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Abstract Background Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. Methods In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides’ best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. Results Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. Conclusions Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.

Abstract Background The incidence and prevalence of nonalcoholic fatty liver disease related hepatocellular carcinoma (NAFLD-HCC) are rapidly increasing worldwide. This study aimed to identify biomarker genes for prognostic prediction model of NAFLD-HCC hepatectomy by integrating text-mining, clinical follow-up information, transcriptomic data and experimental validation. Methods The tumor and adjacent normal liver samples collected from 13 NAFLD-HCC and 12 HBV-HCC patients were sequenced using RNA-Seq. A novel text-mining strategy, explainable gene ontology fingerprint approach, was utilized to screen NAFLD-HCC featured gene sets and cell types, and the results were validated through a series of lab experiments. A risk score calculated by the multivariate Cox regression model using discovered key genes was established and evaluated based on 47 patients’ follow-up information. Results Differentially expressed genes associated with NAFLD-HCC specific tumor microenvironment were screened, of which FABP4 and VWF were featured by previous reports. A risk prediction model consisting of FABP4, VWF, gender and TNM stage were then established based on 47 samples. The model showed that overall survival in the high-risk score group was lower compared with that in the low-risk score group (p = 0.0095). Conclusions This study provided the landscape of NAFLD-HCC transcriptome, and elucidated that our model could predict hepatectomy prognosis with high accuracy.

As an important research tool, cell lines play a vital role in life science research, medical research, and drug development. During the culture of the Scophthalmus maximus head kidney (TK) cell line, we found a phenomenon of cell vacuolization caused by excessive serum concentration. Moreover, the vacuolization of the cells gradually disappeared after passage by trypsin digestion. In clarifying the formation mechanism of this reversible cellular vacuolation, transcriptomics was utilized to explore the mechanism of cell vacuolization caused by excessive serum concentration. Transcriptome analysis indicated that excessive serum concentration could cause the up-regulated expression of PORCN and other genes to promote cell proliferation. Compared with cells whose vacuolization disappeared after trypsin digestion and passage, the expression of mitosis-related genes (BUB1, ttk, Mad2, Cdc20, CDK1, CCNB1), nuclear stability-related genes LMNB1 and tissue stress and repair-related genes HMMR in vacuolated cells caused by excessive serum concentration was significantly up-regulated. There is a regulatory system related to adaptation and stress repair in the cells, which can maintain cell stability to a certain extent. This study provides a theoretical basis for the stable culture of fish cell lines and the solution to the problem of cell vacuolation.

Abstract Soil texture is one of the important physical and natural properties of soil. Much of the current research focuses on soil texture monitoring using non-imaging geophysical spectrometers. However there are fewer studies utilizing unmanned aerial vehicle (UAV) hyperspectral data for soil texture monitoring. UAV mounted hyperspectral cameras can be used for quickly and accurately obtaining high-resolution spatial information of soil texture. A foundation has been laid for the realization of rapid soil texture surveys using unmanned airborne hyperspectral data without field sampling. This study selected three typical farmland areas in Huangshui Basin of Qinghai as the study area, and a total of 296 soil samples were collected. Data calibration of UAV spectra using laboratory spectra and field in situ spectra to explore the feasibility of applying laboratory soil texture models directly to field conditions. This results show that UAV hyperspectral imagery combined with machine learning can obtain a set of ideal processing methods. The pre-processing of the spectral data can obtain high accuracy of soil texture estimation and good mapping effect. The results of this study can provide effective technical support and decision-making assistance for future agricultural land planning on the Tibetan Plateau. The main innovation of this study is to establish a set of processing procedures and methods applicable to UAV hyperspectral imagery to provide data reference for monitoring soil texture in agricultural fields on the Tibetan Plateau.

