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On February 6, 2018, a 6.0 magnitude earthquake struck Hualien, a county of East Taiwan. Hualien Tzu Chi Hospital, the only tertiary hospital in East Taiwan, activated the mass casualty incident (MCI) call and received 144 patients that night. Our operation did not perform satisfactorily despite regular MCI drills. Thus, a new strategy to cope with the increasing frequency of disaster-related MCIs was developed.
To facilitate the management of disaster-related MCIs, we developed a novel Disaster Response System which includes a triage system combining Simple Triage and Rapid Treatment (START) and Five-Level Taiwan Triage and Acuity Scale (TTAS), a novel registration system for MCIs, and anonymous patient identification and reporting system.
We begin the triage with the START method and then shift to the TTAS. The new registration system only needs the patient’s gender, age, and triage category. Patients are then assigned to different treatment areas accordingly. Further dispositions are applied after initial stabilization management. To identify the anonymous disaster victims, we take photographs of victims after clean-up and display them on an electronic bulletin with the patient list to the families in our emergency department. Real-time casualty statistics are collected automatically and synchronized to the governmental administrative system.
This novel Disaster Response System reduces the time from patient arrival to definite treatment and disposition in a simulated mass casualty incident exercise. The victim identification bulletin provides clear information to those who are seeking their family, and thus, avoids the chaos of the scene.
From the experience of the earthquake-related MCI, we found that inadequate training causes time mis-triage and treatment delays. Our Disaster Response System facilitates the workflow with an easily practiced algorithm, reveals on-time and easily accessible information to the public, and altogether improves our MCI management.
In this paper, we make the case that an argument for price-level targeting over inflation targeting need not to be based on some overly restrictive assumptions. We adopt a theoretical framework that deviates from the assumption of rational expectation, and that takes into account the cognitive limitations and a “trial and error” learning mechanism of the agents. The (im)perfect credibility of various monetary policies (e.g., a Taylor-type rule, strict domestic inflation targeting, strict consumer price index (CPI) inflation targeting, exchange rate peg, and domestic price-level and CPI-level targeting) may lead agents to react according to their expectation rules, and then create various degrees of booms and busts in output and inflation. Therefore, relaxing the rational expectation hypothesis has potential consequences for policy planning. We find that price-level targeting prevails over inflation targeting even under different expectation formation and even when the announced inflation target is not fully credible. The counterfactual analysis and sensitivity test confirm that CPI-level targeting is the most effective for improving social welfare and stability in an open economy. The business cycles induced by animal spirits are enhanced by strict inflation targeting.
There is increasing evidence for shared genetic susceptibility between schizophrenia and bipolar disorder. Although genetic variants only convey subtle increases in risk individually, their combination into a polygenic risk score constitutes a strong disease predictor.
To investigate whether schizophrenia and bipolar disorder polygenic risk scores can distinguish people with broadly defined psychosis and their unaffected relatives from controls.
Using the latest Psychiatric Genomics Consortium data, we calculated schizophrenia and bipolar disorder polygenic risk scores for 1168 people with psychosis, 552 unaffected relatives and 1472 controls.
Patients with broadly defined psychosis had dramatic increases in schizophrenia and bipolar polygenic risk scores, as did their relatives, albeit to a lesser degree. However, the accuracy of predictive models was modest.
Although polygenic risk scores are not ready for clinical use, it is hoped that as they are refined they could help towards risk reduction advice and early interventions for psychosis.
Declaration of interest
R.M.M. has received honoraria for lectures from Janssen, Lundbeck, Lilly, Otsuka and Sunovian.
