Net Improvement Research Articles

Prognostic models for COVID-19 needed updating to warrant transportability over time and space

BackgroundSupporting decisions for patients who present to the emergency department (ED) with COVID-19 requires accurate prognostication. We aimed to evaluate prognostic models for predicting outcomes in hospitalized patients with COVID-19, in different locations and across time.MethodsWe included patients who presented to the ED with suspected COVID-19 and were admitted to 12 hospitals in the New York City (NYC) area and 4 large Dutch hospitals. We used second-wave patients who presented between September and December 2020 (2137 and 3252 in NYC and the Netherlands, respectively) to evaluate models that were developed on first-wave patients who presented between March and August 2020 (12,163 and 5831). We evaluated two prognostic models for in-hospital death: The Northwell COVID-19 Survival (NOCOS) model was developed on NYC data and the COVID Outcome Prediction in the Emergency Department (COPE) model was developed on Dutch data. These models were validated on subsequent second-wave data at the same site (temporal validation) and at the other site (geographic validation). We assessed model performance by the Area Under the receiver operating characteristic Curve (AUC), by the E-statistic, and by net benefit.ResultsTwenty-eight-day mortality was considerably higher in the NYC first-wave data (21.0%), compared to the second-wave (10.1%) and the Dutch data (first wave 10.8%; second wave 10.0%). COPE discriminated well at temporal validation (AUC 0.82), with excellent calibration (E-statistic 0.8%). At geographic validation, discrimination was satisfactory (AUC 0.78), but with moderate over-prediction of mortality risk, particularly in higher-risk patients (E-statistic 2.9%). While discrimination was adequate when NOCOS was tested on second-wave NYC data (AUC 0.77), NOCOS systematically overestimated the mortality risk (E-statistic 5.1%). Discrimination in the Dutch data was good (AUC 0.81), but with over-prediction of risk, particularly in lower-risk patients (E-statistic 4.0%). Recalibration of COPE and NOCOS led to limited net benefit improvement in Dutch data, but to substantial net benefit improvement in NYC data.ConclusionsNOCOS performed moderately worse than COPE, probably reflecting unique aspects of the early pandemic in NYC. Frequent updating of prognostic models is likely to be required for transportability over time and space during a dynamic pandemic.

Relationship between cerebral vasospasm vascular territory and functional outcome after aneurysmal subarachnoid hemorrhage

BackgroundVasospasm following aneurysmal subarachnoid hemorrhage (SAH) contributes significant morbidity and mortality after brain aneurysm rupture. However, the association between vascular territory of vasospasm and clinical outcome has not been studied....

Mid- to long-term clinical outcomes after press-fit short stem reverse shoulder arthroplasty

To date, a limited number of studies report mid- to long-term outcomes of press-fit short stem shoulder arthroplasty. The purpose of this study was to report and analyze mid- to long-term outcomes in a series of patients that received press-fit short stem reverse shoulder arthroplasty (RSA). The hypothesis was that press-fit short stem RSA would be a safe and effective treatment with satisfactory mid- to long-term outcomes. The authors retrospectively reviewed the records of 60 patients that received RSA using press-fit uncemented short humeral stems by two surgeons between March 2014 and December 2015. The absolute Constant Score (CS), age-/sex-adjusted CS, and the American Shoulder and Elbow Surgeons (ASES) score were recorded preoperatively and postoperatively at a minimum follow-up of 6 years. The proportions of patients that achieved a satisfactory outcome after RSA were based on the substantial clinical benefit, as proposed for the absolute CS (net improvement ≥19.1). Of the initial cohort of 60 patients, 9 (15%) died of causes unrelated to RSA, 5 (8%) were revised with partial implant removal, and 4 (7%) were lost to follow-up. This left a final cohort of 42 patients (70%) with complete postoperative CS (absolute and age-/sex-adjusted) and ASES scores at a mean follow-up of 6.7±0.5 years (range, 6.1-7.8). Of the final cohort, 11 (18%) had complications, of which 9 (15%) were treated conservatively, and 2 (3%) required reoperations without implant removal. Net improvements in functional outcomes were 34.7±21.2 for the absolute CS, 54%±32% for the age-/sex-adjusted CS, and postoperative ASES scores were 87.9±13.7. Of the 29 patients who had complete records for absolute CS, 22 (76%) received a substantial clinical benefit (net improvement ≥19.1). Mean net improvements of absolute CS exceeded the substantial clinical benefit after press-fit short stem RSA at a follow-up of 6.1 to 8.6 years. While 5 patients (8%) experienced postoperative instability, none had fracture sequelae, which indicates that offset or angular adjustments may be required even in patients with normal bony anatomy. Press-fit short stem RSA is a safe and effective treatment with satisfactory mid- to long-term outcomes, with no stem revisions for aseptic reasons, which compares favorably to the literature that reports high rates of osteolysis and subsequent stem loosening.

