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BackgroundPrimary care patients, especially those with an older age, are one of the most vulnerable populations for post-COVID-19 symptoms. Identifying predictors of post-COVID symptoms can help identify high-risk individuals for preventive care.MethodsOut of 977 primary care patients aged 55 years or above with comorbid physical and psychosocial conditions in a prospective cohort in Hong Kong, 207 patients infected in the previous 5–24 weeks were included. The three most common post-COVID-19 symptoms (breathlessness, fatigue, cognitive difficulty), which lasted beyond the 4-week acute infection period, were assessed using items from the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), together with other self-reported symptoms. Multivariable analyses were conducted to identify predictors of post-acute and long COVID-19 symptoms (5–24 weeks after infection).ResultsThe 207 participants had a mean age of 70.8 ± 5.7 years, 76.3% were female, and 78.7% had ≥2 chronic conditions. In total, 81.2% reported at least one post-COVID symptom (mean: 1.9 ± 1.3); 60.9, 56.5 and 30.0% reported fatigue, cognitive difficulty, and breathlessness respectively; 46.1% reported at least one other new symptom (such as other respiratory-related symptoms (14.0%), insomnia or poor sleep quality (14.0%), and ear/nose/throat symptoms (e.g., sore throat) (10.1%), etc.). Depression predicted post-COVID-19 fatigue. The female sex predicted cognitive difficulty. Receiving fewer vaccine doses (2 doses vs. 3 doses) was associated with breathlessness. Anxiety predicted a higher overall symptom severity level of the three common symptoms.ConclusionDepression, the female sex, and fewer vaccine doses predicted post-COVID symptoms. Promoting vaccination and providing intervention to those at high-risk for post-COVID symptoms are warranted.

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample.MethodsThis cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ).ResultsChildren with autism had significantly more sleep problems than non-autistic children [t(226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t(165) = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t(165) = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ.ConclusionIn summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism.

Additional file 5: Appendix 5. List of excluded meta-epidemiological (ME) studies based on full text with reasons.

Additional file 7: Appendix 7. Main characteristics of 80 meta-epidemiological (ME) studies.

Additional file 10: Appendix 10. Associations between treatment effect estimates and other trial-level characteristics for binary outcome.

Additional file 9: Appendix 9. Details on the subgroup analyses in 48 meta-epidemiological (ME) studies.

Additional file 1: Appendix 1. Definitions of key terms used in this study. Appendix 2. Probabilistic co-occurring clinical features in the latent variables of the global latent tree model illustrated in Fig. 2.

Additional file 3: Appendix 3. Methodological quality of meta-epidemiological (ME) studies.

Additional file 1: Appendix 1. Search strategies and results for systematic reviews on treatments of Alzheimer’s Disease. Appendix 2. Data extraction form for bibliographical characteristics. Appendix 3. AMSTAR 2 critical appraisal form & rating of overall methodological quality. Appendix 4. List of included study. Appendix 5. Methodological quality of each included systematic reviews (SRs) (n = 102). Appendix 6a. Associations between bibliographical characteristics of systematic reviews and individual AMSTAR-2 item performance - results of binary logistic regression. Appendix 6b. Associations between bibliographical characteristics of systematic reviews and individual AMSTAR-2 item performance - results of multinomial logistic regression.

