To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
There is growing interest globally in using real-world data (RWD) and real-world evidence (RWE) for health technology assessment (HTA). Optimal collection, analysis, and use of RWD/RWE to inform HTA requires a conceptual framework to standardize processes and ensure consistency. However, such framework is currently lacking in Asia, a region that is likely to benefit from RWD/RWE for at least two reasons. First, there is often limited Asian representation in clinical trials unless specifically conducted in Asian populations, and RWD may help to fill the evidence gap. Second, in a few Asian health systems, reimbursement decisions are not made at market entry; thus, allowing RWD/RWE to be collected to give more certainty about the effectiveness of technologies in the local setting and inform their appropriate use. Furthermore, an alignment of RWD/RWE policies across Asia would equip decision makers with context-relevant evidence, and improve timely patient access to new technologies. Using data collected from eleven health systems in Asia, this paper provides a review of the current landscape of RWD/RWE in Asia to inform HTA and explores a way forward to align policies within the region. This paper concludes with a proposal to establish an international collaboration among academics and HTA agencies in the region: the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) working group, which seeks to develop a non-binding guidance document on the use of RWD/RWE to inform HTA for decision making in Asia.
Increased intake of vegetables and fruits has been associated with reduced risk of tuberculosis infection. Vegetables and fruits exert immunoregulatory effects and may be beneficial for treating pulmonary tuberculosis. However, it is not clear whether vegetables and fruits have an adjuvant treatment effect on tuberculosis. Furthermore, limited research has been conducted on the effects of colour categories and specific types of vegetables on tuberculosis treatment outcome. Between 2009 and 2013, a hospital-based cohort study was conducted in Linyi, Shandong Province, China. Treatment outcome was ascertained by sputum smear and chest computerized tomography, and dietary intake was assessed by a semi-quantitative food frequency questionnaire. The dietary questionnaire was conducted at the end of month two of treatment initiation. Participants recalled their dietary intake of the previous two months. A total of 2,309 patients were enrolled in this study. After 6 months of treatment, 2,099 patients were successfully treated and 210 were uncured. In multivariate models, higher intake of total vegetables and fruits [OR (95% CI): 0.70 (0.49-0.99)], total vegetables [OR (95% CI): 0.68 (0.48-0.97)], dark-coloured vegetables [OR (95% CI): 0.61 (0.43-0.86)], light-coloured vegetables [OR (95% CI): 0.67 (0.48-0.95)] were associated with reduced failure rate of tuberculosis treatment. No association was found between total fruit intake and reduced failure rate of tuberculosis treatment [OR (95% CI): 0.98 (0.70-1.37)]. High intake of total vegetables and fruits, especially vegetables, is associated with lower risk of failure of tuberculosis treatment in pulmonary tuberculosis patients. The results provide important information for dietary guidelines during tuberculosis treatment.
A Fast Ice Prediction System (FIPS) was constructed and is the first regional land-fast sea-ice forecasting system for the Antarctic. FIPS had two components: (1) near-real-time information on the ice-covered area from MODIS and SAR imagery that revealed, tidal cracks, ridged and rafted ice regions; (2) a high-resolution 1-D thermodynamic snow and ice model (HIGHTSI) that was extended to perform a 2-D simulation on snow and ice evolution using atmospheric forcing from ECMWF: either using ERA-Interim reanalysis (in hindcast mode) or HERS operational 10-day predictions (in forecast mode). A hindcast experiment for the 2015 season was in good agreement with field observations, with a mean bias of 0.14 ± 0.07 m and a correlation coefficient of 0.98 for modeled ice thickness. The errors are largely caused by a cold bias in the atmospheric forcing. The thick snow cover during the 2015 season led to modeled formation of extensive snow ice and superimposed ice. The first FIPS operational service was performed during the 2017/18 season. The system predicted a realistic ice thickness and onset of snow surface melt as well as the area of internal ice melt. The model results on the snow and ice properties were considered by the captain of R/V Xuelong when optimizing a low-risk route for on-ice transportation through fast ice to the coastal Zhongshan Station.
