This article is an example of Lessons from the Field highlighting the practical implementation of a novel time‐controlled mechanism in the gamification of emergency department evacuation training via ...tabletop exercise. Tabletop exercise is one of the most common drill types for disaster preparedness. It is easy to use, effective, and low in cost, but it has some shortcomings. For example, its lack of authenticity is often criticized. We add a time‐control mechanism to the tabletop exercise and use settings similar to real events in an attempt to increase the authenticity of the tabletop exercise and the learning effect. We completed a 3‐h tabletop gamification of emergency room evacuation, which included a time control mechanism. Medical staff in our emergency department were asked to join this tabletop training. We evaluated the effectiveness of the time‐control tabletop exercise through the results of the pretest and posttests and feedback from the participants. A total of 97 emergency medical staff from the Emergency Department of Cheng Kung University Hospital, including 64 nurses, 29 emergency doctors and four nurse practitioners, participated in this tabletop exercise. After experiencing the time‐control tabletop exercise, the participants significantly improved their approach to mass casualty incidents, their method for evacuating patients, and their triage skills. The correct answer rate for the pretest and post‐test rose from 68.75% to 94.33% with statistically significant. The feedback from the participants also showed that the time‐control tabletop exercise was interesting and could increase learning motivation. The time‐control mechanism had a positive impact on the learning effect. It increased the reality of tabletop exercises, promoted participants' learning motivation, and improved their performance on the test.
This paper proposes a millimeter-wave substrate-integrated waveguide (SIW) multiplexer with high channel scalability and high isolation. To allow flexible increase in the number of channels while ...reducing the loading effect, a common SIW that is short-circuited at the far end is used to load all channels at locations with maximum magnetic field intensity. Isolation between channels is further improved by staggering higher-order resonances of SIW cavities to suppress any harmonic passband and thus extends the capability of implementing arbitrary passband frequencies. As a proof-of-concept, a quadruplexer was fabricated with center frequencies at 27.1/28.6/37.6/39.3 GHz, where the measured minimum insertion loss is 3.9/3.8/3.6/3.9 dB and the in-band isolation is greater than 37 dB between any two channels. In the frequency range of 20-45 GHz, the measured isolation is greater than 32 dB.
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•Power output and efficiency of a thermoelectric generator (TEG) is studied.•Temperatures at the module’s surfaces are approximated by sinusoidal functions.•Mean output power and ...efficiency are enhanced by the temperature oscillation.•The maximum mean efficiency of the TEG in this study is 8.45%.•The phase angle of 180° is a feasible operation for maximizing the performance.
Operation control is an effective way to improve the output power of thermoelectric generators (TEGs). The present study is intended to numerically investigate the power output and efficiency of a TEG and find the operating conditions for maximizing its performance. The temperature distributions at the hot side and cold side surfaces of the TEG are approximated by sinusoidal functions. The influences of the temperature amplitudes at the hot side surface and the cold side surface, the phase angle, and the figure-of-merit (ZT) on the performance of the TEG are analyzed. The predictions indicate that the mean output power and efficiency of the TEG are significantly enhanced by the temperature oscillation, whereas the mean absorbed heat by the TEG is slightly influenced. An increase in the temperature amplitude of the hot side surface and the phase angle can effectively improve the performance. For the phase angle of 0°, a smaller temperature amplitude at the cold side surface renders the better performance compared to that with a larger amplitude. When the ZT value increases from 0.736 to 1.8, the mean efficiency at the phase angle of 180° is amplified by a factor of 1.72, and the maximum mean efficiency is 8.45%. In summary, a larger temperature amplitude at the hot side surface with the phase angle of 180° is a feasible operation for maximizing the performance.
The current treatment of osteogenesis imperfecta (OI) is imperfect. Our study thus delves into the potential of using Dickkopf-1 antisense (DKK1-AS) to treat OI.
We analysed serum DKK1 levels and ...their correlation with lumbar spine and hip T-scores in OI patients. Comparative analyses were conducted involving bone marrow stromal cells (BMSCs) and bone tissues from wild-type mice, untreated OI mice, and OI mice treated with DKK1-ASor DKK1-sense (DKK1-S).
