A large‐scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID‐19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory‐Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID‐19 designated hospitals. At the survey’s conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12–1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09–1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06–1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12–1.33, P < 0.001) (iii) COVID‐19 designated hospital (OR: 1.24, 95% CI 1.11–1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17–1.36; P < 0.001) and (iv) COVID‐19‐related departments (OR: 1.16, 95% CI 1.04–1.29, P = 0.006, emotional exhaustion only). To date, this is the first large‐scale study to report the rates of trauma and burnout for nurses during the COVID‐19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID‐19 designated hospitals, and departments involved with treating COVID‐19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.

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The aim of this research is to determine the levels of anxiety, depression, and sleep quality a severe acute respiratory syndrome (SARS) nursing staff experienced before and after a SARS prevention program. The 116 subjects were recruited from nursing staff in the largest obligatory SARS designated treatment hospital in Taiwan. Using general estimating equations (GEE) statistical analysis to control possible for affecting factors, we found that the nursing staff's anxiety and depression along with sleep quality started to improve 2 weeks after the initiation of SARS prevention controls. From this research, we determined that nursing staff members were anxious, depressed, and they could not sleep well at the SARS outbreak. However, the systematic SARS prevention program improved these factors. When faced with these types of diseases, related international medical organizations should establish a comprehensive program to help medical professionals cope better.

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BackgroundThis is the first meta-analysis to compare the treatment effects and safety of administering donepezil alone versus a combination of memantine and donepezil to treat patients with moderate to severe Alzheimer Disease, particularly regarding cognitive functions, behavioral and psychological symptoms in dementia (BPSD), and global functions.MethodsPubMed, Medline, Embase, PsycINFO, and Cochrane databases were used to search for English and non-English articles for inclusion in the meta-analysis to evaluate the effect size and incidence of adverse drug reactions of different treatments.ResultsCompared with patients who received donepezil alone, those who received donepezil in combination with memantine exhibited limited improvements in cognitive functions (g = 0.378, p < .001), BPSD (g = −0.878, p < .001) and global functions (g = −0.585, p = .004). Gradual titration of memantine plus a fixed dose and gradual titration of donepezil as well as a fixed dose and gradual titration of memantine resulted in limited improvements in cognitive functions(g = 0.371, p = .005), BPSD(g = −0.913, p = .001), and global functions(g = −0.371, p = .001).ConclusionBoth in the 24th week and at the final evaluation point, the combination of donepezil and memantine led to greater improvement in cognitive functions, BPSD, and global functions than did donepezil alone in patients with moderate to severe Alzheimer Disease.

The blowout limits of a number of swirl stabilized flames were measured and the trends are explained by applying the concepts proposed in recent flame blowout theories, which previously have been applied only to non-swirling flames. It is shown that swirl flame blowout limits can be compared to wellknown limits for non-swirling simple diffusion flames by using the proper nondimensional parameter, i.e., the inverse DamkohlerUnlike most previous work. four parameters were systematically varied: the fuel tube diameter (dF), the fuel type and thus reaction rate, which is related to the maximum laminar burning velocity (SL), the coaxial air velocity (UA), and the swirl number.Results show that the maximum fuel velocity (UF) and thus the maximum heat release rate for a swirl flame is as much as four times larger than that for a non-swirling flame. Blowout velocity (UF) increases with burner size (dFj and laminar burning velocity squared (SL2); this is similar to non-swirling flames except that a new parameter that includes swirl number must be added. The major reason why swirl increases the stability of a flame is because of a flame-vortex interaction. The toroidal recirculation vortex reduces the centerline velocity below that of a non-swirling flame and the analysis shows that this is strongly stabilizing.

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Primary sinonasal melanoma is an aggressive tumor that often presents a diagnostic challenge owing to its rarity and variable morphology. Unusual immunophenotypic expression of sinonasal melanoma compounds the problem particularly in a limited tissue sample. We studied immunohistochemical patterns of 5 primary sinonasal melanoma using antibodies against pan-cytokeratin, S-100, HMB-45, Melan-A, chromogranin, synaptophysin, neurofilament protein, and calponin and correlated these patterns with histologic appearance. Sinus/nasal mucosa from non-neoplastic cases were stained for Melan-A to evaluate prevalence of melanocytes in the benign mucosa in comparison to the staining pattern of the mucosa adjacent to the tumor. Similar to previous report, small cell pattern appeared to be over represented in the sinonasal melanoma. Small cell population in 4 cases was almost devoid of pigment, and also was either completely negative or only focally positive for S-100. Three cases stained positive for neuroendocrine markers and neurofilament protein bringing olfactory neuroblastoma and small cell neuroendocrine carcinoma in as differential diagnosis. Three cases were focally positive for calponin without spindle cell morphology or desmoplastic reaction. Immunophenotypic heterogeneity along with the unconventional histomorphology of sinonasal melanoma compounds diagnostic problem and warrants a precautionary approach to avoid misinterpretation. It is necessary to apply a broad panel of immunohistochemistry for the purpose of screening when sinonasal melanoma is considered as a differential diagnosis.