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Aims: To use linked routinely-collected health data to estimate diabetes prevalence and incidence in an Australian cohort of adults aged ≥45 years, and examine risk factors associated with incident disease. Research design and methods: The EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45) Study is a linked data study that combines baseline questionnaire responses from the population-based 45 and Up Study (2006–2009, n = 267,153) with multiple routinely-collected health databases up to December 2014. Among participants with ≥1 linked result for any laboratory test, diabetes status was determined from multiple data sources according to standard biochemical criteria, use of glucose-lowering medication or self-report, and the prevalence and incidence rate calculated. Independent risk factors of incident diabetes were examined using multivariable Cox regression. Results: Among 152,169 45 and Up Study participants with ≥1 linked laboratory result in the EXTEND45 database (mean age 63.0 years; 54.9% female), diabetes prevalence was 10.8% (95% confidence interval [CI] 10.6%–10.9%). Incident disease in those without diabetes at baseline (n = 135,810; mean age 62.5 years; 56.1% female) was 10.0 per 1,000 person-years (95% CI 9.8–10.2). In all age groups, diabetes incidence was lower in women compared to men, an association that persisted in the fully adjusted analyses. Other independent risk factors of diabetes were older age, being born outside of Australia (with the highest rate of 19.2 per 1,000 person-years observed in people born in South and Central Asia), lower education status, lower annual household income, residence in a major city, family history of diabetes, personal history of cardiovascular disease or hypertension, higher body mass index, smoking and long sleeping hours. Conclusions: Our study represents an efficient approach to assessing diabetes frequency and its risk factors in the community. The infrastructure provided by the EXTEND45 Study will be useful for diabetes surveillance and examining other important clinical and epidemiological questions.

The large area wire grid polarizers (LA-WGPs) with 50 nm half-pitch were fabricated using ArF immersion lithography overcoming the limit of the shot field size. To realize the 50 nm line and space patterns on a 300 mm wafer, a zero-distance stitching process that connects the shot fields is suggested. To compensate for mutual interference between the shot fields which is called the local flare effect (LFE), the shot field arrangement is changed with optical proximity correction (OPC). Using a master wafer produced by the suggested method, 300 mm large-area WGPs were fabricated by the nano-imprint process. The WGPs have more than 80% transmittance in the visible light region, and the possibility of performance improvement can be confirmed depending on the number and method of the etch process.

A wide range of interest has been recently focused on the reconstruction of long-segment tracheal defects, especially in the field of thoracic reconstructive surgery. Although a number of treatment methods for tracheal reconstruction have been developed, reconstruction of critical sized defects (>6 cm) is always a major challenge in trachea surgery. In the field of tissue engineering, reconstruction of tissues using artificial substitutes has shown promises in addressing this challenge, particularly with much success in tracheal reconstruction achieved by multiple institutions. The aim of this study is to develop an off-the-shelf treatment method that can be achieved without imposing cells even for urgent applications to tracheal disorders or injuries. We designed an off-the-shelf tracheal graft without imposing the cells for the concept of urgent transplantation from a porous PCL bellows framework that we developed in our previous works. We then evaluated the application of our off-the-shelf treatment method using an artificial graft in vivo at a proof-of-concept level using a rabbit model. We successfully demonstrated the potential of an off-the-shelf tracheal graft with luminal collagen stratification for immediate application in emergencies that require an artificial graft. Keywords: Tracheal reconstruction, Tissue engineering, Three-dimensional (3D) bioprinting

