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Objective: This study investigated the association between Type D personality and prognoses in stable coronary artery disease (CAD) patients by mode of endpoints, age, and methodological debates to explain substantial heterogeneity among Type D studies., Design: The prospective study was designed to recruit 590 stable CAD patients in Taiwan. Main outcome measures: Demographic and clinical characteristics, and the 14-item Type D scale-Taiwanese version were recorded at discharge., Results: Hierarchical logistic regression analyses showed, regardless of the methodological debates, Type D personality was significantly associated with MACEs though not non-cardiac outcomes in stable CAD patients after adjusting for possible confounders. Furthermore, Type D personality was especially associated with MACEs in stable CAD patients with younger age (<65 y), rather than older age (≥65 y). Subgroup analysis also showed the adverse effect of Type D personality on MACEs was larger among males, those living in the rural region, those with PTCA or stent, those with heart failure, hypertension, diabetes, and those who were smokers., Conclusions: Regardless of whether the methodological debate is dichotomous or continuous, Type D personality was significantly associated with MACEs in stable CAD patients, some of whom had younger age, were males, smokers, or had comorbidities.

Aim: Hydroxychloroquine (HCQ), commonly used to treat patients with primary Sjögren's syndrome (pSS), has been shown to delay the development of systemic lupus erythematosus (SLE). This study aimed to explore the association between HCQ use and future development of SLE in pSS patients based on a nationwide nested case-control study., Method: Based on the National Health Insurance Research Database of Taiwan, those patients who were diagnosed with SLE at least 1 year after the diagnosis of pSS were identified as cases. Matched controls were randomly selected from pSS patients without a later diagnosis of SLE in a 1:10 ratio. The odds ratios (ORs) of HCQ exposure between cases and controls were analyzed by unconditional logistic regression after adjustment for age., Results: A cohort of 11 772 pSS patients were extracted from the database during the period from January 1, 2000 to December 31, 2010. A total of 111 (0.9%) pSS patients developed SLE during the follow-up period. Most (79%) of them developed SLE within 5 years after the diagnosis of pSS. There was no significant difference in the odds of HCQ exposure between cases and controls, with an adjusted OR of 2.43 (95% CI: 0.73-8.05). Neither did we observe a significant difference in the odds of exposure to a higher average dose of HCQ (≥100 mg/d vs non-exposed) between cases and controls in the sensitivity analysis., Conclusion: Nearly 1% of pSS patients may develop SLE. HCQ use in pSS patients was not associated with a lower possibility of the future development of SLE., (© 2022 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: Vaccination is one of the most important measures worldwide to halt the spread of the corona virus disease 2019 (COVID-19). However, the efficacy and safety of these vaccines in rheumatic patients are not well explored. Therefore, we conducted a systematic review and meta-analysis., Methods: We performed a literature search of the PubMed and EMBASE databases on 17 November 2021. Forty-seven studies relevant to the immunogenicity, efficacy/effectiveness, and safety of COVID-19 vaccines were selected., Results: Our results demonstrated that COVID-19 vaccination is effective in protecting rheumatic patients from severe illness caused by the virus. Both the humoral and cellular immunogenicity of vaccines were impaired in rheumatic patients, which were greatly enhanced after the second vaccine dose. Receiving anti-CD20 therapy was associated with impaired humoral immunogenicity. Adverse events due to COVID-19 vaccines in rheumatic patients were similar to those in healthy controls, except for an increased incidence of arthralgia. The incidence of disease flares after COVID-19 vaccination was low., Conclusion: Our systematic review indicated the importance of full vaccination in rheumatic patients. Withholding anti-CD20 therapy was found to be potentially beneficial for the immunogenicity. Furthermore, the vaccines were found to be safe in general. Despite significant heterogeneity between studies, we recommend that rheumatic patients receive these vaccines amidst the global pandemic.