A novel coronavirus disease, designated as COVID-19, has become a pandemic worldwide. This study aims to estimate the incubation period and serial interval of COVID-19. We collected contact tracing data in a municipality in Hubei province during a full outbreak period. The date of infection and infector–infectee pairs were inferred from the history of travel in Wuhan or exposed to confirmed cases. The incubation periods and serial intervals were estimated using parametric accelerated failure time models, accounting for interval censoring of the exposures. Our estimated median incubation period of COVID-19 is 5.4 days (bootstrapped 95% confidence interval (CI) 4.8–6.0), and the 2.5th and 97.5th percentiles are 1 and 15 days, respectively; while the estimated serial interval of COVID-19 falls within the range of −4 to 13 days with 95% confidence and has a median of 4.6 days (95% CI 3.7–5.5). Ninety-five per cent of symptomatic cases showed symptoms by 13.7 days (95% CI 12.5–14.9). The incubation periods and serial intervals were not significantly different between male and female, and among age groups. Our results suggest a considerable proportion of secondary transmission occurred prior to symptom onset. And the current practice of 14-day quarantine period in many regions is reasonable.
Since December 2019, China has experienced a widespread outbreak of COVID-19. However, at the early stage of outbreak, investigations revealed a variety of patterns resulting in the transmission of COVID-19. Thus, it is essential to understand the transmission types and the potential for sustained human-to-human transmission. Moreover, the information regarding the characteristics of transmission helps in coordinating the current screening programme, and controlling and containing measures, and also, helps in deciding the appropriate quarantine duration. Thus, this investigation reports an outbreak of COVID-19 in a family residing in Wenzhou, Zhejiang, China during the month of January−February 2020.
In this research communication, a cell model with elevated β-CASEIN synthesis was established by stimulating bovine mammary epithelial cells with 0.6 mM methionine, and the genome-wide gene expression profiles of methionine-stimulated cells and untreated cells were investigated by RNA sequencing. A total of 458 differentially expressed genes (DEGs; 219 upregulated and 239 downregulated) were identified between the two groups. Gene Ontology (GO) analysis showed that the two highest-ranked GO terms in ‘molecular function’ category were ‘binding’ and ‘catalytic activity’, suggesting that milk protein synthesis in methionine-stimulated cells requires induction of gene expression to increase metabolic activity. Kyoto Encyclopedia of Genes and Genomes analysis revealed that within the ‘environmental information processing’ category, the subcategory that is most highly enriched for DEGs was ‘signal transduction’. cGMP-PKG, Rap1, calcium, cAMP, PI3K-AKT, MAPK, and JAK-STAT are the pathways with the highest number of DEGs, suggesting that these signaling pathways have potential roles in mediating methionine-induced milk protein synthesis in bovine mammary epithelial cells. This study provides valuable insights into the physiological and metabolic adaptations in cells stimulated with methionine. Understanding the regulation of this transition is essential for effective intervention in the lactation process.
To evaluate open-label treatment with olanzapine in patients with borderline personality disorder (BPD).
In two concurrent studies, patients received 12 weeks of open-label olanzapine after completing 12-weeks of double-blind treatment with either olanzapine or placebo. Open-label olanzapine dosing started at 2.5 or 5mg/day and could be increased up to 20mg/day (Study 1) or 15mg/day (Study 2).
Mean ZAN-BPD total scores decreased from approximately 17 points to approximately 8-10 points during the acute phase. After 12 weeks of open-label olanzapine treatment, mean ZAN-BPD total scores were approximately 6-7 points. Patients treated with placebo during the acute phase and then open-label olanzapine showed changes in weight, prolactin, and other laboratory values similar in magnitude to those seen in acutely olanzapine-treated patients. Patients treated with olanzapine during the acute phase showed smaller changes in weight and laboratory values during the open-label extension.
Overall BPD symptom severity was low by the end of the open-label olanzapine treatment period. The types of treatment emergent adverse events appeared to be consistent with those seen previously in patients treated with olanzapine. The direction and magnitude of effects on safety measures depended on the treatment received during the prior double-blind period.
We examined the efficacy and safety of low vs. moderate olanzapine doses for the treatment of borderline personality disorder (BPD) in the largest controlled clinical trial ever conducted in this population.
