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The China Rural Hypertension Control Project (CRHCP) is a nonphysician-led community-based hypertension intervention program that has demonstrated clear benefits in improving blood pressure (BP) control and reducing the incidence of cardiovascular disease events among hypertensive patients in rural areas of China. However, it is currently unclear whether the benefits of the CRHCP outweigh its costs, and whether promoting this project in China is justifiable from a perspective of healthcare system.
Methods
We employed a Markov model to forecast the anticipated 20-year costs and effectiveness of the CRHCP trial. Cost data for this study was gathered from public records or published papers, whereas clinical data was extracted from the CRHCP trial. Our primary outcome measure was the incremental cost-effectiveness ratio, expressed in Chinese Yuan (CNY) per quality-adjusted life-year (QALY), representing the additional cost per additional QALY gained.
Results
Over a span of 20 years, the cost for a rural hypertensive individual in China who received intensive BP intervention by a nonphysician community healthcare provider would amount to 25,129 CNY, yielding an effectiveness of 8.19 QALY. In contrast, if usual care was provided, the cost would be 26,709 CNY with an effectiveness of 7.94 QALY. The CRHCP program demonstrated lower costs and greater effectiveness for rural hypertensive individuals in China.
Conclusion
Our study indicates that the implementation of the CRHCP program among rural hypertensive individuals in China resulted in increased effectiveness and reduced costs. From the perspective of Chinese healthcare system, the CRHCP program proves to be cost-saving within the current healthcare landscape.
Although numerous neuroimaging studies have depicted neural alterations in individuals with obsessive–compulsive disorder (OCD), a psychiatric disorder characterized by intrusive cognitions and repetitive behaviors, the molecular mechanisms connecting brain structural changes and gene expression remain poorly understood.
Methods
This study combined the Allen Human Brain Atlas dataset with neuroimaging data from the Meta-Analysis (ENIGMA) consortium and independent cohorts. Later, partial least squares regression and enrichment analysis were performed to probe the correlation between transcription and cortical thickness variation among adults with OCD.
Results
The cortical map of case-control differences in cortical thickness was spatially correlated with cortical expression of a weighted combination of genes enriched for neurobiologically relevant ontology terms preferentially expressed across different cell types and cortical layers. These genes were specifically expressed in brain tissue, spanning all cortical developmental stages. Protein–protein interaction analysis revealed that these genes coded a network of proteins encompassing various highly interactive hubs.
Conclusions
The study findings bridge the gap between neural structure and transcriptome data in OCD, fostering an integrative understanding of the potential biological mechanisms.
This study investigates the impact of primary care utilisation of a symptom-based head and neck cancer risk calculator (Head and Neck Cancer Risk Calculator version 2) in the post-coronavirus disease 2019 period on the number of primary care referrals and cancer diagnoses.
Methods
The number of referrals from April 2019 to August 2019 and from April 2020 to July 2020 (pre-calculator) was compared with the number from the period January 2021 to August 2022 (post-calculator) using the chi-square test. The patients’ characteristics, referral urgency, triage outcome, Head and Neck Cancer Risk Calculator version 2 score and cancer diagnosis were recorded.
Results
In total, 1110 referrals from the pre-calculator period were compared with 1559 from the post-calculator period. Patient characteristics were comparable for both cohorts. More patients were referred on the cancer pathway in the post-calculator cohort (pre-calculator patients 51.1 per cent vs post-calculator 64.0 per cent). The cancer diagnosis rate increased from 2.7 per cent in the pre-calculator cohort to 3.3 per cent in the post-calculator cohort. A lower rate of cancer diagnosis in the non-cancer pathway occurred in the cohort managed using the Head and Neck Cancer Risk Calculator version 2 (10 per cent vs 23 per cent, p = 0.10).
Conclusion
Head and Neck Cancer Risk Calculator version 2 demonstrated high sensitivity in cancer diagnosis. Further studies are required to improve the predictive strength of the calculator.
