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Broad-spectrum antibiotic use in febrile neutropenia is often driven by concerns for severe and drug-resistant infections. In select patients who do not have an active infection and improve, their prolonged and unnecessary use contributes to antimicrobial resistance, drug toxicity, and increased healthcare costs. We describe the implementation of an antibiotic de-escalation protocol to reduce inappropriate antibiotic use in febrile neutropenia among hematology patients.
Methods:
We conducted baseline analysis (January–June 2024) of antibiotic use in febrile neutropenia cases admitted under hematology. Interventions included the (i) development of an antibiotic de-escalation protocol to guide clinical management, (ii) a roadshow to educate and improve uptake of this protocol, and (iii) regular feedback via “report cards” for hematology teams. The primary outcome was the proportion of febrile neutropenia cases with inappropriate antibiotic use, with secondary measures including adverse outcomes (in-hospital mortality, Clostridioides difficile infection, need for intensive care).
Results:
Baseline data indicated inappropriate antibiotic use rates of 45.5–66.7% per month from January to June 2024, with 13–28 days of inappropriate therapy. The protocol was developed in July 2024, with a subsequent roadshow to promote its uptake. Regular feedback was provided in the form of “report cards” every 2-monthly thereafter. Post-intervention, inappropriate antibiotic use decreased to a median of 23.35% from July to December 2024, with no observed increase in adverse outcomes.
Conclusions:
The implementation of a structured de-escalation protocol, combined with frequent education and feedback, effectively reduced inappropriate antibiotic use in febrile neutropenia without compromising patient safety.
Supporting family caregivers (FCs) is a critical core function of palliative care. Brief, reliable tools suitable for busy clinical work in Taiwan are needed to assess bereavement risk factors accurately. The aim is to develop and evaluate a brief bereavement scale completed by FCs and applicable to medical staff.
Methods
This study adopted convenience sampling. Participants were approached through an intentional sampling of patients’ FCs at 1 palliative care center in Taiwan. This cross-sectional study referred to 4 theories to generate the initial version of the Hospice Foundation of Taiwan Bereavement Assessment Scale (HFT-BAS). A 9-item questionnaire was initially developed by 12 palliative care experts through Delphi and verified by content validity. A combination of exploratory factor analysis (EFA), reliability measures including items analysis, Cronbach’s alpha and inter-subscale correlations, and confirmatory factor analysis (CFA) was employed to test its psychometric properties.
Results
Two hundred seventy-eight participants conducted the questionnaire. Three dimensions were subsequently extracted by EFA: “Intimate relationship,” “Existential meaning,” and “Disorganization.” The Cronbach’s alpha of the HFT-BAS scale was 0.70, while the 3 dimensions were all significantly correlated with total scores. CFA was the measurement model: chi-squared/degrees of freedom ratio = 1.9, Goodness of Fit Index = 0.93, Comparative Fit Index = 0.92, root mean square error of approximation = 0.08. CFA confirmed the scale’s construct validity with a good model fit.
Significance of results
This study developed an HFT-BAS and assessed its psychometric properties. The scale can evaluate the bereavement risk factors of FCs in clinical palliative care.
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.
Major depressive disorder (MDD) has been increasingly understood as a disruption of brain connectome. Investigating grey matter structural networks with a large sample size can provide valuable insights into the structural basis of network-level neuropathological underpinnings of MDD.
Aims
Using a multisite MRI data-set including nearly 2000 individuals, this study aimed to identify robust topology and connectivity abnormalities of grey matter structural network linked to MDD and relevant clinical phenotypes.
Method
A total of 955 MDD patients and 1009 healthy controls were included from 23 sites. Individualised structural covariance networks (SCN) were established based on grey matter volume maps. Following data harmonisation, network topological metrics and focal connectivity were examined for group-level comparisons, individual-level classification performance and association with clinical ratings. Various validation strategies were applied to confirm the reliability of findings.
Results
Compared with healthy controls, MDD individuals exhibited increased global efficiency, abnormal regional centralities (i.e. thalamus, precentral gyrus, middle cingulate cortex and default mode network) and altered circuit connectivity (i.e. ventral attention network and frontoparietal network). First-episode drug-naive and recurrent patients exhibited different patterns of deficits in network topology and connectivity. In addition, the individual-level classification of topological metrics outperforms that of structural connectivity. The thalamus-insula connectivity was positively associated with the severity of depressive symptoms.
Conclusions
Based on this high-powered data-set, we identified reliable patterns of impaired topology and connectivity of individualised SCN in MDD and relevant subtypes, which adds to the current understanding of neuropathology of MDD and might guide future development of diagnostic and therapeutic markers.
