Financing the "Village": Establishing a Sustainable Financial System for Child Behavioral Health.

An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.

Coenzyme Q0 inhibited the NLRP3 inflammasome, metastasis/EMT, and Warburg effect by suppressing hypoxia-induced HIF-1α expression in HNSCC cells.

Coenzyme Q0 (CoQ0), a quinone derivative from Antrodia camphorata, has antitumor capabilities. This study investigated the antitumor effect of noncytotoxic CoQ0, which included NLRP3 inflammasome inhibition, anti-EMT/metastasis, and metabolic reprogramming via HIF-1α inhibition, in HNSCC cells under normoxia and hypoxia. CoQ0 suppressed hypoxia-induced ROS-mediated HIF-1α expression in OECM-1 and SAS cells. Under normoxia and hypoxia, the inflammatory NLRP3, ASC/caspase-1, NFκB, and IL-1ß expression was reduced by CoQ0. CoQ0 reduced migration/invasion by enhancing epithelial marker E-cadherin and suppressing mesenchymal markers Twist, N-cadherin, Snail, and MMP-9, and MMP-2 expression. CoQ0 inhibited glucose uptake, lactate accumulation, GLUT1 levels, and HIF-1α-target gene (HK-2, PFK-1, and LDH-A) expressions that are involved in aerobic glycolysis. Notably, CoQ0 reduced ECAR as well as glycolysis, glycolytic capability, and glycolytic reserve and enhanced OCR, basal respiration, ATP generation, maximal respiration, and spare capacity in OECM-1 cells. Metabolomic analysis using LC-ESI-MS showed that CoQ0 treatment decreased the levels of glycolytic intermediates, including lactate, 2/3-phosphoglycerate, fructose 1,6-bisphosphate, and phosphoenolpyruvate, and increased the levels of TCA cycle metabolites, including citrate, isocitrate, and succinate. HIF-1α silencing reversed CoQ0-mediated anti-metastasis (N-Cadherin, Snail, and MMP-9) and metabolic reprogramming (GLUT1, HK-2, and PKM-2) under hypoxia. CoQ0 prevents cancer stem-like characteristics (upregulated CD24 expression and downregulated CD44, ALDH1, and OCT4) under normoxia and/or hypoxia. Further, in IL-6-treated SG cells, CoQ0 attenuated fibrosis by inhibiting TGF-ß and Collagen I expression and suppressed EMT by downregulating Slug and upregulating E-cadherin expression. Interesting, CoQ0 inhibited the growth of OECM-1 tumors in xenografted mice. Our results advocate CoQ0 for the therapeutic application against HNSCC.

Associations between the time interval from myomectomy to subsequent pregnancy and the obstetric outcomes: A population-based cohort study.

OBJECTIVE: To investigate the associations between time interval from myomectomy to pregnancy (TIMP) and subsequent pregnancy and obstetric complications, and to explore whether these associations vary according to maternal age at birth. METHODS: A retrospective population-based cohort study was conducted from 2008 to 2017. Data were extracted from the National Health Insurance Research Database and the Taiwan Maternal and Child Health Database, comprising 2024 379 births from 1 391 856 pregnancies. Eligible cases were identified using diagnostic and procedure codes; 4006 first singleton births in 4006 women after their first laparotomic myomectomy were identified. We estimated the risks of pregnancy and obstetric outcomes according to TIMP (<6, 6-11, and ≥12 months). Subgroup analysis was performed by further dividing according to maternal age at birth (18-34 vs ≥35 years old). RESULTS: We observed higher risks of gestational hypertensive disorders (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.22-3.18, P = 0.005) and neonatal death (aOR 4.59, 95% CI 1.49-14.18, P = 0.008) for TIMP of <6 months versus TIMP of 6-11 months. Likewise, a TIMP ≥12 months was associated with increased risks of gestational hypertensive disorders (aOR 1.72, 95% CI 1.14-2.58, P = 0.010), and neonatal death (aOR 3.27, 95% CI 1.16-9.24, P = 0.025) versus a TIMP of 6-11 months. In subgroup analysis, women over 35 years old still had higher risks of gestational hypertensive disorders when TIMP was <6 months (aOR 2.26, 95% CI 1.17-4.37, P = 0.015) or ≥12 months (aOR 2.04, 95% CI 1.17-3.54, P = 0.012), and a higher risk of neonatal death when TIMP was <6 months (aOR 4.05, 95% CI 1.06-15.53, P = 0.041); whereas women aged 18-34 years old did not. CONCLUSIONS: This study suggests that a TIMP between 6 and 11 months is associated with lower risks of gestational hypertensive disorders and neonatal death compared with a TIMP <6 months or ≥12 months, especially for women over 35 years old.

