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Many family characteristics were reported to increase the risk of bipolar disorder (BPD). The development of BPD may be mediated through different pathways, involving diverse risk factor profiles. We evaluated the associations of family characteristics to build influential causal-pie models to estimate their contributions on the risk of developing BPD at the population level. We recruited 329 clinically diagnosed BPD patients and 202 healthy controls to collect information in parental psychopathology, parent-child relationship, and conflict within family. Other than logistic regression models, we applied causal-pie models to identify pathways involved with different family factors for BPD. The risk of BPD was significantly increased with parental depression, neurosis, anxiety, paternal substance use problems, and poor relationship with parents. Having a depressed mother further predicted early onset of BPD. Additionally, a greater risk for BPD was observed with higher numbers of paternal/maternal psychopathologies. Three significant risk profiles were identified for BPD, including paternal substance use problems (73.0%), maternal depression (17.6%), and through poor relationship with parents and conflict within the family (6.3%). Our findings demonstrate that different aspects of family characteristics elicit negative impacts on bipolar illness, which can be utilized to target specific factors to design and employ efficient intervention programs.
Children with attention-deficit hyperactivity disorder (ADHD) may suffer marked impairment in early adulthood, increasing their risk for serious self-harmful behaviors. Deliberate self-poisoning (DSP) is the most common form of deliberate self-harm. An association may exist between ADHD diagnosis and subsequent DSP events. The purpose of study was to determine whether children and adolescents with ADHD are at a greater risk for DSP than are age-matched controls.
Claims data from the Taiwan National Health Insurance Database were used to conduct a retrospective cohort analysis of emergency department visits. The study cohort contained 3685 patients with ADHD (< 8 years old). Each ADHD patient was frequency matched based on sex, age, urbanization, parental occupation, and index year to 10 control patients without ADHD. A Cox proportional-hazards regression model was used to estimate the risk of DSP in the ADHD and comparison cohorts.
The risk of developing DSP was significantly higher in the ADHD cohort than in the comparison cohort (P < .0001 for log-rank test). After adjusting for potential confounders, the regression model showed that the ADHD patients were at a 4.65-fold greater risk of developing DSP than the control patients were (HR = 4.65, 95% CI: 2.41–8.94).
Children with ADHD are at greater risk of developing DSP. Identifying risk factors of DSP is crucial efforts to implement prevention strategies. The identification of the underlying cause of increased DSP among ADHD patients warrants further investigation.
The role of panendoscopy in the modern investigation of head and neck cancer is changing with the development of improved radiological techniques, in-office biopsy capabilities and the low rate of synchronous primary tumours. This study aimed to review the indications for panendoscopy in the investigation of newly diagnosed head and neck cancer.
A retrospective review was conducted of 186 patients with newly diagnosed head and neck cancer, between January 2014 and December 2015, at two tertiary centres.
Obtaining a tissue diagnosis was the most common indication for panendoscopy (65 per cent), followed by surgical planning including transoral robotic surgery suitability assessment (22.6 per cent), and the investigation of carcinoma of an unknown primary (11.3 per cent). Two synchronous primary tumours were identified, generating a yield of 1.1 per cent.
Panendoscopy remains integral in the assessment of transoral robotic surgery suitability. Refining indications for modern panendoscopy could reduce the need for this procedure in this cohort of patients.
This study aimed to examine the relationships between socio-economic status, health-promoting lifestyles, and quality of life among Chinese nursing students.
Nursing students will be future health promoters, but they may not always adopt the recommended healthy lifestyle. Currently, there are insufficient studies examining the health-promoting lifestyles of Chinese nursing students, and the impact of socio-economic status and health-promoting lifestyle on their health.
This was a cross-sectional survey. Data were collected from nursing students studying in pre-registration nursing programs of a university in Hong Kong. The survey was conducted through a self-administered questionnaire that solicited information regarding their socio-economic status, health-promoting lifestyle, quality of life, and perceptions of the barriers to adopting a health-promoting lifestyle.
A total of 538 students returned completed questionnaires for analysis. Among the health-promoting lifestyle subscales, the participants performed best in interpersonal relations and worst in physical activity, and the vast majority of them did not actively engage in health-risk behaviors. Hierarchical regression analyses revealed that only 5% of the variance in quality of life was explained by socio-economic variables, whereas a total of 24% of the variance was explained when health-promoting lifestyle variables were added. In particular, health responsibility, physical activity, spiritual growth, and stress management were statistically significant predictors of quality of life.
Early concerns about how prepared nurses are to take on the role of promoting health still apply today. School administrators should plan the nursing curriculum to include activities that encourage student nurses to participate in health-promoting lifestyles. Future studies are needed to explore the barriers that prevent students from practicing health-promoting behavior.
