Reducing Medication Errors by Adopting Automatic Dispensing Cabinets in Critical Care Units.

Medication errors can have severe consequences and threaten patient safety. The patient safety-related benefits of automated dispensing cabinets (ADCs) have been reported by several previous studies, including a reduction in medication errors in intensive care units (ICUs) and emergency departments. However, the benefits of ADCs need to be assessed, given the different healthcare practice models. This study aimed to compare the rates of medication errors, including prescription, dispensing, and administrative, before and after using ADCs in intensive care units. The prescription, dispensing, and administrative error data before and after the adoption of ADCs were retrospectively collected from the medication error report system. The severity of medication errors was classified according to the National Coordinating Council for Medication Error Reporting and Prevention guidelines. The study outcome was the rate of medication errors. After the adoption of ADCs in the intensive care units, the rates of prescription and dispensing errors reduced from 3.03 to 1.75 per 100,000 prescriptions and 3.87 to 0 per 100,000 dispensations, respectively. The administrative error rate decreased from 0.046 to 0.026%. The ADCs decreased National Coordinating Council for Medication Error Reporting and Prevention category B and D errors by 75% and category C errors by 43%. To improve medication safety, multidisciplinary collaboration and strategies, such as the use of automated dispensing cabinets, education, and training programs from a systems perspective, are warranted.

Machine learning to predict late respiratory support in preterm infants: a retrospective cohort study.

Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our definition and prediction of BPD is challenging yet indispensable. We aimed to apply machine learning (ML) to investigate effective models by using the recently-proposed and data-driven definition to predict late respiratory support modalities at 36 weeks' post menstrual age (PMA). We collected data on very-low-birth-weight infants born between 2016 and 2019 from the Taiwan Neonatal Network database. Twenty-four attributes associated with their early life and seven ML algorithms were used in our analysis. The target outcomes were overall mortality, death before 36 weeks' PMA, and severity of BPD under the new definition, which served as a proxy for respiratory support modalities. Of the 4103 infants initially considered, 3200 were deemed eligible. The logistic regression algorithm yielded the highest area under the receiver operating characteristic curve (AUROC). After attribute selection, the AUROC of the simplified models remain favorable (e.g., 0.801 when predicting no BPD, 0.850 when predicting grade 3 BPD or death before 36 weeks' PMA, and 0.881 when predicting overall mortality). By using ML, we developed models to predict late respiratory support. Estimators were developed for clinical application after being simplified through attribute selection.

The three-dimensional plasma structures and flows of the Earth's upper atmosphere due to the Moon's gravitational force.

The semidiurnal (12.42 h) and semimonthly (14.76 days) lunar tides have been well-known by fishermen for several centuries. The gravitational force of the relative positions between the Sun, the Moon, and the Earth results in two symmetrical tidal bulges (double bulges) appearing at equatorial latitudes directly under and opposite the Moon. We utilize ionospheric GNSS (Global Navigation Satellite System) radio occultation soundings to show the global three-dimensional structures and dynamics of the double bulges of ionospheric lunar tides for the first time. The double-bulge amplitude of ionospheric F2-peak height hmF2, lagging the sublunar or antipodal point by about 2-3 h, is about 3-5 km at the equator and 1.5-2.0 km at ± 35° magnetic latitude. The electron density further depicts global three-dimensional plasma flows in the ionosphere.

Wearable microneedle-based electrochemical aptamer biosensing for precision dosing of drugs with narrow therapeutic windows.

