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Blood clots form in a lower limb due to a prolonged period of inactivity. They can be prevented by improving the deep vein circulation through ankle exercises. However, existing automatic exercise assisting devices are expensive and bulky. In this study, we designed a novel wearable deep vein thrombosis prevention device using thin McKibben muscles. The device has no rigid structure; it is composed almost entirely of soft materials, is extremely lightweight, and occupies little space around the leg. Ankle exercises, including dorsiflexion-plantarflexion, inversion-eversion, and abductionadduction, can be performed in all directions using the proposed device. On evaluating the range of motion with this device, it is found that it can achieve 90% of the maximum range of motion for all directions of ankle exercises. From the preliminary clinical evaluation, the popliteal vein velocity in the lower limbs, measured using an ultrasonic flow meter, increased after the device assisted ankle exercises. The results indicate that the proposed device can effectively improve blood circulation.

In this paper, we proposed, designed, prototyped, and demonstrated a new soft robotic rehabilitation glove with thin McKibben muscles. Rehabilitation gloves have recently attracted considerable attention owing to an increase in the number of patients and a decrease in the number of medical personnel with declining birth rates and rapidly aging society. We proposed a rehabilitation glove that can flex and extend fingers actively using thin McKibben muscles; these are lightweight, flexible, high force per weight, linear actuators. This glove will address the limitations of existing rehabilitation gloves in terms of size, weight, and insufficient extension force. Two design concepts are newly proposed in this paper: a ”three-point bending structure” and a ”flat braided muscle”. By employing these concepts, the glove can be used to extend and flex fingers with thin McKibben muscles, and the entire glove can remain compact within the wrist and hand. With respect to wearability, which is very important in rehabilitation gloves, we contrived a new fitting mechanism and a wearing aid. Experiments conducted showed that the fingers could be successfully extended and flexed from a fingertip angle of -49° to 106° and a 500 g water bottle could be grasped under relaxed conditions. The study showed promising results, and we believe that this glove has immense potential as a future rehabilitation glove.

Understanding students’ subjective perceptions of universities is one of the main issues that needs to be addressed in order to improve aspects such as student retention and achieve sustainable development. Considering subjective well-being as an alternative term for happiness and satisfaction in higher education for sustainability, this study is to develop a measure conceptually and operationally for college campus well-being (CWB) with multiple dimensions, including a psychological, physical, financial, and social dimension of well-being. Subjected to factorial validity and composite reliability, the CWB scale validated by 2793 undergraduate students in central Taiwan was administered. The research demonstrates the appropriate construct validity and suitable-fit indices of the CWB multidimensional scale when used for measuring university-oriented happiness and sustainability in this research context. Differential effects were found among the colleges and between genders. The implications and future research lines are discussed.

BackgroundCulture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses.MethodsDeveloping and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses' cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale.ResultsThe results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach's α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70.ConclusionsThe establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion.

Adventure programming has seen considerable growth throughout the world. While newly established programs aim to meet the needs of their prospective clients, failing to account for cultural differences when conducting or designing programs may impede this goal. Non-western approaches to implementing adventure programs have rarely been discussed, because there is a lack of a clear theoretical framework for addressing cross-cultural issues in adventure programming. This article seeks to address these limitations by drawing attention to the existing literature on the impact of cultural differences on adventure programming and relevant fields (e.g. education), providing suggestions for how such theories could inform facilitation styles. It is proposed that a model adapted from the work of Hofstede offers one useful framework for assessing groups from different cultural contexts, which can strengthen the practice of adventure programs to better meet the needs of participants.

Purpose: Due to the ethical concern around involuntary treatment, this study sought to investigate if youth participants in wilderness therapy who were transported to the program experienced different rates of change than those not transported. Methods: Multilevel modeling techniques were used to investigate rates of change for youth between transported and nontransported youth over 5 points until 6 months postdischarge. In addition, repeated measures analyses of variance investigated parent reports of change over time across transport status, gender, and diagnosis. Results: The findings showed no differences between transported and nontransported youth in changes over time. Overall, all youth improved significantly with changes maintained postdischarge regardless of transport status. Discussion: This study shows that transporting youth to treatment does not appear to interfere with the treatment outcome; however, more research is needed to understand clients’ perception of the transport process.

This paper investigates the dynamics of a 3-link gymnastic robot using both a simulation and an experiment to identify the dominant parameters required for a desired front-flip motion. The objectives of this study are as follows: (1) construct a mathematical model of the gymnast robot and verify the theoretical results via simulation for a 3-link gymnast robot, (2) design a 3-link mechanism and perform experiments under different conditions, and (3) compare the results of both the simulation and the experiment, and analyze the relation between the parameters and the corresponding locomotion. To achieve these objective, first, a theoretical model of a 3-link gymnastic robot is proposed. Then, simulation results are provided to verify the model. Next, a 3-link robot mechanism is designed and fabricated, and experiments are conducted to demonstrate the dynamics behavior observed in the simulation results. This paper provides the ideal initial condition to perform any desired front-flip locomotion. It is found that the initial angle of the 3-link mechanism is the parameter that mainly influences the front-flip performance.

Background: Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer. Aim: The aim of this study was to assess the risk of port system failure in patients with advanced cancer. Design: We conducted a retrospective cohort study in a comprehensive cancer centre. Setting/participants: A detailed chart review was conducted among 566 patients with 573 ports inserted during January–June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion. Results: Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2–46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m2 (HR = 3.4, P = 0.029) increased the risk of port system occlusion. Conclusions: Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.

Summative performance assessments in teacher education, such as the Performance Assessment for California Teachers (PACT) and the edTPA, have been heralded through polices intended to enhance the quality of the teaching profession and raise its stature among other professions. However, the development and implementation of the PACT, and subsequently the edTPA, have not been without controversy and debate. The purpose of this article is to assess the implementation, impact, and evolution of the PACT and edTPA. To do so, we review the growing body of literature on the impact and implementation of the PACT and critically analyze the state policies surrounding the edTPA. We raise questions about the practical and policy implications of the PACT’s evolution, as a statewide assessment, to the edTPA, a nationally available assessment.

To understand the experiences of Asian women in Taiwan who are adjusting to motherhood following previous pregnancy loss.Phenomenology was used as the study design, and interviews were used to collect data in a medical center in Northern Taiwan with six women who had given birth to a healthy baby after previous pregnancy loss. Following ethical approval, interviews were audio-recorded, transcribed, and analyzed to develop data themes.The nautical metaphor was chosen because of the fact that Taiwan is an island and surround by sea. The sea has deep cultural meaning of uncertainty in life for the Taiwanese people. A metaphor of "sailing against the tide" emerged from the data to depict three stages of the women's journey: remembering the previous journey of loss; the rising sun brings new life within; and changing tide brings new birth. The essence of their journey through the pregnancy and birth was a permutation of fear, uncertainty, and a deep desire for reassurance of fetal well-being.This study reinforces the difficulties that women have after a pregnancy loss, but examines it with a unique cultural focus. Nurses and midwives can use these findings to develop caring and understanding practices designed to help women in these circumstances. Pregnancy after a loss is never the same as a previous pregnancy, and is perceived as different from a pregnancy that other "normal" pregnant women have. Women need nurses and midwives who can provide comprehensive practical, physical, culturally specific, psychosocial, and spiritual support to help them successfully chart their journey out of profound loss.