Gender-specific linkages: frailty, polypharmacy, anti-cholinergic burden, and 5-year mortality risk-a real-world analysis

Background

With higher age, frailty escalates the risk of falls, unexpected physical dysfunction, hospitalization, and mortality. Polypharmacy in the older population is a major challenge that not only increases medical costs, but also may worsen the risk of hospitalization and death. More importantly, the properties of anti-cholinergic drugs contribute various negative effects. This study aimed to investigate the sex difference in the association of polypharmacy, anticholinergic burden, and frailty with mortality.

Methods

Participants older than 65 years who attended the geriatric outpatient clinic of the study center between January 2015 and July 2020 were invited to participate in this retrospective study. Comprehensive geriatric assessment data were collected and the phenotype of frailty was determined by Fried's criteria. Cox regression and the Kaplan-Meier curve were used to identify risk factors of 5-year survival along with intergroup differences in the risks.

Results

Of the 2,077 participants, 47.5% were female. The prevalence of frailty and the rate of polypharmacy were 44.7% and 60.6%, respectively. Higher age, male sex, low body mass index, low Mini-Mental State Examination scores, low activities of daily living, frailty status, polypharmacy, and a high Charlson Comorbidity Index score, and greater anticholinergic burden were significant risk factors that were associated with the 5-year all-cause mortality. Male patients with frailty exhibited the highest risks of mortality compared with male patients without frailty and female patients with or without frailty. Polypharmacy was significantly associated with a higher 5-year mortality rate in the frail male group compared with the non-frail male. In frail female group, individuals with a higher anticholinergic burden (as indicated by the Anticholinergic Cognitive Burden Scale) from drug usage exhibited an elevated 5-year mortality rate.

Conclusions

Polypharmacy and greater anticholinergic burden, synergistically interacted with frailty and intensified the 5-year mortality risk in a gender-specific manner. To mitigate mortality risks, clinicians should prudently identify polypharmacy and anticholinergic burden in the older population.

A Randomized Standard-of-Care Controlled Trial of Xenogeneic Platelet-Rich Plasma Lotion to Reduce Acute Radiation Dermatitis in Breast Cancer Patients

PURPOSE/OBJECTIVE(S)

Breast cancer patients experience acute radiation dermatitis (ARD) during radiation therapy (RT). The Multinational Association for Supportive Cancer Care published clinical practice guidelines for the prevention and treatment of ARD in 2013, and mild bathing at the irradiated site is the standard health education. This study examined the prophylactic effect of the newly developed xenogeneic platelet-rich plasma (PRP) lotion on acute radiation dermatitis (ARD) for breast cancer patients.

MATERIALS/METHODS

Ductal carcinoma in situ and early-stage breast cancers were enrolled after breast conserving surgery. Hypo-fractionated whole breast irradiation (42.5 Gy in 16 fractions) followed by tumor bed boost (10 Gy in 5 fractions) was used. Patients were randomly assigned to the Standard of Care (SOC) group (n = 48) or the PRP lotion group (n = 52). In both groups, patients were educated with standard health education on topical skin care. In the PRP lotion group, patients were instructed to apply the provided lotion twice a day, starting from the first day of RT: the first application within 1 hour after the daily RT session, the second at bedtime, and continue during the weekends. Patients were instructed not to apply the lotion within 6 hours before daily RT. We recorded the following skin reaction every week during RT and two weeks after RT: ARD was graded following the RTOG definition by two radiation oncologists; Dermatology Life Quality Index (DLQI) and Visual Analogue Scale for Pain (VAS Pain) were subjectively scored by patients to present patient-reported outcomes. The statistical software was used for all statistical analyses.

RESULTS

The patient characteristics in both groups were balanced except for a higher body mass index in the PRP lotion group. One patient did not complete RT in the SOC group due to pain intolerance. The severity of ARD grading in both groups is shown in Table. In comparison to the SOC group, the PRP lotion group demonstrated significantly reduced and delayed progression of ARD (p<0.01) and VAS Pain (p<0.01) during the whole RT course and two weeks after RT. The DLQI significantly improved at the 2nd week (p = 0.003), 3rd week (p = 0.01), 4th week (p<0.001), and the two weeks post-RT (p<0.001) period; however, this was not observed during the 1st week (p = 0.68). Similarly, the DLQI value progressively worsened two weeks after RT in the SOC group but not in the PRP lotion group.

CONCLUSION

This is the first study to use xenogeneic PRP lotion to prevent ARD clinically. The outcome of this study validated the prophylactic effects of xenogeneic PRP lotion on ARD, subsequently leading to an improved quality of life across the RT course.

Development of advanced photon calibrator for Kamioka gravitational wave detector (KAGRA)

The Kamioka Gravitational wave detector (KAGRA) cryogenic gravitational-wave observatory has commenced joint observations with the worldwide gravitational wave detector network. Precise calibration of the detector response is essential for accurately estimating parameters of gravitational wave sources. A photon calibrator is a crucial calibration tool used in laser interferometer gravitational-wave observatory, Virgo, and KAGRA, and it was utilized in joint observation 3 with GEO600 in Germany in April 2020. In this paper, KAGRA implemented three key enhancements: a high-power laser, a power stabilization system, and remote beam position control. KAGRA employs a 20 W laser divided into two beams that are injected onto the mirror surface. By utilizing a high-power laser, the response of the detector at kHz frequencies can be calibrated. To independently control the power of each laser beam, an optical follower servo was installed for power stabilization. The optical path of the photon calibrator's beam positions was controlled using pico-motors, allowing for the characterization of the detector's rotation response. Additionally, a telephoto camera and quadrant photodetectors were installed to monitor beam positions, and beam position control was implemented to optimize the mirror response. In this paper, we discuss the statistical errors associated with the measurement of relative power noise. We also address systematic errors related to the power calibration model of the photon calibrator and the simulation of elastic deformation effects using finite element analysis. Ultimately, we have successfully reduced the total systematic error from the photon calibrator to 2.0%.

