Probabilistic establishment of speckle-associated inter-chromosomal interactions.

Inter-chromosomal interactions play a crucial role in genome organization, yet the organizational principles remain elusive. Here, we introduce a novel computational method to systematically characterize inter-chromosomal interactions using in situ Hi-C results from various cell types. Our method successfully identifies two apparently hub-like inter-chromosomal contacts associated with nuclear speckles and nucleoli, respectively. Interestingly, we discover that nuclear speckle-associated inter-chromosomal interactions are highly cell-type invariant with a marked enrichment of cell-type common super-enhancers (CSEs). Validation using DNA Oligopaint fluorescence in situ hybridization (FISH) shows a strong but probabilistic interaction behavior between nuclear speckles and CSE-harboring genomic regions. Strikingly, we find that the likelihood of speckle-CSE associations can accurately predict two experimentally measured inter-chromosomal contacts from Hi-C and Oligopaint DNA FISH. Our probabilistic establishment model well describes the hub-like structure observed at the population level as a cumulative effect of summing individual stochastic chromatin-speckle interactions. Lastly, we observe that CSEs are highly co-occupied by MAZ binding and MAZ depletion leads to significant disorganization of speckle-associated inter-chromosomal contacts. Taken together, our results propose a simple organizational principle of inter-chromosomal interactions mediated by MAZ-occupied CSEs.

Editorial Commentary: Biceps Rerouting Augmentation Technique Restores Biomechanics, Improves Healing, and Has Many Advantages for Repair of Large and Massive Rotator Cuff Tears.

The biceps rerouting (BR) augmentation technique has emerged as a useful option for the repair of rotator cuff tears when the torn tendon does not cover the footprint or can only be reduced under excessive tension. BR offers several advantages over traditional methods. It is an all-inside joint procedure, eliminating the need for skin incisions other than those for the arthroscopic portal, thus reducing operative time and infection risk. It does not lead to donor-site morbidity, unlike superior capsular reconstruction. In addition, the rerouted long head of the biceps tendon serves as a depressor of the humeral head and an internal splint, protecting cuff healing. Finally, it provides a biceps tenodesis such that biceps-related symptoms are prevented postoperatively. Clinical studies have shown the efficacy of the BR technique, particularly in achieving low rates of retear. Although the BR technique is a nonanatomic reconstruction, its biomechanical impact effectively restores joint function to a state similar to the original. Considering these findings, the BR technique represents a significant advancement in managing large to massive rotator cuff tears, given its straightforward application and ability to re-establish joint biomechanics.

Bursal acromial resurfacing improves shoulder biomechanics in a cadaveric model of massive rotator cuff tear.

PURPOSE: To investigate the effectiveness of bursal acromial resurfacing (acromiograft) on acromiohumeral distance, subacromial contact area, and pressure in a cadaveric model of massive rotator cuff tear. METHODS: Eight fresh-frozen cadaveric shoulders were tested using a customized shoulder testing system. Humeral head translation, subacromial contact pressure, and the subacromial contact area were evaluated across four conditions: (1) intact shoulder; (2) simulated massive rotator cuff tear; (3) 3-mm acromiograft condition; (4) 6-mm acromiograft condition. The acromiografts were simulated using Teflon and a reported technique. The values were measured at 0°, 20°, and 40° abduction and 0°, 30°, 60°, and 90° external rotation (ER) for each abduction status. RESULTS: Compared with a massive cuff tear, the 6-mm acromiograft significantly reduced the superior translation of the humeral head at all abduction/ER angles (P<0.05). The 3-mm acromiograft also decreased superior translation of the humeral head compared to massive cuff tear, but not all differences were significant. The 3- and 6-mm acromiografts significantly decreased the subacromial contact pressure and increased the subacromial contact area in almost all positions (P<0.05). The 3-mm acromiograft maintained biomechanical properties similar to the intact condition, whereas the 6-mm acromiograft increased the contact area. CONCLUSIONS: This biomechanical study demonstrated that both 3- and 6- mm acromiografts using Teflon in a cadaveric model of a massive cuff tear resulted in recentering of the superiorly migrated humeral head, increased the subacromial contact area, and decreased the subacromial contact pressure. The 3- mm graft was sufficient for achieving the intended therapeutic effects. CLINICAL RELEVANCE: The acromiograft can normalize altered biomechanics and may aid the treatment of massive cuff tears. As grafting the acromion's undersurface is new with limited clinical outcomes, further observation is crucial. Using Teflon instead of ADM allograft for bursal acromial resurfacing could yield different results, requiring careful interpretation.