Abstract Alpha-fetoprotein (AFP)-secreting hepatocellular carcinoma (HCC), which accounts for ~75% of HCCs, is more aggressive with a worse prognosis than those without AFP production. The mechanism through which the interaction between tumors and the microenvironment leads to distinct phenotypes is not yet clear. Therefore, our study aims to identify the characteristic features and potential treatment targets of AFP-negative HCC (ANHC) and AFP-positive HCC (APHC). We utilized single-cell RNA sequencing to analyze 6 ANHC, 6 APHC, and 4 adjacent normal tissues. Integrated multi-omics analysis together with survival analysis were also performed. Further validation was conducted via cytometry time-of-flight on 30 HCCs and multiplex immunohistochemistry on additional 59 HCCs. Our data showed that the genes related to antigen processing and interferon-γ response were abundant in tumor cells of APHC. Meanwhile, APHC was associated with multifaceted immune distortion, including exhaustion of diverse T cell subpopulations, and the accumulation of tumor-associated macrophages (TAMs). Notably, TAM-SPP1+ was highly enriched in APHC, as was its receptor CD44 on T cells and tumor cells. Targeting the Spp1-Cd44 axis restored T cell function in vitro and significantly reduced tumor burden when treated with either anti-Spp1 or anti-Cd44 antibody alone or in combination with anti-Pd-1 antibody in the mouse model. Furthermore, elevated IL6 and TGF-β1 signaling contributed to the enrichment of TAM-SPP1+ in APHC. In conclusion, this study uncovered a highly suppressive microenvironment in APHC and highlighted the role of TAM-SPP1+ in regulating the immune microenvironment, thereby revealing the SPP1-CD44 axis as a promising target for achieving a more favorable immune response in APHC treatment.

ObjectivesUnderstanding the health literacy status of patients with gout diagnosis is essential for improving the health of this population. Our study aimed to investigate the latent profiles of health literacy in patients with gout and to analyze differences in characteristics across potential profiles.MethodsThis was a cross-sectional study. Eligible participants attended the Shandong Gout Medical Center, from March 2023 to May 2023 and self-reported gout diagnosis. We used the Health Literacy Scale for Patients with Gout designed and validated by our team. The scale had good reliability and validity among patients with gout. 243 patients completed the Demographic Information Questionnaire and the Health Literacy Scale for Patients with Gout. We used latent profile analysis to identify the latent profiles of gout patients' health literacy. We used Chi-square tests with Bonferroni correction to analyze differences in demographics and illness characteristics across identified profiles.ResultsThree profiles of patients with gout emerged (prevalence): the low literacy-low critical group (21.81%), the moderate literacy group (42.79%), and the high literacy-stable group (35.39%). The three groups differed in age, education level, monthly income, disease duration, and place of residence (PConclusionsThe health literacy of patients with gout was heterogeneous. Healthcare professionals should adopt targeted interventions based on the characteristics of each latent health literacy profile to improve the health literacy level of patients with gout.

Abstract Background The increased complexity of residents and increased needs for care in long-term care (LTC) have not been met with increased staffing. There remains a need to improve the quality of care for residents. Care aides, providers of the bulk of direct care, are well placed to contribute to quality improvement efforts but are often excluded from so doing. This study examined the effect of a facilitation intervention enabling care aides to lead quality improvement efforts and improve the use of evidence-informed best practices. The eventual goal was to improve both the quality of care for older residents in LTC homes and the engagement and empowerment of care aides in leading quality improvement efforts. Methods Intervention teams participated in a year-long facilitative intervention which supported care aide-led teams to test changes in care provision to residents using a combination of networking and QI education meetings, and quality advisor and senior leader support. This was a controlled trial with random selection of intervention clinical care units matched 1:1 post hoc with control units. The primary outcome, between group change in conceptual research use (CRU), was supplemented by secondary staff- and resident-level outcome measures. A power calculation based upon pilot data effect sizes resulted in a sample size of 25 intervention sites. Results The final sample included 32 intervention care units matched to 32 units in the control group. In an adjusted model, there was no statistically significant difference between intervention and control units for CRU or in secondary staff outcomes. Compared to baseline, resident-adjusted pain scores were statistically significantly reduced (less pain) in the intervention group (p=0.02). The level of resident dependency significantly decreased statistically for residents whose teams addressed mobility (p

Summary: This paper proposed a method based on heart rate variability (HRV) for evaluating the accuracy of wearable devices in measuring heart rate. HRV refers to the variation in time intervals between successive heartbeats, widely used in many fields such as clinical and sports fields. Wearable devices such as Electrocardiogram (ECG) electrode patches have gained popularity due to their portability and ease of use. However, they can be prone to measurement interference caused by environmental noise, human respiration, etc. The proposed method consists of four main components: selection of “gold standard measurement devices”, identification of HRV measurement metrics, construction of an HRV evaluation framework, and quantification of measurement errors. The method is validated through simulated experiments using ECG patches. The evaluation framework and quantification model established in this method have significant implications in establishment of industry standards and diagnosis of diseases in clinical practice.

