Search

Abstract To investigate associations between parent–child relationships, children’s externalizing and internalizing symptoms, and lifestyle responses to the COVID-19 epidemic, we conducted an online survey of a random, representative sample of residents with children aged 3–17 years during mid-March 2020 in Wuhan and Shanghai, China. A total of 1655 parents and children were surveyed with a response rate of 80.1% in the survey. During the epidemic, the frequency of children enquiring about the epidemic (AOR = 1.46, 95% CI: 1.04, 2.06), parents explaining the epidemic to them (AOR = 2.87, 95% CI: 1.80, 4.58), parents expressing negative emotions in front of them (AOR = 2.62; 95% CI = 2.08–3.30), and parents with more irritable attitudes (AOR = 1.93; 95% CI = 1.33–2.81) were significantly associated with children’s externalizing symptoms. For internalizing symptoms, significant associations were found with worse parent–child closeness (AOR = 2.93; 95% CI = 1.80–4.79), the frequency of parents expressing negative emotions in front of them (AOR = 2.64; 95% CI = 1.68, 4.12), and more irritable attitudes (AOR = 2.24; 95% CI = 1.42–3.55). We also found that each indicator of parent–child relationships had the significantly similar associations with children’s lifestyle behaviors. These findings suggest that improving parents’ attitudes towards their children and parent–child closeness during the epidemic, especially among parents with lower educational levels, are important to ensure the wellbeing of children.

Virtual Exchange (VE) provides a strategic approach for higher education institutions to internationalize. This study investigated how a USA Community College (US-CC) system and their partners started and grew their internationalization program through VE with teacher training, assessment, and support from a nonprofit bridge organization. Data were collected on program growth over three years, 2017-20, totaling 13 modules, 29 faculty, and 14 campuses. Cumulatively, students completed 341 pre-module and 202 post-module surveys which assessed the community colleges’ student learning goals: intercultural competence and awareness of the wider world, confidence in finding success in the global workforce, and ability to deploy 21st century skills (e.g. technology and teamwork). Quantitative and qualitative results provided concrete and nuanced evidence of program effectiveness and suggested positive impact. Our findings have two main implications: (1) positive student impact can help grow and sustain VE and other international programming; and (2) teacher training informed by and adapted with student assessment can help institutionalize VE programs.

Abstract Objective This study was aimed to determine how platelet reactivity (PR) on dual antiplatelet therapy predicts ischemic and bleeding events in patients underwent percutaneous coronary intervention (PCI). Design A total of 2768 patients who had received coronary stent implantation and had taken aspirin 100 mg in combination with clopidogrel 75 mg daily for > 5 days were consecutively screened and 1885 were enrolled. The recruited patients were followed-up for 12 months. The primary end-point was the net adverse clinical events (NACE) of cardiovascular death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST) and any bleeding. Result 1709 patients completed the clinical follow-up. By using the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were found to be 37.5 and 25.5% respectively in predicting ischemic and bleeding events. Patients were classified into 2 groups according to PR: inside the window group (IW) [adenosine diphosphate (ADP) induced platelet aggregation (PLADP) 25.5–37.4%)] and outside the window group (OW) (PLADP

Lithium-rich manganese-based cathode material is a promising next-generation lithium-ion battery cathode material, however, it exhibits significant differences in electrochemical performance at different temperatures, which severely limits the application in practical environments. A variety of electrochemical measures were used to characterize the difference in electrochemical performance of lithium-rich material within the temperature range of 5-45℃. The influencing factors of material properties and temperature dependence were analyzed from the perspective of polarization. The results show that the charge/discharge capacity of lithium-rich material decreases with decreasing temperature, which is mainly due to the significant increase in the polarization of the oxygen/manganese ion reaction in the high-voltage and low-voltage ranges with decreasing temperature, resulting in a severe decrease in its capacity contribution.The significantly increased polarization is mainly caused by the poor intrinsic kinetic performance of oxygen/manganese ions, which leading to high apparent activation energy of the charge transfer process. In addition, the participation of oxygen and manganese ions in the charge compensation reaction changes the structure of the material seriously.It induces changes in the composition of the interface film, which increases the apparent activation energy of lithium ion transmission at the interface in the low voltage interval. Moreover, it causes bulk diffusion of lithium ions at the end of the charge and discharge process having higher apparent activation energy. Therefore, improving the oxygen/manganese ion reaction kinetics of lithium-rich material is the main method to enhance its environmental adaptability.

BackgroundSocioeconomic factors have been shown to be associated with amputation in peripheral artery disease (PAD); however, analyses have normally focused on insurance status, race, or median income. We sought to determine whether community-level socioeconomic distress was associated with major amputation and if that association differed by race.Materials and methodsCommunity-level socioeconomic distress was measured using the distressed communities index (DCI). The DCI is a zip code level compositive socioeconomic score (0–100) that accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies. A distressed community was defined as a zip code with DCI of 40 or greater. We calculated one-year risk of major amputation by DCI score for individuals with peripheral artery disease in South Carolina, 2012–2017. Treating death as competing event, we reported Fine and Gray subdistribution hazards ratios (sdHR), adjusted for patient demographic and clinical comorbidities associated with amputation. Further analyses were completed to identify potential differences in outcomes within strata of race and DCI.ResultsAmong 82,848 individuals with peripheral artery disease, the one-year incidence of amputation was 3.5% (95% CI: 3.3%, 3.6%) and was significantly greater in distressed communities than non-distressed communities (3.9%; 95% CI: 3.8%, 4.1% vs. 2.4%; 95% CI: 2.2%, 2.6%). After controlling for death and adjusting for covariates, we found an increased hazard of amputation among individuals in a distressed community (sdHR: 1.25; 95% CI: 1.14, 1.37), which persisted across racial strata. However, regardless of DCI score, Black individuals had the highest incidence of amputation.ConclusionSocioeconomic status is independently predictive of limb amputation after controlling for demographic characteristics and clinical comorbidities. Race continues to be an important risk factor, with Black individuals having higher incidence of amputation, even in non-distressed communities, than White individuals had in distressed communities.

Background Peripheral artery disease (PAD) affects >10 million people in the United States. PAD is associated with poor outcomes, including premature death. Machine learning (ML) has been increasingly used on big data to predict clinical outcomes. This study aims to develop ML models to predict in‐hospital mortality in patients hospitalized for PAD based on a national database. Methods and Results Inpatient hospitalization data were obtained from the 2016 to 2019 National Inpatient Sample. A total of 150 921 inpatients were identified with a primary diagnosis of PAD and PAD‐related procedures using codes of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD‐10‐PCS). Four ML models, including logistic regression, random forest, light gradient boosting, and extreme gradient boosting models, were trained to predict the risk of in‐hospital death based on a selection of variables, including patient characteristics, comorbidities, procedures, and hospital‐related factors. In‐hospital mortality occurred in 1.8% of patients. The performance of the 4 models was comparable, with the area under the receiver operating characteristic curve ranging from 0.83 to 0.85, sensitivity of 77% to 82%, and specificity of 72% to 75%. These results suggest adequate predictability for clinical decision‐making. In all 4 models, the total number of diagnoses and procedures, age, endovascular revascularization procedure, congestive heart failure, diabetes, and diabetes with complications were critical predictors of in‐hospital mortality. Conclusions This study demonstrates the feasibility of ML in predicting in‐hospital mortality in patients with a primary PAD diagnosis. Findings highlight the potential of ML models in identifying high‐risk patients for poor outcomes and guiding personalized intervention.

