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Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation.Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists.Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p

Psychogenic dysphagia is a deglutition disorder characterized by a fear of swallowing, with no structural or functional causes. This report presents the case of a young male patient who had severe malnutrition due to psychogenic dysphagia and was provided visual biofeedback using fiberoptic endoscopic evaluation of swallowing (FEES). A healthy 25-year-old man presented to our clinic with a complaint of throat discomfort when swallowing that had started 6 months prior. As the symptoms worsened, he became fearful of food spreading to his lungs after swallowing and the development of respiratory difficulties. His food intake gradually decreased, resulting in a weight loss of 20 kg within 2 months. Evaluation of organic and other functional causes of dysphagia was performed, but no abnormalities were detected. The sensation of a lump in his throat, fear of swallowing, and anxiety were transformed into somatic symptoms. The patient was diagnosed with psychogenic dysphagia. After visual biofeedback by a physician who performed FEES, the patient resumed eating normally and increased his food intake. If routine tests do not reveal structural or functional causes of dysphagia, assessment of a psychogenic swallowing disorder should be considered. FEES can help in the diagnosis and management of psychogenic dysphagia.

Fluorescence imaging-based diagnostic systems have been widely used to diagnose skin diseases due to their ability to provide detailed information related to the molecular composition of the skin compared to conventional RGB imaging. In addition, recent advances in smartphones have made them suitable for application in biomedical imaging, and various smartphone-based optical imaging systems have been developed for mobile healthcare. However, an advanced analysis algorithm is required to improve the diagnosis of skin diseases. Various deep learning-based algorithms have recently been developed for this purpose. However, deep learning-based algorithms using only white-light reflectance RGB images have exhibited limited diagnostic performance. In this study, we developed an auxiliary deep learning network called fluorescence-aided amplifying network (FAA-Net) to diagnose skin diseases using a developed multi-modal smartphone imaging system that offers RGB and fluorescence images. FAA-Net is equipped with a meta-learning-based algorithm to solve problems that may occur due to the insufficient number of images acquired by the developed system. In addition, we devised a new attention-based module that can learn the location of skin diseases by itself and emphasize potential disease regions, and incorporated it into FAA-Net. We conducted a clinical trial in a hospital to evaluate the performance of FAA-Net and to compare various evaluation metrics of our developed model and other state-of-the-art models for the diagnosis of skin diseases using our multi-modal system. Experimental results demonstrated that our developed model exhibited an 8.61% and 9.83% improvement in mean accuracy and area under the curve in classifying skin diseases, respectively, compared with other advanced models.

Background: A precise anatomical understanding of the adductor canal (AC) and its neural components is essential for discerning the action mechanism of the AC block. We therefore aimed to clarify the detailed anatomy of the AC using micro-computed tomography (micro-CT), histological evaluation, and immunofluorescence (IF) assays.Methods: Gross dissections of 39 thighs provided morphometric data relevant to injection landmarks. Serial sectional images of the AC were defined using micro-CT and ultrasonography. The fascial and neural structures of the AC proper were histologically evaluated using Masson’s trichrome and Verhoeff-Van Gieson staining, and double IF staining using choline acetyltransferase (ChAT) and neurofilament 200 antibodies.Results: The posteromedial branch insertion of the nerve to vastus medialis (NVM) into the lateral border of the AC proper was lower (14.5 ± 2.4 cm [mean ± SD] above the base of the patella) than the origin of the proximal AC. The AC consists of a thin subsartorial fascia in the proximal region and a thick aponeurosis-like vastoadductor membrane in the distal region. In the proximal AC, the posteromedial branch of the NVM (pmNVM) consistently contained both sensory and motor fibers, and more ChAT-positive fibers were observed than in the saphenous nerve (27.5 ± 11.2 / 104 vs. 4.2 ± 2.6 / 104 [counts/µm2], P < 0.001).Conclusions: Anatomical differences in fascial structures between the proximal and distal AC and a mixed neural component of the neighboring pmNVM have been visualized using micro-CT images, histological evaluation, and IF assays.

