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This study aimed to investigate the organization, workload, and psychological impact of COVID-19 on healthcare workers from the domestic Medical Aid Teams (MATs) sent to Wuhan in China.
Leaders and members of MATs involved in the care for COVID-19 patients were invited to participate in a study by completing 2 separate self-report questionnaires from April 1 to 24, 2020.
A total of 9 MAT leaders were involved and 464 valid questionnaires were collected from 140 doctors and 324 nurses. Mean age of the doctors and nurses were 39.34 ± 6.70 (26∼58 years old) and 31.88 ± 5.29 (21∼52 years old), with 72 (15.5%) being males. Nurses were identified as an independent risk factor (HR 1.898; P = 0.001) for a day working time in the multivariate analysis. The proportions of psychological consulting received among nurses were higher than those among doctors (49.7 vs 30.0%, P < 0.001). More than 50% of the anesthetists and emergency doctors who have received psychological consulting thought that it was effective according to self-evaluation.
This study focused on healthcare workers’ situation during the early period of the pandemic. Nurses worked longer than doctors. The effectiveness of psychological consulting depends on the physicians’ specialties and the working conditions of the nurses and psychological consulting targeting different specialties need to be improved.
Chronic inflammation exerts pleiotropic effects in the aetiology and progression of chronic obstructive pulmonary disease (COPD). Glucosamine is widely used in many countries and may have anti-inflammatory properties. We aimed to prospectively evaluate the association of regular glucosamine use with incident COPD risk and explore whether such association could be modified by smoking in the UK Biobank cohort, which recruited more than half a million participants aged 40–69 years from across the UK between 2006 and 2010. Cox proportional hazards models with adjustment for potential confounding factors were used to calculate hazard ratios (HR) as well as 95 % CI for the risk of incident COPD. During a median follow-up of 8·96 years (interquartile range 8·29–9·53 years), 9016 new-onset events of COPD were documented. We found that the regular use of glucosamine was associated with a significantly lower risk of incident COPD with multivariable adjusted HR of 0·80 (95 % CI, 0·75, 0·85; P < 0·001). When subgroup analyses were performed by smoking status, the adjusted HR for the association of regular glucosamine use with incident COPD were 0·84 (0·73, 0·96), 0·84 (0·77, 0·92) and 0·71 (0·62, 0·80) among never smokers, former smokers and current smokers, respectively. No significant interaction was observed between glucosamine use and smoking status (Pfor interaction = 0·078). Incident COPD could be reduced by 14 % to 84 % through a combination of regular glucosamine use and smoking cessation.
Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.
The aim of the present study was to compare the rate of preterm birth (PTB) and growth from birth to 18 years between twins conceived by in vitro fertilization (IVF) and twins conceived by spontaneous conception (SC) in mainland China. The retrospective cohort study included 1164 twins resulting from IVF and 25,654 twins conceived spontaneously, of which 494 from IVF and 6338 from SC were opposite-sex twins. PTB and low birth weight (LBW), and growth, including length/height and weight, were compared between the two groups at five stages: infancy (0 year), toddler period (1–2 years), preschool (3–5 years), primary or elementary school (6–11 years), and adolescence (10–18 years). Few statistically significant differences were found for LBW and growth between the two groups after adjusting for PTB and other confounders. Twins born by IVF faced an increased risk of PTB compared with those born by SC (adjusted odds ratio [aOR] 8.21, 95% confidence interval [CI] [3.19, 21.13], p < .001 in all twins and aOR 10.12, 95% CI [2.32, 44.04], p = .002 in opposite-sex twins). Twins born by IVF experienced a similar growth at five stages (0–18 years old) when compared with those born by SC. PTB risk, however, is significantly higher for twins conceived by IVF than those conceived by SC.
Schizophrenia is considered a polygenic disorder. People with schizophrenia and those with genetic high risk of schizophrenia (GHR) have presented with similar neurodevelopmental deficits in hemispheric asymmetry. The potential associations between neurodevelopmental abnormalities and schizophrenia-related risk genes in both schizophrenia and those with GHR remains unclear.
To investigate the shared and specific alternations to the structural network in people with schizophrenia and those with GHR. And to identify an association between vulnerable structural network alternation and schizophrenia-related risk genes.