Objective: To reflect the potential and intrinsic association among microbiota structure, antibiotic resistance genes distribution and biological toxicity of landfill-leachate according to seasonal change, and accurately assess the potential threat of leachate to the surrounding environment. Methods: On the basis of the leachate water quality monitoring data from January to December 2020, principal component analysis (PCA) was used to identify the main pollutants in the leachate; Vibrio fischeri luminescence inhibition test was used to detect the comprehensive biotoxicity of the leachate; 16S rDNA amplicon sequencing was used for leachate microbiota. q-PCR was used to detect the class 1 integron (intI1), and eight antibiotic resistance genes (sul1, sul2, tetA, tetB, tetM, tetQ, mefA, and mexF); Canonical correspondence (CCA) analysis was carried out for the association analysis. Result: The biotoxicity of leachate in the second quarter was the highest. The dominant phylum of leachate microbiota from 1st quarters to 4th quarters was Proteobacteria (94.97 %, 85.43 %, 88.20 %, and 84.11 %), and the dominant genera were Thiomonas (60.41 %, 26.83 %, 25.66 %, and 30.51 %), Pseudomonas (5.89 %, 1.86 %, 0.68 %, and 4.72 %), Desulfurella (8.52 %, 0.57 %, 3.81 %, and 8.25 %), and Acidithiobacillus (4.71 %, 0.69 %, 0.87 %, and 5.91 %); Nitrospirillum was negatively correlated with chemical oxygen demand (COD) (R=−0.561, P = 0.008) and five-day biochemical oxygen demand (BOD5) (R=−0.591, P = 0.005); Limnohabitans was positively correlated with pH (R=0.444, P = 0.044). Four AR genes (sul1, sul2，tetM, and tetQ) were detected in all the samples, while the second quarter had the highest concentration of sul1(6.31 ± 0.49 lg copies/ng DNA), tetM (3.01 ± 1.38 lg copies/ng DNA) and tetQ (3.64 ± 0.90 lg copies/ng DNA). Conclusion: As the mature landfill, the quality of this leachate met the pollution control standards for domestic waste landfills. Thiomycetes, Pseudomonas, Desulfurization, and Thiopterus acidophyllum constitute the dominant microbiota. However, leachate in the second quarter had more serious contamination, the higher biotoxicity, higher concentration of AR genes, together with higher microbiota richness and diversity, which deserved more attention for the potential threat to the surrounding environment.

A person’s present mental state is closely associated with the frequency and temporal domain features of spontaneous electroencephalogram (EEG) impulses, which directly reflect neurophysiological signals of brain activity. EEG signals are employed in this study to measure the mental workload of drivers while they are operating a vehicle. A technique based on the quantum genetic algorithm (QGA) is suggested for improving the kernel function parameters of the multi-class support vector machine (MSVM). The performance of the algorithm based on the quantum genetic algorithm is found to be superior to that of other ways when other methods and the quantum genetic algorithm are evaluated for the parameter optimization of kernel function via simulation. A multi-classification support vector machine based on the quantum genetic algorithm (QGA-MSVM) is applied to identify the mental workload of oceanauts through the collection and feature extraction of EEG signals during driving simulation operation experiments in a sea basin area, a seamount area, and a hydrothermal area. Even with a limited data set, QGA-MSVM is able to accurately identify the cognitive burden experienced by ocean sailors, with an overall accuracy of 91.8%.

Abstract Background Several American universities have experienced COVID-19 outbreaks, risking the health of their students, employees, and local communities. Such large outbreaks have drained university resources and forced several institutions to shift to remote learning and send students home, further contributing to community disease spread. Many of these outbreaks can be attributed to the large numbers of active infections returning to campus, alongside high-density social events that typically take place at the semester start. In the absence of effective mitigation measures (e.g., high-frequency testing), a phased return of students to campus is a practical intervention to minimize the student population size and density early in the semester, reduce outbreaks, preserve institutional resources, and ultimately help mitigate disease spread in communities. Methods We develop dynamic compartmental SARS-CoV-2 transmission models to assess the impact of a phased reopening, in conjunction with pre-arrival testing, on minimizing on-campus outbreaks and preserving university resources (measured by isolation bed capacity). We assumed an on-campus population of N = 7500, 40% of infected students require isolation, 10 day isolation period, pre-arrival testing removes 90% of incoming infections, and that phased reopening returns one-third of the student population to campus each month. We vary the disease reproductive number (R t ) between 1.5 and 3.5 to represent the effectiveness of alternative mitigation strategies throughout the semester. Results Compared to pre-arrival testing only or neither intervention, phased reopening with pre-arrival testing reduced peak active infections by 3 and 22% (R t = 1.5), 22 and 29% (R t = 2.5), 41 and 45% (R t = 3.5), and 54 and 58% (improving R t ), respectively. Required isolation bed capacity decreased between 20 and 57% for values of R t ≥ 2.5. Conclusion Unless highly effective mitigation measures are in place, a reopening with pre-arrival testing substantially reduces peak number of active infections throughout the semester and preserves university resources compared to the simultaneous return of all students to campus. Phased reopenings allow institutions to ensure sufficient resources are in place, improve disease mitigation strategies, or if needed, preemptively move online before the return of additional students to campus, thus preventing unnecessary harm to students, institutional faculty and staff, and local communities.

Abstract Background Diabetic foot ulcer (DFU) is a serious chronic complication of diabetes. This study aimed to establish weighted risk models for determining DFU occurrence and severity in diabetic patients. Methods This was a multi-center hospital-based cross-sectional study. A total of 1488 diabetic patients with or without an ulcer from three tertiary hospitals were included in the study. Random forest method was used to develop weighted risk models for assessing DFU risk and severity. Receiver operating characteristic curves were used to validate the models and calculate the optimal cut-off values of the important risk factors. Results We developed potent weighted risk models for evaluating DFU occurrence and severity. The top eight important risk factors for DFU onset were plasma fibrinogen, neutrophil percentage and hemoglobin levels in whole blood, stroke, estimated glomerular filtration rate, age, duration of diabetes, and serum albumin levels. The top 10 important risk factors for DFU severity were serum albumin, neutrophil percentage and hemoglobin levels in whole blood, plasma fibrinogen, hemoglobin A1c, estimated glomerular filtration rate, hypertension, serum uric acid, diabetic retinopathy, and sex. Furthermore, the area under curve values in the models using plasma fibrinogen as a single risk factor for determining DFU risk and severity were 0.86 (sensitivity 0.74, specificity 0.87) and 0.73 (sensitivity 0.76, specificity 0.58), respectively. The optimal cut-off values of plasma fibrinogen for determining DFU risk and severity were 3.88 g/L and 4.74 g/L, respectively. Conclusions We have established potent weighted risk models for DFU onset and severity, based on which precise prevention strategies can be formulated. Modification of important risk factors may help reduce the incidence and progression of DFUs in diabetic patients.

Abstract Background Investigations into drivers and barriers to the uptake of learner-centered instructional practices in STEM courses have identified the climate within a department as a potential influential factor. However, few studies have explored the relationship between adoption of learner-centered instructional practices and departmental climate around teaching. Moreover, surveys that have been designed to measure climate around teaching have been focused on measuring individual faculty member’s description of their colleagues’ perceptions of the climate within their department (psychological collective climate) and ignored whether there was a consensus among respondents within the same department on these descriptions. This latter measure (departmental collective climate) is best aligned with the definition of organizational climate. There is thus a need to explore whether departmental climate measured at the individual or collective level relate to the use of learner-centered instructional practices. Results This study demonstrates that the Departmental Climate around Teaching (DCaT) survey provides valid and reliable data that can be used to measure psychological collective climate within a STEM department. Analysis of the 166 faculty members who responded to the survey indicated that (1) four different types of psychological collective climate existed among our population and (2) multiple types could be present within the same STEM department. Moreover, it showed that measuring departmental collective climate is challenging as few constructs measured by the DCaT survey reached high level of consensus within faculty members from the same department. Finally, the analysis found no relationship between psychological collective climate and the level of use of learner-centered instructional practices. Conclusions Results from the validation studies conducted on the DCaT survey that most elements that define a climate (e.g., policies, practices, expectations) are lacking when it comes to teaching. These findings could explain the challenges experienced in this study in measuring departmental collective climate. Without these climate elements, faculty members are left to work autonomously with little expectations for growth in their instructional practices. Establishing policies, practices, and expectations with respect to teaching is thus an essential step toward instructional change at a departmental level.