Abstract Background The number of research publications reporting the use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework and the integrated PARIHS (i-PARIHS) framework has grown steadily. We asked how the last decade of implementation research, predicated on the (i-)PARIHS framework (referring to the PARIHS or i-PARIHS framework), has contributed to our understanding of the conceptualizations of, relationships between, and dynamics among the core framework elements/sub-elements. Building on the Helfrich et al. (2010) review of research on the PARIHS framework, we undertook a critical interpretive synthesis to: (1) identify conceptual and relational advances in the (i-)PARIHS framework and (2) identify conceptual and relational aspects of the (i-)PARIHS framework that warrant further work. Methods We performed a systematic search in PubMed/PubMed Central, Ovid MEDLINE, CINAHL, JSTOR, SCOPUS, Web of Science, and PsycInfo. Articles were eligible for synthesis if they (a) were peer-reviewed articles, written in English, and published between January 2009 and December 2021, (b) applied the (i-)PARIHS framework explicitly to guide implementation research, and (c) made conceptual (expanding the conceptualization of core elements) and/or relational contributions (elaborating relationships among elements/sub-elements, or theorizing the relationships using empirical data). We used a critical interpretive synthesis approach to synthesize conceptual-relational advances of the (i-)PARIHS framework. Results Thirty-seven articles were eligible for synthesis. Twenty-four offered conceptual contributions, and 18 offered relational contributions (5 articles contributed in both ways). We found conceptual expansion of all core (i-)PARIHS elements, with most emphasis on context (particularly outer context and leadership), facilitation, and implementation success. Articles also gave insights into the complex relationships and relational dynamism among these elements, characterized as contingent, interactive, multilevel, and temporal effects. Conclusions We observed developmental advances of the (i-)PARIHS framework and proposed several directions to further advance the framework. Conceptualization of (i-)PARIHS elements (particularly evidence/innovation and recipients) need to be further developed by specifying conceptual and operational definitions of underlying sub-elements. Relationships among (i-)PARIHS elements/sub-elements need to be further elaborated through empirical studies that consider situational contingencies and causal complexities. This will require examining necessity and sufficiency of (i-)PARIHS elements/sub-elements in relation to implementation outcomes, interactions among elements, and mechanism-based explanations.

Abstract SLC1A5 variant (SLC1A5_var) is identified as a mitochondrial glutamine transporter in cancer cells recently. However, the role of SLC1A5_var in Parkinson’s disease (PD) is completely unknown. Here, we found the significant downregulation of SLC1A5_var in astrocytes and midbrain of mice treated with MPTP/MPP+ and LPS. Importantly, overexpression of SLC1A5_var ameliorated but knockdown of SLC1A5_var exacerbated MPTP/MPP+- and LPS-induced mitochondrial dysfunction. Consequently, SLC1A5_var provided beneficial effects on PD pathology including improvement of PD-like motor symptoms and rescue of dopaminergic (DA) neuron degeneration through maintaining mitochondrial energy metabolism. Moreover, SLC1A5_var reduced astrocyte reactivity via inhibition of A1 astrocyte conversion. Further investigation demonstrated that SLC1A5_var restrained the secretion of astrocytic pro-inflammatory cytokines by blunting TLR4-mediated downstream pathways. This is the first study to prove that astrocytic SLC1A5_var inhibits neuroinflammation, and rescues the loss of DA neurons and motor symptoms involved in PD progression, which provides a novel target for PD treatment.

Abstract Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation. Methods Data were collected in 2019 via small group interviews with unit- and care home-level managers (n = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis. Results Sustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system. Conclusions Our findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction.

