Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study.

OBJECTIVE: To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes. DESIGN: A descriptive, multicentre cross-sectional survey. SETTING: Maternity hospitals from the eastern, central and western regions of China. PARTICIPANTS: Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires. RESULTS: A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted ß -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted ß -0.171, 95% CI -0.190 to -0.056, p<0.001). CONCLUSION: The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.

Anionic oxyl radical formed on CrVI-oxo anchored on the defect site of the UiO-66 node facilitates methane to methanol conversion.

The direct conversion of methane to methanol has attracted increasing interest due to abundant and low-cost natural gas resources. Herein, by anchoring Cr-oxo/-oxyhydroxides on UiO-66 metal-organic frameworks, we demonstrate that reactive anionic oxyl radicals can be formed by controlling the coordination environment based on the results of density functional theory calculations. The anionic oxyl radicals produced at the completely oxidized CrVI site acted as the active species for facile methane activation. The thermodynamically stable CrVI-oxo/-oxyhydroxides with the anionic oxyl radicals catalyze the activation of the methane C-H bond through a homolytic mechanism. An analysis of the results showed that the catalytic performance of the active oxyl species correlates with the reaction energy of methane activation and H adsorption energies. Following methanol formation, N2O can regenerate the active sites on the most stable CrVI oxyhydroxides, i.e., the Cr(O)4Hf species. The present study demonstrated that the anionic oxyl radicals formed on the anchored CrVI oxyhydroxides by tuning the coordination environment enabled facile methane activation and facilitated methanol production.

Combined Antitumor Effect of the Serine Protease Urokinase Inhibitor Upamostat and the Sphingosine Kinase 2 Inhibitor Opaganib on Cholangiocarcinoma Patient-Derived Xenografts.

Upamostat is an orally available small-molecule serine protease inhibitor that is a highly potent inhibitor of trypsin 1, trypsin 2, trypsin 3 (PRSS1/2/3), and the urokinase-type plasminogen activator (uPA). These enzymes are expressed in many cancers, especially during tissue remodeling and subsequent tumor cell invasion. Opaganib (ABC294640), a novel, orally available small molecule is a selective inhibitor of the phosphorylation of sphingosine to sphingosine-1-phosphate (S-1-P) by sphingosine kinase 2 (SPHK2). Both sphingosine kinase 1 (SPHK1) and SPHK2 are known to regulate the proliferation-inducing compound S-1-P. However, SPHK2 is more critical in cancer pathogenesis. The goal of this project was to investigate the potential antitumor effects of upamostat and opaganib, individually and in combination, on cholangiocarcinoma (CCA) xenografts in nude mice. PAX165, a patient-derived xenograft (PDX) from a surgically resected CCA, expresses substantial levels of SPHK2, PRSS1, PRSS2, and PRSS3. Four groups of 18 mice each were treated with upamostat, opaganib, both, or vehicle. Mouse weights and PAX165 tumor volumes were measured. Tumor volumes in the upamostat, opaganib, and upamostat plus opaganib groups were significantly decreased compared to the control group.

An ISAR Image Component Recognition Method Based on Semantic Segmentation and Mask Matching.

The inverse synthetic aperture radar (ISAR) image is a kind of target feature data acquired by radar for moving targets, which can reflect the shape, structure, and motion information of the target, and has attracted a great deal of attention from the radar automatic target recognition (RATR) community. The identification of ISAR image components in radar satellite identification missions has not been carried out in related research, and the relevant segmentation methods of optical images applied to the research of semantic segmentation of ISAR images do not achieve ideal segmentation results. To address this problem, this paper proposes an ISAR image part recognition method based on semantic segmentation and mask matching. Furthermore, a reliable automatic ISAR image component labeling method is designed, and the satellite target component labeling ISAR image samples are obtained accurately and efficiently, and the satellite target component labeling ISAR image data set is obtained. On this basis, an ISAR image component recognition method based on semantic segmentation and mask matching is proposed in this paper. U-Net and Siamese Network are designed to complete the ISAR image binary semantic segmentation and binary mask matching, respectively. The component label of the ISAR image is predicted by the mask matching results. Experiments based on satellite component labeling ISAR image datasets confirm that the proposed method is feasible and effective, and it has greater comparative advantages compared to other classical semantic segmentation networks.

Identifying the common elements of psychological and psychosocial interventions for preventing postpartum depression: Application of the distillation and matching model to 37 winning protocols from 36 intervention studies.

