An operational maintenance approach for improving physiological monitor by HFMEA process: an empirical case study.

This study explored the application of healthcare failure mode and effect analysis (HFMEA) to identify and evaluate risk-associated factors in the intensive care unit (ICU) through a clinical-based expert knowledge (decision) for the physiological monitor operational maintenance process. Methods and intervention: A mixed qualitative and quantitative proactive approach to explore the HFMEA process by analyzing 20 units of physiological monitors in the ICU. An HFMEA expert team of six people was formed to perform a risk-based analysis and evaluate the potential hazard index, mitigating the hazard scores and risks. Results: From the main processes and possible failure reasons, one high-risk hazard index greater than or equal to 8 of the standard score was found. This standard score indicates the signed manufacturer's contract for maintenance was the hazard index failure mode on the parts not regularly replaced according to the contract. This systematic hazard index failure mode shows the highest hazard scores in the possible failure reason category, established as a standard maintenance procedure. In addition, the HFMEA expert analysis of the 20 units of physiological monitors within 6 months of the original and remanufactured part maintenance results in operational availability from 90.9% for self-repair to 99.2% for contract manufacturer repair. Conclusions: This study concludes a systematic reference in malpractices caused by maintenance negligence. The HFMEA expert team agrees that hazard failure scores greater than or equal to 8 are vital assessments and evaluations for decision-making, especially in maintaining healthcare intensive unit care physiological monitors.

Delayed Nonarteritic Posterior Ischemic Optic Neuropathy following Herpes Zoster Ophthalmicus: A Case Report.

Posterior ischemic optic neuropathy (PION), a relatively rare condition, is diagnosed primarily based on the clinical presentation of sudden visual impairment, an optic nerve-related visual field defect, and an initial normal optic disc that corresponds to its pathology of acute ischemia. Among its etiologies, nonarteritic PION is one of the most common causes. Studies on cases of PION associated with herpes zoster ophthalmicus (HZO) are limited, and the diagnosis was made based on the appearance of visual symptoms shortly following rashes. We describe a 64-year-old Asian woman with sudden painless visual loss in the upper half visual field of the left eye 6 weeks after ipsilateral HZO. Within a week, her left vision progressed to total visual loss. Initial examination revealed a near-total visual defect and a normal appearance of the optic disc in the left eye. Laboratory and imaging studies excluded the compressive, infiltrative, or inflammatory etiologies of the left optic nerve. Considering the temporal relationship between the skin rash and visual loss, HZO was the most likely cause of the nonarteritic PION. The patient was given a short course of oral valaciclovir and aspirin. At 6 weeks after the visual loss, an examination revealed stationary visual acuity and visual field defect in the left eye with a pale optic disc, and a retinal nerve fiber loss in the left eye. Compared with previous studies, our case demonstrated a delayed presentation of nonarteritic PION following HZO and broadened the scope of herpes zoster optic neuropathy.

Promoting Healthy Behaviors in Older Adults to Optimize Health-Promoting Lifestyle: An Intervention Study.

Introduction: Exercise intervention is the easiest and most effective way to promote human health. This study combined technology and exercise to improve the health behavior of the older adults through a physical activity intervention and to enhance a health-promoting lifestyle. Materials and methods: A quasi-experimental research method was used to openly recruit 120 healthy male and female older adults over 65 years old (average age of males: 71.6 ± 1.25 years; average age of females: 72.3 ± 1.28 years), all of whom wore smart bracelets. The participants were monitored by special personnel during the same period of walking every Monday to Friday. All participants recorded their daily steps, distance walked, and calorie consumption data for a period of 8 weeks. Results: After 8 weeks of walking, all participants showed a positive medium−high correlation of various factors between healthy behaviors and the health-promoting lifestyle scales. In the post-tests of each factor of two scales, males had the highest correlation between regular physical activity and physical activity, and females had the highest correlation between regular physical activity and social support. The variabilities in the explanatory power of the health behaviors of males and females on the health-promoting lifestyle were R2 = 70.9% (p < 0.01) and R2 = 74.1% (p < 0.01), indicating that the variables of healthy behaviors have a positive effect on health-promoting lifestyles in male and female older adults. Conclusions: Walking interventions positively affect the health behaviors of older adults and encourage health-promoting lifestyles. The value of this study is in its contribution to health promotion and public health recommendations for older adults.

Physical Activity and Social Support to Promote a Health-Promoting Lifestyle in Older Adults: An Intervention Study.

