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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.This is a 4-day intensive longitudinal study.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.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.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.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.

Metabolic syndrome (MetS), a major contributor to cardiovascular and metabolic diseases, has been linked with exposure to air pollution. However, the relationship between air pollutants and the five components of MetS [abdominal obesity, elevated triglyceride, decreased high-density lipoprotein cholesterol (HDL-C), elevated blood pressure, and elevated fasting blood glucose levels], has not been clearly described.We examined the association between long-term exposure to air pollutants and the occurrence of MetS and its components by using a longitudinal cohort in Taiwan.The MJ Health Research Foundation is a medical institute that conducts regular physical examinations. The development of MetS, based on a health examination and the medical history of an MJ cohort of 93,771 participants who were enrolled between 2006 and 2016 and had two or more examinations, was compared with estimated exposure to air pollutants in the year prior to health examination. The exposure levels to fine particulate matter [PM with an aerodynamic diameter ofDuring the average follow-up period of 3.4 y, the incidence of MetS was 38.1/1,000 person-years. After mutual adjustment and adjustments for potential covariates, the results indicated that everyOur findings suggest that in apparently healthy adults undergoing physical examination, exposure to

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.醫院安全風氣：由科學到政策—臺灣針扎防治歷程.醫療機構所建立相關的安全政策與制度，讓醫療人員感受到組織安全的相關作為，即是醫院安全風氣，其可以直接影響醫療人員整體工作表現，及間接地影響病人的照護品質，並進一步影響職業危害的發生狀況。醫療職場常見的職業危害，包含傳染性疾病、過勞高風險、輪班造成的晝夜節律、睡眠型態與飲食習慣改變、肌肉骨骼不適、職場暴力、職場壓力及針扎等；本文即是分享臺灣在針扎防治的推動歷程，如何運用實證研究結果的科學證據，倡議及提供政策制定的重要佐證及說帖，進而提升醫院安全風氣與職業危害事件降低之互相影響與改善的過程；未來應鼓勵透過更多的科學研究投入，針對職場壓力源的了解與改善，提供政府主管部門及醫療機構制定政策之參考，以創造安全風氣高的護理執業環境及提升護理人員對執業環境安全的整體知覺，共創合宜、友善的醫療執業環境。.

Vision is typically dominant over audition or touch in human adults. One classic example is the Colavita visual dominance effect: The presentation of a tone sometimes goes undetected when it is paired with a flash even though it is well detected when presented alone. We investigated whether the Colavita visual dominance effect is modulated by stimulus uncertainty in the temporal and spatial domains. In a simple discrimination task, participants were asked to press a predesignated key when detecting a flash, another key when detecting a tone, and both keys when detecting both a flash and a tone. Temporal uncertainty was increased by introducing temporal jitter between trials (Experiment 1), and spatial uncertainty was increased by shifting the flash to different locations (Experiment 2). The Colavita visual dominance effect was reduced when temporal uncertainty was increased, while it remained similar when spatial uncertainty was increased. We therefore demonstrate a novel consideration, where increasing temporal uncertainty balances the competition between vision and audition, suggesting that people's degree of sensory dominance is malleable. Our result therefore highlights the concept that intersensory competition is susceptible to the temporal predictability of the stimulus, which provides critical insights into the design of effective warning systems in the field of ergonomics.

Background Current American Heart Association Pediatric Life Support (PLS) guidelines do not recommend the routine use of sodium bicarbonate (SB) during cardiac arrest in pediatric patients. However, SB administration during pediatric resuscitation is still common in clinical practice. The objective of this study was to assess the impact of SB on mortality and neurological outcomes in pediatric patients with in-hospital cardiac arrest. Methods We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to January 2021. We included studies of pediatric patients that had two treatment arms (treated with SB or not treated with SB) during in-hospital cardiac arrest (IHCA). Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was assessed using GRADE system. Results We included 7 observational studies with a total of 4877 pediatric in-hospital cardiac arrest patients. Meta-analysis showed that SB administration during pediatric cardiac resuscitation was associated with a significantly decreased rate of survival to hospital discharge (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25–0.63, p value = 0.0003). There were insufficient studies for 24-h survival and neurologic outcomes analysis. The subgroup analysis showed a significantly decreased rate of survival to hospital discharge in both the “before 2010” subgroup (OR 0.47; 95% CI 0.30–0.73; p value = 0.006) and the “after 2010” subgroup (OR 0.46; 95% CI 0.25–0.87; p value = 0.02). The certainty of evidence ranged from very low to low. Conclusions This meta-analysis of non-randomized studies supported current PLS guideline that routine administration of SB is not recommended in pediatric cardiac arrest except in special resuscitation situations. Trial registration The protocol was registered with PROSPERO on 8 August 2020 (registration number: CRD42020197837).