Effect of radial flows in fuel channels on thermal performance of counterflow tubular solid oxide fuel cells

Increasing the volumetric power density of solid oxide fuel cell (SOFC) stacks could enable their wider adoption in powering vehicles. The radial flows generated by inserts in gas channels of the tubular SOFC could enhance electrochemical reactions in porous electrodes and improve the power density. In this study, numerical simulations are performed to examine the influence of the enhanced exothermic electrochemical reactions on the temperature distributions in a counterflow tubular SOFC with inserts. We show that the radial flow in the fuel channel could improve the SOFC power density by 30% but lead to an increase in the maximum cell temperature gradient from 12 ℃/cm to 23 ℃/cm. The effects of radial flows under different inlet mass flow rates of hydrogen and methane are also examined. Compared with the conventional tubular SOFC, the percentage of power density improvements and the maximum cell temperature gradients of the tubular SOFC with inserts both increase with increasing inlet hydrogen mass flow rates. The maximum cell temperature gradient is increased from 12.8 ℃/cm to 47.5 ℃/cm as the percentage of net power density improvement is increased from 20% to 45%. We also demonstrate that increasing the inlet methane flow rate could adversely affect the SOFC performance, since the strong radial flow can remove the steam in porous anode, which impedes the methane steam reforming reaction and consequently reduces the output power density. The present work helps improve our understanding of heat and mass transfer characteristics of the radial flows in the tubular SOFC and helps build a foundation for SOFC channel designs.

Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia.

Although promising therapeutics are in the pipeline, bariatric surgery (also known as metabolic surgery) remains our most effective strategy for the treatment of obesity and type 2 diabetes mellitus (T2DM). Of the many available options, Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are currently the most widely used procedures. RYGB and VSG have very different anatomical restructuring but both surgeries are effective, to varying degrees, at inducing weight loss and T2DM remission. Both weight loss-dependent and weight loss-independent alterations in multiple tissues (such as the intestine, liver, pancreas, adipose tissue and skeletal muscle) yield net improvements in insulin resistance, insulin secretion and insulin-independent glucose metabolism. In a subset of patients, post-bariatric hypoglycaemia can develop months to years after surgery, potentially reflecting the extreme effects of potent glucose reduction after surgery. This Review addresses the effects of bariatric surgery on glucose regulation and the potential mechanisms responsible for both the resolution of T2DM and the induction of hypoglycaemia.

Predicting the risk of HIV infection among internal migrant MSM in China: An optimal model based on three variable selection methods.

Internal migrant Men who have sex with men (IMMSM), which has the dual identity of MSM and floating population, should be more concerned among the vulnerable groups for HIV in society. Establishing appropriate prediction models to assess the risk of HIV infection among IMMSM is of great significance to against HIV infection and transmission. HIV and syphilis infection were detected using rapid test kits, and other 30 variables were collected among IMMSM through questionnaire. Taking HIV infection status as the dependent variable, three methods were used to screen predictors and three prediction models were developed respectively. The Hosmer-Lemeshow test was performed to verify the fit of the models, and the net classification improvement and integrated discrimination improvement were used to compare these models to determine the optimal model. Based on the optimal model, a prediction nomogram was developed as an instrument to assess the risk of HIV infection among IMMSM. To quantify the predictive ability of the nomogram, the C-index measurement was performed, and internal validation was performed using bootstrap method. The receiver operating characteristic (ROC) curve, calibration plot and dynamic component analysis (DCA) were respectively performed to assess the efficacy, accuracy and clinical utility of the prediction nomogram. In this study, 12.52% IMMSMs were tested HIV-positive and 8.0% IMMSMs were tested syphilis-positive. Model A, model B, and model C fitted well, and model B was the optimal model. A nomogram was developed based on the model B. The C-index of the nomogram was 0.757 (95% CI: 0.701-0.812), and the C-index of internal verification was 0.705. The model established by stepwise selection methods incorporating 11 risk factors (age, education, marriage, monthly income, verbal violence, syphilis, score of CUSS, score of RSES, score of ULS, score of ES and score of DS) was the optimal model that achieved the best predictive power. The risk nomogram based on the optimal model had relatively good efficacy, accuracy and clinical utility in identifying internal migrant MSM at high-risk for HIV infection, which is helpful for developing targeted intervention for them.