An emerging application in "Navigation through High Shock" is driving a need for small-size, low-weight, and low-power accelerometers that can detect 10 kg amplitudes over 10 kHz bandwidth with a resolution of 10 mg (an effective dynamic range of 120 dB, where 1 g = 9.8m/s2). Simultaneously, the accelerometer should achieve bias instability within 100 μg and eliminate long-term drift to extend bias instability levels to integration times of 100 s and beyond. This thesis describes three transducer design variants of CMOS-MEMS capacitive accelerometer array systems fabricated in a standard 0.18 μm CMOS process. The highest transducer sensitivity accelerometer has a measured full-scale range of +-5 kg, a bandwidth larger than 10 kHz, with a minimum resolution of 5mg and a minimum bias instability of 700 μg. The resolution and full-scale range of the accelerometers correspond to a dynamic range of 120 dB that is on par with state-of-the-art accelerometers. This thesis demonstrates several key enablers to capacitive accelerometer technology that allow meeting the unprecedented high-g and high-dynamic-range requirements of the Navigation through High Shock specifications. First, an interdigitated tapered comb-finger electrode design allows a maximum 10 μm stroke in response to kg shock events while providing a more than five times higher sense capacitance and sense-to-parasitic-capacitance ratio as compared with a conventional parallel-plate design under the same electrode displacement. Second, an hourglass spring beam design that uniformly distributes distortion strain energy across the spring beam provides an optimal mechanical transfer function of an accelerometer transducer given fabrication critical dimensions and the full-scale input target. The interdigitated tapered comb-finger electrode design and hourglass spring beam design lend the accelerometers a maximum of 40 dB boost in transducer sensitivity and a 20 dB enhancement in dynamic range from a legacy design. Third, a MEMS-array offset compensation technique that is area-efficient and low power permits a wideoffset tuning range with high resolution of the arrayed accelerometer system. Fourth,the input range and fast ring-down time of a legacy resonant-frequency-staggered accelerometer array are experimentally validated, which presents significantly less ring-down than state-of-the-art high-shock accelerometers. And fifth, a convex optimization approach further improves an order of magnitude of the figure of merit that delineates the trade-off between transducer sensitivity and ring-down time of the legacy resonant-frequency-staggered accelerometer array. This thesis work has met most of the Navigation through High Shock specifications except achieving bias instability within 100 μg and extended 100 μg bias instability up to integration times of 100 s and beyond. The bias instability is limited by the DC supply flicker noise of the modulation voltage. Nevertheless, there is a path toward the 100 μg bias instability with further improvement on the accelerometer systems and testbeds. Extending 100 μg bias instability of an accelerometer over integration times of 100 s and beyond entails a low-level acceleration random walk. A thorough understanding of the source of acceleration random walk and method to alleviate this major bias error terms for MEMS accelerometers becomes crucial. The duality relation between acceleration random walk and 1/ f2 noise of the accelerometer system is well-studied. However, the physical source of acceleration random walk and 1/ f2 noise of the accelerometer system is an uncharted field in the literature. This thesis proposed a hypothesis that sets out to overthrow the widely-accepted stochastic model for acceleration random walk in the inertial and navigation areas. The hypothesis states — the dominant source of 1/f2 noise of the accelerometer system (or acceleration random walk) arises from temperature-and-stress states variation of the system and acceleration random walk at the integration times up to several hours can be treated as a deterministic error. To validate the thesis hypothesis, this work broadens the commonly-used temperature compensation technique for accelerometers with stress compensation by allocating a large array of temperature sensors and small footprint FET-based stress sensors across the accelerometer chip. A temperature-and-stress-induced drift compensation technique under a deep neural net framework not only demonstrates extendedlow bias instability levels of the accelerometer to integration times beyond 100 s, but shows elimination of acceleration random walk up to 4 h. The drift compensation demonstrates complementary effects of stress versus temperature and shows potential for creating highly stable sensors that measure their on-chip environment and locally process the data for compensation. In addition, the result bolsters the hypothesis that the 1/ f2 noise of the accelerometer system and acceleration random walk at the integration times up to several hours can be treated as a deterministic error.

Additional file 1: Appendix 1. Search strategy.

Additional file 6: Appendix 6. Number of meta-epidemiological studies on trial-level characteristics related to treatment effect estimates published by year.

Additional file 2: Appendix 2. Bibliographical characteristics.

Additional file 1. Appendix 1. Translation of the Rome IV diagnostic questionnaire for functional dyspepsia; Appendix 2. Formulae for calculating diagnostic performance indicators.