Trajectories of nursing hours over the course of hospitalization and estimated additional nurse staffing requirements to reduce the length of stay.

PURPOSE: The aims of this study are to examine the trajectories of nursing hours per patient day (NHPPD) over the course of hospitalization according to the patient's length of stay (LOS) and to estimate changes in the total nursing hours during hospitalization, average NHPPD, and the number of nurses additionally required when the LOS was reduced by 1 day. DESIGN: This retrospective longitudinal study analyzed patient data collected from a tertiary university hospital located in Seoul, South Korea. The study sample included 11,316 inpatients who were discharged between September 1 and October 31, 2022. METHODS: NHPPD over the course of each patient's hospitalization was estimated using the total score of the Korean Patient Classification System-1 (KPCS-1), which nurses evaluated and recorded every day from admission to discharge. The NHPPD trajectories were examined using linear mixed models to analyze repeated KPCS-1 measurements and control for the effects of patient characteristics. The changes in the average NHPPD when LOS was reduced by 1 day were estimated using maximum and minimum estimations. The impact of a 1-day reduction in LOS on staffing requirements was calculated as the number of nurses additionally required to work each shift and to be hired. FINDINGS: The average LOS was 5.6 days, and the short (1-6 days) and medium (7-14 days) LOS groups accounted for 78.9% and 14.3% of patients, respectively. The NHPPD trajectories showed a "rise-peak-decline" pattern. Patients in the short LOS group received the most NHPPD on day 1 (day of admission) or day 2, whereas the NHPPD for patients in the medium LOS group peaked on days 3-6. After peaking, the NHPPD tended to decrease toward the end of hospitalization, with the least NHPPD on the day of discharge, followed by the day before discharge. When LOS was reduced by 1 day, the average NHPPD was estimated to increase by 7.7-50.0% in the maximum estimation, and 0.9-12.5% in the minimum estimation. In response to a 1-day reduction, 1.10-7.44 nurses were additionally required to care for 100 patients each shift and 5.28-35.70 additional nurses needed to be hired in the maximum estimation. In the minimum estimation, these values were 0.13-1.85 additional nurses per shift and 0.65-8.90 additional nurses to be hired, respectively. CONCLUSIONS: Since NHPPD exhibited a "rise-peak-decline" trajectory, reducing the LOS by 1 day was estimated to increase the average NHPPD and lead to additional staffing requirements. The additional nurse requirement for a 1-day reduction was not constant; instead, it increased with each day subtracted from an already shorter LOS. CLINICAL RELEVANCE: Sufficient nurse staffing is necessary to provide increased NHPPD as a result of shortened LOS. Changes in the LOS should be considered when determining nurse staffing requirements.

Varus-valgus alignment of humeral short stem in reverse total shoulder arthroplasty: does it really matter?

BACKGROUND: The utilization of short humeral stems in reverse total shoulder arthroplasty has gained attention in recent times. However, concerns regarding the risk of misalignment during implant insertion are associated with their use. METHODS: Eight fresh-frozen cadaveric shoulders were prepared for dissection and biomechanical testing. A bespoke humeral implant was fabricated to facilitate assessment of neutral, varus, and valgus alignments using a single stem, and 10° was established as the maximum permissible angle for misalignments. Shift in humerus position and changes in deltoid length attributable to misalignments relative to the neutral position were evaluated using a Microscribe 3DLx system. The impingement-free range of motion, encompassing abduction, adduction, internal rotation, and external rotation (ER), was gauged using a digital goniometer. The capacity for abduction was evaluated at maximal abduction angles under successive loading on the middle deltoid. A specialized traction system coupled with a force transducer was employed to measure anterior dislocation forces. RESULTS: Relative to the neutral alignment, valgus alignment resulted in a more distal (10.5 ± 2.4 mm) and medial (8.3 ± 2.2 mm) translation of the humeral component, whereas the varus alignment resulted in the humerus shifting more superiorly (11.2 ± 1.3 mm) and laterally (9.9 ± 0.9 mm) at 0° abduction. The valgus alignment exhibited the highest abduction angle than neutral alignment (86.2°, P < .001). Conversely, the varus alignment demonstrated significantly higher adduction (18.4 ± 7.4°, P < .001), internal rotation (68.9 ± 15.0°, P = .014), and ER (45.2 ± 10.5°, P = .002) at 0° abduction compared to the neutral alignments. Anterior dislocation forces were considerably lower (23.8 N) in the varus group compared to the neutral group at 0°ER (P = .047). Additionally, abduction capability was markedly higher in varus alignment at low deltoid loads than the neutral alignment (5N, P = .009; 7.5 N, P = .007). CONCLUSIONS: The varus position enhances rotational range of motion (ROM) but increases instability, while the valgus position does not significantly impact ROM or instability compared to the neutral position.

