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Quantum field theory predicts a nonlinear response of the vacuum to strong electromagnetic fields of macroscopic extent. This fundamental tenet has remained experimentally challenging and is yet to be tested in the laboratory. A particularly distinct signature of the resulting optical activity of the quantum vacuum is vacuum birefringence. This offers an excellent opportunity for a precision test of nonlinear quantum electrodynamics in an uncharted parameter regime. Recently, the operation of the high-intensity Relativistic Laser at the X-ray Free Electron Laser provided by the Helmholtz International Beamline for Extreme Fields has been inaugurated at the High Energy Density scientific instrument of the European X-ray Free Electron Laser. We make the case that this worldwide unique combination of an X-ray free-electron laser and an ultra-intense near-infrared laser together with recent advances in high-precision X-ray polarimetry, refinements of prospective discovery scenarios and progress in their accurate theoretical modelling have set the stage for performing an actual discovery experiment of quantum vacuum nonlinearity.
Ultrafast optical probing is a widely used method of underdense plasma diagnostic. In relativistic plasma, the motion blur limits spatial resolution in the direction of motion. For many high-power lasers the initial pulse duration of 30–50 fs results in a 10–15 μm motion blur, which can be reduced by probe pulse post-compression. Here we used the compression after compressor approach [Phys.-Usp. 62, 1096 (2019); JINST 17 P07035 (2022)], where spectral broadening is performed in thin optical plates and is followed by reflections from negative-dispersion mirrors. Our initially low-intensity probe beam was down-collimated for a more efficient spectral broadening and higher probe-to-self-emission intensity ratio. The setup is compact, fits in a vacuum chamber and can be implemented within a short experimental time slot. We proved that the compressed pulse retained the high quality necessary for plasma probing.
The influence of Mn2+ on the formation of Fe oxides at pHs of 6.0 and 8.0 and varying Mn/Fe molar ratios (0, 0.1, 1.0, and 10.0) in the FeCl2-NH4OH and FeSO4-NH4OH systems was studied by X-ray powder diffraction (XRD), infrared absorption, transmission electron microscopic, and chemical analyses. In the absence of Mn2+, lepidocrocite (γ-FeOOH) and maghemite (γ-Fe2O3) were the crystalline species formed at pHs of 6.0 and 8.0, respectively, in the FeCl2 system, whereas lepidocrocite and goethite (α-FeOOH) and lepidocrocite were the crystalline species formed at pHs of 6.0 and 8.0, respectively, in the FeSO4 system. The amount of Mn coprecipitated with Fe (as much as 8.1 mole % in the FeCl2 system and 15.0 mole % in the FeSO4 system) increased as the initial solution Mn/Fe molar ratio increased from 0 to 10.0, resulting in the perturbation of the crystallization processes of the hydrolytic products of Fe formed. At pH 6.0, the perturbation led to the formation of poorly ordered lepidocrocite, as reflected in the increasing broadening of its characteristic peaks in the XRD patterns. At pH 8.0, poorly ordered iepidocrocite and a honessite-like mineral (Mn-Fe-SO4-H2O) formed in the FeCl2 and FeSO4 systems, respectively.
The influence of manganese oxide minerals (cryptomelane, hausmannite, and pyrolusite) on the formation of iron oxides was studied in the FeCl2-NH4OH system at different Mn/Fe molar ratios (0, 0.01, 0.1, and 1.0) and pHs (3.0, 4.0, 5.0, and 6.0) by X-ray powder diffraction, infrared absorption, transmission electron microscopic, and chemical analyses. In the absence of Mn minerals, lepidocrocite (γ-FeOOH) precipitated at pHs 5.0 and 6.0; however, no precipitate formed at lower pHs. All the Mn minerals studied promoted the precipitation of iron oxides and oxyhydroxides. In the presence of Mn oxides, Fe2+ was oxidized to Fe3+, which hydrolyzed and precipitated as noncrystalline and/or different crystalline iron oxides and oxyhydroxides, depending on the nature of the Mn oxides present in the system. Simultaneously, Mn2+ was detected in solution after the reaction by electron spin resonance spectroscopy. The presence of cryptomelane and hausmannite resulted in the formation of åkaganeite (β-FeOOH) and magnetite (Fe3O4), respectively. Thus, the effect of Mn oxides on the formation of Fe oxide minerals in the weathering zone merits attention.