Quality improvement (QI) projects are common in healthcare settings and often involve interdisciplinary teams working together towards a common goal. Many interventions and programmes have been introduced through research to convey QI skills and knowledge to healthcare workers, however, a few studies have attempted to differentiate between what individuals ‘learn’ or ‘know’ versus their capacity to apply their learnings in complex healthcare settings. Understanding and differentiating between delivery, receipt, and enactment of QI skills and knowledge is important because while enactment alone does not guarantee desired QI outcomes, it might be reasonably assumed that ‘better enactment’ is likely to lead to better outcomes. This paper describes the development, application and validation of a tool to measure enactment of core QI skills and knowledge of a complex QI intervention in a healthcare setting. Based on the Institute for Healthcare Improvement’s Model for Improvement, existing QI assessment tools, literature on enactment fidelity and our research protocols, 10 indicators related to core QI skills and knowledge were determined. Definitions and assessment criteria were tested and refined in five iterative cycles. Qualitative data from four QI teams in long-term care homes were used to test and validate the tool. The final measurement tool contains 10 QI indicators and a five-point scale. Inter-rater reliability ranged from good to excellent. Usability and acceptability among raters were considered high. This measurement tool assists in identifying strengths and weaknesses of a QI team and allows for targeted feedback on core QI components. The indicators developed in our tool and the approach to tool development may be useful in other health related contexts where similar data are collected.

Ionic liquids (ILs) have garnered increasing attention in the biomedical field due to their unique properties. Although significant research has been conducted in recent years, there is still a lack of understanding of the potential applications of ILs in the biomedical field and the underlying principles. To identify the antibacterial activity and mechanism of ILs on bacteria, we evaluated the antimicrobial potency of imidazole chloride ILs (CnMIMCl) on Staphylococcus aureus (S. aureus). The toxicity of ILs was positively correlated to the length of the imidazolidinyl side chain. We selected C12MIMCl to study the mechanism of S. aureus. Through the simultaneous change in the internal and external parts of S. aureus, C12MIMCl caused the death of the bacteria. The production of large amounts of reactive oxygen species (ROS) within the internal parts stimulated oxidative stress, inhibited bacterial metabolism, and led to bacterial death. The external cell membrane could be destroyed, causing the cytoplasm to flow out and the whole cell to be fragmented. The antibacterial effect of C12MIMCl on skin abscesses was further verified in vivo in mice.

IntroductionEither exposure to secondhand smoke (SHS) or frailty has been linked to adverse health outcomes in nonsmoking adults. However, their relationship is rarely studied. The purpose of this study is to examine the association between serum cotinine level and frailty status among non-smoking older adults.MethodThe study population consisted of 2,703 older adults aged ≥60 from the National Health and Nutrition Examination Survey 2011–2014. Non-smokers were included based on (1) a serum cotinine level ≤ 10 ng/mL and 2) a response of “no” to the question, “Do you currently smoke?” Frailty status was measured based on the Fried Phenotype and had three groups- robust, pre-frailty, and frailty. Multinomial logistic regression models were constructed to examine the association between serum cotinine level quartile and frailty status, controlling for age, sex, race/ethnicity, education, depressive symptoms, alcohol use, and systolic blood pressure.ResultsAbout half of the participants (median age 70.0 years, range 64–78) were female (53.6%), non-Hispanic White (48.3%), and completed some college and above (50.1%). Multinomial logistic regression with a reference group being those in the 1st quantile (the lowest) of serum cotinine level showed that participants in the 4th quartile (the highest) of serum cotinine level had increased odds of pre-frailty vs. robust (OR 1.522, 95% confidence interval [CI] 1.060, 2.185, P = 0.023) as well as increased odds of frailty vs. robust (OR 2.349, 95% CI 1.081, 5.107, P = 0.031).ConclusionsHigher serum cotinine level is associated with increased risk of pre-frailty and frailty versus robust in non-smoking older adults. Prevention and reduction of SHS in older adults may help protect them from developing pre-frailty or frailty.

