Using the Clinical Frailty Scale to Predict the Length of Stay in Otolaryngology Unit in Taiwan

Frailty was a common syndrome in geriatric clinic and general internal medical wards. Some authors had identified the Clinical Frailty Scale (CFS) as a predictor of length of stay in the acute medicine unit. However, the role of the Clinical Frailty Scale in the length of stay in otolaryngology unit had not been well studied. The objective of this study was to find out the correlation of the CFS in elderly patients admitted to otolaryngology unit and their length of stay. A retrospective medical chart review of 203 elderly patients admitted to the otolaryngology ward from January, 2014 to December, 2018 was performed. These patients were hospitalized for treating otorhinolaryngological (ENT) disease or for otorhinolaryngological surgery except for those of ENT related malignancies at Kaohsiung Municipal United Hospital (KMUH). Patients\u27 demographics, CFS scores, Charlson comorbidities Index (CCI), and length of stay (LOS) were recorded. All the participants were divided into three groups: non-frail (CFS 1- 4), mildtomoderately frail (CFS 5- 6), and severely frail (CFS7- 8). Severely frail group had longer lengths of stay (mean= 8.76±0.97 days), comparing to mild to moderate frail group (mean=6.25±0.72 days), and non-frail group (mean= 3.93±0.38 days, p=0.000). For the length of stay stratified by each individual CFS score, it was significant that patients with higher CFS scores had longer lengths of stay (p=.000). The group with higher CFS scores had higher CCI when compared with non-frail group (6.76±1.35 for severely frail, vs. 5.41±1.10 for mild to moderately frail vs. 3.02±0.95 for non-frail, p=0. 000). The use of the CFS for assessment of the elderly patients could help the otolaryngologist to predict the length of stay in otolaryngology unit in Taiwan

Experience with adjuvant chemotherapy for pseudomyxoma peritonei secondary to mucinous adenocarcinoma of the appendix with oxaliplatin/fluorouracil/leucovorin (FOLFOX4)

<p>Abstract</p> <p>Background</p> <p>Pseudomyxoma peritonei (PMP) is a rare condition characterized by mucinous tumors, disseminated intra-peritoneal implants, and mucinous ascites. So far its diagnosis remains challenging to most clinicians.</p> <p>Case presentation</p> <p>A 55-year-old male patient had suffered from acute onset of abdominal pain and abdominal distension for one day prior to his admission. Physical examination revealed tenderness over the right lower quadrant of the abdomen without diffuse muscle guarding. A large amount of ascites was identified by abdominal computed tomography (CT) scan. Paracentesis showed the appearance of sticky mucinous ascites. He underwent laparotomy under the impression of pseudomyxoma peritonei. There was a lot of mucinous ascites, one appendiceal tumor and multiple peritoneal implants disseminated from the subphrenic space to the recto-vesicle pouch. Pseudomyxoma Peritonei caused by mucinous adenocarcinoma of appendiceal origin, was confirmed by histopathology. We performed an excision of the appendiceal tumor combined with copious irrigation and debridement. After the operation, he received 10 cycles of systemic chemotherapy with FOLFOX4 regimen, without specific morbidity. Follow-up of abdominal CT and colonoscopy at post-operative 17 months showed excellent response without evidence of local recurrence or distal metastasis. He made an uneventful recovery (up to the present) for 21 months after the operation.</p> <p>Conclusion</p> <p>This case report emphasizes the possible new role of systemic chemotherapy in the treatment of patients with this rare clinical syndrome.</p

Direct growth of ultra-long platinum nanolawns on a semiconductor photocatalyst

A template- and surfactant-free process, thermally assisted photoreduction, is developed to prepare vertically grown ultra-long Pt nanowires (NWs) (about 30-40 nm in diameter, 5-6 μm in length, and up to 80 NWs/100 μm2 in the wire density) on TiO2 coated substrates, including Si wafers and carbon fibers, with the assistance of the photocatalytic ability and semiconductor characteristics of TiO2. A remarkable aspect ratio of up to 200 can be achieved. TEM analytical results suggest that the Pt NWs are single-crystalline with a preferred 〈111〉 growth direction. The precursor adopted and the heat treatment conditions are crucial for the yield of NWs. The photoelectrons supplied by TiO2 gives rise to the formation of nano-sized Pt nuclei from salt melt or solution. The subsequent growth of NWs is supported by the thermal electrons which also generated from TiO2 during the post thermal treatment. The interactions between the ions and the electrons in the Pt/TiO2 junction are discussed in this study

Development of a short and universal learning self-efficacy scale for clinical skills

