Search

Introduction Segmenting left atrial (LA) substructures, including the LA body, appendage (LAA), and pulmonary veins (PVs), from computed tomography (CT) is central to electroanatomic mapping for ablation and functional studies in patients with atrial fibrillation (AF). However, this process requires manual outlining which needs special training, is subjective, and is difficult to scale. Computer graphics imaging (CGI) has been applied in media, film, and computer-aided design to reliably segment complex structures using their basic geometric representations. Purpose We hypothesized that LA substructures can be “virtually” dissected using CGI to separate geometric contours of the “convex ellipsoid” LA, “tubular” PVs, and “conical” LAA. We further hypothesized that the results of virtual dissection can be used to train a deep learning (DL) model to segment raw CT scans. Methods First, a mathematical method based on CGI techniques – erosion and dilation – was developed to “virtually dissect” the convex LA body from the original concave shell in publicly available digital atria with diverse simulated morphologies (Fig. 1A). The PVs and LAA were then automatically revealed and labeled by a 3D subtraction approach. Second, we refined precise LA/PV/LAA boundaries by tuning hyper-parameters from N=5 patient shells (Fig. 1B). Third, we used virtual dissection to train a DL model to segment CTs in N=20 patient atria (Fig. 1C). Finally, we applied this pipeline to segment raw CTs in a validation cohort of N=105 patients (23.8% women, 63.8±10.3Y; Fig. 1D). Results Virtual dissection accurately identified LA/PV/LAA boundaries in the training set (Dice coefficients 89–98%). In the independent test cohort (N=105), this automated pipeline accurately segmented raw CTs with Dice 81–95% (Fig. 1D) compared to a panel of experts (p Conclusion CGI of basic cardiac geometry combined with deep learning in small datasets can accurately segment raw CT scans in large populations. This computational pipeline may automate and simplify cardiac image processing and ablation procedures, and could be applied to the ventricle or other organ systems for diverse therapeutic strategies or to train machine learning. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health

Background Several mapping systems are being introduced to guide atrial fibrillation (AF) ablation to patient-specific regions of interest. However, results have been extremely heterogeneous between studies, ranging from very poor to very promising. It is unknown if this reflects specific patient characteristics or procedural factors because most prior series were middle sized (N∼30–100 patients). Purpose To study 1 year and 3 year very long-term outcomes from map guided AF-driver ablation in a large patient registry with multiple operators, to identify clinical and procedural features influencing outcomes. In real-world AF patients with diverse comorbidities, we applied a consistent patient-tailored AF mapping and ablation strategy, monitored outcomes carefully and applied statistical and unsupervised machine learning approaches to identify features of success and failure. Method We studied 632 consecutive patients (65±10 y, 178 F) undergoing ablation for drug-refractory AF. 59.7% had persistent AF, and 29.9% had prior unsuccessful ablation (median 1 procedure). All patients underwent pulmonary vein isolation (PVI), followed by ablation of AF regions of interest mapped from 64 pole baskets (RhythmView, Abbott, IL), by 11 operators. Patients were followed using ambulatory ECG monitors quarterly for one year, and at the time of symptoms for 3 years. Results Fig. 1A shows overall freedom from AF at 1-year of 77.5% (95% CI: 74.2%, 80.9%) and at 3 years of 55.5% (95% CI: 51.2%, 60.1%). Freedom from AF/AT at 1-year was 70.1% (95% CI: 66.5%, 73.8%), and at 3 years was 48.6% (95% CI: 44.3%, 53.3%). Success was higher in patients with procedural termination, first ablation versus prior unsuccessful procedures, for paroxysmal AF than non-paroxysmal AF (1 year: AT/AF freedom 74.9% versus 66.7%, p=0.006), and smaller left atrium. Three clusters (Fig 1B) were identified comprising CHA2DS2VASc score, enlarged LA, prior failed case, presenting rhythm and termination during the procedure (Table 2). At 1 year, freedom from AT/AF was 77.8% (95% CI: 72.2%, 82.1%) for cluster 3 and 56.2% (95% CI: 48.3%, 65.4%) for cluster 1 (Fig. 1B). Conclusion In our large registry of N=632 patients undergoing AF-map guided ablations, machine learned clusters identified cohorts with success of 56.2 to 77.8% at 1 year. Future studies should identify if lower success represents technical challenges, such as difficulties in mapping very large atria, or more difficult to treat mechanisms. These results may inform patient inclusion and ablation strategy in upcoming AF treatment trials. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National budget only - NIH, R01 HL149134, R01HL83359

