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In this study, the resistive switching and synaptic properties of a complementary metal-oxide semiconductor-compatible Ti/a-BN/Si device are investigated for neuromorphic systems. A gradual change in resistance is observed in a positive SET operation in which Ti diffusion is involved in the conducting path. This operation is extremely suitable for synaptic devices in hardware-based neuromorphic systems. The isosurface charge density plots and experimental results confirm that boron vacancies can help generate a conducting path, whereas the conducting path generated by a Ti cation from interdiffusion forms is limited. A negative SET operation causes a considerable decrease in the formation energy of only boron vacancies, thereby increasing the conductivity in the low-resistance state, which may be related to RESET failure and poor endurance. The pulse transient characteristics, potentiation and depression characteristics, and good retention property of eight multilevel cells also indicate that the positive SET operation is more suitable for a synaptic device owing to the gradual modulation of conductance. Moreover, pattern recognition accuracy is examined by considering the conductance values of the measured data in the Ti/a-BN/Si device as the synaptic part of a neural network. The linear and symmetric synaptic weight update in a positive SET operation with an incremental voltage pulse scheme ensures higher pattern recognition accuracy.
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INTRODUCTION: This study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting. METHODS AND ANALYSIS: A total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain, ankle sprain or primary headache will be recruited by ED physicians. An intravenous or intramuscular injection of analgesics will be provided as the initial standard pain control intervention for all patients. Patients who still have moderate to severe pain after the 30â min of initial standard ED management will be considered eligible. These patients will be allocated in equal proportions to acupuncture plus standard ED management or to standard ED management alone based on computer-generated random numbers concealed in opaque, sealed, sequentially numbered envelopes. A 30â min session of acupuncture treatment with manual and/or electrical stimulation will be provided by qualified Korean medicine doctors. All patients will receive additional ED management at the ED physician's discretion and based on each patient's response to the allocated intervention. The primary outcome will be pain reduction measured at discharge from the ED by an unblinded assessor. Adverse events in both groups will be documented. Other outcomes will include the patient-reported overall improvement, disability due to neck pain (only for neck-pain patients), the treatment response rate, the use of other healthcare resources and the patients' perceived effectiveness of the acupuncture treatment. A follow-up telephone interview will be conducted by a blinded assessor 72±12â h after ED discharge. ETHICS AND DISSEMINATION: Written informed consent will be obtained from all participants. The study has been approved by the Institutional Review Boards (IRBs). The results of this study will guide a full-scale randomised trial of acupuncture in an ED context. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02013908.
Asunto(s)
Terapia por Acupuntura , Dolor Agudo/etiología , Dolor Agudo/terapia , Traumatismos del Tobillo/complicaciones , Tratamiento de Urgencia , Cefalea/terapia , Dolor de Cuello/terapia , Manejo del Dolor/métodos , Analgesia , Servicio de Urgencia en Hospital , Humanos , Proyectos Piloto , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de InvestigaciónRESUMEN
OBJECTIVES: Patients with non-emergent and non-life threatening conditions often present to the emergency department (ED), which hinders the efficient utilisation of healthcare resources. Acupuncture has frequently been used for such common conditions, although not in the ED context. This study aimed to evaluate the current evidence for acupuncture treatment in the ED and to inform future randomised controlled trials (RCTs) for acupuncture in ED settings. METHODS: Four English databases (MEDLINE, EMBASE, CENTRAL and AMED) were systematically searched to identify studies that tested the effects of acupuncture in ED settings using the search terms of "acupuncture" and "emergency". Data extraction and the risk of bias assessments were performed by two independent reviewers. RESULTS: Of the 102 screened studies, two RCTs and two uncontrolled observational studies were deemed eligible. Sample sizes ranged from 42 to 100. The conditions treated included various musculoskeletal and non-musculoskeletal symptoms and showed substantial clinical heterogeneity. Acupuncture was delivered in conjunction with standard medical care with the goal of immediate pain alleviation; in one RCT, acupuncture resulted in a positive outcome, but it did not in the other. The risk of bias was generally high or unclear. Uncontrolled studies reported beneficial effects for acupuncture, although these studies were prone to bias. Two studies reported mild and transient adverse events associated with acupuncture. CONCLUSIONS: The current evidence is insufficient to make any recommendations concerning the use of acupuncture in the ED. The effectiveness and safety as well as the feasibility of acupuncture should be tested in future RCTs.
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Terapia por Acupuntura/métodos , Servicio de Urgencia en Hospital/organización & administración , Adulto , Anciano , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Various lasers have recently been reported as effective treatment modalities for striae distensae, but pigmentary alterations are a major concern to the darker skin type. The Thermage (Therma Cool TC; Thermage Inc, Hayward, CA) is a radiofrequency device for the lifting of face and neck, and there is no report of using it for striae distensae. OBJECTIVE: The purpose was to evaluate the effectiveness of the Thermage in combination with pulsed dye laser. MATERIALS AND METHODS: Thirty-seven patients with abdominal striae distensae were treated with the Thermage and 585-nm pulsed dye laser in the first session at baseline. An additional two sessions of pulsed dye laser were performed at Weeks 4 and 8. Thermage was used at fluences of 53 to 97 J/cm2 and pulsed dye laser at fluences of 3.0 J/cm2 with 10-mm spot. Skin biopsies were taken of nine patients. RESULTS: In the subjective assessment, 89.2% of the patients showed "good and very good" to overall improvement, and 59.4% were graded as "good and very good" in elasticity. All of the nine specimens showed an increase in the amount of collagen fibers, and increased elastic fibers were found in six specimens. CONCLUSION: The Thermage and pulsed dye laser appear to be an effective treatment for striae distansae.