Dietary xylo‑oligosaccharides and arabinoxylans improved growth efficiency by reducing gut epithelial cell turnover in broiler chickens

Background One of the main roles of the intestinal mucosa is to protect against environmental hazards.Supple-mentation of xylo-oligosaccharides(XOS)is known to selectively stimulate the growth of beneficial intestinal bacteria and improve gut health and function in chickens.XOS may have an impact on the integrity of the intestinal epithelia where cell turnover is critical to maintain the compatibility between the digestive and barrier functions.The aim of the study was to evaluate the effect of XOS and an arabinoxylan-rich fraction(AXRF)supplementation on gut func-tion and epithelial integrity in broiler chickens.Methods A total of 128 broiler chickens(Ross 308)were assigned into one of two different dietary treatments for a period of 42 d:1)control diet consisting of a corn/soybean meal-based diet;or 2)a control diet supplemented with 0.5%XOS and 1%AXRF.Each treatment was randomly distributed across 8 pens(n=8)with 8 chickens each.Feed intake and body weight were recorded weekly.On d 42,one male chicken per pen was selected based on aver-age weight and euthanized,jejunum samples were collected for proteomics analysis.Results Dietary XOS/AXRF supplementation improved feed efficiency(P<0.05)from d 1 to 42 compared to the con-trol group.Proteomic analysis was used to understand the mechanism of improved efficiency uncovering 346 dif-ferentially abundant proteins(DAP)(Padj<0.00001)in supplemented chickens compared to the non-supplemented group.In the jejunum,the DAP translated into decreased ATP production indicating lower energy expenditure by the tissue(e.g.,inhibition of glycolysis and tricarboxylic acid cycle pathways).In addition,DAP were associated with decreased epithelial cell differentiation,and migration by reducing the actin polymerization pathway.Put-ting the two main pathways together,XOS/AXRF supplementation may decrease around 19%the energy required for the maintenance of the gastrointestinal tract.Conclusions Dietary XOS/AXRF supplementation improved growth efficiency by reducing epithelial cell migration and differentiation(hence,turnover),actin polymerization,and consequently energy requirement for maintenance of the jejunum of broiler chickens.

Hydrogen evolution reaction activity enhancement from active site turnover mechanism

Although heteroatom doping is an effective way to improve the catalytic activity of transition metal phosphides(TMPs),the mechanism of activity enhancement needs to be further refined.To this end,we synthesized a Co-doped Ni_(2)P catalyst as a research model and found that the introduction of heterogeneous Co reconstructed the charge distribution around the P site,which effectively enhanced the hydrogen evolution reaction(HER)activity of the pure Ni_(2)P.Based on in-situ Raman real-time monitoring technology,we monitored for the first time that Co doping triggered a switch of the active site(from the original Co-active site to the P-active site),which promoted the adsorption of H_(2)O to enhance the HER activity.The density functional theory(DFT)calculations indicated that the P site of Co-Ni_(2)P expressed the highest activity and the Ni site of pure Ni_(2)P expressed the highest activity,which further confirms the in-situ Raman monitoring results.The active site turnover mechanism discovered in this study will undoubtedly provide more rational and targeted ideas for future catalyst design.

Effects of improved amino acid balance diet on lysine mammary utilization, whole body protein turnover and muscle protein breakdown on lactating sows

Background The study objective was to test the hypothesis that low crude protein(CP)diet with crystalline amino acids(CAA)supplementation improves Lys utilization efficiency for milk production and reduces protein turnover and muscle protein breakdown.Eighteen lactating multiparous Yorkshire sows were allotted to 1 of 2 isocaloric diets(10.80 MJ/kg net energy):control(CON;19.24%CP)and reduced CP with“optimal”AA profile(OPT;14.00%CP).Sow body weight and backfat were recorded on d 1 and 21 of lactation and piglets were weighed on d 1,14,18,and 21 of lactation.Between d 14 and 18,a subset of 9 sows(CON=4,OPT=5)was infused with a mixed solution of 3-[methyl-2H3]histidine(bolus injection)and[13C]bicarbonate(priming dose)first,then a constant 2-h[13C]bicarbonate infusion followed by a 6-h primed constant[1-13C]lysine infusion.Serial blood and milk sampling were performed to determine plasma and milk Lys enrichment,Lys oxidation rate,whole body protein turnover,and muscle protein breakdown.Results Over the 21-d lactation period,compared to CON,sows fed OPT had greater litter growth rate(P<0.05).Compared to CON,sows fed OPT had greater efficiency of Lys(P<0.05),Lys mammary flux(P<0.01)and whole-body protein turnover efficiency(P<0.05).Compared to CON,sows fed OPT tended to have lower whole body protein breakdown rate(P=0.069).Muscle protein breakdown rate did not differ between OPT and CON(P=0.197).Conclusion Feeding an improved AA balance diet increased efficiency of Lys and reduced whole-body protein turnover and protein breakdown.These results imply that the lower maternal N retention observed in lactating sows fed improved AA balance diets in previous studies may be a result of greater partitioning of AA towards milk rather than greater body protein breakdown.