Background and Purpose Moderate-intensity statin plus ezetimibe versus high-intensity statin alone may provide a greater low-density lipoprotein cholesterol (LDL-C) reduction in patients with recent ischemic stroke.Methods This randomized, open-label, controlled trial assigned patients with recent ischemic stroke P= 0.0003). LDL-C level P=0.0001). Multiple lipid goal achievement rate was 71.1% and 53.7% in the ROS10/EZT10 and ROS20 groups (PP=0.0091). The adverse event rates did not differ between the two groups.Conclusion Moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin alone for intensive LDL-C reduction in patients with recent ischemic stroke. With the combination therapy, more than 70% of patients achieved LDL-C reduction ≥50% and 80% had an LDL-C

Surface roughness is a well-known factor in effecting to the hardness value in low indentation depth. The rougher surface induces a greater hardness value. However, the hardening mechanisms, such as the effect of geometrically necessary dislocations (GNDs), with surface roughness is rarely discussed. Therefore, the current study revealed the relationship between the surface roughness effect and the material dislocation through GNDs by using finite element analysis. 3D Crystal plasticity finite element indentation model was developed with various surface roughness between 24 to 140 nm and a range of indentation depth 3.55 to 12.27 µm to indent on the copper (111) material. The experimental indentation work was performed to validate the finite element model. The surface roughness was discovered to contribute to GND density. The GNDs distribution is highly dependent on the geometry of surface asperities, as the surface get rougher the GNDs distribution tends to be inhomogeneous. The GND density is exponentially proportional to the roughness effect. The GND density increases from 3.58 × 1014 m-2 for surface roughness 24 nm to 1.01 × 1015 m-2 for surface roughness 140 nm at indentation depth 3.55 µm. Therefore, GND density which contributes to hardening effect causes rougher surface to induce greater hardness value.

Objective Following the coronavirus disease-2019 (COVID-19) outbreak, the importance of addressing acute stress induced by psychological burdens of diseases became apparent. This study attempted to evaluate the effectiveness of a new mode of psychiatric intervention designed to target similar psychological crises.Methods Participants included 32 out of 114 COVID inpatients at a hospital in Daegu, Korea, who were assessed between March 30 and April 7, 2020. Multiple scales for screening psychological difficulties such as depressed mood, anxiety, insomnia, acute stress, and suicidality were done. Psychological problem evaluations and interventions were conducted in the form of consultations to alleviate participants’ psychological challenges via telepsychiatry. The interventions’ effects, as well as clinical improvements before and after the intervention, were analyzed.Results As a result of screening, 21 patients were experiencing psychological difficulties beyond clinical thresholds after COVID-19 infection (screening positive group). The remaining 11 were screening negative groups. The two groups differed significantly in past psychiatric histories (p=0.034), with the former having a higher number of diagnoses. The effect of the intervention was analyzed, and clinical improvement before and after the intervention was observed. Our intervention was found to be effective in reducing the overall emotional difficulties.Conclusion This study highlighted the usefulness of new interventions required in the context of healthcare following the COVID-19 pandemic.

A strategy was established to minimize the stochastic effects of internal and external exposure to radioactive substances by wearing respiratory protection equipment (RPE) during an emergency evacuation. During the evacuation of residents in the event of a nuclear power plant accident, the stochastic effects of internal exposure caused by the inhalation of radioactive aerosol and external exposure due to accumulated radioactive particles in the filter medium of a mask must be minimized. The radioactivity concentration along an evacuation route considers atmospheric dispersion and the resuspension of particles deposited on surfaces. The effective dose due to internal exposure is evaluated using inhalation dose coefficients for each particle diameter. When the face seal leakage and filter medium penetration ratio for each particle diameter of the RPE (N95) is taken into consideration, the internal dose is reduced by 97.2%. Furthermore, the accumulated radioactivity in the filter medium decreases by 91.4% when the respirator is replaced every 48 h.

Plagiarism has been battering higher education since the onset of the Covid-19 pandemic. Hence, this research aimed to develop a model to elucidate the types, reasons and strategies to mitigate Plagiarism and misconduct in online examinations. The instrument employed for this research was an online questionnaire, and the study population was determined to be built environment students from five institutions of higher learning. A total of 308 survey forms were analysed using factor analysis, structural equation modelling (SEM) and content analysis. In addition, sixteen (16) case studies were presented and examined to validate the findings. Keywords: Modelling, Online Examination, Plagiarism, Online Examination eISSN: 2398-4287 © 2023. The Authors. Published for AMER & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), and cE-Bs (Centre for Environment-Behaviour Studies), College of Built Environment, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v8i24.4628

