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With the advent of web-based technology, online testing is becoming a mainstream mode in large-scale educational assessments. Most online tests are administered continuously in a testing window, which may post test security problems because examinees who take the test earlier may share information with those who take the test later. Researchers have proposed various statistical indices to assess the test security, and one most often used index is the average test-overlap rate, which was further generalized to the item pooling index (Chang & Zhang, 2002, 2003). These indices, however, are all defined as the means (that is, the expected proportion of common items among examinees) and they were originally proposed for computerized adaptive testing (CAT). Recently, multistage testing (MST) has become a popular alternative to CAT. The unique features of MST make it important to report not only the mean, but also the standard deviation (SD) of test overlap rate, as we advocate in this paper. The standard deviation of test overlap rate adds important information to the test security profile, because for the same mean, a large SD reflects that certain groups of examinees share more common items than other groups. In this study, we analytically derived the lower bounds of the SD under MST, with the results under CAT as a benchmark. It is shown that when the mean overlap rate is the same between MST and CAT, the SD of test overlap tends to be larger in MST. A simulation study was conducted to provide empirical evidence. We also compared the security of MST under the single-pool versus the multiple-pool designs; both analytical and simulation studies show that the non-overlapping multiple-pool design will slightly increase the security risk.
CEOs who develop strong clan values as a result of exposure to clan culture in early life wish to bring honor to their clan, motivating them to engage in increased CSR activities. We propose that the influence of CEOs' clan values on CSR is subject to contextual boundaries. Specifically, we predict that the positive relationship between CEOs' clan values and CSR results primarily in an improved level of institutional CSR and varies with CEOs' personal attributes such as overseas experience and hometown identity. An analysis of a longitudinal sample of Chinese publicly listed firms for 2010–2019 provides strong support for our predictions. The implications for upper echelons theory and CSR research are discussed.
The presence of dispersed-phase droplets can result in a notable increase in a system's drag. However, our understanding of the mechanism underlying this phenomenon remains limited. In this study, we use three-dimensional direct numerical simulations with a modified multi-marker volume-of-fluid method to investigate liquid–liquid two-phase turbulence in a Taylor–Couette geometry. The dispersed phase has the same density and viscosity as the continuous phase. The Reynolds number $Re\equiv r_i\omega _i d/\nu$ is fixed at 5200, the volume fraction of the dispersed phase is up to $40\,\%$, and the Weber number $We\equiv \rho u^2_\tau d/\sigma$ is approximately 8. It is found that the increase in the system's drag originates from the contribution of interfacial tension. Specifically, droplets experience significant deformation and stretching in the streamwise direction due to shear near the inner cylinder. Consequently, the rear end of the droplets lags behind the fore head. This causes opposing interfacial tension effects on the fore head and rear end of the droplets. For the fore head of the droplets, the effect of interfacial tension appears to act against the flow direction. For the rear end, the effect appears to act in the flow direction. The increase in the system's drag is attributed primarily to the effect of interfacial tension on the fore head of the droplets which leads to the hindering effect of the droplets on the surrounding continuous phase. This hindering effect disrupts the formation of high-speed streaks, favouring the formation of low-speed ones, which are generally associated with higher viscous stress and drag of the system. This study provides new insights into the mechanism of drag enhancement reported in our previous experiments.
Remote center-of-motion (RCM) manipulators are a key issue in minimally invasive surgeries (MIS). The existing RCM parallel mechanisms (PMs) can only generate RCM motion based on the invariant RCM. To provide mobility for RCM, this paper designed a new family of RCM PMs with movable RCM that features a double-stage topological structure. Drawing mainly on configuration evolution and Lie-group, a general approach is proposed to design double-stage PMs with movable RCM. Feasible limbs for 2R1T RCM motion are enumerated and used to construct the secondary PM. Type synthesis of the primary PMs that realize movable RCM is accomplished based on the method presented. Different connection styles between the two stages that ensure the geometrical conditions of RCM motion are designed. Using different connection styles, double-stage PMs with movable RCM are constructed. These new RCM PMs can realize precise positioning of RCM by taking advantage of the primary PMs, which indicates their potential application prospects in MIS.
