Background and purpose
Physical activity is associated with a reduced incidence of first‐time stroke. However, few studies have examined the effect of pre‐stroke physical activity on post‐stroke ...complications and clinical outcomes.
Methods
A total of 39 835 cases of stroke registered in the nationwide stroke registry system of Taiwan between 2006 and 2009 were analyzed according to five levels of severity as determined by National Institutes of Health Stroke Scale score upon hospital admission. Pre‐stroke physical activity was defined in the Taiwan Stroke Registry as dedicated leisure‐time physical activity for at least 30 min/day for 3 days/week for more than 6 months. A Cox model was used to compare complications and outcomes between active and inactive groups.
Results
The active and inactive groups were similar in age distribution and stroke type distribution, but the active group had better National Institutes of Health Stroke Scale scores upon admission. The active group also had significantly fewer post‐stroke complications. Active patients had lower hospital mortality and better functional outcomes upon discharge as per the modified Rankin Scale. Improved functional status in the active group was significant at 1, 3 and 6 months post‐stroke.
Conclusion
Dedicated leisure‐time physical activity for at least 30 min/day, at least three times per week for more than 6 months was associated with decreased stroke severity, fewer post‐stroke complications, lower mortality and better outcomes.
Nitrification is a series of processes that oxidizes ammonia to nitrate, which contributes to hypoxia development in coastal oceans, especially in eutrophicated regions. The nitrification rate of ...bulk water (NRb) and particle free water (NRpf, particle > 3 μm eliminated) were determined along the Chang Jiang River plume in August 2011 by nitrogen isotope tracer technique. Measurements of dissolved oxygen (DO), community respiration rate (CR), nutrients, dissolved organic nitrogen (DON), total suspended matter (TSM), particulate organic carbon/nitrogen (POC / PON), acid-leachable iron and manganese on suspended particles and both archaeal and β-proteobacterial ammonia monooxygenase subunit A gene (amoA) abundance on size-fractioned particles (> 3 μm and 0.22–3 μm) were conducted. The NRb ranged from undetectable up to 4.6 μmol L−1 day−1, peaking at a salinity of ~ 29. NRb values were positively correlated with ammonium concentration, suggesting the importance of substrate in nitrification. In the river mouth and the inner plume, NRb was much higher than NRpf, indicating that the nitrifying microorganism is mainly particle associated, which was supported by its significant correlation with amoA gene abundance and TSM concentration. The estimated oxygen demands of nitrification accounted for 0.32 to 318% of CR, in which 50% samples demanded more oxygen than that predicted by by the Redfield model (23%), indicating that oxygen might not be the sole oxidant though DO was sufficient (> 58 μmol kg−1) throughout the observation period. The excess nitrification-associated oxygen demand (NOD) showed a tendency to occur at lower DO samples accompanied by higher acid-leachable Fe / Mn, which implied reactive Fe3+ / Mn4+ may play a role as oxidant in the nitrification process. Stoichiometric calculation suggested that reactive Fe on particles was 10 times the oxidant demand required to complete ammonia oxidation in the entire plume. The potential involvement of reactive iron and manganese in the nitrification process in oxygenated water further complicated nitrogen cycling in the turbid river plume.
A new formulation for floc yield strength of cohesive sediment is theoretically derived and incorporated into a flocculation model based on variable fractal dimension. The new flocculation model is ...validated with existing data on the temporal evolution of floc size measured in the laboratory. Comparing with existing flocculation models using a constant yield strength, it is found that new flocculation model based on variable yield strength and variable fractal dimension is superior in predicting the temporal evolution of floc size. It is also demonstrated that the present model results are very similar to that using an empirical formulation of variable yield strength suggested by Sonntag and Russel (1987. Structure and breakup of floccs subjected to fluid stressses. II. Theory. J. Colloid Interface Sci. 115(2), 378–389) when the empirical coefficient is specified according to our theoretical value. Hence, it is concluded that the new variable yield strength formulation derived in this study and the variable fractal dimension are effective in improving the prediction of flocculation process.
We interpret the Taylor–Green cellular vortex model in terms of the Kolmogorov length and velocity scales, in order to study the balance between aggregation and breakup of cohesive sediment in ...fine-scale turbulence. One-way coupled numerical simulations, which capture the effects of cohesive, lubrication and direct contact forces on the flocculation process, reproduce the non-monotonic relationship between the equilibrium floc size and shear rate observed in previous experiments. The one-way coupled results are confirmed by select two-way coupled simulations. Intermediate shear gives rise to the largest flocs, as it promotes preferential concentration of the primary particles without generating sufficiently strong turbulent stresses to break up the emerging aggregates. We find that the optimal intermediate shear rate increases for stronger cohesion and smaller particle-to-fluid density ratios, and we propose a simple model for the equilibrium floc size that agrees well with experimental data reported in the literature.
