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Although many U.S. municipalities have adopted climate protection and sustainability as explicit objectives, they are not among their traditional responsibilities. As a result, compared to policies focused around core functions, those related to sustainability may be at greater risk of retrenchment or change in times of crisis. This research examines how the COVID-19 pandemic has impacted local governments’ sustainability efforts. Using data from a nation-wide survey, we examine the degree to which the pandemic has affected programmatic priorities, resources, and operations related to sustainability. Findings indicate that the pandemic hurt the implementation of sustainability initiatives in almost half of U.S. cities. At the same time, many cities increased the priority of economic and social sustainability initiatives in response to the pandemic. Cities which have formally included sustainability principles into a city plan appear more sensitive to COVID-induced challenges to their program operations.

Nuclear fusion is one of the most attractive alternatives to carbon-dependent energy sources

Aims Obsessive-compulsive disorder (OCD) and schizophrenia are often reported as co-morbid conditions. However, the evidence of an association between OCD and the risk of schizophrenia is limited. This study investigated the risk of schizophrenia in patients newly diagnosed with OCD using a nationally representative sample cohort in South Korea. Methods Data were obtained from the 2002–2013 Korean National Health Insurance Service-National Sample Cohort of the National Health Insurance Service. Using propensity score matching, 2509 patients with OCD and a control group of 7527 patients were included in the analysis. Chi-squared tests were used to investigate and compare the general characteristics of the study population. The risk of schizophrenia was analysed using the Cox proportional hazard model. Results The incidence rate was 45.79/10 000 person-year for patients with OCD and 4.19/10 000 person-year for patients without OCD. Patients with OCD had a higher risk of schizophrenia compared to the control group after adjusting for covariates (hazard ratio = 10.46, 95% confidence interval = 6.07–18.00). Conclusions This study identified an association between the diagnosis of OCD and the risk of schizophrenia in a South Korean national representative cohort. Further research using a prospective design to clarify the causality of OCD in schizophrenia in a controlled environment should be conducted to validate these findings.

This paper deals with the comparative investigation on the performance of various permanent magnet wind power generators according to magnetization patterns and stator coil winding types for wind power applications. With slotless stator core structure, vertical and Halbach magnetization patterns are applied to the three types of coil pitch windings. Based on finite element method, the electromagnetic field analysis is performed, and one of the analysis models is manufactured for its experimental verification. In this study, the machines have almost identical values of induced voltage and resistance which are considered as important equivalent circuit parameters, so their reasonable comparison can be made. Besides, since the generators are integrated with a mechanical energy storage system, the influence of the energy storage on the generator performance is addressed based on the measured phase current including harmonics. From the analysis results presented in this study, the better choice by considering machine topology is proposed.

To address complex and cross-cutting policy problems, multiple independent administrative units within an organization often work together to accomplish a larger objective. Within local governments, doing this requires administrative mechanisms able to facilitate interdepartmental collaboration, through which the efforts of individual units contribute to city-wide policy goals. Research increasingly finds that informal elements of collaboration, such as casual communications, ad hoc meetings, and voluntary working groups, are important for building strong and trusting collaborative ties. Conversely, a nontrivial number of studies also suggest that formal mechanisms, such as mandates, rules, and authority, are necessary for ensuring and sustaining credible commitment over time. This research empirically examines the types of coordination mechanisms employed by US local governments to promote intragovernmental efforts to collaborate around the issue of sustainability—a complex and broad objective that transcends city departments’ traditional boundaries. It particularly focuses on assessing the relative contributions of formal and informal mechanisms toward achieving that end. Results from structural equation modeling analyses of 506 city governments indicate that informal mechanisms are positively and significantly associated with promoting cross-departmental collaboration. Interestingly, the results further show that formal mechanisms, while lacking a direct association with collaboration, have important implications for facilitating collaborative processes indirectly through their influence on informal mechanisms. Overall, our findings suggest a critical need for balancing the two approaches when forging interdepartmental collaboration. Implications for policy and future research are also discussed.

