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This study aimed to describe the clinical manifestations of adenovirus infections and identify potential risk factors for co-infection with chlamydia, viruses and bacteria in hospitalised children from Hangzhou, China. From January to December 2019, the characteristics of hospitalised children infected with adenovirus at Hangzhou Children's Hospital and Zhejiang Xiaoshan Hospital were collected. The clinical factors related to co-infection with chlamydia, viruses and bacteria were assessed using multivariate logistic regression analyses. A total of 5989 children were infected with adenovirus, of which 573 were hospitalised for adenovirus infection. The severity of adenovirus respiratory infection was categorised as follows: mild (bronchiolitis, 73.6%), moderate (bronchopneumonia, 17.6%) or severe (pneumonia, 8.8%). Of the 573 children who were hospitalised, 280 presented with co-infection of chlamydia, viruses or bacteria, while the remaining 293 had only adenovirus infection. Multivariate stepwise logistic regression analyses indicated that elevated ferritin was associated with an increased risk of chlamydia co-infection (odds ratio (OR) 6.50; 95% confidence interval (CI) 1.56–27.11; P = 0.010). However, increased white blood cell (WBC) count was associated with a reduced risk of viral co-infection (OR 0.84; 95% CI 0.75–0.95; P = 0.006). The study indicated that co-infection with chlamydia could be affected by elevated ferritin levels. WBC levels could affect viral co-infection in hospitalised children infected with adenovirus.
Routine Corona Virus Disease 2019 (COVID-19) screening found one asymptomatic COVID-19 patient. An emergency sampling team was organized consisting of 1200 healthcare workers, and a total of 3.2228 million COVID-19 samples had been collected and detected. This study summarizes the on-site management experience in large-scale COVID-19 nucleic acid testing from various aspects: staff preparation, materials preparation, site layout, logistics support, and information system support. Suggestions are put forward for the deficiencies and parts needing improvement. Such as some sampling sites were not properly chosen, different areas were unclearly marked off from each other, and some site moving lines were confounding. How to communicate with the street service workers who had little professional knowledge on the epidemic spread or the working principles of the workflow and site layout. And the way to resolve conflicts on site.
The significance of spiritual care competence among nurses has been emphasized across countries and cultures in many studies. However, there were few studies on correlations among spiritual care competence, spiritual care perceptions, and spiritual health of nurses in China.
Objective
To investigate spiritual care competence, spiritual care perceptions, and spiritual health, and examine the correlations among spiritual care competence, spiritual care perceptions and spiritual health, and the mediating role of spiritual health between other two variables of Chinese nurses.
Methods
A cross-sectional and correlational design was implemented, and the STROBE Checklist was used to report the study. A convenience sample of 2,181 nurses were selected from 17 hospitals in 3 provinces, China. Participants provided data on sociodemographic by completing the Chinese Version of the Spiritual Care Competence Scale, the Chinese Version of the Spiritual Care-Giving Scale, and the Spiritual Health Scale Short Form. Descriptive statistics, univariate, multiple linear regression, and Pearson correlation analysis were used to analyze data.
Results
The total scores of spiritual care competence, spiritual care perceptions, and spiritual health were 58.25 ± 16.21, 144.49 ± 16.87, and 84.88 ± 10.57, respectively, which both were moderate. Spiritual care competence was positively correlated with spiritual care perceptions (r = 0.653, p < 0.01) and spiritual health (r = 0.587, p < 0.01). And spiritual health played a mediating role between the other two variables (accounting for 35.6%).
Significance of results
The spiritual care competence, spiritual care perceptions, and spiritual health of Chinese nurses need to be improved. It is recommended that nursing managers should pay attention to spiritual care education of nurses, and improve spiritual care perceptions and spiritual health in multiple ways, so as to improve their spiritual care competence and to maximize the satisfy spiritual care needs of patients in China.
As an important index to quantitatively measure the motion performance of a manipulator, motion reliability is affected by many factors, such as joint clearance. The present research utilized a UR10 manipulator as the research object. A factor mapping model for influencing the motion reliability was established. The link flexibility factor, joint flexibility factor, joint clearance factor, and Denavit–Hartenberg (DH) parameters were comprehensively considered in this model. The coupling relationship among the various factors was concisely expressed. Subsequently, the nonlinear response surface method was used to calculate the reliability and sensitivity of the manipulator, which provided an applicable reference for its trajectory planning and motion control. In addition, a data-driven fault diagnosis method based on the kernel principal component analysis (KPCA) was used to verify the motion accuracy and sensitivity of the manipulator, and joint rotation failure was considered as an example to verify the accuracy of the KPCA method. This study on the motion reliability of the manipulator is of great significance for the current motion performance, adjusting the control strategy and optimizing the completion effect of the motion task of a manipulator.