AIM: Postpartum depression is prevalent worldwide and seriously endangers maternal and child health. Previous studies have demonstrated the effectiveness of psychological and psychosocial intervention programmes in preventing postpartum depression. However, the literature offers limited practice guidance. Therefore, this study aimed to deeply analyse prior findings to gather rich evidence-based information on this topic. METHODS: Using the distillation and matching model, we conducted a systematic review of psychological and psychosocial interventions used to effectively prevent postpartum depression. Four researchers trained in coding system independently read eligible studies and identified reliable (Cohen's kappa >0.40) and frequently occurring (frequency ≥3 winning study groups) practice elements. RESULTS: Our review included 36 studies containing 37 winning study groups. Fourteen practice elements were identified and subsequently divided into six categories: postpartum practical problems-related, social support-related, interpersonal psychotherapy-related, cognitive behavioural therapy-related, labour trauma-related and non-specific techniques. The most common practice elements were baby care skills and mother-infant bonding/interaction enhancement. Inter-rater reliability averaged 0.86, ranging from 0.48 to 1. CONCLUSION: The practice elements identified in this study provide rich evidence-based information that can guide clinical practitioners in selecting or developing effective, realistically available intervention programmes.

Characteristic Analysis of Featured Genes Associated with Cholangiocarcinoma Progression.

The noninvasive diagnosis of cholangiocarcinoma (CCA) is insufficiently accurate. Therefore, the discovery of new prognostic markers is vital for the understanding of the CCA mechanism and related treatment. The information on CCA patients in The Cancer Genome Atlas database was used for weighted gene co-expression network analysis. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were applied to analyze the modules of interest. By using receiver operating characteristic (ROC) analysis to analyze the Human Protein Atlas (HPA), the featured genes were subsequently verified. In addition, clinical samples and GSE119336 cohort data were also collected for the validation of these hub genes. Using WGCNA, we identified 61 hub genes that regulated the progression and prognosis of CCA. Eight hub genes (VSNL1, TH, PCP4, IGDCC3, RAD51AP2, MUC2, BUB1, and BUB1B) were identified which exhibited significant interactions with the tumorigenic mechanism and prognosis of CCA. In addition, GO and KEGG clarified that the blue and magenta modules were involved with chromosome segregation, mitotic and oocyte meiosis, the cell cycle, and sister chromatid segregation. Four hub genes (VSNL1, PCP4, BUB1, and BUB1B) were also verified as featured genes of progression and prognosis by the GSE119336 cohort data and five human tissue samples.

Coupled oxygen desorption and structural reconstruction accompanying reduction of copper oxide.

Understanding structural transformation and phase transition accompanying reactions in a solid as a catalyst or oxygen carrier is important to the design and optimization of many catalytic or chemical looping reaction processes. Herein, we combined density functional theory calculation with the stochastic surface walking global optimization approach to track the structural transformation accompanying the reduction of CuO upon releasing oxygen. We then used machine learning (ML) methods to correlate the structural properties of CuOx with varying x. By decomposing a reduction step into oxygen detachment and structural reconstruction, we identified two types of pathways: (1) uniform reduction with minimal structural changes; (2) segregated reduction with significant reconstruction. The results of ML analysis showed that the most important feature is the radial distribution functions of Cu-O at a percentage of oxygen vacancy [C(OV)] < 50% and Cu-Cu at C(OV) > 50% for CuOx formation. These features reflect the underlying physicochemical origin, i.e., Cu-O breaking and Cu-Cu formation in the respective stage of reduction. Phase diagram analysis indicates that CuO will be reduced to Cu2O under a typical oxygen uncoupling condition. This work demonstrates the complexity of solid structural transformation and the potential of ML methods in studying solid state materials involved in many chemical processes.

Alternating Expiration and Inspiration Breath-Hold Spares the Chest Wall During Stereotactic Body Radiation Therapy for Peripheral Lung Malignancies.

