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In PMS catalytic oxidation studies, we design and prepare a Mn3O4/CuO (CMO-2) composite catalyst using metal–organic frameworks (MOFs) as precursors. Compared with Mn3O4, its activated per-oxy-monosulfate activation catalyzed the degradation of pollutants with nearly six times higher activity efficiency. The experimental findings demonstrate that CMO-2 derived from metal–organic frameworks offer the advantages of wide adaptability to solution pH, along with improved versatility, stability, and recyclability. Further experiments involving radical scavenging, electrochemistry, and electron spin resonance (EPR) techniques confirm that the CMO-2 derived from MOF structures exhibit more significant interfacial engineering effects. This leads to an expansion of active interfaces, enhancing the accessibility and dispersion of active sites. Consequently, it significantly improves the efficiency of electron-transfer reactions and promotes a wide range of reactive oxygen species (ROSs), including SO4•− •OH and1O2. Based on the synergistic effect of copper-manganese bimetallic, the copper-manganese composite catalyst (CMO-2) prepared by doping 0.5 g of Cu-MOF showed the best catalytic activity in activating PMS, and the resulting ROSS could efficiently degrade organic pollutants. [ABSTRACT FROM AUTHOR]

This research is concentrated on investigating the role and mechanism of miR-652-3p in the protective effects of isoflurane (ISO) against myocardial ischemia–reperfusion (I/R) injury. H9c2 cells underwent pretreatment with varying concentrations of ISO, and subsequently, a hypoxia/reoxygenation (H/R) model was constructed. The levels of miR-652-3p, ISL LIM homeobox 1 (ISL1), and inflammatory cytokines interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) were evaluated through reverse transcription polymerase chain reaction (RT-qPCR). Enzyme-linked immunosorbent assay was employed to investigate concentrations of myocardial injury markers, such as creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI). Cell counting kit-8 was used to evaluate cell viability, while flow cytometry was utilized to measure apoptosis. Additionally, a dual luciferase reporter assay was conducted to validate the targeting relationship between ISL1 and miR-652-3p. Herein, we confirmed that the level of miR-652-3p was gradually increased with prolonged hypoxia; nevertheless, this increase was suppressed by ISO pretreatment (P < 0.05). Additionally, ISO pretreatment prevented the decrease in cell viability, increase in apoptosis, and overproduction of IL-6, TNF-α, CK-MB, and cTnI induced by H/R (P < 0.05). However, the inhibitory effects of ISO were counteracted by the increased levels of miR-652-3p (P < 0.05). ISL1 is a potential target of miR-652-3p. H/R induction suppressed ISL1 levels compared to the control, but ISO treatment increased its expression (P < 0.05). Overexpression of ISL1 inhibited the elimination of the protective effect of ISO on myocardial damage induced by the elevation of miR-652-3p (P < 0.05). The findings of this research confirm that miR-652-3p attenuated the protective effect of ISO on cardiomyocytes in myocardial ischemia by targeting ISL1. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) can impair driving safety due to hypoglycemia, hyperglycemia, diabetic peripheral neuropathy, and diabetic eye diseases. However, few studies have examined the association between DM and driving safety in older adults based on naturalistic driving data. Methods: Data for this study came from a multisite naturalistic driving study of drivers aged 65–79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs) of hard braking events (HBEs, defined as maneuvers with deceleration rates ≥ 0.4 g) associated with DM. Results: Of the 2856 study participants eligible for this analysis, 482 (16.9%) reported having DM at baseline, including 354 (12.4%) insulin non-users and 128 (4.5%) insulin users. The incidence rates of HBEs per 1000 miles were 1.13 for drivers without DM, 1.15 for drivers with DM not using insulin, and 1.77 for drivers with DM using insulin. Compared to drivers without DM, the risk of HBEs was 48% higher for drivers with DM using insulin (aIRR 1.48; 95% CI: 1.43, 1.53). Conclusion: Older adult drivers with DM using insulin appear to be at increased proneness to vehicular crashes. Driving safety should be taken into consideration in DM care and management. [ABSTRACT FROM AUTHOR]

As a new generation of energy-carrying electromagnetic fields (after the electromagnetic field acts on the material, it is absorbed and converted into heat, providing energy for material drying), high-efficiency drying technology, microwave drying (MD), infrared drying (IRD), and radiofrequency drying (RFD) are widely used in agricultural product processing, but uneven drying is the main technical problem for the application and promotion of this technical means. Through the jet mode of pulse generated by compressed air, the materials can be evenly mixed on a large spatial scale. At the same time, air spouting has little effect on the energy transmission and distribution of energy-carrying electromagnetic fields, which is an important means to improve the uniformity of microwave and infrared efficient drying. This paper summarizes the working principle, innovative development, and numerical simulation of spouted bed in microwave and infrared drying; focuses on the cooperative working mode, drying object, and product characteristics of spouting technology in microwave hot air drying, microwave vacuum drying (MVD), and microwave freeze drying (MFD); and expounds the application and technical advantages of spouting technology in IRD. The feasibility of applying spouting technology in RFD was proposed. The review materials provide technical reference for improving the quality of microwave, infrared energy-carrying electromagnetic field efficient drying agricultural products. [ABSTRACT FROM AUTHOR]

Background: As of November 8, 2023, 24 states and the District of Columbia have legalized cannabis for both recreational and medical use (RMCL-states), 14 states have legalized cannabis for medical use only (MCL-states) and 12 states have no comprehensive cannabis legislation (NoCL-states). As more states legalize cannabis for recreational use, it is critical to understand the impact of such policies on driving safety. Methods: Using the 2019 and 2020 Fatality Analysis Reporting System data, we performed multivariable logistic regression modeling to explore the association between state level legalization status and cannabis positivity using toxicological testing data for 14,079 fatally injured drivers. We performed a sensitivity analysis by including multiply imputed toxicological testing data for the 14,876 eligible drivers with missing toxicological testing data. Results: Overall, 4702 (33.4%) of the 14,079 fatally injured drivers tested positive for cannabis use. The prevalence of cannabis positivity was 30.7% in NoCL-states, 32.8% in MCL-states, and 38.2% in RMCL-states (p < 0.001). Compared to drivers fatally injured in NoCL-states, the adjusted odds ratios of testing positive for cannabis were 1.09 (95% confidence interval: 0.99, 1.19) for those fatally injured in MCL-states and 1.54 (95% confidence interval: 1.34, 1.77) for those fatally injured in RMCL-states. Sensitivity analysis yielded similar results. Conclusions: Over one-third of fatally injured drivers tested positive for cannabis use. Drivers fatally injured in states with laws permitting recreational use of cannabis were significantly more likely to test positive for cannabis use than those in states without such laws. State medical cannabis laws had little impact on the odds of cannabis positivity among fatally injured drivers. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) was widely used for the removal of esophageal tumors, and post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) was one of the postoperative adverse events. The aim of this research was to develop and validate a model to predict electrocoagulation syndrome after endoscopic submucosal dissection of esophageal tumors. Materials and methods: Patients who underwent esophageal ESD in our hospital were retrospectively included. A predictive nomogram was established based on the results of multivariate logistic regression analysis, and bootstrapping resampling was used for internal validation. Besides, the clinical usefulness of the nomogram was evaluated using decision curve analysis (DCA) and clinical impact curve. Results: A total of 552 patients who underwent esophageal ESD were included in the study, and the incidence of PPECS was 12.5% (69/552). Risk factors associated with PEECS (p < 0.1) were analyzed by multivariate logistic regression analysis, and the final model included four variables, namely gender, diabetes, tumor size and operation time. The predictive nomogram was constructed based on the above four variables, and the area under the ROC curve (AUC) was 0.811 (95% CI 0.767–0.855). The calibration curve of the nomogram presented good agreement between the predicted and actual probabilities. DCA showed that the model improved patient outcomes by helping to assess the risk of PEECS in patients compared to an all-or-no treatment strategy. In addition, the clinical impact curve of the model also indicates that the nomogram has a high clinical net benefit. Conclusion: In conclusion, we have developed a predictive nomogram for PEECS after ESD for esophageal tumors with good predictive accuracy and discrimination. This predictive nomogram can be effectively used to identify high-risk patients with PEECS, which will help clinicians in clinical decision-making and early intervention. [ABSTRACT FROM AUTHOR]

