Taiwan Mandarin, one of the more syllable-timed dialects of Mandarin, has fewer unstressed syllables than Standard Mandarin. Acoustic analyses show that the supposedly unstressed ...syllables—neutral-tone syllables—in Taiwan Mandarin behave differently from those of Standard Mandarin. Unlike Standard Mandarin, these syllables do not raise their pitch after Tone 3. They have a distinct static mid-low pitch target and the target is implemented with a stronger articulatory strength. Moreover, acoustic analyses demonstrate that not all of these “unstressed syllables” are unstressed. The phonetic evidence suggests that these neutral-tone syllables should be analyzed as unaccented rather than unstressed in Taiwan Mandarin. These unaccented syllables are only lexically marked, and their pitch is neutralized into a mid-low tone. This study sheds light on how rhythm can affect stress and accent in a lexical tone language.
IMPORTANCE: Treatment outcomes depend on adherence to the prescribed regimen. Primary nonadherence refers to not obtaining and starting to take a prescribed medication. The frequency of primary ...nonadherence to acne treatment has not been well characterized. The complexity of multidrug acne regimens may add to this problem but, to our knowledge, has not been explored. OBJECTIVES: To estimate acne treatment primary nonadherence rates and to determine the relationship between primary nonadherence and the number of acne treatments prescribed. DESIGN, SETTING, AND PARTICIPANTS: A review of medical records from an outpatient university dermatology clinic identified patients with an acne diagnosis at a dermatology visit in the past 3 months who were prescribed 1, 2, or 3 or more treatments. Patients were excluded if they were not English speakers, were not prescribed treatment for their acne, or did not have an active telephone number. Using randomized lists, these patients were queried via telephone regarding which acne treatments they obtained. The results were analyzed using Fisher exact tests and multivariable logistic regression. For patients who were prescribed 1, 2, or 3 or more treatments, 47, 48, and 48 eligible patients were contacted, respectively. MAIN OUTCOMES AND MEASURES: The primary study outcomes were the overall rate of primary nonadherence and the rate for each treatment-number subgroup. Secondary outcomes included the association of sex, age, medication type, and electronic prescription status with primary nonadherence. RESULTS: Overall, 27% of patients did not fill all their prescriptions. Of patients who were given 1, 2, or 3 or more treatments, 9%, 40%, and 31%, respectively, did not fill all their prescriptions. There was no statistically significant difference by sex or age for primary nonadherence in any of the 3 treatment-number groups. Based on multivariable analyses, being prescribed a topical retinoid (odds ratio, 2.9; 95% CI, 1.0-8.0) or an over-the-counter product (odds ratio, 3.6; 95% CI, 1.1-12.3) was associated with primary nonadherence. Based on univariate analysis, there was less primary nonadherence with electronic prescriptions compared with paper prescriptions (P < .001). CONCLUSIONS AND RELEVANCE: Primary adherence to an acne treatment regimen is better when only 1 treatment is prescribed. Some patients may not complete acne treatment because 1 or more of their medications were never obtained.
The success of newly recruited medical school department chairs has become increasingly important for achievement of organizational goals. An effective onboarding program for these chairs can greatly ...facilitate early success, as well as satisfaction of the new hire with the position and the school. Onboarding programs can include traditional orientation items such as payroll signup and parking details, but should focus heavily on sharing organizational structure, culture, and how things get done. The goals of onboarding will be well served by implementation of three roles in the process. An Orientation Navigator can assist the new chair in the orientation phase, completing new employee documents and navigating the day-to-day challenges of working at the location. A Peer Mentor, generally a sitting chair, serves as both “buddy” and mentor, providing moral support as well as ensuring that the new chair gains an understanding of the people and processes important for getting things done. A Transition Mentor serves over a longer term as a sounding board and coach outside the peer group, assisting in a variety of ways to promote the chair’s growth, development, and success as a leader. Finally, any onboarding process is significantly compromised without the active participation of the dean, meeting regularly with the chair to clarify expectations, promote assimilation, and solve problems. Successful onboarding begins with a mindfulness of the needs of the newly hired chair, and a well-designed and well-implemented plan will have wide-ranging benefits for the chair and the organization.
BACKGROUND:There is limited information on differences in the dynamics of influenza transmission during time periods when schools are open compared with periods when they are closed.