Therapeutic drug monitoring is essential for dosing pharmaceuticals with narrow therapeutic windows. Nevertheless, standard methods are imprecise and involve invasive/resource-intensive procedures with long turnaround times. Overcoming these limitations, we present a microneedle-based electrochemical aptamer biosensing patch (µNEAB-patch) that minimally invasively probes the interstitial fluid (ISF) and renders correlated, continuous, and real-time measurements of the circulating drugs' pharmacokinetics. The µNEAB-patch is created following an introduced low-cost fabrication scheme, which transforms a shortened clinical-grade needle into a high-quality gold nanoparticle-based substrate for robust aptamer immobilization and efficient electrochemical signal retrieval. This enables the reliable in vivo detection of a wide library of ISF analytes-especially those with nonexistent natural recognition elements. Accordingly, we developed µNEABs targeting various drugs, including antibiotics with narrow therapeutic windows (tobramycin and vancomycin). Through in vivo animal studies, we demonstrated the strong correlation between the ISF/circulating drug levels and the device's potential clinical use for timely prediction of total drug exposure.

Predicting in-hospital length of stay for very-low-birth-weight preterm infants using machine learning techniques.

BACKGROUND/PURPOSE: The in-hospital length of stay (LOS) among very-low-birth-weight (VLBW, BW < 1500 g) infants is an index for care quality and affects medical resource allocation. We aimed to analyze the LOS among VLBW infants in Taiwan, and to develop and compare the performance of different LOS prediction models using machine learning (ML) techniques. METHODS: This retrospective study illustrated LOS data from VLBW infants born between 2016 and 2018 registered in the Taiwan Neonatal Network. Among infants discharged alive, continuous variables (LOS or postmenstrual age, PMA) and categorical variables (late and non-late discharge group) were used as outcome variables to build prediction models. We used 21 early neonatal variables and six algorithms. The performance was compared using the coefficient of determination (R2) for continuous variables and area under the curve (AUC) for categorical variables. RESULTS: A total of 3519 VLBW infants were included to illustrate the profile of LOS. We found 59% of mortalities occurred within the first 7 days after birth. The median of LOS among surviving and deceased infants was 62 days and 5 days. For the ML prediction models, 2940 infants were enrolled. Prediction of LOS or PMA had R2 values less than 0.6. Among the prediction models for prolonged LOS, the logistic regression (ROC: 0.724) and random forest (ROC: 0.712) approach had better performance. CONCLUSION: We provide a benchmark of LOS among VLBW infants in each gestational age group in Taiwan. ML technique can improve the accuracy of the prediction model of prolonged LOS of VLBW.

Equatorial ionization anomaly response to lunar phase and stratospheric sudden warming.

This study examines the ionosphere response to gravitational forces of the lunar phase and dynamical disturbances of the stratospheric sudden warmings (SSWs). The total electron content (TEC) of global ionosphere maps is employed to examine responses of the equatorial ionization anomaly (EIA) crests to lunar phases and twelve SSW events during 2000-2013. The most prominent feature in the ionosphere is the EIA, characterized by two enhanced TEC crests at low latitudes straddling the magnetic equator, which can be used to observe ionospheric plasma dynamics and structures. Results show that the EIA crest appearance time on new/full moons (first/third quarters) leads (lags) that of the overall 14-year average, which causes a pattern of TEC morning enhancements (suppressions) and afternoon suppressions (enhancements). A statistical analysis shows that SSWs can also significantly cause the early appearance of EIA crests, regardless of the lunar phase. Thus, both lunar phase and SSWs can significantly modulate the appearance time of EIA crest and ionospheric plasma dynamics and structures.

Employees' perceived institutional importance, organizational norms, and organizational citizenship behavior: Insights from a multilevel assessment of the institutional anomie theory.

This study contributes to the understanding of organizational citizenship behavior (OCB) and extending the application of institutional anomie theory (IAT). Employing a multilevel moderation framework, this paper explored the influence of employees' perceived institutional importance to their demonstration of OCB and the moderating impacts of organizational norms on this relationship. Utilizing data of 243 employees from 34 banks in the Philippines, results of the hierarchical linear modeling (HLM) analysis revealed the positive influence of the importance of the economy, family, polity, and religion on employees' citizenship acts. Furthermore, goal emphasis and socio-emotional support have significant interacting effects on the association between perceived institutional importance and OCB.

