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Objective:To explore the relationship between empathy, professional values and nursing ability of nurses in geriatric hospital, and to explore the mediating effect of empathy between professional values and clinical nursing ability of geriatric nurses.Methods:This study was a cross-sectional survey. In June 2022, 401 nurses from Beijing Geriatric Hospital were investigated by general data questionnaire, the Nursing Professional Values Scale, the Jefferson Scale of Empathy-Health Professional and the Geriatric Nursing Competence Scale, and the mediation effect of empathy was analyzed by sequential inspection method.Results:The score of the Jefferson Scale of Empathy-Health Professional was (114.25 ± 16.70) points, the score of the Nursing Professional Values Scale was (100.83 ± 17.76) points, the score of the Geriatric Nursing Competence Scale was (2.15 ± 0.76) points. Empathy was positively correlated with professional value and geriatric nursing ability ( r=0.456, 0.386, both P<0.01), while professional value was positively correlated with geriatric nursing ability ( r=0.421, P<0.01). In addition, empathy played a partial mediating effect between professional values and geriatric nursing ability, accounting for 27.78% of the total effect. Conclusions:This research shows that the nurses' empathy, professional value, geriatric nursing ability have significant positive correlation, and empathy between professional value and geriatric nursing ability play a partial intermediary role. It is suggested that managers should promote the cultivation of empathy and positive professional values of geriatric nurses through diversified training and perfect incentive measures, so as to stimulate work enthusiasm and improve the overall geriatric nursing ability.
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In recent years ，biomimetic nanodelivery system based on cell membrane coating has developed rapidly and shows better biocompatibility and efficacy than traditional nanodelivery systems in a variety of diseases . Macrophages，as members of the immune system ，are closely related to the occurrence and development of a variety of diseases . Macrophages are derived from monocytes and can be polarized into M 1 and M 2 types after corresponding stimulation ： M1 macrophages involved in the proinflammatory reaction and M 2 macrophages involved in the inflammatory reaction . This paper reviews the application status of biomimetic nanoparticles coated with macrophage membrane in disease targeted therapy in recent years . Biomimetic nanoparticles coated with macrophage membrane has shown its high targeting and low immunogenicity in the treatment of malignant tumors （breast cancer ，colorectal cancer ，melanoma，glioma），Alzheimer’s disease ，liver ischemia -reperfusion injury ，atherosclerosis and so on . However，the research of Biomimetic nanoparticles coated with macrophage membrane currently focuses on anti -tumor research and is still in the laboratory research stage .
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The first branchial arch (BA1), which is derived from cranial neural crest (CNC) cells, gives rise to various orofacial tissues. Cre mice are widely used for the determination of CNC and exploration of gene functions in orofacial development. However, there is a lack of Cre mice specifically marked BA1's cells. Pax2-Cre allele was previously generated and has been widely used in the field of inner ear development. Here, by compounding Pax2-Cre and R26R-mTmG mice, we found a specific expression pattern of Pax2
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Animals , Mice , Bone Morphogenetic Protein 4 , Branchial Region , Mesenchymal Stem Cells , SkullABSTRACT
Four-dimensional cone beam CT (4D-CBCT) imaging can provide accurate location information of real-time breathing for imaging-guided radiotherapy. How to improve the accuracy of 4D-CBCT reconstruction image is a hot topic in current studies. PICCS algorithm performs remarkably in all 4D-CBCT reconstruction algorithms based on CS theory. The improved PICCS algorithm proposed in this paper improves the prior image on the basis of the traditional PICCS algorithm. According to the location information of each phase, the corresponding prior image is constructed, which completely eliminates the motion blur of the reconstructed image caused by the mismatch of the projection data. Meanwhile, the data fidelity model of the proposed method is consistent with the traditional PICCS algorithm. The experimental results showed that the reconstructed image using the proposed method had a clearer organization boundary compared with that of images reconstructed using the traditional PICCS algorithm. This proposed method significantly reduced the motion artifact and improved the image resolution.
