To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The high overall plant-based diet index (PDI) is considered to protect against type 2 diabetes in the general population. However, whether the PDI affects gestational diabetes mellitus (GDM) risk among pregnant women is still unclear. We evaluated the association between PDI and GDM risk based on a Chinese large prospective cohort - Tongji Maternal and Child Health Cohort. Dietary data were collected at 13-28 weeks of pregnancy by a validated semi-quantitative food frequency questionnaire. The PDI was obtained by assigning plant food groups positive scores while assigning animal food groups to reverse scores. GDM was diagnosed by a 75g 2-h oral glucose tolerance test at 24-28 weeks of gestation. Logistic regression models were fitted to estimate odds ratios (ORs) of GDM, with associated 95% confidence intervals (CIs), comparing women in different PDI quartiles. Among the total 2,099 participants, 169 (8.1%) were diagnosed with GDM. The PDI ranged from 21.0 to 52.0 with a median (IQR, interquartile range) as 36.0 (33.0-39.0). After adjusting for social-demographic characteristics and lifestyle factors etc., the participants with the highest quartile of PDI were associated with 57% reduced odds of GDM compared with women in the lowest quartile of PDI (Adjusted OR 0.43; 95% CI, 0.24-0.77; P for trend = 0.005). An IQR increment in PDI was associated with 29% decreased odds of GDM (Adjusted OR 0.71; 95% CI, 0.56-0.90). Findings suggest that adopting a plant-based diet during pregnancy could reduce GDM risk among Chinese women, which may be valuable for dietary counseling during pregnancy.
There is increasing evidence that blood oxygenation level-dependent signaling in white matter (WM) reflects WM functional activity. Whether this activity is altered in schizophrenia remains uncertain, as does whether it is related to established alterations of gray matter (GM) or the microstructure of WM tracts.
A total of 153 antipsychotic-naïve schizophrenia patients and 153 healthy comparison subjects were assessed by resting-state functional magnetic resonance imaging, diffusion tensor imaging, and high-resolution T1-weighted imaging. We tested for case–control differences in the functional activity of WM, and examined their relation to the functional activity of GM and WM microstructure. The relations between fractional anisotropy (FA) in WM and GM–WM functional synchrony were investigated as well. Then, we examined the associations of identified abnormalities to age, duration of untreated psychosis (DUP), and symptom severity.
Schizophrenia patients displayed reductions of the amplitude of low-frequency fluctuations (ALFF), GM–WM functional synchrony, and FA in widespread regions. Specifically, the genu of corpus callosum not only had weakening in the synchrony of functional activity but also had reduced ALFF and FA. Positive associations were found between FA and functional synchrony in the genu of corpus callosum as well. No significant association was found between identified abnormalities and DUP, and symptom severity.
The widespread weakening in the synchrony of functional activity of GM and WM provided novel evidence for functional alterations in schizophrenia. Regarding the WM function as a component of brain systems and investigating its alternation represent a promising direction for future research.
With the rapid rise in the prevalence of non-tuberculous mycobacteria (NTM) diseases across the world, the microbiological diagnosis of NTM isolates is becoming increasingly important for the diagnosis and treatment of NTM disease. In this study, the clinical presentation, species distribution and drug susceptibility of patients with NTM disease visiting the Chongqing Public Health Medical Centre during March 2016–April 2019 were retrospectively analysed. Among the 146 patients with NTM disease, eight NTM species (complex) were identified. The predominant NTM species in these patients were identified to be Mycobacterium abscessus complex (53, 36.3%), M. intracellulare (38, 26%) and M. fortuitum (17, 11.7%). In addition, two or more species were isolated from 7.5% of the patients. Pulmonary NTM disease (142, 97.3%) showed the highest prevalence among the patients. It was observed that 40.1% of the patients with pulmonary NTM disease had chronic pulmonary obstructive disease and bronchiectasis, while 22.5% had prior tuberculosis. Male patients showed more association with the conditions of cough and haemoptysis than the female patients. In an in vitro antimicrobial susceptibility testing, most of the species showed susceptibility to linezolid, amikacin and clarithromycin, while M. fortuitum exhibited low susceptibility to tobramycin. In conclusion, the prevalence of NTM disease, especially that of the pulmonary NTM disease, is common in Southwest China. Species identification and drug susceptibility testing are thus extremely important to ensure appropriate treatment regimens for patient care and management.