To explore the impact of the Maillard reaction on fried pepper sauce (FPS) flavor and safety quality, acrylamide and volatile organic compounds (VOCs) were measured in FPS. Acrylamide was detected in 10 Maillard treated groups and a total of 110 VOCs were identified, mainly aldehydes, ketones, alcohols, acids, etc., but the content of each group differed. Partial least squares discriminant analysis showed that acrylamide in white sugar-sodium glutamate group and xylose-soy peptide group processing accumulated most acrylamide and least VOCs; Lactose-glycine, lactose-cysteine, lactose-soy peptide, and white sugar-glycine groups were positively correlated with typical Maillard reaction product (2,3-Dihydro-3,5-dihydroxy-6-methyl-4(H)-pyran-4-One); Xylose-glycine, xylose-cysteine, and white sugar-cysteine groups were weakly correlated with typical products, but positively correlated with most VOCs, whereas white sugar-cysteine group lipids showed high oxidation levels. Although white sugar-soy peptide group is not harmful on acrylamide, it has little correlation with VOCs with large responses. Conventional excipient group aroma is relatively simple with a fresh fatty taste, whereas xylose-glycine, xylose-cysteine, xylose-soy peptide, lactose-glycine, and white sugar-cysteine groups all present basic fresh and fatty tastes; lactose-cysteine group has a fruity base note; and lactose-soybean peptide, white sugar-glycine, and white sugar-soybean peptide groups have a fruity base note on an unpleasant fatty aroma. Therefore, processing different exogenous Maillard reaction substrates can achieve FPS aroma regulation and reduce acrylamide harm.

BackgroundCaring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. ObjectiveThis study’s purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. Our study has 2 goals: (1) to advance knowledge translation science by further developing and testing the Promoting Action on Research Implementation in Health Services framework (which outlines how implementation relies on the interplay of context, facilitation, and evidence) and (2) to advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation. MethodsThis is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program’s multiple data sources. This research is ongoing in long-term care (LTC) homes in western Canada. TREC data include the following: 5 waves of survey collection, 2 clinical trials, and regular ongoing outcome data for LTC residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive reanalysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes 4 stakeholder panels: (1) system decision- and policy makers, (2) care home managers, (3) direct care staff, and (4) a citizen engagement group of people living with dementia and family members of LTC residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings. ResultsThis study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023. ConclusionsThe project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes. International Registered Report Identifier (IRRID)DERR1-10.2196/40611

Tree growth may be affected by rising temperature. We conducted two long-term, independent warming experiments in a subtropical forest; one experiment used translocation warming and one experiment used infra-red (IR) warming. Both warming techniques are designed to increase air and soil temperatures (Tair and Tsoil), but may also differentially affect other environmental variables, including soil volumetric water content (SVWC), air relative humidity (RH) and vapor pressure deficit (VPD). Hence, tree response ascribed to Tair and Tsoil may be dependent on the indirect effects of the warming techniques. We experimentally tested these ideas on three native tree species (Machilus breviflora, Syzygium rehderianum, and Schima superba), which occurred at all experimental sites, in subtropical China. We translocated trees from higher elevation sites to lower elevation sites in the coniferous and broadleaf mixed forest (Tair was 0.68 ± 0.05°C higher; 8 years) and mountain evergreen broadleaf forest (Tair was 0.95 ± 0.06°C and 1.63 ± 0.08°C higher; 8 years). IR warming was imposed at an experimental site in a monsoon evergreen broadleaf forest (Tair was 1.82 ± 0.03°C higher; 5 years). We found that both methods directly increased Tair and Tsoil (although to varying degrees), while translocation warming indirectly dried the soil (lower SVWC) and IR warming indirectly dried the air (lower RH and higher VPD). Machilus breviflora exposed to translocation warming exhibited lower photosynthesis due to higher Tsoil and lower SVWC, leading to declining growth. Higher Tair and Tsoil due to translocation warming increased photosynthesis and growth for S. superba. Trees exposed to IR warming exhibited reduced photosynthesis due to lower RH (M. breviflora) and to lower stomatal conductance (gs) as a function of higher Tair (S. rehderianum and S. superba). This study highlights the potential direct and indirect effects of different warming techniques on the physical environment of forest ecosystems, and subsequently their impacts on biological traits of trees. Hence, different warming techniques may provide different outcomes when assessing the impact of warming on trees in future climates.

