Translation, cross-cultural adaptation, and validation of the Chinese version of the COVID-19 health literacy scale in nursing students.

BACKGROUND: Effective communication is an essential component of high-quality nursing care. Health literacy, the ability to access, describe, evaluate and apply health information to make informed decisions, is an important component of effective communication in nursing. Nurses, including student nurses, with good levels of health literacy (HL) are well positioned to communicate reliable public health-related information effectively, at times like the COVID-19 global pandemic. At this time, many nursing students have been at the frontline of patient education, as such, it would be expected that they have high levels of HL. However, it has been suggested that there is the need to improve HL levels in nursing students. AIMS: The aim of this study was to analyse the structure of item response of a back translated Chinese version of the COVID-HLS-Q22 questionnaire and to assess the coronavirus-related HLof Chinese speaking nursing students in Hong Kong using the COVID-HLS-Q22-CN. METHODS: A cross-sectional study of 97 undergraduate nursing students was conducted using two self-reported questionnaires. The HLS-EU-16 scale, with face validity already established, was used to assess scale equivalence Using a cross-over study approach, student participants were randomly assigned in sequential order. The validation process was performed in five phases: direct translation, translation synthesis, back translation, consolidation with experts, and testing with the students. The intended outcome of this study will be a formally tested model of the Chinese version of the COVID-HLS-Q22-CN, that can be replicated in Chinese population. RESULTS: Factorial equivalence was present across language versions in both questionnaires. Internal consistency was excellent for COVID-HLS-Q22-CN (coefficient alpha for Chinese version of questionnaire, 0.957 and English version, 0.953). This suggested that the four subscale are stable across the two questionnaires. CONCLUSION: The COVID-HLS-Q22-CN has proven to be a feasible and reliable tool in the assessment of Hong Kong based Chinese speaking nursing students. The emergence of issues around COVID-related HL further highlights the need to include the teaching of critical health literacy skills within nurse education, preparing the healthcare professionals of the future for public health emergencies.

On-shelf circulation of warm water toward the Totten Ice Shelf in East Antarctica.

The Totten Glacier in East Antarctica, with an ice volume equivalent to >3.5 m of global sea-level rise, is grounded below sea level and, therefore, vulnerable to ocean forcing. Here, we use bathymetric and oceanographic observations from previously unsampled parts of the Totten continental shelf to reveal on-shelf warm water pathways defined by deep topographic features. Access of warm water to the Totten Ice Shelf (TIS) cavity is facilitated by a deep shelf break, a broad and deep depression on the shelf, a cyclonic circulation that carries warm water to the inner shelf, and deep troughs that provide direct access to the TIS cavity. The temperature of the warmest water reaching the TIS cavity varies by ~0.8 °C on an interannual timescale. Numerical simulations constrained by the updated bathymetry demonstrate that the deep troughs play a critical role in regulating ocean heat transport to the TIS cavity and the subsequent basal melt of the ice shelf.

Dominant frazil ice production in the Cape Darnley polynya leading to Antarctic Bottom Water formation.

Antarctic Bottom Water (AABW) occupies the abyssal layer of the world ocean and contributes to the global overturning circulation. It originates from dense shelf water, which forms from brine rejection during sea ice production. An important region of AABW formation has been identified off the Cape Darnley polynya. However, it remains unclear why and how high ice production leads to AABW formation. Using moored acoustic measurements and a satellite microwave algorithm, we reveal that underwater frazil ice dominates in the polynya. This underwater ice formation prevents heat-insulating surface-cover ice forming, thereby enabling efficient ice production. The high ice production in the nearshore and longer residence times create high-salinity source water for the AABW. Underwater frazil ice occurs as long as strong winds continue and occasionally penetrates depths of at least 80 m. Deep-penetrating frazil ice is particularly prominent in this polynya, while it also occurs in other Antarctic coastal polynyas.

Age distribution of Antarctic Bottom Water off Cape Darnley, East Antarctica, estimated using chlorofluorocarbon and sulfur hexafluoride.

