Impact of coronavirus disease 2019 (COVID-19) on antimicrobial resistance among major pathogens causing healthcare-associated infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused great impact on healthcare systems, including antibiotic usage and multi-drug resistant (MDR) bacterial infections at hospitals. We aim to investigate the trends of antimicrobial resistance among the major pathogens causing healthcare-associated infection (HAI) at intensive care units (ICU). MATERIAL AND METHODS: The demographic characteristics of hospitalization, usage of antimicrobial agents, counted by half-an-year DID (defined daily dose per 1000 patient-days), and HAI density of five major MDR bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Klebsiella pneumoniae (CRKP), and carbapenem-resistant Pseudomonas aeruginosa (CRPA), of ICU patients at a medical center in Taiwan during January 2017 to December 2021 were collected and analyzed. RESULTS: The total antibiotic usage, counted by DID, had a significant increasing trend, before COVID-19 occurrence in 2017-2019, but no further increase during the pandemic period in 2020-2021. However, comparing the two time periods, antibiotics consumption was significantly increased during pandemic period. There was no significant change of HAI density in MRSA, VRE, CRAB, CRKP, and CRPA, comparing the pandemic to the pre-pandemic period. Although, CRKP and CRPA infection rates were increasing during the pre-pandemic period, there was no further increase of CRKP and CRPA HAI rates during the pandemic period. CONCLUSION: During COVID-19 pandemic, there was no significant increase in HAI density of five major MDR bacteria at ICU in Taiwan, despite increased antibiotic usage. Strict infection prevention measures for COVID-19 precautions and sustained antimicrobial stewardship probably bring these effects.

Monitoring the performance of a dedicated weaning unit using risk-adjusted control charts for the weaning rate in prolonged mechanical ventilation.

BACKGROUND: Weaning rate is an important quality indicator of care for patients with prolonged mechanical ventilation (PMV). However, diverse clinical characteristics often affect the measured rate. A risk-adjusted control chart may be beneficial for assessing the quality of care. METHODS: We analyzed patients with PMV who were discharged between 2018 and 2020 from a dedicated weaning unit at a medical center. We generated a formula to estimate monthly weaning rates using multivariate logistic regression for the clinical, laboratory, and physiologic characteristics upon weaning unit admission in the first two years (Phase I). We then applied both multiplicative and additive models for adjusted p-charts, displayed in both non-segmented and segmented formats, to assess whether special cause variation existed. RESULTS: A total of 737 patients were analyzed, including 503 in Phase I and 234 in Phase II, with average weaning rates of 59.4% and 60.3%, respectively. The p-chart of crude weaning rates did not show special cause variation. Ten variables from the regression analysis were selected for the formula to predict individual weaning probability and generate estimated weaning rates in Phases I and II. For risk-adjusted p-charts, both multiplicative and additive models showed similar findings and no special cause variation. CONCLUSION: Risk-adjusted control charts generated using a combination of multivariate logistic regression and control chart-adjustment models may provide a feasible method to assess the quality of care in the setting of PMV with standard care protocols.

Automatic tube compensation for liberation from prolonged mechanical ventilation in tracheostomized patients: A retrospective analysis.

BACKGROUND: To analyze the predictability of an automatic tube compensation (ATC) screening test compared with the conventional direct liberation test performed before continuous oxygen support for MV liberation. METHODS: This retrospective study analyzed tracheostomized patients with prolonged MV in a weaning unit of a medical center in Taiwan. In March 2020, a four-day ATC test to screen patient eligibility for ventilator liberation was implemented, intended to replace the direct liberation test. We compared the predictive accuracy of these two screening methods on the relevant outcomes in the two years before and one year after the implementation of this policy. RESULTS: Of the 403 cases, 246 (61%) and 157 (39%) received direct liberation and ATC screening tests, respectively. These two groups had similar outcomes: successful weaning upon leaving the Respiratory Care Center (RCC), success on day 100 of MV, success at hospital discharge, and in-hospital survival. Receiver operating characteristic curve analysis showed that the ATC screening test had better predictive ability than the direct liberation test for RCC weaning, discharge weaning, 100-day weaning, and in-hospital survival. CONCLUSION: This closed-circuit ATC screening test before ventilator liberation is a feasible and valuable method for screening PMV patients undergoing ventilator liberation in the pandemic era. Its predictability for a comparison with the open-circuit oxygen test requires further investigation.

