Search

The early stage of the COVID-19 pandemic was a critical time for increasing loneliness, especially for older people. However, there is insufficient existing research on associated interventions and their effectiveness.This study aimed to investigate the effectiveness of an 8-week online interactive course on the loneliness, depression, social support, and quality of life (QOL) of older adults in the community during the COVID-19 pandemic.A single-blind randomized controlled trial was conducted to collect data from a community in Taiwan. Eighty-nine participants recruited from long-term care institutions were randomly divided into an experimental group (n = 44) and a control group (n = 45). Participants in the experimental group received an 8-week (Monday to Friday) intensive online interactive course, whereas those in the control group watched 8 weeks (Monday to Friday) of unidirectional online video programs.Significant differences were observed in the UCLA Loneliness Scale and in both the psychological health and social relationship domains of the WHO Quality of Life-BREF Scale. In other words, compared with those in the control group, participants in the experimental group experienced more significant improvements in the state of their loneliness as well as QOL in the psychological health and social relationship domains (without the physical health/environment domains) after taking the online interactive course.The results of this study showed that the 8-week online interactive course could effectively improve the loneliness, the psychological health domain, and the social relationship domain of the QOL of the older adults of a particular community during the ongoing pandemic. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.

The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the lasting pandemic of coronavirus disease 2019 (COVID-19) and the post-acute phase sequelae of heterogeneous negative impacts in multiple systems known as the "long COVID." The mechanisms of neuropsychiatric complications of long COVID are multifactorial, including long-term tissue damages from direct CNS viral involvement, unresolved systemic inflammation and oxidative stress, maladaptation of the renin-angiotensin-aldosterone system and coagulation system, dysregulated immunity, the dysfunction of neurotransmitters and hypothalamus-pituitaryadrenal (HPA) axis, and the psychosocial stress imposed by societal changes in response to this pandemic. The strength of safety, well-acceptance, and accumulating scientific evidence has now afforded nutritional medicine a place in the mainstream of neuropsychiatric intervention and prophylaxis. Long chain omega-3 polyunsaturated fatty acids (omega-3 or n-3 PUFAs) might have favorable effects on immunity, inflammation, oxidative stress and psychoneuroimmunity at different stages of SARS-CoV-2 infection. Omega-3 PUFAs, particularly EPA, have shown effects in treating mood and neurocognitive disorders by reducing pro-inflammatory cytokines, altering the HPA axis, and modulating neurotransmission via lipid rafts. In addition, omega-3 PUFAs and their metabolites, including specialized pro-resolvin mediators, accelerate the process of cleansing chronic inflammation and restoring tissue homeostasis, and therefore offer a promising strategy for Long COVID. In this article, we explore in a systematic review the putative molecular mechanisms by which omega-3 PUFAs and their metabolites counteract the negative effects of long COVID on the brain, behavior, and immunity.

This study adopted an advanced model, combining the technology acceptance model, the theory of reasoned action, the diffusion of innovations, trust, and five aspects of perceived risk, to measure the factors that influence the behavioral intentions of older adults to use mobile payments. A total of 365 questionnaires were collected from older adults aged 55 years or older from 20 community care sites in central Taiwan. Partial least-squares structural equation modeling was used to test our research model. The results showed that attitude was the main determinant of M-payment in older adults. Moreover, increasing the usefulness, ease of use, and observability of M-payment helped older adults improve their attitudes toward M-payment, thereby increasing their intention to use it. Trust had a significant effect on the usefulness and ease of use of M-payment, while the main factors affecting trust were only performance and financial risks.

When college students face the COVID-19 pandemic and new learning challenges simultaneously, how to reduce or alleviate their own academic stress has become a topic of concern to students and their parents. The psychological and physiological benefits of regular exercise have been confirmed by related studies. This study aimed to explore the impact of college students’ regular exercise behavior on academic stress and sleep quality during the COVID-19 pandemic. This study used a purposive sampling method to collect data through online questionnaires posted to relevant college student groups in northern, central, southern, and eastern Taiwan and the outlying islands. A total of 320 questionnaires were collected, with a response rate of 91.4%; based on 304 valid questionnaires. The validity rate was 95%. The obtained data were entered in SPSS 24.0 statistical software, and the correlation between variables was analyzed with AMOS 24.0 statistical software. The results show that hypothesis 1 is established, that is, regular exercise behavior of college students during the COVID-19 pandemic has a significant negative impact on academic stress, meaning that during the COVID-19 pandemic, if college students can use their spare time to make exercise part of their life, such a regular schedule will help reduce their academic stress. In addition, the empirical results show that hypothesis 2 is established, that is, regular exercise behavior of college students during the COVID-19 pandemic has a significant positive impact on sleep quality. A possible reason is that under the COVID-19 pandemic, the efficiency of the body to absorb oxygen is increased through regular exercise, which reduces pressure and improves sleep quality. Hypothesis 3 is also confirmed, that is, the academic stress of college students during the COVID-19 pandemic has a significant negative impact on sleep quality. The reason may be that many leisure and social activities have been suspended during the COVID-19 pandemic, and thus college students exercised and studied during the time they originally intended for leisure and social activities, which reduced their academic stress, stabilized their mood, and improved their sleep quality.

