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We aim to examine the relation of several folate forms (5-methyltetrahydrofolate (5-mTHF), unmetabolised folic acid (UMFA) and MeFox) with kidney function and albuminuria, which remained uncertain. The cross-sectional study was conducted in 18 757 participants from National Health and Nutrition Examination Survey 2011–2018. The kidney outcomes were reduced estimated glomerular filtration rate (eGFR) (<60 ml/min/1·73 m2), microalbuminuria (albumin:creatinine ratio (ACR) of 30–299 mg/g) and macroalbuminuria (ACR ≥ 300 mg/g). Overall, there were significant inverse associations between serum 5-mTHF and kidney outcomes with significant lower prevalence of reduced eGFR (OR, 0·71; 95 % CI: 0·57, 0·87) and macroalbuminuria (OR, 0·65; 95 % CI: 0·46, 0·91) in participants in quartiles 3–4 (v. quartiles 1–2; both Pfor trend across quartiles <0·05). In contrast, there were significant positive relationship between serum UMFA and kidney outcomes with significant higher prevalence of reduced eGFR in participants in quartiles 2–4 (v. quartile 1; OR, 2·12; 95 % CI: 1·45, 3·12; Pfor trend <0·001) and higher prevalence of macroalbuminuria in participants in quartile 4 (v. quartiles 1–3; OR, 1·46; 95 % CI: 1·06, 2·01; Pfor trend <0·001). However, there was no significant associations of 5-mTHF and UMFA with microalbuminuria. In addition, there were significant positive relationships of serum MeFox with reduced eGFR, microalbuminuria and macroalbuminuria (all Pfor trend <0·01). In conclusion, higher 5-mTHF level, along with lower UMFA and MeFox level, was associated with lower prevalence of kidney outcomes, which may help counsel future clinical trials and nutritional guidelines regarding the folate supplement.
To examine the association between sleep duration in different stages of life and amnestic mild cognitive impairment (aMCI).
Design, setting, and participants:
A total of 2472 healthy elderly and 505 patients with aMCI in China were included in this study. The study analyzed the association between aMCI and sleep duration in different stages of life.
We compared sleep duration in different stages of life and analyzed the association between Montreal Cognitive Assessment scores and sleep duration by curve estimation. Logistic regression was used to evaluate the association between aMCI and sleep duration.
In the analysis, there were no results proving that sleep duration in youth (P = 0.719, sleep duration < 10 hours; P = 0.999, sleep duration ≥ 10 hours) or midlife (P = 0.898, sleep duration < 9 hours; P = 0.504, sleep duration ≥ 9 hours) had a significant association with aMCI. In the group sleeping less than 7 hours in late life, each hour more of sleep duration was associated with approximately 0.80 of the original risk of aMCI (P = 0.011, odds ratio = 0.80, 95% confidence interval = 0.68–0.95).
Among the elderly sleeping less than 7 hours, there is a decreased risk of aMCI for every additional hour of sleep.
It is essential to investigate the experiences behind why adolescents start and continue to self-harm in order to develop targeted treatment and prevent future self-harming behaviours.
The aims of this study are to understand the motivations for initiating and repeating nonfatal self-harm, the different methods used between first-time and repeated self-harm and the reasons that adolescents do not seek help from health services.
Adolescents with repeated nonfatal self-harm experiences were recruited to participate in individual, semi-structured qualitative interviews. The interviews were analysed with interpretative phenomenological analysis.
We found that nonfatal self-harm among adolescents occurred comparatively early and was often triggered by specific reasons. However, the subsequent nonfatal self-harm could be causeless, with repeated self-harm becoming a maladaptive coping strategy to handle daily pressure and negative emotions. The choice of tools used was related to the ease of accessibility, the life-threatening risk and the size of the scars. Adolescents often concealed their scars on purpose, which made early identification insufficient. Peer influence, such as online chat groups encouraging self-harm by discussing and sharing self-harm pictures, could also lead to increased self-harm. The results also included participants’ opinions on how to stop nonfatal self-harm and their dissatisfaction with the current healthcare services.
The current study provides important implications both for early identification and interventions for adolescents who engage in repeated nonfatal self-harm, and for individualising treatment planning that benefits them. It is also worthwhile to further investigate how peer influence and social media may affect self-harm in adolescents.
