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To investigate the clinical impact of ventilator-associated events (VAEs) on adverse prognoses and risk factors for mortality among intensive care unit (ICU) patients receiving invasive mechanical ventilation (IMV) based on an ICU healthcare-associated infection (ICU-HAI) registry.
A cohort study was conducted based on an ICU-HAI registry including 30,830 patients between 2015 and 2018.
The study was conducted using data from 5 adult ICUs of a referral hospital.
Adult patients in the ICU-HAI registry who received ≥4 consecutive IMV days.
Clinical outcomes and mortality risk factors for VAEs were analyzed using propensity score matching (PSM), multivariate regression models, and sensitivity analyses.
Of 6,426 included patients, 1,803 developed 1,899 VAEs. After PSM, patients with VAEs did have prolonged length of stay in the ICU and in the hospital, increased hospitalization costs, longer days on mechanical ventilation, higher proportion of ≥9 days on mechanical ventilation, higher rate of failure in extubating mechanical ventilation, and excess all-cause mortality in the ICU. Older age (adjusted OR [aOR], 1.02), higher APACHE II score on ICU admission (aOR, 1.06), pneumonia (aOR, 1.49), blood transfusion (aOR 1.43), immunosuppressive drugs (aOR, 1.69), central-line catheter (aOR, 2.06), and ≥2 VAEs in the ICU (aOR, 1.99) were associated with higher risks for all-cause mortality in an ICU.
Patients with VAEs indeed had poorer clinical outcomes. Older age, higher APACHE II score on ICU admission, pneumonia, blood transfusion, immunosuppressive drugs, central-line catheter, and ≥2 VAEs in the ICU were risk factors for all-cause mortality of VAE patients in the ICU.
The aim of this study was to assess the current status of disease-related knowledge and to analyze the relationship among the general condition, illness perception, and psychological status of patients with coronavirus disease 2019 (COVID-19).
A hospital-based cross-sectional study was conducted on 118 patients using convenience sampling. The general questionnaire, disease-related knowledge questionnaire of COVID-19, Illness Perception Questionnaire (IPQ), and Profile of Mood States (POMS) were used to measure the current status of participants.
The overall average score of the disease-related knowledge of patients with COVID-19 was (79.19 ± 14.25), the self-care situation was positively correlated with knowledge of prevention and control (r = 0.265; P = 0.004) and total score of disease-related knowledge (r = 0.206; P = 0.025); the degree of anxiety was negatively correlated with the knowledge of diagnosis and treatment (r = −0.182; P = 0.049). The score of disease-related knowledge was negatively correlated with negative cognition (volatility, consequences, emotional statements) and negative emotions (tension, fatigue, depression) (P < 0.05); positively correlated with positive cognition (disease coherence) and positive emotion (self-esteem) (P < 0.05).
It was recommended that we should pay more attention to the elderly and low-income groups, and increase the knowledge about diagnosis and treatment of COVID-19 and self-care in the future health education for patients.
Cysticercosis caused by the metacestode larval stage of Taenia hydatigena formerly referred to as Cysticercus tenuicollis is a disease of veterinary importance that constitutes a significant threat to livestock production worldwide, especially in endemic regions due to condemnation of visceral organs and mortality rate of infected young animals. While the genetic diversity among parasites is found to be potentially useful in many areas of research including molecular diagnostics, epidemiology and control, that of T. hydatigena across the globe remains poorly understood. In this study, analysis of the mitochondrial DNA (mtDNA) of adult worms and larval stages of T. hydatigena isolated from dogs, sheep and a wild boar in China showed that the population structure consists of two major haplogroups with very high nucleotide substitutions involving synonymous and non-synonymous changes. Compared with other cestodes such as Echinococcus spp., the genetic variation observed between the haplogroups is sufficient for the assignment of major haplotype or genotype division as both groups showed a total of 166 point-mutation differences between the 12 mitochondrial protein-coding gene sequences. Preliminary analysis of a nuclear protein-coding gene (pepck) did not reveal any peculiar changes between both groups which suggests that these variants may only differ in their mitochondrial makeup.
