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Background: Opportunistic infection should be considered when seeing neurological complications in the setting of immunosuppression. Accumulating evidence that enteroviral meningoencephalitis can occur after rituximab administration exists but differentiating it from non-infectious conditions can be challenging. Methods: Case report Results: We describe a 4 year-old-boy with a history of pulmonary capillaritis, treated with immunosuppressive therapy -including steroids, rituximab, and azathioprine. He developed mutism and ataxia after 18 months on rituximab. MRI Brain/Spine revealed extensive T2/FLAIR hyperintensities in the deep subcortical white matter, temporal lobes, globus pallidi, thalami, brainstem, and cerebellum; and swelling of the dorsal cervical cord, showing primarily grey matter involvement. IgG levels had a decreasing trend over the course of Rituximab. CSF, and subsequent brain biopsy, were both positive for enterovirus RNA by RT-PCR. He was thought to have enterovirus encephalitis secondary to rituximab therapy, and was treated with IVIG and fluoxetine. Conclusions: One should consider chronic opportunistic CNS infections in children treated with immunosuppressive therapy, and to consider chronic enterovirus infection when B-cell suppression has occurred. As rituximab is being increasingly used in the pediatric population, and is generally thought to be safe, attention should be paid to any child with chronic neurological signs, particularly younger children who may be at higher risk for chronic enterovirus infection.
Introduction: With the increasing volume of medical literature published each year, it is difficult for clinicians to translate the latest research into practice. Awareness is the first step of knowledge translation and journals have begun using social media to increase the dissemination and awareness of their publications. Infographics can describe research findings visually, are shared broadly on social media, and may be a more effective way to convey information. We hypothesized that infographic abstracts would increase the social media dissemination and online readership of research articles relative to traditional abstracts. Methods: In this randomized controlled trial, 24 original research articles were chosen from the six issues of the Canadian Journal of Emergency Medicine (CJEM) published between July 2016 and May 2017 (4 articles per issue). Half were randomized to the infographic and control groups within each issue. Infographic articles were promoted using a visual infographic outlining the findings of the article. Control articles were promoted using a screen capture image of each articles abstract. Both were disseminated through the journals social media accounts (Twitter and Facebook) along with the link to the selected article. Infographics were also published on CanadiEM.org. Abstract views, full text views, and the change in Altmetric score were tracked for 30 days and compared between groups. Unpaired two-tailed t-tests were used to detect significant differences. Results: Abstract views (mean, SD) were significantly higher for infographic articles (378.9, 162.0) than control articles (175.5, 69.2, p<0.001). Mean Altmetric scores were significantly higher for infographic articles (26.4, 13.8) than control articles (3.4, 1.7, p<0.0001). There was no statistically significant difference in full-text views between infographic (49.7, 90.4) and control articles (25.3, 12.3). Conclusion: CJEM articles promoted on social media using infographics had higher abstract viewership and Altmetric scores than those promoted with traditional abstracts. Although there was no difference in full-text readership, our results suggest that infographic abstracts may have a role in increasing the dissemination of medical literature.
In rock engineering, evaluating the post-peak strength and deformation of rock is necessary. To explore the elasto-plastic behavior of sandstone in the post-peak stage, a series of strain-controlled triaxial tests were conducted under different confining pressures. According to the post-peak characteristics, a constitutive model based on nonlinear elasticity and generalized plasticity is proposed. This proposed model is characterized by the following features: (1) Nonlinear elasticity is observed under hydrostatic and shear loading; (2) the associated flow rule is followed; (3) substantial plastic deformation occurs during shear loading; and (4) post-peak softening behavior is accurately predicted. This model requires twelve material parameters, three for elasticity and nine for plasticity. The proposed model was validated by comparing the triaxial test results of Mushan sandstone at different hydrostatic pressures under dry and saturated conditions. In addition, the model is versatile; it can simulate the deformational behavior of two other sandstones. In summary, the proposed model can reasonably predict the complete stress–strain curve of sandstone.
