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Summary Background Integrating primary prevention into care pathways for older adults is a core strategy of healthy ageing, but evidence remains limited. We aimed to determine whether incorporating a multidomain intervention into primary health care could improve standard value-based health outcomes and quality of life. Methods For this Taiwan Integrated Geriatric Care (TIGER) study, a pragmatic randomised controlled trial, we recruited community-dwelling outpatients aged 65 years or older with at least three chronic medical conditions. We excluded people with malignancies undergoing chemotherapy, people with a life expectancy of less than 12 months, or people who were insufficiently able to communicate with study staff. Participants were randomly assigned (1:1) to usual care or to the integrated multidomain intervention using block randomisation. The integrated multidomain intervention entailed 16 2-h sessions per year, comprising communal physical exercise, cognitive training, nutrition and disease education, plus individualised treatment by specialists in integrated geriatric care. The primary outcome was changes from baseline quality of life, based on 36-item Short Form Health Survey (SF-36) scores, at 3, 6, 9, and 12 months. Intervention effects were analysed per protocol using a generalised linear mixed model. This trial is registered with ClinicalTrials.gov , NCT03528005 . Findings Between June 25, 2018, and Feb 15, 2019, 628 participants were screened, of whom 398 were assigned to the integrated multidomain intervention (n=199) or to usual care (n=199). 335 (84%) participants completed the 12-month follow-up. Compared with the usual care group, the integrated multidomain intervention group had significantly higher mean SF-36 physical component scores across all timepoints (overall difference 0·8, 95% CI 0·2–1·5; p=0·010), but differences at 3, 6, 9, and 12 months did not reach statistical significance. The SF-36 mental component scores did not differ significantly overall, but were significantly higher in the integrated multidomain intervention group at the 12-month follow-up (55·3 [SD 7·6] vs 57·2 [7·0]; p=0·019). No serious adverse events occurred. Interpretation Incorporating multidomain interventions into integrated health care improved quality of life. Our standardised protocol is amenable to inclusion in policies to promote value-based care and healthy ageing. Funding National Health Research Institutes, Taiwan, and Ministry of Science and Technology, Taiwan.

Background Longitudinal adverse outcomes are unclear among adults with diabetes according to the age of onset. Objective To investigate the longitudinal diabetes-related outcomes in adults with new-onset diabetes stratified by age. Design Retrospective cohort study. Setting Taiwan National Health Insurance Research Database claims data from 2000 to 2015. Subjects In total, 115,751 participants aged ≥40 years with new-onset diabetes in 2003 were recruited and stratified by the ages 40–64 (64.3%), 65–74 (21.2%), 75–84 (11.8%) and ≥85 years (2.7%) at the time of diagnosis. Methods Time-varying multivariate Cox proportional hazards model adjusted for covariates was used to examine the associations between the ages of the patients at diabetes onset and the outcomes of interest [all-cause mortality, cardiovascular (CV) mortality, major cardiovascular events (MACE) and hypoglycaemia] during a 10-year follow-up period. Results The results showed that compared with those patients aged 40–64 at diagnosis, patients with older-onset diabetes had significantly higher comorbidities (P Conclusions Patients with diabetes onset at an older age was associated with increased risks of all-cause mortality, CV mortality, MACE and hypoglycaemia after adjusting for the severity of diabetes and anti-diabetic treatment.

In this paper, we present highly reliable 6-channel CWDM of 25G DFB lasers that exhibit low threshold current, high bandwidth, and excellent eye pattern for uncooled operations of -40 to 85°C. Robust reliability is demonstrated to guarantee stable operations for 5G mobile.

Tenderness is a primary indicator of meat quality, which directly influences consumer acceptance of the meat. Ultrasound can effectively increase the tenderness of red meat, such as pork and beef, by breaking up muscle fibers and connective tissues through mechanical force, thus making it a basis for physical tenderization of meat to improve meat quality. In this study, ultrasound (2200 W, 15 kHz) was applied in the processing of pork loin to explore the influences of varying treatment durations (0-6 minutes) and posttreatment aging durations (0-2 days) on the tenderness, texture profile, physical and chemical qualities (myofibrillar fragmentation index, or MFI, and rate of marinade absorption), and sensory evaluation (9-point hedonic scale) of meat. The results indicated that ultrasonic treatment (2200 W) for 6 minutes can effectively tenderize the meat by increasing the MFI to 15.1%, lowering the hardness in texture profile analysis (TPA) to 87.6%, and reducing shear force to 87.9%. Moreover, if pork loin is allowed to age for 48 hours following 6 minutes of ultrasonic treatment, shear force can be further reduced to 72.3%. The sensory evaluation scores for texture, tenderness, and overall acceptance of pork loin increased with the elongated ultrasonic treatment.

