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Background The World Health Organization recommends improving the quality of care in rural areas of developing countries by enhancing teamwork. Effective teamwork is especially essential for rural hospital care delivered to complex patients, which requires multidisciplinary coordination and cooperation. However, evidence on teamwork in hospitals is mostly from urban hospitals and developed countries, leaving team functioning in rural hospitals in developing countries largely under-researched. The distinctive contextual characteristics of rural areas in developing countries, such as increased diversity, impact teamwork dynamics. To advance the understanding of teamwork in hospitals in rural areas of developing countries, this study investigates the relationships among perceived similarity, multidisciplinarity, coordination and perceived quality of care in rural Chinese hospitals. Methods We conducted a quantitative study via an online survey in four rural county-level hospitals from different provincial administrative regions in China. 1017 respondents including doctors, nurses and other healthcare professionals provided valid responses. A multilevel moderated mediation model was used for data analysis. Results Perceived similarity is positively related to coordination, which in turn leads to higher perceived quality of care. Coordination partially mediates the relationship between perceived similarity and perceived quality of care. However, multidisciplinarity does not moderate the effect of perceived similarity on coordination. Conclusions Perceived similarity can promote coordination and subsequently perceived quality of care. Multidisciplinarity does not moderate the relationship between perceived similarity and coordination, and further research into the role of multidisciplinarity is called for. Hospital management may leverage the advantage of similarity to form teams whose members perceive each other as similar. The functioning of teams perceived as less similar may require additional effort to promote coordination and perceived quality of care. Such challenges caused by dissimilarity are especially relevant in the process of workforce strengthening with the aim of quality improvement towards universal health coverage in rural areas of developing countries.

ObjectivesGenerational diversity, increasingly prominent in the composition of the healthcare workforce in rapidly developing countries, has received much attention in practice and research recently. While research has revealed various positive and negative impacts of generational diversity on team functioning, the understanding of the mechanism explaining how generational diversity influences team functioning is still limited. This study in rural Chinese hospitals examines the relationship between (surface-level) generational diversity and (deep-level) perceived similarity and investigates how they influence three teamwork behaviours that importantly determine quality of care, namely speaking up, silence and knowledge sharing.DesignWe adopted a quantitative research design and conducted an online survey to investigate the relationship among generational diversity, perceived similarity, speaking up, silence and knowledge sharing. Multilevel mediation modelling was used to test the hypotheses.SettingThe study was conducted in four rural Chinese hospitals.Participants841 healthcare professionals, including doctors, nurses and other healthcare professionals, were included in the study.Primary and secondary outcome measuresGenerational diversity was measured by calculating the average of individuals’ Blau’s indices regarding all the generations for each team. Perceived similarity, speaking up, silence and knowledge sharing were measured by validated questionnaires from literature.ResultsPerceived similarity is positively related to the three teamwork behaviours, that is, speaking up (β=0.56, p<0.01), silence (β=0.39, p<0.01) and knowledge sharing (β=0.54, p<0.01), while generational diversity is not (speaking up: β=0.08, p>0.05; silence: β=0.44, p>0.05; knowledge sharing: β=0.09, p>0.05). As the relationship between generational diversity and perceived similarity is non-significant (β=0.07, p>0.05), perceived similarity does not mediate the relationship between generational diversity and teamwork behaviour.ConclusionThe findings suggest that increases in generational diversity that result from healthcare workforce strengthening may not impact team behaviours and performance. However, if healthcare workforce strengthening would reduce the perceived similarity in teams, explicit management efforts to mitigate the negative impact on team behaviour and care provision are called for.

Although the importance of leader-member relationships in teamwork is acknowledged in literature, a deeper understanding of this relationship is lacking, especially in rural areas. The impact of leader-member relationships on team outcomes is especially important in rural Chinese hospitals as improving teamwork forms a national health reform priority in these hospitals. This study investigates how leader-member relationships (ie leader-member perceived similarity and power distance orientation) influence team outcomes (ie perceived quality of care and job satisfaction) via speaking up and silence. An online questionnaire was completed by 1017 team members (ie doctors, nurses and other healthcare professionals) of 300 teams in four rural Chinese hospitals in October 2022. The questionnaire measured leader-member perceived similarity, power distance orientation, speaking up, silence, perceived quality of care, job satisfaction and control variables. Multilevel mediation analysis was conducted to test the hypotheses. Leader-member perceived similarity and power distance orientation are positively related to speaking up ( =0.61, <0.01; =0.17, <0.01 respectively) and to silence ( =0.41, <0.01; =0.63, <0.01 respectively). Speaking up is positively related to the perceived quality of care ( =0.24, <0.01; =0.46, <0.01) and job satisfaction ( =0.30, <0.01; =0.54, <0.01), while the impact of silence is not significant. Finally, speaking up mediates the associations of both leader-member perceived similarity and power distance orientation with perceived quality of care ( =0.15, <0.01; =0.08, <0.01 respectively) and job satisfaction ( =0.30, <0.01; =0.54, <0.01 respectively). Speaking up, rather than silence, contributes to team functioning by mediating the impact of leader-member relationships to team outcomes. Hospital management may therefore seek to stimulate speaking up by focussing on leader-member relationships: increasing leader-member similarity and promoting members' power distance orientation. However, any unintended effect of increased silence through these leader-member relationships is an important area of future research, which can adopt multidimensional models of speaking up and silence.

