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The essence of sub-critical transition of oscillatory boundary-layer flows is the non-modal growth of finite-amplitude disturbances. The current understanding of the mechanisms of the orderly and bypass transitions of oscillatory boundary-layer flows is limited. The present study adopts optimisation approaches to predict the maximum energy amplification of two- and three-dimensional perturbations in response to the optimal initial disturbance with or without external forcing. A series of direct numerical simulations are also performed to compare with the results obtained from the stability analyses. In particular, the optimal initial perturbation similar to a Tollmien–Schlichting (T–S) wave yields the largest transient growth under the combined effects of the Orr mechanism and inflectional point instability. With a considerable level of two-dimensional disturbance, the vortex tube nonlinearly develops from the T–S-like wave, and then either deforms into a $\varLambda$-vortex in the near-wall region or rolls up to the free shear region. The further burst of turbulence can follow the first pathway as K-type transition or the second one as vortex tube breakdown due to the elliptical instability. Additionally, non-modal growth can initiate the inception of streaky structures by favourable three-dimensional initial perturbations and/or forcing. The secondary instabilities responsible for the streak breakdown are classified as the varicose (symmetric) and sinuous (anti-symmetric) modes. Under a sufficiently high level of three-dimensional disturbance, the bypass transition is predominantly characterised by the formation of the sinuous mode and turbulent spots, which leads to the suppression of inflection point instability.
Fact, as the logical starting point of evidence law, is empirical in nature. It is this very feature of fact that shapes the basic attribute of evidence, i.e., relevance, and determines that fact-finding is a process of empirical inference. Hence, the truth ascertained by the fact-finder through the “Mirror of Evidence” is probabilistic, characterized by the probability of standards of proof. The “objective fact theory”, which has enjoyed a dominant role in Chinese legal scholarship and judicial practice for a long time, confuses empirical fact with objective existence. As a result, the theory of “objective evidence” was established, and judicial notions such as “seeking truth from fact” and “the perpetrator of every murder case must be captured” are derived from this theory. They not only accounted for the deficiencies in Chinese evidence theories and system, but also led to judicial injustices. In recent years, the Chinese evidence theories and system have evinced a trend of transformation, nevertheless, this transformation is still unfinished.
Nicotine 2,6-dihydroxybenzoate is a nicotine salt that can be used as the nicotine source in tobacco products. X-ray powder diffraction data, unit-cell parameters, and space group for nicotine 2,6-dihydroxybenzoate, C10H15N2⋅C7H5O4, are reported [a = 7.726(8) Å, b = 11.724(3) Å, c = 9.437(1) Å, α = 90°, β = 109.081(3)°, γ = 90°, unit-cell volume V = 802.902 Å3, Z = 2, ρcal = 1.309 g cm−3, and space group P21] at room temperature. All measured lines were indexed and were consistent with the P21 space group.
The apple buprestid, Agrilus mali Matsumura, that was widespread in north-eastern China, was accidently introduced to the wild apple forest ecosystem in mountainous areas of Xinjiang, China. This invasive beetle feeds on domesticated apples and many species of Malus and presents a serious threat to ancestral apple germplasm sources and apple production worldwide. Estimating the potential area at risk of colonization by A. mali is crucial for instigating appropriate preventative management strategies, especially under global warming. We developed a CLIMEX model of A. mali to project this pest's potential distribution under current and future climatic scenarios in 2100 using CSIRO-Mk 3.0 GCM running the SRES A1B emissions scenario. Under current climate, A. mali could potentially invade neighbouring central Asia and eventually the mid-latitude temperate zone, and some subtropical areas and Pampas Steppe in the Southern Hemisphere. This potential distribution encompasses wild apples species, the ancestral germplasm for domesticated apples. With global warming, the potential distribution shifts to higher latitudes, with the potential range expanding slightly, though the overall suitability could decline in both hemispheres. In 2100, the length of the growing season of this pest in the mid-latitude temperature zone could increase by 1–2 weeks, with higher growth rates in most sites compared with current climate in mid-latitudes, at least in China. Our work highlights the need for strategies to prevent the spread of this pest, managing the threats to wild apples in Tian Shan Mountain forests in Central Asia, and commercial apple production globally. We discuss practical management tactics to reduce the spread of this pest and mitigate its impacts.
