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Type 2 diabetes mellitus is a chronic disease increasing in global prevalence. Although habitual consumption of walnuts is associated with reduced risk of CVD, there is inconsistent evidence for the impact of walnut consumption on markers of glycaemic control. This systematic review and meta-analysis aimed to examine the effect of walnut consumption on markers of blood glucose control. A systematic search of Medline, PubMed, CINAHL and Cochrane databases (to 2 March 2019) was conducted. Inclusion criteria were randomised controlled trials conducted with adults which assessed the effect of walnut consumption on fasting blood glucose and insulin, glycated Hb and homeostatic model assessment of insulin resistance. Random effects meta-analyses were conducted to assess the weighted mean differences (WMD) for each outcome. Risk of bias in studies was assessed using the Cochrane Risk of Bias tool 2.0. Sixteen studies providing eighteen effect sizes were included in the review. Consumption of walnuts did not result in significant changes in fasting blood glucose levels (WMD: 0·331 mg/dl; 95 % CI −0·817, 1·479) or other outcome measures. Studies were determined to have either ‘some concerns’ or be at ‘high risk’ of bias. There was no evidence of an effect of walnut consumption on markers of blood glucose control. These findings suggest that the known favourable effects of walnut intake on CVD are not mediated via improvements in glycaemic control. Given the high risk of bias observed in the current evidence base, there is a need for further high-quality randomised controlled trials.
There seems to be geographical differences in decisions about breast conserving surgery (BCS) in breast cancer patients. This study was to evaluate patients’ attitude to BCS and to assess the factors affecting cancer practice in West China.
A structured questionnaire was distributed to 184 patients, eliciting information about the patients’ characteristics, occupation, education, family life, recognition of illness, knowledge about BCS, the main means of gaining surgery information, selecting surgery approaches, preferences to breast reservation.
In all, 163 patients completed the questionnaire. The results indicated that only 7.4% of patients received BCS and 23% of the remaining patients desired to have BCS and the affecting factors were significantly associated with their family life, recognition of illness and the main means of gaining surgery information (P < 0.05). No associations were between BCS selecting and the other variables studied. The most frequent reasons for selecting BCS were keeping the female shape and improving quality of life (71%), the second most were postoperative recovery, minimal influence of physical function (47%) and patients’ knowledge about BCS (42%). The most frequent reasons for not selecting BCS were uncertainty about BCS results and worry about recurrence (81%), the second most was the elderly age unnecessary for BCS (40%).
The findings indicate that breast cancer patients in West China do not take BCS as the first choice as the best treatment method. It is warranted that further study of more patients, attitude of patients’ partners and physicians to BCS.
This article presents a brief review of our case studies of data-driven Integrated Computational Materials Engineering (ICME) for intelligently discovering advanced structural metal materials, including light-weight materials (Ti, Mg, and Al alloys), refractory high-entropy alloys, and superalloys. The basic bonding in terms of topology and electronic structures is recommended to be considered as the building blocks/units constructing the microstructures of advanced materials. It is highlighted that the bonding charge density could not only provide an atomic and electronic insight into the physical nature of chemical bond of materials but also reveal the fundamental strengthening/embrittlement mechanisms and the local phase transformations of planar defects, paving a path in accelerating the development of advanced metal materials via interfacial engineering. Perspectives on the knowledge-based modeling/simulations, machine-learning knowledge base, platform, and next-generation workforce for sustainable ecosystem of ICME are highlighted, thus to call for more duty on the developments of advanced structural metal materials and enhancement of research productivity and collaboration.
This paper presents a numerical approach to predict the thermal residual stresses in polymer nanocomposites reinforced with a periodic array of wavy carbon nanotubes. A three dimensional unit cell model is established to accurately account for the waviness of the nanotube. Periodic boundary conditions are determined for the unit cell with a pair of curved surfaces. Appropriate methods to evaluate the macroscopic stresses and strains are also determined for the unit cell model in which the interior pores of the nanotubes are explicitly included. It is demonstrated that the macroscopic behavior of the nanocomposites is orthotropic due to the symmetries manifested. By employing material properties of the two constituents, the thermal residual stresses and strains induced by high temperature curing and cooling-down are predicted for an epoxy/wavy-nanotube composite. It is also demonstrated that the curing process tends to increase the waviness of the nanotube and the waviness has a significant influence on the distribution of the microscopic residual stresses.
