Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

博士后对学术职业环境满意吗?——基于Nature全球博士后调查数据比较分析

本研究基于已有成果,将博士后学术职业环境划分为学术资源、职业保障、组织管理、科研强度四个维度。利用2020年Nature全球博士后教育调查数据,通过比较分析博士后对学术职业环境的感知与评价。研究发现,相比较国外发达国家博士后而言,我国接近四成博士后对学术职业环境感到满意。为了优化博士后学术职业环境,大学需强化对博士后科研资金的支持力度,保障博士后科研参与机会,减少非学术事务对博士后科研时间的挤占,规范导师指导;大学不断调适大学基层学术组织治理模式,优化院系对博士后学术职业发展的组织支持与服务质量;大学与博士后建立稳定性雇佣关系,不断提升工资薪酬水平,疏通博士后学术职业晋升渠道,营造良好的工作环境;高校实行服务型、便捷式的科研管理方式,制定灵活多元的学术评价机制,破除博士后对“学术GDP主义”的崇拜。

Hyperprolactinemia in Hospitals in Lomé: Diagnostic and Therapeutic Aspects

Introduction. Hyperprolactinemia represents a supraphysiological secretion of prolactin. In clinical practice, it is the most frequently encountered anterior pituitary disorder. However, its real prevalence is little known in Africa. The purpose of this study is to list all cases of hyperprolactinemia over the past four years and to make an inventory of the various etiologies found and their management. Methodology. This is a cross-sectional descriptive study on the files of patients who came for consultation in the internal medicine and endocrinology department with hyperprolactinemia retrospectively collected from January 2017 to December 2020. Included were patients followed or whose the diagnosis of hyperprolactinemia was established in endocrinological consultation during the study period. Results. This study recorded 26 cases of hyperprolactinemia. The female sex represented 73.08% (sex ratio M/F 0.37) and the average age was 33.92 years. The 40 - 50 age group was the most represented with 30.77%. In women, galactorrhea accounted for 73.07%, amenorrhea 57.69% of clinical pictures and infertility 23.08%. In men, infertility accounted for 7.69% of presentations, gynecomastia 11.54% and erectile dysfunction 15.38%. The duration of evolution of the signs was 4 months in 23.08% of the patients. The mean prolactinemia was 702.58 ng/ml. CT was performed in 80.85% of patients. The main etiologies were pituitary adenomas (77%). All our patients were treated with dopaminergic agonists. Cabergoline was prescribed in 77% of patients. The evolution was favorable in 96.25% of patients. Conclusion. Hyperprolactinemia is a pathology that exists in our regions. The main etiology remains pituitary adenomas and treatment with cabergoline.

Window Views of Wards in Foreign Hospitals

Through the collection and systematic analysis of documents related to window views of hospitals,it is found that natural window views had a significant impact on patients’health benefits.The research focused on three aspects:“shortening length of stay”,“pain reduction”and“improvement of recovery rate”,mainly covering three types of patients:“heart patients”,“postoperative patients”and“patients of rehabilitation centers”.Based on the above analysis,summary and sorting,new directions and perspectives of hospital environment design and research under the concept of comprehensive health of people’s physiological,psychological and social adaptation will be obtained to provide references for the research and practice of health architecture,rehabilitation architecture,biophile design and other fields.

The Alienation of Nature in Emily Dickinson’s Poems through the Prism of Taoism

In the poems created by the renowned American poet Emily Dickinson,those related to nature constitute a considerable proportion.However,Dickinson’s attitude toward nature is,in fact,contradictory.On the one hand,Dickinson perceives nature as gentle and kind,akin to a mother.Nature is regarded as“heaven”and embodies harmony.On the other hand,nature possesses its own operational principles and harbors inherent cruelty.According to Dickinson,humans should refrain from excessive interference in the natural order.This article attempts to analyze the similarities in attitude towards nature between Dickinson’s poetry and Taoist philosophy.

Construction of competency evaluation system for infection control personnel in traditional Chinese medicine hospitals

