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.
Introduction: Emergency medicine (EM) is a demanding specialty with high rates of physician burnout. As emergency physicians, we must stay healthy to promote healthy living, optimize our ability to care for our patients, extend our careers, and be there for our families. While we all desire a healthy lifestyle, maintaining one in practice can be difficult. We sought to investigate the strategies emergency physician employ to maintain and improve health and wellness while mitigating the professions stressors. Methods: From April 2015 to July 2017, forty-three wellness champions from Canada, the USA, and Australia were identified using a snowball sampling technique. Each participant answered 5 introductory questions and 8 productivity questions pertaining to health and wellness. These were transcribed and loaded to a publicly accessible blog, ALiEM.com, as part of the Healthy in EM series. Two investigators reviewed the transcripts using inductive methods and a grounded theory approach to generate themes and subthemes using coding software, NVivo (Burlington, Massachusetts), until saturation was achieved. Consensus between investigators (JC, ZP) established the master code and audit trail. An external audit by investigators (TC, BT) not involved with the initial analysis was performed to ensure reliability. Results: Major themes including diet, sleep, exercise and social activities were coded and further subcategorized along with perspectives, habits, personal philosophies, and career diversity. These themes translated across both professional and personal aspects of participants lives. For example, the pre-shift and post-shift strategies often included some form of regimented activities-of-daily-living that required discipline to adhere to at work and home. Conclusion: Our findings show the importance of homeostasis in the professional and personal realm among expert emergency medicine physicians. Among healthy emergency physicians, diet, sleep, and exercise patterns intertwined with perspectives, habits, personal philosophies, and social activities contributed to maintenance of wellness.
Research indicates that children are at higher risk for obesity if their parents have been exposed to a larger number of stressors, yet little is known about effects of parents’ subjective, perceived experience of stress on children’s eating behaviours and adiposity and whether weight-related parenting practices (i.e. parent rules and positive family meal practices) mediate this relationship. The present study evaluated the direct and mediated relationship between parent perceived stress and child waist circumference and parent stress and child consumption of added sugars one year later.
Longitudinal panel data.
Eleven communities in Southern California, USA.
Data were collected over two waves from parent–child dyads (n 599). Most parents were female (81 %) and Hispanic (51 %); children were 11 years old on average (sd 1·53; range 7–15 years) and 31 % received free school lunch.
Perceived parent stress was not significantly associated with child waist circumference or consumption of added sugars one year later, and mediating pathways through parenting practices were not significant. However, parent rules were significantly associated with lower child consumption of added sugars (β=−0·14, P<0·001).
Results suggest that parent rules about the types of foods children can eat, clearly explained to children, may decrease child consumption of added sugars but not necessarily lead to changes in obesity risk. Parent- and family-based interventions that support development of healthy rules about child eating have the potential to improve child dietary nutrient intake.
A compact hybrid rocket motor design that incorporates a dual-vortical-flow (DVF) concept is proposed. The oxidizer (nitrous oxide, N2O) is injected circumferentially into various sections of the rocket motor, which are sectored by several solid fuel “rings” (made of hydroxyl-terminated polybutadiene, HTPB) that are installed along the central axis of the motor. The proposed configuration not only increases the residence time of the oxidizer flow, it also implies an inherent “roll control” capability of the motor. Based on a DVF motor geometry with a designed thrust level of 11.6 kN, the characteristics of the turbulent reacting flow within the motor and its rocket performance were analyzed with a comprehensive numerical model that implements both real-fluid properties and finite-rate chemistry. Data indicate that the vacuum specific impulse (Isp) of the DVF motor could reach 278 s. The result from a preliminary ground test of a lab-scale DVF hybrid rocket motor (with a designed thrust level of 3,000 N) also shows promising performance. The proposed DVF concept is expected to partly resolve the issue of scalability, which remains challenging for hybrid rocket motors development.
Public controversy regarding the potential overdiagnosis and overmedication of children with attention-deficit/hyperactivity disorder (ADHD) has continued for decades. This study used the National Health Insurance Research Database of Taiwan (NHIRD-TW) to explore trends in ADHD diagnosis in youths and the proportion of those receiving medication, with the aim of determining whether ADHD is overdiagnosed and overmedicated in Taiwan.
