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The reliability of cost–utility analyses depends on the quality of health state utility values (HSUVs). Given the increasing number of studies eliciting HSUVs, systematic reviews (SRs) are vital to economic evaluations. Nevertheless, a universally acceptable quality appraisal (QA) tool specific to the SRs of HSUV studies is lacking—this study aimed to develop one and fill this gap.
Methods
We employed a mixed-method approach, starting with a rapid review to identify QA dimensions, QA items, and terminology in the SRs of HSUV-eliciting studies. This informed a modified Delphi process with a seven-member international expert panel, aiming to define key terms, refine the QA tool dimensions, and establish relevant signaling questions. The experts participated in two anonymous online survey rounds interspersed with structured feedback, enabling iterative refinement of their views. Following these surveys, a virtual face-to-face meeting was held to resolve outstanding issues. Consensus was defined a priori at all stages of the modified Delphi process.
Results
The rapid review identified three QA dimensions and 16 initial items, noting the diverse terminologies in defining QA. Response rates to the first- and second-round questionnaires and the virtual consensus meeting were 100, 86, and 71 percent, leading to a consensus on the definitions of scientific quality, QA, the three QA dimensions (reporting, methodological limitation, and risk of bias and relevance), and scope of the QA tool. The number of QA items was refined to 14: all relevant to reporting, six to relevance, and 11 to methodological limitations and bias risk dimensions. The QA tool underscores distinct evaluations for each dimension.
Conclusions
We present the first version of a QA checklist designed to provide SR authors with a tool to appraise the quality of HSUV-eliciting studies comprehensively. The QA tool aims to (i) facilitate QA in SRs of HSUV elicitation studies, (ii) promote consistency in the appraisal process, and (iii) emphasize the importance of differentiating between reporting quality, methodology, and relevance.
Despite growing awareness of the mental health damage caused by air pollution, the epidemiologic evidence on impact of air pollutants on major mental disorders (MDs) remains limited. We aim to explore the impact of various air pollutants on the risk of major MD.
Methods
This prospective study analyzed data from 170 369 participants without depression, anxiety, bipolar disorder, and schizophrenia at baseline. The concentrations of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5), particulate matter with aerodynamic diameter > 2.5 μm, and ≤ 10 μm (PM2.5–10), nitrogen dioxide (NO2), and nitric oxide (NO) were estimated using land-use regression models. The association between air pollutants and incident MD was investigated by Cox proportional hazard model.
Results
During a median follow-up of 10.6 years, 9 004 participants developed MD. Exposure to air pollution in the highest quartile significantly increased the risk of MD compared with the lowest quartile: PM2.5 (hazard ratio [HR]: 1.16, 95% CI: 1.09–1.23), NO2 (HR: 1.12, 95% CI: 1.05–1.19), and NO (HR: 1.10, 95% CI: 1.03–1.17). Subgroup analysis showed that participants with lower income were more likely to experience MD when exposed to air pollution. We also observed joint effects of socioeconomic status or genetic risk with air pollution on the MD risk. For instance, the HR of individuals with the highest genetic risk and highest quartiles of PM2.5 was 1.63 (95% CI: 1.46–1.81) compared to those with the lowest genetic risk and lowest quartiles of PM2.5.
Conclusions
Our findings highlight the importance of air pollution control in alleviating the burden of MD.
