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This paper proposes a web-based workflow scheme for the organization of medical images using FHIR and DICOM servers equipped with standard RESTful APIs. In our integrated workflow, the client systems (including order placer, scheduler, imaging modality, viewer, and report creator) use standard FHIR and DICOMweb APIs. The proposed scheme also facilitates the creation of reports formatted as standard FHIR resources. This paper leverages W3C Scalable Vector Graphics (SVG) to record the image graphic annotations, and encapsulates the SVG image annotation in FHIR observation. FHIR DiagnosticReports and Observations are used to encapsulate reports, findings, and annotations, thereby facilitating the implementation and integration of the scheme within existing structures. The proposed scheme also provides the potential to make it possible to convert results of Computer Aided Detection/Diagnosis from medical images into FHIR DiagnosticReports and Observations to be stored on a FHIR server. The resulting web-based solution uses FHIR XML and/or JSON data to record and exchange information related to imaging workflow. It can also be used to store imaging reports, findings, and annotations linked to the images using the DICOM WADO-RS protocol. As a result, it is possible to integrate all information that is created in medical imaging workflow. Finally, the proposed scheme is easily integrated with other FHIR systems.

A zinc-based metal organic framework, Zn-MOF-74, which has a unique one-dimensional (1D) channel and nanoscale aperture size, was rapidly obtained in 10 min using a de novo mild water-based system at room temperature, which is an example of green and sustainable chemistry. First, catalase (CAT) enzyme was encapsulated into Zn-MOF-74 (denoted as CAT@Zn-MOF-74), and comparative assays of biocatalysis, size-selective protection, and framework-confined effects were investigated. Electron microscopy and powder X-ray diffraction were used for characterization, while electrophoresis and confocal microscopy confirmed the immobilization of CAT molecules inside the single hexagonal MOF crystals at loading of ∼15 wt %. Furthermore, the CAT@Zn-MOF-74 hybrid was exposed to a denaturing reagent (urea) and proteolytic conditions (proteinase K) to evaluate its efficacy. The encapsulated CAT maintained its catalytic activity in the decomposition of hydrogen peroxide (H2O2), even when exposed to 0.05 M urea and proteinase K, yielding an apparent observed rate constant (kobs) of 6.0 × 10-2 and 6.6 × 10-2 s-1, respectively. In contrast, free CAT exhibited sharply decreased activity under these conditions. Additionally, the bioactivity of CAT@Zn-MOF-74 for H2O2 decomposition was over three times better than that of the biocomposites based on zeolitic imidazolate framework 90 (ZIF-90) owing to the nanometer-scaled apertures, 1D channel, and less confinement effects in Zn-MOF-74 crystallites. To demonstrate the general applicability of this strategy, another enzyme, α-chymotrypsin (CHT), was also encapsulated in Zn-MOF-74 (denoted as CHT@Zn-MOF-74) for action against a substrate larger than H2O2. In particular, CHT@Zn-MOF-74 demonstrated a biological function in the hydrolysis of l-phenylalanine p-nitroanilide (HPNA), the activity of ZIF-90-encapsulated CHT was undetectable due to aperture size limitations. Thus, we not only present a rapid eco-friendly approach for Zn-MOF-74 synthesis but also demonstrate the broader feasibility of enzyme encapsulation in MOFs, which may help to meet the increasing demand for their industrial applications.

The purpose of this study is first to propose a comprehensive evaluation model for sustainable island tourism, and then to provide guidelines and suggestions for the development thereof. Based on the advantages of using fuzzy set theory, this study’s method included the fuzzy Delphi method (FDM), the decision-making trial and evaluation laboratory (DEMATEL), the analytic network process (ANP), and FDM- DEMATEL-ANP (FDANP). From the literature review results and experts’ surveys, the dimensions of the evaluation criteria for sustainable island tourism are governance, economy and finance, socio-culture, and the environment. Compared with other studies, its major contributions and differences are the governance and finance dimensions, and the evaluation criteria for the marine industry, marine cultures, and marine environments. The findings show that the relative importance of the dimensions from high to low are economy and finance, governance, the environment, and socio-culture. The top five key criteria begin with having an official administration organization, having a tourism industry, and revenue uncertainties based on public health events. These, along with policies and regulations, and local food and drink, are thought to provide the necessary conditions for sustainable island tourism. The implications for theory and practice and future research directions are discussed.