Introduction: The CJEM Social Media Team was created in 2014 to assist the journal with the dissemination of its research online. It consists of two Social Media Editors (Junior and Senior) and a team of volunteer medical students and residents to assist their work. Collaborative promotional agreements were developed to promote CJEM articles on the Skeptics’ Guide to Emergency Medicine (SGEM) podcast through the ‘Hot off the Press’ (HOP) series and the CanadiEM blog through an infographic series. Methods:CJEM papers were selected for promotion by the Team based on their perceived interest to the online community of emergency physicians. Altmetric scores, which are a measure of online dissemination derived from a weighted algorithm of social media metrics, were collated for articles promoted using the SGEM HOP or CanadiEM blogs. A control group was created using the articles with the top two Altmetric scores in each CJEM issue in 2015 and 2016. Erratum, Letters, and articles written by the social media editors were excluded from the control groups. The success of the social media promotion was quantified through the measurement of Altmetric scores as of January 1, 2017. Unpaired two-tailed t-tests with unequal variance were used to test for significant differences. Results: 106 and 82 eligible articles were published in 2015 and 2016, respectively. Four articles in 2015 and two articles in 2016 were excluded from the control groups because they were written by the social media editors. SGEM HOP podcasts promoted one article in 2015 and five articles in 2016. CanadiEM infographics promoted three articles in 2015 and eight articles in 2016. No articles were promoted in both series. The average Altmetric score was higher for SGEM HOP (61.0) than CanadiEM Infographics (31.5, p<0.04), 2015 controls (15.8, p<0.01), and 2016 controls (13.6, p<0.01). The average Altmetric score for CanadiEM Infographics was higher than 2015 controls (p<0.04) and 2016 controls (p<0.02). There was no significant difference between the control groups. Conclusion: The results suggest that collaborating with established social media websites to promote CJEM articles using podcasts and infographics increases their social media dissemination. Given the nonrandomized design of these results, causative conclusions cannot be drawn. A randomized study of the impact of social media promotion on readership is underway.
Background: Planning for neurology training necessitated a reflection on the experience of graduates. We explored practice characteristics, and training experience of recent graduates. Methods: Graduates from 2010-2014 completed a survey. Results: Response rate was 37% of 211. 56% were female. 91% were adult neurologists. 65% practiced in an outpatient setting. 63% worked in academics. 85% completed subspecialty training (median 1 year). 36% work 3 days a week or less. 82% took general call (median 1 night weekly). Role preparation was considered very good or excellent for most; however poor or fair ratings were 17% in advocacy and 8% in leadership. Training feedback was at least “good” for 87%. Burnout a few times a week or more was noted by 5% (6% during residency, particularly PGY1 and 5). 64% felt overly burdened by paperwork. Although most felt training was adequate, it was poor or fair at preparing for practice management (85%) and personal balance (55%). Most conditions were under-observed in training environment. Many noted a need for more independent practice development and community neurology. Conclusions: Although our training was found to be very good, some identified needs included advocacy training, and more training in general neurology in the longitudinal outpatient/community settings.
In long-term care facilities (LTCFs), the elderly are apt to be infected because those with latent tuberculosis infections (LTBIs) are at an increased risk for reactivation and post-primary TB disease. We report an outbreak of TB in staff and residents in a LTCF. An outbreak investigation was conducted after two TB cases were reported from the LTCF. A tuberculin skin test (TST), bacteriological examination and chest radiograph were administered to all facility staff and residents. An outbreak is defined as at least two epidemiologically linked cases that have identical Mycobacterium tuberculosis genotype isolates. This outbreak infected eight residents and one staff member, who were confirmed to have TB in a LTCF between September 2011 and October 2012. Based on the Becker method, the latent and infectious periods were estimated at 223·6 and 55·9 days. Two initial TST-negative resident contacts were diagnosed as TB cases through comprehensive TB screening. Observing elderly people who have a negative TST after TB screening appears to be necessary, given the long latent period for controlling a TB outbreak in a LTCF. It is important to consider providing LTBI treatment for elderly contacts.
A radio-frequency magnetron sputtering technique and subsequent rapid thermal annealing (RTA) at 600, 700, 800, and 900 °C were implemented to grow high-quality Ga-doped MgxZn1-xO (GMZO) epi-layers. The GMZO films were deposited using a radio-frequency magnetron sputtering system and a 4 inch ZnO/MgO/Ga2O3 (75/20/5 wt %) target. The Hall results, X-ray diffraction (XRD), and transmittance were determined and are reported in this paper. The Hall results indicated that the increase in mobility was likely caused by the improved crystallization in the GMZO films after thermal annealing. The XRD results revealed that MgxZn1-xO (111) and MgO2 (200) peaks were obtained in the GMZO films. The absorption edges of the as-grown and annealed GMZO films shifted toward the short wavelength of 373 nm at a transmittance of 90%. According to these results, GMZO films are feasible for forming transparent contact layers for near-ultraviolet light-emitting diodes.
