Reliability and validity of the hidden hunger assessment scale in China-revised for high school students

Objective:Hidden hunger remains a severe public health problem that affects millions of people worldwide.In China,challenges related to dietary imbalance and hidden hunger persist.Micronutrient inadequacy deserves more attention among adolescents,given its vital role in their growth and development;however,this problem appears to have been largely ignored.High school students,in particular,are often at a high risk of hidden hunger but have limited assessment tools available.Therefore,this study aims to revise the hidden hunger assessment scale for high school students(HHAS-HSS)in China and assess its reliability and validity.Methods:Based on a literature review,expert consultation,pre-experiment,and formal survey,a hidden hunger assessment scale was revised for high school students.The formal survey involved 9336 high school students in 11 of the 16 cities in Anhui Province,China,and 9038 valid questionnaires were collected and included in the analysis.The item analysis,internal consistency reliability,test-retest reliability,content validity,exploratory factor analysis,and confirmatory factor analysis of the HHAS-HSS were examined.Results:The HHAS-HSS included a total of 4 dimensions and 12 items:"vegetables and food diversity"(three items),"fruits and dairy products"(three items),"micronutrient-dense foods"(four items),and"health condition and eating habits"(two items).The results showed a Cronbach's alpha of 0.758,a split-half reliability of 0.829,and a test-retest reliability of o.793,indicating good internal consistency.Using the Bartlett's test and Kaiser-Meyer-Olkin test(KMO)to test the exploratory factor analysis presented a four-factor model of the HHAS-HSS,the KMO0 value was 0.820(P<0.001),which indicated the possibility for factor confirmatory factor analysis.Using the maximum variance rotation method,four factors were obtained,and the cumulative variance explained rate was 57.974%.Confirmatory factor analysis also supported the division of the scale into four dimensions,and the fitting indices were x^(2)=1417.656,x^(2)/df=29.534,goodness-of-fit index=0.974,adjusted goodnessof-fit index=0.958,parsimonious goodness-of-fit index=0.600,normed fit index=0.938,incremental fit index=0.940,Tucker-Lewis index=0.917,comparative fit index=0.939,and root mean square error of approximation=0.056.Except for x^(2)/df,all the indices reached the fitting standard,and the above results showed that the construct validity of the scale reached an acceptable level.Conclusions:The HHAS-HSS has good validity and reliability for Chinese high school students.It is a convenient self-report measure of hidden hunger risk.

Effect of Nursing Intervention Based on Caprini Risk Assessment Scale for Venous Thromboembolism in Perioperative Patients with Liver Cancer

Objective:To explore the effect of nursing intervention based on Caprini risk assessment scale for venous thromboembolism(VTE)in perioperative patients with liver cancer.Methods:A total of 128 hepatocellular cancer(HCC)patients who were hospitalized in our department from January 2021 to March 2022 and met the research criteria were selected.According to odd and even numbers in the order of inclusion,64 cases were divided into two groups:a control group and an observation group.The control group received routine nursing intervention during perioperative period,while the observation group received nursing intervention based on Caprini risk assessment scale for VTE.The incidence of VTE and complications were compared between the two groups.Results:The incidence of VTE and postoperative complications in the observation group were lower than those in the control group(P<0.05).Conclusion:Nursing intervention based on Caprini risk assessment scale for VTE can reduce the incidence of perioperative deep vein thrombosis and complications in patients with liver cancer;thus,it is worthy of clinical application.

Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer

BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale(ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy(ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS(no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications(grade 3-4) and the number of unplanned visits during the chemotherapy period.RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group(age P = 0.880;breast cancer stage P = 0.56;cancer histology P = 0.415;tumour size P = 0.258;lymph node status P = 0.883;immunohistochemical classification P = 0.754;type of surgery P = 0.157), except for premenopausal status(P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits(P = 0.035). Grade 3-4 toxicity did not differ between the study groups(P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group(P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage Ⅱ/Ⅲ.CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.

