Environmental Design Strategies to Decrease the Risk of Nosocomial Infection in Medical Buildings Using a Hybrid MCDM Model

Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach

The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.

An inhibitor of BRD4, GNE987, inhibits the growth of glioblastoma cells by targeting C-Myc and S100A16

PURPOSE

Among children, glioblastomas (GBMs) are a relatively common type of brain tumor. BRD4 expression was elevated in GBM and negatively correlated with the prognosis of glioma. We investigated the anti-GBM effects of a novel BRD4 inhibitor GNE987.

METHODS

We evaluated the anti-tumor effect of GNE987 in vitro and in vivo by Western blot, CCK8, flow cytometry detection, clone formation, the size of xenografts, and Ki67 immunohistochemical staining, and combined ChIP-seq with RNA-seq techniques to find its anti-tumor mechanism.

RESULTS

In vitro experiments showed that GNE987 significantly degraded BRD4, inhibited the proliferation of GBM cells, blocked the cell cycle, and induced apoptosis. Similarly, in vivo experiments, GNE987 also inhibited GBM growth as seen from the size of xenografts and Ki67 immunohistochemical staining. Based on Western blotting, GNE987 can significantly reduce the protein level of C-Myc; meanwhile, we combined ChIP-seq with RNA-seq techniques to confirm that GNE987 downregulated the transcription of S100A16 by disturbing H3K27Ac. Furthermore, we validated that S100A16 is indispensable in GBM growth.

CONCLUSION

GNE987 may be effective against GBM that targets C-Myc expression and influences S100A16 transcription through downregulation of BRD4.

A Hybrid Multiple-Attribute Decision-Making Model for Evaluating the Esthetic Expression of Environmental Design Schemes

A built environment with high-quality esthetic expression can positively contribute to key agendas of urban development. Environmental design is the design of physical environments that mainly respond to people’s behavioral needs and sensory preferences based on environment–behavior relations. Practitioners in this industry often work on esthetic quality improvement. Although previous studies have provided valuable knowledge about important elements of built environment esthetic expression, limited research efforts have been devoted to building a systematic framework that comprises key evaluation elements with high local adaptability and the influence relationships among them. The standards and preferences of esthetic expression in environmental design scheme evaluation are context-based. Providing an effective way to clarify evaluation elements with high local adaptability and the relationships among them may help reduce ambiguity, enhance consensus, and increase efficiency in the decision-making process. Therefore, this study adopted the esthetic expression evaluation of environmental design in China as an example and produced a hybrid decision analysis model by integrating the fuzzy Delphi method (FDM), exploratory factor analysis (EFA), analytic hierarchy process (AHP), and decision-making trial and evaluation laboratory (DEMATEL) method to evaluate the esthetic expression of environmental design schemes. A hierarchical evaluation framework composed of 5 dimensions and 18 evaluation elements was constructed in this study. The key design elements under each dimension and the influence relationships among them were also identified. This paper offers insights into the theoretical investigation and practical development of a systematic evaluation of the esthetic expression of environmental design schemes.