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Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear.
Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified.
The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10–1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07–2.01) during the follow-up compared with the controls.
The unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.
Bipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.
Among the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.
FDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.
Our study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.
The accounting information of a firm is analogous to the characteristics of an organism that contain biological information that influences decisions; such characteristics result from organizational routines (genes). Organizational routines result from organizational learning, and learning from an associated company is an efficient approach for a new venture to establish routines. The study results revealed that the subsidiaries inherited routines from the parent companies related to financial ratios, so we suggest that people should judge the adequacy of a firm’s financial situation by not only referring to the standard of its industry but also to its parent company.
Obesity and hyperlipidaemia increase the risk of CVD. Some strains of probiotics have been suggested to have potential applications in cardiovascular health by lowering serum LDL-cholesterol. In this work, high-fat diet-induced hyperlipidaemia in hamsters was treated with different doses (5×108 and 2·5×109 cells/kg per d) of heat-killed Lactobacillus reuteri GMNL-263 (Lr263) by oral gavage for 8 weeks. The serum lipid profile analysis showed that LDL-cholesterol and plasma malondialdehyde (P-MDA) were reduced in the GMNL-263 5×108 cells/kg per d treatment group. Total cholesterol and P-MDA were reduced in the GMNL-263 2·5×109 cells/kg per d treatment group. In terms of heart function, the GMNL-263 2·5×109 cells/kg per d treatments improved the ejection fraction from 85·71 to 91·81 % and fractional shortening from 46·93 to 57·92 % in the high-fat diet-fed hamster hearts. Moreover, the GMNL-263-treated, high-fat diet-fed hamster hearts exhibited reduced Fas-induced myocardial apoptosis and a reactivated IGF1R/PI3K/Akt cell survival pathway. Interestingly, the GMNL-263 treatments also enhanced the heat-shock protein 27 expression in a dose-dependent manner, but the mechanism for this increase remains unclear. In conclusion, supplementary heat-killed L. reuteri GMNL-263 can slightly reduce serum cholesterol. The anti-hyperlipidaemia effects of GMNL-263 may reactivate the IGF1R/PI3K/Akt cell survival pathway and reduce Fas-induced myocardial apoptosis in high-fat diet-fed hamster hearts.
We have developed a low cost and convenient approach to fabricate ITO-comparable transparent electrodes by using solution process of silver nanowires mixed with poly peroxotitanic acid (PPT) gel. The PPT gel is applied to connect the dispersed silver nanowires to preserve its high conductivity while remaining transparency and reducing surface roughness of the transparent electrode. The silver nanowires were synthesized via a modified polyol method, and the PPT gels were prepared by sol-gel method in appropriate concentrations. After applying the PPT gels, the sheet resistance of the transparent electrodes was improved from 192 Ω/□ to 44.7 Ω/□ with a transmittance of 81 %. And the roughness (RMS) was decreased from 106.3 nm to 48.1 nm. The PPT gel also improved the reliability of the proposed electrodes, which the conductivity was remained after general atmospheric storage of 6 months. We also demonstrate an Alq3 based OLED with the proposed transparent electrodes.
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
An approach formulated by vector algebra is proposed to deal with great circle sailing problems. Using the technique of the fixed coordinates system and relative longitude concept, derivations of formulae for this approach are simpler than those of the conventional methods. Due to fixing the initial great circle course, the great circle track (GCT) is determined. Since the course is fixed (known as “COFI” in this paper), the proposed approach, which we have named the “COFI method”, can directly calculate the waypoints along the GCT. It is considered that the COFI method is a more understandable and straightforward method to solve waypoint problems than older approaches in the literature. Based on the COFI method, a program has been developed for the navigator. In addition, the spherical triangle method with respect to the equator crossing point (STM-E) is developed by supplemental theorem. Several examples are demonstrated to validate the proposed COFI method and STM-E.
Background: Executive dysfunction is not uncommon in patients with amnestic mild cognitive impairment (aMCI). This study aimed to investigate the applicability of executive function tests (EFTs) in aMCI as an aid in establishing the diagnosis of multi-domain MCI.
Methods: One hundred and twenty (120) aMCI patients, 126 Alzheimer's disease (AD) patients, and 100 normal controls were enrolled. The EFTs evaluated included the trail making test, digit backward span, Stroop color–word test, and design fluency and category fluency tests.
