To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This chapter provides the reader with a succinct review surround the issues with uncontrolled pain and provides methods for non-pharmacologic treatment in children. The chapter discusses the sequalae of untreated pain and provides the reader with a detailed explanation of the theory behind distraction techniques. The various distraction techniques are discussed based on age appropriate selection.
In this paper, we develop the isogeometric analysis of the dual boundary element method (IGA-DBEM) to solve the potential problem with a degenerate boundary. The non-uniform rational B-Spline (NURBS) based functions are employed to interpolate the geometry and physical function. To deal with the rank-deficiency problem due to the degenerate boundary, the hypersingular integral equation is introduced to promote the full rank for the influence matrix in the dual BEM. Finally, three numerical examples are given to verify the accuracy of our proposed method. Both circular and square domains subjected to the Dirichlet boundary condition are considered. The engineering problem containing a degenerate boundary is considered, e.g., a seepage flow problem with a sheet pile. Numerical results of the IGA-DBEM agree well with these of the exact solution and the original dual boundary element method.
The role of panendoscopy in the modern investigation of head and neck cancer is changing with the development of improved radiological techniques, in-office biopsy capabilities and the low rate of synchronous primary tumours. This study aimed to review the indications for panendoscopy in the investigation of newly diagnosed head and neck cancer.
A retrospective review was conducted of 186 patients with newly diagnosed head and neck cancer, between January 2014 and December 2015, at two tertiary centres.
Obtaining a tissue diagnosis was the most common indication for panendoscopy (65 per cent), followed by surgical planning including transoral robotic surgery suitability assessment (22.6 per cent), and the investigation of carcinoma of an unknown primary (11.3 per cent). Two synchronous primary tumours were identified, generating a yield of 1.1 per cent.
Panendoscopy remains integral in the assessment of transoral robotic surgery suitability. Refining indications for modern panendoscopy could reduce the need for this procedure in this cohort of patients.
Appropriate selection of tongue cancer patients considering surgery is critical in ensuring optimal outcomes. The American College of Surgeons' National Surgical Quality Improvement Program (‘ACS-NSQIP’) risk calculator was developed to assess patients' 30-day post-operative risk, providing surgeons with information to guide decision making.
A retrospective review of 30-day actual mortality and morbidity of tongue cancer patients was undertaken to investigate the validity of this tool for South Australian patients treated from 2005 to 2015.
One hundred and twenty patients had undergone glossectomy. Predicted length of stay using the risk calculator was significantly different from actual length of stay. Predicted mortality and other complications were found to be similar to actual outcomes.
The American College of Surgeons' National Surgical Quality Improvement Program risk calculator was found to be effective in predicting post-operative complication rates in South Australian tongue cancer patients. However, significant discrepancies in predicted and actual length of stay may limit its use in this population.
Recurrent oropharyngeal squamous cell carcinoma causes great morbidity and mortality. This systematic review analyses survival outcomes following salvage surgery for recurrent oropharyngeal squamous cell carcinoma.
A comprehensive search of various electronic databases was conducted. Studies included patients with recurrent or residual oropharyngeal squamous cell carcinoma treated with salvage surgery. Primary outcomes were survival rates following salvage surgery. Secondary outcomes included time to recurrence, staging at time of recurrence, post-operative complications, and factors associated with mortality and recurrence. Methodological appraisal and data extraction were conducted as per Joanna Briggs Institute methodology.
Eighteen articles were included. The two- and five-year survival rates of the patients were 52 per cent and 30 per cent respectively.
Improvements in treatment modalities for recurrent oropharyngeal squamous cell carcinoma were associated with improvements in two-year overall survival rates, with minimal change to five-year overall survival rates. Various factors were identified as being associated with long-term overall survival, thus assisting clinicians in patient counselling and selection for salvage surgery.
The incidence of oropharyngeal squamous cell carcinoma in the Western world is increasing, with the human papillomavirus epidemic implicated in this observed trend. The optimal treatment modality is yet undetermined regarding oncological outcomes.
This study comprised 98 patients with oropharyngeal squamous cell carcinoma, treated with either primary transoral surgery with adjuvant therapy or primary chemoradiotherapy with curative intent, between 2008 and 2012. Clinicopathological characteristics including tumour–node–metastasis stage, human papillomavirus status, treatment modality, recurrence and overall survival were collated.
Five per cent of primary surgical patients had locoregional recurrences compared with 25 per cent of primary chemoradiotherapy patients. A lower rate of locoregional recurrence was observed in the human papillomavirus positive group.
