Background/Aims: Juvenile myopia is a serious problem in China, the prevalence of which stays at a high level and shows an upward trend. The target of this study was to explore the factors associated with myopia in Ch...Background/Aims: Juvenile myopia is a serious problem in China, the prevalence of which stays at a high level and shows an upward trend. The target of this study was to explore the factors associated with myopia in Chinese children. Methods: A cross-sectional analysis in a random sample survey was conducted in Beijing in 2008. The data collected from 15,316 Chinese school students aged 6 to 18 years, randomly selected from 19 schools were evaluated, including noncycloplegic refraction and possible genetic, environmental and behavioral factors, to explore the key risk factors for myopia. Univariate and multiple logistic regression analyses were performed to compare the OR values, and receiver operator characteristic (ROC) curves were generated to compare the differences among the areas under the ROC curves using the method of multiple comparison with the best. Results: Myopia was associated with shorter sleep times versus longer sleep times (adjusted OR = 3.37;95%CI 3.07-3.70), and the multivariate OR for two compared with no parents with myopic was 2.83 (95%CI 2.47-3.24) and 1.95 (95%CI 1.69-2.24) for reading or writing distances less than33 cmcompared to distances greater than33 cm. Controlling for other factors, children that slept for shorter periods of time had significantly more myopic refractions (?1.69D vs ?1.29D for children with longer sleeping time per day). Analysis of the areas under the ROC curves showed five variables with predictable values better than chance: age, sleeping time, reading or writing distance, hours of studying, and parental myopia. Conclusion: It was not surprising, as proved by other studies, that parental myopia, reading or writing distances, time spent on studying or other activities by using eyes were dominant risk factors associated with juvenile myopia. Our findings indicated that hours of sleeping were also closely related to juvenile myopia, in which the underlying mechanism should be explored in the future study.展开更多
AIM: To investigate the effect of chitooligosaccharides on proliferation of pancreatic islet cells, release of insulin and 2 h plasma glucose in streptozotocin-induced diabetic rats.METHODS: In vitro, the effect of ch...AIM: To investigate the effect of chitooligosaccharides on proliferation of pancreatic islet cells, release of insulin and 2 h plasma glucose in streptozotocin-induced diabetic rats.METHODS: In vitro, the effect of chitooligosaccharides on proliferation of pancreatic islet cells and release of insulin was detected with optical microscopy, colorimetric assay, and radioimmunoassay respectively. In vivo, the general clinical symptoms, 2 h plasma glucose, urine glucose, oral glucose tolerance were examined after sixty days of feeding study to determine the effect of chitooligosaccharides in streptozotocin-induced diabetic rats. RESULTS: Chitooligosaccharides could effectively accelerate the proliferation of pancreatic islet cells. Chitooligosaccharides (100 mg/L) had direct and prominent effect on pancreastic β cells and insulin release from islet cells. All concentrations of chitooligosaccharides could improve the general clinical symptoms of diabetic rats, decrease the 2 h plasma glucose and urine glucose, and normalize the disorders of glucose tolerance.CONCLUSION: Chitooligosaccharides possess various biological activities and can be used in the treatment of diabetes mellitus.展开更多
Winter chill is essential for the growth and development of deciduous species. To understand the relationship between accumulated chilling hours during endodormancy and blooming and fruit shape development, we control...Winter chill is essential for the growth and development of deciduous species. To understand the relationship between accumulated chilling hours during endodormancy and blooming and fruit shape development, we controlled chilling hours and investigated their effects on blooming date and fruit shape of peaches. The results showed that the number of days to full bloom date and the heat requirement for blooming were negatively correlated with accumulated chilling hours. Accumulated chilling hours were significantly negatively correlated with fruit shape index and fruit tip lengths, suggesting that the number of chilling hours affect the fruit shape development. Fewer accumulated chilling hours may be the major reason for longer fruit shape and protruding fruit tips. In conclusion, our results indicate specifically that decreased winter chilling hours can delay the bloom date and may lead to aberrant fruit shape development in peaches. Our study provides preliminary insights into the response of temperate fruit species to global climate change.展开更多