In the present study, acid-modified attapulgite was used, as an adsorbent, to remove as much Cd2+ as possible from aqueous solution. Static adsorption experiments using powdered acid-modified attapulgite, and dynamic adsorption using granular acid-modifed attapulgite, were conducted to explore the practical application of modified attapulgite in the adsorption of Cd2+. The modified attapulgite had a larger specific surface area and thinner fibrous crystals than the unmodified version. No obvious differences were noted, in terms of the crystal structure, between the natural attapulgite and the modified version. The effects of initial concentration, pH, contact time, and ionic strength on the adsorption of Cd2+ were investigated, and the results showed that the adsorption capacity of the modified attapulgite was increased with increasing pH and the initial Cd2+ concentration. The adsorption properties were analyzed by means of dynamic adsorption tests with respect to various Cd2+ concentrations and flow rates. The maximum adsorption capacity of 8.83 mg/g occurred at a flow rate of 1 mL/min and at an initial concentration of 75 mg/L. Because there was better accord between the data and a pseudo-second order model than a pseudo-first-order model, external mass transfer is suggested to be the rate-controlling process. The experimental data were also fitted for the intraparticle diffusion model, implying that the intraparticle diffusion of Cd2+ onto the modified attapulgite was also important for controlling the adsorption process. The Bohart-Adams model was more suitable than the Thomas model for describing the dynamic behavior with respect to the flow rate and the initial Cd2+ concentration. This research provided the theoretical basis for the dynamic adsorption of Cd2+ on the modified attapulgite. Compared to the powdered modified attapulgite, the dynamic adsorption by granular modified attapulgite appeared more favorable in terms of practical application.
The hydraulic conductivity of geosynthetic clay liners (GCLs) is not fully understood and certain gaps in knowledge are still present, such as the effect of coupled mechanical and chemical processes. The current study aimed to develop a simplified mathematical model to predict the hydraulic conductivity of GCLs, particularly regarding the coupled effects of mechanical and chemical processes. Based on Darcy's Law and Poiseuille’s Law, the method combines diffuse double layer (DDL) theory and fractal theory. External factors such as confining pressure and the concentration of the permeating solution, and inherent properties such as exchangeable cations, ionic radius, montmorillonite surface fractal dimension, the distance between two montmorillonite layers (m) after swelling at the exchangeable cation i (i denotes the primary exchangeable cations, such as Na+, Ca2+, K+, and Mg2+ in bentonite), density, and coefficient of viscosity of interlayer water between two montmorillonite layers, were considered. The proposed theoretical model gave relatively accurate predictions. A practical estimate of GCL hydraulic conductivity was also derived. The predictions were compared with experimental results and good qualitative agreement was found. From the experimental results, the proposed prediction model has a maximum deviation of ~1:10–10:1, and the empirical model has a mean deviation of ~1:15–15:1.
This paper studies the relationship between slack and research and development (R&D) investment by addressing the role of the founder as the ‘microfoundation’ among Chinese newly listed firms. We propose a contingent approach to understanding the slack-R&D investment relationship by examining the influence of the founder’s human capital and social ties, which is distinguished into political and managerial ties. Our results show that the founder’s human capital, measured by its educational level, strengthens the relationship between absorbed and unabsorbed slack resources and R&D investment. We also find that the founder’s managerial ties strengthen the relationship between resource slack and R&D intensity, whereas political ties weaken that link. Our results demonstrate the founder’s crucial role in underpinning resource utilization in newly listed firms and emphasise the importance of social ties in driving firms’ R&D activities in emerging economies.
Dietary antioxidant indices (DAI) may be potentially associated with relative telomere length (RTL) of leucocytes. This study aimed to investigate the relationship between DAI and RTL. A cross-sectional study involving 1656 participants was conducted. A generalised linear regression model and a restricted cubic spline model were used to assess the correlation of DAI and its components with RTL. Generalised linear regression analysis revealed that DAI (β = 0·005, P = 0·002) and the intake of its constituents vitamin C (β = 0·043, P = 0·027), vitamin E (β = 0·088, P < 0·001), Se (β = 0·075, P = 0·003), and Zn (β = 0·075, P = 0·023) were significantly and positively correlated with RTL. Sex-stratified analysis showed that DAI (β = 0·006, P = 0·005) and its constituents vitamin E (β = 0·083, P = 0·012), Se (β = 0·093, P = 0·006), and Zn (β = 0·092, P = 0·034) were significantly and positively correlated with RTL among females. Meanwhile, among males, only vitamin E intake (β = 0·089, P = 0·013) was significantly and positively associated with RTL. Restricted cubic spline analysis revealed linear positive associations between DAI and its constituents’ (vitamin E, Se and Zn) intake and RTL in the total population. Sex-stratified analysis revealed a linear positive correlation between DAI and its constituents’ (vitamin E, Se and Zn) intake and RTL in females. Our study found a significant positive correlation between DAI and RTL, with sex differences.
