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Drug induced liver injury (DILI) or hepatotoxicity has been a hot issue to overcome on the safety and physiological function of liver, since it is known to have biochemical, cellular, immunological and molecular alterations in liver mainly induced by alcohol, chemicals, drugs, heavy metals and genetic factors. Recently efficient therapeutic and preventive strategies by some phytochemicals are of interest, targeting oxidative stress mediated hepatotoxicity alone or in combination with anticancer drugs.To assess DILI, the variety of in vitro and in vivo animal models have been developed mainly by using carbon tetrachloride (CCl4), d-Galactosamine, acetaminophen (APAP) and lipopolysaccharide (LPS). Also, the mechanisms on hepatotoxicity by several drugs and herbs have been explored in detail. Recent studies reveal that antioxidants including vitamins and some phytochemicals were reported to prevent against DILI.Antioxidant therapy with some phytochemicals is noteworthy, since oxidative stress is critically involved in DILI via production of chemically reactive oxygen species (ROS) or metabolites, impairment of mitochondrial respiratory chain, and induction of redox cycling.For efficient antioxidant therapy, DILI susceptibility, HLA genetic factors, biomarkers and pathogenesis implicated in hepatotoxicity should be further explored in association with oxidative stress mediated signaling, while more randomized preclinical and clinical trials are required with optimal safe doses of drugs and/or phytochemicals alone or in combination for efficient clinical practice along with development of advanced DILI diagnostic tools.

To assume that copyright just protects "expressions," (unlike "ideas" protected by patents), may be misleading because a particularly ordered procedure is also protected by copyright law. The procedure as well as the image of Park's Sweet Spot Theory require prior written permission from the original copyright holder for its use. Because this would stymie future generations from building further on this idea, I returned the theory-based patent to society so that prospective research and development will have no hindrances in the establishment of new knowledge/solutions in nursing science.

Though icariside E4 (IE4) is known to have anti-noceptive, anti-oxidant, anti-Alzheimer and anti-inflammatory effects, there was no evidence on the effect of IE4 on lipid metabolism so far. Hence, the hypolipogenic mechanism of IE4 was investigated in HepG2 hepatocellular carcinoma cells (HCCs) in association with MID1 Interacting Protein 1(MID1IP1) and AMPK signaling. Here, IE4 did not show any toxicity in HepG2 cells, but reduced lipid accumulation in HepG2 cells by Oil Red O staining. MID1IP1 depletion decreased the expression of SREBP-1c and fatty acid synthase (FASN) and induced phosphorylation of ACC in HepG2 cells. Indeed, IE4 activated phosphorylation of AMPK and ACC and inhibited the expression of MID1IP1 in HepG2 cells. Furthermore, IE4 suppressed the expression of SREBP-1c, liver X receptor-α (LXR), and FASN for de novo lipogenesis in HepG2 cells. Interestingly, AMPK inhibitor compound C reversed the ability of IE4 to reduce MID1IP1, SREBP-1c, and FASN and activate phosphorylation of AMPK/ACC in HepG2 cells, indicating the important role of AMPK/ACC signaling in IE4-induced hypolipogenic effect. Taken together, these findings suggest that IE4 has hypolipogenic potential in HepG2 cells via activation of AMPK and inhibition of MID1IP1 as a potent candidate for treatment of fatty liver disease.

Ethyl carbamate (EC) is a known carcinogen, and therefore its intake is regulated internationally. The objectives of this study were to compare the EC recovery yields under different liquid-liquid extraction (LLE) conditions and to investigate the optimum conditions of the aqueous two-phase system (ATPS) for EC extraction. Our results showed that for the LLE method, addition of 15% NaCl improved the EC yield by 15%, and dichloromethane as the extraction solvent showed a slightly higher yield (about 5%) than chloroform. However, there was little difference in the yield when mixing was performed using an ultrasonic bath compared to a vortex mixer. Using response surface methodology with central composite design to analyze the ATPS results, optimal extraction was found to occur at 21.5°C for 2.8 h in the sample containing 70% alcohol and 15% phosphate, showing a recovery yield of 75.64%. This information can be applied to alcoholic beverages and other fermented food products to analyze EC with better extraction methods, depending on the types of food.