In 2014 Japan’s Cabinet Order No. 302 declared the outer limits of its continental shelf beyond 200 nautical miles (OL) to the west and north of Oki-no-Tori Shima (Area 302). Oki-no-Tori Shima consists of two small, barren, and uninhabitable rocks in the West Pacific. The northern part of Area 302 is broader than what the 2012 recommendations of the Commission on the Limits of the Continental Shelf (CLCS) specify. A question arises whether Order No. 302 violates Article 76(8) of the United Nations Convention on the Law of the Sea (UNCLOS), which provides that the OL established by a coastal state ‘on the basis of’ the CLCS recommendations shall be final and binding. Another question is the role played by the CLCS in ‘assisting’ the coastal states to delimit their national jurisdiction so as to know where the Area (i.e., the Common Heritage of Mankind under UNCLOS Articles 1(1)(1) and 136) begins. The essential questions arising from Area 302 concern how well the UNCLOS mechanism can perform to safeguard the Common Heritage of Mankind through preventing encroachment thereupon by individual coastal states. This article looks at the context and explores the obligations implied by Article 76(8) for coastal states to ‘follow’ the recommendations in establishing the OL, with special reference to the northern part of Area 302. The article also examines legal consequences arising from a breach of these obligations.
To investigate the association between the Metabolic Score for Visceral Fat (METS-VF) and risk of type 2 diabetes mellitus (T2DM) and compare the predictive value of the METS-VF for T2DM incidence with other obesity indices in Chinese people. A total of 12 237 non-T2DM participants aged over 18 years from the Rural Chinese Cohort Study of 2007–2008 were included at baseline and followed up during 2013–2014. The cox proportional hazards regression was used to calculate hazard ratios (HR) and 95 % CI for the association between baseline METS-VF and T2DM risk. Restricted cubic splines were used to model the association between METS-VF and T2DM risk. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the ability of METS-VF to predict T2DM incidence. During a median follow-up of 6·01 (95 % CI 5·09, 6·06) years, 837 cases developed T2DM. After adjusting for potential confounding factors, the adjusted HR for the highest v. lowest METS-VF quartile was 5·97 (95 % CI 4·28, 8·32), with a per 1-sd increase in METS-VF positively associated with T2DM risk. Positive associations were also found in the sensitivity and subgroup analyses, respectively. A significant nonlinear dose–response association was observed between METS-VF and T2DM risk for all participants (Pnonlinearity = 0·0347). Finally, the AUC value of METS-VF for predicting T2DM was largest among six indices. The METS-VF may be a reliable and applicable predictor of T2DM incidence in Chinese people regardless of sex, age or BMI.
Angiopoietin-like 4 (ANGPTL4) is a potent regulator of triacylglycerol metabolism but knowledge of the mechanisms underlying ANGPTL4 transcription in response to fatty acids is still limited in teleost. In this study, we explored the molecular characterization of ANGPTL4 and regulatory mechanisms of ANGPTL4 in response to fatty acids in large yellow croaker (Larimichthys crocea). Here, croaker angptl4 contained a 1416 bp open reading frame encoding a protein of 471 amino acids with highly conserved 12-amino acid consensus motif. Angptl4 was widely expressed in croaker, with the highest expression in the liver. In vitro, oleic and palmitic acids (OA and PA) treatments strongly increased angptl4 mRNA expression in croaker hepatocytes. Moreover, angptl4 expression was positively regulated by peroxisome proliferator-activated receptor family (PPAR-α, β and γ) and expression of pparγ was also significantly increased in response to OA and PA. Moreover, inhibition of PPARγ abrogated OA or PA-induced angptl4 mRNA expression. Beyond that, PA might increase angptl4 expression partly via the insulin signaling. Overall, the expression of ANGPTL4 is strongly upregulated by OA and PA via PPARγ in the liver of croaker, which contributes to improve the understanding of the regulatory mechanisms of ANGPTL4 in fish.
