A Real-Time License Plate Detection and Recognition Model in Unconstrained Scenarios.

Accurate and fast recognition of vehicle license plates from natural scene images is a crucial and challenging task. Existing methods can recognize license plates in simple scenarios, but their performance degrades significantly in complex environments. A novel license plate detection and recognition model YOLOv5-PDLPR is proposed, which employs YOLOv5 target detection algorithm in the license plate detection part and uses the PDLPR algorithm proposed in this paper in the license plate recognition part. The PDLPR algorithm is mainly designed as follows: (1) A Multi-Head Attention mechanism is used to accurately recognize individual characters. (2) A global feature extractor network is designed to improve the completeness of the network for feature extraction. (3) The latest parallel decoder architecture is adopted to improve the inference efficiency. The experimental results show that the proposed algorithm has better accuracy and speed than the comparison algorithms, can achieve real-time recognition, and has high efficiency and robustness in complex scenes.

Construction of the Au Nanoparticle/Graphene Oxide/Au Nanotube (AuNP/GO/AuNT) Sandwich Membrane for Surface-Enhanced Raman Scattering Sensing.

Au nanotube-based composite membrane served as surface-enhanced Raman scattering (SERS) substrate with an ultralarge aspect ratio possesses an excellent flexibility and widely tunable surface plasmon resonance, and by introducing graphene oxide (GO) as a spacer layer, the SERS enhancement of the composite membrane is obviously better than those from the individual blocks of the Au nanotubes (AuNTS) membrane and the Au nanoparticle/graphene oxide (AuNP/GO) membrane. Such a "sandwich" (AuNP/GO/AuNT) structured membrane has a high SERS sensitivity and a wide tunability by controlling the size of Au nanoparticles and the thickness of graphene oxide, and the detection limits of the AuNP/GO/AuNT substrate for R6G and NBA are as low as 10-12 and 10-7 M, respectively; the large enhancement is attributed to the adsorption and chemical mechanism of graphene oxide and the physical mechanism of the Au nanoparticles and nanotubes (the electromagnetic field coupling between them).

Global migration and factors influencing retention of Asian internationally educated nurses: a systematic review.

BACKGROUND: Given nurses' increasing international mobility, Asian internationally educated nurses (IENs) represent a critical human resource highly sought after within the global healthcare workforce. Developed countries have grown excessively reliant on them, leading to heightened competition among these countries. Hence, this review aims to uncover factors underlying the retention of Asian IENs in host countries to facilitate the development of more effective staff retention strategies. METHODS: A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology for mixed-method systematic review. A search was undertaken across the following electronic databases for studies published in English during 2013-2022: CINAHL, Embase, PubMed, Scopus, Web of Science and PsycINFO. Two of the researchers critically appraised included articles independently using the Joanna Briggs Critical Appraisal Tools and Mixed Methods Appraisal Tool (version 2018). A data-based convergent integrated approach was adopted for data synthesis. RESULTS: Of the 27 included articles (19 qualitative and eight quantitative), five each were conducted in Asia (Japan, Taiwan, Singapore and Malaysia), Australia and Europe (Italy, Norway and the United Kingdom); four each in the United States and the Middle East (Saudi Arabia and Kuwait); two in Canada; and one each in New Zealand and South Africa. Five themes emerged from the data synthesis: (1) desire for better career prospects, (2) occupational downward mobility, (3) inequality in career advancement, (4) acculturation and (5) support system. CONCLUSION: This systematic review investigated the factors influencing AMN retention and identified several promising retention strategies: granting them permanent residency, ensuring transparency in credentialing assessment, providing equal opportunities for career advancement, instituting induction programmes for newly employed Asian IENs, enabling families to be with them and building workplace social support. Retention strategies that embrace the Asian IENs' perspectives and experiences are envisioned to ensure a sustainable nursing workforce.

A global overview of healthcare workers' turnover intention amid COVID-19 pandemic: a systematic review with future directions.