Speaking is a challenge for most English learners owing to the lack of practicing environments and partners. The virtual reality (VR) technology has changed this situation by providing learners wit...

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication after vaccination of Oxford-AstraZeneca coronavirus disease 2019 (COVID-19) vaccine (AZD1222) or Janssen COVID-19 vaccine. It makes a rare complication of thrombosis at common and/or uncommon organs with thrombocytopenia after COVID-19 vaccination four to 28 days later and most patients were younger than 60 years of age. We reported the case of a 75-year-old female with end-stage renal disease who received regular hemodialysis. She received Oxford-AstraZeneca COVID-19 vaccination eight days ago and then she suffered from intermittent chest tightness and epigastric pain with tarry stool passage for two days. Severe thrombocytopenia with elevated D-dimer value was noted and computed tomography of the chest showed azygos vein thrombosis. Elevated cardiac enzyme with ST-T change in 12-lead electrocardiogram was also noted. For positive anti-platelet factor 4 antibodies, VITT with myocardial infarction and azygos vein thrombosis was diagnosed.

The sample grids for cryo-electron microscopy (cryo-EM) experiments are usually prepared at a temperature optimal for the storage of biological samples, mostly at 4 °C and occasionally at room temperature. Recently, we discovered that the protein structure solved at low temperature may not be functionally relevant, particularly for proteins from thermophilic archaea. A procedure was developed to prepare protein samples at higher temperatures (up to 70 °C) for cryo-EM analysis. We showed that the structures from samples prepared at higher temperatures are functionally relevant and temperature dependent. Here we describe a detailed protocol for preparing sample grids at high temperature, using 55 °C as an example. The experiment made use of a vitrification apparatus modified using an additional centrifuge tube, and samples were incubated at 55 °C. The detailed procedures were fine-tuned to minimize vapor condensation and obtain a thin layer of ice on the grid. Examples of successful and unsuccessful experiments are provided.

The Analects of Confucius has been identified as an important and influential philosophy around the globe. However, in traditional instruction, it is difficult to express the spirit of this...

Background Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). However, contrast is contraindicated in some patients. The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard. Methods The records of patients with suspected PE seen between 2010 and 2013 were retrospectively reviewed. Inclusion criteria were an acute, central PE confirmed by CTPA and non-enhanced MDCT before contrast injection. Patients with a PE ruled out by CTPA served as a control group. MDCT findings studied were high-attenuation emboli in pulmonary artery (PA), main PA dilatation > 33.2 mm, and peripheral wedge-shaped consolidation. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of unenhanced MDCT to detect PE. Wells score of all patients were calculated using data extracted from medical records prior to imaging analysis. Results Thirty-two patients with a PE confirmed by CTPA and 32 with a PE ruled out by CTPA were included. Among the three main MDCT findings, high-attenuation emboli in the PA showed best diagnostic performance (Sensitivity 72.9%; Specificity 100%), followed by main PA dilatation > 33.2 mm (sensitivity 46.9%; specificity 90.6%), and peripheral wedge-shaped consolidation (sensitivity 43.8%; specificity 78.1%). Given any one or more positive findings on unenhanced MDCT, the sensitivity was 96.9% and specificity was 71.9% for a diagnosis of PE in patients. The area under the curve (AUC) of a composite measure of unenhanced MDCT findings (0.909) was significantly higher than that of the Wells score (0.688), indicating unenhanced MDCT was reliable for detecting PE than Wells score. Conclusions Unenhanced MDCT is an alternative for the diagnosis of acute central PE when CTPA is not available.

