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Heart failure is a progressive and unpredictable heart disease. How to work with these patients to decrease their psychological distress and promote their self-care behaviors is important. Transition care is the continuity of medical care for heart failure patients returning home from the hospital. Intervention through transition care may improve the continuity of medical care for patients with heart failure but it has not been examined in clinical settings in Taiwan.
Objectives
The aims of this study were to explore the effects of a newly developed transition care program on depression, self-efficacy, and self-care behavior of heart failure patients.
Methods
Using an experimental research design and block randomization, participants were divided into the experimental group (received transition care and routine care) and the control group (received routine care only). The Patient Health Questionnaire-9 (PHQ-9), the General Self-Efficacy Scale (GSES), and the Self-Care of Heart Failure Index (SCHFI version 6.2) were used to collect data before discharge and the first month after discharge.
Results
A total of 20 patients with heart failure were recruited. No significant differences were found between the experimental (n=10) and control groups (n=10) in the degree of depression (Z=-.077, p=.938), self-efficacy (Z=-1.214, p=.225), and three self-care behaviors subscales (self-care maintenance Z= -1.214, p=.225; self-care management Z= -.401, p=.689; self-care confidence Z=-.436, p=.663) at discharge. After the one-month posttest, only self-efficacy (Z=-2.545, p=.011) and three self-care behaviors subscales (self-care maintenance Z=-3.097, p=.002; self-care management Z= -2.595, p=.009; self-care confidence Z=-3.671, p<.001) reached a statistical difference between the two groups.
Conclusions
Based on the preliminary results, heart failure patients can improve their self-care behavior and self-efficacy but not depression through transitional care intervention.
Even though depression is a severe health issue among older adults, few studies have explored their knowledge of geriatric depression.
Objectives
This study aimed to explore older adults’ knowledge of geriatric depression and its related factors.
Methods
A cross-sectional survey was conducted. Older adults were recruited by convenience from outpatient clinics of three hospitals in Taiwan.
Results
A total of 327 older adults participated in this study. Their mean score of knowledge was 7.73 (SD=2.12, Range=2-12) on an 18-item knowledge scale, indicating poor knowledge of geriatric depression. Females had significantly higher geriatric depression knowledge scores than males (t=2.50, p=0.01). Junior and senior high school graduates had significantly higher geriatric depression knowledge scores than illiterate and primary school graduates (F=10.23, p<0.01). In addition, their geriatric depression knowledge scores also differed by religious belief (F=4.91, p<0.01), living status (F=8.64, p<0.01), and perceived health condition (F=8.81, p<0.01). Buddhists had significantly higher geriatric depression knowledge scores than Taoists. Living with partners and perceiving their health status as fair and good tended to have higher geriatric knowledge scores than their counterparts. However, their geriatric depression knowledge scores did not significantly correlate with their mean scores of social distance toward older adults with depression.
Conclusions
Older adults tended to have poor geriatric depression knowledge. Improving their knowledge shall be an urgent task. Our results may serve as references for developing further depression prevention.
There has been limited research on clay mineral transformation in serpentinitic soils under humid tropical conditions. In this study, four soil pedons were selected along a toposequence from the summit (Entisol), shoulder (Vertisol), backslope (Alfisol) to footslope (Ultisol) positions to explore the contributions and the significance of landscape and weathering status of serpentinitic rock with regard to clay mineral transformations in eastern Taiwan. Experimental results indicated that the large amount of dithionite-citrate-bicarbonate-extractable Fe (Fed) and clay in the subsurface horizon were mainly caused by the strong leaching potential from intensive rainfall and weathering of the fine-grained parent rocks. The clay mineralogy reflected the clear weathering trend of the soils along the toposequence: (1) the soils on the summit and shoulder contained smectite and serpentine, which are predominant in the young soils derived from serpentinitic rocks; and (2) vermiculite gradually increased in the relatively old soils on backslope and footslope. The mineralogical transformations observed along the toposequence indicated that chlorite and serpentine, initially present in the Entisol on the summit, weather into smectite and interstratified chlorite-vermiculite in the intermediate soil on the shoulder under strong leaching and oxidizing conditions. Furthermore, vermiculite formed as the major weathering product of chlorite and smectite in the soil developed on the backslope. In addition to vermiculite, kaolinite and quartz formed in the soils on the footslope with the greatest concentration of Fed along the toposequence.
