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BACKGROUND: Posttraumatic stress disorder (PTSD) has been associated with ischemic heart disease in women veterans, but evidence for associations with other cardiovascular disorders remains limited in this population. This retrospective longitudinal cohort study evaluated the association of PTSD with incident stroke/transient ischemic attack (TIA) in women veterans. METHODS AND RESULTS: Veterans Health Administration electronic health records were used to identify women veterans aged ≥18 years engaged with Veterans Health Administration health care from January 1, 2000 to December 31, 2019. We identified women veterans with and without PTSD without a history of stroke or TIA at start of follow-up. Propensity score matching was used to match groups on age, race or ethnicity, traditional cardiovascular risk factors, female-specific risk factors, a range of mental and physical health conditions, and number of prior health care visits. PTSD, stroke, TIA, and risk factors used in propensity score matching were based on diagnostic codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for associations of PTSD with an incident stroke/TIA composite. Subanalyses considered stroke and TIA separately, plus age- and race- or ethnicity-stratified analyses were carried out. The analytic sample included 208 092 women veterans (104 046 with and 104 046 without PTSD). PTSD was associated with a greater rate of developing stroke/TIA (HR, 1.33 [95% CI, 1.25-1.42], P

Vultures play a crucial role in scavenging communities as apex scavengers. Scavenging communities in turn are a key component of terrestrial ecosystems, ensuring that dead biomass is removed quickly and efficiently. Anthropogenic disturbances, particularly mass poisonings, have caused crashes in vulture populations in Africa and Asia.We ask if vultures can re‐establish themselves in a scavenging community from a point of near extirpation. To allow for maximum knowledge transfer across ecosystems, we focus on an ecosystem that is otherwise considered pristine.We chose Kruger National Park (KNP), a well‐documented African scavenging community, as our focal ecosystem and parameterised a mathematical model of scavenging‐community dynamics using field data from the park. We predicted the upper limit of vulture population size in an ecosystem like KNP. We then analysed vultures' path to recovery, using this empirically parameterised scavenging‐community model. We used perturbation methods to determine how parameter values that may be specific to KNP influence our predictions.Comparisons of predicted vulture carrying capacity with recent population estimates suggest that the cumulative effect of human activities on vulture abundance is larger than previously believed. Our analysis shows that vulture populations can reach their carrying capacity approximately five decades after a poisoning event that would almost extirpate the population. Over shorter time scales, we predict a decade of enhanced mammal abundance (i.e. mesoscavenger release) before the mammals are excluded from the scavenging community. In our study system, jackals and hyenas are the mammalian groups predicted to benefit from the absence of vultures. However, neither group removes biomass as efficiently as vultures and animal carcasses are predicted to accumulate in the ecosystem while the vulture population recovers.In our framework, the carrying capacity for vulture populations is determined by carcass availability. As evidence for an alternative regulating factor is lacking, we conclude that present‐day vulture population densities are orders of magnitude below their upper limits. Our results therefore suggest that with a recovery plan in place, the long‐term prospects for vulture species and the associated ecosystems are positive. [ABSTRACT FROM AUTHOR]

The Chinese Academy of Engineering Physics Terahertz Free Electron Laser Facility (CAEP THz FEL, CTFEL) is the only high-average power free electron laser terahertz source based on superconducting accelerators in China. The update of the CTFEL is now undergoing and will expand the frequency range from 0.1–4.2 THz to 0.1–125 THz. Two experimental stations for material spectroscopy and biomedicine will be built. A high harmonic generation (HHG) lightsource based beamline at the material spectroscopy experimental station for time-resolved angle-resolved photoemission spectroscopy (ARPES) research will be constructed and the optical design is presented. The HHG lightsource covers the extreme ultraviolet (XUV) photon energy range of 20–50 eV. A Czerny–Turner monochromator with two plane gratings worked in conical diffraction configuration is employed to maintain the transmission efficiency and preserve the pulse time duration. The calculated beamline transmission efficiency is better than 5% in the whole photon energy range. To our knowledge, this is the first time in China to combine THz-infrared FEL with HHG light source, and this experimental station will be a powerful and effective instrument that will give new research opportunities in the future for users doing research on the dynamic evolution of the excited electron band structure of a material's surface. [ABSTRACT FROM AUTHOR]

With emissions regulations becoming increasingly restrictive and the advent of real driving emissions limits, control of engine-out NOx emissions remains an important research topic for diesel engines. Progress in experimental engine development and computational modelling has led to the generation of a large amount of high-fidelity emissions and in-cylinder data, making it attractive to use data-driven emissions prediction and control models. While pure data-driven methods have shown robustness in NOx prediction during steady-state engine operation, deficiencies are found under transient operation and at engine conditions far outside the training range. Therefore, physics-based, mean value models that capture cyclic-level changes in in-cylinder thermo-chemical properties appear as an attractive option for transient NOx emissions modelling. Previous experimental studies have highlighted the existence of a very strong correlation between peak cylinder pressure and cyclic NOx emissions. In this study, a cyclic peak pressure-based semi-empirical NOx prediction model is developed. The model is calibrated using high-speed NO and NO2 emissions measurements during transient engine operation and then tested under different transient operating conditions. The transient performance of the physical model is compared to that of a previously developed data-driven (artificial neural network) model, and is found to be superior, with a better dynamic response and low (<10%) errors. The results shown in this study are encouraging for the use of such models as virtual sensors for real-time emissions monitoring and as complimentary models for future physics-guided neural network development. [ABSTRACT FROM AUTHOR]

The switching response in organic electrochemical transistors (OECT) is a basic effect in which a transient current occurs in response to a voltage perturbation. This phenomenon has an important impact on different aspects of the application of OECT, such as the equilibration times, the hysteresis dependence on scan rates, and the synaptic properties for neuromorphic applications. Here we establish a model that unites vertical ion diffusion and horizontal electronic transport for the analysis of the time‐dependent current response of OECTs. We use a combination of tools consisting of a physical analytical model; advanced 2D drift‐diffusion simulation; and the experimental measurement of a poly(3‐hexylthiophene) (P3HT) OECT. We show the reduction of the general model to simple time‐dependent equations for the average ionic/hole concentration inside the organic film, which produces a Bernards‐Malliaras conservation equation coupled with a diffusion equation. We provide a basic classification of the transient response to a voltage pulse, and the correspondent hysteresis effects of the transfer curves. The shape of transients is basically related to the main control phenomenon, either the vertical diffusion of ions during doping and dedoping, or the equilibration of electronic current along the channel length. [ABSTRACT FROM AUTHOR]