Adsorption of uranyl (UO22+) ions to mineral surfaces is a potentially effective method for removing this hazardous metal from water, but other toxic trace metal ions (Xn+: Rb+, Sr2+, Cr3+, Mn2+, Ni2+, Zn2+, Cd2+) in uraniferous wastewaters compete with UO22+ for adsorption sites and thus may diminish the capacity of adsorbents to sequester UO22+. A better understanding of competitive adsorption among these metal ions and the development of better adsorbents are, therefore, of critical importance. The purpose of the present study was to synthesize and characterize magnetic adsorbents, consisting of MFe2O4 (M = Mn, Fe, Zn, Co, or Ni) nanoparticles synthesized on montmorillonite (Mnt) edge sites, and to investigate their use as adsorbents for UO22+, including competitive adsorption with trace metal ions. Selective adsorption was studied using Langmuir, Freundlich, and Dubinin-Radushkevich isotherms, and the results showed that Xn+ ions were adsorbed primarily on MFe2O4-montmorillonite surfaces, and the UO22+ ions were adsorbed on the interfaces between montmorillonite edge surfaces and MFe2O4 nanoparticles. Using the Freundlich model, the interface adsorption capacity of UO22+ reached 25.1 mg·g–1 in mixed solution. Further, the UO22+ and Cr3+ ions had a redox reaction on the interfaces with synergistic adsorption. Herein, the adsorption capacity of Cr3+ was 60.2 mg·g–1 using the Freundlich isotherm. The results demonstrated that the MFe2O4-montmorillonite with highly selective adsorption of UO22+ ions is applicable to UO22+ treatment in the presence of toxic trace metal ions.
Purple nutsedge (Cyperus rotundus L.) is a globally distributed noxious weed that poses a significant challenge for control due to its fast and efficient propagation through the tuber, which is the primary reproductive organ. Gibberellic acid (GA3) has proven to be crucial for tuberization in tuberous plants. Therefore, understanding the relationship between GA3 and tuber development and propagation of C. rotundus will provide valuable information for controlling this weed. This study shows that the GA3 content decreases with tuber development, which corresponds to lower expression of bioactive GA3 synthesis genes (CrGA20ox, two CrGA3ox genes) and two upregulated GA3 catabolism genes (CrGA2ox genes), indicating that GA3 is involved in tuber development. Simultaneously, the expression of two CrDELLA genes and CrGID1 declines with tuber growth and decreased GA3, and yeast two-hybrid assays confirm that the GA3 signaling is DELLA-dependent. Furthermore, exogenous application of GA3 markedly reduces the number and the width of tubers and represses the growth of the tuber chain, further confirming the negative impact that GA3 has on tuber development and propagation. Taken together, these results demonstrate that GA3 is involved in tuber development and regulated by the DELLA-dependent pathway in C. rotundus and plays a negative role in tuber development and propagation.
Many studies suggest that both psychotherapy and drug therapy are effective in the treatment of bipolar disorders (BDs). However, the pathophysiology of both types of intervention has not been established definitively.
Methods
An activation likelihood estimation meta-analysis was performed to identify the distinct brain activity alterations between psychotherapy and drug therapy for the treatment of BDs. Articles were identified by searching databases including PubMed, Embase, Cochrane Library, and Web of Science databases. Eligible studies on BDs were published up until 10 June 2021.
Results
21 studies were included and we conducted a meta-analysis for different therapies and imaging tasks. After receiving psychotherapy, BD patients showed increased activation in the inferior frontal gyrus (IFG) and superior temporal gyrus. While after taking drug therapy, BD patients displayed increased activation in the anterior cingulate cortex, medial frontal gyrus, IFG, and decreased activation in the posterior cingulate cortex. The regions of brain activity changes caused by psychotherapy were mostly focused on the frontal areas, while drug therapy mainly impacted on the limbic areas. Different type of tasks also affected brain regions which were activated.
Conclusions
Our comprehensive meta-analysis indicates that these two treatments might have effect on BD in their own therapeutic modes. Psychotherapy might have a top-down effect, while drug therapy might have a bottom-up effect. This study may contribute to differential diagnosis of BDs and would be helpful to finding more accurate neuroimaging biomarkers for BD treatment.
