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The present study aimed to investigate the relationship between dietary patterns and the risk of type 2 diabetes mellitus (T2DM) among Taiwanese individuals. Data were collected using a nationwide cohort study (2001–15) from the Triple-High Database. Dietary intake was assessed using the twenty-group food frequency questionnaire and used to calculate alternate Mediterranean diet (aMED) and Dietary Approaches to Stop Hypertension (DASH) scores. Principal component analysis (PCA) and partial least-squares (PLS) regression were used to derive dietary patterns, with incident T2DM as the outcome. Multivariable-adjusted hazard ratios and 95 % confidence intervals were calculated using time-dependent Cox proportional hazards (Cox PH) regression analysis, and subgroup analyses were performed. A total of 4705 participants were enrolled in the study, and 995 had newly developed T2DM during the median 5⋅28-year follow-up period (30⋅7 per 1000 person-years). Six dietary patterns were extracted (PCA: Western, prudent, dairy and plant-based; PLS: health-conscious, fish-vegetable and fruit-seafood). The highest aMED score quartile had a 25 % (hazard ratio 0⋅75; 95 % CI 0⋅61, 0⋅92; P = 0⋅039) lower risk of T2DM than the lowest quartile. This association remained significant after adjustment (adjusted hazard ratio 0⋅74; 95 % CI 0⋅60, 0⋅91; P = 0⋅010), and no effect modifier was found for aMED. The DASH scores, PCA and PLS dietary patterns were not significant after adjustment. In conclusion, high adherence to a MED-type dietary pattern by Taiwanese foods was associated with a lower risk of T2DM in the Taiwanese population, regardless of unhealthy lifestyle habits.
Individuals with gender dysphoria display an incongruence between birth-assigned gender and gender expression. However, there is no existing Chinese measure for gender dysphoria.
Aims
This study aims to validate the Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS) in a Chinese population, and compare the psychometric properties of the UGDS-GS with one frequently used scale for gender dysphoria measurement, the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA).
Method
A total of 2646 Chinese participants were recruited. The following information was collected: sociodemographic variables, gender identity, sexual orientation, gender dysphoria measured by the UGDS-GS and the GIDYQ-AA, anxiety, depression and suicide assessment. Principal component analyses and confirmatory factor analysis (CFA) were conducted to test the fitness of the model. Discriminant validity was tested with one-way analysis of variance.
Results
The UGDS-GS showed good psychometric properties, with the GIDYQ-AA demonstrating slightly better psychometric properties than the UGDS-GS. UGDS-GS also showed strong internal consistency (Cronbach's α = 0.89), and good convergent validity and criterion validity. Exploratory factor analysis showed a one-factor structure (Kaiser-Meyer-Olkin test, 0.93; χ2 = 13 342.50; d.f. = 153; P < 0.001). The UGDS-GS was positively associated with anxiety symptoms, depressive symptoms, suicidal ideation, attempted suicide and self-harm. We also found the results were robust in different samples.
Conclusions
The validated UGDS-GS can significantly stimulate and promote gender dysphoria assessment in Chinese populations, allowing for assessment in a more diverse subset of gender minorities.
Based on a real-world collaboration with innovators in applying early health economic modeling, we aimed to offer practical steps that health technology assessment (HTA) researchers and innovators can follow and promote the usage of early HTA among research and development (R&D) communities.
Methods
The HTA researcher was approached by the innovator to carry out an early HTA ahead of the first clinical trial of the technology, a soft robotic sock for poststroke patients. Early health economic modeling was selected to understand the potential value of the technology and to help uncover the information gap. Threshold analysis was used to identify the target product profiles. Value-of-information analysis was conducted to understand the uncertainties and the need for further research.
Results
Based on the expected price and clinical effectiveness by the innovator, the new technology was found to be cost-saving compared to the current practice. Risk reduction in deep vein thrombosis and ankle contracture, the incidence rate of ankle contracture, the compliance rate of the new technology, and utility scores were found to have high impacts on the value-for-money of the new technology. The value of information was low if the new technology can achieve the expected clinical effectiveness. A list of parameters was recommended for data collection in the impending clinical trial.
Conclusions
This work, based on a real-world collaboration, has illustrated that early health economic modeling can inform medical innovation development. We provided practical steps in order to achieve more efficient R&D investment in medical innovation moving forward.