The popularity of flexible working hours around the world has slowed down the historical trend of reducing working hours.It even shows signs of regression.Whether and how to guide the cur-rent society with flexible wo...The popularity of flexible working hours around the world has slowed down the historical trend of reducing working hours.It even shows signs of regression.Whether and how to guide the cur-rent society with flexible working hours to return to the historical track of reducing working hours,improve the quality of working hours,and promote a smooth transition from the era of traditional standard work-ing hours to the era of flexible working hours has become a question related to the legal regulation of working hours in the new era.In this regard,although Western countries have proposed new regulatory concepts and carried out legislative practices with distinctive charac-teristics,the limitations of legal regulation capabilities have prevented them from proposing a package of institutional solutions.The advan-tage of China in the ability of legal regulation of working hours has been gradually formed in the legislation on working hours unnder the leadership of the CPC in the past century.It enables China to break through the limitations of the West and propose a Chinese approach to answer the question of the legal regulation of working hours in the new era from three aspects:limiting the extension of working hours,improving the quality of flexible working hours,and optimizing the funnctions of the multi-funnctional regulatory system for working hours.展开更多
This study investigates relationships between congestion and travel time performance metrics and crashes on road segments. The study focuses on work zone routes in Iowa, utilizing 2021 commercially-available probe veh...This study investigates relationships between congestion and travel time performance metrics and crashes on road segments. The study focuses on work zone routes in Iowa, utilizing 2021 commercially-available probe vehicle data and crash data. Travel time performance metrics were derived from the probe vehicle data, and crash counts were obtained from the crash data. Additional variables included road characteristics (traffic volume, road type, segment length) and a categorical variable for the presence of a work zone. A mixed effect linear regression model was employed to identify relationships between road segment crash counts and the selected performance metrics. This was accomplished for two sets of models that include congestion performance measures at different defining threshold values, along with travel time performance measures. The study results indicate that the congestion indicators, certain travel time performance measures, and traffic counts were statistically significant and positively correlated with crash counts. Indicator variables for rural interstate locations and non-active work zones have a stronger influence on crash count than those for municipal interstate locations and active work zones. These findings can inform decision-makers on work zone safety strategies and crash mitigation planning, especially in high traffic volume areas prone to congestion and queues.展开更多
There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore,...There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore, this study aimed to determine if there had been a significant change in air temperatures and chill hours, chill units, and chill portion accumulation in South Carolina over the last two decades. Two decades of daily maximum (T<sub>max</sub>) and minimum (T<sub>min</sub>) air temperature records were obtained from weather stations in thirty-one counties in South Carolina. Hourly temperature data, reconstructed from the daily data, were used to calculate the daily and annual chill hours, chill units, and chill portions accumulation using four different chill models for each location and year. The chill models included the T(t) °C model, the 0°C °C model, the Utah model, and the Dynamic model. For each county, regression analyses were conducted to evaluate the historical trends. Despite year-to-year variability, the tendency was a statistically significant (α = 0.05) increase in air temperature, averaging 0.089°C per year for 20 out of 31 counties in South Carolina. The other 11 counties had no significant change in temperature. The average temperature increase in the 31 counties was 0.072°C per year. The temperature increase resulted in a decrease in annual chill accumulation during the fall to spring, averaging 17.7 chill hours, 8.6 chill hours, 17.0 chill units, and 0.40 chill portions per year calculated with the T(t) °C, 0°C °C, Utah, and Dynamic models, respectively. However, whether this decrease in chill values was statistically significant or not depended on the chill model used. This study did not investigate the cause of the observed historical trends in temperature and chill accumulation. Still, if the trends continue, they could significantly impact the future of the temperate fruit tree industry in the state.展开更多
Using a difference-in-differences model, the present paper provides empirical evidence of minimum wage effects on employment and working hours in China. The results show that male employment is not affected by a minim...Using a difference-in-differences model, the present paper provides empirical evidence of minimum wage effects on employment and working hours in China. The results show that male employment is not affected by a minimum wage increase, although men ＂s working hours do increase. In contrast, female employment is more likely to be negatively affected by a minimum wage increase, while their working hours remain unchanged. This may lead to women being in a more disadvantaged position in the workforee, and adopting a monthly minimum wage may induce firms to extend men＇s working hours. Therefore, to better protect disadvantaged workers, we suggest that minimum wage regulation should focus on the target group of less-educated women, and that a unified minimum hourly wage needs to be set for both full-time and part-time workers. Meanwhile, the importance of human capital accumulation shouM be addressed in alleviating the negative effects of minimum wage increases.展开更多