Chlorofluorocarbon (CFC) and sulfur hexafluoride (SF6) were used to investigate the timescale of Antarctic Bottom Water (AABW) that spreads off Cape Darnley (CD) in East Antarctica. The age of the AABW was estimated based on the observed SF6/CFC-12 ratio while taking into account tracer dilution by Lower Circumpolar Deep Water. Along the western canyons off CD and the ~ 3000 to 3500 m isobaths, the bottom water age was < 5 years, reflecting the spread of newly formed CD Bottom Water. Higher ages of ~ 8 years obtained for areas east of CD and > 20 years in the northwestern offshore region indicate inflows of AABW through the Princess Elizabeth Trough and Weddell Sea Deep Water, respectively. This study determined the age distribution in the region off CD, where three different types of AABW spread.

Weakened overturning and tide control the properties of Oyashio Intermediate Water, a key water mass in the North Pacific.

The western subarctic Pacific exhibits major biological productivity fed by the Oyashio Current and its two source waters: Western Subarctic Water, which supplies nutrients from the subarctic Pacific, and cold Okhotsk Sea Intermediate Water (OSIW), which supplies iron from the Sea of Okhotsk. We created seasonal climatologies of water properties to understand how the long-term trend (~ 50 years) and 18.6-year tidal cycle affect the Oyashio Intermediate Water (OYW). We found that over the trend, decreased OSIW outflow due to weakening of North Pacific overturning modifies OYW in winter. Meanwhile, OSIW outflow increases (decreases) in strong (weak) tide years. We predict that the opposite effects of the trend and strong tide will lead to stagnation of OYW properties until the mid-2020s, followed by accelerated warming until the mid-2030s (weak tide). A predicted 1 °C increase in OYW temperature and 50% decrease in OSIW content between 1960 and 2040 potentially have significant impact on biological productivity and carbon drawdown in the North Pacific.

Laboratory and clinical impacts of an overnight laboratory service.

Delayed initiation of effective antimicrobial therapy for sepsis is associated with increased mortality. Whilst automated blood culture machines operate continuously, this does not align with conventional staff working hours and so turn-around-times (TAT) for reporting gram stains to clinicians are 3-7 times longer for blood cultures that flag positive overnight. We retrospectively compared laboratory TATs and clinical outcomes for blood cultures from 183 patients that flagged positive overnight during a 4-month period before and after the implementation of an overnight laboratory service. Enterobacterales and urinary tract infections were the most frequent pathogens and clinical syndrome respectively, and the prevalence of multi-resistant organisms was 15%. Compared with the pre-implementation period, the post-implementation period was associated with shorter median time from blood culture positivity to gram stain (7.4 vs 1.2 h), first genus level identification (7.2 vs 5.8 h) and first antimicrobial susceptibility result (24.1 vs 7.9 h). Similarly, the median time from blood culture positivity to clinicians first being informed was significantly shorter (9.2 vs 1.3 h). After removal of likely contaminants, 78% of patients were on effective empiric antimicrobials and for patients on ineffective empiric antimicrobials, effective therapy was initiated a median of 3.2 h sooner during the post-implementation period, without impact on mortality. Implementation of an overnight laboratory service was associated with significantly faster TAT for reporting blood culture results and more prompt initiation of effective antimicrobials for patients receiving ineffective empiric therapy, improving attainment of sepsis management goals.

Strong ice-ocean interaction beneath Shirase Glacier Tongue in East Antarctica.

Mass loss from the Antarctic ice sheet, Earth's largest freshwater reservoir, results directly in global sea-level rise and Southern Ocean freshening. Observational and modeling studies have demonstrated that ice shelf basal melting, resulting from the inflow of warm water onto the Antarctic continental shelf, plays a key role in the ice sheet's mass balance. In recent decades, warm ocean-cryosphere interaction in the Amundsen and Bellingshausen seas has received a great deal of attention. However, except for Totten Ice Shelf, East Antarctic ice shelves typically have cold ice cavities with low basal melt rates. Here we present direct observational evidence of high basal melt rates (7-16 m yr-1) beneath an East Antarctic ice shelf, Shirase Glacier Tongue, driven by southward-flowing warm water guided by a deep continuous trough extending to the continental slope. The strength of the alongshore wind controls the thickness of the inflowing warm water layer and the rate of basal melting.