Sarcopenic obesity is regarded as a risk factor for the progression and development of non-alcoholic fatty liver disease (NAFLD). Since male sex is a risk factor for NAFLD and skeletal muscle mass markedly varies between the sexes, we examined whether sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio (SVR), that is, an index of skeletal muscle mass combined with abdominal obesity, and the histological severity of NAFLD. The SVR was measured by bioelectrical impedance in a cohort of 613 (M/F = 443/170) Chinese middle-aged individuals with biopsy-proven NAFLD. Multivariable logistic regression and subgroup analyses were used to test the association between SVR and the severity of NAFLD (i.e. non-alcoholic steatohepatitis (NASH) or NASH with the presence of any stage of liver fibrosis). NASH was identified by a NAFLD activity score ≥5, with a minimum score of 1 for each of its categories. The presence of fibrosis was classified as having a histological stage ≥1. The SVR was inversely associated with NASH in men (adjusted OR 0·62; 95 % CI 0·42, 0·92, P = 0·017 for NASH, adjusted OR 0·65; 95 % CI 0·43, 0·99, P = 0·043 for NASH with the presence of fibrosis), but not in women (1·47 (95 % CI 0·76, 2·83), P = 0·25 for NASH, and 1·45 (95 % CI 0·74, 2·83), P = 0·28 for NASH with the presence of fibrosis). There was a significant interaction for sex and SVR (Pinteraction = 0·017 for NASH and Pinteraction = 0·033 for NASH with the presence of fibrosis). Our findings show that lower skeletal muscle mass combined with abdominal obesity is strongly associated with the presence of NASH only in men.
A novel solid-clad-by-liquid method was developed to form a 10-m long by 10-mm wide by 80-μm thick Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite tape. Three deformation routes (cold rolling, cold rolling with intermediate annealing, and cold rolling combined with warm rolling) have been investigated in short Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite substrate. To optimize the dynamic continuous annealing parameters for the long composite substrates, air-cooled and furnace-cooled annealing procedures were compared in short Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite substrates. Improved cube texture of 98.7% in a 10-m long by 10-mm wide by 80-μm thick Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite substrate was achieved via warm rolling deformation at 550 °C and two-step dynamic continuous annealing (750 °C for 1 h followed by 1200 °C for 1 h). The yield strength, Curie temperature, and saturation magnetization of 176 MPa, 324 K, and 18 emu/g, respectively, were obtained.
To examine and quantify the potential dose–response relationship between green tea intake and the risk of gastric cancer.
Design
We searched PubMed, EMBASE, Web of Science, CBM, CNKI and VIP up to December 2015 without language restrictions.
Setting
A systematic review and dose–response meta-analysis of observational studies.
Subjects
Five cohort studies and eight case–control studies.
Results
Compared with the lowest level of green tea intake, the pooled relative risk (95 % CI) of gastric cancer was 1·05 (0·90, 1·21, I2=20·3 %) for the cohort studies and the pooled OR (95 % CI) was 0·84 (0·74, 0·95, I2=48·3 %) for the case–control studies. The pooled relative risk of gastric cancer was 0·79 (0·63, 0·97, I2=63·8 %) for intake of 6 cups green tea/d, 0·59 (0·42, 0·82, I2=1·0 %) for 25 years of green tea intake and 7·60 (1·67, 34·60, I2=86·5 %) for drinking very hot green tea.
Conclusions
Drinking green tea has a certain preventive effect on reducing the risk of gastric cancer, particularly for long-term and high-dose consumption. Drinking too high-temperature green tea may increase the risk of gastric cancer, but it is still unclear whether high-temperature green tea is a risk factor for gastric cancer. Further studies should be performed to obtain more detailed results, including other gastric cancer risk factors such as smoking and alcohol consumption and the dose of the effective components in green tea, to provide more reliable evidence-based medical references for the relationship between green tea and gastric cancer.
Boron carbide (B4C) powder was consolidated at 45 MPa by Spark Plasma Sintering (SPS) for 20 min from 1450 to 2000 °C. The density of the B4C reached 99.6% at 2000 °C. A continuum model was applied to describe the densification mechanism of B4C powder under SPS conditions. The shrinkage rate was sensitive to particle size and temperature. The effect of porosity on thermal diffusion was significant, especially for small particle sizes. It appears that there is Joule heating, discharge, and electromagnetic field involved during the SPS of B4C. The current can enhance the sintering process, and it can obviously reduce the creep activation energy.
Gradual fault detection is always an important issue in integrated navigation systems, and the gradual fault is the most difficult fault to detect. To detect gradual faults in a timely and precise manner in integrated navigation systems, the statistical concepts of the normalised residual mean and the sum of absolute residuals are introduced according to the characteristics of gradual system failure in this paper. The applicability of the improved residual χ2 detection method is discussed. Then, the gradual fault detection program based on the improved residual χ2 detection method is designed with the criterion of normalised residual mean and the sum of absolute residual. The simulation results and vehicle tests show that: 1) The residual of the failed sub-system can be calculated accurately with the improved residual χ2 detection method, which has strong applicability in gradual fault detection; 2) The gradual fault can be detected in a short time by using the normalised residual mean and the sum of absolute residual.
