Recurrent Left-Sided Hepatic Hydrothorax Leading to Liver-Mediated Dyspnea.

Cirrhosis is a common liver condition caused by several etiologies including alcohol use disorder, infectious hepatitis, and metabolic dysfunction associated with liver disease. Although common symptomatic complications of cirrhosis include malaise, gastrointestinal bleeding, and abdominal distension, shortness of breath is a less common phenomenon that may occur. Hepatic hydrothorax (HH) is an uncommon cause of shortness of breath that is believed to be caused by the accumulation of ascitic fluid in the pleural space. While most cases of HH occur with ascites and the right side, we hereby present a case of a 70-year-old female with left-sided HH without ascites.

We Fear So We Judge: A Mediation Analysis on the Relations Among Ageing Anxiety, Ageism, and Ageist Microaggressions.

Ageism remains an obstacle to building an age-friendly environment. Although the rise of ageist microaggressions (i.e., subtle discrimination) threatens older adults from maintaining well-being, the mechanism of ageist microaggressions remains understudied. The present study examined ageist microaggressions using a transactional model. Specifically, we examined whether ageing and death anxieties contribute to self-ageism and influence benevolent and hostile ageism. These ageist beliefs might lead to benevolent and hostile ageist microaggressions, respectively. Cross-sectional data from 214 Hong Kong middle-aged adults (Mage = 50.97) were obtained. The results from a structural equation model revealed that ageing anxiety, but not death anxiety, was a significant predictor of self-ageism, hostile ageism, and hostile ageist microaggressions. A revised model further suggested that benevolent and hostile ageism were predictive of hostile ageist microaggressions. The results highlight the importance of defying the conventional perception of ageing to reduce ageing anxiety, ageism and ageist microaggressions for an age-friendly society.

Temporal variations of vaccine hesitancy amid the COVID-19 outbreaks in Hong Kong.

To inform the dynamic adjustments of vaccination campaigns, this study examined the transitions among vaccine hesitancy profiles over the COVID-19 pandemic progression and their predictors and outcomes. The transition patterns among hesitancy profiles over three periods were identified using a latent transition analysis with individuals from a longitudinal cohort study since the emergence of COVID-19 in Hong Kong. Four profiles (i.e., skeptics, apathetics, fence-sitters, and believers) emerged consistently over time. From Period 1 (third and fourth pandemic waves) to Period 2 (dormant period, vaccine rollout), 14.17% of believers became fence-sitters (ambivalization), and 12.11% of fence-sitters became apathetics (apathetization). From Period 2 to Period 3 (omicron surge and vaccine mandates), 20.21% of believers became fence-sitters. Lower trust in government predicted a transition to skepticism, whereas higher trust predicted the opposite. Staying as believers was associated with decreased hygienic and social distancing behavior. The stable hesitancy profiles amid the rapid vaccine uptake suggest that structural factors rather than personal agency may drive the surge. Ambivalization and apathetization may signal disengagement in preventive behaviors. Trust in the government is crucial in the pandemic response. Public health interventions may improve compliance with guidelines and prevent skepticism and apathy.

The importance of transparency: Declaring the use of generative artificial intelligence (AI) in academic writing.

The integration of generative artificial intelligence (AI) into academic research writing has revolutionized the field, offering powerful tools like ChatGPT and Bard to aid researchers in content generation and idea enhancement. We explore the current state of transparency regarding generative AI use in nursing academic research journals, emphasizing the need for explicitly declaring the use of generative AI by authors in the manuscript. Out of 125 nursing studies journals, 37.6% required explicit statements about generative AI use in their authors' guidelines. No significant differences in impact factors or journal categories were found between journals with and without such requirement. A similar evaluation of medicine, general and internal journals showed a lower percentage (14.5%) including the information about generative AI usage. Declaring generative AI tool usage is crucial for maintaining the transparency and credibility in academic writing. Additionally, extending the requirement for AI usage declarations to journal reviewers can enhance the quality of peer review and combat predatory journals in the academic publishing landscape. Our study highlights the need for active participation from nursing researchers in discussions surrounding standardization of generative AI declaration in academic research writing.

