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Arteriovenous graft (AVG) is an important vascular access route in hemodialysis patients. The optimal waiting time between AVG creation and the first cannulation is still undetermined, therefore the current study investigated the association between ideal timing for cannulation and AVG survival. This retrospective cohort study used data from the Taiwan National Health Insurance Database, which included 6,493 hemodialysis patients with AVGs between July 1st 2008 and June 30th 2012. The waiting cannulation time was defined as the time from the date of shunt creation to the first successful cannulation. Patients were categorized according to the waiting cannulation time of their AVGs as follows: ≤30 days, between 31 and 90 days, between 91 and 180 days, and >180 days. The primary outcome was functional cumulative survival, measured as the time from the first cannulation to shunt abandonment. The AVGs which were cannulated between 31 and 90 days (reference group) after construction had significantly superior functional cumulative survival compared with those cannulated ≤30 days (adjusted HR = 1.651 with 95% CI 1.482–1.839; p < 0.0001) and >180 days (adjusted HR = 1.197 with 95% CI 1.012–1.417; p = 0.0363) after construction. An analysis of the hazard ratios in patients with different demographic characteristics, revealed that the functional cumulative survival of AVGs in most groups was better when they received cannulation >30 days after construction. Consequently, in order to achieve the best long-term survival, AVGs should be cannulated at least 1 month after construction, but you should avoid waiting for >3 months. [ABSTRACT FROM AUTHOR]

The lack of knowledge of advance care planning and training of communication skills among nurses in Taiwan is one of the main reasons for the low rate of advance directive signing. However, there is no specific and effective solution to this problem. The purposes of this study were (1) to develop and pilot testing of an advance care planning simulation-based communication training program and (2) to evaluate the feasibility and acceptability of the program. This study was conducted in three phases. Phase 1: Developing an advance care planning simulation-based communication training program; Phase 2: Conducting a pilot test; Phase 3: Evaluating the feasibility and acceptability of the program. Twelve convenient participants from a medical center in central Taiwan were selected. The participants believed that team-based learning was beneficial for several reasons. First, it helped to clarify the participants' understanding of advance care planning and improve their communication skills. Second, role-playing, as one of the components, was helpful for discovering their own shortcomings in communication skills while debriefing enabled them to identify their blind spots in the communication process. Finally, the reflection log documented their weekly performance so they were able to reflect upon their weekly performance, improve their performance, and become more confident. All twelve participants signed the consent form and completed the whole training program. The participants were satisfied with the program, affirming that the timing and content of the program were appropriate and that the expected learning outcomes could be achieved. According to participant feedback, the program was beneficial in improving their knowledge of advance care planning and confidence in communication. Thus, it is feasible and acceptable to introduce communication of advance care planning programs into the staff training protocols of healthcare organizations. Clinical trial registration:NCT04312295. [ABSTRACT FROM AUTHOR]

Background: Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. Research objectives: This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. Research design: Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after which an exploratory factor analysis was conducted. Participants: We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. Ethical considerations: This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. Findings: The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 – 'Understanding of the research', Factor 2 – 'Trust and confidence' and Factor 3 – 'Doubt and uncertainty'. The three factors accounted for is 52.954 of the total variance with Cronbach's α of.917. Discussion and conclusion: The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application. [ABSTRACT FROM AUTHOR]

The aim of the authors in this study was to identify factors associated with resilience that helped abused nurses face and cope with violent events. The data for this cross-sectional study were collected from June 2013 to December 2013; 272 participants were recruited from emergency rooms and psychiatric wards in four hospitals in central Taiwan. Among these participants, 230 (84.6%) met the inclusion criterion and completed all questionnaires; 69 (30%) of them reported having experienced only verbal violence; 46 (20%) reported having experienced only physical violence, and 115 (50%) reported having experienced a combination of verbal and physical violence. The following were positively associated with resilience score: having a college education or greater (exp(β) = 1.045,p =.018), extraversion (exp(β) = 1.012 per unit increase in the score,p <.001), family support (exp(β) = 1.004 per unit increase in the score,p =.031), peer support (exp(β) = 1.008 per unit increase in the score,p =.006), and lower level of neuroticism (exp(β) = 0.983 per unit increase in the score,p <.001); 43.6% of the variance in resilience was explained by the variables assessed. Adequate support and advanced education are important for abused nurses to enhance their resilience. [ABSTRACT FROM PUBLISHER]

This study examined encouraged and inhibited social feedback behaviors based on the theories of the buffering effect and the bystander effect. A system program was used to collect personal data and social feedback from a Facebook data set to test the research model. The results revealed that the buffering effect induced a positive relationship between social network size and feedback gained from friends when people's social network size was under a certain cognitive constraint. For people with a social network size that exceeds this cognitive constraint, the bystander effect may occur, in which having more friends may inhibit social feedback. In this study, two social psychological theories were applied to explain social feedback behavior on Facebook, and it was determined that social network size and social feedback exhibited no consistent linear relationship. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare the influence of a systematic nursing intervention on primary caregivers' knowledge and skills about nasogastric tube feeding and the number of nasogastric tube-related complications with that of routine nursing instructions Background To ensure the quality of care and reduce the incidence of complications, it is crucial that primary caregivers receive comprehensive health education about nasogastric tube feeding before hospital discharge. Design A quasi-experimental research with pretest/post-test evaluations. Methods The control group included 127 inpatients whose caregivers received routine education about nasogastric tube feeding, while the experimental group included 106 inpatients whose caregivers received systematic nursing intervention including comprehensive educational pamphlets and video education. The evaluation questionnaire included demographic variables, a nasogastric tube care knowledge scale, and a nasogastric tube skills assessment scale. The post-test was administered after the caregiver performed nasogastric tube feeding for the first time, and complications were noted at follow-up within three months of discharge. Results In terms of post-test knowledge and skills, the experimental group scored significantly higher than the control group, despite no difference in the pretests. In addition, the incidence rates for constipation, diarrhoea and abdominal distention were lower in the experimental group. Conclusions Systematic nursing intervention, including comprehensive educational pamphlets and video education, significantly improved the knowledge and skills of primary caregivers for nasogastric tube feeding. The increased ability of caregivers may have contributed to less incidence of complication. Relevance to clinical practice The results of this study underlined the importance of developing nasogastric tube-related nursing interventions and educational strategies for clinical nurses, home care nurses and caregivers. The research tool used here may serve as a reference for assessing the technical operations of healthcare professionals and the knowledge and skills of caregivers. [ABSTRACT FROM AUTHOR]

