Transcriptome and functional analyses of phenotypic plasticity in sea grape Caulerpa okamurae.

Caulerpa is a marine green macroalga distinguished by a large single cell with multiple nuclei. It also exhibits remarkable morphological intraspecies variations, in response to diverse environmental types. However, the molecular mechanisms underlying this phenotypic plasticity remain poorly understood. In this work, we compare the transcriptomes of Caulerpa okamurae Weber Bosse, 1897 displaying altered phenotypes of cultivation and natural phenotypes and investigate significantly regulated genes and their biological functions using differential expression analyses. We observe light-harvesting complex upregulation and cellular framework stability downregulation in altered phenotypes compared to the natural phenotypes. Intertidal macrophytes reduce light capture to avoid photodamage and regulate their morphology to protect against wave damage. In contrast, the lower light conditions and the cultivation environment augment light capture and increase a morphology prioritizing light trapping. Moreover, the addition of simulated wave-sweeping stimuli induces a return to the natural morphology under high-light conditions, showing how mechanical stress affects morphological organization in C. okamurae. We provide detailed gene expression patterns in C. okamurae under varying light intensities and water conditions, suggesting a distinct influence on its morphological traits.

Clinical nurses' work-life balance prediction due to patient safety incidents using classification and regression tree analysis: a secondary data analysis.

BACKGROUND: Patient safety incidents lead to performance difficulties for nurses when providing nursing practice. This affects work-life balance and causes second and third-victimization. This study predicts factors affecting clinical nurses' work-life balance due to patient safety incidents using classification and regression tree analysis techniques. METHODS: This study was a secondary analysis of data from a cohort research project, which used a descriptive survey for data collection. Participants comprised 372 nurses. Data were collected using SurveyMonkey, a mobile-based survey software solution, from January to September 2021. Data included the general characteristics of clinical nurses, second damage, second damage support, third damage, and work-life balance. The specific variables included in the analysis chosen through rigorous Lasso analysis form the foundation for predicting work-life balance. Variables with low explanatory power were excluded, thereafter, the variables selected by Lasso were analyzed with a classification and regression tree model to predict work-life balance. RESULTS: A regression tree was applied to predict work-life balance using seven variables-education level, marital status, position, physical distress, second-victim support, turnover intentions, and absenteeism (selected through Lasso analysis). After pruning, at tree size four, when turnover intentions were < 4.250, physical distress < 2.875, and second-victim support < 2.345, the predicted work-life balance was 3.972. However, when turnover intentions were < 4.250, physical distress < 2.875, and second-victim support ≥ 2.345, then the predicted work-life balance was 2.760. CONCLUSIONS: This study's insights offer crucial groundwork for crafting targeted workforce risk management strategies and fostering a conducive organizational culture to mitigate nursing occupational stress, potentially curbing the recurrence of patient safety incidents and improving nursing practice while enhancing patient outcomes. Future research should explore second and third victim experiences across various healthcare settings globally to understand their impact on WLB and patient safety outcomes.

Development of a web-based care networking system to support visiting healthcare professionals in the community.

BACKGROUND: The role of visiting health services has been proven to be effective in promoting the health of older populations. Hence, developing a web system for nurses may help improve the quality of visiting health services for community-dwelling frail older adults. This study was conducted to develop a web application that reflects the needs of visiting nurses. METHODS: Visiting nurses of public health centers and community centers in South Korea participated in the design and evaluation process. Six nurses took part in the focus group interviews, and 21 visiting nurses and community center managers participated in the satisfaction evaluation. Focus group interviews were conducted to identify the needs of visiting nurses with respect to system function. Based on the findings, a web application that can support the effective delivery of home visiting services in the community was developed. An artificial intelligence (AI) algorithm was also developed to recommend health and welfare services according to each patient's health status. After development, a structured survey was conducted to evaluate user satisfaction with system features using Kano's model. RESULTS: The new system can be used with mobile devices to increase the mobility of visiting nurses. The system includes 13 features that support the management of patient data and enhance the efficiency of visiting services (e.g., map, navigation, scheduler, protocol archives, professional advice, and online case conferencing). The user satisfaction survey revealed that nurses showed high satisfaction with the system. Among all features, the nurses were most satisfied with the care plan, which included AI-based recommendations for community referral. CONCLUSIONS: The system developed from the study has attractive features for visiting nurses and supports their essential tasks. The system can help with effective case management for older adults requiring in-home care and reduce nurses' workload. It can also improve communication and networking between healthcare and long-term care institutions.

