In this paper, we simulate the process of two-dimensional axisymmetric fluid–structure coupling of a droplet impacting on a flexible disk. The effects of dimensionless disk stiffness (K = 0.1–1000), Weber number (We = 1–500) and contact angle (θ = 130° and 60°) on the dynamics of the droplet impacting on the flexible disk are analysed. The results indicate that there are five typical impact modes for a hydrophobic surface (θ = 130°) and four typical impact modes for a hydrophilic surface (θ = 60°) within the range of considered parameters. The analysis of spreading factor reveals that a part of the energy is transferred to the substrate, which is manifested as a weakening of the droplet spreading, when the substrate deforms downwards due to the droplet impact; the squeezing of the droplet causes a tendency to flow from the centre of the droplet to the edge, which is manifested as an enhancement of the droplet spreading, when the substrate recovers from the downward deformation. The effect of the substrate flexibility on the maximum spreading factor depends on the competition of the two mechanisms above. Based on this, a modified scaling law of βmax has been proposed by introducing the effective Weber number (Wem). The analysis of impact force demonstrates that the peak of the impact force is related to the deflection of the flexible substrate which is different from that of a rigid wall; and three typical processes of impact force variation have been summarised. In addition, unlike the rigid substrate scenario, there is an energy interaction between the droplet and the flexible substrate after impact occurs, which is classified as three typical energy transformation processes.

Despite global efforts to end tuberculosis (TB), the goal of preventing catastrophic health expenditure (CHE) due to TB remains unmet. This cross-sectional study was conducted in Guizhou Province, Southwest China. Data were collected from the Hospital Information System and a survey of TB patients who had completed standardized antituberculosis treatment between January and March 2021. Among the 2 283 participants, the average total expenditure and out-of-pocket expenditure were $1 506.6 (median = $760.5) and $683.6 (median = $437.8), respectively. Health insurance reimbursement reduced CHE by 16.8%, with a contribution rate of 24.9%, and the concentration index changed from -0.070 prereimbursement to -0.099 postreimbursement. However, the contribution of health insurance varied significantly across different economic strata, with contribution rates of 6.4% for the lowest economic group and 53.1% for the highest group. For patients from lower socioeconomic strata, health insurance contributed 10.7% to CHE in the prediagnostic phase and 23.5% during treatment. While social health insurance alleviated the financial burden for TB patients, it did not provide sufficient protection for those in lower economic strata or during the prediagnostic stage. This study underscores the need for more effective and equitable subsidy policies for TB patients .

Increasing transboundary crises necessitate the development of crisis management capabilities that transcend boundaries. In such situations, inter-governmental and cross-functional collaboration has become a common practice to address the complexities of governance challenges. This study employs Social Network Analysis to examine the structure, function, and evolution of policy collaboration networks in China in response to COVID-19 and SARS. Since the SARS outbreak, China has embraced a collaborative governance approach, considering the transboundary nature of COVID-19. This approach has led to the involvement of numerous specialized organizations engaged in economic and social development, contributing to the establishment of a larger and more loosely connected collaboration network. While the health department bears the primary responsibility for coordinating public health emergency management, diverse organizations with social governance and economic management functions have also emerged as key actors, providing crucial anti-epidemic information, knowledge, and resources to address this significant cross-border crisis.

The seminal Bolgiano–Obukhov (BO) theory established the fundamental framework for turbulent mixing and energy transfer in stably stratified fluids. However, the presence of BO scalings remains debatable despite their being observed in stably stratified atmospheric layers and convective turbulence. In this study, we performed precise temperature measurements with 51 high-resolution loggers above the seafloor for 46 h on the continental shelf of the northern South China Sea. The temperature observation exhibits three layers with increasing distance from the seafloor: the bottom mixed layer (BML), the mixing zone and the internal wave zone. A BO-like scaling $\alpha =-1.34\pm 0.10$ is observed in the temperature spectrum when the BML is in a weakly stable stratified ($N\sim 0.0018$ rad s$^{-1}$) and strongly sheared ($Ri\sim 0.0027$) condition, whereas in the unstably stratified convective turbulence of the BML, the scaling $\alpha =-1.76\pm 0.10$ clearly deviated from the BO theory but approached the classical $-$5/3 scaling in isotropic turbulence. This suggests that the convective turbulence is not the promise of BO scaling. In the mixing zone, where internal waves alternately interact with the BML, the scaling follows the Kolmogorov scaling. In the internal wave zone, the scaling $\alpha =-2.12 \pm 0.15$ is observed in the turbulence range and possible mechanisms are provided.