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.

We examined whether firefighters in Taiwan have a sleep problem and investigated the related factors of poor sleep quality.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.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.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.

Background Sexual problems are common in male lung cancer survivors. However, the development of erectile dysfunction (ED) in lung cancer patients after surgery has been rarely explored. In this study, we aimed to explore the incidence and risk factors of ED after lung cancer surgery. Methods From 2000 to 2012, 6025 and 24,100 male patients were included in each matched cohort of lung cancer and non-lung cancer patients, respectively. Poisson regression analysis was used to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI). Results The incidence of ED was higher in the lung cancer cohort compared to the non-lung cancer cohort (38.47 vs 28.28 per 10,000 person-years) with an adjusted IRR (aIRR) of 1.34 (95% CI: 1.06-1.70, p=0.014) after the confounders were adjusted for. An increased incidence of ED was observed in the lung cancer cohort aged 40-54 years (aIRR: 5.44, 95% CI: 2.25-13.15, p

Objectives Perceiving simultaneity of a visual and an auditory signal is critical for humans to integrate these multisensory inputs effectively and respond properly. We examined age-related changes in audiovisual simultaneity perception, and the relationships between this perception and working memory performances with aging. Methods Audiovisual simultaneity perception of young, middle-aged, and older adults was measured using a simultaneity judgment (SJ) task, in which a flash and a beep were presented at 1 of 11 stimulus-onset asynchronies (SOAs). Participants judged whether these two stimuli were perceived simultaneously. Precision of simultaneity perception, the SOA corresponding to the point of subjective simultaneity (PSS), and response errors at each SOA were estimated using model fitting. The precision and PSS are associated with multisensory perception per se, whereas the response error reflects executive ability when performing the SJ task. Visual working memory of the same middle-aged and older adults was measured using the Cambridge Neuropsychological Test Automated Battery (CANTAB) beforehand. Results Compared to young adults’ performances, middle-aged and older adults showed a decreased precision, a shift of PSS toward the visual-leading SOAs, and increased response errors at the visual-leading SOAs. Among these changes, only the increased response errors correlated with worse spatial recognition memory in middle-aged and older adults. Discussion Age-related decrements in audiovisual simultaneity perception start from middle age and are manifested in both perceptual and executive parameters. Furthermore, higher-order executive ability is plausibly a common cause for age-related degenerations in the audiovisual simultaneity perception and visual working memory.

Dipeptidyl peptidase-4, a transmembrane glycoprotein expressed in various cell types, serves as a co-stimulator molecule to influence immune response. This study aimed to investigate associations between DPP-4 inhibitors and risk of autoimmune disorders in patients with type 2 diabetes mellitus in Taiwan. This retrospective cohort study used the nationwide data from the diabetes subsection of Taiwan National Health Insurance Research Database between January 1, 2009, and December 31, 2013. Cox proportional hazards models were developed to compare the risk of autoimmune disorders and the subgroup analyses between the DPP-4i and DPP-4i-naive groups. A total of 774,198 type 2 diabetic patients were identified. The adjusted HR of the incidence for composite autoimmune disorders in DPP-4i group was 0.56 (95% CI 0.53–0.60; P

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.

Crossmodal correspondences refer to the fact that certain domains of features in different sensory modalities are associated with each other. Here, we investigated the crossmodal correspondences between speech sounds and visual shapes. Specifically, we tested whether the classification dimensions of English vowels (front–central–back) and consonants (voiced–voiceless, sonorant–obstruent, and stop–continuant) correspond to visual shapes along a bipolar rounded–angular dimension. We adapted eighteen meaningless pseudowords from a previous study that corresponded to either the round or the sharp concept. On each trial, the participants heard one of the pseudowords and saw a rounded shape and an angular shape presented side-by-side on the monitor. Participants judged which shape provided a better match to the spoken pseudoword. A logistic regression was conducted in order to elucidate the effectiveness of classification dimensions of phonemes when predicting variations in the sound–shape matchings. The results demonstrated that the sound–shape matchings were predictable using front–central–back dimensions of vowels, and voiced–voiceless and stop–continuant dimensions of consonants. Hence, we verified that sound–shape matching is underpinned by contrasting dimensions in both vowels and consonants, therefore demonstrating crossmodal correspondences at the phonetic level.

