1,720,967 research outputs found
Aspirin has limited ability to modulate shear-mediated platelet activation associated with elevated shear stress of ventricular assist devices
No full textContinuous flow ventricular assist devices (cfVADs) while effective in advanced heart failure, remain plagued by thrombosis related to abnormal flows and elevated shear stress. To limit cfVAD thrombosis, patients utilize complex anti-thrombotic regimens built upon a foundation of aspirin (ASA). While much data exists on ASA as a modulator of biochemically-mediated platelet activation, limited data exists as to the efficacy of ASA as a means of limiting shear-mediated platelet activation, particularly under elevated shear stress common within cfVADs. We investigated the ability of ASA (20, 25 and 125 μM) to limit shear-mediated platelet activation under conditions of: 1) constant shear stress (30 dynes/cm2 and 70 dynes/cm2); 2) dynamic shear stress, and 3) initial high shear exposure (70 dynes/cm2) followed by low shear exposure-i.e. a platelet sensitization protocol, utilizing a hemodynamic shearing device providing uniform shear stress in vitro. The efficacy of ASA to limit platelet activation mediated via passage through a clinical cfVAD system (DeBakey Micromed) in vitro was also studied. ASA reduced platelet activation only under conditions of low shear stress (38% reduction compared to control, n = 10, p 0.5) with no limitation of platelet sensitization. ASA had limited ability (25.6% reduction in platelet activation rate) to modulate shear-mediated platelet activation induced via cfVAD passage. These findings, while performed under "deconstructed" non-clinical conditions by utilizing purified platelets alone in vitro, provide a potential contributory mechanistic explanation for the persistent thrombosis rates experienced clinically in cfVAD patients despite ASA therapy. An opportunity exists to develop enhanced pharmacologic strategies to limit shear-mediated platelet activation at elevated shear levels associated with mechanical circulatory support devices
The Risk and Protective Factors on Dementia in Patients with Hepatitis C, Hypertension and Diabetes
No full text研究背景： 影響失智症的病因很多，不同失智症的致病因子可能不同，除了遺傳、年齡、性別以外，許多研究指出，感染因子如HIV、與血管相關疾病如糖尿病、高血壓、代謝症候群、吸菸等因素，也是影響失智症發病的影響因子。但失智症確切的致病機轉仍未確定，因此目前失智症的診斷與治療仍有許多面向需要更進一步研究。 C型肝炎為台灣常見的傳染性肝病， C型肝炎病毒(HCV) 感染會增加肝炎、肝硬化與肝癌的機會。因HCV可以穿過血腦屏障，HCV除了對肝臟的影響外，近年來許多研究也發現HCV對腦部有許多影響，如HCV患者的腦中風機率較高、HCV的患者認知功能較一般正常人差等。 高血壓也常被認為是失智症危險因子。高血壓有許多機轉會造成失智症，但治療高血壓與相關治療的藥物是否可以減低失智症發生的機率目前並不清楚。血管張力素受器阻斷劑(Angiotensin receptor blockers, ARBs)是一種降血壓藥物，近期研究發現不只有降血壓的療效，也有降低認知功能退化等效果。 失智症常見的危險因子還有糖尿病，但糖尿病與失智症的因果機轉與關係尚不清楚。血糖控制、治療糖尿病藥物、糖尿病造成神經血管病變，都被懷疑與失智症相關，但是確實的致病機轉尚無定論。 目前失智症尚無有效的治療，找出危險與保護因子是預防失智症的有效方式。因為失智症的影響因子影響的時間長久，又致病因子之間相互影響複雜，雖然有許多相關研究，但是仍然有許多有待證實的問題。本研究將利用台灣健保資料庫來分析C型肝炎、血管張力素受器阻斷劑與糖尿病疾病嚴重度等相關因子對於失智症的影響。 