Robust binaural rendering with the time-domain underdetermined multichannel inverse prefilters.

In this paper, a robust binaural audio rendering system is proposed on the basis of a time-domain underdetermined multichannel inverse filtering approach. The celebrated multiple-input/output inverse theorem is reformulated into a general multichannel model-matching problem with the emphasis on binaural audio reproduction. Robustness with widened sweet spots is achieved by selecting multiple control points in the reproduction zones. The model-matching problem is formulated in the time domain as an underdetermined system, where the number of channels is selected in relation to the number of virtual sources and control points. Under the full-rank condition, exact solutions of inverse filters always exist to fulfill the ideal model-matching criterion. However, the gains of prefilters need to be limited in the design stage by using the Tikhonov regularization at a minor expense of matching performance. The proposed binaural audio system has been implemented on a six-element linear loudspeaker array. Three problems of binaural rendering, cross talk cancellation, source widening, and 5.1 virtual surround, are adopted to validate the proposed approach. Results of objective and subjective tests have demonstrated the efficacy of the proposed approach for binaural audio rendering.

Role ambiguity and economic hardship as the moderators of the relation between abusive supervision and job burnout: An Application of uncertainty management theory.

Based on uncertainty management theory (Lind & Van den Bos, 2002; Van den Bos & Lind, 2002), we explored whether uncertainty in the workplace (role ambiguity) as well as off the workplace (economic hardship) moderates the relationship between abusive supervision and subordinates' job burnout. Using survey method, we obtained 458 valid responses from employees in a transportation company in Taiwan. The results of moderated hierarchical regression showed that both role ambiguity and economic hardship induce the positive relationship between abusive supervision and subordinates' job burnout. Abusive supervision related more strongly to job burnout when subordinates perceived higher role ambiguity (higher uncertainty) or higher economic hardship (higher uncertainty). As predicted, high uncertainty increases subordinates' attentions to the injustice from abusive supervision and thus strengthens the negative psychological consequences of abusive supervision, regardless of whether the source of uncertainty corresponds to the source of (in)justice perception.

Hydrophobic Collapse Initiates the Poly( N-isopropylacrylamide) Volume Phase Transition Reaction Coordinate.

The best-known examples of smart, responsive hydrogels derive from poly( N-isopropylacrylamide) (PNIPAM) cross-linked polymer networks. These hydrogels undergo volume phase transitions (VPTs) triggered by temperature, chemical, and/or environmental changes. PNIPAM hydrogels can undergo more than 50-fold volume changes within ∼1 µs intervals. Studies have tried to elucidate the molecular mechanism of these extraordinarily large responses. Nevertheless, the molecular reaction coordinates that drive the VPT remain unclear. Using visible nonresonance Raman temperature-jump spectroscopy, we determined the molecular ordering of this VPT. The PNIPAM hydrophobic isopropyl and methylene groups dehydrate with time constants of 109 ± 64 and 104 ± 44 ns, initiating the volume collapse of PNIPAM. The subsequent dehydration of the PNIPAM amide groups is significantly slower, as our group previously discovered (360 ± 85 ns). This determination of the ordering of the molecular reaction coordinate of the PNIPAM VPT enables the development of the next generation of super-responsive materials.

Intercellular transfer of pathogenic α-synuclein by extracellular vesicles is induced by the lipid peroxidation product 4-hydroxynonenal.

