OBJECTIVE: We aimed to investigate the ability of readout-segmented echo-planar imaging (rs-EPI)-based diffusion tensor imaging (DTI) in assessing the microstructural change of extraocular muscles (EOMs) and optic nerves in patients with thyroid-associated orbitopathy (TAO) as well as in evaluating disease activity.MATERIALS AND METHODS: We enrolled 35 TAO patients and 22 healthy controls (HCs) who underwent pre-treatment rs-EPI-based DTI. Mean, axial, and radial diffusivity (MD, AD, and RD) and fractional anisotropy (FA) of the medial and lateral EOMs and optic nerve for each orbit were calculated and compared between TAO and HC groups and between active and inactive TAO groups. Factors such as age, sex, disease duration, mediation, and smoking history between groups were also compared. Logistic regression analysis was used to evaluate the predictive value of significant variables for disease activity.RESULTS: Disease duration was significantly shorter in active TAOs than in inactive ones (p < 0.001). TAO patients showed significantly lower FA and higher MD, AD, and RD than HCs for both medial and lateral EOMs (p < 0.001), but not the AD value of lateral EOMs (p = 0.619). Active patients had significantly higher FA, MD, and AD than inactive patients for medial EOMs (p < 0.005), whereas only FA differed significantly in the lateral EOMs (p = 0.018). The MD, AD, and RD of optic nerves were significantly lower in TAO patients than HCs (p < 0.05), except for FA (p = 0.129). Multivariate analysis showed that the MD of medial EOMs and disease duration were significant predictors for disease activity. The combination of these two parameters showed optimal diagnostic efficiency for disease activity (area under the curve, 0.855; sensitivity, 68.4%; specificity, 96.9%).CONCLUSION: rs-EPI-based DTI is promising in assessing microstructural changes of EOMs and optic nerves and can help to indicate the disease activity of TAO, especially through the MD of medial EOMs.
Anisotropy ; Diffusion Tensor Imaging ; Diffusion ; Echo-Planar Imaging ; Humans ; Logistic Models ; Multivariate Analysis ; Muscles ; Negotiating ; Optic Nerve ; Orbit ; Sensitivity and Specificity ; Smoke ; Smoking ; Troleandomycin

PURPOSE: The purpose of this study was to construct and test a structural equation model on nursing work outcomes based on Youssef and Luthans' positive psychological capital and integrated conceptual framework of work performance.METHODS: This study used a structured questionnaire administered to 340 nurses. Data were analyzed using structural equation modeling.RESULTS: Positive psychological capital showed indirect and direct effects on job satisfaction, retention intention, organizational citizenship behavior, and nursing performance. While, the nursing work environment had direct and indirect effects on job satisfaction and nursing performance, it only had indirect effects on intention to work and organizational citizenship behavior. Additionally, a mediating effect on retention intention and organizational citizenship behavior was found between job satisfaction and nursing performance variables.CONCLUSION: The nursing organization needs to build a supportive work environment and reinforce positive psychological capital to improve nursing performance. Additionally, it needs to actively manage the necessary parameters involved in the stages of job satisfaction, retention intention, nursing performance, and organizational citizenship behavior of nurses. The findings propose the continuous management of nursing personnel based on nurses' attitude outcome, behavioral intention, behavioral outcome, and stage of role performance.
Attitude of Health Personnel ; Intention ; Job Satisfaction ; Negotiating ; Nursing ; Psychology, Industrial ; Task Performance and Analysis ; Work Performance

The ezrin-radixin-moesin (ERM) proteins are a family of membrane-associated proteins known to play roles in cell-shape determination as well as in signaling pathways. We have previously shown that amphetamine decreases phosphorylation levels of these proteins in the nucleus accumbens (NAcc), an important neuronal substrate mediating rewarding effects of drugs of abuse. In the present study, we further examined what molecular pathways may be involved in this process. By direct microinjection of LY294002, a PI3 kinase inhibitor, or of S9 peptide, a proposed GSK3β activator, into the NAcc core, we found that phosphorylation levels of ERM as well as of GSK3β in this site are simultaneously decreased. These results indicate that ERM proteins are under the regulation of Akt-GSK3β signaling pathway in the NAcc core. The present findings have a significant implication to a novel signal pathway possibly leading to structural plasticity in relation with drug addiction.
Amphetamine ; Animals ; Glycogen Synthase Kinases ; Humans ; Membrane Proteins ; Microinjections ; Negotiating ; Neurons ; Nucleus Accumbens ; Phosphorylation ; Phosphotransferases ; Plastics ; Proto-Oncogene Proteins c-akt ; Rats ; Reward ; Signal Transduction ; Street Drugs ; Substance-Related Disorders

