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.
The antidepressant effect of low-dose ketamine infusion on Taiwanese patients with anxious vs nonanxious treatment-resistant depression (ANX-TRD vs NANX-TRD) has remained unknown.
In total, 71 patients with TRD were randomized to three groups. Each group had participants who received saline infusions mixed with 0 (a normal saline infusion), 0.2, and 0.5 mg/kg of ketamine. Participants were followed up for 2 weeks. Anxious depression was defined as major depressive disorder with a total score of 7 or more on the 17-item Hamilton Depression Rating Scale Anxiety-Somatization factor. Generalized estimating equation models were used to investigate the effects of treatment (ketamine vs placebo) and depression type (ANX-TRD vs NANX-TRD) in the reduction of depressive symptoms during the follow-up period.
Patients with ANX-TRD were less likely to respond to a single low-dose ketamine infusion than those with NANX-TRD. Among patients with NANX-TRD, low-dose ketamine infusion was significantly superior to placebo for reducing depressive symptoms. However, among patients with ANX-TRD, ketamine was not superior to placebo; nonetheless, approximately 30% of the patients responded to ketamine infusion compared to 13% who responded to the placebo.
Low-dose ketamine infusion was effective for Taiwanese patients with NANX-TRD but not so effective for those with ANX-TRD. A higher level of anxiety severity accompanying depression was related to greater depression severity. This may confound and reduce the antidepressant effect of ketamine infusion.
It is well-known that attention deficit hyperactivity disorder (ADHD) is associated with changes in the dopaminergic system. However, the relationship between central dopaminergic tone and the blood oxygen level-dependent (BOLD) signal during receipt of rewards and penalties in the corticostriatal pathway in adults with ADHD is unclear.
Single-photon emission computed tomography with [99mTC]TRODAT-1 was used to assess striatal dopamine transporter (DAT) availability. Event-related functional magnetic resonance imaging was conducted on subjects performing the Iowa Gambling Test.
DAT availability was found to be associated with the BOLD response, which was a covariate of monetary loss, in the medial prefrontal cortex (r = 0.55, P = .03), right ventral striatum (r = 0.69, P = .003), and right orbital frontal cortex (r = 0.53, P = .03) in adults with ADHD. However, a similar correlation was not found in the controls.
The results confirmed that dopaminergic tone may play a different role in the penalty-elicited response of adults with ADHD. It is plausible that a lower neuro-threshold accompanied by insensitivity to punishment could be exacerbated by the hypodopaminergic tone in ADHD.
Whether the first-degree relatives (FDRs) of patients with obsessive-compulsive disorder (OCD) have an increased risk of the major psychiatric disorders, namely schizophrenia, bipolar disorder, OCD, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), remains unclear.
Using the Taiwan National Health Insurance Research Database with the whole population sample size (n = 23 258 175), 89 500 FDRs, including parents, offspring, siblings, and twins, of patients with OCD were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with OCD.
FDRs of patients with OCD had higher RRs of major psychiatric disorders, namely OCD (RR 8.11, 95% confidence interval (CI) 7.68–8.57), bipolar disorder (RR 2.85, 95% CI 2.68–3.04), MDD (RR 2.67, 95% CI 2.58–2.76), ASD (RR 2.38, 95% CI 2.10–2.71), ADHD (RR 2.19, 95% CI 2.07–2.32), and schizophrenia (RR 1.97, 95% CI 1.86–2.09), compared with the total population. Different familial kinships of FDRs, such as parents, offspring, siblings, and twins consistently had increased risks for these disorders. In addition, a dose-dependent relationship was found between the numbers of OCD probands and the risk of each major psychiatric disorder.
The FDRs, including parents, offspring, siblings, and twins, of patients with OCD have a higher risk of OCD, schizophrenia, bipolar disorder, MDD, ADHD, and ASD. The familial co-aggregation of OCD with OCD and other major psychiatric disorders was existent in a dose-dependent manner. Given the increased risks of psychiatric disorders, medical practitioners should closely monitor the mental health of the FDRs of patients with OCD.
Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear.
Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified.
The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10–1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07–2.01) during the follow-up compared with the controls.
The unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.
Bipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.
Among the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.
FDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.
Our study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.
Attention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts.
