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To explore the progress that the Veterans Health Administration has made to minimize the impact of the penicillin (PCN) allergy label, we determined the proportion of Veterans who reported a PCN-class allergy at the time of hospitalization and described antibiotic use in hospitalizations with and without a PCN-class allergy.
Design:
Cross-sectional study.
Participants:
National sample of 6,541,299 acute care admissions between 2011 and 2022.
Methods:
We calculated the prevalence of PCN-class allergies on admission and used Poisson regression to compare patterns of antibiotic use between hospitalizations with and without a PCN-class allergy.
Results:
The prevalence of PCN-class allergies on admission decreased from 12.99% to 11.20%. Use of cefazolin and non-pseudomonal third-generation cephalosporins increased regardless of PCN-class allergy status (“PCN-class allergy only” +11.46%, “No antibiotic allergy” +4.92%). The prevalence ratio (PR) for antibiotic use in hospitalizations with a PCN-class allergy compared to hospitalizations without antibiotic allergies, decreased for anti-Methicillin Resistant Staphylococcus aureus agents (1.26 [1.25, 1.28] to 1.15 [1.13, 1.17]), carbapenems (1.59 [1.54, 1.65] to 1.47 [1.41, 1.53]), and aztreonam (23.89 [22.45, 25.43] to 17.57 [15.90, 19.42]); and increased for fluoroquinolones (1.58 [1.56, 1.60] to 2.15 [2.09, 2.20]).
Conclusions:
Prevalence of PCN-class allergies is declining and narrow-spectrum βL use is rising among hospitalized Veterans. Prescribing differences are decreasing between hospitalizations with and without a reported PCN-class allergy, except for aminoglycosides, clindamycin, and fluoroquinolones. These findings can serve to identify areas of focus for future analyses or interventions related to the impact of the PCN allergy label on antibiotic selection.
Spatial analysis and disease mapping have the potential to enhance understanding of tuberculosis (TB) dynamics, whose spatial dynamics may be complicated by the mix of short and long-range transmission and long latency periods. TB notifications in Nam Dinh Province for individuals aged 15 and older from 2013 to 2022 were analyzed with a variety of spatio-temporal methods. The study commenced with an analysis of spatial autocorrelation to identify clustering patterns, followed by the evaluation of several candidate Bayesian spatio-temporal models. These models varied from simple assessments of spatial heterogeneity to more complex configurations incorporating covariates and interactions. The findings highlighted a peak in the TB notification rate in 2017, with 98 cases per 100,000 population, followed by a sharp decline in 2021. Significant spatial autocorrelation at the commune level was detected over most of the 10-year period. The Bayesian model that best balanced goodness-of-fit and complexity indicated that TB trends were associated with poverty: each percentage point increase in the proportion of poor households was associated with a 1.3% increase in TB notifications, emphasizing a significant socioeconomic factor in TB transmission dynamics. The integration of local socioeconomic data with spatio-temporal analysis could further enhance our understanding of TB epidemiology.
The effect of reservoir construction on medically important parasites is well known worldwide but lacks information in Vietnam. With 385 active hydropower plants and numerous water reservoirs, Vietnam provides an ideal setting for studying this issue. This study investigated trematode infection in snail first intermediate hosts from three hydropower reservoirs: Hoa Binh, Son La, and Thac Ba. In total, 25,299 snails representing 16 species were examined, with 959 individuals (8 species) shedding identifiable cercariae. Infection prevalence was highest in thiarid snails (5.4%–15.4%), followed by bithynid snails (2.9%–5.8%). Other snail species showed infection prevalence ranging from 0.3% to 2.9%. Infection prevalence varied significantly across regions, with the highest prevalence in Son La, followed by Hoa Binh and Thac Ba reservoirs. However, no significant differences were observed between snails collected from reservoirs versus canals and paddy fields. Morphological identification resulted in nine cercarial morphotypes, with pleurolophocercaria, xiphidiocercariae, and echinostome being the most common types, accounting for 89.2% of all cercarial infections. Echinostome cercariae were found in seven snail species, while the other cercarial morphotypes were shed by two to five species. Gabbia fuchsiana, Parafossarulus manchouricus, and Melanoides tuberculata were the most common hosts, each harboring five cercarial morphotypes, while Radix auricularia only released echinostome type. In conclusion, our findings highlight the endemic presence of trematodes in hydropower reservoirs and emphasize the need to consider the human-environment interaction around these reservoirs for a better understanding of disease transmission risks.