The rate of Fe(II) oxidation at a constant rate of oxygen supply in the presence of citrate was measured at pH 6.0 at various citrate/Fe(II) molar ratios at 23.5°C in 0.01 M ferrous Perchlorate system. The kinetics followed a first-order reaction with respect to Fe(II) concentration at constant pH (6.0) and aeration (5 ml/min). The rate constant decreased exponentially from 41.3 × 10-4 to 7.6 × 10-4/min with an increase in the citrate/Fe(II) molar ratio from 0 to 0.1.
The nature of the hydrolytic products formed after 120 min of oxidation was arrived at by X-ray powder diffraction (XRD), infrared spectrometry (IR), and transmission electron microscopic (TEM) analyses. In the absence of citrate, goethite (α-FeOOH) and poorly crystalline lepidocrocite (γ-FeOOH) were the oxidation products formed at pH 6.0. The formation of lepidocrocite was promoted at the expense of goethite at citrate/Fe(II) molar ratios of 0.0005 to 0.005. The formation of lepidocrocite was especially pronounced at a citrate/Fe(II) molar ratio of 0.001, as observed from the width at half height (WHH) and the area of the 020 XRD peak of lepidocrocite. At a citrate/Fe(II) molar ratio of 0.01, however, the crystallization was perturbed resulting in the formation of noncrystalline Fe oxides, and no precipitate was observed at a citrate/Fe molar ratio of 0.1. The strong complexation of Fe(II) with citrate retarded the kinetics of Fe(II) oxidation and the formation and hydrolysis of Fe(III). The complexation, electrostatic, and steric effects of the coexisting citrate anions in solution apparently influenced the oxygen coordination and the way by which the double rows of edge-sharing Fe(O,OH)6 octahedra linked during crystallization, resulting in the formation of lepidocrocite.
Solutions containing AlCl3 and Si(OH)4 (concentrations ≤ 1.5 mM with molar Si:Al ratios of 1:2, 1:1 and 3:1) and FeCl2 (0, 0.5 and 1.0 mM) were adjusted to pH 8 with Ca(OH)2, and incubated at 23°C and 89°C without exclusion of air in the presence of CaCO3 for 8–12 weeks. The products were characterized by infrared spectroscopy and X-ray diffraction. Systems with 3:1 and 1:1 Si:Al ratios without Fe gave hydrous feldspathoids at 23° and 89°C. Systems with 3:1 Si:Al ratios containing Fe gave aluminous nontronites at 89°C and noncrystalline, nontronite-like products at 23°C. Systems with 1:1 Si:Al ratios with added Fe gave Fe(III)-substituted hydrous feldspathoids at 23°C. At 89°C, the system with 1:1 Si:Al ratios and 0.5 mM Fe produced a “protohalloysite,” while that with 1.0 mM Fe gave a poorly ordered nontronite-like layer silicate. In systems with 1:2 Si:Al ratios, the formation of “protoimogolite” at 23°C was little affected by additions of Fe. At 89°C, the “protoimogolite” decomposed to boehmite and poorly-ordered layer silicate phases. Inclusion of 1 mM MgCl2 in the above systems had no effect on the products at 23°C, but at 89°C produced saponites and a mixed layer saponite-chlorite in the 3:1 Si:Al systems, and saponite-like layer structures in the 1:1 and 1:2 Si:Al systems.
Polynuclear Al13 tridecamer species are the major hydrolyzed species of aluminum, but their occurrence in terrestrial environments has not been established. X-ray diffraction (XRD), 27Al nuclear magnetic resonance (NMR), and scanning electron microscope (SEM) analyses show that the presence of tartaric acid (concentration range of 10−5–10−3 M), one of the commonly occurring low-molecular-weight organic acids, inhibits the formation of the Al13 tridecamer species.
