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.
Despite the fact that social deficits among individuals with autism spectrum disorder (ASD) are lifelong and impact many aspects of personal functioning, evidence-based programs for social skills training were not available until recently. The Program for the Education and Enrichment of Relational Skills (PEERS®) has been shown to effectively improve social skills for adolescents on the spectrum across different social cultures. However, the effectiveness for young adults beyond North America has yet to be examined. This study aimed to investigate the effectiveness of the PEERS intervention in Taiwanese young adults with ASD, and examine its durability and clinical correlates.
We recruited 82 cognitively-able young adults with ASD, randomized to the PEERS treatment or treatment-as-usual.
Following treatment, significant improvement was found in aspects of social deficits, autism severity, social interaction anxiety, empathy, and social skills knowledge either by self-report or coach-report. Additionally, communicative behaviors rated by observers improved throughout the sessions, showing a trend toward more appropriate eye contact, gestures, facial expression during conversation, and appropriate maintenance of conversation and reciprocity. Most effects maintained at 3-month and 6-month follow-ups. The improvement of social deficits was positively correlated with baseline severity, while gains in social skills knowledge were positively correlated with IQ. The improvement of social deficits, autism severity, and empathy were positively correlated with each other.
Overall, the PEERS intervention appears to effectively improve social functioning in Taiwanese young adults with ASD. Improvement of social response and knowledge may be predicted by baseline severity and intelligence respectively.
The population of patients with major depressive disorder (MDD) and suicidal ideation (SI) or behaviors/attempts (SA) is not well characterized. Electronic health records (EHR) may contain useful data elements that are unavailable in other routinely used population-level databases like insurance claims. For example, the Patient Health Questionnaire (PHQ)-9 is a disease severity metric in this population which may influence treatment choices and hence, outcomes. This study sought to describe the treatments, depression severity, and health resource utilization among this population prior to, during, and following a suicide-related event.
Adult patients enrolled in an integrated delivery network with a diagnosis code indicating MDD and without a diagnosis for bipolar or related disorders, dementia, intellectual disability, schizophrenia or other non-mood psychotic disorders between 10/31/2015 and 9/30/2019 were selected from the Optum de-identified EHR database. Only patients with a diagnosis code for SI or probable SA (SI/SA) between 10/31/2016 and 9/3/2019 and healthcare activity ≥12 months prior to their 1st observed SI/SA diagnosis were included. MDD-related treatments and PHQ-9 scores (obtained from physician notes using natural language processing) were described during 3 periods: the 1st SI/SA health care encounter (index period), 12 months before (pre-period), and 6 months after (follow-up period). For those with multiple PHQ-9 scores during a period, the latest one was used. All-cause and MDD-related healthcare utilization were assessed during follow-up period.
A total of 71,161 patients with MDD and SI/SA were included in the analysis; mean (SD) age was 39 years (16 years); 55% were female. Antidepressants were prescribed for 31.3% during the pre-period and 41.2% during the index period. The use of psychotherapy was 9.5% during the pre-period and 18.7% during the index period. In the subgroup with data at 6 months (N=40,261), 43.4% and 20.5% received an antidepressant prescription and psychotherapy, respectively. During follow-up, the percent with ≥1 all-cause (MDD-related) hospitalization, observation stay and ED visit were: 11.8% (7.0%), 5.0% (2.1%), and 33.1% (11.1%). More than half (61.0) had ≥1 outpatient visit, and about 1/3 (33.4%) had ≥1 MDD-related outpatient visit. Very few patients had PHQ-9 scores recorded: pre-period 4.4% (mean [SD] 13.0 [7.5]); index period 1.3% (mean [SD] 17.0 [7.2]); and follow-up period 7.6% (mean [SD] 12.1 [7.5]).
This study documents a high level of health care resource utilization among those with MDD and suicidal thoughts and behaviors. Only a small proportion had documented PHQ-9 scores. Given that sizable proportions did not receive any antidepressant therapy or psychotherapy, even after suicidality was noted in their medical record, continued efforts in screening and treatment intensification are warranted for this vulnerable population.