Revisiting Vaccine Hesitancy in Residential Care Homes for the Elderly for Pandemic Preparedness: A Lesson from COVID-19.

Residents in residential care homes for the elderly (RCHEs) are at high risk of severe illnesses and mortality, while staff have high exposure to intimate care activities. Addressing vaccine hesitancy is crucial to safeguard vaccine uptake in this vulnerable setting, especially amid a pandemic. In response to this, we conducted a cross-sectional survey to measure the level of vaccine hesitancy and to examine its associated factors among residents and staff in RCHEs in Hong Kong. We recruited residents and staff from 31 RCHEs in July-November 2022. Of 204 residents, 9.8% had a higher level of vaccine hesitancy (scored ≥ 4 out of 7, mean = 2.44). Around 7% of the staff (n = 168) showed higher vaccine hesitancy (mean = 2.45). From multi-level regression analyses, higher social loneliness, higher anxiety, poorer cognitive ability, being vaccinated with fewer doses, and lower institutional vaccination rates predicted residents' vaccine hesitancy. Similarly, higher emotional loneliness, higher anxiety, being vaccinated with fewer doses, and working in larger RCHEs predicted staff's vaccine hesitancy. Although the reliance on self-report data and convenience sampling may hamper the generalizability of the results, this study highlighted the importance of addressing the loneliness of residents and staff in RCHEs to combat vaccine hesitancy. Innovative and technology-aided interventions are needed to build social support and ensure social interactions among the residents and staff, especially amid outbreaks.

Faith-Based Spiritual Intervention for Persons with Depression: Preliminary Evidence from a Pilot Study.

Depression is a common, depleting, and potentially life-threatening disorder. This pilot study examined the feasibility and applicability, reported preliminary evidence for effectiveness, and explored the potential healing mechanisms of a faith-based spiritual intervention for people with depression. The intervention consisted of six weekly sessions focused on restoring a connection with the divine, forgiveness and freedom, suffering and transcendence, hope, gratitude, and relapse prevention. Seven adults with mild or moderate depressive symptoms were recruited. A qualitative evaluation was conducted via focus group discussions, and rating scales were administered at baseline, after the intervention, and at the 3-month follow-up. The mean difference scores of the treatment's effect over time were analyzed using Friedman's ANOVA. The themes identified by the focus group included the meaning of the spiritual intervention, the effect of involvement in a spiritual group, and the therapeutic components. The results indicated a significant decrease in the mean scores for depression (PHQ-9) after intervention and at the 3-month follow-up. Participants expressed their improvement in terms of increased knowledge about depression, enhanced coping mechanisms, and improved self-esteem. The preliminary evidence suggested that the faith-based spiritual intervention was effective in reducing depressive symptoms and also helped participants develop a greater sense of connection with themselves, others, and their environment.

Development and validation of the caregiver needs and resources assessment.

Introduction: Existing caregiver assessment tools were long criticized for focusing on the needs and burden while neglecting the importance of the resources. The current study aimed to develop a multidimensional and time-effective assessment tool that measures both needs and resources of non-paid family caregivers of older adults for screening and service-matching purposes. Methods: Items of the Caregiver Needs and Resources Assessment (CNRA) were developed from extensive literature reviews and focus group interviews of family caregivers and social workers in the field. In addition, we collected 317 valid responses from family caregivers of older adults from local non-government organizations in examining the psychometric properties of the CNRA. Results: The results revealed a 12-factor structure that fitted nicely into the conceptual frame of needs and resources domains. Need factors were positively associated with mental health symptoms, while resource factors were positively associated with peace in mind, meaning-making, and personal gain measures. The 36-item CNRA revealed good internal reliability and convergent validity. Discussion: The CNRA has the potential to be used as a compact yet balanced assessment tool for understanding both the needs and resources of caregivers for human service professionals.

Rapid Loss and Recovery of Vision Following Steroid Treatment in Orbital Myositis: A Case Report.