In the absence of tartaric acid, the basic aluminum sulfate crystals were of tetrahedral morphology and conformed to isometric symmetry with a = 17.748 Å and space group of P4232. Increasing amounts of tartaric acid [tartaric acid/Al molar ratio (R) ranging from 0.01 to 0.05] modified the crystal morphology from the tetrahedral particles of isometric symmetry (R = 0) to rod-shaped particles of monoclinic symmetry (R = 0.01) to irregularly shaped X-ray noncrystalline microparticles (R = 0.05). Failure to detect the presence of Al13 tridecamer, the dominant hydrolyzed species of aluminum, in terrestrial environments may be partially attributed to the presence of low-molecular-weight organic acids, which inhibit the formation of Al13 tridecamer species.
The reaction of hydroxy-Al interlayers in montmorillonite with monosilicic acid was studied by chemical analysis, X-ray diffractometry (XRD), and Fourier-transform infrared (FTIR) spectroscopy. Hydroxy-Al interlayers in montmorillonite was prepared by treating Ca-montmorillonite (<2) μm) with hydroxy-Al solutions at an initial Al concentration of 0.5 mM and OH/Al molar ratios of 1.0, 2.0, and 2.5. The resultant partially interlayered montmorillonite was reacted with 0.5, 0.9, and 1.4 mM monosilicic acid solutions.
A substantial amount of monosilicic acid was adsorbed by the interlayer hydroxy-Al polymers through the reaction of Si-OH groups with mainly Al-OH groups, resulting in the formation of silicated Al-interlayers with Si/Al molar ratios up to 0.19. The adsorption of silicic acid by interlayer hydroxy-Al polymers increased the basal spacings of the partially interlayered montmorillonite. This effect was most pronounced for the hydroxy-Al interlayered montmorillonite formed in the systems at an OH/Al ratio of 2.0, in which the d(001) reflections (110°C) shifted from 13.6 Å before silication to 14.1 Å with a shoulder at 17.0 Å after silication. The differential IR spectrum of the silicated hydroxy-Al interlayers in montmorillonite exhibited absorption bands at 935 and 3730 cm−1, which can be assigned to Si-O and Si-OH, respectively, of the adsorbed Si(OH)4. An interlayer structure analogous to that of “proto-imogolite” was, thus, proposed for the silicated interlayer hydroxy-Al polymers in montmorillonite. This study revealed a new mechanism through which Si enters the interlayer spaces of smectite. The silication of hydroxy-Al-interlayered clays in natural environments and the related modifications in surface properties of the clays should receive increasing attention.
The chemistry of Al transformation has been well documented, though little is known about the mechanisms of structural perturbation of Al precipitates by carbonates at a molecular level. The purpose of the present study was to investigate the structural perturbation of Al precipitates formed under the influence of carbonates. Initial carbonate/Al molar ratios (MRs) used were 0, 0.1, and 0.5 after aging for 32 days, then the samples were analyzed by X-ray absorption near edge structure spectroscopy (XANES), X-ray diffraction (XRD), Fourier-transform infrared absorption spectroscopy (FTIR), and chemical analysis. The XRD data were in accord with the FTIR results, which revealed that as the carbonate/Al MR was increased from 0 to 0.1, carbonate preferentially retarded the formation of gibbsite and had relatively little effect on the formation of bayerite. As the carbonate/Al MR was increased to 0.5, however, the crystallization of both gibbsite and bayerite was completely inhibited. The impact of carbonate on the nature of Al precipitates was also evident in the increase of adsorbed water and inorganic C contents with increasing carbonate/Al MR. The Al K- and L- edge XANES data provide the first evidence illustrating the change in the coordination number of Al from 6-fold to mixed 6- and 4-fold coordination in the structural network of short-range ordered (SRO) Al precipitates formed under the increasing perturbation of carbonate. The fluorescence yield spectra of the O K-edge show that the intensity of the peak at 534.5 eV assigned to σ* transitions of Al-O and O-H bonding decreased with increasing carbonate/Al MR. The XANES data, along with the evidence from XRD, FTIR, and chemical analysis showed clearly that carbonate caused the alteration of the coordination nature of the Al-O bonding through perturbation of the atomic bonding and structural configuration of Al hydroxides by complexation with Al in the SRO network of Al precipitates. The surface reactivity of an Al-O bond is related to its covalency and coordination geometry. The present findings were, therefore, of fundamental significance in understanding the low-temperature geochemistry of Al and its impacts on the transformation, transport, and fate of nutrients and pollutants in the ecosystem.