BACKGROUND: Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic. METHODS: A mixed studies systematic review was conducted. The PubMed, Embase, Scopus, CINAHL, Web of Science and PsycINFO databases were searched from January 2020 to March 2022. The Joanna Briggs Institute's Critical Appraisal Tools and the Mixed Methods Appraisal Tool version 2018 were applied by two independent researchers to critically appraise the methodological quality. Findings were synthesised using a convergent integrated approach and categorised thematically. RESULTS: Forty-three studies, including 39 quantitative, two qualitative and two mixed methods studies were included in this review. Eighteen were conducted in the Middle East, ten in the Americas, nine in the Asia-Pacific region and six in Europe. Nurses (n = 35) were included in the majority of the studies, while physicians (n = 13), allied health workers (n = 11) and healthcare administrative or management staff (n = 7) were included in a smaller proportion. Five themes emerged from the data synthesis: (1) fear of COVID-19 exposure, (2) psychological responses to stress, (3) socio-demographic characteristics, (4) adverse working conditions, and (5) organisational support. CONCLUSIONS: A wide range of factors influence healthcare workers' turnover intention in times of pandemic. Future research should be more focused on specific factors, such as working conditions or burnout, and specific vulnerable groups, including migrant healthcare workers and healthcare profession minorities, to aid policymakers in adopting strategies to support and incentivise them to retain them in their healthcare jobs.

Tenacious team, precarious patient: A phenomenological inquiry into interprofessional collaboration during ICU resuscitations.

AIMS: The study aims to explore the lived experiences of interprofessional collaboration among ICU nurses, doctors, and respiratory therapists in managing resuscitations in the ICUs. DESIGN: Descriptive phenomenological design, underpinned by Husserl's philosophy. METHODS: ICU nurses, doctors and respiratory therapists who have experience in managing resuscitations with the interprofessional team were recruited through purposive sampling from April to December 2019. Sixteen ICU professionals participated in individual, semi-structured, in-depth interviews which were audio recorded, and transcribed verbatim. Findings were analysed using Colaizzi's 7-step analysis. RESULTS: The essence of interprofessional collaboration during resuscitations can be described in four main themes. 'Ruminating about professional boundaries' signifies how ICU professionals acknowledged the roles and boundaries that surrounded their scope of practice during resuscitations. 'Rallying the interprofessional team' illustrates how the interprofessional team rapidly band together amongst the aid and hindrance of contextual enablers and inhibitors. 'Responding to interprofessional conflicts' depicts how intra- and interprofessional tensions can occur during resuscitations that can impact patient safety. 'Reaching collective leadership' proposes enhanced resuscitation care through the collective leadership of the interprofessional team. CONCLUSION: Resuscitations represent a precarious turn of events for the critically ill patient where the interprofessional team undergoes a cyclic sequence of teamwork and conflict while attempting to drive the resuscitation into a positive outcome. As ICU professionals attempt to optimise interprofessional collaboration during resuscitations, findings call for enhanced team training initiatives encompassing the interprofessional team, with an emphasis on collective leadership. IMPACT: ICU professionals experience of interprofessional collaboration during resuscitations is poorly understood. By understanding their lived experience, targeted interventions to improve interprofessional collaboration can be conceptualised and implemented. Findings will set pace for future evaluation research on interprofessional collaboration and patient outcomes during resuscitations.

The hand-brain-heart connection: ICU nurses' experience of managing patient safety during COVID-19.