Guidelines help to facilitate treatment decisions based on available evidence, and also to provide recommendations in areas of uncertainty. In this paper, we compare the recommendations for stroke workup and secondary prevention of ischemic stroke and transient ischemic attack of the American Heart Association (AHA)/American Stroke Association (ASA) with the European Stroke Organization (ESO) guidelines. The primary aim of this paper is to offer clinicians guidance by identifying areas where there is consensus and where consensus is lacking, in the absence or presence of high-level evidence. We compared AHA/ASA with the ESO guideline recommendations for 7 different topics related to diagnostic stroke workup and secondary prevention. We categorized the recommendations based on class and level of evidence to determine whether there were relevant differences in the ratings of evidence that the guidelines used for its recommendations. Finally, we summarized major topics of agreement and disagreement, while also prominent knowledge gaps were identified. In total, we found 63 ESO and 82 AHA/ASA recommendations, of which 38 were on the same subject. Most recommendations are largely similar, but not all are based on high-level evidence. For many recommendations, AHA/ASA and ESO assigned different levels of evidence. For the 10 recommendations with Level A evidence (high quality) in AHA/ASA, ESO only labeled 4 of these as high quality. There are many remaining issues with either no or insufficient evidence, and some topics that are not covered by both guidelines. Most ESO and AHA/ASA Guideline recommendations for stroke workup and secondary prevention were similar. However not all were based on high-level evidence and the appointed level of evidence often differed. Clinicians should not blindly follow all guideline recommendations; the accompanying level of evidence informs which recommendations are based on robust evidence. Topics with lower levels of evidence, or those with recommendations that disagree or are missing, may be an incentive for further clinical research. [ABSTRACT FROM AUTHOR]

Introduction Acute Compartment Syndrome (ACS) is a severe trauma caused by elevated intra-muscle-compartment pressure (ICP). The current standard method for diagnosis is to insert a needle into the muscle sterilely under anesthesia. However, to secure the environment is sometimes not easy and leads to delays in diagnosis. Recently, we have focused on shear wave ultrasound elastography (SWE) as an alternative, which can be done concisely in unclean environment and without anesthesia. We would like to report the usefulness of SWE for ACS diagnosis using 2-pedal walking turkey model recently developed in our lab. Materials and Methods A total of 32 1-year-old Bourbon turkeys were used. 5% solution of chicken albumin was infused continuously into the tibialis cranialis (TC) muscle using IV pump. The ICP was increased stepwise from 0 to 50 mmHg. During the rising of ICP, the correlation between values of SWE (kPa) and ICP (mmHg) was measured. After the ICP reached 50 mmHg, half of the turkeys were maintained at this pressure for 2 hours and the rest for 6 hours. After infusion, a fasciotomy was performed on the half turkey. Half of the turkeys were euthanized after 2 weeks and the rest after 6 weeks. SWE of TC muscle and walking gait data on turkeys using a portable walkway system were measured weekly until euthanasia. At euthanasia, isometric tetanic muscle force (ITF) tests to TC muscle and histological evaluations were performed. Results SWE value (kPa) was highly significantly correlated to the actual ICP (mmHg) (R2 = 0.91). Stance of ACS side leg were significantly extended, and swing of the control side shortened from the second to the third week after ACS in the 6 hours infusion-no-fasciotomy group (P  < 0.05*). ITF was significantly reduced mainly in the 6 hours infusion group (P  < 0.05*). Histological evaluation revealed that in the 6 hours infusion and 6 weeks survival group, both the muscle fiber and intercellular distances were significantly expanded (P  < 0.05). Conclusion SWE seems to be a substitute measure of ICP in diagnosing ACS. With regard to our in vivo ACS model using turkey, survival at 50 mmHg ICP for 6 hours and 6 weeks post ACS would be an appropriate situation. [ABSTRACT FROM AUTHOR]

The Andrade rheological model is often employed to describe the response of solar system or extra‐solar planets to tidal perturbations, especially when their properties are still poorly constrained. While for uniform planets with steady‐state Maxwell rheology the analytical form of the Love numbers was established long ago, for the transient Andrade rheology no closed‐form solutions have been yet determined, and the planetary response is usually studied either semi‐analitically in the frequency domain or numerically in the time domain. Closed‐form expressions are potentially important since they could provide insight into the dependence of Love numbers upon the model parameters and the time‐scales of the isostatic readjustment of the planet. First, we focus on the Andrade rheological law in 1‐D and we obtain a previously unknown explicit form, in the time domain, for the relaxation modulus in terms of the higher Mittag‐Leffler transcendental function Eα,β(z) that generalizes the exponential function. Second, we consider the general response of an incompressible planetary model — often referred to as the "Kelvin sphere" — studying the Laplace domain, the frequency domain and the time domain Love numbers by analytical methods. Through a numerical approach, we assess the effect of compressibility on the Love numbers in the Laplace and frequency domains. Furthermore, exploiting the results obtained in the 1‐D case, we establish closed‐form — although not elementary — expressions of the time domain Love numbers and we discuss the frequency domain response of the Kelvin sphere with Andrade rheology analytically. Plain Language Summary: Rheology studies how materials flow when subject to stress. To constrain the rheology of planets, it is useful to consider their response to tidal forces or surface loads that allow to probe their interiors. The Andrade rheological model—introduced in 1910—has recently gained popularity in planetary studies. In contrast with the traditional Maxwell model, the Andrade rheology manifests "transient" creep, an initial stage of flow characterized by a time varying rate of strain. Up to now, the response of a planet characterized by an Andrade rheology has been studied numerically, since exact expressions for the Love numbers were only known in the frequency domain. For the first time, we show that in the case of an incompressible homogeneous planet, analytical Love numbers can also be found in the time domain. They are expressed in terms of the Mittag‐Leffler function, which generalizes the exponential. Using analytical methods, we study the Love numbers of a planet with Andrade rheology in the Laplace, frequency and time domains, also giving some numerical results. Key Points: The Andrade rheological law is widely employed in planetary studies since it accounts for transient flow in a simple wayWe obtain a first analytical expression of the time domain Love numbers for a homogeneous incompressible sphere with Andrade rheologyThe solutions found provide new insight into the planetary response and its sensitivity upon model parameters [ABSTRACT FROM AUTHOR]

Intracranial atherosclerotic disease (ICAD) is a common cause of ischaemic stroke and transient ischaemic attack (TIA) with a high recurrence rate. It is often referred to as intracranial atherosclerotic stenosis (ICAS), when the plaque has caused significant narrowing of the vessel lumen. The lesion is usually considered symptomatic ICAD/ICAS (sICAD/sICAS) when it has caused an ischaemic stroke or TIA. The severity of luminal stenosis has long been established as a prognostic factor for stroke relapse in sICAS. Yet, accumulating studies have also reported the important roles of plaque vulnerability, cerebral haemodynamics, collateral circulation, cerebral autoregulation and other factors in altering the stroke risks across patients with sICAS. In this review article, we focus on cerebral haemodynamics in sICAS. We reviewed imaging modalities/methods in assessing cerebral haemodynamics, the haemodynamic metrics provided by these methods and application of these methods in research and clinical practice. More importantly, we reviewed the significance of these haemodynamic features in governing the risk of stroke recurrence in sICAS. We also discussed other clinical implications of these haemodynamic features in sICAS, such as the associations with collateral recruitment and evolution of the lesion under medical treatment, and indications for more individualised blood pressure management for secondary stroke prevention. We then put forward some knowledge gaps and future directions on these topics.

