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OBJECTIVE We examined the associations of GAD antibodies (GADA) and C-peptide (CP) with insulin initiation, glycemic responses, and severe hypoglycemia in type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS In 5,230 Chinese patients (47.6% men) with T2D (mean ± SD age: 56.5 ± 13.9 years; median diabetes duration: 6 [interquartile range 1, 12] years), enrolled consecutively in 1996–2012 and prospectively observed until 2019, we retrospectively measured fasting CP and GADA in stored serum and examined their associations with aforementioned outcomes. RESULTS At baseline, 28.6% (n = 1,494) had low CP ( CONCLUSIONS There is considerable heterogeneity in autoimmunity and β-cell dysfunction in T2D with GADA+ and high CP associated with early insulin initiation, while GADA+ and low CP, increased the risk of severe hypoglycemia. Extended phenotyping is warranted to increase the precision of classification and treatment in T2D.

Objective We examined the associations of glutamic acid decarboxylase antibodies (GADA) and C-peptide (CP) with insulin initiation, glycemic responses and severe hypoglycemia in type 2 diabetes (T2D). Research Design and Methods In 5230 Chinese patients with T2D (mean±SD age: 56.5±13.9 years, diabetes duration (median, IQR): 6 (1-12) years, 47.6% men) enrolled consecutively in 1996-2012 and prospectively observed till 2019, we retrospectively measured fasting CP and GADA in stored serum and examined their associations with aforementioned outcomes. Results At baseline, 28.6% had low CP (p=0.002) for insulin initiation versus the GADA- group, while the low-CP group had an aHR of 0.88 (0.77-1.00, p=0.051) versus the high-CP group. Following insulin initiation, the GADA+ plus low-CP group had the largest decrements in HbA1c (-1.9% at month 6; -1.5% at month 12) versus -1% in the other 3 groups. The aHR of severe hypoglycemia was 1.29 [(95% CI 1.10-1.52), p=0.002] in the low-CP and 1.38 [(95% CI 1.04-1.83) p=0.024] in the GADA+ group. Conclusions There is considerable heterogeneity in autoimmunity and beta-cell dysfunction in T2D with GADA+ and high CP associated with early insulin initiation while GADA+ and low CP, increased risk of severe hypoglycemia. Extended phenotyping is warranted to increase the precision of classification and treatment in T2D.

Next-generation sequencing has uncovered thousands of long noncoding RNAs (lncRNA). Many are reported to be aberrantly expressed in various cancers, including hepatocellular carcinoma (HCC), and play key roles in tumorigenesis. This review provides an in-depth discussion of the oncogenic mechanisms reported to be associated with deregulated HCC-associated lncRNAs. Transcriptional expression of lncRNAs in HCC is modulated through transcription factors, or epigenetically by aberrant histone acetylation or DNA methylation, and posttranscriptionally by lncRNA transcript stability modulated by miRNAs and RNA-binding proteins. Seventy-four deregulated lncRNAs have been identified in HCC, of which, 52 are upregulated. This review maps the oncogenic roles of these deregulated lncRNAs by integrating diverse datasets including clinicopathologic features, affected cancer phenotypes, associated miRNA and/or protein-interacting partners as well as modulated gene/protein expression. Notably, 63 deregulated lncRNAs are significantly associated with clinicopathologic features of HCC. Twenty-three deregulated lncRNAs associated with both tumor and metastatic clinical features were also tumorigenic and prometastatic in experimental models of HCC, and eight of these mapped to known cancer pathways. Fifty-two upregulated lncRNAs exhibit oncogenic properties and are associated with prominent hallmarks of cancer, whereas 22 downregulated lncRNAs have tumor-suppressive properties. Aberrantly expressed lncRNAs in HCC exert pleiotropic effects on miRNAs, mRNAs, and proteins. They affect multiple cancer phenotypes by altering miRNA and mRNA expression and stability, as well as through effects on protein expression, degradation, structure, or interactions with transcriptional regulators. Hence, these insights reveal novel lncRNAs as potential biomarkers and may enable the design of precision therapy for HCC.

This file contains 4 supplementary figures (Figure S1, Figure S2, Figure S3 and Figure S4), 9 supplementary tables (Table S1,Table S2, Table S3A, Table S3B, Table S3C, Table S3D, Table S3E, Table S4A and Table S4B) and references used in the tables.