Development of the TeamOBS-PPH - targeting clinical performance in postpartum hemorrhage.

INTRODUCTION: This study aimed to develop a valid and reliable TeamOBS-PPH tool for assessing clinical performance in the management of postpartum hemorrhage (PPH). The tool was evaluated using video-recordings of teams managing PPH in both real-life and simulated settings. MATERIAL AND METHODS: A Delphi panel consisting of 12 obstetricians from the UK, Norway, Sweden, Iceland, and Denmark achieved consensus on (i) the elements to include in the assessment tool, (ii) the weighting of each element, and (iii) the final tool. The validity and reliability were evaluated according to Cook and Beckman. (Level 1) Four raters scored four video-recordings of in situ simulations of PPH. (Level 2) Two raters scored 85 video-recordings of real-life teams managing patients with PPH ≥1000 mL in two Danish hospitals. (Level 3) Two raters scored 15 video-recordings of in situ simulations of PPH from a US hospital. RESULTS: The tool was designed with scores from 0 to 100. (Level 1) Teams of novices had a median score of 54 (95% CI 48-60), whereas experienced teams had a median score of 75 (95% CI 71-79; p < 0.001). (Level 2) The intra-rater [intra-class correlation (ICC) = 0.96] and inter-rater (ICC = 0.83) agreements for real-life PPH were strong. The tool was applicable in all cases: atony, retained placenta, and lacerations. (Level 3) The tool was easily adapted to in situ simulation settings in the USA (ICC = 0.86). CONCLUSION: The TeamOBS-PPH tool appears to be valid and reliable for assessing clinical performance in real-life and simulated settings. The tool will be shared as the free TeamOBS App.

Estimation of sea-ice thickness and volume in the Sea of Okhotsk based on ICESat data.

Sea-ice thickness in the Sea of Okhotsk is estimated for 2004-2008 from ICESat derived freeboard under the assumption of hydrostatic balance. Total ice thickness including snow depth (h tot ) averaged over 2004-2008 is 95 cm. The interannual variability of h tot is large; from 77.5 cm (2008) to 110.4 cm (2005). The mode of h tot varies from 50-60 cm (2007 and 2008) to 70-80 cm (2005). Ice thickness derived from ICESat data is validated from a comparison with that observed by Electromagnetic Induction Instrument (EM) aboard the icebreaker Soya near Hokkaido, Japan. Annual maps of h tot reveal that the spatial distribution of h tot is similar every year. Ice volume of 6.3 × 1011 m3 is estimated from the ICESat derived h tot and AMSR-E derived ice concentration. A comparison with ice area demonstrates that the ice volume cannot always be represented by the area solely, despite the fact that the area has been used as a proxy of the volume in the Sea of Okhotsk. The ice volume roughly corresponds to that of annual ice production in the major coastal polynyas estimated based on heat budget calculations. This also supports the validity of the estimation of sea-ice thickness and volume using ICESat data.

Evidence for ice-ocean albedo feedback in the Arctic Ocean shifting to a seasonal ice zone.

Ice-albedo feedback due to the albedo contrast between water and ice is a major factor in seasonal sea ice retreat, and has received increasing attention with the Arctic Ocean shifting to a seasonal ice cover. However, quantitative evaluation of such feedbacks is still insufficient. Here we provide quantitative evidence that heat input through the open water fraction is the primary driver of seasonal and interannual variations in Arctic sea ice retreat. Analyses of satellite data (1979-2014) and a simplified ice-upper ocean coupled model reveal that divergent ice motion in the early melt season triggers large-scale feedback which subsequently amplifies summer sea ice anomalies. The magnitude of divergence controlling the feedback has doubled since 2000 due to a more mobile ice cover, which can partly explain the recent drastic ice reduction in the Arctic Ocean.