An Assessment Scale for Evaluating the Experimental Design Ability of Elementary Science Teachers Based on Primary Trait Analysis

In this study,an assessment scale for evaluating the experimental design ability of elementary science teachers was constructed based on primary trait analysis.This assessment scale contains three first-level indexes and eleven second-level indexes.The corresponding weights of indexes were determined by the objective weighting method.The scores of all the descriptions of the indexes were also assigned.After a trial test,this assessment scale was verified to be reliable and valid for evaluating the experimental design ability of elementary science teachers.

Assessment of neonatal pain:uni-and multidimensional evaluation scales

Neonatal pain is a problem that is easily overlooked.According to the status quo of neonatal pain management,commonly 9 scales are used for evaluation of neonatal pain;details of the specific indicators,such as the applicable neonatal gestational age range,score,and the type of pain,for the domestic references are provided so as to provide reference for the proper evaluation and standardized management of neonatal pain,as well as to promote the management level of neonatal pain.

Outcome assessment of stroke convalescence using multiple scales based on different dimensions

BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ’) of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.

Efficacy of Children Neuropsychological and Behavioral Scale in Screening for Autism Spectrum Disorders through a Combination of Developmental Surveillance

Objective This study aimed to explore the clinical value of Children Neuropsychological and Behavioral Scale-Revision 2016(CNBS-R2016)for Autism Spectrum Disorder(ASD)screening in the presence of developmental surveillance.Methods All participants were evaluated by the CNBS-R2016 and Gesell Developmental Schedules(GDS).Spearman’s correlation coefficients and Kappa values were obtained.Taking GDS as a reference assessment,the performance of the CNBS-R2016 for detecting the developmental delays of children with ASD was analyzed with receiver operating characteristic(ROC)curves.The efficacy of the CNBS-R2016 to screen for ASD was explored by comparing Communication Warning Behavior with Autism Diagnostic Observation Schedule,Second Edition(ADOS-2).Results In total,150 children aged 12–42 months with ASD were enrolled.The developmental quotients of the CNBS-R2016 were correlated with those of the GDS(r=0.62–0.94).The CNBS-R2016 and GDS had good diagnostic agreement for developmental delays(Kappa=0.73–0.89),except for Fine Motor.There was a significant difference between the proportions of Fine Motor,delays detected by the CNBS-R2016 and GDS(86.0%vs.77.3%).With GDS as a standard,the areas under the ROC curves of the CNBS-R2016 were above 0.95 for all the domains except Fine Motor,which was 0.70.In addition,the positive rate of ASD was 100.0%and 93.5%when the cut-off points of 7 and 12 in the Communication Warning Behavior subscale were used,respectively.Conclusion The CNBS-R2016 performed well in developmental assessment and screening for children with ASD,especially by Communication Warning Behaviors subscale.Therefore,the CNBS-R2016 is worthy of clinical application in children with ASD in China.

Advances in research on personalized venous thromboembolism risk assessment tools

This paper describes the de？nition of venous thromboembolism and introduces to personalized venous thromboembolism risk assessment tools overseas. Thoughts are given on the development, amendment,application and validation of these tools. The paper provides a reference for building personalized venous thromboembolism risk assessment tools in China.

Probabilistic seismic performance assessment of lap-spliced RC columns retrofitted by steel wrapping jackets

In this study, the seismic fragility curves of two reinforced concrete（RC） columns that were lap-spliced at the bottom and retrofitted with steel wrapping jackets were generated. Their seismic performance was probabilistically assessed in comparison to that of lap-spliced or continuous reinforcement RC columns. This study used two types of steel wrapping jackets, a full jacket and a split jacket. Analytical models of the four types of columns were developed based on the experimental results of the columns using Open SEES, which is effective in conducting nonlinear time history analyses. A suite of ten artificial ground motions, modified from recorded ground motions, was used to perform nonlinear time history analyses of the analytical models with scaling of the peak ground acceleration from 0.1 g to 1.0 g in increments of 0.1 g. The steel wrapping jackets did not increase the medians for yield（slight damage state） of the lap-spiced column and did not exceed the corresponding median of the continuous reinforcement column. However, the two steel jackets increased the medians for failure by 1.872 and 2.017 times, respectively, and exceeded the corresponding median of the continuous reinforcement column by 11.8% and 20.5%, respectively.

