Search

Background: To compare the effects of proton pump inhibitor (PPI) and histamine‐2 receptor antagonist (H2RA) use on the occurrence of acute kidney injury (AKI) in septic patients at high risk for developing stress ulcers. Methods: Using the Medical Information Mart for Intensive Care IV version 2.2 database, septic patients with high‐risk factors for stress ulcers (i.e., shock, coagulopathy, invasive mechanical ventilation, or chronic liver diseases) were included. Exposures included PPIs and H2RAs within 24 h of intensive care unit (ICU) admission or prior to ICU admission. The primary end point was severe sepsis‐associated AKI as defined by the Kidney Disease Improving Global Outcomes criteria stage 3 (KDIGO‐3). Propensity score matching (PSM) was performed to balance baseline characteristics. Multivariable Cox proportional hazards regression was used to estimate the effect size. Results: 4731 PPI users and 4903 H2RA users were included. After PSM, there were 1785 pairs exposed to PPIs and H2RAs. In the PSM cohort, the cumulative incident KDIGO‐3 rate was higher in the PPI group than in the H2RA group (log‐rank test, p = 0.009). Regression analyses showed that PPI exposure [adjusted hazard ratio 1.32, 95% confidence interval (CI) 1.11–1.58, p = 0.002] was associated with incident KDIGO‐3 compared with H2RA use. This association remained consistent in sensitivity analyses. Additionally, the PPI group had a higher need for kidney replacement therapy compared with the H2RA group (3.6% vs. 2.1%, P = 0.012). Conclusions: Among septic patients at high risk for developing stress ulcers, PPI exposure was associated with incident KDIGO‐3 AKI compared with H2RA use. [ABSTRACT FROM AUTHOR]

The purpose of this study was to employ complexity theory as a theoretical framework and technology to facilitate the development of a life-long learning model for non-working time in the interdependent homes for adults with Autism Spectrum Disorders (ASD). A "Shining Star Sustainable Action Project" of the ROC Foundation for Autistic Children and Adults in Taiwan (FACT) was selected as the research target, and the staff of the FACT, the medical team of the Hualian Yuli Veteran Hospital, adults with autism and their families were interviewed, observed and analyzed to develop this model during four short-stays of the project from July 2009 to December 2010. Participant field observation and informal conversations were employed and qualitative data were analyzed by using the constant comparison method through application of QSR Nvivo 9. The results showed that dynamic interaction, mutual adaptation, self-organization and co-evolution are four key elements for developing a viable life-long learning model for non-working time in the interdependent homes for adults with ASD to adapt to the impact of an aging society, to improve the quality of medical services, and to enhance the quality of life for the medical teams, patients and their families. The present study also found that the model help medical teams to avoid burnout by learning leisure skills and relaxation techniques, ways to release stress and how to enhance life-long learning for themselves and caregivers/patients' families. (Contains 5 figures and 1 table.)

In this study, the bipolar switching properties and electrical conduction behaviors of the ITO thin films RRAM devices were investigated. For the transparent RRAM devices structure, indium tin oxide thin films were deposited by using the RF magnetron sputtering method on the ITO/glass substrate. For the ITO/ITOX/ITO/glass (MIM) structure, an indium tin oxide thin film top electrode was prepared to form the transparent RRAM devices. From the experimental results, the 102 On/Off memory ratio and bipolar switching cycling properties for set/reset stable states were found and discussed. All transparent RRAM devices exhibited the obvious memory window and low set voltage for the switching times of 120 cycles. The electrical transport mechanisms were dominated by the ohmic contact and space charge limit conduction (SCLC) models for set and reset states. Finally, the transmittances properties of the transparent ITO/ITOX/ITO RRAM devices for the different oxygen growth procedures were about 90% according to the UV–Vis spectrophotometer for the visible wavelength range. [ABSTRACT FROM AUTHOR]