Objectives To investigate whether phase angle (PhA) measured by bioelectrical impedance analysis (BIA) and frailty are associated with the outcomes of critical illnesses. Design A single-center prospective cohort study. Setting Medical intensive care unit (ICU) in Seoul National University Hospital, Seoul, Republic of Korea. Participants 97 patients who were admitted to the medical ICU. Measurements On admission, PhA was measured by BIA, and frailty was assessed by the Korean Modified Barthel Index (KMBI) scoring system. Patients were classified according to PhA and KMBI scores, and their impact on the outcomes of critical illnesses was evaluated. Results The patients’ mean age was 62.4 ± 16.4 years, and 56 of the patients (57.7%) were men. Having a high PhA above 3.5 at the time of ICU admission was associated with lower in-hospital mortality (adjusted OR 0.42, p =.042), and a shorter duration of ICU stay (5.6 days vs. 9.8 days, p =.016) compared to those with a low PhA. Other indices measured by BIA were not significantly associated with outcomes of critical illnesses. Frailty (KMBI > 60) was associated with more mechanical ventilation days (2.3 days vs. 7.1 days; p =.018). Conclusion Both PhA and frailty are important prognostic factors predicting the outcomes of critical illnesses. Low PhA scores were associated with increased mortality and a longer duration of ICU stay, and frailty was associated with more mechanical ventilation days.

This manuscript describes a dataset of thoracic cavity segmentations and discrete pleural effusion segmentations we have annotated on 402 computed tomography (CT) scans acquired from patients with non-small cell lung cancer. The segmentation of these anatomic regions precedes fundamental tasks in image analysis pipelines such as lung structure segmentation, lesion detection, and radiomics feature extraction. Bilateral thoracic cavity volumes and pleural effusion volumes were manually segmented on CT scans acquired from The Cancer Imaging Archive "NSCLC Radiomics" data collection. Four hundred and two thoracic segmentations were first generated automatically by a U-Net based algorithm trained on chest CTs without cancer, manually corrected by a medical student to include the complete thoracic cavity (normal, pathologic, and atelectatic lung parenchyma, lung hilum, pleural effusion, fibrosis, nodules, tumor, and other anatomic anomalies), and revised by a radiation oncologist or a radiologist. Seventy-eight pleural effusions were manually segmented by a medical student and revised by a radiologist or radiation oncologist. Interobserver agreement between the radiation oncologist and radiologist corrections was acceptable. All expert-vetted segmentations are publicly available in NIfTI format through The Cancer Imaging Archive at https://doi.org/10.7937/tcia.2020.6c7y-gq39. Tabular data detailing clinical and technical metadata linked to segmentation cases are also available. Thoracic cavity segmentations will be valuable for developing image analysis pipelines on pathologic lungs - where current automated algorithms struggle most. In conjunction with gross tumor volume segmentations already available from "NSCLC Radiomics," pleural effusion segmentations may be valuable for investigating radiomics profile differences between effusion and primary tumor or training algorithms to discriminate between them.

The Institutional Collective Action (ICA) framework has contributed to understanding collective action problems in fragmented governance and identified mechanisms for overcoming them. Participation in collaboration is risky––even if it has the potential to make all parties better off. This framework has uniquely shown how collaboration risk and other transaction costs can be overcome to create effective collaborations for addressing complex policy issues. However, after over a decade of use, the framework is due for critical evaluation and articulation of its state of the art and science to better inform future scholarship. For this purpose, this article defines key concepts and formulates assumptions, as well as reviews the empirical contributions and longstanding limitations of the ICA framework. A robust agenda for future research is also outlined. To move forward, we believe ICA research should focus on the foundational core of the ICA framework, maintain flexibility in explanatory models, and expand the scope beyond the collective action problems at the local level.