Objective Short sleep duration is common among nurses. Sleep restriction has been associated with musculoskeletal discomfort. However, studies on the effect of short sleep duration on chronic neck and shoulder discomfort in nurses have been lacking. The aim of this study was to determine whether short sleep duration is related to chronic neck and shoulder discomfort. Methods We conducted a cross‐sectional survey of female nurses in secondary referral health centers in Taiwan. We applied stratified sampling based on region (north, central, south, and east) to select representative centers for this study. A self‐administered structured questionnaire, including demographic data, the psychological working environment, and musculoskeletal symptoms, was administered to nurses. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of average sleeping hours per working day on chronic neck and shoulder discomfort. Results A total of 1602 (78.9%) questionnaires were eligible for final analysis. The prevalence rates of chronic neck and shoulder discomfort were 33.9% and 34.7%, respectively. Population attributable risk estimation revealed that a sleep duration of

Necrotizing fasciitis is a severe soft-tissue infection with a high mortality rate. There is little literature on the relationship between the ultrasonographic finding of fluid accumulation along the deep fascia and the diagnosis and prognosis of necrotizing fasciitis. This retrospective study showed that when fluid accumulation was present along the deep fascia, patients with clinically suspected necrotizing fasciitis had a higher probability of having necrotizing fasciitis. The ultrasonographic finding of fluid accumulation with a cutoff point of more than 2 mm of depth had the best accuracy (72.7%) for diagnosing necrotizing fasciitis. In regard to the prognosis of necrotizing fasciitis, when fluid accumulation was present along the deep fascia, patients with necrotizing fasciitis had a longer length of hospital stay and were at risk of amputation or mortality. Ultrasonography is a point-of-care imaging tool that facilitates the diagnosis and prognosis of necrotizing fasciitis.

Aim: To compare efficacy between total gastrectomy (TG) and proximal gastrectomy (PG) for upper-third gastric cancer. Materials & methods: PubMed, Embase and Cochrane library were searched to select suitable researches. Stata was used for meta-analysis including 5-year overall survival rate, recurrence rate, complication morbidities and serum nutritional levels. Results: Ten retrospective English researches were contained. Our study showed no significant difference of 5-year overall survival rate, recurrence rate, reflux symptoms and anastomotic leakage. TG experienced longer operation time, more lymph nodes-retrieved number, more estimated blood loss and higher ileus, but less anastomotic stricture. PG showed advantages over TG in terms of serum nutritional levels. Conclusion: PG is more preferable to TG for treatment of upper-third gastric cancer.

Simple Summary Annexin A1 (ANXA1) is associated with the growth and resistance to chemotherapy drugs in lung cancer cells. In this study, the association of ANXA1 with chemosensitivity to Osimertinib, a third generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) was studied. The knockdown of ANXA1 increased chemosensitivity to Osimertinib and decreased tumorigenesis, invasion and migration of lung cancer cells with EGFR mutations. The study showed that ANXA1 plays critical roles in chemosensitivity to Osimertinib in lung cancer cells with EGFR mutations. Abstract Annexin A1 (ANXA1) has been reported to promote tumor growth and resistance to chemotherapy drugs in lung cancer cells. In this study, we focused on the association of ANXA1 and chemosensitivity with a third generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), Osimertinib, in lung cancer cells with EGFR mutations. The overexpression of ANXA1 was observed in the lung cancer cells studied. The downregulation of ANXA1 with small interference RNA (siRNA) decreased the growth of lung cancer cells. In lung cancer cells with EGFR mutations, the knockdown of ANXA1 increased the chemosensitivity to Osimertinib, and decreased the tumorigenesis, invasion and migration of lung cancer cells. Further study showed that the knockdown of ANXA1 inhibited the phosphorylation of EGFR and down-stream Akt pathways and promoted apoptosis in lung cancer cells treated with Osimertinib. A mice xenograft lung cancer model was established in our study and showed that ANXA1 siRNA enhanced the effects of Osimertinib in vivo. Our study results showed that ANXA1 plays critical roles in chemosensitivity to EGFR-TKI in lung cancer cells with the EGFR mutation. Our efforts may be used in the development of lung cancer treatment strategies in the future.