Retrospective study of oral and maxillofacial lesions in older Taiwanese patients.

OBJECTIVE: The aim was to provide information regarding oral and maxillofacial (OMF) lesions in an older Taiwanese population. BACKGROUND: The rate of increase of older people in Taiwan is expected to be rapid. OMF lesions are very frequent in the older population, but no studies have been performed on these lesions in Taiwan. MATERIALS AND METHODS: OMF cases (between 2000 and 2011) in geriatric patients (≥60 years of age) with records of age, sex and histological diagnoses were retrieved from the Oral Pathology Department of our institution. These lesions were classified into four main categories: tumour/tumour-like reactive lesions, cystic/pseudocystic lesions, inflammatory/infective lesions and other miscellaneous lesions. RESULTS: Six thousand seven hundred and twenty-six lesions were collected from a total of 39 503 OMF lesions in older Taiwanese patients in this study. Most of these lesions were distributed in the inflammatory/infective group, followed by tumour/tumour-like reactive lesions. Squamous cell carcinoma was the most common lesion, and, additionally, there was a high frequency of oral potentially malignant disorders. CONCLUSIONS: The present study showed trends similar to previous reports from other countries. However, some detailed information was different, perhaps due to the different criteria and different geographic distribution. Worthy of note, our results indicated that screening for oral potentially malignant disorder and oral malignancy in the older population is essential.

[Anti-atherosclerosis role of N-oleoylethanolamine in CB2].

To observe a PPAR-alpha agonist effect of N-oleoylethanolamine (OEA) on CB2 (cannabinoid receptor 2), an anti-inflammatory receptor in vascular endothelial cell, healthy HUVECs and TNF-alpha induced HUVECs were used to establish a human vascular endothelial cell inflammatory model. Different doses of OEA (10, 50 and 100 micromol x L(-1)) had been given to HUVECs, cultured at 37 degrees C for 7 h and then collected the total protein and total mRNA. CB2 protein expression was detected by Western blotting and CB2 mRNA expression was assayed by real-time PCR. As the results shown, OEA (10 and 50 micromol x L(-1)) could induce the CB2 protein and mRNA expression, but not 100 micromol x L(-1). To detect if anti-inflammation effect of OEA is partly through CB2, CB2 inhibitor AM630 was used to inhibit HUVEC CB2 expression, then the VCAM-1 expression induced by TNF-alpha was detected, or THP-1 adhere to TNF-alpha induced HUVECs was examined. OEA (50 micromol x L(-1)) could inhibit TNF-alpha induced VCAM-1 expression and THP-1 adhere to HUVECs, these effects could be partly inhibited by a CB2 inhibitor AM630. The anti-inflammation effect of OEA is induced by PPAR-alpha and CB2, suggesting that CB2 signaling could be a target for anti-atherosclerosis, OEA have wide effect in anti-inflammation, it may have better therapeutic potential in anti-inflammation in HUVECs, thus achieving anti-atherosclerosis effect.

Overexpression of Smad proteins, especially Smad7, in oral epithelial dysplasias.