The effect of vitamin D (VD) on the risk of preeclampsia (PE) is uncertain. Few of previous studies focused on the relationship between dietary VD intake and PE risk. Therefore, we conducted this 1:1 matched case–control study to explore the association of dietary VD intake and serum VD concentrations with PE risk in Chinese pregnant women. A total of 440 pairs of participants were recruited during March 2016 to June 2019. Dietary information was obtained using a seventy-eight-item semi-quantitative FFQ. Serum concentrations of 25(OH)D2 and 25(OH)D3 were measured by liquid chromatography–tandem MS. Multivariate conditional logistic regression was used to estimate OR and 95 % CI. Restricted cubic splines (RCS) were plotted to evaluate the dose–response relationship of dietary VD intake and serum VD concentrations with PE risk. Compared with the lowest quartile, the OR of the highest quartile were 0·45 (95 % CI 0·29, 0·71, Ptrend = 0·001) for VD dietary intake and 0·26 (95 % CI 0·11, 0·60, Ptrend = 0·003) for serum levels after adjusting for confounders. In addition, the RCS analysis suggested a reverse J-shaped relationship between dietary VD intake and PE risk (P-nonlinearity = 0·02). A similar association was also found between serum concentrations of total 25(OH)D and PE risk (P-nonlinearity = 0·02). In conclusion, this study provides evidence that higher dietary intake and serum levels of VD are associated with the lower risk of PE in Chinese pregnant women.
Varicella is a highly infectious contagious disease, and Chongqing is one of the high incidence areas in China. To understand the epidemic regularity and predict the epidemic trend of varicella is of great significance to the risk analysis and health resource allocation in the health sector. First, we used the ‘STL’ function to decompose the incidence of varicella to understand its trend and seasonality. Second, we established SARIMA model for linear fitting, and then took the residual of the SARIMA model as the sample to fit the LS-SVM model, to explain the non-linearity of the residuals. The monthly varicella incidence peaks in April to June and October to December. Mixed model was compared to SARIMA model, the prediction error of the hybrid model was smaller, and the RMSE and MAPE values of the hybrid model were 0.7525 and 0.0647, respectively, the mixed model had a better prediction effect. Based on the study, the incidence of varicella in Chongqing has an obvious seasonal trend, and a hybrid model can also predict the incidence of varicella well. Thus, hybrid model analysis is a feasible and simple method to predict varicella in Chongqing.
The medium-sized Ergu Fe–Zn polymetallic skarn deposit is located in the central Lesser Xing’an Range, NE China. The ore bodies are mainly hosted in the contact zone between granodiorite intrusions and lower Cambrian dolomitic crystalline limestones or skarns. To reveal the magmatic influence on the mineralization, resource potential and metallogenic geodynamic process of this deposit, a systematic study of the geology, petrology, zircon U–Pb dating, element geochemistry, amphibole geochemistry and Sr–Nd–Pb–Hf isotopes of the Ergu deposit intrusives was conducted. The results show the following: (1) The major rock types in the mine area are medium-grained granodiorite and porphyritic granite, and the rock related to mineralization is medium-grained granodiorite. Zircon U–Pb dating suggests that the granodiorite and porphyritic granite formed at 181.9–183.8 Ma and 182.7 Ma, respectively. Thus, an Early Jurassic magmatic event led to the formation of the Ergu deposit. (2) The granodiorite and porphyritic granite are high-K calc-alkaline I-type granites that formed by comagmatic evolution with varying degrees of fractional crystallization and were likely derived from partial melting of the lower crust. The Ergu deposit occurred in an active continental-margin tectonic setting. (3) The high water content (5.69 wt % H2O), high oxygen fugacity (ΔFMQ = +1.75 to +1.82) and intermediate-plutonic emplacement (3.13 km) of the granodioritic magma are key factors in the formation of the Ergu deposit. The porphyry granite is characterized by high water content (>4 wt % H2O), reduced oxygen fugacity (ΔFMQ = −0.47) and shallow emplacement (<3 km).
Seasonal climate variability is an important component of Earth's climate system, and has a significant impact on ecosystems and social systems. However, the temporal resolution of most proxy-based paleoclimate records is limiting to fully understand the past seasonal changes. Here, we used high-precision monthly resolution Sr/Ca records of three Tridacna squamosa specimens from the northern South China Sea (SCS) to reconstruct the sea surface temperature (SST) seasonality during three time periods from the middle Holocene. The results suggested that SST seasonality in the northern SCS during the middle Holocene (3.21 ± 0.98°C) was smaller than that for recent decades (AD 1994–2004, 4.32 ± 0.59°C). Analysis of modern instrumental data showed that the SST seasonality in the northern SCS was dominated by the winter SST, which was deeply influenced by the intensity of East Asian winter monsoon (EAWM). A strong EAWM usually resulted in cooler winter SST and a larger SST seasonality in the northern SCS. The reconstructed Holocene EAWM records showed that the EAWM strengthened from the middle to late Holocene, which was seen in our reconstruction of less SST seasonality changes during the middle Holocene in the northern SCS. This study highlighted that the Sr/Ca ratios from Tridacna shells can be used as a potential high-resolution indicator of past seasonal climate changes.