Background Streptococcus mutans is a well-known oral pathogen that plays a critical role in the development of dental caries. Many studies have been directed to discover the chemical compounds present in natural products to inhibit the growth and biofilm formation activity of S. mutans. Thymus essential oils exhibit good inhibition on the growth and pathogenesis of S. mutans. However, details about the active compounds in Thymus essential oil and the inhibition mechanism still remain unclear. The aim of this study was to investigate the antimicrobial activity of 6 Thymus species (Three samples of Thymus vulgaris, two samples of Thymus zygis, and one sample of Thymus satureioides essential oils) on S. mutans, to identify the potential active components, and to reveal the underlying mechanism. Methods The composition of Thymus essential oils was analyzed by gas chromatography-mass spectrometry. And its antibacterial effect was evaluated based on the bacterial growth, acid production, biofilm formation and genetic expression of virulence factors by S. mutans. Potential active components of the Thymus essential oil were identified using molecular docking and correlation analysis. Results GC–MS analysis showed that the major components in the 6 Spain Thymus essential oils were linalool, α-terpineol, p-cymene, thymol and carvacrol. MIC and MBC analysis showed that 3 Thymus essential oils showed very sensitive antimicrobial activity, and were chosen for further analysis. The 3 Thymus essential oil exhibited a significant inhibitory effect on acid production, adherence and biofilm formation of S. mutans and the expression of virulence genes, such as brpA, gbpB, gtfB, gtfC, gtfD, vicR, spaP and relA. Correlation analysis showed that phenolic components, such as carvacrol and thymol, were positively related to DIZ value, which suggests that they are the potential antimicrobial components. Molecular docking between the Thymus essential oil components and virulence proteins also found that carvacrol and thymol exhibited strong binding affinity with functional domains of virulence genes. Conclusions Thymus essential oil showed significant inhibition against the growth and pathogenesis of S. mutans depending on their composition and concentration. And phenolic compounds, such as carvacrol and thymol, are the major active components. Thymus essential oil could be used in oral healthcare products as a potential anti-caries ingredient.

This paper describes preparing radiopure molybdenum trioxide powder enriched with Mo-100 isotope for the AMoRE-II experiment. AMoRE-II, the second phase of the AMoRE experiments, will search for the neutrinoless double-beta decay (0νDBD) of the 100Mo isotope using over 100 kg of 100Mo embedded in 200 kg of ultra-pure Li2100MoO4 bolometric crystals. Efficient purification technology was developed and adapted to purify 100MoO3 powder with a 5 kg per month production capacity. Based on the ICP-MS analysis of purified powder, the 232Th and 238U were reduced to 232Th and 238U decay chains, reporting upper limits of 228Ac and 228Th. The 226Ra activity was acceptable at 110 ± 30 μBq/kg. In the last 3 years, 100 kg of pure 100MoO3 powder was produced. The production yield for the final purified product was above 90%, while irrecoverable losses were under 1.5%, and all by-products could be recycled further.

Objective: This paper aims to spur thought-provoking practical debates on current nurse workforce staffing and scheduling systems in relation to a critical review of Ang and colleagues' (2018) article entitled "Nurse workforce scheduling in the emergency department: A sequential decision support system considering multiple objectives." Design: Discussion paper on a practical discourse in connection with the aforementioned published article. Discussion: Mathematical Programming (optimisation) (MP)-based nursing research has been published for nearly thirty years almost exclusively in industrial engineering or health business administration journals, demonstrating a widening gap between nursing research and practice. Nurse scientists' knowledge and skill of MP is insufficient, as are their interdisciplinary collaborations, setting back the advancement of nursing science. Above all, nurse scientists skilled in decision science are desperately needed for that analytic intellection which is rooted in the 'intrinsic nature and value of nursing care.' It is imperative that nurse scientists be well-prepared for the new age of the Fourth Industrial Revolution through both an education in MP and interdisciplinary collaboration with decision science experts in order to prevent potential stereotyped MP-based algorithm-driven destructive influences. Conclusions: The current global nursing shortage makes optimal nursing workforce staffing and scheduling more important. MP helps nurse executives and leaders to ensure the most efficient number of nurses with the most effective composition of nurse staffing at the right time for a reasonable cost. Nurse scientists urgently need to produce a new nursing knowledge base that is directly implementable in nursing practice. Impact Statement: Nurse scientists should take the leading role in producing the mathematical programming-integrated knowledge base that is directly implementable in practice.

