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Families facing end-stage nonmalignant chronic diseases (NMCDs) are presented with similar symptom burdens and need for psycho-social–spiritual support as their counterparts with advanced cancers. However, NMCD patients tend to face more variable disease trajectories, and thus may require different anticipatory supports, delivered in familiar environments. The Life Rainbow Programme (LRP) provides holistic, transdisciplinary, community-based end-of-life care for patients with NMCDs and their caregivers. This paper reports on the 3-month outcomes using a single-group, pre–post comparison.
Patients with end-stage NMCDs were screened for eligibility by a medical team before being referred to the LRP. Patients were assessed at baseline (T0), 1 month (T1), and 3 months (T2) using the Integrated Palliative Outcome Scale (IPOS). Their hospital use in the previous month was also measured by presentations at accident and emergency services, admissions to intensive care units, and number of hospital bed-days. Caregivers were assessed at T0 and T2 using the Chinese version of the Modified Caregiver Strain Index, and self-reported health, psychological, spiritual, and overall well-being. Over-time changes in outcomes for patients, and caregivers, were tested using paired-sample t-tests, Wilcoxon-signed rank tests, and chi-square tests.
Seventy-four patients and 36 caregivers participated in this research study. Patients reported significant improvements in all IPOS domains at both 1 and 3 months [ranging from Cohen's d = 0.495 (nausea) to 1.793 (depression and information needs fulfilled)]. Average hospital bed-days in the previous month fell from 3.50 to 1.68, comparing baseline and 1 month (p < 0.05). At 3 months, caregiver strain was significantly reduced (r = 0.332), while spiritual well-being was enhanced (r = 0.333).
After receiving 3 month's LRP services, patients with end-stage NMCDs and their caregivers experienced significant improvements in the quality of life and well-being, and their hospital bed-days were reduced.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Hair cortisol concentration (HCC) can be used to periodically assess hypothalamic–pituitary–adrenal (HPA) axis function, and appears correlated with prolonged exposure to stress.
Serial assessment (at Baseline, Week 6 and Week 12) of participants (n = 35) with anxiety disorders by psychopathological rating scales, with assays of HCC and levels of peripheral anti- and pro-inflammatory cytokines. Patients underwent antidepressant treatment for an initial 6 weeks, followed by cyclo-oxygenase inhibitor-2 (COX-2) inhibitor (celecoxib) augmentation or ‘treatment as usual’ for a further 6 weeks.
At Baseline (n = 35), HCC was elevated in patients with single-episode but not recurrent-episode anxiety disorders, mean IL-12p70 levels were low, and mean TNF-α levels were elevated. Following 6 weeks of antidepressant treatment (n = 33), mean HCC was within the normal range but mean IL-2 level was low. Celecoxib augmentation (n = 18) was associated with a reduction in anxiety symptoms and normalisation of mean IL-2 levels.
Small sample size. Not all participants were assessed at all time points.
Serial assessment of HCC is practicable in patients with anxiety disorders. These preliminary findings warrant further investigation in larger samples.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Hand, foot and mouth disease (HFMD) is generally a benign febrile exanthematous childhood disease caused by human enteroviruses. The route of transmission is postulated to be faeco-oral in developing areas but attributed more to respiratory droplet in developed areas. Transmission is facilitated by the prolonged environmental survival of these viruses and their greater resistance to biocides. Serious outbreaks with neurological and cardiopulmonary complications caused by human enterovirus 71 (HEV-71) seem to be commoner in the Asian Pacific region than elsewhere in the world. This geographical predilection is unexplained but could be related to the frequency of intra- and inter-typic genetic recombinations of the virus, the host populations' genetic predisposition, environmental hygiene, and standard of healthcare. Vaccine development could be hampered by the general mildness of the illness and rapid genetic evolution of the virus. Antivirals are not readily available; the role of intravenous immunoglobulin in the treatment of serious complications should be investigated. Monitoring of this disease and its epidemiology in the densely populated Asia Pacific epicentre is important for the detection of emerging epidemics due to enteroviruses.