Severe myocardial bridge presenting as paroxysmal atrioventricular block

Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.

[Effects of direct antiviral agent on the frequency of peripheral blood mononuclear cells and their activating factors sCD14s and CD163 in patients with chronic hepatitis C]

Objective: To explore the effects of direct antiviral agent (DAAs) on the frequency of peripheral blood mononuclear cells and their activating factors sCD14s and CD163 in patients with chronic hepatitis C. Methods: Data of 15 treatment-naive chronic hepatitis C patients and 10 healthy controls were collected. Patients with chronic hepatitis C were treated with DAAs for 12 weeks. Blood samples were collected at 0, 4 and 12 weeks respectively, and blood samples of healthy controls were used as controls. Flow cytometry was used to detect the frequency of classical CD14(++)CD16(-) mononuclear cells and pro-inflammatory CD14(+)CD16(+) mononuclear cells in peripheral blood. Serum sCD14s and sCD163 were detected by enzyme-linked immunosorbent assay. The comparison between the two groups was performed by t-test. The comparison between multiple groups was performed by analysis of variance, and further pairwise comparison was performed by LSD-t test. Results: Prior DAAs treatment, peripheral blood CD14(+)CD16(+) mononuclear cell frequency (18.49% ± 1.54% vs. 10.65% ± 0.83%), serum sCD14s [(64 407.38 ± 5778.49) pg/ml vs. (28 370.76 ± 2 357.68 ) pg/ml] and sCD163 [(22 853.80 ± 4 137.61) pg/ml vs. (2 934.41 ± 223.31) pg/ml] were all higher than healthy controls (P < 0.05), while the frequency of CD14(++)CD16(-) mononuclear cells in peripheral blood was lower than healthy controls (59.14%±0.54% vs. 72.75%±1.31%, P < 0.01). During DAAs treatment, CD14(+)CD16(+) mononuclear cells frequency, serum sCD14 and sCD163 were all decreased significantly. After 12 weeks of treatment, CD14(+)CD16(+) mononuclear cells had decreased to nearly normal level (12.42% ± 1.60% vs. 10.65% ± 0.83%, P > 0.05), and serum sCD14 and scd163 were still higher than those of healthy controls [sCD14: (44 390.06 ± 3 330.17) pg / ml vs. (28 370.76 ± 2 357.68) pg/ml, Scd163: (11 494.79 ± 1 836.97) pg / ml vs. (2 934.41 ± 223.31) pg / ml, P < 0.01], while the frequency of CD14(++)CD16(-)mononuclear cells had gradually increased during the course of treatment and neared healthy control level after 12 weeks of treatment. There was no statistically significant difference between the two groups (71.54) % ± 2.99% vs. 72.75% ± 1.31%, P > 0.05). Conclusion: DAAs therapy can reduce the activation of peripheral blood mononuclear cells in patients with chronic hepatitis C.

Effects of red blood cell aggregation on the blood flow in a symmetrical stenosed microvessel

In order to figure out whether red blood cell (RBC) aggregation is beneficial or deleterious for the blood flow through a stenosis, fluid mechanics of a microvascular stenosis was examined through simulating the dynamics of deformable red blood cells suspended in plasma using dissipative particle dynamics. The spatial variation in time-averaged cell-free layer (CFL) thickness and velocity profiles indicated that the blood flow exhibits asymmetry along the flow direction. The RBC accumulation occurs upstream the stenosis, leading to a thinner CFL and reduced flow velocity. Therefore, the emergence of stenosis produces an increased blood flow resistance. In addition, an enhanced Fahraeus-Lindqvist effect was observed in the presence of the stenosis. Finally, the effect of RBC aggregation combined with decreased stenosis on the blood flow was investigated. The findings showed that when the RBC clusters pass through the stenosis with a throat comparable to the RBC core in diameter, the blood flow resistance decreases with increasing intercellular interaction strength. But if the RBC core is larger and even several times than the throat, the blood flow resistance increases largely under strong RBC aggregation, which may contribute to the mechanism of the microthrombus formation.

[Safety and efficacy of DCV-based DAAs therapy for chronic HCV infection in China]

Objective: To evaluate the efficacy and safety of DCV-based DAAs therapy for chronic HCV infected Chinese patients. Methods: An open-label, non-randomized, prospective study was designed. Fifty-two patients with chronic HCV infection were enrolled. Among them, there was one patient after liver transplantation, 2 patients after kidney transplantation, 3 patients with hepatocellular carcinoma, and 4 patients with HBV infection. Thirteen cases with chronic hepatitis C (one compensated cirrhosis) who were negative for resistance-related variants [NS5A RAS (-)] of gene 1b and NS5A were treated with daclatasvir (DCV) + asunaprevir (ASV) for 24 weeks. Twenty-five cases of CHC (six compensated cirrhosis) with GT 1b, 2a, 3a, 3b, 6a were treated with DCV + SOF ± RBV for 24 weeks. 8 cases with decompensated cirrhosis of gene 1b and NS5A RAS(-) were given DCV + SOF + RBV regimen for 12 weeks. Six cases with decompensated cirrhosis, of gene 2a, 1b, 2a, 3a, 3b, were given DCV + SOF + RBV regimen for 24 weeks. HCV RNA, blood routine test, liver and kidney function, and upper abdominal ultrasound/MRI were measured at baseline, 4 weeks of treatment, end of treatment, and 12 weeks of follow-up. The incidence of adverse events and laboratory abnormalities during treatment were recorded. A t-test was used to compare the measurement data between two groups, and analysis of variance was used to compare the measurement data between multiple groups. Results: Sixteen patients (100%) achieved SVR12 after treatment, with 0% recurrence rate. Rapid virological response (RVR) of the four treatment regimens were 76.92%, 54.17%, 87.50%, and 83.33%, respectively, and 32 patients achieved 100% virological response after the completion of treatment. The incidence of adverse events of chronic hepatitis C with cirrhosis and decompensated cirrhosis was 62.5% and 64.29%, respectively. The most common adverse event was fatigue in CHC (25.00%), and elevated indirect bilirubin in decompensated cirrhosis (42.86%). No serious adverse drug events, deaths or adverse reactions occurred. Conclusion: DCV-based DAAs regimen is promising option for the treatment of HCV genotypes, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and HCV infection after liver/kidney transplantation in china. Above all, it has high SVR12 with good tolerability and safety profile.