This paper presents a numerical study on the flow around two tandem circular cylinders beneath a free surface at a Reynolds number of $180$. The free-surface effects on the wake dynamics and hydrodynamic forces are investigated through a parametric study, covering a parameter space of gap ratios from $0.20$ to $2.00$, spacing ratios from $1.50$ to $4.00$ and Froude numbers from $0.2$ to $0.8$. A jet-like flow accompanied by a shear layer of positive vorticity separating from the free surface is formed in the wake at small gap ratios, which significantly alters the wake pattern through its dynamic behaviours. At shallow submergence depths, the three-dimensional wake transitions from mode B to mode A as the distance between the cylinders increases. As submergence depth increases, the wavy deformation of the primary vortex cores disappears in the wake, and the flow transitions to a two-dimensional state. Higher Froude numbers can extend the effect of the free surface to deeper submergence depths. The critical spacing ratio tends to be larger at higher Froude numbers. Furthermore, the free-surface deformation is examined. The free-surface profile typically comprises a hydraulic jump immediately ahead of the upstream cylinder, trapped waves in the vicinity of the two tandem cylinders and well-defined travelling waves on the downstream side. The frequencies of the waves cluster around the vortex shedding frequency, indicating a close association between the generation of waves and the vortex shedding process.
This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.
Methods
In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.
Results
Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.
Conclusions
Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.
EXOSC10 is an exosome-associated ribonuclease that degrades and processes a wide range of transcripts in the nucleus. The initial segment (IS) of the epididymis is crucial for sperm transport and maturation in mice by affecting the absorption and secretion that is required for male fertility. However, the role of EXOSC10 ribonuclease-mediated RNA metabolism within the IS in the regulation of gene expression and sperm maturation remains unknown. Herein, we established an Exosc10 conditional knockout (Exosc10 cKO) mouse model by crossing Exosc10F/F mice with Lcn9-Cre mice which expressed recombinase in the principal cells of IS as early as post-natal day 17. Morphological and histological analyses revealed that Exosc10 cKO males had normal spermatogenesis and development of IS. Moreover, the sperm concentration, morphology, motility, and frequency of acrosome reactions in the cauda epididymides of Exosc10 cKO mice were comparable with those of control mice. Thus, Exosc10 cKO males had normal fertility. Collectively, our genetic mouse model and findings demonstrate that loss of EXOSC10 in the IS of epididymis is dispensable for sperm maturation and male fertility.
We consider the problem of parameter estimation for the superposition of square-root diffusions. We first derive the explicit formulas for the moments and auto-covariances based on which we develop our moment estimators. We then establish a central limit theorem for the estimators with the explicit formulas for the asymptotic covariance matrix. Finally, we conduct numerical experiments to validate our method.
The spatio-temporal scales, as well as a comprehensive self-sustained mechanism of the reattachment unsteadiness in shock wave/boundary layer interaction, are investigated in this study. Direct numerical simulations reveal that the reattachment unsteadiness of a Mach 7.7 laminar inflow causes over $26\,\%$ variation in wall friction and up to $20\,\%$ fluctuation in heat flux at the reattachment of the separation bubble. A statistical approach, based on the local reattachment upstream movement, is proposed to identify the spanwise and temporal scales of reattachment unsteadiness. It is found that two different types, i.e. self-induced and random processes, dominate different regions of reattachment. A self-sustained mechanism is proposed to comprehend the reattachment unsteadiness in the self-induced region. The intrinsic instability of the separation bubble transports vorticity downstream, resulting in an inhomogeneous reattachment line, which gives rise to baroclinic production of quasi-streamwise vortices. The pairing of these vortices initiates high-speed streaks and shifts the reattachment line upstream. Ultimately, viscosity dissipates the vortices, triggering instability and a new cycle of reattachment unsteadiness. The temporal scale and maximum vorticity are estimated with the self-sustained mechanism via order-of-magnitude analysis of the enstrophy. The advection speed of friction, derived from the assumption of coherent structures advecting with a Blasius-type boundary layer, aligns with the numerical findings.
