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Abstract Background Recognizing and appropriately responding to ethical considerations is a crucial element of ethical nursing practice. To mitigate instances of ethical incongruity in healthcare and to promote nurses’ comprehension of their professional ethical responsibilities, it is imperative for researchers to accurately evaluate ethical sensitivity. Conducting a systematic review of the available instruments would enable practitioners to determine the most suitable instrument for implementation in the field of nursing. Aim This review aims to systematically assess the measurement properties of instruments used to measure ethical sensitivity in nursing. Methods A systematic literature search was conducted in July 2022 in the following electronic databases: Scopus, CINAHL, APAPsycINFO, Embase, Web of Science, and PubMed. Two reviewers independently screened and assessed the studies in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The updated criteria for good measurement properties are used to rate the result of measurement properties, and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the quality of the summarized evidence. Results This review encompasses a total of 29 studies that describe 11 different instruments. Neither cross-cultural validity nor responsiveness was examined in any of the included studies. Whereas the majority of the instruments were conducted with at least some type of validity assessment, nearly all of the reliability results rated were indeterminate. Two instruments were recommended, the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units. It is recommended that new self-administration instruments for special nursing settings be developed in accordance with the item response theory (IRT)/Rasch model. Conclusion The selection of ethical sensitivity measurement instruments in nursing, and further research on the development, psychometric, and cross-cultural adaptation of these instruments, could be conducted in accordance with the findings and suggestions of this systematic review. Strengths and limitations • This review was conducted to assess 11 instruments that were used to measure ethical sensitivity in nursing in 29 studies. • The Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units can be recommended, but further reliability and cross-cultural validity testing are needed. • The IRT/Rasch model is also recommended to measure ethical sensitivity in nursing. • The potential limitation of utilizing the COSMIN checklist for assessing methodological quality is worth considering. • Test–retest was considered inappropriate; thus, the reliability testing of ethical sensitivity measurement instruments still needs to be explored.

Abstract Fulminant myocarditis has been defined as the clinical manifestation of cardiac inflammation with rapid-onset heart failure and cardiogenic shock. We report on the case of a 17-year-old boy with hemodynamic derangement and cardiac arrest due to fulminant myocarditis. After about 2 h of intensive cardiopulmonary resuscitation, with 13 days of extracorporeal membrane oxygenation support, the patient finally bridged to orthotopic heart transplantation. The patient recovered uneventfully and was discharged 37 days after transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls confirming the diagnosis and identifying the underlying cause of fulminant myocarditis.

Abstract In this paper, a framework of obstacle avoidance algorithm applied to power line damage safety distance detection is constructed, and its overall architecture and key processes are described in detail. The system design covers three core modules: visual data acquisition and preliminary processing, accurate target recognition and distance measurement, and system error analysis and correction. In the visual data processing chain, we deeply analyze every step from image acquisition to preprocessing to feature extraction, aiming to enhance the adaptability of applications to complex scenes. The target recognition and distance estimation part integrates advanced technology of deep learning to improve the reliability of recognition accuracy and distance estimation. In addition, many common error sources, such as system bias, parallax discontinuity, fluctuation of illumination conditions, etc., are discussed in depth, and corresponding correction strategies are proposed to ensure the accuracy and stability of the system, which provides powerful technical support for achieving efficient and accurate safety monitoring. Specifically, by carefully adjusting the learning rate, convolution kernel size, batch size, pooling layer type, and number of hidden layer nodes, we succeeded in improving the overall accuracy from the initial average of 92.4–95%, and the error rate decreased accordingly.