A total of 97 participants with schizophrenia, 79 participants with GHR and 192 healthy controls, underwent diffusion tensor imaging (DTI) scans at a single site. We used graph theory to characterise hemispheric and whole-brain structural network topological metrics. For 26 people in the schizophrenia group and 48 in the GHR group with DTI scans we also calculated their schizophrenia-related polygenic risk scores (SZ-PRSs). The correlations between alterations to the structural network and SZ-PRSs were calculated. Based on the identified genetic–neural association, bioinformatics enrichment was explored.
There were significant hemispheric asymmetric deficits of nodal efficiency, global and local efficiency in the schizophrenia and GHR groups. Hemispheric asymmetric deficit of local efficiency was significantly positively correlated with SZ-PRSs in the schizophrenia and GHR groups. Bioinformatics enrichment analysis showed that these risk genes may be linked to signal transduction, neural development and neuron structure. The schizophrenia group showed a significant decrease in the whole-brain structural network.
The shared asymmetric deficits in people with schizophrenia and those with GHR, and the association between anomalous asymmetry and SZ-PRSs suggested a vulnerability imaging marker regulated by schizophrenia-related risk genes. Our findings provide new insights into asymmetry regulated by risk genes and provides a better understanding of the genetic–neural pathological underpinnings of schizophrenia.
The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19.
We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020.
Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%), and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), and shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%), and respiratory failure (11.9%) are the top 3 direct causes of death.
COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.
The aim of this study was to analyze the profile of chest injuries, oxygen therapy for respiratory failure, and the outcomes of victims after the Jiangsu tornado, which occurred on June 23, 2016 in Yancheng City, Jiangsu Province, China.
The clinical records of 144 patients referred to Yancheng City No.1 People’s Hospital from June 23 through June 25 were retrospectively investigated. Of those patients, 68 (47.2%) sustained major chest injuries. The demographic details, trauma history, details of injuries and Abbreviated Injury Scores (AIS), therapy for respiratory failure, surgical procedures, length of intensive care unit (ICU) and hospital stay, and mortality were analyzed.
Of the 68 patients, 41 (60.3%) were female and 27 (39.7%) were male. The average age of the injured patients was 57.1 years. Forty-six patients (67.6%) suffered from polytrauma. The mean thoracic AIS of the victims was calculated as 2.85 (SD = 0.76). Rib fracture was the most common chest injury, noted in 56 patients (82.4%). Pulmonary contusion was the next most frequent injury, occurring in 12 patients (17.7%). Ten patients with severe chest trauma were admitted to ICU. The median ICU stay was 11.7 (SD = 8.5) days. Five patients required intubation and ventilation, one patient was treated with noninvasive positive pressure ventilation (NPPV), and four patients were treated with high-flow nasal cannula (HFNC). Three patients died during hospitalization. The hospital mortality was 4.41%.
Chest trauma was a common type of injury after tornado. The most frequent thoracic injuries were rib fractures and pulmonary contusion. Severe chest trauma is usually associated with a high incidence of respiratory support requirements and a long length of stay in the ICU. Early initiation of appropriate oxygen therapy was vital to restoring normal respiratory function and saving lives. Going forward, HFNC might be an effective and well-tolerated therapeutic addition to the management of acute respiratory failure in chest trauma.
Evidence has suggested that honey intake has a beneficial impact on glycaemic control in patients with type 2 diabetes. Whether these findings apply to adults with prediabetes is yet unclear. The aim of the present study was to examine whether honey intake is associated with a lower prevalence of prediabetes. A cross-sectional study was performed in 18 281 participants (mean age 39·6 (sd 11·1) years; men, 51·5 %). Dietary intake was assessed through a validated 100-item FFQ. Prediabetes was defined according to the American Diabetes Association criteria: impaired fasting glucose, impaired glucose tolerance or raised glycosylated Hb. Multivariable logistic regression models were used to estimate the association between honey consumption and prediabetes. As compared with those who almost never consumed honey, the multivariable OR of prediabetes were 0·94 (95 % CI 0·86, 1·02) for ≤3 times/week, 0·77 (95 % CI 0·63, 0·94) for 4–6 times/week and 0·85 (95 % CI 0·73, 0·99) for ≥1 time/d (Pfor trend < 0·01). These associations did not differ substantially in sensitivity analysis. Higher honey consumption was associated with a decreased prevalence of prediabetes. More large prospective cohort studies are needed to investigate this association.