This paper reports higher rates of overall survival and local control for oropharyngeal squamous cell carcinoma treated with primary surgery compared with primary chemoradiotherapy. This reflects overall lower tumour stage and higher human papillomavirus status in this group.
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.
This study aimed to evaluate the association of chronic rhinosinusitis with sudden sensorineural hearing loss using a population-based database.
Sampled subject data were obtained from the Taiwan Longitudinal Health Insurance Database 2000. A total of 3325 patients with sudden sensorineural hearing loss were identified and 9975 controls were randomly selected. A conditional logistic regression was used to calculate the odds ratio for having been previously diagnosed with chronic rhinosinusitis, for cases and controls.
Results and conclusion:
The adjusted odds ratio of having prior chronic rhinosinusitis among cases compared to controls was 1.36 (95 per cent confidence interval = 1.16–1.60). The significant relationship between sudden sensorineural hearing loss and chronic rhinosinusitis was most pronounced among those patients aged 44 years or less (compared to controls) (odds ratio = 2.18; 95 per cent confidence interval = 1.63–2.92). However, the significant relationship between sudden sensorineural hearing loss and prior chronic rhinosinusitis was not sustained for patients older than 60 years compared to controls.
The boundary element method (BEM) is easier than the finite element method (FEM) on the viewpoint of the discretization of one dimension reduction rather than the domain discretization of finite element method. The disadvantage of BEM is the rank deficiency in the influence matrix, e.g., degenerate boundary, degenerate scale, spurious eigenvalues and fictitious frequencies, which do not occur in the FEM. The conventional BEM can not be straightforward applied to solve a problem which contains a degenerate boundary without decomposing the domain to multi-regions. A hypersingular integral equation is used to ensure a unique solution for the problem containing a degenerate boundary. By combining the singular and hypersingular equations, it’s termed the dual BEM due to its dual frame. Following the successful experience on the retrieval of information using the singular value decomposition (SVD) updating term and updating document, this technique is also used to extract out the degenerate-boundary information and the rigid-body information in the dual BEM. It is interesting to find that true information due to a rigid-body mode in physics is found in the right singular vector with respect to the corresponding zero singular value while the degenerate-boundary mode (geometry degeneracy) in mathematics is imbedded in the left singular vector with respect to the corresponding zero singular value. The role of the common right and left singular vectors of SVD for the four influence matrices in the dual BEM is also discussed in this paper. Two examples, a potential flow problem across a cutoff wall and a cracked bar under torsion were demonstrated to see the mathematical SVD structure of four influence matrices in the dual BEM.
A novel allergy biosensor is designed and fabricated by using thin film bulk acoustic resonator (TFBAR) devices with shear mode ZnO piezoelectric thin films. To fabricate TFBAR devices, the off-axis RF magnetron sputtering method for the growth of piezoelectric ZnO piezoelectric thin films is adopted. The influences of the relative distance and sputtering parameters are investigated. In this report, the piezoelectric ZnO thin films with tilting angle are set by controlling the deposition parameters. The properties of the shear mode ZnO thin films are investigated by X-ray diffraction and scanning electron microscopy. The frequency response is measured using an HP8720 network analyzer with a CASCADE probe station. The resonance frequency of the shear mode is 796.75 MHz. The sensitivity of the shear mode is calculated to be 462.5 kHz·cm2/ng.
Although the compartmentalization of poultry industry components has substantial economic implications, and is therefore a concept with huge significance to poultry industries worldwide, the current requirements for compartment status are generic to all OIE member countries. We examined the consequences for potential outbreaks of highly pathogenic avian influenza in the British poultry industry using a metapopulation modelling framework. This framework was used to assess the effectiveness of compartmentalization relative to zoning control, utilizing empirical data to inform the structure of potential epidemiological contacts within the British poultry industry via network links and spatial proximity. Conditions were identified where, despite the efficient isolation of poultry compartments through the removal of network-mediated links, spatially mediated airborne spread enabled spillover of infection with nearby premises making compartmentalization a more ‘risky’ option than zoning control. However, when zoning control did not effectively inhibit long-distance network links, compartmentalization became a relatively more effective control measure than zoning. With better knowledge of likely distance ranges for airborne spread, our approach could help define an appropriate minimum inter-farm distance to provide more specific guidelines for compartmentalization in Great Britain.
