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简介：AbstractPurpose:Firefighters are exposed to high levels of occupational risk factors, such as safety risks, chemical, ergonomic, and physical hazards that may jeopardize their lives. To overcome these hazards, firefighters must be physically, mentally, and personally fit to work. This study aimed to explore the criteria and factors affecting firefighters' resilience based on stakeholders’ experiences.Methods:This qualitative study was carried out using conventional content analysis. In total, 21 face-to-face interviews were conducted by firefighters who were experienced in the field. The interviews were carried out from July 2019 to January 2020. The data were collected using 3 unstructured interviews and then resumed by 18 semi-structured interviews. Data analysis was done using Graneheim method.Results:The participants had more than 5 years of experience in the field of search and rescue. The extracted codes through data analysis were classified into 3 main categories (individual, organizational, and social factors), 9 sub-categories (mental, physical, occupational, managerial, colleagues-related, equipment-related, environmental, community-related, and family-related factors), as well as 19 sub-sub-categories and 570 codes.Conclusion:Firefighters' personality, physical condition, behavior and psychological characteristics can affect their resilience along with organizational and management factors that play significant role in people's safety. Developing a tool for assessing resilience can help decision makers to have a real depict of firefighters' job qualifications.

简介：AbstractBackground:Tuberculosis (TB) is a major global health threat and the leading infectious disease cause of death worldwide. Access to and retention in TB care remains a challenge for patients, particularly those living in rural and remote settings. This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze (Shigatse) prefecture, Xizang Autonomous Region (Tibet Autonomous Region), China from the perspective of persons impacted by TB.Methods:We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture, Xizang Autonomous Region, China between April 2019 and November 2020. Interviews were conducted in Tibetan and Mandarin, transcribed in Mandarin and translated into English. Transcripts were checked against recordings by native Tibetan and Mandarin speakers. QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al.Results:Overall patients reported low awareness of and an indifferent attitude towards TB, although all reported understanding the need to adhere to treatment. Participants reported complex pathways to care, often requiring visits to multiple healthcare facilities. Some participants reported visiting traditional Tibetan medicine (TTM) providers. Participants reported various barriers to accessing care including challenges physically reaching care, out-of-pocket payments for tests, diagnostics and transport. Barriers to maintaining care included medication side effects and worry about treatment effectiveness. Enablers to accessing care identified included knowledge or past experience with TB, integrated models of TTM and western care, supportive village doctors who conducted home visits, free TB treatment and other subsidies, as well as having family support with care and social support as barriers and facilitators to maintaining treatment.Conclusions:We identified barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB. Challenges include complex pathways to care, travel distances, wait times and low awareness. Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness, partnerships with TTM providers, providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care.

简介：精子disomy的层次相关到不孕的层次，现在是众所周知的(象另外的因素一样)。永久维持aneuploidy到经历intracytoplasmic精子注射(ICSI)的不肥沃的男性的后代的风险在帮助复制成为了一个暑热地辩论的问题；然而，在那里仍然是障碍到为精子提供在一个临床的背景屏蔽的disomy的实际实现。主要障碍是花到分析的操作员时间一统计上有意义(足够)房间的数字。“自动化点数”的介绍软件鈥揾ardware联合介绍一个潜在的解决方案给这个问题。在这初步的确认研究，我们分析了10个病人，手工地并且用一个商业地可得到的点阻止。结果显示出在两条途径之间的统计上重要的关联因为当为双精子得分时，精子disomy，而是没有关联得分被发现。对后者的最可能的解释作为一个单个双房间是二个仔细联系的精子头的明显的overscoring。这些结果，和将续起的类似的进一步的研究，通知费用鈥揵enefit的帮助分析那单个诊所需要执行以便决定是否采用从要求ICSI治疗的人为对精子的评价作为一个平淡的工具屏蔽的精子aneuploidy。