Aims/Introduction Maternal hyperglycemia leads to adverse pregnancy outcomes, and also subsequently affects both mothers and their offspring in later life. The prevalence of type 2 diabetes mellitus is increasing worldwide, and gestational diabetes mellitus (GDM) is also believed to be increasing. More precise nationwide and up‐to‐date data on GDM are required. Materials and Methods A population‐based retrospective cohort study was carried out with the Birth Certificate Application database and linked to the National Health Insurance Research Database to explore trends in the annual crude prevalence of GDM in all women who gave birth between 1 January 2004 and 31 December 2015 in Taiwan and their pregnancy outcomes. The registry is considered complete, reliable and accurate. Results A total of 2,468,793 births from 2,430,307 pregnancies were reported between 1 January 2004 and 31 December 2015. Finally, 2,053,305 pregnancies were included for further analysis. The annual prevalence of GDM increased by 1.8‐fold during the 12 years from 2004 to 2015, with a significant continuous increasing trend (from 7.6% to 13.4%, P, The annual prevalence of gestational diabetes mellitus increased by 1.8‐fold in the 12‐year period from 2004 to 2015 in Taiwan, with a significant continuous increasing trend (from 7.6% to 13.4%, P

OBJECTIVE To investigate the association between the risk of stroke and exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) over various exposure periods. METHODS This was a nationwide population-based case-control study in which 10,035 incident patients with a primary diagnosis of ischemic stroke each were matched with two randomly selected controls for sex, age, Charlson Comorbidity Index, year of stroke diagnosis, and level of urbanization. Multiple logistic models adjusted for potential confounders were used to assess the association of PM2.5 with ischemic stroke incidence. RESULTS There were significant short-term, medium-term, and long-term relationships between PM2.5 exposure and ischemic stroke incidence. CONCLUSIONS This study supports existing evidence that PM2.5 should be considered a risk factor for ischemic stroke.

PurposeThis article aims at a Unified Theory of Acceptance and Use of Technology (UTAUT) model framework that was used to investigate the impact of a 16-h smartphone training program on the correlations among different constructs of smartphone use in a sample of older adults.Design/methodology/approachA total of 208 participants aged 60–78 (mean: 65.4) years completed a questionnaire that collected information on demographic variables and the frequency and duration of smartphone use as well as the answers to questions on the six UTAUT constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention and usage behavior. The data were analyzed using partial least squares analysis.FindingsThis study was the first to compare post-training changes in the correlations among UTAUT constructs. The results revealed significant post-training changes in all construct correlations. Behavioral intention and facilitating conditions were shown to significantly impact usage behavior both before and after training and performance expectancy was shown to impact behavioral intention before training. After training, both effort expectancy and social influence were found to impact behavioral intention significantly. Moreover, the impact of facilitating conditions on usage behavior was significantly increased after training.Originality/valueTo date, no study published in the literature has investigated the impact of technological training on the technology-use intentions and behaviors of older adults. The findings of this study suggest that, for older adults, the results of the acceptance and use model for smartphones change significantly and positively between pre-smartphone training and post-smartphone training time points. The findings support that technology training has a positive impact on smartphone use in older adults.

Many medical issues have gradually emerged under the severe impact of the COVID-19 pandemic, which has not only changed the medical culture but also tested medical staffs’ response abilities, emotional pressure, sense of identity, and belonging to the organization. The relationships among medical staffs’ emotional labor, leisure coping strategies, workplace spirituality, and organizational commitment during the COVID-19 pandemic are explored in this study. With medical staffs as the research subjects, a questionnaire survey was conducted using convenience sampling; a total of 360 questionnaires were distributed and 330 were returned, for a recovery rate of 91%. There were 300 valid questionnaires after 30 invalid questionnaires were excluded, for an effective recovery rate of 90%. SPSS and AMOS software were used for statistical analysis. According to the research results: (1) emotional labor had a significant effect on workplace spirituality, (2) workplace spirituality had a significant impact on organizational commitment, (3) emotional labor had a negative and significant impact on organizational commitment, (4) emotional labor had a significant impact on leisure coping strategies, and (5) the mediating effect of workplace spirituality between emotional labor and organizational commitment was not significant. Finally, relevant practical suggestions are provided based on the results of this study.

Objective This study investigated the psychological impact on, coping behaviors of, and traumatic stress experienced by healthcare workers during the early stage of the COVID-19 pandemic and formulated effective support strategies that can be implemented by hospitals and government policymakers to help healthcare staff overcome the pandemic. Methods This cross-sectional study recruited clinical healthcare workers at a regional hospital in Nantou County, Taiwan. The questionnaire collected personal characteristics, data on the impact and coping behaviors of the pandemic, and Impact of Event Scale-Revised (IES-R). A total of 354 valid questionnaires were collected. The statistical methods employed were univariate and multivariate stepwise regression, and logistic regression. Results Perceived impact and coping behaviors were found to be moderate in degree, and traumatic stress was lower than that in other countries. However, our data identified the following subgroups that require special attention: those with young age, those living with minor children, nurses, those with self-rated poor mental health, and those with insufficient COVID-19-related training. Conclusion Managers should pay particular attention to helping healthcare workers in high-risk groups, strengthen COVID-19 training, provide adequate protective equipment and shelter, and offer psychological counseling.

This study aimed at assessing the impacts of the fear of COVID-19 on consumer buying behavior toward dietary supplements. This investigation was a cross-sectional study in which literate adults regardless of gender over the age of 20 were recruited from three pharmacies in three different districts of Wuhan City, China. A total of 598 questionnaires were analyzed after excluding 10 with incomplete information. The current study demonstrated that attitudes, subjective norms, and perceived behavioral control had a positive impact on the intention of purchasing dietary supplements. Fear of COVID-19 was related to an enhanced purchase intention toward dietary supplements. Attitudes, subjective norms, and perceived behavioral control were significant factors that mediated the association between the fear of COVID-19 and the purchase intention of dietary supplements. This study helps provide practical advice for stakeholders in the pharmaceutical and healthcare industries to tailor appropriate strategies for improving product promotion or healthcare-related interventions.

