Numerical Investigation of Layered Homogeneous Skull Model for Simulations of Transcranial Focused Ultrasound.

BACKGROUND AND OBJECTIVES: The influence of the intracranial pressure field must be discussed with the development of a single-element transducer for low-intensity transcranial focused ultrasound because the skull plays a significant role in blocking and dispersing ultrasound wave propagation. Ultrasound propagation is mainly affected by the structure and acoustic properties of the skull; thus, we aimed to investigate the impact of simplifying the acoustic properties of the skull on the simulation of the transcranial pressure field to present guidance for efficient skull modeling in full-wave simulations. MATERIALS AND METHODS: We constructed a three-dimensional computational model for ultrasound transmission with the same structure but varying acoustic properties of the skull. The structural information and heterogeneous acoustic properties of the skull were acquired from computed tomography images, and we segmented the skull into three layers (3 L), including spongy and compact bones. We then assigned homogeneous acoustic properties to a single layer (1 L) or 3 L of the skull. In addition, we investigated the influence of different types of transducers and different ultrasound frequencies (1.1 MHz, 0.5 MHz, and 0.25 MHz) on the intracranial pressure field to provide a comparison of the heterogenous and homogeneous models. RESULTS: We indicated the importance of numerical simulations in estimating the intracranial pressure field of the skull owing to beam distortions. When we simplified the skull model, both the 1 L and 3 L models showed contours of the acoustic focus comparable to those of the heterogeneous model. When we evaluated the peak pressure and volume of the acoustic focus, the 1 L model produced a better estimation of peak pressure with a difference <10%, and the 3 L model is suitable to obtain smaller errors in the volume of the acoustic focus. CONCLUSIONS: In conclusion, we examined the possibility of simplification of skull models using 1 L and 3 L homogeneous properties in the numerical simulation for focused ultrasound. The results show that the layered homogeneous model can provide characteristics comparable to those of the acoustic focus in heterogeneous models.

Cannabinoids modulate the microbiota-gut-brain axis in HIV/SIV infection by reducing neuroinflammation and dysbiosis while concurrently elevating endocannabinoid and indole-3-propionate levels.

BACKGROUND: Although the advent of combination anti-retroviral therapy (cART) has transformed HIV into a manageable chronic disease, an estimated 30-50% of people living with HIV (PLWH) exhibit cognitive and motor deficits collectively known as HIV-associated neurocognitive disorders (HAND). A key driver of HAND neuropathology is chronic neuroinflammation, where proinflammatory mediators produced by activated microglia and macrophages are thought to inflict neuronal injury and loss. Moreover, the dysregulation of the microbiota-gut-brain axis (MGBA) in PLWH, consequent to gastrointestinal dysfunction and dysbiosis, can lead to neuroinflammation and persistent cognitive impairment, which underscores the need for new interventions. METHODS: We performed RNA-seq and microRNA profiling in basal ganglia (BG), metabolomics (plasma) and shotgun metagenomic sequencing (colon contents) in uninfected and SIV-infected rhesus macaques (RMs) administered vehicle (VEH/SIV) or delta-9-tetrahydrocannabinol (THC) (THC/SIV). RESULTS: Long-term, low-dose THC reduced neuroinflammation and dysbiosis and significantly increased plasma endocannabinoid, endocannabinoid-like, glycerophospholipid and indole-3-propionate levels in chronically SIV-infected RMs. Chronic THC potently blocked the upregulation of genes associated with type-I interferon responses (NLRC5, CCL2, CXCL10, IRF1, IRF7, STAT2, BST2), excitotoxicity (SLC7A11), and enhanced protein expression of WFS1 (endoplasmic reticulum stress) and CRYM (oxidative stress) in BG. Additionally, THC successfully countered miR-142-3p-mediated suppression of WFS1 protein expression via a cannabinoid receptor-1-mediated mechanism in HCN2 neuronal cells. Most importantly, THC significantly increased the relative abundance of Firmicutes and Clostridia including indole-3-propionate (C. botulinum, C. paraputrificum, and C. cadaveris) and butyrate (C. butyricum, Faecalibacterium prausnitzii and Butyricicoccus pullicaecorum) producers in colonic contents. CONCLUSION: This study demonstrates the potential of long-term, low-dose THC to positively modulate the MGBA by reducing neuroinflammation, enhancing endocannabinoid levels and promoting the growth of gut bacterial species that produce neuroprotective metabolites, like indole-3-propionate. The findings from this study may benefit not only PLWH on cART, but also those with no access to cART and more importantly, those who fail to suppress the virus under cART.

