The ecosystem of digital technologies in Industry 4.0 is growing continuously, new data and information sources integration rising has carried notable value in waste management transitions with ...various technological barriers remains. The municipal solid waste management technological attributes are illustrated by qualitative information, and it is hard to form the consistent interdependence hierarchical structure under interrelationships. This study applies the fuzzy Delphi method to obtain the valid attributes. Fuzzy decision-making trial and evaluation laboratory is to envisage the interrelationships among the attributes. The analytic network process is to test the consistency among the hierarchical structures. The results provide an insight of municipal solid waste management technological barriers in Taiwan. The cyber-physical limitations, artificial intelligence application challenges, and human interface problems as cause aspects. In practices, (1) inadequate public data, (2) robotic process automation limitations, and (3) lack of predictive and emergency assistance, hinders the municipal solid waste management technological improvement.
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Patients with chronic lung disease (CLD) have an increased risk for severe coronavirus disease-19 (COVID-19) and poor outcomes. Here, we analyze the transcriptomes of 611,398 single cells isolated ...from healthy and CLD lungs to identify molecular characteristics of lung cells that may account for worse COVID-19 outcomes in patients with chronic lung diseases. We observe a similar cellular distribution and relative expression of SARS-CoV-2 entry factors in control and CLD lungs. CLD AT2 cells express higher levels of genes linked directly to the efficiency of viral replication and the innate immune response. Additionally, we identify basal differences in inflammatory gene expression programs that highlight how CLD alters the inflammatory microenvironment encountered upon viral exposure to the peripheral lung. Our study indicates that CLD is accompanied by changes in cell-type-specific gene expression programs that prime the lung epithelium for and influence the innate and adaptive immune responses to SARS-CoV-2 infection.
The details of aerosol processes and size distributions
in the stratosphere are important for both heterogeneous chemistry and
aerosol–radiation interactions. Using in situ, global-scale measurements ...of
the size distribution of particles with diameters > 3 nm from the
NASA Atmospheric Tomography Mission (ATom), we identify a mode of aerosol
smaller than 12 nm in the lowermost stratosphere (LMS) at mid- and high
latitudes. This mode is substantial only in the Northern Hemisphere (NH)
and was observed in all four seasons. We also observe elevated SO2, an
important precursor for new particle formation (NPF) and growth, in the NH
LMS. We use box modelling and thermodynamic calculations to show that NPF
can occur in the LMS conditions observed on ATom. Aircraft emissions are
shown as likely sources of this SO2, as well as a potential source of
nucleation mode particles directly emitted by or formed in the plume of the
engines. These nucleation mode particles have the potential to grow to
larger sizes and to coagulate with larger aerosol, affecting heterogeneous
chemistry and aerosol–radiation interactions. Understanding all sources and
characteristics of stratospheric aerosols is important in the context of
anthropogenic climate change as well as proposals for climate intervention
via stratospheric sulfur injection. This analysis not only adds to the,
currently sparse, observations of the global impact of aviation, but also
introduces another aspect of climate influence, namely a size distribution
shift of the background aerosol distribution in the LMS.
Antiretroviral therapies (ARTs) abrogate HIV replication; however, infection persists as long-lived reservoirs of infected cells with integrated proviruses, which reseed replication if ART is ...interrupted. A central tenet of our current understanding of this persistence is that infected cells are shielded from immune recognition and elimination through a lack of antigen expression from proviruses. Efforts to cure HIV infection have therefore focused on reactivating latent proviruses to enable immune-mediated clearance, but these have yet to succeed in reducing viral reservoirs. Here, we revisited the question of whether HIV reservoirs are predominately immunologically silent from a new angle: by querying the dynamics of HIV-specific T cell responses over long-term ART for evidence of ongoing recognition of HIV-infected cells. In longitudinal assessments, we show that the rates of change in persisting HIV Nef-specific responses, but not responses to other HIV gene products, were associated with residual frequencies of infected cells. These Nef-specific responses were highly stable over time and disproportionately exhibited a cytotoxic, effector functional profile, indicative of recent in vivo recognition of HIV antigens. These results indicate substantial visibility of the HIV-infected cells to T cells on stable ART, presenting both opportunities and challenges for the development of therapeutic approaches to curing infection.
Predicting Survival for Patients With Metastatic Disease Benson, Kathryn R K; Aggarwal, Sonya; Carter, Justin N ...
International journal of radiation oncology, biology, physics,
01/2020, Letnik:
106, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This prospective study aimed to determine the accuracy of radiation oncologists in predicting the survival of patients with metastatic disease receiving radiation therapy and to understand factors ...associated with their accuracy.
This single-institution study surveyed 22 attending radiation oncologists to estimate patient survival. Survival predictions were defined as accurate if the observed survival (OS) was within the correct survival prediction category (0-6 months, >6-12 months, >12-24 months, and >24 months). The physicians made survival estimates for each course of radiation, yielding 877 analyzable predictions for 689 unique patients. Data analysis included Stuart's Tau C, logistic regression models, ordinal logistic regression models, and stepwise selection to examine variable interactions.
Of the 877 radiation oncologists' predictions, 39.7% were accurate, 26.5% were underestimations, and 33.9% were overestimations. Stuart's Tau C showed low correlation between OS and survival estimates (0.3499), consistent with the inaccuracy reported in the literature. However, results showed less systematic overprediction than reported in the literature. Karnofsky performance status was the most significant predictor of accuracy, with greater accuracy for patients with shorter OS. Estimates were also more accurate for patients with lower Karnofsky performance status. Accuracy by patient age varied by primary site and race. Physician years of experience did not correlate with accuracy.