Importance New therapeutic classes of migraine-specific treatment have been developed, including 5-hydroxytryptamine1Freceptor agonists (lasmiditan) and calcitonin gene-related peptide antagonists (rimegepant and ubrogepant). Objective To compare outcomes associated with the use of lasmiditan, rimegepant, and ubrogepant vs triptans for acute management of migraine headaches. Data Sources The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to March 5, 2020. Study Selection Double-blind randomized clinical trials examining current available migraine-specific acute treatments were included. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to extract the data according to a predetermined list of variables of interest, and all network meta-analyses were conducted using a random-effects model. Main Outcomes and Measures The primary outcome was the odds ratio (OR) for freedom from pain (hereafter referred to aspain freedom) at 2 hours after the dose, and the secondary outcomes were ORs for pain relief at 2 hours after the dose and any adverse events. Results A total of 64 randomized clinical trials were included (46 442 participants; 74%-87% women; age range, 36-43 years). Most of the included treatments were associated with reduced pain at 2 hours compared with placebo. Most triptans were associated with higher ORs for pain freedom at 2 hours compared with lasmiditan (range: OR, 1.72 [95% CI, 1.06-2.80] to OR, 3.40 [95% CI, 2.12-5.44]), rimegepant (range: OR, 1.58 [95% CI, 1.07-2.33] to OR, 3.13 [95% CI, 2.16-4.52]), and ubrogepant (range: OR, 1.54 [95% CI, 1.00-2.37] to OR, 3.05 [95% CI, 2.02-4.60]). Most triptans were associated with higher ORs for pain relief at 2 hours compared with lasmiditan (range: OR, 1.46 [95% CI, 1.09-1.96] to OR, 3.31 [95% CI, 2.41-4.55]), rimegepant (range: OR, 1.33 [95% CI, 1.01-1.76] to OR, 3.01 [95% CI, 2.33-3.88]), and ubrogepant (range: OR, 1.38 [95% CI, 1.02-1.88] to OR, 3.13 [95% CI, 2.35-4.15]). The comparisons between lasmiditan, rimegepant, and ubrogepant were not statistically significant for both pain freedom and pain relief at 2 hours. Lasmiditan was associated with the highest risk of any adverse events, and certain triptans (rizatriptan, sumatriptan, and zolmitriptan) were also associated with a higher risk of any adverse events than the calcitonin gene-related peptide antagonists. Conclusions and Relevance For pain freedom or pain relief at 2 hours after the dose, lasmiditan, rimegepant, and ubrogepant were associated with higher ORs compared with placebo but lower ORs compared with most triptans. However, the lack of cardiovascular risks for these new classes of migraine-specific treatments may offer an alternative to triptans.

Given rapidly aging societies worldwide, improving the quality of long-term care through the cultivation of immense nursing assistants is critical. Accordingly, developing a satisfactory learning model to improve the learning outcomes of nursing assistant students is imperative.This study tested the hypothesis that students in long-term care departments who underwent immersive virtual reality (IVR) training would have significantly (1) higher levels of knowledge about the skills of nasogastric tube feeding, (2) higher learning motivations (i.e., intrinsic and extrinsic motivations, task values, and self-efficacy), (3) lower cognitive load, and (4) higher satisfaction than a control group.A randomized controlled trial with pretest and posttest design.We randomly assigned 107 students from the long-term care departments of two universities in central Taiwan to the IVR group (n = 54) or the control group (n = 53).The IVR group learned the procedure of nasogastric tube feeding through IVR, whereas the control group watched a 15-min 2D video. The participants filled pretest and posttest questionnaires on nasogastric tube feeding knowledge. After the experiment was completed, the participants answered another questionnaire on their learning motivations, cognitive load, and learning satisfaction.The nasogastric tube feeding knowledge improved significantly in the IVR and control groups after the intervention, with no significant between-group differences. The IVR group scored significantly higher than the control group on extrinsic goals, task value, and satisfaction; nevertheless, they also experienced a significantly higher cognitive load.Both the IVR training and the traditional 2D video improved the learning outcomes of the nursing assistant students. The students were more satisfied with IVR than with the conventional learning model and indicated that IVR inspired their extrinsic learning motivations and perceived task value. However, IVR incurred a high cognitive load, which must be addressed in future course designs.