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Humans , Algorithms , Cone-Beam Computed Tomography , Methods , Four-Dimensional Computed Tomography , Image Processing, Computer-Assisted , Organ Motion , Radiographic Image Enhancement , Methods , RespirationABSTRACT
Objective @#To learn the preference and determinants for institute-based care of the elderly in Zhejiang Province. @*Methods @#By multi-stage sampling and convenient sampling methods,three communities and three villages from Hangzhou,Jinhua and Yongkang as investigation spots,respondents who aged 60 years or above and lived for one year or more were selected for a questionnaire survey to learn their preference for institute-based care. Logistic regression analysis was used to explore the influencing factors for preference of institute-based care among the elderly. @*Results @#A total of 390 valid questionnaires were collected,accounting for 91.76%. Among them,there were 219 men and 171 women, accounting for 56.15% and 43.85; 155 old people chose institute-based care,accounting for 39.74%. The results of multivariate logistic regression analysis illustrated that the elderly who had three children or more had less preference for institute-based care（OR=0.072,95%CI：0.007-0.742）;the elderly who lived with spouse（OR=0.395,95%CI：0.188-0.833）,with children（OR=0.323,95%CI：0.132-0.791）,with spouse and children（OR=0.305,95%CI：0.139-0.673）,compared with the elderly who lived alone,had less preference for institute-based care;the elderly who lived in rural areas,compard with the elderly who lived in urban areas had less preference for institute-based care（OR=0.404,95%CI：0.224-0.730）;the elderly without chronic diseases had less preference for institute-based care（OR=0.485,95%CI：0.292-0.805）. @*Conclusion @#Having three or more children,living with spouse,living with children,living with spouse and children,living in rural areas and living without chronic diseases are determinants for choosing institute-based care among the elderly.
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Objective To investigate the effect of sertraline on negative emotional and adverse cardiovascular events in patients with coronary heart disease (CHD) complicated with depression. Methods The clinical data of 100 patients with CHD complicated with depression from August 2015 to August 2017 were retrospectively analyzed. The patients were divided into sertraline group and control group according to the treatment method with 50 cases each. All patients of 2 groups were treated with routine therapy of CHD and psychological intervention. The patients of sertraline group were combined with sertraline treatment, and the patients of control group were combined with shugan jieyu capsule. The improvement of negative emotion was evaluated by 17-item Hamilton depression rating scale (HAMD), and the incidence of adverse cardiovascular events was observed. The high-sensitivity c-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), endothelin-1 (ET-1) levels and sinus heart beat all the RR interphase (SDNN) before and after treatment were observed. Results The HAMD score after treatment in sertraline group was significantly lower than that in control group: (8.02 ± 1.19) scores vs. (10.57 ± 1.85) scores, and there was statistical difference (P＜0.01). The total effective rate in sertraline group was significantly higher than that in control group: 92.0% (46/50) vs. 68.0% (34/50), the incidence of the adverse cardiovascular events was significantly lower than that in control group: 4.00% (2/50) vs. 14.00% (7/50), and there were statistical differences (P＜0.05). There were no statistical differences in hs-CRP, IL-6, TNF-α and ET-1 after treatment between 2 groups (P＞0.05). The SDNN after treatment in sertraline group was significantly higher than that in control group: (111.04 ± 20.18) ms vs. (98.34 ± 23.30) ms, and there was statistical difference (P＜0.05). Conclusions Sertraline can effectively improve the depression status in patients with CHD complicated with depression, and it can reduce the incidence of adverse cardiovascular events and improve prognosis.