Purpose: This study explored (a) differences in sleep quality, depression, and stress among second- and third-trimester pregnant and nonpregnant women, and (b) relationships among depression, stress, and sleep quality of pregnant women in Taiwan. Design: Cross-sectional. Methods: A convenience sample of 150 second-trimester and 150 third-trimester pregnant women was recruited from two medical centers in Taiwan. A comparison group of 300 nonpregnant women was recruited by the acquaintance technique. Data were collected from October 2006 to September 2007 using a demographic form, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale, and Perceived Stress Scale. Findings: The prevalence of poor sleepers (PSQI score>5) was 60.0% for second- and third-trimester pregnant women and 48.0% for nonpregnant women. After controlling for significant covariates, pregnant women reported worse global sleep quality, habitual sleep efficiency, and sleep disturbances than nonpregnant women, and poorer sleep quality and sleep latency were most prevalent during their third trimester. A high prevalence of antenatal depression (27.3% to 36.0%) was found in pregnant women, depressed women had worse sleep quality than nondepressed women in all groups, and stress affected sleep quality in pregnant women but not in nonpregnant women. Conclusions: This cross-sectional study provides preliminary evidence that pregnant women suffer significantly more poor sleep quality than nonpregnant women, and that sleep quality of pregnant women was related to stress and depression. Clinical Relevance: Evaluation for sleep quality and depression should be part of routine prenatal check-ups. Information on women's sleep quality, stress, and depressive status can be used to individualize interventions for pregnancy-associated sleep disorder. [ABSTRACT FROM AUTHOR]

Abstract: Eleven red wines imported from foreign country and 40 domestic fruit wines, including 15 red wines, 4 white wines, 7 plum wines, and 14 other fruit wines, sold in the supermarkets in Taiwan were purchased and tested to determine the occurrence of biogenic amines and histamine-forming bacteria. The levels of pH, total soluble solids (TSS), titratable acidity (TA), reducing sugar (RS), total sugar (TS), sulphites, methanol (milligram per liter of pure ethanol), ethanol and Pb in all samples ranged from 3.0 to 4.1, 6.8 to 24.4 °Brix, 0.3 to 1.7g/100mL, 0.2 to 17.6g/100mL, 1.6 to 28.4g/100mL, <2 to 260.5mg/L, <1 to 2559mg/L, 5.0 to 15.6g/100mL and <1 to 46.2μg/L, respectively. The levels of TSS, TA, RS, and TS in plum wine samples were significantly higher than those of the other wines samples, whereas the pH value in plum wine samples was lower than that of the other wines samples. The average content for each of the nine biogenic amines in all samples was less than 5.2mg/L. However, higher levels of histamine and spermine were detected in domestic fruit wine samples than the imported red wine samples. Five histamine-forming isolates isolated from domestic red wine and jackfruit wine, capable of producing 13.0mg/L to 69.1mg/L of histamine in trypticase soy broth (TSB) supplemented with 2g/100mL l-histidine (TSBH) or MRS broth supplemented with 2g/100mL l-histidine (MRSH), were identified as Bacillus pumilus (one strain), Bacillus sp. (two strains) and Acetobacter pasteurianus (one strain) by 16S rDNA sequencing with PCR amplification, and Zygoascus hellenicus var. hellenicus (one strain) by internal transcribed spacer sequencing with PCR amplification. To our knowledge, this is the first report to demonstrate the occurrence of histamine-forming bacilli bacteria, acetic bacteria and yeast in fruit wine. [Copyright &y& Elsevier]

Objective: Menopause is a normal physiological process experienced by women, but it is often accompanied by physical and emotional symptoms that may negatively affect quality of life. This meta-analysis aimed to evaluate the effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms by examining randomized controlled trials.Methods: A systematic search was conducted across six electronic databases to collect relevant articles published up to June 30, 2020. The articles' quality was assessed using the modified Jadad scale. We performed a meta-analysis with Review Manager 5.3, calculating 95% confidence intervals and standardized mean differences, and conducted sensitivity analyses.Results: The meta-analysis of five randomized controlled trials included 475 participants. The results indicated that the mindfulness-based intervention groups showed significant improvements in total quality of life and vasomotor and physical quality of life, compared to control groups (standardized mean differences range: from -0.48 to -0.68, all ps < 0.05). After the sensitivity analyses, evidence of heterogeneity remained. Insufficient data prevented conducting a meta-analysis with the sexual subscale of MENQOL or on vasomotor symptoms of menopause.Conclusion: For menopausal women, mindfulness-based interventions may improve quality of life (except for psychological and sexual subscales). However, there is insufficient evidence to analyze whether such interventions can reduce vasomotor-related menopausal symptoms. Although heterogeneity should be carefully assessed, mindfulness-based interventions may be a novel approach for improving women's overall quality of life during menopause. However, further research is needed to verify these effects. [ABSTRACT FROM AUTHOR]

Abstract: An incident of food borne poisoning causing illness in 43 victims due to ingestion of swordfish fillets occurred in December, 2004, in Taichung Prefecture, central Taiwan. Eight frozen raw swordfish fillets were collected from the suspected restaurant and analyzed for bacterial content and histamine-related quality. The levels of aerobic plate count, total coliform, and total volatile basic nitrogen in all samples ranged from 5.39 to 6.71 logCFU/g, <3–1360 most probable number (MPN)/g, and 6.44–14.56mg/100g, respectively. None of these samples contained Escherichia coli. The suspected swordfish fillets contained 85.9–293.7mg/100g of histamine greater than the hazard action level of 50mg/100g set by the US. Food and Drug Administration (FDA) for tuna fish. Given the allergy-like symptoms of the victims and the high histamine content in the suspected swordfish fillets, this food borne poisoning was strongly suspected to be due to histamine intoxication. In addition, although ten histamine-producing bacteria strains, capable of producing 12.7–33.0ppm of histamine in trypticase soy broth supplemented with 1.0% l-histidine, were identified as Staphylococcus sp. (one strain), S. aureus (two strains) and S. aureus subsp. aureus (seven strains), by 16S rDNA sequencing with PCR amplification, they were not determined to be the main contributors to histamine accumulation in suspected swordfish fillets. [Copyright &y& Elsevier]

Abstract: Thirty-six natto products imported from Japan and three domestic natto products sold in the supermarkets in southern Taiwan were purchased and tested to determine the occurrence of histamine and histamine-forming bacteria. The levels of pH and aerobic plate count (APC) in all samples ranged from 4.9 to 7.3 and 7.8 to 11.2 log CFU/g, respectively. None of these samples contained total coliform and E. coli. Although the average content for each of the nine biogenic amines in all samples was less than 5mg/100g, seven of them (17.9%) had histamine content greater than 5mg/100g, allowable limit suggested by the US Food and Drug Administration for scombroid fish and/or product. Four histamine-producing bacterial strains capable of producing 13.4ppm to 17.5ppm of histamine in trypticase soy broth (TSB) supplemented with 1.0% l-histidine (TSBH) were identified as Bacillus subtilis (two strains) and Staphylococcus pasteuri (two strains) by 16S rDNA sequencing with PCR amplification. To our knowledge, this is the first report to demonstrate the occurrence of histamine-forming bacteria in natto products. [Copyright &y& Elsevier]