BACKGROUND: COVID-19 has challenged critical care nursing through increased critical care service utilization. This may have a profound impact on intensive care unit (ICU) nurses' ability to maintain patient safety. However, the experiences of ICU nurses in managing patient safety during an infectious disease outbreak remains unexplored. AIMS AND OBJECTIVES: To explore ICU nurses' narratives in managing patient safety in the outbreak ICUs during the COVID-19 pandemic. DESIGN: A narrative inquiry design. METHODS: A purposive sample of 18 registered nurses who practiced in the outbreak ICUs during the COVID-19 pandemic were recruited between June and August 2020. Individual semi-structured interviews were conducted, transcribed verbatim, and narratively analysed. RESULTS: Findings reviewed an overarching anatomy-specific storyline of a 'hand-brain-heart' connection that describes nurses' experience with managing patient safety during the COVID-19 pandemic. Firstly, stories on 'the hands of clinical practice' revealed how critical care nursing is practiced and adapted by ICU nurses during the pandemic. In particular, ICU nurses banded together to safeguard patient safety by practicing critical care nursing with mastery. Secondly, stories on 'the brain of psychosocial wellness' highlights the tumultuous impact of COVID-19 on the nurses' psychosocial well-being and how nurses demonstrated resilience to continually uphold patient safety during the pandemic. Lastly, stories on 'the heart of nursing' drew upon the nurses' intrinsic professional nursing identity and values to safeguard patient safety. Specific patient tales further boosted the nurses' commitment to render safe nursing care during the pandemic. CONCLUSIONS: Through their stories, ICU nurses reported how they continually seek to uphold patient safety through clinical competence, resilience, and heightened nursing identity. RELEVANCE TO CLINICAL PRACTICE: ICU nurses require sustainable clinical resources and references such as clinical instructors, as well as visible psychosocial support channels, for ICU nurses to continue to uphold patient safety during COVID-19.

The early stages of caregiving: A qualitative study into the caregiving experiences of Asian family caregivers of persons with newly-diagnosed dementia.

In Asian societies, the responsibility of caring for persons with dementia often falls upon an immediate family member. However, little attention has been paid to the early stages of caregiving, as well as their transition into a more experienced caregiver. Thus, a qualitative descriptive study involving a purposive sample of 11 main family caregivers of a person with newly diagnosed dementia was recruited from a tertiary hospital in Singapore. Three themes emerged from the data analysis: (1) Suspicions to seeking confirmation of dementia, (2) Grappling with dementia diagnosis, and (3) Making adjustments for the future. Areas of needs and support identified during the early caregiving journey suggest the need for caregivers to be prepared for the practical and emotional challenges. Unique to the Asian culture, our findings put forth the advocacy of engaging persons with dementia in the discussions of their long-term care and options.

'From Expert to Novice', Perceptions of General Ward Nurses on Deployment to Outbreak Intensive Care Units during the COVID-19 Pandemic: A Qualitative Descriptive Study.

AIMS AND OBJECTIVES: This study aimed to explore the perceived preparedness and psychosocial well-being of general ward nurses prior to their deployment into the outbreak intensive care units (ICUs) during the COVID-19 pandemic. BACKGROUND: With the surge in COVID-19 cases requiring ICU care, non-ICU nurses maybe deployed into the ICUs. Having experienced through SARS, hospitals in Singapore instituted upskilling programs to secure general ward nurses' competency in providing critical care nursing. However, no studies have explored the perceptions of general ward nurses on deployment into the ICUs during the COVID-19 pandemic. DESIGN: Qualitative descriptive study. METHODS: The study was conducted at Singapore's epicentre of COVID-19 management. Five focus groups were conducted following purposive sampling of 30 general ward nurses identified for outbreak ICU deployment. Focus groups were audio-recorded, transcribed verbatim and data thematically analysed. This study was conducted and reported in accordance with the COREQ checklist. RESULTS: Three salient themes arose, exemplifying the transition from clinical experts in the general wards to practising novices in the outbreak ICUs. Firstly, 'Into the deep end of the pool' described general ward nurses' feelings of anxiety and stress associated with higher exposure risk and expanded responsibilities to nurse critically ill patients. Secondly, 'Preparing for "war"' illustrated deployed nurses' need for clear communication and essential critical care nursing training. Lastly, 'Call of duty' affirmed the nurses' personal and professional commitment to embrace this transition into the ICUs, and their desire for greater psychosocial support. CONCLUSION: The study findings highlight that though general ward nurses perceived their impending ICU deployment positively, they require ongoing support to facilitate a smoother transition. RELEVANCE TO CLINICAL PRACTICE: Findings provided an evidence base to improve the preparedness of general ward nurses deployed into the ICUs during the COVID-19 pandemic within key areas of training, information dissemination and psychosocial resilience.