OBJECTIVE: Transforming growth factor ß, via membrane-bound receptors and downstream Smad2-4, 7, can modulate tumorigenesis. Smad2 and Smad3 heterodimerize with Smad4, and the complex migrates to the nucleus to regulate the expression of target genes. Smad7 is a key negative regulator of this signaling pathway. This study aimed to examine Smad2-4, 7 expression and phosphorylated Smad2-3 (p-Smad2-3) in oral epithelial dysplasia and compared it with normal oral mucosa, hyperkeratosis/epithelial hyperplasia and squamous cell carcinoma (SCC). MATERIALS AND METHODS: Immunohistochemical staining of Smad2-4, 7 and p-Smad2-3, was performed for 75 samples of human oral mucosa, including hyperkeratosis/epithelial hyperplasia (n = 20), mild epithelial dysplasia (n = 11), moderate to severe epithelial dysplasia (n = 11), and SCC (n = 43). Normal buccal mucosa samples (n = 9) were also included. RESULTS: A significant increase in Smad7 expression was observed in the ascending order of samples of normal oral mucosa, hyperkeratosis/epithelial hyperplasia/mild oral epithelial dysplasia, moderate to severe oral epithelial dysplasia, and well-differentiated oral SCC/moderately to poorly differentiated oral SCC. Additionally, significant increases in Smad7 expression were noted as compared with expression of Smad2-4 and p-Smad2-3 in lesions of hyperkeratosis/epithelial hyperplasia, mild oral epithelial dysplasia, moderate to severe oral epithelial dysplasia, well-differentiated oral SCC, and moderately to poorly differentiated oral SCC. CONCLUSIONS: Our results indicate that Smad proteins, particularly Smad7, in oral epithelial dysplasia and SCC could contribute to the attenuation of Smads anti-proliferative signaling in cancer development. CLINICAL RELEVANCE: Smad7 could be a marker for risk of malignant transformation of oral epithelial dysplasia.

A retrospective comparison of the location and diameter of the inferior alveolar canal at the mental foramen and length of the anterior loop between American and Taiwanese cohorts using CBCT.

PURPOSE: The aim was to retrospectively compare the measurements of the location and size of the inferior alveolar canal at the mental foramen and the length of the anterior loop between two cohorts of Americans and Taiwanese using cone-beam computed tomography (CBCT). METHODS: CBCT was performed with an I-CAT(®) Cone-Beam 3D Dental Imaging System and reconstructed into multiple-plane views to measure two populations. RESULTS: There was no statistically significant difference (P = 0.2681) in the distance from the mental foramen to the inferior border of the mandible (mandibular border height) between Americans (9.84 ± 2.01 mm) and Taiwanese (10.13 ± 1.66 mm). No significant difference was found (p = 0.1161) in the inferior alveolar canal diameter between these two cohorts (2.26 ± 0.67 and 2.13 ± 0.47 mm, respectively). However, the anterior loop length of Taiwanese (7.61 ± 1.81 mm) was significantly longer than that of Americans (6.22 ± 1.68 mm) (P < 0.0001). CONCLUSION: Our study indicated that (1) the location of mental foramen of Americans was closer to the inferior border of the mandible than Taiwanese; (2) the diameter of the inferior alveolar canal of Americans was larger than Taiwanese; (3) the anterior loop of Taiwanese was longer than Americans. These differences may be, at least partly, due to the racial influence and this information may possess potential valuable clinical relevance.

[The hypolipidemic and liver protective effect of (Z)-N-(2-hydroxyethyl) docos-13-enamide on hyperlipidemic golden hamsters].

This study is to observe preventive effect of (Z)-N-(2-hydroxyethyl) docos-13-enamide on hyperlipidemia and fatty liver of golden hamsters. Hyperlipidemic golden hamsters fed with high-fat diet was administered orally with (Z)-N-(2-hydroxyethyl) docos-13-enamide (10, 20 and 40 mg x kg(-1)) for 5 weeks. Levels of serum and hepatic lipid content, liver histology, hepatic MDA and SOD levels, serum ALT and AST levels were evaluated in golden hamsters. (Z)-N-(2-Hydroxyethyl) docos-13-enamide has a hypolipidemic effect, and could reduce hepatic lipid content, serum ALT and AST levels, hepatic MDA level, increase hepatic SOD activity. (Z)-N-(2-Hydroxyethyl) docos-13-enamide plays an important role in reducing serum lipid, restraining hepatic fatty deposition and protecting liver to get rid of peroxidation injury of hyperlipidemic golden hamsters. The exact lipid-lowering mechanism of (Z)-N-(2-hydroxyethyl) docos-13-enamide needs further investigation.