Monoclonal antibodies (mAbs) acting on the calcitonin gene-related peptide (CGRP) or on its receptor are new therapeutic biologics to prevent chronic migraine (CM). Four mAbs acting on the CGRP or on its receptor are new therapeutic biologics to prevent CM. The aim of current network meta-analysis (NMA) was to compare the efficacy and acceptability of CGRP mAbs with onabotulinumtoxinA or topiramate for CM. We included randomized controlled trials (RCTs) examining CGRP mAbs and onabotulinumtoxinA or topiramate in patients with CM. All network meta-analytic procedures were conducted using the frequentist model. The primary outcomes were changes in the monthly migraine days and the 50% response rate. The safety was evaluated with acceptability (i.e., drop-out rate) and rate of any adverse event. This NMA of thirteen RCTs, which, in total, consisted of 5634 participants, demonstrated that a single 300 mg of eptinezumab (mean difference = − 2.60 days, 95% confidence intervals (95% CIs) = − 4.43 to − 0.77 compared with placebo) demonstrated the best improvement in monthly migraine days among all interventions. In addition, 675 mg fremanezumab in the first month followed by 225 mg in the second and third months (odds ratio (OR) = 2.96, 95% CIs = 2.20 to 3.97 compared to placebo) was associated with the best response rate among all the interventions. Monthly 140 mg erenumab (MD = − 2.50 days, 95% CIs = − 3.83 to − 1.17 compared with placebo) was the best choice for reducing the number of acute migraine-specific medication use days. The safety analysis revealed that loading dose of 240 mg galcanezumab and monthly 240 mg (OR = 0.43, 95% CIs = 0.22 to 0.84) was associated with the lowest drop-out rate; loading dose fremanezumab 675 mg and monthly 675 mg (OR = 1.44, 95% CIs = 1.10 to 1.89), loading dose of 240 mg galcanezumab and monthly 120 mg (OR = 1.37, 95% CIs = 1.02 to 1.84), and single dose of fremanezumab 675 mg (OR = 1.35, 95% CIs = 1.00 to 1.83) were associated with significantly higher rates of AEs than the placebo/control groups. Our NMA indicated that all four CGRP mAbs demonstrated excellent safety, acceptability, and efficacy profiles compared to the traditional prophylaxis for CM. However, because there are several limitations, the findings of the current NMA should be taken into consideration with caution. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13311-021-01128-0.

This study aimed to validate the influence of empowering leadership on safety behavior in the medical industry and examine the mediating effects of knowledge sharing and safety climate. We adopted a hierarchical linear model to perform a cross-hierarchy analysis on the entire research framework. We examined knowledge sharing and safety behavior on the individual level and examined empowering leadership and safety climate on the organizational level. The findings revealed that empowering leadership is a prerequisite of safety behavior, particularly when leaders are empowering leaders. Such leaders formulate and comply with safety procedures and requirements and enhance safety participation. We validated that knowledge sharing is a key mediator between empowering leadership and safety behavior. Empowering leaders empower employees to participate in decision making and encourage them to resolve problems together and share knowledge, thereby enhancing their knowledge sharing behavior, safety participation willingness, and safety compliance. We also validated the mediating effects of safety climate. Leaders influence employees’ safety behavior through safety climate. When leaders adopt empowering leadership, they create favorable safety climate, which promote safety behavior.

To summarize the clinical neuroimaging evidence pertaining to the potential mechanisms of acupuncture for migraine prophylaxis. From a descriptive perspective, converging evidence from recent neuroimaging studies, mainly from functional MRI (fMRI) studies, has demonstrated that when compared with sham acupuncture, verum acupuncture could normalize the decrease of the functional connectivity of the rostral ventromedial medulla-trigeminocervical complex (RVM/TCC) network, frontal-parietal network, cingulo-opercular networks, and default mode network and could normalize sensorimotor network connectivity with sensory-, affective-, and cognitive-related brain areas. These areas overlap with those of the pain matrix. Verum acupuncture works in a more targeted and unique manner compared with sham acupuncture in patients with migraine. These findings from neuroimaging studies may provide new perspectives on the validation of acupoints specificity and confirm the central modulating effects of acupuncture as a migraine prevention treatment. However, the exact mechanism by which acupuncture works for migraine prophylaxis remains unclear and warrants investigation. Future studies with larger sample sizes are still needed to confirm the current results and to further evaluate the complex and specific effects of acupuncture by analyzing different stimulus conditions, such as verum vs. sham acupuncture, deqi vs. no deqi, different acupuncture points or meridians, and different manipulation methods. Moreover, instead of focusing on the changes in a single area of the brain, researchers should focus more on the relationships among the functional connectivity network of brain areas such as the RVM/TCC, thalamus, anterior cingulate cortex (ACC), superior temporal gyrus (STG), and supplementary motor area (SMA) to explore the underlying mechanism of the effects of acupuncture.

Background: Migraine is the most prevalent neurological disorder and the leading cause of disability in individuals under 50 years of age. Two types of migraine therapies have been defined: acute therapy (abortive or symptomatic treatment), the purpose of which is to interrupt migraine attacks, and preventive treatment (prophylactic treatment), the purpose of which is to reduce the frequency and severity of migraine attacks. Objective: This paper reviews research advances in new agents for acute therapy of migraine. Material and Methods: This review provides an overview of emerging new drugs for acute treatment of migraine based on clinical evidence and summarizes the milestones of different stages of clinical development. Results: Two new formulations of sumatriptan, DFN-11 (3 mg doses of subcutaneous sumatriptan) and DFN-02 (a nasal spray of sumatriptan 10 mg and a permeation-enhancing excipient), have been developed, and both of them showed a fast-onset action with efficacy for acute treatment of migraine with fewer adverse events. New drug discovery programs shifted the focus to the development of ditans, a group of antimigraine drugs targeting 5-HT1F receptors. Only lasmiditan has progressed to phase III clinical trials and was finally approved by the Food and Drug Administration (FDA) for acute migraine treatment. The other target for acute therapy is CGRP receptor antagonists, namely, gepants. Ubrogepant and rimegepant demonstrated statistically significant efficacy, and both were recently approved by the FDA. These 5-HT1F receptor agonists and CGRP receptor antagonists did not cause vasoconstriction, offering advantages over the current mainstay of specific acute migraine treatment. Conclusions: Overall, these new agents have expanded the available acute therapies for migraine treatment and will likely change the strategy with which we treat patients with migraine in the future.