Previous analyses of grey and white matter volumes have reported that schizophrenia is associated with structural changes. Deep learning is a data-driven approach that can capture highly compact hierarchical non-linear relationships among high-dimensional features, and therefore can facilitate the development of clinical tools for making a more accurate and earlier diagnosis of schizophrenia.
To identify consistent grey matter abnormalities in patients with schizophrenia, 662 people with schizophrenia and 613 healthy controls were recruited from eight centres across China, and the data from these independent sites were used to validate deep-learning classifiers.
We used a prospective image-based meta-analysis of whole-brain voxel-based morphometry. We also automatically differentiated patients with schizophrenia from healthy controls using combined grey matter, white matter and cerebrospinal fluid volumetric features, incorporated a deep neural network approach on an individual basis, and tested the generalisability of the classification models using independent validation sites.
We found that statistically reliable schizophrenia-related grey matter abnormalities primarily occurred in regions that included the superior temporal gyrus extending to the temporal pole, insular cortex, orbital and middle frontal cortices, middle cingulum and thalamus. Evaluated using leave-one-site-out cross-validation, the performance of the classification of schizophrenia achieved by our findings from eight independent research sites were: accuracy, 77.19–85.74%; sensitivity, 75.31–89.29% and area under the receiver operating characteristic curve, 0.797–0.909.
These results suggest that, by using deep-learning techniques, multidimensional neuroanatomical changes in schizophrenia are capable of robustly discriminating patients with schizophrenia from healthy controls, findings which could facilitate clinical diagnosis and treatment in schizophrenia.
The sudden outbreak of the COVID-19 pandemic has caused tremendous challenges to the medical system. The government and hospitals have taken robust measures to curb the spread of the deadly virus. Its impact on routine medical services is gradually being taken seriously.
To identify the impact of the novel Coronavirus pandemic on emergency department (ED) patient flow and the performance of the routine ED service.
This retrospective cohort study was undertaken in a tertiary public teaching hospital ED in Chengdu, China. ED data of patients were routinely collected to compare demographic, clinical characteristics and outcomes during an 8-week period from January 1, 2019 to February 25, 2020. Data were analyzed with the chi-square statistical test.
Over the study periods, there were 31855 and 25244 patients presented to the ED in 2019 and 2020 respectively. During the pandemic period in 2020, the daily number of average ED visits was lower than that in 2019 (430 ± 134.9 versus 572 ± 38.6, P = 0.00), with fewer triage 1&2 cases (145 ± 33.3 versus 178 ± 15.0, P = 0.00). Nevertheless, the mortality increased remarkably during the pandemic period in 2020 (0.2% versus 0.1%, P = 0.009), with higher APACHE II scores (28 versus 19, P = 0.022) and shorter ED elapsed time (0.2 versus 1.4 days, P = 0.016) among these death cases.
The COVID-19 pandemic had an evident impact on the patient’s behavioral patterns and routine emergency services, which caused higher ED mortality.