Growth in the immediate postnatal period for extremely low birth weight (ELBW, birth weight < 1000 g) infants is an important topic in neonatal medicine. The goal is to ensure adequate postnatal growth and to minimize complications resulting from suboptimal growth. Past efforts have focused on postnatal nutrition as well as on minimizing comorbidities. It has not been systematically assessed whether antenatal factors play a role in postnatal growth. In this report, we conducted a retrospective study on 91 maternal–neonatal pairs. We prospectively collected maternal and neonatal demographic data, neonatal nutrition in the first 7 days of life and after enteral nutrition is fully established, comorbidity data, as well as weight data from birth to 50 weeks corrected gestational age. We developed a linear mixed-effects model to examine the role of placental insufficiency, as defined by fetal Doppler studies, in postnatal weight z-score trajectory over time in the ELBW population. We relied on Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) for model selection. Interestingly, the selected model included a quadratic term of time and a placental insufficiency-by-time interaction term. In a covariate analysis, AIC and BIC both favored a model that included calories intake in the first 7 days of life and the total duration of antibiotics as fixed-effects, but not their interaction terms with time. Overall, we demonstrated for the first time that placental insufficiency, an antenatal factor, is a major determinant of postnatal weight trajectory in the ELBW population. Prospective studies are warranted to confirm our findings.
Forty-eight different Ag–Al–Zr ternary alloys were prepared in various compositions to determine the metallic glass region in the Ag–Al–Zr ternary system. Experimental results indicated that the metallic glass region in the Ag–Al–Zr ternary system is Ag20–30Al10–30Zr50–60. The Ag20Al30Zr50 and Ag30Al20Zr50 alloys are supposed to have the best glass-forming ability in the Ag–Al–Zr ternary system. The phase equilibria of the Ag–Al–Zr ternary system at 773 K (500 °C) were investigated and compared with the metallic glass region results in the Ag–Al–Zr ternary system. Ternary isothermal sections of the Ag–Al–Zr system at 773 K (500 °C) were established and two ternary intermetallic phases were observed in this isothermal section.
Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated.
DESIGN, SETTING, AND PARTICIPANTS
A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University—Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled.
Surgical hand cleansing with conventional 10% povidone–iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol).
Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count.
Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone–iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable.
To investigate the reciprocal relationship between unhealthy eating behaviours and depressive symptoms from childhood to adolescence.
Unhealthy eating behaviours were measured by the frequencies of eating foods with excess salt, sugar or fat in the past week. Depressive symptoms in the past two weeks were measured using a seven-item scale. Hierarchical linear growth models were used to analyse longitudinal associations between unhealthy eating behaviours and depressive symptoms. Time-fixed variables (sex, parents’ education level and household monthly income) and time-varying variables (parents’ marital status, family activities, body weight, vegetable or fruit consumption, exercising and smoking) were controlled for.
The Child and Adolescent Behaviors in Long-Term Evolution study, which commenced in 2001 and has annual follow-up.
Students (n 2630) followed from 2nd grade (8 years old in 2002) to 11th grade.
The frequency of unhealthy eating behaviours in the previous year and the difference between the frequency in the previous and successive year were positively associated with the initiation and growth rate of depressive symptoms. Depressive symptoms in the previous year and the difference in depressive symptoms between the previous and successive year were positively associated with the initial state and growth rate of unhealthy eating behaviours.
Our results suggest a reciprocal relationship between depressive symptoms and unhealthy eating behaviours. This relationship should be considered when developing programmes targeting depressive symptoms and unhealthy diet in children and adolescents.
Bacillus pasteurii was used as synthesis director for the formation of hollow cylinder and helical NiO micro/nanostructure under urea hydrolysis conditions. Bacteria were capable of precipitating nickel product from nickel solution by metabolic processes. An appropriate amount of both water and bacterial solution were required to precipitate the nickel product in good yield. The average crystallite size of NiO was 11.45 nm and lengths of the cylinder and helices were non-uniform (~2–7 µm) and were varied with bacterial body structure template. The present study demonstrates a feasibility of synthesizing bacteria-guided metal oxide crystals for various functional applications.
