2,547 research outputs found

    Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

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    © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Objectives: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. Design: Population-based cross-sectional survey. Settings: Nursing homes (n= 31) in Wuhan, Mainland Southern China. Participants: Cognitively intact nursing home residents (n= 467) older than 60 years. Measures: Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences. Results: Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098). Conclusions: Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China

    Enhanced Leak Detection

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    A key requirement for Veeder-Root’s Enhanced Leak Detection System is that it be able to test in situ for the presence of leaks at gasoline dispensing facilities. Aside from the obvious issues of safety and lost product, this functionality is obligatory for compliance with environmental standards mandated by federal and state oversight bodies, such as the California State Water Resources Control Board (SWRCB). The SWRCB demands a testing procedure that includes conditions as close to operational as possible, while still using environmentally safe gases as a test fluid. Although the test parameters (e.g., pressure) are allowed to deviate from operating conditions in order to facilitate the test procedure, a prescribed rescaling of the test thresholds must then be applied to account for the deviation. Whether the test is run at operation conditions or in a slightly different parameter regime, the fact that the testing must be done on the product and return lines after installation at a service station presents significant challenges in devising an effective test strategy

    Heat exchanger/reactors (HEX reactors): Concepts, technologies: State-of-the-art

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    Process intensification is a chemical engineering field which has truly emerged in the past few years and is currently rapidly growing. It consists in looking for safer operating conditions, lower waste in terms of costs and energy and higher productivity; and away to reach such objectives is to develop multifunctional devices such as heat exchanger/reactors for instance. This review is focused on the latter and makes a point on heat exchanger/reactors. After a brief presentation of requirements due to transposition from batch to continuous apparatuses, heat exchangers/reactors at industrial or pilot scales and their applications are described

    Test of Cosmic Spatial Isotropy for Polarized Electrons Using a Rotatable Torsion Balance

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    To test the cosmic spatial isotropy, we use a rotatable torsion balance carrying a transversely spin-polarized ferrimagnetic Dy_{6}Fe_{23} mass. With a rotation period of one hour, the period of anisotropy signal is reduced from one sidereal day by about 24 times, and hence the 1/f noise is greatly reduced. Our present experimental results constrain the cosmic anisotropy Hamiltonian H = C_{1} sigma_{1} + C_{2} sigma_{2} + C_{3} sigma_{3} (sigma_{3} is in the axis of earth rotation) to (C_{1}^{2} +C_{2}^{2})^{1/2} = (1.8 +- 5.3) X 10^{-21} eV and | C_{3} | = (1.2 +- 3.5) X 10^{-19} eV. This improves the previous limits on (C_{1},C_{2}) by 120 times and C_{3} by a factor of 800.Comment: 6 pages, 3 figure

    Novel splice variants derived from the receptor tyrosine kinase superfamily are potential therapeutics for rheumatoid arthritis

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    INTRODUCTION: Despite the advent of biological therapies for the treatment of rheumatoid arthritis, there is a compelling need to develop alternative therapeutic targets for nonresponders to existing treatments. Soluble receptors occur naturally in vivo, such as the splice variant of the cell surface receptor for vascular endothelial growth factor (VEGF)--a key regulator of angiogenesis in rheumatoid arthritis. Bioinformatics analyses predict that the majority of human genes undergo alternative splicing, generating proteins--many of which may have regulatory functions. The objective of the present study was to identify alternative splice variants (ASV) from cell surface receptor genes, and to determine whether the novel proteins encoded exert therapeutic activity in an in vivo model of arthritis. METHODS: To identify novel splice variants, we performed RT-PCR using an mRNA pool representing major human tissue types and tumors. Novel ASV were identified by alignment of each cloned sequence to its respective genomic sequence in comparison with full-length transcripts. To test whether these ASV have biologic activity, we characterized a subset of them for ligand binding, and for efficacy in an animal model of arthritis. The in vivo study was accomplished using adenoviruses expressing secreted ASV. RESULTS: We cloned 60 novel human ASV from 21 genes, encoding cell surface receptors--many of which are known to be important in the regulation of angiogenesis. The ASV were characterized by exon extension, intron retention and alternative exon utilization. Efficient expression and secretion of selected ASV--corresponding to VEGF receptor type 1, VEGF receptor type 2, VEGF receptor type 3, angiopoietin receptor Tie1, Met (receptor for hepatocyte growth factor), colony-stimulating factor 1 receptor, platelet-derived growth factor receptor beta, fibroblast growth factor receptor 1, Kit, and RAGE--was demonstrated, together with binding to their cognate ligands. Importantly, ASV derived from VEGF receptor type 1 and Tie1, and to a lesser extent from VEGF receptor type 2 and fibroblast growth factor receptor 1, reduced clinical signs of arthritis in vivo. The reduction was paralleled by decreased joint inflammation and destruction. CONCLUSION: The present study shows that unique ASV derived from receptors that play key roles in angiogenesis--namely, VEGF receptor type 1 and, for the first time, Tie1--can markedly reduce arthritis severity. More broadly, our results demonstrate that ASV are a source of novel proteins with therapeutic potential in diseases in which angiogenesis and cellular hyperplasia play a central role, such as rheumatoid arthritis