In this paper, a novel tensioning and relaxing wearable system is introduced to improve the wearing comfort and load-bearing capabilities of knee exoskeletons. The research prototype of the novel system, which features a distinctive overrunning clutch drive, is presented. Through co-simulation with ANSYS, MATLAB, and SOLIDWORKS software, a comprehensive multi-objective optimization is performed to enhance the dynamics performance of the prototype. Firstly, the wearing contact stiffness of the prototype and the mechanical parameters of the relevant materials are simulated and fitted based on the principle of functional equivalence. And then, its equivalent nonlinear circumferential stiffness model is obtained. Secondly, to enhance the wearing comfort of the exoskeleton, a novel comprehensive performance evaluation index, termed wearing comfort, is introduced. The index considers multiple factors such as the duration of vibration transition, the acceleration encountered during wear, and the average pressure applied. Finally, through the utilization of this indicator, the system’s dynamics performance is optimized via multi-platform co-simulation, and the simulation results validate the effectiveness of the research method and the proposed wearable comfort index. The theoretical basis for the subsequent research on the effectiveness of prototype weight-bearing is provided.

We report a paediatric case where severe mitral valve regurgitation occurred led by blunt chest trauma. Medical treatment was undertaken, and surgical mitral valve repair was postponed until half a year after the initial injury, followed by an uneventful postoperative recovery. We highlight the importance of echocardiographic evaluation for traumatic valve insufficiency. The medical strategy and timing of surgical intervention should be individualised.

We analyze a dataset from a numerically simulated, temporally evolving turbulent wake (Zhou, Phys. Rev. Fluids, vol. 7, 2022, 104802) that exhibits spontaneous anisotropic layering under strong stratification, alongside significant spatiotemporal variability within the flow. This analysis focuses on the irreversible flux coefficient, $\varGamma$, defined as the ratio between turbulent potential and kinetic energy dissipation rates. We find that the volume-averaged $\varGamma$ initially rises, reaches a plateau between 0.45 and 0.49 when the layering dynamics become dominant, and then decreases as viscosity plays a larger role. These peak $\varGamma$ values are consistent with those from prior simulations under strongly stratified conditions. Such efficient mixing occurs when the Ozmidov to Thorpe length scale ratio is between 0.37 and 0.52, consistent with numerical and field data reported by Mashayek et al. (J. Fluid Mech., vol. 826, 2017, pp. 522–552). To account for the coexistence of dynamically distinct regions within the flow, we perform conditional sampling of $\varGamma$ against a locally defined gradient Richardson number, ${\textit {Ri}}$. This reveals a flux-gradient relation between $\varGamma$ and ${\textit {Ri}}$ that remains largely consistent over time. This relation features a large, approximately constant value of $\varGamma$ for ${\textit {Ri}}$ values greater than one, echoing the ‘constant-power’ scenario postulated by Balmforth et al. (J. Fluid Mech., vol. 355, 1998, pp. 329–358).

We investigate the dynamics of a columnar Taylor–Green vortex array under strong stratification, focusing on Froude numbers $0.125\leq Fr \leq 1.0$, with the aim of identifying and understanding the primary instabilities that lead to the vortices’ breakdown. Linear stability analysis reveals that the fastest-growing vertical wavenumber scales with $Fr^{-1}$, while the dimensionless growth rate remains approximately constant. The most unstable eigenmode, identified as the mixed hyperbolic mode by Hattori et al. (J. Fluid Mech., vol. 909, 2021, A4), bears significant similarities to the zigzag instability, first discovered by Billant & Chomaz (J. Fluid Mech., vol. 418, 2000, pp. 167–188). Direct numerical simulations further confirm that the zigzag instability is crucial in amplifying initial random perturbations to finite amplitude, with the flow structure and modal growth rate consistent with the linear stability analysis. In particular, the characteristic vertical length scale of turbulence matches that of the fastest-growing linear mode. These findings underscore the broader relevance of the zigzag instability mechanism beyond its initial discovery in vortex pairs, demonstrating its role in facilitating direct energy transfer from vertically uniform vortical motions to a characteristic vertical length scale proportional to $Fr$ in strongly stratified flows.