Searchable Blockchain-Based Healthcare Information Exchange System to Enhance Privacy Preserving and Data Usability.

Ensuring the security and usability of electronic health records (EHRs) is important in health information exchange (HIE) systems that handle healthcare records. This study addressed the need to balance privacy preserving and data usability in blockchain-based HIE systems. We propose a searchable blockchain-based HIE system that enhances privacy preserving while improving data usability. The proposed methodology includes users collecting healthcare information (HI) from various Internet of Medical Things (IoMT) devices and compiling this information into EHR blocks for sharing on a blockchain network. This approach allows participants to search and utilize specific health data within the blockchain effectively. The results demonstrate that the proposed system mitigates the issues of traditional HIE systems by providing secure and user-friendly access to EHRs. The proposed searchable blockchain-based HIE system resolves the trade-off dilemma in HIE by achieving a balance between security and the data usability of EHRs.

A genome-wide association study for eumelanin pigmentation in chicken plumage using a computer vision approach.

Chicken plumage colouration is an important trait related to productivity in poultry industry. Therefore, the genetic basis for pigmentation in chicken plumage is an area of great interest. However, the colour trait is generally regarded as a qualitative trait and representing colour variations is difficult. In this study, we developed a method to quantify and classify colour using an F2 population crossed from two pure lines: White Leghorn and the Korean indigenous breed Yeonsan Ogye. Using red, green, and blue values in the cropped body region, we identified significant genomic regions on chromosomes 33:3 160 480-7 447 197 and Z:78 748 287-79 173 793. Furthermore, we identified two potential candidate genes (PMEL and MTAP) that might have significant effects on melanin-based plumage pigmentation. Our study presents a new phenotyping method using a computer vision approach and provides new insights into the genetic basis of melanin-based feather colouration in chickens.

Graph Learning-Based Blockchain Phishing Account Detection with a Heterogeneous Transaction Graph.

Recently, cybercrimes that exploit the anonymity of blockchain are increasing. They steal blockchain users' assets, threaten the network's reliability, and destabilize the blockchain network. Therefore, it is necessary to detect blockchain cybercriminal accounts to protect users' assets and sustain the blockchain ecosystem. Many studies have been conducted to detect cybercriminal accounts in the blockchain network. They represented blockchain transaction records as homogeneous transaction graphs that have a multi-edge. They also adopted graph learning algorithms to analyze transaction graphs. However, most graph learning algorithms are not efficient in multi-edge graphs, and homogeneous graphs ignore the heterogeneity of the blockchain network. In this paper, we propose a novel heterogeneous graph structure called an account-transaction graph, ATGraph. ATGraph represents a multi-edge as single edges by considering transactions as nodes. It allows graph learning more efficiently by eliminating multi-edges. Moreover, we compare the performance of ATGraph with homogeneous transaction graphs in various graph learning algorithms. The experimental results demonstrate that the detection performance using ATGraph as input outperforms that using homogeneous graphs as the input by up to 0.2 AUROC.

Distributed Detour Routing Scheme for Link Failure with Minimized Overhead in LEO Satellite Networks.

