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Yi-Ping Weng,1,2 Rei-Mei Hong,2 Vincent Chin-Hung Chen,3,4 Chia-Jui Tsai,5,6 Dah-Cherng Yeh,7 Yu-Hung Fang8 1Department of Nursing, Chia-Yi Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C; 2Department of Nursing, Chia-Yi Chang Gung University of Science and Technology, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C; 3Department of Psychiatry, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C; 4School of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C; 5Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C; 6Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C; 7Breast Medical Center, Cheng Ching Hospital, Chung Kang Branch, Taichung City, Taiwan, R.O.C; 8Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, 61363, Taiwan, R.O.CCorrespondence: Yu-Hung FangDivision of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi branch, No.6, W. Sec., Jiapu Rd, Puzi City, Chiayi County, 61363, Taiwan, R.O.CTel +886-5-362-1000 ext. 2762Fax +886-5-362-3005Email 8902062@adm.cgmh.org.twBackground: Sleep disturbances are common and symptomatic burden in patients with breast cancer, but they are poorly documented and managed in routine clinical practice. This descriptive and cross-sectional study evaluated factors associated with post-treatment sleep disturbances in patients with breast cancer.Patients and Methods: Patients with breast cancer who underwent standard treatment were enrolled and surveyed for their basic demographic data and precancerous and cancer treatment-related factors; they were also administered self-report questionnaires including the Family Adaptation, Partnership, Growth, Affection, Resolve questionnaire; Impact of Event Scale; Center for Epidemiologic Studies Depression Scale; and Maudsley Personality Inventory. Their sleep disturbances were evaluated using the Pittsburgh sleep quality index (PSQI). Independent sample t test and chi-square tests were used to compare the variables between patients with or without sleep disturbance, and multivariate logistic regression analyses were conducted to detect the independent factors.Results: In total, 448 patients, including 145 with PSQI ≤ 5 and 303 with PSQI > 5, completed the investigation. Multiple logistic regression analysis revealed that significantly more patients with sleep disturbances demonstrated psychological distress, severe pain, depression, and impact of stress events than patients without sleep disturbances (adjusted odds ratios [95% confidence intervals]: 2.83 [1.135– 7.067], P = 0.026; 1.14 [1.023– 1.280], P = 0.018; 1.08 [1.036– 1.133], P < 0.001; and 1.03 [1.002– 1.051], P = 0.037, respectively).Conclusion: Patients with breast cancer showed 67.6% prevalence of sleep disturbances after treatment. The patients with sleep disturbances were more likely to have previously experienced psychological disturbances, severe pain, depression within 5 years after diagnosis. After diagnosis for more than 5 years, higher distress caused by traumatic events still associated with sleep disturbances.Keywords: sleep disturbance, breast cancer, depression, pain, post-traumatic stress disorder, symptoms cluster

DIII-D has four neutral beamlines (NB). Each of these beamlines has two ion sources, each of which injects up to 2.5 MW for 3 s. These beamlines intersect the vacuum vessel at an angle of 19.5 deg off from radial, enabling current drive in the same direction as the plasma current (co-injection). In 2004, one of these beamlines (210 deg) was rotated to provide counter-injection (opposite of plasma current). A different beamline (150 deg) has been modified to have the capability to provide off-axis neutral beam current drive. The goal of the off-axis injection is to have the center of the ion sources aimed at a position 40 cm below the geometric center of the plasma. To achieve this off-axis injection, the beamline requires a mechanical lifting system that can elevate the beamline up to 16.5 deg from horizontal. The beamline also requires more strongly vertically focused ion sources (in order to pass the beam through a reduced effective aperture) as well as modified internal components. Additionally, the design of the new internal components incorporated modifications to allow for the doubling of ion source pulse lengths without the need for active cooling. This paper discusses the various beamline system design requirements for off-axis injection, as well as the results from the actual commissioning of the beamline. Overviews of the design and performance of mechanical lifting system (hydraulics and controls), focused ion sources, flexible beamline support systems (vacuum, cryogenic, power and water cooling), and internal beamline collimators are included. Additionally, the in-vessel monitoring and shine-through protection requirements are discussed. The actual data obtained during beamline commissioning and during normal physics operations is also presented. © 2011 IEEE.

