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Schwannomas of the sinonasal tract are rare, accounting for

Background The R2C2, a 4-phase feedback and coaching model, builds relationships, explores reactions, determines content and coaches for change, and facilitates formal feedback conversations between clinical supervisors/preceptors and residents. Formal discussions about performance are typically based on collated information from daily encounter sheets, objective structured clinical examinations, multisource feedback, and other data. This model has not been studied in settings where brief feedback and coaching conversations occur immediately after a specific clinical experience. Objective We explored how supervisors adapt the R2C2 model for in-the-moment feedback and coaching and developed a guide for its use in this context. Methods Eleven purposefully selected supervisors were interviewed in 2018 to explore where they used the R2C2 model, how they adapted it for in-the-moment conversations, and phrases used corresponding to each phase that could guide design of a new R2C2 in-the-moment model. Results Participants readily adapted the model to varied feedback situations; each of the 4 phases were relevant for conversations. Phase-specific phrases that could enable effective coaching conversations in a limited amount of time were identified. Data facilitated a revision of the original R2C2 model for in-the-moment feedback and coaching conversations and design of an accompanying trifold brochure to enable its effective use. Conclusions The R2C2 in-the-moment model offers a systematic approach to feedback and coaching that builds on the original model, yet addresses time constraints and the need for an iterative conversation between the reaction and content phases. The model enables supervisors to coach and co-create an action plan with residents to improve performance.

Introduction The continuous supply of personal protective equipment (PPE) in the National Health Service (NHS) is paramount in order to sustain a safe level of staffing and to reduce transmission of COVID-19 to patients, public and staff. Method A 16-question survey was created to assess the availability and personal thoughts of healthcare professionals regarding PPE supply in England. The survey was distributed via social media (Facebook © and Twitter ©) to all UK COVID-19 healthcare professional groups, with responses collected over 3 weeks in March 2020 during the beginning of the pandemic. Results A total of 121 responses from physicians in 35 different hospitals were collected (105 inpatient wards, 16 from intensive care units). In inpatient wards, eye and face protection were unavailable to 19.1% of respondents. Masks were available to 97.7% of respondents and gloves in all respondents (100%). Body protection was available primarily as a plastic apron (83.8%). All of respondents working in intensive care had access to full-body PPE, except FFP3 respirator masks (available in 87.5%). PPE is ‘Always’ available for 29.8% of all respondents, and ‘Never’ or ‘Almost Never’ in 11.6%. There was a statistically significant difference between London and non-London responders that ‘Always’ had PPE available (43.9% versus 19.0%, p = 0.003). Conclusions This is the first survey to evaluate PPE supply in England during the COVID-19 pandemic. Our survey demonstrated an overall lack of PPE volume supply in the UK, with preferential distribution in London. Eye and full body protection are in most lack of supply.

Background The overall global impact of COVID-19 in children and regional variability in pediatric outcomes are presently unknown. Methods To evaluate the magnitude of global COVID-19 death and intensive care unit (ICU) admission in children aged 0–19 years, a systematic review was conducted for articles and national reports as of December 7, 2020. This systematic review is registered with PROSPERO (registration number: CRD42020179696). Results We reviewed 16,027 articles as well as 225 national reports from 216 countries. Among the 3,788 global pediatric COVID-19 deaths, 3,394 (91.5%) deaths were reported from low- and middle-income countries (LMIC), while 83.5% of pediatric population from all included countries were from LMIC. The pediatric deaths/1,000,000 children and case fatality rate (CFR) were significantly higher in LMIC than in high-income countries (HIC) (2.77 in LMIC vs 1.32 in HIC; p < 0.001 and 0.24% in LMIC vs 0.01% in HIC; p < 0.001, respectively). The ICU admission/1,000,000 children was 18.80 and 1.48 in HIC and LMIC, respectively (p < 0.001). The highest deaths/1,000,000 children and CFR were in infants < 1 year old (10.03 and 0.58% in the world, 5.39 and 0.07% in HIC and 10.98 and 1.30% in LMIC, respectively). Conclusions The study highlights that there may be a larger impact of pediatric COVID-19 fatality in LMICs compared to HICs.

ObjectiveThe objective of our study was to explore the perspectives of patients and general practitioners (GPs) regarding interventions to increase initiation of cholesterol lowering medication (or statins), including a proposed laboratory-based facilitated relay intervention.DesignQualitative descriptive study using interviews and focus groups for data collection, and thematic analysis for data analysis.SettingPrimary care providers and patients in Calgary, Alberta, Canada.Participants17 GPs with primarily community-based, non-academic practices with at least 1 year of practice experience participated in semistructured interviews. 14 patients at high risk of cardiovascular disease participated in focus groups.Main outcome measuresExploration of strategies that might be used to enhance the prescription of, and adherence to statin therapy for patients with statin-indicated conditions.ResultsGPs proposed a variety of interventions to improve statin prescription, including electronic record audit solutions, GP directed education, and patient-oriented campaigns. Patients expressed that they may benefit from being provided access to their laboratory test results, as well as targeted education. Both parties provided positive feedback on the proposed laboratory-based facilitated relay intervention, while pointing out areas for improvement. Notably, GPs were concerned that the patient-directed component of the intervention might jeopardise therapeutic relationships, and patients were concerned about accidental disclosure of personal health information. Important considerations for the design of facilitated relay messaging should include brevity, simplicity and the provision of contact information for inquiries.ConclusionsGPs and patients described several suggestions for increasing statin initiation and welcomed the proposal of a laboratory-based facilitated relay strategy. These findings support further testing of this intervention which may enhance GPs’ ability to successfully engage patients in cardiovascular risk reduction through statin therapy.

