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The paper studied by Yong-chi Li and R.F. Shen (2007) includes some problems regarding the application of the proposed Neural Network (NN) approach. A very limited number of data has been used as testing set (only 3 among 52 data sets) which should be 20–30% of the database. The NN application in the study is not a function approximation problem where same input must always lead to the same output. NNs cannot be used for such an application. Moreover the generalization capability of the NN model has not been investigated. This discussion, aims to points out controversial points of the paper.

BACKGROUND Atherosclerosis and vascular inflammatory response have been considered as risk factors for non-typhoidal Salmonella (NTS) vascular infection. The study aims to assess the risk of vascular infection by measuring atherosclerosis severity, NTS vascular infection (NTSVI) score, and serum levels of inflammatory markers in people with NTS bacteremia. METHODS A prospective observational study was conducted in two medical centers and two regional hospitals. Adults aged ≥50 years with NTS bacteremia who underwent computed tomography (CT) scan for revealing vascular infections were enrolled. The degree of atherosclerosis was scaled by a calcium score determined by a CT scan. Serum concentrations of inflammatory biomarkers were determined in the patients enrolled in a medical center. RESULTS Fourteen (20.3%) of 69 patients with NTS bacteremia had vascular infections. Calcium scores over the thoracic (12,540 vs. 3,261, P = 0.0005) and abdominal (9755 vs. 3,461, P = 0.0006) aorta of those with vascular infections were higher than those without vascular infection. All vascular infections were present in the high-risk group (NTSVI score ≥1), yielding a sensitivity of 100% and specificity of 30.9%. Among 17 low-risk patients (NTSVI score

A high efficiency dual active bridge with coupled inductor (DABCI) for fuel cell vehicles is proposed in this paper and its operation principle is analyzed to reveal the optimal operation modes of this converter, which provides the basis for circuit parameters design. Compared with dual active bridge (DAB), the DABCI is more suitable for high voltage gain applications because its low voltage bridge works like interleaved boost circuit and it is easy to get high voltage gain by adjusting the duty cycle D. In order to reveal the best operation mode of the DABCI, an optimal current stress modulation strategy is proposed, which can realize zero voltage switching (ZVS) operation in wide load range for all switches. Furthermore, the input current ripple is suppressed by interleaving two boost circuits in low voltage bridge, which can extend the life span of fuel cell vehicles. In addition, advanced magnetic integration technology is adopted to improve the system power density. Finally, a 4kW rated prototype is made and experimental results are presented to verify the previous analysis.

Wireless Sensor Networks (WSNs) are being used in various applications such as structural health monitoring and industrial control. Since energy efficiency is one of the major design factors, the existing WSNs primarily rely on low-power, low-rate wireless technologies such as 802.15.4 and Bluetooth. In this paper, by proposing , we strive to tackle the challenges of developing ultra-high-rate WSNs based on the 802.11 (WiFi) standard. As an illustrative structural health monitoring application, we consider spacecraft vibration test and identify system design requirements and challenges. Our main contributions are as follows. First, we propose packet encoding methods to reduce the overhead of assigning accurate timestamps to samples. Second, we propose energy efficiency methods to enhance the system’s lifetime. Third, to enhance sampling rate and mitigate sampling rate instability, we reduce the overhead of processing outgoing packets through the network stack. Fourth, we study and reduce the delay of processing time synchronization packets through the network stack. Fifth, we propose a low-power node design particularly targeting vibration monitoring. Sixth, we use our node design to empirically evaluate energy efficiency, sampling rate, and data rate. We leave large-scale evaluations as future work.

High-voltage and fast-switching silicon carbide (SiC) power modules are needed to construct high-voltage and high power-density converters. Stacking multiple low-voltage SiC devices to increase the equivalent blocking voltage shows advantages in on -state resistance, current capacity, and cost over one single high-voltage device. An indirect series-connected SiC MOSFET power module using quasi-two-level hybrid-clamp topology is proposed in this article. The voltages across the devices are automatically balanced with an open-loop modulation strategy to avoid sensors and control algorithm. Moreover, only ceramic capacitors are needed besides the MOSFETs and diodes in the topology. Thanks to this, the topology was highly integrated into a power module using SiC dies, which is equivalent to a general-purpose two-level medium-voltage SiC MOSFET power module. The switching losses of the power module show advantages over other stacking methods and even a single high-voltage switch and it can be evaluated with a two-level half-bridge (HB). To achieve this, the automatic voltage-balancing performance is analyzed in detail and the parasitic output capacitance in the topology is investigated, based on which the design considerations are presented. The simulation results from LTspice confirm the voltage-balancing and a 3600V/20A HB power module is built in the lab and the experimental results verify the design.

Background Management of comorbidities of people living with HIV (PLHIV) involves different care models, including providing diabetes care and HIV care by the same infectious diseases physician (IDP) (“consolidated care”) or providing diabetes care by the physicians other than IDP (“shared care”). The impact of diabetes care model on PLHIV with diabetes mellitus (DM) has not been well-evaluated. Methods A nationwide cross-sectional sample in the Taiwan National Health Insurance Research Database was used to compare the performance rates of seven guideline-recommended tests provided by the different subspecialists. Results Of 523 PLHIV with DM, there were 54.88% (n = 287) in the consolidated care group and 45.12% (n = 236) in the shared care group. More patients in the consolidated care group received the tests of lipid profile (92.33% vs. 79.24%), creatinine (Cr) (93.73% vs. 78.39%), and alanine transaminase (ALT) (91.99% vs. 75.42%), but fewer received urine protein test (35.54% vs. 51.69%) and fundoscopic examination (8.01% vs. 33.90%). The two groups did not differ in the performance rates of serum fasting glucose and HbA1c. After controlling for demographic factors and diabetic severity, the consolidated group was less likely to miss the serum tests of lipid profile (odds ratio [OR]: 0.30), Cr (OR: 0.19), and ALT (OR: 0.23), but more often missed urine protein test (OR: 1.56) and fundoscopic examination (OR: 4.97). Conclusion These findings suggest the need to focus on different process indicators of diabetes cares in different care models to enhance the diabetes care for PLHIV.