This study examined the latent structure of the broad range of complex neuropsychiatric morbidities occurring one year after COVID-19 infection. As part of the CU-COVID19 study, 248 (response rate = 39·3%) of 631 adults hospitalized for COVID-19 infection in Hong Kong completed an online survey between 3-2021 and 1-2022. Disorder prevalence was compared against a random non-infected household sample (n = 1837). 248 surveys were received on average 321 days post-infection (Mean age: 48·9, 54% female, moderate/severe/critical infection: 58·2%). 32·4% were screened to have > = one mental disorder, 78·7% of whom had concurrent fatigue/subjective cognitive impairment (SCI). Only PTSD (19·1%) was significantly more common than control (14%, p = 0·047). Latent profile analysis classified individuals into P1(12·4%)-no current neuropsychiatric morbidities, P2 (23·1%)-SCI/fatigue, P3 (45·2%)-anxiety/PTSD, P4 (19·3%)-depression. SCI and fatigue pervaded in all profiles (P2-4) with neuropsychiatric morbidities one-year post-infection. SHAP: PTSD, anxiety and depressive symptoms were most important in differentiating P2-4. Past mental health and P4 independently predicted functional impairment. Neuropsychiatric morbidity was associated with past mental health, reduced resilience, financial problems, but not COVID-19 severity. Their confluence with depressive and anxiety symptoms predicted impairment and are associated with psychological and environmental factors.

Mild adolescent idiopathic scoliosis (AIS), with Cobb

Next-generation sequencing has uncovered thousands of long noncoding RNAs (lncRNA). Many are reported to be aberrantly expressed in various cancers, including hepatocellular carcinoma (HCC), and play key roles in tumorigenesis. This review provides an in-depth discussion of the oncogenic mechanisms reported to be associated with deregulated HCC-associated lncRNAs. Transcriptional expression of lncRNAs in HCC is modulated through transcription factors, or epigenetically by aberrant histone acetylation or DNA methylation, and posttranscriptionally by lncRNA transcript stability modulated by miRNAs and RNA-binding proteins. Seventy-four deregulated lncRNAs have been identified in HCC, of which, 52 are upregulated. This review maps the oncogenic roles of these deregulated lncRNAs by integrating diverse datasets including clinicopathologic features, affected cancer phenotypes, associated miRNA and/or protein-interacting partners as well as modulated gene/protein expression. Notably, 63 deregulated lncRNAs are significantly associated with clinicopathologic features of HCC. Twenty-three deregulated lncRNAs associated with both tumor and metastatic clinical features were also tumorigenic and prometastatic in experimental models of HCC, and eight of these mapped to known cancer pathways. Fifty-two upregulated lncRNAs exhibit oncogenic properties and are associated with prominent hallmarks of cancer, whereas 22 downregulated lncRNAs have tumor-suppressive properties. Aberrantly expressed lncRNAs in HCC exert pleiotropic effects on miRNAs, mRNAs, and proteins. They affect multiple cancer phenotypes by altering miRNA and mRNA expression and stability, as well as through effects on protein expression, degradation, structure, or interactions with transcriptional regulators. Hence, these insights reveal novel lncRNAs as potential biomarkers and may enable the design of precision therapy for HCC.

Approximately 20% early-stage (I/II) colorectal cancer (CRC) patients develop metastases despite curative surgery. We aim to develop a formalin-fixed and paraffin-embedded (FFPE)-based predictor of metastases in early-stage, clinically-defined low risk, microsatellite-stable (MSS) CRC patients. We considered genome-wide mRNA and miRNA expression and mutation status of 20 genes assayed in 150 fresh-frozen tumours with known metastasis status. We selected 193 genes for further analysis using NanoString nCounter arrays on corresponding FFPE tumours. Neither mutation status nor miRNA expression improved the estimated prediction. The final predictor, ColoMet19, based on the top 19 genes' mRNA levels trained by Random Forest machine-learning strategy, had an estimated positive-predictive-value (PPV) of 0.66. We tested ColoMet19 on an independent test-set of 131 tumours and obtained a population-adjusted PPV of 0.67 indicating that early-stage CRC patients who tested positive have a 67% risk of developing metastases, substantially higher than the metastasis risk of 40% for node-positive (Stage III) patients who are generally treated with chemotherapy. Predicted-positive patients also had poorer metastasis-free survival (hazard ratios [HR] = 1.92, design-set; HR = 2.05, test-set). Thus, early-stage CRC patients who test positive may be considered for adjuvant therapy after surgery.

