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Purpose To inform the development of an eHealth application for patients with cervical cancer for monitoring supportive care needs, perceived care supply and quality of life. Methods A mixed-method design was conducted. The 19-month process involved: (a) a literature review to screen the components of applications, (b) a cross-sectional needs assessment for patients with cervical cancer to define the needs and application program draft, (c) expert consultation to refine the draft, (d) software development, and (e) a pilot testing and users experience description. Patients in the intervention group received a 7-day application intervention combined with usual care. Supportive care needs, perceived care supply, quality of life and user experience were collected. Results Literature review results conducted the importance of fully preparation before application development, especially the supportive care needs assessment. Subsequent supportive care needs investigation revealed the most urgent needs were informational needs and privacy protection. 43 expert suggestions for application improvement were refined. The new application contained the patient and the healthcare professional portal. At day 7, the pretest/posttest changes significant between-group differences in increasing perceived care supply and quality of life, with the intervention group exhibiting larger tendency on needs and supply than the control. Users had positive experience with the application. Conclusions This study provides feasibility of the application targeting access to supportive care, which may be effective for relieving patients’ needs and improving perceived supply and quality of life.

BackgroundArtificial intelligence (AI)-assisted diagnosis is considered to be the future direction of improving the efficiency and accuracy of pediatric diseases diagnosis, while the existing research based on AI are far from sufficient because of limited data amount, inadequate coverage of disease types, or high construction costs, and have not been applied on a large scale. We aimed to develop an accurate deep learning model trained on millions of real-world data to verify the feasibility of the technology, and build the whole process of outpatient auxiliary diagnosis.Methods and findingsWe applied a Chinese Natural Language Processing (NLP) and an end-to-end deep neural network classifier to the outpatient’s electronic medical records (EMRs) in a single child care center in Shanghai, China, to unstructured text processing and construct an auxiliary diagnostic model, all patients were aged from 0 to 18 years. A training cohort with millions of records and an independent validation cohort with tens of thousands of records were intake separately and calculate diagnosis concordance rate (DCR) of model in each diseases group. The records with inconsistent diagnoses between human and AI were evaluated by clinical experts’ group, and calculate the relative correct rate (RCR) to evaluate the diagnostic performance of the model. A total of 5,271,347 medical records were intake in model training covering sixteen categories of diseases according to disease coding, reaching a DCR of 95· 49% (95· 48∼95· 51). For validation, 91,880 records were obtained from validation dataset, which reached a DCR of 93· 51% (93· 35∼93· 67) and FDCR of 72.04% (71· 75∼72· 33). It was confirmed that the accuracy of the model was still higher than that of human with most RCR>1 in validation dataset.ConclusionsThe deep learning system could support diagnosis of pediatric diseases, which has high diagnostic performance, comprehensive disease coverage, feasible technology, and can be promoted in multiple sites in the future.FundingThe Authors received no specific funding for this work.

BACKGROUND Medical artificial intelligence (MAI) is developing rapidly. It plays an important role in the screening, diagnosis, and management of various diseases. However, developing and implementing MAI also give rise to many ethical dilemmas. Although MAI ethics frameworks have already been published at home and abroad in response to growing concerns, the adoption is still limited. The effective practice of MAI ethics requires comprehensive knowledge, an active attitude, and practical experience. Therefore, it is necessary to develop a scientifically and specifically designed scale for measuring researchers’ ethics knowledge, attitude, and practice (KAP) in MAI research. OBJECTIVE This study aimed to develop and validate an instrument for measuring researchers’ knowledge, attitude, and practice in MAI ethics (KAP-MAIE), and to examine its reliability and validity. METHODS The KAP-MAIE scale was developed according to the KAP model and strict methodology for developing a reliable and valid scale. We established a list of items based on literature review and expert consultation. A pilot survey was conducted on 12 MAI researchers to ascertain the applicability of the scale. In total, 269 MAI researchers were invited to participate in the reliability and validity evaluation of the scale. We performed item analysis for content refinement, correlation analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) for construct validity, and calculated the interrater agreement(IRR), item-level content validity index(I-CVI), and scale-level CVI (S-CVI) for content validity, Cronbach alpha coefficient, and Split-half reliability for internal consistency. RESULTS The KAP-MAIE scale includes a different number of items for each section, namely knowledge (10 items), attitude (6 items), and practice (7 items). The EFA resulted in a three-factor solution consistent with three subscales of knowledge, attitude, and practice, accounting for 74.86% of the variance. The second-order CFA demonstrated a good fit to the data (root mean square error of approximation=0.073). Each subscale correlated with overall scale, and subscales also correlated with each other. The correlation coefficient on subscale and overall scale was higher than that between subscales.The inter-rater agreement, I-CVI, and S-CVI were excellent. The scale also had an exceptional internal consistency (Cronbach alpha=0.933, Split-half reliability=0.727). CONCLUSIONS The proposed KAP-MAIE scale is a reliable and valid instrument that can measure researchers’ knowledge, attitude, and practice in MAI ethics. This is the first instrument developed for this purpose.

