Determinants of quality of life in frontline healthcare providers caring for COVID-19 patients.

AIMS AND OBJECTIVES: To investigate the factors affecting quality of life in healthcare providers who care for patients with COVID-19. BACKGROUND: Healthcare providers caring for COVID-19 patients during the pandemic suffered a deterioration in their quality of life. Several studies have explored their psychological impact of working with COVID patients, but none have examined the causes of this deterioration. DESIGN: A cross-sectional study. METHODS: In the current study, the authors investigated the factors affecting quality of life in 293 healthcare providers recruited from a medical centre in northern Taiwan who had recently cared for patients with suspected or confirmed COVID-19 by analysing their responses to an online self-report questionnaire, using bivariate correlations and structural equation modelling. Reporting of this research adheres to the STROBE guideline. RESULTS: The study identified an important sequence of factors that mediated the effects of perceived success of epidemic prevention policies, family relations problems and education level on quality of life in a sample of healthcare workers caring for COVID-19 patients. The mediators were use of approach-oriented coping strategies and current mental health status. Specifically, use of approach-oriented coping strategies was found to directly cause improved quality of life and indirectly cause improved mental health, whereas use of avoidant coping strategies was found to directly cause worsening of mental health. Poor mental health predicted poor quality of life. CONCLUSIONS: Results suggest that implementation of sound epidemic prevention policies that promote adoption of approach-oriented coping behaviour should lead to a better quality of life in the future for healthcare providers working in challenging circumstances. RELEVANCE TO CLINICAL PRACTICE: Assessment of these policies as well as the providers' family relations are necessary first steps to improving the success of approach-oriented coping behaviour in this population, which in turn can improve their mental health and quality of life. PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor members of the public were involved in the design or execution of the study.

MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis.

BACKGROUND: Nonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloarthritis Society (ASAS), structural changes to sacroiliac joints (SIJs) on MRI cannot be used as criteria in the absence of BME. However, less than half the Asian patients with clinically active axSpA show BME. The incidence of human leukocyte antigen (HLA)-B27 is low in Asian populations, which makes it more difficult to identify nr-axSpA. We used MRI to evaluate the structural damage to SIJs in patients with nr-axSpA with and without BME with the aim of identifying the best methodology for accurate diagnosis, especially in populations with less common BME and HLA-B27. METHODS: One hundred three patients with inflammatory back pain were included in this prospective study. No patient's radiograph met the definition of positive modified New York criteria. BME and structural damage to SIJ including sclerosis and erosion were assessed independently on coronal and axial short-tau inversion recovery and T1-weighted spin echo MRI scans by two well-trained musculoskeletal radiologists using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Demographics of patients were collected. Disease characteristics and structural damage were analyzed in patients with and without BME on SIJ MRI. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of structural damage. RESULTS: All individuals in the cohort had at least one abnormal finding on SIJ MRI, including BME or structural damage; 36 of 103 patients had BME. We identified a significant positive correlation between SPARCC scores and severe erosion assessed by focal joint space widening (fJSW) (p = 0.001) in these 36 patients. Fifty-eight of the 103 enrolled patients fulfilled the ASAS criteria for nr-axSpA in the either absence or presence of BME. Of these 58 patients, 57 and 19 had erosions or fJSW, respectively, and the presence of BME was significantly correlated with fJSW (phi score of 0.319 and p = 0.015). We demonstrated a significant positive correlation between fJSW and either the presence or the severity of BME in patients with nr-axSpA who met the ASAS definition. There was a positive correlation between BME and fJSW across the whole study cohort (phi score of 0.389; p < 0.001). The area under the ROC curve (AUC) for fJSW on SIJ MRI was 0.736, p < 0.001. In both HLA-B27-positive and -negative groups, BME was more common in the presence of fJSW (phi scores of 0.370 and 0.377, p = 0.018 and 0.003, respectively) and SPARCC scores were higher in patients with fJSW (p < 0.001 and p = 0.005). We also identified a positive correlation between fJSW and BME in patients with nr-axSpA and normal serum levels of C-reactive protein (phi score of 0.362 and p = 0.001). CONCLUSION: Structural damage detected on SIJ MRI, sclerosis, erosions and fJSW may be present in patients without detectable inflammation on SIJ MRI. However, fJSW is significantly correlated with the severity of inflammation seen on SIJ MRI, which contributes to the accurate diagnosis of nr-axSpA, and it could be used as an alternative diagnostic test for nr-axSpA in the general population, especially for those who do not carry the HLA-B27 gene, Asian patients without BME, or patients with normal serum inflammatory biomarkers.

