Clinical use of venoarterial extracorporeal membrane oxygenation.

With advances in mechanical circulation, venoarterial extracorporeal membrane oxygenation has become an established technique to provide cardiopulmonary support for patients with cardiovascular collapse. This article reviews the physiological principles of such extracorporeal technique and its interaction with the native heart. Practical aspects including equipment, patient selection, and common complications with their prevention and specific management are summarised. The strategy for weaning from venoarterial extracorporeal membrane oxygenation is also discussed.

Age-Friendliness and Life Satisfaction of Young-Old and Old-Old in Hong Kong.

Age-friendliness, promoted by the World Health Organization (WHO), aims to enable and support individuals in different aspects of life for fostering life satisfaction and personal well-being as they age. We identified specific aspect(s) of age-friendliness associated with life satisfaction and examined similarities and differences in age-friendliness and life satisfaction in young-old and old-old adults. Six hundred and eighty-two ageing adults were asked to complete a survey questionnaire consisting of the Age-friendly City Scale, Satisfaction with Life Scale, and sociodemographic variables. Multiple linear regression analysis was used to examine the effects of various domains of age-friendliness on life satisfaction among the young-old adults (aged 65 to 74, n = 351) and the old-old adults (aged 75 to 97, n = 331). Common domains associated with life satisfaction in both young-old and old-old groups were transportation and social participation. Community and health services were associated with life satisfaction for the young-old group only. On the other hand, civic participation and employment was significantly associated with the old-old group only. Social participation is important for the young-old and the old-old. Ageing older adults can be a resource to the society. Implications for promoting and implementing age-friendliness were discussed in the context of successful and productive ageing and the need for a more refined taxonomy of social activities.

Clinical use of venovenous extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation has been used clinically for more than 40 years. The technique provides respiratory and/or circulatory support via venovenous and veno-arterial configurations, respectively. We review the basic physiological principles of extracorporeal membrane oxygenation systems in venovenous extracorporeal membrane oxygenation. Clinical aspects including patient selection, equipment, setup, and specific patient management are outlined. Pros and cons of the use of extracorporeal membrane oxygenation in respiratory failure are discussed.

Acquired factor V inhibitor in a patient receiving venous-venous extracorporeal membrane oxygenation for Legionella pneumonia.

We report a rare complication of factor V deficiency in a patient having Legionella pneumonia. This patient also had other complications like severe acute respiratory distress syndrome, acute kidney injury, and septic shock that required venous-venous extracorporeal membrane oxygenation support. This is the first reported case of acquired factor V deficiency in a patient receiving extracorporeal membrane oxygenation for Legionella pneumonia. With the combined use of intravenous immunoglobulin, rituximab and plasma exchange, we achieved rapid clearance of the factor V inhibitor within 1 week so as to allow safe decannulation of extracorporeal membrane oxygenation.

Changes in the Attitude and Practice Toward End-of-Life Care: Perspective of Chinese Physicians in Medical Department.

INTRODUCTION: End-of-life care is affected by the attitude and cultural influence of doctors. METHODS: To investigate the attitudes and practices of doctors on end-of-life care by questionnaire survey in 2004 and 2008. RESULTS: In 2004, 31.7% of the respondents agreed that they "do not attempt resuscitation" (DNAR) form was useful and it rose to 54.4% in 2008. A higher proportion of respondents in 2008 claimed that they signed the DNAR form for documentation and accepted withholding noninvasive life-sustaining treatment compared to 2004. In 2004, 50% of the respondents regarded their training and education on handling DNAR issue as inadequate. CONCLUSION: Documentation by DNAR form is gaining wider acceptance. Many doctors are expected to have more training and coaching on communication for handling such sensitive issues.

Efficiency dip observed with InGaN-based multiple quantum well solar cells.

The dip of external quantum efficiency (EQE) is observed on In(0.15)Ga(0.85)N/GaN multiple quantum well (MQW) solar cells upon the increase of incident optical power density. With indium composition increased to 25%, the EQE dip becomes much less noticeable. The composition dependence of EQE dip is ascribed to the competition between radiative recombination and photocurrent generation in the active region, which are dictated by quantum-confined Stark effect (QCSE) and composition fluctuation in the MQWs.

