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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.

Objectives The Laboratory Risk Indicator for Necrotizing Fasciitis score was developed as a clinical decision tool for distinguishing necrotizing fasciitis from other soft tissue infections. We prospectively evaluated the performance of the Laboratory Risk Indicator for Necrotizing Fasciitis score for the diagnosis of patients with necrotizing fasciitis in the extremities. Methods We conducted a prospective and observational cohort study of emergency department patients with necrotizing fasciitis or severe cellulitis in the extremities between April 2015 and December 2016. The Laboratory Risk Indicator for Necrotizing Fasciitis score was calculated for every enrolled patient. The sensitivity, specificity, positive predictive value, and negative predictive value of cut-off scores of 6 and 8 were evaluated. The accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was expressed as the area under the receiver operating characteristic curve. Results A total of 106 patients with necrotizing fasciitis and 825 patients with cellulitis were included. With an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥6, the sensitivity was 43% (95% confidence interval 34% to 53%), specificity was 83% (95% confidence interval 80% to 86%), positive predictive value was 25% (95% confidence interval 20% to 30%), and negative predictive value was 92% (95% confidence interval 91% to 93%); with an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥8, the sensitivity was 27% (95% confidence interval 19% to 37%), specificity was 93% (95% confidence interval 91% to 94%), positive predictive value was 33% (95% confidence interval 25% to 42%), and negative predictive value was 91% (95% confidence interval 90% to 92%). The area under the receiver operating characteristic curve for accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was 0.696 (95% CI 0.640 to 0.751). Conclusion The Laboratory Risk Indicator for Necrotizing Fasciitis score may not be an accurate tool for necrotizing fasciitis risk stratification and differentiation between severe cellulitis and necrotizing fasciitis in the emergency department setting based on our study.

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

We report two experiments designed to extend the well-known Bouba/Kiki effect to the case of an unusual set of commercially produced plateware, and further to assess the influences of these plates on the expected taste of a dessert based on the theory of crossmodal correspondences. The results demonstrate that plates having a smoother circumference are more likely to be matched to ‘Bouba’, while those with a pointier circumference are more likely to be matched to ‘Kiki’ instead, thus demonstrating the typical Bouba/Kiki effect. Importantly, the shape and colour of the plates modulated people’s ratings of the expected taste and liking of the ice cream/sorbet displayed on them. Specifically, the colour of the plate induced a general effect on the expected tastes that were consistent with the white-sweet and black-bitter associations, and the higher expected liking of the ice cream/sorbet was attributed to the higher colour contrast between the food and plate. The shape of the plate modulated ratings of expected liking for the chocolate ice cream and the expected sweetness of the lemon sorbet. Finally, colour and shape conjointly modulated how sour the lemon sorbet was expected to taste. These results provide relevant insights for those chefs, restaurateurs and Instagrammers wishing to optimize the plateware for specific dishes.

BACKGROUND/AIMS Increased risk of bacterial infection is common in cirrhotic patients with upper gastrointestinal bleeding (UGIB). Our study aimed to explore the association of the bacteremia with in-hospital mortality and risk factors of bacteremia in these patients. MATERIALS AND METHODS In our retrospective cohort study, we collected data for cirrhotic patients with UGIB admitted to our hospital between August 2010 and December 2010. The primary outcome was in-hospital mortality. The secondary outcome was bacteremia. A multivariate logistic regression analysis was performed to determine risk factors for mortality and bacteremia. RESULTS A total of 202 patients with cirrhosis presenting with UGIB at the emergency department (ED) were enrolled. Bacteremia was associated with a higher mortality rate (adjusted odds ratio [OR]: 9.7; 95% confidence interval [CI]: 1.9-50.6, p=0.007), whereas shock (systolic blood pressure 0% immature neutrophils of band form) were associated with bacteremia in cirrhotic patients with UGIB (adjusted OR: 5.3; 95% CI: 2.3-12.7, p

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

In this work, silver (Ag) precursors with different thicknesses were sputtered on the surfaces of CuIn alloys, and (AgCu)InSe2 (ACIS) films were formed after selenization at 550 °C under nitrogen condition using a rapid thermal process furnace. The structure and electrical properties of the ACIS films were investigated. The result showed that the distribution of Ag+ ion was more uniform with increasing the thickness of Ag precursor, and the surface of the thin-film became more homogeneous and denser. When Ag/Cu ratio ≥0.249, the small grain particles disappeared. The band gap can be rationally controlled by adjusting Ag content. When (Ag + Cu)/In ratio ≥ 1.15, the surface of the ACIS thin-film mainly exhibited n-type semiconductor. Through the photoelectrochemistry measurement, it was observed that the incorporation of Ag+ ions could improve photocurrent by adjusting the band gap. With the Ag precursor thickness increased, the dark current decreased at the more negative potential.

