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Introduction: Geriatric patients commonly present to the emergency department (ED) after a fall. Unfortunately, recent evidence suggests that ED physicians are poorly adherent to published ED-specific geriatric falls guidelines. This study applied a theoretical domains framework (TDF)-driven approach to systematically investigate barriers and enablers in the provision of guideline-based care to older patients presenting to the ED with a fall. Methods: From June to September 2017, semi-structured interviews of staff ED physicians practicing in Ontario, Canada were conducted and analyzed. An interview guide based on the TDF was used to capture 14 domains that may influence provision of guideline-based care. Interview transcripts were analyzed, and specific beliefs were generated by grouping similar responses. Relevant domains were identified based on frequencies of beliefs, existence of conflicting beliefs, and evidence of strong beliefs that would influence provision of guideline-based care. Results: Eleven interviews were conducted with practicing ED physicians. Thirty specific belief statements across 13 different TDF domains (all except Optimism) were identified as relevant. Overall, Ontario ED physicians are supportive of providing guideline-based care and believe it would lead to better outcomes for geriatric falls patients. Important barriers include knowledge, skills, time and workload constraints, and inconsistent allied health support. Conclusion: This study identified important barriers and enablers to provision of guideline-based care in geriatric ED falls patients. These results will help guide implementation of guidelines nationally and internationally, with a focus on improved knowledge dissemination, implementation of training interventions, and improvements in allied health coverage and supports.
Multiple human immunodeficiency virus (HIV)-1 genotypes in China were first discovered in Yunnan Province before disseminating throughout the country. As the HIV-1 epidemic continues to expand in Yunnan, genetic characteristics and transmitted drug resistance (TDR) should be further investigated among the recently infected population. Among 2828 HIV-positive samples newly reported in the first quarter of 2014, 347 were identified as recent infections with BED-captured enzyme immunoassay (CEIA). Of them, 291 were successfully genotyped and identified as circulating recombinant form (CRF)08_BC (47.4%), unique recombinant forms (URFs) (18.2%), CRF01_AE (15.8%), CRF07_BC (14.4%), subtype C (2.7%), CRF55_01B (0.7%), subtype B (0.3%) and CRF64_BC (0.3%). CRF08_BC and CRF01_AE were the predominant genotypes among heterosexual and homosexual infections, respectively. CRF08_BC, URFs, CRF01_AE and CRF07_BC expanded with higher prevalence in central and eastern Yunnan. The recent common ancestor of CRF01_AE, CRF07_BC and CRF08_BC dated back to 1983.1, 1992.1 and 1989.5, respectively. The effective population sizes (EPS) for CRF01_AE and CRF07_BC increased exponentially during 1991–1999 and 1994–1999, respectively. The EPS for CRF08_BC underwent two exponential growth phases in 1994–1998 and 2001–2002. Lastly, TDR-associated mutations were identified in 1.8% of individuals. These findings not only enhance our understanding of HIV-1 evolution in Yunnan but also have implications for vaccine design and patient management strategies.
The purpose of this study was to investigate whether significant difference exists on radiation dose delivered to organs at risks in megavoltage computed tomography (MVCT) verification using three predefined scanning modes, namely fine (2 mm), normal (4 mm) and coarse (6 mm). This will provide information for the imaging protocol of tomotherapy for the left breast.
Materials and methods
Organ doses were measured using thermoluminescent dosimeters (TLD-100) placed within a female Rando phantom for MVCT imaging. Kruskal–Wallis test was conducted with p<0·05 to evaluate the significant difference between the three MVCT scanning modes.
Statistically significant difference existed in organ absorbed dose between different scan mode selections (p<0·001). Relative to the normal scan selection (4 mm), the absorbed dose to the organs of interests can be scaled down by 0·7 and scaled up by 2·1 for coarse (6 mm) and fine scans (2 mm) respectively.
Optimisation of imaging protocols is of paramount importance to keep the radiation exposure ‘as low as reasonably achievable’. The recommendation of undergoing daily coarse mode for MVCT verification in breast tomotherapy not only mitigates the radiation exposure to normal tissues, but also trims the scan-acquisition time.
Evidence suggests that autism and schizophrenia share similarities in genetic, neuropsychological and behavioural aspects. Although both disorders are associated with theory of mind (ToM) impairments, a few studies have directly compared ToM between autism patients and schizophrenia patients. This study aimed to investigate to what extent high-functioning autism patients and schizophrenia patients share and differ in ToM performance.
