, a Few-Shot Learning method based on the constitutive model is proposed to predict the properties of aluminium alloys.

Background: Although peritoneal dialysis (PD) is an efficient therapy for renal replacement, the long-term survival rate of patients undergoing PD remains low. The platelet-to-albumin ratio (PAR), recently identified as a parameter of inflammatory and nutritional status, is associated with an adverse prognosis for various diseases. However, the association between the serum PAR and prognosis of patients undergoing PD is poorly understood. This study aimed to evaluate whether the PAR is a reliable predictor of cardiovascular disease (CVD) and all-cause mortality in patients undergoing PD. Methods: This multicenter cohort study enrolled patients undergoing PD from January 1, 2009, to September 30, 2018. The patients were divided into four groups according to the quartiles of their baseline PAR. The primary endpoint was all-cause and CVD-related mortality. Cox proportional hazard models were used to determine the association between the PAR and all-cause or CVD-related mortality. The receiver operating characteristic (ROC) curve was utilized to compare the performance among PAR and other inflammatory indicators. C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were applied to examine the incremental prognostic value of PAR compared with baseline model for predicting all-cause and CVD mortality. Results: A total of 2825 patients were included. During the follow-up period of 47.5 ± 28.3 months, 747 (26.4%) mortality cases were observed, of which 415 (55.6%) were CVD-related. Compared with the Q1 (PAR < 4.43), placement in Q4 (PAR > 7.27) was associated with an increased risk of all-cause mortality and CVD mortality (p < 0.001). The adjusted restricted cubic spline analysis indicated that the relationship of the PAR with all-cause and cardiovascular mortality was linear (p for nonlinearity = 0.289 and 0.422, respectively). No positive correlations were shown in the interaction tests. PAR exhibited superior predictive value for mortality compared to other inflammatory indicators, with a respective AUC value of 0.611 (P < 0.001) for all-cause mortality and 0.609 (P < 0.001) for cardiovascular mortality. According to the C-statistic, continuous NRI and IDI, the addition of PAR to the baseline model yielded a moderate but significant improvement in outcome prediction. Conclusions: The PAR is an independent prognostic factor associated with all-cause and cardiovascular mortality in patients undergoing PD. [ABSTRACT FROM AUTHOR]

Background: With frequent conflicts, natural disasters, and public health emergencies globally, mobile medical teams (MMTs) are becoming increasingly critical. Importantly, the competency of critical care nurses in MMTs can substantially affect the effectiveness and quality of its rescue efforts. Yet, these nurses' competencies are not well understood. Aim: This study examined the competencies of critical care nurses in MMTs using the Onion Model. Study Design: A qualitative descriptive method was used to describe the competencies of Chinese MMT critical care nurses. From April to May 2022, a convenience sample of 18 participants (14 critical care nurses and 4 surgeons) from 10 MMTs was recruited for semi‐structured interviews. Deductive and inductive coding methods were combined for content analysis. Results: In total, 29 competencies were identified, which were grouped into four major domains using the Onion Model. From the outer to inner layers, these domains were knowledge and skills, professional abilities, professional quality, and personal traits. Several novel competencies emerged, including field medical equipment operation skills, on‐site hazard identification and safety prevention skills, triage knowledge, and field survival skills. Conclusions: Using the Onion Model, this study furthers the understanding of the competency of critical care nurses in MMTs, especially by revealing the novel competencies. Further, the results can be used to recruit, evaluate, and train critical care nurses for MMTs. Relevance to Clinical Practice: Understanding MMT critical care nurses' competencies can help managers plan and provide relevant training and education before deployment, which can improve nurses' performance, and especially reduce the mortalities and disabilities from trauma. [ABSTRACT FROM AUTHOR]