We aimed to examine whether baseline neutrophil counts affected the risk of new-onset proteinuria in hypertensive patients, and, if so, whether folic acid treatment is particularly effective in proteinuria prevention in such a setting. A total of 8208 eligible participants without proteinuria at baseline were analysed from the renal substudy of the China Stroke Primary Prevention Trial. Participants were randomised to receive a double-blind daily treatment of 10 mg of enalapril and 0·8 mg of folic acid (n 4101) or 10 mg of enalapril only (n 4107). The primary outcome was new-onset proteinuria, defined as a urine dipstick reading of ≥1+ at the exit visit. The mean age of the participants was 59·5 (sd, 7·4) years, 3088 (37·6 %) of the participants were male. The median treatment duration was 4·4 years. In the enalapril-only group, a significantly higher risk of new-onset proteinuria was found among participants with higher neutrophil counts (quintile 5; ≥4·8 × 109/l, OR 1·44; 95 % CI 1·00, 2·06), compared with those in quintiles 1–4. For those with enalapril and folic acid treatment, compared with the enalapril-only group, the new-onset proteinuria risk was reduced from 5·2 to 2·8 % (OR 0·49; 95 % CI 0·29, 0·82) among participants with higher neutrophil counts (≥4·8 × 109/l), whereas there was no significant effect among those with neutrophil counts <4·8 × 109/l. In summary, among hypertensive patients, those with higher neutrophil counts had increased risk of new-onset proteinuria, and this risk was reduced by 51 % with folic acid treatment.
Block-structured Markov chains model a large variety of queueing problems and have many important applications in various areas. Stability properties have been well investigated for these Markov chains. In this paper we will present transient properties for two specific types of block-structured Markov chains, including M/G/1 type and GI/M/1 type. Necessary and sufficient conditions in terms of system parameters are obtained for geometric transience and algebraic transience. Possible extensions of the results to continuous-time Markov chains are also included.
In mainland China, the clinical, epidemiological and genetic features of non-O1/non-O139 Vibrio cholerae (NOVC) bacteraemia have been scarcely investigated. Herein, we describe a patient with NOVC bacteraemia diagnosed in our hospital and present a retrospective analysis of literature reports of 32 other cases in China, detailing the clinical epidemiology, antibiotic resistance and molecular characteristics of isolates. Most patients were male (84.8%; median age, 53 years) and had predisposing factors, such as cirrhosis, malignant tumours, blood diseases and diabetes. In addition to fever, gastroenteritis was the most frequent presenting symptom. The mortality rate during hospitalisation was 12.1%. NOVC bacteraemia cases were more common in June–August, with the majority in coastal provinces and the Yangtze River basin. Only 42.4% of cases were attributed to consumption of marine (aquatic) products. Tetracycline, third-generation cephalosporins, and fluoroquinolones were the most effective antimicrobial agents, and the highest frequencies of resistance were recorded for ampicillin/sulbactam (37.5%), amoxicillin/clavulanic acid (33.3%), ampicillin (29.2%) and sulfamethoxazole (20%). Multi-drug resistant isolates were not detected. Limited data indicate that ctxAB and tcpA genes were absent in all NOVC isolates but other putative virulence genes (hlyA, toxR, hap and rtxA) were common. Ten multilocus sequence types were identified with marked genetic heterogeneity between different isolates. As clinical manifestations of NOVC bacteraemia may vary widely, and isolates exhibit genetic diversity, clinicians and public health experts should be alerted to the possibility of infection with this pathogen because of the high prevalence of liver disease in China.
Gang members engage in many high-risk sexual activities that may be associated with psychiatric morbidity. Victim-focused research finds high prevalence of sexual violence towards women affiliated with gangs.
To investigate associations between childhood maltreatment and psychiatric morbidity on coercive and high-risk sexual behaviour among gang members.
Cross-sectional survey of 4665 men 18–34 years in Great Britain using random location sampling. The survey oversampled men from areas with high levels of violence and gang membership. Participants completed questionnaires covering violent and sexual behaviours, experiences of childhood disadvantage and trauma, and psychiatric diagnoses using standardised instruments.
