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The retention of patients under methadone maintenance treatment (MMT) is an indication for the effectiveness of the therapy. We aimed to explore the relation between mortality and the cumulative MMT duration.
A retrospective cohort analysis was performed using Taiwan Illicit Drug Issue Database (TIDID) and National Health Insurance Research Database (NHIRD) during 2012–2016. We included 9149 and 11 112 MMT patients as the short and long groups according to the length of their cumulative MMT duration, 1–364 and ⩾365 days, respectively. The risk of mortality was calculated by Cox proportional hazards regression model with time-dependent exposure to MMT, and the survival probability was plotted with the Kaplan-Meier curve.
The mortality rates were 2.51 and 1.51 per 100 person-years in the short and long cumulative MMT duration groups, respectively. After adjusting for on or off MMT, age, sex, marital status, education level, maximum methadone dose, and comorbidities (human immunodeficiency virus, depression, hepatitis C virus, hepatitis B virus, alcoholic liver disease, and cardiovascular disease), the long group had a lower risk of death (hazard ratio = 0.67; 95% confidence interval 0.60–0.75) than the short group. Increased risk was observed in patients with advanced age, being male, unmarried, infected by HIV, HCV, and HBV, and diagnosed with depression, ALD, and CVD. Causes of death were frequently related to drug and injury.
Longer cumulative MMT duration is associated with lower all-cause and drug-related mortality rate.
The coronavirus disease 2019 (COVID-19) pandemic is a major threat to the public. However, the comprehensive profile of suicidal ideation among the general population has not been systematically investigated in a large sample in the age of COVID-19.
A national online cross-sectional survey was conducted between February 28, 2020 and March 11, 2020 in a representative sample of Chinese adults aged 18 years and older. Suicidal ideation was assessed using item 9 of the Patient Health Questionnaire-9. The prevalence of suicidal ideation and its risk factors was evaluated.
A total of 56,679 participants (27,149 males and 29,530 females) were included. The overall prevalence of suicidal ideation was 16.4%, including 10.9% seldom, 4.1% often, and 1.4% always suicidal ideation. The prevalence of suicidal ideation was higher in males (19.1%) and individuals aged 18–24 years (24.7%) than in females (14.0%) and those aged 45 years and older (11.9%). Suicidal ideation was more prevalent in individuals with suspected or confirmed infection (63.0%), frontline workers (19.2%), and people with pre-existing mental disorders (41.6%). Experience of quarantine, unemployed, and increased psychological stress during the pandemic were associated with an increased risk of suicidal ideation and its severity. However, paying more attention to and gaining a better understanding of COVID-19-related knowledge, especially information about psychological interventions, could reduce the risk.
The estimated prevalence of suicidal ideation among the general population in China during COVID-19 was significant. The findings will be important for improving suicide prevention strategies during COVID-19.
Examine mother-son, mother-daughter, father-son, and father-daughter resemblance in weight status, and potential modifying effects of socio-demographic and childcare characteristics.
1,973 school-age children and their parents from five mega-cities across China in 2017.
Pearson correlation coefficients (r) for body mass index (BMI) of father-son, father-daughter, mother-son, and mother-daughter pairs were 0·16, 0·24, 0·26, and 0·24, respectively, while their weighted kappa coefficients (k) were 0·09, 0·14, 0·04, and 0·15, respectively. Children aged 6–9 years (r ranged from 0·30 to 0·35) had larger BMI correlation with their parents than their counterparts aged 10–14 years or 15–17 years (r ranged from 0·15 to 0·24). Children residing at home (r ranged from 0·17 to 0·27) had greater BMI correlations with their parents than children residing at school/other places. BMI correlation coefficients were significant if children were mainly cared for by their mothers (r ranged from 0·17 to 0·29) but non-significant if they were mainly cared for by others. Only children who ate the same meal as their parents “most times” (r ranged from 0·17 to 0·27) or had dinner with their parents “at most times” (r ranged from 0·21 to 0·27) had significant BMI correlation with their parents. Similarly, children who had dinner with their parents “most times” but not “sometimes,” had significant BMI correlation coefficients.
Parent-child resemblance in weight status was modest, and varied by child age, gender, primary caregiver, whether having similar food or dinner with parents in China.
