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This work focuses on the dynamical rotatory motion of an asymmetric rigid body (RB) subjected to a constant body-fixed torque and a vector of a gyrostatic moment (GM). The motion is considered in the absence of the first two components of the GM. The novelty of the current work is the conversion of the stability analysis of this body from a two dimensional phase plane to three ones phase space. Specifically, two scenarios of stationary torques are considered, the first one is directed on the minor or major axis, while the latter is presumed to act on the middle axis. Therefore, three dimensional phase space routes are generated. In both scenarios some novel analytical and simulation outcomes are provided regarding equilibrium manifolds, periodic solutions or non-periodic ones, separator surfaces, as well as the extreme periodic solutions. The significance of this work is due to its great applications, especially those that use the gyro's theory. [ABSTRACT FROM AUTHOR]

The demand for gloves (e.g., disposable gloves, medical gloves) is increasing due to the Coronavirus disease 2019 (COVID-19) pandemic. Stability in the supply chain in the glove industry is important, and thus strategies are used to solve the problem of the shortage of nitrile gloves. The blending of nitrile butadiene rubber (NBR) with polyurethane (PU) and the use of the nanocomposite concept is among the feasible approaches. The present study aims to investigate the effects of nanokaolin (NK) on the tensile and chemical properties of carboxylated nitrile butadiene rubber (NBR)/polyurethane (PU) latex blends. Three different loadings of NK (10, 20, and 30 parts per hundred rubber) were added to the NBR/PU (at a blending ratio of 85/15). The zeta potential showed that all the NBR compounds exhibit good colloidal stability. The incorporation of NK increased the crosslink density and tensile strength of the NBR/PU latex blends. The highest tensile strength was achieved when the NK loading was 20 phr. All the NBR blends and nanocomposites (NBR/PU-based) possess tensile properties that fulfill the requirements for glove application. The chemical resistance of NBR compounds was increased by the incorporation of NK due to the higher crosslink density and barrier properties contributed by the NK. [ABSTRACT FROM AUTHOR]

The article discusses opportunistic enteroviral infections in multiple sclerosis (MS) patients undergoing anti-CD20 therapies. It highlights the case of a woman with MS treated with ocrelizumab who developed acute psychiatric symptoms and seizures due to coxsackie B5 enterovirus infection. The article emphasizes the importance of considering infectious differentials in immunosuppressed patients and the potential risks of continued B-cell depletion in hypogammaglobulinemic patients. The study underscores the need for careful treatment strategies with CD20-depleting agents in MS patients. [Extracted from the article]

Background & Aims: Cardiovascular disease contributes to a high rate of morbidity and mortality after liver transplantation (LT). However, the progression of cardiac function and cardiac remodeling in LT recipients remains poorly understood. This study sought to evaluate the progression of cardiac function and structure in LT recipients and identify independent predictors of prognosis using echocardiography. Methods: From 2009 to 2019, 178 adult LT recipients at a tertiary academic transplant center were retrospectively studied. Transthoracic echocardiograms 1‐year pre‐ and post‐LT were assessed. Primary outcomes were progression of systolic and diastolic function. Secondary outcomes included left ventricular remodeling, all‐cause mortality, and heart failure readmission post‐LT. Subgroup analyzes were performed for etiology of native liver disease. A multivariable model was constructed to examine independent predictors of outcomes. Results: Systolic function significantly worsened, with reduction in stroke volume (45–37 ml/m2, p <.001), left ventricular ejection fraction (LVEF) (65%–62%, p <.001) and cardiac index (3.00–2.60 L/min/m2, p <.001). Conversely, there were significant improvements in diastolic indices, including tricuspid regurgitation Vmax (228–215 cm/s, p =.017), left atrial volume index (LAVI) (32–26 ml/m2, p <.001) and right ventricular systolic pressure (RVSP) (31–28 mmHg, p =.001). Additionally, patients had increased relative wall thickness (RWT) (p <.001) and decreased left ventricular end‐diastolic dimension/body surface area (p <.001) post‐LT. The independent predictors for all‐cause mortality and heart failure were increased pre‐LT mitral annular early diastolic velocity (HR 1.11, CI 1.02–1.22, p =.018), LAVI (HR 1.06, CI 1.02–1.11, p =.007) and decreased LVEF (HR.89, CI.82–.97, p =.006). The effect of non‐alcoholic steatohepatitis on cardiovascular outcomes post‐LT was largely comparable to that of Hepatitis B. Conclusion: This study showed reduced systolic and improved diastolic function in LT recipients and highlighted the utility of pre‐LT echocardiogram in the prognostication and risk stratification of LT candidates. [ABSTRACT FROM AUTHOR]

Background. Sexual and gender minority youth (SGMY) experience health inequities compared with cisgender heterosexuals, and these inequities are heightened in areas with high structural stigma. Quantitative research shows school assets (e.g., adult support) are associated with better health for SGMY. Though some qualitative studies elucidated how school staff support SGMY, none have triangulated such strategies in a geographically and sociodemographically diverse sample of school staff and SGMY. This paper describes a multi-perspective qualitative study design and offers lessons learned from conducting such a study. Methods. Using a novel stratified sampling frame, we interviewed 60 SGMY and 29 school staff who attended/worked at high schools in U.S. states with low, medium, and high structural stigma. To ensure sociodemographic diversity, we constructed sampling quotas, and recruited SGMY using social media and staff using a multi-pronged approach. Results. The stratified sampling strategy met our goal of enrolling diverse SGMY and staff participants. SGMY participants attended schools in low (n = 20), medium (n = 22), and high (n = 18) structural stigma states. We enrolled 18 cisgender girls, 18 cisgender boys, and 24 gender minority youth. Fifty-three percent of SGMY were youth of color, and 45% attended schools in rural areas. School staff participants worked at schools in low (n = 11), medium (n = 11), and high (n = 7) structural stigma states. School staff participants were 55% heterosexual, 91% cisgender, and had diverse roles (e.g., teacher, principal, librarian, and nurse). Conclusions. This paper describes new methods for collecting qualitative data from diverse SGMY and school staff. Some lessons learned from this study include the importance of using trauma-informed interviewing methods, having a suicidality safety protocol, establishing a priori sampling quotas, and creating tailored social media advertisements. With these data we will explore the heterogeneity of SGMY and school staff experiences across varying structural stigma levels, yielding foundational information for future school-based interventions. [ABSTRACT FROM AUTHOR]

