Summary of best evidence for prevention and management of frailty.

BACKGROUND: Frailty in older people can seriously affect their quality of life and increase the demand for long-term care and health care expenses. Aims of this study are to provide an evidence-based basis for clinical practice of frailty in older people by systematically searching for the best current evidence on interventions for the prevention and management of frailty. METHODS: According to the '6S' evidence resource model, evidence retrieval is searched from the top-down and collected relevant guidelines, best practices, evidence summaries, systematic reviews and expert consensus. The retrieval time limit was from the database establishment to 20 March 2023. Two reviewers independently screened and evaluated the literature, and then extracted and summarised the evidence according to the JBI grading of evidence and recommendation system. RESULTS: A total of 44 publications were finally included, including 12 guidelines, 5 best practices, 4 expert consensus, 5 evidence summaries and 18 systematic reviews. Through the induction and integration of the evidence, the evidence was finally summarised from eight aspects: frailty screening, frailty assessment, exercise intervention, nutrition intervention, multi-domain intervention, drug administration, social support and health education, and 43 best evidences were formed. CONCLUSIONS: This study summarised the best evidence for the prevention and management of frailty from eight aspects, which can provide guidance for clinical or community medical staff to develop and apply frailty intervention and practice programmes for older people and improved the clinical outcome and quality of life of older people.

Predictive value of preoperative handgrip strength on postoperative outcomes in patients with gastrointestinal tumors: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to explore the predictive value of preoperative handgrip strength on postoperative outcomes in patients with gastrointestinal tumors. METHODS: Databases including Cochrane Library, Pubmed, Embase, Web of Science, and CINAHL Complete were searched for articles published from the establishment of database until August 7, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the quality. RESULTS: Eight studies were included, involving five prospective and three retrospective cohort studies with 2291 participants. The prevalence of preoperative low handgrip strength ranged from 11.8 to 62.7%. Preoperative low handgrip strength was associated with an increased risk of total complications (OR = 2.23, 95%CI = 1.43-3.50), pneumonia (OR = 5.16, 95%CI = 3.17-8.38), ileus (OR = 2.48, 95%CI = 1.09-5.65), and short-term mortality (OR = 7.28, 95%CI = 1.90-27.92). CONCLUSION: This systematic review and meta-analysis indicated that preoperative HGS had important value to predict certain adverse postoperative outcomes among patients with GI tumors. Low handgrip strength criteria, definition of total complications, and country are the potential sources of heterogeneity, and more research are required to test and update these results.

Vitamin D3 Is Transformed into 1,25(OH)2D3 by Triggering CYP3A11(CYP3A4) Activity and Hydrolyzing Midazolam.

BACKGROUND Vitamin D3 (VD3) is a commonly used supplement in clinical practice. Cytochrome P450 3A11 (CYP3A11) is the most important monomeric enzyme involved in metabolism of drugs. This study aimed to investigate effects of vitamin D3 (VD3) on CYP3A11 activity. MATERIAL AND METHODS Forty male Sprague-Dawley (SD) rats were randomly divided a Control group (peanut oil 0.1 ml/kg/d), a Low-VD3 group (100 IU/kg/d), a Medium-VD3 group (400 IU/kg/d), and a High-VD3 (1600 IU/kg/d) group. Blood samples were collected from the jugular vein after midazolam (MDZ) administration. CYP3A11 expressions in liver and colon were detected by Western blotting and immunohistochemistry (IHC) assay. The concentration of serum 25(OH)D3 and serum 1,25(OH)2D3 were evaluated using ELISA. Effects of different dosages of vitamin D3 on metabolism of MDZ were evaluated using high-performance liquid chromatography (HPLC). RESULTS Vitamin D3 significantly enhanced serum 25(OH)D3 and 1,25(OH)2D3 levels in rats compared to Control rats (p<0.05). Expressions of hepatic CYP3A11 were more than 10-fold higher in rats treated with vitamin D3 compared to Control rats (p<0.05). Expressions of colon CYP3A11 were 5-fold higher than in Control rats (p<0.05). CYP3A11 expressions in vitamin D3-treated groups were significantly higher compared to the Control group (p<0.05). MDZ levels were significantly higher in Vitamin D3-treated rats compared to that in Control rats (p<0.05). Concentrations of serum MDZ at every sampling point were remarkably lower in the vitamin D3-treated rats than in Control rats (p<0.05). CONCLUSIONS Vitamin D3 was transformed into 1,25(OH)2D3 by triggering CYP3A11 and CYP3A11 activity and by hydrolyzing MDZ.