Five hundred strains of methicillin-resistant Staphylococcus aureus were tested against various anti-staphylococcal agents. Vancomycin, fusidic acid and fosfomycin were found to be the most effective. Only 1 strain out of 500 was resistant to fosfomycin. Three patients with methicillin-resistant Staphylococcus aureus septicaemia were successfully treated by fosfomycin. We conclude that fosfomycin could be the drug of choice for methicillin-resistant Staphylococcus aureus infection.
In 1980, an outbreak of a mild illness involving twenty pupils and four adults in a boys' boarding school was identified serologically as psittacosis. Intensive epidemiological investigations did not uncover the source. It is suggested either that sources of chlamydia other than avian exist, which may produce a milder illness than the avian type, or that human-to-human spread of a mild form of chlamydiosis occurs.
In November and December 1992, an outbreak of parvovirus B19 infection occurred among patients and staff on an adult mixed surgical ward at a large hospital in London. Three patients and 15 staff members were serologically confirmed as acute cases. The attack rate among susceptible members of staff was 47%. In those infected, arthralgia (80%) and rash (67%) were the most common symptoms. Of six susceptible in-patients on the ward, three became infected. One of the in-patients who had carcinoma of the mouth was viraemic for more than 10 days with marrow suppression resulting in the postponement of chemotherapy until intravenous immunoglobulin was given and he was no longer viraemic. Control measures taken included closure of the ward to new admissions, transfer of only immune staff to the ward, and restriction of the ward nursing staff to working only on that ward. Although no specific exposure was conclusively identified as a risk factor, there was a suggestion of an increased risk of acquiring parvovirus B19 infection among those staff who did not adopt strict hand washing procedures after each physical contact with a patient (RR = 2·33; P = 0·07). Knowledge of parvovirus B19 among interviewed health care workers was poor: only 42% reported knowing about parvovirus B19 and only 38% could name a patient category at risk of a severe outcome following infection. This is the first report of a nosocomial outbreak affecting an adult ward and of possible transmission of parvovirus B19 infection from staff to in-patients. Hospital control of infection teams should include parvovirus B19 in their outbreak containment plans.
There is lack of published data on bulbar signs among the healthy population. This study aims to determine the range of normality of bulbar signs particularly among the elderly.
Systemic examination of bulbar signs was carried out according to a predetermined protocol on a cohort of young and elderly healthy subjects.
A total of 206 subjects were recruited in the study, 104 young adults with mean age of 20 years, and 102 elderly with mean age of 73 years. Uvula deviation was seen in 28 (26.9%) young subjects and 22 (21.6%) elderly. Irregular tongue border was seen in 17 subjects, unilateral in 4 subjects. Fourteen (6.8%) subjects had deviation on tongue protrusion. Occasional tremor of tongue on protrusion is common in both young and old. Persistent (severe) tongue tremor on protrusion was seen in 18.6% of the elderly, and 4.8% of the young. None of the subjects had tremor of tongue at rest. In gag reflex, absence of gagging response was common in elderly, seen in two thirds of the subjects on stimulation of the posterior pharyngeal wall. However, all the subjects had uvular movement. Habituation or suppression of gagging response was seen in close to 90% of young males.
There is wide range of normality in bulbar signs in normal population, particularly among the elderly.
A detailed study of zinc oxide (ZnO) films prepared by filtered cathodic vacuum arc (FCVA) technique was carried out. To deposit the films, a pure zinc target was used and O2 was fed into the chamber. The electrical properties of both undoped and Al-doped ZnO films were studied. For preparing the Al-doped films, a Zn-Al alloy target with 5 wt % Al was used. The resistivity, Hall mobility and carrier concentration of the samples were measured. The lowest resistivity that can be achieved with undoped ZnO films was 3.4×10-3 Ωcm, and that for Al-doped films was 8×10-4 Ωcm. The carrier concentration was found to increase with Al doping.
Superhard and elastic carbon nitride films with hardness and elastic recovery of 47 GPa and 87.5%, respectively, were synthesized by using a double-bend filtered cathodic vacuum arc combined with radio-frequency nitrogen ion beam source. The bombardment of energetic nitrogen atom onto the growing film surface results in the high atomic ratio of N/C (0.4), which contributes to the high sp2 content and the formation of a five-membered ring structure in the carbon nitride film at room temperature. The buckling of the five-membered ring basal planes may facilitate cross-linking between the planes through sp3 coordinated carbon atoms. A rigid three-dimensional network is formed, which contributes to the high hardness and elastic recovery of the deposited films.