Programmed cell death 5 (PDCD5) is a vital signaling protein in the apoptosis pathway in eukaryotes. It is known that there are two dissociated N-terminal regions and a triple-helix core in eukaryotic PDCD5. Structural and functional studies of PDCD5 from hyperthermophilic archaea have been limited to date. Here, the PDCD5 homolog Sso0352 (SsoPDCD5) was identified in Sulfolobus solfataricus, the SsoPDCD5 protein was expressed and crystallized, and the phase was identified by single-wavelength anomalous diffraction. The native SsoPDCD5 crystal belonged to space group C2 and diffracted to 1.49 Å resolution. This is the first crystal structure of a PDCD5 homolog to be solved. SsoPDCD5 shares a similar triple-helix bundle with eukaryotic PDCD5 but has a long α-helix in the N-terminus. A structural search and biochemical data suggest that SsoPDCD5 may function as a DNA-binding protein.

BackgroundMitral regurgitation (MR) is a major contributor for heart failure (HF) and atrial fibrillation. Despite the advancement of MR surgeries, an effective medical therapy to mitigate MR progression is lacking. Sodium glucose cotransporter 2 inhibitors, a new class of antidiabetic drugs, has shown measurable benefits in reduction of HF hospitalization and cardiovascular mortality but the mechanism is unclear. We hypothesized that dapagliflozin (DAPA), a sodium glucose cotransporter 2 inhibitor, can improve cardiac hemodynamics in MR‐induced HF.Methods and ResultsUsing a novel, mini‐invasive technique, we established a MR model in rats, in which MR induced left heart dilatation and functional decline. Half of the rats were randomized to be administered with DAPA at 10 mg/kg per day for 6 weeks. After evaluation of electrocardiography and echocardiography, hemodynamic studies were performed, followed by postmortem tissue analyses. Results showed that DAPA partially rescued MR‐induced impairment including partial restoration of left ventricular ejection fraction and end‐systolic pressure volume relationship. Despite no significant changes in electrocardiography at rest, rats treated with DAPA exhibited lower inducibility and decreased duration of pacing‐induced atrial fibrillation. DAPA also significantly attenuated cardiac fibrosis, cardiac expression of apoptosis, and endoplasmic reticulum stress‐associated proteins.ConclusionsDAPA was able to suppress cardiac fibrosis and endoplasmic reticulum stress and improve hemodynamics in an MR‐induced HF rat model. The demonstrated DAPA effect on the heart and its association with key molecular contributors in eliciting its cardio‐protective function, provides a plausible point of DAPA as a potential strategy for MR‐induced HF.

Protein functions are temperature-dependent, but protein structures are usually solved at a single (often low) temperature because of limitations on the conditions of crystal growth or protein vitrification. Here we demonstrate the feasibility of solving cryo-EM structures of proteins vitrified at high temperatures, solve 12 structures of an archaeal ketol-acid reductoisomerase (KARI) vitrified at 4-70 °C, and show that structures of both the Mg

China has become the largest inbound market for Taiwan’s tourism industry. Even though Taiwan and China have similar cultures, a large inflow of tourists from a single inbound tourism market may pr...

Sleep disturbance is negatively associated with workplace productivity. This study sought to identify whether or not changes in sleep from 2012 to 2013 were associated with changes in health risks, medical conditions, or workplace economic outcomes. Employees of a Fortune 100 financial services corporation were categorized based on changes in self-reported hours of sleep from 2012 to 2013 and compared based on their health risk factors, medical conditions, health care costs, and productivity measures. Consistently poor sleepers had more health risks and medical conditions compared to consistently optimal sleepers. Sleep improvers had a significant reduction in lost on-the-job productivity while consistently poor sleepers and downgraders had significantly more lost productivity compared to optimal sleepers. Employers may wish to incorporate sleep education initiatives as part of their overall health and wellness strategy.