Routine exercise has been established as an effective way to improve overall health. The value of exercise has been established in many diseases, however, there are no studies investigating the impact of exercise for individuals with primary immunodeficiency disease (PID). The purpose of this study was to investigate exercise perceptions and behaviors in individuals diagnosed with PID. An online survey was distributed over a four-week period. Of the 264 responses collected, most were females, 45–54 years old. Respondents reported a measurable loss of function impairing their daily activities due to loss of mobility/physical activity (41.32%), or loss of lung/pulmonary function (40.08%,). They felt exercise decreased stress level and improved their mental well-being (46.25%). Some indicated they participate in exercise (33.20%), while 36.84% had not participated in exercise for at least 1 year. Exercise was limited primarily due to fatigue (86.97%). Exercise is important for those with chronic medical conditions. Most individuals living with PID can participate in low/moderate physical activity, but struggle with vigorous physical activity, since fatigue is the greatest barrier. Respondents view exercise as beneficial, and would like to increase participation in an exercise program.

Background Patients with interstitial lung disease (ILD) constitute a substantial disease burden. Although ILD outcomes have been investigated, the risk of death due to ILD has not been studied in the light of confounders and comorbidities. In this nationwide, 11-year longitudinal, population-based study, we aimed to discover if ILD is an independent risk factor for mortality. Design Data on 1 031 392 (2.2%) randomly selected subjects from 47 279 373 Korean residents were collected from the 2002 Korean National Health Insurance database. The ILD group comprised patients with an initial diagnosis of ILD between January 2003 and December 2007. Each patient was followed until 2013. We used Cox proportional hazard regression analyses to calculate the risk of death adjusted for comorbidities and confounders. Results ILD developed in 783 of the 303 385 subjects during the 5-year period (51 per 100 000 person-years). Death occurred in 157 (23.2%) cases and 272 controls (10.4%). ILD was significantly associated with the risk of death (hazard ratio 2.1, 95% confidence interval [CI] 1.6-2.7) and for those aged 40-59, 60-69 and 70 years. A high proportion of patients with ILD died due to respiratory causes. Conclusion ILD patients had a significantly higher risk of death than matched controls, after adjustment for potential confounders and comorbidities.

Background Approved first-line treatments for patients with BRAF V600–mutant advanced melanoma include nivolumab (a programmed cell death protein 1 inhibitor) plus ipilimumab (a cytotoxic T lymphocyte antigen-4 inhibitor; NIVO+IPI) and the BRAF/MEK inhibitors dabrafenib plus trametinib (DAB+TRAM), encorafenib plus binimetinib (ENCO+BINI), and vemurafenib plus cobimetinib (VEM+COBI). Results from prospective randomized clinical trials (RCTs) comparing these treatments have not yet been reported. This analysis evaluated the relative efficacy and safety of NIVO+IPI versus DAB+TRAM, ENCO+BINI, and VEM+COBI in patients with BRAF-mutant advanced melanoma using a matching-adjusted indirect comparison (MAIC). Patients and methods A systematic literature review identified RCTs for DAB+TRAM, ENCO+BINI, and VEM+COBI in patients with BRAF-mutant advanced melanoma. Individual patient-level data for NIVO+IPI were derived from the phase III CheckMate 067 trial (BRAF-mutant cohort) and restricted to match the inclusion/exclusion criteria of the comparator trials. Treatment effects for overall survival (OS) and progression-free survival (PFS) were estimated using Cox proportional hazards and time-varying hazard ratio (HR) models. Safety outcomes (grade 3 or 4 treatment-related adverse events) with NIVO+IPI and the comparators were compared. Results In the Cox proportional hazards analysis, NIVO+IPI showed improved OS compared with DAB+TRAM (HR = 0.53; 95% confidence interval [CI], 0.39-0.73), ENCO+BINI (HR = 0.60; CI, 0.42-0.85), and VEM+COBI (HR = 0.50; CI, 0.36-0.70) for the overall study period. In the time-varying analysis, NIVO+IPI was associated with significant improvements in OS and PFS compared with the BRAF/MEK inhibitors 12 months after treatment initiation. There were no significant differences between NIVO+IPI and BRAF/MEK inhibitor treatment from 0 to 12 months. Safety outcomes favored DAB+TRAM over NIVO+IPI, whereas NIVO+IPI was comparable to VEM+COBI. Conclusion Results of this MAIC demonstrated durable OS and PFS benefits for patients with BRAF-mutant advanced melanoma treated with NIVO+IPI compared with BRAF/MEK inhibitors, with the greatest benefits noted after 12 months., Highlights • First-line treatments for BRAF V600-mutant melanoma include NIVO+IPI and BRAF/MEK inhibitors. • Results from prospective RCTs comparing NIVO+IPI and BRAF/MEK inhibitors have not yet been reported. • This MAIC evaluated NIVO+IPI versus BRAF/MEK inhibitors for BRAF-mutant advanced melanoma. • OS and PFS benefits were noted with NIVO+IPI versus BRAF/MEK inhibitors beginning at 12 months. • These findings may provide information relevant to the selection of treatments for BRAF-mutant advanced melanoma.

