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Patients with cirrhosis experience worse health-related quality of life (HRQoL), and attempts are warranted further exploration of modifiable factors to improve HRQoL. Data on the impact of malnutrition risk on HRQoL among cirrhosis are limited, thus we aimed to strengthen understanding by clarifying the relationship between nutritional status and low HRQoL in patients with decompensated cirrhosis. Consecutive inpatients with cirrhosis attending our department within a tertiary hospital were studied. Generic health profiles and malnutrition risk were evaluated by the EuroQol-5D (EQ-5D) and Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) score, respectively. Multiple linear regression analysis was used to determine association of malnutrition risk with low HRQoL. In this cohort of 364 patients with median age of 64 years and 49.5% male, 55.5% of the study population reported impairment pertinent to HRQoL in at least one dimension in terms of the EQ-5D. Moreover, malnutrition risk (RFH-NPT score: β coefficient = -0.114, P = 0.038) was proved to be independently associated with poor HRQoL in multiple analysis, after adjustment for significant variables like age, BMI, and markers of decompensation. Notably, we found that health dimensions representing physical function (i.e., mobility, self care and usual activities) are substantially affected, while malnourished patients reported less frequencies of complaints in other domain such as anxiety/depression. In conclusion, the risk of malnutrition assessed by the RFH-NPT score is independently associated with low HRQoL. It is operational to improve HRQoL by identifying patients at high malnutrition risk and providing timely nutrition treatment.
Although maternal mental illnesses have been found to influence child health and development, little is known about the impact of maternal positive well-being on child health and development. Therefore, this longitudinal study investigated the effects of prenatal subjective well-being on birth outcomes and child development by considering the potential modifier effect of parity.
Pregnant women in early stages of pregnancy were recruited at five selected hospitals in Taipei, Taiwan, during their prenatal appointments since 2011. Self-reported evaluations were conducted at seven time points up to 2 years postpartum. Linear regression and generalized estimating equation models were used for examination.
Higher prenatal eudaimonic well-being was associated with longer gestational length (adjusted beta [aβ] = 0.36, 95% confidence interval [CI] = 0.03, 0.68) and higher birth weight (aβ = 124.71, 95% CI = 35.75, 213.66). Higher positive and negative affect were associated with longer gestational length (aβ = 0.38, 95% CI = 0.06, 0.70) and smaller birth weight (aβ = −93.51, 95% CI = −178.35, −8.67), respectively. For child’s outcomes, we found an association between higher prenatal eudaimonic well-being and decreased risks of suspected developmental delay, particularly for children of multiparous mothers (adjusted odds ratio = 0.18, 95% CI = 0.05, 0.70). Higher levels of prenatal depression and anxiety were significantly associated with increased risks of suspected developmental delay for children of primiparous mothers.
Positive prenatal maternal mental health may benefit birth outcomes and child development, particularly for children of multiparous mothers. Interventions for improving prenatal mental health may be beneficial for child development.
Transbronchial lung biopsy is an effective and less-invasive treatment for the early diagnosis of lung cancer. However, the limited dexterity of existing endoscopic instruments and the complexity of bronchial access prevent the application of such procedures mainly for biopsy and diagnosis. This paper proposes a flexible robot for transbronchial lung biopsy with a cable-driven mechanism-based flexible manipulator. The robotic system of transbronchial lung biopsy is presented in detail, including the snake-bone end effector, the flexible catheters and the actuation unit. The kinematic analysis of the snake-bone end effector is conducted for the master-slave control. The experimental results show that the end effector reaches the target nodule through a narrow and tortuous pathway in a bronchial model. In conclusion, the proposed robotic system contributes to the field of advanced endoscopic surgery with high flexibility and controllability.
The wind energy industry relies on computationally efficient engineering-type models to design wind farms. Typically these models do not account for the effect of atmospheric stratification in either the boundary layer or the free atmosphere. This study proposes a new analytical model for fully developed wind-turbine arrays in conventionally neutral atmospheric boundary layers frequently encountered in nature. The model captures the effect of the free-atmosphere stratification, Coriolis force, wind farm layout and turbine operating condition on the wind farm performance. The model is developed based on the physical insight derived from large-eddy simulations. We demonstrate that the geostrophic drag law (GDL) for flow over flat terrain can be extended to flow over fully developed wind farm arrays. The presence of a vast wind farm significantly increases the wind farm friction velocity compared with flow over flat terrain, which is modelled by updated coefficients in the GDL. The developed model reliably captures the vertical wind speed profile inside the wind farm. Furthermore, the power production trends observed in simulations are reliably reproduced. The wind farm performance, normalized by the geostrophic wind speed, decreases as the free-atmosphere thermal stability increases or the Coriolis force decreases. In addition, we find that the optimal wind farm performance is obtained at a lower thrust coefficient than the Betz limit, which indicates that optimal operating conditions for turbines in a wind farm are different than for a single turbine.
