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The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction.
Prospective survey of rhinology patients.
Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent). Obstruction duration (more than one year) (χ2 = 13.5, p = 0.00024), but not obstruction severity, affected willingness to spend more time being assessed. Questionnaires (48 per cent) and nasal inspiratory peak flow measurement (53 per cent) are the most commonly used assessment techniques. Forty-nine per cent of participants found their assessment unhelpful in understanding their obstruction. Eighty-two per cent agreed or strongly agreed that a visual and numerical aid would help them understand their blockage.
Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.
Mycobacterium marinum, a bacterium found in freshwater and saltwater, can infect persons with direct exposure to fish or aquariums. During December 2013, the New York City Department of Health and Mental Hygiene learned of four suspected or confirmed M. marinum skin or soft tissue infections (SSTIs) among persons who purchased whole fish from Chinese markets. Ninety-eight case-patients with non-tuberculous mycobacteria (NTM) SSTIs were identified with onset June 2013–March 2014. Of these, 77 (79%) were female. The median age was 62 years (range 30–91). Whole genome sequencing of clinical isolates revealed two main clusters and marked genetic diversity. Environmental samples from distributors yielded NTM though not M. marinum. We compared 56 case-patients with 185 control subjects who shopped in Chinese markets, frequency-matched by age group and sex. Risk factors for infection included skin injury to the finger or hand (odds ratio [OR]: 15·5; 95% confidence interval [CI]: 6·9–37·3), hand injury while preparing fish or seafood (OR 8·3; 95% CI 3·8–19·1), and purchasing tilapia (OR 3·6; 95% CI 1·1–13·9) or whiting (OR 2·7; 95% CI 1·1–6·6). A definitive environmental outbreak source was not identified.
Introduction: Sepsis protocols call for the acquisition of blood cultures in septic emergency department (ED) patients.However, the criteria for blood cultures are vague, they are costly, only positive 8-12% of the time, with up to half of these being false positives. The objective of this study was to establish if positive blood cultures could be excluded in low-risk sepsis patients with levels of CRP below 20 ml/L. Methods: This was a multicenter prospective cohort study of 765 ED patients at St Paul’s and Mount St Joseph’s hospitals in Vancouver with sepsis (2 or more SIRS criteria and infection) and none of: immuncompromised, injection drug use, indwelling vascular device or septic shock (SBP<90 mmhg). Consecutive patients with sepsis had CRP and blood cultures obtained at the same time.OUTCOMES. True positive blood cultures, false positive blood cultures, positive blood cultures that changed patient management. True and false positive blood cultures were based on Infectious Disease Society of America Guidelines, and change in management was defined as change in type or length of antibiotic therapy and was blindly adjudicated by a medical microbiologist. Results: 765 ED patients with sepsis met inclusion criteria. Mean age was 48.3 years and 57% were male. Blood cultures were positive in 99/765 (12.9%) subjects, of which 19 were false positive (19.2%). CRP was >20 mg/L in 595/765 (77.8%) of patients. Of 170 subjects with a CRP<20 mg/L, 3 had a positive blood culture (1.8%; 95% CI 0.1%- 5%). Management was not changed in any patient with a positive blood culture and CRP level<20 mg/L. Of 19 subjects with a false positive blood culture, CRP was <20 mg/L for 6 (31.6%). Conclusion: In this cohort of low-risk sepsis patients, based on a CRP of <20 mg/L, acquisition of blood cultures could be safely avoided in 22.2% of patients, at significant savings to the health care system.
Some studies demonstrated that physical activity may have beneficial effect on cognitive function. The objective of the study was to estimate the association between physical activity and cognitive function in community-dwelling elderly Chinese in Hong Kong (HK) and Guangzhou (GZ).
In the neighborhood of HK and GZ, a convenience sample of 557 (260 in HK and 297 in GZ) older persons without dementia aged over 60 years (73.4 ± 6.5) was recruited. Physical activity was measured using a checklist. Information on physical activity participation, cognitive function, and other variables were collected. Multivariate linear regression analyses were performed to evaluate the association between physical activity and cognitive function.
