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Aims of this assessment were to describe requirements for physicians to engage in CME/CPD; explore perceptions of In-Country SMEs of their CME/CPD systems; describe perceptions of In-Country physicians about interprofessional continuing education (IPCE) and independent CME/CPD; and provide recommendations that may be adopted to improve quality and effectiveness. This assessment used a mixed-methods approach that included 1:1 interviews with in-country subject matter experts and an electronic survey capturing qualitative and quantitative data from practicing in-country physicians. This assessment reflects a country invested in the education of its physician workforce. CME/CPD systems have embedded governance structures, organizations authorized to provide education, and a recognized credit system. Governing bodies have implemented regulations to limit influence from commercial interest organizations on CME/CPD, and there is opportunity to expand delivery systems to reach physicians across diverse geographic regions, better align content to individual physicians' gaps and learning needs, and reduce cost. There is opportunity to invest in IPCE within a country with a strong professional hierarchy system. This assessment reflects CME/CPD systems that are relatively mature and identifies several opportunities to expand and enhance systems to better meet educational needs of physicians and to positively impact practice and patient outcomes. [ABSTRACT FROM AUTHOR]

In this report, we introduce a 1D photonic crystal (PhC) nanocavity with waveguide-like strain amplifiers within a soft polydimethylsiloxane substrate, presenting it as a potential candidate for highly sensitive pressure and position optical sensors. Due to its substantial optical wavelength response to uniform pressure, laser emission from this nanocavity enables the detection of a minimum applied uniform pressure of 1.6‰ in experiments. Based on this feature, we further studied and elucidated the distinct behaviors in wavelength shifts when applying localized pressure at various positions relative to the PhC nanocavity. In experiments, by mapping wavelength shifts of the PhC nanolaser under localized pressure applied using a micro-tip at different positions, we demonstrate the nanocavity’s capability to detect minute position differences, with position-dependent minimum resolutions ranging from tens to hundreds of micrometers. Furthermore, we also propose and validate the feasibility of employing the strain amplifier as an effective waveguide for extracting the sensing signal from the nanocavity. This approach achieves a 64% unidirectional coupling efficiency for leading out the sensing signal to a specific strain amplifier. We believe these findings pave the way for creating a highly sensitive position-sensing module that can accurately identify localized pressure in a planar space.

The global incidence of early-onset colorectal cancer (EO-CRC) is increasing. Although the mortality rate is relatively stable, some comorbidities have been associated with a higher mortality rate. This study estimated the mortality risk in patients with EO-CRC with various comorbidities using real-world data to identify the high-risk group using Cox proportional regression for overall and cancer-specific mortality. The incidence rate of EO-CRC significantly increased from 6.04 per 100,000 population in 2007 to 12.97 per 100,000 population in 2017. The five-year overall mortality rate was 101.50 per 1000 person year and the cancer-specific mortality rate was 94.12 per 1000 person year. Patients with cerebrovascular disease (CVD) had a higher mortality risk (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.25-2.28; p=0.0007). After subgroup analyses based on age, sex, clinical stage, and treatment type, patients with CVD had a higher overall mortality risk compared to non-CVD patients, except for patients undergoing surgery and chemotherapy. Patients with chronic kidney disease had a higher mortality risk in the early clinical stages (HR: 2.31; 95% CI: 1.08-4.96; p=0.0138). Patients who underwent radiotherapy had a higher overall mortality risk (HR: 1.38; 95% CI: 1.04-1.85; p=0.0285) than those without liver disease. Identifying specific comorbidity mortality risks in patients with EO-CRC allows for risk stratification when screening target groups and may lower disease mortality.

BackgroundLung cancer is one of the leading causes of cancer death worldwide, and tuberculosis (TB) is a common pre-existing disease. However, there is scarce literature studying the mortality risk in patients with prior TB and subsequent lung cancer.MethodsWe recruited lung cancer patients from the Taiwan Cancer Registry from 2011 to 2015 and classified them into two groups according to presence or absence of prior TB. We then matched them in a ratio of 1:4 using the exact matching approach. The mortality risk within 3 years after diagnosis of lung cancer was analyzed and compared between these two groups.ResultsDuring the study period, 43,472 patients with lung cancer were recruited, and of these, 1,211 (2.79%) patients had prior TB. After matching, this cohort included 5,935 patients with lung cancer in two groups: patients with prior TB before lung cancer (n = 1,187) and those without (n = 4,748). After controlling for demographic factors and comorbidities, the patients with prior TB had increased adjusted hazard ratios of 1.13 (95% CI: 1.04–1.23) and 1.11 (1.02–1.21) for all-cause and cancer-specific 3-year mortality, respectively, compared to the lung cancer patients without prior TB. Duration between TB and lung cancer (3 years) had no differences for mortality risk.ConclusionIn the present study, 2.79% patients with lung cancer had prior TB, which was associated with higher 3-year mortality after they developed lung cancer. The mortality risk with prior TB did not decrease even if >3 years passed before diagnosis of lung cancer.

The emerging challenges of global health constantly puts forward new requirements for cultivating medical talents. From the perspective of great health, the First Affiliated Hospital of Sun Yat-sen University aims at cultivating top-notch and innovative medical talents for the future. Since 2018, the hospital has been inheriting and innovating the model of training medical elites and has explored and implemented the clinical postdoctoral program. This program relies on the platform of progressive medical training of the relatively mature 'college system' initiated by our hospital. By regrouping the high-quality interdisciplinary faculty team, the platform optimizes the 'outcome-based' advanced training system and builds effective evaluation and the assessment system, to comprehensively strengthen clinical postdoctoral trainees' abilities of clinical and scientific research and teaching. The program provides reference for the cultivation of high-level medical elites.