Additional file 1: Table 1S. Distribution of population characteristics in included individuals and the total population of UK Biobank. Table 2S. Single-nucleotide polymorphisms used to build the genetic risk score for type 2 diabetes. Table 3S. The coding of the variables under assessment of the covariates in the UK Biobank study. Table 4S. Pearson correlation coefficients among the five air pollutants. Table 5S. Risk of incident type 2 diabetes according to air pollution within each of physical activity category. Table 6S. Association of air pollution with risk of incident type 2 diabetes according to WHO air quality guidelines. Table 7S. Hazard ratios for type 2 diabetes across tertiles categories of type 2 diabetes genetic risk score. Figure 1S. Flow chart of participants enrolment. Figure 2S. Distribution of the polygenic risk score for type 2 diabetes. Figure 3S. Joint associations of physical activity and air pollutants with incidence of type 2 diabetes after excluding participants with type 2 diabetes within 2 years of baseline. Figure 4S. Joint associations of physical activity and air pollutants with incidence of type 2 diabetes after excluding participants with missing data for covariates.Figure 5S. Joint associations of physical activity and air pollutants with incidence of type 2 diabetes after excluding participants who had type 2 diabetes related diseases. Figure 6S. Joint associations of physical activity and air pollutants with incidence of type 2 diabetes after adjusting the employment status. Figure 7S. Joint associations of physical activity or air pollution and genetic risk with the incidence of type 2 diabetes after excluding participants of non-European ancestry.

Additional file 4: Appendix 4. List of included 80 meta-epidemiological studies.

Additional file 1.

Supplemental material, sj-docx-1-ict-10.1177_15347354211038008 for Pharmacological Interventions for the Management of Cancer-Related Fatigue Among Cancer Survivors: Systematic Review and Meta-Analysis by Xuemei Sun, Yancong Chen, William KW Cheung, Irene XY Wu, Fang Xiao and Vincent CH Chung in Integrative Cancer Therapies

Additional file 2.

Additional file 1: Appendix 1. Search strategies for databases. Appendix 2. Risk of bias of included studies. Appendix 3. (a) Contour-enhanced funnel plot of 20 included studies (all prokinetics). (b) Contour-enhanced funnel plot of 17 included studies (domperidone only). Appendix 4. Effect estimates and quality of evidence ratings for comparisons in network meta-analysis on alleviating global symptoms at 4-week follow-up: domperidone as the comparator. Appendix 5. Effect estimates and quality of evidence ratings for comparisons in network meta-analysis on alleviating global symptoms at 2-week follow-up: domperidone as the comparator. Appendix 6. Effect estimates and quality of evidence ratings for comparisons in network meta-analysis on alleviating global symptoms at 4-week follow-up: mosapride as the comparator. Appendix 7. Effect estimates and quality of evidence ratings for comparisons in network meta-analysis on alleviating postprandial fullness: domperidone as the comparator. Appendix 8. Effect estimates and quality of evidence ratings for comparisons in network meta-analysis on alleviating early satiety: domperidone as the comparator. Appendix 9. Effect estimates and quality of evidence ratings for comparisons in network meta-analysis on alleviating epigastric pain: domperidone as the comparator.

Additional file 1: eTable 1. Syntaxes for literature search. eTable 2. 17-item bibliographical characteristics questionnaire. eTable 3. List of included systematic reviews. eTable 4. List of excluded systematic reviews with justifications.

Supplemental material, sj-docx-1-ict-10.1177_15347354211038008 for Pharmacological Interventions for the Management of Cancer-Related Fatigue Among Cancer Survivors: Systematic Review and Meta-Analysis by Xuemei Sun, Yancong Chen, William KW Cheung, Irene XY Wu, Fang Xiao and Vincent CH Chung in Integrative Cancer Therapies

Additional file 3: STROBE Statement���Checklist of items that should be included in reports of cross-sectional studies.

Supplemental material, ServiceGRADE_clean_20200520_v1 for Development of Evidence-Based Chinese Medicine Clinical Service Recommendations for Cancer Palliative Care Using Delphi Approach Based on the Evidence to Decision Framework by Charlene H. L. Wong, Irene X. Y. Wu, Jon Adams, Amie Steel, Jon Wardle, Justin C. Y. Wu, Ting Hung Leung and Vincent C. H. Chung in Integrative Cancer Therapies

Supplemental material, OA_Amstar_2_Appendix1to4_0908 for Methodological quality of systematic reviews on interventions for osteoarthritis: a cross-sectional study by Irene XY Wu, Huan Wang, Lin Zhu, Yancong Chen, Charlene HL Wong, Chen Mao and Vincent CH Chung in Therapeutic Advances in Musculoskeletal Disease