Photodocumentation during endoscopy procedures is one of the indicators for endoscopy performance quality; however, this indicator is difficult to measure and audit in the endoscopy unit. Emerging artificial intelligence technology may solve this problem, which requires a large amount of material for model development. We developed a deep learning-based endoscopic anatomy classification system through convolutional neural networks with an accelerated data preparation approach. We retrospectively collected 8,041 images from esophagogastroduodenoscopy (EGD) procedures and labeled them using two experts for nine anatomical locations of the upper gastrointestinal tract. A base model for EGD image multiclass classification was first developed, and an additional 6,091 images were enrolled and classified by the base model. A total of 5,963 images were manually confirmed and added to develop the subsequent enhanced model. Additional internal and external endoscopy image datasets were used to test the model performance. The base model achieved total accuracy of 96.29%. For the enhanced model, the total accuracy was 96.64%. The overall accuracy improved with the enhanced model compared with the base model for the internal test dataset without narrowband images (93.05% vs. 91.25%, p

We proposed and realized an all-in-fiber polymer microdisk whispering-gallery mode (WGM) resonator, which is composed of a nanoscale polymer waveguide in conjunction with a polymer microdisk. The resonator is manufactured by femtosecond laser-induced two-photon polymerization inside a single-mode optical fiber, and its transmission spectrum has been investigated theoretically and experimentally. The WGM resonance was excited successfully, exhibiting a high Q factor of 2.3 × 103 at a resonant wavelength of 1416.6 nm. The temperature and humidity responses of the resonator were tested as examples of possible application. Temperature sensitivity of -96 pm/°C when the temperature increased from 25 to 60 °C and humidity sensitivity of 54 pm/%RH when the relative humidity increased from 30 to 90% were obtained. The proposed in-fiber microdisk resonator is highly suitable for detection of microorganisms, bacteria, and single molecules.

BACKGROUND Multidisciplinary meeting (MDM) discussion and early palliative care are recommended in lung cancer management. The literature is unclear whether MDM discussion leads to early palliative care and improved end-of-life care. AIMS To evaluate impacts of discussion at an Australian lung MDM on palliative care referral, and MDM and early palliative care on aggressive end-of-life care. METHODS A retrospective, cross-sectional study was conducted of 352 patients diagnosed with primary lung cancer from 2017 to 2019 at the Alfred Hospital, Melbourne. The primary question was whether MDM discussion influenced palliative care referrals. Secondary questions were whether MDM discussion and early palliative care reduced aggressive treatment (chemotherapy, hospitalisation, emergency department visits, intensive care admission and in-hospital death) during the last 30 days of life. Multivariable logistic regression was used to determine independent association between MDM discussion and palliative care referral. RESULTS MDM discussion did not independently impact palliative care referral. There was reduced likelihood of MDM presentation in patients with metastatic disease (P

Although vehicle location-based services are prevalent outdoors, we are back into darkness in many GPS blocked environments, such as tunnels, indoor parking garages, and multilevel flyovers. Existing smartphone-based solutions usually adopt inertial dead reckoning to infer the trajectory, but low-quality inertial sensors in phones are plagued by heavy noises, causing unbounded localization errors through double integrations for movements. In this article, we propose VeTorch , a smartphone inertial odometry that devises an inertial sequence learning framework to track vehicles in real time when GPS signal is not available. Specifically, we transform the inertial dynamics from the phone to the vehicle regardless of the arbitrary phone’s placement in the car and explore a temporal convolutional network to learn the vehicle’s moving dependencies directly from the inertial data. To tackle the heterogeneous smartphone properties and driving habits, we propose a federated learning-based active model training mechanism to produce customized models for individual smartphones, without incurring user privacy issues. We implement a highly efficient prototype and conduct extensive experiments on two large-scale real-world traffic data sets collected by a modern ride-hailing platform. Our results outperform the state-of-the-art vehicular inertial dead-reckoning solutions on both accuracy and efficiency.

Controlling and manipulating individual quantum systems in solids underpins the growing interest in development of scalable quantum technologies1, 2. Recently, hexagonal boron nitride (hBN) has garnered significant attention in quantum photonic applications due to its ability to host optically stable quantum emitters3-7. However, the large band gap of hBN and the lack of efficient doping inhibits electrical triggering and limits opportunities to study electrical control of emitters. Here, we show an approach to electrically modulate quantum emitters in an hBN–graphene van der Waals heterostructure. We show that quantum emitters in hBN can be reversibly activated and modulated by applying a bias across the device. Notably, a significant number of quantum emitters are intrinsically dark, and become optically active at non-zero voltages. To explain the results, we provide a heuristic electrostatic model of this unique behaviour. Finally, employing these devices we demonstrate a nearly-coherent source with linewidths of ~ 160 MHz. Our results enhance the potential of hBN for tunable solid state quantum emitters for the growing field of quantum information science.

We demonstrate the fabrication of large-scale arrays of single photon emitters (SPEs) in hexagonal boron nitride (hBN). Bottom-up growth of hBN onto nanoscale arrays of dielectric pillars yields corresponding arrays of hBN emitters at the pillar sites. Statistical analysis shows that the pillar diameter is critical for isolating single defects, and diameters of ~250 nm produce a near-unity yield of a single emitter at each pillar site. Our results constitute a promising route towards spatially-controlled generation of hBN SPEs and provide an effective and efficient method to create large scale SPE arrays. The results pave the way to scalability and high throughput fabrication of SPEs for advanced quantum photonic applications., 13 pages, 4 figures

Multi-sensor fusion plays a key role in 2D laser-based robot location and navigation. Although it has achieved great success, there are still some challenges, e.g., being fragile when having a large angular rotation. In this paper, we present a deep learning-based approach to localizing a mobile robot using a 2D laser and an inertial measurement unit. A novel recurrent convolutional neural network (RCNN)-based architecture is developed to fuse laser and inertial data for scan-to-scan pose estimation. A scan-to-submap optimization is also introduced to optimize the poses estimated by the RCNN for enhanced robustness and accuracy. Extensive experiments have been conducted in both simulation and practice with a real mobile robot, verifying the effectiveness of the proposed deep sensor fusion system.

