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Introduction: Low acuity patients have been controversially tagged as a source of emergency department (ED) misuse. Authorities for many Canadian health regions have set up policies so these patients preferably present to walk-in clinics (WIC). We compared the cost and quality of the care given to low acuity patients in an academic ED and a WIC of Québec City during fiscal year 2015-16. Methods: We conducted an ambidirectional (prospective and retrospective) cohort study using a time-driven activity-based costing method. This method uses duration of care processes (e.g., triage) to allocate to patient care all direct costs (e.g., personnel, consumables), overheads (e.g., building maintenance) and physician charges. We included consecutive adult patients, ambulatory at all time and discharged from the ED or WIC with a diagnosis of upper respiratory tract infection (URTI), urinary tract infection (UTI) or low back pain. Mean cost [95%CI] per patient per condition was compared between settings after risk-adjustment for age, sex, vital signs, number of regular medications and co-morbidities using generalized log-gamma regression models. Proportions [95%CI] of antibiotic prescription and chest X-Ray use in URTI, compliance with provincial guidelines on use of antibiotics in UTI, and column X-Ray use in low back pain were compared between settings using a Pearson Chi-Square test. Results: A total of 409 patients were included. ED and WIC groups were similar in terms of age, sex and vital signs on presentation, but ED patients had a greater burden of comorbidities. Adjusted mean cost (2016 CAN$) of care was significantly higher in the ED than in the WIC (p < 0.0001) for URTI (78.42[64.85-94.82] vs. 59.43[50.43-70.06]), UTI (78.88[69.53-89.48] vs. 53.29[43.68-65.03]), and low back pain (87.97[68.30-113.32] vs. 61.71[47.90-79.51]). For URTI, antibiotics were more frequently prescribed in the WIC (44.1%[34.3-54.3] vs. 5.8%[1.2-16.0]; p < 0.0001) and chest X-Rays, more frequently used in the ED (26.9%[15.6-41.0] vs. 13.7%[7.7-22.0]; p = 0.05). No significant differences were observed in the compliance with guidelines on use of antibiotics in UTI and in the use of column X-Ray in low back pain. Conclusion: Total cost of care for low acuity patients is lower in walk-in clinics than in EDs. However, our results suggest that quality-of-care issues should be considered in determining the best alternate setting for treating ambulatory emergency patients.
There has recently been an increased interest in mental health indicators for the monitoring of population wellbeing, which is among the targets of Sustainable Development Goals adopted by the United Nations. Levels of subjective wellbeing and suicide rates have been proposed as indicators of population mental health, but prior research is limited.
Data on individual happiness and life satisfaction were sourced from a population-based survey in Hong Kong (2011). Suicide data were extracted from Coroner's Court files (2005–2013). Area characteristic variables included local poverty rate and four factors derived from a factor analysis of 21 variables extracted from the 2011 census. The associations between mean happiness and life satisfaction scores and suicide rates were assessed using Pearson correlation coefficient at two area levels: 18 districts and 30 quantiles of large street blocks (LSBs; n = 1620). LSB is a small area unit with a higher level of within-unit homogeneity compared with districts. Partial correlations were used to control for area characteristics.
Happiness and life satisfaction demonstrated weak inverse associations with suicide rate at the district level (r = −0.32 and −0.36, respectively) but very strong associations at the LSB quantile level (r = −0.83 and −0.84, respectively). There were generally very weak or weak negative correlations across sex/age groups at the district level but generally moderate to strong correlations at the LSB quantile level. The associations were markedly attenuated or became null after controlling for area characteristics.
Subjective wellbeing is strongly associated with suicide at a small area level; socioeconomic factors can largely explain this association. Socioeconomic factors could play an important role in determining the wellbeing of the population, and this could inform policies aimed at enhancing population wellbeing.
Hand, foot and mouth disease (HFMD) is generally a benign febrile exanthematous childhood disease caused by human enteroviruses. The route of transmission is postulated to be faeco-oral in developing areas but attributed more to respiratory droplet in developed areas. Transmission is facilitated by the prolonged environmental survival of these viruses and their greater resistance to biocides. Serious outbreaks with neurological and cardiopulmonary complications caused by human enterovirus 71 (HEV-71) seem to be commoner in the Asian Pacific region than elsewhere in the world. This geographical predilection is unexplained but could be related to the frequency of intra- and inter-typic genetic recombinations of the virus, the host populations' genetic predisposition, environmental hygiene, and standard of healthcare. Vaccine development could be hampered by the general mildness of the illness and rapid genetic evolution of the virus. Antivirals are not readily available; the role of intravenous immunoglobulin in the treatment of serious complications should be investigated. Monitoring of this disease and its epidemiology in the densely populated Asia Pacific epicentre is important for the detection of emerging epidemics due to enteroviruses.