Aim To investigate whether the timing of root canal treatment (primary aim) or other endodontic parameters (secondary aim) is associated with the survival probability of autotransplanted third molars, using a nationwide population-based database. Methodology A total of 1811 third molars autotransplanted between 2000 and 2013 met the inclusion criteria and were followed until the end of 2016. The teeth were classified into three groups on the basis of timing between root canal treatment and the autotransplantation: preoperative, extraoral and postoperative treatment groups. Univariate and multivariate Cox proportional hazards models were used to estimate the association between the timing of root canal treatment and the risk of tooth extraction after autotransplantation. Results Of the 1811 autotransplanted third molars, 462 were extracted, yielding a 17-year survival probability of 0.578. The survival probability of autotransplanted teeth that received postoperative root fillings after 17 years was 0.583, which was significantly higher than the 0.434 and 0.566 for teeth that received preoperative and extraoral root fillings, respectively (P = 0.0013). After adjustment for potential confounding factors, teeth that received postoperative root fillings were associated with a significantly lower tooth extraction hazard ratio (HR) compared with those that received extraoral root fillings (adjusted HR, 1.43; 95% confidence interval [CI], 1.14-1.78) and those that received preoperative root fillings (adjusted HR, 2.13; 95% CI, 1.19-3.82). Furthermore, the use of a rubber dam during postoperative root filling was associated with a significantly lower extraction rate after autotransplantation (adjusted HR, 0.54; 95% CI, 0.43-0.69). Conclusions Postoperative root canal treatment resulted in a significantly lower extraction rate than did preoperative or extraoral root canal treatment amongst autotransplanted third molars during a mean follow-up period of 8.33 years. Rubber dam use is recommended during postoperative root canal treatment to improve the outcomes of autotransplantation.

Bowel preparation is essential for quality colonoscopy. Although most bowel preparation regimens recommend dietary restriction for 24 to 48 hours before the procedure, the evidence for this is poor. This study aimed to investigate whether dietary restriction during bowel preparation improves the quality of colonoscopy.A prospective, randomised controlled pilot study in which the dietary restriction (DR) group (control) was instructed not to ingest high fibre foods for 48 hours prior to the use of a polyethylene glycol (PEG) bowel preparation. The non-dietary restriction (NDR) group were given no dietary instruction but received instructions for the use of the PEGbased preparation. On the day of colonoscopy, the quality of the bowel effluent was assessed, and additional preparation given as necessary. The primary endpoint was quality of bowel cleansing using the Harefield Cleansing Scale during colonoscopy. The secondary endpoints were the need for additional bowel preparation and the quantity of additional bowel preparation given prior to endoscopy. Data were analysed on an intention to treat basis.Twenty-three participants were randomised to the intervention group and thirty-four to the control group. Patient demographics were similar in both groups. Dietary restriction did not influence the success rate of bowel preparation: 97% successful bowel preparation in the DR group, vs 91% successful bowel preparation in the NDR group (The quality of bowel preparation was comparable in patients with and without dietary restrictions prior to colonoscopy. Non-restrictive diets prior to bowel preparation should be considered to increase compliance. The sample size of this pilot study prohibited definite statistical conclusions but demonstrated this to be a reasonable methodology for a larger study.