A floating-point wavelet-based and an integer wavelet-based image interpolations in lifting structures and polynomial curve fitting for image resolution enhancement are proposed in this paper. The proposed prediction methods estimate high-frequency wavelet coefficients of the original image based on the available low-frequency wavelet coefficients, so that the original image can be reconstructed by using the proposed prediction method. To further improve the reconstruction performance, we use polynomial curve fitting to build relationships between actual high-frequency wavelet coefficients and estimated high-frequency wavelet coefficients. Results of the proposed prediction algorithm for different wavelet transforms are compared to show the proposed prediction algorithm outperforms other methods.

Early Chinese immigrants in America centered on the Chinatown, which had fixed blocks and scope of activities. The distinguishing features of its ethnic culture and economy were formed by the ethnic Chinese immigrants who dwelt there. The Chinatown has become identified with the early Chinese immigrants and become one of the most unique residential areas for any ethnic group. Ever since the 1965 amendments to the American Immigration and Nationality Act, however, new Chinese arrivals no longer inhabit Chinatowns after they reach the United States. Without stationary blocks and scopes of activities, new Chinese immigrant communities have become enclaves accommodating multiple ethnic groups instead of one particular ethnicity. These communities are closely connected to a variety of ethnic features and have a tremendously different appearance from that of Chinatown. This transformation is still in progress and has been widely-considered by many scholars researching overseas ethnic Chinese immigrants. Flushing, in New York, is the largest Chinese immigrant community in the twenty-first century. This essay takes it as a case study to look into the evolution of Chinese immigrant communities in the United States. 早期美國華人移民以唐人街為中心，它有固定的街區，一定的活動範圍。老移民住在這個範圍內，形成它鮮明的族裔文化和經濟特色，贏得了早期華人移民的認同，成為美國最具特色的族裔聚居區之一。自1965年新移民法修改後，新移民移入美國，不再以唐人街為居住區域，新華人移民社區無固定的街區，無固定的活動範圍，無單一的族裔聚集區，甚或是多族裔聚集的區域，靠著族裔特色融匯在一起，與過去的唐人街特色迥異，這種改變正在持續中，也是現今研究海外華人的學者關注的課題。本文欲藉由21世紀全球最大的華人移民社區—紐約的法拉盛（Flushing） 為例，探討美國華人移民社區的演變。 (This article is in English).

This letter addresses two difficult challenges for transition metal oxide resistive random access memories (ReRAMs)—sensitivity to operation temperature and random fluctuation of resistance value. A careful study of a WO x ReRAM array reveals that these devices are unstable and their read currents fluctuate with time due to random telegraph noise and structure relaxation. Consequently, even after careful programming, the current distribution can broaden with time and tail bit population grows. Furthermore, ReRAM state is sensitive to temperature and a reference cell made of the same device material must be used. Thus, although the broadening of read current distribution may be tolerated by creating a larger RESET/SET memory window, the current fluctuation still makes it impossible to predict the output of the reference cell, leading to array malfunction. This letter investigates the current (resistance) instability in detail and proposes a reference array with a novel trimming method that can stabilize the reference current level. The proposed reference array has very good dc stress reliability as well as wide-range temperature tracking performance from −40 °C to 85 °C.

Prior to contact silicide formation, cryogenic Ge pre-amorphization implantation (PAI) was adopted in sub-20nm FinFETs to investigate how device characteristics can be affected. As compared to room-temperature PAI, cryogenic PAI does not enhance drive current from the viewpoint of mean value, however, it significantly improves variation in device parameters such as sub-Vt swing (SS), drain induced barrier lowering (DIBL) and total series resistance (RTotal) for N-FinFETs by 22%34% which is due to a reduced number of end of range (EOR) defects caused by Ge PAI. However, the benefit is not observed for P-FinFETs since its source/drain is composed of SiGe which is intrinsically less prone to form EOR defects. In addition, cryogenic PAI also contributes to leakage current reduction for N-FinFETs including gate induced drain leakage (GIDL) by 67%, sub-Vt leakage by 50% and junction leakage by 67% which is primarily due to a lower number of EOR defects that make fewer native point defects. The mechanism for pronounced GIDL reduction for I/O devices than core devices is also proposed. Besides the improved device uniformity as well as leakage current, the process can be fully integrated into incumbent VLSI technology and holds great potential for sub-10nm node. Display Omitted The impact of Ge PAI temperature on sub-20nm N- and P-FinFETs was investigated.Variation of N-FinFET parameters has been improved by cryogenic PAI due to reduced number of end of range (EOR) defects.Cryogenic PAI leads to leakage current reduction for N-FinFETs due to fewer EOR defects, making fewer native point defects.