Expanding upon the framework of the steady-state pin-by-pin 2D/1D decoupling method, a novel and high-performance pin-by-pin transient calculation method has been introduced. This transient method, consistent to the steady-state formulation, is designed for time-dependent calculations utilizing a 3D diffusion-based finite difference method (FDM). The inherent complexity of the large 3D problem is effectively managed by decoupling it into a series of planar (2D) and axial (1D) problems. In addition, tens of thousands of pin-cells are grouped into hundreds of boxes to reduce the computing burden for the 1D calculations without essential loss of the accuracy. Two-level coarse mesh finite difference (CMFD) formulation comprising multigroup nodewise CMFD and two-group assemblywise CMFD is employed as well to accelerate the convergence. Errors originating from the pin-level homogenization, energy group condensation, and the use of lower order calculation methods are simultaneously corrected by the pinwise super homogenization (SPH) equivalence factor.The transient method is evaluated with OECD/NEA PWR MOX/UO2 benchmark. Code-to-code comparison with the nTRACER direct whole core calculation code yielded highly satisfactory results for the transient scenario as well as the steady-state problems. Furthermore, comparative analyses with conventional nodal calculations show superiority of the pin-by-pin calculation.

AIMS: The clinical correlates and outcomes of asymptomatic atrial fibrillation (AF) in hospitalized patients are largely unknown. We aimed to investigate the clinical correlates and in-hospital outcomes of asymptomatic AF in hospitalized Chinese patients. METHODS AND RESULTS: We conducted a cross-sectional registry study of inpatients with AF enrolled in the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation Project between February 2015 and December 2019. We investigated the clinical characteristics of asymptomatic AF and the association between the clinical correlates and the in-hospital outcomes of asymptomatic AF. Asymptomatic and symptomatic AF were defined according to the European Heart Rhythm Association score. Asymptomatic patients were more commonly males (56.3%) and had more comorbidities such as hypertension (57.4%), diabetes mellitus (18.6%), peripheral artery disease (PAD; 2.3%), coronary artery disease (55.5%), previous history of stroke/transient ischaemic attack (TIA; 17.9%), and myocardial infarction (MI; 5.4%); however, they had less prevalent heart failure (9.6%) or left ventricular ejection fractions ≤40% (7.3%). Asymptomatic patients were more often hospitalized with a non-AF diagnosis as the main diagnosis and were more commonly first diagnosed with AF (23.9%) and long-standing persistent/permanent AF (17.0%). The independent determinants of asymptomatic presentation were male sex, long-standing persistent AF/permanent AF, previous history of stroke/TIA, MI, PAD, and previous treatment with anti-platelet drugs. The incidence of in-hospital clinical events such as all-cause death, ischaemic stroke/TIA, and acute coronary syndrome (ACS) was higher in asymptomatic patients than in symptomatic patients, and asymptomatic clinical status was an independent risk factor for in-hospital all-cause death, ischaemic stroke/TIA, and ACS. CONCLUSION: Asymptomatic AF is common among hospitalized patients with AF. Asymptomatic clinical status is associated with male sex, comorbidities, and a higher risk of in-hospital outcomes. The adoption of effective management strategies for patients with AF should not be solely based on clinical symptoms.

Electromagnetic pulse welding (EMPW) is commonly used for welding copper and aluminum alloy. The welding gap is important in the EMPW process. The research focused on the effect of welding gap on the welding process and the mechanical property of joints. During the EMPW experiments, the deformation, collision, and metal jet were recorded with a high-speed camera. The joint mechanical property was tested. SEM and EDS were employed to examine the bonding interface. Results indicated that the welding gap length did not significantly influence the aluminum alloy plate motion behavior when it was long enough. With the welding gap width increasing, the collision velocity initially increased and subsequently decreased, and the angle between the two plates when they first collided increased continuously. The intensity and duration of the metal jet and the joint mechanical properties also increased first and then decreased. The welding marks widened first and then narrowed. [ABSTRACT FROM AUTHOR]

This study introduces a transient analysis module developed for RAST-V and validates it using the Kalinin-3 benchmark problem. For the benchmark analysis, RAST-V standalone and STREAM/RAST-V calculations were performed. STREAM supplies the few-group constants and RAST-V conducts a 3D core simulation utilizing few-group cross-sectional data. To improve accuracy, the main solver was developed based on the advanced semi-analytic nodal method. To evaluate the computational capability of the transient analysis module in RAST-V, Kalinin-3 benchmark is employed. Kalinin-3 represents a coolant transient benchmark that offers experimental data during the deactivation of the Main Circulation Pumps. Consequently, the transient calculations reflected the changes in the reactor flow rate. Benchmark comprising steady-state and transient calculations. During the steady state, the STREAM/RAST-V combination demonstrated a 30 ppm root mean square difference from 0 to 128.50 EFPD. For the transient calculations, STREAM/RAST-V showed power differences within ±7 % over a range of 0–300 s. Axial offset differences were within ±3 %, and the RMS difference in radial power ranged within 2.596 % at both 0 and 300 s. Overall, this study effectively demonstrated the newly developed transient solver in RAST-V and validated it using the Kalinin-3 benchmark problem.

