Having a family doctor is associated with some better patient-reported outcomes of primary care consultations

<b>Background</b> Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference.<p></p> <b>Methods</b> We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient’s concerns.<p></p> <b>Results</b> One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient’s concerns.<p></p> <b>Conclusion</b> People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations

A new micromechanical model of CNT-metal nanocomposites with random clustered distribution of CNTs

Uniform dispersion of carbon nanotubes (CNTs) is a key issue for utilization of their reinforcement potential in CNT-reinforced metal matrix nanocomposites (MMNCs). It was reported that CNT clusters often exist in MMNCs prepared by various techniques, which reduces the load transfer efficiency between the matrix and reinforcement. In this paper, a new micromechanical constitutive model of CNT-reinforced MMNCs is developed, which takes into account of the influences of CNT clusters and misorientations. The strength values of a CNT/Al nanocomposite predicted by the new model are compared first with experimental data for validation. Then, the developed model is applied to predict the size effect, temperature effect and strain rate effect of the nanocomposite in its overall elastoplastic response

Analytical Simulations for Shaking Table Tests of a Full Scale Buckling Restrained Braced Frame

AbstractThe seismic response tests of a full-scale five-story passively-controlled steel building have been conducted on the EDefense shaking table in Japan in March 2009. Before the tests, a blind prediction contest was held to allow researchers and practitioners from all over the world to construct numerical model and predict the dynamic responses of the building frame equipped with buckling restrained braces or viscous dampers. This paper presents the response predictions made before the tests of the buckling restrained braced frame (BRBF). A three-dimensional shell finite element subassembly model was constructed to investigate the stiffness of the buckling-restrained brace end joint. The dynamic test results of the sample steel dampers provided by the organizer were used to calibrate the BRB strength in the numerical model. The details of the numerical model for the composite beam, hollow structural section column, and the beam-to-column panel zone are described. Base on the numerical and test analyses, effective numerical models are presented and the recommended nonlinear modeling techniques for BRBF are provided

A clathrin/dynamin- and mannose-6-phosphate receptor–independent pathway for granzyme B–induced cell death

The 280-kD cation-independent mannose-6-phosphate receptor (MPR) has been shown to play a role in endocytic uptake of granzyme B, since target cells overexpressing MPR have an increased sensitivity to granzyme B–mediated apoptosis. On this basis, it has been proposed that cells lacking MPR are poor targets for cytotoxic lymphocytes that mediate allograft rejection or tumor immune surveillance. In the present study, we report that the uptake of granzyme B into target cells is independent of MPR. We used HeLa cells overexpressing a dominant-negative mutated (K44A) form of dynamin and mouse fibroblasts overexpressing or lacking MPR to show that the MPR/clathrin/dynamin pathway is not required for granzyme B uptake. Consistent with this observation, cells lacking the MPR/clathrin pathway remained sensitive to granzyme B. Exposure of K44A-dynamin–overexpressing and wild-type HeLa cells to granzyme B with sublytic perforin resulted in similar apoptosis in the two cell populations, both in short and long term assays. Granzyme B uptake into MPR-overexpressing L cells was more rapid than into MPR-null L cells, but the receptor-deficient cells took up granzyme B through fluid phase micropinocytosis and remained sensitive to it. Contrary to previous findings, we also demonstrated that mouse tumor allografts that lack MPR expression were rejected as rapidly as tumors that overexpress MPR. Entry of granzyme B into target cells and its intracellular trafficking to induce target cell death in the presence of perforin are therefore not critically dependent on MPR or clathrin/dynamin-dependent endocytosis

Landslides affecting sedimentary characteristics of reservoir basin

Typhoons Aere (2004) and Matsa (2005) caused high nephelometric turbidity in the Shihmen reservoir in northern Taiwan, jeopardizing the operation of the reservoir for several days, and ultimately impacting the living conditions and economy of the downstream residents. The torrential rains caused landslides and debris flows in upland areas, and flowed into riverbeds, likely contributing significantly to the suspended sediment yields in the reservoir. This investigation elucidates how upland landslides affect sediment attributes in the reservoir basin. Study methods including field observations, spatial analysis in GIS and aerial photo interpretation are adopted to trace the sediment sources and contributing factors to the landslide. Torrential rains induced landslides and debris-flows upland, causing river incisions and soil erosion in landslide areas lacking vegetation. These factors, together with the conditions of the engineered structures and geologic vulnerabilities of the area, caused suspended sediment yield in the reservoir. The high nephelometric turbidity could potentially reoccur, with masses of landslide-derived sediment remaining upland and in the riverbed

HUBUNGAN DUKUNGAN KELUARGA DENGAN TINGKAT DEPRESI PADA NARAPIDANA NAPZA DI RUTAN KELAS IIB KAJHU ACEH BESAR

Banda Ace

Running coupling: Does the coupling between dark energy and dark matter change sign during the cosmological evolution?