This study improves the mechanical strength and long-term durability of Ni-8YSZ, a commonly used anode support(AS) for Solid Oxide Fuel Cells (SOFC). Instead of Ni-8YSZ, Ni-3YSZ is due to its high mechanical strength and low cost. 3YSZ alone had the disadvantage of degradation of mechanical strength in high-temperature, humidified hydrogen atmospheres due to phase transformation. The addition of nano-ZrO2 and nano-WO3 was expected to improve mechanical strength and long-term durability due to the Hall-Petch equation. For uniform dispersion, NiO and 3YSZ powders were ball-milled for 100 hours, and nano-ZrO2 or nano-WO3 was also added. The powders were sintered at 1400 oC for 5 hours. Sintered specimens were reduced at 750 oC in a hydrogen atmosphere for 8 hours. The reduced specimens were reduced for 500 and 1000 hours, respectively, at 900 oC in a humidified hydrogen atmosphere, which is an accelerated atmosphere. Ni-3YSZ with nano-ZrO2 added had greatly improved mechanical strength and long-term durability.

Variable renewable energy sources (solar, wind, etc.) are difficult to maintain efficient hierarchical operation and stable power quality from the perspective of the power system. In preparation for this increase in the proportion of renewable energy, it is necessary to prepare counterplan for power system intelligence and flexibility, such as power backup systems, power storage devices, smart control, and demand response. It is expected that control the volatility of renewable energy and supply-demand balance can be solved by producing/storing hydrogen using idle power and generating electricity using fuel cells. High-efficiency SOFC technology that can manage with daily cycle load fluctuations is the best alternative. In this work, the goal is to develop basic technologies for energy network systems that can respond to daily cycle power fluctuations of renewable energy and increase system stability through SOFC cell/stack design and durability enhancement. In this study, in order to secure the ability to cope with the variability of the power system, it is intended to present durability evaluation criteria for simultaneous heat and load cycles. Stack evaluation was performed in the current range of 0.25 ~ 0.50 A/cm2 in the case of the load cycle test and 500 ~ 700 °C in the case of the temperature cycle test.

As an atom-efficient strategy for the large-scale interconversion of olefins, heterogeneously catalysed olefin metathesis sees commercial applications in the petrochemical, polymer and speciality chemical industries1. Notably, the thermoneutral and highly selective cross-metathesis of ethylene and 2-butenes1 offers an appealing route for the on-purpose production of propylene to address the C3 shortfall caused by using shale gas as a feedstock in steam crackers2,3. However, key mechanistic details have remained ambiguous for decades, hindering process development and adversely affecting economic viability4 relative to other propylene production technologies2,5. Here, from rigorous kinetic measurements and spectroscopic studies of propylene metathesis over model and industrial WOx/SiO2 catalysts, we identify a hitherto unknown dynamic site renewal and decay cycle, mediated by proton transfers involving proximal Brønsted acidic OH groups, which operates concurrently with the classical Chauvin cycle. We show how this cycle can be manipulated using small quantities of promoter olefins to drastically increase steady-state propylene metathesis rates by up to 30-fold at 250 °C with negligible promoter consumption. The increase in activity and considerable reduction of operating temperature requirements were also observed on MoOx/SiO2 catalysts, showing that this strategy is possibly applicable to other reactions and can address major roadblocks associated with industrial metathesis processes. ISSN:0028-0836 ISSN:1476-4687

Objective The air pollution on pregnancy outcome (APPO) study is a prospective hospital-based cohort study designed to investigate the maternal and fetal effects of a particulate matter with an aerodynamic below 10 μm (PM10) and PM2.5 (below 2.5 μm) exposure. This study aims to analyze a relationship between particulate matter and adverse pregnancy outcomes and to find related biomarkers and develop management guidelines.Methods About 1,200 pregnant women are recruited for 3 years (from January 2021 to December 2023) from seven university hospitals to investigate the effects of particulate matter on pregnancy complications and adverse pregnancy outcomes. We collect biological samples by 5 mL of maternal venous blood and 15 mL of urine in each trimester of pregnancy, and 5 mL of umbilical cord blood and 2×2×2 cm of placental tissue are collected after delivery. In addition, by applying PM10 and PM2.5 concentration values and time-activity patterns from the time weighted average model, the individual predicted exposure of air pollution for the pregnant women are obtained.Results The average exposure of PM10 and PM2.5 of the participants in the entire period of pregnancy, was exceeded the World Health Organization air quality guidelines (an annual level, PM10 >15 μg/m3, PM2.5 >5 μg/m3). Moreover, it was revealed that the PM concentration was increasing toward the 3rd trimester of pregnancy.Conclusion The APPO study will be able to identify the degree of exposure to air pollution in pregnant women and use it as basic data for estimating individual exposure to particulate matter. And the results of the APPO study will facilitate in the development of health management for pregnant women against air pollution.