Purpose: The potential recurrence rate of malignant phyllodes tumors (MPTs) of the breast is high, and the prognostic factors are still unclear. We therefore aim to study the factors affecting the outcome of MPTs. Methods: A retrospective review of MPT patients treated from 2006 to 2020 at our institution was conducted. Univariate and multivariate Cox proportional hazard models were used to examine the influence of different variables on RFS. Moreover, significant prognostic factors were combined to construct the nomogram to predict the probability of relapse occurring in MPT patients. The 5-year and 10-year RFS rates were estimated using the Kaplan–Meier method. Results: During the study period, 188 MPT patients were identified. The presence of malignant heterologous elements was observed in 23 (12.2%) patients with MPT, and the patients with malignant heterologous elements who received chemotherapy had longer RFS, which could reduce the risk of recurrence (p = 0.022). Recurrence occurred in 56/188 (29.8%) patients, of whom 47 experienced local recurrence and 11 experienced distant metastases. The 5-year and 10-year cumulative RFS rates were 77.5% and 70.1%, respectively. Age (p = 0.041), fibroadenoma surgery history (p = 0.004), surgical margins (p = 0.001) and malignant heterologous elements (p

Shaogan Fuzi Decoction (SGFD), one of the classical prescriptions of Chinese Medicine, has a long history in the treatment of rheumatoid arthritis (RA), but definitive studies on its efficacy and mechanism of action are lacking. This study aims to elucidate the pharmacodynamic role of SGFD against RA and the potential mechanisms based on a combination of network pharmacology and experimental verification. The RA model in rats was induced by intradermal injection of bovine type Ⅱ collagen and incomplete Freund’s adjuvant at the tail root. SGFD was administered once a day by oral gavage for 4 weeks. After SGFD administration, rat’s arthritis index (AI) score and paw swelling decreased to some extent, and synovial inflammation, vascular hyperplasia, and cartilage destruction of the ankle joint were improved. Simultaneously, thymus and spleen index and serum levels of C-reactive protein (CRP) were lowered. Network pharmacology revealed that quercetin, kaempferol, naringenin, formononetin isorhamnetin and licochalcone A were the potentialiy active components, and IL6, TP53, TNF, PTGS2, MAPK3 and IL-1β were potential key targets for SGFD in the treatment of RA. Ingredients-targets molecular docking showed that the components had the high binding activity to these target proteins. The mechanism of SGFD for RA involves various biological functions and is closely correlated with TNF signaling pathway, Osteoclast differentiation, T cell receptor signaling pathway, mitogen-activated protein kinase (MAPK) signaling pathway, NF-κB signaling pathway, toll-like receptor signaling pathway, and so on. Western blot and ELISA showed that the expression of toll-like receptor 4 (TLR4), nuclear factor kappa-B (NF-κB) p65, phosphorylated c-Jun N-terminal kinase (p-JNK), p-p38, phosphorylated extracellular regulated kinase (p-ERK) and TNF-α was significantly upregulated in the synovium of RA rats, and the levels of serum inflammatory factors were significantly increased. SGFD inhibits the activation of the TLR4/NF-κB/MAPK pathway and the expression/production of pro-inflammatory cytokines. In summary, SGFD could improve the symptoms and inflammatory response in collagen-induced arthritis (CIA) rat model. The mechanism might be related to the regulation of TLR4/MAPKs/NF-κB signaling pathway and the reduction of inflammatory factor release, which partially confirms the results predicted by network pharmacology.

Background Insulin receptor substrate‐1 (IRS‐1) rs956115 is associated with vascular risk in patients with coronary artery disease and concomitant diabetes. CYP2C19*2 (rs4244285) modulates clopidogrel response and predicts the outcome of coronary artery disease. This study was designed to explore the association between IRS‐1, CYP2C19*2 genotypes, platelet reactivity, and 1‐year outcome in patients with coronary artery disease undergoing percutaneous coronary intervention. Methods and Results Genotyping was performed using an improved multiplex ligation detection reaction technique. Platelet aggregation was assessed by light transmission aggregometry. Major adverse cardiovascular events were defined as a composite of cardiovascular death, myocardial infarction, and ischemic stroke. A total of 2213 consecutive patients were screened and 1614 were recruited. At 1 month, patients with IRS‐1 CG genotype had significantly lower levels of ADP‐induced platelet aggregation compared with patients with CC homozygotes. Patients with IRS‐1 CG or GG genotype had a 2.09‐fold higher risk of major adverse cardiovascular events compared with those with CC homozygotes (95% CI, 1.04–4.19; P=0.0376). By comparison, patients with CYP2C19*2 GA or AA genotype had higher ADP‐induced platelet aggregation compared with patients with GG homozygotes. Although there was no significant difference in risk of major adverse cardiovascular events between patients with GA/AA and GG genotypes, patients with GA genotype had a 2.19‐fold higher risk than those with GG homozygotes (95% CI, 1.13–4.24; P=0.0200). No interaction between IRS‐1 and CYP2C19*2 genotypes was observed. Conclusions In patients following percutaneous coronary intervention, IRS‐1 GG/CG and CYP2C19*2 GA genotypes were associated with 2.09‐ and 2.19‐fold increased cardiovascular risk, respectively, at 1‐year follow‐up. The association between IRS‐1 genotypes and major adverse cardiovascular events appeared to be independent of known clinical predictors. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01968499.

BackgroundDisease status (eg, cancer stage) has been used in routine clinical practice to determine more accurate treatment plans. Health-related indicators, such as mortality, morbidity, and population group life expectancy, have also been used. However, few studies have specifically focused on the comprehensive and objective measures of individual health status. ObjectiveThe aim of this study was to analyze the perspectives of the public toward 29 health indicators obtained from a literature review to provide evidence for further prioritization of the indicators. The difference between health status and disease status should be considered. MethodsThis study used a cross-sectional design. Online surveys were administered through Ohio University, ResearchMatch, and Clemson University, resulting in three samples. Participants aged 18 years or older rated the importance of the 29 health indicators. The rating results were aggregated and analyzed as follows (in each case, the dependent variables were the individual survey responses): (1) to determine the agreement among the three samples regarding the importance of each indicator, where the independent variables (IVs) were the three samples; (2) to examine the mean differences between the retained indicators with agreement across the three samples, where the IVs were the identified indicators; and (3) to rank the groups of indicators into various levels after grouping the indicators with no mean differences, where the IVs were the groups of indicators. ResultsIn total, 1153 valid responses were analyzed. Descriptive statistics revealed that the top five–rated indicators were drug or substance abuse, smoking or tobacco use, alcohol abuse, major depression, and diet and nutrition. Among the 29 health indicators, the three samples agreed upon the importance of 13 indicators. Inferential statistical analysis indicated that some of the 13 indicators held equal importance. Therefore, the 13 indicators were categorized by rank into seven levels: level 1 included blood sugar level and immunization and vaccination; level 2 included LDL cholesterol; level 3 included HDL cholesterol, blood triglycerides, cancer screening detection, and total cholesterol; level 4 included health literacy rate; level 5 included personal care needs and air quality index greater than 100; level 6 included self-rated health status and HIV testing; and level 7 included the supply of dentists. Levels 1 to 3 were rated significantly higher than levels 4 to 7. ConclusionsThis study provides a baseline for prioritizing 29 health indicators, which can be used by electronic health record or personal health record system designers or developers to determine what can be included in the systems to capture an individual’s health status. Currently, self-rated health status is the predominantly used health indicator. Additionally, this study provides a foundation for tracking and measuring preventive health care services more accurately and for developing an individual health status index.

Abstract Background Family doctor contract services (FDCS) began in China in 2016. Shenzhen, one of the most developed cities in China, also implemented a family doctor (FD) policy in 2017. The objectives of this study were to identify the impact of awareness of FDCS and signing service contracts with FDs on utilization of community health care centers (CHCs). Methods Cross-sectional secondary data based on residents living in Luohu district was used for analysis. Descriptive analysis was conducted to identify utilization of CHCs by awareness of FDCS and signing service contracts with FDs, respectively. Linear probability models (LPM) were used to determine the association of utilization of CHCs with awareness of FDCS and signing service contracts with FDs, respectively. Results Among 1205 adults included in the analysis, 27 % of the participants knew about the FDCS, 5 % signed with FD, and 20 % had chronic disease. Both awareness of the FDCS and signing service contracts with FDs significantly increased the probability of using CHCs as a first choice. Conclusions This study provided evidence that both awareness of FDCS and signing service contracts with FDs had a positive impact on utilization of primary health care services at the community level. More interventions to improve awareness of FDCS are needed to increase the utilization of primary health care services.