BACKGROUND: Riociguat and phosphodiesterase-5 inhibitors (PDE5i), approved for the treatment of pulmonary arterial hypertension (PAH), act on the same pathway via different mechanisms. Riociguat might be an alternative option for patients with PAH who do not respond sufficiently to treatment with PDE5i, but comparisons of the potential benefits of riociguat and PDE5i in these patients are needed. The aim of this trial was to assess the effects of switching to riociguat from PDE5i therapy versus continued PDE5i therapy in patients with PAH at intermediate risk of 1-year mortality.METHODS: Riociguat rEplacing PDE5i therapy evaLuated Against Continued PDE5i thErapy (REPLACE) was an open-label, randomised controlled trial in 81 hospital-based pulmonary hypertension centres in 22 countries. The study enrolled patients aged 18-75 years with symptomatic PAH at intermediate risk of 1-year mortality (based on the European Society for Cardiology-European Respiratory Society guideline thresholds for WHO functional class and 6-min walk distance [6MWD]) who were receiving treatment with a PDE5i with or without an endothelin receptor antagonist for at least 6 weeks before randomisation. Patients were excluded if they had been previously treated with riociguat, had used prostacyclin analogues or prostacyclin receptor agonists within 30 days before randomisation, had clinically significant restrictive or obstructive parenchymal lung disease, or had left heart disease. Patients were randomly assigned (1:1) to remain on PDE5i treatment (oral sildenafil [≥60 mg per day] or oral tadalafil [20-40 mg per day]; the PDE5i group) or to switch to oral riociguat (up to 2·5 mg three times per day; the riociguat group), using an interactive voice and web response system, stratified by cause of PAH. The primary endpoint was clinical improvement by week 24, defined as an absence of clinical worsening and prespecified improvements in at least two of three variables (6MWD, WHO functional class, and N-terminal prohormone of brain natriuretic peptide), analysed using last observation carried forward in all randomly assigned patients with observed values at baseline and week 24 who received at least one dose of study medication (the full analysis set). Secondary endpoints included clinical worsening events. The trial has been completed and is registered with ClinicalTrials.gov, NCT02891850.FINDINGS: Between Jan 11, 2017, and July 31, 2019, 293 patients were screened, of which 226 patients were randomly assigned to the riociguat group (n=111) or to the PDE5i group (n=115). 211 patients completed the study and 14 patients discontinued (seven in each group). One patient assigned to the PDE5i group did not receive treatment, so 225 patients were included in the safety analysis, and one further patient in the PDE5i group had missing components of the composite primary endpoint at baseline, so 224 patients were included in the full analysis set. The primary endpoint was met by 45 (41%) of 111 patients in the riociguat group and 23 (20%) of 113 patients in the PDE5i group; odds ratio [OR] 2·78 (95% CI 1·53-5·06; p=0·0007). Clinical worsening events occurred in one (1%) of 111 patients in the riociguat group (hospitalisation due to worsening PAH) and 10 (9%) of 114 patients in the PDE5i group (hospitalisation due to worsening PAH [n=9]; disease progression [n=1]; OR 0·10 [0·01-0·73]; p=0·0047). The most frequently occurring adverse events were hypotension (15 [14%]), headache (14 [13%]), and dyspepsia (10 [9%]) in the riociguat group, and headache (eight [7%]), cough (seven [6%]), and upper respiratory tract infection (seven [6%]) in the PDE5i group. Serious adverse events were reported in eight (7%) of 111 patients in the riociguat group and 19 (17%) of 114 patients in the PDE5i group. During the study, four patients died in the PDE5i group, one of them during the safety follow-up period.INTERPRETATION: Switching to riociguat from PDE5i treatment, both of which act via the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate pathway, could be a strategic option for treatment escalation in patients with PAH at intermediate risk of 1-year mortality.FUNDING: Bayer AG, Merck Sharp & Dohme.

In this study, GaN-based blue InGaN/GaN light-emitting diodes (LEDs) with different growth rates of the quantum barriers were fabricated and investigated. The LEDs with quantum barriers grown with a higher growth rate exhibit a lower leakage current and less non-radiative recombination centers in the multiple quantum wells (MQWs). Therefore, the LED with a higher barrier growth rate achieves a better light output power by 18.4% at 120 mA, which is attributed to weaker indium fluctuation effect in the QWs. On the other hand, the localized states created by indium fluctuation lead to a higher local carrier density, and Auger recombination in the QWs. Thus, the efficiency droop ratio of the LEDs with a higher barrier growth rate was only 28.6%, which was superior to that with a lower barrier growth rate (39.3%).

Aim To improve the diagnosis of coronary vessel-specific ischemia in non-obstructive coronary artery disease (CAD) using a quantitative whole-heart coronary computed tomography angiography (CCTA) evaluation. To date, predictors of ischemia in non-obstructive CAD remain underexplored. Methods Within the CREDENCE trial, 612 patients with suspected CAD at 13 sites (64±10 years, 70% men) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography with 3-vessel fractional flow reserve (FFR) measurements. For this specific analysis, only vessels with non-obstructive plaque (1–49% maximal diameter stenosis) by CCTA were included. The primary endpoint was coronary vessel-specific ischemia which was defined as FFR ≤0.80 (or ≥90% stenosis). Multivariable logistic regression modeling was performed to evaluate the effect of quantitative CCTA features beyond coronary stenosis on the prevalence of vessel-specific ischemia. Results FFR ≤0.80 (or ≥90% stenosis) was prevalent in 22.8% of 1,102 vessels with non-obstructive plaque. Using a step-wise approach, in addition to diameter stenosis (χ2=72), non-calcified PAV (χ2=126, P30% stenosis (χ2=187, P=0.001) were independent CCTA-predictors of coronary vessel-specific ischemia (Figure 1). In the final model, diameter stenosis was no longer significantly associated with ischemia (P=0.236). Figure 1 Conclusion In vessels with non-obstructive plaque on CCTA, ischemia was present in approximately 20%. Measures of overall non-calcified plaque burden and smaller lumen volume were more important determinants of vessel-specific ischemia than maximal diameter stenosis. Acknowledgement/Funding NIH R01-HLL118019; Dalio Foundation and Michael J. Wolk Foundation

