Gap Area Research Articles

Governance for health system collaboration: The case of the South-West Queensland Primary Care Alliance, Queensland, Australia.

Background: Internationally, as countries orientate health systems to embrace an integrated, person-centered approach it demands a fundamental shift in the way health services are funded, managed and delivered. Requisite to meeting these challenges given the involvement of multiple organisations, and therefore varying governance arrangements, is strengthening of shared governance with clear and transparent accountability mechanisms, across the health system where initiatives to better integrate care are being implemented. Governance models to achieve this have been attempted in several countries. The best fit for the Australian system is likely to be the Alliance contracting approach.
 The Alliancing concept was derived from the construction industry, where different organisations work collaboratively to ensure achievement of common goal, to complete a project successfully, on time and within budget. They help one another and, where relevant, share resources. Alliance governance is the set of rules which govern an Alliance. At their core, they are centered around governance that ensures the building of collaboration and a ‘whole of system’ approach to service planning and delivery. This is different and challenging and calls on members to focus primarily on their community rather their individual circumstances / organisations.
 Target audience: Policy makers, health system executives, funders, researchers.
 Alliance Partners: Western Queensland Primary Health Network, South West Hospital & Health Services, Health Workforce Queensland, Charleville & Western Areas Aboriginal & Torres Strait Islander Community Health, Royal Flying Doctor Service, private general practices, and CheckUP.
 What we did: Thematic analysis of a previous SW partnership project, against evidence-based health governance elements for integrated care, to distil learning for the SW Primary Care 5-year plan and conducted a rapid review to identify further evidence base for the alliance governance model in health. This evidence was incorporated into a stakeholder workshop to advise implementation.
 Results/impact: Using an evidence-based governance framework for integrated care, the South-West Primary Care Alliance was developed. An Alliance Charter, outlining the rules of engagement and commitments, has been passed. A governance framework agreed and an implementation plan adopted.
 Learning for international audience: More recent Australian reform documents identify the importance of a regional approach in bringing together all sources of health funding into one coordinated local service delivery approach. In particular, the ongoing difficulty in aligning Australia’s fragmented Commonwealth and State health systems, mean that for our health system this is the most critical reform step. This is more ambitious than co-commissioning or bilateral project-focused funding. It includes all relevant service delivery organisations making formal governance commitments to work together over time in addressing key areas of service gap or duplication.
 Next steps: Three work programs have been identified by the Alliance Leadership Team for implementation 2023-2025. The first of these, workforce, has an implementation plan set for 2023. As part of the implementation the barriers and critical success factors to implementing and sustaining this model of care will be investigated.

EFFICACY OF MALNUTRITION SCREENING AMONG OLDER VETERANS AT AN URBAN VA HOSPITAL

Abstract Nearly half of the Veteran population is >65 years. Older Veterans are at increased risk of malnutrition associated with increased mortality, morbidity, length of stay, and readmissions. Malnutrition-focused quality measures are needed to combat this public health issue. The purpose of this study was to identify gaps in malnutrition screening at an urban VA facility. Chart auditing was conducted for all medical admissions during 72 hour periods across 14 months. Auditing determined if nutrition screening was completed, with an admission weight, and if nutrition was consulted for nutritionally compromised Veterans. Screening was conducted using the Malnutrition Screening Tool (MST). Additionally, estimated prevalence of nutritionally compromised Veterans was assessed using auditing data from 30 days. Audit data showed that on average only 57.4% (n=458) of Veterans admitted for inpatient care were screened correctly. Of those screened incorrectly, the three most common errors were 1) not collecting a weight on admission (N=82 (42.1%)); 2) inaccurate weight change interpretations (N=41 (21%)); 3) failure to refer nutritionally at-risk Veterans to nutrition services (N=38 19.5%)). Prevalence auditing demonstrated over 1/3 of Veterans were nutritionally compromised at the start of their hospitalization (36.43%, (N=295)). With an increasingly aging population in the United States there is a focus on shifting to value based payment systems. The new CMS Global Composite Malnutrition Score will include evaluation of hospitals malnutrition screening processes. There is a significant opportunity to close these gap areas and to adopt clinically relevant best practices to provide nutrition care earlier to at risk Veterans.