A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors.

BACKGROUND: Frailty is very common among older people with gastric cancer and seriously affects their prognosis. The development of frailty is continuous and dynamic, increasing the difficulty and burden of care. OBJECTIVES: The aims of this study were to delineate the developmental trajectory of frailty in older people with gastric cancer 1 year after surgery, identify heterogeneous frailty trajectories, and further explore their predictors to construct a nomogram for prediction. DESIGN: We conducted a prospective longitudinal observation study. Clinical evaluation and data collection were performed at discharge, and at 1, 3, 6, and 12 months. SETTING AND PARTICIPANTS: This study was conducted in a tertiary hospital and 381 gastric cancer patients over 60 years who underwent radical gastrectomy completed the 1-year follow-up. METHODS: A growth mixture model (GMM) was used to delineate the frailty trajectories, and identify heterogeneous trajectories. A regression model was performed to determine their predictors and further construct a nomogram based on the predictors. Bootstrap with 1000 resamples was used for internal validation of nomogram, a receiver operating characteristic (ROC) curve to evaluate discrimination, calibration curves to evaluate calibration and decision curve analysis (DCA) to evaluate the clinical value. RESULTS: GMM identified three classes of frailty trajectories: "frailty improving", "frailty persisting" and "frailty deteriorating". The latter two were referred to as heterogeneous frailty trajectories. Regression analysis showed 8 independent predictors of heterogeneous frailty trajectories and a nomogram was constructed based on these predictors. The area under ROC curve (AUC) of the nomogram was 0.731 (95 % CI = 0.679-0.781), the calibration curves demonstrated that probabilities predicted by the nomogram agreed well with the actual observation with a mean absolute error of 0.025, and the DCA of nomogram indicated that the net benefits were higher than that of the other eight single factors. CONCLUSIONS: Older gastric cancer patients have heterogeneous frailty trajectories of poor prognosis during one-year postoperative survival. Therefore, early assessment to predict the occurrence of heterogeneous frailty trajectories is essential to improve the outcomes of elderly gastric cancer patients. Scientific and effective frailty interventions should be further explored in the future to improve the prognosis of older gastric cancer patients. CONTRIBUTION OF THE PAPER STATEMENTS: This study constructed a static and dynamic online nomogram with good discrimination and calibration, which can help to screen high-risk patients, implement preoperative risk stratification easily and promote the rational allocation of medical resources greatly. REGISTRATION: ClinicalTrials.gov (Number: NCT05982899). TWEETABLE ABSTRACT: Our findings identified three frailty trajectories and constructed a nomogram to implement preoperative risk stratification and improve patient outcomes.

Formation Mechanisms, Interrelationships, and Effects of Cognitive Factors on Diet and Physical Activity During the Post-Bariatric Surgery Period: A Cross-Sectional Study Based on Compensatory Carry-Over Action Model.

Background: Diet and physical activity (PA) are pivotal behaviors for managing energy balance post-bariatric surgery. Given the need for dual behavioral management, understanding the interplay of cognitive factors influencing these behaviors is crucial. This study applied the compensatory carry-over action model (CCAM) to explore the impact of cognitive factors on behaviors and their subsequent effects on subjective health outcomes. Methods: This cross-sectional study was conducted among patients at the third month after bariatric surgery in China. Data on diet and PA status, behavioral cognitive factors (intention, self-efficacy, compensatory belief, transfer cognition), and subjective health outcomes (perceived stress, well-being, quality of life) were collected. Structural equation model (SEM) was employed to test hypotheses in CCAM and assess mediation relationships. Results: Analysis of data from 239 patients revealed the following: (1) Among antecedent cognitive factors, only compensatory belief significantly influenced diet (P<0.001). (2) Intention and self-efficacy directly correlated with their respective behaviors, while compensatory belief affected intention, and transfer cognition impacted self-efficacy (P<0.05), aligning with CCAM hypotheses. (3) PA demonstrated significant influence only on perceived stress (P=0.004), whereas diet significantly affected all subjective health outcomes (P<0.05). (4) Mediation analysis indicated intention partially mediated the relationship between compensatory belief and diet and fully mediated the relationship between compensatory belief and PA. Self-efficacy completely mediated the relationship between transfer cognition and diet and PA. Conclusion: Transfer cognition's carry-over effect did not directly influence behaviors among antecedent cognitions. Interventions should primarily target improving diet by mitigating compensatory belief. Moreover, diet exhibited a more pronounced impact on overall health compared to PA. Consequently, prioritizing dietary intervention over PA intervention is warranted based on the analysis of CCAM and the aim of promoting joint behaviors post-bariatric surgery.