Novel strategies of Ensemble Model Output Statistics (EMOS) for calibrating wind speed/power forecasts

The issue of the accuracy of wind speed/power forecasts is becoming more and more important as wind power production continues to increase year after year. Having accurate forecasts for the energy market clashes with intrinsic difficulties of wind forecasts due to, e.g., the coarse resolution of Numerical Weather Prediction models. Here, we propose a novel Ensemble Model Output Statistics (EMOS) which accounts for nonlinear relationships between predictands and both predictors and other weather observables used as conditioning variables. The strategy is computationally cheap and easy-to-implement with respect to other more complex strategies dealing with nonlinear regressions. Our novel strategy is assessed in a systematic way to quantify its added value with respect to ordinary, linear, EMOS strategies. Wind speed/power forecasts over Italy from the Ensemble Prediction System (EPS) in use at the European Centre for Medium-Range Weather Forecasts (ECMWF) are considered for this purpose. The calibrations are based on the use of past wind speed measurements collected by 69 SYNOP stations over Italy in the years 2018 and 2019. Our results show the key role played by conditioning variables to disentangle the model error (wind/power) thus allowing a net improvement of the calibration with respect to ordinary EMOS strategies.

Real-Time Nondestructive Evaluation of Additive Manufacturing Using a Laser Vibrometer and Shock Tube

Abstract Additive manufacturing (AM) parts retain a certain degree of individuality and could suffer from a combination of different defect types, and therefore the nondestructive evaluation on AM parts remains a challenging task. Engineering non-contact and nondestructive real-time inspection and in situ quality assurance of AM parts would be a net improvement compared to current quality control methods that are conducted post-production. Here, the authors propose to combine the use of a laser vibrometer with a compression-driven shock tube to assess the quality of AM parts through the evaluation of the vibration spectra of the part. An AM of a cylindrical part was selected for the study, along with different defect types and sizes. These defects include internal voids of different sizes at different locations, local changes in thickness (infill), and local changes in melting temperatures. A numerical model was created and validated using experimental data to conduct model-assisted probability of detection (MAPOD). Results were analyzed by evaluating correlation matrices between different models. Results showed that vibration spectra induced by a shock wave were sensitive to different types and sizes of defects under the studied geometry. The defect index yielded an approximately linear relationship with respect to defect void severity. MAPOD curve studies revealed a minimum detectable void defect of 0.039% of the AM part’s volume.

Predictive models for musculoskeletal injury risk: why statistical approach makes all the difference

ObjectiveCompare performance between an injury prediction model categorising predictors and one that did not and compare a selection of predictors based on univariate significance versus assessing non-linear relationships.MethodsValidation and replication...

Thermodynamic Optimization of Advanced Organic Rankine Cycle Configurations for Geothermal Energy Applications