Objectives Polyomavirus has been reported to be oncogenic due to viral integration into the human genome. A relatively high prevalence of upper urinary tract urothelial carcinoma (UTUC) was noted after kidney transplantation (KT) in Taiwan. However, little was known about the impact of polyomavirus on the urothelial cancer behavior. Therefore, the aim of this study is to analyze the characteristics of polyomavirus-related UTUC after KT. Methods From 2005 to 2014, 27 patients were found to have UTUCs after KT. All the patients underwent standard nephroureterectomy. Detailed perioperative parameters were obtained from chart records. A qualified pathologist who is blinded to the clinical outcome examined large T antigen expression and pathological features. All the patients were divided into two groups according to positive or negative expression of large T antigen. Results In the patient demography, a significantly younger median age was found in patients with large T antigen–positive UTUCs compared with the negative control group (48.1 ± 8.3 years versus 54.6 ± 4.1 years, respectively, P = .013). As for the pathological features and oncologic outcome, there were no obvious differences between these two groups. Non–organ-confined status and positive lymphovascular invasion are prognostic factors associated with systemic disease recurrence (P = .017 and .001, respectively). Conclusions Although UTUC commonly develops in the elderly, earlier onset of post-KT UTUCs was observed especially in patients with positive large T antigen expression in our cohort. This preliminary result provides valuable experience suggesting more frequent upper urinary tract screening for polyomavirus infected patients after KT in Taiwan.

International audience; BACKGROUND: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. METHODS: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0-1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0-2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4-6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. FINDINGS: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10-2·03]; p=0·011), with low heterogeneity across studies (I(2)=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05-1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06-2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4-6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52-1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03-4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [\textless1%], adjusted OR 5·58 [1·22-25·50]; p=0·024). INTERPRETATION: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. FUNDING: None.

High-density Aluminum-doped zinc oxide (AZO) ceramic was prepared via the densification process by ultralow-temperature Two-step Cold sintering processes (TS-CSP). Density, microstructure and electrical properties of the preparation AZO ceramics were investigated. The results show that Al-doping concentration has an important influence on the densification of AZO ceramics. When the doping amount of Al2O3 was 2.0 wt%, and an acetic acid solution was used as a co-solvent, a high-performance AZO ceramic was obtained. AZO ceramics has a uniform phase and containing no other impurities, with a relative density of up to 99.23%and a resistivity as low as 5.58 × 10−3 Ω cm. The AZO ceramic prepared by this method has a significant application prospect.

Stroke thrombolysis with alteplase is currently recommended 0-4·5 h after stroke onset. We aimed to determine whether perfusion imaging can identify patients with salvageable brain tissue with symptoms 4·5 h or more from stroke onset or with symptoms on waking who might benefit from thrombolysis.In this systematic review and meta-analysis of individual patient data, we searched PubMed for randomised trials published in English between Jan 1, 2006, and March 1, 2019. We also reviewed the reference list of a previous systematic review of thrombolysis and searched ClinicalTrials.gov for interventional studies of ischaemic stroke. Studies of alteplase versus placebo in patients (aged ≥18 years) with ischaemic stroke treated more than 4·5 h after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT perfusion were eligible for inclusion. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] score 0-1) at 3 months, adjusted for baseline age and clinical severity. Safety outcomes were death and symptomatic intracerebral haemorrhage. We calculated odds ratios, adjusted for baseline age and National Institutes of Health Stroke Scale score, using mixed-effects logistic regression models. This study is registered with PROSPERO, number CRD42019128036.We identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome at 3 months (adjusted odds ratio [OR] 1·86, 95% CI 1·15-2·99, p=0·011). Symptomatic intracerebral haemorrhage was more common in the alteplase group than the placebo group (ten [5%] of 213 patients vs one [1%] of 201 patients in the placebo group; adjusted OR 9·7, 95% CI 1·23-76·55, p=0·031). 29 (14%) of 213 patients in the alteplase group and 18 (9%) of 201 patients in the placebo group died (adjusted OR 1·55, 0·81-2·96, p=0·66).Patients with ischaemic stroke 4·5-9 h from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase achieved better functional outcomes than did patients given placebo. The rate of symptomatic intracerebral haemorrhage was higher with alteplase, but this increase did not negate the overall net benefit of thrombolysis.None.

Curve number (CN) is well-known by hydrologists for estimating rainfall induced runoff from a catchment. It can also be used as an indicator for measuring the impact of engineering or non-engineering measures on the runoff production in a catchment. In this study, a method is presented to quantify the uncertainty of CN for hydrologic performance of a green roof system. Latin hypercube sampling approach, coupled with the antithetic variate technique, is used to achieve efficient and accurate quantification of the uncertainty features of CN for a green roof system. Elements in green roofs subject to uncertainty considered are rainfall characteristics (i.e. amount and inter-event dry period), soil-plant-climate factors (i.e. field capacity, wilting point, interception, evapotranspiration rate), and model error in SCS I a -S relation. Numerical study shows that model error in SCS I a -S relation has the dominant effect on the uncertainty features of CN for green roof performance.

By utilizing different distribution of strain fields around the edges of oxide, which are dominated by a series of sizes of oxide-patterned windows, long-range ordered self-assembly Ge nanostructur ...

