Large Improvement Research Articles

A significant increase in anthropometric indices during long-term follow-up of pediatric patients with celiac disease, with no endocrine disorders.

Celiac disease (CeD) is likely to be associated with growth impairment and poor weight gain. However, long-term growth patterns following diagnosis are poorly characterized. We evaluated long-term anthropometric changes in a large cohort of pediatric patients with CeD. A retrospective chart review of patients diagnosed with CeD between 1999 and 2018 was conducted. Demographic and clinical data were collected, and anthropometrics were analyzed from diagnosis and throughout follow-up. The study included 500 patients (59.8% females, median (IQR) age at diagnosis 5.7 (3.7-8.9) years), with a mean follow-up of 5.5 (range 1.5-16.2) years. Weight, height, and BMI Z-score-for-age (WAZ, HAZ, and BMIZ) increased significantly from a mean (± SD) of - 0.82 (± 1.21), - 0.73 (± 1.16), and - 0.32 (± 1.11) at diagnosis to - 0.41 (± 1.23), - 0.45(± 1.16), and - 0.17 (± 1.14) at last follow-up, respectively (p < 0.001 for WAZ and HAZ and p = 0.002 for BMIZ). The largest improvements were observed in patients diagnosed before 3years of age (p < 0.01). Patients for whom the final adult height was available (n = 86) improved from HAZ mean (± SD) - 0.89 ± 1.37 at diagnosis to - 0.51 ± 1.28 at adulthood measurement, p < 0.05. Wasting was present in 19.7% and stunting in 16.4% of the cohort at diagnosis and normalized in 77.3% and 64.8%, respectively, within a median (IQR) time of 0.79 (0.42-4.24) and 2.3 (0.72-6.02) years, respectively. Gluten-free diet adherence and frequency of visits were not associated with normalization of wasting or stunting in all age groups. Conclusion: Over a long-term follow-up, pediatric patients with CeD demonstrate significant increases in weight, height, and BMI-for-age. Younger age at diagnosis is associated with greater improvement in weight and linear growth, emphasizing the importance of early diagnosis of CeD. What is Known: • Celiac disease (СeD) is likely to be associated with growth impairment and poor weight gain. • Long-term changes in anthropometric indices after diagnosis of CeD are not well characterized. What is New: • Over a long-term follow-up, pediatric patients with CeD demonstrate significant increases in weight, height, and BMI-for-age. • Young age at diagnosis is associated with larger improvement in weight and linear growth.

Collegiate student-athletes concussion knowledge and attitudes: what a difference a decade Makes.

The purpose of this study was to assess changes in concussion knowledge and attitudes amongst incoming intercollegiate student-athletes over the course of a decade (2010-2012 vs 2021-2023). There were 592 student-athletes from 2 cohorts (2010-2012, 2021-2023) who completed the Rosenbaum Concussion Knowledge and Attitudes Survey (ROCKaS) questionnaire which is comprised of a concussion knowledge index (CKI, 0-24) and attitude index (CAI, 15-75) with higher scores reflecting better performance. A three factor ANOVA (Group, Sex, Concussion History) compared performance on the CKI and CAI. Individual questions were compared between groups with a Chi-Square analysis. For the CKI, there was a significant main effect for Group (2010-2012: 18.5 ± 2.6, 2021-2023: 19.4 ± 2.5, p < 0.001, . For the CAI, there was also a significant main effect for group (2010-2012: 52.9 ± 6.0, 2021-2023: 62.2 ± 6.5, p < 0.001, . The results of this study show a modest increase in concussion knowledge; however, large improvements in concussion attitudes were observed between groups. These results suggest a continued improvement in student-athlete concussion awareness and provide specific areas to continue addressing persistent misconceptions.

Realization and optimization of bismuth-activated Ba3Ga2O5Cl2 yellow phosphor for high-quality white LEDs

