PURPOSE: Sickle cell disease (SCD) is an inherited blood disorder that affects the hemoglobin protein of red blood cells and has a significant impact on morbidity, mortality, and quality of life. Hydroxyurea has been FDA approved since 1998 as a disease-modifying therapy for SCD. However, hydroxyurea has not been optimally utilized for those with SCD. The purpose of this study was to evaluate reasons for hydroxyurea use, from the perspectives of providers, adults with SCD, and parents/caregivers of children with SCD, as well as perceived barriers to its use. We examined indications and reasons for being “on hydroxyurea,” defined by patients as currently taking hydroxyurea, and reported on pain frequency, perceptions of barriers, hydroxyurea adherence, and health care access for patients with SCD who were either on and not on hydroxyurea. METHODS: We conducted a cross sectional analysis of data collected within the Pacific Sickle Cell Regional Collaborative (PSCRC), a consortium of nine western U.S. states. Individuals were eligible for this study if they 1) had a confirmed diagnosis of SCD, 2) were followed at one of the PSCRC sites, and 3) were eligible for hydroxyurea therapy. Parents/caregivers of children with SCD less than 18 years and adults with SCD 18 years and older completed a brief survey about hydroxyurea use, indications, side effects, pain frequency, number of hospital and emergency department (ED) admissions per year, and individual and family perceptions of barriers to hydroxyurea use. Participants completed a follow-up survey annually, but we reported only on baseline data. Data collection occurred between February 2016 and May 2018. RESULTS: Individuals with SCD (n = 413) included 1) children (n=178; 6.7 ± 3.4 years), 2) adolescents (n=66; 15.0 ± 1.4 years), 3) young adults (n=57; 21.4 ± 2.6 years), and 4) adults (n=112; 39.2 ± 10.6 years). The majority were predominantly female (51.6%), African American (93.2%), and had HgbSS (74.1%) genotype. The majority of children (65.2%), adolescents (62.1%), and young adults (54.4%) were on hydroxyurea; fewer adults (39.3%) were on hydroxyurea. The majority with HgbSS (65.5%) were adherent to hydroxyurea. There was no significant difference in hospitalizations for pain, ED visits, and pain severity in the previous 12 months between individuals who were and were not on hydroxyurea, and between individuals who were and were not adherent to hydroxyurea. For those with a current prescription for hydroxyurea, the majority (66.5%) were receiving hydroxyurea for recurrent pain episodes or acute chest syndrome (19.9%). Hydroxyurea was discontinued because of patient/family preference (34.5%), chronic transfusions (31.1%), and side effects (24.1%). Patients prescribed hydroxyurea for empiric use (n=21) had fewer hospitalizations for pain, ED visits, and severe pain interfering with daily activities. The major barriers to hydroxyurea use, from the perspective of individuals with SCD or their caregivers, were 1) forgetting to take the medicine (19.4%), 2) worried about side effects (16.4%), and 3) lack of knowledge about hydroxyurea (13.6%). Fewer young adults (49.1%) and adults (50.0%) had primary care providers than children (78.1%) and adolescents (65.2%). CONCLUSIONS: Barriers to hydroxyurea use persist with emerging solutions to alleviate these barriers. For this sample, while hydroxyurea prescription rates by sickle cell specialists were similar to what has been seen in some other studies, neither hydroxyurea use nor adherence were associated with decreased frequency of hospitalizations for pain, ED visits, and severe acute pain episodes in the previous 12 months. Future studies need to evaluate hydroxyurea prescription patterns, duration on hydroxyurea, and adherence to hydroxyurea. Healthcare providers are recommended to prescribe hydroxyurea for eligible individuals who may benefit from it, such as those HgbSS or HgbS-β0 thalassemia genotype, and prescribe for empiric use to minimize complications. Provider and patient education about hydroxyurea could reduce common barriers experienced by individuals with SCD. It is important to customize educational resources to specific concerns for different age groups. Individuals 18 years and older with SCD have been documented with more ED visits and hospitalizations due to pain, most likely because they did not have a primary care provider and an adult hematologist with expertise in SCD. Future studies need to evaluate whether primary care providers who receive SCD education may promote hydroxyurea use and adherence. Dedicating time and resources for shared decision making between providers and patients/families can address concerns about hydroxyurea and increase patient/family confidence when deciding about hydroxyurea. As more disease-modifying therapies become available for individuals with SCD, strategies for shared decision making facilitate standardization and optimize the use of hydroxyurea and emerging therapies.

