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Lower limb exoskeletons (LLEs) have demonstrated their potential in delivering quantified repetitive gait training for individuals afflicted with gait impairments. A critical concern in robotic gait training pertains to fostering active patient engagement, and a viable solution entails harnessing the patient’s intrinsic effort to govern the control of LLEs. To address these challenges, this study presents an innovative online gait learning approach with an appropriate control strategy for rehabilitation exoskeletons based on dynamic movement primitives (DMP) and an Assist-As-Needed (AAN) control strategy, denoted as DMP-AAN. Specifically tailored for post-stroke patients, this approach aims to acquire the gait trajectory from the unaffected leg and subsequently generate the reference gait trajectory for the affected leg, leveraging the acquired model and the patient’s personal exertion. Compared to conventional AAN methodologies, the proposed DMP-AAN approach exhibits adaptability to diverse scenarios encompassing varying gait patterns. Experimental validation has been performed using the lower limb rehabilitation exoskeleton HemiGo. The findings highlight the ability to generate suitable control efforts for LLEs with reduced human-robot interactive force, thereby enabling highly patient-controlled gait training sessions to be achieved.
The ability to imitate speech is linked to individual cognitive abilities such as working memory and the auditory processing of music. However, little research has focused on the role of specific components of musical perception aptitude in relation to an individual’s native language from a crosslinguistic perspective. This study explores the predictive role of four components of musical perception skills and working memory on phonetic language abilities for speakers of two typologically different languages, Catalan (an intonation language) and Chinese (a tone language). Sixty-one Catalan and 144 Chinese participants completed four subtests (accent, melody, pitch and rhythm) of the Profile of Music Perception Skills, a forward digit span task and a speech imitation task. The results showed that for both groups of participants, musical perception skills predicted speech imitation accuracy but working memory did not. Importantly, among the components of musical perception skills, accent was the only predictive factor for Chinese speakers, whereas melody was the only predictive factor for Catalan speakers. These findings suggest that speech imitation ability is predicted by musical perception skills rather than working memory and that the predictive role of specific musical components may depend on the phonological properties of the native language.
Hong Kong experienced four epidemic waves caused by the ancestral strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020–2021 and a large Omicron wave in 2022. Few studies have assessed antibacterial prescribing for coronavirus disease 2019 (COVID-19) inpatients throughout the pandemic.
To describe inpatient antibacterial prescribing and explore factors associated with their prescription.
Electronic health records of patients with COVID-19 admitted to public hospitals in Hong Kong from 21 January 2020 to 30 September 2022 were used to assess the prevalence and rates of inpatient antibacterial drug use (days of therapy/1,000 patient days [DOT/1,000 PD]). We used multivariable logistic regression to investigate potential associations between patients’ baseline characteristics and disease severity and prescription of an antibacterial drug during hospital admission.
Among 65,810 inpatients with COVID-19, 54.0% were prescribed antibacterial drugs (550.5 DOT/1,000 PD). Compared to waves 1–2 (46.7%; 246.9 DOT/1,000 PD), the prescriptions were lowest during wave 4 (28.0%; 246.9; odds ratio (OR): 0.39, 95% CI: 0.31–0.49) and peaked in early wave 5 (64.6%; 661.2; 0.82, 0.65–1.03). Older age (≥80 years: OR 2.66, 95% CI, 2.49–2.85; 60–79 years: 1.59, 1.51–1.69, compared with 20–59 years), more severe disease (fatal: 3.64, 3.2–4.16; critical: 2.56, 2.14–3.06, compared with severe), and COVID-19 vaccine doses (two doses: 0.74, 0.69–0.78; three doses: 0.69, 0.64–0.74; four doses: 0.52, 0.44–0.62, compared with unvaccinated) were associated with inpatient antibacterial drug use.
Antibacterial prescribing changed over time for hospitalized patients with confirmed COVID-19 and was potentially related to patients’ demographics, medical conditions, and COVID-19 vaccination status as well as healthcare capacity during epidemic waves.