Fighting Fire or Fighting War: Examining the Framing Effects of COVID-19 Metaphors.

Metaphorical language describing the COVID-19 pandemic as a war has been pervasive in public discourse (e.g. "the pandemic is a war," "the virus is an enemy," and "the vaccine is a weapon"). This study employs an online survey experiment (N = 551 U.S. adults) to examine the impact of war metaphors compared to non-metaphorical literal frames and fire metaphors (e.g. "the pandemic is a wildfire"). War metaphors exhibited little advantage over literal frames across a variety of desirable outcomes (i.e. the adoption of pro-health behaviors against COVID-19, perceived solidarity and collective responsibility to curb the pandemic, and intentions to discuss and share the health news with others). However, this study revealed some benefits of war metaphors over fire metaphors. Compared with fire metaphors, health news featuring war metaphors increased both positive emotions and perceived threats of COVID-19, which in turn promoted pro-health behaviors against COVID-19 and perceived solidarity to cope with the public health crisis. Moreover, positive emotions in response to war metaphors also indirectly encouraged the retransmission of science-based COVID-19 health news. This study thus showcased the benefits and limitations of war metaphors and revealed the mediating roles of perceived threats and positive emotions in explaining war metaphorical framing effects. Implications of using war and fire metaphors for communicating about public health crises are also discussed.

Nurse Information Security Policy Compliance, Information Competence, and Information Security Attitudes Predict Information Security Behavior.

Nurses' attitudes toward information security can influence the hospital's information resources management and development. This study investigated the relationships between nurses' information security policy compliance, information competence, and information security attitudes, which are factors that influence information security behavior. Data were collected during September 2020. The participants were 200 clinical nurses from a general hospital in Korea. The self-reported questionnaire included questions on nurses' general characteristics, information security policy compliance, information competence, and information security attitudes. Information security policy compliance ( r = 0.554, P < .001) and information competence ( r = 0.614, P < .001) were positively associated with information security attitudes. Predictors of nurses' information security attitudes were information competence ( ß = .439), information security policy compliance ( ß = .343), prior information security-related education ( ß = .113), and job position (nurse manager; ß = .101). Implications for practice include the need for strategies to develop information security policy compliance and information competence to improve information security behavior, including different approaches tailored to nurses' job positions and previous information security education.

Dancing on the inside: A qualitative study on online dance learning with teacher-AI cooperation.

Recent technologies have extended opportunities for online dance learning by overcoming the limitations of space and time. However, dance teachers report that student-teacher interaction is more likely to be challenging in a distant and asynchronous learning environment than in a conventional dance class, such as a dance studio. To address this issue, we introduce DancingInside, an online dance learning system that encourages a beginner to learn dance by providing timely and sufficient feedback based on Teacher-AI cooperation. The proposed system incorporates an AI-based tutor agent (AI tutor, in short) that uses a 2D pose estimation approach to quantitatively estimate the similarity between a learner's and teacher's performance. We conducted a two-week user study with 11 students and 4 teachers. Our qualitative study results highlight that the AI tutor in DancingInside could support the reflection on a learner's practice and help the performance improvement with multimodal feedback resources. The interview results also reveal that the human teacher's role is essential in complementing the AI feedback. We discuss our design and suggest potential implications for future AI-supported cooperative dance learning systems.

Medial Plantar Fasciocutaneous Flap Reconstruction for Load-Bearing Foot Defects in Patients With Acral Melanoma.