Appropriate selection of tongue cancer patients considering surgery is critical in ensuring optimal outcomes. The American College of Surgeons' National Surgical Quality Improvement Program (‘ACS-NSQIP’) risk calculator was developed to assess patients' 30-day post-operative risk, providing surgeons with information to guide decision making.
A retrospective review of 30-day actual mortality and morbidity of tongue cancer patients was undertaken to investigate the validity of this tool for South Australian patients treated from 2005 to 2015.
One hundred and twenty patients had undergone glossectomy. Predicted length of stay using the risk calculator was significantly different from actual length of stay. Predicted mortality and other complications were found to be similar to actual outcomes.
The American College of Surgeons' National Surgical Quality Improvement Program risk calculator was found to be effective in predicting post-operative complication rates in South Australian tongue cancer patients. However, significant discrepancies in predicted and actual length of stay may limit its use in this population.
Poor insight is prevalent in patients with schizophrenia and has been associated with acute illness severity, medication non-adherence and poor treatment outcomes. Paradoxically, high insight has been associated with various undesirable outcomes, including low self-esteem, depression and low subjective quality of life (QoL) in patients with schizophrenia. Despite the growing body of studies conducted in Western countries supporting the pernicious effects of improved insight in psychosis, which bases on the level of self-stigma, the effects are unclear in non-Western societies. The current study examined the role of self-stigma in the relationship between insight and psychosocial outcomes in a Chinese population.
A total of 170 outpatients with schizophrenia spectrum disorders were recruited from two general university hospitals. Sociodemographic data and clinical variables were recorded and self-report scales were employed to measure self-stigma, depression, insight, self-esteem and subjective QoL. Structural equation modelling (SEM) was used to analyse the cross-sectional data.
High levels of self-stigma were reported by 39% of the participants (n = 67). The influences of insight, self-stigma, self-esteem and depression on subjective QoL were confirmed by the SEM results. Our model with the closest fit to the data (χ2 = 33.28; df = 20; p = 0.03; χ2/df = 1.66; CFI = 0.98; TLI = 0.97; RMSEA = 0.06) demonstrated that self-stigma might fully mediate the association of insight with low self-esteem, depression and poor subjective QoL. High insight into illness contributed to self-stigma, which caused low self-esteem and depression and, consequently, low QoL. Notably, insight did not directly affect self-esteem, depression or QoL. Furthermore, the association of insight with poor psychosocial outcomes was not moderated by self-stigma.
Our findings support the mediating model of insight relevant to the poor psychosocial outcomes of individuals diagnosed with schizophrenia in non-Western societies, in which self-stigma plays a pivotal role. These findings elucidate the direct and indirect effects of insight on psychosocial outcomes and imply that identifying and correcting self-stigma in people with schizophrenia could be beneficial. Additional studies are required to identify whether several other neurocognitive or psychosocial variables mediate or moderate the association of insight with self-esteem, depression and QoL in patients with schizophrenia. Studies with detailed longitudinal assessments are necessary to confirm our findings.
To examine the incidence of asthma in adult patients with major depressive disorder (MDD).
From the National Health Insurance database of Taiwan, we identified 30 169 adult patients who were newly diagnosed with MDD between 2000 and 2010. Individuals without depression were randomly selected four times and frequency matched for sex, age and year of diagnosis. Both cohorts were followed-up for the occurrence of asthma up to the end of 2011. Adjusted hazard ratios (aHRs) of asthma were estimated using the Cox proportional hazards method.
The overall incidence of asthma was 1.91-fold higher in the MDD cohort than in the non-depression cohort (7.55 v. 3.96 per 1000 person-years), with an aHR of 1.66 (95% confidence interval (CI) 1.55–1.78). In both cohorts, the incidence of asthma was higher in patients and controls who were female, aged, with comorbidities and users of aspirin or beta-adrenergic receptor blockers. No significant difference was observed in the occurrence of asthma between patients with MDD treated with selective serotonin reuptake inhibitors (SSRIs) and those treated with non-SSRIs (SSRIs to non-SSRIs aHR = 1.03, 95% CI 0.91–1.17).
Adult patients with MDD are at a higher risk of asthma than those without depression are.
This study aimed to evaluate the association of chronic rhinosinusitis with sudden sensorineural hearing loss using a population-based database.
Sampled subject data were obtained from the Taiwan Longitudinal Health Insurance Database 2000. A total of 3325 patients with sudden sensorineural hearing loss were identified and 9975 controls were randomly selected. A conditional logistic regression was used to calculate the odds ratio for having been previously diagnosed with chronic rhinosinusitis, for cases and controls.