This report describes computer studies which were done to determine the effect on burnup of modifying the heavy water reflector in a 600 MWe CANDU-PHW reactor. It is shown that the burnup penalty increases rapidly as the reflector thickness is reduced. The burnup penalty is significantly lower for mixed reflectors in which some of the heavy water in the outer region of the reflector is replaced by graphite, an organic liquid, or light water, while maintaining the original reflector thickness. / Thesis / Master of Engineering (MEngr)

This research investigated effect of submicron glass fiber modification on mechanical performance of short carbon fiber reinforced vinyl ester resin. Firstly, the mixture of resin and glass fiber was made by mixing submicron fiber into resin in a homogenizer at the speed of 5000 rpm in 30 minutes. Then, this modified resin was reinforced by short carbon fiber at the length of 1 mm, 3mm and 25 mm. The modifying effects were accessed by evaluating mechanical properties such as: bending, tensile, impact test as well as dynamic mechanical analysis. To explain some manners of material caused by adding glass fiber into resin, some techniques were also used (IFSS, SEM, laser microscope scanner, ultrasonic S-scan, X-ray ...). / 博士(工学) / Doctor of Philosophy in Engineering / 同志社大学 / Doshisha University

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This essay presents a study on gender differences with a focus on mild and strong swearwords and their pre-modifying adjectives when describing a person, based on findings from the BNC2014. Previous research implies that men and women use different types of swearwords, suggesting that men tend to use stronger language than women. The aim of this study is to investigate the usage of strong versus mild swearwords to analyze if there are differences in frequency and use of pre-modifying adjectives across gender. A set of mild swearwords (cow, git) and strong swearwords (dick, cunt) from Ofcom’s scale of offensiveness (Ofcom, 2016) was used to manually compare how men and women tend to differ in the way they use these words. Previous research on swearing in connection to gender, offensiveness, and pre-modifying adjectives is presented as well as a definition of the swearwords. The results show that the usage of mild and strong language is equally used in male and female speakers and that negative and other pre-modifying adjectives are most used together with these words. Hopefully, the findings in this study could shed more light on the topic of gender differences and swearing.

Yes / This paper investigated the bond characteristics between eight types of nanofillers modified reactive powder concrete (RPC) and plain steel bars, aiming to explore the modifying mechanisms and establish a bond-slip relationship model for nanofillers modified RPC and steel bar interface. The experimental results indicated that the incorporation of nanofillers can increase the bond strength and reduce the slip between RPC and plain steel bars. It was shown that a 2.15 MPa/20.5% of absolute/relative increase in cracking bond strength, a 1.25 MPa/10.3% of absolute/relative increase in ultimate bond strength, a 2.35 MPa/22.4% of absolute/relative increase in residual bond strength, a 0.592 mm/56.5% of absolute/relative reduction in ultimate bond slip, and a 1.779 mm/52.1% of absolute/relative reduction in residual bond slip were the best achieved due to the addition of various nanofillers. The enhancement of nanofillers on RPC-steel bar interface has been mainly attributed to RPC microstructure improvement, optimization of intrinsic compositions, and elimination of defects in the interface, especially the underside near steel bar, due to the nano-core effect of nanofillers enriched in the interface. In addition, the bond-slip relationship of nanofillers modified RPC-steel bar interface can be accurately described by the proposed model considering an initial branch. / The authors would like to thank the funding offered by the National Science Foundation of China (51978127 and 51908103), and the Fundamental Research Funds for the Central Universities (DUT21RC(3)039).

