Effectiveness of Exercise Interventions on Body Composition, Exercise Capacity, Fatigue, and Quality of Life in Patients with Liver Cirrhosis: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Diminished muscle protein synthesis in cirrhosis leads to reduced strength and mass, impacting daily activities and overall quality of life. AIMS: This study aimed to examine the effectiveness of exercise intervention in body composition, exercise capacity, fatigue, and quality of life in patients with liver cirrhosis. METHODS: A systematic search of medical databases, including PubMed, Embase, Cochrane, and CINAHL, was executed from their inception to November 2022. The inclusion criteria were randomized controlled trials comparing exercise interventions with a control group that did not receive exercise interventions. RESULTS: From the initially identified 2,565 articles, eight studies with a total of 220 patients were eligible for inclusion in this meta-analysis. According to the meta-analysis, exercise significantly improved the six-minute walk distance (6MWD) by 68.93 m (95% CI 14.29-123.57) compared to the control group. Furthermore, the subgroup analysis revealed that combing exercise with amino acid supplementation had a greater positive effect on the 6MWD (MD = 144.72, 95% CI 87.44-202.01). Exercise also significantly increased thigh circumference (MD = 1.26, 95% CI 0.12-2.39) and the thigh ultrasound average compression index (MD = 0.07, 95% CI 0.00-0.14). Moreover, exercise significantly decreased fatigue levels by 0.7 points in patients with liver cirrhosis (95% CI 0.38-1.03). However, no significant effects were observed on body mass index (BMI), fat mass, fat-free mass, and quality of life. CONCLUSIONS: Exercise can improve exercise capacity, thigh muscle thickness, and fatigue in patients with cirrhosis, but it does not have a significant impact on fat mass, BMI, or quality of life.

Socially Assistive Robots for People Living with Dementia in Long-Term Facilities: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND OBJECTIVE: The purpose of our study was to explore the immediate and long-term effects of socially assistive robots (SARs) on neuropsychiatric symptoms (NPSs), behavioral and psychological symptoms of dementia (BPSD), positive emotional experiences, and social interaction in older people living with dementia. METHODS: We set keywords and used Boolean operators to search the CINAHL, Cochrane Library, EMBASE, IEEE Digital Library, MEDLINE, PsycINFO, PubMed, Web of Science, Scopus, and Chinese Electronic Periodical Service from inception to February 2022 for randomized controlled trials. The Cochrane Collaboration bias assessment tool was used to assess article quality, and RevMan 5.4.1 software was used to conduct the meta-analysis. RESULTS: A total of 14 studies were included in the meta-analysis. SARs can help people living with dementia reduce their NPS of depression and anxiety, provide happiness from positive emotional experiences, and improve their social interaction through conversation. However, there was no significant improvement in agitation behavior, overall BPSD, or quality of life in people living with dementia. In follow-up, it was found that the effect of SRT was limited. CONCLUSION: SARs can reduce depression and increase positive emotions in people living with dementia. They may also reduce the burden on healthcare workers during the COVID-19 pandemic. This research was registered on PROSPERO CRD42020169340.

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study.

BACKGROUND: Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults. METHODS: We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T). RESULTS: The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL. CONCLUSIONS: Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

A Performance Improvement for Indoor Positioning Systems Using Earth's Magnetic Field.

Although most indoor positioning systems use radio waves, such as Wi-Fi, Bluetooth, or RFID, for application in department stores, exhibition halls, stations, and airports, the accuracy of such technology is easily affected by human shadowing and multipath propagation delay. This study combines the earth's magnetic field strength and Wi-Fi signals to obtain the indoor positioning information with high availability. Wi-Fi signals are first used to identify the user's area under several kinds of environment partitioning methods. Then, the signal pattern comparison is used for positioning calculations using the strength change in the earth's magnetic field among the east-west, north-south, and vertical directions at indoor area. Finally, the k-nearest neighbors (KNN) method and fingerprinting algorithm are used to calculate the fine-grained indoor positioning information. The experiment results show that the average positioning error is 0.57 m in 12-area partitioning, which is almost a 90% improvement in relation to that of one area partitioning. This study also considers the positioning error if the device is held at different angles by hand. A rotation matrix is used to convert the magnetic sensor coordinates from a mobile phone related coordinates into the geographic coordinates. The average positioning error is decreased by 68%, compared to the original coordinates in 12-area partitioning with a 30-degree pitch. In the offline procedure, only the northern direction data are used, which is reduced by 75%, to give an average positioning error of 1.38 m. If the number of reference points is collected every 2 m for reducing 50% of the database requirement, the average positioning error is 1.77 m.