Supplemental material, sj-pdf-1-aim-10.1177_0964528420920299 for Non-specific effects of acupuncture and sham acupuncture in clinical trials from the patient’s perspective: a systematic review of qualitative evidence by Robin ST Ho, Charlene HL Wong, Justin CY Wu, Samuel YS Wong and Vincent CH Chung in Acupuncture in Medicine

Supplemental material, Appendix_5_The_details_of_AMSTAR_2_assessment for Methodological quality of systematic reviews on interventions for osteoarthritis: a cross-sectional study by Irene XY Wu, Huan Wang, Lin Zhu, Yancong Chen, Charlene HL Wong, Chen Mao and Vincent CH Chung in Therapeutic Advances in Musculoskeletal Disease

Supplemental material, Supplementary_material_20200520 for Development of Evidence-Based Chinese Medicine Clinical Service Recommendations for Cancer Palliative Care Using Delphi Approach Based on the Evidence to Decision Framework by Charlene H. L. Wong, Irene X. Y. Wu, Jon Adams, Amie Steel, Jon Wardle, Justin C. Y. Wu, Ting Hung Leung and Vincent C. H. Chung in Integrative Cancer Therapies

Supplemental material, Supplementary_material for The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis by Holger Cramer, Heidemarie Haller, Petra Klose, Lesley Ward, Vincent CH Chung and Romy Lauche in Clinical Rehabilitation

Supplemental material, Supplemental_Material for Acupuncture and related interventions for carpal tunnel syndrome: systematic review by Irene XY Wu, Victor CK Lam, Robin ST Ho, William KW Cheung, Regina WS Sit, Li-Wei Chou, Yan Zhang, Ting-Hung Leung and Vincent CH Chung in Clinical Rehabilitation

Infection control is an often neglected clinical subject in Hong Kong until the outbreak of severe acute respiratory syndrome (SARS) in 2003. A total of eight healthcare workers, including four medical doctors, succumbed as a result of nosocomial acquisition of SARS-coronavirus (SARS-CoV) at the time. Since then, the importance of infection control practice was much better appreciated by the frontline healthcare workers, as it can be a matter of life-or-death. My thesis summarized our research on the proactive infection control measures to prevent nosocomial transmission of respiratory and gastrointestinal viruses, to control emerging and endemic antibiotic-resistant bacteria, and on the management of unprecedented infection outbreaks in the hospital. Promotion of hand hygiene is the cornerstone of proactive infection control measures. By adopting the concept and practice of directly-observed hand hygiene, we demonstrated successful control of outbreaks and prevention for both respiratory and gastroenteritis viruses. Introduction of electronic devices for continuous monitoring of hand hygiene compliance in high risk clinical areas provides an opportunity for immediate feedback and timely education to frontline staffs. The global dissemination of multiple drug resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), community-associated MRSA (CA-MRSA), vancomycin-resistant enterococcus (VRE), hypervirulent clone of Clostridium difficile, extended-spectrum beta-lactamase (ESBL) producing organisms, and the recently described carbapenem-resistant enterobacteriaceae (CRE), pose a great challenge to the infection control professionals. In Hong Kong, MRSA has been endemic for more than two decades. Although we proved that the appropriate use of single room isolation and hand hygiene can significantly reduce the incidence of nosocomial MRSA in the adult intensive care unit, the isolation facilities remain limited in the general medical and surgical units. Innovations are much in need to manage this old and persistent problem. Therefore, we demonstrated that use of antibiotics, in particular beta-lactams and fluoroquinolones, could increase the risk of environmental contamination by increasing microbial density of MRSA in the anterior nares by 2-3 log10 in as little as 1 week. We also found that some MRSA strains such as spa types t1081 and t037 were more transmissible. Based on these findings, we prioritized our isolation facilities for those patients who are heavily colonized or infected with highly transmissible spa-type t1081, especially when they are receiving antibiotic therapy. Along with our enhancement of hand hygiene practices and antibiotic stewardship program, the incidence of MRSA bacteremia per 1000-patient-days was the lowest among the seven hospital clusters in Hong Kong. We believe that our experience in the control of the MRSA can be extended to contain the spread of CA-MRSA and other MDROs. Besides the prevailing infectious diseases with high endemicity, we have to be vigilant against other potential outbreaks due to uncommon micro-organisms such as the polymicrobial outbreak in patients undergoing intermittent peritoneal dialysis caused by hospital renovation, the unprecedented outbreak of intestinal mucormycosis caused by Rhizopus microsporous among the patients with hematological malignancy, and the nosocomial outbreak of legionellosis in our locality. Extensive outbreak investigations were performed, which demonstrated that environmental factors were also important in causing nosocomial outbreaks.

