This study examines the prevalence of depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong. Recent epidemiological data suggest that the prevalence of mild to ...severe depression, anxiety and stress among qualified nurses in Hong Kong stands at 35.8%, 37.3% and 41.1%, respectively. A total of 661 nursing students were recruited to participate in our cross-sectional mental health survey using the Depression, Anxiety and Stress Scale 21. Multiple logistic regression was used to determine significant relationships between variables. Working in general medicine, being in financial difficulty, having sleep problems, not having leisure activity and perceiving oneself in poor mental health were significant correlates of past-week depression, anxiety and stress. Year of study, physical inactivity and family crisis in the past year correlated significantly with depression. Imbalanced diets significantly correlated with anxiety. Stress was significantly associated with a lack of alone time. This is the first study to confirm empirically that clinical specialty, financial difficulties and lifestyle factors can increase nursing students' levels of depression and anxiety and symptoms of stress. Prevention, including the early detection and treatment of mental disorder, promises to reduce the prevalence of these indicators among this group.
Intratumoral heterogeneity arises through the evolution of genetically diverse subclones during tumor progression. However, it remains unknown whether cells within single genetic clones are ...functionally equivalent. By combining DNA copy number alteration (CNA) profiling, sequencing, and lentiviral lineage tracking, we followed the repopulation dynamics of 150 single lentivirus-marked lineages from 10 human colorectal cancers through serial xenograft passages in mice. CNA and mutational analysis distinguished individual clones and showed that clones remained stable upon serial transplantation. Despite this stability, the proliferation, persistence, and chemotherapy tolerance of lentivirally marked lineages were variable within each clone. Chemotherapy promoted the dominance of previously minor or dormant lineages. Thus, apart from genetic diversity, tumor cells display inherent functional variability in tumor propagation potential, which contributes to both cancer growth and therapy tolerance.
The SK-BR-3 cell line is one of the most important models for HER2+ breast cancers, which affect one in five breast cancer patients. SK-BR-3 is known to be highly rearranged, although much of the ...variation is in complex and repetitive regions that may be underreported. Addressing this, we sequenced SK-BR-3 using long-read single molecule sequencing from Pacific Biosciences and develop one of the most detailed maps of structural variations (SVs) in a cancer genome available, with nearly 20,000 variants present, most of which were missed by short-read sequencing. Surrounding the important
oncogene (also known as
), we discover a complex sequence of nested duplications and translocations, suggesting a punctuated progression. Full-length transcriptome sequencing further revealed several novel gene fusions within the nested genomic variants. Combining long-read genome and transcriptome sequencing enables an in-depth analysis of how SVs disrupt the genome and sheds new light on the complex mechanisms involved in cancer genome evolution.
A major pitfall of many of the established oral epithelial dysplasia (OED) grading criteria is their lack of reproducibility and accuracy to predict malignant transformation. The main objective of ...this study was to determine whether calibration of practicing oral pathologists on OED grading could improve the reproducibility of the WHO 2017 and the binary OED grading systems.
A nationwide online exercise was carried out to determine the influence of calibration on the reproducibility of the WHO 2017 and the binary OED grading systems.
A significant improvement was observed in the inter-observer agreement for the WHO 2017 OED grading system (K 0.196 vs. 0.448; K
0.357 vs. 0.562) after the calibration exercise. The significant difference (p = 0.027) in the level of agreement between those with five or more years and less than 5 years of experience was no more observed (p = 0.426) after the calibration exercise. The percent agreement for binary grading was significantly higher (91.8%) for buccal mucosal lesions as compared to lesions on the tongue after the calibration exercise.
This study validates the significance of calibration in improving the reproducibility of OED grading. The nationwide exercise resulted in a statistically significant improvement in the inter-observer agreement for the WHO 2017 OED grading system among a large number of oral pathologists. It is highly recommended that similar exercises should be organized periodically by professional bodies responsible for continuing education among oral pathologists to improve the reliability of OED grading for optimal treatment of oral potentially malignant disorders.
Background
Sedative-hypnotics are frequently prescribed for insomnia in hospital but are associated with preventable harms.
Objective, Design, and Participants
We aimed to examine whether a ...sedative-hypnotic reduction quality improvement bundle decreases the rate of sedative-hypnotic use among hospitalized patients, who were previously naïve to sedative-hypnotics. This interrupted time series study occurred between May 2016 and January 2019. Control data for 1 year prior to implementation and intervention data for at least 16 months were collected. The study occurred on 7 inpatient wards (general medicine, cardiology, nephrology, general surgery, and cardiovascular surgery wards) across 5 teaching hospitals in Toronto, Canada.
Intervention
Participating wards implemented a sedative-hypnotic reduction bundle (i.e., order set changes, audit-feedback, pharmacist-enabled medication reviews, sleep hygiene, daily sleep huddles, and staff/patient/family education) aimed to reduce in-hospital sedative-hypnotic initiation for insomnia in patients who were previously naïve to sedative-hypnotics. Each inpatient ward adapted the bundle prior to sustaining the intervention for a minimum of 16 months.
