Nursing Students’ Clinical Confidence In Caring Tuberculosis: Indonesian Version Of The U.S Tuberculosis Curriculum Consortium Survey Using Rasch Analysis

Background: Nursing students who are prepared in clinical practicums to comprehend the knowledge, reflect their beliefs about tuberculosis instruction, and perceive their abilities in caring for tuberculosis patients are also at risk. Nursing students’ clinical confidence in caring for tuberculosis patients is essential to be assessed. Knowledge, beliefs, and clinical confidence, as unidimensional constructs based on Bandura’s theory of self-efficacy, had been used in the US National Tuberculosis Curriculum Consortium (NTCC) survey for nursing students. This study's objective was to investigate the Indonesian version of the NTCC survey among nursing students' experiences caring for tuberculosis patients.   Methods: A quantitative study with cross-sectional using an online survey among 250 students 1st to 3rd-yearrd year students in one faculty of nursing in Banten, Indonesia. Prior to data collection, NTCC surveys were translated backward and forward, reviewed by experts, and tested in a pilot project.   Results: Internal consistency using Rasch analysis on each subscale showed good results and gave strong evidence that three subscales are unidimensional. There was an item separation index and reliability score, in that order: knowledge about tuberculosis (8.68 and 0.99), beliefs regarding tuberculosis instructions (6.50 and 0.98), and clinical confidence in caring for tuberculosis patients (6.29 and 0.98).   Conclusion: The Indonesian version of the NTCC survey has excellent internal consistency. This instrument might be improved since the original instrument is 13 years old and there is a cultural gap between the US and Indonesia. Moreover, this instrument might be needed for improving tuberculosis teaching in the nursing curriculum in Indonesia

InfiniCity: Infinite-Scale City Synthesis

Toward infinite-scale 3D city synthesis, we propose a novel framework, InfiniCity, which constructs and renders an unconstrainedly large and 3D-grounded environment from random noises. InfiniCity decomposes the seemingly impractical task into three feasible modules, taking advantage of both 2D and 3D data. First, an infinite-pixel image synthesis module generates arbitrary-scale 2D maps from the bird's-eye view. Next, an octree-based voxel completion module lifts the generated 2D map to 3D octrees. Finally, a voxel-based neural rendering module texturizes the voxels and renders 2D images. InfiniCity can thus synthesize arbitrary-scale and traversable 3D city environments, and allow flexible and interactive editing from users. We quantitatively and qualitatively demonstrate the efficacy of the proposed framework. Project page: https://hubert0527.github.io/infinicity

Composite type A thymoma and diffuse large B-cell lymphoma

AbstractThe concurrent occurrence of thymoma and diffuse large B-cell lymphoma in the thymus has not been previously reported. We describe a 74-year-old man who presented with general weakness, neck lymphadenopathy, night sweats, and body weight loss. A right anterior mediastinal mass was found on computed tomography of the chest. The immunohistochemical stains AE1/AE3, CD20, CD3, and MUM-1 confirmed the different components of the mediastinal tumor. A heavy-chain gene clonality assay and light-chain gene clonality assay confirmed the B-cell clonality of the mediastinal tumor and neck lymph node. The patient had received a complete course of chemotherapy, and the result of positron emission tomography–computed tomography showed complete remission. The pathologic report of this mass revealed composite type A thymoma and diffuse large B-cell lymphoma. If concurrent or composite thymoma and lymphoma are suspected, a thorough examination of the thymoma with a combination of ancillary studies is recommended to rule out the possibility of concurrent lymphoma

Enteric bacterial loads are associated with interleukin-6 levels in systemic inflammatory response syndrome patients