Patients with major depressive disorder are found to show selective attention biases towards mood-congruent information. Although previous studies have identified various structural changes in the brains of these patients, it remains unclear whether the structural abnormalities are associated with these attention biases. In this study, we used voxel-based morphometry (VBM) to explore the structural correlates of attention biases towards depression-related stimuli.
Seventeen female patients with major depressive disorder and 17 female healthy controls, matched on age and intelligence, underwent magnetic resonance imaging (MRI). They also performed positive-priming (PP) and negative-priming (NP) tasks involving neutral and negative words that assessed selective attention biases. The reaction time (RT) to a target word that had been attended to or ignored in a preceding trial was measured on the PP and NP tasks respectively. The structural differences between the two groups were correlated with the indexes of attention biases towards the negative words.
The enhanced facilitation of attention to stimuli in the PP task by the negative valence was only found in the depressed patients, not in the healthy controls. Such attention biases towards negative stimuli were found to be associated with reduced gray-matter concentration (GMC) in the right superior frontal gyrus, the right anterior cingulate gyrus and the right fusiform gyrus. No differential effect in inhibition of attention towards negative stimuli in the NP task was found between the depressed patients and the healthy controls.
Specific structural abnormalities in depression are associated with their attention biases towards mood-congruent information.
Diffusion tensor imaging (DTI) can be used to investigate cerebral structural connectivity in never-medicated individuals with first-episode schizophrenia.
Subjects with first-episode schizophrenia according to DSM-IV-R who had never been exposed to antipsychotic medication (n=25) and healthy controls (n=26) were recruited. Groups were matched for age, gender, best parental socio-economic status and ethnicity. All subjects underwent DTI and structural magnetic resonance imaging (MRI) scans. Voxel-based analysis was performed to investigate brain regions where fractional anisotropy (FA) values differed significantly between groups. A confirmatory region-of-interest (ROI) analysis of FA scores was performed in which regions were placed blind to group membership.
In patients, FA values significantly lower than those in healthy controls were located in the left fronto-occipital fasciculus, left inferior longitudinal fasciculus, white matter adjacent to right precuneus, splenium of corpus callosum, right posterior limb of internal capsule, white matter adjacent to right substantia nigra, and left cerebral peduncle. ROI analysis of the corpus callosum confirmed that the patient group had significantly lower mean FA values than the controls in the splenium but not in the genu. The intra-class correlation coefficient (ICC) for independent ROI measurements was 0.90 (genu) and 0.90 (splenium). There were no regions where FA values were significantly higher in the patients than in the healthy controls.
Widespread structural dysconnectivity, including the subcortical region, is already present in neuroleptic-naive patients in their first episode of illness.
This study presents the mechanical and electrical properties (including elastic modulus, yield strength and electrical resistance) of PDMS/CNTs nanocomposites. The elastic modulus and yield strength were determined from tensile tests. In addition, a high resistance meter was used to measure the electrical resistances of the PDMS/CNTs nanocomposites. The test specimens of nanocomposites were manufactured using the thermoforming method. There were two recipes used during the thermoforming process: 100 °C for 1 hour, and 150 °C for 15 minutes. The mixtures of PDMS and CNTs were stirred by ultrasonic instrument to prevent polymerization. A feeler gap was used to define the thickness of the specimens. Therefore, the thickness could be controlled within the range of ∼100 μm. Four different kinds of specimens were investigated, including pure PDMS, 1.0 wt%, 2.0 wt% and 4.0 wt% CNTs polymeric composites. As for the l00°C recipe, the elastic modulus of pure PDMS, 1.0 wt%, 2.0 wt%, and 4.0 wt% CNTs were 1.05MPa, 1.17MPa, 1.10MPa and 1.35MPa, respectively. A for the l50°C recipe, the elastic modulus of pure PDMS, 1.0 wt%, 2.0 wt% and 4.0 wt% CNTs were 1.32MPa, 1.42MPa, 1.43MPa, and 1.54MPa. The differences of electrical resistance of PDMS/CNTs nanocomposites at two different conditions and the microstructures composed of the mixtures are also described in this article.