In this study, non-stoichiometry lead-free piezoelectric ceramic Li0.058(K0.48Na0.535)0.966(Nb0.9Ta0.1)O3 (LKNNT) thick films were deposited on Pt/Ti/Si substrates using spin-coating method technology to form a LKNNT/Pt/Ti/Si structure of the micro-pressure thick films. Additionally, the influence on the crystalline properties, surface microstructure images, and mechanical properties, and the piezoelectric properties of the non-stoichiometry lead-free piezoelectric ceramic Li0.058(K0.48Na0.535)0.966(Nb0.9Ta0.1)O3 (LKNNT) thick films were observed, analyzed, and calculated using X-ray diffraction (XRD), field-emission scanning electron microscopy (FE-SEM), focused ion beam (FIB) microscopy, nano-indention technology, and other instruments. This study was divided into two parts: The first part was the investigation into the fabrication parameters and properties of the bottom layer (Pt) and buffer layer (Ti). The Pt/Ti/Si structures were achieved by the DC sputtering method, and then the rapid thermal annealing (RTA) post-treatment process was used to re-arrange the grains and reduce defects in the lead-free Li0.058(K0.48Na0.535)0.966(Nb0.9Ta0.1)O3 (LKNNT) thick films. In the second part, lead-free Li0.058(K0.48Na0.535)0.966(Nb0.9Ta0.1)O3 (LKNNT) powder was prepared by the solid-state reaction method, and then acetic acid (C2H4O2) solvent was added to form a slurry for spin-coating technology processing. The fabrication parameters, thick film micro-structure, crystalline properties, nano-indention technology, and the piezoelectric coefficient characteristics of the developed lead-free Li0.058(K0.48Na0.535)0.966(Nb0.9Ta0.1)O3 (LKNNT)/Pt/Ti/Si structure of the micro-pressure thick film devices a were investigated. According to the experimental results, the optimal fabrication processing parameters of the lead-free Li0.058(K0.48Na0.535)0.966(Nb0.9Ta0.1)O3 (LKNNT) were an RTA temperature of 500 °C, a Ti buffer-layer thickness of 273.9 nm, a Pt bottom electrode-layer thickness of 376.6 nm, a theoretical density of LKNNT of 4.789 g/cm3, a lattice constant of 3.968 × 10−8 cm, and a d33 value of 150 pm/V. Finally, regarding the mechanical properties of the micro-pressure devices for when a microforce of 3 mN was applied, the thick film revealed a hardness of 60 MPa, a Young's modulus of 13 GPa, and an elasticity interval of 1.25 μm, which are suitable for future applications of micro-pressure devices. [ABSTRACT FROM AUTHOR]

Using two kinds of targets (gallium and silicon dioxide) and the rf magnetron sputtering deposited technique, GdOx:SiO2 thin film RRAM devices were deposited on TiN/Si substrate to form a metal–insulator–metal (MIM) structure. In addition, different oxygen concentrations and rf sputtering power parameters were prepared for the GdOx:SiO2 thin films. Decrease of the defects and oxygen vacancies of the GdOx:SiO2 thin films were used and repaired by rapid thermal annealing technology. Indium tin oxide (ITO) as the top electrode on the GdOx:SiO2 thin film was prepared by the physical vapor deposition (PVD) method, and ITO/GdOx:SiO2/TiN/Si structures of the GdOx:SiO2 thin films' RRAM devices were also made. In addition, the current–voltage curves and devices' endurance properties were measured by an impedance analyzer. Finally, the crystalline style, the preferred phase, the grain size, and surface microstructure of the thin films were analyzed and observed from X-ray diffraction and field emission scanning electron microscope measurements. [ABSTRACT FROM AUTHOR]

Background. Elderly people often suffer from disturbed sleep. Because traditional Chinese medicine indicates that acupressure therapy may induce sedation, testing the effectiveness of acupressure in enhancing the quality of sleep of institutionalized residents with a well-designed scientific study is needed. Methods. A randomized block experimental design was used. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used as a screening tool to select subjects with sleep disturbance. By matching the effects of hypertension, hypnosis, naps, and exercise, subjects were randomly assigned to an acupressure group, a sham acupressure group, and a control group. Each group had 28 subjects for a total of 84 subjects. The same massage routine was used in the acupressure group and the sham acupressure group, whereas only conversation was employed in the control group. Results. There were significant differences in PSQI subscale scores of the quality, latency, duration, efficiency, disturbances of sleep, and global PSQI scores among subjects in the three groups before and after interventions. Furthermore, there was a significant reduction in the frequencies of nocturnal awakening and night wakeful time in the acupressure group compared to the other two groups. Conclusions. This study confirmed the effectiveness of acupressure in improving the quality of sleep of elderly people and offered a nonpharmacological therapy method for sleep-disturbed elderly people.