The development of high-quality lighting requires phosphors with excellent performance, and dramatically optimizing the luminescent properties of phosphors is a major challenge. Herein, a novel bismuth-activated yellow phosphor (Ba3Ga2O5Cl2:Bi3+) was firstly prepared by a multi-step solid-state reaction, and the crystal structure, luminescence characteristics, decay time, and thermal stability of the phosphor were systematically studied. Subsequently, the cation substitution strategy (Sr → Ba) was adopted to improve the optical properties. A comparison of the thermal quench performance of the phosphors before and after Sr substitution reveals that this strategy can effectively improve the thermal stability from 17.3 %@423 K to 61.1 %@ 423 K. More importantly, the luminescence intensity of the optimized phosphor was increased by about two times, and the quantum yield was significantly improved from 34.7 % to 85.0 %. Such a large improvement could be rationalized by the modulation of the local structure of Bi3+ ions or the change of band gap when Sr and Ba coexist in the host lattice. In addition, a WLED was prepared by combining Ba2.55Sr0.45Ga2O5Cl2:Bi3+ with commercially available blue phosphor (BaMgAl10O17:Eu2+) and red phosphor (CaAlSiN3:Eu2+) on a 365 nm LED chip, which achieved full-spectrum illumination and demonstrated potential applications.

Intravenous Hemin, a potential heme oxygenase-1 activator, does not protect from post-ERCP acute pancreatitis in humans: Results of a randomized multicentric multinational placebo-controlled trial

ObjectiveHemin, a heme oxygenase 1 activator has shown efficacy in the prevention and treatment of acute pancreatitis in mouse models. We conducted a randomized controlled trial (RCT) to assess the protective effect of Hemin administration to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in patients at risk. MethodsIn this multicenter, multinational, placebo-controlled, double-blind RCT, we assigned patients at risk for PEP to receive a single intravenous dose of Hemin (4 mg/kg) or placebo immediately after ERCP. Patients were considered to be at risk on the basis of validated patient- and/or procedure-related risk factors. Neither rectal NSAIDs nor pancreatic stent insertion were allowed in randomized patients. The primary outcome was the incidence of PEP. Secondary outcomes included lipase elevation, mortality, safety, and length of stay. ResultsA total of 282 of the 294 randomized patients had complete follow-up. Groups were similar in terms of clinical, laboratory, and technical risk factors for PEP. PEP occurred in 16 of 142 patients (11.3%) in the Hemin group and in 20 of 140 patients (14.3%) in the placebo group (p = 0.48). Incidence of severe PEP reached 0.7% and 4.3% in the Hemin and placebo groups, respectively (p = 0.07). Significant lipase elevation after ERCP did not differ between groups. Length of hospital stay, mortality and severe adverse events rates were similar between groups. ConclusionWe failed to detect large improvements in PEP rate among participants at risk for PEP who received IV hemin immediately after the procedure compared to placebo. Trial registration numberClinicalTrials.gov number, NCT01855841).

Cognitive and immunological effects of yoga compared to memory training in older women at risk for alzheimer’s disease

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) accompanied by cerebrovascular risk factors (CVRFs) are known to increase the risk of developing dementia. Mind-body practices such as yoga and meditation, have been recognized as safe techniques with beneficial effects on cognitive functions in older adults at risk for cognitive decline. We conducted a randomized, controlled trial to assess the efficacy of Kundalini yoga training (KY) compared to memory enhancement training (MET) on mood and cognitive functioning in a group of older women with CVRFs and SCD (clinicaltrials.gov = NCT03503669). The KY intervention consisted of weekly, 60-min in-person classes with a certified instructor for 12 weeks, with a 12-min guided recording for daily homework practice at home. MET involved 12 weekly in-person group classes with 12-min daily homework exercises. Objective and subjective memory performance were the primary outcomes. Peripheral whole blood samples were collected at baseline, 12-weeks, and 24-weeks follow-up for RNA sequencing and cytokine/chemokine assays. A total of 79 patients (KY = 40; MET = 39) were randomized, and 63 completed the 24-week follow-up (KY = 65% completion rate; MET = 95%; χ2(1) = 10.9, p < 0.001). At 24-weeks follow-up, KY yielded a significant, large effect size improvement in subjective cognitive impairment measures compared to MET. KYOn a transcriptional level, at 12- and 24-week follow-up, KY uniquely altered aging-associated signatures, including interferon gamma and other psycho-neuro-immune pathways. Levels of chemokine eotaxin-1, an aging marker, increased over time in MET but not KY participants. These results suggest clinical and biological benefits to KY for SCD, linking changes in cognition to the anti-inflammatory effects of yoga.

Efficacy of a new water-free topical cyclosporine 0.1% solution for optimizing the ocular surface in patients with dry eye and cataract.

