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The imbalance between supply and demand for organs has been a global crisis, despite the efforts of transplant coordinators from healthcare institutions to promote donor registration. Because the patient’s family has legal rights over the patient’s remains, they can easily undermine any efforts spent on organ procurement by simply refusing the patient’s consent before death in practice. Most related studies seldom mention the decision-making on organ donation from patients’ families. The objectives of this study are to find what are the priorities of those factors acting as the pillars of organ donation by patients’ families. This study applied the analytic network process (ANP) to the prioritization factors contributing toward the willingness of families to donate organs of intensive care unit patients. The purposive sampling method used structured questionnaires and ANP questionnaires to enroll 180 patients’ families from five intensive care units who met the criteria in the regional teaching hospital of southern Taiwan. Through the ANP analysis, it was found that when family members made organ donation decisions, the weights of the four domains are as follows: psychology—47.6%, externality—20.3%, spirituality—19.7%, and physiology—12.3%. The main decision-making factors that influenced the weighting factors were “attitude” (31.5%), “physician’s experience” (0.88%), “religion” (19.3%), and “organ selection” (31.9%). These results could assist organ donation teams to take the best strategies for persuading people to agree with organ donation and formulating an individual organ donation plan.

Text-mining algorithms can identify the most prevalent factors of risk-benefit assessment on the use of complementary and integrative health approaches that are found in healthcare professionals' written notes. The aims of this study were to discover the key factors of decision-making on patients' complementary and integrative health use by healthcare professionals and to build a consensus-derived decision algorithm on the benefit-risk assessment of complementary and integrative health use in diabetes. The retrospective study of an archival dataset used a text-mining method designed to extract and analyze unstructured textual data from healthcare professionals' responses. The techniques of classification, clustering, and extraction were performed with 1398 unstructured clinical notes made by healthcare professionals between 2019 and 2020. The most important factor for decision-making by healthcare professionals about complementary and integrative health use in patients with diabetes was the ingredients of the product. Other important factors were the patient's diabetes control, the undesirable effects from complementary and integrative health, evidence-based complementary and integrative health, medical laboratory data, and the product's affordability. This exploratory text-mining study provides insight into how healthcare professionals decide complementary and integrative health use for patients with diabetes after a risk-benefit assessment from clinical narrative notes.

This study aimed to develop consensus on a decision-making algorithm for benefit-risk assessment of complementary and alternative medicine use in people with diabetes. Delphi-analytic hierarchy process was used with an anonymous voting scheme, based on a three-round procedure, to achieve consensus regarding the important criteria of decision-making algorithm to assess the benefit-risk ratio of complementary and alternative medicine use in people with diabetes. A total of five criteria were considered, namely, the safety of usage (weightage: 46.6%), diabetes-specific patient data (14.6%), complementary and alternative medicine attributes (14.2%), institutional culture in complementary and alternative medicine use (12.8%), and applicability of complementary and alternative medicine (11.8%). The consistency of this hierarchy structure was computed based on the following indices: λmax = 5.041, consistency index = 0.01; random consistency index =1.781; and consistency ratio = 0.009. All criteria to optimize decision-making in ensuring safe use of complementary and alternative medicine in patients with diabetes should be considered by healthcare professionals.

