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To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalized anxiety disorder (GAD).
170 patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale (HAMD), the Severity Subscale of Clinical Global Impression Scale (CGI-S), Global Assessment Function (GAF), and the 12-item Short-Form Health Survey (SF-12). Assessments were conducted at baseline, 4-weeks, 8-weeks and 3-monthsfollow-up.
At 4-weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen d=0.90) and remission rates (GCBT group 21.5%vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36-0.77) showed that the combined therapy was superior. At 8-weeks, all the primary and secondary significant differences found at 4-weeks were maintained with smaller effect sizes (p<0.05, d=0.32-0.48) . At 3-months follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates (OR=2.12, 95% CI 1.02-4.42, p=0.04); and remission rates (OR=2.80, 95% CI 1.27-6.16, p=0.01).
Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest GCBT was effective in changing cognitive style.
We aimed to investigate the association between plasma retinol and incident cancer among Chinese hypertensive adults. We conducted a nested case–control study, including 231 patients with incident cancer and 231 matched controls during a median 4·5-year follow-up of the China Stroke Primary Prevention Trial. There was a significant, inverse association between retinol levels and digestive system cancer (per 10 μg/dl increases: OR 0·79; 95 % CI 0·69, 0·91). When compared with participants in the first quartile of retinol (< 52·3 μg/dl), a significantly lower cancer risk was found in participants in quartile 2–4 ( ≥ 52·3 μg/dl: OR 0·31; 95 % CI 0·13, 0·71). However, there was a U-shaped association between retinol levels and non-digestive system cancers where the risk of cancers decreased (although not significantly) with each increment of plasma retinol (per 10 μg/dl increases: OR 0·89; 95 % CI 0·60, 1·31) in participants with retinol < 68·2 μg/dl, and then increased significantly with retinol (per 10 μg/dl increase: OR 1·65; 95 % CI 1·12, 2·44) in participants with retinol ≥ 68·2 μg/dl. In conclusion, there was a significant inverse dose–response association between plasma retinol and the risk of digestive system cancers. However, a U-shaped association was observed between plasma retinol and the risk of non-digestive cancers (with a turning point approximately 68·2 μg/dl).
Indicators are used as a benchmark for the quality of disaster response. Desirable attributes of indicators include precision, clear definition, improvement opportunity, unbiased, flexibility, and validity. Due to a lack of universally acceptable, objective indicators, it is currently difficult to gauge improvements in mass casualty preparedness within a hospital.
To describe existing indicators relevant to hospital disaster response, and to explore the use of two new indicators (decanting and chain of command).
A structured literature search in indexed databases was used to identify articles related to the measurement of hospital performance in mass casualties using a matrix technique and snowballing. Relevant websites of disaster management organizations were also reviewed and local disaster management experts were interviewed. Proposed indicators were compared against attributes and some (triage time by category, notification time, time to adequate staff response, preventable deaths, decanting times and chain of command for intensive care unit, and emergency department) were tested and measured in two exercises involving more than 90 staff each, held at two Southeast Queensland hospitals in 2017 and 2018.
Over 50 proposed indicators, including indicators within large sets, were identified. Measurement of some indicators was found to be highly subjective. The decanting and chain-of-command indicators emerged as most useful. Intensive Care Unit required 40 mins to decant beds by 50%, while ED required 25 mins to decant beds by 80%. With regards to the chain of command, ED and triage staff performed best, with 66.7% correctly identifying their immediate supervisor. Overall, staff members were able to correctly identify immediate supervisor better compared to team leaders (59.3% and 40% respectively).
There is a need to narrow down, simplify, and objectify indicators for mass casualty performance. Baseline measurements from actual disasters will provide important comparative data.
World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.
This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.
Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.
Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (p<.001) increases in self-confidence, skills, and knowledge (point increases on a five-point Likert scale (95% confidence intervals): 0.8 (0.6-0.9) for confidence and 0.4 (0.2-0.5) for both skills and knowledge. The exercise was critically appraised and a summary of operational learnings was developed. The most common criticism of ETS was its lack of real patients.
Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.
There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder.
Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months.
Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up.
Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.
In 2007, Taiwan began conducting health technology assessments (HTA) to support the National Health Insurance Administration (NHIA) in its reimbursement decisions for drugs, medical devices, and medical services.
In this study, the development, missions, and procedures of the implementation of HTA in Taiwan are briefly introduced. Moreover, the value of HTA is examined by reviewing the outcomes and impacts of recent HTA-related research projects, which are classified into five categories: (i) pharmaceutical products, (ii) medical procedures, (iii) medical devices, (iv) health policy, and (v) social care.
Overall, the 10-year implementation of HTA has not only supported the government's decision making but also enhanced patient care. Furthermore, patient evidence has been highlighted, and patient care pathways have been transformed through patient involvement in HTA.
In conclusion, HTA's value has been determined by both government and social aspects in Taiwan.
Staminodes are sterile stamens that produce no pollen, exhibit diverse structures and perform various functions. Flowers of Phanera yunnanensis possess three fertile stamens with large anthers and long filaments, and seven staminodes with tiny anthers and short filaments. To investigate the adaptive significance of staminodes in this species, we studied effects of staminode removal on pollen removal and deposition, flower visitation rate and fruit set in Xishuangbanna, south-western China. Four species of nectar-foraging pollinators visited flowers, mostly Amegilla zonata and Apis cerana (2.80 ± 0.15 and 1.76 ± 0.41 visits h−1 per flower, respectively). Staminode removal did not affect fruit set, but increased visitation by A. cerana by 2.6-fold, reduced visitation by A. zonata by 68% and increased the pollen removal rate for both pollinators (all effects were significant). Staminode removal significantly reduced pollen deposition rate for A. zonata, but not for A. cerana. These results suggest that the staminodes of P. yunnanensis filter which insects act as pollinators and affect pollen removal and deposition rates. By reducing pollen removal rates, staminodes may implement a pollen-dispensing schedule that spreads pollen dispersal from individual flowers over multiple pollinators. By altering pollen deposition rates, staminodes may influence reproductive fitness in other ways.
Assembly optimization of printed circuit boards (PCBs) has received considerable research attention because of efforts to improve productivity. Researchers have simplified complexities associated with PCB assembly; however, they have overlooked hardware constraints, such as pick-and-place restrictions and simultaneous pickup restrictions. In this study, a hybrid group search optimizer (HGSO) was proposed. Assembly optimization of PCBs for a multihead placement machine is segmented into three problems: the (1) auto nozzle changer (ANC) assembly problem, (2) nozzle setup problem, and (3) component pick-and-place sequence problem. The proposed HGSO proportionally applies a modified group search optimizer (MGSO), random-key integer programming, and assigned number of nozzles to an ANC to solve the component picking problem and minimize the number of nozzle changes, and the place order is treated as a traveling salesman problem. Nearest neighbor search is used to generate an initial place order, which is then improved using a 2-opt method, where chaos local search and a population manager improve efficiency and population diversity to minimize total assembly time. To evaluate the performance of the proposed HGSO, real-time PCB data from a plant were examined and compared with data obtained by an onsite engineer and from other related studies. The results revealed that the proposed HGSO has the lowest total assembly time, and it can be widely employed in general multihead placement machines.
Propofol is a intravenous anaesthetic most commonly used in ultrasound oocyte retrieval. We studied if the use of propofol had an effect on mouse oocyte maturation, pregnancy, childbirth and progeny and investigated the correlation between propofol side effects and reproductive performance in mice. There was no statistical difference in mating, pregnancy, childbirth, litter size, the number of stillbirths and survival between each group (P>0.05). Propofol also had no effect on polar body extrusion in oocyte maturation as well as on pronucleus formation and, subsequently, early embryo development (P>0.05). An increased concentration of propofol had no effect on this result, although propofol at more than 0.01 mg/ml reduced polar body extrusion. Different concentrations of propofol had no effect on oocyte culture in vitro, pronucleus formation and early embryo development.
