While the literature has largely focused on legal challenges to public healthcare rationing decisions, claims against private insurance companies in voluntary health insurance (VHI) schemes have received less attention. This paper aims to fill this gap by analysing a representative sample of 1,547 court of appeal decisions related to treatment funding claims filed against private insurance companies in Brazil from 2018 to 2021. Courts decided 83.6% of cases in favour of patients, ordering VHI companies to fully fund the claimed treatment. Patients´ rate of success is even higher (96%) in the cases in which insurance companies denied coverage on the grounds that the claimed treatment was not listed in the benefits package mandated by regulation. Court decisions present additional challenges to setting priorities through health technology assessment and explicit packages in the VHI sector. This has broader implications for health care equality and access in Brazil.

Under the coupling effect of node position deviation, joint clearance and wear factors, the complex landing gear retraction mechanism suffers from low kinematic accuracy, slow retraction performance and shortened reliable life. Addressing these issues, a time-dependent reliability analysis and optimisation design method for the kinematic accuracy of the retraction mechanism is proposed, considering the uncertainty of node position deviation, initial clearance, and dynamic multi-joint wear. Initially, a wear prediction model and a dynamic model of the retraction mechanism considering node position deviation and joint clearance are established to analyse their influence on retraction accuracy and joint wear depth. Subsequent retraction testing under various working conditions is conducted to ascertain the critical failure condition and validate the simulation model. The time-dependent kinematic accuracy reliability model, accounting for the dynamic evolution of wear clearance, is then established to assess reliability variation with retraction cycles. Finally, the reliability optimisation design focusing on hole-axis matching accuracy aims to strike a balance between accuracy cost and reliability, thereby enhancing performance and prolonging operational life.

Conservation agriculture (CA), as a key component of sustainable intensification, has been widely promoted across sub-Saharan Africa (SSA) to address low crop productivity. However, the focus has mainly been on improving cereal grain yields, with less focus to its impact on nutritional outcomes. This study sought to assess the productivity potential of CA crop diversification systems and associated crop establishment techniques in terms of grain, protein, and energy yields. An on-station trial was implemented in Malawi for four cropping seasons (2014/15 to 2017/18). Four crop establishment techniques (ridge and furrow, jab planter, dibble sticks, and CA basins) were tested, while cropping systems included conventional cropping system (Conv), CA sole cropping (CaSole), CA intercropping (CA-intercropping), and CA rotations (CA-rotation). In 2014/15 and 2015/16 cropping seasons, characterised by medium and low rainfall, respectively, planting basins and ridge-furrow systems produced higher maize yields compared to jab planter and dibble stick systems. In 2015/16, big and small basins yielded 5061 and 3969 kg ha–1, while jab planter and dibble stick yielded 3476 and 3213 kg ha–1. When there was high and persistent rainfall (2016/17 and 2017/18), direct seeding (jab planter and dibble stick) outperformed basins and ridge-furrow systems. Therefore, the choice of planting basin sizes and whether or not to use dibble stick and jab planter needs to be guided by location or site-specific seasonal forecasts for best results. Grain yield in maize-legume rotation systems consistently outperformed other systems, with maize-groundnut rotations surpassing maize-cowpea intercrops by 987–2700 kg ha–1 over four cropping seasons. In intercropping systems, maize-pigeon pea outperformed maize-cowpea by 4–45% during the same period, while maize-cowpea rotation consistently out yielded maize-cowpea intercropping. Intercropping systems, however, provided substantial protein benefits, with maize-pigeon yielding +9.5% (2015/2016), +29.1% (2016/2017) over CA sole, and +2.2% (2017/2018) over cowpea intercropping. Sole systems (conventional and CA sole) yielded the highest caloric energy, while maize-cowpea rotation consistently reduced energy yield by 35% to 54% compared to the highest-yielding systems. Overall intercropping systems can outperform rotation systems in nutritional security but when focus is on maize grain yield alone, intercropping may reduce maize yield when compared to both cereal sole and maize-legume rotation systems.