This study was used to lift nets and trap net fishing at intertidal zone of lagoon and estuarine regions of southern Taiwan. From July 2013 to July 2018, a total 420 specimens of Pisodonophis were analyzed, the average total body length (TL) and average body weight (W) of P. boro eels are 68.4 ± 11.9 cm and 140.4 ± 86.1 g (N = 194), respectively. Typically, P. cancrivorus eels are smaller (TL = 52.8 ± 9.2 cm) and lighter (W = 107.9 ± 73.7 g [N = 119]) than P. boro eels. The natural logarithmic linear relationships between the TL and W of P. boro and P. cancrivorus are respectively expressed as ln(W)b = 2.4405 ln(TL) − 5.4448 (R2 = 0.796, N = 194) and ln(W)c = 3.2168 ln(TL) − 8.2027, (R2 = 0.934, N= 119). P. cancrivorus typically preys on shrimp, crab, and fish; lab assessment revealed that the frequencies of occurrence of these foods in their guts were 49%, 21%, and 15%, respectively (N = 100). The main catch months of P. boro were during the rainy season, and that of P. cancrivorus were the winter season in Taiwan. The average W values of P. boro from Jhuoshuei and Puzih estuaries were 343.2 ± 218.8 g (N = 91) and 140.4 ± 86.1 g (N = 194), respectively. Furthermore, the results of the study revealed that the Puzih estuary is overfished. We suggest that fishery management units should develop some protection measures for the conservation of aquatic ecosystems in estuarine regions. For example, the P. boro weighing less than 113 g will be released back to the estuary.

Purpose: This study aimed to use two different taping directions on the gastrocnemius muscle, the most important muscle for stance stability, to further investigate the effect of different taping directions on overall balance and sensation systems before versus after muscle fatigue.Methods: The participants were 45 healthy athletes who random control method was divided into 3 groups: Placebo taping group (PTG), Facilitation KT group (FKTG), and Inhabitation KT group (IKTG). The neuromuscular balance ability and sensory function test were before versus after muscle fatigue.Results: The two-point discrimination sensitivity of the facilitation taping group was significantly higher than that of the placebo taping group. The eyes open swaying distance of the inhibition taping group was significantly greater than that of the placebo taping group before taping, after taping, and after fatigue from exercise. The swaying speed was also significantly higher in the inhibition taping group than in the placebo and facilitation taping groups. When the participants stood barefoot on one foot with the eyes closed, no significant differences were noted among groups. When standing on a soft cushion on one foot with the eyes open, significant differences were noted between the inhibition taping group and both the placebo and facilitation taping groups before taping, after taping, and after fatigue from exercise . When standing on a soft cushion on one foot with the eyes closed, there were significant differences in the duration of standing among the three groups before taping and after fatigue from exercise.Conclusion: The results of the present study show that muscle taping effectively improves athletes’ proprioception. Therefore, muscle taping during exercise can help to increase the balance of, improve the performance of, and prevent ankle sprains in athletes.

Supportive care is a primary method for treating dengue fever. Understanding the symptoms of dengue fever and its related nursing diagnosis is crucial for nurses as references for individual care. This research study was motivated by the few literature reviews available on this topic.This study was developed to elucidate the symptoms experienced by hospitalized patients with dengue fever and to compare the consistency between symptoms and nursing diagnoses.A retrospective descriptive research method was employed. The data were collected from the electronic medical records of patients in the data pools of two regional hospitals in Kaohsiung City. A total of 105 patient records were acquired covering the period 2014-2016. IBM SPSS Statistics v22 was used to examine the descriptive statistics of patient attributes and symptoms of dengue fever using averages and percentages and the inferential statistics of symptoms, hospitalization days, and nursing diagnosis using the Chi-square test and Kappa consistency coefficient.The average age of inpatients was 51.0 ± 27.3 years and the average length of hospital stays was 6.1 ± 3.6 days. The common symptoms were fever and headache. The consistency between nursing diagnosis and symptoms ranged up to 45.4%, including hyperthermia, acute pain, nausea, risk of ineffective gastrointestinal perfusion, and risk of bleeding. Inconsistency of nursing diagnosis was found to be 27.3%, including anxiety, deficient fluid volume, and risk of falls. The rate of undiagnosed symptoms was found to be 27.3%, including diarrhea, risk of infection, and impaired oral mucous membrane.The reasons for the inconsistency between symptoms and nursing diagnoses may relate to insufficient nursing knowledge of dengue fever and inadequate nursing diagnosis education resulting in insufficient clinical experience / poor judgment amongst nursing staff. The findings of this study suggest the need for continuity of education to make the use of a dengue-fever-symptom checklist more widespread in patient care.登革熱住院病人症狀與護理診斷之相關研究.登革熱臨床處置以支持性療法為主，了解症狀及所需護理診斷可作為護理人員提供個別性照護的參考，但目前無相關研究，故進行本研究。.了解登革熱住院病人的症狀，並探討與護理診斷之一致性。.採回溯性描述性研究設計，資料庫為高雄兩家區域醫院符合疾病診斷碼之住院病人電子病歷，於2014年至2016年間共萃取105位病人資料。運用IBM SPSS Statistics v22，以平均數、百分比進行病人屬性及登革熱症狀之描述性統計，以卡方檢定及Kappa一致性係數進行症狀與住院天數、護理診斷之推論性統計。.住院病人平均51.0 ± 27.3歲，平均住院6.1 ± 3.6天，常見症狀為發燒及頭痛；分析護理診斷與症狀之一致性達45.4%，含體溫過高、急性疼痛、噁心、潛在危險性胃腸灌流失效、潛在危險性出血；無一致性佔27.3%：焦慮、體液容積缺失、潛在危險性跌倒；有症狀卻無護理診斷佔27.3%：腹瀉、潛在危險性感染、口腔黏膜障礙。.臨床症狀與護理診斷不符之可能原因是對登革熱及護理診斷教育不足，導致護理人員在臨床上缺乏經驗或判斷力，建議加強繼續教育並善用「登革熱症狀查檢表」，以提供個別性照護。.