Antisocial men and gang members had high levels of sexual violence and multiple risk behaviours for sexually transmitted infections, childhood maltreatment and mental disorders, including addictions. Physical, sexual and emotional trauma were strongly associated with adult sexual behaviour and more prevalent among gang members. Other violent behaviour, psychiatric morbidity and addictions accounted for high-risk and compulsive sexual behaviours among gang members but not antisocial men. Gang members showed precursors before age 15 years of adult preference for coercive rather than consenting sexual behaviour.
Gang members show inordinately high levels of childhood trauma and disadvantage, sexual and non-sexual violence, and psychiatric disorders, which are interrelated. The public health problem of sexual victimisation of affiliated women is explained by these findings. Healthcare professionals may have difficulties promoting desistance from adverse health-related behaviours among gang members whose multiple high-risk and violent sexual behaviours are associated with psychiatric morbidity, particularly addictions.
We aimed to evaluate the relationship of plasma Mg with the risk of new-onset hyperuricaemia and examine any possible effect modifiers in hypertensive patients. This is a post hoc analysis of the Uric acid (UA) Sub-study of the China Stroke Primary Prevention Trial (CSPPT). A total of 1685 participants were included in the present study. The main outcome was new-onset hyperuricaemia defined as a UA concentration ≥417 μmol/l in men or ≥357 μmol/l in women. The secondary outcome was a change in UA concentration defined as UA at the exit visit minus that at baseline. During a median follow-up duration of 4·3 years, new-onset hyperuricaemia occurred in 290 (17·2 %) participants. There was a significantly inverse relation of plasma Mg with the risk of new-onset hyperuricaemia (per sd increment; OR 0·85; 95 % CI 0·74, 0·99) and change in UA levels (per sd increment; β −3·96 μmol/l; 95 % CI −7·14, −0·79). Consistently, when plasma Mg was analysed as tertiles, a significantly lower risk of new-onset hyperuricaemia (OR 0·67; 95 % CI 0·48, 0·95) and less increase in UA levels (β −8·35 μmol/l; 95 % CI −16·12, −0·58) were found among participants in tertile 3 (≥885·5 μmol/l) compared with those in tertile 1 (<818·9 μmol/l). Similar trends were found in males and females. Higher plasma Mg levels were associated with a decreased risk of new-onset hyperuricaemia in hypertensive adults.
With growing city density and mass gatherings held all over the world in urban spaces, crowd disasters have been happening each year. In considering the avoidance of crowd disasters and the reduction of fatalities, it is important to analyze the efficient spatial layout of the public space in situations of high crowd density. Compared with traditional empirical design methods, computational approaches have better abilities for quantitative analysis and are gradually being adopted in the planning and management of the urban public space. In this paper, we investigated the official documents, publicly available videos, and materials of the Shanghai waterfront crowd disaster which happened on December 31, 2014. Based on the investigation, a detailed site survey was conducted and pedestrian flow data were acquired. To test the influence of different spatial layouts, an agent-based simulator is built, following the ASPFver4.0 (Agent Simulator of Pedestrian Flow) pedestrian walking rules. With the surveyed pedestrian flow data, the original spatial layout of the Shanghai Bund waterfront together with five other comparison scenarios are tested, including both space design and crowd management improvements. In the simulation results, the efficiencies of different space design and crowd management solutions are compared. The results show that even simple crowd control measures such as capacity reserve and more proper route planning will allow for a positive improvement in crowd safety. The results also compare the efficiency of different spatial operations and give general suggestions to the problems urban public space designers should consider in high-density environments.