The Al13 polycation is the predominant hydroxy-Al species in partially neutralized solutions. However, the existence of the Al13 species and the factors governing its formation in terrestrial environments still remain obscure. The objective of this study was to investigate the influence of pyrogallol, a common polyphenol in soils, on the formation of Al13 tridecamer. Hydroxy-Al solutions with an OH/Al molar ratio of 2.2 (pH 4.53) at pyrogallol/Al molar ratios of 0, 0.01, 0.05, 0.1 and 0.5 were prepared and mixed with 0.5 M sodium sulfate to form aluminum sulfate precipitation products. The solid-state 27Al nuclear magnetic resonance (NMR) spectra of the precipitates show that the pyrogallol perturbed the formation of Al13 tridecamer species as indicated by the decrease in the intensity of resonance peak, observed at 62.5 ppm, with increase in the pyrogallol/Al molar ratio. The crystallization of the precipitated Al sulfates was also hampered by pyrogallol, resulting in the formation of X-ray non-crystalline products at a pyrogallol/Al molar ratio of 0.50. The absorbance at 465 and 650 nm of the hydroxy-Al-pyrogallol solutions, the C coprecipitated, the electron spin resonance and 13C CPMAS-NMR spectra of the precipitates indicate the concomitant enhanced abiotic humification of pyrogallol by the X-ray amorphous Al species.
The influence of organics on the crystallization of Al precipitates has been well documented. However, the effects of organics and ageing on the transformation and structural configuration of Al precipitates in relation to their surface and charge properties are not fully understood. This study investigated the structural, microporous and surface properties of Al precipitates formed under the influence of tannate and ageing. The Al precipitates were synthesized at an initial Al concentration of 7 × 10−3 M, an OH/Al molar ratio (MR) of 3.0, and initial tannate/Al MRs of 0, 0.001, 0.01 and 0.1, and aged for 1, 10 and 40 days. As indicated by a decrease in gibbsite and bayerite and an increase in the oxalate-extractable Al contents, the non-crystalline precipitates increased with the increase of the initial tannate/Al MR. This observation is in accord with the X-ray diffraction and Fourier transform infrared (FTIR) data. The impact of tannic acid on the nature of the Al precipitates is also reflected in the increase of the contents of the pyrophosphate-extractable Al, which is indicative of organically bound Al. This observation is in agreement with the increase in the intensity of characteristic FTIR absorption bands of tannate and the organic C and adsorbed water contents. The decrease in the crystallinity of Al precipitates with increase in the tannate/Al MR resulted in the development of microporosity, increase in BET specific surface area and decrease of the average pore diameter and point of zero salt effect (PZSE). The FTIR absorption bands characteristic of tannate of the Al precipitates became weaker with ageing, in accord with the ageing-induced decrease in the contents of organic C and pyrophosphate-extractable Al. Ageing drastically decreased the BET specific surface area of the Al precipitates formed in the absence of tannate but this effect was less conspicuous for the products formed at the tannate/Al molar ratio of 0.1. The ageing-induced change in the PZSE of the Al precipitates formed both in the absence and presence of tannate was not significant. The results accomplished in this study are of fundamental significance to our understanding of the combined effects of organics and ageing on structural configuration of hydrolytic precipitates of Al in relation to their microporosity, surface and charge properties in the environment.
Magnetic resonance imaging of the internal auditory meatus is a highly sensitive and specific way to diagnose vestibular schwannoma. However, the rate of incidental findings with this method is believed to be high and can lead to increased patient anxiety and health interventions with unclear benefit.
Method
A systematic review of the literature was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify incidental findings from magnetic resonance imaging of the internal auditory meatus; 12 studies were identified for inclusion within this review.
Results
A total of 10 666 patients were included within the review. The overall rate of diagnosis of vestibular schwannoma was 0.87 per cent; 21 per cent of the study population had incidental findings on magnetic resonance imaging of the internal auditory meatus, and 9.56 per cent had clinically significant incidental findings.
