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There are no definite guidelines regarding the most adequate steroid regimens for acute acoustic trauma.
To elucidate the dose-dependent differing benefits of oral steroids on hearing improvement following acute acoustic trauma.
Twenty-nine patients treated with oral steroids following a diagnosis of unilateral acute acoustic trauma were retrospectively reviewed. Patients were sorted into two groups with an oral steroid regimen. Group 1 received a 14-day course of treatment: 60 mg prednisolone daily for 10 days, tapering off over days 11–14. Group 2 received prednisolone for a total of 10 days: 60 mg for 5 days, tapering down each day for the remainder. Multivariable linear regression analysis was performed to evaluate the factors associated with the hearing gain.
In the multivariable regression (R2 = 0.51, p < 0.001), patients in group 1 showed more significant improvement in the degree of hearing gain compared to group 2 (p = 0.03).
After comparing the differing benefits of oral steroids on hearing improvement by dosage, we recommend a high dose of prednisolone (60 mg per day) for 10 days, tapering over the remaining 4 days, for better hearing recovery following acute acoustic trauma.
There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group.
We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017–2018. We assessed the yields from different methods of recruitment and retention.
A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield.
Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research.
Healthcare-associated infections (HAIs) are a significant burden on healthcare facilities. Universal gloving is a horizontal intervention to prevent transmission of pathogens that cause HAI. In this meta-analysis, we aimed to identify whether implementation of universal gloving is associated with decreased incidence of HAI in clinical settings.
A systematic literature search was conducted to find all relevant publications using search terms for universal gloving and HAIs. Pooled incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated using random effects models. Heterogeneity was evaluated using the Woolf test and the I2 test.
In total, 8 studies were included. These studies were moderately to substantially heterogeneous (I2 = 59%) and had varied results. Stratified analyses showed a nonsignificant association between universal gloving and incidence of methicillin-resistant Staphylococcus aureus (MRSA; pooled IRR, 0.94; 95% CI, 0.79–1.11) and vancomycin-resistant enterococci (VRE; pooled IRR, 0.94; 95% CI, 0.69–1.28). Studies that implemented universal gloving alone showed a significant association with decreased incidence of HAI (IRR, 0.77; 95% CI, 0.67–0.89), but studies implementing universal gloving as part of intervention bundles showed no significant association with incidence of HAI (IRR, 0.95; 95% CI, 0.86–1.05).
Universal gloving may be associated with a small protective effect against HAI. Despite limited data, universal gloving may be considered in high-risk settings, such as pediatric intensive care units. Further research should be performed to determine the effects of universal gloving on a broader range of pathogens, including gram-negative pathogens.
The Iron Age of Mainland Southeast Asia began in the fifth century bc and lasted for about a millennium. In coastal regions, the development of trade along the Maritime Silk Road led to the growth of port cities. In the interior, a fall in monsoon rains particularly affected the Mun River valley. This coincided with the construction of moats/reservoirs round Iron Age settlements from which water was channelled into wet rice fields, the production of iron ploughshares and sickles, population growth, burgeoning exchange and increased conflict. We explore the social impact of this agricultural revolution through applying statistical analyses to mortuary samples dating before and after the development of wet rice farming. These suggest that there was a swift formation of social elites represented by the wealth of mortuary offerings, followed by a decline. Two associated changes are identified. The first involved burying the dead in residential houses; the second considers the impact of an increasingly aquatic environment on health by examining demographic trends involving a doubling of infant mortality that concentrated on neonates. A comparison between this sequence and that seen in coastal ports suggests two interconnected instances of rapid pathways to social change responding to different social and environmental stressors.
Micron or submicron spatial resolution for x-ray microfluorescence analysis has been pursued using various x-ray point focusing methods,1-4 such as transmission zone plates, tapered capillaries, and Bragg Fresnel lenses. Point focusing using bent crystals does not seem to be a desirable means for achieving a microbeam size, although it is a traditional technique which utilizes perfectly curved crystal surfaces to focus x rays emanating from the source. It is known that point focusing can only be achieved by bending a crystal two dimensionally, which normally introduces imperfections to the crystal since the crystal is an undevelopable surface. Unavoidably, the introduced imperfections will broaden the reflection curve (rocking curve) of the crystal and, in turn, broadens the focal spot size.
This study provides a solution for the bass extension of a microspeaker system in a mobile device that involves using a resonant combination of a front chamber and a rectangular, long, pipe-shaped port. The efficient resonant coupling of the microspeaker system to the acoustic load in this structure enables a microspeaker with modest cone displacement to achieve a high sound pressure level (SPL) and bass extension below the resonance of the microspeaker in free air, and the total dimensions of the structure are minimized. A combination of electro-mechanic-acoustic and finite element methods was applied to determine the SPL and bass extension levels for mobile devices. Simulation results show acceptable agreement with experimental results. A suitable extended-range microspeaker system was applied in a 10 inch tablet. The audio frequency response could be extended from 630 to 300 Hz with the greatest loudness. As much as possible add low bound frequency extension to make the article more clear. Finally, five cases of parameter settings for the front chamber volume, rear chamber volume, rectangular pipe-shaped port, cross-sectional area, and opening area were studied. The results can be applied for optimizing a suitable extended-range microspeaker system.