Yizhi Xingnao prescription improves the cognitive function of patients after a transient ischemic attack

Patients with mild cognitive impairment after a transient ischemic attack were included in this study. They were treated with Yizhi Xingnao prescription, ergoloid mesylates or aspirin for 60 days. Evaluation using the Montreal Cognitive Assessment Scale showed that cognitive function was significantly improved in all patients, especially after the combined treatment of Yizhi Xingnao and aspirin. The scores from the Montreal Cognitive Assessment Scale were improved overall and the effective treatment rate was as high as 79%, which was higher than patients treated with a combination of ergoloid mesylates and aspirin, or aspirin alone. Our experimental findings indicate that YizhiXingnao prescription can improve mild cognitive impairment after a transient ischemic attack, and that it is more effective than ergoloid mesylates.

Effect of cryotherapy on pain management at the puncture site of arteriovenous fistula among children undergoing hemodialysis

Objective: To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD).Methods: A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University.The experiment involved 40 children with AVF undergoing HD.Before puncturing,cryotherapy was applied using 2 cm-3 cm pieces of frozen distilled water in a plastic bag.Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy.A part from a physiological assessment of vital signs,pain was assessed using the Wong-Baker Faces Pain and the Observed Pain Behavior rating scales.All research ethics were applied.Results: HD had a median duration of four years,while cryotherapy had a median application time of 8.8 min.The Wong-Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy.Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture.A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%;p < 0.001).Conclusions: Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD.However,the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings.This study recommends the use of cryotherapy in managing needle puncture pain.Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.

Evaluation of retinal and choroidal changes in patients with Alzheimer’s type dementia using optical coherence tomography angiography

AIM:To evaluate the changes in fundus parameters in patients with Alzheimer’s type dementia(ATD)using optical coherence tomography angiography(OCTA),to record flash electroretinograms(ERG)using the RETeval system and to explore changes in retinal function.METHODS:Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled.All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area,including the vessel length density,the vessel perfusion density and the area of foveal avascular zone(FAZ),as well as the choroidal thickness.The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters.We also recorded the flash ERGs using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD.RESULTS:The vessel parameters[Pvessel length density=0.005 and Pvessel perfusion density=0.006]and average choroid thickness(P<0.001)in the macular area of the ATD group was less than the control group.The FAZ area was statistically significantly enlarged in the ATD group(P<0.001).These parameters were correlated with the Mini-Mental State Examination(MMSE)score and the Montreal Cognitive Assessment(MoCA).CONCLUSION:Patients with ATD exhibit decreases in the parameters associated with fundus.In addition,these indicators significantly correlate with the MMSE score and the MoCA score.OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.

Diffusion tensor tractography studies on mechanisms of recovery of injured fornix

The fornix,which connects the medial temporal lobe and the medial diencephalon,is involved in episodic memory as an important part of the Papez circuit.The mechanisms of recovery of an injured fornix revealed by diffusion tensor tractography in the five studies are summarized as follows：1） recovery through the nerve tract from an injured fornical crus to the medial temporal lobe via the normal pathway of the fornical crus;2）recovery through the nerve tract originating from an ipsi-lesional fornical body connected to the ipsi-lesional medial temporal lobe via the splenium of the corpus callosum;3） recovery through the nerve tract from the ipsi-lesional fornical body extending to the contra-lesional medial temporal lobe via the splenium of the corpus callosum;4） recovery through the nerve tract originating from the ipsi-lesional fornical column connected to the ipsi-lesional medial temporal lobe;and 5） recovery through the nerve tract originating from the contra-lesional fornical column connected to the ipsi-lesional medial temporal lobe via the contra-lesional medial temporal lobe and the splenium of the corpus callosum.These diffusion tensor tractography studies on mechanisms of recovery of injured fornical crus appeared to provide useful information for clinicians caring for patients with brain injury,however,studies on this topic are still in the beginning stages.