Yes / The development of ultra-high performance cementitious composite (UHPCC) represents a significant advancement in the field of concrete science and technology, but insufficient hydration and high autogenous shrinkage relatively increase the pores inside UHPCC, in turn, affecting the macro-performance of UHPCC. This paper, initially, optimized the pore structure of UHPCC using different types and dimensions of nanofillers. Subsequently, the pore structure characteristics of nano-modified UHPCC were investigated by the mercury intrusion porosimeter method and fractal theory. Finally, the fluid permeability of nano-modified UHPCC was estimated by applying the Katz-Thompson equation. Experimental results showed that all incorporated nanofillers can refine the pore structure of UHPCC, but nanofillers with different types and dimensions have various effects on the pore structure of UHPCC. Specifically, CNTs, especially the thin-short one, can significantly reduce the porosity of UHPCC, whereas nanoparticles, especially nano-SiO2, are more conducive to refine the pore size. Among all nanofillers, nano-SiO2 has the most obvious effect on pore structure, reducing the porosity, specific pore volume and most probable pore radius of UHPCC by 31.9%, 35.1% and 40.9%, respectively. Additionally, the pore size distribution of nano-modified UHPCC ranges from 10-1nm to 105nm, and the gel pores and fine capillary pores in the range of 3-50nm account for more than 70% of the total pore content, confirming nanofillers incorporation can effectively weaken pore connectivity and induce pore distribution to concentrate at nanoscale. Fractal results indicated the provision of nanofillers reduces the structural heterogeneity of gel pores and fine capillary pores, and induces homogenization and densification of UHPCC matrix, in turn, decreasing the UHPCC fluid permeability by 15.7%-79.2%. / The authors thank the funding supported from the National Science Foundation of China (51978127, 52178188 and 51908103), the China Postdoctoral Science Foundation (2022M720648 and 2022M710973) and the Fundamental Research Funds for the Central Universities (DUT21RC(3)039). / The full-text of this article will be released for public view at the end of the publisher embargo on 11 May 2024.

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As VLSI circuits continue to have more and more transistors over time, the question of not only how to use, but how to manage the complexity of so many transistors becomes increasingly important. Four hypothesis are given for the design of a system that scales-up as transistors continue to shrink. An architecture is presented that satisfies these hypothesis, and the motivation behind the hypothesis is further explained. The use of this architecture's unique features to implement an efficient, defect-tolerant parallel bootstrap system is discussed. A detailed methodology for implementing this system in vivo is described. A sample problem--simulation of heat flow--is presented, and its solution using the proposed architecture is described in detail. A comparison is made between the proposed architecture and a set of contemporary architectures, and the former is shown to have desirable performance in a number of areas. Conclusion are given, and plans for future work are presented. / Ph. D.

Yes / The development of ultra-high performance cementitious composite (UHPCC) represents a significant advancement in the field of concrete science and technology, but insufficient hydration and high autogenous shrinkage relatively increase the pores inside UHPCC, in turn, affecting the macro-performance of UHPCC. This paper, initially, optimized the pore structure of UHPCC using different types and dimensions of nanofillers. Subsequently, the pore structure characteristics of nano-modified UHPCC were investigated by the mercury intrusion porosimeter method and fractal theory. Finally, the fluid permeability of nano-modified UHPCC was estimated by applying the Katz-Thompson equation. Experimental results showed that all incorporated nanofillers can refine the pore structure of UHPCC, but nanofillers with different types and dimensions have various effects on the pore structure of UHPCC. Specifically, CNTs, especially the thin-short one, can significantly reduce the porosity of UHPCC, whereas nanoparticles, especially nano-SiO2, are more conducive to refine the pore size. Among all nanofillers, nano-SiO2 has the most obvious effect on pore structure, reducing the porosity, specific pore volume and most probable pore radius of UHPCC by 31.9%, 35.1% and 40.9%, respectively. Additionally, the pore size distribution of nano-modified UHPCC ranges from 10-1nm to 105nm, and the gel pores and fine capillary pores in the range of 3-50nm account for more than 70% of the total pore content, confirming nanofillers incorporation can effectively weaken pore connectivity and induce pore distribution to concentrate at nanoscale. Fractal results indicated the provision of nanofillers reduces the structural heterogeneity of gel pores and fine capillary pores, and induces homogenization and densification of UHPCC matrix, in turn, decreasing the UHPCC fluid permeability by 15.7%-79.2%.