A 65-year-old African American man initially presented to the emergency department complaining of headaches, retro-orbital pressure, decreased vision, white flashes and floaters, and palinopsia of both eyes. After complete evaluation, he was diagnosed with migraine with aura and discharged to home with an ophthalmology follow-up. Upon follow-up with the ophthalmology team, he had developed severe periorbital inflammation, proptosis, chemosis, and vision loss that was greatest on the left side. The patient was immediately hospitalized for further evaluation and steroid treatment. His vision, ocular symptoms, and physical findings dramatically and rapidly improved with a 3-day course of high-dose intravenous steroids. Existing literature is sparse on rapid loss and recovery of vision following steroid treatment for orbital myositis. The exact mechanism of vision loss in orbital myositis is not understood and merits further investigation. Orbital myositis is a subset of nonspecific orbital inflammatory syndrome. It remains a poorly understood condition that mimics other, more common conditions such as thyroid eye disease and orbital cellulitis. If left untreated, orbital myositis could progress to the point of continued inflammation, enlargement of ocular tissues, ocular ischemia, and optic neuritis. To reverse these symptoms and prevent further progression, a quick diagnosis followed by steroid treatment is imperative.

Amplifying research influence through the social network, open access publishing, and international collaboration: A mediation analysis on nursing studies literature.

INTRODUCTION: Research impact and influence are commonly measured quantitatively by citation count received by research articles. Many institutes also use citation count as one of the factors in faculty performance appraisal and candidate selection of academic positions. Various strategies were recommended to amplify and accelerate research influence, particularly citation counts, by bringing research articles to a wider reach for potential readers. However, no prior empirical study was conducted to examine and valid effects of those strategies on nursing studies. This study examines and verifies the direct effects and mediation effects of some strategies, namely, the use of Twitter, international collaboration, the use of ResearchGate, and open access publishing, for amplifying the citation of research and review articles in nursing studies. DESIGN: Cross-sectional study design. METHODS: Articles published in top nursing journals in 2016 were identified in PUBMED and the citation metrics for individual articles until 2021 were extracted from Scopus. The primary outcome was the citation count of the article, while the tweet count on Twitter of the article was considered a mediator. The predictors included paper type, the total number of authors, the proportion of authors with a ResearchGate account in the article, funding support, open-accessed article, and the number of different countries stated in the authors' affiliation. A mediation analysis was conducted to examine the predictors' direct and indirect effects (i.e., via tweet count) on the citation count of the article. RESULTS: A total of 2210 articles were included in this study, of which 223 (10.1%) were review articles. The median (IQR) number of Scopus citations, tweets, countries, and percentage of authors with ResearchGate accounts were 12 (6-21), 2 (0-6), 1 (1-1), and 75% (50%-100%) respectively. In the mediation analysis, tweet count, article type, number of countries, percentage of authors with a ResearchGate account, and journal impact factors in 2014 were positively associated with the Scopus citation count. The effects of article type, open access, and journals' impact factors in 2014 on Scopus citation count were mediated by the tweet count. CONCLUSION: This study provides empirical support for some strategies researchers may employ to amplify the citation count of their research articles. The methodology of our study can be extended to compare research influence between entities (e.g., across countries or institutes). CLINICAL RELEVANCE: The citation refers to the research work cited by peers and is one of the indicators for research impact. Higher citations implied the research work is read and used by others, therefore, understanding the associated factors with higher citations is critical.

The way forward to achieve high COVID-19 vaccination and revaccination coverage in a city amid a period of tranquility.

Background: Amid the current COVID-19 pandemic, there is an urgent need for both vaccination and revaccination ("boosting"). This study aims to identify factors associated with the intention to receive a booster dose of the coronavirus (COVID-19) vaccine among individuals vaccinated with two doses and characterize their profiles in Hong Kong, a city with a low COVID-19 incidence in the initial epidemic waves. Among the unvaccinated, vaccination intention is also explored and their profiles are investigated. Methods: From December 2021 - January 2022, an online survey was employed to recruit 856 Hong Kong residents aged 18 years or over from an established population-based cohort. Latent class analysis and multivariate logistic regression modeling approaches were used to characterize boosting intentions. Results: Of 638 (74.5%) vaccinated among 856 eligible subjects, 42.2% intended to receive the booster dose. Four distinct profiles emerged with believers having the highest intention, followed by apathetics, fence-sitters and skeptics. Believers were older and more likely to have been vaccinated against influenza. Older age, smoking, experiencing no adverse effects from a previous COVID-19 vaccination, greater confidence in vaccines and collective responsibility, and fewer barriers in accessing vaccination services were associated with higher intentions to receive the booster dose. Of 218 unvaccinated, most were fence-sitters followed by apathetics, skeptics, and believers. Conclusion: This study foretells the booster intended uptake lagging initial vaccination across different age groups and can help refine the current or future booster vaccination campaign. Given the fourth COVID-19 vaccine dose may be offered to all adults, strategies for improving boosting uptake include policies targeting young adults, individuals who experienced adverse effects from previous doses, fence-sitters, apathetics, and the general public with low trust in the health authorities.