Recent studies of viscous dissipation mechanisms in impacting droplets have revealed distinct behaviours between the macroscale and nanoscale. However, the transition of these mechanisms from the macroscale to the nanoscale remains unexplored due to limited research at the microscale. This work addresses the gap using the many-body dissipative particle dynamics (MDPD) method. While the MDPD method omits specific atomic details, it retains crucial mesoscopic effects, making it suitable for investigating the impact dynamics at the microscale. Through the analysis of velocity contours within impacting droplets, the research identifies three primary contributors to viscous dissipation during spreading: boundary-layer viscous dissipation from shear flow; rim geometric head loss; and bulk viscous dissipation caused by droplet deformation. This prompts a re-evaluation of viscous dissipation mechanisms at both the macroscale and nanoscale. It reveals that the same three kinds of dissipation are present across all scales, differing only in their relative intensities at each scale. A model of the maximum spreading factor (βmax) incorporating all forms of viscous dissipation without adjustable parameters is developed to substantiate this insight. This model is validated against three distinct datasets representing the macroscale, microscale and nanoscale, encompassing a broad spectrum of Weber numbers, Ohnesorge numbers and contact angles. The satisfactory agreement between the model predictions and the data signifies a breakthrough in establishing a universal βmax model applicable across all scales. This model demonstrates the consistent nature of viscous dissipation mechanisms across different scales and underscores the importance of integrating microscale behaviours to understand macroscale and nanoscale phenomena.
Liquid crystal microwave phased arrays (LC-MPAs) are regarded as an ideal approach to realize compact antennas owing to their advantages in cost, size, weight, and power consumption. However, the shortcoming in low radiation deflection efficiency has been one of LC-MPAs’ main application limitations. To optimize the steering performance of LC-MPAs, it is essential to model the channel imperfections and compensate for the phase errors. In this paper, a phase error estimation model is built by training a neural network to establish a nonlinear relationship between the near-field phase error and the far-field pattern, hence realizing fast calibration for LC-MPAs within several measured patterns. Simulations and experiments on a 64-channel, two-dimensional planar antenna were conducted to validate this method. The results show that this method offers precise phase error estimations of 3.58° on average, realizes a fast calibration process with several field-measured radiation patterns, and improves the performances of the LC-MPA by approximately 4%–10% in deflection efficiency at different steering angles.
Infection mechanism plays a significant role in epidemic models. To investigate the influence of saturation effect, a nonlocal (convolution) dispersal susceptible-infected-susceptible epidemic model with saturated incidence is considered. We first study the impact of dispersal rates and total population size on the basic reproduction number. Yang, Li and Ruan (J. Differ. Equ. 267 (2019) 2011–2051) obtained the limit of basic reproduction number as the dispersal rate tends to zero or infinity under the condition that a corresponding weighted eigenvalue problem has a unique positive principal eigenvalue. We remove this additional condition by a different method, which enables us to reduce the problem on the limiting profile of the basic reproduction number into that of the spectral bound of the corresponding operator. Then we establish the existence and uniqueness of endemic steady states by a equivalent equation and finally investigate the asymptotic profiles of the endemic steady states for small and large diffusion rates to provide reference for disease prevention and control, in which the lack of regularity of the endemic steady state and Harnack inequality makes the limit function of the sequence of the endemic steady state hard to get. Finally, we find whether lowing the movements of susceptible individuals can eradicate the disease or not depends on not only the sign of the difference between the transmission rate and the recovery rate but also the total population size, which is different from that of the model with standard or bilinear incidence.
This study presents a dual-channel vortex generator (VG) that leverages the snap-through behaviour of flexible sheets. The VG outperforms a similar-sized rigid VG in generating vortices within dual-channel flows while minimizing pressure loss. Numerical simulations using the immersed boundary-lattice Boltzmann method analyse the dynamics and vortex generation performance of the sheet under various system parameters. Two distinct modes are identified for the elastic sheet: a sustained snap-through mode (SSTM) and a dormant mode (DM). The sheet's mode is predominantly influenced by its length ratio (L*), bending stiffness $(K_b^\ast )$ and flow strength, with the mass ratio having a minimal impact. The sheet exhibiting regular SSTM can effectively generate vortices in both channels and the vortex generation performance can be conveniently tuned by altering the sheet's initial buckling (i.e. L*). An increase in $K_b^\ast $ results in a higher critical Reynolds number (Rec) required for mode transition. An increase in L*, however, initially raises Rec and then lowers it, suggesting an optimal length ratio (approximately 0.7 for our considered system) for minimizing the Rec necessary to trigger SSTM. Furthermore, a disparity in the flow strength between channels is found to suppress the snap-through of the sheet; a greater disparity, however, is permissible to induce the SSTM of more compliant sheets. These findings underscore the potential of snap-through behaviour for enhanced flow manipulation in dual-channel systems.