The purpose of this study was to understand the effect of intervention in the form of physical activity and social support while co-exercising to promote a health-promoting lifestyle in older adults. This study openly recruited 60 healthy male older adults, all of whom wore a wrist-worn Garmin device walker. Experimental group A was monitored by a special person and walked together as a group, experimental group B walked independently outdoors, and the control group went about their daily routine as normal. All participants recorded daily steps and calorie consumption data for eight weeks. The results of the study showed that when walking together in experimental group A, the number of daily walks and calories consumed could be maintained at a high level due to the effect of group and social support. The number of daily walks in experimental group B was inconsistent due to the lack of motivation to walk on their own. The control group consumed the lowest number of calories in their daily routine. The results show that physical activity and social support have positive explanatory power for a health-promoting lifestyle. Finally, physical activity in older adults should be promoted, and social support for interaction with peers can effectively promote a healthy lifestyle and respond to the arrival of the super-aged society in advance.

Interventions for Body Composition and Upper and Lower Extremity Muscle Strength in Older Adults in Rural Taiwan: A Horizontal Case Study.

The purpose of this study was to understand the effects of a physical activity program and high-protein supplementation on body composition and upper and lower extremity muscle strength in male older adults in rural areas. In this study, 60 healthy male older adults (mean age 77.5 ± 4.6 years) from rural areas were recruited and randomly assigned to experimental group A (intervention of the physical activity program and high-protein supplementation), experimental group B (daily routine, with only intervention of high-protein supplementation), or control group C (daily routine). Experimental group A (EGa) carried out a physical activity plan three times a week, with an exercise intensity and calorie consumption of 250 kcal (5METs × â…”hr × 75) for 3 months and drank a high-protein supplement (1.3 g/kg BW/day) after each exercise; experimental group B (EGb) followed only the intervention of high-protein supplementation. All the participants underwent pre- and post-tests for body composition, waist-hip circumference (WC, HC), handgrip strength (HS), 30 s dominant arm curl, 30 s sit to stand, and 2 min step tests. The results of the study showed that EGa significantly decreased body mass index (BMI), body fat mass (BFM), body fat percentage (BFP), WC, HC, and waist-to-hip ratio (WHR) and increased basal metabolic rate and muscle mass. Although both EGa and EGb used high-protein supplementation, EGa's added three-month intervention of a physical activity program made it easier for that group to increase muscle mass and muscle strength. The WHR decreased from 1.015 to 0.931, representing a decrease of 8.28%, and an obvious weight loss effect was achieved. Thus, we concluded that the best way to maintain muscle strength in older adults is through physical activity with resistance and protein supplementation, which can reduce muscle loss in older adults.

Interventions to Improve Body Composition, Upper and Lower Extremity Muscle Strength, and Balance Ability of Older Female Adults: An Intervention Study.

The aim of the present study was to understand the effects of a moderate-intensity physical activity program on the changes observed in the body composition, upper and lower extremity muscle strength, as well as balance in elderly female adults in order to evaluate sarcopenia. In this study, 30 healthy elderly females were recruited and were randomly assigned to either the control group or the experimental group. The experimental group engaged in a moderate-intensity physical activity program twice a week for 8 weeks. Using a body composition analyzer, the senior fitness test, and handgrip strength and gait speed tests, all participants were tested in pre- and post-tests. The results of the study revealed changes in the overall body composition in the experimental group, with significant decreases in body mass index, body fat percentage, and body fat mass and substantial increases in the basal metabolic rate and skeletal muscle mass, while the upper and lower extremity muscle strength and balance ability also showed significant improvements. The moderate-intensity physical activity program also increased upper limb handgrip strength and lower limb gait speed, showing that the plan was able to effectively evaluate sarcopenia. The study concluded that using upper limb handgrip strength and lower limb walking speed to evaluate sarcopenia are useful diagnostic tools. Moderate-intensity physical activity is effective for improving muscle strength and reducing sarcopenia.

Interventions to Improve Physical Capability of Older Adults with Mild Disabilities: A Case Study.

