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BackgroundPrevious studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) can improve postural control in subacute and chronic ischemic stroke, but further research is needed to investigate the effect of rTMS on acute ischemic stroke.ObjectiveWe compared the therapeutic effects of rTMS plus conventional rehabilitation and conventional rehabilitation on postural control in patients with mild hemiparesis in acute ischemic stroke.MethodsEighty-six patients with acute ischemic stroke were randomly assigned to either the experimental group or the control group within 1–7 days of onset. Patients in both groups received conventional rehabilitation for 2 weeks. Patients in the experimental group received rTMS treatments lasting for 2 weeks. Before and after the 2-week treatment, patients were assessed based on the Timed up and Go (TUG) test, Dual-Task Walking (DTW) test, Functional Ambulation Category (FAC), Tinetti Performance Oriented Mobility Assessment (POMA), gait kinematic parameters, Barthel Index (BI), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and National Institutes of Health Stroke Scale (NIHSS). Additionally, TUG and single-task gait velocity were assessed at 2 months after the start of treatment, and independent walking recovery was also followed up.ResultsAfter 2 weeks of treatment, compared to conventional rehabilitation, participants who underwent rTMS treatment plus conventional rehabilitation exhibited notable enhancements in TUG, FAC, POMA, and some gait parameters [single-task gait velocity, gait stride length, gait cadence, gait cycle]. Changes in cognitive function partially mediated the improvement in single-task gait velocity and gait stride length by rTMS plus conventional rehabilitation. Generalized Estimating Equation (GEE) analysis showed that the trend of improvement in single-task gait velocity over time was more pronounced in the experimental group than in the control group. The results of the Kaplan–Meier curve indicated a median gait recovery time of 90 days for patients in the experimental group and 100 days for the control group. Multifactorial Cox regression analyses showed that rTMS plus conventional rehabilitation promoted faster recovery of independent walking compared with conventional rehabilitation.ConclusionrTMS plus conventional rehabilitation outperformed conventional rehabilitation in improving postural control in patients with acute ischemic stroke. Improvements in cognitive function may serve as a mediating factor in the favorable treatment outcome of rTMS plus conventional rehabilitation for improving postural control.Clinical trial registrationhttps://www.chictr.org.cn, identifier ChiCTR1900026225.

Prunus discoidea is a unique cherry blossom germplasm resource native to China. It is widely distributed across the provinces of Anhui, Zhejiang, Jiangxi, Jiangsu, and Henan, with significant variation. We employed phylogeographic analysis to reveal the evolutionary history of P. discoidea to better understand its genetic diversity and structure. This study provides more accurate molecular insights for the effective conservation and utilization of this germplasm resource. We conducted a phylogeographic analysis of 348 individual plants from 13 natural populations using three fragments (rpoB, rps16, and trnD–E) of chloroplast DNA (cpDNA) and one fragment (ITS) of ribosomal DNA. The results revealed that P. discoidea demonstrates a significant level of genetic diversity (Hd = 0.782; Rd = 0.478). Gene flow among populations was limited, and the variation within populations was the main source of genetic diversity in P. discoidea (among populations: 34.26%, within populations: 65.74%). Regarding genetic differences among populations, Nst (0.401) showed greater differences than Gst (0.308; p < 0.05), demonstrating that there was a significant geographical structure of lineage. One lineage was the central region of Anhui and the western region of Hubei. The other lineage was the Jiangsu region and the Zhejiang region. P. discoidea diverged from Prunus campanulata approximately 1.5 million years ago, during the Pleistocene epoch. This study provides a scientific theoretical basis for the conservation and utilization of germplasm resources of P. discoidea.

