Video-stylet vs. channeled hyperangulated videolaryngoscope: Efficacy in simulated Ludwig's angina randomized cadaver trial.

INTRODUCTION: Ludwig's angina (LA) is a life-threatening infection that can affect the floor of the mouth and neck, potentially causing serious airway obstruction. In such cases, rescue airway management and oxygenation can be challenging due to swelling of the mouth floor, trismus, and limited mouth opening. The aim of this study was to assess the efficacy of the Trachway video-stylet (VS) and Pentax AWS hyperangulated videolaryngoscope with channel (HAVL-C) compared to the standard geometric video-laryngoscope (SGVL, Macintosh 3, Trachway) in simulating Ludwig's angina with cadavers. METHODS: Three fresh frozen cadavers were prepared with varying degrees of difficulty to simulate the airway conditions of patients with LA, including mouth floor swelling, restricted mouth opening, and trismus. Fifty-five second-year resident physicians from various specialties participated in the study and received training in airway management using SGVL, VS, and HAVL-C devices. Participants were randomly assigned to intubate simulated LA with cadavers using the three devices in a random order, and intubation times and success rates were recorded. Participants also rated the difficulty of intubation using a visual analogue scale (VAS) score. The primary outcome assessed the first-pass intubation success or failure, while the secondary outcomes measured the intubation time and subjective difficulty using a visual analogue scale with different laryngoscopes. RESULTS: The success rates for intubation within 90 s were 40% for SGVL, 82% for VS, and 76% for HAVL-C. VS and HAVL-C had significantly higher success rates than SGVL, with hazard ratios of 3.4 and 2.7, and 95% confidence intervals (CI) of 2.0-5.7 and 1.6-4.6, p < 0.001, respectively. The odds ratios of successful intubation for VS and HAVL-C were 8.1 and 6.3, respectively, with a 95% CI of 3.7-17.8 and 2.4-16.7, p < 0.001, compared to SGVL. The VAS score was significantly correlated with intubation success rate and time. CONCLUSIONS: In cases of LA, the use of VS and HAVL-C is preferable over SGVL. These findings suggest that using VS and HAVL-C can improve intubation success rates and reduce intubation time in patients with LA.

Differences in patient-physician communication between the emergency department and other departments in a hospital setting in Taiwan.

BACKGROUND: Communication fosters trust and understanding between patients and physicians, and specific communication steps help to build relationships. Communication in the emergency department may be different from that in other departments due to differences in medical purposes and treatments. However, the characteristics of communication in the clinical settings of various departments have not been explored nor compared. OBJECTIVES: This study aimed to construct the steps in patient-physician communication based on the Roter Communication Model and compare communication performance between the emergency department and three other clinical settings-internal medicine, surgery, and family medicine departments. METHODS: Both qualitative and quantitative approaches were adopted. First, in-depth interviews were used to analyze clinical communication steps and meanings. Then, a quantitative questionnaire was designed based on the interview results to investigate differences in communication between the emergency department and the other three departments. Qualitative and quantitative data were analyzed from 20 interviews and 98 valid questionnaires. RESULTS: Patient-physician communication consists of four steps and ten factors. The four steps-greeting and data gathering, patient education and counseling, facilitation and patient activation, and building a relationship-had significant progressive effects. Patient education and counseling had an additional significant effect on building a relationship. The emergency department performed less well in the facilitation and patient activation, building a relationship step and the evaluation method, enhancement method, and attitude factors than the other departments. CONCLUSIONS: To improve the quality of patient-physician communication in the emergency department, physicians should strengthen the steps of facilitation and patient activation to encourage patients' active engagement in their health care.

Phylogeny, ancestral ranges and reclassification of sand dollars.

Classification of the Class Echinoidea is under significant revision in light of emerging molecular phylogenetic evidence. In particular, the sister-group relationships within the superorder Luminacea (Echinoidea: Irregularia) have been considerably updated. However, the placement of many families remains largely unresolved due to a series of incongruent evidence obtained from morphological, paleontological, and genetic data for the majority of extant representatives. In this study, we investigated the phylogenetic relationships of 25 taxa, belonging to eleven luminacean families. We proposed three new superfamilies: Astriclypeoidea, Mellitoidea, and Taiwanasteroidea (including Dendrasteridae, Taiwanasteridae, Scutellidae, and Echinarachniidae), instead of the currently recognized superfamily Scutelloidea Gray, 1825. In light of the new data obtained from ten additional species, the historical biogeography reconstructed shows that the tropical western Pacific and eastern Indian Oceans are the cradle for early sand dollar diversification. Hothouse conditions during the late Cretaceous and early Paleogene were coupled with diversification events of major clades of sand dollars. We also demonstrate that Taiwan fauna can play a key role in terms of understanding the major Cenozoic migration and dispersal events in the evolutionary history of Luminacea.