Suicide rates are high for older persons worldwide. However, no literature could be found on young-old people’s opinions about elderly suicide and the beliefs/expectations that protect them from attempting suicide.
Objectives:
To explore opinions about elderly suicide among community-dwelling young-old people in Taiwan and their reasons for not killing themselves.
Method:
A qualitative descriptive design was used. Young-old (65–74 years old) outpatients were recruited by convenience from two randomly selected medical centers in northern Taiwan if they had never expressed suicidal ideas and had no severe cognitive deficit. Data were collected in individual interviews and analysed by content analysis.
Results:
Among 31 participating young-old people, most participants (87.1%) had heard of elderly suicide. Their opinions about elderly suicide reflected negative emotional reactions (32.3%), judgmental attitudes (32.3%), could happen after losing the meaning of life (9.7%), and expectations of social welfare (9.7%). Reasons for not killing themselves fell into six major themes: living well (32.3%), suicide cannot resolve problems (22.6%), fear of humiliating their children (16.1%), religious beliefs (12.9%), never thought about suicide (12.9%), and living in harmony with nature (12.9%).
Conclusion:
Among the factors that prevented participants from killing themselves, perceptions of living well and of children’s filial behavior, as well as rational thinking could be adjusted. These factors can be addressed and improved by healthcare providers and policy makers to prevent suicide among the young-old. Our findings may also serve as a reference for geriatric researchers in western countries with increasing numbers of elderly ethnic minority immigrants.
Nutritional therapy is a cornerstone of burns management. The optimal macronutrient intake for wound healing after burn injury has not been identified, although high-energy, high-protein diets are favoured. The present study aimed to identify the optimal macronutrient intake for burn wound healing. The geometric framework (GF) was used to analyse wound healing after a 10 % total body surface area contact burn in mice ad libitum fed one of the eleven high-energy diets, varying in macronutrient composition with protein (P5−60 %), carbohydrate (C20−75 %) and fat (F20−75 %). In the GF study, the optimal ratio for wound healing was identified as a moderate-protein, high-carbohydrate diet with a protein:carbohydrate:fat (P:C:F) ratio of 1:4:2. High carbohydrate intake was associated with lower mortality, improved body weight and a beneficial pattern of body fat reserves. Protein intake was essential to prevent weight loss and mortality, but a protein intake target of about 7 kJ/d (about 15 % of energy intake) was identified, above which no further benefit was gained. High protein intake was associated with delayed wound healing and increased liver and spleen weight. As the GF study demonstrated that an initial very high protein intake prevented mortality, a very high-protein, moderate-carbohydrate diet (P40:C42:F18) was specifically designed. The dynamic diet study was also designed to combine and validate the benefits of an initial very high protein intake for mortality, and subsequent moderate protein, high carbohydrate intake for optimal wound healing. The dynamic feeding experiment showed switching from an initial very high-protein diet to the optimal moderate-protein, high-carbohydrate diet accelerated wound healing whilst preventing mortality and liver enlargement.
This paper reported the designed approaches of cycloidal mechanisms, studied its dynamic forces and failure characteristics using finite element methods (FEM). A simplified cycloidal mechanism (CM) is constructed to fulfill dynamic analysis and reliability evaluation. The studied results show that the loads of the mechanism are shared mainly by a half of the outer rollers and the inner pins. The possible failures of the mechanism will occur at the inner pins caused by the bending stress, and at the cycloid disc induced by the contacting stress. The failure of the inner pins will dominate the damage of the mechanism. A method of evaluating stress variation is proposed for fulfilling reliability design. The stress variations are derived according to the data in dynamic analysis by regression analysis. The methods of design modification are reported for improve the reliabilities. The allowable loads of the CM can be decided accordingly based on the analyzed information.