Prior to contact silicide formation, multiple Ge pre-amorphization implantation (PAI) with reverse retrograde Ge profile was investigated for sub-20-nm FinFETs. Compared with conventional single PAI, N-FinFETs from the new PAI scheme exhibit enhanced drive current by 12%, which can be attributed to decreased total series resistance ( ${\mathrm {R}}_{\mathrm {{{Total}}}}$ ) by 15% and enhanced peak electron mobility by 8%. The former arises from reduced Schottky barrier height and better crystallinity of C49/C54 TiSi2, while the latter is resulted from higher tensile strain in the channel induced by TiSi2 with more Ge incorporation. Furthermore, ring oscillator for the new PAI scheme shows better circuit performance as compared with conventional scheme in terms of 6% increase in output frequency. The newly developed PAI process is fully compatible with the incumbent ULSI technology and can be extended to sub-10-nm FinFETs.

Poor sleep can impact occupational functioning. The current study examines health risks, medical conditions, and workplace economic outcomes associated with self-reported hours of sleep among employees.Employees of a global financial services corporation were categorized on the basis of their self-reported average hours of sleep. Differences in health care costs, productivity measures, health risks, and medical conditions were analyzed by hours of sleep while controlling for confounding variables.A strong U-shaped relationship between health care costs, short-term disability, absenteeism, and presenteeism (on-the-job work loss) and the hours of sleep was found among employees. The nadir of the "U" occurs for 7 or 8 hours of sleep per night.Worksite wellness programs often address health risks and medical conditions and may benefit from incorporating sleep education.

While cryo-EM is revolutionizing structural biology, its impact on enzymology is yet to be fully demonstrated. The ketol-acid reductoisomerase (KARI) catalyzes conversion of (2 S)-acetolactate or (2 S)-aceto-2-hydroxybutyrate to 2,3-dihydroxy-3-alkylbutyrate. We found that KARI from archaea Sulfolobus solfataricus (Sso-KARI) is unusual in being a dodecamer, bispecific to NADH and NADPH, and losing activity above pH 7.8. While crystals were obtainable only at pH 8.5, cryo-EM structures were solved at pH 7.5 and 8.5 for Sso-KARI:2Mg

The Stig cyclases from Stigonematalean cyanobacteria are classified as a novel type of calcium-dependent cyclases which catalyze an uncommon reaction cascade comprising Cope rearrangement, 6-exo-trig cyclization, and electrophilic aromatic substitution. Previously we found two calcium ions near the substrate-binding pocket. The calcium-coordinating residues are conserved in all Stig cyclases. In the present study, we use site-directed mutagenesis to investigate the role of calcium coordination. By individually mutating the coordinating residues in either of the Ca2+-binding sites to alanine, the enzyme activity is significantly reduced, suggesting that the presence of Ca2+ in both sites is essential for catalysis. Furthermore, the crystal structure of N137A, in which the Ca2+-binding N137 is replaced by Ala, shows significant local conformational changes, resulting in a squeezed substrate-binding pocket that makes substrate entry ineffective. In conclusion, calcium coordination is important in setting up the structural elements for catalysis. These results add to the fundamental understanding of the mechanism of action of the calcium-dependent Stig cyclases.