Understanding food choices made for meals in overweight and obese individuals may aid strategies for weight loss tailored to their eating habits. However, limited studies have explored food choices at meal occasions. The aim of this study was to identify the usual food choices for meals of overweight and obese volunteers for a weight-loss trial. A cross-sectional analysis was performed using screening diet history data from a 12-month weight-loss trial (the HealthTrack study). A descriptive data mining tool, the Apriori algorithm of association rules, was applied to identify food choices at meal occasions using a nested hierarchical food group classification system. Overall, 432 breakfasts, 428 lunches, 432 dinners and 433 others (meals) were identified from the intake data (n 433 participants). A total of 142 items of closely related food clusters were identified at three food group levels. At the first sub-food group level, bread emerged as central to food combinations at lunch, but unprocessed meat appeared for this at dinner. The dinner meal was characterised by more varieties of vegetables and of foods in general. The definitions of food groups played a pivotal role in identifying food choice patterns at main meals. Given the large number of foods available, having an understanding of eating patterns in which key foods drive overall meal content can help translate and develop novel dietary strategies for weight loss at the individual level.
While studies suggest that nutritional supplementation may reduce aggressive behavior in children, few have examined their effects on specific forms of aggression. This study tests the primary hypothesis that omega-3 (ω-3), both alone and in conjunction with social skills training, will have particular post-treatment efficacy for reducing childhood reactive aggression relative to baseline.
In this randomized, double-blind, stratified, placebo-controlled, factorial trial, a clinical sample of 282 children with externalizing behavior aged 7–16 years was randomized into ω-3 only, social skills only, ω-3 + social skills, and placebo control groups. Treatment duration was 6 months. The primary outcome measure was reactive aggression collected at 0, 3, 6, 9, and 12 months, with antisocial behavior as a secondary outcome.
Children in the ω-3-only group showed a short-term reduction (at 3 and 6 months) in self-report reactive aggression, and also a short-term reduction in overall antisocial behavior. Sensitivity analyses and a robustness check replicated significant interaction effects. Effect sizes (d) were small, ranging from 0.17 to 0.31.
Findings provide some initial support for the efficacy of ω-3 in reducing reactive aggression over and above standard care (medication and parent training), but yield only preliminary and limited support for the efficacy of ω-3 in reducing overall externalizing behavior in children. Future studies could test further whether ω-3 shows promise in reducing more reactive, impulsive forms of aggression.
Introduction: Aligning health systems appropriately to the needs of the elderly is an urgent global priority, according to the WHO. In Canada, ED length of stay has risen 16% for elderly patients in the last year. Agitation requiring chemical restraint is a common, high-risk problem for elderly in the ED. Improving outcomes in this heterogeneous population remain difficult due to inability to effectively identify and evaluate delirium, frailty, multi-morbidity, and incompatibility with the ED system. A data-driven approach to complex health problems is a recognized emerging tool for healthcare innovation. New opportunities for targeted quality improvement in the ED will be uncovered by identifying the clinical characteristics of elderly patients with agitation, and the system process factors that influence their outcomes. Methods: We studied 400 patients in a case-control study at two tertiary-care EDs over five years. Patients were randomly selected if age was greater than 75 years. 200 cases of patients who received an intravenous dose of haloperidol, midazolam and/or lorazepam were selected as a surrogate data marker for having agitation. Controls were randomly matched by age and ED diagnosis. Standardized clinical, systems and process variables were collected. We conducted a univariate analysis. Results: Elderly given intravenous medications for agitation had increased mortality (OR 3.8 CI: 1.6-10.7, p<0.001) and ED length of stay (27 vs. 15 hours, p<0.001). No statistical significance was found in clinical characteristics, CTAS scores, PRISMA7 frailty scores nor sentinel or return visits. There was no statistical difference in median hospital length of stay (8 vs. 6 days, p<0.70). No differences were found in median time from ED physician seeing a patient to first consultant request (73 vs. 83 mins, p=0.75). The largest time intervals contributing to ED length of stay were from first consultant request to hospital request (15 vs. 12 hours, p=0.056) and hospitalization delay (13 vs. 7 hours, p=0.45). Conclusion: Identification of high-risk elderly patients for targeted intervention through a data-driven approach is feasible and informative. Traditional clinical characteristics remain unhelpful in identifying and evaluating outcomes in elderly with agitation. We have identified a process factor that is clinically relevant and pragmatic to evaluate in our ED system. Future research focused on optimizing systems process factors to improve quality of elderly care should be prioritized.
