Frail older adults are predisposed to multiple comorbidities and adverse events. Recent interventional studies have shown that frailty can be improved and managed. In this study, effective ...individualized home-based exercise and nutrition interventions were developed for reducing frailty in older adults.
This study was a four-arm, single-blind, randomized controlled trial conducted between October 2015 and June 2017 at Miaoli General Hospital in Taiwan. Overall, 319 pre-frail or frail older adults were randomly assigned into one of the four study groups (control, exercise, nutrition, and exercise plus nutrition combination) and followed up during a 3-month intervention period and 3-month self-maintenance period. Improvement in frailty scores was the primary outcome. Secondary outcomes included improvements in physical performance and mental health. The measurements were performed at baseline, 1 month, 3 months, and 6 months.
At the 6-month measurement, the exercise (difference in frailty score change from baseline: - 0.23; 95% confidence interval CI: - 0.41, - 0.05; p = 0.012), nutrition (- 0.28; 95% CI: - 0.46, - 0.11; p = 0.002), and combination (- 0.34; 95% CI: - 0.52, - 0.16; p < 0.001) groups exhibited significantly greater improvements in the frailty scores than the control group. Significant improvements were also observed in several physical performance parameters in the exercise, nutrition, and combination groups, as well as in the 12-Item Short Form Health Survey mental component summary score for the nutrition group.
The designated home-based exercise and nutrition interventions can help pre-frail or frail older adults to improve their frailty score and physical performance.
Retrospectively registered at ClinicalTrials.gov (identifier: NCT03477097); registration date: March 26, 2018.
We evaluated the pharmacokinetics, pharmacodynamics, and safety of a single subcutaneous dose of romosozumab 210 mg, a monoclonal antibody against sclerostin, in an open‐label, parallel‐group study ...in participants with severe (stage 4) renal impairment (RI; n = 8) or end‐stage renal disease requiring hemodialysis (ESRD‐RH; n = 8), or healthy participants with normal renal function (n = 8). Compared with the group with normal renal function, the mean romosozumab exposure was 31% and 43% higher as measured by maximum observed serum concentration and area under the concentration‐time curve, respectively, in the severe RI group and similar to those in the ESRD‐RH group. For all 3 groups, the maximum mean percent increase in procollagen type 1 N terminal propeptide and decrease in serum C‐telopeptide levels from baseline were observed on day 15. Changes in procollagen type 1 N terminal propeptide and serum C‐telopeptide were of similar patterns in all 3 groups. The single dose of romosozumab 210 mg was well tolerated. Adverse events (AEs) were reported for 13 patients (7 patients with severe RI and 6 with ESRD‐RH), with no deaths, AEs, or serious AEs leading to withdrawal. The incidence of subjects with postbaseline transient decreases in serum calcium (severe RI, n = 1; ESRD‐RH, n = 5) and increases in intact parathyroid hormone (severe RI, n = 7; ESRD‐RH, n = 7; healthy, n = 3) were greater in severe RI and ESRD‐RH groups than in the healthy group. All reported events of hypocalcemia (severe RI, n = 1; ESRD‐RH, n = 4) were asymptomatic. These results support the use of romosozumab without dose adjustment in patients with severe RI or ESRD‐RH.
Breast cancer is a heterogeneous disease. To guide proper treatment decisions for each patient, robust prognostic biomarkers, which allow reliable prognosis prediction, are necessary. Gene feature ...selection based on microarray data is an approach to discover potential biomarkers systematically. However, standard pure-statistical feature selection approaches often fail to incorporate prior biological knowledge and select genes that lack biological insights. Besides, due to the high dimensionality and low sample size properties of microarray data, selecting robust gene features is an intrinsically challenging problem. We hence combined systems biology feature selection with ensemble learning in this study, aiming to select genes with biological insights and robust prognostic predictive power. Moreover, to capture breast cancer's complex molecular processes, we adopted a multi-gene approach to predict the prognosis status using deep learning classifiers. We found that all ensemble approaches could improve feature selection robustness, wherein the hybrid ensemble approach led to the most robust result. Among all prognosis prediction models, the bimodal deep neural network (DNN) achieved the highest test performance, further verified by survival analysis. In summary, this study demonstrated the potential of combining ensemble learning and bimodal DNN in guiding precision medicine.
Constructing polaritonic devices in monolithic, ultra‐compact photonic architectures with monolayer‐featured exciton‐emitters is decisive to exploit the coherent superposition between entangled ...photonic and excitonic eigenstates for potential realizations of optical nonlinearities, macroscopic condensations, and superfluidity. Here, a feasible strategy for exciton‐polariton formations is demonstrated by implementing a Tamm‐plasmon (TP) polaritonic device with the active material composed of single‐monolayered perovskite (CsPbBr3) quantum dots (QDs). The metallic character of the TP configuration is able to concentrate its resonance mode into a confined region beyond the diffraction limit, which highly overlaps, both spatially and spectrally, with the single‐monolayered CsPbBr3 QDs embedded inside. The mode volume of the device is hence reduced dramatically, leading to an enhanced light–matter coupling strength for the polaritonic emission at room temperature. In particular, it is found that the dispersion relation of the TP polaritonic device is tunable by detuning the excitonic and photonic eigenmodes and that the polariton–polariton interaction energy is strongly dependent on the polariton's spin state. The presented strategy is a determinant step toward the realization of strong light–matter coupling and polariton spintronics in the CsPbBr3 QDs with a single‐monolayered feature.