Particulate matter (PM), which refers to the mixture of particles present in the air, can have harmful effects. Damage to cells by PM, including disruption of organelles and proteins, can trigger autophagy, and the relationship between autophagy and PM has been well studied. However, the cellular regulators of PM-induced autophagy have not been well characterized, especially in keratinocytes. The Aryl Hydrocarbon Receptor (AhR) is expressed in the epidermis and is activated by PM. In this study, we investigated the role of the AhR in PM-induced autophagy in HaCaT cells. Our results showed that PM led to AhR activation in keratinocytes. Activation of the AhR-target gene CYP1A1 by PM was reduced by co-treatment with α-naphthoflavone (α-NF), an AhR inhibitor. We also evaluated activation of the autophagy pathway in PM-treated keratinocytes. In HaCaT cells, treatment with PM treatment led to the induction of microtubules-associated proteins light chain 3 (LC3) and p62/SQSTM1, which are essential components of the autophagy pathway. To study the role of the AhR in mediating PM-induced autophagy, we treated cells with α-NF or used an siRNA against AhR. Expression of LC3-ІІ induced by PM was decreased in a dose dependent manner by α-NF. Furthermore, knockdown of AhR with siAhR diminished PM-induced expression of LC3-ІІ and p62. Together, these results suggest that inhibition of the AhR decreases PM-induced autophagy. We confirmed these results using the autophagy-inhibitors BAF and 3-MA. Taken together, our results indicate that exposure to PM induces autophagy via the AhR in HaCaT keratinocytes.
Autophagy ; Cytochrome P-450 CYP1A1 ; Epidermis ; Keratinocytes ; Negotiating ; Organelles ; Particulate Matter ; Receptors, Aryl Hydrocarbon ; RNA, Small Interfering

PURPOSE: This study examined the mediating and moderating effects of multicultural efficacy in the relationship between cultural empathy and cultural competence in child care teachers. METHODS: A cross-sectional descriptive survey design was used. The participants were 277 child care teachers at private and public daycare centers in G and S districts of Seoul. The survey instruments included a cultural empathy questionnaire, a multicultural efficacy scale, and a cultural competence scale. Data were analyzed using the SPSS and AMOS programs. For data analysis, descriptive statistics, correlation, and mediating and moderating effect analyses were performed. Bootstrapping was implemented to verify the mediating effect of the model developed herein. RESULTS: Positive correlations among cultural empathy, multicultural efficacy, and cultural competence were noted. Multicultural efficacy showed a significant mediating effect on the relationships between cultural empathy and cultural competence. However, there was no moderating effect. CONCLUSION: In order to enhance the cultural competence of child care teachers, it is necessary to develop a strategy that can promote their cultural empathy and multicultural efficacy. Furthermore, these results will ultimately enhance the role of child care teachers, thus contributing to the normal growth and development of multicultural children.
Child ; Child Care ; Child ; Cultural Competency ; Cultural Diversity ; Empathy ; Growth and Development ; Humans ; Negotiating ; Self Efficacy ; Seoul ; Statistics as Topic

PURPOSE: The purpose of this study was to examine the mediating effect of major satisfaction in the relationship between academic self-efficacy and academic achievement among nursing students. METHODS: Data were collected from 142 nursing students from March 5 to March 9, 2018, and the collected data were analyzed using SPSS version 21.0 for Windows. RESULTS: Academic self-efficacy had a significant effect on both major satisfaction (β=.31, p<.001), and academic achievement (β=.43, p<.001). The parameter of major satisfaction was found to have a significant effect on the dependent variable, academic achievement (β=.22, p=.007), and the independent variable, academic self-efficacy, also had a significant effect on academic achievement (β=.39, p<.001). Thus, major satisfaction was found to have a partial mediating effect on the relationship between academic self efficacy and academic achievement. The Sobel test showed that the path of the academic achievement and academic self efficacy variables was significantly mediated by major satisfaction (Z=2.99, p=.003). CONCLUSION: Academic self-efficacy was found to affect academic achievement, and major satisfaction was found to play a partial mediating role in the relationship between academic self efficacy and academic achievement.
Humans ; Job Satisfaction ; Negotiating ; Nursing ; Self Efficacy ; Students, Nursing

