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Many cancers are caused by overweight; however, cancer risk varies among individuals with obesity. Few studies are addressing the relationship between metabolic obesity phenotypes and cancer. This study investigates the association between metabolically healthy overweight (MHOW) or metabolically healthy obesity (MHO) and cancer incidence.In a nationwide, representative community-based prospective cohort study, 5734 Taiwanese adults were classified into eight phenotypes according to body mass index (underweight18.5; normal weight 18.5-23.9; overweight 24-26.9; and obese ≥27 kg/mDuring 73,389 person-years of follow-up, 428 incident cancers were identified. Compared to the participants with metabolically healthy normal weight, participants with MHOW (adjusted HR 1.39, 95% CI, 0.90-2.13) or MHO (adjusted HR 1.07, 95% CI, 0.51-2.22) had a tendency toward a higher risk of cancer. These associations were stronger in MHOW (adjusted HR 1.77, 95% CI, 1.09-2.86) or MHO (adjusted HR 1.39, 95% CI, 0.66-2.93) participants younger than 65 years.This study was the first to investigate the impact of metabolic obesity phenotype on the incidence of cancer in the Taiwanese population. Even in the absence of metabolic abnormalities, overweight, and obesity may cause a modest increase in the risk of developing cancer.

Background Blood lipids are essential components for cellular growth. An inverse association between serum lipid levels and risk of cancer has led to a controversy among previous studies. The aim of this prospective cohort study was to investigate the association between blood lipids change and risk of cancer incidence. Methods A cohort of 4130 Taiwanese adults from the Taiwanese Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia database underwent repeated examinations in 2002 and 2007. Six groups were established based on the combined baseline (lower/higher) and interval change (decreasing/stable/increasing) in plasma lipid levels. Multivariable Cox proportional hazard model was used to investigate the relationship between lipids change and all-cause cancer incidence. Results Two hundred and forty cancer events developed over a median follow-up of 13.4 years. Comparing these with individuals with decreasing lower-baseline lipid levels, cancer risk reduction was demonstrated in those with increasing lower-baseline total cholesterol (adjusted hazard ratio [aHR], 0.48; 95% confidence interval [CI], 0.27 to 0.85), low-density lipoprotein cholesterol (LDL-C; aHR, 0.56; 95% CI, 0.35 to 0.92), and non–high-density lipoprotein cholesterol (non-HDL-C) (aHR, 0.54; 95% CI, 0.31 to 0.92) levels. A decreased risk for cancer incidence also presented in participants with stable lower-baseline, decreasing and increasing higher-baseline LDL-C levels, and with decreasing and stable higher-baseline non-HDL-C levels. Conclusions The interval decline in lower-baseline total cholesterol, LDL-C, and non-HDL-C levels was linked to a higher risk for all-cause cancer incidence. More attention to a potential cancer risk may be warranted for an unexplained fall in serum lipids.

We study the characteristics of graphene grown through low power capacitive coupled radio frequency plasma enhanced chemical vapor deposition (PECVD) and explore its application. Fully-covered, mostly single-layered, and highly defective graphene films were grown on Cu substrates through plasma composed of various argon/methane/hydrogen gas ratio with low RF power within a minute under a moderate substrate temperature at 850 °C . The structural, chemical, and electrical properties of the graphene films were measured through Raman spectroscopy, X-ray photoelectron spectroscopy, and Hall measurement, respectively. The Raman signatures were strongly affected by the argon/hydrogen flow rates and the subsequent thermal annealing, and is strongly correlated to carrier mobility of the film. Through analysis of the defect related Raman bands within the theoretical framework of activated defect model, it is concluded that the defects found in the graphene films are originated from ion bombardment during the growth processes. The vacancy defects on the graphene film provides adsorption sites for gaseous molecules and induces changes of charge transfer in the graphene film. The response of the graphene-based sensor fabricated with the PECVD grown graphene is 6% under 100 ppb of N O 2 , which can be a candidate of potential N O 2 gas sensing material in the future.

Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.

Purpose Heterogeneity assessment has been applied in medical imaging analysis. We aim to evaluate first-order and texture analysis (TA) metrics in 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging for classification of metastatic and benign bone lesions in patients with cervical cancer.Materials and Methods: 18F-FDG PET studies for cervical cancer patients performed on a specific PET/CT system from 2016 to 2018 were retrieved. Bone lesions extracted from studies in 2016-2017 were used as the training dataset and those in 2018 as the validation dataset. Metastatic bone lesions were identified in each dataset, with an equal number of benign bone lesions selected. Cuboid volume of interest (VOI) consisting of 3 by 3 by 5 reconstructed voxels was defined for first-order metrics and cubic VOI consisting of smaller voxels with trilinear interpolation of standardized uptake value (SUV) was adopted for TA metrics. First-order metrics included maximum SUV (SUVmax) of lesion and mean, standard deviation (SUVsd), skewness and kurtosis of voxel SUV in VOI. A total of 4464 TA metrics based on 62 texture features were evaluated. Logistic regression was used for classification with area under the receiver operating characteristic curve (AUC) as the performance measure.Results: From the training and validation datasets, 98 and 42 metastatic bone lesions were identified respectively. SUVsd achieves a better performance than SUVmax in both training (AUC .798 vs .732, P < .001) and validation (AUC .786 vs .684, P < .001) datasets. Top-performing TA metrics achieved significantly better performance in the training dataset but failed to retain this advantage in the validation dataset.Conclusion: This study identified a simple first-order measure of heterogeneity, SUVsd, to be superior to SUVmax in the classification of metastatic and benign bone lesions. The effect of multiple hypothesis testing can result in false-positive findings in TA with multiple features and parameters and careful validation is needed.