To evaluate the risk of suicide attempt in adolescents and young adults with ADHD.
Using a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.
ADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19–4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46–9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22–0.97).
ADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours.
This study modified the surfaces of three kinds of TiNi-based shape memory alloys (SMAs) by dry electrical discharge machining (EDM) in nitrogen (N2) and acetylene (C2H2) gas mixture. The effects of composition of the dielectric medium and work-piece on the machining performance and surface characteristics were investigated. Increasing the ratio of acetylene gas in gas mixture was beneficial for improving the material removal rate (MRR). However, adding a large amount of acetylene gas resulted in unstable discharge. A recast layer, comprising nitrides and carbides, which well adhered on the EDMed surface exhibited high hardness. Among Ti50Ni50, Ti50Ni49.5Cr0.5, and Ti40.5Ni49.5Zr10 SMA as a work-piece, Ti40.5Ni49.5Zr10 SMA has the lowest MRR owing to it possessed the highest melting temperature and thermal conductivity. The recast layer on Ti40.5Ni49.5Zr10 SMA, comprising zirconium nitride, exhibited the highest hardness and adhesion among all the SMAs. However, the high-hardness recast layer deteriorated the shape recovery of the SMA.
IC5146 is one of the filamentary clouds observed in Herschel Gould Belt Survey. Here we present our polarization observations toward IC5146 taken with AIMPOL, TRIPOL and Mimir. Our results reveal that the large scale structure of magnetic field is well perpendicular to the main filament, but is likely parallel to the sub-filaments, which are structure extended out from the main filaments. We have also conducted CO observations to reveal the gas kinematics along the filaments or magnetic field; this result suggests the gas is possibly confined by magnetic field in most of the region until reaching supercritical. Based on our results, we suggests that at least four types of filaments can be found in IC5146, behaving different physical properties and consistent with different formation mechanisms. Our conclusions reveal that filaments are a combination of a variety types of objects.
Previous evidence has shown positive associations between post-traumatic
stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes
mellitus, which are all risk factors for stroke, but the role of PTSD in
the subsequent development of stroke is still unknown.
To investigate the temporal association between PTSD and the development
Identified from the Taiwan National Health Insurance Research Database,
5217 individuals aged 18 years, with PTSD but with no history of stroke,
and 20 868 age- and gender-matched controls were enrolled between 2002
and 2009, and followed up until the end of 2011 to identify the
development of stroke.
Individuals with PTSD had an increased risk of developing any stroke
(hazard ratio (HR) 3.37, 95% CI 2.44–4.67) and ischaemic stroke (HR =
3.47, 95% CI 2.23–5.39) after adjusting for demographic data and medical
comorbidities. Sensitivity tests showed consistent findings (any stroke
HR = 3.02, 95% CI 2.13–4.28; ischaemic stroke HR = 2.89, 95% CI
1.79–4.66) after excluding the first year of observation.
Individuals with PTSD have an increased risk of developing any stroke and
ischaemic stroke. Further studies are required to investigate the
This study presents a numerical solution to the three-dimensional solute transport in heterogeneous media by using a layer-integrated approach. Omitting vertical spatial variation of soil and hydraulic properties within each layer, a three-dimensional solute transport can be simplified as a quasi-three-dimensional solute transport which couples a horizontal two-dimensional simulation and a vertical one-dimensional computation. The finite analytic numerical method was used to discretize the derived two-dimensional governing equation. A quadratic function was used to approximate the vertical one-dimensional concentration distribution in the layer to ensure the continuity of concentration and flux at the interface between the adjacent layers. By integration over each layer, a set of system of equations can be generated for a single column of vertical cells and solved numerically to give the vertical solute concentration profile. The solute concentration field was then obtained by solving all columns of vertical cells to achieve convergence with the iterative solution procedure. The proposed model was verified through examples from the published literatures including four verifications in terms of analytical and experimental cases. Comparison of simulation results indicates that the proposed model satisfies the solute concentration profiles obtained from experiments in time and space.
Cancer is a serious public health problem worldwide, and its relationship
with affective disorders is not clear.
To investigate alcohol- and tobacco-related cancer risk among patients
with affective disorders in a large Taiwanese cohort.
