Houghtonmichelsen2639
The aim of this study was to illustrate the genomic mutational landscape, tumor mutation burden (TMB), PD-L1 expression, CD8
T cell infiltration and their prognostic value in resectable Lung large cell neuroendocrine carcinoma (LCNEC).
The tumor tissues and corresponding normal tissues of 37 LCNEC patients undergoing surgical resection were collected and determined by whole exome sequencing (WES). Subsequently, the tumor samples were stained with the antibodies of PD-L1 and CD8 via multiplex immunohistochemistry (Multi IHC) to evaluate PD-L1 expression and CD8
T cells infiltration in stroma and tumor regions. Univariate and multivariate analysis were applied to assess the association among genomic features, immune profiles, clinical data and prognosis of LCNEC patients.
The median TMB was 5.42 mutations per megabase. Mutations in Wnt (p=0.049) and Hippo (p=0.005) pathways were markedly associated with higher TMB value, mutations in p53 pathway were related with higher stromal PD-L1 expression (p=0.041). LCNEC patients with KEAP1 mutation (p=0.044) or without adjuvant radiochemotherapy (p=0.023) had significantly shorter OS. Multivariate analysis showed that high stromal CD8+T cells infiltration was an independent favorable factor for disease free survival (p=0.030). The patient stratification of KEAP1 mutation status and stroma PD-L1 expression was independent prognostic factors for overall survival (p=0.049).
The investigation of prognostic factor in resectable LCNEC may provide guidance for timely intervention and new therapy strategy for LCENC patients.
The investigation of prognostic factor in resectable LCNEC may provide guidance for timely intervention and new therapy strategy for LCENC patients.
This study aimed to establish and compare the radiomics machine learning (ML) models based on non-contrast enhanced computed tomography (NECT) and clinical features for predicting the simplified risk categorization of thymic epithelial tumors (TETs).
A total of 509 patients with pathologically confirmed TETs from January 2009 to May 2018 were retrospectively enrolled, consisting of 238 low-risk thymoma (LRT), 232 high-risk thymoma (HRT), and 39 thymic carcinoma (TC), and were divided into training (n=433) and testing cohorts (n=76) according to the admission time. Volumes of interest (VOIs) covering the whole tumor were manually segmented on preoperative NECT images. A total of 1218 radiomic features were extracted from the VOIs, and 4 clinical variables were collected from the hospital database. Fourteen ML models, along with varied feature selection strategies, were used to establish triple-classification models using the radiomic features (radiomic models), while clinical-radiomic models were built aftI 0.756-0.8761) than other radiologists, which was slightly lower than the SVM clinical-radiomic model. Combined with other evaluation indicators, SVM, as the best ML model, demonstrated the potential of predicting the simplified risk categorization of TETs with superior predictive performance to that of radiologists' assessment.
Most of the ML models are promising in predicting the simplified TETs risk categorization with superior efficacy to that of radiologists' assessment, especially the SVM models, demonstrated the integration of ML with NECT may be valuable in aiding the diagnosis and treatment planning.
Most of the ML models are promising in predicting the simplified TETs risk categorization with superior efficacy to that of radiologists' assessment, especially the SVM models, demonstrated the integration of ML with NECT may be valuable in aiding the diagnosis and treatment planning.Despite unprecedented progress in developing COVID-19 vaccines, global vaccination levels needed to reach herd immunity remain a distant target, while new variants keep emerging. Obtaining near universal vaccine uptake relies on understanding and addressing vaccine resistance. Simple questions about vaccine acceptance however ignore that the vaccines being offered vary across countries and even population subgroups, and differ in terms of efficacy and side effects. By using advanced discrete choice models estimated on stated choice data collected in 18 countries/territories across six continents, we show a substantial influence of vaccine characteristics. Uptake increases if more efficacious vaccines (95% vs 60%) are offered (mean across study areas = 3.9%, range of 0.6%-8.1%) or if vaccines offer at least 12 months of protection (mean across study areas = 2.4%, range of 0.2%-5.8%), while an increase in severe side effects (from 0.001% to 0.01%) leads to reduced uptake (mean = -1.3%, range of -0.2% to -3.9%). Additionally, a large share of individuals (mean = 55.2%, range of 28%-75.8%) would delay vaccination by 3 months to obtain a more efficacious (95% vs 60%) vaccine, where this increases further if the low efficacy vaccine has a higher risk (0.01% instead of 0.001%) of severe side effects (mean = 65.9%, range of 41.4%-86.5%). MALT1 inhibitor concentration Our work highlights that careful consideration of which vaccines to offer can be beneficial. In support of this, we provide an interactive tool to predict uptake in a country as a function of the vaccines being deployed, and also depending on the levels of infectiousness and severity of circulating variants of COVID-19.