Adherence among HIV-positive injection drug users undergoing methadone treatment in Taiwan.

AIMS: The study aims were to investigate adherence to methadone maintenance treatment (MMT) and to identify associated clinical factors in patients who inject drugs diagnosed with human immunodeficiency virus (HIV) infection in Taiwan. METHODS: Data were from the National Health Surveillance System on HIV and the National Drug Treatment System on MMT. HIV-positive people who inject drugs (HIVPWID) were defined as the study population. Information obtained included age, sex, education, marital status, employment, methadone dose, and date of diagnosis of HIV infection. Adherence was defined as taking methadone for the past 90, 180 and 365 days, then categorized as high (> 90%), moderate (51 to 90%), or low (<=50%) adherent respectively. RESULTS: Of 1641 HIVPWID registered in the datasets from 2007 to 2012, 961 (58.56%) had received MMT. For HIVPWID evaluated at 90 days (n = 951), 271 (28.5%), 382 (40.2%), and 298 (31.3%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 180 days (n = 936), 190 (20.3%), 349 (37.3%), and 397 (42.4%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 365 days (n = 919), 133 (14.5%), 271 (29.5%), and 515 (56.0%) were classified as high, moderate, and low adherent respectively. After controlling for sociodemographics, results showed that methadone dose, location of MMT clinic, and date of HIV diagnosis were significantly associated with MMT adherence. CONCLUSIONS: Study findings underscore the importance to MMT adherence of methadone dosage, early diagnosis of patient's HIV infection, and area of patient residence.

Application of classification criteria of Sjogren syndrome in patients with sicca symptoms: Real-world experience at a medical center.

BACKGROUND: Patients who have symptoms of sicca, such as dry eyes and mouth, may have Sjögren's syndrome (SS). However, the conservative culture makes patients hesitate to undergo an invasive biopsy, which contributes to the difficulty of confirming a diagnosis. We aimed to identify the characteristics of patients with sicca symptoms to develop a better predictive value for each item included in the three different diagnostic criteria for SS and clarify the best diagnostic tools for the local population. METHODS: This is a single-center retrospective case-control study from January 2016 to December 2017. Patients who underwent sialoscintigraphy because of clinical symptoms of xerostomia and xerophthalmia at one medical center were reviewed via the patients' electronic medical records. RESULTS: Of 515 patients enrolled, the severity of results for sialoscintigraphy and Schirmer's test was correlated with a diagnosis of SS and generated receiver operator characteristic curve. The area under curve (AUC) was 0.603 for positive Schirmer's test, 0.687 for positive anti-Ro/La results, 0.893 for a positive salivary gland biopsy. The AUC was 0.626 and 0.602 for Schirmer's test which is redefined as <10 mm/5 minutes in either eye and according to 2016 the American College of Rheumatology/ European League Against Rheumatism criteria, respectively. CONCLUSION: Our results indicate the cut-off point for defining a positive test result in the Schirmer's test is worth modified to <10 mm/5 minutes in either eye.

mTOR Inhibitors in Advanced Biliary Tract Cancers.

Patients with advanced biliary tract cancers (BTCs), including cholangiocarcinoma (CCA), have poor prognosis so novel treatment is warranted for advanced BTC. In current review, we discuss the limitations of current treatment in BTC, the importance of mTOR signalling in BTC, and the possible role of mTOR inhibitors as a future treatment in BTC. Chemotherapy with gemcitabine-based chemotherapy is still the standard of care and no targeted therapy has been established in advanced BTC. PI3K/AKT/mTOR signaling pathway linking to several other pathways and networks regulates cancer proliferation and progression. Emerging evidences reveal mTOR activation is associated with tumorigenesis and drug-resistance in BTC. Rapalogs, such as sirolimus and everolimus, partially inhibit mTOR complex 1 (mTORC1) and exhibit anti-cancer activity in vitro and in vivo in BTC. Rapalogs in clinical trials demonstrate some activity in patients with advanced BTC. New-generation mTOR inhibitors against ATP-binding pocket inhibit both TORC1 and TORC2 and demonstrate more potent anti-tumor effects in vitro and in vivo, however, prospective clinical trials are warranted to prove its efficacy in patients with advanced BTC.