Edge Computing of Online Bounded-Error Query for Energy-Efficient IoT Sensors.

Since the power of transmitting one-bit data is higher than that of computing one thousand lines of code in IoT (Internet of Things) applications, it is very important to reduce communication costs to save battery power and prolong system lifetime. In IoT sensors, the transformation of physical phenomena to data is usually with distortion (bounded-error tolerance). It introduces bounded-error data in IoT applications according to their required QoS2 (quality-of-sensor service) or QoD (quality-of-decision making). In our previous work, we proposed a bounded-error data compression scheme called BESDC (Bounded-Error-pruned Sensor Data Compression) to reduce the point-to-point communication cost of WSNs (wireless sensor networks). Based on BESDC, this paper proposes an online bounded-error query (OBEQ) scheme with edge computing to handle the entire online query process. We propose a query filter scheme to reduce the query commands, which will inform WSN to return unnecessary queried data. It not only satisfies the QoS2/QoD requirements, but also reduces the communication cost to request sensing data. Our experiments use real data of WSN to demonstrate the query performance. Results show that an OBEQ with a query filter can reduce up to 88% of the communication cost when compared with the traditional online query process.

Scale-Mark-Based Gauge Reading for Gauge Sensors in Real Environments with Light and Perspective Distortions.

Nowadays, many old analog gauges still require the use of manual gauge reading. It is a time-consuming, expensive, and error-prone process. A cost-effective solution for automatic gauge reading has become a very important research topic. Traditionally, different types of gauges have their own specific methods for gauge reading. This paper presents a systematized solution called SGR (Scale-mark-based Gauge Reading) to automatically read gauge values from different types of gauges. Since most gauges have scale marks (circular or in an arc), our SGR algorithm utilizes PCA (principal components analysis) to find the primary eigenvector of each scale mark. The intersection of these eigenvectors is extracted as the gauge center to ascertain the scale marks. Then, the endpoint of the gauge pointer is found to calculate the corresponding angles to the gauge's center. Using OCR (optical character recognition), the corresponding dial values can be extracted to match with their scale marks. Finally, the gauge reading value is obtained by using the linear interpolation of these angles. Our experiments use four videos in real environments with light and perspective distortions. The gauges in the video are first detected by YOLOv4 and the detected regions are clipped as the input images. The obtained results show that SGR can automatically and successfully read gauge values. The average error of SGR is nearly 0.1% for the normal environment. When the environment becomes abnormal with respect to light and perspective distortions, the average error of SGR is still less than 0.5%.

Cost-Effective Fitting Model for Indoor Positioning Systems Based on Bluetooth Low Energy.

Bluetooth Low Energy (BLE) is a positioning technology that is commonly used in indoor positioning systems (IPS) such as shopping malls or underground parking lots, because of its low power consumption and the low cost of Bluetooth devices. It also maintains high positioning accuracy. Since the cost of BLE itself is low, it has now been used in larger environments such as parking lots or shopping malls for a long time. However, it is necessary to configure a large number of devices in the environment to obtain accurate positioning results. The most accurate method of using signal strength for positioning is the signal pattern-matching method. The positioning result is compared through a database with the overheads of time and labor costs, since the amount of data will be proportional to the size of the environment for BLE-IPS. A planar model that conforms to the signal strength in the environment was generated, wherein the database comparison method is replaced by an equation solution, to improve various costs but diminish the positioning accuracy. In this paper, we propose to further replace the planar model with a cost-effective fitting model to both save costs and improve positioning accuracy. The experimental results demonstrate that this model can effectively reduce the average positioning error in distance by 31%.