Hierarchical layered double hydroxide (HLDH) was synthesized by using sodium dodecyl sulfate (SDS) as a soft-template agent for the removal of two charged organic dyes (i.e. methylene blue (MB; cationic dye) and methyl orange (MO; anionic dye)). The experimental results based on response surface methodology (RSM) demonstrated distinct removal behaviours of HLDH towards these two dyes: (1) the maximum capacity was 416.7 mg g–1 for MO and 58.7 mg g–1 for MB at 25°C; (2) the increase in temperature could enhance MO removal significantly, whereas it had a negligible effect on the MB treatment process; and (3) rapid removal of MB (5 min) compared to MO (480 min) was observed. In addition, the removal process for both dyes was pH-independent. Multiple characterization techniques further revealed the removal mechanisms, demonstrating that SDS played a significant role in the removal of both dyes; that is, MO replaced SDS to be intercalated into the HLDH interlayer via anion exchange. MB could influence the –SO3 group of SDS, resulting in it modifying the electrodensity of SDS. It could then be further combined with an SDS anion (DS–) via hydrophobic and electrostatic interactions to form DS-MB monolayers. This work not only provides an efficient capture agent for charged dyes, but also offers a deep insight into the underlying removal mechanism.
No relevant studies have yet been conducted to explore which measurement can best predict the survival time of patients with cancer cachexia. This study aimed to identify an anthropometric measurement that could predict the 1-year survival of patients with cancer cachexia. We conducted a nested case–control study using data from a multicentre clinical investigation of cancer from 2013 to 2020. Cachexia was defined using the Fearon criteria. A total of 262 patients who survived less than 1 year and 262 patients who survived more than 1 year were included in this study. Six candidate variables were selected based on clinical experience and previous studies. Five variables, BMI, mid-arm circumference, mid-arm muscle circumference, calf circumference and triceps skin fold (TSF), were selected for inclusion in the multivariable model. In the conditional logistic regression analysis, TSF (P = 0·014) was identified as a significant independent protective factor. A similar result was observed in all patients with cancer cachexia (n 3084). In addition, a significantly stronger positive association between TSF and the 1-year survival of patients with cancer cachexia was observed in participants aged > 65 years (OR: 0·94; 95 % CI 0·89, 0·99) than in those aged ≤ 65 years (OR: 0·96; 95 % CI 0·93, 0·99; Pinteraction = 0·013) and in participants with no chronic disease (OR: 0·92; 95 % CI 0·87, 0·97) than in those with chronic disease (OR: 0·97; 95 % CI 0·94, 1·00; Pinteraction = 0·049). According to this study, TSF might be a good anthropometric measurement for predicting 1-year survival in patients with cancer cachexia.
The function and change of global soil carbon (C) reserves in natural ecosystems are key regulators of future carbon-climate coupling. Microbes play a critical role in soil carbon cycling and yet there is poor understanding of their roles and C metabolism flexibility in many ecosystems. We wanted to determine whether vegetation type and climate zone influence soil microbial community composition (fungi and bacteria) and carbon resource preference. We used a biomarker (phospholipid fatty acids, PLFAs), natural abundance 13C and 14C probing approach to measure soil microbial composition and C resource use, along a 1900–4167-m elevation gradient on Mount Gongga (7556 m asl), China. Mount Gongga has a vertical mean annual temperature gradient of 1.2–10.1°C and a diversity of typical vegetation zones in the Tibetan Plateau. Soils were sampled at 10 locations along the gradient capturing distinct vegetation types and climate zones from lowland subtropical-forest to alpine-meadow. PLFA results showed that microbial communities were composed of 2.1–51.7% bacteria and 2.0–23.2% fungi across the elevation gradient. Microbial biomass was higher and the ratio of soil fungi to bacteria (F/B) was lower in forest soils compared to meadow soils. δ13C varied between −33‰ to −17‰ with C3 plant carbon sources dominant across the gradient. Soil organic carbon (SOC) turnover did not vary among three soils we measured from three forest types (i.e., evergreen broadleaved subtropical, mixed temperate, coniferous alpine) and dissolved organic carbon (DOC) turnover decreased with soil elevation. Forest soil microbial PLFA 14C and δ13C measurements showed that forest type and climate were related to different microbial C use. The 14C values of microbial PLFAs i15, a15, 16:1, br17 decreased with elevation while those of C16:0, cyC17, and cyC19 did not show much difference among three forest ecosystems. Bacteria and bacillus represented by C16:1 and brC17 showed considerable microbial C metabolism flexibility and tended to use ancient carbon at higher altitudes. Anaerobes represented by cyC17 and cyC19 showed stronger C metabolism selectivity. Our findings reveal specific C source differences between and within soil microbial groups along elevation gradients.