This 12-week, double-blind trial involved patients 18-65 years with a diagnosis of DSM-IV BPD randomized to receive 2.5mg/day olanzapine (N=150), 5-10mg/day olanzapine (N=148), or placebo (N=153). The primary efficacy measure was the change from baseline-to-endpoint (last-observation-carried-forward) on the Zanarini Rating Scale for BPD (ZAN-BPD) total score. Rate of response and time-to-response were also examined (response defined as a >=50% reduction in ZAN-BPD total score).
Mean baseline ZAN-BPD total scores ranged from 17.01 to 17.42, indicating moderate symptom severity. Treatment with OLZ5-10 was associated with significantly greater mean change from baseline-to-endpoint in ZAN-BPD total score than placebo (-8.50 vs. -6.79, p=.010). Response rates were significantly higher for OLZ5-10 (73.6%) than for OLZ2.5 (60.1%, p=.018) and placebo (57.8%, p=.006). Time-to-response was significantly shorter for OLZ5-10 than placebo (p=.028). Treatment-emergent adverse events seen more frequently in the olanzapine groups included somnolence, increased appetite, and weight gain. Mean weight change from baseline-to-endpoint was 2.09kg for OLZ 2.5, 3.17kg for OLZ5-10, and 0.02kg for placebo.
The results of this study suggest that moderate doses of olanzapine (5-10mg/day) are effective in the treatment of overall borderline psychopathology. Also, the types of adverse events observed with olanzapine treatment were similar to those seen previously in adult populations.
To address critical energy issues in civic structures, we have developed a novel concept of optical thermal insulation (OTI) without relying on a conventional thermal intervention medium, such as air or argon, as often used in conventional window systems. We have synthesized the photothermal (PT) materials, such as the Fe3O4 and Fe3O4@Cu2−xS nanoparticles, that exhibit strong UV and near-infrared (NIR) absorptions but with good visible transparency. Upon coating the inner surface of the window glass with a PT film, under solar irradiation, the inner surface temperature rises due to the PT effect. Subsequently, the temperature difference, ΔT, is reduced between the single pane and room interior. This leads to lower the thermal loss through a window, reflected by the U-factor, resulting in considerable energy saving without double- or triple-glazing. Comparing with the Fe3O4 coatings, Fe3O4@Cu2−xS is spectrally characterized with a much stronger NIR absorbance, contributing to an increased PT efficiency under simulated solar irradiation (0.1 W/cm2). PT experiments are carried out via both white light and monochromic NIR irradiations (785 nm). The parameters associated with the thermal performance of the PT films are calculated, including PT conversion efficiency, specific absorption rate (SAR), and U-factor. Based on the concept of OTI, we have reached an optimum U-factor of 1.46 W/m2 K for a single pane, which is satisfactory to the DOE requirement (<1.7 W/m2 K).
The experiment was conducted to investigate the effects of dietary threonine (Thr) on growth performance and muscle growth, protein synthesis and antioxidant-related signalling pathways of hybrid catfish Pelteobagrus vachelli♀ × Leiocassis longirostris♂. A total of 1200 fish (14·19 (se 0·13) g) were randomly distributed into six groups with four replicates each, fed six diets with graded level of Thr (9·5, 11·5, 13·5, 15·4, 17·4 and 19·3 g/kg diets) for 56 d. Results showed (P < 0·05) that dietary Thr (1) increased percentage weight gain, specific growth rate, feed efficiency and protein efficiency ratio; (2) up-regulated growth hormone (GH), insulin-like growth factor 1 (IGF-1), proliferating cell nuclear antigen, myogenic regulation factors (MyoD, Myf5, MyoG and Mrf4) and myosin heavy chain (MyHC) mRNA levels; (3) increased muscle protein content via regulating the protein kinase B/target of rapamycin signalling pathway and (4) decreased malondialdehyde and protein carbonyl contents, increased catalase, glutathione-S-transferase, glutathione reductase and GSH activities, up-regulated mRNA levels of antioxidant enzymes related to NFE2-related factor 2 and γ-glutamylcysteine ligase catalytic subunit. These results suggest that Thr has a potential role to improve muscle growth and protein synthesis, which might be due to the regulation of GH-IGF system, muscle growth-related gene, antioxidative capacity and protein synthesis-related signalling pathways. Based on the quadratic regression analysis of specific growth rate, the Thr requirement of hybrid catfish (14·19–25·77 g) was estimated to be 13·77 g/kg of the diet (33·40 g/kg of dietary protein).