Cervical lymph node enlargement as the first and sole manifestation of IgG4-related disease (IgG4-RD) is rare and is often difficult to distinguish from lymphoma. Here, we report a case of a 63-year-old man initially presenting with bilateral posterior neck masses. Ultrasonography revealed multiple matted, ovoid, homogenous, hypoechoic, and enlarged lymph nodes below the right parotid gland. In addition, there was heterogeneous echotexture with small and indistinct hypoechoic nodules over bilateral parotid and submandibular glands which suggested sclerosing sialadenitis. Pathology of the tissues obtained by core needle biopsy revealed reactive hyperplasia, but a diagnosis of lymphoma could not be excluded. Subsequently, excisional biopsy and serological tests were done. The diagnosis of IgG4-RD was confirmed due to marked elevation of serum IgG4 levels and pathological evidence of IgG+ and IgG4+ plasma cell infiltration in the lymph node specimen. The patient's neck masses subsided gradually after 1 week of oral steroid therapy. The differential diagnosis of IgG4-RD should always be considered when sclerosing sialadenitis is presented with cervical lymphadenopathy.

Backgrounds Early integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients. Methods In this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS. Results In total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family’s awareness of disease before PCCS, and patient’s awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses. Conclusion This 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life.

As society gradually relies on technologies to prevent dangers and detect the environment, the processing of data transmission and analysis becomes important. In recent years, firefighters are sacrificed during rescue missions. Even with the high-tech equipment in the current era, the lives of firefighters are not prevented in the fire scene. Thus, this research designs and develops an alarm system for hospitals and schools. The Message Queuing Telemetry Transport (MQTT) technology and fire sensors are utilized and integrated to extract the conditions of the environment. In the system, the subscriber server collects the data on a personal computer. Also, the website and database server monitor the wards in a hospital. Integrating and designing the systems help to understand the emergent situation.

Background This study assessed the performance of visceral adiposity index and body shape index in predicting diabetes mellitus (DM) risk and compared their predictive ability to that of body mass index and waist circumference. Methods Among 8249 consecutive subjects who attended the Nationwide Health Check Up System for Senior Citizens (≥ 65 years) between 2008 and 2018, we examined the associations of several adiposity indices with DM risk and explored gender differences. Results Among all adiposity indicators, Chinese visceral adiposity index (CVAI) demonstrated the highest discriminatory ability for diabetes mellitus with area under receiver operating characteristic curves (AUC) of 0.65, 0.68, and 0.66 for men, women, and all participants, respectively, and optimal cut-offs set as 126.09 in men and 117.77 in women. Compared with body shape index (ABSI), both CVAI and VAI were strongly associated with baseline DM (adjusted OR: 4.85, 95% CI: 4.05–5.82 and 4.22, 95% CI: 3.53–5.05 for 4th vs 1st quartile groups by CVAI and VAI, P Pinteraction Conclusions Our population-based data demonstrated that Chinese visceral adiposity index may serve as a superior clinical indicator of diabetes when compared with conventional anthropometric indices among older adult Chinese, especially in women.

In this study, piezoelectric zinc oxide (ZnO) thin film was deposited on the Pt/Ti/SiNx/Si substrate to construct the FBAR device. The Pt/Ti multilayers were deposited on SiNx/Si as the bottom electrode and the Al thin film was deposited on the ZnO piezoelectric layer as the top electrode by a DC sputtering system. The ZnO thin film was deposited onto the Pt thin film by a radio frequency (RF) magnetron sputtering system. The cavity on back side for acoustic reflection of the FBAR device was achieved by KOH solution and reactive ion etching (RIE) processes. The crystalline structures and surface morphologies of the films were analyzed by X-ray diffraction (XRD) and field emission scanning electron microscope (FE-SEM). The optimized as-deposited ZnO thin films with preferred (002)-orientation were obtained under the sputtering power of 80 W and sputtering pressure of 20 mTorr. The crystalline characteristics of ZnO thin films and the frequency responses of the FBAR devices can be improved by using the rapid thermal annealing (RTA) process. The optimized annealing temperature and annealing time are 400 °C and 10 min, respectively. Finally, the FBAR devices with structure of Al/ZnO/Pt/Ti/SiNx/Si were fabricated. The frequency responses showed that the return loss of the FBAR device with RTA annealing was improved from −24.07 to −34.66 dB, and the electromechanical coupling coefficient (kt2) was improved from 1.73% to 3.02% with the resonance frequency of around 3.4 GHz.

This paper develops a modular multilevel inverter which integrates driving/braking control schemes in a unit for electric vehicles. The multiple driving components are used to balance surg...

The risk of cancer among adults with metabolically healthy obesity (MHO) has not yet been established. We systematically searched from inception to 15 March 2020. We included prospective cohort studies that compared participants with MHO and participants with metabolically healthy non-obesity (MHNO) for incidence of any type of cancer. Benign tumors, cancer mortality or cancer prognosis were not in the scope of our analysis. The Newcastle-Ottawa Scale was used for quality assessment. Ultimately, eight studies with a total of 12 542 390 participants were included. The pooled meta-analysis using random effect model showed participants with MHO demonstrated a significantly increased risk of developing cancer (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.05 to 1.23; and I2 = 39%) than those with MHNO. The subgroup analysis revealed a higher pooled estimate (OR, 1.17; 95% CI, 1.01-1.35; and I2 = 56%) in comparison with metabolically healthy normal weight. No evidence of effect modification by age, sex, ethnicity, smoking, sample size or length of follow-up was found. In conclusion, the present study reports a positive association between MHO and cancer incidence. All individuals with obesity, even in the absence of metabolic dysfunction, should be encouraged to lose weight.