Background: There are limited studies on the effects of statins on outcomes in the moderate chronic kidney disease (CKD) population and their trajectory to end-stage kidney disease. Objective: To examine the long-term effects of lipid-lowering therapy on all-cause mortality, cardiovascular morbidity, CKD progression, and socioeconomic well-being in Australian, New Zealand, and Malaysian SHARP (Study of Heart and Renal Protection) trial participants—a randomized controlled trial of a combination of simvastatin and ezetimibe, compared with placebo, for the reduction of cardiovascular events in moderate to severe CKD. Design: Protocol for an extended prospective observational follow-up. Setting: Australian, New Zealand, and Malaysian participating centers in patients with advanced CKD. Patients: All SHARP trial participants alive at the final study visit. Measurements: Primary outcomes were measured by participant self-report and verified by hospital administrative data. In addition, secondary outcomes were measured using a validated study questionnaire of health-related quality of life, a 56-item economic survey. Methods: Participants were followed up with alternating face-to-face visits and telephone calls on a 6-monthly basis until 5 years following their final SHARP Study visit. In addition, there were 6-monthly follow-up telephone calls in between these visits. Data linkage to health registries in Australia, New Zealand, and Malaysia was also performed. Results: The SHARP-Extended Review (SHARP-ER) cohort comprised 1136 SHARP participants with a median of 4.6 years of follow-up. Compared with all SHARP participants who originally participated in the Australian, New Zealand, and Malaysian regions, the SHARP-ER participants were younger (57.2 [48.3-66.4] vs 60.5 [50.3-70.7] years) with a lower proportion of men (61.5% vs 62.8%). There were a lower proportion of participants with hypertension (83.7% vs 85.0%) and diabetes (20.0% vs 23.5%). Limitations: As a long-term follow-up study, the surviving cohort of SHARP-ER is a selected group of the original study participants, which may limit the generalizability of the findings. Conclusion: The SHARP-ER study will contribute important evidence on the long-term outcomes of cholesterol-lowering therapy in patients with advanced CKD with a total of 10 years of follow-up. Novel analyses of the socioeconomic impact of CKD over time will guide resource allocation. Trial Registration: The SHARP trial was registered at ClinicalTrials.gov NCT00125593 and ISRCTN 54137607.

Objective To assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy. Methods Acute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures. Results There were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p

Abstract Background Tuberculum sellae meningioma associated with aneurysm is extremely rare with a limited number of individual cases previously reported. Because of the complicated anatomical structure of the skull base, comorbid disease in the sellae region is a challenging problem and is associated with high mortality in neurosurgery. Case presentation This case report describes a rare case of comorbid bilateral internal carotid artery aneurysms and tuberculum sellae meningioma. This 58-year-old female presented with headache and nausea. She had lost her light perception in the right eye, and the right optic disc was degenerated. She also had a 5-year history of hypertension. This patient underwent a right pterional craniotomy, and we accomplished to clip the bilateral intracranial aneurysms and concurrently remove the tumor. After the surgery, we confirmed that both of the aneurysms were completely isolated, and the tumor was adequately resected. This patient had not suffered other neurological deficits. Unfortunately, her visual acuity had not recovered. Conclusions As we know, this is the first report of a unilateral surgical approach to clip the bilateral intracranial aneurysms and concurrently remove the tumor. It may provide a reference for clinical treatment of the similar disease.

Data on hyperkalemia frequency among chronic kidney disease (CKD) patients receiving renin-angiotensin aldosterone system inhibitors (RAASis) and its impact on subsequent RAASi treatment are limited. This population-based cohort study sought to assess the incidence of clinically significant hyperkalemia among adult CKD patients who were prescribed a RAASi and the proportion of patients with RAASi medication change after experiencing incident hyperkalemia. We conducted a retrospective, population-based cohort study (1 January 2013-30 June 2017) using Australian national general practice data from the NPS MedicineWise's MedicineInsight program. The study included adults aged ≥18 years who received ≥1 RAASi prescription during the study period and had CKD (estimated glomerular filtration rate [eGFR] 6 mmol/L or a record of hyperkalemia diagnosis) and among patients who experienced incident hyperkalemia, the proportion who had RAASi medication changes (cessation or dose reduction during the 210-day period after the incident hyperkalemia event). Among 20,184 CKD patients with a median follow-up of 3.9 years, 1,992 (9.9%) patients experienced an episode of hyperkalemia. The overall incidence rate was 3.1 (95% CI: 2.9-3.2) per 100 person-years. Rates progressively increased with worsening eGFR (e.g. 3.5-fold increase in patients with eGFR