Pneumococcal serotype replacement is an important issue after the introduction of pneumococcal conjugate vaccine (PCV) in children. After the introduction of 13-valent PCV, the incidence of invasive pneumococcal diseases (IPD) caused by Streptococcus pneumoniae serotype 12F (Sp12F) have increased in some countries; however, an outbreak of Sp12F has not reported in the post-13-valent PCV era. We experienced a local outbreak of Sp12F during March through May 2016 in Tsuruoka city, Japan after the introduction of 13-valent PCV in 2013. The IPD patients were two children and seven adults, three of whom died with a rapid disease progress. Although the clear transmission route was not determined, eight of the nine patients (89%) had close contact with children, which suggests that transmitted colonisation of Sp12F among children and adults might be the source of transmission. Continuous monitoring of IPDs, along with the determination of pneumococcal serotypes, is warranted in the post–13-valent PCV era. New IPD control strategies may be needed if this fatal outbreak continues to occur.
We present possible conceptual designs of a laser system for driving table-top free-electron lasers based on terahertz acceleration. After discussing the achievable performances of laser amplifiers with Yb:YAG at cryogenic and room temperature and Yb:YLF at cryogenic temperature, we present amplification modules with available results and concepts of amplifier chains based on these laser media. Their performances are discussed in light of the specifications for the tasks within the table-top light source. Technical and engineering challenges, such as cooling, control, synchronization and diagnostics, are outlined. Three concepts for the laser layout feeding the accelerator are eventually derived and presented.
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.
Microspeakers are key components of mobile devices in current consumer products; moreover, the user experience of multimedia products plays an essential role. The objective of this study was to investigate the acoustic performance of microspeakers in different enclosure parameters for mobile devices. Two methodologies are performed. The first model is an electro-mechano-acoustical model (EMA) of microspeaker along with distribution model of enclosure effect; the 2nd model, the details of diaphragms are taken into account in calculating the distribution models of microspeaker with enclosure parameters. They were combined and applied to determine microspeaker performance levels for mobile devices. Two methodologies show acceptable agreement with experimental results. The distribution model can well simulate the high frequency response than lumped model of microspeaker. The results can predict microspeaker system performance before industrial design and mechanism placement processes are executed.
The position determination for rock bolt support design based on rock stress distribution is important in ensuring full mobilization of rock bolt tensions during excavation process. The monitoring of the progressive rock stress variation in magnitude and orientation can play an important role in optimal installation of rock bolt. The aim of this paper is to determine the optimal positions for rock bolt installation by computing the progressive directional variation of rock stresses and plot the stress distribution in a two-dimensional stereographic projection to capture the stress transformation during excavation process. Finally, an algorithm based on stress transformation determination for optimal rock bolt installation is proposed.
Poor insight is prevalent in patients with schizophrenia and has been associated with acute illness severity, medication non-adherence and poor treatment outcomes. Paradoxically, high insight has been associated with various undesirable outcomes, including low self-esteem, depression and low subjective quality of life (QoL) in patients with schizophrenia. Despite the growing body of studies conducted in Western countries supporting the pernicious effects of improved insight in psychosis, which bases on the level of self-stigma, the effects are unclear in non-Western societies. The current study examined the role of self-stigma in the relationship between insight and psychosocial outcomes in a Chinese population.
A total of 170 outpatients with schizophrenia spectrum disorders were recruited from two general university hospitals. Sociodemographic data and clinical variables were recorded and self-report scales were employed to measure self-stigma, depression, insight, self-esteem and subjective QoL. Structural equation modelling (SEM) was used to analyse the cross-sectional data.
High levels of self-stigma were reported by 39% of the participants (n = 67). The influences of insight, self-stigma, self-esteem and depression on subjective QoL were confirmed by the SEM results. Our model with the closest fit to the data (χ2 = 33.28; df = 20; p = 0.03; χ2/df = 1.66; CFI = 0.98; TLI = 0.97; RMSEA = 0.06) demonstrated that self-stigma might fully mediate the association of insight with low self-esteem, depression and poor subjective QoL. High insight into illness contributed to self-stigma, which caused low self-esteem and depression and, consequently, low QoL. Notably, insight did not directly affect self-esteem, depression or QoL. Furthermore, the association of insight with poor psychosocial outcomes was not moderated by self-stigma.
Our findings support the mediating model of insight relevant to the poor psychosocial outcomes of individuals diagnosed with schizophrenia in non-Western societies, in which self-stigma plays a pivotal role. These findings elucidate the direct and indirect effects of insight on psychosocial outcomes and imply that identifying and correcting self-stigma in people with schizophrenia could be beneficial. Additional studies are required to identify whether several other neurocognitive or psychosocial variables mediate or moderate the association of insight with self-esteem, depression and QoL in patients with schizophrenia. Studies with detailed longitudinal assessments are necessary to confirm our findings.
