Conectar
IgG4-related disease is a chronic fibroinflammatory disease with multiorgan involvement. Glucocorticoids and/or immunosuppressants as well as rituximab are both first-line treatments in remission induction therapy. However, relapse is common during the maintenance period, particularly in patients with re-elevation of serum IgG4 level. This study aims to evaluate whether adding mycophenolate mofetil (MMF) during the maintenance phase for such patients can reduce the risk of disease flare.
This study is a multicentre, randomised, double-blind, placebo-controlled study. A total of 108 eligible patients with re-elevation of serum IgG4 level during maintenance therapy will be included in this study and randomised in a 1:1 ratio to receive add-on MMF 0.5 g one time per day or placebo for 52 weeks. The primary outcome is the proportion of patients experiencing relapse at week 52. Secondary outcomes include time-to-relapse, changes in disease activity and serum IgG4 level, stratified relapse rate according to the elevation level of IgG4. Analyses will follow the intention-to-treat principle.
The study has been approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (approval no. K3231). Written informed consent will be obtained from all participants before enrolment. Findings will be disseminated through peer-reviewed journals and conference presentations.
Single-arm trials (SATs) with objective performance criteria (OPCs) or performance goals (PGs) are increasingly used for regulatory approval of medical devices and other interventions. However, the comparability of study design characteristics between SAT and their external comparator sources remains unclear. This scoping review aimed to evaluate the comparability of study design characteristics between SATs and their matched OPC/PG sources.
Scoping review.
PubMed, Embase, the Cochrane Library and four Chinese databases—China National Knowledge Infrastructure, Wanfang Data, CQVIP and SinoMed—were searched from inception to 30 April 2026.
We included SATs that used one or more OPCs or PGs as external comparators to evaluate safety and/or effectiveness endpoints and reported specific numerical values of OPCs or PGs.
Two reviewers independently screened the retrieved records and extracted data using a standardised form. For each included SAT, we retrieved the cited OPC/PG sources and extracted study design characteristics data (age, sex, health conditions, outcome definitions and measurement time points) for comparison. Age and sex were compared using summary t-tests and ² tests; health conditions were assessed by two clinicians based on eligibility criteria and baseline characteristics. Results were stratified by OPC versus PG.
A total of 1243 records were identified, and 133 SATs were included. Most studies used PGs (84, 63.2%); 34 (25.6%) claimed to use OPCs, and 15 (11.3%) could not be classified. Of the 60 age comparisons available from 41 studies, 30 showed statistically significant differences; of the 82 sex comparisons available from 59 studies, 60 showed significant differences. Health conditions, outcome definitions and time points were assessed descriptively in a subset of studies, and discrepancies were also observed.
Suboptimal comparability of study design characteristics was observed between SATs and their OPC/PG sources, which might influence the treatment effect estimates. Greater attention to the comparability of study design characteristics in SATs with OPC/PGs may improve the validity of evidence.
Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.
To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.
A multicenter simulated observational study.
The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.
Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564–0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.
Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.
The study was conducted and reported according to the STROBE statement.
No patient or public contribution.
Lung ultrasound (LUS) is accurate for diagnosing pneumonia in the emergency department (ED), but standard training is time-intensive, limiting its widespread implementation. We evaluated LUS proficiency for pneumonia diagnosis and perceived adoption barriers after a short training programme.
This study was conducted in the frame of the PLUS-IS-LESS trial (Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments) (NCT05463406), a pragmatic stepped-wedge cluster-randomised clinical trial evaluating a clinical management algorithm combining LUS and procalcitonin to guide antibiotic use for lower respiratory tract infections (LRTIs) in 10 Swiss EDs.
All medical supervisors (senior registrars and senior physicians) from the participating EDs were invited to go through the PLUS-IS-LESS LUS training programme and all those who completed the training programme were included in this study.
The training programme included an e-learning course, followed by a half-day on-site training session with theory and hands-on practice. For proficiency evaluation, a validated structured assessment of LUS skills (LUS-OSAUS) was adapted into a 32-question online quiz and five bedside LUS examinations. Success was defined as achieving a score ≥80% on both the online quiz and supervised practical assessment. Success rates were compared between physicians according to their characteristics (age, sex, medical experience, previous use of ultrasound or LUS, linguistic region of work and type of hospital) using a ² test. A 6-month follow-up survey identified factors associated with non-certification and barriers to the clinical use of LUS for managing LRTIs.
