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Understanding complex dynamics of cognitive constructs and the interplay between cognition and daily life activities is possible through network analysis. The objectives of this study are to characterize the cognition network and identify central cognitive constructs, and identify the cognitive constructs bridging cognition and daily life activities. In 210 community-dwelling stroke survivors, we employed network analysis to characterize the cognition network, identify the central cognitive constructs, and examine the bridge pathway connecting cognition and daily life activities. Cognitive constructs were positively correlated within the network, forming clusters of fluid (e.g., components of active problem-solving), crystallized (e.g., world knowledge), and functional cognition. Central constructs included inhibition, organization, and cognitive flexibility, whereas bridge constructs included organization, sequencing, and inhibition. Central and bridge constructs identified by this study are potential targets for future research and intervention. The emergence of functional cognition as central and bridge constructs may support its inclusion in occupational therapy practice.

Despite efforts to implement universal health care coverage (UHC) in the Philippines, income poor households continue to face barriers to health care access and use. In light of recent UHC legislation, the aim of this study was to explore how gender and social networks shape health care access and use among women experiencing poverty in Negros Occidental, Philippines. Semi-structured interviews were conducted with women (n = 35) and health care providers (n = 15). Descriptive statistical analyses were performed to report demographic information. Interview data were analyzed thematically using a hybrid deductive-inductive approach and guided by the Patient-Centred Access to Health Care framework. Women’s decisions regarding health care access were influenced by their perceptions of illness severity, their trust in health care facilities, and their available financial resources. Experiences of health care use were shaped by interactions with health professionals, resource availability at facilities, health care costs, and health insurance acquisition. Women drew upon social networks throughout their lifespan for social and financial support to facilitate healthcare access and use. These findings indicate that social networks may be an important complement to formal supports (eg, UHC) in improving access to health care for women experiencing poverty in the Philippines.

Light pollution in recent years has drawn surging public concerns in Hong Kong. The improper management of the light sources causes pollution, particularly light trespass on the community level, which obstructs the residents. Yet more studies are expected to quantitatively and systematically assess the severity of the artificial light trespass problem, and to offer practical solutions for mitigation and urban management. This study was conducted on a typical high-density, mixed-use neighbourhood in Tsim Sha Tsui district. The study consists of on-site measurement and model simulation. Three illuminance measurements were conducted to evaluate the impact of light pollution on the streets and light trespass on the nearby buildings. It was found that the impacts on the buildings (mean illuminance of 3 lx) are less significant than on the streets (mean illuminance of 188 lx) for the target study area. Indoor measurement at various height levels showed a mean illuminance level of 0.6 lx, which is much lower than the international limit of 25 lx. Meanwhile, the modelling work, consisting of correlation, verification and regression analysis, was carried to bridge luminous flux from light sources and illuminance received at the target. A three-dimensional (3D) model was developed to mimic the actual situation and was used to identify the primary light sources causing impacts. While a growing number of research is found on measuring and modelling the intricate light pollution in such a micro scale that elevates explicitly the importance of extrapolating the light pollution effect vertically from street level to building level, direct simulation is still lacking. This study also refined and summarised the research methodology to serve as a feasible and organised protocol for setting up the measurement and modelling work. This can be adapted in future assessments on light trespass issues under similar circumstances elsewhere, like scientific research, urban planning, or property development projects.

The Birmingham Cognitive Screen (BCoS) is a neuropsychological battery designed to assess impairment to a variety of cognitive domains including language in patients with brain injuries. Twenty-two stroke participants and 16 gender-, age-, and education-matched controls were recruited in Hong Kong. The stroke participants were administered HK-BCoS as well as standardized batteries of cognitive and language functions validated for the Cantonese-speaking population in Hong Kong, including the Cantonese version of the Western Aphasia Battery, Cantonese Mini-Mental State Examination, and the Hong Kong–Montreal Cognitive Assessment. Results showed that HK-BCoS demonstrated good concurrent validity with all standardized batteries. HK-BCoS could discriminate between cognitive impairments in stroke patients and normal participants. Furthermore, HK-BCoS was found to have excellent intrarater and interrater reliabilities, good test–retest reliability, and fair split-half reliability as judged according to international criteria. In sum, HK-BCoS is a valid and reliable tool for assessing cognitive processing in Cantonese speakers in Hong Kong.

