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To assess healthy-related quality of life and psychosocial adjustment in children with newly diagnosed cancer and their parents immediately and 6 months after diagnosis and treatment of cancer.
A prospective, case control study was conducted on eighty-nine children with newly diagnosed cancer, aged between 6 months to 16.7 years (mean, 8.2 years), and ninety healthy children of matched age group and social background. The children were assessed with the Child Behavior Checklist (CBCL), and the Parenting Stress Index (PSI) and the SF-36 questionnaire were administered to their parents immediately after diagnosis of cancer, 3 months after chemotherapy, and 6 months after chemotherapy.
No matter at the period immediately after diagnosis of cancer, 3 months or 6 months after starting chemotherapy, the parents of children with cancer scored significantly worse on every domains of SF-36 except body pain and every subscales of PSI except distractibility/hyperactivity and attachment when compared with the control group. The cancer group scored consistently lower on all CBCL syndrome scales than the control group, with anxiety, depression and body pain being significantly different. After starting chemotherapy, the parents reported improved scores on quality of life and decreasing parenting stress in both parent and child domains since 3 months or 6 months after starting chemotherapy.
Considerable distress was experienced by both children with newly diagnosed cancer and their parents during the period immediately after diagnosis. However, parents can adjust gradually since 3 months after starting chemotherapy and experience improved quality of life.
Patients with chronic kidney disease (CKD) have more cognitive impairments. However, the etiologies are not fully clear. Plasma homocysteine levels and vascular burden rise in CKD; meanwhile, high homocysteine levels and vascular factors are known risk factors of dementia in non-CKD patients. Thus, we aimed to investigate the association between homocysteine, vascular burden and cognitive impairment in CKD and to see if the effect of elevated homocysteine on cognitive impairment mediated by vascular factor.
146 patients with CKD and 69 normal comparisons were recruited. Cognitive function was evaluated by comprehensive neuropsychological tests assessing processing speed, executive function, language, visuospatial function, memory, and attention domains. Vascular burden was assessed by Framinghan cardiovascular risk scale (FCRS) which indicates risk of atherosclerotic diseases including stroke.
In controlled analysis, patients with CKD had lower scores in all cognitive domains, and had higher homocysteine levels (18.5±6.4 vs. 9.8±2.9, p< 0.0001) and FCRS(17.0±4.7 vs. 14.0±4.7, p< 0.0001). Among patients with CKD, higher homocysteine levels (p=0.026) were associated with lower score on digit symbol task which is related to processing speed and executive function with controlling for age, sex, education and stage of CKD. The association persisted (p=0.047) after controlling for vascular risks.
Patients with CKD had extensive cognitive impairments. Elevated homocysteine levels may be an risk factor, which is independent of vascular burden, of cognitive impairment on processing speed and executive function. Further studies to investigate if normalization of homocysteine can improve cognitive function will be suggested.
Suicide rates are high for older persons worldwide. However, no literature could be found on young-old people’s opinions about elderly suicide and the beliefs/expectations that protect them from attempting suicide.
To explore opinions about elderly suicide among community-dwelling young-old people in Taiwan and their reasons for not killing themselves.
A qualitative descriptive design was used. Young-old (65–74 years old) outpatients were recruited by convenience from two randomly selected medical centers in northern Taiwan if they had never expressed suicidal ideas and had no severe cognitive deficit. Data were collected in individual interviews and analysed by content analysis.
Among 31 participating young-old people, most participants (87.1%) had heard of elderly suicide. Their opinions about elderly suicide reflected negative emotional reactions (32.3%), judgmental attitudes (32.3%), could happen after losing the meaning of life (9.7%), and expectations of social welfare (9.7%). Reasons for not killing themselves fell into six major themes: living well (32.3%), suicide cannot resolve problems (22.6%), fear of humiliating their children (16.1%), religious beliefs (12.9%), never thought about suicide (12.9%), and living in harmony with nature (12.9%).
Among the factors that prevented participants from killing themselves, perceptions of living well and of children’s filial behavior, as well as rational thinking could be adjusted. These factors can be addressed and improved by healthcare providers and policy makers to prevent suicide among the young-old. Our findings may also serve as a reference for geriatric researchers in western countries with increasing numbers of elderly ethnic minority immigrants.
The purposes of this study were to explore elderly outpatients’ perceived reasons for, opinions of, and suggestions for elderly people considering suicide in Taiwan.
Elderly outpatients (N=83) were recruited in 2011-2012 by convenience sampling from three randomly selected medical centers in Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by content analysis.
Findings revealed that most participants had heard of elderly suicide, with television news as the main source for their information. Their opinions about elderly suicide reflected judgmental attitudes, negative emotional reactions, expectations of social welfare, and could happen after losing one's meaning in life. Their suggestions for elderly people considering suicide fell into four major themes: give up suicidal ideas, seek help, enhance social welfare, and attend religious activities.
