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A submerged active breakwater consists of a large horizontal cylinder moored by a spring and damper retention system. In response to incident waves, the cylinder is forced to oscillate in heave and sway. The spring and damper rates can be tuned to provide a considerable amount of wave attenuation during specific wave conditions. Hydraulic model tests were undertaken in a two-dimensional wave flume at the Queen's University Coastal Engineering Research Laboratory in Kingston, Ontario. The tests investigated the performance of such devices in regular and random wave conditions of varying height and period, and observed the effect of variation in submergence depth. Two breakwaters were placed in series to observe the benefit of using multiple breakwaters. The results were compared with two simple mathematical models. The study showed that these breakwaters can absorb significant amounts of wave energy from regular and irregular waves. The performance was primarily a function of wave frequency and it decreased with increased wave height and increased submergence depth. Two devices in series provided more wave attenuation over broader ranges of wave conditions than a single breakwater. The mathematical models were capable of predicting trends observed in the test data very well but were only satisfactory at predicting the actual wave transmission and power absorption efficiency.

Many-body localization (MBL), the disorder-induced localization of interacting particles, signals a breakdown of conventional thermodynamics because MBL systems do not thermalize and show nonergodic time evolution. We experimentally observed this nonergodic evolution for interacting fermions in a one-dimensional quasirandom optical lattice and identified the MBL transition through the relaxation dynamics of an initially prepared charge density wave. For sufficiently weak disorder, the time evolution appears ergodic and thermalizing, erasing all initial ordering, whereas above a critical disorder strength, a substantial portion of the initial ordering persists. The critical disorder value shows a distinctive dependence on the interaction strength, which is in agreement with numerical simulations. Our experiment paves the way to further detailed studies of MBL, such as in noncorrelated disorder or higher dimensions.

Fast and reliable detection of patients with severe and heterogeneous illnesses is a major goal of precision medicine 1 , 2 . Patients with leukaemia can be identified using machine learning on the basis of their blood transcriptomes 3 . However, there is an increasing divide between what is technically possible and what is allowed, because of privacy legislation 4 , 5 . Here, to facilitate the integration of any medical data from any data owner worldwide without violating privacy laws, we introduce Swarm Learning—a decentralized machine-learning approach that unites edge computing, blockchain-based peer-to-peer networking and coordination while maintaining confidentiality without the need for a central coordinator, thereby going beyond federated learning. To illustrate the feasibility of using Swarm Learning to develop disease classifiers using distributed data, we chose four use cases of heterogeneous diseases (COVID-19, tuberculosis, leukaemia and lung pathologies). With more than 16,400 blood transcriptomes derived from 127 clinical studies with non-uniform distributions of cases and controls and substantial study biases, as well as more than 95,000 chest X-ray images, we show that Swarm Learning classifiers outperform those developed at individual sites. In addition, Swarm Learning completely fulfils local confidentiality regulations by design. We believe that this approach will notably accelerate the introduction of precision medicine. Swarm Learning is a decentralized machine learning approach that outperforms classifiers developed at individual sites for COVID-19 and other diseases while preserving confidentiality and privacy.

In the presence of disorder, an interacting closed quantum system can undergo many-body localization (MBL) and fail to thermalize. However, over long times, even weak couplings to any thermal environment will necessarily thermalize the system and erase all signatures of MBL. This presents a challenge for experimental investigations of MBL since no realistic system can ever be fully closed. In this work, we experimentally explore the thermalization dynamics of a localized system in the presence of controlled dissipation. Specifically, we find that photon scattering results in a stretched exponential decay of an initial density pattern with a rate that depends linearly on the scattering rate. We find that the resulting susceptibility increases significantly close to the phase transition point. In this regime, which is inaccessible to current numerical studies, we also find a strong dependence on interactions. Our work provides a basis for systematic studies of MBL in open systems and opens a route towards extrapolation of closed-system properties from experiments.

‘Smart’ bandages based on multimodal wearable devices could enable real-time physiological monitoring and active intervention to promote healing of chronic wounds. However, there has been limited development in incorporation of both sensors and stimulators for the current smart bandage technologies. Additionally, while adhesive electrodes are essential for robust signal transduction, detachment of existing adhesive dressings can lead to secondary damage to delicate wound tissues without switchable adhesion. Here we overcome these issues by developing a flexible bioelectronic system consisting of wirelessly powered, closed-loop sensing and stimulation circuits with skin-interfacing hydrogel electrodes capable of on-demand adhesion and detachment. In mice, we demonstrate that our wound care system can continuously monitor skin impedance and temperature and deliver electrical stimulation in response to the wound environment. Across preclinical wound models, the treatment group healed ~25% more rapidly and with ~50% enhancement in dermal remodeling compared with control. Further, we observed activation of proregenerative genes in monocyte and macrophage cell populations, which may enhance tissue regeneration, neovascularization and dermal recovery. A wireless ‘smart’ bandage stimulates wound healing.

