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Yu-Chieh Ho,1,&ast; Chia-Ti Wang,1,&ast; Tzu-Chieh Weng,2 Chung-Han Ho,3,4 Kang-Ting Tsai,5,6 Chien-Chin Hsu,1,7 Hung-Jung Lin,1,7,8 Hsiu-Chin Chen,5,9 Chien-Cheng Huang1,7,10 1Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 4Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 5Department of Senior Welfare and Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 6Division of Geriatrics and Gerontology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 7School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan; 8Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan; 9Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan; 10Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chien-Cheng Huang, Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan, Tel +886-6-281-2811, Fax +886-6-281-6161, Email jasonhuang0803@gmail.com Hsiu-Chin Chen, Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan, Tel +886-6-281-2811, Fax +886-6-281-6161, Email 300006@mail.chimei.org.twPurpose: The home-based medical integrated program (HMIP) is a novel model for home healthcare (HHC) in Taiwan, initiated in 2016 to enhance care quality. However, the outcomes of this program on health outcomes and medical resource utilization in HHC patients remain unclear. Thus, we conducted this study to clarify it.Patients and Methods: The authors utilized the Taiwan National Health Insurance Research Database to identify HHC patients who received HMIP and those who did not between January 2015 and December 2017. A retrospective cohort study design was used. Convenience sampling was employed to select patients who met the inclusion criteria: being part of the HHC program and having complete data for analysis.Results: A total of 4982 HHC patients in the HMIP group and 10,447 patients in the non-HMIP group were identified for this study. The mean age in the HMIP group and non-HMIP group was 77.6 years and 76.1 years, respectively. Compared with the non-HMIP group, the HMIP group had lower total medical costs for HHC, fewer outpatient department visits and lower medical costs, lower medical costs for emergency department visits, fewer hospitalizations, and a lower mortality rate (34.6% vs 41.2%, p< 0.001).Conclusion: The HMIP is a promising model for improving care quality and reducing medical resource utilization in HHC patients. While this suggests that the non-HMIP model should be replaced, it’s important to note that both non-HMIP and HMIP models currently coexist. The HMIP may serve as an important reference for other nations seeking to improve care quality and reduce medical resource utilization in their own HHC systems.Keywords: home-based medical integrated plan, health outcomes, medical resource utilization, Taiwan

Background: While the impact of telephone follow-up (TFU) for older emergency department (ED) patients is controversial, its effects on the Asian population remain uncertain. In this study, we evaluated the effectiveness of a novel computer assisted TFU model specifically for this demographic., Methods: At a Taiwanese tertiary medical center, we developed a TFU protocol that included a referral and case management system within the ED hospital information system. We provided TFU to older discharged patients between April 1, 2021, and May 31, 2021. We compared this cohort with a non-TFU cohort of older ED patients and analyzed demographic characteristics and post-ED discharge outcomes., Results: The TFU model was successfully implemented, with 395 patients receiving TFU and 191 without TFU. TFU patients (median age: 76 years, male proportion: 48.9%) differed from non-TFU patients (median age: 74 years, male proportion: 43.5%). Compared with the non-TFU cohort, the multivariate logistic regression analysis revealed that the TFU cohort had a lower total medical expenditure < 1 month (adjusted odds ratio [AOR]: 0.32; 95% CI: 0.21 - 0.47 for amounts exceeding 5,000 New Taiwan Dollars), and higher satisfaction (AOR: 2.80; 95% CI: 1.46 - 5.36 for scores > 3 on a five-point Likert Scale). However, the TFU cohort also had a higher risk of hospitalization < 1 month (AOR: 2.50; 95% CI: 1.31 - 4.77) compared to the non-TFU cohort., Conclusion: Computer-assisted TFU appears promising. Further research involving a larger number of patients and validation in other hospitals is necessary to bolster the evidence and extend the findings to a broader context., (© 2024. The Author(s).)

Objectives: CentriMag® (Abbott, Pleasanton, CA, USA) is indicated for temporary circulatory support for up to 30 days. Extended support is not uncommon, and the results vary considerably. Herein, we review our experience on extended support., Methods: We retrospectively analyzed 19 patients supported with CentriMag as a bridge to recovery, long-term ventricular assist device or transplantation from September 2011 to October 2021., Results: Nineteen patients (16 men and 3 women; mean age 51.7 ± 9.2 years) had CentriMag left ventricular assist device (LVAD) implantation with the skirted-cannula technique. Twelve (63.2%), 6 (31.6%), and 1 (5.3%) patient were in INTERMACS 1, 2, and 3, respectively. The aims of support were bridge-to-decision in 3 patients (15.8%), and bridge-to-transplantation in 16 patients (84.2%). Fourteen patients were supported for longer than 30 days, while 5 patients had their CentriMag removed before 30 days. Of the 5 patients supported for less than 30 days, 3 died early after implantation due to complications of prolonged shock. The other 2 patients were successfully transplanted. Among the 14 patients supported for longer than 30 days, 1 patient died after transplantation and 13 patients survived either after transplantation or weaning off CentriMag. The overall 1-year survival rate was 73.7%. The duration of support for all patients ranged from 6 to 191 days (64 ± 61 days; median 41 days)., Conclusions: The skirted cannula technique for apical cannulation in implantation of CentriMag LVAD is an easy, safe and durable technique. Immediate post-operative and long-term complications are not common. Its use over 30 days is associated with acceptable survival., Competing Interests: All the authors declare that they have no conflicts of interest.

Introduction: Due to long wait times, rising demand and limited resources for Magnetic Resonance Imaging (MRI) services, phone call reminders were implemented as an intervention to increase scanner utilisation and improve non-attendance at the radiology department in Changi General Hospital, Singapore., Aim: This study aims to evaluate the impact of phone reminders on outpatient MRI non-attendance rate as well as the operational efficiency and savings of this intervention through cost-effectiveness analysis., Methods: MRI outpatient records from January to December 2020 (pre-intervention period) and January to December 2021 (post-intervention period) were retrospectively obtained from the hospital systems. Non-attendance rates, costs and savings following the intervention were compared., Results: Outpatient appointment non-attendance rates reduced from 12.85% to 8.93% after intervention. Following the phone reminders, 2,953 patients (21.69%) decided to cancel or reschedule their appointments. Based on the 91.07% attendance rate (100% - 8.93%), another 2689 slots were recovered from the cancellation of these appointments and were given to other patients. The reduction in non-attendance rates (3.92%) after the intervention translates to an increase in attendance of 533 patients while the net revenue generation with the phone reminder intervention was $387,179., Conclusion: Cost analysis indicates that phone reminders provide an inexpensive, easily implemented and personalised method to help increase adherence and improve appointment attendance. Reminding patients by phone calls two day before their appointments also leads to better optimization of appointment slots from cancelations and re-scheduling that can be used to allocate these appointments to other patients., (Copyright © 2023. Published by Elsevier Inc.)