This abstract was withdrawn by the authors.

© 2018 Lee, Carella, Papa and Bubici. A marked increase in the rate of glycolysis is a key event in the pathogenesis of hepatocellular carcinoma (HCC), the main type of primary liver cancer. Liver cirrhosis is considered to be a key player in HCC pathogenesis as it precedes HCC in up to 90% of patients. Intriguingly, the biochemical events that underlie the progression of cirrhosis to HCC are not well understood. In this study, we examined the expression profile of metabolic gene transcripts in liver samples from patients with HCC and patients with cirrhosis. We found that gene expression of glycolytic enzymes is up-regulated in precancerous cirrhotic livers and significantly associated with an elevated risk for developing HCC. Surprisingly, expression levels of genes involved in mitochondrial oxidative metabolism are markedly increased in HCC compared to normal livers but remain unchanged in cirrhosis. Our findings suggest that key glycolytic enzymes such as hexokinase 2 (HK2), aldolase A (ALDOA), and pyruvate kinase M2 (PKM2) may represent potential markers and molecular targets for early detection and chemoprevention of HCC.

Despite the amenability of early-stage prostate cancer to surgery and radiation therapy, locally advanced and metastatic prostate cancer is clinically problematic. Chemical castration is often used as a first-line therapy for advanced disease, but progression to the castration-resistant prostate cancer phase occurs with dependable frequency, largely through mutations to the androgen receptor (AR), aberrant AR signaling, and AR-independent mechanisms, among other causes. Semaphorin 3C (SEMA3C) is a secreted signaling protein that is essential for cardiac and neuronal development and has been shown to be regulated by the AR, to drive epithelial-to-mesenchymal transition and stem features in prostate cells, to activate receptor tyrosine kinases, and to promote cancer progression. Given that SEMA3C is linked to several key aspects of prostate cancer progression, we set out to explore SEMA3C inhibition by small molecules as a prospective cancer therapy. A homology-based SEMA3C protein structure was created, and its interaction with the neuropilin (NRP)-1 receptor was modeled to guide the development of the corresponding disrupting compounds. Experimental screening of 146 in silico‒identified molecules from the National Cancer Institute library led to the discovery of four promising candidates that effectively bind to SEMA3C, inhibit its association with NRP1, and attenuate prostate cancer growth. These findings provide proof of concept for the feasibility of inhibiting SEMA3C with small molecules as a therapeutic approach for prostate cancer.

This study including two parts investigates the influence of design parameters of tapered-spool restrictors and hydrostatic planar bearing on static characteristics of load capacity and static stiffness. The former part provides guides for the design of single-action and double-action tapered-spool restrictors. This part provides design guides for planar hydrostatic bearing and for matching up with tapered-spool restrictor. The equations of flow continuity are utilized to determine the film thickness for open-type planar bearing and worktable displacement for closed-type planar bearing with respect to the recess pressure, respectively. The load capacity can be obtained by multiplying recess pressure by effective area of bearing pad. Furthermore, the static stiffness can be obtained by differentiating the recess pressure with respect to film thickness or worktable displacement. The finding results give that the usage range of recess pressure, and the availability ranges of design parameters of restrictor and bearing parameters. Which are found for getting the maximum stiffness.

The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40–60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period. This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities). Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol. Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.

A low-cost experimental apparatus has been developed to investigate the mode I fatigue crack growth behaviour of thin metallic foils and sheets. The apparatus utilizes magnetic coupling between a ceramic magnet and a rotating steel disc to induce cyclic tensile loads in notched rectangular specimens. To illustrate the testing apparatus, mode I fatigue crack growth in 30-µm-thick high-purity titanium foils was studied. Experiments were performed at ambient temperature using a loading frequency of 2 Hz and a nominal stress ratio of 0.1. The cyclic crack growth data could be fit to a Paris relationship between crack growth rate and stress intensity range. The stress intensity factor exponent, m, in the Paris relationship was between 4 and 6, which is comparable with the relatively high values found in the literature for the tension–tension fatigue of other metallic bulk materials. Incomplete self-similarity analysis was used to explain the observed higher m values for thin metallic foils.

Background and Purpose The present study assessed the effects of cilostazol on LPS-stimulated TLR4 signal pathways in synovial macrophages from patients with rheumatoid arthritis (RA). These effects were confirmed in collagen-induced arthritis (CIA) in mice. Experimental Approach Expression of TLR4, PU.1, NF-κB p65 and IκBα on synovial fluid macrophages from RA patients was determined by Western blotting, and cytokines were measured by elisa. Anti-arthritic effects were evaluated in CIA mice. Key Results Intracellular cAMP was concentration-dependently raised by cilostazol (1–100 μM). Cilostazol significantly suppressed LPS-stimulated increase of TLR4 expression by blocking PU.1 transcriptional activity in RA macrophages. In addition, cilostazol decreased LPS-induced myeloid differentiation factor 88 (MyD88) expression, but not that of TNF receptor-associated factor 6 (TRAF6). Cilostazol also suppressed IkBα degradation and NF-κB p65 nuclear translocation. Moreover, LPS-induced increase of cytokine production (TNF-α, IL-1β) was inhibited by cilostazol, an effect which was accompanied by suppression of IκBα degradation, and NF-κB p65 nuclear translocation. However, expression of anti-inflammatory IL-10 was elevated by cilostazol and forskolin/IBMX. In mice with CIA, post-treatment with cilostazol (30 mg kg−1 day−1) decreased expression of TLR4 in knee joints in association with decreased recruitment of macrophages. Consequently, synovial inflammation, proteoglycan depletion and bone erosion were significantly inhibited by cilostazol treatment. Conclusions and Implications Cilostazol down-regulated LPS-stimulated PU.1-linked TLR4 expression and TLR4/MyD88/NF-κB signal pathways, and then suppressed inflammatory cytokine production in synovial macrophages from RA patients. Also cilostazol markedly inhibited the severity of CIA in mice.