Care aides working in nursing homes experience burnout attributed to various workplace stressors. Burnout dimensions (exhaustion, cynicism, and reduced professional efficacy) interact to form distinct burnout patterns. Using a person-oriented approach, we aimed to identify burnout patterns among care aides and to examine their association with individual and job-related factors. This was a cross-sectional, secondary analysis of the Translating Research in Elder Care 2019–2020 survey data collected from 3765 care aides working in Canadian nursing homes. We used Maslach Burnout Inventory to assess burnout and performed latent profile analysis to identify burnout patterns, then examined their associations with other factors. We identified an engaged pattern (43.2% of the care aide sample) with low exhaustion and cynicism and high professional efficacy; an overwhelmed but accomplished pattern (38.5%) with high levels of the three dimensions; two intermediate patterns—a tired and ineffective pattern (2.4%) and a tired but effective pattern (15.8%). The engaged group reported the most favorable scores on work environment, work-life experiences, and health, whereas the tired and ineffective group reported the least favorable scores. The findings suggest complex experiences of burnout among care aides and call for tailored interventions to distinct burnout patterns.

Background: Breast cancer is the second most common cancer in humans. Its therapy procedures such as breast biopsy can cause anxiety and persistent pain in patients. Virtual reality (VR) has been applied to promote comfort in various populations. However, the effectiveness of VR in relieving pain and anxiety in patients undergoing breast cancer treatment is unclear. Purpose: This study was designed to examine the effect of VR on anxiety and pain in people undergoing treatment for breast cancer. Methods: PubMed, Cochrane, Embase, Scopus, Web of Science, and MEDLINE databases were searched for studies involving VR, pain, and anxiety in patients with breast cancer published up to March 2022. The Cochrane Handbook for Systems quality evaluation standard 6.3.0 was followed to assess risk of bias in the identified studies, with the results reported in line with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses statement. Subsequently, a meta-analysis of the included data was conducted using RevMan 5.3 software. Results: Six randomized controlled trials and one quasi-experimental study were included. The strength of the evidence ranged from moderate to high. Although VR was found to ameliorate anxiety in patients with breast cancer, only three studies showed statistically significant changes. All of the included studies reported statistically significant improvement in pain levels. In addition, two of the studies reported cybersickness symptoms as a common side effect of VR. Conclusions: VR has an important role to play in alleviating pain in patients with breast cancer. However, evidence demonstrating VR's importance in alleviating anxiety symptoms in this population is insufficient. Studies conducted with larger sample sizes and high-quality research methodologies will be necessary to clarify this issue. Clinical nurses should address the potential side effects of VR. [ABSTRACT FROM AUTHOR]

Abstract Background Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustained use), sustainability (sustained benefits), and spread of evidence-based practice innovations in health care. Specifically, this is a post-implementation study of an evidence-informed, Care Aide-led, facilitation-based quality-improvement intervention called SCOPE (Safer Care for Older Persons (in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba (MB), Alberta (AB) and British Columbia (BC). Our study has three aims: (i) to determine the role that adaptation/contextualization plays in sustainment, sustainability and spread of the SCOPE intervention; (ii) to study the relative effects on sustainment, sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation “boosters”, and a “no booster” condition, and (iii) to compare the relative costs and impacts of each booster condition. Methods/design SSaSSy is a two-phase mixed methods study. The overarching design is convergent, with qualitative and quantitative data collected over a similar timeframe in each of the two phases, analyzed independently, then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017, in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation “boosters”, and an untreated control group (no booster), using pretests and post-tests of the dependent variables relating to sustained care and management practices, and resident outcomes. Phase 2 will involve 31 trial sites in BC (17 units) and AB (14 units) nursing homes, where the SCOPE trial concluded in May 2019. Discussion This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions, and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability, and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.

