We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on pa...We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on patient experience with laparoscopic incisions under an ERAS protocol to highlight the problem of psychosocial and aesthetic concerns,which are often overlooked when planning surgical operations.This study,which involved semistructured interviews with sixteen people,aimed to narrow perioperative education and the decision-making process for incision site selection,thus making the processes more focused on patient priorities.The study is based on a timely but under-researched subject area;however,it is possible to outline four possible areas of improvement that would allow the study to be more transparent and,at the same time,more applicable to clinical practice.展开更多
Background: Exposure to adverse childhood experiences (ACEs) is associated with a higher likelihood of developing psychological disorders among adolescents. The current study aimed to analyze the effect of independent...Background: Exposure to adverse childhood experiences (ACEs) is associated with a higher likelihood of developing psychological disorders among adolescents. The current study aimed to analyze the effect of independent and cumulative effects of ACEs exposure on the likelihood of Posttraumatic Stress Disorder (PTSD) and a Complex PTSD (CPSTD) diagnosis in Indian adolescents. Methods: A sample of 411 schoolchildren participated in the study. It was collected data on exposure to ACEs, PTSD, CPTSD, and attachment styles. Results: It was found that exposure to bullying and threats of violence was significantly associated with PTSD and CPTSD diagnosis, and exposure to physical violence and serious illness was associated with CPTSD diagnosis. Exposure to one ACE and exposure to 2 - 3 ACEs were associated with PTSD and CPTSD diagnosis, while exposure to 4 - 5 ACEs was associated with CPTSD diagnosis. Preoccupied and fearful attachment styles were significantly associated with PTSD and CPTSD diagnosis. Conclusion: The results of the study suggest that biological, psychological, and social factors interact and contribute to the differential prevalence of ACE, attachment styles, and PTSD/CPTSD. This study emphasizes the need of addressing childhood trauma as a public health priority in India.展开更多
Objective:To explore symptom experiences and self-coping patterns during the early and late stages of chemotherapy in these patients to provide a basis for developing targeted symptom management strategies.Methods:A t...Objective:To explore symptom experiences and self-coping patterns during the early and late stages of chemotherapy in these patients to provide a basis for developing targeted symptom management strategies.Methods:A total of 27 patients with pancreatic cancer undergoing chemotherapy at two medical institutions were recruited between November 2023 and August 2024.Semi-structured interviews were conducted in person or over the phone.Data were analyzed using traditional content and thematic analyses.Results:Three themes were identified:symptom experience,self-coping patterns,and existing obstacles.During the early stages of chemotherapy,patients reported a higher frequency of unpleasant symptoms and recognized these symptoms earlier in the treatment course.Patients in the early stages primarily relied on external support to cope with symptoms,while those in the later stages adopted self-care strategies.Several challenges related to unpleasant symptoms were observed,which appeared to correlate with the self-coping patterns employed.Conclusion:Patients with pancreatic cancer undergoing chemotherapy experience a complex and diverse range of symptoms,with varying coping patterns at different stages of treatment.Symptom management during chemotherapy presents significant challenges.Healthcare providers should improve the ongoing monitoring of symptoms post-chemotherapy.By linking patients’symptom experiences and self-coping patterns at different stages of chemotherapy to their specific challenges,personalized symptom management strategies can be developed to enhance care quality.展开更多
Objectives Nurses’clinical research activities have contributed to optimizing the care process and improving patient outcomes,and generative artificial intelligence(GAI)may help clinical nurses strengthen their resea...Objectives Nurses’clinical research activities have contributed to optimizing the care process and improving patient outcomes,and generative artificial intelligence(GAI)may help clinical nurses strengthen their research skills.To support research,this study aimed to explore the Chinese nurses’perceptions and experiences of GAI training.Methods This study used a descriptive qualitative design.The China Nurses Network conducted a three-day training session on“GAI for Nursing Research”theme,we selected 23 nurses by a convenience sampling method among participating in the training.The researchers conducted three focus group interviews at the end of each day.All focus groups were interviewed face-to-face to facilitate interaction,data collection,and observation.The data were analyzed using conventional content analysis and coded manually.Results The results showed that nurses’use of GAI to support scientific research was dynamic and characterized by evolving perceptions and practices.Four themes and 11 sub-themes emerged from the analysis:1)utilization efficacy:cope with research ability,affected by many factors;2)booster research:growth and challenges go hand in hand;3)role reversal:from GAI-dominated to nurse-dominated;4)beautiful dream:more features on research,more assistants on clinical care.Conclusions The effectiveness of GAI in supporting clinical nurses in conducting research is mainly limited by differences in personal research literacy,lack of ethical regulation,and information accuracy.In the future,it is necessary to improve nurses’relevant skills through specialized training and promote the standardization of technical regulations to ensure the appropriate application of GAI in nursing research.展开更多
Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in ...Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in patient self-care and improvements in specialized stoma outpatient services.Methods:Using purposive sampling,13 colorectal cancer patients in the post-discharge transition period who had undergone intestinal stoma surgery were selected from a tertiary hospital in Shandong Province between November 2024 and March 2025.Semi-structured interviews were conducted,and data were analyzed using Colaizzi’s seven-step method to extract themes.Results:Three core themes were identified:challenges in self-management during the transition period,outpatient nursing needs during the transition period,and gaps in doctor-patient information continuity.Conclusion:Future efforts should focus on high-risk groups of stoma patients during the transition period by building intelligent and systematic outpatient guidance and support systems to improve their quality of life.展开更多
