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Pregnancy is a complex biological process. The establishment and maintenance of foetal–maternal interface are pivotal events. Decidual immune cells and inflammatory cytokines play indispensable roles in the foetal–maternal interface. The disfunction of decidual immune cells leads to adverse pregnancy outcome. Tumour necrosis factor (TNF)-α, a common inflammatory cytokine, has critical roles in different stages of normal pregnancy process. However, the relationship between the disorder of TNF-α and adverse pregnancy outcomes, including preeclampsia (PE), intrauterine growth restriction (IUGR), spontaneous abortion (SA), preterm birth and so on, is still indefinite. In this review, we thoroughly reviewed the effect of TNF-α disorder on pathological conditions. Moreover, we summarized the reports about the adverse pregnancy outcomes (PE, IUGR, SA and preterm birth) of using anti-TNF-α drugs (infliximab, etanercept and adalimumab, certolizumab and golimumab) currently in the clinical studies. Overall, IUGR, SA and preterm birth are the most common adverse pregnancy outcomes of anti-TNF-α drugs. Our review may provide insight for the immunological treatment of pregnancy-related complication, and help practitioners make informed decisions based on the current evidences.
The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally.
This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group.
1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001].
The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.
We performed U–Pb dating of detrital zircons and conducted petrological and whole-rock geochemical analyses to assess the provenance of the Upper Triassic – Lower Jurassic clastic rocks in the southeastern margin of the South China Block. Detrital zircon U–Pb ages are mainly classified into age groups of 2000–1700, 900–700, 490–390 and 280–210 Ma, consistent with derivation from the Jiangnan orogenic belt, Nanling Belt, as well as Wuyi and Yunkai domains. Lower Jurassic samples yield a special main age population of 200–190 Ma, and these detrital zircon grains have low Th/U and Nb/Hf ratios and high Th/Nb and Hf/Th ratios, showing they are derived from a continental magmatic arc. However, the cross-correlation and likeness coefficients of kernel density estimates of Upper Triassic and Lower Jurassic sandstones are 0.8608 and 0.8403, indicating that their populations are highly similar. Since the tectonic setting is the key factor in controlling the relationship between source and sink, the stable supply of identical provenance suggests that the tectonic setting did not significantly change during Late Triassic – Early Jurassic time. Sandstone petrography, regional facies distribution and the detrital zircon age patterns all reflect a consistent tectonic setting for the South China Block during Late Triassic – Early Jurassic time. The Palaeo-Pacific subduction therefore did not control the tectonic evolution of the South China Block until after the Early Jurassic Epoch.
Older patients with dementia and/or delirium often have challenging behaviours such as refusal of care and aggression. These cause much distress to both healthcare staff and patients, increase burden of care and put older patients at risk of functional decline. Humanitude, a methodology of care developed by Gineste and Marescotti, is a relationship- centred and compassionate care approach that aims to enable patients. The aim of this study is to investigate the effectiveness of Humanitude on older patients’ well-being, mobility and activities of daily living (ADLs).
Twenty patients diagnosed with dementia and/ or delirium were recruited from two geriatric wards. Ten were in the Humanitude ward and the other ten in a conventional ward received usual care for older patients served as concurrent controls.
Patients in Humanitude ward received Humanitude care by trained healthcare workers during day-to-day care, which is based on the 4 pillars of gaze, speech, touch and verticality (maintaining an upright position). Every patient encounter utilizing Humanitude techniques follow a structured care sequence that helps draw the patient into the care relationship.
The outcome measures include Modified Perme ICU Mobility Score, Bradford Well- being Profile and Modified Barthel Index (MBI).
There was significant improvement of median score within the Humanitude group from admission to discharge in mobility (admission: 9.0 [0-27] vs discharge 19.5 [1-36], p=0.002**), MBI (admission: 20 [0.0-46] vs discharge: 54.3 [3-81], p = 0.002**) and well-being (admission: 7.0 [1-15] vs discharge 20.0 [8-26], p=0.002**). The median increase in the score of Humanitude group was also significantly higher than usual care group in mobility (Humanitude: 8 [1-24] vs usual care 0 [-9-16], p= 0.02*), MBI (Humanitude: 17.5 [3-64] vs usual care 0 [-3-17], p= <0.001***), and well-being (Humanitude: 11 [6-20] vs usual care 0 [-5-4], p= <0.001 ***).
Humanitude care improves outcomes in mobility, ADL function and well-being for patients with dementia and/ or delirium in the acute hospital.