CuI/Oxalic Diamide-Catalyzed Cross-Coupling of Thiols with Aryl Bromides and Chlorides.

We report a general copper-catalyzed cross-coupling of thiols with aryl halides by using N-aryl-N'-alkyl oxalic diamide (L3) or N,N'-dialkyl oxalic diamide (L5) as the ligand. Both aryl and alkyl thiols can be coupled with unactivated aryl bromides and chlorides to give the desired products in good yields. Furthermore, this system features a broad substrate scope and good tolerance of functional groups. Importantly, the oxalic diamides are stable and can be prepared easily from commercially available and cheap starting materials.

[Optimization of alcohol precipitation technology of Biqiu granules based on index components and pharmacodynamics].

To evaluate the rationality of alcohol precipitation technology of Biqiu granule by investigating its effect on serum histamine, IgE, IL-4, IFN and TNF-α. The contents of cafferic acid and rosmarinic acid were used as the evaluation indexes, and some factors affecting index were firstly evaluated by Plackett-Burman design; then alcohol precipitation technology was further optimized by Box-Behnken design to determine the optimal alcohol precipitation conditions. The best alcohol precipitation conditions were as follows: the relative density of herb liquor was 1.15 (65 ℃); the concentration of alcohol was 70%, and standing time was 12 hours. Optimal alcohol precipitation technology of Biqiu granules determined by pharmacodynamic screening, Plackett-Burman and Box-Behnken design tests, was stable and feasible with good predictability, providing reliable basis for the industrialization production of Biqiu granules.

[Optimization of one-step pelletization technology of Biqiu granules by Plackett-Burman design and Box-Behnken response surface methodology].

First with the qualified rate of granules as the evaluation index, significant influencing factors were firstly screened by Plackett-Burman design. Then, with the qualified rate and moisture content as the evaluation indexes, significant factors that affect one-step pelletization technology were further optimized by Box-Behnken design; experimental data were imitated by multiple regression and second-order polynomial equation; and response surface method was used for predictive analysis of optimal technology. The best conditions were as follows: inlet air temperature of 85 degrees C, sample introduction speed of 33 r x min(-1), density of concrete 1. 10. One-step pelletization technology of Biqiu granules by Plackett-Burman design and Box-Behnken response surface methodology was stable and feasible with good predictability, which provided reliable basis for the industrialized production of Biqiu granules.

[Optimization of spraying dry technology of Biqiu ranules ethanol extract by Box-Behnken response surface method].

With inlet temperature, specific gravity, feeding speed as independent variables, the comprehensive evaluating indexes of content of schisandrin and arctiin as dependent variable, the experimental data were fitted to a second order polynomial equation. Based on establishing the mathematical relationship between the comprehensive evaluating indexes and respective variables, Box-Benhnken central composite test and response surface analysis method was employed to optimize the spray drying technology of Biqiu granules ethanol extract. The optimal drying parameter was as follows: the inlet temperature was 175 degrees C, the specific gravity was 1.10, feeding speed was 32 r x min(-1). Under these conditions, the comprehensive evaluating indexes of spraying dry processes was 92.68, which was close to the model prediction. The spraying dry technology of Biqiu granules ethanol extract optimized by response surface methodology was accurate and feasible, which provided theoretical experiment basis for the industrialization production.

[Effect of shufeng xuanfei recipe and jiebiao qingli recipe on mRNA and protein expressions of TLR7, MyD88, and NF-kappaB in mice infected with influenza virus].