In the wave of Industry 4.0, GPS sports watches are redeveloping towards digitization and intelligence. Whether the information is correct and real-time, operation interfaces easy to use and the displayed information easy to understand have become issues that consumers and manufacturers emphasize. Thus, this study investigated the effects of output quality and result demonstrability on the perceived usefulness of GPS sports watches with participants of the 2020 Taiwan International Triathlons as the research subjects. In total, 280 respondents, who participated in the 2020 Taiwan International Triathlon, were selected by purposive sampling for a questionnaire survey. The statistical software SPSS was employed to file the data, and the statistical software of AMOS was adopted to analyze the correlation among variables. According to the results, (1) output quality has significantly positive effects on perceived usefulness; (2) result demonstrability has significantly positive effects on perceived usefulness; (3) perceived ease of use has significantly positive effects on perceived usefulness; (4) perceived ease of use has significantly positive effects on behavioral intention to use; and (5) perceived usefulness has significantly positive effects on behavioral intention to use.

Barriers to smartphone use often exist among older adults, and increasing smartphone use is beneficial to increasing older adults’ quality of life. Studies of older adults’ smartphone use intentions have mostly adopted the technology acceptance model or unified theory of acceptance and use of technology (UTAUT). However, these models have their limitations. A meta-UTAUT has been developed, but it has not been extensively verified with older adults. This study used the meta-UTAUT model to explore the influences on older adults’ smartphone use intentions and behaviors. A total of 311 adults aged 60 to 75 years who had minimal experience with smartphones were recruited. They participated in a 16 h smartphone training and then completed a questionnaire. The results demonstrated that the meta-UTAUT model can predict older adults’ smartphone use intentions and behaviors. Performance expectancy (PE) and social influence significantly influenced behavioral intention (BI) and attitude toward using smartphones (AT). PE was the strongest factor influencing BI. AT also affected BI. Although facilitating conditions did not significantly affect BI, they had a high influence on AT. To increase smartphone use among older adults, training can be implemented to teach smartphone skills and emphasize the benefits of using smartphones.

Aim Nursing staff burnout threatens not only nurses' health but also the safety and health of their patients. Organizations should be aware of how work-related conflict can affect this burnout. This study examined the effect of supervisor support and work-family conflict on resource loss and burnout. Methods A cross-sectional method and quantitative approach were adopted. A total of 300 questionnaires were distributed to clinical nursing staff in two regional teaching hospitals, and 239 valid questionnaires were returned. Results Work-family conflict had a mediating effect on the relationship between supervisor support and emotional exhaustion. Emotional exhaustion fully mediated the relationships between depersonalization, work-family conflict, and reduced professional efficacy. Conclusion The mediating effect of emotional exhaustion in work-family conflict results from depersonalization and reduced professional efficacy, whereas work-family conflict mediated the effect of supervisor support on emotional exhaustion. The findings indicate that the medical industry should implement supervisor support strategies to reduce nursing staff work-family conflict and improve interventions for emotional exhaustion.

This study uses molecular dynamics (MD) and the density functional theory (DFT) calculation to investigate the structural, mechanical, thermal, and electronic properties of Mg3Ca7, Mg5Ca5, Mg7Ca3 bulk metallic glasses. A fitting process for the Mg-Ca cross-element parameters of the second-nearest neighbor modified embedded-atom method (2NN MEAM) potential was performed via the particle swarm optimization (PSO) based on density functional theory (DFT) calculations with reference data present in ESI. Using these fitted potential prameters, the Mg3Ca7, Mg5Ca5, Mg7Ca3 structures were constructed with the simulated-annealing basin-hopping (SABH) method. X-ray diffraction results provided the angle distribution range, which indicates that the predicted Mg3Ca7, Mg5Ca5, Mg7Ca3 match those of Mg- and Ca- BMGs. This confirms that the fitted parameters of 2NN MEAM potential can indeed precisely represent the interactions of the Mg and Ca atoms in MgCa BMG. Results from the analysis of Honeycutt-Andersen (HA) index show the local icosahedral-like structures occupy 75.52%, 75.33%, 73.84% within Mg3Ca7, Mg5Ca5, Mg7Ca3. The chemical affinity indicated by Warren-Cowley chemical short-range-order (CSRO) parameters shows the Ca atom has a higher affinity to the Mg atoms while possessing less affinity to itself. The tensile simulation results indicate that the Young’s moduli are about 9.77, 9.56, and 8.52 GPa, and the strengths are about 582, 552 and 507 MPa for Mg3Ca7, Mg5Ca5, and Mg7Ca3, respectively. For the thermal properties, the melting temperatures of Mg3Ca7, Mg5Ca5, and Mg7Ca3 range from 750 to 810 K, which are located within the experimental melting temperatures of MgCa alloys. Einstein equation is utilized to calculate self-diffusion coefficients of Mg3Ca7, Mg5Ca5, and Mg7Ca3 around melting temperatures, based on the MSD profiles at 500 ps time interval. Based on these diffusion coefficients, the diffusion barriers of Mg, Ca, and total atoms can be determined. The diffusion barriers of total, Mg and Ca for Mg7Ca3 are the lowest. The DFT calculation results show most Mg atoms in Mg3Ca7, Mg5Ca5, and Mg7Ca3 tend to possess negative charges, while most Ca atoms have positive charges. The corrosion mechanism of Mg3Ca7, Mg5Ca5, and Mg7Ca3 was explored by using the Fukui function ( f k - ) distribution for an electrophilic reaction. For Mg3Ca7 and Mg5Ca5, the surface Ca sites possess the larger f k - values, which are the better electron donating sites for H2O dissociation. For Mg7Ca3, both surface Mg and Ca atoms possess higher f k - values, indicating the reaction of H2O dissociation and the Mg7Ca3 corrosion could be initialized at either Mg or Ca sites.