Conclusion
Standardised pre-scan counselling may mitigate the risks of overdiagnosis, but future work should be undertaken to assess the benefits of such a strategy as well as the exact significance of some incidental findings.
We summarize what we assess as the past year's most important findings within climate change research: limits to adaptation, vulnerability hotspots, new threats coming from the climate–health nexus, climate (im)mobility and security, sustainable practices for land use and finance, losses and damages, inclusive societal climate decisions and ways to overcome structural barriers to accelerate mitigation and limit global warming to below 2°C.
Technical summary
We synthesize 10 topics within climate research where there have been significant advances or emerging scientific consensus since January 2021. The selection of these insights was based on input from an international open call with broad disciplinary scope. Findings concern: (1) new aspects of soft and hard limits to adaptation; (2) the emergence of regional vulnerability hotspots from climate impacts and human vulnerability; (3) new threats on the climate–health horizon – some involving plants and animals; (4) climate (im)mobility and the need for anticipatory action; (5) security and climate; (6) sustainable land management as a prerequisite to land-based solutions; (7) sustainable finance practices in the private sector and the need for political guidance; (8) the urgent planetary imperative for addressing losses and damages; (9) inclusive societal choices for climate-resilient development and (10) how to overcome barriers to accelerate mitigation and limit global warming to below 2°C.
Social media summary
Science has evidence on barriers to mitigation and how to overcome them to avoid limits to adaptation across multiple fields.
Background: Eye movements reveal neurodegenerative disease processes due to overlap between oculomotor circuitry and disease-affected areas. Characterizing oculomotor behaviour in context of cognitive function may enhance disease diagnosis and monitoring. We therefore aimed to quantify cognitive impairment in neurodegenerative disease using saccade behaviour and neuropsychology. Methods: The Ontario Neurodegenerative Disease Research Initiative recruited individuals with neurodegenerative disease: one of Alzheimer’s disease, mild cognitive impairment, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, or cerebrovascular disease. Patients (n=450, age 40-87) and healthy controls (n=149, age 42-87) completed a randomly interleaved pro- and anti-saccade task (IPAST) while their eyes were tracked. We explored the relationships of saccade parameters (e.g. task errors, reaction times) to one another and to cognitive domain-specific neuropsychological test scores (e.g. executive function, memory). Results: Task performance worsened with cognitive impairment across multiple diseases. Subsets of saccade parameters were interrelated and also differentially related to neuropsychology-based cognitive domain scores (e.g. antisaccade errors and reaction time associated with executive function). Conclusions: IPAST detects global cognitive impairment across neurodegenerative diseases. Subsets of parameters associate with one another, suggesting disparate underlying circuitry, and with different cognitive domains. This may have implications for use of IPAST as a cognitive screening tool in neurodegenerative disease.
Introduction: Selecting appropriate patients for hospitalization following emergency department (ED) evaluation of syncope is critical for serious adverse event (SAE) identification. The primary objective of this study is to determine the association of hospitalization and SAE detection using propensity score (PS) matching. The secondary objective was to determine if SAE identification with hospitalization varied by the Canadian Syncope Risk Score (CSRS) risk-category. Methods: This was a secondary analysis of two large prospective cohort studies that enrolled adults (age ≥ 16 years) with syncope at 11 Canadian EDs. Patients with a serious condition identified during index ED evaluation were excluded. Outcome was a 30-day SAE identified either in-hospital for hospitalized patients or after ED disposition for discharged patients and included death, ventricular arrhythmia, non-lethal arrhythmia and non-arrhythmic SAE (myocardial infarction, structural heart disease, pulmonary embolism, hemorrhage). Patients were propensity matched using age, sex, blood pressure, prodrome, presumed ED diagnosis, ECG abnormalities, troponin, heart disease, hypertension, diabetes, arrival by ambulance and hospital site. Multivariable logistic regression assessed the interaction between CSRS and SAE detection and we report odds ratios (OR). Results: Of the 8183 patients enrolled, 743 (9.0%) patients were hospitalized and 658 (88.6%) were PS matched. The OR for SAE detection for hospitalized patients in comparison to those discharged from the ED was 5.0 (95%CI 3.3, 7.4), non-lethal arrhythmia 5.4 (95%CI 3.1, 9.6) and non-arrhythmic SAE 6.3 (95%CI 2.9, 13.5). Overall, the odds of any SAE identification, and specifically non-lethal arrhythmia and non-arrhythmia was significantly higher in-hospital among hospitalized patients than those discharged from the ED (p < 0.001). There were no significant differences in 30-day mortality (p = 1.00) or ventricular arrhythmia detection (p = 0.21). The interaction between ED disposition and CSRS was significant (p = 0.04) and the probability of 30-day SAEs while in-hospital was greater for medium and high risk CSRS patients. Conclusion: In this multicenter prospective cohort, 30-day SAE detection was greater for hospitalized compared with discharged patients. CSRS low-risk patients are least likely to have SAEs identified in-hospital; out-patient monitoring for moderate risk patients requires further study.