Background: Recovery-oriented, strengths-based intervention engages service users' strengths and resources to support their recovery process. This model was developed in an American context and has been applied in Hong Kong. It is important to formulate an understanding of strengths better fit to Hong Kong Chinese. Aims: This exploratory qualitative study examined Hong Kong Chinese service users' views on strengths and preferred translation for the word strengths, along with its cultural nuances. Method: Twenty-six people with serious mental illnesses were individually interviewed at a mental health center in Hong Kong, based on a photo-elicitation technique and reflection on Chinese terms related to strengths. Analysis of data employed the constant comparative method. Results: Participants reported that social factors, such as support by helping professionals and engagement in family roles, as well as spiritual beliefs and practices, are important for recovery. These insights and their preferred translations of strengths generate a culturally nuanced understanding of strengths. Conclusions & Implications for Practice: The strengths model applied in Hong Kong can be enhanced by a more culturally nuanced perspective, for example, including the importance of family-based identity and filial piety, beliefs related to harmony and fate, and practices such as a temple or church attendance. Impact and Implications: This study investigates how Hong Kong Chinese people view strengths in facilitating recovery from mental illnesses. The term "strengths" in recovery was deemed synonymous with the terms ability (néng lì; 能力) and expertise (zhuān cháng; 專長) in Chinese. This study sheds light on how Chinese conceptualizations of "strengths" in recovery may be applied in interventions. [ABSTRACT FROM AUTHOR]

Background: : Infective endocarditis (IE) confers significant mortality and morbidity in patients with underlying mitral stenosis (MS), with both diseased native valves and after valvular procedures. Purpose: : We examined the clinical and echocardiographic parameters in association with the development of IE on patients with significant MS. Methods: : A total of 478 consecutive patients with index echocardiographic diagnosis of significant mitral stenosis (mitral valve area <1.5 cm2) were included. Patients were grouped into those with or without IE on at least 5 years of follow‐up. Baseline clinical, echocardiographic profile and clinical outcomes were compared. Results: : IE was observed in 4.4% (n = 21) of the cohort. These patients were younger (45.3 ± 14.6 vs. 53.2 ± 15.5 years, p = 0.022) at the time of MS diagnosis. NT‐proBNP was higher in patients who developed IE (13529 ± 12230 vs. 4381 ± 5875 pg/ml, p < 0.001), with larger left atrial diameter (54.4 ± 10.1 vs. 49.9 ± 9.5 mm, p = 0.040) and elevated pulmonary artery systolic pressure (PASP, 62.3 ± 17.2 vs. 47.2 ± 16.5 mmHg, p = 0.026). There was no significant difference in terms of MS severity, other concomitant valvulopathies, or etiology (rheumatic or degenerative) of MS. Patients who smoked had higher incidence of IE (33.3% vs. 14.2%, log‐rank 7.27, p = 0.007). After adjusting for age, valve procedure and PASP, patients who smoked remained at elevated risk of IE (adjusted hazards ratio 2.99, 95% confidence interval 1.18–7.56, p = 0.021). Conclusion: : IE occurs in a proportion of patients with MS. Smoking, younger age of diagnosis of MS as well as dilated left atria with elevated PASP may be associated with an elevated risk of this complication. [ABSTRACT FROM AUTHOR]

Distinguished by their penetrance within a population, antibiotic tolerance and persistence are superficially similar phenomena by which growth-restricted bacteria survive treatment with bactericidal antibiotics. Owing to their apparent similarity, it is often assumed that the same physiological states and molecular mechanisms underlie the ability of individual antibiotic tolerant and persistent bacteria to survive treatment. Experimentally, antibiotic persistence is an extremely challenging phenomenon to study due to both its transience and the co-existence of persisters with non-persisters in the population of interest. In contrast, antibiotic tolerance operates at the whole population level as a result of bacteria acquiring genetic mutations or encountering environmental conditions that result in growth restriction. Therefore, studying antibiotic tolerance is often used as a convenient way to understand the molecular mechanisms governing antibiotic persistence. In this opinion, we discuss our current understanding of these two phenomena, outlining how tolerance and persistence can be distinguished experimentally. We argue that this approach will help avoid controversies in the field, especially in instances where the two phenomena co-exist. Finally, we evaluate the clinical evidence implicating tolerance and persistence in recalcitrance and relapse of bacterial infections. [ABSTRACT FROM AUTHOR]