Human dental pulp stem cells derived from different cryopreservation methods of human dental pulp tissues of diseased teeth.

BACKGROUND: Successful isolation of human dental pulp stem cells (hDPSCs) has been documented at least 120h after tooth extraction. Viable hDPSCs have been isolated chiefly from cryopreserved healthy molar teeth and their undigested dental pulp tissue. Isolation of hDPSCs from diseased but vital teeth after cryopreservation has not been reported. This study aimed to isolate hDPSCs from cryopreserved diseased but vital teeth of various tooth types. MATERIALS: Fifty tooth samples were divided into group A (n = 20) - freshly derived dental pulp tissues, group B (n = 20) - liquid nitrogen (liq N(2) )-stored dental pulp tissues and group C (n = 10) - liq N(2) -stored intact teeth. METHODS AND RESULTS: The success rate for hDPSCs isolation was 100% for groups A and B and only 20% for group C. hDPSCs from all groups demonstrated self-renewal properties and similar multipotent potential characteristics of adipogenic, chondrogenic and osteogenic differentiation. In addition, hDPSCs showed high expression of bone-marrow mesenchymal stem-cell markers (CD29, CD90 and CD105) and very low expression of specific hematopoietic cells markers (CD14, CD34 and CD45). CONCLUSION: Our results indicate that hDPSCs isolated from diseased but vital teeth of various tooth types can be stored in liq N(2) for future usage.

Small nucleolar RNA is potential as a novel player in leukemogenesis and clinical application.

Lack of clarity of the mechanisms that underlie leukemogenesis obstructs the diagnosis, prognosis, and treatment of leukemia. Research has found that small nuclear RNA (snoRNA) plays an essential role in leukemia. These small non-coding RNAs are involved in ribosome biogenesis, including the 2'-O-methylation and pseudouridylation of precursor ribosomal RNA (pre-rRNA), and pre-rRNA splicing. Recently, many snoRNAs were found to be orphans that have no predictable RNA modification targets, but these RNAs have always been found to be located in different subcellular organelles, and they play diverse roles. Using high-throughput technology, snoRNA expression profiles have been revealed in leukemia, and some of the deregulated snoRNAs may regulate the cell cycle, differentiation, proliferation, and apoptosis in leukemic cells and confer drug resistance during leukemia treatment. In this review, we discuss the expression profiles and functions of snoRNAs, particularly orphan snoRNAs, in leukemia. It is possible that the dysregulated snoRNAs are promising diagnosis and prognosis markers for leukemia, which may serve as potential therapeutic targets in leukemia treatment.

Update and review of the gerodontology prospective for 2020's: Linking the interactions of oral (hypo)-functions to health vs. systemic diseases.

New lines of evidence suggest that the oral-systemic medical links and oral hypo-function are progressively transcending beyond the traditional clinical signs and symptoms of oral diseases. Research into the dysbiotic microbiome, host immune/inflammatory regulations and patho-physiologic changes and subsequent adaptations through the oral-systemic measures under ageism points to pathways leading to mastication deficiency, dysphagia, signature brain activities for (neuro)-cognition circuitries, dementia and certain cancers of the digestive system as well. Therefore, the coming era of oral health-linked systemic disorders will likely reshape the future of diagnostics in oral geriatrics, treatment modalities and professional therapies in clinical disciplines. In parallel to these highlights, a recent international symposium was jointly held by the International Association of Gerontology and Geriatrics (IAGG), Japanese Society of Gerodontology (JSG), the representative of USA and Taiwan Academy of Geriatric Dentistry (TAGD) on Oct 25th, 2019. Herein, specific notes are briefly addressed and updated for a summative prospective from this symposium and the recent literature.