Tuberculosis (TB) is the leading cause of death among infectious diseases. China has a high burden of TB and accounted for almost 13% of the world's cases of multi-drug resistant (MDR) TB. Spinal TB is one reason for the resurgence of TB in China. Few large case studies of MDR spinal TB in China have been conducted. The aim of this research was to observe the epidemiological characteristics of inpatients with MDR spinal TB in six provinces and cities of China from 1999–2015. This is a multicentre retrospective observational study. Patients' information was collected from the control disease centre and infectious disease database of hospitals in six provinces and cities in China. A total of 3137 patients with spinal TB and 272 patients with MDR spinal TB were analysed. The result showed that MDR spinal TB remains a public health concern and commonly affects patients 15–30 years of age (34.19%). The most common lesions involved the thoracolumbar spine (35.66%). Local pain was the most common symptom (98.53%). Logistic analysis showed that for spinal TB patients, reside in rural district (OR 1.79), advanced in years (OR 1.92) and high education degree (OR 2.22) were independent risk factors for the development of MDR spinal TB. Women were associated with a lower risk of MDR spinal TB (OR 0.48). The most common first-line and second-line resistant drug was isoniazid (68.75%) and levofloxacin (29.04%), respectively. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR spinal TB treatment, improved infection control and better clinical outcome. Chemotherapy and surgery can yield satisfactory outcomes with timely diagnosis and long-term treatment. These results enable a better understanding of the MDR spinal TB in China among the general public.
Background: Spinal muscular atrophy (SMA) is a children’s neuromuscular disorder. Although motor neuron loss is a major feature of the disease, we have identified fatty acid abnormalities in SMA patients and in preclinical animal models, suggesting metabolic perturbation is also an important component of SMA. Methods: Biochemical, histological, proteomic, and high resolution respirometry were used. Results: SMA patients are more susceptible to dyslipidemia than the average population as determined by a standard lipid profile in a cohort of 72 pediatric patients. As well, we observed a non-alcoholic liver disease phenotype in apreclinical mouse model. Denervation alone was not sufficient to induce liver steatosis, as a mouse model of ALS, did not develop fatty liver. Hyperglucagonemia in Smn2B/-mice could explain the hepatic steatosis by increasing plasma substrate availability via glycogen depletion and peripheral lipolysis. Proteomic analysis identified mitochondrion and lipid metabolism as major clusters. Alterations in mitochondrial function were revealed by high-resolution respirometry. Finally, low-fat diets led to increased survival in Smn2B/-mice. Conclusions: These results provide strong evidence for lipid metabolism defects in SMA. Further investigation will be required to establish the primary mechanism of these alterations and understand how they lead to additional co-morbidities in SMA patients.
Goethite and maghemite are the stable species of Fe oxyhydroxides-oxides formed an acidic and alkaline environments from the oxidation of Fe(II) perchlorate solutions. The influence of montmorillonite on the oxidation products of 0.02 M ferrous perchlorate at pHs of 6.0 and 8.0 was studied by X-ray diffraction, infrared and transmission electron microscopic analyses. Increased rate of OH consumption during the oxidation at constant pH indicated that the presence of montmorillonite accelerated the rate of Fe(II) oxidation. The presence of montmorillonite, with high surface reactivity, at an initial montmorillonite/Fe (w/w) ratios of 1.4 and 3.4 retarded the formation of goethite, lepidocrocite and maghemite, and maghemite and goethite, and promoted the formation of ferrihydrite and lepidocrocite at pHs of 6.0 and 8.0, respectively. Kaolinite, on the other hand, with relatively low surface reactivity had no influence on the nature of the Fe(II) oxidation products formed at either pH.
