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This study aims at investigating the current status of death literacy and parent’s death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent’s death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China.
A cross-sectional design was adopted. Participants who experienced their father’s and/or mother’s death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants.
A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents’ death also had higher levels of DLI.
Significance of results
This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents’ death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.
This study presents novel findings on stochastic electron heating via a random electron cyclotron wave (ECW) in a spherical tokamak. Hard x ray measurements demonstrate the time evolution of hard x ray counts at different energy bands, consistent with predictions from the stochastic heating model. The ECW heating rate shows a positive correlation with applied power, confirming the effectiveness of stochastic heating. Remarkably, the ECW-driven plasma current remains insensitive to ECW incidence angle, consistent with model predictions. The observed stochastic heating of electrons offers potential for exploring innovative non-inductive current drive modes in spherical tokamaks. This research contributes to the understanding of plasma behaviour and motivates the development of new models for non-inductive current drive in fusion devices.
COVID-19 lockdowns increased the risk of mental health problems, especially for children with autism spectrum disorder (ASD). However, despite its importance, little is known about the protective factors for ASD children during the lockdowns.
Based on the Shanghai Autism Early Developmental Cohort, 188 ASD children with two visits before and after the strict Omicron lockdown were included; 85 children were lockdown-free, while 52 and 51 children were under the longer and the shorter durations of strict lockdown, respectively. We tested the association of the lockdown group with the clinical improvement and also the modulation effects of parent/family-related factors on this association by linear regression/mixed-effect models. Within the social brain structures, we examined the voxel-wise interaction between the grey matter volume and the identified modulation effects.
Compared with the lockdown-free group, the ASD children experienced the longer duration of strict lockdown had less clinical improvement (β = 0.49, 95% confidence interval (CI) [0.19–0.79], p = 0.001) and this difference was greatest for social cognition (2.62 [0.94–4.30], p = 0.002). We found that this association was modulated by parental agreeableness in a protective way (−0.11 [−0.17 to −0.05], p = 0.002). This protective effect was enhanced in the ASD children with larger grey matter volumes in the brain's mentalizing network, including the temporal pole, the medial superior frontal gyrus, and the superior temporal gyrus.
This longitudinal neuroimaging cohort study identified that the parental agreeableness interacting with the ASD children's social brain development reduced the negative impact on clinical symptoms during the strict lockdown.
This study aimed to investigate the optimal frozen embryo transfer (FET) strategy for recurrent implantation failure (RIF) patients with three consecutive failed cleaved embryo implantations and no blastocyst preservation. This retrospective analysis was divided into three groups based on the FET strategy: thawed day 3 embryo transfer (D3 FET group); and extended culture of frozen–thawed day 3 embryos to day 5 blastocysts transfer (D3–D5 FET group); thawed blastocyst transfer (D5 FET group). Transplant cycle data were compared between the three groups. In total, 43.8% of vitrified–thawed cleavage embryos developed into blastocysts. Analysis of the three transplantation strategies showed that, compared with the D3 FET group, D3–D5 had a significantly better hCG-positivity rate and live-birth rate (P < 0.05). Pregnancy outcomes in the D3–D5 FET group and D5 FET group were similar regarding hCG-positivity rate, implantation rate, clinical pregnancy rate, and live-birth rate. Our findings propose two potentially valuable transfer strategies for patients experiencing repeated implantation failures. The D3–D5 FET approach presents a greater potential for selecting promising embryos in cases without blastocyst preservation; however, this strategy does entail the risk of cycle cancellation. Conversely, in instances where blastocyst preservation is an option, prioritizing consideration of the D5 FET strategy is recommended.
Carotenoids are important bioactive substances in breast milk, the profile of which is seldom studied. This study aimed to explore the profile of carotenoids in breast milk and maternal/cord plasma of healthy mother–neonate pairs in Shanghai, China, and their correlation with dietary intake. Maternal blood, umbilical cord blood and breast milk samples from five lactation stages (colostrum, transitional milk and early-, mid- and late-term mature milk) were collected. Carotenoid levels were analysed by HPLC. Carotenoid levels in breast milk changed as lactation progressed (P < 0·001). β-Carotene was the primary carotenoid in colostrum. Lutein accounted for approximately 50 % of total carotenoids in transitional milk, mature milk and cord blood. Positive correlations were observed between five carotenoids in umbilical cord blood and maternal blood (P all < 0·001). β-Carotene levels were also correlated between maternal plasma and three stages of breast milk (r = 0·605, P < 0·001; r = 0·456, P = 0·011, r = 0·446; P = 0·013, respectively). Dietary carotenoid intakes of lactating mothers also differed across lactation stages, although no correlation with breast milk concentrations was found. These findings suggest the importance of exploring the transport mechanism of carotenoids between mothers and infants and help guide the development of formulas for Chinese infants as well as the nutritional diets of lactating mothers.
