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We examine the causal effect of stakeholder orientation on firms’ cost of debt. Our test exploits the staggered state-level adoption of constituency statutes, which allows directors to consider stakeholders’ interests when making business decisions. We find a significant drop in loan spreads for firms incorporated in states that adopted such statutes relative to firms incorporated elsewhere. We further show that constituency statutes reduce the cost of debt through the channels of mitigating conflicts of interest between residual and fixed claimants and between holders of liquid claims and holders of illiquid claims, limiting legal liability and lowering takeover threats.
Isolated congenital tricuspid regurgitation other than Ebstein’s anomaly was rare especially for children. The objective of this study was to investigate the clinical characteristics and to assess the results of tricuspid valvuloplasty for children with isolated tricuspid regurgitation.
From January 2010 to June 2019, 10 consecutive patients with isolated tricuspid regurgitation who were unresponsive to drug therapy underwent tricuspid valvuloplasty in our hospital. Patients’ clinical data were analysed retrospectively.
Mean age at operation was 48.5 ± 31.0 (range: 9–106) months and mean weight at operation was 16.1 ± 6.9 (range: 8.6–33.0) kg. All patients presented severe isolated tricuspid regurgitation. According to pathological lesions, the main causes accounted for chordae tendinea rupture (3/10), leaflet cleft (2/10), mal-connected chordal tendinea to leaflets (2/10), elongated chordae (1/10) and chordae absent (1/10), and severe anterior leaflet dysplasia (1/10). Individualised tricuspid valvuloplasty was adapted to all of them successfully. Post-operative echocardiography showed no tricuspid regurgitation in two patients and mild regurgitation in eight patients. The cardiothoracic ratios on their chest roentgenograms decreased from 0.59 ± 0.05 to 0.54 ± 0.05. At the latest follow-up (50.4 ± 47.2 months), echocardiography showed that mild to moderate tricuspid regurgitation in seven patients, moderate tricuspid regurgitation in three patients, and no patient with severe tricuspid regurgitation. All patients were in NYHA functional class I.
For patients with isolated tricuspid regurgitation who were not well responsive to drug therapy, individualised tricuspid valve repair can achieve an excellent result.
In this article, Al75Cu25 (at.%) ribbons were dealloyed by HCl, H2C2O4, H3PO4, and NaOH solutions, respectively, to prepare nanoporous copper (NPC). The dealloying behavior is varied with dealloying solutions, allowing modulating the microstructure and porosity of the NPC. Al75Cu25 ribbons are fully dealloyed in HCl, H2C2O4, and NaOH solutions, whereas they are partially dealloyed in H3PO4 solution. Except the NPC prepared in the NaOH solution, no obvious cracks are traced in other samples. The surface diffusivity (Ds) of Cu atoms along the alloy/solution interfaces is varied with solutions, producing the NPC with different microstructure. NPC with higher specific surface area can be obtained by dealloying the Al75Cu25 ribbons in the HCl solution. Compared with the dealloying in H2C2O4, H3PO4, and NaOH solutions, the dealloying in 10 wt% HCl solution for 25 min at 90 ± 1 °C facilitates the best NPC in this work.
Several observational studies have investigated the association of insomnia with psychiatric disorders. Such studies yielded mixed results, and whether these associations are causal remains unclear. Thus, we aimed to identify the causal relationships between insomnia and five major psychiatric disorders.
The analysis was implemented with six genome-wide association studies; one for insomnia and five for psychiatric disorders (attention-deficit/hyperactivity disorder, autism spectrum disorder, major depressive disorder, schizophrenia, and bipolar disorder). A heterogeneity in dependent instrument (HEIDI) approach was used to remove the pleiotropic instruments, Mendelian randomization (MR)-Egger regression was adopted to test the validity of the screened instruments, and bidirectional generalized summary data-based MR was performed to estimate the causal relationships between insomnia and these major psychiatric disorders.
