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Introduction: Atrial fibrillation (AF) is the most common arrhythmia treated in the emergency department (ED) and is associated with an increased risk of ischemic stroke. Studies have shown that only oral anticoagulant (OAC) therapy reduces risk of AF related stroke. Our objective was to measure the prescribing practices for OACs for new onset AF at a tertiary ED and two surrounding community EDs, and identify rates of adverse effects within 90 days. The findings of this study will provide quality assurance information for the management of patients with new onset AF. This information has the potential to promote adherence to prescribing guidelines for AF in the ED and the reduction of common adverse events such as ischemic stroke. Methods: We conducted a retrospective chart review of 385 patients with new onset AF who presented to the ED between November 2014 to Mach 2018. We defined new onset as symptoms <48 hours and had AF confirmed with electrocardiogram. We recorded the selected therapy choice of cardioversion and/or rate control, gender, age, and assessed CHADS-65 score. We recorded who was prescribed OAC and those who were referred to cardiology, family medicine, or did not have a documented follow up plan. Patients with a previous history of AF or current anticoagulant therapy were excluded. We recorded if any patients returned to the ED within 90 days with ischemic stroke, AF recurrence, myocardial infarction, other embolic disease or death. Results: 86 of 294 (29.5%) of patients who qualified under CHADS-65 received OACs appropriately. 64 of 66 (97.0%) of patients who did not qualify under CHADS-65 did not receive OACs appropriately. 5 patients overall returned within 90 days with ischemic stroke, 4 of those were not prescribed OACs, however this was not statistically significant (P = 0.999). Conclusion: This data suggests that physicians in the study are under-prescribing OACs relative to published guidelines. A larger study is necessary to elucidate the effect of ED OAC prescribing patterns on long-term patient outcome.
Here, we report that a marine sandworm Nereis virens jaw protein, Nvjp1, nucleates hemozoin with similar activity as the native parasite hemozoin protein, HisRPII. X-ray diffraction and scanning electron microscopy confirm the identity of the hemozoin produced from Nvjp1-containing reactions. Finally, we observed that nAl assembled with hemozoin from Nvjp1 reactions has a substantially higher energetic output when compared to analogous thermite from the synthetic standard or HisRPII-nucleated hemozoin. Our results demonstrate that a marine sandworm protein can nucleate malaria pigment and set the stage for engineering recombinant hemozoin production for nanoenergetic applications.
A program was developed to predict d-spacings and intensities for peaks of binary phases, using data of the stoichiometric compositions as a basis, and was extended for ternary systems. Predicted data were compared with results from a series of alloys in the Ni-Ru-Al system, spanning the system near 50 atomic % aluminum, to ascertain the extension of the RuAl and NiAl intermetallic compounds into the ternary system. The microstructures mainly appeared cored, and one sample was single phase.
The program enabled easy identification of the peaks, and also allowed comparison of experimental data with predicted ordered and random spectra.
Evidence suggests that autism and schizophrenia share similarities in genetic, neuropsychological and behavioural aspects. Although both disorders are associated with theory of mind (ToM) impairments, a few studies have directly compared ToM between autism patients and schizophrenia patients. This study aimed to investigate to what extent high-functioning autism patients and schizophrenia patients share and differ in ToM performance.
Thirty high-functioning autism patients, 30 schizophrenia patients and 30 healthy individuals were recruited. Participants were matched in age, gender and estimated intelligence quotient. The verbal-based Faux Pas Task and the visual-based Yoni Task were utilised to examine first- and higher-order, affective and cognitive ToM. The task/item difficulty of two paradigms was examined using mixed model analyses of variance (ANOVAs). Multiple ANOVAs and mixed model ANOVAs were used to examine group differences in ToM.
The Faux Pas Task was more difficult than the Yoni Task. High-functioning autism patients showed more severely impaired verbal-based ToM in the Faux Pas Task, but shared similar visual-based ToM impairments in the Yoni Task with schizophrenia patients.
The findings that individuals with high-functioning autism shared similar but more severe impairments in verbal ToM than individuals with schizophrenia support the autism–schizophrenia continuum. The finding that verbal-based but not visual-based ToM was more impaired in high-functioning autism patients than schizophrenia patients could be attributable to the varied task/item difficulty between the two paradigms.