Since television news was the main source for participants’ information about elderly suicide, this mass medium should be used in suicide prevention to disseminate suicide knowledge, increase access to help, and strengthen suicide-protective factors among the elderly. Furthermore, no participants mentioned depression as a reason for attempted or completed suicide among older people despite depression being a well-known suicide-risk factor. Future suicide-prevention programs should emphasize the role of depression in suicide among older people. Participants also did not suggest that older people considering suicide seek help from the health system. Thus, older people should be educated about the role of the health system in suicide prevention and trained as gatekeepers to recognize signs of suicide ideation and respond appropriately.
Origami, the ancient paper folding art has inspired the engineering equipment and design for decades. The basic concept of origami is very general, which leads to applications ranging from small scale to large scale. Recently, researchers are interested in being able to create self-folding structures. Such a structure enables kinematic manipulation by external forces or moments without folding and/or unfolding operations. This is a beneficial application for many fields including aerospace systems, robots, small devices and self-assembly systems. In this paper, the investigation and analyses of the previous literatures on the key driving force of the actuation structure, including the heat, light, electricity, gas and other actuation methods. The aims are to provide researchers and practitioners with the support to systematically understand the latest technologies in this important and evolving field, with inspiration and direction for follow-up.
In recent years, compact camera modules (CCMs) have been widely used in consumer electrical and electronic products. CCMs with low cost specially are necessary for portable devices. Therefore, the present group recently developed a miniaturized open-loop controlled camera module with low cost for cellphone applications, in which the Lorentz force is balanced by a magnetic restoring force. To enhance the performance of the camera module, this article reports a pattern structure to modify the linearity of the magnetic restoring force. We fabricated a CCM prototype with the dimensions of 8.5 mm × 8.5 mm × 5 mm and demonstrated the usefulness of the pattern structure with the CCM prototype. Its potential applications are foreseeable in portable devices, such as cellphones, web cameras, personal digital assistants and other commercial electronics.
The aim of the study was to evaluate the comparative risk of self-harm associated with the use of different antidepressants.
A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 751 606 new antidepressant users with depressive disorders were included. The study outcome was hospitalization due to self-harm (International Classification of Diseases, Ninth Revision, Clinical Modification codes: E950–E958 and E980–E988). Cox proportional hazards models with stratification of the propensity score deciles were used to estimate the hazard ratios of self-harm hospitalization during the first year following the initiation of antidepressant treatment.
There were 1038 hospitalization episodes due to self-harm that occurred during the follow-up of 149 796 person-years, with an overall incidence rate of 6.9 [95% confidence interval (CI) 6.5–7.4] per 1000. Compared with fluoxetine, the risk of self-harm hospitalization was higher for maprotiline [adjusted hazard ratio (aHR) = 3.00, 95% CI 1.40–6.45], milnacipran (aHR = 2.34, 95% CI 1.24–4.43) and mirtazapine (aHR = 1.40, 95% CI 1.06–1.86), lower for bupropion (aHR = 0.51, 95% CI 0.30–0.86), and similar level of risk was found for other selective serotonin reuptake inhibitors (citalopram, escitalopram, fluvoxamine, paroxetine and sertraline).
The risk of self-harm may vary across different antidepressant drugs. It would be of importance to conduct further research to investigate the influence of antidepressant use on self-harm behaviors.
EVA foams, like all other polymers, also exhibit strain-rate effects and hysteresis. However, currently available approaches for predicting the mechanical response of polymeric foam subjected to an arbitrarily imposed loading history and strain-rate effect are highly limited. Especially, the strain rates in the intermediate rate domain (between 100 and 102 s–1) are extremely difficult to study. The use of data generated through the drop tower technique for implementation in constitutive equations or numerical models has not been considered in past studies. In this study, an experiment including a quasi-static compression test and drop impact tests with a high speed camera was conducted. An inverse analysis technique combined with a finite element model for material parameter identification was developed to determine the stress–strain behavior of foam at different specific strain rates. It was used in this study to simulate multiple loading and unloading cycles on foam specimens, and the results were compared with experimental measurements.
Voice restoration after laryngopharyngectomy can be achieved with an autologous ileocolic flap. We have observed that the length of the flap influences vocal outcome. This investigation aimed to evaluate the association between ileocolic flap length and vocal quality after laryngopharyngectomy.
The charts of patients who underwent voice rehabilitation with an ileocolic flap after laryngopharyngectomy between 1 January 2011 and 30 December 2012 were abstracted. The length of ileum segment in the ileocolic flap was stratified, and voice outcome was evaluated three months post-operatively, while adjusting for confounding variables.