Job satisfaction and moral distress of nurses working as physician assistants: focusing on moderating role of moral distress in effects of professional identity and work environment on job satisfaction.

BACKGROUND: Physician assistant was created in response to a shortage of physicians. However, this profession is not officially recognized in Korea. Many nurses are working as physician assistants. Their job satisfaction was low due to role conflict. Job satisfaction plays a major role in providing high quality nursing. This study aimed to investigate effects of work environment and professional identity on job satisfaction and identify the mediating role of moral distress in such effects. METHODS: Participants were 112 nurses working as physician assistants. They were recruited from three General Hospitals. A questionnaire scale was used to collect data. Data were analyzed using frequency, descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation, and Macro Model 4 with SPSS Statistics. RESULTS: Job satisfaction of nurses working as physician assistants had a score of 3.08 out of 5. It showed significant associations with work environment and professional identity. Moral distress had a partial mediating role in relationships of job satisfaction with work environment and professional identity. CONCLUSION: Many nurses are working as physician assistants, although physician assistant as a profession is not officially recognized in Korea. Nurses working as physician assistants experience confusion about their professional identity and moral distress. For better nursing outcomes, physician assistant policy should be improved, and various strategies should be provided to improve their job satisfaction.

The use of photovoice in nursing education: A scoping review.

Given the variety of uses of photovoice in nursing education, the importance of clarifying and describing this method is apparent. This scoping review aimed to explore the evidence on the use of photovoice in nursing education, describe the state of knowledge in this area, and identify knowledge gaps within the existing literature. A comprehensive search was performed in seven databases including MEDLINE, CINAHL, Embase, and Education Full Text. Three gray literature databases (ProQuest Dissertations and Theses Global database, EThOS, and PapersFirst) were also searched. This scoping review was conducted with reference to the JBI scoping review guidelines and reported using the PRISMA-ScR statement. A total of 22 studies published between 2001 and 2022 were included in this scoping review. The findings indicate that photovoice is used globally in nursing education to teach in various courses and content areas within online, hybrid, and in-person environments. Despite the heterogeneity within the definition of photovoice and associated pedagogical strategies, the results of this scoping review suggest that photovoice can serve as an educational tool for nursing students.

A systematic review of videoconferencing in health professions education: the digital divide revisited in the COVID-19 era.

OBJECTIVES: During the COVID-19 pandemic, educators shifted from traditional lectures to videoconferencing. This systematic review explored the use of videoconferencing as a teaching tool in response to the pandemic as well as issues related to digital equity and inclusion. CONTENT: The review was conducted using the Joanna Briggs Institute for Systematic Reviews methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. SUMMARY: A total of nine studies met eligibility criteria. The participants in the included studies were medical students from various parts of the world. Technical difficulties and lack of human interactions were identified as barriers to learning through videoconferencing. OUTLOOK: To achieve full success, pedagogical videoconferencing must prioritize digital equity and a universal design for learning. Although useful for maintaining education during the pandemic, in the future, videoconferencing will present challenges related to the digital divide as well as opportunities as a teaching tool for nurse educators globally.

Cyclophilin A is an endogenous ligand for the triggering receptor expressed on myeloid cells-2 (TREM2).