Magnesia porous insulation materials were prepared via foam-gelcasting using industrial grade mid-range magnesia powder as the main raw materials, a copolymer of isobutylene and maleic anhydride (Isobam-104) as the dispersing and gelling agent, sodium carboxymethyl cellulose (CMC) as the foam stabilizing agent, and cetyltrimethylammonium bromide (CTAB) as the foaming agent. The effects of processing parameters such as amount of Isobam-104 (0.1 wt%, 0.15 wt%, 0.2 wt%, 0.25 wt%, and 0.3 wt%) and firing temperature (1300 ℃, 1350 ℃, and 1400 ℃) on magnesia porous insulation materials were investigated. In addition, the universal testing machine (WDW-100E) and the scanning electron microscope (SEM) were employed to characterize the firing samples. The results indicated that the compressive strength of the prepared samples increased with the increase in firing temperature, and the porosity decreased gradually. When the firing temperature was 1350 °C, the internal pores of the samples were uniformly distributed, the average pore size was in the range of 26.2 μm to 35.6 μm, and the compressive strength was in the range of 7.8 MPa to 11.5 MPa when porosity varied from 65.2% to 60.4%. The thermal conductivity of the prepared magnesia porous insulation materials was in the range of 0.481 W/(m·K) to 0.842 W/(m·K). [ABSTRACT FROM AUTHOR]

Herein, the multiphase catalyst was prepared for catalytic Suzuki–Miyaura cross-coupling reactions by anchoring palladium nanoparticles on tris(pentaethylene-pentamine)triazine modified boron nitride nanosheets (BNNSs-TPEPTA-Pd). The synthesized catalysts were characterized using various spectroscopic and microscopic techniques such as Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and transmission electron microscopy (TEM), inductively coupled plasma-optical emission spectroscopy (ICP-OES). Subsequent experiments showed that BNNSs-TPEPTA-Pd is an excellent two-dimensional heterogeneous catalyst with a wide range of substrate tolerance, achieving an excellent yield of 95% within 45 min. On average, the catalyst improved the biaryl yield by about 12% and reduzced the reaction time by 4.6 h. In addition, the catalytic effect remained high after eight catalytic cycles. An efficient, stable, and recyclable heterogeneous catalyst was prepared by anchoring palladium nanoparticles on tris(pentaethylene-pentamine)triazine modified boron nitride nanosheets (BNNSs-TPEPTA-Pd). The catalyst was used in the Suzuki–Miyaura cross-coupling reaction to verify its activity. [ABSTRACT FROM AUTHOR]

Objectives: Structural racism (SR) is viewed as a root cause of racial and ethnic disparities in maternal health outcomes. However, evidence linking SR to increased odds of severe adverse maternal outcomes (SAMO) is scant. This study assessed the association between state-level indicators of SR and SAMO during childbirth. Methods: Data for non-Hispanic Black and non-Hispanic white women came from the US Natality file, 2017–2018. The exposures were state-level Black-to-white inequity ratios for lower education level, unemployment, and prison incarceration. The outcome was patient-level SAMO, including eclampsia, blood transfusion, hysterectomy, or intensive care unit admission. Adjusted odds ratios (aORs) of SAMO associated with each ratio were estimated using multilevel models adjusting for patient, hospital, and state characteristics. Results: A total of 4,804,488 birth certificates were analyzed, with 22.5% for Black women. SAMO incidence was 106.4 per 10,000 (95% CI 104.5, 108.4) for Black women, and 72.7 per 10,000 (95% CI 71.8, 73.6) for white women. Odds of SAMO increased 35% per 1-unit increase in the unemployment ratio for Black women (aOR 1.35; 95% CI 1.04, 1.73), and 16% for white women (aOR 1.16; 95% CI 1.01, 1.33). Odds of SAMO increased 6% per 1-unit increase in the incarceration ratio for Black women (aOR 1.06; 95% CI 1.03, 1.10), and 4% for white women (aOR 1.04; 95% CI 1.02, 1.06). No significant association was observed between SAMO and the lower education level ratio. Conclusions for Practice: State-level Black-to-white inequity ratios for unemployment and incarceration are associated with significantly increased odds of SAMO. Significance: What is already known on this subject? Structural racism is viewed as a root cause of racial and ethnic disparities in maternal health outcomes, independent of socioeconomic determinants of health. However, supporting evidence is scant. What this study adds? In this population-based study in 2017–2018, state-level Black-to-white inequities in unemployment and incarceration are associated with significantly increased odds of severe adverse maternal outcomes (i.e., blood transfusion, hysterectomy, and ICU admission) during childbirth for non-Hispanic Black women, and to a lesser extent, for non-Hispanic white women. Addressing structural racism in maternal care may contribute to improving maternal health equity. [ABSTRACT FROM AUTHOR]

Acidic arsenic-containing wastewater from copper smelting poses a potential threat to human and environmental safety due to its high toxicity, acidity, high volumes, and difficulty to be processed and utilized. This study proposed a technique to leach environmentally stable scorodite from wastewater using natural zinc slag as a solid iron source. The leaching behavior of scorodite was investigated through a combination of room-temperature adsorption and high-temperature reactions, after which the underlying mechanisms of this reaction were explored through adsorption kinetics and thermodynamics. Our findings indicated that the optimal reaction conditions of zinc slag with wastewater were the following: Fe/As ratio = 2.5, 80 °C, 10 h. The initial arsenic concentration in the wastewater was reduced from 13,040 mg/L to 140.5 mg/L, with 98.9% of the arsenic being removed. The toxicity characteristic leaching procedure (TCLP) results for the precipitates showed that the leaching concentration of arsenic was only 2 mg/L. For Fe2SiO4 in zinc slag, FeS dissolves to release iron ions, generating FeAsO4·2H2O, FeAsO4, and secondary minerals. Ca2Al2SiO7 generates gypsum to provide surface active sites for the growth of scorodite. This study proposes the industrial application of zinc slag for arsenic removal from copper smelting wastewater, providing a strong methodological basis to promote the development of non-ferrous metallurgical enterprises in a green and efficient manner. [ABSTRACT FROM AUTHOR]