In minimally invasive surgery, surgical instruments with a wrist joint have better flexibility. However, the bending motion of the wrist joint causes a coupling motion between the end-effector and wrist joint, affecting the accuracy of the movement of the surgical instrument. Aiming at this problem, a new gear train decoupling method is proposed in the paper, which can automatically compensate for the coupled motion in real-time. Based on the performance tests of the instrument prototype, a series of decoupling effects tests are carried out. The test results show that the surgical instrument has excellent decoupling ability and stable performance.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in shortages of personal protective equipment (PPE), underscoring the urgent need for simple, efficient, and inexpensive methods to decontaminate masks and respirators exposed to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). We hypothesized that methylene blue (MB) photochemical treatment, which has various clinical applications, could decontaminate PPE contaminated with coronavirus.
Design:
The 2 arms of the study included (1) PPE inoculation with coronaviruses followed by MB with light (MBL) decontamination treatment and (2) PPE treatment with MBL for 5 cycles of decontamination to determine maintenance of PPE performance.
Methods:
MBL treatment was used to inactivate coronaviruses on 3 N95 filtering facepiece respirator (FFR) and 2 medical mask models. We inoculated FFR and medical mask materials with 3 coronaviruses, including SARS-CoV-2, and we treated them with 10 µM MB and exposed them to 50,000 lux of white light or 12,500 lux of red light for 30 minutes. In parallel, integrity was assessed after 5 cycles of decontamination using multiple US and international test methods, and the process was compared with the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O3) decontamination method.
Results:
Overall, MBL robustly and consistently inactivated all 3 coronaviruses with 99.8% to >99.9% virus inactivation across all FFRs and medical masks tested. FFR and medical mask integrity was maintained after 5 cycles of MBL treatment, whereas 1 FFR model failed after 5 cycles of VHP+O3.
Conclusions:
MBL treatment decontaminated respirators and masks by inactivating 3 tested coronaviruses without compromising integrity through 5 cycles of decontamination. MBL decontamination is effective, is low cost, and does not require specialized equipment, making it applicable in low- to high-resource settings.
Bacterial dysentery (BD) brings a major disease burden to developing countries. Exploring the influence of temperature and its interaction with other meteorological factors on BD is significant for the prevention and early warning of BD in the context of climate change. Daily BD cases and meteorological data from 2008 to 2018 were collected in all nine prefecture-level cities in Jilin Province. A one-stage province-level model and a two-stage city-specific multivariate meta-pooled level distributed lag non-linear model were established to explore the correlation between temperature and BD, then the weather-stratified generalised additive model was used to test the interaction. During the study period, a total of 26 971 cases of BD were developed. The one-stage and two-stage cumulative dose-response ‘J’ curves overlapped, and results showed a positive correlation between temperature and BD with a 1–6 days lag effect. Age group ⩾5 years was found to be more sensitive to the effects. Moreover, there was a significant interaction between temperature, humidity and precipitation (P = 0.004, 0.002, respectively) on BD under high temperature (>0 °C), reminding residents and policymakers to pay attention to the prevention of BD in situations with both high temperature and humidity, high temperature and precipitation during the temperate monsoon climate.
The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort.
Design:
In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status.
Setting:
Longitudinal population-based cohort.
Participants:
17 262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China.
Results:
During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22–24 kg/m2, with BMI ≤ 18, 18–20, 20–22, 24–26, 26–28, 28–30 and >30 kg/m2, the hazard ratios for mortality in normotensive participants were 1·92 (95% CI 1·23, 3·00), 1·44 (95% CI 1·01, 2·05), 1·14 (95% CI 0·82, 1·58), 0·96 (95% CI 0·70, 1·31), 0·96 (95% CI 0·65, 1·43), 1·32 (95% CI 0·81, 2·14) and 1·32 (95% CI 0·74, 2·35), respectively, and in hypertensive participants were 1·85 (95% CI 1·08, 3·17), 1·67 (95% CI 1·17, 2·39), 1·29 (95% CI 0·95, 1·75), 1·20 (95% CI 0·91, 1·58), 1·10 (95% CI 0·83, 1·46), 1·10 (95% CI 0·80, 1·52) and 0·61 (95% CI 0·40, 0·94), respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity v. normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants.
Conclusions:
Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.
To describe characteristics of veterans with MDD and the different treatment regimens received during the first observed and treated major depressive episode (MDE).