Background:Adverse childhood experiences(ACEs)are a significant issue in adolescent health due to their robust correlation with deficits in executive functions(EF)and health risk behaviors(HRBs).This study aimed to ex...Background:Adverse childhood experiences(ACEs)are a significant issue in adolescent health due to their robust correlation with deficits in executive functions(EF)and health risk behaviors(HRBs).This study aimed to examine the association between ACEs and a range of HRBs,including substance use,sexual risk behavior,suicidal ideation,physical inactivity,and violence.Methods:This cross-sectional study used self-administered questionnaire and cluster sampling in seven junior high schools in Samarinda,Indonesia,with a sample size of 534 students.Data analysis using descriptive statistics,the Chi-square test,the independent t-test,ANOVA,binary logistic regression,and mediation analysis with macro-PROCESS.Results:The most common ACEs were community violence(68.0%),physical neglect(52.8%),psychological/emotional abuse(52.6%),physical abuse(50.4%),and peer bullying(45.9%).Adolescents with more than five ACEs showed significantly higher involvement in smoking/vaping(67.9%),suicidal ideation(75.2%),sexual risk behavior(57.7%),bullying(64.3%),and physical fighting(59.7%)(p<0.001).ACEs were significantly correlated with EF deficits(r=0.471,p<0.01)and HRB(r=0.578,p<0.01).Regression analysis confirmed that ACEs predicted EF deficits(β=0.466,p<0.001)and HRB(β=0.469,p<0.001),with EF deficits partially mediating this relationship(β=0.107,95%CI[0.045,0.094]).In addition,two subdomains of EF deficits,self-motivation(β=0.042)and self-regulation of emotion(β=0.032),significantlymediated the relationship between ACEs and HRBs.Conclusion:These findings suggest an important role for EF deficits in linking childhood adversity to engagement in risky behaviors.Addressing ACEs and EF deficits(self-motivation and self-regulation of emotion)through early intervention may be important in reducing long-term health risks among Indonesian adolescents.展开更多
With the intensifying global climate crisis,carbon emissions trading has emerged as a crucial market-based instrument for emissions reduction,attracting significant attention from government agencies and academia worl...With the intensifying global climate crisis,carbon emissions trading has emerged as a crucial market-based instrument for emissions reduction,attracting significant attention from government agencies and academia worldwide.As of January 2024,28 carbon trading markets have been established globally,encompassing approximately 17%of global greenhouse gas emissions and serving approximately 1/3 of the global population.With various nations setting carbon neutrality targets and delineating carbon reduction pathways,the con-struction,operation,and regulatory frameworks of carbon markets are becoming increasingly refined and comprehensive.This study elucidates the importance and necessity of establishing carbon markets from the perspective of energy system transformation and sus-tainable economic development.Second,it provides a comparative analysis of the operational mechanisms,trading scales,and emission reduction outcomes of major carbon markets in the European Union,United States,and New Zealand,systematically summarizing their development processes and recent advancements.Finally,this study addresses issues and challenges in the construction of China’s carbon market.Drawing on the successful experiences of leading global carbon markets in institutional design and market operations,we pro-pose development strategies and recommendations for a carbon market with Chinese characteristics.These strategies are intended to align with international standards while meeting China’s national conditions,thereby contributing insights into the global carbon market trading system.展开更多
Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline...Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline‘Chronic Coronary Heart Disease’recommends that general practitioners(GPs)provide advice on PA to IHD patients.However,the provision of PA advice seems to be inadequately implemented in general practice.One reason is the lack of medical training in providing PA advice effectively and efficiently.International guidelines recommend such training for health professionals.This study aims to explore experiences,perceptions and attitudes,including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients.Methods Between March and June 2023,12 face-to-face problem-centred interviews and six focus group discussions(n=37)with GPs were conducted.Interview and discussion guides were developed and pilot tested by the multi-professional study team.We used a purposive sampling strategy,and data were collected in an iterative process.Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure(deductive and inductive approach).GPs were involved throughout the entire research process,for example,in multi-professional analysis groups.Results Although GPs are mostly aware of the health benefits of PA for patients with IHD,PA advice is not routinely provided.Conversations on PA tend to be rather unstructured,and advice is often addressed more generally than customised to the patients’needs and preferences.Priority is given to other lifestyle issues,such as smoking cessation.PA advice is perceived as time-consuming and rather ineffective with regard to the target behaviour.GPs frequently express frustration in this context.GPs express a lack of and simultaneously a need for communication strategies(structure and tools)that can be integrated into everyday GP practice to motivate patients to PA.Conclusion The results provide relevant insights into the current practice of GPs with regard to their attitudes on,experiences with,and requirements for the provision of PA advice to IHD patients.These results are helpful to inform the development of appropriate GP training in the provision of very brief PA advice to IHD patients.展开更多
Transitioning from outcrossing to self-fertilization is a widespread reproductive strategy in plants,especially in environments where pollination is limited.Despite its prevalence,this transition has rarely been exami...Transitioning from outcrossing to self-fertilization is a widespread reproductive strategy in plants,especially in environments where pollination is limited.Despite its prevalence,this transition has rarely been examined using transplant experiments,and previous studies have overlooked the contribution of the male parent in elucidating mating diversity.In this study,six transplanted populations were generated to investigate the relationship of the pollination environment with plant mating patterns and fecundity in Primula oreodoxa,a species that exhibits both distyly(predominantly outcrossing)and homostyly(predominantly selfing),based on data from 3582 individuals and 11 SSR markers.Homostylous plants had fruit and seed sets comparable to those of distylous plants at lower elevations but exhibited a clear reproductive advantage at higher elevations,particularly compared with the S morph.As elevation increased,the populational selfing rates increased,and the genetic diversity among the progeny was reduced.Furthermore,the visitation frequency of long-tongued pollinators was negatively and positively correlated with the selfing rate and number of mates,respectively,in the L and S morphs.In contrast,short-tongued pollinator visitation showed opposite correlations with the selfing rate and number of mates in homostylous morphs.In most populations,individuals functioned consistently as both female and male,and mating occurred randomly,suggesting a breakdown of the distyly polymorphism.Overall,our results provide experimental validation of the reproductive advantages of homostyly at high elevations by revealing that pollinator visitation shapes the selfing rate and mating diversity within populations,potentially driving the divergence of mating systems along environmental gradients.展开更多