Tri-octahedral clay minerals have the potential to be used as CO2 sorbents at intermediate temperatures (200–400°C) owing to their thermal stability in this temperature range. In this study, Laponite RD®, a commercially synthesized hectorite (with Na+ as the exchangeable cation) was used to investigate its capacity of CO2 adsorption at 200°C and ambient pressure. Various cations such as Co2+, Ni2+, Mg2+ and Ca2+ were employed to exchange Na+, with the aim being to study their effects on the capacity for adsorbing CO2. The commercial sample showed an adsorption capacity of 144 µmolCO2 g–1. Most of the other exchanged samples displayed a lower quantity of CO2 adsorbed. An exception was the Ca2+-saturated sample, which exhibited a better performance (163 µmolCO2 g–1) compared with Laponite RD®. Thus, with its greater affinity towards CO2, such a sample could be a good candidate for CO2 capture. For all of the samples, most of the CO2 was desorbed, and the formation of carbonate bonds was not observed using Fourier-transform infrared spectroscopy, suggesting that the CO2 was mainly physisorbed.
The literature on green tea consumption and glucose metabolism has reported conflicting findings. This cross-sectional study examined the association of green tea consumption with abnormal glucose metabolism among 3000 rural residents aged 40–60 years in Khánh Hòa province in Vietnam. Multinomial logistic regression analysis was conducted to examine the association of green tea consumption (0, < 200, 200–< 400, 400–< 600 or ≥ 600 ml/d) with prediabetes and diabetes (based on the American Diabetes Association criteria). Linear regression analysis was performed to examine the association between green tea consumption and the log-transformed homeostatic model assessment of insulin resistance (HOMA-IR) (a marker of insulin resistance) and the log-transformed homeostatic model assessment of β-cell function (HOMA-β) (a marker of insulin secretion). The OR for prediabetes and diabetes among participants who consumed ≥ 600 ml/d v. those who did not consume green tea were 1·61 (95 % CI = 1·07, 2·42) and 2·04 (95 % CI = 1·07, 3·89), respectively. Higher green tea consumption was associated with a higher level of log-transformed HOMA-IR (Pfor trend = 0·04) but not with a lower level of log-transformed HOMA-β (Pfor trend = 0·75). Higher green tea consumption was positively associated with the prevalence of prediabetes, diabetes and insulin resistance in rural Vietnam. The findings of this study indicated prompting the need for further research considering context in understanding the link between green tea consumption and glucose metabolism, especially in rural settings in low- and middle-income countries.
Because of their isolating capacity, smectite-rich clays have been proposed as buffer and backfill materials in high-level radioactive waste repositories. These repositories have to guarantee long-term safety for ~1 million years. Thermodynamics and kinetics of possible alteration processes of bentonite determine its long-term performance as a barrier material. Smectites in 25 different clays and bentonites were investigated in order to identify possible differences in their rates of alteration. These samples were saturated for 30 days in 1 M NaCl solution and deionized water, and then overhead rotated at speeds of 20 rpm and 60 rpm. Depending on the octahedral and interlayer composition, each of the smectites studied had specific rate of alteration, a so-called specific dissolution potential of smectite. The bentonites were classed as ‘slow-reacting bentonite’, ‘moderate-reacting bentonite’, or ‘fast-reacting bentonite’ corresponding to a relatively low (ΔP specific dissolution potential — <-5%), moderate (-5% < ΔP < -20%), or high specific dissolution potential (ΔP > -20%), respectively. The larger the amount of octahedral Fe and Mg compared to octahedral Al, the greater the specific dissolution potential. The present study found that the interlayer composition has a discernible impact on the rate of alteration. In experiments with rotation speeds of 60 rpm and a 1 M NaCl solution, Na+ was found to be the stabilizing cation in the interlayers of all the smectites. The Na-stabilizing mechanism was identified in only some of the smectites (type A) in experiments with 20 rpm (1 M NaCl solution). A second stabilization mechanism (by interlayer cations; Ca and Mg) was identified for other smectites (type B). Each bentonite has a specific rate of alteration. ‘Slow-reacting bentonite’ and clay with smectite-illite interstratifications are recommended as potential clay barriers in HLW repositories. The experimental and analytical procedures described here could be applied to potential barrier materials to identify ‘slow-reacting bentonite’.
