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Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a severe and life-threatening complication, characterised by multi-organ failure and high short-term mortality. However, there is limited information on the impact of various comorbidities on HBV-ACLF in a large population. This study aimed to investigate the relationship between comorbidities, complications and mortality. In this retrospective observational study, we identified 2166 cases of HBV-ACLF hospitalised from January 2010 to March 2018. Demographic data from the patients, medical history, treatment, laboratory indices, comorbidities and complications were collected. The mortality rate in our study group was 47.37%. Type 2 diabetes mellitus was the most common comorbidity, followed by alcoholic liver disease. Spontaneous bacterial peritonitis, pneumonia and hepatic encephalopathy (HE) were common in these patients. Diabetes mellitus and hyperthyroidism are risk factors for death within 90 days, together with gastrointestinal bleeding and HE at admission, HE and hepatorenal syndrome during hospitalisation. Knowledge of risk factors can help identify HBV-ACLF patients with a poor prognosis for HBV-ACLF with comorbidities and complications.
In our center, previous infection prevention and control (IPC) resources were concentrated on multidrug-resistant organisms other than CRAB because the rate of CRAB was stable with no evidence of outbreaks. Triggered by an increase in the baseline rate of CRAB isolated in clinical cultures, we investigated horizontal transmission of CRAB to guide targeted IPC actions.
We prospectively collected clinical data of patients with positive CRAB cultures. We identified genetic relatedness of CRAB isolates using whole-genome sequencing. Findings were regularly presented to the IPC committee, and follow-up actions were documented.
During the study period, 66 CRAB isolates were available for WGS. Including 12 clinical isolates and 10 environmental isolates from a previous study, a total of 88 samples were subjected to WGS, of which 83 were successfully sequenced and included in the phylogenetic analysis. We identified 5 clusters involving 44 patients. Genomic transmissions were explained by spatiotemporal overlap in 12 patients and by spatial overlap only in 12 patients. The focus of transmission was deduced to be the intensive care units. One cluster was related to a retrospective environmental isolate, suggesting the environment as a possible route of transmission. Discussion of these findings at multidisciplinary IPC meetings led to implementation of measures focusing on environmental hygiene, including hydrogen peroxide vapor disinfection in addition to terminal cleaning for rooms occupied by CRAB patients.
We showed that WGS could be utilized as a “tool of persuasion” by demonstrating the presence of ongoing transmission of CRAB in an endemic setting, and by identifying actionable routes of transmission for directed IPC interventions.
Ammannia multiflora Roxb. is a dominant broadleaf weed that is a serious problem in southern China rice fields, and acetolactate synthase (ALS)-inhibiting herbicides have been used for its control for more than 20 years. Excessive reliance on ALS-inhibiting herbicides has led to herbicide resistance in A. multiflora. In this study, 10 A. multiflora populations from the Jiangsu Province of China were collected, and the resistance levels and target site–resistance mechanisms to ALS-inhibiting herbicides bensulfuron-methyl and penoxsulam were investigated. The dose–response assays showed that eight populations evolved resistance to bensulfuron-methyl (9.1- to 90.9-fold) and penoxsulam (5.0- to 103.1-fold). Amplification of ALS genes indicated that there were three ALS genes (AmALS1, AmALS2, and AmALS3) in A. multiflora. Sequence analysis revealed amino acid mutations at Pro-197 in either AmALS1 (Pro-197-Ala, Pro-197-Ser, and Pro-197-His) or AmALS2 (Pro-197-Ser and Pro-197-Arg) in resistant populations, and no mutations were found in AmALS3. Moreover, two independent mutations (Pro-197-Ala in AmALS1 and Pro-197-Ser in AmALS2 or Pro-197-Ala in AmALS1 and Pro-197-Arg in AmALS2) coexisted in two resistant populations, respectively. In addition, the auxin mimic herbicides MCPA and florpyrauxifen-benzyl, the photosystem II inhibitor bentazon, and the protoporphyrinogen oxidase inhibitor carfentrazone-ethyl can effectively control the resistant A. multiflora populations. Our study demonstrates the wide prevalence of ALS inhibitor–resistant A. multiflora populations in Jiangsu Province and the diversity of Pro-197 mutations in ALS genes and provides alternative herbicide options for controlling resistant A. multiflora populations.