Triggering receptor expressed on myeloid cells 2 (TREM2) is a cell surface receptor expressed on macrophages, microglial cells, and pre-osteoclasts, and that participates in diverse cellular function, including inflammation, bone homeostasis, neurological development, and coagulation. In spite of the indispensable role of the TREM2 protein in the maintenance of immune homeostasis and osteoclast differentiation, the exact ligand for TREM2 has not yet been identified. Here, we report a putative TREM2 ligand which is secreted from MC38 cells and identified as a cyclophilin A (CypA). A specific interaction between CypA and TREM2 was shown at both protein and cellular levels. Exogenous CypA specifically interacted and co-localized with TREM2 in RAW264.7 cells, and the physical interactions were shown to regulate TREM2 signaling transduction. The Pro144 residue in the extracellular domain of TREM2 was found to be the specific binding site of CypA. When considered together, this provides evidence that CypA interacts specifically with TREM2 as a potent ligand.

Neurocognitive and psychological functioning of pediatric brain tumor patients undergoing proton beam therapy for three different tumor types.

BACKGROUND: A high proportion of pediatric patients with brain tumors (BTs) are known to experience a decline in neurocognitive function after treatment. We prospectively examined neuropsychological functioning of patients with BTs of varying tumor types at different time points before, during, and after proton beam therapy. MATERIALS AND METHODS: A total of 98 patients with posterior fossa tumors (PFTs; n = 33), germ cell tumors (GCTs; n = 52), and other supratentorial tumors (STTs; n = 13) underwent baseline neuropsychological assessments and 57 patients underwent follow-up assessments. RESULTS: All groups displayed significantly lower performance intelligence quotient (PIQ) and processing speed (PS) scores than the normative means at baseline. The PFT group exhibited significantly lower scores for full-scale IQ, PIQ, PS, attention, and executive function. The GCT group displayed full-scale IQ scores within the normal range, but a significantly high proportion had memory deficits. In the STT group, all functions except for the PIQ and PS were intact. Longitudinal evaluations demonstrated stable global IQ scores over time in all groups. In the PFT group, verbal comprehension, attention, and PS improved over time. However, in the GCT group, verbal IQ scores declined significantly and psychological problems worsened over time, which were correlated with poorer neurocognitive function at 3-5 years after treatment. In the STT group, no significant changes were observed. CONCLUSION: Because patients with BTs exhibit various types of neurocognitive deficit before radiotherapy, early cognitive treatment tailored to the tumor type maybe beneficial. Interventions for psychological problems and memory function may be necessary, especially for patients with GCT.

What topics are women interested in during pregnancy: exploring the role of social media as informational and emotional support.

BACKGROUND: Social media plays an important role as a source for obtaining or sharing health information. It is frequently used as a resource by pregnant women who seek information and emotional support regarding their physical and role changes. To provide high-quality support for pregnant women, it is important to determine what topics they want information on from social media during their pregnancy, and what effects they expect from each topic. This study investigates what topics pregnant women are interested in according to their stage of pregnancy and need for informational or emotional support from each topic of interest. METHODS: An online survey was conducted with 302 pregnant Korean women. The survey questionnaires included information sources and experience of social media. Along with the questionnaires, they were asked to describe three to ten health topics that they were most interested in in the last two weeks. RESULTS: Social media (72.85%) and search engines (72.85%) were found to be most frequently used for pregnancy-related health information. The topics of interest slightly differed by stage, but mainly postpartum care, pregnancy symptoms, and daily life issues ranked high. Mood related topics appeared frequently among women in their first trimester or post-partum stage of pregnancy. Informational support was mostly needed for daily life issues, and emotional support needs centered mostly around stories about family and mood during pregnancy. CONCLUSIONS: Pregnant women have different needs for informational or emotional support, depending on their stage of pregnancy and their topics of interest. Therefore, social media support should be delivered with varying content and platforms tailored to women's needs at each trimester.

Patient-level and organizational-level factors influencing in-hospital falls.