Aim To determine compensatory enlargement and luminal reduction of coronary arteries during the progression of atherosclerosis with serial coronary computed tomography angiography (CCTA) by using volumetric measurements. To date, the impact of coronary plaque progression on temporal remodeling, as opposed to the static remodeling, has only been studied with invasive imaging modalities and primarily two-dimensional areas rather than three-dimensional volumes. Methods In total, 1,245 patients with suspected coronary artery disease (CAD) at 13 sites (61±9 years, 39% women) underwent serial CCTA with interscan interval of ≥2 years. The primary objective was to assess volumetric temporal remodeling, defined as the linear association between the change in coronary plaque, lumen and vessel volume at follow-up CCTA on a per-segment level. Temporal remodeling was determined in strata of low and high baseline plaque burden as well as different coronary segments at baseline. Linear regression analysis and Pearson's correlation coefficients were calculated to assess associations. Results Amongst 1,245 patients with 19,920 segments, the median interscan interval was 3.3 (IQR 2.6–4.8) years. For each 1 mm3 increase in plaque volume, the increase in vessel volume was 0.72 mm3 and the decrease in lumen volume was 0.28 mm3 (Figure 1, both p Figure 1. Volumetric temporal remodeling Conclusion In general, coronary plaque grows approximately 70% outward and 30% into the coronary lumen during the progression of atherosclerosis. Volumetric temporal remodeling is not limited by baseline plaque burden, but is potentially dependent on its location within the coronary artery tree. Acknowledgement/Funding NRF of Korea (Grant No. 2012027176); Dalio Institute of Cardiovascular Imaging and Michael J. Wolk Foundation

SummaryWhat is known and objective Rhabdomyolysis is a severe potential adverse drug reaction of statin therapy. We report a case of rhabdomyolysis due to drug–drug interaction (DDI) between atorvastatin and fluconazole and review the literature. Case summary A 70-year-old woman received atorvastatin for hyperlipidaemia without any problem for 4 years. When intravenous fluconazole was added for treating a fungal infection, rhabdomyolysis developed 2 weeks later. Removal of atorvastatin led to the resolution of her rhabdomyolysis. What is new and conclusion Our case demonstrates that in some subjects even a moderate CYP3A4 inhibitor such as fluconazole may lead to rhabdomyolysis in subjects receiving a statin.

The papaya (Carica papaya L.) is one of the most important economic tropical fruits in the world, and the hermaphrodite is the preferred type in field cultures. We analyzed the sexual ratio of offspring from the cultivar 'Taiwan Seed Station No. 7' (T7) by a self-cross and its cross with Taichung Sunrise (TS). Female progeny from the T7 self-crossing were not observed. This finding may be caused by a lethal gene that is linked to females. In this study, we selected 192 simple sequence repeats (SSRs) to analyze the polymorphism between T7 and TS. A total of 37 SSRs were identified for T7 and TS. In addition, 14 SSRs served as the molecular makers for identification of T7, TS and their hybrid offsprings. Thus, the results show that the genetic similarity between T7 and TS is rather high. This suggests that T7 may be a mutant of TS. Phylogenetic analysis from the SSR polymorphisms of the above parent strains and 15 F1 offspring revealed the genetic distance of the F1 offspring located between T7 and TS. The results of this study may provide an opportunity for elucidating the genetic characteristics of all hermaphrodites via identification of molecular makers.

Background Family ecology in early childhood may influence children's activity and participation in daily life. The aim of this study was to describe family functioning, family expectations of their children, family support to their children, and supports for families of young children with cerebral palsy (CP) based on children's gross motor function level. Methods Participants were 398 children with CP (mean age = 44.9 months) and their parents residing in the USA and Canada. Parents completed four measures of family ecology, the Family Environment Scale (FES), Family Expectations of Child (FEC), Family Support to Child (FSC) and Family Support Scale (FSS). Results The median scores on the FES indicated average to high family functioning and the median score on the FSS indicated that families had helpful family supports. On average, parents reported high expectations of their children on the FEC and strong support to their children on the FSC. On the FES, higher levels of achievement orientation were reported by parents of children in Gross Motor Function Classification System (GMFCS) level II than parents of children in level I, and higher levels of control were reported by parents of children in level I than parents of children in level IV. On the FEC, parents of children with limited gross motor function (level V) reported lower expectations than parents of children at all other levels. Conclusions Family ecology, including family strengths, expectations, interests, supports and resources, should be discussed when providing interventions and supports for young children with CP and their families.