A white cast iron of composition Fe81C14Si5 can be cast into a nanostructure with network morphology by a fluxing technique. The conventional morphology of white cast iron, which is brittle, is eutectic. The mechanical behavior of network white cast iron is attractive. Hardness tests indicate that its average hardness value is ∼770 HV. The indentations made during hardness tests have no cracks. A stylus surface profiler was employed to study the surface profile at and near the indentations. The studies indicate that there are severe plastic flows, but without cracks.
We find evidence for dust in the intervening QSO absorbers from the spectra of QSOs in the Sloan Digital Sky Survey Data Release 1. No evidence is found for the 2175 Å feature which is present in the Milky Way dust extinction curve.
Charcoal-burning, a new suicide method, emerged in Hong Kong during the latest economic recession. With-in 2 months charcoal-burning had become the third most common suicide method.
To examine the characteristics of suicides by charcoal-burning, and to delineate the pathways linking macro-level economic and social changes with the subjective experiences of those surviving a charcoal-burning suicide attempt.
Both quantitative and qualitative methods were used. In the coroner's records study, the first 160 cases of suicide by charcoal-burning were compared with a control group. In the ethnographic enquiry, we interviewed 25 consecutive informants who had survived serious suicide attempt using charcoal-burning.
People who completed suicide by the charcoal-burning method were more likely to have been economically active and physically healthy, and were less likely to have had pre-existing mental illness. Charcoal-burning suicide was associated with overindebtedness. Media reports were pivotal in linking overindebtedness and financial troubles with charcoal-burning.
The political economy of suicide by charcoal-burning illustrated how historical, socio-economic and cultural forces shaped the lived experience that preceded suicide.
The ABO blood group is the most important blood group system in transfusion medicine. Since the ABO gene was cloned and the molecular basis of the three major alleles delineated about 10 years ago, the gene has increasingly been examined by a variety of DNA-based genotyping methods and analysed in detail by DNA sequencing. A few coherent observations emerge from these studies. First, there is extensive sequence heterogeneity underlying the major ABO alleles that produce normal blood groups A, B, AB and O when in correct combination with other alleles. Second, there is also extensive heterogeneity underlying the molecular basis of various alleles producing ABO subgroups such as A2, Ax and B3. There are over 70 ABO alleles reported to date and these alleles highlight the extensive sequence variation in the coding region of the gene. A unifying system of nomenclature is proposed to name these alleles. Third, extensive sequence variation is also found in the non-coding region of the gene, including variation in minisatellite repeats in the 5′ untranslated region (UTR), 21 single nucleotide polymorphisms (SNPs) in intron 6 and one SNP in the 3′ UTR. The haplotypes of these variations reveal a specific relationship with the major ABO alleles. Fourth, excluding the common alleles, about half of the remaining alleles are due to new mutations and the other half can better be explained by intragenic recombination (both crossover and gene conversion) between common alleles. In particular, the recombination sites in hybrid alleles can be quite precisely defined through haplotype analysis of the SNPs in intron 6. This indicates that recombination is equally as important as point mutations in generating the genetic diversity of the ABO locus. Finally, a large number of ABO genotyping methods are available and are based on restriction analysis, allele specific amplification, mutation screening techniques or their combinations.
We used spoligotyping to study 500 randomly selected pretreatment Mycobacterium tuberculosis (MTB) strains isolated in Hong Kong during the 2 year period 1998–9. It was found that amongst all MTB strains studied, the ‘Beijing’ genotype strains were highly prevalent in our geographic area, representing about 70% of the isolates. Unlike previous observations in Vietnam, no significant associations were found either between ‘Beijing’ genotype strains and all other anti-tuberculosis drug resistance phenotypes, or with particular patients' age groups, except for a weak association with isoniazid susceptibility. Eighteen of these strains exhibited spoligotype patterns that were similar but not identical to the ‘Beijing’ specific pattern. This is the first geographical area where genetic diversity among ‘Beijing’ genotype of MTB strains has been observed on this scale.