Ageing is related to changes in physical health, including loss of mobility and muscle function. It can lead to impaired physical capability and reduced quality of life. The purpose of this study was to investigate whether a physical activity rehabilitation program (PARP) could improve range of joint motion (ROM), grip strength, and gait speed of older adults with mild disabilities. Forty older adults in a long-term care center in Taiwan joined as human participants and were split into control and experimental groups. The participants in the experimental group joined a PARP for eight weeks. The ROM of bodily joints, grip strength, and gait speed of all participants were measured both before and after the eight-week period. The results showed that all the ROMs, grip strength, and gait speed of the participants in the experimental group increased significantly after attending the program. The improvement of the ROMs for male and female participants in the experimental group ranged from 3.8% to 71% and from 7.8% to 75%, respectively. Male participants had greater improvement on gait speed (50%) than their female counterparts (22.9%). Female participants, on the other hand, had greater improvement on grip strength (25.4%) than their male counterparts (20.3%). The ROM, grip strength, and gait speed of the control group, on the other hand, did not change significantly during the same period. The results showed that the PARP adopted in this study was effective in increasing the ROM, grip strength, and gait speed of those who had joined the PARP. This study shows that an eight-week PARP without the use of gym machines was beneficial in reducing sarcopenia in elderly people with mild disabilities.

Predict the exercise behavior intention of the older adults in Taipei City to promote exercise behavior.

The purpose of this study employed the theory of planned behavior as a research framework to analyze the explanatory power of exercise attitude, subjective norms, and perceived behavioral control on exercise intention among older adults and to obtain insight on exercise behavior among older adults. The study used Ajzen's theory of planning behavior as a basis to compile the "Exercise Behavior Intention Questionnaire of the Older Adults." Results showed that there were significant differences were detected in the exercise intentions of older adults with different subjective norms and perceived behavioral control. This indicated that older adults of greater age have a greater need for companionship from family members and stronger subjective norms. In addition, exercise attitude, subjective norms, and perceived behavioral control explained the variance in exercise intention among older adults, verifying the positive explanatory power of these variables on exercise intention in older adults. The study concluded that the theory of planned behavior, improving older adults' exercise attitude alone was insufficient for increasing their exercise behavior intention. In particular, older adults of greater age had greater needs for social support from the main groups, and they required encouragement to enhance their self-efficacy and confidence.

pH responsive selective protein adsorption by carboxylic acid functionalized large pore mesoporous silica nanoparticles SBA-1.

Cubic mesoporous silica nanoparticles (MSNs) with the SBA-1 moiety, functionalized with carboxylic acid (COOH) groups as well as enlarged mesopores, are successfully synthesized using tetraethyl orthosilicate (TEOS) and carboxyethylsilanetriol sodium salt (CES) as silica sources, complexes formed by polyacrylic acid (PAA) and hexadecylpyridinium chloride (CPC) as templates, and trimethylbenzene (TMB) as pore expander. The successful incorporation of organic functionalities are confirmed by 13C and 29Si solid-state NMR. The structural properties of cubic mesostructures are characterized by powder XRD, N2 adsorption-desorption isotherms, and TEM measurements. The prepared MSNs exhibit a remarkably high adsorption capacity of 1138 mg g-1 at pH 8.2 when they are used as the supports to immobilize papain. Both factors of the large pore size of the support and the favorable electrostatic attractions between the carboxylate groups on the adsorbent surface and the papain molecules play important roles in reaching such a high adsorption capacity. The immobilized papain possesses better thermal stability, pH tolerance, and heat resistance in comparison to the free papain. The materials are also used for selective adsorption of a single protein (papain) from the binary mixture of two different types of proteins (papain and hemoglobin). Our results demonstrate that proteins such as papain and hemoglobin with different isoelectric points and shapes can be effectively separated from their binary mixture by simply tuning the pH of the buffer.

Zno Micro/Nanostructures Grown on Sapphire Substrates Using Low-Temperature Vapor-Trapped Thermal Chemical Vapor Deposition: Structural and Optical Properties.

In this research, the Zn(C5H7O2)2·xH2O-based growth of ZnO micro/nanostructures in a low temperature, vapor-trapped chemical vapor deposition system was attempted to optimize structural and optical properties for potential biomedical applications. By trapping in-flow gas molecules and Zinc vapor inside a chamber tube by partially obstructing a chamber outlet, a high pressure condition can be achieved, and this experimental setup has the advantages of ease of synthesis, being a low temperature process, and cost effectiveness. Empirically, the growth process proceeded under a chamber condition of an atmospheric pressure of 730 torr, a controlled volume flow rate of input gas, N2/O2, of 500/500 Standard Cubic Centimeters per Minute (SCCM), and a designated oven temperature of 500 °C. Specifically, the dependence of structural and optical properties of the structures on growth duration and spatially dependent temperature were investigated utilizing scanning electron microscopy, X-ray diffraction (XRD), photoluminescence (PL), and ultraviolet-visible transmission spectroscopy. The experimental results indicate that the grown thin film observed with hexagonal structures and higher structural uniformity enables more prominent structural and optical signatures. XRD spectra present the dominant peaks along crystal planes of (002) and (101) as the main direction of crystallization. In addition, while the structures excited with laser wavelength of 325 nm emit a signature radiation around 380 nm, an ultraviolet lamp with a wavelength of 254 nm revealed distinctive photoluminescence peaks at 363.96 nm and 403.52 nm, elucidating different degrees of structural correlation as functions of growth duration and the spatial gradient of temperature. Transmittance spectra of the structures illustrate typical variation in the wavelength range of 200 nm to 400 nm, and its structural correlation is less significant when compared with PL.