Previous studies have explored the association between parenting style and offspring’s psychological well-being, and the association between offspring’s achievement attribution pattern and psychological well-being. However, little is known about the role of offspring’s achievement attribution in the relationship between parenting and offspring’s psychological well-being. We aimed to find the role of adolescents’ achievement attribution pattern in the relationship between parent–child communication quality and adolescents’ mental health.
A cross-sectional analysis was conducted on 2,725 adolescents aged from 9 to 18 years who are participating in the China Family Panel Studies. Participants supplied demographic information and completed a series of psychological scales including the Center for Epidemiologic Studies Depression scale, an adapted version of the Parental Bonding Instrument, an achievement attribution scale, and single-item measures of subjective well-being and subjective interpersonal popularity.
Linear regression analysis revealed that after controlling for demographic factors good parent–child communication negatively correlated with depression symptoms, and positively associated with subjective well-being and subjective interpersonal popularity. Next, mediation analysis found that internal attribution of achievement partly mediated the effects of parent–child communication quality on adolescents’ depression, subjective well-being, and subjective interpersonal popularity. The result was robust after controlling demographic variables.
An internal attribution pattern of achievement partially accounted for the associations between parent–child communication quality and adolescents’ psychological outcomes including depression, subjective well-being, and subjective interpersonal popularity. Future interventions for adolescents’ mental health promotion can target parent–child communication and adolescents’ positive achievement attribution pattern.
The impact of Strouhal number St (= 0.1–1.0), Reynolds number Re (= 50–2000) and dimensionless wavelength λ (= 0.5–2.0) on the hydrodynamic performance of a travelling wavy foil of a constant length is extensively investigated. The relationship of time-mean thrust with St, Re and λ is presented, suggesting that the propulsive force increases with increasing St, Re and λ. As such, the drag–thrust boundary advances as these parameters increase. A shorter λ makes the thrust steadier while a longer λ enhances the maximum instantaneous thrust. The latter is beneficial for prey to escape from a predator. The fluid added mass caused by the foil oscillation increases with St and λ but declines with Re (<500). Seven types of wake structures produced by the foil are identified, discussed and connected to thrust generation, showing how St, Re and λ affect the fluid dynamics, wake transition, vortex strength, wake jet, velocity, added mass, added damping, power input, efficiency and pressure profiles. The outcome of this work renders a physical basis for understanding the swimming of aquatic animals.
Lithospheric thinning occurred in the North China Craton (NCC) that resulted in extensive Mesozoic magmatism, which has provided the opportunity to explore the mechanism of the destruction of the NCC. In this study, new zircon U–Pb ages, geochemical and Lu–Hf isotopic data are presented for Early Cretaceous adakitic rocks in the Liaodong Peninsula, with the aim of establishing their origin as well as the thinning mechanism of the NCC. The zircon U–Pb data show that crystallization occurred during 127–120 Ma (i.e. Early Cretaceous). These rocks are characterized by high Sr (294–711 ppm) content and Sr/Y ratio (38.5–108), low Yb (0.54–1.24 ppm) and Y (4.9–16.4 ppm) contents, and with no obvious Eu anomalies, implying that they are adakitic rocks. They are enriched in large-ion lithophile elements (e.g. Ba, K, Pb and Sr) and depleted in high-field-strength elements (e.g. Nb, Ta, P and Ti). These adakitic rocks have negative zircon ϵHf(t) contents (−28.9 to −15.0) with two-stage Hf model ages (TDM2) of 3004–2131 Ma. Based on the geochemical features, such as low TiO2 and MgO contents, and high La/Yb and K2O/Na2O ratios, these adakites originated from the partial melting of thickened eclogitic lower crust. They were in an extensional setting associated with the slab rollback of the Palaeo-Pacific Ocean. In combination with previous studies, as a result of the rapid retracting of the Palaeo-Pacific Ocean during 130–120 Ma, the asthenosphere upwelled and modified the thickened lithospheric mantle, which lost its stability, resulting in the lithospheric delamination and thinning of the NCC.