One hundred and thirteen mid-lactation cows fed same diets and supplemented with 20 g/d rumen-protected methionine (RPM) for 8 weeks were used to investigate the individual responses of dairy cows to RPM in terms of lactation performance, amino acids (AA) metabolism, and milk metabolites. Among the cows, 10 cows exhibited positive responses (PR) and 10 cows showed limited responses (LR) in energy-corrected milk yield to RPM were used for further analysis. The lactation performance changed from gradual decline to steady increase in PR cows, while kept downward trend in LR cows following RPM supplementation. In PR cows, the AA metabolism was notably enhanced after RPM supplementation, evidenced by increased mammary blood flow (69.4%, P = 0.05), mammary uptake and clearance rate and uptake-to-output ratio (U:O) of essential AA. The improved AA metabolism could be attributed to the enrichment of pyrimidine (P = 0.06) and pyruvate (P = 0.07) metabolism pathways, which may have stimulated mammary cell proliferation and enhanced AA uptake. Additionally, the upregulation of milk biotin (fold change > 2, variable importance projection > 1), known to support milk yield, likely contributed to the PR observed in PR cows. Conversely, in LR cows, RPM supplementation did not improve AA metabolism, decrease was observed in mammary uptake, mammary clearance rate, and U:O of cysteine, potentially due to cysteine being irreversibly converted from methionine. Moreover, the enrichment of central carbon metabolism in cancer pathway (P = 0.06), which also utilize methionine, along with the lysine degradation pathway (P = 0.04), suggests that methionine in the mammary glands may have been diverted toward non-lactational metabolic processes, resulting in absence of PR in LR cows. Our results indicate that the responses to RPM in dairy cows are individualized, with variation in lactation performance likely driven by differential AA metabolism.

This paper presents a three-stage E-band low-noise amplifier (LNA) fabricated in a 28-nm Complementary Metal Oxide Semiconductor High-Performance Compact Plus process. The proposed E-band LNA achieves a peak gain of 16.8 dB, exhibiting a gain variation of less than ±0.5 dB across the frequency range of 67.8–90.4 GHz. The measured 3-dB gain bandwidth spans from 64 to 93.8 GHz, and the minimum measured noise figure (NF) is 3.8 dB. By employing a one-stage common-source with a two-stage cascode topology, the proposed E-band LNA demonstrates competitiveness in terms of gain flatness and NF when compared to recently published E-band CMOS LNAs.

Introduction: Late-life depression (LLD) is associated with cognitive deficit with risk of future dementia. By examining the entropy of the spontaneous brain activity, we aimed to understand the neural mechanism pertaining to cognitive decline in LLD.

Methods: We collected MRI scans in older adults with LLD (n = 32), mild cognitive impairment [MCI (n = 25)] and normal cognitive function [NC, (n = 47)]. Multiscale entropy analysis (MSE) was applied to resting-state fMRI data. Under the scale factor (tau) 1 and 2, reliable separation of fMRI data and noise was achieved. We calculated the brain entropy in 90 brain regions based on automated anatomical atlas (AAL). Due to exploratory nature of this study, we presented data of group-wise comparison in brain entropy between LLD vs. NC, MCI vs. NC, and LLD and MCD with a p-value below 0.001.

Results: The mean Mini-Mental State Examination (MMSE) score of LLD and MCI was 27.9 and 25.6. Under tau 2, we found higher brain entropy of LLD in left globus pallidus than MCI (p = 0.002) and NC (p = 0,009). Higher brain entropy of LLD than NC was also found in left frontal superior gyrus, left middle superior gyrus, left amygdala and left inferior parietal gyrus. The only brain region with higher brain entropy in MCI than control was left posterior cingulum (p-value = 0.015). Under tau 1, higher brain entropy was also found in LLD than in MCI in right orbital part of medial frontal gyrus and left globus pallidus (p-value = 0.007 and 0.005).

