Experiences of Early and Enhanced Clinical Exposure for Postgraduate Neonatal Nursing Students at the University of Zambia, School of Nursing Sciences: Lessons and Implications for the Future

Background and Objectives: Early and Enhanced Clinical Exposure immediately places postgraduate students in a clinical setting and incorporates continual hands-on instruction throughout their studies. It aims to motivate students by strengthening their academics, improving clinical and communication skills, and increasing their confidence. The underlying principles are to provide a clinical context and to ensure that the patient remains the centre of learning. The School of Nursing Sciences implemented this model in 2021 to produce hands-on Masters-level neonatal practitioners who can work in multidisciplinary clinical contexts. Therefore, this study explored the experiences of postgraduate nursing students on the Early and Enhanced Clinical Exposure model and draw implications for the future. Methods: A phenomenological study design was utilized at the University of Zambia, School of Nursing Sciences and comprised of eight Master of Science Neonatal Nursing students in their second year. Convenience sampling was used to select the study site and participants. Data was collected between 15th January 2023 and 31st January 2023 using an in-depth interview guide. Audio recording and notes were transcribed immediately after data collection. Data analysis was conducted using thematic analysis and codes and themes were constructed from the coded data. Ethical clearance and permission were sought before conducting the study. Results: Four major themes emerged from the study: identity and role confusion, challenging and hectic experiences, positive educational experiences, and personal and professional growth. These themes contributed to the promotion of evidence-based practice by helping students to assess, diagnose, and treat various conditions, as well as gain interest, experience, knowledge, and exposure. Conclusion: The model has a significant impact on motivation to learn, as evidenced by reported increased skill level with potential for use in clinical practice. It is recommended that it be implemented in all postgraduate programs for full-time students.

Impact of Multidisciplinary Collaborative Intervention on Isolation Implementation in Prevention and Control of Multi-drug Resistance Infection

Objective Contact precautions,especially the initiation of isolation,are important measures to prevent and control multidrug-resistant organisms(MDROs).However,the implementation in clinical practice remains weak.This study aimed to analyze the impact of multidisciplinary collaborative intervention on isolation implementation in multidrug-resistant infection,and determine the factors that affect the implementation of isolation measures.Methods A multidisciplinary collaborative intervention related to isolation was conducted at a teaching tertiary hospital in central China on November 1,2018.The information of 1338 patients with MDRO infection and colonization at 10 months before and after the intervention was collected.Then,the issuance of isolation orders was retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were performed to analyze the factors that affected the isolation implementation.Results The overall issuance rate of isolation orders was 61.21%,which increased from 33.12%to 75.88%(P<0.001)after the implementation of the multidisciplinary collaborative intervention.The intervention(P<0.001,OR=0.166)was a promoting factor for the issuance of isolation orders,in addition to the length of stay(P=0.004,OR=0.991),department(P=0.004),and microorganism(P=0.038).Conclusion The isolation implementation remains far lower than policy standards.Multidisciplinary collaborative interventions can effectively improve the compliance to isolation measures implemented by doctors,thereby promoting the standardized management of MDROs,and providing reference for further improving the quality of hospital infection management.

Effects of China's National Essential Medicines Policy on the Use of Injection in Primary Health Facilities

The overuse of injection exists more than 20 years since economic reform in China.It is a persistent problem and seems becoming a new challenge in the new health reform period.This study was designed to assess the effect of national essential medicines policy(NEMP) on injection use at primary health facilities in China by investigating their prescription information.Questionnaires were designed and disseminated to collect empirical data on injection use at 120 primary health facilities in 6 provinces from January to September in 2010 and 2011.The injection use was measured as the indicator as the percentage of prescriptions with one or more injections.The results showed that the percentage of prescriptions with one or more injections was decreased from 38.91% to 36.82%(2 =11.158,P=0.001) in the all survey areas during the NEMP reform.The difference in level of the injection use in 2011 was significant among the eastern,central and western regions(2 =223.584,P=0.000);level of the injection use in western region was the lowest(27.73%),while that in the central region was the highest(43.10%).The level of the injection use in 2011 among different provinces was also of great difference(26.00%-58.25%,range:32.25%).The level of the injection use in 2011 was still much higher than the standard suggested by WHO for developing countries(13.4%-24.1%).It was concluded that NEMP has improved injection use in China,but the injection abuse situation remains serious,indicating that one of the priorities to the next stage of NEMP is to promote the rational use of drugs,especially the injection use.