Individual, family and social-related factors of eating behavior among Chinese children with overweight or obesity from the perspective of family system.

Purpose: The purpose of the present study is to examine the factors contributing to the development of eating behavior in overweight and obese children from the perspective of the family system. Methods: A cross-sectional survey was conducted by using convenience sampling method to select 388 participants in two primary schools in Jiangsu, China. Individual, family and social-related factors were collected. Individual factors included age, gender, ethnicity, single child, social anxiety, depression, physical activity, sleep duration, screen time. Family factors included family environment, family structure, family function, family income, parenting style, parental feeding behavior, home food environment and marital satisfaction. Social-related factors included place of residence, number of surrounding restaurants and social support. Univariate analysis, correlation analysis and multivariate analysis were used to identify factors of eating behavior among Chinese children with overweight and obese. Results: In this study, 388 participants took part with a 94.865% response rate. In the univariate analysis, the significant differences regarding Dutch Eating Behavior Questionnaire (DEBQ) scores were found between children aged 6-9 years and those aged >9 years. Correlation analysis indicated that parent's nutrition literacy (r = 0.118, P < 0.05), pressure to eat (r = 0.212, P < 0.01), perception of child weight (r = -0.112, P < 0.05) and family function (r = -0.563, P < 0.01) were associated with children's eating behavior. With regard to psychosocial factors, children's social anxiety (r = 0.299, P < 0.01) and depressive symptoms (r = 0.081, P < 0.05) were in positive correlation with eating behavior. The independent variables included in the initial model were age, father's employment status, social anxiety, maternal punishment and harshness, parents' nutrition literacy, pressure to eat, family function and perception of child weight. These variables in the final model accounted for 20.7% of the variance. Conclusion: We found that age, father's employment status, social anxiety, maternal punishment and harshness, parents' nutrition literacy, pressure to eat, family function and perception of child weight have great effect on children's eating behavior who are overweight or obese. As early childhood is a critical timeline for child development, children's social anxiety, parenting style, parent's nutrition literacy, parent's feeding behavior and family function should be intervened to promote eating behavior. Intervention programs aimed at promoting healthy eating behaviors among children, thereby mitigating the risk of pediatric obesity, should primarily target parents.

Exploration of frailty trajectories and their associations with health outcomes in older gastric cancer survivors undergoing radical gastrectomy: A prospective longitudinal observation study.

BACKGROUND: Frailty is commom among gastric cancer survivors and increases the burden of care. AIMS: Our aims were to identify the frailty trajectories and investigate their associations with health outcomes in older gastric cancer survivors. METHODS: We finally recruited 381 patients aged ≧60 who underwent radical gastrectomy and recorded frailty at discharge from the hospital, 1, 3, 6, and 12 months after surgery. Growth mixture modeling was used to investigate the frailty trajectories and linear regression models were used to examine their associations with health outcomes. RESULTS: Three classes of frailty trajectories were identified: the "improving frailty", "maintaining frailty" and "deteriorating frailty". Compared with class 1, patients who followed class 2 and class 3 frailty trajectories were more likely to have more severe disability (ß = -14.22, 95 % CI: -17.92, -10.61, P < 0.001; ß = -48.34, 95 % CI: -52.25, -44.42, P < 0.001), worse quality of life (ß = 10.89, 95 % CI: 7.71,14.08, P < 0.001; ß = 34.82, 95 % CI: 31.46, 38.19, P < 0.001), and more frequency readmission within 1 year (ß = 1.02, 95 % CI: 0.98, 1.06, P < 0.001; ß = 2.10, 95 % CI: 2.01, 2.14, P < 0.001) after controlling potential confounders. However, class 2 and class 3 have no significant difference from class 1 in the total hospitalization costs (ß = 1672.12, 95 % CI: -7145.95, 10496.19, P = 0.709; ß = 7651.60, 95 % CI: -1670.28, 16793.47, P = 0.107). CONCLUSIONS: Our study suggested the significant prognostic heterogeneity in frailty trajectories, and what we need to do is to identify patients with heterogeneous trajectory and intervene in them to reduce adverse outcomes, promote rational use of resources, and reduce the burden of care.