Thirty high-functioning autism patients, 30 schizophrenia patients and 30 healthy individuals were recruited. Participants were matched in age, gender and estimated intelligence quotient. The verbal-based Faux Pas Task and the visual-based Yoni Task were utilised to examine first- and higher-order, affective and cognitive ToM. The task/item difficulty of two paradigms was examined using mixed model analyses of variance (ANOVAs). Multiple ANOVAs and mixed model ANOVAs were used to examine group differences in ToM.
The Faux Pas Task was more difficult than the Yoni Task. High-functioning autism patients showed more severely impaired verbal-based ToM in the Faux Pas Task, but shared similar visual-based ToM impairments in the Yoni Task with schizophrenia patients.
The findings that individuals with high-functioning autism shared similar but more severe impairments in verbal ToM than individuals with schizophrenia support the autism–schizophrenia continuum. The finding that verbal-based but not visual-based ToM was more impaired in high-functioning autism patients than schizophrenia patients could be attributable to the varied task/item difficulty between the two paradigms.
7″-resolution CO (1-0) observations of M82 with the Owens Valley millimeter-wave interferometer have resolved 2 components of molecular gas in the central 1.5 arcmin of the galaxy: (1) a high plane of M82, and (2) shell-like or filamentary structures of molecular gas, with size-scale as large as 400 pc, extending most likely out of the plane of the galaxy.
Patients with schizophrenia have intact ability to experience emotion, but empirical evidence suggests that they fail to translate emotional salience into effortful behaviour. Previous research in patients with chronic schizophrenia suggests that working memory is important in integrating emotion and behaviour. This study aimed to examine avolition and anhedonia in patients with first-episode schizophrenia and clarify the role of working memory in emotion–behaviour coupling.
We recruited 72 participants with first-episode schizophrenia and 61 healthy controls, and used a validated emotion-inducing behavioural paradigm to measure participants' affective experiences and how experienced emotion coupled with behaviour. Participants were given the opportunity to expend effort to increase or decrease their exposure to emotion-inducing photographs. Participants with schizophrenia having poor working memory were compared with those with intact working memory in their liking and emotion–behaviour coupling.
Patients with first-episode schizophrenia experienced intact ‘in-the-moment’ emotion, but their emotion was less predictive of the effort expended, compared with controls. The emotion–behaviour coupling was significantly weaker in patients with schizophrenia with poor working memory than in those with intact working memory. However, compared with controls, patients with intact working also showed substantial emotion–behaviour decoupling.
Our findings provide strong evidence for emotion–behaviour decoupling in first-episode schizophrenia. Although working memory deficits contribute to defective translation of liking into effortful behaviour, schizophrenia alone affects emotion–behaviour coupling.
Dysregulation of the striatum and altered corticostriatal connectivity have been associated with psychotic disorders. Social anhedonia has been identified as a predictor for the development of schizophrenia spectrum disorders. The aim of the present study was to examine corticostriatal functional connectivity in individuals with high social anhedonia.
Twenty-one participants with high social anhedonia score and 30 with low social anhedonia score measured by the Chinese version of the Revised Social Anhedonia Scale were recruited from university undergraduates (age 17–21 years) to undergo resting-state functional MRI scans. Six subdivisions of the striatum in each hemisphere were defined as seeds. Voxel-wise functional connectivity analyses were conducted between each seed and the whole brain voxels, followed by repeated-measures ANOVA for the group effect.
Participants with high social anhedonia showed hyper-connectivity between the ventral striatum and the anterior cingulate cortex and the insula, and between the dorsal striatum and the motor cortex. Hypo-connectivity in participants with high social anhedonia was also observed between the ventral striatum and the posterior cingulate cortex. Partial correlation analyses further showed that the functional connectivity between the ventral striatum and the prefrontal cortex was associated with pleasure experience and emotional suppression.
Our findings suggest that altered corticostriatal connectivity can be found in participants with high levels of social anhedonia. Since social anhedonia has been considered a predictor for schizophrenia spectrum disorders, our results may provide novel evidence on the early changes in brain functional connectivity in at-risk individuals.
In this talk, we will show the beaming effect for Fermi/LAT blazars, then we discuss the correlations between γ-ray luminosity and other parameters, such as radio Doppler factors, superluminal motions, and core-dominance parameters. We also compare the Doppler factors determined from the γ-ray luminosity, X-ray emissions, and the short-term time scales with those from other methods. Our discussions suggest that γ-ray emissions may be strongly beamed.