Objective: Animal-assisted therapy (AAT) has the potential to improve the symptomology, negative emotions, and level of well-being in older adults, as well as patients with mental illness. However, there remains limited evidence supporting the treatment efficacy of AAT in middle-aged and older adults with schizophrenia. Therefore, this study implemented a randomized controlled trial to assess the efficacy of a 12-week AAT psychological intervention with dogs for middle-aged and older patients with chronic schizophrenia in a clinical setting. Method: Patients, age ≥ 40 years, with chronic schizophrenia were allocated randomly to either the AAT group or control group. Patients in the AAT group received an additional hour -long AAT session every week for 12 weeks. Patients in the control group received the usual treatment plus an hour long non-animal related intervention. All patients were assessed based on primary outcome measures before and after the 12-week intervention, including the Positive and Negative Syndrome Scale (PANSS), Depression Anxiety Stress Scales Assessment (DASS), and Chinese Happiness Inventory (CHI). Results: Patients who received AAT had greater improvements in the PANSS and DASS-stress subscale scores than the control group (p < 0.05). The effect was small (success ratio different, SRD = 0.25) for the PANSS and the DASS-stress subscale (SRD = 0.15). There were no significant differences in the change scores of the CHI between the AAT and control groups (p = 0.461). Conclusions: AAT seemed to be effective in reducing psychiatric symptoms and stress levels of middle-aged and older patients with schizophrenia. AAT could be considered as a useful adjunctive therapy to the usual treatment programs. [ABSTRACT FROM AUTHOR]

Aims: To identify key factors influencing institutional nurses' self‐perceived competencies in spiritual care. Background: In the past decade, interest in spiritual care has been increasing; however, in long‐term care facilities, limited knowledge is available about nurses' competencies in spiritual care. Methods: The cross‐sectional study was conducted with 202 nurses in 11 long‐term care facilities. Data were collected in a survey using the Spirituality and Spiritual Care Rating Scale, the Nurse Spiritual Care Therapeutics Scale, the Spiritual Care Competence Scale and demographic questions. Data were analysed using stepwise linear regression. Results: Study findings revealed that nurses' perceptions of spirituality and spiritual care, frequency of spiritual care provision and self‐satisfaction with the spiritual care given all significantly predicted overall spiritual care competence, which together explain 58% of the total variance. Conclusions: Improving nurses' perceptions of spirituality and spiritual care and encouraging the performance of spiritual care may be an effective pathway to enhance the spiritual care competence of institutional nurses. Implications for Nursing Management: Additional continuing education on spiritual care topics and the establishment of clear guidance and support from institutional administrators are required to enable nurses to deal with spiritual issues as they arise and improve the quality of holistic care. [ABSTRACT FROM AUTHOR]

aims to analyze the prevalence of dyslipidemia and identify the cardiovascular disease (CVD) risk stratification among older adults living in Quanzhou, China's southeast coastal region, where the ancient Maritime Silk Road starts. Methods: A population-based cross-sectional survey of 2,018 adults was conducted in 60–98-year-old residents in Quanzhou from September 2016 to March 2018 using multistage stratified cluster random sampling. The 10-year CVD risk was also estimated by applying the Chinese model recommended by the Chinese Guidelines for Prevention of Cardiovascular Diseases. Results: The overall prevalence of dyslipidemia among older adults was 56.8%. The prevalence of high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG) were 8.4%, 13.9%, 23.1% and 11.4%, respectively. The mean levels of TC, LDL-C, HDL-C and TG were 5.12±1.18, 3.37±0.81, 1.03±0.27 and 1.65±0.76 mmol/L, respectively. Older adults had low risk, moderate risk and high risk for CVD, which were 49.7%, 36.8% and 13.5%, respectively. Age, body mass index and abdominal obesity were significantly associated with the risk of increasing LDL-C levels and were positively correlated to CVD risk. Conclusion: The prevalence of high TC, high LDL-C, low HDL-C and high TG was relatively low among older adults in Quanzhou, but their lipid levels were high. Approximately half of the elderly adults had moderate or high CVD risk. The personalized primary prevention and control of CVD are recommended for elderly people to identify high-risk individuals. [ABSTRACT FROM AUTHOR]