Health Disparities among the Western, Central and Eastern Rural Regions of China after a Decade of Health Promotion and Disease Prevention Programming

Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Classification and influencing factors of rural elderly's vulnerability to health-related poverty in central and western regions of China

Objective:To calculate the health poverty vulnerability index of elderly households in rural areas of central and western China,and then to classify these samples,lastly to decompose their influencing factors.Methods:First,based on survey data in 2018,the three-stage feasible generalized least squares was used to calculate the health poverty vulnerability index of elderly households,and then combined with whether the household income was below the poverty line and whether the family was healthy poverty vulnerability,the sample households were divided into four categories,and then used multiple unordered logistic regression to analyze various types of influencing factors,and finally used the Shapley index to decompose the contribution of each influencing factor.Results:The average vulnerability of health poverty was 0.5979±0.25199,with 1169 households greater than or equal to 0.5,accounting for 63.26%;the number of households stuck in poverty,temporary poverty,potential poverty,and escaped from poverty were 489,300,680,and 379 households,accounting for 26.46%,16.23%,36.80%,and 20.51%of the total sample;compared with escaped from poverty families,the three variables of marital status,the number of chronically ill patients,and the number of annual hospitalizations were the com­mon influencing factors of other three types families;The Shapley decomposition showed that the interviewees’education level and family members engaged in non-agricultural work have contributed significantly to the three types,however two indicators:time required to visit a medical institution and self-assessment of health status of the main interviewees showed great differences in different types of families.Conclusion:Rural elderly households have a high level of vulnerability to health poverty;potential poverty house­holds and persistent poverty households account for a large proportion,and continuous intervention should be carried out;it is necessary to unify the implementation of basic poverty alleviation work,but also to enhance refined management capabilities and adopt differentiated intervention measures.

Perceptions of Nurses at Ndola Teaching Hospital towards Sexual Health Needs of People with Mental Health Problems

Sexual and reproductive health (SRH) is among the fundamental packages of health care, which all clients seeking health care should receive. However, it is unclear how healthcare providers, in particular, nurses perceive the issue of people with mental problems having sexual health needs. The aim of this study was to explore perceptions of nurses at Ndola Teaching Hospital towards sexual health needs of people with mental health problems. A general descriptive qualitative study design was utilized and data were collected using three focus group discussions (FGDs) that were recorded and later transcribed verbatim. Purposive sampling was used to select 21 nurses who participated in the study. Nine were male, while 12 were female. Each FGD comprised seven participants. Thematic analysis was used to analyze the data, and six major themes: 1) physiological interplay among different body systems, 2) disease process and effects of psychotropic, 3) participant differences in age, gender, educational level, and cultural backgrounds, 4) staff shortages in mental health units, 5) deficient record keeping, and 6) Social stereotypes and labelling theories emerged. Despite acknowledging the existence of sexual activity among people with mental health problems;participants had both positive and negative perceptions. It is, therefore, recommended that interventions aimed at strengthening implementation of SRH guidelines among nurses caring for people with mental health problems should be put in place.

Satisfaction of Village Doctors with the Township and Village Health Services Integration Policy in the Western Minority-inhabited Areas of China

Township and Village Health Services Integration Management（TVHSIM） is an essential form of China＇s two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China＇s new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors＇ satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors＇ personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels（all P〈0.05）. Age（P〈0.05） and years of practice（P〈0.01） were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level（P〈0.05） was negatively correlated with Operations Management as well. However, social insurance status（P〈0.05） was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors＇ satisfaction with TVHSIM（P〈0.01）. In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

Prevalence and Antimicrobial Susceptibility Status of Gram-Negative and Gram-Positive Bacteria on Handheld Shopping Trolleys and Baskets in Supermarkets in Ndola, Zambia