Total number of physical activities showed significant association with the delayed recall test (p < 0.01) and category verbal fluency test (CVFT) (p < 0.01). However, with further adjustment for participation in intellectual activity, the coefficients were no longer statistically significant (p > 0.05)
Physical activity may not be associated with better cognitive function among elderly Chinese independently of other factors.
With the proportion of older adults in Hong Kong projected to double in size in the next 30 years, it is important to develop measures for detecting individuals in the earliest stage of Alzheimer's disease (AD, 0.5 in Clinical Dementia Rating, CDR). We tested the utility of a non-verbal prospective memory task (PM, ability to remember what one has to do when a specific event occurs in the future) as an early marker for AD in Hong Kong Chinese.
A large community dwelling sample of older adults who are healthy controls (CDR 0, N = 125), in the earliest stage of AD (CDR 0.5, N = 125), or with mild AD (CDR 1, N = 30) participated in this study. Their reaction time/accuracy data were analyzed by mixed-factor analyses of variance to compare the performance of the three CDR groups. Logistic regression analyses were performed to test the discriminative power of these measures for CDR 0 versus 0.5 participants.
Prospective memory performance declined as a function of AD severity: CDR 0 > CDR 0.5 > CDR 1, suggesting the effects of early-stage AD and AD progression on PM. After partialling out the variance explained by psychometric measures (e.g., ADAS-Cog), reaction time/accuracy measures that reflected the PM still significantly discriminated between CDR 0 versus 0.5 participants in most of the cases.
The effectiveness of PM measures in discriminating individuals in the earliest stage of AD from healthy older adults suggests that these measures should be further developed as tools for early-stage AD discrimination.
The epidemiology of varicella is believed to differ between temperate and tropical countries. We conducted a varicella seroprevalence study in elementary and college students in the US territory of American Samoa before introduction of a routine varicella vaccination programme. Sera from 515 elementary and 208 college students were tested for the presence of varicella-zoster virus (VZV) IgG antibodies. VZV seroprevalence increased with age from 76·0% in the 4–6 years group to 97·7% in those aged ⩾23 years. Reported history of varicella disease for elementary students was significantly associated with VZV seropositivity. The positive and negative predictive values of varicella disease history were 93·4% and 36·4%, respectively, in elementary students and 97·6% and 3·0%, respectively, in college students. VZV seroprevalence in this Pacific island appears to be similar to that in temperate countries and suggests endemic VZV circulation.
We examined the impact of the neonatal hepatitis B immunization programme, first provided to all neonates born to mothers screened positive for hepatitis B surface antigen (HBsAg) in late 1983, on the age-specific prevalence of HBsAg carriage in teenage mothers managed in 1998–2008. HBsAg carriage was found in 2·5%, 2·7%, 8·8% and 8·0% of mothers aged ⩽16, 17, 18, and 19 years, respectively (P = 0·004), which was also correlated with advancing age (P = 0·011). While neither difference nor correlation with age was found in mothers born before 1984, the prevalence of 1·2%, 1·5%, 7·1% and 8·3%, respectively, was significantly different among (P = 0·008) and correlated with (P = 0·002) age in mothers born 1984 onwards. Regression analysis indicated there was a significantly higher incidence of HBsAg carriage from age 17 onwards (adjusted odds ratio 2·55, 95% confidence interval 1·07–6·10, P = 0·035), suggesting that the protective effect of the vaccine declined in late adolescence.