There have been no large-scale studies on the epidemiology of benign convulsions with mild gastroenteritis (CwG) since the introduction of the rotavirus vaccine in South Korea in 2007. This study aimed to analyze the trends in rotavirus gastroenteritis (RVGE) and rotavirus-associated CwG (RaCwG) after rotavirus vaccination. Further, we aimed to analyze changes in norovirus gastroenteritis (NVGE) and norovirus-associated CwG (NaCwG) using nationwide data from the Korean Health Insurance Review and Assessment Service. Between 2007 and 2019, this study analyzed children aged

Using polyethylene as carbon precursor, we have fabricated cost-effective carbon fibers with a sheath-core structure via conjugate melt spinning. Low-density polyethylene (LDPE) and high-density polyethylene (HDPE) were used as the sheath and core of the fiber, respectively, while sulfonation with sulfuric acid was conducted to enable the crosslinking of polyethylene. We demonstrated that carbonization and activation of the sheath-core-structured polyethylene fiber can result in a well-developed microporous structure in the sheath layer, and due to the core-sheath structure, the resulting activated carbon fibers exhibit a high tensile strength of ~455 MPa, initial modulus of ~14.4 GPa, and Brunauer-Emmett-Teller (BET) surface area of ~1224 m2/g. Finally, activated carbon fibers with a hollow, sheath-core, and porous were successfully fabricated by controlling the degree of crosslinking of the LDPE/HDPE sheath-core fiber.

In this study, a carbon fiber-reinforced thermoplastic composite was fabricated using a new aromatic polyamide (APA) as a matrix. Non-isothermal crystallization behaviors in the cooling process of APA resin (a semi-crystalline polymer) and composite were analyzed by using a differential scanning calorimeter (DSC). To determine the optimum molding conditions, processing parameters such as the molding temperature and time were varied during compression molding of the Carbon/APA composite. The tensile and flexural properties and morphologies of the fabricated composites were analyzed. Molding at 270 °C and 50 MPa for 5 min. showed relatively good mechanical properties and morphologies; thus, this condition was selected as the optimal molding condition. In addition, to enhance the thermal conductivity of the Carbon/APA composite, a study was conducted to add hexagonal boron nitride (h-BN) as a filler. The surface of h-BN was oxidized to increase its miscibility in the resin, which resulted in better dispersity in the APA matrix. In conclusion, a Carbon/APA (h-BN) composite manufactured under optimal molding conditions with an APA resin containing surface-treated h-BN showed a thermal conductivity more than twice that of the case without h-BN.

Sea hare-derived compounds induce macrophage activation and reduce asthmatic parameters in mouse models of allergic asthma. These findings led us to study the role of sea hare hydrolysates (SHH) in cancer pathophysiology. SHH treatment-induced M1 macrophage activation in RAW264.7 cells, peritoneal macrophages, and THP-1 cells, as did lipopolysaccharide (LPS) (+ INF-γ), whereas SHH reduced interleukin (IL)-4 (+IL-13)-induced M2 macrophage polarization. In addition, SHH treatment inhibited the actions of M1 and M2 macrophages, which have anticancer and pro-cancer effects, respectively, in non-small cell lung cancer cells (A549 and HCC-366) and tumor-associated macrophages (TAMs). Furthermore, SHH induced G2/M phase arrest and cell death in A549 cells. SHH also downregulated STAT3 activation in macrophages and A549 cells, and the down-regulation was recovered by colivelin, a STAT3 activator. SHH-induced reduction of M2 polarization and tumor growth was blocked by colivelin treatment. SHH-induced cell death did not occur in the manner of apoptotic signaling pathways, while the death pattern was mediated through pyroptosis/necroptosis, which causes membrane rupture, formation of vacuoles and bleb, activation of caspase-1, and secretion of IL-1β in SHH-treated A549 cells. However, a combination of SHH and colivelin blocked caspase-1 activation. Z-YVAD-FMK and necrostatin-1, pyrotosis and necroptosis inhibitors, attenuated SHH’s effect on the cell viability of A549 cells. Taken together, SHH showed anticancer effects through a cytotoxic effect on A549 cells and a regulatory effect on macrophages in A549 cells. In addition, the SHH-induced anticancer effects were mediated by non-apoptotic regulated cell death pathways under STAT3 inhibition. These results suggest that SHH may be offered as a potential remedy for cancer immunotherapy.

