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Background: Postoperative pain control is pivotal for surgical care; it facilitates patient recovery. Although patient-controlled analgesia (PCA) has been available for decades, inadequate pain control remains. Nurses' knowledge of and attitude toward PCA may influence the efficacy on clinic application. Purpose: The purpose of this study is to evaluate nurses' knowledge of and attitude toward postoperative PCA and investigate the associated factors. Methods: This is a cross-sectional study. We enrolled registered nurses from a 2200-bed medical center in northern Taiwan within one year. The participants completed an anonymous self-reported PCA knowledge inventory and PCA attitude inventory. Data were analyzed descriptively and associated were tested using logistic regression. Results: With 303 participants enrolled, we discovered that nurses had limited knowledge of and a negative attitude toward PCA. Under half of the participants know how to set up a bolus dose and lockout intervals. The majority held misconceptions regarding side effect management for opioids. The minority agree to increase the dose when a patient experienced persistent pain or suggested the use of PCA. Surprisingly, participants with a bachelor's or master's degree had lower knowledge scores than those with a junior college degree. Those with 6–10 years of work experience also are lower than those with under 5 years of experience. However, the participants with experience of using PCA for patient care had higher knowledge scores and a more positive attitude. Conclusions: Although postoperative PCA has been available for decades and education programs are routinely provided, nurses had limited knowledge of and a negative attitude toward PCA. A higher education level and longer work experience were not associated with more knowledge. The current education programs on PCA should be revised to enhance their efficacy in delivering up-to-date knowledge and situation training which may convey supportive attitude toward clinical application of PCA. [ABSTRACT FROM AUTHOR]

The injury severity score (ISS) is used in daily practice to evaluate the severity of trauma patients; however, the score is not always consistent with the prognosis. After injury, systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS) are related to the prognosis of trauma patients. We aimed to evaluate the associations between the immune response and prognosis in trauma patients. Patients who admitted to the Trauma Intensive Care Unit (ICU) were eligible. Whole blood samples were collected at admission, and then 6, 12, 24, 48 and 72 h after admission. Natural killer (NK) cells, lymphocyte subset population and cytokines release were identified using flow cytometry. We grouped patients by their ISS (≤ 25 and > 25 as very severe injury) and ICU stay (≤ 10 days as a short ICU stay and > 10 days as a long ICU stay) for evaluation. Fifty-three patients were enrolled. ICU stay but not ISS was close correlated with activity daily living (ADL) at discharge. Patients with a long ICU stay had an immediate increase in NK cells followed by lymphopenia which persisted for 48 h. Immediate activation of CD8+ T cells and then exhaustion with a higher programmed cell death-1 (PD-1) expression and suppression of CD4+ T cells with a shift to an anti-inflammatory Th2 phenotype were also observed in the patients with a long ICU stay. When the patients were grouped by ISS, the dynamics of immune responses were inconsistent to those when the patients were grouped by ICU stay. Immune responses are associated with the prognosis of trauma patients, however the currently used clinical parameters may not accurately reflect immune responses. Further investigations are needed to identify accurate predictors of prognosis in trauma patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the complementary effects of polyphenolic compounds from pine bark extract (PE) as a strong antioxidative substrate on the symptoms of inattention and impulsivity in children with attention‐deficit hyperactivity disorder (ADHD). This was a randomized, double‐blind, crossover, placebo‐controlled study that included two experimental units (4 weeks with PE supplementation and 4 weeks with placebo supplementation) separated by a 2‐week washout period. ADHD participants were supplemented with 25 mg or 50 mg PE. We recruited 20 participants (17 boys and 3 girls) with a mean age of 10.0 ± 2.1 years. PE supplementation caused a significant reduction in the inattention and hyperactivity‐impulsivity items of SNAP‐IV. During the period of PE supplementation, the item of commissions in the Continuous Performance Test III (CPT III) significantly decreased, which was used to evaluate the symptoms of inattention and impulsivity. In addition, the erythrocytic reduced glutathione/oxidized glutathione ratio significantly increased, and the plasma TBARs level significantly decreased after 4 weeks of PE supplementation. However, there was no significant correlation between CPT III (commission) and antioxidative status indictors. PE supplementation may have potential effects of ameliorating inattention and impulsivity, and elevating the antioxidative status in children with ADHD. [ABSTRACT FROM AUTHOR]

In most secret image sharing schemes, the secrecy level of each pixel is the same. However, in real applications, different pixels may require different secrecy levels. For example, in a patient's medical image, the region with the patient's name must be highly protected. To solve this problem, Wang and Lin proposed a scheme that allows a dealer to divide an image into multiple regions, each of which is associated with a certain level of secrecy. In their scheme, an extra pixel-security-level map (PSLM) is required to record the secrecy level of each pixel, and the shadow size of the PSLM is approximately 20 % of that of the secret image. It is unreasonable to have such a large overhead. To reduce the shadow size of the PSLM, they restricted each region to be a rectangle. Furthermore, any two participants can reconstruct the PSLM, enabling the content of regions with high secrecy levels to be compromised easily. To resolve these disadvantages, this paper proposes a new encoding scheme for PSLMs. The location of each region is protected according to its secrecy level, thus improving the security of the image. Moreover, the shape of each region is unrestricted, and the shadow size of the PSLM is reduced significantly. [ABSTRACT FROM AUTHOR]

In the area of secret image sharing (SIS), most papers focused on the schemes for threshold or some special access structures. Regarding general access structures (GAS), few results have been found in the literature. Two SIS schemes for GAS were proposed in 2001 and 2010, both are based on qualified sets. However, one distorts the reconstructed secret image, and some extra information is needed in both schemes. Here, we propose three polynomial based SIS schemes for GAS. Considering either qualified or forbidden sets, these schemes can reconstruct the secret image perfectly without any extra information needed. Some proof and analysis on the shadow sizes of the three schemes are given to lead us to choose the one with the smallest size. In addition, we also give some comparisons with two existing schemes, and security issue is also addressed in conclusion. [ABSTRACT FROM AUTHOR]