We investigate the coupling effects of the two-phase interface, viscosity ratio and density ratio of the dispersed phase to the continuous phase on the flow statistics in two-phase Taylor–Couette turbulence at a system Reynolds number of $6\times 10^3$ and a system Weber number of 10 using interface-resolved three-dimensional direct numerical simulations with the volume-of-fluid method. Our study focuses on four different scenarios: neutral droplets, low-viscosity droplets, light droplets and low-viscosity light droplets. We find that neutral droplets and low-viscosity droplets primarily contribute to drag enhancement through the two-phase interface, whereas light droplets reduce the system's drag by explicitly reducing Reynolds stress due to the density dependence of Reynolds stress. In addition, low-viscosity light droplets contribute to greater drag reduction by further reducing momentum transport near the inner cylinder and implicitly reducing Reynolds stress. While interfacial tension enhances turbulent kinetic energy (TKE) transport, drag enhancement is not strongly correlated with TKE transport for both neutral droplets and low-viscosity droplets. Light droplets primarily reduce the production term by diminishing Reynolds stress, whereas the density contrast between the phases boosts TKE transport near the inner wall. Therefore, the reduction in the dissipation rate is predominantly attributed to decreased turbulence production, causing drag reduction. For low-viscosity light droplets, the production term diminishes further, primarily due to their greater reduction in Reynolds stress, while reduced viscosity weakens the density difference's contribution to TKE transport near the inner cylinder, resulting in a more pronounced reduction in the dissipation rate and consequently stronger drag reduction. Our findings provide new insights into the physics of turbulence modulation by the dispersed phase in two-phase turbulence systems.
This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.
Methods
In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.
Results
Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.
Conclusions
Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.
Foodborne diseases are ongoing and significant public health concerns. This study analysed data obtained from the Foodborne Outbreaks Surveillance System of Wenzhou to comprehensively summarise the characteristics of foodborne outbreaks from 2012 to 2022. A total of 198 outbreaks were reported, resulting in 2,216 cases, 208 hospitalisations, and eight deaths over 11 years. The findings suggested that foodborne outbreaks were more prevalent in the third quarter, with most cases occurring in households (30.8%). Outbreaks were primarily associated with aquatic products (17.7%) as sources of contamination. The primary transmission pathways were accidental ingestion (20.2%) and multi-pathway transmission (12.1%). Microbiological aetiologies (46.0%), including Vibrio parahaemolyticus, Salmonella ssp., and Staphylococcus aureus, were identified as the main causes of foodborne outbreaks. Furthermore, mushroom toxins (75.0%), poisonous animals (12.5%), and poisonous plants (12.5%) were responsible for deaths from accidental ingestion. This study identified crucial settings and aetiologies that require the attention of both individuals and governments, thereby enabling the development of effective preventive measures to mitigate foodborne outbreaks, particularly in coastal cities.
The delay-shift of the pre-pulse may mislead the determination of its origination and cause problems for the temporal contrast improvement of high-peak-power lasers, especially when the corresponding post-pulse is beyond the time window of the measurement device. In this work, an empirical formula is proposed to predict the delay-shift of pre-pulses for the first time. The empirical formula shows that the delay-shift is proportional to the square of the post-pulse’s initial delay, and also the ratio of the third-order dispersion to the group delay dispersion’s square, which intuitively reveals the main cause for the delay-shift and may provide a convenient routing for identifying the real sources of pre-pulses in both chirped-pulse amplification (CPA) and optical parametric chirped-pulse amplification (OPCPA) systems. The empirical formula agrees well with the experimental results both in the CPA and the OPCPA systems. Besides, a numerical simulation is also carried out to further verify the empirical formula.
The primary objectives of this umbrella review were to (a) quantify the relative importance, of “severity” and “rarity” criteria in health resource allocation; and (b) analyze the contextual factors influencing the relative importance. The secondary objective was to examine how “severity” and “rarity” criteria are defined.
Methods
Searches were carried out in PubMed and Embase to identify eligible systematic reviews. Quality appraisal of systematic reviews was undertaken. From identified systematic reviews, primary studies were extracted and further screened for eligibility. The inclusion of severity and rarity criteria and their respective weights in primary studies were examined. Descriptive and regression analyses were performed.