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Objective To investigate the relationship between gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome(OSAS). Methods Patients diagnosed as GERD and healthy controls without GERD related symptoms or endoscopic esophagitis were enrolled from October 2017 and December 2017. All subjects completed Berlin Questionaire to assess the risk of OSAS. Univariate and multivariate logistic regression models were applied to identify risk factors of OSAS. Results A total of 177 subjects (97 GERD, 80 controls) were finally selected. Significantly more patients in GERD group had high risk OSAS than those in controls [36.1％(35/97) vs. 17.5％(14/80), P=0.005]. In GERD group, patients with erosive reflux diseases (ERD) had especially higher proportion of high risk OSAS compared with the non-ERD group and the healthy controls [53.3％(24/45) vs. 20.8％(10/48) and 17.5％(14/80), P=0.001]. On univariate analysis, male, aging and reflux esophagitis were identified as risk factors of OSAS (all P<0.01). On multivariate analysis, male (OR=12.156, 95％CI 1.382-106.905, P=0.024), aging (OR=1.132, 95％CI 1.051-1.220, P=0.001), acid regurgitation with reflux esophagitis (OR=5.157, 95％CI 1.327-20.034, P=0.018) were significant risk factors. Conclusions More GERD patients are combined with high risk OSAS than controls, especially subjects with reflux esophagitis. Male and aging GERD patients with acid regurgitation and reflux esophagitis need further evaluation on OSAS screening.
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Objective To investigate the effect of gefitinib, an inhibitor of epidermal growth factor receptor ( EGFR ) , on the proliferation and osteogenic differentiation of endosteum-derived stem cells ( EDSCs ) in rats. Methods Femoral fracture models were established in healthy male 4-week old SD rats. They were randomly divided into 2 groups. The experimental group was subjected to intragastric lavage with gefitinib, an EGFR signaling inhibitor ( 100 mg/kg·d ) while the control group to intragastric lavage with an isodose of methyl cellulose. Bilateral femurs and tibias were harvested one week after lavage for separation of EDSCs and bone marrow mesenchymal stem cells ( BMSCs ) respectively using density gradient centrifuga-tion. After proliferative cloning in vitro, expression of the cell surface antigens ( CD29, CD34, CD44 and CD45) of the third passage cells was detected by flow cytometry (FCM). Proliferation of the cells was detected by BrdU, cell cycle was measured by FCM, and expression of the genes related to cell cycle inhibitory factors (p15, p16, p21 and p27) was determined by PCR. ALP staining was performed 14 days after osteogenesis induction. After 21 days of chondrogenic induction, von Kossa staining was conducted. qRT-PCR of the mRNA obtained was used to detect expression of osteogenic differentiation of related genes ( osteocalcin, bsp, runx2 and osterix ). Results CD29 and CD44 were positively expressed while CD34 and CD45 negatively expressed in EDSCs and BMSCs. After the EGFR signaling pathway was blocked by gefitinib, BrdU detection found that gefitinib inhibited BMSCs ( 11.15%) much more than EDSCs ( 0.25%). Cell cycle detection showed that the volume of EDSCs was increased in phases G0/G1 and S but decreased significantly in phase G2-M. ALP staining showed that the increase of EDSCs ALP+ cells (53.31% ) was significantly higher than that of BMSCs (25.04% ) . The increased expression percentages of the genes related to cell cycle inhibitors in EDSCs (103.9%, 58.0%, 117.3% and 105.1%, respectively) were significantly higher than those in BMSCs (39.3%, 38.4%, 24.5% and 83.4%, respectively) ( P ＜0.05). The increased expression percentages of the genes related to osteogenic differentiation in EDSCs (247.0%, 289.9%, 66.1% and 233.2%, respectively) were significantly higher than those in BMSCs (106.5%, 186.4%, 41.7% and 190.8%, respectively). All the above differences were statistically significant ( P ＜0.05) . Conclusions Gefitinib, an EGFR inhibitor, can inhibit proliferation of EDSCs and BMSCs but promote their osteogenic differentiation. It inhibits proliferation of BMSCs more significantly as it promotes osteogenic differentiation of EDSCs.
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Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification.Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+Lamivudine (3TC)+Efavirenz (EFV) since 2012.There were 5 126 patients initiated TDF+3TC+EFV therapy (TDF group) and 8 934 patients initiated AZT+3TC+EFV therapy (AZT group).Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups.Cox proportional hazard model was used to investigate the risk factors associated with regimen modification.Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years.There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%.Two hundred patients who changed their initial regimen due to pregnancy were excluded.There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%.Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%.There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%.The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/mL were risk factors associated with regimen modification.