Purpose.To identify prognostic factors associated with clear cell sarcomas in 14 Chinese patients.Methods.Medical records of 7 men and 7 women (mean age, 36 years) with histologically confirmed clear cell sarcoma of tendons and aponeuroses were reviewed. Patient demographics, tumour characteristics, and treatment modalities were retrieved. Prognostic factors associated with favourable 5-year survival were determined.Results.The most affected sites were the thigh (n=5) and the foot (n=4); the mean time from symptom onset to diagnosis was 9.5 months. The tumour stage at diagnosis was IIA in 8 patients, IIB in 2, and III in 4. The mean tumour size was 4.5 cm in diameter. One patient was lost to follow-up. For the remaining 13 patients, the mean time to disease-related mortality was 2.5 years. Nine patients had distant metastases; the most common sites were lungs and pleura (n=7), followed by distant lymph nodes (n=4), bone (n=2), pericardium (n=2), and brain (n=1). All patients underwent surgical excision. Three women and one man (mean age, 27 years) attained 5-year disease-free survival. All had stage IIA tumours at diagnosis. Their mean tumour size was 1.75 cm in diameter, which was significantly smaller than that of all patients (4.5 cm). Tumour size of ⩽2.5 cm in diameter (p=0.004) and stage IIA tumour at diagnosis (p=0.04) were significant prognostic factors for 5-year survival.Conclusion.Tumour size of ⩽2.5 cm and early stage tumour are associated with 5-year disease-free survival. Early detection is crucial for the prognosis of clear cell sarcomas.

Failure to anticipate the need to discharge patients to rehabilitation centers and skilled nursing facilities results in expensive delays in the discharge of patients after surgery. Early identification of patients at high risk for discharge to these extended care facilities could mitigate these delays and expenditures. The purpose of this study was to identify preoperative patient factors associated with discharge to extended care facilities after major general thoracic surgery. Discharge records were identified for all patients undergoing major general thoracic surgery admitted to a university hospital between January 2006 and May 2009 who had a stay of longer than one day. The following risk factors were selected a priori based on clinical judgment: age, preoperative albumin, pre-operative Zubrod score, history of peripheral vascular disease, and use of home oxygen. Multiple logistic regression analysis was used to estimate the statistical significance and magnitude of risk associated with each predictor of patient discharge to extended care facilities. Of the 1646 patients identified, 68 (4.1%) were discharged to extended care facilities. Hospital length of stay was on average six days longer for patients discharged to these facilities than for patients discharged home ( P < 0.0001). Multivariate analysis demonstrated that advanced age, lower preoperative albumin, and increased preoperative Zubrod score were statistically significant predictors of discharge to extended care facilities. Age, preoperative nutritional status, and functional status are strong predictors of patient discharge to extended care facilities. Early identification of these patients may improve patient discharge planning and reduce hospital length of stay after major thoracic surgery.

This study aims at investigating whether a gratitude induction procedure can reduce death anxiety and promote emotional well-being. Ninety Chinese undergraduate students were randomly assigned into one of three experimental conditions: gratitude, hassle, and neutral. In each condition, participants were instructed to spend 15–20 minutes to reflect on past events and to write up to five events of the designated category. Subsequently, they responded to measures of death anxiety and affect. Results showed that those in the gratitude condition reported much lower death anxiety than those in the neutral or the hassle group. However, gratitude had no effect on positive or negative affect. The findings suggest that the effect of gratitude may be specific to death anxiety, which does not occur in the context of the enhancement of overall emotional well-being.

The management of small abdominal aortic aneurysms (AAA) is by ultrasound surveillance. The study aimed to calculate their growth rate, identify risk factors and determine appropriate screening intervals. The local screening programme and hospital records were used to identify patients with a small (< 5.5 cm) AAA. The dates and maximum diameter of serial scans of patients with two or more scans were obtained. Patients were subdivided by 0.5 cm increments above 3.0 cm. The rate of growth was calculated by linear regression for each patient using both the absolute measurements and logarithmically (ln) transformed measurements. The 95th centile of growth rate within each subgroup was used to estimate the minimum time to grow to 5.5 cm. A total of 252 were included. The mean (± SD) AAA size on the initial scan was 3.9 (± 0.7) cm. Statin use and initial size were predictive factors for the growth rate. The median rate of growth increased according to size from 0.075 to 0.432 cm/year for AAA < 3.5 cm and > 5.0 cm, respectively. It also steadily increased for ln measurements from 0.022 (or 2.2%/year) to 0.078 or (7.8%/year). The minimum time (months) to reach 5.5 cm was 61, 17, 11 and 5 for AAA < 3.5 cm, 3.5–3.9 cm, 4.0–4.4 cm and 4.5–4.9 cm, respectively. Based on ln measurements, the times were similar at 60, 17, 10 and 4 months. In conclusion, the rate of growth increased steadily with AAA size. An aneurysm < 3.5 cm does not require a repeat scan for 5 years, while those measuring 3.5–3.9 cm and 4.0–4.4 cm require a repeat scan after 17 and 11 months.