Summary
Background
Aspirin increases the risk of gastrointestinal bleeding.
Aim
To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users.
Methods
Low‐dose (75‐325 mg daily) ...aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine‐2 receptor antagonists (H2RAs), nitrates, alendronate, selective serotonin reuptake inhibitors (SSRIs) and calcium channel blockers.
Results
A total of 53 805 aspirin users and 269 025 controls were included. Aspirin group had a higher incidence of LGIB within 1 year than control group (0.20% vs 0.06%, P<.0001). Aspirin (hazard ratio HR: 2.75, 95% confidence interval CI: 2.06‐3.65), NSAIDs (HR: 8.61, 95% CI: 3.28‐22.58), steroids (HR: 10.50, 95% CI: 1.98‐55.57), SSRIs (HR: 11.71, 95% CI: 1.40‐97.94), PPIs (HR: 8.47, 95% CI: 2.26‐31.71), and H2RAs (HR: 10.83, 95% CI: 2.98‐39.33) were significantly associated with LGIB.
Conclusions
The risk of LGIB was higher in low‐dose aspirin users than in aspirin nonusers in this nationwide cohort. Low‐dose aspirin, NSAIDs, steroids, SSRIs, PPIs and H2RAs were independent risk factors for LGIB.
Linked ContentThis article is linked to Taha and Chen et al papers. To view these articles visit https://doi.org/10.1111/apt.14114 and https://doi.org/10.1111/apt.14138.
We investigate the dynamics of cohesive particles in homogeneous isotropic turbulence, based on one-way coupled simulations that include Stokes drag, lubrication, cohesive and direct contact forces. ...We observe a transient flocculation phase, followed by a statistically steady equilibrium phase. We analyse the temporal evolution of floc size and shape due to aggregation, breakage and deformation. Larger turbulent shear and weaker cohesive forces yield smaller elongated flocs. Flocculation proceeds most rapidly when the fluid and particle time scales are balanced and a suitably defined Stokes number is $O(1)$. During the transient stage, cohesive forces of intermediate strength produce flocs of the largest size, as they are strong enough to cause aggregation, but not so strong as to pull the floc into a compact shape. Small Stokes numbers and weak turbulence delay the onset of the equilibrium stage. During equilibrium, stronger cohesive forces yield flocs of larger size. The equilibrium floc size distribution exhibits a preferred size that depends on the cohesive number. We observe that flocs are generally elongated by turbulent stresses before breakage. Flocs of size close to the Kolmogorov length scale preferentially align themselves with the intermediate strain direction and the vorticity vector. Flocs of smaller size tend to align themselves with the extensional strain direction. More generally, flocs are aligned with the strongest Lagrangian stretching direction. The Kolmogorov scale is seen to limit floc growth. We propose a new flocculation model with a variable fractal dimension that predicts the temporal evolution of the floc size and shape.
A previous genetic study has suggested that schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) share common ...disease-associated genes. However, whether individuals with first-degree relatives (FDRs) with schizophrenia have a higher risk of these major psychiatric disorders requires further investigation. This study used Taiwan's National Health Insurance Research Database and identified 151 650 patients with schizophrenia and 227 967 individuals with FDRs with schizophrenia. The relative risks (RRs) of schizophrenia and other major psychiatric disorders were assessed in individuals with FDRs with schizophrenia. The individuals with FDRs with schizophrenia exhibited higher RRs (95% confidence interval) of major psychiatric disorders, namely schizophrenia (4.76, 4.65-4.88), bipolar disorder (3.23, 3.12-3.35), major depressive disorder (2.05, 2.00-2.10), ASD (2.55, 2.35-2.77) and ADHD (1.31, 1.25-1.37) than were found in the total population. Several sensitivity analyses were conducted to confirm these results. A dose-dependent relationship was observed between the risks of major psychiatric disorders and the numbers of FDRs with schizophrenia. The increased risks of major psychiatric disorders were consistent in different family relationships, namely among parents, offspring, siblings and twins. Our study supports the familial dose-dependent co-aggregation of schizophrenia, bipolar disorder, major depressive disorder, ASD and ADHD, and our results may prompt governmental public health departments and psychiatrists to focus on the mental health of individuals with FDRs with schizophrenia.
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