An inoculation site-retained mRNA vaccine induces robust immune responses against SARS-CoV-2 variants.

mRNA-based vaccines and therapeutic agents hold great promise in prevention and treatment of human diseases, yet high percentage of systemic adverse effect in clinic remains a big safety concern. One major potential cause is a high level of leakage of the locally inoculated mRNA vaccine nanoparticles into circulation. We have screened and optimized a core-shell structured lipopolyplex (LPP) formulation for mRNA with a tissue-retention property. Upon intramuscular inoculation, the mRNA-encapsulated LPP nanoparticles were preferentially taken up by the phagocytic antigen-presentation cells, and potently promoted dendritic cell maturation. We applied the new formulation to prepare a prophylactic vaccine for SARS-CoV-2, and observed potent humoral and cellular immune responses from the vaccine in both murine models and non-human primates. More importantly, the vaccine demonstrated a benign safety profile in non-human primates, with limited side effects after repeated treatment with high dosages of LPP/mRNA. Taken together, the inoculation site-retained vaccine formulation serves as a promising vehicle for mRNA vaccines and therapeutic agents.

Microstructure Evolution with Rapid Thermal Annealing Time in (001)-Oriented Piezoelectric PZT Films Integrated on (111) Si.

In our recently published paper (Y.-Y. Wang et al., High performance LaNiO3-buffered, (001)-oriented PZT piezoelectric films integrated on (111) Si, Appl. Phys. Lett. 121, 182902, 2022), highly (001)-oriented PZT films with a large transverse piezoelectric coefficient e31,f prepared on (111) Si substrates were reported. This work is beneficial for the development of piezoelectric micro-electro-mechanical systems (Piezo-MEMS) because of (111) Si's isotropic mechanical properties and desirable etching characteristics. However, the underlying mechanism for the achievement of a high piezoelectric performance in these PZT films going through a rapid thermal annealing process has not been thoroughly analyzed. In this work, we present complete sets of data in microstructure (XRD, SEM and TEM) and electrical properties (ferroelectric, dielectric and piezoelectric) for these films with typical annealing times of 2, 5, 10 and 15 min. Through data analyses, we revealed competing effects in tuning the electrical properties of these PZT films, i.e., the removal of residual PbO and proliferation of nanopores with an increasing annealing time. The latter turned out to be the dominating factor for a deteriorated piezoelectric performance. Therefore, the PZT film with the shortest annealing time of 2 min showed the largest e31,f piezoelectric coefficient. Furthermore, the performance degradation occurred in the PZT film annealed for 10 min can be explained by a film morphology change, which involved not only the change in grain shape, but also the generation of a large amount of nanopores near its bottom interface.

Family characteristics in adolescents with overweight or obesity: a network analysis.

Background: Rates of overweight and obesity continue to grow in adolescents. Overweight and obesity in adolescence are associated with numerous immediate and long-term adverse health conditions. Throughout adolescence, parents and the family have an important and central influence on adolescents' health and lifestyle. The home environment may be a major factor in shaping children's weight. However, our current understanding of the interplay between family-related variables in adolescents with overweight or obesity is limited and fragmented. This study aimed to assess the relationship between family-related variables in adolescents who are overweight or obese using network analysis and inform future health promotion for family-based intervention. Methods: Participants (n = 488) were recruited from middle schools in Nanjing from October 2022 to March 2023. Participants, together with their parents, completed a questionnaire at school about the family food environment, family size, family APGAR index, family physical activity facilities, parental mental health, rearing behavior, parental weight status, drinking history, marital satisfaction, and sociodemographic characteristics. Results: The network split into three distinct communities of items. Network analysis showed that parental mental health and paternal rearing styles-rejection were the most central nodes in the network. In contrast, maternal weight status was the most peripheral and least connected nodes. Conclusion: Family-related variables constituted a connected network in adolescents with overweight or obesity. The pattern of network node connections supports that interventions could prioritize targeting changing parental mental health and paternal rearing styles in adolescents with overweight or obesity.

