To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The condition of caregivers is important to the quality of care received by people with Parkinson’s disease (PD), especially at the late disease stages. This study addresses the distress placed on caregivers by participants’ neuropsychiatric symptoms at different stages of PD in Taiwan
This prospective study enrolled 108 people with PD. All participants were examined with the Unified Parkinson’s Disease Rating Scale (UPDRS), Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), and Clinical Dementia Rating (CDR) scale. Caregiver distress was measured using the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D). Statistical analysis was used to explore the PD-related factors that contribute to caregiver distress.
The mean follow-up interval in the 108 PD participants were 24.0 ± 10.2 months with no participant lost to follow-up due to death. NPI-distress (the sum of NPI caregiver distress scale across the 12 domains of the NPI) was positively correlated with NPI-sum (the total score across the 12 domains of the NPI) (r = 0.787, p < 0.001), CDR (r = 0.403, p < 0.001), UPRDS (r = 0.276, p = 0.004), and disease duration (r = 0.246, p = 0.002), but negatively correlated with CASI (r = −0.237, p = 0.043) and MMSE (r = −0.281, p < 0.001). Multiple linear regression analysis showed that only NPI-sum and disease duration were independently correlated with NPI-distress.
The disease duration and NPI-sum are independent predictors of caregiver distress in Taiwanese populations with PD. Early detection and reduction of neuropsychiatric symptoms in people with PD can help decrease caregiver distress.
Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.
Observational study of acute-care hospitals in Ontario, Canada
A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.
Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.
Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.
The bigfin reef squid Sepioteuthis lessoniana is a neritic species widely distributed in coastal waters of the Indo-Pacific region and is of interest to fisheries for its high commercial value. Squid samples were collected from Keelung (KL) and Penghu (PH), around northern Taiwan from October 2012 to September 2013. A total of 949 squid were examined, and 620 squid were aged using statoliths. The age range of the squid in KL (55–183 days) was similar to that in PH (77–186 days). The squid hatched almost year-round, except in January and December in KL. Two seasonal cohorts were identified: a spring cohort (hatched in March to May) and an autumn cohort (July to October). Concentrations of nine trace elements in statoliths were analysed using solution-based inductively coupled plasma mass spectrometry (ICP-MS). Significant differences in Fe/Ca, Cu/Ca and Sr/Ca were found between the two locations, while significant differences in concentration ratios of Sr/Ca and Ba/Ca were noted between the two seasonal cohorts. Results of a principal component analysis and cluster analysis varied in life-history traits between the two geographic stocks and in elemental concentrations between the two seasonal cohorts. Squid in KL and PH might undertake different migration routes, while seasonal variability in oceanographic conditions was apparent in the two locations.
This paper provides an optimal asset allocation strategy to enhance risk management performance in the face of a financial crisis; this strategy entails constructing a good asset model – a multivariate jump-diffusion (MJD) model which includes idiosyncratic and systematic jumps simultaneously – and choosing suitable asset allocations and objective functions for fund management. This study also provides the dependence structure for the MJD model. The empirical implementation demonstrates that the proposed MJD model provides more detailed information about the financial crisis, allowing fund managers to determine an appropriate asset allocation strategy that enhances investment performance during the crisis.
Beginning in 2007, all newly diagnosed cancer patients at the Koo Foundation Sun Yat-Sen Cancer Center (KF–SYSCC) were screened for psychosocial distress. Our social workers, as part of the psychosocial care team (PCT), have engaged in proactive outreach with patients identified as distressed. The goal of the present study was to assess the prevalence of psychosocial distress and the extent of contact between the PCT and distressed patients.
Newly diagnosed patients who were treated at KF–SYSCC between 2007 and 2010 for cancer were eligible if there were at least 100 patients with the same type of cancer. Before treatment began, they were screened with the Pain Scale and the Distress Thermometer (DT) and had the option to specify a desire for help. The rates of distress were analyzed by cancer type and by probable related factors. Information regarding contact with the PCT was retrieved from computerized databases.
Overall, some 5,335 cancer patients representing 12 major cancer types were included in our study. Of these, 1,771 (33.20%) were significantly distressed. By multivariate logistic regression, younger age, female gender, higher pain score, and disease stage, but not cancer type, were found to be associated with higher rates of distress. Among these distressed patients, 628 (36%) had some contact with the PCT.