Pathological scarring,manifested in the form of hypertrophic scars(HTS)and keloid scars(KS),represents a major clinical challenge due to its aesthetic and functional implications for patients.Understanding the molecul...Pathological scarring,manifested in the form of hypertrophic scars(HTS)and keloid scars(KS),represents a major clinical challenge due to its aesthetic and functional implications for patients.Understanding the molecular mechanisms involved in these types of scars and developing effective treatments requires the use of controlled ex-perimental models,especially animals,to overcome the limitations of clinical studies.The aim of this sistematic review is to critically analyze the animal models used in the last five years(2020-2025)for the study of pathological scars,highlighting their advantages,limitations and applicability in the development of new therapeutic strat-egies.Murine,rabbit and porcine models,as well as alternative models,offer varied perspectives on the formation and treatment of HTS and KS,with an emphasis on histological and molecular correlations with human pathology.By synthesizing recent data,the paper highlights the essential role of preclinical research in optimizing an-tifibrotic treatments and in advancing the translation of data into the clinical sphere.Overall,animal models remain essential for bridging mechanistic insights with clinical translation,supporting the development of more effective and personalized anti-scar therapies.展开更多
Recovered samples of Jilin H5 chondrite experimentally shocked to 12-133 GPa were studied to explore the behavior of opaque minerals under shock loading using SEM-EDS,Raman spectroscopy,and TIMA.The following results ...Recovered samples of Jilin H5 chondrite experimentally shocked to 12-133 GPa were studied to explore the behavior of opaque minerals under shock loading using SEM-EDS,Raman spectroscopy,and TIMA.The following results were obtained.Firstly,at pressures lower than 53GPa,the opaque minerals still keep the unmelted state,while at 78 GPa and higher,FeNi metal and troilite form eutectic intergrowths occurring as disorderly fine veinlets filling the shock-induced fractures in silicate minerals.Secondly,single kamacite grains still maintain their contour at 12 GPa,but a part of brittle troilite grains was fragmented and squeezed into the shock-induced fractures within kamacite grains.At53 and 133 GPa,many more troilite fragments are poured in the kamacite interior to form disordered hybrid aggregates or to form squiggly strips,respectively.Similar phenomena are observed within single troilite grains,but the mineral squeezed into troilite grains is kamacite.Thirdly,chromite is a hard and refractory oxide mineral.When the shock pressure rises step by step from 12 to 133 GPa,the shock effect of chromite is only fragmentation.Its grain size decreases from tens of um at 53 GPa to a few um at 133 GPa.And,fourthly,native copper exhibits distinct redistribution behavior at high temperature.In Jilin samples shock-loaded to 12 GPa,copper initially located at troilite-kamacite interfaces partially transferred into small troilite grains containing fine FeNi particles.At 53 and 133 GPa,native copper preferentially transferred into larger troilite grains containing more particles of eutectic FeNi metal.展开更多
To meet the need for cultivating application-oriented talents in local universities,this study introduced a project-based learning approach into the reform of bioinformatics experimental teaching.The course was struct...To meet the need for cultivating application-oriented talents in local universities,this study introduced a project-based learning approach into the reform of bioinformatics experimental teaching.The course was structured around a project titled"Influenza Virus Analysis",comprising four progressive modules:database utilization and information retrieval,sequence alignment and phylogenetic analysis,functional and structural prediction,and omics data analysis.These modules were integrated into a coherent research workflow that connected fragmented knowledge and technical skills.During implementation,flipped classroom and group collaboration methods were employed,alongside the establishment of a diversified assessment system emphasizing process evaluation.Teaching practice indicates that the reform effectively enhances students professional application skills,learning experience,and scientific literacy,facilitating a shift from"tool operation"to"problem-solving"capabilities.This study provides a reference model for the reform of bioinformatics experimental teaching in local universities.展开更多
To improve the accuracy of rockburst risk evaluation in mining and tunnelling engineering,the influence of intermediate principal stress σ_(2) deserves further consideration,which has been neglected in general predic...To improve the accuracy of rockburst risk evaluation in mining and tunnelling engineering,the influence of intermediate principal stress σ_(2) deserves further consideration,which has been neglected in general prediction frameworks.This study employs an integrated approach that combines true-triaxial unloading experiments with three-dimensional grain-based discrete element modeling(PFC3D-GBM)to examine the effects of σ_(2) on strain systematically burst and elucidate the underlying mechanisms.Through this dual experimental–numerical methodology,the strainburst characteristics under varying σ_(2) are analyzed in detail regarding mechanical responses,failure evolution and patterns,microscope fracture mechanisms,and energy partitioning.The results indicate that elevated σ_(2) can enhance the bearing capacity of rock,thereby necessitating a higher stress condition required for strainburst.However,it also enlarges the potential strainburst intensity,manifesting as deeper rockburst pits and more violent ejection of rock fragments.An increasing σ_(2) facilitates the microscope transgranular fractures,inhibits intergranular tensile fractures,and raises the kinetic energy conversion ratio slightly.It affects the intensity of strainburst through the following mechanisms,including the increase of energy storage limit,the intensification of Poisson effect for lateral expansion,and the enhancement of the transgranular fracturing mechanism.In practical engineering,the depth and range of support needs to be ensured under high σ_(2) conditions,and it is recommended to use prestressing techniques to control the development of significant slabbing.展开更多
