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Data on aortic valve outcomes following surgical repair of doubly committed subarterial ventricular septal defect remain limited.
Methods:
This retrospective study included doubly committed subarterial ventricular septal defect patients who underwent surgical repair at our centre from 2013 to 2023. The primary outcome was the incidence of new-onset aortic regurgitation during follow-up.
Results:
A total of 320 patients were included, with a median age of 2.0 (0.9–7.2) years. Among them, 289 patients underwent surgical repair alone (repair group), and 31 received additional aortic valve surgery (repair + aortic valve surgery group). Preoperatively, 58 (18.1%) patients exhibited aortic regurgitation ≥ mild (10.7% in the repair group vs 87.1% in the repair + aortic valve surgery group, P < 0.001). The overall median follow-up was 40.5 (16.0–72.0) months. At the last follow-up, 23 (7.4%) patients had aortic regurgitation ≥ mild (3.8 vs 52.2%, P < 0.001), and 6 (1.9%) had aortic regurgitation > mild (0.3 vs 21.7%, P < 0.001). Sixteen (5.1%) patients developed new-onset aortic regurgitation during follow-up (1.7 vs 47.8%, log-rank P < 0.001), and 6 (1.9%) of them developed new-onset aortic regurgitation > mild (0.3 vs 21.7%, log-rank P < 0.001). Age, ventricular septal defect size, preoperative aortic regurgitation > mild, and maximum aortic valve flow velocity (AVmax) were related to concurrent aortic valve surgery and new-onset aortic regurgitation.
Conclusions:
Based on our retrospective data, the mid-term aortic valve outcomes after doubly committed subarterial ventricular septal defect repair were relatively satisfactory, with a low incidence of new-onset aortic regurgitation during follow-up. However, aortic valve outcomes for patients who received concurrent aortic valve surgery were less satisfactory.
Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.
Methods
In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.
Results
Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.
Conclusions
Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.
OBJECTIVES/GOALS: Hypertension is a major risk factor for coronavirus disease 2019 (COVID-19) severity. Our goal was to determine if hypertension worsens lung pathology induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in hamsters. METHODS/STUDY POPULATION: Male hamsters (7-8 weeks old) were infused with angiotensin II (AII; 200 ng/kg/min via osmotic minipump) for 4 weeks to induce hypertension. During the last week of the infusion, the hamsters were inoculated intranasally with vehicle (V) or SARS-CoV-2 (S; 1 x 105 plaque forming units/ml). Half of the hamsters were sacrificed 1 day post-inoculation (dpi-1) and the other half on dpi-6. Two scoring systems were applied to lung tissue sections stained with hematoxylin and eosin to determine the degree and severity of lung pathology: the first system assessed all pertinent alterations in the lungs, while the second system only assessed the pathology related to the pulmonary vasculature. Lung histopathology scores were calculated as the sum of the airway and lung alveolar scores in arbitrary units (AU). RESULTS/ANTICIPATED RESULTS: Studies revealed that the SARS-CoV-2-infected hamsters exhibited a 76-fold higher total airway score compared to vehicle controls [(AU): V, 0.25 ± 0.1; S, 19.00 ±1.35; p<0.05; n=4]. Total lung alveolar scores (27-fold) [(AU): V, 0.30 ± 0.11; S, 8.0 ± 4.1; p<0.05; n=4] and total vascular scores (17-fold) [(AU): V, 0.35 ± 0.2; S, 6.0 ±1.4; p<0.05; n=4] were also markedly higher compared to controls on dpi-1. AII increased blood pressure, which was sustained through the 4-week infusion period. Under these conditions, body weight slightly dropped by 4.5%. Ongoing studies are assessing the effect of hypertension on the % of airway, alveoli and vessels affected, airway and alveolar severity, and bronchiolar epithelial and type II pneumocyte hyperplasia. DISCUSSION/SIGNIFICANCE: Establishing the hypertensive hamster as a small animal model of COVID-19 will facilitate investigations into why preexisting hypertension is a risk factor for disease severity. These studies could lead to the development of novel therapeuticsfor treating COVID-19 patients with hypertension.