AbstractBackgroundLoss of intestinal integrity is a critical contributor to excessive inflammation following severe trauma or major surgery. In the case of enterocyte damage, intestinal fatty acid-binding protein (IFABP) is released into the extracellular space. Excessive production of interleukin (IL)-6 can induce systemic inflammatory response syndrome (SIRS). However, the correlation of IL-6 with gut barrier failure and bacterial translocation in critically ill patients has not been well characterized.PurposesTo define the relationship between enteric bacterial loads and IL-6 levels in patients with SIRS.MethodsVariables related to prognosis and treatment were measured in 85 patients with SIRS upon admission to the emergency room. IL-6 and IFABP were measured using an enzyme-linked immunosorbent assay. Enteric bacterial loads in blood were measured through quantitative real-time polymerase chain reaction with primers specific for enteric bacteria.ResultsMultivariate analysis revealed a positive correlation between enteric bacterial loads and IL-6 levels in blood. Elevated IFABP concentration was associated with low blood pressure, high respiration rate, hyperglycemia, and high Sequential Organ Failure Assessment score. Elevated C-reactive protein concentrations were associated with higher soluble CD14 levels in blood.ConclusionEnterocyte damage is associated with hypotension and tachypnia in patients with SIRS. Gut function failure may permit enteric bacteria to enter the blood, thereby elevating IL-6 levels and inducing a systemic inflammatory response, resulting in multiple organ failure

Hypertension is an important predictor of recurrent colorectal adenoma after screening colonoscopy with adenoma polypectomy

AbstractBackgroundThe predictors of recurrent colorectal adenoma have not been fully examined. This study aimed to evaluate the predictors of recurrent colorectal adenoma after initial screening colonoscopy with adenoma polypectomy.MethodsA retrospective cohort study was conducted at the Taipei Veterans General Hospital from 2003 to 2011. After screening, 356 patients who had undergone two consecutive colonoscopies with colorectal adenoma polypectomy at the initial colonoscopy were enrolled. The recurrence group was patients with recurrent colorectal adenoma at the second colonoscopy, whereas the nonrecurrence group was patients without recurrence. Anthropometric data, biochemical tests, metabolic comorbidities, and adenoma characteristics at initial colonoscopy were compared between the two groups. Cox proportional hazard regression analysis was conducted to identify the predictors of recurrent colorectal adenoma.ResultsDuring a mean follow-up interval of 3.07 ± 1.42 years, 94 patients (26.4%) were in the recurrence group, 262 patients (73.6%) were in the nonrecurrence group. The recurrence group was older, had a wider waist circumference, higher levels of serum alanine aminotransferase (ALT) and triglyceride, a higher prevalence of smoking, nonalcoholic fatty liver disease, metabolic syndrome, and hypertension, and a higher occurrence of initial multiply-located adenomas when compared with the nonrecurrence group (p < 0.05). Cox regression analysis showed that hypertension, smoking, higher ALT level (>40 IU/mL), and multiply-located adenomas were independent predictors for recurrent colorectal adenoma. The risk of recurrent adenoma increased when hypertension was combined with smoking, high ALT level, or multiply-located adenomas.ConclusionHypertension is an important predictor for recurrent colorectal adenoma after screening colonoscopy with polypectomy

TREATING PEDIATRIC ASTHMA WITH HOLISTIC APPROACHES OF TRADITIONAL CHINESE MEDICINE: A RETROSPECTIVE STUDY

Background: Asthma is a chronic disease increasingly found in children. To find more economical and efficient alternatives to treat pediatric asthma, the Bureau of National Health Insurance of Taiwan launched the Traditional Chinese Medicine Holistic Treatment Program (TCMHTP). The effect of traditional Chinese medicine (TCM) holistic treatments on pediatric asthma was evaluated based on data collected from the program. Materials and Methods: A retrospective study was performed by analyzing a dataset from Changhua Christian Hospital, Taiwan, between January 1st, 2006 and December 31st, 2010. Patients aged between 2 and 15 years, who had been diagnosed with asthma, and had participated in the TCMHTP were recruited, whereas those with other severe diseases were excluded. We analyzed the frequency of emergency department visits (EDV), inpatient admission rate (IAR), and length of hospitalization (LH) of the patients, before and after TCM treatments. Spectral analysis of heart rate variability (HRV) was also conducted. Results: Fifty-eight patients were recruited. The average age of the patients receiving TCM treatments was 5.67±3.03 years. The frequency of EDV decreased from 0.94±0.85 to 0.67±1.19 times annually (p=0.095), the annual IAR decreased from 0.62±0.78 to 0.26±0.67 (p=0.002) and the average LH decreased from 3.32±4.25 to 0.80±1.64 (p=0.000) days per year. Parasympathetically mediated HRV decreased significantly from 60.42±15.33 to 54.89±16.45 nu (p=0.016). Conclusion: The present study revealed that an appropriate period of TCM holistic treatment intervention can not only significantly lower exacerbations and hospitalization frequency but also reduce vagal tone in asthmatic children