Rock-ice avalanches in cold high-mountain regions pose severe hazards due to their high mobility,yet the quantitative controls of particle-size ratio and ice content remain insufficiently constrained.This study invest...Rock-ice avalanches in cold high-mountain regions pose severe hazards due to their high mobility,yet the quantitative controls of particle-size ratio and ice content remain insufficiently constrained.This study investigates their coupled effects using inclinedflume experiments and Discrete Element Method(DEM)simulations,covering three gravel sizes(2-5 mm,5-7 mm,7-10 mm)and four ice-content levels(0%,20%,40%,60%).Run-out distance,velocity,energy components,flow regime(Savage number),and segregation indexαwere quantified.Increasing ice content significantly enhances mobility,but with diminishing marginal effectiveness.From 0%to 40%ice content,run-out distance increases by 41%-86%,whereas the additional increase from 40%to 60%contributes only 12%-23%.Particle-size ratio strongly governs segregation intensity.Fine-gravel groups reach segregation indices ofα=0.92-0.98,indicating nearly complete upward migration of ice,whereas medium-gravel and coarse-gravel groups exhibit much weaker segregation,stabilizing atα=0.68-0.74 and 0.60-0.69.Savage number analyses reveal marked flow-regime transitions.At 0%ice content,Savage numbers reach 1.0-1.5,indicating a collisional regime.Increasing ice content suppresses collisionality,with Savage numbers decreasing to 0.03-0.07 at 60%ice content,consistent with dense-regime flow.DEM energy analyses confirm this regime shift:for finegravel mixtures,collision energy decreases by 14%,while sliding-friction energy increases by 33%as ice content increases from 0%to 60%,reflecting enhanced overburden effects imposed by upward-segregated ice layers.Medium and coarse mixtures exhibit weaker or opposite energy-shift patterns,demonstrating strong size dependence.Mechanistically,large particle-size contrasts promote strong segregation and form dense basal rock layers that increase basal friction and reduce mobility.When particle sizes are similar or ice content is high,segregation remains limited,allowing ice to mix into the basal layer,thereby reducing basal friction and enhancing mobility.This research quantitatively demonstrates how composition controls particle spatial distribution,flow regime,and energy dissipation,offering new mechanistic insights into the propagation and deposition behaviors of rock-ice avalanches and improving hazard assessment in vulnerable high-mountain regions.展开更多
The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decrease...The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decreased.Moreover,the development of minimally invasive endoscopic treatment has been introduced for these early lesions.Endoscopic submucosal dissection(ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis.We review the results of ESD including experiences in Japan and Korea,as well as western countries.展开更多
Clinical practice remains an integral part of nursing curriculum because clinical practice provides students with an opportunity to achieve professional competence. Creating a conducive learning environment for studen...Clinical practice remains an integral part of nursing curriculum because clinical practice provides students with an opportunity to achieve professional competence. Creating a conducive learning environment for students is responsibility of academic staff, clinical nurses and students alike. However, studies in Malawi have reported poor clinical learning environment for students. This study therefore aimed at exploring nurses’ experiences of clinical teaching environment in Malawi. The study used a qualitative research design utilizing a descriptive phenomenological approach. Participants were randomly identified from teaching hospitals across Malawi by nursing managers to attend a six week clinical preceptorship training at one University nursing college. Immediately before commencement of the training, participants were invited to voluntarily participate in a focus group discussion pertaining to their experiences with clinical environment. We conducted focus group discussions with 9 trainees in 2013 and 12 trainees in 2014 training cohorts. Findings reveal that nurses meet a number of challenges in teaching students in the clinical area. Four themes emerged from the study, namely, inadequate faculty support, poor clinical teaching environment, poor competence among nurses and unsupportive working conditions. Nurses require support from academic staff and their managers to ensure a conducive clinical teaching environment.展开更多
Ernest Hemingway, one of the brightest stars on the literary stage of both American and the whole world literature in the twentieth century, had gained an everlasting reputation by the image of"the tough man"...Ernest Hemingway, one of the brightest stars on the literary stage of both American and the whole world literature in the twentieth century, had gained an everlasting reputation by the image of"the tough man"he created in lots of his works.Hence, to readers, Hemingway must be a strong man both physically and mentally. Though Hemingway had passed away, he left us an inestimable literary treasure, and we can draw some lessons from his suicide tragedy. To modern people who are展开更多
Professor Jiping ZHAO has unique thoughts on the diagnosis and treatment of peripheral facial paralysis.She pays the great attention to clinical differentiation in treatment with acupuncture, especially meridian diffe...Professor Jiping ZHAO has unique thoughts on the diagnosis and treatment of peripheral facial paralysis.She pays the great attention to clinical differentiation in treatment with acupuncture, especially meridian differentiation. She believes that the differentiation of lesion is core and the early judgment is critical for the better therapeutic effects on intractable facial paralysis. The local acupoints are selected in the guide of the theory of meridian sinew and stimulated on the base of three-needling theory. The distal acupoints are decided in light of the syndrome differentiation, of which, Hégǔ(合谷 LI 4), Zúsānlǐ(足三里ST 36) and Taichōng(太冲 LR 3) are the basic acupoints. Additionally, Professor ZHAO lays the emphasis on the 5 th branch of facial nerve(cervical branch) in diagnosis and treatment.展开更多
文摘We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on patient experience with laparoscopic incisions under an ERAS protocol to highlight the problem of psychosocial and aesthetic concerns,which are often overlooked when planning surgical operations.This study,which involved semistructured interviews with sixteen people,aimed to narrow perioperative education and the decision-making process for incision site selection,thus making the processes more focused on patient priorities.The study is based on a timely but under-researched subject area;however,it is possible to outline four possible areas of improvement that would allow the study to be more transparent and,at the same time,more applicable to clinical practice.