ABSTRACT Background and Aims The immune microenvironment (IME) plays a crucial role in the progression of hepatocellular carcinoma (HCC). In HCC, the IME is often compromised by hepatitis B virus (HBV) infection, chronic inflammation, and fibrosis. Both antiviral therapy (AVT) and the alleviation of inflammation and fibrosis (AIF) have been shown to improve prognosis. However, the relationship among the IME of HCC, AVT, and AIF remains unclear. Methods A total of 140 and 110 primary HBV‐related HCC patients were enrolled as training and validation sets, respectively, to establish a HCC‐immune microenvironment score (H‐IME score). Immunohistochemistry was performed to assess the number of granzyme B+ (GrB+) and Foxp3+ cells, as well as the expression of CTLA‐4, PD‐1, LAG3, TIGIT, TIM3, and VISTA. Another cohort consisting of 114 recurrent HBV‐related HCC patients with paired primary and recurrent tissues was used to study the relationship among the IME of HCC, AVT, and AIF. Results The H‐IME score, including GrB, Foxp3, CTLA‐4, PD‐1, LAG3, and TIGIT, was established to evaluate the IME. A higher H‐IME score indicates stronger immunosuppressive activities. Both AVT and AIF were found to inhibit immunosuppressive activities in the IME. Compared to primary tumors, the H‐IME scores of recurrent tumors in the effective AVT group (e‐AVT, classified by HBV DNA) with AIF decreased, while the scores increased in the non‐AVT group without AIF. Conclusions The IME of HCC is closely related to AVT and AIF. e‐AVT can enhance anti‐tumor activities in the IME by alleviating inflammation and fibrosis.

Abstract To better detect targets that may cause external damage to transmission lines, the authors present You Only Look Once‐Asymptotic Feature Pyramid Network (YOLO‐AFPN), a lightweight but efficient model. Firstly, the authors adopt a feature comparison strategy based on the knowledge of transmission line scenes, which facilitates increased attention to target features during the training. Secondly, the YOLOv8 detection network is built, and the backbone adds three layers of simple parameter‐free attention module, which extracts features while maintaining lightness, and improves the detection capability in complex scenarios. Then, in the feature fusion stage, an AFPN is constructed, which improves the multi‐scale target detection capability while reducing the number of model parameters by asymptotically fusing features that have small semantic gaps between neighbouring layers. When during the training process, the improved Mosaic data augmentation method is used to enhance the number of distributions of small targets, improve the robustness of the model. Finally, the improved model is validated, and the experimental results show that the improved model can achieve mean average precision of 86.1% at 6.6 MB, which is better than the original network for detection and meets the requirements for deployment on edge devices.

Abstract Introduction Post-stroke depression (PSD) is a prevalent complication that has been shown to have a negative impact on rehabilitation outcomes and quality of life and poses a significant risk for suicidal intention. However, models for discriminating and predicting PSD in stroke survivors for effective secondary prevention strategies are inadequate as the pathogenesis of PSD remains unknown. Prognostic prediction models that exhibit greater rule-in capacity have the potential to mitigate the issue of underdiagnosis and undertreatment of PSD. Thus, the planned study aims to systematically review and critically evaluate published studies on prognostic prediction models for PSD. Methods and analysis A systematic literature search will be conducted in PubMed and Embase through Ovid. Two reviewers will complete study screening, data extraction, and quality assessment utilizing appropriate tools. Qualitative data on the characteristics of the included studies, methodological quality, and the appraisal of the clinical applicability of models will be summarized in the form of narrative comments and tables or figures. The predictive performance of the same model involving multiple studies will be synthesized with a random effects meta-analysis model or meta-regression, taking into account heterogeneity. Ethics and dissemination Ethical approval is considered not applicable for this systematic review. Findings will be shared through dissemination at academic conferences and/or publication in peer-reviewed academic journals. Systematic review registration PROSPERO CRD42023388548.

The damage evolution process of layered rock is influenced by its fine structure, lamination direction, and confining pressure, exhibiting significant anisotropic characteristics. This study focuses on shale as the research object, employing indoor tests and theoretical analysis to define damage variables and initial damage based on ultrasonic wave velocity. This research investigates the damage evolution law of layered rock under varying confining pressures and dip angles. The findings reveal that damage variables defined using transverse wave velocity effectively reflect the damage evolution process. Additionally, confining pressure significantly affects damage evolution, with increasing pressure causing a rightward shift in the damage variable–strain curve and an increase in initial damage. The slab inclination angle also influences damage evolution; samples with 45° and 60° inclinations are more susceptible to damage, with initial damage showing a trend of increasing and then decreasing. To accurately describe the relationship between damage variables and strain during the loading process, this paper establishes a segmented damage evolution equation characterized by wave velocity. Initially, an inverse proportional function is employed to characterize the strain before crack closure. Subsequently, a logistic function represents the curve from crack strain to peak strain. This combined approach provides a comprehensive depiction of the damage evolution. This study underscores the importance of considering confining pressure and laminar inclination in the analysis of rock stability and integrity. These results provide critical insights into the damage evolution characteristics of layered rocks, offering valuable references for engineering safety assessments.