Fullerene chemistry is booming, but how the chemical reactions affect fullerene's materials properties has seldom been studied. We have investigated optical limiting behavior of a series of fullerene derivatives, polymers, and glasses and have observed the following structure-property relationships for optical limiting in the fullerene materials: (i) The fullerene polymers with aromatic and chlorine moieties, i.e., C60-containing polycarbonate (C60-PC), polystyrene (C60- PS), and poly(vinyl chloride) (C60-PVC), limit the 8-ns pulses of 532-nm laser light more effectively than does the parent C60; (ii) the fullerene polymers with carbonyl groups, i.e., C60- containing CR-39 (C60-CR-39) and poly(methyl methacrylate), (C60-PMMA), do not enhance C60's limiting power; and (iii) the aminated fullerene derivatives, i.e., HxC60 (NHR)x [R = -(CH2CH2O)2H (1), x = 11; -(CH2)6OH (2), x = 7; -cyclo-C6H11 (3), x = 11; -(CH2)3Si(OC2H5)3 (4), x = 4], and their sol-gel glasses, i.e., 1–3/SiO2 (physical blending) and 4-SiO2 (chemical bonding), show complex limiting responses, with 4(-SiO2) performing consistently better than 1-3(/SiO2). The fullerene glasses are optically stable and their optical limiting properties remainunchanged after being subjected to continuous attack by the strong laser pulses for ca. 1 h.
Potassium (K) ions have been implanted in hydrothermally grown ZnO to a dose of 1 × 1015 cm-2, followed by isochronal annealing in a tube furnace (30min) and by rapid thermal annealing (30s) on two separate samples. For annealing temperatures below 700°C, only a minor redistribution of Li is observed behind the projected range of the K+ ions. At temperatures between 700 and 750°C, however, both annealing treatments show a wide region behind the implantation peak which is depleted of Li, and this depletion is used as a tracer to monitor diffusion of intrinsic defects like the Zn interstitial. The results are interpreted as Zn interstitials being released from the implanted region in a burst at temperatures above ∼700°C, followed by rapid migration, replacement of Li on Zn site through the kick-out mechanism, and migration of Li away from the active region.
Background: This study aimed to assess if decisional capacity and the four decision-making abilities related to decisions concerning medication management were impaired among community-dwelling Chinese older persons in Hong Kong with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), as compared with cognitively normal older adults.
Methods: Two hundred and ninety-one Chinese community-dwelling older adults were recruited. The four decision-making abilities and decisional capacity were assessed by using the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED) and independent clinician ratings based on the definition in the UK Mental Capacity Act 2005, respectively.
Results: Ninety-nine participants (34%) were diagnosed with MCI and ninety-five (33%) with mild AD. Although almost all (96%) of the participants in the MCI group were found to be mentally competent to make decisions on medication management in clinician ratings, their decision-making abilities as measured by the ACED were significantly lower than those of the cognitively normal controls.
Conclusions: Results from this study suggest that abilities related to decisions on medication management are impaired before the clinical diagnosis of dementia is made. Use of specific and structured assessment of the relevant decisional abilities may enhance clinical judgment.
Background: The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB.
Methods: The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest.
Results: The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest.
Conclusions: The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.
The hardness and fracture toughness of a model two-phase composite consisting of crystalline Si3N4 particles in a matrix of amorphous Si3N4 are examined. The composite is created by heat treating high purity, partially amorphous CVD Si3N4 in N2 for various times and temperatures in order to induce crystallization of the a phase. Microindentation tests at temperatures up to 1200 °C are conducted to evaluate the high temperature hardness and fracture toughness. The role of the microstructure is examined using optical and transmission electron microscopy. Finally, the relationship between the microstructure and the mechanical properties is discussed.
Deposition by aqueous acetate solution (DAAS) technique was used to synthesize undoped and 5 wt% Cr-, Mn-, Eu-, or Pr-doped Pb(Zr0.53Ti0.47O3 [PZT] thin films. The dopant was incorporated into PZT either in the precursor coating solution or via thermal diffusion into undoped PZT. X-ray diffraction shows that ion-doped PZT thin films on Pt<l 1 l>/Ti/SiO2/Si<100> (in particular, the Mn- and Eu- doped samples) display better crystallinity and smaller lattice parameters than those on sapphire substrates. The enhancement of photoconductivity at visible wavelengths measured by excitation photocurrent spectroscopy (EPS) goes as Cr-doped∼Mn-doped > Eu-doped ∼ Pr-doped. Only Mn-doped PZT perovskites have the band gap energy red-shifted to 360 nm from 330 nm. The space charge (or photovoltaic) field was estimated to be < 8 v when about 100 v was applied to ion-doped PZT thin films with 260 or 320 nm light. By using laser irradiation at selected wavelengths and switching the polarity of applied bias voltage, the expected changes in resistance (Ry) and remanent polarization (±Pr) states were observed in the P-E hysteresis loops. The possible applications of extrinsic ion-doped PZT thin films in optical memory devices are discussed.
