Background Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive. Methods We examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (<37 weeks gestation) and 480 term controls who delivered a singleton infant at term (≥37 weeks gestation). Maternal nightly sleep and reports of vital exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous preterm labor or preterm premature rupture of membranes. In addition, cases were categorized as very (<32 weeks), moderate (32–33 weeks), and late (34- <37 weeks) preterm birth for additional analyses. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results After adjusting for confounders, we found that short sleep duration (≤6 hours) was significantly associated with preterm birth (aOR = 1.56; 95% CI 1.11-2.19) compared to 7–8 hours of sleep. Vital exhaustion was also associated with increased odds of preterm birth (aOR = 2.41; 95% CI 1.79-3.23) compared to no exhaustion (Ptrend <0.001). These associations remained significant for spontaneous preterm labor and preterm premature rupture of membranes. We also found evidence of joint effects of sleep duration and vital exhaustion on the odds of spontaneous preterm birth. Conclusions The results of this case–control study suggest maternal sleep duration, particularly short sleep duration, and vital exhaustion may be risk factors for spontaneous preterm birth. These findings call for increased clinical attention to maternal sleep and the study of potential intervention strategies to improve sleep in early pregnancy with the aim of decreasing risk of preterm birth.

Master of Science / Department of Animal Sciences and Industry / John M. Gonzalez / Pigs fed ractopamine-HCl (RAC) are more prone to fatigue and exhaustion when improperly handled. Wireless electromyography (EMG) can be used to directly measure median power frequency (MdPF) and root mean square (RMS) as indicators of action potential conduction velocity and muscle fiber recruitment, respectively. The objectives of this study were to determine the effect of RAC on exhaustion, EMG measures, and muscle fiber type characteristics when barrows were subjected to increased levels of activity. Thirty-four barrows were assigned to one of two treatments: a commercial finishing diet containing 0 mg/kg (CON) RAC or a diet formulated to meet the requirements of finishing barrows fed 10 mg/kg RAC (RAC+) for 35 d. After 32 d of feeding, barrows were walked around a circular track at 0.79 m/s until subjective exhausted was reached. Time, distance, and speed were measured. Wireless surface EMG sensors were affixed to the Deltoideus (DT), Triceps brachii lateral head (TLH), Tensor fasciae latae (TFL), and Semitendinosus (ST) muscles. After harvest, samples of each muscle were collected for fiber type, succinate dehydrogenase, and capillary density analysis. Speed was not different (P = 0.82) between treatments, but RAC+ barrows reached subjective exhaustion quicker and covered less distance than CON barrows (P < 0.01). The end-point MdPF was not affected by the RAC diet. The RAC diet did not change end-point RMS values in the DT or TLH; however, the RAC+ barrows tended to have decreased ST and increased TFL end-point RMS values (P < 0.07). The percentage of type I fibers tended to be greater (P = 0.07) in RAC+ barrows, but the RAC diet tended to increase (P = 0.07) size of type I fibers and increase (P = 0.03) the size of type IIA fibers. Succinate dehydrogenase was not different between treatments. The RAC+ barrows had more (P = 0.03) capillaries per fiber than CON barrows. A diet containing RAC contributes to increased onset of subjective exhaustion, possibly due to rapid loss of active muscle fibers and chronic loss of oxidative muscle fibers with no change in muscle metabolism.