This paper characterizes the geometry of converging near-elliptic shock waves at a Mach number of 6. The converging shocks are produced by elliptic conical surfaces with shapes made up from adjacent straight generators, each deflected a constant angle from the free-stream direction. Combined shock tunnel experiments and numerical analyses are conducted to depict the evolution of the converging shock waves for several elliptic entry aspect ratios $AR$s (i.e. the ratio of the major axis to the minor axis). It is revealed that the deviation from axial symmetry is amplified as the shock front approaches the centreline, which results in different shock interaction types compared with the axisymmetric case. Three typical shock interaction types are classified depending on various ARs. For a small AR, faster shock strengthening in the major plane dominates, although a Mach reflection (type A) that resembles the axisymmetric flow field is formed. However, for a sufficiently large AR, the shock strengthening is eventually terminated by the intersection of the weaker shocks in the minor plane owing to their smaller off-centre distances, which results in a regular reflection (type B). Between these two interaction patterns, there is a critical AR for which both the shock fronts in the major and minor planes intersect at the centreline coincidentally, and this critical intersection (type C) exhibits an extreme case of a shock front converging to a singular point. This study indicates that deviation from axial symmetry affects the evolution of the shock structures in converging flow.
According to the World Health Organization, there were approximately 0.5 million new cases of rifampicin-resistant tuberculosis in 2018, of which 78 percent were multidrug-resistant tuberculosis (MDR-TB), and China has one of the largest shares of the global burden (14%). In recent years, the Chinese government has made progress in TB control and prevention, but for MDR-TB, treatment options are still limited and expensive, and novel drugs are not always available. This research aims to evaluate the cost-effectiveness of adding bedaquiline to a background regimen (BR) of drugs for MDR-TB treatment in China, and to provide evidence for government to improve public health policies.
A cohort-based Markov model was developed to evaluate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR alone in MDR-TB treatment, over a 10-year time horizon. Data were sourced from a phase II clinical trial, real-world data in China, published literature, and expert opinion. Outcomes were evaluated in quality-adjusted life years (QALYs) and life-years gained (LYG). The discount rate was 3.5%. Probabilistic and deterministic sensitivity analyses were conducted.
The discounted costs per person for BBR was CNY 135,706 [USD 19,172], compared with CNY 92,465 [USD 13,063] for BR. The discounted utility per person for BBR was also higher than that for BR (3.943 QALYs versus 3.193 QALYs). The ICER of BBR was CNY 58,096 [USD 8,208]/QALY, which was lower than the willingness-to-pay threshold of CNY 212,676 [USD 30,046] (three-times the gross domestic product per capita). Therefore, BBR was considered to be cost-effective. The sensitivity analysis confirmed the robustness of the results. BBR remained cost-effective in the sensitivity analysis, with a 77.2 percent probability of being cost-effective versus BR.
In China, bedaquiline is not included in the National Reimbursement Medicine List, which results in a heavy financial burden for MDR-TB patients. From this study, BBR was cost-effective by significantly reducing time to sputum culture conversion and increasing QALYs and LYGs, which offset the higher drug costs.
No studies have directly compared the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in patients with atrial fibrillation (AF), with or without a history of ischemic stroke and transient ischemic attack (TIA). This is important for two reasons: first, previous research reports important differences between DOACs and warfarin across other patient subgroups, and second, patients with previous stroke or TIA have a high risk of recurrent stroke.
Using 2012–2014 Medicare claims data, we identified patients newly diagnosed with AF in 2013–014 who started taking apixaban, dabigatran, rivaroxaban, or warfarin. We categorized the patients according to whether they had a history of stroke or TIA. We constructed Cox proportional hazard models that included indicator variables for treatment groups, a history of stroke or TIA, and the interaction between them, and controlled for demographic and clinical characteristics.
