Search

Objective.The Outcome Measures in Rheumatology (OMERACT) Shared Decision Making (SDM) Working Group aims to determine the core outcome domain set for measuring the effectiveness of SDM interventions in rheumatology trials.Methods.A white paper was developed to clarify the draft core domain set. It was then used to prepare for interviews to investigate reasons for lack of consensus on it and to suggest further improvements.Results.OMERACT scientists/clinicians (n = 13) and patients (n = 10) suggested limiting the core domain set to outcome domains, removing process domains, and clarifying remaining domains.Conclusion.A revised core domain set will undergo further consensus-building.

We calibrate the lateral mode AFM (LFM) by determining the position-sensitive photodetector (PSPD) signal dependency on the lateral tip displacement, which is analogous to the constant-compliance region in normal-force calibration. By stick-slip on stiff, amorphous surfaces (silica or glass), the lateral tip displacement is determined accurately using the feedback loop control of AFM system. The sufficiently high contact stiffness between the Si AFM tip and stiff, amorphous surfaces substantially reduces the error of PSPD signal dependency on the lateral tip displacement. No damage or modification of the AFM probe is involved and only a clean silicon or glass wafer is needed.

Objective Electroencephalogram (EEG) reactivity is a robust predictor of neurological recovery after cardiac arrest, however interrater-agreement among electroencephalographers is limited. We sought to evaluate the performance of machine learning methods using EEG reactivity data to predict good long-term outcomes in hypoxic-ischemic brain injury. Methods We retrospectively reviewed clinical and EEG data of comatose cardiac arrest subjects. Electroencephalogram reactivity was tested within 72 h from cardiac arrest using sound and pain stimuli. A Quantitative EEG (QEEG) reactivity method evaluated changes in QEEG features (EEG spectra, entropy, and frequency features) during the 10 s before and after each stimulation. Good outcome was defined as Cerebral Performance Category of 1–2 at six months. Performance of a random forest classifier was compared against a penalized general linear model (GLM) and expert electroencephalographer review. Results Fifty subjects were included and sixteen (32%) had good outcome. Both QEEG reactivity methods had comparable performance to expert EEG reactivity assessment for good outcome prediction (mean AUC 0.8 for random forest vs. 0.69 for GLM vs. 0.69 for expert review, respectively; p non-significant). Conclusions Machine-learning models utilizing quantitative EEG reactivity data can predict long-term outcome after cardiac arrest. Significance A quantitative approach to EEG reactivity assessment may support prognostication in cardiac arrest.

Background: The 1-year results of the use of the Nellix (Endologix Inc, Irvine, Calif) endovascular aneurysm sealing (EVAS) device were initially promising. However, midterm complications including migration and aneurysm growth occurred more frequently than expected, which provided an incentive to refine the instructions for use. Strategies for the management of complications arising after endovascular aneurysm repair are often not applicable for EVAS, given the unique configuration of the Nellix device, and new techniques are needed. This study analyzes the clinical outcomes of both elective and emergency deployment of a new Nellix device within a primarily placed device, for failure of EVAS, which we refer to as a Nellix-in-Nellix application (NINA).Methods: This is a global, retrospective, observational cohort study focusing on the early outcome of NINA for failed EVAS, including data from 11 European institutions and 1 hospital in New Zealand.Results: A total of 41 patients were identified who underwent a NINA procedure. Of these, 32 (78%) were placed electively and 9 (22%) were placed on an emergency basis. Seven patients were initially treated with chimney EVAS (n = 5 in the elective NINA group and n = 2 in the emergency NINA group). The average time between the primary EVAS procedure and NINA was 573 days (interquartile range, [IQR] 397-1078 days) and 478 days (IQR, 120-806) for the elective and emergency groups, respectively. The indication for elective NINA was endoleak with migration (50%), endoleak without migration (25%), migration without endoleak (16%), and other (9%). Chimney grafts were used in 21 of 32 patients in the elective group and 3 of 9 patients in the emergency group. Technical success was achieved in 94% of patients in the elective group and 100% of patients in the emergency group. At latest follow-up (median, 104 days; IQR, 49-328 days), there were three aneurysm-related deaths (9%), no ruptures, and five device-related reinterventions (16%) within the elective group. In the emergency group (median follow-up, 23 days; IQR, 7-61 days), there were four aneurysm-related deaths and three aneurysm-related reinterventions.Conclusions: In conclusion, a NINA can be used to treat late failures of EVAS with an acceptable technical success rate and can be used when more established treatment options are unfeasible or contraindicated. The durability of this technique needs to be further reviewed.

We investigated how different graphical representations convey the underlying uncertainty distribution in ensemble predictions. In ensemble predictions, a set of forecasts is produced, indicating the range of possible future states. Adopting a use case from life sciences, we asked non-expert participants to compare ensemble predictions of the growth distribution of individual children to that of the normal population. For each individual child, the historical growth data of a set of 20 of its best matching peers was adopted as the ensemble prediction of the child’s growth curve. The ensemble growth predictions were plotted in seven different graphical formats (an ensemble plot, depicting all 20 forecasts and six summary representations, depicting the peer group mean and standard deviation). These graphs were plotted on a population chart with a given mean and variance. For comparison, we included a representation showing only the initial part of the growth curve without any future predictions. For 3 months old children that were measured at four occasions since birth, participants predicted their length at the age of 2 years. They compared their prediction to either (1) the population mean or to (2) a “normal” population range (the mean ± 2(standard deviation)). Our results show that the interpretation of a given uncertainty visualization depends on its visual characteristics, on the type of estimate required and on the user’s numeracy. Numeracy correlates negatively with bias (mean response error) magnitude (i.e. people with lower numeracy show larger response bias). Compared to the summary plots that yield a substantial overestimation of probabilities, and the No-prediction representation that results in quite variable predictions, the Ensemble representation consistently shows a lower probability estimation, resulting in the smallest overall response bias. The current results suggest that an Ensemble or “spaghetti plot” representation may be the best choice for communicating the uncertainty in ensemble predictions to non-expert users.

The influence of partial substitution of manganese by nickel or magnesium in Na0.44MnO2on cathode performance in sodium ion batteries has been investigated. Partial substitution changes the structure of parent Na0.44MnO2 from tunnel into layered P2-type, or a mixture of P2- and P3-type materials. Substitution smoothes the charge/discharge curves and may significantly improve capacity, albeit with a lower capacity retention relative to pristine Na0.44MnO2. In particular, high discharge capacities are found in the voltage range 2.0–4.2 V at 0.1 C rate for Na0.44Mn0.89Ni0.11O2 (193 mAh g−1) and Na0.44Mn0.89Mg0.11O2 (188 mAh g−1), with a capacity retention of 74% and 81%, respectively, after 70 cycles.

Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

A systematic approach is described for the fabrication of defect-free high-silica zeolite membranes with CHA (SSZ-13) topology. Home-made hydrothermally-synthesized CHA seeds were coated on porous α-alumina substrates with a pore diameter of 80 nm and by means of a further hydrothermal treatment a zeolite membrane layer was formed. In order to obtain a thin and defect-free zeolite layer, the influence on the final microstructure of seed concentration during coating, coating method (rubbing, dip- or spin-coating) and crystal growth time was investigated. The template removal procedure was optimized to avoid the formation of cracks or defects. For an optimal thermal treatment, using a step-wise temperature increase to 500 °C, the membranes exhibit CO2/CH4 permselectivities of 25–30 with CO2 permeances of around 2 x 10−7 mol m−2 s−1 Pa−1 at 22 °C and 2 bar of pressure difference. O2 plasma pre-treatment prior to template removal increased the CO2/CH4 permselectivity to 176, while maintaining the same CO2 permeance values when no pre-treatment was used. The SF6 permeances, both at low (22 °C) and high (200 °C) temperatures, were below the detection limit (2 x 10−10 mol m−2 s−1 Pa−1), which in return results in very high N2/SF6 permselectivities of more than 700.

This review paper presents some of the topics discussed at the 2018 ‘Chemical process development trends’ seminar organized by the Swiss Process and Chemical Engineers Society in Basel, Switzerland. The first subject covers the use of computer aided tools for systematic reaction route selection, the second one addresses the recent development in the field of process intensification with a focus on reactive distillation and dividing wall column technology, and the third topic highlights recent developments in the field of continuous filtration in the pharmaceutical industry.

For an edge-coloured graph G, the minimum colour degree of G means the minimum number of colours on edges which are incident to each vertex of G. We prove that if G is an edge-coloured graph with minimum colour degree at least 5, then V(G) can be partitioned into two parts such that each part induces a subgraph with minimum colour degree at least 2. We show this theorem by proving amuch stronger form. Moreover, we point out an important relationship between our theorem and Bermond and Thomassen’s conjecture in digraphs.

The application of stacked-FETs in power amplifiers allows for a supply voltage higher than supported by the breakdown voltage of a single transistor. Potential benefits of the increased supply voltage are reduced supply currents and a lower matching ratio at the output of the amplifier. Furthermore, an increased output power per chip area is obtained due to the reduction in passive structures resulting in more area-efficient power combining. In this paper, the procedure for the design of integrated microwave stacked-FET is discussed. Several options for the correct distribution of RF voltage and current swings are investigated and the relationship between the number of stacked transistors and bandwidth is addressed. The procedure is demonstrated by the design of an S-band GaAs stacked-FET containing three transistors. This stacked-FET is applied in an S-band HPA that has a PAE of more than 40% at an output power of 20 W, which is more than twice the output power of any previously reported GaAs stacked-FET HPA.

Objective.The OMERACT-Adherence meeting was convened to discuss the conceptual and methodological challenges in developing a core domain set (Adherence-CDS) for trials of interventions for medication adherence in rheumatology.Methods.Forty participants from nine countries participated.Results.Four ideas emerged: for adherence trials, the Adherence-CDS could include adherence and the condition-specific CDS; many factors affect adherence and are intervention targets, contextual factors, or outcome domains; adherence is a critical factor in drug trials; and standardized adherence measures are needed.Conclusion.Despite the challenges, the meeting clarified an approach to developing an Adherence-CDS that complements existing OMERACT work and methodology.

Essentially, all motion in living organisms emerges from the collective action of biological molecular machines transforming chemical energy, originally harvested from light, into ordered activity. As a man-made counterpart to nature’s biomolecular machines, chemists have created artificial molecular machines that display controlled and even directional motion in response to light. However, to be of practical value, the motion of these light-fuelled molecular machines will have to be coupled to the rest of the world. Inspired by the complex functional movement seen in the plant and animal world, chemists have undertaken the challenge to harness molecular motion and, so, they have set artificial molecular motors and switches to work and perform useful mechanical action at the macroscopic level. Here, we review these recent developments. We show how modern research has embraced the full complexity of the molecular world by aiming at the design of autonomous, and sometimes adaptive, molecular systems that work continuously under the effect of illumination. We report evidence that molecular motion can be engineered into highly sophisticated movements and that, from a fundamental point of view, continuous movement can only emerge when man-made molecules cooperate, in space and time. Eventually, unravelling the rules of molecular motion will support the creation of molecular materials that produce work continuously under a constant input of energy. The natural world has long provided inspiration for the production of artificial, adaptive materials. This Review discusses how unravelling the rules of molecular motion has enabled integration of the cooperative, and sometimes synchronized, operation of light-responsive molecular machines, across length scales, into responsive and autonomous matter.

Background and aim: Telehealth is a strategy to expand the reach of pulmonary rehabilitation (PR). Smartphones can monitor and transmit oxygen saturation (SpO2) and heart rate (HR) data to ensure patient safety during home-based or other exercise. The purpose of this study was to evaluate the usability, validity and reliability of a Kenek O2 pulse oximeter and custom prototype smartphone application (smartphone oximeter) during rest and exercise in healthy participants and those with chronic lung disease. Methods: Fifteen individuals with chronic lung disease and 15 healthy controls were recruited. SpO2 and HR were evaluated at rest and during cycling and walking. SpO2 was valid if the mean bias was within +± 2%, the level of agreement (LoA) was within ± 4%; HR was valid if the mean bias was within ± 5 beats per min (bpm), LoA was within ± 10 bpm. Usability was assessed with a questionnaire and direct observation. Results: The smartphone oximeter was deemed easy to use. At rest, SpO2 measures were valid in both groups (bias 10 bpm) in either group. Conclusions: The smartphone oximeter did not record HR or SpO2 accurately in patients with chronic lung disease during exercise, although SpO2 was valid at rest. During exercise, patients with chronic lung disease should pause to ensure greatest accuracy of SpO2 and HR measurement.