A web-based calculator combining Geriatric Nutritional Risk Index (GNRI) and Tilburg Frailty Indicator (TFI) predicts postoperative complications among young elderly patients with gastric cancer.

AIM: Nutritional status and frailty are significant indicators reflecting physiological reserve. We sought to establish and validate a web-based calculator containing the Geriatric Nutritional Risk Index (GNRI) and the Tilburg Frailty Indicator (TFI) together with general clinical information to predict total complications among elderly patients with gastric cancer. METHODS: This was a prospective cohort study of 582 elderly patients with gastric cancer in a tertiary hospital in China. Nutritional status and frailty were assessed by the GNRI and the TFI, respectively. The nomogram was built and further converted into a web-based calculator. The receiver operating characteristic analysis was performed to evaluate the discrimination of the nomogram. Calibration was assessed using the calibration curve and Hosmer-Lemeshow test via the bootstrap resampling procedure. The decision curve analyses (DCAs) were employed to quantify the net benefits of a certain threshold probability for assessing the clinical values. RESULTS: The GNRI (odds ratio [OR], 0.921; 95% confidence interval [CI], 0.895-0.949; P < 0.001), the TFI (OR, 1.243; 95% CI, 1.113-1.386; P < 0.001), surgical approach (OR, 1.913; 95% CI, 1.073-3.408; P = 0.028) and comorbidity (OR = 1.599, 95%CI = 1.028-2.486, P = 0.037) were independently associated with total complications. The nomogram demonstrated good discrimination (area under the receiver operating characteristic curve: training cohort, 0.735; validation cohort, 0.777) and calibration (P = 0.135). The DCA curves of the nomogram also showed good positive net benefits. CONCLUSIONS: The web-based calculator incorporating the GNRI, the TFI, surgical approach, and comorbidity could successfully predict total complications among elderly patients with gastric cancer with good accuracy in a convenient manner. Geriatr Gerontol Int 2023; 23: 205-212.

Adverse outcomes and health-ecological influencing factors of preoperative frailty among elderly patients with gastric cancer.

PURPOSE: Frailty is defined as a state of decreased physiologic reserves arising from cumulative deficits in multiple homeostatic systems, which is important in the field of clinical oncology. We aimed to explore the relationship between preoperative frailty and adverse outcomes, and systematically analyze the factors influencing frailty based on the health ecology model among elderly gastric cancer patients. METHODS: A observational study was conducted to select 406 elderly patients who would undergo gastric cancer surgery at a tertiary hospital. The logistic regression model was used to examine the relationship between preoperative frailty and adverse outcomes, including total complications, prolonged length of stay (PLOS), and 90-day hospital readmission. Based on the health ecology model, the factors which may influence frailty were collected from four levels. Univariate and multivariate analysis were utilized to determine the factors influencing preoperative frailty. RESULTS: Preoperative frailty was associated with total complications (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.588-4.852), PLOS (OR 2.338, 95%CI 1.342-4.073), and 90-day hospital readmission (OR 2.640, 95% CI 1.275-5.469). Besides, nutritional risk (OR 4.759, 95% CI 2.409-9.403), anemia (OR 3.160, 95% CI 1.751-5.701), number of comorbidity ≥ 2 (OR 2.318, 95% CI 1.253-4.291), low physical activity level (OR 3.069, 95% CI 1.164-8.092), apathetic attachment (OR 2.656, 95% CI 1.457-4.839), personal monthly income ≤ 1000 yuan (OR 2.033, 95% CI 1.137-3.635) and anxiety (OR 2.574, 95% CI 1.311-5.053) were independent risk factors for frailty. High physical activity level (OR 0.413, 95% CI 0.208-0.820) and improved objective support (OR 0.818, 95% CI 0.683-0.978) were independent protective factors for frailty. CONCLUSIONS: Preoperative frailty was associated with multiple adverse outcomes and could be affected by factors of different dimensions from the health ecology perspective, including nutrition, anemia, comorbidity, physical activity, attachment style, objective support, anxiety, and income, which can guide the formation of a comprehensive prehabilitation for frailty among elderly gastric cancer patients.