[Formula][1] The use of acupuncture in clinical medicine can be traced back to ancient China where, as an integral part of the healthcare system, acupuncture was used to treat a variety of conditions within the context of traditional Chinese medicine (TCM). Since the 6th century, the medical use of acupuncture has become more widespread in Asia and nowadays acupuncture is used widely throughout the world. Among the various alternative and complementary therapies, acupuncture is perhaps one of the most popular therapies, especially in its role to fill the ‘effectiveness gaps’ of medical care provided by conventional Western medicine.1 These ‘effectiveness gaps’ include conditions for which conventional medicine often fails to achieve satisfying outcomes for patients, and include chronic back pain, neck pain, headache, and other medically unexplained symptoms. As these conditions are often managed in primary care, it is not surprising to find that acupuncture is one of the most popular complementary and alternative therapies used by primary care providers. In the UK, it has been estimated that each week, about one in 10 GPs either refer patients to have acupuncture for their problems or practise it themselves.2 The NHS in the UK currently supports the use of acupuncture for persistent low back pain lasting between 6weeks … [1]: /embed/graphic-1.gif

© 2017 American Headache Society Background: Given the safety concerns regarding pharmacological agents, and the considerable impact of headache and migraine on the sufferer's quality of life, many people seek other treatment options beyond conventional medication and care to address their symptoms; this includes complementary and alternative medicine (CAM). Some CAM interventions have shown promising results in clinical trials of headache and migraine management. Nonetheless, there has been little research exploring the reasons for using CAM, and the types of CAM used, among this population. Objective: The study aimed to answer the following questions: (1) Which CAM modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers?. Methods: This secondary analysis of data from the 2012 U.S. NHIS (a national cross-sectional survey) examined the use of CAM among migraine/headache sufferers, including the main reasons related to CAM use. Data were weighted and analyzed using STATA 14.0. Results: The sample of 34,525 adults included 6558 (18.7%) headache/migraine sufferers. Of the headache/migraine sufferers, a substantial proportion (37.6%, n = 2427) used CAM for various conditions; however, CAM use specifically for headache/migraine was much less prevalent (3.3%, n = 216). Of those who used CAM for headache/migraine, about half used CAM in conjunction with prescription (47.8%, n = 100) or over-the-counter medication (55.1%, n = 113). As severity of headache/migraine increased so did the likelihood of using CAM (severe migraine odds ratio [OR] = 2.32; 95% confidence interval [CI]: 1.41, 3.82; both recurring headache/severe migraine OR = 3.36; 95% CI: 2.08, 5.43; when compared to those with recurring headache only). The most frequently used CAM modality among all headache/migraine sufferers (N = 6558) was manipulative therapy (22.0%, n = 1317), herbal supplementation (21.7%, n = 1389) and mind-body therapy (17.9%, n = 1100). The top 3 reasons for using CAM for headache were general wellness (28.7%, n = 60/209), improving overall health (26.8%, n = 56/209), and reducing stress (16.7%, n = 35/209). Conclusions: Although CAM is used by many sufferers of headache/migraine, the use of CAM specifically for the treatment of headache/migraine is relatively low in the United States. The study also assesses the key differences of CAM use among headache/migraine sufferers in NHIS 2012 compared with those in NHIS 2007, and identifies shortfalls in the evidence-base of several CAM modalities used by U.S. adults for headache/migraine. This information may assist health providers and consumers in making informed decisions about the safest and most appropriate approach to managing headache/migraine.