Background: Supermarkets are a place visited by individuals with different health conditions daily where microbiological contaminants through touch onto fomites such as trolleys and baskets can be passed on to other people hence potentially spreading infectious diseases. This study aimed to investigate the presence of Gram-negative and Gram-positive bacteria on handheld shopping trolleys and baskets and their antimicrobial susceptibility status against commonly used antibiotics in Zambia. Methods: A cross-sectional study was conducted. Trolleys and basket handles were swabbed and standard microbiological methods were used to identify the bacteria and disc diffusion to determine their antimicrobial susceptibility status. Data was collected from December 2021 to April 2022. Data was analysed using IBM Statistical Package for Social Sciences (SPSS) Version 22. Results: Twenty-eight percent of the 200 total samples were found to be culture-positive and predominant isolates were Staphylococcus aureus (17.3%), Pseudomonas species (4.5%), Escherichia coli (2%), Corynebacterium species (2%), Staphylococcus species (1.5%) and Enterobacter aerogenes (0.5%). Staphylococcus aureus showed the most resistance to azithromycin (17%) followed by ciprofloxacin (2.8%), nitrofurantoin (2.8%) and chloramphenicol (2.8%). Escherichia coli showed 100% resistance to amoxicillin, cloxacillin and ampicillin, 75% resistance to ciprofloxacin and the least resistance to azithromycin (25%) while it was susceptible to nitrofurantoin. Staphylococcus species, Corynebacterium species, Enterobacter aerogenes and Pseudomonas species showed no resistance to any antibiotics. Conclusion: The study showed the presence of microorganisms with considerable antimicrobial resistance to antibiotics in Zambia on trolley and basket handles indicating the need for more initiatives to address proper hygiene in public environmental sites for better infection prevention and control.

Symptom presentation and evolution in the first 48 hours after injury are associated with return to play after concussion in elite Rugby Union

Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of injury.We aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h(head injury assessment(HIA2)and 48 h(HIA3)after injury were associated with time to RTP)to identify whether a more conservative graduated RTP may be appropriate.Methods:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive seasons.Players were classified as shorter or longer returns,depending on whether RTP occurred within 7 days(allowing them to be considered to play the match 1 week after injury)or longer than 8 days,respectively.Symptom,cognitive,and balance performance during screens was assessed relative to baseline(normal or abnormal)and to the preceding screen(improving or worsening).Associations between sub-test abnormalities and RTP time were explored using odds ratios(OR,longer vs.shorter).Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving.Results:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time(HIA2:OR=2.21,95%confidence interval(95%CI):1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75).Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15).Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3.Cognitive and balance performance were not associated with longer return and did not affect median days absence.Conclusion:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times.This may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.

Exploring China's Western and Central County Systems Performance Measured by Outcomes Framework Scores-A Cross-sectional Survey of Routine Healthcare Data

This study was designed to measure the performance of county health systems in central and western China utilizing routine healthcare data.Drawing on a literature review and expert consultation,the study established a theoretical framework and an indicator system for performance review.Questionnaires were designed and disseminated to collect empirical data on health system performance in four counties of two central and western provinces.Quantitative data were subjected to descriptive statistical analysis through SPSS12.0.Three dimensions were introduced in the performance review framework—health outcomes,financial risk protection and consumer and provider satisfaction.Health outcomes were assessed from four secondary indicators：infant mortality rate;maternal mortality rate;under-5 child mortality rate;and the incidence of Class A and Class B notifiable diseases.Financial risk was assessed using two secondary indicators：the proportion of the cost of inpatient care that was reimbursed under the New Cooperative Medical System（NCMS） insurance scheme,and the rate of NCMS funds utilization.The assessment of satisfaction was made using two secondary indicators：the overall satisfaction of local residents with healthcare services,and the satisfaction of health practitioners at the township and village level.The study indicated better health system performance in the two counties in Chongqing than those in Shanxi.It was concluded that outcome framework scores can fairly reveal performance differences among county health systems in central and western China,and can provide practical evidence for optimizing the operation and inputs of county health systems.Caution needs to be exercised in generalizing such performance outcomes as many factors such as spending and organization that contribute to county health system performance were not included in the study.

