Ceramics are strong but brittle. According to the classical theories, ceramics are brittle mainly because dislocations are suppressed by cracks. Here, the authors report the combined elastic and plastic deformation measurements of nanoceramics, in which dislocation-mediated stiff and ductile behaviors were detected at room temperature. In the synchrotron-based deformation experiments, a marked slope change is observed in the stress–strain relationship of MgAl2O4 nanoceramics at high pressures, indicating that a deformation mechanism shift occurs in the compression and that the nanoceramics sample is elastically stiffer than its bulk counterpart. The bulk-sized MgAl2O4 shows no texturing at pressures up to 37 GPa, which is compatible with the brittle behaviors of ceramics. Surprisingly, substantial texturing is seen in nanoceramic MgAl2O4 at pressures above 4 GPa. The observed stiffening and texturing indicate that dislocation-mediated mechanisms, usually suppressed in bulk-sized ceramics at low temperature, become operative in nanoceramics. This makes nanoceramics stiff and ductile.

Introduction: Emergency department (ED) staff carry a high risk for the burnout syndrome of increased emotional exhaustion, depersonalization and decreased personal accomplishment. Previous research has shown that task-oriented coping skills were associated with reduced levels of burnout compared to emotion-oriented coping. ED staff at one hospital participated in an intervention to teach task-oriented coping skills. We hypothesized that the intervention would alter staff coping behaviors and ultimately reduce burnout. Methods: ED physicians, nurses and support staff at two regional hospitals were surveyed using the Maslach Burnout Inventory (MBI) and the Coping Inventory for Stressful Situations (CISS). Surveys were performed before and after the implementation of communication and conflict resolution skills training at the intervention facility (I) consisting of a one-day course and a small group refresher 6 to 15 months later. Descriptive statistics and multivariate analysis assessed differences in staff burnout and coping styles compared to the control facility (C) and over time. Results: 85/143 (I) and 42/110 (C) ED staff responded to the initial survey. Post intervention 46 (I) and 23(C) responded. During the two year study period there was no statistically significant difference in CISS or MBI scores between hospitals (CISS: (Pillai's trace = .02, F(3,63) = .47, p = .71, partial η2 = .02); MBI: (Pillai's trace = .01, F(3,63) = .11, p = .95, partial η2 = .01)) or between pre- and post-intervention groups (CISS: (Pillai's trace = .01, F(3,63) = .22, p = .88, partial η2 = .01); MBI: (Pillai's trace = .09, F(3,63) = 2.15, p = .10, partial η2 = .01)). Conclusion: We were not able to measure improvement in staff coping or burnout in ED staff receiving communication skills intervention over a two year period. Burnout is a multifactorial problem and environmental rather than individual factors may be more important to address. Alternatively, to demonstrate a measurable effect on burnout may require more robust or inclusive interventions.

We disagree with Rahnev & Denison (R&D) that optimality should be abandoned altogether. Rather, we argue that adopting a normative approach enables researchers to test hypotheses about the brain's computational goals, avoids just-so explanations, and offers insights into function that are simply inaccessible to the alternatives proposed by R&D.

Rabies is one of the major public health problems in China, and the mortality rate of rabies remains the highest among all notifiable infectious diseases. A meta-analysis was conducted to investigate the post-exposure prophylaxis (PEP) vaccination rate and risk factors for human rabies in mainland China. The PubMed, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical and Wanfang databases were searched for articles on rabies vaccination status (published between 2007 and 2017). In total, 10 174 human rabies cases from 136 studies were included in this meta-analysis. Approximately 97.2% (95% confidence interval (CI) 95.1–98.7%) of rabies cases occurred in rural areas and 72.6% (95% CI 70.0–75.1%) occurred in farmers. Overall, the vaccination rate in the reported human rabies cases was 15.4% (95% CI 13.7–17.4%). However, among vaccinated individuals, 85.5% (95% CI 79.8%–83.4%) did not complete the vaccination regimen. In a subgroup analysis, the PEP vaccination rate in the eastern region (18.8%, 95% CI 15.9–22.1%) was higher than that in the western region (13.3%, 95% CI 11.1–15.8%) and this rate decreased after 2007. Approximately 68.9% (95% CI 63.6–73.8%) of rabies cases experienced category-III exposures, but their PEP vaccination rate was 27.0% (95% CI 14.4–44.9%) and only 6.1% (95% CI 4.4–8.4%) received rabies immunoglobulin. Together, these results suggested that the PEP vaccination rate among human rabies cases was low in mainland China. Therefore, standardised treatment and vaccination programs of dog bites need to be further strengthened, particularly in rural areas.