Synchronous renal cell carcinoma and pheochromocytoma presenting as acute decompensated heart failure

We report a 49-year-old woman who presented with a hypertensive crisis and acute heart failure and reduced left ventricular systolic function. An abdominal ultrasonography revealed a huge lobulated heterogeneous mass at the lower pole of the right kidney and a mass over the left suprarenal area, which were further delineated by magnetic resonance imaging. The patient underwent laparoscopic right radical nephrectomy and left adrenalectomy. Histopathological analysis confirmed the diagnoses of clear cell renal cell carcinoma of the right kidney with metastasis to the lung; and atypical pheochromocytoma of the left adrenal gland. Target therapy was initiated, which resulted in stabilization of the patient's tumors and the recovery of her heart function. To avoid a delayed diagnosis and catastrophic outcome, clinicians should consider such rare causes of acute decompensated heart failure.

Blazar spectral variability as explained by a twisted inhomogeneous jet

Blazars are active galactic nuclei, which are powerful sources of radiation whose central engine is located in the core of the host galaxy. Blazar emission is dominated by non-thermal radiation from a jet that moves relativistically towards us, and therefore undergoes Doppler beaming. This beaming causes flux enhancement and contraction of the variability timescales, so that most blazars appear as luminous sources characterized by noticeable and fast changes in brightness at all frequencies. The mechanism that produces this unpredictable variability is under debate, but proposed mechanisms include injection, acceleration and cooling of particles, with possible intervention of shock waves or turbulence. Changes in the viewing angle of the observed emitting knots or jet regions have also been suggested as an explanation of flaring events and can also explain specific properties of blazar emission, such as intra-day variability, quasi-periodicity and the delay of radio flux variations relative to optical changes. Such a geometric interpretation, however, is not universally accepted because alternative explanations based on changes in physical conditions-such as the size and speed of the emitting zone, the magnetic field, the number of emitting particles and their energy distribution-can explain snapshots of the spectral behaviour of blazars in many cases. Here we report the results of optical-to-radio-wavelength monitoring of the blazar CTA 102 and show that the observed long-term trends of the flux and spectral variability are best explained by an inhomogeneous, curved jet that undergoes changes in orientation over time. We propose that magnetohydrodynamic instabilities or rotation of the twisted jet cause different jet regions to change their orientation and hence their relative Doppler factors. In particular, the extreme optical outburst of 2016-2017 (brightness increase of six magnitudes) occurred when the corresponding emitting region had a small viewing angle. The agreement between observations and theoretical predictions can be seen as further validation of the relativistic beaming theory.

Dexmedetomidine protected COPD-induced lung injury by regulating miRNA-146a

OBJECTIVE

To study the mechanism of protection provided by dexmedetomidine against COPD-induced lung injury.

METHODS

COPD rat model was determined by measuring lung function, and comparing HE staining between two different groups. We got the lung tissue and cells from the control and COPD groups. The cells were divided into three groups: control group, and blank and drug groups that were from the COPD rats. Cell apoptosis, relative gene expression and TNF-α and IL-1β from nutrient solution were measured.

RESULTS

The TV, PEF, EF50, FEV0.3 and FEV0.3/FVC in COPD group were significantly lower than in control group (1.26±0.17 vs 2.65±0.21; 17.61±0.35 vs 38.55±0.24; 1.20±0.14 vs 1.81±0.06; 2.52±0.28 vs 4.44±0.26; 63.39±0.22 vs 88.45±0.34, p < 0.05, respectively). Cell apoptosis was significantly different in blank and drug groups (21.65±0.86 vs 10.74±0.15; p < 0.05, respectively). The gene expressions of miRNA-146a, p53 and Bcl-2 were significantly downregulated compared with blank group.

CONCLUSION

Dexmedetomidine protected COPD-induced lung injury by inhibiting miRNA-146a expression to reduce cell apoptosis (Tab. 1, Fig. 3, Ref. 25).

Simulation of a single red blood cell flowing through a microvessel stenosis using dissipative particle dynamics

The motion and deformation of a single red blood cell flowing through a microvessel stenosis was investigated employing dissipative particle dynamics (DPD) method. The numerical model considers plasma, cytoplasm, the RBC membrane and the microvessel walls, in which a three dimensional coarse-grained spring RBC. The suspending plasma was modelled as an incompressible Newtonian fluid and the vessel walls were regarded as rigid body. The body force exerted on the free DPD particles was used to drive the flow. A modified bounce-back boundary condition was enforced on the membrane to guarantee the impenetrability. Adhesion of the cell to the stenosis vessel surface was mediated by the interactions between receptors and ligands. Firstly, the motion of a single RBC in a microfluidic channel was simulated and the results were found in agreement with the experimental data cited by [1]. Then the mechanical behavior of the RBC in the microvessel stenosis was studied. The effects of the bending rigidity of membrane, the size of the stenosis and the driven body force on the deformation and motion of red blood cell were discussed.

Postoperative adverse outcomes after non-hepatic surgery in patients with liver cirrhosis

BACKGROUND

Postoperative adverse outcomes in patients with liver cirrhosis are not completely understood. This study evaluated the association between liver cirrhosis and adverse outcomes after non-hepatic surgery.