A Fast Ice Prediction System (FIPS) was constructed and is the first regional land-fast sea-ice forecasting system for the Antarctic. FIPS had two components: (1) near-real-time information on the ice-covered area from MODIS and SAR imagery that revealed, tidal cracks, ridged and rafted ice regions; (2) a high-resolution 1-D thermodynamic snow and ice model (HIGHTSI) that was extended to perform a 2-D simulation on snow and ice evolution using atmospheric forcing from ECMWF: either using ERA-Interim reanalysis (in hindcast mode) or HERS operational 10-day predictions (in forecast mode). A hindcast experiment for the 2015 season was in good agreement with field observations, with a mean bias of 0.14 ± 0.07 m and a correlation coefficient of 0.98 for modeled ice thickness. The errors are largely caused by a cold bias in the atmospheric forcing. The thick snow cover during the 2015 season led to modeled formation of extensive snow ice and superimposed ice. The first FIPS operational service was performed during the 2017/18 season. The system predicted a realistic ice thickness and onset of snow surface melt as well as the area of internal ice melt. The model results on the snow and ice properties were considered by the captain of R/V Xuelong when optimizing a low-risk route for on-ice transportation through fast ice to the coastal Zhongshan Station.
Although prenatal exposure to high ambient temperatures were reported to be associated with preterm birth, limited research assessed the impact of weather-related extreme heat events (EHE) on birthweight, particularly by trimester. We, therefore, investigated the impact of prenatal EHE on birthweight among term babies (tLBW) by trimester and birthweight percentile. We conducted a population-based case–control study on singleton live births at 38–42 gestational weeks in New York State (NYS) by linking weather data with NYS birth certificates. A total of 22,615 cases were identified as birthweight <2500 gram, and a random sample of 139,168 normal birthweight controls was included. EHE was defined as three consecutive days with the maximum temperatures of ≥32.2 °C/90 °F (EHE90) and two consecutive days of temperatures ≥97th percentile (EHE97) based on the distribution of the maximum temperature for the season and region. We estimated odds ratios (ORs) and 95% confidence intervals (95% CI) with multivariable unconditional logistic regression, controlling for confounders. Overall exposure to EHE97 for 2 d was associated with tLBW (OR 1.05; 95% CI 1.02, 1.09); however, the strongest associations were only observed in the first trimester for both heat indicators, especially when exposure was ≥3 d (ORs ranged: 1.06–1.13). EHE in the first trimester was associated with significant reduction in mean birthweight from 26.78 gram (EHE90) to 36.25 gram (EHE97), which mainly affected the 40th and 60th birthweight percentiles. Findings revealed associations between multiple heat indicators and tLBW, where the impact was consistently strongest in the first trimester.
The extent of intertidal flats in the Yellow Sea region has declined significantly in the past few decades, resulting in severe population declines in several waterbird species. The Yellow Sea region holds the primary stopover sites for many shorebirds during their migration to and from northern breeding grounds. However, the functional roles of these sites in shorebirds’ stopover ecology remain poorly understood. Through field surveys between July and November 2015, we investigated the stopover and moult schedules of migratory shorebirds along the southern Jiangsu coast, eastern China during their southbound migration, with a focus on the ‘Critically Endangered’ Spoon-billed Sandpiper Calidris pygmaea and ‘Endangered’ Nordmann’s Greenshank Tringa guttifer. Long-term count data indicate that both species regularly occur in globally important number in southern Jiangsu coast, constituting 16.67–49.34% and 64.0–80.67% of their global population estimates respectively, and it is highly likely that most adults undergo their primary moult during this southbound migration stopover. Our results show that Spoon-billed Sandpiper and Nordmann’s Greenshank staged for an extended period of time (66 and 84 days, respectively) to complete their primary moult. On average, Spoon-billed Sandpipers and Nordmann’s Greenshanks started moulting primary feathers on 8 August ± 4.52 and 27 July ± 1.56 days respectively, and their moult durations were 72.58 ± 9.08 and 65.09 ± 2.40 days. In addition, some individuals of several other shorebird species including the ‘Endangered’ Great Knot Calidris tenuirostris, ‘Near Threatened’ Bar-tailed Godwit Limosa lapponica, ‘Near Threatened’ Eurasian Curlew Numenius arquata and Greater Sand Plover Charadrius leschenaultii also underwent primary moult. Our work highlights the importance of the southern Jiangsu region as the primary moulting ground for these species, reinforcing that conservation of shorebird habitat including both intertidal flats and supratidal roosting sites in this region is critical to safeguard the future of some highly threatened shorebird species.