The objectives of this study were to develop a high performance liquid chromatography-mass spectrometry (HPLC-MS) method for determination of chlorophylls and their derivatives in Gynostemma pentaphyllum Makino, a traditional Chinese herb possessing vital biological activities. Chlorophylls were extracted with a quaternary solvent system of hexane-acetone-ethanol-toluene (10:7:6:7, v/v/v/v), followed by separation of a total of 15 chlorophylls and their derivatives within 32 min using a gradient mobile phase of acetone, acetonitrile and methanol and a HyPURITY C18 column, with detection at 660 nm and flow rate at 1 mL/min. Identification was carried out on the basis of retention behavior, absorption spectra and mass spectra using atmospheric pressure chemical ionization (APCI) in positive ion mode for detection. Of the 15 analytes, chlorophyll a, chlorophyll b, pheophytin a and pheophytin b were quantified by using standard calibration curves, with the other 11 being quantified with an internal standard Fast Green FCF. Chlorophyll extracts in G. pentaphyllum were found to contain pheophytin a (2508.3 microg/g), pheophytin a' (111.2 microg/g), chlorophyll a (113.8 microg/g), chlorophyll a' (11.0 microg/g), hydroxypheophytin a (88.6 microg/g), hydroxypheophytin a' (66.5 microg/g), pyropheophytin a (76.0 microg/g), hydroxychlorophyll a (23.8 microg/g), pheophytin b (319.6 microg/g), pheophytin b' (13.2 microg/g), chlorophyll b (287.9 microg/g), chlorophyll b' (11.1 microg/g), hydroxychlorophyll b (15.0 microg/g), hydroxypheophytin b (11.2 microg/g) and hydroxypheophytin b' (8.5 microg/g).

Gynostemma pentaphyllum (Thunb.) Makino, a traditional Chinese herb possessing antitumor and antioxidant activities, has been shown to contain several functional components like saponins and flavonoids. However, their identities remain uncertain. The objectives of this study were to develop an appropriate extraction, purification and HPLC-MS method to determine saponins and flavonoids in G. pentaphyllum. Both flavonoids and saponins were extracted with methanol, followed by purification with a C18 cartridge to elute the former with 50% methanol and the latter with 100% methanol. A total of 34 saponins were separated within 40 min by a Gemini C18 column and a gradient mobile phase of acetonitrile and 0.1% formic acid in water, in which 18 saponins were identified by LC-MS with ESI mode and Q-TOF (LC/MS/MS). Similarly, a total of eight flavonoids were separated within 45 min by the same column and a gradient solvent system of methanol and 0.1% formic acid in water, with identification being carried out by a post-column derivatization method and LC-MS with ESI mode. The amounts of flavonoids in G. pentaphyllum ranged from 170.7 to 2416.5 mug g(-1), whereas saponins were from 491.0 to 89,888.9 mug g(-1).

The genetic relationship of 12 Dendrobium species in Taiwan was determined based on sequence analysis of the internal transcribed spacer (ITS) region of ribosomal DNA. Aligned sequences of the complete ITS region obtained from the 12 taxa and two outgroups resulted in 684 characters. Genetic distances and a phylogenetic tree were constructed, and four main clusters were generated among the 12 Dendrobium species. From the results, Dendrobium linawianum, Dendrobium moniliforme, Dendrobium tosaense, Dendrobium leptoclandum, and Dendrobium falconeri are grouped with Dendrobium aurantiacum; Dendrobium chameleon is grouped with Dendrobium miyakei; and Dendrobium crumenatum is grouped with Dendrobium equitans. In addition, Dendrobium furcatopedicellatum and Dendrobium somai are grouped together but are separated from other Dendrobium species. In the present study, results also support Epigeneium nakaharai not being placed in the genus Dendrobium. In addition, it may be preferable to place D. furcatopedicellatum and D. somai in a genus different from Dendrobium.

Molecular markers among 24 accessions of subtribe Oncidiinae genotypes were investigated based on random amplified polymorphic DNA (RAPD) analysis. Eighty decamer primers were screened, and 14 primers producing clear and reproducible DNA patterns were selected. In total, 263 bands were scored, of which 257 revealed polymorphism. Phenetic similarity based on the percentage of band sharing was estimated, ranging from 0.25 to 0.71 among the 24 accessions. Cluster analysis based on molecular data of band distribution in all the samples showed six major clusters and one individual not belonging to any of the six clusters. In addition, the genus Miltonia is segregated from other genera among the Oncidiinae in this study. DNA markers at molecular level provide an appropriate tool for identifying Oncidiinae genotypes.