Health literacy and patient activation among adults with chronic diseases in Singapore: A cross-sectional study.

AIMS: Increased patient activation levels can improve health outcomes. Hence, this study aims to examine the relationships between sociodemographic variables and domain-specific health literacies with patient activation. DESIGN: A cross-sectional design. METHODS: 200 outpatient adults with chronic diseases completed a survey that assessed their domain-specific health literacy and patient activation levels. Univariate and multivariate analysis of the variables were conducted on patient activation with 95% confidence interval (CI). RESULTS: Multiple linear regression analyses observed a positive linear relationship between the following domain-specific health literacy variables-"actively manage my health" (p < .0001, 95% CI: 0.89-2.29), "understanding health information" (p = .008, 95% CI: 0.28-1.85), and "finding good health information" (p = .02, 95% CI 0.13-1.51) with patient activation. The other sociodemographic and clinical variables were not statistically significant. Increased focus from healthcare professionals is needed on helping patients better find and understand health information and encouraging them to actively manage their health; elements which would raise their activation levels.

Widely tunable surface plasmon resonance and uniquely superior SERS performance of Au nanotube network films.

Three-dimensional Au network films with flexibility and transferability were fabricated based on sputtering deposition onto electrospun nanofibers as a template. The films are constructed using long Au nanotubes that are cross-linked with each other and that have dense nanoparticles on the tube wall surface. The surface plasmon resonance (SPR) peaks for the films are tunable in a wide range, from visible light to the near-infrared region, by tuning the inner diameter and/or wall thickness of the nanotubes. Such structured film exhibits significant surface-enhanced Raman scattering (SERS) activity with good signal uniformity and stability, and possesses great potential in thein situdetection of trace organic pollutants on a solid surface by simple transferring. This study provides a Au film with a unique structure and widely tunable SPR forin situSERS sensing and other needs.

Resilience of community health emergency staff / 预防医学

Objective@#To learn the level of resilience among community health emergency staff in Zhejiang Province and its influencing factors under the epidemic situation of coronavirus disease 2019. @*Methods@#Using stratified cluster sampling method, the community health emergency workers from six counties in Zhejiang Province were recruited in this study. A self-designed questionnaire, a scale for core emergency response capability of medical workers and 10 Items Connor-Davidson Resilience Scale ( CD-RISC-10 ) were employed. The multivariate linear regression model was used to analyze the influencing factors for resilience. @*Results@#A total of 749 people were surveyed, with 699 valid questionnaires ( effective rate 93.32% ). Among the 699 community health emergency staffs, the total scores of resistance and core emergency response capability were 34.97±7.95 and 118.38±27.60. The multivariate linear regression analysis showed that core emergency response capability ( β＇=0.410 ), education background (diploma: β＇=0.158; bachelor: β＇=0.196), position ( top: β＇=0.083 ) and self-rated physical fitness ( not qualified: β＇=-0.152; less qualified: β＇=-0.235; generally qualified: β＇=-0.219; more qualified: β＇=-0.107 ) were the influencing factors for resilience of community health emergency staff. @*Conclusion@#The resilience of community health emergency staff in Zhejiang Province is at a medium level, and is associated with education background, physical fitnes and position.

My health, myself: a qualitative study on motivations for effective chronic disease self-management among community dwelling adults.