This article presents a brief review of our case studies of data-driven Integrated Computational Materials Engineering (ICME) for intelligently discovering advanced structural metal materials, including light-weight materials (Ti, Mg, and Al alloys), refractory high-entropy alloys, and superalloys. The basic bonding in terms of topology and electronic structures is recommended to be considered as the building blocks/units constructing the microstructures of advanced materials. It is highlighted that the bonding charge density could not only provide an atomic and electronic insight into the physical nature of chemical bond of materials but also reveal the fundamental strengthening/embrittlement mechanisms and the local phase transformations of planar defects, paving a path in accelerating the development of advanced metal materials via interfacial engineering. Perspectives on the knowledge-based modeling/simulations, machine-learning knowledge base, platform, and next-generation workforce for sustainable ecosystem of ICME are highlighted, thus to call for more duty on the developments of advanced structural metal materials and enhancement of research productivity and collaboration.
Malnutrition and acute kidney injury (AKI) are common complications in hospitalised patients, and both increase mortality; however, the relationship between them is unknown. This is a retrospective propensity score matching study enrolling 46 549 inpatients, aimed to investigate the association between Nutritional Risk Screening 2002 (NRS-2002) and AKI and to assess the ability of NRS-2002 and AKI in predicting prognosis. In total, 37 190 (80 %) and 9359 (20 %) patients had NRS-2002 scores <3 and ≥3, respectively. Patients with NRS-2002 scores ≥3 had longer lengths of stay (12·6 (sd 7·8) v. 10·4 (sd 6·2) d, P < 0·05), higher mortality rates (9·6 v. 2·5 %, P < 0·05) and higher incidence of AKI (28 v. 16 %, P < 0·05) than patients with normal nutritional status. The NRS-2002 showed a strong association with AKI, that is, the risk of AKI changed in parallel with the score of the NRS-2002. In short- and long-term survival, patients with a lower NRS-2002 score or who did not have AKI achieved a significantly lower risk of mortality than those with a high NRS-2002 score or AKI. Univariate Cox regression analyses indicated that both the NRS-2002 and AKI were strongly related to long-term survival (AUC 0·79 and 0·71) and that the combination of the two showed better accuracy (AUC 0·80) than the individual variables. In conclusion, malnutrition can increase the risk of AKI and both AKI and malnutrition can worsen the prognosis that the undernourished patients who develop AKI yield far worse prognosis than patients with normal nutritional status.
Underground Nuclear Astrophysics in China (JUNA) will take the advantage of the ultra-low background in Jinping underground lab. High current accelerator with an ECR source and detectors were commissioned. JUNA plans to study directly a number of nuclear reactions important to hydrostatic stellar evolution at their relevant stellar energies. At the first period, JUNA aims at the direct measurements of 25Mg(p,γ)26 Al, 19F(p,α) 16 O, 13C(α, n) 16O and 12C(α,γ) 16O near the Gamow window. The current progress of JUNA will be given.