Results: Of the aMCI participants, 66% exhibited impairment in at least one EFT. Among the five selected EFTs, the category fluency test was the most discriminative in detecting executive dysfunction between patients with aMCI (standardized β = 0.264) or AD (standardized β = 0.361) with the controls, followed by the Stroop test. The performance of aMCI patients with two or more impaired EFTs was significantly different from those of controls but not from those of AD patients.
Conclusion: In the clinical setting, aMCI patients who fail in two or more EFTs may represent a unique population with multi-domain MCI that require close follow-up.
Congenital anomalies of the coronary arteries are present in 0.2–1.4% of the general population. These anomalies represent one of the most confusing issues in the field of cardiology and challenges for interventional cardiologists and cardiac surgeons if the anomalies are unrecognised. Double right coronary artery is one of the rarest coronary arteries. Previously, the probability of developing atherosclerotic changes in patients with a double right coronary artery was considered to be equal to that in those without it. In reality, however, a high prevalence of atherosclerotic coronary artery disease was found in patients with a double right coronary artery originating from a single ostium after our comprehensive literature search through the PubMed database. Owing to the fact that double right coronary artery is both a congenital and potentially atherosclerotic coronary artery disease at diagnosis, coronary intervention or cardiac operation is more complicated than previously believed. Individuals with a double right coronary artery may be unaware of its presence until an accidental finding during coronary angiography or cardiac operation and are at risk for unsuspected complications of atherosclerotic coronary artery disease or during cardiac operation. Therefore, it is important to obtain information on the anatomic variants of this congenital coronary anomaly in patients who are undergoing either coronary intervention, aortic root operation or myocardial revascularisation. To our knowledge, this is the first comprehensive article to discuss the anomalies and their clinical implications.
Plasma immersion ion implantation (PIII) is a technique of material processing and surface modification, using controllable negative high voltage pulsed bias to attract the ion generated from the plasma. The method using PIII treatment quickly improves the performance of solar cell made of crystalline silicon, including monocrystalline, multicrystalline and polycrystalline silicon. Hydrogen ions are attracted and quickly implanted into solar cell under a predetermined negative pulse voltage, thus, the passivation of the crystal defects of the solar cell can be realized in a short period. Meanwhile, the properties of the antireflection layer can not be damaged as the proper operating conditions are used. Consequently, the series resistance can be significantly reduced and the filling factor increases as a result. Both the short-circuit and the open-circuit voltage can be increased. The efficiency can be enhanced.
In this study, nanoporous silica films were prepared from the poly(hydrogen silsesquioxane)(HSSQ) and a templating agent. Three different kinds of the HSSQ with different molecular weight and Si-OH end group content were prepared through the variation of the water/triethoxysilane ratio or pH. The templaing agent for generating nanopore was triphenylsilanol (TPS). The experimental results of refractive index, dielectric constant, and FE-SEM supported the formation of the nano-size pores in the prepared silica films. The dielectric constant of the prepared nanoporous thin films could be reduced form 2.89 (porosity: 12%) to 1.85 (porosity: 58%) by increasing the added TPS. The surface roughness of the prepared nanoporous silica film in comparison with the film thickness was less than 1%. For successful generating small and uniform nanopore in the film, low molecular weight or high Si-OH content of the prepared HSSQ would be required. The current approach is useful for preparing new kinds of low dielectric constant materials.
The authors report the study of the dependence of the device performance of polymer solar cells based on single 50-nm heterojunction poly(3-hexylthiophene)/[6,6]-phenyl-C61-butyric acid methylester (P3HT/PCBM) layer on annealing process. Annealing before and after cathode deposition were performed for comparison. In the case of post-annealing at 150¢XC for 60 min., the device attains a conversion efficiency of 4.9%, a fill factor of 53 %, and an open-circuit voltage of 0.67 V. These values are comparable with the highest values reported previously. The annealing process is expected to modify the network morphology of the P3HT/PCBM layer. This study demonstrates that it is possible to attain good solar cell performance with the combination of single thin active layer and post-annealing treatment. This may open up an opportunity to fabricate tandem polymer solar cells.