The objectives of this study were to survey elementary school students regarding the environmental conditions of their elementary schools and to assess the relationship between air pollution and allergic disease using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Therefore, this study was designed as a cross-sectional study. In this study, seven elementary schools were selected and they were classified into three categories. The selection included one school with no traffic-related or other pollutants, three with traffic-related pollutants, and three with traffic-related and other pollutants from industrial and filling station sources. The ISAAC questionnaire survey was given to all of the students except to those in the 1st grade who were presumed to be less likely to be exposed to the school environment than the remainder of the students attending those seven schools. The assessment of allergic disease was conducted on a total of 4,545 students. Three school zones with critical exposure were selected within each school and they were evaluated based on the levels of black carbon (BC), PM10, SO2, NO2, and O3. There was a significant increase in the risks based on the odds ratios of treatment experiences (within 1 year) for allergy-related diseases such as asthma and allergic rhinitis (a) in the school group with traffic-related pollutants and the school group with complex pollutants were 2.12 (1.41-3.19) and 1.59 (1.06-2.37), respectively, in comparison to the school groups with no exposure to pollutants. This was determined based on the odds ratio of symptoms and treatment experiences for allergy-related diseases by group based on the home town zone as a reference. Also, in the case of atopic dermatitis, the odds ratio of treatment experiences (within 1 year) was 1.42 (1.02-1.97), which indicated elevated risks compared to the students in the S1 school. A regression analysis was used to assess the relationship between the substances and the symptomatic experiences within the last year. There were significant increases in the odds ratio of the symptoms associated with allergic rhinitis and the BC and SO2 in the complex pollution areas. The results of the assessment of the relationship between atopic dermatitis-associated symptoms and O3 showed that the odds ratio increased with statistical significance.

The acoustic level of a hard disk drive is an important specification. This is especially so for enterprise HDD which is required to operate under a high spinning speed. In order to reduce the acoustics level of a HDD, an in depth understanding behind the mechanisms whereby the noise is being generated in a HDD should be established. This paper will study the acoustics characteristics of a high speed permanent magnet brushless DC motor (PM BLDC) and investigate the physics underlying the generation of noise associated with a motor. An analysis procedure of the PM BLDC motor noise generating mechanisms is proposed. Through finite element analysis and experimental verification, the results indicate that the major noise source for the high speed PM BLDC motor is due to the presence of electromagnetic (EM) torque ripples. Furthermore, it has been observed that the noise radiated by a HDD can be amplified when its structural dynamics are close to the frequency components of the noise source. Finally, a methodology which discusses the steps involved in the prediction of motor radiated noise will be presented.

Panax ginseng is one of the most commonly used Chinese medicines in China, Asia and Western countries. The beneficial effects of ginseng have been attributed to the biological activities of its constituents, the ginsenosides. In this review, we summarize recent publications on the anti-inflammatory effects of ginseng extracts and ginsenosides on cellular responses triggered by different inducers including endotoxin, tumor necrosis factor-alpha (TNF-α), interferon-gamma and other stimuli. Proinflammatory cytokines, chemokines, adhesion molecules and mediators of inflammation including inducible nitric oxide synthase, cyclooxygenase-2 and nitric oxide orchestrate the inflammatory response. Ginseng extracts and ginsenosides including Rb₁, Rd, Rg₁, Rg₃, Rh₁, Rh₂, Rh₃ and Rp₁ have been reported to have anti-inflammatory properties in different studies related to inflammation. Ginsenosides inhibit different inducers-activated signaling protein kinases and transcription factor nuclear factor-kappaB leading to decreases in the production of cytokines and mediators of inflammation. The therapeutic potential of ginseng on TNF-α-mediated inflammatory diseases is also discussed. Taken together, this summary provides evidences for the anti-inflammatory effects of ginseng extracts and ginsenosides as well as the underlying mechanisms of their effects on inflammatory diseases.

A high temperature combustion method was used to analyze the 14 C and 3 H activities in graphite and the dose assessment was carried out to determine the clearance in the conservative way. By this method, the 3 H and 14 C were simultaneously trapped in the nitric acid and carbosorb, respectively. Accordingly, the sample preparation time for the measurement was reduced to the half. The combustion temperature was more than 800 degrees in centigrade for obtaining total tritium and 14 C in the sample. The combustion ratio was about 99% on the graphite sample with the weight of 0.1 g. Minimum detectable activity was 0.05 Bq/g for the 14 C and 0.15 Bq/g for the 3 H at the same background counting time. The recoveries from the combustion furnace were around 100% and 90% in 14 C and 3 H, respectively. The radioactivity were 2,530 ~ 3,160 Bq/g in 14 C and 1,700 ~2,040 Bq/g in 3 H at this experiment. The experimental uncertainty was less than 6% in both radionuclides where the furnace recovery was dominant factor. An individual effective dose from beta and gamma radionuclides was estimated by consideration of the scenario of inhalation, ingestion and external exposure. 60 Co, the radioactivity of which was measured by using HPGe detector, had a predominant effect in estimating the effective dose. The estimation showed that the graphite wastes from the dismantled research reactor should be disposed of as a low level radioactive waste rather than clearance.