Deterministic processes drive turnover-dominated beta diversity of breeding birds along the central Himalayan elevation gradient

Beta diversity,the variation of community composition among sites,bridges alpha and gamma diversity and can reveal the mechanisms of community assembly through applying distance-decay models and/or partitioning beta diversity into turnover and nestedness components from functional and phylogenetic perspectives.Mountains as the most natural experiment system provide good opportunities for exploring beta diversity patterns and the underlying ecological processes.Here,we simultaneously consider distance-decay models and multiple di-mensions of beta diversity to examine spatial variations of bird communities,and to evaluate the relative importance of niche-based and neutral community assembly mechanisms along a 3600-m elevational gradient in the central Himalayas,China.Our results showed that species turnover dominates taxonomic,functional,and phylogenetic beta diversity.We observed strongest evidence of spatial distance decays in taxonomic similarities of birds,followed by its phylogenetic and functional analogues.Turnover component was highest in taxonomic beta diversity,while nestedness component was highest in functional beta diversity.Further,all correlations of assemblage similarity with climatic distance were higher than that with spatial distances.Standardized values of overall taxonomic,functional,and phylogenetic beta diversity and their turnover components increase with increasing elevational distance,while the standardized values of taxonomic and phylogenetic nestedness decreased with increasing elevational distance.Our results highlighted the niche-based deterministic processes in shaping elevational bird diversity patterns that were determined by the relative roles of decreasing trend of environmental filtering and increasing trend of limiting similarity along elevation distances.

Corroborative Activities and Recognition Between Community Comprehensive Care Unit’s Nurses and Care Managers in Supporting Discharge of Elderly from Hospital - A Secondary Publication

Objective: The purpose of this study was to clarify the collaborative activities and mutual recognition between community comprehensive care unit nurses (Ns) and care managers (CM) in supporting the discharge of the elderly from the hospital. Methods: A total of 300 nurses working in community comprehensive care wards and 360 care managers working in B City in A Prefecture were surveyed using an anonymous self-administered questionnaire. Results: The highest percentage of responses regarding necessary collaborative activities with multiple professions in supporting hospital discharge were the same for Ns and CMs. The items regarding practice with the highest percentages were “relationship as a team” for Ns, and “user-centered awareness” for CM. While these professionals were willing to share information about their patients’ lives after discharge, the percentage of those explaining their expertise was low. It is thought that collaborative activities focusing on these aspects would lead to more appropriate discharge support.

Association of bone turnover biomarkers with severe intracranial and extracranial artery stenosis in type 2 diabetes mellitus patients

BACKGROUND Intracranial and extracranial artery stenosis is associated with cerebral infarction.Vascular calcification and atherosclerosis are the main causes of stenosis and major risk factors for cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus(T2DM).Bone turnover biomarkers(BTMs)are associated with vascular calcification,atherosclerosis,glucose,and lipid metabolism.AIM To investigate the association of circulating BTM levels with severe intracranial and extracranial artery stenosis in patients with T2DM.METHODS For this cross-sectional study including 257 T2DM patients,levels of the BTMs serum osteocalcin(OC),C-terminal cross-linked telopeptide of type I collagen(CTX),and procollagen type I N-peptide were measured by electrical chemiluminescent immunoassay,and artery stenosis was assessed by color Doppler and transcranial Doppler.Patients were grouped according to the existence and location(intracranial vs.extracranial)of artery stenosis.Correlations between BTM levels,previous stroke,stenosis location,and glucose and lipid metabolism were analyzed.RESULTS T2DM patients with severe artery stenosis had a higher frequency of previous stroke and levels of all three tested BTMs(all P<0.05)than patients without.Some differences in OC and CTX levels were observed according to the location of artery stenosis.Significant associations were also observed between BTM levels and some glucose and lipid homeostasis parameters.On multivariate logistic regression analysis,all BTMs were significant predictors of artery stenosis in T2DM patients with and without adjustment for confounding factors(all P<0.001),and receiver operating characteristic curve analysis demonstrated the ability of BTM levels to predict artery stenosis in T2DM patients.CONCLUSION BTM levels were found to be independent risk factors for severe intracranial and extracranial artery stenosis and were differentially associated with glucose and lipid metabolism in patients with T2DM.Therefore,BTMs may be promising biomarkers and potential therapeutic targets for artery stenosis.