BACKGROUND: Telemedicine is becoming an emerging innovative supplement to the traditional medical system in China. In the present study, we described the rapid implementation of the telemedicine in pediatrics during the coronavirus disease 2019 (COVID-19) outbreak and explored its value in response to the demand for pediatric medical services during the epidemic. METHODS: An Internet-based platform for multidisciplinary online medical consultation was established on February 8, 2020, by a national children’s medical center in China. The medical data of the traditional hospital visits and novel online visits from the first two months (February 8 to March 31) after the establishment of the platform were collected and analyzed. The demographic features, changes in the disease spectrum and characteristics of online medical services were described. RESULTS: The total number of visits was significantly lower (by 75.3%) than that of in the same period in the previous year. The disease spectrum was different with a significant decrease of >95% in the number of patients with infectious or contagious diseases. The online visits accounted for 14.7% of all visits. Online patients came from all over the country, covering 91% of the administrative regions of China, and the largest proportion of inquiries were for infants (33.7%) (P

This study aimed to obtain the first national estimate of the prevalence of autism spectrum disorder (ASD) in Chinese children. We targeted the population of 6 to 12-year-old children for this prevalence study by multistage convenient cluster sampling. The Modified Chinese Autism Spectrum Rating Scale was used for the screening process. Of the target population of 142,086 children, 88.5% (n = 125,806) participated in the study. A total of 363 children were confirmed as having ASD. The observed ASD prevalence rate was 0.29% (95% CI: 0.26%–0.32%) for the overall population. After adjustment for response rates, the estimated number of ASD cases was 867 in the target population sample, thereby achieving an estimated prevalence of 0.70% (95% CI: 0.64%–0.74%). The prevalence was significantly higher in boys than in girls (0.95%; 95% CI: 0.87%–1.02% versus 0.30%; 95% CI: 0.26%–0.34%; P

C-reactive protein (CRP) can increase up to 1000-fold in blood and form complexes with very low density lipoproteins (VLDL). These complexes are associated with worse outcomes for septic patients, and this suggests a potential pathological role in sepsis. Complex formation is heightened when CRP is over 200 mg/l and levels are associated with the severity of sepsis and blood bacterial culture positivity. Using a mouse bacteremia model, blood bacterial clearance can be delayed by i.v. injection of CRP–VLDL complexes. Complexes are more efficiently taken up by activated U937 cells in vitro and Kupffer cells in vivo than VLDL alone. Both in vitro–generated and naturally occurring CRP–VLDL complexes reduce phagocytosis of bacteria by activated U937 cells. Fcγ and scavenger receptors are involved and a competitive mechanism for clearance of CRP–VLDL complexes and bacteria is demonstrated. Interaction of phosphocholine groups on VLDL with CRP is the major driver for complex formation and phosphocholine can disrupt the complexes to reverse their inhibitory effects on phagocytosis and bacterial clearance. Increased formation of CRP–VLDL complexes is therefore harmful and could be a novel target for therapy in sepsis.

Objective To systematically review male partners' caring experience and supportive care needs when caring for women with gynaecologic cancer. Methods The PRISMA guidelines were used to conduct this systematic review. We performed a comprehensive literature search in nine databases and qualitative studies published in English or Chinese from inception to January 2020. The included papers were appraised, using the Critical Appraisal Skills Program tool for qualitative research. An inductive thematic analysis method was adopted to synthesise major findings to construct core concepts and themes. Results Eight studies were included in this review, and four overarching themes emerged the following: the negative experience of disease, the need for supportive care to cope, adapting to a new life and post-traumatic growth. Conclusions This study shows that male partners had both negative and positive experiences in the caring process, and they could adjust themselves to some extent. Their perceived supportive care needs were often neglected. Relevance to clinical practice Male partners of women with gynaecologic cancer are an under-recognised group. The couple-oriented or family-oriented supportive care programmes should be implemented to meet the supportive care needs of male partners to enhance their health and well-being.