56 Years of the Marburg Virus—A Review of Therapeutics

Background: The Marburg virus (MARV) is the causative agent of Marburg virus disease (MVD). This filovirus first appeared in 1967 and has since caused several outbreaks with case fatality rates between 23% and 90%. The earliest cases of MVD are thought to be caused by exposure to an infected animal, either a reservoir host (some bat species, e.g., Rousettus aegyptiacus) or a spill-over host, such as non-human primates. The virus is spread between people by direct contact with blood or other bodily fluids (including saliva, sweat, faeces, urine, tears, and breast milk) from infected individuals. Despite the high fatality rate, the Marburg virus has no vaccine or drug treatment. Recent outbreaks of the virus in 2023 in Tanzania and Equatorial Guinea have reignited the need to develop effective therapeutics, especially in the wake of the COVID-19 pandemic. Purpose: This review seeks to highlight the drug discovery efforts aimed at developing vaccines or possible treatments as potential therapeutics. Several existing antiviral agents are being probed, and vaccines are in pre-clinical and clinical stages. Natural products are also an important source of possible drugs or lead compounds and when coupled with computational techniques, these strategies offer possible therapeutics for the Marburg virus, especially in Africa, which has a high disease burden. Methods: Using the search engines Google Scholar and PubMed;keywords e.g. Marburg virus, Marburg treatments, Marburg virus drug discovery were utilized. Several results were yielded, and articles published in recent years were accepted into the final list.Results and Conclusion: This study shows there is a growing interest in therapeutics for the Marburg virus, especially with the recent outbreaks and pandemic preparedness. Initiatives that to support vaccine development and access like the MARVAC consort time are critical to fighting this public health threat.

Cardiovascular risk burden,dementia risk and brain structural imaging markers:a study from UK Biobank

Background Cardiovascular risk burden is associated with dementia risk and neurodegeneration-related brain structure,while the role of genetics and incident cardiovascular disease(CVD)remains unclear.Aims To examine the association of overall cardiovascular risk burden with the risk of major dementia subtypes and volumes of related brain regions in a large sample,and to explore the role of genetics and CVD onset.Methods A prospective study among 354 654 participants free of CVD and dementia(2006-2010,mean age 56.4 years)was conducted within the UK Biobank,with brain magnetic resonance imaging(MRl)measurement availablefor 15104participants since 2014.CVD risk burden was evaluated by the Framingham General Cardiovascular Risk Score(FGCRS).Dementia diagnosis was ascertained from inpatient and death register data.Results Overamedian 12.0-yearfollow-up,3998 all-cause dementia cases were identified.Higher FGCRS was associated with increasedall-cause dementia risk after adjusting for demographic,major lifestyle,clinical factors and the polygenic risk score(PRS)of Alzheimer's disease.Comparing the high versus low tertile of FGCRS,the odds ratios(ORs)and 95%confidence intervals(Cls)were 1.26(1.12 to 1.41)for all-cause dementia,1.67(1.33 to 2.09)for Alzheimer's disease and 1.53(1.07 to 2.16)for vascular dementia(all p_(treng)<0.05).Incident stroke and coronary heart disease accounted for 14%(95%Cl:9% to 21%)of the association between FGCRS and all-cause dementia.Interactions were not detected for FGCRS and PRS on the risk of any dementia subtype.We observed an 83%(95%Cl:47%to 128%)higher all-cause dementia risk comparing the high-high versus low-low FGCRS-PRS category.For brain volumes,higher FGCRS was associated with greater log-transformed white matter hyperintensities,smaller cortical volume and smaller grey matter volume.Conclusions Our findings suggest that the positive association of cardiovascular risk burden with dementia risk also applies to major dementia subtypes.The association of cardiovascular risk burden with all-cause dementia is largely independent of CVD onset and genetic predisposition to dementia.

The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients

BACKGROUND:Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients.The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes(such as acute pulmonary edema necessitating endotracheal intubation).We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefi t from volume resuscitation.DATA RESOURCES:We performed a search using PubMed,Scopus,and MEDLINE.The following search terms were used:fluid responsiveness,ultrasound,non-invasive,hemodynamic,fluid challenge,and passive leg raise.Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient’s cardiovascular ability to respond to intravenous fl uid administration using ultrasound.RESULTS:Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava,common carotid artery,subclavian vein,internal jugular vein,and femoral vein.Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients.CONCLUSION:Ultrasound in combination with passive leg raise is a non-invasive,costand time-effective modality that can be employed to assess volume status and response to fluid resuscitation.Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava,and internal jugular vein.A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.