ObjectiveThis review aimed to analyze and compare the accuracy of eight screening tools for sarcopenia in older Chinese adults according to different diagnostic criteria.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched between the publication of the first expert consensus on sarcopenia in 2010 and April 2023 using relevant MeSH terms. We evaluated the risk bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The pooled result of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and plot the summary receiver operating characteristic curve (SROC) were calculated by using a bivariate random-effects model. The accuracies of sensitivity and specificity of the screening tools were compared using the Z-test.ResultsA total of 30 studies (23,193 participants) were included, except for calf circumference (CC), Ishii, and Finger-ring Test; Screening tools for sarcopenia in older Chinese adults have consistently shown low to moderate sensitivity and moderate to high specificity. Regional and sex differences affect the accuracy of the screening tools. In terms of sensitivity and specificity, the CC, Ishii, and Finger-ring Test were superior to the other screening tools.ConclusionThe Asian Working Group on Sarcopenia (AWGS) 2019 criteria are more appropriate for the diagnosis of sarcopenia in older Chinese adults. According to the AWGS 2019, CC and Ishii are recommended for sarcopenia screening in older Chinese adults.

Summary: Saccharides are essential organic compounds that perform critical functions in sustaining life processes. As biomolecules, their vibrational frequencies predominantly fall in the terahertz (THz) range, making them amenable to analysis using THz techniques. In this study, L-sorbose and D-melibiose were measured using a THz time-domain spectroscopy system covering a frequency range of 0.1–2.0 THz, and their crystal structures were simulated using density functional theory. The experimental results demonstrated significant agreement with the simulation findings. In addition, the spectral properties of the two saccharides in solution were determined using microfluidic chip technology, thereby facilitating a comparison between the solid and aqueous states. The results demonstrate that the intramolecular and intermolecular interactions of the saccharides were weakened by the presence of water molecules, and the THz absorption spectrum of the same substance solution was found to be correlated with its concentration and temperature.

Abstract Purpose The prognostic factors for diffuse large B‐cell lymphoma (DLBCL) have been fully explored, but prognostic information for bulky mass DLBCL patients is limited. This study aimed to analyze the prognostic value of MYC protein expression and other biological parameters in bulky mass DLBCL patients. Methods We defined a bulky mass as a maximum tumor diameter ≥7.5 cm and studied 227 patients with de novo bulky mass DLBCL. Results In all patients with bulky mass DLBCL, the 1‐year and 3‐year OS rates were 72.7% and 57.1%, respectively, and the 1‐year and 3‐year PFS rates were 52.0% and 42.5%, respectively. The MYC overexpression group (n = 140) showed significantly worse overall survival (OS; p = 0.019) and progression‐free survival (PFS; p = 0.001) than the non‐MYC overexpression group (n = 87). Subgroup analyses demonstrated that the MYC overexpression group was associated with inferior OS and PFS in the subgroups with the International Prognostic Index score of 3–5 (OS: p = 0.011; PFS: p

Prunus conradinae (subgenus Cerasus, Rosaceae) is a significant germplasm resource of wild cherry blossom in China. To ensure the comprehensiveness of this study, we used a large sample size (12 populations comprising 244 individuals) which involved the fresh leaves of P. conradinae in Eastern, Central, and Southwestern China. We combined morphological and molecular evidence (three chloroplast DNA (cpDNA) sequences and one nuclear DNA (nr DNA) sequence) to examine the population of P. conradinae variation and differentiation. Our results revealed that Central, East, and Southwest China are important regions for the conservation of P. conradinae to ensure adequate germplasm resources in the future. We also found support for a new variant, P. conradinae var. rubrum. We observed high genetic diversity within P. conradinae (haplotype diversity [Hd] = 0.830; ribotype diversity [Rd] = 0.798), with novel genetic variation and a distinct genealogical structure among populations. There was genetic variation among populations and phylogeographic structure among populations and three geographical groups (Central, East, and Southwest China). The genetic differentiation coefficient was the lowest in the Southwest region and the gene exchange was obvious, while the differentiation was obvious in Central China. In the three geographic groups, we identified two distinct lineages: an East China lineage (Central China and East China) and a Southwest China lineage ((Central China and Southwest China) and East China). These two lineages originated approximately 4.38 million years ago (Mya) in the early Pliocene due to geographic isolation. P. conradinae expanded from Central China to East China at 3.32 Mya (95% HPD: 1.12–5.17 Mya) in the Pliocene. The population of P. conradinae spread from East China to Southwest China, and the differentiation time was 2.17 Mya (95% (HPD: 0.47–4.54 Mya), suggesting that the population of P. conradinae differentiated first in Central and East China. The population of P. conradinae experienced differentiation from Central China to Southwest China around 1.10 Mya (95% HPD: 0.11–2.85 Mya) during the early Pleistocene of the Quaternary period. The southeastern region of East China, near Mount Wuyi, likely serves as a refuge for P. conradinae. This study establishes a theoretical foundation for the classification, identification, conservation, and exploitation of germplasm resources of P. conradinae.