Abstract Primary liver cancer (PLC) poses a leading threat to human health, and its treatment options are limited. Meanwhile, the investigation of homogeneity and heterogeneity among PLCs remains challenging. Here, using single-cell RNA sequencing, spatial transcriptomic and bulk multi-omics, we elaborated a molecular architecture of 3 PLC types, namely hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (CHC). Taking a high-resolution perspective, our observations revealed that CHC cells exhibit internally discordant phenotypes, whereas ICC and HCC exhibit distinct tumor-specific features. Specifically, ICC was found to be the primary source of cancer-associated fibroblasts, while HCC exhibited disrupted metabolism and greater individual heterogeneity of T cells. We further revealed a diversity of intermediate-state cells residing in the tumor-peritumor junctional zone, including a congregation of CPE+ intermediate-state endothelial cells (ECs), which harbored the molecular characteristics of tumor-associated ECs and normal ECs. This architecture offers insights into molecular characteristics of PLC microenvironment, and hints that the tumor-peritumor junctional zone could serve as a targeted region for precise therapeutical strategies.

Abstract Background CD73 promotes progression in several malignancies and is considered as a novel immune checkpoint. However, the function of CD73 in intrahepatic cholangiocarcinoma (ICC) remains uncertain. In this study, we aim to investigate the role of CD73 in ICC. Methods Multi-omics data of 262 ICC patients from the FU-iCCA cohort were analyzed. Two single-cell datasets were downloaded to examine the expression of CD73 at baseline and in response to immunotherapy. Functional experiments were performed to explore the biological functions of CD73 in ICC. The expression of CD73 and HHLA2 and infiltrations of CD8 + , Foxp3 + , CD68 + , and CD163 + immune cells were evaluated by immunohistochemistry in 259 resected ICC samples from Zhongshan Hospital. The prognostic value of CD73 was assessed by Cox regression analysis. Results CD73 correlated with poor prognosis in two ICC cohorts. Single-cell atlas of ICC indicated high expression of CD73 on malignant cells. TP53 and KRAS gene mutations were more frequent in patients with high CD73 expression. CD73 promoted ICC proliferation, migration, invasion, and epithelial-mesenchymal transition. High CD73 expression was associated with a higher ratio of Foxp3 + /CD8 + tumor-infiltrating lymphocytes (TILs) and CD163 + /CD68 + tumor-associated macrophages (TAMs). A positive correlation between CD73 and CD44 was observed, and patients with high CD73 expression showed elevated expression of HHLA2. CD73 expression in malignant cells was significantly upregulated in response to immunotherapy. Conclusions High expression of CD73 is associated with poor prognosis and a suppressive tumor immune microenvironment in ICC. CD73 could potentially be a novel biomarker for prognosis and immunotherapy in ICC.

China, the world's greatest emitter of greenhouse gases, has committed to reaching peak carbon dioxide emissions by 2030 and carbon neutrality by 2060. One strategy to accomplish this aim is switching to a low-carbon economy via advancing renewable energy (RE) projects. Therefore, this study focuses on solar, wind, biomass, and hydropower and examines the beneficial employment effects of RE projects in China. The study uses fuzzy-based Multi-Criteria Decision Making (MCDM) methodologies, such as the Analytical Hierarchy Process (AHP) and Weighted Aggregated Sum Product Assessment (WASPAS), to evaluate numerous employment effect criteria and sub-criteria. Based on these evaluations, the report prioritizes four main types of RE projects. According to the fuzzy AHP technique results, direct employment, skill requirements, and local employment are the most crucial employment effect factors. The study then employed the fuzzy WASPAS approach to assessing various RE initiatives' employment prospects. According to the findings, hydropower is the best choice for creating jobs, followed by wind and solar power initiatives. In recent years, the hydro, wind, and solar power industries have experienced rapid expansion, creating numerous job possibilities in production, installation, operation, and maintenance. Additionally, creating RE projects can boost regional economic growth and lessen poverty.