Background: Lower levels of perceived social support have been known as an independent predictor of hospital readmissions in patients with heart failure (HF). However, the impact of sources of perceived social support on readmissions remain unexplored., Purpose: The main purpose of this study was to investigate and compare the relative importance of social support from significant other, family, and friends on all-cause readmission and cardiac readmission in patients with HF., Methods: The prospective cohort study was used to recruit a total of 299 patients with HF in Taiwan between May 2012 and December 2014. Demographic and clinical characteristics, Multidimensional Perceived Social Support Scale (MPSSS), and 18-month follow-up readmissions were recorded during the hospital stay. Univariate and multivariate logistic regressions were constructed to determine the impact of levels and sources of perceived social support with all-cause readmission and cardiac readmission., Results: A total of 158 patients (52.8%) and 118 patients (39.5%), respectively, had all-cause readmission and cardiac readmissions within 18 months. Multivariate logistic regression yielded inverse associations between levels of perceived social support and readmissions by 18-months. Importantly, social support from significant other was significantly associated with a lower risk of readmissions, both of all-cause readmission and cardiac readmission, in patients with HF, even after controlling for possible covariates, social support from family and friends., Conclusions: Social support from significant other, rather than from family and friends, was relatively and inversely associated with 18-month all-cause readmission and cardiac readmission in patients with HF, which is consistent with the hierarchical compensatory model., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: A clinically viable measure of listening effort is crucial in safeguarding the educational success of hard-of-hearing students enrolled in mainstream schools. To this end, a novel behavioral paradigm of listening effort targeting school-age children has been designed and reported in Hsu et al. (2017). The current article consists of two follow-up experiments investigating the effects of noise, processing depth, and age in a similar paradigm, first in a group of participants with normal hearing (NH) followed by a sample of school-age cochlear implant (CI) users. Research objectives include the construction of normative values of listening effort and comparing outcomes between age-matched NH and CI participants., Design: In Experiment 1, the listening effort dual-task paradigm was evaluated in a group of 90 NH participants with roughly even age distribution between 6 and 26 years. The primary task asked a participant to verbally repeat each of the target words presented in either quiet or noise, while the secondary task consisted of categorization true-or-false questions "animal" and "dangerous," representing two levels of semantic processing depth. Two outcome measures were obtained for each condition: a classic word recognition score (WRS) and an average response time (RT) measured during the secondary task. The RT was defined as the main listening effort metric throughout the study. Each NH participant's long-term memory retrieval speed and working memory capacity were also assessed through standardized tests. It was hypothesized that adding noise would negatively affect both WRS and RT, whereas an increase in age would see significant improvement in both measures. A subsequent Experiment 2 administered a shortened version of the paradigm to 14 school-age CI users between 5 and 14 years old at a university clinic. The patterns of results from the CI group were expected to approximate those of the NH group, except with larger between-subject variability., Results: For NH participants, while WRS was significantly affected by age and noise levels, RT was significantly affected by age, noise levels, and depth of processing. RT was significantly correlated with long-term memory retrieval speed but not with working memory capacity. There was also a significant interaction effect between age and noise levels for both WRS and RT. The RT data set from the NH group served as a basis to establish age-dependent 95% prediction intervals for expected future observations. For CI participants, the effect of age on the two outcome measures was more visible when target words were presented in quiet. Depending on the condition, between 35.7% and 72.7% of the children with CI exhibited higher-than-norms listening effort as measured by categorization processing times., Conclusion: Listening effort appears to decrease with age from early school-age years to late teenage years. The effects of background noise and processing depth are comparable with those reported in Hsu et al. (2017). Future studies interested in expanding the paradigm's clinical viability should focus on the reduction of testing time while maintaining or increasing the sensitivity and external validity of its outcome measures., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Risk factors for sepsis have not been assessed in patients receiving tumor necrosis factor-alpha inhibitors (TNFi) for immune-mediated inflammatory diseases (IMIDs) who are vulnerable to serious/hospitalized infections., Methods: Data from 2003-2017 were obtained from Taiwan's National Health Insurance Research Database to identify patients receiving TNFi, including etanercept, adalimumab, and golimumab, for IMIDs including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis (PsO), psoriatic arthritis (PsA), Crohn's disease (CD), and ulcerative colitis (UC). To investigate risk factors for sepsis, we used the Sepsis-3 definition and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox regression analysis., Results: There were 17,764 patients (mean age 49.3 ± 14.3 years; females, 57.6%) receiving TNFi for IMIDs, including RA (58.6%), AS (19.1%), PsO (15.1%), PsA (2.5%), CD (3.0%), and UC (1.7%). The overall incidence rate of sepsis was 1088 per 100,000 person-years. After adjustment for potential confounders, recent sepsis within 3 months before TNFi initiation (HR, 2.35; 95% CI, 1.73-3.20), CD (HR, 3.36; 95% CI 2.11-5.34; reference group: AS) and glucocorticoid use (prednisolone-equivalent dose, mg/day HR, 1.05; 95% CI, 1.05-1.06) were associated with the risk of sepsis. Intriguingly, golimumab users appeared to have a lower risk of sepsis compared with etanercept users (HR, 0.56; 95% CI, 0.38-0.83). In addition, socioeconomic status, including urbanization level and insured amount, was associated with sepsis in a dose-response manner., Conclusions: Recent sepsis, CD, concomitant glucocorticoid use, and low socioeconomic status, which were associated with an increased risk of sepsis, are crucial for individualized risk management plans., Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest., (© The Author(s), 2020.)

