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Ketamine has emerged as a novel therapeutic agent for major depressive episodes, spurring interest in its potential to augment electroconvulsive therapy (ECT).
We sought to update our preliminary systematic review and meta-analysis, focusing on randomised controlled trials (RCTs) involving an index course of ECT, and testing the hypothesis that lack of efficacy is due to barbiturate anaesthetic co-administration.
We searched EMBASE, CENTRAL and Medline to identify RCTs examining the efficacy of ketamine during a course of ECT. Data were synthesised from ten trials (ketamine group n = 333, comparator group n = 269) using pooled random effects models.
Electroconvulsive therapy with ketamine was not associated with greater improvements in depressive symptoms or higher rates of clinical response or remission, nor did it result in pro-cognitive effects. This held true when limiting analysis to trials without barbiturate anaesthetic co-administration. Increased rates of confusion were reported.
Overall, our analyses do not support using ketamine over other induction agents in ECT.
We developed the Hong Kong Specific Learning Difficulties Behavior Checklist for Junior Secondary School Students (BCL-JS) for teachers to rate the frequency of 52 reading-related behavioral characteristics of Chinese secondary school students. An item factor analysis based on ratings on 947 students yielded seven distinct dimensions. In a separate sample of 90 students, the seven constructs of the BCL-JS significantly correlated with students’ performances on most literacy and reading-related cognitive measures, and differentiated adolescents with or without dyslexia. Discriminant analysis showed that the BCL-JS had a high rate of correct classification (82.2%). These findings support that the BCL-JS is a reliable screening tool for Chinese junior secondary school students at risk for dyslexia.
Clinical researchers in acute emergency settings are commonly faced with the difficulty of satisfying the conventional ethical requirement of obtaining informed consent, whilst ensuring a representative group of patients is recruited into studies. We discuss our own experience in addressing institutional ethical requirements to obtain informed consent in a multi-centre trial, recruiting highly agitated patients in the emergency setting in Melbourne, Australia. We suggest that, through the application of existing ethical and legal frameworks and pre-emptive communication with the key stakeholders in ethics committees, hospital insurers and legal representatives, a balance can be struck between ethical and legal requirements on the one hand, and the integrity of the research question, on the other.
We evaluated the efficacy, safety and patient satisfaction with the use of propofol for procedural sedation and analgesia in the emergency department (ED).
All patients receiving propofol for procedural sedation and analgesia in the ED between December 1, 2003, and November 30, 2005, were prospectively assessed. Propofol was administered using a standardized protocol, which included an initial dose of 0.25–0.5 mg/kg followed by 10–20 mg/minute until sedated. Efficacy was evaluated using procedural success rate, recovery time and physician satisfaction. Adverse respiratory effects were defined as apnea for more than 30 seconds or an oxygen saturation of less than 90%. Hypotension was defined as systolic blood pressure < 90 mm Hg or > 20% decrease from baseline. Patient and physician satisfaction were determined using 5-point Likert scales.
Our study included 113 patients with a mean age of 50 (standard deviation [SD] 19) years; 62% were male. The most common procedures were orthopedic manipulation (44%), cardioversion (37%), and abscess incision and drainage (13%). The mean total propofol dose required was 1.6 (SD 0.9) mg/kg. Procedural success was achieved in 90% of cases and the mean patient recovery time was 7.6 (SD 3.4) minutes. No patient (0%, 95% confidence interval [CI] 0%–3%) experienced apnea; however, 1 patient (1%, 95% CI 0%–5%) experienced emesis, which resulted in an oxygen saturation <90%. Nine patients (8%, 95% CI 4%–15%) experienced hypotension and 7 (6%, 95% CI 3%–12%) experienced pain on injection. All patients were very satisfied (92%, 95% CI 85%–96%) or satisfied (8%, 95% CI 4%–15%), and 94% (95% CI 88%–98%) reported no recollection of the procedure. The majority of physicians were very satisfied (85%, 95% CI 77%–91%) or satisfied (6%, 95% CI 3%–12%) with the sedation and the conditions achieved.
When administered as part of a standardized protocol, propofol appears to be a safe and effective agent for performing procedural sedation and analgesia in the ED, and is associated with high patient and physician satisfaction.
The Pension Benefits Guarantee Fund (PBGF) was established in the province of Ontario in 1980, thus creating in Canada a rare opportunity for intranational empirical research on the impacts of governmental protection on private plans and their participants. This paper examines Canadian data on pension plans for effects attributable to Ontario's government guarantees for some plans. We find that significant variables related to an increase in the number of pension plans in Canada are higher interest rates, a larger labour market, and, consistent with the deferred compensation theory from labour economics, lower real disposable income of workers. The number of members in pension plans is related significantly to the same variables and also to tax rates and unemployment. The analyses show that the Ontario environment for pension plans is significantly different from the rest of Canada. Those plans covered by the Pension Benefit Guarantee Fund exhibit a lower degree of funding per participant than do the remainder of the plans in the sample, supporting the argument that a government guarantee is related to a moral hazard problem in Ontario pension financing.