Sterol regulatory element-binding protein 2 (SREBP2) is considered to be a major regulator to control cholesterol homoeostasis in mammals. However, the role of SREBP2 in teleost remains poorly understand. Here, we explored the molecular characterisation of SREBP2 and identified SREBP2 as a key modulator for 3-hydroxy-3-methylglutaryl-coenzyme A reductase and 7-dehydrocholesterol reductase, which were rate-limiting enzymes of cholesterol biosynthesis. Moreover, dietary palm oil in vivo or palmitic acid (PA) treatment in vitro elevated cholesterol content through triggering SREBP2-mediated cholesterol biosynthesis in large yellow croaker. Furthermore, our results also found that PA-induced activation of SREBP2 was dependent on the stimulating of endoplasmic reticulum stress (ERS) in croaker myocytes and inhibition of ERS by 4-Phenylbutyric acid alleviated PA-induced SREBP2 activation and cholesterol biosynthesis. In summary, our findings reveal a novel insight for understanding the role of SREBP2 in the regulation of cholesterol metabolism in fish and may deepen the link between dietary fatty acid and cholesterol biosynthesis.
Understanding the neural mechanism underlying the transition from suicidal ideation to action is crucial but remains unclear. To explore this mechanism, we combined resting-state functional connectivity (rsFC) and computational modeling to investigate differences between those who attempted suicide(SA) and those who hold only high levels of suicidal ideation(HSI).
A total of 120 MDD patients were categorized into SA group (n=47) and HSI group (n=73). All participants completed a resting-state functional MRI scan, with three subregions of the insula and the dorsal anterior cingulate cortex (dACC) being chosen as the region of interest (ROI) in seed-to-voxel analyses. Additionally, 86 participants completed the balloon analogue risk task (BART), and a five-parameter Bayesian modeling of BART was estimated.
In the SA group, the FC between the ventral anterior insula (vAI) and the superior/middle frontal gyrus (vAI-SFG, vAI-MFG), as well as the FC between posterior insula (pI) and MFG (pI-MFG), were lower than those in HSI group. The correlation analysis showed a negative correlation between the FC of vAI-SFG and psychological pain avoidance in SA group, whereas a positive correlation in HSI group. Furthermore, the FC of vAI-MFG displayed a negative correlation with loss aversion in SA group, while a positive correlation was found with psychological pain avoidance in HSI group.
In current study, two distinct neural mechanisms were identified in the insula which involving in the progression from suicidal ideation to action. Dysfunction in vAI FCs may gradually stabilize as individuals experience heightened psychological pain, and a shift from positive to negative correlation patterns of vAI-MFC may indicate a transition from state to trait impairment. Additionally, the dysfunction in PI FC may lead to a lowered threshold for suicide by blunting the perception of physical harm.
To understand the extent to which employees choose to improvise under authoritarian leadership, we applied social information processing theory to examine the mechanisms and boundary conditions of such leadership’s influence on subordinates’ perceptions of managerial intolerance of errors and their improvisation from the perspective of negative leadership. Data from a multi-wave questionnaire survey of 319 frontline teams analysed using SPSS and Mplus revealed that authoritarian leadership can have an inhibitory effect on subordinates’ improvisation due to perceiving managerial intolerance of errors. Even so, the negative mediating effect is significantly weakened by the moderating effect of a leader–member exchange (LMX) relationship and task complexity. That is, when the level of the LMX relationship or task complexity is high, it mitigates authoritarian leadership’s indirect inhibitory effect on subordinates’ improvisation via their perceptions of management’s intolerance of errors.
The latest international guideline recommended the add-on therapy of ezetimibe and PCSK9 inhibitors in selected people for the secondary prevention of cardiovascular diseases (CVDs). However, it remains unclear whether these regimens fit the Chinese healthcare system economically.
