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BACKGROUND: Healthcare professionals (HCPs) on the front lines against COVID-19 may face increased workload, and stress. Understanding HCPs' risk for burnout is critical to supporting HCPs and maintaining the quality of healthcare during the pandemic. METHODS: To assess exposure, perceptions, workload, and possible burnout of HCPs during the COVID-19 pandemic we conducted a cross-sectional survey. The main outcomes and measures were HCPs' self-assessment of burnout and other experiences and attitudes associated with working during the COVID-19 pandemic. FINDINGS: A total of 2,707 HCPs from 60 countries participated in this study. Fifty-one percent of HCPs reported burnout. Burnout was associated with work impacting household activities (RR=1·57, 95% CI=1·39–1·78, P<0·001), feeling pushed beyond training (RR=1·32, 95% CI=1·20–1·47, P<0·001), exposure to COVID-19 patients (RR=1·18, 95% CI=1·05–1·32, P=0·005), making life prioritizing decisions (RR=1·16, 95% CI=1·02–1·31, P=0·03). Adequate personal protective equipment (PPE) was protective against burnout (RR=0·88, 95% CI=0·79–0·97, P=0·01). Burnout was higher in high-income countries (HICs) compared to low- and middle-income countries (LMICs) (RR=1·18; 95% CI=1·02–1·36, P=0·018). INTERPRETATION: Burnout is prevalent at higher than previously reported rates among HCPs working during the COVID-19 pandemic and is related to high workload, job stress, and time pressure, and limited organizational support. Current and future burnout among HCPs could be mitigated by actions from healthcare institutions and other governmental and non-governmental stakeholders aimed at potentially modifiable factors, including providing additional training, organizational support, support for family, PPE, and mental health resources. FUNDING: N/A

At present, the air environment in China is characterized by complex pollution. In this paper, the pollutant sources, transport paths and aerosol optical properties during the dust pollution was conducted to analyse based on ground-based lidar, space-borne sensor and atmospheric transmission model. Firstly, the NMMB/BSC-Dust model, the VIIRS-Suomi NPP date and HYSPLIT were carried out to analyse the dust transport paths and the dust particle size, and then the concentration of particles was analysed. Finally, the optical properties of aerosol particles in the dust weather were studied. During the formation of this weather, there is high dust in the Gobi and Taklamakan deserts. With the influence of wind direction, the dust moves from north to south, and the dust load significantly increased in southern China. Dust at the low altitude is generally transported from the Taklamakan Desert, while dust at the high altitude is generally transported from the Gobi Desert. The hourly average change of PM 10 is from 36 μg/m 3 to 818 μg/m 3 , while the hourly average change of PM 2.5 is from 15 μg/m 3 to 197 μg/m 3 . The dust was the main cause of the pollution weather. In this study, the formation process of the dust pollution revealed which can be used to provide guidance for government for the prevention work of dust pollution.