Variability is one of the extreme observational properties of BL Lacertae objects. AO 0235+164 is a well studied BL Lac through the whole electro-magnetic wavebands, it is violently variable in the optical bands. In the present work, we show its optical R band photometric observations carried out during the period of Nov. 2006 to Dec. 2012 using the Ap6E CCD camera attached to the primary focus of the 70 cm meniscus telescope at Abastumani Observatory, Georgia. It shows a large variation of ΔR = 4.88 mag (14.20 - 19.08 mag) during our monitoring period. When periodicity analysis methods are adopted to its R observations from our Abastumani monitoring programme and those in the literature, the signs of some periods, P1 = 8.26 yr, P2 = 0.55 yr, P3 = 0.85 yr, P4 = 1.99 yr are found.
In this work, we reported the optical photometry monitoring results for two brightest nearby quasars, PHL 1811 and 3C 273 using the ST-6 camera at Abastumani Observatory, Georgia. For PHL 1811, we found 3 microvariability events with time scale of ΔT = 6.0 min. For 3C273, we found that the largest variations are ΔV = 0.369 ± 0.028 mag, ΔR = 0.495 ± 0.076 mag, and ΔI = 0.355 ± 0.009 mag. When periodicity analysis methods are adopted to the available data, a period of p = 5.80 ± 1.12 years is obtained for PHL 1811, and p = 21.10 ± 0.14, 10.00 ± 0.14, 7.30 ± 0.09, 13.20 ± 0.09, 2.10 ± 0.06, and 0.68 ± 0.05 years are obtained for 3C 273.
It is not clear whether the progressive changes in brain microstructural deficits documented in previous longitudinal magnetic resonance imaging (MRI) studies might be due to the disease process or to other factors such as medication. It is important to explore the longitudinal alterations in white-matter (WM) microstructure in antipsychotic-naive patients with first-episode schizophrenia during the very early phase of treatment when relatively ‘free’ from chronicity.
Thirty-five patients with first-episode schizophrenia and 22 healthy volunteers were recruited. High-resolution diffusion tensor imaging (DTI) was obtained from participants at baseline and after 6 weeks of treatment. A ‘difference map’ for each individual was calculated from the 6-week follow-up fractional anisotropy (FA) of DTI minus the baseline FA. Differences in Positive and Negative Syndrome Scale (PANSS) scores and Global Assessment of Functioning (GAF) scores between baseline and 6 weeks were also evaluated and expressed as a 6-week/baseline ratio.
Compared to healthy controls, there was a significant decrease in absolute FA of WM around the bilateral anterior cingulate gyrus and the right anterior corona radiata of the frontal lobe in first-episode drug-naive patients with schizophrenia following 6 weeks of treatment. Clinical symptoms improved during this period but the change in FA did not correlate with the changes in clinical symptoms or the dose of antipsychotic medication.
During the early phase of treatment, there is an acute reduction in WM FA that may be due to the effects of antipsychotic medications. However, it is not possible to entirely exclude the effects of underlying progression of illness.
Evidence shows that cognitive deficits and white matter (WM) dysconnectivity can independently be associated with clinical manifestations in schizophrenia. It is important to explore this triadic relationship in order to investigate whether the triplet could serve as potential extended endophenotypes of schizophrenia.
Diffusion tensor images and clinical performances were evaluated in 122 individuals with first-episode schizophrenia and 122 age- and gender-matched controls. In addition, 65 of 122 of the patient group and 40 of 122 controls were measured using intelligence quotient (IQ) testing.
The schizophrenia group showed lower fractional anisotropy (FA) values than controls in the right cerebral frontal lobar sub-gyral (RFSG) WM. The schizophrenia group also showed a significant positive correlation between FA in the RFSG and performance IQ (PIQ); in turn, their PIQ score showed a significant negative correlation with negative syndromes.
Overall, these findings support the hypothesis that WM deficits may be a core deficit that contributes to cognitive deficits as well as to negative symptoms.
Prospective memory (PM) refers to the ability to remember to carry out an intended action in the future. PM is consistently found to be impaired in individuals with schizophrenia. Bipolar disorder and schizophrenia may represent conditions along a continuum, and share similar neurocognitive and genetic architecture. This study aimed to compare the nature and extent of PM impairment in individuals with schizophrenia and bipolar disorder.