Coronavirus Disease-19 (COVID-19) has been in a global pandemic currently and relating symptoms were reported variously around the world. We reported a previously healthy man of COVID-19 presenting with anosmia as the obvious symptom with relevant radiological findings on brain magnetic resonance imaging.

Background: The geriatric nutritional risk index (GNRI) calculated as 1.489 × albumin (g/dL) +41.7× (current body weight/ideal body weight) is useful in identifying high-risk for malnutrition in elderly patients with subacute or chronic diseases. Given that trauma patients have sustained injuries in an acute condition, this study is designed to explore the association between GNRI on admission and outcomes in elderly and young adult patients with trauma. Materials and Methods: From January 01, 2009, to December 31, 2019, a total of 1772 elderly and 2194 young adult trauma patients were categorized into four nutritional risk groups according to GNRI: high-risk group (GNRI 98). Propensity score-matched patient cohorts were created in different nutritional risk groups against the no-risk group to minimize the confounding effects of sex, age, pre-existing comorbidities, Glasgow Coma Scale score, and Injury Severity Score on outcome measurements. Primary outcome was in-hospital mortality, and secondary outcome was the length of hospital stay. Results: Young adult patients with trauma were comparable in pattern of mortality outcomes and hospital stays to that in elderly patients. Analysis of the selected propensity score-matched patient cohorts revealed that both elderly and young adult patients in the high-risk group had significantly higher odds of mortality (elderly, odds ratio [OR], 6.5; 95% confidence interval [CI], 3.00-14.03; P < 0.009; young adult, OR, 2.7; 95% CI, 1.45-5.11; P = 0.001) and longer hospital stay (elderly, 21.5 days vs. 12.4 days, respectively, P < 0.001; young adults, 22.5 days vs. 14.1 days, respectively, P < 0.001) than those of the no-risk group. Conclusion: This study demonstrated that the GNRI could serve as a useful screening method to identify high-risk malnutrition in acutely injured trauma patients, including not only the elderly trauma patients but also the young adult trauma patients.

Gastric cancer is common, especially in East Asian countries, and is associated with high recurrence and mortality rates. Currently, there is no standard third-line treatment for metastatic gastric cancer. In this report, we present the case of a 69-year-old man with advanced gastric cancer, whose tumor was negative for human epidermal growth factor receptor 2 (HER2) according to immunohistochemical analysis. Next-generation sequencing performed on paraffin sections of the postoperative tumor samples indicated the presence of the ERBB3 V104L mutation. The patient received irinotecan plus pyrotinib as a third-line therapy and achieved a progression-free survival of 7.6 months with a high quality of life. Therefore, the combined administration of irinotecan and pyrotinib may improve the clinical condition of patients with gastric cancer harboring an ERBB3 mutation. Moreover, ERBB3 could be a potential therapeutic target for gastric cancer.

The real-time monitoring of the grid-connected renewable energy generations is of great significance to the operation and control of active distribution systems (ADS). Considering the detailed photovoltaic (PV) system model and ambient influencing factors, this paper develops a state estimation framework for the ADS with integrated PV power plants. Firstly, suitable models of PV arrays and power converters for steady-state state estimation are developed. Based on these models, the state variables of a PV generation system are selected, and the measurement equations are derived. Finally, combined with the state estimation model of distribution networks, a framework for state estimation and bad data processing of an ADS with PV power plants is presented. A parameter estimation approach for PV power plants based on multiple measurement scans is also developed in order to address the practical situation of unknown model parameters. Simulation results show that the proposed framework can effectively capture the operating state of the distribution network and PV power plants. In addition, it enhances the estimation accuracy and bad data processing capability compared to conventional state estimation frameworks.

Food allergy is often understood as an IgE-mediated hypersensitivity, characterized by allergic symptoms which occur "immediately" after the ingestion of a relevant food allergen. Increasingly, however, other food-related immune-mediated disorders are recognized in which symptoms can have a delayed onset and IgE does not play a central role. One of the described examples of the latter is eosinophilic esophagitis (EoE) - a disease defined pathologically by local eosinophilic inflammation in the esophagus in the setting of symptoms of esophageal dysfunction. The evidence that EoE is a food-mediated allergic disease includes i) almost all patients respond to an elemental diet and many respond to a diet in which dairy, wheat, eggs and/or soy are eliminated, ii) the presence of food-specific IgE and Th2 cells are consistent with a loss of tolerance to trigger foods and iii) many EoE patients have concomitant IgE-mediated food allergy and other allergic co-morbidities. This narrative review focuses on the hypothesis that EoE is a form of chronic food allergy. The goal is to describe similarities and differences in EoE and IgE-mediated food allergy, and to consider ways that these two increasingly common forms of food allergy are related to each other.

With the development of renewable energy generation, medium-voltage dc collection in large-scale photovoltaic (PV) plants has become a research focus with less losses and less system complexity. Maximum power point tracking control of PV panels requires converters with a large input voltage range and a stable output, among which active-clamp isolated boost converters qualify for PV applications, due to their high and variable step-up ratio. In this paper, an improved dual-active-clamp quasi-resonant isolated boost converter is proposed to increase the efficiency and decrease the voltage pressure across switches. The proposed topology has an additional resonant branch with a small resonant capacitor on top of the conventional active-clamp isolated boost converters, where the capacitor resonates with the leakage inductor of the transformer to improve the voltage and current waveforms during switching transients. The proposed converter achieves soft switching of all the switches at both turn-on and turn-off transients, while retaining good voltage regulation ability. Additionally, the induced voltage spikes due to the parasitic inductors in the conventional topology are suppressed well. Discussions on detailed steady-state operation, zero-voltage switching (ZVS) regions, and design considerations are given to show the advantages of the proposed converter. Simulation and experimental results are presented to verify the expected performances.