This study presents a comprehensive analysis on the extreme positive and negative events of wall shear stress and heat flux fluctuations in compressible turbulent boundary layers (TBLs) solved by direct numerical simulations. To examine the compressibility effects, we focus on the extreme events in two representative cases, i.e. a supersonic TBL of Mach number $M=2$ and a hypersonic TBL of $M=8$, by scrutinizing the coherent structures and their correlated dynamics based on conditional analysis. As characterized by the spatial distribution of wall shear stress and heat flux, the extreme events are indicated to be closely related to the structural organization of wall streaks, in addition to the occurrence of the alternating positive and negative structures (APNSs) in the hypersonic TBL. These two types of coherent structures are strikingly different, namely the nature of wall streaks and APNSs are shown to be related to the solenoidal and dilatational fluid motions, respectively. Quantitative analysis using a volumetric conditional average is performed to identify and extract the coherent structures that directly account for the extreme events. It is found that in the supersonic TBL, the essential ingredients of the conditional field are hairpin-like vortices, whose combinations can induce wall streaks, whereas in the hypersonic TBL, the essential ingredients become hairpin-like vortices as well as near-wall APNSs. To quantify the momentum and energy transport mechanisms underlying the extreme events, we proposed a novel decomposition method for extreme skin friction and heat flux, based on the integral identities of conditionally averaged governing equations. Taking advantage of this decomposition method, the dominant transport mechanisms of the hairpin-like vortices and APNSs are revealed. Specifically, the momentum and energy transports undertaken by the hairpin-like vortices are attributed to multiple comparable mechanisms, whereas those by the APNSs are convection dominated. In that, the dominant transport mechanisms in extreme events between the supersonic and hypersonic TBLs are indicated to be totally different.
Physical and/or chemical changes such as refinement, component dissolution, exchange/adsorption, structural evolution and recombination of phyllosilicate minerals occur continuously in a naturally weakly acidic water environment. To compare the differential dissolution of cations that occupy various sites in vermiculite, trioctahedral vermiculite was dissolved in various concentrations of oxalate for 24 h and in 0.2 M oxalate for various durations. The concentration of ions in the leaching solution and the phase, structure and morphology of the original samples and acid-leached samples were analysed. Structural analysis showed that the 001 reflections of vermiculite gradually shifted to a higher angle and eventually disappeared after the dissolution of interlayer cations caused by acid leaching. The amount and rate of dissolution of each cation in the vermiculite showed that the octahedral cation Mg2+ is more soluble than Fe2+ and Fe3+. The dissolution rates of Al3+, Mg2+ and Ca2+ were greatest in the first 4 h and then decreased gradually. Amorphous silicon dioxide and calcium oxalate were formed during acid leaching, and calcium oxalate was formed in the first 4 h. After leaching with oxalate for various periods, the cation-exchange capacity (CEC) of the samples first increased and then decreased. Micromorphology analysis showed that the acid erosion process started from the edges. The results of this work contribute to our understanding of many natural geochemical processes, and they will be useful for several applications such as soil improvement, ecological restoration and environmental protection.
Inflammation plays a critical role in the progression of chronic liver diseases, and diet can modulate inflammation. Whether an inflammatory dietary pattern is associated with higher risk of hepatic steatosis or fibrosis remains unclear. We aimed to investigate the associations between inflammatory dietary pattern and the odds of hepatic steatosis and fibrosis.
In this nationwide cross-sectional study, diet was measured using two 24-h dietary recalls. Empirical dietary inflammatory pattern (EDIP) score was derived to assess the inflammatory potential of usual diet, which has been validated to highly predict inflammation markers in the study population. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were derived from FibroScan to define steatosis and fibrosis, respectively.
US National Health and Nutrition Examination Survey.
4171 participants aged ≥18 years.
A total of 1436 participants were diagnosed with S1 steatosis (CAP ≥ 274 dB/m), 255 with advanced fibrosis (LSM ≥ 9·7 kPa). Compared with those in the lowest tertile of EDIP-adherence scores, participants in the highest tertile had 74 % higher odds of steatosis (OR: 1·74, 95 % CI (1·26, 2·41)). Such positive association persisted among never drinkers, or participants who were free of hepatitis B and/or C. Similarly, EDIP was positively associated with CAP in multivariate linear model (P < 0·001). We found a non-significant association of EDIP score with advanced fibrosis or LSM (P = 0·837).