Bifunctional Cage-Type Cubic Mesoporous Silica SBA-1 Nanoparticles for Selective Adsorption of Dyes.

Bifunctional SBA-1 mesoporous silica nanoparticles (MSNs) with carboxylic acid and amino groups (denoted as CNS-10-10) have been successfully synthesized, characterized, and employed as adsorbents for dye removal. Adsorbent CNS-10-10 shows high affinity towards cationic and anionic dyes in a wide pH range, and exhibits selective dye removal of a two-dye mixture system of cationic methylene blue and anionic eosin Y. By changing the pH of the medium, the selectivity of the adsorption behavior can be easily modulated. For comparison purposes, the counterparts, that is, pure silica SBA-1 MSNs (CS-0) and those with either carboxylic acid or amino functional groups (denoted as CS-10 and NS-10, respectively) were also prepared to evaluate their dye-adsorption behaviors. As revealed by the zeta-potential measurements, the electrostatic interaction between the adsorbent surface and the dye molecule plays an important role in the adsorption mechanism. Adsorbent CNS-10-10 can be easily regenerated and reused, and maintains its adsorption efficiency up to 80 % after four cycles.

Functionalization of cubic mesoporous silica SBA-16 with carboxylic acid via one-pot synthesis route for effective removal of cationic dyes.

In this work, we demonstrate that a high density of −COOH groups loading, up to 60 mol% based on silica, is successfully incorporated into SBA-16 via a one-pot synthesis route, which involves co-condensation of carboxyethylsilanetriol sodium salt (CES) and tetraethylorthosilicate (TEOS) templated by Pluronic F127 and P123 in an acidic medium. A variety of characterization techniques are performed to confirm quantitative incorporation of carboxylic groups into ordered cubic mesostructures. These functionalized materials are used to effectively remove two cationic dyes methylene blue (MB) and phenosafranine (PF) with the maximum adsorption capacities of 561 and 519 mg g(-1), respectively, at pH 9. The zeta potential results reveal that the electrostatic interactions between cationic dye molecule and negatively charged surface of the adsorbent play a crucial role in their high adsorption capacities. For a binary component system consisting of MB and PF, competitive adsorption of these two dyes is observed with adsorption capacity values slightly lower than those of the corresponding single dye systems. The dye adsorbed material can be easily regenerated by simple acid washing and be reused for five times with MB removal efficiency still up to 98.6%, showing its great potentials in environmental remediation.

A pentacyclic nitrogen-bridged thienyl-phenylene-thienyl arene for donor-acceptor copolymers: synthesis, characterization, and applications in field-effect transistors and polymer solar cells.

A pentacyclic benzodipyrrolothiophene (BDPT) unit, in which two outer thiophene rings are covalently fastened with the central phenylene ring by nitrogen bridges, was synthesized. The two pyrrole units embedded in BDPT were constructed by using one-pot palladium-catalyzed amination. The coplanar stannylated Sn-BDPT building block was copolymerized with electron-deficient thieno[3,4-c]pyrrole-4,6-dione (TPD), benzothiadiazole (BT), and dithienyl-diketopyrrolopyrrole (DPP) acceptors by Stille polymerization. The bridging nitrogen atoms make the BDPT motif highly electron-abundant and structurally coplanar, which allows for tailoring the optical and electronic properties of the resultant polymers. Strong photoinduced charge-transfer with significant band-broadening in the solid state and relatively higher oxidation potential are characteristic of the BDPT-based polymers. Poly(benzodipyrrolothiophene-alt-benzothiadiazole) (PBDPTBT) achieved the highest field-effect hole mobility of up to 0.02 cm(2) V(-1) s(-1). The photovoltaic device using the PBDPTBT/PC(71)BM blend (1:3, w/w) exhibited a V(oc) of 0.6 V, a J(sc) of 10.34 mA cm(-2), and a FF of 50%, leading to a decent PCE of 3.08%. Encouragingly, the device incorporating poly(benzodipyrrolothiophene-alt-thienopyrrolodione) (PBDPTTPD)/PC(71)BM (1:3, w/w) composite delivered a highest PCE of 3.72%. The enhanced performance arises from the lower-lying HOMO value of PBDPTTPD to yield a higher V(oc) of 0.72 V.

