Physicochemical Properties of High-Entropy Oxides.

The development of industry has triggered an increasingly severe demand for new functional materials. In recent years, researches on high-entropy oxides (HEOs) are more comprehensive and in-depth, and their fascinating properties are gradually known to the public. The unique elemental synergistic effect and lattice distortion endow the high-entropy family with various untapped potential, and wide application fields and outstanding performance of HEOs make them candidates for future materials. In this review, the concept, structure, and synthesis of HEOs are firstly highlighted. Secondly, a variety of excellent properties and applications in the fields of mechanics, electrics, thermotics, optics and magnetics are summarized. This work provides a comprehensive overview about HEOs, facilitating the development of modern functionalities of the high-entropy family.

High-concentration LiPF6/sulfone electrolytes: structure, transport properties, and battery application.

Non-flammable and oxidatively stable sulfones are promising electrolyte solvents for thermally stable high-voltage Li batteries. In addition, sulfolane-based high-concentration electrolytes (HCEs) show high Li+ ion transference numbers. However, LiPF6 has not yet been investigated as the main salt in sulfone-based HCEs for Li batteries. In this study, we investigated the phase behaviors, solvate structures, and transport properties of binary and ternary mixtures of LiPF6 and the following sulfone solvents: sulfolane (SL), dimethyl sulfone (DMS), ethyl methyl sulfone (EMS), and 3-methyl sulfolane (MSL). The stable crystalline solvates Li(SL)4PF6 and Li(DMS)2.5PF6 with high melting points were formed in the LiPF6/SL and LiPF6/DMS mixtures, respectively. In contrast, LiPF6/EMS, LiPF6/MSL, and LiPF6/SL/another sulfone mixtures remained liquids over a wide temperature range. Raman spectroscopy revealed that SL and another sulfone are competitively coordinated to Li+ ions to dissociate LiPF6 in the ternary mixtures. Although the ionic conductivity decreased with increasing LiPF6 concentration due to an increase in viscosity, Li+ ions diffused faster than PF6-via exchanging ligands in the HCE [LiPF6]/[SL]/[DMS] = 1/2/2, resulting in a higher Li ion transference number than that in conventional Li battery electrolytes.

Developmental changes in audiotactile event perception.

The fission and fusion illusions provide measures of multisensory integration. The sound-induced tap fission illusion occurs when a tap is paired with two distractor sounds, resulting in the perception of two taps; the sound-induced tap fusion illusion occurs when two taps are paired with a single sound, resulting in the perception of a single tap. Using these illusions, we measured integration in three groups of children (9-, 11-, and 13-year-olds) and compared them with a group of adults. Based on accuracy, we derived a measure of magnitude of illusion and used a signal detection analysis to estimate perceptual discriminability and decisional criterion. All age groups showed a significant fission illusion, whereas only the three groups of children showed a significant fusion illusion. When compared with adults, the 9-year-olds showed larger fission and fusion illusions (i.e., reduced discriminability and greater bias), whereas the 11-year-olds were adult-like for fission but showed some differences for fusion: significantly worse discriminability and marginally greater magnitude and criterion. The 13-year-olds were adult-like on all measures. Based on the pattern of data, we speculate that the developmental trajectories for fission and fusion differ. We discuss these developmental results in the context of three non-mutually exclusive theoretical frameworks: sensory dominance, maximum likelihood estimation, and causal inference.

Incomplete off-duty work hours and sleep quality among firefighters: a cross-sectional study, Taiwan.