Autonomous ships are gaining in importance and are expected to shape the future of the global shipping industry. This evolutionary shift raises serious issues about compliance with the International Regulations for Preventing Collisions at Sea 1972 (COLREGs). This paper reviews the literature on autonomous ships from the perspective of the obligations of good seamanship imposed by COLREGs. The authors conclude that to facilitate the introduction of autonomous ships, the application barriers presented by COLREGs need to be analysed. With this goal, this paper presents a perspective from navigational practice. Four nautical scientists and two deck officers were invited to give their opinions. The analysis indicates that COLREGs require further elaboration and amendments to eliminate uncertainty of interpretation. In particular, the paper highlights the need to amend the ‘look-out’ rule (COLREGs Rule 5) to permit look-out by ‘computer vision’ alone while, at the same time, preserving the distinction between vessels navigating in restricted visibility and in sight of one another.
Malnutrition and acute kidney injury (AKI) are common complications in hospitalised patients, and both increase mortality; however, the relationship between them is unknown. This is a retrospective propensity score matching study enrolling 46 549 inpatients, aimed to investigate the association between Nutritional Risk Screening 2002 (NRS-2002) and AKI and to assess the ability of NRS-2002 and AKI in predicting prognosis. In total, 37 190 (80 %) and 9359 (20 %) patients had NRS-2002 scores <3 and ≥3, respectively. Patients with NRS-2002 scores ≥3 had longer lengths of stay (12·6 (sd 7·8) v. 10·4 (sd 6·2) d, P < 0·05), higher mortality rates (9·6 v. 2·5 %, P < 0·05) and higher incidence of AKI (28 v. 16 %, P < 0·05) than patients with normal nutritional status. The NRS-2002 showed a strong association with AKI, that is, the risk of AKI changed in parallel with the score of the NRS-2002. In short- and long-term survival, patients with a lower NRS-2002 score or who did not have AKI achieved a significantly lower risk of mortality than those with a high NRS-2002 score or AKI. Univariate Cox regression analyses indicated that both the NRS-2002 and AKI were strongly related to long-term survival (AUC 0·79 and 0·71) and that the combination of the two showed better accuracy (AUC 0·80) than the individual variables. In conclusion, malnutrition can increase the risk of AKI and both AKI and malnutrition can worsen the prognosis that the undernourished patients who develop AKI yield far worse prognosis than patients with normal nutritional status.
Flow around a high-speed rotating circular cylinder for
is investigated numerically. The Reynolds number is defined as
being the free-stream flow velocity, the diameter of the cylinder and the kinematic viscosity of the fluid, respectively. The aim of this study is to investigate the effect of a high rotation rate on the wake flow for a range of Reynolds numbers. Simulations are performed for Reynolds numbers of 100, 150, 200, 250 and 500 and a wide range of rotation rates from 1.6 to 6 with an increment of 0.2. Rotation rate is the ratio of the rotational speed of the cylinder surface to the incoming fluid velocity. A systematic study is performed to investigate the effect of rotation rate on the flow transition to different flow regimes. It is found that there is a transition from a two-dimensional vortex shedding mode to no vortex shedding mode when the rotation rate is increased beyond a critical value for Reynolds numbers between 100 and 200. Further increase in rotation rate results in a transition to three-dimensional flow which is characterized by the presence of finger-shaped (FV) vortices that elongate in the wake of the cylinder and very weak ring-shaped vortices (RV) that wrap the surface of the cylinder. The no vortex shedding mode is not observed at Reynolds numbers greater than or equal to 250 since the flow remains three-dimensional. As the rotation rate is increased further, the occurrence frequency and size of the ring-shaped vortices increases and the flow is dominated by RVs. The RVs become bigger in size and the flow becomes chaotic with increasing rotation rate. A detailed analysis of the flow structures shows that the vortices always exist in pairs and the strength of separated shear layers increases with the increase of rotation rate. A map of flow regimes on a plane of Reynolds number and rotation rate is presented.