Experimental investigations on the resistive memory switching in sub-micron sized NiO memory cell are presented to elucidate the resistive memory switching mechanism. The voltage or current-biased I-V measurements show that the resistive switching transitions can be regarded as the combination of a voltage-controlled negative differential resistance phenomenon and a current-controlled negative differential resistance phenomenon. Along with experimental observations of multiple resistance states, these indicate that the memory switching in NiO would come from the percolative formation and rupture of filamentary conducting paths. Pulse experiments further suggest that the memory switching would come from local domains inside filaments.

One of the groups with high risk for osteonecrosis is patients with systemic lupus erythematosus (SLE). No predictive test, however, is known to detect osteonecrosis. The purpose of this study was to evaluate haemodynamic flow to the proximal femur in SLE patients.Twenty-two SLE patients without osteonecrosis were evaluated in comparison with 15 healthy controls. Medial and lateral circumflex arteries of 44 hips in the 22 SLE patients and 30 hips in the healthy controls were examined using ultrasound equipment with colour and power Doppler capability. Arterial pulsatility index (PI) and peak systolic velocity (PSV) were determined with neutral and internal rotation positions (stimulated ischaemia).PSV was significantly increased in SLE patients compared to healthy controls in both the neutral position (70.6+/-40.4 vs. 46.9+/-19.3; p0.001) and after internal rotation of the femoral head (74.8+/-42.3 vs. 49.9+/-19.9; p0.001). PI was also higher in SLE patients than in healthy controls in both the neutral position (8.9+/-6.3 vs. 5.5+/-3.4; p0.001) and after internal rotation (8.1+/-7.1 vs. 3.9+/-2.4; p0.001).PSV and PI of arteries to the femur head in SLE patients were significantly higher than in healthy controls.

Introduction Sarcopenia and osteoporosis are age-related declines in the quantity of muscle and bone, respectively. Both contribute in disability, fall, and hip fracture in the elderly. This study reported the prevalence of sarcopenia in Chinese geriatric patients with hip fracture, and the correlation between relative appendicular skeletal muscle mass index and other factors. Methods This case series was conducted in Kowloon West Cluster Orthopaedic Rehabilitation Centre in Hong Kong. Data of all geriatric patients with primary hip fracture admitted to the above Centre from June to December 2014 were studied. Isometric grip strength, the maximal handgrip strength, was measured using a JAMAR hand dynamometer. Body composition including appendicular and whole-body lean body mass was measured using dual-energy X-ray absorptiometry. Pearson's correlation was used to examine the correlation between relative appendicular skeletal muscle mass index and other factors. Results A total of 239 patients with a mean age of 82 years were included in the study. Stratifying patients as male or female, the mean (± standard deviation) hand grip strength was 20.6 ± 7.3 kg and 13.6 ± 4.5 kg, the mean relative appendicular skeletal muscle mass index was 5.72 ± 0.83 kg/m(2) and 4.87 ± 0.83 kg/m(2), and the mean hip bone mineral density was 0.696 ± 0.13 g/cm(2) and 0.622 ± 0.12 g/cm(2), respectively. The prevalence of sarcopenia based on relative appendicular skeletal muscle mass index and hand grip strength according to the Asian Working Group for Sarcopenia definition was 73.6% in males and 67.7% in females. According to the European Working Group on Sarcopenia definition, the prevalence of pre-sarcopenia was 20.8% in males and 12.4% in females. Relative appendicular skeletal muscle mass index was positively correlated with hand grip strength, body weight, hip bone mineral density, body mass index, and total fat mass in males; and hand grip strength, body weight, body height, body mass index, and total fat mass in females. Except for body height in females, all correlations were statistically significant. Conclusion The prevalence of sarcopenia was very high in geriatric hip fracture patients, and much higher than that in community-dwelling elderly population. Apart from the need to prescribe osteoporosis medicine, sarcopenia screening and treatment should be offered and is essential to reduce subsequent fall, subsequent fracture, fracture-related complications and economic burden to Hong Kong.

The fast implementation of elliptic curve cryptosystems relies on the efficient computation of scalar multiplication. Based on the double-base chain representation of scalar using powers of 2 and 3, we propose a new representation with powers of 1/2 and 3 instead. Thus the efficient point halving operation can be incorporated in the new double-base chain to achieve fast scalar multiplication. Experimental results show that our approach leads to a lower complexity which contributes to the efficient implementation of elliptic curve cryptosystems.

Cofiring coal in municipal solid waste incinerators (MSWls) has previously been reported to reduce polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs/Fs) emissions due to increasing the flue gas SO2 concentration. The present study was focused on understanding the primary mechanism responsible for the suppressant effect of SO2 on total PCDD/F formation and toxic equivalent (TEQ) emissions. The addition of SO2, simulating the effect of coal addition on the flue gas composition, resulted in significant reductions in the TEQ emissions due to reactions involving SO2 in the postcombustion zone. However, emissions of total PCDDs/Fs, unlike the TEQ value, were dependent upon the Cl2 and SO2 injection temperatures due to increases in non-TEQ correlated isomers. The conversion of metal chlorides in the fly ash to sulfates, thus reducing the sites responsible for chlorination/oxidation reactions, was concluded to be the main suppressant mechanism; proposed reactions for copper and iron are presented. This mechanism was found to be independent of combustion conditions and could have prolonged effects on PCDD/F emissions from deposits formed with high flue gas S/Cl ratios.