AbstractA study of mass and heat transport on fully developed laminar and transient free convective flow in a vertical cylinder containing a porous substance inside it. The Laplace Transform Method (LTM) is used to solve the governing equations with suitable boundary conditions. A compact form solution represented by using Bessel and modified Bessel functions. The numerical results were thoroughly scrutinized using graphs and tables to illustrate the effects of newly discovered fluid characteristics, including time, Grashof, mass Grashof, Schmidt, Prandtl, Darcy numbers, viscosity ratio on the concentration and the velocity profiles. The velocity and concentration profiles progressively increase with varying time values until reaching a steady state. Furthermore, it is found that the velocity profiles are decreased by the Prandtl, Schmidt number, and viscosity ratio. In contrast, the Darcy, Grashof, and mass Grashof numbers exhibit an opposite effect. The rate of mass transport, skin friction, and mass flux are presented in tables. The major finding of the current research is that the viscosity ratio parameter decelerates the skin friction and mass flux. This study has potential applications in innovative fields such as solar energy systems, chemical engineering processes, etc. [ABSTRACT FROM AUTHOR]

The fuel injection rate (ROI) is a crucial factor that affects the combustion and emissions of diesel engines. This study focuses on the injection pressure in a common rail system, which is divided into a high-pressure section and a low-pressure section. A control-oriented ROI shaping (ROIs) model is developed based on the switching strategy between high and low injection pressure. Three types of ROI were generated, namely ROIB (conventional ROI), boot-ROI (low followed by high injection pressure), and anti-boot-ROI (high followed by low injection pressure) respectively. The 1-D and 3-D numerical simulations are conducted to analyze the impact of the shaped ROI on combustion and emissions for steady condition and transient condition. In terms of overall results, boot-ROI shows significant advantage among the three types of ROI. For the steady condition, the boot-ROI was able to increase the IMEP (indicated mean effective pressure) (1.57 bar) at high load conditions with almost unchanged NOx emission. For low load conditions with delayed SOI (start of injection), the exhaust temperature is close to that of the ROIB with a reduction of 0.51 g/kW·h in NOx emissions. For transient condition, the boot-ROI also shows its advantage. It was found to improve the BSFC (brake specific fuel consumption) with almost unchanged NOx emission during load-down process. And in load-up process, the BSFC and soot emission also could be improved with slightly increase in NOx emission through advance of SOI when boot-ROI was adopted. The one-dimensional model using boot-ROI reduces fuel consumption by 2 g/kW·h in experiment with WHTC cycles, with slightly higher soot emission and similar NOx emission. [ABSTRACT FROM AUTHOR]

Atherosclerosis is a condition which disrupts blood flow due to plaque build-up inside the arteries. Under conditions where consecutive plaques are prevailing blood hammer principle is exhibited. The pressure and shear stress produced at an infinitesimal area act as the governing equation for stent modeling. The leading order pressure lays the foundation for the design of cardiac stents with definite dimensions. The designed stent was encapsulated inside a crimper validated through ANSYS-static and transient structural simulation to derive the total deformation, equivalent strain, and stress exerted on the stent. Five different biomaterials stainless steel 316, cobalt, chromium, platinum, and Poly lactic acid were selected for the material assessment. Static and Transient structural analysis for a period of 1 and 10 secs was implemented for a stent with and without a crimper. The material performance in terms of total deformation, equivalent stress, and strain are analyzed. The paper envisions the dynamics of blood hammer in atherosclerosis that provides the changes in the pressure and clotting process. It shows the promising results of the stent behavior in varied forces which gives valuable insights for future improvement in stent design and material selection. [ABSTRACT FROM AUTHOR]

This paper presents the design of a disturbance observer-based controller that regulates the output voltage of three-phase four-leg voltage source inverters (VSIs) deployed for grid-forming operation in Renewable Energy-based Distributed Generation (REDG) Systems. The primary objective of the controller is to provide a symmetric and sinusoidal voltage at the output of the VSI when supplying highly unbalanced and nonlinear loads. The controller employs the feedback linearization (FL) technique and incorporates a disturbance observer (DO) to address a range of disturbances that include oscillations resulting from unbalanced loads, harmonics generated by nonlinear loads, and non-oscillatory disturbances. Notably, the controller adopts a direct control scheme without the need for nested current control loops and does not use any transformation frames. Simulation studies and experimental investigations were conducted to assess the controller's performance under various load conditions, including both linear and nonlinear types, as well as load transients. The findings demonstrate the controller's capability to accurately track references while complying with the IEEE power quality standards for the tested conditions. [ABSTRACT FROM AUTHOR]

Larkin carves a niche as a poet of nature as he treats nature as the source for fragile happiness in his contact with nature. He does not recall the events of his contact with nature. As a nature poet, he marks a clear-cut difference between Wordsworth and Robert Frost. Nature is plentiful with its beauty in variety for the gaiety of onlookers. Poets look at nature and react to it in diverse ways. Some poets like Wordsworth worship nature, giving it the status of divinity. Some poets like Robert Frost treat nature as the source for rejuvenation on their momentary contact with nature. Some poets like Philip Larkin enjoy the beauty in nature for a little while and shares the plight of transient lives of leaves and flowers. He observes cyclic changes in nature and sympathies with the pathetic plight of the non-human world. He shares the suffering of animals, birds, and other objects of nature. [ABSTRACT FROM AUTHOR]

In this study, the resistive switching phenomena in TiN/Ti/HfO2/Ti metal–insulator–metal stacks is investigated, mainly focusing on the analysis of set and reset transitions. The electrical measurements in a wide temperature range reveal that the switching transitions require less voltage (and thus, less energy) as temperature rises, with the reset process being much more temperature sensitive. The main conduction mechanism in both resistance states is Space-charge-limited Conduction, but the high conductivity state also shows Schottky emission, explaining its temperature dependence. Moreover, the temporal evolution of these transitions reveals clear differences between them, as their current transient response is completely different. While the set is sudden, the reset process development is clearly non-linear, closely resembling a sigmoid function. This asymmetry between switching processes is of extreme importance in the manipulation and control of the multi-level characteristics and has clear implications in the possible applications of resistive switching devices in neuromorphic computing. [ABSTRACT FROM AUTHOR]

Ultrasound‐directed self‐assembly (DSA) uses ultrasound waves to organize and orient particles dispersed in a fluid medium into specific patterns. Combining ultrasound DSA with vat photopolymerization (VP) enables manufacturing materials layer‐by‐layer, wherein each layer the organization and orientation of particles in the photopolymer is controlled, which enables tailoring the properties of the resulting composite materials. However, the particle packing density changes with time and location as particles organize into specific patterns. Hence, relating the ultrasound DSA process parameters to the transient local particle packing density is important to tailor the properties of the composite material, and to determine the maximum speed of the layer‐by‐layer VP process. This paper theoretically derives and experimentally validates a 3D ultrasound DSA model and evaluates the local particle packing density at locations where particles assemble as a function of time and ultrasound DSA process parameters. The particle packing density increases with increasing particle volume fraction, decreasing particle size, and decreasing fluid medium viscosity is determined. Increasing the particle size and decreasing the fluid medium viscosity decreases the time to reach steady‐state. This work contributes to using ultrasound DSA and VP as a materials manufacturing process. [ABSTRACT FROM AUTHOR]