Worldwide, the number of individuals with dementia is growing in an epidemic manner, with an estimated 35.6 million people affected in 2010 (Prince et al., 2013). With the population aging in Asia, dementia care will become a major public health challenge in this region in the coming decades. Over half of the patients with dementia in the world will live in Asia by 2030. In China alone, a recent review of dementia studies showed that there were 9.2 million dementia patients in 2010 (Chan et al., 2013). These figures are staggering. In many Asian countries, dementia is regarded as a shameful illness, and the local terms for dementia are derogatory. Dementia carries a stigma that may lead to patients’ reluctance in seeking treatment and delay in diagnosis. In addition, local names for dementia frequently conjure up pictures of severe stage of dementia, and may lead to therapeutic nihilism, discouraging mental health professionals from working with elderly patients with dementia. As Asia faces the challenges of a rapidly aging population and provisions of care for growing number of dementia patients, change in local names for dementia has become an issue of attention.
The potential relationship between anaesthesia, surgery and onset of
dementia remains elusive.
To determine whether the risk of dementia increases after surgery with
anaesthesia, and to evaluate possible associations among age, mode of
anaesthesia, type of surgery and risk of dementia.
The study cohort comprised patients aged 50 years and older who were
anaesthetised for the first time since 1995 between 1 January 2004 and 31
December 2007, and a control group of randomly selected patients matched
for age and gender. Patients were followed until 31 December 2010 to
identify the emergence of dementia.
Relative to the control group, patients who underwent anaesthesia and
surgery exhibited an increased risk of dementia (hazard ratio = 1.99) and
a reduced mean interval to dementia diagnosis. The risk of dementia
increased in patients who received intravenous or intramuscular
anaesthesia, regional anaesthesia and general anaesthesia.
The results of our nationwide, population-based study suggest that
patients who undergo anaesthesia and surgery may be at increased risk of
Background: Executive dysfunction is not uncommon in patients with amnestic mild cognitive impairment (aMCI). This study aimed to investigate the applicability of executive function tests (EFTs) in aMCI as an aid in establishing the diagnosis of multi-domain MCI.
Methods: One hundred and twenty (120) aMCI patients, 126 Alzheimer's disease (AD) patients, and 100 normal controls were enrolled. The EFTs evaluated included the trail making test, digit backward span, Stroop color–word test, and design fluency and category fluency tests.
Results: Of the aMCI participants, 66% exhibited impairment in at least one EFT. Among the five selected EFTs, the category fluency test was the most discriminative in detecting executive dysfunction between patients with aMCI (standardized β = 0.264) or AD (standardized β = 0.361) with the controls, followed by the Stroop test. The performance of aMCI patients with two or more impaired EFTs was significantly different from those of controls but not from those of AD patients.
Conclusion: In the clinical setting, aMCI patients who fail in two or more EFTs may represent a unique population with multi-domain MCI that require close follow-up.
Spectral clustering is a technique for finding group structure in data. It makes use of the spectrum of the data similarity matrix to perform dimensionality reduction for clustering in fewer dimensions. Spectral clustering algorithms have been shown to be more effective in finding clusters than traditional algorithms such as k-means. However, spectral clustering suffers from a scalability problem in both memory use and computation time when the size of a dataset is large. To perform clustering on large datasets, in this work, we parallelize both memory use and computation using MapReduce and MPI. Through an empirical study on a document set of 534,135 instances and a photo set of 2,121,863 images, we show that our parallel algorithm can effectively handle large problems.
Clustering is one of the most important subfields of machine learning and data mining tasks. In the last decade, spectral clustering (e.g., Shi and Malik, 2000; Meila and Shi, 2000; Fowlkes et al., 2004), motivated by normalized graph cut, has attracted much attention. Unlike traditional partition-based clustering, spectral clustering exploits a pairwise data similarity matrix. It has been shown to be more effective than traditional methods such as k-means, which considers only the similarity between instances and k centroids (Ng, Jordan, and Weiss, 2001).Because of its effectiveness, spectral clustering has been widely used in several areas such as information retrieval and computer vision (e.g., Dhillon, 2001; Xu, Liu, and Gong, 2003; Shi and Malik, 2000; Yu and Shi, 2003).