Objective The study aimed to examine the relationship on attitudes toward suicide, frustrated interpersonal needs, and non-suicidal self-injury (NSSI) of the university students. Methods The participants included 175 university students. Data were analyzed using the SPSS PROCESS macro (Model 4). Results Depression showed a fully mediating effect on the relationship between one's attitude toward suicide and NSSI behaviors. Furthermore, depression showed a full mediating impact on the relationship between frustrated interpersonal needs and NSSI behaviors. Conclusions These findings indicate that suicidal attitudes and frustrated interpersonal needs should be considered significant factors for developing NSSI preventions and intervention among university students.

Ethyl carbamate (EC) has been identified as a possible human carcinogen belonging to Group 2A. EC is naturally formed during the fermentation and storage of alcoholic drinks and fermented foods. When ingested in large amounts, EC can cause various health problems, such as gastroenteric hemorrhage, vomiting, and cancer. In this study, optimization of EC formation from cyanate was examined using response surface methodology (RSM), a central composite design that includes variables such as alcohol concentration (10, 15, 20, 25, and 30%), pH (2.5, 3.0, 3.5, 4.0, and 4.5), storage temperature (5, 10, 15, 20, and 25°C), and storage duration (2, 4, 6, 8, and 10 days). EC content was determined using gas chromatography with flame ionization detection and the results were optimized using RSM. EC formation from cyanate degradation was found to increase with storage duration and temperature, acidity, and alcohol concentration. Cy-anate degradation was associated with the formation of EC. Approximately 83.1±0.1% of cyanate was degraded to 538±9 μM of EC. However, not all of the cyanate reacted with ethanol during fermentation to form EC. This study aimed to develop the ideal conditions for EC analysis to reduce EC production in alcoholic drinks and fermented foods.

Aim: This study evaluated the clinical implication of KRAS proto-oncogene, GTPase (KRAS) mutation variants in patients with resected colon cancer (CC). Patients and Methods: We retrospectively reviewed 482 patients diagnosed with CC who underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The inclusion criteria were: Pathologically diagnosed with primary CC; stage I-III CC according to the 7th edition of American Joint Committee on Cancer staging system; and with available test results for KRAS mutation status. In total, 345 patients met these criteria and were included in this study. Results: Among the 345 patients, 140 (40.6%) exhibited KRAS mutations, with their incidences as follows: 90/140 (64.3%) in exon 2 codon 12, 37/140 (26.4%) in exon 2 codon 13, 1/140 (0.1%) in exon 3 codon 59, 7/140 (5.0%) in exon 3 codon 61, and 5/140 (3.6%) in exon 4 codon 146. KRAS mutation status was not a significant prognostic factor for disease-free survival or overall survival. Although there were no significant differences in survival between patients with exon 2 codon 12 and exon 2 codon 13 mutations, poorer disease-free survival (p=0.085) and overall survival (p=0.005) were seen in those with exon 3 codon 61 mutation than in others. Conclusion: KRAS mutation status was not correlated with survival, but exon 3 codon 61 mutation might be a factor for poor prognosis in patients after resection of CC.

There have been discussions suggesting an ethics committee be established which would oversee humanity’s efforts in Artificial Intelligence (AI) and its applications to our society. This concern arises mostly because of the limitations of existing data used for the development of AI algorithms that intrinsically reflect unfair and discriminatory factors of the real world in which we live. However, it is hard to find a paper that philosophically addresses a pedagogical issue about the necessary shift from strict teaching to informative guidance: i.e., a conversation about developing the discernment and critical thinking skills which would allow people who use AI-integrated services to themselves monitor the AI’s ethical applications and thus secure the well-being of our society. This paper is differentiated from other papers in that it sheds light on the social problems that can arise if people become uncritically compliant with unethical and indiscriminate applications of AI, and it conveys the lesson that contemporary ordinary citizens should be alert to these pitfalls as well.