研究方法： 藉由台灣健保資料庫資料，針對五十歲以上的患者，以世代研究設計方式，來探討 (一) C型肝炎；(二) 血管張力素受器阻斷劑；(三) 糖尿病嚴重度與失智症的關聯。 研究族群如下： (一) C型肝炎研究：根據年齡、性別、地域、投保薪資與共病，以一比一方式配對出58570組C型肝炎患者與健康族群。 (二) ARB研究：根據年齡、性別、地域、投保薪資與共病，以一比一方式配對出24531組血管張力素受器阻斷劑患者與非暴露族群。 (三) 糖尿病研究針對新發糖尿病患者為目標族群，共431178位患者納入追蹤。以aDCSI作為糖尿病疾病嚴重度之評估指標研究失智症的風險比值。 上述研究分別控制其年齡、性別、收入(投保金額)、地區與其他影響失智症的共病，追蹤自1997年至2009年，研究發生失智症的機會。Kaplan-Meier method來評估探討因子對於失智症的累積風險，以Cox 比例風險回歸 (Cox Proportional Hazards Model)來分析其風險比值(Hazard Ratios)。 結果： (一) 配對後C型肝炎組有2989位患者罹患失智症，發生率為56.0/每萬人年；相較於健康族群的47.7/每萬人年，有明顯差異。經校正肝臟相關疾病、肝硬化、肝昏迷、肝癌等因子後，C型肝炎對於失智症風險比值為1.36。 (二) 配對後ARB劑組有1322位患者罹患失智症，發生率為51.1/每萬人年；相較於血管疾患高風險族群的87.1/每萬人年，有明顯差異。ARB的累積劑量上，大於1460 DDD (藥物耗用標準化之定義每日劑量, defined daily dose) 的病患風險明顯低於小於1460 DDD病患 (HR 0.37 vs. 0.61; p < 0.05)。 (三) 納入研究新發糖尿病病患，6.2%診斷為失智症。不同嚴重度病患aDCSI 分數為1、2、3與大於3的各組其失智症風險比值(與DCSI=0)分別為1.04 (0.99-1.09), 1.40 (1.34-1.46), 1.54 (1.47-1.61) 與1.70 (1.63-1.78)。糖尿病惡化速度越快族群，失智症的風險比值也越高 (風險比值 2.38, 6.95, 24.0；aDCSI值增加 0.51-1.00, 1.01-2.00 與>2.00/每年，對比於 aDCSI值增加 <0.50/每年，P < 0.001 for trend)。 結論：由我們的研究結果發現：C型肝炎會增加36% 的失智症風險；在血管相關疾患高風險病患，血管張力素受器阻斷劑可能降低失智症風險；糖尿病病患惡化速率越快，失智症的風險越高。因為失智症影響健康層面廣泛，目前並無良好的治療，僅能以減少危險因子，來降低失罹患失智症風險。惟機轉仍須進一步研究確認。Background: Dementia is a syndrome of chronic, progressive cognitive impairment involving multiple domains of cognition, significant enough to cause functional impairment and not due to a medically reversible cause. The clinical hallmark of dementia is a gradual decline in cognitive function, and patients with assessments that indicate cognitive impairment should be further evaluated to determine an appropriate diagnosis or identify other causes. Although not all subjects with cognitive impairment develop dementia, cognitive deficits have been proposed to be able to identify patients at risk of developing dementia in the pre-clinical stage. The early detection of cognition decline and risk factors are important to prevent the progression of dementia. The reimbursement database of the National Health Insurance program in Taiwan provides an opportunity for research. There were three objectives to this research; (1) to investigate the potential increased risk for dementia in patients infected with hepatitis C virus (HCV) in Taiwan; (2) to investigate the effects of antihypertensive drugs, especially angiotensin receptor blockers (ARBs) on dementia and its subtypes; (3) to determine if there is a relationship between the severity of diabetes and the risk of dementia in Taiwanese patients. Methods: We conducted three population-based cohort studies based on the Taiwan National Health Insurance Research Database. (1) In the HCV cohort study, a total of 58,570 matched (1:1) pairs of HCV-infected patients and non-HCV-infected patients were included from all potential participants aged 50 years or more. (2) In the ARB study, a total of 24,531 matched pairs (1:1) of