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Our study aimed to develop and validate a nomogram to assess talaromycosis risk in hospitalized HIV-positive patients. Prediction models were built using data from a multicentre retrospective cohort study in China. On the basis of the inclusion and exclusion criteria, we collected data from 1564 hospitalized HIV-positive patients in four hospitals from 2010 to 2019. Inpatients were randomly assigned to the training or validation group at a 7:3 ratio. To identify the potential risk factors for talaromycosis in HIV-infected patients, univariate and multivariate logistic regression analyses were conducted. Through multivariate logistic regression, we determined ten variables that were independent risk factors for talaromycosis in HIV-infected individuals. A nomogram was developed following the findings of the multivariate logistic regression analysis. For user convenience, a web-based nomogram calculator was also created. The nomogram demonstrated excellent discrimination in both the training and validation groups [area under the ROC curve (AUC) = 0.883 vs. 0.889] and good calibration. The results of the clinical impact curve (CIC) analysis and decision curve analysis (DCA) confirmed the clinical utility of the model. Clinicians will benefit from this simple, practical, and quantitative strategy to predict talaromycosis risk in HIV-infected patients and can implement appropriate interventions accordingly.
The self-generated magnetic field in three-dimensional (3-D) single-mode ablative Rayleigh–Taylor instability (ARTI) relevant to the acceleration phase of a direct-drive inertial confinement fusion (ICF) implosion is investigated. It is found that stronger magnetic fields up to a few thousand teslas can be generated by 3-D ARTI rather than by its two-dimensional (2-D) counterpart. The Nernst effects significantly alter the magnetic field convection and amplify the magnetic fields. The magnetic field of thousands of teslas yields the Hall parameter of the order of unity, leading to profound magnetized heat flux modification. While the magnetic field significantly accelerates the bubble growth in the short-wavelength 2-D modes through modifying the heat fluxes, the magnetic field mostly accelerates the spike growth but has little influence on the bubble growth in 3-D ARTI. The accelerated growth of spikes in 3-D ARTI is expected to enhance material mixing and degrade ICF implosion performance. This work is focused on a regime relevant to direct-drive ICF parameters at the National Ignition Facility, and it also covers a range of key parameters that are relevant to other ICF designs and hydrodynamic/astrophysical scenarios.
Natural infection by Trichinella sp. has been reported in humans and more than 150 species of animals, especially carnivorous and omnivorous mammals. Although the presence of Trichinella sp. infection in wild boars (Sus scrofa) has been documented worldwide, limited information is known about Trichinella circulation in farmed wild boars in China. This study intends to investigate the prevalence of Trichinella sp. in farmed wild boars in China. Seven hundred and sixty-one (761) muscle samples from farmed wild boars were collected in Jilin Province of China from 2017 to 2020. The diaphragm muscles were examined by artificial digestion method. The overall prevalence of Trichinella in farmed wild boars was 0.53% [95% confidence interval (CI): 0.51–0.55]. The average parasite loading was 0.076 ± 0.025 larvae per gram (lpg), and the highest burden was 0.21 lpg in a wild boar from Fusong city. Trichinella spiralis was the only species identified by multiplex polymerase chain reaction. The 5S rDNA inter-genic spacer region of Trichinella was amplified and sequenced. The results showed that the obtained sequence (GenBank accession number: OQ725583) shared 100% identity with the T. spiralis HLJ isolate (GenBank accession number: MH289505). Since the consumption of farmed wild boars is expected to increase in the future, these findings highlight the significance of developing exclusive guidelines for the processing of slaughtered farmed wild boar meat in China.
In this study, we examine how local government debt responds to environmental policies in China. We show that when an environmental policy impacts the economy, local governments are likely to increase debt issuance, with this effect becoming stronger when local officials have greater career incentives within the Chinese bureaucratic system. Over-accumulation of local government debt, which leads to social welfare losses, is closely tied to the urgency local officials feel to secure promotions. Our analysis offers valuable insights for better coordination between fiscal and environmental policies.