OBJECTIVE: We examined whether firefighters in Taiwan have a sleep problem and investigated the related factors of poor sleep quality. METHODS: In this cross-sectional study, 2123 male shift firefighters in the Greater Taipei area were invited, and 37.7% of them satisfactorily completed the questionnaire online. The Chinese version of Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality. Multiple logistic and linear regression analyses were used to determine the associations among demographic characteristics, work-related characteristics, and poor sleep quality. RESULTS: As revealed by 801 valid questionnaires, 77.2% were poor sleepers (PSQI cutoff score > 6), and 61.2% reported incomplete off-duty in the past month. Moreover, 42.6% of incomplete off-duty workers reported extended overtime of more than 5 h on off-duty days in the past month. Poor sleep quality was associated with the following factors: (1) demographic characteristics: age, working tenure, having children, and chronotype and (2) work-related characteristics: shift schedule and incomplete off-duty. The final model for poor sleep quality as per PSQI included age, chronotype, shift schedule, and incomplete off-duty hours in the past month. Longer hours of incomplete off-duty work were associated with increased risks of overall poor sleep quality and of poor subjective sleep quality, long sleep latency, sleep disturbances, and daytime dysfunction. CONCLUSION: Firefighters are advised to have a complete off-duty day to avoid poor sleep quality, long sleep latency, short sleep duration, sleep disturbances, and daytime dysfunction. Our results confirm the need for implementing appropriate shift schedules to ensure adequate rest time for firefighters.

TRIM58 functions as a tumor suppressor in colorectal cancer by promoting RECQL4 ubiquitination to inhibit the AKT signaling pathway.

BACKGROUND: This study aimed to investigate the underlying molecular mechanisms of TRIM58 in the development of colorectal cancer (CRC). CRC is one of the most common cancers of the digestive tract worldwide. The ubiquitin-proteasome system regulates many oncogenic or tumor-suppressive proteins. TRIM58, an E3 ubiquitin ligase and a member of the tripartite motif protein family, is a potential prognostic marker that indicates poor prognosis in cancer. Currently, the precise molecular mechanisms for the TRIM58-mediated CRC progression remain unclear. METHODS: To examine the effects of TRIM58 on cell viability, cell cycle progression, and apoptosis in CRC, Cell Counting Kit-8 and flow cytometry assays were employed. The AKT inhibitor LY294002 was used to examine the effects of AKT signaling on TRIM58-mediated cell viability, cell cycle progression, and apoptosis in CRC. Additionally, Co-IP and ubiquitination assays were used to examine the correlation between TRIM58 and RECQL4. RESULTS: TRIM58 overexpression inhibited CRC cell viability and promoted cell cycle arrest and apoptosis, in which the TRIM58 knockdown demonstrated inversed effects via the AKT signaling pathway. TRIM58 inhibited RECQL4 protein levels through its ubiquitin ligase activity, and RECQL4 overexpression inhibited TRIM58 overexpression-mediated CRC cell viability, cell cycle progression, and apoptosis. The downregulation of TRIM58 and upregulation of RECOL4 were observed in human CRC tissue, and TRIM58 demonstrated antitumor effects in CRC-induced tumor growth in a mouse model. CONCLUSIONS: TRIM58 acts as a tumor suppressor in CRC through the promotion of RECQL4 ubiquitination and inhibition of the AKT signaling pathway and may be investigated for the successful treatment of CRC.

Hospital factors that predict intention of health care workers to leave their job during the COVID-19 pandemic.

PURPOSE: To identify factors responsible for hospital health care workers' intention to leave their job during the COVID-19 pandemic. DESIGN: A cross-sectional study was performed. METHODS: A self-administered questionnaire was delivered to solicit hospital health care workers' demographics, intention to leave, workplace environment, and changes related to COVID-19 from July to November 2020 in Taiwan. Principal component analysis was performed to compare group-related factors. Multiple logistic regression was used to determine the risk factors for the intention of health care workers to leave their job. FINDINGS: Among the 1209 health care workers (mean age, 36.3 years) who participated in the study, intention to leave the job was found to be related to factors relating to COVID-19, including perceived risk, affected social relationships, and increased workload and job stress, after adjustment for demographic and work factors. Supportive administration/management were protective factors against leaving the job. These results were supported by sensitivity analyses. CONCLUSIONS: Our findings suggest that the intention of health care workers to leave their job during a pandemic is related to potentially modifiable factors relating to the infection itself and work environment. CLINICAL RELEVANCE: High perceived risk of COVID-19, affected social relationaops, and increased workload and job stress were positively associated with the intention of health care workers to leave their job, whereas supportive administration and management were protective factors against leaving the job. Development of workplace strategies is important to help mitigate these above factors, improve psychological wellbeing, and promote workforce stability.

Snacking among shiftwork nurses related to non-optimal dietary intake.