Youths (age ≤18 years) who had at least two NHIRD-TW claims records with ADHD diagnosis between January 2000 and December 2011 were selected as the subject cohort. In total, the study sample comprised 145 018 patients with ADHD (mean age at a diagnosis of ADHD: 7.7 ± 3.1 years; 21.4% females). The number of cases of ADHD were calculated annually for each year (from 2000 to 2011), and the number of cases per year who received medication was determined as those with at least one record of pharmacotherapy (immediate-release methylphenidate, osmotic controlled-release formulation of methylphenidate, and atomoxetine) in each year.
The prevalence rates of a diagnosis of ADHD in the youths ranged from 0.11% in 2000 to 1.24% in 2011. Compared with children under 6 years of age, the ADHD diagnosis rates in children aged between 7 and 12 years (ratio of prevalence rates = 4.36) and in those aged between 13 and 18 years (ratio of prevalence rates = 1.42) were significantly higher during the study period. The prevalence in males was higher than that in females (ratio of prevalence rates = 4.09). Among the youths with ADHD, 50.2% received medications in 2000 compared with 61.0% in 2011. The probability of receiving ADHD medication increased with age. More male ADHD patients received medications that females patients (ratio of prevalence rates = 1.16).
The rate of ADHD diagnosis was far lower than the prevalence rate (7.5%) identified in a previous community study using face-to-face interviews. Approximately 40–50% of the youths with ADHD did not receive any medications. These findings are not consistent with a systematic public opinion about overdiagnosis or overmedication of ADHD in Taiwan.
The Rho/ROCK pathway is involved in numerous pivotal cellular processes that have made it an area of intense study in cancer medicine, however, Rho-associated coiled-coil containing protein kinase (ROCK) inhibitors are yet to make an appearance in the clinical cancer setting. Their performance as an anti-cancer therapy has been varied in pre-clinical studies, however, they have been shown to be effective vasodilators in the treatment of hypertension and post-ischaemic stroke vasospasm. This review addresses the various roles the Rho/ROCK pathway plays in angiogenesis, tumour vascular tone and reciprocal feedback from the tumour microenvironment and explores the potential utility of ROCK inhibitors as effective vascular normalising agents. ROCK inhibitors may potentially enhance the delivery and efficacy of chemotherapy agents and improve the effectiveness of radiotherapy. As such, repurposing of these agents as adjuncts to standard treatments may significantly improve outcomes for patients with cancer. A deeper understanding of the controlled and dynamic regulation of the key components of the Rho pathway may lead to effective use of the Rho/ROCK inhibitors in the clinical management of cancer.
Despite evidence of inhibitory control and visual processing impairment in attention deficit hyperactivity disorder (ADHD), knowledge about its corresponding alterations in the brain is still evolving. The current study used counting Stroop functional MRI and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to investigate if brain activation of inhibitory control and visual processing would differ in youths with ADHD relative to neurotypical youths.
We assessed 25 youths with ADHD [mean age 10.9 (s.d. = 2.2) years] and 23 age-, gender- and IQ-matched neurotypical youths [mean age 11.2 (s.d. = 2.9) years]. The participants were assessed by using the Wechsler Intelligence Scale for Children, third edition, and two tests from the CANTAB: rapid visual information processing (RVP) and pattern recognition memory (PRM) outside the scanner.
Youths with ADHD showed more activation than neurotypical youths in the right inferior frontal gyrus [Brodmann area (BA) 45] and anterior cingulate cortex, which were correlated with poorer performance on the RVP test in the CANTAB. In contrast, youths with ADHD showed less activation than neurotypical youths in the left superior parietal lobule (BA 5/7), which was correlated with the percentage of correct responses on the PRM test in the CANTAB.
Our findings suggest that youths with ADHD might need more inhibitory control to suppress interference between number and meaning and may involve less visual processing to process the numbers in the counting Stroop task than neurotypical youths.
Based on the electron configurations of Mo and Zn, the valence electron difference between Mo6+ and Zn2+ is 4. Therefore, a small amount of Mo doping can produce sufficient free carriers to reduce the ion scattering effects. The Mo doped ZnO (MZO) thin film prepared by RF sputtering was studied in this research. Structural, electrical, and optical characteristics of the films were discussed. The MZO film shows a resistivity of 1.1 × 10-2 Ω⋅cm, a carrier concentration of 2.2 × 1021 cm-3,a mobility of 0.63 cm2/V⋅s, and average transparency of 81.0% at both the powers of 20 W to the Mo target and of 125 W to the ZnO target. The MZO film becomes a stable p-type semiconductor at high power process toward Mo target. The film preserves its p-type characteristics after exposure to air for one and a half months. The crystal structure of the p-ZnO films is amorphous with an average transparency of 34.5%.