A technique is proposed for increasing the data rate transmitted through an inductively coupled chip-to-chip link by resetting the channel state variables. This allows the data rate to be increased well beyond what is implied by the channel bandwidth. In the proposed scheme, the two sides of the link are resonated at the highest possible quality factor, maximizing link gain, and minimizing interference. The transmit signal is a binary matched pulse which maximizes the received signal for a given transmitter voltage limit. High-efficiency switching transmitters can be used for this type of signal. The proposed technique can be applied to communication links in which channel state variables are accessible for reset. For increasing the data rate, it is shown that the proposed state-variable reset technique results in a higher signal-to-noise ratio of the received signal and a higher energy efficiency compared to reducing the quality factor to widen the bandwidth, using equalization, or using multi-level signaling. The technique is demonstrated on a chip-to-chip link with coupled 1.5 mm $\times1.5$ mm planar inductors separated by 0.5 mm in a 0.18 $\mathrm {\mu m}$ CMOS process. 500 Mb/s data rate is achieved over a link which has a band-pass bandwidth of 185 MHz.

In the innovation process of firms, suppliers increasingly play a key role as external sources of ideas. Although the beneficial impact of supplier integration has been acknowledged, there is also evidence that not all such innovation efforts are successful, particularly regarding the identification of truly innovative solutions. Therefore, in recent years, large firms have begun to move beyond their existing supply base, drawing on innovation ideas from start-ups, that is, with young firms with whom they have no pre-existing bonds. Yet there is no empirical evidence regarding whether start-ups’ ideas actually outperform those of established suppliers. We address this question by presenting a unique, real-world comparison of 314 supplier and start-up ideas – ideas that were identified, evaluated, and followed up over the course of an open innovation initiative conducted by a large automotive manufacturer. We find that start-ups’ ideas are characterized by a higher degree of novelty and to some extent higher benefit for end customers but, on the downside, are less likely to be implemented than suppliers’ ideas. Overall, our study adds new dimensions to the discourse on open innovation and provides valuable insights regarding the outcome of supplier and start-up involvement in the front end of the innovation process.

Chronic diseases are the main cause for death in the world. Among all risk factors concerning chronic diseases, those related to an unhealthy diet are most important. Although much research was done on dietary behavior, there are only few quantitative studies on the relationship between dietary taste and chronic diseases. In this article, a taste dataset of the major categories of Chinese cuisine is established based on crowdsourced data from Chinese recipe websites. For a quantitative analysis of people's taste in different regions, additionally the locations of restaurants by category (using their respective points of interest) are integrated. Using the software Geodetector, these regional taste preferences are then correlated with the three chronic diseases, hemorrhagic stroke, pancreatic cancer, and upper respiratory tract infection. For all the three diseases, the results indicate very salty, moderate sweet and very spicy food as the primary risk factors. Also, the degree of sweetness is not linear with the risk of pancreatic cancer. These results are statistically significant. In this study, a quantitative method on discovering potential health risk factors based on mining of crowdsourced data is proposed for the first time. This method can be applied before disease- related experiments to filter potential factors, and it is helpful for the public health department to make quick corresponding intervention policies.

PurposeThe purpose of this paper is to investigate the early development stages of International New Ventures (INVs). Specifically, the authors explore how INVs acquire and leverage four kinds of capital – strategic, managerial, financial and social – to recognise a foreign opportunity, begin the pre-foreign entry activities, and finally start the INV.Design/methodology/approachA stage-based, multidimensional framework was used to investigate how INVs acquire and use the four capitals throughout the internationalisation process. Drawing on four case studies of high-tech INVs, this study tracks their development in three stages: foreign opportunity, pre-foreign operation and post-foreign operation.FindingsResults indicate INVs build advantages and internationalisation activities occur before formal operations begin. INVs deliberately orchestrate certain kinds of capital contingent to the specific internationalisation stage. Further, the authors find that not all types of capital are equally important throughout the internationalisation process: INVs identify foreign opportunities when endowed with managerial and social capital; INVs source a majority of their managerial and financial capitals externally before internationalising; and INVs only contribute all four capitals simultaneously after internationalising.Research limitations/implicationsFindings contribute to knowledge about the development of INVs pre-internationalisation and pre-founding. The study is limited to a comparative sample of INVs, which impacts the generalisability. However, the findings provide a starting point for investigating similar effects using more representative samples.Practical implicationsEntrepreneurs can be proactive in networking activities to allow them greater opportunity to interact with potential resource providers dependent on the stage of internationalisation.Originality/valueThis study contributes to the international entrepreneurship literature with qualitative evidence of the micro-level processes of internationalisation. Very few studies investigate the early, pre-internationalisation and pre-foundation, development stages of INVs.

To meet food demand after the failure of irrigation system developments, agricultural intensification is occurring in inland valley agro-ecosystems in sub-Saharan Africa. Agricultural enhancement in inland valleys, which undermines environmental sustainability, was assessed using ‘Driving Force–Pressure–State–Impact–Response’ approach in four agro-ecological zones of Benin. The survey revealed that inland valleys are largely devoid of ligneous species. Crop residues are mainly transferred from inland valley fields to feed cattle, burnt in situ by the farmers themselves or abandoned to wildfires or to pasture—not mulched. Crop diversification is not universal and is limited to rice and vegetables crops. Monocropping of rice, practised by 83.3% of inland valley farmers, requires large chemical fertilizer application despite their impacts on environment including land degradation and water contamination. A major challenge is to determine means of characterizing entire agro-ecosystems of inland valleys in a way that is simple enough to be effectively and efficiently monitored. Inland valley agricultural development projects might include backstopping activities and policies that enable monitoring of chemical inputs and farming practices in inland valleys to reduce negative impacts on the environment and human health.

Purpose of Review: The main objective of this article is to investigate the current trends in the use of induced pluripotent stem cells (iPSCs) for bone tissue repair and regeneration. Recent Findings: Pluripotent stem cell–based tissue engineering has extended innovative therapeutic approaches for regenerative medicine. iPSCs have shown osteogenic differentiation capabilities and would be an innovative resource of stem cells for bone tissue regenerative applications. Summary: This review recapitulates the current knowledge and recent progress regarding utilization of iPSCs for bone therapy. A review of current findings suggests that a combination of a three-dimensional scaffolding system with iPSC technology to mimic the physiological complexity of the native stem cell niche is highly favorable for bone tissue repair and regeneration.

Nuclear power has become a common source of energy for communities around the world. Despite relatively few global incidents, the potential for nuclear disaster always exists. Effective risk communication plays a critical role in reducing the loss of life and property when a nuclear failure arises. An overlooked aspect of existing studies on nuclear risk communication is to evaluate the information sources within and beyond the emergency planning zone (EPZ). To this end, the study has evaluated the effectiveness of risk communication for Arkansas Nuclear One, the only nuclear power plant in Arkansas, US. A structured survey was distributed to 185 local residents, especially to those living within the 10-mile EPZ of the plant. The survey aimed to assess public risk perception, preparedness levels, and the channels through which the information was received. The de facto preparedness knowledge in terms of R-score was quantified, interpolated, and visualized. The results identify the inequalities of demographic, contextual, and spatial factors in dictating risk communication within and beyond the nuclear EPZ. They reveal that the spatial awareness of the EPZ may serve as a better indicator of residents' preparedness level than their residential proximity to the nuclear power plant. The study further suggests that the active acquisition and effective comprehension of locational knowledge in the at-risk communities have significantly improved the preparedness level. This finding sheds new lights on policy recommendations for emergency management departments to proactively distribute health information and alleviate public stresses about the nuclear industry.