Timely detection of highly infectious pathogens is essential for preventing and controlling public health risks. However, most traditional testing instruments require multiple tedious steps and ultimately testing in hospitals and third-party laboratories. The sample transfer process significantly prolongs the time to obtain test results. To tackle this aspect, a portable fiber optic surface plasmon resonance (FO-SPR) device was developed for the real-time detection of infectious pathogens. The portable device innovatively integrated a compact FO-SPR sensing component, a signal acquisition and processing system, and an embedded power supply unit. A gold-plated fiber is used as the FO-SPR sensing probe. Compared with traditional SPR sensing systems, the device is smaller size, lighter weight, and higher convenience. To enhance the detection capacity of pathogens, a monolayer graphene was coated on the sensing region of the FO-SPR sensing probe. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was used to evaluate the performance of the portable device. The device can accurately detect the SARS-CoV-2 spike S1 protein in phosphate-buffered saline (PBS) and artificial saliva within just 20 min, and the device successfully detected cultured SARS-CoV-2 virus. Furthermore, the FO-SPR probe has long-term stability, remaining stable for up to 8 days. It could distinguish between the SARS-CoV-2 spike protein and the MERS-CoV spike protein. Hence, this FO-SPR device provides reliable, rapid, and portable access to test results. It provides a promising point-of-care testing (POCT) tool for on-site screening of infectious pathogens.

Abstract With the continuous development of terahertz (THz) detection technology, the use of terahertz spectroscopy to study chemical samples has become one of the indispensable tools in the field of biochemistry. While most biomolecules biological activity can only be expressed in aqueous solutions, water as a polar molecule has strong absorption properties for terahertz waves, making it difficult to use terahertz technology to study the activity of biological samples in aqueous solutions. In this study, a sandwich-type terahertz microfluidic chip with high terahertz wave transmission was designed and combined with a terahertz time domain spectroscopy (THz-TDS) system to test the terahertz spectra of distilled water, 0.9 mol/L NH4Cl, (NH4)2SO4, (NH4)2CO3 and CH3COONH4 solutions, respectively, and to investigate the effect of the electric field action time on the hydrogen bond in the solution under the action of an external electric field. The experimental results show that the terahertz spectra of different ammonium solutions at the same concentration differ significantly, indicating that the ion hydration process affects the intermolecular hydrogen bonding in water, while the applied electric field also affects the hydrogen bonding in water, resulting in a change in the terahertz waves water absorption.

The effect of oral processing on flavor release and change in composition of steamed sturgeon meat was investigated. Oral processing caused changes in the concentrations of taste compounds including amino acids, 5′-nucleotides, organic acids, and Na+. Sensory omics demonstrated that the concentrations of 12 volatile compounds increased significantly (p