An accurate dynamic model of a robot is fundamentally important for a control system, while uncertainties residing in the model are inevitable in a physical robot system. The uncertainties can be categorized as internal disturbances and external disturbances in general. The former may include dynamic model errors and joint frictions, while the latter may include external payloads or human-exerted force to the robot. Disturbance observer is an important technique to estimate and compensate for the uncertainties of the dynamic model. Different types of disturbance observers have been developed to estimate the lumped uncertainties so far. In this paper, we conducted a brief survey on five typical types of observers from a perspective of practical implementation in a robot control system, including generalized momentum observer (GMO), joint velocity observer (JVOB), nonlinear disturbance observer (NDOB), disturbance Kalman filter (DKF), and extended state observer (ESO). First, we introduced the basics of each observer including equations and derivations. Two common types of disturbances are considered as two scenarios, that is, constant external disturbance and time-varying external disturbance. Then, the observers are separately implemented in each of the two simulated scenarios, and the disturbance tracking performance of each observer is presented while their performance in the same scenario has also been compared in the same figure. Finally, the main features and possible behaviors of each type of observer are summarized and discussed. This survey is devoted to helping readers learn the basic expressions of five typical observers and implement them in a robot control system.
The COVID-19 pandemic has had a profound impact on the mental health of healthcare workers (HCWs). We aimed to identify the factors associated with depression among HCWs during the pandemic. We conducted literature search using eight electronic databases up to July 27 2022. Observational studies with more than 200 participants investigating correlates of depression in HCWs after COVID-19 outbreak were included. We used fixed- and random-effects models to pool odds ratios (ORs) across studies, and Cochran's chi-squared test and I2 statistics to assess study heterogeneity. Publication bias was evaluated by funnel plots. Thirty-five studies involving 44,362 HCWs met the inclusion criteria. Female (OR=1.50, 95% CI [1.23,1.84]), single (OR=1.36, 95% CI [1.21,1.54]), nurse (OR=1.69, 95% CI [1.28,2.25]), history of mental diseases (OR=2.53, 95% CI [1.78,3.58]), frontline (OR=1.79, 95% CI [1.38,2.32]), health anxiety due to COVID-19 (OR=1.88, 95% CI [1.29,2.76]), working in isolation wards (OR=1.98, 95% CI [1.38,2.84]), and insufficient personal protective equipment (OR=1.49, 95% CI [1.33,1.67]) were associated with increased risk of depression. Instead, HCWs with a positive professional prospect (OR=0.34, 95% CI [0.24,0.49]) were less likely to be depressed. This meta-analysis provides up-to-date evidence on the factors linked to depression among HCWs during the COVID-19 pandemic. Given the persistent threats posed by COVID-19, early screening is crucial for the intervention and prevention of depression in HCWs.
Casualties need to be triaged, stabilized and treated before they can be evacuated to the hospital. However, when Field Medical Teams (FMTs) arrive at the First Aid Post (FAP), the staff has to perform outside of their usual settings. There are also differences in the conception of medical operations, organization of the FAP, availability of medical equipment and supply, as well as means of communication, command, and control which can affect their performance and eventually the optimal survival of casualties during a mass casualty incident.
Method:
Guided by Kern’s model for curriculum development, Disaster Medical Responder's Course (DMRC) was developed. The curriculum focused on disaster response operations and processes; roles and responsibilities; command, control and communication; as well as supplies and resources. The content was taught through interactive lectures and skill stations. Course evaluation was based on the Kirkpatrick Model. A feedback form evaluated the reaction of the participants as to whether the course was relevant, if they learnt new knowledge and skills, and if they could apply these to their roles as FMTs. A tabletop exercise evaluated learning with participants working collaboratively.