Records of newly admitted patients with affective disorders from January
1997 through December 2002 were retrieved from the Psychiatric Inpatient
Medical Claims database in Taiwan. Cancers were stratified by site and
grouped into tobacco- or alcohol-related cancers. Standardised incidence
ratios (SIRs) were calculated to compare the risk of cancer between those
with affective disorders and the general population.
Some 10 207 patients with bipolar disorder and 9826 with major depression
were included. The risk of cancer was higher in patients with major
depression (SIR = 2.01, 95% CI 1.85–2.19) than in those with bipolar
disorder (SIR 1.39, 95% CI 1.26–1.53). The elevated cancer risk among
individuals ever admitted to hospital for affective disorders was more
pronounced in tobacco- and/or alcohol-related cancers.
Elevated cancer risk was found in patients who had received in-patient
care for affective disorders. They require holistic approaches to
lifestyle behaviours and associated cancer risks.
This study investigated the microstructure and machining characteristics of a Zr38.5Ti16.5Cu15.25Ni9.75Be20 bulk metallic glass (Zr-BMG) alloy machined using electro-discharge machining (EDM). After EDM, the hardening effect near the outer surface of the electro-discharge machined (EDMed) Zr-BMG alloy originated from the surface carbides of the recast layer, ZrC and TiC. The thickness of the recast layer, crater size, and the surface roughness increased with greater pulse energy. Furthermore, the EDM can generate a porous recast layer and convert the Zr-BMG alloy surface into a carbide surface, which is a potential method to fabricate biomaterials. Experimental results also show that the material removal rate of this alloy in the EDM process was significantly related to the pulse current IP and pulse duration τP. Many electro-discharge craters and recast materials were observed on the surface of the EDMed Zr-BMG alloy. The surface roughness of the EDMed Zr-BMG alloy was found to obey the empirical equation of Ra = β(IP × τP)α.
Interfacial reactions at 100 and 150 °C in the Sn–20.48 at.% In–3.05 at.% Ag (Sn–20.0 wt% In–2.8 wt% Ag)/Ni couples are studied. Three unusual phenomena are observed. First, liquation is found in Sn–20.48 at.% In–3.05 at.% Ag (Sn–In–Ag)/Ni couples that are reacted at 150 °C, which is lower than the melting points of both the solder and the Ni substrate. In addition to the Ni3Sn4 phase, liquid phase is formed in the reaction layer. Second, the liquid phase disappears and isothermal solidification occurs when there is prolonged isothermal heat treatment at 150 °C. The results are similar to those for transient liquid phase bonding. Third, the thickness of the reaction layer in Sn–In–Ag/Ni couples that are reacted for 1440 h at 150 °C is 40 times thicker than that of those reacted at 100 °C. The reaction mechanisms for these three unusual phenomena: liquation, isothermal solidification, and an extraordinary increase in the reaction rate for only 50 °C difference in temperature are elaborated and are related to each other.
Modulation of the cellular response by the administration of probiotic bacteria may be an effective strategy for preventing or inhibiting tumour growth. We orally pre-inoculated mice with probiotics Lactobacillus acidophilus NCFM (La) for 14 d. Subcutaneous dorsal-flank tumours and segmental orthotopic colon cancers were implanted into mice using CT-26 murine colon adenocarcinoma cells. On day 28 after tumour initiation, the lamina propria of the colon, mesenteric lymph nodes (MLN) and spleen were harvested and purified for flow cytometry and mRNA analyses. We demonstrated that La pre-inoculation reduced tumour volume growth by 50·3 %, compared with untreated mice at 28 d after tumour implants (2465·5 (sem 1290·4) v. 4950·9 (sem 1689·3) mm3, P < 0·001). Inoculation with La reduced the severity of colonic carcinogenesis caused by CT-26 cells, such as level of colonic involvement and structural abnormality of epithelial/crypt damage. Moreover, La enhanced apoptosis of CT-26 cells both in dorsal-flank tumour and segmental orthotopic colon cancer, and the mean counts of apoptotic body were higher in mice pre-inoculated with La (P < 0·05) compared with untreated mice. La pre-inoculation down-regulated the CXCR4 mRNA expressions in the colon, MLN and extra-intestinal tissue, compared with untreated mice (P < 0·05). In addition, La pre-inoculation reduced the mean fluorescence index of MHC class I (H-2Dd, -Kd and -Ld) in flow cytometry analysis. Taken together, these findings suggest that probiotics La may play a role in attenuating tumour growth during CT-26 cell carcinogenesis. The down-regulated expression of CXCR4 mRNA and MHC class I, as well as increasing apoptosis in tumour tissue, indicated that La may be associated with modulating the cellular response triggered by colon carcinogenesis.