Temperature, humidity, and ionisation effect of iodine oxoacid nucleation.

Iodine oxoacids are recognised for their significant contribution to the formation of new particles in marine and polar atmospheres. Nevertheless, to incorporate the iodine oxoacid nucleation mechanism into global simulations, it is essential to comprehend how this mechanism varies under various atmospheric conditions. In this study, we combined measurements from the CLOUD (Cosmic Leaving OUtdoor Droplets) chamber at CERN and simulations with a kinetic model to investigate the impact of temperature, ionisation, and humidity on iodine oxoacid nucleation. Our findings reveal that ion-induced particle formation rates remain largely unaffected by changes in temperature. However, neutral particle formation rates experience a significant increase when the temperature drops from +10 °C to -10 °C. Running the kinetic model with varying ionisation rates demonstrates that the particle formation rate only increases with a higher ionisation rate when the iodic acid concentration exceeds 1.5 × 107 cm-3, a concentration rarely reached in pristine marine atmospheres. Consequently, our simulations suggest that, despite higher ionisation rates, the charged cluster nucleation pathway of iodic acid is unlikely to be enhanced in the upper troposphere by higher ionisation rates. Instead, the neutral nucleation channel is likely to be the dominant channel in that region. Notably, the iodine oxoacid nucleation mechanism remains unaffected by changes in relative humidity from 2% to 80%. However, under unrealistically dry conditions (below 0.008% RH at +10 °C), iodine oxides (I2O4 and I2O5) significantly enhance formation rates. Therefore, we conclude that iodine oxoacid nucleation is the dominant nucleation mechanism for iodine nucleation in the marine and polar boundary layer atmosphere.

Local incomplete combustion emissions define the PM2.5 oxidative potential in Northern India.

The oxidative potential (OP) of particulate matter (PM) is a major driver of PM-associated health effects. In India, the emission sources defining PM-OP, and their local/regional nature, are yet to be established. Here, to address this gap we determine the geographical origin, sources of PM, and its OP at five Indo-Gangetic Plain sites inside and outside Delhi. Our findings reveal that although uniformly high PM concentrations are recorded across the entire region, local emission sources and formation processes dominate PM pollution. Specifically, ammonium chloride, and organic aerosols (OA) from traffic exhaust, residential heating, and oxidation of unsaturated vapors from fossil fuels are the dominant PM sources inside Delhi. Ammonium sulfate and nitrate, and secondary OA from biomass burning vapors, are produced outside Delhi. Nevertheless, PM-OP is overwhelmingly driven by OA from incomplete combustion of biomass and fossil fuels, including traffic. These findings suggest that addressing local inefficient combustion processes can effectively mitigate PM health exposure in northern India.

Maternal and neonatal outcomes in women with congenital heart disease: A nationwide population-based study.

BACKGROUND: We evaluated the outcomes of pregnancy in women with congenital heart disease (CHD) and their offspring in Taiwan. We also investigated how different severity levels may influence the outcomes. METHODS: We used data (2009-2017) from the Birth Certificate Application database in Taiwan, which is linked to the National Health Insurance Research Database and Taiwan Maternal and Child Health Database. We identified 2990 women with CHD who had 4227 births. Based on the CHD subtypes, patients were further divided into "severe CHD" and "simple CHD" groups. RESULTS: Women with CHD have a significant risk of stillbirth. In maternal cardiac events, they had the highest risk of heart failure, followed by arrhythmia. The severity of CHD had a significant effect on the outcomes as well. The neonatal birth event that mothers with CHD have the highest risk of is preterm birth at < 32 weeks of gestation. The prominent difference in neonatal morbidities between mothers with severe and simple CHD is recurrent CHD in the offspring. The offspring of the severe CHD group had a higher risk of severe CHD, whereas those of the simple CHD group had a higher risk of simple CHD. CONCLUSION: During pregnancy, the monitoring of heart function and cardiac rhythm could be more intensive in mothers with CHD. In addition to accurately assessing fetal growth and development during antenatal care, mothers with severe CHD should be provided with careful fetal heart structure assessment and genetic testing along with counseling.