People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its determinants among PwD receiving HHC. We conducted a retrospective cohort study using a Taiwanese national population database. People with new dementia diagnosis in 2007-2016 who received HHC were included. We calculated the accumulative mortality rate and applied Poisson regression model to estimate the risk of mortality for each variable (adjusted risk ratios, aRR) with a 95% confidence interval (CI). We included 95,831 PwD and 57,036 (59.5%) of them died during the follow-up period (30.5% died in the first-year). Among comorbidities, cirrhosis was associated with the highest mortality risks (aRR 1.65, 95% CI 1.49-1.83). Among HHC-related factors, higher visit frequency of HHC (> 2 versus ≦1 times/month, aRR 3.52, 95% CI 3.39-3.66) and higher level of resource utilization group (RUG, RUG 4 versus 1, aRR = 1.38, 95% CI 1.25-1.51) were risk factor of mortality risk. Meanwhile, HHC provided by physician and nurse was related to reduced mortality risk (aRR 0.79, 95% CI 0.77-0.81) compared to those provided by nurse only. Anticipatory care planning and timely end-of life care should be integrated in light of the high mortality rate among PwD receiving HHC. Determinants associated with increased mortality risk facilitate the identification of high risk group and tailoring the appropriate care goals. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020., (© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Background: An Alluvial diagram illustrates the flow of values from one set to another. Edges (or links/connections) are the connections between nodes (or actors/ vertices). There has been an increase in the use of Alluvial deposits in medical research in recent years. However, there was no illustration of such research on the way to draw the Alluvial for the readers. Our objective was to demonstrate how to draw the Alluvial in Microsoft Excel by using 2 examples, including variable characteristics for COVID-19 patients and research achievements (RAs) on the topic of COVID-19, epidemiology, pathogenesis, and vaccine (CEPV), and provide an easy and friendly method of drawing the Alluvial in MS Excel., Methods: Blood samples were collected and analyzed from 485 infected individuals in Wuhan, China. An operational decision tree and 2 Alluvial diagrams were shown to be capable of identifying variable characteristics in COVID-19 patients. A second example is the 100 top-cited articles downloaded from the Web of Science core collection (WoSCC) on the CEPV topic. On the Alluvial diagram, the mean citations (=citations/publications) and x-index were used to identify the top 5 members with the highest RAs in each entity (country, institute, journal, and research area). Two examples (i.e., blood samples taken from 485 infected individuals in Wuhan, China, and 100 top-cited articles on the CEPV topic) were illustrated and compared with traditional visualizations without flow relationships between nodes., Results: The top members in entities with the x-index are U Arab Emirates (242), Jama-J. Am. Med. Assoc. (27.18), Lancet (58.34), San Francisco Va Med (178), and Chaolin Huang (189) in countries, institutes, departments, and authors, respectively. The most cited article with 1315 citations was written by Huang and his colleagues and published by Lancet in 2021., Conclusion: This study generates several Alluvial diagrams as demonstrations. The tutorial material and MP4 video provided in the Excel module allow readers to draw the Alluvial on their own in an easy and friendly manner., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Oral azacitidine (Oral-AZA) maintenance therapy improved relapse-free (RFS) and overall survival (OS) significantly versus placebo for AML patients in remission after intensive chemotherapy (IC) in the phase 3 QUAZAR AML-001 study. Immune profiling was performed on the bone marrow (BM) at remission and on-treatment in a subset of patients with the aim of identifying prognostic immune features and evaluating associations of on-treatment immune effects by Oral-AZA with clinical outcomes. Post-IC, increased levels of lymphocytes, monocytes, T cells and CD34 + CD117+ BM cells were prognostically favourable for RFS. CD3+ T-cell counts were significantly prognostic for RFS in both treatment arms. At baseline, high expression of the PD-L1 checkpoint marker was identified on a subset of CD34 + CD117+ BM cells; many of which were PD-L2+. High co-expression of T-cell exhaustion markers PD-1 and TIM-3 was associated with inferior outcomes. Oral-AZA augmented T-cell numbers during early treatment, increased CD4+:CD8+ ratios and reversed T-cell exhaustion. Unsupervised clustering analysis identified two patient subsets defined by T-cell content and expression of T-cell exhaustion markers that were enriched for MRD negativity. These results indicate that Oral-AZA modulates T-cell activity in the maintenance setting of AML, and these immune-mediated responses are associated with clinical outcomes., (© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

The Geriatric Influenza Death (GID) score was developed to help decision making in older patients with influenza in the emergency department (ED), but external validation is unavailable. Thus, we conducted a study was to fill the data gap. We recruited all older patients (≥65 years) who visited the ED of three hospitals between 2009 and 2018. Demographic data and clinical characteristics were retrospectively collected. Discrimination, goodness of fit, and performance of the GID score were evaluated. Of the 5,508 patients (121 died) with influenza, the mean age was 76.6±7.4 (standard deviation) years, and 49.3% were males. The GID score was higher in the mortality group (1.7±1.1 vs. 0.8±0.8, p <0.01). With 0 as the reference, the odds ratio for morality with score of 1, 2 and ≥3 was 3.08 (95% confidence interval [CI]: 1.66-5.71), 6.69 (95% CI: 3.52-12.71), and 23.68 (95% CI: 11.95-46.93), respectively. The area under the curve was 0.722 (95% CI: 0.677-0.766), and the Hosmer-Lemeshow goodness of fit test was 1.000. The GID score had excellent negative predictive values with different cut-offs. The GID score had good external validity, and further studies are warranted for wider application., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Delirium is one of the most common geriatric syndromes in older patients, accounting for 25% of hospitalized older patients, 31 to 35% of patients in the intensive care unit, and 8% to 17% of older patients in the emergency department (ED). A number of articles have been published in the literature regarding delirium. However, it is unclear about article citations evolving in the field. This study proposed a temporal heatmap (THM) that can be applied to all bibliographical studies for a better understanding of cited articles worth reading., Methods: As of November 25, 2022, 11,668 abstracts published on delirium since 2013 were retrieved from the Web of Science core collection. Research achievements were measured using the CJAL score. Social network analysis was applied to examine clusters of keywords associated with core concepts of research. A THM was proposed to detect articles worth reading based on recent citations that are increasing. The 100 top-cited articles related to delirium were displayed on an impact beam plot (IBP)., Results: The results indicate that the US (12474), Vanderbilt University (US) (634), Anesthesiology (2168), and Alessandro Morandi (Italy) (116) had the highest CJAL scores in countries, institutes, departments, and authors, respectively. Articles worthy of reading were highlighted on a THM and an IBP when an increasing trend of citations over the last 4 years was observed., Conclusion: The THM and IBP were proposed to highlight articles worth reading, and we recommend that more future bibliographical studies utilize the 2 visualizations and not restrict them solely to delirium-related articles in the future., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Helicobacter pylori (HP) eradication therapy (HPE) is recommended for patients with unexplained immune thrombocytopenia (ITP); however, the role of HPE in preventing ITP in patients with HP infection remains unclear. Therefore, this study was designed to clarify it., Methods: This study was conducted at a tertiary medical center and included all adult patients with HP infection between January 1, 2016 and December 31, 2018. We compared the risk of developing ITP between patients with and without HPE. All patients were followed up until December 31, 2020., Results: After excluding patients with thrombocytopenia, 1995 adult patients with HP infection, including 1188 patients with HPE and 807 patients without HPE, were included in this study. The mean age of the patients with HPE was 57.9 years, whereas that of those without HPE was 61.6 years. The percentage of males was 56% in patients with HPE and 59% in those without HPE. Patients without HPE had a higher risk of ITP than those with HPE after adjusting for age, sex, the Charlson Comorbidity Index, and comorbidities [adjusted odds ratio (OR) 1.76; 95% confidence interval (CI) 1.16-2.68]. Stratified analyses showed that the higher risk was found only in males (adjusted OR: 1.70; 95% CI 1.03-2.80). In addition to HPE, male sex and anemia were independent predictors of ITP in patients with HP infection., Conclusion: This study showed that adult patients with HP infection not receiving HPE had a higher risk of developing ITP. We suggest that HPE should be considered, particularly in males and those who have anemia, to prevent ITP., (© 2023. The Author(s).)