We report the use of the geometric design standard for road markings published in the "Standard Details of Road Elements" ('SDRE') by the Land Transport Authority ('LTA') of Singapore as a convenient and sufficiently accurate means of estimating distances between features of the roadway, particularly useful for performing speed analysis based on videos. In this study, onsite measurements (by measuring tape, total station or 3D laser scanner) from various locations in Singapore, as well as the corresponding distances based on Google Earth Pro, were compared with those estimated using the SDRE. We demonstrate herein that the SDRE estimated 85.7% of all corresponding onsite measurements to within ±5%, and can thus be relied upon for crash reconstruction. This study also evaluated the distance accuracies associated with using the geometric design standard (the SDRE) and Google Earth Pro, and determined that both methods were robust and accurate, with overall average absolute percentage errors of less than 1% and would be beneficial for obtaining measurements for crash reconstruction, especially when the site of interest is not accessible.

The protective role of mattering on suicide ideation among university students was examined. Our study is grounded in the Interpersonal-Psychological Theory of Suicide, which led to a hypothesis that between depression levels and state self-esteem has significant serial multiple mediating effects on the relationship between mattering and suicide ideation. University students from various nationality who study in Indonesia and Malaysia (n=509) responded to General Mattering Scale, State Self-Esteem Scale, Beck’s Depression Inventory, and Suicide Ideation Attributes Scale, as well as demographic details including their gender, spirituality, education, birth order and nationality. The result of Bootstrap analyses with 95% confident interval from 5000 samples suggested that the serial mediation partially occurred to the link between mattering and suicide ideation.

Acute limb ischemia is both a limb-threatening and life-threatening disease process. Nontraumatic acute peripheral arterial occlusion is most commonly caused by a thrombosis or an embolism.There is limited evidence on the use of bedside ultrasound for the detection of acute limb ischemia, but duplex ultrasonography is standard in the diagnosis and operative planning in chronic limb ischemia. Emergency physicians may use bedside ultrasound in the evaluation of patients with symptoms and signs suggestive of this disease entity.A 64-year-old man with a past medical history of hypertension and an ischemic stroke presented to the Emergency Department with2 h of severe upper left leg pain that radiated down to his foot. A bedside ultrasound of the left lower extremity was emergently performed. On B-mode ultrasound evaluation, echogenic material was visualized in the left common femoral artery, the artery was noncompressible, and there was an absence of Doppler flow signal. He was then directly taken to the operating room for an emergent limb-saving procedure.A focused examination of the aorta, iliac vessels, and femoral artery bifurcation with bedside ultrasonography may help to localize peripheral arterial occlusions and can assist the emergency physician in seeking timely surgical consultation and management.

3 Abstract: Vegetarians adhering to a well-planned diet are assumed to meet nutrient requirements. This study was designed to evaluate the nutrient intake of adult vegetarians and non-vegetarians in Kual a Lumpur. A cross-section al comparison between three types of diet practices was carried out in Kual a Lumpur, with 35 respondents in each group (non-vegetarian, ovolacto-vegetarian and strict-vegetarian). Anthropometric indices such as weight and body fat composition were measured using TANITA electronic balance scale, while three-day dietary recalls was assessed using a computer dietary analysis software programme, Nutritionist-pro. Statistical analysis had shown non significant difference in the three diet practices with respect to anthropometri c indices. The benefits of vegetarian practices were obviously presented in the dietary intake of nutrients. Both ovolacto-vegetarians and strict-vegetarians had significantly higher mean dietary intake of fiber, folate, magnesium, vitamin A and vitamin C than non-vegetarians (p

Pollutant emissions for vehicles are a function of the amount of energy it consumes and the feedstock for that energy. A model was built to capture the energy and pollutant damage costs associated with using electric vehicles (EVs), hybrid vehicles and internal combustion engine cars in Singapore based on vehicles currently available in the Singapore market. These damage costs were compared to vehicle purchase price and fuel costs. This is part of broader work to compare the costs and benefits of EVs with hybrid and ICE vehicles in Singapore.