Direct numerical simulations of the droplet impact on a flat solid surface with an annular part are conducted. We investigate droplet impact on a superhydrophobic substrate with a superhydrophilic annulus to understand the formation conditions of droplets in different states. The location and size of superhydrophilic annulus are carried out through the phase diagram. We describe the formation process of droplets in three different states and the spreading radius with time to catch the rupture time of the film. Two different ruptures occur in the spreading stage or the retraction stage, respectively. The rupture times from these two mechanisms observed numerically are found to be a key factor resulting in partial rebound and lens-shaped/ring-shaped droplets. Finally, the influence of non-dimensional numbers on the formation of the ring-shaped droplet is demonstrated. The Weber number can alter the amplitude of the up and down oscillation on the droplet's upper surface, while the Froude number affects primarily the time to form the central penetrating hole. This gives the guidance and method to control the ring-shaped droplets formation time.

Background: Efgartigimod is a human IgG1 antibody Fc fragment recently approved by Health Canada for patients with acetylcholine receptor antibody positive (AChR-Ab+) generalized myasthenia gravis (gMG). We assessed cost-effectiveness of efgartigimod vs chronic IVIg for adult patients with AChR-Ab+ gMG. Methods: A Markov model estimated costs (treatment and administration, disease monitoring, complications from chronic corticosteroid use, exacerbation and crisis management, adverse events, end-of-life care) and benefits (quality-adjusted life-years [QALYs]). The analysis was conducted from the Canadian healthcare system perspective. Health state transition probabilities were estimated using data from ADAPT, ADAPT+, and a network meta-analysis comparing efgartigimod with chronic IVIg. Utility values were obtained from MyRealWorld MG. Patients with MG-ADL ≥5 who did not die/discontinue were assumed to receive treatment every 4 weeks or every 3 weeks over the lifetime horizon. Results: Over the lifetime horizon, efgartigimod and chronic IVIg were predicted to have total discounted QALYs of 16.80 and 13.35, and total discounted costs of $1,913,294 and $2,170,315, respectively. Efgartigimod dominated chronic IVIg with incremental QALYs of 3.45 and cost savings of $257,020 over the lifetime horizon. Conclusions: Efgartigimod may provide greater benefit at lower costs than chronic IVIg for Canadian patients with AChR-Ab+ gMG, with substantial healthcare system savings over the lifetime horizon.

Seed dormancy is an important trait associated with pre-sprouting and malting quality in barley. Genome-wide association studies (GWASs) have been used to detect quantitative trait loci (QTLs) underlying complex traits in major crops. In the present study, we collected 295 barley (Hordeum vulgare L.) accessions from Australia, Europe, Canada and China. A total of 25,179 single nucleotide polymorphism (SNP)/diversity arrays technology sequence markers were used for population structure, linkage disequilibrium and GWAS analysis. Candidate genes within QTL regions were investigated, and their expression levels were analysed using RNAseq data. Five QTLs for seed dormancy were identified. One QTL was mapped on chromosome 1H, and one QTL was mapped on chromosome 4H, while three QTLs were located on chromosome 5H. This is the first report of a QTL on the short arm of chromosome 5H in barley. Molecular markers linked to the QTL can be used for marker-assisted selection in barley breeding programmes.

This paper retrospectively analysed the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in some parts of China. Between January 2013 and December 2019, we collected 4,145 respiratory samples, including pharyngeal swabs and alveolar lavage fluid. The highest PCR-positive rate of M. pneumoniae was 74.5% in Beijing, the highest resistance rate was 100% in Shanghai, and Gansu was the lowest with 20%. The highest PCR-positive rate of M. pneumoniae was 74.5% in 2013, and the highest MRMP was 97.4% in 2019; the PCR-positive rate of M. pneumoniae for adults in Beijing was 17.9% and the MRMP was 10.48%. Among the children diagnosed with community-acquired pneumonia (CAP), the PCR-positive and macrolide-resistant rates of M. pneumoniae were both higher in the severe ones. A2063G in domain V of 23S rRNA was the major macrolide-resistant mutation, accounting for more than 90%. The MIC values of all MRMP to erythromycin and azithromycin were ≥ 64 μg/ml, and the MICs of tetracycline and levofloxacin were ≤ 0.5 μg/ml and ≤ 1 μg/ml, respectively. The macrolide resistance varied in different regions and years. Among inpatients, the macrolide-resistant rate was higher in severe pneumonia. A2063G was the common mutation, and we found no resistance to tetracycline and levofloxacin.