Mechanistic studies have suggested that antioxidants have beneficial effects on age-related macular degeneration (AMD). This study aimed to investigate the association between the types and sources of dietary vitamin and carotenoid intakes and AMD risk in China. A matched case-control study of 260 patients who were clinically diagnosed with AMD and 260 matched controls was performed. The participants were interviewed for dietary information and potential confounders, and comprehensive ophthalmic examinations were performed. Conditional logistic models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) across the categories of specific vitamins and carotenoids and their main sources. When comparing the extreme quartiles, the ORs(95% CI) were 0.30 (0.10, 0.88) for lutein and 0.28 (0.11, 0.74) for β-cryptoxanthin. The associations between AMD and other dietary vitamin and carotenoid intakes were generally weaker and non-significant. Higher intakes of spinach and egg, which are important sources of lutein, were associated with a reduced odds of AMD, with an OR comparing the highest and lowest categories of spinach being 0.42 (95%CI: 0.20, 0.88) and that comparing the highest and lowest categories of the egg being 0.52 (95% CI: 0.27, 0.98). Participants who were in the highest category of both egg intake and spinach intake had a much greater reduced odds of having AMD (OR: 0.23; 95%CI: 0.08, 0.71) than those in the lowest category of egg intake and spinach intake. In conclusion, a higher intake of lutein and lutein-rich foods was associated with a significantly decreased odds of AMD. These findings provide further evidence of the benefits of lutein and lutein-rich foods in the prevention of AMD.
Fibronectin type III domain-containing protein 5 (FNDC5) is a transmembrane protein and the precursor of irisin, which serves as a systemic exerkine/myokine with multiple origins. Since its discovery in 2012, this hormone-like polypeptide has rapidly evolved to a component significantly involved in a gamut of metabolic dysregulations and various liver diseases. After a decade of extensive investigation on FNDC5/irisin, we are still surrounded by lots of open questions regarding its diagnostic and therapeutic values. In this review, we first concentrated on the structure–function relationship of FNDC5/irisin. Next, we comprehensively summarised the current knowledge and research findings regarding pathogenic roles/therapeutic applications of FNDC5/irisin in the context of non-alcoholic fatty liver disease, fibrosis, liver injury due to multiple detrimental insults, hepatic malignancy and intrahepatic cholestasis of pregnancy. Moreover, the prominent molecules involved in the underlying mechanisms and signalling pathways were highlighted. As a result, emerging evidence reveals FNDC5/irisin may act as a proxy for diagnosing liver disease pathology, a sensitive biomarker for assessing damage severity, a predisposing factor for surveilling illness progression and a treatment option with protective/preventive impact, all of which are highly dependent on disease grading and contextually pathological features.
Interactions between the boundary layer and two successive incident shock waves (ISWs) often occur in the supersonic mixed-compression inlets. However, the flow mechanism involved in such interactions has been studied rarely. In this study, we investigate experimentally and analytically the turbulent boundary layer separation flow induced by the single ISW and dual ISWs at the identical total deflection angles in a Mach 2.73 flow. Schlieren photography, wall pressure measurement and surface oil-flow visualisation are employed to diagnose the flow field. Experiments with the impingement points of the two ISWs intersecting on the bottom wall exhibit a separated flow with a triangle-like separation bubble, namely the first kind of dual-ISW/turbulent boundary layer interaction (ISWTBLI). Comparative studies show that various flow features of this kind of dual-ISWTBLI, including the extent of the separation region, pressure distribution and surface-flow topological structures, are nearly identical to those of the single-ISWTBLI with an identical total deflection angle. As the distance between the two ISWs increases, the shape of the separation region in the dual-ISWTBLI changes from triangle-like to quadrilateral-like, and the height of the separation region decreases accordingly, forming the second kind of dual-ISWTBLI. Furthermore, an inviscid model is developed for the dual-ISWTBLI to describe the complex shock wave system and elucidate the cause of a quadrilateral-like separation bubble in the second kind of dual-ISWTBLI. Moreover, based on a previous work by Souverein et al. (J. Fluid Mech., vol. 714, 2013, pp. 505–535) on the single-ISWTBLI, a modified scaling method is established for the first kind of dual-ISWTBLI.