BACKGROUND: Chronic diseases continue to be a significant cause of morbidity and mortality despite modifiable risk factors. This suggests that current primary healthcare provision needs to delve beyond patient education, to understand the motivators that drive patients to undertake chronic disease self-management. Understanding these motivations within the context of a multi-cultural community can facilitate tailored support for chronic disease self-management. OBJECTIVES: To explore the motivations behind effective chronic disease self-management in community dwelling adults in Singapore. METHODS: A qualitative descriptive study was carried out in five clinics in a large medical centre. Twelve participants who were assessed to be optimally managing their chronic diseases were recruited using purposive sampling. Individual in-depth interviews were conducted until data saturation, with data thematically analysed. RESULTS: Three salient themes emerged from the data. Firstly, 'Regaining self-control, avoiding complications' describes the participants' journey towards personal mastery in self-management, as well as a fear of debilitating complications resulting in their desire for good health. Secondly, 'Preserving social identities and roles' illustrates how participants yearn to maintain their pre-existing roles and functions through maintenance of their health. Finally, 'Accessing proximal support systems' highlights resources and supports surrounding the participants that encourage continued chronic disease self-management. Within each theme, specific motivators and challenges encountered by participants in their self-management journey were discussed. CONCLUSIONS: Findings can prompt primary healthcare providers to leverage on the patients' life goals and social roles in chronic disease self-management support. This may empower patients to engage in self-management and strengthen primary care provision.

Interprofessional collaboration during medical emergencies among doctors, nurses, and respiratory therapists in the intensive care unit: A phenomenological study protocol.

AIM: The aim of this study was to explore the lived experiences of interprofessional collaboration among nurses, doctors, and respiratory therapists during medical emergencies in the intensive care unit. DESIGN: Descriptive phenomenological study. METHOD: Participants will be recruited through purposive sampling with maximum variation across the ICUs in a tertiary hospital in Singapore. Guided by data saturation, data collection will include individual semi-structured interviews with ICU nurses, physicians, and respiratory therapist who have attended to medical emergencies such as cardiopulmonary arrest or difficult airway management in the ICUs. Interviews will be audio recorded, transcribed verbatim, and analysed via Colaizzi's descriptive phenomenology method. Research Ethics Committee approval was sought from the National Healthcare Group, Domain Specific Review Board (April 2019). The study is funded by the National Healthcare Group - Health Outcomes and Medical Education Research Grant (April 2019). The study is expected to be concluded by April 2020. DISCUSSION: Whilst interprofessional collaboration remains a major interest among nursing research, there is a paucity of evidence surrounding interprofessional collaboration in the specific context of medical emergencies in the ICUs. This is especially crucial as the failure of interprofessional collaboration during medical emergencies can be catastrophic to patient safety. Hence, this study will adopt a qualitative approach to contribute to the evidence base surrounding this lesser known phenomenon. The findings generated from this study will inform future team training initiatives, advance nursing leadership initiatives, and identify barriers and facilitators towards fostering greater interprofessional collaboration during medical emergencies. IMPACT: The evidence gained from this study contributes to the limited knowledge base of interprofessional collaboration during medical emergencies. Findings will have vast impact on nursing and interprofessional programs such as crisis leadership and management. The findings could also inform practice frameworks during medical emergencies to support interprofessional collaboration and optimize patient care.

The PEST Model: A Quality Improvement Project to Reduce Self-extubation in the Intensive Care Unit.

BACKGROUND: Self-extubation is an adverse patient event that can lead to severe complications. Gaps in clinical practice from the lack of nursing awareness and decision making capacity have often resulted in cases of preventable self-extubation. Review of current evidence suggests that initiatives to support nursing clinical decision making can help prevent adverse patient events such as self-extubation. AIMS: The aim of this study was to reduce the incidence of self-extubation by 50% in a cardiology intensive care unit over 1 year. METHODS: A quality improvement project was undertaken with a PEST model of nursing care introduced from January 2017 to December 2017 in the cardiology intensive care unit to guide nursing staff to assess and render appropriate interventions along patient domains such as pain, endotracheal tube securement, sedation, and tie to prevent incidences of self-extubation. RESULTS: Incidences of self-extubation have reduced to 5 cases in 2017, reflecting a 50% improvement from 10 cases in 2016. CONCLUSIONS: Formalizing practice standards into an easy-to-remember mnemonics or framework can improve patient outcomes. Policy makers must be aware that initiatives to facilitate decision making can improve patient safety.