PURPOSE: The proximity of tumors to the chest wall brings additional risks of chest wall pain during stereotactic body radiation therapy. Herein, we dosimetrically compared alternated breath-hold (ABH) plans with single BH plans and determined the common characteristics of eligible patients who may obtain better chest wall sparing using this technique. METHODS AND MATERIALS: Twenty patients with lung lesions adjacent to the chest wall were enrolled and received respiratory training. Their half-fraction end expiration BH and deep inspiration BH plans were summed to generate the ABH plans. Dosimetric parameters of the chest wall were compared between single and alternated BH plans, and the correlation between tumor location and the outcome of chest wall sparing was quantitatively evaluated. Pretreatment cone beam computed tomography variations in eligible patients were recorded as well. RESULTS: Compared with the end expiration BH and deep inspiration BH plans, the ABH plans reduced chest wall dosimetric results with median reductions of 2.0% and 3.9% (Dmax: maximum point dose), 15.4% and 14.8% (D1cc: dose to a volume of 1 cm3), and 48.8% and 63% (V30: volume receiving 30 Gy or more), respectively. Relative tumor displacements (ratio of tumor displacement in the superior-inferior direction to planning target volume diameter) were greater in the lower lobe than in the upper and middle lobes (1.17 vs 0.18). Meanwhile, better median reductions of 44% (Dmax), 46% (D1cc), and 98% (V30) were obtained in the lower lobe cohort using the ABH technique. Pretreatment variations for all BHs met the 5-mm threshold. CONCLUSIONS: The ABH technique can significantly spare the adjacent chest wall without compromising planning target volume coverage in comparison with the single BH, and patients with tumors in the lower lobes can obtain better chest wall sparing than in the upper and middle lobes. Further investigation is warranted to validate these findings.

Correlation between the Properties of Surface Lattice Oxygen on NiO and Its Reactivity and Selectivity towards the Oxidative Dehydrogenation of Propane.

Modified NiO catalysts with controllable vacancies and dopants are promising for alkene production from oxidative dehydrogenation (ODH) of light alkanes, and a molecular understanding of the modification on elementary reaction steps would facilitate the design of highly efficient catalysts and catalytic processes. In this study, density functional theory (DFT) calculations was used to map out the complete reaction pathways of propane ODH on the NiO (100) surfaces with different modifiers. The results demonstrated that the presence of vacancies (O and Ni) and dopants (Li and Al) alters the electrophilicity of surface oxygen species, which in turn affects the reactivity towards C-H bond activation and the overall catalytic activity and selectivity. The strongly electrophilic O favors a radical mechanism for the first C-H activation on O followed by the second C-H activation on O-O site, whereas weak electrophilic O favors concerted C-H bond breaking over Ni-O site. The C-H bond activation proceeds through a late transition state, characterized by the almost completion of the O-H bond formation. Consequently, the adsorption energy of H adatom on O rather than p-band center or Bader charge of O has been identified to be an accurate descriptor to predict the activation barrier for C-H breaking (activity) as well as the difference between the activation barriers of propene and CH3 CCH3 (selectivity) of ODH.

A multiomic ferroptosis-associated prognostic signature incorporating epigenetic and transcriptional biomarkers for hepatocellular carcinoma.

Background: Ferroptosis was reported to have tremendous promise in the treatment and prognosis of hepatocellular carcinoma (HCC). Here, we identified a novel ferroptosis-related prognostic signature incorporating epigenetic and transcriptional biomarkers could help predicting survival of patients with HCC. Methods: We employed multi-omics and clinical data from The Cancer Genome Atlas (TCGA) database to identify the ferroptosis-associated methylation CpG sites associated with HCC survival using sure independence screening (SIS). Then we utilized Kaplan-Meier curves to evaluate the prognostic significance of gene expression and DNA methylation. Receiver operating characteristic (ROC) curve was used predicting the 3- and 5-year survival. Mediation analysis of ferroptosis-related methylation and transcriptional score was performed. Results: We firstly identified 114 significant CpG sites under the criteria of false discovery rate (FDR) <0.05 in training set. Then we screened out 5 candidate CpG sites in validation set for multivariate screening and stepwise regression. We found that the high-risk group had significantly shorter survival time than the low-risk group in the prognostic signature combined with epigenetic and transcriptional scores (HR =2.72 95% CI: 2.01-3.68, P=8.75E-11). And the predictive model involving clinical information, gene expression, and methylation data performed best for 3-year survival prediction (AUC =0.672) and 5-year survival prediction (AUC =0.742). Conclusions: Our results suggested a signature combining clinical information, ferroptosis-related gene expression, and methylation presented a superior ability for prognostic prediction in HCC, which may bring us novel tool and targets in the treatment of HCC.

Understanding the role of Cu+/Cu0 sites at Cu2O based catalysts in ethanol production from CO2 electroreduction -A DFT study.