We developed a novel suprapubic single-port robotic right hemicolectomy (spRHC) procedure for patients with right colon cancer using a da Vinci SP Surgical System. The aim of this study was to determine the safety and feasibility of this technique. We performed the spRHC procedure on five patients with right colon cancers between July and September 2020. All procedures including colon mobilization, D3 lymphadenectomy, and intracorporeal anastomosis were completed using the single-port robotic platform through a mini-transverse suprapubic incision and an additional assistant port. Data regarding patient characteristics, perioperative outcomes and pathologic results were analyzed. Four of the five patients were males. The median age was 69 years (range, 58–77 years).Two patients received preoperative chemotherapy for advanced colon cancer. The median total operative time was 160 min (range, 150–240 min). The median docking time was 4 min 40 s (range, 2 min 10 s–5 min 10 s). The median console time was 105 min (range, 100–120 min). There were no conversions to multiport or open surgeries. The median hospital stay was 7 days (range, 5–12 days). One patient experienced a wound infection. The median number of harvested lymph nodes was 41 (range, 39–50 lymph nodes). SpRHC is safe and feasible. However, further comparative studies are needed to assess whether this procedure can provide patients with significant benefits compared with multiport robotic surgery.

To target benign prostatic hyperplasia (BPH) as a common urinary disease in old men, in the current study, the antiproliferative and apoptotic mechanism of SH-PRO, a mixture of Angelica gigas and Astragalus membranaceus (2:1), was evaluated in BPH-1 cells and rats with testosterone-induced BPH. Herein, SH-PRO significantly reduced the viability of BPH-1 cells and dihydrotestosterone (DHT)-treated RWPE-1 cells. Also, SH-PRO increased the sub-G1 population in BPH-1 cells and consistently attenuated the expression of pro-PARP, pro-caspase 3, Bcl2, FOXO3a, androgen receptor (AR), and prostate-specific antigen (PSA) in BPH-1 cells and DHT-treated RWPE-1 cells. Of note, SH-PRO generated reactive oxygen species (ROS) in BPH-1 cells, while ROS inhibitor N-acetyl-l-cysteine (NAC) disturbed the ability of SH-PRO to reduce the expression of pro-PARP, FOXO3a, catalase, SOD, and increase sub-G1 population in BPH-1 cells. Furthermore, oral treatment of SH-PRO significantly abrogated the weight of the prostate in testosterone-treated rats compared to BPH control with the reduced expression of AR, PSA, and DHT and lower plasma levels of DTH, bFGF, and EGF with no toxicity. Overall, these findings highlight the antiproliferative and apoptotic potential of SH-PRO via ROS-mediated activation of PARP and caspase 3 and inhibition of FOXO3a/AR/PSA signaling as a potent anti-BPH candidate.

The da Vinci single-port (SP) system is designed to facilitate single-incision robotic surgery in a narrow space. We developed a new procedure of rectal resection using this system. The aim of the present study was to evaluate the technical feasibility and safety of SP robotic rectal resection for rectal cancer patients based on our initial experience. A study was conducted on consecutive patients with mid or low rectal cancer who had SP robotic resection at our institution between July and September 2020. The demographic characteristics, perioperative data, and pathology results of the patients were retrospectively analyzed. There were 5 patients (3 males, 2 females, median age 57 years (range 36–73 years). The median tumor height from the anal verge was 4 cm (range 3−5 cm). Two patients received preoperative chemoradiotherapy for advanced rectal cancer. A single docking was conducted, and the median docking time was 4 min 20 s (range 3 min 30 s to 5 min). The median total operation time was 195 min (range 155−240 min), and the median time of pelvic dissection was 45 min (range 36−62 min). All patients had circumferential and distal tumor-free resection margins. One patient experienced an anastomosis-related complication. The median duration of hospital stay was 7 days (range 7−8 days). Our initial experience suggests that SP robotic rectal resection is safe and feasible. Further clinical trials comparing SP and multiport robotic rectal resection should be conducted to verify the superior aspects of this new system.