Recent progress in microdissection and in DNA sequencing has facilitated the subsampling of multi-focal cancers in organs such as the liver in several hundred spots, helping to determine the pattern of mutations in each of these spots. This has led to the construction of genealogies of the primary, secondary, tertiary, and so forth, foci of the tumor. These studies have led to diverse conclusions concerning the Darwinian (selective) or neutral evolution in cancer. Mathematical models of the development of multi-focal tumors have been devised to support these claims. We offer a model for the development of a multi-focal tumor: it is a mathematically rigorous refinement of a model of Ling et al. (2015). Guided by numerical studies and simulations, we show that the rigorous model, in the form of an infinite-type branching process, displays distributions of tumor size which have heavy tails and moments that become infinite in finite time. To demonstrate these points, we obtain bounds on the tails of the distributions of the process and an infinite series expansion for the first moments. In addition to its inherent mathematical interest, the model is corroborated by recent literature on apparent super-exponential growth in cancer metastases.

An electromechanical coupling model is established for the space-tethered combination (STC) under microgravity environment after target capture by the tethered robot system (TRS). A linearized dynamic model of the STC is put forward with its controllability and observability as a control system analyzed. A double closed-loop tension control strategy is proposed to mitigate the impact and suing longitudinal vibration caused by the velocity difference between the platform and target. Experiment setup is built on a ground-based flotation platform to investigate the impact of the STC. Results of simulation and experimental validation show that the proposed tension control strategy is responsive and rapid in tension tracking and effectively prevent impact.

Active drag reduction of an Ahmed body with a slant angle of $25^{\circ }$ , corresponding to the high-drag regime, has been experimentally investigated at Reynolds number $Re=1.7\times 10^{5}$ , based on the square root of the model cross-sectional area. Four individual actuations, produced by steady blowing, are applied separately around the edges of the rear window and vertical base, producing a drag reduction of up to 6–14 %. However, the combination of the individual actuations results in a drag reduction 29 %, higher than any previous drag reductions achieved experimentally and very close to the target (30 %) set by automotive industries. Extensive flow measurements are performed, with and without control, using force balance, pressure scanner, hot-wire, flow visualization and particle image velocimetry techniques. A marked change in the flow structure is captured in the wake of the body under control, including the flow separation bubbles, over the rear window or behind the vertical base, and the pair of C-pillar vortices at the two side edges of the rear window. The change is linked to the pressure rise on the slanted surface and the base. The mechanisms behind the effective control are proposed. The control efficiency is also estimated.

Finite-amplitude manifestations of stratified shear flow instabilities and their spatio-temporal coherent structures are believed to play an important role in turbulent geophysical flows. Such shear flows commonly have layers separated by sharp density interfaces, and are therefore susceptible to the so-called Holmboe instability, and its finite-amplitude manifestation, the Holmboe wave. In this paper, we describe and elucidate the origin of an apparently previously unreported long-lived coherent structure in a sustained stratified shear flow generated in the laboratory by exchange flow through an inclined square duct connecting two reservoirs filled with fluids of different densities. Using a novel measurement technique allowing for time-resolved, near-instantaneous measurements of the three-component velocity and density fields simultaneously over a three-dimensional volume, we describe the three-dimensional geometry and spatio-temporal dynamics of this structure. We identify it as a finite-amplitude, nonlinear, asymmetric confined Holmboe wave (CHW), and highlight the importance of its spanwise (lateral) confinement by the duct boundaries. We pay particular attention to the spanwise vorticity, which exhibits a travelling, near-periodic structure of sheared, distorted, prolate spheroids with a wide ‘body’ and a narrower ‘head’. Using temporal linear stability analysis on the two-dimensional streamwise-averaged experimental flow, we solve for three-dimensional perturbations having two-dimensional, cross-sectionally confined eigenfunctions and a streamwise normal mode. We show that the dispersion relation and the three-dimensional spatial structure of the fastest-growing confined Holmboe instability are in good agreement with those of the observed confined Holmboe wave. We also compare those results with a classical linear analysis of two-dimensional perturbations (i.e. with no spanwise dependence) on a one-dimensional base flow. We conclude that the lateral confinement is an important ingredient of the confined Holmboe instability, which gives rise to the CHW, with implications for many inherently confined geophysical flows such as in valleys, estuaries, straits or deep ocean trenches. Our results suggest that the CHW is an example of an experimentally observed, inherently nonlinear, robust, long-lived coherent structure which has developed from a linear instability. We conjecture that the CHW is a promising candidate for a class of exact coherent states underpinning the dynamics of more disordered, yet continually forced stratified shear flows.