Asatone is an active component extracted from the Chinese herb Radix et Rhizoma Asari. Our preliminary studies have indicated that asatone has an anti-inflammatory effect on RAW 264.7 culture cells challenged with lipopolysaccharide (LPS). Acute lung injury (ALI) has high morbidity and mortality rates due to the onset of serious lung inflammation and edema. Whether asatone prevents ALI LPS-induced requires further investigation. In vitro studies revealed that asatone at concentrations of 2.5–20[Formula: see text][Formula: see text]g/mL drastically prevented cytotoxicity and concentration-dependently reduced NO production in the LPS-challenged macrophages. In an in vivo study, the intratracheal administration of LPS increased the lung wet/dry ratio, myeloperoxidase activity, total cell counts, white blood cell counts, NO, iNOS, COX, TNF-[Formula: see text], IL-1[Formula: see text], and IL-6 in the bronchoalveolar lavage fluid as well as mitogen-activated protein kinases in the lung tissues. Pretreatment with asatone could reverse all of these effects. Asatone markedly reduced the levels of TNF-[Formula: see text] and IL-6 in the lung and liver, but not in the kidney of mice. By contrast, LPS reduced anti-oxidative enzymes and inhibited NF-[Formula: see text]B activations, whereas asatone increased anti-oxidative enzymes in the bronchoalveolar lavage fluid and NF-[Formula: see text]B activations in the lung tissues. Conclusively, asatone can prevent ALI through various anti-inflammatory modalities, including the major anti-inflammatory pathways of NF-[Formula: see text]B and mitogen-activated protein kinases. These findings suggest that asatone can be applied in the treatment of ALI.

ObjectivesThe study aimed to investigate the association of insulin resistance (IR), which was estimated by the homoeostasis model assessment for IR (HOMA-IR), with albuminuria and renal function impairment in a general Chinese population.DesignA retrospective cross-sectional study.Setting and participantsA total of 13 742 adults (age: ≥18 years) who underwent a health check-up at a hospital in Southeast China during 2013–2014 were enrolled. 216 subjects were excluded due to lack of enough fasting time, be pregnant, have chronic diseases influencing metabolic functions or have glomerulonephritis, renal cancer, kidney transplant. Eventually, 7552 men and 5974 women were included for the present analysis.Primary outcome measuresThe association of HOMA-IR with albuminuria and renal function impairment were analysed. The HOMA-IR cut-off value for detecting albuminuria and renal function impairment were determined.ResultsAn increase in the HOMA-IR quartile was significantly associated with the prevalence of albuminuria and renal function impairment in all men and women aged >45 years. The multivariable logistic regression analyses revealed a significant association of the HOMA-IR with albuminuria and renal function impairment in subjects aged >45 years of the fourth quartiles compared with those of the first quartile after adjusting for potential confounders (albuminuria: men OR, 2.39; 95% CI 1.51 to 3.79, p=0.001; renal function impairment: men OR, 2.30; 95% CI 1.50 to 3.51; p45 years and 1.86 in women aged >45 years.ConclusionsOur study revealed that HOMA-IR was significantly associated with albuminuria and renal function impairment in individuals aged >45 years.

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

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

Perceiving simultaneity is critical in integrating visual and auditory signals that give rise to a unified perception. We examined whether background color modulates people's perception of audiovisual simultaneity. Two hypotheses were proposed and examined: (1) the red-impairment hypothesis: visual processing speed deteriorates when viewing a red background because the magnocellular system is inhibited by red light; and (2) the blue-enhancement hypothesis: the detection of both visual and auditory signals is enhanced when viewing a blue background because it stimulates the blue-light sensitive intrinsically photosensitive retinal ganglion cells (ipRGCs), which trigger a higher alert state. Participants were exposed to different backgrounds while performing an audiovisual simultaneity judgment (SJ) task: a flash and a beep were presented at pre-designated stimulus onset asynchronies (SOAs) and participants judged whether or not the two stimuli were presented simultaneously. Experiment 1 demonstrated a shift of the point of subjective simultaneity (PSS) toward the visual-leading condition in the red compared to the blue background when the flash was presented in the periphery. In Experiment 2, the stimulation of ipRGCs was specifically manipulated to test the blue-enhancement hypothesis. The results showed no support for this hypothesis, perhaps due to top-down cortical modulations. Taken together, the shift of PSS toward the visual-leading condition in the red background was attributed to impaired visual processing speed with respect to auditory processing speed, caused by the inhibition of the magnocellular system under red light.

Cullin 4A (Cul4A) is overexpressed in a number of cancers and has been established as an oncogene. This study aimed to elucidate the role of Cul4A in lung cancer invasion and metastasis. We observed that Cul4A was overexpressed in non-small cell lung cancer (NSCLC) tissues and the overexpression of Cul4A was associated with poor prognosis after surgical resection and it also decreased the expression of the tumor suppressor protein annexin A10 (ANXA10). The knockdown of Cul4A was associated with the upregulation of ANXA10, and the forced expression of Cul4A was associated with the downregulation of ANXA10 in lung cancer cells. Further studies showed that the knockdown of Cul4A inhibited the invasion and metastasis of lung cancer cells, which was reversed by the further knockdown of ANXA10. In addition, the knockdown of Cul4A inhibited lung tumor metastasis in mouse tail vein injection xenograft models. Notably, Cul4A regulated the degradation of ANXA10 through its interaction with ANXA10 and ubiquitination in lung cancer cells. Our findings suggest that Cul4A is a prognostic marker in NSCLC patients, and Cul4A plays important roles in lung cancer invasion and metastasis through the regulation of the ANXA10 tumor suppressor.