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简介：Objective:ToexaminetheexpressionsofMDM2,P53andP27proteinsinchronicesophagitis,para-cancermucosaandesophagealcarcinoma.Methods:ImmunohistochemistrywasusedtodetecttheexpressionsofMDM2,P53andP27proteinsinforty-sevenpatientssufferingfromchronicesophagitisandeighty-fivecasesofesophagealcarcinomaandcorrespondingpara-cancermucosa.Flowcytometry((FCM)wasappliedtodetectthequantitiesoftheseproteinsexpressedinfreshtissuesof48casesofesophagealcancerandtheirpara-cancertissuesand24casesofrelativenormalmucosaatthesurfaceofcuttingedge.Results:Immunohistochemistryresultsshowedthattheexpressionsofthethreestudiedproteinswereverysimilarintheepitheliaofchronicesophagitisandpara-cancermucosa(P>0.05).BoththequalitativeandquantitativestudiesdisplayedthattheP53proteinhadnoexpressionanditsaccumulationswouldappearonlyintheearlystagesofesophaguscancerationwhiletheMDM2andP27proteinshaddifferentdegreesofexpressionsincasesofnormalesophagealmucosa.MDM2proteinmarkedlyincreasedintheadvancedstagesofesophagealcanceration.AquantitativestudyshowedthattheexpressionofP27proteinhadalinearityofdecreasingtendency(F=9.132,P=0.002)inthecourseofesophagealcanceration.Conclusion:Chronicesophagitismaybeaprecancerouslesion.OwingtothechangesoftheP53andP27proteins,wecanalsoconcludethattheseoccurintheearlystagesofesophagusoncogenesis,howeverthechangesofMDM2expressionmayoccurintheadvancedstageofesophagealcanceration.

简介：AbstractAround 450 million people are affected by pneumonia every year, which results in 2.5 million deaths. Coronavirus disease 2019 (Covid-19) has also affected 181 million people, which led to 3.92 million casualties. The chances of death in both of these diseases can be significantly reduced if they are diagnosed early. However, the current methods of diagnosing pneumonia (complaints + chest X-ray) and Covid-19 (real-time polymerase chain reaction) require the presence of expert radiologists and time, respectively. With the help of deep learning models, pneumonia and Covid-19 can be detected instantly from chest X-rays or computerized tomography (CT) scans. The process of diagnosing pneumonia/Covid-19 can become faster and more widespread. In this paper, we aimed to elicit, explain, and evaluate qualitatively and quantitatively all advancements in deep learning methods aimed at detecting community-acquired pneumonia, viral pneumonia, and Covid-19 from images of chest X-rays and CT scans. Being a systematic review, the focus of this paper lies in explaining various deep learning model architectures, which have either been modified or created from scratch for the task at hand. For each model, this paper answers the question of why the model is designed the way it is, the challenges that a particular model overcomes, and the tradeoffs that come with modifying a model to the required specifications. A grouped quantitative analysis of all models described in the paper is also provided to quantify the effectiveness of different models with a similar goal. Some tradeoffs cannot be quantified and, hence, they are mentioned explicitly in the qualitative analysis, which is done throughout the paper. By compiling and analyzing a large quantum of research details in one place with all the data sets, model architectures, and results, we aimed to provide a one-stop solution to beginners and current researchers interested in this field.

简介：AbstractThe pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to unprecedented social and economic disruption. Many nucleic acid testing (NAT) laboratories in China have been established to control the epidemic better. This proficiency testing (PT) aims to evaluate the participants’ performance in qualitative and quantitative SARS-CoV-2 NAT and to explore the factors that contribute to differences in detection capabilities. Two different concentrations of RNA samples (A, B) were used for quantitative PT. Pseudovirus samples D, E (different concentrations) and negative sample (F) were used for qualitative PT. 50 data sets were reported for qualitative PT, of which 74.00% were entirely correct for all samples. Forty-two laboratories participated in the quantitative PT. 37 submitted all gene results, of which only 56.76% were satisfactory. For qualitative detection, it is suggested that laboratories should strengthen personnel training, select qualified detection kits, and reduce cross-contamination to improve detection accuracy. For quantitative detection, the results of the reverse transcription digital PCR (RT-dPCR) method were more comparable and reliable than those of reverse transcription quantitative PCR (RT-qPCR). The copy number concentration of ORF1ab and N in samples A and B scattered in 85, 223, 50, and 106 folds, respectively. The differences in the quantitative result of RT-qPCR was mainly caused by the non-standard use of reference materials and the lack of personnel operating skills. Comparing the satisfaction of participants participating in both quantitative and qualitative proficiency testing, 95.65% of the laboratories with satisfactory quantitative results also judged the qualitative results correctly, while 85.71% of the laboratories with unsatisfactory quantitative results were also unsatisfied with their qualitative judgments. Therefore, the quantitative ability is the basis of qualitative judgment. Overall, participants from hospitals reported more satisfactory results than those from enterprises and universities. Therefore, surveillance, daily qualitiy control and standardized operating procedures should be strengthened to improve the capability of SARS-CoV-2 NAT.