Origami, the ancient paper folding art has inspired the engineering equipment and design for decades. The basic concept of origami is very general, which leads to applications ranging from small scale to large scale. Recently, researchers are interested in being able to create self-folding structures. Such a structure enables kinematic manipulation by external forces or moments without folding and/or unfolding operations. This is a beneficial application for many fields including aerospace systems, robots, small devices and self-assembly systems. In this paper, the investigation and analyses of the previous literatures on the key driving force of the actuation structure, including the heat, light, electricity, gas and other actuation methods. The aims are to provide researchers and practitioners with the support to systematically understand the latest technologies in this important and evolving field, with inspiration and direction for follow-up.
In the recent years, the development of wind turbines has been so hectic in Taiwan. The design of the turbine blades directly impacts power effectiveness. In this study, the effects of manufacturing parameters and environmental factors on the mechanical properties of carbon fiber/epoxy composites that are used in turbine blades are discussed. Parameters of the manufacturing process affect the mechanical properties. Carbon composites made by a different numbers of layers are tested on various aspects of performance such as mechanical strength and corrosion resistance.
This study investigated the flow bifurcations of flows driven by a pressure gradient in a rectangular curved tube. When fluid flows within a curved tube, due to the centrifugal effect, secondary vortices can be induced in the cross section of the tube. The secondary flow states are dependent on the magnitude of the pressure gradient (q) and the aspect ratio (γ). In this study, the continuation method was applied to investigate the flow bifurcations in a curved tube with increasing pressure gradient (1 < q < 6000) and aspect ratio (0.9 < γ < 1.4).
The bifurcation diagrams are composed of solution branches, which are linked by limiting points or bifurcation points. The flow states in a solution branch belong to the same group. The ranges of the flow states and the relationship between the states can also be derived from the bifurcation diagrams. In this study, two types of bifurcation were found, one in the range of 0.9 < γ < 1.17, and another in the range of 1.18 < γ < 1.4. The ranges of stable flow solutions and the distributions of limit and bifurcation points in both pressure gradient and aspect ratio are derived in this study.
Prior to integrated circuit (IC) packaging, die performance must be verified using probe cards to screen for defective products. With the decrease in IC line width, the dimensions of the pads used for performance verification and the spacing between adjacent pads have also decreased. However, when the pad pitch is reduced to less than 30 μm, commonly used probe cards will face manufacturing problems in miniaturization. To resolve probe card manufacturing problems caused by the miniaturization of IC components, the use of an anisotropic conductive film (ACF) in probe cards was proposed in this study. Theoretical calculations and experimental testing of this probe structure were conducted to demonstrate the feasibility of this concept.
In theoretical calculations, composite material and buckling theory were utilized to evaluate the buckling behavior of the ACF. In experimental testing, photolithography and electroplating techniques were used to control the line width and spacing intervals of the micron-scale metal wires in the ACF. After the ACF was fabricated, the mechanical properties of the ACF during wafer testing were assessed. Theoretical analyses and experimental testing verified that ACFs can potentially be applied to the performance verification of IC products. In the ACF structure, multiple probes came into contact with each pad. Therefore, ACFs can potentially be applied to the performance verification of IC components with pad diameters of less than 20 μm. The results of this study directly benefit the miniaturization of ICs.
In recent years, compact camera modules (CCMs) have been widely used in consumer electrical and electronic products. CCMs with low cost specially are necessary for portable devices. Therefore, the present group recently developed a miniaturized open-loop controlled camera module with low cost for cellphone applications, in which the Lorentz force is balanced by a magnetic restoring force. To enhance the performance of the camera module, this article reports a pattern structure to modify the linearity of the magnetic restoring force. We fabricated a CCM prototype with the dimensions of 8.5 mm × 8.5 mm × 5 mm and demonstrated the usefulness of the pattern structure with the CCM prototype. Its potential applications are foreseeable in portable devices, such as cellphones, web cameras, personal digital assistants and other commercial electronics.