Mammalian adipose tissue can be divided into two major types, namely, white adipose tissue (WAT) and brown adipose tissue (BAT). According to classical view, the main function of WAT is to store excess energy in the form of triglycerides, while BAT is a thermogenic tissue that acts a pivotal part in maintaining the core body temperature. White adipocytes display high plasticity and can transdifferentiate into beige adipocytes which have many similar morphological and functional properties with brown adipocytes under the stimulations of exercise, cold exposure and other factors. This phenomenon is also known as ‘browning of WAT’. In addition to transdifferentiation, beige adipocytes can also come from de novo differentiation from tissue-resident progenitors. Activating BAT and inducing browning of WAT can accelerate the intake of glycolipids and reduce the insulin secretion requirement, which may be a new strategy to improve glycolipids metabolism and insulin resistance of obese and type 2 diabetes mellitus (T2DM) patients. This review mainly discusses the significance of brown and beige adipose tissues in the treatment of obesity and T2DM, and focuses on the effect of the browning agent on obesity and T2DM, which provides a brand-new theoretical reference for the prevention and treatment of obesity and T2DM.

Introduction Using a cross-sectional population-based survey, electronic vapor product (EVP) use was evaluated in relation to physical activity levels among high school students in Georgia. Methods We used self-reported EVP and cigarette use from the Georgia Student Health Survey 2.0 data from 2018 (N =362 933) and used multi-level multinomial logistic regression models to estimate relative risks of the type of product use relative to no-use by levels of physical activity. Results Nearly 7% of the students were EVP-only users. The relative risks of being an EVP-only user were 11% and 23% higher for those who were physically active 2-3 days/week and 4-5 days/week, respectively, compared to those who were physically active

Objectives: To investigate the feasibility of delivering a low-dose mindfulness-based stress reduction (MBSR) intervention among prediabetes/diabetes patients in a clinical setting. Design and setting: This was a single-arm, mixed methods, feasibility study among prediabetes/diabetes patients at a healthcare center in United States. Intervention: The low-dose MBSR intervention was delivered in group format over 4 waves and each wave comprised 8–10 h of 8 sessions over 6–8 weeks. Main outcome measures: We evaluated recruitment, adherence, and attrition rates, participants’ satisfaction, motivation and barriers of low-dose MBSR. Psychological, behavioral, and physical measures were compared between pre- and post-intervention. Results: We enrolled 19 participants of 34 eligible individuals with a recruitment rate of 55.9%. Among 19 enrolled participants, 4 dropped out after baseline data collection and did not attend any session and 1 attended one session but did not finish post-intervention data collection, resulting in an attrition rate of 26.3%. Among 15 participants attending at least one session, 46.7% attended all sessions and 80.0% attended at least 5 sessions. Qualitative analysis among 11 participants indicated that 90.9% had positive overall experience with the intervention. Compared to pre-intervention, there was a significant reduction in depression score (mean reduction = 5.04, SD = 7.66, p = 0.02), a higher proportion of engaging in flexibility exercises (42.86% vs. 85.71%, p = 0.01) and a lower level of glycosylated hemoglobin (HbA1c) (mean reduction = 1.43%, SD = 2.54%, p = 0.03) at post-intervention. Conclusions: Delivering a low-dose MBSR intervention to prediabetes/diabetes patients in a primary care setting is feasible. Future studies with randomized controlled design and larger sample are warranted.

This study presents a command filtered control scheme for multi-input multi-output (MIMO) strict feedback nonlinear unmodeled dynamical systems with its applications to power systems. To deal with dynamic uncertainties, a dynamic signal is introduced, together with radial basis function neural networks (RBFNNs) to overcome the influences of the dynamic uncertainties. Command filters (CFs) are used to prevent the explosion of complexity, where the compensating signals can eliminate the effect of filter errors. Compared with single-input single-output strict feedback nonlinear systems, the method proposed in this study has more suitability. In the end, the simulation experiments are carried out by applying the developed algorithm to power systems, where the simulation results verify the efficacy of the approach proposed.

Objective: To estimate demographic predictors of medical expense in hospitalization of moderate COVID-19. Methods: From January to March 2020, a total of 39 patients were treated and recovered from COVID-19 in a tertiary medical center in East China. Detailed cost data were collected and we estimated the demographic predictors of both total hospital expense and daily hospital expense. Results: The mean medical expense for treating hospitalized moderate COVID-19 cases was $1177.81. Every additional year in the patient’s age corresponds to .9% more in total hospital expense (Coef. = 0.009, 95% CI 0.002-0.017, P < 0.01). The difference in daily medical expense between age groups was not statistically significant. Conclusions: Hospitalization cost was significantly elevated among the older patients, and the age effect in cost was mainly driven by the longer length of stay in the hospital. From a cost-saving perspective, the elderly population might deserve priority consideration when COVID-19 vaccination programs are implemented.

Background: Due to the lack of updated information on teicoplanin (TEI) for continuous renal replacement therapy (CRRT), no exact dosage regimen has been recommended. The aim of this study was to optimize the dosage regimen of TEI in renal dysfunction patients with or without CRRT, evaluate the influence factors of the eradication of Gram-positive bacteria, and evaluate the effect of CRRT on the clearance of TEI.Methods: Patients with renal dysfunction receiving TEI treatment in the ICU were prospectively recruited and divided into CRRT and non-CRRT groups. Logistic regression analysis was used to screen the factors affecting the eradication of Gram-positive bacteria. The filtrate concentration of the CRRT group was measured at the time of TEI Cmin, and the filtration coefficient of TEI was calculated to evaluate the effect of CRRT on the clearance of TEI.Results: A total of 106 patients were included, 40 cases in the CRRT group and 66 cases in the non-CRRT group. After giving high-loading doses of TEI, 75.8 and 70% of TEI Cmin in the non-CRRT and CRRT groups reached the range of 10–30 mg/L before the 3rd dose, respectively. The risk of G+ bacteria being uneradicated was higher while the APACHEⅡscore was higher than 22.5. The albumin level before the start of TEI administration and before the 6th–8th dose was lower than 32.8 g/L and 29.3 g/L, respectively, and Cmin before the 3rd dose and 6th–8th dose was lower than 13.2 mg/L and 17.1 mg/L, respectively, with the duration of TEI therapy shorter than 10.5 days. The correlation coefficient (r) was 0.6490 between Cmin before the 3rd dose and the albumin level (p < 0.001). The filtration coefficient of TEI was 10.7 ± 2.4% at Cmin and 11.1 ± 2.5% at Cmax. The GFR had no correlation with the filtration coefficient (r = −0.06204; r = −0.08059). The clearance of TEI in CRRT patients was negatively correlated with the albumin level (r = −0.6305, p = 0.0013).Conclusion: The early stage of the albumin level can significantly affect the initial Cmin and clinical efficacy of TEI, and also had effect on the clearance of TEI by CRRT. The filtration coefficient of TEI was stable, even with a higher ultrafiltration rate.

Abstract Background Postoperative atrial fibrillation (POAF) is one of the most common complications of esophagectomy, which may extend the inpatient hospital stay. Minimally invasive esophagectomy (MIE) has been increasingly used in clinical practice; however, its POAF risk and short-term mortality remain unclear. This study aimed to examine the POAF risk and in-hospital mortality rate between patients receiving MIE and open esophagectomy (OE). Methods Esophageal cancer patients who underwent MIE or OE from a retrospective cohort study were evaluated. A multivariate logistic regression model was built to assess the associations between esophagectomy (MIE vs. OE) and various outcomes (POAF, in-hospital mortality). Covariates included age, sex, body mass index, neoadjuvant therapy, tumor stage, surgery incision type, comorbidities, cardia conditions, peri-operative medication, and complications. Results Of the 484 patients with esophageal cancer, 63 received MIE. A total of 53 patients developed POAF. Compared to patients receiving OE, MIE patients had 81% reduced odds of POAF (adjusted odds ratio [aOR] 0.185, 95% CI 0.039–0.887, P = 0.035). No statistically significant association was found for in-hospital mortality (aOR 0.709, 95% CI 0.114–4.409, P = 0.712). Conclusions MIE is associated with a lower risk of POAF, compared to traditional surgery. No significant short-term survival benefit was found for MIE.