Sarcopenia is a core contributor to several health consequences, including falls, fractures, physical limitations and disability. The pathophysiological processes of sarcopenia may be counteracted with the proper diet, delaying sarcopenia onset. Dietary pattern analysis is a whole diet approach used to investigate the relationship between diet and sarcopenia. Here, we aimed to investigate this relationship in an elderly Chinese population. A cross-sectional study with 2423 participants aged more than 60 years was performed. Sarcopenia was defined based on the guidelines of the Asian Working Group for Sarcopenia, composed of low muscle mass plus low grip strength and/or low gait speed. Dietary data were collected using a FFQ that included questions on 100 food items along with their specified serving sizes. Three dietary patterns were derived by factor analysis: sweet pattern, vegetable pattern and animal food pattern. The prevalence of sarcopenia was 16·1 %. The higher vegetable pattern score and animal food pattern score were related to lower prevalence of sarcopenia (Ptrend = 0·006 and < 0·001, respectively); the multivariate-adjusted OR of the prevalence of sarcopenia in the highest v. lowest quartiles were 0·54 (95 % CI 0·34, 0·86) and 0·50 (95 % CI 0·33, 0·74), separately. The sweet pattern score was not significantly related to the prevalence of sarcopenia. The present study showed that vegetable pattern and animal food pattern were related to a lower prevalence of sarcopenia in Chinese older adults. Further studies are required to clarify these findings.
Automatic generation of high-quality meshes is a base of CAD/CAE systems. The element extraction is a major mesh generation method for its capabilities to generate high-quality meshes around the domain boundary and to control local mesh densities. However, its widespread applications have been inhibited by the difficulties in generating satisfactory meshes in the interior of a domain or even in generating a complete mesh. The element extraction method's primary challenge is to define element extraction rules for achieving high-quality meshes in both the boundary and the interior of a geometric domain with complex shapes. This paper presents a self-learning element extraction system, FreeMesh-S, that can automatically acquire robust and high-quality element extraction rules. Two central components enable the FreeMesh-S: (1) three primitive structures of element extraction rules, which are constructed according to boundary patterns of any geometric boundary shapes; (2) a novel self-learning schema, which is used to automatically define and refine the relationships between the parameters included in the element extraction rules, by combining an Advantage Actor-Critic (A2C) reinforcement learning network and a Feedforward Neural Network (FNN). The A2C network learns the mesh generation process through random mesh element extraction actions using element quality as a reward signal and produces high-quality elements over time. The FNN takes the mesh generated from the A2C as samples to train itself for the fast generation of high-quality elements. FreeMesh-S is demonstrated by its application to two-dimensional quad mesh generation. The meshing performance of FreeMesh-S is compared with three existing popular approaches on ten pre-defined domain boundaries. The experimental results show that even with much less domain knowledge required to develop the algorithm, FreeMesh-S outperforms those three approaches in essential indices. FreeMesh-S significantly reduces the time and expertise needed to create high-quality mesh generation algorithms.
Poor utilisation efficiency of carbohydrate always leads to metabolic phenotypes in fish. The intestinal microbiota plays an important role in carbohydrate degradation. Whether the intestinal bacteria could alleviate high-carbohydrate diet (HCD)-induced metabolic phenotypes in fish remains unknown. Here, a strain affiliated to Bacillus amyloliquefaciens was isolated from the intestine of Nile tilapia. A basal diet (CON), HCD or HCD supplemented with B. amy SS1 (HCB) was used to feed fish for 10 weeks. The beneficial effects of B. amy SS1 on weight gain and protein accumulation were observed. Fasting glucose and lipid deposition were decreased in the HCB group compared with the HCD group. High-throughput sequencing showed that the abundance of acetate-producing bacteria was increased in the HCB group relative to the HCD group. Gas chromatographic analysis indicated that the concentration of intestinal acetate was increased dramatically in the HCB group compared with that in the HCD group. Glucagon-like peptide-1 was also increased in the intestine and serum of the HCB group. Thus, fish were fed with HCD, HCD supplemented with sodium acetate at 900 mg/kg (HLA), 1800 mg/kg (HMA) or 3600 mg/kg (HHA) diet for 8 weeks, and the HMA and HHA groups mirrored the effects of B. amy SS1. This study revealed that B. amy SS1 could alleviate the metabolic phenotypes caused by HCD by enriching acetate-producing bacteria in fish intestines. Regulating the intestinal microbiota and their metabolites might represent a powerful strategy for fish nutrition modulation and health maintenance in future.
Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity.
Eight databases were searched from inception till 30 May 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random effects model. Overall effect was evaluated using Hedges’ g, and heterogeneity was assessed using Cochran’s Q and I2.
Cluster randomised controlled trials (cluster-RCT) delivered in school.
Children and adolescents (6–18 years of age) with overweight and obesity.
Twelve cluster-RCT from seven countries with 1755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced BMI and BMI z-scores with a medium effect (g = 0·52). Subgroup analyses showed greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41·2 % of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency.
School-based interventions are a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCT with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).
The North Qilian orogenic belt in North China has been defined as a subduction–collision zone between the Alxa Block and the Qilian Block. We present petrography, zircon U–Pb geochronology, major- and trace-element geochemistry, and Sr–Nd–Pb–Hf isotope analysis for the Yushigou diabase from the Longshoushan area, which is located SW of the Alxa Block, aiming to understand its petrogenetic link to subduction processes. The Yushigou diabase belongs to the tholeiite series, and shows enrichment in light rare earth and large-ion lithophile elements, and a depletion in heavy rare earth and high-field-strength elements. Laser ablation – inductively coupled plasma – mass spectrometry U–Pb zircon dating yielded an emplacement age of 414 ± 9 Ma, with an ϵHf(t) value in the range of −10.3 to 1.8. The whole-rock initial 206Pb/204Pb, 207Pb/204Pb and 208Pb/204Pb ratios of the diabase range over 16.811–17.157, 15.331–15.422 and 37.768–37.895, respectively. The (87Sr/86Sr)i ratios vary between 0.7086 and 0.7106, and ϵNd(t) values vary between −14.4 and −13.4, which are significantly higher than the ϵHf(t) value (Nd–Hf decoupling). An interpretation of the elemental and isotopic data suggests that the Yushigou diabase was derived from partial melting of an enriched mantle I (EM-I) -type lithospheric mantle in the spinel–garnet transitional zone. Based on the geochemical features and previous regional geological data, we propose that the Silurian magmatism was most likely triggered by slab break-off after the closure of the North Qilian Ocean, and ancient continental materials from the subduction slab metasomatized the overlying lithospheric mantle during exhumation.
A gravity-driven water film falling down an ice sheet is considered within the framework of a long-wave approximation. The integral-boundary-layer method, modified with the account of the phase transition, is adopted to describe the evolution of both the free surface of a water film and the interface between the ice and water. A set of governing equations consisting of five coupled nonlinear partial differential equations is established. The linear instability analysis of the uniform base flow is performed, and the result is in good agreement with the Orr–Sommerfeld analysis of the linearized Navier–Stokes equations. The phase transition at the interface between the ice and water plays a role in stabilizing the system linearly with long-wavelength perturbations. The nonlinear solutions of the steady travelling waves are constructed numerically. The phase transition tends to suppress the dispersion of the interfacial wave. Comparisons to direct numerical simulation of the Navier–Stokes equations, which are performed with an extended marker and cell method, show a remarkable agreement. The integral-boundary-layer method captures the water film thickness and the topography of the ice sheet satisfactorily. The phase transition is observed to enhance the backflow phenomenon in the capillary region of the solitary-like interfacial wave.
This study aims to ascertain the long-term epidemic trends of malaria and evaluates the probability of achieving the eradication goal by 2020 in China. Data on malaria incidence and deaths were extracted from the China Information System for Disease Control and Prevention. The epidemic trends by sex, age and spatial distribution and predictions of malaria were estimated by using Joinpoint and Poisson regressions. From 1950 to 2016, 227 668 374 malaria cases were reported in China, with an annualised average incidence of 337.02 (336.98–337.07, 95% confidence interval (CI)) per 100 000 population. The incidence decreased with an average annual per cent change (AAPC) of −11.4% (−16.6 to −6.0). There were 36 085 malaria deaths, with an annualised average mortality of 0.534 (0.529–0.540) per 1 000 000 population. The mortality decreased with an AAPC of −8.7% (−13.7 to −3.4). The predicted number of malaria cases and deaths for 2020 is 2 562 and 10, respectively, and zero for indigenous cases. The disease burden of malaria dramatically decreased in China. Though, the goal of malaria elimination is realistic by 2020 in China, routine clinical and entomological surveillance should be continually conducted, especially for the cross-border areas and imported malaria cases.