This study aimed to assess the relationship between COVID-19 infection-related conditions and depressive symptoms among medical staff after easing the zero-COVID policy in China, and to further examine the mediating role of professional burnout.
Methods
A total of 1716 medical staff from all levels of health care institutions in 16 administrative districts of Beijing, China, were recruited to participate at the end of 2022 in this cross-sectional study. Several multiple linear regressions and mediating effects tests were performed to analyze the data.
Results
At the beginning of the end of the zero-COVID policy in China, 91.84% of respondents reported infection with COVID-19. After adjusting for potential confounding variables, the severity of infection symptoms was significantly positively associated with high levels of depressive symptoms (β = 0.06, P < 0.001), and this association was partially mediated by professional burnout. Specifically, emotional exhaustion (95% CI, 0.131, 0.251) and depersonalization (95% CI, 0.009, 0.043) significantly mediated the association between the severity of infection symptoms and depressive symptoms.
Conclusions
The mental health of medical staff with more severe symptoms of COVID-19 infection should be closely monitored. Also, interventions aimed at reducing emotional exhaustion and depersonalization may effectively reduce their risk of developing depressive symptoms.
where $N\geq2$, $0 \lt s \lt 1$, $2 \lt q \lt p \lt 2_s^*=2N/(N-2s)$, and $\mu\in\mathbb{R}$. The primary challenge lies in the inhomogeneity of the nonlinearity.We deal with the following three cases: (i) for $2 \lt q \lt p \lt 2+4s/N$ and µ < 0, there exists a threshold mass a0 for the existence of the least energy normalized solution; (ii) for $2+4s/N \lt q \lt p \lt 2_s^*$ and µ > 0, we reveal the existence of the ground state solution, explore the strong instability of standing waves, and provide a blow-up criterion; (iii) for $2 \lt q\leq2+4s/N \lt p \lt 2_s^*$ and µ < 0, the strong instability of standing wave solutions is demonstrated. These findings are illuminated through variational characterizations, the profile decomposition, and the virial estimate.
In contemporary neuroimaging studies, it has been observed that patients with major depressive disorder (MDD) exhibit aberrant spontaneous neural activity, commonly quantified through the amplitude of low-frequency fluctuations (ALFF). However, the substantial individual heterogeneity among patients poses a challenge to reaching a unified conclusion.
Methods
To address this variability, our study adopts a novel framework to parse individualized ALFF abnormalities. We hypothesize that individualized ALFF abnormalities can be portrayed as a unique linear combination of shared differential factors. Our study involved two large multi-center datasets, comprising 2424 patients with MDD and 2183 healthy controls. In patients, individualized ALFF abnormalities were derived through normative modeling and further deconstructed into differential factors using non-negative matrix factorization.
Results
Two positive and two negative factors were identified. These factors were closely linked to clinical characteristics and explained group-level ALFF abnormalities in the two datasets. Moreover, these factors exhibited distinct associations with the distribution of neurotransmitter receptors/transporters, transcriptional profiles of inflammation-related genes, and connectome-informed epicenters, underscoring their neurobiological relevance. Additionally, factor compositions facilitated the identification of four distinct depressive subtypes, each characterized by unique abnormal ALFF patterns and clinical features. Importantly, these findings were successfully replicated in another dataset with different acquisition equipment, protocols, preprocessing strategies, and medication statuses, validating their robustness and generalizability.
Conclusions
This research identifies shared differential factors underlying individual spontaneous neural activity abnormalities in MDD and contributes novel insights into the heterogeneity of spontaneous neural activity abnormalities in MDD.
In this paper, we investigate Kolmogorov-type theorems for small perturbations of degenerate Hamiltonian systems. These systems are index by a parameter ξ as $ H(y,x,\xi) = \langle\omega(\xi),y\rangle {+ \bar h(y,\xi)}+\varepsilon P(y,x,\xi,\varepsilon) $, where ɛ > 0. We assume that the frequency mapping $\omega(\cdot)$, $\bar h(y,\cdot)=O(|y|^2)$ and the perturbation $\varepsilon P(y,x,\cdot, \varepsilon)$ maintain Hölder continuity about ξ. We prove that the persistent invariant tori retain the same frequency as those of the unperturbed tori, under a certain topological degree condition and a weak convexity condition for the frequency mapping. Notably, this paper presents, to our understanding, pioneering results on the KAM theorem under such conditions with only assumption of Hölder continuous dependence of frequency mapping ω on the parameter.