Results:
DMRC has been sustainable since 2013 with six to eight courses per year. There had been numerous revisions of the content and delivery to keep up-to-date with the latest concept of operations, best practices from the literature, as well as educational methodologies. The last update was in 2020 in response to the COVID-19 pandemic where course schedule and mode of delivery were adjusted to comply with the safe management measures.
Conclusion:
FMTs will require training so they can function to their maximum capacity and capability. In Singapore, DMRC is the course for this unique and important training of FMTs. DMRC plays a pivotal role in ensuring the preparedness and operational readiness of FMTs for mass casualty incidents.
Mycoplasma genitalium (MG) and Chlamydia trachomatis (CT) are the most common sexually transmitted pathogens, which can cause cervicitis, pelvic inflammation and infertility in female. In the present study, we collected the basic information, clinical results of leucorrhoea and human papillomavirus (HPV) infection of patients, who were involved in both MG and CT RNA detection in West China Second Hospital of Sichuan University from January 2019 to April 2021, ranging from 18 to 50 years old. The results showed that the infection frequencies of MG and CT were 2.6% and 6.5%, respectively. The infection rate of CT in gynaecological patients was significantly higher than that of MG (P < 0.001). Moreover, patients with CT infection often had symptoms of gynaecological diseases, while patients with MG infection remain often asymptomatic. By exploring the connection between MG or CT infection and vaginal secretions, we found that the infection of MG or CT promoted to the increase of vaginal leukocytes, and CT infection exacerbated the decrease of the number of Lactobacillus in the vagina. Further analysis suggested that independent infection and co-infection of MG or CT resulted in abnormal vaginal secretion, affecting the stability of vaginal environment, which may induce vaginal diseases. Unexpectedly, our study found no association between MG or CT infection and high-risk HPV infection. In conclusion, our study explored the infection of MG and CT among women in Southwest China for the first time, and revealed that the infection of MG or CT would affect the homeostasis of vaginal environment, which laid a foundation for the clinical diagnosis and treatment of MG and CT infection.
HMGR, 3-hydroxy-3-methylglutaryl-CoA reductase, is a major rate-limiting enzyme in mevalonate (MVA) pathway for isoprenoids and subsequent tanshinone biosynthesis in the Chinese traditional bulk herbal medicine Danshen, Salvia miltiorrhiza, mainly for cardiovascular disorders. In this paper, the genomic SmHMGR genes of 38 cultivated populations of S. miltiorrhiza collected in China were for the first time sequenced to reveal the genetic diversity and phylogeny. The SmHMGR gene was shown to be intron-free, 1650~1659 bp in complete CDS with the majority being 1656 bp, and two unique populations (W-FJLY-V-1 and W-SCHY-W-1) being 1659 and 1650 bp respectively. A total of 103 SNP variation sites were detected with a variation rate of 6.22%, most of which occurred in S. miltiorrhiza f. alba population W-SCHY-W-1; a total of 25 amino acid variation sites were found, of which 19 was in W-SCHY-W-1. The same four populations, W-SCHY-W-1, V-HBAG-V-1, V-JLCC-V-1 and S-NM-V-1 could be discriminated from the remaining 34 by both the SNP fingerprints and the deduced amino acid variation sites. Other or composite DNA markers are needed for better identification. The SmHMGR gene of white flower S. miltiorrhiza f. alba population W-SCHY-W-1 is especially rich in variations and worthy of further studies. Phylogenetic trees based on both the gene and the deduced amino acid sequences showed a very similar two-clade topological structure. This research enriched the content and the genetic means for the molecular identification, genetic diversity and phylogenetic studies of the cultivated S. miltiorrhiza populations, and laid a solid foundation for further related and in-depth investigations.