Because of its unique mechanical, chemical, and biological properties, 3D-printed polyether ether ketone (PEEK) has great potential as customized bone replacement and other metal alloy implant replacement. PEEK samples were printed using fused deposition modeling (FDM) and evaluated in terms of their dimensional accuracy, crystallinity, and mechanical properties. Crystallinity and mechanical properties increased with elevated chamber temperature and post-printing annealing. Variations of material properties from three printers are evident. Many factors affect the quality of 3D-printed PEEK. Future FDA regulations for 3D-printed products are needed for this highly customizable manufacturing process to ensure safety and effectiveness for biomedical applications.
We use ultrafast coherent two-dimensional electronic spectroscopy (2DES) to study the ultrafast spectral diffusion dynamics of colloidal CdSe quantum dots (QDs) and CdSe nanoplatelets (NPLs). The Center Line Slope (CLS) and Nodal Line Slope (NLS) techniques were employed to analyse the 2DES spectra. We show that no spectral diffusion dynamics occurs for the CdSe QDs. On the other hand, spectral diffusion was observed in the CdSe 5 mono-layers NPLs heavy-hole transition. The normalized Frequency Fluctuation Correlation Function (FFCF) of the CdSe NPLs heavy-hole transition was measured to have a major fast decay component at 140 fs.
Since the late 1990s, hand, foot and mouth disease (HFMD) has become a common health problem that mostly affects children and infants in Southeast and East Asia. Global climate change is considered to be one of the major risk factors for HFMD. This study aimed to assess the correlation between meteorological factors and HFMD in the Asia-Pacific region. PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data and Weipu Database were searched to identify relevant articles published before May 2018. Data were collected and analysed using R software. We searched 2397 articles and identified 51 eligible papers in this study. The present study included eight meteorological factors; mean temperature, mean highest temperature, mean lowest temperature, rainfall, relative humidity and hours of sunshine were positively correlated with HFMD, with correlation coefficients (CORs) of 0.52 (95% confidence interval (CI) 0.42–0.60), 0.43 (95% CI 0.23–0.59), 0.43 (95% CI 0.23–0.60), 0.27 (95% CI 0.19–0.35), 0.19 (95% CI 0.02–0.35) and 0.19 (95% CI 0.11–0.27), respectively. There were sufficient data to support a negative correlation between mean pressure and HFMD (COR = −0.51, 95% CI −0.63 to −0.36). There was no notable correlation with wind speed (COR = 0.10, 95% CI −0.03 to 0.23). Our findings suggest that meteorological factors affect the incidence of HFMD to a certain extent.
The magnetism and microstructure of Cr25Ni35Nb and Cr35Ni45Nb alloy tubes after 5 years of service were investigated in this paper. The saturation magnetization of the Cr25Ni35Nb alloy tube in the thickness direction is more than 20 emu/g, and the tube becomes ferromagnetic. The inner and outer walls of Cr35Ni45Nb alloy tubes also become ferromagnetic. But the saturation magnetization of the Cr35Ni45Nb alloy tubes approaches to zero in the center zone. The primary carbides M7C3 and NbC are changed into M23C6 and G phase at the outer region of the furnace tube. However, the M23C6-type carbides were replaced by carbon-rich carbides M7C3 at the carburization zone. Cr-depleted zones are formed at the inner and outer walls of the furnace tubes owing to oxidation. Carburization and oxidation reduce the Cr content of the matrix. Accordingly, the saturation magnetization is very high at the carburization zone and Cr-depleted zone. The magnetism of Cr25Ni35Nb and Cr35Ni45Nb alloy tubes has a high correlation with the Cr content of the matrix. Carburization and oxidation are the main reasons that make the paramagnetic ethylene pyrolysis furnace tube change to ferromagnetic.
A coaxial-output rolled strip pulse-forming line (RSPFL) with a dry structure is researched for the purpose of miniaturization and all-solid state of pulse-forming lines (PFL). The coaxial-output RSPFL consists of a coaxial-output electrode (COE) and a rolled strip line (RSL). The COE is characterized by quasi-coaxial structure, making the output pulse propagate along the axial direction with a small output inductance. The RSL is rolled on the COE, whose transmission characteristics are analyzed theoretically. It shows that the RSL can be regarded as a planar strip line when the rolling radius of the strip line is larger than 60 times of the thickness of the insulation dielectric layer of RSL. CST modeling was carried out to simulate the discharging characteristic of the coaxial-output RSPFL. It shows that the coaxial-output RSPFL can deliver a discharging pulse with a rise time <6 ns when the impedance of the RSL matches that of the COE, which confirms the theoretical analysis. A prototype of the coaxial-output RSPFL was developed. A 49-kV discharging pulse on a matched load was achieved when it was charged to 100 kV. The discharging waveform has a pulse width of 32 ns, with a rise time of 6 ns, which is consistent with the simulation waveform. An energy-storage density of 1.9 J/L was realized in the coaxial-output RSPFL. By the method of multi-stage connection in series, a much higher output voltage is convenient to be obtained.