This study considers the possibility of utilizing agri-byproducts as energy sources via pelletization and torrefaction. Pellets were placed in a capsule and torrefied in an electrical furnace. Subsequently, they were cooled for 30 min, and their mass loss was measured. To investigate the resulting changes in fuel characteristics, ultimate and proximate analyses were performed, and calorific values were measured. To estimate the water absorption of the pellets, hygroscopicity evaluations were conducted. Based on the experimental results, the energy yield, lower heating value, and exergy were calculated to determine the optimum conditions for torrefaction. The calculation was performed by utilizing the useful exergy and standards applied to biomass power plants. We determined that torrefaction for agro-pellets should be conducted under low-to-intermediate temperatures (210−250 °C) within a period of 50 min. Under these conditions, 7−55% mass reductions were observed, the higher heating value increased from 4110 to 6880 kcal kg−1, and the lower heating value changed from 3780 to 6520 kcal kg−1 owing to reduced hygroscopicity. So, Agro-byproducts can contribute to the practical application by improving the heating value through torrefaction as an alternative to wood pellets.

This research proposes an algorithm that improves the position accuracy of indoor pedestrian dead reckoning, by compensating the position error with a magnetic field map-matching technique, using multiple magnetic sensors and an outlier mitigation technique based on roughness weighting factors. Since pedestrian dead reckoning using a zero velocity update (ZUPT) does not use position measurements but zero velocity measurements in a stance phase, the position error cannot be compensated, which results in the divergence of the position error. Therefore, more accurate pedestrian dead reckoning is achievable when the position measurements are used for position error compensation. Unfortunately, the position information cannot be easily obtained for indoor navigation, unlike in outdoor navigation cases. In this paper, we propose a method to determine the position based on the magnetic field map matching by using the importance sampling method and multiple magnetic sensors. The proposed method does not simply integrate multiple sensors but uses the normalization and roughness weighting method for outlier mitigation. To implement the indoor pedestrian navigation algorithm more accurately than in existing indoor pedestrian navigation, a 15th-order error model and an importance-sampling extended Kalman filter was utilized to correct the error of the map-matching-aided pedestrian dead reckoning (MAPDR). To verify the performance of the proposed indoor MAPDR algorithm, many experiments were conducted and compared with conventional pedestrian dead reckoning. The experimental results show that the proposed magnetic field MAPDR algorithm provides clear performance improvement in all indoor environments.

In this article, a porous hollow biotemplated nanoscale helix that can serve as a low Reynolds number robotic swimmer is reported. The nanorobot utilizes repolymerized bacterial flagella from Salmonella typhimurium as a nanotemplate for biomineralization. We demonstrate the ability to generate templated nanotubes with distinct helical geometries by using specific alkaline pH values to fix the polymorphic form of flagellar templates. Using uniform rotating magnetic fields to mimic the motion of the flagellar motor, we explore the swimming characteristics of these silica templated flagella and demonstrate the ability to wirelessly control their trajectories. The results suggest that the biotemplated nanoswimmer can be a cost-effective alternative to the current top-down methods used to produce helical nanorobots.

