Reduction In Slope Research Articles

Accounting for adaptation when projecting climate change impacts on health: a review of methods

Abstract Exposure to high and low temperatures can cause harm to health. Temperature related health effects are likely to increase in the future, due to global warming, unless populations can adapt to a warming environment. Adaptation occurs through multiple mechanisms, however, the amount that populations may adapt to rising temperatures is unclear. There are currently a variety of methods used to include adaptation in projections, but it is unclear how underlying assumptions are made and whether they are based on evidence. With increasing interest from decisionmakers around implementation of adaptation strategies, an important step in responding to climate change will be to understand how adaptation can statistically be incorporated when estimating future health burdens. A systematic scoping review was conducted to identify all quantitative methods to include adaptation in studies projecting future temperature-related health impacts under climate change. Approaches employed in studies were coded into methodological categories. Advantages and disadvantages of each method were also explored, along with the empirical basis for model assumptions. Eight methodological categories were identified from the included fifty-nine studies. More recent methods of including adaptation in projections use a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most used approaches in the literature to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were categorised as using an empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence where possible. Key messages • Including adaptation in future projections considerably affects temperature-related mortality numbers. • All future impact assessments should include adaptation uncertainty and assumptions should be based on evidence where possible.

Anterior Slope–Modifying Osteotomies Alter the Length Change Behavior of the Superficial Medial Collateral Ligament: A Biomechanical Study

Background: Increased tibial slope has been shown to lead to higher rates of anterior cruciate ligament graft failure. A slope-decreasing osteotomy can reduce in situ anterior cruciate ligament force and may mitigate this risk. However, how this procedure may affect the length change behavior of the medial ligamentous structures is unknown. Purpose/Hypothesis: The purpose of this study was to examine the effect of anterior slope–modifying osteotomies on the medial ligamentous structures. It was hypothesized that (1) decreasing the tibial slope would lead to shortening of the superficial medial collateral ligament (sMCL), (2) while the fibers of the posterior oblique ligament (POL) would be unaffected. Study Design: Descriptive laboratory study. Methods: Eight fresh-frozen cadaveric knee specimens underwent anatomic dissection to precisely identify the medial ligamentous structures. The knees were mounted in a custom-made kinematics rig with the quadriceps muscle and iliotibial tract loaded. An anterior slope–modifying osteotomy was performed and fixed using an external fixator, which allowed modification of the wedge height between −15 and +10 mm in 5-mm increments. Threads were mounted between pins positioned at the anterior, middle, and posterior parts of the tibial and femoral attachments of the sMCL and POL. For different tibial slope modifications, length changes between the tibiofemoral pin combinations were recorded using a rotary encoder as the knee was flexed between 0° and 120°. Results: All sMCL fiber regions shortened with slope reduction (P < .001) and lengthened with slope increase (P < .001), with the anterior sMCL fibers more affected than the posterior sMCL fibers. A 15-mm anterior closing-wedge high tibial osteotomy (ACWHTO) resulted in a 6.9% ± 3.0% decrease in the length of the anterior sMCL fibers compared with a 3.6% ± 2.3% decrease for the posterior sMCL fibers. A 10-mm anterior opening-wedge high tibial osteotomy (AOWHTO) increased anterior sMCL fiber length by 5.9% ± 2.3% and posterior sMCL fiber length by 1.6% ± 1.0%. The POL fibers were not significantly affected by a slope-modifying osteotomy. Conclusion: Tibial slope–modifying osteotomies changed the length change pattern of the sMCL such that an AOWHTO increased whereas an ACWHTO decreased the sMCL strain. This effect was most pronounced for the anterior fibers of the sMCL. The length change pattern of the POL remained unaffected by slope-modifying osteotomy. Clinical Relevance: Surgeons should be aware that anterior tibial slope–modifying osteotomies affect the biomechanics of the sMCL. After an extensive ACWHTO, patients may develop a medial or anteromedial instability, while an AOWHTO may overconstrain the medial compartment.

Microsaccadic suppression of peripheral perceptual detection performance as a function of foveated visual image appearance.