Firefighters are frequently exposed to traumatic events and stressful environments and are at particularly high risk of depressive symptoms.
Aims:
The present study aimed to examine the impact of a combined internet-delivered cognitive behavioral therapy (iCBT) and attention bias modification (ABM) intervention to reduce depressive symptoms in firefighters.
Method:
The study was a randomized controlled trial carried out in Kunming, China, and involved the recruitment of 138 active firefighters as participants. The intervention lasted for an 8-week duration, during which participants participated in ABM exercises on alternating days and concurrently underwent eight modules of iCBT courses delivered through a smartphone application. Baseline and post-intervention assessments were conducted to evaluate the effects of the intervention.
Results and Discussion:
Results indicated that the combined iCBT and ABM intervention was significantly effective in reducing symptoms of depression compared with the no intervention control group (U=1644, p<0.001, Wilcoxon r=0.280). No significant change was observed in attention bias post-intervention (U=2460, p=0.737, Wilcoxon r=0.039), while a significant increase was observed in attention-bias variability (U=3172, p<0.001, Wilcoxon r=–0.287). This study provides evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters. This study provides conceptual support and preliminary evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters.
The emergency response capacity of nurses is quite important during the COVID-19 epidemic. This study aimed to determine the relationship of resilience with emergency response capacity and occupational stresses during COVID-19 re-outbreak.
Methods
This is a cross-sectional study that involved 241 new nurses. Questionnaires (including demographic characteristics and self-report questionnaires) were sent via QR code and used to conduct an online survey of new nurses. Resilience, emergency response capacity, and occupational stressors were measured using questionnaires.
Results
Mean resilience score was 62.68 ± 14.04, which corresponds to a moderate level. Age, marital status, and work experience were significantly associated with resilience (P = 0.037, P = 0.046, P = 0.011) and emergency response capacity (P = 0.018, P = 0.045, P < 0.000). Total score and 3 dimensions of resilience were positively correlated with emergency response competency questionnaire and 3 dimensions (P < 0.01). Total scores of the nurse job stress scale and patient care dimension were negatively correlated with resilience scores (P < 0.05). Resilience played a partial mediating role in occupational stressors and emergency response capacity, and mediating effect accounted for 45.79% of the total effect.
Conclusions
The nursing superintendent must pay more attention to the resiliency of new nurses to reduce occupational stressors and improve emergency response capacity while helping new nurses cope with COVID-19 re-outbreak.
This study examined the sour grapes/sweet lemons rationalization through 2 conditions: ‘attainable’ (sweet lemons) and ‘unattainable’ (sour grapes), reflecting China’s 2019-nCoV vaccination strategy. The aim was to find ways to change people’s beliefs and preferences regarding vaccines by easing their safety concerns and encouraging more willingness to get vaccinated. An online survey was conducted from January 22 to 27, 2021, with 3,123 residents across 30 provinces and municipalities in the Chinese mainland. The direction of belief and preference changed in line with the sour grapes/sweet lemons rationalization. Using hypothetical and real contrasts, we compared those for whom the vaccine was relatively unattainable (‘sour grapes’ condition) with those who could get the vaccine easily (‘sweet lemons’). Whether the vaccine was attainable was determined in the early stage of the vaccine roll-out by membership in a select group of workers that was supposed to be vaccinated to the greatest extent possible, or, by being in the second stage when the vaccine was available to all. The attainable conditions demonstrated higher evaluation in vaccine safety, higher willingness to be vaccinated, and lower willingness to wait and see. Hence, we propose that the manipulation of vaccine attainability, which formed the basis of the application of sour grapes/sweet lemons rationalization, can be utilized as a means to manipulate the choice architecture to nudge individuals to ease vaccine safety concerns, reducing wait-and-see tendencies, and enhancing vaccination willingness. This approach can expedite universal vaccination and its associated benefits in future scenarios resembling the 2019-nCoV vaccine rollout.
