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To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS).
Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5–12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M).
Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63–2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline.
Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.
Depressive symptoms are common in bereaved caregivers; however, there have been few prospective studies using a structured interview. This study investigated the prevalence and preloss predictors of major depressive disorder (MDD) in bereaved caregivers of patients in a palliative care unit.
This prospective cohort study collected caregiver sociodemographic and psychological data before the death of a palliative care unit patient, including MDD, care-burden, coping style, and hopeful attitude. Postloss MDD was assessed 6 and 13 months after death, and a multivariate logistic regression analysis was conducted to identify its predictors.
Of 305 caregivers contacted, 92 participated in this study. The prevalence of preloss MDD was 21.8%; the prevalences of postloss MDD were 34.8% and 24.7% at 6 and 13 months, respectively. Preloss MDD predicted postloss MDD at 6 months (odds ratio [OR] = 5.38, 95% confidence interval [CI95%] = 1.29, 22.43); preloss nonhopeful attitude and unemployment status of caregivers predicted postloss MDD at 13 months (OR = 8.77, CI95% = 1.87, 41.13 and OR = 7.10, CI95% = 1.28, 39.36, respectively).
Significance of results
Approximately 35% of caregivers suffered from MDD at 6 months postloss, but the prevalence of MDD decreased to about 25% at 13 months. Preloss MDD significantly predicted postloss MDD at 6 months, whereas hopeful attitude and unemployment at baseline were significantly associated with postloss MDD at 13 months.
Although late-life anxiety occurs frequently and is associated with higher morbidity, few longitudinal studies have been concerned with the evaluation thereof. We investigated the prevalence, incidence, and persistence of anxiety and related factors over a two-year period in community-dwelling Korean elderly individuals.
A total of 1,204 Korean elderly individuals were evaluated at baseline, and 909 were followed up two years later. The community version of the Geriatric Mental State Schedule was used to estimate anxiety at both baseline and follow-up interviews. We defined “prevalence” as the rate of anxiety symptoms (for both anxiety cases and sub-threshold anxiety) at baseline; “incidence” as the rate of anxiety symptoms at follow-up in those without baseline anxiety symptoms; and “persistence” as the rate of anxiety symptoms at follow-up in those with baseline anxiety symptoms. Associations between various covariates and anxiety status were examined using multivariate logistic regression models.
The prevalence, incidence, and persistence of anxiety symptoms were 38.1%, 29.3%, and 41.1%, respectively. Prevalent anxiety symptoms were associated independently with female, rented housing, more stressful life event and medical illness, physical inactivity, depression, insomnia, and lower cognitive function. Incident anxiety symptoms were predicted by older age, female gender, depression, and insomnia; persistent anxiety symptoms were predicted by older age, more medical illness, and baseline depression.
Since depression was associated with prevalent, incident, and persistent anxiety symptoms, effective detection and management thereof is important in older adults to reduce anxiety. Furthermore, preventive collaborative care should be considered, particularly for older, female, insomniac patients.
Epidemiological studies have reported that higher education (HE) is associated with a reduced risk of incident Alzheimer's disease (AD). However, after the clinical onset of AD, patients with HE levels show more rapid cognitive decline than patients with lower education (LE) levels. Although education level and cognition have been linked, there have been few longitudinal studies investigating the relationship between education level and cortical decline in patients with AD. The aim of this study was to compare the topography of cortical atrophy longitudinally between AD patients with HE (HE-AD) and AD patients with LE (LE-AD).
We prospectively recruited 36 patients with early-stage AD and 14 normal controls. The patients were classified into two groups according to educational level, 23 HE-AD (>9 years) and 13 LE-AD (≤9 years).
As AD progressed over the 5-year longitudinal follow-ups, the HE-AD showed a significant group-by-time interaction in the right dorsolateral frontal and precuneus, and the left parahippocampal regions compared to the LE-AD.
Our study reveals that the preliminary longitudinal effect of HE accelerates cortical atrophy in AD patients over time, which underlines the importance of education level for predicting prognosis.
This study aimed to assess the prevalence, incidence, and persistence of suicidal ideation (SI), and to investigate the psychosocial factors associated with these.
A total of 1,204 community dwelling elderly adults aged 65 years or older were evaluated at baseline, 909 (75%) of whom were followed two years later. The presence of SI was identified using the questions from the community version of the Geriatric Mental State (GMS) diagnostic schedule (GMS B3) at both baseline and follow-up interviews. Baseline measures included demographic status, years of education, rural/urban residence, accommodation, past and current occupation, monthly income, marital status, stressful life events, social support deficits, number of physical illnesses, severity of pain, physical activity, disability, depressive symptoms, anxiety, insomnia, cognitive function, alcohol consumption, and smoking.
Baseline SI prevalence, follow-up incidence (SI rate at follow-up of 805 elderly subjects who did not have SI at baseline), and persistence (SI rate at follow-up of 104 elderly subjects who had SI at baseline) were 11.5%, 9.6%, and 36.5%, respectively. Baseline SI was independently associated with no current employment, lower monthly income, stressful life events, more severe pain, presence of disability, depressive symptoms, and smoking. Incident SI was independently predicted by baseline unmarried status, social support deficit, severe pain, presence of depressive symptoms, and smoking. Persistent SI was independently predicted by baseline stressful life events and depressive symptoms.
Depressive symptoms were independently associated with prevalent, incident, and persistent SI, but other predictors varied according to incidence and persistence outcomes.