Sea urchins live in a challenging environment that requires rapid and efficient responses against pathogens and invaders. This response may be also important in reproductive processes once males and females release their gametes into water. In addition, the gonads are organs with dual function: reproductive organ and nutrient reserve, therefore it needs efficient protective mechanisms to preserve the nutrients as well as the reproductive cells. The aim of this study was to evaluate the presence and characterize antimicrobial molecules in the male and female gonads of the sea urchin Lytechinus variegatus. Through HPLC purification, antimicrobial activity test and mass spectrometry several antimicrobial molecules were found in the gonads of both gender. Computational in silico analyses showed that they are fragments of a glycoprotein called toposome, also known as major yolk protein (MYP) which is one of the major proteins found in the gonads. Although different functions have been reported for this protein, this is the first description of a direct antimicrobial activity in Lytechinus variegatus. The results indicate that when undergoing proteolysis the toposome generates different fragments with antimicrobial activity which may indicate the importance of a rapid defense response strategy against invading microorganisms in the gonads used by both males and females sea urchins. • The presence of antimicrobial molecules were investigated in the gonads of L. varegatus. • Several antimicrobial molecules have been found in both females and males. • Male and female seems to present the same antimicrobial molecules. • The results indicate that toposome fragments have antimicrobial activity in the gonads. • Protein fragments show similarity with other antimicrobial peptides already described. [ABSTRACT FROM AUTHOR]

This study focuses on modelling dengue cases in northeastern Thailand through two meteorological covariates: cumulative rainfall and average maximum temperature. We propose two nonlinear integer-valued GARCHX models (Markov switching and threshold specification) with a negative binomial distribution, as they take into account the stylized features of weekly dengue haemorrhagic fever cases, which contain nonlinear dynamics, lagged dependence, overdispersion, consecutive zeros and asymmetric effects of meteorological covariates. We conduct parameter estimation and one-step-ahead forecasting for two proposed models based on Bayesian Markov chain Monte Carlo (MCMC) methods. A simulation study illustrates that the adaptive MCMC sampling scheme performs well. The empirical results offer strong support for the Markov switching integer-valued GARCHX model over its competitors via Bayes factor and deviance information criterion. We also provide one-step-ahead forecasting based on the prediction interval that offers a useful early warning signal of outbreak detection. [ABSTRACT FROM AUTHOR]

Background: Limited data suggest that adolescents with multiple sclerosis (MS) frequently discontinue school. While it is known that cognitive impairment occurs in 30% to 50% of children with MS, the functional impact of childhood MS on academic achievement is virtually unknown. Objective: To that end, this paper builds an evidence-based argument for evaluating educational outcomes in children with MS. Methods: This will be accomplished through (a) a review of pediatric MS and its cognitive consequences; (b) a selective review of the utility of neuropsychological batteries in assessing academic outcomes in pediatric populations in general; and (c) a brief overview of modifiable factors that have a potential benefit on school outcomes in children with MS. Conclusion: Scholastic achievement should be assessed as part of the routine cognitive screening of children and adolescents with MS. [ABSTRACT FROM AUTHOR]

This article highlights the potential of halloysite nanotube (HNT) as a multifunctional filler for polypropylene/polyamide 66 (PP/PA66) blends, for their roles as the reinforcing agent, compatibilizer, nucleating agent, and thermal stabilizer. The flexural modulus and strength of PP/PA66 were improved by the incorporation of HNT due to the reinforcing ability and compatibilization effects of HNT. 4 parts per hundred resin (phr) of HNT improved the thermal stability of PP/PA66 blends due to its heat barrier effects. Adding HNT increased the degree of crystallinity for PP and PA66, where the effects of HNT were more prominent in the PA66 phase, attributed to additional hydrogen bonding formation between the PA66 and HNT. [ABSTRACT FROM AUTHOR]

Background Paradoxical low-flow (LF) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) may have poorer prognosis than normal-flow (NF) AS, though its pathophysiology remained unclear. In particular, LV stiffness has not been compared between LF vs NF. We used a novel echocardiography-derived index of LV stiffness to compare between these groups. Consecutive patients with medically-managed isolated severe AS (aortic valve area < 1 cm2) and preserved LVEF (>50%) were studied. Echocardiographic LV stiffness index was measured by a method previously validated against cardiac catheterization. We compared LF (stroke volume index, SVI < 35 ml/m2) and NF severe AS. Of the 352 patients, 121 (34%) were LF. Both LF and NF groups had similar demographics, valve areas and indices. Compared to NF, LF severe AS had higher LV stiffness indices (>0.11 ml−1 OR 3.067, 95% CI 1.825–5.128, p < 0.001). Increased LV stiffness was associated with concentric remodelling and more severe diastolic dysfunction, especially in LF AS. An LV stiffness index of > 0.11 ml−1 was independently associated with increased mortality, after adjusting for age, clinical and echocardiographic parameters (HR 2.283 95% CI 1.318–3.968, p = 0.003). Non-invasive echocardiographic-derived index of LV stiffness may be important in LF AS. Increased LV stiffness was related to LV concentric remodelling and diastolic dysfunction, and associated with poorer clinical outcomes in medically-managed AS. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the kinetics of non-isothermal crystallization of polypropylene/high-density polyethylene/halloysite nanotube (PP/HDPE/HNT) nanocomposites using three methods, that is, Avrami equation, combined Ozawa–Avrami method (hereafter called Mo model), and Kissinger equation. The Avrami exponent (n) is in the range of 1–2 for all the PP/HDPE/HNT nanocomposites indicating instantaneous nucleation while the crystallization rate constant (Zt) values of PP/HDPE increased with the addition of HNT. This proved that addition of HNT increases the crystallization rate. The reduction of half crystallization time (t 1/2) for PP/HDPE as the increasing HNT loading indicates faster crystallization rate. In the Mo model, the cooling rate chosen at unit crystallization time F (T) values for PP/HDPE decreases with the addition of HNT. Kissinger equation showed that the activation energy (E a) of crystallization for the PP/HDPE decreases with the addition of HNT. All the results demonstrated that HNT can accelerate the crystallization rate for the PP/polyethylene blends. [ABSTRACT FROM AUTHOR]

How can we achieve widespread adoption of surgical innovations into clinical practice quickly and frugally? [ABSTRACT FROM AUTHOR]