Background: Nurse practitioners (NPs) in Taiwan have practiced mainly in acute care hospitals since 2006. Although organizational support and level of support have been associated with the successful integration of NP roles and effective practice outcomes, organizational support in the context of NPs in inpatient settings is an area that has been rarely explored in the literature. Purpose: The purpose of this study was to investigate the relationship between organizational support and the practice outcomes of job satisfaction, care effectiveness, and intention to leave in NPs. Methods: A national survey of 512 NPs was conducted that included a demographic characteristics datasheet, the Nurse Practitioner Primary Care Organizational Climate Questionnaire, the Misener Nurse Practitioner Job Satisfaction Scale, and the Nurse Practitioner Care Effectiveness Scale. Multiple regression analysis was applied to explore the specific factors associated with job satisfaction. The statistical significance level was set at.05 with a two-tailed test. All statistical analyses were conducted using SPSS Statistics Version 22.0 software. Results: More than half of the participants were found to be dissatisfied with their hospital managers (54.8%) and with each dimension of organizational support. Overall, 82.1% of the participants were satisfied with their current practice. A multiple regression analysis showed that the participants who perceived higher levels of organizational support in the workplace (β =.53, p <.001), expressed satisfaction with working with their managers (β =.25, p <.001), or perceived better care outcomes (β =.10, p <.001) reported higher job satisfaction. In addition, the participants who expressed intention to leave within 1 year (β = −.09, p <.001) and those with higher patient loads (β = −.09, p <.001) reported lower job satisfaction. Organizational support was found to explain 50% of the variance in job satisfaction. Conclusions/Implications for Practice: The results of this study highlight organizational support as the most important factor affecting job satisfaction in NPs. Therefore, administrators work to promote organizational support and improve the work environment to enhance the job satisfaction, increase the clinical practice retention, and improve the care outcomes of NPs. [ABSTRACT FROM AUTHOR]

Objective: Mindfulness-based stress reduction (MBSR) is a potentially effective supplement for the treatment of insomnia; however, there is no comprehensive review of its mental health effects among insomnia patients. This study aimed to synthesize relevant quantitative evidence and evaluate MBSR application and effectiveness for insomnia patients' sleep quality and mental health.Methods: A systematic search through eight databases from the earliest available dates until August 2019 was conducted. Randomized controlled trials assessing the effects of MBSR on sleep quality, anxiety, and depression as outcome measures among insomnia patients comprising patients aged above 18 years were included in this meta-analysis. Each study's quality was assessed using the modified Jadad quality scale. The Review Manager 5.3 software was used to calculate the standardized mean differences (SMD) with 95% confidence intervals (CIs) for the data analyses.Results: In total, data for 497 patients in seven randomized controlled trials were analyzed. The results revealed that compared to the control group, the MBSR group significantly improved in sleep quality (SMD = -0.69, 95% CI: -1.12~ - 0.26, Z = 3.16, p = .002), depression (SMD = -1.83, 95% CI: -2.81-0.84, Z = 3.63, p < .001), and anxiety (SMD = -1.74, 95% CI: -2.90-0.59, Z = 2.96, p = .003). A sensitivity analysis was undertaken. After carefully reviewing included trials, we can reasonably conclude that these heterogeneities did not impair the overall effect size of MBSR in the results.Conclusions: MBSR significantly improved sleep quality and mental health. Future research is needed using standardized methods examining the long-term effects of MBSR on the mental health of individuals with insomnia. [ABSTRACT FROM AUTHOR]

Aim: To construct a model addressing the pathways from baseline diabetes distress, attribution of peer reactions, parenting style and 3‐month self‐management to 6‐month glycated haemoglobin levels in adolescents with type 1 diabetes. Design: A prospective design was adopted. Methods: A total of 177 adolescents aged 10–19 with type 1 diabetes were enrolled from four hospitals in Taiwan. Diabetes distress, attribution of peer reactions and parenting style were collected at baseline, self‐management was collected at the third month and glycated haemoglobin levels were collected at the sixth month. Data were collected from May 2015–June 2016. Results: Baseline diabetes distress and 3‐month self‐management directly affected 6‐month glycated haemoglobin levels. Baseline attribution of peer reactions directly affected baseline diabetes distress and 3‐month self‐management; also, it indirectly affected 6‐month glycated haemoglobin levels through 3‐month self‐management. Baseline parenting style directly affected baseline diabetes distress, baseline attribution of peer reactions, 3‐month self‐management and 6‐month glycated haemoglobin levels; it also indirectly affected 6‐month glycated haemoglobin levels through baseline diabetes distress and 3‐month self‐management. Conclusion: A model simultaneously incorporating individual, parental and peer factors to glycaemic control in adolescents with type 1 diabetes has been constructed. Improving diabetes distress and self‐management should be essential strategies to improve glycaemic control in adolescents with type 1 diabetes. Encouraging adolescents with type 1 diabetes to communicate openly with peers about diabetes care and educating their parents to provide more responsive and autonomy‐encouraging parenting style might be vital strategies to improve diabetes distress, 3‐month self‐management and glycaemic control. Impact: Individual, parental and peer factors should be simultaneously considered to improve glycaemic control in adolescents with type 1 diabetes. Nurses should evaluate these factors to tailor interventions improving glycaemic control in adolescents with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to develop and psychometrically test a new instrument for measuring nurse's positive energy of retention (NPER). Background: The shortage of professional nurses is an unresolved global issue. Few studies explored the issue of the retention of nurses in terms of a positive psychological viewpoint. Design: Methodological study. Methods: Data collection was from June 2016–August 2017. Nurses (N = 947) recruited from northern, central and southern Taiwan covering different levels of hospitals were divided into three samples, which were used for explaratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross‐validation respectively. Results: EFA resulted in a three‐factor solution: proactive and persevering characteristics, nursing professional identity and passion accounting for 61.8% of total variance. The proposed three‐factor model was confirmed by CFA. Cross‐validation provided further evidence for the construct validity of the NPER instrument with 24 items. Cronbach's alpha coefficient of three subscales of the instrument were 0.95, 0.89, and 0.92 separately and 0.96 for the total scale. Conclusion: Psychometric properties indicate that the newly formulated NPER instrument is a valid and reliable assessment tool to recruit nurses who are more likely to remain in nursing. Impact: The study addressed the personal intrinsic factors, which are very important for nurses' retention. The NPER instrument consisted of three subscales is a reliable and psychometrically valid new instrument. Managers could apply the NPER instrument to recruit nurses possessing the attributes of positive energy of retention. Furthermore, researchers could use the rigorous process provided in the study to establish a new instrument. [ABSTRACT FROM AUTHOR]

Aim: To identify the 'positive energy' that inspires nurses' retention in the profession. Background: Previous studies focused on the negative extrinsic factors associated with nurses leaving the profession. However, scant research explored the personal intrinsic essence regarding why nurses remain in the profession. Method: This study used a qualitative descriptive design. Ten focus groups including 53 participants were recruited by purposive sampling from five hospitals in Taiwan. Data were collected between March 2015 and January 2016 through semi‐structured focus group interviews. The data were examined by content analysis. Results: Six themes were identified, including sense of mission, achievement, passion, meaning of nursing, personal characteristics and intrinsic coping. Conclusion: Findings emerged from this study characterizing 'positive energy' as a steady inner strength, not easily changed with the external environment, which inspires the retention of staff nurses. Implications for Nursing Management: The themes identified in this study can be used to develop an instrument for assessing nurses' inner attributes which may help managers recruit nurses possessing 'positive energy' of retention. Future researchers may develop an intervention programme to cultivate nurses 'positive energy' and further test its effect on nurse retention. [ABSTRACT FROM AUTHOR]