    Optical Trapping of an Ion

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    For several decades, ions have been trapped by radio frequency (RF) and neutral particles by optical fields. We implement the experimental proof-of-principle for trapping an ion in an optical dipole trap. While loading, initialization and final detection are performed in a RF trap, in between, this RF trap is completely disabled and substituted by the optical trap. The measured lifetime of milliseconds allows for hundreds of oscillations within the optical potential. It is mainly limited by heating due to photon scattering. In future experiments the lifetime may be increased by further detuning the laser and cooling the ion. We demonstrate the prerequisite to merge both trapping techniques in hybrid setups to the point of trapping ions and atoms in the same optical potential.Comment: 5 pages, 3 figure

    Dynamic modeling of mean-reverting spreads for statistical arbitrage

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    Statistical arbitrage strategies, such as pairs trading and its generalizations, rely on the construction of mean-reverting spreads enjoying a certain degree of predictability. Gaussian linear state-space processes have recently been proposed as a model for such spreads under the assumption that the observed process is a noisy realization of some hidden states. Real-time estimation of the unobserved spread process can reveal temporary market inefficiencies which can then be exploited to generate excess returns. Building on previous work, we embrace the state-space framework for modeling spread processes and extend this methodology along three different directions. First, we introduce time-dependency in the model parameters, which allows for quick adaptation to changes in the data generating process. Second, we provide an on-line estimation algorithm that can be constantly run in real-time. Being computationally fast, the algorithm is particularly suitable for building aggressive trading strategies based on high-frequency data and may be used as a monitoring device for mean-reversion. Finally, our framework naturally provides informative uncertainty measures of all the estimated parameters. Experimental results based on Monte Carlo simulations and historical equity data are discussed, including a co-integration relationship involving two exchange-traded funds.Comment: 34 pages, 6 figures. Submitte

    Laser cooling of a diatomic molecule

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    It has been roughly three decades since laser cooling techniques produced ultracold atoms, leading to rapid advances in a vast array of fields. Unfortunately laser cooling has not yet been extended to molecules because of their complex internal structure. However, this complexity makes molecules potentially useful for many applications. For example, heteronuclear molecules possess permanent electric dipole moments which lead to long-range, tunable, anisotropic dipole-dipole interactions. The combination of the dipole-dipole interaction and the precise control over molecular degrees of freedom possible at ultracold temperatures make ultracold molecules attractive candidates for use in quantum simulation of condensed matter systems and quantum computation. Also ultracold molecules may provide unique opportunities for studying chemical dynamics and for tests of fundamental symmetries. Here we experimentally demonstrate laser cooling of the molecule strontium monofluoride (SrF). Using an optical cycling scheme requiring only three lasers, we have observed both Sisyphus and Doppler cooling forces which have substantially reduced the transverse temperature of a SrF molecular beam. Currently the only technique for producing ultracold molecules is by binding together ultracold alkali atoms through Feshbach resonance or photoassociation. By contrast, different proposed applications for ultracold molecules require a variety of molecular energy-level structures. Our method provides a new route to ultracold temperatures for molecules. In particular it bridges the gap between ultracold temperatures and the ~1 K temperatures attainable with directly cooled molecules (e.g. cryogenic buffer gas cooling or decelerated supersonic beams). Ultimately our technique should enable the production of large samples of molecules at ultracold temperatures for species that are chemically distinct from bialkalis.Comment: 10 pages, 7 figure
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