The hazard ratio (HR) for stroke with dabigatran, compared with warfarin, was 0.64 (95% confidence interval [CI]: 0.48–0.85) for patients with a history of stroke or TIA and 0.94 (95% CI: 0.75–1.16) for patients without a history of stroke or TIA (p-value for interaction = 0.034). In patients with previous stroke or TIA, the risk of stroke was lower with dabigatran (HR 0.64, 95% CI: 0.48–0.85) and rivaroxaban (HR 0.70, 95%CI: 0.56–0.87), compared with apixaban, but there was no difference for patients in the other subgroup.
DOACs were generally more effective than warfarin for preventing stroke. The superiority of dabigatran was more pronounced in patients with a history of stroke or TIA. The comparative effectiveness of DOACs differed substantially between patients with and without a history of stroke or TIA; specifically, apixaban was less effective in patients with a history of stroke or TIA. Our results reinforce the need to tailor anticoagulation to patient characteristics and to support the investigation of the underlying mechanisms associated with DOACs.
Manure and chemical fertilizers have different effects on soil properties, the nitrogen cycle, and crop yield. This study aimed to investigate the effects of different fertilizer applications under the same N input on soil physicochemical properties and soil bacterial communities and to explain the contributions of soil properties to grain yield. Manure substitution of chemical fertilizer was conducted in leaching monitoring systems. The study began in 2009 and sampling was carried out in 2014 and 2016. Three fertilizer treatments with the same total N, P, and K application rates and one control treatment were designed as follows: (1) CK, without nitrogen fertilizer; (2) 100%U, whole nitrogen coming from urea; (3) 100%M, whole nitrogen coming from composted cattle manure; and (4) 50%U + 50%M, half nitrogen from composted cattle manure and half nitrogen from urea. Soil organic carbon (SOC) content was positively correlated with total N (TN), NO3−–N, and NH4+–N contents, the mean weight diameter of soil aggregates, and the Shannon diversity index of bacteria, whereas SOC content was not significantly correlated with grain yield. NO3−–N content was positively correlated with grain yield. Substituting half the amount of chemical fertilizer with manure as a nitrogen source improved soil stability, increased bacterial diversity, and enhanced nitrogen supply, while reducing nitrogen loss from ammonia volatilization and nitrogen leaching. Substituting half the amount of chemical fertilizer with manure as a nitrogen source was a more sustainable way to increase grain yield through a sustainable nitrate supply and to reduce N loss.
With the aging of population, miniaturization of family size and changes of diseases spectrum, the demand for long-term care of Chinese elderly is increasing, which is challenging the existing long-term care system. China is currently carrying out pilot work for a long-term care insurance system, and Jingmen is one of the pilot cities, however more detailed research on payment is needed. Therefore, this paper draws on case-mixed-adjusted prospective payment system to provide designs for long-term care insurance in pilot cities.
Adopting a case analysis method, this paper focuses on system for payment of Skilled Nursing Facility under Part A of the Medicare program—Patient Driven Payment Model, and discusses the implementation plan of a long-term care insurance in Jingmen City from the perspectives of payment methods, payment grouping and payment standards.
Currently Jingmen adopts per-diem payment for long-term care insurance, so it is necessary to establish a payment based on population characteristics and demands. So, the patients should be classified into a group for each of the five case-mix adjusted components: physical therapy, occupational therapy, speech therapy, nursing and non-therapy ancillary. In addition, this payment model also includes a “variable per diem adjustment” to account for the changes in patient costs more accurately.
The theoretical system of a long-term care insurance payment method is developed, and a localization plan for case-mixed-adjusted prospective payment system for long-term care insurance is provided. Therefore, Jingmen long-term care insurance payment should adopt “case-mixed adjustment”, strengthening the relationship between individual clinical characteristics and payment.