Pulsed Excimer-Laser Annealing (ELA) has become an important technology to produce high performance, poly-Si Thin Film Transistors (TFTs) for large area electronics. The much-improved performance of these poly-Si TFTs over the conventional hydrogenated amorphous Si TFTs enables the possibility of building next generation flat panel imagers with higher-level integration and better noise performance. Both the on-glass integration of peripheral driver electronics to reduce the cost of interconnection and the integration of a pixel level amplifier to improve the noise performance of large area imagers have been demonstrated and are discussed in this paper.
This paper presents a study of the effects of electron beam (e-beam) exposure on the chemical and physical properties of FLARE™ 1.0X, a non-fluorinated member of the FLARE™ family of poly(arylene ether) dielectric coatings. Spin-coated films of this poly(arylene ether) were cured by large-area e-beam exposure, as well as by conventional thermal processing. Neither swelling nor dissolution was observed for the e-beam cured films after immersion in N-methylpyrrolidone (NMP) at 90 °C for 1 hour. The glass transition temperature (Tg) for films cured with a low e-beam dose is slightly higher than, or nearly the same as, the (Tg) for thermally-cured films (∼ 270 °C). However, the Tg for films cured with a high e-beam dose exceeds 400 °C. Dielectric constants of e-beam cured films and thermally cured films are nearly the same. FTIR spectra of FLARE™ films obtained before and after e-beam exposure suggest that e-beam curing does not induce any significant change in the chemical structure. Increased solvent resistance, higher Tg, and low dielectric constant are properties that make this e-beam cured poly(arylene ether) film an excellent candidate for interlevel dielectric integration processes.
Ag/Ti bilayer films deposited on silicon dioxide substrates were annealed in ammonia ambient in the temperature range of 400 - 600 °C. Rutherford backscattering spectrometry (RBS) and Auger electron spectroscopy (AES) have shown that Ti segregates to both the surface to form a TiN(O) layer and to the Ti/SiO2 interface to form a Ti-oxide/Ti-silicide bilayer. The annealed bilayer structure had minimal Ti accumulations in Ag. Resistivity values of ˜2 μΩ-cm were obtained in encapsulated Ag bilayer films, which are comparable to that of the as-deposited. X-ray analysis confirmed the absence of intermetallic phase transformation.
Ion beam synthesis of CoSi2 layers in Si by MEVVA (Metal Vapor Vacuum Arc) implantation has been performed under various conditions. The formation and characteristics of these CoSi2 layers have been studied by XTEM, RBS, AFM, X-ray diffraction, ellipsometry, electrical and Hall effect measurements. It was found that a higher substrate temperature during implantation results in an as-implanted Co distribution closer to the surface and hence the formation of a shallower CoSi2 layer after annealing. Buried CoSi2 layers of good crystal quality and low resistivity CoSi2 can be formed by MEVVA implantation and annealing under appropriate conditions. A strong temperature dependence of the Hall coefficient showing a large peak at around 100K was observed for the CoSi2 layers formed in p-type Si substrates but not in n-type substrates. The properties and their dependence on the processing conditions, in particular, the substrate temperature during implantation, are presented and discussed.
Ion beam synthesis of CoSi2 layers in Si by NIEVVA (Metal Vapor Vacuum Arc) implantation has been performed under various conditions. The formation and characteristics of these CoSi2 layers have been studied by XTEM, RBS, AFM, X-ray diffraction, ellipsometry, electrical and Hall effect measurements. It was found that a higher substrate temperature during implantation results in an as-implanted Co distribution closer to the surface and hence the formation of a shallower CoSi2 layer after annealing. Buried CoSi2 layers of good crystal quality and low resistivity CoSi2 can be formed by MEVVA implantation and annealing under appropriate conditions. A strong temperature dependence of the Hall coefficient showing a large peak at around 100K was observed for the CoSi2 layers formed in p-type Si substrates but not in n-type substrates. The properties and their dependence on the processing conditions, in particular, the substrate temperature during implantation, are presented and discussed.