This is a pooled analysis from 2 phase III clinical trials investigating a water-free topical cyclosporine 0.1% for the treatment of moderate to severe dry eye. The analyses included 1162 patients: 35% with cataract, 20% with pseudophakia, and 45% without cataract. Demographics or baseline characteristics were comparable across groups except for age and vision. The cyclosporine-treated patients achieved large mean improvements from baseline by day 15: -3.7 in patients without cataract, -3.2 in patients with cataract, and -3.1 in pseudophakic patients. These improvements were statistically significantly higher compared with the respective vehicle groups. In the cataract subgroup, 59% of patients treated with cyclosporine achieved ≥3 grade improvements in corneal staining score, as early as day 15. The magnitude of the effect and early onset of action make this new cyclosporine solution a promising candidate for preoperative management of ocular surface in patients undergoing cataract surgery.

Motivational drivers for health professionals in a large quality improvement collaborative project in Brazil: a qualitative study

BackgroundThe success of collaborative quality improvement (QI) projects in healthcare depends on the context and engagement of health teams; however, the factors that modulate teams’ motivation to participate in these projects are still unclear. The objective of the current study was to explore the barriers to and facilitators of motivation; the perspective was health professionals in a large project aiming to implement evidence-based infection prevention practices in intensive care units of Brazilian hospitals.MethodsThis qualitative study was based on content analysis of semistructured in-depth interviews held with health professionals who participated in a collaborative QI project named “Improving patient safety on a large scale in Brazil”. In accordance with the principle of saturation, we selected a final sample of 12 hospitals located throughout the five regions of Brazil that have implemented QI; then, we conducted videoconference interviews with 28 health professionals from those hospitals. We encoded the interview data with NVivo software, and the interrelations among the data were assessed with the COM-B model.ResultsThe key barriers identified were belief that improvement increases workload, lack of knowledge about quality improvement, resistance to change, minimal involvement of physicians, lack of supplies, lack support from senior managers and work overload. The primary driver of motivation was tangible outcomes, as evidenced by a decrease in infections. Additionally, factors such as the active participation of senior managers, teamwork, learning in practice and understanding the reason for changes played significant roles in fostering motivation.ConclusionThe motivation of health professionals to participate in collaborative QI projects is driven by a variety of barriers and facilitators. The interactions between the senior manager, quality improvement teams, and healthcare professionals generate attitudes that modulate motivation. Thus, these aspects should be considered during the implementation of such projects. Future research could explore the cost-effectiveness of motivational approaches.

Effects of plyometric jump training on measures of physical fitness and lower-limb asymmetries in prepubertal male soccer players: a randomized controlled trial

BackgroundHigh level of physical fitness is a paramount soccer performance factor. As such, developing key components of physical fitness such as sprinting, jumping, and change of direction (CoD) at an early age empowers both short- and long-term performance success. Although previous research in prepubertal male soccer players has reported physical fitness performance enhancements following plyometric jump training (PJT), the effects on inter-limb asymmetries remain unclear.ObjectiveTo assess the effects of PJT on measures of physical fitness and inter-limb asymmetries in prepubertal male soccer players.MethodsA total of 27 participants were recruited, and randomly assigned to either a PJT group (n = 13; age = 12.7 ± 0.2 years; maturity offset = -1.6 ± 0.7) or an active control group (CG) (n = 14; age = 11.8 ± 0.4 years; maturity offset = -2.51 ± 0.61). The training intervention lasted eight-week and was conducted during the in-season period, with twice-weekly sessions. Physical fitness tests were conducted before and after the intervention, including the 505 change-of-direction (CoD; [505 CoD test]), countermovement-jump (CMJ) height, standing-long-jump (SLJ) distance, and single-leg hop test for distance with dominant (SHTD-D) and non-dominant legs (SHTD-ND). A jump-based asymmetry score was calculated as the difference between HTD and HTND.ResultsANCOVA analysis revealed significant between-group differences in all physical fitness measures at post-test. Specifically, the PJT group showed significant large improvements in CMJ height, SLJ distance, HTD and HTND, and CoD speed (d = 0.84 to 2.00; ∆1.05% to 16.85%). Moreover, the PJT group showed a significant, small reduction in the inter-limb asymmetry score (d = 0.43; ∆-45.21%). In contrast, no significant changes were reported in the CG between pre-and post-tests (d = 0.07 to 0.24; ∆0.21% to 0.98%).ConclusionsThe incorporation of PJT into the training schedules of prepubertal male soccer players resulted in positive effects on various measures of physical fitness. Furthermore, our findings suggest that PJT can reduce lower-limb asymmetry, which could potentially decrease the risk of lower limb injuries.Trial registrationThis study does not report results related to healthcare interventions using human participants and therefore it was not prospectively registered.