Scholars continue to argue about whether bipolar disorders (BD) and unipolar depression (UD) are distinguishable with regard to neurocognitive function. This study aims to explore the cognitive profiles of UD and BD by applying the Brief Assessment of Cognition in Affective Disorders (BAC-A) for neuropsychological assessment.
This cross-sectional study included 68 patients with UD, 67 patients with BD, and 135 healthy control subjects. We evaluated the participants’ cognitive functions at euthymic status using the BAC-A, which is made up of six traditional cognitive subtests and the Affective Processing Test. We then used a discriminant function analysis (DFA) to determine whether cognitive performance can be used to distinguish these participant groups.
Healthy controls demonstrated better performance in all subtests of the BAC-A than both the UD and BD patients, with the exception of delayed recognition of affective interference. Compared with the BD group, the UD group exhibited better performance in working memory and emotion inhibition. Furthermore, using all BAC-A indexes, a total of 70% of participants could be correctly classified using a DFA model, and the discriminating validity between UD and BD was superior to using either the traditional cognitive domains or the Affective Processing Test alone.
We have found that UD patients may exhibit an intermediate performance between healthy subjects and BD patients in working memory and emotional inhibition tests. The BAC-A can potentially assist in differentiating BD patients from UD patients at euthymic status in clinical settings.
In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists.
We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of ‘Yes’ or ‘No’ questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback.
For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components.
Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.
To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).
We analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.
Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).
Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.
From 20 primary schools in Hong Kong, a sample of 59 boys and 62 girls in 4th grade and 98 boys and 99 girls in 5th grade (N = 318) responded to a survey about their learning-to-learn capabilities including (a) reading to learn, (b) self-management, (c) desire for knowledge, and (d) originality of ideas, and two facilitating factors for enabling such capabilities, including (e) academic self-concept, and (f) effort goal orientation. Confirmatory factor analysis provided support for the validity of the six psychological constructs. Analysis of variance found that although boys and girls did not differ in academic self-concept, desire for knowledge and originality, girls scored higher in effort goal orientation, reading to learn, and self-management. There was a gender x grade interaction effect in reading to learn, indicating that 5th grade girls were more willing than 4th grade girls to acquire knowledge through reading whereas 5th grade boys were less willing than 4th grade boys to do so. Advocates of education reform need to consider gender differences when formulating policies to promote students’ learning-to-learn capabilities and particularly to encourage boys to read.
Carbon nanotubes (CNTs) have unique thermal/electrical/mechanical properties and high aspect ratios. Growth of CNTs directly onto reactive material substrates (such as metals and carbon based foam structures, etc.) to create a micro-carbon composite layer on the surface has many advantages: possible elimination of processing steps and resistive junctions, provision of a thermally conductive transition layer between materials of varying thermal expansion coefficients, etc. Compared to growing CNTs on conventional inert substrates such as SiO2, direct growth of CNTs onto reactive substrates is significantly more challenging. Namely, control of CNT growth, structure, and morphology has proven difficult due to the diffusion of metallic catalysts into the substrate during CNT synthesis conditions. In this study, using a chemical vapor deposition method, uniform CNT layers were successfully grown on copper foil and carbon foam substrates that were pre-coated with an appropriate buffer layer such as Al2O3 or Al. SEM images indicated that growth conditions and, most notably, substrate surface pre-treatment all influence CNT growth and layer structure/morphology. The SEM images and pull-off testing results revealed that relatively strong bonding existed between the CNT layer and substrate material, and that normal interfacial adhesion (0.2‒0.5 MPa) was affected by the buffer layer thickness. Additionally, the thermal properties of the CNT/substrate structure were evaluated using a laser flash technique, which showed that the CNT layer can reduce thermal resistance when used as a thermal interface material between bonded layers.
We investigated the electrical properties of the rf-sputtered HfxZn1-xO/ZnO heterostructures. The thermal annealing on ZnO prior to the HfxZn1-xO deposition greatly influences the properties of the heterostructures. A highly conductive interface formed at the interface between HfxZn1-xO and ZnO thin films as the ZnO annealing temperature exceeded 500°C, leading to the apparent decrease of the electrical resistance. The resistance decreased with an increase of either thickness or Hf content of the HfxZn1-xO capping layer. The Hf0.05Zn0.95O/ZnO heterostructure with a 200-nm-thick 600°C-annealed ZnO exhibits a carrier mobility of 14.3 cm2V-1s-1 and a sheet carrier concentration of 1.93×1013 cm-2; the corresponding values for the bare ZnO thin film are 0.47 cm2V-1s-1 and 2.27×1012 cm-2, respectively. Rf-sputtered HfZnO/ZnO heterostructures can potentially be used to increase the carrier mobility of thin-film transistors in large-area electronics.