The plate counting method widely used at present to discern viable from non-viable Brucella in the host or cell is time-consuming and laborious. Therefore, it is necessary to establish a rapid, simple method for detecting and counting viable Brucella organisms.

A more stable and reliable method of the fatty acid values determination in grain was studied based on the establishment of manual titration method associated with the automatic potentiometric titration.The GB/T 20569—2006 Guidelines for evaluation of paddy storage character for the sample pre-treatment was used, and the manual titration was replaced by automatic potentiometric titration to determine the free fatty acid in grain with KOH as the standard titration solution.At the same time, the change of pH values in test solution were determined during titration, following by the corresponding real time change curves of pH-titration volume which will be stopped at the set terminal PH values, and phenolphthalein indicator was used as the finish monitoring in the process of the titration.The results showed that the titration processes were not affected by man-made factors, and the accuracy has no significant difference compared with manual titration method, thus ensuring the determination results has better repeatability, reproducibility and stability,and with the wider application scope.

Background: Air pollution exposure is an environmental risk to public health. And the available data on relationships of air pollution and neonatal disease burden are scarce. This study assessed neonatal disease burden attributable to Particulate Matter 2.5 (PM 2.5) pollution in China.Methods: This is a retrospective analysis with data from the GBD2019 database. Data of PM 2.5 pollution exposure levels and neonatal disease burden attributable to PM 2.5 in China from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019 (GBD 2019); Data of PM2.5 concentration was collected from the Bulletin of the State of the Ecological Environment in China; Data of perinatal mortality was collected from the Chinese Maternal and Child Health Surveillance Network. Deaths, Disability-adjusted life years (DALYs), Year of life lost (YLLs), and Years lived with disability (YLDs) are primary indicators used to assess neonatal diseases burden. The correlation of PM2.5 pollution and neonatal death was analyzed. Average Annual Percentage Change (AAPC) and increment were used to assess exposure levels and disease burden trends.Results: PM 2.5 pollution exposure level of newborns in China is much higher than global average, 32.08 per 100 people (95% UI: 26.57–38.06) in 2019 compared to 1990 (15.86 per 100 people, 95% UI: 6.83–30.88), with an increase of 102.27%. And it is statistically verified PM2.5 concentration was positively correlated with neonatal disease deaths (r = 0.9534, p = 0.0009) and DALYs (r = 0.9534, p = 0.0009). The overall disease burden of neonatal diseases attributed to PM 2.5 pollution in China has decreased from 1990 to 2019, with a decrement of 5738.34 deaths (decreased: 56.85%), 51.01 person/years (decreased: 56.84%) for DALYs, 51.23 person/years (decreased: 57.11%) for YLLs and an increase of 150.69 person/years (increased: 31.71%) for YLDs.Conclusion: There exists positive correlation between environmental pollution and neonatal diseases in China. The number of neonatal disease deaths, DALYs, and YLLs due to PM 2.5 pollution showed a decreasing trend with the environmental pollution control. For the rising YLDs, there is a need to improve survival rates while focusing on prognosis of neonatal disease and reducing the burden of disease brought on by disability. Controlling environmental pollution is likely to help reduce neonatal disease burden, especially premature birth and neonatal encephalopathy.

Objective: The objective of the study was to assess the impact of multifaceted clinical pharmacist-led antimicrobial stewardship (AMS) program on the rational use of antibiotics for patients who receive vascular and interventional radiology therapies.Methods: A quasi-experimental retrospective intervention design with a comparison group was applied to the practice of antibiotic use in the department of vascular and interventional radiology in a Chinese tertiary hospital. We used difference-in-differences (DID) analysis to compare outcomes before and after the AMS intervention between the intervention group and control group, to determine whether intervention would lead to changes in irrationality of antibiotic prescribing, antibiotic utilization, cost of antibiotics, and length of hospital stay.Results: The DID results showed that the intervention group was associated with a reduction in the average consumption of antibiotics (p = 0.017) and cost of antibiotics (p = 0.006) and cost per defined daily dose (DDD) (p = 0.000). There were no significant differences in the mean change of total costs and length of stay between the two groups (p > 0.05). The average inappropriate score of perioperative antimicrobial prophylaxis in the intervention group declined by 0.23, while it decreased by 0.02 in the control group [0.21 (95% CI, −0.271 to −0.143); p = 0.000]. The average inappropriate score of non-surgical antimicrobial prophylaxis in the intervention group declined by 0.14, while it increased by 0.02 in the control group [0.16 (95% CI, −0.288 to −0.035); p = 0.010]. The average inappropriate score of the therapeutic use of antibiotics in the intervention group declined by 0.07, while it decreased by 0.01 in the control group [0.06 (95% CI, −0.115 to −0.022); p = 0.003].Conclusions: This study provides evidence that implementation of AMS interventions was associated with a marked reduction of antibiotic use, cost of antibiotics, and irrationality of antibiotic prescribing in China.

Introduction: Intravenous thrombolysis for acute ischemic stroke remains underused in the developing countries. In 2016, a theory-based resource integration project was initiated at a major stroke center in China. This report describes the implementation process and results of the quality improvement project. Description: Eighteen environment-tailored interventions were implemented, including stroke code activation, electronic wristband bundling, structured information sharing, etc. The project was implemented from July 2016 to June 2017. A total of 519 acute ischemic stroke patients were included. After the intervention, median DNT decreased from 62 min to 37 min ('P' < 0.001). The percentage of cases treated within 30, 45 or 60 minutes increased from 2.5%, 17.4% and 44.6% to 27.4%, 69.4% and 84.7% respectively (P < 0.001). The median length of inpatient stay decreased from 10 days to 8 days ('P' < 0.001). The proportion of patients with severe disability decreased from 25.5% to 15.8% post-intervention. Discussion: Adequate pre-intervention activities are important conditions for the smooth implementation of the complex service integration initiative. The new treatment pathway has undergone a process of destruction, remodeling and solidification before stable and effective operation. In order to realize the full effect of service integration, whole society efforts are also required. Conclusions: Introduction of the theory-based resource integration project was associated with increased thrombolysis administrations, shorter DNT, and no statistically significant change in adverse outcomes. The basic principles of this project might be applicable to various resource settings.

Most of the existing studies on maker-space focus on internal subjects (such as makers) or external factors (such as policy support, ecological environment, and more). There has been relatively little discussion on the design of a series of mechanisms of maker-space. This paper theorizes the operating mechanism for platform services, resource gathering, network connections and endogenous cultural protection for the maker-space. It uses the method of fuzzy set qualitative comparative analysis (fsQCA) to analyze data from 63 maker-spaces in Zhejiang Province. The study proposes a reasonable mechanism design scheme for maker-space. The results show that the innovativeness of a maker-space is the result of the synergistic effect of various operating mechanisms. Among them, the platform service function, the channel for gathering resources, the formal linkages, and the culture for sharing achievements are indispensable support mechanisms for maker-spaces. Two effective ways to promote innovation in maker-space are outlined: first, preventing interventions from external resource providers; second, building an inclusive culture of trial and error.