OBJECTIVES/GOALS: Early clinical case reports have described incidental epileptiform changes during electrophysiological monitoring. The objective of this study was to perform a systematic review of all existing investigations of epileptiform activity during sevoflurane use in pediatric anesthesia. The heterogenous EEG data will be analyzed in a meta analysis METHODS/STUDY POPULATION: A targeted, PICO-based clinical question was crafted and registered a priori on PROSPERO on 3/19/21. Under the guidance of a librarian from the Albert Einstein College of Medicine, a boolean search string was generated to search articles and gray literature for terms such as pediatric, sevoflurane and electroencephalogram in PubMed, OVID, Cochrane, Google Scholar, etc. We utilized the software platform tool COVIDENCE to manage our review. 495 references were imported for initial screening. 56 English-language, full-text studies were included for further review. The final 13 references were included in data extraction and Newcastle-Ottawa bias assessment. The characteristics of the studies and their primary outcomes were collected in tabular form. Strategies for data synthesis were discussed weekly. RESULTS/ANTICIPATED RESULTS: Epileptiform changes reported in the literature during pediatric sevoflurane anesthesia ranged from 0 - 95%. EEG data were acquired using a variety of recording systems with variable number of leads and heterogeneous outcomes reported. The periods of anesthesia monitoring were also heterogeneous. Characteristics of the studies are presented in Table 1. 495 references were imported for screening with 13 final references for data extraction. EEG abnormalities were reported in 204/649 (31.4%) subjects ranging in age from neonate to 18 years; the majority of studies utilized less than 16 channels of (10/13, 76.9%) (Table 1). There was variability in sevoflurane dosing, premedication (e.g., midzolam, hydroxyzine), and periods of anesthesia monitored. DISCUSSION/SIGNIFICANCE: There was heterogeneity noted across reviewed literature including study design, phases of anesthesia, ventilation methods, number of EEG leads recorded and adjuvant anesthetics administered. Nevertheless, this review rigorously classified epileptiform activity during Sevoflurane thereby influencing modern anesthesia.
Previous analyses of grey and white matter volumes have reported that schizophrenia is associated with structural changes. Deep learning is a data-driven approach that can capture highly compact hierarchical non-linear relationships among high-dimensional features, and therefore can facilitate the development of clinical tools for making a more accurate and earlier diagnosis of schizophrenia.
To identify consistent grey matter abnormalities in patients with schizophrenia, 662 people with schizophrenia and 613 healthy controls were recruited from eight centres across China, and the data from these independent sites were used to validate deep-learning classifiers.
We used a prospective image-based meta-analysis of whole-brain voxel-based morphometry. We also automatically differentiated patients with schizophrenia from healthy controls using combined grey matter, white matter and cerebrospinal fluid volumetric features, incorporated a deep neural network approach on an individual basis, and tested the generalisability of the classification models using independent validation sites.
We found that statistically reliable schizophrenia-related grey matter abnormalities primarily occurred in regions that included the superior temporal gyrus extending to the temporal pole, insular cortex, orbital and middle frontal cortices, middle cingulum and thalamus. Evaluated using leave-one-site-out cross-validation, the performance of the classification of schizophrenia achieved by our findings from eight independent research sites were: accuracy, 77.19–85.74%; sensitivity, 75.31–89.29% and area under the receiver operating characteristic curve, 0.797–0.909.
These results suggest that, by using deep-learning techniques, multidimensional neuroanatomical changes in schizophrenia are capable of robustly discriminating patients with schizophrenia from healthy controls, findings which could facilitate clinical diagnosis and treatment in schizophrenia.
Traditional belief revision usually considers generic logic formulas, whilst in practical applications some formulas might even be inappropriate for beliefs. For instance, the formula
$p \wedge q$
is syntactically consistent and is also an acceptable belief when there are no restrictions, but it might become unacceptable under restrictions in some context. If we assume that p represents ‘manufacturing product A’ and q represents ‘manufacturing product B’, an example of such a context would be the knowledge that there are not enough resources to manufacture them both and, hence,
$p \wedge q$
would not be an acceptable belief. In this article, we propose a generic framework for belief revision under restrictions. We consider restrictions of either fixed or dynamic nature, and devise several postulates to characterize the behaviour of changing beliefs when new evidence emerges or the restriction changes. Moreover, we show that there is a representation theorem for each type of restriction. Finally, we discuss belief revision of qualitative spatio-temporal information under restrictions as an application of this new framework.