In order to better understand the provenance of the sediments and environmental change associated with the Permian-Triassic (P/T) biotic crisis, a comparative clay mineralogical study of the Permian-Triassic boundary (PTB) sediments between the Meishan section (the Global Stratotype Section and Point of the PTB) and the Xiakou section, southern China, was undertaken using X-ray diffraction and differential scanning calorimetry (DSC). The results showed that clay minerals of the packstone bed 24e, in which the preludial mass extinction occurred at Meishan, consist of 56% mixed-layer illite-smectite (I-S), 39% illite, and 5% kaolinite. A dehydroxylation effect was measured at 652°C, indicating that I-S and illite of this bed contain mainly cis-vacant (cv) layers related to volcanic origin. The dehydroxylation event correlates with bed P257 at Xiakou. The white clay bed 25 also corresponding to the main extinction event at Meishan contains 95% I-S and 5% kaolinite, with a strong endothermic effect at 676°C and a weaker one at 514°C in the DSC curve. These results are attributed to dehydroxylation of cv layers in I-S clays, suggesting that I-S in the white clay bed was derived from marine alteration of volcanic ash, in agreement with the conodont-correlated clay (P258) at Xiakou. (Conodonts are tooth-like microfossils and are usually used as an indicator of age in PTB stratigraphy.) Increases in chlorite and illite contents in the black clays (bed 26) at Meishan and the conodont-correlated black clay layer (P259b) at Xiakou probably indicate stronger erosional processes under cooler and more arid conditions. Volcanic materials found in a bed which marked the prelude to the main episode of mass extinction reinforce the temporal link between volcanism and the mass extinction.
OBJECTIVES/GOALS: Hamsters develop COVID-19 similarly to people because the SARS-CoV-2 spike protein binds with high affinity to hamster ACE2 resulting in host cell entry and replication. Our goal was to establish a hamster model that mirrors the lung and brain pathophysiology observed in COVID-19. METHODS/STUDY POPULATION: Hamsters infected with SARS CoV-2 are sacrificed on day 1 and day 6 postinfection. Lung histopathology scoring model was implemented for assessment all pathological relevant changes in the lungs of infected animals on tissue sections stained with hematoxylin and eosin. To quantify the extent and severity of lung pathology, two scoring systems were used: the first evaluated all relevant changes in the lungs of the infected animals and the second evaluated only the pathology associated with the pulmonary vasculature. Percentage of airway affected, airway severity, bronchiolar epithelial hyperplasia, alveoli affected, alveolar severity, type II pneumocyte hyperplasia and vessels affected were analyzed. Total airway score plus total lung alveolar score give lung histopathology score. RESULTS/ANTICIPATED RESULTS: Compared to the control hamster, the hamsters day 1 postinfection, exhibited a higher total airway score [9.00 ± 1.35 vs. 0.25 ± 0.1; p DISCUSSION/SIGNIFICANCE: Establishing this outstanding small animal model of COVID-19 will facilitate studies investigating diagnostics, prognosis and response to treatment in COVID-19 disease. These studies will provide insights that will complement on-going clinical trials on angiotensin type 1 receptor (AT1R) blockers (ARBs) in COVID-19.
OBJECTIVES/GOALS: Rodents are the most widely used experimental animals to study disease mechanisms due to their availability and cost-effectiveness. An international drive to investigate the pathophysiology of COVID-19 is inhibited by the resistance of rats and mice to SARS-CoV-2 infection. Our goal was to establish an appropriate small animal model. METHODS/STUDY POPULATION: To recreate the cytokine storm that is associated with COVID-19, we injected angiotensin converting enzyme 2 knockout (ACE2KO) mice (C57BI/6 strain) with lipopolysaccharide (LPS) intraperitoneally and measured the expression of multiple cytokines as a function of time and LPS dose. We then chose a minimum dose (500ug/kg) and time (3h) when multiple cytokines were elevated to measure lung injury scores using a point-counting technique on tissue sections stained with hematoxylin and eosin. The data are expressed as mean percentage of grid points lying within the peribronchial and superficial area in up to 20 fields. Percentage of peribronchial and superficial intrapulmonary hemorrhage, congestion, neutrophil infiltration and area of alveolar space were all assessed. RESULTS/ANTICIPATED RESULTS: Compared to the wildtype group (WT-G), the LPS-injected ACE2KO mice (LPS-G) exhibited a higher percentage of peribronchial intrapulmonary hemorrhage [(%): LPS-G, 10.56 ± 2.06 vs. WT-G, 5.59 ± 0.53; p DISCUSSION/SIGNIFICANCE: Establishing this novel mouse model of COVID-19 will facilitate studies investigating tissue-specific mechanisms of pathogenesis in this disease. This model can also be used to discover novel therapeutic targets and the design of clinical trials focusing on diagnostics, treatments and outcomes in COVID-19.