We observed significant causal effects of insomnia on the risk of autism spectrum disorder and bipolar disorder, with odds ratios of 1.739 (95% confidence interval: 1.217–2.486, p = 0.002) and 1.786 (95% confidence interval: 1.396–2.285, p = 4.02 × 10−6), respectively. There was no convincing evidence of reverse causality for insomnia with these two disorders (p = 0.945 and 0.546, respectively). When insomnia was considered as either the exposure or outcome variable, causal estimates for the remaining three psychiatric disorders were not significant.
Our results suggest a causal role of insomnia in autism spectrum disorder and bipolar disorder. Future disease models should include insomnia as a factor for these two disorders to develop effective interventions. More detailed mechanism studies may also be inspired by this causal inference.
Multimorbid adults are more likely to have depression. However, existing data are mostly cross-sectional or retrospective with poor control of baseline depressive symptoms and a focus on long-term effects. This prospective study examined the short-term independent predictive association of multimorbidity with depressive symptoms. We collected baseline and three-month follow-up data from a population-based sample of 300 community-dwellers (aged 18–77) in Hong Kong. Multiple regression was used to examine the predictive association of baseline multimorbidity (two or more physical chronic conditions), relative to having one or zero conditions, with depressive symptoms in three months measured by the Center for Epidemiological Studies-Depression (CES-D, out of 60) scale. Multivariable adjustments were made for socio-demographics, baseline CES-D scores, and baseline self-perceived physical health status. A sub-analysis was conducted to compare multimorbid participants with monomorbid (one condition) ones. In our sample, 48 participants (16%) had multimorbidity. Adjusted analysis showed that on average, multimorbid participants had 2.71 (95% CI, 0.36–5.06, Cohen’s d = 0.128) more points in the CES-D scale at three-month follow-up than non-multimorbid participants (zero or one condition) did, which was independent of baseline CES-D scores, self-perceived physical health status, and socio-demographics. Compared with monomorbid participants, multimorbidity was associated with a similar difference of 2.92 (95% CI, 0.81–5.66, Cohen’s d = 0.220) points. Incremental R-square changes associated with the inclusion of multimorbidity were significant (P < 0.05). In conclusion, the effect of multimorbidity on depressive symptoms may take a shorter period to manifest than previously assumed. The mental health of adults with multimorbidity warrants more attention.
The overuse of antibiotics and the rapid emergence of antibiotic resistance prompted the launch of an antimicrobial stewardship programme in 2011. This study aimed to investigate the trends and correlations between antibiotic consumption and resistance of Staphylococcus aureus in a tertiary hospital of northwest China from 2010 to 2016. Trends were analysed by linear regression, and correlations were assessed by an autoregressive integrated moving average model. The total consumption of antibiotics halved during the 7-year study period, while the rates of resistance of S. aureus decreased significantly or remained stable; methicillin-resistant S. aureus (MRSA) declined markedly, from 73.3% at the beginning of the study to 41.4% by the end. This latter decrease was significantly correlated with the consumption of several classes of antibiotics. In conclusion, reduction in antibiotic use impacted significantly on resistance rates and contributed to a decline in MRSA prevalence.
This article documents the development of a community-based drug intervention for low- to mild-risk drug users who surrendered as part of the Philippine government's anti-drug campaign. It highlights the importance of developing evidence-informed drug recovery interventions that are appropriate to the Asian culture and to developing economies. Interviews and consultations with users and community stakeholders reveal the need for an intervention that would improve the drug recovery skills and life skills of users. Evidence-based interventions were adapted using McKleroy and colleagues’ (2006) Map of Adaptation Process (MAP) framework. The resulting intervention reflected the country's collectivist culture, relational values, propensity for indirect and non-verbal communication, and interdependent self-construal. The use of small groups, interactive and creative methodologies, and the incorporation of music and prayer also recognised the importance of these in the Philippine culture.
