Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

The measurement of meaning

With digital equipment becoming increasingly networked, either on wired or wireless networks, for personal and professional use alike, distributed software systems have become a crucial element in information and communications technologies. The study of these systems forms the core of the ARLES' work, which is specifically concerned with defining new system software architectures, based on the use of emerging networking technologies. In this context, we concentrate on the study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence.

반도체 공정 overview

Objective: Meta-analyses of behavior change (BC) interventions typically find large heterogeneity in effectiveness and small effects. This study aimed to assess the effectiveness of active BC interventions designed to promote physical activity and healthy eating and investigate whether theoretically specified BC techniques improve outcome. Design: Interventions, evaluated in experimental or quasi-experimental studies, using behavioral and/or cognitive techniques to increase physical activity and healthy eating in adults, were systematically reviewed. Intervention content was reliably classified into 26 BC techniques and the effects of individual techniques, and of a theoretically derived combination of self-regulation techniques, were assessed using meta-regression. Main Outcome Measures: Valid outcomes of physical activity and healthy eating. Results: The 122 evaluations (N 44,747) produced an overall pooled effect size of 0.31 (95% confidence interval 0.26 to 0.36, I 2 69%). The technique, “self-monitoring,” explained the greatest amount of among-study heterogeneity (13%). Interventions that combined selfmonitoring with at least one other technique derived from control theory were significantly more effective than the other interventions (0.42 vs. 0.26). Conclusion: Classifying interventions according to component techniques and theoretically derived technique combinations and conducting meta-regression enabled identification of effective components of interventions designed to increase physical activity and healthy eating.

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Effective Techniques in Healthy Eating and Physical Activity Interventions: A Meta-Regression

Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012.

Mindfulness-based meditation to decrease stress and anxiety in college students: A narrative synthesis of the research

Objective: This study applied the Health Belief Model to investigate factors in the decision by caregivers to vaccinate their children for influenza. Design: Cross-sectional study. Sample and Measurements: Purposive sampling obtained 2,778 useable responses to surveys of 33 public health centers and 40 medical institutions participating in vaccination programs in southern Taiwan. Data were collected using the Caregiver Demographics and Children's Health History Questionnaire, Children's Influenza Vaccination History Questionnaire, and a Health Belief Model Questionnaire. Multiple logistic regression was used to analyze predictors of influenza vaccinations in children. Results: Predictors of vaccination revealed by logistic regression analysis included age, current employment, and residence of the caregiver as well as chronic disease, hospitalization, and influenza histories of the child. Other predictors revealed by the Health Belief Model were perceived susceptibility of the children to influenza, percei...

Using the Health Belief Model to understand caregiver factors influencing childhood influenza vaccinations.

PURPOSE. To understand the process and difficulties that Chinese family caregivers experience when making a nursing home placement decision for their loved ones with dementia.



DESIGN AND METHODS.  Using a grounded theory approach, data were collected through individual interviews with 30 Chinese family caregivers in Taiwan.



FINDINGS.  A stage-based framework was generated that described how caregivers went through the decision-making process, what specific challenges they encountered within the process, and how they overcame difficulties to reach their decisions.



PRACTICE IMPLICATIONS.  By identifying the stages of the decision-making process and various challenges that caregivers experience, clinicians can enhance discussions with caregivers to decrease the decision-making burden. Clinicians might develop family-centered interventions for the decision-making process through the post-placement stage while taking into account cultural influences.

Decision-making process of nursing home placement among Chinese family caregivers.

An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers

Aims To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. Background The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. Design This study is an integrative review of published research from 2000 to 2017. Methods The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrard's matrix was utilised to analyse and synthesise the studies. Results Ethical dilemmas arose from end-of-life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses. Conclusions This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. Relevance to nursing practice Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.

Joanne Kraenzle Schneider

Papers

Mindfulness-based meditation to decrease stress and anxiety in college students: A narrative synthesis of the research

Using the Health Belief Model to understand caregiver factors influencing childhood influenza vaccinations.

Decision-making process of nursing home placement among Chinese family caregivers.

An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers

Ethical dilemmas in nursing: An integrative review