The Organic Rankine Cycle (ORC) is commonly accepted as a viable technology to convert from low to medium temperature geothermal energy into electrical energy. In practice, the reference technology for converting geothermal energy to electricity is the subcritical simple ORC system. Over time, geothermal ORC plants with more complex configurations (architectures) have been developed. In the open literature, a large number of advanced architectures or configurations have been introduced. An analysis of the scientific literature indicates that there is some confusion regarding the terminology of certain advanced ORC system architectures. A new categorization of advanced configurations has been proposed, with a special emphasis on the application of geothermal energy. The basic division of advanced plant configurations is into dual-pressure and dual-stage ORC systems. In this study, the real potential of advanced ORC architectures or configurations to improve performance as compared with the simple ORC configuration was explored. The research was conducted for a wide range of geothermal heat source temperatures (from 120 °C to 180 °C) and working fluids. Net power output improvements as compared with the basic subcritical simple ORC (SORC) configuration were examined. The ability to produce net power with different ORC configurations depends on the magnitude of the geothermal fluid temperature and the type of working fluid. At a lower value of geothermal fluid temperature (120 °C), the most net power of 18.71 (kW/(kg/s)) was realized by the dual-pressure ORC (DP ORC configuration) with working fluid R1234yf, while the double stage serial-parallel ORC configuration with a low-temperature preheater in a high-temperature stage ORC (DS parHTS LTPH ORC) generated 18.51 (kW/(kg/s)) with the working fluid combination R1234yf/R1234yf. At 140 °C, three ORC configurations achieved similar net power values, namely the simple ORC configuration (SORC), the DP ORC configuration, and the DS parHTS LTPH ORC configuration, which generated 31.03 (kW/(kg/s)) with R1234yf, 31.07 (kW/(kg/s)) with R1234ze(E), and 30.96 (kW/(kg/s)) with R1234ze(E)/R1234yf, respectively. At higher values of geothermal fluid temperatures (160 °C and 180 °C) both the SORC and DP ORC configurations produced the highest net power values, namely 48.58 (kW/(kg/s)) with R1234ze(E), 67.23 (kW/(kg/s)) with isobutene for the SORC configuration, and 50.0 (kW/(kg/s)) with isobutane and 69.67 (kW/(kg/s)) with n-butane for the the DP ORC configuration.

Possible evidence of near transfer effects after adaptive working memory training in persons with multiple sclerosis

BackgroundCognitive deficits, especially in working memory (WM) and information processing (IP) efficiency, are common in people with multiple sclerosis (PwMS). Few studies have examined the efficacy of n-back training in improving these two cognitive functions in PwMS. In the present study, we examined the effects of an intensive n-back training program by measuring the gains on the trained task (2- and 3-back tasks), but we also studied possible near transfer effects to other tests that assess WM and IP, as well as far transfer effects or improvements in other cognitive functions. MethodsA sample consisting of 35 PwMS with different cognitive statuses. All the participants underwent an adaptive n-back training for 10 days (60 min/day), and they were neuropsychologically assessed at baseline (D1) and after training (D10). The effectiveness of the training was tested: (1) by using mean-based comparisons and Cohen's d values; (2) by estimating and comparing the quartile values of the D1 and D10 distributions. Two indexes of improvement in individual performance were calculated, the net score improvement index (NSI) and the percent of maximum possible individualized improvement (PMPI). ResultsRepeat practice improves 2- and 3-back performance, showing more correct responses (CR) and lower reaction times (RT) on D10 compared to D1. These results were corroborated by the NSI and PMPI scores, but the gains after training were more statistically significant for the 3-back (observing higher CR and lower RT after training) than for the 2-back (observing gains in CR, but not in RT). We also observed a possible transference of this improvement on the n-back task to other WM/IPS tests. Specifically, statistically significant pre-post training differences were found in the values in three quartiles of the Paced Auditory Serial Addition Test (PASAT; q25, p < 0.03; q50, p < 0.001; q75, p < 0.002) and of the Symbol Digit Modalities Test (SDMT; q25, p < 0.03; q50, p < 0.001; q75, p < 0.001) as well as in two quartiles of the Letter-Number Sequencing Task (LNST; q50, p < 0.004; q75 p < 0.001), and in one quartile of the Digit Backwards Span Test (DSBT; q75, p < 0.001). Reliable change analyses confirmed these performance improvements on the PASAT, SDMT, and LNST. ConclusionsThis study confirmed that the intensive and adaptive n-back training produced improvements in the trained task in PwMS with different cognitive statuses. Furthermore, these gains were not only observed on the trained task, but they seemed to be also transferred to other tests that measured WM and IP functions.