Optical lenses are extensively used to enhance the performance of light-emitting diodes. Both uniformity and efficiency are important performance indicators in lens design; however, improving uniformity always lowers efficiency. In this study, the Taguchi method and principal component analysis (PCA) are integrated to optimise the lens shape for two quality objectives, namely, uniformity and efficiency. The Taguchi method was conducted twice to establish the signal/noise ratio of the two quality characteristics for calculating the principal components in PCA. Then, the optimum parameters obtained by the Taguchi method were processed by PCA. The correlated individual responses were converted to the principal components which explained most of the dataset and were considered as the single quality characteristic for the optimisation. The combined method resolved the difficulties of optimising multiple quality characteristics without sacrificing any particular quality characteristic while the traditional Taguchi method can only be applied to the single quality characteristic. A LED light source fitted with a secondary lens designed by the proposed method showed over 92% light efficiency and an improvement in uniformity. [ABSTRACT FROM AUTHOR]

Objectives: Cardiovascular disease (CVD) is excessive and premature among individuals with bipolar disorder (BD). Cerebrovascular reactivity (CVR), reflecting vasodilatory capacity of cerebral blood vessels in response to vasoactive substances, is a marker of cerebrovascular health. Despite informative findings in other diseases, CVR has not previously been examined in BD. Methods: Twenty‐five adolescents with BD and 25 age and sex‐matched psychiatrically healthy controls (HCs) completed six 15‐second breath‐holds (BHs) during functional magnetic resonance imaging (fMRI) at 3‐Tesla. CVR was determined by comparing blood‐oxygenation‐level dependent (BOLD) signal changes. Voxel‐wise contrasts were analyzed. Body mass index (BMI) was examined as a potential confound. Results: CVR in the posterior cingulate gyrus and periventricular white matter was lower in BD vs HC. After controlling for differences in BMI, additional between‐group CVR differences were observed in the temporal poles, supramarginal gyrus, and lingual gyrus. There were no regions in which CVR was significantly greater in BD vs HC. CVR was not associated with mood symptoms. Conclusions: This preliminary study provides evidence of cerebrovascular dysfunction in BD, including regions known to be susceptible to cerebrovascular dysfunction and/or disease. These findings warrant additional research on the causes and consequences of cerebrovascular dysfunction in early‐onset BD. [ABSTRACT FROM AUTHOR]

Purpose: To report cost reductions of vitrectomy under local anesthesia.Patients and methods: This was a retrospective cohort study using medical records of consecutive patients undergoing vitrectomy surgery for retinal detachment under general or local anesthesia. Data of patient's fulfilling the inclusion criteria were included in the study. The patients were divided into two groups: Group 1 (local anesthesia) and Group 2 (general anesthesia). The preoperative data were checked and validated by a peer group consisting of two ophthalmologists, two internists, and two anesthesiologists independently in a blind manner. The calculation of the cost was done using the cost minimization analysis. The cost data were obtained from the finance division of the hospital for each individual treatment. The cost data included unit cost of laboratory tests, surgery, and medications.Result: There were 100 subjects (50 subjects in each group) assessed by peer groups and declared eligible to undergo surgery under either local or general anesthesia. Both groups were equal. The total average cost for vitreous surgery under general anesthesia for each patient was $322.17, whereas for local anesthesia it was $220.57. The mean difference was $101.60 (46.06%) saving on local anesthesia.Conclusion: Vitrectomy surgery under local anesthesia can reduce the cost by almost half that of general anesthesia. The present study showed that the type of anesthesia determined the ultimate cost for the surgery. Hence, surgery under local anesthesia appears affordable and cost-effective, especially in a developing country like Indonesia. [ABSTRACT FROM AUTHOR]

Background: The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic and recovery parameters. The aim of the study was to assess the effects of dexmedetomidine premedication on haemodynamic, seizure duration, recovery characteristics and agitation following ECT. Material and method: 60 patients aged 18–60 years scheduled for ECT were enrolled in the study. Dexmedetomidine (0.5 μg/kg) diluted to 10 ml with 0.9% saline or 10 ml 0.9% saline (control) were infused intravenously over 10  min before induction of anaesthesia with thiopentone. Motor seizure duration, heart rate, mean arterial blood pressure, time to spontaneous respiration, obeying verbal commands and post-ECT agitation score were recorded. Statistical analysis was carried out using MS Excel and Primer of Biostatistics. Results: Post-ECT rise in mean arterial blood pressure (MAP) and heart rate (HR) in the dexmedetomidine group was significantly less (p< 0.001) compared with the control group at 1, 3, and 5 mins. Motor seizure duration was comparable in both groups. Mean agitation score was significantly low in the dexmedetomidine group (1.5 ± 0.50) compared with the control group (1.93 ± 0.52). Conclusion: A dexmedetomidine dose of 0.5 μ g/kg IV administered over 10 min before the induction of anaesthesia may be useful in preventing the acute hyperdynamic responses to ECT and post-ECT agitation without altering the duration of seizure activity and recovery time. [ABSTRACT FROM PUBLISHER]

Epoxy/glass fiber/organo-montmorillonite hybrid composites with triaryl phosphates and decabromodiphenyl oxide flame retardants were prepared by vacuum-assisted resin infusion technique. The effects of triaryl phosphates and decabromodiphenyl oxide on the flammability properties of epoxy/glass fiber/organo-montmorillonite composites were evaluated through UL-94 vertical flammability test and limiting oxygen index. Epoxy/glass fiber/organo-montmorillonite hybrid composite showed no rating in UL-94 test up to 40 phr of triaryl phosphates. Field emission scanning electron microscopy showed the amount of char formed increased, denser char structure and better coverage of glass fibers as triaryl phosphates loading increased. Interestingly, the hybridization of 30 phr decabromodiphenyl oxide with respect to 10 phr triaryl phosphates flame retardants showed V-0 rating with limiting oxygen index of 33%. [ABSTRACT FROM PUBLISHER]

