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Introduction: Many cardiac arrest survivors die later due to hemorrhage or thromboembolism, thought to be caused by acquired coagulopathy in post-cardiac arrest syndrome (PCAS) from shock and reperfusion injury. Understanding PCAS is a priority identified by the AHA for the prevention of complications in cardiac arrest survivors. Shock dysregulates both coagulation and fibrinolysis. The key effector enzyme thrombin (Th), is responsible for both up- and down-regulating coagulation and fibrinolysis. Measuring early Th activity may allow for predicting PCAS coagulopathy, and early medical intervention in the ED. Therefore, we aimed to characterize the time-course profile of early coagulation using an established pig model of cardiac arrest. Methods: Yorkshire pigs were anaesthetised and intubated, had VF-arrest induced by pacing, and were resuscitated per ACLS. Rotational thromboelastometry (ROTEM) was performed on whole blood at four times: baseline, intra-arrest, post-arrest, and death, using the fibrin-based test with tissue factor to initiate clotting in the presence of a platelet inhibitor cytochalasin D (FIBTEM). Clot time (CT), clot formation time (CFT), alpha-angle during clot formation (Alpha), clot amplitude at 10 min (A10), maximum clot firmness (MCF), and maximum lysis as total percentage (ML%) were quantified. The primary outcome is the overall coagulation initiation measured by CFT, while secondary outcomes include ROTEM parameters reflecting Th activity. Parameters are compared over time in SPSS using repeated measures ANOVA and Bonferroni correction. Results: Pilot data from one experiment show that cardiac arrest causes immediate early changes to coagulation that subsequently normalized with ROSC (Figure 1). CFT was impaired immediately upon cardiac arrest (2.3-fold increase), normalized with ROSC, and impaired again at death when compared with baseline. Consistent with clotting impairment, A10, Alpha, and MCF were all reduced with cardiac arrest, normalized with ROSC, and impaired again at death. Conclusion: Higher initial indices of coagulopathy in patients with cardiac arrest appear to correlate with death and thromboembolism. In this pilot, CFT is acutely modified by cardiac arrest. Since CFT is affected by overall Th activity, early Th dysregulation may be a critical driver of coagulopathy. Th may therefore be a lead target that is modifiable in the emergency post-arrest setting to decrease morbidity and mortality from PCAS in cardiac arrest survivors.
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.
This study surveys patients with schizophrenia or schizoaffective disorder, to understand the relationship between sexual function and treatment with antipsychotic medication. The study compares patients on single versus multiple antipsychotics as well differences between first and second generation agents.
Design and methods:
Patients diagnosed with schizophrenia or schizoaffective disorder at Beth Israel Medical Center are eligible. Once patients are evaluated to ensure they meet enrollment criteria and are consented, they are administered the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and either the International Index of Erectile Function for men, or the Female Sexual Function Index for women. Inclusion criteria include age 18-65, able to participate in a structured interview, fulfill DSM-IV criteria for Schizophrenia or Schizoaffective disorder, and on stable doses of one or more antipsychotic medications for at least six weeks. Exclusion Criteria include patients taking Selective Serotonin Reuptake Inhibitors (SSRIs), and inability to provide informed consent.
Presently, data suggests sexual function is impaired secondary to antipsychotic use. Further extrapolation of data is pending further enrollment.
Preliminary results point to better sexual function with certain second generation antipsychotics. It also appears that patients on single antipsychotic may have better sexual function than patients on multiple agents.
The main aim of the present studies is to determine whether, or to some extent, specific cognitive domains could differentiate the main subtypes of mood disorder in the depressed and clinically remitted status respectively.
Three groups of bipolar I (n = 92), bipolar II (n = 131) and unipolar depression patients (n = 293) were tested with a battery of neuropsychological tests at baseline and after 6 weeks of treatment, contrasting with 202 healthy controls on cognitive performance.