Many UK hospitals rely heavily on natural ventilation as their main source of airflow in patient wards. This method of ventilation can have cost and energy benefits, but it may lead to unpredictable flow patterns between indoor spaces, potentially leading to the unexpected transport of infectious material to other connecting zones. However, the effects of weather conditions on airborne transmission are often overlooked. A multi-zone CONTAM model of a naturally ventilated hospital respiratory ward, incorporating time-varying weather, was proposed. Coupling this with an airborne infection model, this study assessed the variable risk in interconnected spaces, focusing particularly on occupancy, disease and ventilation scenarios based on a UK respiratory ward. The results suggest that natural ventilation with varying weather conditions can cause irregularities in the ventilation rates and interzonal flow rates of connected zones, leading to infrequent but high peaks in the concentration of airborne pathogens in particular rooms. This transient behaviour increases the risk of airborne infection, particularly through movement of pathogens between rooms, and highlights that large outbreaks may be more likely under certain conditions. This study demonstrated how ventilation rates achieved by natural ventilation are likely to fall below the recommended guidance, and that the implementation of supplemental mechanical ventilation can increase ventilation rates and reduce the variability in infection risks. This model emphasises the need for consideration of transient external conditions when assessing the risk of transmission of airborne infection in indoor environments. [ABSTRACT FROM AUTHOR]

For many species, the relationship between space use and diet composition is complex, with individuals adopting varying space use strategies such as territoriality to facilitate resource acquisition. Coyotes (Canis latrans) exhibit two disparate types of space use; defending mutually exclusive territories (residents) or moving nomadically across landscapes (transients). Resident coyotes have increased access to familiar food resources, thus improved foraging opportunities to compensate for the energetic costs of defending territories. Conversely, transients do not defend territories and are able to redirect energetic costs of territorial defense towards extensive movements in search of mates and breeding opportunities. These differences in space use attributed to different behavioral strategies likely influence foraging and ultimately diet composition, but these relationships have not been well studied. We investigated diet composition of resident and transient coyotes in the southeastern United States by pairing individual space use patterns with analysis of stable carbon (δ13C) and nitrogen (δ15N) isotope values to assess diet. During 2016–2017, we monitored 41 coyotes (26 residents, 15 transients) with GPS radio-collars along the Savannah River area in the southeastern United States. We observed a canopy effect on δ13C values and little anthropogenic food in coyote diets, suggesting 13C enrichment is likely more influenced by reduced canopy cover than consumption of human foods. We also observed other land cover effects, such as agricultural cover and road density, on δ15N values as well as reduced space used by coyotes, suggesting that cover types and localized, resident-like space use can influence the degree of carnivory in coyotes. Finally, diets and niche space did not differ between resident and transient coyotes despite differences observed in the proportional contribution of potential food sources to their diets. Although our stable isotope mixing models detected differences between the diets of resident and transient coyotes, both relied mostly on mammalian prey (52.8%, SD = 15.9 for residents, 42.0%, SD = 15.6 for transients). Resident coyotes consumed more game birds (21.3%, SD = 11.6 vs 13.7%, SD = 8.8) and less fruit (10.5%, SD = 6.9 vs 21.3%, SD = 10.7) and insects (7.2%, SD = 4.7 vs 14.3%, SD = 8.5) than did transients. Our findings indicate that coyote populations fall on a feeding continuum of omnivory to carnivory in which variability in feeding strategies is influenced by land cover characteristics and space use behaviors. [ABSTRACT FROM AUTHOR]

We have previously demonstrated protection from impending cortical ischemic stroke is achievable by sensory stimulation of the ischemic area in an adult rat model of permanent middle cerebral artery occlusion (pMCAo). We have further demonstrated that a major underpinning mechanism that is necessary for such protection is the system of collaterals among cerebral arteries that results in reperfusion of the MCA ischemic territory. However, since such collateral flow is weak, it may be necessary but not sufficient for protection and therefore we sought other complementary mechanisms that contribute to sensory-based protection. We hypothesized that astrocytes-neuron lactate shuttle (ANLS) activation could be another potential underpinning mechanism that complements collateral flow in the protection process. Supporting our hypothesis, using functional imaging, pharmacological treatments, and postmortem histology, we showed that ANLS played a pivotal role in sensory stimulation-based protection of cortex and therefore serves as the other supporting mechanism underpinning the protection process.

A three-dimensional microchannel flow boiling model was developed based on the VOF model and the Lee model, and the flow and heat transfer in microchannels with Kagome structures were numerically simulated. The characteristics of bubble flow patterns, gas phase distribution, and heat transfer were analyzed under the heat fluxes of 5–8 MW/m2 and flow velocities of 0.2–0.5 m/s. The results show that at a flow velocity of 0.5 m/s, the disturbances caused by fluid impact on the Kagome structure result in bubble break-up, effectively suppressing the formation of large bubbles. However, at a flow velocity of 0.2 m/s, bubbles tend to be adhered on the surface of the Kagome structure, causing local blockage and deteriorating heat transfer. Compared to the flow velocity of 0.5 m/s, the average heat transfer coefficient in the microchannel decreases by up to 75.4 % and the pressure loss decreases by 45.38 % at the flow velocity of 0.2 m/s.

Abstract The Andrade rheological model is often employed to describe the response of solar system or extra‐solar planets to tidal perturbations, especially when their properties are still poorly constrained. While for uniform planets with steady‐state Maxwell rheology the analytical form of the Love numbers was established long ago, for the transient Andrade rheology no closed‐form solutions have been yet determined, and the planetary response is usually studied either semi‐analitically in the frequency domain or numerically in the time domain. Closed‐form expressions are potentially important since they could provide insight into the dependence of Love numbers upon the model parameters and the time‐scales of the isostatic readjustment of the planet. First, we focus on the Andrade rheological law in 1‐D and we obtain a previously unknown explicit form, in the time domain, for the relaxation modulus in terms of the higher Mittag‐Leffler transcendental function Eα,β(z) that generalizes the exponential function. Second, we consider the general response of an incompressible planetary model — often referred to as the “Kelvin sphere” — studying the Laplace domain, the frequency domain and the time domain Love numbers by analytical methods. Through a numerical approach, we assess the effect of compressibility on the Love numbers in the Laplace and frequency domains. Furthermore, exploiting the results obtained in the 1‐D case, we establish closed‐form — although not elementary — expressions of the time domain Love numbers and we discuss the frequency domain response of the Kelvin sphere with Andrade rheology analytically.