Background: Endoscopic full-thickness resection is a common endoscopic procedure for treating gastrointestinal submucosal tumors. Nasogastric tube placement is frequently performed after abdominal surgery, but the routine use of this approach remains controversial. The aim of this research was to explore whether nasogastric tube placement after gastric endoscopic full-thickness resection is necessary. Methods: A retrospective study enrolled patients who underwent gastric endoscopic full-thickness resection in our hospital between January 2014 and January 2019, and all the patients had a tumor size ≤ 2 cm. The patients were divided into two groups according to whether a nasogastric tube was placed. Postprocedural adverse events and hospital stay duration were compared between the two groups using 1:1 propensity score matching. Results: A total of 461 patients were enrolled in this study, including 385 patients in the nasogastric tube group (NGT group) and 76 patients in the non-nasogastric tube group (non-NGT group). After matching, the baseline characteristics of 73 patients in the NGT group and 73 patients in the non-NGT group were balanced (p > 0.05). The postprocedural fever rate in the NGT group was significantly higher than that in the non-NGT group (23.3% vs. 9.6%, p = 0.044). 6.9% (5/73) of patients experienced severe nasogastric tube-related throat discomfort. However, the duration of hospitalization stay was not different between the two groups. Conclusions: For patients with tumor size ≤ 2 cm, routine nasogastric tube placement after gastric endoscopic full-thickness resection may be unnecessary. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, and its prevalence has increased markedly in the past two decades. Research indicates that people with ASD are at increased risk for premature mortality from injuries. Often, children with ASD are prescribed multiple medications, increasing their risk for intentional and unintentional poisonings. We examined the epidemiologic patterns of emergency department (ED)-treated poisonings in children with ASD and the association of ED-treated poisonings with ASD according to common co-occurring conditions. Methods: We analyzed data from the Nationwide Emergency Department Sample for 2016–2018 to estimate the frequencies of ED-treated poisonings among autistic children aged 1–20 years and adjusted odds ratios of ED-treated poisoning associated with ASD in the presence or absence of co-occurring attention-deficit hyperactivity disorder (ADHD) or intellectual disability (ID). The ICD-10-CM external cause-of-injury matrix was utilized to identify poisoning cases. Results: During 2016–2018, there were an estimated 523,232 ED visits in children with ASD aged 1–20 years, including 12,152 (2.3%) visits for poisoning. Of ED-treated poisonings in children with ASD, 73.6% were related to pharmaceutical drugs, such as psychotropic medications and prescription opioids, 16.6% were intentional, 36.5% were unintentional, and 47.0% were undetermined. Among children with ASD, those aged 5–9 had the highest odds of poisoning-related ED visits compared to all other age-groups (adjusted OR = 3.41; 95% CI 3.15, 3.68). The odds of poisoning for children with ASD were 59.0% greater than for their peers (adjusted OR = 1.59; 95% CI 1.53, 1.66) and varied significantly with age and co-occurring ADHD or ID. Conclusions: Children with ASD are at a significantly increased risk of poisoning, particularly among those aged 5–9 years. Co-occurring ADHD or ID with ASD further increases the risk of poisoning. Interventions to reduce poisoning in children with ASD should prioritize the safety of prescription medications. [ABSTRACT FROM AUTHOR]

This paper derives the complementary energy functional based on the Voronoi element of particle-reinforced composites containing interphases to compute the interfacial debonding and thermal stress. When calculating interfacial debonding stress, it is assumed that the surface force is zero at the interface where debonding occurs, and a new modified complementary energy functional is derived with this boundary condition. When considering the thermal stress due to temperature change, the thermal strain is introduced into the complementary energy functional, and the thermal stress is then calculated. According to the derived formula, a Fortran program named Voronoi cell finite element model (VCFEM) is written. The interfacial debonding and thermal stress is calculated using both VCFEM and the finite element software MARC, and the calculation results are compared. It shows that the calculation results of the VCFEM are roughly comparable to those of the MARC, verifying the effectiveness of the VCFEM. [ABSTRACT FROM AUTHOR]

Background and aims: The American Society for Gastrointestinal Endoscopy (ASGE) has developed a complexity-grading system for endoscopic retrograde cholangiopancreatography (ERCP) to predict technical success and adverse events. This study aimed to assess the association between the degree of difficulty for ERCP and the rates of success and adverse event, in turn demonstrating the validity and practicality of this system. Methods: ERCP procedures performed in the First Affiliated Hospital of Nanchang University from January 2011 to December 2020 were retrospectively reviewed. Procedural success and adverse events were recorded based on difficulty level according to the ASGE-grading system. Results: A total of 20,652 ERCP procedures performed during the study period were analyzed, including 1908 procedures considered grade 1(9.2%), 10,170 procedures considered grade 2 (49.2%), 7764 procedures considered grade 3 (37.6%), 810 procedures considered grade 4 (3.9%). The overall success rate increased from 92.8% in 2011–2015 to 94.0% in 2016–2020, while the distribution of procedures and the incidence of complications showed little variation. The success rate revealed a significantly decreasing trend with increasing difficulty (ranging from 55.6 to 98.6%), mainly for biliary diseases. In addition, the difficulty scale was not associated with any differences in the rate of adverse event, except for the pancreatitis for grade 1 procedures, which had a low incidence. Conclusions: The ASGE-grading system can help predict the success rate of ERCP procedures but showed poor performance in predicting adverse events. Further exploration may be required to improve the grading system by adjusting or including certain clinical parameters, and to validate the system for extrapolation to other endoscopy units. [ABSTRACT FROM AUTHOR]

A creative approach for fabricating porous magnesia materials with improved mechanical and thermal properties using walnut shell powders as pore-forming agent combined with self-created porous magnesia aggregates is reported in the present work. The work focused on the microstructure and binding mechanism of the novel walnut shell powders (WSP), which treated by silica sol, aluminum sol, and oleic acid, and the properties and microstructure of porous magnesia materials. The results showed that the surface of the sols-treated walnut shell powders was spherical and significantly dispersed. The oleic acid-treated walnut shell powder (OWS) did not differ much from the original state; the surface was rough and agglomeration. The porous magnesia material with the addition of SWS has excellent properties, forms closed pores and low conductivity. When the SWS was added at 10%, the bulk density, porosity, compressive strength, and thermal conductivity of samples were 1.64 g·cm−3, 53.97%, 22 MPa, and 0.447 W/(m·K), respectively. [ABSTRACT FROM AUTHOR]

Recent research indicates that children with autism are at increased risk of maltreatment. We examined news media reports on homicide incidents involving children with autism as victims in the United States between 2000 and 2019. Of the 52 victims studied, 47 (90.4%) were male. Age of victims ranged from 2 to 20 years (mean = 10.4 ± 5.3 years). Parents and other caregivers accounted for 63.5% and 13.5% of the perpetrators, respectively. The leading injury mechanism was gunshot wounds (23.1%), followed by drowning (19.2%), and suffocation, strangulation, or asphyxiation (19.2%). The most commonly cited contributing factor (47.1%) was overwhelming stress from caring for the autistic child. These results underscore the importance of supporting services for caregivers of children with autism. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to compare the efficacy and safety of needle-knife fistulotomy (NKF) to that of conventional cannulation methods (CCMs) when used for primary biliary access in patients with duodenal papillary tumors. Methods: Consecutive patients who had duodenal papillary tumors and who underwent endoscopic retrograde cholangiopancreatography (ERCP) were retrospectively enrolled. Successful cannulation rates, cannulation and procedure times, and the prevalence of adverse events were compared between the NKF and CCM groups. Results: A total of 404 patients (NKF, n = 124; CCM, n = 280) with duodenal papillary tumors were included. The primary and overall cannulation rates were 92.1% (372/404) and 96.0% (388/404), respectively. Compared to CCMs, NKF was associated with a significantly higher successful cannulation rate (99.2% versus 88.9%, P < 0.001) and significantly lower cannulation times (2.1 ± 2.0 min versus 4.7 ± 5.2 min), procedure times (8.8 ± 3.8 min versus 12.9 ± 7.6 min), and unintentional pancreatic duct cannulation rates (1.6% versus 20%), with P < 0.001 for all. Overall adverse events occurred less frequently in the NKF group (3.2% versus 10.7%, P = 0.011). Of these adverse events, post-ERCP pancreatitis (PEP) was significantly lower in the NKF group than in the CCM group (1.6% versus 6.8%, P = 0.03). Bleeding and cholangitis rarely occurred with either cannulation method (0.8% versus 2.1%, P = 0.681, and 0.8% versus 1.7%, P = 0.671, respectively). Conclusion: NKF is a more effective and safer procedure than CCMs for patients with duodenal papillary tumors. [ABSTRACT FROM AUTHOR]

Understanding the interaction between the star wheel arm and coal particles is important to efforts for improving the loading efficiency and reducing the energy consumption of the feeder star wheel. The interaction mechanism between the star wheel arm and coal particles is the theoretical basis of the research. First, the design method of the star wheel arm shape was provided, then a model of the star wheel was constructed with EDEM and a simulation structure. Finally, the influence of the parameters on loading efficiency and energy consumption was determined. Results have been shown that the coal particles in the active zone of the material pile exerts a fluidity effect on loading efficiency and torque. The loading efficiency and energy consumption have been increased with increase in the number of arm and height of the arm. The feeder inclination angle 14° is the best coal loading angle. [ABSTRACT FROM AUTHOR]

