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In this chapter, the air pollution trends in historical London (1950 – 66) and contemporary Beijing (2000 – 16) are compared. In both cases, coal is the main source of air pollution, due to coal-fired electricity generation and coal-burning activities that provide heating. In London, the Clean Air Act of 1956 marked a successful milestone in the history of air pollution abatement in the UK. In Beijing, various policies have been introduced but air qualities in China have not been improved substantially. By examining the effectiveness of respective pollution control regulations/policies in a broader socioeconomic context, policy implications on respective jurisdictions are drawn. For effective implementation of air pollution control policies at the local level, it would be good for China to move beyond simply introducing stringent policies and regulations at the central or the provincial level. More resources can be re-directed to resolving the competing interests of stakeholders across different levels of jurisdictions.
Anxiety disorders are prevalent yet under-recognized in late life. We examined the prevalence of anxiety disorders in a representative sample of community dwelling older adults in Hong Kong.
Data on 1,158 non-demented respondents aged 60–75 years were extracted from the Hong Kong Mental Morbidity survey (HKMMS). Anxiety was assessed with the revised Clinical Interview Schedule (CIS-R).
One hundred and thirty-seven respondents (11.9%, 95% CI = 10–13.7%) had common mental disorders with a CIS-R score of 12 or above. 8% (95% CI = 6.5–9.6%) had anxiety, 2.2% (95% CI = 1.3–3%) had an anxiety disorder comorbid with depressive disorder, and 1.7% (95% CI = 1–2.5%) had depression. Anxious individuals were more likely to be females (χ2 = 25.3, p < 0.001), had higher chronic physical burden (t = −9.3, p < 0.001), lower SF-12 physical functioning score (t = 9.2, p < 0.001), and poorer delayed recall (t = 2.3, p = 0.022). The risk of anxiety was higher for females (OR 2.8, 95% C.I. 1.7–4.6, p < 0.001) and those with physical illnesses (OR 1.4, 95% C.I. 1.3–1.6, p < 0.001). The risk of anxiety disorders increased in those with disorders of cardiovascular (OR 1.9, 95% C.I. 1.2–2.9, p = 0.003), musculoskeletal (OR 2.0, 95% C.I. 1.5–2.7, p < 0.001), and genitourinary system (OR 2.0, 95% C.I. 1.3–3.2, p = 0.002).
The prevalence of anxiety disorders in Hong Kong older population was 8%. Female gender and those with poor physical health were at a greater risk of developing anxiety disorders. Our findings also suggested potential risk for early sign of memory impairment in cognitively healthy individuals with anxiety disorders.
Selective area growth of thin films reduces the number of steps in microfabrication processing and enables novel device structures. Here, we report, for the first time, selective area epitaxy of an oxide material on a GaN surface. Chlorination of the GaN surface via wet chemical processing is found effective to disrupt Mg adsorption and selectively prevent molecular beam epitaxy growth of MgO. MgO films grown on neighboring, nonchlorinated surfaces are epitaxial with a (111) MgO||(0001) GaN crystallographic relationship. Better than 3 μm lateral resolution for the selective area growth of MgO on GaN is demonstrated.
Background: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. Aims: This study investigated clinicians’ reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). Method: Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. Results: Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups. Conclusions: Diagnostic labels may negatively impact on clinicians’ judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.
The health benefits of exercise are clear. In targeting interventions it would be valuable to know whether characteristic patterns of physical activity (PA) are associated with particular population subgroups. The present study used cluster analysis to identify characteristic hourly PA patterns measured by accelerometer.
Objectively measured PA in Hong Kong adults.
Four-day accelerometer data were collected during 2009 to 2011 for 1714 participants in Hong Kong (mean age 44·2 years, 45·9 % male).
Two clusters were identified, one more active than the other. The ‘active cluster’ (n 480) was characterized by a routine PA pattern on weekdays and a more active and varied pattern on weekends; the other, the ‘less active cluster’ (n 1234), by a consistently low PA pattern on both weekdays and weekends with little variation from day to day. Demographic, lifestyle, PA level and health characteristics of the two clusters were compared. They differed in age, sex, smoking, income and level of PA required at work. The odds of having any chronic health conditions was lower for the active group (adjusted OR = 0·62, 95 % CI 0·46, 0·84) but the two groups did not differ in terms of specific chronic health conditions or obesity.
Implications are drawn for targeting exercise promotion programmes at the population level.
Background: This study aimed to assess if decisional capacity and the four decision-making abilities related to decisions concerning medication management were impaired among community-dwelling Chinese older persons in Hong Kong with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), as compared with cognitively normal older adults.