Environmental hypoxia exposure causes fertility problems in human and animals. Compelling evidence suggests that chronic hypoxia impairs spermatogenesis and reduces sperm motility. However, it is unclear whether paternal hypoxic exposure affects fertilization and early embryo development. In the present study, we exposed male mice to high altitude (3200 m above sea level) for 7 or 60 days to evaluate the effects of hypoxia on sperm quality, zygotic DNA methylation and blastocyst formation. Compared with age-matched controls, hypoxia-treated males exhibited reduced fertility after mating with normoxic females as a result of defects in sperm motility and function. Results of in vitro fertilization (IVF) experiments revealed that 60 days’ exposure significantly reduced cleavage and blastocyst rates by 30% and 70%, respectively. Immunohistochemical staining of pronuclear formation indicated that the pronuclear formation process was disturbed and expression of imprinted genes was reduced in early embryos after paternal hypoxia. Overall, the findings of this study suggested that exposing male mice to hypoxia impaired sperm function and affected key events during early embryo development in mammals.
Nowadays, automated essay evaluation (AEE) systems play an important role in evaluating essays and have been successfully used in large-scale writing assessments. However, existing AEE systems mostly focus on grammar or shallow content measurements rather than higher-order traits such as ideas. This paper proposes a new formulation of graph-based features for concept maps using word embeddings to evaluate the quality of ideas for Chinese compositions. The concept map derived from the student’s composition is composed of the concepts appearing in the essay and the co-occurrence relationship between the concepts. By utilizing real compositions written by eighth-grade students from a large-scale assessment, the scoring accuracy of the computer evaluation system (named AECC-I: Automated Evaluation for Chinese Compositions—Ideas) is higher than the baselines. The results indicate that the proposed method deepens the construct-relevant coverage of automatic ideas evaluation in compositions and that it can provide constructive feedback for students.
This study aims to identify error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment (PPE).
A total of 56 health care workers, including 37 nurses and 19 physicians, were recruited to don and doff the PPE recommended by the Chinese Center for Disease Control and Prevention. Operational errors and sites of self-contamination were recorded using UV-fluorescent labeling and video surveillance.
Three main errors during donning were identified: choosing a loose-fitting coverall that was difficult to handle; ignoring to inspect the seal of N95 respirator or gloves; and forgetting to pull up the zipper completely. Four main errors during doffing were identified: removing the N95 respirator in a wrong way; touching the scrubs with contaminated hands and elbows; touching contaminated external surfaces of the goggles; and performing insufficient hand hygiene. Key sites that were easily contaminated during the doffing of PPE included left hand and wrist, left lower leg, chest, and left abdomen.
Identifying the steps prone to errors and key sites of self-contamination in the process of PPE donning and doffing can facilitate the training of PPE use and provide detailed evidence for optimizing standardized protocols to reduce contamination.
Salicylic acid (SA), a phytohormone, has been considered to be a key regulator mediating plant defence against pathogens. It is still vague how SA activates plant defence against herbivores such as chewing and sucking pests. Here, we used an aphid-susceptible wheat variety to investigate Sitobion avenae response to SA-induced wheat plants, and the effects of exogenous SA on some defence enzymes and phenolics in the plant immune system. In SA-treated wheat seedlings, intrinsic rate of natural increase (rm), fecundity and apterous rate of S. avenae were 0.25, 31.4 nymphs/female and 64.4%, respectively, and significantly lower than that in the controls (P < 0.05). Moreover, the increased activities of phenylalanine-ammonia-lyase, polyphenol oxidase (PPO) and peroxidase in the SA-induced seedlings obviously depended on the sampling time, whereas activities of catalase and 4-coumarate:CoA ligase were suppressed significantly at 24, 48 and 72 h in comparison with the control. Dynamic levels of p-coumaric acid at 96 h, caffeic acid at 24 and 72 h and chlorogenic acid at 24, 48 and 96 h in wheat plants were significantly upregulated by exogenous SA application. Nevertheless, only caffeic acid content was positively correlated with PPO activity in SA-treated wheat seedlings (P = 0.031). These findings indicate that exogenous SA significantly enhanced the defence of aphid-susceptible wheat variety against aphids by regulating the plant immune system, and may prove a potential application of SA in aphid control.