The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting.

Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.

Tailoring InSb Nanowires for High Thermoelectric Performance Using AAO Template-Assisted Die Casting Process.

Herein, we demonstrate a facile technique for the fabrication of one-dimensional indium antimonide (InSb) nanowires using anodic aluminium oxide (AAO) template-assisted vacuum die-casting method. The filling mechanism of the vacuum die-casting process is investigated on varying AAO pore structures through different electrolytes. It is found that the anodizing electrolytes play a vital role in nanowire growth and structure formation. The as-obtained InSb nanowires from the dissolution process show a degree of high crystallinity, homogeneity, and uniformity throughout their structure. The TEM and XRD results elucidated the InSb zinc-blende crystal structure and preferential orientation along the c-axis direction. The thermoelectric characteristics of InSb nanowires were measured with a four-electrode system, and their resistivity, Seebeck coefficient, power factor, thermal conductivity, and ZT have been evaluated. Further, surface-modified nanowires using the reactive-ion etching technique showed a 50% increase in thermoelectric performance.

Changing surface ocean circulation caused the local demise of echinoid Scaphechinus mirabilis in Taiwan during the Pleistocene-Holocene transition.

Abundant fossil specimens of Scaphechinus mirabilis, now occurring mostly in temperate waters, have been found in the Toukoshan Formation (Pleistocene) in Miaoli County, Taiwan. Environmental changes leading to its extirpation (local extinction) have thus far been elusive. Here, we reconstruct past environmental and oceanic conditions off northwest Taiwan by analyzing clumped isotopes, as well as stable oxygen isotopes, of well-preserved fossil echinoid tests collected from the Toukoshan Formation. Radiocarbon dates suggest that these samples are from Marine Isotope Stage 3 (MIS 3). Paleotemperature estimates based on clumped isotopes indicate that fossil echinoids were living in oceanic conditions that range from 9 to 14 °C on average, comparable with the estimate derived for a modern sample from Mutsu Bay, Japan. Notably, this temperature range is ~ 10 °C colder than today's conditions off northwest Taiwan. The substantially lower temperatures during ~ 30 ka (MIS 3) compared to the modern conditions might be due to the rerouting of surface currents off northwest Taiwan when the sea level was ~ 60 m lower than today, in addition to the cooling caused by a lower atmospheric CO2 level during the Last Glacial Period. Colder waters brought here by the China Coastal Current (CCC) and the existence of shallow subtidal zones termed "Miaoli Bay" (mainly located in the present-day Miaoli county) during MIS 3 plausibly sustained generations of S. mirabilis, yielding tens of thousands of fossil specimens in the well-preserved fossil beds. The likely extirpation driver is the drastic change from a temperate climate to much warmer conditions in the shallow sea during the Pleistocene-Holocene transition.

Patient-physician communication in the emergency department in Taiwan: physicians' perspectives.

BACKGROUND: Effective patient-physician communication promotes trust and understanding between physicians and patients and reduces medical disputes. In this study, the Roter Interaction Analysis System was used to explore physician-patient communication behaviors in the emergency departments of Taiwanese hospitals. METHOD: Data was collected from the dialogues between 8 emergency physicians and 54 patients through nonparticipant observation, and 675 pieces of data were quantitatively and qualitatively analyzed. RESULTS: The results showed that: 1. Emergency physicians' communication behaviors are task-focused. They usually ask closed-ended questions to collect data to identify the symptoms quickly and provide medical treatment. 2. Socioemotion-oriented physician-patient communication behaviors are less common in the emergency department and only serve as an aid for health education and follow-up. Due to time constraints, it is difficult to establish relationships with patients and evoke their positivity. CONCLUSIONS: It is suggested that future education programs on physician-patient communication in the emergency department should focus on strengthening physicians' ability to communicate with patients in a more open way. They should adopt socioemotional-oriented communication skills, expressing respect and kindness, and allowing patients to briefly describe their symptoms and participate in the treatment process to achieve physician-patient consensus.

A Study to Analyze Narrative Feedback Record of an Emergency Department.