We present a technique to generate ultra-smooth surfaces and direct pattern imprinting on thin metal films by flattening the bumps and spikes of a freshly vacuum deposited metal film. The technique was implemented by using a small footprint mechanical imprint press that has the capability to vary the applied pressure from 100MPa to 600MPa. The mechanical press was incorporated with a tactile force sensor that enabled direct monitoring of the applied pressure. We demonstrated the feasibility of the technique on an e-beam evaporated silver (Ag) metal film with thickness ranging from 150Å (optically thin) to 1000Å (optically thick). The film was deposited on double-polished (100)-oriented silicon surface and double-polished borosilicate glass, resulting in a varying degree of film smoothness. The surface morphology of the pressed thin film was then studied using atomic force microscopy and SEM. Our demonstration with the e-beam evaporated silver thin film exhibits the potential for applications in decreasing the scattering-induced losses in optical metamaterials, plasmonic nanodevices and electrical shorts in molecular-scale electronic devices.
Family intervention in schizophrenia can reduce patient relapse and improve medication adherence, but few studies on this have involved a Chinese population.
To examine the effects of a mutual support group for Chinese families of people with schizophrenia, compared with psychoeducation and standard care.
Randomised controlled trial in Hong Kong with 96 families of out-patients with schizophrenia, of whom 32 received mutual support, 33 psychoeducation and 31 standard care. The psychoeducation group included patients in all the sessions, the mutual support group did not. Intervention was provided over 6 months, and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up.
Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods, compared with the other two conditions. The number of readmissions did not decrease significantly, but their duration did.
Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden.
The present study examined word learning difficulties in Chinese dyslexic children, readers of a nonalphabetic script. A total of 105 Hong Kong Chinese children were recruited and divided into three groups: Dyslexic (mean age 8;8), CA control (mean age 8;9), and RL control (mean age 6;11). They were given a word learning task and a familiar word writing task. It was found that the Dyslexic group performed less well than the RL group in learning irregular words over trials but not the regular ones. Error analyses showed that the Dyslexic group made more orthographic and word association errors but less intra-wordlist interference errors than the RL control group. The Dyslexic group also performed significantly less well than both control groups in writing familiar words (e.g. their own name). These findings suggest that Chinese dyslexic children have difficulty learning new words, especially irregular ones, and retaining overlearned words in long-term memory. We conclude that Chinese dyslexic children have a specific impairment in word learning like their alphabetic counterparts.
Our observation is that both the on-current and off-current of state-of-the-art p-channel MOS transistors tend to become larger when the L-shaped spacer becomes smaller due to two different mechanisms: a decrease in the effective channel length Leff (Mechanism A) and a decrease in the series resistance (Mechanism B). In our analysis, we use drain induced barrier lowering (DIBL) as a measure of Leff and we assume that there is a linear relationship between the on-current, the logarithm of the off current and DIBL. Our assumption is supported by our theoretical derivations.
Positron Annihilation Lifetime Spectroscopy (PALS) (1, 2) is a useful tool to pre-screen metal barrier integrity for Si-based porous low-k dielectrics. Pore size of low-k, thickness of metal barrier Ta, positronium (Ps) leakage from PALS, trench sidewall morphology, electrical test from one level metal (1LM) pattern wafer and Cu diffusion analysis were all correlated. Macro-porous low-k (pore size >= 200A) and large scale meso-porous low-k (>50∼200A) encounter both Ps leakage and Cu diffusion into low-k dielectric in the 0.25μmL/0.3μmS structures when using SEMATECH in-house PVD Ta 250A as barrier layer. For small scale meso-porous (>20∼50A) and micro-porous (<=20A) low-k, no Ps leakage and no Cu diffusion into low-k were observed even with PVD Ta 50A, which is proved also owing to sidewall densification to seal all sidewall pores due to plasma etch and ash. For future technology, smaller pore size of porous Si-based low-k (=< 50A) will be preferential for dense low-k like trench sidewall to avoid metal barrier integrity due to coverage problems from sidewall pores.
Micro-Raman spectroscopic investigations of arsenic-implanted silicon show lines characteristic of silicon crystallites even at implant doses above the amorphization threshold. The intensity and frequency of occurrence of the lines increase with the implanted dose. Polarization/orientation Raman studies indicate the crystallites are silicon in the hexagonal phase (Si-IV) and silicon in the diamond phase (Si-I). The latter are oriented differently than the substrate silicon. Monte Carlo simulations of the arsenic ion energy loss and published molecular dynamics studies suggest that each arsenic ion deposits sufficient energy to locally melt the silicon lattice. This is taken as the basis of the present attempt to explain the origin of the crystallites. A one-dimensional numerical model is developed to determine the time scale for the liquid silicon to solidify. The effect of amorphous silicon on the solidification is also investigated.
The English and Chinese versions of the General Health Questionnaire (GHQ) were administered to a sample of 72 bilingual respondents for the evaluation of version equivalence by a series of item analyses, reliability analyses and factor analyses. Although certain notable discrepancies were observed at the item level, the two versions were found to be comparable at the scale level. In addition, cogent evidence was provided for the relative robustness of the symptom dimensions as assessed by the two versions of the GHQ.
The 30-item General Health Questionnaire (GHQ), the 24-item Self-Reporting Questionnaire (SRQ), and a Chinese version of the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 225 English-speaking Chinese. The GHQ was found to have high internal consistency as a scale and to assess 5 dimensions of psychopathology: anxiety, inadequate coping, depression, insomnia, and social dysfunctioning. As a brief screening instrument, it correlated 0·49 with the SRQ. In the ‘case–non-case’ classification, it yielded a concordance rate of above 75% with the SRQ. Using the MMPI modal profiles derived from classification research as criterion measures, sensitivity, specificity and correct classification rates were above 70%. Implications for future research with the GHQ are discussed.
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