Risk modeling of femoral neck fracture based on geometric parameters of the proximal epiphysis

BACKGROUND Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates.AIM To model the potential risk of hip fracture via femur geometric parameters.METHODS Seventy educational cadaveric femurs from people aged 14 to 80 years,10 X-ray images from the records of the Human Anatomy Department and 10 X-ray images from the Department of Traumatology,Orthopedics and Disaster Surgery of Sechenov University,were evaluated.The parameters of the fractured bone were measured using images captured with a Canon d60 camera.The projection values of the proximal epiphysis of the cadaveric femurs and geometric parameters of the bones shown in the X-ray images were measured with Autodesk software(AutoCAD 2018).Analysis of the video frames showing bone rotation reveal that the greater trochanter can be inscribed in a parallelepiped,where one of the faces is parallel to the plane of view in the frontal standard projection and is rectangular.The angle of bone rotation obtained by turning the cube corresponded to the angle measured with the second technique.This reliable method of calculating the rotation of the bone relative to the anterior projection was employed in subsequent calculations.The geometric parameters of the femur were measured using X-ray images according to the proposed method.RESULTS The geometric parameters of 70 femurs were analyzed,and correlation coefficients were calculated.Our measurement results were compared with those reported by other authors.The potential influence of femur geometry on force distribution in the proximal epiphysis of the femur was described,and a 2-dimensional model of the femur epiphysis associated with minimal neck fracture risk was provided.The assessment of the geometric parameters of the femoral epiphysis indicated the greatest risk of a varus fracture of the neck if the angle of the minimal resistance zone(AMRZ)index>24°and the neck-shaft angle(NSA)<127.5°.In contrast,the minimum risk was observed at AMRZ<14°and NSA>128.87°.CONCLUSION The proposed method provides the potential femur neck fracture risk based on geometric parameters.

Observation on the Therapeutic Effect of Shangjinbitong Powder(伤筋痹痛散)on Improving Acupoint Plaster

Objective:To study the therapeutic effect of Shangjinbitong Powder(伤筋痹痛散)on improving acupoint plaster,in order to provide some scientific basis for clinical use.Methods:This project was carried out from June 2020 to January 2021,30 patients with low back pain in the outpatient department of orthopedics and traumatology in our hospital and 30 patients with low back pain in the rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine were selected as the research objects.Patients with low back pain in our hospital were treated with Shangjinbitong Powder as the control group,and patients in rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine as the research group were treated with acupoint plaster improved by Shangjinbitong Powder.After one week of treatment,the effective rates of the two groups were compared.Results:The effective rate of treatment in the study group was significantly higher than that in the control group(P<0.05).There were no adverse reactions such as infection,scald and bleeding in the study group and the control group during the treatment.Conclusion:Shangjinbitong Powder improved acupoint plaster has good curative effect,convenient use,certain safety and clinical popularization value.

Reliability and validity of the Chinese version of the Scale for Assessment and Rating of Ataxia

Background The Scale for the Assessment and Rating of Ataxia （SARA） was shown to be a reliable and valid measurement for patients with spinocerebellar ataxia （SCA）. The Brazilian version and the Japanese version of SARA were favorable for good reliability and validity. This study aimed to translate SARA into Chinese and test its reliability and validity in measurement of cerebellar ataxia. Methods SARA was translated into Chinese. A total 39 patients with degeneration cerebellar ataxia were evaluated independently by two neurologists with the Chinese version of SARA. Then the patients were evaluated by one of above neurologists with International Cooperative Ataxia Rating Scale （ICARS）. The statistical analyses were performed using SPSS 17.0 for Windows. Results The Cronbach＇s alpha coefficient of the Chinese version of SARA was 0.78, which represents a good internal consistence. The correlation coefficient of the Chinese version of SARA scores between the two evaluators was 0.86, illustrating that the inter-rater reliability of Chinese version of SARA was good. The correlation coefficient between the Chinese version of SARA and ICARS was 0.91, illustrating that the criterion validity of Chinese version of SARA was not bad. Conclusions The Chinese version of SARA is reliable and effective for the assessment of degeneration cerebellar ataxia. Compared with ICARS, the evaluation of Chinese version of SARA is more objective, the assessment time is shortened, and the maneuverability is better.