AIMS: To compare nurses' non-optimal eating behaviours across different shifts, to examine whether non-day shifts were related to deviation from optimal dietary behaviours compared with day shifts and whether such deviation was related to non-optimal macronutrient intake. DESIGN: This is a 4-day intensive longitudinal study. METHODS: A convenience sample of hospital nurses was recruited in Taiwan. From September 2018 through January 2019, 120 participants completed 4-days of 24-h dietary recalls. One-way ANOVA and Kruskal-Wallis H test were used to compare differences in energy and macronutrient intake and frequency of meals and snacking, respectively. Generalized linear regressions examined (1) the associations between shiftwork schedules and non-optimal eating behaviours and (2) associations between non-optimal eating and high energy contribution of non-optimal macronutrients. RESULTS: Nurses consumed less energy on evening and night shifts compared with day shifts. However, energy intake from snacking was higher on evening and night shifts relative to day shifts. Nurses consumed less meals but had higher snacking frequency on non-day shifts. In addition, high energy intake from snacking was positively associated with high energy intake from saturated fat. CONCLUSIONS: Nurses were more likely to have non-optimal eating behaviours on non-day shifts, which may contribute to an increased intake of saturated fat; thus, increasing their risk of chronic diseases. Strategies to improve non-day shift nurses' non-optimal eating behaviours may be beneficial to their health. IMPACT: Shiftwork is known to affect nurses' eating behaviours; however, which shift is associated with unhealthy eating remains inconclusive. Despite lower energy intakes, nurses had higher intake by snacking on evening and night shifts. High snacking intake was associated with a high intake of saturated fat. Hospitals can increase the availability of healthy foods on evening or night shifts, which may improve non-day shift nurses' non-optimal eating behaviours.

[Safety Climate in Hospitals: From Science to Policy-The Progress of Needlestick Prevention in Taiwan].

In hospitals, safety climate refers to the safety policies and regulations established by medical institutions and the measures taken to ensure medical personnel feel safe while working at these institutions. Safety climate can directly affect the overall work performance of medical personnel and indirectly affect patient care quality, which in turn impacts the rate of occupational hazards. Common occupational hazards in the medical workplace include contracting infectious diseases, overwork, irregular circadian rhythm due to working shifts, changes in sleep patterns and dietary habits, musculoskeletal discomfort, workplace violence, workplace stress, and needlestick injuries. This paper was developed to explore the history of promoting needlestick prevention in Taiwan, and discusses how to use the results of empirical research as scientific evidence and critical proofs to advocate for needlestick prevention and to establish related policies. In addition, the process of how improvements to the hospital safety climate and the prevention of occupational hazard incidents mutually influence and complement each other was examined. Future studies are encouraged to explore this topic to further elucidate the sources of workplace stress and to devise methods to ameliorate their influence on workplace stress in medical institutions. The results of these studies may be referenced by relevant government agencies and medical institutions when developing policies promoting safe environments in hospitals that improve the safe-work perceptions of nursing personnel and create comfortable and friendly medical environments.

Physicians' Risk Tolerance and Head Computed Tomography Use for Pediatric Patients With Minor Head Injury.

OBJECTIVES: Traumatic brain injury is the leading cause of death and disability in children worldwide. The objective of this study was to determine the association between physician risk tolerance and head computed tomography (CT) use in patients with minor head injury (MHI) in the emergency department (ED). METHODS: We retrospectively analyzed pediatric patients (<17 years old) with MHI in the ED and then administered 2 questionnaires (a risk-taking subscale [RTS] of the Jackson Personality Inventory and a malpractice fear scale [MFS]) to attending physicians who had evaluated these patients and made decisions regarding head CT use. The primary outcome was head CT use during ED evaluation; the secondary outcome was ED length of stay and final diagnosis of intracranial injury (ICI). RESULTS: Of 523 patients with MHI, 233 (44.6%) underwent brain CT, and 16 (3.1%) received a final diagnosis of ICI. Among the 16 emergency physicians (EPs), the median scores of the MFS and RTS were 22 (interquartile range, 17-26) and 23 (interquartile range, 19-25), respectively. Emergency physicians who were most risk averse tended to order more head CT scans compared with the more risk-tolerant EPs (56.96% vs 37.37%; odds ratio, 8.463; confidence interval, 2.783-25.736). The ED length of stay (P = 0.442 and P = 0.889) and final diagnosis (P = 0.155 and P = 0.835) of ICI were not significantly associated with the RTS and MFS scores. CONCLUSIONS: Individual EP risk tolerance, as measured by RTS, was predictive of CT use in pediatric patients with MHI.