The interfacial reactions in Sn-0.7wt%Cu/ENIG SUS304 couples at 240, 255, and 270 °C are examined in this study. The Ni-containing ternary Cu6Sn5 phase is formed at the Ni/liquid interface in the early reaction stage then it detaches massively from the SUS304 substrate and splits into two layers in the molten solder as the reaction time increases. This phase finally disintegrates and disappears. The square pillar-shaped FeSn2 phase is found on top of the SUS304 substrate when the Cu6Sn5 layer detaches. The reaction phase formation, detachment, and split mechanisms are proposed. The spalling phenomenon is reviewed and discussed. The growth mechanism of the FeSn2 phase obeys the parabolic law, and the activation energy is determined to be 112.5 KJ/mol.
In this work, we report on the growth of ultraviolet (UV) AlGaN/GaN multiple quantum wells (MQWs) structure using atomic layer deposition (ALD) technique. The AlGaN/GaN MQW sample grown on the sapphire substrate consisted of three GaN QWs and four AlGaN barriers comprised AlN/GaN superlattices (SLs). The root-mean-square value of the surface morphology was only 0.35 nm observed from the atomic force microscope image and no crack was found on the surface. Both of the high resolution X-ray diffraction curves and transmission electron microscope images showed sharp interfaces between SLs layers and QWs with good periodicity. These results demonstrate that the ALD could be a very useful technique for controlling the crystalline quality and thickness of the III-nitride epilayer.
Ordered arrays of Ta2O5 nanodots were prepared using anodic aluminum oxide (AAO) as a template to support localized oxidation of TaN. Films of TaN (50 nm) and Al (1.5 μm) were deposited successively on p-type Si wafers and followed by a two-step anodization process at 40 V using oxalic acid as the electrolyte. The first anodization promoted growth of irregular AAO from overlying Al film. After chemical etching, the second anodization was performed to develop well-organized AAO channels and initiate oxidation of underlying TaN film to form tantalum oxide nanodots at the AAO pore bottoms. X-ray photoelectron spectroscopy results confirmed the chemical nature of nanodots as stoichmetric Ta2O5. X-ray diffraction demonstrated the amorphous characteristic of Ta2O5. As shown in field-emission scanning electron microscopy and transmission electron results, the Ta2O5 nanodots exhibited a hillock structure 80 nm in diameter at the bottom and 50 nm in height. We also synthesized 30-nm nanodots by adjusting AAO formation electrochemistry. This demonstrates the general applicability of the AAO template method for nanodot synthesis from nitride to oxide at a desirable size.
At a medical center in Taiwan, all workers were examined by chest radiography, to determine the prevalence of pulmonary tuberculosis. The prevalence of tuberculosis among all hospital workers was 0.12%, that among nurses was 0.35%, and that among externally contracted cleaners was 0.57%. All of the Mycobacterium tuberculosis isolates recovered from 2 nurses and from a patient with pulmonary tuberculosis were the Beijing strain, but the strains had different serotypes.
Copper metallization for GaAs was evaluated by using Cu/Ta/GaAs multilayers for its thermal stability. A thin Ta layer of 30 nm thickness was sputtered on the GaAs substrate as the diffusion barrier before copper film metallization. As judged from the results of sheet resistance, X-ray diffraction, Auger electron spectroscopy and transmission electron microscopy, the Cu/Ta films on GaAs were very stable up to 500 °C without Cu migration into GaAs. After 550 °C annealing, the interfacial mixing of Ta with GaAs substrate occurred, resulting in the formation of TaGa2 and TaAs2, and the diffusion of Ga and As through the Ta layer formed the Cu3Ga and Cu3As phases at the Cu/Ta interface. After 600 °C annealing, the reaction of GaAs with Ta and Cu formed TaAs and Cu3Ga, as a result of Cu migration and interfacial instability.