Results
Twenty-nine systematic reviews were screened, of which nine met the inclusion criteria. Primary studies included in these systematic reviews were retrieved and screened, resulting in forty articles included in the final analysis. Disease severity was more frequently considered (n = 29/40) than disease rarity (n = 23/40) as an evaluation criterion. Out of all cases where both were included as evaluation criteria, disease severity was assigned higher weights 84 percent of the time (n = 21/25).
Conclusions
Our review found consistent evidence that disease severity is more relevant and preferred to rarity as a priority-setting criterion albeit constraints in statistical analysis imposed by limited sample size and data availability. Where funding for rare diseases is concerned, we advocate that decision-makers be explicit in clarifying the significance of disease severity and/or rarity as a value driver behind decisions. Our findings also reinforce the relevance of disease severity as a criterion in priority setting.
Choline and betaine are important in the body, from cell membrane components to methyl donors. We aimed to investigate trends in dietary intake and food sources of total choline, individual choline forms and betaine in Chinese adults using data from the China Health and Nutrition Survey (CHNS) 1991–2011, a prospective cohort with a multistage, random cluster design. Dietary intake was estimated using three consecutive 24-h dietary recalls in combination with a household food inventory. Linear mixed-effect models were constructed using R software. A total of 11 188 men and 12 279 women aged 18 years or older were included. Between 1991 and 2011, total choline intake increased from 219·3 (95 % CI 215·1, 223·4) mg/d to 269·0 (95 % CI 265·6, 272·5) mg/d in men and from 195·6 (95 % CI 191·8, 199·4) mg/d to 240·4 (95 % CI 237·4, 243·5) mg/d in women (both P-trends < 0·001). Phosphatidylcholine was the major form of dietary choline, and its contribution to total choline increased from 46·9 % in 1991 to 58·8 % in 2011. Cereals were the primary food source of total choline before 2000, while eggs had ranked at the top since 2004. Dietary betaine intake was relatively steady over time with a range of 134·0–151·5 mg/d in men (P-trend < 0·001) and 111·7–125·3 mg/d in women (P-trend > 0·05). Chinese adults experienced a significant increase in dietary intake of choline, particularly phosphatidylcholine during 1991–2011 and animal-derived foods have replaced plant-based foods as the main food sources of choline. Betaine intake remained relatively stable over time. Future efforts should address the health effects of these changes.
This paper reports a replication of part of Tavakoli and Foster’s (2008) investigation into the influence of narrative task design on second language (L2) oral performance. The initial study found in part that narratives with both foreground and background information elicited significantly greater syntactic complexity than those with only foreground information. This close replication adds the variable of literacy, conducting the study with adult refugees to New Zealand with low first language (L1) literacy. Participants narrated two of the four cartoon strips in Tavakoli and Foster (2008). In contrast to the initial study, background information in the narrative tasks had no impact on the syntactic complexity, lexical diversity, or fluency of performances. However, given the tendency of participants to omit background events, this outcome is discussed in terms of visual literacy, and aptness to describe rather than connect the cartoon frames. The implications for the use of narrative tasks with such learners are explored.
Recent studies of viscous dissipation mechanisms in impacting droplets have revealed distinct behaviours between the macroscale and nanoscale. However, the transition of these mechanisms from the macroscale to the nanoscale remains unexplored due to limited research at the microscale. This work addresses the gap using the many-body dissipative particle dynamics (MDPD) method. While the MDPD method omits specific atomic details, it retains crucial mesoscopic effects, making it suitable for investigating the impact dynamics at the microscale. Through the analysis of velocity contours within impacting droplets, the research identifies three primary contributors to viscous dissipation during spreading: boundary-layer viscous dissipation from shear flow; rim geometric head loss; and bulk viscous dissipation caused by droplet deformation. This prompts a re-evaluation of viscous dissipation mechanisms at both the macroscale and nanoscale. It reveals that the same three kinds of dissipation are present across all scales, differing only in their relative intensities at each scale. A model of the maximum spreading factor (βmax) incorporating all forms of viscous dissipation without adjustable parameters is developed to substantiate this insight. This model is validated against three distinct datasets representing the macroscale, microscale and nanoscale, encompassing a broad spectrum of Weber numbers, Ohnesorge numbers and contact angles. The satisfactory agreement between the model predictions and the data signifies a breakthrough in establishing a universal βmax model applicable across all scales. This model demonstrates the consistent nature of viscous dissipation mechanisms across different scales and underscores the importance of integrating microscale behaviours to understand macroscale and nanoscale phenomena.