Silver porous nanotube built three-dimensional films with structural tunability based on the nanofiber template-plasma etching strategy.

A facile and high-throughput strategy is presented to fabricate three-dimensional (3D) hierarchically porous Ag films, with clean surfaces, via plasma etching Ag-coated electrospun nanofiber template. The films are built of Ag porous nanotubes and are homogeneous in macro-size but rough and porous in nanoscale. Each nanotube-block is micro/nanostructured with evenly distributed nanopores on the tube walls. The film architecture (or the shape, arrangement, and distribution density of porous nanotubes; the number and size of nanopores) can be easily controlled by the nanofiber-template configuration, Ag coating, and plasma etching conditions. Such hierarchically porous films could be very useful, such as in catalysis, sensors, and nanodevices. They have exhibited significantly structurally enhanced surface-enhanced Raman scattering performance with good stability and reproduction, and shown the possibility of molecule-level detection. Also, the strategy is universal for fabricating other hierarchically structured 3D metal porous films, such as porous Ag hollow sphere arrays.

Au nanochain-built 3D netlike porous films based on laser ablation in water and electrophoretic deposition.

A green and controllable strategy is presented to fabricate homogeneous and Au nanochain-built three-dimensional netlike porous films based on electrophoretic deposition in the colloidal solution prepared by laser ablation in water.

Surface decoration of ZnO nanorod arrays by electrophoresis in the au colloidal solution prepared by laser ablation in water.

A simple and green strategy is presented to decorate ZnO nanorod array, based on electrophoresis deposition in the Au colloidal solution prepared by laser ablation in water and subsequent further laser irradiation. The surface of nanorods is homogeneously decorated with Au nanoparticles. The Au nanoparticles have good interfacial connection and strong binding with ZnO nanorods. The decoration morphology can be easily controlled by the size of Au colloids. Further experiments have revealed that suitable electrophoretic potential, small Au colloid's size, and enough inter-nanorod's spacing are crucial to formation of a homogeneous and strong surface decoration. Such Au nanoparticle-decorated ZnO nanorod array is functionalized and exhibits excellent surface-enhanced Raman scattering performance and shows the possibility of molecule-level detection. This study provides a new opportunity for the controllable surface modification of 1D semiconductor nanostructures and deepens the understanding of the physical mechanism of electrophoretic deposition.

Investigating the genetic instability in the peripheral lymphocytes of 36 untreated lung cancer patients with comet assay and micronucleus assay.

The aim of present investigation was to study the genetic instability in peripheral lymphocytes of lung cancer patients. The micronucleus (MN) assay and comet assay were simultaneously used to detect the spontaneous genetic change and ionizing irradiation (IR) induced genetic damage in peripheral lymphocytes from 36 lung cancer patients and 30 controls. In MN assay, the results of both two indicators, micronucleated cell frequency (MCF) and micronucleus frequency (MNF), indicated that the average values of MCF, MNF and IR-induced MCF, MNF of lung cancer patients were 9.25+/-0.58, 10.17+/-0.72, 66.14+/-2.07 and 75.64+/-2.34 per thousand, respectively, which were significantly higher than those (6.10+/-0.65, 6.60+/-0.74, 60.50+/-1.71 and 67.60+/-2.13 per thousand) of controls (P<0.05 or 0.01). In comet assay, the results of mean tail moment (MTM) and IR-MTM showed 0.84+/-0.07 and 1.09+/-0.11, respectively, which were significantly higher than those (0.60+/-0.05 and 0.70+/-0.10) of controls (P<0.05). However, the difference between lung cancer group and control group for the mean tail length (MTL) and IR-MTL was not significant (P>0.05). The results of present investigation indicated that the genetic instability in peripheral lymphocytes of 36 lung cancer patients was significantly higher than that of controls.