OBJECTIVE: To observe effect of Shufeng Xuanfei Recipe (SXR) and Jiebiao Qingli Recipe (JQR) on mRNA and protein expressions of Toll-like receptor 7 (TLR7), myeloid differentiation factor 88 (MyD88), and nuclear factor-kappaB (NF-kappaB) in mice infected with influenza virus FM1. METHODS: One hundred and eight mice were randomly divided into nine groups, i.e., the normal control group, the model group, the Oseltamivir group (at the daily dose of 2.5 g/mL), the high dose SXR group (at the daily dose of 3.762 g/kg), the middle dose SXR group (at the daily dose of 1.881 g/kg), the low dose SXR group (at the daily dose of 0.941 g/kg), the high dose JQR group (at the daily dose of 4.368 g/kg), the middle dose JQR group (at the daily dose of 2.184 g/kg), and the low dose JQR group (at the daily dose of 1.092 g/kg), 12 in each group. All mice were mildly anesthetized by ether. Mice in the normal control group were treated by nasal drop of 0.05 mL normal saline, while mice in the rest groups were infected by nasal drop of 0.05 mL influenza virus strain FM1 (LD50). The successful modeling rate was 100%. All medication was performed by gastrogavage 2 h after infection. Distilled water was given by gastrogavage to mice in the normal control group and the model group at the daily dose of 0.2 mL, each time per day for 4 successive days. mRNA expressions of TLR7, MyD88, and NF-kappaB in the lung tissue were determined by Western blot. RESULTS: Compared with the normal control group, mRNA expressions of TLR7, MyD88, and NF-kappaB increased in the model group (P < 0.01). Compared with the model group, mRNA and protein expressions of TLR7, MyD88, and NF-kappaB decreased in the Oseltamivir group, the high, middle, and low dose SXR groups (P < 0.05, P < 0.01); mRNA and protein expressions of TLR7 and NF-kappaB decreased in the high and middle dose JQR groups (P < 0.05, P < 0.01); mRNA expressions of MyD88 decreased in the high and middle dose JQR groups (P < 0.05); protein expressions of MyD88 decreased in the middle dose JQR group (P < 0.05); protein expressions of TLR7 and NF-kappaB decreased in the low dose JQR group (P < 0.05). Compared with the Oseltamivir group, protein expressions of MyD88 decreased in the low dose SXR group (P < 0.05); protein expressions of NF-kappaB decreased in the middle and low dose SXR groups (P < 0.01); mRNA and protein expressions of TLR7 (P < 0.05, P < 0.01), and protein expressions of MyD88 (P < 0.01) decreased in the high, middle, and low dose JQR groups; mRNA and protein expressions of NF-kappaB decreased in the low dose JQR group (P < 0.05, P < 0.01). CONCLUSIONS: Each dose SXR and middle dose JQR could down-regulating the activity of NF-kappaB through adjusting MyD88 dependent TLR signal pathway, thus fighting against influenza virus. SXR was more effective than JQR.

Influence of resilience on perceived stress and depression among Taiwanese army military personnel.

Resilience has been reported to attenuate psychological burden and promote mental health. Military personnel constitute a population with a high psychological burden and poor sleep quality and are thus at a high risk of depression. This study is aim to examine the mechanism underlying the effects of resilience on perceived stress, sleep quality, and depression among Taiwanese army military personnel. A cross-sectional survey was conducted between May 2020 and February 2021. Participants comprised 1505 voluntary army military service personnel aged 20 years or older; they completed self-reported questionnaires measuring their perceived stress, resilience, sleep quality, and depression. Data were analysed using structural equation modelling. The results indicated that the association between resilience and depression was partially mediated by perceived stress and sleep quality. Perceived stress is a significant mediator on the association between resilience and depression. A high level of sleep disturbance was observed in this population and results found that sleep quality showed a slight partial mediation effect on the association between resilience and depression. Resilience can alleviate the effects of stress, which in turn alleviates depression among military personnel. Promoting resilience-enhancing education and mitigating environmental barriers to sleep is essential for reducing depressive symptoms among military personnel.

Techno-Economic Analysis for Direct Processing of Wet Solid Residues Originated from Grain and Inedible Plant Wastes.

Large number of solid wastes is produced from ethanol and wine plants sourcing from grain and inedible plant wastes, for example, WDGS (wet distiller's grain with soluble) and DDGS (dry distiller's grain with soluble) produced from ethanol plants using corn. This study investigates alternative methods for using these co-products through combustion and anaerobic digestion. Process simulation and economic analysis were conducted using current market prices to evaluate the viability of the processes. Products in the form of energy are produced. Optimization of the corn ethanol plant was also explored for re-using the heat and electricity produced in those processes. These processes will supply more viable options to utilisation of those wastes. The anaerobic digestion of WDGS to produce electricity scenario was found to have the biggest profit among the four scenarios which can bring the annual income of 14.1 million Australian dollar to the ethanol plant. An environmental analysis of the CO2 emissions was also conducted. Using the Australian state emission factor, the amount of CO2 offset through both combustion and anaerobic digestion can be seen. The anaerobic digestion of WDGS to supply heat to the plant was proved having the largest CO2 abatement with the value of 0.58 kg-CO2e/L-EtOH. Supplementary Information: The online version contains supplementary material available at 10.1007/s12155-022-10501-6.