This study is part of our effort to map recombination hotspots in two regions (site A, 18 kb; site B,
40 kb) of the human phosphoglucomutase PGM1 gene. Twenty-two PCR amplified fragments
comprising six groups, covering about 5.2 kb, were screened for single nucleotide polymorphisms
(SNPs) using non-isotopic single stranded conformation polymorphism (SSCP) analysis. Fourteen
fragments were variable and seven of these showed common polymorphism. Our strategy for
screening for polymorphic sites in the PGM1 gene was based on the results of allelic association
analysis between each new marker and the sites of the classical isozyme polymorphism (2/1 in exon
4 and +/− in exon 8). Samples from four populations (Caucasian, Chinese, Vietnamese and New
Guinean) were typed for each of the seven polymorphic markers. Between two and four common
alleles were found in each case, together with a few rare alleles. Co-dominant inheritance patterns
were demonstrated by family studies. The molecular basis of each new marker was determined by
direct sequencing of the PCR products: most were SNPs except two that were small
insertions/deletions. Direct sequence analysis of a 2.1 kb segment in sixteen individuals revealed no
additional nucleotide variation indicating a very high level of efficiency of the SSCP screening
method used in this study. The overall nucleotide diversity (θ) for PGM1 was estimated as 0.9×10−3
based on 33 segregating sites in a sequence of 5187 nt and a sample size of 614 individuals.
Zinc Oxide crystals have historically been grown in hydrothermal autoclaves with a basic mineralizer; however, doubts have been raised about the quality of such crystals because they have often exhibited large x-ray rocking curve widths and low photoluminescence (PL) yield with large linewidths. Several ZnO crystals were grown hydrothermally and sliced parallel to the c-plane. This resulted in opposite surfaces (the C+ and C−) exhibiting pronounced chemical and mechanical differences. Different surface treatments were investigated and compared by PL both at room temperature and liquid helium temperatures, and by double axis X-ray rocking curve measurements. The high quality of hydrothermally-grown ZnO is substantiated by the narrow rocking curve widths and sharp PL peaks obtained. A critical factor in obtaining these results was found to be surface preparation.
High quality barium titanate films were grown on (001)LaAlO3 and r-Al2O3 in a wide thickness range of 0.5-10 µtm by sol-gel technique. Significant improvement of the films' crystallinity and optical quality was observed if acetate precursors are used vs. alkoxide precursors, and in the presence of lead oxide. The material is transparent at 350-2000 nm, indicating the possibility of its application in light controlling devices at wavelengths used in optical communication: 1300 and 1500 nm. Maximum field induced relative phase shift of 0.22 radian was measured in the film with composition of Ba0.9Pb0.1TiO3 under a field strength of 3.106 V/cm.
We evaluated the utility of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) and measured the prevalence of major depression six weeks after confinement among Chinese women in Hong Kong.
A prospective cohort of 145 women completed the EPDS, the 12-item General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) six weeks after giving birth. They were then assessed with the Structured Clinical Interview for DSM–III–R, non-patient version (SCID–NP) to establish psychiatric diagnosis. The criterion validity of EPDS was tested against this clinical diagnosis, and the concurrent validity against the GHQ and BDI scores was also evaluated. The internal consistency of the scales was measured by Cronbach's α coefficient.
The Chinese EPDS had satisfactory psychometric properties and a cut-off score of 9/10 is recommended for screening depressive illness in a general postnatal population. At six weeks postpartum, 5.5% of the study population suffered from major depression.
The Chinese EPDS will be useful for screening for postnatal depression.
Zinc Oxide crystals have historically been grown in hydrothermal autoclaves with a basic mineralizer; however, doubts have been raised about the quality of such crystals because they have often exhibited large x-ray rocking curve widths and low photoluminescence (PL) yield with large linewidths. Several ZnO crystals were grown hydrothermally and sliced parallel to the c-plane. This resulted in opposite surfaces (the C+ and C-) exhibiting pronounced chemical and mechanical differences. Different surface treatments were investigated and compared by PL both at room temperature and liquid helium temperatures, and by double axis X-ray rocking curve measurements. The high quality of hydrothermally-grown ZnO is substantiated by the narrow rocking curve widths and sharp PL peaks obtained. A critical factor in obtaining these results was found to be surface preparation.
Using off-axis reactive rf sputtering, we have grown extremely smooth, nearly epitaxial, (001) oriented ZnO films on c-axis sapphire substrates. Atomic Force Microscopy was used to determine that these films are extremely smooth, having an rms roughness of only a few tenths of a nanometer. Based on high resolution x-ray diffraction (HXRD), the ZnO is highly oriented, with a rocking curve width of less than 400 arc seconds for the (006) diffraction peak, and only somewhat larger for the (112) reflection. HXRD Phi scans show that the ZnO (112) reflection is rotated in the a-b plane by 30 degrees from the sapphire (113) direction. These two measurements indicate excellent in-plane orientation. We are investigating the use of these buffer layers for subsequent GaN growth. Electrical resistivities of the films exceeded 100 kΩ-cm making ZnO a potential candidate as an insulating buffer layer.