BACKGROUND: Acral lentiginous melanoma (ALM) is a rare subtype of malignant melanoma that usually involves the weight-bearing plantar area. Plantar defect reconstruction has traditionally been performed with skin grafts or free flaps. This study examined the efficacy and safety of a medial plantar artery perforator flap (MPAPF) for plantar defect reconstruction after wide excision of an ALM. METHOD: Twenty-five patients who underwent reconstruction with a MPAPF between 2011 and 2021 were enrolled in this study. The defects were classified into 6 plantar zones. Demographic and clinical data were retrospectively analyzed. RESULTS: Reconstruction with medial plantar fasciocutaneous island flaps was performed in all cases, except for 4 patients who had lesions in forefoot, which required free medial plantar flaps. Defects in lateral and posterior heel were more likely to present with venous congestion and require longer healing times and revision surgery (P < 0.05). The average follow-up period was 49 months. Four and 5 patients developed local recurrence and distant metastasis, respectively. Four cases of hyperkeratosis and paresthesia were documented, but there were no cases of ulceration or wound dehiscence. None of the cases required secondary debulking procedures. CONCLUSIONS: The MPAPF is safe and effective for plantar defect reconstruction among patients with ALM. Meticulous dissection and adequate tunneling are needed, particularly for defects in the lateral and posterior heel, to minimize flap congestion and revision operations.

Distal femoral phenotypes in Asian varus osteoarthritic knees.

PURPOSE: There has been a general consensus regarding the varus phenotype of the proximal tibia in osteoarthritic patients with varus knee alignment of the whole limb. However, a valgus phenotype of the distal femur may occur in osteoarthritic patients with varus knee alignment. This study evaluated the distal femur phenotype in varus osteoarthritic knees. METHODS: This study included 128 patients who underwent primary total knee arthroplasty (TKA) by computer-assisted navigation for primary medial osteoarthrosis with varus knee alignment. The hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA) were measured on which radiographs preoperatively. The radiographic parameters were compared between groups with HKA angle varus ≥ 10° and < 10°. RESULTS: The MPTA was significantly lower (4°) in the HKA angle varus ≥ 10° group than in the < 10° group (82.13° vs. 86.13° P = 0.001), but the LDFA did not differ significantly between the groups (89.81° vs. 89.19° P = 0.181). Regarding the JLCA, the varus ≥ 10° group showed a 1.3° greater lateral widening than the varus < 10° group (4.87 vs. 3.56, P = 0.002). The MPTA was the only independent predictor of the MA of the lower limb (ß = -  0.353, P < 0.001). CONCLUSION: One-third of varus osteoarthritic knees had a distal femur valgus phenotype. Varus knee alignment was mainly affected by proximal tibia varus rather than by distal femur varus. LEVEL OF EVIDENCE: Level III, consecutive case series.

Deep-learning-based hologram generation using a generative model.

We propose a new learning and inferring model that generates digital holograms using deep neural networks (DNNs). This DNN uses a generative adversarial network, trained to infer a complex two-dimensional fringe pattern from a single object point. The intensity and fringe patterns inferred for each object point were multiplied, and all the fringe patterns were accumulated to generate a perfect hologram. This method can achieve generality by recording holograms for two spaces (16 Space and 32 Space). The reconstruction results of both spaces proved to be almost the same as numerical computer-generated holograms by showing the performance at 44.56 and 35.11 dB, respectively. Through displaying the generated hologram in the optical equipment, we proved that the holograms generated by the proposed DNN can be optically reconstructed.

Characteristics and surgical outcomes of cleft palate in kabuki syndrome: a case series of 11 patients.