Simulation-based learning that focuses on the development and assessment of communication and counseling skills can help nursing students achieve better skill performance and gain self-confidence with decision-making ability. It is unknown whether virtual simulation as an instructional design significantly improves educational outcomes than a traditional lecture with low-fidelity simulation in students.The aim was to explore the effect of a virtual simulation-based educational smartphone application on nursing students' beliefs and self-efficacy in communicating with patients about complementary and alternative medicine (CAM) use.A quasi-experimental study with pretest-posttest nonequivalent control group design.A total of 101 nursing students, who were in their second or third-year nursing program at a Southern Taiwan university volunteered to participate in the academic year 2020-2021. Participants were assigned to an experimental or control group in an elective course.All participants received a 4-hour lecture that included an in-class lecture with low-fidelity simulation (paper-based scenarios) about the risk-benefit assessment of a patient's CAM use. The experimental group received a series of 13 virtual simulation exercises with clinical scenarios by means of a smartphone application. Data from belief and self-efficacy scales were collected at the beginning and end of the course from September 2020 to February 2021. Descriptive and inferential statistics were analyzed using the IBM® SPSS® version 23.0.Although both groups significantly improved their belief and self-efficacy scale scores, the experimental group had significant differences in overall self-efficacy in communicating with patients about CAM use compared with the control group, specifically the CAM perceptions and self-confidence scores.Although both in-class and virtual simulation improved nursing students' belief and self-efficacy, the virtual simulation-based educational app is effective as an adjunct learning tool in significantly increasing nursing students' self-efficacy in communicating with patients about CAM use to help minimize their risks.

Background and Objectives: Sleeper stretching (SS) can improve the shoulder&rsquo, s range of motion (ROM) for pitchers with glenohumeral internal rotation deficit (GIRD). However, no evidence has proven the effect of Kinesio taping (KT) on shoulder strength and ROM. Therefore, this study compared the effects of SS and KT on shoulder rotation ROM, muscle strength, and sub-acromial distance in pitchers with GIRD. Materials and Methods: Thirty-one pitchers with GIRD were allocated into control, KT, and SS groups. Shoulder rotation ROM, muscle strength, and sub-acromial space were measured before and after treatment with SS or KT. Results: The results revealed that KT and SS significantly enhanced shoulder rotation ROM in pitchers with GIRD. External rotator strength significantly increased following KT but significantly decreased after SS. KT and SS exerted no effects on the sub-acromial space. Conclusions: KT and SS improve shoulder rotation ROM in pitchers with GIRD. In addition, KT improves shoulder external rotator strength, and SS reduces it.

