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Abstract Background As with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized. Methods This is a single-center cross-sectional observational study of patients aged 55 to 75 years old who visited the ED with urgent conditions, Patient Acuity Category Scale (PACS) P2 or P3, who were subsequently discharged. The patients visited a public hospital in Singapore on four randomly selected weekdays in April 2023. The utilisation of hospital resources and manpower was studied. A formulated criteria was used to determine the appropriate site of care, such as an Urgent Care Centre (UCC), Primary Care Providers (PCP) clinic or the ED. Results There were 235 eligible patients during the study period, with a mean age of 65.1 years of which a majority, 183 (77.9%) were allocated to patient acuity category scale P2. Most of the patients were walk-in patients with no referrals (169 (71.9%)). Based on the criteria, the majority of 187 (79.6%) of these patient may be safely managed at an outpatient setting; 71 (30.2%) patients by PCP, 116 (49.4%) patients may be managed by an UCC, with the remaining 48 (20.4%) requiring ED care. Conclusion Our findings indicate that a significant portion of discharged older ED adults with urgent but non-emergent conditions may be adequately managed at outpatient medical services that are appropriately resourced. More research is needed on healthcare initiatives aimed at developing the capabilities of outpatient medical services to manage mild to moderate acute conditions to optimise ED resource allocation.

Abstract Background Our study aims to explore the relationship, shared gene signature, and the underlying mechanisms that connect rheumatoid arthritis (RA) to colorectal cancer (CRC). Methods Mendelian randomization (MR) analysis was conducted to assess the causality between RA and CRC. Summary statistic data-based Mendelian randomization (SMR) leveraging eQTL data was employed to identify the CRC-related causal genes. Integrated analyses of single-cell RNA sequencing and bulk RNA sequencing were employed to comprehensively investigate the shared gene signature and potential mechanisms underlying the pathogenesis of both RA and CRC. Predictive analysis of the shared hub gene in CRC immunotherapy response was performed. Pan-cancer analyses were conducted to explore the potential role of MYO9A in 33 types of human tumors. Results MR analysis suggested that RA might be associated with a slight increased risk of CRC (Odds Ratio = 1.04, 95% Confidence Interval = 1.01–1.07, P = 0.005). SMR analysis combining transcriptome analyses identified MYO9A as a causal gene in CRC and a shared gene signature in both RA and CRC. MYO9A may contribute to tumor suppression, while downregulation of MYO9A may impact CRC tumorigenesis by disrupting epithelial polarity and architecture, resulting in a worse prognosis in CRC. Additionally, MYO9A shows promise as a powerful predictive biomarker for cancer prognosis and immunotherapy response in CRC. Pan-cancer analyses demonstrated MYO9A may have a protective role in the occurrence and progression of various human cancers. Conclusion RA might be associated with a slight increased risk of CRC. MYO9A is a shared gene signature and a potential immune-related therapeutic target for both CRC and RA. Targeting the MYO9A-mediated loss of polarity and epithelial architecture could be a novel therapeutic approach for CRC.

A sense of humor constitutes a core factor that influences teacher-student interactions. The humor that teachers utilize in class may influence teacher-student relationships, either positively or negatively. Moreover, teachers' humor style influences students' humor style, and vice versa. This study aimed to construct patterns of humor styles based on typology and explore how these patterns influence their interactions. Data were collected from 990 Taiwanese students regarding their self-reported humor styles and perceptions of class teachers as well as the interaction between the two. Subsequently, k-means clustering was conducted by dividing participants into four clusters based on the collected data: positive humor endorsers, negative humor endorsers, humor deniers, and contradictory humor endorsers. Among these, the grouping of contradictory humor endorsers differed from previous findings. Among the four clusters, the teachers of positive humor endorsers were perceived to have a significantly higher influence and proximity to students, whereas contradictory humor endorsers were perceived to have the lowest influence and proximity to students. The research findings revealed that different patterns of teachers' and students' humor styles have a distinct influence on their interactions, which deepens our understanding of the extent to which their humor styles consistently impact their interactions., Author(s): Ching-Lin Wu [sup.1] [sup.2] , Hsiang-Ju Huang [sup.3] , Pei-Zhen Chen [sup.3] , Hsueh-Chih Chen [sup.2] [sup.3] [sup.4] Author Affiliations: (1) grid.412090.e, 0000 0001 2158 7670, Program of Learning [...]