Results and conclusion:
The adjusted odds ratio of having prior chronic rhinosinusitis among cases compared to controls was 1.36 (95 per cent confidence interval = 1.16–1.60). The significant relationship between sudden sensorineural hearing loss and chronic rhinosinusitis was most pronounced among those patients aged 44 years or less (compared to controls) (odds ratio = 2.18; 95 per cent confidence interval = 1.63–2.92). However, the significant relationship between sudden sensorineural hearing loss and prior chronic rhinosinusitis was not sustained for patients older than 60 years compared to controls.
The public health threat posed by zoonotic Plasmodium knowlesi appears to be growing: it is increasingly reported across South East Asia, and is the leading cause of malaria in Malaysian Borneo. Plasmodium knowlesi threatens progress towards malaria elimination as aspects of its transmission, such as spillover from wildlife reservoirs and reliance on outdoor-biting vectors, may limit the effectiveness of conventional methods of malaria control. The development of new quantitative approaches that address the ecological complexity of P. knowlesi, particularly through a focus on its primary reservoir hosts, will be required to control it. Here, we review what is known about P. knowlesi transmission, identify key knowledge gaps in the context of current approaches to transmission modelling, and discuss the integration of these approaches with clinical parasitology and geostatistical analysis. We highlight the need to incorporate the influences of fine-scale spatial variation, rapid changes to the landscape, and reservoir population and transmission dynamics. The proposed integrated approach would address the unique challenges posed by malaria as a zoonosis, aid the identification of transmission hotspots, provide insight into the mechanistic links between incidence and land use change and support the design of appropriate interventions.
These periodic patterns may in turn become unstable through one of two different
mechanisms, an Eckhaus instability or an oscillatory instability. We study the dynamics
near the instability threshold in each of these cases using the corresponding modulation
equations and compare the results with those obtained from direct numerical simulation of
the equation. We also study the stability properties and dynamical evolution of different
types of fronts present in the protosnaking region of this equation. The results provide
new predictions for the dynamical properties of generic systems in the weakly subcritical
A review of the annual prevalence of Pseudomonas aeruginosa at a regional hospital in Taiwan revealed a significant increase in the incidence of extensive drug-resistant P. aeruginosa (XDRPA) from 2·1% in 2003 to 5·8% in 2007. The first XDRPA isolate was recovered in 2001 from the emergency ward. The widespread dissemination of XDRPA isolates to more than 10 other wards was discovered the following year. Six pulsotypes of 67 XDRPA isolates from 2006 onwards were identified and 91% were a single strain, suggesting the existence of a hidden outbreak. Prior to the recognition of the outbreak, the majority of cases were not considered to be healthcare-associated infections until molecular evidence was provided. A cohort measure was launched by the infection control practitioners that effectively controlled the outbreak. Patients with XDRPA were mostly referred from neighbouring long-term care facilities, which may have been the reservoir of the XDRPA clone.
We examine the interaction of a spherical foreign particle with a propagating solidification front in a binary alloy. Depending on the material properties and the speed of the front, the particle may be pushed ahead of the front, or engulfed and incorporated into the solid phase. We apply numerical boundary integral and continuation methods to determine the critical speed for particle capture, as a function of the system parameters. We reconcile the differing predictions of previous theoretical works, and show that many typical systems may obey a new scaling of the critical speed, as obtained here. We show that due to constitutional undercooling, the presence of solute decreases particle speeds by an order of magnitude below those for a single-component system. We briefly consider the case of spherical bubbles, where thermocapillary and solutocapillary effects play a large role.
In this paper, simple techniques were proposed to fabricate germanium nanocrystal capacitors by one-step thermal oxidation and/or rapid thermal annealing on polycrystalline-SiGe (poly-SiGe) deposited with a LPCVD (low pressure chemical vapor deposition) system. This thermal oxidation method can directly result in the top-control oxide layer via the oxidation of amorphous-Si film and the formation of Ge nanocrystals from the poly-SiGe film. Otherwise, the rapid thermal annealing method can be also used to form Ge nanocrystals as comparison.
During operation, a superconducting radio frequency cavity is cooled down to below critical superconducting temperature by liquid helium. Thus it is under external pressure by liquid helium while an ultrahigh vacuum inside. Being a niobium-made shell structure, the SRF cavity's shape and consequently the electromagnetic resonance frequency are sensitive to external load variations. A CESR-III 500MHz superconducting radio frequency cavity is illustrated to investigate this relationship. A simulation that links the calculations on mechanical structure and radio frequency electromagnetic field with the finite element code ANSYS® is demonstrated herein. The changes of electromagnetic resonance frequency associated with external loads and mechanical properties of niobium are studied systematically. A complete understanding on the mechanism is thus achieved. The computed results also indicate that the electromagnetic resonance frequency increases as the cavity is either cooled to cryogenic temperature or stretched longitudinally, while the reduction of the helium vessel pressure also raises the resonance frequency. Besides, the electromagnetic resonance frequency shift is ruled by the coefficient of thermal expansion when the cavity is cooled from room temperature to liquid helium temperature. Young's modulus and thickness of the cavity wall dominate the structure stiffness and thus also affect the frequency shift.