Conclusions: Our result is consistent with prior hypothesis where higher brain entropy was found during early aging process as compensation. We found such phenomenon particular in left globus pallidus in LLD, which could be served as a discriminative brain region. Being a key region in reward system, we hypothesis such region may be associated with apathy and with unique pathway of cognitive decline in LLD. We will undertake subsequent analysis longitudinally in this cohort

Key words: resting-state fMRI, Late-life depression, Brain entropy, globus pallidus, cognitive decline

Purple nutsedge (Cyperus rotundus L.) is one of the world’s resilient upland weeds, primarily spreading through its tubers. Its emergence in rice (Oryza sativa L.) fields has been increasing, likely due to changing paddy-farming practices. This study aimed to investigate how C. rotundus, an upland weed, can withstand soil flooding and become a problematic weed in rice fields. The first comparative analysis focused on the survival and recovery characteristics of growing and mature tubers of C. rotundus exposed to soil-flooding conditions. Notably, mature tubers exhibited significant survival and recovery abilities in these environments. Based on this observation, further investigation was carried out to explore the morphological structure, nonstructural carbohydrates, and respiratory mechanisms of mature tubers in response to prolonged soil flooding. Over time, the mature tubers did not form aerenchyma but instead gradually accumulated lignified sclerenchymal fibers, with lignin content also increasing. After 90 d, the lignified sclerenchymal fibers and lignin contents were 4.0 and 1.1 times higher than those in the no soil-flooding treatment. Concurrently, soluble sugar content decreased while starch content increased, providing energy storage, and alcohol dehydrogenase activity rose to support anaerobic respiration via alcohol fermentation. These results indicated that mature tubers survived in soil-flooding conditions by adopting a low-oxygen quiescence strategy, which involves morphological adaptations through the development of lignified sclerenchymal fibers, increased starch reserves for energy storage, and enhanced anaerobic respiration. This mechanism likely underpins the flooding tolerance of mature C. rotundus tubers, allowing them to endure unfavorable conditions and subsequently germinate and grow once flooding subsides. This study provides a preliminary explanation of the mechanism by which mature tubers of C. rotundus from the upland areas confer flooding tolerance, shedding light on the reasons behind this weed’s increasing presence in rice fields.

This study aimed to understand the potassium voltage-gated channel KQT-like subfamily, member 1 gene polymorphism in a rural elderly population in a county in Guangxi and to explore the possible relationship between its gene polymorphism and blood sugar. The 6 SNP loci of blood DNA samples from 4355 individuals were typed using the imLDRTM Multiple SNP Typing Kit from Shanghai Tianhao Biotechnology Co. The data combining epidemiological information (baseline questionnaire and physical examination results) and genotyping results were statistically analyzed using GMDR0.9 software and SPSS22.0 software. A total of 4355 elderly people aged 60 years and above were surveyed in this survey, and the total abnormal rate of glucose metabolism was 16·11 % (699/4355). Among them, male:female ratio was 1:1·48; the age group of 60–69 years old accounted for the highest proportion, with 2337 people, accounting for 53·66 % (2337/4355). The results of multivariate analysis showed that usually not doing farm work (OR 1·26; 95 % CI 1·06, 1·50), TAG ≥ 1·70 mmol/l (OR 1·19; 95 % CI 1·11, 1·27), hyperuricaemia (OR 1·034; 95 % CI 1·01, 1·66) and BMI ≥ 24 kg/m2 (OR 1·06; 95 % CI 1·03, 1·09) may be risk factors for abnormal glucose metabolism. Among all participants, rs151290 locus AA genotype, A allele carriers (AA+AC) were 0.70 times more likely (0.54 to 0.91) and 0.82 times more likely (0.70 to 0.97) to develop abnormal glucose metabolism than CC genotype carriers, respectively. Carriers of the T allele at the rs2237892 locus (CT+TT) were 0.85 times more likely to have abnormal glucose metabolism than carriers of the CC genotype (0.72 to 0.99); rs2237897 locus CT gene. The possibility of abnormal glucose metabolism in the carriers of CC genotype, TT genotype and T allele (CT + TT) is 0·79 times (0·67–0·94), 0·74 times (0·55–0·99) and 0·78 times (0·66, 0·92). The results of multifactor dimensionality reduction showed that the optimal interaction model was a three-factor model consisting of farm work, TAG and rs2237897. The best model dendrogram found that the interaction between TAG and rs2237897 had the strongest effect on fasting blood glucose in the elderly in rural areas, and they were mutually antagonistic. Environment–gene interaction is an important factor affecting abnormal glucose metabolism in the elderly of a county in Hechi City, Guangxi.