Purpose: The aim of the study was to determine the effectiveness of dignity therapy for end-of-life patients with cancer. Methods: This study used a quasi-experimental study design with a nonrandomized controlled trial. Dignity therapy was used as an intervention in the experimental group, and general visit was used in the control group. Thirty end-of-life patients with cancer were recruited, with 16 in the experimental group and 14 in the control group. Outcome variables were the participants' dignity, demoralization, and depression. Measurements were taken at the following time points: pre-test (before intervention), post-test 1 (the 7th day), and post-test 2 (the 14th day). The effectiveness of the intervention in the two groups was analyzed using the generalized estimating equation, with the p value set to be less than .05. Results: After dignity therapy, the end-of-life patients with cancer reflected increased dignity significantly [β = −37.08, standard error (SE) = 7.43, Wald χ2 = 24.94, p

This paper presents an investigation into the reliability of substrate bonding between metal layers and gallium arsenide vertical-injection light-emitting diodes (GaAs VLEDs). In this study, molybdenum (Mo) acts as a buffer layer between the GaAs VLED and the aluminum-based metal core printed circuit board (MCPCB). The thermal expansion coefficient (CTE) value of GaAs is approximately equal to that of the Mo layer under the substrate. This is beneficial for slowing the decay of the adhesive bond due to temperature cycling from − 40°C to 125°C for 50 cycles. The experimental results show that the use of the Mo buffer layer greatly improved the electrical and optical performance of the LED packages. The average leakage current was reduced from 33.63 mA to 2.37 mA at the reversed voltage of − 3 V and the increase in light output power was 130% at an injection current of 0.7 A. The results also show that a Mo buffer layer can reduce the risk of cracking on bonding wires after the thermal shock test (TST). These results are useful for improving the aging of GaAs VLEDs.

We propose and demonstrate Mach-Zehnder interferometer (MZI), which is the refractive index (RI) insensitive and temperature highly sensitive based on etched multi-core fiber (MCF) structure. The MCF and Fiber Bragg Grating (FBG) are used as hybrid sensing elements. The fabrication of the interferometer is provided a new taper-like structure by etching the MCF to further expose the side cores to the surroundings. The interferometer has produced a sensitivity of 103.2pm/°C within the ambient temperature up-to 70°C. Moreover, the superior temperature sensitivity is 89.19pm/°C, 66.64pm/°C, 56.42pm/°C in the range of 24°C to 130°C, and RI-insensitive in the range of 1.34 to 1.38, for different waists of etched seven-core fiber interferometers (E7CFIs) $\sim ~84.70\mu \text{m}$ , $93.10\mu \text{m}$ , $108.67\mu \text{m}$ , respectively. Compared with the conventional FBGs, the sensitivity of the interferometer is significantly improved by 8 times. E7CFI’s novel and advantageous features can easily be distinguished other devices. Besides, the proposed sensing architecture is compact, easy to fabricate, highly sensitive, easy to reproduce, and makes it an inexpensive fiber optic device.

Background/aim We aimed to examine the association of the genotypes of Nijmegen breakage syndrome 1 (NBS1), a critical gene in DNA double strand break repair machinery, with bladder cancer risk in Taiwan. Materials and methods NBS1 rs1805794 genotypes among 375 bladder cancer patients and 375 non-cancer healthy controls were determined via the polymerase chain reaction-restriction fragment length polymorphism methodology and their association with bladder cancer risk were evaluated. Results The results showed that the percentages of GG, CG and CC of NBS1 rs1805794 genotypes were 45.4%, 43.7% and 10.9% in the bladder cancer patient group and 47.2%, 43.2% and 9.6% in the non-cancer control group, respectively (p for trend=0.7873). The analysis of allelic frequency distributions showed that the variant C allele of NBS1 rs1805794 does not contribute to an increased bladder cancer susceptibility (p=0.5066). Conclusion The genotypes of NBS1 rs1805794 are not closely associated with personal susceptibility to bladder cancer.

Recent discoveries in the field of graphene-based heterostructures have led to the demonstration of high-performance photodetectors. However, the studies to date have been largely limited to the heterojunction with a Schottky barrier, restricted by an inevitable compromise between photoresponsivity and photodetectivity. Here, a new class of graphene-based tunneling photodetectors is introduced by inserting the Al2O3 tunneling layer between silicon and graphene. The photocarriers can tunnel through the designed insulator layer which simultaneously blocks the dark current, thus maintaining high photodetectivity with desirable photoresponsivity. We further modulate the thickness of the Al2O3 layer to explore the tunneling mechanism for the photocarriers, in which a photoresponsivity of 0.75 A/W, a high current ratio of 4.8 × 103 and a photodetectivity of 3.1 × 1012 Jones are obtained at a 13.3-nm-thick Al2O3 layer. In addition, the fabrication process is compatible with conventional semiconductor processing, providing further flexibility to large-scale integrated photodetectors with high performance.