Two novel extraction chromatographic resins (EC), termed as RL-1 and RL-2, were prepared by impregnating two benzene-centered tripodal iglycolamide ligands (Bz-T-DGA) containing different spacer groups where the ligands are termed as L-1 and L-2, respectively. They were employed for the uptake of actinide and fission product ions, viz. Am3+, Eu3+, UO22+, Np4+, Pu4+, Sr2+, and Cs+, from acidic feeds. Weight distribution coefficient (Kd) values were measured by the batch method and the loaded metal ions were back extracted using a 0.01 M EDTA solution at pH 4. Kinetic modeling of the sorption data of Am(III) on both resins suggested pseudo-second order rate kinetics with rate constants of 1.68 × 10−6 and 2.47 × 10−6 g/cpm.min for the resins containing L-1 and L-2, respectively. Sorption isotherm studies indicated the Langmuir monolayer chemisorption phenomenon with Eu(III) experimentally determined saturation uptake capacities of 6.02 ± 0.11 and 5.49 ± 0.14 mg per g of RL-1 and RL-2 resins, respectively. As the batch uptake study results appeared encouraging, column studies were also carried out using both resins. The resin reusability data indicated a marginal change in the Kd values for the RL-1 resin up to three repeat runs beyond which a steady decrease of the Kd value was seen. On the other hand, in the case of RL-2 a steady decrease in the Kd values was observed for three repeat runs beyond which there was marginal change.

Background and Purpose— Hemorrhagic transformation (HT) after acute ischemic stroke may cause severe neurological deterioration and affects functional outcome. Identifying patients most likely to suffer from this complication could potentially be used for future treatment selection. Reperfusion after endovascular therapy could be associated with different risk factors for HT than intravenous thrombolytics as these treatments largely differ. In this study, we aimed to identify clinical and imaging markers that are associated with HT subtypes in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) population. Methods— In this post hoc analysis, all patients with follow-up imaging were included. HT was classified according to ECASS II (European Cooperative Acute Stroke Study). Variables with an association of P Results— Of the 478 out of 500 included patients in this subanalysis, 46% had HT (n=222). Of these, 66% had hemorrhagic infarction (n=147) and 34% PH (n=75). Symptomatic intracranial hemorrhage was observed in 7.3% (n=35) of all patients. Baseline National Institutes of Health Stroke Scale (odds ratio [OR], 1.05,95% CI, 1.01–1.09 per point) and absent/poor collaterals (OR, 1.90; 95% CI, 1.05–3.42) were significantly associated with hemorrhagic infarction. Increased systolic blood pressure (OR, 1.17; 95% CI, 1.05–1.31 per 10 mm Hg) and atrial fibrillation (OR, 1.94; 95% CI, 1.08–3.48) were associated with PH. Increased systolic blood pressure (OR, 1.28; 95% CI, 1.12–1.48) and antiplatelet use (OR, 2.6; 95% CI, 1.08–6.3) were associated with symptomatic intracranial hemorrhage. Conclusions— Clinical and imaging stroke severity parameters were associated with HT, both in hemorrhagic infarction and PH, whereas baseline patients characteristics like systolic blood pressure, atrial fibrillation, and antiplatelet use were only associated with PH or symptomatic intracranial hemorrhage. Clinical Trial Registration— URL: http://www.controlled-trials.com . Unique identifier: ISRCTN10888758.

Bioinstructive scaffolds for regenerative medicine are characterized by intrinsic properties capable of directing cell response and promoting wound healing. The design of such scaffolds requires the incorporation of well-defined physical properties that mimic the native extracellular matrix (ECM). Here, inspired by epithelial tissue morphogenesis, we present a novel approach to code nanofiber materials with controlled hierarchical wavy structures resembling the configurations of native EMC fibers through using thermally shrinking materials as substrates onto which the fibers are deposited. This approach could serve as a platform for fabricating functional scaffolds mimicking various tissues such as trachea, iris, artery wall and ciliary body. Modeling affirms that the mechanical properties of the fabricated wavy fibers could be regulated through varying their wavy patterns. The nanofibrous scaffolds coded with wavy patterns show an enhanced cellular infiltration. In addition, we further investigated whether the wavy patterns could regulate transforming growth factor-beta (TGF-β) production, a key signalling pathway involved in connective tissue development. Our results demonstrated that nanofibrous scaffolds coded with wavy patterns could induce TGF-β expression without the addition of a soluble growth factor. Our new approach could open up new avenues for fabricating bioinstructive scaffolds for regenerative medicine., Bioinstructive scaffolds for regenerative medicine are characterized by their intrinsic properties that are capable of directing cell response and promoting wound healing.

This paper presents a study on the stochastic bearing capacity of two parallel strip footings supported on a heterogeneous sand layer confined by a rigid base. Variability of the sand is represented by a truncated normal distribution function of its friction angle to produce a geostatistical equivalent to the deterministic bearing capacity. A method was first demonstrated to derive an analytical distribution function of the bearing capacity for a single surface footing with a rigid base layer for which an exact bearing capacity function is available. For the twin foundation problem with no explicit deterministic solutions, a Monte Carlo simulation was adopted. The stochastic bearing capacity relative to its deterministic equivalent was determined for a set of layer thicknesses and footing distances in terms of the assumed geostatistical characteristics of the sand and resulting bearing capacity distributions. The Monte Carlo methodology is adaptable in design to model other bearing capacity problems with more complex and random soil distributions.

Lord’s (1980) equity theorem claims observed-score equating to be possible only when two test forms are perfectly reliable or strictly parallel. An analysis of its proof reveals use of an incorrect statistical assumption. The assumption does not invalidate the theorem itself though, which can be shown to follow directly from the discrete nature of the equating problem it addresses. But, surprisingly, an obvious relaxation of the problem is enough to obtain exactly the opposite result: As long as two test forms measure the same ability, they can always be equated, no matter their reliability, degree of parallelness, or even difference in length. Also, in spite of its lack of validity, the original proof of Lord’s theorem has an important interim result directly applicable to the problem of assembling a new test form pre-equated to an old form.