The total body burden of chromium associated with skin disease and smoking among cement workers.

BACKGROUND: Hand eczema and other skin diseases have been associated with the exposure of chromium among cement workers. Studies on skin disease and other factors associated with the body burden of chromium are limited. OBJECTIVE: The present study investigated the role of skin disease and smoking in the association with body burden of chromium among cement workers. METHODS: Forty-five workers (38 men and 7 women) were recruited for this study and interviewed to obtain information on demographic status, lifestyle, employment history, and affecting factors. Urine samples were collected to measure the urinary chromium concentration to represent the body burden of chromium. RESULTS: The average urinary chromium concentration was approximately 6 times higher in non-smoking workers with hand eczema than in non-smoking workers with no skin disease (45.5 vs. 7.6 microg/L). The average chromium level increase to 87.0 microg/L for smokers with the disease. Compared with workers with no hand eczema, the odds ratio of having urinary chromium concentration exceeding the biological exposure index level significantly increased to 11.6 (95% CI=1.3-102.2) for non-smoking workers with skin disease, and to 48.0 (95% CI=4.5-510.8) for smoking workers with skin disease. The multiple regression analysis showed that the use of gloves may reduce significantly the chromium exposure. CONCLUSIONS: Inadequate protection and personal behavior increase the internal dose of chromium in cement workers. Total body burden of chromium are higher among cement workers with skin disease and smoking habit. These workers deserve intervention education on personal hygiene to reduce the exposure of chromium.

Experimental and DFT study of the tautomeric behavior of cobalt-containing secondary phosphine oxides.

New cobalt-containing secondary phosphine oxides [(mu-PPh(2)CH(2)PPh(2))Co(2)(CO)(4){mu,eta-PhC[triple chemical bond]CP(==O)(H)(R)}] (8 a: R=tBu; 8 b: R=Ph) were prepared by reaction of secondary phosphine oxides PhC[triple chemical bond]CP- (==O)(H)(R) (6 a: R=tBu; 6 b: R=Ph) with dppm-bridged dicobalt complex [(mu-PPh(2)CH(2)PPh(2))Co(2)(CO)(6)] (2). The molecular structures of 8 a and 8 b were determined by single-crystal X-ray diffraction. Although palladium-catalyzed Heck reactions employing 8 b as ligand gave satisfying results, 8 a performed poorly in the same reaction. Judging from these results, a tautomeric equilibrium between 8 b and its isomeric form [(mu-PPh(2)CH(2)PPh(2))Co(2)(CO)(4){mu,eta-PhC[triple chemical bond]CP(OH)(Ph)}] 8 b' indeed takes place, but it is unlikely between 8 a and [(mu-PPh(2)CH(2)PPh(2))Co(2)(CO)(4){mu,eta-PhC[triple chemical bond]CP(OH)(tBu)}] (8 a'). The DFT studies demonstrated that reasonable activation energies for the tautomeric conversions can be achieved only via a bimolecular pathway. Since a tBu group is much larger than a Ph group, the conversion is presumably only feasible in the case of 8 bright harpoon over left harpoon8 b', but not in the case of 8 aright harpoon over left harpoon8 a'. Another cobalt-containing phosphine, namely, [(mu-PPh(2)CH(2)PPh(2))Co(2)(CO)(4){mu,eta-PhC[triple chemical bond]CP(NEt(2))(tBu)}] (7 a), and its oxidation product [(mu-PPh(2)CH(2)PPh(2))Co(2)(CO)(4){mu,eta-PhC[triple chemical bond]CP(==O)(NEt(2))(tBu)}] 7 a' were prepared from the reaction of PhC[triple chemical bond]CP(NEt(2))(tBu) (5 a) with 2. The molecular structures of 7 a and 7 a' were determined by single-crystal X-ray diffraction. The phosphorus atom is surrounded by substituents in a tetrahedral environment. A P--N single bond (1.676(3) A) is observed in the molecular structure of 7 a. Heck reactions employing 7 a/Pd(OAc)(2) as catalyst system exhibited efficiency comparable to that of 8 a/Pd(OAc)(2).