Background. Type 1 diabetes mellitus (T1DM) causes the irreversible destruction of pancreatic beta cells. The Bacillus Calmette–Guerin (BCG) vaccine can modulate the immune response and decelerate disease progression. The aim of this study is to investigate the efficacy of the BCG vaccine for the treatment of T1DM. Objective. Six databases were systematically searched from inception to the end of August 2019. The randomized controlled trials (RCTs) that evaluated glycemic control in response to the BCG vaccine for T1DM were enrolled. The primary outcome was glycated hemoglobin (HbA1c) level, and secondary outcomes included fasting and stimulated C-peptide level, daily insulin dosage, and clinical remission. The revised Cochrane risk of bias tool was used for quality assessment, and meta-analyses were conducted to evaluate the efficacy of the BCG vaccine. Results. Four studies with a total of 198 subjects were included. The results of HbA1c and fasting C-peptide levels were extracted for further quantitative assessment. The pooled meta-analysis demonstrated no significant difference in HbA1c levels (mean difference [MD], −0.12; 95% confidence interval [CI], −0.53 to 0.30; I2=56%) or fasting C-peptide levels (MD, −0.15; 95% CI, −0.35 to 0.06; I2=0%) in the BCG intervention group as compared with that in the placebo group. Conclusions. There is no robust evidence to support the use of the BCG vaccine for the treatment of T1DM although the HbA1c levels tended to improve. Additional RCTs to assess the long-term effects of the BCG vaccine on glycemic control are warranted.

To assess the clinical roles of [18F]fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) performed 2-3 months after completion of concurrent chemoradiotherapy (CCRT), along with pretherapy characteristics, in patients with advanced squamous cell carcinoma of the uterine cervix enrolled in a prospective randomized clinical trial. Posttherapy PET/CT in patients with advanced FIGO stage or positive pelvic or para-aortic lymph node (PALN) defined on pretherapy PET/CT was classified as positive, equivocal, or negative. Overall survival (OS) rates between patients with different PET/CT results are compared. Pretherapy characteristics are examined for association with posttherapy PET/CT results and for prognostic significance in patients with equivocal or negative PET/CT. PET/CT scans (n = 55) were positive, equivocal and negative in 9, 13 and 33 patients, respectively. All patients with positive scans were confirmed to have residual or metastatic disease and died despite salvage therapies. There is a significant OS difference between patients with positive and equivocal scans (P

In this study, a 3.5-GHz solidly mounted resonator (SMR) was developed by doping scandium in aluminum nitride to form AlScN as the piezoelectric thin film. Molybdenum (Mo) of 449 nm thickness and silicon dioxide (SiO2) of 371 nm thickness were used as the high and low acoustic impedance films, respectively, which were alternately stacked on a silicon substrate to form a Bragg reflector. Then, an alloy target with atomic ratio of 15% Sc was adopted to deposit the piezoelectric AlScN thin film on the Bragg reflector, using a radio frequency magnetron sputtering system. The characteristics of the c-axis orientation of the AlScN thin films were optimized by adjusting sputtering parameters as sputtering power of 250 W, sputtering pressure of 20 mTorr, nitrogen gas ratio of 20%, and substrate temperature of 300 °C. Finally, a metal top electrode was coated to form a resonator. The X-ray diffraction (XRD) analysis showed that the diffraction peak angles of the AlScN film shifted towards lower angles in each crystal phase, compared to those of AlN film. The energy dispersive X-ray spectrometer (EDX) analysis showed that the percentage of scandium atom in the film is about 4.5%, regardless of the sputtering conditions. The fabricated resonator exhibited a resonance frequency of 3.46 GHz, which was a small deviation from the preset resonance frequency of 3.5 GHz. The insertion loss of −10.92 dB and the electromechanical coupling coefficient of 2.24% were obtained. As compared to the AlN-based device, the AlScN-based resonator exhibited an improved electromechanical coupling coefficient by about two times.

Metal-oxide-semiconductor field-effect transistor (MOSFET) can be utilized to raise switching frequency (SF) while zero voltage switching-clamped voltage (ZVS-CV) is a simple technique to eliminate switching loss without extra resonant circuit. Then, heat sink and filter can both be so shrunk that compact inverter can fit the single-phase system in residential site while high efficiency fulfills regulation(s). In order to ensure the ZVS-CV operation, the inverter’s filter inductor must flow such high ripple current that can charge or discharge parasitic capacitances of a MOSFET totem pole, however trades off conduction loss of MOSFET. This study proposes a simple scheme for adapting the SF ripple current to the profile of line frequency (LF) sinusoid meanwhile ZVS-CV operation is maintained, thus efficiency is optimized. Simulations are conducted with 220 V 60 Hz LF single phase full-bridge buck inverter to verify the efficiency enhancement on a load about 1 kW.

The application of capacitive power transfer (CPT) technology is widely researched to overcome the drawback of inductive power transfer (IPT) technology. The main drawback of IPT is not only eddy-current losses generated by magnetic fields in the foreign object located in the air-gap but also the pad size and total cost considerations. This paper implements a four-plate compact capacitive coupler for suficient air-gap distance CPT as proposed by other scientific paper. The four-plate arrangement is also designed by referring to the previous research which results in a good coupling capacitance. The LCL compensation is utilized to resonate with the four plates coupler. The resonant network equation is proposed in previous research by employing the superposition theorem to analyze the two AC sources in the coupler separately. Whereas, this paper proposes the resonant analysis by implementing wye-delta and delta-wye transform in the equivalent impedance network. Hence, that approach could bring a contribution by generating a gain curve for further study. The circuit model is simulated in PSIM software to verify the gain curve and specific resonant parameter. The ANSYS Maxwell software is employed to simulate the coupler design. Finally, a 260-W prototype of the CPT system with a 60-mm air-gap distance is constructed and experimentally tested to validate the gain curve and mathematical analysis for the equivalent impedance network, as the main focus of this research.

We designed and fabricated bi-polar type photoconductive antenna (PCA) for efficient generation of broadband terahertz (THz) radiation. The falling time of overlayingly generated photocurrent from bi-polar PCA can achieve 200 fs via superimposing two primarily opposite polarity photocurrent pulses having falling time of 100 ps with time delay of 200 fs. The simulation results disclosed a possibility to shift the central frequency from 0.1 to 1.3 THz and enhance the THz power by twice in the range 1.5-3.3 THz by using low cost substrate with long carrier life time such as semi-insulating gallium arsenide (SI-GaAs).