Compared to data on adolescents and adults, limited research has been conducted on biological correlates among young children with possible psychological difficulties, especially in Asian countries. By focusing on various peripheral biochemical indicators, we investigated potential biological correlates of psychological states in a community sample of Taiwanese school children aged 6-10 years. In total, 307 students (159 obese children and 148 normal-weight children) were selected from first- and fourth-grade school children in eight elementary schools in the Taipei metropolitan area in 2009. These children underwent a comprehensive health examination, including a physical examination, blood sample analysis, and questionnaire administration in a hospital. Differences in anthropometric and serum biochemical readings were compared between children with average and worse levels on each of the five psychological domains. We found that interleukin (IL)-1β [ β = 1.29, 95 % confidence interval ( CI) 0.50-2.09], IL-10 ( β = 1.61, 95 % CI <0.01-3.24), fasting blood glucose ( β = 0.08, 95 % CI 0.01-0.15), homocysteine ( β = 0.63, 95 % CI 0.09-1.18), and aspartate transaminase (AST) ( β = 0.15, 95 % CI <0.01-0.31) were significantly positively associated with anxiety. In addition, IL-1β, insulin, AST, and alanine aminotransaminase (ALT) were significantly positively associated with depression. Anger and disruptive behaviors were also related to specific biological correlates. Specific biological correlates, including AST/ALT, cardiovascular disease-related variables, and specific cytokines, were linked to particular psychological states among young children in this Asian population. These might provide a route for better understanding the biological aspects of children's mental health and might contribute to research on diagnostic or predictive biomarkers for psychiatric diseases in young children. [ABSTRACT FROM AUTHOR]

Heterozygosity-fitness correlations (HFCs) provide insights into the genetic bases of individual fitness variation in natural populations. However, despite decades of study, the biological significance of HFCs is still under debate. In this study, we investigated HFCs in a large population of the sexually dimorphic lizard Takydromus viridipunctatus (Lacertidae). Because of the high prevalence of parasitism from trombiculid mites in this lizard, we expect individual fitness (i.e., survival) to decrease with increasing parasite load. Furthermore, because morphological asymmetry is likely to influence individuals' mobility (i.e., limb asymmetry) and male biting ability during copulation (i.e., head asymmetry) in this species, we also hypothesize that individual fitness should decrease with increasing morphological asymmetry. Although we did not formally test the relationship between morphological asymmetry and fitness in this lizard, we demonstrated that survival decreased with increasing parasite load using a capture-mark-recapture data set. We used a separate sample of 140 lizards to test the correlations between individual heterozygosity (i.e., standardized mean d2 and HL based on 10 microsatellite loci) and the two fitness traits (i.e., parasite load and morphological asymmetry). We also evaluated and excluded the possibility that single-locus effects produced spurious HFCs. Our results suggest male-only, negative correlations between individual heterozygosity and parasite load and between individual heterozygosity and asymmetry, suggesting sex-specific, positive HFCs. Male T. viridipunctatus with higher heterozygosity tend to have lower parasite loads (i.e., higher survival) and lower asymmetry, providing a rare example of HFC in reptiles. [ABSTRACT FROM AUTHOR]

Lots of lithium ion battery (LIB) products contain lithium metal oxide LiNi5Co2Mn3O2 (LNCM) as the positive electrode's active material. The stable surface of this oxide results in high resistivity in the battery. For this reason, conductive carbon-based materials, including acetylene black and carbon black, become necessary components in electrodes. Recently, carbon nano-tube (CNT) has appeared as a popular choice for the conductive carbon in LIB. However, a large quantity of the conductive carbon, which cannot provide capacity as the active material, will decrease the energy density of batteries. The ultra-high cost of CNT, compared to conventional carbon black, is also a problem. In this work, we are going to introduce long-length carbon nano-tube s(L-CNT) into electrodes in order to design a reduced-amount conductive carbon electrode. The whole experiment will be done in a 1Ah commercial type pouch LIB. By decreasing conductive carbon as well as increasing the active material in the positive electrode, the energy density of the LNCM-based 1Ah pouch type LIB, with only 0.16% of L-CNT inside the LNCM positive electrode, could reach 224 Wh/kg and 549 Wh/L, in weight and volume energy density, respectively. Further, this high energy density LIB with L-CNT offers stable cyclability, which may constitute valuable progress in portable devices and electric vehicle (EV) applications. [ABSTRACT FROM AUTHOR]

In this study, three different approaches were applied to obtain thermoplastic polyurethane (TPU) nanocellular foams. The TPU was synthesized with a 4, 4′-methylenebis (phenyl isocyanate) and 1, 4-butanediol (MDI/BD) hard segment system using a pre-polymer method. The three approaches included increasing the hard segment content, adding a graphene nucleation agent, and replacing the soft segments. Although the synthesized TPUs had a different hardness, it was possible to obtain nanocellular structures with all of the methods. The cell structure is not a function of hardness only. Crystallinity affects the cell structure as well. The addition of graphene and replacement of the soft segments were more effective at yielding nanocellular foams. Our best results showed that after adding 0.1 wt% of graphene, the average cell size of the TPU foam decreased to 715 nm, and the cell density was improved to 4.94 × 1011 cells/cm3. The relative density of the foam could be as low as 0.77. This study first reported elastomer-based nanocellular structures with such low relative density. [ABSTRACT FROM AUTHOR]