Introduction: The Canadian Syncope Risk Score (CSRS) was developed to identify patients at risk for serious adverse events (SAE) within 30 days of an Emergency Department (ED) visit for syncope. We sought to validate the score in a new cohort of ED patients. Methods: We conducted a multicenter prospective cohort study at 8 large academic tertiary-care EDs across Canada from March 2014 to Dec 2016. We enrolled adults (age 16 years) who presented within 24 hours of syncope, after excluding those with persistent altered mentation, witnessed seizure, intoxication, and major trauma requiring hospitalization. Treating ED physicians collected the nine CSRS predictors at the index visit. Adjudicated SAE included death, arrhythmias and non-arrhythmic SAE (myocardial infarction, serious structural heart disease, pulmonary embolism, severe hemorrhage and procedural interventions within 30-days). We assessed area under the Receiver Operating Characteristic (ROC) curve, score calibration, and the classification performance for the various risk categories. Results: Of the 2547 patients enrolled, 146 (5.7%) were lost to follow-up and 111 (4.3%) had serious condition during the index ED visit and were excluded. Among the 2290 analyzed, 79 patients (3.4%; 0.4% death, 1.4% arrhythmia) suffered 30-day serious outcomes after ED disposition. The accuracy of the CSRS remained high with area under the ROC curve at 0.87 (95%CI 0.82-0.92), similar to the derivation phase (0.87; 95%CI 0.84-0.89). The score showed excellent calibration at the prespecified risk strata. For the very-low risk category (0.3% SAE of which 0.2% were arrhythmia and no deaths) the sensitivity was 97.5% and negative predictive value was 99.7% (95%CI 98.7-99.9). For the very high-risk category (61.5% SAE of which 26.9% were arrhythmia and 11.5% death) the specificity was 99.4% and positive predictive value was 61.5% (95% CI 43.0-77.2). Conclusion: In this multicenter validation study, the CSRS accurately risk stratified ED patients with syncope for short-term serious outcomes after ED disposition. The score should aid in minimizing investigation and observation of very-low risk patients, and prioritization of inpatient vs outpatient investigations or following of the rest. The CSRS is ready for implementation studies examining ED management decisions, patient safety and health care resource utilization.
Litter size has a great impact on the profit of swine producers. Uterine development is an important determinant of reproduction efficiency and could hence affect litter size. Chinese Erhualian pig is one of the most prolific breeds in the world, even though large phenotypic variation in litter size was observed within Erhualian sows. To dissect the genetic basis of the phenotypic variation, we herein conducted genome-wide association studies for total number born and number born alive (NBA) of Erhualian sows. In total, one significant single nucleotide polymorphism (SNP) (P<1.78e−06) and 11 suggestive SNPs (P<3.57e−05) were identified on 10 chromosomes, confirming seven previously reported quantitative trait loci (QTL) and uncovering six QTL for litter size or uterus length. One locus on Sus scrofa chromosome (SSC) 13 (79.28 to 90.43 Mb) harbored a cluster of suggestive SNPs associated with multiparous NBA. The SNP (rs81447100) within this region was confirmed to be significantly (P<0.05) associated with litter size in Erhualian (n=313), Sutai (n=173) and Yorkshire (n=488) populations. Retinol binding protein 2 and retinol binding protein 1 functionally related to the development of uterus were located in a region of 2 Mb around rs81447100. Moreover, four genes related to embryo implantation and development were also detected around other significant SNPs. Taken together, our findings provide a potential marker (rs81447100) for the genetic improvement of litter size not only in Chinese Erhualian pigs but also in European commercial pig breeds like Yorkshire, and would facilitate the final identification of causative variant(s) underlying the effect of SSC13 QTL on litter size.