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Accurate prognostication is important for patients and their families to prepare for the end of life. Objective Prognostic Score (OPS) is an easy-to-use tool that does not require the clinicians’ prediction of survival (CPS), whereas Palliative Prognostic Score (PaP) needs CPS. Thus, inexperienced clinicians may hesitate to use PaP. We aimed to evaluate the accuracy of OPS compared with PaP in inpatients in palliative care units (PCUs) in three East Asian countries.
This study was a secondary analysis of a cross-cultural, multicenter cohort study. We enrolled inpatients with far-advanced cancer in PCUs in Japan, Korea, and Taiwan from 2017 to 2018. We calculated the area under the receiver operating characteristics (AUROC) curve to compare the accuracy of OPS and PaP.
A total of 1,628 inpatients in 33 PCUs in Japan and Korea were analyzed. OPS and PaP were calculated in 71.7% of the Japanese patients and 80.0% of the Korean patients. In Taiwan, PaP was calculated for 81.6% of the patients. The AUROC for 3-week survival was 0.74 for OPS in Japan, 0.68 for OPS in Korea, 0.80 for PaP in Japan, and 0.73 for PaP in Korea. The AUROC for 30-day survival was 0.70 for OPS in Japan, 0.71 for OPS in Korea, 0.79 for PaP in Japan, and 0.74 for PaP in Korea.
Significance of results
Both OPS and PaP showed good performance in Japan and Korea. Compared with PaP, OPS could be more useful for inexperienced physicians who hesitate to estimate CPS.
The origins of metal coinage and the monetisation of ancient economies have long been a research focus in both archaeology and economic history. Recent excavations of an Eastern Zhou period (c. 770–220 BC) bronze foundry at Guanzhuang in Henan Province, China, have yielded clay moulds for casting spade coins. The technical characteristics of the moulds demonstrate that the site functioned as a mint for producing standardised coins. Systematic AMS radiocarbon-dating indicates that well-organised minting developed c. 640–550 BC, making Guanzhuang the world's oldest-known, securely dated minting site. This discovery provides important new data for exploring the origin of monetisation in ancient China.
We develop a theory of graph algebras over general fields. This is modelled after the theory developed by Freedman et al. (2007, J. Amer. Math. Soc.20 37–51) for connection matrices, in the study of graph homomorphism functions over real edge weight and positive vertex weight. We introduce connection tensors for graph properties. This notion naturally generalizes the concept of connection matrices. It is shown that counting perfect matchings, and a host of other graph properties naturally defined as Holant problems (edge models), cannot be expressed by graph homomorphism functions with both complex vertex and edge weights (or even from more general fields). Our necessary and sufficient condition in terms of connection tensors is a simple exponential rank bound. It shows that positive semidefiniteness is not needed in the more general setting.
Sarcopenic obesity is regarded as a risk factor for the progression and development of non-alcoholic fatty liver disease (NAFLD). Since male sex is a risk factor for NAFLD and skeletal muscle mass markedly varies between the sexes, we examined whether sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio (SVR), that is, an index of skeletal muscle mass combined with abdominal obesity, and the histological severity of NAFLD. The SVR was measured by bioelectrical impedance in a cohort of 613 (M/F = 443/170) Chinese middle-aged individuals with biopsy-proven NAFLD. Multivariable logistic regression and subgroup analyses were used to test the association between SVR and the severity of NAFLD (i.e. non-alcoholic steatohepatitis (NASH) or NASH with the presence of any stage of liver fibrosis). NASH was identified by a NAFLD activity score ≥5, with a minimum score of 1 for each of its categories. The presence of fibrosis was classified as having a histological stage ≥1. The SVR was inversely associated with NASH in men (adjusted OR 0·62; 95 % CI 0·42, 0·92, P = 0·017 for NASH, adjusted OR 0·65; 95 % CI 0·43, 0·99, P = 0·043 for NASH with the presence of fibrosis), but not in women (1·47 (95 % CI 0·76, 2·83), P = 0·25 for NASH, and 1·45 (95 % CI 0·74, 2·83), P = 0·28 for NASH with the presence of fibrosis). There was a significant interaction for sex and SVR (Pinteraction = 0·017 for NASH and Pinteraction = 0·033 for NASH with the presence of fibrosis). Our findings show that lower skeletal muscle mass combined with abdominal obesity is strongly associated with the presence of NASH only in men.