AIM: In-hospital fall is one key safety issue in a healthcare setting. Although healthcare providers apply several strategies for preventing falls, falls still occur in hospitals. The aim of this study was to investigate patient-level and organizational-level factors influencing in-hospital falls. DESIGN: A multicentre retrospective observational study. METHODS: This study used the national healthcare database and supplemented with organizational data obtained through a survey. Data extraction and survey were conducted between July and August 2020. A mixed-effect logistic regression model was used to analyse factors influencing in in-hospital falls. RESULTS: A total of 43,286 patients admitted in 86 hospitals were included in this study. Fall rate was 0.85 per 1000 days. Length of stay was significantly longer for fall patients than for no-fall patients. Patient-level factors (including age, mobility impairment and surgery) and organizational-level factors (including nurse staffing and proportion of new nurses) were significant factors influencing in-hospital falls. CONCLUSION: Since in-hospital falls increase economic burden to patients, we should consider various fall prevention strategies to reduce falls. For a strategy to be applied stably to patients, organizational factors must be supported. IMPACT: Proactive fall management in acute settings is essential to ensure patient safety. Considering that the number of patients with fall risk is increasing due to ageing, organizational factors should be supported to provide quality nursing care for fall risk patients. Therefore, nurse leaders should primarily ensure an appropriate level of nurse staffing. They also need to make efforts to strengthen clinical competency of nurses.

Difference between self-reported adherence to standard precautions and surveillance and factors influencing observed adherence: a quantile regression approach.

BACKGROUND: Standard precautions are minimum healthcare-associated infection prevention practices applied in all healthcare settings. The aim of this study was to investigate adherence to standard precautions using a survey and surveillance. Factors affecting observed adherence to standard precautions were also determined. METHODS: This cross-sectional observational study included 163 clinical nurses who were directly involved in patient care. Differences in adherence according to investigative methods are represented as a boxplot. Quantile regression was used to identify factors affecting observed adherence, including organizational factors (such as department, safety environment, and patient safety climate) and personal factors (such as knowledge and awareness). Stata SE version 14.2 was used for all statistical analyses. RESULTS: The observed adherence to standard precautions was 76.8 out of 100, whereas the self-reported adherence was approximately 95. Hand hygiene adherence received the lowest score of less than 70. Factors influencing observed adherence were self-reported adherence (p = 0.043) in 25% and 50% quantiles, work experience (p = 0.002) in the 25% quantile, and working department (p = 0.030) in the 50% quantile. There were no significant factors in the 75% quantile. CONCLUSION: Inadequate adherence to standard precautions might increase healthcare-associated infections. Thus, an organizational environment such as nurse staffing needs to be established so that clinical nurses with high competency can comply with standard precautions in clinical settings.

The impact of resilience on turnover among newly graduated nurses: A 1-year follow-up study.

AIM: This study aimed to analyse the impact of resilience on turnover among newly graduated nurses. BACKGROUND: Nurse turnover is a major issue in nurse management that results in economic losses and affects patient and nurse outcomes. Newly graduated nurses experience stress and burnout during their transition period, leaving their job due to contextual and personal factors. Nurses' resilience affects turnover directly and indirectly through the mediating effect of stress and burnout. METHODS: We conducted a 1-year follow-up study to investigate factors influencing the turnover of newly graduated nurses. Survival analysis was used to analyse factors influencing the turnover. RESULTS: Turnover probability increased steadily and was approximately 0.20 within 2 years. Resilience was a significant factor affecting newly graduated nurses leaving their job in a short period of time. CONCLUSION: Newly graduated nurses' resilience is a significant factor influencing the turnover within a short period of time. Personal resources such as resilience and work environment should be considered for retaining newly graduated nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should recognize the impact of resilience on newly graduated nurses' turnover during the transitional period and establish strategies to enhance such resilience to promote a smooth transition and ultimately reduce turnover.

Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence.