Disruption prediction and avoidance is a critical need for next-step tokamaks, such as ITER. Disruption Event Characterization and Forecasting (DECAF) research fully automates analysis of tokamak data to determine chains of events that lead to disruptions and to forecast their evolution allowing sufficient time for mitigation or complete avoidance of the disruption. Disruption event chains related to local rotating or global magnetohydrodynamic (MHD) modes and vertical instability are examined with warnings issued for many off-normal physics events, including density limits, plasma dynamics, confinement transitions, and profile variations. Along with Greenwald density limit evaluation, a local radiative island power balance theory is evaluated and compared to the observation of island growth. Automated decomposition and analysis of rotating tearing modes produce physical event chains leading to disruptions. A total MHD state warning model comprised of 15 separate criteria produces a disruption forecast about 180 ms before a standard locked mode detector warning. Single DECAF event analyses have begun on KSTAR, MAST, and NSTX/-U databases with thousands of shot seconds of device operation using from 0.5 to 1 × 106 tested sample times per device. An initial multi-device database comparison illustrates a highly important result that plasma disruptivity does not need to increase as βN increases. Global MHD instabilities, such as resistive wall modes (RWMs), can give the briefest time period of warning before disruption compared to other physics events. In an NSTX database with unstable RWMs, the mode onset, loss of boundary and current control, and disruption event warnings are found in all cases and vertical displacement events are found in 91% of cases. An initial time-dependent reduced physics model of kinetic RWM stabilization created to forecast the disruption chain predicts instability 84% of the time for experimentally unstable cases with a relatively low false positive rate. Instances of the disruption event chain analysis illustrate dynamics including H–L back transitions for rotating MHD and global RWM triggering events. Disruption warnings are issued with sufficient time before the disruption (on transport timescales) to potentially allow active profile control for disruption avoidance, active mode control, or mitigation.

Local governments are leading sustainability efforts through a range of initiatives, often voluntarily. While a spate of research exists to explain what drives these voluntary decisions, we are still limited in understanding how localities follow through with the resources to implement their adopted plans. This is particularly the case for environment and climate protection programs that are transboundary in nature and thus require more innovative and longer-term approaches than those that are relatively low-cost and easier to implement with future savings. This research examines local investment in promoting three of these program areas: air quality, biodiversity preservation, and ecological restoration. It investigates how local governments vary according to resource commitment and what factors explain those variations. We find several factors significant, including community capacity, political ideology, and institutional arrangements for service production and delivery. Variations are, however, found across different types of resource commitment, suggesting a more complex picture of local resource availability for advancing sustainability efforts.

This paper deals with electromagnetic torque and current characteristics of an induction motor with rotor bar breakage, and electromagnetic field analysis based on finite element method and motor current signal analysis is performed according to various load conditions. Although various monitoring techniques of rotor bar breakages were dealt with in previous studies using MCSA, they cannot be, in fact, applied to every case. Therefore, in this paper, electromagnetic field analysis of induction motor with various rotor bar fault conditions is performed to establish fault monitoring criteria in MCSA method. This study employs 0.4(kW) squirrel cage induction motor, and experimentally measured torque and current supports the analysis results.

Many municipalities are taking meaningful action in pursuit of climate, environmental, and energy objectives. These issues are complex and transboundary and thus provide fertile ground for collaboration, particularly in metropolitan regions. However, despite the many benefits that can result from collaboration, it also entails transaction risk. As a result, cities have incentive to be selective about who they collaborate with. In some cases, cities, particularly those with considerable internal resources and capacities, might find it easier to “go it alone.” We pull from the literature on collaboration risk, transaction cost economics, and organizational capacity to develop hypotheses about the relationship between capacity and collaboration in urban sustainability initiatives. Our analysis finds that the extent to which cities collaborate with external organizations on climate and energy issues is shaped by local administrative capacity; however, the relationship is nonlinear.