Repeat self-harm is an important risk factor for suicide. Few studies have explored risk factors for non-fatal repeat self-harm in Asia.
To investigate the risk of non-fatal repeat self-harm in a large cohort of patients presenting to hospital in Taipei City, Taiwan.
Prospective cohort study of 7601 patients with self-harm presenting to emergency departments (January 2004–December 2006). Survival analysis was used to examine the rates, timing and factors associated with repeat self-harm.
In total 778 (10.2%) patients presented to hospital with one or more further episodes of self-harm. The cumulative risk of non-fatal repetition within 1 year of a self-harm episode was 9.3% (95% CI 8.7–10.1). The median time to repetition within 1 year was 105 days. Females had a higher incidence of repeat self-harm than males (adjusted hazard ratio 1.25, 95% CI 1.05–1.48) but males had shorter median time to repetition (107 v. 80 days). Other independent risk factors for repeat self-harm within 1 year of an index episode were: young age, self-harm by medicine overdose and increasing number of repeat episodes of self-harm.
The risk of non-fatal repeat self-harm in Taipei City is lower than that seen in the West. Risk factors for repeat non-fatal self-harm differ from those for fatal self-harm. The first 3 months after self-harm is a crucial period for intervention.
The advantages and limitations of image guidance systems for endoscopic sinus surgery are unclear. We report our experience and present a meta-analysis of the evidence.
We performed a retrospective analysis of endoscopic sinus surgery procedures performed with versus without image guidance. A total of 355 cases was included. Primary outcomes included complication rates and time to revision surgery. A literature search was conducted to enable identification and analysis of studies of similar comparisons.
Within 1.5 years of the index sinus surgical procedure, the risk of revision surgery was significantly higher for patients treated with non-assisted versus computer-assisted endoscopic sinus surgery (p = 0.001). Meta-analysis did not indicate a reduction in complications or revision surgery procedures with the use of image guidance systems, although the majority of included studies showed a non-significant reduction in revision surgery.
Our study offers some evidence that computer-assisted endoscopic sinus surgery may delay residual disease and reduce the requirement for revision surgery. Although this finding was not borne out in the meta-analysis, the majority of identified studies demonstrated a trend towards fewer revision procedures after computer-assisted endoscopic sinus surgery. This type of surgery may offer other advantages that are not easily measurable.
Generic and interaction aspects of oxygen precipitation, related defect formation and denudation in Cz-Si wafers are presented. Bulk defect profiles and homogenization control are shown to be achievable by proper design of post-growth annealing.
Gettering-related phenomena are discussed including stacking fault-rich bulk defect structures and peculiarities in different epitaxy systems.
Most previous studies of long-term mortality risk following self-harm
have been conducted in Western countries with few studies from Asia.
To investigate suicide and non-suicide mortality after non-fatal
self-harm in Taipei City, Taiwan.
Prospective cohort study (median follow-up 3.3 years) of 7601 individuals
presenting to hospital with self-harm (January 2004 to December 2006).
Standardised mortality ratios (SMRs) for suicide and non-suicide
mortality were calculated.
Suicide risk in the year following self-harm was over 100 times higher
than in the general population (SMR = 119.6, 95% CI 99.6–142.5). Males
and middle-aged and older adults had the highest subsequent risk of
suicide. Compared with people who took an overdose, individuals who used
hanging or charcoal burning in their index episode had the highest risk
of suicide. For non-suicide mortality the SMRs were 6.7 (95% CI 5.7–7.8)
in the first year and 4.4 (95% CI 3.9–4.9) during the whole follow-up
Patterns of increased all-cause and suicide mortality following an
episode of self-harm are similar in Taipei City to those seen in Western
countries. Designing better aftercare following non-fatal self-harm,
particularly for those with underlying physical disorders or who have
used lethal self-harm methods, should be a priority for suicide
prevention programmes in Asia.