To estimate lean content of Taiwan native broiler carcasses accurately, objectively and rapidly, electrical conductivity measurements of broiler carcasses and other relative factors (carcass weight, length and temperature) were used in multiple linear regression analysis for lean prediction. Forty native broiler carcasses, with average market weight 2477.5±465.5 g, were scanned through a 10 MHz electromagnetic field created by an electromagnetic scanner (SA-3203) to measure the total body electrical conductivity (TOBEC) index. After scanning, each broiler carcass was separated into wing, breast, leg and back. Each primal cut was dissected into lean, fat and bone. The weight, length, temperature and TOBEC index of broiler carcass were significantly correlated with lean weight of broiler carcass (P0.001). Regression analysis for lean estimation with carcass weight, length, temperature and TOBEC index showed higher coefficient of determination (R(2)=0.968) and lower coefficient of variation (CV=4.178) with an equation using beheaded carcass weight, temperature and TOBEC index as variables.

Tantalum (Ta) and nitrogen-contained tantalum (Ta–N) thin films are sputter deposited on Si-based substrates with and without a titanium adhesion layer. The impact of varying the nitrogen flow rate and the underlying titanium on the phase formation process is investigated using X-ray diffraction analysis, resistivity measurement and scanning electron microscopy. Our results indicate that the titanium layer inhibits the formation of high-resistivity tetragonal β-Ta, and leads to the deposition of low-resistivity cubic α-Ta arising from its epitaxial orientation on the underlying titanium. Consequently, the electrical properties and microstructures of the Ta-based films are significantly changed.

Chromium Carbide/Nickel-Chrome is a good wear resistant coating at elevated temperatures up to 850°C. High velocity oxy-fuel (HVOF) is a promising process for preparation of the CrC/NiCr coatings. During thermal spray process, the speed and surface temperature of in-flight molten particles are two key factors affecting the sprayed coating quality. Coating deposited by higher kinetic energy and adequate surface temperature molten particles is expected to be dense and hard. In this study, the influences of HVOF process parameters on molten particle speed and surface temperature, and the properties of prepared CrC/NiCr coatings were subjected to a DOE investigation. According to the experimental results, the major control factors affecting particle temperature are powder feed rate, stand-off distance and gun barrel length. Stand-off distance and oxygen flow rate are major factors affecting particle speed. Based on the evaluated specimens, porosity contents of all the prepared coatings are less than one percent, and coatings deposited by molten particles heated to range of 1650°C–1725°C showed relatively lower porosity contents. Coatings deposited by higher particle speed exhibited relatively better abrasion-wear resistance.

We have designed and performed the optical modeling of a cruciform cylindrical lens to replace the corrective lens in a confocal optical system and demonstrated a coupling efficiency of 85%. This represents more than 3 dB improvement over the conventional confocal system of single mode fiber coupling for 980 nm pump lasers. Also, the fiber alignment tolerance is about three times more relaxed than that of the wedged fiber lens.

This study investigated the effects of three aural advance organizers on student comprehension of L2 videotaped materials. The subjects were 160 low-intermediate Chinese students of English in Taiwan. They viewed three video programs with three different advance organizers: (a) main characters, (b) vocabulary and (c) main characters + vocabulary. Prior to viewing the three videos, the students were introduced respectively to the above three kinds of advance organizers. After two consecutive viewings of each video without captions, ten comprehension questions in multiple-choice form in L1 were administered. A statistical analysis of the results using Analysis of Variance (ANOVA) showed a significant difference and indicated that under the advance organizer (b) condition, subjects performed better at comprehension than under the other two conditions, and more surprisingly, students performed least satisfactorily under the combined (c) condition. This study points out that in preparing advance organizers for EFL students, teachers should focus on new words rather than on video characters, which students are able to find out and have fun doing. More importantly, the advance organizers should be concise instead of being thorough, especially for less motivated students, as the longer warm-up period might decrease their attention and hence offset the effect the advance organizers are intended to produce.

This paper presents two variable rate vector quantization schemes for image compression. The idea is to designate more bits to regions of an image that are active or difficult to code, and fewer bits to less active regions. The proposed schemes design variable rate tree-structured vector quantizers by growing the tree one node at a time. Basing the decision to split on some min-max-like criteria other than the conventional mean-squared-error (MSE) measure, these two schemes aim to provide reconstructed images with less noticeable edge degradation. A comparison with a previously proposed scheme of Riskin and (see IEEE Trans. Signal Process., vol.39, no.11, p.2500-2507, 1991) shows that the proposed schemes have better performance in terms of image visual quality with reduced implementational complexity. >

This study reviews the effects of strategy orientation and synergy on new product performance using a meta-analytic approach. Based on empirical studies published before 2011, this study reveals interesting findings. First, the bivariate correlations show that market orientation and technological synergy are identified as the dominant drivers of new product performance. Second, moderator regression analyses demonstrate that strategy orientation and synergy have stronger associations with new product performance in traditional manufacturing markets. Third, the association of marketing synergy and new product performance is weaker in advanced countries.

Quartz filter surfaces were modified with aminopropyltrialkoxysilanes and used to collect gas phase acids. The filters were chemically characterized by titrimetric, gravimetric, and chromatographic methods; on the basis of these experiments, filter preparation methods were optimized. Analytical procedures for formic and acetic acids were developed based on their displacement from a sampled surface by a strong acid eluant and subsequent analysis of the eluant by ion chromatography. Passive collection of the acids from air and elution of the acids from the filter were highly efficient; in active sampling, efficiency of collection for acetic acid was less consistent than for formic acid. Analytical results from samples taken in Las Vegas are reported; concentration levels are consistent with previously reported values.