Interactive segmentation of medical images using deep learning.

Medical image segmentation algorithms based on deep learning have achieved good segmentation results in recent years, but they require a large amount of labeled data. When performing pixel-level labeling on medical images, labeling a target requires marking ten or even hundreds of points along its edge, which requires a lot of time and labor costs. To reduce the labeling cost, we utilize a click-based interactive segmentation method to generate high-quality segmentation labels. However, in current interactive segmentation algorithms, only the interaction information clicked by the user and the image features are fused as the input of the backbone network (so-called early fusion). The early fusion method has the problem that the interactive information is much sparse at this time. Furthermore, the interactive segmentation algorithms do not take into account the boundary problem, resulting in poor model performance. So we propose early fusion and late fusion strategy to prevent the interaction information from being diluted prematurely and make better use of the interaction information. At the same time, we propose a decoupled head structure, by extracting the image boundary information, and combining the boundary loss function to establish the boundary constraint term, so that the network can pay more attention to the boundary information and further improve the performance of the network. Finally, we conduct experiments on three medical datasets (Chaos, VerSe and Uterine Myoma MRI) to verify the effectiveness of our network. The experimental results show that our network greatly improved compared with the baseline, and NoC@80(the number of interactive clicks over 80% of the IoU threshold) improved by 0.1, 0.1, and 0.2. In particular, we have achieved a NoC@80 score of 1.69 on Chaos. According to statistics, manual annotation takes 25 min to label a case(Uterine Myoma MRI). Annotating a medical image with our method can be done in only 2 or 3 clicks, which can save more than 50% of the cost.

Evaluating and Enhancing Snow Compaction Process in the Noah‐MP Land Surface Model

AbstractThe accuracy of snow density in land surface model (LSM) simulations impacts the accuracy of simulated terrestrial water and energy budgets. However, there has been little research that has focused on enhancing snow compaction in operationally used LSMs. A baseline snow simulation with the widely used Noah‐MP LSM systematically overestimates snow depth by 55 mm even after removing daily snow water equivalent (SWE) biases. To reduce uncertainties associated with snow compaction, we enhance the most sensitive Noah‐MP snow compaction parameter—the empirical parameter for compaction due to overburden (Cbd)—such that Cbd is calculated as a function of surface air temperature as opposed to a fixed value in the baseline simulation. This enhancement improves accuracy in simulated snow compaction across the majority of western U.S. (WUS) SNOTEL test sites (biases reduced at 88% of test sites), with modest bias reductions in cooler accumulation periods (biases reduced at 70% of test sites) and substantial improvements during warmer ablation periods (biases reduced at 99% of test sites). Relatively larger improvements during warm conditions are attributable to the default Cbd value being reasonable for cold temperatures (≤−5°C). Improvements in simulated snow depth and density with observations outside of the training sites and optimization periods support that the snow compaction enhancement is transferable in space and time. Differences between enhanced and baseline gridded simulations across the total WUS support that the enhancement can have important impacts on snowpack evolution, snow albedo feedback, and snow hydrology.

Towards Efficient Cross-Modal Anomaly Detection Using Triple-Adaptive Network and Bi-Quintuple Contrastive Learning

Cross-modal anomaly detection is a relatively new and challenging research topic in machine learning field, which aims at identifying the anomalies whose patterns are disparate across different modalities. As far as we know, this topic has yet to be well studied, and existing works often suffer from the incomplete anomalous data detection and low data utilization problems. To alleviate these limitations, this paper proposes an efficient deep cross-modal anomaly detection approach via Triple-adaptive Network and Bi-quintuple Contrastive Learning (TN-BCL), which lies among the earliest attempt to detect various cross-modal anomalies within the heterogeneous multi-modal data. To be specific, a triple-adaptive network is explicitly designed to identify various anomalies, whose patterns are disparate in both single-modal scenario and cross-modal scenario. On the one hand, the top branch network is utilized to adaptively detect the attribute anomalies and part of mixed anomalies in multi-modal data samples. On the other hand, the bottom two-branch network, with shared residual blocks, is leveraged to learn the discriminative cross-modal embeddings. At the same time, an efficient bi-quintuple contrastive learning method is designed to enhance the feature correlation between the same attribute data, while maximally enlarging the feature difference between different attribute data. Besides that, the bidirectional learning scheme is employed to significantly improve the data utilization. Through the joint exploitation of the above, different kinds of anomalous samples can be well detected across different modalities. Extensive experiments show that the proposed framework outperforms the state-of-the-art competing methods, with a large improvement margin.