Background: Dementia is a progressive disease that worsens over time as cognitive abilities deteriorate. Effective preventive interventions require early detection. However, there are no reports in the literature concerning apps that have been developed and designed to predict patient dementia classes (DCs). This study aimed to develop an app that could predict DC automatically and accurately for patients responding to the clinical dementia rating (CDR) instrument., Methods: A CDR was applied to 366 outpatients in a hospital in Taiwan, with assessments on 25 and 49 items endorsed by patients and family members, respectively. The 2 models of convolutional neural networks (CNN) and artificial neural networks (ANN) were applied to examine the prediction accuracy based on 5 classes (i.e., no cognitive decline, very mild, mild, moderate, and severe) in 4 scenarios, consisting of 74 (items) in total, 25 in patients, 49 in family, and a combination strategy to select the best in the aforementioned scenarios using the forest plot. Using CDR scores in patients and their families on both axes, patients were dispersed on a radar plot. An app was developed to predict patient DC., Results: We found that ANN had higher accuracy rates than CNN with a ratio of 3:1 in the 4 scenarios. The highest accuracy rate (=93.72%) was shown in the combination scenario of ANN. A significant difference was observed between the CNN and ANN in terms of the accuracy rate. An available ANN-based app for predicting DC in patients was successfully developed and demonstrated in this study., Conclusion: On the basis of a combination strategy and a decision rule, a 74-item ANN model with 285 estimated parameters was developed and included. The development of an app that will assist clinicians in predicting DC in clinical settings is required in the near future., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Aims: A computerized tool and interdisciplinary care were implemented to develop a novel model for older patients with delirium in the emergency department (ED)., Methods: We developed a computerized tool using a delirium triage screen and brief confusion assessment in the hospital information system, performed education for the healthcare providers, and developed a continuous care protocol. Comparisons for outcomes between pre- and post-intervention periods were performed., Results: Compared with the pre-intervention period, patients in the post-intervention period had shorter hospitalization stay, lower expenditure of hospitalization, more likely to return home, lower ED revisits of ≤ 3 days, re-hospitalization of ≤ 14 days, and mortality of ≤ 1 month. All mentioned differences were not statistically significant., Conclusions: A novel model was successfully developed for delirium management in older patients in the ED. Outcome differences were not significant; however, the result is promising, which gives us an important reference in the future., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The relativistic charge carriers in monolayer graphene can be manipulated in manners akin to conventional optics. Klein tunneling and Veselago lensing have been previously demonstrated in ballistic graphene pn-junction devices, but collimation and focusing efficiency remains relatively low, preventing realization of advanced quantum devices and controlled quantum interference. Here, we present a graphene microcavity defined by carefully-engineered local strain and electrostatic fields. Electrons are manipulated to form an interference path inside the cavity at zero magnetic field via consecutive Veselago refractions. The observation of unique Veselago interference peaks via transport measurement and their magnetic field dependence agrees with the theoretical expectation. We further utilize Veselago interference to demonstrate localization of uncollimated electrons and thus improvement in collimation efficiency. Our work sheds new light on relativistic single-particle physics and provide a new device concept toward next-generation quantum devices based on manipulation of ballistic electron trajectory., (© 2022. The Author(s).)