Significance of results:
This Taiwanese study with a large sample size revealed a prevalence rate of psychosocial distress similar to rates found in Western countries. Contact with the PCT was established in only 36% of significantly distressed patients, despite a proactive outreach program. It is very important to have screening results made available in a timely fashion to the psycho-oncology team so that appropriate care can be offered promptly.
The Virtue Existential Career Model (VEC) is a Chinese career development model based on the Classic of Changes. It is designed to supplement the person-environment fit paradigm of Taiwan's 12-Year Basic Education for junior high school students. We adopted an action research approach with two parts, reflection-on-action and critical-emancipatory. An easy-to-use VEC career curriculum and a career information system (Career Genesis; CG) were developed by a team of staff members from government agencies (Tainan Department of Education and Student Counseling Centers), junior high schools, and the Chinese Career Research Center of National Changhua University of Education, Taiwan. The outcome of this project was strong on fostering interconnectedness. Implementing our VEC curriculum and CG to 30 junior high school students received statistically significant immediate increases in resilience, adaptation, and liking of career decision. The feedback and reflections suggest that mandating, attracting, and simplifying are useful strategies to promote our VEC model as well as to facilitate social change and create a multiple-win situation for all parties involved. This approach also follows the tao (道) of the Classic of Changes to provide new knowledge.
Bilateral facial nerve palsy is an exceedingly rare condition and presents a diagnostic challenge. Bilateral facial nerve palsy may result from cranial trauma, congenital abnormalities, inflammation, infiltration, or infection, but is rarely associated with syphilis. Here, we report a case of syphilis in which bilateral facial nerve palsy was the only initial symptom.
A 22-year-old man presented at our emergency department with isolated bilateral facial nerve palsy. Results for initial serum and cerebrospinal fluid examinations were normal, including the rapid plasma reagin titer. One week later, the patient developed rashes on the torso, palms, and soles. At this time, a high serum rapid plasma reagin titer was detected, and the Treponema pallidum particle agglutination test was positive. Once the tests were confirmed, the patient admitted to a history of unprotected sexual behavior. Penicillin G treatment was effective, and a 3-month follow-up examination demonstrated a complete recovery.
We recommend that syphilis be considered when diagnosing sexually experienced young men presenting with bilateral facial nerve palsy, even in the absence of skin manifestations. Failure to recognize facial signs of syphilis could result in inappropriate management, affecting the patient’s clinical outcome.
The Doba gabbro was collected from an exploration well through the Cretaceous Doba basin of southern Chad. The gabbro is composed mostly of plagioclase, clinopyroxene and Fe–Ti oxide minerals and displays cumulus mineral textures. Whole-rock 40Ar–39Ar step-heating geochronology yielded a Late Permian plateau age of 257 ± 1 Ma. The major and trace elemental geochemistry shows that the gabbro is tholeiitic in composition and has trace element ratios (i.e. La/YbN > 7; Sm/YbPM > 3.4; Nb/Y > 1; Zr/Y > 5) indicative of a basaltic melt derived from a garnet-bearing mantle source. The moderately enriched Sr–Nd isotopes (i.e. ISr = 0.70495 to 0.70839; ɛNd(T) = −1.0 to −1.3) fall within the mantle array (i.e. OIB-like) and are similar to other Late Permian plutonic rocks of North-Central Africa (i.e. ISr = 0.7040 to 0.7070). The enriched isotopic composition of the Doba gabbro contrasts with the more depleted compositions of the spatially associated Neoproterozoic post-Pan-African within-plate granites. The contrasting Nd isotope composition between the older within-plate granites and the younger Doba gabbro indicates that different mantle sources produced the rocks and thus may mark the southern boundary of the Saharan Metacraton.
To challenge the Taiwan Ministry of Education's (TMOE) dominant enforcement of a person-environment fit model, the Chinese Career Research Center incorporated yin-yang alternation principles from the Classic of Changes (I Ching, Yi Jing or 易經) to develop the model of career development touching the sky yet grounded (TSG) and corresponding practice guidelines, a career website (CCN), and four career service projects. Using Lewin's (1946) cyclical-spiral process of action research, CCN and TSG service projects were promoted to complement the TMOE's fit model, and feedback was utilised to revise our TSG model and its applications. Yin-yang alternation principles and the four stages of chien (the creative) from the Classic of Changes were applied to develop social action strategies. Social change was indicated by counsellors’ and students’ changes in their career views, as well as the TMOE's direct financial support for TSG service projects. This progress is encouraging for whoever is interested in developing culture-inclusive indigenous psychology with practical outcomes.