There is limited information relating Ca intake to bone and height acquisition among Oriental children who consume little or even no milk. The present controlled study investigated the acquisition of bone mass and height of Chinese children with an initial Ca intake of approximately 567 mg/d who were supplemented to about 800 mg/d. Eighty-four 7-year-old Hong Kong Chinese children underwent an 18-month randomized, double-blind, controlled Ca-supplementation trial. The children were randomized to receive either 300 mg elemental Ca or a placebo tablet daily. Bone mass of the distal one-third radius was measured by single-photon absorptiometry, lumbar spine and femoral neck were determined using dual-energy X-ray absorptiometry. Measurements were repeated 6-monthly. Baseline serum 25-hydroxycholecalciferol concentration and physical activity were also assessed. Baseline Ca intakes of the study group and controls were respectively 571 (SD 326) and 563 (SD 337) mg/d. There were no significant differences in baseline serum 25-hydroxycholecalciferol concentration (P = 0·71) and physical activity (P = 0·36) between the study and control groups. After 18 months the study group had significantly greater increases in lumbar-spinal bone mineral content (20·9 v. 16. 34%; P = 0·035), lumbar-spinal area (11·16 v. 8·71%; P = 0middot;049), and a moderately greater increment in areal bone mineral density of the radius (7·74 0·600%; P = 0.081) when compared with the controls. The results confirm a positive effect of Ca on bone mass of the spine and radius but no effects on femoral-neck and height increase. A longer trial is warranted to confirm a positive Ca effect during childhood that may modify future peak bone mass.
A double-blind controlled Ca supplementation trial was conducted for 6 months in thirty-four 7-year-old Chinese children from Hongkong and Jiangmen, China. The children were randomly allocated to the study group (n 17) or control group (n 17), and a CaCO3 tablet (300 mg Ca) or a placebo tablet was taken daily. True fractional Ca absorption (TFCA) was evaluated before and after the trial using stable isotopes: 8 mg44Ca mixed in 100 g chocolate milk was given after an intravenous injection of 0·75 mg 42Ca. There was no significant difference in baseline TFCA between the study group (60·6 (SD 11·4)%) and the controls (58·2 (SD 9.0)% P = 0·55). Serum 25-hydroxycholecalciferol levels were comparable between the two groups (P = 0·71). After 6 months, TFCA of the study group (55·6 (SD 12·7)%) was significantly lower than that of the controls (64·3 (SD 10·7)% P = 0·015). By comparing the individual changes in TFCA after the trial between the two groups there was a non-significant reduction in TFCA (5·03 (SD 12·4)% P = 0·11, Wilcoxon signed-rank test) in the study group (60·6–55·6%), whereas a significant increase in TFCA (6·17(SD 7·7)% P = 0·004, Wilcoxon signed-rank test) was observed in the controls (58·2–64·3%). The differential in TFCA between the two groups after 6 months was significantly different (P = 0·001), and remained significant after adjustment for baseline dietary intakes, weight and height by multiple-regression analysis (P = 0·003). If the mechanism of TFCA from chocolate milk in response to the treatment effects is similar to that from the total diet, then our results suggest that children with adequate vitamin D status can adapt to a change in Ca intake by adjusting the efficiency of TFCA. In corollary, children on habitually-low Ca diets have a higher TFCA than the counterparts with higher Ca diets.
Photoelastic optical waveguides using strain-compensated InAsP/InGaP multiplequantum-well (MQW) have been fabricated. Lateral light confinement for waveguiding is achieved by introducing stress into semiconductor heterostructures with stable WNi surface stressor stripes. The waveguides have been characterized at both 1.52 μm and 1.32 μm wavelength in term of TE/TM intensity ratio. At 1.52 μm, the waveguides favor the propagation of TE mode, and the TE/TM intensity ratio can be as large as 15 dB. At 1.32 μm, the TE and TM intensity can be comparable. Anisotropy of waveguides fabricated along  or  directions has also been observed in term of TE/TM intensity ratio, which suggests the presence of anisotropic property of the strain-compensated MQW.