Evidence on the association between maternal Hb concentration and preterm birth (PTB) risk is inconclusive. This paper aimed to explore whether women with anaemia or high Hb level before pregnancy would be at higher risk of PTB. We conducted a population-based cohort study with 2 722 274 women aged 20–49 years, who participated in National Free Pre-Pregnancy Checkups Project between 2013 and 2015 and delivered a singleton before 2016 in rural China. Logistic models were used to estimate OR and 95 % CI after adjusting for confounding variables. Restricted cubic spline models were applied to evaluate the dose–response relationships. A total of 192 819 (7·08 %) women had preterm deliveries. Compared with women with Hb of 110–149 g/l, the multivariable-adjusted OR for PTB was 1·19 (95 % CI 0·98, 1·44) for women with Hb<70 g/l, 1·01 (95 % CI 0·97, 1·03) for 70–99 g/l, 0·96 (95 % CI 0·95, 0·98) for 100–109 g/l, 1·04 (95 % CI 1·01, 1·06) for 150–159 g/l, 1·11 (95 % CI 1·05, 1·17) for 160–169 g/l and 1·19 (95 % CI 1·11, 1·27) for ≥170 g/l, respectively. The multivariable-adjusted OR for very PTB (VPTB) was 1·07 (95 % CI 1·03, 1·12) and 1·06 (95 % CI 1·01, 1·12) for women with Hb <110 and ≥150 g/l, compared with those with Hb of 110–149 g/l, respectively. Our study identified a U-shaped relationship between maternal preconception Hb concentration and PTB risk. Both preconception anaemia and high Hb level can significantly increase VPTB risk. Appropriate intervention for women with abnormal Hb levels before pregnancy is very necessary.
Let P be the transition matrix of a positive recurrent Markov chain on the integers with invariant probability vector πT, and let (n)P̃ be a stochastic matrix, formed by augmenting the entries of the (n + 1) x (n + 1) northwest corner truncation of P arbitrarily, with invariant probability vector (n)πT. We derive computable V-norm bounds on the error between πT and (n)πT in terms of the perturbation method from three different aspects: the Poisson equation, the residual matrix, and the norm ergodicity coefficient, which we prove to be effective by showing that they converge to 0 as n tends to ∞ under suitable conditions. We illustrate our results through several examples. Comparing our error bounds with the ones of Tweedie (1998), we see that our bounds are more applicable and accurate. Moreover, we also consider possible extensions of our results to continuous-time Markov chains.
Multiple drug resistance (MDR) intra-abdominal infections (IAIs) are associated with noteworthy direct and societal costs. Compared to previous studies, the present one takes both resistance rate and total medical costs (TMCs) into consideration, focusing on the impact of MDR on TMCs in IAIs, as well as further estimating the additional costs at a national level.
All inpatients discharged between 1 January 2014, and 31 December 2015 from a teaching hospital were included. Due to limits in budget and the large number of inpatients, the randombetween (bottom, top) function was applied to randomly select 40 percent of patients per year. Subsequently, we manually screened out 254 patients with IAIs, according to the International Classification of Disease (tenth revision) and electronic medical records. Eventually, 101 IAIs patients were included, in which 37 were infected by non-MDR bacteria and 64 by MDR bacteria. The Kruskal-wallis non-parametric test and multiple linear regression were employed to analyze the effect of single and multiple variables on TMCs.
Compared to patients with non-MDR infections, those with MDR were associated with significantly higher TMCs, higher antimicrobial costs, increased insurance, combination antimicrobial therapy, higher usage of antimicrobial agents, greater number of pathogens, longer length of stay, and longer intensive care unit stays. In addition, the average TMCs among patients with MDR were CNY131,801.17 (1USD was equal to CNY 6.227 in 2015), which were CNY 90,200.99 higher than those with non-MDR infections. If our results are generalizable to the whole country, the total attributable TMCs are estimated to be CNY37.06 billion, and the societal costs of CNY111.18 billion in 2015.
This real-world data analysis demonstrated the significant excessive burden MDR infections are posing to the current Chinese healthcare system in terms of both TMCs and healthcare resource utilization. Enhanced antimicrobial stewardship in China is necessary to curb the distribution of MDR bacteria.
Using multi-level analysis, the present study proposes that psychological empowerment and perceived organizational support serve as mediators of the effects of human resource management (HRM) bundle on individual innovative behavior. We tested the model using data from 705 employees of 162 firms in China. The results revealed that both psychological empowerment and perceived organizational support partially mediate the relationship between HRM bundle and individual innovative behavior. This study contributes to the understanding of how HRM bundle impact on individual innovative behavior.