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Objective To investigate the duodenum absorptive character of monosialotetrahexosylganglioside sodium (GM1) in rats.Methods The contents of phenolsulfonphthalein (as indicators) and GM1 were determined with ultraviolet-visible (UV) method and high performance liquid chromatography (HPLC) method in rats with in situ cycle intestinal perfusion model.Results The ratio of duodenum absorption of GM1 was 10％ in 2 h after cycle and 22％ in 6 h after cycle,respectively.The Ka was (0.030± 0.012)h,and absorption t1/2 was (25.50 ± 8.56)h in 8 h after cycle.Conclusions GM1 is absorption in rat duodenum,and the accumulate absorption of GM1 is almost linearly related to the cycle time.The absorption dynamics of GM1 may be first-order kinetic process.
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Objective To develop an LC-MS/MS method for simultaneous determination of metolazone and valsartan in beagle dog plasma.Methods The chromatographic separation was achieved on an Agilent Poroshell 120(2.1 mm ×30 mm × 2.7 μm)analytical column.The multiple reaction monitoring mode operating in positive ion was adopted in MS detection, and precursors to the product ion transitions of m/z 366.2/259, 436.2/291 and 423.4/207 were used to measure metola-zone, valsartan and internal standard ( losartan potassium) .Results The method was linear over the concentration range of 0.5 ng/ml-100 ng/ml for metolazone and 5-5000 ng/ml for valsartan, with the correlation coefficients ( r2 ) of 0.9937 and 0.9939, respectively.The average intra-day precision values ( RSD) were 2.09% -8.85% for metolazone and 2.36%-13.12%for valsartan.The matrix effect values were 87.73%-98.62%for metolazone and 99.03%-137.35%for valsartan.The average recovery was 75.74%-81.82%for metolazone and 83.89%-95.64%for valsartan.Conclu-sion This analytical method for metolazone and valsartan is simple, accurate and sensitive, so it can be used for pharma-cokinetic research of metolazone and valsartan immediate release tablets in beagle dogs.
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Objective To develop an LC-MS/MS method for the determination of ropivacaine in rat plasma. Methods The chromatographic separation was achieved on an Agela MP C18(2.1 mm×50 mm,3μm)analytical column. The multiple reaction monitor?ing(MRM)mode of the positive ion was adopted in the MS detection,and the precursors to the product ion transitions of m/z 275.2/126.1 and 326.0/291 were used to measure ropivacaine and internal standard(midazolam). Results The method was linear over the ropiva?caine concentration range of 0.5-250 ng/ml with the correlation coefficients r of 0.9946. The average inter-day precision values(RSD) were 1.32%-6.74%,the matrix effect values were 95.5%-102.6% and the average recovery values were 89.8%-104.7%. Conclu?sion The analysis methods for ropivacaine are simple,accurate and sensitive,thus can be used for the pharmacokinetic research of ropivacaine incorporated cubic liquid crystal in rat.
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BACKGROUND:Bone marrow mesenchymal stem cel transplantation has not been thoroughly reported on its effects on apoptosis in hepatoma carcinoma cel s and inflammatory factor level. OBJECTIVE:To investigate the effect of rat bone marrow mesenchymal stem cel s on dynamic change of inflammatory factors and cel apoptosis during hepatocarcinogenesis. METHODS:Sixty healthy Sprague-Dawley rats were divided randomly into healthy group (n=30), control group (n=30) and transplantation group (n=30). Healthy group was given ordinary feed and normal water, while other groups were given diethylnitrosamine solution in drinking water to induce liver cancer models. Then, rats in the transplantation group were subjected to bone marrow mesenchymal stem cel transplantation via the tail vein. Two weeks after cel transplantation, CXCL5, interleukin-8 and interleukin-6 levels were tested by ELISA, mRNA level of hepatocyte nuclear factor 1αdetected by RT-PCR, expression of Bcl-2 and Bax in liver tissue measured by immunohistochemical method, and liver cancer cel apoptosis index detected by TUNEL technique. RESULTS AND CONCLUSION:After modeling, the expressions of CXCL5, interleukin-8 and interleukin-6 in the control group were significantly higher than those in the healthy group (P0.05). Bone marrow mesenchymal stem cel transplantation significantly up-regulated the mRNA level of hepatocyte nuclear factor 1αin the liver tissue that was decreased obviously after modeling (P<0.05). In addition, the expression of Bcl-2 was reduced, while the expression of Bax and the apoptosis index increased significantly in the transplantation group compared with the control group (P<0.05). These findings indicate that bone marrow mesenchymal stem cel transplantation contributes to hepatocyte differentiation and regeneration in liver cancer rats by reducing serum inflammatory factor levels and promoting apoptosis in hepatoma carcinoma cel s.