SSRN papers, 8 p.; From the early decades of the twentieth century, a dominant characteristic of the modern "capitalist" corporation, especially in the United States, was the separation of asset ownership in the form of publicly traded shares from allocative control over the corporation’s resources by salaried managers. By the 1950s some depicted managerial-controlled large enterprise as the "soulful" corporation in which the allocation of resources resulted in enhanced social welfare. In the 1960s, however, some conservative academics looked to market forces, dubbed the "market for corporate control", to ensure that managers as employees would give primacy to shareholders in the allocation of corporate resources. This market for corporate control could enable hostile takeovers in which shareholders who accumulated large public equity stakes in a company could discipline managers to allocate resources in ways that "the market" deemed to be efficient. The notion that market allocation could control managerial organization was then developed theoretically based on the conceptualisation that the corporation (and indeed any firm) could be conceptualised as a "nexus of contracts" or a "collection of assets". Rather than view the corporation as a social organization with its unique history and competitive capabilities in which public shareholders had come to play a peripheral role, neoclassical economists conceptualised the corporation as a set of voluntary contracts among owners of resources and as a portfolio of assets with different market-determined rates of returns. This conceptualisation of the corporation to fit with the dominant neoclassical theory of the market economy had implications. We provide this Summary of certain fundamentals of economics in an effort to help prevent analytical errors which can have severe and damaging effects on corporations.

We present a state-space analysis of discrete-time disturbance observer (DOB) for a class of sampled-data control systems. Unlike the continuous-time case, it is well-known that sampling process may yield non-minimum phase zeros (called sampling zeros). Motivated by the truncated Taylor series (TTS) model which well describes the behavior of sampling zeros in the state-space, we present a condition for robust stability of the uncertain sampled-data control system with the discrete-time DOB. In particular, using the discrete-time singular perturbation theory, we show that the uncertain plant with disturbance behaves like a disturbance-free nominal model with the help of the discrete-time DOB.

It is critical that the risk of lymph node metastasis (LNM) is evaluated for determining the suitability of endoscopic resection for T1 colorectal cancer (CRC). Reported risk factors for LNM in completely resected T1 CRC are deep submucosal invasion, grade 3, angiolymphatic invasion, and budding. The aim of the present study was to identify the histopathologic factors associated with LNM in T1 CRC.The study involved 435 patients with T1 CRC treated by endoscopic or surgical resection between January 2001 and April 2010 at the National Cancer Center, Korea. The 435 patients were classified into two groups - those undergoing surgical resection (n = 324) and those undergoing endoscopic resection (n = 111). In the surgically resected group, details regarding depth of submucosal invasion, angiolymphatic invasion, tumor grade, budding, and background adenoma (BGA) were evaluated with respect to presence or absence of LNM. In the endoscopically resected group, the results of follow-ups and additional salvage surgeries were studied.In the surgically resected group, LNM was detected in 42 patients (13.0 %). Grade 3, angiolymphatic invasion, budding, and the absence of BGA were identified as factors associated with LNM in univariate and multivariate analyses (P0.05). Among the 50 patients in the endoscopically resected group with high risk, three were diagnosed as being LNM-positive during the follow-up period. There was no LNM in the endoscopically resected group with low risk.Grade 3, angiolymphatic invasion, budding, and the absence of BGA are the risk factors that predict LNM in patients with T1 CRC. In cases where endoscopically resected T1 CRC has no risk factor, cautious follow-up could be recommended. However, if the tumor has any risk factor, additional surgical resection should be considered.

What is known and objective Teicoplanin and vancomycin show similar clinical and bacteriological efficacy in clinical trials. Teicoplanin has been reported to have a lower adverse drug reaction (ADR) rate than vancomycin. Cross-reactivity between these two glycopeptides is controversial. Our aim was to study the cross-reactivity between teicoplanin and vancomycin through an assessment of all the reported ADRs of these drugs in our University hospital. Methods Over a period of 2 years, 170 cases of vancomycin therapy, which were closely monitored by doctors and clinical pharmacists, were used to analyse ADRs. Teicoplanin therapy was used as an alternative in cases of vancomycin intolerance. When an ADR related to vancomycin or teicoplanin was suspected, specialists were consulted to confirm if these were true ADR and to determine whether the implicated drug should be stopped. All ADRs for the two glycopeptides were assessed for causality using the Naranjo probability scale. Results and discussion Thirty-eight of 170 patients (22·4%) treated with vancomycin developed ADRs. Twenty-four patients were switched to teicoplanin. However, 14 of those 24 patients (58·3%) developed ADRs. The time of onset of ADRs involving vancomycin was 12·7 ± 10·9 days (range, 1-46 days). The time of onset of sequential teicoplanin-induced ADRs was 11·7 ± 4·7 days (range, 2-20 days). Of the 14 patients with ADRs related to sequential teicoplanin therapy, six showed cross-reactivity between vancomycin and teicoplanin. The incidence of vancomycin-induced neutropenia was 4·7% (8/170), whereas the incidence of teicoplanin-induced neutropenia subsequent to vancomycin intolerance was as high as 33·3% (8/24). Furthermore, 71·4% (10/14) of the teicoplanin-induced ADRs were associated with haematological abnormalities such as neutropenia, thrombocytopenia or leucopenia. What is new and conclusion Teicoplanin, used as an alternative in cases of vancomycin intolerance, was associated with a high incidence of ADRs and haematological reactions, most notably neutropenia. This high rate of ADRs suggests cross-reactivity between the two glycopeptides.