Monitoring mangroves is critical to protect the coastal ecosystems. Some studies resorted to remote sensing for constructing mangrove indices (MIs). However, there are still some drawbacks in existing MIs. On the one hand, difficulty still persists in distinguishing mangroves from nonmangrove vegetation and nonvegetated areas at the same time. On the other hand, the existing MIs have not fully utilized the phenological trajectories, which can greatly help to distinguish mangroves from other land covers. To overcome these issues, we built a novel mangrove index, namely generalized composite mangrove index (GCMI) by compositing vegetation indices (VIs) and water indices (WIs) based on Sentinel-2 time series data. Firstly, to determine the optimal indices, a similarity trend distance (ST distance) measure was proposed based on Pearson correlation coefficient and dynamic time warping (DTW). Secondly, in order to optimize the weights of selected indices, a population reconstruction genetic algorithm (PRGA) was designed. Finally, mangroves were mapped by feeding the time series of GCMI into random forest classifier. Experiments conducted over three areas along the southern coast of China demonstrate that: 1) GCMI enhances the separability between mangroves and other land covers compared to the existing VIs, WIs, and MIs, with an averaged overall accuracy of 91.45%; 2) ST distance outperforms Euclidean distance, Cosine distance, Pearson correlation coefficient, and DTW in optimizing the weights of GCMI; 3) PRGA greatly improves the probability of attaining global optimal result. The innovation lies in the presented GCMI considering both the vegetation trajectory information and water inundation using time series.

Abstract Purpose Current knowledge of Lymphoma Associated Hemophagocytic Syndrome (LAHS) mainly relies on T/NK-cell LAHS cases, while B-cell lymphoma associated hemophagocytic syndrome (B-LAHS) variant are rare. We aimed at identifying a single-center cohort of patients with B-LAHS to shed light on relevant clinical and laboratory features, diagnosis, treatment and prognosis. Methods The clinical data of 36 patients with B-LAHS, admitted to the First Affiliated Hospital of Zhengzhou University in the time period ranging from January 2011 to May 2021 were analyzed retrospectively. Survival analysis was performed using the Kaplan–Meier method and groups were compared using the log-rank test. Results The 36 patients included 17 males and 19 females with a median age of 53.5 years (range: 28–74 years). Among these, the most common histopathological type diagnosed was diffuse large B-cell lymphoma (69%). The initial symptoms included fever (100%), splenomegaly (97%), multicavity effusion (83%), abnormal liver function (58%), and jaundice (44%). Patients treated with dexamethasone only seemed to have an inferior prognosis compared to those treated with etoposide-involving regimens (χ2 = 20.037, p < 0.001). Patients received based on the Hemophagocytic Lymphohistocytosis (HLH)-2004 protocol combined with multidrug chemotherapy had a significantly improved Overall Survival (OS) compared to patients who only underwent treatment according to the HLH-2004 regimen (χ2 = 30.744, p < 0.001). The 2-week mortality rate was 13.9% and the 1-year OS rate was 19.4%. Compared with the median survival time of 34 patients without Epstein-Barr virus (EBV) infection, 97 days (range: 24–322 days), two patients with EBV infection died within 8 days. Conclusion B-LAHS is relatively rare and has a high early mortality rate, mostly in middle-aged and elderly patients. The HLH-2004 regimen combined with multidrug chemotherapy is a reasonable choice for the treatment of B-LAHS, and EBV infection may be used as a reference indicator of a poor prognosis.

ObjectiveThe prognostic nutritional index (PNI) is an important prognostic factor for survival outcomes in various hematological malignancies. The current study focused on exploring the predictive value of the PNI in newly diagnosed follicular lymphoma (FL) in China.Materials and methodsThe clinical indicators and follow-up data of 176 patients who received chemotherapy or immunotherapy combined with chemotherapy with FL in our hospital from January 2016 to March 2022 were retrospectively analyzed. Cox proportional hazard model was used for univariate and multivariate analyses. Kaplan–Meier curves were used to calculate survival rates and draw survival curves. The log-rank test was applied to compare differences between groups.ResultsThe optimal cut-off value of PNI was 44.3. All patients were divided into a high PNI group (>44.3) and a low PNI group (≤44.3). The low PNI group had a low CR rate and a high risk of death, with a tendency toward POD24, and Both OS and PFS were worse than those in the high PNI group. PNI was able to predict OS and PFS in FL patients and was the only independent predictor of OS (P = 0.014 HR 5.024; 95%CI 1.388∼18.178) in multivariate analysis. PNI could re-stratify patients into groups of high FLIPI score, high FLIPI2 score, no POD24, and rituximab combined with chemotherapy. Moreover, integrating PNI into the FLIPI and FLIPI2 models improved the area under the curve (AUC) for more accurate survival prediction and prognosis.ConclusionPNI is a significant prognostic indicator for newly diagnosed FL in China that can early identify patients with poor prognosis and guide clinical treatment decisions.