Superelasticity of shape memory alloy (SMA) results from the reversible thermoelastic martensitic transformation. Although this property has been studied extensively at the macroscale, the study of this superelastic behavior at the micro/nanoscale is relatively new. In this work, we processed TiNi-based SMAs with different compositions and different phase transformation temperatures. Nanoindentations were performed with different peak loads and at various temperatures to systematically characterize the degree of localized stress-induced martensitic transformation at the nanoscale for each SMA. Micropillar compression tests were also performed to study the global superelastic behavior at the microscale. The physics of stress-induced martensitic transformation versus the phase transformation temperature, the testing temperature, and the peak load relations was explored and the difference between the localized and the global superelastic behaviors was discussed. Our results demonstrate the potential of integrating TiNi-based SMAs into functional micro- and nanodevices.
Hypokalemic periodic paralysis is the most common form of periodic paralysis and is characterized by attacks of muscle paralysis associated with a low serum potassium (K+) level due to an acute intracellular shifting. Thyrotoxic periodic paralysis (TPP), characterized by the triad of muscle paralysis, acute hypokalemia, and hyperthyroidism, is one cause of hypokalemic periodic paralysis. The triggering of an attack of undiagnosed TPP by β2-adrenergic bronchodilators has, to our knowledge, not been reported previously. We describe two young men who presented to the emergency department with the sudden onset of muscle paralysis after administration of inhaled β2-adrenergic bronchodilators for asthma. In both cases, the physical examination revealed an enlarged thyroid gland and symmetrical flaccid paralysis with areflexia of lower extremities. Hypokalemia with low urine K+ excretion and normal blood acid-base status was found on laboratory testing, suggestive of an intracellular shift of K+, and the patients' muscle strength recovered at serum K+ concentrations of 3.0 and 3.3 mmol/L. One patient developed hyperkalemia after a total potassium chloride supplementation of 110mmol. Thyroid function testing was diagnostic of primary hyperthyroidism due to Graves disease in both cases. These cases illustrate that β2-adrenergic bronchodilators should be considered a potential precipitant of TPP.
The potential relationship between anaesthesia, surgery and onset of
dementia remains elusive.
To determine whether the risk of dementia increases after surgery with
anaesthesia, and to evaluate possible associations among age, mode of
anaesthesia, type of surgery and risk of dementia.
The study cohort comprised patients aged 50 years and older who were
anaesthetised for the first time since 1995 between 1 January 2004 and 31
December 2007, and a control group of randomly selected patients matched
for age and gender. Patients were followed until 31 December 2010 to
identify the emergence of dementia.
Relative to the control group, patients who underwent anaesthesia and
surgery exhibited an increased risk of dementia (hazard ratio = 1.99) and
a reduced mean interval to dementia diagnosis. The risk of dementia
increased in patients who received intravenous or intramuscular
anaesthesia, regional anaesthesia and general anaesthesia.
The results of our nationwide, population-based study suggest that
patients who undergo anaesthesia and surgery may be at increased risk of
Optical control is a reversible and convenient technology, able to be measured in real-time, which makes it excellent for application to microfluidic, biomechanical, and electro-mechanical devices. These advantages are especially attractive for photo-responsive materials. In this study, we developed a new photo-responsive, electrostrictive material from a composite material made by mixing a dielectric polymer P(VDF-TrFE-CFE) and an organic photoconductive material TiOPc. The photo-responsibility of the material has been validated by corresponding actuators. We found that under white light illumination, deformation will increase which can be attributed to a decrease in the TiOPc impedance. We identified that the optimal TiOPc concentration for actuator applications is 10% P(VDF-TrFE-CFE)/TiOPc. Moreover, controlling the fluid flow within the capillary tube through light illumination also validated the photo-responsive actuator. Our results show that the mechanism and the photo-responsive material can be used to pursue further study on light controlling microfluidic, and related electro-mechanical devices.