ARB-exposed and non-ARB-exposed subjects were included. (3) In the diabetes study, a total of 431,178 new-onset diabetic patients were included as the diabetes cohort. The severity of diabetes was evaluated using the adapted Diabetes Complications Severity Index (aDCSI). Each subject was individually tracked from 1997 to 2010 (2009 in the HCV cohort) to identify incident cases of dementia (onset in 1999 or later). Cox proportional hazard regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between HCV infection and dementia, ARBs and dementia, and the severity of diabetes and dementia. Results: (1) There were 2,989 dementia cases in the HCV-infected cohort during the follow-up period of 533,861.1 person-years; the overall incidence rate of dementia was significantly different from the non-HCV cohort (56.0 vs. 47.7 cases per 10,000 person-years, p < 0.05). The adjusted HR for dementia was 1.36 (95% CI, 1.27-1.42) for the HCV-infected patients after adjusting for alcohol-related disease, liver cirrhosis, hepatic encephalopathy and hepatocellular carcinoma. (2) There were 1,322 cases (5.4%) of dementia in the ARB cohort and 2,181 cases (8.9%) in the non-ARB cohort during the eleven-year follow-up period. The multivariate-adjusted HRs for dementia, Alzheimer’s disease and vascular dementia were 0.54 (95% CI, 0.51-0.59), 0.53 (95% CI, 0.43-0.64) and 0.63 (95% CI, 0.54-0.73) for the subjects who received ARB treatment, respectively. In terms of cumulative dosage, the subjects with more than 1460 defined daily doses (DDD) of ARBs had a lower risk than those who received less than 1460 DDD (HR 0.37 vs. 0.61; p < 0.05). (3) A total of 431,178 new-onset diabetic patients were included, 6.2% of whom were diagnosed with dementia. At the end of the follow-up period, the HRs for dementia were 1.04 (95% CI, 0.99-1.09), 1.40 (95% CI, 1.34-1.46, p < 0.001), 1.54 (95% CI, 1.47-1.61, p < 0.001) and 1.70 (95% CI, 1.63-1.78, p < 0.001) with an aDCSI score of 1, 2, 3 and more than 3, respectively. Compared with the patients with mild progressive, the adjusted HRs increased with aDCSI change (two-year HRs: 1.30, 1.53, 1.97; final HRs 2.38, 6.95, 24.0 with an increase in aDCSI score per year of 0.51-1.00, 1.01-2.00 and more than 2.00, respectively, vs. less than 0.50; p < 0.001 for trend). Conclusions: These results suggest that HCV infection may increase the risk of dementia, and that the use of ARBs may be associated with a reduced risk of dementia in patients at high vascular risk. Diabetic patients with rapid progression and exacerbated severity had a higher risk of dementia. Further mechanistic research is needed to validate our findings
Impacts of the Depressive Disorder on Work Productivity: Patients of the Impairment Benefit Program
No full text憂鬱症所造成的社會經濟負擔除了直接醫療所需花費，還有間接的損失，如請假與生產力下降的工作損失、死亡等。對於精神疾病所造成之能力缺損與生產力降低，目前在工作效率減低、工作穩定性不佳所造成收入的缺損、生病造成之升遷影響等因素，現有評估方式往往難以列入計算。本研究希望透過勞工於勞工保險投保之相關資料，來了解憂鬱症對於被保險人勞動力的影響。
