Mobile phone applications (MPAs) for substance use disorder (SUD) treatment are increasingly used by patients. Although pilot studies have shown promising results, multiple previous systematic ...reviews noted insufficient evidence for MPA use in SUD treatment—many of the previously published reviews evaluated different trials. Subsequently, we aimed to conduct an umbrella review of previously published reviews investigating the efficacy of MPAs for SUD treatment, excluding nicotine/tobacco because umbrella reviews have been done in this population and the nicotine/tobacco MPA approach often differs from SUD-focused MPAs. No previous reviews have included a statistical meta-analysis of clinical trials to quantify an estimated overall effect. Seven reviews met inclusion criteria, and 17 unique studies with available data were taken from those reviews for the meta-analysis. Overall, reviews reported a lack of evidence for recommending MPAs for SUD treatment. However, MPA-delivered recovery support services, cognitive behavioral therapy, and contingency management were identified across multiple reviews as having promising evidence for SUD treatment. Hedges g effect size for an MPA reduction in substance use–related outcomes relative to the control arm was insignificant (0.137; 95% CI, −0.056 to 0.330; P=.16). In subgroup analysis, contingency management (1.29; 95% CI, 1.088-1.482; τ2=0; k=2) and cognitive behavioral therapy (0.02; 95% CI, 0.001-0.030; τ2=0; k=2) were significant. Although contingency management’s effect was large, both trials were small (samples of 40 and 30). This review includes an adapted framework for the American Psychiatric Association’s MPA guidelines that clinicians can implement to review MPAs critically with patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Age is the main risk factor for sporadic Alzheimer's disease. Yet, cognitive decline in aged rodents has been less well studied, possibly due to concomitant changes in sensory or locomotor function ...that can complicate cognitive tests. We tested mice that were 3, 11, and 23 months old in cognitive, sensory, and motor measures, and postmortem measures of gliosis and neural activity (c-Fos). Hippocampal synaptic function was also examined. While age-related impairments were detectable in tests of spatial memory, greater age-dependent effects were observed in tests of associative learning active avoidance (AA). Gross visual function was largely normal, but startle responses to acoustic stimuli decreased with increased age, possibly due to hearing impairments. Therefore, a novel AA variant in which light alone served as the conditioning stimuli was used. Age-related deficits were again observed. Mild changes in vision, as measured by optokinetic responses, were detected in 19- versus 4-month-old mice, but these were not correlated to AA performance. Thus, deficits in hearing or vision are unlikely to account for the observed deficits in cognitive measures. Increased gliosis was observed in the hippocampal formation at older ages. Age-related changes in neural function and plasticity were observed with decreased c-Fos in the dentate gyrus, and decreased synaptic strength and paired-pulse facilitation in CA1 slices. This work, which carefully outlines age-dependent impairments in cognitive and synaptic function, c-Fos activity, and gliosis during normal aging in the mouse, suggests robust translational measures that will facilitate further study of the biology of aging.
A hypoeutectic, Fe-modified Al–Ce–Ni alloy (Al–6Ce–3Ni-0.7Fe, wt.%) is studied in terms of microstructure, thermal stability, ambient temperature strengthening, and creep resistance. The as-cast ...microstructure consists of primary Al dendrites and interdendritic binary eutectic regions (Al–Al11Ce3 and/or Al–Al9(Fe,Ni)2), with micron/submicron lamellar spacing, depending on the location along the height of the ingot. The cast alloy exhibits excellent coarsening resistance at 400 °C, with mostly unchanged microstructure and microhardness after 6 weeks of aging, indicating good thermal stability of Al11Ce3 and Al9(Fe,Ni)2. Orowan strengthening and load transfer are identified as strengthening mechanisms at ambient and elevated temperature. A high volume fraction of the intermetallic phases (providing load transfer) and relatively coarse eutectic spacing (for modest Orowan strengthening) result in a moderate as-cast microhardness of 566 ± 32 MPa. Creep resistance at 300 and 350 °C is similar to a binary Al-12.5Ce eutectic alloy (with twice the Ce content) because of two countering effects: Al–6Ce–3Ni-0.7Fe shows a higher volume fraction of strengthening intermetallic phases, but it also exhibits a large fraction of primary Al dendrites which weaken the alloy. By contrast, the alloy, when laser-remelted at the surface, has a fully eutectic microstructure without primary aluminum dendrites achieved by high undercooling on solidification, with a refined network of eutectic phases that doubles the microhardness as compared to the cast alloy. Whereas coarsening is faster due to the shorter diffusion distances between the eutectic phases, hardness remains ∼30% higher than the as-cast alloy after ∼6 weeks aging at 400 °C.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, SAZU, SBCE, UL, UPCLJ, UPUK, ZAGLJ