Mutations in GLIS3, which encodes a Krüppel-like zinc finger transcription factor, were found to underlie sporadic neonatal diabetes. Inactivation of Glis3 by gene targeting in mice was previously shown to lead to neonatal diabetes, but the underlying mechanism remains largely unknown. We aimed to elucidate the mechanism of action of GLIS family zinc finger 3 (GLIS3) in Glis3 ( -/- ) mice and to further decipher its action in in-vitro systems.We created Glis3 ( -/- ) mice and monitored the morphological and biochemical phenotype of their pancreatic islets at different stages of embryonic development. We combined these observations with experiments on Glis3 expressed in cultured cells, as well as in in vitro systems in the presence of other reconstituted components.In vivo and in vitro analyses placed Glis3 upstream of Neurog3, the endocrine pancreas lineage-defining transcription factor. We found that GLIS3 binds to specific GLIS3-response elements in the Neurog3 promoter, activating Neurog3 gene transcription both directly, and synergistically with hepatic nuclear factor 6 and forkhead box A2.These results indicate that GLIS3 controls fetal islet differentiation via direct transactivation of Neurog3, a perturbation that causes neonatal diabetes in mice.

Background The range of health problems associated with children with cerebral palsy (CP) is well documented in the literature; however, the existing data are often either reported for samples of children with all types of CP, or stratified by typology of motor disorder, rather than using the Gross Motor Function Classification System (GMFCS), which has been shown to be the most reliable way of classifying children with CP. Furthermore, availability of research on pre-school-aged children (under 5 years) is sparse. The aim of this study is to compare the prevalence and impact of health problems in pre-school children with and without CP, stratified by the GMFCS. Methods Parents of 430 pre-school-aged children with CP (243 boys, 187 girls; mean age = 3 years 2 months, SD = 11 months) and 107 typically developing (TD) children (56 boys, 51 girls; mean age = 3 years 4 months, SD = 11 months) participated. Using the consensus definition of CP and the World Health Organization's International Classification of Functioning, Disability and Health, a parent survey was developed to assess the prevalence and impact of 16 health problems. The measure demonstrates good test–retest reliability (ICC > 0.80) and discriminant validity across GMFCS levels (P < 0.001). Results Both the prevalence and impact of health problems is greater in children with CP compared with TD children (P < 0.001). The number and impact of health problems increase with ascending GMFCS level (P≤ 0.01), except for the impact of health problems between groups GMFCS I and GMFCS II/III (P= 0.19). Children with CP have an average of between 3.4 and 6.7 health problems, compared with fewer than one in TD children. Conclusions Service providers working with pre-school-aged children with CP need to consider health problems and their impact when planning care.

A large proportion of research on soldered joints focuses on the effects of stress on the service life of a solder joint. However, the shape of a joint also has a great effect on its service life. During the reflow process, the solder joint experiences heating, melting, cooling and then solidification. Conventionally, the shape of a solder joint is often predicted using the energy method after the reflow process. This, however, does not consider the evolution of the solder alloy during reflow. In this study, a computer aided analytical system is developed based on computational heat transfer and fluid dynamics techniques to simulate the shape evolution of solder joints during reflow. Experimental observations of the shape evolution of the joint during reflow were also conducted. The simulation results obtained for a solder ball 760 μm in diameter on a rectangular pad were found to be consistent with the experimental observations.

Changes in the structure and mechanical properties of Ti50Zr25Co25 melt-spun ribbons upon electrolytic hydrogenation have been investigated. Structural analyses of the as-spun ribbons revealed the sporadic presence of icosahedral (i) quasicrystalline short-range order (SRO) in the amorphous structure. Upon cathodic charging with hydrogen, the i-SRO vanished for a hydrogen content of about 21 at.% (hydrogen-to-metal atom ratio, H/M: 0.26), resulting in a fully amorphous structure. Simultaneously, the fracture strength was found to increase while the ribbons preserved their bending ductility. However, a significant reduction in the fracture strength and ductility of the ribbons was observed for hydrogen concentrations larger than 26 at.%. Variations in the mechanical stability are discussed based on a structure-property correlation.