Effect of Linc-POU3F3 on radiotherapy resistance and cancer stem cell markers of esophageal cancer cells. / Linc-POU3F3å¯¹é£Ÿç®¡ç™Œç»†èƒžæ”¾å°„æ²»ç–—æŠµæŠ—åŠè‚¿ç˜¤å¹²ç»†èƒžæ ‡å¿—ç‰©çš„å½±å“.

OBJECTIVES: Long non-coding RNA (LncRNA) is an important transcriptional and post-transcriptional regulatory molecule in the body. In recent years, relationship between LncRNA and malignant phenotype of tumor cells has been revealed gradually. This study aims to investigate the expression characteristics of pit-oct-unc class 3 homeobox 3 related long non-coding RNA (Linc-POU3F3) in esophageal cancer and its relationship with radiation resistance (IR) as well as the expressions of cancer stem cell (CSC) markers in esophageal cancer cells. METHODS: The expression characteristics and potential interaction molecules of Linc-POU3F3 in esophageal cancer were collected from the public database via bioinformatics retrieval. Forty-two pair samples of esophageal cancer tissues and corresponding adjacent tissues were collected. Human normal esophageal epithelial cells (HEEC) and human esophageal cancer cell lines (ECA109, TE-1, TE-2, TE-13) were cultured. Real-time quantitative PCR (qPCR) was used to detect the expression level of Linc-POU3F3 in clinical tissues and cells. The formation of TE-13 IR cell line induced by different doses of radiation served as IR group cells, and the same condition treated with 0 Gy dose was set as control group (control) cells. Meanwhile, we used cell transfection technology to construct random interference sequence (siControl) cells and interference (siLinc-POU3F3) cells. In ECA109 cells, we transfected blank and over expressed Linc-POU3F3 plasmids as vector and over-expressed group (oeLinc-POU3F3). The mRNA and protein expressions of CD44, CD133 and CD90 were detected by qPCR and Western blotting, respectively. MTS [3-(4,5-dimenthylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt] was used to detect the cell viability under different radiation doses, and the resistance of IR cells was verified by clone formation experiment. RESULTS: The expression of Linc-POU3F3 was correlated with the tumor progression and poor prognosis of esophageal cancer. The level of Linc-POU3F3 mRNA expression was significantly higher in esophageal cancer tissues and cell lines than that in normal adjacent tissues and cell lines (all P<0.01). The expressions of Linc-POU3F3 mRNA and protein expressions of CD44, CD133, and CD90 in IR cells were significantly higher than those in control cells (all P<0.01). The expression of Linc-POU3F3 in siLinc-POU3F3 cell was significantly lower than that in the siControl cells (P<0.01), and the inhibition rate was 87.21%. The mRNA and protein expressions of CD44, CD133, and CD90 in the siLinc-POU3F3 cells were significantly lower than those in the siControl cells (all P<0.05). The expressions of linc-POU3F3, CD44, CD133, and CD90 mRNA and protein in the oeLinc-POU3F3 cells were significantly higher than those in the vector cells. The relative activity and clone formation ability in the IR cells were significantly higher than those in the control cells at 2, 4, and 8 Gy doses (all P<0.01). The relative activity in the siLinc-POU3F3 cells was significantly lower than that in the siControl cells at 4 and 8 Gy doses (P<0.01). The relative activity in the oeLinc-POU3F3 cells was significantly higher than that in the vector cells at 4 and 8 Gy doses (P<0.01). CONCLUSIONS: Linc-POU3F3 is up-regulated in esophageal cancer and can promote IR and the expression of CSC markers in esophageal cancer cells.

Validation of the diagnosis and triage algorithm for acute myocardial infarction in the setting of left bundle branch block.