Background: Both transoral incisionless fundoplication (TIF) and radiofrequency ablation (Stretta) are representative endoscopic treatments for gastroesophageal reflux disease (GERD), but they have not been directly compared. This systematic review and network meta-analysis (NMA) evaluated the comparative effects of Stretta, TIF, and proton pump inhibitors (PPIs).Methods: PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Embase were searched for randomized controlled trials (RCTs) that compared the efficacy of either the Stretta, TIF, or PPIs/sham procedure for GERD treatment. The NMA was conducted using frequentist methods.Results: A total of 516 participants from 10 RCTs were included in this NMA. Both Stretta (mean difference, MD - 9.77, 95% confidence interval, CI - 12.85 to - 6.70) and TIF (MD - 12.22, 95% CI - 15.93 to - 8.52) were significantly superior to PPIs at improving health-related quality of life (HRQL) scores and heartburn scores (Stretta: MD - 1.53, 95% CI - 2.98 to - 0.08; TIF: MD - 9.60, 95% CI - 17.79 to - 1.41). Stretta (MD - 3.77, 95% CI - 6.88 to - 0.65) was less effective at increasing lower esophageal sphincter (LES) pressure than TIF. Stretta was significantly superior to TIF (MD - 3.25, 95% CI - 5.95 to - 0.56) at improving esophageal acid exposure. Regarding the decrease in PPIs utility and esophagitis incidence, no significant differences were found between TIF and Stretta.Conclusion: In terms of short-term reduction of the HRQL score and heartburn score in patients with GERD, TIF and Stretta may be comparable to each other, and both may be more effective than PPIs. TIF may increase the LES pressure in comparison with Stretta and PPIs. PPIs may reduce the percentage of time pH < 4.0 when compared with TIF. This evidence should be interpreted with caution given the small number of included studies and inherent heterogeneity. Registration No. CRD42020188345. [ABSTRACT FROM AUTHOR]

Serious wear phenomena occur in mining machinery under complex working conditions, and the wear of machine parts is primarily caused by the synergistic effect of adhesive wear, abrasive wear, corrosive wear, etc. However, the existing friction and wear testing equipment cannot be used to carry out wear tests under complex working conditions. To simultaneously meet the test requirements of adhesive wear, abrasive wear, and corrosive wear, a novel sliding friction and wear tester that can simulate complex working conditions was developed in the present research. The tester is composed of a loading mechanism, a speed-regulating mechanism, a corrosion chamber, and a control and display system. Wear tests of the middle plate of a scraper conveyor, a key equipment of coal mining, were carried out to verify the consistency and effectiveness of the tester. The test results were consistent, and those under the same test conditions were similar with a maximum standard deviation of 2.4 mg. The wear condition of the middle plate specimens was close to the actual wear condition of the middle plate. Moreover, the surfaces of the middle plate specimens after grinding exhibited obvious adhesive, abrasive, and corrosive wear characteristics, and the wear degrees of the specimens under the same test conditions were similar. The quality loss of the middle plate specimens was found to increase with the increase of coal gangue percentage, and the main wear mechanism was the synergistic action of abrasive, adhesive, and corrosive wear. [ABSTRACT FROM AUTHOR]

Since planar laser-induced fluorescence (PLIF) temperature measurements in a combustion-flow field can only be performed in regions in which OH is abundant (i.e., the reaction and high-temperature burnout zones), this paper investigates the feasibility of using photolysis of dissolved water to generate additional OH in the low-temperature and non-reaction zones of the flow field. Multi-line fluorescence showed that the generated OH had reached thermal equilibrium within 50 ns after dissociation with a fitting temperature of 300 K in room-temperature air. To further verify the technical accuracy, averaged PLIF images from dissociated OH were calibrated and compared with thermocouple measurements in a heated-flow field, and the average deviation in the 423–823 K temperature range was less than 40 K, with a relative system error better than 5%. The results of this paper confirm the feasibility and accuracy of the photo-fragment PLIF (PF-PLIF) temperature measurement in a low-temperature flow field. This makes it an effective complement to traditional PLIF measurements, with great significance for analysis and model validation of combustion processes in low temperature. [ABSTRACT FROM AUTHOR]

The foaming and foam stabilization mechanisms of potassium laurate (PL), potassium oleate (PO), sodium dodecyl sulfate (SDS), and sodium dodecylbenzenesulfonate (SDBS) were investigated in this study. Magnesia porous ceramics were fabricated by a foaming method, and the sample microstructures were analyzed by scanning electron microscopy (SEM) following heat treatment. Results showed that the foaming ability of the surfactants decreased in the order PO > SDS > SDBS > PL. The addition of calcium stearate (CS), a foam-stabilizing agent, extended the half-lives of SDS, SDBS, and PO foams in the order SDBS > PO > SDS. However, the addition of CS to PL significantly decreased its foam half-life. Pore sizes of the heat-treated samples decreased in the order PL > SDS > SDBS > PO, while the evenness of the pore distribution decreased in the order PO > SDBS > SDS > PL. Porous ceramics prepared with PO and CS had the smallest and most evenly distributed pores in the range of 5–10 μm. [ABSTRACT FROM AUTHOR]

Background and Aims: Endoscopic submucosal dissection (ESD) was developed as a feasible and reliable treatment for gastrointestinal mucosal or submucosal lesions. Bacteremia may occur after ESD. Currently, the use of prophylactic antibiotics after gastric ESD is controversial. This study was designed to explore the value of prophylactic antibiotics in the treatment of gastric mucosal and submucosal lesions after ESD.Methods: In this prospective study, in total, 103 patients who underwent gastric ESD were included, and the frequency of bacteremia and changes in inflammation-related indicators before and after the procedure were investigated. The patients did not receive prophylactic antibiotics.Results: The body temperature (T), white blood cell count (WBC), and procalcitonin (PCT) and C-reactive protein (CRP) levels did not significantly differ between the perforation group (N = 40) and nonperforation group before gastric ESD (N = 63) (all P > 0.05). The T, WBC, and CRP levels (all P < 0.05) in the patients with perforation were significantly higher than those in the patients without perforation 24 h after gastric ESD. The incidence of bacteremia did not significantly differ between the two groups (all P > 0.05). In total, 6 of 309 blood cultures were cultured with bacteria. The total frequency of bacteremia in the perforation and nonperforation groups was 2.5% and 3.2%, respectively. No sepsis occurred in any patients.Conclusion: Regardless of whether perforation occurred after gastric ESD, the incidence of bacteremia was transient and low. Therefore, based on our single-center study in China, prophylactic antibiotics may not be necessary in patients with intraoperative perforation during gastric ESD.Trial Registration: A single-center prospective study at chictr.org.cn (ChiCTR1800019668). [ABSTRACT FROM AUTHOR]

Background: The potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors. Methods: Data for this study came from the five-site Longitudinal Research on Aging Drivers (LongROAD) project. Participants were active drivers, age 65–79 years at enrollment, and patients at one of the 5 participating sites. Medication names and doses were obtained at baseline based on the "brown-bag review" method. Medications were coded using the American Hospital Formulary Service system. Driving data were collected by a GPS accelerometer installed in the study participants' main vehicles. Results: Medication data were available for 2949 (98.6%) of the 2990 participants, and 2898 (96.9% of all participants) had both medication data and at least 30 recorded days of driving. The median number of medications taken per study participant was seven, with a range of 0–51. Total number of medications was significantly associated with a higher rapid deceleration rate. Certain medication classes were significantly associated with other driving outcomes, including central nervous system agents (more speeding events), hormones and gastrointestinal medications (more rapid decelerations), electrolytes (fewer rapid decelerations), and antihistamines (greater right to left turn ratio). Conclusions: Older adult drivers are taking large quantities of prescription and non-prescription medications that may affect their driving safety. Certain medication classes are associated with potentially adverse driving patterns, such as speeding and rapid decelerations, while others are associated with potentially protective maneuvers, such as right hand turning. Further research is warranted to identify and mitigate potential adverse effects of such medications on driving safety in older adults. [ABSTRACT FROM AUTHOR]