METHODS:Data on ...school openings, influenza surveillance, and absolute humidity were incorporated into a regression model to estimate the increase in the reproductive number for the 2009 A(H1N1) influenza pandemic associated with the opening of school in 10 US states.
RESULTS:The estimate for the average increase in the reproductive number for the 2009 A(H1N1) influenza pandemic associated with the beginning of the school year was 19.5% (95% credible interval = 10%–29%).
CONCLUSIONS:Whether schools are open or closed can have a major impact on community transmission dynamics of influenza.
Little is known about recent trends in physician reporting of sleep apnea during outpatient practice visits.
To assess trends in the frequency of adult outpatient visits for sleep apnea in the United ...States, the clinicians who provided those visits, and the characteristics of patients reported to have sleep apnea; and to assess whether the reporting of a diagnosis of sleep apnea varies across regions of the country as a function of body weight and insurance status.
We reviewed annual stratified samples of patients identified as having sleep apnea during physician office visits in the U.S. National Ambulatory Medical Care Survey database, and during visits to hospital outpatient practices in the U.S. National Hospital Ambulatory Medical Care Survey database, between 1993 and 2010. The aggregate data set included records of 838,000 ambulatory practice visits.
During this 17-year period, survey reports of a diagnosis of sleep apnea increased 14.6- fold, from 420,000 to 6.37 million per year (P = 0.0002). Thirty-three percent were reported by primary care providers, 17% by pulmonologists, and 10% by otolaryngologists. Over the period of observation, reports of a diagnosis of sleep apnea by "other groups" increased considerably (P < 0.001). The per capita rate of sleep apnea diagnoses per 1,000 persons per year differed across regions of the United States (P < 0.0001). Regions that reported a higher rate of sleep apnea appeared to be influenced by obesity (P < 0.001) and health insurance status (P < 0.005).
Diagnoses of sleep apnea during outpatient visits to hospital-based and non-hospital-based practices in the United States were much more frequent in 2010 than in 1993, as reported by outpatient practice clinicians participating in national surveys. Although the majority of diagnoses of sleep apnea were reported by primary care providers, pulmonologists, and otolaryngologists (60%), there was a substantial increase in reports of sleep apnea by clinicians practicing other specialties during the study period. Reporting of a diagnosis of sleep apnea varied by obesity prevalence and health insurance status across U.S. geographic regions.
Abstract
The COVID-19 crisis has forced healthcare professionals to make tragic decisions concerning which patients to save. Furthermore, The COVID-19 crisis has foregrounded the influence of ...self-serving bias in debates on how to allocate scarce resources. A utilitarian principle favors allocating scarce resources such as ventilators toward younger patients, as this is expected to save more years of life. Some view this as ageist, instead favoring age-neutral principles, such as “first come, first served”. Which approach is fairer? The “veil of ignorance” is a moral reasoning device designed to promote impartial decision-making by reducing decision-makers’ use of potentially biasing information about who will benefit most or least from the available options. Veil-of-ignorance reasoning was originally applied by philosophers and economists to foundational questions concerning the overall organization of society. Here we apply veil-of-ignorance reasoning to the COVID-19 ventilator dilemma, asking participants which policy they would prefer if they did not know whether they were younger or older. Two studies (pre-registered; online samples; Study 1, N=414; Study 2 replication, N=1,276) show that veil-of-ignorance reasoning shifts preferences toward saving younger patients. The effect on older participants is dramatic, reversing their opposition toward favoring the young, thereby eliminating self-serving bias. These findings provide guidance on how to remove self-serving biases to healthcare policymakers and frontline personnel charged with allocating scarce medical resources during times of crisis.