There was a significant association between flap length and loudness, maximum phonation time and sound pressure level (p < 0.05). All three parameters were best in the 10 cm length group.
Voice rehabilitation after laryngopharyngectomy is possible with an ileocolic flap. The optimal ileocolic flap contains a 10 cm ileum segment. Complications are frequent but amenable to revision surgery.
An uneven neurocognitive profile is a hallmark of autism spectrum disorder (ASD). Studies focusing on the visual memory performance in ASD have shown controversial results. We investigated visual memory and sustained attention in youths with ASD and typically developing (TD) youths.
We recruited 143 pairs of youths with ASD (males 93.7%; mean age 13.1, s.d. 3.5 years) and age- and sex-matched TD youths. The ASD group consisted of 67 youths with autistic disorder (autism) and 76 with Asperger's disorder (AS) based on the DSM-IV criteria. They were assessed using the Cambridge Neuropsychological Test Automated Battery involving the visual memory [spatial recognition memory (SRM), delayed matching to sample (DMS), paired associates learning (PAL)] and sustained attention (rapid visual information processing; RVP).
Youths with ASD performed significantly worse than TD youths on most of the tasks; the significance disappeared in the superior intelligence quotient (IQ) subgroup. The response latency on the tasks did not differ between the ASD and TD groups. Age had significant main effects on SRM, DMS, RVP and part of PAL tasks and had an interaction with diagnosis in DMS and RVP performance. There was no significant difference between autism and AS on visual tasks.
Our findings implied that youths with ASD had a wide range of visual memory and sustained attention impairment that was moderated by age and IQ, which supports temporal and frontal lobe dysfunction in ASD. The lack of difference between autism and AS implies that visual memory and sustained attention cannot distinguish these two ASD subtypes, which supports DSM-5 ASD criteria.
Catalyst-free vapor phase transport was applied for the growth of ZnO nanoemitters. A single-crystalline ZnO:Al seed layer was deposited and used as a pseudo-catalyst. The desired morphology of nanostructures can be achieved by means of modifying the growth rates of crystal planes via adjustment in the growth conditions. The field emission characteristics of ZnO nanoemitters satisfied the Fowler-Nordheim relationship. The high aspect ratio of nanoemitters had a low turn-on electric field of 0.18 MV/m at emission current density of 0.1 μA/cm2. A stable electron emission with a variation of less than 14% was measured.
In this study the Maximum Likelihood Estimator is utilized to identify the characteristics of failure of class-H insulation by considering accelerated life test data under censored situations from Nelson. The hazard rate function is considered in terms of the reliability, h(R), so-called AE model. The AE model is used to model the failures which are expressed as the serial connection between three modes, namely the turn, phase, and ground. This is the so-called competing failure. The main concern in the present investigation relates to the characteristic of changes in cumulative damage with temperature. The characteristic of the damage process basically change, with less capability of cumulation. The failure tends to be unpredictable in a constant hazard rate situation in much higher temperature environments. The parameters of the model are related to the temperature and follow the Arrhenius law. The numerical results indicate that the AE model is well fitted to the data and gives more information to identify the failure modes with fewer parameters. This is better than the using Weibull distribution with both parameters varied with temperature. According to the predicted lifetime, the turn needs to be rearranged primarily, followed by the phase. The ground mode only has influence on the failure at much higher temperatures.
We investigated lactate dehydrogenase isoenzyme patterns in the cyst fluid of auricular pseudocysts and autogenous blood, to assist the diagnosis of auricular pseudocyst.
Twenty patients with auricular pseudocysts participated in this study conducted in Kaohsiung Medical University Hospital between February 2007 and June 2010. Patterns of lactate dehydrogenase in cyst fluid and autogenous blood were analysed.
Levels of lactate dehydrogenase 1 and 2 were lower in auricular pseudocysts than in autogenous blood, whereas levels of lactate dehydrogenase 4 and 5 were higher; this difference was statistically significant (p < 0.001).
Lactate dehydrogenase isoenzyme patterns in auricular pseudocyst fluid indicated higher percentage distributions of lactate dehydrogenase 4 and 5 and lower percentage distributions of lactate dehydrogenase 1 and 2. An effective laboratory method of evaluating the different lactate dehydrogenase isoenzyme components was developed; this method may improve the accuracy of auricular pseudocyst diagnosis.