A magnetic dipole quasi-Yagi antenna based on a dielectric resonator (DR) is proposed in this letter. The dominate TE1δ1 mode of the rectangular DR is used as a magnetic dipole which can be differentially fed by the coplanar strip line (CPS). Thanks to the DR employment, the proposed antenna has several advantages such as compact size and flexible design which means the 3-D dimensions of the DR can be easily adjusted to cater for various applications. Meanwhile, the gain of the proposed DR quasi-Yagi antenna is higher than that of traditional electric dipole counterparts. Furthermore, since the DR driver is horizontally polarized, both the metal strip and DR can be used as a director for enhancing the end-fire gain. To verify the design concept, a prototype operating at the X-band is fabricated and measured. Good agreement between the simulated and measured results can be observed.
This study aimed to determine whether increased carotenoids intake was associated with reduced risk of gestational diabetes mellitus (GDM). We performed a cross-sectional analysis using data from Tongji Maternal and Child Health Cohort study. The dietary carotenoids intake of 1978 pregnant women was assessed using a researcher-administered FFQ before undertaking an oral glucose tolerance test at 24–28 weeks. Multivariate logistic and linear regression analyses were used to obtain the effect estimates. Participants in the highest quartile of lycopene intake showed a lower risk of GDM (OR 0·50; 95 % CI 0·29, 0·86; Pfor trend = 0·007) compared with those in the lowest quartile; each 1 mg increase in lycopene consumption was associated with a 5 % (95 % CI 0·91, 0·99; Pfor trend = 0·020) decrease in GDM risk. No significant association was found between α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin intake and GDM risk. Multiple linear regression analysis suggested an inverse association between lycopene intake and fasting blood glucose (FBG) (Pfor trend < 0·001); each 1 mg increase in lycopene intake was associated with 0·005 (95 % CI 0·002, 0·007; Pfor trend < 0·001) mmol/l decrease in FBG. Interaction analysis indicated consistent effect on each age or pre-BMI subgroup; however, a stronger protective effect of lycopene intake against GDM was observed among primigravid women (OR 0·20; 95 % CI 0·07, 0·55 in the highest v. the lowest quartile of intake; Pfor interaction = 0·036). In conclusion, dietary lycopene intake was mainly assumed via reducing FBG to decrease GDM risk, and the protection was relatively increased among primigravid women.
There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder.
Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months.
Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up.
Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.
In a rice (Oryza sativa L.)–wheat (Triticum aestivum L.) rotation system, a study was conducted to determine the effects of different fertilization regimens (no fertilization, replacement of a portion of chemical fertilizer with composted pig manure, chemical fertilizer only, and straw return combined with chemical fertilizer) on the weed communities and wheat yields after 4 and 5 yr. The impact of the long-term recurrent fertilization regimen initiated in 2010 on the composition and diversity of weed communities and the impact of the components and total amount of fertilizer on wheat yields were assessed in 2014 and 2015. Totals of 19 and 16 weed species were identified in experimental wheat fields in 2014 and 2015, respectively, but the occurrence of weed species varied according to the fertilization regimen. American sloughgrass [Beckmannia syzigachne (Steud.) Fernald], water starwort [Myosoton aquaticum (L.) Moench], and lyrate hemistepta (Hemistepta lyrata Bunge.) were adapted to all fertilization treatments and were the dominant weed species in the experimental wheat fields. The greatest number of weed species were observed under the no-fertilization treatment, in which 40% of the weed community was composed of broadleaf weeds and the lowest wheat yields were obtained. With fertilizer application, the number of weed species was reduced, the height of weeds increased significantly, the density of broadleaf weeds was significantly reduced, the biodiversity indices of weed communities decreased significantly, and higher wheat yields were obtained. Only the chemical fertilizer plus composted pig manure treatment and the chemical fertilizer–only treatment increased the density of grassy weeds and the total weed community density. The treatment with chemical fertilizer only also resulted in the highest density of B. syzigachne. Rice straw return combined with chemical fertilizer yielded the lowest total weed density, which suggests that it inhibited occurrence of weeds. The different fertilizer regimens not only affected the weed species composition, distribution, and diversity, but also the weed density. Our study provides new information from a rice–wheat rotation system on the relationship between soil amendments and agricultural weed infestation.