Genes involved in melanin production directly impact insect pigmentation and can affect diverse physiology and behaviours. The role these genes have on sex behaviour, however, is unclear. In the present study, the crucial melanin pigment gene black was functionally characterised in an urban pest, the German cockroach, Blattella germanica. RNAi knockdown of B. germanica black (Bgblack) had no effect on survival, but did result in black pigmentation of the thoraxes, abdomens, heads, wings, legs, antennae, and cerci due to cuticular accumulation of melanin. Sex-specific variation in the pigmentation pattern was apparent, with females exhibiting darker coloration on the abdomen and thorax than males. Bgblack knockdown also resulted in wing deformation and negatively impacted the contact sex pheromone-based courtship behaviour of males. This study provides evidence for black function in multiple aspects of B. germanica biology and opens new avenues of exploration for novel pest control strategies.

Accurately predicting neurosyphilis prior to a lumbar puncture (LP) is critical for the prompt management of neurosyphilis. However, a valid and reliable model for this purpose is still lacking. This study aimed to develop a nomogram for the accurate identification of neurosyphilis in patients with syphilis. The training cohort included 9,504 syphilis patients who underwent initial neurosyphilis evaluation between 2009 and 2020, while the validation cohort comprised 526 patients whose data were prospectively collected from January 2021 to September 2021. Neurosyphilis was observed in 35.8% (3,400/9,504) of the training cohort and 37.6% (198/526) of the validation cohort. The nomogram incorporated factors such as age, male gender, neurological and psychiatric symptoms, serum RPR, a mucous plaque of the larynx and nose, a history of other STD infections, and co-diabetes. The model exhibited good performance with concordance indexes of 0.84 (95% CI, 0.83–0.85) and 0.82 (95% CI, 0.78–0.86) in the training and validation cohorts, respectively, along with well-fitted calibration curves. This study developed a precise nomogram to predict neurosyphilis risk in syphilis patients, with potential implications for early detection prior to an LP.

The laboratory generation and diagnosis of uniform near-critical-density (NCD) plasmas play critical roles in various studies and applications, such as fusion science, high energy density physics, astrophysics as well as relativistic electron beam generation. Here we successfully generated the quasistatic NCD plasma sample by heating a low-density tri-cellulose acetate (TCA) foam with the high-power-laser-driven hohlraum radiation. The temperature of the hohlraum is determined to be 20 eV by analyzing the spectra obtained with the transmission grating spectrometer. The single-order diffraction grating was employed to eliminate the high-order disturbance. The temperature of the heated foam is determined to be T = 16.8 ± 1.1 eV by analyzing the high-resolution spectra obtained with a flat-field grating spectrometer. The electron density of the heated foam is about $N_e=4.0\pm 0.3\times {10}^{20}{\text{cm}}^{-3}$ under the reasonable assumption of constant mass density.

In preparation for an experiment with a laser-generated intense proton beam at the Laser Fusion Research Center at Mianyang to investigate the 11B(p,α)2α reaction, we performed a measurement at very low proton energy between 140 keV and 172 keV using the high-voltage platform at the Institute of Modern Physics, Lanzhou. The aim of the experiment was to test the ability to use CR-39 track detectors for cross-section measurements and to remeasure the cross-section of this reaction close to the first resonance using the thick target approach. We obtained the cross-section σ = 45.6 ± 12.5 mb near 156 keV. Our result confirms the feasibility of CR-39 type track detector for nuclear reaction measurement also in low-energy regions.