Molecular dynamics (MD) simulation and density functional theory (DFT) calculations were used to predict the material properties and explore the improvement on the surface corrosion resistance for the Mg66Zn30Ca3Sr1 bulk metallic glass (BMG). The Mg66Zn30Ca4 BMG was also investigated to realize the influence of the addition of Sr element on the material behaviors of Mg66Zn30Ca4. The Mg-Zn-Ca-Sr parameters of the next nearest-neighbor modified embedded atom method (2NN MEAM) potential were first determined by the guaranteed convergence particle swarm optimization (GCPSO) method based on the reference data from the density functional theory (DFT) calculation. Besides, using the 2NN MEAM parameters of the Mg-Zn-Ca-Sr system, the structures of Mg66Zn30Ca4 and Mg66Zn30Ca3Sr1 were predicted by the simulated-annealing basin-hopping (SABH) method. The local atomic arrangements of the predicted BMG structures are almost the same as those measured in some related experiments from a comparison with the calculated and experimental X-ray diffraction (XRD) profiles. Furthermore, the HA index analysis shows that the fractions of icosahedra-like local structures are about 72.20% and 72.73% for Mg66Zn30Ca4 and Mg66Zn30Ca3Sr1, respectively, indicating that these two BMG structures are entirely amorphous. The uniaxial tensile MD simulation was conducted to obtain the stress-strain relationship as well as the related mechanical properties of Mg66Zn30Ca4 and Mg66Zn30Ca3Sr1. Consequently, the predicted Young’s moduli of both BMGs are about 46.4 GPa, which are very close to the experimental values of 48.8 ± 0.2 and 49.1 ± 0.1 GPa for Mg66Zn30Ca4 and Mg66Zn30Ca3Sr1, respectively. However, the predicted strengths of Mg66Zn30Ca4 and Mg66Zn30Ca3Sr1 are about 850 and 900 MPa, both are slightly higher than the measured experimental values about 747 ± 22 and 848 ± 21 MPa for Mg66Zn30Ca4 and Mg66Zn30Ca3Sr1. Regarding the thermal properties, the predicted melting temperature of Mg66Zn30Ca3Sr1 by the square displacement (SD) profile is about 620 K, which is very close to the experimental melting temperature of about 613 K. The self-diffusion coefficients of Mg, Zn, Ca, and Sr elements were also calculated for temperatures near their melting points by means of the Einstein equation. The methodology can determine the diffusion barriers for different elements by utilizing these diffusion coefficients resulting in a fact that the diffusion barriers of Ca and Sr elements of Mg66Zn30Ca3Sr1 are relatively high. For the electronic properties predicted by the DFT calculation, the projected density of states (PDOS) profiles of surface Mg, Zn, Ca, and Sr elements clearly show that the addition of Sr into Mg66Zn30Ca4 effectively reduces the s and p orbital states of surface Mg and Zn elements near the Fermi level, particularly the p orbits, which suppresses the electron transfer as well as increases the surface corrosion resistance of Mg66Zn30Ca4. Consequently, this study has provided excellent 2NN MEAM parameters for the Mg, Zn, Ca, and Sr system by the GCPSO method to predict real BMG structures as well as by means of the DFT calculation to explore the electronic properties. Eventually, through our developed numerical processes the material properties of BMGs with different compositions can be predicted accurately for the new BMG design.

This study investigated the influences of nursing assistants’ job competency on their intrinsic and extrinsic satisfaction and intention to stay in the profession of long-term care institutions. Understanding the relationship between job competency and job satisfaction, both intrinsic and extrinsic, would enable institutions to strengthen service workers’ intention to stay and to retain essential personnel. This study was a cross-sectional study in which nursing assistants from 26 nursing homes and 15 elderly welfare institutions in Taiwan. The relationship between job competency and intention to stay was discovered to be significantly mediated by intrinsic and extrinsic job satisfaction. Given the staff shortages and difficulty retaining staff in long-term care environments, organizations must be able to strengthen employees’ intention to stay, one suggestion is to improve the employees’ competency, because higher competency results in higher quality of care and greater extrinsic job satisfaction. Furthermore, greater job competency is more likely to result in affirmation and accomplishment, both of which increase intrinsic job satisfaction and thus positively influence intention to stay.

The lack of an efficient approach in managing pharmaceutical prices in the procurement system led to a substantial burden on government budgets. In Thailand, although the reference price policy was implemented to contain the drug expenditure, there have been some challenges with the price dispersion of medicines and pricing information transparency. This phenomenon calls for the development of a potential algorithm to estimate appropriate prices for medical products. To serve this purpose, in this paper, we first developed the model by the sequential minimal optimization (SMO) algorithm for predicting the range of the prices for each medicine, using the Waikato environment for knowledge analysis software, and applying feature selection techniques also to examine improving predictive accuracy. We used the dataset comprised of 2424 records listed on the procurement system in Thailand from January to March 2019 in the application and used a 10-fold cross-validation test to validate the model. The results demonstrated that the model derived by the SMO algorithm with the gain ratio selection method provided good performance at an accuracy of approximately 92.62%, with high sensitivity and precision. Additionally, we found that the model can distinguish the differences in the prices of medicines in the pharmaceutical market by using eight major features—the segmented buyers, the generic product groups, trade product names, procurement methods, dosage forms, pack sizes, manufacturers, and total purchase budgets—that provided the highest predictive accuracy. Our findings are useful to health policymakers who could employ our proposed model in monitoring the situation of medicine prices and providing feedback directly to suggest the best possible price for hospital purchasing managers based on the feature inputs in their procurement system.