Cell identity is a reflection of a cell type-specific gene expression profile, and consequently, cell type-specific transcription factor networks are considered to be at the heart of a given cellular phenotype. Although generally stable, cell identity can be reprogrammed in vitro by forced changes to the transcriptional network, the most dramatic example of which was shown by the induction of pluripotency in somatic cells by the ectopic expression of defined transcription factors alone. Although changes to cell fate can be achieved in this way, the efficiency of such conversion remains very low, in large part due to specific chromatin signatures constituting an epigenetic barrier to the transcription factor-mediated reprogramming processes. Here we discuss the two-way relationship between transcription factor binding and chromatin structure during cell fate reprogramming. We additionally explore the potential roles and mechanisms by which histone variants, chromatin remodelling enzymes, and histone and DNA modifications contribute to the stability of cell identity and/or provide a permissive environment for cell fate change during cellular reprogramming. [ABSTRACT FROM AUTHOR]

This work studies a two degrees-of-freedom (DOF) dynamical system whose governing system is solved analytically using the multiple scales approach (MSA). The solvability requirements are obtained in light of the elimination of secular terms. All resonance states are classified to understand the equilibrium of the dynamical system. Two of them are examined in parallel to get the associated equations for the system's modulation. All probable fixed points are identified at the states of stability and instability using the criteria of Routh-Hurwitz (RH). The curves of resonance and the system's behavior during the motion are plotted and analyzed. The numerical solutions (NS) of the governing system are obtained using the method of Runge-Kutta fourth-order, and they are compared with the analytical solutions (AS). The comparison reveals high consistency between them and proves the accuracy of the MSA. To determine the positive effects of different parameters on the motion, stability zones are studied from the perspective of their graphs. The applications of such works are very important in our daily lives and were the reason for the development of several things, including protection from earthquakes, car shock absorbers, structure vibration, human walking, television towers, high buildings, and antennas. [ABSTRACT FROM AUTHOR]

This is the second of a two-part study on the archaeology and technological development of the machine textile industry in the 20th century. The previous paper, Part 1 ( IAR, 35·2), described the changes in two long-established textile technologies: the production of yarns from short fibres such as cotton and wool; and the weaving of fabrics. The main part of this paper describes completely new technologies that resulted from the manufacture of new continuous filament yarns. Other technologies are also mentioned. [ABSTRACT FROM AUTHOR]

Grouted sleeves are one of the accepted techniques used for the repair of corroded pipelines. The sleeves are attached over the region of pipe that requires repair, creating an annulus that is then filled with grout material. In this study, the repair system consists of a composite sleeve with polymeric grout. A finite element (FE) study is carried out to predict the effects of selected properties of the composite sleeve and grout on the pipe integrity, subjected to internal fluid pressure. The primary purpose is to identify the main effects and interactions between different material properties, which are useful to aid design decisions for such repairs. While structural reinforcement is provided by the sleeve, the grout plays an important role in transferring hoop pressure in the pipe to the sleeve. Since experimental observations indicate the development of cracks in the grout solely under curing conditions, it is imperative to investigate the effects of such defects. Several different repair conditions that have potential to critically influence the integrity of a repaired pipe are investigated. [ABSTRACT FROM AUTHOR]

PLA nanocomposites containing 2 wt% of OMMT clay were prepared using twin screw extruder followed by injection moulding. EPR-g-MAH (5–20 phr) was used to improve the impact properties of PLA/OMMT nanocomposites. The mechanical properties of PLA nanocomposites were studied through tensile, flexural and impact tests. The morphology and dispersion of OMMT were examined using TEM and XRD. The thermal properties were characterised using differential scanning calorimetry and thermogravimetric analysis. The impact strength and thermal stability of the PLA/OMMT nanocomposites were improved significantly in the presence of EPR-g-MAH. The degree of crystallinity of PLA/OMMT was influenced by the loading of EPR-g-MAH. TEM and XRD results revealed the formation of PLA nanocomposites as the OMMT was exfoliated in the presence of EPR-g-MAH. [ABSTRACT FROM AUTHOR]

A series of maleic anhydride grafted poly(lactic acid) (PLA-g-MAH) was prepared by mixing PLA, dicumyl peroxide (DCP) and maleic anhydride (MAH). Effects of DCP and MAH concentration on the grafting percentage were determined. PLA composites were prepared via melt mixing with halloysite clay (HNC; 3 wt%) and various amount of PLA-g-MAH (4–10 phr) using internal mixer followed by compression molding. Properties of the PLA composites were characterized using three-point bending flexural tests, scanning electron microscopy and differential scanning calorimetry. It was found that the grafting percentage of PLA-g-MAH was influenced by both DCP and MAH concentrations; however, DCP showed more profound effect. By the addition of PLA-g-MAH, the adhesion between PLA and HNC improved, which can be manifested by the enhancement in flexural properties. Degree of crystallinity of PLA/HNC increased significantly by the addition of PLA-g-MAH. [ABSTRACT FROM PUBLISHER]

Aims and objectives To explore the reasons why nurses leave public hospitals for the private sector. Background While the global shortage of nurses is aggravating, this problem in public hospitals in Hong Kong is worsened by the trend of nurses moving to private hospitals. Thus, it is important to understand from the perspective of nurses the reasons affecting their decision to stay or leave a hospital. Design Qualitative approach using narrative analysis. Methods Data were collected using individual semistructured interviews. Twelve participants who had moved to a private hospital from a public hospital were encouraged to explain why they had made the move. Crossley's analytic method was adopted to analyse the collected data. Results The nurses' stories were categorised into five sections: 'life in public hospitals', 'decision-making', 'life in the private hospitals', 'future plans' and 'values and beliefs'. Conclusions The results are consistent with those of previous studies showing that job satisfaction and demographic factors play significant roles in the decision of nurses to switch to another hospital. This study revealed specific reasons why the nurses made the move, such as the fairness of the remuneration policy, significant people and stressors. Relevance to clinical practice The results have relevance for hospital management with regard to strategies to consider when addressing the issues of staff retention and recruitment. [ABSTRACT FROM AUTHOR]