Background: An individual's research domain (RD) can be determined from objective publication data (e.g., medical subject headings and Medical Subject Headings (MeSH) terms) by performing social network analysis. Bibliographic coupling (such as cocitation) is a similarity metric that relies on citation analysis to determine the similarity in RD between 2 articles. This study compared RD consistency between articles as well as their cited references and citing articles (ARCs)., Methods: A total of 1388 abstracts were downloaded from PubMed and authored by 3 productive authors. Based on the top 3 clusters in social network analysis, similarity in RD was observed by comparing their consistency using the major MeSH terms in author articles, cited references and citing articles (ARC). Impact beam plots with La indices were drawn and compared for each of the 3 authors., Results: Sung-Ho Jang (South Korea), Chia-Hung Kao (Taiwan), and Chin-Hsiao Tseng (Taiwan) published 445, 780, and 163 articles, respectively. Dr Jang's RD is physiology, and Dr Kao and Dr Tseng's RDs are epidemiology. We confirmed the consistency of the RD terms by comparing the major MeSH terms in the ARC. Their La indexes were 5, 5, and 6, where a higher value indicates more extraordinary research achievement., Conclusion: RD consistency was confirmed by comparing the main MeSH terms in ARC. The 3 approaches of RD determination (based on author articles, the La index, and the impact beam plots) were recommended for bibliographical studies in the future., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The negative impacts of COVID-19 (ImpactCOVID) on public health are commonly assessed using the cumulative numbers of confirmed cases (CNCCs). However, whether different mathematical models yield disparate results based on varying time frames remains unclear. This study aimed to compare the differences in prediction accuracy between 2 proposed COVID-19 models, develop an angle index that can be objectively used to evaluate ImpactCOVID, compare the differences in angle indexes across countries/regions worldwide, and examine the difference in determining the inflection point (IP) on the CNCCs between the 2 models., Methods: Data were downloaded from the GitHub website. Two mathematical models were examined in 2 time-frame scenarios during the COVID-19 pandemic (the early 20-day stage and the entire year of 2020). Angle index was determined by the ratio (=CNCCs at IP÷IP days). The R2 model and mean absolute percentage error (MAPE) were used to evaluate the model's prediction accuracy in the 2 time-frame scenarios. Comparisons were made using 3 visualizations: line-chart plots, choropleth maps, and forest plots., Results: Exponential growth (EXPO) and item response theory (IRT) models had identical prediction power at the earlier outbreak stage. The IRT model had a higher model R2 and smaller MAPE than the EXPO model in 2020. Hubei Province in China had the highest angle index at the early stage, and India, California (US), and the United Kingdom had the highest angle indexes in 2020. The IRT model was superior to the EXPO model in determining the IP on an Ogive curve., Conclusion: Both proposed models can be used to measure ImpactCOVID. However, the IRT model (superior to EXPO in the long-term and Ogive-type data) is recommended for epidemiologists and policymakers to measure ImpactCOVID in the future., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Aim: Home healthcare (HHC) provides continuous care for disabled patients. However, HHC referral after the emergency department (ED) discharge remains unclear. Thus, this study aimed its clarification., Methods: A computer-assisted HHC referral by interdisciplinary collaboration among emergency physicians, case managers, nurse practitioners, geriatricians, and HHC nurses was built in a tertiary medical center in Taiwan. Patients who had HHC referrals after ED discharge between February 1, 2020 and September 31, 2020, were recruited into the study. A non-ED HHC cohort who had HHC referrals after hospitalization from the ED was also identified. Comparison for clinical characteristics and uses of medical resources was performed between ED HHC and non-ED HHC cohorts., Results: The model was successfully implemented. In total, 34 patients with ED HHC and 40 patients with non-ED HHC were recruited into the study. The female proportion was 61.8% and 67.5%, and the mean age was 81.5 and 83.7 years in ED HHC and non-ED HHC cohorts, respectively. No significant difference was found in sex, age, underlying comorbidities, and ED diagnoses between the two cohorts. The ED HHC cohort had a lower median total medical expenditure within 3 months (34,030.0 vs. 56,624.0 New Taiwan Dollars, p = 0.021) compared with the non-ED HHC cohort. Compared to the non-ED HHC cohort, the ED HHC cohort had a lower ≤ 1 month ED visit, ≤ 6 months ED visit, and ≤ 3 months hospitalization; however, differences were not significant., Conclusion: An innovative ED HHC model was successfully implemented. Further studies with more patients are warranted to investigate the impact., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: The COVID-19 pandemic caused >0.228 billion infected cases as of September 18, 2021, implying an exponential growth for infection worldwide. Many mathematical models have been proposed to predict the future cumulative number of infected cases (CNICs). Nevertheless, none compared their prediction accuracies in models. In this work, we compared mathematical models recently published in scholarly journals and designed online dashboards that present actual information about COVID-19., Methods: All CNICs were downloaded from GitHub. Comparison of model R2 was made in 3 models based on quadratic equation (QE), modified QE (OE-m), and item response theory (IRT) using paired-t test and analysis of variance (ANOVA). The Kano diagram was applied to display the association and the difference in model R2 on a dashboard., Results: We observed that the correlation coefficient was 0.48 (t = 9.87, n = 265) between QE and IRT models based on R2 when modeling CNICs in a short run (dated from January 1 to February 16, 2021). A significant difference in R2 was found (P < .001, F = 53.32) in mean R2 of 0.98, 0.92, and 0.84 for IRT, OE-mm, and QE, respectively. The IRT-based COVID-19 model is superior to the counterparts of QE-m and QE in model R2 particularly in a longer period of infected days (i.e., in the entire year in 2020)., Conclusion: An online dashboard was demonstrated to display the association and difference in prediction accuracy among predictive models. The IRT mathematical model was recommended to make projections about the evolution of CNICs for each county/region in future applications, not just limited to the COVID-19 epidemic., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Little is known about the effects of seamless hospital discharge planning on long-term care (LTC) costs and effectiveness. This study evaluates the cost and effectiveness of the recently implemented policy from hospital to LTC between patients discharged under seamless transition and standard transition. A total of 49 elderly patients in the standard transition cohort and 119 in the seamless transition cohort were recruited from November 2016 to February 2018. Data collected from medical records included the Multimorbidity Frailty Index, Activities of Daily Living Scale, and Malnutrition Universal Screening Tool during hospitalization. Multiple linear regression and Cox regression models were used to explore risk factors for medical resource utilization and medical outcomes. After adjustment for effective predictors, the seamless cohort had lower direct medical costs, a shorter length of stay, a higher survival rate, and a lower unplanned readmission rate compared to the standard cohort. However, only mean total direct medical costs during hospitalization and 6 months after discharge were significantly ( p < 0.001) lower in the seamless cohort (USD 6192) compared to the standard cohort (USD 8361). Additionally, the annual per-patient economic burden in the seamless cohort approximated USD 2.9-3.3 billion. Analysis of the economic burden of disability in the elderly population in Taiwan indicates that seamless transition planning can save approximately USD 3 billion in annual healthcare costs. Implementing this policy would achieve continuous improvement in LTC quality and reduce the financial burden of healthcare on the Taiwanese government.

Layers of two-dimensional materials stacked with a small twist angle give rise to beating periodic patterns on a scale much larger than the original lattice, referred to as a "moiré superlattice." Here, we demonstrate a higher-order "moiré of moiré" superlattice in twisted trilayer graphene with two consecutive small twist angles. We report correlated insulating states near the half filling of the moiré of moiré superlattice at an extremely low carrier density (∼10^{10}  cm^{-2}), near which we also report a zero-resistance transport behavior typically expected in a 2D superconductor. The full-occupancy (ν=-4 and ν=4) states are semimetallic and gapless, distinct from the twisted bilayer systems.

In this study, we investigated the effect of mTOR inhibitor (mTORi) drug-eluting biodegradable stent (DE stent), a putative restenosis-inhibiting device for coronary artery, on thermal-injury-related ureteral stricture in rabbits. In vitro evaluation confirmed the dose-dependent effect of mTORi, i.e., rapamycin, on fibrotic markers in ureteral component cell lines. Upper ureteral fibrosis was induced by ureteral thermal injury in open surgery, which was followed by insertion of biodegradable stents, with or without rapamycin drug-eluting. Immunohistochemistry and Western blotting were performed 4 weeks after the operation to determine gross anatomy changes, collagen deposition, expression of epithelial-mesenchymal transition markers, including Smad, α-SMA, and SNAI 1. Ureteral thermal injury resulted in severe ipsilateral hydronephrosis. The levels of type III collagen, Smad, α-SMA, and SNAI 1 were increased 28 days after ureteral thermal injury. Treatment with mTORi-eluting biodegradable stents significantly attenuated thermal injury-induced urinary tract obstruction and reduced the level of fibrosis proteins, i.e., type III collagen. TGF-β and EMT signaling pathway markers, Smad and SNAI 1, were significantly modified in DE stent-treated thermal-injury-related ureteral stricture rabbits. These results suggested that intra-ureteral administration of rapamycin by DE stent provides modification of fibrosis signaling pathway, and inhibiting mTOR may result in fibrotic process change.

To evaluate the trend of healthcare utilization among patients with dementia (PwD) in different post-diagnosis periods, Taiwan's nationwide population database was used in this study. PwD were identified on the basis of dementia diagnoses during 2002-2011. We further subdivided the cases into 10 groups from the index year to the 10th year after diagnosis. The frequency of emergency department visits and hospitalizations, the length of stay, outpatient and department visits, and the number of medications used were retrieved. The Joinpoint regression approach was used to estimate the annual percent change (APC) of healthcare utilization. The overall trend of healthcare utilization increased with the progression of dementia, with a significant APC during the first to second year after diagnosis ( p < 0.01), except that the frequency of outpatient visits showed a decreasing trend with a significant APC from the first to fifth year. All sex- and age-stratified analyses revealed that male gender and old age contributed to greater use of healthcare services but did not change the overall trend. This study provides a better understanding of medical resource utilization across the full spectrum of dementia, which can allow policymakers, physicians, and caregivers to devise better care plans for PwD.