High-voltage thin-film GaN LEDs fabricated on ceramic substrates: the alleviated droop effect at 670 W/cm(2).

High-voltage thin-film GaN LEDs with the emission wavelength of 455 nm were fabricated on ceramic substrates (230 W/m · K). The high-voltage operation was achieved by three cascaded sub-LEDs with dielectric passivation and metal bridges conformally deposited on the side walls. Under the driving power of 670 W/cm(2), the high-voltage LEDs exhibit much alleviated efficiency droop and the operative temperature below 80 °C. The excellent performances were attributed to the improved current spreading within each sub-LED and the superior heat sinking of the ceramic substrate.

A rare neurological complication due to lithium poisoning.

Lithium salts have been used in treatment of depression and bipolar disorder for more than 50 years. Neurotoxic side-effects such as nystagmus, ataxia, tremor, fasciculation, clonus, seizure and even coma have been well described in the literature. We present a case of generalised peripheral neuropathy following lithium intoxication. It is a rare presentation with delayed onset and characterised by a rapid downhill course. Diagnosis was confirmed by nerve conduction tests, which showed axonal neuropathy. Despite the profound neurological effects of this toxicity, it is readily reversible with supportive care and the prognosis is good.

Familial aggregation and heritability of insomnia in a community-based study.

BACKGROUND: Emerging data suggested a significant familial aggregation of insomnia. We aimed to clarify the familial aggregation and heritability of insomnia disorder by using structural clinical interviews for the ascertainment of insomnia and psychiatric disorders in a community-based sample. METHODS: Seventy-five adolescents with insomnia and their 180 first degree relatives, together with 141 age- and sex-matched non-insomnia controls and their 382 first degree relatives, were recruited. Each subject underwent a structured clinical interview and completed a series of psychometric inventories. The rates of insomnia disorder among the first degree relatives were employed to analyze familial aggregation. Heritability of insomnia was analyzed by SOLAR program as based on father-mother-offspring trios. RESULTS: Our study confirmed a significant familial aggregation of insomnia with a first degree relatives' recurrence risk of 2.33 for current insomnia and 2.82 for lifetime insomnia, respectively. The heritability±SE of current and lifetime insomnia disorder was 0.48±0.13 and 0.61±0.11 (p<0.001), respectively, which were higher than insomnia symptoms as estimated by the Insomnia Severity Inventory (h(2)±SE=0.27±0.09) and the Pittsburgh Sleep Quality Index (h(2)±SE=0.30±0.11). After exclusion of comorbid psychiatric disorders, the heritability for current and lifetime primary insomnia was 0.45±0.17 (p=0.007) and 0.58±0.21 (p=0.004), respectively. CONCLUSIONS: Our study demonstrates a significant familial aggregation with a high heritability of insomnia disorder. The strong heritability of insomnia persists despite the exclusion of psychiatric disorders. Further molecular genetic investigation of insomnia is indicated.

Solar energy harvesting scheme using syringe-like ZnO nanorod arrays for InGaN/GaN multiple quantum well solar cells.

Syringe-like ZnO nanorod arrays (NRAs) synthesized by a hydrothermal method were applied as the light-harvesting layer on InGaN-based multiple quantum well (MQW) solar cells. Theoretical calculations show that the NRAs with an abrupt shrinkage of tip diameter can further suppress surface reflectance in comparison with the flat NRAs. InGaN-based MQW solar cells with the syringe-like NRAs exhibit greatly improved conversion efficiencies by 36%. These results are attributed to the improved flatness of the refractive index profile at the air/device interface, which results in enhanced light trapping effect on the device surface.

Weight changes and their associations with demographic and clinical characteristics in risperidone maintenance treatment for schizophrenia.