Influence of sleep fragmentation and fatigue on turnover of female nurses working rotating shifts.

AIMS AND OBJECTIVES: To investigate whether the sleep quality and fatigue of female nurses working rotating shifts could be used to predict future turnover status. BACKGROUND: Female nurses working rotating shifts often suffer from sleep problems and fatigue, and the turnover rates of nurses are generally higher than those of other hospital personnel. DESIGN: A prospective study. METHODS: We recruited a total of 198 female nurses working rotating shifts from December 2017 to March 2019. The nurses completed the Checklist Individual Strength (CIS) scale and wore an actigraph for seven consecutive days in order to collect their sleep parameters. Their turnover status was tracked until 31 May 2021 at which time 55 participants (27.8%) had resigned. The Cox proportional hazard model was used to analyse the factors influencing turnover. In addition, the study adhered to the STROBE checklist. RESULTS: The results revealed significant differences between the nurses in the still-working group and the resigned group in terms of the sleep quality parameters sleep efficiency (SE) and wake after sleep onset (WASO) as well as CIS scores. WASO was significantly correlated with intensity of fatigue, and fatigue was common among all of the nurses working rotating shifts. As time progressed, the sleep quality parameter WASO and CIS scores could be used to predict turnover status after 2.4 years. CONCLUSION: The results of this study indicated more sleep fragmentation and poor sleep efficiency in the resigned group. Sleep fragmentation was highly correlated with fatigue, and sleep fragmentation and fatigue could be used to predict turnover status. RELEVANCE TO CLINICAL PRACTICE: We suggest that relevant hospital management pay more attention to the sleep conditions and fatigue of female nurses working rotating shifts when arranging personnel and schedules and offer them more understanding.

Effects of personalized music intervention on nurse burnout: A feasibility randomized controlled trial.

Burnout is highly prevalent among nurses; however, the effect of personalized music intervention on burnout remains unclear on nurses. We aimed to investigate the effects of personalized music intervention in relieving burnout among nurses. Forty-two eligible nurses were recruited for an assessor-blinded, two-arm parallel randomized controlled trial. The participants were randomly assigned to the following two groups: The personalized music group (n = 21), which listened to music of their choice for 30 min per session three times per week for 5 weeks; and the wait-list control group (n = 21), which did not listen to any music for relaxation. At baseline, nurses in the personalized music group had worse emotional exhaustion and greater depression compared with the wait-list control group. Results from an analysis of covariance using baseline emotional exhaustion and depression as covariates indicated that nurses who received personalized music intervention experienced less emotional exhaustion than the nurses in the wait-list control experienced. Personalized music intervention can be used for nurses as an adjuvant approach to reduce emotional exhaustion and then improve their well-being.

Protection procedures and preventions against the spread of coronavirus disease 2019 in healthcare settings for nursing personnel: Lessons from Taiwan.

BACKGROUND: Since coronavirus disease 2019 was first discovered, at the time of writing this article, the number of people infected globally has exceeded 1 million. Its high transmission rate has resulted in nosocomial infections in healthcare facilities all over the world. Nursing personnel account for nearly 50% of the global health workforce and are the primary provider of direct care in hospitals and long-term care facilities. Nurses stand on the front line against the spread of this pandemic, and proper protection procedures are vital. OBJECTIVES: The present study aims to share the procedures and measures used by Taiwan nursing personnel to help reduce global transmission. REVIEW METHODS: Compared with other regions, where large-scale epidemics have overwhelmed the health systems, Taiwan has maintained the number of confirmed cases within a manageable scope. A review of various national and international policies and guidelines was carried out to present proper procedures and preventions for nursing personnel in healthcare settings. RESULTS: This study shows how Taiwan's health system rapidly identified suspected cases as well as the prevention policies and strategies, key protection points for nursing personnel in implementing high-risk nursing tasks, and lessons from a nursing perspective. CONCLUSIONS: Various world media have affirmed the rapid response and effective epidemic prevention strategies of Taiwan's health system. Educating nurses on procedures for infection control, reporting cases, and implementing protective measures to prevent nosocomial infections are critical to prevent further outbreaks.

Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer.