Skin disease in captive bats: results of an online survey of zoos and rehabilitators in Europe, North America and Australasia.

BACKGROUND: Bats may be held captive in zoos and breeding programmes, and for rehabilitation due to illness, abandonment or injury. OBJECTIVES: To describe the frequency and characteristics of skin disease in captive bats. METHODS: Zoos (n = 164) in Europe, North America, Australia and New Zealand, Wildlife Disease Association members and rehabilitators were invited to complete online questionnaires on skin lesions and housing. Associations between lesion type and site, frequency, species, age, suspected cause and season, and their association with housing in zoos were tested using chi-squared and two-sample z-tests. RESULTS: Skin lesions were seen by 38.5% (15 of 39) of responding zoos and more frequently by rehabilitators (66.7%, 18 of 27; P = 0.024). Of the total of 153 lesions of any type reported by zoos and rehabilitators, almost two thirds occurred on the pinnae (49 of 153, 32%) or wing membranes (45 of 153, 29%). Amongst pinnal lesions, crusting (27%), swelling and redness (25%) and necrosis (20%) were most frequent. In zoos, pinnal (P = 0.001) and wing lesions (P = 0.045) were associated with "season", being more common in winter. Pruritus was rare but more often reported from rehabilitation centres (12 of 77 observed lesions) than from zoos (1 of 76) (P = 0.0015). Lesions most often affected adult and geriatric bats in zoos, and juveniles and adults in rehabilitation. Eight respondents reported that skin disease necessitated euthanasia in individual bats. There was no significant association between type of housing and lesions. CONCLUSION: Pinnal and wing lesions were common in captive bats, often with necrosis. Further research into the causes is needed to improve health and welfare of captive bats.

Record linkage in Scotland and its applications to health research.

AIMS AND OBJECTIVES: This paper will focus on the key concepts behind record linkage and describe how probability matching of Scottish health records can be used for national health research. BACKGROUND: Record linkage can bring together two or more records relating to the same individual. This allows information from multiple sources to be joined together to produce richer data sets for research purposes and has wide applicability in public health and epidemiological research. The probability matching techniques underpinning record linkage bring together records on a patient basis using key identifying information on each record. Scotland has a strong track record for performing linkage for research purposes owing to routinely collected and well-maintained national administrative health data sets, the emergence of the Scottish record linkage system and organisations like the Information Services Division of NHS National Services Scotland who centrally hold permanently linked patient-based databases. Design. A record linkage retrospective population cohort study is described within this paper. METHODS: The paper will describe current linkage methodology before discussing typical applications in the setting of Information Services Division and focusing on a particular linkage study investigating rates and risk factors for gastroschisis. RESULTS: Conclusions from the gastroschisis study are typical of the types of important findings drawn from analysing linked health data. CONCLUSIONS: Scotland's good track record for linking records for health research is evidenced by the high volume of research projects, publications and findings resulting from probability matching of national health data. Relevance to clinical practice. Record linkage allows information relating to the same person held across different data sources to be brought together. Probabilistic record linkage can overcome data quality issues, producing accurate matches. This allows linked, analysable, patient-based databases, capable of answering complex research questions, to be produced from several data sources with wide applications in the field of health research.

The use of data-mining to identify indicators of health-related quality of life in patients with irritable bowel syndrome.