Aim and objectives: This study aimed to determine the influence of work excitement, workplace violence and the violence prevention climate on professional commitment and turnover intention. Background: Workplace violence can easily cause the quality of nursing care to decline. Improvements in the working environment and working conditions can improve nurses' professional commitment and satisfaction. Design: A cross‐sectional multicentre study with convenience sampling was conducted. We have complied with the guidelines of STROBE Checklist in presenting this research. Methods: Out of 900 questionnaires, 696 were deemed valid for analysis (77.33%). This study collected data on sociodemographic information, experiences of workplace violence, professional commitment, work excitement, violence prevention climate and turnover intention. Results: The results show that professional commitment has a significant effect on turnover intention. Professional commitment positively influences work excitement, especially when the work is challenging and varied. It also indirectly influences turnover intention by generating work excitement. Workplace violence introduces an interactive moderating effect on the relationship between professional commitment and work excitement. A violence prevention climate changes the interactive moderating effect of workplace violence on professional commitment, which in turn influences turnover intention. Conclusions: Positive work experience, institutional organisational policies and support systems are the mediating and moderating factors in the relationship between professional commitment and turnover intention. Nurses expect organisations to maintain good staff relations, provide a positive working environment and learning opportunities and strengthen communication channels, all of which affect nurse retention. Relevance to clinical practice: Workplace violence is a serious crisis that can lead to turnover intention among hospital nurses. To enhance interpersonal relationships in the workplace and improve nurse retention, hospitals should schedule an adequate amount of staff and provide sufficient equipment and supplies to create a safe and positive work environment. [ABSTRACT FROM AUTHOR]

An immunosilver chromatographic strip based on a monoclonal antibody was developed for the detection of melamine (MEL) residues in milk and animal feed. Colloidal silver nanoparticles (AgNPs), of a diameter of approximately 10.4 nm, were surface-modified with trisodium citrate dehydrate (TSC) in order to improve their stability and dispersion. The anti-MEL monoclonal antibody (mAb) was successfully immobilized on the surface of AgNPs by ionic interactions and characterized using XRD, UV–Vis, TEM and XPS analyses. Surface modification of Ag-mAb conjugates with varying cross-reactivity and thermo-stability was employed to design and prepare labels for use in a lateral flow immunoassay (LFIA) to examine whether these factors affect the performance of the assay. The results showed that no cross-reactions with homologues cyanuric acid, ammeline or ammelide were found, and the test strip remained stable after storage for one year at room temperature. Under optimized conditions, a detection limit of 0.30 ppm for standard melamine was achieved, and limits of detection of 0.750 ppm and 0.875 ppm were obtained in milk and animal feed, respectively. • Colloidal Ag-based lateral flow immunoassay for the detection of melamine in food samples. • The limits of detection of optical density for melamine in liquid milk and animal feed were determined to be 0.15 and 0.075 ppm. • We demonstrated the binding mode and reaction mechanics between colloidal AgNPs and mAb using the XPS method. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners (NPs) play an important role in addressing growing health care needs. Among NPs, organizational empowerment is positively associated with overall practice outcomes. Therefore, efforts to promote organizational empowerment in practice are necessary to increase job satisfaction among NPs as well as decrease the stress and intention to leave. Purpose: This study investigated the relationships of organizational empowerment and practice outcomes of job satisfaction, work stress, and intention to leave in acute care practices. Methodological orientation: This study was conducted as a cross-sectional design with a national survey of 946 acute care NPs. Questionnaires contained demographic and practice characteristics, Misener Nurse Practitioner Job Satisfaction Scale, Condition for Work Effectiveness Questionnaire II, and the work stress VAS scale. Hierarchical Linear Model (HLM) was used to investigate individual NP-level or organization-level effects on job satisfaction. The factors associated with job satisfaction were examined by stepwise multiple regression. Results: The organizational empowerment was low, work stress was moderately high, and job satisfaction was between slightly unsatisfied and slightly satisfied. The HLM results indicated that organization-level effects did not affect the job satisfaction of NPs. Nurse practitioners with greater formal power, resources, and informal power had higher job satisfaction. Conversely, NPs with an intention to leave and a higher level of stress showed lower job satisfaction. Conclusions: Organizational empowerment, intention to leave, and stress affect job satisfaction of acute care NPs in Taiwan. Implications for practic: To enhance the job satisfaction of NPs, health care administrators should empower NPs by providing access to opportunity, support, information, and resources in the health care delivery system. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether early oral intake after cesarean delivery has an effect on gastrointestinal outcomes during postpartum recovery.Data Sources: Electronic searches of published studies between 1980 and 2011 were conducted using PubMed, Medline, CINAHL, ClinicalTrials.gov, and Airiti databases.Methods Of Study Selection: Randomized controlled trials (RCTs) and nonrandomized trials were included. Data were extracted in a systematic manner and the quality of each study was appraised independently by two reviewers. Meta-analyses were conducted only for RCTs using the RevMan5.Tabulation, Integration, and Results: Seventeen studies met eligible criteria and were retrieved, including 14 RCTs and three non-RCTs. The majority of early oral intake was provided within 6-8 hours after cesarean delivery. Early oral intake was significantly related to the return of gastrointestinal functions compared with delayed oral intake (bowel sounds -9.2 hours; passage of flatus -10 hours; bowel evacuation -14.6 hours). Early oral intake did not significantly increase the occurrence of gastrointestinal complications compared with delayed oral intake after cesarean delivery (ileus symptoms 18.7% compared with 18%, odds ratio [OR] 0.98; vomiting 5% compared with 5.5%, OR 0.9; nausea 10.3% compared with 10.3%, OR 1.03; abdominal distention 9.3% compared with 11.6%, OR 0.82; diarrhea 3.4% compared with 5%, OR 0.62).Conclusion: Early oral intake after cesarean delivery improves the return of gastrointestinal function and does not increase the occurrence of gastrointestinal complications. A clinical implication based on the findings of the current evidence is proposed. [ABSTRACT FROM AUTHOR]

Abstract: Seven soybean and 19 black bean douchi products sold in the supermarkets in southern Taiwan were purchased and tested to determine the occurrence of histamine and histamine-forming bacteria. The levels of pH, salt content, water content, yeast and mold, and aerobic plate count (APC) in all samples ranged from 4.7 to 5.9, 4.4% to 14.0%, 6.8% to 51.6%, 3.0 to 5.1logCFU/g, and 5.2 to 9.2logCFU/g, respectively. None of these samples contained total coliform and Escherichia coli. Although black bean douchi products had an average histamine content of 29.0mg/100g, 18 of them had histamine contents greater than 5mg/100g, the allowable level set by the US Food and Drug Administration (FDA) for scombroid fish and/or products. In contrast, only four soybean douchi products had histamine levels greater than 5mg/100g. Among the black bean samples, four contained histamine at 56.3, 62.1, 80.2 and 80.8mg/100g, that are above the 50mg/100g hazard action level. Eight histamine-forming bacterial strains, capable of producing 11.7–601ppm of histamine in trypticase soy broth (TSB) supplemented with 1% l-histidine (TSBH), were identified as Bacillus subtilis (four strains) Staphylococcus pasteuri (one strain) and Staphylocuccus capitis (three strains) by 16S rDNA sequencing with PCR amplification. S. capitis, which was previously reported to be halotolerant, was a potent histamine-former capable of producing more than 500ppm of histamine in TSBH in the presence of 0.5–10% NaCl. [Copyright &y& Elsevier]

