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An in-house self-held respiration monitoring device (SHRMD) was developed for providing deep inspiration breath hold (DIBH) radiotherapy. The use of SHRMD is evaluated in terms of reproducibility, stability and heart dose reduction.
Methods and materials:
Sixteen patients receiving radiotherapy of left breast cancer were planned for treatment with both a free breathing (FB) scan and a DIBH scan. Both FB and DIBH plans were generated for comparison of the heart, left anterior descending (LAD) artery and lung dose. All patients received their treatments with DIBH using SHRMD. Megavoltage cine images were acquired during treatments for evaluating the reproducibility and stability of treatment position using SHRMD.
Compared with FB plans, the maximum dose to the heart by DIBH technique with SHRMD was reduced by 29·9 ± 15·6%; and the maximum dose of the LAD artery was reduced by 41·6 ± 18·3%. The inter-fractional overall mean error was 0·01 cm and the intra-fractional overall mean error was 0·04 cm.
This study demonstrated the potential benefits of using the SHRMD for DIBH to reduce the heart and LAD dose. The patients were able to perform stable and reproducible DIBHs.
The aim of this study was to provide a comprehensive overview of the evolution of health technology assessment (HTA) in Malaysia over the past decade.
We described the evolution of HTA program in Malaysia based on review of administrative data, publicly available information and quantitative description of impact evaluation.
Health Technology Assessment HTA was formalized in Malaysia in 1995 as a central structure within the Ministry of Health, Malaysia in 1995. Expansion of activities demonstrated over the years including Horizon Scanning of health technologies and implementation of evidence-based Clinical Practice Guidelines. Improvement on the processes in terms of types of report, quality, monitoring, and impact evaluation as well as accessibility was also carried out. Examples of impact/influence of the reports have also been demonstrated.
HTA program in Malaysia has evolved over the past decades. Its role in policy formulation and decision making of health technologies has become more significant over the years and is foreseen to be bigger in the future. As a trusted source of evidence, HTA in Malaysia will continue to strengthen the health system by advocating informed decision making and value-based medicine. As other countries in this region is trying to establish their own HTA processes and procedures, this review on the evolution of the HTA program in Malaysia might give some insights on developing a sustainable HTA program.
Ladies and gentlemen, it is my great honor to talk about musicology and ethnomusicology in Korea. But I am afraid that to listen to tedious details, such as the names of many articles and books, and the names of foreign authors and apparently insignificant dates of their publications, especially on a hot mid-summer day, would be uncomfortable. So I beg you to read my paper on the publicly announced topic at your leisure and to allow me to talk of my broad daydream about the ultimate aim of musicology and ethnomusicology.
Leading sociologists who live and work in East Asia examine their region's most dangerous and explosive social problems, and some of their most stunning success stories, from the viewpoint of Civil Sphere Theory. This new and increasingly influential sociological understanding of democracy aims to describe and explain the moral codes and institutional foundations of democratic solidarity, as it manifests itself within a distinct social sphere. Part of a multi-volume project, this collection includes cases from Japan, mainland China, Hong Kong, Taiwan, and South Korea, bringing together efforts by sociologists based in East Asian academic institutions. Through an extraordinary blend of sophisticated social theory and path-breaking empirical research, The Civil Sphere in East Asia aims to advance civil sphere theory by globalizing and regionalizing it at the same time.
Although federal regulation of vehicle fuel economy is often seen as environmental policy, over 70% of the estimated benefits of the 2017–2025 federal standards are savings in consumer expenditures on gasoline. Rational-choice economists question the counting of these benefits since studies show that the fuel efficiency of a car is reflected in its price at sale and resale. We contribute to this debate by exploring why most consumers in the United States do not purchase a proven fuel-saving innovation: the hybrid-electric vehicle (HEV). A database of 110 vehicle pairs is assembled where a consumer can choose a hybrid or gasoline version of virtually the same vehicle. Few choose the HEV. A total cost of ownership model is used to estimate payback periods for the price premiums associated with the HEV choice. In a majority of cases, a rational-choice explanation is sufficient to understand consumer disinterest in the HEV. However, in a significant minority of cases, a rational-choice explanation is not readily apparent, even when non-pecuniary attributes (e.g., performance and cargo space) are considered. Future research should examine, from a behavioral economics perspective, why consumers do not choose HEVs when pricing and payback periods appear to be favorable.