Microsaccades are known to be associated with a deficit in perceptual detection performance for brief probe flashes presented in their temporal vicinity. However, it is still not clear how such a deficit might depend on the visual environment across which microsaccades are generated. Here, and motivated by studies demonstrating an interaction between visual background image appearance and perceptual suppression strength associated with large saccades, we probed peripheral perceptual detection performance of human subjects while they generated microsaccades over three different visual backgrounds. Subjects fixated near the center of a low spatial frequency grating, a high spatial frequency grating, or a small white fixation spot over an otherwise gray background. When a computer process detected a microsaccade, it presented a brief peripheral probe flash at one of four locations (over a uniform gray background) and at different times. After collecting full psychometric curves, we found that both perceptual detection thresholds and slopes of psychometric curves were impaired for peripheral flashes in the immediate temporal vicinity of microsaccades, and they recovered with later flash times. Importantly, the threshold elevations, but not the psychometric slope reductions, were stronger for the white fixation spot than for either of the two gratings. Thus, like with larger saccades, microsaccadic suppression strength can show a certain degree of image dependence. However, unlike with larger saccades, stronger microsaccadic suppression did not occur with low spatial frequency textures. This observation might reflect the different spatiotemporal retinal transients associated with the small microsaccades in our study versus larger saccades.

Efficient electrocatalysts for OER: Amorphous cerium-doped cobalt sulfide with enhanced performance and durability

Developing highly efficient electrocatalysts is essential for advancing the oxygen evolution reaction (OER), a key step in water splitting. In this study, a novel approach for the synthesis of an amorphous sulfide structure has been presented. First, a cerium-doped zeolitic imidazolate framework-67 (Ce-ZIF-67) using a co-precipitation method, followed by a multi-step transformation process. This process includes oxidation to form cerium-doped cobalt oxide (Ce-CO) and a subsequent sulfidation step to produce an amorphous cerium-doped cobalt sulfide (Ce-CS) structure. The introduction of cerium and the formation of an amorphous sulfide structure result in a significantly enhanced OER performance due to increased atomic disorder, improved electron mobility, and an expanded active surface area. Remarkably, the Ce-CS structure achieved a reduction in overpotential from 352 mV for Ce-CO to 291 mV at 100 mA cm−2 in 1.0 M KOH, alongside a Tafel slope reduction from 86.2 mA decade−1 to 67.2 mV decade−1. These enhancements underline the importance of cerium doping and amorphization in optimizing electrocatalytic efficiency. Furthermore, the Ce-CS catalyst demonstrated exceptional durability, with no observable degradation in performance or structural integrity after 10 h of continuous operation. This work presents a pioneering strategy for designing and synthesizing highly effective OER electrocatalysts, contributing a significant advancement to the field.

Guidelines for clinical evaluation of chronic kidney disease in early stages

BackgroundFor the development of pharmaceutical products in kidney field, appropriate surrogate endpoints which can predict long-term prognosis are needed as an alternative to hard endpoints, such as end-stage kidney disease. Though international workshop has proposed estimated glomerular filtration rate (GFR) slope reduction of 0.5–1.0 mL/min/1.73 m /year and 30% decrease in albuminuria/proteinuria as surrogate endpoints in early and advanced chronic kidney disease (CKD), it was not clear whether these are applicable to Japanese patients.MethodsWe analyzed J-CKD-DB and CKD-JAC, Japanese databases/cohorts of CKD patients, and J-DREAMS, a Japanese database of patients with diabetes mellitus to investigate the applicability of eGFR slope and albuminuria/proteinuria to the Japanese population. Systematic review on those endpoints was also conducted including the results of clinical trials published after the above proposal.ResultsOur analysis showed an association between eGFR slope and the risk of end-stage kidney disease. A 30% decrease in albuminuria/proteinuria over 2 years corresponded to a 20% decrease in the risk of end-stage kidney disease patients with baseline UACR ≥ 30 mg/gCre or UPCR ≥ 0.15 g/gCre in the analysis of CKD-JAC, though this analysis was not performed on the other database/cohort. Those results suggested similar trends to those of the systematic review.ConclusionThe results suggested that eGFR slope and decreased albuminuria/proteinuria may be used as a surrogate endpoint in clinical trials for early CKD (including diabetic kidney disease) in Japanese population, though its validity and cutoff values must be carefully considered based on the latest evidence and other factors.