The mobility of low Earth orbit (LEO) satellites causes the LEO satellite network to experience topology changes. Topology change includes periodic topology change that occurs naturally and unpredictable topology change that occurs due to instability of the inter-satellite link between satellites. Periodic and unpredictable topology change causes frequent topology change, requiring massive communications throughout the network due to frequent route convergence. LEO satellites have limited onboard power because they operate on batteries. The waste of limited satellite onboard resources shortens the lifespan of the satellite, and achieving stable end-to-end transmission is challenging for the network. In this regard, minimizing communication overhead is a fundamental consideration when designing a routing scheme. In this paper, we propose a distributed detour routing scheme with minimal communication overhead. This routing scheme consists of a rapid detour, selective flooding, and link recovery procedures. When a link failure occurs in the network, a rapid detour can detect link failure using only a precalculated routing table. Subsequently, selective flooding searches for the optimal detour point within the minimum hop region and flood to detour point. After link recovery, a procedure is defined to traverse the pre-detour path and switch it back to the original path. The simulation results show that the proposed routing scheme achieves a reduction of communication overhead by 97.6% compared with the n-hop flooding approach.

Turnover intention and retention of newly licensed nurses in their first job: A longitudinal study.

AIM: To examine newly licensed nurses' retention in their first job and factors related to their turnover. BACKGROUND: Newly licensed nurses have a high turnover rate within three years of entering their first job. INTRODUCTION: The factors affecting newly licensed nurses' turnover should be identified and prevented. METHODS: This longitudinal study tracked newly licensed nurses for three years. Data were collected online, and nurses could participate four times in the survey. The Kaplan-Meier method was used to estimate survival curves and to present nurses' retention. Cox proportional hazards regression model was used to analyze factors related to turnover. RESULTS: The estimated survival probabilities in nurses' first job at one, two, and three years were 0.927, 0.778, and 0.686, respectively. Nurses who reported turnover intention within one year in the first survey had significantly lower survival probabilities than those who did not have turnover intention. Turnover was more likely among male nurses. Turnover intention was associated with a significant increased likelihood of nurses leaving their first job. DISCUSSION: More than one third of newly licensed nurses left their first job within three years of employment. To reduce nurses' turnover, it is necessary to understand and manage turnover intention in advance. Specific steps should be taken to address male nurses' turnover. CONCLUSIONS: Turnover intention was the most powerful predictor of turnover. Further research should investigate reasons for turnover intention at the beginning of employment, and strategies to prevent turnover should be developed before nurses enter the workforce. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Newly licensed nurses with turnover intention at the beginning of their career should receive particular attention, and wellness programs should be prepared to promote retention.

Nurses' steps, distance traveled, and perceived physical demands in a three-shift schedule.

BACKGROUND: The physical job demands of hospital nurses are known to be very high. Although many studies have measured the physical activities of nurses subjectively using questionnaires, it remains necessary to quantify and measure nurses' physical activity at work using objective indicators. This study was conducted to address this gap in the literature by analyzing nurses' physical activity using both objective measurements and subjective perceptions. The number of steps, distance traveled, and actual work hours were measured during work, and the influence of related factors was analyzed. METHODS: Using a cross-sectional design, survey and activity tracking data were collected from nurses who worked in three shifts in two tertiary hospitals located in the capital region of South Korea. The participants comprised 117 nurses working in four different units (medical ward, surgical ward, intensive care unit, emergency room), and data from 351 shifts were used in the final analysis. Between-group differences in the main variables were analyzed using the t-test, the Mann-Whitney test, analysis of variance, or the Kruskal-Wallis test, as appropriate. The relationships were examined through multiple linear regression analysis. RESULTS: The average number of steps and distance traveled were greatest for nurses working in the emergency room, followed by the intensive care unit, surgical ward, and medical ward (in descending order). Younger nurses and those with shorter unit experience tended to have the greatest number of steps and distance traveled. CONCLUSION: Using activity trackers, this study derived physical activity measures such as number of steps and distance traveled, enabling an objective examination of physical activity during shifts. Nurses' level of physical activity differed depending on the type of nursing unit, nurses' age, and unit experience. These results suggest the need for support programs that are specific to the job demands of specific nursing units.

Prevalence and risk factors of maternal depression among women who participated in a home visitation program in South Korea.