Health system reform is considered a tough issue worldwide. Great efforts have been made toward health system building and strengthening. However, it is still unclear which health system is appropriate for different countries. This study aimed to systematically compare the characteristics of the establishment periods between eighty-eight counties of National Health Service (NHS) and Social Health Insurance (SHI).
Forty-eight NHS countries and forty SHI countries with data availability were selected. The establishment years of current health systems and other eighteen indicators in economics, society, population and health during establishment periods were collected. Comparison between NHS and SHI was conducted by descriptive analysis of every indicator.
Most NHS countries were established during the cold war, while SHI had been set up since the cold war ended. The median of gross domestic product (GDP) per capita, urbanization rate and aging rate of SHI were USD 1535 in current dollars, 58.2 percent and 9.8 percent, respectively; compared with USD 1387, 41.2 percent and 4.7 percent, respectively of NHS. NHS countries had a smaller total population, lower mortality rate and elderly dependency ratio, while the birth rate and children's dependency ratio were higher. SHI countries showed a higher life expectancy and lower mortality rate in infants and children. NHS countries spent less in total health expenditure and a lower proportion of GDP. The median health expenditure per capita of SHI and NHS were USD 188 and USD 131 in current dollars, respectively. There was little difference among maternal mortality rates, and public and private health expenditure proportions.
NHS and SHI countries had different characteristics during the health system establishment periods. NHS was established earlier than SHI overall, so that SHI revealed higher levels in economic and social development. Health outcomes of NHS countries were slightly lower than SHI ones, while health expenditure was more in SHI countries. Specific social, economic, demographic and health conditions should be considered when countries are building their own health systems.
A novel scheme for power-combined frequency tripler adopting 2N diodes is proposed in this work. Even mode coupled suspended substrate stripline is used to divide and recombine the input and output power. The circuits of the tripler are printed on both sides of the substrate, with N diodes on the front side and the other N diodes on the back side. The front diodes and back diodes are in anti-parallel connection, and DC biased separately to increase the bandwidth and power capacity. Three Q-band prototypes with two, four, and six diodes are fabricated and tested. The output compression powers at output frequency of 43.5 GHz for two/four/six-diode tripler are 9.2, 11, and 12 dBm, respectively. Power capacity is improved with the proposed tripler. Optimum DC bias is also discussed in this work, and it is found that it first increases with drive power, and then drops when large drive power applied because of the increased series resistance of the diode due to high junction temperature.
A theoretical model is developed to predict the maximum spreading of liquid metal drops when impacting onto dry surfaces under the influence of a vertical magnetic field. This model, which is constructed based on the energy conversion principle, agrees very well with the numerical results, covering a wide range of impact speeds, contact angles and magnetic strengths. When there is no magnetic field, we found that the maximum spreading factor can be predicted well by an interpolating scheme between the viscous and capillary effects, as proposed by Laan et al. (Phys. Rev. Appl., vol. 2 (4), 2014, 044018). However, when gradually increasing the magnetic field strength, the induced Lorentz forces are dominant over the viscous and capillary forces, taking the spreading behaviour into the ‘Joule regime’, where the Joule dissipation is significant. For most situations of practical interest, namely when the strength of the magnetic field is less than 3 T, all three energy conversion routes are important. Therefore, we determine the correct scaling behaviours for the magnetic influence by first equating the loss of kinetic energy to the Joule dissipation in the Joule regime, then by interpolating it with the viscous dissipation and the capillary effects, which allows for a universal rescaling. By plotting the numerical results against the theoretical model, all the results can be rescaled onto a single curve regardless of the materials of the liquid metals or the contact angles of the surfaces, proving that our theoretical model is correct in predicting the maximum spreading factor by constructing a balanced formula between kinetic energy, capillary energy, viscous dissipation energy and Joule dissipation energy.