Исследование процесса впуска в газовых двигателях с внешним смесеобразованием

Purpose: To identify existing problems, namely the low homogeneity of the air-fuel mixture and fuel losses when valves are closed, and the advantages of central fuel injection, namely its relative ease of adjustment and location of gas injectors, and its main differences from distributed injection. To show existing ways to solve these problems. To demonstrate the lack of environmental and economic efficiency in central fuel injection. To calculate the amount of fuel entering the engine exhaust system when the valves are closed. To show ways to increase the efficiency of fuel utilization during engine operation. Methods: Calculation of the mass of natural gas entering the engine exhaust system during the valve overlap period, considering the duration of the period, the cross-sectional area of the valve gap, the total amount of fuel supplied during the intake stroke, the density of the fuel, the flow rate when entering the cylinder and the stoichiometric ratio. Results: The need to consider the amount of fuel consumed when operating a gas engine is shown. The existing problems of using central fuel supply are indicated. A method for calculating gas fuel losses when valves are closed is formulated and justified. It has been established which parameters influence the mass of fuel that does not enter the cylinder during the intake process. It is concluded that it is necessary to use other injection methods, or to significantly improve the intake process of central injection. Practical significance: The influence of the method of supplying fuel to a gas internal combustion engine on the environmental friendliness of the engine and fuel efficiency is shown. A method has been formulated for calculating gas fuel losses during the period of valve overlap, considering the design parameters of the intake system and the duration of opening of the intake valves.

Predictive factors for postoperative visual function in eyes with epiretinal membrane

Our current study aimed to investigate the association of preoperative OCT parameters with visual function after vitrectomy surgery in eyes with epiretinal membrane (ERM). This study enrolled 33 eyes with ERM that underwent vitrectomy surgery. In addition to visual acuity (VA), metamorphopsia was measured pre- and postoperatively for each eye. Using the preoperative horizontal and vertical OCT images, SUKIMA (the gap area between the ERM and retinal surface) was measured respectively and the average of horizontal SUKIMA and vertical SUKIMA was used for the analysis. The associations of baseline parameters (age, axial length, preoperative central retinal thickness [CRT], inner nuclear layer [INL] thickness, ectopic inner foveal layer [EIFL] and SUKIMA) with postoperative VA, the change in VA, postoperative metamorphopsia and the improvement in metamorphopsia were investigated using multivariate regression analysis followed by the model selection. The result suggested that age and INL thickness were related to the postoperative VA, whereas age and preoperative CRT were significantly associated with the change in VA. In contrast, only SUKIMA was correlated with the postoperative metamorphopsia, whilst age, EIFL and SUKIMA were associated with the improvement in metamorphopsia. Measuring SUKIMA might be useful for predicting postoperative metamorphopsia and the improvement in metamorphopsia in ERM eyes.

Hydraulic Expansion Joint Contact State of Heat Exchanger Based on New Contact Area Measurement Method

The contact state of a seamless internal threaded copper tube and an aluminium foil fin not only affects the heat transfer efficiency of a tube–fin heat exchanger but also seriously affects its service life. In this study, hydraulic expansion technology was used to connect the copper tube with an internal thread with a 7 mm diameter to the fin of the heat exchanger. The influence of the expansion pressure and pressure holding time on the contact state was analysed through experiments and finite element simulation, and the variation law of the two on the contact state was obtained. The contact state was characterised by the contact gap and contact area. In order to obtain the specific contact area value, a new method of measuring the contact area was developed to reveal the variation in contact area between the copper tube and the fin after expansion. The results show that the contact gap decreases with an increase in expansion pressure, while the pressure holding time remains the same. The contact area increases with an increase in expansion pressure, and the rate of increase slows. When the expansion pressure is 18 MPa, the average contact gap is approximately 0.018 mm. When the expansion pressure reaches 16 MPa, the contact area ratio is 91.0%. When the expansion pressure increases to 18 MPa, the contact area ratio only increases by approximately 0.6%. Compared with the influence of the expansion pressure on the increase in contact area, the influence of the pressure holding time on the contact area is lower.

Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map.

Social isolation and loneliness are more common in older adults and are associated with a serious impact on their well-being, mental health, physical health, and longevity. They are a public health concern highlighted by the COVID-19 pandemic restrictions, hence the need for digital technology tools to enable remotely delivered interventions to alleviate the impact of social isolation and loneliness during the COVID-19 restrictions. To map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings. We searched the following databases from inception to May 16,2021, with no language restrictions. Ovid MEDLINE, Embase, APA PsycInfo via Ovid, CINAHL via EBSCO, Web of Science via Clarivate, ProQuest (all databases), International Bibliography of the Social Sciences (IBSS) via ProQuest, EBSCO (all databases except CINAHL), Global Index Medicus, and Epistemonikos. Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate following the eligibility criteria. We developed and pilot tested a data extraction code set in Eppi-Reviewer and data were individually extracted and coded based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map. We included 200 articles (103 primary studies and 97 systematic reviews) that assessed the effects of digital interventions to reduce social isolation and/or loneliness in older adults. Most of the systematic reviews (72%) were classified as critically low quality, only 2% as high quality and 25% were published since the COVID-19 pandemic. The evidence is unevenly distributed with clusters predominantly in high-income countries and none in low-income countries. The most common interventions identified are digital interventions to enhance social interactions with family and friends and the community via videoconferencing and telephone calls. Digital interventions to enhance social support, particularly socially assistive robots, and virtual pets were also common. Most interventions focused on reducing loneliness and depression and improving quality of life of older adults. Major gaps were identified in community level outcomes and process indicators. No included studies or reviews assessed affordability or digital divide although the value of accessibility and barriers caused by digital divide were discussed in three primary studies and three reviews. Adverse effects were reported in only two studies and six reviews. No study or review included participants from the LGBTQIA2S+ community and only one study restricted participants to 80 years and older. Very few described how at-risk populations were recruited or conducted any equity analysis to assess differences in effects for populations experiencing inequities across PROGRESS-Plus categories. The restrictions placed on people during the pandemic have shone a spotlight onto social isolation and loneliness, particularly for older adults. This evidence and gap map shows available evidence on the effectiveness of digital interventions for reducing social isolation or loneliness in older adults. Although the evidence is relatively large and recent, it is unevenly distributed and there is need for more high-quality research. This map can guide researchers and funders to consider areas of major gaps as priorities for further research.

The electronic structure regulation improving xylene gas sensing properties in p-type Zn-doped α-Fe2O3 nanoparticles

Xylene is a highly carcinogenic inert gas, and achieving highly selective detection toward xylene gas is crucial for environmental protection and physical health. Herein, α-Fe2O3 nanoparticles doped with different Zn contents (ZF-0, ZF-1, ZF-2 and ZF-3) have been prepared through a feasible solvothermal and subsequent annealing treatment. The successful doping of Zn has been confirmed through EDS, XPS and XRD characterizations. After Zn doping, the baseline resistance in air reduces, the band gap and specific surface area decrease, but oxygen vacancy defects increase for α-Fe2O3 nanoparticles. When applied as gas sensors, all as-prepared α-Fe2O3 samples show typical p-type semiconductor gas sensing behaviors. Especially, the ZF-2 sample with appropriate amount of Zn doping exhibits an excellent xylene gas sensing selectivity. Meanwhile, the ZF-2 sensor shows a high response, fast response/recovery speed, well stability and repeatability and a detection limit of 5 ppm at 240 °C. The acceptor level and oxygen vacancy defects in ZF-2 nanoparticles promote the catalytic oxidation of xylene gas by p-type Zn-doped α-Fe2O3 oxide semiconductors, thereby resulting in better xylene gas sensing performance.