METHODS

Reimbursement claims were used to identify patients with preoperative liver cirrhosis who underwent non-hepatic surgery from 2004 to 2007. Control patients without cirrhosis were matched by age, sex, type of surgery and anaesthesia. The adjusted odds ratios (ORs) and 95 per cent confidence intervals (c.i.) of postoperative adverse events associated with liver cirrhosis were analysed by multivariable logistic regression.

RESULTS

Thirty-day mortality rates among 24 282 patients with cirrhosis and 97 128 control patients were 1·2 per cent (299 deaths) and 0·7 per cent (635 deaths) respectively. Liver cirrhosis was associated with postoperative 30-day mortality (OR 1·88, 95 per cent c.i. 1·63 to 2·16), acute renal failure (OR 1·52, 1·34 to 1·74), septicaemia (OR 1·42, 1·33 to 1·51) and intensive care unit admission (OR 1·39, 1·33 to 1·45). Postoperative mortality increased in patients who had liver cirrhosis with viral hepatitis (OR 2·87, 1·55 to 5·30), alcohol dependence syndrome (OR 3·74, 2·64 to 5·31), jaundice (OR 5·47, 3·77 to 7·93), ascites (OR 5·85, 4·62 to 7·41), gastrointestinal haemorrhage (OR 3·01, 2·33 to 3·90) and hepatic coma (OR 5·11, 3·79 to 6·87).

CONCLUSION

Patients with liver cirrhosis had increased mortality and complications after non-hepatic surgery, particularly those with cirrhosis-related clinical indicators.

Characteristic dermoscopic features of primary cutaneous amyloidosis: a study of 35 cases

BACKGROUND

Primary cutaneous amyloidosis (PCA) is a relatively common skin disorder among Asians and South Americans. It is usually diagnosed clinically. However, for cases with atypical presentations, the diagnosis can be a challenge and skin biopsy may be necessary. Dermoscopy has been proved to be a valuable, noninvasive tool in the diagnosis of cutaneous pigmented diseases. Most lesions of PCA show hyperpigmentation and the major histopathological abnormalities of PCA occur in the epidermis and dermal papillae. Dermoscopy might be a powerful tool to provide valuable information for the diagnosis of PCA.

OBJECTIVES

We aimed to find characteristic dermoscopic features of PCA.

MATERIALS AND METHODS

Cases with typical clinical presentations of PCA, either macular or lichen subtypes, were included in this study. All were evaluated using a hand-held, polarized and nonpolarized dermoscope.

RESULTS

A total of 35 patients with clinically diagnosed PCA were enrolled. Eighteen patients had lesions consistent with macular amyloidosis and 17 with lichen amyloidosus. We found two major dermoscopic patterns characteristic of PCA. The most common dermoscopic finding of PCA was a central hub, which could be either white or brown, surrounded by various configurations of pigmentation. For cases of lichen amyloidosus with prominent hyperkeratosis, the central hub was replaced by a scar-like morphology.

CONCLUSIONS

This is the first study to report the characteristic dermoscopic features of PCA. We demonstrate that the use of a dermoscope may assist in achieving an accurate diagnosis of PCA.

Magnetic field dependence of the lowest-frequency edge-localized spin wave mode in a magnetic nanotriangle

An understanding of the spin dynamics of nanoscale magnetic elements is important for their applications in magnetic sensing and storage. Inhomogeneity of the demagnetizing field in a non-ellipsoidal magnetic element results in localization of spin waves near the edge of the element. However, relative little work has been carried out to investigate the effect of the applied magnetic fields on the nature of such localized modes. In this study, micromagnetic simulations are performed on an equilateral triangular nanomagnet to investigate the magnetic field dependence of the mode profiles of the lowest-frequency spin wave. Our findings reveal that the lowest-frequency mode is localized at the base edge of the equilateral triangle. The characteristics of its mode profile change with the ground state magnetization configuration of the nanotriangle, which, in turn, depends on the magnitude of the in-plane applied magnetic field.

Effect of caffeine, norfloxacin and nimesulide on heartbeat and VEGF expression of zebrafish larvae

The use of pharmaceuticals during pregnancy may causes abnormalities to the embryo. Sometime the drug also effect to the new born if the drug transferred through lactation. We have used zebrafish model to see the effect of some pharmaceuticals on embryos and larvae. Three drugs, caffeine, norfloxacin and nimesulide, were used for this study to see the effect mainly the hatching rate of eggs, heart beat rate and the vascular endothelial growth factor (VEGF) expression of the larvae. VEGF is an important signaling protein that involved generating the new blood vessels during embryonic development. We have used 10, 20, 50, 100 microg ml(-1) concentrations of all the drugs to see the effect. No significant mortality or malformations were observed in zebrafish embryos. Hatching was stared from 60 hr. In control group, 91% hatching rate was observed. Lowest hatching rate was observed using highest concentration of norfloxacin (100 microg ml(-1)) and nimesulide (100 microg ml(-1)) i.e. 55 and 56% respectively. In control group, 110 to 115 heart beat rate was counted per minute. Significantly higher heart beat was observed in caffeine treated group which is 125 to 140 min(-1) Lower heart beat was noted in nimesulide treated group which is 100 min(-1). We have tried to observe the possible effect of VEGF of the larvae by these three drugs. Expression of VEGF was very low in caffeine treated group. Almost no VGF expression was observe in 100 microg ml(-1) caffeine treated group. These studies suggest that there is a possibility that high dosage of caffeine can harm the unborn baby or new born babies, if the mothers use caffeine.

A hypothetical relationship between the nuclear reprogramming factors for induced pluripotent stem (iPS) cells generation--bioinformatic and algorithmic approach

A hypothetical evolutionary relationship was generated between the nuclear reprogramming factors for induced pluripotent stem (iPS) cells generation. Utilizing bioinformatics techniques, sequence analyses and phylogenetic tree algorithms, a comparative study has been performed to understand the evolutionary relationship of human nuclear reprogramming factors of induced pluripotent stem cells (iPSCs) generation. Among the total six nuclear reprogramming factors, the four reprogramming factors (SOX2, C-MYC, KLF4, and LIN28) have significant evolutionary origin. Our study shows SOX2 and C-MYC have evolutionary relationship and common point of origin. Likewise, KLF4 and LIN28 are having evolutionary relationship and have common point of origin. Based on these evidences, we propose that our study may be a great help to the future researchers to understand the mechanism(s) as well as pathway of nuclear reprogramming process.