Singapore is a diamond-shaped island with several surrounding smaller islets. It has a flat coastline with a land area of 710 km2 in 2009. With a highly urbanized city and limited land space, Singapore has been faced with problems of road congestion and rapid growth in car population. Electric vehicles (EVs) provide low emission urban transportation. Even taking into account the emissions from power plants needed to fuel EVs, the use of EVs still reduce carbon dioxide emissions significantly. From the energy aspect, EVs are efficient. EVs are promising alternative fuel vehicles that can reduce energy consumptions and carbon dioxide emissions in Singapore. A life cycle cost model was built to calculate life cycle costs of EVs and internal combustion engine cars in Singapore. It was found that EV is the most expensive car under current Green Vehicle Rebate scheme. The EV will be economically viable in Singapore if there is a breakthrough at batteries to cut EV prices.

Besides its application in media printing, drop-on-demand (DoD) printing is becoming an attractive alternative to traditional micro-fabrication to build 3D structures with wide applications. In DoD printing, each type of nozzle (ejector) has its uniqueness and limitation in the dispensing material properties, driving parameters, and the ejected droplet dimension. This paper presents a multi-nozzle DoD printing machine to satisfy the increasing demand for multi-material dispensing in industry. On the hardware aspect, a microcontroller-based synchronizer is designed to synchronize the printing process from multi-nozzles with respect to a movable positioning stage. This real-time control contributes to accurate micro-droplet deposition. On the software aspect, a three-layer framework is proposed, including user interface, system manager, and hardware interface layer. This proposed structure greatly improves the system flexibility with which the user can dynamically configure the desired dispensers for 3D structure printing. Integrating these techniques into the printing system, the developed DoD system can achieve a flexible and friendly user interface, while dispensing a wide range of functional materials using various types of dispensing nozzles.

In a world where environmental protection and energy conservation are growing concerns, the development of electric, hybrid, and fuel cell vehicles has taken on an accelerated pace. The dream of having commercially viable electric and hybrid vehicles is becoming a reality. It is important that the automobile companies have both proper technical and commercialization roadmaps hand-in-hand. The company CEOs should take the lead in drawing the technical and commercialization roadmaps. This task should not just be dedicated to the R&D departments or sales departments, since this is a major project that will have major effects on the company and society. In addition to having clear objectives, the senior management should also have holistic and creative thinking to oversee the progress of the project.

Equilibrium moisture sorptions of two dried aqueous herbal extracts and their mixtures with dextrans of various molecular weights were investigated as a function of relative humidity at ambient temperature, and the data were analyzed by both the Guggenheim-Anderson-deBoer (GAB) and Brunauer-Emmett-Teller (BET) equations. Glass transition temperatures (T(g)) of the samples were measured by differential scanning calorimetry, and their dependence on the moisture contents of the extracts was analyzed by the linear, Fox and expanded Gordon-Taylor mathematical models. All dextran-extract mixtures exhibited single T(g) values, indicating that they existed as single homogeneous phases. The BET equation was found adequate for description of the moisture sorption isotherms for all samples. The dextrans appeared to reduce the hygroscopicity of the herbal extracts solely by a dilution effect. The observed increase in T(g) and accompanying decrease in tackiness of the herbal extracts in the presence of dextrans may be explained by the ability of dextrans to restrict the molecular mobility of simple sugars and to counteract the plasticizing effect of water in the extracts. The expanded Gordon-Taylor equation has proved useful in predicting the T(g) of hygroscopic amorphous herbal mixtures.

The main battery type employed in standby applications is the valve-regulated lead-acid (VRLA) battery. Float charging is normally used to maintain the battery in its fully charged state, however, float charging has limitations that can damage the battery and shorten its life. New charge regimes have evolved in recent years to tackle the intrinsic problems of float charging. The intermittent charge (IC) regime and the interrupted charge control (ICC) regime have been developed to prolong the service life of the battery in standby applications. The battery is normally maintained in the standby mode for a long period of time and there are infrequent discharge tests to verify the efficacy of the battery. Hence, the service life of the battery is highly correlated to its charge regime. This paper reviews the charge regimes for VRLA batteries, and assesses their charging performance and their impact on the service life of the battery. Recognising that temperature plays a significant role in battery operation, temperature compensation schemes are described for different charge regimes.

Secure and pervasive 3D CAD model sharing among all collaborative participants is vital to successful Product Lifecycle Management (PLM) applications. However, existing product data management (PDM) solutions only provide rigid 3D data access control mechanism like 'all-or-nothing' scenario and thus prevents companies from sharing their 3D data effectively. 3D data sharing can be facilitated if proper technologies are available to break the previous two-grade (grant-or-deny) scheme into more levels and present to a user a 3D model with proper level of detail reduction. Therefore, a collaborator can work on his 3D data as full model while viewing other models in lighter visualisation as mesh or bounding boxes. This paper proposes role-based visualisation to realise the above concept and a prototype system is developed to validate the proposed approach in commercial CAD/PDM applications. Several key issues and future work are discussed.