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The Abstract of Thesis Title¡GThe study of the relationship among hospital employees, emotion labor load and customer-oriented behavior. School¡GNational SUN YAT-SEN University Department¡GInstitute of Human Resource Management Academic year¡G91 Author¡GHsiu-Ching Tai Adviser¡GDr. Bih-Shiaw Jaw Dr. Liang-Chih Huang Abstract At the world competition period, business must pay more attention to customer oriented service and customer satisfaction as the company core ability to face the challenges. Customer-oriented behavior is the necessary condition for business to exist in the world and it becomes the business management trend. Medical treatment in Taiwan will make a revolution in the 21st century by the medical policy changes. This situation makes the hospital management become harder and face more challenges. Medical service industry doesn¡¦t only have normal trait like the common service industry, but also have many specific traits. However, the hospital is a working environment with high emotional labor load. If hospital employees can not deal with their emotions appropriately, it will cause emotional exhaustion and influences customer-oriented behaviors. In order to understand if the emotional exhaustion is a mediator between the emotional labor load and the customer-oriented behavior, also, if the emotional management affects the emotion labor load, emotion exhaustion and customer-oriented behavior is the research purpose. The samples are 503 employees of two hospitals at Kaohsiung, but the valid questionnaires are 399. After SPSS for Windows 8.0 statistic analyzing, the results are summarized as following: 1. The hospital employees with different characters will lead to variance emotional labor load, emotional exhaustion, emotional management and customer-oriented behaviors. 2. There is a relationship between the emotional labor load, emotional exhaustion and customer-oriented behaviors. 3. The relationship between the emotional labor load and customer-oriented behavior has prediction. 4. The emotional exhaustion has intermediary effect between emotional labor load and customer-oriented behavior. 5. The emotional management of emotional empathy, emotional expression and awareness have mediator effects between the emotional labor load and emotional exhaustion. Therefore, the high emotional labor load of hospital employees can be eliminated by emotional expression and awareness, and the emotional exhaustion can be decreased. Then, this situation will influence the customer-oriented behavior. Also, management use human resource management proposal to reinforce employees¡¦ emotional manage skills. IT will help employees decrease the emotional labor load, emotional exhaustion, and improve customer-oriented behavior. Key Words: hospital employees, emotional labor load, emotional exhaustion, emotional management, customer-oriented behavior.

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The Tim-3+ T cells in HIV infection are dysfunctional in proliferation or cytokine production. Here, we evaluated the effects of Tim-3 expression on the cytotoxicity of CD8+ T cells in HIV infection by examining 1) the ability of Tim-3+ CD8+ T cells to make perforin and 2) the direct ability of Tim-3+ CD8+ T cells to kill HIV infected CD4+ target cells. Tim-3+ CD8+ T cells maintained higher levels of perforin. However, these cells were defective in their ability to degranulate. Blocking the Tim-3 signalling pathway enhanced the cytotoxic capabilities of HIV specific CD8+ T cells by increasing: their degranulation capacity, their ability to release perforin, their ability to target activated granzyme B to HIV antigen expressing CD4+ T cells and their ability to suppress HIV infection of CD4+ T cells. Thus, the Tim-3 receptor can down-regulate the CD8+ T cell cytotoxicity through inhibition of degranulation and perforin/granzyme secretion.

The Tim-3+ T cells in HIV infection are dysfunctional in proliferation or cytokine production. Here, we evaluated the effects of Tim-3 expression on the cytotoxicity of CD8+ T cells in HIV infection by examining 1) the ability of Tim-3+ CD8+ T cells to make perforin and 2) the direct ability of Tim-3+ CD8+ T cells to kill HIV infected CD4+ target cells. Tim-3+ CD8+ T cells maintained higher levels of perforin. However, these cells were defective in their ability to degranulate. Blocking the Tim-3 signalling pathway enhanced the cytotoxic capabilities of HIV specific CD8+ T cells by increasing: their degranulation capacity, their ability to release perforin, their ability to target activated granzyme B to HIV antigen expressing CD4+ T cells and their ability to suppress HIV infection of CD4+ T cells. Thus, the Tim-3 receptor can down-regulate the CD8+ T cell cytotoxicity through inhibition of degranulation and perforin/granzyme secretion.