Introduction: Reported mortality rates for endovascular repair (EVR) of ruptured abdominal aortic aneurysm (rAAA) vary from 0% to 50%. Selection bias, inaccurate reporting, and lack of uniform reporting standards are responsible for this significant discrepancy. Material and Methods: Existing literature about the classification/reporting systems of rAAA is reviewed. A standard way of reporting rAAA based on the physiological, radiological, and operative findings is proposed. Conclusion: The proposed system attempts to provide a universal language of communicating the severity of rupture, address the reporting bias, and allow comparing the outcomes of rAAA.

Aim: To explore the psychopathology of foreign domestic workers (FDWs) who had an acute psychiatric disorder in Hong Kong. Method: This was a retrospective chart review. Demographic and clinical data were extracted from case records of FDWs who were admitted for the first time as inpatients for psychiatric treatment to three regional hospitals of the same catchment area in Hong Kong between 2000 and 2004. Relevant socio-demographic data on local FDWs and the general population of Hong Kong were obtained from local government departments. Results: Twenty-seven Filipino and 14 Indonesian FDWs presenting with their first and so far only psychiatric admission were identified. There were significantly more FDWs who were single or never married in the sample. Filipino FDWs tended to fall ill after 4 years of service in Hong Kong while the corresponding figure for Indonesian FDWs was 2 years. Indonesian FDWs were older and had less access to social and medical services than their Filipino counterparts. Home sickness and marital problems were more commonly identified as stressors rather than workrelated difficulties. Acute and Transient Psychotic Disorder (ICD-10) was diagnosed in over 60% of the subjects, making FDWs two times more vulnerable than local women of similar age for this illness. Conclusions: FDWs constitute a vulnerable group in terms of psychiatric morbidity. Concerted political, social and psychological efforts would be require to alleviate the distress faced by this particularly disadvantaged subset of female expatriates.

Introduction: the objective of this abdominal aortic aneurysm (AAA) screening study was to determine attendance and disease prevalence patterns in Northern Ireland and the role of deprivation and other risk factors. Patients and methods: patients from primary care practices from Belfast, Lisburn, and Saintfield were screened. Past medical history and deprivation details were determined. Results: 2264 men from Belfast, 1104 men in Lisburn, and 284 in Saintfield were invited to attend. Overall, 1659 (45.3%) men attended, with 40.6% from Belfast, 55.0% from Lisburn, and 45.8% from Saintfield ( P < .0001). Ninety-two (5.5%) new AAAs were diagnosed, with 6.5%, 3.8%, and 6.2% in the 3 areas ( P = .055). As deprivation decreased, attendance increased and prevalence decreased. Smoking, peripheral arterial disease, number of medications prescribed, and geographical origin were independent risk factors for AAAs. Conclusion: aneurysm prevalence is influenced by geographical origin and deprivation, which should, therefore, be important factors in health care planning and screening provision.

The purpose of this study was to review the outcome of endovascular abdominal aortic aneurysm repair (EVAR) using custom-made aortouni-iliac (AUI) devices with femorofemoral bypass. Between June 1999 and March 2001, 23 consecutive patients (1 female, 22 male) at high risk of open aortic aneurysm repair underwent EVAR with custom devices in an AUI configuration. The mean follow-up was 37 months (range 2–72 months), and the mean age was 76.8 years (range 67.5–88.7 years). Increased surgical risk was evidenced by 92% and 69% of patients with significant pulmonary or cardiac disease, respectively. The preoperative mean aneurysm diameter ( n = 23) 62 ± 8.2 mm was significantly greater than the postoperative diameter, ( n = 23) 54 ± 16.4 mm. Ten endoleaks occurred. Migration of the stent graft occurred in 9% ( n = 2). Secondary interventions were necessary in 23%, whereas tertiary interventions were required in 9%. Patients at high risk of open aneurysm repair received sufficient protection from aneurysm rupture with custom-made AUI devices.

