Understanding patterns of multimorbidity in the US older adult population and their relationship with mortality is important for reducing healthcare utilization and improving health. Previous ...investigations measured multimorbidity as counts of conditions rather than specific combination of conditions.
This cross-sectional study with longitudinal mortality follow-up employed latent class analysis (LCA) to develop clinically meaningful subgroups of participants aged 50 and older with different combinations of 13 chronic conditions from the National Health Interview Survey 2002-2014. Mortality linkage with National Death Index was performed through December 2015 for 166,126 participants. Survival analyses were conducted to assess the relationships between LCA classes and all-cause mortality and cause specific mortalities.
LCA identified five multimorbidity groups with primary characteristics: "healthy" (51.5%), "age-associated chronic conditions" (33.6%), "respiratory conditions" (7.3%), "cognitively impaired" (4.3%) and "complex cardiometabolic" (3.2%). Covariate-adjusted survival analysis indicated "complex cardiometabolic" class had the highest mortality with a Hazard Ratio (HR) of 5.30, 99.5% CI 4.52, 6.22; followed by "cognitively impaired" class (3.34 2.93, 3.81); "respiratory condition" class (2.14 1.87, 2.46); and "age-associated chronic conditions" class (1.81 1.66, 1.98). Patterns of multimorbidity classes were strongly associated with the primary underlying cause of death. The "cognitively impaired" class reported similar number of conditions compared to the "respiratory condition" class but had significantly higher mortality (3.8 vs 3.7 conditions, HR = 1.56 1.32, 1.85).
We demonstrated that LCA method is effective in classifying clinically meaningful multimorbidity subgroup. Specific combinations of conditions including cognitive impairment and depressive symptoms have a substantial detrimental impact on the mortality of older adults. The numbers of chronic conditions experienced by older adults is not always proportional to mortality risk. Our findings provide valuable information for identifying high risk older adults with multimorbidity to facilitate early intervention to treat chronic conditions and reduce mortality.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Long noncoding RNAs (lncRNAs) have been shown to regulate tumor biology and might be used for cancer diagnosis, prognosis and potential therapeutic targets. Although up-regulation of lncRNA UCA1 ...(urothelial carcinoma-associated 1) in several cancers has been found, its role in gastric cancer remains elusive. The aim of this study was to detect the expression of lncRNA UCA1 in gastric cancer and its clinical association. The expression of UCA1 was detected in 112 pairs of tumorous and adjacent normal tissues from patients with gastric cancer, as well as in four gastric cancer cell lines and a human normal gastric epithelium cell line using RT-qPCR. Results showed that UCA1 expression was remarkably increased in gastric cancer tissues and cell lines compared with that in the normal control. Clinicopathologic analysis revealed that high UCA1 expression correlated with worse differentiation, tumor size, invasion depth and TNM stage in gastric cancer. Kaplan–Meier analysis showed that increased UCA1 expression contributed to poor overall survival (
p
= 0.017) and disease-free survival (
p
= 0.024) of patients. A multivariate survival analysis also indicated that UCA1 could be an independent prognostic marker. The levels of UCA1 in gastric juice from gastric patients were significantly higher than those from normal subjects (
p
= 0.016). Moreover, validation analysis showed that UCA1 levels were robust in differentiating gastric cancer patients from control subjects area under the curve (AUC) = 0.721; 95 % confidence interval (CI) = 0.655–0.788,
p
< 0.01. These results suggested that UCA1 might serve as a promising biomarker for early detection and prognosis prediction of gastric cancer.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
To assess the current prevalence of and risk factors for infertility among couples of reproductive age in China.
Design
Population‐based cross‐sectional study.
Setting
We approached 25 270 ...couples in eight provinces/municipalities, of whom 18 571 (response rate 74%) were interviewed.
Population
Couples living together and married for more than 1 year, of whom the female spouse was 20–49 years old.
Methods
Women were approached via telephone and face‐to‐face conversation to complete the standardised and structured questionnaire by trained interviewers.
Main outcome measures
Prevalence of and risk factors for infertility.