OBJECTIVE: A significant number of patients with KS have cleft palate (CP) or submucous cleft palate (SMCP) and show delayed speech development. However, few reports have discussed the characteristics of CP in KS and the outcomes of postoperative speech development. The purpose of this study was to investigate the characteristics and surgical outcomes of CP in patients with KS, and to discuss the importance of the diagnosis of CP or SMCP. METHODS: We conducted a retrospective study on patients with clinically diagnosed KS who underwent palatoplasty. Clinical and surgical data were collected from patients' medical records, and velopharyngeal function was evaluated using nasopharyngoscopy and speech analysis. RESULTS: In 11 cases, 5 patients had CP (45.5%) and 6 had SMCP (54.5%). Four patients who were genetically tested had a pathogenic variant of KMT2D. Seven of nine patients (77.8%) who underwent conventional palatoplasty showed velopharyngeal insufficiency and hypernasality. All patients who underwent pharyngeal flap surgery achieved velopharyngeal competency. Statistical analysis revealed a statistically significant difference in postoperative results between non-syndromic and KS patients. CONCLUSION: Patients with SMCP may be more common than previously reported. The results showed that it is difficult to produce optimal results with conventional palatoplasty; therefore, pharyngeal flap surgery should be considered as a treatment to obtain favorable results. Pharyngeal flap surgery in patients with KS should be carefully designed based on speech evaluation and nasopharyngoscopic findings.

Digital Hologram Watermarking Based on Multiple Deep Neural Networks Training Reconstruction and Attack.

This paper proposes a method to embed and extract a watermark on a digital hologram using a deep neural network. The entire algorithm for watermarking digital holograms consists of three sub-networks. For the robustness of watermarking, an attack simulation is inserted inside the deep neural network. By including attack simulation and holographic reconstruction in the network, the deep neural network for watermarking can simultaneously train invisibility and robustness. We propose a network training method using hologram and reconstruction. After training the proposed network, we analyze the robustness of each attack and perform re-training according to this result to propose a method to improve the robustness. We quantitatively evaluate the results of robustness against various attacks and show the reliability of the proposed technique.

Impact of nurses' compassion competence and transcultural self-efficacy on their global health nursing competency.

AIM: To develop a GHNC scale and verify the effects of nurses' compassion competence (CC) and transcultural self-efficacy (TSE) on GHNC. BACKGROUND: Global health nursing competency (GHNC) is essential for professional nursing care for multicultural populations. METHODS: Using a cross-sectional design, data were collected from 318 nurses of recruited through convenience sampling. Factor analysis and multiple regressions were performed to measure GHNC and determine its influential factors, respectively. RESULTS: The GHNC scale was developed with 15 items in four domains: perception of global society, cultural attitude, nursing practice, and communication skill. The communication factor of CC and cognitive factor of TSE significantly affected GHNC. CONCLUSIONS: The GHNC scale has sufficient validity and reliability for use in nursing practice and research. It can be used to identify the current position of GHNC and develop programs to improve GHNC by enhancing nurses' CC and TSE.

Effect of Remote Ischemic Preconditioning Conducted in Living Liver Donors on Postoperative Liver Function in Donors and Recipients Following Liver Transplantation: A Randomized Clinical Trial.

OBJECTIVE: This study aimed to assess the effects of remote ischemic preconditioning (RIPC) on liver function in donors and recipients after living donor liver transplantation (LDLT). BACKGROUND: Ischemia reperfusion injury (IRI) is known to be associated with graft dysfunction after liver transplantation. RIPC is used to lessen the harmful effects of IRI. METHODS: A total of 148 donors were randomly assigned to RIPC (n = 75) and control (n = 73) groups. RIPC involves 3 cycles of 5-minute inflation of a blood pressure cuff to 200 mm Hg to the upper arm, followed by 5-minute reperfusion with cuff deflation. The primary aim was to assess postoperative liver function in donors and recipients and the incidence of early allograft dysfunction and graft failure in recipients. RESULTS: RIPC was not associated with any differences in postoperative aspartate aminotransferase (AST) and alanine aminotransferase levels after living donor hepatectomy, and it did not decrease the incidence of delayed graft hepatic function (6.7% vs 0.0%, P = 0.074) in donors. AST level on postoperative day 1 [217.0 (158.0, 288.0) vs 259.5 (182.0, 340.0), P = 0.033] and maximal AST level within 7 postoperative days [244.0 (167.0, 334.0) vs 296.0 (206.0, 395.5), P = 0.029) were significantly lower in recipients who received a preconditioned graft. No differences were found in the incidence of early allograft dysfunction (4.1% vs 5.6%, P = 0.955) or graft failure (1.4% vs 5.6%, P = 0.346) among recipients. CONCLUSIONS: RIPC did not improve liver function in living donor hepatectomy. However, RIPC performed in liver donors may be beneficial for postoperative liver function in recipients after living donor liver transplantation.