Multiband terahertz metamaterial perfect absorber for microorganisms detection

We report a multi-resonant terahertz (THz) metamaterial perfect absorber (MPA)-based biosensor in the working frequency range of 0 - 3.8 THz for sensing of microorganisms (such as fungi, yeast) and wheat pesticides. Nearly 100% absorption is realized at f_1= 1.7THz, f_2= 2.8THz, f_3=3.2THz, and f_4=3.5THz. We designed our THz MPA sensor making resonators’ gap area compatible with the microorganisms’ size. To obtain optimum performance of the MPA, a mapping of amplitudes and shifts in the absorption resonance peaks with different structural parameters of the resonators is carried out. A very high-frequency shift is obtained for microorganisms such as Penicillium chrysogenum (fungi), yeast, and pesticides (Imidacloprid, N, N-Diethyldithiocarbamate sodium salt trihydrate, Daminozide, N, N-Diethyldithiocarbamate sodium salt hydrate, and Dicofol). An equivalent circuit model using Advance Design System (ADS) software is developed. The calculated results through the model show similar trends as obtained in the simulations using CST. Investigations of the effect of incidence angle of THz wave on the absorption spectra of the MPA are also carried out. It is found that incidence angle does not impact the stability of the lower resonance absorption peak (1.79THz). Due to the wide working frequency range, the proposed sensor is extremely suitable for the detection of all range of pesticides because their specific absorption fingerprint lies in the frequency range of 0–3.8THz. We believe that our sensor could be a potential detection tool for detecting pesticide residues in agriculture and food products. The THz MPA-based biosensor is capable of detecting a very small change in the effective dielectric constant of the MPA environment. Therefore, it can also offer huge opportunities in label-free biosensing for future biomedical applications.

Analysis of the material removal and heat transfer during internal cooling grinding of GH4169

Nickel-based superalloys exhibit exceptional characteristics and have extensive applications in marine, energy, chemical, and various other fields. Nevertheless, nickel-based superalloys tend to produce substantial heat while being ground. The air barrier effect makes it difficult to spray coolant onto the grinding surface, resulting in poor cooling that leads to surface quality deterioration. This paper proposes a pressurized internal cooling grinding wheel with a removable abrasive ring to investigate the effects of flow channel structure and abrasive ring mounting position on grinding performance. A model was constructed to assess the flow and temperature fields of the grinding arc area, utilizing flow-solid heat transfer. The simulation results indicated that the cooling effect was more effective when the flow channel structure was a 2 mm diameter arc and the runner outlet was placed in the gap area. Additional trials were carried out on the grinding of GH4169 superalloys using pressurized internal cooling wheels to assess and evaluate the impact of flow channel structure and runner outlet position on grinding temperature, surface roughness, and surface topography. The findings indicate that the grinding wheel, characterized by its arc-shaped flow channel structure and runner outlet position within the gap area, exhibits superior grinding performance, resulting in reduced grinding temperature and enhanced surface quality.

Analysis of the effect of rigid vegetation patches on the hydraulics of an open channel flow with Realizable k-ε and Reynolds stress turbulence models

In this study, the effect of vegetation patches naturally located in the river and stream bed on flow characteristics was observed under laboratory conditions by using representative rigid vegetation. Then, the behavior of rigid vegetation was compared with two different (Realizable k-ε and Reynolds Stress) turbulence models using a CFD software (ANSYS-Fluent). Firstly, our use of models was validated. Then, they were used for numerical simulation. The velocity distributions energy dissipation, and turbulent intensities, at the determined points for the patches located in the downstream part, were analyzed with graphics and simulations. The vertical distribution of the average velocities was calculated at typical locations downstream. The magnitude of flow velocities was observed to decrease within the vegetation patch zone. The minimum values of the velocity magnitude were observed just behind the vegetation structures. Higher velocities were simulated in the vegetation patch regions compared with the gap regions. This identifies that the gap areas are appropriate for the deposition of sediments and advantageous for aquatic living beings in terms of physical atmosphere and nutriment. A maximum of 7 % energy dissipation difference occurred between the highest and lowest SVF values. For equal SVF values, a 1 % energy dissipation difference was obtained. This situation can be associated with the number of rods, and rod spacing being equal to the rod diameter. The 3-D turbulence intensity was only numerically measured and compared. Between the Realizable k-ε model and the RES model, the maximum 0.05 %turbulence density difference was observed (for SC1 and SC3 scenarios). We can associate this situation with the vortex and complex turbulent flow, which is formed from the channel bottom to the water surface, depending on the diameter of the rigid vegetation and the rod sequence. It was observed that there are effective methods to predict the flow model within both models.