Dark-recovery experiences, coping strategies, and needs of adult heart transplant recipients in Taiwan

AIMS

The aim of this project was to identify the dark-recovery experiences (DRE) that adult heart transplant recipients (AHTRs) perceived as causing the most suffering after heart transplantation (HT). In artition, we sought to explore the stage-specific difficulties, coping strategies, and helpers for transplant recipients DRE in Taiwan.

METHODS

A qualitative design was employed using a sample group of patients with DRE. Retrospective data collected by face-to-face in-depth interviews were subjected to content analysis.

RESULTS

A total of 20 AHTRs (16 men, 4 women) participated in this research. Their ages ranged from 32-70 years (mean, 46.95 years). Their post-HT timeframe ranged from 3 months-2.10 years. The subjects reported DRE the across preoperative intensive care unit (ICU), postoperative floor unit, and even after the hospital discharge stages. Four major difficulties during DRE were reported: (1) becoming a burden for families (all stages); (2) unfamiliar with medical protocols, environment, and policy (ICU stage); (3) mental and physical discomforts caused by the invasive examinations and unstable health condition (post-ICU to postdischarge stages); and (4) sense of uncertainty about health progression and quality of life in the future (post-ICU to postdischarge stages). Four coping strategies were used for DRE: (1) asking religious support (all stages); (2) changing mindsets and taking positive attitudes to live with difficulties (ICU to postdischarge stages); (3) setting goals for health maintenance and recovery (post-ICU to postdischarge stages); and (4) planning to look for an appropriate job in the future (postdischarge stages). Families and religious persons were cited as helpers (all stages), as well as health professionals (ICU to postdischarge stages), other AHTRs (post-ICU to postdischarge stages), and the social welfare systems (postdischarge stages).

CONCLUSION

DRE, coping strategies, and related helpers in Taiwan were systematically explored in this project. With this information, the transplantation team will be empowered to provide better care for AHTRs during their most vulnerable time.

Search for the associated production of the standard-model Higgs Boson in the all-hadronic channel

We report on a search for the standard-model Higgs boson in pp collisions at square root(s) = 1.96 TeV using an integrated luminosity of 2.0 fb(-1). We look for production of the Higgs boson decaying to a pair of bottom quarks in association with a vector boson V (W or Z) decaying to quarks, resulting in a four-jet final state. Two of the jets are required to have secondary vertices consistent with B-hadron decays. We set the first 95% confidence level upper limit on the VH production cross section with V(--> qq/qq')H(--> bb) decay for Higgs boson masses of 100-150 GeV/c2 using data from run II at the Fermilab Tevatron. For m(H) = 120 GeV/c2, we exclude cross sections larger than 38 times the standard-model prediction.

First observation of B(s)(0) --> D(s)(+/-)K(-/+) and measurement of the ratio of branching fractions B(B(s)(0) --> D(s)(+/-)K(-/+)/B(B(s)(0) --> D(s)(+)pi(-))

A combined mass and particle identification fit is used to make the first observation of the decay B(s)(0) --> D(s)(+/-)K(-/+) and measure the branching fraction of B(s)(0) --> D(s)(+/-)K(-/+) relative to B(s)(0) --> D(s)(+)pi(-). This analysis uses 1.2 fb(-1) integrated luminosity of pp collisions at square root(s) = 1.96 TeV collected with the CDF II detector at the Fermilab Tevatron collider. We observe a B(s)(0) --> D(s)(+/-)K(-/+) signal with a statistical significance of 8.1 sigma and measure B(B(s)(0) --> D(s)(+/-)K(-/+) /B(B(s)(0) --> D(s)(+)pi(-) 0.097+/-0.018(stat) +/- 0.009(syst).

Measurement of the top-quark mass with dilepton events selected using neuroevolution at CDF

We report a measurement of the top-quark mass M_{t} in the dilepton decay channel tt[over ] --> bl;{'+} nu_{l};{'}b[over ]l;{-}nu[over ]_{l}. Events are selected with a neural network which has been directly optimized for statistical precision in top-quark mass using neuroevolution, a technique modeled on biological evolution. The top-quark mass is extracted from per-event probability densities that are formed by the convolution of leading order matrix elements and detector resolution functions. The joint probability is the product of the probability densities from 344 candidate events in 2.0 fb;{-1} of pp[over ] collisions collected with the CDF II detector, yielding a measurement of M_{t} = 171.2 +/- 2.7(stat) +/- 2.9(syst) GeV / c;{2}.

Direct bound on the total decay width of the top quark in pp collisions at sqrt[s]=1.96 TeV

We present the first direct experimental bound on the total decay width of the top quark, Gamma(t), using 955 pb(-1) of the Tevatron's pp collisions recorded by the Collider Detector at Fermilab. We identify 253 top-antitop pair candidate events. The distribution of reconstructed top quark mass from these events is fitted to templates representing different values of the top quark width. Using a confidence interval based on likelihood-ratio ordering, we extract an upper limit at 95% C.L. of Gamma(t)<13.1 GeV for an assumed top quark mass of 175 GeV/c(2).