Background The temporal and spatial scales of exposure assessment may influence observed associations between fine particulate air pollution (PM2.5) and mortality, but few studies have systematically examined this question. Methods We followed 2.4 million adults in the 2001 Canadian Census Health and Environment Cohort for nonaccidental and cause-specific mortality between 2001 and 2011. We assigned PM2.5 exposures to residential locations using satellite-based estimates and compared three different temporal moving averages (1, 3, and 8 years) and three spatial scales (1, 5, and 10 km) of exposure assignment. In addition, we examined different spatial scales based on age, employment status, and urban/rural location, and adjustment for O3, NO2, or their combined oxidant capacity (Ox). Results In general, longer moving averages resulted in stronger associations between PM2.5 and mortality. For nonaccidental mortality, we observed a hazard ratio of 1.11 (95% CI = 1.08, 1.13) for the 1-year moving average compared with 1.23 (95% CI = 1.20, 1.27) for the 8-year moving average. Respiratory and lung cancer mortality were most sensitive to the spatial scale of exposure assessment with stronger associations observed at smaller spatial scales. Adjustment for oxidant gases attenuated associations between PM2.5 and cardiovascular mortality and strengthened associations with lung cancer. Despite these variations, PM2.5 was associated with increased mortality in nearly all of the models examined. Conclusions These findings support a relationship between outdoor PM2.5 and mortality at low concentrations and highlight the importance of longer-exposure windows, more spatially resolved exposure metrics, and adjustment for oxidant gases in characterizing this relationship.

Purpose Infections caused by carbapenemase-producing Klebsiella pneumoniae are emerging causes of morbidity and mortality worldwide. Optimal treatment for non–carbapenemase-producing carbapenem-resistant K pneumoniae (nCP-CRKP) bacteremia remains undefined. The goal of this study was to assess the clinical outcome, predictors of mortality, and therapeutic strategy of carbapenems for nCP-CRKP bacteremia. Methods A retrospective study of monomicrobial bacteremia caused by nCP-CRKP, at a medical center between 2010 and 2015 was conducted. CRKP which was defined as a minimum inhibitory concentration (MIC) of ≥ 2 for ertapenem or ≥ 4 mg/L for meropenem, or imipenem. Multiplex polymerase chain was applied to detect carbapenemase genes. The patients definitively treated with combination therapy were compared with monotherapy using a propensity score–matched analysis to assess therapeutic effectiveness. The primary end point was the 30-day crude mortality and clinical prognostic factors were assessed. Findings Overall 171 patients met criteria were eligible for the study and their overall 30-day mortality rate was 38.6%. The multivariate logistic regression analysis showed that combination therapy was associated with a lower 30-day mortality rate (adjusted odds ratio [aOR], 0.11; 95% CI, 0.03–0.43; P = 0.001) and less clinical (aOR, 0.21; 95% CI, 0.08–0.58; P = 0.003) and microbiologic (aOR, 0.36; 95% CI, 0.19–0.71; P = 0.003) failure. However, the 30-day mortality rate in the cases infected by a pathogen with a meropenem MIC ≤8 mg/L receiving carbapenem-containing or carbapenem-sparing combination regimens was similar (15 of 58 [25.9%] vs 5 of 20 [23.3%]; P = 1.0). Implications Combination therapy, regardless of carbapenem-containing or carbapenem-sparing, with one or more active agents improved survival more than monotherapy and was more effective in patients with critical illness. (Clin Ther. 2020; 42:XXX–XXX) © 2020 Elsevier HS Journals, Inc.

A fiber-optic shape sensing based on 7-core fiber Bragg gratings (FBGs) is proposed and experimentally demonstrated. The investigations are presented for two-dimensional and three-dimensional shape reconstruction by distinguishing bending and twisting of 7-core optical fiber with FBGs. The curvature and bending orientation can be calculated by acquiring FBG wavelengths from any two side cores among the six outer cores. And the shape sensing in three-dimensional (3D) space is computed by analytic geometry theory. The experiments corresponding of two-dimensional (2D) and 3D shape sensing are demonstrated and conducted to verify the theoretical principles. The resolution of curvature is about 0.1m−1 for 2D measuring. The error of angle in shape reconstruction is about 1.89° for 3D measuring. The proposed sensing technique based on 7-core FBGs is promising of high feasibility, stability, and repeatability, especially for the distinguishing ability on the bending orientation due to the six symmetrical cores on the cross-section.

Calibration of an analog-to-digital converter is an essential step to compensate for static errors and ensure accurate digital output. In addition, ad-hoc deployments and operations require fault-tolerant IoT devices capable of adapting to unpredictable environments. In this paper, we present the design and implementation of Excalibur – a low-cost, accurate, and scalable calibration tool. Excalibur is a programmable platform, which provides linear current output and rational function voltage output with a dynamic range. The basic idea is to use a set of digital switches to connect with a parallel resistor network and program the digital switches to change the total resistance of the circuit. The total resistance and output frequency of Excalibur is controlled by a program communicating through the GPIO and I2C interfaces. The software provides two salient features to improve accuracy and reliability: time synchronization and self-calibration. Furthermore, Excalibur is equipped with a temperature sensor to measure the temperature before calibration, and a current sensor which enables current calibration without using a digital multimeter. We present the mathematical model and a solution to compensate for thermal and wire resistance effects and validate scalability by incorporating the concept of the Fibonacci sequence. Our extensive experimental studies show that Excalibur can significantly improve measurement accuracy. For example, for ATMega2560, the ADC error reduces from 0.2% to 0.01%, for ADS8353, the error reduces from 0.17% to 0.0014%, for INA219, the error reduces from 0.42% to 0.02%, and for MCP3208, the error reduces from 5.29% to 0.01%.

A simple, high-accuracy and non-destructive method for the measurement of diaphragm thickness and microgap width based on modulated tri-beam interference is demonstrated. With this method, a theoretical estimation error less than 0.5% for a diaphragm thickness of ~1 μm is achievable. Several fiber-tip air bubbles with different diaphragm thicknesses (6.25, 5.0, 2.5 and 1.25 μm) were fabricated to verify our proposed measurement method. Furthermore, an improved technique was introduced by immersing the measured object into a liquid environment to simplify a four-beam interference into tri-beam one. By applying this improved technique, the diaphragm thickness of a fabricated in-fiber rectangular air bubble is measured to be about 1.47 μm, and the averaged microgap width of a standard silica capillary is measured to be about 10.07 μm, giving a corresponding measurement error only 1.27% compared with actual scanning electron microscope (SEM) results.