Main Measures
The primary outcome measure was the proportion of sedative-hypnotic-naïve inpatients newly prescribed a sedative-hypnotic for sleep in hospital. Secondary measures include prescribing rates of other sedating medications, fall rates, length of stay, and mortality.
Key Results
We included 8,970 patient discharges in the control period and 10,120 in the intervention period. Adjusted sedative-hypnotic prescriptions among naïve patients decreased from 15.48% (95% CI: 6.09–19.42) to 9.08% (
p
<0.001) (adjusted OR 0.814; 95% CI: 0.667–0.993,
p
=0.042). Unchanged secondary outcomes included mortality (adjusted OR 1.089; 95% CI: 0.786–1.508,
p
=0.608), falls (adjusted rate ratio 0.819; 95% CI: 0.625–1.073,
p
=0.148), or other sedating drug prescriptions (adjusted OR 1.046; 95% CI: 0.873–1.252,
p
=0.627).
Conclusions
A sedative-hypnotic reduction quality improvement bundle implemented across 5 hospitals was associated with a sustained reduction in sedative-hypnotic prescriptions.
To revise the 2009 Canadian Geriatrics Society (CGS) Core Competencies in the Care of Older Persons for Canadian Medical Students by applying current frameworks and using a modified Delphi process.
...The working group chose the Geriatric 5Ms model and CanMEDS framework to develop and structure the competencies. National (i.e., Canadian) Delphi participants were recruited, and 3 Delphi survey rounds were conducted from 2019 to 2021. Each survey round collected quantitative data using a 7-point Likert scale (LS) and qualitative data using free-text comments. The purpose of the first round was to establish the importance of the components of the proposed competencies (categorized into 13 subsections) and identify additional themes. The second round assessed agreement with 31 proposed competencies organized into 7 themes: aging, caring for older adults, mind, mobility, medications, multicomplexity, and matters the most. The third survey-rated agreement levels after further revisions to the competencies were applied. The final 33 competencies were shared with survey participants for feedback and other stakeholders for external validation.
Mean LSs for the importance of the 13 competency component subsections on the first survey varied from 5.11 to 6.54, with an agreement level of 73%-93%. New themes emerged from the qualitative comments. Mean LSs for the 31 competencies on the second survey ranged from 5.57 to 6.81, with an agreement level of 80%-97%. Mean LSs for the revised competencies on the third survey ranged from 5.83 to 6.65, with an agreement level of 83%-95%.
The authors developed the 33 Aging Care 5Ms Competencies for Canadian medical students using a consensus process. The competencies fulfill an important need in medical education, and ultimately, society. The authors strongly believe that the competencies can be woven into existing undergraduate medical curricula through purposeful integration and collaboration, including with other specialties.
Merging galaxy clusters with radio relics provide rare insights to the merger dynamics as the relics are created by the violent merger process. We demonstrate one of the first uses of the properties ...of the radio relic to reduce the uncertainties of the dynamical variables and determine the three-dimensional (3D) configuration of a cluster merger, ACT-CL J0102-4915, nicknamed El Gordo. From the double radio relic observation and the X-ray observation of a comet-like gas morphology induced by motion of the cool core, it is widely believed that El Gordo is observed shortly after the first core passage of the subclusters. We employ a Monte Carlo simulation to investigate the 3D configuration and dynamics of El Gordo. Using the polarization fraction of the radio relic, we constrain the estimate of the angle between the plane of the sky and the merger axis to be
$\alpha = 21\mathrm{^{\circ }}\pm ^9_{11}$
. We find the relative 3D merger speed of El Gordo to be
$2400\pm ^{400}_{200}\,\mathrm{km\,s}^{-1}$
at pericentre. The two possible estimates of the time since pericentre (TSP) are
$0.46\pm ^{0.09}_{0.16}$
and
$0.91\pm ^{0.22}_{0.39}$
Gyr for the outgoing and returning scenario, respectively. We put our estimates of the TSP into context by showing that if the time-averaged shock velocity is approximately equal to or smaller than the pericentre velocity of the corresponding subcluster in the centre-of-mass frame, the two subclusters are more likely to be moving towards, rather than away, from each other, post apocentre. We compare and contrast the merger scenario of El Gordo with that of the Bullet Cluster, and show that this late-stage merging scenario explains why the south-east (SE) dark matter lensing peak of El Gordo is closer to the merger centre than the SE cool core.
Transcutaneous auricular vagus nerve stimulation (taVNS) is considered a safe and promising tool for limb rehabilitation after stroke, but its effect on cough has never been studied. It is known that ...the ear and larynx share vagal afferent pathways, suggesting that stimulating the ear with taVNS might have effects on cough sensitivity. The specific stimulation parameters used can influence outcomes.