The rapid development of the digital economy has provided a new impetus for rural residents to extend their working hours.Based on the data collected by the China Labor-force Dynamics Survey(CLDS)in 2014,2016,and 2018...The rapid development of the digital economy has provided a new impetus for rural residents to extend their working hours.Based on the data collected by the China Labor-force Dynamics Survey(CLDS)in 2014,2016,and 2018,this paper measured the development level of the digital economy in China from the perspectives of internet development and digital financial inclusion,and tested the mechanisms of how the digital economy affected rural residents’working hours.The results showed that the digital economy extended rural residents’working hours by expanding information channels and enhancing human capital,and this mechanism was affected by heterogeneity in rural residents’educational background,age,and social capital.Building on these findings,this paper holds that to increase rural residents’income by extending their working hours and achieving common prosperity for all,it is necessary to expand the opportunities for rural residents to participate in skills training and promote their accumulation of human capital.展开更多
Background: Dual Practice (DP) allows full-time public sector doctors to concurrently offer the same clinical services in the private sector. The debate against this practice seems to be largely influenced by its pote...Background: Dual Practice (DP) allows full-time public sector doctors to concurrently offer the same clinical services in the private sector. The debate against this practice seems to be largely influenced by its potential to reduce the contracted hours in the public sector and shift attention to private work. Purpose: The purpose of this secondary research is to estimate the monetary value of hours lost to the Nigerian public healthcare system when full-time government employee doctors are engaged in private practice. It attempts to quantify the amount of resource outflow from the public system due to absences and lateness arising from competition for time between the public system’s contracted hours and private practice. Methods: Sensitivity analysis in Excel 2010 was used to calculate doctors’ hourly pay in the public sector using the 2015 Consolidated Medical Salary Structure for medical and dental officers in Nigeria’s federal public service. The parameters used for the calculation were the official 40-hour working week and the average monthly gross pay of doctors on different grade levels. Hypothetical scenarios of hours lost due to absences associated with DP were created. The value of different hypothetical hour losses by the percentage of doctors assumed to engage in dual practice across all doctor grade levels was then computed. Results: The estimated annual value of hours lost from dual practice to a single public tertiary care hospital was N4,851,754 or 15,855 USD (best case scenario) and N19,407,017 or 63,422 USD (worst case scenario) for the normal routine work and N1,800,133 or 5883 USD (best case scenario) and N3,600,266 or 11,766 USD (worst case scenario) for the on-call duty. Conclusion: The government may have been paying salaries for large volumes of work not rendered in the public sector. The overall financial impact of dual practice in the Nigerian public system might be negative.展开更多
Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during ho...Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during hospitalization often display clinical decline for several hours before the event is observed. Non-critical care Nurses’ inconsistent recognition and response to patient deterioration lead to an increase in the length of hospital stay, unexpected admissions to the ICU, and increased morbidity and mortality. Aim: The study aimed to assess the factors that facilitate or impede the detection of early warning signs among adult patients hospitalized in tertiary care settings. Training should be provided to improve nurses’ knowledge, practice and attitude toward early warning signs of deteriorating patients leading to enhanced clinical judgment, skills and decision-making in addressing alerts. Methodology: A literature search was carried out in various databases;these were Cumulative Index to Nursing and Allied Health Literature (CINHAL), Google Scholar, PubMed, Science Direct, and Sage. The search area was narrowed from 2017 to 2022. The keywords used were “prevalence” AND “unplanned ICU admission”, “the importance of early warning signs” “outcome failure in rescue” “patient deterioration, communication” “improvement in early detection” AND “patient outcome admission” AND “early warning signs” AND “Pakistan”. After the analysis process, around 33 articles that met the inclusion criteria and were most relevant to the scope and context of the current study were considered. Conclusion: Most of the studies had reviewed literature in a qualitative retrospective observational study, content analysis, mixed method, and quasi-experimental study. The literature review identified that long hours of shift, nurse staffing levels, missed vital signs, lack of nursing training and education, and communication impact nurses’ ability to recognize and respond to early warning signs.展开更多