BACKGROUND: Detecting acute ST-segment elevation myocardial infarction (STEMI) in the setting of left bundle branch block (LBBB) remains a challenge to clinicians. Several diagnostic and triage algorithms have been proposed to accurately identify LBBB patients with an acute culprit vessel. We aimed to validate the algorithm proposed by Cai et al., which uses patients' hemodynamic status and the modified Sgarbossa electrocardiography criteria to guide reperfusion therapy. METHODS: This retrospective study was performed with a chart review in emergency departments (EDs) of 2 medical centers, 2 regional hospitals, and 1 local hospital. From January 2010 to December 2014, 2432 consecutive patients were diagnosed as having STEMI in the ED, including 65 patients with LBBB (2.6%). RESULTS: The patients with LBBB were older and more frequently presented with acute pulmonary edema (58.5% vs 22.1%, p < 0.001), cardiogenic shock (16.9% vs 6.3% p = 0.006), and VT/VF episodes (7.7% vs 2.2%, p = 0.034) and had a higher 30-day mortality rate (20.0% vs 10.4% p = 0.032) than those without LBBB. We then tested the algorithm proposed by Cai et al. and noted a sensitivity of 93.8% in identifying a culprit lesion. CONCLUSIONS: The inconsistency of the guideline recommendations reflects the uncertainty of diagnostic and therapeutic strategies and the pressing need for tools to accurately identify the true acute myocardial infarction in patients presenting with chest pain and LBBB. The algorithm proposed by Cai et al. had good sensitivity and would allow emergency physicians to implement the timely treatment protocol for this high-risk population.

Effectiveness of Sodium Bicarbonate Administration on Mortality in Cardiac Arrest Patients: A Systematic Review and Meta-analysis.

BACKGROUND: The 2010 Advanced Cardiac Life Support guidelines stated that routine sodium bicarbonate (SB) use for cardiac arrest patients was not recommended. However, SB administration during resuscitation is still common. OBJECTIVES: To evaluate the effect of SB on return of spontaneous circulation (ROSC) and survival-to-discharge rates in adult cardiac arrest patients. METHODS: We searched Medline, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to December 2019. We included trials on nontraumatic adult patients after cardiac resuscitation and SB treatment vs. controls. RESULTS: A meta-analysis was performed with six observational studies, including 18,406 adult cardiac arrest patients. There were no significant differences in the ROSC rate (odds ratio [OR] 1.185; 95% confidence interval [CI] 0.680-2.065) and survival-to-discharge rate (OR 0.296; 95% CI 0.066-1.323) between the SB and no-SB groups. In the subgroup analysis based on the year factor, there were no significant differences in the mortality rate in the After-2010 group. In the subgroup analysis based on the continent, the ROSC rate (OR 0.521; 95% CI 0.432-0.628) and survival-to-discharge rate (OR 0.102; 95% CI 0.066-0.156) were significantly lower in the North American group. CONCLUSIONS: SB use was not associated with improvement in ROSC or survival-to-discharge rates in cardiac resuscitation. In addition, mortality was significantly increased in the North American group with SB administration.

Effect of long non-coding RNA long stress-induced noncoding transcript 5 on erlotinib resistance to lung cancer cells and the underlying mechanisms. / é•¿é“¾éžç¼–ç RNAåº”æ¿€è¯±å¯¼é•¿é“¾éžç¼–ç è½¬å½•æœ¬5å¯¹è‚ºç™Œç»†èƒžåŽ„æ´›æ›¿å°¼æ•æ„Ÿæ€§çš„å½±å“åŠå ¶æœºåˆ¶.