Summary: Recently, with the widespread application of metamaterials in the terahertz (THz) modulation field, solid-state THz modulators have made breakthrough progress; however, there are still challenges in preparing flexible THz modulators with wide modulation bandwidths. In this study, a THz microfluidic chip was fabricated using cycloolefin copolymers with high transmission (90%) of THz waves. The THz modulation characteristics of TiO2, Ag, and Fe3O4 nanosols under the control of an optical field, electric field, and magnetic field, respectively, were investigated. Under the action of photogenerated carrier migration, colloidal electrophoresis, and magneto-optical effect, all three nanosols exhibit broadband modulation performance in the frequency range of 0.3–2.4 THz, and the maximum modulation depth is 24%, 33%, and 54%, respectively. Contrary to previous studies based on traditional solid-state materials, this study innovatively explores the possibility of modulating THz waves with liquid materials, laying the foundation for the application of flexible liquid-film THz modulators.

The Extended Kalman Filter (EKF) has received abundant attention with the growing demands for robotic localization. The EKF algorithm is more realistic in non-linear systems, which has an autonomous white noise in both the system and the estimation model. Also, in the field of engineering, most systems are non-linear. Therefore, the EKF attracts more attention than the Kalman Filter (KF). In this paper, we propose an EKF-based localization algorithm by edge computing, and a mobile robot is used to update its location concerning the landmark. This localization algorithm aims to achieve a high level of accuracy and wider coverage. The proposed algorithm is helpful for the research related to the use of EKF localization algorithms. Simulation results demonstrate that, under the situations presented in the paper, the proposed localization algorithm is more accurate compared with the current state-of-the-art localization algorithms.

Castleman disease (CD) is a rare lymphoproliferative disorder. The mechanistic target of rapamycin (mTOR) pathway is a key regulator of various cellular functions, which may be related with the potential mechanisms of CD occurrence. We retrospectively collected the clinical information of 60 CD patients diagnosed in the First Affiliated Hospital of Zhengzhou University. And FFPE biopsy specimens were collected from 31 patients (12 unicentric CD patients and 19 multicentric CD patients) to detect the mTOR pathway protein expression. We are the first to demonstrate that thrombocytopenia and hypoalbuminemia are independent poor prognostic factors for CD. Moreover, mTOR activation was higher in CD compared to reactive lymphoid hyperplasia (used as a control group). This study offers some elucidation for the management and treatment of CD patients.

Multiwalled carbon nanotubes (MWCNTs) have excellent electronic, mechanical, and structural characteristics; however, their poor dispersion structure and large aggregates severely inhibit their function. A stable MWCNT dispersion in an aqueous solvent has been realized via ultrasonic dispersion and surfactant modification, providing a reference for improving MWCNT dispersion in various materials and solvents. In this study, a cyclic olefin copolymer with high transmittance to terahertz (THz) waves is used to prepare microfluidic chips. Then, the microfluidic and THz technologies are combined to study the THz absorption characteristics of MWCNT aqueous dispersion under different electric field (EF) intensities, magnetic field (MF) intensities, and MF action time. The results show that the THz spectral intensity of MWCNT aqueous dispersion decreases and the absorption coefficient increases with the increase of EF intensity, MF intensity, and MF action time. This phenomenon is explained from a microscopic perspective. The combination of microfluidic and THz technologies provides technical support for studying the characteristics of MWCNT aqueous dispersion and lays a foundation for elucidating the molecular microstructure of MWCNT aqueous dispersion.