Dimensional metrology for micro/nano structure is crucial for addressing quality issues and understanding the performance of micro-fabricated products and micro-fabrication processes. Most of the established methods are based on optical microscopy for planar dimensions and stylus profilometry for out-of-plane dimensions. Contact profilers suffer from slow speed of measurement for three-dimensional profiles and are not suitable for delicate surfaces and parts. Advanced systems using white light interferometer are equipped with CCD cameras and interfaced with a microscope to conduct an array of measurements ranging from two-dimensional to three-dimensional profiles and surface roughness analysis. This paper presents a methodology based on white light interferometer for the dimensional measurement of 3D micro-structures, demonstrated on micro-gears and moulds produced by UV lithography and vacuum casting, respectively. Physical artifacts, such as gauge blocks, are also utilized to verify and validate the measurements on the microcomponents.

In our academic emergency department, our senior residents lead their own patient care team, known as the red team (RT). Attending physicians are responsible for managing their own team (AT) and precepting the senior resident's cases.We hypothesized that the RT would have the same number of morbidity and mortality (MM) cases and similar numbers of adverse outcomes as the AT. We also hypothesized that there would be no increase in MM cases during the first quarter of every academic year.We obtained data from MM cases from 2009-2013, including month and year of patient visit, standard of care code (SoCC), and whether the patient was seen by the RT or an AT. Data were analyzed using a χ(2) test comparing expected outcomes with observed outcomes.There was a total of 117 MM cases during the study period with a SoCC ≥ 3; 76 cases were AT and 41 cases were RT. There was no statistically significant difference between expected and observed number of cases. Mean RT and AT SoCCs were 4.03 and 4.23, respectively. There was no statistically significant difference between the two groups for SoCC. Mean SoCC was not significantly different for the first quarter of the year.We found that our patient care model did not lead to an increased number of MM cases and RT cases were not associated with worse outcomes overall. Additionally, there was no increased rate of MM cases in the beginning of the academic year.

Cardiac death has been linked in many populations to prolongation of the QT interval (QTe). However, basic science research suggested that the best estimate of the time point when repolarisation begins is near the T-wave peak. We found QT peak (QTp) was longer in hypertensive subjects with LVH. A prolonged "depolarisation" phase, rather than "repolarisation" (T peak to T end) might therefore account for the higher incidence of cardiac death linked to long QT. Hypothesis: We have tested the hypothesis that QT peak (QTp) prolongation predicts cardiac death in stroke survivors. Methods and Results: ECGs were recorded from 296 stroke survivors (152 male), mean age 67.2 (SD 11.6) approximately 1 year after the event. Their mean blood pressure was 152/88 mmHg (SD 29/15mmHg). These ECGs were digitised by one observer who was blinded to patient outcome. The patients were followed up for a median of 3.3 years. The primary endpoint was cardiac death. A prolonged heart rate corrected QT peak (QTpc) of lead I carried the highest relative risk of death from all cause as well as cardiac death, when compared with the other more conventional QT indices. In multivariate analyses, when adjusted for conventional risk factors of atherosclerosis, a prolonged QTpc of lead I was still associated with a 3-fold increased risk of cardiac death. (adjusted relative risk 3.0 (95% CI 1.1 - 8.5), p=0.037). Conclusion: QT peak prolongation in lead I predicts cardiac death after stroke.

Background: We aim to assess whether social deprivation independently predicts case fatality after a stroke patient has been admitted to hospital, and to assess whether social deprivation affected duration of hospital stay. Methods: Cohort study in a tertiary teaching hospital included consecutive patients admitted to hospital within 48 h of their stroke between 1988 and 1994. Outcome measures were case fatality at 1 year and length of hospital stay. The socioeconomiccategory was derived from the postcode sectorof residence for the patients (Carstairs index). Cause of death was determined by data linkage to the Registrar General data for Scotland. Results: 2,042 stroke patients were included. A significant age difference existed between the deprivation categories (76.0 ± 10.9 years in the affluent cohort vs. 71.4 ± 10.7 years in the deprived cohort). Smoking was more common in the deprived group. ECG findings and neurological score on admission were similar between the groups. No difference existed between groups for length of hospital stay (p = 0.793), and in the proportions remaining alive at 1 year (p = 0.416). When entered into a multivariate Cox regression analysis, the deprivation categories did not predict mortality. Age, sex, Philadelphia Geriatric Center Instrumental Activities of Daily Living (IADL) Scale Score, Orgogozo neurological score on admission, and ECG abnormalities were the significant predictors. Conclusions: Stroke patients living in more socially deprived areas had their strokes at an earlier age but were not at a greater risk of dying or longer hospital stay once they had been admitted to hospital.

