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To determine sociodemographics and caregiver burdens associated with overnight hospitalization, hospice utilization, and hospitalization frequency among persons with dementia (PWD).
Cross-sectional analysis of PWD (n = 899) of the National Health and Aging Trends Study linked to the National Study of Caregiving. Logistic and proportional odds regression determined the effects of caregiver burdens on overnight hospitalization, hospice use, and hospitalization frequency. Differences between PWD alive not-alive groups were compared on overnight hospitalization and frequency.
Alive PWD (n = 804) were 2.36 times more likely to have an overnight hospital stay (p = 0.004) and 1.96 times more likely to have multiple hospitalizations when caregivers found it physically difficult to provide care (p = 0.011). Decedents aged 65–74 (n = 95) were 4.55 times more likely to experience overnight hospitalizations than 85+, hospitalizations were more frequent (odds ratio [OR] = 4.84), and there was a significant difference between PWD alive/not alive groups (p = 0.035). Decedents were 5.60 times more likely to experience an overnight hospitalization when their caregivers had financial difficulty, hospitalizations were more frequent when caregivers had too much to handle (OR = 8.44) and/or no time for themselves (OR = 10.67). When caregivers had no time for themselves, a significant difference between alive/not alive groups (p = 0.018) was detected in hospitalization frequency. PWD whose caregivers had emotional difficulty helping were 5.89 times more likely to utilize hospice than caregivers who did not report emotional difficulty.
Significance of results
Care transitions among PWD at the end of life are impacted by the circumstances and experiences of their caregivers. Subjective caregiver burdens represent potentially modifiable risks for undesired care transitions and opportunities for promoting hospice use. Future work is warranted to identify and address these issues as they occur.
Neuroinflammation and brain structural abnormalities are found in bipolar disorder (BD). Elevated levels of cytokines and chemokines have been detected in the serum and cerebrospinal fluid of patients with BD. This study investigated the association between peripheral inflammatory markers and brain subregion volumes in BD patients.
Euthymic patients with bipolar I disorder (BD-I) aged 20–45 years underwent whole-brain magnetic resonance imaging. Plasma levels of monocyte chemoattractant protein-1 (MCP-1), chitinase-3-like protein 1 (also known as YKL-40), fractalkine (FKN), soluble tumour necrosis factor receptor-1 (sTNF-R1), interleukin-1β, and transforming growth factor-β1 were measured on the day of neuroimaging. Clinical data were obtained from medical records and interviewing patients and reliable others.
We recruited 31 patients with a mean age of 29.5 years. In multivariate regression analysis, plasma level YKL-40, a chemokine, was the most common inflammatory marker among these measurements displaying significantly negative association with the volume of various brain subareas across the frontal, temporal, and parietal lobes. Higher YKL-40 and sTNF-R1 levels were both significantly associated with lower volumes of the left anterior cingulum, left frontal lobe, right superior temporal gyrus, and supramarginal gyrus. A greater number of total lifetime mood episodes were also associated with smaller volumes of the right caudate nucleus and bilateral frontal lobes.
The volume of brain regions known to be relevant to BD-I may be diminished in relation to higher plasma level of YKL-40, sTNF-R1, and more lifetime mood episodes. Macrophage and macrophage-like cells may be involved in brain volume reduction among BD-I patients.
To determine if specific dietary patterns are associated with breast cancer (BC) risk in Chinese women.
Latent class analysis (LCA) was performed to identify generic dietary patterns based on daily food-frequency data.
The Chinese Wuxi Exposure and Breast Cancer Study (2013–2014).
A population-based case–control study (695 cases, 804 controls).
Four dietary patterns were identified, Prudent, Chinese traditional, Western and Picky; the proportion in the controls and cases was 0·30/0·32/0·16/0·23 and 0·29/0·26/0·11/0·33, respectively. Women in Picky class were characterised by higher extreme probabilities of non-consumption of specific foods, the highest probabilities of consumption of pickled foods and the lowest probabilities of consumption of cereals, soya foods and nuts. Compared with Prudent class, Picky class was associated with a higher risk (OR = 1·42, 95 % CI 1·06, 1·90), while the relevant association was only in post- (OR = 1·44, 95 % CI 1·01, 2·05) but not in premenopausal women. The Western class characterised by high-protein, high-fat and high-sugar foods, and the Chinese traditional class characterised by typical consumption of soya foods and white meat over red meat, both of them showed no difference in BC risk compared with Prudent class did.