Three-dimensional Discrete Element Method simulations have been performed to study the deformation of cross-anisotropic granular materials under principal stress rotation (PSR), for rotation planes oriented at different angles θ with respect to the bedding plane. The simulations have been conducted with a novel technique for applying specified stresses at three-dimensional boundaries. The results are qualitatively in agreement with experimental results from literature. Cumulative volume contraction is always observed under continuous PSR and increases with increasing θ. The dilatancy rate decreases with increasing number of PSR cycles, tending to zero. The noncoaxiality angle between the strain increment and the stress in the PSR plane increases with increasing number of cycles, reaching the same asymptotic value for samples of various densities and for various θ. Periodic oscillations of the dilatancy rate and noncoaxiality angle within each PSR cycle are observed with an increasing oscillation magnitude with increasing θ, due to the larger fabric anisotropy within the PSR plane. When θ = 30 or 60°, significant noncoaxial strain accumulation occurs in the plane perpendicular to the PSR plane due to the oblique angle between the PSR plane and the bedding plane, echoing the major principal fabric direction's being neither parallel nor perpendicular to the PSR plane. The macroscopic behavior of the samples is related to the microscopic parameters including coordination number and fabric anisotropy. With increasing number of cycles, the difference between normalized stress/strain/fabric increment tensors tends to become constant, with only a small lag between each pair, irrespective of θ.

Objective: Adherence and inhaler technique are often suboptimal in asthma and chronic obstructive pulmonary disease (COPD). New inhalers have been developed to improve these determinants of treatment effectiveness. We assessed treatment adherence, satisfaction, and ease of use of DuoResp® Spiromax® among SPRINT study participants. Methods: The Phase IV SPRINT study was conducted in 10 European countries. Asthma and COPD patients were receiving a fixed-dose combination of inhaled corticosteroid (ICS) and long-acting β2-agonist (LABA), delivered via various inhalers including DuoResp Spiromax. DuoResp Spiromax users self-assessed adherence using the 8-item Morisky Medication Adherence Scale (MMAS-8®), and ease of use and satisfaction using 10-point scales, during a single physician’s office visit. Results: Of 1661 (asthma: n = 1101; COPD: n = 560) SPRINT study participants, 342 (asthma: n = 235; COPD: n = 107) received DuoResp Spiromax prior to inclusion. Overall, 72.5% of DuoResp Spiromax users reported medium or high adherence (MMAS-8 score ≥6). Mean (standard deviation [SD]) satisfaction score for DuoResp Spiromax was 8.9 (1.6). Almost all (98.8%) DuoResp Spiromax users were at least satisfied with their inhaler; 85.4% were very satisfied. Mean (SD) ease of use score for DuoResp Spiromax was 9.1 (1.3). Conclusions: Asthma and COPD patients using DuoResp Spiromax reported moderate-to-high medication adherence, were very satisfied with their inhaler and found it easy to use.

The objective of this paper was to explore the potential of hybrid-polarized (RH and RV) RISAT-1 SAR data to retrieve the height of wheat crop—an important winter crop in South Asian countries including India. The images acquired over north-west India in 2015 covered critical growth stages of wheat. The field campaigns were carried out in synchronous with the SAR passes. Considering the dominant role of underlying soil cover in the total backscatter $({\boldsymbol{\sigma }_{\boldsymbol{total}}^0})$ response from a target, we propose that refining the $\boldsymbol{\sigma }_{\boldsymbol{total}}^0$ by reducing the effect of underlying soil can significantly improve the retrieval accuracy of crop height (CH). To achieve this, we modified the existing water cloud model (WCM) to estimate soil-corrected vegetation backscatter $({\boldsymbol{\sigma }_{\boldsymbol{veg}}^0})$ . Leaf area index and interaction factor showed great potential as the vegetation descriptors in modeling $\boldsymbol{\sigma }_{\boldsymbol{total}}^0$ using WCM. A comparative analysis between the CH retrieved from $\boldsymbol{\sigma }_{\boldsymbol{total}}^0$ and $\boldsymbol{\sigma }_{\boldsymbol{veg}}^0$ using multilayer perceptron neural networks revealed the response of C -band backscatter to CH. CH was moderately correlated to $\boldsymbol{\sigma }_{\boldsymbol{total}}^0$ , but the results improved considerably with the substitution of $\boldsymbol{\sigma }_{\boldsymbol{total}}^0$ with $\boldsymbol{\sigma }_{\boldsymbol{veg}}^0$ . This holds true particularly in the early growth stages of crop growth when the vegetation cover is scarce and there is a substantial effect of soil background on the remote sensing signal. Thus, the results suggest suitability of C -band hybrid-polarized data for the assessment of CH.

Agriculture is a key sector and a major consumer of water resources; therefore, a clear understanding of the agricultural water demand for crop production and consumption is imperative for addressing water scarcity problems, particularly in water export regions. This study provides new insights into the influential factors driving the changes in the agricultural production water footprint (WFprod) and consumption water footprint (WFcon) in the net water import and net water export regions. The WFprod and WFcon of wheat are evaluated in Beijing city (the net water import region) and Heilongjiang province (the net water export region) over the period 1996–2015. The statistical significances of the influential factors, i.e., climate change, gross domestic product, population, dietary demand and technology update are determined using a multivariate linear regression model (LRM) and nonlinear regression model (NLRM). The results indicate that the gross domestic product and population were the dominant positive influential factors, whereas technology update and dietary demand were the dominant negative influential factors affecting the changes in the WFprod and WFcon in the net water import region. In the net water export region, technology update was the dominant negative influential factor affecting the changes in the WFprod and WFcon. Climate change did not contribute significantly to the changes in the WFprod and WFcon of wheat; however, it was an important factor (especially precipitation for the green WF with an average relative importance of more than 22% and the blue WF with an average relative importance of more than 15%) affecting the changes in the WFprod and WFcon of the crop. An in-depth analysis of the influential factors that contribute to the changes in the WFs is fundamentally important for decision-makers to develop countermeasures and strategic planning implementations to mitigate water resource pressure in China.

The advantages of a nexus approach in addressing complex environmental challenges are becoming increasingly clear. In Central Asia, however, the nexus between water–food–energy has not received adequate attention, as the very few studies that have been conducted fell short of quantifying nexus trade‐offs and benefits at a practical, small scale. This paper applies a quantitative accounting method to assess water and energy use intensity in irrigated areas of the Karshi Steppe of Central Asia that are supplied by pumping water uphill (lift‐irrigated) from the underlying river. The results indicated that the potential water and energy savings as well as the greenhouse gas (GHG) emission reductions could be achieved by applying an optimal planning deficit irrigation schedule simulated using CROPWAT 8. Some 575 MCM (million cubic metres) of water and 259 GWh of electricity can be saved, while the CO₂ equivalent emissions can be reduced by almost 122 000 t. Achieving these savings requires a mix of technical and policy components. This paper describes an example of proper irrigation planning as a tool for water/energy savings and consequent reduction of CO₂ emissions. © 2019 John Wiley & Sons, Ltd.