Moral emotions such as shame, guilt and pride are crucial to young children’s social-emotional development. Due to the restrictions caused by hearing loss in accessing the social world, deaf and hard of hearing (DHH) children may encounter extra difficulties in their development of moral emotions. However, little research so far has investigated the development trajectory of moral emotions during preschool years in DHH children. The present study used a longitudinal design to explore the development trajectories of shame, guilt, and pride, in a sample of 259 Chinese DHH and typically hearing (TH) preschoolers aged 2 to 6 years old. The results indicated that according to parent reports, DHH children manifested lower levels of guilt and pride compared to their TH peers, yet the manifested levels of shame, guilt, and pride increased throughout the preschool time at a similar pace in all children. Moreover, whilst guilt and pride contributed to increasing levels of psychosocial functioning over the preschool years, shame contributed to lower social competence and more externalizing behaviors in DHH and TH preschoolers. The outcomes imply that early interventions and adjustment to hearing loss could be useful to safeguard the social development of children with severe hearing loss, and cultural variances shall be taken into consideration when studying moral emotions in a Chinese cultural background.

Regolith-hosted rare earth element (REE) deposits hosted by the granitic regolith in South China provide >90% of the world’s heavy REEs. Kaolinite is one of the major carriers of REE ions in regolith. The formation and transformation of kaolinite can be affected by chemical weathering and hydrodynamic conditions, but the contribution of each factor has not been evaluated. This study systematically investigated the variation in abundance of phyllosilicate minerals and structural order of kaolinite in the Renju regolith-hosted REE deposit. The total abundance of 1:1 phyllosilicate minerals increased upwards along the profile from Section I to Section III. However, semi-quantitative analyses indicated that Section III-1 (depth at 10–16 m) featured an evident decrease in both abundance and structural order of kaolinite upward along the profile. The morphological feature and abundance of kaolinite revealed intensive kaolinite-to-halloysite transformation and kaolinite dissolution in Section III-1. This suggests that the alternating wetting and drying zone in Section III-1 provided a favorable kinetic environment for the entry of water molecules into the kaolinite interlayer and the kaolinite-to-halloysite transformation, resulting in both lower structural order and abundance of kaolinite in Section III-1. Moreover, REE ions started to be enriched from the alternating wetting and drying zone and formed high-grade ores at the lower part of the water table, due to a significant increase in pore water and decrease in the seepage velocity. Therefore, the abundance and structural order of secondary kaolinite can serve as important indicators of hydrodynamic changes in regolith, as well as the mineralization of regolith-hosted REEs.

Motivated by the work initiated by Chapman [‘Determinants of Legendre symbol matrices’, Acta Arith. 115 (2004), 231–244], we investigate some arithmetical properties of generalised Legendre matrices over finite fields. For example, letting $a_1,\ldots ,a_{(q-1)/2}$ be all the nonzero squares in the finite field $\mathbb {F}_q$ containing q elements with $2\nmid q$, we give the explicit value of the determinant $D_{(q-1)/2}=\det [(a_i+a_j)^{(q-3)/2}]_{1\le i,j\le (q-1)/2}$. In particular, if $q=p$ is a prime greater than $3$, then

$$ \begin{align*}\bigg(\frac{\det D_{(p-1)/2}}{p}\bigg)= \begin{cases} 1 & \mbox{if}\ p\equiv1\pmod4,\\ (-1)^{(h(-p)+1)/2} & \mbox{if}\ p\equiv 3\pmod4\ \text{and}\ p>3, \end{cases}\end{align*} $$

where $(\frac {\cdot }{p})$ is the Legendre symbol and $h(-p)$ is the class number of $\mathbb {Q}(\sqrt {-p})$.