We present a comparison of directional couplers and multi-mode interferometers based on the unique properties of high-index contrast ridge waveguides. The two devices are intimately related as the MMI is structurally derived from the DC. For the first time, the continuous evolution from the two-mode coupling characteristic of DC to the multi-mode mixing and interference characteristic of MMI is shown. We show that practical directional couplers with reasonable gap size can also be quite compact and have the same coupling length for both TE and TM polarizations. Consequently, the DC can be just as polarization insensitive as the MMI. These features, however, require careful design control involving a large set of design parameters. On top of that, we also show a novel design of polarization splitter based on both DC and MMI. By comparison, the MMI design is more robust and involves fewer design variables.

A dynamic compartment model was developed to evaluate the transport of accidentally released radionuclides onto rice-fields. In the model, the surface water compartment and shoot-base absorption were introduced to account for the effect of an irrigation which is essential to rice cultivation. Allowance was made for the effect of a soil mixing by a plough and an irrigation before transplanting the rice. The rate of root-uptake and shoot-base absorption were modeled in terms of the function of the biomass. In order to test the validation of the model, some 137 Cs deposition experiments were carried out for several years while cultivating rice in a greenhouse using soils sampled from rice-fields around Kori, Yonggwang and Ulchin nuclear power plants in Korea. The model prediction agreed well to the experimental results within one order of magnitude.

We reviewed the intraoperative anaesthetic management and outcome of seven consecutive cases of endovascular stent graft surgery for thoracic aortic aneurysms or dissections over a period of 20 months in our institution. Seven males (median age 63) underwent endovascular stent graft surgery of the thoracic aorta under general anaesthesia. Four were emergency procedures for acute dissection or leaks of thoracic aneurysms. The duration of the procedures ranged from 120 to 300 minutes. Intraoperative stent migration occurred in one patient. Induced hypotension and immobilization were critical during stent deployment. Six out of the seven patients were discharged home between three to 20 days postoperatively. There was no 30-day mortality. One patient died sixty days postoperatively. Anaemia and respiratory complications were the most common postoperative problems encountered. None of the patients sustained spinal cord ischaemia, acute myocardial infarction or renal impairment. Endovascular stent graft surgery of the thoracic aorta is a relatively new alternative to conventional open surgery. Our experience suggests satisfactory short-term outcome even for patients with acute dissection. However, long-term survival and results require further evaluation.

Investigations into the single-phase velocity field of a model aeroengine bearing chamber are presented. Adequately resolving the airflow field is important to subsequent computational modeling of two-phase fluid transport and heat transfer characteristics. A specially designed test rig, representing the features of a Rolls Royce Trent series aeroengine bearing chamber, was constructed. Experimental data for the airflow field was obtained using particle image velocimetry (PIV). The results show a strong influence of shaft rotation and chamber geometry on the flow features within the bearing chamber. A computational fluid dynamics (CFD) simulation was carried out using the commercial CFD code FLUENT 6. Flow features were adequately modeled, showing the features of secondary velocities. Turbulence modeling using the differential Reynolds stress (RSM) model shows good agreement with the experimental data.

This study was carried out to test the hypothesis that palpation for lumps may be more difficult in large breasts than in small breasts, resulting in a delay in the detection and diagnosis of breast cancer, and to determine whether this hypothesis is confirmed in Asian women. Of 833 new breast cancer patients registered in the Daegu Cancer Registry in 1997-1999, 579 were used in the final data analysis, after excluding patient records containing many missing data on study variables related with cancer staging. There was no difference in means of body mass index (BMI) according to tumour, either in all cases or in those under 49 years of age. In the 50+ age group, the means+/-standard deviations of BMI of T1, T2 and T3 were 23.7+/-2.8, 24.2+/-3.0, and 26.2+/-4.3, respectively (P=0.01). In univariate logistic regression of tumour characteristics with BMI, no statistically significant odds ratios were found either by continuous or quartiles of BMI. In conclusion, these results suggest that the hypothesis is partially confirmed in Korean breast cancer patients and further studies are needed to clarify the relationship between BMI and tumour stage at diagnosis.

Background and aims: Smoking tobacco has opposite effects on the different forms of inflammatory bowel disease (IBD). It predisposes to the development of Crohn's disease (CD) yet is associated with a reduced incidence of ulcerative colitis (UC). We have studied sib pairs discordant for both smoking and IBD phenotype (UC or CD) to investigate whether smoking determines the type of IBD that develops in individuals with very similar genetic susceptibility. Patients: Smoking habits and disease characteristics were analysed in 242 IBD pedigrees (658 patients). Within this group there were 339 affected sibling pairs of whom 89 were discordant for smoking when diagnosed. Results: Smoking at diagnosis was associated with development of CD (odds ratio (OR) 3.55; 95% confidence limits 2.50–5.02; p

The use of a near-field scanning optical microscope (NSOM) to measure the diffusion of fluorescently tagged molecules on a quasi-two-dimensional system is described. The heart of the apparatus lies in the circular motion of the NSOM probe, allowing the detection of small displacements on single molecules. Using a 100 nm tip, and a simulated diffusion coefficient of D∼1×10−12 m2/s, we found that molecules can be tracked within ∼40 nm over several seconds. We foresee that D as large as ∼5×10−12 m2/s can be measured with minor modifications to the experimental setup. These values of D encompass those found in many liquid crystalline systems, particularly lipids in bilayer membranes.