Methods: Two hundred and ninety-one Chinese community-dwelling older adults were recruited. The four decision-making abilities and decisional capacity were assessed by using the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED) and independent clinician ratings based on the definition in the UK Mental Capacity Act 2005, respectively.
Results: Ninety-nine participants (34%) were diagnosed with MCI and ninety-five (33%) with mild AD. Although almost all (96%) of the participants in the MCI group were found to be mentally competent to make decisions on medication management in clinician ratings, their decision-making abilities as measured by the ACED were significantly lower than those of the cognitively normal controls.
Conclusions: Results from this study suggest that abilities related to decisions on medication management are impaired before the clinical diagnosis of dementia is made. Use of specific and structured assessment of the relevant decisional abilities may enhance clinical judgment.
It is controversial if distant recurrence of glioblastoma is more common after temozolomide (TMZ) concurrent with radiotherapy (RT). Optimal therapy for patients with recurrent disease after RT/TMZ is unclear. Our purpose was to evaluate recurrence patterns in glioblastoma and the effect of treatment at recurrence upon survival.
We performed a retrospective review of 67 patients with newly diagnosed glioblastoma treated with RT/TMZ between 2003-2007. Statistical analyses included Kaplan-Meier method for survival, and multivariate Cox proportional hazards model for the effect of salvage treatment on survival.
58 patients (86.6%) recurred locally; 9 patients (13.4%) had a distant non-contiguous focus of new disease. Median survival(MS) was 17 months; median time-to-progression(TTP) 6.8 months. The local and distant groups had comparable prognostic factors. There was no difference in MS(p=0.35) or TTP(p=0.95) by location of recurrence. At relapse, 26 patients(38.8%) received continuous, dose-intense TMZ, 24(35.8%) other therapy(4.5% RT; 20.9% lomustine+/-procarbazine; 4.5% etoposide; 1.5% conventional TMZ; 4.5% TMZ then lomustine), and 17(25.4%) were untreated. Dose-intense TMZ was associated with prolonged MS compared to all other patients(21.5 months vs. 12.4 months, p=0.019, HR=3.86, 95%CI: 1.81-8.22) and similar to MS with other chemotherapy regimens(18.8 months, p=0.40, HR=1.30, 95% CI: 0.65-2.61).
The pattern of recurrence of glioblastoma treated with RT/TMZ was predominantly local. Second-line treatment with continuous dose-intense TMZ may prolong survival in patients with recurrent glioblastoma. Overall survival is similar to other conventional salvage regimens; however TMZ may be better tolerated. This study is limited by its retrospective nature and potential selection bias. Prospective controlled studies are needed.
Performances of a-Si:H TFT's are partly restricted by the parasitic capacitances due to the source-drain/gate overlapping and the channel length. These capacitances are inherent to the conventional photolithographic process  and to the MIS structure.
The use of the self-aligned a-Si:H TFT technology should allow the manufacture of short channel TFT's (L < 5 μm) where the overlapping length becomes negligible, on a large area as well as in high definition matrices. Such transistors could constitute in the near future the solution for high performances matrix arrays as well as their peripheral electronics.
Clarifying the local amorphization on the grain boundaries, the in-situ observation during ion-irradiation was carried out for poly-crystalline Si film. The critical dose of amorphous formation increased exponentially with increasing temperature, where the local amorphization was developed at middle temperature. The critical dose was affected by the doped impurity and the grain size. The preferential amorphization on and near grain boundaries had two processes; first stage with rapid growth rate and second stage with almost constant growth rate. The importance of stress was demonstrated from the acceleration due to the stress on the first stage of amorphization.
Pseudoprogression (psPD) is now recognised following radiotherapy with concurrent temozolomide (RT/TMZ) for glioblastoma multiforme (GBM). The aim of this study was to determine the incidence of psPD following RT/TMZ and the effect of psPD on prognosis.
All patients receiving RT/TMZ for newly diagnosed GBM were identified from a prospective database. Clinical and radiographic data were retrospectively reviewed. Early progression was defined as radiological progression (RECIST criteria) during or within eight weeks of completing RT/TMZ. Pseudoprogression was defined as early progression with subsequent disease stabilization, without salvage therapy, for at least six months from completion of RT/TMZ. The primary outcome was overall survival (Kaplan-Meier) and log rank analysis was used to compare groups.
Out of 111 patients analyzed, 104 were evaluable for radiological response. Median age was 58 years and median follow-up 55 weeks. Early progression was confirmed in 26% and within this group 32% had psPD. Median survival for the whole cohort was 56.7 weeks [95% CI (51.0, 71.3)]. Median survival for patients with psPD was significantly higher than for patients with true early progression (124.9 weeks versus 36.0 weeks, p=0.0286).