Abstract: Twelve white and ten brown sufu products sold in the supermarkets in southern Taiwan were purchased and tested to determine the occurrence of histamine and histamine-forming bacteria. The levels of pH, salt content, and aerobic plate count (APC) in all samples ranged from 4.6 to 6.6, 6.2% to 12.0%, and 3.0 to 7.9logCFU/g, respectively. None of these samples contained total coliform and Escherichia coli. Although the average content for each of the nine biogenic amines in all samples was less than 5mg/100g, only one brown sufu sample had histamine content (15.8mg/100g) greater than the 5.0mg/100g allowable limit suggested by the US Food and Drug Administration. Two histamine-producing bacterial strains capable of producing 1.33mg/100ml and 1.34mg/100ml of histamine in trypticase soy broth (TSB) supplemented with 1.0% l-histidine (TSBH) were identified as Bacillus subtilis by 16S rDNA sequencing with PCR amplification. [Copyright &y& Elsevier]

Background: Our previous ex vivo study has shown that autofluorescence spectroscopy at 330-nm excitation can discriminate specimens of normal buccal pouch mucosa (normal), epithelial hyperkeratosis (hyperkeratosis), epithelial dysplasia (dysplasia), and squamous cell carcinoma (SCC) taken from DMBA-treated hamsters by using the method of partial least-squares discriminant analysis (PLSDA).Methods: This study used a fiber optics-based fluorescence spectroscopy system to measure the autofluorescence spectra of 23 normal, 14 hyperkeratosis, 28 dysplasia, and 10 SCC samples in vivo. PLSDA with cross-validation was used to analyze the autofluorescence spectral data of all samples.Results: We found that at 330-nm excitation, the autofluorescence spectra of all samples had two main peaks: one at 380 nm and the other at 460 nm. The hyperkeratosis samples had a higher 380-nm emission peak (EP) and a lower 460-nm EP than normal samples. On the contrary, the dysplasia samples had a lower 380-nm EP and a higher 460-nm EP than normal samples. Furthermore, the SCC samples had a much lower 380-nm EP and a much higher 460-nm EP than all other samples. To quantify the spectral changes during the progression of oral carcinogenesis, ratios of the area under the spectrum of 380 +/- 15 nm to that under the spectrum of 460 +/- 15 nm (denoted as A(380 +/- 15 nm)/A(460 +/- 15 nm)) for all samples were calculated. The mean ratio values of A(380 +/- 15 nm)/A(460 +/- 15 nm) decreased gradually from hyperkeratosis to normal, to dysplasia, and to SCC samples. Significant differences in this mean ratio were found between any two groups of normal, hyperkeratosis, dysplasia, and SCC samples. By choosing proper thresholds, PLSDA with cross-validation could provide an accurate identification rate of 86% for hyperkeratosis, of 87% for normal, and of 89% for dysplasia samples. In addition, by choosing a proper threshold, we could separate benign (normal and hyperkeratosis) from dysplasia or SCC tissues with a sensitivity of 92% and a specificity of 95%.Conclusion: Our results indicate that the autofluorescence spectroscopy technique is a useful diagnostic tool for in vivo diagnosis of oral pre-cancers and cancers in DMBA-induced hamster buccal pouch carcinogenesis model. [ABSTRACT FROM AUTHOR]

The clinical efficacy of ticagrelor versus clopidogrel has not been replicated in East Asian populations. The pronounced bleeding risk with ticagrelor was of concern given the increased bleeding tendency in Asian populations. This study evaluated efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction (NSTEMI) in the entire Taiwan. We used the Taiwan National Health Insurance Research Database to identify 6203 patients aged ≥ 20 years with NSTEMI hospitalization and prescription of dual antiplatelets at discharge between January 2014 and December 2014. Cohorts of ticagrelor and clopidogrel were matched 1:1 based on propensity score matching to balance baseline covariates. The primary composite efficacy endpoints included death from any cause, non-fatal myocardial infarction, and non-fatal stroke. The secondary efficacy endpoints were the individual components. The primary safety endpoint was major bleeding requiring hospitalization. The incidence of primary efficacy endpoint was 20.3% in the ticagrelor users and 20.7% in the clopidogrel users (adjusted HR 0.94; 95% CI 0.73–1.22), with the median (interquartile range, IQR) follow-up period of 5.2 (2.3–8.5) months. The incidence of primary safety endpoint was 2.3% in the ticagrelor users and 3.2% in the clopidogrel users (adjusted HR 0.67; 95% CI 0.33–1.35). Regarding the secondary efficacy endpoint, patients treated with ticagrelor had significantly lower incidence of stroke (adjusted HR 0.44; 95% CI 0.21–0.94; p = 0.033). In this nationwide Taiwanese cohort of NSTEMI, treatment with ticagrelor after discharge, as compared to clopidogrel, had similar rates of ischemic composite events and major bleeding. Nevertheless, the median follow-up time was only 5.2 months, and the reduced stroke events with ticagrelor compared to clopidogrel needs further verification. [ABSTRACT FROM AUTHOR]

The clinicopathological significance of altered SWI/SNF complex has not been well evaluated in gastric cancer (GC). We examined SMARCA2, SMARCA4, SMARCB1 and ARID1A expression by immunohistochemistry in 1224 surgically resected GCs with subtyping into Epstein-Barr virus (EBV), microsatellite instability (MSI) and non-EBV/MSI Lauren histotypes. SWI/SNF mutations were investigated using the GC dataset of the TCGA Pan-Cancer Atlas. Clinicopathological association was assessed by statistical analysis. There were 427 cases (35%) of SWI/SNF-attenuated GC, including 344 SMARCA2 (28%), 28 SMARCA4 (2%), 11 SMARCB1 (1%) and 197 ARID1A (16%) cases. Simultaneous alterations of multiple subunits were observed. Compared to SWI/SNF-retained cases, SWI/SNF-attenuated GC exhibited a significant predilection to older ages, EBV and MSI genotypes, higher lymphatic invasion and less hematogenous recurrence (P < 0.05). SWI/SNF attenuation was an independent risk factor for short overall survival (P = 0.001, hazard ratio 1.360, 95% confidence interval 1.138–1.625). The survival impact stemmed from SMARCA2-attenuated GCs in stage III and non-EBV/MSI diffuse/mixed subtypes (P = 0.019 and < 0.001, respectively). ARID1A-lost/heterogeneous GCs were more aggressive in the EBV genotype (P = 0.016). SMARCB1 or SMARCA4 loss was not restricted to rhabdoid/undifferentiated carcinoma. In the TCGA dataset, 223 of 434 GCs (52%) harbored deleterious SWI/SNF mutations, including ARID1A (27%), SMARCA2 (9%), ARID2 (9%), ARID1B (8%), PBRM1 (7%), and SMARCA4 (7%). SWI/SNF-mutated GCs displayed a favorable outcome owing to the high percentage with the MSI genotype. In conclusion, SWI/SNF-altered GCs are common and the clinicopathological significance is related to the genotype. [ABSTRACT FROM AUTHOR]

This qualitative study was designed to identify patients’ experiences and perceptions related to living with late-stage chronic kidney disease. Interviews were held for 15 patients with late-stage chronic kidney disease from two medical centers in Taiwan. Five themes were identified using content analysis: experiencing moderate to severe symptoms and signs; tracing back to causes; realizing the long-term, irreversible nature of the disease; facing the consequence of unavoidable deterioration; and coping with the disease. The findings present the special lived experiences of Taiwanese chronic kidney disease patients and highlight the need for healthcare providers to assess patients’ illness representation before offering interventions for patients coping with chronic kidney disease. [ABSTRACT FROM AUTHOR]