Few studies have been conducted to investigate the association of kidney function decline with the trajectories of homocysteine (Hcy) over time, using repeated measurements. We aimed to investigate the association of kidney function with changes in plasma Hcy levels over time. Data were collected from the Rugao Longevity and Ageing Study. In detail, plasma Hcy and creatinine levels were measured in both waves (waves 2, 3 and 4) during the 3·5-year follow-up (n 1135). Wave 2 was regarded as the baseline survey. The estimated glomerular filtration rate (eGFR) was calculated based on creatinine. Subjects were categorised into four groups according to quartiles of eGFR at baseline. Linear mixed-effect models were used to investigate the association of eGFR with subsequent plasma Hcy levels. The mean eGFR at baseline was 90·84 (sd 11·42) ml/min per 1·73 m2. The mean plasma Hcy level was 14·09 (sd 6·82) at baseline and increased to 16·28 (sd 8·27) and 17·36 (sd 10·39) μmol/l during follow-ups. In the crude model, the interaction between time and eGFR at baseline was significant (β = −0·02, 95 % CI −0·02, −0·01, P = 0·002). After adjusting for confounding factors, a significant relationship remained (β = −0·02, 95 % CI −0·02, −0·01, P = 0·003), suggesting that kidney function decline at baseline was associated with a faster increase in Hcy levels. Kidney function decline is associated with a more pronounced increase in plasma Hcy levels. Further studies with longer follow-up periods and larger sample sizes are needed to validate our findings.
The North Qilian Orogenic Belt is surrounded by the Tarim Craton to the NW and the North China Craton to the NE. The Precambrian continental crust remnants that are distributed in the North Qilian Orogenic Belt are termed the North Qilian Block (NQB), and their tectonic evolution has profound implications for the evolution of the Columbia Supercontinent. Here we present major- and trace-element and Sr–Nd–Hf isotope data for (meta-) basalts from the Beidahe Group (BDHG) and Zhulongguan Group (ZLGG) in the western North Qilian Orogenic Belt, to investigate the tectonic evolution of the NQB during the Proterozoic Eon. The protoliths of Palaeoproterozoic amphibole gneisses and plagioclase amphibolites from the BDHG are calc-alkaline series basalts. These metabasalts show island-arc-basalt affinities with variable Nd and Hf isotopes (ϵNd(t) = −5.0–0.6 and 2.7–4.3; ϵHf(t) = −14.2–2.0 and 6.9–8.8) and were generated by partial melting of the asthenospheric mantle that was metasomatized by aqueous fluid and sediment melt in a continental-arc setting. The early Mesoproterozoic ZLGG basalts show features of shoshonite-series basalts and are geochemically similar to ocean-island basalts. These basalts show variable (87Sr/86Sr)i, ϵNd(t) and ϵHf(t) values of 0.70464–0.70699, −1–2.6 and −1.5–5.7, and are products of mantle plume magmatism that participated with subducted oceanic crust in an intracontinental rift setting. This study suggests that the NQB underwent tectonic evolution from palaeo-oceanic subduction to intracontinental rifting during the Palaeoproterozoic–Mesoproterozoic eras. Furthermore, the above tectonomagmatic events were in response to convergence–splitting events of the Columbia Supercontinent during the Palaeoproterozoic–Mesoproterozoic eras.
