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

PURPOSE: This study examined the relationship among the use of food-related content (FRC), dietary behaviors, and dietary self-efficacy to demonstrate the need for nutrition education to help adolescents build healthy eating habits and provide evidence for developing nutrition education programs for adolescents. METHODS: Three hundred and eighty-one high school students in Seoul and Gyeonggi areas participated in the study. The subjects were divided into three groups (low, medium, and high) according to the level of use of the FRC, and their general characteristics, dietary behaviors, and dietary self-efficacy were analyzed. Correlation analysis was performed between FRC usage, dietary behaviors, and dietary self-efficacy, and the mediating effects of dietary self-efficacy on the relationship between the level of the use of FRC and dietary behaviors were estimated. RESULTS: A higher level of FRC usage was associated with an increased daily cost of eating out and snacking, but no difference was observed in the BMI range. The subjects in a group with a high level of FRC usage ate convenience store or instant foods instead of homemade meals (p = 0.033), had a late-night meal or snack (p = 0.024), and turned to emotional eating under stress (p < 0.001) more than those in the low level group. In addition, the high level group checked the nutrition facts label more carefully when purchasing processed foods (p = 0.016) and exercised at least 30 minutes daily, not considering physical education classes (p = 0.057). The higher level of FRC use, the lower the dietary self-efficacy, whereby the subscales ‘environmental stimulus control efficacy’ and ‘affective factor control efficacy’ showed complete mediating effects. CONCLUSION: Given that FRC has been increased recently, adolescents are in need of support to help them control and enhance their dietary self-efficacy as well as develop healthy dietary behaviors through proper nutrition education programs.
Adolescent ; Eating ; Education ; Gyeonggi-do ; Humans ; Meals ; Negotiating ; Physical Education and Training ; Seoul ; Snacks

OBJECTIVES: Suicide is the most frequent cause of death among Korean adolescents, and adolescents who have experienced trauma have an increased risk of post-traumatic stress disorder (PTSD) symptoms, depression, and suicide attempts. However, resilience and self-esteem are protective factors. We examined the effects of resilience and self-esteem on the relationship among traumatic experiences, PTSD symptoms, depression, and suicidal ideation. METHODS: Middle-school students (n=403) completed questionnaires assessing traumatic experiences, PTSD symptoms, depression, suicidal ideation, resilience, and self-esteem. Path analysis was performed to investigate the mediating effects of PTSD symptoms, resilience, self-esteem, and depression on the relationship between trauma exposure and suicidal ideation. RESULTS: Traumatic experience was positively correlated with PTSD symptoms, depression, and suicidal ideation. PTSD symptoms and depression were positively correlated with suicidal ideation. The relationship between traumatic experiences and suicidal ideation was mediated by PTSD symptoms, which had both direct and indirect effects on suicidal ideation; the indirect effect was mediated by resilience, self-esteem, and depression. CONCLUSION: Korean adolescents who had experienced trauma were more likely to develop PTSD symptoms, increasing their risk of depression and suicidal ideation. However, self-esteem and resilience may help protect against depression and suicidal ideation. Our findings could inform suicide prevention initiatives.
Adolescent ; Cause of Death ; Depression ; Humans ; Negotiating ; Protective Factors ; Stress Disorders, Post-Traumatic ; Suicidal Ideation ; Suicide

PURPOSE: This study aimed to develop and evaluate the effects of an empathy education program for undergraduate nursing students. METHODS: The study employed a non-equivalent control group pretest-posttest design. A total of 46 nursing students were voluntarily recruited by convenience sampling from senior nursing students from the nursing department of K college in I city, Korea. Participants were divided into two groups, an experimental group of 23 and a control group of 23. The experimental intervention (empathy education program) was conducted from April 19 to May 6, 2016 and consisted of 150-minute sessions, twice a week, for 3 weeks for a total of 15 hours. RESULTS: Participants demonstrated improvements in perspective taking in cognitive empathy, improved empathic concern in emotional empathy, and improved communicative empathy. Analysis of reflective writings identified four theme clusters regarding communicative empathy: improvement of empathic expression, experiencing comfort and healing, improvement of interpersonal relationships, and experience of conflict resolution. Improved interpersonal ability and caring were also identified. CONCLUSION: The empathy education program improved cognitive, emotional and communicative empathy, and interpersonal skills and care, which are all necessary qualities for nurses.
Education ; Empathy ; Humans ; Interpersonal Relations ; Korea ; Negotiating ; Nursing ; Social Skills ; Students, Nursing