Mastery of strengthening strategies to achieve high-capacity anodes for lithium-ion batteries can shed light on understanding the nature of diffusion-induced stress and offer an approach to use submicro-sized materials with an ultrahigh capacity for large-scale batteries. Here, we report solute strengthening in a series of silicon (Si)–germanium (Ge) alloys. When the larger solute atom (Ge) is added to the solvent atoms (Si), a compressive stress is generated in the vicinity of Ge atoms. This local stress field interacts with resident dislocations and subsequently impedes their motion to increase the yield stress in the alloys. The addition of Ge into Si substantially improves the capacity retention, particularly in Si0.50Ge0.50, aligning with literature reports that the Si/Ge alloy showed a maximum yield stress in Si0.50Ge0.50. In situ X-ray diffraction studies on the Si0.50Ge0.50 electrode show that the phase change undergoes three subsequent steps during the lithiation process: removal of surface oxide layer, formation of cluster-size Lix(Si,Ge), and formation of crystalline Li15(Si,Ge)4. Furthermore, the lithiation process starts from higher index facets, i.e., (220) and (311), then through the low index facet (111), suggesting the orientation-dependence of the lithiation process in the Si0.50Ge0.50 electrode.
Apathy is a condition characterized by a lack of motivation that manifests in emotional, behavioral, and cognitive domains. Although previous studies have indicated that apathy is associated with frontal lesions, few studies have focused on the different subdomains of apathy, and no in vivo human biochemical data have been obtained to examine the neurochemical changes related to apathy in patients with Alzheimer's disease (AD). Thus, we investigated the frontal neurochemical alterations related to apathy among patients with AD using proton magnetic resonance spectroscopy (1H MRS).
Apathy was assessed through the Apathy Evaluation Scale (AES). 1H MRS was performed to measure neurochemical metabolite levels in the anterior cingulate region and right orbitofrontal region. Associations between neurochemical metabolites and the total score and subscores of each domain of the AES were analyzed.
Altogether, 36 patients completed the study. Patients with lower N-acetylaspartate/creatine ratios (NAA/Cr) in the anterior cingulate region demonstrated higher total apathy scores (β = −0.56, p = 0.003) with adjustments for age, gender, educational level, dementia severity, and depression severity. In a further analysis, a lower NAA/Cr in the anterior cingulate region was associated with all subdomains of apathy, including cognition (β = −0.43, p = 0.028), behavior (β = −0.55, p = 0.002), and emotion (β = −0.50, p = 0.005). No statistically significant associations were discovered in the right orbitofrontal region.
Our results suggest that apathy, in each of its cognitive, behavioral, or emotional subdomains is associated with brain neurochemical alterations in the anterior cingulate region. Abnormal neuronal integrity over the anterior cingulate cortex may exhibit a central role in causing all aspects of apathy in patients with AD.
To examine and quantify the potential dose–response relationship between green tea intake and the risk of gastric cancer.
We searched PubMed, EMBASE, Web of Science, CBM, CNKI and VIP up to December 2015 without language restrictions.
A systematic review and dose–response meta-analysis of observational studies.
Five cohort studies and eight case–control studies.
Compared with the lowest level of green tea intake, the pooled relative risk (95 % CI) of gastric cancer was 1·05 (0·90, 1·21, I2=20·3 %) for the cohort studies and the pooled OR (95 % CI) was 0·84 (0·74, 0·95, I2=48·3 %) for the case–control studies. The pooled relative risk of gastric cancer was 0·79 (0·63, 0·97, I2=63·8 %) for intake of 6 cups green tea/d, 0·59 (0·42, 0·82, I2=1·0 %) for 25 years of green tea intake and 7·60 (1·67, 34·60, I2=86·5 %) for drinking very hot green tea.