Most children with autism spectrum disorder (ASD) are not diagnosed until the age of 4, thus missing the opportunity for early intervention. The objective of this study was to investigate the feasibility of an early screening program for ASD applied during well-child visits in a community-based sample. The study lasted for 4 years and was divided into two stages. Stage I involved the implementation of the basic screening model in 2014. Toddlers received level 1 screening via section A of the Chinese-validated version of the Checklist for Autism in Toddlers (CHAT-23) during 18- and 24-month well-child visits in Xuhui District, Shanghai, China. Screen-positive children were referred to receive section B of the CHAT-23 for level 2 screening, and those still screen-positive were referred to undergo diagnosis and evaluation. Stage II involved the implementation of the improved screening model from 2015 to 2017 with the following modifications: (a) an added observational component in level 1 screening; (b) telephone follow-ups with the screen-positive families; and (c) dissemination of information on ASD to families. The results showed that 42 of 22,247 screened children were diagnosed with ASD. The ASD diagnosis rates were 0.1% in Stage I and 0.21% in Stage II. The screen-positive rate and the show rate of referral for level 1 screening increased by 76.92% and 58.43%, respectively, in Stage II compared to Stage I. Our results suggest that with appropriate logistic support, this two-level screening model is feasible and effective for the early screening of ASD during well-child visits. Autism Res 2018, 11: 1206-1217. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Difficulty in the timely identification of autism spectrum disorder (ASD) results in missed opportunities for many ASD children to receive early intervention. In this study, we established an early screening model for ASD among children aged 18-24 months in the community by relying on the three-level child healthcare system in China. The results showed that this model can effectively identify and diagnose ASD in children at an early age and thus enable early intervention.

This study aimed to establish norms for the modified Chinese version of the Autism Spectrum Rating Scale (ASRS). Participants were recruited from Shanghai, Harbin, Guangzhou, and Changsha, China, and their parents and teachers were invited to complete the Chinese Parent version and the Teacher version of the ASRS. In both versions, boys had significantly higher sub-scale scores and total score (T-score) by 1–3 and 4–5 points respectively, than girls (both P

Ischemia-induced brain damage leads to apoptosis like delayed neuronal death in selectively vulnerable regions, which could further result in irreversible damages. Previous studies have demonstrated that neurons in the CA1 area of hippocampus are particularly sensitive to ischemic damage. Atorvastatin (ATV) has been reported to attenuate cognitive deficits after stroke, but precise mechanism for neuroprotection remains unknown. Therefore, the aims of this study were to investigate the neuroprotective mechanisms of ATV against ischemic brain injury induced by cerebral ischemia reperfusion. In this study, four-vessel occlusion model was established in rats with cerebral ischemia. Rats were divided into five groups: sham group, I/R group, I/R+ATV group, I/R+ATV+LY, and I/R+SP600125 group. Cresyl violet staining was carried out to examine the neuronal death of hippocampal CA1 region. Immunoblotting was used to detect the expression of the related proteins. Results showed that ATV significantly protected hippocampal CA1 pyramidal neurons against cerebral I/R. ATV could increase the phosphorylation of protein kinase B (Akt1) and nNOS, diminished the phosphorylation of JNK3 and c-Jun, and further inhibited the activation of caspase-3. Whereas, all of the aforementioned effects of ATV were reversed by LY294002 (an inhibitor of Akt1). Furthermore, pretreatment with SP600125 (an inhibitor of JNK) diminished the phosphorylation of JNK3 and c-Jun, and further inhibited the activation of caspase-3 after cerebral I/R. Taken together, our results implied that Akt-mediated phosphorylation of nNOS is involved in the neuroprotection of ATV against ischemic brain injury via suppressing JNK3 signaling pathway that provide a new experimental foundation for stroke therapy.

This study aimed to investigate the validity and reliability of the Chinese parent version of the Autism Spectrum Rating Scale (ASRS, 6-18 years) for a general sample of Chinese children. The study involved assessing 1625 community-based subjects aged 6-12 years from four sites (Shanghai, Guangzhou, Changsha, and Harbin city) in China and 211 clinic-based participants aged 6-18 with a confirmed diagnosis of autism spectrum disorders (ASDs). The internal consistency (Cronbach's alpha) ranged from 0.585 to 0.929, and the test-retest reliability (interclass correlations) ranged from 0.542 to 0.749, indicating no significant difference between the two tests at an interval of 2-4 weeks. The construct validity was relatively excellent, and the concurrent validity with the Social Responsiveness Scale (SRS) (Pearson correlations) was 0.732 between the two total scores. Receiver operating characteristics (ROC) analyses showed excellent and comparable discriminant validity of the ASRS with respect to the SRS, with an area under the curve (AUC) of 0.9507 (95% CI: 0.93-0.97) versus 0.9703 (95% CI: 0.96-0.98), respectively. Our data suggested a cutoff ≥60 for the Chinese version of the ASRS, with good accuracy in screening autism symptoms (sensitivity=94.2%, specificity=77%). The Chinese parent version of the ASRS is therefore a reliable and valid tool for screening autistic symptoms in Chinese children in general.