This paper presents a new design scheme that an electronic protractor includes two swing arms and one variable resistor located on the top of swing arms for measuring angles. The variable resistor connects the liquid crystal display (LCD) screen through an angle-to-voltage (A/V) controlled circuit, an analog-to-digital (A/D) converter, a single chip processor, and a LCD driver. The protractor can change the resistance of the variable resistor simultaneously and display the measuring angle on the LCD screen through the processing of the A/V controlled circuit, the A/D converter, single chip processor, and the LCD driver when the swing arms are open or close to make the angular deviations. The present electronic protractor is claimed on those measuring devices through the above process.

The gamma titanium aluminides under consideration for engineering applications are in fact multi-phase alloys consisting predominantly of gamma (ordered, face-centered tetragonal) and may contain minor amounts of the ordered hexagonal phase, alpha-two B2 (ordered bcc) or TiB[sub 2]. It is generally believed that the best balance of properties is achieved through a duplex microstructure consisting of equiaxed gamma grains and lamellar colonies of alpha-two and gamma laths. However, the reason for the exceptional performance of the duplex microstructure is as yet inconclusive. The present study is limited to the cast form of alloy Ti-48Al-2Cr-2Nb (at.%), developed by Huang. The microstructure of the nominal Ti-48Al-2Cr-2Nb (48-2-2) consists of alpha-two plus gamma with small amounts of B2. The duplex alpha-two/gamma structure is required to obtain the best balance of properties. However, an investigation of the effects of interstitial content on the tensile properties of 48-2-2 revealed that a B2/gamma structure could be stabilized at room temperature by lowering the oxygen content of the alloy.

An analysis of the vibration of a spinning annular plate with grounded circular line guides is presented. The equation of motion for a freely spinning plate is first derived, and traveling modes are introduced so that a modal expansion method can be applied. Galerkin's method is then employed to yield the discretized equations. The forced vibration due to a circular traveling line load is then obtained in preparation for the employment of receptance. Unlike the ordinary receptance defined in the literature, the traveling line receptance is introduced in this paper. The frequency equation for the spinning plate with grounded circular line guides is obtained, and the effects of guide stiffness and location on the frequency changes are discussed. The mode shapes for one circular line guide are also drawn. The results show that, unlike point supports, a circular line guide improves the critical rotational speed effectively. Numerical results for two guides are also illustrated. The approach developed can be applied to multi-guide cases without much difficulty.

This paper proposes a vector quantization technique which is referred to here as the Principal Component Vector Quantization algorithm. It also proposes an artificial neural network with an on-line learning algorithm for codebook design, encoding, and decoding. For unknown distribution cases, the proposed technique can be implemented directly without calling for repeated use of training sequences. The main features of the proposed technique include (i) codebook design complexity is only linearly proportional to the codebook size; (ii) encoding complexity is in the order of that of typical tree structured schemes. (iii) The proposed scheme is suitable for coding video sequences which may involve nonstationary training sequences. Note that the same neural network structure can be used to implement general full-search vector quantization algorithms, featuring constant encoding time which is independent of the codebook size.

Ventricular-assist devices (VADs) have benefitted patients with end-stage heart failure as a bridge to heart transplantation (HTx). Herein, we describe our experience with HTx in the presence of extracorporeal membrane oxygenation (ECMO) together with the Thoratec VAD (Thoratec Corp, Pleasanton, California). From May 1996 to June 2009, mechanical circulatory support with the Thoratec VAD was provided in 20 patients. Before implantation of the VAD, circulation in 17 patients was maintained using ECMO. Although 350 patients underwent HTx during that period, only 13 patients (65%) received suitable donor organs for orthotopic HTx. The 20 patients ranged in age from 10 to 80 years; 3 were female, and 17 were male; and 17 (85%) required ECMO before VAD implantation. In 11 of 17 patients (65%), the VAD was implanted as a double bridge to HTx. The demand for mechanical circulatory support in patients with acute hemodynamic collapse has led to major improvements in clinically available systems such as ECMO as a double bridge to VAD implantation. We use ECMO as a rescue procedure in patients with acute hemodynamic deterioration. However, during ECMO support, left ventricular afterload increases. If prolonged support is necessary, a VAD may be required. We observed that 65% of patients who received support from an ECMO hybridized with the Thoratec VAD could wait for a suitable donor for HTx. We recommend use of ECMO for short-term support (1 week) and the Thoratec VAD for medium- or long-term support as a bridge to HTx.

