The new X-ray absorption fine-structure beamline with sub-second time resolution at the Taiwan Photon Source.

The new TPS 44A beamline at the Taiwan Photon Source, located at the National Synchrotron Radiation Research Center, is presented. This beamline is equipped with a new quick-scanning monochromator (Q-Mono), which can provide both conventional step-by-step scans (s-scans) and on-the-fly scans (q-scans) for X-ray absorption fine-structure (XAFS) spectroscopy experiments, including X-ray absorption near-edge structure (XANES) and extended X-ray absorption fine-structure (EXAFS) spectral measurements. Ti and Te K-edge XAFS spectra were used to demonstrate the capability of collecting spectra at the limits of the working energy range. The Ni and Cu K-edge XAFS spectra for a Cu-doped Pt/Ni nanocomposite were acquired to test the performance of the newly commissioned beamline. Pt L3- and Ru K-edge quick-scanning XAFS (QXAFS) spectra for standard Pt and Ru foils, respectively, revealed the stability of the q-scan technique. The results also demonstrated the beamline's ability to collect XAFS spectra on a sub-second timescale. Furthermore, a Zn(s)|Zn2+(aq)|Cu(s) system was tested to indicate that the states of the Zn electrode could be observed in real time for charging and discharging conditions using an in situ/operando setup combined with QXAFS measurements.

Evaluation of Electronic Health Records on the Nursing Process and Patient Outcomes Regarding Fall and Pressure Injuries.

Digitalizing the nursing process has become a trend in medical care. The purpose of this study was to evaluate implementation of the Standardized Computerized Nursing Process Documentation System and patient outcomes. We analyzed hospitalized patients' electronic health record database with a total of 19 659 patients in 2015. The analysis focused on nurses' selection of nursing care plans for patients with a high risk of falls or pressure injuries through admission assessments. The effectiveness of implemented nursing care plans following falls or pressure injuries was explored. The results reveal that 55% of the hospitalized patients had a risk of falling, and 27.85% of patients were at risk of pressure injuries. Patients receiving nursing care plan who experienced falls or pressure injuries were significantly higher than those without a nursing care plan (P < .001). This study could not provide direct evidence for the effect of nursing care plans on reducing the incidence of falls and pressure injuries, which may be attributable to patient characteristics. Furthermore, an analysis on data from 2007 to 2017 using a run chart revealed that the mean incidence rate for pressure injuries decreased, whereas that for falls remained stable. The results indicate that the system did not increase the occurrence of such incidences.

Evaluation of a mobile shift report system on nursing documentation quality.

Nursing shift report is vital for patient care. Accordingly, healthcare facilities have made great efforts to establish a standardized nurse-to-nurse shift handoff process to ensure patient care quality. The purpose of this study was to determine whether the use of a standardized mobile intershift handoff system would affect the quality of nursing documentation. The study is based on nursing handoff records from 19 inpatient units in four major care areas (internal medicine, general surgery, obstetrics/pediatrics, and long-term care) of a medical center in central Taiwan. Data collection was performed before and after implementation of the mobile, point-of-care handoff system in 2010. A medical review tool was used to compare 25-item charting compliance on 228 charts. Results show that the designed content of the handoff system was related to a corresponding compliance change in initial assessment, pain reassessment, and use of accurate abbreviation. Although overall compliance rates among inpatient units varied, the statistical test showed that the pattern of changes was consistent. As more items were added to the new handoff system for reminder purposes, documentation compliance increased; however, since the new handoff system did not include nursing diagnosis, patient outcome tracking compliance was reduced. The results of the study reveal that implementing a standardized point-of-care handoff system could improve nursing documentation compliance and quality.

Cost-effectiveness of treating ureteral stones in a Taipei City Hospital: shock wave lithotripsy versus ureteroscopy plus lithoclast.

AIM: To compare cost-effectiveness, success rates and sat isfaction score of ureteroscopic lithotripsy with lithoclast (URSL) and extracorporeal shock wave lithotripsy (ESWL) for ureteral stones in a Taipei City Hospital. METHODS: This is a retrospective study. From July 1998 to June 2000, 448 patients who underwent treatment for ureteral stones were included. The patients were divided into two treatment groups according to the initial method adopted for the management of their stone. Medical records and hospital financial records were collected for costs of implementing each treatment program. The satisfaction scores of patients (rating from 0 to 10) were collected by telephone interviews. Success was defined as complete clearance of the stone or fragmentation of stones smaller than 2 mm by plain abdominal film and complete relief of symptoms after initial treatment. RESULTS: A total of 360 patients were in the ESWL group (including 144 upper, 48 middle and 168 lower third stones) and 88 in the URSL group (including 28 upper, 24 middle and 36 lower third stones). The range of stone size was from 0.6 to 1.9 cm. The overall treatment cost was comparable in both groups with a trend for it to be higher in the ESWL group without reaching statistical significance (TWD 20,901.5 +/- 8,911.3 vs. 19,876.1 +/- 4,782.2). Stratified by the location of stone, the overall treatment cost was significantly higher in the ESWL group than in the URSL group for patients with upper third ureteral stones irrespective of stone size. The efficiency quotient for ESWL and URSL was 0.62 and 0.65, respectively. The success rate was significantly higher in the URSL group than in the ESWL group (89.8 vs. 71.7%). Satisfaction scores were similar for both groups with a trend to be higher in the ESWL group without reaching statistical significance (7.97 +/- 1.01 vs. 7.53 +/- 1.37). CONCLUSIONS: The overall treatment cost of patients with upper third ureteral stone was significantly higher in the ESWL group than in the URSL group, but the success rate was significantly higher in the URSL group than in the ESWL group.