Cu2O based electrocatalysts generally exhibit better selectivity for C2 products (ethylene or ethanol) in electrochemical carbon dioxide reduction. The surface characteristic of the mixed Cu+ and Cu0 chemical state is believed to play an essential role that is still unclear. In the present study, density functional theory (DFT) calculations have been performed to understand the role of copper chemical states in selective ethanol formation using a partially reduced Cu2O surface model consisting of adjacent Cu+/Cu0 sites. We mapped out the free energy diagram of the reaction pathway from CO intermediate to ethanol and discussed the relation between the formation of critical reduction intermediates and the configuration of Cu+/Cu0 sites. The results showed that Cu+ sites facilitate the adsorption and stabilization of *CO, as well as its further hydrogenation to *CHO. More importantly, as compared to the high reaction energy (1.23 eV) of the dimerization of two *CO on Cu+/Cu0 sites, the preferable formation of *CHO on the Cu+ site makes the C-C coupling reaction with *CO on the Cu0 site happen under a relatively lower energy barrier of 0.58 eV. Furthermore, the post C-C coupling steps leading to the formation of the key intermediate *OCHCH2 to C2 compound are all thermodynamically favoured. Noteworthily, it is found that *OCHCH2 inclines to the ethanol formation because the coordinatively unsaturated Cu+ site could maintain the C-O bond of *OCHCH2, and the weak binding between *O and Cu+/Cu0 sites helps inhibit the pathway toward ethylene. These findings may provide guidelines for the design of CO and CO2 reduction active sites with enhanced ethanol selectivity.

New Era of Mapping and Understanding Common Fragile Sites: An Updated Review on Origin of Chromosome Fragility.

Common fragile sites (CFSs) are specific genomic loci prone to forming gaps or breakages upon replication perturbation, which correlate well with chromosomal rearrangement and copy number variation. CFSs have been actively studied due to their important pathophysiological relevance in different diseases such as cancer and neurological disorders. The genetic locations and sequences of CFSs are crucial to understanding the origin of such unstable sites, which require reliable mapping and characterizing approaches. In this review, we will inspect the evolving techniques for CFSs mapping, especially genome-wide mapping and sequencing of CFSs based on current knowledge of CFSs. We will also revisit the well-established hypotheses on the origin of CFSs fragility, incorporating novel findings from the comprehensive analysis of finely mapped CFSs regarding their locations, sequences, and replication/transcription, etc. This review will present the most up-to-date picture of CFSs and, potentially, a new framework for future research of CFSs.

Oncological outcomes of patients with salivary gland cancer treated with surgery and postoperative intensity-modulated radiotherapy: a retrospective cohort study.

Background: Salivary gland cancer (SGC) is relatively rare and constitutes a variety of histological subtypes. Previously published studies of SGC patients suggest that postoperative radiation using conventional radiotherapy (RT) or 3-dimensional (3D) conformal radiotherapy may have led to suboptimal oncological outcomes. Methods: We identified 60 patients with major SGC treated with surgery followed by postoperative intensity-modulated radiotherapy (IMRT). Data for overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), prognostic factors, and treatment-related toxicities were analyzed. Survival was analyzed using the Kaplan-Meier method and compared using the log-rank test. Results: With a median follow-up of 55.5 months, based on Kaplan-Meier analyses, the OS and PFS rates for SGC patients at 3, 5, and 10 years were 90.7%, 85.1%, and 85.1% and 80.1%, 72.7%, and 63.1%, respectively. The LRRFS and DMFS rates at 3, 5, and 10 years were 87.4%, 82.1%, and 82.1% and 85.3%, 78.4%, and 66.1%, respectively. In multivariable analysis (MVA), the node stage (N stage) was an independent predictor of PFS [P=0.047; hazard ratio (HR) =0.089]. A positive margin was a significant prognostic factor for PFS (P=0.036; HR =4.086), LRRFS (P=0.026; HR =5.064), and DMFS (P=0.011; HR =6.367). Major nerve involvement was significantly correlated with PFS (P=0.034; HR =2.394) and DMFS (P=0.008; HR =2.115). The interval from surgery to radiotherapy predicted PFS (P=0.036; HR =3.934) and DMFS (P=0.012; HR =6.231). Adenoid cystic carcinoma (ACC) was the most common histology (n=21; 35%). For ACC, the 5-year OS, PFS, LRRFS, and DMFS were 100%, 67.7%, 76.2%, and 90.2%, respectively. The most common acute toxicities were mucositis and dermatitis, and xerostomia was the most common late adverse event. Lung metastasis was the most common pattern of distant failure. Conclusions: N stage, positive margin, major nerve involvement, and interval from surgery to radiotherapy were important factors associated with PFS, LRRFS, and DMFS. Postoperative IMRT leads to improved survival for SGC patients, with acceptable toxicities.