Palliative care can improve the quality of life of adolescents and young adults (AYA) with cancer. However, little is known about the utilization of palliative care among AYA cancer patients. Identifying factors associated with the utilization of palliative care could inform efforts to improve palliative care access among AYA patients living with cancer.
Methods
Using data from the National Inpatient Sample 2016–2019, a representative sample of US hospitalizations, we examined palliative care encounters and associated characteristics among hospitalizations of AYA with cancer and high inpatient mortality risk. Survey design–adjusted bivariate and multivariable logistic regression models were used to examine associations of patient- and hospital-level characteristics with palliative care.
Results
Of 10,979 hospitalizations by AYA cancer patients with high mortality risk, 19.9% received palliative care services between 2016 and 2019. After adjusting for all characteristics, independent predictors of palliative care use were as follows: older age (25–39 years old vs. 25–39 years; odds ratio [OR] 1.31, 95% confidence interval [CI] 1.15–1.49), Hispanic/Latinx (vs. non-Hispanic White; OR 1.16, 95% CI 1.01–1.34), female (vs. male; OR 1.27, 95% CI 1.14–1.41), public insurance (vs. private insurance; OR 1.23, 95% CI 1.10–1.38), hospital location in the US South (vs. Northeast; OR 0.78, 95% CI 0.66–0.94), and a large hospital (vs. small; OR 0.83, 95% CI 0.72–0.96).
Significance of results
Less than 20% of AYAs with cancer and high risk of mortality received inpatient palliative care services. Further research is needed to explore the reasons for lower palliative care utilization in the younger age groups.
Trauma exposure can cause post-traumatic stress symptoms (PTSS), and persistently experiencing PTSS may lead to the development of post-traumatic stress disorder (PTSD). Research has shown that PTSS that emerged within days of trauma was a robust predictor of PTSD development.
Aims
To investigate patterns of early stress responses to trauma and their associations with development of PTSD.
Method
We recruited 247 civilian trauma survivors from a local hospital emergency department. The PTSD Checklist for DSM-5 (PCL-5) and Acute Stress Disorder Scale (ASDS) were completed within 2 weeks after the traumatic event. Additionally, 3 months post-trauma 146 of these participants completed a PTSD diagnostic interview using the Clinician Administered PTSD Scale for DSM-5.
Results
We first used latent profile analysis on four symptom clusters of the PCL-5 and the dissociation symptom cluster of the ASDS and determined that a four-profile model (‘severe symptoms’, ‘moderate symptoms’, ‘mild symptoms’, ‘minimal symptoms’) was optimal based on multiple fit indices. Gender was found to be predictive of profile membership. We then found a significant association between subgroup membership and PTSD diagnosis (χ2(3) = 11.85, P < 0.01, Cramer's V = 0.263). Post hoc analysis revealed that this association was driven by participants in the ‘severe symptoms’ profile, who had a greater likelihood of developing PTSD.
Conclusions
These findings fill the knowledge gap of identifying possible subgroups of individuals based on their PTSS severity during the early post-trauma period and investigating the relationship between subgroup membership and PTSD development, which have important implications for clinical practice.
The subduction model of the Neo-Tethys during the Early Cretaceous has always been a controversial topic, and the scarcity of Early Cretaceous magmatic rocks in the southern part of the Gangdese batholith is the main cause of this debate. To address this issue, this article presents new zircon U–Pb chronology, zircon Hf isotope, whole-rock geochemistry and Sr–Nd isotope data for the Early Cretaceous quartz diorite dykes with adakite affinity in Liuqiong, Gongga. Zircon U–Pb dating of three samples yielded ages of c. 141–137 Ma, indicating that the Liuqiong quartz diorite was emplaced in the Early Cretaceous. The whole-rock geochemical analysis shows that the Liuqiong quartz diorite is enriched in large-ion lithophile elements (LILEs) and light rare-earth elements (LREEs) and is depleted in high-field-strength elements (HFSEs), which are related to slab subduction. Additionally, the Liuqiong quartz diorite has high SiO2, Al2O3 and Sr contents, high Sr/Y ratios and low heavy rare-earth element (HREE) and Y contents, which are compatible with typical adakite signatures. The initial 87Sr/86Sr values of the Liuqiong adakite range from 0.705617 to 0.705853, and the whole-rock ϵNd(t) values vary between +5.78 and +6.24. The zircon ϵHf(t) values vary from +11.5 to +16.4. Our results show that the Liuqiong adakite magma was derived from partial melting of the Neo-Tethyan oceanic plate (mid-ocean ridge basalt (MORB) + sediment + fluid), with some degree of subsequent peridotite interaction within the overlying mantle wedge. Combining regional data, we favour the interpretation that the Neo-Tethyan oceanic crust was subducted at a low angle beneath the Gangdese during the Early Cretaceous.