Of 122 trained physicians, 83 (68 %) completed both quiz and supervised LUS and 61 (50%) achieved certification. The most challenging items were pleural line assessment (83% success), recognition of consolidations (83%) and decision-making based on LUS findings (72%). Physicians <40 years had a higher success rate (p=0.009). Among those without complete certification, limited access to an ultrasound machine and low perceived added value of LUS were the main identified reasons. Lack of time was the most frequently reported barrier overall to LUS integration into ED workflows (77%).
After receiving short training and focused proficiency testing, only half of physicians achieved certification, underscoring the challenges of broad LUS implementation. Limited time, equipment access and low perceived clinical value were key barriers, and integrating LUS findings into decision-making remained difficult. Ongoing support, supervision and protected time may be needed to enhance LUS adoption in EDs.
by Andrea K. Finlay, Ingrid Binswanger, Alex H.S. Harris, Matthew Stimmel, Mengfei Yu, Kreeti Singh, Jack Tsai
Military veterans with criminal legal involvement have a need for healthcare and housing to attenuate their risks of suicide, overdose, and homelessness. Links between criminal legal involvement and Veterans Health Administration (VHA) care are poorly understood, partly because it is challenging to correctly identify veterans with criminal legal involvement. This study’s primary objective was to assess VHA data sources and codes from the electronic health record that indicate contact with Veterans Justice Programs (VJP) staff – a broad proxy for criminal legal involvement. We examined three data sources used in previous research to identify veterans who had contact with VJP staff: (1) presence of VJP clinic stop codes in the outpatient encounter records, (2) Homeless Outreach Management and Evaluation System (HOMES) VJP form records collected during VJP outreach, and (3) chart note titles that included VJP terms. In Fiscal Year 2024, there were 52,672 unique VHA-eligible veterans with VJP contact as determined by at least one indicator: 80% with clinic stop codes, 22% with HOMES records, and 63% with chart note titles (Fleiss’ κ = 0.22, p < .001). Patient characteristics varied in their association with each data source, suggesting substantial proportions of veterans with specific characteristics who received VJP services would be missing when only one or two data sources were used. Depending on the data source, diagnosis of a clinical condition varied by 9% and there was a 6% difference observed in a performance measure. These results suggest that the use of all three data sources to identify veterans with VJP contact is the most comprehensive strategy among those examined. Results are most applicable to VHA, the largest healthcare system to serve a criminal legal involved population, and provide information that other healthcare systems may need various data sources and indicators to identify patients with criminal legal involvement.To explore the association between fluid balance and the occurrence of pressure injury in patients with sepsis during ICU stay.
Retrospective cohort study.
Patients were categorised based on cumulative fluid balance percentage: fluid negative balance (< 0%), neutral fluid balance (≥ 0% and ≤ 10%), and fluid overload (> 10%). Cox proportional hazard regression models were used to assess the associations between fluid balance and pressure injury occurrence.
A total of 10,669 patients with sepsis were included, 2346 (22.0%) developed pressure injuries. Patients with pressure injury had higher cumulative fluid balance within the first 3 days. In multivariable models, fluid overload on Days 1, 2, and 3 after admission was independently associated with a higher hazard of pressure injury occurrence during ICU stay, with hazard ratios of 1.30, 1.30, and 1.39, respectively.
Fluid overload occurs in 21.7% of patients with sepsis by day 3 of ICU admission and is independently associated with a higher hazard of pressure injury occurrence.
Integrating fluid management into nursing practice may support earlier identification and prevention of pressure injuries in the ICU.
This study examines the association between cumulative fluid balance and pressure injury occurrence in patients with sepsis during ICU stay. The findings may inform ICU nursing practice and pressure injury prevention strategies.
Following STROBE guideline:
This study utilised data from the Medical Information Mart for Intensive Care-IV 3.0 database.
This retrospective study used the publicly available database and did not require trial registration.
To explore the cultural challenges and complexities faced by researchers conducting studies with cancer patients in the Chinese cultural context.
A descriptive qualitative study.
Semi-structured interviews were conducted with 22 nurse researchers from tertiary hospitals, medical universities, and secondary nursing colleges from all six regions in China between April 2023 and December 2024. Data were analysed using inductive thematic analysis as described by Braun and Clarke.