Research and application advances in rehabilitation assessment of stroke

Stroke has a high incidence and disability rate, and rehabilitation is an effective means to reduce the disability rate of patients. To systematize rehabilitation assessment, which is the foundation for rehabilitation therapy, we summarize the assessment methods commonly used in research and clinical applications, including the various types of stroke rehabilitation scales and their applicability, and related biomedical detection technologies, including surface electromyography(sEMG),motion analysis systems, transcranial magnetic stimulation(TMS), magnetic resonance imaging(MRI), and combinations of different techniques. We also introduce some assessment techniques that are still in the experimental phase, such as the prospective application of artificial intelligence(AI) with optical correlation tomography(OCT) in stroke rehabilitation. This review provides a useful bibliography for the assessment of not only the severity of stroke injury, but also the therapeutic effects of stroke rehabilitation, and establishes a solid base for the future development of stroke rehabilitation skills.

Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation:a qualitative study

Background:Scar assessment plays a key role during burns aftercare,to monitor scar remodelling and patients’psychosocial well-being.To aid assessment,subjective scar assessment scales are available that use health-care professionals’and patients’opinions to score scar characteristics.The subjective scales are more widely used in clinical practice over objective scar measures.To date,there is no research that considers patients’views on scar assessment and the role of subjective and objective assessment tools.Therefore,the aim of this qualitative study was to explore patients’perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation.Methods:Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring.Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital,Birmingham,UK.Topics covered during interview included patient experience of scar assessment,the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars.A thematic analysis using the Framework Method was conducted.Results:Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment.These are:patient-led care;continuity in care;learning how to self-manage scarring;and psychological assessment.Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies,indicating their potential patient-centred contributions.The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools.Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial function-ing.However,minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose.Patients perceived objective tools to be of primary use for health-care professionals,though the measures may aid patients’understanding of scar properties.Conclusions:Scar assessment tools should be used to support,rather than replace,health-care professionals’subjective judgements of scarring.Adapting the way in which clinicians introduce and use scar assessment tools,according to patient needs,can support a patient-centred approach to scar assessment.

Environmental impacts of a large-scale incinerator with mixed MSW of high water content from a LCA perspective

Large-scale incinerators are applied widely as a result of the heavy burden of municipal solid waste（MSW） generated, while strong opposition is arising from the public living nearby. A large-scale working incineration plant of 1500 ton/day was chosen for evaluation using life cycle assessment. It was found that the corresponding human toxicity impacts via soil（HTs）, human toxicity impacts via water（HTw） and human toxicity impacts via air（HTa）categories are 0.213, 2.171, and 0.012 personal equivalents（PE）, and global warming（GW100）and nutrient enrichment（NE） impacts are 0.002 and 0.001 PE per ton of waste burned for this plant. Heavy metals in flue gas, such as Hg and Pb, are the two dominant contributors to the toxicity impact categories, and energy recovery could reduce the GW100 and NE greatly. The corresponding HTs, HTw and HTa decrease to 0.087, 0.911 and 0.008 PE, and GW100 turns into savings of- 0.007 PE due to the increase of the heating value from 3935 to5811 k J/kg, if a trommel screener of 40 mm mesh size is used to pre-separate MSW. MSW sorting and the reduction of water content by physical pressure might be two promising pre-treatment methods to improve the combustion performance, and the application of stricter standards for leachate discharge and the flue gas purification process are two critical factors for improvement of the environmental profile identified in this work.

Evaluation of the scales assessing the severity of myasthenia gravis

Objective To evaluate the reliability and validity of the 4 myasthenia gravis(MG)scales widely used for assessing the grades of disease severity in Chinese MG patients.Methods Sixty MG patients were examined by a neurologist with the following four MG scales:Quantitative Myasthenia Gravis Score(QMGS),Myasthenia Gravis Composite(MGC),Myasthenic Muscle Scale(MMS),Absolute and Relative Score of MG(ARS-