This study investigates the as-cast and aged microstructures, thermal stability, ambient temperature strengthening, and creep resistance of three ternary Al–Ce–Ni alloys (wt%): near-eutectic ...Al–10Ce–5Ni (with both eutectic and hypoeutectic regions), hypoeutectic Al-7.5Ce-3.75Ni (with numerous primary Al dendrites), and hypereutectic Al-12.5Ce-6.25Ni (with coarse, blocky primary Al3Ni and Al11Ce3 precipitates and some primary Al dendrites). Depending on the alloy composition and local solidification conditions, the following eutectic morphologies are found: (i) coarse Al–Ce eutectic colonies where Al11Ce3 is in the form of “Chinese script”, (ii) intermingled regions of binary Al–Ce and Al–Ni eutectic colonies, with finer Al3Ni and Al11Ce3 fibers, (iii) large ternary eutectic colonies, where the binary Al3Ni and Al11Ce3 phases are alternating or intertwining within the individual, fine fibers (diameters of ∼60–170 nm, depending on solidification rates), and (iv) ternary eutectic zones (between primary Al dendrites), where fine Al3Ni and Al11Ce3 build up a 3D-interconnected network. The high volume fraction of intermetallic phases and extremely fine eutectic spacing/fiber diameter both contribute to high ambient strengthening (higher as-cast microhardness than binary Al–Ce or Al–Ni), and also provide enhanced creep resistance at 300 and 350 °C. The alloys are coarsening-resistant up to 425 °C for extended periods, with a gradual decrease in microhardness. The alloys aged at 400 °C to 1050 h show fiber fragmentation and coarsening of the resulting particles, with the faster-diffusing Ni driving more rapid coarsening of the Al3Ni particles which engulf finer, more stable Al11Ce3 particles. Severe overaging (performed at 590 °C for 24 h) leads to Al3Ni and Al11Ce3 spheroids which remain submicron-sized in eutectic colonies, but micron-sized at colony boundary and at Al dendrite-eutectic interface. Creep resistance at 300 °C of overaged Al–10Ce–5Ni remains substantial, consistent with load-transfer based composite strengthening being an important strengthening mechanism in these alloys, making them excellent candidates for replacement of heavier steel or titanium parts operating under stress up to 300 °C.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, SAZU, SBCE, UL, UPCLJ, UPUK, ZAGLJ
Here, a hypoeutectic, Fe-modified Al–Ce–Ni alloy (Al–6Ce–3Ni-0.7Fe, wt.%) is studied in terms of microstructure, thermal stability, ambient temperature strengthening, and creep resistance. The ...as-cast microstructure consists of primary Al dendrites and interdendritic binary eutectic regions (Al–Al11Ce3 and/or Al–Al9(Fe,Ni)2), with micron/submicron lamellar spacing, depending on the location along the height of the ingot. The cast alloy exhibits excellent coarsening resistance at 400 °C, with mostly unchanged microstructure and microhardness after 6 weeks of aging, indicating good thermal stability of Al11Ce3 and Al9(Fe,Ni)2. Orowan strengthening and load transfer are identified as strengthening mechanisms at ambient and elevated temperature. A high volume fraction of the intermetallic phases (providing load transfer) and relatively coarse eutectic spacing (for modest Orowan strengthening) result in a moderate as-cast microhardness of 566 ± 32 MPa. Creep resistance at 300 and 350 °C is similar to a binary Al-12.5Ce eutectic alloy (with twice the Ce content) because of two countering effects: Al–6Ce–3Ni-0.7Fe shows a higher volume fraction of strengthening intermetallic phases, but it also exhibits a large fraction of primary Al dendrites which weaken the alloy. By contrast, the alloy, when laser-remelted at the surface, has a fully eutectic microstructure without primary aluminum dendrites achieved by high undercooling on solidification, with a refined network of eutectic phases that doubles the microhardness as compared to the cast alloy. Whereas coarsening is faster due to the shorter diffusion distances between the eutectic phases, hardness remains ~30% higher than the as-cast alloy after ~6 weeks aging at 400 °C.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, SAZU, SBCE, UL, UPCLJ, UPUK, ZAGLJ
Liver transplantation for patients with acute-on-chronic liver failure (ACLF) with 3 or more failing organs (ACLF-3) is controversial. We compared liver waitlist mortality or removal according to ...model for end-stage liver disease (MELD) score vs ACLF category. We also studied factors associated with reduced odds of survival for 1 year after liver transplantation in patients with ACLF-3.
We analyzed data from the United Network for Organ Sharing (UNOS) from 2005 through 2016. We identified patients who were on the waitlist (100,594) and those who received liver transplants (50,552). Patients with ACLF were identified based on the European Association for the Study of the Liver-chronic liver failure criteria. Outcomes were evaluated with competing risks regression, Kaplan-Meier analysis, and Cox proportional hazards regression.
Patients with ACLF-3 were more likely to die or be removed from the waitlist, regardless of MELD-sodium (MELD-Na) score, compared with the other ACLF groups; the proportion was greatest for patients with an ACLF-3 score and MELD-Na score below 25 (43.8% at 28 days). Mechanical ventilation at liver transplantation (hazard ratio HR 1.49; 95% confidence interval CI 1.22–1.84), donor risk index above 1.7 (HR 1.22; 95% CI 1.09–1.35), and liver transplantation within 30 days of listing (HR 0.89; 95% CI 0.81–0.98) were independently associated with survival for 1 year after liver transplantation
In an analysis of data from the UNOS registry, we found high mortality among patients with ACLF-3 on the liver transplant waitlist, even among those with lower MELD-Na scores. So, certain patients with ACLF-3 have poor outcomes regardless of MELD-Na score. Liver transplantation increases odds of survival for these patients, particularly if performed within 30 days of placement on the waitlist. Mechanical ventilation at liver transplantation and use of marginal organs were associated with increased risk of death.
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