Utilizing Digital Technology for Chatbot Innovation for E-Business

Over the past few years, chatbot research has accelerated. The performance, acceptance, and deployment of these tools for internal team communication or customer communication are the subject of research by academics and practitioners. Although there are a ton of current studies available, not all of them discuss the implications of Chatbots for digital business transformation. The primary goal of the research discussed in this paper was to conduct a systematic review of Chatbots, identify their function in the transformation of digital businesses, and identify the areas that need more research, benefits, and the gap areas for innovation of the Chatbots for E-business using the technology.

Study of the Antioxidant, Antimicrobial, and Wound Healing Properties of Raw Hydrolyzed Extract from Nile Tilapia Skin (Oreochromis niloticus).

Oreochromis niloticus (Nile tilapia) skin is a by-product of Brazilian fish farming, rich in collagen. The present study aims to evaluate the wound healing, antioxidant, and antimicrobial potential of the raw hydrolyzed extract of Nile tilapia skin, as well as the identification of the main compounds. The in vitro activity was performed using antioxidant, antimicrobial and scratch wound healing assays. An in vivo experiment was performed to evaluate the wound healing potential. On days 1, 7, 14 and 21, the lesions were photographed to assess wound retraction and on the 7th , 14th and 21st days the skins were removed for histological evaluation and the blood of the animals was collected for glutamic oxaloacetic transaminase and glutamic pyruvic transaminase determination. The chemical study was carried out through liquid chromatography-tandem mass spectrometry and de novo sequencing of peptides. The in vitro assays showed a reduction of the gap area in 24 h, dose-dependent antimicrobial activity for both bacteria, and antioxidant activity. The chemical analysis highlighted the presence of active biopeptides. The histological evaluation showed that the raw hydrolyzed extract of Nile tilapia skin has a healing potential, and does not present toxicological effects; therefore, is promising for the treatment of wounds.

Binary metal doped and graphene anchored LaCrO3 perovskite with boost light harvesting properties for environmental remediation

This study developed visible light-driven ABO3 type (perovskite) lanthanum chromite (LaCrO3) and Co–Ni co-doped (La1-xCoxCr1-yNiyO3; LCCNO) photocatalyst using a straightforward micro-emulsion process. Later, LCCNO nanoparticles were deposited on reduced graphene oxide (r-GO) utilizing an ultrasonication approach to form nanocomposite (LCCNO/r-GO). The investigation included structural, morphological, and elemental analyses, which were conducted using techniques such as x-ray diffraction (XRD), Fourier transform infrared (FT-IR), scanning electron microscopy (SEM), and energy dispersive x-ray (EDX) analysis. The present study investigated the impact of Co–Ni co-doping and rGO reinforcement on the bandgap and electrical conductivity in the context of optical analysis and current-voltage (I–V) experimentation. The nanomaterial's photocatalytic activity (PCA) was evaluated using crystal violet (CV), a well-recognized commercial dye. The composite as a photocatalyst exhibits superior CV dye photodegradation efficiency (99.02%; 100 min) compared to pure LCO (36.44%; 100 min) and co-doped LCCNO (73.74%; 100 min) counterparts due to its low band gap (2.14 eV), high conductivity (6.4 × 105 Sm−1), and large surface area (123.7 m2/g). Furthermore, a series of studies were conducted to examine the primary active free radicals generated by the composite material and to evaluate its long-term viability as a photocatalyst. The present research investigates the beneficial effects of co-doping and the incorporation of carbonaceous materials on the photocatalytic performance of ABO3-type perovskite.