文摘Background/Aims: Juvenile myopia is a serious problem in China, the prevalence of which stays at a high level and shows an upward trend. The target of this study was to explore the factors associated with myopia in Chinese children. Methods: A cross-sectional analysis in a random sample survey was conducted in Beijing in 2008. The data collected from 15,316 Chinese school students aged 6 to 18 years, randomly selected from 19 schools were evaluated, including noncycloplegic refraction and possible genetic, environmental and behavioral factors, to explore the key risk factors for myopia. Univariate and multiple logistic regression analyses were performed to compare the OR values, and receiver operator characteristic (ROC) curves were generated to compare the differences among the areas under the ROC curves using the method of multiple comparison with the best. Results: Myopia was associated with shorter sleep times versus longer sleep times (adjusted OR = 3.37;95%CI 3.07-3.70), and the multivariate OR for two compared with no parents with myopic was 2.83 (95%CI 2.47-3.24) and 1.95 (95%CI 1.69-2.24) for reading or writing distances less than33 cmcompared to distances greater than33 cm. Controlling for other factors, children that slept for shorter periods of time had significantly more myopic refractions (?1.69D vs ?1.29D for children with longer sleeping time per day). Analysis of the areas under the ROC curves showed five variables with predictable values better than chance: age, sleeping time, reading or writing distance, hours of studying, and parental myopia. Conclusion: It was not surprising, as proved by other studies, that parental myopia, reading or writing distances, time spent on studying or other activities by using eyes were dominant risk factors associated with juvenile myopia. Our findings indicated that hours of sleeping were also closely related to juvenile myopia, in which the underlying mechanism should be explored in the future study.
基金Supported by the National High Technology Research and Development Program of China (863 Program, 2001AA625050) and the National Key Research and Development Program of China during the Tenth Five-Year Plan Period, No. 2001BA708B04-07
文摘AIM: To investigate the effect of chitooligosaccharides on proliferation of pancreatic islet cells, release of insulin and 2 h plasma glucose in streptozotocin-induced diabetic rats.METHODS: In vitro, the effect of chitooligosaccharides on proliferation of pancreatic islet cells and release of insulin was detected with optical microscopy, colorimetric assay, and radioimmunoassay respectively. In vivo, the general clinical symptoms, 2 h plasma glucose, urine glucose, oral glucose tolerance were examined after sixty days of feeding study to determine the effect of chitooligosaccharides in streptozotocin-induced diabetic rats. RESULTS: Chitooligosaccharides could effectively accelerate the proliferation of pancreatic islet cells. Chitooligosaccharides (100 mg/L) had direct and prominent effect on pancreastic β cells and insulin release from islet cells. All concentrations of chitooligosaccharides could improve the general clinical symptoms of diabetic rats, decrease the 2 h plasma glucose and urine glucose, and normalize the disorders of glucose tolerance.CONCLUSION: Chitooligosaccharides possess various biological activities and can be used in the treatment of diabetes mellitus.
基金supported by the grants from the Agricultural Science and Technology Innovation Program, China (CAAS-ASTIP-2015-ZFRI)the Comprehensive Experimental Station of Zhengzhou of China Agriculture Research System (CARS-31-Z-10)
文摘Winter chill is essential for the growth and development of deciduous species. To understand the relationship between accumulated chilling hours during endodormancy and blooming and fruit shape development, we controlled chilling hours and investigated their effects on blooming date and fruit shape of peaches. The results showed that the number of days to full bloom date and the heat requirement for blooming were negatively correlated with accumulated chilling hours. Accumulated chilling hours were significantly negatively correlated with fruit shape index and fruit tip lengths, suggesting that the number of chilling hours affect the fruit shape development. Fewer accumulated chilling hours may be the major reason for longer fruit shape and protruding fruit tips. In conclusion, our results indicate specifically that decreased winter chilling hours can delay the bloom date and may lead to aberrant fruit shape development in peaches. Our study provides preliminary insights into the response of temperate fruit species to global climate change.