OBJECTIVES: To explore the relationship between long non-coding RNA (lncRNA) long stress-induced noncoding transcript 5 (LSINCT5) and erotinib resistance to lung cancer cells and the potential mechanisms. METHODS: Human lung cancer cell line A549, H520, H358, H1299, SPCA1, and PC9 were collected and cultured. Epidermal growth factor receptor (EGFR) mutant lung cancer cell line PC9 was divided into a control group, a resistance group, a interference group I and II. The control group was treated with dimethylsulfoxide (DMSO) for 10 weeks and then was transfected with control target sequence expression vector. The resistant group was treated with erlotinib at gradient concentration (0.1, 0.2, 0.4, 0.8, and 1.6 µmol/L, respectively) for 2 weeks and then transfected with control target sequence expression vector. Interference group I and II were treated with erlotinib at gradient concentration (0.1, 0.2, 0.4, 0.8, and 1.6 µmol/L, respectively) for 2 weeks and then transfected with the shRNA targeting expression vectors 1 and 2. 50% inhibitory concentration (IC50) of erlotinib was detected by cell counting kit-8 (CCK-8) assay. The mRNA expressions of LSINCT5, phosphatidylinositol 3-kinase (PI3K) and protein kinase B (Akt) were measured by real-time PCR. The protein levels of PI3K, Akt, and phospho-Akt (p-Akt) were detected by Western blotting. The divergences of Akt and IgG binding to LSINCT5 were detected by RNA immunoprecipitation (RNA-IP) experiment. RESULTS: The expression of LSINCT5 in PC9 cells was significantly higher than that in other lung cancer cell lines (all P<0.05). Compared with the control group, the IC50 of erotinib and the expression of LSINCT5, PI3K, and Akt mRNA and protein in the resistance group were significantly higher (all P<0.05), and the IC50 of erotinib and the expression of LSINCT5, Akt, and p-Akt in the interference group I and II were significantly lower (all P<0.05). Compared with IgG, LSINCT5 binding to Akt was increased significantly (P<0.05). CONCLUSIONS: The expression of LSINCT5 is high in the erlotinib-resistant cells. Interference with LSINCT5 may inhibit the expression and activity of Akt and promote the cell sensitivity to erlotinib.

Derivation and Validation of the SWAP Score for Very Early Prediction of Neurologic Outcome in Patients With Out-of-Hospital Cardiac Arrest.

STUDY OBJECTIVE: For patients with out-of-hospital cardiac arrest who receive cardiopulmonary resuscitation in an emergency department (ED), the early evaluation of their neurologic prognosis is essential for emergency physicians. The aim of this study is to establish a simple and useful assessment tool for rapidly estimating the prognosis of patients with out-of-hospital cardiac arrest after their arrival at an ED. METHODS: A total of 852 patients admitted from January 1, 2015, to June 30, 2017, were prospectively registered and enrolled in the derivation cohort. Multivariate logistic regression on this cohort identified 4 independent factors associated with unfavorable outcomes: initial nonshockable rhythm (odds ratio [OR] 3.40; 95% confidence interval [CI] 1.58 to 7.32), no witness of collapse (OR 3.19; 95% CI 1.51 to 6.75), older than 60 years (OR 3.65; 95% CI 1.64 to 8.09), and pH less than or equal to 7.00 (OR 3.27; 95% CI 1.42 to 7.54). The shockable rhythm-witness-age-pH (SWAP) score was developed and 1 point was assigned to each predictor. RESULTS: For a SWAP score of 4, the specificity was 97.14% (95% CI 91.62% to 100%) for unfavorable outcomes in the derivation cohort. For validation, we retrospectively collected data for 859 patients with out-of-hospital cardiac arrest from January 1, 2012, to December 31, 2014. A SWAP score of 4 was 100% specific (95% CI 99.9% to 100%) for unfavorable outcomes in the validation cohort. CONCLUSION: The SWAP score is a simple and useful predictive model that may provide information for the very early estimation of prognosis for patients with out-of-hospital cardiac arrest. Further research is required to integrate ultrasonographic findings and validate the SWAP score's application in other populations.

Developmental changes in the perception of audiotactile simultaneity.

We charted the developmental trajectory of the perception of audiotactile simultaneity by testing three groups of children (aged 7, 9, and 11 years) and one group of adults. A white noise burst and a tap to the index finger were presented at 1 of 13 stimulus onset asynchronies (SOAs), and the participants were asked to report whether the two stimuli were simultaneous. Compared with adults, 7-year-olds made significantly more simultaneous responses at 9 of the 13 SOAs, whereas 9-year-olds differed from adults at only 2 SOAs. The precision of simultaneity perception was lower, and response errors were higher, in younger children than in adults. The 11-year-olds were adult-like on all measures, thereby demonstrating that judgments about simultaneity for audiotactile stimuli are mature by 11 years. This developmental pattern is similar to that for simultaneity perception for visuotactile stimuli but later than that for audiovisual stimuli. The longer developmental trajectories of the perception of simultaneity between touch and vision and between touch and audition may arise from the need to coordinate and recalibrate between different reference frames and different neural transmission times in each sensory system during body growth; in addition, the ubiquity of audiovisual experience in everyday life may accelerate the development of that modality pairing.