Switching state-space models have been widely used in many applications arising from science, engineering, economic, and medical research. In this paper, we present a Monte Carlo Expectation Maximization (MCEM) algorithm for learning the parameters and classifying the states of a state-space model with a Markov switching. A stochastic implementation based on the Gibbs sampler is introduced in the expectation step of the MCEM algorithm. We study the asymptotic properties of the proposed algorithm, and we also describe how a nesting approach and the Rao-Blackwellized forms can be employed to accelerate the rate of convergence of the MCEM algorithm. Finally, the performance and the effectiveness of the proposed method are demonstrated by applications to simulated and physiological experimental data.

This article reviews the status of electric vehicles/hybrid electric vehicles (EV/HEVs) worldwide and their state of the art, with emphasis on the engineering philosophy and key technologies. The importance of the integration of technologies of automobile, electric motor drive, electronics, energy storage and controls, and the importance of the integration of society strength from government, industry, research institutions, electric power utilities, and transportation authorities are addressed. The challenged of EV commercialization is discussed. EV is a multidisciplinary subject involving broad and complex aspects. However, it has core technologies; chassis and body technology, propulsion technology, and energy source technology. The electric propulsion system is the heart of the EV. It consists of motor drive, transmission and controller, plus the integration with engine power train in the case of the HEV.

A geometric benchmark part is proposed, designed and fabricated for the performance evaluation of rapid prototyping machines/processes. The benchmark part incorporates key shapes and features of better‐known benchmark parts. It also includes new geometric features, such as freeform surfaces, certain mechanical features and pass‐fail features that are increasingly required or expected of RP processes/systems. The part is suitable for fabrication on a typical RP machines. In this paper, the application of the benchmark part is demonstrated using relatively common RP processes. The ability of the benchmark part to determine achievable geometric features and accuracy by the aforementioned RP processes is presented and discussed.

A support structure is necessary for part fabrication in some layered manufacturing (LM) processes, but the utilization of support structures often causes low efficiency and poor quality of the finished parts. In this paper, a process planning approach based on a multi-orientational deposition (MOD) method is proposed to minimize the use of support structures, so as to improve the efficiency in LM process and surface quality of a part built. An algorithm to determine the successive layer area difference (SLAD) for layer deposition and its application to overhang feature extraction and reduction using the MOD method is also introduced.

Background: QT peak prolongation identiied patients at risk of death or non-fatal MI. We tested the hypothesis that QT peak prolongation might be associated with signiicant myocardial ischaemia in two separate cohorts to see how widely applicable the concept was. Methods and Results: In theirst study, 134 stroke survivors were prospectively recruited and had 12-lead ECGs and Nuclear myocardial perfusion scanning. QT peak was measured in lead I of a 12-lead ECG and heart rate corrected by Bazett's formula (QTpc). QTpc prolongation to 360ms or more was 92% speciic at diagnosing severe myocardial ischaemia. This hypothesis-generating study led us to perform a second prospective study in a different cohort of patients who were referred for dobutamine stress echocardiography. 13 of 102 patients had signiicant myocardial ischaemia. Signiicant myocardial ischaemia was associated with QT peak prolongation at rest (mean 354ms, 95% CI 341-367ms, compared with mean 332ms, 95% CI 327-337ms in those without signiicant ischaemia; p=0.002). QT peak prolongation to 360ms or more was 88% speciic at diagnosing signiicant myocardial ischaemia in the stress echocardiography study. QT peak prolongation to 360ms or more was associated with over 4-fold increase odds ratio of signiicant myocardial ischaemia. The Mantel- Haenszel Common Odds Ratio Estimate=4.4, 95% CI=1.2-16.0, p=0.023. Conclusion: QT peak (QTpc) prolongation to 360ms or more should make us suspect the presence of signiicant myocardial ischaemia. Such patients merit further investigations for potentially treatable ischaemic heart disease to reduce their risk of subsequent death or non-fatal MI.