Our objective was to explore the hypothesis that the risk of leptomeningeal dissemination (LMD) in patients who underwent stereotactic radiosurgery (SRS) for brain metastases is influenced by the ...site of the primary cancer, the addition of whole brain radiation therapy (WBRT), surgical resection, and control over their systemic disease. We conducted a retrospective cohort analysis of 805 patients who were treated with SRS for brain metastases between 1999 and 2012 at the Wake Forest Baptist Medical Center, and excluded all patients with evidence of LMD before SRS. The primary outcome was LMD. Forty-nine of 795 patients developed LMD with a cumulative incidence of 6.2 % (95 % Confidence Interval (CI), 4.7–8.0). Median time from SRS to LMD was 7.4 months (Interquartile Range (IQR), 3.3–15.4). A colorectal primary site (Hazard Ratio (HR), 4.5; 95 % CI 2.5–8.0;
p
< 0.0001), distant brain failure (HR, 2.0; 95 % CI 1.2–3.2;
p
= 0.007), breast primary site (HR, 1.6; 95 % CI 1.0–2.7;
p
= 0.05), the number of intracranial metastases at time of initial SRS (HR, 1.1; 95 % CI 1.0–1.2;
p
= 0.02), and age (by 5-year interval) (HR, 0.9; 95 % CI 0.8, 0.9;
p
= 0.0006) were independent factors associated with LMD. There was no evidence that surgical resection before SRS altered the risk of LMD (HR, 1.1; 95 % CI 0.6–2.0,
p
= 0.78). In patients who underwent SRS for brain metastases, a colorectal or breast primary site, distant brain failure, younger age, and an increased number of intracranial metastases were independently associated with LMD. Given its relative rarity as an outcome, multi-institutional prospective studies will likely be necessary to validate and quantify these relationships.
The role of neutrophil-lymphocyte ratio (NLR) as a predictor for survival in single fraction SBRT-treated non-small cell lung cancer (NSCLC) patients remains unclear. We performed an observational ...cohort study to determine the role of pretreatment NLR in predicting survival of early-stage NSCLC patients after single fraction SBRT.
A single-institution database of peripheral early-stage NSCLC patients treated with SBRT from February 2007 to May 2022 was queried. Optimal threshold of neutrophil-lymphocyte ratio (NLR) was defined based on maximally selected rank statistics. Cox multivariable analysis (MVA), Kaplan-Meier, and propensity score matching were performed to evaluate outcomes.
A total of 286 patients were included for analysis with median follow up of 19.7 months. On Cox multivariate analysis, as a continuous variable, NLR was shown to be an independent predictor of OS (adjusted hazards ratio aHR 1.06, 95% CI 1.02-1.10, p = 0.005) and PFS (aHR 1.05, 95% CI 1.01-1.09, p = 0.013). In addition, NLR was associated with DF (aHR 1.11, 95% CI 1.05-1.18, p < 0.001). Maximally selected rank statistics determined 3.28 as the cutoff point of high NLR versus low NLR. These findings were confirmed upon propensity matching.
Pretreatment NLR is an independent predictor for survival outcomes of peripheral early-stage NSCLC patients after single fraction SBRT.
Indigenous languages in Taiwan are experiencing various degrees of language endangerment. Reversing language shift, however, faces difficulties due to the minority status of the languages. This study ...identifies two Indigenous singer-songwriters who released popular music sung in their endangered Indigenous languages as micro-level language planning actors and investigates their language activism. Drawing on the framework of strategies in language activism, this study analyses their grass-root initiatives in language activism by examining their public discourse about their ideologies and actions. This study finds that through strategic creating and representing, the musicians aimed to encourage Indigenous youth to use their ethnic language, develop their confidence through popular music, and shift the image of Indigenous languages from traditional, inferior, and underprivileged to international, modern, and confident. Moreover, this study found that, unlike previous studies, the Taiwanese musicians employed various connecting strategies to create a sustainable virtuous cycle to motivate Indigenous people to revitalize their languages. Furthermore, their strategies consider language ecology and aim to connect non-Indigenous Taiwanese with their initiatives to create a friendly societal environment for the Indigenous people. The findings contribute to the development of a repertoire of strategies in language activism and have practical implications for Indigenous language revitalization.
Rosacea Triggers: Alcohol and Smoking Alinia, Hossein; Tuchayi, Sara Moradi; Patel, Nupur U ...
Dermatologic clinics
36, Številka:
2
Journal Article
Recenzirano
A variety of triggers are thought to exacerbate rosacea. A validated self-assessment tool and survey was used to study the relationship between rosacea severity and triggers. Subjects were adult ...patients with a clinical diagnosis of rosacea. Increased severity of disease was significantly associated with consumption of many alcoholic beverages in 1 day and employment at a job requiring extensive sun exposure. The authors' findings may inform physician counseling practices; patients may be provided with practical measures for managing their rosacea, such as limiting alcohol consumption over short periods of time and increasing sun protection, especially in the summer.
PDF