Abstract Background The Australian government has implemented a compulsory aged care accreditation system to guide and monitor the risk management approach in registered residential aged care (RAC) homes. This research assessed the contribution of electronic health records (EHR) to risk management in RAC homes in relation to the extent that aged care accreditation fulfils its role. Methods A convenience sample of 5560 aged care accreditation reports published from 2011 to 2018 was manually downloaded from the Accreditation Agency web site. A mixed-method approach of text data mining and manual content analysis was used to identify any significant differences in failure to meet accreditation outcomes among the RAC homes. This took account of whether EHR or paper records were used, year of accreditation, and size and location of the homes. Results It appears that aged care accreditation was focused on structure and process, with limited attention to outcome. There was a big variation between homes in their use of measurement indicators to assess accreditation outcomes. No difference was found in outcomes between RAC homes using EHR and those using paper records. Only 3% of the RAC homes were found to have failed some accreditation outcomes. Failure in monitoring mechanism was the key factor for failing many accreditation outcomes. The top five failed outcomes were Human Resource Management, Clinical Care, Information Systems, Medication Management and Behavioural Management. Conclusions Sub-optimal outcomes have limited the effectiveness of accreditation in driving and monitoring risk management for care recipient safety in RAC homes. Although EHR is an important structure and process component for RAC services, it made a limited contribution to risk management for accreditation in Australian RAC homes. Either EHR was not effective, or the accreditation process was not robust enough to recognize its influence. Aged care accreditation in Australia needs to develop further outcome-based measures that are supported by robust data infrastructure and clear guidance.

BackgroundDespite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. ObjectiveThis study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. MethodsWe adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. ResultsIn stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient’s risk level, as informed by the person’s response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. ConclusionsThis study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.

BackgroundMobile health services are gradually being introduced to support patients’ self-management of chronic conditions. The success of these services is contingent upon patients’ continuous use of them. ObjectiveThis study aims to develop a model to measure the success of patients’ continuous use of mobile health services for the self-management of chronic conditions. MethodsThe proposed model was derived from the information systems continuance model and the information systems success model. This model contains 7 theoretical constructs: information quality, system quality, service quality, perceived usefulness, user satisfaction, perceived health status, and continuous use intention. A web-based questionnaire survey instrument was developed to test the model. The survey was conducted to collect data from 129 patients who used a mobile health app for hypertension management from 2017 to 2019. The questionnaire items were derived from validated instruments and were measured using a 5-point Likert scale. The partial least squares modelling method was used to test the theoretical model. ResultsThe model accounted for 58.5% of the variance in perceived usefulness (R2=0.585), 52.3% of the variance in user satisfaction (R2=0.523), and 41.4% of the variance in patients’ intention to make continuous use of mobile health services (R2=0.414). The continuous use intention was significantly influenced by their perceived health status (β=.195, P=.03), perceived usefulness (β=.307, P=.004), and user satisfaction (β=.254, P=.04) with the mobile health service. Information quality (β=.235, P=.005), system quality (β=.192, P=.02), and service quality (β=.494, P

BackgroundHypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. ObjectiveThis study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. MethodsA semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. ResultsThe patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. ConclusionsThe mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions.