Methods
A retrospective study was performed using the Veterans Health Administration (VHA) database from 4/1/2015 to 2/28/2019 (study period), supplemented with Medicare Part A/B/D data from 4/1/2015 to 12/31/2017. Adult veterans with ≥1 MDD diagnosis in the VHA database between 10/1/2015 and 2/28/2017 (index date) were included if they received ≥1 line of therapy (LOT) within a complete MDE. An MDE was considered as starting on the date of the first observed MDD diagnosis preceded by ≥6 months depression-free period (i.e. a period without an MDD diagnosis or antidepressant (AD) use); an MDE was considered as ended on the date of the last MDD diagnosis or the end of the medication supply of the last AD/augmentation medication, whichever came last and then followed by ≥6 months depression-free period. An MDE was required to begin and end during the study period. A LOT was defined as ≥1 AD at adequate dose and duration (≥6 weeks of continuous therapy with no gaps longer than 14 days) with or without an augmenting medication. Patients were required to have VA benefit enrollment for ≥6 months before (baseline) and ≥24 months after index (follow-up). Patient baseline demographic and clinical characteristics as well as the number and type of LOTs (up to the first six LOTs) received during the first observed and treated MDE were evaluated.
Results
Overall, 40,240 veterans with MDD were identified (mean ± standard deviation [SD] age: 50.9±16.3 years).The majority were male (83.9%), White (63.4%), and non-Hispanic (88.6%); 60.1% were unemployed or retired at some point during the study period. The most commonly observed baseline comorbidities included hypertension (27.5%), hyperlipidemia (20.8%), post-traumatic stress disorder (17.5%), and diabetes (14.8%). During the first observed and treated MDE (mean ± SD duration: 14.7 ± 8.6 months), patients received a mean of 1.6±1.0 LOTs, with 36.5% and 14.6% of patients receiving ≥2 and ≥3 LOTs, respectively; 0.8% of patients received ≥6 LOTs. The most commonly observed therapies were SSRI monotherapy (58.9%) followed by SNRI monotherapy (8.8%) in LOT1; SSRI monotherapy followed by AD augmented with anticonvulsants in LOT2 (SSRI monotherapy: 48.7%; AD augmentation with anticonvulsants:12.1%) and LOT3 (SSRI monotherapy: 43.5%; AD augmentation with anticonvulsants:15.0%).
Conclusions
This study used an episodic approach to evaluate the current standard of care among veterans with MDD. During the first observed and treated MDE, about one in seven veterans received ≥3 LOTs, suggesting presence of treatment-resistant MDD. Monotherapy with SSRIs or SNRIs and combination therapies of AD with anticonvulsants were the most common therapies in the first three LOTs.
In this paper, we present a reanalysis of the silicon He-$\mathrm{\alpha}$ X-ray spectrum emission in Fujioka et al.’s 2009 photoionization experiment. The computations were performed with our radiative-collisional code, RCF. The central ingredients of our computations are accurate atomic data, inclusion of satellite lines from doubly excited states and accounting for the reabsorption of the emitted photons on their way to the spectrometer. With all these elements included, the simulated spectrum turns out to be in good agreement with the experimental spectrum.
The aim was to systematically analyse the association of the specific flavonoids, Mg and their interactions from different food sources with the metabolic syndrome (MetS) and its components in a cohort study. A total of 6417 participants aged 20 to 74 years from the Harbin Cohort Study on Diet, Nutrition and Chronic Non-communicable Diseases were included. Multivariate logistic regression analyses, forest plot and restricted cubic spline were performed in the study. After a 5·3-year follow-up, 1283 incident cases of the MetS were reported. Those with a higher total flavonoid intake had a lower risk of the MetS (fourth v. first quartile, relative risk (RR) 0·58; 95 % CI 0·37, 0·93; P = 0·024) and central obesity (RR 0·56; 95 % CI 0·33, 0·95; P = 0·032). Further analysis showed that the specific flavonoids quercetin, kaempferol, isorhamnetin, luteolin, and flavonoids from fruits, potatoes and legumes had the similar associations with risk of the MetS and central obesity (P < 0·05 for all). A higher intake of total flavonoids, quercetin and luteolin combined with a high level of Mg was more strongly associated with a lower risk of the MetS (RR 0·60; 95 % CI 0·45, 0·81 for total; RR 0·61; 95 % CI 0·45, 0·82 for quercetin; RR 0·52; 95 % CI 0·38, 0·71 for luteolin; all Pfor interaction < 0·01). Dose–response effects showed an L-shaped curve between the total intake of five flavonoids and the risk of the MetS. A higher flavonoid intake is associated with a lower risk of the MetS and central obesity; their combination with Mg helps to strengthen their negative association with the MetS.
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.