In this study, the motion of Lagrange's gyro about its fixed point in the presence of a perturbed torque, a gyroscopic torque, and a varied restoring one is searched. We assume sufficiently small angular velocity components in the direction of the principal axes that differ from the dynamical symmetry one and a restoring torque that is considered to be greater than the perturbing one. In this manner, we replace the familiar small parameter that was used in previous works with a large one. In such cases, the gyro equations for motion (EOM) are formulated in the form of a two-degrees-of-freedom (DOF) autonomous system. We average the obtained system to get periodic solutions and motion's geometric interpretation of the problem using the large parameter. The regular precession and the pure rotation of the motion are obtained. A numerical study is evaluated for asserted the used techniques and showed the influence of the changing parameters of motion on the gyro behavior. The trajectories of the motions and their stabilities are discussed and analyzed. The novelty of this work lies in how to adapt the method of large parameter (MLP) to solve the rigid body problem, especially since it has been assumed initially that its angular velocity or its initial energy are very small. MSC (2000): 70E20, 70E17, 70E15, 70E05 [ABSTRACT FROM AUTHOR]

Background The male:female (M:F) mortality ratio for under-five mortality varies considerably across and within societies. Maternal education has been linked to better outcomes for girls, but the evidence is mixed. We examined how the M:F ratio for under-five mortality varies by maternal education in sub-Saharan Africa and southern Asia.Methods We used recent Demographic and Health Surveys from 31 sub-Saharan African and 4 southern Asian countries. M:F mortality ratios were determined using information on 49 769 deaths among 521 551 children. We estimate M:F ratios for under-five (month 0–59), neonatal (month 0), post-neonatal (month 1–11) and child mortality (month 12–59) by maternal education while controlling for demographic and household characteristics. M:F ratios for under-five mortality and child mortality are compared with more ‘gender neutral’ thresholds (of 1.25 and 1.17, respectively) estimated on the basis of the Human Mortality Database.Results In sub-Saharan Africa, the M:F ratio for under-five mortality is 1.09 [95% confidence interval (CI) 1.06–1.13] among non-educated mothers, 1.14 (95% CI 1.09–1.19) among mothers with some primary education and 1.25 (95% CI 1.16–1.34) among mothers with some secondary or more education. For southern Asia, the ratios are 0.88 (95% CI 0.82–0.95), 1.10 (95% CI 0.97–1.25) and 1.13 (95% CI 1.02–1.26), respectively. The M:F ratio for child mortality also shows an educational gradient in both regions, with the M:F ratio being lower among non-educated mothers. In southern Asia, the M:F ratio for child mortality is particularly low among mothers with no education, M:F ratio = 0.54 (95% CI 0.41–0.72).Conclusions Among mothers with more education, the difference in the mortality chances of boys and girls more closely resembles a ‘gender neutral’ situation than among women with no or little education. Girls benefit both in absolute and relative terms from having a more educated mother. [ABSTRACT FROM PUBLISHER]

As the Agulhas Current flows along the south-east coast of South Africa, a number of processes operate that bring cold, deep water up onto the narrow shelf. As a consequence, upwelling along the coastline is enhanced farther southward and downstream. This situation is investigated off Algoa Bay and along the south-east coast to Port Alfred, where measurements demonstrate that marked temperature variability occurs at the coastline, particularly in summer when temperature structures are more intense and easterly-component winds more common. There is no indication that upwelling is more prevalent at Port Alfred; increasing variability farther south is evident at Woody Cape/Cape Padrone, where the coastline veers westwards, forming the eastern boundary of Algoa Bay. Here it is found that, after a wind change to north-easterly, cold water is upwelled along the shoreline between 19 hours and 2.5 days later. Such upwelling progresses north-eastwards with the movement of the wind and weather systems, although colder water also moves south-westwards into Algoa Bay. Winds, currents, sea level and sea temperatures are highly correlated, with fluctuations in sea level measuring >50 cm being associated with coastal trapped waves (CTWs). Such barotropic wind-driven CTWs are frequently active during upwelling, although it is unclear whether there is any interaction between the two phenomena. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period.Background: Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation.Methods: By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors.Results: Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95-0.95, p < 0.001).Conclusions: From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States. [ABSTRACT FROM AUTHOR]

Symptoms of chronic rhinosinusitis (CRS) often persist despite treatment. Because nontuberculous mycobacteria (NTM) are resistant to commonly used antimicrobial drugs and are found in drinking water that patients may use for sinus irrigation, we investigated whether some CRS patients were infected with NTM in New York, New York, USA, during 2001-2011. Two approaches were chosen: 1) records of NTM-infected CRS patients were reviewed to identify common features of infection and Mycobacterium species; 2) samples from plumbing in households of 8 NTM-infected patients were cultured for NTM presence. In 3 households sampled, M. avium sharing rep-PCR and pulsed field gel electrophoresis fingerprints identified M. avium isolates clonally related to the patients' isolates. We conclude that patients with treatment-resistant CRS may be infected with NTM and should have cultures performed for NTM so appropriate therapy can be instituted. In addition, the results suggest that CRS patients can be infected by NTM in their household plumbing. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care.Design: Prospective cohort study.Setting: Eight urban hospitals, five countries in Asia.Participants: Adult patients with severe sepsis or septic shock.Interventions: Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles.Main Outcome Measures: Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model.Methods: In the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care.Results: Five hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables.Conclusions: Through education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model. [ABSTRACT FROM AUTHOR]