Our findings suggest that a diet score that is associated with inflammatory markers is associated with hepatic steatosis. Reducing or avoiding pro-inflammatory diets intake might be an attractive strategy for fatty liver disease prevention.
In order to solve the problems of low loading capacity and low driving efficiency for the powered exoskeleton, this paper presents a bionic multi-chamber pneumatic actuator based on muscle scale mechanism. Firstly, the bionic muscle scale mechanism and multi-chamber structure design for the novel pneumatic actuator are introduced. Afterward, the driving characteristics of the multi-chamber actuator are analyzed theoretically, including analysis of output force and analysis of energy efficiency. Then, the load matching control strategy for the novel actuator is optimized, and the load matching performance, displacement tracking accuracy, and energy efficiency are studied by simulation. Finally, the prototype of the multi-chamber actuator is developed, and the exoskeleton testing platform is built, experiment and discussion are conducted for the driving characteristics, which realized the high energy efficiency and the feasibility of load matching.
While previous research has identified the performance implications of leaders’ positive implicit followership theories (IFTs, i.e., personal expectations regarding followers’ positive characteristics), this study focuses on the effect of leader–follower congruence in positive IFTs on followers’ job performance. To test our predictions, we conducted two complementary studies. The results of Study 1 (an experiment, N = 200) show that leader–follower congruence (versus incongruence) in positive IFTs is positively related to followers’ relational identification with the leader, which, in turn, is positively related to followers’ job performance. Moreover, followers’ uncertainty avoidance strengthens this relationship. These findings were replicated in Study 2 (a three-wave survey, N = 223) through polynomial regression and response surface analysis. This study improves our understanding of IFTs by showing that leader–follower congruence in this domain is related to followers’ outcomes.
Despite observed ethnic differences in eating patterns and obesity, evidence in China is limited. This study examined ethnic differences in eating patterns and their associations with weight outcomes among multi-ethnic adults in West China. A cross-sectional survey collected self-reported data on demographics, eating behaviours, weight and height in 2021. Principal component analysis and multivariate regression were conducted to identify eating patterns and examine their associations with weight outcomes. In total, 4407 subjects aged ≥ 18 years were recruited across seven provinces in West China. Four eating patterns were identified: ‘meat-lover’ – characterised by frequent consumption of meat and dairy products, ‘indulgent’ – by frequent intakes of added salt, sugar, alcohol and pickled food, ‘diversified-eating’ – by frequently consuming food with diversified cooking methods and eating out and ‘nutri-health-concerned’ – by good food hygiene behaviours and reading food labels. Ethnic differences in eating patterns were observed. Compared with Han, Hui were less likely to exhibit meat-lover or diversified-eating patterns; Tibetans were less likely to have meat-lover or nutri-health-concerned patterns; Mongolians were more likely to have indulgent pattern. BMI was positively associated with meat-lover pattern in both genders (exp(β): 1·029; 95 % CI: 1·001, 1·058 for men; 1·018; 1·000, 1·036 for women) and negatively associated with nutri-health-concerned pattern in women (0·983; 0·966, 1·000). Mongolians were two times more likely to be overweight/obese than Han (OR: 3·126; 1·688, 5·790). Considerable ethnic differences existed in eating patterns in West China. Mongolians were more likely to be overweight/obese, which was associated with their indulgent eating patterns. Ethnic-specific healthy eating intervention programs are needed.
The interpretation and understanding of the relationship between Middle to Late Holocene climate change in monsoon margins of northwest China with the westerlies and Asian monsoon (AM) remain controversial. Here we present a new multi-proxy sedimentary dataset from the Heihe River basin in the middle part of the Hexi Corridor on the northern margin of the Qinghai-Tibet Plateau (QTP), which is a sensitive zone for the interaction between the westerlies and AM. Fluctuations in grain size, δ13Corg, δ18O, magnetic susceptibility, total organic carbon, total nitrogen, and C/N ratio document regional lake and climate evolution since 5334 cal yr BP. Results show that climate conditions on the millennial timescale are humid in the late Middle Holocene (MH) and dry to wet in the Late Holocene (LH). Combined with the multi-model ensemble simulation from PMIP3-CMIP5, high lake levels and wetter climate in the late MH are closely linked to the strengthening Asian summer monsoon. Simultaneously, the slight wetting trend since the late LH may be the superimposing effect of enhanced westerlies and the weakening Asian winter monsoon. These findings can provide insights into the interpretation of the interaction between the westerlies and AM during the Holocene in East Asia.
