[Improving the Surveillance Alarm Response Rate Among Nurses in the Internal Medicine Intensive Care Unit].

BACKGROUND & PROBLEMS: According to the Emergency Care Research Institute, "not responding to alarms" is a top-ten health-technology hazard that ranked first between 2008 and 2014. The failure of clinical nurses to respond to alarms in time due to lack of awareness, fatigue, or other cause represents a great threat to patient safety. Between August 2014 and August 2015, two patients in this unit died because the red alert on the physiological alarm surveillance system was not answered and dealt with promptly. PURPOSE: To raise the 10-second response rate to red alerts from 22% to 100% in order to enhance inpatient safety. METHODS: Establish standard operating procedures for alarms and for the handling of physiologic monitor devices when alarms sound; form a gatekeeper system; and arrange on-the-job training. RESULTS: The 10-second response rate to red alerts increased from 22% to 100% between November 2016 and November 2017. CONCLUSIONS: By following standard operating procedures, personnel now have a guide to respond to and handle red alerts comprehensively. Implementing the gatekeeper system also increased the team spirit of the unit and helped personnel appreciate the importance of cooperation in handling alarms. In addition, the functions of the physiologic monitor devices and the 10-second response rate for red alerts will be included in the annual quality control checklist of the unit for follow up, review, and further improvement.

Miniaturized LED primary optics design used for short-distance color mixing.

Color-tunable LED light fixtures generally change colors by controlling LEDs of multiple colors. This type of light source requires additional secondary optics and light-mixing distances to deliver color-mixing functions and perform high color uniformity. However, the color-mixing elements increase the optics size, resulting in more difficulties in making tiny lighting fixtures. Therefore, in this study, we introduce a LED primary optics design method that retains standard LED package size while featuring a color-mixing chamber. This method combines a lens having a rotational symmetry with a freeform profile and a zigzag structure by using double total internal reflection to disperse light uniformly. In contrast to a typical hemispherical lens, our design effectively lowers the weighted average color difference from 0.03 to 0.0035, and maintains optical efficiency of at least 90% without using any optical diffuser.

Ovarian cancer stem-like cells show induced translineage-differentiation capacity and are suppressed by alkaline phosphatase inhibitor.

Spheroid formation is one property of stem cells-such as embryo-derived or neural stem cells-that has been used for the enrichment of cancer stem-like cells (CSLCs). However, it is unclear whether CSLC-derived spheroids are heterogeneous or whether they share common embryonic stemness properties. Understanding these features might lead to novel therapeutic approaches. Ovarian carcinoma is a deadly disease of women. We identified two types of spheroids (SR1 and SR2) from ovarian cancer cell lines and patients' specimens according to their morphology. Both types expressed stemness markers and could self-renew and initiate tumors when a low number of cells were used. Only SR1 could differentiate into multiple-lineage cell types under specific induction conditions. SR1 spheroids could differentiate to SR2 spheroids through epithelial-mesenchymal transition. Alkaline phosphatase (ALP) was highly expressed in SR1 spheroids, decreased in SR2 spheroids, and was absent in differentiated progenies in accordance with the loss of stemness properties. We verified that ALP can be a marker for ovarian CSLCs, and patients with greater ALP expression is related to advanced clinical stages and have a higher risk of recurrence and lower survival rate. The ALP inhibitor, levamisole, disrupted the self-renewal of ovarian CSLCs in vitro and tumor growth in vivo. In summary, this research provides a plastic ovarian cancer stem cell model and a new understanding of the cross-link between stem cells and cancers.This results show that ovarian CSLCs can be suppressed by levamisole. Our findings demonstrated that some ovarian CSLCs may restore ALP activity, and this suggests that inhibition of ALP activity may present a new opportunity for treatment of ovarian cancer.

Selection of immunodominant fragments from envelope gene for vaccine against Japanese encephalitis virus in DNA priming-protein boosting protocols.

Fragmentation of E gene of JEV into smaller fragments, none of the fragments either in plasmids form or in recombinant protein form can induce optimal protection against the virus infection. It is only when DNA priming-protein boosting strategies are used then the N-terminal E(A) and the C-terminal E(B) showed full protection against JEV as those induced by commercial vaccine, provided both fragments are preceded in the N-terminal by a signal peptide M(15) derived from C-terminal of prM gene in JEV genome. When the subfragments of E(A): E(A1) and E(A2) and E(B): E(B1) and E(B2) are tested, only E(A1) subfragment can replace E(A) in protein boosting to induce optimal protection against JEV, E(A2), E(B1), E(B2) in plasmid or protein forms are not. Therefore, along the E gene (978-2330 bp) N-terminal, E(A1) (978-1580 bp) and C-terminal E(B) (1851-2330 bp) are the most effective in inducing immunity against JEV but not the middle fragment E(A2) (1518-1877 bp) (see for orientation of E(A1), E(A2) and E(B) in E gene). Under the notion that molecular complexity determines the outcome of immune response of the host, E(B) being shorter, simpler in molecular structure and can be easily expressed in soluble form in E. coli (as opposed to insoluble E(A1)), E(B) probably will be the choice as a candidate vaccine to protect the host against JEV infection.