Neutral beam current drive (NBCD) experiments in DIII-D using vertically shifted plasmas to move the current drive away from the axis have clearly demonstrated robust off-axis NBCD. Time-dependent measurements of magnetic field pitch angles by the motional Stark effect diagnostic are used to obtain the evolution of the poloidal magnetic flux, which indicates a broad off-axis NBCD profile with a peak at about half the plasma minor radius. In most cases, the measured off-axis NBCD profile is consistent with calculations using an orbit-following Monte Carlo code for the beam ion slowing down including finite-orbit effects provided there is no large-scale magnetohydrodynamic activity such as Alfv́n eigenmodes modes or sawteeth. An alternative analysis method shows good agreement between the measured pitch angles and those from simulations using transport-equilibrium codes. Two-dimensional image of Doppler-shifted fast ion Dα light emitted by neutralized energetic ions shows clear evidence for a hollow profile of beam ion density, consistent with classical beam ion slowing down. The magnitude of off-axis NBCD is sensitive to the alignment of the beam injection relative to the helical pitch of the magnetic field lines. If the signs of toroidal magnetic field and plasma current yield the proper helicity, both measurement and calculation indicate that the efficiency is as good as on-axis NBCD because the increased fraction of trapped electrons reduces the electron shielding of the injected ion current, in contrast with electron current drive schemes where the trapping of electrons degrades the efficiency. The measured off-axis NBCD increases approximately linearly with the injection power, although a modest amount of fast ion diffusion is needed to explain an observed difference in the NBCD profile between the measurement and the calculation at high injection power. © 2009 American Institute of Physics.

Modification of the two existing DIII-D neutral beamlines is planned to allow vertical steering to provide off-axis neutral beam current drive (NBCD) peaked as far off-axis as half the plasma minor radius. New calculations for a downward-steered beam indicate strong current drive with good localization off-axis so long as the toroidal magnetic field, BT, and the plasma current, Ip, point in the same direction. This is due to good alignment of neutral beam injection (NBI) with the local pitch of the magnetic field lines. This model has been tested experimentally on DIII-D by injecting equatorially mounted NBs into reduced size plasmas that are vertically displaced with respect to the vessel midplane. The existence of off-axis NBCD is evident in the changes seen in sawtooth behaviour in the internal inductance. By shifting the plasma upwards or downwards, or by changing the sign of the toroidal field, off-axis NBCD profiles measured with motional Stark effect data and internal loop voltage show a difference in amplitude (40-45%) consistent with differences predicted by the changed NBI alignment with respect to the helicity of the magnetic field lines. The effects of NBI direction relative to field line helicity can be large even in ITER: off-axis NBCD can be increased by more than 30% if the BT direction is reversed. Modification of the DIII-D NB system will strongly support scenario development for ITER and future tokamaks as well as provide flexible scientific tools for understanding transport, energetic particles and heating and current drive. © 2009 IAEA, Vienna.

The goals of DIII-D advanced tokamak (AT) experiments are investigation and optimization of the upper limits of energy confinement and MHD stability in a tokamak plasma, and simultaneous maximization of the fraction of non-inductive current drive. Significant overall progress has been made in the past two years, as the performance figure of merit βNH89P of 9 has been achieved in ELMing H mode for over 16τE without sawteeth. The tokamak was also operated at βNH ≈ 7 for over 35τE or 3τR, with the duration limited by the hardware. Real time feedback control of β (at 95% of the stability boundary), optimizing the plasma shape (e.g., δ, divertor strike and X points, double/single null balance) and particle control (ne/nGW ≈ 0.3, Zeff < 2.0) were necessary for the long pulse results. A new quiescent double barrier (QDB) regime with simultaneous inner and edge transport barriers and no ELMs has been discovered with a βNH89P of 7. The QDB regime has been obtained to date only with counter NBI. Further modification and control of internal transport barriers (ITBs) has also been demonstrated with impurity injection (broader barrier), pellets and ECH (strong electron barrier). The new Divertor-2000, a key ingredient in all these discharges, provides effective density, impurity and heat flux control in the high triangularity plasma shapes. Discharges at ne/nGW ≈ 1.4 have been obtained with gas puffing by maintaining the edge pedestal pressure; this operation is easier with Divertor-2000. We are developing several other tools required for AT operation, including real time feedback control of resistive wall modes with external coils and control of neoclassical tearing modes with ECCD.