Previous studies have identified numerous factors that affect incident-reporting behavior. However, few studies have applied an individual psychology perspective to identify and examine the factors affecting the intention of nursing staff to report incidents. We integrate the theory of planned behavior, organizational behavior, psychological behavior, and social exchange theory to identify which factors affect the intentions of nursing staff to report incidents. Samples were collected from nursing staff at 40 regional or larger hospitals for model verification. The results of this study show that psychological safety, attitude toward reporting incidents, subjective norms, and perceived behavioral control correlate positively with the intention to report incidents. The perceived cost and perceived benefit of incident reporting directly affects the attitude toward incident-reporting behavior, and self-efficacy influences perceived behavioral control. Furthermore, subjective norms and the perceived benefits of incident reporting mediate the effect of psychological safety on attitude toward incident-reporting behavior.

Object: Review recent publications of patient safety culture to investigate the relationship between leadership behavior, safety culture, and safety performance in the healthcare industry. Method: This study is a cross-sectional study, 350 questionnaires were mailed to hospital workers with 195 valid responses obtained, and a 55.7% valid response rate. Confirmatory factor analysis (CFA) was carried out to test the factor structure and determine if the composite reliability was significant with a factor loading of >0.5, resulting in an acceptable model fit. Results: Through the analysis of One-way ANOVA, the results showed that physicians significantly have more negative patient safety culture perceptions and safety performance perceptions than non- physicians. Conclusions: The path analysis results show that leadership behavior affects safety culture and safety performance in the health care industry. Safety performance was affected and improved with contingency leadership and a positive patient safety organization culture. The study suggests improving safety performance by providing a well-managed system that includes: consideration of leadership, hospital worker training courses, and a solid safety reporting system., {"references":["L. T. Kohn, J. M. Corrigan, and M.S. Donaldson, To Err is Human:\nBuilding a Safer Health System. Institute of Medicine Report,\nWashington, DC: National Academy Press, 2000.","Department of Health, \"An Organization with a Memory: Report of an\nexpert group on learning from adverse events in the NHS chaired by the\nChief Medical Officer,\" London, 2000, pp. 35.","G.R. Baker, P. Norton, Patient Safety and Healthcare Error in the\nCanadian Healthcare System: A Systematic Review and Analysis of\nLeading Practices in Canada with Reference to Key Initiatives\nElsewhere, A report to Health Canada, Ottawa: Health Canada, 2002.","\"Strategies for leadership: An Organizational Approach to Patient\nSafety\". http://www.ihatoday.org/issues/safety/tools/vhatoolfinal.pdf","S. J. Singer, D. M. Gaba, J. J. Geppert, A. D. Sinaiko, S. K. Howard, and\nK. C. Park, \"The culture of safety: results of an organization-wide\nsurvey in 15 California hospitals,\" Quality and Safety in Health Care,\nvol. 12, pp. 112-118, 2003.","J. B. Sexton, E. J. Thomas, R. L. Helmreich, et al. (2004) Frontline\nassessments of healthcare culture: Safety Attitudes Questionnaire norms\nand psychometric properties. Austin, TX: The University of Texas\nCenter of Excellence for Patient Safety Research and Practice,\nTechnical Report No. 04-01. Grant No.1PO1HS1154401. Sponsored by\nthe Agency for Healthcare Research and Quality.\nhttp://www.uth.tmc.edu/schools/med/imed/patient_safety/SAQ_Norms\n_and_Psychometric_Properties_for_Website.pdf.","P. J. Pronovost, B. Weast, C. G. Holzmueller, B. J. Rosenstein, R. P.\nKidwell, K. Haller, et al, \"Evaluation of the culture of safety: Survey of\nclinicians and managers in an academic medical center,\" Qual Saf\nHealth Car, vol. 12, pp. 405-410, 2003.","D. M. DeJoy, B. S. Schaffer, M. G. Wilson, R. J. Vandenberg, and M.\nM. Butts, \"Creating safer workplaces: assessing the determinants and\nrole of safety climate,\" Journal Safety Research, vol. 35, pp. 81-90,\n2004.","L. J. Weng, \"The Perception of healthcare workers a hospital safety\nculture,\" M.S. thesis, institute and department of pubic health,\nKaohsiung Medical university, 2004.\n[10] Y. T. Kuo, \"Physicians- Perception of Patient Safety Culture and\nPractices in a Tertiary Care Hospital in Taiwan,\" M.S. thesis,\ndepartment and graduate institute of health care management, Chang\nGung University, 2004.\n[11] C. L. Shih, \"An Exploratory Study of Patient Safety Culture in\nHospitals: Patient Safety Climate and its Association with Hospital\nWorkers- Safety Practice,\" M.S. thesis, graduate institute of health care\norganization administration, national Taiwan university, 2004.\n[12] R. Flin and S. Yule, \"leadership for safety: industrial experience,\" Qual\nSaf Health Care, vol. 13, pp. 180-184, 2004.