SUMMARYAlcohol consumption is a possible co-factor of high-risk human papillomavirus (HR-HPV) persistence, a major step in cervical carcinogenesis, but the association between alcohol and continuous HPV infection remains unclear. This prospective study identified the association between alcohol consumption and HR-HPV persistence. Overall, 9230 women who underwent screening during 2002–2011 at the National Cancer Center, Korea were analysed in multivariate logistic regression. Current drinkers [odds ratio (OR) 2·49, 95% confidence interval (CI) 1·32–4·71] and drinkers for ⩾5 years (OR 2·33, 95% CI 1·17–4·63) had a higher risk of 2-year HR-HPV persistence (HPV positivity for 3 consecutive years) than non-drinkers and drinkers for vs. HPV negativity for 3 consecutive years). A high drinking frequency (⩾twice/week) and a high beer intake (⩾3 glasses/occasion) had higher risks of 1-year (OR 1·80, 95% CI 1·01–3·36) HPV positivity for 2 consecutive years) and 2-year HR-HPV persistence (OR 3·62, 95% CI 1·35–9·75) than non-drinkers. Of the HPV-positive subjects enrolled, drinking habit (OR 2·68, 95% CI 1·10–6·51) and high consumption of beer or soju (⩾2 glasses/occasion; OR 2·90, 95% CI 1·06–7·98) increased the risk of 2-year consecutive or alternate HR-HPV positivity (vs. consecutive HPV negativity). These findings suggest that alcohol consumption might increase the risk of cervical HR-HPV persistence in Korean women.

The internal flow characteristics of a gasoline direct injector (GDI) have been studied to improve fuel economy and reduce exhaust emissions. Computational fluid dynamics (CFD) is used to examine the internal flow of the GDI with the purpose of designing the optimum geometry of the injector. The design parameters include orifice length, cone angle, swirl angle, orifice diameter, and needle lift. Numerical results show that optimum sizes of the orifice length, cone angle, swirl angle, orifice diameter, and needle lift are 0.8 mm, 140°, 120°, 0.8 mm, and 70 m, respectively. The size of the lift does not affect the formation of the air core significantly near the tip of the needle compared with the ball-type needle. The vena contracta phenomenon near the orifice inlet can be released by smoothing the edge.

Atom positions and local structure around a perfect dislocation and the central stacking fault of a Z-shape faulted dipole in deformed GaAs were evaluated numerically through high resolution electron microscopic (HREM) analysis. It was revealed around the central stacking fault, connecting the two stair-rods of the dipole, that there exists a local atomic displacement by the original faulting reaction with the motion of a Shockley dislocation. In addition, the stacking fault was found to be a unique atomic structure due to relaxation, different from that of the intrinsic stacking fault of a dissociated dislocation.

Comparisons of a flowfield-dependent mixed explicit?implicit ( FDMEI) method with other numerical schemes and experimental data are presented. Several benchmark examples are investigated to confirm the soluton accuracy and stability through more careful comparisons. In the FDM EI method, the implicitness parameters dictate the schemes which are adjusted to the physical phenomena, compared with other numerical schemes dictated by arbitrarily selected constant parameters. Thus, tendencies of the implicitness parameters are dependent on the flow field. However, the implicitness parameters are more dependent on the flowfield in high-speed flows than in low-speed flows. Numerical results show that the FDMEI method is superior to other numerical schemes in accuracy and stability in all speed regimes, resolving shocks and vortexes.

BACKGROUNDGenetic anticipation has been proposed to explain observed age differences at diagnosis of Crohn’s disease in affected parents and offspring.AIMSTo compare affected parent-child pairs with Crohn’s disease and ulcerative colitis with a control group of non-familial patients with inflammatory bowel disease (IBD) in order to quantify whether ascertainment bias could account for this effect.METHODS137 affected parent-child pairs from 96 families and 214 patients with sporadic IBD were studied. Age at onset of symptoms and diagnosis were ascertained by interview and disease confirmed from clinical records.RESULTSOf the 137 affected parent-child pairs, 50 had Crohn’s disease only, 51 had ulcerative colitis only, and in 36, one had Crohn’s disease and the other ulcerative colitis. The median age of parents at diagnosis was 17.5 years older, 16 years older, and 18 years older in the Crohn’s disease, ulcerative colitis, and mixed disease families respectively (pCONCLUSIONSThere was no evidence of genetic anticipation or genomic imprinting of age at diagnosis in this sample of IBD families. Ascertainment bias is responsible for the age differences at diagnosis between affected parents and children.

Splinter or foreign body removal from the hand and foot is a common occurrence. Usually only the deep seated, broken or missed splinters are referred to the surgeon for removal. Unless the object is radio-opaque, plain radiograph will not give any useful information, hence removal can sometimes be very difficult and traumatic. We are reporting a case where a radiolucent splinter was removed with the aid of ultrasonography. This modality can help to localize a splinter at the pre and intra-operative period, minimizing amount of exploration and time of operation.