Background Learning self-efficacy, defined as learners’ confidence in their capability to learn specific subjects, is crucial for the enhancement of academic progress, because it is positively correlated with academic achievements and effective learning strategy use. In this study, we developed a universal scale called the Learning Self-Efficacy Scale (L-SES) for Clinical Skills for undergraduate medical students and validated it through item analysis and content validity index (CVI) calculation. Design The L-SES was developed based on the framework of Bloom’s taxonomy, and the questions were generated through expert consensus and CVI calculation. A pilot version of the L-SES was administered to 235 medical students attending a basic clinical skills course. The collected data were then examined through item analysis. Results The first draft of the L-SES comprised 15 questions. After expert consensus and CVI calculation, 3 questions were eliminated; hence, the pilot version comprised 12 questions. The CVI values of the 12 questions were between .88 and 1, indicating high content validity. Moreover, the item analysis indicated that the quality of L-SES reached the qualified threshold. The results showed that the L-SES scores were unaffected by gender (t = −0.049; 95% confidence interval [−.115, .109], p > .05). Conclusion The L-SES is a short, well-developed scale that can serve as a generic assessment tool for measuring medical students’ learning self-efficacy for clinical skills. Moreover, the L-SES is unaffected by gender differences. However, additional analyses in relevant educational settings are needed

Effects of unilateral eccentric versus concentric training of nonimmobilized arm during immobilization

Introduction The present study tested the hypothesis that eccentric training (ET) of nonimmobilized arm would attenuate negative effects of immobilization and provide greater protective effects against muscle damage induced by eccentric exercise after immobilization, when compared with concentric training (CT). Methods Sedentary young men were placed to ET, CT, or control group (n = 12 per group), and their nondominant arms were immobilized for 3 wk. During the immobilization period, the ET and CT groups performed five sets of six dumbbell curl eccentric-only and concentric-only contractions, respectively, at 20%-80% of maximal voluntary isometric contraction (MVCiso) strength over six sessions. MVCiso torque, root-mean square (RMS) of electromyographic activity during MVCiso, and bicep brachii muscle cross-sectional area (CSA) were measured before and after immobilization for both arms. All participants performed 30 eccentric contractions of the elbow flexors (30EC) by the immobilized arm after the cast was removed. Several indirect muscle damage markers were measured before, immediately after, and for 5 d after 30EC. Results ET increased MVCiso (17% ± 7%), RMS (24% ± 8%), and CSA (9% ± 2%) greater (P \u3c 0.05) than CT (6% ± 4%, 9% ± 4%, 3% ± 2%) for the trained arm. The control group showed decreases in MVCiso (-17% ± 2%), RMS (-26% ± 6%), and CSA (-12% ± 3%) for the immobilized arm, but these changes were attenuated greater (P \u3c 0.05) by ET (3% ± 3%, -0.1% ± 2%, 0.1% ± 0.3%) than CT (-4% ± 2%, -4% ± 2%, -1.3% ± 0.4%). Changes in all muscle damage markers after 30EC were smaller (P \u3c 0.05) for the ET and CT than the control group, and ET than the CT group (e.g., peak plasma creatine kinase activity: ET, 860 ± 688 IU L-1; CT, 2390 ± 1104 IU L-1; control, 7819 ± 4011 IU L-1). Conclusions These results showed that ET of the nonimmobilized arm was effective for eliminating the negative effects of immobilization and attenuating eccentric exercise-induced muscle damage after immobilization

Microstructural differences in white matter tracts across middle to late adulthood : a diffusion MRI study on 7167 UK Biobank participants

Acknowledgements This research was approved by the UK Biobank (application number: 24089) and was supported by the Roland Sutton Academic Trust (grant number: 0039/R/16) and Taiwan National Health Research Institute (NHRI-EX109-10928NI). We acknowledge the valuable contributions of members of the UK Biobank Imaging Working Group and the UK Biobank coordinating center. The UK Biobank (including the imaging enhancement) was supported by the UK Medical Research Council and the Wellcome Trust. The authors are grateful for the provision of simultaneous multislice (multiband) pulse sequence and reconstruction algorithms by the Center for Magnetic Resonance Research, University of Minnesota. Finally, the authors are extremely grateful to all UK Biobank study participants, who have generously donated their time to make this resource possible. This article was edited by Wallace Academic Editing.Peer reviewedPostprin

Application of Multiple Sensors in Monitoring Land Subsidence in Central Taiwan

Source: ICHE Conference Archive - https://mdi-de.baw.de/icheArchive

Vehicle Handling and Stability Enhancement with Active Steering Control Systems

ABSTRACT This paper presents an analysis and comparison of a vehicle with active front steering and rear-wheel steering. Based on linear analysis of base vehicle characteristics under varying speed and road surfaces, desirable vehicle response characteristics are presented and a set of performance matrices for active steering systems is formulated. Using poleplacement approach, controllability issues under active front wheel steering and rear-wheel steering controls are discussed. A frequency response optimization approach is then used to design the closed-loop controllers