2D transition metal dichalcogenides (TMDCs) have been extensively attractive for nano-electronics and nano-optoelectronics due to their unique properties. Especially, WSe2, having bipolar carrier transport ability and sizable bandgap, is a promising candidate for future photodetectors. Here, we report an in-plane WSe2 homojunction formed by the interface gate of the substrate. In this architecture, an insulated h-BN flake was used to make only part of WSe2 flake contact substrate directly. Finally, the structures of WSe2/substrate and WSe2/h-BN/substrate construct an in-plane homojunction. Interestingly, the device can operate in both photovoltaic and photoconductive modes at different biases. As a result, a responsivity of 1.07 A W−1 with a superior detectivity of over 1012 jones and a fast response time of 106 μs are obtained simultaneously. Compared with previously reported methods adopted by chemical doping or electrostatic gating with extra bias voltages, our design provides a more facile and efficient way for the development of high-performance WSe2-based photodetectors. [ABSTRACT FROM AUTHOR]

Efficient nanoporous amberlite (XAD-4) based solid strong acid (XAD-4–SO3H–SO2CF3) has been successfully synthesized by decorating SO2CF3, a strong electron withdrawing group onto the network of nanoporous solid acid of XAD-4–SO3H. N2 sorption isotherms and TG curves show that XAD-4–SO3H–SO2CF3 has large BET surface area and good thermal stability. XPS spectra show that the group of SO2CF3 has been introduced onto the network of XAD-4–SO3H. TEM results shows that the well-dispersion of C, S, and O elements. Catalytic property tests show that XAD-4–SO3H–SO2CF3 exhibits excellent catalytic activities in biomass transformation toward acylation of anisole with acetyl chloride, synthesis of bisphenol-A and esterification of acetic acid with cyclohexanol when compared with those of solid strong acids of Amberlyst-15, SBA-15-0.1–SO3H, H3PW12O40 and XAD-4–SO3H. [ABSTRACT FROM AUTHOR]

Background: Use of alcohol and other drugs is a major risk factor for assaultive injuries and violent deaths. The purpose of this study was to examine the time trends in the prevalence of alcohol and marijuana detected in homicide victims. Methods: We analyzed toxicological testing data for homicide victims (n = 12,638) from the 2004–2016 National Violent Death Reporting System in 9 US states (Colorado, Georgia, Massachusetts, New Jersey, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin). We used the Cochran-Armitage test for trend to assess the statistical significance of changes in the prevalence of alcohol and marijuana detected in these homicide victims during the study period. Results: Overall, 37.5% of the homicide victims tested positive for alcohol, 31.0% positive for marijuana, and 11.4% positive for both substances. During the study period, the prevalence of marijuana increased from 22.3% (95% confidence interval [CI] = 19.6, 25.0) in 2004 to 42.1% (95% CI = 39.2, 44.9) in 2016 (Z = -15.7; P <.001) while the prevalence of alcohol declined slightly (Z = 1.5; P = 0.143). Marked increases in the prevalence of marijuana were observed in both sexes and across age and racial groups. Conclusions: Marijuana is increasingly detected in homicide victims irrespective of demographic characteristics. Further research is needed to assess the causal role of marijuana use and concurrent use of marijuana and alcohol in homicide victimization. [ABSTRACT FROM AUTHOR]

Semiconductor nanocrystals (NCs) heavily doped with cation/anion vacancies or foreign metal ions can support localized surface plasmon resonance (LSPR) in the near-infrared (NIR) and mid-infrared (MIR) spectral wavelengths. Typically, nonstoichiometric copper sulfide Cu2−xS NCs with different x values (0 < x ≤ 1) have attracted numerous attention because of hole-based, particle size, morphology, hole density and crystal phase-dependent LSPR. In spite of excited development of methodology for LSPR manipulation, systematic LSPR tuning of Cu2−xS NCs with a special crystal phase has been limited. Herein, roxbyite Cu1.8S nanodisks (NDs) were selected as a model and their LSPR was readily tuned by particle size, hole density via chemical oxidation and reduction, self-assembly and disassembly in solution and plasmon coupling in multilayer films. Particle size, hole density and plasmon coupling severely affect their LSPR peak position and absorption intensity. Therefore, the ability of flexible LSPR tuning gifts roxbyite Cu1.8S NDs great potential in plasmonic applications, including photocatalysis, photothermal agent, two-photon photochemistry and many others in NIR and MIR regions. [ABSTRACT FROM AUTHOR]

Background: Critical illness disproportionately affects people in low-income countries (LICs). Efforts to improve critical care in LICs must account for differences in demographics and infrastructure compared to high-income settings. Part of this effort includes the development and validation of intensive care unit (ICU) risk stratification models feasible for use in LICs. The purpose of this study was to validate and compare the performance of ICU mortality models developed for use in sub-Saharan Africa. Materials and Methods: This was a prospective, observational cohort study of ICU patients in a referral hospital in Malawi. Models were selected for comparison based on a Medline search for studies which developed ICU mortality models based on cohorts in sub-Saharan Africa. Model discrimination was evaluated using the area under the curve with 95% confidence intervals (CI). Results: During the study, 499 patients were admitted to the study ICU, and after exclusions, there were 319 patients. The cohort was 62% female, with the mean age 31 years (IQR: 23-41), and 74% had surgery preceding ICU admission. Discrimination for hospital mortality ranged from 0.54 (95% CI 0.48, 0.60) for the Universal Vital Assessment (UVA) to 0.72 (95% CI 0.66, 0.78) for the Malawi Intensive care Mortality Evaluation (MIME). After tenfold cross-validation, these results were unchanged. Conclusions: The MIME outperformed other models in this prospective study. Most ICU models developed for LICs had poor to modest discrimination for hospital mortality. Future research may contribute to a better risk stratification model for LICs by refining and enhancing the MIME. [ABSTRACT FROM AUTHOR]

In this work, a simple strategy to fabricate amorphous carbon-coated tungsten oxide with oxygen vacancies (WO3−x/C, 0 < x < 1) via pyrolysis of hybrid-polyoxometalates (hybrid-POMs) in nitrogen atmosphere is reported. TGA, XRD, Raman, FTIR, SEM, TEM, EDS, XPS and BET have been used to characterize the as-prepared products. The results showed that their compositions, microstructures and concentrations of oxygen vacancies were closely related with the species of organic amines in the hybrid-POMs. When the WO3−x/C composites were used as catalysts for degradation of dyes such as methylene blue, methyl orange and Rhodamine B under visible light irradiation, they showed much enhanced photocatalytic abilities compared to that of WO3 and P25, which could be ascribed to the coating of WO3 by amorphous carbon and the construction of defects (oxygen vacancy) in WO3. The synthetic strategy presented in our work is simple and shows a great potential in fabricating efficient transition metal-based composites for photocatalysis applications and so on. [ABSTRACT FROM AUTHOR]

Japanese encephalitis virus SA14-14-2 (JEV SA14-14-2) is a widely used vaccine in China and other southeastern countries to prevent Japanese encephalitis in children. In this study, a stable infectious cDNA clone of JEV SA14-14-2 with a low copy number pACYC177 vector dependent on the T7 promoter and T7 terminator was developed. Two introns were inserted into the capsid gene and envelope gene of JEV cDNA for gene stability. Hepatitis delta virus ribozyme (HDVr) was engineered into the 3′ UTR cDNA of JEV for authentic 3′ UTR transcription. The rescued virus showed biological properties indistinguishable from those of the parent strain (JEV SA14-14-2). The establishment of a JEV SA14-14-2 reverse genetics system lays the foundation for the further development of other flavivirus vaccines and viral pathogenesis studies. [ABSTRACT FROM AUTHOR]