PURPOSE: The psychosocial health of mother is crucial for healthy prenatal period and early childhood. We investigated the prevalence and risk factors of maternal depression during pregnancy and postpartum among women who participated in a home visitation program in Seoul, South Korea (Seoul Healthy First Step Project, SHFSP). METHODS: We analyzed 80,116 women who participated in the SHFSP, which was launched by Seoul metropolitan government in 2013, and defined peripartum depression as a score ≥ 10 on the Korean version of the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic factors and psychosocial health status were evaluated through a standardized questionnaire completed by participants upon program registration. We calculated the prevalence of women at risk for peripartum depression and evaluated associated factors by multivariable logistic regression analysis. RESULTS: Prevalence of women at risk for peripartum depression was 17.7% (prepartum depression: 14.2%, postpartum depression: 24.3%). Younger maternal age, low income (OR 2.40, 95% CI 2.03-2.84), disability (2.61, 1.96-3.47), single parenthood (3.27, 2.69-3.99), and smoking (2.02, 1.44-2.83) increased the peripartum depression risk. Furthermore, experience of stress, change, or loss over the past 12 months (3.36, 3.22-3.50), history of treatment for emotional issues (2.47, 2.27-2.70), experience of child abuse (1.91, 1.74-2.11), and domestic violence (2.25, 1.81-2.80) increased the risk for peripartum depression, whereas having helpers for the baby (0.62, 0.58-0.67), having someone to talk with (0.31, 0.27-0.35), and considering oneself confident (0.30, 0.29-0.31) decreased the risk. CONCLUSIONS: Policies to reduce and manage peripartum depression should be strengthened, with a focus on high-risk pregnant and puerperal women.

Apoptosis Occurs in the Anterior Talofibular Ligament of Patients With Chronic Lateral Ankle Instability: An In Vitro Study.

BACKGROUND: Chronic lateral ankle instability is treated operatively, whereas most acute ankle sprains associated with acute anterior talofibular ligament injury are usually treated nonoperatively. This treatment strategy is widely accepted and has been validated using a variety of clinical or radiological methods. We suspected that there may be biological differences between chronic and acutely injured ligaments, particularly with respect to apoptosis. Apoptosis is known to cause ligament degeneration. If it could be demonstrated that apoptosis occurs more in the anterior talofibular ligament tissues of patients with chronic lateral ankle instability compared with patients with acute anterior talofibular ligament injury, biological evidence could be supported. QUESTIONS/PURPOSES: We sought to (1) elucidate the difference in the extent of apoptosis between patients with chronic lateral ankle instability and those with acute anterior talofibular ligament injury. In addition, we asked: (2) What is the expression level of apoptotic enzymes such as caspases 3, 7, 8, and 9 and cytochrome c in each patient group? (3) Is there a correlation between apoptotic activities and the symptom duration period of chronic lateral ankle instability? METHODS: Between March 2019 and February 2021, 50 patients were prospectively enrolled in this study. Anterior talofibular ligament tissues were harvested from patients who were divided into two groups: the chronic lateral ankle instability group and the acute anterior talofibular ligament injury group. Patients with insufficient remaining ligaments were excluded from the chronic lateral ankle instability group, and cases in which the tissue was severely damaged or the quality of collected tissue was insufficient because of severe impingement into the fracture site were excluded from the acute anterior talofibular ligament injury group. Tissues were collected from 21 patients (11 males and 10 females) in the chronic lateral ankle instability group with a mean age of 37 ± 14 years and from 17 patients (6 males and 11 females) in the acute anterior talofibular ligament injury group with a mean age of 49 ± 17 years. To investigate our first purpose, apoptotic cells were counted using a TUNEL assay. To answer our second question, Western blotting for apoptotic enzymes such as caspases 3, 7, 8, and 9 and cytochrome c was performed to investigate apoptotic activity. Immunohistochemistry was also used to detect apoptotic enzymes. To answer our third question, the time elapsed after the first symptom related to chronic lateral ankle instability occurred and the expression level of each enzyme was investigated. RESULTS: More apoptotic cells were observed in the chronic lateral ankle instability group than in the acute anterior talofibular ligament injury group in the TUNEL assay. Western blotting revealed that the apoptotic activities of the chronic lateral ankle instability group were higher than those of the acute anterior talofibular ligament injury group: caspase 3 was 117 in the chronic lateral ankle instability group and 59 in the acute anterior talofibular ligament injury group (mean difference 58 [95% confidence interval (CI) 31 to 86]; p < 0.001), caspase 7 was 138 in the chronic lateral ankle instability group and 45 in the acute anterior talofibular ligament injury group (mean difference 93 [95% CI 58 to 128]; p < 0.001), caspase 8 was 126 in the chronic lateral ankle instability group and 68 in the acute anterior talofibular ligament injury group (mean difference 58 [95% CI 29 to 89]; p < 0.001), caspase 9 was 128 in the chronic lateral ankle instability group and 54 in the acute anterior talofibular ligament injury group (mean difference 74 [95% CI 44 to 104]; p < 0.001), and cytochrome c was 139 in the chronic lateral ankle instability group and 51 in the acute anterior talofibular ligament injury group (mean difference 88 [95% CI 46 to 129]; p < 0.001). Immunohistochemistry revealed higher expression of caspases 3, 7, 8, and 9 and cytochrome c in the chronic lateral ankle instability group compared with those in the acute anterior talofibular ligament injury group. Caspases 3, 7, and 9 showed no correlation with duration of chronic lateral ankle instability symptoms: the Pearson correlation coefficient was 0.22 [95% CI -0.25 to 0.69] for caspase 3 (p = 0.36), 0.29 [95% CI -0.16 to 0.74] for caspase 7 (p = 0.23), and 0.29 [95% CI -0.16 to 0.74] for caspase 9 (p = 0.23). CONCLUSION: In chronic lateral ankle instability, apoptotic activity in the anterior talofibular ligament was higher than in acute anterior talofibular ligament injury. CLINICAL RELEVANCE: Apoptosis occurs more in chronic injured ligaments than in acutely injured ligaments. Although urgent surgical repair is not required for acute anterior talofibular ligament injury, chronic lateral ankle instability may progress if the nonoperative treatment is not successful. Further research should focus not only on timing of apoptotic progression, but also on biological augmentation to reverse or prevent apoptosis within the anterior talofibular ligament.