The prognostic factor for in-hospital mortality in tuberculosis (TB) patients requiring intensive care unit (ICU) care remains unclear. Therefore, a retrospective study was conducted aiming to estimate the in-hospital mortality rate and the risk factors for mortality in a high-burden setting. All patients with culture-confirmed TB that were admitted to the ICU of the hospital between March 2012 and April 2019 were identified retrospectively. Data, such as demographic characteristics, comorbidities, laboratory measures and mortality, were obtained from medical records. The Cox proportional hazards regression model was used to identify prognostic factors that influence in-hospital mortality. A total of 82 ICU patients with confirmed TB were included in the analysis, and 22 deaths were observed during the hospital stay, 21 patients died in the ICU. In the multivariable model adjusted for sex and age, the levels of serum albumin and white blood cell (WBC) count were significantly associated with mortality in TB patients requiring ICU care (all P < 0.01), the hazard ratios were 0.8 (95% confidence interval (CI): 0.7–0.9) per 1 g/l and 1.1 (95% CI: 1.0–1.2) per 1 × 109/l, respectively. In conclusion, in-hospital mortality remains high in TB patients requiring ICU care. Low serum albumin level and high WBC count significantly impact the risk of mortality in these TB patients in China.
Power scaling based on traditional ytterbium-doped fibers (YDFs) is limited by optical nonlinear effects and transverse mode instability (TMI) in high-power fiber lasers. Here, we propose a novel long tapered fiber with a constant cladding and tapered core (CCTC) along its axis direction. The tapered-core region of the fiber is designed to enhance the stimulated Raman scattering (SRS) threshold and suppress higher-order mode resonance in the laser cavity. The CCTC YDF was fabricated successfully with a modified chemical vapor deposition (MCVD) method combined with solution doping technology, which has a cladding diameter of 400 μm and a varying core with a diameter of ~24 μm at both ends and ~31 μm in the middle. To test the performance of the CCTC fiber during high-power operation, an all-fiber laser oscillator based on a CCTC YDF was investigated experimentally. As a result, a maximum output power of 3.42 kW was achieved with an optical-to-optical efficiency of 55.2%, although the TMI effect was observed at an output power of ~3.12 kW. The measured beam quality (M2 factor) was ~1.7, and no sign of the Raman component was observed in the spectrum. We believe that CCTC YDF has great potential to simultaneously mitigate the SRS and TMI effects, and further power scaling is promising by optimizing the structure of the YDF.
During the 1960s and 1970s, the notion that the uterus is a useless and pathological organ after a woman has had ‘enough’ children emerged alongside news reports of excessive hysterectomy in Taiwan. This notion and hysterectomy became two sides of the same coin, the former pointing to the burden of birth control and cancer risk, and the latter to sterilization and removing cancer risk. I explore how, in post-war Taiwan, the notion became commonplace through the intersection of three historical formations: the medical tradition of employing surgery to manage risk (such as appendectomy for appendicitis), American-dominated family planning projects that intensified the surgical approach and promoted reproductive rationality, and cancer prevention campaigns that helped cultivate a sense of cancer risk. The gender politics operating in the family planning and cancer prevention projects were apparent. The burden of birth control fell mainly on women, and the cancer prevention campaign, centring almost exclusively on early detection of cervical cancer, made cancer into a woman’s disease. I argue that the discourses of reproductive rationality and disease risk were parallel and, in several key ways, intersecting logics that rendered the uterus useless and pathological and then informed surgeons’ practice of hysterectomy. Exploring the ways in which the uterus was envisioned and targeted in the history of medicine in Taiwan, this paper shows overlapping bio-politics in three strands of research in an East Asian context – namely women’s health, family planning and cancer prevention – and offers a case for global comparison.