New compression method for full-complex holograms using the modified zerotree algorithm with the adaptive discrete wavelet transform.

In this paper, we propose a new method for coding a full complex hologram with random phase. Since holograms with random phase have very unique spatial and frequency characteristics, a new compression method suitable for such holograms is required. We analyze the frequency characteristics of holograms with random phases and propose a new adaptive discrete wavelet transform (aDWT). Next, we propose a new modified zerotree alogrithm (mZTA) suitable for the subband configuration generated by the modified wavelet transform method. The results of the compression using the proposed method showed higher efficiency than the previous method, and the reconstructed images showed visually superior results.

A systematic review and meta-analysis of the effects of global health competency improvement programs on nurses and nursing students.

AIMS: To identify trends in global health competency improvement programs for nurses and to verify their effects. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Articles published from 2000-2017 in Ovid MEDLINE, Embase, and ProQuest and the Cumulative Index to Nursing and Allied Health Literature database, Cochrane Library, Research Information Sharing Service, DataBase Periodical Information Academic, Korean Studies Information Service System, and National Assembly Library. REVIEW METHODS: Cochrane methods were used to conduct a systematic review, meta-analysis, and sensitivity analysis. RESULTS: Nineteen studies were reviewed. Among them, 12 studies were used for the meta-analysis. The meta-analysis indicated that global health competency improvement programs affected multicultural self-efficacy and cultural competence. CONCLUSION: The findings can be used as the basis for global health competency improvement programs. More studies are needed to clarify their effectiveness. IMPACT: Global health competency improvement programs can be beneficial to improve cultural competence and multicultural self-efficacy for nurses and nursing students.

Sleep quality among shift-work nurses: A systematic review and meta-analysis.

AIM: We systematically reviewed the quality of sleep measurement instruments applied to shift-work nurses and analyzed the effects of intervention research. BACKGROUND: There is a need to test the effects of experimental studies worldwide that conducted interventions to improve the sleep quality of nurses who work shiftwork. METHODS: In this systematic literature review and meta-analysis, we used PICO (Participant, Intervention, Comparison, and Outcome) and searched for papers in Korean and English published up until August 2018. We utilized Cochrane Review Manager Software 5.3. RESULTS: Thirteen articles from 1991 to 2018 were included in the systematic literature review, and 6 of those were used in a meta-analysis. The instrument used most often to asses subjective sleep quality was the Pittsburgh Sleep Quality Index. Additionally, an actigraph and sleep logs were used to collect physiological data about participants' sleep quality. Intervention types were categorized into aroma-inhalation therapy, shift-rotation interventions, physical-activity interventions, and cognitive-behavioral therapy. Ultimately, the effects of the aroma-inhalation therapy intervention significantly improved shift-work nurses' sleep quality. CONCLUSIONS: We established a basic understanding of a strategy to measure and improve participants' sleep quality. Consequently, sleep interventions that can positively promote nurses' health and foster effective job performance should be developed.

Comparison of variability in breast density assessment by BI-RADS category according to the level of experience.