基金funded by the National Social Science Fund of China (Western Region Program)“Research on Improving the Quality of Legislation in China on Rest and Vacation from a Global Perspective”(Project Approval Number:19XFX014)。
文摘The popularity of flexible working hours around the world has slowed down the historical trend of reducing working hours.It even shows signs of regression.Whether and how to guide the cur-rent society with flexible working hours to return to the historical track of reducing working hours,improve the quality of working hours,and promote a smooth transition from the era of traditional standard work-ing hours to the era of flexible working hours has become a question related to the legal regulation of working hours in the new era.In this regard,although Western countries have proposed new regulatory concepts and carried out legislative practices with distinctive charac-teristics,the limitations of legal regulation capabilities have prevented them from proposing a package of institutional solutions.The advan-tage of China in the ability of legal regulation of working hours has been gradually formed in the legislation on working hours unnder the leadership of the CPC in the past century.It enables China to break through the limitations of the West and propose a Chinese approach to answer the question of the legal regulation of working hours in the new era from three aspects:limiting the extension of working hours,improving the quality of flexible working hours,and optimizing the funnctions of the multi-funnctional regulatory system for working hours.
文摘This study investigates relationships between congestion and travel time performance metrics and crashes on road segments. The study focuses on work zone routes in Iowa, utilizing 2021 commercially-available probe vehicle data and crash data. Travel time performance metrics were derived from the probe vehicle data, and crash counts were obtained from the crash data. Additional variables included road characteristics (traffic volume, road type, segment length) and a categorical variable for the presence of a work zone. A mixed effect linear regression model was employed to identify relationships between road segment crash counts and the selected performance metrics. This was accomplished for two sets of models that include congestion performance measures at different defining threshold values, along with travel time performance measures. The study results indicate that the congestion indicators, certain travel time performance measures, and traffic counts were statistically significant and positively correlated with crash counts. Indicator variables for rural interstate locations and non-active work zones have a stronger influence on crash count than those for municipal interstate locations and active work zones. These findings can inform decision-makers on work zone safety strategies and crash mitigation planning, especially in high traffic volume areas prone to congestion and queues.
文摘There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore, this study aimed to determine if there had been a significant change in air temperatures and chill hours, chill units, and chill portion accumulation in South Carolina over the last two decades. Two decades of daily maximum (T<sub>max</sub>) and minimum (T<sub>min</sub>) air temperature records were obtained from weather stations in thirty-one counties in South Carolina. Hourly temperature data, reconstructed from the daily data, were used to calculate the daily and annual chill hours, chill units, and chill portions accumulation using four different chill models for each location and year. The chill models included the T(t) °C model, the 0°C °C model, the Utah model, and the Dynamic model. For each county, regression analyses were conducted to evaluate the historical trends. Despite year-to-year variability, the tendency was a statistically significant (α = 0.05) increase in air temperature, averaging 0.089°C per year for 20 out of 31 counties in South Carolina. The other 11 counties had no significant change in temperature. The average temperature increase in the 31 counties was 0.072°C per year. The temperature increase resulted in a decrease in annual chill accumulation during the fall to spring, averaging 17.7 chill hours, 8.6 chill hours, 17.0 chill units, and 0.40 chill portions per year calculated with the T(t) °C, 0°C °C, Utah, and Dynamic models, respectively. However, whether this decrease in chill values was statistically significant or not depended on the chill model used. This study did not investigate the cause of the observed historical trends in temperature and chill accumulation. Still, if the trends continue, they could significantly impact the future of the temperate fruit tree industry in the state.
基金the National Social Science Foundation of China(Grant No.13CYJ017)the China Postdoctoral Science Foundation(Grant No.2012M520506)the Ministry of Education of China(Grant No.12JJD790042)
文摘Using a difference-in-differences model, the present paper provides empirical evidence of minimum wage effects on employment and working hours in China. The results show that male employment is not affected by a minimum wage increase, although men ＂s working hours do increase. In contrast, female employment is more likely to be negatively affected by a minimum wage increase, while their working hours remain unchanged. This may lead to women being in a more disadvantaged position in the workforee, and adopting a monthly minimum wage may induce firms to extend men＇s working hours. Therefore, to better protect disadvantaged workers, we suggest that minimum wage regulation should focus on the target group of less-educated women, and that a unified minimum hourly wage needs to be set for both full-time and part-time workers. Meanwhile, the importance of human capital accumulation shouM be addressed in alleviating the negative effects of minimum wage increases.