Scrutinizing the physical, structural, elastic, optical and gamma ray shielding properties of Samarium ions infused Niobium Bariumtelluroborate glasses

The present work reports the physical, structural, elastic, optical, and radiation shielding studies on (80˗X)H3BO3+10TeO2+9.5Nb2O5+XBaO+0.5Sm2O3 (where X = 10, 20, 30, 40, 50 in wt%) glasses which is prepared by the melt quenching technique. The bending and stretching vibrations of the different compounds used are analyzed through FTIR instrumentation. The density and refractive indices are measured experimentally following Archimedes's principles and by using Abbe's refractometer, respectively. Various structural parameters are calculated to resolve the actual placement of atoms in the glass complex, which explains the compactness of the network. Elastic properties of the synthesized glasses are calculated to estimate the resistance of glass under stress. Additionally, the optical band gap is calculated, and the nature of bonds in the network is ionic compared to the covalent nature. Boron–Boron distance is the lowest for 50BNTBSm sample. The decrease in OPD content is linked with the decrease in the number of oxygen atoms, for 10BNTBSm and 50BNTBSm glasses, it is 289 and 209 oxygen atoms, respectively. Λth value is high for 10BNTBSm glass sample with the minimum BaO reinforcement. The Urbach's energy varies from 0.534 to 0.967 eV, corresponding to xBNTBSm samples indicating fewer defects in the glasses. Moreover, gamma-ray and fast neutron attenuation properties of xBNTBSm are determined and compared with numerous shielding materials such as concrete and other types of glasses. Results showed that replacing 40% of H3BO3 with BaO leads to a net improvement in gamma-ray attenuation properties. However, this situation was the opposite in the fast neutron absorption properties. A clear superiority of sample 50BNTBSm was also reported against the compared absorbent materials. It can be concluded that replacing 40% of H3BO3 with BaO would provide some significant improvements to Niobium Bariumtelluroborate glasses.

A Simple Nomogram for Predicting Osteoarthritis Severity in Patients with Knee Osteoarthritis.

Objective To explore the influencing factors of knee osteoarthritis (KOA) severity and establish a KOA nomogram model. Methods Inpatient data collected in the Department of Joint Surgery, Chengde Medical University Affiliated Hospital from January 2020 to January 2022 were used as the training cohort. Patients with knee osteoarthritis who were admitted to the Third Hospital of Hebei Medical University from February 2022 to May 2022 were taken as the external validation group of the model. In the training group, the least absolute shrinkage and selection operator (LASSO) method was used to screen the factors of KOA severity to determine the best prediction index. Then, after combining the significant factors from the LASSO and multivariate logistic regressions, a prediction model was established. All potential prediction factors were included in the KOA severity prediction model, and the corresponding nomogram was drawn. The consistency index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), GiViTi calibration band, net classification improvement (NRI) index, and integrated discrimination improvement (IDI) index evaluation of a model predicted KOA severity. Decision curve analysis (DCA) and clinical influence curves were used to study the model's potential clinical value. The validation group also used the above evaluation indexes to measure the diagnostic efficiency of the model. Spearman correlation was used to investigate the relationship between nomogram-related markers and osteoarthritis severity. Results The total sample included 572 patients with knee osteoarthritis, including 400 patients in the training cohort and 172 patients in the validation cohort. The nomogram's predictive factors were age, pulse, absolute value of lymphocytes, mean corpuscular haemoglobin concentration (MCHC), and blood urea nitrogen (BUN). The C-index and AUC of the model were 0.802. The GiViTi calibration band (P = 0.065), NRI (0.091), and IDI (0.033) showed that the modified model can distinguish between severe KOA and nonsevere KOA. DCA showed that the KOA severity nomogram has clinical application value with threshold probabilities between 0.01 and 0.78. The external verification results also show the stability and diagnosis of the model. Age, pulse, MCHC, and BUN are correlated with osteoarthritis severity. Conclusions A nomogram model for predicting KOA severity was established for the first time that can visually identify patients with severe KOA and is novel for indirectly evaluating KOA severity by nonimaging means.

Medicaid expansion increases survival for patients with cancer.

Medicaid expansion increases survival for patients with cancer.