The authors' data indicate that the L-mode to H-mode transition in the DIII-D tokamak is associated with the sudden reduction in anomalous, fluctuation-connected transport across the outer midplane of the plasma. In addition to the reduction in edge density and magnetic fluctuations observed at the transition, the edge radial electric field becomes more negative after the transition. They have determined the scaling of the H-mode power threshold with various plasma parameters; the roughly linear increase with plasma density and toroidal field are particularly significant. Control of the ELM frequency and duration by adjusting neutral beam input power has allowed us to produce H-mode plasmas with constant impurity levels and durations up to 5 s. Energy confinement time in ohmic H-mode plasmas and in deuterium H-mode plasmas with deuterium beam injection can exceed saturated ohmic confinement times by at least a factor of two. Energy confinement times above 0.3 s have been achieved in these beam-heated plasmas with plasma currents in the range of 2.0 to 2.5 MA. Local transport studies have shown that electron and ion thermal diffusivities and angular momentum diffusivity are comparable in magnitude and all decrease with increasing plasma current.

In this study, risk factors were identified to assess the impact of burnout on the health and daytime function of 412 female flight attendants from an international airline from 2017 to 2018 with convenience sampling. Data were obtained from self-administered questionnaires. Analysis of variance, Pearson's correlation analysis, and independent t-tests were used to assess the relationships between burnout and demographic and work-related factors. A structural equation model analysis was performed to assess the effect of burnout impact factors on mental health using the Brief Symptom Rating Scale, six common physical symptoms, and daytime dysfunction (a subscale of the Athens Insomnia Scale). The results showed a moderate level of burnout, as reported by 19.2 percent of the participants. Personal and work-related characteristics, including marital status and working hours, were not significantly associated with burnout. Smoking behavior was the only significant risk factor ( T  = -3.64). The impact model of burnout revealed a moderate direct effect of burnout on mental health symptoms (95 percent CI: 0.27, 0.47) and daytime dysfunction (95 percent CI: 0.04, 0.11) and a small direct effect on physical symptoms (95 percent CI: 0.28, 0.47). Our findings increase our understanding of the risk and impact factors related to burnout in female flight attendants.

Background: Fatigue in flight attendants is an important issue concerning flight safety and occupational health. It is well known that work-related factors and certain lifestyle habits can cause fatigue. But very few studies have focused on the difference between having work experience flight attendants and no flight experience trainees., Objective: The present study was performed to compare and investigate the relationships between fatigue and health-related lifestyle habits among flight attendants and trainees., Methods: A questionnaire-based cross-sectional study with convenience sampling was conducted. A total of 107 flight attendants and 109 trainees were recruited in an international airline. The research was using a self-developed health-related lifestyle habits questionnaire and the Checklist Individual Strength (CIS) scale. The relationships between health-related lifestyle habits and fatigue were examined by Pearson's chi-square test and Fisher's exact test. Logistic regression was used to identify factors predicting fatigue among flight attendants and trainees., Results: Nearly half of the participants had fatigue and poor health-related lifestyle habits. Logistic regression showed that trainees with sleeping hours less than 7 hours, had a higher probability of fatigue than those who sleep more than 7 hours. In addition, the flight attendants with an irregular sleep pattern, unbalanced diet, sedentary leisure-time, no use relaxation technique, and an exercise frequency below once a week had a higher probability of fatigue., Conclusion: The flight attendants' sleep patterns, diet, activity, and relaxation had a more significant impact on fatigue than trainees. Therefore, a healthy lifestyle is important in this population for good workplace performance.

Background: Sleep and mental health are very important in the aviation industry. Reports show that gender is one of the risk factors of insomnia, and most Asian flight attendants are female. Therefore, it is necessary to understand insomnia, and the correction to mental health among female flight attendants., Objective: To investigate the prevalence of insomnia in female flight attendants and its association with mental health., Methods: We used a cross-sectional design. We recruited 412 female flight attendants with more than 3 months of working experience. We collected the socio-demographic and work-related data, measured insomnia and mental health by the Athens Insomnia and Brief Symptom Rating Scales. Descriptive statistics, single-factor analysis of variance, Pearson's correlation analysis, and structural equation modeling were performed to analyze the relationships., Results: There are 45.4% of female flight attendants having insomnia, and 24.8% had suspicious insomnia. The most considerable and serious insomnia problem was falling asleep (15.3%, 4.9%). Factors related to insomnia include smoking, drinking, family load (e.g., housekeeping and caring for family), economic stress and late-night/early morning workdays during last month. Also, insomnia had a direct association with mental health (T = 17.11, p < 0.001)., Conclusion: We found that insomnia is negatively correlated with the above factors and mental health. We recommend that airline industries can run their sleep-education programs and provide relevant mental-health-promotion programs for flight attendants.