Hydrophobicity, swellability, and dispersion are important properties for organo-montmorillonites (OMnt) and have yet to be fully characterized for all OMnt configurations. The purpose of the present work was to examine the preparation of OMnt from the reaction of Ca2+-montmorillonite (Ca2+-Mnt) with a high concentration of surfactant and to reveal the relevant properties of hydrophobicity and dispersion of the resultant OMnt. A series of OMnt samples were prepared using a small amount of water and cetyltrimethylammonium bromide (CTAB) with a concentration more than the CTAB critical micelle concentration (CMC). The relationship between OMnt microstructure and the hydrophobicity and swellability properties was investigated in detail. The resulting OMnt samples were characterized using powder X-ray diffraction patterns (XRD), Fourier-transform infrared (FTIR) spectroscopy, thermogravimetric and differential thermogravimetry (TG-DTG), water contact angle tests, swelling indices, and transmission electron microscopy (TEM). The addition of CTAB and water in the OMnt preparation affected the OMnt microstructure and properties. An increase in CTAB concentration led to a more ordered arrangement of cetyltrimethylammonium (CTA+) cations in the interlayer space of the OMnt and a large amount of CTA+ cations on the outer surfaces of the OMnt. The swelling indices and the water contact angles of OMnt samples depended on the distribution of the CTAB surfactant on OMnt and the orientation of the surfactant hydrophilic groups on the inner and on the outer surfaces of OMnt. A maximum swelling index of 39 mL/g in xylene was achieved with an average water contact angle of 62.0° ± 2.0° when the amount of CTAB added was 2 times the cation exchange capacity (CEC) of Mnt and the lowest water to dry Mnt mass ratio was 3 during the preparation of OMnt samples. The platelets of OMnt aggregated together in xylene by electrostatic attraction and by hydrophobic interactions.

We present the results of two population surveys conducted 10 years apart (December 2010–February 2011 and December 2020–January 2021) of the Critically Endangered white-headed langur Trachypithecus leucocephalus in the Chongzuo White-Headed Langur National Nature Reserve, Guangxi Province, China. In the first survey, we recorded 818 individuals in 105 groups and 16 solitary adult males. In the second survey, we recorded 1,183 individuals in 128 groups and one solitary adult male. As a result of government policies, poaching for food and traditional medicine is no longer a primary threat to these langurs. However, severe forest loss and fragmentation caused by human activities could limit any future increase of this langur population.

Objectives: Rapid and accurate screening for carbapenemase-producing organism (CPOs) in hospitalized patients is critical for infection control and prevention. The Xpert Carba-R assay is designed for rapid detection of CPOs, but 1 assay is usually conducted for only 1 sample. We evaluated a pooling strategy for CPO screening using the Xpert Carba-R assay. Methods: Swab sets containing 2 swabs were collected from 415 unique patients at Peking University People’s Hospital. One swab was used for the pooling test, in which 5 swabs from different patients were mixed in 1 sample treatment solution. The prevalence of CPOs in the hospital (5.3%) predicted that 5:1 pooling was most economical. As the reference method, the other swab was tested by culture using sequencing. Results: Of 415 samples, 383 were CPO negative using the pooling test strategy and 31 were positive. All samples that were negative by pooling were negative by culture and sequencing. Among the 31 positive samples identified by the pooling strategy, 26 were positive by culture and sequencing (including 24 samples with 1 targeted gene and 2 samples with double targeted genes, 1 NDM+/IMP+ and 1 VIM+/IMP+), and 5 were negative. Overall, 198 tests were conducted in the study, and 217 were saved compared with testing individually. The efficiency of the pooling strategy was 215%. The overall sensitivity was 1 (95% CI, 0.840–1), the specificity was 0.987 (95% CI, 0.968–0.995), the accuracy was 0.987 (95% CI, 0.970–0.996), positive predictive value was 0.838 (95% CI, 0.655–0.939), and the negative predictive value was 1 (95% CI, 0.988–1). Conclusions: The pooling strategy using the Xpert Carba-R assay showed good potential in screening CPO with good sensitivity and a significantly lower cost.

Instrument delivery is critical part in vascular intervention surgery. Due to the soft-body structure of instruments, the relationship between manipulation commands and instrument motion is non-linear, making instrument delivery challenging and time-consuming. Reinforcement learning has the potential to learn manipulation skills and automate instrument delivery with enhanced success rates and reduced workload of physicians. However, due to the sample inefficiency when using high-dimensional images, existing reinforcement learning algorithms are limited on realistic vascular robotic systems. To alleviate this problem, this paper proposes discrete soft actor-critic with auto-encoder (DSAC-AE) that augments SAC-discrete with an auxiliary reconstruction task. The algorithm is applied with distributed sample collection and parameter update in a robot-assisted preclinical environment. Experimental results indicate that guidewire delivery can be automatically implemented after 50k sampling steps in less than 15 h, demonstrating the proposed algorithm has the great potential to learn manipulation skill for vascular robotic systems.