BACKGROUND: The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. METHODS: A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. RESULTS: In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p < 0.001; B = 15.666, SE = 4.542, p = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL (R2 = 0.51, F = 5.41, p < 0.001). CONCLUSIONS: During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.

Visual Guidance and Egg Collection Scheme for a Smart Poultry Robot for Free-Range Farms.

Free-range chicken farming allows egg-laying hens to move freely through their environment and perform their natural behavior, including laying her eggs. However, it takes time to gather these eggs manually, giving rise to high labor costs. This study proposes a smart mobile robot for poultry farms that can recognize eggs of two different colors on free-range farms. The robot can also pick up and sort eggs without damaging them. An egg feature extraction method with automatic thresholding is employed to detect both white and brown eggs, and a behavior-based navigation method is applied to allow the robot to reach the eggs while avoiding obstacles. The robot can move towards the position of each egg via visual tracking. Once the egg is within the collection area of the robot, it is gathered, sorted and stored in the tank inside the robot. Experiments are carried out in an outdoor field of size 5 m × 5 m under different climatic conditions, and the results showed that the average egg recognition rate is between 94.7% and 97.6%. The proposed mobile poultry robot is low in production cost and simple in operation. It can provide chicken farmers with automatic egg gathering on free-range farms.

Impact of window views on recovery-an example of post-cesarean section women.

OBJECTIVE: The objective of this study was to examine the impact of urban landscape from window views on quality of care for women who underwent Cesarean Section (C-section) in Taiwan. DESIGN: The participants were randomly assigned into 46 different hospital rooms to see the effects of various window views and daylight exposure on women's recovery from post C-section care. SETTING: We carried out this study in the obstetrics departments of three tertiary hospitals located in two major cities of Taiwan: Taipei City and New Taipei City. PARTICIPANTS: A total of 296 women who underwent C-sections and used patient-controlled analgesic (PCA) for pain control after their surgery during the 10-month data collection period were recruited for this study. INTERVENTION: The 46 different patient rooms provided diverse window views and different daylight exposure for the participants. MAIN OUTCOME MEASURES: Recovery for the women who underwent C-sections in this study was defined as PCA usage and perceived pain measured by Brief Pain Inventory (BFI). RESULTS: Higher satisfaction of window view significantly decreased analgesic usage (P = 0.057), reduced the scores of overall perceived pain (P = 0.046), pain severity (P = 0.004), and 'pain's interference with relations with others, enjoyment of life, and mood (REM).' (P = 0.095). CONCLUSIONS: To maximize benefit and well-being of patients recovering from surgery, health care architects should design patient rooms to create maximum satisfaction with visual impacts and optimize window views. By doing so, it may decrease the use of pain medication and substantially reduce healthcare costs.

[An Experience Applying Life Review and Resilience to a Geriatric Patient With Functional Limitations and Depression].

Negative self-values and attitudes during the process of adapting to disease tend to engender depression in the elderly. This case study describes a nursing experience with an elderly patient with depression related to a decline in activity and family role changes related to unexpected spinal infection. The nursing care in this study was provided between February 28th and April 25th, 2017. A comprehensive geriatric assessment was employed, with results showing that the patient was affected by negative self-identity and attitudes. The geriatric depression scale showed moderate depression. Life review strategy was employed in the interview to impart a positive influence on a different life stage and a resilience model was used to interpret the interview transcript. The protective factors were identified and used to develop an individualized nursing intervention that included promoting the support of the husband in order to enhance positive attitude, promoting interactions with the grandchildren in order to increase feelings of independence. Finally, the patient became cognizant of family support and expressed positive words and self-values, which improved depression symptoms. This case report provides a valuable nursing care experience as a reference for similar cases in the future.

Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials.