Path to normality: Assessing the level of social-distancing measures relaxation against antibody-resistant SARS-CoV-2 variants in a partially-vaccinated population.

Introduction: Two years into the coronavirus 2019 (COVID-19) pandemic, populations with less built-up immunity continued to devise ways to optimize social distancing measures (SDMs) relaxation levels for outbreaks triggered by SARS-CoV-2 and its variants to resume minimal economics activities while avoiding hospital system collapse. Method: An age-stratified compartmental model featuring social mixing patterns was first fitted the incidence data in second wave in Hong Kong. Hypothetical scenario analysis was conducted by varying population mobility and vaccination coverages (VCs) to predict the number of hospital and intensive-care unit admissions in outbreaks initiated by ancestral strain and its variants (Alpha, Beta, Gamma, Delta and Omicron). Scenarios were "unsustainable" if either of admissions was larger than the maximum of its occupancy. Results: At VC of 65%, scenarios of full SDMs relaxation (mean daily social encounters prior to COVID-19 pandemic = 14.1 contacts) for outbreaks triggered by ancestral strain, Alpha and Beta were sustainable. Restricting levels of SDMs was required such that the optimal population mobility had to be reduced to 0.9, 0.65 and 0.37 for Gamma, Delta and Omicron associated outbreaks respectively. VC improvement from 65% to 75% and 95% allowed complete SDMs relaxation in Gamma-, and Delta-driven epidemic respectively. However, this was not supported for Omicron-triggered epidemic. Discussion: To seek a path to normality, speedy vaccine and booster distribution to the majority across all age groups is the first step. Gradual or complete SDMs lift could be considered if the hybrid immunity could be achieved due to high vaccination coverage and natural infection rate among vaccinated or the COVID-19 case fatality rate could be reduced similar to that for seasonal influenza to secure hospital system sustainability.

Rhabdomyosarcoma-Induced Uterine Inversion.

Nonpuerperal uterine inversion is a rare clinical condition that involves prolapse of the uterine fundus into the uterine cavity and vaginal vault and possibly passed the introitus. The majority of these cases commonly involve benign tumors such as leiomyoma. However, another common cause of nonpuerperal uterine inversion is due to malignancies such as sarcomas. Rhabdomyosarcoma is a rare and aggressive malignancy of soft tissue cells that are common in children and rare in adults. One subtype called embryonal rhabdomyosarcoma is exceptionally rare. Therefore, report of embryonal rhabdomyosarcoma-induced uterine inversion is an exceedingly scarce and rarely documented clinical condition. In this case report, we present a rare case of a nulliparous 27-year-old female who presented with embryonal rhabdomyosarcoma-induced uterine inversion.

Do caregiver interventions improve outcomes in relatives with dementia and mild cognitive impairment? A comprehensive systematic review and meta-analysis.