This is the second in a series of five papers describing the information, decision, and action in crew context (IDAC) model for human reliability analysis. An example application of this modeling technique is also discussed in this series. The model is developed to probabilistically predict the responses of the nuclear power plant control room operating crew in accident conditions. The operator response spectrum includes cognitive, psychological, and physical activities during the course of an accident. This paper identifies the IDAC set of performance influencing factors (PIFs), providing their definitions and causal organization in the form of a modular influence diagram. Fifty PIFs are identified to support the IDAC model to be implemented in a computer simulation environment. They are classified into eleven hierarchically structured groups. The PIFs within each group are independent to each other; however, dependencies may exist between PIFs within different groups. The supporting evidence for the selection and organization of the influence paths based on psychological literature, observations, and various human reliability analysis methodologies is also indicated.

This is the fourth in a series of five papers describing the Information, Decision, and Action in Crew context (IDAC) operator response model for human reliability analysis. An example application of this modeling technique is also discussed in this series. The model has been developed to probabilistically predicts the responses of a nuclear power plant control room operating crew in accident conditions. The operator response spectrum includes cognitive, emotional, and physical activities during the course of an accident. This paper assesses the effects of the performance-influencing factors (PIFs) affecting the operators’ problem-solving responses including information pre-processing (I), diagnosis and decision making (D), and action execution (A). Literature support and justifications are provided for the assessment on the influences of PIFs.

By employing three different measurement methods, we rigorously show that micron-scale ballistic thermal conduction can be found in Si-Ge heterogeneously interfaced nanowires exhibiting low thermal conductivities. The heterogeneous interfaces localize most high-frequency phonons and suppress the total thermal conductivity below that of Si or Ge. Remarkably, the suppressed thermal conductivity is accompanied with an elongation of phonon mean free paths over 5 \ensuremath{\mu}m at room temperature, which is not only more than 25 times longer than that of Si or Ge but also longer than those of the best thermal conductors like diamond or graphene. We estimate that only 0.1% of the excited phonons carry out the heat transfer process, and, unlike phonon transport in Si or Ge, the low-frequency phonons in Si-Ge core-shell nanowires are found to be insensitive to twin boundaries, defects, and local strain. The ballistic thermal conduction persisting over 5 \ensuremath{\mu}m, along with the suppressed thermal conductivity, will enable wave engineering of phonons at room temperature and inspire new improvements of thermoelectric devices.

We studied the optical and electrical properties of InN epilayers with rapid thermal annealing (RTA). The intensity of the photoluminescence (PL) and the carrier mobility were found to increase as the temperature of RTA was increased. We suggest that the formation of compensating acceptors (indium vacancies) after RTA is responsible for the improvement of the quality in InN. The dependence of the PL emission peak on carrier concentration provides a possible method for estimating the carrier concentration in degenerate InN.

The formation of the icosahedral (i) quasicrystalline phase has been studied in the cast Al87Mn4Si2Be7 alloy. Under low cooling rates, i-phase particles of about 5 to 15 µm formed in the αAl matrix. A thorough examination of the microstructure revealed the existence of cubic crystalline phases embedded in the i-particles. Microstructural and thermal analyses indicated that the i-particles nucleated heterogeneously from the cubic AlMn(Si)Be4 phases by a peritectic reaction, however with a slight misorientation.

Summary In June 2003, Taiwan introduced a severe acute respiratory syndrome (SARS) telephone hotline service to provide concerned callers with rapid access to information, advice and appropriate referral where necessary. This paper reports an evaluation of the knowledge, attitude, practices and sources of information relating to SARS among physicians who staffed the SARS fever hotline service. A retrospective survey was conducted using a self-administered postal questionnaire. Participants were physicians who staffed a SARS hotline during the SARS epidemic in Taipei, Taiwan from June 1 to 10, 2003. A response rate of 83% was obtained. All respondents knew the causative agent of SARS, and knowledge regarding SARS features and preventive practices was good. However, only 54% of respondents knew the incubation period of SARS. Hospital guidelines and news media were the major information sources. In responding to two case scenarios most physicians were likely to triage callers at high risk of SARS appropriately, but not callers at low risk. Less than half of all respondents answered both scenarios correctly. The results obtained suggest that knowledge of SARS was generally good although obtained from both medical and non-medical sources. Specific knowledge was however lacking in certain areas and this affected the ability to appropriately triage callers. Standardized education and assessment of prior knowledge of SARS could improve the ability of physicians to triage callers in future outbreaks.