文摘Background: Exposure to adverse childhood experiences (ACEs) is associated with a higher likelihood of developing psychological disorders among adolescents. The current study aimed to analyze the effect of independent and cumulative effects of ACEs exposure on the likelihood of Posttraumatic Stress Disorder (PTSD) and a Complex PTSD (CPSTD) diagnosis in Indian adolescents. Methods: A sample of 411 schoolchildren participated in the study. It was collected data on exposure to ACEs, PTSD, CPTSD, and attachment styles. Results: It was found that exposure to bullying and threats of violence was significantly associated with PTSD and CPTSD diagnosis, and exposure to physical violence and serious illness was associated with CPTSD diagnosis. Exposure to one ACE and exposure to 2 - 3 ACEs were associated with PTSD and CPTSD diagnosis, while exposure to 4 - 5 ACEs was associated with CPTSD diagnosis. Preoccupied and fearful attachment styles were significantly associated with PTSD and CPTSD diagnosis. Conclusion: The results of the study suggest that biological, psychological, and social factors interact and contribute to the differential prevalence of ACE, attachment styles, and PTSD/CPTSD. This study emphasizes the need of addressing childhood trauma as a public health priority in India.
基金supported by the State Key Laboratory of Ultrasonic Medical Engineering/the Chongqing Science and Technology Bureau(Project No.2022KFKT7011)the Postdoctoral Fellowship Program of CPSF(GZC20233357)+1 种基金the Health Commission of Sichuan Province Medical Science and Technology Program(24QNMP007)the Medical Research Program of Health Commission of Chengdu(2023535).
文摘Objective:To explore symptom experiences and self-coping patterns during the early and late stages of chemotherapy in these patients to provide a basis for developing targeted symptom management strategies.Methods:A total of 27 patients with pancreatic cancer undergoing chemotherapy at two medical institutions were recruited between November 2023 and August 2024.Semi-structured interviews were conducted in person or over the phone.Data were analyzed using traditional content and thematic analyses.Results:Three themes were identified:symptom experience,self-coping patterns,and existing obstacles.During the early stages of chemotherapy,patients reported a higher frequency of unpleasant symptoms and recognized these symptoms earlier in the treatment course.Patients in the early stages primarily relied on external support to cope with symptoms,while those in the later stages adopted self-care strategies.Several challenges related to unpleasant symptoms were observed,which appeared to correlate with the self-coping patterns employed.Conclusion:Patients with pancreatic cancer undergoing chemotherapy experience a complex and diverse range of symptoms,with varying coping patterns at different stages of treatment.Symptom management during chemotherapy presents significant challenges.Healthcare providers should improve the ongoing monitoring of symptoms post-chemotherapy.By linking patients’symptom experiences and self-coping patterns at different stages of chemotherapy to their specific challenges,personalized symptom management strategies can be developed to enhance care quality.
基金supported by a grant from the National Natural Science Foundation of China(No.72174130)。
文摘Objectives Nurses’clinical research activities have contributed to optimizing the care process and improving patient outcomes,and generative artificial intelligence(GAI)may help clinical nurses strengthen their research skills.To support research,this study aimed to explore the Chinese nurses’perceptions and experiences of GAI training.Methods This study used a descriptive qualitative design.The China Nurses Network conducted a three-day training session on“GAI for Nursing Research”theme,we selected 23 nurses by a convenience sampling method among participating in the training.The researchers conducted three focus group interviews at the end of each day.All focus groups were interviewed face-to-face to facilitate interaction,data collection,and observation.The data were analyzed using conventional content analysis and coded manually.Results The results showed that nurses’use of GAI to support scientific research was dynamic and characterized by evolving perceptions and practices.Four themes and 11 sub-themes emerged from the analysis:1)utilization efficacy:cope with research ability,affected by many factors;2)booster research:growth and challenges go hand in hand;3)role reversal:from GAI-dominated to nurse-dominated;4)beautiful dream:more features on research,more assistants on clinical care.Conclusions The effectiveness of GAI in supporting clinical nurses in conducting research is mainly limited by differences in personal research literacy,lack of ethical regulation,and information accuracy.In the future,it is necessary to improve nurses’relevant skills through specialized training and promote the standardization of technical regulations to ensure the appropriate application of GAI in nursing research.
文摘Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in patient self-care and improvements in specialized stoma outpatient services.Methods:Using purposive sampling,13 colorectal cancer patients in the post-discharge transition period who had undergone intestinal stoma surgery were selected from a tertiary hospital in Shandong Province between November 2024 and March 2025.Semi-structured interviews were conducted,and data were analyzed using Colaizzi’s seven-step method to extract themes.Results:Three core themes were identified:challenges in self-management during the transition period,outpatient nursing needs during the transition period,and gaps in doctor-patient information continuity.Conclusion:Future efforts should focus on high-risk groups of stoma patients during the transition period by building intelligent and systematic outpatient guidance and support systems to improve their quality of life.
基金supported by the STI 2030-Major Projects(2021ZD0200500).