Immunohistochemical expression of SP-NK-1R-EGFR pathway and VDR in colonic inflammation and neoplasia

AIM:To determine the expression of neurokinin-1receptor(NK-1R),phosphorylated epidermal growth factor receptor(p EGFR),cyclooxygenase-2(Cox-2),and vitamin D receptor(VDR)in normal,inflammatory bowel disease(IBD),and colorectal neoplasia tissues from Puerto Ricans.METHODS:Tissues from patients with IBD,colitisassociated colorectal cancer(CAC),sporadic dysplasia,and sporadic colorectal cancer(CRC),as well as normal controls,were identified at several centers in Puerto Rico.Archival formalin-fixed,paraffin-embedded tissues were de-identified and processed by immunohistochemistry for NK-1R,p EGFR,Cox-2,and VDR.Pictures of representative areas of each tissues diagnosis were taken and scored by three observers using a4-point scale that assessed intensity of staining.Tissues with CAC were further analyzed by photographing representative areas of IBD and the different grades of dysplasia,in addition to the areas of cancer,within each tissue.Differences in the average age between the five patient groups were assessed with one-way analysis of variance and Tukey-Kramer multiple comparisons test.The mean scores for normal tissues and tissues with IBD,dysplasia,CRC,and CAC were calculatedand statistically compared using one-way analysis of variance and Dunnett’s multiple comparisons test.Correlations between protein expression patterns were analyzed with the Pearson’s product-moment correlation coefficient.Data are presented as mean±SE.RESULTS:On average,patients with IBD were younger(34.60±5.81)than normal(63.20±6.13,P<0.01),sporadic dysplasia(68.80±4.42,P<0.01),sporadic cancer(74.80±4.91,P<0.001),and CAC(57.50±5.11,P<0.05)patients.NK-1R in cancer tissue(sporadic CRC,1.73±0.34;CAC,1.57±0.53)and sporadic dysplasia(2.00±0.45)were higher than in normal tissues(0.73±0.19).p EGFR was significantly increased in sporadic CRC(1.53±0.43)and CAC(2.25±0.47)when compared to normal tissue(0.07±0.25,P<0.05,P<0.001,respectively).Cox-2 was significantly increased in sporadic colorectal cancer(2.20±0.23 vs 0.80±0.37 for normal tissues,P<0.05).In comparison to normal(2.80±0.13)and CAC(2.50±0.33)tissues,VDR was significantly decreased in sporadic dysplasia(0.00±0.00,P<0.001 vs normal,P<0.001 vs CAC)and sporadic CRC(0.47±0.23,P<0.001 vs normal,P<0.001 vs CAC).VDR levels negatively correlated with NK-1R(r=-0.48)and p EGFR(r=-0.56)in normal,IBD,sporadic dysplasia and sporadic CRC tissue,but not in CAC.CONCLUSION:Immunohistochemical NK-1R and p EGFR positivity with VDR negativity can be used to identify areas of sporadic colorectal neoplasia.VDR immunoreactivity can distinguish CAC from sporadic cancer.

Epidemic Factors and Control of Hepatic Echinococcosis in Qinghai Province

Hepatic echinococcosis, also called echinococcosis, is a health-threatening disease commonly found in pasture, and belongs to parasitic zoonoses. The purpose of this study was to investigate the prevalence and the risk factors of echinococcosis in Qinghai province in order to provide fundamental data for prevention and control of echinococcosis in Qinghai province. A total of 23 445 people from 21 counties were enrolled in this study by multi-stage stratified random sampling. Echinococcosis was diagnosed by using B-mode ultrasonography and serological tests. The results showed that the prevalence of echinococcosis was 4.47%（95%CI： 4.21%–4.73%） and serum positive rate（seroprevalence） was 15.47%（95%CI： 14.92%–16.02%） in 2010. The distribution of echinococcosis differed in age, sex, ethnicity, occupation and regions in Qinghai（P0.05）. GLMM analysis revealed that gender（female vs. male）, ethnicity（Tibetan vs. other ethnicities）, profession（herders vs. other professions） and region（autonomous prefectures vs. cities） were significant risk factors for echinococcosis（P0.05）. It was concluded that the prevalence of echinococcosis in 2010 was about 4% in Qinghai province, and the distribution of echinococcosis in Qinghai was associated with age, sex, ethnicity and profession.

Bootstrapping Data Envelopment Analysis of Efficiency and Productivity of County Public Hospitals in Eastern, Central, and Western China after the Public Hospital Reform

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.