Approximately one third of patients with early progression were found to have psPD which was associated with a favourable prognosis. Maintenance TMZ should not be abandoned on the basis of seemingly discouraging imaging features identified within the first three months after RT/TMZ.
Paul Tenenbein, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington,
M. Sean Kincaid, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington,
Arthur M. Lam, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington
Review the pathophysiology of traumatic brain injury.
Summarize the systemic manifestations of acute traumatic brain injury.
Review the current guidelines regarding management of traumatic brain injury.
Discuss the anesthetic management of traumatic brain injury and the potential complications.
Traumatic brain injury (TBI) imposes a significant burden on society, the presence of which is the primary determinant in quality of outcome following trauma . With respect to age, it occurs in a bimodal fashion. Young persons between 15 and 24 years suffer head injuries in motor vehicles and violence, especially in association with alcohol use. Older persons, particularly those older than 75 years, suffer from an increased frequency of falls leading to head injury. It is estimated that 1.6 million head injuries occur annually in the United States with 250,000 patients requiring hospitalization [2, 3]. The results of these injuries include 60,000 deaths and 70,000–90,000 permanent neurologic disabilities [2, 4]. It is estimated that $100 billion is spent annually in the United States alone providing care for these individuals. Primary prevention is essential to decrease the burden of this problem. But for those who do sustain TBI, there is much we can do to provide the best possible care for these patients. Although the Brain Trauma Foundation has provided guidelines for the management of severe traumatic brain injury (www.braintrauma.org), there are still many institutional differences in the care these patients receive, potentially affecting outcome .
To reconstruct the infection curve for the 2003 severe acute respiratory syndrome (SARS) epidemic in Taiwan and to ascertain the temporal changes in the daily number of infections that occurred during the course of the outbreak.
The peaks of the epidemic correspond well with the occurrence of major infection clusters in the hospitals. The overall downward trend of the infection curve after early May corresponds well to the date (May 10) when changes in the review and classification procedure were implemented by the SARS Prevention and Extrication Committee.
The major infection control measures taken by the Taiwanese government over the course of the SARS epidemic, particularly those regarding infection control in hospitals, played a crucial role in containing the outbreak.
Insertion of a voice prosthesis through the tracheoesophageal puncture (TEP) is one way to restore the voice after total laryngectomy. The second generation Provox® voice prosthesis is presently one of the most popular devices. Although TEP can be done primarily, there are many centres that prefer it to be done at a second stage for various reasons. However, secondary TEP for retrograde replacement of prosthesis can be difficult and general anaesthesia is very often necessary. Moreover, the presence of neck stiffness and fibrosis from the surgery or previous radiotherapy could affect the neck extension for proper positioning of the trocar. Similarly, it is difficult to insert the prosthesis if there is stenosis at the pharyngoesophageal segment. We describe a technique in which creation of secondary TEP and insertion of Provox®2 is done with local anaesthesia under the same setting. The procedure is well tolerated and can be safely performed on an out-patient basis.
We have reported the advantageous clinical outcome of adding cognitive therapy to medication in the prevention of relapse of bipolar disorder.
This 30-month study compares the cost-effectiveness of cognitive therapy with standard care.
We randomly allocated 103 individuals with bipolar 1 disorder to standard treatment and cognitive therapy plus standard treatment. Service use and costs were measured at 3-month intervals and cost-effectiveness was assessed using the net-benefit approach.
The group receiving cognitive therapy had significantly better clinical outcomes. The extra costs were offset by reduced service use elsewhere. The probability of cognitive therapy being cost-effective was high and robust to different therapy prices.
Combination of cognitive therapy and mood stabilisers was superior to mood stabilisers alone in terms of clinical outcome and cost-effectiveness for those with frequent relapses of bipolar disorder.
Canada has no formal training program in disaster medicine for health care professionals. The University of Alberta’s Division of Emergency Medicine has developed a means to fill the gap. Disaster Medicine Online (DMO) is an Internet-based, interactive, facilitator-guided distance-learning course on the fundamentals of disaster medicine. The 3-week pilot of DMO was offered in March 2002 and taken by a multidisciplinary group of 22 health care professionals, including resident and attending physicians, paramedics and nurses. Evaluation of the learning materials and educational methodology by experts and learners demonstrated a high degree of satisfaction with the Web interface, site usability, lesson content and format, and the interactive components of the online course. Learners reported spending a mean of 11.2 hours (range = 5–20) over the 3-week course period. Twenty of 22 learners completed the final assignment, and all 20 were successful in passing the course. Overall, 95% of learners said they would pursue another module if offered, and 100% would recommend DMO to their colleagues. DMO is a viable option for health care professionals who would like to pursue continuing medical education in this area without having to take time out of their personal and professional lives to travel to a face-to-face, traditional educational program.