By the conventional solid state reaction method, a small amount of lithium fluoride (LiF) was used as the sintering promoter to improve the sintering and piezoelectric characteristics of (Ba0.95Ca0.05)(Ti0.93Sn0.07)O3 (BCTS) lead-free piezoceramic sheets. Using X-ray diffraction (XRD) and a scanning electron microscope (SEM), the inferences of the crystalline and surface microstructures were obtained and analyzed. Then, the impedance analyzer and d33-meter were used to measure the dielectric and piezoelectric characteristics. In this study, the optimum sintering temperature of the BCTS sheets decreased from 1450 °C to 1390 °C due to LiF doping. For the 0.07 wt % LiF-doped BCTS sheets sintered at 1390 °C, the piezoelectric constant (d33) is 413 pC/N, the electric–mechanical coupling coefficient (kp) is 47.5%, the dielectric loss (tan δ) is 3.9%, and the dielectric constant (εr) is 8100, which are all close to or even better than that of the pure undoped BCTS ceramics. The Curie temperature also improved, from 85 °C for pure BCTS to 140 °C for BCTS–0.07 LiF sheets. Furthermore, by using the vibration system and fixing 1.5 g tip mass at the end of the sheets, as the vibration frequency is 20 Hz, the proposed piezoelectric ceramic sheets also reveal a good energy harvesting performance at the maximum output peak voltage of 4.6 V, which is large enough and can be applied in modern low-power electronic products. [ABSTRACT FROM AUTHOR]

By the conventional solid-state liquid-phase sintering technique, Li0.058(K0.480Na0.535)0.966(Nb0.9Ta0.1)O3+ x wt% ZnO (x = 0, 0.2, 0.4, 0.6, 0.8, 1, 3) lead-free piezoelectric ceramics were fabricated. The addition of ZnO liquid-phase sintering promoters could improve the grain-growth of LKNNT ceramics significantly and its inferences were investigated detailed in this paper. The crystal phases and micro-structures were analyzed by means of the X-ray diffraction and scanning electronic microscopy, respectively. Using the impedance analyzer, the dielectric constant, loss tangent, Curie temperature, phase transition point, and electromechanical coupling factor were measured. And the piezoelectric constants were measured by the d33meter. Compared to pure LKNNT ceramic (sintered at 1090°C, d33= 279 pC/N, and kp= 0.46), for x = 0.6 specimen, even though the optimal d33and kpvalues were only 272 pC/N and kp= 0.44, but the optimal sintering temperature have been improved from 1090°C to 1020°C successfully. [ABSTRACT FROM PUBLISHER]

In this study, a series of Li0.058(K0.480Na0.535)0.966(Nb0.90Ta0.10)O3+ (x)LiF (x = 0, 0.1, 0.2, 0.3, 0.4, 0.5 wt%) lead-free piezoelectric ceramics were fabricated by a conventional solid-state reaction method. The incorporation of LiF could significantly improve the sintering ability of LKNNT ceramics by reducing the optimal sintering temperature from 1090°C to 1020°C. The crystal phases and micro-structures were analyzed by means of the X-ray diffraction and scanning electronic microscopy, respectively. The impedance analyzer was used to measure the Curie temperature, phase transition point, and electro-mechanical coupling factor. And the d33meter was used to measure the piezoelectric constants. From the results, due to the addition of 0.2 wt% LiF, uniform and condensed grains can be obtained and hence the sintering temperature can be lowered down. As the contents of LiF increased, the orthorhombic to tetragonal phase transition points TO-Twere almost no changed, but the Curie temperature TCdecreased from 425°C (x = 0) to 405°C (x = 0.5). And furthermore, the electro-mechanical coupling factor kpand piezoelectric constant d33were all decreased with increases of LiF contents. Hence, even though the reducing of little amount of piezoelectric characteristics, the LiF addition can improve the sintering ability of the LKNNT ceramics effectively. [ABSTRACT FROM PUBLISHER]