Drinking green tea has a certain preventive effect on reducing the risk of gastric cancer, particularly for long-term and high-dose consumption. Drinking too high-temperature green tea may increase the risk of gastric cancer, but it is still unclear whether high-temperature green tea is a risk factor for gastric cancer. Further studies should be performed to obtain more detailed results, including other gastric cancer risk factors such as smoking and alcohol consumption and the dose of the effective components in green tea, to provide more reliable evidence-based medical references for the relationship between green tea and gastric cancer.
To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.
A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.
One core theme emerged: “protective preparation.” This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.
Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.
Kawasaki disease, which is characterised by systemic vasculitides accompanied by acute fever, is regularly treated by intravenous immunoglobulin to avoid lesion formation in the coronary artery; however, the mechanism of intravenous immunoglobulin therapy is unclear. Hence, we aimed to analyse the global expression profile of serum exosomal proteins before and after administering intravenous immunoglobulin.
Two-dimensional electrophoresis coupled with mass spectrometry analysis was used to identify the differentially expressed proteome of serum exosomes in patients with Kawasaki disease before and after intravenous immunoglobulin therapy.
Our analysis revealed 69 differential protein spots in the Kawasaki disease group with changes larger than 1.5-fold and 59 differential ones in patients after intravenous immunoglobulin therapy compared with the control group. Gene ontology analysis revealed that the acute-phase response disappeared, the functions of the complement system and innate immune response were enhanced, and the antibacterial humoral response pathway of corticosteroids and cardioprotection emerged after administration of intravenous immunoglobulin. Further, we showed that complement C3 and apolipoprotein A-IV levels increased before and decreased after intravenous immunoglobulin therapy and that the insulin-like growth factor-binding protein complex acid labile subunit displayed reverse alteration before and after intravenous immunoglobulin therapy. These observations might be potential indicators of intravenous immunoglobulin function.
Our results show the differential proteomic profile of serum exosomes of patients with Kawasaki disease before and after intravenous immunoglobulin therapy, such as complement C3, apolipoprotein A-IV, and insulin-like growth factor-binding protein complex acid labile subunit. These results may be useful in the identification of markers for monitoring intravenous immunoglobulin therapy in patients with Kawasaki disease.
In Taiwan the discussion of civil society emerged in the 1980s and peaked in the early 1990s, when the society underwent political democratization. Civil society was considered a public sphere, enjoying relatively autonomy from the control of the state or the market. The birth of civil society in Taiwan came about by the proliferation of non-profit organizations, community organizations, and professional and voluntary groups through continuous social mobilization. Lawmaking was indispensable for the consolidation of civil society. New ordinances, ranging from human rights, environmental regulation to cultural preservation, were brought to the agenda. The emergence of civil society allowed people to leverage themselves from the control of the state and the market. In addition to this, the new Taiwanese identity that took shape in the 1990s reinforced the civil society that was in the making. However, across the turn of the millennium, as the state– society relationship reconfigured, civil society also differentiated. Both the market and the state tried to entrench civil society, which more often than not led to many different voices within civil society. Conflicts among various social groups have become a noticeable feature in the debates and decision-making processes of public affairs.
Against this backdrop we would like to trace the early history of the development of the idea of heritage preservation in Taiwan. The emergence of the heritage preservation movement and related policies is closely intertwined with the changing cultural politics that reflect the contested meanings of national and local identities in Taiwan. Before the lifting of martial law in 1987, civil society had played a significant role in heritagemaking. Since 1987, civil society has further pushed the state to change the laws and policies governing heritage preservation.