Results
Among women ‘at risk’ of pregnancy, the prevalence of infertility was 15.5% (2680/17 275). Among 10 742 women attempting to become pregnant, the prevalence of infertility was 25.0% (2680/10 742), which increased with age in the second population. Among women who failed to achieve pregnancy in the last 12 months, 3470 finished our questionnaire about fertility care, and 55.2% (1915/3470) of them had sought medical help. Sociodemographic risk factors for infertility included lower educational level adjusted odds ratio (aOR) 3.4, 95% CI 2.0–5.5 and employment (aOR 2.3, 95% CI 1.9–2.9). Clinical risk factors were irregular menstrual cycle (aOR 1.8, 95% CI 1.2–2.5), light menstrual blood volume (aOR 1.6, 95% CI 1.2–2.0), history of cervicitis (aOR 1.5, 95% CI 1.2–2.0) and endometriosis (aOR 3.1, 95% CI 1.1–9.3), previous stillbirth (aOR 2.1, 95% CI 1.3–3.3) and miscarriage (aOR 2.7, 95% CI 2.1–3.5). In addition, history of operation was a significant risk factor of infertility.
Conclusions
Among couples of reproductive age in China, the prevalence of infertility was 25%, and almost half of the couples experiencing infertility had not sought medical help.
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In China, 25% of couples actively attempting to become pregnant suffered infertility.
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In China, 25% of couples actively attempting to become pregnant suffered infertility.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
In this research, samples of the H13 steel, a commonly used hot work tool steel in the die/mould manufacturing industry, were additively manufactured using selective laser melting (SLM). Their ...as-built microstructures were characterised in detail using transmission electron microscopy (TEM) and compared with that of the conventionally manufactured H13 (as-supplied). SLM resulted in the formation of martensite and also its partial decomposition into fine α-Fe and Fe
3
C precipitates along with retained austenite. TEM analyses further revealed that the lattice of the resulting α-Fe phase is slightly distorted due to enhanced Cr, Mo and V contents. Substantially high residual stresses in the range of 940–1420 MPa were detected in the as-built H13 samples compared with its yield strength of ~1650 MPa. In addition, it was identified that the high residual stress existed from just about two additive layers (100 µm) above the substrate along the build direction. The high residual stresses were mainly attributed to the martensitic transformation that occurred during SLM. The research findings of this study suggest that the substantially high residual stresses can be easily problematic in the AM of intricate H13 dies or moulds by SLM.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Recent studies have revealed that the interactions between clustered vertical-axis wind turbines (VAWTs) can help improve the total power production. Thus this study compares four typical ...arrangements (I, II, III, IV) of multi-turbines placed in close proximity to investigate their efficiencies of power generation. A series of computational fluid dynamic (CFD) simulations, based on two-dimensional (2D) unsteady Reynolds-averaged Navier-Stokes (URANS) theory, are performed for all four arrangements to achieve the maximum average power coefficient. First, the accuracy of the CFD model is validated against the field test results of 1.2 kW Windspire VAWT in reference. Then the performance of each arrangement at different proximities is investigated. It is found that the constraint effect in the lateral direction and the upstream turbines’ blockage effect can be triggered at a certain separation distance, which greatly affects the average power generation. In most cases, the 3-VAWT cluster is of higher efficiency than the 2-VAWT cluster in terms of the average power coefficient. The developed 3-VAWT cluster (Arrangement IV) has an average power coefficient up to 11.1% higher than that of an isolated turbine. In order to demonstrate the useful guidance of this study in practical applications, the performance of a newly developed wind-solar-aquaculture (WSA) system with multi-VAWTs is appraised. For the foundation of this system with restricted space, employment of the 3-VAWT cluster (Arrangement III) will yield yearly energy generation greater than that by three isolated turbines.
•Separation distances of clustered vertical-axis wind turbines (VAWTs) are optimized.•Constraint effect and blockage effect affect the efficiency of clustered VAWTs.•In most cases, the 3-VAWT cluster is of higher efficiency than the 2-VAWT cluster.•3-VAWT cluster yields yearly energy generation higher than that by 3 isolated VAWTs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
NADPH donates high energy electrons for antioxidant defense and reductive biosynthesis. Cytosolic NADP is recycled to NADPH by the oxidative pentose phosphate pathway (oxPPP), malic enzyme 1 (ME1) ...and isocitrate dehydrogenase 1 (IDH1). Here we show that any one of these routes can support cell growth, but the oxPPP is uniquely required to maintain a normal NADPH/NADP ratio, mammalian dihydrofolate reductase (DHFR) activity and folate metabolism. These findings are based on CRISPR deletions of glucose-6-phosphate dehydrogenase (G6PD, the committed oxPPP enzyme), ME1, IDH1, and combinations thereof in HCT116 colon cancer cells. Loss of G6PD results in high NADP, which induces compensatory increases in ME1 and IDH1 flux. But the high NADP inhibits dihydrofolate reductase (DHFR), resulting in impaired folate-mediated biosynthesis, which is reversed by recombinant expression of
DHFR. Across different cancer cell lines, G6PD deletion produced consistent changes in folate-related metabolites, suggesting a general requirement for the oxPPP to support folate metabolism.