Investigation of physical, strength, and ductility characteristics of concrete reinforced with banana (Musaceae) stem fiber

Natural fibers derived from plant wastes possess a negligible carbon footprint and a high tensile strength. Therefore, researchers are focusing on the technical evaluation of cementitious materials with bio-based fibers. The stems of the banana plant consist of high-quality textile-grade fiber bundles possessing high tensile strength and toughness. Owing to these characteristics banana stem fiber (BSF) can be used as a reinforcement for plain concrete. Therefore, this study is devoted to the evaluation of the properties of concrete with various concentrations of BSF. The performance of BSF in concrete was also compared with artificial polypropylene fiber (PPF) at the same volumes of fibers (i.e., 0.25, 0.5, and 1%). The results revealed that 0.25% and 0.5% volumes of BSF were highly useful to the tensile and flexural strength of concrete. However, residual compressive and tensile strength improved with the increasing volume of BSF. At 0.5% BSF, compressive strength, splitting tensile strength, and flexural strength of concrete experienced net improvements of 6%, 40%, and 10%, respectively. The mechanical performance of BSF was comparable to that of the artificial PPF. Electrical resistivity increased with the rising fiber volume. Whereas, ultrasonic pulse velocity gradually decreased with rising fiber content and reduced by 7% at 1% BSF. Scanning electron microscopic (SEM) analysis revealed a negligible shrinkage of BSF filaments in the cementitious matrix. This behavior was contrary to that observed with other natural fibers.

Diagnostic value of maternal alpha-fetoprotein variants in second-trimester biochemical screening for trisomy 21 and 18

To evaluate the clinical predictive value of serum alpha-fetoprotein variants (AFP-L2, AFP-L3) in combination with maternal serum prenatal screening biomarkers in predicting fetal trisomy 21 and trisomy 18. We analyze the data of singleton pregnant women at 15–20+6 weeks of 731,922 gravidas from October 2007 to September 2019. The research objects were separated into the following groups: control (n = 569), trisomy 21 (n = 116), and trisomy 18 (n = 52). The cases were diagnosed by chromosomal karyotypic analysis of amniotic fluid cells. Level of AFP-L2 and AFP-L3 were detected in maternal serum among control women and patients. Receiver operator characteristic analysis, detection rate, false positive rate, false negative rate, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio, comprehensive discriminant improvement, net weight classification improvement, decision curve analysis and Hosmer–lemeshow (H-L) test were used to investigate the predictive value of free β-hCG, AFP, AFP-L2 and AFP-L3 on the risk models of trisomy 21, 18. There was a statistically significant difference in maternal serum AFP-L2 and AFP-L3 multiple of the median (MoM) among the trisomy 21, trisomy 18, and control groups. The AUCs of AFP-L2 and AFP-L3 for the screening trisomy 21 and trisomy 18 fetus were 0.785, 0.758 and 0.775, 0.754. According to ROC, the optimal cut-off values of AFP-L2 and AFP-L3 for predicting trisomy 21 and trisomy 18 fetuses all were 1.09 MoM and 1.30 MoM, respectively. The risk-calculation model constructed by AFP-L2 + AFP-L3 MoM manifested better efficiency than the original single-value truncation method using AFP MoM alone. Compared with different modeling methods, the AUC of trisomy 21 fetuses predicted by AFP-L2 + AFP-L3 + free β-hCG achieved an optimal value (0.938), while the AUC of trisomy 18 fetus predicted by AFP-L2 + free β-hCG was the best (0.991). Compared with AFP, the IDI of AFP-L2 or AFP-L3 alone increased 9.56% and 12.34%; the NRI increased 26.50% and 26.70 in predicting trisomy 21. For trisomy 18, the IDI of AFP-L2 or AFP-L3 alone declined with 8.12% and 1.52%; the NRI declined with 13.84% and 8.54%. In the combined model, the model with best detection rate, false positive rate and positive likelihood ratio was AFP-L2 + AFP-L3 + free β-hCG, followed by AFP-L2 + free β-hCG and AFP-L3 + free β-hCG, and finally AFP + free β-hCG. Maternal serum AFP-L2 and AFP-L3 in the second trimester is a good marker for screening trisomy 21 and trisomy18 with high sensitivity and specificity. The combined screening results are better than the single marker, and the efficiency of AFP-L2 + AFP-L3 + free β-hCG is the best.