LCA captures the heterogeneity of individuals embedded in the population and could be a useful approach in the study of dietary pattern and disease. Our results indicated that the Picky class might have a positive association with the risk of BC.
The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a public health emergency of international concern. The current study aims to explore whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with the development of death in patients with COVID-19. A total of 131 patients diagnosed with COVID-19 from 13 February 2020 to 14 March 2020 in a hospital in Wuhan designated for treating COVID-19 were enrolled in the current study. These 131 patients had a median age of 64 years old (interquartile range: 56–71 years old). Furthermore, among these patients, 111 (91.8%) patients were discharged and 12 (9.2%) patients died in the hospital. The pooled analysis revealed that the NLR at admission was significantly elevated for non-survivors, when compared to survivors (P < 0.001). The NLR of 3.338 was associated with all-cause mortality, with a sensitivity of 100.0% and a specificity of 84.0% (area under the curve (AUC): 0.963, 95% confidence interval (CI) 0.911–1.000; P < 0.001). In view of the small number of deaths (n = 12) in the current study, NLR of 2.306 might have potential value for helping clinicians to identify patients with severe COVID-19, with a sensitivity of 100.0% and a specificity of 56.7% (AUC: 0.729, 95% CI 0.563–0.892; P = 0.063). The NLR was significantly associated with the development of death in patients with COVID-19. Hence, NLR is a useful biomarker to predict the all-cause mortality of COVID-19.
In recent years, banded leaf sheath blight in maize (Zea mays L.) has become an important disease that seriously affects quality and yield. This paper aims to evaluate the sensitivity of Rhizoctonia solani Kuhn to thifluzamide on maize, to clarify the effect of seed coating using a thifluzamide suspension agent on safety and physiological indicators and to determine the effectiveness of control of banded leaf sheath blight in the field. In this study, the thifluzamide sensitivity of 102 strains of R. solani in maize from Shandong was determined using the mycelial growth rate method; the average half-maximal effective concentration value (EC50) was 0.086 ± 0.004 μg/ml and displayed a unimodal frequency distribution, indicating that thifluzamide had strong inhibitory activity on the mycelial growth of R. solani in maize. In an indoor pot test, the root activities under 24 g a.i./100 kg seed were found to increase by 78.01%, compared with the control. Similarly, chlorophyll content increased most significantly at this dose, by 32.3%. Thifluzamide (FS) could significantly increase the per-plot yield. Among the examined dosages, 48 g a.i./100 kg seed had the most significant treatment effect, with the yield rate increasing by 15.7% and 14.1%, respectively, in 2017 and 2018 compared with the control. The field effectiveness against banded leaf sheath blight in maize was highest at the dosage of 48 g a.i./100 kg seed for a seed dressing with thifluzamide (FS). These results indicate that thifluzamide has enormous potential for controlling banded leaf sheath blight in maize.
About 30,000 astronomical photographic plates were digitised between 2012–2017 with a special digitising machine that has high precision in both astrometry and photometry. All the images from the plates, together with plate information and measured coordinates of all the objects on the plates, have been stored in the Chinese Virtual Observatory.
The in vivo effects of administering free and microencapsulated Lactobacillus plantarum LIP-1 cells (2·0×109 colony-forming units/d) were evaluated in high-fat-diet-induced hyperlipidaemic rats. Results from real-time quantitative PCR targeting to LIP-1 cells showed a higher colon colonisation count of LIP-1 in the rats receiving microencapsulated cells compared with free cells (P<0·05). Moreover, the microencapsulated LIP-1 treatment resulted in a more obvious lipid-lowering effect (P<0·05). Meanwhile, their faecal samples had significantly less lipopolysaccharide-producing bacteria (especially Bilophila, Sutterella and Oscillibacter) and mucosa-damaging bacteria (Bilophila and Akkermansia muciniphila), whereas significantly more SCFA-producing bacteria (P<0·05) (namely Lactobacillus, Alloprevotella, Coprococcus, Eubacterium and Ruminococcus) and bacteria that potentially possessed bile salt hydrolase activity (Bacteroides, Clostridium, Eubacterium and Lactobacillus), and other beneficial bacteria (Alistipes and Turicibacter). Further, Spearman’s correlation analysis showed significant correlations between some of the modulated gut bacteria and the serum lipid levels. These results together confirm that microcapsulation enhanced the colon colonisation of LIP-1 cells, which subsequently exhibited more pronounced effects in improving the gut microbiota composition of hyperlipidaemic rats and lipid reduction.
Isolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.
A 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.
A score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06–3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57–8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24–4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39–4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16–4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).
A model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB.
Gauged river flow records from China generally span only a few decades, which hampers the detection of long-term, decadal- to centennial-scale cycles and trends in streamflow variability. New and updated tree-ring chronologies help reconstructed the water-year (October–September) streamflow for the Aksu River, which is an important river at the edge of the Taklimakan Desert that drains into the Tarim Basin. The reconstruction dates back to 1692 and has an adjusted r2 of 0.61 (1957–2006). Based on frequency, intensity and duration of droughts and pluvial events, the lowest streamflows occurred in the 1920s. Since then streamflow has continuously increased, and was exceptionally rapidly after the 1960s, until today. The start and end of the 20th century to the present were the highest streamflow periods. The mid-20th century was the longest and driest period over the past 300 yr. The reconstructed streamflow series has a strong positive correlation with the North Atlantic Oscillation Index. Changes in mid-latitude circulation patterns influencing precipitation may have indirectly resulted in streamflow variations along the Aksu River over the past 300 yr. The rapid increase and the exceptional streamflows of the 1960s are likely linked with global warming and mid-latitude atmospheric circulation changes.
We compared the epidemiological and clinical features of avian influenza A(H7N9) virus infections in the population in Zhejiang province, China, between March and April 2013 (first wave) and October 2013 and February 2014 (second wave). No statistical difference was found for age, sex, occupation, presence of underlying conditions, exposure history, white blood cell count, lymphocyte percentage and illness timeline and duration (all P > 0·05). The virus spread to 30 new counties compared to the first wave. The case-fatality rate was 22% in the first wave and 42% in the second (P = 0·023). Of those infected, 66% in the first wave and 62% in the second wave had underlying conditions. The proportion of those exposed to live poultry markets were 80% and 66%, respectively. We recommend permanent closure of live poultry markets and reformation of poultry supply and sales.
August–July precipitation has been reconstructed back to AD 1724 for the Mohe region in the northern Greater Higgnan Mountains, China, using Pinus sylvestris var. mongolica tree-ring width. The reconstruction explains 39% of the variance in the precipitation observed from AD 1960–2008. Some droughts noted in historical documents are precisely captured in our reconstruction. Wet periods occurred during the periods of AD 1734–1785, AD 1805–1830, AD 1863–1880, AD 1922–1961, and AD 1983–1998; while the periods of AD 1786–1804, AD 1831–1862, AD 1881–1921, and AD 1962–1982 were relatively dry. Power spectral and wavelet analyses demonstrated the existence of significant 24-yr, 12-yr, and 2-yr cycles of variability. The results of the spatial correlations suggest that our reconstruction contains climatic signals for the southern Stanovoy Range and the northern Greater Higgnan Mountains. The positive correlations between the new reconstructed precipitation series and two precipitation reconstructions indicate that our precipitation reconstruction captures broad-scale regional climatic variations. A comparison between the weakening tendency of summer monsoon and the dry period of our reconstruction reveals that the annual precipitation in the Mohe region is partly influenced by the East Asian Summer Monsoon.
We have developed a low cost and convenient approach to fabricate ITO-comparable transparent electrodes by using solution process of silver nanowires mixed with poly peroxotitanic acid (PPT) gel. The PPT gel is applied to connect the dispersed silver nanowires to preserve its high conductivity while remaining transparency and reducing surface roughness of the transparent electrode. The silver nanowires were synthesized via a modified polyol method, and the PPT gels were prepared by sol-gel method in appropriate concentrations. After applying the PPT gels, the sheet resistance of the transparent electrodes was improved from 192 Ω/□ to 44.7 Ω/□ with a transmittance of 81 %. And the roughness (RMS) was decreased from 106.3 nm to 48.1 nm. The PPT gel also improved the reliability of the proposed electrodes, which the conductivity was remained after general atmospheric storage of 6 months. We also demonstrate an Alq3 based OLED with the proposed transparent electrodes.