To investigate the effect of various stimulation parameters on change in cough sensitivity, compared to the reference parameter of 25 Hz stimulation at the left concha (most commonly-used parameter for stroke rehabilitation). Design, setting, and participants: Randomized, single-blind, active-controlled, eight-period cross-over design conducted March to August 2022 at a New Zealand research laboratory with 16 healthy participants.
All participants underwent eight stimulation conditions which varied by stimulation side (right ear, left ear), zone (ear canal, concha), and frequency (25 Hz, 80 Hz). Main outcome measures: Change in natural and suppressed cough threshold (from baseline to after 10 min of stimulation) assessed using a citric acid cough reflex test.
When compared to the reference parameter of 25 Hz stimulation at the left concha, there was a reduction in natural cough threshold of -0.16 mol/L for 80 Hz stimulation at the left canal (
= 0.004), indicating increased sensitivity. For the outcome measure of suppressed cough threshold, there was no significant effect of any of the stimulation conditions compared to the active reference.
Since stroke patients often have cough hyposensitivity with resulting high risk of silent aspiration, using 80 Hz taVNS at the left canal may be a better choice for future stroke rehabilitation studies than the commonly used 25 Hz taVNS at the left concha. Treatment parameters should be manipulated in future sham-controlled trials to maximize any potential treatment effect of taVNS in modulating cough sensitivity.
ACTRN12623000128695.
Background and Aims: OHVIRA is a rare congenital urogenital anomaly. Diagnosis is often delayed because patients have normal onset of puberty and menstruation if there is partial obstruction with a ...communicating fenestration in the hemivagina. Symptoms can be non-specific such as abdominal pain and dysmenorrhoea, but urinary retention and a pelvic mass have been reported. Haematocolpos can cause anatomical distortion, making imaging difficult. Definitive management is by vaginoplasty but that can be complex, especially in an anatomically small child, or cases with chronic inflammation. Retrograde bleeding during obstruction is common, leading to endometriosis and ascending infection. This is associated with complex surgery, increased morbidity and subfertility, which is why early diagnosis and timely management are important. Method: Medical records were retrieved from 6 patients with OHVIRA treated between 1 April 2021 and 31 March 2023 at a tertiary referral centre. For each patient, age of diagnosis, referral source, symptoms, diagnostic investigations, diagnostic challenges, anatomical findings, surgical managements, complications and outcomes were reviewed. Results: Patient’s ages ranged from 10 to 33 years. Median age of diagnosis was 30. Cases were referred from paediatric surgery (n=1), gynaecology (n=2), general surgery (n=2) and urology (n=1). Symptoms included abdominal pain (n=4), pyrexia (n=2), intra-menstrual bleeding (n=2) and vaginal discharge (n=1). 3 patients had been misdiagnosed before referral. All had unilateral haematocolpos and underwent ultrasound (n=6) and either MRI (n=4) or CT (n=2), followed by vaginoplasty. 2 patients had emergency surgery for pelvic abscesses. There were no intra- or post-operative complications, or adverse outcomes. Conclusion: Median age at diagnosis was advanced, and symptoms and referral source were variable. Misdiagnosis was frequent. Surgical management was successful with a single stage vaginoplasty. Ascending infection can be a consequence of delayed diagnosis and management. It is important to evaluate any female with dysplastic or absent kidneys for uterovaginal abnormalities.
Background
Novel clinical challenges are faced by cardiac surgeons under the coronavirus disease 2019 (COVID‐19) pandemic. Amidst the uncertainties faced due to the socioeconomic and public health ...impact, there is little evidence surrounding COVID‐19 vaccination in patients undergoing cardiac surgery. Timing of vaccination and postvaccination adverse effects are required parameters to discuss with cardiac surgical patients.
Methods
This is a single‐center, retrospective observational study. All patients who underwent adult cardiac surgery at the Prince of Wales Hospital, Hong Kong from January 2021 to December 2021 were included. Postoperative clinical outcomes, COVID‐19 vaccination status, and vaccination‐related adverse effects were collected.
Results
A total of 426 patients; 117 (27%) underwent isolated coronary artery bypass grafting, 111 (26%) underwent valvular surgery, and 97 (23%) underwent aortic surgery. Patients received either Sinovac CoronaVac or Pfizer BNT162b2 vaccine. Overall vaccination rate with at least 1 dose was 52% (n = 212), 15% (n = 63) received the first dose before surgery, 36% (n = 149) received the first dose vaccination after surgery. Rate of completion with second and third doses of vaccination were 22% (n = 89) and 4.9% (n = 20), respectively. The mean timing of first dose of vaccine after surgery was 216 ± 84 days from operation. Three (1.4%) patients recorded vaccination‐related complications.
Conclusions
COVID‐19 vaccination is safe in patients who received major cardiac surgery, with low adverse effects recorded and no vaccine‐related mortality observed. A time frame of 3–6 months after cardiac surgery receiving COVID‐19 vaccination is reasonable and could serve as a guidance for future COVID‐19 vaccination booster programs.
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