Background The coronavirus pandemic continues to shake the embedded structures of traditional in-person education across all learning levels and across the globe. In healthcare simulation, the pandemic tested the innovative and technological capabilities of simulation programs, educators, operations staff, and administration. This study aimed to answer the question: What is the state of distance simulation practice in 2021? Methods This was an IRB-approved, 34-item open survey for any profession involved in healthcare simulation disseminated widely and internationally in seven languages from January 14, 2021, to March 3, 2021. Development followed a multistep process of expert design, testing, piloting, translation, and recruitment. The survey asked questions to understand: Who was using distance simulation? What driving factors motivated programs to initiate distance sim? For what purposes was distance sim being used? What specific types or modalities of distance simulation were occurring? How was it being used (i.e., modalities, blending of technology and resources and location)? How did the early part of the pandemic differ from the latter half of 2020 and early 2021? What information would best support future distance simulation education? Data were cleaned, compiled, and analyzed for dichotomized responses, reporting frequencies, proportions, as well as a comparison of response proportions. Results From 32 countries, 618 respondents were included in the analysis. The findings included insights into the prevalence of distance simulation before, during, and after the pandemic; drivers for using distance simulation; methods and modalities of distance simulation; and staff training. The majority of respondents (70%) reported that their simulation center was conducting distance simulation. Significantly more respondents indicated long-term plans for maintaining a hybrid format (82%), relative to going back to in-person simulation (11%, p Conclusion This study gives a perspective into the rapid adaptation of the healthcare simulation community towards distance teaching and learning in reaction to a radical and quick change in education conditions and environment caused by COVID-19, as well as future directions to pursue understanding and support of distance simulation.

Although cartilage degeneration and invasion of the subchondral bone plate in entheseal lesion has been considered to consequently lead bony ankylosis in ankylosing spondylitis (AS), no evident mechanisms are known.To identify histopathological and physiological changes in enthesitis-related ankylosis in AS, we performed molecular characterization of transcription factors and surface markers, and transcriptome analysis with human tissues. Entheseal tissue containing subchondral bone was obtained from the facet joints of 9 patients with AS and 10 disease controls, and assessed by using differential staining techniques. Enthesis cells were isolated, characterized, stimulated with TNF and/or IL-17A, and analysed by cell-based experimental tools.We found diffusely distributed granular tissue and cartilage in the subchondral bone in AS. Co-expression of SOX9, a specific transcription factor in cartilage, and matrix metalloproteinase 13 (MMP13) was found in the granular tissues within the subchondral bone from AS patients. Intriguingly, SOX9 expression was significantly higher in AS enthesis cells than controls and correlated with TNFR1 and IL-17RA expressions, which is important for high reactivity to TNF and IL-17A cytokines. Co-stimulation by TNF and IL-17A resulted in accelerated mineralization/calcification features, and increased OCN expression in AS enthesis cells. Furthermore, SOX9 overexpression in enthesis leads to promoting mineralization feature by TNF and IL-17A stimuli. Finally, OCN expression is elevated in the destructive enthesis of advanced AS.These findings provide insight into the links between inflammation and the mineralization of entheseal tissue as the initiation of spinal ankylosis, emphasizing the importance of SOX9

Municipalities around the globe are increasingly adopting and integrating sustainability goals into their service functions. As with many public programs, local sustainability initiatives benefit from regular and systematic assessment aimed at determining the extent to which efforts are achieving their performance goals. However, there currently is little understanding of how local governments are collecting and tracking data on their sustainability-related performance and to what extent they integrate its lessons into their sustainability management practice. This study helps fill this gap by investigating U.S. local governments’ sustainability performance management systems and provides empirical evidence on some of their key institutional and system characteristics. Our findings indicate that a significant number of U.S. local governments are engaged in sustainability performance assessment, but they vary in their ability to establish appropriate indicators as well as supporting mechanisms, indicating significant room for improvement in local sustainability performance management.

The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment. To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing. We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing. The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1–17 years). The use of BPs was significantly associated with AFFs (p

Background We aimed to compare trough infliximab levels and the development of anti-drug antibody (ADA) for 1 year between Crohn’s disease (CD) and ulcerative colitis (UC) patients who were biologic-naïve and to evaluate their impact on clinical outcomes. Methods This was a prospective, multi-center, observational study. Biologic-naïve patients with moderate to severe CD and UC who started CT-P13 therapy were eligible for the study. The trough drug and ADA levels were measured serially for 1-year after CT-P13 initiation. Clinical outcomes were assessed with intention-to-treat purpose. Results 267 patients who received CT-P13 treatment were enrolled in the study (CD 168, UC 99). The rates of clinical remission (72% vs. 32.3%, p Conclusion CD shows favorable pharmacokinetics of infliximab including high trough drug and low ADA level compared with UC which might be related with better clinical outcomes for 1-year of infliximab.