Emerging evidence suggests that astrocyte loss is one of the most important pathological features in the hippocampus of patients with major depressive disorder (MDD) and depressive mice. Pyroptosis is a recently discovered form of programmed cell death depending on Caspase–gasdermin D (Casp-GSDMD), which is involved in multiple neuropsychiatric diseases. However, the involvement of pyroptosis in the onset of MDD and glial pathological injury remains obscure. Here, we observed that depressive mice showed astrocytic pyroptosis, which was responsible for astrocyte loss, and selective serotonin reuptake inhibitor (SSRI) treatment could attenuate the pyroptosis induced by the chronic mild stress (CMS) model. Genetic KO of GSDMD, Casp-1, and astrocytic NOD-like receptor protein 3 (NLRP3) inflammasome in mice alleviated depression-like behaviors and inhibited the pyroptosis-associated protein expression. In contrast, overexpression of astrocytic GSDMD–N-terminal domain (GSDMD-N) in the hippocampus could abolish the improvement of behavioral alterations in GSDMD-deficient mice. This work illustrates that targeting the NLRP3/Casp-1/GSDMD–mediated pyroptosis may provide potential therapeutic benefits to stress-related astrocyte loss in the pathogenesis of depression.

Rhizobium lipopolysaccharide (LPS) is an important component of the cell wall of gram-negative bacteria and serves as a signal molecule on the surface of rhizobia, participating in the symbiosis during rhizobia–legume interaction. In this study, we constructed a deletion mutant of ADP-L-glycerol-D-mannoheptosyl-6-exoisomerase (rfaD) of Mesorhizobium huakuii 7653R and a functional complementary strain. The results showed that the deletion of rfaD did not affect the free-living growth rate of 7653R, but that it did affect the LPS synthesis and that it increased sensitivity to abiotic stresses. The rfaD promoter-GUS reporter assay showed that the gene was mainly expressed in the infection zone of the mature nodules. The root nodules formation of the rfaD mutant was delayed during symbiosis with the host plant of Astragalus sinicus. The symbiotic phenotype analyses showed that the nodules of A. sinicus lost symbiotic nitrogen fixation ability, when inoculated with the rfaD mutant strain. In conclusion, our results reveal that the 7653R rfaD gene plays a crucial role in the LPS synthesis involved in the symbiotic interaction between rhizobia and A. sinicus. This study also provides new insights into the molecular mechanisms by which the rhizobia regulate their own gene expression and cell wall components enabling nodulation in legumes.

Non-coal-mining accidents occur frequently in China, and individual unsafe behaviors are the direct cause. The cognitive diversity of practitioners in the non-coal-mining industry leads to various behaviors in work and hinders communication between groups. The aim of this study is to analyze the differences in risk perception (accidents and occupational diseases) between non-coal-mining practitioners (experts, miners, and managers) and to explore the contributing factors. The questionnaire survey method was used to collect the data on risk perception and influencing factors from 402 respondents working in non-coal mines and universities in China. Project analysis and exploratory factor analysis were used for preprocessing. A t-test and linear regression analysis were used to test the significance of the differences and assess the function of the factors, respectively. Regarding risk perception, two risks both have significant differences between the three groups. With the perceptions of accidents and occupational diseases ranked from high to low, the order of the practitioners is as follows: managers (3.88), experts (3.71), miners (3.55) and experts (4.14), miners (3.90), and managers (3.88). Regarding the influencing factors, risk attitude, risk communication, educational level, enterprise trust, and occupational satisfaction have great effects on the three groups. More precisely, three groups have different important predictors. Risk attitude has the greatest impact on miners (0.290) and experts (0.369), but sensibility preference has the greatest impact on managers (0.518). In summary, cognitive discrepancies are common among non-coal-mining practitioners, but the degree of deviation varies with the type and dimension of the risk. There are six factors that have a significant impact on all practitioners, but the effect is limited by specific risks and groups.