This paper proposes a complete basis set for analyzing elastic wave scattering in half-space. The half-space is an isotropic, linear, and homogeneous medium except for a finite inhomogeneity. The wave bases are obtained by combining buried source functions and their reflected counter-waves generated from the infinite-plane boundary. The source functions are the vector wave functions of infinite-space. Based on the source functions expressed in the Fourier expansion form, the reflected counter-waves are easily obtained by solving the infinite-plane boundary conditions. Few representations adopt Wely's integration, but the Fourier expansion is developed from it and applied to decouple the angular-differential terms of the vector wave functions. In addition to the scattering of the finite inhomogeneity, the transition matrix method is extended to express the surface boundary conditions. For the numerical application in this paper, the P- and the SV- waves are assumed as the incoming fields. As an example, this paper computes stress concentrations around a cavity. The steepest-descent path method yielding the optimum integral paths is used to ensure the numerical convergence of the wave bases in the Fourier expansion. The resultant patterns from these approaches are compared with those obtained from numerical simulations.
Bandgap engineered ZnSxO1-x films were grown on Fluorinated Ethylene Propylene (FEP) substrates and analyzed using transmission spectroscopy. FEP is considered as a potential substrate for application in flexible electronics and semiconductor films.
Shigella flexneri 4a caused sustained outbreaks in a large long-stay psychiatric centre, Taiwan, 2001–2006. Trimethoprim-sulphamethoxazole (SXT) prophylaxis was administered in 2004. We recovered 108 S. flexneri 4a isolates from 83 symptomatic (including one caregiver) and 12 asymptomatic subjects (11 contacts, one caregiver). The isolates were classified into eight antibiogram types and 15 genotypes (six clusters) by using antimicrobial susceptibility testing and pulsed-field gel electrophoresis of NotI-digested DNA, respectively. These characteristics altered significantly after SXT prophylaxis (P < 0·05), with concomitant emergence of SXT-resistant isolates in two antibiogram types. P01 (n = 71), the predominant epidemic genotype, caused infection in two caregivers and five patients under their care; two P01 isolates were recovered from the same patient 6 months apart. These results indicate the importance of sustained person-to-person transmission of S. flexneri 4a by long-term convalescent, asymptomatic or caregiver carriers, and support the emergence of SXT-resistant strains following selective pressure by SXT prophylaxis.
The introduction and the widespread use of the varicella vaccine in Taiwan has led to a 75–80% decrease in the incidence of varicella in children. However the vaccine's long-term impact on the incidence of herpes zoster (HZ) has attracted attention. By controlling gender, underlying diseases, and age effects, a Poisson regression was applied on the 2000–2008 chart records of 240 000 randomly selected residents who enrolled in the Universal National Health Insurance. The results show that, as the vaccine coverage in children increases, the incidence of varicella decreases. However, the incidence of HZ increased even before the implementation of the free varicella vaccination programme in 2004, particularly in females. The increase in the incidence of HZ cannot be entirely and directly attributed to the widespread vaccination of children. Continuous monitoring is needed to understand the secular trends in HZ before and after varicella vaccination in Taiwan and in other countries.
This study utilized a U-shape platform device to generate a single cavitation bubble for the detail analysis of the flow field characteristics and the cause of the counter jet during the process of bubble collapse induced by pressure wave. A series of bubble collapse flows induced by pressure waves of different strengths are investigated by positioning the cavitation bubble at different stand-off distances to the solid boundary. It is found that the Kelvin-Helmholtz vortices are formed when the liquid jet induced by the pressure wave penetrates the bubble surface. If the bubble center to the solid boundary is within one to three times the bubble's radius, a stagnation ring will form on the boundary when impacted by the penetrated jet. The liquid inside the stagnation ring is squeezed toward the center of the ring to form a counter jet after the bubble collapses. At the critical position, where the bubble center from the solid boundary is about three times the bubble's radius, the bubble collapse flows will vary. Depending on the strengths of the pressure waves applied, either just the Kelvin-Helmholtz vortices form around the penetrated jet or the penetrated jet impacts the boundary directly to generate the stagnation ring and the counter jet flow. This phenomenon used the particle image velocimetry method can be clearly revealed the flow field variation of the counter jet. If the bubble surface is in contact with the solid boundary, the liquid jet can only splash radially without producing the stagnation ring and the counter jet. The complex phenomenon of cavitation bubble collapse flows are clearly manifested in this study.
It is found that the performance of self-assembled In0.5Ga0.5As/GaAs multi-stack quantum dot lasers is sensitive to the GaAs spacer thickness between the dots. Reducing the spacer thickness from 30 nm to 10 nm leads to narrow photoluminescence linewidth, low threshold current, high characteristic temperature and high internal quantum efficiency. This behavior is attributed to inhomogeneous broadening caused by dot size fluctuation related to spacer thickness.