A review of the annual prevalence of Pseudomonas aeruginosa at a regional hospital in Taiwan revealed a significant increase in the incidence of extensive drug-resistant P. aeruginosa (XDRPA) from 2·1% in 2003 to 5·8% in 2007. The first XDRPA isolate was recovered in 2001 from the emergency ward. The widespread dissemination of XDRPA isolates to more than 10 other wards was discovered the following year. Six pulsotypes of 67 XDRPA isolates from 2006 onwards were identified and 91% were a single strain, suggesting the existence of a hidden outbreak. Prior to the recognition of the outbreak, the majority of cases were not considered to be healthcare-associated infections until molecular evidence was provided. A cohort measure was launched by the infection control practitioners that effectively controlled the outbreak. Patients with XDRPA were mostly referred from neighbouring long-term care facilities, which may have been the reservoir of the XDRPA clone.
This paper presents the flow structure under a partially inundated bridge deck measured by using particle image velocimetry (PIV) and flow visualization techniques. The approaching flow was subcritical having Froude number F in the range 0.12 ∼ 0.55. The proximity ratio Pr (= ratio of clearance below the bridge deck h to the total depth of deck D) was varied from 0.57 to 2. Depending upon the Froude number F and proximity ratio Pr, four types of flow structures under the bridge deck were recognized. In flow Type I, the water surface elevation on the downstream side of bridge deck is slightly lower than the counterpart on the upstream side, and the shear layer formed at the bottom of upstream girder continuously fluctuates and touches soffit of all girders. In the case of flow Type II, the water surface on downstream side of bridge deck is lower than that on the upstream side and the shear layer originating from the upstream girder impinges near the third cavity between girders. However, in both the cases, the cavities between the girders are completely occupied by vortices. On the contrary, in the cases of flow Type III and flow Type IV, the flow is separated from the upstream girder edge. However, in flow Type III, the separated flow impinges on successive girders and cavities are partially filled by water; while in flow Type IV, the flow is totally separated from the deck bottom like orifice flow. The phenomena of vortex formation within the cavities are discussed for the cases of flow Type I and flow Type II. Also, for the vertical distribution of mean streamwise velocity in the shear layer below bridge deck, the nonlinear regression equations are developed. Using the distributions of measured mean streamwise velocity within the shear layer below the bridge deck at different streamwise distances, the similarity profile is obtained. The mean velocity deficit (usl – usu) and representative thickness bs are considered as the appropriate characteristic velocity and length scales for developing similarity profile. The proposed characteristic scales provided unique similarity profiles having promising regression coefficient. The similarity profile proposed is suitable for more general case of bridge deck having different bridge girders and even for rectangular block without girder. Further, the turbulence characteristics for the flow below the bridge deck are also presented.
As critical dimensions decrease, key dimension-related dielectric etch challenges emerge, including via and trench uniformity and etch depth profile. The transition to ultra-low-k films such as BDIII (Black Diamond; k=2.55) dielectrics requires consideration of film sensitivity to compositional modification, polymer interactions at pores, and the effect of diffusion. Use of N2/O2 plasma at 60 ˚C to modify the M1 trench profile has been demonstrated to lower the RC delay by 14% as compared to traditional CO2 plasmas at 60˚C. Use of a DHF solution to clean the etching residue in the dual damascene structure results in >97% yield with a tight range of via chain resistance.
In April 2009, 2009 pandemic influenza A (H1N1) (hereafter, pH1N1) virus was identified in California, which caused widespread illness throughout the United States. We evaluated pH1N1 transmission among exposed healthcare personnel (HCP) and assessed the use and effectiveness of personal protective equipment (PPE) early in the outbreak.
Two hospitals and 1 outpatient clinic in Southern California during March 28-April 24, 2009.
Sixty-three HCP exposed to 6 of the first 8 cases of laboratory-confirmed pH1N1 in the United States.
Baseline and follow-up questionnaires were used to collect demographic, epidemiologic, and clinical data. Paired serum samples were obtained to test for pH1N1-specific antibodies by microneutralization and hemagglutination-inhibition assays. Serology results were compared with HCP work setting, role, and self-reported PPE use.
Possible healthcare-associated pH1N1 transmission was identified in 9 (14%) of 63 exposed HCP; 6 (67%) of 9 seropositive HCP had asymptomatic infection. The highest attack rates occurred among outpatient HCP (6/19 [32%]) and among allied health staff (eg, technicians; 8/33 [24%]). Use of mask or N95 respirator was associated with remaining seronegative (P = .047). Adherence to PPE recommendations for preventing transmission of influenza virus and other respiratory pathogens was inadequate, particularly in outpatient settings.
pH1N1 transmission likely occurred in healthcare settings early in the pandemic associated with inadequate PPE use. Organizational support for a comprehensive approach to infectious hazards, including infection prevention training for inpatient- and outpatient-based HCP, is essential to improve HCP and patient safety.
