Is EQ-5D-5L Better Than EQ-5D-3L? A Head-to-Head Comparison of Descriptive Systems and Value Sets from Seven Countries

Objective: This study describes the first empirical head-to-head comparison of EQ-5D-3L (3L) and EQ-5D-5L (5L) value sets for multiple countries. Methods: A large multinational dataset, including 3L and 5L data for eight patient groups and a student cohort, was used to compare 3L versus 5L value sets for Canada, China, England/UK (5L/3L, respectively), Japan, The Netherlands, South Korea and Spain. We used distributional analyses and two methods exploring discriminatory power: relative efficiency as assessed by the F statistic, and an area under the curve for the receiver-operating characteristics approach. Differences in outcomes were explored by separating descriptive system effects from valuation effects, and by exploring distributional location effects. Results: In terms of distributional evenness, efficiency of scale use and the face validity of the resulting distributions, 5L was superior, leading to an increase in sensitivity and precision in health status measurement. When compared with 5L, 3L systematically overestimated health problems and consequently underestimated utilities. This led to bias, i.e. over- or underestimations of discriminatory power. Conclusion: We conclude that 5L provides more precise measurement at individual and group levels, both in terms of descriptive system data and utilities. The increased sensitivity and precision of 5L is likely to be generalisable to longitudinal studies, such as in intervention designs. Hence, we recommend the use of the 5L across applications, including economic evaluation, clinical and public health studies. The evaluative

A GIS-based assessment of spatial accessibility to County hospitals: A case study of dancheng County, China

National Science Foundation of China; Shanghai Jiao Tong University; Nanyang Technological University<span class="MedBlackText">The aim of this study was to investigate Chinese rural people's accessibility to healthcare. GIS techniques and the gravity-based model were combined to calculate the measure of accessibility to county hospitals in Dancheng County. The result demonstrates that when travel friction coefficient is 1.0, the highest accessibility is found in the county seat and declines outward to other settlements. The residents in the east and southeast part of the county have worse accessibility to county hospitals. To improve rural people's accessibility to health services, the paper suggests that the local government should build a county-level hospital in the east part of the county and increase road class to reduce travel time. The suggestions can be applied to other counties in rural China. Finally, bus routes and timetables should be considered in a future study of measuring rural people's access to services in the county seat. </span

Scaling behavior of the dipole coupling energy in two-dimensional disordered magnetic nanostructures

Numerical calculations of the average dipole-coupling energy $\bar E_\mathrm{dip}$ in two-dimensional disordered magnetic nanostructures are performed as function of the particle coverage $C$. We observe that $\bar E_\mathrm{dip}$ scales as $\bar E_\mathrm{dip}\propto C^{\alpha^*}$ with an unusually small exponent $\alpha^*\simeq 0.8$--1.0 for coverages $C\lesssim20$. This behavior is shown to be primarly given by the contributions of particle pairs at short distances, which is intrinsically related to the presence of an appreciable degree of disorder. The value of $\alpha^*$ is found to be sensitive to the magnetic arrangement within the nanostructure and to the degree of disorder. For large coverages $C\gtrsim20$ we obtain $\bar E_\mathrm{dip}\propto C^\alpha$ with $\alpha=3/2$, in agreement with the straighforward scaling of the dipole coupling as in a periodic particle setup. Taking into account the effect of single-particle anisotropies, we show that the scaling exponent can be used as a criterion to distinguish between weakly interacting ($\alpha^* \simeq 1.0$) and strongly interacting ($\alpha^* \simeq 0.8$) particle ensembles as function of coverage.Comment: accepted for publication in Phys.Rev.

Numerical solution of the eXtended Pom-Pom model for viscoelastic free surface flows

In this paper we present a finite difference method for solving two-dimensional viscoelastic unsteady free surface flows governed by the single equation version of the eXtended Pom-Pom (XPP) model. The momentum equations are solved by a projection method which uncouples the velocity and pressure fields. We are interested in low Reynolds number flows and, to enhance the stability of the numerical method, an implicit technique for computing the pressure condition on the free surface is employed. This strategy is invoked to solve the governing equations within a Marker-and-Cell type approach while simultaneously calculating the correct normal stress condition on the free surface. The numerical code is validated by performing mesh refinement on a two-dimensional channel flow. Numerical results include an investigation of the influence of the parameters of the XPP equation on the extrudate swelling ratio and the simulation of the Barus effect for XPP fluids

Hamiltonian 2-forms in Kahler geometry, III Extremal metrics and stability

This paper concerns the explicit construction of extremal Kaehler metrics on total spaces of projective bundles, which have been studied in many places. We present a unified approach, motivated by the theory of hamiltonian 2-forms (as introduced and studied in previous papers in the series) but this paper is largely independent of that theory. We obtain a characterization, on a large family of projective bundles, of those `admissible' Kaehler classes (i.e., the ones compatible with the bundle structure in a way we make precise) which contain an extremal Kaehler metric. In many cases, such as on geometrically ruled surfaces, every Kaehler class is admissible. In particular, our results complete the classification of extremal Kaehler metrics on geometrically ruled surfaces, answering several long-standing questions. We also find that our characterization agrees with a notion of K-stability for admissible Kaehler classes. Our examples and nonexistence results therefore provide a fertile testing ground for the rapidly developing theory of stability for projective varieties, and we discuss some of the ramifications. In particular we obtain examples of projective varieties which are destabilized by a non-algebraic degeneration.Comment: 40 pages, sequel to math.DG/0401320 and math.DG/0202280, but largely self-contained; partially replaces and extends math.DG/050151