Privacy Preservation in Patient Information Exchange Systems Based on Blockchain: System Design Study.

BACKGROUND: With the increasing sophistication of the medical industry, various advanced medical services such as medical artificial intelligence, telemedicine, and personalized health care services have emerged. The demand for medical data is also rapidly increasing today because advanced medical services use medical data such as user data and electronic medical records (EMRs) to provide services. As a result, health care institutions and medical practitioners are researching various mechanisms and tools to feed medical data into their systems seamlessly. However, medical data contain sensitive personal information of patients. Therefore, ensuring security while meeting the demand for medical data is a very important problem in the information age for which a solution is required. OBJECTIVE: Our goal is to design a blockchain-based decentralized patient information exchange (PIE) system that can safely and efficiently share EMRs. The proposed system preserves patients' privacy in the EMRs through a medical information exchange process that includes data encryption and access control. METHODS: We propose a blockchain-based EMR-sharing system that allows patients to manage their EMRs scattered across multiple hospitals and share them with other users. Our PIE system protects the patient's EMR from security threats such as counterfeiting and privacy attacks during data sharing. In addition, it provides scalability by using distributed data-sharing methods to quickly share an EMR, regardless of its size or type. We implemented simulation models using Hyperledger Fabric, an open source blockchain framework. RESULTS: We performed a simulation of the EMR-sharing process and compared it with previous works on blockchain-based medical systems to check the proposed system's performance. During the simulation, we found that it takes an average of 0.01014 (SD 0.0028) seconds to download 1 MB of EMR in our proposed PIE system. Moreover, it has been confirmed that data can be freely shared with other users regardless of the size or format of the data to be transmitted through the distributed data-sharing technique using the InterPlanetary File System. We conducted a security analysis to check whether the proposed security mechanism can effectively protect users of the EMR-sharing system from security threats such as data forgery or unauthorized access, and we found that the distributed ledger structure and re-encryption-based data encryption method can effectively protect users' EMRs from forgery and privacy leak threats and provide data integrity. CONCLUSIONS: Blockchain is a distributed ledger technology that provides data integrity to enable patient-centered health information exchange and access control. PIE systems integrate and manage fragmented patient EMRs through blockchain and protect users from security threats during the data exchange process among users. To increase safety and efficiency in the EMR-sharing process, we used access control using security levels, data encryption based on re-encryption, and a distributed data-sharing scheme.