A droplet impinging on a superhydrophobic substrate in an electric field is an important process in droplet manipulation and electrostatic spraying. Here, the entire impinging dynamic of the droplet in a vertical electric field is studied by a visualization experiment and numerical simulation with OpenFOAM. We investigate the effect of an electrostatic force on droplet impact in depth, where four ejection modes and three rebound modes are found experimentally. In particular, the filamentous ejecting phenomenon occurs after a droplet impinging on a superhydrophobic substrate is first discovered. In the numerical simulation, the strong coupling between the dynamic distribution of the interface electric charge and the evolution of the droplet profile can lead to different ejection modes, and the different ejection behaviours are caused by the combined effects of electrostatic pressure, capillary pressure, dynamic pressure and static pressure on the droplet apex. A charge scaling law for the ejection droplets is proposed. Furthermore, a set of theoretical models is established, which can successfully predict the threshold electric capillary number for different droplet ejection modes. The results reveal some important characteristics for a droplet impinging on a superhydrophobic surface in an electric field, which could facilitate the design of electrically operated droplet equipment and guide the safe and stable operation of the device.
OBJECTIVES/GOALS: The SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus-2), which underlies the current COVID-19 pandemic, among other tissues, also targets the central nervous system (CNS). The goal of this study is to investigate mechanisms of neuroinflammation in Lipopolysaccharides (LPS)-treated mouse model and SARS-CoV-2-infected hamsters. METHODS/STUDY POPULATION: In this research I will assay vascular reactivity of cerebral vessels to assess vascular dysfunction within the microcirculation. I will determine expression of proinflammatory cytokines, coagulation factors and AT1 receptors (AT1R) in isolated microvessels from the circle of Willis to assess inflammation, thrombosis and RAS activity in the microvasculature. LPS and SARS-CoV-2, are both associated with coagulopathies and because of that I will measure concentration of PAI-1, von Willebrand Factor, thrombin and D-dimer to assess the thrombotic pathway in the circulation. Histology and immunohistochemistry will assess immune cell type infiltration into the brain parenchyma, microglia activation and severity of neuroinflammation and neural injury. RESULTS/ANTICIPATED RESULTS: We hypothesize that under conditions of reduced ACE2 (e.g., SARS-CoV-2 infection), AT1R activity is upregulated in the microvasculature. In the presence of an inflammatory insult, these AT1Rs promote endothelialitis and immunothrombosis through pro-thrombotic pathways and pro-inflammatory cytokine production leading to endothelial dysfunction in the microvasculature, blood brain barrier (BBB) injury, deficits in cognition and increased anxiety. We will test this hypothesis through 2 aims: Aim 1: Determine the role of the pro-injury arm of the RAS in the pathophysiology of the brain in animal models of neuroinflammation and COVID-19. Aim 1: Determine the role of the protective arm of the RAS in the pathophysiology of the brain in animal models of neuroinflammation and COVID-19. DISCUSSION/SIGNIFICANCE: This study will provide insights that will complement on-going clinical trials on angiotensin type 1 receptor (AT1R) blockers (ARBs) in COVID-19. This research is a necessary first step in understanding mechanisms of brain pathogenesis that can set the groundwork for future studies of more complex models of disease.
This survey examined and compared the disaster perception and preparedness of 2421 residents with and without chronic disease in Shenzhen, China.
Methods:
The participants were recruited and were asked to complete a survey in 2018.
Results:
Three types of disasters considered most likely to happen in Shenzhen were: typhoons (73.5% vs 74.9%), major transport accidents (61.5% vs 64.7%), and major fires (60.8% vs 63.0%). Only 5.9% and 5% of them, respectively, considered infectious diseases pandemics to be likely. There were significant differences between those with and without chronic disease in disaster preparedness, only a small percentage could be considered to have prepared for disaster (20.7% vs 14.5%). Logistic regression analyses showed that those aged 65 or older (odds ratio [OR] = 2.76), who had attained a Master’s degree or higher (OR = 2.0), and with chronic disease (OR = 1.38) were more prepared for disasters.
Conclusions:
Although participants with chronic disease were better prepared than those without, overall, Shenzhen residents were inadequately prepared for disasters and in need of public education.