Parkinson's disease (PD) is characterized by accumulations of toxic α-synuclein aggregates in vulnerable neuronal populations in the brainstem, midbrain, and cerebral cortex. Recent findings suggest that α-synuclein pathology can be propagated transneuronally, but the underlying molecular mechanisms are unknown. Advances in the genetics of rare early-onset familial PD indicate that increased production and/or reduced autophagic clearance of α-synuclein can cause PD. The cause of the most common late-onset PD is unclear, but may involve metabolic compromise and oxidative stress upstream of α-synuclein accumulation. As evidence, the lipid peroxidation product 4-hydroxynonenal (HNE) is elevated in the brain during normal aging and moreso in brain regions afflicted with α-synuclein pathology. Here, we report that HNE increases aggregation of endogenous α-synuclein in primary neurons and triggers the secretion of extracellular vesicles (EVs) containing cytotoxic oligomeric α-synuclein species. EVs released from HNE-treated neurons are internalized by healthy neurons which as a consequence degenerate. Levels of endogenously generated HNE are elevated in cultured cells overexpressing human α-synuclein, and EVs released from those cells are toxic to neurons. The EV-associated α-synuclein is located both inside the vesicles and on their surface, where it plays a role in EV internalization by neurons. On internalization, EVs harboring pathogenic α-synuclein are transported both anterogradely and retrogradely within axons. Focal injection of EVs containing α-synuclein into the striatum of wild-type mice results in spread of synuclein pathology to anatomically connected brain regions. Our findings suggest a scenario for late-onset PD in which lipid peroxidation promotes intracellular accumulation and then extrusion of EVs containing toxic α-synuclein species; the EVs are then internalized by adjacent neurons, so propagating the neurodegenerative process.

When supervisors perceive non-work support: test of a trickle-down model.

Using the trickle-down model as the theoretical foundation, we explored whether subordinates' perceived supervisory non-work support (subordinates' PSNS) mediates the relationship between supervisors' perception of higher-level managers' non-work support (supervisors' PSNS) and subordinates' organizational citizenship behaviors. Using dyadic data collected from 132 employees and their immediate supervisors, we found support for the aforementioned mediation process. Furthermore, supervisors' perceived in-group/out-group membership of subordinates moderated the aforementioned supervisors' PSNS-subordinates' PSNS relationship, such that this relationship is stronger for out-group subordinates. Theoretical and practical implications and future research directions are discussed.

Hydration of cations: a key to understanding of specific cation effects on aggregation behaviors of PEO-PPO-PEO triblock copolymers.

This work reports results from the interactions of a series of monovalent and divalent cations with a triblock copolymer, poly(ethylene oxide)-b-poly(propylene oxide)-b-poly(ethylene oxide) (PEO-PPO-PEO). Phase transition temperatures of the polymer in the presence of chloride salts with six monovalent and eight divalent cations were measured using an automated melting point apparatus. The polymer undergoes a two-step phase transition, consisting of micellization of the polymer followed by aggregation of the micelles, in the presence of all the salts studied herein. The results suggest that hydration of cations plays a key role in determining the interactions between the cations and the polymer. The modulation of the phase transition temperature of the polymer by cations can be explained as a balance between three interactions: direct binding of cations to the oxygen in the polymer chains, cations sharing one water molecule with the polymer in their hydration layer, and cations interacting with the polymer via two water molecules. Monovalent cations Na(+), K(+), Rb(+), and Cs(+) do not bind to the polymer, while Li(+) and NH4(+) and all the divalent cations investigated including Mg(2+), Ca(2+), Sr(2+), Ba(2+), Co(2+), Ni(2+), Cu(2+), and Cd(2+) bind to the polymer. The effects of the cations correlate well with their hydration thermodynamic properties. Mechanisms for cation-polymer interactions are discussed.

Crystalline growth of rubrene film enhanced by vertical ordering in cadmium arachidate multilayer substrate.