BACKGROUND: This study explored the impact of a fatigue management health education intervention (FMI) on flight attendants fatigue management knowledge, attitudes, behavioral intention, self-efficacy, and fatigue intensity. METHODS: A quasi-experimental pretest-posttest design was used. The sample included 70 flight attendants of an international airline company in Taiwan. The experimental group ( N 34) received an FMI, while the control group ( N 36) had no intervention. Fatigue management knowledge, attitude, behavior intention, self-efficacy, and fatigue intensity were assessed at baseline and 1 wk later. Single-factor analysis of covariance and Jensen Neman methods were used to assess the differences in outcomes between the two groups. RESULTS: Attitude and self-efficacy in the experimental group were significantly improved after the FMI [standardized mean difference (SMD), 0.96; 1.98]. The intervention also reduced their fatigue intensity (SMD 6.05) and both knowledge and behavioral intention scores were increased in more than 80% of subjects in the experimental group. DISCUSSION: FMI can effectively improve fatigue management knowledge, attitudes, behavioral intention, and self-efficacy and reduce fatigue intensity in flight attendants. Hu CJ, Lee FP, Hong RM. Fatigue management health education intervention effects on flight attendants . Aerosp Med Hum Perform. 2020; 91(12):911917.

BACKGROUND: Work ability is an important component of occupational health assessments and reflects how a persons' physical and mental health affect their ability to perform their job. However, little is known about factors relating to the work ability status of flight attendants. The aim of this study was to investigate the physical, mental, and work-related factors that affect flight attendants' work ability. METHODS : A questionnaire-based cross-sectional study and simple random sampling was conducted with participants employed at a Taiwan-based airline for longer than 1 yr. Analysis of variance and Pearson correlation tests were carried out to analyze work ability according to the flight attendants' social demographics, physical and mental health, and work-related factors. Multiple regression analysis was used to predict the flight attendants' work abilities. RESULTS: A total of 472 flight attendants were recruited and the response rate was 78.67%. The work ability of the flight attendants ranged from 'moderate' to 'excellent' (WAI score, 34.1 ± 1.8 to 45.1 ± 1.5). In a regression analysis, work ability was positively associated with gender, age, and good eating habits; in contrast, insomnia and work-related burnout were negatively associated with work ability (R² = 32.4%). DISCUSSION: Insomnia, work-related burnout, and eating habits had a significant impact on flight attendants' work abilities. Hence, it is important to address insomnia and high workloads and maintain a healthy lifestyle in the workplace. Hu C-J, Hong R-M, Yeh G-L, Hsieh I-C. Insomnia, work-related burnout, and eating habits affecting the work ability of flight attendants . Aerosp Med Hum Perform. 2019; 90(7):601-605.

Background: Cigarette smoking is a primary risk factor affecting mental and physical health worldwide. Many chronic diseases are closely related to smoking. Adolescents in Taiwan are increasingly using tobacco, especially in rural areas., Objectives: This research project used a mixed-method study to examine the effects of art therapy on smoking cessation in rural Taiwanese youth smokers., Methods: Participants from years 10-11, were drawn from three senior high schools in Taiwan. The experimental group participated in a six-week smoking cessation intervention using art therapy. The comparison group participated in typical courses on smoking cessation. Quantitative measures included need for smoking, nicotine dependence, self-esteem, self-efficacy, and smoking cessation status. Qualitative analysis was based on phenomenology., Results: A total of 66 students (n = 40 experimental group; n = 26 comparison group) were the subjects of quantitative analysis. No differences were noted in baseline characteristics of groups. Generalized estimating equation analyses suggested significant between-group differences in change from pre- to follow-up test scores in the "social domain" (B = -5.12, p < 0.05). Qualitative data (n = 17 experimental group; n = 10 control group) suggested three domains: effects of art therapy on smoking prevention, benefits of art therapy on other outcome measures, and comparison between art therapy and traditional smoking cessation programs. Conclusions/importance: The findings of this study can potentially contribute significantly to existing knowledge regarding the perceptions of art therapy on reoccurring tobacco use in Taiwanese youth.

Most smokers start young. Initiation of cigarette smoking at an earlier age leads to more life-years for tobacco use, makes quitting harder, and increases the risk of serious health consequences. Despite these challenges, research focusing on smoking behavior among adolescent boys in Taiwan is rare. Although the Taiwanese government enacted the Tobacco Hazards Prevention Act in 2009, aimed at prevention and reducing the rate of smoking, the percentage of high school students who smoke has continued to increase. In 2006, 7.5% of adolescent boys engaged in smoking. By 2012 the rate had increased to 24.6%. This paper explores the experiences that contribute to adolescent Taiwanese boys making the decision to smoke. A phenomenological approach to inquiry was used as the philosophical foundations for this study with twelve adolescent boys who engaged in smoking behaviors. Data was gathered through two face-to-face semi-structured interviews and a focus group. Data analysis was performed using Colaizzi's analysis method. Findings indicated that decisions to begin smoking were motivated by curiosity and as a means of establishing friendships while decisions to continue smoking were linked to the addictive nature of smoking and as a means of coping with stress and passing the time. The findings can be used to inform the prevention of tobacco use and to reduce the high smoking rates among adolescent boys.