Natural clays are often employed as substrates for heterogeneous catalysts. However, the direct use of raw clays as catalysts has received less research attention. The objective of the present study was to help fill this gap by investigating catalytic properties of raw pelagic clays (PC) collected from the Indian Ocean. The raw PC were discovered to be efficient catalysts in the reduction of 4-nitrophenol (4-NP) in the presence of NaBH4. The effects of parameters including pH values, dosages of PC, and initial concentration of 4-NP and NaBH4 on the conversion or degradation rate of 4-NP have been investigated. The 4-NP was observed to be completely degraded within 480 s under conditions of 0.10 mM 4-NP, 25.0 mM NaBH4, and 0.20 g/L PC at an initial pH value of 7.0. The apparent rate constant was evaluated to be 27.53 × 10–3 s–1. Unlike previous pseudo-first order kinetics experiments, the induction period and degradation stages were observed to occur simultaneously during the PC catalysis. The S-shaped kinetics for 4-NP conversion was found to be perfectly matched by Fermi's function, and the enzyme-like catalysis by PC was appointed to describe the kinetics. Species of Fe(III), Mn(IV), and Mn(III) in PC were found to be essential, and were partly reduced to Fe(0) and Mn(II) by NaBH4 in our reaction, contributing to rapid conversion of 4-NP to 4-aminophenol (4-AP). The raw PC was converted to magnetic PC (m-PC) particles, which made PC particles separate easily for cycling use. This discovery would also have applications in continuous flow-fluid catalysis.

Previous studies revealed that consuming spicy food reduced mortality from CVD and lowered stroke risk. However, no studies reported the relationship between spicy food consumption, stroke types and dose–response. This study aimed to further explore the association between the frequency of spicy food intake and the risk of stroke in a large prospective cohort study. In this study, 50 174 participants aged 30–79 years were recruited. Spicy food consumption data were collected via a baseline survey questionnaire. Outcomes were incidence of any stroke, ischaemic stroke (IS) and haemorrhagic stroke (HS). Multivariable-adjusted Cox proportional hazard models estimated the association between the consumption of spicy food and incident stroke. Restricted cubic spline analysis was used to examine the dose–response relationship. During the median 10·7-year follow-up, 3967 strokes were recorded, including 3494 IS and 516 HS. Compared with those who never/rarely consumed spicy food, those who consumed spicy food monthly, 1–2 d/week and 3–5 d/week had hazard ratio (HR) of 0·914 (95 % CI 0·841, 0·995), 0·869 (95 % CI 0·758, 0·995) and 0·826 (95 % CI 0·714, 0·956) for overall stroke, respectively. For IS, the corresponding HR) were 0·909 (95 % CI 0·832, 0·994), 0·831 (95 % CI 0·718, 0·962) and 0·813 (95 % CI 0·696, 0·951), respectively. This protective effect showed a U-shaped dose–response relationship. For obese participants, consuming spicy food ≥ 3 d/week was negatively associated with the risk of IS. We found the consumption of spicy food was negatively associated with the risk of IS and had a U-shaped dose–response relationship with risk of IS. Individuals who consumed spicy food 3–5 d/week had a significantly lowest risk of IS.

Few studies have evaluated the joint effect of trace elements on spontaneous preterm birth (SPTB). This study aimed to examine the relationships between the individual or mixed maternal serum concentrations of Fe, Cu, Zn, Se, Sr and Mo during pregnancy, and risk of SPTB. Inductively coupled plasma MS was employed to determine maternal serum concentrations of the six trace elements in 192 cases with SPTB and 282 controls with full-term delivery. Multivariate logistic regression, weighted quantile sum regression (WQSR) and Bayesian kernel machine regression (BKMR) were used to evaluate the individual and joint effects of trace elements on SPTB. The median concentrations of Sr and Mo were significantly higher in controls than in SPTB group (P < 0·05). In multivariate logistic regression analysis, compared with the lowest quartile levels of individual trace elements, the third- and fourth-quartile Sr or Mo concentrations were significantly associated with reduced risk of SPTB with adjusted OR (aOR) of 0·432 (95 CI < 0·05). In multivariate logistic regression analysis, compared with the lowest quartile levels of individual trace elements, the third- and fourth-quartile Sr or Mo concentrations were significantly associated with reduced risk of SPTB with adjusted aOR of 0·432 (95 % CI 0·247, 0·756), 0·386 (95 % CI 0·213, 0·701), 0·512 (95 % CI 0·297, 0·883) and 0·559 (95 % CI 0·321, 0·972), respectively. WQSR revealed the inverse combined effect of the trace elements mixture on SPTB (aOR = 0·368, 95 % CI 0·228, 0·593). BKMR analysis confirmed the overall mixture of the trace elements was inversely associated with the risk of SPTB, and the independent effect of Sr and Mo was significant. Our findings suggest that the risk of SPTB decreased with concentrations of the six trace elements, with Sr and Mo being the major contributors.