Plasma jets are widely investigated both in the laboratory and in nature. Astrophysical objects such as black holes, active galactic nuclei and young stellar objects commonly emit plasma jets in various forms. With the availability of data from plasma jet experiments resembling astrophysical plasma jets, classification of such data would potentially aid in not only investigating the underlying physics of the experiments but also the study of astrophysical jets. In this work we use deep learning to process all of the laboratory plasma images from the Caltech Spheromak Experiment spanning two decades. We found that cosine similarity can aid in feature selection, classify images through comparison of feature vector direction and be used as a loss function for the training of AlexNet for plasma image classification. We also develop a simple vector direction comparison algorithm for binary and multi-class classification. Using our algorithm we demonstrate 93 % accurate binary classification to distinguish unstable columns from stable columns and 92 % accurate five-way classification of a small, labelled data set which includes three classes corresponding to varying levels of kink instability.
The dispersed phase in turbulence can vary from almost inviscid fluid to highly viscous fluid. By changing the viscosity of the dispersed droplet phase, we experimentally investigate how the deformability of dispersed droplets affects the global transport quantity of the turbulent emulsion. Different kinds of silicone oil are employed to result in the viscosity ratio, $\zeta$, ranging from $0.53$ to $8.02$. The droplet volume fraction, $\phi$, is varied from 0 % to 10 % with a spacing of 2 %. The global transport quantity, quantified by the normalized friction coefficient $c_{f,\phi }/c_{f,\phi =0}$, shows a weak dependence on the turbulent intensity due to the vanishing finite-size effect of the droplets. The interesting fact is that, with increasing $\zeta$, $c_{f,\phi }/c_{f,\phi =0}$ first increases and then saturates to a plateau value which is similar to that of the rigid particle suspension. By performing image analysis, this drag modification is interpreted from the point of view of droplet deformability, which is responsible for the breakup and coalescence effect of the droplets. The statistics of the droplet size distribution show that, with increasing $\zeta$, the stabilizing effect induced by interfacial tension becomes substantial and the pure inertial breakup process becomes dominant. The measurement of the droplet distribution along the radial direction of the system shows a bulk-clustering effect, which can be attributed to the non-negligible coalescence effect of the droplet. It is found that the droplet coalescence effect could be suppressed as $\zeta$ increases, thereby affecting the contribution of interfacial tension to the total stress, and accounting for the observed emulsion rheology.
Hormone-sensitive lipase (HSL) is one of the rate-determining enzymes in the hydrolysis of TAG, playing a crucial role in lipid metabolism. However, the role of HSL-mediated lipolysis in systemic nutrient homoeostasis has not been intensively understood. Therefore, we used CRISPR/Cas9 technique and Hsl inhibitor (HSL-IN-1) to establish hsla-deficient (hsla-/-) and Hsl-inhibited zebrafish models, respectively. As a result, the hsla-/- zebrafish showed retarded growth and reduced oxygen consumption rate, accompanied with higher mRNA expression of the genes related to inflammation and apoptosis in liver and muscle. Furthermore, hsla-/- and HSL-IN-1-treated zebrafish both exhibited severe fat deposition, whereas their expressions of the genes related to lipolysis and fatty acid oxidation were markedly reduced. The TLC results also showed that the dysfunction of Hsl changed the whole-body lipid profile, including increasing the content of TG and decreasing the proportion of phospholipids. In addition, the systemic metabolic pattern was remodelled in hsla-/- and HSL-IN-1-treated zebrafish. The dysfunction of Hsl lowered the glycogen content in liver and muscle and enhanced the utilisation of glucose plus the expressions of glucose transporter and glycolysis genes. Besides, the whole-body protein content had significantly decreased in the hsla-/- and HSL-IN-1-treated zebrafish, accompanied with the lower activation of the mTOR pathway and enhanced protein and amino acid catabolism. Taken together, Hsl plays an essential role in energy homoeostasis, and its dysfunction would cause the disturbance of lipid catabolism but enhanced breakdown of glycogen and protein for energy compensation.