Background and objectives: Faced with the serious problem of an aging population, exercise is one of the most effective ways to maintain the health of the elderly. In recent years, with the popularization of smartphones, the elderly have increasingly accepted technological products that incorporate artificial intelligence (AI). However, there is not much research on using artificial intelligence bracelets to enhance elders&rsquo, motivation and participation in exercise. Therefore, the purpose of this study is to evaluate the effectiveness of the combination of sports smart bracelets and multi-sport training programs on the motivation of the elderly in Macau. Materials and Methods: The study was conducted with a randomized trial design in a 12 week multi-sport exercise training intervention. According to the evaluation, a total of sixty elders&rsquo, pre- and post-test data were included in this study. Results: After 12 weeks of multi-sport exercise training, the evaluation scores on the exercise motivation scale (EMS) increased significantly in the group wearing exercise bracelets and those taking part in the multi-component exercise program, and the degree of progress reached a statistically significant level, but the control group did not show any statistically significant difference. The influence of the combination of sports smart bracelets and multi-sport training programs on elders&rsquo, motivation is clearer. Conclusions: The use of sports smart bracelets by elderly people in conjunction with diverse exercise training can effectively enhance elders&rsquo, motivation and increase their participation in regular exercise. The combination of sports smart bracelets and multi-sport training programs is worth promoting in the elderly population.

Background The use of virtual simulation methods in nursing education offers potential advantages for students to experience and learn in a safe and realistic environment by acquiring skills and attitudes to prepare for clinical experiences. Objective The study's aim was to test the hypothesis that nursing students who used a mobile learning app would have significantly (1) higher levels of knowledge about medication administration and nasotracheal suctioning, (2) better development of skill performances on medication administration and nasotracheal suctioning, (3) higher satisfaction, and (4) lower cognitive load than a control group. Design A randomized experimental study with pretest and posttest design. Settings and participants One hundred nursing students were randomly assigned to an experimental or control group at a Southern Taiwan university's school of nursing. Methods The experimental group received the virtual simulation-based mobile learning app and the control group used traditional paper materials. Participants were assessed on knowledge before and after the intervention. Skill performance and intrinsic and extraneous cognitive load were measured after the intervention. Results The experimental group who used the mobile app had significantly higher knowledge scores, significantly lower intrinsic and extraneous cognitive load, better skill performance, and higher satisfaction than the control group. Conclusions The implementation of a mobile app for simulation learning had a positive impact on nursing students’ knowledge and skill performances as well as the reduction of learning cognitive loading. Nurse educators and researchers should collaborate in developing virtual learning resources to support clinical nursing education. Tweetable abstract: The mobile app for learning achieved higher knowledge and satisfaction scores, demonstrated better skill performance without increasing cognitive load.

Background Conventional healthcare professionals have insufficient knowledge about complementary/alternative medicine (CAM) and often lack competencies to overcome attitudinal barriers to communicate effectively with patients about CAM. Interacting with a virtual simulation-based educational application program may help nurses learn current evidence and acquire communication skills when consulting with patients. Objectives The aim of this pilot study was to evaluate nurses' attitudes towards patients' CAM use and their competency in communicating with patients about CAM after interacting with a virtual simulation-based educational app. Design A quasi-experimental study with one-group, pretest-posttest design. Methods A total of 49 nurses volunteered to participate in the study. Participants interacted with a virtual simulation software app on a smartphone that included audiovisual presentations about CAM, 13 exercises, and a risk-benefit decision assessment. Data about nurses' attitudes and communication competency were collected at baseline and after completing the 13 exercises. Descriptive and comparative statistics were analyzed using the IBM® SPSS® version 22.0. Results Both the nurses' attitudes about patients' CAM use and communication competency improved significantly following the completion of the 13 exercises. The risk-benefit decision scores correlated significantly with the increase in nurses' attitudes and their communication competency. Conclusions Using a virtual simulation-based educational app may help nurses not only increase their attitudes towards CAM but also increase their communication competency in consulting with patients about CAM use.