Introduction: Published data regarding robot-assisted hiatal hernia repair are mainly limited to small cohorts. This study aimed to provide information on the morbidity and mortality of robot-assisted complex hiatal hernia repair and redo anti-reflux surgery in a high-volume center. Materials and methods: All patients that underwent robot-assisted hiatal hernia repair, redo hiatal hernia repair, and anti-reflux surgery between 2011 and 2017 at the Meander Medical Centre, Amersfoort, the Netherlands were evaluated. Primary endpoints were 30-day morbidity and mortality. Major complications were defined as Clavien–Dindo ≥ IIIb. Results: Primary surgery 211 primary surgeries were performed by two surgeons. The median age was 67 (IQR 58–73) years. 84.4% of patients had a type III or IV hernia (10.9% Type I; 1.4% Type II; 45.5% Type III; 38.9% Type IV, 1.4% no herniation). In 3.3% of procedures, conversion was required. 17.1% of patients experienced complications. The incidence of major complications was 5.2%. Ten patients (4.7%) were readmitted within 30 days. Symptomatic early recurrence occurred in two patients (0.9%). The 30-day mortality was 0.9%. Redo surgery 151 redo procedures were performed by two surgeons. The median age was 60 (IQR 51–68) years. In 2.0%, the procedure was converted. The overall incidence of complications was 10.6%, while the incidence of major complications was 2.6%. Three patients (2.0%) were readmitted within 30 days. One patient (0.7%) experienced symptomatic early recurrence. No patients died in the 30-day postoperative period. Conclusions: This study provides valuable information on robot-assisted laparoscopic repair of primary or recurrent hiatal hernia and anti-reflux surgery for both patient and surgeon. Serious morbidity of 5.2% in primary surgery and 2.6% in redo surgery, in this large series with a high surgeon caseload, has to be outweighed by the gain in quality of life or relief of serious medical implications of hiatal hernia when counseling for surgical intervention.

Flood is a major natural hazard with extremely large impact on social-ecological systems. Therefore, developing reliable and efficient tools to identify areas vulnerable to potential flooding is vital for water managers, engineers and decision makers. Moreover, being able to accurately classify the level of hazard is a step forward towards more efficient flood hazard mapping. This study presents a multi-criteria index approach to classify potential flood hazards at the river basin scale. The presented methodology was implemented in the Mashhad Plain basin in North-east Iran, where flood has been a major issue in the last few decades. In the present study, seven factors, selected based on their greater influence towards flooding, were identified and extracted from the basic thematic layers to be used to generate a five-class Flood Hazard Index (FHI) map. The Soil and Water Assessment Tool (SWAT) was used to develop a runoff coefficient map, which was found to be the most influential factor. A sensitivity analysis was performed and the results incorporated to generate a modified Flood Hazard Index (mFHI) map. The accuracy of the proposed method was evaluated against the well-documented flood records in the last 42 years at the study area. The results showed that, for both FHI and mFHI maps, more than 97% of historical flood events have occurred in moderate to very high flood hazard areas. This demonstrates that incorporating hydrological model (such as SWAT) and multi-criteria analysis introduces a robust methodology to generate comprehensive potential flood hazard maps. Moreover, the proposed modified methodology can be used to identify high potential flood hazard zones and work towards more efficient flood management and mitigation strategies.

Objective: Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data. Design: Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery. Setting: Two European tertiary referral hospitals. Population: Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS). Methods: Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7). Main outcome measures: Primary outcome: anatomical and subjective cure. Secondary outcomes: surgical safety and intraoperative variables. Results: A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P

Hepatocellular carcinoma (HCC) remains one of the most lethal malignancies. The current chemotherapy with typically low tumor uptake and high toxicity reveals a poor anti-HCC efficacy. Here, we report transferrin-guided polycarbonate-based polymersomal doxorubicin (Tf-Ps-Dox) as a low-toxic and potent nanotherapeutic agent for effective treatment of liver tumor using a transferrin receptor (TfR)-positive human liver tumor SMMC-7721 model. Tf-Ps-Dox was facilely fabricated with small size of ca. 75 nm and varying Tf densities from 2.2% to 7.0%, by postmodification of maleimide-functionalized Ps-Dox (Dox loading content of 10.6 wt%) with thiolated transferrin. MTT assays showed that Tf-Ps-Dox had an optimal Tf surface density of 3.9%. The cellular uptake, intracellular Dox level, and anticancer efficacy of Tf-Ps-Dox to SMMC-7721 cells were inhibited by supplementing free transferrin, which supports that Tf-Ps-Dox is endocytosed through TfR. Interestingly, Tf-Ps-Dox exhibited a high accumulation of 8.5%ID/g (percent injected dose per gram of tissue) in subcutaneous SMMC-7721 tumors, which was 2- and 3-fold higher than that of nontargeted Ps-Dox and clinically used liposomal Dox formulation (Lipo-Dox), respectively. The median survival times of mice bearing orthotopic SMMC-7721 tumors increased from 82, 88 to 96 days when treated with Tf-Ps-Dox at Dox doses from 8, 12 to 16 mg/kg, which was significantly longer than that of Ps-Dox at 8 mg/kg (58 days) and Lipo-Dox at 4 mg/kg (48 days) or PBS (36 days). Notably, unlike Lipo-Dox, no body weight loss and damage to major organs could be discerned for all Tf-Ps-Dox groups, indicating that Tf-Ps-Dox caused low systemic toxicity. This transferrin-dressed polymersomal doxorubicin provides a potent and low-toxic treatment modality for human hepatocellular carcinoma. STATEMENT OF SIGNIFICANCE: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Vast work has focused on developing HCC-targeted nanotherapeutics. However, none of the nanotherapeutics has advanced to clinics, partly because the ligands used have not been validated in patients. Transferrin (Tf) is a natural ligand for transferrin receptor (TfR) that is overexpressed on cancerous cells, and it is currently under clinical trials (MBP-426 and CALAA-01) for the treatment of solid tumors. We designed Tf-functionalized polymersomal doxorubicin (Tf-Ps-Dox) for targeted therapy of orthotopic SMMC-7721 tumor in nude mice. Tf-Ps-Dox showed potent anti-HCC efficacy and significantly improved survival time with low toxicity as compared with nontargeted Ps-Dox and clinical liposomal Dox (Lipo-Dox). Hence, Tf-Ps-Dox is very appealing for targeted treatment of HCC.