Photocatalytic water splitting to form hydrogen can effectively alleviate energy and environmental problems attracting wide attention. However, the current photocatalysts have low photocatalytic efficiencies due to the narrow absorption spectrum, which is far from the actual application requirements. Herein, we use the as-prepared zinc porphyrin self-assemblies to visible-light-drive photocatalytic hydrogen evolution with Pt as the cocatalyst and ascorbic acid (AA) as the sacrificial agent. The results exhibit morphology-dependent performance and hexagonal stacks achieved optimal H2 evolution rate (47.1 mmol/h/g), then followed by nanodiscs, nanorod and tetragonal stacks, meanwhile the nanorods with different aspect ratios show size-dependent properties. The UV-vis absorption and photoluminescence spectra and the shortening of decay time of the corresponding ZnTPyP aggregates reveal that the well-defined self-assembled porphyrin networks are J-aggregation and boost efficient energy transfer with respect to monomer. Such porphyrin self-assemblies are standing for one of the most promising photosensitizers in photocatalysis field and provide an important reference for designing the next generation of hydrogen production.
Previously, the concept of Ply Drop Sequence (PDS) is introduced by the authors for the designing of composite laminated structures with multiple regions. Compared to deleting a contiguous innermost/outermost plies in the classical guide-based blending, using PDS is more flexible than dropping plies between adjacent regions. In this article, a new blending model called the Permutation for Panel Sequence (PPS) blending model is proposed to correct the problem of repeated searching of discrete points in the design space for the previous PDS blending model. The proposed method is also applied to an 18-panel horseshoe benchmark problem. The results demonstrate that the useful searching points in the PPS method are less than those in the PDS method when the number of the panels is less than the number of plies in the guide laminate, and the PPS method obtains a faster convergence speed compared with the PDS method.
Laser-driven magnetic reconnection (LDMR) occurring with self-generated B fields has been experimentally and theoretically studied extensively, where strong B fields of more than megagauss are spontaneously generated in high-power laser–plasma interactions, which are located on the target surface and produced by non-parallel temperature and density gradients of expanding plasmas. For properties of the short-lived and strong B fields in laser plasmas, LDMR opened up a new territory in a parameter regime that has never been exploited before. Here we review the recent results of LDMR taking place in both high and low plasma beta environments. We aim to understand the basic physics processes of magnetic reconnection, such as particle accelerations, scale of the diffusion region, and guide field effects. Some applications of experimental results are also given especially for space and solar plasmas.
The fractional derivatives include nonlocal information and thus their calculation requires huge storage and computational cost for long time simulations. We present an efficient and high-order accurate numerical formula to speed up the evaluation of the Caputo fractional derivative based on the L2-1σ formula proposed in [A. Alikhanov, J. Comput. Phys., 280 (2015), pp. 424-438], and employing the sum-of-exponentials approximation to the kernel function appeared in the Caputo fractional derivative. Both theoretically and numerically, we prove that while applied to solving time fractional diffusion equations, our scheme not only has unconditional stability and high accuracy but also reduces the storage and computational cost.
In this study, the petrology, zircon U–Pb ages, Lu–Hf isotopic compositions, whole-rock geochemistry and Sr–Nd isotopes for newly recognized low-Mg and high-Mg adakitic rocks from the North Altun orogenic belt were determined. The results will provide important insights for understanding the continuities of the North Qilian and North Altun orogenic belts during early Palaeozoic time. The low-Mg adakitic granitoids (445 to 439 Ma) are characterized by high SiO2 (69–70 wt %), low Mg no. (43–48) and low Cr and Ni contents. In contrast, the high-Mg adakitic granitoids (425 to 422 Ma) have relatively lower SiO2 (65–67 wt %), higher Mg no. (60–62) and higher Cr and Ni contents. The low-Mg adakitic rocks have high initial 87Sr/86Sr ratios (0.7073–0.7084), negative εNd(t) (−1.9 to −4.0) and εHf(t) values (−6.8 to −2.0), and old zircon Hf model ages (1.4–1.7 Ga). In contrast, the high-Mg adakitic rocks show lower initial 87Sr/86Sr ratios (0.7044–0.7057), higher εNd(t) (−0.7 to 3.1) and positive εHf(t) values (2.0 to 6.9), with younger zircon Hf model ages (0.9–1.2 Ga). These results suggest that the low-Mg adakitic rocks were probably generated by the partial melting of thickened crust, whereas the high-Mg adakitic rocks were derived from the anatexis of delaminated lower crust, which subsequently interacted with mantle magma upon ascent. The data obtained in this study provide significant information about the geological and tectonic processes after the closure of the Altun Ocean. The continent–continent collision and thickening probably occurred during 450–440 Ma with the formation of low-Mg adakitic rocks, and the transition of the tectonic regime from compression to extension probably occurred at 425–422 Ma with the formation of high-Mg adakitic rocks. The geochemical, geochronological and petrogenetic similarities between the North Altun and North Qilian adakitic rocks suggest that these two orogenic belts were subjected to similar tectonomagmatic processes during early Palaeozoic times.
