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While Multicultural Counseling Training (MCT) and Intercultural Training (ICT) represent two prominent, culture-focused specialties that concern with cultural, intercultural, and human diversity issues, there have been surprisingly little to no intersections or interactions between the two disciplines up to this point. To bridge this gap, the current chapter offers a comprehensive and synergetic review of MCT and its relevance and implication for ICT. Accordingly, the present chapter systematically surveys and analyzes: (1) MCT’s historical roots and development; (2) its parallels and similarities to ICT; (3) the definition of multicultural counseling practice and training; (4) the advent of professional standards for MCT; (5) MCT’s operationalization and measurement of cultural competence; (6) its training models, methods, and techniques; and (7) the prevailing and emerging themes and issues of MCT. In this review, striking parallels and intriguing divergences between MCT and ICT are identified, juxtaposed, and examined, from their respective historical, sociopolitical, intellectual, and methodological traditions and contexts. Critical thoughts and recommended directions to encourage a greater intellectual cross-fertilization and interdisciplinary collaboration between the two specialty areas are considered and presented. As follows, this integrative review represents among the first systematic attempts to facilitate the linkage and the synthesis between these two eminent, allied disciplines.
Many family characteristics were reported to increase the risk of bipolar disorder (BPD). The development of BPD may be mediated through different pathways, involving diverse risk factor profiles. We evaluated the associations of family characteristics to build influential causal-pie models to estimate their contributions on the risk of developing BPD at the population level. We recruited 329 clinically diagnosed BPD patients and 202 healthy controls to collect information in parental psychopathology, parent-child relationship, and conflict within family. Other than logistic regression models, we applied causal-pie models to identify pathways involved with different family factors for BPD. The risk of BPD was significantly increased with parental depression, neurosis, anxiety, paternal substance use problems, and poor relationship with parents. Having a depressed mother further predicted early onset of BPD. Additionally, a greater risk for BPD was observed with higher numbers of paternal/maternal psychopathologies. Three significant risk profiles were identified for BPD, including paternal substance use problems (73.0%), maternal depression (17.6%), and through poor relationship with parents and conflict within the family (6.3%). Our findings demonstrate that different aspects of family characteristics elicit negative impacts on bipolar illness, which can be utilized to target specific factors to design and employ efficient intervention programs.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
This study proposed the application of a novel immersed boundary method (IBM) for the treatment of irregular geometries using Cartesian computational grids for high speed compressible gas flows modelled using the unsteady Euler equations. Furthermore, the method is accelerated through the use of multiple Graphics Processing Units – specifically using Nvidia’s CUDA together with MPI - due to the computationally intensive nature associated with the numerical solution to multi-dimensional continuity equations. Due to the high degree of locality required for efficient multiple GPU computation, the Split Harten-Lax-van-Leer (SHLL) scheme is employed for vector splitting of fluxes across cell interfaces. NVIDIA visual profiler shows that our proposed method having a computational speed of 98.6 GFLOPS and 61% efficiency based on the Roofline analysis that provides the theoretical computing speed of reaching 160 GLOPS with an average 2.225 operations/byte. To demonstrate the validity of the method, results from several benchmark problems covering both subsonic and supersonic flow regimes are presented. Performance testing using 96 GPU devices demonstrates a speed up of 89 times that of a single GPU (i.e. 92% efficiency) for a benchmark problem employing 48 million cells. Discussions regarding communication overhead and parallel efficiency for varying problem sizes are also presented.
Hemostasis, a process which causes bleeding to stop, can be enhanced using chitosan; but the detailed mechanism is unclear. Red blood cells (RBCs) adhere to chitosan because of their opposite charges, but the adhesion force is small, 3.83 pN as measured here using an optical tweezer, such that the direct adhesion cannot be the sole cause for hemostasis. However, it was observed in this study that layer structures of aggregated RBCs were formed next to chitosan objects in both static and flowing environments, but not formed next to cotton and rayon yarns. The layer structure is the clue for the initiation of hemostatsis. Through the supporting measurements of zeta potentials of RBCs and pH's using blood-chitosan mixtures, it is proposed here that the formation of the RBC layer structure next to chitosan objects is due to the reduction of repulsive electric double layer force between RBCs, because of the association of H+ deprotonated from chitosan with COO− on RBC membrane, under the DLVO (Derjaguin-Landau-Verwey-Overbeek) theory. The results are beneficial for designing effective chitosan-based wound dressings, and also for general biomedical applications.