We aimed to evaluate insulin secretion and insulin sensitivity in adults born preterm and their children. Subjects were adults born both preterm and at term, with their children aged 5-10 years born at term. Insulin sensitivity and secretion were assessed using hyperglycemic clamps in adults and frequently sampled intravenous glucose tolerance tests using Bergman minimal model in children. In total, 52 adults aged 34-38 years participated (31 born preterm, mean gestational age 33.3 weeks). Adults born preterm were less insulin sensitive than those born at term (19.0 ± 2.5 vs. 36.3 ± 5.2 mg · kg(-1) · min(-1)mU · L; P < 0.05) with compensatory increased first-phase insulin secretion (56.1 ± 8.5 vs. 25.3 ± 3.7 mU/L; P < 0.001) but similar disposition index indicating appropriate insulin secretion. These differences were independent of sex and remained when subjects born <32 weeks' gestation were excluded from analyses. In total, 61 children were studied (37 of preterm parents, mean age 7.9 ± 0.3 years). Children of parents born preterm had similar insulin sensitivity to children of parents born at term, but a correlation between parental and offspring insulin sensitivity was noted only among children of parents born preterm. In conclusion, adults born preterm have insulin resistance in midadulthood, but this was not associated with insulin resistance in their children. [ABSTRACT FROM AUTHOR]

Background Clinicians find standardized mean differences (SMDs) calculated from continuous outcomes difficult to interpret. Our objective was to determine the performance of methods in converting SMDs or means to odds ratios of treatment response and numbers needed to treat (NNTs) as more intuitive measures of treatment effect.Methods Meta-epidemiological study of large-scale trials (&geq;100 patients per group) comparing active treatment with placebo, sham or non-intervention control. Trials had to use pain or global symptoms as continuous outcomes and report both the percentage of patients with treatment response and mean pain or symptom scores per group. For each trial, we calculated odds ratios of observed treatment response and NNTs and approximated these estimates from SMDs or means using all five currently available conversion methods by Hasselblad and Hedges (HH), Cox and Snell (CS), Furukawa (FU), Suissa (SU) and Kraemer and Kupfer (KK). We compared observed and approximated values within trials by deriving pooled ratios of odds ratios (RORs) and differences in NNTs. ROR <1 and positive differences in NNTs imply that approximations are more conservative than estimates calculated from observed treatment response. As measures of agreement, we calculated intraclass correlation coefficients.Results A total of 29 trials in 13 654 patients were included. Four out of five methods were suitable (HH, CS, FU, SU), with RORs between 0.92 for SU [95% confidence interval (95% CI), 0.86–0.99] and 0.97 for HH (95% CI, 0.91–1.04) and differences in NNTs between 0.5 (95% CI, −0.1 to −1.6) and 1.3 (95% CI, 0.4–2.1). Intraclass correlation coefficients were &geq;0.90 for these four methods, but &leq;0.76 for the fifth method by KK (P for differences &leq;0.027).Conclusions The methods by HH, CS, FU and SU are suitable to convert summary treatment effects calculated from continuous outcomes into odds ratios of treatment response and NNTs, whereas the method by KK is unsuitable. [ABSTRACT FROM PUBLISHER]

Contents Seventy pluriparous high-yielding cows were used to investigate the impact of metabolic traits and body condition score (BCS) during early lactation on subclinical endometritis diagnosed at weeks 5, 6 and 7 postpartum (pp). Blood samples were collected from animals with no peripartum problems from the second (W2) to seventh (W7) weeks pp to estimate some blood metabolites including non-esterified fatty acids (NEFA), β-hydroxybutyric acid (BHBA), blood glucose, total cholesterol (T-chol) and blood urea nitrogen (BUN). Reproductive tract examination was carried out at weeks 5, 6 and 7 pp by endometrial cytology (percentage of polymorphonuclear cells; PMN%). Based on PMN%, animals having <5% were defined as subclinical endometritis group (ENDM group) while animals unaffected by endometritis were defined as no subclinical endometritis group (NOENDM group). Animals with endometritis during week 5 were identified as ENDM5, during week 6 identified as ENDM6 and during week 7 identified as ENDM7 or animals with no endometritis during weeks 5 (NOENDM5), 6 (NOENDM6) and 7 (NOENDM7) pp. Animals diagnosed at week 5; BUN and BCS were lower p < 0.05 in ENDM 5 than NOENDM5 group at W2, W4, W6 and W7. Cows diagnosed at week 6; T-chol was significantly higher (p = 0.05) in ENDM6 group (279.2 ± 12.5 mg/dl) than NOENDM6 group (246 ± 9.5 mg/dl) at W7. Moreover, blood glucose was significantly low (p < 0.05) in ENDM6 group when compared to NOENDM group at W4 pp (49.2 ± 1.8 vs 53.8 ± 1.3 mg/dl). BCS was significantly lower (p < 0.001) in animals suffered from endometritis during week 7 when compared to NOENDM7 cows at W3, W4, W5, W6 and W7. In conclusion, lower blood glucose, BUN and BCS could be a risk factor for cytologically diagnosed endometritis at weeks 5, 6 and 7 pp. [ABSTRACT FROM AUTHOR]