Background The location and number of involved sub-segments in small bowel Crohn’s disease (CD) vary on each patient. This study aimed to evaluate the distribution and characteristics of involved small intestine lesions through a detailed image review at the time of diagnosis and to evaluate the relationship between them and clinical outcomes. Methods CD patients who underwent computed tomography (CT) at the initial diagnosis were retrospectively enrolled. Two abdominal radiologists reviewed the CT images of all patients. They independently rated the presence of “bowel wall thickening”, “stricture”, and “fistula or abscess” in the jejunum, distal jejunum/proximal ileum, ileum, and terminal ileum, respectively. Score 1 was assigned if both radiologists concurred regarding the presence of a lesion. Based on the total score summed across different locations in the small bowel (e.g., imaging score), we divided the patients into three groups as 0, 1–2, and 3–4. Major clinical outcomes were compared among these groups. Results A total of 152 patients were enrolled. The proportion of the patients involved in the jejunum, distal jejunum/proximal ileum, ileum, and terminal ileum was 2.0%, 30.3%, 82.2%, and 71.7%, respectively; 32.3% of the patients had Montreal classification L4 (involvement of jejunum or distal jejunum/proximal ileum). Agreement on fistula or abscess was almost perfect (kappa value = 1.0 for most segments); the degree of agreement on bowel wall thickness and stricture varied according to involved segments (kappa value = 0.690–0.936). There were 15 (9.9%), 100 (65.8%), and 37 (24.3%) patients in groups 0, 1–2, and 3–4, respectively. In Kaplan-Meier survival analysis, there was no difference in the major clinical outcomes among three groups based on the imaging score (emergency room visit p = 0.093; operation p = 0.080; new use of corticosteroid p = 0.139; and new use of biologics p = 0.126). In the multivariable analysis, disease behavior was the only risk factor associated with all clinical outcomes after adjusting other factor (emergency room visit, HR 2.127 [1.356–3.337], p = 0.001; operation, HR 8.216 [2.629–25.683], p < 0.001; new use of corticosteroid, HR 1.816 [1.249–2.642], p =0.002; and new use of biologics, HR 2.352 [1.492–3.708], p < 0.001). Conclusion As a result of a detailed CT review, about one-third and one-fourth of patients newly diagnosed as small bowel CD had L4 lesions and multiple lesions (> 2 segments), respectively. However, the location and number of involved sub-segments in small bowel CD did not affect the clinical outcomes. Initial disease behavior is a more critical factor associated with clinical outcomes than characteristics of disease location.

This paper presents the shallow-water bathymetry survey using high definition color images obtained at the altitude of 150 m above sea level using a drone. Image processing algorithms using multi-variable linear regression applied to red, green, blue and grey band images obtained from HD camera has been developed. Optical passive remote sensing analysis conducted at Wolpo beach showed promising results. Estimated water depths of within 6m water depth in one HD camera image with dimensions of 270m by 180m showed the coefficient of determination of 0.990, RMSE 0.144m, and the maximum error of 0.38m compared with water depth surveyed through manual as well as ship-board echo-sounder measurements. In order to increase the accuracy of estimated water depth, we also applied artificial neural network(ANN) technique. Estimation of water depth using ANN showed improved results with the coefficient of determination of 0.995, RMSE 0.088m, and the maximum error of 0.217m. Sources of error in the estimation of water depth include sunglint, waves and breaking waves, as well as turbidity and sea bottom characteristics. Sun glint, waves and breaking waves can be removed rather easily through relative luminance and time average filtering technique, respectively. However, errors caused by turbidity of water and sea bottom characteristics are relatively difficult to calibrate. We could identify the large errors in the depth estimation due to seagrass habitat on the sea bottom which cause reduced reflectance of the RGB band. By applying the Beer-Lambert law on each RGB band separately, we could pinpoint the existence of the seagrass on the sea bottom.