本研究使用資料來源為為勞保局於95年度勞保局委託研究“勞工保險殘廢給付『精神障害』等級及審查標準之研究“所發表之民國94年10至12月核定精神障害類別之資料。採計量統計方法。分析憂鬱症之勞保被保險人與所有被保險人之年齡、性別、診斷與診斷代碼、殘廢等級、初診時間與殘廢申請時間、職業異動與投保薪資等變項差異 。
比較109位憂鬱症被保險人與母群體所有勞保被保險人之差異，申請勞保殘廢給付者其薪資（21754.86元新台幣/月）較所有勞保人薪資（27059.98）平均低5305.12元， 兩組間達顯著差異（t=5.4023, p<0.00001）。 憂鬱症勞工在工作年資中，工作投保單位變換平均為6.99次，工作變換率為0.58次/年，是一般勞工的三倍。憂鬱症通過殘廢給付之疾病時間為4.14年、通過組之疾病年-年資比為24.99%， 遠高於未通過組之2.75年（p < 0.05）。
由本研究結果得知憂鬱症病患其薪資的確較一般人為低，這表示憂鬱症並不是單純短期的一個疾病，它影響的範疇遠比我們想像中來的深遠。因此憂鬱症所造成的失能，不論是可見還是不可見，對於個人、家庭、企業，社會，甚至國家都有不可忽視的影響。The depressive disorder made a lot of social economic burdens. The burdens include not only the direct cost – the medical cost, but also the indirect cost, such as the poor work efficiency, lower productivity, absenteeism, instability in work and death. It’s difficult to evaluate the all deficit values by the current methods.
In this study, we use the data of the depressed workers for the impairment benefit payment of the labor insurance from the Oct to Dec in 2005. The study is compiled statistics by quantity. The items for statistics are the age, sex, disease names and codes, disability levels, duration of diseases, number of the job-change and the salary for the insurance. Among the 109 depressed workers, the average salary for insurance is 21754.86 NTD per month, which is significant lower than the average salary of total labors (p value < 0.00001). The job-change rate is 0.58 times per year which is 3 times than the healthy labors. The illness year is higher in the disable depressed worker than non-disable.
The salaries of the depressed workers are lower than the healthy workers. This implicates that depressive disorders are not short term diseases. The impacts of depressive disorders are under estimated. It will be the important issue about the influence of depressive disorders in the families, business, and countries.口試委員審定書 ii
誌謝 iii
中文摘要 iv
英文摘要 v
目錄 vi
表目錄 viii
第一章 緒論 01
第一節 研究背景 01
第二節 研究動機與目的 02
第三節 研究架構 03
第二章 文獻探討 04
第一節 憂鬱症的種類、定義與疾病特性 04
第二節 憂鬱症的影響 06
第三節 目前對於憂鬱症產值損失的評估方式 11
第四節 薪資與勞動力 14
第五節 勞保投保薪資與實際薪資之關係 18
第三章 研究方法 19
第一節 研究設計與研究步驟 19
第二節 研究對象 20
第三節 統計方法 21
第四章 研究結果 22
第一節 精神障礙在勞保殘廢給付 22
第二節 勞保殘廢給付之憂鬱症 24
第三節 憂鬱症與勞保殘廢給付審核 28
第五章 結論與建議 31
第一節 憂鬱症患者的特性 31
第二節 工作的變動與工作變換率 33
第三節 殘廢認定與憂鬱症的關係 34
第四節 研究限制 35
第五節 結論與建議 37
參考文獻 40
附錄 43
附件一、主要勞動經濟指標 43
附件二、現行勞工保險相關條例 44
附件三、民國95年底勞工保險投保人數 46
附件四、勞工保險被保險人數及平均年齡─按性別及年齡組別分 47
附件五、勞工保險被保險人數及平均投保薪資─按月投保薪資分 49
附件六、勞工保險民國95底月投保薪資人數統計一覽表 51
附件七、勞工保險被保險人數─按月投保薪資及年齡組別、性別分.. 52
附件八、歷年來勞工保險其他勞工之投保人數及應計保險費人數
─按身分別分 5
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Microfluidic emulation of mechanical circulatory support device shear-mediated platelet activation
Get PDFVariations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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