“Subsyndromal” obsessive-compulsive disorder symptoms (OCDSs) are common and cause impaired psychosocial functioning. OCDSs are better captured by dimensional models of psychopathology, as opposed to categorical diagnoses. However, such dimensional approaches require a deep understanding of the underlying neurocognitive drivers and impulsive and compulsive traits (ie, neurocognitive phenotypes) across symptoms. This study investigated inhibitory control and self-monitoring across impulsivity, compulsivity, and their interaction in individuals (n = 40) experiencing mild–moderate OCDSs.
EEG recording concurrent with the stop-signal task was used to elicit event-related potentials (ERPs) indexing inhibitory control (ie, N2 and P3) and self-monitoring (ie, error-related negativity and correct-related negativity (CRN): negativity following erroneous or correct responses, respectively).
During unsuccessful stopping, individuals high in both impulsivity and compulsivity displayed enhanced N2 amplitude, indicative of conflict between the urge to respond and need to stop (F(3, 33) = 1.48, P < .05, 95% Cl [−0.01, 0.001]). Individuals high in compulsivity and low in impulsivity showed reduced P3 amplitude, consistent with impairments in monitoring failed inhibitory control (F(3, 24) = 2.033, P < .05, 95% CI [−0.002, 0.045]). Following successful stopping, high compulsivity (independent of impulsivity) was associated with lower CRN amplitude, reflecting hypo-monitoring of correct responses (F(4, 32) = 4.76, P < .05, 95% CI [0.01, 0.02]), and with greater OCDS severity (F(3, 36) = 3.32, P < .05, 95% CI [0.03, 0.19]).
The current findings provide evidence for differential, ERP-indexed inhibitory control and self-monitoring profiles across impulsive and compulsive phenotypes in OCDSs.
There is increasing attention on the association of socioeconomic status and individual behaviors (SES/IB) with mental health. However, the impacts of SES/IB on mental disorders are still unclear. To provide evidence for establishing feasible strategies on disease screening and prevention, we implemented Mendelian randomization (MR) design to appraise causality between SES/IB and mental disorders.
We conducted a two-sample MR study to assess the causal effects of SES and IB (dietary habits, habitual physical activity, smoking behaviors, drinking behaviors, sleeping behaviors, leisure sedentary behaviors, risky behaviors, and reproductive behaviors) on three mental disorders, including bipolar disorder, major depressive disorder and schizophrenia. A series of filtering steps were taken to select eligible genetic instruments robustly associated with each of the traits. Inverse variance weighted was used for primary analysis, with alternative MR methods including MR-Egger, weighted median, and weighted mode estimate. Complementary methods were further used to detect pleiotropic bias.
After Bonferroni correction and rigorous quality control, we identified that SES (educational attainment), smoking behaviors (smoking initiation, number of cigarettes per day), risky behaviors (adventurousness, number of sexual partners, automobile speeding propensity) and reproductive behavior (age at first birth) were causally associated with at least one of the mental disorders.
MR study provides robust evidence that SES/IB play broad impacts on mental disorders.
Little is known about how sociodemographic and clinical factors affect the caregiving burden of persons with schizophrenia (PwSs) with transition in primary caregivers.
This study aimed to examine the predictive effects of sociodemographic and clinical factors on the caregiving burden of PwSs with and without caregiver transition from 1994 to 2015 in rural China.
Using panel data, 206 dyads of PwSs and their primary caregivers were investigated in both 1994 and 2015. The generalised linear model approach was used to examine the predictive effects of sociodemographic factors, severity of symptoms and changes in social functioning on the caregiving burden with and without caregiver transition.
The percentages of families with and without caregiver transition were 38.8% and 61.2%, respectively. Among families without caregiver transition, a heavier burden was significantly related to a larger family size and more severe symptoms in PwSs. Deteriorated functioning of ‘social activities outside the household’ and improved functioning of ‘activity in the household’ were protective factors against a heavy caregiving burden. Among families with caregiver transition, younger age, improved marital functioning, deteriorated self-care functioning, and better functioning of ‘social interest or concern’ were significant risk factors for caregiving burden.
The effects of sociodemographic and clinical correlates on the caregiving burden were different among families with and without caregiver transition. It is crucial to explore the caregiver arrangement of PwSs and the risk factors for burden over time, which will facilitate culture-specific family interventions, community-based mental health services and recovery.
Increasing evidence supports sarcopenia as an important parameter for predicting cardiometabolic risks. The objective of this study was to investigate the relationship between muscle mass, muscle strength, and physical performance, and cardiovascular risk among older community-dwelling adults.
The associations between dynapenia, sarcopenia, and Framingham risk score (FRS) were estimated by multivariate regression models.