Emergence of drug resistance to all available therapies is the major challenge to improving survival in myeloma. Cereblon (CRBN) is the essential binding protein of the widely used immunomodulatory drugs (IMiDs) and novel CRBN E3 ligase modulator drugs (CELMoDs) in myeloma, as well as certain proteolysis targeting chimeras (PROTACs), in development for a range of diseases. Using whole-genome sequencing (WGS) data from 455 patients and RNA sequencing (RNASeq) data from 655 patients, including newly diagnosed (WGS, n = 198; RNASeq, n = 437), lenalidomide (LEN)-refractory (WGS, n = 203; RNASeq, n = 176), and pomalidomide (POM)-refractory cohorts (WGS, n = 54; RNASeq, n = 42), we found incremental increases in the frequency of 3 CRBN aberrations, namely point mutations, copy losses/structural variations, and a specific variant transcript (exon 10 spliced), with progressive IMiD exposure, until almost one-third of patients had CBRN alterations by the time they were POM refractory. We found all 3 CRBN aberrations were associated with inferior outcomes to POM in those already refractory to LEN, including those with gene copy losses and structural variations, a finding not previously described. This represents the first comprehensive analysis and largest data set of CBRN alterations in myeloma patients as they progress through therapy. It will help inform patient selection for sequential therapies with CRBN-targeting drugs., (© 2021 by The American Society of Hematology.)

Introduction: Studies show trabecular bone score (TBS) may provide information regarding bone quality independent of bone mineral density (BMD) in type 2 diabetes (DM2) patients. We analyzed our Southeast Asian severe osteoporotic hip fracture patients to study these differences., Methods: We conducted a retrospective cross-sectional analysis of subjects admitted to Changi General Hospital, Singapore with severe osteoporotic hip fractures from 2014-2017 who had BMD performed. Electronic records were reviewed and subjects were classified as having diabetes according to the WHO 2019 criteria. DM2 patients were classified according to their HbA1c into well controlled (HbA1c < 7%) and poorly controlled (HbA1c ≥ 7%) DM2., Results: Elderly patients with hip fractures present with average femur neck T scores at the osteoporotic range, however those with DM2 had higher BMD and TBS values compared to non DM2 patients. These differences were statistically significant in elderly women-poorly controlled elderly DM2 women with hip fracture had the highest total hip T-score (-2.57 ± 0.86) vs (-2.76 ± 0.96) in well controlled DM2 and (-3.09 ± 1.01) in non DM2 women with hip fracture, p < 0.001. In contrast, TBS scores were lower in poorly controlled DM2 women with hip fracture compared to well controlled DM2 women with hip fracture (1.22 ± 0.11) vs (1.24 ± 0.09), but these were still significantly higher compared to non DM2 women with hip fracture (1.19 ± 0.10), p < 0.001. In elderly men with hip fractures, univariate analysis showed no statistically significant differences in TBS or hip or LS BMD between those with poorly controlled DM2, well controlled DM2 and non DM2. The differences in TBS and BMD remained significant in all DM2 women with hip fractures even after adjustments for potential confounders. Differences in TBS and BMD in poorly controlled DM2 men with hip fractures only became significant after accounting for potential confounders. However, upon inclusion of LS BMD into the multivariate model these differences were attenuated and remained significant only between elderly women with well controlled DM2 and non DM2 women with hip fractures., Conclusions: Elderly patients with DM2 and severe osteoporosis present with hip fractures at a higher BMD and TBS values compared to non DM2 patients. These differences were significant after adjustment for confounders in all DM2 women and poorly controlled DM2 men with hip fractures, TBS differences were attenuated with the inclusion LS BMD. Further studies are needed to ascertain differences in BMD and TBS in older Southeast Asian DM2 patients with variable glycemic control and severe osteoporosis., Competing Interests: The authors have declared that no competing interests exist.

OBJECTIVE. Outpatient appointment no-shows are a common problem. Artificial intelligence predictive analytics can potentially facilitate targeted interventions to improve efficiency. We describe a quality improvement project that uses machine learning techniques to predict and reduce outpatient MRI appointment no-shows. MATERIALS AND METHODS. Anonymized records from 32,957 outpatient MRI appointments between 2016 and 2018 were acquired for model training and validation along with a holdout test set of 1080 records from January 2019. The overall no-show rate was 17.4%. A predictive model developed with XGBoost, a decision tree-based ensemble machine learning algorithm that uses a gradient boosting framework, was deployed after various machine learning algorithms were evaluated. The simple intervention measure of using telephone call reminders for patients with the top 25% highest risk of an appointment no-show as predicted by the model was implemented over 6 months. RESULTS. The ROC AUC for the predictive model was 0.746 with an optimized F1 score of 0.708; at this threshold, the precision and recall were 0.606 and 0.852, respectively. The AUC for the holdout test set was 0.738 with an optimized F1 score of 0.721; at this threshold, the precision and recall were 0.605 and 0.893, respectively. The no-show rate 6 months after deployment of the predictive model was 15.9% compared with 19.3% in the preceding 12-month preintervention period, corresponding to a 17.2% improvement from the baseline no-show rate ( p < 0.0001). The no-show rates of contactable and noncontactable patients in the group at high risk of appointment no-shows as predicted by the model were 17.5% and 40.3%, respectively ( p < 0.0001). CONCLUSION. Machine learning predictive analytics perform moderately well in predicting complex problems involving human behavior using a modest amount of data with basic feature engineering, and they can be incorporated into routine workflow to improve health care delivery.

Background: The prevalence of geriatric syndromes and the need for hospice care in the emergency department (ED) in Asian populations remain unclear. This study was conducted to fill the data gap., Methods: Using a newly developed emergency geriatric assessment (EGA), we investigated the prevalence of geriatric syndromes and the need for hospice care in older ED patients of a tertiary medical center between September 1, 2016, and January 31, 2017., Results: We recruited a total of 693 patients with a mean age of 78.0 years (standard deviation 8.2 years), comprising 46.6% of females. According to age subgroups, 37.4% of patients were aged 65-74 years, 37.4% were aged 75-84 years, and 25.2% were aged ≥85 years. The prevalence rates of geriatric syndromes were as follows: delirium (11.4%), depression (23.4%), dementia (43.1%), deterioration of activities of daily living (ADL) for <1 year (29.4%), vision impairment (22.2%), hearing impairment (23.8%), sleep disturbance (13.1%), any fall in <1 year (21.8%), polypharmacy (28.7%), pain (35.1%), pressure ulcer (5.6%), incontinence or retention (29.6%), indwelling device or physical restrain (21.6%), nutrition problem (35.7%), frequent use of medical resources (50.1%), lack of advance care planning (84.0%), caregiver problem (4.6%), socioeconomic problem (5.5%), and need for family meeting (6.2%). The need for hospice care was 11.9%. Most geriatric syndromes increased with advancing age except depression, sleep disturbance, polypharmacy, pain, nutrition problem, lack of advance care planning, caregiver problem, and socioeconomic problem., Conclusion: Geriatric syndromes and the need for hospice care were common in the older ED patients. Further studies about subsequent intervention for improving geriatric care are needed., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Ya-Ting Ke et al.)