Applying zeta diversity to understand species turnover patterns of small mammals in the Mountains of Southwest China

DEAR EDITOR,Mountainous regions are generally characterized by high species turnover,yet studies applying novel conceptual frameworks to analyze the spatial structure and organization of montane biota along elevational gradients remain scarce.Based on the zeta diversity framework—a novel turnover metric that focuses on average number of species shared across sites—and a comprehensive presence-absence dataset of small mammals collected from 22 elevational gradients in the Mountains of Southwest China(MSC).

Organizational commitment and turnover intention among rural nurses in the Philippines: Implications for nursing management

Objectives:The unrelenting migration trend of Filipino nurses to other countries has threatened the quality of patient care services in the country.This study explored the extent of nurses'organizational commitment and turnover intention in the Philippines.Furthermore,predictors of nurses'organizational commitment and turnover intention were identified.Methods:A cross-sectional research design was adopted for this study.Two hundred nurses from nine rural hospitals in the Central Philippines were asked to participate in the study and 166 nurses responded(an 83%response rate).Two standardized instruments were used:the Organizational Commitment Questionnaire and the Six-item Turnover Intention Inventory Scale.Results:Findings revealed that Philippine nurses were moderately committed(3.13±0.24)to and were undecided(2.42±0.67)whether or not to leave their organization.Nurses'age(P=0.006),gender,(t=-2.25,P=0.026),education(t=2.38,P<0.001),rank(t=4.38,P<0.001),and work experience(t=2.18,P=0.031)correlated significantly with organizational commitment,while nurses'age(P=0.028)and education(t=1.99,P=0.048)correlated significantly with turnover intention.An inverse relationship was identified between the organizational commitment and turnover intention(r=-0.22,P=0.005).Conclusion:The findings of this study highlight the need for formulation and implementation of interventions to promote life-long commitment in nurses and to reduce turnover rates.

The Impact of Saudi Nurses’ Happiness on Their Turnover Intentions

Highly happy nurses are more productive, engaged and loyal. If nurses are satisfied, then their intention to leave is low. Aim: to investigate the impact of Saudi nurses’ happiness on their intention to turnover in the Kingdom of Saudi Arabia. Research Hypothesis: H0. There is no relationship between the nurses’ happiness on their intention to turnover among Saudi nurses. H1. The happy Saudi nurses will have a lower turnover intention among Saudi nurses in the Medina region. Design: Quantitative, cross-sectional, and correlational study designs have been used. Setting: Big public hospital in Medina from June to October 2022. Sample: A quota, convenience sample of 281 Saudi nurses. Tools: A. Oxford happiness inventory to measure the nurses’ happiness. B. Turnover Intention Scale to evaluate the Saudi nurses’ intention to leave their current job. Results: More than half of the nurses had moderate happiness, but more than 75% of the Saudi nurses had a desire to leave. The relationship between happiness and turnover intentions is negative. Conclusion: Magnet-like work environments in Saudi Arabia are critical to recruit and retain nurses with critical nursing shortages. Recommendations: Encourage governmental policy-makers to formulate national policies and KPIs in order to make them happy and retain them. .

Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Conflict management styles of nurse managers and influencing factors in children’s hospital, Vietnam

Objective:This study aimed to describe the conflict management styles and identify factors affecting the conflict management styles of nurse managers.Materials and Methods:A cross-sectional study was conducted by interviewing nurse managers with a questionnaire,including the Rahim Organizational Conflict Inventory-II Form B,used to assess an individual’s approach to conflict management across five styles:cooperating,competing,compromising,obliging,and avoiding.Results:A total of 30 nurse managers participated in this study.The mean scores of the cooperating style were the highest at 4.3±0.4,followed by a compromising style at 3.4±0.5,an avoiding style at 3.1±0.6,an accommodating style at 2.9±0.7,and a competing style at 2.8±0.8(χ^(2)=66.624,P<0.001).The mean scores for avoiding style among bachelor’s degree nurse managers(3.2±0.6)were higher than those of master’s degree nurse managers(2.7±0.6)(P=0.036).Nurse managers over 40 years old,holding a managerial position for≥10 years,and frequent conflict handling rated higher mean scores for the cooperating style than their counterparts(P<0.05).Conclusion:The cooperating style was the most commonly used conflict management style among nurse managers.Factors affecting the conflict management style were age,education level,and experience in management and conflict handling.These findings are useful for developing interventions that enhance the competencies of nurse managers in conflict management.