Optimizing the Support System of a Shallow Buried Tunnel under Unsymmetrical Pressure

In the construction process of tunnel inlet sections, the rock mass can sustain unsymmetrical pressure due to asymmetrical terrain on the two sides of the tunnel. The fact that the inlet sections are usually under shallow buried conditions with strongly weathered rock mass exacerbates the issue. This paper discusses optimization strategies of the initial support of a shallow buried tunnel based on the analytical results of asymmetrical loading characteristics. Numerical simulation is performed with particle flow code (PFC) using the Jianshanji tunnel project as an example. The simulation results show that the bench excavation has slightly less total deformation than the full-section excavation but the deformation range is wider, especially in the tunnel arch. Both lining support and slope reduction treatments can effectively improve rock deformation, with lining support demonstrating better performance in controlling deformation and adjusting stress distribution. Based on the simulation results, the bench excavation and lining support are used in the actual project, and the corresponding optimization control measures were adopted to address deformation issues, including crushed-stone backfilling for compression resistance, advanced grouting reinforcement, and grouting. The field data show that the tunnel stability is effectively improved by adopting the optimization schemes, which further validates the effectiveness of the proposed unsymmetrical control method.

Tailoring Interventions for Control of Endemic Carbapenem-Resistant Acinetobacter baumannii: An Interrupted Time Series Analysis.

We examined temporal trends in carbapenem-resistant Acinetobacter baumannii (CRAB) infections in a hospital with hyperendemic CRAB and assessed the efficacy of varied infection control strategies in different ward types. We retrospectively analyzed all CRAB clinical samples from 2006 to 2019 and categorized infections as hospital-onset (HO) or community-onset. We used interrupted time series analysis to assess the impact of interventions on the incidence of all HO-CRAB infections and bloodstream infections (BSIs) at the hospital and ward group levels. Over 14 years, 4009 CRAB infections were identified (89.7% HO), with 813 CRAB BSI (93.2% HO). The incidence per 100 000 patient-days of CRAB infections peaked in 2008 at 79.1, and that of CRAB BSI peaked in 2010 at 16.2. These rates decreased by two-thirds by 2019. In the general intensive care unit (ICU), hand hygiene and environmental cleaning interventions were followed by a significant reduction in the level of HO-CRAB infections, with an additional decrease in the slope after the introduction of active surveillance and 2% chlorhexidine bathing. In the surgical ICU and surgical department, a reduction in slope or level of CRAB infection was observed after moving ventilated patients to single rooms. In medical wards, a multimodal intervention was followed by a reduction in the slope of HO-CRAB infections and BSIs. In wards where CRAB infections were uncommon, the incidence of HO-CRAB infections decreased throughout the study period. Ward-specific variables determine the success of interventions in reducing CRAB infections; therefore, interventions should be tailored to each setting.

Transcranial Alternating Current Stimulation over Frontal Eye Fields Mimics Attentional Modulation of Visual Processing.

Attentional control over sensory processing has been linked to neural alpha oscillations and related inhibition of cerebral cortex. Despite the wide consensus on the functional relevance of alpha oscillations for attention, precise neural mechanisms of how alpha oscillations shape perception and how this top-down modulation is implemented in cortical networks remain unclear. Here, we tested the hypothesis that alpha oscillations in frontal eye fields (FEFs) are causally involved in the top-down regulation of visual processing in humans (male and female). We applied sham-controlled, intermittent transcranial alternating current stimulation (tACS) over bilateral FEF at either 10 Hz (alpha) or 40 Hz (gamma) to manipulate attentional preparation in a visual discrimination task. Under each stimulation condition, we measured psychometric functions for contrast perception and introduced a novel linear mixed modeling approach for statistical control of neurosensory side effects of the electric stimulation. tACS at alpha frequency reduced the slope of the psychometric function, resulting in improved subthreshold and impaired superthreshold contrast perception. Side effects on the psychometric functions were complex and showed large interindividual variability. Controlling for the impact of side effects on the psychometric parameters by using covariates in the linear mixed model analysis reduced this variability and strengthened the perceptual effect. We propose that alpha tACS over FEF mimicked a state of endogenous attention by strengthening a fronto-occipitoparietal network in the alpha band. We speculate that this network modulation enhanced phasic gating in occipitoparietal cortex leading to increased variability of single-trial psychometric thresholds, measurable as a reduction of psychometric slope.