The oxidation behavior of a number of ternary and quaternary γ-TiAl alloys in air has been studied under rapid thermal cycling conditions for periods of hundreds of hours in the temperature range 850–1000°C. The ability of the γ-TiAl alloys to form a protective alumina scale on oxidation was found to be much influenced by the presence of low concentrations of other elements, binary combinations of which were often more effective in promoting oxidation-resistance than single element additions. For example, whereas the alloys Ti48Al4Cr and Ti48Al4Ta formed spalling unprotective TiO 2 Al 2 O 3 scales at 850°C. Ti48Al4Nb, Ti48Al4W and the quaternary alloys Ti48Al2Cr2Nb and Ti48Al2Mn2W formed protective Al 2 O 3 scales. The alumina-forming alloys Ti48Al16Cr, Ti48Al12Nb and Ti48Al2Cr6Ta were very oxidation-resistant even at 900°C.

Patients with Parkinson's disease tend to have a reduced response to levodopa after 5 to 20 years of therapy, with “on—off” fluctuations consisting of dyskinesia alternating with immobility. In an effort to modify the motor disability of advanced Parkinson's disease, we implanted embryonic mesencephalic tissue containing dopamine cells into the caudate and putamen of seven patients. Two patients received unilateral grafts in the caudate and the putamen on the side opposite the side with worse symptoms. Five patients received bilateral grafts implanted in the putamen only. In six of the seven patients, the fetal tissue was obtained from a single embryo with a gestational age of seven to eight weeks. The tissue was injected by means of 10 to 14 needle passes. There were no surgical complications. Four of the seven patients underwent immunosuppression with cyclosporine and prednisone. All patients reported improvement according to the Activities of Daily Living Scale when in the on state 3 to 12 months after surgery (P1 levodopa was found to produce dramatic clinical benefit by replacing dopamine in the caudate nucleus and putamen.2 However, the early success of drug treatment usually diminishes after 5 to 10 years of therapy, as the smooth motor control produced by the drugs is replaced by a fluctuating response called the “on—off” phenomenon, in which periods of continual immobility, or “freezing spells” (“off”), alternate with excessive, abnormal movements (“on”). (Despite these abnormal movements, patients generally prefer the on periods…

An approach to the dynamic analysis of a rotating tire-wheel-suspension unit is developed. A rotating ring on an elastic foundation and a vertically movable center mass model the tire and the wheel respectively. The interaction of the wheel motion with the rotating tire results in a parametrically excited system with periodic coefficients. The flexural response of the rotating tire is shown, however, to be independent of the movement of the wheel and hence can be solved for analytically. The system response due to a concentrated force provided by ground contacting is solved for as an example to illustrate the solution procedure. Force transmission as a function of rotation and damping ratio is illustrated. The results show that the damping constant of the suspension hardly affects the force transmission and stability, for a constant point load. The damping ratio of the n = 1 mode of the tire, that is presumably provided by the tire sidewall, is found dramatically to dominate the force transmission to the axle and the stability criteria.

Context Amyloid senile plaques and tau neurofibrillary tangles are neuropathological hallmarks of Alzheimer disease that accumulate in the brains of people without dementia years before they develop dementia. Positron emission tomography (PET) scans after intravenous injections of 2-(1-{6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile (FDDNP), which binds to plaques and tangles in vitro, demonstrate increased cerebral binding in patients with Alzheimer disease compared with cognitively intact controls. Here we investigated whether known risk factors for Alzheimer disease and dementia are associated with FDDNP-PET binding. Objective To determine if impaired cognitive status, older age, apolipoprotein E-4 ( APOE-4 ) genetic risk for Alzheimer disease, family history of dementia, and less education are associated with increased regional cerebral FDDNP-PET binding. Design Cross-sectional clinical study. Setting A university research institute. Participants Volunteer sample of 76 middle-aged and older persons without dementia (mean age, 67 years) including 36 with mild cognitive impairment. Of the 72 subjects with genetic data, 34 were APOE-4 carriers. Main Outcome Measures The FDDNP-PET signal in brain regions of interest, including medial and lateral temporal, posterior cingulate, parietal, and frontal. Results For all regions studied, cognitive status was associated with increased FDDNP binding ( P APOE-4 demonstrated higher frontal FDDNP binding than noncarriers. In the mild cognitive impairment group, age was associated with increased medial and lateral temporal FDDNP binding, and APOE-4 carriers had higher medial temporal binding than noncarriers. Conclusions Impaired cognitive status, older age, and APOE-4 carrier status are associated with increased brain FDDNP-PET binding in persons without dementia, consistent with previous clinical and postmortem studies associating these risk factors with amyloid plaque and tau tangle accumulation. Stratifying subject groups according to APOE-4 carrier status, age, and cognitive status may therefore be an informative strategy in future clinical trials using FDDNP-PET.