Background Evidence suggests differences in clinical characteristics, causes, and prognoses between heart failure with reduced ejection fraction ( HF r EF ) and heart failure with preserved ejection fraction (HFpEF). Most studies have failed to support the prognostic relevance of anxiety in HF r EF or unclassified HF with mean left ventricular ejection fraction <40%. Meanwhile, the association between anxiety and prognoses in HF p EF remains unexamined. This study compared the prognostic value of anxiety between HF r EF and HF p EF . Methods and Results A total of 158 patients with HF r EF (left ventricular ejection fraction=28.51±7.53%) and 108 patients with HFpEF (left ventricular ejection fraction=64.53±9.67%) were recruited between May 2012 and December 2014. Demographic and clinical characteristics, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory- II scale, and 18-month follow-up outcomes were recorded during the hospital stay. There were significant differences in age, sex, comorbidities, laboratory biomarkers, discharge medications, and unhealthy behaviors, which supported the contention that HF r EF and HF p EF represent 2 distinct phenotypes, although there were no significant differences in anxiety and 18-month outcomes. Multiple logistic regression yielded no significant associations between anxiety and 18-month outcomes in HF r EF . By contrast, trait anxiety could predict 18-month all-cause mortality (odds ratio, 1.429; 95% CI, 1.020-2.000; P=0.038), all-cause readmission or death (odds ratio, 1.147; 95% CI , 1.036-1.271; P=0.008), and cardiac readmission or death (odds ratio, 1.133; 95% CI , 1.031-1.245; P=0.010) in HF p EF after adjusting for possible confounders. Conclusions Trait anxiety was independently associated with 18-month all-cause mortality, all-cause readmission or death, and cardiac readmission or death in HF p EF , but not in HF r EF .

Waxing is an important aspect of automobile detailing, aimed at protecting the finish of the car and preventing rust. At present, this delicate work is conducted manually due to the need for iterative adjustments to achieve acceptable quality. This paper presents a robotic waxing system in which surface images are used to evaluate the quality of the finish. An RGB-D camera is used to build a point cloud that details the sheet metal components to enable path planning for a robot manipulator. The robot is equipped with a multi-axis force sensor to measure and control the forces involved in the application and buffing of wax. Images of sheet metal components that were waxed by experienced car detailers were analyzed using image processing algorithms. A Gaussian distribution function and its parameterized values were obtained from the images for use as a performance criterion in evaluating the quality of surfaces prepared by the robotic waxing system. Waxing force and dwell time were optimized using a mathematical model based on the image-based criterion used to measure waxing performance. Experimental results demonstrate the feasibility of the proposed robotic waxing system and image-based performance evaluation scheme., Competing Interests: The authors declare no conflict of interest.

Objectives: A reliable and practical measure of listening effort is crucial in the aural rehabilitation of children with communication disorders. In this article, we propose a novel behavioral paradigm designed to measure listening effort in school-age children based on different depths and levels of verbal processing. The paradigm consists of a classic word recognition task performed in quiet and in noise coupled to one of three additional tasks asking the children to judge the color of simple pictures or a certain semantic category of the presented words. The response time (RT) from the categorization tasks is considered the primary indicator of listening effort., Design: The listening effort paradigm was evaluated in a group of 31 normal-hearing, normal-developing children 7 to 12 years of age. A total of 146 Dutch nouns were selected for the experiment after surveying 14 local Dutch-speaking children. Windows-based custom software was developed to administer the behavioral paradigm from a conventional laptop computer. A separate touch screen was used as a response interface to gather the RT data from the participants. Verbal repetition of each presented word was scored by the tester and a percentage-correct word recognition score (WRS) was calculated for each condition. Randomized lists of target words were presented in one of three signal to noise ratios (SNR) to examine the effect of background noise on the two outcome measures of WRS and RT. Three novel categorization tasks, each corresponding to a different depth or elaboration level of semantic processing, were developed to examine the effect of processing level on either WRS or RT. It was hypothesized that, while listening effort as measured by RT would be affected by both noise and processing level, WRS performance would be affected by changes in noise level only. The RT measure was also hypothesized to increase more from an increase in noise level in categorization conditions demanding a deeper or more elaborate form of semantic processing., Results: There was a significant effect of SNR level on school-age children's WRS: their word recognition performance tended to decrease with increasing background noise level. However, depth of processing did not seem to affect WRS. Moreover, a repeated-measure analysis of variance fitted to transformed RT data revealed that this measure of listening effort in normal-hearing school-age children was significantly affected by both SNR level and the depth of semantic processing. There was no significant interaction between noise level and the type of categorization task with regard to RT., Conclusions: The observed patterns of WRS and RT supported the hypotheses regarding the effects of background noise and depth of processing on word recognition performance and a behavioral measure of listening effort. The magnitude of noise-induced change in RT did not differ between categorization tasks, however. Our findings point to future research directions regarding the potential effects of age, working memory capacity, and cross-modality interaction when measuring listening effort in different levels of semantic processing.