Asymmetric forces exerted on the horse's back during riding are assumed to have a negative effect on rider–horse interaction, athletic performance, and health of the horse. Visualized on a saddle pressure mat, they are initially blamed on a nonfitting saddle. The contribution of horse and rider to an asymmetric loading pattern, however, is not well understood. The aim of this study was to investigate the effects of horse and rider asymmetries during stance and in sitting trot on the force distribution on the horse's back using a saddle pressure mat and motion capture analysis simultaneously. Data of 80 horse-rider pairs (HRP) were collected and analyzed using linear (mixed) models to determine the influence of rider and horse variables on asymmetric force distribution. Results showed high variation between HRP. Both rider and horse variables revealed significant relationships to asymmetric saddle force distribution (P < .001). During sitting trot, the collapse of the rider in one hip increased the force on the contralateral side, and the tilt of the rider's upper body to one side led to more force on the same side of the pressure mat. Analyzing different subsets of data revealed that rider posture as well as horse movements and conformation can cause an asymmetric force distribution. Because neither horse nor rider movement can be assessed independently during riding, the interpretation of an asymmetric force distribution on the saddle pressure mat remains challenging, and all contributing factors (horse, rider, saddle) need to be considered.

Item does not contain fulltext Children with dyslexia are often provided with audio-support to compensate for their reading problems, but this may intervene with their learning. The aim of the study was to examine modality and redundancy effects in 21 children with dyslexia, compared to 21 typically developing peers (5th grade), on study outcome (retention and transfer knowledge) and study time in user-paced learning environments and the role of their executive functions (verbal and visual working memory, inhibition, and cognitive flexibility) on these effects. Results showed no effects on retention knowledge. Regarding transfer knowledge, a modality effect in children with dyslexia was found, and a reversed redundancy effect in typically developing children. For transfer knowledge, written text with pictures supported knowledge gain in typically developing children, but not in children with dyslexia who benefited more from auditory-presented information with pictures. Study time showed modality and reversed redundancy effects in both groups. In all children, studying in a written text with pictures condition took longer than with audio replacing the text or being added to it. Results also showed that executive functions were related to learning, but they did not differ between the groups, nor did they impact the found modality and redundancy effects. The present research thus shows that, irrespectively of children’s executive functions, adding audio-support for all children, can potentially lead to more efficient learning. 10 p.

Prescriber adherence to guideline-recommended medication in patients with heart failure (HF) in clinical practice is suboptimal. We analyzed how evolving guideline recommendations influenced medication profiles after a first HF hospitalization. We extracted medication profiles from the Dutch PHARMO Database Network for 22,476 patients with a diagnosis of HF at hospital discharge between 2001 and 2015. The percentage of patients prescribed the combination of a beta-blocker (BB) and an angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) increased from 24 to approximately 45% within this 15-year period. The percentage of patients who also used a mineralocorticoid-receptor antagonist (MRA) reached approximately 20%. The probability of being prescribed these combinations decreased with increasing age. As a consequence of the policy change in the ESC guideline 2001, the use of BB increased from less than 40% in 2001 to about 70% by 2015. The percentage of patients prescribed an ACEI and/or an ARB, an MRA, or a diuretic was about stable, at respectively 63%, 37%, and 82%. Although the 2012 ESC guideline also advised MRA in the New York Heart Association (NYHA) class II, there was no increase in MRA prescriptions. Compliance with the ESC guidelines varied for the individual recommendations. Remarkably, there was no significant increase in MRA prescriptions. At the same time, developments were demonstrated, which were not instigated by the guidelines, like the shift from ACEI to ARB. Although the exact HF classification of our patients was unknown, given a relatively stable case mix, our data provide insight into “real-world” pharmacological management.

Purpose This contribution to the special issue integrates findings addressed by the other papers. In order to structure the insights delivered by the studies and to address the perspectives with the objectives of the special issue, the purpose of this paper is to identify two major components: system characteristics and culture. Design/methodology/approach These are discussed and subsequently the studies are positioned according to this framework. Findings The authors further discuss elements involved in increasing the power of clients of the educational system, needs for capacity building, and the need for horizontal and vertical accountability. Originality/value Discussion paper to a special issue on data-based decision making.

Veel gemeentelijke beleidsplannen schuldhulpverlening kennen een belangrijke rol toe aan vrijwilligers. Vrijwilligers helpen voorkomen dat mensen in de schulden raken, door hulp te bieden bij het ordenen van de administratie en het aanvragen van voorzieningen. Daarnaast zouden ze, zo is de verwachting, de schuldhulpverlening toegankelijker maken en de kans op terugval beperken. Maken vrijwilligers de gemeentelijke schuldhulpverlening daadwerkelijk effectiever? Om dat te bepalen voeren wij sinds oktober 2017 een onderzoek uit in het werkgebied van de Stadsbank Oost-Nederland. Dat werkgebied omvat 22 gemeenten in Twente en de Achterhoek.

In this micromechanical study of the behaviour of granular materials, relationships are investigated between deformation at the continuum macro-scale and at the micro-scale of interparticle contacts. Special attention is paid to the role of the microstructure, or fabric, as it is well known to have a strong influence on the behaviour of granular materials. Two-dimensional Discrete Element Method simulations of isobaric tests have been used to formulate truncated Fourier series representations for suitably-averaged relative displacement increment vectors at interparticle contacts and of parameters that describe the fabric. Based on a micromechanical expression for the average strain tensor that is valid in the two-dimensional case considered here and on these Fourier series representations, a Strain–Displacement–Fabric relationship has been derived that links the macro-scale dilatancy rate to the micro-scale relative displacements and fabric. Results of the Discrete Element Method simulations, using samples with different densities, have been employed to verify the accuracy of the proposed relationship for the dilatancy rate.

The presence of a rigid layer underlying a soil bed layer supporting twin footings affects the footing bearing capacity and settlement. In this study, the bearing capacity and settlement of twin large-scale circular footings on unreinforced and geocell-reinforced sand layers with various thicknesses are investigated. The role of layer thickness, distance between two adjacent footings, and footing diameter indicates that the rigid base substantially influences the footing bearing pressure, settlement and tilt. The results show that the maximum bearing capacity is achieved when two footings are in contact and the rigid base is at shallow depth. The influence of the footing interference on settlement and tilting of closely spaced footings at a given load decreases with decreasing depth of rigid base and reinforcing the sand with geocells. This is observed for rigid bases located at less than about 2B, where B is the footing diameter.