Psychiatric diagnosis is based on categorical diagnostic classification, yet similarities in genetics and clinical features across disorders suggest that these classifications share commonalities in neurobiology, particularly regarding neurotransmitters. Glutamate (Glu) and gamma-aminobutyric acid (GABA), the brain's primary excitatory and inhibitory neurotransmitters, play critical roles in brain function and physiological processes.
Methods
We examined the levels of Glu, combined glutamate and glutamine (Glx), and GABA across psychiatric disorders by pooling data from 121 1H-MRS studies and further divided the sample based on Axis I disorders.
Results
Statistically significant differences in GABA levels were found in the combined psychiatric group compared with healthy controls (Hedge's g = −0.112, p = 0.008). Further analyses based on brain regions showed that brain GABA levels significantly differed across Axis I disorders and controls in the parieto-occipital cortex (Hedge's g = 0.277, p = 0.019). Furthermore, GABA levels were reduced in affective disorders in the occipital cortex (Hedge's g = −0.468, p = 0.043). Reductions in Glx levels were found in neurodevelopmental disorders (Hedge's g = −0.287, p = 0.022). Analysis focusing on brain regions suggested that Glx levels decreased in the frontal cortex (Hedge's g = −0.226, p = 0.025), and the reduction of Glu levels in patients with affective disorders in the frontal cortex is marginally significant (Hedge's g = −0.172, p = 0.052). When analyzing the anterior cingulate cortex and prefrontal cortex separately, reductions were only found in GABA levels in the former (Hedge's g = − 0.191, p = 0.009) across all disorders.
Conclusions
Altered glutamatergic and GABAergic metabolites were found across psychiatric disorders, indicating shared dysfunction. We found reduced GABA levels across psychiatric disorders and lower Glu levels in affective disorders. These results highlight the significance of GABA and Glu in psychiatric etiology and partially support rethinking current diagnostic categories.
This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.
Methods
In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.
Results
Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.
Conclusions
Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.
The research on elasto-inertial turbulence (EIT), a new type of turbulent flow, has reached the stage of identifying the minimal flow unit (MFU). On this issue, direct numerical simulations of FENE-P fluid flow in two-dimensional channels with variable sizes are conducted in this study. We demonstrate with the increase of channel length that the simulated flow experiences several different flow patterns, and there exists an MFU for EIT to be self-sustained. At Weissenberg number ($Wi$) higher than the one required to excite EIT, when the channel length is relatively small, a steady arrowhead regime (SAR) flow structure and a laminar-like friction coefficient is achieved. However, as the channel length increases, the flow can fully develop into EIT characterized with high flow drag. Close to the size of the MFU, the simulated flow behaves intermittently between the SAR state with low drag and EIT state with high drag. The flow falling back to ‘laminar flow’ is caused by the insufficient channel size below the MFU. Furthermore, we give the relationship between the value of the MFU and the effective $Wi$, and explain its physical reasons. Moreover, the intermittent flow regime obtained based on the MFU gives us an opportunity to look into the origin and exciting process of EIT. Through capturing the onset process of EIT, we observed that EIT originates from the sheet-like extension structure located near the wall, which is maybe related to the wall mode rather than the centre mode. The fracture and regeneration of this sheet-like structure is the key mechanism for the self-sustaining of EIT.