In this paper, the influence of inclining angle of turbine blades on classification results was studied employing mica as the experimental materials. Based on the experimental results, the fish-hook effect in air classification appearing in Tromp curve was explained and discussed in term of particle agglomeration. The results obtained showed that the smaller the inclining angle of the blades, the smaller the classified particle cut size was, but the lower the classification precision was. The fish-hook effect decreased and the classification precision increased with the increase in inclining angle of blades, which may be attributed to decrease in the critical agglomerated particle size.

Based on the pneumatic mechanics and the gas-solid two-phase fluid theory, a model of gas-solid two-phase flow speed field was set up for horizontal turbines during the classifying process, and the formula of classified particle cut size in irregular speed fields was deduced. In order to evaluate the model, a number of experiments were carried out in a fluidized-bed jet-mill using samples such as calcium carbonate, carbon silicon, alumina, etc. It was found that the formula of classified particle cut size agreed with the experimental results very well. Furthermore, the relationship between the structural parameters of turbine and the classifying results was discussed, and the turbine structure was optimized according to the formula of classified particle cut size.

A noise prediction program has been incorporated into a blade design process of the arbitrary vortex flow rotor-only axial fans which are widely used in low pressure applications. Parametrical studies of different geometrical designs are conducted to investigate the influence on noise radiation from axial fans. The noise prediction program is based on the Carolus’s semi-empirical model, in which the broad-band aeroacoustic noise is mostly attributed to three independent sources: incident turbulence, turbulent boundary layer, and blunt trailing edge. In addition, the well-known Fukano’s vortex shedding model is also utilized for indicative comparison. It is indicated that the total sound pressure level is most sensitive to the flow relative velocity, while the chord length can be considered as a secondary cause.Copyright © 2011 by ASME

A broad-band noise prediction code based on the work of Carolus et al was written and incorporated into the low-pressure axial fan design program. For the convenience of design calculation, the turbulence statistics were determined by a semi-rational formula for fully-developed duct flow instead of the experiment. The code predicts 3 different forms of broad-band noise that were superimposed to calculate the total noise emission. The outputs include noise spectra, overall sound power and overall pressure level. In addition, Fukano's model was also utilized for indicative comparison. The influence of the variation of the design parameters, including twisted power, hub ratio and solidity, on the fan noise characteristics was calculated and analyzed. It is indicated that the total sound pressure level is most sensitive to the flow relative velocity, while the chord length can be considered as a secondary cause.

Some technologies of computer simulation are introduced into the smashing-mechanic field in the article. The specific method in the course of air-flowed colliding smash, including model building, calculates and the image display of the actual working-situation is emphasized. In the end the article points out that competitive, intelligentize and visualize are the development and application direction of the computer simulation technique in the air-fluent smash field in the future.

The purpose of this study was to explore the psychometric properties of the Chinese version of the autism spectrum rating scale (ASRS). We recruited 1,625 community-based children and 211 autism spectrum disorder (ASD) cases from 4 sites, and the parents of all participants completed the Chinese version of the ASRS. A robust weighted least squares means and variance adjusted estimator was used for exploratory factor analysis. The 3-factor structure included 59 items suitable for the current sample. The item reliability for the modified Chinese version of the ASRS (MC-ASRS) was excellent. Moreover, with 60 as the cut-off point, receiver operating characteristic analysis showed that the MC-ASRS had excellent discriminate validity, comparable to that of the unmodified Chinese version (UC-ASRS), with area under the curve values of 0.952 (95% CI: 0.936–0.967) and 0.948 (95% CI: 0.930–0.965), respectively. Meanwhile, the confirm factor analysis revealed that MC-ASRS had a better construct validity than UC-ASRS based on the above factor solution in another children sample. In conclusion, the MC-ASRS shows better efficacy in epidemiological screening for ASD in Chinese children. Electronic supplementary material The online version of this article (doi:10.1007/s12264-017-0104-7) contains supplementary material, which is available to authorized users.