OBJECTIVE: This study aimed to characterize weight changes in schizophrenia patients taking risperidone as part of a randomized, controlled, open-label clinical trial. METHODS: A total of 374 patients with schizophrenia who had been clinically stabilized following an acute episode were randomly assigned to a 'no-dose-reduction' group (initial optimal therapeutic doses continued throughout the study), a '4-week group' (initial optimal therapeutic doses continued for 4 weeks followed by a half dose reduction that was maintained until the end of the study) or a '26-week group' (initial optimal therapeutic doses continued for 26 weeks followed by a half dose reduction until the end of the study). Participants were assessed monthly using standardized assessment instruments during the first 6 months, and then every 2 months until the last recruited patient completed the 1-year follow-up. Weight gain was defined as gaining at least 7% of initial body weight, weight loss as losing at least 7% of initial body weight. A BMI <18.5 kg m⁻² was defined as underweight, 18.5-24.9 kg m⁻² as normal range, and ≥ 25 kg m⁻² as overweight or obese. RESULTS: At the end of follow-up, of the patients who started within the underweight range (n=22), 77.3% gained weight, whereas 4.5% lost weight. The corresponding figures were 39.6% and 4.8% in patients who started at normal weight (n=273), respectively, and 17.7% and 17.7% in patients who started at overweight (n=79), respectively. At the same time, 59.1% of the patients who started at underweight range went into the normal weight and 13.6% into the overweight/obese range, respectively, while 24.5% of those who started at normal weight went into the overweight/obese range, and 1.1% into underweight range, respectively; 20.3% of those who started at overweight range went into normal weight at the end of the follow-up. Multiple logistic regression analyses revealed that being underweight or normal weight at study entry predicted weight gain compared to being overweight, whereas being overweight at entry was associated with a higher likelihood of weight loss compared to being normal weight. No correlation was found between weight change and dose reduction. CONCLUSIONS: Weight change is a common, long-term, but heterogeneous side effect in risperidone maintenance treatment for stable schizophrenia patients. Special attention should be paid to fluctuations in weight that may occur throughout the course of treatment with risperidone.

Slope-tunable Si nanorod arrays with enhanced antireflection and self-cleaning properties.

Slope-tunable Si nanorod arrays (NRAs) were fabricated with colloidal lithography and reactive ion etching (RIE). Sharpened NRAs fabricated by increasing the SF6/O2 flow ratio during RIE exhibit enhanced antireflection (AR) and hydrophobic properties, which are attributed to the smooth gradient in the effective refractive index of NRAs, and the enlarged water/air interface of the water drops in the NRA layers, respectively. Enhanced AR characteristics via modifying the slope of NRAs are accompanied by broad-band working ranges, omnidirectionality, and polarization insensitivity. Detailed experimental and theoretical analysis of slope-tunable NRAs should benefit the development of various self-cleaning optoelectronic devices with efficient light management.

Effects of SP6 acupressure on pain and menstrual distress in young women with dysmenorrhea.

OBJECTIVES: This study aims to evaluate the effects of Sanyinjiao (SP6) acupressure in reducing the pain level and menstrual distress resulting from dysmenorrhea. METHODS: Forty participants with dysmenorrhea were assigned to either the acupressure group (n = 19) or the control group (n = 21). The acupressure group received 20 min of SP6 acupressure during the initial intervention session and was taught to perform the technique for them to do twice a day from the first to third days of their menstrual cycle, 3 months subsequent to the first session. In contrast, the control group was only told to rest. Outcomes were measured through (1) the Pain Visual Analogue Scale (PVAS), (2) the Short-Form McGill Pain Questionnaire (SF-MPQ), and (3) the Short-Form Menstrual Distress Questionnaire (SF-MDQ). RESULTS: There was a statistically significant decrease in pain score for PVAS (p = 0.003) and SF-MPQ (p = 0.02) immediately after the 20 min of SP6 acupressure. In the self-care periods, significant reduction of PVAS (p = 0.008), SF-MPQ (p = 0.012), and SF-MDQ (p = 0.024) scores was noted in the third month of post-intervention. CONCLUSIONS: SP6 acupressure has an immediate pain-relieving effect for dysmenorrhea. Moreover, acupressure applied to the SP6 acupoint for 3 consecutive months was effective in relieving both the pain and menstrual distress level resulting from dysmenorrhea.

Nurses' perception of disaster: implications for disaster nursing curriculum.