In this paper we put forward a running coupling scenario for describing the interaction between dark energy and dark matter. The dark sector interaction in our scenario is free of the assumption that the interaction term $Q$ is proportional to the Hubble expansion rate and the energy densities of dark sectors. We only use a time-variable coupling $b(a)$ (with $a$ the scale factor of the universe) to characterize the interaction $Q$. We propose a parametrization form for the running coupling $b(a)=b_0a+b_e(1-a)$ in which the early-time coupling is given by a constant $b_e$, while today the coupling is given by another constant, $b_0$. For investigating the feature of the running coupling, we employ three dark energy models, namely, the cosmological constant model ($w=-1$), the constant $w$ model ($w=w_0$), and the time-dependent $w$ model ($w(a)=w_0+w_1(1-a)$). We constrain the models with the current observational data, including the type Ia supernova, the baryon acoustic oscillation, the cosmic microwave background, the Hubble expansion rate, and the X-ray gas mass fraction data. The fitting results indicate that a time-varying vacuum scenario is favored, in which the coupling $b(z)$ crosses the noninteracting line ($b=0$) during the cosmological evolution and the sign changes from negative to positive. The crossing of the noninteracting line happens at around $z=0.2-0.3$, and the crossing behavior is favored at about 1$\sigma$ confidence level. Our work implies that we should pay more attention to the time-varying vacuum model and seriously consider the phenomenological construction of a sign-changeable or oscillatory interaction between dark sectors.Comment: 8 pages, 5 figures; refs added; to appear in EPJ

Recalibration of the limiting antigen avidity EIA to determine mean duration of recent infection in divergent HIV-1 subtypes.

ArticleBackground: Mean duration of recent infection (MDRI) and misclassification of long-term HIV-1 infections, as proportion false recent (PFR), are critical parameters for laboratory-based assays for estimating HIV-1 incidence. Recent review of the data by us and others indicated that MDRI of LAg-Avidity EIA estimated previously required recalibration. We present here results of recalibration efforts using >250 seroconversion panels and multiple statistical methods to ensure accuracy and consensus. Methods: A total of 2737 longitudinal specimens collected from 259 seroconverting individuals infected with diverse HIV-1 subtypes were tested with the LAg-Avidity EIA as previously described. Data were analyzed for determination of MDRI at ODn cutoffs of 1.0 to 2.0 using 7 statistical approaches and sub-analyzed by HIV-1 subtypes. In addition, 3740 specimens from individuals with infection >1 year, including 488 from patients with AIDS, were tested for PFR at varying cutoffs. Results: Using different statistical methods,MDRI values ranged from 88-94 days at cutoff ODn = 1.0 to 177-183 days at ODn = 2.0. The MDRI values were similar by different methods suggesting coherence of different approaches. Testing formisclassification among long-terminfections indicated that overall PFRs were 0.6%to 2.5%at increasing cutoffs of 1.0 to 2.0, respectively. Balancing the need for a longer MDRI and smaller PFR (<2.0%) suggests that a cutoff ODn = 1.5, corresponding to an MDRI of 130 days should be used for cross-sectional application. The MDRI varied among subtypes from 109 days (subtype A&D) to 152 days (subtype C). Conclusions: Based on the new data and revised analysis, we recommend an ODn cutoff = 1.5 to classify recent and long-term infections, corresponding to an MDRI of 130 days (118-142). Determination of revised parameters for estimation of HIV-1 incidence should facilitate application of the LAg-Avidity EIA for worldwide use.This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC)

Collaborative multidisciplinary management and expertise of cT2-3 locally advanced operable esophageal squamous cell carcinoma:two case reports

Background: The accurate clinical staging of esophageal squamous cell carcinoma (ESCC) is pivotal for guiding treatment strategies. However, the current precision in staging for clinical T (cT)2 and cT3 stages remains unsatisfactory. This article discusses the role of multidisciplinary teams (MDTs) in the clinical staging and formulation of neoadjuvant treatment strategies for locally advanced operable ESCC. These challenges underscore the importance of precise staging in the decision-making process for appropriate therapeutic interventions.Case Description: Through the lens of two patient case studies with locally advanced resectable ESCC, the article showcases the intricate process of treatment planning undertaken by MDTs. It captures a range of expert perspectives from Japan, China, Hong Kong (China), Korea, the USA, and Europe, focusing on the challenges of differentiating between cT2 and cT3 stages of the disease, which is a critical determinant in the management and therapeutic approach for patients.Conclusions: The article concludes that the accurate staging of ESCC is a cornerstone in determining the most suitable treatment strategies. It underscores the vital role that MDTs play in both clinical staging and the decision-making process for treatment. Highlighting the limitations in current diagnostic methods, the article emphasizes the urgent need for advanced research and the refinement of diagnostic tools to improve the precision of staging, particularly between the cT2 and cT3 stages. It suggests that future research should consider whether a reclassification of these stages could be warranted to enhance treatment planning and outcomes for patients with ESCC.<br/