The Gulf of Maine northern shrimp Pandalus borealis population once supported a significant commercial winter fishery for the New England states. However, the fishery has been on moratorium since 2014 due to consecutive recruitment failures. The issue of parasite-infected eggs, so-called ‘white eggs,’ has long been identified for the Gulf of Maine northern shrimp, which makes shrimp eggs nonviable and subsequently hampers the recruitment potential. Furthermore, the proportion of infected females was observed to increase with water temperature. As Gulf of Maine temperatures have been increasing for decades, it is important to re-visit issues related to white eggs to evaluate possible impacts of climate-induced environmental changes on the white egg infection rates. We used biological samples collected by the Northeast Fisheries Science Center in 2012-2016 to evaluate the probability that a female shrimp was infected (Pinf) and the proportion of white eggs in an infected female shrimp (pwe). Although Pinf was high, with an average of 73.81% over the Gulf of Maine, pwe was mostly inf and pwe examined in this study was not well explained by environmental factors or female body size. However, the average rates of both Pinf and pwe observed in this study were higher than those observed in the 1960s when the bottom temperatures were cooler. The results can be used to account for egg mortality and provide information on potential impacts of possible climate-induced variability on shrimp population dynamics.

Nonalcoholic fatty liver disease (NAFLD) is a very common liver disease, and its incidence has significantly increased worldwide. The liver X receptor α (LXRα) is a multifunctional nuclear receptor that controls lipid homeostasis. Inhibition of LXRα transactivation may be beneficial for NAFLD and hyperlipidemia treatment. Ursolic acid (UA) is a plant triterpenoid with many beneficial effects; however, the mechanism of its action on LXRα remains elusive. We evaluated the effects of UA on T0901317 (T090)-induced LXRα activation and steatosis. UA significantly decreased the LXR response element and sterol regulatory element-binding protein-1c ( SREBP-1c) gene promoter activities, mRNA, protein expression of LXRα target genes, and hepatic cellular lipid content in a T090-induced mouse model. A molecular docking study indicated that UA bound competitively with T090 at the LXRα ligand binding domain. UA stimulated AMP-activated protein kinase (AMPK) phosphorylation in hepatic cells and increased corepressor, small heterodimer partner-interacting leucine zipper protein (SMILE) but decreased coactivator, steroid receptor coactivator-1 (SRC-1) recruitment to the SREBP-1c promoter region. In contrast, UA induced SRC-1 binding but decreased SMILE binding to reverse cholesterol transport-related gene promoters in intestinal cells, increasing lipid excretion from intestinal cells. Additionally, UA reduced valproate-induced LXRα mediated and rifampin-induced pregnane X receptor mediated lipogenesis, offering potential treatments for drug-induced hepatic steatosis. Thus, UA displays liver specificity and can be selectively repressed while RCT stimulation by LXRα is preserved and enhanced. This is a novel therapeutic option to treat NAFLD and may be helpful in developing LXR agonists to prevent atherosclerosis.