AIMS AND OBJECTIVES: The aims of the study were to identify nurses' perception of disaster, whether they considered some of the events that have occurred in Hong Kong to be disasters and the types of disastrous events that they considered likely in Hong Kong. BACKGROUND: The frequent occurrence of disasters has caused concern internationally. When disaster strikes, the demands on nursing staff are much higher than those on other healthcare professionals. There is little understanding of the concept of disaster among nurses in Hong Kong. DESIGN: This was a descriptive study. A questionnaire was used to explore nurses' perception of disaster. METHOD: The questionnaire was distributed to all registered nurses studying in a master's degree programme in a university in Hong Kong. FINDINGS: Only 123 out of the 164 respondents (75%) gave a description of disaster in the open-ended question. Sixty-one per cent of them described unfortunate events with large numbers of victims as disasters. The 'Lan Kwai Fong tragedy--stampede caused by over-crowdedness' (90.9%) and the severe acute respiratory syndrome outbreak (89.6%) were commonly referred to as disasters in Hong Kong. Fires in tall buildings (61.6%), infectious disease outbreaks (61%) and stampedes caused by overcrowding (48.8%) were rated as the events most likely to happen in Hong Kong. CONCLUSION: Understanding how nurses perceive disaster and the likelihood of disastrous events is the initial step for disaster planning and the development of a disaster nursing curriculum in Hong Kong. RELEVANCE TO CLINICAL PRACTICE: All nurses around the world should be equipped with knowledge and skills for disaster care. This study provides information and implications for related research and the development of a disaster nursing curriculum to meet the global demand for disaster preparedness.

A community-based study of insomnia in Hong Kong Chinese children: Prevalence, risk factors and familial aggregation.

OBJECTIVES: There has been limited data on familial aggregation of insomnia. We aimed to explore the prevalence, risk factors and familial aggregation of childhood insomnia with a large community-based sample. METHODS: A community-based epidemiologic study of sleep disorders was conducted among primary school children. Those children with at least one reported biological parent were recruited. A total of 5695 children (mean age 9.2; SD 1.8), 4939 of their reported biological mothers (mean age 38.9; SD 4.6) and 4289 of their reported biological fathers (mean age 43.3; SD 5.5) were studied. RESULTS: The rates of insomnia 3 times/week in the past 12 months were 4.0%, 12.8% and 9.7% for children, mothers and fathers, respectively. A robust familial aggregation of insomnia was found even after adjustment of the shared environmental and socio-demographic factors. There was a significant dose-response relationship among the children across their parental status from neither, fathers, mothers to both parents with insomnia [3.0%, 7.1%, 9.5% and 11.9%; with ORs (95% CIs)=2.48 (1.82-4.37) for fathers, 3.42 (2.55-4.59) for mothers and 4.42 (2.42-8.10) for both parents, respectively]. In addition, the frequency of insomniac symptoms of the parents also had a dose-response effect on the rate of insomnia of their children. CONCLUSIONS: Insomnia is a common problem in both children and their parents. A significant familial aggregation of childhood onset insomnia was seen in this study even after adjustment of the co-risk factors. There was a dose-response effect of parental insomnia on the rate of insomnia of their children with a slight predilection of maternal influences.

Effects of age and gender on the movement workspace of the trapeziometacarpal joint.

While researchers have suggested that joint mobility would probably be affected by age and gender, research findings often present discrepancies. Little research has been performed on the factors which effect mobility of the trapeziometacarpal (TMC) joint. The purpose of this study was to address the effects of age and gender on the ranges of motion of the normal TMC joint. Eighty normal subjects divided into four age groups participated in this study. The TMC joint motions were recorded using an electromagnetic tracking system. In order to achieve a maximal range of TMC joint motion which was defined as the maximal workspace, each subject was asked to perform actively maximal circumduction, flexion-extension, and abduction-adduction of the TMC joint. Numerical and statistical methods were used to compute the TMC workspace and to detect significant differences. A workspace-to-length ratio was determined as an index to examine the effects of the age and gender on the joint mobility. The results demonstrated that age and gender had significant influences on the TMC workspace among the groups studied. The understanding of TMC joint mobility under different age and gender conditions is achieved through this study. The findings can be used to report clinical measures in the determination of the extent of impairment of osteoarthritis as well as the outcomes between pre- and post-surgical (or non-surgical) interventions.