Objective: Being overweight is associated with an increased risk of diabetes mellitus, hypertension, and cardiovascular disease. Lipoprotein-associated phospholipase A2 (Lp-PLA2) can independently predict the risk of cardiovascular disease. This study is aimed to investigate whether Lp-PLA2 was associated with an overweight status. Methods: This was a cross-sectional study that enrolled 3760 Chinese adults (age, 18–50 years) who underwent medical examination department of Xiamen Chang-Gung Hospital (XCGH) from 2018 to 2020. To explore the distribution of overweight classifications in the Chinese population, we evaluated the correlation of the overweight status with Lp-PLA2, after correcting for possible influencing factors. Results: The Lp-PLA2 level was greater in male than in female subjects ( p < 0.001). Subjects with a central overweight status had a greater Lp-PLA2 level than those with normal weight and a peripheral overweight status, in both male and female cohorts. The Lp-PLA2 level was significantly greater in those with additional comorbidities (namely diabetes mellitus (DM), hypertension (HTN), overweight, and metabolic syndrome (MetS)). The age-adjusted and LDL-adjusted Lp-PLA2 level also was significantly higher in the DM (+) and HTN (−) subgroups than in the DM (−), HTN (−), DM (−), and HTN (+) subgroups. Conclusion: Lp-PLA2 is associated with sex, central overweight status, diabetes, hypertension, and MetS in adults aged < 50 years and the age-adjusted and LDL-adjusted Lp-PLA2 was significantly higher in the DM (+) and HTN (−) subgroups than in the DM (−) and HTN (−) and DM (−) and HTN (+) subgroups.

To study whether the ethanol extract of Phellinus merrillii (EPM) has chemopreventive potential against liver carcinogenesis. Thirty male Spraque-Dawley rats were randomly divided into control group, EPM control group, hepatocarcinoma control group, low-dose EPM group and high-dose EPM group, 6 in each group. Using the Solt and Farber protocol in a rat model of hepatocarcinogenesis, the chemopreventive effect of EPM on diethylnitrosamine (DEN)-initiated, 2-acetylaminofluorene (2-AAF) and partial hepatectomy (PH)-promoted liver carcinogenesis in rats was evaluated. Basic pathophysiological and histological examinations, together with the serum levels of glutamic oxaloacetic transaminase (sGOT), glutamic pyruvic transaminase (sGPT) and gamma-glutamyl transpeptidase (γ-GT) were measured. Treatment of EPM at the concentration of 2 g/kg body weight in the diet for 8 weeks clearly prevented the development of carcinogenesis and reduced the levels of sGOT, sGPT, and serum γ-GT of rats as compared with the hepatocarcinoma control group (P

We measured the typical developmental trajectory of the window of audiovisual simultaneity by testing four age groups of children (5, 7, 9, and 11 years) and adults. We presented a visual flash and an auditory noise burst at various stimulus onset asynchronies (SOAs) and asked participants to report whether the two stimuli were presented at the same time. Compared with adults, children aged 5 and 7 years made more simultaneous responses when the SOAs were beyond ± 200 ms but made fewer simultaneous responses at the 0 ms SOA. The point of subjective simultaneity was located at the visual-leading side, as in adults, by 5 years of age, the youngest age tested. However, the window of audiovisual simultaneity became narrower and response errors decreased with age, reaching adult levels by 9 years of age. Experiment 2 ruled out the possibility that the adult-like performance of 9-year-old children was caused by the testing of a wide range of SOAs. Together, the results demonstrate that the adult-like precision of perceiving audiovisual simultaneity is developed by 9 years of age, the youngest age that has been reported to date.

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

Backgrounds. The objective of this study was to investigate the relationships among intention to leave, emergency physician clinical activities, work-family conflicts, and gender differences in emergency physicians (EPs).Methods. The survey instrument was a self-administered questionnaire containing basic demographic information and characteristics of clinical activities. The work-family conflicts were assessed by the Chinese version of the work-family conflict (WIF) scale. The questionnaires were mailed to board-certified EPs between January 2014 and August 2014. Student’st-test, Chi-square test, and one-way analysis of variance (ANOVA) were used to test the difference between subgroups. Logistic regression analysis was performed to determine the factors associated with intention to leave and gender differences.Results. The study included 222 respondents for analysis after exclusions. Compared with physicians not planning to leave, those planning to leave ED practice showed higher dissatisfaction with their clinical work hours (50.0% versus 31.4%, p = 0.035) and night/day shift ratio (52.9% versus 31.0%, p = 0.013) and tended to work with night/day shift ratio exceeding 40% (67.6% versus 45.7%, p = 0.019). Female physicians were more likely to leave ED practice (females versus males, 26.5% versus 10.1%, p = 0.008). A significantly higher level of WIF scale was noted in the group with intention to leave ED practice (3.7 ± 0.6 versus 3.3 ± 0.7, p = 0.001).Conclusions. Females and EPs with higher level of WIF scale were more likely to leave emergency clinical practice. Instead of the number of clinical practice hours, the satisfaction with the clinical work hours and night shift frequency were significantly associated with the intention to leave.

Chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is associated with an increase in all-cause mortality. Studies regarding association among various body compositions in different inflamed states and the risk of CKD were rare. We aimed to evaluate the relationship among body composition, high-sensitivity C-reactive protein (hsCRP) level, and the risk of CKD. This was a retrospective cross-sectional study using annual health examination data from 2 medical centers in northern and southern Taiwan between January and December 2015. We performed a variance analysis of the estimated glomerular filtration rate (eGFR) distribution in groups based on hsCRP and body fat percentage (BFP), and a multivariate logistic regression model was used to assess the relationship among BFP, hsCRP levels, and CKD. A total of 10,267 subjects aged ≥18 years undergoing health examination were analyzed. In our study, overweight/obese patients were associated with increased risk of CKD. Nevertheless, in subjects with elevated hsCRP level, overweight/obese group with a higher BFP had a lower risk of CKD as compared with overweight/obese with normal BFP group (for BMI ≧ 23 kg/m2, high BFP/high hsCRP: odds ratio [OR] for CKD 1.86, 95% confidence interval [CI] = 1.10–3.17, P = .02; normal BFP/high hsCRP group: OR 2.32, 95% CI = 1.23–4.37, P = .01) after adjusting for various confounders. Our findings suggest that various body compositions in different inflamed states may interfere with the risk of CKD. These results provide an important method for the early detection of impaired renal function by identifying various body compositions and inflammation states to detect CKD at an earlier stage.

Background: High occupational stress has been associated with altered eating behaviors and obesity. Occupational stress is reported to be high in Asian countries. Furthermore, many Asian countries are increasingly consuming Western-type foods (e.g., incorporating drinks with meals) which collectively may also be contributing to obesity. Therefore, the aim of this study was to examine (a) associations between sugar-sweetened beverage (SSB) consumption as meal replacement and obesity and (b) associations between workload and substituting meals with SSB in nurses. Methods: A representative sample of 854 hospital-based nurses completed a structured questionnaire about SSB consumption, workload, and body mass index (BMI). Log binomial regression models were employed to test associations between SSBs and obesity rates and associations between workload and SSBs. Results: Most participants (57.6%) consumed SSBs as meal replacements during work. This was related to high workloads during shifts. Substituting SSBs for meals was significantly associated with increased likelihood of obesity (aPRR = 1.4, 95% CI (1.1, 1.7)). Workload was positively associated with SSB intake as meal substitutes (aPRR = 1.4, 95% CI (1.2, 1.6)). Conclusions: Our findings show that SSBs are used as meal substitutes and is due to the workload demands. Sugar-sweetened beverage consumption is also positively associated with the increased likelihood of obesity. Interventions that modify workloads and decrease SSB consumption may improve workers&rsquo, eating behaviors and health.

We examined the ability of people to evaluate their confidence when making perceptual judgments concerning a classic crossmodal correspondence, the Bouba/Kiki effect: People typically match the "Bouba" sound to more rounded patterns and match the "Kiki" sound to more angular patterns instead. For each visual pattern, individual participants were more confident about their own matching judgments when they happened to fall in line with the consensual response regarding whether the pattern was rated as "Bouba" or "Kiki". Logit regression analyses demonstrated that participants' confidence ratings and matching judgments were predictable by similar regression functions. This implies that the consensus and confidence underlying the Bouba/Kiki effect are underpinned by a common process, whereby perceptual features in the patterns are extracted and then used to match the sound according to rules of crossmodal correspondences. Combining both matching and confidence measures potentially allows one to explore and quantify the strength of associations in human knowledge.

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

To account for infants’ perceptual and cognitive development, the constructivist model proposes that learning a new object depends on the capability of processing simpler lower-level units, and then integrating these units into more complex higher-level units based on their relationships, such as regular co-occurrence. Here, we demonstrate that the process of associating visual and auditory attributes to build a new multisensory object representation is not only observed in the course of development, but also in the course of infants’ in-the-moment information processing. After a brief familiarization session of learning two pairs of novel audiovisual stimuli, 15-month-old infants showed two components in pupil dilations over time: A rapid dilation was observed when processing perceptually novel compared to familiar stimuli, and a slower dilation was observed when processing novel combinations of familiar stimuli. However, in 10-month-old infants, only the effect elicited by novel stimuli was observed. Our results therefore demonstrate that detecting perceptual novelty occurred earlier than detecting association novelty in infants’ information processing. These results support the view that infants perceive newly-learned objects by processing their constituent attributes and then integrating these components, as suggested by the constructivist model.

Supplemental digital content is available in the text., Objectives Traumatic brain injury is the leading cause of death and disability in children worldwide. The objective of this study was to determine the association between physician risk tolerance and head computed tomography (CT) use in patients with minor head injury (MHI) in the emergency department (ED). Methods We retrospectively analyzed pediatric patients (

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

Asatone is an active component extracted from the Chinese herb Radix et Rhizoma Asari. Our preliminary studies have indicated that asatone has an anti-inflammatory effect on RAW 264.7 culture cells challenged with lipopolysaccharide (LPS). Acute lung injury (ALI) has high morbidity and mortality rates due to the onset of serious lung inflammation and edema. Whether asatone prevents ALI LPS-induced requires further investigation. In vitro studies revealed that asatone at concentrations of 2.5-20[Formula: see text][Formula: see text]g/mL drastically prevented cytotoxicity and concentration-dependently reduced NO production in the LPS-challenged macrophages. In an in vivo study, the intratracheal administration of LPS increased the lung wet/dry ratio, myeloperoxidase activity, total cell counts, white blood cell counts, NO, iNOS, COX, TNF-[Formula: see text], IL-1[Formula: see text], and IL-6 in the bronchoalveolar lavage fluid as well as mitogen-activated protein kinases in the lung tissues. Pretreatment with asatone could reverse all of these effects. Asatone markedly reduced the levels of TNF-[Formula: see text] and IL-6 in the lung and liver, but not in the kidney of mice. By contrast, LPS reduced anti-oxidative enzymes and inhibited NF-[Formula: see text]B activations, whereas asatone increased anti-oxidative enzymes in the bronchoalveolar lavage fluid and NF-[Formula: see text]B activations in the lung tissues. Conclusively, asatone can prevent ALI through various anti-inflammatory modalities, including the major anti-inflammatory pathways of NF-[Formula: see text]B and mitogen-activated protein kinases. These findings suggest that asatone can be applied in the treatment of ALI.