基金This paper is part of the Youth Program of Science and Technology Research of Chongqing Municipal Education Commission(KJQN202300545)Youth Program of National Social Science Fund of China(21CJY001)Science and Technology Research Program of Chongqing Municipal Education Commission(KJQN202300567).
文摘The rapid development of the digital economy has provided a new impetus for rural residents to extend their working hours.Based on the data collected by the China Labor-force Dynamics Survey(CLDS)in 2014,2016,and 2018,this paper measured the development level of the digital economy in China from the perspectives of internet development and digital financial inclusion,and tested the mechanisms of how the digital economy affected rural residents’working hours.The results showed that the digital economy extended rural residents’working hours by expanding information channels and enhancing human capital,and this mechanism was affected by heterogeneity in rural residents’educational background,age,and social capital.Building on these findings,this paper holds that to increase rural residents’income by extending their working hours and achieving common prosperity for all,it is necessary to expand the opportunities for rural residents to participate in skills training and promote their accumulation of human capital.
文摘Background: Dual Practice (DP) allows full-time public sector doctors to concurrently offer the same clinical services in the private sector. The debate against this practice seems to be largely influenced by its potential to reduce the contracted hours in the public sector and shift attention to private work. Purpose: The purpose of this secondary research is to estimate the monetary value of hours lost to the Nigerian public healthcare system when full-time government employee doctors are engaged in private practice. It attempts to quantify the amount of resource outflow from the public system due to absences and lateness arising from competition for time between the public system’s contracted hours and private practice. Methods: Sensitivity analysis in Excel 2010 was used to calculate doctors’ hourly pay in the public sector using the 2015 Consolidated Medical Salary Structure for medical and dental officers in Nigeria’s federal public service. The parameters used for the calculation were the official 40-hour working week and the average monthly gross pay of doctors on different grade levels. Hypothetical scenarios of hours lost due to absences associated with DP were created. The value of different hypothetical hour losses by the percentage of doctors assumed to engage in dual practice across all doctor grade levels was then computed. Results: The estimated annual value of hours lost from dual practice to a single public tertiary care hospital was N4,851,754 or 15,855 USD (best case scenario) and N19,407,017 or 63,422 USD (worst case scenario) for the normal routine work and N1,800,133 or 5883 USD (best case scenario) and N3,600,266 or 11,766 USD (worst case scenario) for the on-call duty. Conclusion: The government may have been paying salaries for large volumes of work not rendered in the public sector. The overall financial impact of dual practice in the Nigerian public system might be negative.
文摘Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during hospitalization often display clinical decline for several hours before the event is observed. Non-critical care Nurses’ inconsistent recognition and response to patient deterioration lead to an increase in the length of hospital stay, unexpected admissions to the ICU, and increased morbidity and mortality. Aim: The study aimed to assess the factors that facilitate or impede the detection of early warning signs among adult patients hospitalized in tertiary care settings. Training should be provided to improve nurses’ knowledge, practice and attitude toward early warning signs of deteriorating patients leading to enhanced clinical judgment, skills and decision-making in addressing alerts. Methodology: A literature search was carried out in various databases;these were Cumulative Index to Nursing and Allied Health Literature (CINHAL), Google Scholar, PubMed, Science Direct, and Sage. The search area was narrowed from 2017 to 2022. The keywords used were “prevalence” AND “unplanned ICU admission”, “the importance of early warning signs” “outcome failure in rescue” “patient deterioration, communication” “improvement in early detection” AND “patient outcome admission” AND “early warning signs” AND “Pakistan”. After the analysis process, around 33 articles that met the inclusion criteria and were most relevant to the scope and context of the current study were considered. Conclusion: Most of the studies had reviewed literature in a qualitative retrospective observational study, content analysis, mixed method, and quasi-experimental study. The literature review identified that long hours of shift, nurse staffing levels, missed vital signs, lack of nursing training and education, and communication impact nurses’ ability to recognize and respond to early warning signs.