Abstract Aims To translate the U.S. version of the Nursing Brand Image Scale to Chinese (NBIS-C) and evaluate its psychometric properties when administered to a national sample of Chinese nurses, and identify nursing brand image profiles in Chinese nurses. Design A cross-sectional study was conducted to validate the NBIS-C among nurses in China. Methods The psychometric properties of the NBIS-C were tested in accordance with the COSMIN checklist. The reliability, validity, and responsiveness of the 42-item NBIS-C were examined in a national sample of 759 nurses recruited from 29 Chinese provinces. Latent Profile Analyses (LPA) were conducted to reveal nurses’ perceptions of the brand image of nursing. Results Results of this study demonstrated acceptable validity (content validity, structural validity, and construct validity), reliability (internal consistency and test-retest reliability), adequate responsiveness, and no floor/ceiling effect of the NBIS-C. LPA yielded five subgroups: Integrated, Traditional, Subordinate, Creative and Leader. Conclusion The psychometric properties of the NBIS-C are suitable for assessing the image of nursing among Chinese nurses. Future studies with a larger, more diverse sample are recommended. Although the role of nurses in China has evolved, nurses in general have failed to communicate a consistent, positive, and accurate brand image for the nursing profession.

Vehicle electrification is a critical application of lithium-ion batteries (LIBs), and it is essential to develop LIBs that can operate at sub-ambient temperatures with satisfying performance. Conventional LIBs have performance deficits at low temperatures which hinder their use in extreme environments. One approach to address this problem is to rationally engineer the electrode/electrolyte interface with electrolyte additives to improve the electrochemical kinetics at sub-ambient temperatures. In this work, silicic acid (SiAc) is incorporated into standard LIB electrolyte as an additive to enhance the capacity and energy density of LIBs at temperatures down to −20 °C. Full-cell impedance analysis and X-ray photoelectron spectroscopy of cycled electrodes point towards an additive-induced change in surface chemistry which alters the charge transfer process. It is proposed that the SiAc additive participated in the formation of solid electrolyte interphase (SEI) and lowered the activation energy of the interface impedance, assisting lithium ion transport across the interface at lower temperatures.

PurposeTo dissect the tumor ecosystem following immune checkpoint blockades (ICBs) in intrahepatic cholangiocarcinoma (ICC) at a single-cell level.MethodsSingle-cell RNA sequencing (scRNA-seq) data of 10 ICC patients for the ICB clinical trial were extracted from GSE125449 and systematically reanalyzed. Bulk RNA-seq data of 255 ICC patients were analyzed. Infiltration levels of SPP1+CD68+ tumor-associated macrophages (TAMs) were examined by dual immunofluorescence (IF) staining in 264 resected ICC samples. The correlation between SPP1+ TAMs and clinicopathological features as well as their prognostic significance was evaluated.ResultsAmong the 10 patients, five received biopsy at baseline, and others were biopsied at different timings following ICBs. Single-cell transcriptomes for 5,931 cells were obtained. A tighter cellular communication network was observed in ICB-treated ICC. We found a newly emerging VEGF signaling mediated by PGF-VEGFR1 between cancer-associated fibroblasts (CAFs) and endothelial cells in ICC following ICBs. SPP1 expression was dramatically upregulated, and SPP1+ TAM gene signatures were enriched in TAMs receiving ICB therapy. We also identified SPP1+ TAMs as an independent adverse prognostic indicator for survival in ICC.ConclusionOur analyses provide an overview of the altered tumor ecosystem in ICC treated with ICBs and highlight the potential role of targeting CAFs and SPP1+TAMs in developing a more rational checkpoint blockade-based therapy for ICC.

Under the strong influence of climate change and human activities, the frequency and intensity of disturbance events in the forest ecosystem both show significant increasing trends. Pine wood nematode (Bursapherenchus xylophilus, PWN) is one of the major alien invasive species in China, which has rapidly infected the forest and spread. In recent years, its tendency has been to spread from south to north, causing serious losses to Pinus and non-Pinus coniferous forests. It is urgent to carry out remote sensing monitoring and prediction of pine wilt disease (PWD). Taking Anhui Province as the study area, we applied ground survey, satellite-borne optical remote sensing imagery and environmental factor statistics, relying on the Google Earth Engine (GEE) platform to build a new vegetation index NDFI based on time-series Landsat images to extract coniferous forest information and used a random forest classification algorithm to build a monitoring model of the PWD infection stage. The results show that the proposed NDFI differentiation threshold classification method can accurately extract the coniferous forest range, with the overall accuracy of 87.75%. The overall accuracy of the PWD monitoring model based on random forest classification reaches 81.67%, and the kappa coefficient is 0.622. High temperature and low humidity are conducive to the survival of PWN, which aggravates the occurrence of PWD. Under the background of global warming, the degree of PWD in Anhui Province has gradually increased, and has transferred from the southwest and south to the middle and northeast. Our results show that PWD monitoring and prediction at a regional scale can be realized by using long time-series multi-source remote sensing data, NDFI index can accurately extract coniferous forest information and grasp disease information in a timely manner, which is crucial for effective monitoring and control of PWD.