Liver X receptor α (LXRα) controls important biological and pathophysiological processes such as lipid homeostasis. Inhibiting LXRα transactivation may beneficial in the treatment of nonalcoholic fatty liver disease (NAFLD), which is one of the main causes of liver diseases and hyperlipidemia. Oleanolic acid (OA) is a naturally occurring triterpenoid found in many plants. It has several beneficial effects on biological pathways; however, the mechanisms underlying its effects on LXRα are unclear. Therefore, we evaluated the effects of OA on T0901317-induced LXRα activation and explored whether OA can attenuate hepatic lipogenesis. The results showed that OA significantly decreased the promoter activities of LXR response element and sterol regulatory element binding protein-1c (SREBP-1c). It also decreased the mRNA and protein expression of LXRα target genes. These resulted in reduced hepatocellular lipid content. Our results also revealed that the overall binding pose of OA is similar to the X-ray pose of T0901317. Furthermore, OA stimulated AMP-activated protein kinase phosphorylation in hepatic cells. Additionally, it increased small heterodimer partner-interacting leucine zipper protein (SMILE) but decreased steroid receptor coactivator-1 (SRC-1) recruitment to the SREBP-1c promoter region. OA also enhanced LXRα-mediated induction of reverse cholesterol transport (RCT)-related gene, ATP-binding cassette transporter (ABC) A1, and ABCG1 expression in intestinal cells. It was found that OA increased the binding of SRC-1 but decreased SMILE recruitment to the ABCG1 gene promoter region. Furthermore, it reduced valproate- and rifampin-induced LXRα- and pregnane X receptor-mediated lipogenesis, respectively, which indicates its potential benefit in treating drug-induced hepatic steatosis. The results also show that OA is liver-specific and can be selectively repressed of lipogenesis. Moreover, it preserves and enhances LXRα-induced RCT stimulation. The results show that OA may be a promising treatment for NAFLD. Additionally, it can be used in the development of LXRα agonists to prevent atherosclerosis.

This study investigated the effects of rowing with different seat cushion and cadence conditions on oxyhemoglobin (O2Hb) and total hemoglobin (tHb) levels of the erector spinae (ES) as well as the effects on heart rate (HR) and ratings of perceived exertion (RPE). Thirty healthy adults completed tests under three unstable air seat cushion pressure levels (0, 80, and 140 mmHg) and three rowing cadences (slow: 18 bpm, medium: 30 bpm, and fast: 36 bpm) on a rowing machine, for a total of nine test conditions. During the exercise period, rowing on cushions set to 80 mmHg resulted in greater O2Hb and tHb changes than did rowing at 0 mmHg (p &lt, 0.05). When rowing cadence increased, the O2Hb and tHb decreased during the exercise period, whereas HR and RPE increased (p &lt, 0.05). During the recovery period, O2Hb and tHb on cushions set to 140 mmHg during slow rowing were higher than those at 0 mmHg during slow rowing and 140 mmHg during fast rowing (p &lt, 0.05). Rowing on an appropriate pressure of seat cushion and using a slow cadence contribute to increasing muscle oxygenation of low back during exercise.

Background Interactions between transcriptional inducers of cytochrome P450 (CYP450) enzymes and therapeutic drugs may be prevented by antagonizing the activation of a nuclear receptor (NR), pregnane X receptor (PXR, NR1I2), thus improving therapeutic efficacy. Purpose In the present study, we aim to identify that ursolic acid (UA), a widely distributed pentacyclic triterpene, may act as an effective antagonist of PXR and its sister NR receptor, constitutive androstane receptor (CAR, NR1I3). Methods The hepatocellular carcinoma cell line, HepG2, was used to evaluate the promoter activity of PXR and CAR target genes, CYP3A4 and CYP2B6, respectively. Catalytic activities, mRNA, and protein expression of CYP3A4 and CYP2B6 were evaluated in a differentiated HepaRG cell line. Coregulation of PXR with coregulators on CYP3A4 promoter response elements was also been characterized. Results Transient transfection assays showed that UA effectively attenuated CYP3A4 and CYP2B6 promoter activities mediated by rifampin (RIF, human PXR agonist) and CITCO (human CAR agonist). These inhibitory effects were well correlated with the expression and catalytic activities of CYP3A4 and CYP2B6. Furthermore, the interaction of co-regulators with PXR and the transcriptional complexes in the CYP3A4 promoter activity and CYP3A4 promoter xenobiotic response element (everted repeat 6, ER6), respectively, were disrupted in the presence of UA. UA showed an antagonistic effect against PXR, and reversed the cytotoxic effects of isoniazid (INH) induced by RIF. Taken together, these results show that UA inhibits the transactivation effects of PXR and CAR, and reduces the expression and function of CYP3A4 and CYP2B6. Conclusion The present study suggests that UA could be a powerful agent for reducing potentially dangerous interactions between transcriptional inducers of CYP enzymes and therapeutic drugs.