Microwave heating, isothermal sintering, and mechanical properties of powder metallurgy titanium and titanium alloys

This article presents a detailed assessment of microwave (MW) heating, isothermal sintering, and the resulting tensile properties of commercially pure Ti (CP-Ti), Ti-6Al-4V, and Ti-10V-2Fe-3Al (wt pct), by comparison with those fabricated by conventional vacuum sintering. The potential of MW sintering for titanium fabrication is evaluated accordingly. Pure MW radiation is capable of heating titanium powder to ≥1573 K (1300 C), but the heating response is erratic and difficult to reproduce. In contrast, the use of SiC MW susceptors ensures rapid, consistent, and controllable MW heating of titanium powder. MW sintering can consolidate CP-Ti and Ti alloys compacted from -100 mesh hydride-dehydride (HDH) Ti powder to ~95.0 pct theoretical density (TD) at 1573 K (1300 C), but no accelerated isothermal sintering has been observed over conventional practice. Significant interstitial contamination occurred from the Al2O3-SiC insulation-susceptor package, despite the high vacuum used (≤4.0 × 10-3 Pa). This leads to erratic mechanical properties including poor tensile ductility. The use of Ti sponge as impurity (O, N, C, and Si) absorbers can effectively eliminate this problem and ensure good-to-excellent tensile properties for MW-sintered CP-Ti, Ti-10V-2Fe-3Al, and Ti-6Al-4V. The mechanisms behind various observations are discussed. The prime benefit of MW sintering of Ti powder is rapid heating. MW sintering of Ti powder is suitable for the fabrication of small titanium parts or titanium preforms for subsequent thermomechanical processing

Molecular and functional expression of anion exchangers in cultured normal human nasal epithelial cells

AIMS: Anions have an important role in the regulation of airway surface liquid (ASL) volume, viscosity and pH. However, functional localization and regulation of anion exchangers (AEs) have not been clearly described. The aim of this study was to investigate the regulation of AE mRNA expression level in accordance with mucociliary differentiation and the functional expression of AEs cultured normal human nasal epithelial (NHNE) cells. METHODS: Nasal mucosal specimens from three patients are obtained and serially cultured cells are subjected to morphological examinations, RT-PCR, Western blot analysis and immunocytochemistry. AE activity is assessed by pHi measurements. RESULTS: Expression of ciliated cells on the apical membrane and expression of MUC5AC, a marker of mucous differentiation, increased with time. AE2 and SLC26A4 mRNA expression decreased as mucociliary differentiation progressed, and AE4, SLC26A7 and SLC26A8 mRNA expression increased on the 14th and 28th day after confluence. Accordingly, AE4 protein expression also progressively increased. AE activity in 100 mM K(+) buffer solutions was nearly twofold higher than that in 5 mM K(+) buffer solutions. Moreover, only luminal AE activity increased about fourfold over the control in the presence of 5 microM forskolin. In the presence of 100 microM adenosine-5'-triphosphate (ATP) which evokes intracellular calcium signalling through activation of purinergic receptors, only luminal AE activity was again significantly increased. On the other hand, 500 microM 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS), an inhibitor of most SLC4 and SLC26AE isoforms, nearly abolished AE activity in both luminal and basolateral membranes. We found that AE activity was affected by intracellular cAMP and calcium signalling in the luminal membrane and was DIDS-sensitive in both membranes of cultured NHNE cells. CONCLUSION: Our findings through molecular and functional studies using cultured NHNE cells suggest that AEs may have an important role in the regulation of ASL.ope

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Dynamic active-site generation of atomic iridium stabilized on nanoporous metal phosphides for water oxidation

Designing efficient single-atom catalysts (SACs) for oxygen evolution reaction (OER) is critical for water-splitting. However, the self-reconstruction of isolated active sites during OER not only influences the catalytic activity, but also limits the understanding of structure-property relationships. Here, we utilize a self-reconstruction strategy to prepare a SAC with isolated iridium anchored on oxyhydroxides, which exhibits high catalytic OER performance with low overpotential and small Tafel slope, superior to the IrO2. Operando X-ray absorption spectroscopy studies in combination with theory calculations indicate that the isolated iridium sites undergo a deprotonation process to form the multiple active sites during OER, promoting the O–O coupling. The isolated iridium sites are revealed to remain dispersed due to the support effect during OER. This work not only affords the rational design strategy of OER SACs at the atomic scale, but also provides the fundamental insights of the operando OER mechanism for highly active OER SACs