In this article, we improve our main results from [LL21] in two directions: First, we allow ramified places in the CM extension $E/F$ at which we consider representations that are spherical with respect to a certain special maximal compact subgroup, by formulating and proving an analogue of the Kudla–Rapoport conjecture for exotic smooth Rapoport–Zink spaces. Second, we lift the restriction on the components at split places of the automorphic representation, by proving a more general vanishing result on certain cohomology of integral models of unitary Shimura varieties with Drinfeld level structures.
The southeastern Central Asian Orogenic Belt (CAOB) records the assembly process between several micro-continental blocks and the North China Craton (NCC), with the consumption of the Paleo-Asian Ocean (PAO), but whether the S-wards subduction of the PAO beneath the northern NCC was ongoing during Carboniferous–Permian time is still being debated. A key issue to resolve this controversy is whether the Carboniferous magmatism in the northern NCC was continental arc magmatism. The Alxa Block is the western segment of the northern NCC and contiguous to the southeastern CAOB, and their Carboniferous–Permian magmatism could have occurred in similar tectonic settings. In this contribution, new zircon U–Pb ages, elemental geochemistry and Sr–Nd isotopic analyses are presented for three early Carboniferous granitic plutons in the southwestern Alxa Block. Two newly identified aluminous A-type granites, an alkali-feldspar granite (331.6 ± 1.6 Ma) and a monzogranite (331.8 ± 1.7 Ma), exhibit juvenile and radiogenic Sr–Nd isotopic features, respectively. Although a granodiorite (326.2 ± 6.6 Ma) is characterized by high Sr/Y ratios (97.4–139.9), which is generally treated as an adikitic feature, this sample has highly radiogenic Sr–Nd isotopes and displays significantly higher K2O/Na2O ratios than typical adakites. These three granites were probably derived from the partial melting of Precambrian continental crustal sources heated by upwelling asthenosphere in lithospheric extensional setting. Regionally, both the Alxa Block and the southeastern CAOB are characterized by the formation of early Carboniferous extension-related magmatic rocks but lack coeval sedimentary deposits, suggesting a uniform lithospheric extensional setting rather than a simple continental arc.
The sudden outbreak of coronavirus disease-2019 (COVID-19) sparked widespread concern about organisational resilience in the management domain. The resources, operations and practices of organisational resilience have to be considered in particular contexts at different stages and in relation to numerous inputs, processes and outputs. Selected as one example, the preparation, response and development of a retail supermarket's management and operations in China is examined through an empirical case study. Supply chain and digital construction, improvisational ability, system management and corporate social responsibility all played a positive role in this organisation's response to the outbreak of COVID-19 (2019–2020) in the Chinese management context. Organisational resilience is reflected in the case study organisation's self-interested and altruistic policies and practices. The case provides valuable insights on efficacious management practices for organisational resilience building in the retail industry.
The coexistence of underweight (UW) and overweight (OW)/obese (OB) at the population level is known to affect iron deficiency (ID) anaemia (IDA), but how the weight status affects erythropoiesis during pregnancy is less clear at a population scale. This study investigated associations between the pre-pregnancy BMI (pBMI) and erythropoiesis-related nutritional deficiencies.
Anthropometry, blood biochemistry and 24-h dietary recall data were collected during prenatal care visits. The weight status was defined based on the pBMI. Mild nutrition deficiency-related erythropoiesis was defined if individuals had an ID, folate depletion or a vitamin B12 deficiency.
The Nationwide Nutrition and Health Survey in Taiwan (Pregnant NAHSIT 2017–2019).
We included 1456 women aged 20 to 45 years with singleton pregnancies.
Among these pregnant women, 9·6 % were UW, and 29·2 % were either OW (15·8 %) or OB (13·4 %). A U-shaped association between the pBMI and IDA was observed, with decreased odds (OR; 95 % CI) for OW subjects (0·6; 95 % CI (0·4, 0·9)) but increased odds for UW (1·2; 95 % CI (0·8, 2·0)) and OB subjects (1·2; 95 % CI (0·8, 1·8)). The pBMI was positively correlated with the prevalence of a mild nutritional deficiency. Compared to normal weight, OB pregnant women had 3·4-fold (3·4; 95 % CI (1·4, 8·1)) higher odds for multiple mild nutritional deficiencies, while UW individuals had lowest odds (0·3; 95 % CI (0·1, 1·2)). A dietary analysis showed negative relationships of pBMI with energy, carbohydrates, protein, Fe and folate intakes, but positive relationship with fat intakes.
The pre-pregnancy weight status can possibly serve as a good nutritional screening tool for preventing IDA during pregnancy.