Zhao Huang,1,* Nan Ma,2,* Yan-Lu Xiong,1,* Lei Wang,1 Wei-Miao Li,1 Yuan-Yang Lai,1 Chen-Xi Zhang,1 Zhi-Pei Zhang,1 Xiao-Fei Li,1 Jin-Bo Zhao1 1Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China; 2Department of Ophthalmology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China*These authors contributed equally to this workCorrespondence: Jin-Bo Zhao; Xiao-Fei LiDepartment of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Baqiao, Xi'an, Shaanxi 710038, People's Republic of ChinaTel +86 29 8471 7367Fax +86 29 8471 7367Email zhaojinbo@aliyun.com; lxfchest@fmmu.edu.cnPurpose: High metastasis is a leading risk factor for the survival of non-small cell lung cancer (NSCLC) and epithelial-mesenchymal transition (EMT) is a vital step of metastasis. The expression of novel oncogene with kinase domain (NOK) has been observed in some human malignancies, including non-small cell lung cancer (NSCLC); however, the biological function of NOK in NSCLC remains unclear. In the study, we explored the function of NOK in NSCLC, with an aim to elucidate the relevant underlying mechanisms.Patients and methods: We investigate the expression of NOK, p-Akt, p-GSK-3β, E-cadherin and N-cadherin expression by immunohistochemical analysis using tissue microarrays of 72 paired NSCLC samples of cancerous and adjacent normal tissues. The associations between NOK expression and clinicopathological factors, overall survival, other proteins were assessed. Immunofluorescence analysis of NSCLC tissues was performed to study the location of NOK, Akt and GSK-3β. Up or down-regulated of NOK were conducted in two NSCLC cell lines to analyze its impact on AKT/GSK3β pathway.Results: Statistical analysis revealed NOK expression increased in NSCLC tissues compared with normal tissues (P<0.05). It also showed that low NOK expression were associated with a higher possibility of non-lymphatic metastasis, an early pN stage and clinical stage (P<0.05). Moreover, NOK expression was positively correlated with the expression of oncogene p-Akt (Thr308), p-GSK-3β (Ser9) and N-cadherin (P<0.05). Immunofluorescence analysis of NSCLC tissues revealed that NOK is co-located with Akt and GSK-3β. Further study in NSCLC cell lines revealed that NOK overexpression can activate the AKT/GSK3β pathway. Conversely, knockdown of NOK can suppress the AKT/GSK3β pathway.Conclusion: Our results suggest that NOK overexpression correlated significantly with lymphatic metastasis, advanced pN and clinical stage in NSCLC. And NOK may promote EMT by activating the AKT/GSK3β/N-cadherin pathway in NSCLC.Keywords: NOK/STYK1, epithelial-mesenchymal transition, Akt, GSK3β, N-cadherin, non-small cell lung cancer

At present, the air environment in China is characterized by complex pollution. In this paper, the pollutant sources, transport paths and aerosol optical properties during the dust pollution was conducted to analyse based on ground-based lidar, space-borne sensor and atmospheric transmission model. Firstly, the NMMB/BSC-Dust model, the VIIRS-Suomi NPP date and HYSPLIT were carried out to analyse the dust transport paths and the dust particle size, and then the concentration of particles was analysed. Finally, the optical properties of aerosol particles in the dust weather were studied. During the formation of this weather, there is high dust in the Gobi and Taklamakan deserts. With the influence of wind direction, the dust moves from north to south, and the dust load significantly increased in southern China. Dust at the low altitude is generally transported from the Taklamakan Desert, while dust at the high altitude is generally transported from the Gobi Desert. The hourly average change of PM10 is from 36 μg/m3 to 818 μg/m3, while the hourly average change of PM2.5 is from 15 μg/m3 to 197 μg/m3. The dust was the main cause of the pollution weather. In this study, the formation process of the dust pollution revealed which can be used to provide guidance for government for the prevention work of dust pollution.

PURPOSE: Ontario Health (Cancer Care Ontario), formerly known as CCO, is the provincial governmental agency in Ontario, Canada responsible for developing radiation therapy-specific capital investment strategies, updated every 5 years, to ensure equitable access and to gain the highest value from these investments in infrastructure. These plans are informed by the changing landscape of health care delivery, technologic advancements affecting radiation therapy care, patient desire for care closer to home, and expected increases in utilization of radiation therapy services. In this article, we describe the development, model, and final recommendations of CCO's fifth radiation therapy capital investment strategy. METHODS AND MATERIALS: A panel of multidisciplinary provincial experts, in combination with 2 patient and family advisors, developed planning principles to guide the development of a patient-centered strategy. Adaption of the previously used model for radiation therapy planning was used. RESULTS: The development of the capital investment strategy took place from fall 2017 to fall 2018. The model included 3 main factors: patient demand (including utilization targets), machine throughput, and machine demand and supply. The final recommendation is for an investment of 26 new radiation therapy machines in the province by 2028. CONCLUSIONS: The strategy plans for continued province-wide access to quality radiation therapy care and ensures machines are added to the system at the right place and in the right time. Ongoing data collection throughout this period is necessary to ensure the strategy achieves its goals and to allow for planning of future strategies.