The locus coeruleus (LC) innervates the cerebrovasculature and plays a crucial role in optimal regulation of cerebral blood flow. However, no human studies to date have examined links between these systems with widely available neuroimaging methods. We quantified associations between LC structural integrity and regional cortical perfusion and probed whether varying levels of plasma Alzheimer’s disease (AD) biomarkers (Aß42/40 ratio and ptau181) moderated these relationships.
Participants and Methods:
64 dementia-free community-dwelling older adults (ages 55-87) recruited across two studies underwent structural and functional neuroimaging on the same MRI scanner. 3D-pCASL MRI measured regional cerebral blood flow in limbic and frontal cortical regions, while T1-FSE MRI quantified rostral LC-MRI contrast, a well-established proxy measure of LC structural integrity. A subset of participants underwent fasting blood draw to measure plasma AD biomarker concentrations (Aß42/40 ratio and ptau181). Multiple linear regression models examined associations between perfusion and LC integrity, with rostral LC-MRI contrast as predictor, regional CBF as outcome, and age and study as covariates. Moderation analyses included additional terms for plasma AD biomarker concentration and plasma x LC interaction.
Results:
Greater rostral LC-MRI contrast was linked to lower regional perfusion in limbic regions, such as the amygdala (ß = -0.25, p = 0.049) and entorhinal cortex (ß = -0.20, p = 0.042), but was linked to higher regional perfusion in frontal cortical regions, such as the lateral (ß = 0.28, p = 0.003) and medial (ß = 0.24, p = 0.05) orbitofrontal (OFC) cortices. Plasma amyloid levels moderated the relationship between rostral LC and amygdala CBF (Aß42/40 ratio x rostral LC interaction term ß = -0.31, p = 0.021), such that as plasma Aß42/40 ratio decreased (i.e., greater pathology), the strength of the negative relationship between rostral LC integrity and amygdala perfusion decreased. Plasma ptau181levels moderated the relationship between rostral LC and entorhinal CBF (ptau181 x rostral LC interaction term ß = 0.64, p = 0.001), such that as ptau181 increased (i.e., greater pathology), the strength of the negative relationship between rostral LC integrity and entorhinal perfusion decreased. For frontal cortical regions, ptau181 levels moderated the relationship between rostral LC and lateral OFC perfusion (ptau181 x rostral LC interaction term ß = -0.54, p = .004), as well as between rostral LC and medial OFC perfusion (ptau181 x rostral LC interaction term ß = -0.53, p = .005), such that as ptau181 increased (i.e., greater pathology), the strength of the positive relationship between rostral LC integrity and frontal perfusion decreased.
Conclusions:
LC integrity is linked to regional cortical perfusion in non-demented older adults, and these relationships are moderated by plasma AD biomarker concentrations. Variable directionality of the associations between the LC and frontal versus limbic perfusion, as well as the differential moderating effects of plasma AD biomarkers, may signify a compensatory mechanism and a shifting pattern of hyperemia in the presence of aggregating AD pathology. Linking LC integrity and cerebrovascular regulation may represent an important understudied pathway of dementia risk and may help to bridge competing theories of dementia progression in preclinical AD studies.