Differentiation of human umbilical cord Wharton's jelly-derived mesenchymal stem cells into germ-like cells in vitro.

Recent studies have demonstrated that mesenchymal stem cells could differentiate into germ cells under appropriate conditions. We sought to determine whether human umbilical cord Wharton's jelly-derived mesenchymal stem cells (HUMSCs) could form germ cells in vitro. HUMSCs were induced to differentiate into germ cells in all-trans retinoic acid, testosterone and testicular-cell-conditioned medium prepared from newborn male mouse testes. HUMSCs formed "tadpole-like" cells after induction with different reagents and showed both mRNA and protein expression of germ-cell-specific markers Oct4 (POUF5), Ckit, CD49(f) (alpha6), Stella (DDPA3), and Vasa (DDX4). Our results may provide a new route for reproductive therapy involving HUMSCs and a novel in vitro model to investigate the molecular mechanisms that regulate the development of the mammalian germ lineage.

Preceptors' Subjective Competency Ratings in Acute Care Hospitals in Taiwan.

BACKGROUND: This study focused on developing a Subjective Competency Scale (SCS) in acute care hospitals and identified factors that affect preceptors' competency to precept new graduate nurses (NGNs). METHOD: This study was conducted in two stages that included collecting information on preceptor training courses and conducting a cross-sectional questionnaire survey. A total of 350 preceptors completed the survey in 2011. The validity and reliability of the SCS were determined. RESULTS: An SCS was developed using 22 items and five factors: teaching/assessment skills, interpersonal/communication skills, confidence/self-assurance, problem-solving/stress-coping skills, and self-reflection. These explained 69.73% of the variance. Cronbach's alpha for these five factors of scale ranged from .715 to .889. Preceptors' subjective competency was correlated positively with age, years as a nurse, years as a preceptor, willingness to be a preceptor, and self-rated relationship with NGNs (p < .001). CONCLUSION: The SCS exhibited high validity and reliability; therefore, it can be used for future preceptors' subjective competency assessment and evaluation. [J Contin Educ Nurs. 2019;50(2):69-78.].

Expression of inhibitors of apoptosis family protein in 7,12-dimethylbenz[a]anthracene-induced hamster buccal-pouch squamous-cell carcinogenesis is associated with mutant p53 accumulation and epigenetic changes.

Fifty outbred Syrian golden hamsters were equally divided into three experimental groups and two control groups. The pouches of the experimental groups were painted bilaterally with a 0.5% 7,12-dimethylbenz[a]anthracene (DMBA) solution thrice a week for 3, 7 and 14 weeks. One of the control groups was applied with mineral oil while another control group remained untreated throughout the experiment. Neither survivin nor cIAP2 could be detected in any of the control tissues, whereas survivin and cIAP2 were found to be significantly increased in 3-, 7- and 14-week DMBA-treated pouches compared with the control pouches. Expression of XIAP, cIAP1 and NAIP were noted for both the control and 3-, 7- and 14-week DMBA-treated pouches, but levels were found to be significantly elevated in the experimental groups compared with the control pouches. p53 was not detected in any control tissues, but was significantly increased in 3-, 7- and 14-week DMBA-treated pouches. Direct sequencing revealed a point mutation (C-->G) of p53 for pouch tissues treated with DMBA for 3 and 7 weeks, and there was a wide variation in the p53 sequence of the 14-week DMBA-treated pouch tissues, as compared with the control tissues. The control tissues had a survivin- and cIAP2-methylated allele, whereas the DMBA-treated tissues showed no evidence of survivin- and cIAP2-methylation. Neither the control nor DMBA-treated pouches showed evidence of XIAP-, cIAP1- or NAIP-methylation. Our results suggest that the expression of inhibitors of apoptosis family in DMBA-induced hamster buccal-pouch squamous-cell carcinogenesis may be modulated by both genetic (mutant p53) and epigenetic mechanisms.