This study was designed to explore the association between undernutrition in the growth period and cardiovascular risk factors in a middle-aged Chinese population. A total of 1756 subjects, aged 45–60 years, were invited to participate in the Hefei Nutrition and Health Study and divided into three groups according to their self-reported animal food intake in the growth period. Group 1, Group 2 and Group 3 were defined as undernutrition, nutritional improvement and the good nutrition group, respectively. In the three groups, the subjects in Groups 1 and 2 had more oil and salt intake (P<0.001), and less eggs and milk intake (P<0.001), when compared with the subjects in Group 3. After adjusting for age, education, smoking status and other confounding factors, it was found that male participants who experienced nutritional improvement before age 18 had higher risk of hypertension [odds ratio (OR)=1.68; 95% confidence intervals (CI): 1.05, 2.69] than those with good nutrition, and female participants with undernutrition (OR=1.52; 95% CI: 1.01, 2.29) and nutritional improvement (OR=1.68; 95% CI: 1.04, 2.69) before age 18 had a higher risk of hypertension than those with good nutrition. For diabetes, obesity, hypercholesterolemia and hypertriglyceridemia, our results did not found difference among the three groups both in male and female. Our findings indicated that nutritional deficiency in childhood was associated with bad dietary behaviors and a significantly increased risk of hypertension in middle age. Therefore, early adequate nutrition is very important for the prevention of non-communicable diseases later.

We prove the existence and give constructions of a $(p(k)-1)$ -fold perfect resolvable $(v,k,1)$ -Mendelsohn design for any integers $v>k\geq 2$ with $v\equiv 1\hspace{0.2em}{\rm mod}\hspace{0.2em}\,k$ such that there exists a finite Frobenius group whose kernel $K$ has order $v$ and whose complement contains an element $\unicode[STIX]{x1D719}$ of order $k$ , where $p(k)$ is the least prime factor of $k$ . Such a design admits $K\rtimes \langle \unicode[STIX]{x1D719}\rangle$ as a group of automorphisms and is perfect when $k$ is a prime. As an application we prove that for any integer $v=p_{1}^{e_{1}}\cdots p_{t}^{e_{t}}\geq 3$ in prime factorisation and any prime $k$ dividing $p_{i}^{e_{i}}-1$ for $1\leq i\leq t$ , there exists a resolvable perfect $(v,k,1)$ -Mendelsohn design that admits a Frobenius group as a group of automorphisms. We also prove that, if $k$ is even and divides $p_{i}-1$ for $1\leq i\leq t$ , then there are at least $\unicode[STIX]{x1D711}(k)^{t}$ resolvable $(v,k,1)$ -Mendelsohn designs that admit a Frobenius group as a group of automorphisms, where $\unicode[STIX]{x1D711}$ is Euler’s totient function.

The oxidative study has always been particularly topical in poultry science. However, little information about the occurrence of cellular apoptosis and autophagy through the reactive oxygen species (ROS) generation in nuclear factor-κB (NF-κB) signal pathway was reported in the liver of broilers exposed to hydrogen peroxide (H2O2). So we investigated the change of growth performance of broilers exposed to H2O2 and further explored the occurrence of apoptosis and autophagy, as well as the expression of NF-κB in these signaling pathways in the liver. A total of 320 1-day-old Arbor Acres male broiler chickens were raised on a basal diet and randomly divided into five treatments which were arranged as non-injected treatment (Control), physiological saline (0.75%) injected treatment (Saline) and H2O2 treatments (H2O2(0.74), H2O2(1.48) and H2O2(2.96)) received an intraperitoneal injection of H2O2 with 0.74, 1.48 and 2.96 mM/kg BW. The results showed that compared to those in the control and saline treatments, 2.96 mM/kg BW H2O2-treated broilers exhibited significantly higher feed/gain ratio at 22 to 42 days and 1 to 42 days, ROS formation, the contents of oxidation products, the mRNA expressions of caspases (3, 6, 8), microtubule-associated protein 1 light chain 3 (LC3)-II/LC3-I, autophagy-related gene 6, Bcl-2 associated X and protein expressions of total caspase-3 and total LC3-II, and significantly lower BW gain at 22 to 42 days and 1 to 42 days, the activities of total superoxide dismutase and glutathione peroxidase, the expression of NF-κB in the liver. Meanwhile, significantly higher feed/gain ratio at 1 to 42 days, ROS formation, the contents of protein carbonyl and malondialdehyde, the mRNA expression of caspase-3 and the protein expressions of total caspase-3 and total LC3-II, as well as significantly lower BW gain at 22 to 42 days and 1 to 42 days were observed in broilers received 1.48 mM/kg BW H2O2 treatment than those in control and saline treatments. These results indicated that oxidative stress induced by H2O2 had a negative effect on histomorphology and redox status in the liver of broilers, which was associated with a decline in growth performance of broilers. This may attribute to apoptosis and autophagy processes triggered by excessive ROS that suppress the NF-κB signaling pathway.