Controversial data exist about the impact of Down syndrome on outcomes after surgical repair of atrioventricular septal defect.
Aims:
(A) assess trends and outcomes of atrioventricular septal defect with and without Down syndrome and (B) determine risk factors associated with adverse outcomes after atrioventricular septal defect repair.
Methods:
We queried The National Inpatient Sample using International Classification of Disease codes for patients with atrioventricular septal defect < 1 year of age from 2000 to 2018. Patients’ characteristics, co-morbidities, mortality, and healthcare utilisation were evaluated by comparing those with versus without Down syndrome.
Results:
In total, 2,318,706 patients with CHD were examined; of them, 61,101 (2.6%) had atrioventricular septal defect. The incidence of hospitalisation in infants with atrioventricular septal defect ranged from 4.5 to 7.5% of all infants hospitalised with CHD per year. A total of 33,453 (54.7%) patients were associated with Down syndrome. Double outlet right ventricle, coarctation of the aorta, and tetralogy of Fallot were the most commonly associated with CHD in 6.9, 5.7, and 4.3% of patients, respectively. Overall atrioventricular septal defect mortality was 6.3%. Multivariate analysis revealed that prematurity, low birth weight, pulmonary hypertension, and heart block were associated with mortality. Down syndrome was associated with a higher incidence of pulmonary hypertension (4.3 versus 2.8%, p < 0.001), less arrhythmia (6.6 versus 11.2%, p < 0.001), shorter duration for mechanical ventilation, shorter hospital stay, and less perioperative mortality (2.4 versus 11.1%, p < 0.001).
Conclusion:
Trends in atrioventricular septal defect hospitalisation had been stable over time. Perioperative mortality in atrioventricular septal defect was associated with prematurity, low birth weight, pulmonary hypertension, heart block, acute kidney injury, and septicaemia. Down syndrome was present in more than half of atrioventricular septal defect patients and was associated with a higher incidence of pulmonary hypertension but less arrhythmia, lower mortality, shorter hospital stay, and less resource utilisation.
Leonetti and Luca [‘On the iterates of the shifted Euler’s function’, Bull. Aust. Math. Soc., to appear] have shown that the integer sequence $(x_n)_{n\geq 1}$ defined by $x_{n+2}=\phi (x_{n+1})+\phi (x_{n})+k$, where $x_1,x_2\geq 1$, $k\geq 0$ and $2 \mid k$, is bounded by $4^{X^{3^{k+1}}}$, where $X=(3x_1+5x_2+7k)/2$. We improve this result by showing that the sequence $(x_n)$ is bounded by $2^{2X^2+X-3}$, where $X=x_1+x_2+2k$.
Gibbons are often difficult to observe in dense forest habitats using traditional ground-based methods. This makes it challenging to estimate group sizes and, in turn, population sizes. This has proven to be a key constraint on accurate monitoring of the last remaining population of the Critically Endangered cao vit gibbon Nomascus nasutus. However, new technologies are beginning to circumvent the problems associated with traditional methods. We hypothesized that, by using an unoccupied aerial vehicle (UAV) equipped with thermal and standard (RGB) cameras, we could obtain more accurate group size counts than by using ground-based observations, as fewer gibbons would be missed. We tested this during a population survey of the cao vit gibbon, finding that the thermal video footage revealed additional individuals that were not counted by ground-based surveyors. Statistically, there was strong evidence (93% probability) that UAV-derived counts were higher (by 41%) than concurrent ground-based counts. We recorded six primate groups of three species (cao vit gibbon, rhesus macaque Macaca mulatta and Assamese macaque Macaca assamensis), including 24 gibbons across four groups (c. 20% of the global population). The RGB video footage also revealed seven female gibbons, two of which were carrying infants, providing vital group composition data. These data have contributed directly to a more accurate population survey of the species than would have been possible using direct observation only. We anticipate more widespread use of UAVs in the study of gibbons and other threatened species, leading to a more robust evidence base for their conservation.