Preoperative low handgrip strength (HGS) with HGS asymmetry is associated with adverse outcomes among older adults with gastric cancer.

INTRODUCTION: This study aimed to explore the associations of low hand grip strength (HGS), HGS asymmetry, their combinations, and frailty on hospital readmissions, total complications, and prolonged length of stay (PLOS) among older adults with gastric cancer. MATERIALS AND METHODS: This study included 342 patients with gastric cancer aged ≥60 years who were scheduled to undergo radical surgery. The Tilburg Frailty Indicator (TFI) was used to collect information on frailty. HGS was measured twice for each hand using an electronic handgrip dynamometer. The highest HGS readings on each hand were used for calculating the HGS asymmetry ratio: non-dominant HGS (kg)/dominant HGS (kg). The Fine and Gray proportional subdistribution hazard model and the logistic regression model were used for the analyses, with covariates adjusted. RESULTS: Low HGS (subdistribution hazard ratios [SHR] = 2.10, 95% confidence interval [CI] = 1.05-3.93, P = 0.036) and low HGS with HGS asymmetry (SHR = 3.95, 95% CI = 1.50-10.36, P = 0.005) were significantly associated with hospital readmissions. Frailty was associated with total complications (odds ratio [OR] = 2.87, 95% CI = 1.61-5.13, P < 0.001) and PLOS (OR = 1.98, 95% CI = 1.19-3.29, P < 0.001). Low HGS, HGS asymmetry, and their combinations were not significantly associated with total complications and PLOS. DISCUSSION: Preoperative low HGS and low HGS with HGS asymmetry were associated with hospital readmissions, while frailty was associated with total complications and PLOS among older adults with gastric cancer. In the future, more rigorously designed studies are needed to verify our results further to improve preoperative clinical assessment and frailty evaluation among older adults with gastric cancer.

BMI trajectories, associations with outcomes and predictors in elderly gastric cancer patients undergoing radical gastrectomy: a prospective longitudinal observation study.

OBJECTIVES: Elderly gastric cancer patients undergoing radical gastrectomy are prone to experience unexpected weight loss. Preoperative weight risk prediction may be a promising way to prevent weight loss and improve prognosis. The objectives of this study were to explore the BMI trajectory of elderly gastric cancer patients one year after surgery, evaluate theirs the association with outcomes, and explore their related predictors, so as to provide evidence for weight management and prognosis improvement. METHODS: 412 gastric cancer patients were included and recorded BMI at 6 time points. The trajectories of BMI were analyzed by growth mixture modeling, and the associations of BMI trajectories with outcomes as well as their predictors were investigated by regression models. RESULTS: We identified 3 classes of BMI trajectories: the "slow-decreasing BMI", "rapid-decreasing BMI" and "maintaining BMI". Compared with class1, patients in class 2 were more likely to have a higher frequency of readmission within 1-year(ß = 0.59, 95%CI: 0.29, 0.89, P < 0.001) and a higher rate of mortality within 1-year(ß = 24.74, 95%CI: 9.60, 63.74, P < 0.001) ; patients in class 3 were more likely to have a higher quality of life (ß=-10.46, 95%CI: -17.70, -3.22, P = 0.005) and fewer readmission times within one year (ß=-0.43, 95%CI: -0.77, -0.09, P = 0.015). Predictors of decreasing BMI trajectories were TNM stage, comorbidity, anxiety, family cohesion and social support(P < 0.05). CONCLUSIONS: Our findings can provide a basis for screening high-risk elderly gastric cancer patients with poor prognosis, implementing risk stratification, formulating accurate weight management programs and improving prognosis. IMPLICATIONS FOR CANCER SURVIVORS: The results of our study can provide gastric cancer survivors with preoperative risk screening based on predictive factors so that nutritional support and weight management can be implemented in a timely manner to improve prognosis.

Achieving a Record-High Capacitive Energy Density on Si with Columnar Nanograined Ferroelectric Films.