The resonance of a rotating cylindrical shell due to the action of harmonic moving loads is investigated. Instabilities caused by rotation are found for the n = 1 free vibration modes, which correspond to synchronous whirl and in which the shell vibrates as a flexural beam. A general modal expansion method in which in-plane membrane effects are neglected is adopted to solve for, analytically, the forced response of the shell to harmonic traveling loading. The closed form solution is then specialized for various cases so that the individual and combined effects of rotation, moving load speed and harmonic frequency on the resonance are looked into. It is first discovered that, according to the theory, no resonance situation would occur for a stationary constant point load case. Two critical driving frequencies associated with each mn are then obtained for a stationary harmonic load case, where m is the axial half-wave number and n is the circumferential wavenumber. The resonance expressions for the case of a moving constant load, after normalization, come out the same as those for the case of a stationary harmonic load. This means that the moving load imposes effects similar to those of a harmonic force. The simultaneous presence of the load speed and harmonic frequency, however, bifurcates the resonant frequencies. The bifurcations of resonant frequencies due to rotation, moving load speed, and harmonic frequency are then explained and discussed from various viewpoints.

Objective: To compare the in vivo uptake of two amyloid-binding PET agents, PIB and FDDNP, in human subjects with a prion protein (PrP) gene ( PRNP ) mutation that produces a clinical syndrome similar to Alzheimer disease (AD). Background: Amyloid imaging with specific PET ligands offers great promise for early detection and differential diagnosis of AD. Genetic forms of prion disease can present with clinical features that resemble AD, and at autopsy may show deposition of mutant PrP-amyloid. FDDNP binds to PrP-amyloid in postmortem human specimens, but has not been reported in vivo in prion disease. The ability of PIB to bind PrP-amyloid is not known. Methods: Two brothers with a 6 octapeptide repeat insertion mutation (6-OPRI) in the PRNP gene underwent clinical, structural MRI, and FDG-PET evaluations. One brother received a PIB-PET evaluation, while the other received an FDDNP-PET scan. PET results were compared with five normal subjects and five individuals with AD scanned with either agent. Results: PIB uptake was similar to controls in one brother, while FDDNP uptake was intermediate between AD and controls in the other brother. Conclusions: Different amyloid-binding agents may have differential sensitivity to prion-related brain pathology. A combination of amyloid imaging agents may be useful in the diagnosis of early-onset dementia.

Amyloid senile plaques and tau neurofibrillary tangles are neuropathological hallmarks of Alzheimer's disease that accumulate in the cortical regions of the brain in persons with mild cognitive impairment who are at risk for Alzheimer's disease. Noninvasive methods to detect these abnormal proteins are potentially useful in developing surrogate markers for drug discovery and diagnostics.We enrolled 83 volunteers with self-reported memory problems who had undergone neurologic and psychiatric evaluation and positron-emission tomography (PET). On the basis of cognitive testing, 25 volunteers were classified as having Alzheimer's disease, 28 as having mild cognitive impairment, and 30 as having no cognitive impairment (healthy controls). PET was performed after injection of 2-(1-{6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile (FDDNP), a molecule that binds to plaques and tangles in vitro. All subjects also underwent 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) PET, and 72 underwent magnetic resonance imaging (MRI).Global values for FDDNP-PET binding (average of the values for the temporal, parietal, posterior cingulate, and frontal regions) were lower in the control group than in the group with mild cognitive impairment (P0.001), and the values for binding in the group with mild cognitive impairment were lower than in the group with Alzheimer's disease (P0.001). FDDNP-PET binding differentiated among the diagnostic groups better than did metabolism on FDG-PET or volume on MRI.FDDNP-PET scanning can differentiate persons with mild cognitive impairment from those with Alzheimer's disease and those with no cognitive impairment. This technique is potentially useful as a noninvasive method to determine regional cerebral patterns of amyloid plaques and tau neurofibrillary tangles.

Transmission line pulse (TLP) measurements have been shown to correlate well with ESD performance in most cases. However, some recent researches suggested in some cases miscorrelation can happen. A test chip was designed and fabricated in TSMC 0.13 /spl mu/m technology to test this correlation. We found that in some conditions, TLP measurements (IT2) do not correlate well with ESD testing in both human body and machine models.

In this paper, a new framework for brain warping via landmark matching is proposed using implicit representations or the level set method. We demonstrate this powerful technique by matching landmark curves identified on brain surfaces. Each landmark curve to be matched is represented by the intersection of the zero level sets of two level set functions. A diffeomorphic mapping from the template to the target image is then generated by solving a non-linear Euler transport equation with a semi-Lagrangian formulation for the corresponding level set functions. This representation technique has applications in mapping growth processes, recovering intra-operative brain deformation, and integrating and comparing brain imaging data across subjects and groups.

Four kinds of bran, which are milled from important rice cultivators in Taiwan, have high contents of dietary fiber, fat and protein. The use of rice bran in Kung-wan, an emulsified pork meatball, was investigated. It was found that protein and fat contents, and white index of meatballs decreased as the amount of bran increased. A texture profile analysis (TPA) also indicated the hardness, gumminess and chewiness of the Kung-wan decreased. The sensory scores of taste, texture and overall acceptability of meatballs with less than 10% added bran showed no significant difference from those for meatballs without bran. However, the added amount of 15% enriched meatballs resulted in inferior sensory scores. The bran's particle size profoundly affected the sensory and physico-chemical properties of the meat products. Meatballs enriched with smaller bran particles possessed higher TPA indices and sensory scores than those added with larger ones. No significant differences in proximate composition, cooking yield, color and sensory quality were found among emulsified meatballs enriched with four different kinds of bran. Conclusively, the suitable amount of rice bran that should be added to emulsified pork meatballs was less than 10% and a smaller particle size would result in better quality.