Efficacy of Jian’ganle(健肝乐) versus Hugan Pian(护肝片),Glucuronolactone and Reduced Glutathione in Prevention of Antituberculosis Drug-induced Liver Injury

Summary： Evidence-based medicine is advocated by WHO and adopted by developed countries for many years. In China, however, the selection of essential medicine and various medical insurance reimbursement schemes medicine is usually based on experts＇ experience of prescription practice which is under heavy critics resulting from the lack of related comparative efficacy and evidence-based research. The efficacy of Jian＇ganle in prevention of drug-induced liver injury （DILI） caused by antituberculotics was evaluated in this study by comparison with Hugan Pian, glucuronolactone and reduced glutathione. Evidence was provided for relevant sectors such as Ministry for Human Resources and Social Security of the People＇s Republic of China and National Health and Family Planning Commission of the Peo- ple＇s Republic of China to select and renew the Essential Medicine List （EML）, the new rural cooperative medical scheme in China （NRCMS） list or the reimbursement list of industrial injury insurance. A total of 189 patients with initial pulmonary tuberculosis were divided into four groups who took antituberculotics combined with Jian＇ganle, Hugan Pian, glucuronolactone and reduced glutathione respectively. Their liver function profile including alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBIL）, direct bilirubin （DBIL）, total protein （TP）, albumin （A） and globulin （G） were detected at admission as baseline and after treatment. The Jian＇ganle group was compared with the three others by chi-square tests. In an aspect of maintaining bilirubin indexes normal, Jian＇ganle was more efficacious than glucuronolactone. And Jian＇ganle had a little more efficacy than reduced glutathione to maintain protein indexes normal as well. And the therapeutic regimen of antituberculotics combined with Jian＇ganle was the best in treating tuberculosis and preventing DILI at the same time. The study showed that among the four hepatinicas which demonstrated similar prevention of DILI caused by antituberculotics, Jian＇ganle has more advantages over the three others to some extent, which provides a reliable basis for health sectors to select and renew the EML, NRCMS List or the reimbursement list of industrial injury insurance.

Experimental Study of Assessment on Ventricular Activation Origin and Contraction Sequence by Doppler Tissue Imaging

To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M mode DTI revealed that the activation in mid interventricular septum was earlier than that in mid left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non invasively.

T-cell/histiocyte-rich large B-cell lymphoma in a child:A case report and review of literature

T-cell/histiocyte-rich large B-cell lymphoma is uncommon in children population. There were few cases reported in the literature with wide range clinical presentations including advanced stage, and more involvement of liver, spleen and bone marrow. Head and neck lymphadenopathy tends to present in younger children. We report a case of 10-year-old boy who initially presented intermittent fever, headaches and neck lymphadenopathy. Subsequently, he developed diffuse lymphadenopathy and hepatosplenomegaly. T-cell/histiocyte-rich large B-cell lymphoma was diagnosed on a cervical lymph node biopsy. Cervical lymphadenopathy in this age group is most commonly reactive or nonmalignant processes. Lymphoma is much less frequent; mainly are non-Hodgkin lymphomas. However, a subset of large B-cell lymphoma called T-cell/histiocyte-rich B-cell lymphoma is rare in children.

The study of KBP of road construction workers of highway AIDS prevention project before and after intervention

Objective:To get scientific basis for further health education through the research of the road construction workers'KBP before and after the interventions of highway AIDS prevention project.Methods:Multi-stage random sampling method was employeed to select workers of 8 sites from 14 sites along highway to investigate their AIDS knowledge,belief and performance(KBP)before and after highway AIDS prevention project.Results:Over 90%of the investigated workers had ever heard about AIDS,and the non-skilled workers of lower educational level improved more after intervention.The correct answer rate of the three transmitting ways of AIDS of drivers which is the focused group of highway before and after intervention had the obvious statistical significance(P<0.05),and the other group's correct answer rates also had improved after intervention.Most people's understanding of preventing AIDS through correct use of condoms when having sex had a statistically significanl differenee(P<0.05)after prevention.The rates of using condoms of foremen and skilled workers when having sex with commercial sex worker/casual partner increased after intervention.Conclusions:The health education of HIV among the road construction workers is effective and further health education of HIV prevention should be cairied out among the road construction workers to improve their knowledge and awareness of avoiding the high-risk behaviors.