At the acute depressive state, the three patients groups (bipolar I, bipolar II and unipolar depression) showed cognitive dysfunction in processing speed, memory, verbal fluency and executive function but not attention compared with controls. And post comparisons revealed that bipolar I patients performed significantly worse in these impaired cognitive domain than bipolar II and unipolar depression patients in verbal fluency and executive function. After treatment, clinically remitted bipolar I and bipolar II patients only displayed cognitive impairment in processing speed and visual memory in relative to controls, while remitted unipolar depression patients showed cognitive impairment in executive function in addition to processing speed and visual memory.
Bipolar I, bipolar II and unipolar depression patients have a similar pattern of cognitive impairment during the state of acute depressive episodes. At the clinically remission, still both bipolar disorder and unipolar depression patients showed cognitive deficits in processing speed and visual memory, and executive dysfunction might be a status-maker for bipolar disorder, but a trait-marker for unipolar depression
Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings.
To explore (1) the prevalence and risk factors for hazardous alcohol-drinking problems and (2) previous assessments and interventions for alcohol-drinking problems among a general Chinese patient population.
Self-report data were collected from 484 patients at five randomly selected hospitals.
The prevalence of hazardous alcohol-drinking problems was 19.2%. Logistic regression analysis revealed that risk factors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29.1% of participants were assessed for drinking problems in the past year. Only 38.7% of participants with drinking problems had received a drinking intervention in the past year.
Alcohol problems in Taiwanese general hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups and integrating psychiatric healthcare teams in general hospitals are important to prevent patients’ drinking problems.
The main aim of this study is to investigate the capacity of a number of variables from four dimensions (clinical, psychosocial, cognitive and genetic domains) to predict the antidepressant treatment outcome, and combined the predictors in one integrate regression model with the aim to investigate which predictor contributed most.
In a semi-naturalistic prospective cohort study with a total of 241 fully assessed MDD patients, decrease in HAM-D scores from baseline to after 6 weeks of treatment was used to measure the antidepressant treatment outcome.
The clinical and psychosocial model (R2 = 0.451) showed that HAM-D scores at baseline and MMPI-2 scale paranoia was the best clinical and psychosocial predictor of treatment outcome respectively. The cognitive model (R2 = 0.502) revealed that combination of better performance on TMT-B test and worse performance on TOH and WAIS-R Digit Backward testes could predict decline in HAM-D scores. The genetics analysis only found median of percent improvement in HAM-D scores in G-allele of GR gene BclI polymorphism carriers (72.2%) was significant lower than that in non-G allele carriers (80.1%). The integrate model showed that three predictors, combination of HAM-D scores at baseline, MMPI-2 scale paranoia and TMT-B test, explained 57.1% of the variance.
Three markers, HAM-D scores at baseline, MMPI-2 scale paranoia and TMT-B test, might serve as predictor of antidepressant outcome in daily psychiatric practice.
The presence of comorbid anxiety disorders (AD) and bipolar II disorders (BP-II) compounds disability complicates treatment, worsens prognosis, and has been understudied. The genes involved in metabolizing dopamine and encoding dopamine receptors, such as aldehyde dehydrogenase 2 (ALDH2) and dopamine D2 receptor (DRD2) genes, may be important to the pathogenesis of BP-II comorbid with AD. We aimed to clarify ALDH2 and DRD2 genes for predisposition to BP-II comorbid with and without AD. The sample consisted of 335 subjects BP-II without AD, 127 subjects BP-II with AD and 348 healthy subjects as normal control. The genotypes of the ALDH2 and DRD2 Taq-IA polymorphisms were determined using polymerase chain reactions plus restriction fragment length polymorphism analysis. Logistic regression analysis showed a statistically significant association between DRD2 Taq-I A1/A2 genotype and BP-II with AD (OR = 2.231, P = 0.021). Moreover, a significant interaction of the DRD2 Taq-I A1/A1 and the ALDH2*1*1 genotypes in BP-II without AD was revealed (OR = 5.623, P = 0.001) compared with normal control. Our findings support the hypothesis that a unique genetic distinction between BP-II with and without AD, and suggest a novel association between DRD2 Taq-I A1/A2 genotype and BP-II with AD. Our study also provides further evidence that the ALDH2 and DRD2 genes interact in BP-II, particularly BP-II without AD.