Silicon carbide (SiC) nanostructure is a type of promising field emitter due to high breakdown field strength, high thermal conductivity, low electron affinity, and high electron mobility. However, the fabrication of the SiC nanotips array is difficult due to its chemical inertness. Here we report a simple, industry-familiar reactive ion etching to fabricate well-aligned, vertically orientated SiC nanoarrays on 4H-SiC wafers. The as-synthesized nanoarrays had tapered base angles &gt, 60°, and were vertically oriented with a high packing density &gt, 107 mm−2 and high-aspect ratios of approximately 35. As a result of its high geometry uniformity—5% length variation and 10% diameter variation, the field emitter array showed typical turn-on fields of 4.3 V μm−1 and a high field-enhancement factor of ~1260. The 8 h current emission stability displayed a mean current fluctuation of 1.9 ± 1%, revealing excellent current emission stability. The as-synthesized emitters demonstrate competitive emission performance that highlights their potential in a variety of vacuum electronics applications. This study provides a new route to realizing scalable field electron emitter production.

Background: Social media can be used to engage consumers in hospital service design and quality improvement (QI) activities, however its uptake may be limited by a lack of guidance to support implementation. This article presents the perceived barriers and enablers in using social media for consumer engagement derived from an interview study with public hospital stakeholders. Methods: Semi-structured interviews with 26 Australian hospital service providers and consumer representatives. Data were analysed using a deductive content analysis method. Results: Data were collected between October 2019 and April 2020. Facebook was the platform most commonly used for consumer engagement activities. Barriers and enablers to social media-based consumer engagement were identified. The barrier themes were (1) fears and concerns; (2) lack of skills and resources for social media engagement; (3) lack of organisational processes and support; and (4) problems with social media platforms and the changing social media landscape. The enabler themes were: (1) hospitals facilitating access and use; (2) making discussions safe; (3) cultivating a social media community; and (4) building on success. Conclusion: Using social media to facilitate consumer engagement in hospital service design and QI activities is feasible and acceptable to service providers and consumers. Hospitals and their executives can create a supportive environment for social media-based engagement activities through developing clear governance systems and providing training and support to all users. Consumers need to be involved in co-designing social media-based activities and determining which forms of engagement are accessible and acceptable. For some consumers and service providers, barriers such as a lack of resources and distrust of social media companies might mean that social media-based engagement will be less acceptable for them. Because of this it is important that hospitals provide complementary methods of engagement (eg, face-to-face) alongside social media-based methods.

The SPR phenomenon results in an abrupt change in the optical phase such that one can measure the phase shift of the reflected light as a sensing parameter. Moreover, many studies have demonstrated that the phase changes more acutely than the intensity, leading to a higher sensitivity to the refractive index change. However, currently, the optical phase cannot be measured directly because of its high frequency; therefore, investigators usually have to use complicated techniques for the extraction of phase information. In this study, we propose a simple and effective strategy for measuring the SPR phase shift based on phase-shift interferometry. In this system, the polarization-dependent interference signals are recorded simultaneously by a pixelated polarization camera in a single snapshot. Subsequently, the phase information can be effortlessly acquired by a phase extraction algorithm. Experimentally, the proposed phase-sensitive SPR sensor was successfully applied for the detection of small molecules of glyphosate, which is the most frequently used herbicide worldwide. Additionally, the sensor exhibited a detection limit of 15 ng/mL (0.015 ppm). Regarding its simplicity and effectiveness, we believe that our phase-sensitive SPR system presents a prospective method for acquiring phase signals.

The nanocone-shaped carbon nanotubes field-emitter array (NCNA) is a near-ideal field-emitter array that combines the advantages of geometry and material. In contrast to previous methods of field-emitter array, laser ablation is a low-cost and clean method that does not require any photolithography or wet chemistry. However, nanocone shapes are hard to achieve through laser ablation due to the micrometer-scale focusing spot. Here, we develop an ultraviolet (UV) laser beam patterning technique that is capable of reliably realizing NCNA with a cone-tip radius of ≈300 nm, utilizing optimized beam focusing and unique carbon nanotube–light interaction properties. The patterned array provided smaller turn-on fields (reduced from 2.6 to 1.6 V/μm) in emitters and supported a higher (increased from 10 to 140 mA/cm2) and more stable emission than their unpatterned counterparts. The present technique may be widely applied in the fabrication of high-performance CNTs field-emitter arrays.

This prospective study aimed to investigate the clinical and microbiological characteristics of different Aeromonas species. Clinical isolates of Aeromonas species between 2016 to 2018 were collected in a university hospital in southern Taiwan. The species was determined by rpoD or gyrB sequencing. A total of 222 Aeromonas isolates from 160 patients in 164 episodes were identified. The crude in-hospital mortality was 17.2%. The most frequently isolated species was Aeromonas veronii (30.6%), followed by A. caviae (24.8%), A. hydrophila (23%), and A. dhakensis (16.7%). The major clinical manifestations were primary bacteremia (31.1%), skin and soft tissue infection (22.6%), and biliary tract infection (18.3%). The most common underlying diseases were malignancy (45.1%), diabetes mellitus (27.4%), and liver cirrhosis or chronic hepatitis (26.2%). A. hydrophila and A. dhakensis predominated in the skin and soft tissue infection (pA. vernoii and A. caviae prevailed in primary bacteremia and biliary tract infections (p=0.012). Pneumonia, malignancy, and ascF-ascG genotype were independent factors associated with mortality. Ertapenem susceptibility was decreased in A. sobria (42.9%), A. veronii (66.7%), A. dhakensis (73%), and A. hydrophila (84.3%). Cefotaxime resistance was found in 30.9% of A. caviae and 18.9% of A. dhakensis isolates, much more prevalent than the other species. The metallo-β-lactamase blaCphA was almost invariably present in A. dhakensis, A. hydrophila, and A. veronii (100%, 100% and 89.9%, respectively). Amp-C β-lactamases such as blaMOX and blaAQU-1 were identified in all A. caviae and 91.9% of A. dhakensis isolates. Cefepime, fluoroquinolones and tigecycline showed good in vitro activity against aeromonads.