Purpose This study explored the risk factors, cut-off points, sensitivity, specificity, positive predictive values, and negative predictive values of physical performance testing among community-dwelling frail elderly people in Taiwan. Organizing Construct The empirical measurement of frailty is based on the following five indicators: weight loss, weakness, exhaustion, slow responses, and minimal physical activity. The frail phenotype is considered present if three or more of the indicators are observed. Meanwhile, a short battery of physical performance tests was conducted to assess the balance, mobility, and flexibility among elderly people. Methods A cross-sectional research design was executed. Participants were evaluated using a short battery of physical performance tests to assess their physical performance. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed. Findings The logistic regression results showed that the factors significantly correlated to frailty included falls in the previous year, smoking, hypertension, and bone and joint disease. Physical performance test scores were analyzed using the ROC curves to discriminate frailty statuses. The analysis results showed that the areas under the ROC curves for the diagnostic accuracy of right-hand grip, left-hand grip, and the 8-foot up-and-go test reached 0.70, and the optimal cut-off points determined using Youden's index were 17.25 kg, 20.75 kg, and 8.13 s, respectively. Conclusions The research findings suggest that physical performance variables can be used to effectively screen elderly people at risk for frailty in the community. Clinical Relevance The findings offer reference values for physical performance tests specific to community-dwelling frail elderly people. The information can enable health practitioners to achieve early identification of frailty among elderly people with anthropometric characteristics similar to those associated with people in Asian countries. [ABSTRACT FROM AUTHOR]

Summary: Objective: To examine the factors correlating with repetitive use of complementary and alternative medicine (CAM). Research design: In 2006, a community-based epidemiological survey was conducted in Taiwan. A total of 2457 participants (1237 men and 1220 women) aged 18 and over participated in the study. Results: From the application of regression tree analysis and the Health Belief Model, we have noticed the following findings. First, demand motive was the most dominant discriminator factor for the repetitive use of CAM. Second-layer discriminators were evaluated on the basis of action benefits and barriers, as well as sources of action information. Another predominant factor is the heterogeneity of individual background. When participants used CAM for treatment of illness, their household income was ≥1000 US dollars per month, they had past experience of western medicine seeking without effects and aged between 30 and 60 years, the predicted mean values for all types of CAM use is 5.62 (the highest). By contrast, when participants used CAM for maintenance of health, their household income was <2000 US dollars per month, they are male, with moderate or good self-rated health who had less than 9 education years, the predicted mean values for all types of CAM use is 1.36 (the lowest). Conclusion: Upon the above components, it assists us to understand the multiple interactive reasons on people''s repetitive use of CAM. It also provides essential information for specific CAM issues. Furthermore, from the different perspectives; it stimulates the thoughts for the future medical care projects. [Copyright &y& Elsevier]

Based on the resultant solution of two-dimensional (2D) Poisson's equation in silicon region, a new, compact and analytical model for nanoscale fully depleted, symmetrical tri-material gate stack double-gate (STMGSDG) metal–oxide–semiconductor field-effect transistor (MOSFET) has been developed. The STMGSDG MOSFET exhibits significantly reduced short-channel effects (SCEs) when compared with the symmetrical single-material gate stack double-gate (SSMGSDG) MOSFET. It is found that the threshold voltage roll-off for the fully depleted STMGSDG MOSFET can be effectively reduced by using both thin Si film and thin gate oxide. Besides, the high ratio of large work function of metal gate 1 (L1) to the total gate can efficiently suppress the drain-induced barrier lowering (DIBL) and maintain the low threshold voltage degradation. This study not only presents a precise 2D analytical model of the surface potential and threshold voltage, but also discusses the electric field distribution in the channel region, subthreshold swing and subthreshold current for the STMGSDG MOSFET. The new model is verified to be in a good agreement with numerical simulation results over a wide range of the device parameters. [ABSTRACT FROM AUTHOR]