To investigate the potential of poultry products as the source of human infections associated with quinolone-resistant campylobacters, 140 human and 75 poultry isolates of nalidixic acid-resistant campylobacters were collected between 1996 and 1998, and analysed by two molecular typing methods. By the analysis of restriction fragment length polymorphism of the flagellin gene, 33 distinct patterns were obtained, with 18 of which shared by both human (89%) and poultry (93%) isolates. By the pulsed-field gel electrophoresis of SmaI-restricted macrofragments, 105 different profiles were obtained, and 11 were found in both human (40%) and poultry (23%) isolates. When the two typing methods were combined, 112 unique genotypes were obtained, 11 of which were shared by both populations, including 53 (38%) human isolates and 14 (19%) poultry isolates. Although domestic poultry products are still important sources of the quinolone-resistant campylobacter infections in humans, there are other factors that might contribute to these increasing infections simultaneously. A more stringent policy in the use of antimicrobial agents in food animals can no longer be ignored.
Chronic hyperglycemia is a common feature of all forms of diabetes mellitus and may contribute greatly to the increase in the incidence of atherosclerosis. It has been demonstrated that increasing arterial permeability to the macromolecules can cause low-density lipoproteins (LDLs) to infiltrate and accumulate in the intima. This event is crucial for developing the plaques in the arterial wall. in this study, we use Evans blue to study the permeability of arterial endothelium in the streptozotocin (STZ)-induced hyperglycemic rats. We also use colloidal gold-labeled LDL to investigate in situ the distribution of LDL in the aortic intima of hyperglycemic rats.
The hyperglycemia was induced in male Sprague-Dawley rats (7 weeks) by a single intraperitoneal injection of streptozotocin (60 mg/kg). The blood glucose concentration and hemoglobin glycation were measured once in every week. The uptake of drinking water is monitored in the regular time interval. After 3 months into the experiment, ten hyperglycemic and control rats were anesthetized.
We have used x-ray microbeam fluorescence and diffraction for in-situ measurements of electromigration-induced Cu diffusion and stress evolution in passivated, polycrystalline 10[.proportional]m-wide, 200[.proportional]m-long Al(0.25 at.% Cu) conductor lines. Cu migration is in the direction of the electron flow and is determined by the direction and magnitude of the current and by the temperature during electromigration. The effective charge and diffusivity of Cu in Al(Cu) have been obtained from analysis of the Cu concentration profiles. The evolution of electromigration-induced strains normal to the sample surface has been monitored by x-ray microbeam diffraction. A linear strain profile developed after about 9 hrs of electromigration with 1.5[.dotmath]105 A/cm2 at 300°C, corresponding to 3MPa/[.proportional]m equi-biaxial stress. From the Cu profile measured at the same time, the critical Cu concentration for significantly slowing down Al grain boundary diffusion is estimated to be ∼0.15 at. %. These data also confirm that downstream Cu transport is accompanied by a counter flow of Al in the upstream direction.
Sixty patients were randomly assigned to two equal groups. Group I received epidural morphine 1 mg after surgery and used a patient-controlled analgesia device programmed to deliver morphine 0.2 mg h−1, 0.2 mg per bolus. Group II received an epidural loading dose of morphine 1 mg plus ketamine 5 mg and used a patient-controlled analgesia device programmed to deliver morphine 0.2 mg+ketamine 0.5 mg h−1, morphine 0.2 mg+ketamine 0.5 mg per bolus with a lockout time of 10 min. The mean morphine consumption was 8.6±0.7 mg for group I and 6.2±0.2 mg for group II. Although group II utilized significantly less morphine (P<0.05), pain relief was significantly better in group II than in group I (P<0.05) in the first 3 h. Vomiting occurred more frequently in group I (26%) than in group II (13%). The frequency and severity of pruritus and level of sedation were similar in the two groups. These findings suggest that patient-controlled epidural analgesia with morphine plus ketamine may provide effective analgesia with a lesser dose of morphine and fewer subsequent side effects, compared with patient-controlled epidural analgesia with morphine alone after lower abdominal surgery.
The interplay between stress and electromigration has been recognized since I. A. Blech et al. used x-ray topography in 1976 to demonstrate that stress gradients developed during electromigration. Availability of high brightness synchrotron x-ray sources, high stability energy dispersive detectors, high resolution area detectors, and pinholes, capillaries and other optical elements for forming x-ray microbeams, has made possible more quantitative, real time measurements of strains and composition changes which develop in polycrystalline metal conductor lines during electromigration. This paper describes advances made in this area, implications of results which have been obtained, and prospects for further progress.