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Magnetic field-assisted freeze-casting of porous alumina structures is reported. Different freeze-casting parameters were investigated and include the composition of the original slurry (Fe3O4 and PVA content) and the control of temperature during the free casting process. The optimum content of the additives in the slurry were 3 and 6 wt% for PVA and Fe3O4, respectively. These conditions provided the most unidirectional porous structures throughout the length of the sample. The sintering temperature was maintained at 1500 °C for 3 h. The application of a vertical magnetic field (parallel to ice growth direction) with using a cooling rate mode technique was found to enhance the homogeneity of the porous structure across the sample. The current study suggests that magnetic field-assisted freeze-casting is a viable method to create highly anisotropic porous ceramic structures.
Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients.
This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests.
A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use.
PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.
The purposes of this study were to explore elderly outpatients’ perceived reasons for, opinions of, and suggestions for elderly people considering suicide in Taiwan.
Elderly outpatients (N=83) were recruited in 2011-2012 by convenience sampling from three randomly selected medical centers in Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by content analysis.
Findings revealed that most participants had heard of elderly suicide, with television news as the main source for their information. Their opinions about elderly suicide reflected judgmental attitudes, negative emotional reactions, expectations of social welfare, and could happen after losing one's meaning in life. Their suggestions for elderly people considering suicide fell into four major themes: give up suicidal ideas, seek help, enhance social welfare, and attend religious activities.
Since television news was the main source for participants’ information about elderly suicide, this mass medium should be used in suicide prevention to disseminate suicide knowledge, increase access to help, and strengthen suicide-protective factors among the elderly. Furthermore, no participants mentioned depression as a reason for attempted or completed suicide among older people despite depression being a well-known suicide-risk factor. Future suicide-prevention programs should emphasize the role of depression in suicide among older people. Participants also did not suggest that older people considering suicide seek help from the health system. Thus, older people should be educated about the role of the health system in suicide prevention and trained as gatekeepers to recognize signs of suicide ideation and respond appropriately.
This study examined the way organizations were involved in the response to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV, MERS) outbreak that occurred in Korea in 2015.
Data and Methods:
We collected organizational network data through a content analysis of online news articles and the government’s white paper. Social network analysis was used to analyze the key organizations and their connections in crucial response tasks.
Three national health authorities (Central MERS Management Headquarters [CMMH], Korea Centers for Disease Control [KCDC], Ministry of Health and Welfare [MOHW]) led the response. CMMH, which did not appear in the government’s response plans, played a significant role in all 3 networks. KCDC also was involved in all 3 networks, but was most prominent in the laboratory testing network. MOHW appeared only in the patient management network. Each health authority coordinated and collaborated with distinctive types of organizations in the networks, but unclear lines of responsibilities also were found.
The study demonstrated that the roles and responsibilities of health authorities at the national level were fragmented and lacked clarity. Public health emergency preparedness must consider carefully the way to establish collaborative response systems.
Has the eurozone (EZ) really gained from integration? This study applied two econometric frameworks, mGARCH and gMMPI, to test this hypothesis, using panel data that span 1996–2014, a total of 19 years, involving the EZ, EU, G8, G20 and some emerging economies. The empirical outcomes initially showed that the EZ economies experienced neither superior output growth nor a better capital market return than non-EZ economies or the pre-EZ period. They further suggested that each EZ country had a higher degree of risk bearing and, as a group, a greater risk linkage. Moreover, the results indicated that the EZ had a higher productivity gain if the risk premium was counted as part of productivity. Nonetheless, the EZ did not show a substantial productivity gain when the effect of the risk factor was controlled. The ratio of risk bearing to risk premium gain was shown to be 1 to 0.97. The general conclusion is that, other than the risk premium, there was no extra productivity gain for the EZ from taking the risk.
Rat gambling task (rGT) is a recently developed animal model making translational research possible in psychiatric disorders related to decision-making deficits. Methiopropamine (MPA) is a structural analog to methamphetamine and a temporary controlled substance. Although increasing concerns have been raised regarding MPA's abuse, few sources of information exist regarding its psychopharmacology. Thus, we investigated whether MPA produces any changes in the choice of preference in rGT.
Rats were trained in a touch screen chamber to learn the relationships between 4 different light signals on the screen and accompanied reward outcomes and punishments set up with different schedules, for one session of 30 min each day. Once animals showed a stabilized pattern of preference, they were given a total of 5 IP injections (a single injection per day, every other day) with saline or MPA followed by 2 weeks of withdrawal. Upon MPA challenge injection, their preference of choice was re-tested in rGT chambers.