Phase retrieval is necessary for propagation-based phase-contrast imaging (PB-PCI). Arhatari established a model for predicting the impact of the sample-to-detector distance and the system noise on the phase retrieval performance. We have extended Arhatari's model to account for the parameters of excessive source size, finite detector resolution, and geometrical magnification for more practical cases. However, there exist interaction effects among these parameters resulting in difficulty of predicting the phase retrieval performance. In this study, we found that optimizing the trade-off among these parameters for phase retrieval is consistent with the improvement of edge enhancement to noise ratio (EE/N) in the “forward problem” of the PB-PCI. Hence, we engaged in establishing a relationship between EE/N and phase retrieval performance in terms of the “forward problem” and “inverse problem” of the PB-PCI, respectively. Our results showed that, at fixed detector resolution, phase retrieval from the phase-contrast projections at the same EE/N level resulted in the consistent phase retrieval performance. Therefore, the performance of phase retrieval can be predicted based on the EE/N level and be quantitatively optimized by increasing EE/N.
A bottom-feed omni-directional CP (circularly polarized) antenna array is proposed in this letter. The antenna array is composed of four elements (two printed ZPS (zero-phase-shift) line loops and two half-wavelength dipoles). The four elements are fed with the same phase and amplitude. The ZPS line loops provide the horizontal polarization while the dipoles provide the vertical polarization. Therefore, omni-directional circular polarization is formed in the far field. The feeding network consists of a 1–4 T-shaped power divider formed by parallel strip lines. In order to balance the amplitude of the feeding coaxial cable, the structure is used in the bottom to transfer parallel strip line to micro-strip line. Besides, the loops and the dipoles are placed on the different side of the network to guarantee the omni-directional radiation property. The measured impedance bandwidth of the fabricated antenna is 0.13 GHz (2.40–2.53 GHz) and the measured maximum CP gain at 2.45 GHz is 4.8 dBic.
Challenges remain in the judgement of pathological murmurs in newborns at maternity hospitals, and there are still many simple major CHD patients in developing countries who are not diagnosed in a timely fashion. This study aimed to evaluate the accuracy of cardiac auscultation on neonatal CHD by general paediatricians.
We conducted a prospective study at three hospitals. All asymptomatic newborns underwent auscultation, pulse oximetry monitoring, and echocardiography. Major CHD was classified and confirmed through follow-up. We evaluated the accuracy of various degrees of murmurs for detecting major CHD to determine the most appropriate standards and time of auscultation.
A total of 6750 newborns were included. The median age of auscultation was 43 hours. Cardiac murmurs were identified in 6.6% of newborns. For all CHD, 44.4% had varying degrees of murmurs. A murmur of grade ≥2 used as a reference standard for major CHD had a sensitivity of 89.58%. The false positive rate of murmurs of grade ≥2 for detecting major CHD was significantly negatively related to auscultation time, with 84.4% of false positives requiring follow-up for non-major CHD cardiac issues. Auscultation after 27 hours of life could reduce the false positive rate of major CHD from 2.7 to 0.9%.
With appropriate training, maternity hospital’s paediatricians can detect major CHD with high detection rates with an acceptable false positive rate.
Multi-functions devices attract much attention due to their great potential and large demands in wearable electronics. Besides some studies of integrated different functional devices as one, there is a novel strategy to fabricate multi-functions devices, that using one device to achieve two or more functions. Herein, we report the temperature sensing and energy storage multi-functions device based on graphene supercapacitor. By measuring the change of leakage current of supercapacitor, the obtained device could detect the environmental temperature. Integrating the planar-structure supercapacitor on one flexible printed circuit board with electronic components together, the obtain device presents perfect mechanical stability that no noticeable difference of both capacitance and leakage current under any bending status. Importantly, the temperature sensing function exhibits a high accuracy of 1 °C with a high resolution of 0.0588 °C. This work demonstrates the feasibility of the strategy of one device achieve two functions: using one supercapacitor to achieve temperature sensing and energy storage dual function simultaneously.