Background: Because the reliability of repetitive transcranial magnetic stimulation (rTMS) in treating poststroke cognitive impairment has not been convincingly demonstrated, we systematically examined the effectiveness of this regimen with 2 protocols., Methods: We randomly allocated 41 patients with poststroke cognitive impairment to receive 5 Hz rTMS (n = 11), intermittent theta burst stimulation (iTBS; n = 15) or sham stimulation (n = 15). Each group received 10 stimulation sessions over the left dorsolateral prefrontal cortex. We performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Beck Depression Inventory at baseline and after the intervention., Results: The 5 Hz rTMS group showed significantly greater improvement than the sham group in RBANS total score (p = 0.006), attention (p = 0.001) and delayed memory (p < 0.001). The iTBS group showed significantly greater improvement than the sham group in RBANS total score (p = 0.005) and delayed memory (p = 0.007). The 5 Hz rTMS group exhibited a superior modulating effect in attention compared to the iTBS group (p = 0.016). Patients without comorbid hypertension (p = 0.008) were predisposed to favourable therapeutic outcomes., Limitations: Although we included only patients with left hemispheric stroke, heterogeneity associated with cortical and subcortical implications existed. We did not investigate the remote effects of rTMS., Conclusion: Our results demonstrated that both 5 Hz rTMS and iTBS were effective for poststroke cognitive impairment in terms of global cognition, attention and memory function; the domain of attention was susceptible to 5 Hz modulation. Treatment with 5 Hz rTMS may slow cognitive decline, representing both a pivotal process in poststroke cognitive impairment and an aspect of neuroplasticity that contributes to disease-modifying strategies., Clinical Trial Registration: NCT02006615; clinicaltrials.gov/ct2/show/NCT02006615., Competing Interests: None declared., (© 2020 Joule Inc. or its licensors)

Non-bacterial prostatitis is an inflammatory disease that is difficult to treat. Oligonucleotide aptamers are well known for their stability and flexibility in conjugating various inflammatory molecules. In this study, we investigated the effects of inflammatory cytokine-targeting aptamers (ICTA), putative neutralizers of TNF-alpha and IL-1 beta activation, on local carrageenan-induced prostate inflammation, allodynia, and hyperalgesia in rats. In vitro evaluation confirmed the binding capability of ICTA. Intraprostatic injection of carrageenan or control vehicle was performed in six-week-old rats, and ICTA (150 µg) or vehicle was administered in the prostate along with carrageenan injection. The von Frey filament test was performed to determine mechanical allodynia, and prostate inflammation was examined seven days after drug administration. Local carrageenan administration resulted in a reduction of the tactile threshold. The levels of mononuclear cell infiltration, pro-inflammatory cytokine interleukin-1 beta (b), caspase-1 (casp-1), and Nucleotide-binding oligomerization domain, Leucine rich Repeat and Pyrin domain containing proteins 1 and 3 (NALP1 and NALP3) in the prostate of rats were increased seven days after carrageenan injection. Treatment with ICTA significantly attenuated the carrageenan-induced hyperalgesia and reduced the elevated levels of proteins including TNF-a and IL-1b in the rats. Apoptosis markers, B-cell lymphoma 2-associated X protein (Bax) and caspase-3, were elevated in ICTA-treated Chronic pelvic pain syndrome (CPPS) rats. These results suggest that ICTA provides protection against local carrageenan-induced enhanced pain sensitivity, and that the neutralization of proinflammatory cytokines may result in inflammatory cell apoptosis.

Purpose: CC-486 is an oral formulation of azacitidine that allows for extended dosing schedules to prolong azacitidine exposure to malignant cells and maximize clinical activity. CC-486 300 mg daily, administered for 14 or 21 days of 28-day treatment cycles, is currently under investigation in two ongoing phase III trials. The 300-mg daily dose in these studies is administered as two 150-mg tablets (Formulation A)., Methods: We evaluated the bioequivalence of one 300-mg CC-486 tablet (Formulation B) with Formulation A and food effect on Formulation B, in adult patients with cancer in a 2-stage crossover design study., Results: The ratios of the geometric means of the maximum azacitidine plasma concentration (C max ) and of the area under the plasma concentration-time curve from time 0 extrapolated to infinity (AUC ∞ ) were 101.5% and 105.7%, demonstrating the bioequivalence of Formulations A and B. Formulation B was rapidly absorbed under fasted and fed conditions. The geometric mean of C max was significantly decreased by ~ 21% in the fed state. Median T max was reached at 2 h and 1 h post-dose in fed and fasted states, respectively (P < 0.001). Nevertheless, systemic drug exposure (AUC) in fed and fasted states was within the 80-125% boundaries of bioequivalence and differences in C max and T max are not expected to have a clinical impact., Conclusion: The single 300-mg CC-486 tablet was bioequivalent to two 150-mg tablets, which have shown to be efficacious and generally well-tolerated in clinical trials, and can be taken with or without food.

Introduction: Chronic pain may cause many comorbidities in the elderly; however, nationwide data about this issue remain insufficient. We conducted this study to address the data gap., Material and Methods: We identified geriatric participants (≥ 65 years) with chronic pain between 2000 and 2013 from the Taiwan National Health Insurance Research Database. The causes of chronic pain and use of analgesics between two sexes and among three age subgroups were compared., Results: A total of 21,018 participants were identified with the mean age (standard deviation) of 72.7 years (5.6) and the female percentage of 50.8%. The prevalence of chronic pain in the elderly was 21.5%, and it was higher in the females than males. The proportions of each age subgroup were 65-74 (66.8%), 75-84 (29.4%), and ≥ 85 years (3.8%). Common causes of chronic pain were osteoarthritis (21.9%), spinal disorders (19.0%), peripheral vascular diseases (12.4%), and osteoporosis (11.4%). Non-steroidal anti-inflammatory drugs were the most common medication, followed by acetaminophen and opioids. The most commonly used opioid was morphine. The use of opioids increased with age., Conclusions: This study delineated the causes of chronic pain and use of analgesics in a geriatric population, which may help further studies about this issue in the future., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Termedia & Banach.)