The thermal diffusivities of 25 kinds of polyolefin films, including high-density polyethylene, low-density polyethylene, linear low-density polyethylene, polypropylene, 4-methylpentene, and ethylene–octene copolymer, were determined by temperature wave analysis in a continuous temperature scan. The thermal diffusivity decreased with increasing temperature, and the temperature dependence was steeper in the solid state than in the melt state. A supercooling phenomenon was observed in the crystallization process during cooling. The thermal diffusivity of polyethylene in the solid state was in a good correlation with the density at room temperature, and a higher temperature coefficient was observed in high-density polyethylene with a higher thermal diffusivity. The influence of the catalyst system on the thermal diffusivity was also observed in the ethylene–octene copolymer. The thermal diffusivity was sensitive to the precise change in the microstructure of the crystalline polyolefin, which was influenced not only by the chemical structure but also by the thermal history. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 99: 1104–1110, 2006

The precipitation behaviour of a hexagonal two-dimensional aperiodic phase in Al-rich Al–Mn–Be alloy has been investigated. Upon heat treatment at temperatures above 450°C, the icosahedral phase formed in a conventionally cast Al–2.5 at.% Mn–3 at.% Be alloy transforms into the stable hexagonal H1 phase. The solute partitioning during transformation leads to the precipitation of a hexagonal two-dimensional aperiodic approximant phase (H′ phase). The precipitates have an orientation relationship with the α-Al matrix. The similarity of the diffraction features indicates that the hexagonal two-dimensional aperiodic structure of the H′ phase is an intermediate structure between the true sixfold quasiperiodic structure and the hexagonal structure of the crystalline counterpart H1 phase.

Major limitations of the conventional methods for human reliability analysis (HRA), particularly those developed for operator response analysis in probabilistic safety assessments (PSA) of nuclear power plants, are summarized as a motivation for the need and a basis for developing requirements for the next generation HRA methods. It is argued that a model-based approach that provides explicit cognitive causal links between operator behaviors and directly or indirectly measurable causal factors should be at the core of the advanced methods. An example of such causal model is briefly reviewed, where due to the model complexity and input requirements can only be currently implemented in a dynamic PSA environment. The computer simulation code developed for this purpose is also described briefly, together with current limitations in the models, data, and the computer implementation.

The shear strength of the under bump metallurgy (UBM) structure in both the high-melting solder bump and low-melting solder bump after aging were evaluated. Scanning electron microscopy and transmission electron microscopy were examined in the intermetallic compounds (IMCs) and bump joint profiles at the interface between solder and UBM. In 900 h aging experiments, the maximum shear strength of Sn–97wt.%Pb and Sn–37wt.%Pb decreased by 25% and 20%, respectively. The growth of Cu 6 Sn 5 and Cu 3 Sn was ascertained by the aging treatment. The crack path changes from the interior of a solder to the IMC interface. Compare with the Cu–Sn IMC, the amount of Ni–Sn IMC was small. The Ni layer is considered as the diffusion barrier.

The occurrence of deoxynivalenol (DON) was investigated in 514 cereal-based products (corn-based, n = 125; barley-based, n = 96; wheat-based, n = 94; rice-based, n = 199) marketed in Korea during 2007-2008, and estimates of DON intake were determined. Samples were analysed by high-performance liquid chromatography (HPLC) with ultraviolet light (UV) detection after immunoaffinity clean-up. The limits of detection (LOD) and limits of quantification (LOQ) were 2.2 and 5.6 µg kg(-1), respectively. Recoveries and repeatability expressed as coefficients of variation (CV) were 82.3-100% and 2.4-15.3% in beer, bread and dried corn. The incidences and mean levels of DON were 56% and 68.9 µg kg(-1) for corn-based products, 49% and 24.1 µg kg(-1) for wheat-based products, 43% and 7.5 µg kg(-1) for barley-based products, and 16% and 3.4 µg kg(-1) for rice-based products, respectively. The estimated daily intake of DON from the consumption of rice-based, wheat-based, barley-based and corn-based products were 0.0038 µg kg(-1) bw day(-1), 0.0032 µg kg(-1) bw day(-1), 0.0015 µg kg(-1) bw day(-1) and 0.0002 µg kg(-1) bw day(-1), respectively. These values represent 0.38%, 0.32%, 0.25% and 0.01% of the provisional maximum tolerable daily intake (PMTDI) of 1 µg kg(-1) bw day(-1). These results indicate that rice-based products are major contributors to DON exposure in Korea, even though the current exposure level is unlikely to cause adverse health effects.