OBJECTIVE Migraine affects approximately 10% of working-age adults and is associated with increased health care costs, absenteeism, and presenteeism in the workplace. A migraine education program was offered to United States employees of a global financial services organization. METHODS Two hundred forty three employees (46% response rate) completed both a baseline and 6-month follow-up migraine questionnaire. The program included webinars, E-mailed educational tips, and intranet-based resources. RESULTS No change was found in the frequency of migraines but improvements were observed in the severity, workdays missed, effectiveness at work during migraine, and work/activity limitations. Participants reported taking action to identify and reduce migraine triggers. CONCLUSIONS A worksite disease education program for migraine headache has the potential to significantly impact lost productivity and absenteeism for migraineurs.

Molecular mechanisms underlying the repair of nitrosylated [Fe-S] clusters by the microbial protein YtfE remain poorly understood. The X-ray crystal structure of YtfE, in combination with EPR, magnetic circular dichroism (MCD), UV, and (17) O-labeling electron spin echo envelope modulation measurements, show that each iron of the oxo-bridged Fe(II) -Fe(III) diiron core is coordinatively unsaturated with each iron bound to two bridging carboxylates and two terminal histidines in addition to an oxo-bridge. Structural analysis reveals that there are two solvent-accessible tunnels, both of which converge to the diiron center and are critical for capturing substrates. The reactivity of the reduced-form Fe(II) -Fe(II) YtfE toward nitric oxide demonstrates that the prerequisite for N2 O production requires the two iron sites to be nitrosylated simultaneously. Specifically, the nitrosylation of the two iron sites prior to their reductive coupling to produce N2 O is cooperative. This result suggests that, in addition to any repair of iron centers (RIC) activity, YtfE acts as an NO-trapping scavenger to promote the NO to N2 O transformation under low NO flux, which precedes nitrosative stress.

Na+/K+-ATPase α1 was reported to directly interact with and recruit FGF2 (fibroblast growth factor 2), a vital cell signaling protein implicated in angiogenesis, to the inner plasma membrane for subsequent secretion. Cardenolides, a class of cardiac glycosides, were reported to downregulate FGF2 secretion upon binding to Na+/K+-ATPase α1 in a cell system with ectopically expressed FGF2 and Na+/K+-ATPase α1. Herein, we disclose that the cardenolides ouabain and reevesioside A significantly enhance the secretion/release of FGF2 and the phosphorylation of FGFR1 (fibroblast growth factor receptor 1) in a time- and dose-dependent manner, in A549 carcinoma cells. A pharmacological approach was used to elucidate the pertinent upstream effectors. Only the ERK1/2 inhibitor U0126 but not the other inhibitors examined (including those inhibiting the unconventional secretion of FGF2) was able to reduce ouabain-induced FGF2 secretion and FGFR1 activation. ERK1/2 phosphorylation was increased upon ouabain treatment, a process found to be mediated through upstream effectors including ouabain-induced phosphorylated EGFR and a reduced MKP1 protein level. Therefore, at least two independent lines of upstream effectors are able to mediate ouabain-induced ERK1/2 phosphorylation and the subsequent FGF2 secretion and FGFR1 activation. These finding constitute unprecedent insights into the regulation of FGF2 secretion by cardenolides.

Although the development of Chinese tourists to Taiwan is a relatively recent phenomenon, China has quickly become a major tourist-generating market in Taiwan. The study aimed to investigate Taiwan residents’ perceptions of tourism impacts from the largest inbound tourism market of Chinese tourists to Taiwan, and their attitudes toward the development of the Chinese tourism market, the largest source of tourism in Taiwan’s inbound tourism market. This study employed questionnaires to acquire data from Taiwan residents using a convenience sampling method. The results showed that respondents with different backgrounds perceived different tourism quality impacts, overall tourism impacts, and attitudes toward tourism development of the inbound tourism market. Respondents’ attitudes toward tourism development were influenced by their perceptions of tourism quality impacts and overall tourism impacts. The perception of overall tourism impact is a significant predicator of attitude toward tourism develop...