In this paper, the generation of relativistic electron mirrors (REMs) and the reflection of an ultra-short laser off this mirrors are discussed, applying two-dimensional particle-in-cell (2D-PIC) simulations. REMs with ultra-high acceleration and expanding velocity can be produced from a solid nanofoil illuminated normally by an ultra-intense femtosecond laser pulse with a sharp rising edge. Chirped attosecond pulse can be produced through the reflection of a counter-propagating probe laser off the accelerating REM. In the electron moving frame, the plasma frequency of the REM keeps decreasing due to its rapidly expanding. The laser frequency, on the contrary, keeps increasing due to the acceleration of REM and the relativistic Doppler shift from the lab frame to the electron moving frame. Within an ultra-short time interval, the two frequencies will be equal in the electron moving frame, which leads the resonance between laser and REM. The reflected radiation near this interval and the corresponding spectra will be amplified due to the resonance. Through adjusting the arriving time of the probe laser, certain part of the reflected field could be selectively amplified or depressed, leading to the selectively adjusting of the corresponding spectra.
Primary immunodeficiency diseases (PIDs) are a heterogeneous group of over 200 disorders with defects in the function and/or development of the immune system. Although early screening is imperative for improving therapeutic efficiency and preventing disease-associated morbidity, its widespread use has been limited, owing to the low incidence of PIDs. It is particularly important to evaluate the cost-effectiveness of PIDs screening for newborns. The aim of this study was to provide an overview of the existing cost-effectiveness evidence on newborn screening of PIDs and to provide reference for decision-makers in China and other developing countries.
We conducted a systematic review using three electronic databases (PubMed, CNKI, and CSPD) of cost and cost-effectiveness studies of PIDs screening published during 2000–2019. Two reviewers independently searched databases and screened titles, abstracts and full texts; a third reviewer resolved disputes when necessary. The initial search returned 124 references, of which 10 full articles were included in the review. Five of the studies conducted analyses using model-based techniques.
Severe combined immunodeficiency (SCID) was the predominantly studied condition (80%). Most studies (70%) examined the T-cell receptor excision circle (TREC) assay. A healthcare system's perspective was commonly used (50%) for cost calculations, and most studies (50%) were US-based. The majority (67%) of the studies found the TREC assay an effective screening tool for SCID, but the incremental cost-effectiveness ratio (ICER) varied across screening test specificity and disease incidence.
Evidence from the published literature demonstrated that newborn screening for PIDs generally appeared to be cost-effective, and most importantly, it is lifesaving and allows children with PIDs an opportunity to live a healthier life. However, the type of PIDs included in this study were limited and most studies were done in developed countries whose health systems are different from low-/middle-income countries (LMIC). Further research is required to identify the cost-effectiveness of PIDs screening both in developed and developing countries.
The orientation between twin boundary (TB) and loading direction may play an intriguing role in the deformation behaviors of twinned metallic materials. In this aspect, its essential effect on the high-entropy alloy (HEA) nanocrystals is elusive. Attention herein is focused on the atomic-scaled deformation mechanisms and fracture behaviors of HEA nanocrystals containing twins of even smaller spacings via a combined approach of in situ tensile tests inside a high-resolution transmission electron microscope and molecular dynamics simulations. The results indicate that the deformation mechanisms (especially dislocation activities) of HEA nanocrystals depend on the load orientation with respect to TBs. Because of the low activation energy and uneven local composition of HEA, the surface acts as an effective dislocation source and, together with Schmid factor, dominate the activated dislocation slip system. The load orientation-dependent TB-dislocation interactions may transform the type of fracture from semi-brittle to ductile. Our results indicate that the deformation mechanisms and the types of fracture in HEA nanocrystals can be controlled by changing the orientation.