Background/Aims: The hepatic venous pressure gradient (HVPG) reflects portal hypertension, but its measurement is invasive. Transient elastography (TE) is a noninvasive method for evaluating liver stiffness (LS). We investigated the correlation between the value of LS, LS to platelet ratio (LPR), LS-spleen diameter-to-platelet ratio score (LSPS) and HVPG according to the etiology of cirrhosis, especially focused on alcoholic cirrhosis. Methods: Between January 2008 and March 2017, 556 patients who underwent HVPG and TE were consecutively enrolled. We evaluated LS, LPR, and LSPS according to the etiology of cirrhosis and analyzed their correlations with HVPG. Results: The LS value was higher in patients with alcoholic cirrhosis than viral cirrhosis based on the HVPG (43.5 vs. 32.0 kPa, P

This study aims to develop a free, limited-edition workshop as an effective knowledge translation strategy to enhance nurse leader-perceived self-efficacy for competence using Park's Sweet Spot Theory and to evaluate its effectiveness over time.This is a study showing the process of developing a study protocol and its details.A 2-day workshop was developed for innovators and early adopters among nurse leaders with a macro-level influence based on Rogers's diffusion of innovations theory, which consists of an introduction of Park's Sweet Spot Theory, hands-on experience, a summary session, and a presentation of a certificate of completion. The workshop will be held at the University of Alberta Faculty of Nursing, using the "enabling blends" mode. A hybrid design of comparative effectiveness research and analysis of change will be utilized to assess nurse leader-perceived self-efficacy.This protocol is significant as the first step in providing scientific rationales on how to effectively implement new knowledge-optimal safe nurse staffing levels derived from Park's Sweet Spot Theory-into the right (safe yet efficient) nursing workforce policy-making to alleviate global nursing shortages.

Infection with high-risk (HR) Human Papillomavirus (HPV) is associated with the development of precancerous lesions or invasive carcinoma of the uterine cervix. Thus, the high viral load (VL) of HR-HPV DNA currently serves as a representative quantitative marker for cervical cancer. However, the clinical significance of low HPV DNA VL remains undetermined. This study aimed to evaluate the clinical association between the low HPV DNA VL and cytology/histologic diagnosis of cervical samples. We searched the electronic medical databases for the resultant analyses of HPV genotyping among patients who underwent treatment for any cervical lesion or who had undergone gynecological examinations with any positive HPV results according to the national cancer screening service between 2015 and 2016. HPV testing with genotyping and semi-quantitative VL measurement was conducted using an AnyplexTM II H28 Detection assay (H28 assay, Seegene, Seoul, Republic of Korea). The H28 assay is a multiplex semi-quantitative real-time PCR test using the tagging of oligonucleotide cleavage and extension (TOCE) technology. The VL was semi-quantified as high (3+; positive signal before 31 PCR cycles), intermediate (2+; positive between 31 and 39 PCR cycles), or low (1+; positive after 40 PCR cycles). Out of 5940 HPV VL analyses, 356 assays (5.99%) were reported as low VL (1+) of HPV DNA. Matched cytology diagnoses were mostly negative findings (n = 347, 97.5%), except for seven cases of atypical squamous cells of undetermined significance (1.9%) and two cases of atypical glandular cells (0.6%). During the follow-up periods, abnormal cytologic diagnoses were identified, including one case of high-grade squamous intraepithelial lesion (HSIL) and two low-grade squamous intraepithelial lesions (LSILs). The matched, confirmative histologic diagnosis of HSIL cytology was compatible with chronic inflammation, wherein the two LSILs had regular check-ups. None revealed clinically concerned outcomes associated with HPV-related squamous lesions. The cytology was most likely negative for malignancy when the VL of HPV DNA was low (1+). Additional strategic monitoring and management may thus be unnecessary.