CeRA-eSP: Code-Expanded Random Access to Enhance Success Probability of Massive MTC.

With the growing interest in the Internet of Things (IoT), research on massive machine-type communication (mMTC) services is being actively promoted. Because mMTC services are required to serve a large number of devices simultaneously, a lack of resources during initial access can be a significant problem when providing mMTC services in cellular networks. Various studies on efficient preamble transmission have been conducted to solve the random access problem of mMTC services. However, supporting a large number of devices simultaneously with limited resources is a challenging problem. In this study, we investigate code-expanded random access (CeRA), which extends the limited preamble resources to the code domain to decrease the high collision rate. To solve the existing CeRA phantom codeword and physical uplink shared channel (PUSCH) resource shortage problems, we propose an optimal preamble codeword set selection algorithm based on mathematical analysis. The simulation results indicate that the proposed code-expanded random access scheme to enhance success probability (CeRA-eSP) achieves a higher random access success rate with a lower access delay compared to the existing random access schemes.

The time of postoperative corticosteroid injection can be individualized after arthroscopic rotator cuff repair.

BACKGROUND: Intra-articular corticosteroid injection is an effective treatment for pain and to improve the range of motion (ROM) of the shoulder joint. However, consideration of when it would be effective to inject corticosteroids after rotator cuff repair is more limited. The purpose of this study was to compare the outcomes of corticosteroids injection given at 4 and 8 weeks after arthroscopic rotator cuff repair. METHODS: Between December 2016 and January 2018, 42 patients who underwent arthroscopic supraspinatus tendon repair were enrolled. Nineteen patients received 40 mg of triamcinolone injection 4 weeks after surgery (group 1), while 23 patients received the same injection 8 weeks after surgery (group 2). Clinical outcome was evaluated using ROM, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Korean Shoulder score, and a visual analog scale (VAS) score before surgery and at 3, 6, and 12 months after surgery. Tendon integrity was assessed with magnetic resonance imaging (MRI) and sonography at 12 months after surgery. RESULTS: Significant improvements in pain and functional scores were observed at the last follow-up in both groups (p < 0.05). There was no significant difference in VAS pain score between the two groups at any time point after surgery (p > 0.05). Functional scores and ROM in all directions also showed no statistical difference between the two groups (p > 0.05). Retears of the repaired tendon, assessed at 12 months postoperatively, were observed in two patients from group 1 (10.5%) and two patients from group 2 (8.7%), thus indicating no significant difference between the two groups (p > 0.05). CONCLUSION: Since there was no significant difference in clinical outcomes and tendon integrity, postoperative corticosteroid injection can be individualized according to the patient for 4-8 weeks after the rotator cuff repair.

Effort-Reward Imbalance and Its Effects on Satisfaction With Working Conditions and Sleep-Related Problems: Comparison of Nurses and Other Occupations.

PURPOSE: This study aimed to compare effort-reward imbalance (ERI) among registered nurses, social workers, and elementary school teachers, and to analyze the effects of ERI on satisfaction with working conditions and sleep-related problems. DESIGN: A secondary data analysis was conducted using cross-sectional data from the Korean Working Conditions Survey collected in 2017. The study sample included 276 registered nurses, 97 social workers, and 229 elementary school teachers. METHODS: The effort index was measured using two dimensions (work intensity and working time quality) with seven subdimensions. The reward index consisted of three dimensions (social support, earning, and prospects) with five subdimensions. The ERI index was computed by dividing the average effort score by the average reward score. Linear or logistic regression analysis was conducted to compare efforts, rewards, and ERI among the three occupations and to examine the effects of ERI on satisfaction and sleep-related problems. FINDINGS: Nurses had a significantly higher effort score than the other two groups. However, nurses had a lower reward score than elementary school teachers, but a higher score than social workers. The highest ERI index was found among nurses (0.47 ± 0.16), followed by social workers (0.39 ± 0.30) and elementary school teachers (0.30 ± 0.15). All three occupations showed an inverse relationship between ERI and satisfaction with working conditions and positive relationships between ERI and sleep-related problems. CONCLUSIONS: The high ERI (i.e., more effort relative to reward) perceived by nurses was associated with diminished satisfaction and increased sleep-related problems. CLINICAL RELEVANCE: To attract future generations to nursing as a career choice and to ensure a sustainable nurse workforce, the nurse-perceived ERI should be decreased by reducing work demands and increasing both monetary and nonmonetary rewards.