Micropile groups (MPGs) are an effective means of geological disaster prevention for small- and medium-sized landslides, with the advantages of light structures and convenient construction. However, the mechanical and deformation characteristics of MPGs are complex, and their practical application is ahead of theoretical research, which greatly limits the popularization and application of MPGs. This paper conducts a series of centrifuge model tests to investigate the mechanical and deformation characteristics and the antislip mechanism of MPGs, then compare them with those of conventional piles (CPs). In particular, MPGs with and without the platform in the strengthening process of the talus slope are compared, and monitoring the reinforcement effect of MPGs subjected to gravity loading. The results suggest that the soil pressure shows a triangular distribution pattern and is influenced by the position of the potential slip zone and the geometry of the bedrock surface. The compatibility deformation of the pile-soil leads to the stress release of the soil behind the pile, which is an important part affecting the antislip mechanism of the MPG. The platform limits 75% of the pile top displacement of the MPG and simultaneously redistributes the stress of the piles, providing a better overall antislip effect of the pile-soil composite. Key words: centrifuge modelling test, micropile group, talus slope, compatibility deformation, pile-soil interaction, antislip mechanism, 1. Introduction There are many geological disasters in China, with landslides (mainly small- and medium-sized landslides) accounting for the largest proportion (>50%)(Pei et al. 2021). As an antislip facility, micropiles [...]

Abstract Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are prevalent among men who have sex with men (MSM) in China. However, compared to syphilis and HIV, the testing rate for chlamydia and gonorrhea remains low. The purpose of this pilot study was to evaluate the feasibility for conducting rapid nucleic acid test for chlamydia and gonorrhea in MSM community-based organizations (CBO). Method We recruited our participants through an MSM CBO where free HV and syphilis testing were routinely provided. We collected data including social-demographic background, sexual history, chlamydia and gonorrhea testing history, and reasons for accepting this on-site rapid testing. Urine and/or anorectal swab samples were collected and tested for chlamydia and gonorrhea on-site and the testing results were delivered in about 1.5 h. Positive cases received on-site free treatment. Results From August 2020 to October 2020, 634 MSM visited the CBO for syphilis and HIV testing and 158 (158/634, 24.9%) accepted the on-site chlamydia and gonorrhea rapid test, 135 were finally enrolled. The positive rate fo chlamydia was 16.3% (22/135) and 3.0% (4/135) for gonorrhea, respectively. Only 19.3% participants had previously undergone chlamydia and gonorrhea testing and 68.9% (93/135) participants reported that they had heard of gonorrhea, 47.4% (64/135) had heard of chlamydia. The main reason for testing was “free for charge” (66.2%), followed by “convenient, ‘shorter waiting time” (45.2%) and “had high-risk sexual behavior recently” (16.3%). Conclusions This pilot study showed that the chlamydia and gonorrhea infection rate remains high among MSM, while the testing rate was low. On-site rapid testing is feasible and potentially preferred by MSM.

Abstract Background X chromosome inactivation (XCI) is an epigenetic phenomenon that one of two X chromosomes in females is transcriptionally silenced during early embryonic development. Skewed XCI has been reported to be associated with some X-linked diseases. There have been several methods measuring the degree of the skewness of XCI. However, these methods may still have several limitations. Results We propose a Bayesian method to obtain the point estimate and the credible interval of the degree of XCI skewing by incorporating its prior information of being between 0 and 2. We consider a normal prior and a uniform prior for it (respectively denoted by BN and BU). We also propose a penalized point estimate based on the penalized Fieller’s method and derive the corresponding confidence interval. Simulation results demonstrate that the BN and BU methods can solve the problems of extreme point estimates, noninformative intervals, empty sets and discontinuous intervals. The BN method generally outperforms other methods with the lowest mean squared error in the point estimation, and well controls the coverage probability with the smallest median and the least variation of the interval width in the interval estimation. We apply all the methods to the Graves’ disease data and the Minnesota Center for Twin and Family Research data, and find that SNP rs3827440 in the Graves’ disease data may undergo skewed XCI towards the allele C. Conclusions We recommend the BN method for measuring the degree of the skewness of XCI in practice. The R package BEXCIS is publicly available at https://github.com/Wen-YiYu/BEXCIS .