We investigated the prevalence of β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 51 carbapenem-resistant Enterobacteriaceae (CRE) from five teaching hospitals in central China. The prevalence of carbapenem resistance in Enterobacteriaceae was 1·0% (51/5012). Of 51 CRE, 31 (60·8%) isolates were positive for one tested carbapenemase gene, while 10 (19·6%) were simultaneously positive for two tested carbapenemase genes. The positive rates of blaKPC-2, blaNDM-1, blaIMP-4, blaIMP-26 and blaIMP-8 were 54·9%, 17·6%, 11·8%, 11·8% and 3·9%, respectively. Of 10 CRE with two carbapenemase genes, three, five, one and one were positive for blaKPC-2 and blaIMP-4, blaKPC-2 and blaIMP-26, blaKPC-2 and blaIMP-8, and blaKPC-2 and blaNDM-1, respectively. Eight of nine blaNDM-1-positive isolates lacked carbapenemases by the modified Hodge test, while 27/28 isolates harbouring blaKPC-2 were positive for carbapenemases determined by this test; 41·2% of the CRE-positive isolates also harboured ESBL genes in various combinations (three and two positive for blaKPC-2 also carried blaDHA-1 and blaCMY-2). The positive rates of qnrS1, qnrA1, qnrB and aac-(6/)-Ib-cr in CRE were 25·5%, 9·8%, 23·5% and 15·7%, respectively. In particular, 7/9 isolates harbouring blaNDM-1 were positive for these quinolone resistance genes, of which five carried qnrS1 and two carried qnrS1 and qnrB4. All but two of 29 Klebsiella pneumoniae isolates were grouped into 20 clonal clusters by PFGE, with the predominant cluster accounting for four blaKPC-2-positive isolates distributed in the same hospital. We conclude that there is a high prevalence of blaNDM-1 and PMQR determinants in CRE isolates in central China. Multiple resistance determinants in various combinations co-exist in these strains and we report for the first time the co-existence of blaKPC-2 and blaIMP-26 in a strain of Klebsiella oxytoca.
Three robust tree-ring density chronologies were developed for the western Tianshan Mountains of northwestern China. The chronologies were significantly correlated and form a regional chronology (GLD). The GLD had significant and positive correlations with temperature of warm seasons. Based on this relationship, the mean minimum temperatures of May to August were reconstructed using the GLD chronology for the period AD 1657 to 2008. The temperature reconstruction exhibited temperature patterns on interannual to centennial timescales, and showed that the end of the 20th century is the warmest period in the past 352 years. The reconstructed temperature variation has a teleconnection with large-scale atmospheric–oceanic variability and captures long- and broad-scale regional climatic variations.
We investigated the virulence gene carriage and molecular type characteristics of Staphylococcus aureus isolates from bloodstream infections (BSIs) and skin and soft tissue infections (SSTIs) in children. A total of 71 isolates, 16 of which were methicillin-resistant S. aureus (MRSA), were investigated by PCR for virulence-associated gene profiles, sequence type and spa type. This revealed that 76·7% and 53·7% of the SSTI and BSI isolates, respectively, exhibited simultaneous carriage of ⩾10 virulence genes. Compared to BSI isolates, carriage rates for hla, hlb, cna, clfA, seb, sec and pvl genes were significantly higher in SSTI isolates. By contrast, carriage of eta, etb and sea was significantly higher for BSI isolates. Thirty-four sequence types (STs) and 36 spa types were identified in the 71 isolates and included 14 novel STs and four novel spa types. ST59-MRSA-IV/V-t437 was the most common clone in the MRSA isolates. We concluded that virulence determinants are widely distributed in isolates of S. aureus strains from children with BSIs and SSTIs, with an unexpectedly high rate in SSTI isolates. Future profiling of S. aureus virulence determinants may allow the prediction of severity and outcome for children with these infections.