From the analysis, two themes were developed: (i) sociocultural factors, and (ii) strategies to navigate cultural complexities. Nearly all participants reported significant difficulties in conducting research with cancer patients, stemming not only from the vulnerability associated with a cancer diagnosis, but also from the cultural taboo surrounding cancer and death, and the influential role of family members in decision-making and patient protection. Researchers emphasised the need to carefully balance family members' roles as gatekeepers, manage power dynamics with healthcare professionals, uphold patient autonomy, and communicate sensitively while maintaining research integrity. To address these challenges, participants recommended consulting family members before approaching patients, involving both patients and families throughout the research process, improving ethical training for researchers, and developing culturally sensitive ethical guidelines specific to China.
Cultural traditions and norms play a significant role in shaping cancer research practices in China.
Developing culturally sensitive ethical guidelines specific to the Chinese context is essential to support research personnel and ensure the ethical integrity of cancer research.
China's taboos surrounding cancer and death, and deeply embedded cultural traditions and norms, family-centred decision-making, and filial piety profoundly shape the conduct of research involving patients with cancer, particularly when a tension exists with universal ethical principles.
The Consolidated Criteria for Reporting Qualitative Research.
No patient or public contribution.
To evaluate the effectiveness of a dyadic illness management–based intervention (Dyadic Guidance and Empowerment Program, D-GEP) in alleviating demoralization among women with gynaecological malignancies and their family caregivers during the hospital-to-home transition.
An assessor-blinded, two-arm parallel randomized controlled trial with repeated outcome assessments.
Women-caregiver dyads were recruited from a tertiary hospital in Changchun, China (June–August 2025) and randomly allocated to the intervention or control group (1:1). The intervention group received D-GEP, comprising two pre-discharge face-to-face sessions, a 4-week WeChat-based video education programme comprising 20 videos, and a dyadic telephone follow-up conducted 3 weeks after discharge. The control group received standard discharge planning and a telephone follow-up. Outcomes were assessed at baseline (T0), immediate post-intervention (T1) and 3 months post-intervention (T2). Data were analysed according to the intention-to-treat principle.
A total of eighty-four women-caregiver dyads were recruited. Eighty women (95%) and 78 caregivers (93%) completed the full protocol. At 3 months, D-GEP significantly reduced demoralization among both women and family caregivers compared with standard care, with large intervention effect sizes observed. In addition, the symptom burden of women and family caregiver burden were also significantly reduced, whereas dyadic mutuality and family hardiness (women-reported) improved. However, no significant effect was found on women's self-perceived burden. The intervention demonstrated high adherence rates and minimal attrition.
The D-GEP effectively reduces demoralization and improves key dyadic outcomes for women with gynaecological malignancies and their family caregivers.
Nurses can implement this theory-driven dyadic programme to mitigate psychological distress and enhance mutual support, thereby facilitating improved continuity and quality of care during discharge and follow-up.
To our knowledge, this study provides randomized controlled evidence that a theory-driven dyadic intervention may effectively reduce demoralization among women with gynaecological cancer and their family caregivers during the transition from hospital to home care. The scalable D-GEP model, combining brief in-person sessions, video education and telephone follow-up, offers a practical framework for oncology nurses to integrate dyadic care into routine discharge planning. These findings have important implications for oncology practice in Asian healthcare systems and other settings where family engagement is central to cancer care delivery.
This study was conducted and reported in accordance with the CONSORT 2025 guidelines for randomized controlled trials.
No Patient or Public Contribution.
Chinese Clinical Trial Registry, No. ChiCTR2500104008. Registered on 10/06/2025, first recruitment on 20/06/2025.
by Qianqian Jia, Lili Zhang, Yang Han, Yating Yang, Qian Sun, Zhuo Liu, Chenxi Wu, Qiujun Wang, Fei Liu, Shujuan Liang
BackgroundUltrasound-guided external oblique intercostal plane block (EOIPB) is a modified block technique used in the past few years for anterolateral upper abdominal wall analgesia. This study observed the efficacy of EOIPB in laparoscopic common bile duct exploration (LCBDE).
ObjectivesTo evaluate the efficacy of EOIPB in patients undergoing LCBDE.