Voor het kwaad, van bijvoorbeeld de wreedheid van het nazisme, zijn geen bevredigende verklaringen. De geschiedenis houdt haar geheimen vast. Dat maakt het volgens Jan Hoogland moeilijk om van de geschiedenis te leren.

Background The public transport access, an important dimension of neighborhood built environments and usually defined as the access to public transport stops/stations (PTS), has been revealed to be associated with more participation in physical activity (PA) in western countries. The perceptions of such features could have additional benefits to healthy behaviors. However, such research is lacking in developing countries. This study aimed to explore the association between perceived PTS access and PA participation among urban adults in China. Methods A population-based cross-sectional survey conducted in Nanjing in 2017 was used, where 1,568 participants aged 35–74 were recruited from eight randomly selected urban neighborhoods under a multi-stage sampling strategy. The individual's PTS access and PA participation were self-reported using the Physical Activity Neighborhood Environment Scale and the International Physical Activity Questionnaire, respectively. Mixed-effect logistic regression models were used to estimate the association between perceived PTS access and PA participation. Results Among 1,551 participants who completed the survey, 84.7% of participants achieved the World Health Organization (WHO) recommended PA level. After adjusting for potential individual- and neighborhood-level confounders, participants who perceived a PTS within 10–15 min’ walking distance from their residence were 3.18 (95%CI = [1.74, 5.80]) times more likely to meet WHO recommended PA guidelines than their counterparts who did not perceive any PTS in their neighborhoods. This association also held true in either men (OR = 2.71, 95%CI = [1.07, 6.86]) or women (OR = 3.50, 95%CI = [1.59, 7.70]), separately. Conclusions Such findings will provide health practitioners and urban planners evidence-based insights on potential health effects of expanding and improving public transport systems, and on how to incorporate these effects into strategies of PA promotion and chronic disease prevention.

We consider the integrated planning of spare parts and service engineers that are needed for serving a group of systems. These systems are subject to different failure types, and for each failure, a service engineer with the necessary spare part has to be assigned to repair the system. The service provider follows a backlogging policy with part reservations. That is, a repair request is backlogged if one of the required resources is not immediately available upon demand. Moreover, a spare part is reserved if the requested spare part is in stock but no service engineer is immediately available. The spare parts are typically slow-movers and are managed according to a base-stock policy. The objective is to jointly determine the stock levels and the number of service engineers to minimize the total service costs subject to a constraint on the expected total waiting times of the repair calls. For the evaluation of a given setting, we present an exact method (computationally feasible for small problems) and an accurate approximation. For the joint optimization, we present a greedy heuristic that efficiently produces close-to-optimal results. We test how the heuristic performs compared to the optimal solution and the separate optimization of spare parts and service engineers in an extensive numerical study. In a case study with 93 types of spare parts, we show that the solution of the greedy algorithm is always within 2% of the optimal solution and is up to 20% better than a separated optimization approach encountered in practice.

In recent decades, wild cherry has been one of the species most widely used for reforestation in Europe. Studies aiming to select and improve trees to give them the best growth rates and wood properties have increased in response to growers’ demands. However, information relating to key physiological processes such as transpiration or stomatal conductance and to the effect of the common practice of pruning on plant–water relations is scarce. The main objective of this study was to assess the effects of environmental conditions on canopy conductance dynamics. Its secondary objective was to examine the short- and medium-term effects of branch pruning on tree transpiration, growth and derived water productivity. To this end, we measured sap flow in an experimental plantation where trees were subjected to drip irrigation and rain-fed conditions and where variables characterizing climate, soil and tree growth were also monitored. The results demonstrated that the Jarvis–Stewart approach was appropriate for studying the responses of canopy conductance to environmental factors. As well as the role of vapour pressure deficit and net radiation in controlling the daily variations of canopy conductance, the single effects of decreasing soil water content (optimum relative extractable water, REW, higher than 0.4) and increasing air temperature (optimum of 21 °C), as summer conditions approached, were correctly incorporated into the modelling exercise. Soil water content exerted the greatest control on canopy conductance for trees growing under rain-fed conditions, while air temperature did for irrigated trees. Pruning significantly reduced transpiration to about 35% when pre- and post-sub-periods were compared, but also affected annual water productivity regardless of the irrigation treatment. To assess the long-term effects of pruning on water productivity, measurements in both pruned and unpruned trees would be desirable. © 2019 Elsevier B.V., This research was financially supported by the GRIFO (AGL2010-21012) and CONSOLIDER-MONTES (CSD 2008-00040) projects. A.J. Molina is beneficiary of a Juan de la Cierva post-doctoral fellowship. A. Galindo is beneficiary of a Ramón Areces foundation post-doctoral fellowship. The field work of Eulalia Serra, Beatriz Grau, Marc Ferrer and Cristian Morales is greatly appreciated. We also want to thank the work of two anonymous reviewers in improving the quality of the manuscript.

The film thickness for grease lubricated bearings is normally calculated using the base oil viscosity, where it is assumed that the bearing is running under fully flooded conditions. It is well known that this is not accurate since grease lubricated bearings are usually running under starved lubrication conditions leading to thinner films. Single contact measurements have shown that, in the case of starvation, the film thickness decreases with increasing speed. It is shown in this paper that this effect seems to be very small though. The film thickness measurements, for three types of thickener material and base oil, show that the film thickness is almost independent of speed. To quantify this starvation effect, the film thickness can be expressed as the ratio between real film thickness and calculated film thickness using the base oil viscosity, hg/hff. The measurements in this paper show that hg/hff > 1 for very low speeds but decreases with speed asymptomatically reaching a constant value. It is shown here that hg/hff depends on speed, load and temperature and on the grease properties. It is not only the base oil viscosity that determines the film thickness. It is also governed by other grease properties that are today not known.

Separation in organic mixtures is challenging but inevitable in many chemical and pharmaceutical processes. A membrane-based technique known as organic solvent nanofiltration (OSN) offers a sustainable and reliable solution due to its characteristics of low energy consumption and high efficiency. However, fabrication of a robust membrane that can maintain its separation performance in direct contact with organic solvents for a long period of time is challenging. The most common way to make a polymeric membrane resistant to organic solvents is to cross-link it with a three-dimensional network of polymer chains. However, selection of the right cross-linker for a particular polymer may not be very straightforward. Therefore, in this review, we aim to briefly introduce the common materials used for the fabrication of OSN membranes and demonstrate the state-of-art cross-linking procedures to improve the chemical stability of the membranes. This review may be helpful to researchers when selecting and modifying materials for the development of OSN membranes.

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.