The ability of the aorta to buffer blood flow and provide diastolic perfusion (Windkessel function) is a determinant of cardiovascular health. We have reported cardiac dysfunction indicating downstream vascular abnormalities in young adult baboons who were intrauterine growth restricted (IUGR) at birth as a result of moderate maternal nutrient reduction. Using 3 T MRI, we examined IUGR offspring (eight male, eight female; 5.7 years; human equivalent 25 years) and age-matched controls (eight male, eight female; 5.6 years) to quantify distal descending aortic cross-section (AC) and distensibility (AD). ANOVA showed decreased IUGR AC/body surface area (0.9±0.05 cm2/m2v. 1.2±0.06 cm2/m2, M±s.e.m., P<0.005) and AD (1.7±0.2 v. 4.0±0.5×10−3/mmHg, P<0.005) without sex difference or group-sex interaction, suggesting intrinsic vascular pathology and impaired development persisting in adulthood. Future studies should evaluate potential consequences of these changes on coronary perfusion, afterload and blood pressure.
For nearly a century, the incidence of cancer in people with schizophrenia was lower than in the general population. In the recent decade, the relationship between cancer and schizophrenia has become obscured. Thus, we investigated the cancer risk among young and middle-aged patients with schizophrenia.
Records of newly admitted patients with schizophrenia (n = 32 731) from January 2000 through December 2008 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan, and the first psychiatric admission of each patient during the same period was defined as the baseline. We obtained 514 incident cancer cases that were monitored until December 2010. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with schizophrenia and the general population. Stratified analyses of cancer incidences were performed by gender, site of cancers and duration since baseline (first psychiatric admission).
The incidence of cancer for all sites was slightly higher than that of the general population for the period (SIR = 1.15 [95% CI 1.06–1.26], p = 0.001). Men had a significantly higher incidence of colorectal cancer (SIR = 1.48 [95% CI 1.06–2.06], p = 0.019). Women had a higher incidence of breast cancer (SIR = 1.47 [95% CI 1.22–1.78], p < 0.001). Intriguingly, the risk for colorectal cancer was more pronounced 5 years after the first psychiatric admission rather than earlier (SIR = 1.94 [1.36–2.75], p < 0.001) and so was the risk for breast cancer (SIR = 1.85 [1.38–2.48], p < 0.001). The cancer incidence was higher in patients with schizophrenia contradicting the belief that schizophrenia was protective of cancers.
Our analyses suggest that men and women with schizophrenia were more vulnerable to certain types of cancers, which indicates the need for gender-specific cancer screening programs. The fact that risk of colorectal cancer was more pronounced 5 years after the first psychiatric admission could imply the impact of unhealthy lifestyles or the possibility of delayed diagnoses.
To evaluate the chance of improvement and risk of decline in olfaction among patients with post-traumatic olfactory loss.
This study comprised 80 patients. Changes in olfaction were determined using a visual analogue scale and the ‘Sniffin’ Sticks' test. Logistic regression was used to identify predictors for olfactory changes.
Olfactory changes were observed in 9–35 per cent of patients. The rates of improvement and decline according to visual analogue scale scores were 35 per cent and 10 per cent respectively, whereas those in the Sniffin’ Sticks test were 9 per cent and 11 per cent respectively. There was a predictive link between non-anosmia and decline in Sniffin’ Sticks test scores (odds ratio = 16.61, p = 0.003). A positive correlation was observed between the scores in the first and last examinations (rho = 0.532, p < 0.001).
Patients should be informed that they may experience an improvement or decline in olfaction following post-traumatic olfactory dysfunction. This study provides evidence to support comprehensive counselling regarding prognosis as an integral part of management strategies.
The association between Kawasaki disease (KD) and Attention deficit hyperactivity disorder (ADHD) has rarely been studied. In this study, we investigated the hypothesis that KD may increase the risk of ADHD using a nationwide Taiwanese population-based claims database.