Background: The effects of biological and physical factors on cognitive aging are widely studied. Less is known about the role of psychosocial factors such as stress and social relationships for cognitive functioning.Methods: Speakers in Session IV of the Summit focused on possible mechanisms linking social interactions and stressful experiences to cognitive changes with aging.Results: Elevated cortisol, repetitive thinking, negative emotions, neuroticism, chronic stress, and early life adversity were negatively associated with memory and other cognitive dimensions in later life. In contrast, supportive social relationships were found to be positively related to cognitive functioning. Some evidence was provided for multidirectional, causal relationships involving stress and negative affect as both antecedents and consequences of cognitive decline.Conclusions: The findings contribute to understanding the potential underlying causal processes linking psychosocial factors and cognitive aging with a developmental focus on the etiology of declines and onset of cognitive impairments. This work provides an important foundation for future research to identify modifiable factors and to design interventions to minimize cognitive declines and optimize cognitive health in adulthood. [ABSTRACT FROM AUTHOR]

Dupuytren's disease is a fibroproliferative disease of the palmar fascia which has been described for centuries, yet the aetiology and pathophysiology remain poorly understood. Surgery and collagenase injections comprise the main therapeutic options but disease recurrence is common. We explore the evidence underlying the current disease theories and outline other potential therapeutic options. [ABSTRACT FROM AUTHOR]

CONTEXT: The Pain Anxiety Symptoms Scale (PASS) was designed to assess pain-related anxiety and fear. Although the scale is a reliable measure with good psychometric properties, its validity among ethnic Chinese has yet to be evaluated. OBJECTIVES: This study aimed to translate the English-language version of the 20-item PASS into Chinese (ChPASS-20) and evaluate its factor structure, reliability, and validity. METHODS: A total of 223 Chinese patients with chronic musculoskeletal pain attending orthopedic specialist clinics completed the ChPASS-20, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item Tampa Scale of Kinesiophobia, the Hospital Anxiety and Depression Scale, and questions assessing sociodemographic and pain characteristics. RESULTS: Confirmatory factor analyses showed that all the five-factor solutions tested met the minimum acceptable fit criterion. The four ChPASS-20 subscales and the entire scale demonstrated good internal consistency (Cronbach's [alpha]s: 0.72-0.92). All ChPASS-20 scales showed significant positive correlations with depression, pain intensity, and disability. Hierarchical multiple regression analyses showed that the ChPASS-20 total score predicted concurrent depression [F(4,159)=11.97, P<0.001], pain intensity [F(4,161)=2.47, P<0.05], and pain disability [F(4,191)=5.47, P<0.001] scores, and the ChPASS-20 Avoidance subscale (standardized beta coefficient=0.21, P<0.05) emerged as a significant independent predictor of concurrent pain disability. CONCLUSION: Our data support the factorial validity, reliability, and construct validity of the ChPASS-20 in a Chinese population.Copyright © 2012 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

The recent trend in treatment of hypopharyngeal cancer is organ preservation in order to maintain swallowing and speech function as well as improve quality of life. Transoral robotic surgery (TORS) can remove hypopharyngeal lesions successfully without an external incision, preserving physiologic functions of affected organs. However, studies have yet to assess the oncologic and functional results of TORS for the treatment of hypopharyngeal cancer. This prospective study evaluated the oncologic and functional results of TORS for the treatment of hypopharyngeal cancer obtained at our institution over a period of 3years and confirmed the validity of TORS as a surgical organ-preserving strategy. Between April 2008 and September 2011, 23 patients who were diagnosed with hypopharyngeal cancer underwent TORS for removal of a primary lesion. The da Vinci Robotic system (Intuitive Surgical Inc., Sunnyvale, California) was used to remove the lesion. The Kaplan-Meier method was used to analyze overall survival and disease-free survival. Videopharyngogram study (VEF) was performed and functional outcome swallowing scale (FOSS) was utilized to measure and evaluate swallowing function. Acoustic wave form analysis was conducted to evaluate voice status. Overall survival at 3years was 89% and disease-free survival was 84%. On the VEF study, serious aspiration or delay of swallowing was not observed during the pharyngeal stage of the swallowing process. Overall, 96% of the patients showed favorable swallowing abilities with an FOSS score ranging from 0 to 2. The fundamental frequency variation (vF0) and jitter were increased upon acoustic waveform analysis (vF0=2.71±0.063, Jitter=2.01±0.034), but the harmonic-to-noise ratio (HNR) and shimmer were maintained close to the normal range (HNR=1.28±0.001, Shim=1.74±0.036). The oncologic and functional results of TORS were quite acceptable for the treatment of hypopharyngeal cancer. TORS is a valid treatment option as a surgical, organ-preserving strategy for select patients with hypopharyngeal cancer. [ABSTRACT FROM AUTHOR]

Background: Tumor enlargement after chemotherapy is considered one of the high-risk factors for local recurrence and survival in osteosarcoma. We hypothesized patients with this risk factor will have similar survival regardless of the development of local recurrence.Questions/purposes: We asked (1) the prognostic factors for survival in our cohort, (2) how much effect local recurrence has on survival among patients with similar preoperative risk factors, and (3) what prognostic factors are important for survival in these selected patients.Methods: We analyzed the prognostic factors for survival in 449 patients with extremity osteosarcoma without metastatic disease at initial diagnosis and treatment (38 with local recurrence, 411 without local recurrence). We compared the survival difference between patients with local recurrence (n = 38) and without local recurrence (control, n = 76) matched for age, location, initial tumor volume, and tumor volume change after chemotherapy, and assessed prognostic factors in this subgroup.Results: In a cohort study, multivariate analysis revealed initial tumor volume, tumor enlargement, inadequate margin, and local recurrence predicted poor survival. In the case-control study, the 10-year metastasis-free survival rates of two groups were 13.1 ± 10.7% and 19.3 ± 9%, respectively. In the case-controlled groups, tumor enlargement and initial tumor volume showed multivariate significance.Conclusions: Local recurrence has a small impact on survival in patients with high-risk osteosarcoma.Level Of Evidence: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]