文摘Background:Adverse childhood experiences(ACEs)are a significant issue in adolescent health due to their robust correlation with deficits in executive functions(EF)and health risk behaviors(HRBs).This study aimed to examine the association between ACEs and a range of HRBs,including substance use,sexual risk behavior,suicidal ideation,physical inactivity,and violence.Methods:This cross-sectional study used self-administered questionnaire and cluster sampling in seven junior high schools in Samarinda,Indonesia,with a sample size of 534 students.Data analysis using descriptive statistics,the Chi-square test,the independent t-test,ANOVA,binary logistic regression,and mediation analysis with macro-PROCESS.Results:The most common ACEs were community violence(68.0%),physical neglect(52.8%),psychological/emotional abuse(52.6%),physical abuse(50.4%),and peer bullying(45.9%).Adolescents with more than five ACEs showed significantly higher involvement in smoking/vaping(67.9%),suicidal ideation(75.2%),sexual risk behavior(57.7%),bullying(64.3%),and physical fighting(59.7%)(p<0.001).ACEs were significantly correlated with EF deficits(r=0.471,p<0.01)and HRB(r=0.578,p<0.01).Regression analysis confirmed that ACEs predicted EF deficits(β=0.466,p<0.001)and HRB(β=0.469,p<0.001),with EF deficits partially mediating this relationship(β=0.107,95%CI[0.045,0.094]).In addition,two subdomains of EF deficits,self-motivation(β=0.042)and self-regulation of emotion(β=0.032),significantlymediated the relationship between ACEs and HRBs.Conclusion:These findings suggest an important role for EF deficits in linking childhood adversity to engagement in risky behaviors.Addressing ACEs and EF deficits(self-motivation and self-regulation of emotion)through early intervention may be important in reducing long-term health risks among Indonesian adolescents.
基金support of the SGCC Science and Technology Project“Cost Analysis,Market Bidding Mechanism Research and Validation of New Power Sys-tem Transformation under a Diversified Value System”(1400-202357380A-2-3-XG)for this article.
文摘With the intensifying global climate crisis,carbon emissions trading has emerged as a crucial market-based instrument for emissions reduction,attracting significant attention from government agencies and academia worldwide.As of January 2024,28 carbon trading markets have been established globally,encompassing approximately 17%of global greenhouse gas emissions and serving approximately 1/3 of the global population.With various nations setting carbon neutrality targets and delineating carbon reduction pathways,the con-struction,operation,and regulatory frameworks of carbon markets are becoming increasingly refined and comprehensive.This study elucidates the importance and necessity of establishing carbon markets from the perspective of energy system transformation and sus-tainable economic development.Second,it provides a comparative analysis of the operational mechanisms,trading scales,and emission reduction outcomes of major carbon markets in the European Union,United States,and New Zealand,systematically summarizing their development processes and recent advancements.Finally,this study addresses issues and challenges in the construction of China’s carbon market.Drawing on the successful experiences of leading global carbon markets in institutional design and market operations,we pro-pose development strategies and recommendations for a carbon market with Chinese characteristics.These strategies are intended to align with international standards while meeting China’s national conditions,thereby contributing insights into the global carbon market trading system.
基金funded as a junior research group in health services research by the German Ministry of Education and Research(BMBF)(funding period:05/2022-04/2027,grant number:01GY2103).
文摘Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline‘Chronic Coronary Heart Disease’recommends that general practitioners(GPs)provide advice on PA to IHD patients.However,the provision of PA advice seems to be inadequately implemented in general practice.One reason is the lack of medical training in providing PA advice effectively and efficiently.International guidelines recommend such training for health professionals.This study aims to explore experiences,perceptions and attitudes,including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients.Methods Between March and June 2023,12 face-to-face problem-centred interviews and six focus group discussions(n=37)with GPs were conducted.Interview and discussion guides were developed and pilot tested by the multi-professional study team.We used a purposive sampling strategy,and data were collected in an iterative process.Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure(deductive and inductive approach).GPs were involved throughout the entire research process,for example,in multi-professional analysis groups.Results Although GPs are mostly aware of the health benefits of PA for patients with IHD,PA advice is not routinely provided.Conversations on PA tend to be rather unstructured,and advice is often addressed more generally than customised to the patients’needs and preferences.Priority is given to other lifestyle issues,such as smoking cessation.PA advice is perceived as time-consuming and rather ineffective with regard to the target behaviour.GPs frequently express frustration in this context.GPs express a lack of and simultaneously a need for communication strategies(structure and tools)that can be integrated into everyday GP practice to motivate patients to PA.Conclusion The results provide relevant insights into the current practice of GPs with regard to their attitudes on,experiences with,and requirements for the provision of PA advice to IHD patients.These results are helpful to inform the development of appropriate GP training in the provision of very brief PA advice to IHD patients.
基金funded by grants from the National Natural Science Foundation of China(31800314,32370239,U160323)the foundation of South China Botanical Garden,Chinese Academy of Sciences(QNXM-06)to SY and the Doctoral Research Foundation of China West Normal University(412994).
文摘Transitioning from outcrossing to self-fertilization is a widespread reproductive strategy in plants,especially in environments where pollination is limited.Despite its prevalence,this transition has rarely been examined using transplant experiments,and previous studies have overlooked the contribution of the male parent in elucidating mating diversity.In this study,six transplanted populations were generated to investigate the relationship of the pollination environment with plant mating patterns and fecundity in Primula oreodoxa,a species that exhibits both distyly(predominantly outcrossing)and homostyly(predominantly selfing),based on data from 3582 individuals and 11 SSR markers.Homostylous plants had fruit and seed sets comparable to those of distylous plants at lower elevations but exhibited a clear reproductive advantage at higher elevations,particularly compared with the S morph.As elevation increased,the populational selfing rates increased,and the genetic diversity among the progeny was reduced.Furthermore,the visitation frequency of long-tongued pollinators was negatively and positively correlated with the selfing rate and number of mates,respectively,in the L and S morphs.In contrast,short-tongued pollinator visitation showed opposite correlations with the selfing rate and number of mates in homostylous morphs.In most populations,individuals functioned consistently as both female and male,and mating occurred randomly,suggesting a breakdown of the distyly polymorphism.Overall,our results provide experimental validation of the reproductive advantages of homostyly at high elevations by revealing that pollinator visitation shapes the selfing rate and mating diversity within populations,potentially driving the divergence of mating systems along environmental gradients.