By varying the oil volume fraction, the microscopic droplet size and the macroscopic rheology of emulsions are investigated in a Taylor–Couette turbulent shear flow. Although here oil and water in the emulsions have almost the same physical properties (density and viscosity), unexpectedly, we find that oil-in-water (O/W) and water-in-oil (W/O) emulsions have very distinct hydrodynamic behaviours, i.e. the system is clearly asymmetric. By looking at the micro-scales, the average droplet diameter hardly changes with the oil volume fraction for O/W or for W/O. However, for W/O it is about $50\,\%$ larger than that of O/W. At the macro-scales, the effective viscosity of O/W is higher when compared to that of W/O. These asymmetric behaviours are expected to be caused by the presence of surface-active contaminants from the walls of the system. By introducing an oil-soluble surfactant at high concentration, remarkably, we recover the symmetry (droplet size and effective viscosity) between O/W and W/O emulsions. Based on this, we suggest a possible mechanism responsible for the initial asymmetry and reach conclusions on emulsions where interfaces are fully covered by the surfactant. Next, we discuss what sets the droplet size in turbulent emulsions. We uncover a $-6/5$ scaling dependence of the droplet size on the Reynolds number of the flow. Combining the scaling dependence and the droplet Weber number, we conclude that the droplet fragmentation, which determines the droplet size, occurs within the boundary layer and is controlled by the dynamic pressure caused by the gradient of the mean flow, as proposed by Levich (Physicochemical Hydrodynamics, Prentice-Hall, 1962), instead of the dynamic pressure due to turbulent fluctuations, as proposed by Kolmogorov (Dokl. Akad. Nauk. SSSR, vol. 66, 1949, pp. 825–828). The present findings provide an understanding of both the microscopic droplet formation and the macroscopic rheological behaviours in dynamic emulsification, and connects them.
We report dispersion management based on a mismatched-grating compressor for a 100 PW level laser, which utilizes optical parametric chirped pulse amplification and also features large chirped pulse duration and an ultra-broadband spectrum. The numerical calculation indicates that amplified pulses with 4 ns chirped pulse duration and 210 nm spectral bandwidth can be directly compressed to sub-13 fs, which is close to the Fourier-transform limit (FTL). More importantly, the tolerances of the mismatched-grating compressor to the misalignment of the stretcher, the error of the desired grating groove density and the variation of material dispersion are comprehensively analyzed, which is crucially important for its practical application. The results demonstrate that good tolerances and near-FTL compressed pulses can be achieved simultaneously, just by keeping a balance between the residual second-, third- and fourth-order dispersions in the laser system. This work can offer a meaningful guideline for the design and construction of 100 PW level lasers.
Immune cells play a key role in maintaining renal dynamic balance and dealing with renal injury. The physiological and pathological functions of immune cells are intricately connected to their metabolic characteristics. However, immunometabolism in chronic kidney disease (CKD) is not fully understood. Pathophysiologically, disruption of kidney immune cells homeostasis causes inflammation and tissue damage via triggering metabolic reprogramming. The diverse metabolic characteristics of immune cells at different stages of CKD are strongly associated with their different pathological effect. In this work, we reviewed the metabolic characteristics of immune cells (macrophages, natural killer cells, T cells, natural killer T cells and B cells) and several non-immune cells, as well as potential treatments targeting immunometabolism in CKD. We attempt to elaborate on the metabolic signatures of immune cells and their intimate correlation with non-immune cells in CKD.
It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS).
Methods
We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively.
Results
Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively).
Conclusions
This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.
The relationship of a diet low in fibre with mortality has not been evaluated. This study aims to assess the burden of non-communicable chronic diseases (NCD) attributable to a diet low in fibre globally from 1990 to 2019.
Design:
All data were from the Global Burden of Disease (GBD) Study 2019, in which the mortality, disability-adjusted life-years (DALY) and years lived with disability (YLD) were estimated with Bayesian geospatial regression using data at global, regional and country level acquired from an extensively systematic review.
Setting:
All data sourced from the GBD Study 2019.
Participants:
All age groups for both sexes.
Results:
The age-standardised mortality rates (ASMR) declined in most GBD regions; however, in Southern sub-Saharan Africa, the ASMR increased from 4·07 (95 % uncertainty interval (UI) (2·08, 6·34)) to 4·60 (95 % UI (2·59, 6·90)), and in Central sub-Saharan Africa, the ASMR increased from 7·46 (95 % UI (3·64, 11·90)) to 9·34 (95 % UI (4·69, 15·25)). Uptrends were observed in the age-standardised YLD rates attributable to a diet low in fibre in a number of GBD regions. The burden caused by diabetes mellitus increased in Central Asia, Southern sub-Saharan Africa and Eastern Europe.
Conclusions:
The burdens of disease attributable to a diet low in fibre in Southern sub-Saharan Africa and Central sub-Saharan Africa and the age-standardised YLD rates in a number of GBD regions increased from 1990 to 2019. Therefore, greater efforts are needed to reduce the disease burden caused by a diet low in fibre.