Participants were 38 out-patients with schizophrenia and 40 out-patients with bipolar disorder in an early psychosis intervention programme, and 37 healthy controls. Time-, event- and activity-based PMs were assessed using a dual-task laboratory paradigm. Self-reported PM performance was gauged using the Prospective and Retrospective Memory Questionnaire. Analysis of covariance (ANCOVA), with intelligence quotient (IQ) and education included as covariates, was used to examine group difference on various types of PM. Repeated measures of ANCOVA were used to examine the group × PM type interaction effect. Correspondence between laboratory and self-reported PM measures was examined using correlational analysis.
The group × PM type interaction effect was not significant, but the main effect of group was significant. Patients with schizophrenia and patients with bipolar disorder both performed more poorly than healthy participants in PM. The two clinical groups did not significantly differ in PM. Laboratory and self-reported PM measures did not correlate significantly with each other.
Patients with bipolar disorder shared a similar PM impairment with those with schizophrenia. Findings of this study extended the similarity in neurocognitive impairments between the two psychiatric disorders to PM.
Carbon is implanted into fused silica with doses of 1, 3, 6, 10×1016 ions/cm2. Infrared spectroscopy has identified the formation of CO and CO2 molecules in the implanted glasses. The relationships among concentrations of carbon dioxide, carbon monoxide and carbon doses are established by the infrared measurements. Annealing under different atmospheres have dramatic effects on CO and CO2 concentrations.
Nanoclusters of Ag metal in MgO(100) single crystals was formed by implantation of 1.5 MeV silver ions at fluences of 6 x 1016 ion/cm2 and at 1.2 x 1017 ion/cm2, and subsequent annealing at temperatures between 600°C to 1100°C. The formation of the Ag metallic clusters was confirmed using optical absorption spectrophotometry by the absorption band at 430 nm. This is in agreement with the theoretical prediction using Mie's theory, with calculated average nanocluster size about 3 nm. Using ion channeling we confirmed that the orientation of the Ag nanoclusters was in the same direction of the host crystal. Using Z-scan we found the nonlinear refractive index of Ag implanted MgO to be 4.9 x 10-8 esu.
The effects of in situ interventions which alter defect interactions during implantation, and thereby affect the final damage state, have been investigated. Specifically, we examined the effects of internal electric fields and charge carrier injection on damage accumulation in silicon. In the first part of this work, we implanted H or He ions into diode structures which were either reverse or forward biased during implantation. In the second part, we implanted B or Si ions into plain silicon wafers whilst illuminating them with UV light. In each case, the overall effect is one of damage reduction. Both the electric field and charge carrier injection effects may be understood as resulting from changes in defect interactions caused in part by changes to the charge state of defects formed during implantation.
200 eV and 30 keV Si2+ FIB were implanted in an MBE-grown GaAs layer in a dose range of 1012 and 1013 cm-2. Successive overlayer regrowth of the GaAs cap layer and postannealing at 800 °C for 3 – 30 s was performed to form buried thin δ-doped like layers. From the measurement of the sheet carrier density and the mobility, it was observed that doped layers had a carrier density ranging from 5×1011 to 1×1013 cm-2 and mobilities which were almost the same order in magnitude as that of an MBE-grown δ-doped sample.
Using a newly developed ion beam apparatus, PANDA (Positive And Negative ions Deposition Apparatus), carbon nitride films were prepared by simultaneous deposition of mass-analyzed low energy positive and negative ions such as C2-, N+, under ultra high vacuum conditions, in the order of 10−6 Pa on silicon wafer. The ion energy was varied from 50 to 400 eV. The film properties as a function of their beam energy were evaluated by Rutherford Backscattering Spectrometry (RBS), Fourier Transform Infrared spectroscopy (FTIR) and Raman scattering. From the results, it is suggested that the C-N triple bond contents in films depends on nitrogen ion energy.
Polycrystalline Si (Poly-Si) films were successfully grown at temperature less than 500 °C by using a direct Si ion beam deposition technique. In this process, the ion beam energy of Si- is directly coupled to the formation of the films. High substrate temperature (>600 °C), normally required for conventional CVD techniques, has been a major barrier for the Poly-Si Thin Film Transistor Liquid Crystal Display (TFT LCD) which uses a glass substrate. Thus, the ability to produce Poly-Si film below the glass transition temperature and to control the grain size will make this direct Si- ion beam deposition process a potential alternative technique for future TFT LCD. The grain size dependence on the ion beam energy and substrate temperature was investigated using a Transmission Electron Microscope (TEM). The grain size could be controlled from 0.1 μm to 1 μm at ion beam energies from 10 to 50 eV with a substrate temperature less than 500 °C. The resistivity of the as-deposited film was of the order of 100 Ωcm due to in-situ doping effect.