Background: Sepsis remains a common but fatal complication among patients with immune suppression. We aimed to investigate the performance of metagenomic next-generation sequencing (mNGS) compared with standard microbiological diagnostics in patients with hematologic malignancies. Methods: We performed a prospective study from June 2019 to December 2019. Adult patients with hematologic malignancies and a clinical diagnosis of sepsis were enrolled. Conventional diagnostic methods included blood cultures, serum galactomannan for Aspergillus, cryptococcal antigen and cytomegalovirus (CMV) viral loads. Blood samples for mNGS were collected within 24 h after hypotension developed. Results: Of 24 patients enrolled, mNGS and conventional diagnostic methods (blood cultures, serology testing and virus RT-PCR) reached comparable positive results in 9 cases. Of ten patients, mNGS was able to identify additional pathogens compared with conventional methods, most of the pathogens were virus. Conclusion: Our results show that mNGS may serve as adjunctive diagnostic tool for the identification of pathogens of hematologic patients with clinically sepsis.

Single-photon emitters in hexagonal boron nitride (hBN) are promising constituents for integrated quantum photonics. Specifically, engineering these emitters in large-area, high-quality, exfoliated hBN is needed for their incorporation into photonic devices and two dimensional heterostructures. Here, we report on two different routes to generate high-density quantum emitters with excellent optical properties-including high brightness and photostability. We study in detail high-temperature annealing and plasma treatments as an efficient means to generate dense emitters. We show that both an optimal oxygen flow rate and annealing temperature are required for the formation of high-density quantum emitters. In parallel, we demonstrate that the plasma treatment in various environments, followed by standard annealing is also an effective route for emission engineering. Our work provides vital information for the fabrication of quantum emitters in high-quality, exfoliated hBN flakes and paves the way toward the integration of the quantum emitters with photonic devices.

Integration of solid-state quantum emitters into nanophotonic circuits is a critical step towards fully on-chip quantum photonic-based technologies. Among potential materials platforms, quantum emitters in hexagonal boron nitride (hBN) have emerged as a viable candidate over the last years. While the fundamental physical properties have been intensively studied, only a few works have focused on the emitter integration into photonic resonators. Yet, for a potential quantum photonic material platform, the integration with nanophotonic cavities is an important cornerstone, as it enables the deliberate tuning of the spontaneous emission and the improved readout of distinct transitions for a quantum emitter. In this work, the resonant tuning of a monolithic cavity integrated hBN quantum emitter is demonstrated through gas condensation at cryogenic temperature. In resonance, an emission enhancement and lifetime reduction are observed, with an estimate for the Purcell factor of ≈15.

(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan’s National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars—NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79–3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04–2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21–1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51–6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.

Purpose: this study investigated the effects of the intensity of machine-based bicep curl resistance exercise on ultrafast ultrasound-derived muscle strain rate and carotid ultrafast pulse wave velocity (ufPWV), and examined the association between muscle strain rate, ufPWV, and established carotid function measures in habitual resistance-trained individuals. Methods: twenty-three young habitual resistance-trained males (age: 24 ± 1 year, body mass index = 24 ± 1 kg/m2) were recruited to participate in two bouts of acute bicep curl exercise. After one-repetition maximum determination (1RM), the participants were randomly assigned to engage in bicep curls at 40 or 80%1RM intensity (10 reps × five sets) by a crossover study design. The muscle strain rate of bicep muscle, carotid ufPWV during systole(ufPWV-sys), and diastole (ufPWV-dia) were obtained pre- and post-exercise. In addition, carotid function measures were calculated by obtained carotid diameter and central blood pressure changes. Results: compared with pre-exercise, the reduction in post-exercise muscle strain rate and its area under the curve of 80%1RM was greater than those of 40%1RM. Both ufPWV-sys and ufPWV-dia increased regardless of exercise intensity. Baseline bicep muscle strain rate correlated not only with ufPWV-sys (r = −0.71, p = 0.001), ufPWV-dia (r = −0.74, p = 0.001), but also carotid compliance (r = 0.49, p = 0.02), distensibility (r = 0.54, p = 0.01) and ß stiffness (r= −0.84, p &lt, 0.0001). The ufPWVs also correlated with ß stiffness (r = 0.64–0.76, p = 0.01). Conclusion: muscle stiffness measured by ultrafast ultrasound elastography increases positively with resistance exercise intensity, and it appears to correlate with carotid ufPWV and established carotid function measures in habitual resistance-trained individuals.

Myocardial fibrosis is a pathological change in the progress of modern heart disease. It is mainly characterized by dysregulation or marked increase of collagen volume in myocardial components. The physiological mechanism of fibrosis in different pathologies is very diverse. It has been proved that the use of MRI for the detection of heart failure patients can provide accurate measurements of left ventricle and right ventricle and assessment of myocardial function, but the accurate segmentation of myocardial contour is still an important prerequisite for the detection of fibrosis. This study uses Mask R-CNN on the ACDC challenge Database to repeatedly adjust the characteristics of the boundary of the Bounding box, and separately divided the left ventricular area and the right ventricular area. The proposed method can achieve up to 95% hit rate with 0.89 IoU.

In this study, a skin sensing module is designed for the robotic arm. Based on this module, the robotic arm can perceive physical contacts or collisions, and trigger its predefined safety mechanism. A solution is provided to deal with the hidden work safety issue arisen with the advancement of human-robot collaboration. The purpose of this work is to protect the machine operators and improve their working environment by providing the modularization of the signal transmission. According to the proposed architecture through sensitive pressure sensing technique and wireless transmission, the robotic arm in execution can respond in a timely manner for protection, and ensure the task execution and safety control of the robot arm.