Effect of micro-silica on the physical, tensile, and load-deflection characteristics of micro fiber-reinforced high-performance concrete (HPC)

In this research, the influence of micro-silica (MS) was studied on the tensile and flexural behavior of micro-carbon fiber (MCF) reinforced HPC. For this purpose, a total of twelve concrete mixes were designed incorporating six different doses of MCF (at 0%, 0.15%, 0.25%, 0.5%, 0.75% and 1%) with and without MS.The examined properties included compressive strength, splitting tensile strength, load-deflection behavior, ultrasonic pulse velocity, and water absorption. It was found that without MS inclusion, MCF shows a nominal contribution to the mechanical properties. However, the efficiency of MCF incorporation improved phenomenally due to MS addition. The incorporation of MCF at an optimum dose (0.5–0.75% volume fraction) showed 32% and 6% net improvements in modulus of rupture with and without MS, respectively. The micro-filler and pozzolanic effect of MS particles enhanced the bond strength and efficiency of micro-filaments of MCF. MS incorporation delayed the fracture of fiber-reinforced HPC under flexural loading.

Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study.

BackgroundCompared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances.ObjectiveWe performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population.MethodsWe recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience–Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment.ResultsParticipants’ baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them “a great deal” to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one’s abilities to provide care to the care recipient (4/12, 33%).ConclusionsThe study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency.

Consciousness-Domain Index: a data-driven clustering-based consciousness labeling.

Assessing consciousness results in one of the most complex neurological diagnosis. Even more complex and uncertain is prognosticating on consciousness recovery. Currently, consciousness is assessed by using a six-items scale, the Coma Recovery Scale-Revised. Namely, scores on the sub-items can individually assign or not a specific level of consciousness to a patient. In our work, by using solely the six sub-items of the CRS-R, we implemented a clustering algorithm labeling patients with the Consciousness-Domains Index (CDI) starting from a dataset of 190 patients with a Disorder of Consciousness (DoC). Then, the CDI is compared with the clinical state at admission and at six months via univariate analysis. The number of clusters best dividing the groups resulted equal to two and the most influencing sub-items resulted the visual and motor one. The CDI closely resembles the clinical state at admission (CSA) (Cohen's k=0.85). On the other hand, when comparing CDI and CSA, a net improvement was found in the prognostic power of the neurological outcome at six months, targeted as presence/absence of a DoC ( ). Data-driven techniques pave the way for automated and model-based search of prognostic factors, together with the use of such prognostic factors in multivariate prognostic models. Future works will address the external validation of the CDI, together with the inclusion of the CDI in a multivariate supervised model, in order to assess the true potential of such novel index. Clinical Relevance- A completely data-driven index was derived from a clustering of CRS-R sub-items. It correlates with the neurological outcome at six months better than the state of consciousness at admission.

Experimental investigation on the oxidation process and mechanism of steel billet under oxygen-enriched combustion atmosphere

ABSTRACT Oxygen-enriched combustion is a promising next-generation combustion technology for the metallurgy industry, allowing net efficiency improvement compared to traditional combustion technology. In this paper, an experimental investigation of the Q235 billet oxidation process for oxygen-enriched combustion, based on a thermogravimetric furnace, is carried out to comprehend the scaling kinetic reheat by oxygen-enriched combustion. The formation of iron oxide scale under different temperatures (800–1200°C) and atmospheric combustion conditions was investigated by an isothermal kinetic experiment to simulate an oxygen-enriched combustion atmosphere (21–40%O2). This experiment observed the effects of heating time, surface temperature, combustion oxygen content, and oxidizing gas composition in the flue gas (H2O, CO2) on weight gain of billet oxidation. Conducted investigations demonstrate that the surface temperature of the billet and the oxygen content of the combustion is positively related to the oxidation rate. Temperature is the primary factor affecting the oxidation of billet. The oxide scales gaining weight in the component of oxygen-enriched combustion flue gas, O2, H2O, and CO2 are 26, 62, and 39 (mg/cm2), respectively. Although oxygen oxidation is the most vital factor among the flue gas, the water vapor is the dominant factor in the oxidation degree of the billet as its highest content. Moreover, the dynamic curve under different atmosphere and temperature conditions was investigated. Kinetic analysis shows that the billet oxidation process with oxygen-enriched combustion is closer to the SCM model.