Large-scale outbreaks of the dinoflagellate Karenia mikimotoi caused substantial mortality of abalone, Haliotis discus hannai in Fujian, China in 2012, resulting in 20 billion in economic losses to abalone industries. However, the mechanism behind the mortality, especially the reaction of abalone to this microalgal toxicity, which possibly differed significantly from the former ‘fish killer’ strain in the South China Sea (SCS). Our study revealed that K. mikimotoi FJ-strain exhibited a four-fold higher haemolytic toxicity than the SCS-strain during the late exponential phase. At the microalgal cell density of 3 × 107 cell L−1, the FJ-strain caused abalone mortality of 67% in 48 h, with decreased granulocyte–hyalinocyts ratio and phagocytic activity by 58.96% and 75.64%, respectively, increased haemocyte viability by 4.8-fold and severe gill damage. The toxic effect only worked for the haemolytic toxicity from active algal cells, which were probably produced under the contact of algal cells and abalone gills. However, under exposure to the SCS-strain, more than 80% of individuals survived under aeration. The results indicated that FJ-strain was a new K. mikimotoi ecotype with stronger toxicity. It evoked severe effects, with complete abalone mortality within 24 h under the cascading effect of non-aeration (dissolved oxygen declined to 2.0 mg L−1), when exposed to K. mikimotoi FJ-strain at the above density. Thus, apart from the microalgal toxicity, DO depletion exacerbated the mortality of abalone in the experiment. The massive abalone mortalities in Fujian were probably caused by the combination of microalgal toxic effects and oxygen depletion, leading to immunological depression and histopathological disruption.
Genes involved in melanin production directly impact insect pigmentation and can affect diverse physiology and behaviours. The role these genes have on sex behaviour, however, is unclear. In the present study, the crucial melanin pigment gene black was functionally characterised in an urban pest, the German cockroach, Blattella germanica. RNAi knockdown of B. germanica black (Bgblack) had no effect on survival, but did result in black pigmentation of the thoraxes, abdomens, heads, wings, legs, antennae, and cerci due to cuticular accumulation of melanin. Sex-specific variation in the pigmentation pattern was apparent, with females exhibiting darker coloration on the abdomen and thorax than males. Bgblack knockdown also resulted in wing deformation and negatively impacted the contact sex pheromone-based courtship behaviour of males. This study provides evidence for black function in multiple aspects of B. germanica biology and opens new avenues of exploration for novel pest control strategies.
Binary nanodroplet collisions have received increasing attention, whilst the identification of collision outcomes and the viscous dissipation mechanism have remained poorly understood. Using molecular dynamics simulations, this study investigates binary nanodroplet collisions over wide ranges of Weber number (We), Ohnesorge number (Oh) and off-centre distances. Coalescence, stretching separation and shattering are identified; however, bouncing, reflexive separation and rotational separation reported for millimetre-sized collisions are not observed, which is attributed to the enhanced viscous effect caused by the ‘natural’ high-viscosity characteristics of nanodroplets. Intriguingly, as an intermediate outcome, holes form in retracting films at relatively high We, arising from the vibration and thermal fluctuation of the films. Due to the combined effects of inertial, capillary and viscous forces, binary nanodroplet collisions fall into the cross-over regime, so estimating viscous dissipation becomes extremely important for distinguishing outcome boundaries. Based on the criterion that stretching separation is triggered only when the residual off-centre kinetic energy exceeds the surface energy required for separation, the boundary equation between coalescence and stretching separation is established. Here, viscous dissipation is calculated by the extracted flow feature from simulations, showing that the ratio of viscous dissipation to the initial kinetic energy depends only on Oh, not on We. Because of complex viscous dissipation mechanisms, the same boundary equation in the cross-over regime has also not been satisfactorily revealed for macroscale collisions. Therefore, the proposed equation is tested for wide data sources from both macroscale and nanoscale collisions, and satisfying agreement is achieved, demonstrating the universality of the equation.