This article presents a brief review of our case studies of data-driven Integrated Computational Materials Engineering (ICME) for intelligently discovering advanced structural metal materials, including light-weight materials (Ti, Mg, and Al alloys), refractory high-entropy alloys, and superalloys. The basic bonding in terms of topology and electronic structures is recommended to be considered as the building blocks/units constructing the microstructures of advanced materials. It is highlighted that the bonding charge density could not only provide an atomic and electronic insight into the physical nature of chemical bond of materials but also reveal the fundamental strengthening/embrittlement mechanisms and the local phase transformations of planar defects, paving a path in accelerating the development of advanced metal materials via interfacial engineering. Perspectives on the knowledge-based modeling/simulations, machine-learning knowledge base, platform, and next-generation workforce for sustainable ecosystem of ICME are highlighted, thus to call for more duty on the developments of advanced structural metal materials and enhancement of research productivity and collaboration.
Particle-in-Cell (PIC) simulation is an interpolation-based method on the Newton–Maxwell (N–M) system. Its well-known drawback is its shape/interpolation functions often causing the violation of continuity equations (CEs) at mesh nodes and that of Maxwell equations (MEs) at particles' positions. Whether this drawback can be overcome by choosing/solving suitable shape/interpolation functions is of fundamental importance for the PIC simulation. Until now, these shape/interpolation functions are usually subjectively chosen and, hence, always invoke the drawback. Here, we first investigate whether these shape/interpolation functions can be self-consistently solved by considering under what condition the CEs and the MEs can be satisfied anywhere. Strict mathematical analysis reveals that strict self-consistent shape/interpolation functions are unavailable. Only few approximately self-consistent shape/interpolation functions are luckily found by some authors. This fact drives us to present another universal interpolation-free strict method on the N–M system.
There is no agreement regarding which solvent is more suitable to obtain sol–gel–derived titania (TiO2) samples with an enhanced photocatalytic behavior. Furthermore, the solvent effect on the preparation of TiO2-RGO (reduced graphene oxide) nanocomposites has not been published yet and could be an attractive experimental strategy to modulate structure and properties. On the basis of these observations, TiO2-RGO nanocomposites were fabricated in this study. It was evaluated for the influence of using either isopropyl (IsoprOH) or ethyl (EtOH) alcohol on the textural and photocatalytic properties of the prepared materials. The use of IsoprOH led to samples with smaller crystallite size, narrower apparent band gap, smaller isoelectric point, larger adsorption capacity, and higher photocatalytic activity. In addition, the incorporation of RGO into TiO2 greatly improved the adsorption capacity and photocatalytic activity of the latter. However, the optimal loading of RGO to prepare composites with enhanced photocatalytic activities was 1 wt%. This finding can be related to the stacking of RGO sheets when concentrations above 1 wt% are used, which could prevent UV light to reach the TiO2 particles and also decrease the photocatalytic capacity of the composites. Moreover, materials with RGO concentration above 1 wt% could exhibit a highly negatively charged surface, which may decrease the separation of the generated electron–hole pairs and lead to faster recombination rates of charge carriers.
Perceived loneliness, an increasingly prevalent social issue, is closely associated with major depressive disorder (MDD). However, the neural mechanisms previously implicated in key cognitive and affective processes in loneliness and MDD still remain unclear. Such understanding is critical for delineating the psychobiological basis of the relationship between loneliness and MDD.