In this paper, we introduce a lower extremity exoskeleton CUHK-EXO that is developed to help paraplegic patients, who have lost the motor and sensory functions of their lower limbs to perform basic daily life motions. Since the sit-to-stand and stand-to-sit (STS) motion is the first step for paraplegic patients toward walking, analysis of the exoskeleton's applicability to the STS motion assistance is performed. First, the human-exoskeleton system (HES) is modeled as a five-link model during the STS motion, and the center of pressure (COP) on the ground and center of gravity of the whole system are calculated. Then, a description of the CUHK-EXO hardware design is presented, including the mechatronics design and actuator selection. The COP position is an important factor indicating system balance and wearer's comfort. Based on the COP position, a trajectory online modification algorithm (TOMA) is proposed for CUHK-EXO to counteract disturbances, stabilize system balance, and improve the wearer's comfort in the STS motion. The results of STS motion tests conducted with a paraplegic patient demonstrate that CUHK-EXO can provide a normal reference pattern and proper assistive torque to support the patient's STS motion. In addition, a pilot study is conducted with a healthy subject to verify the effectiveness of the proposed TOMA under external disturbances before future clinical trials. The testing results verify that CUHK-EXO can counteract disturbances, and help the wearer perform the STS motion safely and comfortably.
Experimental X-ray powder diffraction data, unit-cell parameters, and space group for niclosamide, C13H8N2O4Cl2, are reported [a = 13.571(1) Å, b = 7.181(8) Å, c = 13.742(3) Å, β = 97.984(7)°, unit-cell volume V = 1326.40 Å3, Z = 4, and space group P21/c]. All measured lines were indexed and are consistent with the P21/c space group. No detectable impurity was observed.
Sn–Ag–Cu solder interconnects were made by solidifying the solder balls in a magnetic field and subsequently tested for their electromigration behavior. The orientation of the tin grains was analyzed by electron backscattered diffraction. It was found that the c-axis of Sn grain tended to rotate away from the direction of the magnetic field during solidification, resulting in an enhanced electromigration resistance for the solder joint when the current was applied along the direction of the magnetic field, as evidenced by a smaller electromigration-induced polarity effect in the growth of the interfacial intermetallic compound. Such a reduced polarity-effect of electromigration is shown to agree well with the anisotropy in the diffusivity of the active diffusion species, Cu, in the tetragonal Sn. The difference of free energy change caused by the anisotropy in the magnetic susceptibility of the tetragonal Sn during solidification is suggested to be the main factor for this phenomenon.
Depression among older adults is under-recognized either in the community or in general hospitals in Chinese culture. This study aimed to develop a culturally appropriate screening instrument for late-life depression in the non-psychiatric settings and to test its reliability and validity for a diagnosis of depression.
Using a Delphi method, we developed a geriatric depression inventory (GDI), consisting of 12 core symptoms of depressive disorder in old age. We investigated its reliability and validity on 89 patients with late-life depression and 249 non-depression controls. Both self-report (GDI-SR) and physician-interview (GDI-RI) versions were assessed.
Cronbach's α coefficient was 0.843 for GDI-SR and 0.880 for GDI-RI. Both GDI-SR and GDI-RI showed good concurrent validity with the 15-item Geriatric Depression Scale (GDS-15) (GDI-SR: r = 0.750, p < 0.001; GDI-RI: r = 0.733, p < 0.001). The area under the curve of the receiver operating characteristic (ROC) was 0.938 for GDI-SR and 0.961 for GDI-RI, suggesting good to excellent discrimination of depression versus non-depression. Using a cut-off of three items endorsed, sensitivity and specificity were 92.1% and 81.9% for GDI-SR, and 93.3% and 87.1% for GDI-RI.
The GDI, either based on self-report or rater interview, is a reliable and valid instrument for the detection of depression among older adults in non-psychiatric medical settings in Chinese culture.
To determine the association of gestational weight gain (GWG) or pre-pregnancy BMI with postpartum weight retention (PPWR).
PubMed, Cochrane Controlled Trials Register, EMBASE, Science Citation Index Expanded, Current Contents Connects and Biosis Previews were used to search articles.
Publications that described the influence of pre-pregnancy BMI or GWG on PPWR.