Psychological Work Environment and Suicidal Ideation Among Nurses in Taiwan.

PURPOSE: Nurses are exposed to a poor psychological work environment; this may cause poor mental health, which is a risk factor for suicidal ideation. We investigated the association between psychological work environment and suicidal ideation among hospital nurses in Taiwan. DESIGN: We conducted a cross-sectional survey in Taiwan female nurses using stratified sampling by region (north, central, south, and east) to select representative centers for this study. METHODS: A self-report questionnaire including items on demographic data, the psychological work environment, and suicidal ideation was sent to nurses working in hospitals. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of the psychological work environment on suicidal ideation. FINDINGS: A total of 2,734 eligible questionnaires (76.8%) were returned. The prevalence of suicidal ideation was 18.3%, and higher risk was found to be associated with the educational level of junior college or below, higher personal burnout, higher client-related burnout, and always feeling stressed at work. Estimation of population attributable risk showed that higher personal burnout, client-related burnout, and always feeling stressed at work were the most crucial factors among nurses, accounting for 19.4%, 8.6%, and 10.5% of suicidal ideation, respectively. CONCLUSIONS: A considerable proportion of nurses developed suicidal ideation. A poor psychological work environment was a relevant factor for suicidal ideation. CLINICAL EVIDENCE: This study provides relevant knowledge for nursing management levels in preventing the development of suicidal ideation among nurses. Not only for nurses' mental health, but for patient safety and care quality, further studies in improving nurses' psychological work environment are warranted.

Obesity, hyperhomocysteinaemia and risk of chronic kidney disease: a population-based study.

Background: Obesity is associated with increased risk of cardiovascular disease and chronic kidney disease (CKD). Hyperhomocysteinaemia refers to increased oxidative stress and has been associated with the risk of CKD. Objectives: We investigated the association among body mass index (BMI), homocysteine level and impaired renal function in a Taiwanese adult population. Methods: This was a retrospective cross-sectional study involving 24826 subjects who underwent a health check-up from January 2013 to December 2015. A multivariate linear regression model was developed to analyse the relationship among BMI, serum homocysteine and estimated glomerular filtration rate (eGFR). A multivariate logistic regression model was used to assess the relationship among weight categories, hyperhomocysteinaemia and CKD. Results: The prevalence of CKD in the quartile groups of homocysteine were 2.5%, 2.7%, 3.4% and 5.2% (P < 0.01). For every one-unit increase in BMI (kg/m2), the eGFR decreased by 0.50 ml/min/1.73 m2. Overweight/obese subjects with high homocysteine levels had a higher odds ratio (OR) for CKD, as compared with normal weight subjects (1.84 versus 1.38, respectively; P < 0.01 versus P = 0.02, respectively). Overweight/obese female subjects with hyperhomocysteinaemia had an OR of 3.40 [P < 0.01; 95% confidence interval (CI): 2.06-5.61] for CKD; in males, the OR was 1.66 (P < 0.01; 95% CI: 1.38-1.99). Conclusions: Patients who are overweight/obese with higher homocysteine levels have an increased risk of CKD, especially females. Additional studies exploring whether the effect of weight loss or homocysteine-lowering therapies such as folic acid, vitamin B12 supplements that may prevent or slow the progression of declining renal function, is warranted.

Developmental changes in the perception of visuotactile simultaneity.