Genetic diversity of MHC-B in 12 chicken populations in Korea revealed by single-nucleotide polymorphisms.

This study used a single-nucleotide polymorphism (SNP) panel to characterise the diversity in the major histocompatibility complex B region (MHC-B) in 12 chicken populations in Korea. Samples were genotyped for 96 MHC-B SNPs using an Illumina GoldenGate genotyping assay. The MHC-B SNP haplotypes were predicted using 58 informative SNPs and a coalescence-based Bayesian algorithm implemented by the PHASE program and a manual curation process. In total, 117 haplotypes, including 24 shared and 93 unique haplotypes, were identified. The unique haplotype numbers ranged from 0 in Rhode Island Red to 32 in the Korean native commercial chicken population 2 ("Hanhyup-3ho"). Population and haplotype principal component analysis (PCA) indicated no clear population structure based on the MHC haplotypes. Three haplotype clusters (A, B, C) segregated in these populations highlighted the relationship between the haplotypes in each cluster. The sequences from two clusters (B and C) overlapped, whereas the sequences from the third cluster (A) were very different. Overall, native breeds had high genetic diversity in the MHC-B region compared with the commercial breeds. This highlights their immune capabilities and genetic potential for resistance to many different pathogens.

Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes.

AIM: To examine the relationships among nurse staffing, nurses prioritization of nursing activities, missed care, quality of nursing care, and nurse outcomes. BACKGROUND: Inadequate staffing is associated with increased missed care, which threatens the quality of care and nurse outcomes. METHODS: The study sample included 2114 staff nurses from 156 medical or surgical units of 49 general hospitals who had participated in a cross-sectional survey conducted in 2015. Nurse staffing was measured using the patient-to-nurse ratio and perceived staffing adequacy. The Missed Nursing Care Survey was used to measure how frequently nurses had missed each of 24 activities. Multilevel regression analyses were employed to examine the relationships among variables. RESULTS: The prevalence of missed care differed by nursing activity. Poorer staffing was associated with an increased number of missed activities. A higher number of missed activities and poorer staffing were associated with poorer patient safety, quality of nursing care and job satisfaction, and a higher intent to leave. Nurses gave the highest priority to focused patient reassessments, timely medications, and patient teaching, under hypothetical conditions of improved staffing. CONCLUSION: Adequate staffing is required to reduce missed care and to improve quality of care and nurse outcomes.

Genetic diversity and phylogenetic relationship analyzed by microsatellite markers in eight Indonesian local duck populations.

OBJECTIVE: At least eight local duck breeds have been recognized and documented as national germplasm of Indonesia so far. It is necessary to genetically characterize the local duck breeds for aiding conservation and future improvement strategies. Thus, this study was carried out to assess genetic diversity and phylogenetic relationship of eight local duck populations of Indonesia using microsatellite markers. METHODS: In total, 240 individuals (30 individuals each population) from Alabio (AL), Bayang (BY), Magelang (MG), Mojosari (MJ), Pegagan (PG), Pitalah (PT), Rambon (RM), and Turi (TR) duck populations were genotyped using 22 microsatellite markers. RESULTS: The results showed a moderate level of genetic diversity among populations, with a total of 153 alleles detected over all loci and populations, ranging from 3 to 22 alleles per locus. Observed (Ho) and expected heterozygosity (He), as well as polymorphism information content over all loci and populations were 0.440, 0.566, and 0.513, respectively. Heterozygote deficiency in the overall populations (FIT = 0.237), was partly due to the heterozygote deficiency within populations (FIS = 0.114) and moderate level of genetic differentiation among populations (FST = 0.137). The most diverse population was MG (He = 0.545) and the least diverse population was AL (He = 0.368). The majority of populations were relatively in heterozygote deficiency (except AL), due to inbreeding. The genetic distances, phylogenetic trees, and principal coordinates analysis concluded that the populations can be grouped into two major clusters, resulting AL, MG, and MJ in one cluster separated from the remaining populations. CONCLUSION: The present study revealed a considerable genetic diversity of studied populations and thus, proper management strategies should be applied to preserve genetic diversity and prevent loss of alleles.