Reintroductions of large carnivore species present unique opportunities to model population dynamics as populations can be monitored from the beginning of a reintroduction. However, analysis of the population dynamics of such reintroduced populations is rare and may be limited in incorporating the complex movements and environmental interactions of large carnivores. Starting in 2004, Asiatic black bears Ursus thibetanus were reintroduced and tracked in the Republic of Korea, along with their descendants, using radio telemetry, yielding 33,924 tracking points over 12 years. Along with information about habitat use, landscape, and resource availability, we estimated the population equilibrium and dispersal capability of the reintroduced population. We used a mixed modelling approach to determine suitable habitat areas, population equilibria for three different resources-based scenarios, and least-cost pathways (i.e. corridors) for dispersal. Our population simulations provided a mean population equilibrium of 64 individuals at the original reintroduction site and a potential maximum of 1,438 individuals in the country. The simulation showed that the bear population will disperse to nearby mountainous areas, but a second reintroduction will be required to fully restore U. thibetanus. Northern suitable habitats are currently disconnected and natural re-population is unlikely to happen unless supported. Our methodologies and findings are also relevant for determining the outcome and trajectories of reintroduced populations of other large carnivores.
We carry out direct numerical simulations of turbulent Rayleigh–Bénard convection in a square box with rough conducting plates over the Rayleigh number range $10^7\leqslant Ra\leqslant 10^9$ and the Prandtl number range $0.01\leqslant Pr\leqslant 100$. In Zhang et al. (J. Fluid Mech., vol. 836, 2018, R2), it was reported that while the measured Nusselt number $Nu$ is enhanced at large roughness height $h$, the global heat transport is reduced at small $h$. The division between the two regimes yields a critical roughness height $h_c$, and we now focus on the effects of the Prandtl number ($Pr$) on $h_c$. Based on the variations of $h_c$, we identify three regimes for $h_c(Pr)$. For low $Pr$, thermal boundary layers become thinner with increasing $Pr$. This makes the boundary layers easier to be disrupted by rough elements, leading to the decrease of $h_c$ with increasing $Pr$. For moderate $Pr$, the corner-flow rolls become much more pronounced and suppress the global heat transport via the competition between the corner-flow rolls and the large-scale circulation (LSC). As a consequence, $h_c$ increases with increasing $Pr$ due to the intensification of the corner–LSC competition. For high $Pr$, the convective flow transitions to the plume-controlled regime. As the rough elements trigger much stronger and more frequent plume emissions, $h_c$ again decreases with increasing $Pr$.
In the development process of high-speed aircraft, the head of the aircraft is subject to high temperatures and high speed flows, supporting the maximum heat flow and thus requiring a reliable cooling system. A new type of head cooling system is proposed herein. An internal flow channel model of the heat transfer in a ball head made from high-temperature alloy steel is constructed, then an experimental platform is built to carry out relevant experiments on the performance of this cooling system. Firstly, the influence of different experimental conditions on the cooling efficiency of the ball head is studied. For given liquid-nitrogen supply pressure, a higher heating heat flux density on the outer surface of the ball head corresponds to higher cooling efficiency. Then, the vaporisation effect under different experimental conditions is evaluated using temperature sensors at the inlet and outlet of the ball head heat exchange channel in combination with images of the visualised glass tube. It is found that liquid nitrogen can vaporise completely when flowing through the heat exchange channel. The characteristics of the heating effect and liquid nitrogen injection for the ball head were evaluated using an infrared camera. Finally, under different experimental conditions of liquid-nitrogen supply pressure, it is found that liquid nitrogen can vaporise completely in each case, and the total temperature of the vaporised nitrogen is about 300K. It can thus be collected as a secondary gas source.
The oceans have a huge capability to store, release, and transport heat, water, and various chemical species on timescales from seasons to centuries. Their transports affect global energy, water, and biogeochemical cycles and are crucial elements of Earth’s climate system. Ocean variability, as represented, for example, by sea surface temperature (SST) variations, can result in anomalous diabatic heating or cooling of the overlying atmosphere, which can in turn alter atmospheric circulation in such a way as to feedback on ocean thermal and current structures to modify the original SST variations. Ocean–atmosphere interactions in one ocean basin can also influence remote regions via interbasin teleconnections that can trigger responses having both local and far-field impacts. This chapter highlights the defining aspects of the climate in individual ocean basins, including mean states, seasonal cycles, interannual-to-interdecadal variability, and interactions with other basins. Key components of the global and tropical ocean observing system are also described.
