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Introduction: During the COVID-19 epidemic in Singapore, there was an urgent demand to train more nurses within a short timeframe to perform the Water Swallow Test (WST). The previous training model involved training with actual patients and was time-consuming. Hence, the model was revamped and standardised patients (SPs) were engaged for nurses’ training. This study further investigated nurses’ feedback about the new training model and compared the efficiency and learner-reported outcomes of the previous and new models. Methods: Nurses who completed WST training from January 2018 to July 2020 were enrolled. Training records were accessed to determine the number of nurses trained under the previous and new models. Nurses were invited to complete post-training evaluation forms and their responses were analysed. Descriptive statistics and the Mann-Whitney U test were used for data analysis. Results: Under the previous model, 52 nurses were trained over 2 years, whereas under the new model, 112 nurses were trained over two months. From the evaluation form responses, the majority of nurses trained under the new model agreed that they achieved the learning objectives and were confident in performing the WST. There was also no significant difference (p>0.05) found between learner-reported outcomes for both training models. Conclusion: Our findings demonstrated that the new model that engaged SPs was more efficient in training more nurses. Nurses were also satisfied with the new training model, which achieved similar learner-reported outcomes as the previous model.

Extracorporeal membrane oxygenation (ECMO) is a superior life support technology, commonly employed in critical patients with severe respiratory or hemodynamic failure to provide effective respiratory and circulatory support, which is especially recommended for the treatment of critical neonates. However, the vascular management of neonates with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is still under controversy. Reconstruction or ligation for the right common carotid artery (RCCA) after ECMO is inconclusive. This review summarized the existed studies on hemodynamics and neurological function after vascular ligation or reconstruction hoping to provide better strategies for vessel management in newborns after ECMO. After reconstruction, the right cerebral blood flow can increase immediately, and the normal blood supply can be restored rapidly. But the reconstructed vessel may be occluded and stenotic in long-term follow-ups. Ligation may cause lateralization damage, but there could be no significant effect owing to the establishment of collateral circulation. The completion of the circle of Willis, the congenital anomalies of cerebral or cervical vasculature, the duration of ECMO, and the vascular condition at the site of arterial catheterization should be assessed carefully before making the decision. It is also necessary to follow up on the reconstructed vessel sustainability, and the association between cerebral hemodynamics and neurological function requires further large-scale multi-center studies.

The present study aims to investigate the effects of smartphone use by college students on their perceived academic performance. Using five hypotheses derived from the literature related to smartphone use, the initial model was set up for path analysis to reveal the relationships among variables regarding college students' smartphone use in the academic setting. Moreover, multiple group analyses were additionally conducted to verify whether students exhibited different relationships in the hypothesized model depending on their majors. The results from path analyses showed that all path coefficients were positive and statistically significant, which indicated that all five hypothesized paths were supported. Above all, the results from multiple group analysis showed that one path (from "Behavioural Intention to Use Smartphone to Academic Performance") differed significantly across groups. The findings from the current study provide educational policymakers and educators with information on how smartphone utilization in learning activities influences students' academic performance.

Objective: We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. Methods: Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non‐standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area‐Tract‐level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional hazard analyses were performed. Results: Of 983 eligible patients, 85.6% (841/983) lived in urban areas. Overall, only 37.5% received standard‐of‐care (SOC) for the definitive management of locally advanced bladder cancer. Individuals living in rural areas (OR 0.53, 95% CI: 0.31–0.91, p = 0.02) were less likely to receive standard of care treatment. Both rural residence and receipt of non‐standard of care therapy were associated with an increased risk of bladder cancer‐specific (adj HR 1.53, 95% CI: 1.09–2.14, p = 0.01 and adj HR: 1.85, 95% CI: 1.43–2.39, <0.0001) and overall mortality (adj HR: 1.28, 95% CI: 1.01–1.61, p = 0.04 and adj HR: 1.73 95% CI: 1.44–2.07, p < 0.0001). Conclusions: Most patients with locally advanced bladder cancer in Louisiana do not receive SOC therapy. Individuals living in rural locations are more likely to receive non‐standard of care therapy than individuals in urban areas. Nonstandard of care treatment and rural residence are both associated with worse survival outcomes for Louisiana residents with locally advanced bladder cancer. [ABSTRACT FROM AUTHOR]