Human activities such as oil and gas production can enhance the natural level of naturally occurring radioactive materials (NORM) in by-product and waste streams. Iran has been among the top five oil producing countries since 2005. This high production rate emphasizes the importance of NORM management to ensure the safety of humans and wildlife. Petroleum storage and transport facilities are located at Lavan Island, Iran. Presence of animals including dolphins, sea turtles, and chinkaras make this island one of the most unique wildlife refuges in Iran. This paper combines waste disposal methods relevant to the petroleum offshore industries, NORM waste characteristics, and geographical, geological, and climate conditions of Lavan Island in order to develop enveloping exposure scenarios. Sludge burning is determined as the most concerning scenario by assuming chinkaras as the endpoint. Ecological and radiological assessment procedure is modeled with MATLAB-Simulink as a dynamic system. Clearance level for radiation protection of chinkaras is calculated as 41 Bq/kg. This value may be insufficient for radiation protection of workers, because exposure pathways are not derived based on human behavior. According to environmental pathways and condition of chinkaras, this value sufficiently covers all aspects of radiation protection.

In order to broaden the use of microrobots in practical fields, autonomous control algorithms such as obstacle avoidance must be further developed. However, most previous studies of microrobots used manual motion control to navigate past tight spaces and obstacles while very few studies demonstrated the use of autonomous motion. In this paper, we demonstrated a dynamic obstacle avoidance algorithm for bacteria-powered microrobots (BPMs) using electric field in fluidic environments. A BPM consists of an artificial body, which is made of SU-8, and a high dense layer of harnessed bacteria. BPMs can be controlled using externally applied electric fields due to the electrokinetic property of bacteria. For developing dynamic obstacle avoidance for BPMs, a kinematic model of BPMs was utilized to prevent collision and a finite element model was used to characteristic the deformation of an electric field near the obstacle walls. In order to avoid fast moving obstacles, we modified our previously static obstacle avoidance approach using a modified vector field histogram (VFH) method. To validate the advanced algorithm in experiments, magnetically controlled moving obstacles were used to intercept the BPMs as the BPMs move from the initial position to final position. The algorithm was able to successfully guide the BPMs to reach their respective goal positions while avoiding the dynamic obstacles.

Advances in microrobotics for biological applications are often limited due to their complex manufacturing processes, which often utilize cytotoxic materials, as well as limitations in the ability to manipulate these small devices wirelessly. In an effort to overcome these challenges, we investigated a facile method for generating biocompatible hydrogel based robots that are capable of being manipulated using an externally generated magnetic field. Here, we experimentally demonstrate the fabrication and autonomous control of loaded-alginate microspheres, which we term artificial cells. In order to generate these microparticles, we employed a centrifuge-based method in which microspheres were rapidly ejected from a nozzle tip. Specifically, we used two mixtures of sodium alginate; one containing iron oxide nanoparticles and the other containing mammalian cells. This mixture was loaded into a needle that was fixed on top of a microtube containing calcium chloride, and then briefly centrifuged to generate hundreds of Janus microspheres. The fabricated microparticles were then magnetically actuated with a rotating magnetic field, generated using electromagnetic coils, prompting the particles to roll across a glass substrate. Also, using vision-based feedback control, a single artificial cell was manipulated to autonomously move in a programmed pattern.

Polymer actuators are important components in lab-on-a-chip and micromechanical systems because of the inherent properties that result from their large and fast mechanical responses induced by molecular-level deformations (e.g., isomerization). They typically exhibit bending movements via asymmetric contraction or expansion with respect to changes in environmental conditions. To enhance the mechanical properties of actuators, a strain gradient should be introduced by regulating the molecular alignment; however, the miniaturization of polymer actuators for microscale systems has raised concerns regarding the complexity of such molecular control. Herein, a novel method for the fabrication of micro-actuators using a simple molecular self-alignment method is presented. Amphiphilic molecules that consist of azobenzene mesogens were located between the hydrophilic and hydrophobic surfaces, which resulted in a splayed alignment. Thereafter, molecular isomerization on the surface induced a large strain gradient and bending movement of the actuator under ultraviolet-light irradiation. Moreover, the microelectromechanical systems allowed for the variation of the actuator size below the micron scale. The mechanical properties of the fabricated actuators such as the bending direction, maximum angle, and response time were evaluated with respect to their thicknesses and lengths. The derivatives of the polymer actuator microstructure may contribute to the development of novel applications in the micro-robotics field.