Characterizing ruminal parameters in the context of sampling routine and feed efficiency is fundamental to understand the efficiency of feed utilization in the bovine. Therefore, we evaluated microbial and volatile fatty acid (VFA) profiles, rumen papillae epithelial and stratum corneum thickness and rumen pH (RpH) and temperature (RT) in feedlot cattle. In all, 48 cattle (32 steers plus 16 bulls), fed a high moisture corn and haylage-based ration, underwent a productive performance test to determine residual feed intake (RFI) using feed intake, growth, BW and composition traits. Rumen fluid was collected, then RpH and RT logger were inserted 5.5±1 days before slaughter. At slaughter, the logger was recovered and rumen fluid and rumen tissue were sampled. The relative daily time spent in specific RpH and RT ranges were determined. Polynomial regression analysis was used to characterize RpH and RT circadian patterns. Animals were divided into efficient and inefficient groups based on RFI to compare productive performance and ruminal parameters. Efficient animals consumed 1.8 kg/day less dry matter than inefficient cattle (P⩽0.05) while achieving the same productive performance (P⩾0.10). Ruminal bacteria population was higher (P⩽0.05) (7.6×1011v. 4.3×1011 copy number of 16S rRNA gene/ml rumen fluid) and methanogen population was lower (P⩽0.05) (2.3×109v. 4.9×109 copy number of 16S rRNA gene/ml rumen fluid) in efficient compared with inefficient cattle at slaughter with no differences (P⩾0.10) between samples collected on-farm. No differences (P⩾0.10) in rumen fluid VFA were also observed between feed efficiency groups either on-farm or at slaughter. However, increased (P⩽0.05) acetate, and decreased (P⩽0.05) propionate, butyrate, valerate and caproate concentrations were observed at slaughter compared with on-farm. Efficient had increased (P⩽0.05) rumen epithelium thickness (136 v. 126 µm) compared with inefficient cattle. Efficient animals also spent 318% and 93.2% more time (P⩽0.05) in acidotic (4.14% v. 1.30%) (pH⩽5.6) and optimal (5.6<pH<6.0) (8.53% v. 4.42%) RpH range compared with inefficient cattle. The circadian patterns revealed lower (P⩽0.05) RpH and no differences (P⩾0.10) in RT pre-, during, and post-prandial periods in efficient compared with inefficient cattle. In essence, superior feed efficiency in cattle seems linked to rumen features consistent with improved efficiency of feed utilization. Microbial abundance, rumen epithelial histomorphology, and RpH, may serve as indicators for feed efficiency in cattle. The divergences of assessments made on-farm and at slaughter should be considered in the development of proxies for feed efficiency.
Solid electrolyte interface (SEI) layer plays a key role in lithium-ion batteries’ degradation research. However, SEI layer microstructure prediction still needs further investigation, especially the lithium-ion diffusion in SEI layer considering its morphology evolution during the growth of SEI. Due to the unique advantage of avoiding explicitly tracking the interfaces with sharp composition gradients, a phase field model is developed to simulate the SEI formation and its morphology evolution that is regarded as a solidification process. Fick’s law and mass balance are applied to investigate lithium-ion concentration distribution and diffusion coefficients of different SEI layers (i.e., compact and porous SEI layers) predicted by the developed phase field model. The simulation results show lithium-ion diffusion coefficients between 298K and 318K are 1.34-1.87(10-16) m2/s and 1.73-2.18(10-12) m2/s for compact SEI and porous SEI layer, respectively. The developed model has great potential to be extended to three dimensional spaces for SEI layer spatial growth investigation and other interfaces with complex morphology evolution.
The study of the evolution of organic matter subjected to space conditions, and more specifically to Solar photons in the vacuum ultraviolet range (120–200 nm) has been undertaken in low-Earth orbit since the 1990s, and implemented on various space platforms. This paper describes a photochemistry experiment called AMINO, conducted during 22 months between 2009 and 2011 on the EXPOSE-R ESA facility, outside the International Space Station. Samples with relevance to astrobiology (connected to comets, carbonaceous meteorites and micrometeorites, the atmosphere of Titan and RNA world hypothesis) have been selected and exposed to space environment. They have been analysed after return to the Earth. This paper is not discussing the results of the experiment, but rather gives a general overview of the project, the details of the hardware used, its configuration and recent developments to enable long-duration exposure of gaseous samples in tight closed cells enabling for the first time to derive quantitative results from gaseous phase samples exposed in space.
To improve the urine distributing mechanism of bladder power pump, a novel urethra valve was proposed in this study. The urine-flow-rate performance equation of the valve was derived on the basis of hydromechanics and electromagnetic theories, and the effect of different parameters on the urine-flow-rate performance was analyzed. The reliability simulation model of the valve was established according to the working principle and fault tree of the valve, a reliability simulation algorithm was proposed based on the basic idea of Monte Carlo method, and some reliability indexes were gained. The results show that increasing electromagnet current and decreasing air gap can increase the maximal urine-flow-rate, the reliability of the valve reaches 0.73 when the average life of the valve is 50000 times, and the shedding and aging of elastic bands are the weak links of the valve. The conclusions can provide the basis for the structural optimization and reliability improvement of bladder power pump, as well as the guidance for the design of implantable biomedicine electromechanical device.