基金Ministry of Research,Innovation and Digitization,CCCDI-UEFISCDI,Grant/Award Number:PN-IV-P7-7.1-PED-2024-1578,within PNCDI Ⅳ.
文摘Pathological scarring,manifested in the form of hypertrophic scars(HTS)and keloid scars(KS),represents a major clinical challenge due to its aesthetic and functional implications for patients.Understanding the molecular mechanisms involved in these types of scars and developing effective treatments requires the use of controlled ex-perimental models,especially animals,to overcome the limitations of clinical studies.The aim of this sistematic review is to critically analyze the animal models used in the last five years(2020-2025)for the study of pathological scars,highlighting their advantages,limitations and applicability in the development of new therapeutic strat-egies.Murine,rabbit and porcine models,as well as alternative models,offer varied perspectives on the formation and treatment of HTS and KS,with an emphasis on histological and molecular correlations with human pathology.By synthesizing recent data,the paper highlights the essential role of preclinical research in optimizing an-tifibrotic treatments and in advancing the translation of data into the clinical sphere.Overall,animal models remain essential for bridging mechanistic insights with clinical translation,supporting the development of more effective and personalized anti-scar therapies.
基金Science and Technology Planning Project of Guangdong Province,2023B1212060048,Xiande Xie。
文摘Recovered samples of Jilin H5 chondrite experimentally shocked to 12-133 GPa were studied to explore the behavior of opaque minerals under shock loading using SEM-EDS,Raman spectroscopy,and TIMA.The following results were obtained.Firstly,at pressures lower than 53GPa,the opaque minerals still keep the unmelted state,while at 78 GPa and higher,FeNi metal and troilite form eutectic intergrowths occurring as disorderly fine veinlets filling the shock-induced fractures in silicate minerals.Secondly,single kamacite grains still maintain their contour at 12 GPa,but a part of brittle troilite grains was fragmented and squeezed into the shock-induced fractures within kamacite grains.At53 and 133 GPa,many more troilite fragments are poured in the kamacite interior to form disordered hybrid aggregates or to form squiggly strips,respectively.Similar phenomena are observed within single troilite grains,but the mineral squeezed into troilite grains is kamacite.Thirdly,chromite is a hard and refractory oxide mineral.When the shock pressure rises step by step from 12 to 133 GPa,the shock effect of chromite is only fragmentation.Its grain size decreases from tens of um at 53 GPa to a few um at 133 GPa.And,fourthly,native copper exhibits distinct redistribution behavior at high temperature.In Jilin samples shock-loaded to 12 GPa,copper initially located at troilite-kamacite interfaces partially transferred into small troilite grains containing fine FeNi particles.At 53 and 133 GPa,native copper preferentially transferred into larger troilite grains containing more particles of eutectic FeNi metal.
基金Supported by Undergraduate Higher Education Teaching Quality and Reform Projects of Guangdong Province(Yuejiao Gao Han[2024]No.9,Yuejiao Gao Han[2024]No.30)Guangdong Basic and Applied Basic Research Foundation(2023A1515110973)+1 种基金Guangdong Provincial Young Innovative Talents Project of General Colleges and Universities(2023KQNCX089)Quality Engineering and Teaching Reform Projects of Zhaoqing University(zlgc202239,zlgc202207,zlgc2024005,zlgc2024038).
文摘To meet the need for cultivating application-oriented talents in local universities,this study introduced a project-based learning approach into the reform of bioinformatics experimental teaching.The course was structured around a project titled"Influenza Virus Analysis",comprising four progressive modules:database utilization and information retrieval,sequence alignment and phylogenetic analysis,functional and structural prediction,and omics data analysis.These modules were integrated into a coherent research workflow that connected fragmented knowledge and technical skills.During implementation,flipped classroom and group collaboration methods were employed,alongside the establishment of a diversified assessment system emphasizing process evaluation.Teaching practice indicates that the reform effectively enhances students professional application skills,learning experience,and scientific literacy,facilitating a shift from"tool operation"to"problem-solving"capabilities.This study provides a reference model for the reform of bioinformatics experimental teaching in local universities.
基金supported by the National Natural Science Foundation of China(No.42507210)the Fundamental Research Funds for the Central Universities(No.2025XJSB01)+1 种基金the State Key Laboratory for Tunnel Engineering(No.SKLTEK202421)the Foundation of Key Laboratory of Deep Coal Resource Mining(China University of Mining and Technology),Ministry of Education(No.KLDCRMMOE24KF11).