A simultaneity judgment (SJ) task was used to measure the developmental trajectory of visuotactile simultaneity perception in children (aged 7, 9, 11, and 13 years) and adults. Participants were presented with a visual flash in the center of a computer monitor and a tap on their right index finger (located 20° below the flash) with 13 possible stimulus onset asynchronies (SOAs). Participants reported whether the flash and tap were presented at the same time. Compared with the adult group, children aged 7 and 9 years made more simultaneous responses when the tap led by more than 300 ms and when the flash led by more than 200 ms, whereas they made fewer simultaneous responses at the 0 ms SOA. Model fitting demonstrated that the window of visuotactile simultaneity became narrower with development and reached adult-like levels between 9 and 11 years of age. Response errors decreased continuously until 11 years of age. The point of subjective simultaneity (PSS) was located on the tactile-leading side in all participants tested, indicating that 7-year olds (the youngest age tested) are adult-like on this measure. In summary, the perception of visuotactile simultaneity is not fully mature until 11 years of age. The protracted development of visuotactile simultaneity perception may be related to the need for crossmodal recalibration as the body grows and to the developmental improvements in the ability to optimally integrate visual and tactile signals.

The association of emergency department administration of sodium bicarbonate after out of hospital cardiac arrest with outcomes.

BACKGROUND: Sodium bicarbonate administration is mostly restricted to in-hospital use in Taiwan. This study was conducted to investigate the effect of sodium bicarbonate on outcomes among patients with out-of-hospital cardiac arrest (OHCA). METHODS: This population-based study used a 16-year database to analyze the association between sodium bicarbonate administration for resuscitation in the emergency department (ED) and outcomes. All adult patients with OHCA were identified through diagnostic and procedure codes. The primary outcome was survival to hospital admission and secondary outcome was the rate of death within the first 30days of incidence of cardiac arrest. Cox proportional-hazards regression, logistic regression, and propensity analyses were conducted. RESULTS: Among 5589 total OHCA patients, 15.1% (844) had survival to hospital admission. For all patients, a positive association was noted between sodium bicarbonate administration during resuscitation in the ED and survival to hospital admission (adjusted odds ratio [OR]: 4.47; 95% confidence interval [CI]: 3.82-5.22, p<0.001). In propensity-matched patients, a positive association was also noted (adjusted OR, 4.61; 95% CI: 3.90-5.46, p<0.001). CONCLUSIONS: Among patients with OHCA in Taiwan, administration of sodium bicarbonate during ED resuscitation was significantly associated with an increased rate of survival to hospital admission.

Visceral Adiposity Index as a Predictor of Chronic Kidney Disease in a Relatively Healthy Population in Taiwan.

OBJECTIVES: Abdominal obesity is an independent risk factor for cardiovascular disease and chronic kidney disease (CKD). Visceral adiposity index (VAI), a simple formula representing visceral adipose dysfunction, has already been proven to have a strong correlation with various cardiometabolic disorders. Limited studies are available regarding the relationship between VAI and renal function decline. Therefore, the purpose of this study was to evaluate the relationship between VAI and renal function and to estimate the risk of chronic kidney disease in a relatively healthy adult population in Taiwan. DESIGN: The design of the study is retrospective cross-sectional analysis. SUBJECTS: This study involved 23,570 subjects aged ≥18 years who underwent annual heath checkups between January and December 2013. A multivariate logistic regression model was used to assess the relationship between VAI and CKD. Receiver-operating characteristic curve and Youden index were developed to determine the discrimination power of VAI for metabolic syndrome and CKD. INTERVENTION: None, observational study. MAIN OUTCOME MEASURE: The main outcome measure of this study was CKD. RESULTS: In our study, the adjusted odds ratio (OR) of abnormal VAI for CKD was 1.5 (95% confidence interval [CI], 1.08-2.08; P = .016) in all subjects. A higher VAI was superior in association with CKD in men than women (OR, 1.62; 95% CI, 1.13-2.32; P = .009 vs. OR, 1.28; 95% CI, 0.66-2.47; P = .469, respectively). The area under the curve for VAI was 0.694 (95% CI, 0.660-0.729; P < .001), and using a Youden index with a cut-off VAI value of 2.96 for CKD discrimination obtained a sensitivity of 67.7% and specificity of 65.1%. CONCLUSIONS: A higher VAI score was associated with increased risks of CKD. VAI would be an applicable tool for early detection of CKD in relatively healthy adults in Taiwan, especially men.