Background Prognostic factors for the outcomes in traumatic cardiac arrest (TCA) patients transported to hospitals without prehospital return of spontaneous circulation (ROSC) remain uncertain. The aim of this study is to investigate factors associated with outcomes in TCA patients without prehospital ROSC. Methods We conducted a retrospective cohort study using a multi-institutional, 5-year database. Only TCA patients without prehospital ROSC were included. The primary outcome was ROSC in the emergency department (ED), and the secondary outcome was 30-day survival. Logistic regression analysis was performed to determine the factors associated with primary and secondary outcomes. Results Among 463 TCA patients, 73 (16%) had ROSC during ED resuscitation, and among those with sustained ROSC, 10 (14%) survived for at least 30 days. Injury severity score ≧ 16 (OR, 0.06; 95% CI: 0.02–0.20), trauma center admission (OR, 2.69; 95% CI: 1.03–7.03), length of ED resuscitation (OR, 0.98; 95% CI: 0.96-0.99), and total resuscitation length > 20 min (OR, 0.21; 95% CI: 0.08–0.54) were associated with ROSC. Conclusions In TCA patients transported to hospitals without prehospital ROSC, resuscitation attempts could be beneficial. We should aim to resuscitate patients as soon as possible with appropriate treatments for trauma patients, early activation of trauma team, and then, as a result, shorter resuscitation time will be achieved.

We examined the time-courses and categorical specificity of the crossmodal semantic congruency effects elicited by naturalistic sounds and spoken words on the processing of visual pictures (Experiment 1) and printed words (Experiment 2). Auditory cues were presented at 7 different stimulus onset asynchronies (SOAs) with respect to the visual targets, and participants made speeded categorization judgments (living vs. nonliving). Three common effects were observed across 2 experiments: Both naturalistic sounds and spoken words induced a slowly emerging congruency effect when leading by 250 ms or more in the congruent compared with the incongruent condition, and a rapidly emerging inhibitory effect when leading by 250 ms or less in the incongruent condition as opposed to the noise condition. Only spoken words that did not match the visual targets elicited an additional inhibitory effect when leading by 100 ms or when presented simultaneously. Compared with nonlinguistic stimuli, the crossmodal congruency effects associated with linguistic stimuli occurred over a wider range of SOAs and occurred at a more specific level of the category hierarchy (i.e., the basic level) than was required by the task. A comprehensive framework is proposed to provide a dynamic view regarding how meaning is extracted during the processing of visual or auditory linguistic and nonlinguistic stimuli, therefore contributing to our understanding of multisensory semantic processing in humans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sodium bicarbonate administration is mostly restricted to in-hospital use in Taiwan. This study was conducted to investigate the effect of sodium bicarbonate on outcomes among patients with out-of-hospital cardiac arrest (OHCA).This population-based study used a 16-year database to analyze the association between sodium bicarbonate administration for resuscitation in the emergency department (ED) and outcomes. All adult patients with OHCA were identified through diagnostic and procedure codes. The primary outcome was survival to hospital admission and secondary outcome was the rate of death within the first 30days of incidence of cardiac arrest. Cox proportional-hazards regression, logistic regression, and propensity analyses were conducted.Among 5589 total OHCA patients, 15.1% (844) had survival to hospital admission. For all patients, a positive association was noted between sodium bicarbonate administration during resuscitation in the ED and survival to hospital admission (adjusted odds ratio [OR]: 4.47; 95% confidence interval [CI]: 3.82-5.22, p0.001). In propensity-matched patients, a positive association was also noted (adjusted OR, 4.61; 95% CI: 3.90-5.46, p0.001).Among patients with OHCA in Taiwan, administration of sodium bicarbonate during ED resuscitation was significantly associated with an increased rate of survival to hospital admission.