Path-following control of wheeled mobile robots has been a crucial research topic in robotic control theory and applications. In path-following control with obstacles, the path-following control and collision avoidance goals might be conflicting, making it challenging to obtain near-optimal solutions for path-following control and obstacle avoidance with low tracking error and input energy consumption. To address this problem, we propose a potential field-based dual heuristic programming (P-DHP) algorithm with an actor–critic (AC) structure for path-following control of mobile robots with obstacle avoidance. In the proposed P-DHP, the path-following control and collision avoidance problems are decoupled into two ones to resolve the control conflict. Firstly, a neural network-based AC is constructed to approximate the near-optimal path-following control policy in a no-obstacle environment. Then, with the trained path-following control policy fixed, a potential field-based control policy structure is constructed by another AC network to generate opposite control forces as the robot moves toward the obstacle, which can guarantee the robot’s control safety and reduce the tracking error and input energy consumption in obstacle avoidance. The simulated and experimental results show that P-DHP can realize near-optimal path-following control with the satisfaction of safety constraints and outperforms state-of-the-art approaches in control performance.
OBJECTIVES/GOALS: Determine if the Conserved Transcriptional Response to Adversity transcriptomic profile established in primary blood mononuclear cells (PBMC) of chronically stress caregivers, is present in individuals with early Alzheimer’s disease. Chronic stress is a risk factor for Alzheimer’s, and may be an untapped biomarker for disease risk and pathology. METHODS/STUDY POPULATION: To collect preliminary data on the Conserved Transcriptional Response to Adversity profile in individuals with Alzheimer’s disease, we were able to utilize primary blood mononuclear cell samples from a small open label pilot study called Senolytic Therapy to Modulate the Progression of Alzheimer’s Disease, designed to clear stressed senescent cells. We hypothesized senolytics may beneficially reverse this stress profile. We developed a NanoString assay (measuring 19 inflammatory, 31 type-1 interferon, and 3 antibody synthesis genes) to compare these transcriptomic changes within 4 individuals measured at baseline, post-treatment with an intermittent 12-week senolytic therapy, and at an optional extended post-treatment follow-up time point > 3 months after their post treatment visit. RESULTS/ANTICIPATED RESULTS: There was relative downregulation of expression in transcription in 7 of 19 measured inflammatory genes (FOS, PTGS2, IL8, FOS, Il1b, JUNB, and JUN) in Alzheimer’s disease participants after receiving senolytic treatment (baseline vs. post-treatment). This is consistent with a decrease in the inflammatory arm of the Conserved Transcriptional Response to Adversity profile. These differences were not significant between baseline and the extended follow-up, indicative of a transient effect of senolytic. There were no changes in type 1 interferon or antibody synthesis genes. This data provides preliminary evidence for larger controlled studies to further establish this profile in Alzheimer’s disease, providing exciting evidence for transcript changes that may be reproducible with senolytic therapy. DISCUSSION/SIGNIFICANCE: Literature relevant to Alzheimer’s disease indicates global increases in inflammation paired with deficits in immune response, capturing some genes associated with the Conserved Transcriptional Response to Adversity. This profile may be a useful biomarker for prediction of disease severity or risk of dementia due to chronic stress.
This study aimed to compare the pre- and post-operative vestibular and equilibrium functions of patients with cholesteatoma-induced labyrinthine fistulas who underwent different management methods.
Data from 49 patients with cholesteatoma-induced labyrinthine fistulas who underwent one of three surgical procedures were retrospectively analysed. The three management options were fistula repair, obliteration and canal occlusion.
Patients underwent fistula repair (n = 8), canal occlusion (n = 18) or obliteration procedures (n = 23). Patients in the fistula repair and canal occlusion groups suffered from post-operative vertigo and imbalance, which persisted for longer than in those in the obliteration group. Despite receiving different management strategies, all patients achieved complete recovery of equilibrium functions through persistent efforts in rehabilitation exercises.