BACKGROUND: For airway management of intensive care unit (ICU) patients who are intubated, a 5-10-mL bolus of sterile normal saline (NS) solution is commonly instilled into an endotracheal or tracheostomy tube before suctioning. However, NS instillation has been associated with adverse events such as dyspnea, increasing heart rate, decreasing of oxygenation, blood pressure, and other vital parameters. OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the necessity of NS instillation before suctioning in ICU patients. DATA SOURCES: The PubMed, Embase, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were searched for studies published before May 2016. REVIEW METHODS: RCTs evaluating the outcome of NS instillation before suctioning in ICU patients undergoing endotracheal intubation or tracheostomy were included. Individual effect sizes were standardised, and a meta-analysis was conducted to calculate the pooled effect size by using a random-effect model. The primary outcome was the oxygen saturation immediately and 2 and 5min after suctioning. The secondary outcomes were the heart rate and blood pressure after suctioning. RESULTS: We reviewed 5 RCTs including 337 patients. Oxygen saturation was significantly higher in the non-NS group than in the NS group 5min after suctioning. The pooled mean difference in oxygen saturation was -1.14 (95% confidence interval: -2.25 to -0.03). The heart rate and blood pressure did not differ significantly between the non-NS and NS groups. CONCLUSION: NS instillation before suctioning does not benefit patients undergoing endotracheal intubation or tracheostomy. Moreover, it reduces oxygen saturation 5min after suction. However, our reviewed studies had a low methodological quality. Thus, additional studies involving large-scale RCTs are warranted.

Endocytotic routes of cobra cardiotoxins depend on spatial distribution of positively charged and hydrophobic domains to target distinct types of sulfated glycoconjugates on cell surface.

Cobra cardiotoxins (CTX) are a family of three-fingered basic polypeptides known to interact with diverse targets such as heparan sulfates, sulfatides, and integrins on cell surfaces. After CTX bind to the membrane surface, they are internalized to intracellular space and exert their cytotoxicity via an unknown mechanism. By the combined in vitro kinetic binding, three-dimensional x-ray structure determination, and cell biology studies on the naturally abundant CTX homologues from the Taiwanese cobra, we showed that slight variations on the spatial distribution of positively charged or hydrophobic domains among CTX A2, A3, and A4 could lead to significant changes in their endocytotic pathways and action mechanisms via distinct sulfated glycoconjugate-mediated processes. The intracellular locations of these structurally similar CTX after internalization are shown to vary between the mitochondria and lysosomes via either dynamin2-dependent or -independent processes with distinct membrane cholesterol sensitivity. Evidence is presented to suggest that the shifting between the sulfated glycoconjugates as distinct targets of CTX A2, A3, and A4 might play roles in the co-evolutionary arms race between venomous snake toxins to cope with different membrane repair mechanisms at the cellular levels. The sensitivity of endocytotic routes to the spatial distribution of positively charged or hydrophobic domains may provide an explanation for the diverse endocytosis pathways of other cell-penetrating basic polypeptides.

MicroRNA miR-24 enhances tumor invasion and metastasis by targeting PTPN9 and PTPRF to promote EGF signaling.

MicroRNAs are known to play regulatory roles in gene expression associated with cancer development. We analyzed levels of the microRNA miR-24 in patients with breast carcinoma and found that miR-24 was higher in breast carcinoma samples than in benign breast tissues. We generated constructs expressing miR-24 and studied its functions using both in vitro and in vivo techniques. We found that the ectopic expression of miR-24 promoted breast cancer cell invasion and migration. In vivo experiments in mice indicated that the expression of miR-24 enhanced tumor growth, invasion into local tissues, metastasis to lung tissues and decreased overall mouse survival. In the miR-24-expressing cells and tumors, EGFR was highly phosphorylated, whereas expression of the phosphatases tyrosine-protein phosphatase non-receptor type 9 (PTPN9) and receptor-type tyrosine-protein phosphatase F (PTPRF) were repressed. We confirmed that miR-24 could directly target both PTPN9 and PTPRF. Consistent with this, we found that the levels of phosphorylated epidermal growth factor receptor (pEGFR) were higher whereas the levels of PTPN9 and PTPRF were lower in the patients with metastatic breast carcinoma. Ectopic expression of PTPN9 and PTPRF decreased pEGFR levels, cell invasion, migration and tumor metastasis. Furthermore, we found that MMP2, MMP11, pErk, and ADAM15 were upregulated, whereas TIMP2 was downregulated; all of which supported the roles of miR-24 in tumor invasion and metastasis. Our results suggest that miR-24 plays a key role in breast cancer invasion and metastasis. miR-24 could potentially be a target for cancer intervention.