Aim and objectives. This correlation study examined the relationship among recently workplace violence, depressive tendency, social support, and resilience of victimised nurses, and we also tried to identify protective factors and potential targets for preventive interventions for these nurses. Background. Workplace violence in hospitals negatively affects occupational health and safety of medical professionals, especially for emergency department nurses. Design. A cross-sectional, correlation research design was applied. Methods. Hierarchical regression was used to examine data which were collected from June 2013 to December 2013 from emergency departments in Taiwan. One hundred and eighty nurses were recruited from two hospitals. Structured interviews and questionnaires were applied to collect data, including the Social Support Scale, the Resilience Scale and the Center for Epidemiologic Studies Depression. Results. A total of 159 (88-33%) nurses had suffered from physical or verbal violence by patients or their family. Resilience and peer support were significantly higher in the group without depressive tendency. Components of resilience of personal strength, social competence, structure style and religious beliefs were significant factors which accounted for 46-0% of variance in depressive tendency. Three of the five components of resilience: personal strength, social competence and structured style were found to have profounder effects against depressive tendency than peer support. Conclusions. Hospital managers should establish a safer working environment for emergency department nurses and reinforce their resilience against depression when they encounter workplace violence. Relevance to clinical practice. This study showed that three of the five components of resilience: personal strength, social competence and structured style are protective factors against depressive tendency in victimised nurses. Improving these three components with coping and problem-solving skills by healthcare manager would be effective measures for enhancing their resilience in situations of workplace violence. [ABSTRACT FROM AUTHOR]

Purpose This study investigated the relationship among personality traits, social network integration (SNI), and resilience in emergency department (ED) nurses who had suffered from physical or verbal violence by patients or their families. Design and Methods A cross-sectional study with convenience sampling was conducted for exploring the related factors of resilience on abused nurses. A total of 187 participants met our inclusion criteria and completed all questionnaires. Findings Higher degrees of extraversion and peer support were associated with greater resilience among all abused nurses, whereas neuroticism was inversely associated with their resilience. Conclusions Among all forms of SNI, only peer support was shown to enhance an individual's resilience. In addition, personality traits were associated with resilience, and religions did not play an important role in enhancing resilience among our participants. Clinical Relevance Through a clearer understanding of the role of peer support in resilience among ED nurses, healthcare managers should provide and enhance their peer support to intensify their resilience for prevention of consequences of workplace violence. [ABSTRACT FROM AUTHOR]

In-hospital bleeding (IHB) is associated with the risk of subsequent cardiovascular events (CVE) in acute coronary syndrome (ACS). We investigated whether increased risk of CVE by IHB is influenced by chronic kidney disease (CKD) or both have detrimental effects on CVE. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of <60 ml/min per 1.73 m. The primary end point is the composite of death, non-fatal myocardial infarction and non-fatal stroke at 12 months. 53 (1.88 %) and 949 (33.7 %) patients suffered from IHB and CKD, respectively. Both IHB and CKD are independently associated with increased risk of the primary end point (HR 2.04, 95 % CI 1.05-3.99, p = 0.037 and HR 2.17, 95 % CI 1.63-2.87, p < 0.01, respectively). The Kaplan-Meier curves show significantly higher event rates among those with IHB and CKD in the whole, ST-elevation and non-ST elevation populations (all p < 0.01). Patients with IHB(+)/CKD(−), IHB(−)/CKD(+) and IHB(+)/CKD(+) have 1.88-, 2.13- and 2.98-fold risk to suffer from the primary end point compared with those without IHB and CKD ( p = 0.23, <0.01 and <0.01, respectively). IHB or CKD is independently associated with poor cardiovascular outcome and patients with both IHB and CKD have the worst outcome in ACS. [ABSTRACT FROM AUTHOR]

Background: The efficacy of clopidogrel is inconclusive in the chronic kidney disease (CKD) population with acute coronary syndrome (ACS). Furthermore, CKD patients are prone to bleeding with antiplatelet therapy. We investigated the efficacy and safety of clopidogrel in patients with ACS and CKD. Methods: In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m2. The primary endpoints are the combined outcomes of death, non-fatal myocardial infarction and stroke at 12 months. Results: Overall 949 (33.7%) patients had CKD and 2660 (94.36%) patients received clopidogrel treatment. CKD is associated with increased risk of the primary endpoint at 12 months (HR 2.39, 95% CI 1.82 to 3.15, p<0.01). Clopidogrel use is associated with reduced risk of the primary endpoint at 12 months (HR 0.42, 95% CI: 0.29–0.60, p<0.01). Cox regression analysis showed that clopidogrel reduced death and primary endpoints for CKD population (HR 0.35, 95% CI: 0.21–0.61 and HR 0.48, 95% CI: 0.30–0.77, respectively, both p<0.01). Patients with clopidogrel(−)/CKD(−), clopidogrel(+)/CKD(+) and clopidogrel(−)/CKD(+) have 2.4, 3.0 and 10.4 fold risk to have primary endpoints compared with those receiving clopidogrel treatment without CKD (all p<0.01). Clopidogrel treatment was not associated with increased in-hospital Thrombolysis In Myocardial Infarction (TIMI) bleeding in CKD population. Conclusion: Clopidogrel could decrease mortality and improve cardiovascular outcomes without increasing risk of bleeding in ACS patients with CKD. [ABSTRACT FROM AUTHOR]

Abstract: Objective: It is not clear whether the prognostic value of pretreatment serum CA125 levels is independent or through association with other clinicopathological features in endometrial cancer. Methods: All patients with endometrial cancer treated between 2000 and 2010 were retrospectively reviewed. The correlation of clinicopathological characteristics, CA125 and treatment outcomes was analyzed. Receiver operating characteristics (ROC) curves were used to determine the CA125 cut-off values. Cox proportional hazard regression was used for multivariate analysis. Results: Of the 923 eligible patients, 757 had serum CA125 levels measured before treatment. We identified 264 (34.9%) patients with pretreatment serum CA125>35U/mL. By multivariate analysis, advanced stage (P =0.001), serous or clear cell carcinoma (P =0.008), positive peritoneal cytology (P =0.042), and lymph node metastases (P =0.004) were significant risk factors for cancer-specific survival (CSS), while serum CA125>35U/mL (P =0.067) was of borderline statistical significance. Using ROC curve stratified by age, we found that a serum CA125>35U/mL was significant for CSS (HR=2.34, 95% CI=1.04–5.29) among patients >49years old. After adjustment for confounding factors, serum CA125>105U/mL was significant (HR=6.03, 95% CI=1.19–30.63) in patients ≤49years old. Conclusions: These results suggest that an age-stratified cut-off level for CA125 (35U/mL in patients >49years old and 105U/mL in patients ≤49years old) can improve the prognostic stratification of patients with endometrial cancer. [Copyright &y& Elsevier]