Comparison of two different running models for the shock wave lithotripsy machine in Taipei City Hospital: self-support versus outsourcing cooperation.

To compare two different running models including self-support and outsourcing cooperation for the extracorporeal shock wave lithotripsy (SWL) machine in Taipei City Hospital, we made a retrospective study. Self-support means that the hospital has to buy an SWL machine and get all the payment from SWL. In outsourcing cooperation, the cooperative company provides an SWL machine and shares the payment with the hospital. Between January 2002 and December 2006, we used self-support for the SWL machine, and from January 2007 to December 2008, we used outsourcing cooperation. We used the method of full costing to calculate the cost of SWL, and the break-even point was the lowest number of treatment sessions of SWL to make balance of payments every month. Quality parameters including stone-free rate, retreatment rate, additional procedures and complication rate were evaluated. When outsourcing cooperation was used, there were significantly more treatment sessions of SWL every month than when utilizing self-support (36.3 +/- 5.1 vs. 48.1 +/- 8.4, P = 0.03). The cost of SWL for every treatment session was significantly higher using self-support than with outsourcing cooperation (25027.5 +/- 1789.8 NT$ vs. 21367.4 +/- 201.0 NT$). The break-even point was 28.3 (treatment sessions) for self-support, and 28.4 for outsourcing cooperation, when the hospital got 40% of the payment, which would decrease if the percentage increased. No significant differences were noticed for stone-free rate, retreatment rate, additional procedures and complication rate of SWL between the two running models. Besides, outsourcing cooperation had lower cost (every treatment session), but a greater number of treatment sessions of SWL every month than self-support.

A dedicated small-angle X-ray scattering beamline with a superconducting wiggler source at the NSRRC.

At the National Synchrotron Radiation Research Center (NSRRC), which operates a 1.5 GeV storage ring, a dedicated small-angle X-ray scattering (SAXS) beamline has been installed with an in-achromat superconducting wiggler insertion device of peak magnetic field 3.1 T. The vertical beam divergence from the X-ray source is reduced significantly by a collimating mirror. Subsequently the beam is selectively monochromated by a double Si(111) crystal monochromator with high energy resolution (DeltaE/E approximately 2 x 10(-4)) in the energy range 5-23 keV, or by a double Mo/B4C multilayer monochromator for 10-30 times higher flux ( approximately 10(11) photons s(-1)) in the 6-15 keV range. These two monochromators are incorporated into one rotating cradle for fast exchange. The monochromated beam is focused by a toroidal mirror with 1:1 focusing for a small beam divergence and a beam size of approximately 0.9 mm x 0.3 mm (horizontal x vertical) at the focus point located 26.5 m from the radiation source. A plane mirror installed after the toroidal mirror is selectively used to deflect the beam downwards for grazing-incidence SAXS (GISAXS) from liquid surfaces. Two online beam-position monitors separated by 8 m provide an efficient feedback control for an overall beam-position stability in the 10 microm range. The beam features measured, including the flux density, energy resolution, size and divergence, are consistent with those calculated using the ray-tracing program SHADOW. With the deflectable beam of relatively high energy resolution and high flux, the new beamline meets the requirements for a wide range of SAXS applications, including anomalous SAXS for multiphase nanoparticles (e.g. semiconductor core-shell quantum dots) and GISAXS from liquid surfaces.

Cost-effective upgrade of a focusing system for inelastic X-ray scattering experiments under high pressure.

Inelastic X-ray scattering (IXS) is a powerful technique capable of probing the dynamic behavior and electronic structure of materials. For IXS experiments under high pressure up to the megabar range using state-of-the-art diamond-anvil-cell technology, the sample volume is limited to the order of 1 x 10(-3) mm(3) for which a beam focus of the same order and less is often required. In this paper a scheme utilizing a set of low-cost and compact Kirkpatrick-Baez mirrors for upgrading the existing optical system of the Taiwan IXS beamline at SPring-8 is described. The scheme as implemented improves the focus to 13 microm x 16 microm (horizontal x vertical) with a transmission of up to 72% and a flux density gain of over 30 times, which has enhanced substantially the efficiency of the beamline for high-pressure research.