MethodsSixty patients undergoing elective LCBDE were randomly assigned to two groups, an EOIPB group and a control group. In the EOIPB group, the patients received ultrasound-guided right EOIPB with a total of 20 mL of 0.5% ropivacaine before anesthesia induction. In the control group, the patients received no intervention before anesthesia induction. The primary outcomes were visual analog scale (VAS) scores within 24 h postoperatively and the number of patient-controlled analgesia (PCA) uses 24 h postoperatively. The secondary outcomes were dermatomal coverage of EOIPB, intraoperative vital signs, the intraoperative dose of remifentanil, and the 24-h postoperative quality of recovery-40 (QoR-40) score of the two groups.
ResultsIn the EOI group, VAS scores at rest and movement were significantly lower than in the control group at 30 min, 6 h, and 12 h postoperation (p p > 0.05). The number of PCA uses within 24 h was significantly lower in the EOIPB group (1.60 ± 0.89) compared to the control group (2.50 ± 1.11, p p p p p p Conclusion
The use of EOIPB in LCBDE can reduce VAS scores and the number of PCA uses 24 h postoperatively. EOIPB also steadied the intraoperative vital signs, reduced the dose of remifentanil, and improved the quality of recovery. EOIPB can be safely and effectively used in LCBDE.
To identify latent fatigue profiles in adolescent and young adult (AYA) cancer patients and explore associated clinical and socioeconomic factors to guide precision nursing.
A cross-sectional observational study.
A total of 218 AYA cancer patients were recruited from a tertiary cancer center between December 2025 and February 2026. Latent Profile Analysis was used to identify fatigue subgroups based on the Piper Fatigue Scale-Revised. Multinomial logistic regression was applied to examine correlates.
Three distinct profiles emerged: ‘Low-Fatigue Well-Adapted’ (32.6%), ‘High-Fatigue Somatic-Dominant’ (38.1%), and ‘High-Fatigue Emotional-Cognitive Exhaustion’ (29.4%). The Somatic-Dominant group exhibited severe sensory fatigue but mild distress, strongly associated with chemotherapy (OR = 2.42, 95% CI: 1.03–5.68, p = 0.041) and non-working status (OR = 3.02, 95% CI: 1.38–6.58, p = 0.006). Conversely, the Emotional-Cognitive Exhaustion group showed severe affective and cognitive exhaustion. This profile was significantly linked to active chemotherapy (OR = 4.95, 95% CI: 1.98–12.38, p < 0.001), lower income levels (higher income: OR = 0.52, 95% CI: 0.38–0.71, p < 0.001), and gastrointestinal cancer (OR = 3.15, 95% CI: 1.12–8.85, p = 0.029).
Fatigue in AYA patients appears highly heterogeneous, manifesting either as somatic-dominant patterns potentially associated with chemotherapy or multidimensional exhaustion linked to survival and economic pressures.
Nursing practice should transition from a uniform approach to phenotype-based precision symptom management. Patients with somatic-dominant fatigue require physical rehabilitation, whereas those experiencing emotional-cognitive exhaustion urgently need integrated nutritional, psychological, and socioeconomic support to mitigate their multidimensional burden.
What problem did the study address? ○
The study addressed the limitation of treating cancer-related fatigue as a uniform symptom in AYA patients, which masks individual variability and the hidden burden of chronic socioeconomic constraints.
What were the main findings? ○
Three distinct fatigue phenotypes were identified, revealing significant symptom heterogeneity. Severe emotional-cognitive exhaustion was strongly linked not only to chemotherapy but also to chronic economic constraints of maintaining employment while ill.
Where and on whom will the research have an impact? ○
This research will impact oncology nurses, social workers, and clinical policymakers globally by providing an evidence-based framework for precision symptom management and targeted socioeconomic interventions for vulnerable AYA cancer survivors.
This study adhered to the STROBE reporting guidelines for cross-sectional studies.
No patient or public contribution.
Gastrointestinal cancers present with complex symptom burdens that significantly impact treatment outcomes and patients' quality of life. Symptom clusters have been examined in various cancer types, yet a comprehensive synthesis of their patterns and impact in gastrointestinal cancer remains lacking.
To summarize symptom clusters in gastrointestinal cancer patients, explore their longitudinal stability, and determine the relationship between relatively stable symptom clusters and quality of life.
A systematic review and meta-analysis.
The included studies were sourced from PubMed, Embase, Cochrane Library, Web of Science, Medline, and the CNKI database, covering publications up to September 2024.