Background Different quitting trajectories may reflect the stages of behavior change among smokers. The nature of quitting patterns could help the public health sector to design appropriate cessation plans. This study compared demographic, health, and behavioral characteristics and the effects of long-term abstinence between early and delayed abstainers. Methods We retrospectively sampled 142 abstainers from smoking cessation clinic participants for a study conducted from January 1 to December 31, 2017. Baseline information was obtained at the first clinic visit, and phone interviews were conducted 2 weeks, 3 months, and 6 months later. The 7-day point prevalence abstinence was employed for measuring their quitting status. We defined early abstainers as those who attained abstinence by second week and delayed abstainers as those who had done so by the third month. We compared their characteristics and 6-month quit rates and examined potential predictors between the two quitting patterns. Results One hundred forty-two participants were included with 87 (61.3%) early abstainers and 55 (38.7%) delayed abstainers. Early abstainers were older with more comorbidities, presenting longer smoking duration, higher exhaled carbon monoxide (CO) concentration and Fagerstrom Test of Cigarette Dependence (FTCD) scores. The 6-month abstinence rate was high for both quitting patterns with no significant difference (83.9% versus 81.8%, p = 0.7462). Higher FTCD scores and exhaled CO concentration were potential predictors for early abstainers with adjusted odds ratio 1.16 (95% confidence interval [CI], 1.01–1.33) and 1.04 (95% CI, 1.00–1.08) respectively. Conclusions Our results associated early abstainers with older age, more comorbidities and higher nicotine dependence. Both groups achieved good long-term abstinence maintenance. Although early abstainers may achieve earlier reduction of health risks, smokers could still benefit from long-term abstinence if they can manage to quit smoking even at later phases of cessation courses.

Background Anxiety is commonly experienced during the delivery process and has shown to have adverse effects on maternal and infant health outcomes. Music interventions tend to reduce the effects of anxiety in diverse populations, are low cost, are easily accessible, and have high acceptability. The aim of this review and meta-analysis was to assess the effectiveness of music interventions in reducing anxiety levels among women during labor. Methods Seven databases from inception to the end of December, 2018, without any language or time restriction including Embase, PubMed, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, PsycINFO, Airiti Library, and PerioPath: Index to Taiwan Periodical Literature were searched using key terms related to pregnancy, anxiety, and music. Randomized controlled trials that assessed the effect of music during labor and measured anxiety levels as an outcome were included. Meta-analyses were conducted to assess anxiety reduction following a music intervention compared to that after placebo treatment. Results A total of 14 studies that investigated a total of 1,310 participants were included in this review. The meta-analyses indicated that those in the intervention group had a significant decrease in anxiety scores (standardized mean difference = −2.40, 95% confidence interval (CI) [−3.29 to −1.52], p < 0.001; I2 = 97.66%), heart rate (HR) (difference in means = −3.04 beats/min, 95% CI [−4.79 to −1.29] beats/min, p = 0.001; I2 = 0.00%), systolic blood pressure (SBP) (difference in means = −3.71 mmHg, 95% CI [−7.07 to −0.35] mmHg, p = 0.031; I2 = 58.47%), and diastolic blood pressure (DBP) (difference in means = −3.54 mmHg, 95% CI [−5.27 to −1.81] mmHg, p < 0.001; I2 = 0.00%) as compared to the women in the control group. Conclusions Music interventions may decrease anxiety scores and physiological indexes related to anxiety (HR, SBP, and DBP). Music interventions may be a good non-pharmacological approach for decreasing anxiety levels during labor.

A Three-Level Bi-Directional Half-Bridge CLLC Resonant DC-DC converter for DC micro-grid application is studied on this paper, which uses dual resonant tanks to achieve wide range voltage regulation and meanwhile employs bi-directional capability. All power switches on this converter can achieve ZVS function at the whole load and the voltage stress on all power switches at both sides can be clamped at half of input voltage and output voltage since the three-level circuit architecture using the proposed synchronous rectifier (SR)control, therefore, the voltage stresses of the transformer, resonant tanks, power switches and other components are only half compared with conventional half-bridge CLLC resonant converter, the downsizing rated of components selection can be more flexible. Finally, the laboratory prototype is built to verify the performance of voltage balancing on input/output capacitor, voltage stress on switches and efficiency, the measured efficiency can be up to 95.6% over different load conditions.

In the paper, the performance of a 5 kW DC/DC Wye-Delta-based series resonant converter designed for 400V input voltage and 48V output voltage server power supply is evaluated. The paper also performs operation modes analysis, circuit characteristics analysis, and use time domain analysis on Wye-Delta-based series resonant converter for circuit design to replace FHA analysis due to waveform distortion. Finally, a full-load efficiency up to 96.07% and power-density up to 2.84W/cm3 server power supply is implemented.

Circadian clocks, endogenous oscillators generating daily biological rhythms, have important roles in the nervous system to control diverse cellular processes-not only in the suprachiasmatic nucleus (SCN), where the master clocks reside to synchronize all circadian clocks in the body but also in other non-SCN areas. Accumulating evidence has shown relationships between circadian abnormalities (e.g., sleep disturbances and abnormal rest-activity rhythms) and disease progressions in various neurodegenerative diseases, including Alzheimer's (AD) and Parkinson's (PD) disease. Although circadian abnormalities were frequently considered as consequences of disease onsets, recent studies suggest altered circadian clocks as risk factors to develop neurodegenerative diseases via altered production or clearance rates of toxic metabolites like amyloid β. In this review, we will summarize circadian clock-related pathologies in the most common neurodegenerative diseases in the central nervous system, AD and PD. Then, we will introduce the current clinical trials to rescue circadian abnormalities in AD and PD patients. Finally, a discussion about how to improve targeting circadian clocks to increase treatment efficiencies and specificities will be followed. This discussion will provide insight into circadian clocks as potential therapeutic targets to attenuate onsets and progressions of neurodegenerative diseases.