Complete removal of the cholesteatoma matrix overlying the fistula is reliable for preventing iatrogenic hearing deterioration due to unremitting labyrinthitis. Thus, among the three fistula treatments, obliteration is the optimal method for preserving post-operative vestibular functions.
Breast milk leptin plays a potential role in preventing childhood obesity. However, the associations of breast milk leptin with maternal metabolism in pregnancy and dietary patterns during lactation are still unclear. We aimed to explore associations of breast milk leptin with maternal metabolic profiles in pregnancy and dietary patterns during lactation. A total of 332 participants were recruited for this retrospective cohort study. Breast milk samples were collected at approximately 6 weeks postpartum. Breast milk leptin and twenty-three metabolic profiles in pregnancy were measured in this study. A semi-quantitative FFQ was used to gather dietary information during lactation. Both principal component analysis and the diet balance index were used to derive dietary patterns. Among twenty-three maternal metabolic profiles, maternal serum glucose (β = 1·61, P = 0·009), γ-glutamyl transferase (β = 0·32, P = 0·047) and albumin (β = −2·96, P = 0·044) in pregnancy were correlated with breast milk leptin. All dietary patterns were associated with breast milk leptin. Given the joint effects of maternal metabolism in pregnancy and dietary patterns during lactation, only diet quality distance was significantly associated with leptin concentrations in breast milk (low level v. almost no diet problem: β = −0·46, P = 0·011; moderate/high level v. almost no diet problem: β = −0·43, P = 0·035). In conclusion, both maternal metabolism in pregnancy and dietary patterns during lactation were associated with breast milk leptin. Maternal diet balance during lactation was helpful to improve breast milk leptin concentration.
According to the public data collected from the Health Commission of Gansu Province, China, regarding the COVID-19 pandemic during the summer epidemic cycle in 2022, the epidemiological analysis showed that the pandemic spread stability and the symptom rate (the number of confirmed cases divided by the sum of the number of asymptomatic cases and the number of confirmed cases) of COVID-19 were different among 3 main epidemic regions, Lanzhou, Linxia, and Gannan; both the symptom rate and the daily instantaneous symptom rate (daily number of confirmed cases divided by the sum of daily number of asymptomatic cases and daily number of confirmed cases) in Lanzhou were substantially higher than those in Linxia and Gannan. The difference in the food sources due to the high difference of the population ethnic composition in the 3 regions was probably the main driver for the difference of the symptom rates among the 3 regions. This work provides potential values for prevention and control of COVID-19 in different regions.
Dynamic interpersonal therapy (DIT) is a brief, structured psychodynamic psychotherapy with demonstrated efficacy in treating major depressive disorder (MDD). The aim of the study was to determine whether DIT is an acceptable and efficacious treatment for MDD patients in China.
Patients were randomized to 16-week treatments with either DIT plus antidepressant medication (DIT + ADM; n = 66), general supportive therapy plus antidepressant medication (GST + ADM; n = 75) or antidepressant medication alone (ADM; n = 70). The Hamilton Depression Rating Scale (HAMD) administered by blind raters was the primary efficacy measure. Assessments were completed during the acute 16-week treatment and up to 12-month posttreatment.
The group × time interaction was significant for the primary outcome HAMD (F = 2.900, df1 = 10, df2 = 774.72, p = 0.001) in the acute treatment phase. Pairwise comparisons showed a benefit of DIT + ADM over ADM at weeks 12 [least-squares (LS) mean difference = −3.161, p = 0.007] and 16 (LS mean difference = −3.237, p = 0.004). Because of the unexpected high attrition during the posttreatment follow-up phase, analyses of follow-up data were considered exploratory. Differences between DIT + ADM and ADM remained significant at the 1-, 6-, and 12-month follow-up (ps range from 0.001 to 0.027). DIT + ADM had no advantage over GST + ADM during the acute treatment phase. However, at the 12-month follow-up, patients who received DIT remained less depressed.
Acute treatment with DIT or GST in combination with ADM was similarly efficacious in reducing depressive symptoms and yielded a better outcome than ADM alone. DIT may provide MDD patients with long-term benefits in symptom improvement but results must be viewed with caution.