BACKGROUND: This study adopts the Situation-Behavior-Impact-Action (SBIA) model to examine the compliance of narrative feedback in the Entrustable Professional Activities (EPAs)-based e-Portfolio system for clinical preceptors in the emergency department of a regional teaching hospital, and analyzes the applicability of its application in emergency clinical training to increase the feasibility of improving the quality of clinical preceptors' feedback content. METHODS: Application of data mining technique to analyze 928 data points was recorded by 14 clinical teachers from April 2017 to May 2019. These data points were narrative feedback from workplace direct observation, which was recorded in the EPAs-based e-Portfolio. RESULTS: The majority of the narrative feedback consisted of only one component, behavior observed (53.99%) and action suggestion (17.24%). Some feedback consisted of two to three components; which were behavior observed-action suggestion (20.37%) and situation description-behavior observed- action suggestion (1.29%). Only a few feedbacks consisted of all four components: situation description- behavior observed-possible impact-action suggestion (0.75%). CONCLUSIONS: The current narrative feedback is from the basic appearance of SBIA, but there still got room for improvement. The narrative feedback should be given according to SBIA model in order to provide a comprehensive and constructive learning outcome. The narrative feedback recorded in EPAsbased e-Portfolio provides the delay of feedback effect. Thus, multiple feedbacks from various clinical teachers could make the assessments more concrete and outline the authentic clinical condition of the trainees.

User Experience Evaluation of the EPAs-Based e-Portfolio System and an Analysis of Its Impact.

BACKGROUND: To carry out competency-based medical education, this study has established five Entrustable Professional Activities (EPAs) for the emergency medicine residents. The EPAs involve substantial data collection, which requires integration and analysis for the fi nal interpretation. Therefore, the "EPAs-Based e-Portfolio System" has been developed for assisting users to perform ad-hoc assessment, recording of a discussion, teaching, and feedback. The purpose of this study is to examine, from the perspective of the Technology Acceptance Model, residents and clinicians' experience of the EPAs-Based e-Portfolio System, including the use of functions such as recording, feedback, and assessment, as well as the impact thereof. METHODS: This study uses in-depth interviews as a means of data collection. The interviewees are from emergency medicine training hospitals in north, central, and south Taiwan-11 resident doctors and nine medical teachers. RESULTS: The interviewees agree that (1) the EPAs-based e-Portfolio System provides users with a complete learning trajectory record through cloudization and ease of use; (2) it can assist users to gain feedback, case review, and reflection; (3) information on user status can reflect their learning progress, competencies, and performance; (4) other potential functions that can be added include shortcut keys, initiation of assessment sheets by a learner, feedback to teacher's comment, and voice/picture input. CONCLUSIONS: The results of this study indicate that the easier a system is for users to use, the more helpful they will consider it and the more positive they will be, which will then translate into greater willingness to use the system and higher frequency of actual use. The system can authentically reflect trainees' professional capabilities if the ad-hoc teaching and feedback in the clinical setting connect strongly with the online assessment and recording.

High Mass Ion Detection with Charge Detector Coupled to Rectilinear Ion Trap Mass Spectrometer.

Conventional linear ion trap mass analyzers (LIT-MS) provide high ion capacity and show their MS n ability; however, the detection of high mass ions is still challenging because LIT-MS with secondary electron detectors (SED) cannot detect high mass ions. To detect high mass ions, we coupled a charge detector (CD) to a rectilinear ion trap mass spectrometer (RIT-MS). Immunoglobulin G ions (m/z ~150,000) are measured successfully with controlled ion kinetic energy. In addition, when mass-to-charge (m/z) ratios of singly charged ions exceed 10 kTh, the detection efficiency of CD is found to be greater than that of SED. The CD can be coupled to LIT-MS to extend the detection mass range and provide the potential to perform MS n of high mass ions inside the ion trap. Graphical Abstract ᅟ.

Contribution of Phe-7 to Tat-dependent export of ß-lactamase in Xanthomonas campestris.

Strains of Xanthomonas campestris pv. campestris isolated in Taiwan are commonly resistant to ampicillin owing to the constitutive expression of a chromosomally encoded ß-lactamase that is secreted into the periplasm. In this study, we found that levels of ß-lactamase vary among X. campestris pv. campestris strains, a difference that can be attributed to amino acid substitutions at least at positions 7 and 206, with the former having the major impact. Bioinformatic and PCR analyses indicated that X. campestris pv. campestris possesses tatABC genes and that the signal peptide of X. campestris pv. campestris pre-Bla contains the typical twin-arginine motif (N-R-R-Q-F-L at amino acid residues 3 to 8 in strain X. campestris pv. campestris strain 11), suggesting that Bla is secreted via the Tat pathway. To assess the importance of Phe(7) in the efficient export of X. campestris pv. campestris Bla, we prepared mutant constructs containing amino acid substitutions and monitored their expression by measuring enzyme activity and detecting Bla protein by Western blotting. The results indicate that replacement of Phe(7) with Leu severely inhibited Bla export whereas replacement with Pro almost abolished it. Although a change to Arg caused moderate inhibition of export, replacement with Tyr had no effect. These results suggest that for efficient export of Bla by X. campestris pv. campestris, the aromatic-aromatic interactions and stability of protein structure around the twin-arginine motif are important, since only proteins that can attain a folded state in the cytoplasm are competent for export via the Tat pathway.