Study on the Evolution Pattern of Complex Topographic Flow Field in Typical Tableland and Hogback Ridge

The flow field in complex mountainous wind farms is highly intricate, affecting the accuracy of wind resource assessments and the reliability of wind turbine operation. In order to study the evolving characteristics of the flow field in typical complex terrains under different inflow wind directions and wind speeds, this paper, based on the open-source software OpenFOAM, adopts a neutral atmospheric boundary layer model combined with Reynolds-averaged turbulence model to construct a high-precision flow field model for complex terrains. The research reveals that this model requires fewer computational resources and can effectively simulate the flow characteristics around complex terrains. Wind resource distribution in tableland terrains and hogback ridge terrains is more influenced by the height of the mountains, and the recovery speed of the wake behind the mountains decreases with a reduction in slope. In hogback ridge terrains, under a wind direction of 0 °, the wind acceleration effect at the top of the hogback ridge is stronger than under a wind direction of 270°, as it experiences more intense compression from the mountains. This paper can provide reference for micro-siting in complex terrain.

Dry Downhill Particle Motion on Mars

We recently flew a new setup on parabolic flights for the first time to study particle motion on Martian slopes under Martian gravity. Here, we describe the initial experiments. We used dust/sand beds at varying ambient pressure of a few hundred pascals. The inclination of the particle bed was varied from 0° to 45° and parts of the surface were illuminated under varying conditions. We could observe downhill motion of material related to the insolation at the lowest light flux used of 591 ± 11 W m−2 for JSC Martian simulant. Motion occurred at significantly lower inclinations under illumination than without illumination, i.e., down to about 10° compared to about 20°–30°, respectively. We attribute this reduction in slope to thermal creep gas flow in the subsoil. This induces a Knudsen compressor, which supports grains against gravity and leads to smaller angles of repose. This is applicable to recurring slope lineae and slopes on Mars in general.

Tibial Slope Is Not Associated With Implant Migration Following Cemented Total Knee Arthroplasty With a Single Implant Design

BackgroundThe influence of tibial slope on tibial component migration following total knee arthroplasty has not been widely studied, although excessive posterior slope has been implicated in some failures. As implant micromotion measured with radiostereometric analysis can indicate successful fixation, the purpose of this study was to determine the associations between tibial slope, tibial component migration, and inducible displacement. MethodsRadiostereometric analyses at 6 visits over 2 years quantified implant migration for 200 cemented total knee arthroplasties. Longitudinal data analysis examined the influence of postoperative tibial slope on implant migration (overall maximum total point motion (MTPM) migration and anterior–posterior tilt migration), accounting for age, sex, and body mass index. The correlations of tibial slope with 1-year migration, continuous migration, and inducible displacements were also examined. Additionally, the amount of change in slope was compared to migration. ResultsThe mean posterior tibial slope was 8.0° (standard deviation [SD] 3.8°) preoperatively and 3.8° (SD 3.1°) postoperatively, with a mean reduction in slope of 4.2° (SD 4.7°). Postoperative tibial slope (range 14.0° posterior slope to 3.4° anterior slope) was not associated with longitudinal overall migration (P = .671) or anterior–posterior tilt migration (P = .704). There was no association between postoperative tibial slope and migration at 1 year postoperatively (P = .441 for MTPM migration, P = .570 for tilt migration), change in migration from 1 to 2 years (P = .951), or inducible displacement (P = .970 MTPM, P = .730 tilt). The amount of change in tibial slope was also not associated with migration or inducible displacement. ConclusionsResidual and change in postoperative tibial slope were not associated with implant migration into tilt or overall migration, or inducible displacement for a single implant design. These findings support positioning tibial implants in a range of slopes, which may support patient-specific approaches to implant alignment.

Accurate surgical posterior tibial slope alteration can be achieved in total knee arthroplasty regardless of surgeon skill level or local soft tissue thickness-A retrospective radiograph-based study.