Search for maximal flavor violating scalars in same-charge lepton pairs in pp collisions at sqrt[s]=1.96 TeV

Models of maximal flavor violation (MxFV) in elementary particle physics may contain at least one new scalar SU(2) doublet field Phi(FV)=(eta(0),eta(+)) that couples the first and third generation quarks (q_(1), q_(3)) via a Lagrangian term L(FV)=xi(13)Phi(FV)q(1)q(3). These models have a distinctive signature of same-charge top-quark pairs and evade flavor-changing limits from meson mixing measurements. Data corresponding to 2 fb(-1) collected by the Collider Dectector at Fermilab II detector in pp[over ] collisions at sqrt[s]=1.96 TeV are analyzed for evidence of the MxFV signature. For a neutral scalar eta(0) with m_(eta;(0))=200 GeV/c(2) and coupling xi(13)=1, approximately 11 signal events are expected over a background of 2.1+/-1.8 events. Three events are observed in the data, consistent with background expectations, and limits are set on the coupling xi(13) for m(eta(0)=180-300 GeV/c(2).

Measurement of the single-top-quark production cross section at CDF

We report a measurement of the single-top-quark production cross section in 2.2 fb;{-1} of pp collision data collected by the Collider Detector at Fermilab at sqrt[s]=1.96 TeV. Candidate events are classified as signal-like by three parallel analyses which use likelihood, matrix element, and neural network discriminants. These results are combined in order to improve the sensitivity. We observe a signal consistent with the standard model prediction, but inconsistent with the background-only model by 3.7 standard deviations with a median expected sensitivity of 4.9 standard deviations. We measure a cross section of 2.2(-0.6)(+0.7)(stat+syst) pb, extract the Cabibbo-Kobayashi-Maskawa matrix-element value |V(tb)|=0.88(-0.12)(+0.13)(stat+syst)+/-0.07(theory), and set the limit |V(tb)|>0.66 at the 95% C.L.

Search for supersymmetry in pp collisions at sqrt[s]=1.96 TeV Using the trilepton signature for chargino-neutralino production

We use the three lepton and missing energy trilepton signature to search for chargino-neutralino production with 2.0 fb;{-1} of integrated luminosity collected by the CDF II experiment at the Tevatron pp[over ] collider. We expect an excess of approximately 11 supersymmetric events for a choice of parameters of the mSUGRA model, but our observation of 7 events is consistent with the standard model expectation of 6.4 events. We constrain the mSUGRA model of supersymmetry and rule out chargino masses up to 145 GeV/c;{2} for a specific choice of parameters.

Search for the Higgs boson produced in association with Z-->l+l in pp collisions at sqrt[s]=1.96 TeV

We present a search for the Higgs boson in the process qq-->ZH-->l;{+}l;{-}bb[over ]. The analysis uses an integrated luminosity of 1 fb;{-1} of pp[over ] collisions produced at sqrt[s]=1.96 TeV and accumulated by the upgraded Collider Detector at Fermilab (CDF II). We employ artificial neural networks both to correct jets mismeasured in the calorimeter and to distinguish the signal kinematic distributions from those of the background. We see no evidence for Higgs boson production, and set 95% C.L. upper limits on sigma{ZH}B(H-->bb[over ]), ranging from 1.5 to 1.2 pb for a Higgs boson mass (m{H}) of 110 to 150 GeV/c(2).

Forward-backward asymmetry in top-quark production in pp[over] collisions at sqrt[s]=1.96 TeV

We present measurements of the forward-backward charge asymmetry in top pair production using 1.9 fb;{-1} of pp[over ] collisions at sqrt[s]=1.96 TeV recorded with the Collider Detector at Fermilab II. Correcting for acceptance and measurement dilutions we obtain parton-level asymmetries of A_{FB};{pp[over ]}=0.17+/-0.08 in the pp[over ] frame and A_{FB};{tt[over ]}=0.24+/-0.14 in the tt[over ] frame. The values are consistent with the standard model expectation and disfavor exotic production mechanisms with significant negative values.

Search for the flavor-changing neutral-current decay t-->Zq in pp collisions at sqrt[s] = 1.96 TeV

We report a search for the flavor-changing neutral-current decay of the top quark t-->Zq (q=u, c) in pp collisions at sqrt[s]=1.96 TeV using a data sample corresponding to an integrated luminosity of 1.9 fb(-1) collected by the CDF II detector. This decay is strongly suppressed in the standard model and an observation of a signal at the Fermilab Tevatron would be an indication of physics beyond the standard model. Using Z+ > or = 4 jet final state candidate events, with and without an identified bottom quark jet, we obtain an upper limit of B(t-->Zq) < 3.7% at 95% C.L.

Search for large extra dimensions in final states containing one photon or jet and large missing transverse energy produced in pp collisions at square root[s]=1.96 TeV

We present the results of searches for large extra dimensions in samples of events with large missing transverse energy E_{T} and either a photon or a jet produced in pp[over ] collisions at sqrt[s]=1.96 TeV collected with the Collider Detector at Fermilab II. For gamma+E_{T} and jet+E_{T} candidate samples corresponding to 2.0 and 1.1 fb;{-1} of integrated luminosity, respectively, we observe good agreement with standard model expectations and obtain a combined lower limit on the fundamental parameter of the large extra dimensions model M_{D} as a function of the number of extra dimensions in the model.

Search for doubly charged Higgs bosons with lepton-flavor-violating decays involving tau leptons

We search for pair production of doubly charged Higgs particles (H+/- +/-) followed by decays into electron-tau (etau) and muon-tau (mutau) pairs using data (350 pb(-1) collected from [over]pp collisions at sqrt[s]=1.96 TeV by the CDF II experiment. We search separately for cases where three or four final-state leptons are detected, and combine results for exclusive decays to left-handed etau (mutau) pairs. We set an H+/- +/- lower mass limit of 114(112) GeV/c(2) at the 95% confidence level.