\n[13] T. C. Wu, \"The Correlational Study between Safety Climate and Safety\nPerformance in Four Categories of Manufacturing Industries in Central\nTaiwan,\" Ph.D. dissertation, Department of Industrial Education and\nTechnology, National Changhua University of Education, 2000.\n[14] A. Neal, M. A. Griffin, and P. M. Hart, \"The impact of organizational\nclimate on safety climate and individual behavior,\" Safety Science, vol.\n34, pp. 99-109, 2000.\n[15] M. F. Hsieh, \"The Impact of Safety Climate on Safety performance ÔÇö A\nCase Study of Highway Bus Drivers,\" M.S. thesis, department of\ntransportation and communication management science, National\nCheng Kung University, 2003.\n[16] O. L. Siu, D. R. Phillip, and T. W. Leung, \"Safety climate and safety\nperformance among construction workers in Hong Kong the role of\npsychological strains as mediators,\" Accident analysis and prevention\nvol. 36, pp. 359-366, 2004.\n[17] Y. H. Huang., M. RO, G. S. Smith, and P. Y. Chen. \"Safety climate and\nself-reported injury: Assessing the mediating role of employee safety\ncontrol, \"Accident Analysis & Prevention, vol.38, pp.425-433.\n[18] T.C. Wu, C.H Chen, C.C Li.,\"A correlation among safety leadership,\nsafety climate and safety performance,\" Journal of Loss Prevention in\nthe Process Industries 21 307-318.2008\n[19] R.S. Stricoff, \"Safety Performance Measurement: Identifying\nProspective Indicators with High Validity,\" Professional Safety, 45(1),\npp.36-39.2000.\n[20] P. Swuste, \"Editorial: WOS2006, regulatory issues, safety climate,\nculture, and management,\" Safety Science, 46(3): 345-348.2008.\n[21] D. Zohar, \"Safety climate in industrial organizations: Theoretical and\napplied implications,\" Journal of Applied Psychology, vol. 65, no. 1,\npp.96-102, 1980.\n[22] T. Cox, and S. Cox, \"The structure of employee attitudes to safety an\nEuropean example,\" Work and Stress, vol. 5, no. 2, pp.93-106, 1991.\n[23] E.H. Schein, \"Organizational culture and leadership\".\n2nd edition. San Francisco: Jossey-bass.1992.\n[24] F. W. Guldenmund, \"The nature of safety culture a review of theory\nand research,\" Safety Science, vol. 34, no. 1-3, pp. 215-257, 2000.\n[25] M. D. Cooper, \"Towards a model of safety culture,\" Safety Science, vol.\n36, pp.111-136, 2000.\n[26] M. O-Toole, \"The relationship between employees- perceptions of\nsafety and organizational culture,\" Safety Research, vol. 33, no. 2, pp.\n231-243, 2002.\n[27] A. Neal, M. A. Griffin, and P. M. Hart, \"The impact of organizational\nclimate on safety climate and individual behavior,\" Safety Science, 34,\npp.99-109.2000\n[28] A. Neal, and M. A. Griffin, \"Safety climate and safety behavior,\"\nAustralian Journal of Management, 27, 67-77.2002\n[29] L. C. Lin, \"The Effect of Safety Climate on Safety Performance --- A\nCase of Container Terminal Operators in Kaohsiung Port,\" M.S. thesis,\ndepartment of transportation and communication management science,\nNational Cheng Kung University, 2003.\n[30] T. Katz-Navon, E. Naveh, Z. Stern, \"Safety climate in healthcare\norganizations: a multidimensional approach,\" Academy of Management\n48 (6), 1075-1089.2005\n[31] Y.H. Huang, M. Ho, G. S. Smith, , & P. Y. Chen, \"Safety climate and\nself-reported injury: Assessing the mediating role of employee safety\ncontrol,\" Accident Analysis and Prevention, 38(3), 425-433.2006\n[32] G N. Stock, K L. McFadden, C R. Gowen, \"Organizational culture,\ncritical success factors, and the reduction of hospital errors,\"\nInternational Journal of Production Economics, 106(2), 368-392.2007\n[33] J. K. Hemphill and A. E. Coons, \"Development of the leader Behavior\nDescription Questionnaire. In R.M. Stogdill & A.E.Coons Eds. .\nLeader behavior Its description and measurement,\" Columbus\nBureau of Business Research, Ohio State University, 1957.\n[34] R. White and R. Lippert, Leader Behavior and Member Reaction in\nThree Social Climates. In Cartwright D. and Zander A.eds. Group\nDynamics:Research and Theory, New York: Harper & Row, 1953,\npp.385-611.\n[35] R. Pater, \"Leadership skills for 21st century, Proceedings of ASSE\nProfessional Development Conference and Exposition. Anaheim,\nCalifornia,\" Session, vol. 631, pp. 1-10, 2001.\n[36] T.-C Wu, C.-W .Liu, & M.-C. Lu, Safety climate in university and\ncollege laboratories: Impact of organizational and individual factors.\nJournal of Safety Research, 38(1), 91-102.2007\n[37] A. O-Dea, & R. Flin., \"Site managers and safety leadership in the\noffshore oil and gas industry,\" Safety Science, 37(1), 39-57.2001\n[38] D. Zohar, \"The effects of leadership dimensions, safety climate, and\nassigned priorities on minor injuries in work groups,\" Journal of\nOrganizational Behavior, vol. 23, no. 1, pp. 75-92, 2002.\n[39] J. S. Lee, \"The relationship study of the hospital organization culture,\nleadership, and organizational citizenship behaviors,\" M.S. thesis,\ninstitute of human resource, National Sun Yat-Sen University, 2002.\n[40] D. Zohar, The influence of leadership and climate on occupational\nhealth and safety. In D.A. Hofmann & L.E. Tetrick (Eds.) Health and\nSafety in Organizations: A Multilevel Perspective, 201-232,\nJossey-Bass, San Francisco.2003\n[41] S. Clarke & K. Ward, \"The Role of Leader Influence Tactics and Safety\nClimate in Engaging Employees' Safety Participation,\" Risk Analysis,\n26(5), 1175-1185.2006."]}