To retrospectively report on the impact of local soft tissue thickness and surgeon skill level on the accuracy of surgical posterior tibial slope (PTS) alteration achieved in patients undergoing total knee arthroplasty (TKA) utilising lateral knee radiographs. Pre- and postoperative radiographs of 82 patients undergoing primary TKA using conventional mechanical alignment technique were measured by two observers and subjected to quality criteria for accurate measurement of the PTS. All patients underwent a standardised surgical approach for PTS alteration: cruciate-retaining (CR) cases with preoperative PTS ≤ 10° were set for reconstruction of the preoperative PTS. Cases indicated for posterior-stabilised (PS) design and/or with a preoperative PTS > 10° were set for 3° of postoperative PTS. Pretibial subcutaneous fat (PSF) and surgeon skill level were analysed for their predictive quality regarding the accuracy of surgical PTS alteration achieved. The overall mean postoperative PTS was significantly lower than the preoperative values (6.2°, SD 2.7 vs. 7.7°, SD 3.2; p = 0.002103). Neither local soft tissue thickness, namely PSF, nor surgeon skill level was found to be a predictor of the accuracy of surgical PTS alteration achieved. Among cases set for PTS reconstruction, 25.9% and 42.6% achieved a postoperative PTS within ±1° and ±2° of preoperative values, respectively. In patients with a PTS > 10° or those indicated for PS design, slope reduction was achieved with a mean postoperative PTS of 6.5°. Furthermore, 14.3% and 32.1% of cases were within ±1° and ±2° of 3, respectively. This study demonstrates that accurate surgical alteration of the PTS is possible in TKA regardless of local knee soft tissue thickness or surgeon skill level. This proves the clinical feasibility of both targeted reduction as well as reconstruction of the PTS in TKA. Level III, retrospective cohort study.

National taxation on sugar-sweetened beverages and its association with overweight, obesity, and diabetes

BackgroundConsumption of sugar-sweetened beverages (SSBs) has been linked to several adverse health outcomes, thus many countries introduced taxation to reduce it. ObjectivesTo summarize national SSB taxation laws and to assess their association with obesity, overweight and diabetes. MethodsWe conducted a systematic scoping review up to January 2022 on PubMed, Web of Science, Embase, and Google Search to identify taxes on SSBs. An interrupted time series analysis (ITSA) was conducted on 17 countries with taxation implemented in 2013 or before to evaluate the level and slope modifications in the rate of change of standardized prevalence rates of overweight, obesity, and diabetes. Random-effects meta-regression was used to assess whether year of entry into force of the law, national income, and tax design affected observed results. ResultsWe included 76 tax laws issued between 1940 and 2020 by 43 countries, which were heterogeneous in terms of tax design, amount, and taxed products. Among children and adolescents, ITSA showed level or slope reduction for prevalence of overweight and obesity in 5 (Brazil, Samoa, Palau, Panama, Tonga) and 6 (El Salvador, Uruguay, Nauru, Norway, Palau, Tonga) countries out of 17, respectively. No clear pattern of modification of results according to investigated factors emerged from the meta-regression analysis. ConclusionsTaxation is highly heterogeneous across countries in terms of products and design, which might influence its effectiveness. Our findings provide some evidence regarding a deceleration of the increasing prevalence rates of overweight and obesity among children occurring in some countries following introduction of taxation.PROSPERO registration number: CRD42021233309.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. Boehringer Ingelheim and Eli Lilly.

Symptom Trajectories in the Electronic Health Record during the Transition to Maintenance Dialysis.

How symptoms recorded in the electronic health record change during the transition to dialysis has not been fully explored. We used the Optum deidentified Integrated Claims-Clinical dataset to identify individuals with CKD stages 4 or 5 who transitioned to dialysis. We searched structured data elements from clinical notes, identified by natural language processing, for symptoms recorded across weekly intervals in the 6 months before and after dialysis initiation and estimated changes in the odds of a symptom being recorded with an interrupted time series analysis using segmented logistic regression. The cohort comprised 728 individuals (aged 68±13 years, 44% women, 56% White, 30% Black). Before dialysis initiation, 83% were recorded as having pain, 68% fatigue/weakness, 66% shortness of breath, 61% nausea/vomiting, and 37% difficulty concentrating. Before dialysis initiation, odds of pain being recorded increased (slope: odds ratio [OR] 1.02 per week, 95% confidence interval [CI], 1.01 to 1.03); initiation was associated with a decrease (intercept change: OR 0.70, 95% CI, 0.59 to 0.82). After initiation, odds of pain were unchanged (postdialysis slope: OR 1.00 per week, 95% CI, 0.99 to 1.01), although this represented an improved trajectory relative to the predialysis period (change in slope: OR 0.98 per week, 95% CI, 0.96 to 0.99). For fatigue/weakness, odds increased before initiation (OR 1.03 per week, 95% CI, 1.02 to 1.04) but decreased on initiation (OR 0.62, 95% CI, 0.51 to 0.75) and thereafter (OR 0.98 per week, 95% CI, 0.97 to 0.99), representing a reduction in slope (OR 0.95 per week, 95% CI, 0.94 to 0.97). Patterns for shortness of breath, nausea/vomiting, and difficulty concentrating were similar to those of pain. Thus, the odds of five key symptoms being recorded in the electronic health record increased over time in the 6 months before dialysis initiation, decreased immediately on initiation, and, generally, remained unchanged in the 6 months thereafter.