Thermal effects on the crystal structure, electrical and optical characteristics of the Al and F co-doped ZnO films (ZnO:AlF3) are discussed in the paper. The ZnO:AlF3 thin films are prepared by RF sputtering with a constant power (ZnO/AlF3=100W/75W) toward the ZnO and AlF3 targets. The substrate temperature varied from room temperature to 250 °C with a step of 50 °C during thin film deposition. The crystalline quality of the ZnO:AlF3 film improved as the substrate temperature increased, with a corresponding increase in grain size. The improvement of the film quality leads to a higher electron mobility, with electron mobility of 0.85 cm2/V-s for the film deposited at the substrate temperature of 250 °C. The doping effect of fluorine in ZnO, and hence carrier concentration, was reduced at high temperature due to the vaporization of fluorine. This led to a reduction of carrier concentration with increase of temperature from 25 to 200°C. The corresponding resistivity increased from 3.60×10−2 to 6.0×10−2 Ω-cm. While for a further increase in substrate temperature, the doping of Al to the ZnO film was increased and resulted in an increase in carrier concentration.
Light effects on the performance of the a-Si:H PIN photodiode has been studied. The leakage current-voltage and capacitance-voltage curves under the red, green and blue light illuminations were measured. The apparent charge storage density in the negative voltage range was quantified from the capacitance-voltage curve; charges in the positive voltage range were estimated from the leakage current-voltage curve. A comparison of charge storage capacities of diodes with different intrinsic layer thicknesses is also presented. The diode under the long wavelength light illumination condition stored more charges than that under the short wavelength light illumination condition because the former could penetrate the intrinsic a-Si:H layer deeper than the latter could. The leakage current and charge storage capacity of the diode are determined by the generation of electron-hole pairs, the depletion of charges in the intrinsic layer, and the supply of charges from the electrodes. The number of incident photons is critical to the process.
The polycrystalline n+/intrinsic silicon thin film stacks with various original intrinsic amorphous silicon layer thicknesses were formed using the multiple pulsed rapid thermal annealing process with the Ni-induced crystallization mechanism. The thick polycrystalline silicon stack was prepared by repeated steps of 1) amorphous silicon thin film deposition, 2) solution oxidation, 3) dehydrogenation, 4) pulsed rapid thermal annealing, and 5) oxide stripping. The poly-Si film properties, such as the grain size, orientation, and volume fraction of the crystalline phase, were related to the original intrinsic silicon film thickness and the total thermal budget. This process is effective in preparing the high volume fraction polycrystalline silicon thin film, which is important for low-cost thin-film solar cells, electronic and optoelectronic devices.
Background: Population-based studies face challenges in measuring brain structure relative to cognitive aging. We examined the feasibility of acquiring state-of-the-art brain MRI images at a community hospital, and attempted to cross-validate two independent approaches to image analysis.
Methods: Participants were 49 older adults (29 cognitively normal and 20 with mild cognitive impairment (MCI)) drawn from an ongoing cohort study, with annual clinical assessments within one month of scan, without overt cerebrovascular disease, and without dementia (Clinical Dementia Rating (CDR) < 1). Brain MRI images, acquired at the local hospital using the Alzheimer's Disease Neuroimaging Initiative protocol, were analyzed using (1) a visual atrophy rating scale and (2) a semi-automated voxel-level morphometric method. Atrophy and volume measures were examined in relation to cognitive classification (any MCI and amnestic MCI vs. normal cognition), CDR (0.5 vs. 0), and presumed etiology.
Results: Measures indicating greater atrophy or lesser volume of the hippocampal formation, the medial temporal lobe, and the dilation of the ventricular space were significantly associated with cognitive classification, CDR = 0.5, and presumed neurodegenerative etiology, independent of the image analytic method. Statistically significant correlations were also found between the visual ratings of medial temporal lobe atrophy and the semi-automated ratings of brain structural integrity.
Conclusions: High quality MRI data can be acquired and analyzed from older adults in population studies, enhancing their capacity to examine imaging biomarkers in relation to cognitive aging and dementia.