High energy density dielectric film capacitors are desirable in modern electronic devices. Their miniaturization and integration into Si-based microsystems create opportunities for in-circuit energy supply, buffering, and conditioning. Here, we present a CMOS (complementary metal oxide semiconductor)-compatible route for the fabrication of BaTiO3 film capacitors on Si with a record-high recoverable energy density and good efficiency (∼242 J/cm3 and ∼76% at 8.75 MV/cm). These BaTiO3 films were sputter-deposited at 350 °C and consisted of slightly compressed superfine columnar nanograins with a (001) texture. Such a nanostructure was endowed with a high breakdown strength, a reduced remnant polarization, and an enhanced maximum polarization, which are accountable for their excellent energy storage performance. Moreover, these BaTiO3 film capacitors displayed a high electrical fatigue resistance, a wide range of operating temperatures, and an excellent frequency stability. With an engineered nanostructure, the prototype perovskite of BaTiO3 has shown great promise for capacitive energy storage applications.

Microstructural Origin of the High-Energy Storage Performance in Epitaxial Lead-Free Ba(Zr0.2Ti0.8)O3 Thick Films.

In our previous work, epitaxial Ba(Zr0.2Ti0.8)O3 thick films (~1-2 µm) showed an excellent energy storage performance with a large recyclable energy density (~58 J/cc) and a high energy efficiency (~92%), which was attributed to a nanoscale entangled heterophase polydomain structure. Here, we propose a detailed analysis of the structure-property relationship in these film materials, using an annealing process to illustrate the effect of nanodomain entanglement on the energy storage performance. It is revealed that an annealing-induced stress relaxation led to the segregation of the nanodomains (via detailed XRD analyses), and a degraded energy storage performance (via polarization-electric field analysis). These results confirm that a nanophase entanglement is an origin of the high-energy storage performance in the Ba(Zr0.2Ti0.8)O3 thick films.

The association between metabolic syndrome and presence of frailty: a systematic review and meta-analysis.

BACKGROUND: Frailty represents a progressive deterioration in multi-system of the body and could increase vulnerability to stressors. Recently, several studies found that metabolic syndrome was significantly associated with frailty and emphasized its role in assessing and preventing frailty. However, these conclusions are controversial. We conducted this systematic review and meta-analysis to evaluate the association between metabolic syndrome and frailty. METHODS: Databases including Pubmed, Embase, Web of Science, CINAHL Complete, China National Knowledge Infrastructure (CNKI) and Wanfang Data Knowledge Service Platform were searched for studies on the association between metabolic syndrome and frailty, from inception to 17th June 2022. Two researchers independently screened the literature, extracted the data and evaluated the quality. Stata/SE 15.0 software was used to perform the statistical analysis. RESULTS: Eleven studies were included in this review and eight studies were included in the meta-analysis, involving one prospective cohort studies and ten cross-sectional studies with 12,640 participants. The pooled results indicated that metabolic syndrome was significantly associated with frailty (OR = 1.82, 95% CI = 1.46-2.27) with a low heterogeneity (I2 = 32.1%), and there were significant associations between MetS and weakness (OR = 1.35, 95% CI = 1.15-1.58, I2 = 0.0%), slow gait speed (OR = 1.80, 95% CI = 1.51-2.14, I2 = 93.4%), weight loss (OR = 1.77, 95% CI = 1.36-2.29, I2 = 0.0%) and decreased physical activity (OR = 1.87, 95% CI = 1.49-2.35, I2 = 39.7%). CONCLUSIONS: The findings of this systematic review and meta-analysis suggested that metabolic syndrome could be significantly associated with the presence of frailly. Future studies need to further consider the effects of measurement tools, age and specific disease status in this association. Furthermore, the casual relationship between them is to be determined.

Determinants of Dietary Adherence Among Chinese Patients After Bariatric Surgery Based on the Attitude-Social Influence-Efficacy Model.