Background Pneumonia is a leading cause of hospitalization and death worldwide. However, studies focusing on risk factors of community-acquired pneumonia (CAP) in the home health care (HHC) population remain scarce. Aims This study aimed to evaluate risk factors associated with hospitalization for CAP among HHC patients in Taiwan. Methods This retrospective cross-sectional study extracted data from patients’ electronic medical records between 1 January 2017 and 31 December 2017. Multiple logistic regression analyses were performed to explore factors associated with hospitalization for CAP. Results In total, 598 patients (men/women: 236/362) were included. One hundred ninety-nine patients (33.28%) were hospitalized for pneumonia. Inpatients showed a higher proportion of the following: male sex, functional impairment, hypoalbuminemia, anemia, nasogastric tube use, excessive polypharmacy, stroke, dementia, heart failure, chronic respiratory disease, and chronic liver disease. Furthermore, nasogastric tube use (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.88–4.82), anemia (OR 2.37, 95% CI 1.48–3.80), male sex (OR 2.14, 95% CI 1.43–3.20), chronic respiratory disease (OR 2.09, 95% CI 1.33–3.30), dementia (OR 1.94, 95% CI 1.27–2.97), heart failure (OR 1.69, 95% CI 1.11–2.56), and hypoalbuminemia (OR 1.57, 95% CI 1.03–2.40) significantly increased the risk of hospitalization for CAP. Conclusions Our results revealed risk factors associated with hospitalization for CAP in HHC patients. In addition to chronic diseases, malnutrition is an important risk factor. Caregivers should make prompt assessments and take preventive measures for such patients.

Introduction: Cerebral vasoconstriction is often encountered in the post-CPR phase, which inevitably worsens neurological prognosis. Nitric oxide (NO) confers vasodilatation and anti-apoptotic protective effect, but may cause systemic hypotension. We designed an Au-polymersomes/S-nitrosoglutathione (Au-PLGA/GSNO) nanoparticle that can be selectively triggered by shockwave (SW) to release NO, and investigated its role in mitigating post-CPR cerebral vasoconstriction and apoptotic neuronal injury. Methods: Using an established rat model of asphyxia cardiac arrest and CPR, Au-PLGA/GSNO (7500 PPM, 3.33 mg/kg Au and 42 ug/kg GSNO) was infused into carotid artery together with the same volume of SonoVue 10 min after CPR, with simultaneous stimulation by SW (PiezoWave, 134 mJ/mm 2 ) distal to the infusion site. The blood pressure (BP) was continuously monitored and brain tissue perfusion recorded by OxyFLO probe. Cerebral vasculature was video-taped by CytoCam. The blood was sampled 2 h post-CPR for measurement of nitrate/nitrite. The brain was harvested for measurement of casepase-3, endothelial NO synthase (eNOS) and protein kinase B (Akt). In a subgroup the brain was harvested at 24 h for TUNEL stain. Results: Marked cerebral vasoconstriction was noted after CPR with brain perfusion reduced to about half that of baseline. With infusion of Au-PLGA/GSNO + SonoVue and SW stimulation, the cerebral vasoconstriction was ameliorated and brain perfusion improved to baseline level ( P < 0.05 vs. CPR control), while BP showed no significant difference. The plasma nitrate/nitrite 2 h post-CPR was significantly increased ( P < 0.05). The cleaved caspase-3 of the brain was reduced ( P < 0.001) and TUNEL stain of the CA1 and CA3 regions of hippocampus significantly abrogated. Interestingly, the phosphorylated (P)-eNOS and P-Akt were also increased (both P < 0.001), suggesting reciprocating activation of the upstream Akt-eNOS signaling. Conclusion: Nano Au-PLGA/GSNO with SW-induced release of NO selectively mitigates post-CPR cerebral vasoconstriction and apoptotic neuronal death without systemic hypotension. Being effective and safe, such therapeutic strategy can be applied not only in post-CPR care but in other diseases such as subarachnoid hemorrhage.

A proof-of-concept of the enhancement in thermoelectric properties using C/BCN core/shell nanotube heterojunctions has been reported. We demonstrated a scalable two-step reaction route to produce C/BCN core/shell nanotubes with bulk quantities. Systematic X-ray photoelectron spectroscopy (XPS) and atomic-scale high-resolution transmission electron microscope electron energy loss spectroscopy (HRTEM-EELS) characterizations indicate that the synthetic heterostructures with CNT core and BCN shell can be prepared by the developed method. Thermoelectric property measurements revealed that moderate BCN shell effectively improves the Seebeck coefficient, leading to a 6.4-fold increase in thermoelectric power factor of 0.64 μW/mK 2 . Our study provides a fundamental understanding for the rational design of nanostructured heterojunctions for improved thermoelectric properties of carbon-based materials.

Public–private partnership (PPP) is a strategy where governments encourage private institutions to financially support public construction projects, by providing proper incentives based on collaboration with private institutions. However, disputes may occur during a contract management. This paper investigates various public–private partnership (PPP) disputes and their critical influential factors for associating fundamental project information and dispute resolutions. In this study, knowledge is extracted from the association rules so that dispute handling patterns can be identified from historical database. Analytical results show that the rule sets achieve 83.92% confidence level. By applying the results in practice, project managers can determine the likely method for dispute resolutions with known project attributes, dispute items, and the phase in which a dispute occurs. This research demonstrates an effective application and valuable reference for early notice of dispute handling methods in public infrastructure projects.