Search for pair production of scalar top quarks decaying to a tau lepton and a b quark in pp over collisions at sqrt s=1.96 TeV

We search for pair production of supersymmetric top quarks (t over1), followed by R-parity violating decay t over1-->taub with a branching ratio beta, using 322 pb(-1) of pp over collisions at sqrt s=1.96 TeV collected by the upgraded Collider Detector at Fermilab. Two candidate events pass our final selection criteria, consistent with the standard model expectation. We set upper limits on the cross section sigma(t over1t over1) x beta2 as a function of the top-squark mass m(t over1). Assuming beta=1, we set a 95% confidence level limit m(t over1)>153 GeV/c2. The limits are also applicable to the case of a third-generation scalar leptoquark (LQ3) decaying LQ3-->taub.

Search for resonant tt[overline] production in pp[overline] collisions at sqrt[s]=1.96 TeV

We report on a search for narrow-width particles decaying to a top and antitop quark pair. The data set used in the analysis corresponds to an integrated luminosity of 680 pb(-1) collected with the Collider Detector at Fermilab in run II. We present 95% confidence level upper limits on the cross section times branching ratio. Assuming a specific top-color-assisted technicolor production model, the leptophobic Z' with width Gamma(Z')=0.012M(Z'), we exclude the mass range M(Z')<725 GeV/c(2) at the 95% confidence level.

Search for the Higgs boson in events with missing transverse energy and b quark jets produced in pp collisions at square root(s)=1.96 TeV

We search for the standard model Higgs boson produced in association with an electroweak vector boson in events with no identified charged leptons, large imbalance in transverse momentum, and two jets where at least one contains a secondary vertex consistent with the decay of b hadrons. We use approximately 1 fb(-1) integrated luminosity of pp collisions at square root(s)=1.96 TeV recorded by the Collider Detector at Fermilab II experiment at the Tevatron. We find 268 (16) single (double) b-tagged candidate events, where 248+/-43 (14.4+/-2.7) are expected from standard model background processes. We observe no significant excess over the expected background and thus set 95% confidence level upper limits on the Higgs boson production cross section for several Higgs boson masses ranging from 110 to 140 GeV/c(2). For a mass of 115 GeV/c(2), the observed (expected) limit is 20.4 (14.2) times the standard model prediction.

Strong evidence for ZZ production in pp[over] collisions at sqrt[s]=1.96 TeV

We report the first evidence of Z boson pair production at a hadron collider with a significance exceeding 4 standard deviations. This result is based on a data sample corresponding to 1.9 fb(-1) of integrated luminosity from pp[over] collisions at sqrt[s]=1.96 TeV collected with the Collider Detector at Fermilab II detector. In the lll'l' channel, we observe three ZZ candidates with an expected background of 0.096(-0.063)+0.092 events. In the llnunu channel, we use a leading-order calculation of the relative ZZ and WW event probabilities to discriminate between signal and background. In the combination of lll'l' and llnunu channels, we observe an excess of events with a probability of 5.1 x 10(-6) to be due to the expected background. This corresponds to a significance of 4.4 standard deviations. The measured cross section is sigma(pp[over]-->ZZ)=1.4(-0.6)+0.7(stat+syst) pb, consistent with the standard model expectation.

Observation of the decay Bc+/--->J/psipi+/- and measurement of the Bc+/- mass

The Bc+/- meson is observed through the decay Bc+/--->J/psipi+/-, in data corresponding to an integrated luminosity of 2.4 fb(-1) recorded by the Collider Detector at Fermilab II detector at the Fermilab Tevatron. A signal of 108+/-15 candidates is observed, with a significance that exceeds 8sigma. The mass of the Bc+/- meson is measured to be 6275.6+/-2.9(stat)+/-2.5(syst) MeV/c2.

First flavor-tagged determination of bounds on mixing-induced CP violation in Bs0 --> J/psiphi decays

This Letter describes the first determination of bounds on the CP-violation parameter 2beta(s) using B(s)(0) decays in which the flavor of the bottom meson at production is identified. The result is based on approximately 2000 B(s)(0)-->J/psiphi decays reconstructed in a 1.35 fb(-1) data sample collected with the CDF II detector using pp collisions produced at the Fermilab Tevatron. We report confidence regions in the two-dimensional space of 2beta(s) and the decay-width difference DeltaGamma. Assuming the standard model predictions of 2beta(s) and DeltaGamma, the probability of a deviation as large as the level of the observed data is 15%, corresponding to 1.5 Gaussian standard deviations.

Search for heavy toplike quarks using lepton plus jets events in 1.96 TeV pp collisions

We present the results of a search for pair production of a new heavy toplike quark t' decaying to a W boson and another quark using the Collider Detector at Fermilab II detector in run II of the Tevatron pp collider. Using a data sample corresponding to 760 pb(-1) of integrated luminosity, we fit the observed spectrum of total transverse energy and reconstructed t' quark mass to a combination of standard model processes and t' pair production. We see no evidence for t't' production, and we infer a lower limit of 256 GeV/c(2) on the mass of the t' at 95% C.L. assuming standard strong couplings for the t'.

Resonant electron heating and molecular phonon cooling in single C60 junctions

We study heating and heat dissipation of a single C(60) molecule in the junction of a scanning tunneling microscope by measuring the electron current required to thermally decompose the fullerene cage. The power for decomposition varies with electron energy and reflects the molecular resonance structure. When the scanning tunneling microscope tip contacts the fullerene the molecule can sustain much larger currents. Transport simulations explain these effects by molecular heating due to resonant electron-phonon coupling and molecular cooling by vibrational decay into the tip upon contact formation.

Measurement of Lifetime and Decay-Width Difference in B_{s};{0}-->J/psivarphi Decays

We measure the mean lifetime tau=2/(Gamma_{L}+Gamma_{H}) and the decay-width difference DeltaGamma=Gamma_{L}-Gamma_{H} of the light and heavy mass eigenstates of the B_{s}{0} meson, B_{sL}{0} and B_{sH}{0}, in B_{s}{0}-->J/psivarphi decays using 1.7 fb;{-1} of data collected with the CDF II detector at the Fermilab Tevatron pp[over ] collider. Assuming CP conservation, a good approximation for the B_{s}{0} system in the standard model, we obtain DeltaGamma=0.076_{-0.063}{+0.059}(stat)+/-0.006(syst) ps{-1} and tau=1.52+/-0.04(stat)+/-0.02(syst) ps, the most precise measurements to date. Our constraints on the weak phase and DeltaGamma are consistent with CP conservation.