Evaluation of the lower extremity functional test to predict lower limb injuries in professional male footballers

The Lower Extremity Functional Test (LEFT) is a reliable and valid test for the measurement of athletic fitness, fatigue resistance, and speed performance. Contradictory results exist regarding the screening value of the LEFT in predicting lower limb injuries. The purpose of this study was to investigate the screening value of the LEFT in predicting lower limb injuries in professional male footballers. One hundred and twenty-one professional male football players participated in the study. LEFT was recorded pre-season and the lower-limb injuries were recorded during a 9-month season. Logistic regression analysis was used to determine the accuracy of the prognosis of LEFT. A total of twenty-five lower limb injuries were recorded. The model explained 53% of the variance in lower limb injury, showing that predictions by LEFT score is reliable, and correctly predicted 89.3% of cases, which is a large improvement. ROC analysis showed significant accuracy of the LEFT score (AUC 0.908, 95% CI 1.126–1.336, p = 0.001, OR = 1.227) in discriminating between injured and uninjured players. The optimum cut-off level of the LEFT score was 90.21 s; Our findings showed that the LEFT score was able to predict lower limb injuries in professional male footballers. The slower an athlete’s LEFT scores, the more susceptible they are to future injury risk. Sports medicine specialists, football coaches and managers are suggested to use LEFT as a pre-season screening test to identify and prevent the weakness and functional imbalance of the athletes before the injury occurs by conducting this test.

Progress and Outlook of 10% Efficient AlGaN‐Based (290–310 nm) Band UVB LEDs

Eco‐friendly and low‐cost aluminum gallium nitride (AlGaN) for the epitaxial growth of ultraviolet‐B (UVB) light‐emitting diodes (LEDs) on c‐Sapphire has the possibility of high external‐quantum efficiency (EQE). In this review paper a special growth techniques for 50% relaxed and 4 μm thick AlGaN buffer layer underneath the multi‐quantum wells (MQWs) are challenged to achieve a maximum internal‐quantum efficiency of 50–57% in 310–290 nm band UVB LEDs. The influence of a thin “Valley” layer in p‐type multi‐quantum barrier electron‐blocking layer on 2D hole generation and injection via intraband tunneling was attempted. Finally, the influence of soft polarized Mg‐doped p‐type Al‐graded AlGaN hole injection layer assisted by excimer laser annealing for better hole injection toward the MQWs was investigated and quite high hole concentration of 2 × 1016 cm−3 and resistivity of 24 Ω‐cm at room temperature was achieved. Consequently, the EQE of transparent 310 and 304 nm UVB LEDs, respectively, reached to a confirmed world record values of ≈5% and ≈10% with light powers of 29 and 40 mW on wafer. This EQE value can surpass 21% if flip‐chip, nanoPSS, photonic crystal, and lens with highly reflective p‐electrodes are incorporated in LED.

Teach to comply? Evidence from a taxpayer education program in Rwanda

AbstractThere is virtually no evidence on the role of taxpayer education to improve tax compliance. We address this gap by providing the first evaluation of a taxpayer education program on compliance behavior, as well as taxpayer knowledge and perceptions. Using a unique dataset of administrative and survey data, we show that training new taxpayers leads to a large and significant improvement on three compliance outcomes: the probability to file declarations, to report a zero-tax amount, and tax due. These results are robust to three estimation strategies: a simple regression exploiting baseline balance across a wide set of observable variables, propensity score matching, and an IV strategy using random assignment to take part in our survey. We identify reduced compliance costs as the key mechanism at play in explaining the relationship between tax education and compliance—particularly increased knowledge and better perceptions on complexity. The effects we document persist over time, beyond the year of implementation.

Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals.

Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.

Gender Diversity Among Youth Attending an Intensive Interdisciplinary Pain Treatment Program.

Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.

