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BackgroundWithin hospital systems, diverse subsets of patients are subject to minimally invasive procedures that provide therapeutic relief and necessary health data that are often perceived as anxiogenic or painful. These feelings are particularly relevant to patients experiencing procedures where they are conscious and not sedated or placed under general anesthesia that renders them incapacitated. Pharmacologic pain management and topical anesthetic creams are used to manage these feelings; however, distraction-based methods can provide nonpharmacologic means to modify the painful experience and discomfort often associated with these procedures. Recent studies support distraction as a useful method for reducing anxiety and pain and as a result, improving patient experience. Virtual reality (VR) is an emerging technology that provides an immersive user experience and can operate through a distraction-based method to reduce the negative or painful experience often related to procedures where the patient is conscious. Given the possible short-term and long-term outcomes of poorly managed pain and enduring among patients, health care professionals are challenged to improve patient well-being during medically essential procedures. ObjectiveThe purpose of this pilot project is to assess the efficacy of using VR as a distraction-based intervention for anxiety or pain management compared to other nonpharmacologic interventions in a variety of hospital settings, specifically in patients undergoing lumbar puncture procedures and bone marrow biopsies at the oncology ward, patients receiving nerve block for a broken bone at an anesthesia or surgical center, patients undergoing a cleaning at a dental clinic, patients conscious during an ablation procedure at a cardiology clinic, and patients awake during a kidney biopsy at a nephrology clinic. This will provide the framework for additional studies in other health care settings. MethodsIn a single visit, patients eligible for the study will complete brief preprocedural and postprocedural questionnaires about their perceived fear, anxiety, and pain levels. During the procedure, research assistants will place a VR headset on the patient and the patient will undergo a VR experience to distract from any pain felt from the procedure. Participants’ vitals, including blood pressure, heart rate, and rate of respiration, will also be recorded before, during, and after the procedure. ResultsThe study is already underway, and results support a decrease in perceived pain by 1.00 and a decrease in perceived anxiety by 0.3 compared to the control group (on a 10-point Likert scale). Among the VR intervention group, the average rating for comfort was 4.35 out of 5. ConclusionsThis study will provide greater insight into how patients’ perception of anxiety and pain could potentially be altered. Furthermore, metrics related to the operational efficiency of providing a VR intervention compared to a control will provide insight into the feasibility and integration of such technologies in routine practice. International Registered Report Identifier (IRRID)DERR1-10.2196/52649

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) serves as a bridging intervention for subsequent definitive haemorrhagic control. This study compared the clinical outcomes of REBOA and resuscitative thoracotomy (RT) in patients with bleeding below the diaphragm., Materials and Methods: This retrospective cohort study included adult trauma patients who presented to the Trauma Quality Improvement Program between 2020 and 2021 and who underwent either REBOA or RT in the emergency department (ED). Patients with severe head and chest injuries, characterised by an Abbreviated Injury Scale (AIS) score greater than 3, were excluded. The clinical data of patients treated with REBOA and those treated with RT were compared, and multivariable logistic regression (MLR) was employed to identify prognostic factors associated with mortality., Results: A total of 346 patients were enrolled: 138 (39.9 %) received REBOA, and 208 (60.1 %) received RT at the ED. Patients in the RT group underwent ED cardiopulmonary resuscitation (CPR) more frequently (58.2 % vs. 23.2 %; p < 0.001) and had a higher mortality rate (87.0 % vs. 45.7 %; p < 0.001). Patients who died had lower Glasgow Coma Scale scores (6 [4.5] vs. 11 [4.9]; p < 0.001), underwent more ED CPR (58.6 % vs. 9.8 %; p < 0.001), and received RT more frequently (74.2 % vs. 26.5 %, p < 0.001). The MLR revealed that the major prognostic factors for mortality were systolic blood pressure (odds ratio [OR] 0.988, 95 % confidence interval [CI] 0.978-0.998; p = 0.014), ED CPR (OR 11.111, 95 % CI 4.667-26.452; p < 0.001), abdominal injuries with an AIS score ≥ 4 (OR 4.694, 95 % CI 1.921-11.467; p = 0.001) and RT (OR 5.693, 95 % CI 2.690-12.050; p < 0.001)., Conclusions: In cases of blunt trauma, prompt identification of the bleeding source is crucial. For patients with bleeding below the diaphragm, REBOA led to higher survival rates than did RT. However, it is important to consider the limitations of the database and the necessary exclusions from our analysis., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Molecules based on benzimidazolone-dioxazine are known as blue/violet pigments and have been commercialized for decades. However, unfavorable solubility limits the application of these structures as building blocks of conjugated polymers despite their low band gaps. Herein, a series of donor-acceptor conjugated polymers containing soluble benzimidazolone-dioxazine structures as the acceptors and oligothiophene as donors are synthesized and investigated. With increasing numbers of thiophene rings, the steric hindrance diminishes and high molecular weight polymers can be achieved, leading to an improved performance in organic field effect transistor devices. The hole mobility of polymers with three to six thiophene units is in the order of 10 -1 cm 2 V -1 s -1 . Among all the polymers, polymer P3 with three thiophene units between benzimidazolone-dioxazine structures shows the best hole mobility of 0.4 cm 2 V -1 s -1 . Grazing-incidence wide-angle X-ray scattering results reveal that the high mobility of organic field-effect transistors (OFETs) can be accredited by matched donor-acceptor packing in the solid thin films., (© 2022 The Authors. Macromolecular Rapid Communications published by Wiley-VCH GmbH.)