Very few studies have emphasized the effects of high-pressure sintering on snow density evolution, even though snow as a type of engineering material is widely used in construction engineering in cold regions for snow pavement, snow runway and polar infrastructure. This study presents new experimental results of snow densification under high pressures of up to 100 MPa for a temperature range from −3.5 to −17.3°C and uniaxial compression at the temperature of −10°C and constant strain rates from 5 × 10−4 to 10−1 s−1. Results reveal that density evolution of snow to ice under high-pressure sintering can be achieved in a wide temperature range within a duration as short as 5 min. The compressive strength of snow-sintered ice was ~1.2–2.2 times as large as that of water-frozen ice reported by previous work. The orthogonal experiment showed that pressure is a more significant factor affecting the final density in comparison with sintering temperature and time. The increased rates of ice fabrication, low limitations on temperature and reliable sintered snow strength indicate that snow-ice engineering, such as airport construction in Greenland and Antarctica, can be improved by high-pressure sintering of snow to overcome the harsh environment.
Bathymetric simultaneous localisation and mapping (SLAM) methods yield accurate navigation results for autonomous underwater vehicles (AUVs) and can construct consistent seabed terrain maps. Multiple independently working vehicles can complete tasks like surveying and mapping efficiently, which means cooperative bathymetric SLAM using multiple AUVs is suitable for large-scale seabed mapping. However, the transmission of bathymetric measurements collected using a multi-beam echo sounder over a low bandwidth, noisy, and unreliable acoustic channel is difficult, making cooperative bathymetric SLAM very challenging. This paper develops a graph-based cooperative bathymetric SLAM system that can compress many bathymetric measurements into small-scale acoustic packets and yield accurate navigation results with a 10% loss of acoustic packets caused by unreliable acoustic communication. According to the simulation conducted using the field data, the new algorithm is shown to be robust and capable of providing accurate location and mapping results over a low bandwidth, noisy, and unreliable acoustic channel.
To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines.
Design:
Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group.
Setting:
From nine cities in mainland China.
Participants:
A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014.
Results:
The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8–17·1), 14·2 (12·1–16·4) and 12·6 (10·4–14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes.
Conclusions:
Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.
Interscale kinetic energy transfer in chemically reacting compressible isotropic turbulence is studied using numerical simulations at turbulent Mach numbers 0.2 and 0.8 for isothermal and exothermic reactions. At low turbulent Mach number $M_{t}=0.2$ for exothermic reaction, heat release greatly enhances expansion and compression motions, and induces the formation of shocklets which are not observed for isothermal reaction at the same turbulent Mach number. It is found that heat release through exothermic reactions enhances both the positive and the negative components of pressure–dilatation, as well as positive and negative components of subgrid-scale (SGS) kinetic energy flux, indicating an increase of both forward-scatter and backscatter of kinetic energy. The SGS flux of kinetic energy has a tendency to be from large scales to small scales. The solenoidal components of pressure–dilatation and SGS kinetic energy flux are minorly influenced by heat release of reaction, while the dilatational components of pressure–dilatation and SGS kinetic energy flux are significantly intensified by heat release at all length scales. Heat release enhances the kinetic energy of the dilatational mode through the pressure work, and leads to the increase of dilatational kinetic energy transfer from large scales to small scales through dilatational SGS flux, as well as the viscous dissipation of dilatational kinetic energy at small scales. Taylor Reynolds number has a minor influence on the qualitative statistical properties of interscale kinetic energy transfer terms.
To explore the associations between dietary tastes and chronic diseases quantitatively.
Design:
We used the Geodetector method to establish associations between seven tastes and a variety of chronic diseases from the perspective of spatial stratified heterogeneity and explained the effects of dietary tastes on the spatial distribution of chronic diseases.
Setting:
We used crowdsourcing online recipe data to extract multiple taste information about cuisines, combined with point of interest data on categorised restaurant data in different regions, to quantitatively analyse the taste preferences of people in different regions.
Participants:
Crowdsourcing online recipe data and restaurant data in different regions.
Results:
The results showed that sixteen diseases were significantly associated with dietary tastes among the seventy-one types of chronic diseases. Compared with the effects of individual tastes, the interactions of tastes increased the risk of sixteen diseases, and many combinations of tastes produced nonlinear enhancement effects on the risk for diseases.
Conclusions:
This study presents a quantitative study approach based on the crowdsourcing of data to explore potential health risk factors, which can be applied to the exploratory analysis of disease aetiology and help public health authorities to develop corresponding interventions.