Reviving spent lithium‐ion batteries: The advancements and challenges of sustainable black mass recovery

AbstractIdeally, once batteries reach their end‐of‐life, they are expected to be collected, dismantled, and converted into black mass (BM), which contains significant amounts of valuable metals. BM can be regarded as a sort of urban mine, where recyclers extract and reintroduce the materials into new battery manufacturing. Focusing on BM, this article discusses the necessity of BM recovery and current recycling situations. Although the benefits of recycling are widely acknowledged, many challenges and issues remain. The BM market is still in its infancy and relevant regulatory frameworks need to be updated with respect to the widespread use and advancement of lithium‐ion batteries. Current BM producing and processing technologies are gaining momentum and still have room for large improvements in terms of economic feasibility and environmental footprint. Finding solutions for these challenges in the end requires efforts from both researchers and industrial stakeholders with growing interests and long‐term patient engagement. Battery regulations and legal support are highly anticipated for industries to keep high levels of commitment to long‐term investments.

The influencing factors of residents’ willingness to pay in marine ecological restoration: The integration of the theory of planned behavior and social capital theory

Public participation in marine ecological restoration is of great significance to marine environmental protection and ecological security in China. Based on the contingent valuation method, this paper evaluates residents’ preference for marine ecological restoration, and shows that residents show the strongest preference for the increase in the number of intertidal organisms, followed by the improvement in coastal environment and seawater quality. The mean willingness to pay (WTP) for a large improvement in marine environment is predicted and is 108.96 CNY/a. Additionally, a comprehensive framework, which integrates social capital theory and the theory of planned behavior, is constructed to explore the influencing factors of residents’ WTP from the social and psychological levels. The results suggest that behavioral attitude, perceived behavioral control, and social network show a significantly direct impact on residents’ WTP. Furthermore, a mechanism is constructed from pushing power and pulling power to effectively promote public participation. This paper reveals public’s preference for marine ecological restoration and its formation mechanism, which can provide theoretical basis and empirical reference for promoting the public participation in marine ecological restoration.

Recent trends in disease-modifying therapy use and associated sickness absence and disability pension among people with multiple sclerosis in Sweden

Background: Disease-modifying therapies (DMTs) have led to improved health and work productivity among people with multiple sclerosis (PwMS). Objectives: To describe trajectories of recent DMT use and their association with sickness absence and/or disability pension (SADP) among PwMS in Sweden. Methods: A longitudinal register–based study was conducted among 1395 PwMS with treatment start in 2014/2015. While DMT use over 5 years was assessed using sequence analysis resulting in four clusters, a 7-year (Y−2 toY4) trend of SADP was analyzed using zero-inflated negative binomial regression. Results: Four clusters of DMT use trajectories were identified: long-term non-high-efficacy (483, 34.6%), long-term high-efficacy (572, 41%), escalation (221, 15.8%), and discontinuation (119, 8.5%). Progressive MS and higher expanded disability status scale scores were associated with the escalation, long-term high-efficacy, or discontinuation clusters. PwMS in the long-term high-efficacy and escalation clusters had higher likelihood of being on SADP. However, PwMS initiating high-efficacy DMTs demonstrated steeper decline in SADP than others. Conclusion: Using sequence analysis, this study showed recent DMT use trajectories among PwMS where initiation of high-efficacy DMTs has become more common. The trend of SADP was stable and lower in those using non-high-efficacy DMTs and larger improvements were shown in those initiating high-efficacy DMTs.

Systematic determination of the optimized Zr content of Ba(ZrxTi1-x)O3 with high dielectric constant at room temperature for high-voltage system application

In this study, by replacing the B-site element in BaTiO3, a ferroelectric material, with an element with a larger ionic radius, a ferroelectric material with high permittivity at room temperature was synthesized. The powders were prepared by solid-state reaction to perform lattice substitution with Zr4+ (0.72 Å), which has a larger ionic radius than Ti4+ (0.605 Å). To perform effective solid-state reaction and better understand the correlation between variables, this study introduced a design of experiment (DOE) based on the orthogonal array (OA) method included in the PIAno software. By substituting 0.222 mol of Zr, which has a large ionic radius, the crystal structure was deformed through an effective diffuse phase transition (DPT), and this resulted in the largest improvement in permittivity at room temperature. In addition, the powder, which underwent solid-state reaction at 1300 °C, formed the densest structure during sintering, which established the conditions for realizing the best dielectric properties. These results can be utilized as a key material for improving the properties of passive devices used in high-voltage industrial systems in societies undergoing the fourth industrial revolution.