The accepted and peer reviewed manuscript to the article Despite the rapid growth of research on the crossmodal correspondence between visually presented shapes and basic tastes (e.g., sweet, sour, bitter, and salty), most studies that have been published to date have focused on shape contour (roundness/angularity). Meanwhile, other important features, such as symmetry, as well as the underlying mechanisms of the shape–taste correspondence, have rarely been studied. Over two experiments, we systematically manipulated the symmetry and contours of shapes and measured the influences of these variables on shape–taste correspondences. Furthermore, we investigated a potential underlying mechanism, based on the common affective appraisal of stimuli in different sensory modalities. We replicated the results of previous studies showing that round shapes are associated with sweet taste, whereas angular shapes are associated with sour and bitter tastes. In addition, we demonstrated a novel effect that the symmetry group of a shape influences how it is associated with taste. A significant relationship was observed between the taste and appraisal scores of the shapes, suggesting that the affective factors of pleasantness and threat underlie the shape–taste correspondence. These results were consistent across cultures, when we compared participants from Taiwanese and Western (UK, US, Canada) cultures. Our findings highlight that perceived pleasantness and threat are culturally common factors involved in at least some crossmodal correspondences. 1, Forfatterversjon

Since the system dynamic of a voice coil motor (VCM) is difficult to obtain, this paper uses a B-spline neural network to online approximate an unknown nonlinear term in the system dynamics of a VCM by tuning its interior parameters. Meanwhile, a B-spline neural position control (BNPC) system, which is composed of a position controller and a fuzzy compensator, is proposed. A proportional-integral adaptation law is derived to speed up the convergence of tracking error in the sense of the projection algorithm and Lyapunov stability theorem. Finally, the proposed BNPC system is implemented on a 32-b microcontroller. The experimental results show that the proposed BNPC system is robust against payload variations with high accuracy motion response.

Background: Hypoglycemia is associated with a higher risk of death. This study analyzed various body mass index (BMI) categories and mortalities of severe hypoglycemic patients with type 2 diabetes mellitus (DM) in a hospital emergency department. Methods: The study included 566 adults with type 2 diabetes who were admitted to 1 medical center in Taiwan between 2008 and 2009 with a diagnosis of severe hypoglycemia. Mortality data, demographics, clinical characteristics and the Charlson's Comorbidity Index were obtained from the electronic medical records. Patients were stratified into 4 study groups as determined by the National Institute of Health (NIH) and World Health Organization classification for BMI, and the demographics were compared using the analysis of variance and χ2 test. Kaplan-Meier's analysis and the Cox proportional-hazards regression model were used for mortality, and adjusted hazard ratios were adjusted for each BMI category among participants. Results: After controlling for other possible confounding variables, BMI

Many Chinese characters consist of two radicals and it has long been debated whether characters are decomposed into radicals during the processing of character recognition. Here we examine this issue utilizing a novel repetition blindness (RB) paradigm that provides a sensitive measure of internal representations in the early stages of processing. We found a radical-RB effect (i.e., two characters are less likely to be correctly reported when they share a common radical) for both high- and low-frequency characters (Experiment 1). Experiment 2 was to exclude the possibility that radical-RB effect can be explained by character-level similarity. Finally, the radical-RB effect was found to be robust irrespective of how frequently a radical is presented in different characters (Experiment 3). All these results suggest that radicals are represented during the processing of characters, supporting the analytic (rather than holistic) hypothesis of Chinese character recognition. A model that highlights a dynamic process of binding radicals to construct character representations is proposed.

Fermentative production of lactic acid from algae-based carbohydrates devoid of lignin has attracted great attention for its potential as a suitable alternative substrate compared to lignocellulosic biomass. A Chlorella sp. GD mutant with enhanced thermo-tolerance was obtained by mutagenesis using N-methyl-N′-nitro-N-nitrosoguanidine to overcome outdoor high-temperature inhibition and it was used as a feedstock for fermentative lactic acid production. The indoor experiments showed that biomass, reducing sugar content, photosynthetic O2 evolution rate, photosystem II activity (F v/F m and F v′/F m′), and chlorophyll content increased as temperature, light intensity, and CO2 concentration increased. The mutant showed similar DIC affinity and initial slope of photosynthetic light response curve (α) as that of the wild type but had higher dissolved inorganic carbon (DIC) utilization capacity and maximum photosynthesis rate (P max). Moreover, the PSII activity (F v′/F m′) in the mutant remained normal without acclimation process after being transferred to photobioreactor. This suggests that efficient utilization of incident high light and enhanced carbon fixation with its subsequent flux to carbohydrates accumulation in the mutant contributes to higher sugar and biomass productivity under enriched CO2 condition. The mutant was cultured outdoors in a photobioreactor with 6% CO2 aeration in hot summer season in southern Taiwan. The harvested biomass was subjected to separate hydrolysis and fermentation (SHF) for lactic acid production with carbohydrate concentration equivalent to 20 g/L glucose using the lactic acid-producing bacterium Lactobacillus plantarum 23. The conversion rate and yield of lactic acid were 80% and 0.43 g/g Chlorella biomass, respectively. These results demonstrated that the thermo-tolerant Chlorella mutant with high photosynthetic efficiency and biomass productivity under hot outdoor condition is an efficient fermentative feedstock for large-scale lactic acid production.

Background Shiftwork and long work hours have been reported as significant risk factors for nurses’ burnout. In addition, whether nurses have ability to control their own schedule , such as having options and decision over swapping shifts or taking unpaid leave, remain lacking. Objective To examine the associations between nurses’ work schedule control (WSC) and their effect on burnout. Method A total of 3431 fulltime registered nurses working in the hospital were systematically sampled in 2013. A structured self-administered questionnaire was performed to assess nurses’ WSC, work schedule demands (WSDs) and their effect on burnout. The WSC was assessed by asking nurses’ experiences of requesting leave. Personal and client burnout status were measured using the Chinese version of the Copenhagen Burnout Inventory. Multivariable logistic regression was used to analyse the associations between nurses’ WSC and their effect on burnout. The WSDs, including shiftwork patterns and average weekly working hours, were controlled. Results A total of 2631 questionnaires were eligible for final analysis. Only 5% of participants experienced unrestricted leave. After adjusting for demographic data, both average weekly working hours and unrestricted leave were significantly associated with nurses’ personal and client burnout. Nurses exposed to rotating shift work were more likely to experience client burnout. Conclusion This study identified that work schedule control (WSC) was related to personal and client burnout among hospital nurses. Hospitals wishing to proactively reduce nurses’ burnout may permit more unrestricted leaves when requested by the staff nurse.