OBJECTIVES: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. METHODS: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. RESULTS: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. CONCLUSIONS: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.
Chronic Disease ; Dataset ; Delivery of Health Care ; Education ; Employment ; Healthcare Disparities ; Insurance Coverage ; Korea ; Logistic Models ; Methods ; Needs Assessment ; Negotiating ; Socioeconomic Factors

PURPOSE: The purpose of this study was to explore the effects of head nurses' authentic leadership and empowerment on job satisfaction, and nursing performance of nurses and to identify the mediating effect of empowerment in the relationships of head nurses' authentic leadership, with nurses' job satisfaction, and nursing performance. METHODS: The sample for this study was 149 nurses from 2 general hospitals located in Busan. Data were collected using self-administered questionnaires and the SPSS/WIN 23.0 program was used for analysis. Mediation analysis was performed according to the Baron and Kenny method and Sobel test. RESULTS: Head nurses' authentic leadership showed positive correlations with empowerment, job satisfaction, and nursing performance. Empowerment showed partial mediating effects in the relationship between head nurses' authentic leadership and nurses job satisfaction, and a perfect mediating effect in the relationship between head nurses' authentic leadership and the performance of nursing. CONCLUSION: The results indicate that it is necessary to develop strategies and applications to enhance nurses' empowerment for improved job satisfaction and nursing performance.
Busan ; Head ; Hospitals, General ; Job Satisfaction ; Leadership ; Methods ; Negotiating ; Nursing ; Power (Psychology) ; Work Performance

PURPOSE: The objective of this study was to verify a mediating effect of followership in the relationship of organizational citizenship behavior and nurse managers' empowering leadership as perceived by nurses. METHODS: The study was a descriptive research involving 222 nurses working on nursing units in a university hospital. Data were analyzed using independent t-test, one way ANOVA, Mann-Whitney U, Scheffé test, Pearson correlation coefficients, and simple and multiple regression techniques with the SPSS 23.0 program. Mediation analysis was performed according to the Baron and Kenny method and Sobel test. RESULTS: Nurse managers' empowering leadership and followership showed a positive correlation (r=.22, p=.001), and a significantly positive correlation with organizational citizenship behavior (r=.32, p<.001). Also, followership and organizational citizenship behavior showed a positive correlation (r=.52, p<.001). The results of the study verified that nurses' followership had a mediating effect on organizational citizenship behavior in nurse unit managers' empowering leadership, a positive effect on organizational citizenship behavior and ultimately an increase in organizational achievement. CONCLUSION: Nurse managers need to be aware of the importance of empowering leadership, and endeavor to enhance it further. As for the organizational level, support to strengthen empowering leadership is required.
Humans ; Leadership ; Methods ; Negotiating ; Nurse Administrators ; Nursing ; Power (Psychology)

This study investigated the effect of emotional stability (ES) on insomnia through anxiety in preoperative patients with cataracts. Fifty-four subjects completed a self-questionnaire that included the Insomnia Severity Index (ISI), the International Personality Item Pool (IPIP) for ES, and the Hospital Anxiety and Depression scale (HADS). Pathway analysis was performed to analyze the mediating effects of ES, the anxiety subscale scores of the HADS, and the ISI scores. The low-ES group exhibited an insomnia severity that was significantly higher than that of the high-ES group (p=0.048). According to the pathway analysis, the significant indirect effect of ES on the ISI scores was mediated by the scores on the anxiety subscale of the HADS. Cataract patients with low ES waiting to undergo surgery have a high risk of experiencing insomnia due to anxiety. Before surgery, it is essential to identify patients’ personality characteristics and provide appropriate intervention.
Anxiety ; Cataract ; Depression ; Humans ; Negotiating ; Sleep Initiation and Maintenance Disorders