Background: Parkinson’s disease (PD) is a degenerative disorder of the central nervous system mainly affecting the motor system. Presently, there is no effective and safe drug to treat patients with PD. Ginkgo biloba extract (GBE), obtained from leaves of the Ginkgo biloba tree, is a complex mixture of ingredients primarily containing two active components: flavonoids and terpenoids. In this study, we investigated the effects of GBE on A53T α-synuclein transgenic mice, a PD model that has better simulated the progression of PD patients than other models such as the 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine–induced PD model. Methods: Fifty α-synuclein A53T transgenic mice were fed and treated with GBE, and locomotor activity was detected by pole test, forced swim test, and wire-hang test. The expression of tyrosine hydroxylase and dopamine transporters was detected using immunohistochemistry. Superoxide dismutase activity, glutathione peroxidase activity, and malondialdehyde expression were detected using an assay kit. Results: Our results show that GBE treatment improved locomotor activity and that superoxide dismutase and glutathione peroxidase inhibited the expression of methane dicarboxylic aldehyde and recovered the expression of tyrosine hydroxylase and dopamine transporters. Conclusions: The GBE treatment improved locomotor activity and inhibited the development of PD in the A53T α-synuclein transgenic mice, which may be partly responsible for decreased oxidative damage and maintain the normal dopamine homeostasis.
Previous studies have indicated that there is dopamine transporter (DAT) dysregulation and P300 abnormality in adults with attention-deficit hyperactivity disorder (ADHD); however, the correlations among the three have not been fully explored.
A total of 11 adults (9 males and 2 females) with ADHD and 11 age-, sex-, and education-level-matched controls were recruited. We explored differences in DAT availability using single-photon emission computed tomography and P300 wave of event-related potentials between the two groups. The correlation between DAT availability and P300 performance was also examined.
DAT availability in the basal ganglia, caudate nucleus, and putamen was significantly lower in the ADHD group. Adults with ADHD had lower auditory P300 amplitudes at the Pz and Cz sites, as well as longer Fz latency than controls. DAT availability was negatively correlated to P300 latency at Pz and Fz.
Adults with ADHD had both abnormal DAT availability and P300 amplitude, suggesting that ADHD is linked to dysfunction of the central dopaminergic system and poor cognitive processes related to response selection and execution.
This study aimed to investigate the impacts of dietary threonine on intestinal immunity and inflammation in juvenile grass carp. Six iso-nitrogenous semi-purified diets containing graded levels of threonine (3·99–21·66 g threonine/kg) were formulated and fed to fishes for 8 weeks, and then challenged with Aeromonas hydrophila for 14 d. Results showed that, compared with optimum threonine supplementation, threonine deficiency (1) decreased the ability of fish against enteritis, intestinal lysozyme activities (except in the distal intestine), acid phosphatase activities, complement 3 (C3) and C4 contents and IgM contents (except in the proximal intestine (PI)), and it down-regulated the transcript abundances of liver-expressed antimicrobial peptide (LEAP)-2A, LEAP-2B, hepcidin, IgZ, IgM and β-defensin1 (except in the PI) (P<0·05); (2) could up-regulate intestinal pro-inflammatory cytokines TNF-α, IL-1β, IL-6, IL-8 and IL-17D mRNA levels partly related to NF-κB signalling; (3) could down-regulate intestinal anti-inflammatory cytokine transforming growth factor (TGF)-β1, TGF-β2, IL-4/13A (not IL-4/13B) and IL-10 mRNA levels partly by target of rapamycin signalling. Finally, on the basis of the specific growth rate, against the enteritis morbidity and IgM contents, the optimum threonine requirements were estimated to be 14·53 g threonine/kg diet (4·48 g threonine/100 g protein), 15.05 g threonine/kg diet (4·64 g threonine/100 g protein) and 15·17 g threonine/kg diet (4·68 g threonine/100 g protein), respectively.
In indirect-drive inertial confinement fusion, the radiation symmetry must be controlled for the achievement of hotspot ignition. The radiation symmetry is of great importance. In this paper, we investigate the drive asymmetry of the M-band (2–5 keV) radiation emitted from an Au holhraum wall by using the three-dimensional view-factor code IRAD3D. Analysis of the M-band flux drive at the Shenguang-III laser facility shows that it is asymmetric and that the asymmetry varies with time. For a given cross section over the pole, the initial M-band flux asymmetries are P2 = 11.59, P4 = 1.41, and P6 = −0.64%. When the asymmetries are artificially added to a symmetric radiation drive, the position of the deuterium-tritium (DT) ice/gas interface is asymmetric for a National Ignition Facility capsule in 1D simulation. This means that M-band flux asymmetry can lead to implosion asymmetry even if the total radiation is symmetric. Pure CH and Si-doped CH capsules are considered. The results show that a mid-Z dopant can partly reduce the asymmetry. However, the asymmetry is still very large. Thus, it is necessary to study the M-band flux asymmetry and its influence on the implosion symmetry.