Background/purpose: Emergency air medical transport (EAMT) of patients in remote areas with neurological emergencies to higher-level facilities is an integral part of the regionalized healthcare system. EAMT is safe and feasible for head injuries. Debates persist on the high cost, safety, and risk of EAMT, thereby calling for alternatives., Methods: We conducted a retrospective cohort study by including all patients with intracranial hemorrhage (ICH) who visited the Kinmen Hospital from January 2006 to December 2016. Routine neurosurgical dispatch (RNSD) implemented since 2009, dispatches neurosurgeons to Kinmen. EAMT and 90-day mortality were assessed., Results: We enrolled 560 patients: 173 pre-stage and 387 post-stage. RNSD resulted in less EAMT deployment ([adjusted odds ratio AOR] = 0·23, p < 0·001) and lower 90-day mortality ([adjusted hazard ratio AHR] 0·66, p = 0·043). RNSD resulted in decreased EAMT among all subgroups, especially in age ≥81 years (AOR 0.03, p < 0.001), age 41-60 years (AOR 0.10, p < 0.001), traumatic intracranial hemorrhage (TICH) (AOR 0·11, p < 0·001), and Glasgow Coma Scale (GCS) 9-12 (AOR 0.14, p 0.001). The risk of 90-day mortality was higher in male (AHR 1.81, p = 0·006), GCS 3-8 (AHR 35.52, p < 0·001) and GCS 9-12 (AHR 7.46, p < 0·01) and lower in age 21-40 years (AHR 0.46, p = 0.034)., Conclusion: Incorporating RNSD with EAMT is a plausible alternative to EAMT with a significant decrease in EAMT and decreased 90-day mortality in patients with ICH compared with non-neurosurgical care with EAMT. Despite a 34% decrease in 90-day mortality after RNSD, patient characteristics such as disease severity, age, and sex still dictated patient outcomes., (Copyright © 2019. Published by Elsevier B.V.)

Lithium-ion capacitors (LICs) represent a new type of energy-storage devices, which have combined merits of high energy density Li-ion battery and high power density supercapacitor. Nevertheless, one significant challenge for LICs is the imbalanced kinetics between the fast capacitive cathode and relatively slow intercalation anode that limit the energy-storage performance. Here, the asymmetric LIC devices were developed based on a nitrogen-doped, carbonized zeolitic imidazolate framework (ZIF-8) cathode and a three-dimensional, nano-network-structured, conversion reaction-based Ni/NiO/C anode. These nanostructures associated with both the cathode and anode enable rapid electron and ions transport in the LIC devices, which allows the asymmetric LICs to be operated on either high energy mode (energy density of 114.7 Wh/kg at power density of 98.0 W/kg) or high power mode (power density of 60.1 kW/kg at energy density of 17.6 Wh/kg). The device also exhibited long-term cycle stability with 87% capacitance retention after 12 000 cycles. These results demonstrate that the rational design of nanoporous electrode structures can deliver a balanced, high-performance-activated cZIF-8|Ni/NiO/C-based lithium-ion capacitor.

Spontaneous perforated Meckel's diverticulum is a rare complication and mimics appendicitis or diverticulitis in elderly adults. We report the case of a 51-year-old man who presented to the emergency department with abdominal pain that had progressively increased over the previous two hours. The provisional diagnosis was appendicitis or diverticulitis, and we recommended computed tomography for further evaluation. Computed tomography of the abdomen showed an outpouching, blind-ending, fluidfilled structure in continuity with the distal ileum that depicted wall perforation and extraluminal air bubbles, consistent with perforated Meckel's diverticulum. In this case report, computed tomography provided a clear imaging diagnosis of perforated Meckel's diverticulum preoperatively. Thus, in patients with acute abdomen, complicated Meckel's diverticulum should be included in the differential diagnosis., Competing Interests: The authors declare that they have no confl ict of interest related to the subject matter or materials discussed in this article., (Copyright © 2018 by Taiwan Society of Emergency Medicine & Ainosco Press. All Rights Reserved.)