Metabolic profile of irradiated whole blood by chemical isotope-labeling liquid chromatography-mass spectrometry.

Irradiated blood is a new type of blood product used to prevent transfusion-associated graft-versus-host disease. However, the effects of irradiation on the metabolism of plasma, red blood cells (RBCs), and peripheral blood mononuclear cells (PBMCs) are largely unknown. We developed a workflow for testing metabolic changes in whole blood to determine the impact of irradiation by chemical isotope labeling liquid chromatography-mass spectrometry (CIL LC-MS). Blood parameters, PBMC proliferation and apoptosis were examined before and after irradiation. Next, the amine/phenol metabolites in the blood components were assayed by 12C- and13C-dansylation labeling LC-MS. We identified 1654, 1730, and 1666 peak pairs in plasma, RBCs, and PBMCs, respectively. We screened out 367, 177, and 219 significant metabolites in plasma, RBCs, and PBMCs, respectively, by principle component analyses, volcano plots, and Venn plots. Metabolic pathway analyses showed that irradiation modulated taurine and hypotaurine metabolism in plasma and purine metabolism in RBCs and PBMCs. Changes in potential biomarkers, including an increase in hypoxanthine level and a decrease in adenine level, may be related to the dysfunction of DNA synthesis in PBMCs. The decreased AMP level in RBCs may interfere with RBC storage lesions. Our research provides a more comprehensive perspective on blood metabolism associated with irradiation.

Identification of IFN-Induced Transmembrane Protein 1 With Prognostic Value in Pancreatic Cancer Using Network Module-Based Analysis.

Despite improvements reported in diagnosis and treatments in recent decades, pancreatic cancer is still characterized by poor prognosis and low survival rate among solid tumors. Intensive interests have grown in exploring novel predictive biomarkers, aiming to enhance the efficiency in early detection and treatment prognosis. In this study, we identified the differentially expressed genes (DEGs) in pancreatic cancer by analyzing five gene expression profiles and established the functional modules according to the functional interaction (FI) network between the DEGs. A significant upregulation of the selected DEG, interferon (IFN)-induced transmembrane protein 1 (IFITM1), was evaluated in several bioinformatics online tools and verified with immunohistochemistry staining from samples of 90 patients with pancreatic cancer. Prognostic data showed that high expression of IFITM1 associated with poor survival, and multivariate Cox regression analysis showed IFITM1 was one of the independent prognostic factors for overall survival. Meanwhile, significant correlations of the expression of IFITM1 and the infiltration of immune cells were found by TIMER. Furthermore, a higher level of IFITM1 was assessed in pancreatic cancer cell lines compared to normal human pancreatic duct epithelial cells, and silencing IFITM1 in tumor cells remarkedly inhibited cancer tumorigenicity. Collectively, our findings suggested that IFITM1 might have promising utility for pancreatic cancer.

Reduction in rectal doses of pelvic radiotherapy with excessive rectal gas extraction: a single-institution case report.

During radiotherapy for pelvic tumors, there might be insufficient radiation doses delivered that result from concerns of immediately adjacent critical organs, most notebly the rectum. Several measures have been proposed to reduce the rectal doses, such as use of a radioprotective spacer to shift the rectum away from the lesion or an endorectal balloon to reduce the internal target volume (ITV). The removal of rectal gas is supposed to achieve the similar effect by reducing the rectal volume and ITV. This is because the distance of the rectum to lesions can be increased with decreasing rectal volumes, which also makes it easy for physicists to avoid the rectum during field design. Besides, a reduced ITV can be obtained due to stability in rectal volume, as with use of an endorectal balloon. The procedure is most suitable for patients receiving stereotactic body radiotherapy (SBRT) and high dose rate brachytherapy (HDR-BR) because of limited treatment sessions. In this study, we showed that the rectal dose decreased significantly with rectal gas extraction, as manifested by dose parameters of D2 cm3 and D0.1 cm3 (the doses delivered to the most exposed 2 cm, 3 and 0.1 cm3 of the rectum, respectively). This technique is especially benefitable for candidates with excessive rectal gas fillings.

Randomized Clinical Trial of a Prenatal Breastfeeding and Mental Health Mixed Management Intervention.

BACKGROUND: The continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding. RESEARCH AIM: To compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care. METHODS: Chinese primigravida (N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group (n = 84) or the control group (n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups. RESULTS: Significant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum (p < .05) and feeding patterns at 3 months and 6 months postpartum (p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points (p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI (p < .05). CONCLUSIONS: A prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health.This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

Validation of the 7-item Generalized Anxiety Disorder scale (GAD-7) as a screening tool for anxiety among pregnant Chinese women.