AIM: To examine the health-related quality of life in a cohort of individuals with irritable bowel syndrome and to explore the use of several data-mining methods to identify which socio-demographic and irritable bowel syndrome symptoms are most highly associated with impaired health-related quality of life. BACKGROUND: Health-related quality of life can be adversely affected by irritable bowel syndrome. Little is presently known about the predictive factors that may influence the quality of life in these patients. DESIGN: Cross-sectional survey design involving the general population of the UK. Methods. Individuals with symptoms of irritable bowel syndrome were recruited to a longitudinal cohort survey via a UK-wide newspaper advert. Health-related quality of life was measured using a battery of validated questionnaires. Several data-mining models to determine which factors are associated with impaired health-related quality of life are considered in this study and include logistic regression, a classification tree and artificial neural networks. RESULTS: As well as irritable bowel syndrome symptom severity, results indicate that psychological morbidity and socio-demographic factors such as marital status and employment status also have a major influence on health-related quality of life in irritable bowel syndrome. CONCLUSION: Health-related quality of life is impaired in community-based individuals in the UK with irritable bowel syndrome. Although not always as easily interpreted as logistic regression, data-mining techniques indicate subsets of factors that are highly associated with impaired quality of life. These models tend to include subsets of irritable bowel syndrome symptoms and psychosocial factors. RELEVANCE TO CLINICAL PRACTICE: Identification of the role of psychological and socio-demographic factors on health-related quality of life may provide more insight into the nature of irritable bowel syndrome. Greater understanding of these factors will facilitate more flexible and efficient nursing assessment and management of this patient group.

Lipoprotein(a), interleukin-10, C-reactive protein, and 8-year outcome after percutaneous coronary intervention.

BACKGROUND: This prospective study investigated the association between preprocedural biomarker levels and incident major adverse cardiac events (MACE) in complex patients undergoing percutaneous coronary intervention (PCI) with sirolimus-eluting stenting. HYPOTHESIS: Lipoprotein(a) (Lp[a]), interleukin-10 (IL-10), and high-sensitivity C-reactive protein (CRP) have long-term prognostic value in patients undergoing PCI. METHODS: Between April 2002 and February 2003, 161 patients were included in the study. Blood was drawn before the procedure, and biomarkers were measured. Patients were followed-up for MACE (death, nonfatal myocardial infarction, and repeat revascularization). Cox proportional hazard models were used to determine risk of MACE for tertiles of biomarkers. Both 1-year and long-term follow-up (median, 6 years; maximum, 8 years) were evaluated. RESULTS: Mean age was 59 years, and 68% were men. During long-term follow-up, 72 MACE occurred (overall crude cumulative incidence: 45% [95% confidence interval (CI): 37%-52%]). Lp(a) was associated with a higher 1-year risk of MACE, with an adjusted hazard ratio (HR) of 3.1 (95% CI: 1.1-8.6) for the highest vs the lowest tertile. This association weakened and lost significance with long-term follow-up. IL-10 showed a tendency toward an association with MACE. The 1-year HR was 2.1 (95% CI: 0.92-5.0). Long-term follow-up rendered a similar result. The association of CRP with MACE did not reach statistical significance at 1-year follow-up. However, CRP was associated with long-term risk of MACE, with an HR of 1.9 (95% CI: 1.0-3.5). CONCLUSIONS: In this prospective study, preprocedural Lp(a) level was associated with short-term prognosis after PCI. The preprocedural CRP level was associated with long-term prognosis after PCI.

Approaches for dealing with missing data in health care studies.

AIM: The aims of this study were to highlight the problems associated with missing data in healthcare research and to demonstrate the use of several techniques for dealing with missing values, through the use of an illustrative example. BACKGROUND: In healthcare research studies, it is almost impossible to avoid at least some missing values during data collection, which in turn can threaten the validity of the study conclusions. A range of methods for reducing the impact of missing data on the validity of study findings have been developed, depending on the nature and patterns which the missing values may take. DESIGN: A discursive study. METHODS: Several techniques designed to deal with missing data are described and applied to an illustrative example. These methods include complete-case analysis, available-case analysis, as well as single and multiple imputation. CONCLUSIONS: If research data contain missing values that are not randomly distributed, then the study results are likely to be biased unless an effective approach to dealing with the missing values is implemented. RELEVANCE TO CLINICAL PRACTICE: If nursing and healthcare practice is to be informed by research findings, then these findings must be reliable and valid. Researchers should report the details of missing data, and appropriate methods for dealing with missing values should be incorporated into the data analysis.