Two reviewers independently screened and extracted data using prespecified criteria, in accordance with PRISMA 2020. The primary outcome was symptom clusters; the secondary outcome was their association with quality of life. Meta-analysis and visualizations were conducted using R 4.4.2.
A total of 45 studies were included in this review. The common symptom clusters observed in gastrointestinal cancer patients were the pain-fatigue-sleep disturbance symptom cluster, the gastrointestinal symptom cluster I, and the psychological symptom cluster. Each of these clusters showed a moderate negative correlation with quality of life. Subgroup analyses identified cancer type, time point, study quality, and publication year as potential sources of heterogeneity.
This review identifies three stable symptom clusters in gastrointestinal cancer, which show a moderate negative correlation with quality of life, highlighting the need for standardized assessments.
Common symptom clusters have been identified in gastrointestinal cancer patients. These clusters show a moderate negative correlation with quality of life. Clinical staff can prioritize the management of these common symptom clusters, enabling integrated management of multiple symptoms to enhance efficiency, improve patient outcomes, and quality of life.
No patient or public contribution.
PROSPERO: CRD42024584049
To propose an ethical decision-making framework for artificial intelligence (AI) involvement in person-centred fundamental care, organised around the relational dependency of care activities and grounded in the Fundamentals of Care Framework and the Caring Life Course Theory.
Discursive paper integrating care ethics, the Fundamentals of Care Framework, the Caring Life Course Theory, person-centred care theory and technology ethics scholarship.
Peer-reviewed literature (primarily 2006–2026, plus seminal earlier care-ethics works) from nursing, bioethics, technology ethics and health informatics was searched across CINAHL Complete, PubMed, PsycINFO and Scopus. Policy documents from the World Health Organisation (WHO), the International Council of Nurses (ICN) and the European Union (EU) were also reviewed.
The Relational Care–Artificial Intelligence Alignment (RCAA) framework operates within the three established dimensions of the Fundamentals of Care Framework (relationship, integration of care and context) and classifies fundamental care activities by relational dependency into three zones: Zone 1 (high dependency), where AI serves as background support; Zone 2 (moderate dependency), where collaborative human–AI partnership is appropriate; and Zone 3 (low dependency), where autonomous AI operation under human oversight is acceptable. Five ethical principles guide zone placement: relational autonomy, non-maleficence of depersonalisation, universal access to person-centred fundamental care, transparency and explicability and proportionality. Each is grounded in established care ethics, bioethics or AI governance traditions. Establishing the nurse–patient relationship and eliciting patient preferences sit at the entry point of the framework.
The framework offers a structured approach for determining where AI can participate in fundamental care while preserving the relational essence of nursing. It is offered as a heuristic to facilitate discussion and action across clinical, educational and policy settings.
The framework can inform institutional AI adoption policies, guide nursing curricula and support regulatory standards for technology deployment in care.
What problem did the study address? The absence of a systematic ethical framework, anchored in established person-centred fundamental care theory, for determining appropriate boundaries of artificial intelligence involvement in fundamental nursing care. What were the main findings? A relational dependency-based classification, situated within the Fundamentals of Care Framework, can guide artificial intelligence involvement through three zones of human–machine collaboration while preserving patient choice and the centrality of the nurse–patient relationship. Where and on whom will the research have an impact? Nurses, healthcare organisations, policymakers and technology developers working through artificial intelligence integration into person-centred care.
This study did not include patient or public involvement in its design, conduct or reporting. We acknowledge this as a limitation and discuss it explicitly in the Strengths and Limitations section.
To explore influencing factors of frailty in community-dwelling elderly individuals with chronic diseases, and to construct a risk prediction model for frailty with internal validation.
A cross-sectional design.
A total of 684 questionnaires were distributed, and 678 valid questionnaires were collected, with an effective response rate of 99.2% by convenience sampling from March to October 2024 in Changsha, Hunan Province, China. General information questionnaire, Tilburg Frailty indicator scale (TFI), General Self-efficacy Scale (GSES), and Physical Resilience Instrument for Older Adults (PRIFOR) were used to collect data. A total of 678 valid samples (frailty rate 24.0%) were randomly divided into training set (n = 474) and validation set (n = 204) at a ratio of 7:3. Baseline characteristics between the two sets were compared, and binary logistic regression analysis was used to determine the influencing factors using IBM SPSS v26.0. The LASSO regression, nomogram, area under the receiver operating characteristic curve (AUC), calibration curve, decision curve, and SHapley Additive exPlanations plots of prediction model were established using R version 4.5.2.