We isolated the unique and interactive cognitive and neural substrates of loneliness and MDD among 27 MDD patients (mean age = 51.85 years, 20 females), and 25 matched healthy controls (HCs; mean age = 48.72 years, 19 females). We assessed participants' behavioral performance and neural regional and network functions on a Stroop color-word task, and their resting-state neural connectivity.
Behaviorally, we found greater incongruence-related accuracy cost in MDD patients, but reduced incongruence effect on reaction time in lonelier individuals. When performing the Stroop task, loneliness positively predicted prefrontal-anterior cingulate-parietal connectivity across all participants, whereas MDD patients showed a decrease in connectivity compared to controls. Furthermore, loneliness negatively predicted parietal and cerebellar activities in MDD patients, but positively predicted the same activities in HCs. During resting state, MDD patients showed reduced parietal-anterior cingulate connectivity, which again positively correlated with loneliness in this group.
We speculate the distinct neurocognitive profile of loneliness might indicate increase in both bottom-up attention and top-down executive control functions. However, the upregulated cognitive control processes in lonely individuals may eventually become exhausted, which may in turn predispose to MDD onset.
Seasonal influenza virus epidemics have a major impact on healthcare systems. Data on population susceptibility to emerging influenza virus strains during the interepidemic period can guide planning for resource allocation of an upcoming influenza season. This study sought to assess the population susceptibility to representative emerging influenza virus strains collected during the interepidemic period. The microneutralisation antibody titers (MN titers) of a human serum panel against representative emerging influenza strains collected during the interepidemic period before the 2018/2019 winter influenza season (H1N1-inter and H3N2-inter) were compared with those against influenza strains representative of previous epidemics (H1N1-pre and H3N2-pre). A multifaceted approach, incorporating both genetic and antigenic data, was used in selecting these representative influenza virus strains for the MN assay. A significantly higher proportion of individuals had a ⩾four-fold reduction in MN titers between H1N1-inter and H1N1-pre than that between H3N2-inter and H3N2-pre (28.5% (127/445) vs. 4.9% (22/445), P < 0.001). The geometric mean titer (GMT) of H1N1-inter was significantly lower than that of H1N1-pre (381 (95% CI 339–428) vs. 713 (95% CI 641–792), P < 0.001), while there was no significant difference in the GMT between H3N2-inter and H3N2-pre. Since A(H1N1) predominated the 2018–2019 winter influenza epidemic, our results corroborated the epidemic subtype.
Temperature resulting from the joule heating power and the turn-on and turn-off dissipation of high-power, high-frequency applications is the root cause of their thermal instability, electrical performance degradation, and even thermal-fatigue failure. Thus, the study presents thermal and electrical characterizations of the power MOSFET module packaged in SOT-227 under natural convection and forced convection through three-dimensional (3D) thermal-electric (TE) coupled field analysis. In addition, the influences of some key parameters like electric loads, ambient conditions, thermal management considerations (heat sink, heat spreader) and operation conditions (duty cycle and switching frequency) on the power loss and thermal performance of the power module are addressed. The study starts from a suitable estimation of the power losses, where the conduction losses are calculated using the temperature- and gate-voltage-dependent on-state resistance and drain current through the device, and the switching losses are predicted based on the ideal switching waveforms of the power MOSFETs applied. The effectiveness of the theoretical predictions in terms of device’s power losses and temperatures is demonstrated through comparison with the results of circuit simulation and thermal experiment.
A simple and facile stereolithography 3D printing technique was utilized to fabricate piezoelectric photopolymer-based polyvinylidene fluoride (PVDF) blends. Different process variables, such as solvent (N,N-dimethylformamide, DMF) to PVDF ratio and PVDF solution to photopolymer resin (PR) ratio, were engineered to enhance the dispersion of the PVDF into the PR so as to achieve the maximum piezoelectric coupling coefficient. Our results demonstrate that a ratio of 1:10 (PVDF:DMF) and 2 wt%-PVDF/PR was optimal for the best dissolution of the PVDF, 3D printability, and piezoelectric properties. Under these conditions, the blend generated ±0.121 nA under 80 N dynamic loading excitation. We believe that the findings of this work would promote many further studies on the mass production of flexible piezoelectric polymer blends with higher quality finished surface and design flexibility.