Depending upon their preference of choice, rats were separated as risk-averse or risk-seeking groups. When they were pre-exposed to and challenged with MPA, rats in the risk-averse group significantly changed their preference toward more disadvantageous choices. These effects were not shown when they were pre-exposed to saline and challenged with MPA.
These results indicate that MPA badly influences decision-making behavior as in gambling task, implying that it may aggravate pathological symptoms of bad choices, resulting in negative consequences, observed in the patients with behavioral addictions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Large prospective observational studies have cast doubt on the common assumption that endovascular thrombectomy (EVT) is superior to intravenous thrombolysis for patients with acute basilar artery occlusion (BAO). The purpose of this study was to retrospectively review our experience for patients with BAO undergoing EVT with modern endovascular devices.
All consecutive patients undergoing EVT with either a second-generation stent retriever or direct aspiration thrombectomy for BAO at our regional stroke center from January 1, 2013 to March 1, 2019 were included. The primary outcome measure was functional outcome at 1 month using the modified Rankin Scale (mRS) score. Multivariable logistic regression was used to assess the association between patient characteristics and dichotomized mRS.
A total of 43 consecutive patients underwent EVT for BAO. The average age was 67 years with 61% male patients. Overall, 37% (16/43) of patients achieved good functional outcome. Successful reperfusion was achieved in 72% (31/43) of cases. The median (interquartile range) stroke onset to treatment time was 420 (270–639) minutes (7 hours) for all patients. The procedure-related complication rate was 9% (4/43). On multivariate analysis, posterior circulation Alberta stroke program early computed tomography score and Basilar Artery on Computed Tomography Angiography score were associated with improved functional outcome.
EVT appears to be safe and feasible in patients with BAO. Our finding that time to treatment and successful reperfusion were not associated with improved outcome is likely due to including patients with established infarcts. Given the variability of collaterals in the posterior circulation, the paradigm of utilizing a tissue window may assist in patient selection for EVT. Magnetic resonance imaging may be a reasonable option to determine the extent of ischemia in certain situations.
Impaired illness awareness or insight into illness (IIA) is a common feature of schizophrenia that contributes to medication nonadherence and poor clinical outcomes. Neuroimaging studies suggest IIA may arise from interhemispheric imbalance in frontoparietal regions, particularly in the posterior parietal area (PPA) and the dorsolateral prefrontal cortex (dlPFC). In this pilot study, we examined the effects of transcranial direct current stimulation (tDCS) on brain regions implicated in IIA.
Eleven patients with schizophrenia with IIA (≥3 PANSS G12) and 10 healthy controls were included. A crossover design was employed where all participants received single-session bi-frontal, bi-parietal, and sham stimulation in random order. For each condition, we measured (i) blood oxygen level-dependent (BOLD) response to an illness awareness task pre- and post-stimulation, (ii) regional cerebral blood-flow (rCBF) prior to and during stimulation, and (iii) changes in illness awareness.
At baseline, patients with schizophrenia showed higher BOLD-response to an illness awareness task in the left-PPA compared to healthy controls. Bi-parietal stimulation reduced the interhemispheric imbalance in the PPA compared to sham stimulation. Relatedly, bi-parietal stimulation increased rCBF beneath the anode (21% increase in the right-PPA), but not beneath the cathode (5.6% increase in the left-PPA). Bi-frontal stimulation did not induce changes in rCBF. We found no changes in illness awareness.
Although single-session tDCS did not improve illness awareness, this pilot study provides mechanistic justification for future investigations to determine if multi-session bi-parietal tDCS can induce sustained changes in brain activity in the PPA in association with improved illness awareness.
Addition of multispecies impurity ions to the total-f gyrokinetic particle-in-cell code XGCa is reported, including a cross-verification of neoclassical physics against the NEO code. This new version of the neoclassical gyrokinetic code XGCa is used to benchmark and confirm the previous reduced-equation-based prediction that high-
impurity particles in the Pfirsch–Schlüter regime can exhibit a significant level of up–down poloidal asymmetry, through the large parallel friction force, and thus influence the radial plasma transport significantly. The study is performed in a plasma with weak toroidal rotation. In comparison, when the impurity particles are in the plateau regime, the up–down poloidal asymmetry becomes weak, with the parallel friction force becoming weaker than the parallel viscous force. It is also found that the linearization of the perturbed distribution function, based on the small poloidal asymmetry assumption, can become invalid. Using the numerical data from XGCa, each term in the parallel fluid force-balance equation have been analysed to find that both the main ions and the electrons respond to the poloidal potential variation adiabatically when the high-
tungsten possesses large poloidal variation.
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.