In order to establish a compact all-optical Thomson scattering source, experimental studies were conducted on the 45 TW Ti: sapphire laser facility. By including a steel wafer, mixed gas, and plasma mirror into a double-exit jet, several mechanisms, such as shock-assisted ionization injection, ionization injection, and driving laser reflection, were integrated into one source. So, the source of complexity was remarkably reduced. Electron bunches with central energy fluctuating from 90 to 160 MeV can be produced. Plasma mirrors were used to reflect the driving laser. The scattering of the reflected laser on the electron bunches led to the generation of X-ray photons. Through comparing the X-ray spots under different experimental conditions, it is confirmed that the X-ray photons are generated by Thomson scattering. For further application, the energy spectra and source size of the Thomson scattering source were measured. The unfolded spectrum contains a large amount of low-energy photons besides a peak near 67 keV. Through importing the electron energy spectrum into the Monte Carlo simulation code, the different contributions of the photons with small and large emitting angles can be used to explain the origin of the unfolded spectrum. The maximum photon energy extended to about 500 keV. The total photon production was 107/pulse. The FWHM source size was about 12 μm.
Fast neutron absorption spectroscopy is widely used in the study of nuclear structure and element analysis. However, due to the traditional neutron source pulse duration being of the order of nanoseconds, it is difficult to obtain a high-resolution absorption spectrum. Thus, we present a method of ultrahigh energy-resolution absorption spectroscopy via a high repetition rate, picosecond duration pulsed neutron source driven by a terawatt laser. The technology of single neutron count is used, which results in easily distinguishing the width of approximately 20 keV at 2 MeV and an asymmetric shape of the neutron absorption peak. The absorption spectroscopy based on a laser neutron source has one order of magnitude higher energy-resolution power than the state-of-the-art traditional neutron sources, which could be of benefit for precisely measuring nuclear structure data.
All-fiber coherent beam combiners based on the self-imaging effect can achieve a near-perfect single laser beam, which can provide a promising way to overcome the power limitation of a single-fiber laser. One of the key points is combining efficiency, which is determined by various mismatches during fabrication. A theoretical model has been built, and the mismatch error is analyzed numerically for the first time. The mismatch errors have been numerically studied with the beam quality and combining efficiency being chosen as the evaluation criteria. The tolerance of each mismatch error for causing 1% loss is calculated to guide the design of the beam combiners. The simulation results are consistent with the experimental results, which show that the mismatch error of the square-core fiber is the main cause of the efficiency loss. The results can provide useful guidance for the fabrication of all-fiber coherent beam combiners.
In this paper, we design and fabricate dual-tunable waveguides in a two-dimensional periodic plate with threaded holes. Dual tunability is realized by using rods held with nuts as well as assembly prestress of the nuts. A straight waveguide, a bent waveguide, and a wave splitter are designed by changing the distribution of rods and nuts in different circuits. The experimental and numerical results show that the frequencies of guided waves can be tuned by the assembly prestress. By increasing the amount of prestress, the frequency range of the passing band can be shifted upward. Confinements, guiding, and splitting of Lamb waves are clearly observed in both experimental measurements and numerical simulations. This work is essential for the practical design of reconfigurable phononic devices.
An example of a nonfinitely based involution monoid of order five has recently been discovered. We confirm that this example is, up to isomorphism, the unique smallest among all involution monoids.