Background/Aims: The controlled attenuation parameter (CAP), based on tran sient elastography, is widely used for noninvasive assessment of the degree of hepatic steatosis (HS). We investigated the correlation of the degree HS between CAP and ultrasound (US) in patients with HS. Methods: In total, 986 patients with US-based HS who underwent transient elas tography within 1 month were evaluated. The US-based grade of HS was catego rized as mild (grade 1), moderate (grade 2), or severe (grade 3). Results: The CAP was significantly correlated with the US-based grade of HS (r = 0.458, p < 0.001). The median CAP value of each US-based HS grade showed a pos itive correlation with grade (271.1, 303.7, and 326.7 dB/m for grades 1, 2, and 3). In a multivariate analysis, the US-based HS grade, body mass index, serum albumin, alanine aminotransferase, and total cholesterol, and liver stiffness were all sig nificantly correlated with the CAP value (all p < 0.05). The areas under the receiver operating characteristic curves for grade 2 to 3 and grade 3 HS were 0.749 (95% confidence interval [CI], 0.714 to 0.784) and 0.738 (95% CI, 0.704 to 0.772). The opti mal cut-off CAP values to maximize the sum of the sensitivity and specificity for grade 2 to 3 and grade 3 HS were 284.5 dB/m (sensitivity 78.6%, specificity 61.7%) and 298.5 dB/m (sensitivity 84.6%, specificity 55.6%). Conclusions: The correlation of the degree of HS between CAP and US was sig nificantly high in patients with HS, and the optimal cut-off CAP values for grade 2 to 3 and grade 3 HS were 284.5 and 298.5 dB/m.

A concept of household container to create and keep the modified atmosphere (MA) beneficial for fresh produce mix was devised and tested under typical chilled storage conditions of 3°C. The container system containing mixed products is initialized by applying weak hypobaric condition (0.9 atm) and subsequently injecting CO2 gas at an appropriate low level (0.03 atm). The passive atmosphere modification by produce respiration is then induced to reach a target until gas diffusion tube of proper dimension starts to open. The design was made to attain quasi-steady state mass balance of O2, CO2 and N2 to maintain the desired MA through the storage. Interrupted opening for taking out or placing some products was to reinitialize the loop of control logic. The developed concept was tested by the container which held commodities of spinach, pak choi, oyster mushroom, peeled onion, strawberry and cut carrot. The target optimum MA of 11% O2 and 10% CO2 (0.11 and 0.10 atm, respectively) was set to avoid injurious range of O2 and CO2 concentrations for any commodities. The developed container system could work to reach and maintain beneficial MA of 0.10-0.12 atm O2 and 0.07-0.10 atm CO2 close to the target during the storage contributing to quality retention of products measured in weight loss, chlorophyll content of spinach, ascorbic acid content of pak choi, color of onion, texture of oyster mushroom, bacterial count of strawberry and carotenoids of carrot. The container system shows potential to improve current preservation practice of fresh produce mix on consumers’ level.

Background Diabetic neuropathic osteoarthropathy (DNOAP) is known as debilitating diabetes complications. The aim of study is to compare bone mineral density (BMD) among diabetic foot and DNOAP, and investigate the impact of BMD proceeded from diabetic foot to DNOAP. Methods A DNOAP group (subgroup A and subgroup B) and control group were examined for this study. Subgroup A (n=21) were patients diagnosed with DNOAP with the development of new foot and ankle fractures, whereas subgroup B (n=4) were patients being managed with the diabetic foot before a diagnosis of DNOAP. BMD was also evaluated before the diagnosis. Control group (n=30) was diabetic foot patients without DNOAP. The demographic data, clinical and radiologic data, comorbidities, and BMD were compared for each group. And optimal BMD score was reviewed to predict fractures in neuropathic arthropathy. Results BMD was significantly lower in DNOAP group (group A and B) compared with control group. Also neuropathic arthropathy group showed poor radiological results. After comparisons of 2 group lumbar and femur BMD was significantly different, but logistic regression analysis revealed that low femur T-score could be risk predictors of the condition. Base on the data of group B and control group, the cut-off point for predicting foot and ankle fracture-related with DNOAP was -1.65 of femur BMD. Conclusions Low BMD shows greater incidence in foot and ankle fracture patients associated with neuropathic arthropathy. A femur T score can be a risk predictor of diabetic neuropathic arthropathy for diabetic foot patients.