License plate location is an important stage in vehicle license plate recognition for automated transport system. This paper presents a real time and robust method of license plate location. License ...plate area contains rich edge and texture information. We first extract out the vertical edges of the car image using image enhancement and Sobel operator, then remove most of the background and noise edges by an effective algorithm, and finally search the plate region by a rectangle window in the residual edge image and segment the plate out from the original car image. Experimental results demonstrate the great robustness and efficiency of our method.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
We leveraged IDH wild-type glioblastomas, derivative neurospheres, and single-cell gene expression profiles to define three tumor-intrinsic transcriptional subtypes designated as proneural, ...mesenchymal, and classical. Transcriptomic subtype multiplicity correlated with increased intratumoral heterogeneity and presence of tumor microenvironment. In silico cell sorting identified macrophages/microglia, CD4+ T lymphocytes, and neutrophils in the glioma microenvironment. NF1 deficiency resulted in increased tumor-associated macrophages/microglia infiltration. Longitudinal transcriptome analysis showed that expression subtype is retained in 55% of cases. Gene signature-based tumor microenvironment inference revealed a decrease in invading monocytes and a subtype-dependent increase in macrophages/microglia cells upon disease recurrence. Hypermutation at diagnosis or at recurrence associated with CD8+ T cell enrichment. Frequency of M2 macrophages detection associated with short-term relapse after radiation therapy.
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•GBM-intrinsic transcriptional subtypes: proneural, classical, mesenchymal•NF1 deficiency drives recruitment of tumor-associated macrophages/microglia•Resistance to radiotherapy may associate with M2 macrophage presence•CD8+ T cells are enriched in temozolomide-induced hypermutated GBMs at recurrence
Wang et al. define three IDH wild-type glioblastoma-intrinsic gene expression subtypes, which are partly shaped by the tumor immune environment. NF1 deficiency results in increased macrophage/microglia infiltration. Comparison of matched primary and recurrent tumors reveals frequent expression subtype changes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We report the realization of a quantum circuit in which an ensemble of electronic spins is coupled to a frequency tunable superconducting resonator. The spins are nitrogen-vacancy centers in a ...diamond crystal. The achievement of strong coupling is manifested by the appearance of a vacuum Rabi splitting in the transmission spectrum of the resonator when its frequency is tuned through the nitrogen-vacancy center electron spin resonance.
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CMK, CTK, FMFMET, IJS, NUK, PNG, UM
K-12 school buildings constitute a substantial portion of commercial buildings in the U.S. and are responsible for significant energy consumption. This paper presents a nationwide study to ...investigate the actual energy performance of secondary school buildings constructed per the requirements of ASHRAE Standard 90.1 - 2004 and − 2010. A total of 73 building candidates are included in the analysis after careful screening and inspection, which covers eight ASHRAE climate zones. A Python-based Change Point Model (CPM) is developed to normalize the energy consumption data of the selected 73 buildings following the ASHRAE procedure. The energy use indices (EUI) and energy cost indices (ECI) of single buildings and the aggregated average of all buildings are computed to evaluate the actual energy performance of secondary school buildings. The results suggest that the actual national aggregated average EUI of secondary school buildings is 61 and 41 kBTU/(sq. ft. yr) for buildings designed per ASHRAE Standard 90.1 - 2004 and − 2010, respectively. This indicates a 20% saving in EUI and ECI for the update from the 2004 standard to 2010 one in real buildings, compared with a 38% saving-ratio obtained by Pacific Northwest National Laboratory (PNNL) in a nationwide simulation study.
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BFBNIB, DOBA, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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