Differentiating acute bacterial infection from other causes of lower respiratory tract illness is challenging. In this trial, procalcitonin was investigated as a point-of-care test to aid in determining whether antibiotics were needed in the treatment of these illnesses.

Body mass of wild pigs ( Sus scrofa ) can provide useful information regarding reproductive capacity of a population, and population health and resilience for this highly-destructive invasive species. Body mass of females is an indicator of whether they reproduce before 1 year of age, which could have substantial impacts on reproductive capacity of a population. Measuring body mass can be difficult because large wild pigs may require > 1 person to weigh, are often located in remote areas making equipment difficult to transport, or are often culled without access to the carcass (e.g., shooting from aircraft). We evaluated our ability to accurately estimate the body mass of wild pigs by visual inspection, and identified which factors (i.e., morphometrics and demographics) influenced the accuracy of our estimates. We visually estimated the body mass of wild pigs and then collected actual weights of 1,210 wild pigs across 5 regions (Alabama, Texas, Hawaii, Guam, Queensland). We also collected morphometric measurements and age to evaluate how these factors impacted our estimates. On average we found our estimates were accurate, averaging only -0.14 kg underestimated weights across all wild pigs weighed. However, our estimates were most severely underestimated (e.g., up to -20 kg) for younger wild pigs (i.e., < 1–3 years) that were heavier (i.e., > 30 kg). We also confirmed that although growth rates slowed after 1 year of age, wild pigs continued to grow in body length, head length, height, and girth as they aged, which explained why the age of an animal influenced our ability to generate accurate estimates. We surmised that young-yet-heavy wild pigs were disproportionally stouter than older animals, thus were underestimated due to their shortened appearance. Underestimating the body mass for young-yet-heavy females could misinform management plans, because these animals may have substantial influence on the reproductive capacity of a population. For visually estimating body mass of wild pigs, we recommend considering indicators of age (e.g., morphological proportions) to avoid underestimating young-yet-heavy animals with stout appearances. We also recommend calibrating observers regularly using known weights and morphometrics.

Adults with chronic kidney disease (CKD) are hospitalized more frequently than those without CKD, but the magnitude of this excess morbidity and the factors associated with hospitalizations are not well known. Data from 3,939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study between 2003 and 2008 at 7 clinical centers in the United States were used to estimate primary causes of hospitalizations, hospitalization rates, and baseline participant factors associated with all-cause, cardiovascular, and non-cardiovascular hospitalizations during a median follow up of 9.6 years. Multivariable-adjusted Poisson regression was used to identify factors associated with hospitalization rates, including demographics, blood pressure, estimated glomerular filtration rate (eGFR), and proteinuria. Hospitalization rates in CRIC were compared with rates in the Nationwide Inpatient Sample (NIS) from 2012. Of the 3,939 CRIC participants, 45.1% were female, and 41.9% identified as non-Hispanic black, with a mean age of 57.7 years, and the mean eGFR is 44.9 ml/min/1.73m2. CRIC participants had an unadjusted overall hospitalization rate of 35.0 per 100 person-years (PY) [95% CI: 34.3 to 35.6] and 11.1 per 100 PY [95% CI: 10.8 to 11.5] for cardiovascular-related causes. All-cause, non-cardiovascular, and cardiovascular hospitalizations were associated with older age (≥65 versus 45 to 64 years), more proteinuria (≥150 to <500 versus <150 mg/g), higher systolic blood pressure (≥140 versus 120 to <130 mmHg), diabetes (versus no diabetes), and lower eGFR (<60 versus ≥60 ml/min/1.73m2). Non-Hispanic black (versus non-Hispanic white) race/ethnicity was associated with higher risk for cardiovascular hospitalization [rate ratio (RR) 1.25, 95% CI: 1.16 to 1.35, p-value < 0.001], while risk among females was lower [RR 0.89, 95% CI: 0.83 to 0.96, p-value = 0.002]. Rates of cardiovascular hospitalizations were higher among those with ≥500 mg/g of proteinuria irrespective of eGFR. The most common causes of hospitalization were related to cardiovascular (31.8%), genitourinary (8.7%), digestive (8.3%), endocrine, nutritional or metabolic (8.3%), and respiratory (6.7%) causes. Hospitalization rates were higher in CRIC than the NIS, except for non-cardiovascular hospitalizations among individuals aged >65 years. Limitations of the study include possible misclassification by diagnostic codes, residual confounding, and potential bias from healthy volunteer effect due to its observational nature. In this study, we observed that adults with CKD had a higher hospitalization rate than the general population that is hospitalized, and even moderate reductions in kidney function were associated with elevated rates of hospitalization. Causes of hospitalization were predominantly related to cardiovascular disease, but other causes contributed, particularly, genitourinary, digestive, and endocrine, nutritional, and metabolic illnesses. High levels of proteinuria were observed to have the largest association with hospitalizations across a wide range of kidney function levels.