The development of highly efficient and environment friendly methods for arsenic pollution treatment has attracted special attention. Herein, a new polyoxometalate-thiacalix[4]arene-based metal-organic complex [Ag2L(HL)][PW12O40]·2C2H5OH·2CH3CN (1) (L = thiacalix[4]arene-based ligand) was synthesized and applied for BiVO4 (BVO) surface modification to efficiently enhance the simulated sunlight-driven photoelectrocatalytic oxidation of arsenic(III). Compared with the pristine BVO, the removal efficiency of arsenic(III) was drastically increased to 312% at 0.6 V with the optimized 1@BVO photoanode (B1-20) versus the saturated calomel electrode (SCE) under the simulated sunlight (100 mW cm-2). The removal efficiency of arsenic(III) (25 mg L-1) with B1-20 was up to 100% within 40 min with a faradaic efficiency of 45%. More importantly, electron spin resonance measurements and reactive species trapping experiments demonstrated that the Z-scheme heterojunction formation of 1 plays a key role in the enhanced photoelectrocatalytic performance of 1@BVO. Furthermore, density functional theory (DFT) calculations were used to investigate the relationship between the photoelectrocatalytic properties and the structure of 1. This work developed a new photoelectrocatalytic application for the polyoxometalate-thiacalix[4]arenebased metal-organic complexes by their efficient combination with BVO. [ABSTRACT FROM AUTHOR]

To improve driving safety on superhighways, longitudinal profile design parameters of a superhighway are calculated via force analysis while a car is driven on a slope. The calculations consider characteristics of drivers, cars, and roads. According to the vehicle type, design speed, and natural conditions, the maximum longitudinal slope of a superhighway is calculated and compared with those of an ordinary superhighway and high-speed railway. Based on analysis of the vehicle climbing performance, braking performance, and driver visual characteristics, the maximum and minimum slope lengths of a superhighway are calculated. By analyzing the elements of vertical curves, the minimum radius and minimum length of the vertical curves of a superhighway are calculated by considering factors such as mitigating the impact at the slope bottom, driving at night, and driving time along vertical curves. Analysis and calculation results show that when the maximum longitudinal slope is 2.50%, 2.25%, and 2.00%, the minimum slope length is 450 m, 400 m, and 350 m, respectively, and the minimum vertical curve length is 145 m, 130 m, and 115 m, respectively, and the superhighway travel requirements can be satisfied at speeds of 180 km/h, 160 km/h, and 140 km/h, respectively.

This study aimed to understand green finance’s impact on fertilizer use and agricultural carbon emissions. We selected the macro panel data of 30 provinces (cities) in China from 2000 to 2019. The main research methods are standardized test framework (cross-sectional dependence, unit root and cointegration test), the latest causal test, impulse response, and variance decomposition analysis. Examined the long-term equilibrium relationship between green finance, fertilizer use, and agricultural carbon emissions. The results show: fertilizer consumption and agricultural carbon emissions have a positive correlation. However, green finance can significantly reduce agricultural carbon emissions. The causal test confirmed the bidirectional causal relationship between agricultural carbon emissions and fertilizer use. At the same time, verified one-way causality from green finance to both of them. Interpret the results of impulse response and variance decomposition analysis: among the changes in agricultural carbon emissions, chemical fertilizers contributed 2.45%, green finance contributed 4.34%. In addition, the contribution rate of green finance to chemical fertilizer changes reached 11.37%. Green finance will make a huge contribution to reducing fertilizer use and agricultural carbon emissions within a decade. The research conclusions provide an important scientific basis for China’s provinces (cities) to formulate carbon emission reduction policies. China has initially formed a policy system and market environment to support the development of green finance, in 2020, the “dual carbon” goal was formally proposed. In 2021, the national “14th Five-Year Plan” and the 2035 Vision Goals emphasized the importance of green finance. It plays an important supporting role in carbon emission reduction goals, and green finance has become an important pillar of national strategic goals.

This paper considers the equilibrium behavior of M/M/1 unreliable queue which has two-phase vacations and vacation interruption. It enters buffer period, when the system becomes empty. If customers arrive within this time, the server transitions into the working state; otherwise, the server enters the working vacation, their service rates become slower. In addition, the working vacation can be end because of the vacation interruption. We discuss two information cases: the fully visible queue and the fully invisible queue. The strategy of equilibrium threshold and social benefit are considered in the first case. In the other case, we get the probability of the servers by using generating function. Then we calculate some performance measures and research the individual equilibrium strategy of customers and equilibrium social benefit. Moreover, we use numerical examples to demonstrate how information levels and system parameters impact equilibrium strategy and social benefit. [ABSTRACT FROM AUTHOR]