Assessing the importance of nitric acid and ammonia for particle growth in the polluted boundary layer.

Aerosols formed and grown by gas-to-particle processes are a major contributor to smog and haze in megacities, despite the competition between growth and loss rates. Rapid growth rates from ammonium nitrate formation have the potential to sustain particle number in typical urban polluted conditions. This process requires supersaturation of gas-phase ammonia and nitric acid with respect to ammonium nitrate saturation ratios. Urban environments are inhomogeneous. In the troposphere, vertical mixing is fast, and aerosols may experience rapidly changing temperatures. In areas close to sources of pollution, gas-phase concentrations can also be highly variable. In this work we present results from nucleation experiments at -10 °C and 5 °C in the CLOUD chamber at CERN. We verify, using a kinetic model, how long supersaturation is likely to be sustained under urban conditions with temperature and concentration inhomogeneities, and the impact it may have on the particle size distribution. We show that rapid and strong temperature changes of 1 °C min-1 are needed to cause rapid growth of nanoparticles through ammonium nitrate formation. Furthermore, inhomogeneous emissions of ammonia in cities may also cause rapid growth of particles.

Multifunctional Dy2NiMnO6/Reduced Graphene Oxide Nanocomposites and Their Catalytic, Electromagnetic Shielding, and Electrochemical Properties.

Multifunctional nanocomposites have shown great interest in clean energy systems and environmental applications in recent years. Herein, we first reported the synthesis of Dy2NiMnO6 (DNMO)/reduced graphene oxide (rGO) nanocomposites utilizing a hybrid approach involving sol-gel and solvothermal processes. Subsequently, we investigated these nanocomposites for their applications in catalysis, electromagnetic interference shielding, and supercapacitors. A morphological study suggests spherical-shaped DNMO nanoparticles of an average size of 382 nm that are uniformly distributed throughout the surface without any agglomeration. The as-prepared nanocomposites were used as catalysts to investigate the catalytic reduction of 4-nitrophenol in the presence of NaBH4. DNMO/rGO nanocomposites demonstrate superior catalytic activity when compared with bare DNMO, with the rate of reduction being influenced by the composition of the DNMO/rGO nanocomposites. In addition, novel multifunctional DNMO/rGO was incorporated into polyvinylidene difluoride (PVDF) to develop a flexible nanocomposite for electromagnetic shielding applications and exhibited a shielding effectiveness of 6 dB with 75% attenuation at a frequency of 8.5 GHz compared to bare PVDF and PVDF-DNMO nanocomposite. Furthermore, the electrochemical performance of DNMO/rGO nanocomposites was investigated as an electrode material for supercapacitors, exhibiting the highest specific capacitance of 260 F/g at 1 A/g. These findings provide valuable insights into the design of DNMO/rGO nanocomposites with remarkable performance in sustainable energy and environmental applications.

Recent progress in graphene and its derived hybrid materials for high-performance supercapacitor electrode applications.

Graphene, the most fascinating 2D form of carbon with closely packed carbon atoms arranged in a layer, needs more attention in various fields. For its unique electrical, mechanical, and chemical properties with a large surface area, graphene has been in the limelight since its first report. Graphene has extraordinary properties, making it the most promising electrode component for applications in supercapacitors. However, the persistent re-stacking of carbon layers in graphene, caused by firm interlayer van der Waals attractions, significantly impairs the performance of supercapacitors. As a result, many strategies have been used to get around the aforementioned problems. The utilization of graphene-based nanomaterials has been implemented to surmount the aforementioned constraints and considerably enhance the performance of supercapacitors. This review highlights recent progress in graphene-based nanomaterials with metal oxide, sulfides, phosphides, nitrides, carbides, and conducting polymers, focusing on their synthetic approach, configurations, and electrochemical properties for supercapacitors. It discusses new possibilities that could increase the performance of next-generation supercapacitors.

