Effect of Pre-dispersing Metakaolin in Water on the Properties, Hydration, and Metakaolin Distribution in Mortar

The effects of pre-dispersing metakaolin (MK) in water on the properties and hydration of mortar and distribution of MK particles in mortar were characterized by analytical techniques. Zeta-potential of MK-water dispersion significantly decreased with the increase of pH of solution, resulting in a stable dispersion at pH of 8 with zeta-potential of −40 mV. The bulk density of MK-water slurry rapidly increased with water/MK ratio due to the surface tension force of water and filling of spaces by water, resulting in a maximum bulk density of 665.2 kg/m3 at water/MK ratio of 1.0. Comparing to that of powder MK, pre-dispersing MK in water did not alter hydration products, slightly improved compressive strength, and pore structure, but further reduced shrinkage and significantly improved the uniformed distribution of MK particles in mortar

Early Experience with Pay-for-Performance from Concept to Practice

The adoption of pay-for-performance mechanisms for quality improvement is growing rapidly. While there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care. In this study, we examine the impact of a prototypical physician pay-for-performance program on quality of care. We evaluate a natural experiment with pay-for-performance using administrative reports of physician group quality from PacifiCare Health Systems for both an intervention group (California physician groups) and a contemporaneous comparison group (Pacific Northwest physician groups). Compared to physician groups in the Pacific Northwest, PacifiCare’s California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6 percentage point difference in improvement (p<.05)). In total, PacifiCare awarded $3.4 million (27% of the amount set aside) in bonus payments between July 2003 and April 2004, the first year of the program. For all three measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments. We conclude that paying providers to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline. Paying explicitly for quality improvement may be a more effective means to induce accelerated improvement in quality. This evaluation is developed from and is informed by a decade-long collaboration between the researchers (affiliates of Harvard’s Sloan Center for Managed Care Industry Research) and PacifiCare that began with a series of in-depth site visits to the physician groups in PacifiCare’s network, followed by a survey of those groups that examined the use of organizational and financial mechanisms for managing care

Directional mechanical stability of Bacteriophage φ29 motor’s 3WJ-pRNA: Extraordinary robustness along portal axis

The molecular motor exploited by bacteriophage φ29 to pack DNA into its capsid is regarded as one of the most powerful mechanical devices present in viral, bacterial, and eukaryotic systems alike. Acting as a linker element, a prohead RNA (pRNA) effectively joins the connector and ATPase (adenosine triphosphatase) components of the φ29 motor. During DNA packing, this pRNA needs to withstand enormous strain along the capsid’s portal axis—how this remarkable stability is achieved remains to be elucidated. We investigate the mechanical properties of the φ29 motor’s three-way junction (3WJ)–pRNA using a combined steered molecular dynamics and atomic force spectroscopy approach. The 3WJ exhibits strong resistance to stretching along its coaxial helices, demonstrating its super structural robustness. This resistance disappears, however, when external forces are applied to the transverse directions. From a molecular standpoint, we demonstrate that this direction-dependent stability can be attributed to two Mg clamps that cooperate and generate mechanical resistance in the pRNA’s coaxial direction. Our results suggest that the asymmetric nature of the 3WJ’s mechanical stability is entwined with its biological function: Enhanced rigidity along the portal axis is likely essential to withstand the strain caused by DNA condensation, and flexibility in other directions should aid in the assembly of the pRNA and its association with other motor components

CCND1 as a Predictive Biomarker of Neoadjuvant Chemotherapy in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma

BACKGROUND: Cyclin D1 (CCND1) has been associated with chemotherapy resistance and poor prognosis. In this study, we tested the hypothesis that CCND1 expression determines response and clinical outcomes in locally advanced head and neck squamous cell carcinoma (HNSCC) patients treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. METHODOLOGY AND FINDINGS: 224 patients with HNSCC were treated with either cisplatin-based chemotherapy followed by surgery and radiotherapy (neoadjuvant group, n = 100) or surgery and radiotherapy (non-neoadjuvant group, n = 124). CCND1 expression was assessed by immunohistochemistry. CCND1 levels were analyzed with chemotherapy response, disease-free survival (DFS) and overall survival (OS). There was no significant difference between the neoadjuvant group and non-neoadjuvant group in DFS and OS (p = 0.929 and p = 0.760) when patients treated with the indiscriminate administration of cisplatin-based chemotherapy. However, in the neoadjuvant group, patients whose tumors showed a low CCND1 expression more likely respond to chemotherapy (p<0.001) and had a significantly better OS and DFS than those whose tumors showed a high CCND1 expression (73% vs 8%, p<0.001; 63% vs 6%, p<0.001). Importantly, patients with a low CCND1 expression in neoadjuvant group received more survival benefits than those in non-neoadjuvant group (p = 0.016), however patients with a high CCND1 expression and treated with neoadjuvant chemotherapy had a significantly poor OS compared to those treated with surgery and radiotherapy (p = 0.032). A multivariate survival analysis also showed CCND1 expression was an independent predictive factor (p<0.001). CONCLUSIONS: This study suggests that some but not all patients with HNSCC may benefit from neoadjuvant chemotherapy with cisplatin-based regimen and CCND1 expression may serve as a predictive biomarker in selecting patients undergo less than two cycles of neoadjuvant chemotherapy

Response of riparian vegetation to water-table changes in the lower reaches of Tarim River, Xinjiang Uygur, China

The lower reaches of Tarim River in the Xinjiang Uygur region of western China had been dried out for more than 30 years before water began to be diverted from Konqi (Peacock) River via a 927-km-long channel in year 2000, aimed at improving the riparian ecological systems. Since then, eight intermittent water deliveries have been carried out. To evaluate the response of riparian vegetation to these operations, the groundwater regime and vegetation changes have been monitored along the 350-km-long stem of the river using a network of 40 dug wells at nine transects across the river and 30 vegetation plots at key sites. Results show that the water table rose remarkably, i.e. from a depth of 9.87m before the water delivery to 3.16m after the third water delivery. The lateral distance of affected water table extended to 1,050m from the riverbank after the fourth water delivery. The riparian vegetation has changed in composition, type, distribution, and growing behavior. This shows that the water deliveries have had significant effects on restoration of riparian ecosystems

A multicentre study on the clinical characteristics of newborns infected with coronavirus disease 2019 during the omicron wave

ObjectiveTo investigate the clinical characteristics and outcomes of newborns infected with coronavirus disease 2019 (COVID-19) during the Omicron wave.MethodsFrom December 1, 2022, to January 4, 2023, clinical data were collected from neonates with COVID-19 who were admitted to 10 hospitals in Foshan City, China. Their epidemiological histories, clinical manifestations and outcomes were analysed. The neonates were divided into symptomatic and asymptomatic groups. The t test or χ2 test was used for comparisons between groups.ResultsA total of 286 children were diagnosed, including 166 males, 120 females, 273 full-term infants and 13 premature infants. They were 5.5 (0–30) days old on average when they were admitted to the hospital. These children had contact with patients who tested positive for COVID-19 and were infected through horizontal transmission. This study included 33 asymptomatic and 253 symptomatic patients, among whom 143 were diagnosed with upper respiratory tract infections and 110 were diagnosed with pneumonia. There were no severe or critical patients. Fever (220 patients) was the most common clinical manifestation, with a duration of 1.1 (1–6) days. The next most common clinical manifestations were cough with nasal congestion or runny nose (4 patients), cough (34 patients), poor appetite (7 patients), shortness of breath (15 patients), and poor general status (1 patient). There were no significant abnormalities in routine blood tests among the neonates infected with COVID-19 except for mononucleosis. However, compared with the asymptomatic group, in the symptomatic group, the leukocyte and neutrophil granulocyte counts were significantly decreased, and the monocyte count was significantly increased. C-reactive protein (CRP) levels were significantly increased (≥10 mg/L) in 9 patients. Myocardial enzyme, liver function, kidney function and other tests showed no obvious abnormalities.ConclusionsIn this study, neonates infected with the Omicron variant were asymptomatic or had mild disease. Symptomatic patients had lower leucocyte and neutrophil levels than asymptomatic patients

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049