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Adolescents with CHD require transition to specialised adult-centred care. Previous studies have shown that adolescents’ knowledge of their medical condition is correlated with transition readiness. Three-dimensional printed models of CHD have been used to educate medical trainees and patients, although no studies have focused on adolescents with CHD. This study investigates the feasibility of combining patient-specific, digital 3D heart models with tele-education interventions to improve the medical knowledge of adolescents with CHD.
Adolescent patients with CHD, aged between 13 and 18 years old, were enrolled and scheduled for a tele-education session. Patient-specific digital 3D heart models were created using images from clinically indicated cardiac magnetic resonance studies. The tele-education session was performed using commercially available, web-conferencing software (Zoom, Zoom Video Communications Inc.) and a customised software (Cardiac Review 3D, Indicated Inc.) incorporating an interactive display of the digital 3D heart model. Medical knowledge was assessed using pre- and post-session questionnaires that were scored by independent reviewers.
Twenty-two adolescents completed the study. The average age of patients was 16 years old (standard deviation 1.5 years) and 56% of patients identified as female. Patients had a variety of cardiac defects, including tetralogy of Fallot, transposition of great arteries, and coarctation of aorta. Post-intervention, adolescents’ medical knowledge of their cardiac defects and cardiac surgeries improved compared to pre-intervention (p < 0.01).
Combining patient-specific, digital 3D heart models with tele-education sessions can improve adolescents’ medical knowledge and may assist with transition to adult-centred care.
Unit cohesion may protect service member mental health by mitigating effects of combat exposure; however, questions remain about the origins of potential stress-buffering effects. We examined buffering effects associated with two forms of unit cohesion (peer-oriented horizontal cohesion and subordinate-leader vertical cohesion) defined as either individual-level or aggregated unit-level variables.
Longitudinal survey data from US Army soldiers who deployed to Afghanistan in 2012 were analyzed using mixed-effects regression. Models evaluated individual- and unit-level interaction effects of combat exposure and cohesion during deployment on symptoms of post-traumatic stress disorder (PTSD), depression, and suicidal ideation reported at 3 months post-deployment (model n's = 6684 to 6826). Given the small effective sample size (k = 89), the significance of unit-level interactions was evaluated at a 90% confidence level.
At the individual-level, buffering effects of horizontal cohesion were found for PTSD symptoms [B = −0.11, 95% CI (−0.18 to −0.04), p < 0.01] and depressive symptoms [B = −0.06, 95% CI (−0.10 to −0.01), p < 0.05]; while a buffering effect of vertical cohesion was observed for PTSD symptoms only [B = −0.03, 95% CI (−0.06 to −0.0001), p < 0.05]. At the unit-level, buffering effects of horizontal (but not vertical) cohesion were observed for PTSD symptoms [B = −0.91, 90% CI (−1.70 to −0.11), p = 0.06], depressive symptoms [B = −0.83, 90% CI (−1.24 to −0.41), p < 0.01], and suicidal ideation [B = −0.32, 90% CI (−0.62 to −0.01), p = 0.08].
Policies and interventions that enhance horizontal cohesion may protect combat-exposed units against post-deployment mental health problems. Efforts to support individual soldiers who report low levels of horizontal or vertical cohesion may also yield mental health benefits.
The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)–laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports.
Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients’ clinical samples and environmental samples was analyzed.
All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 × 102 copies/mL (range, 1.1 × 102 to 9.4 × 104 copies/mL). The contamination rate was highest on patients’ mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001).
SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.
To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care.
Two internal medicine wards of a public, university-affiliated, tertiary-care hospital in Malaysia.
We randomly allocated 2 wards to hand hygiene promotion delivered either by PICAs (study arm 1) or by MSCAs (study arm 2). The primary outcome was hand hygiene compliance using direct observation by validated auditors. Secondary outcomes were hand hygiene knowledge and observations from ward tours.
Mean hand hygiene compliance in study arm 1 and study arm 2 improved from 48% (95% confidence interval [CI], 44%–53%) and 50% (95% CI, 44%–55%) in the preintervention period to 66% (63%–69%) and 65% (60%–69%) in the intervention period, respectively. We detected no statistically significant difference in hand hygiene improvement between the 2 study arms. Knowledge scores on hand hygiene in study arm 1 and study arm 2 improved from 60% and 63% to 98% and 93%, respectively. Staff in study arm 1 improved hand hygiene because they did not want to disappoint the efforts taken by the PICAs. Staff in study arm 2 felt pressured by the MSCAs to comply with hand hygiene to obtain good overall performance appraisals.