Ornamental grasses may become invasive weeds depending on their ability to naturalize and outcompete other species. Miscanthus sacchariflorus (Maxim) Franch. (Amur silvergrass) is a tall, self-incompatible, nonnative grass that has become naturalized in eastern North America, forming monospecific stands and raising concerns about its potential invasiveness. To understand the extent of clonal and sexual reproduction in feral populations, we examined their population genetic structure, seed production, and ploidy. We surveyed 21 populations in Iowa and Minnesota using eight polymorphic microsatellite markers. Only 34 multilocus genotypes (MLGs) were detected from a total of 390 samples. All of the study populations had more than one MLG, thereby allowing cross-pollination with near neighbors, but most were dominated by one or a few MLGs. Low genetic divergence suggests that all populations may have originated from similar cultivars. Cluster analysis showed that the six populations from Minnesota were extremely similar to each other, whereas the 15 populations from Iowa were somewhat more diverse. Seed production was quantified for 20 populations and ploidy for 11 populations. Average seed production was very low (< 0.30 seeds per panicle), although most populations did produce seeds. Because the populations were diploid (2x), they also may have the potential to hybridize with ornamental varieties of Miscanthus sinensis (Chinese silvergrass; eulaliagrass), a diploid close relative. Clonal growth, self-incompatibility, and spatial isolation of compatible clones may contribute to pollen-limited seed set in these populations. Low seed set may affect the rate of spread of feral M. sacchariflorus, which appears to disperse vegetatively as well as by seed. Although this species is not widely viewed as invasive, it is worth monitoring as a species that may become more widespread in the future.
Three-dimensional integrated circuit packages with through-silicon vias (TSVs) provide a good solution to the integration of different chips and help achieve high performance. The signals are transmitted to different layers directly through the vias, thereby enabling the high performance of the chips. Plasma-enhanced chemical vapor-deposited SiO2, polyimide, and benzo-cyclo-butene are commonly used as the passivation layer for three-dimensional packages. In the 3D stacked chips, mismatch of the coefficient of thermal expansion between the passivation material and silicon will generate thermal/mechanical stress in the metal trace and the stress affects the behavior of electromigration. However, few studies have examined the relationship among the external mechanical stress and critical product of electromigration. In the present study, external stress is applied to the aluminum thin film by a four-point bending equipment. In order to apply higher external stress in the aluminum thin film, the fracture strength of the silicon substrate should be improved. Reduces the edge chipping of the test sample is a key factor for improving the fracture strength of the silicon substrate and a special cutting approach is employed to obtain higher silicon strength. A two-step cutting method is applied to reduce front side chipping and also a dicing before grinding approachis adopted to reduce backside chipping, the above-mentioned technology can enable more than 275MPa of external stress on the aluminum thin film and can make the critical length effect more visible. The residual stress of the aluminum thin film is at stress-free state after annealing at 300°C for 10h. The critical product is found to be reduced from 1,294A/cm to 1,281A/cm when 120MPa of mechanical tensile stress is applied. It increased to 1,315A/cm under 120MPa of mechanical compressive stress. Clearly, electromigration behavior is enhanced by tensile stress and decreased by compressive stress. In the current research, a modified equation for Blech condition is proposed with a stress-dependent effective charge number, the effective charge number increased when tensile stress was applied and decreased when compressive stress was applied.
Heptavalent pneumococcal conjugate vaccine (PCV7) was introduced to Japan in 2010. We investigated the impact of PCV7 on childhood community-acquired pneumonia (CAP) and pneumococcal pneumonia (PP). Children aged <5 years living in Chiba city, Japan, who were admitted to hospitals were enrolled to estimate the incidence of CAP based on the mid-year population. PP was determined by the presence of Streptococcus pneumoniae in cultured blood and/or sputum samples of CAP patients. The incidence of CAP and S. pneumoniae isolated from PP patients was compared before (April 2008–March 2009) and after (April 2012–March 2013) the introduction of PCV7 immunization. The annual incidence of CAP was reduced [incidence rate ratio 0·81, 95% confidence interval (CI) 0·73–0·90]. When comparing post-vaccine with pre-vaccine periods, the odds ratio for PP incidence was 0·60 (95% CI 0·39–0·93, P = 0·024). PCV7-covered serotypes markedly decreased (66·6% in pre-vaccine vs. 15·6% in post-vaccine, P < 0·01), and serotypes 6C, 15A, 15C and 19A increased. Multidrug-resistant international clones in the pre-vaccine period (Spain6B-2/ST90, Taiwan19F-14/ST236) decreased, while Sweden15A-25/ST63 was the dominant clone in the post-vaccine period. A significant reduction in the incidence of both CAP hospitalizations and culture-confirmed PP of vaccine serotypes was observed at 2 years after PCV7 vaccination.