AIM: To analyse patient factors and nurse staffing-related issues involving hospital-acquired pressure ulcers in patients at two types of hospital. BACKGROUND: Hospital-acquired pressure ulcers are important for the safety of hospitalized patients. Hospital-acquired pressure ulcers not only cause health problems, but also pose an economic burden to patients. In addition to patient factors such as mobility and skin integrity, hospital factors such as nurse staffing can also affect the management of such patients. METHODS: This study is a retrospective review of patient data and analysis of factors related to hospital-acquired pressure ulcers using stratified Cox proportional hazards regression. RESULTS: A total of 53,923 patients were included. The incidence of hospital-acquired pressure ulcers was 0.98 per 1,000 days. Hospital-acquired pressure ulcers were affected by gender, age, previous falls, low oxygen levels, positioning and toilet use. When the levels of nurse staffing were determined as one of the hospital factors, the daily hours of patient care was increased thereby contributing to the reduced incidents of hospital-acquired pressure ulcers. CONCLUSION: Strategies for preventing hospital-acquired pressure ulcers should be based on the analysis of risk factors. IMPLICATIONS FOR NURSING MANAGEMENT: Most individual risk factors for hospital-acquired pressure ulcers identified cannot be modified easily in a short time. Nurse staffing should be set at adequate levels to prevent hospital-acquired pressure ulcers.

Novel Animal Model of Spontaneous Cerebral Petechial Hemorrhage Using Focused Ultrasound in Rats.

Background and Objectives: Petechial cerebral hemorrhages can be caused by various factors, such as traumas, cerebral infarctions, and aging, and is related to the disruption of the blood-brain barrier or the cellular damage of blood vessels. However, there is no animal model that recapitulates cerebral petechial hemorrhages. Materials and Methods: Here, we implemented a petechial hemorrhage using a novel technology, i.e., microbubble-assisted focused ultrasound (MB + FUS). Results: This method increases the permeability of the blood-brain barrier by directly applying mechanical force to the vascular endothelial cells through cavitation of the microbubbles. Microbubble-enhanced cavitation has the advantage of controlling the degree and location of petechial hemorrhages. Conclusions: We thus generated a preclinical rat model using noninvasive focal MB + FUS. This method is histologically similar to actual petechial hemorrhages of the brain and allows the achievement of a physiologically resembling petechial hemorrhage. In the future, this method shall be considered as a useful animal model for studying the pathophysiology and treatment of petechial cerebral hemorrhages.

TREM2 promotes natural killer cell development in CD3-CD122+NK1.1+ pNK cells.

BACKGROUND: Triggering receptor expressed on myeloid cells 2 (TREM2) signaling is considered to regulate anti-inflammatory responses in macrophages, dendritic cell maturation, osteoclast development, induction of obesity, and Alzheimer's disease pathogenesis. However, little is known regarding the effect of TREM2 on natural killer (NK) cells. RESULTS: Here, we demonstrated for the first time that CD3-CD122+NK1.1+ precursor NK (pNK) cells expressed TREM2 and their population increased in TREM2-overexpressing transgenic (TREM2-TG) mice compared with that in female C57BL/6 J wild type (WT) mice. Both NK cell-activating receptors and NK cell-associated genes were expressed at higher levels in various tissues of TREM2-TG mice than in WT mice. In addition, bone marrow-derived hematopoietic stem cells (HSCs) of TREM2-TG mice (TG-HSCs) successfully differentiated into NK cells in vitro, with a higher yield from TG-HSCs than from WT-HSCs. In contrast, TREM2 signaling inhibition by TREM2-Ig or a phosphatidylinositol 3-kinase (PI3K) inhibitor affected the expression of the NK cell receptor repertoire and decreased the expression levels of NK cell-associated genes, resulting in significant impairment of NK cell differentiation. Moreover, in melanoma-bearing WT mice, injection of bone marrow cells from TREM2-TG mice exerted greater antitumor effects than that with cells from WT control mice. CONCLUSIONS: Collectively, our data clearly showed that TREM2 promoted NK cell development and tumor regression, suggesting TREM2 as a new candidate for cancer immunotherapy.