Previous studies have shown that spermidine (Spd) can improve tolerance to high temperature stress in tomato seedlings. To further understand how Spd regulates the molecular components of high temperature stress signaling pathways, we performed a genome-wide transcriptome analysis in tomato seedlings treated with high temperature and/or exogenous Spd. The results demonstrate that, under high temperature conditions, Spd significantly alleviated the inhibition of plant growth, as well as improving the net photosynthetic rate and pigment contents. The transcriptome analysis revealed thousands of differentially expressed genes (DEGs) in response to high temperature with or without Spd treatment. Half of the genes were induced by high temperature, part of the genes were induced by high temperature with exogenous Spd, and some were induced by the coordinated effect of high temperature and Spd. A GO analysis indicated that genes involved in cellular processes, metabolic processes, and nucleotide binding in the sample were subjected to high temperature. Some DEGs were also involved in plant physiological processes. These results suggest potential genes and molecular pathways were involved in the exogenous Spd-mediated tolerance to high temperature stress in tomato plants. A JA signaling test was designed, which indicated that MYC2 and JAS1 in heat-resistant materials were both increased, through quantitative RT-PCR.

As the featured material of the superionic thermoelectric (TE) material family, copper-chalcogenide Cu2-xSe is attracting growing research interest for its excellent TE performance derived from the satisfactory power factor and the ultra-low thermal conductivity induced by the superionic effect. Various efforts have been made and proved to be effective to further enhance the TE performance for Cu2-xSe. However, this material is still far from the application stage, which is mainly due to concerns regarding control of the properties and the costly complex fabrication technology. Here we report a scalable pathway to achieve high-performance and tunable Cu2-xSe, utilizing conventional sintering technology and copper (Cu)-vacancy engineering with an effective mass model. The figure of merit zT is a competitive value of 1.0 at 800 K for the optimized binary Cu2-xSe, based on the precise modeling prediction and Cu-vacancy engineering. The changes in TE properties of Cu2-xSe under heating-cooling cycle tests are also revealed. Our work offers the referable method along with the decent parent material for further enhancement of TE performance, paving a possible route for the application and industrialization of Cu2-xSe TE materials. Keywords: Thermoelectric, Copper selenide, Copper-vacancy engineering, Effective mass model

To evaluate the probiotic characteristics and safety of Enterococcus durans isolate A8-1 from a fecal sample of a healthy Chinese infant, we determined the tolerance to low pH, survival in bile salts and NaCl, adhesion ability, biofilm formation, antimicrobial activity, toxin gene distribution, hemolysis, gelatinase activity, antibiotic resistance, and virulence to Galleria mellonella and interpreted the characters by genome resequencing. Phenotypically, E. durans A8-1 survived at pH 5.0 in 7.0% NaCl and 3% bile salt under aerobic and anaerobic condition. The bacterium had higher adhesion ability toward mucin, collagen, and Bovine Serum Albumin (BSA) in vitro and showed high hydrophobicity (79.2% in chloroform, 49.2% in xylene), auto-aggregation activity (51.7%), and could co-aggregate (66.2%) with Salmonella typhimurium. It had adhesion capability to intestinal epithelial Caco-2 cells (38.74%) with moderate biofilm production and antimicrobial activity against several Gram-positive pathogenic bacteria. A8-1 can antagonize the adhesion of S. typhimurium ATCC14028 on Caco-2 cells to protect the integrity of the cell membrane by detection of lactate dehydrogenase (LDH) and AKP activities. A8-1 also helps the cell relieve the inflammation induced by lipopolysaccharide by reducing the expression of cytokine IL-8 (P = 0.002) and TNF-α (P > 0.05), and increasing the IL-10 (P < 0.001). For the safety evaluation, A8-1 showed no hemolytic activity, no gelatinase activity, and had only asa1 positive in the seven detected virulence genes in polymerase chain reaction (PCR), whereas it was not predicted in the genome sequence. It was susceptible to benzylpenicillin, ampicillin, ciprofloxacin, levofloxacin, moxifloxacin, tigecycline, nitrofurantoin, linezolid, vancomycin, erythromycin, and quinupristin/dalofopine except clindamycin, which was verified by the predicted lasA, lmrB, lmrC, and lmrD genes contributing to the clindamycin resistance. The virulence test of G. mellonella showed that it had toxicity lower than 10% at 1 × 107 CFU. According to the results of these evaluated attributes, E. durans strain A8-1 could be a promising probiotic candidate for applications.

BackgroundTumor-infiltrating immune cells (TIICs) play a key role in immunoregulatory networks and are related to tumor development. Emerging evidence shows that these cells are associated with sensitivity to chemotherapy and radiotherapy. However, the predictive role of TIICs in the outcomes of neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC) is unclear.MethodsImaging mass cytometry (IMC) was performed to comprehensively assess the immune status before nCRT in 6 patients with LARC (3 achieved pathological complete response (pCR), 3 did not) with matched clinicopathological parameters. Immunohistochemistry (IHC) for CD8, CD163 and Foxp3 on biopsy samples from 70 patients prior to nCRT and logistic regression analysis were combined to further evaluate its predictive value for treatment responses in an independent validation group.ResultsA trend of increased CD8+ cytotoxic T lymphocytes (CTLs) and decreased CD163+ tumor-associated macrophages (TAMs) and Foxp3+ regulatory T cells (Tregs) in the pCR group was revealed by IMC. In the validation group, CTLs and TAMs were strong predictors of the clinical response to nCRT. High levels of CTLs were positively associated with the pCR ratio (OR=1.042; 95% CI: 1.015~1.070, p=0.002), whereas TAMs were correlated with a poor response (OR=0.969; 95% CI: 0.941~0.998, p=0.036). A high density of TAMs was also associated with an advanced cN stage.ConclusionCTLs in the tumor microenvironment (TME) may improve the response to nCRT, whereas TAMs have the opposite effect. These results suggest that these cells might be potential markers for the clinical outcomes of nCRT and aid in the clinical decision-making of LARC for improved clinical outcomes.

This study seeks to quantify and rank the contribution of selected factors to the observed racial/ethnic disparities in low-birth-weight births (LBWBs) and preterm births (PTBs). Based on vital statistics data on births to primiparous women and characteristics of mothers in the State of Nebraska during the period of 2005 to 2014 (n = 93,375), unadjusted and adjusted odds ratios were estimated to examine the association between selected variables and the odds of having LBWBs or PTBs. Fairlie decomposition analysis was performed to quantify the contribution of each selected factor to racial/ethnic differences in LBWB and PTB rates. The prevalence of PTBs was 9.1% among non-Hispanic White (NHW) women, as compared to 12.8% among non-Hispanic Black (NHB) women and 10.6% among Hispanic women. The corresponding prevalence of LBWBs in the three groups were 5.9%, 11.9%, and 7.2%, respectively. The higher educational attainment among NHW women, relative to NHB women accounted for 10% of the observed difference in LBWB rate between the two groups. Health insurance coverage was the second most important factor accounting for the observed disparities in birth outcomes. Addressing socioeconomic disadvantages in NHB and Hispanic women would be important for them to narrow their gaps with NHW women in LBWB and PTB prevalence. More research is needed to identify key factors leading to the disparities in birth outcomes between NHW and NHB women.

Remote sensing nighttime lights (NTLs) offers a unique perspective on human activity, and NTL images are widely used in urbanization monitoring, light pollution, and other human-related research. As one of the payloads of sustainable development science Satellite-1 (SDGSAT-1), the Glimmer Imager (GI) provides a new multi-spectral, high-resolution, global coverage of NTL images. However, during the on-orbit testing of SDGSAT-1, a large number of stripes with bad or corrupted pixels were observed in the L1A GI image, which directly affected the accuracy and availability of data applications. Therefore, we propose a novel destriping algorithm based on anomaly detection and spectral similarity restoration (ADSSR) for the GI image. The ADSSR algorithm mainly consists of three parts: pretreatment, stripe detection, and stripe restoration. In the pretreatment, salt-pepper noise is suppressed by setting a minimum area threshold of the connected components. Then, during stripe detections, the valid pixel number sequence and the total pixel value sequence are analyzed to determine the location of stripes, and the abnormal pixels of each stripe are estimated by a clustering algorithm. Finally, a spectral-similarity-based method is adopted to restore all abnormal pixels of each stripe in the stripe restoration. In this paper, the ADSSR algorithm is compared with three representative destriping algorithms, and the robustness of the ADSSR algorithm is tested on different sizes of GI images. The results show that the ADSSR algorithm performs better than three representative destriping algorithms in terms of visual and quantitative indexes and still maintains outstanding performance and robustness in differently sized GI images.