Background A ‘surgery as needed’ strategy has been proposed for patients with oesophageal cancer who truly achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT). However, the ability to detect residual disease remains problematic. This study investigated the anatomical locations and pathological characteristics of residual cancer in patients with oesophageal squamous cell carcinoma (SCC) who achieved a near pCR following nCRT. Methods Patients with oesophageal SCC who achieved a near pCR after nCRT were eligible. Near pCR was defined as residual cancer in the resection specimen representing less than 10 per cent of the apparent original tumour area. Results Detailed histopathological reassessment of 76 consecutive patients (mean age 54·4 years) with a near pCR was undertaken. Some 32 patients (42 per cent) with a near pCR had no detectable mucosal lesions. Residual tumour was identified most frequently in the submucosal layer (54, 71 per cent), followed by the mucosa (44, 58 per cent), muscle layer (36, 47 per cent) and adventitia (22, 29 per cent) (P < 0·001). Among patients without ypT1a disease, increasing depth of tumour invasion correlated negatively with the likelihood of mucosal involvement. Of patients with ypT3 disease, 16 of 22 had no detectable cancer located in the mucosa, compared with six of 29 with ypT1b disease (P < 0·001). Conclusion Better tools for predicting pCR are required before considering a ‘surgery as needed’ approach in the management of oesophageal cancer.

Background The prognostic value of histologic response for osteosarcoma may have changed with induction chemotherapy schedules over time. We hypothesized that the increased intensity of induction therapy provided on INT0133 compared to the Children's Cancer Group study CCG-782 would diminish the impact of histologic response on the risk of events after definitive surgery. Methods Retrospective analysis was performed for patients aged

This paper examines the abnormal returns of acquiring real estate investment trusts (REITs) around the announcement of acquisitions before and after the subprime mortgage crisis. Based on 182 domestic and cross-border US REIT acquisition announcements from 2005 to 2010, the acquiring trusts experienced a 0.73% abnormal return, on average. When the sample was divided into pre-crisis, crisis, and after-crisis subsamples, the acquiring trusts enjoyed the largest abnormal returns (1.86%) for domestic acquisitions during the crisis period. Before the crisis, when the acquisition was cross-border, the target was private, or the transaction was cash-financed, the acquiring trust experienced larger abnormal returns. During the crisis period, the acquiring trust gained larger abnormal returns when the transaction value was larger. After the crisis period, the acquiring trust achieved less abnormal returns in cross-border mergers. For both pre- and after-crisis periods, the shareholders of the acquirer enjoyed larger abnormal returns when the mergers were cash-financed, regardless of whether the target was public or privately held. Neither the blockholder monitoring nor the signaling hypothesis can explain such value gains. The structural changes in the acquirer&rsquo, s abnormal returns are possibly due to the increased risk aversion of the market participants following the crisis.

In this paper, the low voltage stress of switches, high voltage gain DC-DC converter is proposed. The operating principle of the converter is similar to that of the conventional buck converter. Therefore, the proposed converter can be operated in the discontinuous conduction mode, continuous conduction mode, depending on the design. Moreover, the controller is also similar to that of the traditional buck converter, results in the simple controller. Furthermore, the voltage stress of every switch is reduced significantly compared with the conventional converter. Therefore, the use of the low voltage rating switches reduces the losses significantly. A 200W converter prototype is successfully built and tested to verify the feasibility of the proposed converter.

This paper proposes the design and implementation of a digital controlled three-phase three-level inverter using T-type topology. The advantages of this topology are reducing components usage, minimizing the devices stress, and resulting lower output voltage Total Harmonic Distortion (THD). This design employs a high-performance TMS320F28335 Digital Signal Processor (DSP) from Texas Instruments. The chip is powered with Floating Point Unit (FPU) feature for processing three-phase controlled algorithm. The proposed modulation strategy is Carrier-Based Pulse Width Modulation (CBPWM) that can be implemented with a very simple algorithm and fast processing time. In addition, it can generate the highest modulation index up to 1.154 that is feasible under linear modulation, such as Space Vector Modulation (SVM). Finally, a 6 kW three-phase T-type inverter is verified by simulation and experimental result. It can reach 99% efficiency in the full-load condition.

Currently, electric vehicle technology is becoming more and more mature. Although the anti-lock braking system (ABS) has been commonly applied, most electric vehicles (EVs) still use traditional hydraulic-based disc braking, which has the drawbacks that vehicle wheels are is easy to skid in the rainy day, and easy to be abraded during emergency brake. As a novel method of braking, regenerative braking has the advantages of compact structure, sensitive response, reliability and controllable braking distance. In this research task, a regenerative driving and braking control system for EVs with satisfactory braking performance is proposed. When braking, a motor is converted into a generator-the acquired energy can be used to generate reverse magnetic braking torque with fast response. On this basis, an anti-lock braking controller is realize. A PID controller is also designed to drive the motor and a fuzzy slip ratio controller is designed and used to obtain the optimal slip ratio. Finally, real-world experiments are conducted to verify the proposed method.

Background: Previous surveillance methods to monitor the prognoses of patients with bronchiectasis are too complex for use in daily practice. The 6-minute walk test (6MWT) is a simple exercise test to predict the prognosis of chronic obstructive airway disease and numerous chronic lung diseases, including idiopathic pulmonary fibrosis. No studies have investigated exercise-induced oxygen desaturation (EID) and distance-saturation product (DSP) of 6MWT to predict the prognoses of patients with bronchiectasis. Methods: This was a prospective study to identify correlations between variables of 6MWT and mortality in patients with bronchiectasis over a 6-year period. The study cohort included 69 patients with stable non-cystic fibrosis (non-CF) bronchiectasis who were regularly evaluated for functional status via 6-minute walk distance (6MWD), spirometry, BODE index, EID, and DSP. Results: Of the 69 patients, 9 (13%) died and 60 (87%) survived during the 6-year follow-up period. The percentage of EID was higher [seven of nine patients (78%) vs . 22 of 60 patients (27%), P=0.003] in the non-survivors group. The 6MWD (467.9±77.1 vs . 363.7±126.7 m, P=0.001) was higher in the survivors group. DSP was significantly lower in the non-survivors group (411.0±78.4 vs . 283.9±90.0 m%, P 280 m% (P Conclusions: DSP is a simple parameter to predict 6-year mortality in patients with non-CF bronchiectasis.