A multicenter study of sharps injuries (SIs) and other blood or body fluid (OBBF) exposures was conducted among 33,156 healthcare workers (HCWs) from 175 hospitals in Anhui, China. In total, 12,178 HCWs (36.7%) had experienced at least 1 SI in the previous 12 months and 8,116 HCWs (24.5%) had experienced at least 1 OBBF exposure during the previous 12 months.
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 study aimed to explore the impacts of COVID-19 outbreak on mental health status in general population in different affected areas in China.
This was a comparative study including two groups of participants: (1) general population in an online survey in Ya'an and Jingzhou cities during the COVID-19 outbreak from 10–20 February 2020; and (2) matching general population selected from the mental health survey in Ya'an in 2019 (from January to May 2019). General Health Questionnaire (GHQ-12), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used.
There were 1775 participants (Ya'an in 2019 and 2020: 537 respectively; Jingzhou in 2020: 701). Participants in Ya'an had a significantly higher rate of general health problems (GHQ scores ⩾3) in 2020 (14.7%) than in 2019 (5.2%) (p < 0.001). Compared with Ya'an (8.0%), participants in Jingzhou in 2020 had a significantly higher rate of anxiety (SAS scores ⩾50, 24.1%) (p < 0.001). Participants in Ya'an in 2020 had a significantly higher rate of depression (SDS scores ⩾53, 55.3%) than in Jingzhou (16.3%) (p < 0.001). The risk factors of anxiety symptoms included female, number of family members (⩾6 persons), and frequent outdoor activities. The risk factors of depression symptoms included participants in Ya'an and uptake self-protective measures.
The prevalence of psychological symptoms has increased sharply in general population during the COVID-19 outbreak. People in COVID-19 severely affected areas may have higher scores of GHQ and anxiety symptoms. Culture-specific and individual-based psychosocial interventions should be developed for those in need during the COVID-19 outbreak.
The present study was conducted to test the hypothesis that dietary supplementation with a nano chitosan–zinc complex (CP–Zn, 100 mg/kg Zn) could alleviate weaning stress in piglets challenged with enterotoxigenic Escherichia coli K88 by improving growth performance and intestinal antioxidant capacity. The in vivo effects of CP–Zn on growth performance variables (including gastrointestinal digestion and absorption functions and the levels of key proteins related to muscle growth) and the antioxidant capacity of the small intestine (SI) were evaluated in seventy-two weaned piglets. The porcine jejunal epithelial cell line IPEC-J2 was used to further investigate the antioxidant mechanism of CP–Zn in vitro. The results showed that CP–Zn supplementation increased the jejunal villus height and decreased the diarrhoea rate in weaned piglets. CP–Zn supplementation also improved growth performance (average daily gain and average daily feed intake), increased the activity of carbohydrate digestion-related enzymes (amylase, maltase, sucrase and lactase) and the mRNA expression levels of nutrient transporters (Na+-dependent glucose transporter 1, glucose transporter type 2, peptide transporter 1 and excitatory amino acid carrier 1) in the jejunum and up-regulated the expression levels of mammalian target of rapamycin (mTOR) pathway-related proteins (insulin receptor substrate 1, phospho-mTOR and phospho-p70S6K) in muscle. In addition, CP–Zn supplementation increased glutathione content, enhanced total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-px) activity, and reduced malondialdehyde (MDA) content in the jejunum. Furthermore, CP–Zn decreased the content of MDA and reactive oxygen species, enhanced the activity of T-SOD and GSH-px and up-regulated the expression levels of nuclear factor erythroid 2-related factor 2 (Nrf2) pathway-related proteins (Nrf2, NAD(P)H:quinone oxidoreductase 1 and haeme oxygenase 1) in lipopolysaccharide-stimulated IPEC-J2 cells. Collectively, these findings indicate that CP–Zn supplementation can improve growth performance and the antioxidant capacity of the SI in piglets, thus alleviating weaning stress.