Some reviews suggest benefits of nonpharmacological interventions for informal caregivers of people with dementia and mild cognitive impairment. These benefits may transfer to the care-recipients (CRs) through increased caregiving capability, reduced burden and depression among caregivers, and decreased negative mood contagion. However, large-scale review on these effects on the CRs is lacking. We searched PsycINFO, CINAHL with Full Text, MEDLINE, and PubMed from inception to end of 2020 and found 142 articles that reported randomized controlled trials (RCTs) of caregiver interventions using CR outcomes. Interventions were found to reduce neuropsychiatric symptoms (NPS) in general and behavioral and mood disturbance specifically, enhance cognition and quality of life, and delay institutionalization and mortality, with care coordination/case management, educational intervention with psychotherapeutic components (psychoeducation-b), and direct training of the CR (with caregiver involvement) being the more potent interventions. The kinds of benefit depend on the types of intervention. NPS was reduced by psychoeducation-b, care coordination/case management, and CR training. Cognition and quality of life were enhanced by CR training and care coordination/case management, respectively. Institutionalization was delayed by multicomponent interventions and respite (based on one study). However, the effects were generally small to very small. Together with existing findings on caregiver outcomes, a tripartite scaffolding model of caregiver support is proposed. The model is composed of three components: (a) care coordination/case management (i.e., enhanced usual care), (b) psychoeducation-b, and (c) CR training. Future directions in terms of developing consensual guidelines, a registry of intervention manuals, and family-centered programs with flexibility in delivery are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effect of prior outbreak work experience to future outbreak responses for nurses in Hong Kong: A cross-sectional study.

Background: During the early phase of the Coronavirus Disease 2019 (COVID-19) epidemic, health care workers had elevated levels of psychological distress. Historical exposure to disease outbreak may shape different pandemic responses among experienced health care workers. Aim: Considering the unique experience of the 2003 SARS outbreak in Hong Kong, this study examined the association between prior epidemic work experience and anxiety levels, and the mediating role of perceived severity of COVID-19 and SARS in nurses. Methods: In March 2020, a cross-sectional survey targeting practising nurses in Hong Kong was conducted during the early phase of the COVID-19 epidemic. The interrelationships among participants' work experience during the SARS outbreak, perceived severity of SARS and COVID-19, and anxiety level were elucidated using structural equation model (SEM). Findings: Of 1,061 eligible nurses, a majority were female (90%) with a median age of 39 years (IQR = 32-49). A significant and negative indirect association was identified between SARS experience and anxiety levels (B=-0.04, p=0.04) in the SEM with a satisfactory fitness (CFI=0.95; RMSEA=0.06). SARS-experienced nurses perceived SARS to be less severe (B=-0.17, p=0.01), translated an equivalent perception to COVID-19 (B=1.29, p<0.001) and resulted in a lower level of anxiety (B=0.19, p<0.001). Conclusions: The less vigorous perception towards the severity of SARS and COVID-19 may explain SARS-experienced nurses' less initial epidemic-induced anxiety. The possible role of outbreak-experienced nurses in supporting outbreak-inexperienced nurses, both emotionally and technically, should be considered when an epidemic commences. Interventions aiming to facilitate the understanding of emerging virus should also be in place.

Ocular transmissibility of COVID-19: possibilities and perspectives.

Since the initial outbreak of coronavirus disease 2019 (COVID-19), extensive research has emerged from across the globe to understand the pathophysiology of this novel coronavirus. Transmission of this virus is a subject of particular interest as researchers work to understand which protective and preventative measures are most effective. Despite the well understood model of aerosol-respiratory mediated transmission, the exact mechanism underlying the inoculation, infection and spread of COVID-19 is currently unknown. Given anatomical positioning and near constant exposure to aerosolized pathogens, the eye may be a possible gateway for COVID-19 infection. This critical review explores the possibility of an ocular-systemic or ocular-nasal-pulmonic pathway of COVID-19 infection and includes novel insights into the possible immunological mechanisms leading to cytokine surge.

Profiling vaccine believers and skeptics in nurses: A latent profile analysis.