Background: Augmented renal clearance (ARC) risk factors and effects on vancomycin (VCM) of obstetric patients were possibly different from other populations based on pathophysiological characteristics. Our study was to establish a regression model for prediction of ARC and analyze the effects of ARC on VCM treatment in critically ill obstetric patients.Methods: We retrospectively included 427 patients, grouped into ARC and non-ARC patients. Logistic regression analysis was used to analyze the factors related to ARC. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the model for ARC. Patients who received VCM therapy were collected. The published VCM population pharmacokinetic (PPK) model was used to calculate pharmacokinetic parameters. A linear regression analysis was made between the predicted and measured concentrations.Results: Of the 427 patients, ARC was present in 201 patients (47.1%). The independent risk factors of ARC were heavier, greater gestational age, higher albumin level, fewer caesarean section, severe preeclampsia and vasoactive drug; more infection, hypertriglyceridemia and acute pancreatitis. We established the above nine-variable prediction regression model and calculated the predicted probability. ROC curve showed that the predicted probability of combined weight, albumin and gestational age had better sensitivity (70.0%) and specificity (89.8%) as well as the maximal area under the curve (AUC, AUC = 0.863). 41 cases received VCM; 21 cases (51.2%) had ARC. The initial trough concentration in ARC patients was lower than in non-ARC patients (7.9 ± 3.2 mg/L vs 9.5 ± 3.3 mg/L; p = 0.033). Comparing the predicted trough concentration of two published VCM PPK models with the measured trough concentration, correlation coefficients (r) were all more than 0.8 in the ARC group and non-ARC group. AUC was significantly decreased in the ARC group (p = 0.003; p = 0.013), and clearance (CL) increased in the ARC group (p < 0.001; p = 0.008) when compared with the non-ARC group.Conclusion: ARC is a common state in critically ill obstetric patients. The regression model of nine variables had high predictive value for predicting ARC. The published VCM PPK models had good predictive performance for predicting trough concentrations of obstetric patients. Pharmacokinetic parameters of VCM are different in ARC obstetric patients, which results in enhanced VCM clearance and decreased trough concentration.

Purpose: Strong evidence supports the relationship between health coverage and improved health status. Little is known about the lasting impact of prior health insurance on the prior insured's use of health services. We aimed to examine the association between prior insurance status and health service utilization (HSU) among the long-term uninsured (LTU) in South Carolina. Methods: The current study used data from in-person interviews of the LTU collected in a 2014 cross-sectional South Carolina survey. Men and women between 18?64 years of age who reported not having health insurance for at least 24 months at the time of data collection were included. Propensity score analysis was used to examine the associations between prior insurance status and three outcome variables: (1) having a usual source of care, (2) HSU, and (3) delaying health care needs. Results: Prior health insurance significantly predicted a greater likelihood of having a usual source of care (effect size: 9.2%, p=0.004) and having had at least one preventive visit during the past 2 years (effect size: 6.4%, p=0.035). Prior insurance coverage was positively associated with delayed health care utilization, but the result was not statistically significant (p=0.703). Conclusions: Among the LTU, ever having insurance coverage was positively associated with having a usual source of care and HSU. The lasting impact of insurance coverage on HSU behavior extends beyond the period of insurance coverage, which provides a more comprehensive and deeper understanding of the long-term implications of national and local efforts in expanding insurance coverage.

Isothermal constant strain thermal compression test was carried out by Gleeble-3500 thermal simulation test machine. Based on the experimental data, the flow behavior of Ti-22Al-24Nb-0.5Y alloy was studied. The factors affecting the flow stress of the alloy were analyzed by orthogonal test, and a constitutive model based on BP neural network was established. The results show that the main factors affecting the flow stress of the alloy successively are the strain rate, deformation temperature and strain. The flow stress of Ti-22Al-24Nb-0.5Y alloy in hot deformation is more sensitive to the strain rate and the deformation temperature. The deformation of the alloy is characterized by flow softening at low deformation temperature and high strain rate, but the deformation tends to steady flow with high deformation temperature and low strain rate. The high temperature constitutive model of alloy established by BP neural network has high accuracy. The correlation coefficient reaches 0.9949, the average relative error is 3.23%, the predictive value with the deviation within 10% data points reaches up to 98.79%, and the prediction model can be used as a constitutive relation for the finite element simulation in Ti2AlNb based alloy plastic forming process.

A new method to realize full-pipelined SHA256 based on data storage is proposed. For the full-pipelined SHA256, only A and E need to be calculated each time when the status registers of the data compressor are updated, while B-D and F-H can be obtained directly from A-C and E-G of the previous round. Since A and E will no longer be used after they have been transmitted forward for four stages, the life cycles of each stage′s A and E are both 4 clock cycles. For the traditional pipeline structure, all status registers which are used to store A-H will be updated at the same time, which hence introduce a large dynamic power. Therefore, in order to reduce the numbers of registers, and then reduce the dynamic power of registers, this paper proposes a storage scheme, which uses latches to store each stage′s A and E. When the latter stage needs to use A and E of previous stage, it selects A and E stored in the latches of previous stages using MUXs. Therefore, only the values of two sets of latches(A and E) will update per stage, which can reduce the dynamic power consumption of the circuit. In the proposed scheme, latch is used instead of flip-flop as a storage unit, and data is selected by using MUXs which are composed of transfer gates. The proposed scheme is realized and verified using a 28 nm process, the simulation results show that when compared with traditional structure, the power consumption of the pipelined SHA256 using data storage scheme is reduced by about 27.5%, and the area is reduced by about 49.2%.

The flow stress curves in the deformation temperature range of 850-1200℃, the strain rate of 0.001-10s-1 and the deformation degree of 60% were obtained by hot compression test of A100 ultra-high strength steel on Gleeble-3500 thermal mechanical simulator. The effect of friction and temperature rise on the flow stress during the hot compression process was analyzed, and the flow stress curves were corrected. Phenomenological constitutive model based on introducing the strain parameter was established by the Arrhenius hyperbolic sine function equation. The results show that the influence of friction and temperature rise on the flow stress is gradually obvious with the decrease of deformation temperature or the increase of strain rate. Through comparison between experimental and predicted values, the absolute average relative error is 4.902% and the correlation coefficient is 0.99. It is revealed that the established constitutive model can accurately predict the flow stress under different strains.

The isothermal compression tests of Ti-2.7Cu alloy were tested to study the hot deformation behavior in temperature range of 740-890℃ and strain rate range of 0.001-10s-1 on a Gleeble-3500 thermomechanical simulator. Constitutive model based on strain compensation was established by the Arrhenius hyperbolic sine function equation, and set up a constitutive equation for PSO-BP neural network. The results show that the flow stress is more sensitive to deformation temperature and strain rate, the flow stress is decreased with the increase of deformation temperature and decrease of strain rate; the flow stress curves present stable states in high temperature and low strain rate. For a constitutive equation based on strain compensation, the data points with the predicted error less than 15% account for 85.28% of all test data by error calculation; and for the constitutive equation based on PSO-BP neural network, the data points with the predicted error less than 15% account for 96.67% of all test data. PSO-BP neural network model has higher accuracy, it can better predict the flow stress of Ti-2.7Cu at elevated temperature.

Introduction: Peroxiredoxin 6 (Prdx6) is a bifunctional protein with glutathione peroxidase activity and phospholipase A2 activity. Previous studies have shown a significant positive correlation between the intracellular survival ability of Brucella and Prdx6. Here, the Prdx6 enzyme with a single activity was constructed to facilitate study of the relationship between the single function of Prdx6 and Brucella infection.

As an attractive candidate for anode materials, silicon has attracted extensive attention. The instability of electrode/electrolyte interphase due to the inherent volume variation upon (de)lithiation is one of the major factors that limit the commercialization of Si materials. The in-depth understanding of the interface reaction of Si is helpful to modify the interface properties of Si, and further improve the electrochemical performance. This review summarizes the research on the interface reaction mechanism of Si during (de)lithiation process, including Li-Si alloying process, the reactions of primary oxide layer and the formation of passivation film on the Si surface. Moreover, the effect of the three processes on the Si electrochemical performance are also discussed.