Axl is a key regulator of intestinal γδ T-cell homeostasis.

Gut-homing γδ T cells are induced by chemokines and cell adhesion molecules and play a critical role in homeostasis and mucosal immunity; however, little is known regarding their upstream regulators. We investigated the role of Axl as a specific regulator of chemokines and cell adhesion molecule in the distribution of intestinal γδ T cells. The population of γδ T-cell receptor-positive cells including Vγ1 and Vγ7 subsets was remarkably increased in the intraepithelial lymphocytes of Axl-/- mice compared with those of wild-type (WT) mice. An increased number of migrated γδ T cells were observed in the coculture with intraepithelial cells from Axl-/- mice. The mRNA expression level of chemokine (C-C motif) ligand (CCL) 25 was specifically higher in the small intestine of Axl-/- mice than in WT mice. In adoptive transfer, the migration of both thymic and extrathymic γδ T cells was increased in Axl-/- mice. The activation of Axl signaling down-regulated CCL25 expression via ERK signaling pathway and reduced the population of γδ T cells. Systemic dissemination was suppressed in Axl-/- mice infected with Salmonella typhimurium. Thus, our findings suggest that Axl plays a critical role in regulating the migration of γδ T cells for the maintenance of homeostasis and bacterial resistance.-Kim, S.-M., Park, M., Yee, S.-M., Ji, K.-Y., Lee, E.-H., Nguyen, T.-V., Nguyen, T. H.-L., Jang, J., Kim, E.-M., Choi, H.-R., Yun, C.-H., Kang, H.-S. Axl is a key regulator of intestinal γδ T-cell homeostasis.

Application of geographically weighted regression models to predict spatial characteristics of nitrate contamination: Implications for an effective groundwater management strategy.

Groundwater nitrate contamination has been the main water quality problem threatening the sustainable utilization of water resources in Jeju Island, South Korea. The spatially varying distribution of nitrate levels associated with complex environmental and anthropogenic factors has been a major challenge restricting improved groundwater management. In this study, we applied ordinary least squares (OLS) regression and geographically weighted regression (GWR) models to determine the relationships between the NO3-N concentration and various parameters (topography, hydrology and land use) across the island. A comparison between the OLS regression and GWR prediction models showed that the GWR models outperformed the OLS regression models, with a higher R2 and a lower corrected Akaike Information Criterion (AICc) value than the OLS regression models. Interestingly, the GWR model was able to provide undiscovered information that was not revealed in the OLS regression models. For example, the GWR model found that orchards (OR) and urban (UR) variables significantly contributed to nitrate enrichment in the certain parts of the island, whereas these variables were ignored as a statistically insignificant factor in the OLS regression model. Our study highlighted that GWR models are a useful tool for investigating spatially varying relationships between groundwater quality and environmental factors; therefore, it can be applied to establish advanced groundwater management plans by reflecting the spatial heterogeneity associated with environmental and anthropogenic conditions.

Why newly graduated nurses in South Korea leave their first job in a short time? A survival analysis.

BACKGROUND: South Korea is one of the countries with a very low percentage of active nurses among the Organization for Economic Cooperation and Development (OECD) countries. Although the number of nurses has increased steadily, the number of active nurses has not increased more than expected due to continued turnover. METHODS: This study used data of a longitudinal panel of Graduates Occupational Mobility Survey (GOMS) and performed survival analysis to determine the turnover rate of nurses and the average time of turnover. RESULTS: The turnover rate was the highest at 25% within first year and 50% of nurses left their first job during the study period. The hospital size and salary levels were major factors that affected the turnover rate, with small-scale hospitals and extremely low salary levels having the highest turnover. Dissatisfaction with the organization and dissatisfaction with the profession also directly impacted job turnover. Turnover rate of male nurses was higher than that of female nurses. CONCLUSION: Turnover of newly graduated nurses is highly inefficient personnel management. A strategy for reducing the turnover is needed.