Objective: Glutamate is an excitatory neurotransmitter in the central nervous system that participates in initiation and maintenance of sleep and wakefulness. The mechanisms involved occur in the brainstem, lateral hypothalamus, and basal forebrain. Our previous study suggested that higher levels of glutamate in cerebrospinal fluid (CSF) contributed to poorer sleep quality. Smoking has been shown to be harmful to sleep quality. In the present study, we recruited non-smokers and heavy smokers and measured the concentration of CSF glutamate in order to investigate the associations among smoking status, sleep quality, and CSF glutamate levels.Methods: We recruited 147 men (n = 68 non-smokers, 30.31 ± 9.10 years; n = 79 heavy smokers, 34.54 ± 10.71 years). Glutamate concentrations in CSF were measured by spectrophotometry, and subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).Results: PSQI total scores were significantly higher in heavy smokers than that in non-smokers (p < 0.001). Glutamate concentrations in CSF were lower in heavy smokers than that in non-smokers (p < 0.001). CSF glutamate levels positively correlated with PSQI total scores in the non-smokers group (r = 0.313, p = 0.011, effect size = 0.324). No correlation was found between CSF glutamate levels and PSQI total scores in the heavy smokers group (p > 0.05). Multivariable linear regression analysis showed that years of smoking was contributed to the PSQI total scores (p = 0.008), and cigarettes smoked per day contributed to the decreased CSF glutamate levels in heavy smokers (p = 0.001).Conclusion: Poorer subjective sleep quality and lower CSF glutamate concentrations were observed in the heavy smokers group than in the non-smokers group. In addition, lack of correlation was observed between CSF glutamate levels and PSQI scores in the heavy smokers. [ABSTRACT FROM AUTHOR]

Feline panleukopenia virus (FPV) infects cats and can be fatal to kittens. There is evidence that canine parvovirus originated from FPV, which makes FPV important in studies of the family Parvoviridae. In the present study, the entire genome of FPV strain HH-1/86 was converted into a full-length infectious clone (pFPV). The FPV strain HH-1/86 has a 5123-nt single stranded DNA genome with a Y-shaped inverted 3′ terminal repeat (ITR) and a U-shaped inverted 5′ ITR. Feline kidney cells (F81) were transfected with the pFPV clone which contained a genetic marker, and a rescued virus was obtained (rFPV). The rFPV was identified by its cytopathic effects, indirect immunofluorescence, growth curve analysis, western blot assay and hemagglutination, and was indistinguishable from the parent virus. The FPV infectious clone will facilitate the study of pathogenicity and viral replication of FPV and the inter-species transmission of parvoviruses. [ABSTRACT FROM AUTHOR]

Objectives This study examined the prevalence and temporal trends in (a) pulmonary hypertension (PH) during pregnancy and (b) mortality and morbidity during pregnancy with and without PH. Methods This was a retrospective observational study of the 2003-2014 New York State Inpatient Database. PH was categorized as primary or secondary and pregnancy as loss or termination of pregnancy, preterm birth, or term birth. The Centers for Disease Control and Prevention definition of maternal morbidity was used, including 17 diagnoses and 5 procedures. Changes were assessed using Cochran-Armitage trend tests. Results Of 2,940,868 pregnancy-related discharges, 746 indicated a diagnosis of PH (25/100,000; 95% CI 24-27). PH was secondary in 677/746 (91%) discharges and 488/746 were term births (65%). Prevalence of secondary PH increased from 17 to 30/100,000 between 2003- 2004 and 2013-2014 (+ 69%; P < 0.001), with an increase in the prevalence of heart valve disease, obesity, and systemic hypertension. Primary PH decreased 81% (P = 0.002). Term-birth PH discharges increased from 13 to 22/100,000 between 2003-2004 and 2013-2014 (+ 66%; P = 0.003), without change in preterm births and loss or termination of pregnancies. No change in morbidity in PH discharges was observed between 2003-2004 and 2013-2014, contrasting with a 64% increase in discharges without PH. Conclusions for Practice Prevalence of secondary PH during pregnancy markedly increased since 2003, underscoring the importance of screening for PH, especially in women with heart valve disease, obesity, or systemic hypertension. [ABSTRACT FROM AUTHOR]

Purpose: Risk stratification for postoperative acute kidney injury (AKI) evaluates a patient's risk for developing this complication using preoperative characteristics. Nevertheless, it is unclear if these characteristics are also associated with mortality in patients who actually develop this complication, so we aimed to determine these associations.Methods: The 2011-15 American College of Surgeons National Surgical Quality Improvement Program was used to obtain a historical, observational cohort of high-risk intraabdominal general surgery patients with AKI, which was defined as an increase in serum creatinine > 177 µmol·L-1 (2 mg·dL-1) above the preoperative value and/or the need for dialysis. Latent class analysis, a model-based clustering technique, classified patients based on preoperative comorbidities and risk factors. The associations between the latent classes and the time course of AKI development and mortality after AKI were assessed with the Kruskall-Wallis test and Cox models.Results: A seven-class model was fit on 3,939 observations (derivation cohort). Two patterns for the time course of AKI diagnosis emerged: an "early" group (median [interquartile range] day of diagnosis 3 [1-10]) and a "late" group (day 9 [3-16]). Three patterns of survival after AKI diagnosis were identified (groups A-C). Compared with the group with the lowest mortality risk (group A), the hazard ratios (95% confidence intervals) for 30-day mortality were 1.79 [1.55 to 2.08] for group B and 3.55 [3.06 to 4.13] for group C. These differences in relative hazard were similar after adjusting for the postoperative day of AKI diagnosis and surgical procedure category.Conclusions: Among patients with AKI after high-risk general surgery, the preoperative comorbid state is associated with the time course of and survival after AKI. This knowledge can stratify mortality risk in patients who develop postoperative AKI. [ABSTRACT FROM AUTHOR]

Background The incidence of severe maternal morbidity (SMM) during childbirth is increasing in the United States. A better characterization of risk factors for SMM may identify targets for improving maternal outcomes. This study aims to characterize patient-, hospital-, and neighborhood-level factors associated with SMM during childbirth. Methods SMM during childbirth was identified in the 2013-2014 State Inpatients Database for New York. Hospital and neighborhood characteristics were abstracted from the American Hospital Association and the Area Health Resources files. Multilevel modeling was used to identify factors associated with SMM, with and without blood transfusion, and its between-hospital variation. Results 403,116 delivery-related discharges from 139 hospitals were analyzed; 1557 (0.39%) recorded SMM without blood transfusion. In the final multilevel model, 7 patient-level factors were associated with a greater than fourfold increase in the risk of SMM: pulmonary hypertension, postpartum hemorrhage, placenta accreta, chronic kidney disease, cardiac conduction disorders, emergent cesarean delivery, and preeclampsia. Three hospital-level factors were associated with SMM: proportion of non-White patients, proportion of Medicaid beneficiaries, and coding intensity. No neighborhood-level factors were predictive of SMM. The proportion of variation in SMM explained by the model was 23.5 with 23.2% related to patient-level factors. The model explained 55% of the between-hospital variation, primarily related to patient-level factors. Similar results were observed for SMM with blood transfusion. Conclusions This study confirms the association between patient-level factors and SMM. It identifies patient-level factors as the major driver of between-hospital variation in SMM. Efforts to improve maternal outcomes should target patient-level factors. [ABSTRACT FROM AUTHOR]