The disease burden of infectious diarrhea cannot be underestimated. Its seasonal patterns indicate that weather patterns may play an important role and have an important effect on it. The objective of this study was to clarify the relationship between temperature and infectious diarrhea, and diarrhea-like illness.
Distributed lag non-linear model, which was based on the definition of a cross-basis, was used to examine the effect.
Viral diarrhea usually had high incidence in autumn-winter and spring with a peak at -6°C; Norovirus circulated throughout the year with an insignificant peak at 8°C, while related bacteria usually tested positive in summer and peaked at 22°C. The lag-response curve of the proportion of diarrhea-like cases in outpatient and emergency cases revealed that at -6°C, with the lag days increasing, the proportion increased. Similar phenomena were observed at the beginning of the curves of virus and bacterial positive rate, showing that the risk increased as the lag days increased, peaking on days 16 and 9, respectively. The shape of lag-response curve of norovirus positive rate was different from others, presenting m-type, with 2 peaks on day 3 and day 18.
Weather patterns should be taken into account when developing surveillance programs and formulating relevant public health intervention strategies.
A recently developed pneumonia caused by SARS-CoV-2 has quickly spread across the world. Unfortunately, a simplified risk score that could easily be used in primary care or general practice settings has not been developed. The objective of this study is to identify a simplified risk score that could easily be used to quickly triage severe COVID-19 patients. All severe and critical adult patients with laboratory-confirmed COVID-19 on the West campus of Union Hospital, Wuhan, China, from 28 January 2020 to 29 February 2020 were included in this study. Clinical data and laboratory results were obtained. CURB-65 pneumonia score was calculated. Univariate logistic regressions were applied to explore risk factors associated with in-hospital death. We used the receiver operating characteristic curve and multivariate COX-PH model to analyse risk factors for in-hospital death. A total of 74 patients (31 died, 43 survived) were finally included in the study. We observed that compared with survivors, non-survivors were older and illustrated higher respiratory rate, neutrophil-to-lymphocyte ratio, D-dimer and lactate dehydrogenase (LDH), but lower SpO2 as well as impaired liver function, especially synthesis function. CURB-65 showed good performance for predicting in-hospital death (area under curve 0.81, 95% confidence interval (CI) 0.71–0.91). CURB-65 ⩾ 2 may serve as a cut-off value for prediction of in-hospital death in severe patients with COVID-19 (sensitivity 68%, specificity 81%, F1 score 0.7). CURB-65 (hazard ratio (HR) 1.61; 95% CI 1.05–2.46), LDH (HR 1.003; 95% CI 1.001–1.004) and albumin (HR 0.9; 95% CI 0.81–1) were risk factors for in-hospital death in severe patients with COVID-19. Our study indicates CURB-65 may serve as a useful prognostic marker in COVID-19 patients, which could be used to quickly triage severe patients in primary care or general practice settings.
LMNA mutations cause a variety of inherited diseases referred to as laminopathies which are associated with a wide spectrum of disease phenotypes, ranging from skeletal muscle disease, pre-mature ageing, metabolic disorders, and cardiac abnormalities. We present a case of a 14-year-old boy with dilated cardiomyopathy induced by the LMNA mutation (p. R429C) and described its electrocardiogram and imaging features.