The Wood Snipe Gallinago nemoricola is one of the least known shorebird species, and its habitat associations are very poorly understood. Here we provide the first assessment of the habitat use of the Wood Snipe during the breeding season. Between May and July 2021 at a 4-km2 alpine meadow in Sichuan province, China, we conducted population surveys and behavioural observations to identify sites where breeding Wood Snipe occurred and foraged. We quantified the habitat characteristics and food resource availability of these sites and compared them with randomly selected “background” sites. Comparison between 34 occurrence sites and 25 background sites indicated that during the breeding season, Wood Snipes are not distributed evenly across alpine meadow habitats, but preferred habitats in the lower part (3,378–3,624 m) of the alpine meadow with intermediate levels of soil moisture. In addition, comparison between 17 foraging sites and 24 background sites showed that the Wood Snipe tended to forage at sites with higher soil fauna abundance. We found weak evidence for denser vegetation cover at its height and no evidence for other biotic habitat variables such as vegetation composition or other abiotic habitat variables such as slope, soil penetrability, or disturbance level to influence Wood Snipe habitat associations. Our results suggest that the actual distribution range of the Wood Snipe during the breeding season may be smaller than expected from the extent of apparently suitable habitat. We advise caution in evaluating the potential habitat availability and distribution of the Wood Snipe, and call for further research to better understand the ecology of this rare species to inform its conservation.
In this work, we report numerical results on the flow instability and bifurcation of a viscoelastic fluid in the upstream region of a cylinder in a confined narrow channel. Two-dimensional direct numerical simulations based on the FENE-P model (the finite-extensible nonlinear elastic model with the Peterlin closure) are conducted with numerical stabilization techniques. Our results show that the macroscopic viscoelastic constitutive relation can capture the viscoelastic upstream instability reported in previous experiments for low-Reynolds-number flows. The numerical simulations reveal that the non-dimensional recirculation length (LD) is affected by the cylinder blockage ratio (BR), the Weissenberg number (Wi), the viscosity ratio (β) and the maximum polymer extension (L). Close to the onset of upstream recirculation, LD with Wi satisfy Landau-type quartic potential under certain parameter space. The bifurcation may exhibit subcritical behaviour depending on the values of L2 and β. The parameters β and L2 have nonlinear influence on the upstream recirculation length. This work contributes to our theoretical understanding of this new instability mechanism in viscoelastic wake flows.
Objectives: Rapid and accurate screening for carbapenemase-producing organism (CPOs) in hospitalized patients is critical for infection control and prevention. The Xpert Carba-R assay is designed for rapid detection of CPOs, but 1 assay is usually conducted for only 1 sample. We evaluated a pooling strategy for CPO screening using the Xpert Carba-R assay. Methods: Swab sets containing 2 swabs were collected from 415 unique patients at Peking University People’s Hospital. One swab was used for the pooling test, in which 5 swabs from different patients were mixed in 1 sample treatment solution. The prevalence of CPOs in the hospital (5.3%) predicted that 5:1 pooling was most economical. As the reference method, the other swab was tested by culture using sequencing. Results: Of 415 samples, 383 were CPO negative using the pooling test strategy and 31 were positive. All samples that were negative by pooling were negative by culture and sequencing. Among the 31 positive samples identified by the pooling strategy, 26 were positive by culture and sequencing (including 24 samples with 1 targeted gene and 2 samples with double targeted genes, 1 NDM+/IMP+ and 1 VIM+/IMP+), and 5 were negative. Overall, 198 tests were conducted in the study, and 217 were saved compared with testing individually. The efficiency of the pooling strategy was 215%. The overall sensitivity was 1 (95% CI, 0.840–1), the specificity was 0.987 (95% CI, 0.968–0.995), the accuracy was 0.987 (95% CI, 0.970–0.996), positive predictive value was 0.838 (95% CI, 0.655–0.939), and the negative predictive value was 1 (95% CI, 0.988–1). Conclusions: The pooling strategy using the Xpert Carba-R assay showed good potential in screening CPO with good sensitivity and a significantly lower cost.