Batch experiments of komatiite–H2O–CO2 system with temperatures from 200 to 450°C were performed to simulate the interactions between the newly formed ultramafic crust and the proto-atmosphere on Earth before the formation of its earliest ocean. Particularly, magnetite nanocrystals were observed in the experiment carried out at 450°C that are characterized by their hexagonal platelet-like morphology and porous structure. Exactly the same set of lattice fringes on the two opposite sides of one pore suggests post-crystallization erosion. The results demonstrate that magnetite could be produced by the direct interactions between the ultramafic rocky crust and the atmosphere before the formation of the ocean on the Hadean Earth. These magnetite nanoparticles could serve as a catalyst in the synthesis of simple organic molecules during the organochemical evolution towards life.
During 1997–2012 we conducted a nationwide camera-trapping survey and assessed the availability of prey and habitat for the clouded leopard Neofelis nebulosa in Taiwan. We surveyed 1,249 camera-trap sites over 113,636 camera-trap days, from the seashore to an altitude of 3,796 m and covering various types of vegetation. No clouded leopards were photographed during 128,394 camera-trap days, including at 209 sites in other studies, confirming the presumed extinction of clouded leopards in Taiwan. Assessment of the prey base revealed altitudinal distribution patterns of prey species and prey biomass. Areas at lower altitudes and with less human encroachment and hunting supported a higher prey biomass and more of the typical prey species of clouded leopards. Habitat analysis revealed 8,523 km2 of suitable habitat but this was reduced to 6,734 km2 when adjacent areas of human encroachment were subtracted. In the absence of hunting and large mammalian carnivores the major prey of clouded leopards in Taiwan, such as Formosan macaques Macaca cyclopis, Reeves's muntjacs Muntiacus reevesi, Formosan serow Capricornis swinhoei and sambar Rusa unicolor, could become over-abundant. Thus, it is important to address the cascading effect of the disappearance of top-down predator control. Our assessment indicated that, with proper regulation of hunting, habitat restoration and corridor improvement, it may be possible to reintroduce the clouded leopard.
Surface properties affect the attachment of micro- and macroscopic marine organisms. The current study examined the settlement response of the mussel Mytilus coruscus plantigrades to natural biofilms formed on surfaces of different wettability. The percentages of plantigrade settlement were not influenced by the biofilms formed on variously wettable surfaces in the short term, but after 10 days, the plantigrade settlement rates decreased on biofilms formed on lower wettability surfaces. In general, lower wettability of the surfaces resulted in the decrease of the dry weight, bacterial and diatom density and the thickness of natural biofilms when compared to high wettability surfaces. In contrast, chlorophyll-a concentration in biofilms was independent of the initial wettability of the surfaces. Comparative cluster analysis of bacterial denaturing gradient gel electrophoresis patterns revealed that high variability existed between the bacterial community on high wettability surfaces and that on low wettability surfaces. Thus, surface wettability affects the formation of natural biofilms, and this variation in biofilms developed on different wettability surfaces may explain the discrepancy in their corresponding inducing activities on M. coruscus plantigrade settlement. This finding provides new insight into interactions between mussel settlement, biofilm characteristics and surface properties.
The spin Hamiltonian parameters (g factor and hyperfine structure constants) of Cr+ in ZnX (X = S, Se, Te) and CdTe are theoretically investigated, using the perturbation formulas of these parameters for a tetrahedral 3d5 cluster. Both the contributions from the crystal-field (CF) and charge transfer (CT) mechanisms are considered from the cluster approach. The calculated results show good agreement with the experimental data. The CT contribution to g-shift Δg (=g − gs, where gs =2.0023 is the spin only value) is opposite (positive) in sign related to the CF one, and its importance (characterized by the relative ratio (|ΔgCT/ΔgCF|) is 11%, 66% and 104% (71%) for ZnS, ZnSe and ZnTe (CdTe), respectively. ACT from the CT contribution to hyperfine structure constant is the same (positive) in sign and about 50–53% in magnitude as compared with ACF from the CF one.
Polycrystalline Ba8Ga16MgxGe30−x compounds were synthesized by combining solid-state reaction with spark plasma sintering (SPS) method. The structural and electronic properties of Mg-substituted Ge type-I clathrate phase Ba8Ga16MgxGe30−x (x = 1, 2, 3, 4) were investigated experimentally and theoretically. Theoretically structural and electronic properties of Ba8Ga16MgxGe30−x were calculated by first-principles method based on the density-functional theory. The results indicate a strong preference for the occupation of the 6c sites by Mg. It is found that Mg substitution for Ge can lower the melting points and bulk modulus of this system. The formation energies and the binding energies decrease with increasing Mg content, suggesting that the Mg-doped Ba8Ga16Ge30 clathrates are stable in a limited range of composition. The calculated results show that these alloys are all indirect gap semiconductors and the values of band gap increase with the increase of Mg content. All specimens exhibit the behavior of the p-type conduction, which is originated from the presence of a shallow acceptor energy level. The electrical conductivity and the room-temperature carrier mobility decrease with increasing Mg content, while the room-temperature carrier concentration increases with increasing Mg content.