Does repetitive dilatation and curettage or hysteroscopic biopsy in patients treated with progestins for endometrial hyperplasia or carcinoma affect subsequent fetomaternal outcomes? A population-based study using the National Health Insurance Research Database of Taiwan.

OBJECTIVE: To investigate the impact of repeated dilatation and curettage or hysteroscopic biopsy on fetomaternal outcomes in patients receiving progestin treatment for endometrial hyperplasia or early-stage carcinoma. METHOD: This was a population-based study using the Taiwan National Health Insurance Research Database between 2009 and 2017 of women who gave birth and had a history of endometrial hyperplasia and early-stage carcinoma treated with progestins. Logistic regression analysis was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) reflecting the association between repeated procedures and fetomaternal outcomes. RESULTS: A total of 6956 women with 8690 deliveries were identified. Compared with those who had two or fewer procedures, women who received more than two procedures had a significantly higher risk for cervical insufficiency (aOR, 5.09 [95 CI, 2.31-11.24]). Furthermore, women who had more than two procedures were prone to have adverse neonatal outcomes, including Apgar score < 7 at 1 min (aOR, 1.97 [95% CI, 1.13-3.43]) and 5 min (aOR, 3.11 [95% CI, 1.33-7.23]) and preterm delivery <32 weeks (aOR, 2.86 [95% CI, 1.50-5.45]). CONCLUSION: Undergoing more than two procedures was associated with subsequent maternal cervical insufficiency, preterm delivery <32 weeks, and low neonatal Apgar score. Health care providers should be aware of the potential risks and balance the benefits and harms of repeated procedures.

A Review of Bio-Based Activated Carbon Properties Produced from Different Activating Chemicals during Chemicals Activation Process on Biomass and Its Potential for Malaysia.

Activated carbon is the preferred adsorbent for gas and water treatment in various industry across the world due to its efficiency, reliability, and accessibility. Recently, in Malaysia, studies are mainly focused on the fabrication of activated carbon from lignocellulosic biomass-based precursors from agricultural waste such as coconut shell, rice husk, and palm kernel shell. Activated carbon fabrication is a two-step process; the precursor will first undergo carbonization, then, activation is carried out either physically or chemically to develop its porous surface for adsorption purposes. The main benefit of activated carbon is the customizable pore structure for different utilization, which can be easily achieved by the chemical activation process. The types and concentration of chemicals used for activation, pre-treatment of precursor, duration of the activation process, and the mass ratio of precursor to chemicals are proven to effectively influence the resulting pore structure. However, the chemicals used in the activation process can be harmful to the environment. Thus, the chemical recovery process is necessary after the activation process. Nonetheless, more in-depth research on producing activated carbon from abundant biomass materials with bio-based chemical agents for activation is needed to achieve an ecological and sustainable manufacturing process.

Starch-Based Polymer Materials as Advanced Adsorbents for Sustainable Water Treatment: Current Status, Challenges, and Future Perspectives.

Over the past three decades, chemical and biological water contamination has become a major concern, particularly in the industrialized world. Heavy metals, aromatic compounds, and dyes are among the harmful substances that contribute to water pollution, which jeopardies the human health. For this reason, it is of the utmost importance to locate methods for the cleanup of wastewater that are not genuinely effective. Owing to its non-toxicity, biodegradability, and biocompatibility, starch is a naturally occurring polysaccharide that scientists are looking into as a possible environmentally friendly material for sustainable water remediation. Starch could exhibit significant adsorption capabilities towards pollutants with the substitution of amide, amino, carboxyl, and other functional groups for hydroxyl groups. Starch derivatives may effectively remove contaminants such as oil, organic solvents, pesticides, heavy metals, dyes, and pharmaceutical pollutants by employing adsorption techniques at a rate greater than 90%. The maximal adsorption capacities of starch-based adsorbents for oil and organic solvents, pesticides, heavy metal ions, dyes, and pharmaceuticals are 13,000, 66, 2000, 25,000, and 782 mg/g, respectively. Although starch-based adsorbents have demonstrated a promising future for environmental wastewater treatment, additional research is required to optimize the technique before the starch-based adsorbent can be used in large-scale in situ wastewater treatment.