Did growing up as singletons (only-children) convince young adults born under China's one-child policy of the superiority of singleton status and therefore the desirability of not having more than one child? This article draws on interviews with 52 childless newlyweds in Dalian, China, to help answer this question. We found that far from convincing them of the superiority of singleton status, the feelings of loneliness experienced by singletons in childhood and adulthood have convinced most of them that it is better to have a sibling than to be a singleton and thus it is better to have two children instead of one. Moreover, interviewees who did have siblings tended to corroborate singletons’ beliefs about how valuable a sibling can be in both childhood and adulthood.
Triiodide perovskites CsPbI3, CsSnI3, and FAPbI3 (where FA is formamidinium) are highly promising materials for a range of optoelectronic applications in energy conversion. However, they are thermodynamically unstable at room temperature, preferring to form low-temperature (low-T) non-perovskite phases with one-dimensional anisotropic crystal structures. While such thermodynamic behavior represents a major obstacle toward realizing high-performance devices based on their high-temperature (high-T) perovskite phases, the underlying phase transition dynamics are still not well understood. Here we use in situ optical micro-spectroscopy to quantitatively study the transition from the low-T to high-T phases in individual CsSnI3 and FAPbI3 nanowires. We reveal a large blueshift in the photoluminescence (PL) peak (~38 meV) at the low-T/high-T two-phase interface of partially transitioned FAPbI3 wire, which may result from the lattice distortion at the phase boundary. Compared to the experimentally derived activation energy of CsSnI3 (~1.93 eV), the activation energy of FAPbI3 is relatively small (~0.84 eV), indicating a lower kinetic energy barrier when transitioning from a face-sharing octahedral configuration to a corner-sharing one. Further, the phase propagation rate in CsSnI3 is observed to be relatively high, which may be attributed to a high concentration of Sn vacancies. Our results could not only facilitate a deeper understanding of phase transition dynamics in halide perovskites with anisotropic crystal structures, but also enable controllable manipulation of optoelectronic properties via local phase engineering.
As strict measures were taken, the COVID-19 epidemic has been gradually brought under control. As a port city, Shanghai’s main problem has shifted from treating local cases to preventing foreign imports. To prevent the re-outbreak of COVID-19 caused by imported cases, the Shanghai government has set up central isolation sites for all people entering the country from abroad to be placed under medical observation. This report describes how to set up central isolation sites and run it effectively. We put isolation sites in transformed hotels, arranged personnel according to a huge data network, and set up specific procedures to manage guests. The epidemic situation in Shanghai has confirmed the feasibility and effectiveness of the methods that other jurisdictions can adapt for their use.
The present study aimed to investigate the association of the Chinese visceral adiposity index (CVAI) and its 6-year change with hypertension risk and compare the ability of CVAI and other obesity indices to predict hypertension based on the Rural Chinese Cohort Study. Study participants were randomly recruited by a cluster sampling procedure, and 10 304 participants ≥18 years were included. Modified Poisson regression was used to derive adjusted relative risks (RR) and 95 % CI. We identified 2072 hypertension cases during a median of 6·03 years of follow-up. The RR for the highest v. lowest CVAI quartile were 1·29 (95 % CI 1·05, 1·59) for men and 1·53 (95 % CI 1·22, 1·91) for women. Per-sd increase in CVAI was associated with hypertension for both men (RR 1·09, 95 % CI 1·02, 1·16) and women (RR 1·14, 95 % CI 1·06, 1·22). Also, the area under the receiver operating characteristic curve value for hypertension was higher for CVAI than the four other obesity indices for both sexes (all P < 0·05). Finally, per-sd increase in CVAI change was associated with hypertension for both men (RR 1·26, 95 % CI 1·16, 1·36) and women (RR 1·23, 95 % CI 1·15, 1·30). Similar results were observed in sensitivity analyses. CVAI and its 6-year change are positively associated with hypertension risk. CVAI has better performance in predicting hypertension than other visceral obesity indices for both sexes. The current findings suggest CVAI as a reliable and applicable predictor of hypertension in rural Chinese adults.