Calcium‐ion batteries (CIBs) are considered as potential next‐generation energy storage systems due to their abundant reserves and relatively low cost. However, irreversible structural changes and weak conductivity still hinder in current CIBs cathode materials. Herein, an organic molecular intercalation strategy is proposed, in which V2O5 regulated with quinoline, pyridine, and water molecules are studied as cathode material to provide fast ion diffusion channels, large storage host, and high conductivity for Ca ions. Among them, V2O5‐quinoline (QVO) owns the largest interplanar spacing of 1.25 nm and the V‐O chains are connected with organic molecular by hydrogen bond, which stabilizes the crystal structure. As a result, QVO exhibits a specific capacity of 168 mAh g−1 at 1 A g−1 and capacity retention of 80% after 500 cycles at 5 A g−1 than the other materials. Furthermore, X‐Ray diffraction and X‐ray absorption spectroscopy results reveal a reversible order‐disorder transformation mechanism of Ca2+ for QVO, which can make full use of the abundant active sites for high capacity and simultaneously achieve fast reaction kinetics for excellent rate performance. These results demonstrate that QVO is a promising cathode material for CIBs, providing more choices for the development of high‐performance CIBs. [ABSTRACT FROM AUTHOR]

Graded gravel is a typical filler for railroad subgrade and the procedures for designing and evaluating it are crucial. The current specifications only stipulate the physical indicators of graded gravel material groups and the mechanical indications following on-site compaction. The lack of indoor mechanical standards makes it impossible to predict the on-site construction. Furthermore, the specification specifies various varieties and vast ranges of gradation, making it difficult to construct a skeleton structure. The current specification uses the heavy compaction method (HCM) and static compaction method (SCM) for the test method of graded gravel, which are no longer compatible with the current vibration compaction molding process. In this work, the effects of grading types, compaction coefficients, and water content conditions on the mechanical properties of the subgrade surface grading gravel were studied. Then the correlation between the field and indoor mechanical indexes was investigated and the K30 predictive index of graded gravel was proposed and verified by combining it with the test section. The results show that compared with HCM and SCM, the correlation between vertical vibration compaction method (VVCM) and the field was greater than 90%. Compared with standard graded gravel, the California bearing ratio (CBR), Rc , and E0 of the strongly embedded skeleton compact gradation (VGM) graded gravel can be increased by 55%, 162%, and 171%, respectively. When the compaction coefficient increases by 1%, the CBR, Rc , and E0 can be increased by 12%, 28%, 31%, respectively. Compared with graded gravel with the optimal water content, the CBR, Rc , and E0 of dry graded gravel can be increased by 7%, 94%, and 14%. The proposed CBR1 design standard, Evd acceptance standard, and graded gravel design method can better predict the K30 index on-site. [ABSTRACT FROM AUTHOR]

Bleb leakage is a notorious complication of glaucoma filtration surgery which increases the risk of sight‑threatening conditions. A 25‑year‑old female with severe bilateral juvenile open‑angle glaucoma was treated for blebitis and exogenous endophthalmitis secondary to chronic bleb leak after undergoing XEN implantation, followed by multiple rounds of bleb needling, and augmented trabeculectomy. In the right eye, visual acuity was hand movement with cataract, intraocular pressure was 6 mmHg and the bleb was large, highly elevated from 10 to 1 o’clock, avascular, thin wall, and cystic with leaking points. Combined surgery of low‑setting phacoemulsification and amniotic membrane transplantation without excising and manipulating the bleb was performed in the same setting. At postoperative 1 month, 6 months, and 1 year, her right vision had improved to 6/24, and the intraocular pressure was 12–14 mmHg, and the bleb leakage had resolved. This successful treatment was accomplished by maintaining the bleb’s viability, preventing additional injury, and promoting wound healing. [ABSTRACT FROM AUTHOR]

In order to develop high performance thermal reflective coating for asphalt pavement, this paper studied the effect of the ratio of functional fillers on thermal insulation performance, the effect of the ratio of binder materials on bond strength and the effect of the content of functional fillers on thermal insulation performance and bond strength, and then prepared the thermal reflective coating and evaluated its durability. The results show that, under different mass ratios of TiO2 and SiO2, the thermal insulation performance of the thermal reflective coating increases with the increase of TiO2 mass ratio. Under the same dosage of curing agent, the maximum bond strength is obtained when the dosage of toughening agent is 20%-30%. With the same amount of toughening agent, the maximum bond strength is obtained when the amount of curing agent is 30%-40%. With the increase of the content of functional fillers, the thermal insulation performance of the thermal reflective coating increases, and the bond strength decreases slowly at first and then rapidly. The thermal reflective coating was prepared according to the optimum ratio of each component. The wear rate of the coating increases with the increase of wear times, and the increase rate is fast in the early stage. The thermal insulation performance decreases linearly with the increase of wear rate. With the increase of wear times, the skid resistance first increases rapidly and then decreases slowly. [ABSTRACT FROM AUTHOR]