Seventeen studies that satisfied the eligibility criteria were included in the analyses. Women with inadequate and excessive GWG had significantly lower mean PPWR of −2·14 kg (95 % CI –2·43, –1·85 kg) and higher PPWR of 3·21 kg (95 % CI 2·79, 3·62 kg), respectively, than women with adequate GWG. When postpartum time spans were stratified into 1–3 months, 3–6 months, 6–12 months, 12–36 months and ≥15 years, the association between inadequate GWG and PPWR faded over time and became insignificant (−1·42 kg; 95 % CI −3·08, 0·24 kg) after ≥15 years. However, PPWR in women with excess GWG exhibited a U-shaped trend; that is, a decline during the early postpartum time span (year 1) and then an increase in the following period. Meta-analysis of qualitative studies showed a significant relationship between excessive GWG and higher PPWR risk (OR=2·08; 95 % CI 1·60, 2·70). Moreover, meta-analysis of pre-pregnancy BMI on PPWR indicated that mean PPWR decreased with increasing BMI group.
These findings suggest that GWG, rather than pre-pregnancy BMI, determines the shorter- or longer-term PPWR.
Traditionally tissue engineering entails the seeding and culturing of differentiated somatic cells onto biodegradable scaffolds, with subsequent implantation of the cell–scaffold constructs into the defective or damaged sites to regenerate tissues . In this approach, the scaffold acts as a three-dimensional (3D) framework to provide physical support and accommodate cell growth and deposition of extracellular matrices, and its biodegradability allows the scaffold material to be resorbed in pace with new tissue formation. Despite some encouraging successes in clinical trials [2, 3], two key limitations with this approach include the limited source of exogenous donor cells and the lack of adequate vascularity to maintain vitality of the newly regenerated tissues. To address these limitations, current advanced tissue engineering techniques gear toward harnessing a biomimetic scaffold that provides a synthetic regenerative microenvironment to support natural tissue regeneration and angiogenesis . In addition to providing physical support, the ideal biomimetic scaffold would preferably also deliver bioactive factors, which instruct endogenous stem cell recruitment and differentiation three-dimensionally and in a controlled manner  (Figure 20.1). Various bioactive factors, including growth factors [6–8], nucleic acids , and integrin-binding ligands , have successfully been delivered or presented on biodegradable scaffolds. Among these, growth factors are the most important soluble signals in the natural regenerative microenvironment, being actively involved in stem cell recruitment, proliferation, and differentiation, angiogenesis, and tissue morphogenesis. Although they are potent, growth factors are expensive and have short half-lives in vivo. Therefore, scaffolds with controlled-release capacity are desired in order to preserve growth factor bioactivity and to prolong their function at therapeutic levels over an extended time period. However, there remain significant challenges in delivering growth factors effectively from scaffolds, including the need to preserve the bioactivity of growth factors during the possibly harsh incorporation process, the control of their release over an extended period during tissue regeneration, and the need for release to be restricted locally so as to avoid toxic or unwanted systemic side effects. Additionally, each individual delivery strategy is related, and sometimes restricted, to the type of scaffold utilized.
We examine the impact of rigorous trade suppression during 1550–1567 on the sharp rise of piracy in this period of Ming China. By analyzing a uniquely constructed historical data set, we find that the enforcement of a “sea (trade) ban” policy led to a rise in pirate attacks that was 1.3 times greater among the coastal prefectures more suitable for silk manufactures—our proxy for greater trade potential. Our study illuminates the conflicts in which China subsequently engaged with the Western powers, conflicts that eventually resulted in the forced abandonment of its long upheld autarkic principle.
Metal nanoparticle–decorated graphene oxides are promising materials for use in various optoelectronic applications because of their unique plasmonic properties. In this paper, a simple, environmentally friendly method for the synthesis of gold nanoparticle–decorated graphene oxide that can be used to improve the efficiency of organic photovoltaic devices (OPVs) is reported. Here, the amino acid glycine is empolyed as an environmentally friendly reducing reagent for the reduction of gold ions in the graphene oxide solutions. Furthermore, these nanocomposites are empolyed as the anode buffer layer in OPVs to trigger surface plasmonic resonance, which improved the efficiency of the OPVs. The results indicate that such nanomaterials appear to have great potential for application in OPVs.