A series of new synthetic armored cables were developed and tested to ensure that they were suitable for use with the RECoverable Autonomous Sonde (RECAS), which is a newly designed freezing-in thermal ice probe. The final version of the cable consists of two concentric conductors that can be used as the power and signal lines. Two polyfluoroalkoxy jackets are used for electrical insulation (one for insulation between conductors, and the other for insulation of the outer conductor). The outer insulation layer is coated by polyurethane jacket to seal the connections between the cable and electrical units. The 0.65 mm thick strength member is made from aramid fibers woven together. To hold these aramid fibers in place, a sheathing layer was produced from a polyamide fabric cover net. The outer diameter of the final version of the cable is ~6.1 mm. The permissible bending radius is as low as 17–20 mm. The maximal breaking force under straight tension is ~12.2 kN. The cable weight is only ~0.061 kg m−1. The mechanical and electrical properties and environmental suitability of the cable were determined through laboratory testing and joint testing with the probe.
Major depressive disorder (MDD) is a common debilitating disorder characterized by impaired spontaneous brain activity, yet little is known about its alterations in dynamic properties and the molecular mechanisms associated with these changes.
Based on the resting-state functional MRI data of 65 first-episode, treatment-naïve patients with MDD and 66 healthy controls, we compared dynamic regional homogeneity (dReHo) of spontaneous brain activity between the two groups, and we investigated gene expression profiles associated with dReHo alterations in MDD by leveraging transcriptional data from the Allen Human Brain Atlas and weighted gene co-expression network analysis.
Compared with healthy controls, patients with MDD consistently showed reduced dReHo in both fusiform gyri and in the right temporal pole and hippocampus. The expression profiles of 16 gene modules were correlated with dReHo alterations in MDD. These gene modules were enriched for various biological process terms, including immune, synaptic signalling, ion channels, mitochondrial function and protein metabolism, and were preferentially expressed in different cell types.
Patients with MDD have reduced dReHo in brain areas associated with emotional and cognitive regulation, and these changes may be related to complex polygenetic and polypathway mechanisms.
Sodium niobate (NaNbO3)-based dielectrics have received much attention for energy storage applications due to their low-cost, lightweight, and nontoxic nature. The field-induced metastable ferroelectric phase in NaNbO3-based dielectrics, however, leads to a large hysteresis of the polarization–electric field (P–E) loops and hence deteriorate the energy storage performance. In this study, the hysteresis was successfully reduced by introducing Bi3+ and Ti4+ into A-site and B-site of NaNbO3, respectively. MnO2 addition was added to further increase the ceramic density and enhance the cycling reliability. As a result, a high recoverable energy density of 4.3 J/cm3 and a high energy efficiency of 90% were simultaneously achieved in the ceramic capacitor at an applied electric field of 360 kV/cm. Of particular importance is that the ceramic capacitor exhibits a stable energy storage properties over a wide temperature range of −70 to 170 °C, with much improved electric cycling reliability up to 105 cycles.
Detecting the turbulent/non-turbulent interface is a challenging topic in turbulence research. In the present study, machine learning methods are used to train detectors for identifying turbulent regions in the flow past a circular cylinder. To ensure that the turbulent/non-turbulent interface is independent of the reference frame of coordinates and is physics-informed, we propose to use invariants of tensors appearing in the transport equations of velocity fluctuations, strain-rate tensor and vortical tensor as the input features to identify the flow state. The training samples are chosen from numerical simulation data at two Reynolds numbers,
and 3900. Extreme gradient boosting (XGBoost) is utilized to train the detector, and after training, the detector is applied to identify the flow state at each point of the flow field. The trained detector is found robust in various tests, including the applications to the entire fields at successive snapshots and at a higher Reynolds number
. The objectivity of the detector is verified by changing the input features and the flow region for choosing the turbulent training samples. Compared with the conventional methods, the proposed method based on machine learning shows its novelty in two aspects. First, no threshold value needs to be specified explicitly by the users. Second, machine learning can treat multiple input variables, which reflect different properties of turbulent flows, including the unsteadiness, vortex stretching and three-dimensionality. Owing to these advantages, XGBoost generates a detector that is more robust than those obtained from conventional methods.