A three-phase interleaved boost converter stage of an ac-dc PFC converter that uses GaN switches is developed that utilizes a feed-forward band-stop filter control method to suppress low-frequency output voltage ripple. To increase power density, the converter switches at 500 kHz, operates in triangular current mode (TCM) to achieve zero voltage switching (ZVS), and uses GaN switching devices. A 1-kW laboratory prototype was designed and tested to verify feasibility. With the proposed controller, output ripple was reduced by 70%. Overall efficiency is greater than 96.5% and power density is 65.028 W/in3.

Bidirectional dc-dc converter is an important part of battery energy storage to efficiently control the power flow in or out of the battery. Due to the limited stored energy, it is very important to maximize the amount of deliverable energy to the load by minimizing the losses in the power conversion. In this paper, the proposed high efficiency bidirectional DC-DC converter is based on series resonant converter (SRC) topology. The circuit is realized by using full bridge on primary and secondary side. Silicon carbide (SiC) MOSFET is utilized on the primary side to significantly reduce the losses on the primary side switches. A 1.5 kW 750V/ 15V prototype converter was implemented and tested to verify the design. From the experimental results, a 96.22% of peak efficiency for both buck and boost modes was achieved.

BACKGROUND The purpose of the present study was to determine whether a synergistic exercise model based on aerobics with additional fall-preventive components could provide extra benefits compared with the same duration of aerobic-synergistic exercise alone. METHODS A total of 102 adults aged 65 years and over from three geographically separated communities were assigned to three groups: the general aerobic exercise (GAE) group (N.=44), the GAE plus ball game group (BG group; N.=30) and the GAE plus square-stepping exercise group (SSE group; N.=28). Each group participated in one hour of exercise intervention and two hours of leisure activities twice weekly for 12 weeks. Each exercise session consisted of one hour of combined exercises performed in the following order: 10 minutes of warm-up activities, 20 minutes of aerobics, 20 minutes of the respective exercise model, and 10 minutes of cool-down activities. Functional fitness tests, including aerobic endurance, leg strength, flexibility, reaction time, static balance and mobility, were measured before and after the intervention. Paired t-tests and mixed model analyses were conducted to compare the differences in each measurement within and among the groups. RESULTS All of the groups exhibited significantly positive effects (P

This study examined the effects of a school-based drug use prevention programme for middle-school students in Taiwan. The curriculum consisted of 10 lessons and 4 homework assignments involving parent-child activities. A quasi-experimental design was used. The study was conducted in an urban middle-school located in Taipei city and in a middle-school located in a rural area in Taoyuan county. A total of 327 middle-school students in the intervention group and 314 students in the comparison group successfully participated in the baseline (September 2011) and follow-up surveys (November 2011). A mixed-model approach was used to examine the effects. Multivariate analysis results indicated that the school-based drug-prevention programme increased the students' drug-related knowledge, drug-prevention attitudes, enhanced life skills, and improved perceived parental involvement in the prevention of drug use. The results of this study endorse the implementation of school-based drug use prevention programmes that include parent-child activities to enhance youth drug-prevention knowledge, attitudes, and life skills. Language: en

A microfluidic immunoassay system was developed for the study of the enhancement of protein binding reaction. The system mainly consisted of a thermopneumatic actuator and a reaction chamber. Reagent was pre-installed in the on-chip reservoir and manipulated by the actuator. Such design could eliminate the external tubing connections in order to reduce the waste of reagent and improve the portability. The on-chip actuator could manipulate the reagent bi-directionally to induce vortexes in the chamber. Enhancement of protein binding reaction was demonstrated by the protein model pair, i.e., mouse IgG and anti-mouse IgG. By such bi-directional fluid motion, more binding opportunities between suspended protein and its surface-immobilized counterpart were generated to improve the performance of immunoassay. It showed that an 83.74 % enhancement of the binding reaction was achieved, compared with the static situation. As a whole, the proposed microfluidic system is highly integrated and can enhance the protein binding efficiency using such novel design. The developed system can be easily extended to multi-reagents immunoassay protocols and provides a useful platform for point-of-care applications.

Prenatal anxiety is extremely common and may result in adverse effects on both the mother and the baby. Music interventions have been used to reduce anxiety in various medical patients and in pregnant women during childbirth. This study aims to assess the clinical efficacy of music interventions in women during pregnancy rather than during labor. Seven databases were searched from inception to September 2019 without language restrictions. We included only randomized controlled trials that compared music intervention and control groups for anxiety reduction in pregnant women. We used the revised Cochrane risk-of-bias tool (RoB 2.0) for quality assessment. Finally, 11 studies with 1482 participants were included. The pooled meta-analysis results showed that music interventions significantly decreased anxiety levels (standardized mean difference (SMD), &minus, 0.42, 95% confidence interval (CI), &minus, 0.83 to &minus, 0.02, I2 = 91%). Moreover, subgroup analysis showed that listening to music at home had significant anxiolytic benefits (SMD, &minus, 0.28, 95% CI, &minus, 0.47 to &minus, 0.08, I2 = 0%). However, meta-regression revealed a nonsignificant trend for increase in the anxiety-reducing effects of music interventions with increasing maternal age. In conclusion, music interventions may be beneficial in reducing anxiety and may be applied in pregnant women.

Regular exercise is potentially an effective way to prevent or reduce depressive symptoms for older adults. However, little research has focused on gender differences in exercise dose effects on depressive symptoms in older people. The purpose of this study was to test gender differences in the preventive effects of different exercise doses on depressive symptoms among community-dwelling older adults in Taiwan. This study was a secondary analysis of a longitudinal cohort study in a sample of older Taiwanese adults (N = 2,673; mean age 74.2 ± 5.7 years). Four different doses of moderate-intensity exercise were examined including three 15-min sessions/week, three 30-min sessions/week, six 15-min sessions/week, and six 30-min sessions/week. Descriptive statistics and generalized linear mixed models were used to analyze characteristics of the sample and hypotheses testing. All analysis models were adjusted according to age, gender, education, marital status, smoking, social participation, and chronic conditions. The results indicated that regular exercise with at least 15 min per session, 3 times a week of moderate intensity was significantly associated with lower levels of depressive symptoms for women, but there were no significant preventive effects on depressive symptoms for men. This study suggests that moderate-intensity exercise may play a protective role in depression prevention for older women, even with a very low dose (three 15-min sessions/week). Gender differences should be considered for future research and clinical practice when designing exercise interventions on preventing depression for older adults.