From the Surface Velocity Program (SVP) drifter current data, a detailed and complete track of strong ocean currents in the north-western Pacific is provided using the bin average method. The focus of this study is on the Kuroshio, the strong western boundary current of the North Pacific flowing northward along the east coast of Taiwan and then turning eastward off southern Japan. With its average flow speed of about 2 knots, the Kuroshio can significantly increase the ship's speed for a “super-slow-steaming” container ship travelling at speeds of 12 knots between the ports of Southeast Asia and Japan. By properly utilizing knowledge of strong ocean currents to follow the Kuroshio on the northbound runs and avoid it on the return trip, considerable fuel can be saved and the transit time can be reduced. In the future, the detailed Kuroshio saving-energy route could be built into electronic chart systems for all navigators and shipping routers.
The clinical urination assist measures are usually taken to overcome the neurogenic bladder difficult to cure, but easily cause patients bladder stones, urinary system infection and other complications. To solve the problem of the urination assist of neurogenic bladder, a bladder power pump (BPP) driven by external electromagnet was proposed in this study according to the structure and micturition mechanism of human urinary bladder. The mathematic models of the BPP were established based on the theories of electromagnetics and fluid dynamics. A simulated experiment system with a bladder physical model for simulating human urinary system was designed according to the similarity criterion of fluid dynamincs. The micturition performance of the BPP was investigated by simulation and experiment. The results showed that the intravesical pressure and urine flow rate of the bladder physical model can be controlled by adjusting electromagnet exciting current. The micturition performance of the BPP is basically accordant with that of human urinary bladder detrusor. The established mathematic models are simple and practicable, which can provide the theoretical guidance for the performance analysis and structural optimization design of the BPP.
We present a preliminary analysis of the self-absorbed [CII]-spectra observed with SOFIA/GREAT towards NGC 2024. Together with the detected [13CII] hyperfine satellites, the observed spectra require surprisingly high column densities of C+, both in the warm core and the foreground absorption component. Such high column densities are a challenge to explain with present state-of-the-art PDR models of the UV/molecular cloud interaction.
The relationship between recurrent major depression (MD) in women and suicidality is complex. We investigated the extent to which patients who suffered with various forms of suicidal symptomatology can be distinguished from those subjects without such symptoms.
We examined the clinical features of the worst episode in 1970 Han Chinese women with recurrent DSM-IV MD between the ages of 30 and 60 years from across China. Student's t tests, and logistic and multiple logistic regression models were used to determine the association between suicidality and other clinical features of MD.
Suicidal symptomatology is significantly associated with a more severe form of MD, as indexed by both the number of episodes and number of MD symptoms. Patients reporting suicidal thoughts, plans or attempts experienced a significantly greater number of stressful life events. The depressive symptom most strongly associated with lifetime suicide attempt was feelings of worthlessness (odds ratio 4.25, 95% confidence interval 2.9–6.3). Excessive guilt, diminished concentration and impaired decision-making were also significantly associated with a suicide attempt.
This study contributes to the existing literature on risk factors for suicidal symptomatology in depressed women. Identifying specific depressive symptoms and co-morbid psychiatric disorders may help improve the clinical assessment of suicide risk in depressed patients. These findings could be helpful in identifying those who need more intense treatment strategies in order to prevent suicide.
Modeling of free radical polymerizations of the liquid-crystalline monomer 6-[4-(4-heptyloxyphenylazo)phenoxy]hexylacrylate using the PREDICI software package is reported. The model accounts for all elemental reactions that were identified to be important for radical polymerizations of acrylate-type monomers. On the basis of butyl acrylate kinetic data a remarkable agreement between number average molar masses from modelling (Mn,sim) and from experiments (Mn,exp) is observed: Mn,sim = 17800 g·mol−1 and Mn,exp = 17400 g·mol−1. Similarly, dispersity values of 1.8 and 1.6 were determined via modelling and experiments, respectively. It is shown that the assumption of butyl acrylate kinetics provides a reasonable approximation even for acrylate-based monomers having mesogenic substituents.
The synthesis of semi-interpenetrating networks (SIPN) based on linear poly(ethyl 2-cyanoacrylate) (PECA) and oligo(ethylene glycol) diglycidyl ether (OEGDG) based polymer networks was motivated by the hypothesis that the brittleness of polycyanoacrylates may be overcome by incorporating them into a polymer network architecture. A sequential synthetic route was applied, in which first PECA was prepared by anionic polymerization. Subsequently, OEGDG was crosslinked with different anhydrides and curing catalysts to form networks with hydrolyzable ester bonds and interpenetrating PECA. These SIPNs showed a low water uptake compared to other polyether based networks. Some of the obtained materials were transparent and exhibited a great flexibility, which was maintained also after 24 h of immersion in water and subsequent drying. Such networks could be components of future stimuli-sensitive material systems.