Conservation gaps identification through patterns of species richness established from species niche models of mammals in a sector of Chaco Seco ecoregion

The identification of biodiversity conservation priority sectors that are not formally protected, have an essential part of conservation strategies and goals at global and local scale. Ecological niche modeling is a relevant and important tool for analysis and distribution of species, also is used to determine the biodiversity patterns through the regions. The main objective of this work was to identify the sites with high biodiversity patterns in a sector of Chaco Seco ecoregion that haven’t been protected with environmental legislation. Through biodiversity sampling with foot transects, camera traps and interviews, it was registered the presence of large and medium mammals in Santiago del Estero Province. Biodiversity pattern maps were then developed from potential distribution models (SDMs) of 5 mammalian species selected for being relevant for conservation. To define zones that could be characterized like conservation gaps, pattern maps were contrasted with protected areas layers and legal schemes of land use planning and also, protected forest. For the SDM, 171 records were used, 43 for M. gouazoubira, 40 for P. concolor, 20 for M. trydactila, 43 on P. tajacu and 25 on C. wagneri. Three models were used to make the biodiversity patterns, one of these, Fuzzy union, were used for the subsequent calculation. The total area of high biodiversity increases to 39.486 km², which represents the 29% of provincial area. In consequence the 81% remaining represents the conservation gaps areas for that sector of the ecoregion.

Does virtual consultation between primary and specialised care improve healthcare quality? A scoping review of healthcare quality domains assessment

BackgroundVirtual consultation has been proposed as a promising tool to improve the coordination and quality of healthcare between primary and specialised care. However, despite its potential facilitators, the evidence on...

Bridging the gap between the scale of protected areas and the conservation target of Kunming-Montreal Global Biodiversity Framework in Anhui Province

Kunming-Montreal Global Biodiversity Framework sets specific targets for future protected area (PA) scale. To bridge the gap between the scale of PA and conservation targets in Anhui Province, we identified priority conservation areas under different scenarios based on systematic conservation planning theory with biodiversity and key ecosystem services as conservation objects and HAI as conservation costs, and then identified conservation gap areas based on GAP analysis, and finally set specific PA construction targets for each city. The results of the study show that due to the small scale of established PA in Anhui Province, effective conservation of important areas for biodiversity and key ecosystem services cannot be achieved. Identifying priority conservation areas based on systematic conservation planning theory can effectively enhance conservation benefits of biodiversity and key ecosystem services. Therefore, we propose to use the conservation gap area as the potential construction area of PA and expand PA network which accounts for 23.08% of the total area of Anhui Province. Our work provides spatially explicit potential construction areas of PA to bridge the gap between the scale of PA and the conservation target of Kunming-Montreal Global Biodiversity Framework in Anhui Province, and provides a reference for cities to set construction targets for PA.

A comprehensive study of the effects of spark discharge duration on low-carbon combustion of high-pressure direct-injection propane: Factors affecting combustion, in-cylinder performance, and emissions

To address emissions and fuel depletion, stringent emissions regulations encourage the replacement of diesel with clean and sustainable fuels. Propane has benefits over liquid fuels due to its advantageous chemical and physical properties, such as low carbon number in the fuel component and no fuel evaporation problems. The effects of spark release duration on propane direct injection were studied using experiments and simulation on a modification head of large-bore RCEM using three spark ignition strategies. The validated model CFD was applied to study the combustion and emission of propane as well as the spatial distribution of propane in the research engine. The main objective was to determine how high-pressure direct injection of propane can increase the efficiency of CI engines and reduce particulate and standard emissions. Data analysis revealed that propane releases heat more gradually than diesel fuel. However, the steady burning of DI propane offered extra benefits, such as improved combustion rate, which affected exhaust gas production. The emissions reduction was realized with DI-propane combustion compared to diesel combustion. Propane produces fewer particulates than diesel. THC and NOx emissions from diesel vehicles were 1.8% lower and 32.3% higher, respectively, than propane combustion. It is feasible to decrease NOx, particulate, and unburned fuel pollutants while maintaining CO2 emissions at levels comparable to a diesel engine. Both the onset of propane injection and the length of ignition timing have been shown to be optimum factors in emissions and performance. As the spark duration advances, the temperature in the cylinder increases, leading to a heat release peak resulting from combustion of residual fuel near the cylinder liner and in the gap area.