Suicide rates vary widely across nations and ethnic groups. This study aims to explore potential factors contributing to inter-ethnic differences in suicide rates.
Study subjects came from a case-control psychological autopsy study conducted in Taiwan, including 116 consecutive suicides from two aboriginal groups and Taiwanese Han; 113 of them each matched with two living controls. Gender-, age- and method-specific suicide rates, population attributable fraction (PAF) of suicide for five major risk factors, help-seeking before suicide and emergency medical aid after suicide were compared between the three ethnic groups.
One aboriginal group (the Atayal) had significantly higher adjusted rate ratios (RR) of suicide than the other aboriginal group (the Ami) [RR 0.20, 95% confidence intervals (CI) 0.12–0.34] and the Han (RR 0.26, 95% CI 0.16–0.40). Such differences can be explained by higher PAFs of suicide for three major risk factors (substance dependence, PAF 47.6%, 95% CI 25.5–64.2; emotionally unstable personality disorder, PAF 52.7%, 95% CI 32.8–69.0; family history of suicidal behaviour, PAF 43.5%, 95% CI 23.2–60.2) in this group than in the other two groups. This higher suicide rate was substantially reduced from 68.2/100 000 per year to 9.1/100 000 per year, comparable with the other two groups, after stepwise removal of the effects of these three risk factors. Suicide rates by self-poisoning were also significantly higher in this group than in the other two groups.
Higher rates of specific risk factors and use of highly lethal pesticides for suicide contributed to the higher suicide rate in one ethnic group in Taiwan. These findings have implications for developing ethnicity-relevant suicide prevention strategies.
In this paper, we report the development of AlGaN-based deep ultraviolet LEDs by rf plasma-assisted molecular beam epitaxy (MBE) emitting between 277 and 300 nm. Some of these devices were evaluated after fabrication at bare-die and some at wafer-level configurations. Devices with total optical output of 1.3 mW at injection current of 200 mA were produced, with maximum external quantum efficiency (EQE) of 0.16%. These performance values are equivalent to those reported for deep UV-LEDs grown by the Metalorganic chemical vapor deposition (MOCVD) method and measured at bare-die configuration. In parallel, we have evaluated the internal quantum efficiency (IQE) of AlGaN quantum wells, and found that such wells emitting at 250 nm have an IQE of 50%. From the analysis of these data, we concluded that the efficiency of deep UV LEDs is not limited by the IQE but by the light extraction efficiency, injection efficiency or a combination of both.
The invasive grass Bromus tectorum (cheatgrass, downy brome) has extensive ecological breadth in its introduced range, and is increasing in abundance at high elevations. As a predominantly selfing species with high potential population growth rates, it is a likely candidate for having general-purpose genotypes that facilitate its invasion into high elevations. We evaluated evidence for general-purpose genotypes by examining phenotypic and molecular variation in B. tectorum from low- and high-elevation sites in the Rocky Mountains. Common garden experiments revealed that plants from high elevations germinated faster, but no other phenological, morphological, or physiological differences were found between elevations. Leaf length was longer for low-elevation sites in a common garden using field-collected seeds, but this was not found in a common garden using greenhouse-grown seeds, suggesting maternal effects. For most traits, there was significant phenotypic variation among sites and individuals. Using microsatellites, we genotyped individuals from low- and high-elevation sites. We found no indication of genetic differentiation at these loci between high and low elevations, but there was significant variation within and among sites. No single genotype was common across sites. The success of B. tectorum is not due to a few general-purpose genotypes, but rather many genotypes associated with many different phenotypes. Understanding the mechanisms behind the success of invaders enhances our knowledge of basic evolutionary and ecological processes and is crucial to our ability to manage ongoing, and prevent future, invasions, especially into new habitats.
This paper studies the impact of LTPS (low temperature polycrystalline silicon) TFTs with fluorine implantation under NBTI (Negative bias temperature instability) stress. The fluorinated TFTs' devices can obtain better characteristics with samller threshold voltage shift, lower trap states and lower subthreshold swing variation. Therefore, the fluorine implantation does not only improve initial electrical characteristics, but also suppresses the NBTI-induced degradation.
In this paper, simple techniques were proposed to fabricate germanium nanocrystal capacitors by one-step thermal oxidation and/or rapid thermal annealing on polycrystalline-SiGe (poly-SiGe) deposited with a LPCVD (low pressure chemical vapor deposition) system. This thermal oxidation method can directly result in the top-control oxide layer via the oxidation of amorphous-Si film and the formation of Ge nanocrystals from the poly-SiGe film. Otherwise, the rapid thermal annealing method can be also used to form Ge nanocrystals as comparison.