Objectives: Antimicrobial resistance (AMR) has emerged as a major concern in Vietnam, mainly due to the inappropriate use of antibiotics. Appropriate antibiotic management enables us to minimize the likelihood of antibiotic resistance and the spread of resistant bacteria. We evaluated vancomycin and colistin resistance and related factors in the intensive care unit (ICU) of Hue Central Hospital, a national hospital in central Vietnam. Methods: Using a cross-sectional descriptive study, we enrolled 362 patients who were prescribed antibiotics and were admitted to the ICU in 2019. Pathogens isolated from 473 routine clinical samples were subjected to antimicrobial susceptibility testing following the recommendations in the Clinical & Laboratory Standards Institute M100, 28thEdition. Colistin testing was performed using the broth microdilution method. Statistical significance was determined using the Fisher exact test. Results: The most commonly identified microorganisms were Acinetobacter baumannii (31.5%), Klebsiella pneumoniae (31.2%), Pseudomonas aeruginosa (12%), and Staphylococcus aureus (8.9%). All isolates of A. baumannii, K. pneumoniae, and P. aeruginosa tested with colistin were nonresistant. Moreover, >65% of A. baumannii isolates were resistant to all antibiotics except colistin. S. aureus had the highest resistance rate to erythromycin (80.6%), but no vancomycin-resistant isolates were identified. Factors associated with resistance to at least 1 antibiotic tested included length of stay (OR, 5.32; 95% CI, 1.47–19.17; P = .017), duration of antibiotics therapy (OR, 5.25; 95% CI, 1.46–18.95; P = .017), and the use of tracheal intubation and ventilator (OR, 3.08; 95% CI, 1.09–8.72; P = .038). Conclusions: These data indicated that although the vancomycin and colistin resistance rate is low, patients with longer length of stay, longer time on antibiotics, and invasive ventilation were at higher risk of AMR infection. Decreasing device use and strong antibiotic stewardship program at the hospital would help to reduce AMR infections.
Objectives: SARS-CoV-2 is a novel and highly infectious virus. An effective response requires rapid training of healthcare workers (HCWs). We measured the change in knowledge related to COVID-19 and associated factors before and after training of HCWs in Vietnam. Methods: A quasi-experimental design was used to evaluate HCW knowledge related to prevention and control of SARS-CoV-2 before and after attending a 2-day training-of-trainers course. Between June and September 2020, 963 HCWs from 194 hospitals in 21 provinces received the training. HCW knowledge was assessed using a 20-item questionnaire consisting of multiple-choice questions at the beginning and closing of the training course. A participant received 1 point for each correct answer. He or she was considered to have improved knowledge the posttest score was higher than the pretest score with a score ≥15 on the posttest. We applied the McNemar test and logistic regression model to test the level of association between demographic factors and change in knowledge of COVID-19. Results: Overall, 100% of HCWs completed both the pretest and posttest. At baseline, only 14.7% scored ≥15. Following the training, 78.4% scored ≥15 and 64.3% had improved knowledge according to the predetermined definition. Questions related to the order of PPE donning and doffing and respiratory specimen collection procedures were identified as having the greatest improvement (44.6% and 60.7%, respectively). Being female (OR, 1.5; 95% CI, 1.1–2.0), having a postgraduate degree (OR, 2.5; 95% CI, 1.4–4.4), working in a nonmanager position (OR, 1.5; 95% CI, 1.1–2.1), previous contact with a COVID-19 patient (OR, 1.5; 95% CI, 1.1–2.0), and working in northern Vietnam (OR, 2.0; 95% CI, 1.4–2.6), were associated with greater knowledge improvement. Conclusions: Most HCWs demonstrated improved knowledge of COVID-19 prevention and control after attending the training. Particular groups may benefit from additional training: those who are male, leaders and managers, those who hold an undergraduate degree, and those who work in the southern provinces.