Our study cohort consisted of patients who were diagnosed with KD between January 1997 and December 2005 (N = 651). For a comparison cohort, five age- and gender-matched control patients for every patient in the study cohort were selected using random sampling (N = 3255). The cumulative incidence of ADHD was 3.89/1000 (from 0.05 to 0.85) in this study. All subjects were tracked for 5 years from the date of cohort entry to identify whether or not they had developed ADHD. Cox proportional hazard regression analysis was performed to evaluate 5-year ADHD-free survival rates.
Of all patients, 83 (2.1%) developed ADHD during the 5-year follow-up period, of whom 21 (3.2%) had KD and 62 (1.9%) were in the comparison cohort. The patients with KD seemed to be at an increased risk of developing ADHD (crude hazard ratio (HR): 1.71; 95% confidence interval (CI) = 1.04–2.80; p < 0.05). However, after adjusting for gender, age, asthma, allergic rhinitis, atopic dermatitis and meningitis, the adjusted hazard ratios (AHR) of the ADHD in patients with KD showed no association with the controls (AHR: 1.59; 95% CI = 0.96–2.62; p = 0.07). We also investigated whether or not KD was a gender-dependent risk factor for ADHD, and found that male patients with KD did not have an increased risk of ADHD (AHR: 1.62; 95% CI = 0.96–2.74; p = 0.07) compared with the female patients.
The findings of this population-based study suggest that patients with KD may not have an increased risk of ADHD and whether or not there is an association between KD and ADHD remains uncertain.
Through silicon via (TSV) is the critical structure for three dimensional (3D) integration, which provides vertical interconnection between stacking dies. In TSV structure, large coefficient differences of thermal expansion exist between silicon substrate, dielectric material, and filled metal. Due to the large thermal mismatch, the high thermal stress occurring at the interface of different materials would result in delamination. Therefore, thermal-mechanical reliability is a key issue for 3D integration. In this study, we investigated the thermal-mechanical stress distribution of TSV under the condition of the accelerated thermal cycling loading by finite element analysis based on a 3D model of TSV structure. Due to the thermal expansion, that the TSV structure squeezed the surface area between TSVs at a high temperature resulted in compressive stresses at the surface area between TSVs. Therefore, a proper distance between the stress-sensitive device and the TSV should be kept. The stress analysis shows that the maximum thermal stress occurs in the outside region of TSV interface and in the annular region of TSV at a high temperature and at a low temperature, respectively. This study helps to obtain a clear thermal stress distribution of TSV and possible failure regions can be determined.
Transcritical flow of a stratified fluid past a broad localised topographic obstacle is studied analytically in the framework of the forced extended Korteweg–de Vries, or Gardner, equation. We consider both possible signs for the cubic nonlinear term in the Gardner equation corresponding to different fluid density stratification profiles. We identify the range of the input parameters: the oncoming flow speed (the Froude number) and the topographic amplitude, for which the obstacle supports a stationary localised hydraulic transition from the subcritical flow upstream to the supercritical flow downstream. Such a localised transcritical flow is resolved back into the equilibrium flow state away from the obstacle with the aid of unsteady coherent nonlinear wave structures propagating upstream and downstream. Along with the regular, cnoidal undular bores occurring in the analogous problem for the single-layer flow modelled by the forced Korteweg–de Vries equation, the transcritical internal wave flows support a diverse family of upstream and downstream wave structures, including kinks, rarefaction waves, classical undular bores, reversed and trigonometric undular bores, which we describe using the recent development of the nonlinear modulation theory for the (unforced) Gardner equation. The predictions of the developed analytic construction are confirmed by direct numerical simulations of the forced Gardner equation for a broad range of input parameters.
To investigate whether inadequate dose to Point-A necessitates treatment plan changes in a time of computed tomography (CT)-image-guided brachytherapy treatment planning for cervix cancer.
Materials and methods
A total of 125 tandem and ovoid insertions from 25 cervix patients treated were reviewed. CT-image-based treatment planning was carried out for each insertion. Point-A is identified and the dose documented; however, dose optimisation in each plan was based on covering target while limiting critical organ doses (PlanTarget). No attempts were made to equate prescription and Point-A dose. For each insertion, a second hypothetical treatment plan was generated by prescribing dose to Point-A (PlanPoint-A). Plans were inter-compared using dose–volume histogram analyses.