Based on the Chinese context, this simulation study evaluated four therapeutic strategies including the high-dose statin-only group, ezetimibe plus statin group, PCSK9 inhibitors plus statin group, and PCSK9 inhibitors plus ezetimibe plus statin group. The team developed a Markov model to estimate the incremental cost-effectiveness ratio (ICER). With each 1-yr cycle, the simulation subjects could have nonfatal cardiovascular events (stroke and/or myocardial infarction) or death (vascular or nonvascular death event) with a follow-up duration of 20 yr. Cardiovascular risk reduction was gathered from a network meta-analysis, and cost and utility data were gathered from hospital databases and published research.
For Chinese adults receiving high-dose statins for secondary prevention of CVDs, the ICER was US$68,910 per quality-adjusted life year (QALY) for adding PCSK9 inhibitors, US$20,242 per QALY for adding ezetimibe, US$51,552 per QALY for adding both drugs. Given a threshold of US$37,655 (three times of Chinese GDP), the probability of cost-effectiveness is 2.9 percent for adding PCSK9 inhibitors, 53.1 percent for adding ezetimibe, and 16.8 percent for adding both drugs. To meet the cost-effectiveness, an acquisition price reduction of PCSK9 inhibitors of 33.6 percent is necessary.
In Chinese adults receiving high-dose statins for the secondary prevention of CVDs, adding ezetimibe is cost-effective compared to adding PCSK9 inhibitors and adding both drugs.
In this paper, several linear two-dimensional consecutive k-type systems are studied, which include the linear connected-(k, r)-out-of-$(m,n)\colon\! F$ system and the linear l-connected-(k, r)-out-of-$(m,n)\colon\! F$ system without/with overlapping. Reliabilities of these systems are studied via the finite Markov chain imbedding approach (FMCIA) in a novel way. Some numerical examples are provided to illustrate the theoretical results established here and also to demonstrate the efficiency of the developed method. Finally, some possible applications and generalizations of the developed results are pointed out.
Aphids exhibit seasonally alternating asexual and sexual reproductive modes. Different morphs are produced throughout the life cycle. To evaluate morph-specific fitness during reproductive switching, holocyclic Sitobion avenae were induced continuously under short light conditions, and development and reproduction were compared in each morph. Seven morphs, including apterous and alate virginoparae, apterous and alate sexuparae, oviparae, males, and fundatrices, were produced during the life cycle. The greatest proportions of sexuparae, oviparae, males, and virginoparae were in the G1, G2, G3, and G4 generations, respectively. Regardless of asexual or sexual morphs, alate morphs exhibited a marked delay in age at maturity compared with that of apterous morphs. Among the alate morphs, males had the longest age at maturity, followed by sexuparae and virginoparae. Among the apterous morphs, sexuparae were older at maturity than the fundatrices, virginoparae, and oviparae. The nymphs of each morph had equal survival potentials. For the same wing morphs, apterous sexuparae and oviparae exhibited substantial delays in the pre-reproductive period and considerable reductions in fecundity, compared with those of apterous virginoparae and fundatrices, whereas alate sexuparae and alate virginoparae had similar fecundity. The seven morphs exhibited Deevey I survivorship throughout the life cycle. These results suggest that sexual production, particularly in males, has short-term development and reproduction costs. The coexistence of sexual and asexual morphs in sexuparae offspring may be regarded as an adaptive strategy for limiting the risk of low fitness in winter.
Despite rising incidences of global disasters, basic principles of disaster medicine training are barely taught in Singapore’s 3 medical schools. The aim of this study was to evaluate the current levels of emergency preparedness, attitudes, and perceptions of disaster medicine education among medical students in Singapore.
The Emergency Preparedness Information Questionnaire (EPIQ) was provided to enrolled medical students in Singapore by means of an online form, from March 6, 2020, to February 20, 2021. A total of 635 (25.7%) responses were collated and analyzed.
Mean score for overall familiarity was low, at 1.50 ± 0.74, on a Likert scale of 1 for not familiar to 5 for very familiar. A total of 90.6% of students think that disaster medicine is an important facet of the curriculum, and 93.1% agree that training should be provided for medical students. Although 77.3% of respondents believe that they are unable to contribute to a disaster scenario currently, 92.8% believe that they will be able to contribute with formal training.
Despite low levels of emergency preparedness knowledge, the majority of medical students in Singapore are keen for adaptation of disaster medicine into the current curriculum to be able to contribute more effectively. This can arm future health-care professionals with the confidence to respond to any potential emergency.