Bowen’s disease (BD) and Bowenoid papulosis most prevalent symptoms were itching and pain. (BP) are premalignant skin lesions, mostly appearOnly one case was asymptomatic. Cervical cancer ing on sun-exposed areas. Lesions on the vulvar was the most common antecedent malignancy. regions are relatively rare and there is still confuThree cases, one BP and two BD, underwent sion about the various terms used to describe these radiotherapy for cervical cancer l-8 years prior to similar disorders [ 1,2]. Experience with more clinithe development of these vulvar lesions. One case cal cases will help our understanding of these of BD had a concurrent vulvar squamous cell cardiseases. cinoma. Seven cases of BD and three cases of BP of the vulva were analyzed. All ten cases, representing 23.8% of all vulvar neoplasia in the same 5-year study period, were diagnosed by vulvar biopsy. The histopathologic patterns of these two diseases are generally similar but could be differentiated by the relative frequencies of several parameters [3,4]. The clinical characteristics of all these cases were reviewed and compared (Table 1). The mean ages of the patients with BP and BD were 66 (range 59-72) and 60 (range 25-84) years, respectively. All the three cases with BP and five of the seven patients with BD were menopausal. The The gross appearance of these vulvar lesions was different. Most BP were papular or papillary lesions measuring from 0.5 to 1.5 cm in diameter and without superficial skin discoloration; whereas skin erosion, ulceration and pigmentation were more frequently seen in BD. The lesions of BD measured from 0.5 cm to 4.0 cm in diameter and were generally larger than those of BP. No significant difference between BP and BD regarding the number and site of the lesions could be found.

The authors present a vector quantization technique, referred to as principal component vector quantization (PCVQ), and investigate the problem of abrupt scene changes of video signals. This technique, featuring a simple design procedure, is implemented by an artificial neural network with a learning algorithm for online codebook design based on the local statistics for each difference scene. This network features online learning and a constant encoding time that is independent of the codebook size. The PCVQ was examined via simulation on an abrupt scene change problem which had nonstationary training sequences. >

A three-phase multi-functional battery energy storage system (BESS) is designed and implemented in this paper. When the utility power is in normal condition, the proposed BESS can be arranged to shave the peak load or charge the battery bank. In either case, since the load is unbalanced, harmonic and reactive powers can be compensated through the proposed active power filtering control, the power factor is maintained near to unity and the line currents drawn from the utility are balanced and sinusoidal with very low distortion. As a utility power failure occurs, the proposed BESS can immediately supply uninterruptible power to the loads. In this case, an instantaneous control technique is developed to yield good three-phase voltage waveforms. The determination of reactive components, the dynamic modeling and the design of controllers for the proposed BESS are made. Some experimental results are provided to demonstrate the effectiveness of the proposed BESS. >

A variable perturbation method for codebook design in vector quantization (VQ) is proposed. The resulting codebook can be used as the initial codebook in the implementation of the LBG (Line, Buzo, Gray, 1990) VQ algorithm. The proposed method is based on the concept of entropy implemented as a learning algorithm for a feedforward neural network. Such a neural network with the proposed learning algorithm can construct a codebook for input vectors with an unknown distribution without memorizing long training data. >

The use of multilayer perceptrons (MLP) in the realization of arbitrary functions which map from a finite subset of E/sup n/ into E/sup m/ is investigated. A least upper bound of hidden neurons needed to solve this problem is derived. It is shown that as long as the number of hidden neurons exceeds this bound, an MLP can realize arbitrary switching functions without requiring learning algorithms. In studying classification problems, an upper bound which is tighter than the ones obtained with the common assumption of the general position condition on the input set is derived. In addition, a lower bound is derived in addressing recognition problems. >

The device degradation, characterized by threshold voltage shift (/spl Delta/ V/sub th/), in deep sub-micron p/sup +/ polysilicon gate pMOSFETs due to negative bias temperature instability (NBTI) stress is studied. It is found that the negative threshold voltage shift tends to saturate with stress time. Both hydrogen ions and neutral atoms are believed to contribute to the generation of interface states. The I-V characteristics are compared before and after stresses and it shows that the interface degradation is symmetrical for S/D. In this work, a simple physical model is proposed to qualitatively explain the time evolution of the negative threshold voltage shift /spl Delta/ V/sub th/. This saturation implies continued formation of oxide-trapped holes and the accumulation of positive fixed oxide charges, inhibiting further transport of hydrogen ions and resulting in a gradual decrease in interface trap formation. Moreover, the activation energy E/sub A/ and field-acceleration parameter are also extracted to establish a general phenomenological model to predict the device lifetime of pMOSFETs characterized by threshold voltage shift.