Three novel donor-acceptor alternating polymers containing ladder-type pentacyclic heteroacenes (PBo, PBi, and PT) are synthesized, characterized, and further applied to organic field effect transistors (OFETs) and polymer solar cells. Significant aspects of quinoidal characters, electrochemical properties, optical absorption, frontier orbitals, backbone coplanarity, molecular orientation, charge carrier mobilities, morphology discrepancies, and the corresponding device performances are notably different with various heteroarenes. PT exhibits a stronger quinoidal mesomeric structure, linear and coplanar conformation, smooth surface morphology, and better bimodal crystalline structures, which is beneficial to extend the π-conjugation and promotes charge transport via 3-D transport pathways and in consequence improves overall device performances. Organic photovoltaics based on the PT polymer achieve a power conversion efficiency of 6.04% along with a high short-circuit current density (J SC ) of 14.68 mA cm -2 , and a high hole mobility of 0.1 cm 2 V -1 s -1 is fulfilled in an OFET, which is superior to those of its counterparts, PBi and PBo.

Background: Intensive care nurses may have an important role in empowering families by providing psychological support and fulfilling the family's pivotal need for information., Aim: To determine whether 'education of families by tab' about the patient's condition was more associated with improved anxiety, stress, and depression levels than the 'education of families by routine'., Research Design: A randomized control trial of 74 main family caregivers (intervention: 39; control: 35)., Setting: An adult intensive care unit., Main Outcome Measures: Depression Anxiety Stress Scale, and Communication and Physical Comfort Scale., Results: Although information need satisfaction was not significantly different between intervention and control groups, the former reported significantly better depression score on Depression Anxiety Stress Scale comparing to the control group (p<0.01; η 2 =0.09) with a medium effect size. Reduction of anxiety in the intervention group were clinically significant., Conclusion: The results suggest that use of 'education of family by tab' is promising for intensive care nurses to provide psychological support for family members. More studies are needed to investigate this aspect of family care for better psychological support and information need satisfaction that contributes to the evidence-based practice of intensive care nursing., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

We report pentacene-based organic field-effect transistor memory devices utilizing supramolecular electrets, consisting of a polyimide, PI(6FOH-ODPA), containing hydroxyl groups for hydrogen bonding with amine functionalized aromatic rings (AM) of 1-aniline (AM1), 2-naphthylamine (AM2), 2-aminoanthracene (AM3), and 1-aminopyrene (AM4). The effect of the phenyl ring size and composition of AM1-AM4 on the hole-trapping capability of the fabricated devices was investigated systematically. Under an operating voltage under ±40 V, the prepared devices using the electrets of 100 % AM1-AM4/PI ratios exhibited a memory window of 0, 8.59, 25.97, and 29.95 V, respectively, suggesting that the hole-trapping capability increased with enhancing phenyl ring size. The memory window was enhanced as the amount of AM in PI increased. Furthermore, the devices showed a long charge-retention time of 10(4)  s with an ON/OFF current ratio of around 10(3) -10(4) and multiple switching stability over 100 cycles. This study demonstrated that the electrical characteristics of the OFET memory devices could be manipulated through the chemical compositions of the supramolecular electrets., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The electrical memory characteristics of the n-channel organic field-effect transistors (OFETs) employing diverse polyimide (PI) electrets are reported. The synthesized PIs comprise identical electron donor and three different building blocks with gradually increasing electron-accepting ability. The distinct charge-transfer capabilities of these PIs result in varied type of memory behaviors from the write-one-read-many (WORM) to flash type. Finally, a prominent flexible WORM-type transistor memory is demonstrated and shows not only promising write-many-read-many (WMRM) multilevel data storage but also excellent mechanical and retention stability., (© 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Primary hepatocellular carcinoma (HCC) extending to the adjacent organ(s) is sometimes encountered in patients with large, peripherally located tumours. Over a 4-year period, a total of 151 patients received curative resection of HCC at the Surgical Department of Veterans General Hospital-Taipei, Taiwan. Of these patients, 21 underwent hepatic resection combined with en-bloc resection of the adjacent organ(s) because tumour extension was found during operation. Subsequent histological examination of the resected specimens found evidence of HCC invasion into the resected adjacent organ(s) in only nine patients (group I), and the remaining 12 patients showed no evidence of extrahepatic HCC invasion (group II). Twenty-seven HCC patients with clinico-pathologically matched tumours but without extrahepatic extension were selected as controls (group III). One patient in group I died of hepatic failure after the operation. The morbidity rate was 48% in group I and group II patients, and 30% in group III patients. The difference was not statistically significant. On evaluating the clinico-pathological factors, including DNA ploidy status of the tumours, there were no significant differences between tumours with and without extrahepatic invasion. Patients with locally invasive HCC (group I) had disease-free and overall survival rates comparable with those of the patients without local tumour invasion (group II and III). We conclude that HCC with invasion to the adjacent organ(s) does not seem to be directly related to the 'aggressiveness' of the tumour, and extrahepatic infiltration of the tumour does not preclude a chance of cure. Our results underscore the need for en-bloc resection as treatment of choice for these patients.