Background: Effective strategies to improve diagnostic stewardship around C. difficile infection (CDI) remain elusive. Electronic medical record-based solutions, such as ‘hard’ and ‘soft’ stops, have been associated with reductions in testing, but may not be sustainable due to alert fatigue. Additionally, data on the potential for undertesting, missed diagnoses, and the implications regarding patient harm or clusters of transmission are limited. In this study, we assessed the efficacy of a behavioral approach to diagnostic stewardship, while monitoring for unintended consequences. Methods: This quality improvement study was conducted January 2018–May 2019; baseline period: January–April 2018, implementation period: May–December 2018, sustainment period: January 2019–May 2019. First, we conducted an internal analysis and identified 3 barriers to appropriate testing: clinician’s perceived risk of CDI, inconsistent definition of diarrhea, and lack of involvement of nurses in diagnostic stewardship. A multidisciplinary team to address these barriers was then convened. The team utilized the Bristol stool scale to improve the reliability of diarrhea description, and created a guideline-concordant testing algorithm with clinicians and nurses. The primary outcome was the number of tests ordered. The secondary outcomes were the proportion of inappropriate tests and the proportion of delayed tests. Delayed tests were defined as CDI-compatible diarrhea based on the algorithm where the test was sent >24 hours after symptom onset. Results: During the baseline period, we detected no significant change in number of tests ordered month to month, with 194.2 tests ordered per month on average. During the postimplementation period, the number of tests ordered decreased by ~4.5 each month between January 2018 and May 2019 (P < .0001). The proportion of inappropriate tests steadily decreased from 54% to 30% across the 3 study periods, and the number of delayed testing changed from 11% to 1% then increased to 20% in the sustainment period. There were no cases of toxic megacolon associated with delayed testing. Conclusions: The decision to test for CDI is complex. Interventions that address this issue as a simple ‘right’ and ‘wrong’ fail to address the root cause of CDI overdiagnosis, and they have no embedded mechanism to detect unintended consequences. Our study demonstrates that by taking a behavioral approach and addressing clinicians’ safety concerns, we were able to sustain a significant reduction in testing. We could not determine the significance of the increase in delayed testing given the low numbers; however, further studies are needed to evaluate the safety of CDI reduction strategies through diagnostic stewardship only.
Rice (Oryza sativa L.) is the primary staple crop in Taiwan, and it can be grown twice a year. The prevalent subspecies grown in Taiwan is Japonica, and a transplanting system is used for rice production. Although the transplanting system is known for efficient weed control at the seedling stage, weedy red rice (WRR, O. sativa f. spontanea) infestation is progressively being reported. Fieldwork and previous studies have suggested that WRR infestation in Taiwan is probably related to growers’ operating practices and their perception of WRR. However, no data are available for a detailed investigation. The present study aimed to collect data on rice growers’ backgrounds, farming practices, and perceptions of WRR to quantify and characterize the patterns of farming operations for rice growers in Taiwan and to investigate factors contributing to WRR infestation. We collected 408 questionnaires completed by rice growers from 17 counties covering all rice production regions in Taiwan. The growers’ median age was 51 to 60 yr, and 75% of respondents had paddies from 0.25 to 2.75 ha in size, which corresponded with nationwide data for farmers’ backgrounds. In general, growers applied similar farming practices for both cropping seasons. Most respondents did not notice WRR infestation or consider it to be a problem: only 9.8% noticed a moderate to severe infestation of WRR in their fields. The major perceived causes of WRR infestation was seed impurity (55.1%) or cultivar degeneration (18.6%). Correlation analysis and farming patterns estimated with a nonnegative matrix factorization algorithm showed that WRR contamination rate was due to the use of dry or wet tillage. The present study provides the first quantitative and qualitative evidence of rice production practices and growers’ perceptions of WRR infestation in Taiwan.
To measure the associations of sociodemographic and behavioural factors with fruit and vegetable consumption among adults in China.
A cross-sectional study.
A 2015 wave of the China Health and Nutrition Survey.
Totally, 11 910 adults aged 18 to 64 years.
Adjusted log binomial regression analyses showed that adults with higher income levels had higher fruit intake than those with low income levels (medium income group, risk ratio (RR): 1·28; 95 % CI: 1·16, 1·41; high income group, RR: 1·58; 95 % CI: 1·43, 1·74). Current smokers had lower fruit intake than non-smokers (RR: 0·86; 95 % CI: 0·77, 0·96). Adults living in southern China had higher vegetable intake (RR: 1·88; 95 % CI: 1·76, 2·01) but lower fruit intake (RR: 0·85; 95 % CI: 0·79, 0·91) than adults in northern China. With increasing age, adults had higher fruit intake (50–64 years, RR: 1·20; 95 % CI: 1·09, 1·33; reference category 18–34 years) and higher vegetable intake (35–49 years, RR: 1·13; 95 % CI: 1·05, 1·22; 50–64 years, RR: 1·22; 95 % CI: 1·13, 1·31).