We examined audiovisual and visuotactile integration in the central and peripheral visual field using visual fission and fusion illusions induced by sounds or taps. The fission illusion occurs when a single flash is perceived as two flashes if paired with two beeps or taps; the fusion illusion, by contrast, occurs when two flashes are perceived as a single flash if the flashes are paired with a single beep or tap. Beeps and taps induced similar patterns of illusions: the fission illusion was larger in the periphery than in the center, whereas the fusion illusion was larger in the center than in the periphery. An analysis based on signal detection theory revealed that both a decline in discriminability and a shift in criterion were associated with the more pronounced fission induced by sounds in the periphery. In contrast, only a shift in criterion was associated with the larger fission induced by taps in the periphery, and the larger fusion induced by a sound or tap in the center. To accommodate these findings, two accounts are proposed: audiovisual signals are more likely to be integrated in peripheral than in central vision, and the interpretation of visual signals favors discontinuous percepts, especially in the periphery.

The present study compared the time courses of the cross-modal semantic priming effects elicited by naturalistic sounds and spoken words on visual picture processing. Following an auditory prime, a picture (or blank frame) was briefly presented and then immediately masked. The participants had to judge whether or not a picture had been presented. Naturalistic sounds consistently elicited a cross-modal semantic priming effect on visual sensitivity (d') for pictures (higher d' in the congruent than in the incongruent condition) at the 350-ms rather than at the 1,000-ms stimulus onset asynchrony (SOA). Spoken words mainly elicited a cross-modal semantic priming effect at the 1,000-ms rather than at the 350-ms SOA, but this effect was modulated by the order of testing these two SOAs. It would therefore appear that visual picture processing can be rapidly primed by naturalistic sounds via cross-modal associations, and this effect is short lived. In contrast, spoken words prime visual picture processing over a wider range of prime-target intervals, though this effect was conditioned by the prior context.

In healthcare settings, nurses&rsquo, workload, burnout, and job satisfaction are associated to the patient&ndash, nurse ratio. Whether this ratio also affects their intention to leave the nursing profession, along with the underlying stress pathway, remains unclear. This study aimed to investigate the effects of the patient&ndash, nurse ratio on nurses&rsquo, intention to leave and considering the mediating roles of burnout and job dissatisfaction. The study analyzed the data of two pooled cross-sectional surveys collected in 2013 and 2014. Measures were obtained by a structure questionnaire, which queried the average daily patient&ndash, nurse ratio (ADPNR), nurses&rsquo, personal burnout, client-related burnout, job dissatisfaction, intention to leave, and other demographics. ADPNRs were standardized according to hospital levels. Multiple regression models examined mediation hypotheses, and a percentile bootstrap confidence interval was applied to determine the significance of indirect effects. A total of 1409 full-time registered nurses in medical and surgical wards of 24 secondary or tertiary hospitals in Taiwan completed self-administered questionnaires. Most of the participants were female (97.2%), and the mean age was 29.9 years. The association between the standardized ADPNR and intention to leave their job was significantly mediated by personal burnout, client-related burnout, and job dissatisfaction. Higher standardized ADPNRs predicted higher levels of personal burnout, client-related burnout, and job dissatisfaction, each of which resulted in higher levels of intention to leave the current job. The results highlight that appropriate patient&ndash, nurse ratio standards may be further discussed by selecting personal burnout, client-related burnout, and job dissatisfaction as indicators.

Supplemental Digital Content is available in the text, Background: This meta-analysis compared radiotherapy (RT) versus concurrent chemoradiotherapy (RT+CT) in treating patients with inoperable stage III non–small-cell lung cancer (NSCLC). Methods: Medline, Cochrane, EMBASE, Google Scholar databases were searched until July 28, 2015 using the following keywords non-small cell lung cancer, advanced cancer, incurable/inoperable/unresectable, chemotherapy, radiotherapy, chemoradiotherapy/chemoradiation. Randomized controlled trials (RCTs) and two-armed prospective studies that compared combined RT+CT with RT alone in patients with locally advanced (stage III) nonresectable NSCLC were eligible for inclusion. Treatment effect on overall survival, progression-free survival (PFS), and objective response rate (ORR) were evaluated. Results: Ultimately, 13 RCT studies were included in the systematic review and meta-analysis. The 13 studies included a total of 1936 patients with incurable/inoperable stage III NSCLC, of which 975 received RT alone and 961 received RT+CT combination therapy. The average age ranged from 54 to 77 years. At 1 and 2 years after treatment, the pooled data reveal that patients receiving CT+RT combination therapy had higher overall survival (pooled hazard ratio (HR), 0.72; 95% CI, 0.62–0.84; P < .001; 1-yr: HR, 0.67; 95% CI, 0.54–0.84; P < .001; 2-year: HR, 0.57; 95% CI, 0.45–0.73; P < .001), higher PFS (pooled HR, 0.73, 95% CI, 0.60–0.89; P = .002; 1-year: HR, 0.36; 95% CI, 0.24–0.53; P < .001; 2-year: HR, 0.38; 95% CI, 0.23–0.63; P < .001). Conclusion: Our findings show higher efficacy for concurrent CT+RT over RT alone in treating locally-advanced, unresectable stage III NSCLC.