Background:This study uses a literature review and the Delphi expert consultation method to construct a competency evaluation model for infection control personnel in traditional Chinese medicine(TCM)hospitals.The aim is to strengthen infection control management in TCM hospitals,assess the competency of infection control personnel in their positions,and assist them in identifying the competencies that need improvement.Methods:Based on the literature research method and the Delphi expert consultation method,a competency model for the position was constructed through two rounds of expert consultations,analyzing the relationships between various factors and establishing a hierarchical structure model.Pairwise comparisons were made among the elements at the same level to construct a judgment matrix.Through the analytic hierarchy process,the weight coefficients of the indicators at each level in the competency model were obtained.Results:This study conducted a comprehensive assessment of various capabilities and practices related to hospital infection control.The survey results indicate that participants excelled in multiple areas,with a high overall satisfaction rate.95.28%of participants were able to develop hospital infection monitoring plans based on national infection control policies,demonstrating a good understanding and execution of these policies.94.09%of participants were familiar with high-risk populations and key departments in the hospital.91.73%of participants were able to establish monitoring scopes based on the trends of multidrug-resistant bacteria and conduct information monitoring,reflecting strong response capabilities.92.91%of participants were able to collaborate with relevant departments to conduct bacterial resistance monitoring,showing a good team spirit.94.49%of participants were able to perform targeted monitoring,including surgical site infections,indicating that they have effective monitoring strategies.91.34%of participants were able to collect and organize monitoring data and establish a systematic database,demonstrating good data management skills.90.16%of participants were able to interpret laws and regulations related to hospital infection management,indicating a high level of legal knowledge.89.37%of participants generally possessed good communication skills.92.52%of participants were able to guide medical staff on occupational safety and protective knowledge,showing an emphasis on occupational health.Participants demonstrated a strong desire to learn and innovate,with 87.01%actively participating in continuing education and research activities,reflecting a pursuit of professional development.Conclusion:Based on the results of the two rounds of expert consultations,a competency evaluation model for infection control personnel in TCM hospitals was formed.Through the analytic hierarchy process,the weight coefficients of various indicators at different levels in the model were obtained,and the research results have good scientific validity and reliability.

Problems and Development Suggestions of Nature Education in Jiangxi Province

The forest coverage rate of Jiangxi Province ranks second in China.It has rich natural resources,a long history of ancient color culture and rich red culture.In the development of nature education,Jiangxi Province has great potential and advantages.This paper introduces the development conditions of nature education in Jiangxi Province,summarizes the problems existing in the development of nature education in Jiangxi Province from the aspects of the types of nature education and the construction of nature education base,such as simple content and single form,imperfect infrastructure and lack of professionals,and puts forward some suggestions on the development of nature education in Jiangxi Province.

The Macrolichens of Barluk Mountain National Nature Reserve, Xinjiang Province, China

A checklist of the macrolichens (foliose, fruticose & squamulose) of Barluk Mountain National Nature Reserve located in northwestern China is presented. It was derived from 47 inventories of preserved and undeveloped areas which yielded more than 670 collections containing 102 taxa (99 species, 1 subspecies, 2 varieties). Eight species were found that were new to Xinjiang, China. Twenty-eight species and 2 varieties were found on rock, 31 species on bark of deciduous and coniferous trees, 26 species on soil and 14 species and 1 subspecies over mosses. Foliose lichens were dominant with 76 species, followed by 16 species of squamulose lichens and 7 species of fruticose lichens.

Adaptive Network Sustainability and Defense Based on Artificial Bees Colony Optimization Algorithm for Nature Inspired Cyber Security

Cyber Defense is becoming a major issue for every organization to keep business continuity intact.The presented paper explores the effectiveness of a meta-heuristic optimization algorithm-Artificial Bees Colony Algorithm(ABC)as an Nature Inspired Cyber Security mechanism to achieve adaptive defense.It experiments on the Denial-Of-Service attack scenarios which involves limiting the traffic flow for each node.Businesses today have adapted their service distribution models to include the use of the Internet,allowing them to effectively manage and interact with their customer data.This shift has created an increased reliance on online services to store vast amounts of confidential customer data,meaning any disruption or outage of these services could be disastrous for the business,leaving them without the knowledge to serve their customers.Adversaries can exploit such an event to gain unauthorized access to the confidential data of the customers.The proposed algorithm utilizes an Adaptive Defense approach to continuously select nodes that could present characteristics of a probable malicious entity.For any changes in network parameters,the cluster of nodes is selected in the prepared solution set as a probable malicious node and the traffic rate with the ratio of packet delivery is managed with respect to the properties of normal nodes to deliver a disaster recovery plan for potential businesses.

《Nature》揭示:禁食机制下的脂肪依赖性肿瘤会消退

近日,一篇发表在《Nature》上的研究显示,研究发现了一种能让小鼠摆脱胰腺癌的新方法,该疗法通过抑制脂肪代谢,切断肿瘤的能量供应,只要小鼠持续遵循生酮饮食,肿瘤生长便会停滞。研究中,研究团队聚焦于机体在禁食状态下如何转向脂肪作为能源的问题。研究者发现直接关联到胰腺癌的生物学研究,首次揭示了真核生物翻译起始因子(eukaryotic translation initiation factor,eIF4E)在禁食期间如何调控机体代谢,使其从消耗碳水化合物转变为消耗脂肪。

Theoretical Analysis and Practical Reflection on the Role Conflict of Double-Qualified Teachers in University-Affiliated Hospitals

Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.