Sacubitril/valsartan for treatment of symptomatic non-obstructive hypertrophic cardiomyopathy: a randomised, controlled, phase II clinical trial (SILICOFCM)

Abstract Aim To evaluate the effect of sacubitril/valsartan on exercise capacity, cardiac structure, and function in patients with hypertrophic cardiomyopathy (HCM). Methods Phase II, randomised, open-label multicentre study enrolled adult patients with symptomatic non-obstructive HCM (NYHA class I–III) who were randomly assigned (2:1) to receive sacubitril/valsartan (target dose 97/103mg) or usual care for 16 weeks. Primary endpoint was a change in peak oxygen consumption (peak VO2). Secondary endpoints included echocardiography measures of cardiac structure and function, natriuretic peptides and other biomarkers, and Minnesota Living with Heart Failure quality of life (QoL). Results Between May 2018 and November 2021, 354 patients were screened for eligibility, 115 patients (mean age 58 years [SD 11], 37% women) met the study inclusion criteria and were randomly assigned to sacubitril/valsartan (N=79) or usual care (N=36). At 16 weeks, there was no significant change in peak VO2 from baseline in sacubitril/valsartan (15.3 [4.3] vs 15.9 [4.3] ml/kg/min, p=0.13), or usual care group (p=0.47). There was a significant reduction in ventilatory efficiency slope (30.1 [7] vs 28.4 [4.9], p=0.03), but not in the control group (p=0.09). No significant changes were found in systolic or diastolic function, cardiac structure, or plasma biomarkers. The QoL score decreased significantly in the sacubitril/valsartan by 6 points (p=0.005) but not in the usual care group (p=0.66). Conclusion In patients with hypertrophic cardiomyopathy, 16 weeks of treatment with sacubitril/valsartan was well tolerated and contributed to a significant improvement in ventilatory efficiency and quality of life but not in exercise capacity or cardiac function.

Fabrication and performance of highly stacked GeSi nanowire field effect transistors

AbstractHorizontal gate-all-around field effect transistors (GAAFETs) are used to replace FinFETs due to their good electrostatics and short channel control. Highly stacked nanowire channels are widely believed to enhance drive current of these devices and improve overall transistor density due to their small footprint. Here we demonstrate the fabrication and characterization of nanowire FETs with stacked 16 Ge0.95Si0.05 nanowires and stacked 12 Ge0.95Si0.05 nanowires without parasitic channels. The device has the high on current (ION) of 190 μA per stack (9400 μA/μm per channel footprint) at overdrive voltage (VOV) = drain-source voltage (VDS) = 0.5 V and the high maximum transconductance (Gm,max) of 490μS (24000μS/μm) at VDS = 0.5 V among reported Si/Ge/GeSi 3D nFETs. Note that the transistor performance can be evaluated by the delay, which is depicted as CV/I. If the transistor ION is improved, the delay of standard cell can be reduced, leading to faster operation of the circuit. The subthreshold slope reduction and ION/IOFF improvement are achieved by the parasitic channel removal. In technology computer aided design (TCAD) simulation, the wrap around contacts are useful to reduce the current difference between the channels. With the proper design of transistor height, the gate delay can be also improved.