The following paper investigates the prevalence and characteristics of asymptomatic norovirus infection in the population living around oyster farm sites. Two consecutive surveys were conducted from January 2014 to December 2014 and 4549 stool samples were screened during the same time period. The total asymptomatic infection rate was 4.04% (184/4549). Norovirus infection rate was 5.20% in oyster farming population which was significantly higher compared with non-farming population where the infection rate was 3.65% (χ2 = 5.49, P < 0.05). A total of 184 NoV positive samples were identified by real time-quantitative polymerase chain reaction (RT-qPCR) and semi-nested RT-PCR and 136 sequences were obtained. The sequences were clustered into 14 genotypes. GI strains were clustered into six genotypes, including GI.2, GI.3, GI.5, GI.6, GI.8 and GI.9; while GII strains were clustered into GII.2, GII.3, GII.4, GII.5, GII.6, GII.8 and GII.13. GI.9 and GII.17 were the predominant and most prevalent genotypes, respectively. The GII.17 genotype replaced GII.4 becoming the dominant genotype in the oyster farming area in 2014. To sum up, long-term monitoring of asymptomatic infection is crucial for the detection of new variant strains and for identifying outbreaks during the early stage.
Haxilegen Glacier No.51 (43.731°N, 84.391°E; CN5Y741C0051) is located in the Kuytun river basin, Erenharbirga range, eastern Tien Shan. This study presents the annual mass balance of Haxilegen Glacier No.51 for 7 hydrological years and uses a temperature-index and an accumulation model to reconstruct the annual mass balance from 1999 to 2015. The model is calibrated against annual altitudinal mass-balance measurements and then applied to the period with no measurements. We find an accumulated mass balance of −6.06 ± 0.88 m w.e.a−1 over the period of 16 hydrological years, with an average annual value of −0.32 ± 0.22 m w.e.a−1. The mean glacier-wide annual, summer and winter balances for 1999 to 2015 are −0.37, −0.54 and 0.16 ± 0.22 m w.e.a−1, respectively, with a high correlation coefficient (r = 0.95, p < 0.001) between annual balance and summer balance. The calculated mass-balance sensitivity of the glacier to temperature is −0.51 m w.e.a−1 °C−1 and to precipitation is 0.08 m w.e.a−1 for a 10% increase. The sensitivity of seasonal mass balance indicates that temperature during the melt season (May–August) and annual precipitation are the major contributors to mass-balance fluctuation.
The topological insulator/superconductor heterostructure is one of the most promising platforms to create and manipulate Majorana bound states. Here, we used molecular beam epitaxy to grow high-quality (Bi0.5Sb0.5)2Te3 films on Nb surfaces. To promote proper (Bi0.5Sb0.5)2Te3 film nucleation in the early growth stage, we developed a two-step growth method. Bi, Sb, and Te clusters were first evaporated at a low temperature of 180 °C, which is below the typical growth temperature and then annealed to form a crystalized passivation layer. Second, a standard (Bi0.5Sb0.5)2Te3 film was grown under the normal deposition temperature of 280 °C. We used reflection high-energy electron diffraction, high-resolution transmission electron microscopy, X-ray photoelectron spectroscopy, and X-ray diffraction to further characterize the (Bi0.5Sb0.5)2Te3 film and passivation layer quality. Finally, the top Nb film was laid down by magnetron sputtering at room temperature. The hetero-Nb/epitaxial (Bi0.5Sb0.5)2Te3/Nb stacks were further fabricated into micro-Josephson junctions and showed clear Josephson currents demonstrating an excellent material quality.
A high power laser system was used to drive the ignition of inertial confinement fusion (ICF), of which the high energy, the uniform focal spot, the accurate laser waveform, and the synchronization between the laser beams are key parameters. To accomplish this, global laser characteristics control should be assured, which was the main purpose of the injection laser system. In this paper, the key technological progress involved in the improvement of the performance of the injection laser of SG-II is reported, including frequency domain control, time domain control, near-field spatial shaping, pre-amplifier technology, and the optical parametric chirped pulse amplification pump source.