Background Only few studies have assessed variability in the results obtained by the readers with different experience levels in comparison with automated volumetric breast density measurements. Purpose To examine the variations in breast density assessment according to BI-RADS categories among readers with different experience levels and to compare it with the results of automated quantitative measurements. Material and Methods Density assignment was done for 1000 screening mammograms by six readers with three different experience levels (breast-imaging experts, general radiologists, and students). Agreement level between the results obtained by the readers and the Volpara automated volumetric breast density measurements was assessed. The agreement analysis using two categories-non-dense and dense breast tissue-was also performed. Results Intra-reader agreement for experts, general radiologists, and students were almost perfect or substantial (k = 0.74-0.95). The agreement between visual assessments of the breast-imaging experts and volumetric assessments by Volpara was substantial (k = 0.77). The agreement was moderate between the experts and general radiologists (k = 0.67) and slight between the students and Volpara (k = 0.01). The agreement for the two category groups (nondense and dense) was almost perfect between the experts and Volpara (k = 0.83). The agreement was substantial between the experts and general radiologists (k = 0.78). Conclusion We observed similar high agreement levels between visual assessments of breast density performed by radiologists and the volumetric assessments. However, agreement levels were substantially lower for the untrained readers.

Detection of Parameter Change in Random Coefficient Integer-Valued Autoregressive Models.

This paper considers the problem of testing for parameter change in random coefficient integer-valued autoregressive models. To overcome some size distortions of the existing estimate-based cumulative sum (CUSUM) test, we suggest estimating function-based test and residual-based CUSUM test. More specifically, we employ the estimating function of the conditional least squares estimator. Under the regularity conditions and the null hypothesis, we derive their limiting distributions, respectively. Simulation results demonstrate the validity of the proposed tests. A real data analysis is performed on the polio incidence data.

Survey of Thoracic CT Protocols and Technical Parameters in Korean Hospitals: Changes before and after Establishment of Thoracic CT Guideline by Korean Society of Thoracic Radiology in 2008.

We retrospectively reviewed the thoracic CT scan protocols and technical parameters obtained from hospitals in Korea, one group during May 2007 (n = 100) and the other group during January 2012 (n = 173), before and after the establishment of the thoracic CT Guideline in 2008. Each group was also divided into two subgroups according to the health care delivery level, i.e. the "A" subgroup from primary and the "B" subgroup from secondary and tertiary care hospitals. When comparing the data from 2007 and 2012, the tube current decreased from 179.1 mAs to 137.2 mAs. The scan interval decreased from 6.4 mm to 4.8 mm. Also, the insufficient scan range decreased from 19.0% to 8.7%, and the suboptimal quality scans decreased from 33.0% to 5.2%. Between groups A and B, group B had lower tube voltages, smaller scan thicknesses, and smaller scan intervals. However, group B had more phase numbers. In terms of the suboptimal quality scans, a decrease was seen in both groups. In conclusion, during the five-year time period between 2007 and 2012, a reduction in the tube current values was seen. And the overall image quality improved over the same time period. We assume that these changes are attributed to the implementation of the thoracic CT guideline in 2008.

ED crowding and the outcomes of out-of-hospital cardiac arrest.

OBJECTIVE: Emergency department (ED) overcrowding is a worldwide problem associated with adverse outcomes. This study was performed to investigate the association between ED overcrowding and the outcomes and quality of cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA). METHODS: Prospectively collected data including patients' demographics, Utstein factors, and outcomes on 608 consecutive OHCA patients at a single ED from January 2008 to December 2012 were retrospectively analyzed. The patients were categorized into 4 groups according to ED occupancy rate. The primary outcome was resuscitation outcome, a composite of rates of return of spontaneous circulation (ROSC), survival at discharge, and neurologic outcome at 6months. The secondary outcome was resuscitation quality assessed by time to advanced airway, time to first drug administration, resuscitation duration in refractory cases, and rate of initiation of therapeutic hypothermia after ROSC in the ED. RESULTS: There was no significant difference in rates of ROSC, survival at discharge, and good neurologic outcome according to ED occupancy rate in the univariate and multivariate analyses (P>.05). In addition, ED overcrowding was not associated with resuscitation quality (P>.05). CONCLUSION: Emergency department overcrowding was not associated with the outcomes of OHCA or resuscitation quality.