On the basis of the linear magnetoelectroelasticity, the interaction problem between a generalized screw dislocation and a fibrous three-phase magnetoelectroelastic composite penetrated by a semi-infinite wedge crack is investigated in this paper. The fibrous magnetoelectroelastic composite is composed of three dissimilar materials bonded along two concentric circular interfaces. The magnetoelectroelastic materials are assumed to be transversely isotropic and have the same poling direction. The analytical derivations are based on the complex variable, conformal mapping, analytical continuation and image singularity methods. Numerical calculations are given graphically for studying the effects of material combinations, geometric models, wedge angles and the load type on the generalized stress fields, the generalized stress intensity factors, and the forces on the dislocation.
As a promising transition metal dichalcogenide (TMDC), molybdenum disulfide (MoS2) has recently attracted a lot of attention due to its graphene-liked two dimensional layer structure, which leads to potential applications in electronic and optoelectronic devices. However, the fabrication of mono- or few-layer MoS2 is limited to ether liquid exfoliation or CVD, and the chemical solution deposition is limited to ammonium thiomolybdate-based precursor. In this paper, hydrazine-based dimensional reduction technique is applied in the chemical solution deposition of MoS2 thin-film, and a larger area uniform thin-film is obtained from bulk powder MoS2. This solution-based process could be applied with a variety coating techniques and lead to wafer level MoS2 thin film production.
Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design.
Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed.
Results suggested that EI patients had reduced suicide rate (χ2(1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR −0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery.
The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.
A photoactivated ZnO nanomesh with precisely controlled dimensions and geometries is fabricated by using nanosphere lithography process. The nanomesh structures effectively increase the surface-to-volume ratio to improve the sensing response under the same testing gas. And the periodical nanostructures also increase the effective light path and lead to more efficient light activation for gas sensing. With the increase of the photoinduced oxygen ions by UV illumination, a distinguished sensing response is observed at room temperature. In the optimized case, the sensing response (△R/R0) of the ZnO nanomesh at the butanol concentration of 500 ppm is 97.5%, which is 4.54 times higher than the unpatterned one.
Atom probe is a powerful technique for studying the composition of nano-precipitates, but their morphology within the reconstructed data is distorted due to the so-called local magnification effect. A new technique has been developed to mitigate this limitation by characterizing the distribution of the surrounding matrix atoms, rather than those contained within the nano-precipitates themselves. A comprehensive chemical analysis enables further information on size and chemistry to be obtained. The method enables new insight into the morphology and chemistry of niobium carbonitride nano-precipitates within ferrite for a series of Nb-microalloyed ultra-thin cast strip steels. The results are supported by complementary high-resolution transmission electron microscopy.
Photoelectrochemical (PEC) etching technique has been proven to be an effective method to etch GaN. Despite its success, investigations on etching-induced damage are still scare. In this work, the damage induced by PEC etching of GaN in KOH electrolyte was studied. Photoluminescence (PL) spectroscopy was used to explore the origin of etching-induced damaged layer. From the variable temperature PL measurements, the origin of etching-induced damage was attributed to be the defect complex of VGa-ON (gallium vacancy bonds to oxygeon on nitrogen antisite). With determination of the defect origin, the electronic transition in the etch damage-related yellow luminescence (YL) band was suggested to be deep donor-like state to shallow-acceptor transition. In addition, a post-treatment method with boiled KOH chemical etching was developed to remove the thin damaged layer. In this method, crystallographic etching characteristics of boiled KOH was observed to assist in the formation of smooth sidewall facets. As revealed by the reduction of yellow luminescence, we propose this novel technique as a near damage-free etching method.
Damage-free etching of GaN by Cl2, assisted by an ArF (193 nm) excimer laser, is demonstrated. At low temperatures, photo-assisted etching can provide a better etch rate and largely improve the surface morphology and quality. AFM results show that the etched GaN surface is obtained with a root-mean-square roughness of 1.7 nm. As compared with the photoluminescence spectra of photoelectrochemical wet etched GaN, the photo-assisted cryogenic etching is proved to be a damage-free dry etching technique.