简介：ＱＵＡＬＩＴＡＴＩＶＥＳＴＵＤＹＯＦＳＩＡＬＯＭＵＣＩＮＳＣＨＡＮＧＥＳＤＵＲＩＮＧＮ－ＭＥＴＨＹＬ－Ｎ－ＮＩＴＲＯＳＯＵＲＥＡ－ＩＮＤＵＣＥＤＣＯＬＯＮＩＣＣＡＲＣＩＮＯＧＥＮＥＳＩＳＩＮＭＩＣＥＷａｎｇＱｉａｎｇ王强；ＷａｎｇＹｕａｎｈｅ王元和；...

简介：AbstractPurpose:The median time from the event leading to the spinal cord injury (SCI) to the time of decompressive surgery is estimated to be 6.9 days in Iran, which is much longer than the proposed ideal time (less than 24 h) in published guidelines. The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.Methods:This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.Results:The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews. Overall, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons. Other notable factors include delay in transferring patients to the trauma center, delay in availability of necessary equipment, and scarce medical personnel.Conclusion:In the perspective of neurosurgeons, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.

简介：AbstractBackground:Fecal immunochemical tests (FITs) are the most widely used non-invasive tests in colorectal cancer (CRC) screening. However, evidence about the direct comparison of the test performance of the self-administered qualitative a laboratory-based quantitative FITs in a CRC screening setting is sparse.Methods:Based on a CRC screening trial (TARGET-C), we included 3144 pre-colonoscopy fecal samples, including 24 CRCs, 230 advanced adenomas, 622 non-advanced adenomas, and 2268 participants without significant findings at colonoscopy. Three self-administered qualitative FITs (Pupu tube) with positivity thresholds of 8.0, 14.4, or 20.8 μg hemoglobin (Hb)/g preset by the manufacturer and one laboratory-based quantitative FIT (OC-Sensor) with a positivity threshold of 20 μg Hb/g recommended by the manufacturer were tested by trained staff in the central laboratory. The diagnostic performance of the FITs for detecting colorectal neoplasms was compared in the different scenarios using the preset and adjusted thresholds (for the quantitative FIT).Results:At the thresholds preset by the manufacturers, apart from the qualitative FIT-3, significantly higher sensitivities for detecting advanced adenoma were observed for the qualitative FIT-1 (33.9% [95% CI: 28.7-39.4%]) and qualitative FIT-2 (22.2% [95% CI: 17.7-27.2%]) compared to the quantitative FIT (11.7% [95% CI: 8.4-15.8%]), while at a cost of significantly lower specificities. However, such difference was not observed for detecting CRC. For scenarios of adjusting the positivity thresholds of the quantitative FIT to yield comparable specificity or comparable positivity rate to the three qualitative FITs accordingly, there were no significant differences in terms of sensitivity, specificity, positive/negative predictive values and positive/negative likelihood ratios for detecting CRC or advanced adenoma between the two types of FITs, which was further evidenced in ROC analysis.Conclusions:Although the self-administered qualitative and the laboratory-based quantitative FITs had varied test performance at the positivity thresholds preset by the manufacturer, such heterogeneity could be overcome by adjusting thresholds to yield comparable specificities or positivity rates. Future CRC screening programs should select appropriate types of FITs and define the thresholds based on the targeted specificities and manageable positivity rates.