The first piece of legislation in this area, the Cultural Heritage Preservation Act, was promulgated in Taiwan in 1982, while the country was still under authoritarian rule. The implementation of the Heritage Act and associated cultural policies inevitably reflected the Chinese nationalist historical narrative; however, at the same time, it created negotiable spaces for diverse narratives through the imported notion of “cultural heritage”, which could be seen as an indirect challenge to the dominant narrative.
Do authoritarian governments always censor news about protests to prevent unrest from spreading? Existing research on authoritarian politics stresses the danger that information spread within the society poses for a regime. In particular, media and Internet reports of social unrest are deemed to threaten authoritarian rule, as such reports may incite more protests and thus spread instability. We show that such reasoning is incomplete if social protests are targeted at local officials. Allowing media the freedom to report local protests may indeed lead to protest diffusion, but the increased probability of citizen protest also has two potential benefits for the regime: (1) identifying and addressing more social grievances, thus releasing potential revolutionary pressure on the regime; (2) forcing local officials to reduce misbehavior, thus reducing underlying social grievances. For authoritarian governments whose survival is vulnerable to citizen grievances, allowing the media to report social protests aimed at local governments can therefore enhance regime stability and protect its interests under many circumstances. We construct a game-theoretic model to analyze the problem and illustrate the argument with examples from China.
X-ray powder diffraction data for piperaquine, C29H32Cl2N6, are reported [a = 15.8865(1) Å, b = 12.5975(3) Å, c = 13.2647(3) Å, β = 91.2890(1)°, unit-cell volume V = 2654.02 Å3, Z = 4, and space group P21/n]. All measured lines were indexed and are consistent with the P21/n space group. No detectable impurities were observed.
X-ray powder diffraction data for 5-Chloro-N-(4-nitrophenyl)pentanamide, C11H13ClN2O3, are reported [a = 8.036(4) Å, b = 15.972(5) Å, c = 9.829(5) Å, α = 90°, β = 104.227(2)°, γ = 90°, V = 1222.98 Å3, Z = 4, ρx = 1.3941 g cm−3 and space group P21/c]. All measured lines were indexed and are consistent with the P21/c space group. No detectable impurities were observed.
Two things distinguish Taiwan from other Asian countries regarding women's political representation: a high level of female political representation by Asian standards and an early implementation of quotas by global standards. Women constitute 33.6% in the country's parliament, second in Asia only to East Timor (38.5%). Taiwan has also achieved a higher level of women's parliamentary representation than Japan (8.1%), South Korea (15.7%), and Singapore (23%). Unlike other young democracies that adopted gender quotas in the 1990s or even later, Taiwan has had reserved seats for women since the early 1950s when the country was under authoritarian rule. Quota reforms were later instigated subsequent to Taiwan's democratization.
IL-27, a member of the IL-12 family, has been involved in maternal tolerance to the foetus and successful pregnancy. Growing evidences indicate that IL-27 plays a crucial role in pregnancy.
We carried out the present study in order to investigate whether polymorphisms in the IL27 are associated with the risk for CHDs, including atrial septal defect and ventricular septal defect.
Patients and methods
We conducted this case–control study among 247 atrial septal defect patients, 150 ventricular septal defect patients, and 368 healthy controls in a Chinese population using polymerase chain reaction-restriction fragment length polymorphism assay.
Significantly increased risk for atrial septal defect (p=0.001, OR=1.490, 95% CI=1.178–1.887) and ventricular septal defect (p=0.004, OR=1.502, 95% CI=1.139–1.976) was observed to be associated with the allele G of rs153109. In a dominant model, we have also observed that increased susceptibilities for atrial septal defect (p<0.01, OR=1.89, 95% CI=1.35–2.63) and ventricular septal defect (p<0.01, OR=2.50, 95% CI=1.67–3.85) were statistically associated with rs153109; however, no association was found between CHD risk and rs17855750 in the IL27 gene.
The 153109 of the IL27 gene may be associated with the susceptibility to CHD, including atrial septal defect and ventricular septal defect.