BACKGROUND: Anxiety is common during pregnancy. The 7-item Generalized Anxiety Disorder scale (GAD-7) is a self-rating scale for detecting anxiety and has been validated in various populations, but it has not been validated in pregnant Chinese women. The objective of this study was to validate the GAD-7 as a screening tool to detect anxiety during pregnancy among Chinese women. METHODS: The GAD-7 and the anxiety subscale of the Hospital Anxiety and Depression scale (HADS-A) were administered to 140 pregnant Chinese women to evaluate the Cronbach's alpha and the criterion-related validity. Additionally, a diagnostic study (n=170) was conducted by using the Mini International Neuropsychiatric Interview (MINI) as a gold standard to examine the screening performance of the GAD-7. We calculated the sensitivity, specificity, and area under the curve (AUC) by receiver operating characteristic (ROC) analysis. RESULTS: Cronbach's alpha for the GAD-7 was 0.84. The Pearson correlation coefficient between GAD-7 and HADS-A scores was 0.66 (P<0.01). At the maximum Youden Index of 0.53, the optimal cutoff score for the GAD-7 among pregnant women was 7, and an AUC of 0.83, a sensitivity of 96.8%, and a specificity of 56.1% were obtained. LIMITATION: The majority of the participants were in the first trimester, and thus, the findings cannot be generalized to all pregnant women. CONCLUSIONS: The GAD-7 is a suitable screening instrument for detecting antenatal anxiety in mainland China. Further validation is warranted in women in different trimesters of pregnancy.

Multi-Institutional Validation of Two-Streamed Deep Learning Method for Automated Delineation of Esophageal Gross Tumor Volume Using Planning CT and FDG-PET/CT.

BACKGROUND: The current clinical workflow for esophageal gross tumor volume (GTV) contouring relies on manual delineation with high labor costs and inter-user variability. PURPOSE: To validate the clinical applicability of a deep learning multimodality esophageal GTV contouring model, developed at one institution whereas tested at multiple institutions. MATERIALS AND METHODS: We collected 606 patients with esophageal cancer retrospectively from four institutions. Among them, 252 patients from institution 1 contained both a treatment planning CT (pCT) and a pair of diagnostic FDG-PET/CT; 354 patients from three other institutions had only pCT scans under different staging protocols or lacking PET scanners. A two-streamed deep learning model for GTV segmentation was developed using pCT and PET/CT scans of a subset (148 patients) from institution 1. This built model had the flexibility of segmenting GTVs via only pCT or pCT+PET/CT combined when available. For independent evaluation, the remaining 104 patients from institution 1 behaved as an unseen internal testing, and 354 patients from the other three institutions were used for external testing. Degrees of manual revision were further evaluated by human experts to assess the contour-editing effort. Furthermore, the deep model's performance was compared against four radiation oncologists in a multi-user study using 20 randomly chosen external patients. Contouring accuracy and time were recorded for the pre- and post-deep learning-assisted delineation process.

A density functional theory study on reduction-induced structural transformation of copper-oxide-based oxygen carrier.

A clear understanding of the structural transformation of copper-oxide-based oxygen carriers accompanying their reduction by fuels helps to design more efficient oxygen carriers for chemical looping combustion. Herein, density functional theory calculations have been performed on the bulk CuO, CuO(111) surface, and (CuO)32 cluster models with the same number of CuO molecular units to investigate structural transformation accompanying the reduction. The results showed that the averaged reaction energies of desorbing an oxygen molecule from the bulk and surface models are roughly the same [246.2 kJ/(mol O2) and 245.9 kJ/(mol O2), respectively]. The slab model does not significantly lower the overall reaction energy compared to the bulk model. In contrast, the averaged reaction energy using the cluster model is significantly lower [127.5 kJ/(mol O2)] than that of bulk and slab models. The key structural difference is the obvious Cu-Cu bond formation in the cluster model, which would result in nucleation of a metallic Cu phase. The results also showed that different states can be reached by desorbing different number oxygen atoms in a single step, corresponding to different reaction rates, when the system reaches the same level of reduction. These results demonstrate the complexity of reactions involving solid state materials and are consistent with the structural diversity observed experimentally. This study illustrates the importance of particle sizes and reaction conditions in the formation of suboxides during CuO reduction.