The present study investigated the effects of dietary vitamin A on immune function in the proximal intestine (PI), mid intestine (MI) and distal intestine (DI) of young grass carp (Ctenopharyngodon idella). Fish were fed graded levels of dietary vitamin A for 10 weeks, and then a challenge test using an injection of Aeromonas hydrophila was conducted for 14 d. The results showed that, compared with the optimum vitamin A level, vitamin A deficiency significantly decreased fish growth performance, increased enteritis morbidity, decreased intestinal innate humoral immune response and aggravated intestinal inflammation. However, liver-expressed antimicrobial peptide 2A/B mRNA in the DI and IL-6, IL-17D, IL-10, transforming growth factor (TGF)-β1 and TGF-β2 mRNA in the PI were not affected by vitamin A levels. Meanwhile, vitamin A deficiency disturbed inflammatory cytokines in the PI, MI and DI, which might be partly linked to p38 mitogen-activated protein kinase (p38MAPK) signalling and NF-κB canonical signalling pathway (IκB kinase β (IKKβ), IKKγ, inhibitor of κBα, NF-κB p65 and c-Rel) rather than NF-κB non-canonical signalling pathway (NF-κB p52 and IKKα). However, the signalling molecules NF-κB p65 and p38MAPK did not participate in regulating cytokines in the PI. These results suggested that vitamin A deficiency decreased fish growth and impaired intestinal immune function, and that different immune responses in the PI, MI and DI were mediated partly by NF-κB canonical signalling and p38MAPK signalling pathways. On the basis of percentage of weight gain, to protect fish against enteritis morbidity and acid phosphatase activity, the optimum dietary vitamin A levels were estimated to be 0·664, 0·707 and 0·722 mg /kg, respectively.
Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated.
DESIGN, SETTING, AND PARTICIPANTS
A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University—Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled.
Surgical hand cleansing with conventional 10% povidone–iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol).
Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count.
Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone–iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable.
This study investigated the effects of glycinin on the growth, intestinal oxidative status, tight junction components, cytokines and apoptosis signalling factors of fish. The results showed that an 80 g/kg diet of glycinin exposure for 42 d caused poor growth performance and depressed intestinal growth and function of juvenile Jian carp (Cyprinus carpio var. Jian). Meanwhile, dietary glycinin exposure induced increases in lipid peroxidation and protein oxidation; it caused reductions in superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx) activities; and it increased MnSOD, CuZnSOD, GPx1b and GPx4a mRNA levels, suggesting an adaptive mechanism against stress in the intestines of fish. However, dietary glycinin exposure decreased both the activity and mRNA levels of nine isoforms of glutathione-S-transferase (GST) (α, μ, π, ρ, θ, κ, mGST1, mGST2 and mGST3), indicating toxicity to this enzyme activity and corresponding isoform gene expressions. In addition, glycinin exposure caused partial disruption of intestinal cell–cell tight junction components, disturbances of cytokines and induced apoptosis signalling in the distal intestines>mid intestines>proximal intestines of fish. Glycinin exposure also disturbed the mRNA levels of intestinal-related signalling factors Nrf2, Keap1a, Keap1b, eleven isoforms of protein kinase C and target of rapamycin/4E-BP. Interestingly, glutamine was observed to partially block those negative influences. In conclusion, this study indicates that dietary glycinin exposure causes intestinal oxidative damage and disruption of intestinal physical barriers and functions and reduces fish growth, but glutamine can reverse those negative effects in fish. This study provides some information on the mechanism of glycinin-induced negative effects.
We propose a new Adomian decomposition method (ADM) using an integrating factor for the Emden–Fowler equation. With this method, we are able to solve certain Emden–Fowler equations for which the traditional ADM fails. Numerical results obtained from testing our linear and nonlinear models are far more reliable and efficient than those from existing methods. We also present a complete error analysis and a convergence criterion for this method. One drawback of the traditional ADM is that the interval of convergence of the Adomian truncated series is very small. Some techniques, such as Pade approximants, can enlarge this interval, but they are too complicated. Here, we use a continuation technique to extend our method to a larger interval.