The objective of this study was to evaluate the applicability of paravertebral blockade (PVB) for endovascular abdominal aortic aneurysm repair compared with general anesthesia (GA). Data from patients who underwent elective infrarenal endovascular abdominal aortic aneurysm repair between August 2001 and July 2002 using PVB or GA were retrospectively reviewed and compared with respect to risk factors, intraoperative hemodynamic characteristics, operative outcome, and complications. Ten patients underwent elective infrarenal endovascular abdominal aortic aneurysm repair under PVB, whereas 15 patients were operated on under GA. One conversion from PVB to GA was necessary for block failure. The perioperative (< 30 days) cardiovascular morbidity and overall mortality were zero in both groups. The PVB group benefited significantly with respect to the incidence of intraoperative hypotension ( p < .05) and blood pressure lability ( p < .01), as well as postoperative nausea ( p < .01). Our preliminary results indicate that PVB is feasible and can be performed safely in a patient population with significant comorbidities.

Dedicated teachers around the world have continually sought to find better instructional strategies for their subjects. This paper presents the development of a multimedia application for teaching rapid prototyping to professionals and tertiary-level students. A CD-ROM was used as the instructional medium. This paper considers learning factors such as the organization and structure of the information, application of animations, visual aids and sound, the human—computer interface, and presentation styles, in relation to the CD-ROM's purpose of enhancing the education process for rapid prototyping technology.

This paper reports an experimental investigation of comfort sensations of people wearing polo shirts with different garment treatments. Subjects are asked to rate their comfort sensations before and after exercising. Before exercise, overall discomfort is largely determined by tactile sensations ( e.g., itchiness and prickliness): after exercise. overall discomfort is mostly governed by moisture related sensations ( e.g., dampness and clinginess).

This paper reports an experimental investigation of the effect of repeated laundering on the comfort-related and low stress mechanical properties of polo shirt fabrics with and without wrinkle-free treatments. Comparisons are made of untreated fabrics, fabrics treated with a hydrophobic wrinkle-free treatment, and fabrics treated with a hydrophilic wrinkle-free treatment. The results show that a wrinkle-free treatment can reduce the adverse effects of washing on many low stress mechanical properties. In general, the surface water absorption rate, warm/cool feeling. and low-stress mechanical properties of wrinkle-free treated fabrics are more stable against repeated laundering, because untreated fabrics tend to shrink and become more compact. The extensibility of a wrinkle-free treated fabric decreases significantly after twelve washing cycles. Application of a hydrophilic softener in the wrinkle-free finish can improve the surface water absorption rate, but the durability of the hydrophilic softener to repeated laundering should be further improved to prevent deterioration of fabric properties after washing.

Background. Ainhum and pseudoainhum are the conditions identified by the presence of a constriction band, usually over the extremities. Case details. We report a case of pseudoainhum in a Caucasian female with underlying chronic lower limb peripheral arterial disease (PAD). The management of pseudoainhum in patients with PAD is discussed. Conclusion. Revascularization of the limb should be considered in the management of patients with pseudoainhum when it is associated with severe PAD. Improved tissue perfusion prevents further ischemia and reduces the risk of developing nonhealing ulcers.

High-resolution 1H NMR has been used to study the molecular dynamics of the piperidine derivative. Detailed analysis of variable temperature NMR data allowed the identification of the origin of two sets of methyl resonance peaks with unequal intensities in the room-temperature proton NMR spectrum of the compound.

We report the basis for the presence of two molecular dynamic processes, in enamino spiro-ketal-type compounds (structure in Fig. 1), that occur in a 330-350 K temperature range. Nuclear magnetic resonance (NMR) is a powerful tool for investigating such molecular dynamic processes in small and large molecules. This capability is a result of the pronounced influence of dynamic effects on NMR spectra. Analysis of experimental NMR data suggests that one of the two molecular processes is cis-trans isomerization across nineteen chemical bonds. To the best of our knowledge, this is the first example of monitoring cis-trans isomerization involving this many chemical bonds by NMR.