Synthesis of Mesoporous Eu3+-Doped Zinc/Silicate Phosphors for Highly Selective and Sensitive Detection of Sulfide Ions.

A mesoporous Eu3+-doped zinc/silicate phosphor with a large surface area (>100 m2g-1) and amorphous structure was prepared in an aqueous solution without using any organic template. The residual concentration of the Zn2+ ion in the filtrate is lower than the standard of effluent 3.5 ppm under a pH 8-11 preparation condition. When a sulfide ion (S2-) is present in aqueous solution, the phosphor can react with the sulfide ion to transform from the amorphous structure to the crystalline ZnS, which causes structural transformation and a subsequent decrease in luminescent intensity. This distinct phosphor with a high surface area and amorphous structure can be applied through the structure transformation mechanism for highly selective and sensitive detection of the sulfide ions at low concentrations. In addition, the luminescent efficiency was obtained from adjustments in the pH value, calcination temperature, and Eu3+ ion concentration. The quenching efficiency, the limit of detection (CLOD), S2- ion selectivity, and phosphor regeneration ability were systematically explored in sulfide ion detection tests. Due to the novel S2- ion-induced structural transformation, we found that the amorphous Eu3+-doped zinc/silicate phosphors demonstrate a CLOD sensitivity as low as 1.8 × 10-7 M and a high Stern-Volmer constant (KSV) of 3.1 × 104 M-1. Furthermore, the phosphors were easily regenerated through simple calcination at 500 °C and showed a KSV value of 1.4 × 104 M-1. Overall, the Eu3+-doped zinc/silicates showed many advantageous properties for detecting sulfide ions, including low toxicity, green synthesis, good selectivity, high sensitivity, and good renewability.

Islam and Veterinary Science: Rethinking Animal Suffering Through Islamic Animal Ethics and the Evolving Definition of Halal Slaughter.

In the midst of recent European activism against religious slaughter, the idea that religious slaughter is cruel to animals is often seen as commonsense, and the mandatory pre-slaughter stunning is often portrayed as the moral technology that assures animal welfare. Nevertheless, this portrayal seems to blur the fact that the current notion of animal welfare itself is built upon a changing selection of value assumptions, which are not without problems or academic debates. It also ignores the fact that contemporary veterinary scientists and Muslim scholars have been working together for four decades to learn more about farm animals and their suffering. Despite stereotypes, the idea of animal ethics is not foreign to Islam. In Islam, animals represent God's wisdom and wonder, and humans are obliged to attend to their health and living conditions. When killing animals for food is conducted, the slaughter must be done in the name of God as a sacred ritual in order to assure that the life of the animal is not taken lightly and that the slaughter is not a sign of hostility toward the universe. Before the act of sacrifice, the animal must be healthy, and no harm should be forced upon it. Accordingly, the requirement of pre-slaughter stunning has posed a question to Muslim scholars: Does stunning kill the animal or cause harm? What defines harm, and whose definition counts? This paper reconstructs a socio-technological history of halal slaughter through scientific research on animal suffering since the 1980s. On the basis of archival research of New Zealand veterinary scientists' works and in-depth interviews with Malaysian veterinary scientists, this article outlines three phases of the evolution of halal slaughter that aims to fulfill multiple sets of moral obligations toward farm animals, and demonstrates how veterinary scientists establish common ground between secular and Islamic animal ethics. In this vein, I am envisioning a possibility of veterinary anthropology that recognizes the field's trans-cultural characteristics, and continues to challenge the rigid binaries between the West and the Rest, and between science and culture.

The charm-quark contribution to light-by-light scattering in the muon ( g - 2 ) from lattice QCD.

We compute the hadronic light-by-light scattering contribution to the muon g - 2 from the charm quark using lattice QCD. The calculation is performed on ensembles generated with dynamical (u, d, s) quarks at the SU(3) f symmetric point with degenerate pion and kaon masses of around 415 MeV. It includes the connected charm contribution, as well as the leading disconnected Wick contraction, involving the correlation between a charm and a light-quark loop. Cutoff effects turn out to be sizeable, which leads us to use lighter-than-physical charm masses, to employ a broad range of lattice spacings reaching down to 0.039 fm and to perform a combined charm-mass and continuum extrapolation. We use the η c meson to define the physical charm-mass point and obtain a final value of a µ HLbL , c = ( 2.8 ± 0.5 ) × 10 - 11 , whose uncertainty is dominated by the systematics of the extrapolation. Our result is consistent with the estimate based on a simple charm-quark loop, whilst being free of any perturbative scheme dependence on the charm mass. The mixed charm-light disconnected contraction contributes a small negative amount to the final value.