Metabolically healthy obesity (MHO) might be an alternative valuable target in obesity treatment. We aimed to assess whether alternative Mediterranean (aMED) diet and Dietary Approaches to Stop Hypertension (DASH) diet were favourably associated with obesity and MHO phenotype in a Chinese multi-ethnic population. We conducted this cross-sectional analysis using the baseline data of the China Multi-Ethnic Cohort study that enrolled 99 556 participants from seven diverse ethnic groups. Participants with self-reported cardiometabolic diseases were excluded to eliminate possible reverse causality. Marginal structural logistic models were used to estimate the associations, with confounders determined by directed acyclic graph (DAG). Among 65 699 included participants, 11·2 % were with obesity. MHO phenotype was present in 5·7 % of total population and 52·7 % of population with obesity. Compared with the lowest quintile, the highest quintile of DASH diet score had 23 % decreased odds of obesity (OR = 0·77, 95 % CI 0·71, 0·83, Ptrend < 0·001) and 27 % increased odds of MHO (OR = 1·27, 95 % CI 1·10, 1·48, Ptrend = 0·001) in population with obesity. However, aMED diet showed no obvious favourable associations. Further adjusting for BMI did not change the associations between diet scores and MHO. Results were robust to various sensitivity analyses. In conclusion, DASH diet rather than aMED diet is associated with reduced risk of obesity and presents BMI-independent metabolic benefits in this large population-based study. Recommendation for adhering to DASH diet may benefit the prevention of obesity and related metabolic disorders in Chinese population.
Stochastic models are essential for precise navigation and positioning of the global navigation satellite system (GNSS). A stochastic model can influence the resolution of ambiguity, which is a key step in GNSS positioning. Most of the existing multi-GNSS stochastic models are based on the GPS empirical model, while differences in the precision of observations among different systems are not considered. In this paper, three refined stochastic models, namely the variance components between systems (RSM1), the variances of different types of observations (RSM2) and the variances of observations for each satellite (RSM3) are proposed based on the least-squares variance component estimation (LS-VCE). Zero-baseline and short-baseline GNSS experimental data were used to verify the proposed three refined stochastic models. The results show that, compared with the traditional elevation-dependent model (EDM), though the proposed models do not significantly improve the ambiguity resolution success rate, the positioning precision of the three proposed models has been improved. RSM3, which is more realistic for the data itself, performs the best, and the precision at elevation mask angles 20°, 30°, 40°, 50° can be improved by 4⋅6%, 7⋅6%, 13⋅2%, 73⋅0% for L1-B1-E1 and 1⋅1%, 4⋅8%, 16⋅3%, 64⋅5% for L2-B2-E5a, respectively.
Parakmeria omeiensis is a Critically Endangered tree species in the family Magnoliaceae, endemic to south-west China. The tree is functionally dioecious, but little is known about the species’ status in the wild. We investigated the range, population size, age structure, habitat characteristics and threats to P. omeiensis. We located a total of 74 individuals in two populations on the steep slopes of Mount Emei, Sichuan province, growing under the canopy of evergreen broadleaved forest in well-drained gravel soil. A male-biased sex ratio, lack of effective pollinating insects, and habitat destruction result in low seed set and poor seedling survival in the wild. We have adopted an integrated conservation approach, including strengthening in situ conservation, cultivation of saplings, ex situ conservation and reintroduction, to protect this species. The successful conservation of P. omeiensis has important implications for the conservation of the genus Parakmeria and the family Magnoliaceae.
Traditional decision rules have limitations when a new technology is less effective and less costly than a comparator. We propose a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously. We illustrate this framework using the example of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) for treatment-resistant depression.
Methods
We modeled the quality-adjusted life-years (QALYs) associated with the new intervention (rTMS), an active control (ECT), and a placebo control, and we estimated the fraction of effectiveness preserved by the new intervention through probabilistic sensitivity analysis (PSA). We then assessed the probability of cost-effectiveness using a traditional cost-effectiveness acceptability curve (CEAC) and our new decision-making framework. In our new framework, we considered the new intervention cost-effective in each simulation of the PSA if it preserved at least 75 percent of the effectiveness of the active control (thus demonstrating non-inferiority) and had a positive NMB at a given willingness-to-pay threshold (WTP).