Capacitors, resistors and inductors are surface mounted components on circuit boards, which occupy up to 70% of the circuit board area. For selected applications, these passives are packaged inside green ceramic tape substrates and sintered at temperatures over 700°C in a co-fired process. These high temperature processes are incompatible with organic substrates, and low temperature processes are needed if passives are to be embedded into organic substrates. A new high permeability dual-phase Nickel Zinc Ferrite (DP NZF) core fabricated using a low temperature sol-gel route was developed for use in embedded inductors in organic substrates. Crystalline NZF powder was added to the sol-gel precursor of NZF. The solution was deposited onto the substrates as thin films and heat-treated at different temperatures. The changes in the microstructures were characterized using XRD and SEM. Results showed that addition of NZF powder induced low temperature transformation of the sol-gel NZF phase to high permeability phase at 250°C, which is approximately 350°C lower than transformation temperature for pure NZF sol gel films. Electrical measurements of DP NZF cored two-layered spiral inductors indicated that the inductance increased by three times compared to inductors without the DP NZF cores. From microstructural observations, the increase is correlated with the changes in microstructural connectivity of the powder phase.
Bulk single crystals of GaN were used for epitaxial growth of GaN films by molecular beam epitaxy. Low temperature photoluminescence yields much higher intensity emission in the near bandedge region for epitaxial films with respect to the situation in bulk crystals. Character of this luminescence changes also. Dominant band-to-band transitions in the bulk crystals are exchanged by bound exciton and/or donor-acceptor pair transitions observed in the epitaxial layers. We will compare the obtained results with the available data on the homoepitaxial samples grown by metalorganic chemical vapor deposition method and discuss the importance of establishing the basic information on energetic positions of excitonic transitions in stress free samples.
This study reports on the use of zirconolite-rich Synroc to demonstrate the safe immobilisation of ‘high-fired’ Pu02. The zirconolite-rich Synroc used in this study was prepared by adding 13 wt% Pu with equimolar amounts of Gd and Hf, relative to Pu, as neutron absorbers. The incorporation of the Pu and neutron absorbers has been studied microstructurally as well as by longer-term leach testing. This work has shown that the sintered ceramic can immobilise 13 wt% of Pu with almost complete incorporation of the Pu (≃ 98%) into the zirconolite phase. Durability studies have shown that under a wide range of leaching conditions there is no major separation of the Pu and neutron absorbers, with the majority of these elements either remaining in the matrix or leaching at low (< 10−4 g m−2 d−1) and comparable rates from the waste form.
WO3 doped TiO2 nanotube(WO3-doped TNT) thin film was fabricated by anodizing the TiO2 nanotube (TNT) film in an NH4F electrolyte containing WO4- ions. The sample was characterized by Field Emission Scanning Electron Microscopy (FE-SEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and UV–Vis diffuse reflectance spectroscopy (DRS). The results show that WO3 was successfully doped into TiO2 nanotubes and the absorption edge of WO3 doped TNT appeared to be red shifted. The photoelectrocatalytic (PEC) activity of WO3 doped TNT electrode was evaluated through the PEC degradation of aqueous Acid Blue 80. The experimental results demonstrated that the PEC degradation rate of WO3 doped TNT is increased by 48% and by 167% over that of non-doped TNT under UVA light irradiation and visible-light irradiation, respectively, at an applied potential of 1.54V. The degradation rates of WO3 doped TNT under photocatalytic (PC), electrochemical (EC), and PEC processes were compared. The results reveal the synergetic effect of PC and EC processes.