A radio-frequency magnetron sputtering technique and subsequent rapid thermal annealing (RTA) at 600, 700, 800, and 900 °C were implemented to grow high-quality Ga-doped MgxZn1-xO (GMZO) epi-layers. The GMZO films were deposited using a radio-frequency magnetron sputtering system and a 4 inch ZnO/MgO/Ga2O3 (75/20/5 wt %) target. The Hall results, X-ray diffraction (XRD), and transmittance were determined and are reported in this paper. The Hall results indicated that the increase in mobility was likely caused by the improved crystallization in the GMZO films after thermal annealing. The XRD results revealed that MgxZn1-xO (111) and MgO2 (200) peaks were obtained in the GMZO films. The absorption edges of the as-grown and annealed GMZO films shifted toward the short wavelength of 373 nm at a transmittance of 90%. According to these results, GMZO films are feasible for forming transparent contact layers for near-ultraviolet light-emitting diodes.
The cardioprotective effects of HDL have been largely attributed to their role in the reverse cholesterol transport pathway, whose efficiency is affected by many proteins involved in the formation and remodelling of HDL. The aim of the present study was to determine the effects, and possible mechanisms of action, of unsaturated fatty acids on the expression of genes involved in HDL metabolism in HepG2 cells. The mRNA concentration of target genes was assessed by real-time PCR. Protein concentrations were determined by Western blot or immunoassays. PPAR and liver X receptor (LXR) activities were assessed in transfection experiments. Compared with the SFA palmitic acid (PA), the PUFA arachidonic acid (AA), EPA and DHA significantly decreased apoA-I, ATP-binding cassette A1 (ABCA1), lecithin-cholesterol acyltransferase (LCAT) and phospholipid transfer protein mRNA levels. EPA and DHA significantly lowered the protein concentration of apoA-I and LCAT in the media, as well as the cellular ABCA1 protein content. In addition, DHA repressed the apoA-I promoter activity. AA lowered only the protein concentration of LCAT in the media. The activity of PPAR was increased by DHA, while the activity of LXR was lowered by both DHA and AA, relative to PA. The regulation of these transcription factors by PUFA may explain some of the PUFA effects on gene expression. The observed n-3 PUFA-mediated changes in gene expression are predicted to reduce the rate of HDL particle formation and maturation.
The present study was conducted to test the hypothesis that dietary arginine promotes digestion and absorption capacity, and, thus, enhances fish growth. This improvement might be related to the target of rapamycin (TOR) and eIF4E-binding protein (4E-BP). A total of 1200 juvenile Jian carp, Cyprinus carpio var. Jian, with an average initial weight of 6·33 (se 0·03) g, were fed with diets containing graded concentrations of arginine, namely, 9·8 (control), 12·7, 16·1, 18·5, 21·9 and 24·5 g arginine/kg diet for 9 weeks. An real-time quantitative PCR analysis was performed to determine the relative expression of TOR and 4E-BP in fish muscle, hepatopancreas and intestine. Dietary arginine increased (P < 0·05): (1) glutamate-oxaloacetate transaminase and glutamate-pyruvate transaminase activities in muscle and hepatopancreas; (2) intestine and hepatopancreas protein content, folds height, and trypsin, chymotrypsin, lipase, Na+/K+-ATPase, alkaline phosphatase, γ-glutamyl transpeptidase and creatine kinase activities in intestine; (3) Lactobacillus counts; (4) relative expression of TOR in the muscle, hepatopancreas and distal intestine (DI); (5) relative expression of 4E-BP in proximal intestine (PI) and mid-intestine (MI), as compared with the control group. In contrast, dietary arginine reduced (P < 0·05): (1) plasma ammonia content; (2) Aeromonas hydrophila and Escherichia coli counts; (3) relative expression of TOR in PI and MI; (4) relative expression of 4E-BP in the muscle, hepatopancreas and DI. The arginine requirement estimated by specific growth rate using quadratic regression analysis was found to be 18·0 g/kg diet. These results indicate that arginine improved fish growth, digestive and absorptive ability and regulated the expression of TOR and 4E-BP genes.