This work designed a facile preparation for an SiO2/C composite as the anode material for lithium ion battery. Both SiO2 and carbon are amorphous. SiO2 and carbon are mixed uniformly. The SiO2/C composite shows high specific capacity, cycle stability, and rate capability in lithium ion battery charge–discharge test. A stable reversible capacity of 1024 mA h/g at the current density of 100 mA/g is reached. The capacity retains 83% after 100 cycles. The uniform mixture of SiO2 and carbon leads to reduced volume change during the lithiation and delithiation of SiO2, together with the amorphous nature of SiO2 explains the high cycling stability. The carbon coating is a key factor for the high capacity and stability due to the increased electrical conductivity and reduced volume change. The resistance of the solid electrolyte interface film and charge transfer resistance of the SiO2/C composite are much smaller than those of pure carbon, which is a direct proof of the improved conductivity of the material by the carbon coating.
Bulk nanocrystalline (NC) silvers were fabricated by spark plasma sintering process. The effects of sintering temperature on physical and mechanical properties of the NC silvers were investigated. The results indicate that no impurities were introduced into the bulk compacts during the preparation procedure. Both the density and the electrical conductivity of the NC Ag increase with an increase in sintering temperature. However, the micro-hardness and ultimate tensile strength (UTS) of the bulk compacts increase initially and then decrease with increasing sintering temperature. The NC Ag sintered at 500 °C exhibits the highest micro-hardness of 85.3 HV along with the best compression yield strength of 379 MPa and the highest UTS of 534 MPa. The deterioration of the mechanical properties of the NC Ag sintered at 550 °C should be attributed to the rapid grain growth.
Accumulating evidence suggests that altered immunity contributes to the
development of major depressive disorder (MDD).
To examine whether complement factor H (CFH), a regulator of activation
of the alternative pathway of the complement cascade, confers
susceptibility to MDD.
Expression analyses were tested in 53 unmedicated people with MDD and 55
healthy controls. A two-stage genetic association analysis was performed
in 3323 Han Chinese with or without MDD. Potential associations between
CFH single nucleotide polymorphisms and age at MDD
onset were evaluated.
CFH levels were significantly lower in the MDD group at
both protein and mRNA levels (P = 0.009 and
P = 0.014 respectively). A regulatory variant in the
CFH gene, rs1061170, showed statistically significant
genotypic and allelic differences between the MDD and control groups
(genotypic P = 0.0005, allelic P =
0.0001). Kaplan–Meier survival analysis showed that age at onset of MDD
was significantly associated with the C allele of
rs1061170 (log rank statistic χ2 = 6.82, P =
0.009). The C-allele carriers had a younger age at onset
of MDD (22.2 years, s.d. = 4.0) than those without the C
allele (23.6 years, s.d. = 4.3).
CFH is likely to play an important role in the
development of MDD. rs1061170 has an important effect on age at onset of
MDD in Han Chinese and may therefore be related to early pathogenesis of
MDD, although further study is needed.
The effects of pre-treatments on the precipitate microstructures of an Al–Zn–Mg–Cu alloy are investigated. Meanwhile, the creep-rupture behavior of the under-aged and peak-aged alloys are comparatively analyzed. Additionally, the effects of pre-treatment on the fracture mechanisms are discussed. It is found that the precipitate microstructures are sensitive to pre-treatments. The intragranular precipitates of the peak-aged alloy are larger than those of the under-aged. The precipitate free zone of the peak-aged alloy is wider than that of the under-aged. Some large intergranular precipitates appear on the grain boundaries of the under-aged alloy, and induce the nucleation of microvoids. Eventually, the creep fracture of the under-aged alloy is accelerated. Therefore, the differences in microstructures lead to the shorter creep-rupture life of the under-aged alloy, compared to the peak-aged alloy.