Insomnia was associated with cerebral structural changes and Alzheimer’s disease. However, associations among cerebral perfusion, insomnia with cerebral small vessel disease (CSVD), and cognitive performance were little investigated.
This cross-sectional study included 89 patients with CSVDs and white matter hyperintensities (WMHs). They were dichotomized into the normal sleep and poor sleep group, according to Pittsburgh sleep quality index (PSQI). Baseline characteristics, cognitive performance, and cerebral blood flow (CBF) were measured and compared between the two groups. The association or correlation between cerebral perfusion, cognition, and insomnia was analyzed using binary logistic regression.
Our study found that declined MoCA score (P = .0317) was more prevalent in those with poor sleep. There was a statistical difference in the recall (P = .0342) of MMSE, the delayed recall (P = .0289) of MoCA between the two groups. Logistic regression analysis showed educational background (P < .001) and insomnia severity index (ISI) score (P = .039) were independently correlated with MoCA scores. Arterial spin labeling demonstrated that left hippocampal gray matter perfusion was significantly reduced (P = .0384) in the group with poor sleep. And, negative correlation was found between left hippocampal perfusion and PSQI scores.
In the patients with CSVDs, insomnia severity was associated with cognitive decline. Left hippocampal gray matter perfusion was correlated with PSQI scores in CSVDs.
The oscillatory Kelvin–Helmholtz (K–H) instability of a planar liquid sheet was experimentally investigated in the presence of an axial oscillating gas flow. An experimental system was initiated to study the oscillatory K–H instability. The surface wave growth rates were measured and compared with theoretical results obtained using the authors’ early linear method. Furthermore, in a larger parameter range experimentally studied, it is interesting that there are four different unstable modes: first disordered mode (FDM), second disordered mode (SDM), K–H harmonic unstable mode (KHH) and K–H subharmonic unstable mode (KHS). These unstable modes are determined by the oscillating amplitude, oscillating frequency and liquid inertia force. The frequencies of KHH are equal to the oscillating frequency; the frequency of KHS equals half the oscillating frequency, while the frequencies of FDM and SDM are irregular. By considering the mechanism of instability, the instability regime maps on the relative Weber number versus liquid Weber number (Werel–Wel) and the Weber number ratio versus the oscillating frequency (Werel/Wel–$\varOmega$s2) were plotted. Among these four modes, KHS is the most unexpected: the frequency of this mode is not equal to the oscillating frequency, but the surface wave can also couple with the oscillating gas flow. Linear instability theory was applied to divide the parameter range between the different unstable modes. According to linear instability theory, K–H and parametric unstable regions both exist. However, note that all four modes (KHH, KHS, FDM and SDM) corresponded primarily to the K–H unstable region obtained from the theoretical analysis. Nevertheless, the parametric unstable mode was also observed when the oscillating frequency and amplitude were relatively low, and the liquid inertia force was relatively high. The surface wave amplitude was small but regular, and the evolution of this wave was similar to that of Faraday waves. The wave oscillating frequency was half that of the surface wave.
The notion of ordered system signature, originally defined for independent and identical coherent systems, is first extended to the case of independent and non-identical coherent systems, and then some key properties that help simplify its computation are established. Through its use, a dynamic ordered system signature is defined next, which facilitates a systematic study of dynamic properties of several coherent systems under a life test. The theoretical results established here are then illustrated through some specific examples. Finally, the usefulness in the evaluation of aging used systems of the concepts introduced is demonstrated.
The purpose of this study was to analyse the clinical characteristics of patients with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) PCR re-positivity after recovering from coronavirus disease 2019 (COVID-19). Patients (n = 1391) from Guangzhou, China, who had recovered from COVID-19 were recruited between 7 September 2021 and 11 March 2022. Data on epidemiology, symptoms, laboratory test results and treatment were analysed. In this study, 42.7% of recovered patients had re-positive result. Most re-positive patients were asymptomatic, did not have severe comorbidities, and were not contagious. The re-positivity rate was 39%, 46%, 11% and 25% in patients who had received inactivated, mRNA, adenovirus vector and recombinant subunit vaccines, respectively. Seven independent risk factors for testing re-positive were identified, and a predictive model was constructed using these variables. The predictors of re-positivity were COVID-19 vaccination status, previous SARs-CoV-12 infection prior to the most recent episode, renal function, SARS-CoV-2 IgG and IgM antibody levels and white blood cell count. The predictive model could benefit the control of the spread of COVID-19.