As a degenerative disease, the progression of dementia needs continued care provision and poses both psychological and financial burden for family caregivers of persons with dementia (PWD). This study seeks to compare predictors of care costs and caregiver burden, and to identify modifiable factors that could alleviate the burden faced by dementia caregivers.
This study interviewed 231 PWD–caregiver dyads in a dementia clinic at a teaching hospital in southern Taiwan in 2013. A follow-up study was conducted a year later, and 167 dyads completed the second interview. Data collected included PWD characteristics, caregiver characteristics, relationship to PWD, and social support to caregivers. Caregiver burden was measured with the Zarit Burden Interview instrument. The association between each predictor variable and cost of care and caregiver burden scores was examined using linear mixed models.
Predictors of care costs were found to be different from predictors of caregiver burden: functional declines measured by Katz’s activities of daily living (ADL) scale were associated with total cost as compared to behavioral disturbance measured by Neuropsychiatric Inventory (NPI), which showed no impact on care costs. However, NPI was a significant predictor of caregiver burden. Caregivers who were better-off financially also reported significantly lower caregiver burden.
Since predictors of care costs were different from the predictors of caregiver burden, providing training to caregivers in addressing PWD’s behavioral disturbance and proving financial assistance to low income caregivers could be effective in reducing caregiver burden.
Intensive silvopastoral systems (ISS) are a sustainable alternative to monoculture systems (MS). The presence of trees and legumes improves animal welfare due to the increased food quality and quantity and the presence of shade while providing a variety of environmental services. As cattle behaviour is greatly affected by environmental conditions, knowledge on the behavioural trade-offs that cattle make to meet their demands while foraging in different grazing systems is important, as this will help us understand the perceived advantages of ISS. This pilot study assessed the behaviour of heifers in an ISS (n=8 heifers) and MS (n=8 heifers) in the Mexican tropics during the dry and rainy seasons, and its relationship with forage availability, mean travelled distance and the temperature humidity index (THI). In both seasons, daily foraging times were longer in the MS than the ISS (P<0.01). The duration of rumination was higher for ISS (P<0.01) and the duration of lying was higher for the dry season (P<0.05). The decrease in foraging times in relation to THI was significantly higher in the ISS than in the MS (mean slope±SE: ISS=−4.64±0.34; MS=−2.34±0.22; t=−14.20, P<0.001). The results suggest that the forage availability and access to shade in the ISS allow cattle to rest longer and increase rumination, whereas cattle in MS spend more time searching for food and foraging at times of the day were the temperatures were higher as a compensatory strategy, which potentially decreases cattle’s welfare and production qualities when compared with the ISS. In conclusion, ISS are likely to generate positive behavioural trade-offs that result in better welfare conditions and higher productive potential.
Monitoring milk quality traits and the classification of raw milk are important steps for generating high-quality dairy products. Given the important roles of the BRG1/BRM-associated factor 60c (BAF60c) gene in the regulation of physiological growth and production, the objective of the current study was to analyse the association between the BAF60c gene and milk quality and establish a gene-based method for pre-evaluating raw milk quality. For this purpose, DNA was isolated from 507 milk samples and genotyped using the polymerase chain reaction-restricted fragment length polymorphism method. Milk quality traits including milk protein percentage (MPP), milk fat percentage (MFP), lactose percentage (LP) and total solids content (TSC) were also evaluated from the same 507 milk samples. The newly found 6060 T > C mutation of the BAF60c gene was associated significantly with MPP and LP, but not with MFP and TSC. The results demonstrated that this mutation could be used for the pre-evaluation of MPP and LP; therefore, raw milk could be graded according to different genotypes.
Electroconvulsive therapy (ECT) is one of the most effective treatments for depression, although the underlying mechanisms remain unclear. Animal studies have shown that electroconvulsive shock induced neuroplastic changes in the hippocampus.
To summarise volumetric magnetic resonance imaging studies investigating the effects of ECT on limbic brain structures.
A systematic review and meta-analysis was conducted to assess volumetric changes of each side of the hippocampus and amygdala before and after ECT. Standardised mean difference (SMD) was calculated.
A total of 8 studies (n = 193) were selected for our analyses. Both right and left hippocampal and amygdala volumes increased after ECT. Meta-regression analyses revealed that age, percentage of those responding and percentage of those in remission were negatively associated with volume increases in the left hippocampus.
ECT increased brain volume in the limbic structures. The clinical relevance of volume increase needs further investigation.