Abstract The switching response in organic electrochemical transistors (OECT) is a basic effect in which a transient current occurs in response to a voltage perturbation. This phenomenon has an important impact on different aspects of the application of OECT, such as the equilibration times, the hysteresis dependence on scan rates, and the synaptic properties for neuromorphic applications. Here we establish a model that unites vertical ion diffusion and horizontal electronic transport for the analysis of the time‐dependent current response of OECTs. We use a combination of tools consisting of a physical analytical model; advanced 2D drift‐diffusion simulation; and the experimental measurement of a poly(3‐hexylthiophene) (P3HT) OECT. We show the reduction of the general model to simple time‐dependent equations for the average ionic/hole concentration inside the organic film, which produces a Bernards‐Malliaras conservation equation coupled with a diffusion equation. We provide a basic classification of the transient response to a voltage pulse, and the correspondent hysteresis effects of the transfer curves. The shape of transients is basically related to the main control phenomenon, either the vertical diffusion of ions during doping and dedoping, or the equilibration of electronic current along the channel length.

To reduce climate impact, switching to carbon-free electrofuels is an interesting option to reduce greenhouse gas emissions from electricity generation. The emission of other pollutants than CO2, such as nitrogen oxides (NOx), however, remains a concern. This research focuses on investigating the impact of transient phases, such as start-up and load change, on the NOx emissions expected from the rich combustion of mixtures of hydrogen and ammonia in gas turbines. Stochastic processes account for the inherent variability and uncertainty on the transient trajectories. The trajectories are simulated using a one-dimensional premixed flame model built in Cantera to compute the levels of pollutant formations, among others. The results indicate significant variations in the equivalence ratio, leading to high NOx emission peaks. The study concludes that the impact of the uncertainties related to the transient trajectories on the NOx emissions is low compared to the overall variations of the equivalence ratio, although they can accentuate observed peaks.

Though early ASD diagnosis is highly stable, this case report describes a rare situation in which symptoms resolved without intervention over a 4 month period. We do not recommend delaying diagnosis in symptomatic children who meet criteria but when major behavioral changes are reported after diagnosis, reevaluation may be beneficial.

The relationship between past medical histories (PMH) and dementia-related neuropathologies is not well understood. Using the National Alzheimer's Coordinating Center (NACC) database, we explored the relationship between patient-reported PMH and various vascular and degenerative neuropathologies. We examined the following PMH: transient ischemic attack (TIA), stroke, traumatic brain injury, seizures, hypertension, cardiovascular events, hypercholesterolemia, B12 deficiency, diabetes mellitus, and thyroid disease. We dichotomized the following neuropathologies: atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy (CAA), Alzheimer disease neuropathology (ADNP), Lewy bodies (LB), hippocampal sclerosis, frontotemporal lobar degeneration (FTLD), and TAR DNA-binding protein-43 (TDP-43). Separate logistic regression models assessed the relationship between the outcome of individual neuropathologies and all PMHs. Additional logistic regressions were stratified by sex to further examine these associations. Hypertension history was associated with an increased likelihood of atherosclerosis (OR = 1.7) and arteriolosclerosis (OR = 1.3), but decreased odds of ADNP (OR = 0.81), CAA (OR = 0.79), and LB (OR = 0.78). History of TIA was associated with an increased likelihood of atherosclerosis (OR = 1.3) and arteriolosclerosis (OR = 1.4) and lower odds of ADNP (OR = 0.72). Seizure history was associated with an increased likelihood of ADNP (OR = 1.9) and lower odds of FTLD (OR = 0.49). Hypertension history was associated with a greater likelihood of vascular pathologies yet a lower likelihood of ADNP and other neurodegenerative pathologies.

Background and objectivesTo understand the role of premature (defined as ≤ 60 years) cardiovascular disease (CVD) in brain health earlier in life, we examined the associations of premature CVD with midlife cognition and white matter health.MethodsWe studied a prospective cohort in the Coronary Artery Risk Development in Young Adults study, who were 18-30 years at baseline (1985-1986) and followed up to 30 years when 5 cognitive tests measuring different domains were administered. A subset (656 participants) had brain MRI measures of white matter hyperintensity (WMH) and white matter integrity. A premature CVD event was adjudicated based on medical records of coronary heart disease, stroke/TIA, congestive heart failure, carotid artery disease, and peripheral artery disease. We conducted linear regression to determine the associations of nonfatal premature CVD with cognitive performance (z-standardized), cognitive decline, and MRI measures.ResultsAmong 3,146 participants, the mean age (57% women and 48% Black) was 55.1 ± 3.6 years, with 5% (n = 147) having premature CVD. Adjusting for demographics, education, literacy, income, depressive symptoms, physical activity, diet, and APOE, premature CVD was associated with lower cognition in 4 of 5 domains: global cognition (-0.22, 95% CI -0.37 to -0.08), verbal memory (-0.28, 95% CI -0.44 to -0.12), processing speed (-0.46, 95% CI -0.62 to -0.31), and executive function (-0.38, 95% CI -0.55 to -0.22). Premature CVD was associated with greater WMH (total, temporal, and parietal lobes) and higher white matter mean diffusivity (total and temporal lobes) after adjustment for covariates. These associations remained significant after adjusting for cardiovascular risk factors (CVRFs) and excluding those with stroke/TIA. Premature CVD was also associated with accelerated cognitive decline over 5 years (adjusted OR 3.07, 95% CI 1.65-5.71).DiscussionPremature CVD is associated with worse midlife cognition and white matter health, which is not entirely driven by stroke/TIA and even independent of CVRFs. Preventing CVD in early adulthood may delay the onset of cognitive decline and promote brain health over the life course.

BackgroundThe aim of this study was to determine the effect of smoking status on subsequent stroke risk in patients with minor ischemic stroke or TIA and to determine whether smoking modifies the effect of clopidogrel-based DAPT on subsequent stroke risk.MethodsThis was a post-hoc analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which had a 90-day follow-up period. We used multivariable Cox regression and subgroup interaction analysis to determine the effect of smoking on the risk of subsequent ischemic stroke and major hemorrhage, respectively.ResultsData from 4877 participants enrolled in the POINT trial were analyzed. Among these, 1004 were current smokers and 3873 were non-smokers at the time of index event. Smoking was associated with a non-significant trend toward an increased risk of subsequent ischemic stroke during follow up (adjusted HR, 1.31 (95% CI, 0.97-1.78), p = 0.076). The effect of clopidogrel on ischemic stroke did not differ between non-smokers (HR, 0.74 (95% CI, 0.56-0.98), p = 0.03) and smokers (HR, 0.63 (95% CI, 0.37-1.05), p = 0.078), p for interaction = 0.572. Similarly, the effect of clopidogrel on major hemorrhage did not differ between non-smokers (hazard ratio, 1.67 (95% CI, 0.40-7.00), p = 0.481) and smokers (HR, 2.59 (95% CI, 1.08-6.21), p = 0.032), p for interaction = 0.613.ConclusionsIn this post-hoc analysis of the POINT trial we found that the effect of clopidogrel on reducing subsequent ischemic stroke as well as risk of major hemorrhage did not depend on smoking status, indicating that smokers benefit to a similar degree from DAPT as non-smokers.