Yanhai Xi,*,1 Tingwang Jiang,*,2 Yinglan Yu,3 Jiangmin Yu,1 Mintao Xue,1 Ning Xu,1 Jiankun Wen,1 Weiheng Wang,1 Hailong He,1 Yan Shen,3 Daquan Chen,4 Xiaojian Ye,1 Thomas J Webster51Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; 2Department of Immunology and Microbiology, Institution of Laboratory Medicine of Changshu, Changshu 215500, Jiangsu, People's Republic of China; 3Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, China Pharmaceutical University, Nanjing, People's Republic of China; 4Department of Pharmaceutics, School of Pharmacy, Yantai University, Yantai 264005, People's Republic of China; 5Department of Chemical Engineering, Northeastern University, Boston, MA, USA*These authors contributed equally to this workIntroduction: Curcumin (CUR) is a general ingredient of traditional Chinese medicine, which has potential antitumor effects. However, its use clinically has been limited due to its low aqueous solubility and bioavailability. In order to improve the therapeutic effect of CUR on osteosarcoma (i.e., bone cancer), a multifunctional micelle was developed here by combining active bone accumulating ability with tumor CD44 targeting capacity.Methods: The CUR loaded micelles were self-assembled by using alendronate-hyaluronic acid-octadecanoic acid (ALN-HA-C18) as an amphiphilic material. The obtained micelles were characterized for size and drug loading. In addition, the in vitro release behavior of CUR was investigated under PBS (pH 5.7) medium containing 1% Tween 80 at 37â"ƒ. Furthermore, an hydroxyapatite (the major inorganic component of bone) affinity experiment was studied. In vitro antitumor activity was evaluated. Finally, the anti-tumor efficiency was studied.Results: The size and drug loading of the CUR loaded ALN-HA-C18 micelles were about 118 ± 3.6 nm and 6 ± 1.2%, respectively. CUR was released from the ALN-HA-C18 micelles in a sustained manner after 12 h. The hydroxyapatite affinity experiment indicated that CUR loaded ALN-HA-C18 micelles exhibited a high affinity to bone. CUR loaded ALN-HA-C18 micelles exhibited much higher cytotoxic activity against MG-63 cells compared to free CUR. Finally, CUR loaded ALN-HA-C18 micelles effectively delayed anti-tumor growth properties in osteosarcoma bearing mice as compared with free CUR.Conclusion: The present study suggested that ALN-HA-C18 is a novel promising micelle for osteosarcoma targeting and delivery of the hydrophobic anticancer drug CUR.Keywords: curcumin, alendronate, hyaluronic acid, osteosarcoma

Ye Wang,1,* Qi-Wei Yang,1,2,* Qing Yang,2,* Tie Zhou,1 Min-Feng Shi,1,3 Chen-Xia Sun,4 Xiu-Xia Gao,4 Yan-Qiong Cheng,1 Xin-Gang Cui,2 Ying-Hao Sun1 1Department of Urology, Changhai Hospital, 2Department of Urology, The Third Affiliated Hospital, 3Reproductive Center, Changhai Hospital, Second Military Medical University, Shanghai, 4The Reproductive Center, Institute for Nutritional Sciences, Shanghai Institute for Biological Science, Chinese Academy of Science, Shanghai, People's Republic of China *These authors contributed equally to this work Abstract: Disordered copper metabolism plays a critical role in the development of various cancers. As a nanomedicine containing copper, cuprous oxide nanoparticles (CONPs) exert ideal antitumor pharmacological effects in vitro and in vivo. Prostate cancer is a frequently diagnosed male malignancy prone to relapse, and castration resistance is the main reason for endocrine therapy failure. However, whether CONPs have the potential to treat castration-resistant prostate cancer is still unknown. Here, using the castration-resistant PC-3 human prostate cancer cell line as a model, we report that CONPs can selectively induce apoptosis and inhibit the proliferation of cancer cells in vitro and in vivo without affecting normal prostate epithelial cells. CONPs can also attenuate the stemness of cancer cells and inhibit the Wnt signaling pathway, both of which highlight the great potential of CONPs as a new clinical castration-resistant prostate cancer therapy. Keywords: cuprous oxide nanoparticle, prostate cancer, CRPC, nanomedicine, Wnt signaling pathway