Evidence for D0-D(0) mixing using the CDF II detector

We measure the time dependence of the ratio of decay rates for the rare decay D{0}-->K{+}pi{-} to the Cabibbo-favored decay D{0}-->K{-}pi;{+}. A signal of 12.7x10;{3} D{0}-->K{+}pi{-} decays was obtained using the Collider Detector at Fermilab II detector at the Fermilab Tevatron with an integrated luminosity of 1.5 fb;{-1}. We measure the D0-D[over ]{0} mixing parameters (R_{D},y{'},x{'2}), and find that the data are inconsistent with the no-mixing hypothesis with a probability equivalent to 3.8 Gaussian standard deviations.

Search for Bs0 --> micro+ micro- and B0 --> micro+ micro- decays with 2 fb-1 of pp collisions

We have performed a search for B(s)(0) --> micro(+) micro(-) and B(0) --> micro(+) micro(-) decays in pp collisions at square root s = 1.96 TeV using 2 fb(-1) of integrated luminosity collected by the CDF II detector at the Fermilab Tevatron Collider. The observed number of B(s)(0) and B0 candidates is consistent with background expectations. The resulting upper limits on the branching fractions are B(B(s)0) --> micro(+) micro(-)) <5.8 x 10(-8) and B(B(0) --> micro(+) micro(-))<1.8 x 10(-8) at 95% C.L.

Measurement of inclusive jet cross sections in Z/gamma*(-->e+e-) + jets production in pp[over ] collisions at square root s = 1.96 TeV

Inclusive jet cross sections in Z/gamma* events, with Z/gamma* decaying into an electron-positron pair, are measured as a function of jet transverse momentum and jet multiplicity in pp[over ] collisions at square root s = 1.96 TeV with the upgraded Collider Detector at Fermilab in run II, based on an integrated luminosity of 1.7 fb(-1). The measurements cover the rapidity region |y(jet)|<2.1 and the transverse momentum range p(T)(jet)>30 GeV/c. Next-to-leading order perturbative QCD predictions are in good agreement with the measured cross sections.

First measurement of W boson production in association with a single Charm quark in pp collisions at sqrt(s)=1.96 TeV

We present the first measurement of the production cross section of a W boson with a single charm quark (c) in pp collisions at sqrt(s)=1.96 TeV, using soft muon tagging of c jets. In a data sample of approximately 1.8 fb(-1), recorded with the Collider Detector at Fermilab II detector at the Fermilab Tevatron, we select events with W+1 or 2 jets. We use the charge correlation between the W and the muon from the semileptonic decay of a charm hadron to extract the Wc signal. We measure sigma Wc(PTc >20 GeV/c,|eta c|<1.5) x BR(W-->l nu)=9.8+/-3.2 pb, in agreement with theoretical expectations.

Observation of orbitally excited B(s) mesons

We report the observation of two narrow resonances consistent with states of orbitally excited (L=1) B_(s) mesons using 1 fb;(-1) of pp[over ] collisions at sqrt[s]=1.96 TeV collected with the Collider Detector at Fermilab II detector at the Fermilab Tevatron. We use two-body decays into K- and B+ mesons reconstructed as B(+)-->J/psiK(+), J/psi-->mu(+)mu(-) or B(+)-->D[over ](0)pi(+), D[over ](0)-->K(+)pi(-). We deduce the masses of the two states to be m(B_(s1))=5829.4+/-0.7 MeV/c(2) and m(B_(s2);(*))=5839.6+/-0.7 MeV/c;(2).

Direct measurement of the W Boson width in ppover collisions at square roots = 1.96 TeV

A direct measurement of the total decay width of the W boson Gamma(W) is presented using 350 pb(-1) of data from pp[over ] collisions at square root s = 1.96 TeV collected with the CDF II detector at the Fermilab Tevatron. The width is determined by normalizing predicted signal and background distributions to 230 185 W candidates decaying to enu and micronu in the transverse-mass region 50<M(T)<90 GeV and then fitting the predicted shape to 6055 events in the high-M(T) region, 90<M(T)<200 GeV. The result is Gamma(W)=2032 +/- 45(stat)+/-57(syst) MeV, consistent with the standard model expectation.

Cross-section-constrained top-quark mass measurement from dilepton events at the Tevatron

We report the first top-quark mass measurement that uses a cross-section constraint to improve the mass determination. This measurement is made with a dilepton tt event candidate sample collected with the Collider Detector II at Fermilab. From a data sample corresponding to an integrated luminosity of 1.2 fb(-1), we measure a top-quark mass of 170.7(-3.9)(+4.2)(stat)+/-2.6(syst)+/-2.4(theory) GeV/c(2). The measurement without the cross-section constraint is 169.7(-4.9)(+5.2)(stat)+/-3.1(syst) GeV/c(2).

Integration of CMAC technique and weighted regression for efficient learning and output differentiability

Cerebellar model articulation controllers (CMAC) have attractive properties of learning convergence and speed. Many studies have used CMAC in learning control and demonstrated successful results. However, due to the fact that CMAC is a table lookup technique, a model implemented by a CMAC does not provide a derivative of its output. This is an inconvenience when using CMAC in learning structures that require such derivatives. This paper presents a new scheme that integrates the CMAC addressing technique with weighted regression to resolve this problem. Derivatives exist everywhere except on the boundaries of quantized regions. Compared with the conventional CMAC, the new scheme requires the same amount of memory and has similar learning speed, but provides output differentiability and more precise output. Compared with the typical weighted regression technique, the new scheme offers an efficient way to organize and utilize collected information.