Abstract: Background: Our aims were to evaluate the genotype distribution of human papillomavirus (HPV) and the correlation between HPV parameters and clinicopathological/treatment variables with prognosis in cervical adeno-adenosquamous carcinoma (AD/ASC). Patients and methods: Consecutive patients who received primary treatment for cervical AD/ASC International Federation of Gynecology and Obstetrics (FIGO) stages I–IV between 1993 and 2008 were retrospectively reviewed. Prognostic models were constructed and followed by internal validation with bootstrap resampling. Results: A total of 456 AD/ASC patients were eligible for HPV genotyping, while 452 were eligible for survival analysis. HPV18 was detected in 51.5% and HPV16 in 36.2% of the samples. Age >50years old, FIGO stages III–IV and HPV16-negativity were significantly related to cancer relapse, and age >50, FIGO stages III–IV, HPV16-negativity and HPV58-positivity were significant predictors for cancer-specific survival (CSS) by multivariate analyses. HPV16-positivity was also significantly associated with good prognosis in those receiving primary radiotherapy or concurrent chemoradiation (RT/CCRT) (CSS: hazard ratio 0.41, 95% confidence interval 0.21–0.78). Patients with FIGO stages I–II and HPV16-negative AD/ASC treated with primary RH-PLND had significantly better CSS (p <0.0001) than those treated with RT/CCRT. Conclusions: Age >50years old, FIGO stages III–IV and HPV16-negativity were significant poor prognostic factors in cervical AD/ASC. Patients with HPV16-negative tumour might better be treated with primary surgery (e.g. radical hysterectomy for stages I–II and pelvic exenteration for stage IVA). Those with unresectable HPV16-negative tumour (stage IIIB) should undergo CCRT in combination with novel drugs. The inferences of a single-institutional retrospective study require prospective studies to confirm. [Copyright &y& Elsevier]

Aims. To report a study examining the relationships among coping, anxiety and resilience and to identify predictors of anxiety and resilience in adolescents undergoing cancer treatment. Background. Anxiety is the main psychological disturbance in adolescents with cancer, but predictors in the context of anxiety related cancer treatments have not been investigated. Design. Cross-sectional study. Methods. Adolescents ( n = 131) recruited from three medical centres between 2010-2011. The eligible participants were diagnosed with cancer, without mental disease and receiving chemotherapy. Participants were assessed with the paediatric cancer coping scale, revised children's manifest anxiety scale, second edition, and the Haase adolescent resilience in illness scale. Results. Over 20% of participants scored high on worry. The most commonly used coping strategy was cognitive coping, followed by problem-oriented coping and finally by defensive coping. There was a statistically significant correlation between defensive coping and level of worry. Resilience was positively correlated with cognitive coping and problem-oriented coping. The cognitive coping and defensive coping were found to predict anxiety and resilience significantly by a step-wise multiple regression analysis and accounted for 40·9% and 46·5% of total variance, respectively. Conclusions. Cognitive coping and defensive coping are predictors for the level of anxiety and resilience in adolescents undergoing cancer treatment. Health providers should evaluate coping behaviour in patients and work towards a cognitive and problem-oriented coping style that will benefit the patient's mental health during treatment. [ABSTRACT FROM AUTHOR]

While the new disease-specific self-efficacy scale for early CKD appears to be a promising new tool (…), additional evaluation is needed to further refine it.Background Self-management has been associated with positive health outcomes among adults with chronic kidney disease (CKD). Perceived disease-related self-efficacy (DSE) is considered a critical component in the successful self-management of chronic disease. A valid and reliable instrument for measuring CKD patients' self-efficacy is needed. This study aims to develop and test a new instrument to measure the DSE of patients with early stage CKD. Methods A total of 594 Taiwanese patients with early stage CKD recruited from two medical centers and one regional hospital in southern Taiwan completed the questionnaire. The CKD self-efficacy (CKD-SE) was evaluated using exploratory factor analyses (EFA) and measures of reliability. Results EFA identified four distinct factors with loadings ranging from 0.557 to 0.970: autonomy, self-integration, problem solving and seeking social support, accounting for 64.348% of the total variance. Cronbach's alpha coefficients for the subscales ranged from 0.843 to 0.901. Conclusion This promising 25-item CKD-SE instrument can be used for the early identification of patients with low DSE, thus allowing the development of interventions to help these patients attain an appropriate level of DSE. [ABSTRACT FROM PUBLISHER]

Background: Current tuberculosis (TB) reporting protocols are insufficient to achieve the goals established by the Stop TB partnership. Some countries have recommended implementation of active case finding program. We assessed the effect of Cough Officer Screening (an active screening system) on the rate of TB detection and health care system delays over the course of four years.Methods: Patients who were hospitalized at the Changhua Christian Hospital (Changhua, Taiwan) were enrolled from September 2004 to July 2006 (Stage I) and August 2006 to August 2008 (Stage II). Stage II was implemented after a Plan-Do-Check-Act (PDCA) cycle analysis indicated that we should exclude ICU and paediatric patients.Results: In Stage I, our COS system alerted physicians to 19,836 patients, and 7,998 were examined. 184 of these 7,998 patients (2.3%) had TB. Among these 184 patients, 142 (77.2%) were examined for TB before COS alarming and 42 were diagnosed after COS alarming. In Stage II, a total of 11,323 patients were alerted by the COS system. Among them, 6,221 patients were examined by physicians, and 125 of these patients (2.0%) had TB. Among these 125 patients, 113 (90.4%) were examined for TB before COS alarming and 12 were diagnosed after COS alarming. The median time from COS alarm to clinical action was significantly less (p = 0.041) for Stage I (1 day; range: 0-16 days) than for Stage II (2 days; range: 0-10 days).Conclusion: Our COS system improves detection of TB by reducing the delay from infection to diagnosis. Modifications of scope may be needed to improve cost-effectiveness. [ABSTRACT FROM AUTHOR]

Abstract: An incident of food-borne poisoning, causing illness in three victims due to ingestion of dried milkfish, occurred in February, 2006, in Tainan Prefecture, southern Taiwan. The leftovers of the victims’ dried milkfish and three other dried milkfish samples, from the same retail store as the leftover fish, were collected and tested to determine the occurrence of histamine and histamine-forming bacteria. The levels of pH, aerobic plate count (APC) and total volatile basic nitrogen (TVBN) in the leftover dried milkfish sample were significantly higher than those of the other three milkfish samples. None of the tested milkfish samples contained total coliform and Escherichia coli. Although the histamine contents in the three other milkfish samples were less than 5mg/100g, the suspected milkfish sample contained 61.6mg/100g of histamine, which is greater than the hazard action level of 50mg/100g. Given the allergy-like symptoms of the victims and the high histamine content in the suspected milkfish sample, this food-borne poisoning was strongly suspected to be due to histamine intoxication. Four histamine-producing bacterial strains, capable of producing 11.9–1243ppm of histamine in trypticase soy broth supplemented with 1.0% l-histidine (TSBH), were identified as Staphylococcus sciuri subsp. sciuri, Serratia grimesii, Bacillus cereus and Raoultella ornithinolytica, by 16S rDNA sequencing with PCR amplification. R. ornithinolytica was a potent histamine-former capable of producing more than 800ppm of histamine in TSBH in the presence of 1.5% or 3.5% NaCl. Therefore, R. ornithinolytica could be the causative bacterium responsible for the production of high content of histamine that eventually led to this dried milkfish poisoning incident. [Copyright &y& Elsevier]