Although the attitude of PICAs and MSCAs in terms of leadership, mode of action and perception of their task by staff were very different, or even opposed, both PICAs and MSCAs effectively changed behavior of staff toward improved hand hygiene to comparable levels.
The authors design six alumina hybrid structures consisting of stretching-dominated plates and different space-filling lattices comprised of hollow tubes and perform finite element simulations to study mechanical and failure behaviors of such hybrid structures. The authors investigate the effects of three geometrical parameters on the stiffness and failure of these hybrid structures and further compare their advantages and disadvantages. The authors find that the failure modes of these hybrid structures can be tuned by altering cell unit type and geometrical parameters. Among these hybrid structures, the ones with effective support from the lattice unit cells in the stretching direction exhibit better specific stiffness and strength. By varying the lattice and plate thickness, the authors find that the relations between stiffness/failure strength and density follow a power law. When intrinsic material failure occurs, the power law exponent is 1; when buckling failure arises, the power law exponent is 3. However, by varying tube thickness, their relations follow unusual power relations with the exponent changing from nearly 0 to nearly infinity. In addition, the hybrid structures also exhibit defect insensitivity. This study shows that such hybrid structures are able to greatly expand the design space of architectured cellular materials for engineering applications.
The area of dry-season rice (Oryza sativa L.) has rapidly increased in Cambodia owing to the large-scale development of irrigation infrastructure. But little is known of potential productivity and adaptive crop management. The objective of our study was to evaluate potential yield and nutrient requirements of dry-season rice in Cambodia, and the economic feasibility of soil-specific management recommended by the government. Field experiments were conducted on four soil types (Bakan, equivalent to Alfisol; Krakor, Inceptisol; Prateah Lang, Plinthustalfs; and Toul Samroung, Endoaqualfs) in four provinces (Battambang, Kampong Thom, Pursat, and Siem Reap) during the 2016 and 2017 dry seasons to compare 14 (2016) and 8 (2017) N-P-K combinations. Grain yield ranged from 1.0 to 5.5 t ha−1 in 2016 and from 1.3 to 6.7 t ha−1 in 2017. Potential yield from the experiments was 6–7 t ha−1 on Toul Samroung soil, 5–6 t ha−1 on Bakan soil, and 3–5 t ha−1 on Prateah Lang and Krakor soils. A rate of 140-60-60 kg ha−1 of N-P2O5-K2O was more than enough to achieve the best yields on any soil group. On the other hand, modest application rates in soil-specific management (44–78 kg ha−1 of N, 23–28 kg ha−1 of P2O5, 0–30 kg ha−1 of K2O) proved reasonable for resource-poor farmers in Cambodia, since the treatment always provided >75 % of the highest economic profit in high-input plots.
Rice is widely grown in rainfed lowlands during the wet season in the Mekong region. Limited nutrient availability is a common constraint on crop yield, and the optimal rate of fertilizer application depends on the soil type. The objective of our study was to evaluate rice productivity and the economic feasibility of various nutrient management regimes in Cambodia. We conducted field experiments on three soil types (Prey Khmer, Prateah Lang, and Toul Samroung, equivalent to Psamments, Plinthustalfs, and Endoaqualfs, respectively) in four provinces (Battambang, Kampong Thom, Pursat, and Siem Reap) during the 2016 and 2017 wet seasons to compare nine (2016) and seven (2017) N–P–K combinations. Grain yield ranged from 0.9 to 4.8 t ha−1 in 2016 and from 1.0 to 5.2 t ha−1 in 2017, depending on soil type and nutrient management. The Prey Khmer soil contained around 80% sand, and rice yield responded most weakly to nutrient management. The moderate fertilizer input in the current soil-specific recommendation was effective on this soil type. However, on more fertile soils with a higher clay content and a higher cation-exchange capacity (Toul Samroung and Prateah Lang), an additional 20 kg N ha−1 combined with adding 15 kg ha−1 of P2O5 or 20 kg ha−1 of K2O significantly increased yield and economic return. Although P and K use during Cambodia’s wet season is uncommon, our results demonstrate the importance of these nutrients in improving the country’s rice production.