Our findings identify a range of sociodemographic and behavioural factors associated with fruit and vegetable consumption among Chinese adults. They also point to the need for public health nutrition interventions for socially disadvantaged populations in China.
Rare earth elements (REE) in marine minerals have been widely used as proxies for the redox status of depositional and/or diagenetic environments. Phosphate nodules, which are thought to grow within decimetres below the sediment–water interface and to be able to scavenge REE from the ambient pore water, are potential archives of subtle changes in REE compositions. Whether their REE signals represent specific redox conditions or they can be used to track the overlying water chemistry is worth exploring. Through in situ laser ablation – inductively coupled plasma – mass spectrometry (LA-ICP-MS), we investigate the REE compositions of a drill-core-preserved phosphate nodule from the lower Cambrian Niutitang Formation in the Daotuo area, northeastern Guizhou Province, South China. REE distributions of the nodule show concentric layers with systematic decreases in Ce anomalies (Ce/Ce*) from the core to the rim. The lowest Ce/Ce* appears in the outer rim where REE concentrations are relatively high. These results are interpreted to reflect REE exchange with pore water at a very early stage or bathymetric variation during apatite precipitation. The origin of the shale-normalized middle REE (MREE) enrichment in our sample is less constrained. Possible driving factors include preferential MREE substitution for Ca in the apatite lattice, degradation of organic matter and deposition beneath a ferruginous zone. Although speculative, the last possibility is consistent with the chemically stratified model for early Cambrian oceans, in which dynamic fluctuations of the chemocline provided an ideal depositional context for phosphogenesis.
A higher dietary intake or serum concentration of betaine has been associated with greater lean body mass in middle-aged and older adults. However, it remains unknown whether betaine intake is associated with age-related loss of skeletal muscle mass (SMM). We assessed the association between dietary betaine intake and relative changes in SMM after 3 years in middle-aged adults. A total of 1242 participants aged 41–60 years from the Guangzhou Nutrition and Health Study 2011–2013 and 2014–2017 with body composition measurements by dual-energy X-ray absorptiometry were included. A face-to-face questionnaire was used to collect general baseline information. After adjustment for potential confounders, multiple linear regression found that energy-adjusted dietary betaine intake was significantly and positively associated with relative changes (i.e. percentage loss or increase) in SMM of legs, limbs and appendicular skeletal mass index (ASMI) over 3 years of follow-up (β 0·322 (se 0·157), 0·309 (se 0·142) and 0·303 (se 0·145), respectively; P < 0·05). The ANCOVA models revealed that participants in the highest betaine tertile had significantly less loss in SMM of limbs and ASMI and more increase in SMM of legs over 3 years of follow-up, compared with those in the bottom betaine tertile (all Ptrend < 0·05). In conclusion, our findings suggest that elevated higher dietary betaine intake may be associated with less loss of SMM of legs, limbs and ASMI in middle-aged adults.
This paper proposes a novel laser beam tracking mechanism for a mobile target robot that is used in shooting ranges. Compared with other traditional tracking mechanisms and modules, the proposed laser beam tracking mechanism is more flexible and low cost in use. The mechanical design and the working principle of the tracking module are illustrated, and the complete control system of the mobile target robot is introduced in detail. The tracking control includes two main steps: localizing the mobile target robot with regards to the position of the laser beam and tracking the laser beam by the linear quadratic regulator (LQR). First of all, the state function of the control system is built for this tracking system; second, the control law is deduced according to the discretized state function; lastly, the stability of the control method is proved by the Lyapunov theory. The experimental results demonstrate that the Hue, Saturation, Value feature-extracting method is robust and is qualified to be used for localization in the laser beam tracking control. It is verified through experiments that the LQR method is of better performance than the conventional Proportional Derivative control in the aspect of converge time, lateral error control, and distance error control.
We report electronic medical record interventions to reduce Clostridioides difficile testing risk ‘alert fatigue.’ We used a behavioral approach to diagnostic stewardship and observed a decrease in the number of tests ordered of ~4.5 per month (P < .0001). Although the number of inappropriate tests decreased during the study period, delayed testing increased.