Variables in the model included religion, living arrangement, regular exercise, duration of chronic diseases, number of medications, health status, general self-efficacy, and physical resilience. The AUC, calibration, and decision-making ability in both sets were satisfactory.
The frailty prediction model demonstrated good discrimination, calibration, and clinical utility, providing a scientific basis for the prevention and early screening of frailty in elderly individuals with chronic diseases.
The model can help community healthcare professionals to calculate the risk probability of frailty in elderly individuals with chronic diseases, formulate personalized preventive care measures for high-risk groups as soon as possible to achieve early prevention or delay of frailty and its related complications, and improve the prognosis.
No patient or public contribution.
TRIPOD-AI checklist.
Mixed-methods observational implementation and economic evaluation study.
Perioperative care bundles have the potential to improve patient outcomes but their successful implementation depends on staff engagement and the resources required. Data on implementation costs and staff perceptions are limited for perioperative brain health initiatives.
To estimate the resource use and costs of implementing a perioperative brain healthcare bundle in a Swiss hospital and to explore staff perceptions relevant to sustainable adoption.
Retrospective mixed-methods study combining semi-structured interviews with economic modelling.
Single tertiary-level Swiss hospital. Cost estimates were expressed in 2024 Swiss Francs (CHF).
Five anaesthesiologists and five nurses involved in perioperative care and bundle implementation were interviewed using semi-structured interviews. Postoperative delirium incidence was assessed in patients admitted to the post-anaesthesia care unit (PACU).
Implementation of a perioperative brain healthcare bundle, including staff training, workflow adaptation and routine postoperative delirium screening.
Primary outcomes were total implementation time and costs, and postoperative delirium incidence in the PACU measured using the Nursing Delirium Screening Scale. Secondary outcomes included staff perceptions of workload and feasibility, hospital length of stay and net cost impact.
Staff perceptions of the care bundle were generally positive, with initial concerns about workload decreasing over time. Implementation required an estimated 803 hours (695–912) and cost CHF 326 612 (275 370–374 781). The economic model estimated a reduction of 300 (270–330) PACU-detected postoperative delirium cases, corresponding to 421 (341–509) hospital days saved and net cost savings of CHF 389 523 (159 209–688 988) within 12 months. Scenario and probabilistic sensitivity analyses projected cumulative net savings exceeding CHF 2 million over 5 years, with a breakeven point at approximately 2 months.
Implementation of a perioperative brain healthcare bundle was well accepted by staff and associated with substantial cost savings in this single-centre model-based analysis, supporting its potential scalability as a perioperative quality improvement intervention.
by Yibiao Li, Hui Zhong, Yufei Dong, Lei Lu
Understanding inter-city disparities in urban expressed happiness (EH) and the key predictors for these differences is critical for advancing socially sustainable urban development. However, the key predictors for EH remain poorly understood, and existing studies have largely overlooked the potential association with future climate change. In this study, we analyzed 5,118,772 geotagged Weibo posts from 50 Chinese cities using SnowNLP for sentiment analysis, machine learning models, and LDA topic modeling to investigate the inter-city differences in EH, its underlying predictors, and the potential association with further climate change. Sentiment analysis revealed pronounced variations in EH across Chinese cities, with more positive emotions observed during weekends and holidays. Incorporating 17 potential predictors, we developed ten machine learning models. A random forest model achieved the best performance, with an R² that exceeded all other models by 1.05%–60.00% and an RMSE that was 7.41%–60.95% lower than the alternatives. SHAP analysis showed that landscape, socioeconomic, environmental, and geographic factors accounted for 24.58%–38.97%, 20.64%–40.12%, 11.96%–29.33%, and 11.47%–23.71% of the total feature importance in the EH prediction models, respectively. Among individual variables, the normalized difference vegetation index (NDVI) exhibited the highest feature importance, accounting for 18.56%–32.16% of the total importance, followed by per capita GDP, PM2.5 concentration, AQI, and temperature. Scenario-based projections suggest an association between projected climate warming and potential changes in urbanites’ EH. Overall, this study identifies the key predictors associated with urbanites’ EH and highlights the potential association of future climate warming with EH, providing valuable evidence for urban planning and policy interventions.
FreshRSS 