BACKGROUND: A tailored immunization program is deemed more successful in encouraging vaccination. Understanding the profiles of vaccine hesitancy constructs in nurses can help policymakers in devising such programs. Encouraging vaccination in nurses is an important step in building public confidence in the upcoming COVID-19 and influenza vaccination campaigns. OBJECTIVES: Using a person-centered approach, this study aimed to reveal the profiles of the 5C psychological constructs of vaccine hesitancy (confidence, complacency, constraints, calculation, and collective responsibility) among Hong Kong nurses. DESIGN: Cross-sectional online survey. SETTINGS: With the promotion of a professional nursing organization, we invited Hong Kong nurses to complete an online survey between mid-March and late April 2020 during the COVID-19 outbreak. PARTICIPANTS: 1,193 eligible nurses (mean age = 40.82, SD = 10.49; with 90.0% being female) were included in the analyses. METHODS: In the online survey, we asked the invited nurses to report their demographics, COVID-19-related work demands (including the supply of personal protective equipment, work stress, and attitudes towards workplace infection control policies), the 5C vaccine hesitancy components, seasonal influenza vaccine uptake history, and the COVID-19 vaccine uptake intention. Latent profile analysis was employed to identify distinct vaccine hesitancy antecedent subgroups. RESULTS: Results revealed five profiles, including "believers" (31%; high confidence, collective responsibility; low complacency, constraint), "skeptics" (11%; opposite to the believers), "outsiders" (14%; low calculation, collective responsibility), "contradictors" (4%; high in all 5C constructs), and "middlers" (40%; middle in all 5C constructs). Believers were less educated, reported more long-term illnesses, greater work stress, higher perceived personal protective equipment sufficiency, and stronger trust in government than skeptics. They were older and had higher perceived personal protective equipment sufficiency than middlers. Also, believers were older and had greater work stress than outsiders. From the highest to the lowest on vaccination uptake and intention were believers and contradictors, then middlers and outsiders, and finally skeptics. CONCLUSION: Different immunization programs can be devised based on the vaccine hesitancy profiles and their predictors. Despite both profiles being low in vaccination uptake and intention, our results distinguished between outsiders and skeptics regarding their different levels of information-seeking engagement. The profile structure reveals the possibilities in devising tailored interventions based on their 5C characteristics. The current data could serve as the reference for the identification of individual profile membership and future profiling studies. Future endeavor is needed to examine the generalizability of the profile structure in other populations and across different study sites. Tweetable abstract: Covid-19 vaccine hesitancy profiles of Hong Kong nurses (believers, sceptics, outsiders, contradictors and middlers) highlight the importance of tailored vaccine campaigns.

Real-time FPGA-based implementation of the AKAZE algorithm with nonlinear scale space generation using image partitioning.

The first step in a scale invariant image matching system is scale space generation. Nonlinear scale space generation algorithms such as AKAZE, reduce noise and distortion in different scales while retaining the borders and key-points of the image. An FPGA-based hardware architecture for AKAZE nonlinear scale space generation is proposed to speed up this algorithm for real-time applications. The three contributions of this work are (1) mapping the two passes of the AKAZE algorithm onto a hardware architecture that realizes parallel processing of multiple sections, (2) multi-scale line buffers which can be used for different scales, and (3) a time-sharing mechanism in the memory management unit to process multiple sections of the image in parallel. We propose a time-sharing mechanism for memory management to prevent artifacts as a result of separating the process of image partitioning. We also use approximations in the algorithm to make hardware implementation more efficient while maintaining the repeatability of the detection. A frame rate of 304 frames per second for a 1280 × 768 image resolution is achieved which is favorably faster in comparison with other work.

Psychobehavioral Responses and Likelihood of Receiving COVID-19 Vaccines during the Pandemic, Hong Kong.

To access temporal changes in psychobehavioral responses to the coronavirus disease (COVID-19) pandemic, we conducted a 5-round (R1-R5) longitudinal population-based online survey in Hong Kong during January-September 2020. Most respondents reported wearing masks (R1 99.0% to R5 99.8%) and performing hand hygiene (R1 95.8% to R5 97.7%). Perceived COVID-19 severity decreased significantly, from 97.4% (R1) to 77.2% (R5), but perceived self-susceptibility remained high (87.2%-92.8%). Female sex and anxiety were associated with greater adoption of social distancing. Intention to receive COVID-19 vaccines decreased significantly (R4 48.7% to R5 37.6%). Greater anxiety, confidence in vaccine, and collective responsibility and weaker complacency were associated with higher tendency to receive COVID-19 vaccines. Although its generalizability should be assumed with caution, this study helps to formulate health communication strategies and foretells the initial low uptake rate of COVID-19 vaccines, suggesting that social distancing should be maintained in the medium term.