The prevalence and genotype distribution of human papillomavirus (HPV) infection in women with normal cervical cytology varies widely according to the population studied. Two non-overlapping population-based cohort studies of women aged ⩾30 years for the periods 2008–2009 (n=5026) and 2004–2005 (n=10 014) were analysed. The prevalence rate of HPV was 11·0% (95% CI 10·5–11·6). HPV infection was significantly associated with age, menopausal status, and inversely associated with hormone replacement therapy. There was an increasing trend of α3/α15, α5/α6, and multiple HPV infections with increasing age. The five most common types were HPV52, 18, 53, 58 and 70, while HPV16, 31, 33 ranked 21st, 25th, and 16th, respectively, in the merged cohort with normal cytology (n=14 724). HPV16, 31, and 33 were significantly associated with abnormal cytology, which could have resulted in their rarity in the total merged cohort (n=15 040).
YBa2Cu3O7 (YBCO) films have been deposited by photo-assisted MOCVD at rates of greater than 0.3μm/min on both single crystal oxide substrates and atomically textured metallic substrates. The YBCO films of thickness from 0.5μm to 3μm deposited on LaAlO3 substrates are shown to be highly atomically ordered with Jc> 1 × 106 A/cm2. CeO2 buffer layers have also been developed by photo-assisted MOCVD for the integration of YBCO with metallic substrates. The CeO2 layers were found to be crack-free when grown on nickel even above 1 micron thickness, and exhibited crystal orientation and in-plane alignment similar to that of the atomically textured Ni substrates. YBCO films grown on the thick CeO2 buffer layers on nickel substrates have shown promising results with Jc∼6 × 105 A/cm2.
Just as the 40+ years of technology developments associated with the electronic application of semiconductor fabrication processes is “morphing” into a micro-electro- mechanical systems (MEMS) technology in the past dozen years or so, so it seems may the “mature” multilayer ceramic fabrication technology associated with capacitor components and interconnect substrates for the integrated circuit industry, be morphed into MEMS – microsystems technology applications. This paper highlights work underway in Motorola Labs aimed at exploring the potential to develop 3D multilayer ceramic structures to integrate (monolithic and hybrid) multiple functions to create microsystems for wireless, energy and life science applications. By multiple functions, we refer to the ability for a microsystem to perform electronic, fluidic, thermonic, photonic and mechatronic (or actuator) based functions. Current capabilities of the multilayer ceramic materials and processes to achieve integrated functionalities for wireless applications will be described including the development of a new dielectric enabling increased performance for wireless applications. Also to be highlighted will be exploratory microscale fuel cell prototypes exploiting advances in the multilayer ceramic lamination and feature forming technologies enabling the insertion of 3D microchannels for microfluidic functions. These prototypes also feature the ability of the technology to provide thermonic functionality for microreactor devices. Feasibility of a light source that can be integrated into the technology platform hinting at photonic applications will be described. Many materials science and engineering advancements are needed to achieve the potential of this “old” but newly “morphing” technology and some of these will be noted.
The formation of Y-Ba-Cu-O phases, including the high Tc superconducting YBa2Cu3O7−x (Y123) phase, during solid state reaction of the mixture of Y2O3: BacO3: CuO, in molar ratio of 0.2:0.6:1 to conform the formula of the perovskite (Y0.4 Ba0.6)CuO3 composition was studied by means of DTA, DTG and X-ray difractometry(XRD). For continuous heating at 10 C/min, it was found that the Y123 phase exists at 790–995 C, and gradually disappears at higher temperatures. The insulating Y2BaCuO5 (Y211) phase exists at 985 to 1190 C, the maximum experiment temperature. While the semiconducting YBa3Cu2O7-y, (Y132) phase coexists with the Y123 phase. For isothermal heating, it was found that the most appropriate temperature and time for the formation of the Y123 phase is 900 C and 16 hours. Semiquantitative data on the amount of phases presented, including the above mentioned phases and other binary Ba-Y-O or Ba-Cu-O phases, during heating are also given. High temperature superconductor with a Tc of around 93 K can be synthesized reproducibly by the processes based on this study.
In a recent MRS symposium, the effect of boron on grain boundary hardness (GBH) in Ni3Al was reported. Addition of 0.2 at.% of boron decreased the GBH in all three sets of alloys tested (24, 25, and 26 at.% Al). The present paper summarizes the study of the effect of boron on hardness within grains. Boron-induced softening was again observed in grain interiors. However, it occurred only in alloys with 24 and 25 at.% Al, but not in the alloy with 26 at.% Al. An explanation for this behavior is presented.