In the Three Gorges and adjacent areas, there are three planation surfaces and five terraces along the Yangtze River that record the evolution history of the river system. Here, we used diagnostic heavy minerals, U-Pb geochronology, and trace elements of detrital zircons from one planation surface, two terraces, and a modern point bar to reconstruct the evolution history of the upper Yangtze River, specifically the Chuan River in the Sichuan Basin. The sediments in the lowest planation surface had different felsic source rocks derived from east of the Three Gorges, which indicated that before the disintegration of the lowest planation surface (0.75 Ma), there were two paleorivers: the westward-flowing paleo-Chuan River and eastward-flowing paleo-Yangtze River separated by the Huangling Dome. At 0.75–0.73 Ma, the dominant detrital zircons from the Sichuan Basin in the sediments of terrace T5 (the highest terrace) confirmed that the paleo-Yangtze River cut through the Three Gorges and captured the paleo-Chuan River, and the Daliang Mountains became the new drainage divide. Finally, the appearance of materials from the upper Jinsha River in terrace T2 indicated that the paleo-Yangtze River progressively captured the paleo-Jinsha River, and the modern upper Yangtze River formed before 0.05 Ma. These river capture events of the upper Yangtze River confirmed the Quaternary uplift of the SE Tibetan Plateau.
Family dysfunction plays an important role in cyberbullying and cybervictimization. However, little research has investigated the longitudinal relations and the mediating mechanisms between them during adolescence. This study examined the longitudinal relations between family dysfunction and cyberbullying and cybervictimization, along with whether depressive symptoms function as mediators between them at the within-person level. A total of 3,743 Chinese adolescents (46.2% females; Mage = 9.92 years; SD = 0.51) participated a five-wave longitudinal study with a 6-month time interval. The results of random intercept cross-lagged panel model found that: (1) family dysfunction directly predicted depressive symptoms and vice versa at the within-person level; (2) depressive symptoms directly predicted cyberbullying and cybervictimization at the within-person level, but not vice versa; (3) family dysfunction indirectly predicted cyberbullying and cybervictimization via depressive symptoms at the within-person level; (4) at the between-person level, there were significant associations among family dysfunction, depressive symptoms, cyberbullying and cybervictimization. The results are discussed on the basis of the mechanisms that lead to cyberbullying and cybervictimization.
The flow past a cylinder in proximity to a plane wall is investigated numerically for small gap ratios. Three vortex dynamic processes associated with different hairpin vortex generation mechanisms are identified for the first time, and the wake-induced turbulent transition is analysed. The vortex shedding is suppressed at $G/D = 0.1$, while the spanwise vortex is generated via a Kelvin–Helmholtz instability and evolves into hairpin vortices. For $G/D= 0.3$, the upper and lower rollers alternatively shedding from the cylinder, interact with the secondary vortex. The split secondary vortex merges with the upper roller and results in a new vortex downstream, which develops into hairpin vortices. When $G/D = 0.9$, the secondary vortex interacts with the lower roller and then evolves into hairpin vortices. A tertiary vortex induced by the secondary vortex is observed, rotating in the opposite direction to the secondary vortex the wake-induced transitions share the same route. The velocity fluctuations deviate from the optimal growth theory in the pre-transitional region. In the transitional region low-frequency disturbances penetrate the sheltering edge to generate streaks where the disturbance energy declines. In the turbulent region the logarithmic layer is formed, indicating that the turbulent equilibrium is established.
Many protected areas worldwide have been established to protect the last natural refuges of flagship animal species. However, long-established protected areas do not always match the current distributions of target species under changing environmental conditions. Here we present a case study of the Asian elephant Elephas maximus in Xishuangbanna, south-west China, to evaluate whether the established protected areas match the species’ current distribution and to identify key habitat patches for Asian elephant conservation. Our results show that currently only 24.5% of the predicted Asian elephant distribution in Xishuangbanna is located within Xishuangbanna National Nature Reserve, which was established for elephant conservation. Based on the predicted Asian elephant distribution, we identified the most important habitat patches for elephant conservation in Xishuangbanna. The three most important patches were outside Xishuangbanna National Nature Reserve and together they contained 43.3% of the estimated food resources for Asian elephants in all patches in Xishuangbanna. Thus, we identified a spatial mismatch between immobile protected areas and mobile animals. We recommend the inclusion of the three identified key habitat patches in a new national park currently being planned by the Chinese authorities for the conservation of the Asian elephant.