Length and mass data for 1260 (536 females, 683 males, 41 sex unknown) striped marlin Kajikia audax were collected at the fish markets of Tungkang, Singkang and Nanfangao from July 2004 to September 2010. Of these samples, 534 gonads (236 females and 298 males) ranging from 95 to 206 cm in eye-to-fork length (LEF ) and 8 to 88 kg in round mass (MR ), were collected. Chi-square tests indicated sex ratios were homogeneous among months in 2004 and 2006-2008, but not in 2005, 2009 and 2010; and there were significant differences in sex ratio by size. The overall sex ratio (RS ) differed significantly from the expected 0·5. Kajikia audax are sexually dimorphic and the proportions of females increased with size between 140 and 210 cm LEF . Reproductive activity was assessed using a gonado-somatic index (IG ), external appearance of the gonads and histological examination and results indicated that the spawning season occurred from April to August with a peak in June to July. Based on histological observations and the distribution of oocyte diameters, K. audax are multiple spawners and their oocytes develop asynchronously. The estimated length-at-50% maturity (LEF50 ) was c. 181 cm (c. 4·8 years of age) for females. The proportion of reproductively active females in the spawning season with ovaries containing postovulatory follicles (0·27) indicated that they spawned every 3·7 days on average. The hydrated oocyte method estimated mean ± S.D. batch fecundity (FB ) to be 4·4 ± 2·02 million eggs; average relative fecundity was 53·6 ± 13·9 oocytes g-1 MR ; and the average annual fecundity was 181·3 ± 48·3 million eggs. The parameters estimated in this study are key information for stock assessments of K. audax in the north-western and central Pacific and will contribute to the conservation, management and sustainable yield of this species.

The gap between the expectation and the development of role competency is a dilemma that nurse practitioners (NPs) face in clinical settings.This study was designed to explore the perceived importance and actual practice of the role competencies of NPs and to compare the differences between the ideal and practical domains as well as related factors.This cross-sectional design study used Q-sort to collect data. A 56-item "Nurse Practitioner Role Capacity Questionnaire" was used as the research tool. Two questionnaires: Perceptions of Important Role Competencies and Actual Execution of Role Competencies were distributed to NPs twice, at times that were 2 weeks apart. A total of 40 participants were recruited, including 21(52.5%) internal medicine NPs and 19 (47.5%) surgical medicine NPs.The significant differences that were identified in this study between the perceived importance and actual practice of role competencies were, by domain: medical assistance (t = -5.62, p.001), clinical research (t = 4.14, p.001), professional consultation (t = 2.29, p = .027), and direct care (t = 2.21, p = .033). The correlative factors for these differences were: education level (t = -2.17, p = .036) and membership in the Nurse Practitioner Association (t = -2.36, p = .017). NPs with higher levels of education and with membership in the Nurse Practitioner Association earned higher scores for self-expectation in important clinical competency.NPs face discrepancies in their role expectations, in important part due to their role as providers of medical assistance in clinical practical settings. NPs need to learn and demonstrate the roles and functions of advanced nursing practice to enhance nursing professionalism profoundly.比較專科護理師自覺重要角色能力與實際執行角色能力之看法：以Q方法探討.專科護理師（nurse practitioner, NP）之進階護理角色在臨床期盼上仍有落差，導致NP自身對角色能力期待與發展產生困境。.本研究藉由調查NP角色能力之自覺重要性與實際執行現況，來探討理想與實務層面下的差異性及其影響因素。.以橫斷性研究設計，利用Q方法進行資料收集。測量工具以「專科護理師角色能力問卷量表」共56題，二個研究問題相隔二週做調查。研究對象共40名，含內科21位（52.5%）與外科19位（47.5%）。.NP自覺重要角色能力與實際執行角色能力有顯著差異的結構面有：醫療輔助（t = -5.62, p.001）、臨床研究（t = 4.14, p.001）、專業諮商 （t = 2.29, p = .027）及直接照護（t = 2.21, p = .033）。基本屬性中，在教育程度（t = -2.17, p = .036）與是否加入專科護理師學會（t = -2.36, p = .017）達顯著差異，顯示學歷愈高或具專科護理師會員者，對重要角色能力抱持高度自我期許。.專科護理師在面臨角色期望仍有不符，尤其在實務面極重在醫療輔助上，專科護理師需回歸及落實進階護理的角色與功能，以利護理專業之提升。.