Ralstonia taiwanensis is a root nodule bacterium originally isolated from Mimosa sp. in southern Taiwan. Some strains of R. taiwanensis demonstrated the ability to grow on medium containing phenol as the sole carbon source, especially strain TJ86, which was able to survive and grow at phenol concentrations of up to 900 mg/l. The dependence of the phenol degradation rate on the phenol concentration can be described by Haldane''s model with a low KS (the apparent half-saturation constant) of 5.46 μM and an extremely high KSI (the apparent inhibition constant) 9075 μM. The optimal phenol degradation rate was 61 μmol/min/g cell, which occurred at a phenol concentration of 228 μM. The phenol-limited growth kinetics of TJ86 by Andrews''s model also followed a similar trend to that of phenol degradation, indicating the close links between phenol degradation and cell growth. Strain TJ86 also achieved 100 and 40% degradation for soil samples amended with 500 and 1000 μg phenol/g soil (dry weight) within 9 days, respectively. Moreover, strain TJ86 cometabolically degraded trichloroethene (TCE) after being cultivated with media containing phenol or m-cresol as the carbon substrate. The sequence of the large-subunit phenol hydroxylase (LmPH) gene obtained from TJ86 displayed high homology to that of other phenol-utilizing bacteria. Results from kinetic and phylogenetic analyses suggest that strain TJ86 most likely belongs to group I phenol-degrading bacteria which are considered to be efficient TCE degraders. It is proposed that the symbiotic relationship between rhizobia R. taiwanensis and its host plant Mimosa sp. may have the potential for rhizoremediation of aquatic and soil environments contaminated by phenol and TCE. [Copyright &y& Elsevier]

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses'' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses'' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7–86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education. [Copyright &y& Elsevier]

Background: The utility of muscle health for predicting asymptomatic vertebral fracture (VF) is uncertain. We aimed to determine the effects of muscle health on bone quantity and quality in the older adults and to integrate these factors into a predictive model for VF. Methods: We prospectively recruited participants with a body mass index <37 kg/m2. The total lean mass (TLM), appendicular skeletal muscle index, presence of sarcopenia, and bone mineral density were determined by dual-energy X-ray absorptiometry, and bone quality by the trabecular bone score (TBS). VF was diagnosed based on spine radiography. Results: A total of 414 females and 186 males were included; 257 participants had VF. Lower TLM was significantly associated with poorer bone quantity and quality in both males and females. A low TBS (OR: 11.302, p = 0.028) and sarcopenia (Odds ratio (OR): 2.820, p = 0.002) were significant predictors of VF in males, but not bone quantity. Moreover, integrating TBS and sarcopenia into the predictive model improved its performance. Conclusions: Although TLM was associated with bone quantity and quality in both sexes, sarcopenia and a low TBS were significant predictors of asymptomatic VF only in male participants. [ABSTRACT FROM AUTHOR]

A silver nanoparticle (AgNP)-based sandwich-type lateral flow immunoassay (LFIA) was evaluated for rapid detection of Staphylococcal enterotoxin B (SEB) in milk and honey. The role of trisodium citrate dihydrate (TSC) in the formation of Ag/TSC nanoparticles was established using UV–Vis spectroscopy. The association of silver with TSC in Ag/TSC nanoparticles was studied by the decrease in the intensity of anodic peak potential at 0.47 V and shift to 0.30 V in cyclic voltammetry (CV). The morphological, compositional and interaction studies of the AgNPs conjugated with the anti-SEB polyclonal antibody (Ag-sAb) was established using transmission electron microscopy (TEM) and X-ray photo electron spectroscopy (XPS) measurements. The visible detection limit and optical detection limit of the SEB test strip were 0.5 and 0.125 ppm, respectively, in SEB standard solution. This assay showed no cross-reaction with Staphylococcal enterotoxin A, Staphylococcal enterotoxin C or Salmonella typhi. Finally, the SEB test strip was effectively applied for the detection of SEB in spiked liquid milk and viscous honey, with optical detection limits of 0.25 and 0.5 ppm, respectively. Schematic illustration of citrate and the anti- Staphylococcal enterotoxin B polyclonal antibody conformation on the surface of silver nanoparticle. Unlabelled Image • Ag-based lateral flow immunoassay was evaluated for detection of Staphylococcal enterotoxin B. • The binding mode of Ag and antibody using FTIR and X-ray photoelectron spectroscopy method • ImageJ software was analyzed the optical densities of the test line and control lines. • The optical detection limits in liquid milk and viscous honey were 0.25 and 0.5 ppm. [ABSTRACT FROM AUTHOR]

(1) Background: A functional shunt is critical to hemodialysis, but the ideal timing of shunt cannulation is still not established. In this study, we assessed the association between ideal puncture timing and shunt survival. (2) Methods: This retrospective cohort study using data from the Taiwan Health and Welfare database, which included 26885 hemodialysis patients with arteriovenous fistulas from 1 July 2008 to 30 June 2012. Fistulas were categorized by functional maturation time, defined as the time from the date of shunt construction to the first successful cannulation. Functional cumulative survival, measured as the duration from the first puncture to shunt abandonment, was mainly regarded. (3) Results: The fistulas created between 91 and 180 days prior to the first cannulation had significantly greater cumulative functional survival (HR 0.883; 95% CI 0.792–0.984), and there was no more benefit on their survival from waiting more than 180 days (HR 0.957; 95% CI 0.853–1.073) for shunt maturity. (4) Conclusions: Our results showed that to achieve better long-term shunt survivals, fistulas should be constructed at least 90 days before starting hemodialysis. Notably, there was no additional benefit on waiting more than 180 days prior to cannulation. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study aims to develop a valid and reliable chronic kidney disease self-management instrument (CKD-SM) for assessing early stage chronic kidney disease patients' self-management behaviours. Background. Enhancing early stage chronic kidney disease patients' self-management plays a key role in delaying the progression of chronic kidney disease. Healthcare provider understanding of early stage chronic kidney disease patients' self-management behaviours can help develop effective interventions. A valid and reliable instrument for measuring chronic kidney disease patients' self-management behaviours is needed. Design. A cross-sectional descriptive study collected data for principal components analysis with oblique rotation. Methods. Mandarin- or Taiwanese-speaking adults with chronic kidney disease ( n = 252) from two medical centres and one regional hospital in Southern Taiwan completed the CKD-SM. Construct validity was evaluated by exploratory factor analysis. Internal consistency and test-retest reliability were estimated by Cronbach's alpha and Pearson correlation coefficients. Results. Four factors were extracted and labelled self-integration, problem-solving, seeking social support and adherence to recommended regimen. The four factors accounted for 60·51% of the total variance. Each factor showed acceptable internal reliability with Cronbach's alpha from 0·77-0·92. The test-retest correlations for the CKD-SM was 0·72. Conclusion. The psychometric quality of the CKD-SM instrument was satisfactory. Research to conduct a confirmatory factor analysis to further validate this new instrument's construct validity is recommended. Relevance to clinical practice. The CKD-SM instrument is useful for clinicians who wish to identify the problems with self-management among chronic kidney disease patients early. Self-management assessment will be helpful to develop intervention tailored to the needs of the chronic kidney disease population. [ABSTRACT FROM AUTHOR]