Objective: To study the relationship of Nε-(carboxymethyl)-lysine level (CML)
with microstructure changes of white matter (WM), and cognitive impairment
in patients with type 2 diabetes mellitus (T2DM) and to discuss the
potential mechanism underlying T2DM-associated cognitive impairment. Methods: The study was performed in T2DM patients (n=22) with disease course
≥5 years and age ranging from 65 to 75 years old. A control group consisted
of 25 sex- and age-matched healthy volunteers. Fractional anisotropy (FA) of
several WM regions was analyzed by diffusion tensor imaging scan. Plasma CML
levels were measured by enzyme-linked immunosorbent assay, and cognitive
function was assessed by Mini-Mental State Examination and Montreal
cognitive assessment (MoCA). Results: The total Mini-Mental State Examination score in the patient group
(25.72±3.13) was significantly lower than the control group (28.16±2.45)
(p<0.05). In addition, the total MoCA score in the patient group
(22.15±3.56) was significantly lower than the control group 25.63±4.12)
(p<0.01). In the patient group, FA values were significantly decreased in
the corpus callosum, cingulate fasciculus, inferior fronto-occipital
fasciculus, parietal WM, hippocampus, and temporal lobes relative to
corresponding regions of healthy controls (p<0.05). Plasma CML level was
negatively correlated with average FA values in the global brain (r=−0.58,
p<0.01) and MoCA scores (r=−0.47, p<0.05). Conclusions: In T2DM, WM microstructure changes occur in older patients, and
elevations in CML may play a role in the development of cognitive
Salivary α-amylase (sAA) is responsible for the ‘pre-digestion’ of starch in the oral cavity and accounts for up to 50 % of salivary protein in human saliva. An accumulating body of literature suggests that sAA is of nutritional importance; however, it is still not clear how sAA is related to individual's nutritional status. Although copy number variations (CNV) of the salivary amylase gene (AMY1) are associated with variation in sAA levels, a significant amount of sAA variation is not explained by AMY1 CNV. To measure sAA responses to gustatory stimulation with citric acid, we used sAA ratio (the ratio of stimulated sAA levels to those of resting sAA) and investigated acute sAA responses to citric acid in children with normal (Normal-BMI, n 22) and low (Low-BMI, n 21) BMI. The AMY1 gene copy number was determined by quantitative PCR. We, for the first time, demonstrated attenuated acute sAA responses (decreased sAA ratio) to gustatory stimulation in Low-BMI (thinness grade 3) children compared with the Normal-BMI children, which suggest that sAA responses to gustatory stimulation may be of nutritional importance. However, child's nutritional status was not directly related to their resting or stimulated sAA levels, and it was not associated with AMY1 gene copy number. Finally, AMY1 CNV might influence, but did not eventually determine, sAA levels in children.
The present study aimed to translate the English version of the Nutritional Form For the Elderly into Simplified Chinese, as well as to test the reliability (homogeneity and stability) and validity (content and construct validity) of the Chinese version of the Nutritional Form For the Elderly (NUFFE-CHI).
The study adopted a cross-sectional design. The English version of the NUFFE was translated into Simplified Chinese and a questionnaire survey was conducted. The data were analysed with statistical methods to estimate the homogeneity, stability, content and construct validity.
Jinzhou City, China.
A total number of 701 community-dwelling older adults answered the questionnaire, including background variables and the NUFFE-CHI. A small group of the participants (n 50) completed the NUFFE-CHI twice for test–retest reliability.
Cronbach’s α was 0·65 and the split-half reliability was 0·67. Item-to-total correlation analyses showed that the scale has sufficient internal consistency. The test–retest reliability regarding the total scores of NUFFE-CHI was reflected in an intra-class correlation coefficient of 0·88. The intra-class correlation coefficients between the test and retest of the NUFFE-CHI items varied between 0·43 and 0·98. A content validity index of 0·83 explained good content validity. Construct validity was demonstrated in an exploratory factor analysis with a six-factor solution, explaining 57·65 % of the variance.
This first testing of the NUFFE-CHI indicates sufficient evidence for reliability, content and construct validity. Further testing studies regarding homogeneity, concurrent validity, sensitivity and specificity are required before the NUFFE-CHI can be used as a screening instrument in clinical settings and in research.