Translating research evidence into clinical practice to improve care involves healthcare professionals adopting new behaviours and changing or stopping their existing behaviours. However, changing healthcare professional behaviour can be difficult, particularly when it involves changing repetitive, ingrained ways of providing care. There is an increasing focus on understanding healthcare professional behaviour in terms of non-reflective processes, such as habits and routines, in addition to the more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding healthcare professional behaviour, although to date, each perspective has only been applied in isolation.
To combine theories of habit and routine to generate a broader understanding of healthcare professional behaviour and how it might be changed.
Sixteen experts met for a two-day multidisciplinary workshop on how to advance implementation science by developing greater understanding of non-ng theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors, operating at multiple levels of analysis, which can impact on the behaviours of healthcare professionals, and so quality of care provision.
A learning environment is an important determinant of students' learning behaviours, professional competencies, and academic performances. It is also an essential indicator of the quality of teaching programmes. To date, there is not a Tunisian study, that analysed nurse students' perceptions of the educational environment.
This study aimed to assess the perception of Tunisian higher nursing institutes students regarding the quality of the learning environment, and identify the factors associated with it.
Multi-site cross-sectional survey.
Five universities of nursing sciences in Tunisia.
Undergraduate nursing students (n=736).
A cross-sectional descriptive study was conducted during the academic year 2019-2020. The Dundee Ready Educational Environment Measure (DREEM) questionnaire was used to describe the students' perceptions of the learning environment. The participants were recruited using a convenience sampling method. Statistical analyses were performed using SPSS version 20. One-way analysi It is essential to re-engineer the curriculum and shift the teaching paradigm towards 'student-centred curriculum' to enhance both the effectiveness and the efficiency of the learning environment.
The study reported positive perceptions of the students regarding their academic learning environment. However, the DREEM scores reflected a traditional learning environment. It is essential to re-engineer the curriculum and shift the teaching paradigm towards 'student-centred curriculum' to enhance both the effectiveness and the efficiency of the learning environment.
History-taking is an essential skill for nurses. In nursing education, it is necessary to objectively assess history-taking skills in a way that accurately reflects differences among students. Current history-taking evaluation methods lack objectivity, consistency and standardization, which makes it difficult to identify factors that influence history-taking skill. A virtual standardized patient (VSP) can provide history-taking practice with repeatability and consistency. It can make objective and standardized assessment possible by eliminating the subjectivity of different teachers and patients.
To evaluate the history-taking skills of nursing undergraduates using a VSP, and to explore its independent influencing factors.
A cross-sectional design was employed with a sample of convenience from 3 universities. All 174 nursing undergraduates had their history-taking level evaluated using one VSP via computer or mobile terminal. For each query raised by the students, the VSP could give a preset response. Tand consistent assessment of history-taking education. Ethnicity, previous academic performance and supportive communication skills independently influenced the students' history-taking level. Mature history-taking skills require not only solid theoretical knowledge but good communication skills.
Using the VSP as a history-taking assessment method is an effective way to achieve a relatively objective, standardized and consistent assessment of history-taking education. Ethnicity, previous academic performance and supportive communication skills independently influenced the students' history-taking level. Mature history-taking skills require not only solid theoretical knowledge but good communication skills.
This research explored the experiences and perceptions of leadership preparation in pre-registration nursing education. The development of leadership skills in the pre-registration period is often considered a continuous process, and evidence suggests there has been an inconsistent approach to leadership within undergraduate nurse education. Exploring perceptions of experiences in this area was deemed important to guide future leadership development for undergraduate nursing students and formed the rationale for this Doctoral study.
The phenomena of interest were the expectations, experiences and perceptions of student nurses, academics, and nurses in preparation for the role of leadership. A narrative methodology to learning and contexts of learning was applied, data collection included semi structured interviews conducted early in 2020. Metaphorical associations through images are thought to support leadership development and philosophies; therefore, photographic elicitation was used to evoke associatioed a juxtaposition between aligning their experience of leadership with the educational preparation of students and the experiences from clinical leadership, within the social constructs of dual professions and learning contexts.
Participants' experience shaped each story of perceptions of leadership, both within education and in clinical practice. Students' narratives revealed tensions between expectations of leadership, defining leadership and associating their experiences with a personal vision of self as leader in the future role, along with a perceived disconnect between the social and cultural experiences and context of learning. Tensions within the experiences of the academics also revealed a juxtaposition between aligning their experience of leadership with the educational preparation of students and the experiences from clinical leadership, within the social constructs of dual professions and learning contexts.