Significant inverse correlations were noted between serum DKK1 levels and lumbar spine (correlation coefficient = - 0.679, p = 0.043) as well as hip T-scores (correlation coefficient = - 0.689, p = 0.042) in OI patients. DKK1-AS improved bone mineral density (p = 0.002), trabecular bone volume/total volume fraction (p < 0.001), trabecular separation (p = 0.010), trabecular thickness (p = 0.001), trabecular number (p < 0.001), and cortical thickness (p < 0.001) in OI mice. DKK1-AS enhanced the transcription of collagen 1α1, osteocalcin, runx2, and osterix in BMSC from OI mice (all p < 0.001), resulting in a higher von Kossa-stained matrix area (p < 0.001) in ex vivo osteogenesis assays. DKK1-AS also reduced osteoclast numbers (p < 0.001), increased β-catenin and T-cell factor 4 immunostaining reactivity (both p < 0.001), enhanced mineral apposition rate and bone formation rate per bone surface (both p < 0.001), and decreased osteoclast area (p < 0.001) in OI mice. DKK1-AS upregulated osteoprotegerin and downregulated nuclear factor-kappa B ligand transcription (both p < 0.001). Bone tissues from OI mice treated with DKK1-AS exhibited significantly higher breaking force compared to untreated OI mice (p < 0.001).
Our study elucidates that DKK1-AS has the capability to enhance bone mechanical properties, restore the transcription of osteogenic genes, promote osteogenesis, and inhibit osteoclastogenesis in OI mice.
Data on predictors and time to relapse in patients with psoriasis who discontinue therapy in a real-world setting are scarce.
To investigate predictors of relapse after withdrawal of ustekinumab in ...patients with psoriasis.
This study screened 500 patients with psoriasis who received ustekinumab (669 treatment episodes) between 2011 and 2018. Overall, 202 patients (accounting for 304 treatment episodes) who had responded to therapy and were withdrawn from ustekinumab treatment were included.
The cumulative probabilities of being relapse-free at 6, 12, 18, 24, and 36 months after withdrawal from ustekinumab treatment were 49.3%, 12.6%, 5.3%, 4.7%, and 1.6%, respectively. Multivariate regression analyses with a generalized estimating equation showed that after adjustments, biologic-naive status, maximum improvement in Psoriasis Area and Severity Index during ustekinumab treatment, time to achieve a 50% improvement in baseline Psoriasis Area and Severity Index score after initiation of ustekinumab, family history of psoriasis, chronic kidney disease, and immunosuppressant use while not taking ustekinumab were significant predictors of time to relapse following discontinuation of ustekinumab.
Nonrandomized allocation of duration of treatment and follow-up.
Given the high rates of relapse, withdrawal of ustekinumab from patients with well-controlled psoriasis cannot be recommended.
The present study aims to investigate the performance of a thermoelectric generator (TEG) under the influence of sinusoidal temperature distribution at the hot side or cold side surface. The impacts ...of the period and amplitude of the periodic temperature, the temperature difference between the two surfaces, and the external load resistance on the power output and efficiency of the TEG are studied. The numerical simulations indicate that the period of temperature fluctuation plays no part on the TEG performance, whereas the power output of the TEG is significantly affected by the oscillating temperature. The higher the temperature amplitude, the larger the power output. With the temperature amplitude of 75 K at the hot side surface, the power output can be intensified up to 18%. In contrast, the maximum improvement in the power output is less than 1% when the oscillating temperature is excited at the cold side surface with the temperature amplitude of 15 K. The predictions also suggest that the optimal external load resistance is not affected by the boundary conditions of oscillating temperature, and the TEG performance is identical when the temperature difference between the two surfaces is fixed.
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•Performance of a TEG intensified by temperature oscillation is studied numerically.•The period of temperature fluctuation plays no part on the TEG performance.•The higher the temperature amplitude, the larger the output power.•The power can be intensified up to 18% with the amplitude of 75 K at the hot side surface.•Intensifying power for temperature fluctuation at the hot side surface is more effective.