The aim of the study was to evaluate the comparative risk of self-harm associated with the use of different antidepressants.
Method
A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 751 606 new antidepressant users with depressive disorders were included. The study outcome was hospitalization due to self-harm (International Classification of Diseases, Ninth Revision, Clinical Modification codes: E950–E958 and E980–E988). Cox proportional hazards models with stratification of the propensity score deciles were used to estimate the hazard ratios of self-harm hospitalization during the first year following the initiation of antidepressant treatment.
Results
There were 1038 hospitalization episodes due to self-harm that occurred during the follow-up of 149 796 person-years, with an overall incidence rate of 6.9 [95% confidence interval (CI) 6.5–7.4] per 1000. Compared with fluoxetine, the risk of self-harm hospitalization was higher for maprotiline [adjusted hazard ratio (aHR) = 3.00, 95% CI 1.40–6.45], milnacipran (aHR = 2.34, 95% CI 1.24–4.43) and mirtazapine (aHR = 1.40, 95% CI 1.06–1.86), lower for bupropion (aHR = 0.51, 95% CI 0.30–0.86), and similar level of risk was found for other selective serotonin reuptake inhibitors (citalopram, escitalopram, fluvoxamine, paroxetine and sertraline).
Conclusions
The risk of self-harm may vary across different antidepressant drugs. It would be of importance to conduct further research to investigate the influence of antidepressant use on self-harm behaviors.
EVA foams, like all other polymers, also exhibit strain-rate effects and hysteresis. However, currently available approaches for predicting the mechanical response of polymeric foam subjected to an arbitrarily imposed loading history and strain-rate effect are highly limited. Especially, the strain rates in the intermediate rate domain (between 100 and 102 s–1) are extremely difficult to study. The use of data generated through the drop tower technique for implementation in constitutive equations or numerical models has not been considered in past studies. In this study, an experiment including a quasi-static compression test and drop impact tests with a high speed camera was conducted. An inverse analysis technique combined with a finite element model for material parameter identification was developed to determine the stress–strain behavior of foam at different specific strain rates. It was used in this study to simulate multiple loading and unloading cycles on foam specimens, and the results were compared with experimental measurements.
Reducers are extensively used in many machines for reducing the speeds of mechanism. This paper proposed a new design of speed reducers to meet the performance requirements in high rigidness and large speed-reduction ratios. The movements of the reducer are designed based on the principles of differential displacements of the deceleration gear rings. The geometric models of the related components were designed using CAD software. The motions of mechanism were simulated for identifying the feasibility of designing including acquiring the kinematic properties. The mathematical models of structural stresses analysis were proposed so that the bending and contact stresses of the gear rings could be evaluated, accordingly. Finite element methods (FEM) were also used to analyze the structural stresses of the reducer. The studied results showed that the bending fracture of the gear rings would prior to its contacting fracture. The allowable loading of the reducer was then established according to the analyzed results of the maximum stresses on various transmitted torques. The methods of reliability evaluation were reported for considering the strength variation and calculating the reliabilities of the reducer at various loadings. The studied results are useful in structural design, stress analysis and reliability evaluation for developing high speed-reduction mechanisms.