A Mediterranean dietary pattern is widely recommended for the prevention of chronic disease. We sought to define the most likely effects of the Mediterranean diet on vascular disease and mortality.We searched MEDLINE, EMBASE and the Cochrane Central Register without language restriction for randomized controlled trials comparing Mediterranean to control diets. Data on study design, patient characteristics, interventions, follow-up duration, outcomes and adverse events were sought. Individual study relative risks (RR) were pooled to create summary estimates.Six studies with a total of 10950 participants were included. Effects on major vascular events (n = 477), death (n = 693) and vascular deaths (n = 315) were reported for 3, 5 and 4 studies respectively. For one large study (n = 1000) there were serious concerns about the integrity of the data. When data for all studies were combined there was evidence of protection against major vascular events (RR 0.63, 95% confidence interval 0.53-0.75), coronary events (0.65, 0.50-0.85), stroke (0.65, 0.48-0.88) and heart failure (0.30, 0.17-0.56) but not for all-cause mortality (1.00, 0.86-1.15) or cardiovascular mortality (0.90, 0.72-1.11). After the study of concern was excluded the benefit for vascular events (0.69, 0.55-0.86) and stroke (0.66, 0.48-0.92) persisted but apparently positive findings for coronary events (0.73, 0.51-1.05) and heart failure (0.25, 0.05-1.17) disappeared.The Mediterranean diet may protect against vascular disease. However, both the quantity and quality of the available evidence is limited and highly variable. Results must be interpreted with caution.

Purpose of review: There is growing acknowledgement that engaging patients to identify their research priorities is important. Using a case study of patients on or nearing dialysis, we sought to assess the extent to which recently completed and ongoing clinical research was consistent with priorities identified by patients, caregivers, and clinicians. Sources of information: Over a 4-year sampling frame (January 2010 to December 2013), we systematically searched the medical literature (top 5 nephrology and top 10 general medicine journals accessed through MEDLINE via Ovid), international randomized controlled trial (RCT) registries, and national government and kidney research funding organizations (Canada, U.S., Australia, and U.K.) for published clinical studies, registered RCTs, and funded clinical studies, respectively. Published clinical studies, registered RCTs, and funded clinical studies were categorized as to whether or not they were consistent with the top 10 research priorities identified by patients, their caregivers, and clinicians in a recent comprehensive research priority setting exercise. Findings: The search yielded 4293 published articles, 688 RCTs, and 70 funded studies, of which 1116 articles, 315 RCTs, and 70 funded studies were eligible for inclusion. Overall 194 published studies (17.4 %), 71 RCTs (22.5 %), and 15 funded studies (21.4 %) included topics consistent with the top 10 research priorities identified by patients. Four of the top 10 research priorities, including strategies to improve the management of itching, increase access to kidney transplantation, assess the psychosocial impact of kidney failure, and determine the effects of dietary restriction received virtually no attention. Limitations: The top 10 priorities we used to categorize included studies were identified by Canadian patients, caregivers, and clinicians. The top research priorities may vary across different countries. The proportion of published studies that are consistent with the top 10 priorities could be different in nephrology journals with lower impact factors. Studies related to kidney transplantation and the psychosocial impact of kidney failure may have been published in journals not included in our search strategy. Implications: The majority of recently completed or ongoing clinical studies in patients on or nearing dialysis do not address the top research priorities of patients, raising concerns that current clinical research may not be meeting the needs of the ultimate consumer, in this case, patients on or nearing dialysis. Greater involvement of patients in research is required to bridge the gap between research and patients' needs.