Bleomycin is a glycopeptide drug that exerts potent genotoxic potential and is highly effective in the treatment of certain cancers when used in combination therapy. Unfortunately, however, tumors often develop resistance against bleomycin, and the mechanism of this resistance remains unclear. It has been postulated that bleomycin hydrolase, a protease encoded by the BLH1 gene in humans, may account for tumor resistance to bleomycin. In support of such a notion, earlier studies showed that exogenous expression of yeast Blh1 in human cells can enhance resistance to bleomycin. Here we show that (i) yeast blh1 mutants are not sensitive to bleomycin, (ii) bleomycin-hypersensitive yeast mutants were no more sensitive to this agent upon deletion of the BLH1/LAP3/GAL6 gene, and (iii) overproduction of Blh1 in either the parent or bleomycin-hypersensitive mutants did not confer additional resistance to these strains. Therefore, yeast Blh1 apparently has no direct role in protecting this organism from the lethal effects of bleomycin, even though the enzyme can degrade the drug in vitro. Clearly, additional studies are required to establish the actual biological role of Blh1 in yeast.Key words: yeast, bleomycin hydrolase, bleomycin, DNA damage, resistance.

A major challenge for the effective use of Ti-based MXenes in applications with harsh environmental conditions is their poor resistance to oxidation. Here, authors report an air-stable Ti3C2T x composite with extracted bentonite able to endure high-temperature annealing in air by an oxygen adsorption competition mechanism.

Although Ti 3 C 2 T x MXene is a promising material for many applications such as catalysis, energy storage, electromagnetic interference shielding due to its metallic conductivity and high processability, it’s poor resistance to oxidation at high temperatures makes its application under harsh environments challenging. Here, we report an air-stable Ti 3 C 2 T x based composite with extracted bentonite (EB) nanosheets. In this case, oxygen molecules are shown to be preferentially adsorbed on EB. The saturated adsorption of oxygen on EB further inhibits more oxygen molecules to be adsorbed on the surface of Ti 3 C 2 T x due to the weakened p-d orbital hybridization between adsorbed O 2 and Ti 3 C 2 T x , which is induced by the Ti 3 C 2 T x /EB interface coupling. As a result, the composite is capable of tolerating high annealing temperatures (above 400 °C for several hours) both in air or humid environment, indicating highly improved antioxidation properties in harsh condition. The above finding is shown to be independent on the termination ratio of Ti 3 C 2 T x obtained through different synthesis routes. Utilized as terahertz shielding materials, the composite retains its shielding ability after high-temperature treatment even up to 600 °C, while pristine Ti 3 C 2 T x is completely oxidized with no terahertz shielding ability. Joule heating and thermal cycling performance are also demonstrated. A major challenge for the effective use of Ti-based MXenes in applications with harsh environmental conditions is their poor resistance to oxidation. Here, authors report an air-stable Ti 3 C 2 T x composite with extracted bentonite able to endure high-temperature annealing in air by an oxygen adsorption competition mechanism.

This multicenter, randomized, noninferiority trial compared electroacupuncture with prucalopride for the treatment of severe chronic constipation (SCC). Participants with SCC (≤ 2 mean weekly complete spontaneous bowel movements [CSBMs]) were randomly assigned to receive either 28-session electroacupuncture over 8 weeks with follow-up without treatment over 24 weeks or prucalopride (2 mg/d before breakfast) over 32 weeks. The primary outcome was the proportion of participants with ≥3 mean weekly CSBMs over weeks 3-8, based on the modified intention-to-treat population, with -10% as the noninferior margin. Five hundred sixty participants were randomized, 280 in each group. Electroacupuncture was noninferior to prucalopride for the primary outcome (36.2% vs 37.8%, with a difference of -1.6% [95% confidence interval, -8% to 4.7%], P < 0.001 for noninferiority); almost the same results were found in the per-protocol population. The proportions of overall CSBM responders through weeks 1-8 were similar in the electroacupuncture and prucalopride groups (24.91% vs 25.54%, with a difference of -0.63% [95% confidence interval, -7.86% to 6.60%, P = 0.864]). Except during the first 2-week treatment, no between-group differences were found in outcomes of excessive straining, stool consistency, and quality of life. Adverse events occurred in 49 (17.69%) participants in the electroacupuncture group and 123 (44.24%) in the prucalopride group. One non-treatment-related serious adverse event was recorded in the electroacupuncture group. Electroacupuncture was noninferior to prucalopride in relieving SCC with a good safety profile. The effects of 8-week electroacupuncture could sustain for 24 weeks after treatment. Electroacupuncture is a promising noninferior alternative for SCC (see Visual Abstract, http://links.lww.com/AJG/B776).