The 4-(4-pyridinyl)thiazole-2-thiol (HPTT) molecule with biological activities is a sulfur-containing organic ligand. Here, one new sulfur-containing coordination polymer based on HPTT and potassium thiocyanate (KSCN), namely, {[Cd(PTT)(HPTT)(SCN)}n, has been synthesized and characterized by physicochemical methods. The single-crystal X-ray diffraction analyses reveal the compound crystallizes in a monoclinic P21/n space group and features a one-dimensional line structure. The crystal structure is stabilized through intramolecular C–H···N and C–H···S hydrogen bonds and intermolecular N–H···N, C–H···π, and π⋯π interactions, generating a two-dimensional supramolecular layer structure. The interactions are also analyzed using Hirshfeld surface analysis. Moreover, the compound shows a relatively thermal stability and solid-state photoluminescence at room temperature. One new sulfur-containing coordination polymer based on 4-(4-pyridinyl)thiazole-2-thiol and potassium thiocyanate has been synthesized and characterized. The single-crystal X-ray diffraction analyses reveal the compound crystallizes in a monoclinic P21/n space group and features a one-dimensional line structure. The crystal structure is stabilized by hydrogen bonds and π⋅⋅⋅π stacking interactions, generating a two-dimensional supramolecular layer structure. The interactions are also analyzed using Hirshfeld surface analysis. [ABSTRACT FROM AUTHOR]

To enhance the power-to-hydrogen (P2H) efficiency and multiple energy utilization efficiency of the hydrogen-electric integrated energy system (HE-IES), an optimal operation framework considering the P2H factor is proposed. First, the proton exchange membrane electrolytic cells model which considers mass transfer characteristics is established. Efficient hydrogen production operating parameters are obtained through simulation to maximize the P2H efficiency. Second, the HE-IES is established, including the hydrogen flow system, wind power (WP), energy storage systems, gas boiler, combined heat and power and methanation unit. Based on the characteristics of the devices and efficient hydrogen operating parameters, the optimal operation framework considering the P2H efficiency factor is proposed. To realize the low economic operating costs and maximize the utilization of WP, a multi-objective function based on fuzzy membership function solving is applied. Finally, the case studies show that the proposed operation framework reduces the economic operation cost by 28.29% and improves the WP utilization rate by 31.9%. [ABSTRACT FROM AUTHOR]

Elevating the charging cut‐off voltage is an effective strategy to increase the energy density of LiCoO2. However, unstable interfacial structures and unfavorable phase transitions in bulk are inevitably triggered during deep de‐lithiation at high voltage. Herein, an integrated surface‐to‐bulk Ti‐modification strategy is applied to LiCoO2, enabling uniform Li2TiO3 coating on the surface and gradient Ti‐doping toward the structural bulk. The resultant Ti‐modified LiCoO2 (T‐LCO) electrode can be stably cycled up to 4.6 V, providing a high‐rate capability of 137 mAh g−1 at 5C and a long‐life stability with 80.5% capacity retention after 400 cycles at 1C, far outperforming the unmodified LiCoO2 electrode with only 50.7% capacity retention. In situ X‐ray diffraction characterization and density functional theory calculation reveal that the synergistic modification of T‐LCO enhances Li+ diffusion, facilitates the construction of high‐quality cathode/electrolyte interphase, reduces the phase transition from O3 to H1‐3 and Co3d/O2p band overlap, and restrains layer‐to‐spinel phase distortion, thus improving structural stability at 4.6 V. This work presents a “two birds one step” strategy to enhance the cycling stability and achievable capacity of high‐voltage LiCoO2 for developing high energy density lithium‐ion batteries. [ABSTRACT FROM AUTHOR]