Introduction: Emergency Department (ED) staff burnout correlates with psychological coping strategies used by Emergency department health professionals (EDHPs). Staff at two urban referral EDs in New Brunswick took part in a survey of burnout and coping strategies after one ED experienced an influx of new physicians and a newly renovated ED in 2011. Six years later, ED crowding and EDHP staffing problems became prevalent at both EDs. We compared levels of burnout at two urban referral EDs to determine if burnout and coping worsened over time. Methods: An anonymous survey of all EDHPs at 2 urban referral EDs was performed in 2011 and in 2017. A demographics questionnaire, the Maslach Burnout Inventory (MBI, measuring emotional exhaustion, depersonalization and personal accomplishment), and the Coping Inventory for Stressful Situations (CISS, measuring task-oriented, emotion-oriented, and avoidance-oriented coping styles) were collected. Descriptive statistics and linear regression models examined relationships over time and between the two hospitals. Results: Burnout scores were similar both at the two facilities and in 2011 (n=153) and 2017 (n=127). There were no differences between samples or EDs for important factors. Emotion-oriented coping was associated with higher levels of burnout, while task-oriented coping was inversely correlated with burnout. Experiencing professional stress was a significant predictor of emotional exhaustion, while those working longer years in their current department had higher emotional exhaustion and depersonalization. By 2017, both EDs had experienced significant nursing staff turnover (50%) compared to 2011. Conclusion: Burnout scores remained consistent after 6 years at these two urban referral EDs. Given the evidence that increased years of service is associated with increased burnout, high staff turnover rate at both EDs could explain how scores remained constant. Staff turnover may represent a way these ED systems cope in a challenging environment. In 2017, task-oriented copers continued to score lower while emotionally-oriented copers showed higher burnout risk, and experiencing professional stress remains a strong predictor of burnout.

Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.

In ovo feeding (IOF) of l-arginine (Arg) can affect growth performance of broilers, but the response of IOF of Arg on breast muscle growth is unclear, and the mechanism involved in protein deposition remains unknown. Hense, this experiment was conducted to evaluate the effects of IOF of Arg on breast muscle growth and protein-deposited signalling in post-hatch broilers. A total of 720 fertile eggs were collected from 34-week-old Arbor Acres breeder hens and distributed to three treatments: (1) non-injected control group; (2) 7.5 g/l (w/v) NaCl diluent-injected control group; (3) 0.6 mg Arg/egg solution-injected group. At 17.5 days of incubation, fertile eggs were injected 0.6 ml solutions into the amnion of the injected groups. Upon hatching, 80 male chicks were randomly assigned to eight replicates of 10 birds each and fed ad libitum for 21 days. The results indicated that IOF of Arg increased relative breast muscle weight compared with those of control groups at hatch, 3-, 7- and 21-day post-hatch (P<0.05). In the Arg-injected group, the plasma total protein and albumen concentrations were higher at 7- and 21-day post-hatch than those of control groups (P<0.05). The alanine aminotransferase activity in Arg group was higher at hatch than that of control groups (P<0.05). The levels of triiodothyronine at four time points and thyroxine hormones at hatch, 7- and 21-day post-hatch in Arg group were higher than those of control groups (P<0.05). In addition, IOF of Arg increased the amino acid concentrations of breast muscle at hatch, 7- and 21-day post-hatch (P<0.05). In ovo feeding of Arg also enhanced mammalian target of rapamycin, ribosomal protein S6 kinase-1 and eIF4E-bindingprotein-1 messenger RNA expression levels at hatch compared with those of control groups (P<0.05). It was concluded that IOF of Arg treatment improved breast muscle growth, which might be associated with the enhancement of protein deposition.