The stability and performance of nanoscale junctions are closely related to the local effective temperature. The local effective temperature is mainly caused by the competition between heating and cooling processes in inelastic electron-phonon scat- tering. Local cooling occurs when the rate of energy in cooling exceeds that in heating. Previous research has been done using either specific potential configuration or an adatom to achieve local cooling. We propose an engineer-able local-cooling mechanism in asymmetric two-terminal tunneling junctions, in which one electrode is made of metal, whereas the other is made of a selectable bad-metal, such as heavily-doped polysilicon. The width of energy window of the selectable material, defined as the width covering all possible energy states counting from the conduction band minimum, can be engineered through doping. Interestingly, we have shown that substantial local cooling can be achieved at room temperature when the width of energy window of the low-density electrode is comparable to the energy of the phonon. The unusual local cooling is caused by the narrowed width of energy window, which obstructs the inelastic scattering for heating.

From first-principles approaches, we investigate the thermoelectric efficiency of a molecular junction where a benzene molecule is connected directly to the platinum electrodes. We calculate the thermoelectric figure of merit ZT in the presence of electron-vibration interactions with and without local heating under two scenarios: linear response and finite bias regimes. In the linear response regime, ZT saturates around the electrode temperature T(e) = 25 K in the elastic case, while in the inelastic case we observe a non-saturated and a much larger ZT beyond T(e) = 25 K attributed to the tail of the Fermi-Dirac distribution. In the finite bias regime, the inelastic effects reveal the signatures of the molecular vibrations in the low-temperature regime. The normal modes exhibiting structures in the inelastic profile are characterized by large components of atomic vibrations along the current density direction on top of each individual atom. In all cases, the inclusion of local heating leads to a higher wire temperature T(w) and thus magnifies further the influence of the electron-vibration interactions due to the increased number of local phonons.

Waste iron was used to treat high concentration chromate (534 mg/L as Cr) from electroplating wastewater by plug flow reactor (PFR) due to the following reasons: (1) two wastes are treated simultaneously, (2) low pH of the electroplating wastewater ( approximately 2) benefits the reaction between these two wastes, (3) effluent pH is elevated in the PFR, reducing the base requirement to meet the pH discharge standard for wastewater (pH 6-9). Complete chromate reductions were achieved at pH 1.7 for hydraulic retention time (HRT) of 98 min, pH 1.5 for HRT of 40 min and pH 1.3 for HRT of 20 min. Consequently, optimum HRT for complete chromate reduction was obtained for different pHs. Although more acids were used to lower influent pH to reduce HRT, effluent pH was higher due to more hydrogen ion reacting with chromate. Eventually, fewer bases are required to fulfill the discharge pH requirement of wastewater. Effluent pH 3-5 was observed with high turbidity, indicating the precipitations of chromium oxide and hydroxide were enhanced by the dissolved iron coagulation. X-ray diffraction was conducted to examine the remaining species. Other than chromium oxide and hydroxide species, an iron-chromium complex (Cr2FeO4) was also observed.

To extend the absorption range of titanium dioxide into the visible-light region, the nitrogen incorporation process is investigated. This work presents a simple procedure for preparing nitrogen doped titanium dioxide nanocrystal (TiOxNy) by calcinating the mixture of Degussa P-25 (DP-25) TiO2 and NH4Cl at temperatures between 350 and 500 degrees C under airtight condition. Analysis of X-ray photoelectron spectroscopy indicated the molecular state nitrogen was incorporated into TiO2 lattice leading to the observable shift of the absorption edge to longer wavelength region with higher absorption intensity. These TiOxNy samples exhibit photocatalytic activity for methylene blue decomposition in aqueous solution under visible light irradiation. The correlation between the photocatalytic activity of TiOxNy and nitrogen content, rutile phase composition, and surface area was investigated and discussed.