The hot ductility of Ti-bearing steel was studied by theoretical calculation and a
thermal simulation experiment. Meanwhile, microsegregation and precipitates were analyzed.
The results showed that the S, P and O elements were enriched at the grain boundaries,
while the hot ductility was deteriorated by inclusions of (Fe, Mn, Si, Al)(S,O) in the
interdendritic region. At a temperature of 1300 °C, large TiN particles have little effect
on the hot ductility. In the temperature range from 1000 °C to 900 °C, the Reduction of
Area (R.A) declined rapidly from 81.77%
to 31.77%, with the size of particles decreasing from 5 to 20 nm and quantity increasing
from 1.2 inds/μm2 to 354 inds/μm2,
respectively. In the temperature range from 900 °C to 850 °C,
R.A decreased from 31.77% to 30.12%
with the ferric films gradually thickening. The critical stress, 63.58 MPa, was equal to
tensile strength at 912 °C. Intergranular fracture occurred easily with higher critical
stress below 912 °C.
In the present study, we aimed to examine the effects of soya oligosaccharides (SOS) and soya oligopeptides (SOP) on blood lipid levels, release of vasoactive substances, antioxidant activity and faecal bile acid (FBA) excretion in rats fed a high-fat diet (HFD). Male Sprague–Dawley rats were evenly divided into five groups according to diets as follows: regular diet (control), HFD, HFD enriched with 2 % of SOS (SOS), HFD enriched with 3 % of SOP (SOP) and HFD enriched with 2 % SOS and 3 % SOP (SOSP). The results showed that SOS and SOP significantly reduced plasma total cholesterol, LDL-cholesterol and TAG, whereas HDL-cholesterol concentration was significantly increased. Furthermore, SOS and SOP reduced plasma apoB, apoE and the apoB:apoAI ratio, whereas apoAI was significantly increased. Moreover, SOS and SOP also reduced plasma thromboxane A2 (TXA2) and the TXA2:prostacyclin (PGI2) ratio, whereas plasma PGI2 and nitric oxide were significantly increased. In addition, SOS and SOP significantly reduced serum and liver malondialdehyde concentrations and increased FBA excretion. However, we did not observe obvious influences of SOS and SOP on superoxide dismutase activities in the liver of HFD-fed rats. The combination of 2 % SOS and 3 % SOP showed a more marked effect than SOS or SOP alone in improving the lipid profile, release of vasoactive substances and increasing FBA excretion (P < 0·05). In summary, SOS and SOP might help prevent atherosclerosis through improving abnormal blood lipid levels, regulating vasoactive substances and protecting against oxidative stress.
We have grown GaAs directly on silicon substrates by molecular beam epitaxy (MBE) at low substrate temperatures (∼250 °C). The silicon wafer surface cleaning and GaAs film growth processes were done at temperatures lower than the Si-Al eutectic temperature, in order to enable monolithic integration of low-temperature-grown-GaAs (LT-GaAs) photoconductive switches with Si-CMOS circuits. In situ reflection high-energy electron diffraction (RHEED), ex situ x-ray diffraction (XRD) and atomic force microscopy (AFM) studies were performed to characterize the LT-GaAs film quality. The film surfaces show less than 1 nm root-mean-square (rms) roughness and the anti-phase domain (APD) density is below the XRD detection limit. Metal-semiconductor-metal (MSM) photoconductive switches were made using this material. A time-resolved electro-optic sampling technique was used to determine the responsivity and speed of the switches. A full-width at half-maximum (FWHM) switching time of ∼2 picoseconds was achieved and the responsivity of switches made from LT-GaAs on Si material was comparable to that of switches made from LT-GaAs on GaAs material.