Current measurement systems based on the IEEE-1159 standard have some limitations and robustness problems under noisy and fast-changing conditions. Besides, applying different methods for each Power Quality Disturbance (PQD) to every window is required but time-consuming and not feasible. Therefore, different kinds of two-stage methods, Detection and Classification (D&C), have been improved in many studies. Then, the required measurement can be performed to define disturbance. For this purpose, a new approach based on features of subcomponents with Machine Learning Algorithms (MLAs) to detect and classify PQDs is proposed. 21-class dataset including single and multiple PQDs under different noisy conditions was prepared randomly. Of this dataset, determined features were extracted and some of these were selected. Then, selected features were trained and tested with some MLAs in a workstation. Results obtained from comparative MLAs and the other classification methods show that the best MLA with related features is Random Forest with 96.97% while LightGBM, k-Nearest Neighbors, and XGBoost 96.85%, 96.73%, and 92.82% accuracy, respectively. Because the selected features, optimized parameters, and the related MLA were obtained by investigating for features provided from the PQDs in the whole parameter space, this approach brings the advantages of high accuracy, low D&C complexity, and computing load. [ABSTRACT FROM AUTHOR]

AbstractComparison of results for global responses predicted by different multiphysics simulations of benchmark problems may fail to reveal potentially significant local modeling issues. An examination of code interactions in coupled simulations can provide more information, which may help identify potential modeling issues that went unnoticed during verification (and validation) of the individual codes, or may call into question approximations otherwise deemed reasonable at the individual code level.We illustrate this challenge for the case of coupled neutronics/thermal-hydraulic transient simulations using one of the problems and contributed results documented in International Atomic Energy Agency TECDOC-1994. This recently published report documents the specifications of four numerical multiphysics pressurized heavy water reactor (PHWR) transient challenge problems and the results contributed by 10 participants. Our work is based on the pump rundown problem, where TECDOC-1994 suggests that differences in modeling and methods employed in thermal-hydraulics may be the dominant factor in the observed differences. We performed a more detailed assessment with two different multiphysics coupled computational frameworks using NESTLE-C/ARIANT and PUMA/RELAP-5. We also studied a pump seizure transient, a more challenging variant of the pump rundown transient. Several aspects were investigated: comparisons of standalone results, sensitivity to gap modeling, selection of boundary conditions at the pressurizer, and an examination of correlations used in ARIANT and RELAP-5.Our assessment goes beyond the results for global parameters and dives into details of predictions at the channel level. This paper briefly describes the PHWR pump rundown transient problem and a pump seizure variant, the computational methods employed, and the areas investigated, and discusses some selected results. [ABSTRACT FROM AUTHOR]

Dissipative supramolecular assemblies are hallmarks of living systems, contributing to their complex, dynamic structures and emerging functions. Living cells can spatiotemporally control diverse biochemical reactions in membrane compartments and condensates, regulating metabolite levels, signal transduction or remodeling of the cytoskeleton. Herein, we constructed membranous compartments using self‐assembly of lipid‐like amphiphiles (lipidoid) in aqueous medium. The new double‐tailed lipidoid features Cu(II) coordinated with a tetravalent chelator that dictates the binding of two amphiphilic ligands in cis‐orientation. Hydrophobic interactions between the lipidoids coupled with intermolecular hydrogen bonding led to a well‐defined bilayer vesicle structure. Oil‐soluble SNAr reaction is efficiently upregulated in the hydrophobic cavity, acting as a catalytic crucible. The modular system allows easy incorporation of exposed primary amine groups, which augments the catalysis of retro aldol and C−N bond formation reactions. Moreover, a higher‐affinity chelator enables consumption of the Cu(II) template leveraging the differential thermodynamic stability, which allows a controllable lifetime of the vesicular assemblies. Concomitant temporal upregulation of the catalytic reactions could be tuned by the metal ion concentration. This work offers new possibilities for metal ion‐mediated dynamic supramolecular systems, opening up a massive repertoire of functionally active dynamic "life‐like" materials. [ABSTRACT FROM AUTHOR]

Data from the steady-state operation of gas turbine engines are used in gas path diagnostic procedures. A method to identify steady-state operation is thus required. This paper initially explains and demonstrates the factors that cause a deviation in engine health when transient data are used for diagnosis and shows that there is a threshold in the slope of time traces, below which the variation in engine health parameters is acceptable. A methodology for deriving a criterion for steady-state operation based on actual flight data is then presented. The slope of the exhaust gas temperature variation with time and the size of its time-series window, from which this slope is determined, are the required parameters that must be specified when applying this criterion. It is found that the values of these parameters must be selected so that a sufficient number of steady-state points are available without compromising the accuracy of the diagnostic procedure. [ABSTRACT FROM AUTHOR]

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The need to achieve high energies in particle accelerators has led to the development of new accelerator technologies, resulting in higher beam intensities and more compact devices with stronger accelerating fields. In such scenarios, beam-loading effects occur, and intensity-dependent gradient reduction affects the accelerated beam as a consequence of its interaction with the surrounding cavity. In this study, a power-diffusive partial differential equation is derived to account for this effect. Its numerical resolution has been implemented in the tracking code RF-Track, allowing the simulation of apparatuses where transient beam loading plays an important role. Finally, measurements of this effect have been carried out in the CERN Linear Electron Accelerator for Research (CLEAR) facility at CERN, finding good agreement with the RF-Track simulations. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the impact of diesel and kerosene on the transient processes occurring in a micro-turbojet aviation engine. The experiments were conducted under two distinct ambient temperature conditions, 0 and 20 °C. Specifically, we analyzed the starting phase of the micro-engine while operating with kerosene and diesel at both ambient temperature settings. Comparative graphs were generated, and the starting time was meticulously examined. Subsequently, we constructed performance maps for the engine using both fuels and across the two ambient temperature scenarios. We then executed a transient process, comprising sudden acceleration and deceleration, under the aforementioned ambient temperature conditions and with both fuels. The fluctuations in temperature within the combustion chamber, thrust force, and fuel consumption are presented for both rapid acceleration and deceleration events. Furthermore, we conducted comparisons between the thrust force, fuel flow rate, combustion chamber temperature, and specific fuel consumption for the two fuels tested and under the two ambient temperature conditions, both during idle and at higher engine regimes. In the idle regime at 0 °C, the kerosene flow is about 0.78% higher than diesel, with the kerosene thrust approximately 1.92% greater. At 20 °C, the kerosene consumption rises by roughly 5.56% compared to diesel, while the thrust increases by about 1.38%. It was observed that at the maximum operating regime, at 0 °C, the kerosene flow exceeds diesel by around 6%, with the kerosene thrust slightly higher, by about 0.63%. At 20 °C, the kerosene consumption rises by roughly 13.19% compared to diesel, while the thrust increases by about 5.91%. In higher regimes, the kerosene consumption surpasses diesel, but the thrust increase is not significant. Thus, diesel's use as a fuel for the microturbo engine is justified due to its lower consumption at both 0 °C and 20 °C. [ABSTRACT FROM AUTHOR]