Management Measures for Preventing Postoperative Incision Infections in General Surgery at Primary Hospitals

Objective:To analyze the management measures and effects of preventing postoperative incision infections in the general surgery department of primary hospitals.Methods:Forty-nine surgical patients with 11 healthcare workers who were admitted to the general surgery department of the primary hospital between August 2021 and August 2022 were selected as the routine group for routine incision infection management.Forty-nine surgical patients with 11 healthcare workers admitted to the same department between September 2022 and September 2023 were selected as the prevention group for prophylactic management of postoperative incision infections.The incision infection rate,knowledge,attitude,and practice(KAP)scores,and management satisfaction of the patients as well as the management skill scores of healthcare workers were compared between the two groups.Results:The rate of postoperative incision infection in the prevention group was lower than that in the routine group;after implementing management measures,patients in the prevention group had higher KAP scores than those in the routine group;patients in the prevention group were more satisfied with the management than those in the routine group;and healthcare workers in the prevention group had higher scores than those in the routine group,with P<0.05 for the comparison between the groups.Conclusion:The implementation of preventive management for general surgery patients in primary hospitals can reduce the incidence of postoperative incision infection and improve the KAP of patients,with higher management satisfaction.It can also enhance the management skills of healthcare workers,thus improving their overall management level.

《Nature》子刊:苏佳琪等开发基于牛奶的水凝胶,用作酒精中毒的解毒剂

近日,苏黎世联邦理工学院Raffaele Mezzenga、苏佳琪等人在《Nature》子刊《Nature Nanotechnology》上发表的一篇研究显示,该研究开发了一种口服的、基于牛奶蛋白的水凝胶——FeSA@FibBLG,或可作为急性酒精中毒的有效解毒剂,能够稳定耐受胃酸消化且持续显著降低酒精中毒小鼠血液中的酒精水平,同时避免额外积累有毒的乙醛,还可增强肝脏保护,并显著减轻肠道损伤和生态失调,强调了其作为酒精相关疾病的新疗法的潜力。

Nature’s Gift

NATURAL WONDERS IN CHINA AND AFRICA Qilian Mountains National Park Located in Northwest China’s Gansu and Qinghai provinces,Qilian Mountains National Park spans 50,200 square km,serving as a vital ecological security barrier and water source conservation area in west China.Established in 2017 to address ecosystem damage,intensive food chain protection and wildlife monitoring in the area began in early 2011.

A Comparative Analysis of the Control Effect of Medical Expenses between General Hospitals and Traditional Chinese Medicine Hospitals from 2012 to 2021

Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.

Spatiotemporal Evolution of Ecological Quality in Alpine Freshwater Lake Nature Reserves in the Past 20 Years

The Caohai Nature Reserve is one of the three major plateau freshwater lakes in China.Since the 1950s,human activities such as land reclamation and population relocation have greatly damaged Caohai.A rapid evaluation of the spatiotemporal evolution trend of the ecological quality of the Caohai Nature Reserve is significant for the maintenance and construction of the ecosystem in this area.The research is based on the Google Earth Engine(GEE)remote sensing cloud computing platform.Landsat TM/OLI images from May to October in five time periods:2000-2002,2004-2006,2009-2011,2014-2016,and 2019-2021 were obtained to reconstruct the optimal cloud image set by averaging the images in each time period.By constructing four ecological indicators:Greenness(NDVI),Wetness(Wet),Hotness(LST),and Dryness(NDBSI),and using Principal Component Analysis(PCA)method to obtain the Remote Sensing Ecological Index(RSEI)for the corresponding years,the spatiotemporal variation of ecological quality in the Caohai Nature Reserve over 20 years was analyzed.The results indicate:①the mean value of RSEI increased from 0.460 in 2000-2002 to 0.772 in 2019-2021,a 67.83%increase,indicating a significant improvement in the ecological quality of the reserve over the 20 years;②from the perspective of functional zoning of the Caohai Nature Reserve,the ecological quality of the core area showed a degrading trend,while the ecological quality of the buffer zone and experimental zone significantly improved;③with the implementation of ecological restoration projects,the ecological quality of the reserve gradually recovered and improved from 2014 to 2021.The trend of RSEI value changes is well correlated with human interventions,indicating that the PCA-based RSEI model can be effectively used for ecological quality assessment in lake areas.

Exploration of Teaching Development Strategies for Double-Qualified Teachers in University- Affiliated Hospitals Based on Role Conflict Theory

This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.

《Nature》:新开发的可穿戴超声贴片可连续、无创监测大脑血流

近日,一篇发表在《Nature》上的研究显示,研究人员开发出一种可穿戴超声贴片(wearable ultrasound patch),其可对大脑血流进行连续、无创的监测。该研究将贴片在36名健康志愿者身上进行了测试,以检验其测量脑部主要动脉血流速度(收缩期峰值、平均流速和舒张末期速度)的能力,发现测量结果与传统超声探头的测量结果非常吻合。

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.