Personal Thermal Management by Radiative Cooling and Heating

Maintaining thermal comfort within the human body is crucial for optimal health and overall well-being.By merely broadening the setpoint of indoor temperatures,we could significantly slash energy usage in building heating,ventilation,and air-conditioning systems.In recent years,there has been a surge in advancements in personal thermal management(PTM),aiming to regulate heat and moisture transfer within our immediate surroundings,clothing,and skin.The advent of PTM is driven by the rapid development in nano/micro-materials and energy science and engineering.An emerging research area in PTM is personal radiative thermal management(PRTM),which demonstrates immense potential with its high radiative heat transfer efficiency and ease of regulation.However,it is less taken into account in traditional textiles,and there currently lies a gap in our knowledge and understanding of PRTM.In this review,we aim to present a thorough analysis of advanced textile materials and technologies for PRTM.Specifically,we will introduce and discuss the underlying radiation heat transfer mechanisms,fabrication methods of textiles,and various indoor/outdoor applications in light of their different regulation functionalities,including radiative cooling,radiative heating,and dual-mode thermoregulation.Furthermore,we will shine a light on the current hurdles,propose potential strategies,and delve into future technology trends for PRTM with an emphasis on functionalities and applications.

Overview of the immunological mechanisms in hepatitis B virus reactivation:Implications for disease progression and management strategies

Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.

Heat transfer enhanced inorganic phase change material compositing carbon nanotubes for battery thermal management and thermal runaway propagation mitigation

Developing technologies that can be applied simultaneously in battery thermal management(BTM)and thermal runaway(TR)mitigation is significant to improving the safety of lithium-ion battery systems.Inorganic phase change material(PCM)with nonflammability has the potential to achieve this dual function.This study proposed an encapsulated inorganic phase change material(EPCM)with a heat transfer enhancement for battery systems,where Na_(2)HPO_(4)·12H_(2)O was used as the core PCM encapsulated by silica and the additive of carbon nanotube(CNT)was applied to enhance the thermal conductivity.The microstructure and thermal properties of the EPCM/CNT were analyzed by a series of characterization tests.Two different incorporating methods of CNT were compared and the proper CNT adding amount was also studied.After preparation,the battery thermal management performance and TR propagation mitigation effects of EPCM/CNT were further investigated on the battery modules.The experimental results of thermal management tests showed that EPCM/CNT not only slowed down the temperature rising of the module but also improved the temperature uniformity during normal operation.The peak battery temperature decreased from 76℃to 61.2℃at 2 C discharge rate and the temperature difference was controlled below 3℃.Moreover,the results of TR propagation tests demonstrated that nonflammable EPCM/CNT with good heat absorption could work as a TR barrier,which exhibited effective mitigation on TR and TR propagation.The trigger time of three cells was successfully delayed by 129,474 and 551 s,respectively and the propagation intervals were greatly extended as well.

Managing the surge:A comprehensive review of the entire disposal framework for retired lithium-ion batteries from electric vehicles

Anticipating the imminent surge of retired lithium-ion batteries(R-LIBs)from electric vehicles,the need for safe,cost-effective and environmentally friendly disposal technologies has escalated.This paper seeks to offer a comprehensive overview of the entire disposal framework for R-LIBs,encompassing a broad spectrum of activities,including screening,repurposing and recycling.Firstly,we delve deeply into a thorough examination of current screening technologies,shifting the focus from a mere enumeration of screening methods to the exploration of the strategies for enhancing screening efficiency.Secondly,we outline battery repurposing with associated key factors,summarizing stationary applications and sizing methods for R-LIBs in their second life.A particular light is shed on available reconditioning solutions,demonstrating their great potential in facilitating battery safety and lifetime in repurposing scenarios and identifying their techno-economic issues.In the realm of battery recycling,we present an extensive survey of pre-treatment options and subsequent material recovery technologies.Particularly,we introduce several global leading recyclers to illustrate their industrial processes and technical intricacies.Furthermore,relevant challenges and evolving trends are investigated in pursuit of a sustainable end-of-life management and disposal framework.We hope that this study can serve as a valuable resource for researchers,industry professionals and policymakers in this field,ultimately facilitating the adoption of proper disposal practices.