The optimized N2O fluence is demonstrated for plasma enhanced chemical vapor deposition (PECVD) of Si-rich substoichiometric silicon oxide (SiOx) films with buried Si nanocrystals. Strong room-temperature photoluminescence (PL) at 550-870 nm has been observed in SiOx films grown by PECVD under a constant SiH4 fluence of 20 sccm with an N2O fluence varying from 105 sccm to 130 sccm. A 22-nm-redshift in the central PL wavelength has been detected after annealing from 15 min to 180 min. The maximum PL irradiance is observed from the SiOx film grown at the optimal N2O fluence of 120 sccm after annealing for 30 minutes. Larger N2O fluence or longer annealing time leads to a PL band that is blue-shifted by 65 nm and 20 nm, respectively. Such a blue shift is attributed to shrinkage in the size of the Si nanocrystals with the participation of oxygen atoms from N2O incorporated within the SiOx matrix. The (220)-oriented Si nanocrystals exhibit radii ranging from 4.4 nm to 5.0 nm as determined by transmission electron microscopy (TEM). The luminescent lifetime lengthens to 52 μs as the nc-Si size increase to > 4 nm. Optimal annealing times for SiOx films prepared at different N2O fluences are also reported. A longer annealing process results in a stronger oxidation effect in SiOx films prepared at higher N2O fluences, yielding a lower PL irradiance at shorter wavelengths. In contrast, larger Si nanocrystals can be precipitated when the N2O fluence becomes lower; however, such a SiOx film usually exhibits weaker PL at longer wavelength due to a lower nc-Si density. These results indicate that a N2O/SiH4 fluence ratio of 6:1 is the optimized PECVD growth condition for the Si-rich SiO2 wherein dense Si nanocrystals are obtained after annealing.
In this work, the charge-trapping distributions of polysilicon-oxide-nitride-oxide-silicon (SONOS) structure are studied. The trapping energy level of SiNx films with different composition ratio deposited by low-pressure chemical vapor deposition (LPCVD) were first characterized by photoluminescence (PL) measurement. Moreover, using F-N/CHE program and charge pumping techniques, the vertical location and the lateral distribution of programmed charges are investigated in the nitride films with different composition ratio. The study offers strong evidence that the density of charge-trapping levels in the Si-rich nitride is higher than the standard nitride. A simple qualitative model and calculation explains that the trapping level distributions in the SiNx films are shallower by increasing relative Si-content. Furthermore, we have observed the nitride trap vertical location was changed by adjusted Si/N composition ratio. And the lateral distribution of hot electron programmed charges in the modified nitride is broader than that in the standard nitride because it offered more charge-trapping sites and shallower charge-trapping levels. In summary, the study can help researchers to understand the nitride charge-trapping mechanism and the analysis of optical/electrical characteristics.
A void free 3C-SiC film grown on Si(100) can be achieved by low pressure chemical vapor deposition using the modified four-step method. The diffusion step plays an important role to enhance the quality of the 3C-SiC buffer layer on Si(100). X-ray photoelectron spectroscopy was used to characterize the bonding characteristics of the 3C-SiC buffer layer of about 10 nm thick. The Si-C bonds are partially formed on the as-carburized Si(100) before the diffusion step. The ratio of C-C to Si-C bonds on the as-carburized Si(100) is about 7:3, which can be lowered to about 1:9 after the diffusion step at 1350 oC for 5 min or at 1300 oC for 7 min. According to XPS data and Fick's second law, the diffusivity of Si across the 3C-SiC interlayer are determined to be 2.2×10-16 cm2/s and 3.13×10-16 cm2/s at 1300°C and 1350°C, respectively. The derived activation energy is 1.6 eV for the diffusion of Si atoms in the 3C-SiC buffer layer.
Episodic memory tasks are one of the most sensitive tools to discriminate Alzheimer’s disease (AD). This study aimed to validate a shorter version verbal memory test that will efficiently assess Chinese elderly with memory complaints. One hundred and eighty-five elderly with normal cognition (NC) and 217 AD patients were evaluated. Each participant received the Chinese Version Verbal Learning Test (CVVLT) consisting of 9 two-character nouns with 4 learning trials, 2 delayed recalls in 30 seconds and 10 minutes, and a word recognition test. In the NC elderly, age and sex had significant effects on recall scores in CVVLT, while education level showed an inverse correlation with 3 different patterns of errors made during the learning, recall, and recognition trials. AD patients had lower scores across all recall tests. In those with lower educational level, NC elderly had higher perseveration errors than AD patients. The cutoff value between the AD and NC groups in the 10-minute recall was 4/5 for those aged >75 years and 5/6 for those aged <75 years. This study has good validity in discriminating AD participants and the data here can help in diagnosing AD and mild cognitive impairment using the CVVLT. (JINS, 2010, 16, 244–251.)