Cullin 4A (Cul4A) reportedly has oncogenic roles in several cancer types by regulating tumor suppressors through the ubiquitination and proteolysis of the tumor suppressor. In addition, Cul4A is associated with chemosensitivity to chemotherapy drugs. This study investigated the association between Cul4A and lung cancer cell chemosensitivity to paclitaxel, particularly with respect to the role of the p33 inhibitor of the growth 1 (p33ING1b) tumor suppressor. The results showed that the Cul4A knockdown upregulated the p33ING1b expression in lung cancer cells and increased the lung cancer cell and mice tumor xenograft chemosensitivity to paclitaxel. The Cul4A knockdown also inhibited the growth and increased the apoptosis in the tumor xenografts treated with paclitaxel. Notably, the p33ING1b overexpression increased the lung cancer cell chemosensitivity to paclitaxel, but the p33ING1b knockdown reduced the chemosensitivity. A further analysis demonstrated that Cul4A regulates the expression of p33ING1b through protein-protein interactions, ubiquitination, and protein degradation. In conclusion, the present findings suggest that Cul4A mediates the chemosensitivity of lung cancer cells to paclitaxel by regulating p33ING1b. These findings may offer novel insights into future therapeutic strategies for lung cancer that target Cul4A.

Background/purpose Superspreading events (SSEs) are pivotal in the spread of SARS-CoV-2. This study aimed to investigate an SSE of COVID-19 in a hospital and explore the transmission dynamics and heterogeneity of SSE. Methods We performed contact tracing for all close contacts in a cluster. We did nasopharyngeal or throat swabbing for SARS-CoV-2 by real-time RT-PCR. Environmental survey was performed. The epidemiological and clinical characteristics of the SSE were studied. Results Patient 1 with congestive heart failure and cellulitis, who had onset of COVID-19 two weeks after hospitalization, was the index case. Patient 1 led to 8 confirmed cases, including four health care workers (HCW). Persons tested positive for SARS-CoV-2 were HCW (n = 4), patient 1's family (n = 2), an accompanying person of an un-infected in-patient (n = 1), and an in-patient admitted before the SSE (n = 1). The attack rate among the HCW was 3.2 % (4/127). Environmental survey confirmed contamination at the bed rails, mattresses, and sink in the room patient 1 stayed, suggesting fomite transmission. The index case's sputum remained positive on illness day 35. Except one asymptomatic patient, at least three patients acquired the infection from the index case at the pre-symptomatic period. The effective reproduction number (Rt) was 0.9 (8/9). Conclusion The host factor (heart failure, longer viral shedding), transmissibility of SARS-CoV-2 (Rt, pre-symptomatic transmission), and possible multiple modes of transmission altogether contributed to the SSE. Rapid response and advance deployment of multi-level protection in hospitals could mitigate COVID-19 transmission to one generation, thereby reducing its impact on the healthcare system.

A high-speed and power-efficient heterogeneous octa-core CPU complex is realized in a 7nm FinFET process. On-chip sensors that handle guard band in terms of process $(V_{PGB})$, voltage, temperature $(V_{TGB})$, and aging $(V_{AGB})$ are designed for power enhancement in dynamic frequency and voltage scaling (DVFS). A process sensor (P-sensor) is used to determine per-die V PGB for Smartphone operation voltage $(V_{sov})$ with machine learning (ML). A temperature sensor (T-sensor) senses run-time local thermal and temperature inversion (T-inversion) to scale V TGB in DVFS. An aging sensor (A-sensor) converts cell degradation to corresponding V AGB for aging compensation. Lastly, a voltage sensor (V-sensor) sustains system stability against supply noise. With sensor assistance, the CPU performs up to 2.8GHz speed with 13% power improvement in a fully integrated 5G multi-mode Smartphone SoC that supports the sub-6GHz band with 2.6Gbps upload and 4.7Gbps download speeds.

