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Supported by (1) medical research grants CMRPG3C0041/42 from Chang Gung Memorial Hospital and NRRPG2H0031 from Ministry of Science and Technology, Taiwan to Chemin Lin (2) NMRPG3G6031/32 from Ministry of Science and Technology, Taiwan to Shwu-Hua, Lee (3) the KKHo International Charitable Foundation to Tatia Lee.
Suicide rate tends to peak in old age, and major depression is the most salient risk factor for late-life suicide. However, few studies have focused on the neuroscientific facet of suicide in the context of late-life depression (LLD).
We recruited 114 participants of LLD (28 with history of suicide attempt and 86 without) and 47 elderly controls. They received MRI scanning and behavioral assessment. White matter hyperintensity (WMH) was quantified by an automated segmentation algorithm and graph theoretical analysis was applied to resting-state fMRI. We used ANCOVA to compare group difference in WMH loading and multivariate generalized linear model to compare global and local topological parameters in fMRI signals, controlling for demographics. Partial correlation was conducted between imaging parameters and behavioral data in group of suicide attempters.
We found significant higher WMH in suicide attempters than those of LLD without suicide attempts and elderly controls (F =7.091; p = 0.001). Suicide attempters also had increased betweenness centrality (BC) in right superior occipital gyrus (SOG) (Bonferroni corrected), right precuneus (False positive corrected) and right superior temporal gyrus (uncorrected) and decreased BC in left hippocampus (uncorrected). In suicide attempters, higher BC in right SOG correlated with higher WMH, higher depression severity, higher illness awareness and insight, and lower cognitive function (digit backward), while higher BC in right precuneus correlated with higher decrease awareness and insight and higher cognitive function (digit backward).
Resonating with the vascular hypothesis in LLD, higher WMH was found in those having history of suicide attempts. However, the re-organized brain topology changes are related with divergent cognitive function and convergent heightened disease insight.
There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney.
A convenience sample of 206 caregiver–patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion.
Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place.
Significance of results:
Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.
A simple technique for the formation of Ge nanocrystals embedded in amorphous Lu2O3 high-k dielectric was demonstrated by pulsed laser ablation followed by rapid thermal annealing in N2 ambient. The structure and composition of the Ge nanocrystals in the oxide matrix have been studied by transmission electron microscopy (TEM) and x-ray photoelectron spectroscopy (XPS) analysis. A significant change in the structure and chemical composition of the film was obtained upon annealing. Cross-sectional and plan-view TEM images confirmed the formation of small Ge nanocrystals in amorphous Lu2O3 matrix with a mean size of about 6nm in diameter and a high areal density of 7 × 1011cm−2. The nanocrystals are well-isolated by the amorphous Lu2O3 in between, with almost spherical shape which are favorable for non-volatile memory (NVM) application due to an effective charge confinement. XPS measurements on the as-deposited sample indicate the existence of Ge in its oxidized state, consisting of GeO2 and Ge suboxides. A spontaneous reduction of GeO2 and GeOx was obtained after the annealing treatment, which provides Ge nuclei for nanocrystal formation. It is found that a low annealing temperature of 400oC is sufficient to dissociate the GeO2 and GeOx leading to the formation of Ge nanocrystals. The application of the nanocrystals in NVM devices was demonstrated by C-V characterization of the memory capacitor devices fabricated with Al2O3 control oxide layer. C-V results show a significant effect of the structure and composition of the film on the electrical performance of the device. The annealed device exhibits good memory behavior with a large memory window of 1.2V achieved with a low operation voltage.
To evaluate the relationship between Staphylococcus aureus nasal and tracheal colonization and infection in medical intensive care unit (MICU) patients. The primary outcome was the incidence of S. aureus infection in colonized versus non-colonized patients.
Prospective, observational cohort study. Patients admitted to the MICU during the study period were screened for S. aureus nasal and tracheal colonization by culture and a PCR assay twice weekly. Demographic, clinical, and microbiologic data were collected in the MICU and for 30 days after discharge. PFGE and antibiotic susceptibility testing were performed on all S. aureus nasal, tracheal, and clinical isolates.
Twenty-three percent of patients (47 of 208) were nasally colonized with S. aureus. Twenty-four percent of these patients developed S. aureus infections versus 2% of noncolonized patients (P < .01). Nine of 11 patients with both nasal colonization and infection were infected by their colonizing strain. Two of 47 nasally colonized patients developed an infection with a different strain of S. aureus. Fifty-three percent of intubated patients with nasal colonization (10 of 19) had tracheal colonization with S. aureus as opposed to 4.9% of intubated, non-colonized patients (3 of 61) (P < .01). Parenteral antibiotics were ineffective at clearing nasal colonization. PCR detected S. aureus colonization (nasal and tracheal) within 6.5 hours with a sensitivity of 83% and a specificity of 99%.
The incidence of S. aureusinfection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible. (Infect Control Hosp Epidemiol 2005;26:622-628)
The development of a transformation system is a significant technical hurdle in the study of many filamentous fungi. Recently
Agrobacterium tumefaciens was shown to transform several filamentous fungi, but until now only one independent confirmation of this
promising finding has been published. Fusarium circinatum (teleomorph Gibberella circinata) is an important pathogen of pine that has
not been transformed previously. A. tumefaciens strain AGL1(pPK2) transformed three different isolates of F. circinatum with an
efficiency of 2–150 transformants 10−5
conidia. The T-DNA was integrated into the genome and was stable through mitotic and
meiotic cell divisions. Most F. circinatum transformants contained a single T-DNA copy. Half of the tested transformants also
contained non-T-DNA vector sequences. These findings should facilitate future analysis of F. circinatum pathogenicity and stimulate
wider use of this valuable transformation method in fungal research.
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