Low temperature solid oxide fuel cells (SOFCs) are a promising solution to revolutionize stationary, transportation, and personal power energy conversion efficiency. Through investigation of fundamental conduction mechanisms, we have developed the highest conductivity solid electrolyte, stabilized bismuth oxide (Dy0.08W0.04Bi0.88O0.36). To overcome its inherent thermodynamic instability in the anode environment, we invented a functionally graded bismuth oxide/ceria bilayered electrolyte. For compatibility with this bilayared electrolyte, we developed high performance bismuth ruthenate–bismuth oxide composite cathodes. Finally, these components were integrated into an anode-supported cell with an anode functional layer, resulting in an exceptionally high power density of ∼2 W/cm2 at moderate temperatures (650 °C) and sufficient power down to 300–400 °C for most applications. Moreover, because SOFCs can operate on conventional fuels, these low temperature SOFCs provide one of the most efficient energy conversion technologies available without relying on a hydrogen infrastructure.
An organic/inorganic hybrid-type nonvolatile memory TFT was proposed as a core device for the future flexible electronics. The structural feature of this memory TFT was that a ferroelectric copolymer and an oxide semiconductor layers were employed as a gate insulator and an active channel, respectively. The memory TFT with the structure of Au/poly(vinylidene fluoride-trifluoroethylene)/Al2O3/ZnO/Ti/Au/Ti/poly(ethylene naphthalate) could be successfully fabricated at the process temperature of below 150°C. It was confirmed that the TFT well operated as a memory device even under the bending situations.
We investigated the pressure dependence of the inductive coupled plasma (ICP) oxidation on the electrical characteristics of the thin oxide films. Activation energies and electron temperatures with different pressures were estimated. To demonstrate the pressure effect on the plasma oxide quality, simple N type metal-oxide-semiconductor (NMOS) transistors were fabricated and investigated in a few electrical properties. At higher pressure than 200mTorr, plasma oxide has a slightly higher on-current and a lower interfacial trap density. The on-current gain seems to be related to the field mobility increase and the lower defective interface to the electron temperature during oxidation.
Polarization degradation due to metal etch and/or photoresist(PR) strip processes has been investigated for Pt/SrBi2Ta2O9(SBT)/Pt ferroelectric capacitors. Interconnect metal line consisting of TiN/Al/Ti/TiN/Ti layers has been patterned by normal photolithography and plasma etch processes. We used two different sources for metal etcher, helicon or electron cyclotron resonance(ECR) source, and stripped the PR with either microwave or helicon source stripper. Polarization degradation was evaluated by measuring switching and non-switching polarization of the ferroelectric capacitors.
Neither etch machine nor etch parameters played an important role for determining polarization of the ferroelectric capacitors. Photoresist strip process, however, significantly affected the polarization of the ferroelectric capacitors. Factors affecting polarization of the ferroelectric capacitors were presence of hydrogen and plasma density during the strip process. Hydrogen atoms and protons produced by H2O or NH3 plasma penetrated through the dielectric layer and caused hydrogen induced damage. Thus the hydrogen damage was dependent on strip temperature and time. Photoresist strip with high density plasma results in charging damage to ferroelectric capacitors. It is believed that charges from the plasma are trapped at domain boundaries and interfaces, leading to polarization degradation. Damage free metal etching process for the ferroelectric capacitor was applied for the fabrication of the fully working ferroelectric random access memory.
Adenoid hypertrophy is known as the most common cause of nasal obstruction in children; thus, adenoidectomy with, or without, tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Although many methods have been suggested, few studies have reported on how to assess adenoid size, pre-operatively. Acoustic rhinometry is an objective technique as well as a non-invasive method, which can be easily used in young children. This study confirmed that acoustic rhinometry is a non-invasive and objective technique for assessing the geometry of the nasal cavity and nasopharynx. Forty children were evaluated using symptomology, two different radiological measurements and acoustic rhinometry; the results were compared with endoscopic findings. Clinical symptoms and A/N ratio measured with Fujioka's method significantly correlated with the endoscopic assessment findings (r = 0.769 and 0.604 respectively). Significant increases in the cross-sectional area and volume of the nasopharynx were observed at the adenoid notch after adenoidectomy (p<0.005 and p<0.005, respectively). Acoustic rhinometry showed a high degree of correlation of which adenoid occupied the nasopharyngeal airway under endoscopic examination (r = 0.771). Thus, the study concluded that acoustic rhinometry can be as good an objective method for measuring adenoid sizes as endoscopy and can be used as one of the pre-operative examination tools for adenoidectomy.
Dislocation-free Si1−xGex epilayers are successfully grown on (100) silicon at 440°C by ultrahigh vacuum electron cyclotron resonance chemical vapor deposition (UHV-ECRCVD). The effects of process parameters on the crystallinity of Si1−xGex epitaxial layers were studied. As the GeH4 flow rate increases and consequently Ge fraction increases above 20%, Si1−xGex epilayers become damaged heavily by ions. When Ge fraction is larger than 20%, process parameters like total pressure need to be adjusted to reduce the ion flux for high quality Sil−xGex. Growth rate of Si1−xGex epitaxial layers increases at 440°C with Ge content in the film. It is presumed that the hydrogen desorption from the surface is the rate-limiting step, however, the enhancement in growth rate is comparatively suppressed and delayed.
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