Development and Validation of an Instrument to Measure Work-Related Stress among Rescue Workers in Traumatic Mass-Casualty Disasters.

Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers' work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74-0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster.

Resilience as a mediator of interpersonal relationships and depressive symptoms amongst 10th to 12th grade students.

BACKGROUND: The aim of this study was to explore the associations among interpersonal relationships, resilience and depressive symptoms, and to examine if resilience is a mediator between interpersonal relationships and depressive symptoms in senior high school students. METHODS: Of 463 randomly selected participants from among 3,900 high school students, 450 (97.19%) consented to and completed a structured 4-part questionnaire consisting of demographic items, Inventory of Adolescent Resilience, Taiwan Relationship Inventory for Children and Adolescents, and Center for Epidemiologic Studies Depression Scale for Children. The associations between interpersonal relations and resilience and their associations with depressive symptoms were analyzed using MPlus 8.0 software for structural equation modeling. RESULTS: Results from structural equation modeling indicate that resilience and interpersonal relationships were negatively associated with students' depressive symptoms, and resilience partially mediated the associations between interpersonal relationships and depressive symptoms after controlling for demographics. CONCLUSION: Findings support that resilience and better interpersonal relationships are protective factors against depressive symptoms in adolescents. The positive association between the two protectors implies that interpersonal relationships might increase resilience and then alleviate depression amongst adolescents.

Machine Learning Algorithms to Predict In-Hospital Mortality in Patients with Traumatic Brain Injury.

Traumatic brain injury (TBI) can lead to severe adverse clinical outcomes, including death and disability. Early detection of in-hospital mortality in high-risk populations may enable early treatment and potentially reduce mortality using machine learning. However, there is limited information on in-hospital mortality prediction models for TBI patients admitted to emergency departments. The aim of this study was to create a model that successfully predicts, from clinical measures and demographics, in-hospital mortality in a sample of TBI patients admitted to the emergency department. Of the 4881 TBI patients who were screened at the emergency department at a high-level first aid duty hospital in northern Taiwan, 3331 were assigned in triage to Level I or Level II using the Taiwan Triage and Acuity Scale from January 2008 to June 2018. The most significant predictors of in-hospital mortality in TBI patients were the scores on the Glasgow coma scale, the injury severity scale, and systolic blood pressure in the emergency department admission. This study demonstrated the effective cutoff values for clinical measures when using machine learning to predict in-hospital mortality of patients with TBI. The prediction model has the potential to further accelerate the development of innovative care-delivery protocols for high-risk patients.

Using tabletop exercises to evaluate nurses' clinical performance of hazardous materials disaster management: A cross-sectional study.

BACKGROUND: Hazardous materials (Hazmat) disaster is a specific event with low probability but may be a heavy burden on public health. Competence in Hazmat disaster emergency management is necessary for nurses who care about mass casualties in the first line, especially for nurses in military hospitals. However, less attention has been paid to evaluation of competence of Hazmat disaster emergency responses using tabletop exercises. OBJECTIVE: To identify competence in Hazmat disaster emergency response and factors influencing performance on tabletop exercises. METHODS: A cross-sectional design was employed in this study. Competence of nurses responding to a hazardous materials invasion was evaluated by a tabletop exercise. In each case the "Task Based Checklist" was used for evaluation. Multivariate analysis of covariance was conducted to detect the effects of traditional training on performance in Hazmat disaster tabletop exercises. RESULTS: A total of 161 nurses were recruited for this study. A checklist with 12 items comprised of two dimensions of disaster management was created and validated (CVI = 0.90). Inter-rater reliability for the evaluators ranged from 0.88 to 1. Performance on Hazmat site control, debris management and individual skills in decontamination were found to be suboptimal. Traditional disaster nursing training had no significant influence either on performance on Hazmat site control or patient care after controlling for differences in education level, age and gender. CONCLUSIONS: The tabletop exercise is an innovative method for disaster nursing educators seeking to evaluate response competence in Hazmat disaster simulation exercises. It is necessary to consider the characteristics of the participants when designing the training program and educational strategies. Participants from the military hospital were shown to have limited competence in Hazmat disaster emergency management.