Background: Metformin use reportedly reduces cancer risk and improves survival in lung cancer patients. This study aimed to investigate the effect of metformin use in patients with diabetes mellitus (DM) and lung cancer receiving epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy. Methods: A nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. From January 1, 2004, to December 31, 2012, a total of 373 metformin and 1260 non-metformin lung cancer cohorts with type 2 DM and EGFR-TKI treatment were studied. Results: Metformin use was significantly associated with a reduced risk of death (hazard ratio: 0.73, 95% confidence interval [CI]: 0.62-0.85, P < .001), as well as a significantly longer median progression-free survival (9.2 months, 95% CI: 8.6-11.7, vs 6.4 months, 95% CI: 5.9-7.2 months, P < .001) and median overall survival (33.4 months, 95% CI: 29.4-40.2, vs 25.4 months, 95% CI: 23.7-27.2 months, P < 0.001). Conclusions: In conclusion, metformin may potentially enhance the therapeutic effect and increase survival in type 2 DM patients with lung cancer receiving EGFR-TKI therapy.

Dioscorea japonica Thunb. var. pseudojaponica (DP) is consumed as food and widely used in traditional Chinese medicine in Taiwan. The aims of this study are to investigate the antioxidant and anti-inflammatory effects of ethanol extract of DP (EDP) and its reference compounds. Fingerprint chromatogram from HPLC indicated that EDP contains gallic acid and vanillic acid. EDP was evaluated for its antioxidant effects and LPS-induced nitrite oxide (NO) production in RAW264.7 cells. EDP decreased the LPS-induced NO production and expressions of iNOS and COX-2 in RAW264.7 cells. In-vivo anti-inflammatory activities of EDP were assessed in mouse paw oedema induced by λ-carrageenan (Carr). We investigated the antioxidant mechanism of EDP via studies of the activities of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) and the levels of malondialdehyde (MDA) in the oedematous paw. The results showed that EDP might be a natural antioxidant and anti-inflammatory agent.

Hispolon (a phenolic compound isolated from Phellinus linteus) has been shown to possess strong antioxidant, anti-inflammatory, anticancer, and antidiabetic properties. In this study, we investigated the antiproliferative effect of hispolon on human hepatocellular carcinoma NB4 cells using the MTT assay, DNA fragmentation, DAPI (4, 6-diamidino-2-phenylindole dihydrochloride) staining, and flow cytometric analysis. Hispolon inhibited the cellular growth of NB4 cells in a dose-dependent manner through the induction of cell cycle arrest at G0/G1 phase measured using flow cytometric analysis and apoptotic cell death, as demonstrated by DNA laddering. Exposure of NB4 cells to hispolon-induced apoptosis-related protein expressions, such as the cleavage form of caspase 3, caspase 8, caspase 9, poly (ADP ribose) polymerase, and the proapoptotic Bax protein. Western blot analysis showed that the protein levels of extrinsic apoptotic proteins (Fas and FasL), intrinsic related proteins (cytochrome c), and the ratio of Bax/Bcl-2 were increased in NB4 cells after hispolon treatment. Hispolon-induced G0/G1-phase arrest was associated with a marked decrease in the protein expression of p53, cyclins D1, and cyclins E, and cyclin-dependent kinases (CDKs) 2, and 4, with concomitant induction of p21waf1/Cip1 and p27Kip1. We conclude that hispolon induces both of extrinsic and intrinsic apoptotic pathways in NB4 human leukemia cells in vitro.

Summary Temporal simultaneity provides an essential cue for integrating multisensory signals into a unified perception. Early visual deprivation, in both animals and humans, leads to abnormal neural responses to audiovisual signals in subcortical and cortical areas [1–5]. Behavioral deficits in integrating complex audiovisual stimuli in humans are also observed [6, 7]. It remains unclear whether early visual deprivation affects visuotactile perception similarly to audiovisual perception and whether the consequences for either pairing differ after monocular versus binocular deprivation [8–11]. Here, we evaluated the impact of early visual deprivation on the perception of simultaneity for audiovisual and visuotactile stimuli in humans. We tested patients born with dense cataracts in one or both eyes that blocked all patterned visual input until the cataractous lenses were removed and the affected eyes fitted with compensatory contact lenses (mean duration of deprivation = 4.4 months; range = 0.3–28.8 months). Both monocularly and binocularly deprived patients demonstrated lower precision in judging audiovisual simultaneity. However, qualitatively different outcomes were observed for the two patient groups: the performance of monocularly deprived patients matched that of young children at immature stages, whereas that of binocularly deprived patients did not match any stage in typical development. Surprisingly, patients performed normally in judging visuotactile simultaneity after either monocular or binocular deprivation. Therefore, early binocular input is necessary to develop normal neural substrates for simultaneity perception of visual and auditory events but not visual and tactile events.