Aim There is very little literature reporting the association of matrix metalloproteinase-1 (MMP1) with personal susceptibility to bladder cancer. In the current study, we carried out the first examination of the contribution of MMP1 rs1799750 to bladder cancer risk in Taiwanese. Materials and methods A total of 375 bladder cancer cases and 375 healthy controls were genotyped for MMP1 rs1799750 via polymerase chain reaction-restriction fragment length polymorphism methodology and this was evaluated for association with clinicopathological factors. Results The frequencies of MMP1 rs1799750 2G/2G, 1G/2G, and 1G/1G genotypes were 35.7%, 44.8% and 19.5% in the group with bladder cancer and 32.5%, 46.4%, and 21.1% in the healthy control group (p for trend=0.6362). The odds ratios (ORs) for bladder cancer risk after adjusting for age and gender for those carrying 1G/2G and 1G/1G genotypes at MMP1 rs1799750 were 0.88 (95% CI=0.62-1.24, p=0.4357) and 0.83 (95% CI=0.61-1.26, p=0.3990), respectively, compared with the wild-type 2G/2G genotype. In allelic frequency analysis, the adjusted OR for those carrying the 1G allele at MMP1 rs1799750 was 0.87 (95% CI=0.71-1.23, p=0.3479) compared to those people carrying a 2G allele. Conclusion Our findings indicated that the genotypes at MMP1 rs1799750 appear to play little role in determining personal susceptibility to bladder cancer for Taiwanese.

The search for ever higher frequency information processing has become an area of intense research activity within the micro, nano, and optoelectronics communities. Compared to conventional semiconductor-based diffusive transport electron devices, electron tunneling devices provide significantly faster response times due to near-instantaneous tunneling that occurs at sub-femtosecond timescales. As a result, the enhanced performance of electron tunneling devices is demonstrated, time and again, to reimagine a wide variety of traditional electronic devices with a variety of new “lightwave electronics” emerging, each capable of reducing the electron transport channel transit time down to attosecond timescales. In response to unprecedented rapid progress within this field, here the current state-of-the-art in electron tunneling devices is reviewed, current challenges and opportunities are highlighted, and possible future research directions are identified.

This paper investigates the potential of detecting stroke gaits by Deep Neural Network (DNN) models based on data from different sensor systems. Stroke survivors usually experience partial disability and need long-term rehabilitation. Because correct evaluation of stroke gaits is crucial for clinics to apply suitable medical treatments and rehabilitation strategies, we propose a method to detect stroke gaits by generalized gait data that might be obtained from different measurement systems. In this paper, we measure the subjects’ gait data by two equipment: an IMU system and a motion capture system. Then, we apply the IMU data to develop DNN models, which achieve an accuracy of 99.04% in detecting the stroke gaits by k-fold validation. Last, we applied the data measured by the motion capture system to test the DNN models. The results showed that the model could successfully detect stroke gaits with an average accuracy of 98.68%. In addition, we also applied a public dataset, where the gait data was measured by different IMU systems, to evaluate the model performance. The results show that the DNN models achieve an average accuracy of 98.25% in distinguishing normal gaits. These results confirm the possibility of detecting abnormal gaits based on data measured at different locations by assorted sensor systems.

Optical‐field driven electron tunneling in nanojunctions has made demonstrable progress toward the development of ultrafast charge transport devices at subfemtosecond time scales, and have evidenced great potential as a springboard technology for the next generation of on‐chip “lightwave electronics.” Here, the empirical findings on photocurrent the high nonlinearity in metal–insulator–metal (MIM) nanojunctions driven by ultrafast optical pulses in the strong optical‐field regime are reported. In the present MIM device, a 14th power‐law scaling is identified, never achieved before in any known solid‐state device. This work lays important technological foundations for the development of a new generation of ultracompact and ultrafast electronics devices that operate with suboptical‐cycle response times., The authors report on the high nonlinearity photocurrent in metal‐insulator‐metal nano‐junctions driven by ultrafast optical pulses in the strong optical‐field regime. A 14th power‐law scaling is first achieved in the solid‐state device. This work lays important technological foundations for the development of a new generation of ultracompact and ultrafast electronics devices that operate with sub‐optical‐cycle response times.

Background: The frail elderly are prone to falls and fractures, which can result in dependency, disability, admission to institutions, and even death. They are at increased risk of frailty due to decreased physical activity, cognitive decline, and depression. Some evidence suggests that music therapy with physical activities may be particularly beneficial. Objective: This study aimed to investigate the intervention effect of music therapy with physical activities (MTPA) on frail elderly in the community. Methods: A quasi-experimental design was adopted. We selected 10 community care centers in southern Taiwan, in which elderly people over the age of 65 were assigned to a MTPA group and a comparison group after obtaining their informed consent. The MTPA group performed group music activities once a week for 120 min for 12 weeks, while the comparison group only continued with their daily activities. Instruments in this study included the Kihon Checklist, Senior Fitness Test (with Body Mass Index (BMI) and seven physical fitness items), Mini-Mental Status Examination (MMSE), and Geriatric Depression Scale Short Form (GDS-SF). Results: A total of 132 community elders agreed to participate in this study, and 122 completed both the pretest and posttest, with 62 in the music therapy group and 60 in the comparison group. The results of ANCOVA showed that after intervention, except for BMI, the Kihon frailty assessment, seven fitness scores individually and in total, MMSE, and depression showed significant improvements in the music therapy group relative to the comparison group (all p &lt, 0.05). Conclusion: MTPA can improve the frailty index, cognitive function, depression, and physical fitness index in the community elderly. The results of this study can be used as a reference for the design of activities for the community elderly, to provide them with appropriate activities, improve their physical functions, and improve or delay their disability.