Previous studies have supported the theory that there is a positive association between ferritin and carotid atherosclerosis in Western people. Diet plays an important role in determining serum ferritin concentration. Asian dietary patterns are different from Western dietary patterns, implying that there may be a difference in the association of ferritin with carotid atherosclerosis between Asian and Western people. However, few studies focus on the association between ferritin and carotid atherosclerosis among Asians. The aim of this study was to investigate how serum ferritin levels are associated with carotid atherosclerosis in an Asian adult population. A cross-sectional assessment was performed in 8302 adults in Tianjin, China. Carotid intima-media thickness (IMT) and plaques were assessed using ultrasonography, and serum ferritin was measured using the protein chip-chemiluminescence method. Multiple logistic regression analysis was used to examine the association between quartiles of serum ferritin concentration and carotid atherosclerosis. In the present study, the overall prevalence of IMT and carotid plaques in participants is 29·2 and 22·7 %, respectively. In women, after adjustments for potentially confounding factors, the OR of IMT and carotid plaques by increasing serum ferritin quartiles were 1·00, 1·39 (95 % CI 0·98–1·99), 1·39 (95 % CI 0·99–1·97), 1·81 (95 % CI 1·30–2·55) (Pfor trend<0·001) and 1·00, 1·24 (95 % CI 0·89–1·73), 1·18 (95 % CI 0·85–1·65), 1·59 (95 % CI 1·15–2·20) (Pfor trend<0·01), respectively. However, no association was found between serum ferritin and carotid atherosclerosis in men. The study demonstrated that increased serum ferritin levels are independently associated with IMT and carotid plaques in Asian women but not in Asian men.
Twenty Small Tailed Han (STH) and 20 Ujumqin (UJU) ewes naturally infected with gastrointestinal nematodes were randomly assigned to one of four treatments arranged in a 2 × 2 factorial design, receiving anthelmintic treatment (AT) or non-anthelmintic treatment (NonAT) prior to lambing. After lambing, the effects of AT on feed intake, digestion and milk yield in ewes, and the growth rates of lambs fed their mother's milk were assessed for 28 days. Faecal samples were collected to determine faecal egg counts (FECs), milk was collected to measure milk yield and ewes and lambs were weighed to quantify daily body weight change. The results showed that AT significantly increased ewe dry matter intake (2411 g/d for AT and 2209 g/d for NonAT) and decreased FECs (50 eggs/g for AT and 2655 eggs/g for NonAT). All ewes lost weight after lambing, but body weight loss in the AT (43 g/d) was significantly less than in NonAT (84 g/d), and STH ewes (70 g/d) lost more weight than UJU ewes (58 g/d). Anthelmintic-treated ewes produced more milk for their lambs to consume. However, the extent of these positive effects of AT differed between STH and UJU ewes. The average daily body weight gain of lambs in AT was higher than those in NonAT. In conclusion, effective AT in ewes before lambing benefits subsequent lactation in ewes and growth rate in lambs.
In this paper, a new optimisation method incorporating lamination parameters and a guide-based blending model is proposed. Lamination parameters for a guide laminate and ply number of each panel are employed as design variables for optimisation with a parallel real-coded genetic algorithm incorporating structure behaviour and manufacturing constraints. During the optimisation process, with a form of least squares fitting adopted, another genetic algorithm is used to obtain the guide stacking sequence of the guide laminate from the guide lamination parameters, and then the laminate configurations of each panel are obtained from the guide stacking sequence and number of plies for each panel. The proposed framework is demonstrated via design of an 18-panel horseshoe configuration, where each panel is optimised individually with a buckling constraint. Numerical results indicate that the present algorithm is capable of obtaining fully blended designs.