Background: Surgical care is essential to health systems but remains a challenge for low- and middle-income countries (LMICs). Current metrics to assess access and delivery of surgical care focus on the structural components of surgery and are not readily applicable to all settings. This study assesses a new metric for surgical care access and delivery, the ratio of emergent surgery to elective surgery (Ee ratio), which represents the number of emergency surgeries performed for every 100 elective surgeries.Methods: A systematic search of PubMed and Medline was conducted for studies describing surgical volume and acuity published between 2006 and 2016. The relationship between Ee ratio and three national indicators (gross domestic product, per capital healthcare spending, and physician density) was analyzed using weighted Pearson correlation coefficients (rw) and linear regression models.Results: A total of 29 studies with 33 datasets were included for analyses. The median Ee ratio was 14.6 (IQR 5.5-62.6), with a range from 1.6 to 557.4. For countries in sub-Saharan Africa the median value was 62.6 (IQR 17.8-111.0), compared to 9.4 (IQR 3.4-13.4) for the United States and 5.5 (IQR 4.4-10.1) for European countries. In multivariable linear regression, the per capita healthcare spending was inversely associated with the Ee ratio, with a 63-point decrease in the Ee ratio for each 1 point increase in the log of the per capita healthcare spending (regression coefficient β = −63.2; 95% CI −119.6 to −6.9; P = 0.036).Conclusions: The Ee ratio appears to be a simple and valid indicator of access to available surgical care. Global health efforts may focus on investment in low-resource settings to improve access to available surgical care. [ABSTRACT FROM AUTHOR]

Background: Multiple perioperative complications increase mortality risk, and certain complications synergistically increase this risk to a greater degree than might be expected if the complications were independent, but these effects are not well established. Methods: This is a retrospective cohort study of 422,827 intraabdominal general surgery patients (American College of Surgeons National Surgical Quality Improvement Program 2005-2011). Eight complications were evaluated: acute respiratory failure (ARF), acute kidney injury (AKI), sepsis/septic shock, stroke, cardiac arrest (CA), myocardial infarction (MI), deep vein thrombosis/pulmonary embolus, and transfusion. Each combination of two complications (28 total) was modeled using a Cox model for 30-day mortality, with adjustment for preoperative comorbidities and risk factors. Additive interaction was determined with the relative excess risk due to interaction (RERI). A positive RERI indicates that the mortality risk with both complications is greater than the sum of the individual mortality risks. Bonferroni correction was applied ( α = 0.05/28 = 0.0018). Results: Seven combinations demonstrated positive interaction: sepsis-CA (RERI 88.1; p < 0.0001), ARF-AKI (RERI 50.5; p < 0.0001), AKI-sepsis (RERI 33.9; p < 0.0001), sepsis-stroke (RERI 33.9; p < 0.0001), ARF-stroke (RERI 32.3; p < 0.0001), AKI-MI (RERI 24.5; p = 0.0013), and ARF-sepsis (RERI 19.2; p < 0.0001). Two combinations demonstrated negative interaction: ARF-CA (RERI −65.1; p = 0.0017) and CA-transfusion (RERI −52.0, p < 0.0001). Conclusions: Interaction effects exist between certain complications to increase the risk of short-term mortality. ARF, AKI, sepsis, and stroke were most likely to be involved in positive interactions. Further research into the mechanisms for these effects will be necessary to develop strategies to minimize the compounding effects of multiple complications in the perioperative period. [ABSTRACT FROM AUTHOR]

The objective of the study is to investigate the clinical features of Behçet's disease (BD) complicated with cerebral venous sinus thrombosis (CVST). We retrospectively analyzed the clinical features of age- and gender-matched BD patients with and without CVST. Of the 840 BD patients enrolled, 21 (2.5%, 11 female, mean age 30.3 ± 9.5) were diagnosed as CVST. Eighteen patients (85.7%) developed neurologic manifestations after BD onset, with an average interval of 47.6 months (SD 36.1). Onset of neurologic symptoms was mostly progressive (89.5%), with headache (95.2%) being the most common symptom. Intracranial hypertension occurred in 17 cases (89.5%). Thrombosis was detected mostly in transverse (71.4%) and superior sagittal (66.7%) sinuses, with more frequently (66.7%) dual or multiple sinuses involved. In addition, extra cranial thrombosis was presented in 11 cases. Cerebral infarction was presented in four cases. Compared with BD patients without CVST, the prevalence of extra cranial vascular involvement (52.4 versus 20.6%; P = 0.005) and BDCAF 2006 score (3.7 ± 1.4 versus 1.8 ± 1.3; P = 1.7863 × 10) was higher in BD patients with CVST. During a median 7-month follow-up (range 0.3-88.8 months), 18 patients (85.7%) achieved remission following glucocorticoid, immunosuppressant therapy, anticoagulants, and dehydration, although 3 patients experienced (14.3%) flare. No death was reported. CVST is rare complication of BD and predominately progressively developed in active BD and after BD onset. It typically features intracranial hypertension syndrome and is frequently complicated with extra cranial thrombosis; thus, systemic thrombus screening is highly recommended. Promptly, diagnosis and aggressive treatment are keys to improve the prognosis. [ABSTRACT FROM AUTHOR]

Background: The reported prevalence of autism spectrum disorder (ASD) has increased markedly in the past two decades. Recent research indicates that children with ASD are at a substantially increased risk of injury mortality, particularly from unintentional drowning. The purpose of this study was to explore the circumstances of fatal unintentional drowning incidents involving children with ASD under 15 years of age. Findings: During January 2000 through May 2017, US newspapers reported a total of 23 fatal drowning incidents involving 18 boys and 5 girls with ASD. Age of victims ranged from 3 to 14 years (mean = 7.7 ± 2.9 years). These drowning incidents most commonly occurred in ponds (52.2%), followed by rivers (13.0%), and lakes (13.0%). For 11 incidents with location data available, the distance between victim residence and the water body where drowning occurred averaged 290.7 m (± 231.5 m). About three-quarters (73.3%) of the drowning incidents occurred in the afternoon hours from 12:00 to 18:59. Wandering was the most commonly reported activity that led to drowning, accounting for 73.9% of the incidents. Conclusions: Fatal drowning in children with ASD typically occur in water bodies near the victims' homes in the afternoon hours precipitated by wandering. Multifaceted intervention programs are urgently needed to reduce the excess risk of drowning in children with ASD. [ABSTRACT FROM AUTHOR]

Polyamide 6 (PA 6) is an important thermoplastic with excellent strength, stiffness, and good chemical resistance. The notch sensitivity and low notch impact toughness of PA 6, however, limit its application. A core-shell structured polyacrylic modifier, poly( n-butyl acrylate)/poly(methyl methacrylate- co-methacrylic acid) modifier (PBM- co-MAA), was used to toughen PA 6. To study the effect of PBM- co-MAA particles on the toughness of PA 6, various contents of poly(BA) in PBM- co-MAA latexes of 300 nm were synthesized by seed emulsion polymerization. The results showed that polymerization had an instantaneous conversion higher than 95 wt% and an overall conversion higher than 97 wt%. The PBM- co-MAA particles had a clear core-shell structure confirmed by transmission electron microscope (TEM). The mechanical properties of PA 6/PBM- co-MAA blends showed that the notch impact strength of PA 6/PBM- co-MAA blends with 85 wt% poly(BA) and 0.5 wt% MAA in PBM- co-MAA was nearly six times greater than that of pure PA 6, being consistent with the scanning electron microscope (SEM) observations on the fractured surfaces. The notch impact strengths of PA 6/PBM- co-MAA blends were also better than that of PA 6/PBM blend, which did not contain MAA functional group in the modifier. Dynamic mechanical analysis (DMA) results showed improved compatibility between PA 6 matrix and core-shell toughening modifier, which should contain a functional group in the shell layer and a suitable core rubbery content to toughen PA 6 effectively. [ABSTRACT FROM AUTHOR]