The Bouba/Kiki effect constitutes a classic sound-shape correspondence, with the meaningless sounds "Bouba" and "Kiki" being mapped onto smooth and spiky patterns, respectively. While it is commonly believed that the Bouba/Kiki effect is driven by the local rounded and angular features of a pattern, here we investigated the importance of an alternative level of visual processing-namely the global contours. We adopted compound radial frequency (RF) patterns and segmented them into convexities (outward curves) or concavities (inward curves). Note that convexities are more informative in terms of inferring the global contour than concavities. When the perceptual grouping of segments was facilitated by increasing their length, the grouping of convexities was more efficient than that of concavities as manifested by the closer matching judgments to the compound RF patterns. When we interfered with the perceptual grouping of segments by rotating each segment by 180°, the matching consensus of convexities was higher when they were presented in the original than in the reversed orientation. Hence, the Bouba/Kiki effect was susceptible to the factors modulating the perceptual grouping process going from segments to the global contour, suggesting that the Bouba/Kiki effect may occur at the global level of shape perception. Sound-shape correspondences would therefore seem to be expressed at multiple levels of information processing, furthering our understanding of the development, underpinning neural mechanisms, and applications of crossmodal correspondences. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Emergency transfusion strategies for patients with upper gastrointestinal bleeding (UGIB) have not been well developed. The BISHE is a recently developed scoring system for prediction of patients likely to require massive transfusion but has not been validated. In this study, we evaluated the predictive ability of the BISHE score and that of a revised scoring system in an effort to improve care for patients with UGIB and allow better resource allocation. Methods: This prospective observational cohort study included patients who were admitted to our hospital between July 1, 2016 and June 30, 2019 and required massive transfusion (defined as receiving three units of red blood cells over one hour) in the emergency department. The predictive accuracy of the BISHE score and that of the revised scoring system were compared using area under the receiver-operating characteristic (AUROC) curve analysis. Results: Liver cirrhosis, an international normalized ratio >1.5, and hemoglobin Conclusions: Compared with the BISHE score, the revised scoring system was better able to identify patients likely to require massive transfusion.

Although nurses work in stressful environments, stressors in such environments have yet to be clearly assessed. This study aimed to develop a Nurses&rsquo, Occupational Stressor Scale (NOSS) with high reliability and validity. Candidate questions for the NOSS were generated by expert consensus following focus group feedback, and were used to survey in 2013. A shorter version was then developed after examination for validity and reproducibility in 2014. The accuracy of the short version of the NOSS for predicting nurses&rsquo, stress levels was evaluated based on receiver operating characteristic curves to compare existing instruments for measuring stress outcomes, namely personal burnout, client-related burnout, job dissatisfaction, and intention to leave. Examination for validity and reproducibility yielded a shorter version of NOSS with only 21 items was considered sufficient for measuring stressors in nurses&rsquo, work environments. Nine subscales were included: (1) work demands, (2) work&ndash, family conflict, (3) insufficient support from coworkers or caregivers, (4) workplace violence and bullying, (5) organizational issues, (6) occupational hazards, (7) difficulty taking leave, (8) powerlessness, and (9) unmet basic physiological needs. The 21-item NOSS proved to have high concurrent and construct validity. The correlation coefficients of the subscales for test-retest reliability ranged from 0.71 to 0.83. The internal consistency (Cronbach&rsquo, s &alpha, ) coefficients ranged from 0.35 to 0.77. The NOSS exhibited accurate prediction of personal burnout, client-related burnout, job dissatisfaction, and intention to leave.

In patients experiencing out-of-hospital cardiac arrest (OHCA), hypotension is common after return of spontaneous circulation (ROSC). Both dopamine and norepinephrine are recommended as inotropic therapeutic agents. This study aimed to determine the impact of the use of these two medications on hypotension. This is a multicenter retrospective cohort study. OHCA patients with ROSC were divided into three groups according to the post resuscitation inotropic agent used for treatment in the emergency department, namely, dopamine, norepinephrine, and dopamine and norepinephrine combined therapy. Thirty-day survival and favorable neurologic performance were analyzed among the three study groups. The 30-day survival and favorable neurologic performance rates in the three study groups were 12.5%, 13.0%, and 6.8% as well as 4.9%, 4.3%, and 1.2%, respectively. On controlling the potential confounding factors by logistic regression, there was no difference between dopamine and norepinephrine treatment in survival and neurologic performance (adjusted odds ratio (aOR): 1.0, 95% confidence interval (CI) 0.48–2.06; aOR: 0.8, 95% CI: 0.28–2.53). The dopamine and norepinephrine combined treatment group had worse outcome (aOR: 0.6, 95% CI: 0.35–1.18; aOR: 0.2, 95% CI: 0.05–0.89). In conclusion, there was no significant difference in post-ROSC hypotension treatment between dopamine and norepinephrine in 30-day survival and favorable neurologic performance rates.