Muscle mass is estimated by skeletal muscle mass index using a bioelectrical impedance analysis. Muscle strength is measured by handgrip strength using an analogue isometric dynamometer. Physical performance is measured by gait speed using a 6-m walking distance. Dynapenia was defined as low muscle strength and/or slow gait speed presents with normal muscle mass. The diagnosis of presarcopenia and sarcopenia was based on criteria proposed by the Asian Working Group for Sarcopenia in 2014. The FRS was used for evaluating 10-year coronary heart disease (CHD) risk.
Adults aged 65 years and older who attended health examinations from 2015 to 2017 were recruited.
There were totally 709 subjects enrolled in this study. Dynapenic men (n 47) had 17·70 ± 5·08 % FRS and sarcopenic women (n 74) had 7·74 ± 6·06 % FRS. Participants with presarcopenia had the lowest FRS (men: 15·41 ± 5·35 %; women: 5·25 ± 3·70 %). Men with dynapenia had higher FRS than the presarcopenia group with odds ratio (OR) of 2·52 (95 % confidence interval (CI): 1·03, 6·14). Women with sarcopenia had significantly higher FRS than the presarcopenia group with OR of 2·81 (95 % CI: 1·09, 7·27).
Older dynapenic men and older sarcopenic women had higher risks of 10-year CHD. Presarcopenic older adults had the lowest CHD risk in both genders.
The paper deals with the workspace-based optimization of a novel humanoid robotic arm. The eight-degree-of-freedom hybrid manipulator that conforms to the kinematics characteristics of the human arm is briefly introduced. According to the structural features of this mechanism and the requirements of tasks in the complex environment, the workspace is divided into three parts, the orientation space of the humanoid shoulder joint, the position space of the humanoid elbow joint, and the active orientation space of the end-moving platform. Moreover, a multi-parameter planar model is proposed for the optimization problem with multidimensional parameters and highly nonlinear constraints. Based on the visualized optimization result, the coupling effect of each parameter on the corresponding workspace is clearly presented. Considering the compactness and the processing and assembling technology of this mechanism, a set of structural parameters satisfying the workspace-based optimization objective is obtained. Simulation results show that the corresponding workspace of the three parts has increased significantly by the factor of 1.45, 1.68, and 1.3, respectively.
For the safety problems caused by the limited landing space of the deck during the arresting process of the carrier-based aircraft, a dynamic model of the carrier-based aircraft’s landing and arresting is built. Based on the batch simulation method, the lateral dynamics safety envelope of the aircraft during the arresting was defined, and the dynamic response of the key points in the envelope during the arresting process was investigated. Subsequently, the influence of engine thrust and aircraft quality on the arresting safety envelope was studied based on reasonable safety evaluation indicators, and the safety status envelope of the deck arresting was given. Then, the particular Hamilton-Jacobi partial differential equation is used to obtain the lateral dynamics safety envelope of the carrier-based aircraft in the process of landing and arresting by backward inversion. Results indicate that engine thrust and landing quality have little effect on the yaw angle in the arresting safety boundary during the arresting. Additionally, with the engine thrust and landing quality increase, the maximum safe off-centre distance gradually decreases, and the safety boundary decreases accordingly. During the phase of landing glide, the engine thrust and quality have little effect on the maximum safe eccentric distance. When the engine thrust is increased by 40%, the maximum safe yaw angle is reduced from 0.3°, and the safety boundary is reduced by 4.2%. When the aircraftquality increases by 40%, the maximum safe yaw angle is reduced by 0.4°, and the safety boundary is reduced by 2.8%. The findings of this paper can provide framework for the research on theaircraft-to-carrier dynamic matching characteristics of the carrier-based system, and is of great significance to the research on improving the safety of the carrier-based aircraft landing arresting.
In training deep learning networks, the optimizer and related learning rate are often used without much thought or with minimal tuning, even though it is crucial in ensuring a fast convergence to a good quality minimum of the loss function that can also generalize well on the test dataset. Drawing inspiration from the successful application of cyclical learning rate policy to computer vision tasks, we explore how cyclical learning rate can be applied to train transformer-based neural networks for neural machine translation. From our carefully designed experiments, we show that the choice of optimizers and the associated cyclical learning rate policy can have a significant impact on the performance. In addition, we establish guidelines when applying cyclical learning rates to neural machine translation tasks.