In 2017, the Vietnamese government began drafting eighty-five articles of a regulatory bill to open three special economic zones (SEZs) in Phu Quoc, Van Don and Bac Van Phong that offered foreign investors fewer regulations and greater fiscal incentives. The SEZ project first appeared in Quang Ninh province’s proposal for the establishment of Van Don in 2014 after Pham Minh Chinh’s meeting in 2013 with Chinese SEZ researchers from the China Center for Special Economic Zone Research (CCSEZR) of Shenzhen University. The initiative was then expanded into Bac Van Phong’s and Phu Quoc’s economic zones of Khanh Hoa and Kien Giang provinces, respectively, at the “International Science EEZ development – Experience and Opportunities” conference, which was co-organized by the Quang Ninh government and CCSEZR on 20 March 2014. The seminar brought together more than four hundred provincial government and private industry leaders, policy experts and academic professors to discuss “the mechanisms and specific policies for the special economic zones” (Tuan Anh 2015).
In October 2017, the SEZ draft bill was proposed and submitted for revision at the fourth session of the 14th National Assembly (NA), and then re-submitted at the fifth session. On 23 May 2018, Nguyen Khac Dinh, chairman of the 14th NA’s legal committee, announced that the majority of NA delegates agreed on the necessity to open public discussions on the bill’s regulatory scope and potential benefits of SEZs for the Vietnamese economy (Lawsoft 2018). According to the Politburo’s Conclusion No. 21, the reasons for opening these economic zones include “taking advantage of the regional potential; attracting strong investment capital, advanced technology, new management methods; generating more resources and motivations; and helping accelerate the process of economic development and restructuring of provinces, regions and the country as a whole” (Le Kien 2017). The draft law contains a controversial provision permitting the foreign lease of land in SEZs for up to ninety-nine years, and this sparked numerous waves of demonstrations and riots between June and September of 2018. At the sixth session, the NA conclusively approved the withdrawal of the SEZ bill. Out of 483 delegates, 423 of them voted in favour of the postponement, only 8 voted against it, and 55 abstained.
Psychotic disorders and schizotypal traits aggregate in the relatives of probands with schizophrenia. It is currently unclear how variability in symptom dimensions in schizophrenia probands and their relatives is associated with polygenic liability to psychiatric disorders.
Aims
To investigate whether polygenic risk scores (PRSs) can predict symptom dimensions in members of multiplex families with schizophrenia.
Method
The largest genome-wide data-sets for schizophrenia, bipolar disorder and major depressive disorder were used to construct PRSs in 861 participants from the Irish Study of High-Density Multiplex Schizophrenia Families. Symptom dimensions were derived using the Operational Criteria Checklist for Psychotic Disorders in participants with a history of a psychotic episode, and the Structured Interview for Schizotypy in participants without a history of a psychotic episode. Mixed-effects linear regression models were used to assess the relationship between PRS and symptom dimensions across the psychosis spectrum.
Results
Schizophrenia PRS is significantly associated with the negative/disorganised symptom dimension in participants with a history of a psychotic episode (P = 2.31 × 10−4) and negative dimension in participants without a history of a psychotic episode (P = 1.42 × 10−3). Bipolar disorder PRS is significantly associated with the manic symptom dimension in participants with a history of a psychotic episode (P = 3.70 × 10−4). No association with major depressive disorder PRS was observed.
Conclusions
Polygenic liability to schizophrenia is associated with higher negative/disorganised symptoms in participants with a history of a psychotic episode and negative symptoms in participants without a history of a psychotic episode in multiplex families with schizophrenia. These results provide genetic evidence in support of the spectrum model of schizophrenia, and support the view that negative and disorganised symptoms may have greater genetic basis than positive symptoms, making them better indices of familial liability to schizophrenia.
Increasingly diverse caregiver populations have prompted studies examining culture and caregiver outcomes. Still, little is known about the influence of sociocultural factors and how they interact with caregiving context variables to influence psychological health. We explored the role of caregiving and acculturation factors on psychological distress among a diverse sample of adults.
Design:
Secondary data analysis of the California Health Interview Survey (CHIS).