Effect of embedded periodic fiber placement gap defects on the microstructure and bistable behavior of thermoplastic composite laminates

AbstractBy inducing periodic gaps, conventional automated fiber placement avoids overlap defects, which are generally prohibited in composite component manufacturing. However, bistable laminates are highly sensitive to imperfections, and it is critical to explore the effect of periodic gaps on the performance of bistable laminates. The principal curvatures and load–displacement curves of thermoplastic composite laminates with manually embedded periodic gaps was studied using experimental and numerical methods in this paper. SEM microscopy was used to observe the gap areas of the cross section of laminates to assess the microstructure of gaps with width variations after curing. In addition, a numerical method was proposed based on the experimentally determined evolution of gap widths and thicknesses of laminate. Subsequently, the effects of gap width, single‐layer thickness, and total thickness on the principal curvature were investigated. Gaps embedded in the 0° and 90° layers of bistable laminates demonstrated a substantial decrease in the snap load of the laminates. Interestingly, by embedding different gap widths in the 0° layers of the laminates, the snap load discrepancy between the snap‐through and snap‐back processes increased as the gap width widened, and the same trend was also found in the curvatures in the two stable states.Highlights Bistable characteristics of laminates with periodic gap defects. Utilizing gaps embedding in 0° layer to tailor the mechanical properties.

Economic openness, financial bias, and the urban–rural income gap

AbstractWe develop a theoretical model to analyze the impact of economic openness and financial bias (i.e., open sector bias and urban area bias) on the urban–rural income gap. Our theoretical model puts forth three propositions, which we empirically test using a dynamic panel data model. We use data from 30 provinces in China spanning from 2004 to 2017 for our empirical analysis. Our results reveal a U‐shaped relationship between the urban–rural income gap and the level of regional economic openness. We also find an inverted U‐shaped relationship between the urban–rural income gap and the open sector bias of regional financial development. Moreover, our analysis indicates a positive relationship between the urban–rural income gap and urban area bias in regional financial development. These three propositions hold true for both nominal and real measures of the income gap.

Initial and Residual 3D Fracture Displacement Is Predictive for Patient-Reported Functional Outcome at Mid-Term Follow-Up in Surgically Treated Tibial Plateau Fractures.

Conventional measures of fracture displacement have low interobserver reliability. This study introduced a novel 3D method to measure tibial plateau fracture displacement and its impact on functional outcome. A multicentre study was conducted on patients who had tibial plateau fracture surgery between 2003 and 2018. Eligible patients had a preoperative CT scan (slice thickness ≤ 1 mm) and received a Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A total of 362 patients responded (57%), and assessment of initial and residual fracture displacement was performed via measurement using the 3D gap area (mm2). Patients were divided into four groups based on the 3D gap area size. Differences in functional outcome between these groups were assessed using analysis of variance (ANOVA). Multiple linear regression was used to determine the association between fracture displacement and patient-reported outcome. Functional outcome appeared significantly worse when initial or residual fracture displacement increased. Multivariate linear regression showed that initial 3D gap area (per 100 mm2) was significantly negatively associated with all KOOS subscales: symptoms (-0.9, p < 0.001), pain (-0.0, p < 0.001), ADL (-0.8, p = 0.002), sport (-1.4, p < 0.001), and QoL (-1.1, p < 0.001). In addition, residual gap area was significantly negatively associated with the subscales symptoms (-2.2, p = 0.011), ADL (-2.2, p = 0.014), sport (-2.6, p = 0.033), and QoL (-2.4, p = 0.023). A novel 3D measurement method was applied to quantify initial and residual displacement. This is the first study which can reliably classify the degree of displacement and indicates that increasing displacement results in poorer patient-reported functional outcomes.