Expression of survivin and XIAP for DMBA-induced hamster buccal pouch squamous cell carcinogenesis is associated with p53 accumulation.

Apoptosis (programmed cell death) is regulated by a number of inhibitory or stimulatory factors. One such family of antiapoptotic proteins is the inhibitors of apoptosis proteins (IAPs), of which survivin and X chromosome-linked IAP (XIAP) are members. The expression of survivin and XIAP, as well as their association with p53, in chemically-induced experimental oral carcinogenesis is not completely understood. The objective of the present study was, therefore, to investigate the protein expression of these two IAP family members and their relationship with p53 status, in 7,12-dimethylbenz[a]anthracene (DMBA)-induced hamster buccal pouch squamous cell carcinogenesis. Immunohistochemical analysis of survivin, XIAP and p53 protein expression was performed in DMBA-induced pouch squamous cell carcinogenesis. Fifty outbred, young (6 weeks), male Syrian golden hamsters (Mesocricatus auratus) were randomly divided into three experimental groups (each group consisting of 10 animals treated with DMBA for 3-, 7- or 14-weeks), and two control groups (with 10 animals in each). The pouches of the three experimental groups were painted bilaterally with a 0.5% DMBA solution three times a week. The treatment protocol for animals in one of the control groups was identical with only mineral oil applied, while the other control group remained untreated throughout the experiment. Survivin staining could not be detected by immunohistochemistry in any of the untreated or mineral oil treated hamster pouch-tissue specimens. Cytoplasmic staining of survivin proteins was apparent in the entire epithelial layer (excluding the keratinized layer) in all 3-week DMBA treated pouch-tissue analyzed. In addition, cytoplasmic survivin staining was observed in all specimens of 7- and 14-week DMBA treated pouch-tissue. XIAP positivity was confined to the outermost keratinized layer of the pouch-tissue from control animals and those treated with DMBA for 3-weeks. However, XIAP staining was detected in the whole epithelial layer (except the basal layer) in 7- and 14-week DMBA treated pouch-tissue. p53 was not detected in any untreated and mineral oil treated pouch-tissue, whereas nuclear p53 staining was observed for all 3-, 7- and 14-week DMBA treated pouch-tissue. The results of this study demonstrate the association between survivin/XIAP and p53 expression in this experimental model system for oral carcinogenesis, although their exact interactions remain to be clarified. Moreover, our findings suggest that the DMBA-induced hamster buccal pouch mucosa may serve as an appropriate experimental model for investigation of potential novel therapeutic tools for oral squamous-cell carcinomas.

Oral care experiences with 181 nasopharyngeal carcinoma patients receiving radiotherapy in a Taiwanese hospital.

OBJECTIVE: The aim of this study is to present our experiences of the oral care of a cohort of nasopharyngeal carcinoma (NPC) patients before receiving radiation therapy in our institution. PATIENTS AND METHODS: A total of 181 (141 males and 40 females) pre-radiation therapy NPC patients who underwent regular recall dental examination and treatment according to a standard protocol of our Dental Department were collected. RESULTS: One hundred and twelve (68.71%) did not have disease recurrence and only 12 patients (7.36%) had metastasis. The rate of expire was 14.92%. The average number of carious tooth was 2.45 (range: 0-16) whereas the mean number extracted tooth was 2.65 (range: 0-14). One hundred and sixty-four patients were recorded to have suffered from oral mucositis. About 7% patients had oral mucositis in the 1st week, but about 50% of patients developed oral mucositis from the 2nd week to the 3rd week after the beginning of radiotherapy. One hundred and thirty-three patients had records of oral infection. About 67% of the patients suffered from candidiasis during radiotherapy. Xerostomia was found in almost 80% of patients during radiation therapy. The mean number of carious tooth of the patient population during/after radiation therapy was significantly higher than the patient population before radiation therapy (7.18+/-7.10 vs. 2.45+/-2.85; chi2=46.32, p<0.0001). Eighty-four patients were regularly followed-up and the rate of lost follow-up was about 53.6%. One hundred and eighteen patients had custom-made fluoride trays fabricated. As comparing patients with fluoride trays to those without, the former had a significantly higher rate of dental follow-up compliance (chi2=48.56, p<0.0001). CONCLUSIONS: The data and protocol presented in this study would enhance the care and life quality of the NPC patients. Our study showed that a pre-radiotherapy dental care regimen should be conducted simultaneously with the patient's treatment plan to treat the disease. Fluoride tray fabrication is recommended for dentate NPC patients receiving radiation therapy, as it may enhance compliance with dental follow-up.