Objective Treatment of massive irreparable rotator cuff tears (RCT) has shown limited clinical success and a variety of subsequent complications. Superior capsule reconstruction (SCR) has been proved to reestablish superior stability but does not restore the dynamic force or shoulder kinematics. There are numerous reports of the short‐term failure of SCR grafts at the glenoid side, which relate to the non‐biological healing of grafts. To restore both dynamic and static stability and to provide biologic augmentation, an integrated procedure for massive irreparable RCT using an Achilles tendon–bone allograft (ATBA) was developed. Method This was a retrospect study completed between October 2019 and April 2020. A 71‐year‐old woman with massive and irreparable rotator cuff tears was enrolled in our study. The ATBA was folded into a double‐layer structure. The superior layer (proximal portion) served as a bridge patch to dynamic the glenohumeral joint, while the inferior layer (distal portion) served as the superior capsule to restore static stability of glenohumeral joint. To enhance biologic healing on the glenoid side, we fixed the calcaneus of the graft on the superior–posterior side of the superior glenoid rim. The recovery of shoulder function (including strength, range of motion, acromiohumeral interval, and fatty infiltration) was assessed at 6 months postoperation. Result At 6‐month follow‐up, the patient's strength had improved significantly (from abduction of grade 3 preoperatively to grade 4 at 6 months). Radiographic analysis showed an increase in the acromiohumeral interval from 3 to 7 mm. Magnetic resonance imaging revealed an intact graft, with the thickness of the ligament part maintained (at 6–7 mm). Most importantly, recovery of atrophy and fatty infiltration of the supraspinatus were observed. No graft tears were observed on the glenoid side. Conclusion This technique could provide a preferable treatment option by restoring shoulder kinematics and augmentating biological healing for patients with massive irreparable RCT.

BackgroundExercise prescription of cardiac rehabilitation (CR) is vital in patients with cardiovascular diseases (CVDs) and those carrying high risk for CVDs. However, the relation between the implementation rate of exercise prescription and cardiovascular events (CVEs) is unclear.Design and MethodsIn this retrospective study, using the administration data from the Rehabilitation Center in a hospital, patients aged ≥18 years with CVDs were consecutively enrolled from November 2018 to May 2021. Patients were divided into the high execution group (HEG) and low execution group (LEG) depending on whether they completed more than half the time of the exercise prescriptions. Baseline characteristics, ultrasonic cardiogram, cardiopulmonary exercise test, follow-up data, and CVEs were collected.ResultsThe mean age of the 197 CR patients was 61.8 ± 13.7 years and the mean follow-up duration was 10.9 ± 4.2 months. Among them, 15 patients suffered CVEs: 4 in the HEG and 11 in the LEG. The incidence of CVEs showed significant differences between HEG and LEG (chi-square test). Free-event survival analysis using Kaplan–Meier survival plots showed that patients in LEG had poor survival. Cox proportional hazards regression analysis revealed that the prescription implementation rate was an independent predictor of CVEs.ConclusionsOur study suggested a significant effect of exercise prescription execution rate on the occurrence of CVEs. Further, the HEG of exercise prescription was associated with lower CVDs.

This is a 5 years multicentre database study that recruited subjects from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR), aimed to determine risk factors that affect cataract surgery visual outcome and evaluates post-cataract surgery vision. All age-related cataract surgeries with primary intraocular lens (IOL) implantation were included. Cases with secondary cataract, previous ocular surgeries and incomplete data were excluded. A total of 131425 cases were included in the study. Amongst all types of cataract surgery, 92.9% attained post-operative best-corrected visual acuity better than 6/18 and the outcome improved to 97.1% when ocular comorbidities were excluded. Factors with Odds Ratio (OR) >1.5 associated with an impaired visual outcome included: elderly patients of 80 years old and above; systemic disease such as renal failure; ocular co-morbidities; pre-operative vision worse than 6/60; general anaesthesia, retrobulbar anaesthesia or subconjunctival anaesthesia; extracapsular cataract extraction (ECCE), intracapsular cataract extraction (ICCE), anterior chamber intraocular lens (ACIOL) implantation or combined cataract surgery; the presence of intra- and post-operative complications. In conclusion, a good visual outcome was achieved after cataract surgery in most cases. This large multicentre study provides information about risk factors for poor visual outcome post-cataract surgery and may serve as a basis for evidence-based guidelines.