Magnetite nanoparticles have been synthesized by thermal decomposition of hematite (Fe2O3) powder in the presence of high boiling point solvent. The mixture of hematite and 1- octadecene solvent was heated and stirred in nitrogen gas at the temperature of 320 °C for the desired time (∼2 to 28 hrs). The influence of the reaction time on transformation process was analyzed with X-ray diffraction (XRD), Mössbauer spectroscopy (MS), and magnetic measurements. XRD patterns show that the phase of intermediate was composed of spinel phase and corundum phase (α-Fe2O3). The 57Fe Mössbauer spectra show that the spinel phase originated from the magnetite particles. The structure transformation proportion of hematite to magnetite strongly depends on reaction times. After reflux for 28 hrs the hematite-magnetite transformation was complete. The mean crystallite size of pure phase of magnetite particles is about 40 nm. The saturation magnetization increases with the reaction time, which corresponds to an increase of concentration of magnetite in the samples. A pronounced feature of the Hc and σr/σs observed in samples is the steplike change which appears at 125 K and is characteristic of the Verwey transition. The hyperfine parameters of Mössbauer spectrum measured at low temperature also indicate that the Verwey phase transition occurs. In other words, the Verwey transition is an indication that the magnetite particles exactly grew up in the synthesized compounds. This thermal decomposition process provided a method to prepare pure magnetite as well as magnetite/hematite nanocomposites useful for various magnetic applications.
Tensile fatigue behavior of a hot-isostatically-pressed (HIPed) silicon nitride was investigated over ranges of constant stresses, constant stress rates, and cyclic loading at 1150-1370°C. At 1150°C, static and dynamic fatigue failures were governed by a slow crack growth mechanism. Creep rupture was the dominant failure mechanism in static fatigue at 1260 and 1370°C. A transition of failure mechanism from slow crack growth to creep rupture appeared at stress rates ≤10−2 MPa/s for dynamic fatigue at 1260 and 1370°C. At 1 150-1370°C, cyclic loading appeared to be less damaging than static loading as cyclic fatigue specimens displayed greater failure times than static fatigue specimens under the same maximum stresses.
The carbon nanotubes provide large surface that can enhance the gas adsorption properties and increase the conductivity at a lower temperature for gas sensing. The gas sensing properties of the hybrid TiO2/CNTs material are examined in this study. The sol-gel technique is used to prepare a thin layer of nano-TiO2 coated on CNTs. The structure of TiO2/CNTs hybrid materials is identified by X-ray diffraction (XRD) and Raman spectrum. The granules and surface morphology are analyzed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The electrical properties of the hybrid TiO2/CNTs indicate that the operation temperature can be lowered to ambient temperature and this will enhance the gas sensitivity for detecting CO gas. The n-type or p-type behavior of hybrid TiO2/CNTs can be controlled by the coating thickness of hybrid TiO2. According to the image results, the mechanisms of the n-type and p-type behavior of hybrid TiO2/CNTs system are proposed.
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.
Biomaterials such as DNA are currently being explored as potential application in nanotechnology. DNA templates were immobilized on crystal-violet-treated mica by spin coating as a grid-like network. The DNA templates were then activated with PdCl2, followed by reduction with dimethylamine borane (DMAB) to form seeding nanoclusters on the DNA chain. Afterward the DNA chain with deposition of zero-valence Pd nanoclusters was grew in a Co electroless plating bath. SEM/EDS analysis revealed that Co nanoparticles could be assembled on the DNA template to form magnetic nanowires with a diameter of 25nm to 250nm by a conventional electroless plating. Vibrating Sample Magnetometer analysis indicated that Co-DNA nanowires showed a paramagnetic characteristic. Grid-like networks of DNA template were effectively preserved after Co electroless plating. These characteristics indicated that DNA is an ideal template for the production of magnetic nanowires, which could be useful in the development of high-density memory storage or magnetic field sensors.