A series of anthracene and 2-tert-butyl–substituted anthracene derivatives featuring 9-ethyl-9H-carbazol-3-yl or 4-(9-ethyl-9H-carbazol-3-yl)phenyl groups were synthesized for use as light-emitting layer in sky-blue organic light emitting devices (OLEDs). Efficient conjugation between the carbazole and anthracene unit resulted in strong blue emissions and high quantum efficiencies of anthracene derivatives in solution. Electroluminescence (EL) properties of non-doped OLEDs incorporated with these anthracene derivatives, along with an electron-transporting layer (ETL), tri-(8-hydroxyquinoline)aluminum (Alq3) or 1,3,5-tris(N-phenyl benzimidizol-2-yl)benzene (TPBI) were investigated. The OLEDs incorporated with TPBI provided superior EL performance than did those incorporated with Alq3. A hole-blocking layer 2,9-dimethyl-4,7-diphenyl-1,10-phenanthroline (BCP) was inserted at the interface of light emitting layer and ETL to enhance the EL performance for the OLED with Alq3 as ETL. High brightness (37423 cd/m2), and great current efficiency (5.89 cd/A) were observed for the 4-(9-ethyl-9H-carbazol-3-yl)phenyl-substituted anthracene derivatives based OLEDs.

In this paper, we propose the concept of attack scenarios, which can be learned and selected from a set of malicious applications and described by sets of Android APIs, to characterize Android malware. Because of its characteristics that produce almost no false-positive, attack scenarios can be used as a pre-filter for machine-learning based detectors to enhance the detection performance at low false-positive rate. By combining different machine learning techniques, we demonstrate that the proposed approach can increase the detection rates. To evaluate our approach, we analyze 20,914 Android application containing 3,145 malicious samples on two different machine learning techniques, KNN and SVM. The experiment results show that the proposed approach can raise the detection rate up to 95.9% malware at 1% false positive rate and 95.9% malware at 0.1% false positive rate respectively.

This paper presents a fully-integrated Ka-band 4RX/4TX phased-array transceiver IC. The four transceiver channels are synchronized by an I/Q standing wave oscillator (SWO). Their signal phases are shifted by hybrid analog IF and LO phase interpolators, and can be controlled digitally and independently. The SWO further composes an on-chip PLL, and is locked to a 1.09 GHz off-chip global reference to scale to a large array at board level. Each receiver channel achieves 66 dB maximum conversion gain and 4.4 dB minimum noise figure. Each transmitter channel achieves 18 dBm maximum output power. The chip is mounted on a high-frequency laminate, inside which embedded cables connect its RF pads to Vivaldi antennas also inside the same PCB. With the PCB, each channel achieves 360° phase shifting capability under a maximum calibrated 3.7° phase errors. The PCB module presents successful beam steering with 23° measured four-channel 3-dB beamwidth. This chip consumes a peak 5 W power at transmit mode, and is fabricated in TSMC 65nm CMOS technology with a 4 × 2.5 mm2 chip area.

Return-Oriented Programming (ROP) is the cornerstone of today’s exploits. Yet, building ROP chains is predominantly a manual task, enjoying limited tool support. Many of the available tools contain bugs, are not tailored to the needs of exploit development in the real world and do not offer practical support to analysts, which is why they are seldom used for any tasks beyond gadget discovery. We present PSHAPE (Practical Support for Half-Automated Program Exploitation), a tool which assists analysts in exploit development. It discovers gadgets, chains gadgets together, and ensures that side effects such as register dereferences do not crash the program. Furthermore, we introduce the notion of gadget summaries, a compact representation of the effects a gadget or a chain of gadgets has on memory and registers. These semantic summaries enable analysts to quickly determine the usefulness of long, complex gadgets that use a lot of aliasing or involve memory accesses. Case studies on nine real binaries representing 147 MiB of code show PSHAPE’s usefulness: it automatically builds usable ROP chains for nine out of eleven scenarios.

This letter studies and implements a high-efficiency LiFePO4 battery charger. The modular design can satisfy the requirements of series/parallel charging for electric vehicle applications. A CC-CC-CV charging scheme is also realized to meet the characteristics of LiFePO4 battery stacks. A 2 kW laboratory prototype is built and tested. The experimental results are shown to verify the feasibility of the proposed scheme. Copyright © 2012 John Wiley & Sons, Ltd.

One of the key issues regarding multi-axis contour following tasks in modern high-precision machining applications is how to effectively reduce contour error. Generally, among existing approaches, the Cross-Coupled Control (CCC) structure is widely used in multi-axis contour following tasks to improve contouring accuracy. However, when a servomechanism is operated in reverse or low-speed motions, the inherent friction force and external disturbance effects will degrade the CCC performance. Therefore, to cope with the aforementioned problems, this paper exploits the Karnopp friction model-based compensator and the Virtual Plant Disturbance Compensator (VPDC) to improve tracking performance as well as contouring accuracy. Moreover, an integrated motion control scheme is also developed to further improve contouring performance. The proposed scheme consists of two position loop controllers with velocity command feedforward, a modified CCC, two friction force compensators, and two disturbance compensators. To evaluate the performance of the proposed approach, several free-form contour following experiments have been conducted on an X-Y table driven by two linear motors. Experimental results verify that the proposed approach can significantly enhance contouring performance for free-form contour following tasks.