Polyaniline nanofiber (PANF) was synthesized using interfacial polymerization and was mixed with aqueous solution of poly(vinyl alcohol) (PVA) to form PANF–PVA binaries. The PANF suspension in water could be stabilized by PVA for more than 3 months due to the hydrogen bonding interaction between PANF and PVA. The specific characteristics of PANF–PVA films was checked by scanning electron microscopy, conductivity measurement, thermogravimetric analysis, Fourier transform infrared spectroscopy, and cyclic voltammetry. The composite film contained 25 wt% PVA (PANF–PVA25) casting at 105 °C was found to have a porous structure and good conductivity. The presence of hydrogen bonding interaction between PANF and PVA improves the electroactivity and electroactive stability of PANF–PVA25 for electrochemical applications. However, an ether linkage between PANF and PVA polymer chain was also found as casting the PANF–PVA film at 200 °C, which is unfavorable for electrochemical applications.
Most biological materials are hierarchically structured composites that often possess exceptional mechanical properties. We show that nanoindentation can be a powerful tool for understanding the structure‑mechanical property relationship of biological materials and illustrate this for fish teeth and scales, not heretofore investigated at the nanoscale. Piranha and shark teeth consist of enameloid and dentin. Nanoindentation measurements show that the reduced modulus and hardness of enameloid are 4‑5 times higher than those of dentin. Arapaima scales are multilayered composites that consist of mineralized collagen fibers. The external layer is more highly mineralized, resulting in a higher modulus and hardness compared with the internal layer. Alligator gar scales are composed of a highly mineralized external ganoin layer and an internal bony layer. Similar design strategies, gradient structures, and a hard external layer backed by a more compliant inner layer are exhibited by fish teeth and scales and seem to fulfill their functional purposes.
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.
Previous scholars considered competence a ‘fuzzy concept’ and addressed confusions such as ‘competency vs. competence’ and ‘competence vs. core competence’. However, the issue ‘What is the essence of employee competence?’ remains unclear. By inference, the essence of competence is addressed in adoption of an organization's sustained competitive advantage viewpoint different from the traditional viewpoint of enhancing individual employability. This paper contends that employee competence is strategically driven by organizational core competence. Psychologically, employee competence and organizational core competence are similar and linked in terms of person–organization fit and person–job fit. A contextual competence framework is established enlightening the essence of employee competence and redefines competence as a ‘temporary asset’ rooted in the interactively organizational context. Contextual variables including shared values, mutual trust and mutual investment bolster the alignment between employee competence and organizational core competence and develop employee competence as firm-specific, thus becoming a source for sustained organizational competitive advantage.
It has been known for some time that the somata of neurons in sensory ganglia respond to electrical or chemical stimulation and release transmitters in a Ca2+-dependent manner. The function of the somatic release has not been well delineated. A unique characteristic of the ganglia is that each neuronal soma is tightly enwrapped by satellite glial cells (SGCs). The somatic membrane of a sensory neuron rarely makes synaptic contact with another neuron. As a result, the influence of somatic release on the activity of adjacent neurons is likely to be indirect and/or slow. Recent studies of neuron–SGC interactions have demonstrated that ATP released from the somata of dorsal root ganglion neurons activates SGCs. They in turn exert complex excitatory and inhibitory modulation of neuronal activity. Thus, SGCs are actively involved in the processing of afferent information. In this review, we summarize our understanding of bidirectional communication between neuronal somata and SGCs in sensory ganglia and its possible role in afferent signaling under normal and injurious conditions. The participation of purinergic receptors is emphasized because of their dominant roles in the communication.
Direct conversion of an amorphous carbon (C) film to capsules by gallium (Ga), and nickel and cobalt (NiCo) alloy particles upon heating is investigated in situ by transmission electron microscopy (TEM). Capsules are catalyzed in an NH3 atmosphere when the temperature is raised to 1050 °C. High resolution TEM reveals that graphene flakes initially nucleate at the surface of the catalysts, then segregate and transform into faceted multi-shell capsules upon continued heating. The solubility of carbon in the NiCo alloy particles can be differentiated from the solubility of carbon in Ga particles by the thickness of the walls. The C/Ga binary phase in nanoparticles is discussed regarding the formation of thin-walled carbon capsules.