Recent advancements in zero- to three-dimensional carbon networks with a two-dimensional electrode material for high-performance supercapacitors.

Supercapacitors have gained significant attention owing to their exceptional performance in terms of energy density and power density, making them suitable for various applications, such as mobile devices, electric vehicles, and renewable energy storage systems. This review focuses on recent advancements in the utilization of 0-dimensional to 3-dimensional carbon network materials as electrode materials for high-performance supercapacitor devices. This study aims to provide a comprehensive evaluation of the potential of carbon-based materials in enhancing the electrochemical performance of supercapacitors. The combination of these materials with other cutting-edge materials, such as Transition Metal Dichalcogenides (TMDs), MXenes, Layered Double Hydroxides (LDHs), graphitic carbon nitride (g-C3N4), Metal-Organic Frameworks (MOFs), Black Phosphorus (BP), and perovskite nanoarchitectures, has been extensively studied to achieve a wide operating potential window. The combination of these materials synchronizes their different charge-storage mechanisms to attain practical and realistic applications. The findings of this review indicate that hybrid composite electrodes with 3D structures exhibit the best potential in terms of overall electrochemical performance. However, this field faces several challenges and promising research directions. This study aimed to highlight these challenges and provide insights into the potential of carbon-based materials in supercapacitor applications.

Post-surgical discharge opioid prescribing, use and handling after introduction of a stewardship program.

SummaryOpioids are often used to provide postsurgical analgesia but may cause harm if used inappropriately. We introduced an opioid stewardship program in three Melbourne hospitals to reduce the inappropriate use of opioids after patient discharge. The program had four pillars: prescriber education, patient education, a standardised quantity of discharge opioids, and general practitioner (GP) communication. Following introduction of the program, we undertook this prospective cohort study. The study aimed to describe post-program discharge opioid prescribing, patient opioid use and handling, and the impact of patient demographics, pain and surgical treatment factors on discharge prescribing. We also evaluated compliance with the program components. We recruited 884 surgical patients from the three hospitals during the ten-week study period. Discharge opioids were dispensed to 604 (74%) patients, with 20% receiving slow-release opioids. Junior medical staff undertook 95% of discharge opioid prescribing, which was guideline-compliant for 78% of patients. Of the patients discharged with opioids, a GP letter was sent for only 17%. Follow-up at two weeks was successful in 423 (70%) patients and in 404 (67%) at three months. At the three-month follow-up, 9.7% of patients reported ongoing opioid use; in preoperatively opioid naïve patients, the incidence was 5.5%. At the two-week follow-up, only 5% reported disposal of excess opioids, increasing to 26% at three months. Ongoing opioid therapy at three months in our study cohort (9.7%; 39/404) was associated with preoperative opioid consumption and higher pain scores at the three-month follow-up. The introduction of the opioid stewardship program resulted in highly guideline-compliant prescribing, but hospital-to-GP communication was uncommon and opioid disposal rates were low. Our findings suggest that opioid stewardship programs can improve postoperative opioid prescribing, use and handling, but the realisation of these gains will require effective program implementation.

The goals of care framework and the perioperative period: A practical approach.

The goals of care (GOC) framework (2014) is an illness phase categorisation system that enables limitations of medical treatment (LOMT) to be documented and communicated within a healthcare system. It incorporates a clinical assessment of illness phase and GOC discussion on aims and LOMT for an episode of care. Together, this results in documentation of a GOC category that guides treatment escalation decisions during episodes of patient deterioration. Confusion exists about incorporating this framework into the perioperative period, particularly management of treatment escalation required for patient survival during surgery that is at variance with agreed goals and limitations. A historical tendency for automatic and unilateral suspension of limitations during surgery may be susceptible to ethical or medicolegal challenge. This article highlights the difference between the GOC framework and 'not for resuscitation' framework, considers the unique considerations of the perioperative period and addresses misconceptions of the GOC framework in patients undergoing surgery. Finally, it provides an approach to the GOC framework for patients considered for surgery by emphasising illness phase assessment and the need for the GOC category to accurately reflect the clinical situation throughout the perioperative period, guiding treatment escalation intraoperatively and postoperatively.