Temporal variations in the taxonomic relatedness of periphytic ciliate
microfauna during colonization periods were studied in coastal waters of the
Yellow Sea, northern China, from May to June 2010. Samples were collected at
two depths of 1 and 3 m, using glass slides as artificial substrates. The
colonization dynamics of ciliate microfauna on the slides revealed similar
patterns in species composition at both depths. In the immature communities
(1–7 days), the taxonomic patterns showed high variability compared to those
in the mature ones (10 days and more). However, taxonomic relatedness
parameters at the two depths differed during early stages of colonization
(e.g. 1–3 days). Taxonomic diversity (Δ) was subject to high variability
(coefficients of variation >10%) in both immature and mature communities,
whereas taxonomic distinctness (Δ*), average taxonomic distinctness
(Δ+) and variation in taxonomic distinctness (Λ+)
showed high stability (coefficients of variation <10%) during the
colonization times of 3–21 days. These findings suggest that 3–21-day
exposure times are sufficient to detect the taxonomic distinctness of
periphytic ciliate microfauna at water depths of 1–3 m for the purposes of
ecological research and monitoring of marine ecosystems.
To selectively detect Cu2+ ions is very important for controlling daily intake of Cu2+ ions and monitoring numerous biological processes. Fluorescence spectroscopic technique is a useful one for detection of copper ions. Previous methods always involve the use of metal Cd-based quantum dots (QDs), which suffer to the photobleaching and subsequent release of toxic metal ions. Herein, a simple method has been developed to detect Cu2+ ions by using pristine graphene QDs. Graphene QDs are synthesized by chemical oxidation of pitch graphite fibers. Our results indicate the photoluminescence (PL) of as-synthesized graphene QDs could be quenched by a group of metal ions while adding biothiol cysteine can only cause the significant recovery of the PL of graphene QDs quenched by Cu2+ ions. Our approach provides an easy and environmental friendly method for detection of Cu2+ ions and has the potential for future practical applications.
Community parameters of diatoms have been used as useful bioindicators for bioassessment of both lentic and lotic systems. The influence of enumeration time periods on detecting community parameters of periphytic diatom assemblages within different exposure times was studied using an artificial substratum in coastal waters of the Yellow Sea, northern China, during the period May–June 2010. Samples were collected at a depth of 1 m, and were examined with different enumeration time periods. Enumeration time periods represented a significant influence on detecting the community features of periphytic diatoms, although no significant changes occurred in periphytic diatom community structure between two enumeration schemes (within 24 h and 24–48 h). The delayed enumeration (within 24–48 h) may result in the similarity of the communities being reduced 10–29%, and in species numbers decreasing and in abundance increasing with exposure duration, respectively. The diversity (richness, evenness and diversity of species) indices were significantly decreased in almost all samples with >10% standard errors at some exposure times by the delayed enumeration scheme. These results suggest that the delayed enumeration may have resulted in the species richness and individual abundance of periphytic diatoms significantly decreasing and increasing, respectively, and thus significantly affected the analyses of species diversity for assessing water quality in marine ecosystems.
To obtain highly dispersed and highly active catalysts by impregnating of active species onto the monolith directly, cordierite honeycomb ceramics were modified by nitric acid solution of 68wt%. Effects of acid treatment temperature and time on the performance of cordierite were investigated. Specific surface area, pore size distribution, morphology and structure of cordierite were characterized by N2-physical adsorption, SEM, XRD, respectively. Concentrations of ions in the acid solution were measured by AAS. It is shown that the corrosion content of cordierite increases and more micropores are generated with increasing time of acid treatment, leading to an upward trend of specific surface area. The coefficient of thermal expansion and compression strength decrease obviously at a higher temperature, which is mainly attributed to the removal of Al and Mg ions from the silicate structure and delayed formation of free amorphous silica on the surface of the cordierite. The optimal modification process of cordierite matrix acid erosion is at 110°C for 6 h.
In this paper we are interested in bounding or calculating the additive functionals of the first return time on a set for discrete-time Markov chains on a countable state space, which is motivated by investigating ergodic theory and central limit theorems. To do so, we introduce the theory of the minimal nonnegative solution. This theory combined with some other techniques is proved useful for investigating the additive functionals. This method is used to study the functionals for discrete-time birth-death processes, and the polynomial convergence and a central limit theorem are derived.
In this paper, we investigate computable lower bounds for the best strongly ergodic rate of convergence of the transient probability distribution to the stationary distribution for stochastically monotone continuous-time Markov chains and reversible continuous-time Markov chains, using a drift function and the expectation of the first hitting time on some state. We apply these results to birth–death processes, branching processes and population processes.