Background: Lung cancer patients are high-risk for active tuberculosis (TB); however, fragility and drug-drug interaction might lead to TB treatment interruption. TB treatment incompletion occurrence and predictors among lung cancer patients remain unclear. Methods: We recruited lung cancer patients with new-onset TB from Taiwan Cancer Registry and Taiwanese National Health Insurance 2007–2015 databases. TB treatment incompletion was the identified primary outcome, and associated risk factors were analyzed. Results: A total of 1155 lung cancer patients with new-onset TB were identified and classified as treatment incompletion (n=706, 61.13%) or completion (n=449). Gender and age distribution was similar in both groups. Under multivariable logistic regression, advanced cancer (stage III and IV) and no first-line TB drugs use were independent factors for treatment incompletion; but older age was not significant. For patients surviving >1 year since TB diagnosis, independent factors for treatment incompletion included no first-line TB drugs use (except pyrazinamide) and absence of hypertension. Cancer stage had borderline significance. Conclusions: TB treatment incompletion occurred in 61.13% of lung cancer patients. Clinicians should carefully titrate anti-TB medications and monitor side effects in lung cancer patients, especially those with treatment incompletion risk factors, to avoid treatment interruption due to fragility and/or drug intolerance.

Abstract Pulmonary function testing (PFT) allows for quantitative analysis of lung function. However, as a result of the coronavirus disease 2019 (COVID-19) pandemic, a majority of international medical societies have postponed PFTs in an effort to mitigate disease transmission, complicating the continuity of care in high-risk patients diagnosed with COVID-19 or preexisting lung pathologies. Here, we describe the development of a non-contact wearable pulmonary sensor for pulmonary waveform analysis, pulmonary volume quantification, and crude thoracic imaging using the eddy current (EC) phenomenon. Statistical regression analysis is performed to confirm the predictive validity of the sensor, and all data are continuously and digitally stored with a sampling rate of 6,660 samples/second. Wearable pulmonary function sensors may facilitate rapid point-of-care monitoring for high-risk individuals, especially during the COVID-19 pandemic, and easily interface with patient hospital records or telehealth services.

Abstract Existing paradigms for stroke diagnosis typically involve computed tomography (CT) imaging to classify ischemic versus hemorrhagic stroke variants, as treatment for these subtypes varies widely. Delays in diagnosis and transport of unstable patients may worsen neurological status. To address these issues, we describe the development of a rapid, portable, and accurate eddy current damping (ECD) stroke sensor. Copper wire was wound to create large (11.4 cm), medium (4.5 cm), and small (1.5 cm) solenoid coils with varying diameters, with each connected to an inductance-to-digital converter. Eight human participants were recruited between December 15, 2019 and March 15, 2020, including two hemorrhagic stroke, two ischemic stroke, one subarachnoid hemorrhage, and three control participants. Observers were blinded to lesion type and location. A head cap with 8 horizontal scanning paths was placed on the patient. The sensor was tangentially rotated across each row on the patient’s head circumferentially. Consent, positioning, and scanning with the sensor took roughly 15 min from start to end for each participant and all scanning took place at the patient bedside. The ECD sensor accurately classified and imaged each of the varying stroke types in each patient. The sensor additionally detected ischemic and hemorrhagic lesions located deep inside the brain, and its range is selectively tunable during sensor design and fabrication.

This study, bases on both the attribution theory and trust repair theory, and explores the effects of attribution and government intervention in the trust repair process, willingness to reconcile and one's intention to share during the COVID-19 pandemic. Questionnaires are distributed online, and 799 responses are collected, as based on convenience sampling. Partial least squares structural equation modeling is used to conduct analysis. Results show that controllability, stability, affective repair, functional repair, and informational repair have a positive and significant effect on individuals' willingness to reconcile, but the locus of causality does not have a significant effect. Willingness to reconcile has a positive effect on individuals' intention to share. Based on these findings, it is recommended that governments develop appropriate strategies to repair peoples' levels of trust and eliminate the chance of any major crisis event recurrence. Moreover, the findings further confirm that governments and public sector organizations can use the attribution theory and trust repair strategies to affect positive change. Plain language summary: Rebuilding trust during the COVID-19 pandemic: the impact of explanation and government actions This research examines how people rebuild trust during the COVID-19 pandemic, using ideas from attribution theory and trust repair theory. We look at the impact of attribution (how people explain events) and government actions on trust repair, willingness to reconcile, and the intention to share. We gathered 799 responses through online questionnaires using convenience sampling. We used a method called partial least squares structural equation modeling for analysis. Our results show that factors like controllability, stability, affective repair, functional repair, and informational repair positively and significantly influence people's willingness to reconcile. However, the cause of events (locus of causality) doesn't have a significant effect. Willingness to reconcile, in turn, positively affects the intention to share. Based on these findings, we suggest that governments should develop effective strategies to rebuild trust and prevent future crises. The results also support the idea that governments and public sector organizations can use attribution theory and trust repair strategies to bring about positive changes. [ABSTRACT FROM AUTHOR]