Participants:
The 2009 CHIS surveyed 47,613 adults representative of the population of California. This study included Latino and Asian American Pacific Islander (AAPI) caregivers and non-caregivers (n = 13,161).
Measurements:
Multivariate weighted regression analyses examined caregiver status and acculturation variables (generational status, language of interview, and English language proficiency) and their associations with psychological distress (Kessler-6 scale). Covariates included caregiving context (e.g., support and neighborhood factors) and demographic variables.
Results:
First generation caregivers had more distress than first-generation non-caregivers (β=0.92, 95% CI: (0.18, 1.65)); the difference in distress between caregivers and non-caregivers was smaller in the third than first generation (β=-1.21, 95% CI: (-2.24, -0.17)). Among those who did not interview in English (β=1.17, 95% CI: (0.13, 2.22)) and with low English proficiency (β=2.60, 95% CI: (1.21, 3.98)), caregivers reported more distress than non-caregivers.
Conclusions:
Non-caregivers exhibited the "healthy immigrant effect," where less acculturated individuals reported less distress. In contrast, caregivers who were less acculturated reported more distress.
We extend a result of Lieb [‘On the lowest eigenvalue of the Laplacian for the intersection of two domains’, Invent. Math.74(3) (1983), 441–448] to the fractional setting. We prove that if A and B are two bounded domains in $\mathbb R^N$ and $\lambda _s(A)$, $\lambda _s(B)$ are the lowest eigenvalues of $(-\Delta )^s$, $0<s<1$, with Dirichlet boundary conditions, there exists some translation $B_x$ of B such that $\lambda _s(A\cap B_x)< \lambda _s(A)+\lambda _s(B)$. Moreover, without the boundedness assumption on A and B, we show that for any $\varepsilon>0$, there exists some translation $B_x$ of B such that $\lambda _s(A\cap B_x)< \lambda _s(A)+\lambda _s(B)+\varepsilon .$
Acute myocarditis is one of the common complications of coronavirus disease 2019 (COVID-19) with a relatively high case fatality. Here reported is a fulminant case of a 42-year-old previously healthy woman with cardiogenic shock and refractory cardiac arrest due to COVID-19-induced myocarditis who received veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) after 120 minutes of cardiopulmonary resuscitation (CPR). This is the first adult case of cardiac arrest due to COVID-19-induced myocarditis supported by ECMO that fully recovered with normal neurological functions. The success of the treatment course with full recovery emphasized the potential role of ECMO in treating these patients.
Although compelling evidence from observational studies supports a positive association between consumption of cereal fibre and CVD risk reduction, randomised controlled trials (RCT) often target viscous fibre type as the prospective contributor to lipid lowering to reduce CVD risk. The objective of our study is to compare the lipids-lowering effects of viscous dietary fibre to non-viscous, cereal-type fibre in clinical studies. RCT that evaluated the effect of viscous dietary fibre compared with non-viscous, cereal fibre on LDL cholesterol and alternative lipid markers, with a duration of ≥ 3 weeks, in adults with or without hypercholesterolaemia were included. Medline, EMBASE, CINAHL and the Cochrane Central Register were searched through October 19, 2021. Data were extracted and assessed by two independent reviewers. The generic inverse variance method with random effects model was utilised to pool the data which were expressed as mean differences (MD) with 95 % CI. Eighty-nine trials met eligibility criteria (n 4755). MD for the effect of viscous dietary fibre compared with non-viscous cereal fibre were LDL cholesterol (MD = –0·26 mmol/l; 95 % CI: –0·30, −0·22 mmol/l; P < 0·01), non-HDL cholesterol (MD = –0·33 mmol/l; 95 % CI: –0·39, −0·28 mmol/l; P < 0·01) and Apo-B (MD = –0·04 g/l; 95 % CI: –0·06, −0·03 g/l; P < 0·01). Viscous dietary fibre reduces LDL cholesterol and alternative lipid markers relative to the fibre from cereal sources, hence may be a preferred type of fibre-based dietary intervention targeting CVD risk reduction.