文摘To improve the accuracy of rockburst risk evaluation in mining and tunnelling engineering,the influence of intermediate principal stress σ_(2) deserves further consideration,which has been neglected in general prediction frameworks.This study employs an integrated approach that combines true-triaxial unloading experiments with three-dimensional grain-based discrete element modeling(PFC3D-GBM)to examine the effects of σ_(2) on strain systematically burst and elucidate the underlying mechanisms.Through this dual experimental–numerical methodology,the strainburst characteristics under varying σ_(2) are analyzed in detail regarding mechanical responses,failure evolution and patterns,microscope fracture mechanisms,and energy partitioning.The results indicate that elevated σ_(2) can enhance the bearing capacity of rock,thereby necessitating a higher stress condition required for strainburst.However,it also enlarges the potential strainburst intensity,manifesting as deeper rockburst pits and more violent ejection of rock fragments.An increasing σ_(2) facilitates the microscope transgranular fractures,inhibits intergranular tensile fractures,and raises the kinetic energy conversion ratio slightly.It affects the intensity of strainburst through the following mechanisms,including the increase of energy storage limit,the intensification of Poisson effect for lateral expansion,and the enhancement of the transgranular fracturing mechanism.In practical engineering,the depth and range of support needs to be ensured under high σ_(2) conditions,and it is recommended to use prestressing techniques to control the development of significant slabbing.
基金funded by the Natural Science Foundation of China(Grants No 42277127)。
文摘Rock-ice avalanches in cold high-mountain regions pose severe hazards due to their high mobility,yet the quantitative controls of particle-size ratio and ice content remain insufficiently constrained.This study investigates their coupled effects using inclinedflume experiments and Discrete Element Method(DEM)simulations,covering three gravel sizes(2-5 mm,5-7 mm,7-10 mm)and four ice-content levels(0%,20%,40%,60%).Run-out distance,velocity,energy components,flow regime(Savage number),and segregation indexαwere quantified.Increasing ice content significantly enhances mobility,but with diminishing marginal effectiveness.From 0%to 40%ice content,run-out distance increases by 41%-86%,whereas the additional increase from 40%to 60%contributes only 12%-23%.Particle-size ratio strongly governs segregation intensity.Fine-gravel groups reach segregation indices ofα=0.92-0.98,indicating nearly complete upward migration of ice,whereas medium-gravel and coarse-gravel groups exhibit much weaker segregation,stabilizing atα=0.68-0.74 and 0.60-0.69.Savage number analyses reveal marked flow-regime transitions.At 0%ice content,Savage numbers reach 1.0-1.5,indicating a collisional regime.Increasing ice content suppresses collisionality,with Savage numbers decreasing to 0.03-0.07 at 60%ice content,consistent with dense-regime flow.DEM energy analyses confirm this regime shift:for finegravel mixtures,collision energy decreases by 14%,while sliding-friction energy increases by 33%as ice content increases from 0%to 60%,reflecting enhanced overburden effects imposed by upward-segregated ice layers.Medium and coarse mixtures exhibit weaker or opposite energy-shift patterns,demonstrating strong size dependence.Mechanistically,large particle-size contrasts promote strong segregation and form dense basal rock layers that increase basal friction and reduce mobility.When particle sizes are similar or ice content is high,segregation remains limited,allowing ice to mix into the basal layer,thereby reducing basal friction and enhancing mobility.This research quantitatively demonstrates how composition controls particle spatial distribution,flow regime,and energy dissipation,offering new mechanistic insights into the propagation and deposition behaviors of rock-ice avalanches and improving hazard assessment in vulnerable high-mountain regions.
文摘The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decreased.Moreover,the development of minimally invasive endoscopic treatment has been introduced for these early lesions.Endoscopic submucosal dissection(ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis.We review the results of ESD including experiences in Japan and Korea,as well as western countries.
文摘Clinical practice remains an integral part of nursing curriculum because clinical practice provides students with an opportunity to achieve professional competence. Creating a conducive learning environment for students is responsibility of academic staff, clinical nurses and students alike. However, studies in Malawi have reported poor clinical learning environment for students. This study therefore aimed at exploring nurses’ experiences of clinical teaching environment in Malawi. The study used a qualitative research design utilizing a descriptive phenomenological approach. Participants were randomly identified from teaching hospitals across Malawi by nursing managers to attend a six week clinical preceptorship training at one University nursing college. Immediately before commencement of the training, participants were invited to voluntarily participate in a focus group discussion pertaining to their experiences with clinical environment. We conducted focus group discussions with 9 trainees in 2013 and 12 trainees in 2014 training cohorts. Findings reveal that nurses meet a number of challenges in teaching students in the clinical area. Four themes emerged from the study, namely, inadequate faculty support, poor clinical teaching environment, poor competence among nurses and unsupportive working conditions. Nurses require support from academic staff and their managers to ensure a conducive clinical teaching environment.
文摘Ernest Hemingway, one of the brightest stars on the literary stage of both American and the whole world literature in the twentieth century, had gained an everlasting reputation by the image of"the tough man"he created in lots of his works.Hence, to readers, Hemingway must be a strong man both physically and mentally. Though Hemingway had passed away, he left us an inestimable literary treasure, and we can draw some lessons from his suicide tragedy. To modern people who are
基金Supported by "Double Hundred Project" of Beijing Administration of Traditional Chinese MedicineThe Fund for Beijing Science & Technology Development of TCM:QN2016-13
文摘Professor Jiping ZHAO has unique thoughts on the diagnosis and treatment of peripheral facial paralysis.She pays the great attention to clinical differentiation in treatment with acupuncture, especially meridian differentiation. She believes that the differentiation of lesion is core and the early judgment is critical for the better therapeutic effects on intractable facial paralysis. The local acupoints are selected in the guide of the theory of meridian sinew and stimulated on the base of three-needling theory. The distal acupoints are decided in light of the syndrome differentiation, of which, Hégǔ(合谷 LI 4), Zúsānlǐ(足三里ST 36) and Taichōng(太冲 LR 3) are the basic acupoints. Additionally, Professor ZHAO lays the emphasis on the 5 th branch of facial nerve(cervical branch) in diagnosis and treatment.