Synthesis of non-planar graphene-wrapped copper nanoparticles with iron(III) oxide decoration for high performance supercapacitors.

The performance of supercapacitors strongly depends on the electrochemical characterizations of electrode materials. Herein, a composite material consisted of iron(III) oxide (Fe2O3) and multilayer graphene-wrapped copper nanoparticles (Fe2O3/MLG-Cu NPs) is fabricated on a flexible carbon cloth (CC) substrate via two-step synthesis process for supercapacitor application. Where, MLG-Cu NPs are prepared on CC by one-step chemical vapor deposition synthesis approach; thereafter, the Fe2O3is further deposited on the MLG-Cu NPs/CC via successive ionic layer adsorption and reaction method. The related material characterizations of Fe2O3/MLG-Cu NPs are well investigated by scanning electron microscopic, high resolution transmission electron microscopy), Raman spectrometer and X-ray photoelectron spectroscopy; the electrochemical behaviors of the pertinent electrodes are studied by cyclic voltammogram, galvanostatic charge/discharge (GCD) and electrochemical impedance spectroscopy measurements. The flexible electrode with Fe2O3/MLG-Cu NPs composites exhibits the best specific capacitance of 1092.6 mF cm-2at 1 A g-1, which is much higher than those of electrodes with Fe2O3(863.7 mF cm-2), MLG-Cu NPs (257.4 mF cm-2), multilayer graphene hollow balls (MLGHBs, 14.4 mF cm-2) and Fe2O3/MLGHBs (287.2 mF cm-2). Fe2O3/MLG-Cu NPs electrode also exhibits an excellent GCD durability, and its capacitance remains 88% of its original value after 5000 cycles of the GCD process. Finally, a supercapacitor system consisted of four Fe2O3/MLG-Cu NPs/CC electrodes can efficiently power various light-emitting diodes (i.e. red, yellow, green, and blue lights), demonstrating the practical application of Fe2O3/MLG-Cu NPs/CC electrode.

Neonatal and pregnancy complications following maternal depression or antidepressant exposure: A population-based, retrospective birth cohort study.

OBJECTIVES: Depression is common during pregnancy, and antidepressants are often prescribed for treatment. However, depression and antidepressant use both increase the risk of neonatal and pregnancy complications. To separately evaluate the effects of antidepressant use and the underlying depression on pregnancy and neonatal complications by using a robust statistical method to control for confounding by indication. METHODS: All study data were obtained from Taiwan's National Health Insurance Research Database. Pregnant women were divided into three groups: those with no depression and no antidepressant exposure(n = 1619,198), depression and no antidepressant exposure(n = 2006), and depression and antidepressant exposure(n = 7857). Antidepressant exposure was further divided into that before pregnancy and during each trimester. RESULTS: Mothers with depression but no antidepressant exposure exhibited increased risks of intrauterine growth restriction and preterm delivery, compared with mothers without depression. In mothers with depression, antidepressant exposure before pregnancy or during the first trimester conferred increased risks of gestational diabetes mellitus, malpresentation, preterm delivery and cardiovascular anomalies, compared with no antidepressant exposure. Moreover, antidepressant exposure during the second or third trimester conferred increased risks of anemia, a low Apgar score, preterm delivery and genitourinary defects. However, antidepressants administered before pregnancy and during all trimesters did not increase the risk of stillbirth. CONCLUSION: Depression and antidepressant treatment for depression during pregnancy may individually increase the risks of some neonatal and pregnancy complications. Physicians should thoroughly consider the risks and benefits for both the mother and fetus when treating depression during pregnancy by using antidepressants.

Characterisation of Polypropylene Composite Reinforced with Chemi-Thermomechanical Pulp from Oil Palm Trunk via Injection Moulding Process.