In this work ice breaking caused by a pair of interacting collapsing bubbles was studied by an experimental approach. The bubbles were generated by an underwater electric discharge simultaneously, positioned either horizontally or vertically below a floating ice plate and observed via high-speed photography. The bubble-induced shock waves, which turn out to be crucial to the fracturing of the ice, were visualized using a shadowgraph method and also measured using pressure transduces. Unique bubble behaviour was observed, including bubble coalescence, bubble splitting, inclined counter-jets and asymmetric toroidal bubble collapse. Bubble dynamic properties, such as jet speed, jet energy and bubble centre displacement, were measured. Shock wave emission and ice breaking capability of the two bubbles were investigated over a range of inter-bubble and bubble–boundary distances. Regions where the damaging potential of the bubble pair are strengthened or weakened were summarized and possible reasons for the variation in the ice breaking capability were analysed based on bubble morphology, jet characteristics and shock wave pressure. The findings may contribute to more efficient ice breaking and also inspire new ways to manipulate cavitation bubble damage.
To identify the association of the glucokinase gene (GCK) rs4607517 polymorphism with gestational diabetes mellitus (GDM) and determine whether sweets consumption could interact with the polymorphism on GDM in Chinese women.
We conducted a case–control study at a hospital including 1015 participants (562 GDM cases and 453 controls). We collected the data of pre-pregnancy BMI, sweets consumption and performed genotyping of the GCK rs4607517 polymorphism. Logistic regression was performed to test the association between the rs4607517 polymorphism and GDM, and the stratified analyses by sweets consumption were conducted, using an additive genetic model.
A case–control study of women at a hospital in Beijing, China.
One thousand and fifteen Chinese women.
The GCK rs4607517 A allele was significantly associated with GDM (OR 1·35, 95 % CI 1·03, 1·77; P = 0·028). Furthermore, stratified analyses showed that the A allele increased the risk of GDM only in women who had a habitual consumption of sweet foods (sweets consumption ≥ once per week) (OR 1·61, 95 % CI 1·17, 2·21; P = 0·003). Significant interaction on GDM was found between the rs4607517 A allele and sweets consumption (P = 0·004).
This study for the first time reported the interaction between the GCK rs4607517 polymorphism and sweets consumption on GDM. The results provided novel evidence for risk assessment and personalised prevention of GDM.
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.
The study of the petrogenesis of some magmatic rocks with special geochemical attributes provides effective information for us to explore the deep geodynamic background of their formation. A series of granitic porphyry dykes have been found in the mélange zone of the Asa region in southern Tibet, whose genesis may be closely related to the evolution of the Meso-Tethyan Ocean. Regional geodynamic evolution is investigated by whole-rock geochemical analysis, zircon U–Pb dating and Lu–Hf isotopic analysis of two porphyritic granites. The Asa porphyritic granites have high SiO2 (74.29–78.65 wt %) and alkalis (Na2O + K2O = 6.51–9.35 wt %) contents, and low Al2O3 (11.60–14.51 wt %), CaO (0.04–0.19 wt MgO (0.01–0.10 wt %) contents. They are enriched in Zr, Nb, Ce, Y and Hf and depleted in Ti, Ba, Sr and P, consistent with A-type granites. The samples are relatively rich in LREEs, with LREE/HREE ratios of 1.73–3.04. They display negative Eu anomalies (Eu/Eu* = 0.24–0.28) and obvious Ce anomalies in some samples. Zircon U–Pb analyses show that the porphyritic granites formed in late Early Cretaceous time, 107.4 to 105.5 Ma. Zircon εHf(t) values are in the range of 6.9 to 12.0. These data indicate that the porphyritic granites were sourced from interaction between mantle-derived and juvenile lower crust-derived melts, with the addition of oceanic sediment-derived melts. This occurred when the subducting Bangong–Nujiang oceanic crust split to create a slab window. Rising asthenosphere triggered re-melting of lower crust basalts, resulting in the formation of the late Early Cretaceous A-type granites around Asa.
Research on graph representation learning has received great attention in recent years since most data in real-world applications come in the form of graphs. High-dimensional graph data are often in irregular forms. They are more difficult to analyze than image/video/audio data defined on regular lattices. Various graph embedding techniques have been developed to convert the raw graph data into a low-dimensional vector representation while preserving the intrinsic graph properties. In this review, we first explain the graph embedding task and its challenges. Next, we review a wide range of graph embedding techniques with insights. Then, we evaluate several stat-of-the-art methods against small and large data sets and compare their performance. Finally, potential applications and future directions are presented.