The Indo-Pacific Warm Pool (IPWP) significantly influences the global hydrological cycle through its impact on atmospheric-oceanic circulation. However, gaining a comprehensive understanding of the hydrologic climate dynamics within the IPWP and its broader effects on the global climate have been hindered by spatial and temporal limitations in paleoclimate records on orbital timescales. In this study, we reconstructed precipitation records (approximated from δ18Osw-ivc) over the past 450 kyr, based on planktonic foraminiferal Mg/Ca and δ18O data obtained from International Ocean Discovery Program Site U1486 in the western tropical Pacific. The δ18Osw-ivc record revealed a generally consistent pattern with precession variations over the past 450 kyr, closely corresponding to changes in boreal summer insolation at the equator. The δ18Osw-ivc record displayed an anti-phased relationship with Chinese speleothem δ18O records on the precession band, with lower precipitation in the western tropical Pacific and higher precipitation in the East Asia summer monsoon region during periods of high Northern Hemisphere summer insolation. This anti-phased correlation primarily resulted from the north-south migration of the Intertropical Convergence Zone (ITCZ), influenced by the interhemispheric insolation contrast. By considering additional δ18Osw-ivc records from various locations within the IPWP region, we identified synchronous precipitation changes within the IPWP on the precession band. The synchronization of precipitation on both margins of the ITCZ’s seasonal range and differences between central and marginal regions of the ITCZ within the IPWP revealed the expansion and contraction of the ITCZ on precession band.
This study investigates neuropsychological and psychosocial outcomes in patients with traumatic brain injury (TBI) and post-traumatic epilepsy (PTE) compared to a healthy control group.
Method:
Utilizing a quasi-experimental cross-sectional design, the research involved patients with TBI and PTE referred from a Taiwanese medical center. An age- and education-matched control group of healthy adults without traumatic injuries was also recruited. The study involved analyzing retrospective medical records and applying a comprehensive suite of neuropsychological tests and psychosocial questionnaires.
Results:
Executive function measures revealed significantly reduced performance in both the TBI and PTE groups compared to controls. Specifically, the MoCA scores were lowest in the PTE group, followed by the TBI group, and highest in the controls. Measures of subjective symptomatology showed comparably elevated levels in both the TBI and PTE groups relative to controls.
Conclusion:
The research suggests that PTE may intensify the difficulties faced by individuals with TBI, but its impact on overall recovery might not be significant, considering the trajectory of the brain injury itself. Notably, the MoCA results indicate that cognitive deficits are more pronounced in PTE patients compared to those with TBI, underscoring the necessity for targeted neuropsychological assessments. Further investigation is essential to explore PTE’s broader neuropsychological and psychosocial impacts. These findings advocate for tailored care strategies that address both neuropsychological and psychosocial needs, ensuring comprehensive management of TBI and PTE.
This paper presents an artificial neural network (ANN)-based nonlinear model predictive visual servoing method for mobile robots. The ANN model is developed for state predictions to mitigate the unknown dynamics and parameter uncertainty issues of the physics-based (PB) model. To enhance both the model generalization and accuracy for control, a two-stage ANN training process is proposed. In a pretraining stage, highly diversified data accommodating broad operating ranges is generated by a PB kinematics model and used to train an ANN model first. In the second stage, the test data collected from the actual system, which is limited in both the diversity and the volume, are employed to further finetune the ANN weights. Path-following experiments are conducted to compare the effects of various ANN models on nonlinear model predictive control and visual servoing performance. The results confirm that the pretraining stage is necessary for improving model generalization. Without pretraining (i.e., model trained only with the test data), the robot fails to follow the entire track. Weight finetuning with the captured data further improves the tracking accuracy by 0.07–0.15 cm on average.