Background: Oral cancer is the 2nd most common cause of death due to cancer in the south-western coastal region of Taiwan; the standardized mortality of oral cancer is higher than elsewhere in the world. According to the evidence, alcohol, betel-nut and cigarette (ABC) consumption cause oral, nasopharyngeal and related cancers. This study describes the relationships between ABC consumers and health promoting behaviors among community adults living around an area with a high prevalence of oral cancer., Methods: A population-based, cross-sectional study design was conducted in oral cancer epidemic areas in south-western coastal Taiwan in 2010, 6,203 community residents over 20 years of age participated. Demographic data, ABC habits, and health-promoting behaviors were explored. A logistic regression analyses were used to identify factors associated with ABC consumers., Results: A high percentage of participants consumed alcohol, betel-nut and cigarettes. Betel-nut and cigarette consumers took low levels of exercise, adopted a poor diet, and had poor oral hygiene. After adjusting for potential confounders, the logistic regression model indicated that middle aged males of poor education and low economic status, who did not exercise regularly and had poor oral hygiene, were more likely to chew betel quid and smoke cigarettes., Conclusions: It has identified that BC consumers are negatively associated with health promoting behaviors. Further research is required to understand the reasons why the subjects consume ABC, and explore ways to prevent initiation and enhance cessation of ABC habits in this population.

The lived experiences of being resilient as described by 13 single Taiwanese mothers after divorce was the focus of this study. A descriptive phenomenological approach to inquiry was the theoretical framework underpinning the study. Information was gathered through two in-depth face-to-face digitally recorded interviews with each participant. Each of the participants had suffered from depression. For the analysis of the participants' transcripts of interview the authors used Colaizzi's method. Four themes emerged from the analysis process: having faith in God, bending with the ebb and flow of daily life, finding strength in the support and friendship of others, and new found freedom and hope for the future. Findings of this study have the potential to enhance understanding of the mental health needs of single mothers and their children in the provision of holistic health care delivery.

N-Ethylmaleimide-sensitive factor (NSF) mediates docking and/or fusion of transport vesicles in the multi-pathways of vesicular transport. NSF was highly expressed in brain and adrenal gland. Immunostaining of cerebellum with an anti-NSF monoclonal antibody showed that NSF is predominantly localized in the molecular layers and the glomeruli of the granule cell layers. This distribution coincided well with that of synaptophysin, a marker protein of synaptic vesicles. Purification and immunoprecipitation revealed that NSF is associated with brain synaptic vesicles. The present results suggest that NSF is associated with synaptic vesicles without Ca2+ influx.

N-Ethylmaleimide-sensitive factor (NSF) was originally characterized as the protein that restores in vitro protein transport activity of the Golgi membranes inactivated by N-ethylmaleimide. This protein has two homologous regions, each containing the consensus sequence for nucleotide binding, and possesses ATPase activity. To investigate the role of the two nucleotide-binding regions in NSF, we have replaced two lysyl residues (Lys-274 and Lys-557) located in the consensus sequences with glutamine or methionine via site-directed mutagenesis. The mutant NSF proteins in which Lys-274 was replaced had no ability to restore protein transport between N-ethylmaleimide-treated Golgi membranes and, in addition, inhibited the protein transport assay using normal Golgi membranes. This inhibition, which was eliminated by N-ethylmaleimide treatment, was caused by the impairment of the function of donor Golgi membranes. Although wild-type NSF showed a protective effect against inhibition by the Lys-274 mutant NSF protein when added at the start of the protein transport assay, its protective effect diminished after the time for the formation of transport vesicles had passed. These results support the idea that NSF incorporated into transport vesicles is nonexchangeable for exogenously added NSF. On the other hand, the mutant proteins in which Lys-557 was replaced had slight but significant protein transport activity. They did not inhibit the protein transport assay using normal Golgi membranes. The mutant NSF proteins in which Lys-274 and Lys-557 were replaced had about 20 and 25% of the ATPase activities of wild-type NSF, respectively. Their ATPase activities were sensitive to N-ethylmaleimide and dependent on their protein concentrations, as observed in wild-type NSF.