In clinical practice, cam-out failure at the recess-screwdriver interfaces may occur when tightening or removing a bone screw. For titanium-based periarticular fixation, the literature reports have revealed that cold welding at the plate-screw interfaces makes the screw recess especially prone to cam-out failure during screw removal. In this study, the effects of the four recess shapes (cross, hexagon, star, and crest), three torque value (0.8, 1.0, and 1.2N-m), and the three interfacial misfits (0.00, 0.05, and 0.10mm) on the cam-out failure were numerically evaluated. The free-rotation angle, torque-recess angle, slippage-resisting length, and interfacial stress distribution were defined and chosen as comparison indices for the twelve recess-misfit variations. The results revealed that the interfacial slippage, torque transfer, and stress distribution are highly related to both recess shape and interfacial misfit. The stresses of all recesses and screwdrivers consistently initiate at the contact sites. However, the recess profile significantly affects the stress propagation. The stress patterns of the recess and screwdriver are quite different between the cross-star and hexagon-crest groups. The cross-star group is superior to the hexagon-crest group in terms of the torque-recess angle and slippage-resisting length over. This makes the recess of the cross-star group less stressed than its counterpart. However, the volumes of the cross and the star screwdriver are more highly stressed than the hexagon due to the irregular shape and the thinner flange, respectively. The greater torque and misfit increase the performance difference between the four recess designs. In conclusion, the geometry of the cross and star groups provide the better performance of the screw recess in terms of torque-transferring efficiency and slippage-resisting ability. If the screwdriver material is properly strengthened and the stress-concentrating corners are modified, the cross and star groups would be the optimal designs that protects and extends the lifetime of both recess and reused screwdriver.
In this study, a novel procedure has been developed for predicting the notched strengths of composite plates each with a center hole. In this approach, the stress distribution of a composite plate with a center hole is first obtained by a finite element analysis, in which the experimental notched strength is applied at the boundary of the finite element model. Secondly, the point stress criterion (PSC) is used to find the characteristic length for each plate with different size of hole by an interpolation of the finite element analysis results. The characteristic length is then expressed as an empirical function of the hole size as well as the width of the plate. Finally, the notched strengths of composite plates are predicted based on the empirical function and the finite element analysis results incorporated with the principle of superposition in elasticity. For validation, three different cases from the literatures are adopted for comparison. It is shown that the predicted notched strengths by this new methodology agree well with both the experimental results and the results from analytical solutions based PSC.
This study performs parametric analyses on the displacement ductility capacity of a fixed-head reinforced concrete pile in homogeneous clay, considering the spread of plasticity in the pile. The parametric study regards the pile as a limited ductility structure, which conditionally allows the pile to have inelastic response during large loading. The variables considered include the pile section parameters and p-y model parameters. A large number of pushover analyses are conducted to examine the displacement ductility capacity of the pile. The results show that the plastic hinging will occur at the pile head region for a fixed-head pile, and the displacement ductility capacity of the pile is mainly influenced by the over-strength ratio of the pile section. Furthermore, the second plastic region may occur in ground when the axial force is in high tension. Based on the design concept of limited ductility structures, the high tensile force in pile should be avoided in pile design. A quantitative relationship between the displacement ductility capacity and over-strength ratio is suggested for engineering applications.
We report production of a self-injected, collimated (8 mrad divergence), 600 pC bunch of electrons with energies up to 350 MeV from a petawatt laser-driven plasma accelerator in a plasma of electron density ne = 1017 cm−3, an order of magnitude lower than previous self-injected laser-plasma accelerators. The energy of the focused drive laser pulse (150 J, 150 fs) was distributed over several hot spots. Simulations show that these hot spots remained independent over a 5 cm interaction length, and produced weakly nonlinear plasma wakes without bubble formation capable of accelerating pre-heated (~1 MeV) plasma electrons up to the observed energies. The required pre-heating is attributed tentatively to pre-pulse interactions with the plasma.
We report formation of thin silicon oxide films on the silicon surfaces by combination of oxygen radical and high pressure H2O vapor heat treatment for passivation of silicon surfaces at a low temperature. Oxygen plasma was generated by 13.56 MHz radio frequency induction-coupled remote plasma with mixed gases of O2 and Ar at 2 sccm, 2x10-2 Pa and at a power of 50 W. Oxygen radical was produced from the plasma via a metal mesh closing plasma in the reactor. The top surfaces of 20 Wcm n-type silicon substrates with the rear surface coated by thermally grown SiO2 layers were exposed by oxygen radical from 1 to 5 min to oxidize the silicon surface. The samples were subsequently annealed with 9.0x105 Pa H2O vapor heat treatment at 260oC for 3 h. The effective minority carrier lifetime estimated using photo-induced carrier microwave absorption system in the case of 635 nm light illumination at 1.5 mW/cm2 to the top surface increased from 1.3x10-4 to 5.1x10-4s as the oxygen radical treatment duration increased from 1 to 5 min. The recombination velocity decreased from 380 to 90 cm/s. 500 kHz capacitance response with bias gate voltages characteristics of metal oxide semiconductor structure resulted in the effective oxide thicknesses (EOT) ranging from 1.3 to 1.7 nm. These results indicate a capability of thin oxide formation and effective passivation of silicon surfaces at a low temperature.