Results
rTMS was less effective (i.e., associated with fewer QALYs) and less costly than ECT. The traditional CEAC approach showed that the probabilities of rTMS being cost-effective were 100 percent, 39 percent, and 14 percent at WTPs of $0, $50,000, and $100,000 per QALY gained, respectively. In the new decision framework, the probabilities of rTMS being cost-effective were reduced to 23 percent, 21 percent, and 13 percent at WTPs of $0, $50,000, and $100,000 per QALY, respectively.
Conclusions
This new framework provides a different perspective for decision making with considerations of both non-inferiority and WTP thresholds.
Although laser solid forming (LSF) has a wide range of applications in material manufacturing, the technique has been severely limited due to the solidification cracks during rapid laser melting/solidification. In this paper, an LSF technology assisted by friction stir processing (FSP) is proposed to eliminate the LSF crack through the FSP thermomechanical coupling effect, with the Ni–16Cr–8Fe alloy as a representative material. By FSP-assisted LSF, the cracks at the top surface of the Ni–16Cr–8Fe alloy layer were eliminated. Meanwhile, the severe plastic deformation layers can be observed and gradient grains with tens of nanometers to tens of micrometers from the top surface to the inner. The LSF-printed dendrite microstructure was transformed into nanocrystals or nanotwins in the deformation zone with twining as the main deformation mechanism. The grain refinement results in the increase of hardness about 30%.
To determine whether self-reports of disaster-related psychological distress predict older adults’ health care utilization during the year after Hurricane Sandy, which hit New Jersey on October 29, 2012.
Methods
Respondents were from the ORANJ BOWL Study, a random-digit dialed sample from New Jersey recruited from 2006 to 2008. Medicare hospital, emergency department (ED) and outpatient claims data from 2012 and 2013 were matched to 1607 people age 65 and older in 2012 who responded to follow-up surveys conducted from July 2013 to July 2015 to determine their hurricane-related experiences.
Results
In total, 7% (107) of respondents reported they experienced a lot versus 93% (1493) respondents reported they experienced little or no fear and distress from Hurricane Sandy. Those who experienced a lot versus little or no fear and distress had higher probability of all-cause hospital admissions and more ED visits through 3 months (hazard ratio [HR]: 2.19, 95% CI: 1.03-4.63; incidence ratio [IR]: 2.57, 95% CI: 1.21-5.35), and ED and outpatient visits (IR: 2.20, 95% CI: 1.44-3.37; IR: 1.37, 95% CI: 1.02-1.87) through the year after the hurricane.
Conclusions
A self-reported assessment of disaster-related psychological distress is a strong predictor of older adults’ health care needs the year after the disaster. The results indicate that disaster preparedness should extend beyond acute health care needs to address longer-term health consequences of disasters. (Disaster Med Public Health Preparedness. 2018;12:578–581)
Four isonitrogenous and isoenergetic purified diets containing free arachidonic acid (ARA) or EPA (control group), 0·30 % ARA, 0·30 % EPA and 0·30 % ARA+EPA (equivalent) were designed to feed juvenile grass carp (10·21 (sd 0·10) g) for 10 weeks. Only the EPA group presented better growth performance compared with the control group (P<0·05). Dietary ARA and EPA were incorporated into polar lipids more than non-polar lipids in hepatopancreas but not intraperitoneal fat (IPF) tissue. Fish fed ARA and EPA showed an increase of serum superoxide dismutase and catalase activities, and decrease of glutathione peroxidase activity and malondialdehyde contents (P<0·05). The hepatopancreatic TAG levels decreased both in ARA and EPA groups (P<0·05), accompanied by the decrease of lipoprotein lipase (LPL) activity in the ARA group (P<0·05). Fatty acid synthase (FAS), diacylglycerol O-acyltransferase and apoE gene expression in the hepatopancreas decreased in fish fed ARA and EPA, but only the ARA group exhibited increased mRNA level of adipose TAG lipase (ATGL) (P<0·05). Decreased IPF index and adipocyte sizes were found in the ARA group (P<0·05). Meanwhile, the ARA group showed decreased expression levels of adipogenic genes CCAAT enhancer-binding protein α, LPL and FAS, and increased levels of the lipid catabolic genes PPARα, ATGL, hormone-sensitive lipase and carnitine palmitoyltransferase 1 (CPT-1) in IPF, whereas the EPA group only increased PPARα and CPT-1 mRNA expression and showed less levels than the ARA group. Overall, dietary EPA is beneficial to the growth performance, whereas ARA is more potent in inducing lipolysis and inhibiting adipogenesis, especially in IPF. Meanwhile, dietary ARA and EPA showed the similar preference in esterification and the improvement in antioxidant response.