Probabilistic ecological risk assessment of heavy metals using the sensitivity of resident organisms in four Korean rivers.

The environment has been continuously exposed to heavy metals by various routes, from both natural and artificial sources. In particular, heavy metals in water can affect aquatic organisms adversely, even at very low concentrations, and can lead to the disturbance of the ecosystem balance and biodiversity. Ecological risk assessments are conducted to protect the environment from such situations, primarily by deriving the predicted no-effect concentration (PNEC) from the species sensitivity distribution (SSD). This study developed the SSDs based on the species living in Korean freshwater for four heavy metals including cadmium (Cd), copper (Cu), lead (Pb), and zinc (Zn). The species compositions of the SSDs were examined, and three types of PNECs were derived by applying different assessment factors (AF). In addition, the occurrence and concentrations of heavy metals in Korean rivers were investigated, and the ecological risk assessment was carried out to compare the SSDs with the environmental concentrations. The SSDs were developed using a sufficient number of species, but the missing data of plants and insects provided an incomplete species composition. The results show that Cd and Pb in the environmental concentrations of rivers would not cause any risk to aquatic organisms from the derived PNEC. However, some organisms might be adversely affected by the concentrations of Zn, and a small amount of risk was expected under the conservative PNEC. The distribution of Cu in the rivers was not considered to be safe for aquatic organisms because the average environmental concentrations potentially affected the proportion of the SSD, and the environmental concentrations exceeded the PNECs. The concentrations of Cu and Zn in industrial waters indicated a considerable risk to aquatic organisms, and the probability of exceeding the PNECs appeared to be quite high. Therefore, this study indicates that additional actions and parallel field studies are required based on the risk posed to aquatic organisms by Cu and Zn in four Korean rivers.

Design and Implementation of a Trust Information Management Platform for Social Internet of Things Environments.

As the vast amount of data in social Internet of Things (IoT) environments considering interactions between IoT and people is accumulated and processed through cloud and big data technologies, the services that utilize them are applied in various fields. The trust between IoT devices and their data is recognized as the core of IoT ecosystem creation and growth. Connection with suspicious IoT devices may pose a risk to services and system operation. Therefore, it is essential to analyze and manage trust information for devices, services, and people, as well as to provide the trust information to the other devices or users that need it. This paper presents a trust information management framework which contains a generic IoT reference model with trust capabilities to achieve the goal of converged trust information management. Additionally, a trust information management platform (TIMP) consisting of trust agents, trust information brokers, and trust information management systems has been proposed, which aims to provide trustworthy and safe interactions among people, virtual objects, and physical things. Implementing and deploying a TIMP enables a trustworthy ecosystem to be built while activating social IoT businesses by reducing transaction costs, as well as by eliminating the uncertainties in the use of social IoT services and data transactions.

Multilevel factors influencing falls of patients in hospital: The impact of nurse staffing.

AIM: The objective of this study was to investigate both individual and organizational factors influencing the falls of patients in hospitals. BACKGROUND: Falls and fall-related injuries, which cause health problems and increase the economic burden to patients, are a critical issue for patient safety. METHODS: This study retrospectively reviewed patient data and analysed factors influencing patient falls using a mixed-effect model. RESULTS: The total number of patients in the study was 60,049, and the characteristics of the patients showed statistically significant differences according to the type of hospital where the fall occurred. The average rate of falls was 0.92 per 1,000 days. The rate of falls in general hospitals was the highest among all hospitals. Age, mobility impairment and hours per patient day for care delivered by registered nurses were factors influencing patients' falls. CONCLUSION: Since the number of patient falls in an acute-care setting might increase in the future because of the growing elderly population, we should consider these risk factors for falls and construct preventative programs accordingly. IMPLICATIONS FOR NURSING MANAGEMENT: An adequate level of nursing staff is an essential factor in the number of patient falls.