Anemia is associated with worse outcome in stroke, but the impact of anemia with intravenous thrombolysis or endovascular therapy has hardly been delineated. The aim of this study was to analyze the role of anemia on infarct evolution and outcome after acute stroke treatment. 1158 patients from Bern and 321 from Los Angeles were included. Baseline data and 3 months outcome assessed with the modified Rankin Scale were recorded prospectively. Baseline DWI lesion volumes were measured in 345 patients and both baseline and final infarct volumes in 180 patients using CT or MRI. Multivariable and linear regression analysis were used to determine predictors of outcome and infarct growth. 712 patients underwent endovascular treatment and 446 intravenous thrombolysis. Lower hemoglobin at baseline, at 24h, and nadir until day 5 predicted poor outcome (OR 1.150-1.279) and higher mortality (OR 1.131-1.237) independently of treatment. Decrease of hemoglobin after hospital arrival, mainly induced by hemodilution, predicted poor outcome and had a linear association with final infarct volumes and the amount and velocity of infarct growth. Infarcts of patients with newly observed anemia were twice as large as infarcts with normal hemoglobin levels. Anemia at hospital admission and any hemoglobin decrease during acute stroke treatment affect outcome negatively, probably by enlarging and accelerating infarct growth. Our results indicate that hemodilution has an adverse effect on penumbral evolution. Whether hemoglobin decrease in acute stroke could be avoided and whether this would improve outcome would need to be studied prospectively.

Onchocerciasis (\"river blindness\") has been targeted for elimination. New treatments that kill or permanently sterilize female worms could accelerate this process. Prior studies have shown that triple drug treatment with ivermectin plus diethylcarbamazine and albendazole (IDA) leads to prolonged clearance of microfilaremia in persons with lymphatic filariasis. We now report results from a randomized clinical trial that compared the tolerability and efficacy of IDA vs. a comparator treatment (ivermectin plus albendazole, IA) in persons with onchocerciasis. The study was performed in the Volta region of Ghana. Persons with microfiladermia and palpable subcutaneous nodules were pre-treated with two oral doses of ivermectin (150 μg/kg) separated by at least 6 months prior to treatment with either a single oral dose of ivermectin 150 μg/kg plus albendazole 400 mg (IA), a single oral dose of IDA (IDA1, IA plus diethylcarbamazine (DEC. 6 mg/kg) or three consecutive daily doses of IDA (IDA3). These treatments were tolerated equally well. While adverse events were common (approximately 30% overall), no severe or serious treatment-emergent adverse events were observed. Skin microfilariae were absent or present with very low densities after all three treatments through 18 months, at which time nodules were excised for histological assessment. Nodule histology was evaluated by two independent assessors who were masked regarding participant infection status or treatment assignment. Significantly lower percentages of female worms were alive and fertile in nodules recovered from study participants after IDA1 (40/261, 15.3%) and IDA3 (34/281, 12.1%) than after IA (41/180, 22.8%). This corresponds to a 40% reduction in the percentage of female worms that were alive and fertile after IDA treatments relative to results observed after the IA comparator treatment (P = 0.004). Percentages of female worms that were alive (a secondary outcome of the study) were also lower after IDA treatments (301/574, 52.4%) than after IA (127/198, 64.1%) (P = 0.004). Importantly, some comparisons (including the reduced % of fertile female worms after IDA1 vs IA treatment, which was the primary endpoint for the study) were not statistically significant when results were adjusted for intraclass correlation of worm fertility and viability for worms recovered from individual study participants. Results from this pilot study suggest that IDA was well tolerated after ivermectin pretreatment. They also suggest that IDA was more effective than the comparator treatment IA for killing or sterilizing female O. volvulus worms. No other short-course oral treatment for onchocerciasis has been demonstrated to have macrofilaricidal activity. However, this first study was too small to provide conclusive results. Therefore, additional studies will be needed to confirm these promising findings. The study is registered at Cinicaltrials.gov under the number NCT04188301.