Cu-based composites reinforced with in-situ TiB 2 particles were synthesized through the reaction among Cu, Ti and B 4 C using a 3-kW CO 2 laser. The in-situ reaction resulted in the formation of TiB 2 and non-stoichiometric TiC 1− x particles in a Cu matrix. Some porosity was observed in the Cu–Ti–B 4 C system. However, with addition of Ni in the Cu–Ti–B 4 C system, almost full densed parts could be obtained due to improvement of wetting.

Objective: To investigate patients' adherence to statin treatment prescribed following their first myocardial infarction (MI) and to estimate the effect of adherence to statins on recurrence of MI and all cause mortality. Design: Cohort study using a record linkage database. Setting: Tayside, Scotland, UK. Patients: Patients who experienced their first MI between January 1990 and November 1995. Main outcome measures: Percentage of statin use and adherence to statins by patients after an MI and the relative risk of hospitalisation for recurrent MI. The effect of adherence on all cause mortality was also examined. The covariates used were age, sex, socioeconomic deprivation, serum cholesterol concentration, diabetes mellitus, cardiovascular drug use, and other hospitalisations. Results: Of 5590 patients who experienced an incident MI, 717 (12.8%) experienced at least one further MI. Only 7.7% of patients used statins after an MI during the study period. Compared with those not taking statins, those who had 80% or better adherence to statin treatment had an adjusted relative risk of recurrent MI of 0.19 (95% confidence interval (CI) 0.08 to 0.47) and all cause mortality of 0.47 (95% CI 0.22 to 0.99). There was no significant reduction in either end point for those who were less than 80% adherent to statins. Conclusions: Despite the infrequent use of statin during the study period, good adherence to statin treatment was associated with lower risk of recurrent MI.

Background and Purpose — The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke. Methods — This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality. Results — The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine Conclusions — After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.

This paper presents a study of the effect of titanium carbide (TiC) on the performance of sintered copper-based materials as electrical discharge machining (EDM) electrodes. The aim of this study was to provide a preliminary evaluation of EDM electrodes fabricated by laser-based sintering using rapid prototyping technology (RP). Six batches of titanium carbide with content from 5% to 45% were fabricated by mixing, ball milling, pressing, and liquid phase sintering with copper-tungsten (Cu–W) and copper (Cu), respectively. The performance of the newly formed material is compared with commercial electrodes. The densification of TiC/Cu–W system was improved by the addition of nickel (Ni), as Ni shows good solubility in both Cu and W. The distribution of particle size becomes narrow as the proportion of TiC is increased. A uniform dispersion of small TiC particles in the Cu–W system and a narrow particle size distribution provide the possibility of obtaining dense electrodes. With increasing TiC, the relative density first increased and then decreased, whereas the electrical resistivity first decreased and then increased. EDM electrodes, with the addition of TiC, show good performance in surface finishing. This is an important characteristic as RP-sintered EDM electrodes are expected to be used as finishing electrodes. The surface roughness of most specimens is less than those machined using commercial electrodes. Electrodes with 15% TiC show the highest relative density, lowest electrical resistivity, and good EDM performance, i.e. lowest tool wear ratio (TWR) and highest material removal rate (MRR) at low current, and the best surface finish not only at low current, but also at high current.

A solid laser-diode plotter (SLP) system is one of the commercial rapid prototyping (RP) systems developed and marketed in Japan. In the SLP system, two semiconductor lasers are employed instead of a UV laser or a diode-pumped solid state laser, as used in the stereolithography process to cure a specially designed photopolymer. An ascending platform is used to build the suspended solid model, and only a small amount of resin is cured in a thin layer on a plate of glass just below the last layer built. Hence, the SLP system is a low-cost RP system and is well suited for educational purposes, because a high-power laser is not involved and only a small amount of resin is used. However, the over-curing of the overhanging area is a processing problem in the ascending platform method, because the built part is suspended. In order to reduce the over-curing of the SLP parts, the Taguchi method was employed to analyse the processing parameters. The effect of the processing parameters on the over-curing was investigated and presented. The results show that the over-curing of the SLP parts was reduced about 40% using the optimal processing parameters as analysed by the Taguchi method.