An aiming device for an extraoral radiographic technique.

To assist certain patient populations who are unable to tolerate intraoral films and/or sensors during endodontic therapy, an alternative technique (extraoral film placement) has been innovated by Newman and Friedman (2003). In this study, we devise and test a film/sensor-beam alignment aiming device for taking a periapical radiograph using this extraoral radiographic technique. An instrument is assembled from the following components: (1) two locator rings for bite-wing radiography, (2) two metal supporting indicator rods for bite-wing radiography, (3) a bite block for horizontal bite-wing radiography, and (4) a rubber tube of about 2 cm in length. Using our newly-devised aiming device to take periapical radiographs using the extraoral technique, appropriate images of the left upper and right lower molar areas for a series of 12 adult volunteers were successfully obtained. Angulation of the x-ray cone, with reference to the horizontal plane, was -20 degrees to -30 degrees and -10 degrees to -15 degrees for the upper and lower teeth, respectively. This study therefore shows that appropriate images can be easily obtained using this aiming device.

Mobile computing acceptance factors in the healthcare industry: a structural equation model.

OBJECTIVE: This paper presents a revised technology acceptance model to examine what determines mobile healthcare systems (MHS) acceptance by healthcare professionals. METHOD: Conformation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique was used to evaluate the causal model. RESULTS: The results indicated that compatibility, perceived usefulness and perceived ease of use significantly affected healthcare professional behavioral intent. MHS self-efficacy had strong indirect impact on healthcare professional behavioral intent through the mediators of perceived usefulness and perceived ease of use. Yet, the hypotheses for technical support and training effects on the perceived usefulness and perceived ease of use were not supported. CONCLUSION: This paper provides initial insights into factors that are likely to be significant antecedents of planning and implementing mobile healthcare to enhance professionals' MHS acceptance. The proposed model variables explained 70% of the variance in behavioral intention to use MHS; further study is needed to explore extra significant antecedents of new IT/IS acceptance for mobile healthcare. Such as privacy and security issue, system and information quality, limitations of mobile devices; the above may be other interesting factors for implementing mobile healthcare and could be conducted by qualitative research.

Management development: a study of nurse managerial activities and skills.

This study discusses an activity competency model that may be used to investigate the perceived importance of managerial activities and skills required by three levels of nurse managers (top, middle, and supervisory management). Our findings indicate that the importance of nurse managerial activities differs significantly according to the level of nurse management. A set of critical managerial activities and skills/knowledge needs for each level of nurse managers was identified in the study. These findings provide guidelines for nursing-management development programs, training, and career planning. They also can serve as a guideline for recruiting and selecting an effective nurse manager.

Central giant cell granuloma of the mandible in a 7-year-old boy: a case report.

Central giant cell granuloma is a relatively uncommon benign bony lesion of a variably aggressive nature. This paper presents the case of a 7-year-old boy with central giant cell granuloma in the anterior mandible. In children with mixed dentition, a pathologic lesion could be the underlying cause of regular tooth mobility and exfoliation of primary teeth and can easily be overlooked, especially in cases that are not accompanied by an obvious bony expansion. The clinician needs to be aware of possible oral pathology when tooth mobility and displacement are present, and central giant cell granuloma should be considered in the differential diagnosis for children with maligned and mobile teeth.