Responding to the extreme scarcity of medical resources during the early outbreak of the coronavirus disease (COVID-19) in Wuhan, China, an emergency specialist hospital of Leishenshan started to construct on January 26, 2020, and accommodate patients on February 6, 2020. The clinical laboratory center of Leishenshan Hospital (CLCLH) was constructed at the same time within 11 days to support the treatment of inpatients in Leishenshan Hospital and the testing of suspected patients from different fever clinics in Wuhan. The CLCLH could perform a total of 320 clinic, 299 biochemistry, 31 microorganism, and 47 infection and immunity examinations per day. It could also complete an average of 239 nucleic acid tests and 118 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody examinations per day. No suspected cases were documented among the health care workers during the operation of the CLCLH. The construction and operation experiences of the CLCLH is provided in this study and might be used by other countries as reference. The content of this study is divided into 4 parts: (1) the establishment of the CLCLH, including its layout and medical resource allocation; (2) the major testing items; (3) the specific procedure of COVID-19 indicator examination; and (4) the standardized personal protection measures.
The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19.
We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020.
Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%), and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), and shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%), and respiratory failure (11.9%) are the top 3 direct causes of death.
COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.
Nitrogen is an important element for the growth of flue-cured tobacco and is closely related to its yield and quality. In order to pursue higher economic benefits, excessive fertilizer is generally applied in flue-cured tobacco production, which is unfavourable for the sustainable development of flue-cured tobacco production and for the environment. In 2016 and 2017, experiments using different nitrogen fertilizer application rates in flue-cure tobacco were conducted in Yunnan province, and the changes in agronomic, economic and chemical indices as well as in residual soil nitrogen were compared. Linear and quadratic models were used to compare the response of tobacco to nitrogen fertilizer. With increasing nitrogen fertilizer rate, the proportions of superior to medium tobacco and the average price of flue-cured tobacco leaves initially increased and then decreased, while fresh weight, dry weight and the proportion of inferior tobacco showed the opposite trend. Total sugar and reducing sugar contents decreased with increasing nitrogen fertilizer rates, while total nitrogen and nicotine contents increased. Sensory evaluation scores had the highest value when 90 kg N/ha and 120 kg N/ha were applied. Soil nitrate contents increased as nitrogen fertilizer rate increased. The quadratic model was suitable for the response of cultivar K326 to nitrogen and 90 kg N/ha could meet the needs of cultivar K326.
The clinical characteristics of patients with COVID-19 were analysed to determine the factors influencing the prognosis and virus shedding time to facilitate early detection of disease progression. Logistic regression analysis was used to explore the relationships among prognosis, clinical characteristics and laboratory indexes. The predictive value of this model was assessed with receiver operating characteristic curve analysis, calibration and internal validation. The viral shedding duration was calculated using the Kaplan–Meier method, and the prognostic factors were analysed by univariate log-rank analysis and the Cox proportional hazards model. A retrospective study was carried out with patients with COVID-19 in Tianjin, China. A total of 185 patients were included, 27 (14.59%) of whom were severely ill at the time of discharge and three (1.6%) of whom died. Our findings demonstrate that patients with an advanced age, diabetes, a low PaO2/FiO2 value and delayed treatment should be carefully monitored for disease progression to reduce the incidence of severe disease. Hypoproteinaemia and the fever duration warrant special attention. Timely interventions in symptomatic patients and a time from symptom onset to treatment <4 days can shorten the duration of viral shedding.