Objectives - To examine the incidence, clinical state, personal risk factors, haematology and biochemistry of heat exhaustion cases occurring at a deep underground metalliferous mine. To describe the underground and surface thermal conditions associated with the occurrence of heat exhaustion cases.Methods - A one-year prospective case-series of acute heat exhaustion cases was undertaken at a deep underground metalliferous mine in tropical and Australia. A case-control study of body mass index (BMI) and maximal oxygen uptake (VO(subscript)2max) in heat exhaustion was also undertaken. A history was obtained using a structured questionnaire. Pulse rate, blood pressure, tympanic temperature and urine specific gravity were measured before treatment. Venous blood was analysed for haematological and biochemical parameters, during the acute presentation and after recovery. BMI and VO(subscript)2max were measured after recovery and in a group of controls. Psychrometric wet bulb temperature, dry bulb temperature and air velocity were measured at the underground sites where heat exhaustion had occurred. Air cooling power and psychrometric wet bulb globe temperatures were derived. Surface 24-hour mean wet bulb and dry bulb temperatures were recorded. Surface 24-hour mean wet bulb globe temperatures were derived.Results - 106 cases were studied in the case series. The incidence of heat exhaustion during the year was 43.0 cases per million man-hours. In February it was 147 cases per million man-hours. The incidence rate ratio for mines operating below 1200m compared to those operating above 1200m was 3.17. Mean estimated fluid intake was 0.64 litres/hour (SD 0.29, Range 0.08-1.50).The following were raised on acute presentation compared to recovery (P value, % of acute cases above the normal clinical range): neutrophils (P<0.001, 36%), anion gap (P<0.001, 63%), urea (P<0.001, ++ / 21%), creatinine (P<0.001, 30%), glucose (P<0.001, 15%), serum osmolality (P=0.030, 71%), creatine kinase (P=0.002, 45%), aspartate transaminase (P<0.001, 14%), lactate dehydrogenase (P<0.001, 9.5%), and ferritin (P<0.001, 26%). The following were depressed on acute presentation compared to recovery (P value, % of acute cases below the normal clinical range): eosinophils (P=0.003, 3 8%) and bicarbonate (P=0.0 11, 32%). Urea and creatinine were significantly raised in miners with heat cramps compared to miners without this symptom (P<0.001), while there was no significant difference in sodium concentration (P=0.384).Mean psychrometric wet bulb temperature was 29.0 degrees celsius (SD 2.2, Range 21.0-34.0). Mean dry bulb temperature was 37.4 degrees celsius (SD 2.4, Range 31.0-43.0). Mean air velocity was 0.54 m/s (SD 0.57, Range 0.00-4.00). Mean air cooling power was 148 W/m(subscript)2 (SD 49, Range 33-290). Mean psychrometric wet bulb globe temperature was 31.5 degrees celsius (SD 2.0, Range 25.2-35.3). Few cases (<5%) occurred at a psychrometric wet bulb temperature <25.0'C, dry bulb temperature <33.8'C, air velocity >1.56 m/s, air cooling power >248 W/m(subscript)2, or psychrometric wet bulb globe temperature <28.5 degrees Celsius.The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred compared to those days on which it did not occur (P<0.001). The relative risk of heat exhaustion on days when the surface 24-hour mean wet bulb globe temperature was in the range 26.0-28.0 degrees celsius was 4.82 (95% CI 2.12-10.96).65 cases of heat exhaustion and 119 controls were studied in the case-control study. Heat exhaustion cases had a significantly higher BMI than controls (P=0.006). The odds ratios increased with BMI. For a BMI of 32.00-36.99, compared to a BMI of less than 27.00 the odds ratio was 3.63 (95% ++ / confidence interval 1.42-9.36). V0(subscript)2max was not significantly lower in cases than controls. The odds ratios for heat exhaustion increased with decreasing VO(subscript)2max, but not significantly. The sample size provided 80% power of detecting an odds ratio of 2.5 or greater.Conclusion - Heat exhaustion in underground miners is associated with hypohydration, neutrophil leukocytosis, eosinopenia, metabolic acidosis, increased glucose and ferritin, and a mild rise in CK, AST and LD. Heat cramps are associated with hypohydration but not hyponatraemia. The incidence of heat exhaustion increases during summer and at depth. An increased fluid intake is required. Heat exhaustion would be unlikely to occur if ventilation and refrigeration achieved air cooling power >250W/m2 at all underground work sites. Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion. Deep underground miners should be advised to maintain a BMI of 24-27.

Issued also as Thesis (Ph. D.)--Columbia University. / Bibliography: p. 91-100.

Issued also as Thesis (Ph. D.) Columbia University. / Bibliography: p. 91-100.