Whole-process case management effects on mental state and selfcare ability in patients with liver cancer

BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical cancer.In a previous study,the whole-process management model was applied to patients with breast cancer,which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction.METHODS In this single-center,randomized,controlled study,60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group(n=30),who received whole-process case management on the basis of routine nursing mea-sures,and a control group(n=30),who were given routine nursing measures.We compared differences between the two groups in terms of anxiety,depression,the level of hope,self-care ability,symptom distress,sleep quality,and quality of life.RESULTS Post-intervention,Hamilton anxiety scale,Hamilton depression scale,memory symptom assessment scale,and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention,and the observation group had lower scores than the control group(P<0.05).Herth hope index,self-care ability assessment scale-revision in Chinese,and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention,with higher scores in the observation group compared with the control group(P<0.05).CONCLUSION Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer,alleviate symptoms and problems,and improve the level of hope,self-care ability,sleep quality,and quality of life,as well as provide feasible nursing alternatives for patients with liver cancer.

Systematic review of risk factors,prognosis,and management of colorectal signet-ring cell carcinoma

BACKGROUND Colorectal signet-ring cell carcinoma(CSRCC)is a rare clinical entity which accounts for approximately 1%of all colorectal cancers.Although multiple studies concerning this specific topic have been published in the past decades,the pathogenesis,associated risk factors,and potential implications on treatment are still poorly understood.Besides the low incidence,historically confusing histological criteria have resulted in confusing data.Nevertheless,the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis,highlight the actual interest to synthesize the known literature regarding CSRCC.AIM To provide an updated overview of risk factors,prognosis,and management of CSRCC.METHODS A literature search in the MEDLINE/PubMed database was conducted with the following search terms used:‘Signet ring cell carcinoma’and‘colorectal’.Studies in English language,published after January 1980,were included.Studies included in the qualitative synthesis were evaluated for content concerning epidemiology,risk factors,and clinical,diagnostic,histological,and molecular features,as well as metastatic pattern and therapeutic management.If possible,presented data was extracted in order to present a more detailed overview of the literature.RESULTS In total,67 articles were included for qualitative analysis,of which 54 were eligible for detailed data extraction.CSRCC has a reported incidence between 0.1%-2.4%and frequently presents with advanced disease stage at the time of diagnosis.CSRCC is associated with an impaired overall survival(5-year OS:0%-46%)and a worse stagecorrected outcome compared to mucinous and not otherwise specified adenocarcinoma.The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised.Surgery is the mainstay of treatment,although the rates of curative resection in CSRCC(21%-82%)are lower compared to those in other histological types.In case of peritoneal metastasis,cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients.CONCLUSION CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation.As such,diagnostic modalities and therapeutic approach should be tailored accordingly.

Clinical value of precise rehabilitation nursing in management of cerebral infarction

BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.

An Analysis of Amazon’s High Turnover Rate

Amazon’s internal and external environments were analyzed using PEST and SWOT models.Taking into account of relevant literature on strategic human resource management(SHRM)and models like the Harvard model and the human resource management/industrial relation(HRM/IR)model,the reasons for Amazon’s employee high turnover rate were analyzed.In this paper,several solutions to this issue are indicated,including improving incentive policies and organizing training.At the end of this paper,my personal experiences and the lessons learned throughout the course are summarized.

Fourth Industrial Revolution: A Readiness Assessment of Project Managers in Tanzania

The Fourth Industrial Revolution (4IR) is transforming the way we live, learn, work, and relate to one another. However, there is still an awareness inadequacy of the 4IR among project managers and the society in Tanzania, thus low readiness to conceptualize, implement and manage 4IR-related projects in the country. This study aimed to assess the 4IR readiness of project managers in Tanzania. The assessment is made in the frame of 4 readiness dimensions: strategy and governance structure, technology awareness, human capital digital skills development, and social-economic impact. The research used a quantitative method with the diffusion of innovations theory perspective, and data were collected mainly through an online survey questionnaire. The survey aimed at answering the research question concerning the project managers’ readiness for the 4IR. The 50 valid samples were completed by project managers from various industries such as agriculture, finance, consulting, construction, education and training, government, healthcare, Information Technology, and manufacturing. Data were analysed using SPSS. The results revealed that despite the generally low awareness of 4IR, several project managers in Tanzania have some varying awareness of 4IR technologies such as artificial intelligence, Internet of Things (IoT), data analytics, blockchain, robotics, cryptocurrency, chatbots, drones, and other digital transformation platforms. The results also indicated that project managers in Tanzania had little extent in readiness to initiate, develop and implement 4IR products and services due to inadequate 4IR-related awareness, strategy and governance structure, human capital digital skills development, and social economic impact. Consequently, some recommendations are made in the frame of the four assessed readiness dimensions for improvement. The value of this research is mainly to provide the state of 4IR readiness of project managers and associated recommendations to policymakers, practitioners, academia, donors, business industry and youth in digital innovation. The study also contributes to the body of knowledge on 4IR, project management and digital transformation.