Enhancing Overland Flow Infiltration through Sustainable Well-Managed Thinning: Contour-Aligned Felled Log Placement in a Chamaecyparis obtusa Plantation

Contour felling is a restoration method used to decrease overland flow (OF) and soil erosion in the world. However, the impact of thinning and the placement of felled logs on OF remains inconclusive. Low ground cover and soil permeability promote OF in Chamaecyparis obtusa (Siebold et Zucc.) Endl plantations, making thinning a method for reducing runoff. We examined the relationship between OF and ground cover in a C. obtusa plantation in Japan. Event-based runoff was monitored in three plots from 2016 to 2021, with 40% thinning conducted in 2019. In plot T1, logs were randomly scattered, and, in T2, logs followed contour lines, while control plots stayed the same. After thinning, both treatment plots showed lower OF than the control plot. The ANCOVA test shows a significant slope reduction in treatment plots compared to the control plot from pre-thinning to post-thinning (T1: 0.67 to 0.26, T2: 0.66 to 0.12, p &lt; 0.001, Tukey HSD test). However, in plot T2, OF remained stable for two years post-thinning, affirming the enduring effectiveness of contour-aligned log placement. This study backs the notion that aligning fallen logs with contour lines boosts long-term OF infiltration, supporting sustainable forest and soil management.

Effect of nano‐silica on fatigue behavior of glass fiber‐reinforced epoxy composite laminates: A Weibull distribution approach

AbstractThe aim of this study is to assess the impact of nano‐silica in glass fiber‐reinforced epoxy composite (GFEC) subjected to static and fatigue loading. Laminates were prepared in compression molding machine followed by the tensile test and tension‐tension fatigue testing at five different stress levels (from 50% to 90% of ultimate tensile strength). The addition of 3 wt% of nano‐silica with epoxy improved the tensile and fatigue strength as compared to neat GFEC. Scanning electron microscope (SEM) images of the fractured specimen showed the damage pattern which indicates that neat GFEC laminate exhibited damage patterns characterized by fiber breakage and matrix cracking. On the other hand, the modified GFEC with nano‐silica showed damage patterns including fiber pullout accompanied by fiber breakage and matrix cracking. During cyclic loading, the stress–strain hysteresis loop shows a reduced slope, indicating a decrease in the dynamic modulus of the specimen. This reduction in slope signifies a loss of stiffness during cyclic loading, particularly at high‐stress levels. The highest dynamic modulus at high‐stress levels indicates a rapid progression of severe damage and a shorter fatigue life. On the other hand, at low‐stress levels, the lower magnitude of dynamic modulus suggests a moderate damage progression and a longer fatigue life.Highlights Effect of nano‐silica in GFEC under static and fatigue loading conditions. GFEC with 3 wt% of nano‐silica shows improved tensile and fatigue strength. Examination of damage patterns through SEM analysis of the fractured surface. Depiction of the failure modes using damage pattern under fatigue loading. Comparison of fatigue life and dynamic modulus for neat and modified GFEC.

The effects of carvacrol and p-cymene on Aβ1-42 -induced long-term potentiation deficit in male rats.

Alzheimer's disease (AD) is the most common type of dementia in which oxidative stress plays an important role. In this disease, learning and memory and the cellular mechanism associated with it, long-term potentiation (LTP), are impaired. Considering the beneficial effects of carvacrol (CAR) and p-cymene against AD, their effect was assessed on in vivo hippocampal LTP in the perforant pathway (PP)-dentate gyrus (DG) pathway in an Aβ1-42 -induced rat model of AD. Male Wistar rats were randomly assigned to five groups: sham: intracerebroventricular (ICV) injection of phosphate-buffered saline, Aβ: ICV Aβ1-42 injections, Aβ + CAR (50 mg/kg), Aβ + p-cymene (50 mg/kg), and Aβ + CAR + p-cymene. Administration of CAR and p-cymene was done by gavage daily 4 weeks before and 4 weeks after the Aβ injection. The population spike (PS) amplitude and field excitatory postsynaptic potentials (fEPSP) slope were determined in DG against the applied stimulation to the PP. Aβ-treated rats exhibited impaired LTP induction in the PP-DG synapses, resulting in significant reduction in both fEPSP slope and PS amplitude compared to the sham animals. Aβ-treated rats consumed either CAR or p-cymene separately (but not their combination), and showed an enhancement in fEPSP slope and PS amplitude of the DG granular cells. These data indicate that CAR or p-cymene can ameliorate Aβ-associated changes in synaptic plasticity. Surprisingly, the combination of CAR and p-cymene did not yield the same effect, suggesting a potential interaction between the two substances.