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Objective Establishing the drug?resistant Candida albicans disseminative infected mice model for new drug screening. Methods The disseminative infected mouse model was generated by intravenously injecting a clinical Drug?resistant Candida albicans strain ( CaR) to immunosuppressive ICR mice. The features of model was evaluated by clinical symptom, survival condition, fungal burden in tissue, histopathology, cytokines assay and medication. Results After infected with CaR (0 day), the death of mice started at the first day, though, compared to clinical drug sensitive strain ( CaS) infected group, the difference of mortality rate in 16?day observation period was not significant in two groups (CaR, 90?7%;CaS, 86?2%, P =0?158), mice in CaR group died faster than those in CaS group at the early stage;On the fourth day of infection, Candida albicans could be detected in the different tissues, and we found fungal burden in kidney and brain was a significant difference. The typical granuloma caused by fungal infection was the main histopathological feature observed in the kidney, brain and heart. Cytokines in renal tissue were detected by flow cytometry, The changes of IL?1α,IL?6,TNF?αand IFN?γin kidney were significant. Compared with CaS group, IL?1 and IFN?γ were significantly higher and TNF?αdecreased significantly in CaR group. The mice of groups CaR and CaS were treated with 10 mg/kg fluconazole, the mortality rates were 83?3% and 37?5%, which have a significant difference. Conclusions In this study, we successfully established a drug?resistant Candida albicans disseminative infected mice model which is potential tool for the development of new anti?infectious agent.
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Aim To make a research of rats with focal cerebral ischemia/reperfusion injury on pathological changes in brain and the changes of AQP4 and related proteins, in order to explore the relationship between AQP4 and brain edema. Methods Adult male SD rats, weighting 250~300 g, were randomly divided in-to Sham group and cerebral ischemia/reperfusion ( I/R) injury model group. The I/R model group was di-vided into the I/R-6 h, 12 h, 24 h, 48 h-four time point groups. The animal model of the right MCA is-chemia/reperfusion was established by suture method in mature SD rats. The nerve symptom score was con-ducted in the corresponding time points. Then, the permeability of brain tissue was detected by EB stai-ning;TTC staining was conducted to observe the cere-bral infarction volume;the dry wet weight method was used to detect the changes of brain water content; im-munohistochemical( IHC) , WB and RT-PCR were ap-plied to detect the expression of AQP4 , and the related factors at different time points of the model rats after is-chemia-reperfusion around infarcts. Results Com-pared with the Sham group, then ever function score of the rats in I/R model groups were much higher. With the increase of the reperfusion time, the cerebral in-farction volume, brain tissue permeability and the brain water content were also increased. IHC results showed that AQP4 expression gradually rose with widen distribution. WB and RT-PCR results verified the in-creasing level of AQP4 expression. The detection of the related proteins expression showed apparent changes. The expression of MMP-9 was increased, while the Oc-cludin and JAM-1 expression showed a decreasing trend. The I/R-48 h model group showed the most ob-vious differences in the expression of the related pro-teins and mRNA ( P <0. 01 vs Sham, respectively ) . Conclusion Accompanied with the aggravating cere-bral injury after cerebral ischemia/reperfusion, the ex-pression of AQP4 and MMP-9 level were activated, while the degradation of TJPs, Occludin and JAM-1, was increased. These factors are combined to make the formation of brain edema. This study makes a further research on the formation mechanism of the early stage for cerebral edema on I/R model and offers a potential for intervention in the filed of looking for a reliable drug therapy on cerebral edema.