The growth of highly crystalline rubrene thin films for organic field effect transistor (OFET) application remains a challenge. Here, we report on the vapor-deposited growth of rubrene films on the substrates made of cadmium arachidate (CdA) multilayers deposited onto SiO2/Si(100) via the Langmuir-Blodgett technique. The CdA films, containing 2n+1 layers, with integer n ranging from 0 to 4, are surface-terminated identically by the methyl group but exhibit the thickness-dependent morphology. The morphology and structure of both CdA and rubrene films are characterized by X-ray reflectivity (XRR), X-ray diffraction (XRD), near-edge X-ray absorption fine structure (NEXAFS) spectroscopy, and atomic force microscopy (AFM). Crystalline rubrene films, evidenced by XRD and marked by platelet features in AFM images, become observable when grown onto the CdA layer thicker than 5L. XRD data show that vertical ordering, that is, ordering along surface normal, of CdA multilayer substrates exerts a strong influence in promoting the crystalline growth of rubrene films. This promoted growth is not due to the surface energy of CdA layer but derived from the additional interaction localized between rubrene and CdA island sidewall and presumably strengthened by a close dimensional match between the a-axis of rubrene lattice and the layer spacing of CdA multilayer. The best OFET mobility is recorded for 9L CdA substrate and reaches 6.7 × 10(-2) cm(2) V(-1) s(-1), presumably limited by the roughness of the interface between CdA and rubrene films.

Abusive supervision and workload demands from supervisors: exploring two types of supervisor-related stressors and their association with strain.

Our study aimed to identify two types of stressors from supervisors: abusive supervision (AS) and workload demands from supervisors (WDS). AS reflects the relationship dimension of supervisor-related stressors, and WDS reflects the task dimension of supervisor-related stressors. In Study 1, we attempted to distinguish between AS and WDS. The results of confirmatory factor analysis showed that AS and WDS are two distinct dimensions of supervisor-related stressors. In Study 2, we utilized job demands-resources model and investigated whether AS and WDS can uniquely predict subordinates' emotional exhaustion (EE). We also explored whether perceived job characteristics (PJCs) have differential moderating effects on the relationships between the two dimensions of supervisor-related stressors (AS and WDS) and EE. Consistent with our predictions, the results showed that both AS and WDS have incremental predictive effects on EE after controlling for the effect of the other. The results also revealed that PJCs weaken the WDS-EE relationship, not the AS-EE relationship. We discussed the theoretical and practical implications at the end.

Measurement equivalence/invariance of the abusive supervision measure across workers from Taiwan and the United States.

Growing international research interest in negative-leadership behaviors prompts the need to examine whether measures of ineffective leadership developed in the United States are equivalent across countries outside the United States. B. J. Tepper's (2000) abusive supervision measure has been used widely inside and outside the United States and merits research attention on its construct equivalence across different cultural settings. The authors conducted a series of multigroup confirmatory factor analyses to investigate the measurement equivalence of this measure across Taiwan (N = 256) and the United States (N = 389). Configural invariance was established, suggesting that both U.S. and Taiwanese samples perceive abusive supervision as a single-factor concept. Furthermore, the establishment of partial metric invariance and partial scalar invariance suggests that the abusive supervision measure is applicable to crosscultural comparisons in latent means, construct variance, construct covariances, and unstandardized path coefficients with the caution that workers from different cultures calibrate their responses differently when answering some items.

Effect of Oriental Medicinal Plant Extracts on Spore Germination of Alternaria brassicicola and Nature of Inhibitory Substances from Speedweed.

Among 65 species of oriental medicinal plants tested, 39 contained substances inhibitory to conidial germination of Alternaria brassicicola, with the most inhibitory extract from speedweed (Polygonum perfoliatum). The inhibitory substances in dried speedweed were insoluble in water. However, the inhibitors were readily extracted with ethanol or methanol, but not with acetone, ether, or chloroform. The ethanol extract was very effective in controlling black leaf spot of spoon cabbage, Brassica campestris subsp. chinensis, caused by A. brassicicola. The inhibitory effect of the extract was not affected by treatment with anion exchange resins, but was partially reduced by cation exchange resins, indicating the presence of two inhibitory substances in the extract, one with a positive charge and the other with no charge on its molecule. The inhibitory substances in the extract were dialyzable with molecular weight minimums of 10,000 or 1,000, but not 500 or 100, suggesting that both inhibitors have molecular weights between 500 and 1,000.