Broadband and efficient terahertz absorbing films are crucial to high-performance terahertz detectors, which are in demand for next-generation wireless communications, astronomy, security screening, medical imaging and so on. Recent studies reported a series of two-dimensional materials for enhanced light absorption in terahertz waves, such as graphene, transition metal dichalcogenides and topological insulators, among others. However, it is still challenging to achieve the intrinsic thin-film absorption limit (50%) across the whole ultrabroad terahertz band. Here we demonstrate that ultrathin 10.2-nm-thick (~λ/30,000) Ti3C2Tx MXene assemblies can reach the intrinsic thin-film absorption limit across the entire 0.5–10 THz band. Such intriguing phenomena are attributed to the highly concentrated free electrons (~1021 cm−3), short relaxation time (~10 fs) and unique intra- and interflake (hopping) electron transport properties in Ti3C2Tx MXenes. Our results are validated by alternating current impedance theory using the Drude–Smith model, rather than classic direct current impedance matching. We believe that our findings will stimulate more studies of broadband terahertz technologies with MXenes and beyond, providing a route to developing compact, supercontinuum terahertz optoelectronic or photothermoelectric devices.Ultrathin 10.2-nm-thick (~λ/30,000) Ti3C2Tx MXene assemblies that offer an absorption of 49.2%, which is close to the theoretical limit of 50%, in the range of 0.5–10 THz are reported, benefiting terahertz optoelectronic and photothermoelectric devices.

Long noncoding RNAs (lncRNAs), non-protein-coding transcripts exceeding 200 nucleotides, are critical regulators of gene expression through chromatin remodeling, transcriptional modulation, and post-transcriptional modifications. While ionizing radiation (IR) induces cellular damage through direct DNA breaks, reactive oxygen species (ROS)-mediated oxidative stress, and bystander effects, the functional involvement of lncRNAs in the radiation response remains incompletely characterized. Here, through genome-wide CRISPR activation (CRISPRa) screening in non-small cell lung cancer (NSCLC) cells, we identified LOC401312 as a novel radiosensitizing lncRNA, the stable overexpression of which significantly enhanced IR sensitivity. Transcriptomic profiling revealed that LOC401312 transcriptionally upregulates carbamoyl-phosphate synthase 1 (CPS1), a mitochondrial enzyme involved in pyrimidine biosynthesis. Notably, CPS1 overexpression recapitulated the radiosensitization phenotype observed with LOC401312 activation. Mechanistic investigations revealed that CPS1 suppresses the phosphorylation of ATM kinase (Ser1981) protein, which is a key mediator of DNA damage checkpoint activation. This study established the LOC401312–CPS1–ATM axis as a previously unrecognized regulatory network governing radiation sensitivity, highlighting the potential of lncRNA-directed metabolic rewiring to impair DNA repair fidelity. Our findings not only expand the functional landscape of lncRNAs in DNA damage response but also provide a therapeutic rationale for targeting the LOC401312–CPS1 axis to improve radiotherapy efficacy in NSCLC.

Background Self-management plays an important role in the disease management of glaucoma patients. The effectiveness of the program can be improved by assessing the patient’s perspective and needs to tailor self-management support. Most studies have focused on assessing one of these self-management behaviours, such as medication adherence, and there is a lack of systematic assessment of the support needs and challenges of self-management for patients with glaucoma. Therefore, in this study, we conducted an in-depth investigation into the self-management challenges and support needs of patients with primary glaucoma, providing a basis for nursing staff to implement self-management support. Method The phenomenological method and semistructured interviews were used in this study. A total of 20 patients with primary glaucoma were recruited between June and December 2022. Colaizzi’s analysis method was used to analyse the interview data. Results Challenges for patients include becoming an expert in glaucoma, managing negative emotions, adapting to daily life changes and resuming social activities. To address these challenges, four themes of patient self-management support needs were identified: (1) health information support, (2) social support, (3) psychological support, and (4) daily living support. Conclusion Patients with primary glaucoma experience varying degrees of challenge in dealing with medical, emotional, and social aspects. Comprehending the support needs of patients, healthcare professionals should deliver targeted, personalized and comprehensive self-management interventions to enhance their capacity of patients to perform self-management and improve their quality of life.