PURPOSE: To explore main determinants of dietary adherence among Chinese patients after bariatric surgery based on the Attitude-Social influence-Efficacy (ASE) model. METHODS: A cross-sectional survey was conducted by using convenience sampling method to select 288 participants in a tertiary hospital in Jiangsu, China. General information and disease-related information were collected as well as applying the Dietary Adherence Scale after Bariatric Surgery (DASBS) and Attitude-Social influence-Efficacy Questionnaire after Bariatric Surgery (ASEQBS). Univariate analysis, correlation analysis, and multivariate analysis were used to identify determinants of dietary adherence among patients after bariatric surgery. RESULTS: A total of 288 questionnaires were effectively collected. The mean DASBS score was 54.90 ± 10.08 among post-bariatric patients. Univariate analysis results showed that education level, time since surgery, smoking, exercise, participation in peer support groups, and participation in nutrition counseling had significant effects on postoperative diet adherence level of patients (P < 0.05). The correlation analysis results showed that the total score of dietary adherence was positively correlated with the total score of intention, attitude, social influence, and self-efficacy, and the correlation coefficients were 0.511, 0.550, 0.460, and 0.484, respectively (P < 0.05). The results of multiple linear regression analysis showed that time since surgery, attitude, intention, social influence, exercise, and self-efficacy entered the regression equation (P < 0.05). The standardized regression coefficients of attitude and intention are 0.237 and 0.196, respectively. The regression model could explain 44.0% of the total variation. CONCLUSION: The dietary adherence of Chinese post-bariatric patients is at an upper-middle level, which needs to be further improved. Time since surgery, exercise, intention, attitude, social influence, and self-efficacy had significant effects on patients' dietary adherence. Attitude had the greatest effect on dietary adherence, followed by intention. The results shed light on that these factors should be emphasized to take personalized intervention strategy in designing dietary intervention program, in order to improve the patient's dietary adherence and surgical outcomes.

Energy Storage Properties of Sol-Gel-Processed SrTiO3 Films.

Dielectric films with a high energy storage density and a large breakdown strength are promising material candidates for pulsed power electrical and electronic applications. Perovskite-type dielectric SrTiO3 (STO) has demonstrated interesting properties desirable for capacitive energy storage, including a high dielectric constant, a wide bandgap and a size-induced paraelectric-to-ferroelectric transition. To pave a way toward large-scale production, STO film capacitors were deposited on Pt(111)/Ti/SiO2/Si(100) substrates by the sol-gel method in this paper, and their electrical properties including the energy storage performance were studied as a function of the annealing temperature in the postgrowth rapid thermal annealing (RTA) process. The appearance of a ferroelectric phase at a high annealing temperature of 750 °C was revealed by X-ray diffraction and electrical characterizations (ferroelectric P-E loop). However, this high dielectric constant phase came at the cost of a low breakdown strength and a large hysteresis loss, which are not desirable for the energy storage application. On the other hand, when the RTA process was performed at a low temperature of 550 °C, a poorly crystallized perovskite phase together with a substantial amount of impurity phases appeared, resulting in a low breakdown strength as well as a very low dielectric constant. It is revealed that the best energy storage performance, which corresponds to a large breakdown strength and a medium dielectric constant, is achieved in STO films annealed at 650 °C, which showed a large energy density of 55 J/cm3 and an outstanding energy efficiency of 94.7% (@ 6.5 MV/cm). These findings lay out the foundation for processing high-quality STO film capacitors via the manufacturing-friendly sol-gel method.

Compensatory Belief in Health Behavior Management: A Concept Analysis.

PURPOSE: This study aimed to identify the exact definition of the concept of compensatory belief (CB) and to help clinicians and caregivers to distinguish patients who tend to form such beliefs. METHODS: This study is a conceptual analysis based on the strategy of Walker and Avant (2014). We retrieved studies from existing literature using databases such as PubMed, CINAHL, Wiley, and Web of Science, and extracted information from the results. No date limitations were applied. RESULTS: A total of 35 articles were sourced for data extraction. The identified attributes of CB were as follows: cognitive coping strategy, pleasure without guilt, compensatory behaviors, automatic motivated self-regulatory process, and implicit cognition. The observed antecedents were: failure to resist desire, reluctance, a conflicting motivational state, seeking appropriate balance, and self-image maintenance. The consequences of CB were lower health-related intentions, justification of unhealthy choices, relief from cognitive dissonance, continued existence of conflict feeling, and poor long-term health. CONCLUSION: Compensatory belief stems from motivational dissonance or confliction. Despite causing feelings of pleasure and relief, it can negatively impact long-term health. Although CB is crucial to establish healthy behaviors, it is easily ignored in medical work.