We report a fuel-dependent reactor electron antineutrino ($\overline{\nu}_e$) yield using six 2.8 GW$_{\text{th}}$ reactors in the Hanbit nuclear power plant complex, Yonggwang, Korea. The analysis uses $850\,666$ $\overline{\nu}_e$ candidate events with a background fraction of 2.0 % acquired through inverse beta decay (IBD) interactions in the near detector for 1807.9 live days from August 2011 to February 2018. Based on multiple fuel cycles, we observe a fuel $^{235}$U dependent variation of measured IBD yields with a slope of $(1.51 \pm 0.23) \times 10^{-43} $cm$^2$/fission and measure a total average IBD yield of $(5.84 \pm 0.13) \times 10^{-43} $cm$^2$/fission. The hypothesis of no fuel-dependent IBD yield is ruled out at 6.6 $\sigma$. The observed IBD yield variation over $^{235}$U isotope fraction does not show significant deviation from the Huber-Mueller (HM) prediction at 1.3 $\sigma$. The measured fuel-dependent variation determines IBD yields of $(6.15 \pm 0.19) \times 10^{-43} $cm$^2$/fission and $(4.18\pm 0.26) \times 10^{-43} $cm$^2$/fission for two dominant fuel isotopes $^{235}$U and $^{239}$Pu, respectively. The measured IBD yield per $^{235}$U fission shows the largest deficit relative to the HM prediction. Reevaluation of the $^{235}$U IBD yield per fission may mostly solve the Reactor Antineutrino Anomaly (RAA) while $^{239}$Pu is not completely ruled out as a possible contributor of the anomaly. We also report a 2.9 $\sigma$ correlation between the fractional change of the 5 MeV excess and the reactor fuel isotope fraction of $^{235}$U., Comment: 6 pages and 5 figures, v4 note: (1) data files for figure 1, figure 2, figure 5 are included for arXiv users (2) minor modifications in abstract and main text for clarification

The JSNS$^{2}$ (J-PARC Sterile Neutrino Search at J-PARC Spallation Neutron Source) experiment will search for neutrino oscillations over a 24 m short baseline at J-PARC. The JSNS$^{2}$ inner detector will be filled with 17 tons of gadolinium-loaded liquid scintillator (LS) with an additional 31 tons of unloaded LS in the intermediate $\gamma$-catcher and outer veto volumes. JSNS$^{2}$ has chosen Linear Alkyl Benzene (LAB) as an organic solvent because of its chemical properties. The unloaded LS was produced at a refurbished facility, originally used for scintillator production by the RENO experiment. JSNS$^{2}$ plans to use ISO tanks for the storage and transportation of the LS. In this paper, we describe the LS production, and present measurements of its optical properties and long term stability. Our measurements show that storing the LS in ISO tanks does not result in degradation of its optical properties., Comment: 7 pages, 4 figures

Background As the treatment paradigm of inflammatory bowel disease changes towards patient-centred treatment, it is becoming increasingly important to measure patient-reported outcomes (PROs). We aimed to identify the changes of emotional health and work- or activity-related outcomes one year after the diagnosis of ulcerative colitis (UC) and its predictors in patients enrolled in the moderate-to-severe UC in Korea (MOSAIK) cohort (ClinicalTrials.gov: NCT02229344). Methods The MOSAIK cohort is the first nationwide, prospective, inception cohort on moderate-to-severe UC in Korea. Between August 2014 and March 2017, consecutive patients from 30 tertiary hospitals were enrolled. PRO data including hospital anxiety and depression scale (HADS) for emotional health, and work productivity and activity impairment (WPAI) questionnaire for work- or activity-related outcomes, were collected within the first 4 weeks of diagnosis via patient surveys. Wilcoxon-signed rank tests and linear mixed-effects regression models were used for paired comparisons between baseline and 1 year and assessing the predictors of HADS and WPAI. Results Of the 368 enrolled patients, 333 eligible patients were analyzed. The mean age at diagnosis was 39 years and 57.7% (192/333) were male. A considerable number of patients had moderate to high (≥11 by HADS) levels of anxiety and depression (16.0% and 20.5%, respectively), and about half of patients had work and activity impairment (45.5% and 45.8%%, respectively) at baseline. After 1 year follow-up, significant reduction of anxiety and depression (mean difference [MD] in HADS score -1.3 for both anxiety and depression, P Conclusion Newly diagnosed moderate-to-severe UC patients had considerable anxiety, depression, and work and activity impairment at baseline, but significant improvement was noted after 1 year. Controlling symptoms and disease activity was the most important factor to improve PROs after 1 year.