DOI: 10.3969/j.issn.1672-6731.2018.12.012

BackgroundIdiopathic orbital inflammation (IOI) is a disfiguring and vision-threatening fibroinflammatory disorder. The pathogenesis of IOI has not been elucidated. We sought to clarify the regulatory T cell (Treg) distribution and function in patients with IOI.MethodsThe frequency, phenotype and function of Tregs were identified by multicolor flow cytometry and in vitro cell functional assays. Plasma and tissue samples were obtained to investigate cytokines, chemokines and their receptors of interest by relative real-time polymerase chain reaction (PCR) and Luminex assays.ResultsCompared with healthy subjects, patients with IOI exhibited obvious increases of Tregs in peripheral blood and affected orbital tissues. Circulating Tregs from patients with IOI were significantly more polarized to a Th17-like phenotype with defective regulatory function, whereas orbit-derived Tregs were polarized to a Th2-like phenotype. Furthermore, ST2 expression levels in circulating Tregs and interleukin (IL)-33 mRNA levels in orbital tissues were decreased in IOI. IL-33 restored the suppressive function of Tregs, reduced interferon (IFN)-γ production by Tregs and decreased the activation of orbital fibroblasts (OFs) cocultured with Tregs in IOI.ConclusionIncreased Tregs with proinflammatory and profibrotic polarization were first identified in IOI, suggesting that Treg plasticity and heterogeneity plays an essential role in IOI pathogenesis. Additionally, our study identified a regulatory effect of IL-33 on inflammation and fibrosis in IOI. Reversing the plastic Tregs via IL-33 might be a potential option for IOI patients.

Background: To assess racial/ethnic differences in disease severity, hospital outcomes, length of stay and healthcare costs among hospitalized patients with peripheral artery disease (PAD).Methods: This study used data from the National Inpatient Sample (NIS) to explore the racial/ethnic disparities in PAD-related hospitalizations including presence of PAD with chronic limb threatened ischemia (CLI), amputation, in-hospital mortality, length of hospital stays and estimated medical costs. Race-ethnicity groups included non-Hispanic White, Black, Hispanic, Asian or Pacific Islander, Native American, and others (multiple races). Regression analyses adjusted for age, gender, Charlson Comorbidity Index, primary payer, patient location, bed size of the admission hospital, geographic region of the hospital, and rural/urban location of the hospital.Results: A total of 341,480 PAD hospitalizations were identified. Compared with non-Hispanic Whites, Native Americans had the highest odds of PAD with CLI (OR = 1.77, 95% CI: 1.61, 1.95); Black (OR = 1.71, 95% CI: 1.66, 1.76) and Hispanic (OR = 1.36, 95% CI: 1.31,1.41) patients had higher odds of amputation; Asian or Pacific Islanders had a higher mortality (OR = 1.20, 95% CI: 1.01,1.43), whereas Black (OR = 0.81, 95% CI: 0.76, 0.87) patients has a lower mortality; Asian or Pacific Islanders incurred higher overall inpatient costs (Margin = 30093.01, 95% CI: 28827.55, 31358.48) and most prolonged length of stay (IRR = 0.14, 95% CI: 0.09, 0.18).Conclusions: Our study identified elevated odds of amputation among Hispanic patients hospitalized with PAD as well as higher hospital mortality and medical expenses among Asian or Pacific Islander PAD inpatients. These two demographic groups were previously thought to have a lower risk for PAD and represent important populations for further investigation.

Background: Mindful walking (MW) interventions employ mindfulness training combined with physical activity. Wearable mobile devices have been increasingly used to measure outcomes of physical activity interventions. The purpose of this study was to understand MW participants’ attitudes towards MW and the use of mobile devices in health promotion interventions, including barriers and facilitators of intervention engagement and adherence. Few qualitative studies have documented participant experience with these two types of interventions. Method: The pilot study involved a randomized MW intervention including 38 participants with self-reported inadequate physical activity. Half of them were randomized to receive MW intervention plus a FitBit device and the other received the FitBit device only. We used a qualitative thematic analysis of the narrative data collected through open-ended survey questions at three time points. Participants in the MW intervention were asked to describe their experiences with MW, while all participants were asked to describe their experience with wearing the FitBit to track their step counts. Results: Participants reported a broad range of perceived benefits and challenges related to adopting the MW intervention and using the mobile device. Participants were generally willing to try to adopt the recommended MW practice and to see value of MW in increasing physical activity and improving overall health. Participants reported using a variety of additional device features beyond goal setting and step counts, indicating using the devices may have been effective in providing additional motivation for participants in meeting physical activity goals in both the control and intervention groups. While most of the feedback about MW (in the intervention group) and the device (all participants) was overwhelmingly positive, a minority of participants reported barriers such as lack of patience with meditation and discomfort with wearing the device. Conclusion: Most participants in the MW intervention see the health benefits of this program and most participants using the wearable physical activity tracking device reported the motivational benefits of this device. Issues with the MW intervention (e.g., lack of patience) and the wearable device (e.g., discomfort with wearing) need to be addressed in future interventions.

In the current research experiment, a sensitive, precise and rapid bioanalytical approach involving the detection of fedratinib concentrations in rat plasma by ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) technique was optimized and established, and it was employed to describe the changes of fedratinib concentrations after oral treatment with various antifungal drugs (isavuconazole, posaconazole, fluconazole and itraconazole). An Acquity UPLC BEH reverse-phase C18 column (2.1 mm × 50 mm, 1.7 μm) was used for chromatographic separation of fedratinib and bosutinib (as internal standard (IS) in our study) under a linear gradient elution of the mobile phase, which was composed of solution A (acetonitrile) and solution B (water with 0.1% formic acid), along with 0.40 ml/min flow rate. The analyte and internal standard were measured with electrospray ion source in positive ion mode on a XEVO TQS triple quadrupole tandem mass spectrometer. The newly developed UPLC-MS/MS assay displayed enough linearity within the concentration range of 0.5–500 ng/ml for calibration curve. The intra- and inter-day of precision and accuracy were evaluated and validated to meet the requirements for the guidelines of bioanalytical assay. In addition, the findings of matrix effect, recovery, and stability were all within the acceptable limits. The new UPLC-MS/MS method was also successfully applied to characterize the pharmacokinetic changes of fedratinib in rats in the present of different antifungal drugs (such as isavuconazole, posaconazole, fluconazole and itraconazole). It turned out that fluconazole resulted in a prominent inhibitory effect on fedratinib metabolism in rats, followed by treatment with itraconazole and isavuconazole. Therefore, the toxicity of fedratinib should be avoided when the concurrent use of fedratinib with CYP3A4 inhibitors may occur.

Physical activity is important for health. However, there is a lack of literature related to the physical activity levels of adults living in urban villagers, which is a vulnerable population in China. The aim of this study is to compare the physical activity and sedentary behavior engagements between urban villagers and non-urban villagers using the 2019 Luohu Shenzhen, China Community Diagnosis Questionnaire. A total of 1205 adults living in urban villages and non-urban villages were included in the analysis. Unadjusted and multiple multivariate logistic regression were conducted for the dependent variable of engagement in recreational physical activity, frequency of recreational physical activity per week, and hours spent in sedentary behaviors per day. Descriptive analysis was conducted to identify the reasons for not engaging in physical activity among urban villagers and non-urban villagers. Across the included sample, 29.05% were urban villagers and 70.95% were non-urban villagers. The results suggested that urban villagers are more likely to engage in physical activity than non-urban villager (OR = 1.90, 95% CI [1.40, 2.59], p < 0.001). However, it was also found that urban village status had no significant association for frequency in engaging in physical activity and average hours spent in sedentary behaviors. Both urban villagers and non-urban villages indicated that lack of time, lack of safe and appropriate environment, and working in labor intensive occupations as some of the reasons for not engaging in physical activity. There is a need for tailed interventions and policies for promoting physical activity among urban villagers and non-urban villagers. Additional studies are needed to further our understanding of the physical activity behaviors among urban villagers in China.