There is an increasing demand for low-level light therapy devices for the treatment of dermatologic conditions, such as acne, hair loss, undesirable body hair, and skin aging. This study evaluated the safety and effectiveness of a novel hand-held low-level light therapy device with a 680 nm red laser diode and a 450 nm blue light-emitting diode for the treatment of mild-to-moderate acne. A prospective clinical study was conducted on 57 patients with mild-to-moderate acne and Fitzpatrick skin types II–IV. Treatments were self-administered by the patients at home daily for 4 weeks. Conventional treatment was restricted during the study period. The number of inflammatory and noninflammatory lesion counts, Investigator’s Global Assessment grade, patients’ self-assessment, and adverse events were measured every two weeks, and follow-ups were performed until four weeks after the final treatment. Moreover, we evaluated the bactericidal effect of low-level light therapy on Cutibacterium acnes, a causative agent of acne vulgaris, in vitro. The mean number of inflammatory acne lesions decreased statistically at weeks 4 ( ∗ ∗ ∗ p < 0.001 ) and 8 ( ∗ ∗ ∗ p < 0.001 ). The proportion of Investigator’s Global Assessment grade 3, indicating moderate acne severity, decreased significantly at the final visit. No severe adverse reactions were reported. Furthermore, there was a significant reduction in the viability of Cutibacterium acnes following low-level light therapy exposure in vitro. The results of this study demonstrate that this novel, hand-held, and low-level light therapy device are safe and effective for the treatment of inflammatory acne, with good adherence.

We propose an active weighting algorithm for composite adaptive control to reduce the state and estimate errors while maintaining the estimation quality. Unlike previous studies that construct the composite term by simply stacking, removing, and pausing observed data, the proposed method efficiently utilizes the data by providing a theoretical set of weights for observations that can actively manipulate the composite term to have desired characteristics. As an example, a convex optimization formulation is provided, which maximizes the minimum eigenvalue while keeping other constraints, and an illustrative numerical simulation is also presented.

Endolysins produced by bacteriophages play essential roles in the release of phage progeny by degrading the peptidoglycan layers of the bacterial cell wall. Bacteriophage-encoded endolysins have emerged as a new class of antibacterial agents to combat surging antibiotic resistance. The crystal structure of mtEC340M, an engineered endolysin EC340 from the PBEC131 phage that infects Escherichia coli, was determined. The crystal structure of mtEC340M at 2.4 Å resolution consists of eight α-helices and two loops. The three active residues of mtEC340M were predicted by structural comparison with peptidoglycan-degrading lysozyme.

An audit committee (AC) report is the primary channel through which investors learn about the responsibilities and activities of an AC. AC members may use personal language (“we”) or impersonal language (“the audit committee”) in an AC report. Psychology research suggests that personal (vs. impersonal) language signals that the language user has greater warmth and sense of communion (i.e., being part of a larger group). Applying this theory, we predict that an AC's use of personal (vs. impersonal) language leads investors to perceive a warmer and more communal AC, and that an AC's perceived warmth/communion (cued by personal language) positively impacts investor judgments. We further posit that the positive effect of personal language is stronger when AC compensation is largely short term than long term. This is because investors need more assurance of AC oversight effectiveness when AC compensation is short term, which makes investors rely more on heuristic cues such as AC language to make judgments. Consistent with this prediction, we find that when AC compensation is largely short term, nonprofessional investors (proxied by Master of Business Administration students) react more positively to an AC's use of personal language than impersonal language. The effect of AC language is insignificant when AC compensation is largely long term, as the long-term compensation structure already provides assurance about the AC's oversight effectiveness, and thus, investors rely less on heuristic cues. Furthermore, we find that the perceived warmth of AC members explains the effect of AC language. Finally, our interviews with nonprofessional investors corroborate some of our main findings and validate their practice implications. Ministry of Education (MOE) Published version The authors also thank the Singapore Ministry of Education Academic Research Fund Tier 2 MOE2019-T2-2-137 and the UOB Endowed Chair Fund for financial support.