Abstract Background Intensive care information systems (ICIS) are continuously evolving to meet the ever changing information needs of intensive care units (ICUs), providing the backbone for a safe, intelligent and efficient patient care environment. Although beneficial for the international advancement in building smart environments to transform ICU services, knowledge about the contemporary development of ICIS worldwide, their usage and impacts is limited. This study aimed to fill this knowledge gap by researching the development and implementation of an ICIS in a Chinese hospital, nurses’ use of the system, and the impact of system use on critical care nursing processes and outcomes. Methods This descriptive case study was conducted in a 14-bed Respiratory ICU in a tertiary hospital in Beijing. Participative design was the method used for ICU nurses, hospital IT department and a software company to collaboratively research and develop the ICIS. Focus group discussions were conducted to understand the subjective perceptions of the nurses toward the ICIS. Nursing documentation time and quality were compared before and after system implementation. ICU nursing performance was extracted from the annual nursing performance data collected by the hospital. Results A participative design process was followed by the nurses in the ICU, the hospital IT staff and the software engineers in the company to develop and implement a highly useful ICIS. Nursing documentation was fully digitized and was significantly improved in quality and efficiency. The wrong data, missing data items and calculation errors were significantly reduced. Nurses spent more time on direct patient care after the introduction of the ICIS. The accuracy and efficiency of medication administration was also improved. The outcome was improvement in ward nursing performance as measured by ward management, routine nursing practices, disinfection and isolation, infection rate and mortality rate. Conclusions Nurses in this ICU unit in China actively participated in the ICIS development and fully used the system to document care. Introduction of the ICIS led to significant improvement in quality and efficiency in nursing documentation, medication order transcription and administration. It allowed nurses to spend more time with patients to improve quality of care. These led to improvement in overall nursing performance. Further study should investigate how the ICIS system contributes to the improvement in decision making of ICU nurses and intensivists.

Electronic health records (EHR) are introduced into healthcare organizations worldwide to improve patient safety, healthcare quality and efficiency. A rigorous evaluation of this technology is important to reduce potential negative effects on patient and staff, to provide decision makers with accurate information for system improvement and to ensure return on investment. Therefore, this study develops a theoretical model and questionnaire survey instrument to assess the success of organizational EHR in routine use from the viewpoint of nursing staff in residential aged care homes. The proposed research model incorporates six variables in the reformulated DeLone and McLean information systems success model: system quality, information quality, service quality, use, user satisfaction and net benefits. Two variables training and self-efficacy were also incorporated into the model. A questionnaire survey instrument was designed to measure the eight variables in the model. After a pilot test, the measurement scale was used to collect data from 243 nursing staff members in 10 residential aged care homes belonging to three management groups in Australia. Partial least squares path modeling was conducted to validate the model. The validated EHR systems success model predicts the impact of the four antecedent variables-training, self-efficacy, system quality and information quality-on the net benefits, the indicator of EHR systems success, through the intermittent variables use and user satisfaction. A 24-item measurement scale was developed to quantitatively evaluate the performance of an EHR system. The parsimonious EHR systems success model and the measurement scale can be used to benchmark EHR systems success across organizations and units and over time.

We proposed and demonstrated a novel tilted fiber Bragg grating (TFBG)-based surface plasmon resonance (SPR) label-free biosensor via a special boronic acid derivative to detect glycoprotein with high sensitivity and selectivity. TFBG, as an effective sensing element for optical sensing in near-infrared wavelengths, possess the unique capability of easily exciting the SPR effect on fiber surface which coated with a nano-scale metal layer. SPR properties can be accurately detected by measuring the variation of transmitted spectra at optical communication wavelengths. In our experiment, a 10° TFBG coated with a 50 nm gold film was manufactured to stimulate SPR on a sensor surface. To detect glycoprotein selectively, the sensor was immobilized using designed phenylboronic acid as the recognition molecule, which can covalently bond with 1,2- or 1,3-diols to form five- or six-membered cyclic complexes for attaching diol-containing biomolecules and proteins. The phenylboronic acid was synthetized with long alkyl groups offering more flexible space, which was able to improve the capability of binding glycoprotein. The proposed TFBG-SPR sensors exhibit good selectivity and repeatability with a protein concentration sensitivity up to 2.867 dB/ (mg/mL) and a limit of detection (LOD) of 15.56 nM.