Background: Drug overdose is a public health crisis in the United States, due in part to the unintended consequences of increases in prescribing of opioid analgesics. Many clinicians evaluate risk markers for opioid-related harms when prescribing opioids for chronic pain; however, more data on predictive risk markers are needed. Risk markers are attributes (modifiable and non-modifiable) that are associated with increased probability of an outcome. This review aims to identify risk markers associated with fatal and non-fatal prescription drug overdose by synthesizing findings in the existing peer-reviewed and grey literature. Eligible cohort, case-control, cross-sectional, and case-cohort studies were reviewed and data were extracted for qualitative and quantitative synthesis. Findings: Summary odds ratios (SOR) were estimated from 29 studies for six risk markers: sex, age, race, psychiatric disorders, substance use disorder (SUD), and urban/rural residence. Heterogeneity was assessed and effect estimates were stratified by study characteristics. Of the six risk markers identified, SUD had the strongest association with drug overdose death (SOR = 5.24, 95% confidence interval (CI) = 3.53 - 7.76), followed by psychiatric disorders (SOR = 3.94, 95% CI = 3.09 - 5.01), white race (SOR = 2.28, 95% CI = 1.93 - 2.70), the 35-44 year age group relative to the 25-34 year reference group (SOR = 1.52, 95% CI = 1.31 - 1.76), and male sex (SOR = 1.33, 95% CI = 1.17 - 1.51). Conclusions: This review highlights fatal and non-fatal prescription drug risk markers most frequently assessed in peer-reviewed and grey literature. There is a need to better understand modifiable risk markers and underlying reasons for drug misuse in order to inform interventions that may prevent future drug overdoses. [ABSTRACT FROM AUTHOR]

Background: As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults. Methods: The Longitudinal Research on Aging Drivers (LongROAD) project is a multisite prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental and technological factors in driving safety during the process of aging. Results: A total of 2990 active drivers aged 65-79 years at baseline have been recruited through primary care clinics or health care systems in five study sites located in California, Colorado, Maryland, Michigan, and New York. Consented participants were assessed at baseline with standardized research protocols and instruments, including vehicle inspection, functional performance tests, and 'brown-bag review' of medications. The primary vehicle of each participant was instrumented with a small data collection device that records detailed driving data whenever the vehicle is operating and detects when a participant is driving. Annual follow-up is being conducted for up to three years with a telephone questionnaire at 12 and 36 months and in-person assessment at 24 months. Medical records are reviewed annually to collect information on clinical diagnoses and healthcare utilization. Driving records, including crashes and violations, are collected annually from state motor vehicle departments. Pilot testing was conducted on 56 volunteers during March-May 2015. Recruitment and enrollment were completed between July 2015 and March 2017. Conclusions: Results of the LongROAD project will generate much-needed evidence for formulating public policy and developing intervention programs to maintain safe mobility while ensuring well-being for older adults. [ABSTRACT FROM AUTHOR]

A new analytical method has been developed to detect three kinds of DNA simultaneously based on magnetic beads and color-encoded plasmonic nanocrystals. Magnetic beads modified with capture DNA are employed to collect the specific target DNA, and color-encoded plasmonic nanocrystals are applied to signal the target through DNA hybridization. As a proof of concept, three types of representative metal nanocrystals of gold nanoparticle (AuNP), gold nanorod (AuNR), and gold/silver nanoparticle (Au/AgNP) were employed to signal three dissimilar virus-related protective antigen genes, Ebola virus (EV), Variola virus (VV), and Bacillus anthracis (BA), respectively. Detection limits of 0.5-3 fM were obtained showing the high sensitivity for DNA detection. The microscopic discrimination of the encoded nanoparticles allows simple, rapid, accurate, and cost-effective detection of multiple DNA molecules, indicative of the potential in practical applications. [ABSTRACT FROM AUTHOR]

Background: Improving physical functioning may be a future intervention to keep older adults driving safely longer as it can help maintain both physical and cognitive health longer. This systematic review assesses the evidence on the association between three physical functioning measures: the Short Physical Performance Battery, the Timed Up-and-Go test, and the Rapid Pace Walk with driving outcomes in older adults. Methods: Older adult studies published between 1994 and 2015 that included the Short Physical Performance Battery, the Timed Up-and-Go test, or the Rapid Pace Walk as a measure of physical functioning and included a driving-related outcome were identified through a comprehensive search and reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Thirteen studies involving 5,313 older adults met the inclusion criteria. Lower Short Physical Performance Battery scores were associated with reduced driving exposure and increased cessation in all three Short Physical Performance Battery studies. The Timed Up-and-Go test was not associated with the driving outcomes (cessation, ability, crashes, and citations) in either of the two Timed Up-and-Go studies. Poorer Rapid Pace Walk scores were associated with decreased driving ability in two studies and with reduced driving exposure in one study, but not associated with driving ability, crashes, citations, or cessation in the remaining five Rapid Pace Walk studies. Conclusions: The Timed Up-and-Go test measure appears not to be a useful measure of physical functioning for the driving outcomes included here. The Rapid Pace Walk may be useful in studies of driving ability and exposure. More driving studies should consider using the Short Physical Performance Battery to determine if it may be useful as a risk factor assessment for identifying individuals at risk of certain driving outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to review to review the reported associations of depression and antidepressants with motor vehicle crashes. Purpose: A literature search for material published in the English language between January, 1995, and October, 2015, in bibliographic databases was combined with a search for other relevant material referenced in the retrieved articles. Methods: Retrieved articles were systematically reviewed for inclusion criteria: 19 epidemiological studies (17 case-control and 2 cohort studies) fulfilled the inclusion criteria by estimating the crash risk associated with depression and/or psychotropic medications in naturalistic settings. Results: The estimates of the odds ratio (OR) of crash involvement associated with depression ranged from 1.78 to 3.99. All classes of antidepressants were reported to have side effects with the potential to affect driving safety. The majority of studies of antidepressant effects on driving reported an elevated crash risk, and ORs ranged from 1.19 to 2.03 for all crashes, and 3.19 for fatal crashes. In meta-analysis, depression was associated with approximately 2-fold increased crash risk (summary OR = 1.90; 95% CI, 1.06 to 3.39), and antidepressants were associated with approximately 40% increased crash risk (summary OR = 1.40; 95%CI, 1.18 to 1.66). Conclusion: Based on the findings of the studies reviewed, depression, antidepressants or the combination of depression and antidepressants may pose a potential hazard to driving safety. More research is needed to understand the individual contributions of depression and the medications used to treat depression. [ABSTRACT FROM AUTHOR]

Background: Concurrent use of marijuana and alcohol in drivers is of increasing concern but its role in crash causation has not been well understood. Methods: Using a case-control design, we assessed the individual and joint effects of marijuana and alcohol use on fatal crash risk. Cases ( n = 1944) were drivers fatally injured in motor vehicle crashes in the United States at specific times in 2006, 2007 and 2008. Controls ( n = 7719) were drivers who participated in the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Results: Overall, cases were significantly more likely than controls to test positive for marijuana (12.2% vs. 5.9%, p < 0.0001), alcohol (57.8% vs. 7.7%, p < 0.0001) and both marijuana and alcohol (8.9% vs. 0.8%, p < 0.0001). Compared to drivers testing negative for alcohol and marijuana, the adjusted odds ratios of fatal crash involvement were 16.33 [95% confidence interval (CI): 14.23, 18.75] for those testing positive for alcohol and negative for marijuana, 1.54 (95% CI: 1.16, 2.03) for those testing positive for marijuana and negative for alcohol, and 25.09 (95% CI: 17.97, 35.03) for those testing positive for both alcohol and marijuana. Conclusions: Alcohol use and marijuana use are each associated with significantly increased risks of fatal crash involvement. When alcohol and marijuana are used together, there exists a positive synergistic effect on fatal crash risk on the additive scale. [ABSTRACT FROM AUTHOR]