Effects of endurance exercise training on risk components for metabolic syndrome, interleukin-6, and the exercise capacity of postmenopausal women.

We conducted this study to investigate how an exercise program affects the risk components of metabolic syndrome (MS), serum interleukin (IL)-6 levels, and exercise capacity in postmenopausal women. A randomized clinical trial design was used. Women in an exercise group participated in a treadmill-exercise program for 12 weeks, whereas women in a control group maintained their customary lifestyle. Data on variables were collected at baseline and after 12 weeks of the study, which was completed by 46 women (mean age, 56.0 ± 7.0 y). Our results indicate endurance exercise exerted significant beneficial effects on waist circumference, serum high-density lipoprotein cholesterol (HDL-C) and IL-6 levels, and exercise capacity (all P < 0.05). The beneficial effects on IL-6 and exercise capacity were correlated with improvements in HDL-C levels (r = -0.33, P = 0.03 and r = 0.31, P = 0.04, respectively). Our results suggest that health-care providers can incorporate an exercise program in treatments to improve the health of postmenopausal women.

A shRNA functional screen reveals Nme6 and Nme7 are crucial for embryonic stem cell renewal.

In contrast to the somatic cells, embryonic stem cells (ESCs) are characterized by its immortalization ability, pluripotency, and oncogenicity. Revealing the underlying mechanism of ESC characteristics is important for the application of ESCs in clinical medicine. We performed systematic functional screen in mouse ESCs with 4,801 shRNAs that target 929 kinases and phosphatases. One hundred and thirty-two candidate genes that regulate both ESC expansion and stem cell marker expression were identified. Twenty-seven out of the 132 genes were regarded as most important since knockdown of each gene induces morphological changes from undifferentiated to differentiated state. Among the 27 genes, we chose nonmetastatic cell 6 (Nme6, also named as Nm23-H6) and nonmetastatic cell 7 (Nme7, also designated as Nm23-H7) to study first. Nme6 and Nme7 both belong to the members of nucleoside diphosphate kinase family. We demonstrate that Nme6 and Nme7 are important for the regulation of Oct4, Nanog, Klf4, c-Myc, telomerase, Dnmt3B, Sox2, and ERas expression. Either knockdown of Nme6 or Nme7 reduces the formation of embryoid body (EB) and teratoma. The overexpression of either Nme6 or Nme7 can rescue the stem cell marker expression and the EB formation in the absence of leukemia inhibiting factor. This implies the importance of Nme6 and Nme7 in ESC renewal. This finding not only pinpoints Nme6 or Nme7 can regulate several critical regulators in ESC renewal but also increases our understanding of the ESC renewal and oncogenesis.

Factors Related to Nurse Satisfaction with Supervisor Leadership.

The satisfaction of nurses with the leadership of their supervisors exerts a positive association with their job satisfaction. This study identified factors associated with nurse satisfaction with supervisor leadership and developed a model of causal relationships based on social exchange theory. A satisfaction scale was developed to measure how nurses felt about the leadership of their supervisor, which also assessed the validity and reliability using a cross-sectional descriptive survey questionnaire administered to nurses working in a teaching hospital in northern Taiwan. A total of 607 valid questionnaires were returned. Structural equation modeling was used to test the theoretical model of this study. Only questions that were scored above 3 were included in the scale. A total of 30 questions were placed under seven constructs of this scale upon the assessment of content validity. The results indicate that satisfaction with shift schedules, educational training, and internal communication exerted direct, significant, and positive associations with satisfaction with the supervisor leadership. Furthermore, satisfaction with policies and guidelines exerted direct, significant, and positive associations with satisfaction with internal communication and exerted indirect associations with satisfaction with supervisor leadership through internal communication. In particular, satisfaction with shift schedules and internal communication were most significantly associated with satisfaction with supervisor leadership. The results of this study offer a reference for hospital management and emphasize focusing on the arrangement of nurse shifts in all departments. The establishment of diverse communication channels can enhance the degree of nurse satisfaction with supervisor leadership.