Background Microbial dysbiosis has long been postulated to be associated with the pathogenesis of inflammatory bowel disease (IBD). Although evidence supporting the anti-colitic effects of melatonin have been accumulating, it is not clear how melatonin affects the microbiota. Herein, we investigated the effects of melatonin on the microbiome in colitis and identified involvement of Toll-like receptor (TLR) 4 signalling in the effects. Methods Colitis was induced in 8-week-old wild-type (WT) and TLR4 KO mice by administration of 2.5% dextran sulphate sodium (DSS) in drinking water and intraperitoneal (i.p.) treatment with melatonin (Mel) or vehicle (Veh). Body weight changes were monitored daily. Results DSS-treatment for 10 days significantly increased body weight loss in the vehicle-treated group of both wild-type and TLR4 KO mice. Melatonin improved dextran sulphate sodium (DSS)-induced colitis and reverted microbial dysbiosis in wild-type (WT) mice but not in TLR4 knockout (KO) mice. Induction of goblet cells was observed with melatonin administration, which was accompanied by suppression of Il1b and Il17a and induction of melatonin receptor and Reg3β, an antimicrobial peptide (AMP) against Gram-negative bacteria. In vitro, melatonin treatment of HT-29 intestinal epithelial cells promotes mucin and wound healing and inhibits growth of Escherichia coli. Conclusion we showed that melatonin significantly increases goblet cells, Reg3β and the ratio of Firmicutes to Bacteriodetes by suppressing Gram-negative bacteria through TLR4 signalling. Our study suggests that sensing of bacteria through TLR4 and regulation of bacteria through altered goblet cells and AMPs is involved in the anti-colitic effects of melatonin. Melatonin may have use in therapeutics for IBD.

This study was conducted to determine the cutoff value and efficacy of the EuroQol Visual Analogue Scale (EQ-VAS) for predicting frailty. The EQ-VAS medians (Interquartile Range) were compared and analyzed against the FFI. The subjects were 1471 older adults aged 70 to 84 years who had completed both EQ-VAS and Fried Frailty index (FFI) in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study. Of the 1471 subjects,600 were classified as robust, 716 as pre-frail, and 155 as frail. The median EQ-VAS scores were 80.00 (20.00) for robust, 75.00 (25.00) for pre-frail, and 60.00 (25.00) for frail subjects.The medians of all five components of the FFI, weight loss (70.00 vs. 80.00), grip strength (70.00 vs. 80.00), exhaustion (70.00 vs. 80.00), walking velocity (70.00 vs. 80.00), and physical activity (70.00 vs. 80.00), were lower in the abnormal groups. We tested the efficacy of EQ-VAS as a diagnostic tool to predict frailty, and the area under the curve of EQ-VAS was 0.71 withthe optimal cut-off value of 72. EQ-VAS presented negative correlation with FFI, and the optimal cut off value for frailty was 72. These results suggest that EQ-VAS is a valuable tool for assessing frailty andmay be a good predictor of frailty in Korean elderly population.

We evaluated the effect of tree genotype on the resistance of balsam fir,Abies balsamea(Linnaeus) Miller (Pinaceae), to damage from the balsam twig aphid,Mindarus abietinusKoch (Hemiptera: Aphididae), by visually assessing aphid damage in clonal seed orchards located in New Brunswick and Nova Scotia, Canada, during four consecutive years. Estimates of clone mean heritability were moderate, suggesting that heritability of resistance is influenced by genetic factors. In New Brunswick, positive phenotypic and genetic correlations of clone-mean damage among years indicate that clones rank similarly each year. Our results suggest that selectively breeding for increased resistance could result in genetic gains.

The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment.To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing.We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing.The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1-17 years). The use of BPs was significantly associated with AFFs (p 0.001, odds ratio = 25.65; 95% confidence interval = 10.74-61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment.The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.