Abstract Purpose To assess the short-term results of repeated intra-articular platelet rich plasma (PRP) injections into the knee in patients with early osteoarthritis (OA) and to determine a better ...treatment protocol. Methods This is a retrospective study in 191 knees (127 patients) with minimum of 12 months follow-up. We compared the clinical results of three types of injection method, once a month, twice monthly, and three injections at monthly interval. The outcomes were assessed using Visual Rating Scale (VRS), functional score, knee score, range of motion (ROM), WOMAC Stiffness/Pain/Function score, IKDC score, before the first injection and at 12 months post treatment. Results There were significant improvements in all scores after treatment as compared to the pre-treatment values (p < 0.05), except Knee score after 1st and 2nd injection and ROM in three groups. The parameters of Visual Rating Scale (VRS), functional score, and WOMAC Stiffness/Pain/Function score showed significant differences among the three groups in favour of the three injections group (p < 0.05). At 12 months, the effects began to decline in one injection and two injections groups, and the data in one injection group showed significant difference compared to two injection group (p < 0.001). Three injections group had higher scores and more improvement at 12 months after treatment when compared to the other two groups. Conclusion PRP injection appears to be effective in early symptomatic OA knees. The results after treatment are encouraging with significant reduction in pain and improvement in knee function at 12 months after treatment when compared to the pre-treatment status. Three injections per month yielded significantly better results in short-term follow-up.
The increasing use of biologics is accompanied by a risk of hepatitis B (HBV) and C virus (HCV) reactivation.
To determine the predictors of HBV and HCV reactivation in patients with psoriasis ...receiving biologics.
This study screened 2060 patients with psoriasis (3562 treatment episodes) who were taking biologics from 2009 to 2018. There were 359 patients with psoriasis with HBV (561 treatment episodes) and 61 with HCV infection (112 treatment episodes).
During 8809 and 1522 person-months of follow-up, 88 treatment episodes for HBV involved HBV reactivation, and 14 episodes of HCV involved reactivation. The reactivation rate was significantly higher in treatment episodes of chronic HBV infection than in that of occult HBV (34.3% vs 3.2%, P = .001) and resolved HBV (34.3% vs 5.0%, P < .001). The multivariate analysis revealed that being hepatitis B surface antigen seropositive, being hepatitis B e-antigen seropositive, and tumor necrosis factor-α–inhibitor therapy were risk factors for HBV reactivation, whereas antiviral prophylaxis was effective in reducing the risk of HBV reactivation. No predictors were significantly associated with HCV reactivation.
Observational design and a lack of a comparison group.
Patients with psoriasis on biologics have a risk of HBV and HCV reactivations, particularly those who are seropositive for hepatitis B surface antigen and hepatitis B e-antigen and undergoing tumor necrosis factor-α–inhibitor therapy.
Psoriasis is a common, chronic immune-mediated disorder that occurs worldwide. The prevalence of psoriasis in Taiwan is lower than that in Caucasian countries. Nevertheless, an increasing trend in ...the prevalence of psoriasis and psoriatic arthritis has been observed in Taiwan over the past decade. Accumulating studies have also suggested that psoriasis is not a disease limited to the skin and joints but has far-reaching systemic effects, associated with a higher prevalence of comorbid diseases, such as cardiovascular diseases, diabetes mellitus, metabolic syndrome, depression, and chronic kidney disease, than in the normal population. To date, our understanding of the mechanisms linking psoriasis and comorbidities remains far from complete. Psoriasis and its comorbid diseases confer substantial disease and health care burdens and have a significant negative impact on the quality of life of affected patients. The discovery of new, promising drugs has revolutionized psoriasis treatment, but patients still have unmet needs that require further investigation. Studies specifically on the Taiwanese population with psoriasis remain scarce. Herein, we review the medical literature, with a focus on studies examining the Taiwanese population, with regard to epidemiology, comorbidities, and effects of antipsoriatic agents on comorbidities, as well as the efficacy and safety of novel antipsoriatic treatments for patients with psoriasis.
Foodborne diseases are an important public health problem in the world. The bacterial resistance against presently used antibiotics is becoming a public health issue; hence, the discovery of new ...antimicrobial agents from natural sources attracts a lot of attention. Antibacterial activities of oligogalacturonide from commercial microbial pectic enzyme (CPE) treated citrus pectin, which exhibits antioxidant and antitumor activities, against 4 foodborne pathogens including Salmonella Typhimurium, Staphylococcus aureus, Listeria monocytogenes, and Pseudomonas aeruginosa was assessed. Pectin hydrolysates from CPE hydrolysis exhibited antibacterial activities. However, no antibacterial activity of pectin was observed. Citrus oligogalacturonide from 24‐h hydrolysis exhibited bactericidal effect against all selected foodborne pathogens and displayed minimal inhibitory concentration at 37.5 μg/mL for P. aeruginosa, L. monocytogenes, and S. Typhimurium, and at 150.0 μg/mL for S. aureus.
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