The Advanced Molybdenum-based Rare process Experiment (AMoRE) searches for neutrino-less double-beta (0{\nu}\b{eta}\b{eta}) decay of 100Mo in enriched molybdate crystals. The AMoRE crystals must have low levels of radioactive contamination to achieve low background signals with energies near the Q-value of the 100Mo 0{\nu}\b{eta}\b{eta} decay. To produce low-activity crystals, radioactive contaminants in the raw materials used to form the crystals must be controlled and quantified. 100EnrMoO3 powder, which is enriched in the 100Mo isotope, is of particular interest as it is the source of 100Mo in the crystals. A high-purity germanium detector having 100% relative efficiency, named CC1, is being operated in the Yangyang underground laboratory. Using CC1, we collected a gamma spectrum from a 1.6-kg 100EnrMoO3 powder sample enriched to 96.4% in 100Mo. Activities were analyzed for the isotopes 228Ac, 228Th, 226Ra, and 40K. They are long-lived naturally occurring isotopes that can produce background signals in the region of interest for AMoRE. Activities of both 228Ac and 228Th were < 1.0 mBq/kg at 90% confidence level (C.L.). The activity of 226Ra was measured to be 5.1 \pm 0.4 (stat) \pm 2.2 (syst) mBq/kg. The 40K activity was found as < 16.4 mBq/kg at 90% C.L., Comment: 20 pages, 6 figures, 5 tables

Purpose To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. Methods International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A meta-analysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. Results Five RCTs and six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. Conclusions This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. Results of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.

This paper aims to propose Park's sweet spot theory-driven implementation strategy, which makes optimal safe staffing policy really work in nursing practice.For the last 40 years, mainstream nursing workforce research has emphasized that having more registered nurses leads to better patient outcomes, and yet staffing policies have failed to implement this crucial concept. Meanwhile, global nursing shortages have become rampant, a problem that only dilutes the skill-mix ratios in the nursing workforce. Low fertility and an aging population worldwide are then accelerating these shortages. These dire circumstances may be persisting because of unclear, unsubstantiated cost-efficiency in the nursing workforce. For this reason, there remains a dearth of well-researched evidence for a clear threshold on optimal safe staffing levels that could maximize quality of care relative to cost given limited healthcare financial budgets and which could also be fitted into each care setting. Along with that, an implementation strategy for optimal safe staffing levels is nonexistent.An implementation strategy has been developed through interdisciplinary consilience-based theory synthesis of both prospective theory and regulatory focus theory combined with Park's optimized nursing staffing (sweet spot) estimation theory.A theory-driven novel implementation strategy is proposed, which functions as a nudge strategy that uses the synchronous balance of quality of care, nurse staffing, and cost. It illustrates (1) how to create shared value among patients, nurses, and stakeholders through robust evidence-based, informed shared decision-making rationales on the optimal safe nurse staffing levels and (2) how to induce stakeholders to overcome resistance to innovation and improve their nursing workforce through value chain in management science.This novel implementation strategy may be a viable solution to mitigate the nursing shortage by leading stakeholders (1) to compete with each other (on the basis of nursing sufficiency) and (2) to competitively demonstrate the patient-centered value (patient-perceived care quality relative to cost) of their institutions.

Global inequality exists in the availability of a nursing workforce, supported evidentially by the ratio, in low-income countries, of only 9.1 nurses per 10 000 people versus 107.7 nurses per 10 000 people in high-income countries. Mongolia is no exception with 42.14 nurses per 10 000 people and a nursing shortage severe enough to endanger patient safety and well-being. This paper details both a policy analysis and contextually well-designed recommendations to strengthen Mongolia's nursing science and practice systems. Obstacles that significantly affect the successful development of nursing and midwifery professions in Mongolia include (1) a lack of strategic planning and regulation; (2) low status of nurses and midwives; (3) absence of professional representation for nurses and midwives; and (4) a dearth of strategic programs for postgraduate training of nurses and midwives. The suggested recommendations include the appointment of a chief nursing office within the government and a cohort of nurse leaders to work to establish a nursing and midwifery board as an independent, professional regulatory body in Mongolia to develop and implement standards to ensure best practice, higher standards of nurse education, and regulate the profession.