This work demonstrates a feasible strategy for room temperature polaritonic emissions by implementing a Tamm‐plasmon polaritonic device embedded with the CsPbBr3 quantum dots with a single‐monolayered feature.
Objective
To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence.
Study Design
Retrospective cohort ...study.
Methods
Patients newly diagnosed with OSA during 1997–2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence.
Results
This study included 3,978 OSA patients and 15,912 non‐OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval CI, 1.27–3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06–0.98).
Conclusion
OSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development.
Level of Evidence
IV Laryngoscope, 130:2292–2298, 2020
This study evaluated short-term (1-month) and long-term (1-year) mortality risks associated with the glomerular filtration rate (eGFR) on admission for patients with intracerebral hemorrhage.
From ...the Taiwan Stroke Registry data from April 2006 to December 2016, we identified and stratified patients with intracerebral hemorrhage into five subgroups by the eGFR level on admission: ≥90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m2 or on dialysis. Risks for 1-month and 1-year mortality after intracerebral hemorrhage were compared by the eGFR levels.
Both the 1-month and 1-year mortality rates progressively increased with the decrease in eGFR levels. The 1-month mortality rate in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was approximately 5.5-fold greater than that in patients with eGFR ≥ 90 mL/min/1.73 m2 (8.31 versus 1.50 per 1000 person-days), with an adjusted hazard ratio (HR) of 4.59 95% confidence interval (CI) = 2.71-7.78. Similarly, the 1-year mortality in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was 7.5 times that in patients with eGFR ≥ 90 mL/min/1.73 m2 (2.34 versus 0.31 per 1000 person-days), with an adjusted HR of 4.54 (95% CI 2.95-6.98).
Impairment of renal function is an independent risk factor for mortality in patients with intracerebral hemorrhage in a gradual way. The eGFR level is a prognostic indicator for patients with intracerebral hemorrhage.
Abstract
Selective-area growth (SAG) of single-crystal wurtzite GaN nanorods (NRs) directly onto Si(001) substrates with un-etched native SiO
x
amorphous layer, assisted by a patterning TiN
x
mask ...fabricated by nanosphere lithography (NSL), has been realized by reactive magnetron sputter epitaxy (MSE). The GaN NRs were grown vertically to the substrate surface with the growth direction along
c
-axis in the well-defined nano-opening areas. A 5-step structural and morphological evolution of the SAG NRs observed at different sputtering times depicts a comprehensive growth model, listed in sequence as: formation of a polycrystalline wetting layer, predominating
c
-axis oriented nucleation, coarsening and coalescence of multi-islands, single NR evolution, and finally quasi-equilibrium crystal shape formation. Room-temperature cathodoluminescence spectroscopy shows a strong GaN bandedge emission with a uniform luminescence across the NRs, indicating that the SAG NRs are grown with high quality and purity. In addition, single-longitudinal-mode lasing, attributed to well-faceted NR geometry forming a Fabry–Pérot cavity, was achieved by optical pumping, paving a way for fabricating high-performance laser optoelectronics using MSE.
In this case study, a system to recover waste heat comprised 24 thermoelectric generators (TEG) to convert heat from the exhaust pipe of an automobile to electrical energy has been constructed. ...Simulations and experiments for the thermoelectric module in this system are undertaken to assess the feasibility of these applications. A slopping block is designed on the basis of simulation results to uniform the interior thermal field that improves the performance of TEG modules. Besides simulations, the system is designed and assembled. Measurements followed the connection of the system to the middle of an exhaust pipe. Open circuit voltage and maximum power output of the system are characterized as a function of temperature difference. Through these simulations and experiments, the power generated with a commercial TEG module is presented. Overview this case study and our previous work, the results establish the fundamental development of low-temperature waste heat thermoelectric generator system that enhances the TEG efficiency for vehicles.
Purpose
– The purpose of this paper is to provide a better picture of factors influencing behavioral decisions in online shopping by identifying different targets of trust and discussing their ...antecedents and outcomes.
Design/methodology/approach
– Online survey data from 242 ihergo members were used to test the proposed model, and structural equation modeling with partial least squares was performed to analyze the measurement and structural models.
Findings
– The findings show that the four types of trust identified in this study are critical determinants of perceived risk and attitude. In addition, the majority of the antecedents are found to be associated with their respective types of trust.
Research limitations/implications
– The research extends the theory of reasoned action and prior research to discuss four types of consumer trust, as well as their respective antecedents and subsequent consequences. The result is a more descriptive model that better explicates consumers’ decision-making processes in online shopping.
Practical implications
– Given the intense competition between online shopping sites, web site managers should strive to provide a safe and user-friendly shopping environment. In addition, the vendor can enhance trust by encouraging satisfied customers to provide positive endorsements.
Originality/value
– This study is possibly the first of its kind, in identifying the four types of trust and their respective antecedents in the context of an online group-buying auction, and thus serves to enrich the existing literature concerning trust-building factors.
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