Background: Several neurovascular procedures require temporary occlusion of cerebral arteries, leading to ischemia of unpredictable length, occasionally causing brain infarction. Experimental models of cerebral ischemia–reperfusion injury have established that platelet adhesion and coagulation play detrimental roles in reperfusion injury following transient cerebral ischemia. Therefore, in a model of cerebral ischemia–reperfusion injury (IRI), we investigated the therapeutic potential of a dual antiplatelet and anticoagulant (APAC) heparin proteoglycan mimetic which is able to bind to vascular injury sites. Methods: Brain ischemia was induced in mice by transient occlusion of the right middle cerebral artery for 60 min. APAC, unfractionated heparin (UFH) (both at heparin equivalent doses of 0.5 mg/kg), or vehicle was intravenously administered 10 min before or 60 min after the start of ischemia. At 24 h later, mice were scored for their neurological and motor behavior, and brain damage was quantified. Results: Both APAC and UFH administered before the onset of ischemia reduced brain injury. APAC and UFH pretreated mice had better neurological and motor functions (p < 0.05 and p < 0.01, respectively) and had significantly reduced cerebral infarct sizes (p < 0.01 and p < 0.001, respectively) at 24 h after transient occlusion compared with vehicle-treated mice. Importantly, no macroscopic bleeding complications were observed in either APAC- or UFH-treated animals. However, when APAC or UFH was administered 60 min after the start of ischemia, the therapeutic effect was lost, but without hemorrhaging either. Conclusions: Pretreatment with APAC or UFH was safe and effective in reducing brain injury in a model of cerebral ischemia induced by transient middle cerebral artery occlusion. Further studies on the use of APAC to limit ischemic injury during temporary occlusion in neurovascular procedures are indicated. [ABSTRACT FROM AUTHOR]

Industrial hemp Cannabis sativa L. is an economically important crop mostly grown for its fiber, oil, and seeds. Due to its increasing applications in the pharmaceutical industry and a lack of knowledge of gene functions in cannabinoid biosynthesis pathways, developing an efficient transformation platform for the genetic engineering of industrial hemp has become necessary to enable functional genomic and industrial application studies. A critical step in the development of Agrobacterium tumefaciens-mediated transformation in the hemp genus is the establishment of optimal conditions for T-DNA gene delivery into different explants from which whole plantlets can be regenerated. As a first step in the development of a successful Agrobacterium tumefaciens-mediated transformation method for hemp gene editing, the factors influencing the successful T-DNA integration and expression (as measured by transient β-glucuronidase (GUS) and Green Florescent Protein (GFP) expression) were investigated. In this study, the parameters for an agroinfiltration system in hemp, which applies to the stable transformation method, were optimized. In the present study, we tested different explants, such as 1- to 3-week-old leaves, cotyledons, hypocotyls, root segments, nodal parts, and 2- to 3-week-old leaf-derived calli. We observed that the 3-week-old leaves were the best explant for transient gene expression. Fully expanded 2- to 3-week-old leaf explants, in combination with 30 min of immersion time, 60 µM silver nitrate, 0.5 µM calcium chloride, 150 µM natural phenolic compound acetosyringone, and a bacterial density of OD600nm = 0.4 resulted in the highest GUS and GFP expression. The improved method of genetic transformation established in the present study will be useful for the introduction of foreign genes of interest, using the latest technologies such as genome editing, and studying gene functions that regulate secondary metabolites in hemp. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Previous studies on carotid endarterectomy and transfemoral carotid artery stenting demonstrated that perioperative outcomes differed according to preoperative neurologic injury severity, but this has not been assessed in transcarotid artery revascularization (TCAR). In this study, we examined contemporary perioperative outcomes in patients who underwent TCAR stratified by specific preprocedural symptom status. METHODS: Patients who underwent TCAR between 2016 and 2021 in the Vascular Quality Initiative were included. We stratified patients into the following groups based on preprocedural symptoms: asymptomatic, recent (symptoms occurring 180 days before TCAR). First, we used trend tests to assess outcomes in asymptomatic patients versus those with an increasing severity of recent neurologic injury (recent ocular TIA vs recent hemispheric TIA vs recent stroke). Then, we compared outcomes between asymptomatic and formerly symptomatic patients. Our primary outcome was in-hospital stroke/death rates. Multivariable logistic regression was used to adjust for demographics and comorbidities across groups. RESULTS: We identified 18,477 patients undergoing TCAR, of whom 62.0% were asymptomatic, 3.2% had a recent ocular TIA, 7.6a % had recent hemispheric TIA, 18.0% had a recent stroke, and 9.2% were formerly symptomatic. In patients with recent symptoms, we observed higher rates of stroke/death with increasing neurologic injury severity: asymptomatic 1.1% versus recent ocular TIA 0.8% versus recent hemispheric TIA 2.1% versus recent stroke 3.1% (Ptrend < .01). In formerly symptomatic patients, the rate of stroke/death was higher compared with asymptomatic patients, but this difference was not statistically significant (1.7% vs 1.1%; P = .06). After risk adjustment, compared with asymptomatic patients, there was a higher odds of stroke/death in patients with a recent stroke (odds ratio [OR], 2.8; 95% confidence interval [CI], 2.1-3.7; P < .01), a recent hemispheric TIA (OR, 2.0; 95% CI, 1.3-3.0; P < .01), and former symptoms (OR, 1.6; 95% CI, 1.1-2.5; P = .02), but there was no difference in stroke/death rates in patients with a recent ocular TIA (OR, 0.9; 95% CI, 0.4-2.2; P = .78). CONCLUSIONS: After TCAR, compared with asymptomatic status, a recent stroke and a recent hemispheric TIA were associated with higher stroke/death rates, whereas a recent ocular TIA was associated with similar stroke/death rates. In addition, a formerly symptomatic status was associated with higher stroke/death rates compared with an asymptomatic status. Overall, our findings suggest that classifying patients undergoing TCAR as symptomatic versus asymptomatic may be an oversimplification and that patients specific preoperative neurologic symptoms should instead be used in risk assessment and outcome reporting for TCAR.