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To establish a stable mouse model of systemic Candida infection and to set up related standard operation procedure .Methods ICR mice were infected with C.albicans or C.parapsilosis by tail vein injection after immunosuppres-sion by cyclophosphamide .The quality control key points included immunosuppression , strain preparation, inoculation doses and the route of inoculation .Survival analysis , bacterial loads and pathological examination were performed to evaluate the prepared model .Results The developed model showed fugal-specific lesions in multiple organs , especially in the kidneys revealed by histopathological examination .Conclusions A stable mouse model of systemic Candida albicans infection can be successfully established by following standardized operation procedure .This mouse model may provide a useful tool for studies on pathogenesis and immune defense of fungal infection and new anti-fungal drug development and so on .
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Nowadays, nanotechnologies have shown wide application foreground in the biomedical field of medicine laboratory tests, drug delivery, gene therapy and bioremediation. However, in recent years, nanomaterials have been labeled poisonous, because of the disputes and misunderstandings of mainstream views on their safety. Besides, for the barriers of technical issues in preparation like: (1) low efficacy (poor PK & PD and low drug loading), (2) high cost (irreproducibility and difficulty in scale up), little of that research has been successfully translated into commercial products. Currently, along with the new theory of "physical damage is the origin of nanotoxicity", biodegradability and biocompatibility of nanomaterials are listed as the basic principle of safe application of nanomaterials. Combining scientific design based on molecular level with precision control of process engineering will provide a new strategy to overcome the core technical challenges. New turning point of translational medicine in nanotechnology may emerge.
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OBJECTIVE:To better carry out the pharmaceutical services in outpatient pharmacy,and provide reference for the safe,effective and rational drug use of outpatients. METHODS:Questionnaires were designed based on the related information pro-vided by consultation services of outpatient pharmacy in our hospital and referring to the related literatures to randomly select and investigate the patients of outpatient pharmacy in our hospital,and the results were statistically analyzed. RESULTS:There were to-tally 450 questionnaires,involving 417 valid questionnaires with the effective recovery of 92.67%. The questions about pharmaceuti-cal service of surveyed patients were dosage and precautions,respectively with the number of 254(60.91%)and 251(60.19%);followed by functions and indications,with the number of 234 (56.12%);besides,there were also with widespread concerns, such as drugs efficacy,medication time,and medication of elderly,children and pregnant women,etc. Among the surveyed pa-tients,20.75% were blind medication;89.45% thought the pharmacists’guidance was helpful for medication;there were still 21.35% without pharmacists’medication guidance. CONCLUSIONS:The survey shows the poor awareness of rational drug use and lacking knowledge of drugs in outpatients,they are eager for medication guidance from professional pharmacists. However,the pharmaceutical service in outpatient pharmacy needs to be improved. It is suggested to actively promote the pharmacy services by implementing points medication,adopting red and blue for warning labels,providing comprehensive drug counseling services and carrying out rational drug use education,etc.
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Objective To establish a management information system for bacteria ( virus ) preservation in order to improve the management efficiency and quality of bacteria ( virus) preservation organizations to the largest possible extent . Methods Client/Server(C/S) structure was adopted to design the system with Visual Basic 6.0 and SQL Server2000 as the platform of development .A bacteria ( virus) information database was established with the E-R model and 3NF.The system was developed by face to object language program .Results Devices needed were supplied .Functional modules of bacteria ( virus ) information management , scientific research project management , user management and system maintenance were constructed .Visiting permission was installed on the platform and database to maximize the protection of bacteria ( virus ) information safety .Conclusion Bacteria ( virus ) information flow management , involving storage , classification, preservation, collection and record, is achieved.All the resources of the preservation organization are integrated.Bacteria (virus) management efficiency is increased and bacteria (virus) information safety is ensured.
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Objective:With the development of science and technology, large medical equipments have been universally applied in clinical diagnosis. It is important in hospital management to search for the way to obtain the maximum economic and social benefits by efficiently analyzing cost benefit of large medical equipment. Methods:To ascertain cost benefit of medical equipment by profit margin of investments and cost-redemption periods. Results:Proposals on purchase and management of department medical equipment were presented. Conclusion:Scientific evaluation and analysis on large medical equipment would play a positive role in purchase, use and economic returns of department medical equipment.