Ion adsorption-type rare earth deposits (IADs) are developed via prolonged weathering of REE-rich volcanic and metamorphic rocks. Intense magmatic activity which occurred during the Yanshanian (199.6–65.5 Ma) and Caledonian periods (542–359.2 Ma) provided an abundant material basis for the formation of IADs in South China. High concentrations of REE and the high proportion of ion-exchangeable REE were found in the Maofeng Mountain regolith, Guangzhou city. However, the geochemical patterns and mechanisms of REE enrichment in the regolith were still poorly understood. The present study investigated the regolith profile (0–8 m) developed in Maofeng Mountain based on metallogenic and geochemical characteristics, sequential extraction, and physical and chemical parameters of the regolith profile. The bedrock contained abundant REE resources (245–287 mg kg–1) and the chondrite-normalized REE patterns showed the enrichment of light REE (LREE) and negative cerium (Ce) and europium (Eu) anomalies. The distribution patterns of REE in the bedrock were inherited by the regolith. REE enrichment of the regolith occurred mainly in the completely weathered layer (B1, B2, and B3 horizons), particularly in the depth range 2.5–4.5 m (849–2391 mg kg–1). The position of REE enrichment was controlled by the soil pH (5.52–6.02), by the amount of kaolinite and halloysite, and by the permeability of the metamorphic rock. In the REE-enriched horizon (2–8 m), the REE were hosted mainly in ion-exchangeable fractions (75–2158 mg kg–1), representing 79% of the total REE. Given the pH of 4.73–6.02, REE fractionation driven by the adsorption of kaolinite was limited. Fe–Mn (oxyhydr)oxides played an important role in REE enrichment and the reducible fraction holds up to 21% (139 mg kg–1) of the total REE. The enrichment of LREE was observed in the reducible fraction potentially because of the preferential release of LREE from the LREE-bearing minerals (monazite) and then scavenged by Fe–Mn (oxyhydr)oxides. Positive Ce anomalies (Ce/Ce*: 10) were found in the reducible fraction because trivalent Ce was oxidized by Fe–Mn (oxyhydr)oxides to cerianite (CeO2). The present study helps to understand the enrichment and fractionation of REE in the IADs of South China.

Very metal-poor (VMP, [Fe/H]<-2.0) stars serve as invaluable repositories of insights into the nature and evolution of the first-generation stars formed in the early galaxy. The upcoming China Space Station Telescope (CSST) will provide us with a large amount of spectral data that may contain plenty of VMP stars, and thus it is crucial to determine the stellar atmospheric parameters ($T_{\textrm{eff}}$, $\log$ g, and [Fe/H]) for low-resolution spectra similar to the CSST spectra ($R\sim 200$). This study introduces a novel two-dimensional Convolutional Neural Network (CNN) model, comprised of three convolutional layers and two fully connected layers. The model’s proficiency is assessed in estimating stellar parameters, particularly metallicity, from low-resolution spectra ($R \sim 200$), with a specific focus on enhancing the search for VMP stars within the CSST spectral data. We mainly use 10 008 spectra of VMP stars from LAMOST DR3, and 16 638 spectra of non-VMP stars ([Fe/H]>-2.0) from LAMOST DR8 for the experiments and apply random forest and support vector machine methods to make comparisons. The resolution of all spectra is reduced to $R\sim200$ to match the resolution of the CSST, followed by pre-processing and transformation into two-dimensional spectra for input into the CNN model. The validation and practicality of this model are also tested on the MARCS synthetic spectra. The results show that using the CNN model constructed in this paper, we obtain Mean Absolute Error (MAE) values of 99.40 K for $T_{\textrm{eff}}$, 0.22 dex for $\log$ g, 0.14 dex for [Fe/H], and 0.26 dex for [C/Fe] on the test set. Besides, the CNN model can efficiently identify VMP stars with a precision rate of 94.77%, a recall rate of 93.73%, and an accuracy of 95.70%. This paper powerfully demonstrates the effectiveness of the proposed CNN model in estimating stellar parameters for low-resolution spectra ($R\sim200$) and recognizing VMP stars that are of interest for stellar population and galactic evolution work.