The effects of various parameters, such as thermal properties of substrates, thermal interface materials (TIMs) and heat sinks on the thermal performance of the light emitting diode (LED) light bars and backlight module are investigated experimentally and numerically in terms of junction temperature (Tj) and thermal resistances from junction to air (Rj-a). The results show that the measured Rj-a of the light bars by powering-on five LEDs in the test is different from one by powering-on only one LED, resulting from the extra heat coming from the adjacent LED packages affecting the Tj for the case of powering-on five LEDs. For the modules, Rj-a is significantly reduced by using the heat sinks for all backlight modules, and aluminum and iron heat sinks do not show any obvious difference in heat dissipation along with any substrates and TIMs. Furthermore, both experimental and simulation results show that the thermal conductivity of the substrates are more important and dominant than TIM and heat sink for the Rj-a of the backlight modules concerned, and also demonstrate that the thermal field for the local model can represent the one in full-scale backlight module.
Voice restoration after laryngopharyngectomy can be achieved with an autologous ileocolic flap. We have observed that the length of the flap influences vocal outcome. This investigation aimed to evaluate the association between ileocolic flap length and vocal quality after laryngopharyngectomy.
Methods:
The charts of patients who underwent voice rehabilitation with an ileocolic flap after laryngopharyngectomy between 1 January 2011 and 30 December 2012 were abstracted. The length of ileum segment in the ileocolic flap was stratified, and voice outcome was evaluated three months post-operatively, while adjusting for confounding variables.
Results:
There was a significant association between flap length and loudness, maximum phonation time and sound pressure level (p < 0.05). All three parameters were best in the 10 cm length group.
Conclusion:
Voice rehabilitation after laryngopharyngectomy is possible with an ileocolic flap. The optimal ileocolic flap contains a 10 cm ileum segment. Complications are frequent but amenable to revision surgery.
Through silicon via (TSV) is the critical structure for three dimensional (3D) integration, which provides vertical interconnection between stacking dies. In TSV structure, large coefficient differences of thermal expansion exist between silicon substrate, dielectric material, and filled metal. Due to the large thermal mismatch, the high thermal stress occurring at the interface of different materials would result in delamination. Therefore, thermal-mechanical reliability is a key issue for 3D integration. In this study, we investigated the thermal-mechanical stress distribution of TSV under the condition of the accelerated thermal cycling loading by finite element analysis based on a 3D model of TSV structure. Due to the thermal expansion, that the TSV structure squeezed the surface area between TSVs at a high temperature resulted in compressive stresses at the surface area between TSVs. Therefore, a proper distance between the stress-sensitive device and the TSV should be kept. The stress analysis shows that the maximum thermal stress occurs in the outside region of TSV interface and in the annular region of TSV at a high temperature and at a low temperature, respectively. This study helps to obtain a clear thermal stress distribution of TSV and possible failure regions can be determined.
Pregnancy-associated pyogenic granuloma (pregnancy tumour) is not uncommon. However, control of severe bleeding associated with the lesion by transarterial embolisation has never been reported.
Case report:
We report the case of a 33-year-old pregnant woman (34 weeks gestation) who presented with a pregnancy-associated pyogenic granuloma of the mandibular gingiva with a life-threatening haemorrhage. The bleeding stopped soon after transarterial micro-embolisation and regressed after one month; thus, no further surgical excision was needed. The patient was free of post-operative wound pain and infection, and there was no recurrence after one year of follow up.
Conclusion:
In general, surgical excision is the first treatment choice for pregnancy tumours. However, it is limited by the risk of marked deformity or incomplete excision when large lesions or difficult surgical areas are encountered. For large tumours, transarterial embolisation may be a safer alternative.
Haemangioma of the adult larynx is an uncommon, benign lesion. The optimal surgical method of treating these lesions is controversial because only very limited case series are available. This paper reports the results of transoral robotic resection of a supraglottic haemangioma in an adult and reviews the literature.
Methods and results:
A 58-year-old woman presented having experienced a lump-in-the-throat sensation for 1 year. Investigations on laryngoscopy revealed a lobulated, dark red mass in the region of the supraglottis. This was successfully excised by transoral robotic excision without complications.
Conclusion:
Adult supraglottic haemangiomas can be treated successfully with transoral robotic excision; this potentially allows more of the surrounding mucosal tissue to be spared and enables easy control of bleeding.