A total of 250 treatment plans were analysed. For the study population, the median cumulative dose at Point-A was 80 Gy (range 70–95) for PlanTarget compared with 84·25 Gy for PlanPoint-A. Bladder and rectal doses were higher for PlanPoint-A compared with PlanTarget (p < 0·0001). Target D90 did not correlate with Point-A dose (p = 0·60).
Depending on applicator geometry, tumour size and patient anatomy, Point-A dose may vary in magnitude compared with prescription dose. Treatment plan modifications purely based on inadequate Point-A dose are unnecessary, as these may result in higher organ-at-risk doses and not necessarily improve target coverage.
This paper studies the behavior of second grade viscoelastic fluid past a cavity in a horizontal channel. The effects of Reynolds number, fluid elasticity and the aspect ratio of the cavity on the flow field are simulated numerically. The equations are converted into the vorticity and stream function equations. The solution is obtained by the finite difference method.
The behavior of viscoelastic fluids is quite different from the Newtonian fluid, due to the effects of fluid elasticity. Only one flow pattern appears when the Newtonian fluid past the cavity. However, three kinds of flow patterns appear while the viscoelastic fluids past the cavity by increasing Reynolds number from 20 to 300. The flow field is affected by the fluid elasticity as well as the aspect ratio of the cavity. The transitional flow pattern appears at lower Reynolds number as the higher elasticity fluid past the cavity with larger aspect ratio.
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.
We recovered larval trombiculid mites (i.e. chiggers), vectors of scrub typhus, from small mammal hosts in Taiwan, and compared the relative degree of engorgement (RDE) of the dominant chigger (Leptotrombidium imphalum) from different hosts. Naturally occurring chiggers recovered from Rattus losea and Bandicota indica were 1·4x and 1·3x as engorged as those from Apodemus agrarius. Within each host species, RDE was negatively related to chigger loads, but was mostly unrelated to gender or to body or reproductive condition of hosts. We documented significant variation in chigger engorgement both within and among host species; to the extent that RDE is a proxy for fitness, this contradicts predictions of the Ideal Free Distribution (IFD) that the per capita fitness of vectors should be similar among hosts. Failure to meet predictions of the IFD may reflect the limited mobility of chiggers, which consequently must be less selective in the hosts on which they feed. Further disease control efforts should consider vector feeding success in addition to vector abundance and may be able to capitalize on the unsuitability of certain hosts in supporting disease vectors.
We report on a measles outbreak originating in an anthroposophic community in Austria, 2008. A total of 394 (94·9%) cases fulfilled the outbreak case definition including 168 cases affiliated to the anthroposophic community. The source case was a school pupil from Switzerland. The Austrian outbreak strain was genotype D5, indistinguishable from the Swiss outbreak strain. A school-based retrospective cohort study in the anthroposophic school demonstrated a vaccine effectiveness of 97·3% in pupils who had received a single dose of measles-containing vaccine and 100% in those who had received two doses. The vaccination coverage of the cases in the anthroposophic community was 0·6%. Of the 226 outbreak cases not belonging to the anthroposophic community, the 10–24 years age group was the most affected. Our findings underline the epidemiological significance of suboptimal vaccination coverage in anthroposophic communities and in older age groups of the general population in facilitating measles virus circulation. The findings of this outbreak investigation suggest that the WHO European Region is unlikely to achieve its 2010 target for measles and rubella elimination.
To monitor the changing trend of extended-spectrum β-lactamase (ESBL)-producing bacteria, a 7-year continuous study was launched in 2001 at the largest tertiary hospital in Taiwan. A significant increase over the study period was evident for ESBL-producing isolates of Escherichia coli (4·8–10·0%) and Klebsiella pneumoniae (15·0–23·4%). Molecular investigation conducted in three separate periods revealed the prevalent ESBL types and their genetic relatedness. CTX-M-producing isolates (73·8%) were more prevalent than SHV-type ESBLs (37·0%), the most frequent being CTX-M-14 (34·3%), CTX-M-3 (25·9%), and SHV-12 (25·7%). However, a marked increase of CTX-M-15-producing isolates from 2·1% in 2002 to 29·6% in 2007 was also noted. The increase of ESBL-producing isolates in both species may be mainly due to the horizontal transmission of resistance plasmids, while clonal expansion of some epidemic strains further added to the dispersion of ESBL-producing K. pneumoniae.