Situated between the North China Craton to the east and the Tarim Craton to the west, the northern Alxa area in westernmost Inner Mongolia in China occupies a key location for interpreting the late-stage tectonic evolution of the southern Central Asian Orogenic Belt. New LA-ICP-MS zircon U–Pb dating results reveal 282.2 ± 3.9 Ma gabbros and 216.3 ± 3.2 Ma granites from the Yagan metamorphic core complex in northern Alxa, NW China. The gabbros are characterized by low contents of Si, Na, K, Ti and P and high contents of Mg, Ca, Al and Fe. These gabbros have arc geochemical signatures with relative enrichments in large ion lithophile elements and depletions in high field strength elements, as well as negative εNd(t) (−0.91 to −0.54) and positive εHf(t) (2.59 to 6.37) values. These features indicate that a depleted mantle magma source metasomatized by subduction fluids/melts and contaminated by crustal materials was involved in the processes of magma migration and emplacement. The granites show high-K calc-alkaline and metaluminous to weakly peraluminous affinities, similar to A-type granites. They have positive εNd(t) (1.55 to 1.99) and εHf(t) (5.03 to 7.64) values. These features suggest that the granites were derived from the mixing of mantle and crustal sources and formed in a postcollisional tectonic setting. Considering previous studies, we infer that the final closure of the Palaeo-Asian Ocean in the central part of the southern Central Asian Orogenic Belt occurred in late Permian to Early–Middle Triassic times.
Advanced Ni8W/Ni12W/Ni8W alloy composite substrates used in YBCO-coated conductors with a strong cube texture and high yield strength have been fabricated, and a CeO2 buffer layer film was successfully deposited on the composite substrates. Through in situ tensile testing coupled with electron backscattered diffraction (EBSD) analysis, the stability of the cube texture of Ni8W/Ni12W/Ni8W alloy composite substrates has been investigated. The stress–strain curve shows that the yield strength (at 0.2% strain) of the composite substrates exceeds 250 Mpa. The orientation of grains and boundaries on the surface of the substrates was almost unchanged, while the strain exceeds 0.2%, which indicated that the composite substrates are adequate for depositing buffer layers and YBCO layers by the reel-to-reel process.
A novel solid-clad-by-liquid method was developed to form a 10-m long by 10-mm wide by 80-μm thick Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite tape. Three deformation routes (cold rolling, cold rolling with intermediate annealing, and cold rolling combined with warm rolling) have been investigated in short Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite substrate. To optimize the dynamic continuous annealing parameters for the long composite substrates, air-cooled and furnace-cooled annealing procedures were compared in short Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite substrates. Improved cube texture of 98.7% in a 10-m long by 10-mm wide by 80-μm thick Ni–5 at.% W/Ni–9.3 at.% W/Ni–5 at.% W composite substrate was achieved via warm rolling deformation at 550 °C and two-step dynamic continuous annealing (750 °C for 1 h followed by 1200 °C for 1 h). The yield strength, Curie temperature, and saturation magnetization of 176 MPa, 324 K, and 18 emu/g, respectively, were obtained.
Nutrition therapy is considered an important treatment of burn patients. The aim of the study was to delineate the nutritional support in severe burn patients and to investigate association between nutritional practice and clinical outcomes. Severe burn patients were enrolled (n 100). In 90 % of the cases, the burn injury covered above 70 % of the total body surface area. Mean interval from injury to nutrition start was 2·4 (sd 1·1) d. Sixty-seven patients were initiated with enteral nutrition (EN) with a median time of 1 d from injury to first feed. Twenty-two patients began with parenteral nutrition (PN). During the study, thirty-two patients developed EN intolerance. Patients received an average of about 70 % of prescribed energy and protein. Patients with EN providing <30 % energy had significantly higher 28- d and in-hospital mortality than patients with EN providing more than 30 % of energy. Mortality at 28 d was 11 % and in-hospital mortality was 45 %. Multiple regression analysis demonstrated that EN providing <30 % energy and septic shock were independent risk factors for 28- d prognosis. EN could be initiated early in severe burn patients. Majority patients needed PN supplementation for energy requirement and EN feeding intolerance. Post-pyloric feeding is more efficient than gastric feeding in EN tolerance and energy supplement. It is difficult for severe burn patients to obtain enough feeding, especially in the early stage of the disease. More than 2 weeks of underfeeding is harmful to recovery.