Residents of Hong Kong have undergone a dietary transition from a traditional Chinese diet that is high in seafood to a more Western diet. This may have affected the nutritional composition of breast milk of Hong Kong mothers. The present study aims to investigate the relationship between the dietary pattern and the fatty acid profile of the breast milk of lactating women in Hong Kong. Seventy-three volunteering healthy Hong Kong lactating mothers participated in the study. Their dietary intakes were assessed by using a 3-d dietary record and FFQ. The mean n-3 fatty acid levels were approximately 0·4 % (EPA) and 0·9 % (DHA) of total fatty acids in the breast milk of lactating mothers who had exclusively breastfed their infants aged 2–6 months. Maternal dietary intakes of n-3 fatty acids were positively associated with their levels in the breast milk. The levels of maternal intakes of freshwater and saltwater fish, especially the consumption of salmon, croaker and mandarin, were significantly correlated with the content of DHA in breast milk. The present study is among the very few in the literature to determine the fatty acid profile of breast milk in Hong Kong populations and verify certain dietary factors that influence this profile. High levels of n-3 PUFA, especially DHA, were observed in the breast milk of Hong Kong lactating women. The findings may serve as a dietary reference for lactating mothers to optimise the fatty acid profile of their breast milk.
We present a side-by-side comparison of the stability of three different types of benchmark solution-processed organic solar cells (OSCs), subject to thermal cycling stress conditions. We study the in situ performance during 5 complete thermal cycles between −100 and 80 °C and find that all the device types investigated exhibit superior stability, albeit with a distinct temperature dependence of device efficiency. After applying a much harsher condition of 50 thermal cycles, we further affirm the robustness of the OSC against thermal cycling stress. Our results suggest that OSCs could be a promising candidate for applications with large variations and rapid change in the operating temperature such as outer space applications. Also, a substantial difference in the efficiency drops from high to low temperature for different systems is observed. It suggests that maintaining optimum performance with minimal variations with operating temperature is a key challenge to be addressed for such photovoltaic applications.
The prospect of autonomous weapons systems (AWS) has raised persistent questions of responsibility and accountability, the contours and content of which remain ill defined. This chapter seeks to clarify these questions by differentiating between two distinct, yet converging, categories of responsibility issues. The first category of responsibility issues is created by the autonomy of the weapons systems itself and arises from the circumstances in which they are used (a ‘circumstantial responsibility problem’). The second set of issues is only exposed by AWS because it is conceptual in nature, arising from the relationships between different conceptions of responsibility (a ‘conceptual responsibility problem’). Drawing this basic differentiation is critical because it suggests the existence of two independent problems that both require a solution, whereas only the former has been addressed in the literature to date.
As identified, the core of the problem is that the would-be direct perpetrators, who would ordinarily be individually responsible for unlawful behaviour, will be replaced by autonomous entities that are incapable of bearing direct responsibility for such consequences at the outset. There are two basic avenues to solve this circumstantial responsibility problem: either meaningfully ascribe responsibility to the autonomous entities themselves or impute responsibility to proximate human beings. Neither avenue, however, is entirely satisfactory. On the one hand, assigning responsibility to artificial agents is unsatisfying and seems to entail impunity. On the other hand, imputing responsibility to proximate individuals raises a risk of scapegoating the individuals associated with these operations. These inadequacies suggest that alterations in legal doctrine are necessary to accommodate the prospect of AWS.
I also argue, however that resolving the circumstantial responsibility problem issues surrounding autonomous weapons usage is necessary, but insufficient, because a distinct set of conceptual responsibility issues would still remain. This set of responsibility issues is inherent within the disparate, but interrelated, ideas that together inform the concept of responsibility and that occur where causal forms of responsibility are conflated or substituted with types of role responsibility. Unlike circumstantial responsibility issues, which are created by the autonomy of the weapons system breaking the chain of causality, I suggest that conceptual responsibility issues are merely revealed by the challenges of artificial autonomy and remain unchanged with alterations in practice.