Objectives: Whether early medication reconciliation and integration can reduce polypharmacy and potentially inappropriate medication (PIM) in the emergency department (ED) remains unclear. Polypharmacy and PIM have been recognized as significant causes of adverse drug events in older adults. Therefore, this pilot study was conducted to delineate this issue., Design: An interventional study., Setting: A medical center in Taiwan., Participants: Older ED patients (aged ≥65 years) awaiting hospitalization between December 1, 2017, and October 31, 2018 were recruited in this study. A multidisciplinary team and a computer-based and pharmacist-assisted medication reconciliation and integration system were implemented., Measurements: The reduced proportions of major polypharmacy (≥10 medications) and PIM at hospital discharge were compared with those on admission to the ED between pre- and post-intervention periods., Results: A total of 911 patients (pre-intervention = 243 vs post-intervention = 668) were recruited. The proportions of major polypharmacy and PIM were lower in the post-intervention than in the pre-intervention period (-79.4% vs -65.3%; P < .001, and - 67.5% vs -49.1%; P < .001, respectively). The number of medications was reduced from 12.5 ± 2.7 to 6.9 ± 3.0 in the post-intervention period in patients with major polypharmacy (P < .001)., Conclusion: Early initiation of computer-based and pharmacist-assisted intervention in the ED for reducing major polypharmacy and PIM is a promising method for improving geriatric care and reducing medical expenditures. J Am Geriatr Soc 67:2298-2304, 2019., (© 2019 The American Geriatrics Society.)

Walking trajectory is frequently measured to assess animal behavior. Air-supported spherical treadmills have been developed for real-time monitoring of animal walking trajectories. However, current systems for mice mainly employ computer mouse microcameras (chip-on-board sensors) to monitor ball motion, and these detectors exhibit technical issues with focus and rotation scale. In addition, computational methods to analyze and quantify the "random walk" of organisms are under-developed. In this work, we overcame the hurdle of frame-to-signal translation to develop a treadmill system with camera-based detection. Moreover, we generated a package of mathematical methods to quantify distinct aspects of Drosophila walking trajectories. By extracting and quantifying certain features of walking dynamics with high temporal resolution, we found that depending on their internal state, flies employ different walking strategies to approach environmental cues. This camera-based treadmill system and method package may also be applicable to monitor the walking trajectories of other diverse animal species., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

In order to cut down influence on the uncertainty disturbances of a linear motion single axis robot machine, such as the external load force, the cogging force, the column friction force, the Stribeck force, and the parameters variations, the micrometer backstepping control system, using an amended recurrent Gottlieb polynomials neural network and altered ant colony optimization (AACO) with the compensated controller, is put forward for a linear motion single axis robot machine drive system mounted on the linear-optical ruler with 1 um resolution. To achieve high-precision control performance, an adaptive law of the amended recurrent Gottlieb polynomials neural network based on the Lyapunov function is proposed to estimate the lumped uncertainty. Besides this, a novel error-estimated law of the compensated controller is also proposed to compensate for the estimated error between the lumped uncertainty and the amended recurrent Gottlieb polynomials neural network with the adaptive law. Meanwhile, the AACO is used to regulate two variable learning rates in the weights of the amended recurrent Gottlieb polynomials neural network to speed up the convergent speed. The main contributions of this paper are: (1) The digital signal processor (DSP)-based current-regulation pulse width modulation (PWM) control scheme being successfully applied to control the linear motion single axis robot machine drive system; (2) the micrometer backstepping control system using an amended recurrent Gottlieb polynomials neural network with the compensated controller being successfully derived according to the Lyapunov function to diminish the lumped uncertainty effect; (3) achieving high-precision control performance, where an adaptive law of the amended recurrent Gottlieb polynomials neural network based on the Lyapunov function is successfully applied to estimate the lumped uncertainty; (4) a novel error-estimated law of the compensated controller being successfully used to compensate for the estimated error; and (5) the AACO being successfully used to regulate two variable learning rates in the weights of the amended recurrent Gottlieb polynomials neural network to speed up the convergent speed. Finally, the effectiveness of the proposed control scheme is also verified by the experimental results.

Background: Diet is associated with self-reported indices of sexual health. The mechanisms responsible for these changes remain poorly understood., Aim: To investigate the hemodynamic and histological impact of dietary change in a rat model of hyperlipidemia-associated erectile dysfunction., Methods: 40 2-month old male Sprague-Dawley rats were divided into 4 groups. 10 rats were fed a diet of standard chow and served as negative controls (N group). The remaining 30 age-matched rats were divided at random into 3 groups: (i) high-fat diet for 5 months starting at age 5 months (H group); (ii) high-fat diet for 5 months starting at age 4 months followed by 1 month of standard chow (H+N1M group); and (iii) high-fat diet for 5 months starting at age 2 months followed by 3 months of standard chow (H+N3M group). All rats underwent erectile function testing and sacrifice at age 10 months., Outcomes: Intracavernous pressure (ICP) and mean arterial pressure (MAP) were measured to evaluate erectile function. Blood samples were collected to measure serum testosterone and lipid levels, and penile tissue specimens were obtained for histological examination., Results: Total body weight, low-density lipoprotein, and serum glucose were significantly higher in the H group compared with the N and H+N3M groups. Serum high-density lipoprotein level was significantly lower in the H group compared with the N and H+N3M groups. The mean ICP/MAP ratio was significantly lower in the H group compared with the N and H+N3M groups (0.33 ± 0.05 vs 0.79 ± 0.07 vs 0.73 ± 0.13; P < .05 for both). Markers for intracorporal neuronal nitric oxide synthase and endothelial cells were more weakly expressed in the H group compared with the N and H+N3M groups. There was no significant difference in smooth muscle content among the groups. Mean cavernosal oxidative stress and the apoptotic index were significantly higher in the H group compared with the N and H+N3M groups. No significant between-group differences were noted with respect to serum testosterone; the H group had significantly higher serum glucose and low-density lipoprotein levels, effects that were partially mitigated in the H +N1M and H+N3M groups., Clinical Translation: Administration of a healthy diet is associated with normalization of functional and histological penile defects associated with a high-fat diet., Strengths & Limitations: Metabolic changes were clearly linked to functional improvements in penile blood flow. Differences between rat and human lipoprotein metabolism are a limitation of this study., Conclusion: Dietary changes may have positive effects on penile hemodynamics in a rat model of hyperlipidemia-associated erectile dysfunction. Huang Y-C, Ho D-R, Lin J-H, et al. Dietary Modification Is Associated with Normalization of Penile Hemodynamics in Rats Fed a High-Fat Diet. J Sex Med 2019;16:791-802., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

The Drosophila olfactory system is an attractive model for exploring the wiring logic of complex neural circuits. Remarkably, olfactory local interneurons exhibit high diversity and variability in their morphologies and intrinsic properties. Although olfactory sensory and projection neurons have been extensively studied of development and wiring; the development, mechanisms for establishing diversity, and integration of olfactory local interneurons into the developing circuit remain largely undescribed. In this review, we discuss some challenges and recent advances in the study of Drosophila olfactory interneurons., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To compare the fatigue and fracture resistance of metal ceramic crowns (MCCs) with nickel-chromium and CAD/CAM-fabricated titanium copings., Methods: Twelve premolar MCCs were fabricated with cast nickel-chromium alloy (Ni group) and CAD/CAM-fabricated titanium (Ti group) copings, respectively. To minimize the differences among specimens, the geometric dimensions of the MCCs were tested with a laboratory scanner and digital measurement software and then adjusted. After cemented to identically milled titanium dies, each specimen was subjected to thermocycling (5-55℃, 5000 cycles) and cyclic loading (75000 cycles) test, followed by a static load-to-fracture test to measure the fracture loads(F). The fractures were characterized using stereomicroscope. SPSS13.0 software package was used for statistical analysis., Results: The mean fracture loads were (1645±356)N for Ni group and (1555±331)N for Ti group. No significant difference was observed (P=0.525). Most of the fractures were confined to the palatal third. The chief failure mode for all specimens from Ni group and most of the specimens from Ti groups was mixed failure. Adhesive failure was noted in 3 specimens from Ti group., Conclusions: The fracture resistance of MCCs with CAD/CAM-fabricated titanium copings is similar to that of MCCs with nickel-chromium copings.