As the products made from wood-plastic composites (WPCs) become more sophisticated and required more detail profiles, the injection moulding processing method with wood pulp as the reinforcing material is the answer to cater to the rapid change and demands of composite products. The general objective of this study was to study the effects of the material formulation, as well as the injection moulding process parameters, on the properties of a polypropylene composite reinforced with chemi-thermomechanical pulp from oil palm trunks (PP/OPTP composite) via the injection moulding process. The PP/OPTP composite with a material formulation of 70% pulp/26% PP/4% Exxelor PO produced using injection moulding at 80 °C as the mould temperature and with 50 tonnes of injection pressure exhibited the highest physical and mechanical properties. The increment loading of pulp increased the water absorption capacity of the composite. Higher loading of the coupling agent effectively reduced the water absorption capacity and increased the flexural strength of the composite. The increase in mould temperature from unheated to 80 °C prevented excessive heat loss of the flowing material, which enabled the molten material to flow better and filled up all cavities in the mould. The increased injection pressure slightly improved the physical properties of the composite, but the effect on the mechanical properties was insignificant. For the future development of WPCs, further studies should be focused on the viscosity behaviour, as a greater understanding of the processing parameters' effects on the PP/OPTP's viscosity behaviour will lead to improved product design and enable great potential usage of WPCs.

Exploring the Biocontrol Efficacy of Trichoderma spp. against Rigidoporus microporus, the Causal Agent of White Root Rot Disease in Rubber Trees (Hevea brasiliensis).

Rigidoporus microporus, which causes white root rot disease (WRD) in Hevea brasiliensis, is a looming threat to rubber plantation in Malaysia. The current study was conducted to determine and evaluate the efficiency of fungal antagonists (Ascomycota) against R. microporus in rubber trees under laboratory and nursery conditions. A total of 35 fungal isolates established from the rubber tree rhizosphere soil were assessed for their antagonism against R. microporus by the dual culture technique. Trichoderma isolates can inhibit the radial growth of R. microporus by 75% or more in the dual culture test. Strains of T. asperellum, T. koningiopsis, T. spirale, and T. reesei were selected to assess the metabolites involved in their antifungal activity. Results indicated that T. asperellum exhibited an inhibitory effect against R. microporus in both volatile and non-volatile metabolite tests. All Trichoderma isolates were then tested for their ability in producing hydrolytic enzymes such as chitinase, cellulase and glucanase, indole acetic acid (IAA), siderophores production, and phosphate solubilization. From the positive results of the biochemical assays, T. asperellum and T. spirale were selected as the biocontrol candidates to be further tested in vivo against R. microporus. The nursery assessments revealed that rubber tree clone RRIM600 pretreated with only T. asperellum or with the combination of T. asperellum and T. spirale was able to reduce the disease severity index (DSI) and exert higher suppression of R. microporus compared to other pretreated samples, with the average DSI below 30%. Collectively, the present study demonstrates that T. asperellum represents a potential biocontrol agent that should be further explored to control R. microporus infection on rubber trees.

Association between initial in-hospital heart rate and glycemic control in patients with acute ischemic stroke and diabetes mellitus.

BACKGROUND: A high resting heart rate (HR) has been associated with an increased risk of diabetes mellitus. This study explored the association between initial in-hospital HR and glycemic control in patients with acute ischemic stroke (AIS) and diabetes mellitus. METHODS: We analyzed data from 4,715 patients with AIS and type 2 diabetes mellitus enrolled in the Chang Gung Research Database between January 2010 and September 2018. The study outcome was unfavorable glycemic control, defined as glycated hemoglobin (HbA1c) ≥ 7%. In statistical analyses, the mean initial in-hospital HR was used as both a continuous and categorical variable. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression analysis. The associations between the HR subgroups and HbA1c levels were analyzed using a generalized linear model. RESULTS: Compared with the reference group (HR < 60 bpm), the adjusted ORs for unfavorable glycemic control were 1.093 (95% CI 0.786-1.519) for an HR of 60-69 bpm, 1.370 (95% CI 0.991-1.892) for an HR of 70-79 bpm, and 1.608 (95% CI 1.145-2.257) for an HR of ≥ 80 bpm. Even after adjusting for possible confounders, the HbA1c levels after admission and discharge among diabetic stroke patients increased significantly in the subgroups with higher HRs (p < 0.001). CONCLUSIONS: High initial in-hospital HR is associated with unfavorable glycemic control in patients with AIS and diabetes mellitus, particularly in those with an HR of ≥ 80 bpm, compared with those with an HR of < 60 bpm.