The Hkakabo Razi region located in northern Myanmar is an Important Bird Area and part of the Eastern Himalayan Biodiversity Hotspot. Within the framework of the World Heritage Convention to enlist the site under criterion (ix) and (x), we conducted a biodiversity assessment for passerine birds using DNA barcoding and other molecular markers. Of the 441 bird species recorded, we chose 16 target species for a comparative phylogeographic study. Genetic analysis was performed for a larger number of species and helped identifying misidentified species. We found phylogeographic structure in all but one of the 16 study species. In 13 species, populations from northern Myanmar were genetically distinctive and local mitochondrial lineages differed from those found in adjacent regions by 3.9–9.9% uncorrected genetic distances (cytochrome-b). Since the genetic distinctiveness of study populations will be corroborated by further differences in morphology and song as in other South-East Asian passerines, many of them will be candidates for taxonomic splits, or in case an older taxon name is not available, for the scientific description of new taxa. Considering the short time frame of our study we predict that a great part of undetected faunal diversity in the Hkakabo Razi region will be discovered.
In this study, the pull-in phenomenon of a Nano-actuator is investigated employing a nonlocal Bernoulli-Euler beam model with clamped-clamped conditions. The model accounts for viscous damping, residual stresses, the van der Waals (vdW) force and electrostatic forces with nonlocal effects. The hybrid differential transformation/finite difference method (HDTFDM) is used to analyze the nonlocal effects on a graphene sheet nanobeam, which is electrostatically actuated under the influence of the coupling effect, the von Kármán nonlinear strains and the fringing field effect. The pull-in voltage as calculated by the presented model deviates by no more than 0.29% from previous literature, verifying the validity of the HDTFDM. Furthermore, the nonlocal nonlinear behavior of the electrostatically actuated nanobeam is investigated, and the effects of viscous damping, residual stresses, and length-gap ratio are examined in detail. Overall, the results reveal that small scale effects significantly influence the characteristics of the graphene sheet nanobeam actuator.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
The initial classic Fontan utilising a direct right atrial appendage to pulmonary artery anastomosis led to numerous complications. Adults with such complications may benefit from conversion to a total cavo-pulmonary connection, the current standard palliation for children with univentricular hearts.
A single institution, retrospective chart review was conducted for all Fontan conversion procedures performed from July, 1999 through January, 2017. Variables analysed included age, sex, reason for Fontan conversion, age at Fontan conversion, and early mortality or heart transplant within 1 year after Fontan conversion.
A total of 41 Fontan conversion patients were identified. Average age at Fontan conversion was 24.5 ± 9.2 years. Dominant left ventricular physiology was present in 37/41 (90.2%) patients. Right-sided heart failure occurred in 39/41 (95.1%) patients and right atrial dilation was present in 33/41 (80.5%) patients. The most common causes for Fontan conversion included atrial arrhythmia in 37/41 (90.2%), NYHA class II HF or greater in 31/41 (75.6%), ventricular dysfunction in 23/41 (56.1%), and cirrhosis or fibrosis in 7/41 (17.1%) patients. Median post-surgical follow-up was 6.2 ± 4.9 years. Survival rates at 30 days, 1 year, and greater than 1-year post-Fontan conversion were 95.1, 92.7, and 87.8%, respectively. Two patients underwent heart transplant: the first within 1 year of Fontan conversion for heart failure and the second at 5.3 years for liver failure.
Fontan conversion should be considered early when atrial arrhythmias become common rather than waiting for severe heart failure to ensue, and Fontan conversion can be accomplished with an acceptable risk profile.