Objectives This study aimed to develop and validate scales to assess attitudes towards patient’ s use of TCM (APUTCM) and to measure a communicative competence in TCM (CCTCM) among nurses. Methods The instrument development process was conducted from Sep 2013 to Jul 2014, using the following steps: 1) item development; 2) internal review and refinement; 3) face and content validation; 4) instrument administration to a development sample; and 5) evaluation of validity and reliability. A convenience sample was used to recruit registered and advanced practice nurses who worked in different regions throughout Taiwan. A total of 755 respondents completed the online questionnaire. Statistical analyses were performed using the software of SPSS Version 21.0 and Analysis of Moment Structures (AMOS) version 24.0. Results The scale-level indexes (S-CVI) of content validity for both scales were over 80%. The reliabilities for the 13-item APUTCM scale and for the five-item CCTCM scale were 0.88 and 0.84, respectively. The model suitability for both scales was assessed, and the findings revealed suitable parameters for all indicators: GFI = 0.954, AGFI = 0.932, CFI = 0.959, RMSEA = 0.62, and chi-square/df = 3.891 for APUTCM; and GFI = 0.992, AGFI = 0.969, CFI = 0.992, RMSEA = 0.63, and chi-square/df = 4.04 for CCTCM. The convergent and divergent validity of scores on both scales provided evidence in the expected direction. Conclusion This scale development study provides preliminary evidence that suggests that the 13-item APUTCM and the five-item CCTCM are reliable and valid scales for assessing attitudes toward patient’s TCM use and communicative competence in TCM.

Liver X receptor (LXR) is a nuclear receptor that regulates various biological processes, including de novo lipogenesis, cholesterol metabolism, and inflammation. Selective inhibition of LXR may aid the treatment of nonalcoholic fatty liver disease (NAFLD). Sesamin is a naturally occurring lignan in many dietary plants and has a wide range of beneficial effects on metabolism. The mechanism underlying sesamin action especially on the regulation of LXR remains elusive. Reporter assays, mRNA and protein expression, and in silico modeling were used to identify sesamin as an antagonist of LXRα. Sesamin was applied to the hepatic HepaRG and intestinal LS174T cells and showed that it markedly ameliorated lipid accumulation in the HepaRG cells, by reducing LXRα transactivation, inhibiting the expression of downstream target genes. This effect was associated with the stimulation of AMP-activated protein kinase (AMPK) signaling pathway, followed by decreased T0901317-LXRα-induced expression of SREBP-1c and its downstream target genes. Mechanistically, sesamin reduced the recruitment of SRC-1 but enhanced that of SMILE to the SREBP-1c promoter region under T0901317 treatment. It regulated the transcriptional control exerted by LXRα by influencing its interaction with coregulators and thus decreased mRNA and protein levels of genes downstream of LXRα and reduced lipid accumulation in hepatic cells. Additionally, sesamin reduced valproate- and rifampin-induced LXRα and pregnane X receptor (PXR) transactivation. This was associated with reduced expression of target genes and decreased lipid accumulation. Thus, sesamin is an antagonist of LXRα and PXR and suggests that it may alleviate drug-induced lipogenesis via the suppression of LXRα and PXR signaling.

Supplemental Digital Content is available in the text, Background: Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. Methods: The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. Results: The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ± 25.22 to 41.24 ± 21 48 (P = .015) in CAI group after medial wedge intervention. Conclusion: Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.