The finite-amplitude instability of the buoyancy-driven boundary layer is considered on a vertical plate immersed in a thermally stratified ambient medium, where the wall and surrounding fluid have different temperature gradients. Although the linear stability in this configuration has been investigated, the finite-amplitude solution arising from the critical instability has been studied only for specific parameter values. We extend this by using the amplitude expansion method. The primary bifurcations to the two-dimensional least unstable mode for different temperature gradient ratios ($0 \leqslant \lambda \leqslant 10$) and Prandtl numbers ($10^{-1} \leqslant Pr \leqslant 10^{4}$) are investigated. Only supercritical bifurcations are found to occur when $0 \leqslant \lambda < 2$ and $Pr \leqslant 2800$, while subcritical bifurcations are also found for larger values of temperature gradient ratio and Prandtl number. Analysis of the contribution of the nonlinear terms in the Landau coefficient reveals that the interaction of the modification of the mean flow and second harmonic for velocity with the fundamental mode for temperature plays an important role in subcritical bifurcation. Based on the Landau equation, the threshold amplitude of the nonlinear equilibrium solution is discussed as well. These encouraging results should be helpful for understanding such a buoyancy-driven flow system.
Edited by
James Law, University of Newcastle upon Tyne,Sheena Reilly, Griffith University, Queensland,Cristina McKean, University of Newcastle upon Tyne
This chapter provides new evidence on the effects of kindergarten instructional policies on reading and math achievement gaps between students from low and high socio-economic status (SES) families. Children enrolled in full-day kindergarten see greater gains in reading and math between fall and spring kindergarten than their counterparts who were enrolled half-day. There are also gains associated with instruction time and ability grouping within kindergarten programs. However, these effects are not significantly different for children from low vs high SES families. These results indicate that kindergarten instructional policies do matter for kindergarten learning but also suggest that if such policies are to play a role in reducing SES gaps, it would be through differentially assigning children from low SES families to them rather than through differential gains by SES.
Neuroimaging studies in Wilson’s disease (WD) have identified various alterations in white matter (WM) microstructural organization. However, it remains unclear whether these alterations are localized to specific regions of fiber tracts, and what diagnostic value they might have. The purpose of this study is to explore the spatial profile of WM abnormalities along defined fiber tracts in WD and its clinical relevance.
Methods:
Ninety-nine patients with WD (62 men and 37 women) and 91 age- and sex-matched controls (59 men and 32 women) were recruited to take part in experiments of diffusion-weighted imaging with 64 gradient vectors. The data were calculated by FMRIB Software Library (FSL) software and Automated Fiber Quantification (AFQ) software. After registration, patient groups and normal groups were compared by Mann–Whitney U test analysis.
Results:
Compared with the controls, the patients with WD showed widespread fractional anisotropy reduction and mean diffusivity, radial diffusivity elevation of identified fiber tracts. Significant correlations between diffusion tensor imaging (DTI) parameters and the neurological Unified Wilson’s Disease Rating Scale (UWDRS-N), serum ceruloplasmin, and 24-h urinary copper excretion were found.
Conclusions:
The present study has provided evidence that the metrics of DTI could be utilized as a potential biomarker of neuropathological symptoms in WD. Damage to the microstructure of callosum forceps and corticospinal tract may be involved in the pathophysiological process of neurological symptoms in WD patients, such as gait and balance disturbances, involuntary movements, dysphagia, and autonomic dysfunction.
In this article, we explore the challenges of global governance and the particular challenge presented by global data governance. We discuss a range of challenges to developing meaningful global governance institutions for regulating how companies and governments around the world manage and utilize consumer data. These challenges are compounded by their global nature and the complexities of Internet-based technologies. We argue that the following gaps exist for effective global data governance: (a) there is no overarching global framework for protecting consumer data, and it is partial and incomplete; (b) there is a lack of data protection for international data transfers, as much of the regulation that is being developed is not global in scale; and (c) new areas of data collection and use compound concerns to effective data governance in a globalized digital world. Moreover, we highlight important needs in terms of both global governance and impending challenges related to current and new uses of data. Any global governance framework should recognize the need for an iterative process where communication is ongoing between the necessary stakeholders. Agreements should incorporate common goals to maximize the potential development of global data governance norms. However, goals must remain flexible to the different data environments across nation-states while maintaining a global scope to ensure data protection. In addition, any agreement should consider the emerging challenges in this area. These challenges include new methods of data collection and use, as well as protecting individuals from manipulation and undue influence based on how their data are being used, processed, and collected.