PURPOSE: The aim of this study was to examine the mediating effect of self-efficacy in the relationship of physical and psychological symptoms to exercise adherence in patients with heart failure. METHODS: The participants in this study were 186 patients with heart failure in two hospitals located in Busan. The measures included questions about general and disease characteristics, physical symptoms, psychological symptoms, self-efficacy for exercise, and exercise adherence. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients, simple and multiple regression using Baron and Kenny steps for mediation. RESULTS: There were significant differences in age, gender and comorbidity on exercise adherence. There were also significant correlations among physical and psychological symptoms, self-efficacy for exercise, and exercise adherence. Self-efficacy for exercise showed partial mediating effects in the relationship between physical symptoms and exercise adherence. CONCLUSION: Based on the findings of this study, the enhancement of self-efficacy for exercise may positively affect the exercise compliance of the patients with health failure, even while they are experiencing physical symptoms. Therefore, it is necessary to develop effective strategies to enhance self-efficacy for exercise.
Busan ; Comorbidity ; Compliance ; Heart Failure ; Heart ; Humans ; Negotiating

PURPOSE: This study was done to identify the effects of nurses' time pressure on their safety care activities through the mediation of burnout. METHODS: Participants, 147 nurses with at least one year of work experience in two university hospitals were enrolled in this study. Data were collected using a self-reported questionnaire from July 31, to August 31, 2017 and analyzed with t-test, ANOVA, and Pearson's correlation coefficients. SPSS 23.0 was used for analysis. Mediating effects were examined with stepwise simple and complex regression, and statistical significance was verified with the Sobel test. RESULTS: Time pressure and burnout were significantly negatively correlated with safety care activities, and there was a positive correlation between time pressure and burnout. Regarding the mediating effects of burnout in the relationship between time pressure and safety care activity, time pressure had a significant effect on safety care activity both directly and indirectly through burnout, confirming a partial mediation effect of burnout. CONCLUSION: Strategies for enhancing work efficiency to reduce nurses' time pressure are needed to promote safety care activities. Furthermore, because burnout facilitated by time pressure among nurses influences their patient care activities, interventions for burnout management must also be implemented simultaneously.
Hospitals, University ; Negotiating ; Patient Care ; Patient Safety

PURPOSE: This study was done to investigate the mediating effect of nursing professionalism on the relationship between nurse's character and organizational commitment of the nurse. METHODS: The participants in this study were 170 nurses who had over 3 months of work experience in hospitals in 2 regions of South Korea. Data were collected using self-report questionnaires. Data collection period was from December 15, 2018 to January 15, 2019, Data were analyzed using the IBM SPSS/WIN 25.0 program. RESULTS: The significant predictors for organizational commitment of nurses were nursing professionalism (β=.42), total clinical career (β=−.30), monthly income (β=−.27) and clinical career in current hospital (β=−.24). These variables explained 36.0% of the variance in the organizational commitment of nurses. Nursing professionalism was found to have a mediating effect on the relationship between nurses' character and organizational commitment. CONCLUSION: These results highlight the importance of nurses' organizational commitment and can be used as meaningful data for intervention research to promote the character of nurses and nursing professionalism.
Data Collection ; Korea ; Negotiating ; Nursing ; Professionalism

PURPOSE: The study was done to investigate the mediating effects of voice behavior on the relationships between empathy and fairness and intention in helping behavior of nursing students. METHODS: A structured self-report questionnaire was used to measure empathy, fairness, voice behavior and intention in helping behavior. During November 2018, data were collected from 128 nursing students in D and G cities. Data were analyzed using hierarchical multiple linear regression with the SPSS/WIN 24.0 program. RESULTS: Empathy, fairness and voice behavior were positively correlated with intention in helping behavior of participants and voice behavior was positively correlated with empathy, fairness and intention in helping behavior of participants respectively. Also, voice behavior had a partial mediating effect on the relationship between empathy, fairness and intention in helping behavior. CONCLUSION: Findings indicate that empathy and fairness are important factors related to the intention in helping behavior of nursing students. It is also expected that voice behavior can further promote the intention in helping behavior of nursing students.
Bullying ; Empathy ; Helping Behavior ; Humans ; Intention ; Linear Models ; Negotiating ; Nursing ; Students, Nursing ; Voice