Self-assembled Polydiacetylenes (PDAs) with two different functional groups were successfully immobilized and chemisorbed on the surface of SiC substrates coated with thermally grown SiO2. Patterned PDAs on the surface of SiC with thermally grown SiO2 have shown selective response only to α-CDs (cyclodextrins) and not to γ-CDs through the manipulation of the outer structures of these PDAs. This shows the potential of integrating PDA-based chemosensors with high temperature SiC microelectronics and MEMS systems. (© 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

BACKGROUND & AIMS: Some families have multiple members with inflammatory bowel disease (IBD). Do clinical features of familial differ from sporadic cases? Is there concordance between affected family members? Do environmental factors affect familial clustering? METHODS: In 67 families, each with three or more first-degree relatives with IBD, the 213 affected family members were interviewed, and their case records were reviewed. RESULTS: The clinical manifestations of familial cases did not differ from IBD reported in a large series. There was concordance for type of disease (P

This paper describes a parallel computing system and a software algorithm for real-time interaction between a human user and a synthesized, humanlike, moving image. The realistic humanlike agent on a monitor can recognize the palm position and finger motion (finger sign) of the user. She/he then tracks and gazes at the hand position to change her/his facial expression in response to the finger sign in real time. This visual software agent (VSA) is expected to play an important role in building an advanced human interface. We regard this type of interactive agent as avisual software robot. To achieve real-time image recognition and image synthesis, we have developed a parallel visual computer system the transputer network with visual interface to transputers (TN-VIT). The imagesynthesis speed of the TN-VIT is about 24 frames/s, including finger-sign recognition. Some samples of synthesized images and experimental results are shown.

In recent years, thin wafer applications are expanded in Through Silicon Via (TSV), flexible electronics, MEMS, power device etc. Especially high density TSV applications drive the need for ultra-thin wafers. As wafer thickness decreases, thin wafer handling technology have to be required. Thin wafer is less stable, more vulnerable to stress and, so it has to be protected mechanically. Temporary bonding of the thin wafer and the carrier allows further semiconductor manufacturing process without the risk of wafer breakage. The carrier wafer material is silicon or glass that gives mechanical stability on thin wafer and protects the fragile thin wafer. One of several conditions of temporary bonder must not ingenerate air bubble in temporary bonding process. Because some semiconductor processes proceed in vacuum environment, there must not be air bubble. Some conditions need to bond without air bubble. First, the uniformity of the adhesive is important since air bubble trapped within the adhesive will result in blistering. Second, the coating thickness of adhesive must be uniform. Third, the bonding process should be achieved in vacuum environment. This study is related to the third condition and temporary bonder used in vacuum environment. Compared with air environment, the most difficult problem is the wafer handling in bonder used in vacuum environment. When the size of device wafer is equal to the size of carrier wafer, the wafer handler must pick the wafer behind. Vacuum picker is used most usually to wafer handling but it is impossible in vacuum environment. In this study, we developed mechanical picker to solve this problem and studied about pressure uniformity that became an issue in thermo compression bonding usually.

This paper presents our work on developing a flexible, adaptive and multifunctional gripper system for the assembly of camera phone lens modules. Key features of the system include tool change system for different end tools and visual position measurement of the component after grasping. This paper presents the development work and discusses the findings of system tests carried out in order to validate the developed gripper system.

Under frame side sill and carbody of rolling stock structures are designed for preventing corrosion in order to meet mechanical requirements. However during long operation time more than 30 years, there are corrosion in the under frame side sill caused by environmental effect, vibration and etc. So, detection and evaluation of the corrosion in the under frame nondestructive is one of important and extending their life time. So, in this study, we have investigated performance of pulsed eddy current testing method by measuring thickness variation of fabricate of carbody and under frame for rolling stocks. And then, the process of evaluating remaining life according to testing of corrosion amount is introduced.

We develop highly‐resistive (i.e. low‐carrier‐density) and ultrafast Fe‐ion implanted InGaAs layers for the applications of THz photomixer and photoconductive switch. The measured Hall mobility, sheet resistance, carrier density, and carrier lifetime of the optimized 1.2‐μm‐thick Fe‐implanted InGaAs layer are 3.4×102 cm2/Vs, 0.24 MΩ, 6.5×1014 cm−3, and 0.13ps, respectively.

This paper describes a system that can synthesize realistic sequential images of moving goldfish based on the image understanding result of real goldfish. To analyze and synthesize images in real-time, we have constructed a hardware system that consists of 32 paralell transputers with a high-speed visual-data interface called VIT (Visual Interface for Transpputer Network). The system is very flexible and powerful for various types of image processing because it can be extended according to the required computational cost. In the understanding process, we assume that the target object, a goldfish in this case, deforms its shape pliably in 3-D space and moves only in a two-dimensional direction. A modeling, called the Bone-Structured Solid Modeler, which is suitable for representing deformable objects such as living things, plays an important role in the understanding and synthesis processes of the deformable object. Three types of constraints for motion, namely, static, dynamic, and object, are utilized to verify the estimated pose and orientation of the object. In the motion synthesis process, realistic moving images are synthesized by controlling the model employing the motion understanding result. Simulation results are presented to show the effectiveness of the system. The technology discussed in this paper is expected to play a key role in the realization of future visual human interfaces.