Coffee is one of the most popular beverages worldwide, and there is an increasing concern of the health risk of coffee consumption in pregnancy. Preeclampsia (PE) is a serious pregnancy disease that causes elevated blood pressure and proteinuria in pregnant women and growth restriction of fetuses due to poorly developed placental vasculature. The aim of our study is to investigate the possible effect of coffee intake during pregnancy in rats with potential underlying vasculature conditions. The endothelial nitric oxide synthase inhibitor N(gamma)-nitro-L-arginine methyl ester (L-NAME) at a high dose (125 mg/kg/d) was used to induce PE in pregnant rats, which were used as the positive control group. In addition, low-dose L-NAME (10 mg/kg/d) was used to simulate the compromised placental vasculature function in pregnant rats. Coffee was given together with low-dose L-NAME to the pregnant rats from gestational day 10.5–18.5. Our results show that the pregnant rats treated with low-dose L-NAME + coffee, but not low-dose L-NAME alone, developed PE symptoms such as prominent fetal growth restriction, hypertension, and proteinuria. Therefore, our findings suggest that coffee intake during pregnancy may cause an increased risk of PE in susceptible women.
The effect of single dietary fibre (DF) on lowering uric acid (UA) level has been reported in the literature. However, the potential protective mechanism of DF against potassium oxybate-induced hyperuricaemia (HUA), as modelled by prophylactic administration, remains unclear. The data demonstrate that DF significantly decreased serum and cerebral tissue UA concentrations, inhibited xanthine oxidase expression and activity in the liver and reduced levels of creatinine and urea nitrogen in the serum. Additionally, it mitigated the deposition of amyloid-β in cerebral tissue. Correlation analysis showed that DF modulated the Toll-like receptor 4/NF-κB signalling pathway, attenuating oxidative stress and inflammatory responses in HUA mice. Additionally, DF helps to maintain the composition of the gut microbiota, reducing harmful Desulfovibrio and enriching beneficial Akkermansia and Ruminococcus populations. The results of the faecal metabolomics analysis indicate that DF facilitates the regulation of metabolic pathways involved in oxidative stress and inflammation. These pathways include pyrimidine metabolism, tryptophan metabolism, nucleotide metabolism and vitamin B6 metabolism. Additionally, the study found that DF has a preventive effect on anxiety-like behaviour induced by HUA. In summary, DF shows promise in mitigating HUA and cognitive deficits, primarily by modulating gut microbiota and metabolites.
Pulmonary atresia with intact ventricular septum and critical pulmonary stenosis usually have to undergo treatment in the neonatal period. Compared to traditional surgical intervention, catheter-based cardiac interventions may achieve similar or superior outcomes for neonates with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, there is limited literature on anaesthesia techniques, challenges, and risks associated with cardiac catheterisation in this population.
Methods:
This article retrospectively analysed the clinical data of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis neonates who were treated with interventional cardiac catheterisation in our hospital from January 2015 to October 2022. Clinical outcomes considered were haemodynamic or pulse oxygen saturation instability, vasoactive requirements, prolonged intubation (>24 h postoperatively), and cardiovascular adverse events.
Results:
A total of 63 patients met the inclusion criteria. All patients survived the intervention. Among the patients with critical pulmonary stenosis, 40 successfully received percutaneous balloon pulmonary valvuloplasty, while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with pulmonary atresia with intact ventricular septum, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation and percutaneous balloon pulmonary valvuloplasty. Of these, five patients underwent ductal stenting due to unstable pulmonary blood flow. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy.
Conclusions:
There are various clinical techniques and risk challenges in the interventional cardiac catheterisation of neonatal pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, and predicting the procedure process and potential complications, anaesthesia and surgical risks can be effectively managed.
The measurement of X-ray continuous emission from laser-driven plasma was achieved through multiple monochromatic imaging utilizing a multilayer mirror array. This methodology was exemplified by the development of an eight-channel X-ray imaging system, capable of operating in the energy range of several keV with a spatial resolution of approximately 3 μm. By integrating this system with a streak camera, the temperature and trajectory of imploding capsules were successfully measured at the kJ-class Shenguang III prototype laser facility. This approach provides a synchronous diagnostic method for the spatial, temporal and spectral analysis of laser-driven plasma, characterized by its high efficiency and resolution.