The original version of this Article contained errors in Figs. 4 and 6. In Fig. 4, panel a, text labels UAS-FLP and LexAop2>stop>myr::smGdP-HA were shifted upwards during typesetting of the figure, and in Fig. 6, panel h, the number 15 was incorrectly placed on the heat map scale. These have now been corrected in both the PDF and HTML versions of the Article.

An efficient urban environmental design considers appropriate thermal comfort condition, shaded space, and activity intensity. Physiologically equivalent temperature (PET) and visible sky, i.e., the sky view factor (SVF), are usually used as indicators to determine the outdoor thermal comfort and amount of shaded space, respectively. The activity intensity in urban parks, which is dependent on culture and micrometeorological conditions, was represented inappropriately by attendance density in Taiwan. To optimize the park design and improve the park utilization rate in Taiwan, several environmental factors such as sound pressure levels and numbers of park visitors were measured, and PET values and SVF values were calculated from primary micrometeorological data such as wind speed and globe temperature. This study proposed equivalent continuous sound pressure level (Leq) as a novel indicator to represent park activity intensity and investigated the correlation between Leq and SVF at different PET values. Leq was more appropriate than was attendance density in representing the park activity intensity in Taiwan. In addition, Leq was highly negatively correlated with SVF when visitors felt that the outdoor thermal comfort condition was hot or very hot. In other words, a lower degree of shading in the park resulted in lower activity intensity. Park visitors tended to engage in activities in the shaded regions because of more favorable thermal comfort conditions (i.e., neutral PET). The established quantitative relationships among Leq, PET, and SVF can serve as a reference for park planning.

Drosophila olfactory local interneurons (LNs) in the antennal lobe are highly diverse and variable. How and when distinct types of LNs emerge, differentiate, and integrate into the olfactory circuit is unknown. Through systematic developmental analyses, we found that LNs are recruited to the adult olfactory circuit in three groups. Group 1 LNs are residual larval LNs. Group 2 are adult-specific LNs that emerge before cognate sensory and projection neurons establish synaptic specificity, and Group 3 LNs emerge after synaptic specificity is established. Group 1 larval LNs are selectively reintegrated into the adult circuit through pruning and re-extension of processes to distinct regions of the antennal lobe, while others die during metamorphosis. Precise temporal control of this pruning and cell death shapes the global organization of the adult antennal lobe. Our findings provide a road map to understand how LNs develop and contribute to constructing the olfactory circuit.

Local interneurons (LNs) in the Drosophila olfactory system exhibit neuronal diversity and variability, yet it is still unknown how these features impact information encoding capacity and reliability in a complex LN network. We employed two strategies to construct a diverse excitatory-inhibitory neural network beginning with a ring network structure and then introduced distinct types of inhibitory interneurons and circuit variability to the simulated network. The continuity of activity within the node ensemble (oscillation pattern) was used as a readout to describe the temporal dynamics of network activity. We found that inhibitory interneurons enhance the encoding capacity by protecting the network from extremely short activation periods when the network wiring complexity is very high. In addition, distinct types of interneurons have differential effects on encoding capacity and reliability. Circuit variability may enhance the encoding reliability, with or without compromising encoding capacity. Therefore, we have described how circuit variability of interneurons may interact with excitatory-inhibitory diversity to enhance the encoding capacity and distinguishability of neural networks. In this work, we evaluate the effects of different types and degrees of connection diversity on a ring model, which may simulate interneuron networks in the Drosophila olfactory system or other biological systems.

This paper describes the preparation of nanoarrays composed of silver nanoparticles (AgNPs: 20-50 nm) for use as surface-enhanced Raman scattering (SERS) substrates. The AgNPs were grown on porous anodic aluminum oxide (AAO) templates by electrochemical plating, and the inter-channel gap of AAO channels is between 10 and 20 nm. The size and interparticle gap of silver particles were adjusted in order to achieve optimal SERS signals and characterized by scanning electron microscopy, atomic force microscopy, and Raman spectroscopy. The fluctuation of SERS intensity is about 10-20% when measuring adenine solutions, showing a great reproducible SERS sensing. The nanoparticle arrays offer a large potential for practical applications as shown by the SERS-based quantitative detection and differentiation of adenine (A), thymine (T), cytosine (C), guanine (G), β-carotene, and malachite green. The respective detection limits are <1 ppb for adenine and <0.63 ppm for β-carotene and malachite green, respectively. Uniform and reproducible Raman enhancement enabled by Ag nanoparticle array embedded in anodic aluminum oxide differentiates and helps quantify DNA canonical nucleobases (adenine, thymine, cytosine, and guanine).

Background: There is a high incidence rate of upper tract urothelial carcinoma (UTUC) in patients on dialysis. However, the studies about nephroureterectomy (NU) in this high surgical risk group are limited. The aim of this study is to investigate the outcomes of NU in this population., Results: There were total 931 patients enrolled and 218, 582, 131 patients were non-NU, unilateral and one-stage bilateral NU, respectively. NU provided better 5-year overall survival (66% versus 51% in non-NU, P = 0.001). 19.7% of patients with unilateral NU had successive contralateral NU with a mean interval period of 695 days. Even for the elderly, there were no significant difference in duration of hospitalization, 30- and 90-day mortality between unilateral and bilateral NU., Materials and Methods: Patients on dialysis with UTUC between January 1998 and December 2012 were assessed from the nationwide cohort of Taiwan National Health Insurance Research Database. We classified these patients into non-NU and NU groups. In NU group, we analyzed clinical outcomes of patient groups between different NU types and surgical methods., Conclusions: Although the high surgical risk in patients on dialysis with UTUC, NU provided better 5-year overall survival. One-stage bilateral NU both provides comparable safety profile and avoids 19.7% of successive contralateral NU in less than two years. Even in the elderly, one-stage bilateral NU is safe and feasible., Competing Interests: CONFLICTS OF INTEREST All authors declare there are no competing financial interests in relation to this work.

Although wafer-level camera lenses are a very promising technology, problems such as warpage with time and non-uniform thickness of products still exist. In this study, finite element simulation was performed to simulate the compression molding process for acquiring the pressure distribution on the product on completion of the process and predicting the deformation with respect to the pressure distribution. Results show that the single-gate compression molding process significantly increases the pressure at the center of the product, whereas the multi-gate compressing molding process can effectively distribute the pressure. This study evaluated the non-uniform thickness of product and changes in the process parameters through computer simulations, which could help to improve the compression molding process., Competing Interests: The authors declare no conflict of interest.