In response to the complex and challenging task of long-distance inspection of small-diameter and variable-diameter mine holes, this paper presents a design for an adaptive small-sized mine hole robot. First, focusing on the environment of small-diameter mine holes, the paper analyzes the robot’s functions and overall structural framework. A two-wheeled wall-pressing robot with good mobility, arranged in a straight line, is designed. Furthermore, an adaptive variable-diameter method is devised, which involves constructing an adaptive variable-diameter model and proposing a control method based on position and force estimators, enabling the robot to perceive external forces. Lastly, to verify the feasibility of the structural design and adaptive variable-diameter method, performance tests and analyses are conducted on the robot’s mobility and adaptive variable-diameter capabilities. Experimental results demonstrate that the robot can move within small-diameter mine holes at any inclination angle, with a maximum horizontal crawling speed of 3.96 m/min. By employing the adaptive variable-diameter method, the robot can smoothly navigate convex platform obstacles and slope obstacles in mine holes with diameters ranging from 70 mm to 100 mm, achieving the function of adaptive variable-diameter within 2 s. Thus, it can meet the requirements of moving inside mine holes under complex conditions such as steep slopes and small and variable diameters.
With the over-use of tetracycline (TC) and its ultimate accumulation in aquatic systems, the demand for TC removal from contaminated water is increasing due to its severe threat to public health. Clay minerals have attracted great attention as low-cost adsorbents for controlling water pollution. The objective of the present study was to measure the adsorption behavior and mechanisms of TC on allophane, a nanosized clay mineral with a hollow spherical structure; to highlight the advantage of the allophane nanostructure, a further objective was to compare allophane with halloysite and montmorillonite, which have nanostructures that differ from allophane. Structural features and surface physicochemical properties were characterized by transmission electron microscopy (TEM), Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), zeta potential, N2-physisorption, and acid–base titration. The adsorption data showed that TC adsorption followed the pseudo-second order and Langmuir models. The adsorption was pH dependent, as all three clay minerals performed better under neutral to weakly alkaline conditions and maintained high adsorption performance in the presence of co-existing Na+/K+/Ca2+/Mg2+ cations. Regeneration of the adsorbent was excellent, with efficiencies exceeding 75% after five recycles. By comparison, allophane always exhibited the greatest adsorption capacity, up to 796 mg g–1 at ~pH 9. The TC adsorption on allophane and halloysite was dominated by inner-sphere complexation, together with a small amount of electrostatic adsorption, while that on montmorillonite involved mainly interlayer cation exchange. The findings provide insights into the effects of nanostructures of clay minerals on their TC adsorption performance and highlight the huge potential of allophane as an efficient and inexpensive adsorbent for TC removal.
A high-energy picosecond 355 nm ultraviolet (UV) laser operating at 100 Hz was demonstrated. A 352 mJ, 69 ps, 1064 nm laser at 100 Hz was realized firstly by cascaded regenerative, laser diode end-pumped single-pass and side-pumped main amplifiers. The stimulated Raman scattering-based beam shaping technique, thermally induced birefringence compensation and 4f spatial filter-image relaying systems were used to maintain a relatively homogeneous beam intensity distribution during the amplification process. By using lithium triborate crystals for second- and third-harmonic generation (THG), a 172 mJ, approximately 56 ps, 355 nm UV laser was achieved with a THG conversion efficiency of 49%. To the best of our knowledge, it is the highest pulse energy of a picosecond 355 nm UV laser so far. The beam quality factor ${M}^2$ and pulse energy stability were ${M}_x^2$=3.92, ${M}_y^2$=3.71 and root mean square of 1.48%@3 hours. This laser system could play significant roles in applications including photoconductive switch excitation, laser drilling and laser micro-fabrication.
Er:CaF2 crystals are crucial gain media for producing 3 μm mid-infrared (MIR) lasers pumped by 976 nm continuous-wave (CW) lasers owing to their low phonon energy and high conversion efficiency. This study investigated the damage characteristics and mechanism of Er:CaF2 crystals irradiated with a 976 nm CW laser. The laser-induced damage threshold of Er:CaF2 crystals with different Er3+ doping levels was tested; the damage morphology consists of a series of regular 70° cracks related to the angle of the crystal slip system on the surface. A finite-element model was used to calculate the temperature and stress fields of the crystals. The results indicated that the damage can be attributed to surface tensile stresses caused by the temperature gradient, and crystals with higher doping concentrations were more susceptible to damage owing to stronger light absorption. These findings provide valuable insights into the development of high-power MIR lasers.