The heavy reliance on coal for energy contributes to both air pollutants and CO2 emissions in China. As air pollution control becomes one of the top government priorities in recent years, many measures to tackle air pollution, such as curbing coal consumption, increasing energy efficiency, and encouraging renewable energy investments, can simultaneously reduce carbon emissions. However, air pollution abatement measures are not always aligned with carbon mitigation goals. For instance, installing sulfur scrubbers on coal power plants can significantly reduce air pollutant emissions, but does not mitigate carbon emissions. Given the political saliency of air pollution concerns, it is critical for policymakers to understand the potential synergies and trade-offs between these two objectives: improving air quality and protecting human health in the near term, and achieving deep decarbonization to tackle climate change in the long term.
Increasing the scale of renewable integration is a key component of China’s decarbonization strategy. While the immediate challenge is to reduce renewable curtailment and increase its penetration, mitigating climate change in the long term will require a transition from an electricity system dominated by coal to one that consists primarily of renewables. This chapter summarizes the current governance structure and policies for renewable energy development and integration in China. It identifies two key considerations for China to transition towards large-scale penetration of renewables: geographic mismatch between renewable resources and demand centers, and concerns associated with integrating high penetration of intermittent renewable energy resources. Responding to these considerations, this chapter discusses four foundational elements that China needs to put in place in the near term to plan for the longer-term transition: flexible conventional generators, an appropriately large and more integrated transmission network, storage technology development, and demand-side flexibility/responsiveness.
Climate change is a key problem of the 21st century. China, as the largest emitter of greenhouse gases, has committed to stabilize its current emissions and dramatically increase the share of electricity production from non-fossil fuels by 2030. However, this is only a first step: in the longer term, China needs to aggressively strive to reach a goal of zero-emissions. Through detailed discussions of electricity pricing, electric vehicle policies, nuclear energy policies, and renewable energy policies, this book reviews how near-term climate and energy policies can affect long-term decarbonization pathways beyond 2030, building the foundations for decarbonization in advance of its realization. Focusing primarily on the electricity sector in China - the main battleground for decarbonization over the next century – it provides a valuable resource for researchers and policymakers, as well as energy and climate experts.
Our study was conducted to assess the sepsis-associated hospitalisations and antimicrobials prescribed for sepsis inpatients in Hong Kong. Demographic, diagnostic and antimicrobial prescription data were analysed for patients admitted to public hospitals with a diagnosis of septicaemia from 2000 to 2015. A total of 223 250 sepsis hospitalisations were recorded in Hong Kong from 2000 to 2015 during which the hospitalisation rate increased by 85.6%. The majority of the sepsis hospitalisations occurred in adults ≥65 years and children aged 0–4 years. Adults with a secondary diagnosis of sepsis were often admitted with a primary diagnosis of urological conditions or pneumonia; whereas diabetes mellitus was the most common secondary diagnosis among those with primary sepsis. Paediatric sepsis patients aged 0–4 years were often diagnosed with disorders relating to short gestation and low birthweight. Antimicrobial prescriptions increased by 51.1% and 34.4% for primary and secondary sepsis patients, respectively. β-Lactam and β-lactamase inhibitor combinations were the most used antibiotics whereas the usage of carbapenems increased more than 10 times over the study period. A substantial burden of hospitalisations was attributable to sepsis in Hong Kong, particularly in the extremes of age. Broad-spectrum and last-resort antibiotics had been increasingly dispensed for sepsis inpatients.
Pneumatic launch systems for Unmanned Aerial Vehicles (UAVs), including mechanical and pneumatic systems, are complex and non-linear. They are subjected to system parameters during launch, which leads to difficulty in engineering research analysis. For example, the mismatch between the UAV parameters and the parameter design indices of the launch system as well as the unclear design indices of the launching speed and overload of UAVs have a great impact on launch safety. Considering this situation, some studies are presented in this paper. Taking the pneumatic launch system as a research object, a pneumatic launcher dynamic simulation model is built based on co-simulation considering the coupling characteristics of the mechanical structure and transmission system. Its accuracy was verified by laboratory test results. Based on this model, the paper shows the effects of the key parameters, including the mass of the UAV, cylinder volume, pressure and moment of inertia of the pulley block, on the performance of the dynamic characteristics of the launch process. Then, a method for matching the parameter characteristics between the UAV and launch system based on batch simulation is proposed. The set of matching parameter values of the UAV and launch system that satisfy the launch take-off safety criteria are calculated. Finally, the influence of the system parameters of the launch process on the launch performance was analysed in detail, and the design optimised. Meaningful conclusions were obtained. The analysis method and its results can provide a reference for engineering and theoretical research and development of pneumatic launch systems.
Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.