The sampled radiation oncologists have a 40% accuracy in predicting patient survival. Future investigation should explore how survival estimates influence treatment decisions and how to improve survival prediction accuracy.
Bacillary dysentery caused by
is a major cause of under-five mortality in developing countries, where a novel
serotype 1c has become very common since the 1980s. However, the origin and ...diversification of serotype 1c remain poorly understood. To understand the evolution of serotype 1c and their antimicrobial resistance, we sequenced and analyzed the whole-genome of 85 clinical isolates from the United Kingdom, Egypt, Bangladesh, Vietnam, and Japan belonging to serotype 1c and related serotypes of 1a, 1b and Y/Yv. We identified up to three distinct O-antigen modifying genes in
1c strains, which were acquired from three different bacteriophages. Our analysis shows that
1c strains have originated from serotype 1a and serotype 1b strains after the acquisition of bacteriophage-encoding
operon. The maximum-likelihood phylogenetic analysis using core genes suggests two distinct
1c lineages, one specific to Bangladesh, which originated from ancestral serotype 1a strains and the other from the United Kingdom, Egypt, and Vietnam originated from ancestral serotype 1b strains. We also identified 63 isolates containing multiple drug-resistant genes in them conferring resistance against streptomycin, sulfonamide, quinolone, trimethoprim, tetracycline, chloramphenicol, and beta-lactamase. Furthermore, antibiotic susceptibility assays showed 83 (97.6%) isolates as either complete or intermediate resistance to the WHO-recommended first- and second-line drugs. This changing drug resistance pattern demonstrates the urgent need for drug resistance surveillance and renewed treatment guidelines.
Abstract The nares represent an important bacterial reservoir for endogenous infections. This study aimed to assess the prevalence of nasal colonization by different important pathogens, the ...associated antimicrobial susceptibility and risk factors. We performed a prospective cohort study among 1878 nonhospitalized volunteers recruited from the general population in Germany. Participants provided nasal swabs at three time points (each separated by 4–6 months). Staphylococcus aureus, Enterobacteriaceae and important nonfermenters were cultured and subjected to susceptibility testing. Factors potentially influencing bacterial colonization patterns were assessed. The overall prevalence of S. aureus, Enterobacteriaceae and nonfermenters was 41.0, 33.4 and 3.7%, respectively. Thirteen participants (0.7%) were colonized with methicillin-resistant S. aureus. Enterobacteriaceae were mostly (>99%) susceptible against ciprofloxacin and carbapenems (100%). Extended-spectrum β-lactamase–producing isolates were not detected among Klebsiella oxytoca, Klebsiella pneumoniae and Escherichia coli . Several lifestyle- and health-related factors (e.g. household size, travel, livestock density of the residential area or occupational livestock contact, atopic dermatitis, antidepressant or anti-infective drugs) were associated with colonization by different microorganisms. This study unexpectedly demonstrated high nasal colonization rates with Enterobacteriaceae in the German general population, but rates of antibiotic resistance were low. Methicillin-resistant S. aureus carriage was rare but highly associated with occupational livestock contact.
Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). The correlates of ST with DES are not yet completely ...elucidated.
From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST (1.27%). The ST occurred acutely in 5 patients, subacutely (< or =30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographic, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller-diameter stents. Discontinuation of clopidogrel was higher in these patients (36.8% versus 10.7%; P<0.0001). The mean duration to ST from the stent implantation was 8.9+/-8.5 days in subacute and 152.7+/-100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31% versus 3%; P<0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (P<0.05).
ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.
Intramuscular triglyceride (IMTG) concentration is elevated in insulin-resistant individuals and was once thought to promote insulin resistance. However, endurance-trained athletes have equivalent ...concentration of IMTG compared with individuals with type 2 diabetes, and have very low risk of diabetes, termed the "athlete's paradox." We now know that IMTG synthesis is positively related to insulin sensitivity, but the exact mechanisms for this are unclear. To understand the relationship between IMTG synthesis and insulin sensitivity, we measured IMTG synthesis in obese control subjects, endurance-trained athletes, and individuals with type 2 diabetes during rest, exercise, and recovery. IMTG synthesis rates were positively related to insulin sensitivity, cytosolic accumulation of DAG, and decreased accumulation of C18:0 ceramide and glucosylceramide. Greater rates of IMTG synthesis in athletes were not explained by alterations in FFA concentration, DGAT1 mRNA expression, or protein content. IMTG synthesis during exercise in Ob and T2D indicate utilization as a fuel despite unchanged content, whereas IMTG concentration decreased during exercise in athletes. mRNA expression for genes involved in lipid desaturation and IMTG synthesis were increased after exercise and recovery. Further, in a subset of individuals, exercise decreased cytosolic and membrane di-saturated DAG content, which may help explain insulin sensitization after acute exercise. These data suggest IMTG synthesis rates may influence insulin sensitivity by altering intracellular lipid localization, and decreasing specific ceramide species that promote insulin resistance.
We present a typology of 'Stayers' and 'Leavers' among rural island youth (aged 18-30) to illustrate their employment-education-location decision, based on semi-structured interviews with 30 young ...adults, and 81 older adults, in rural locations in Ireland, Newfoundland, Faroe Islands, and Shetland. Although there are exceptions, rural labour markets tend to be less diverse, and jobs in the primary sector, which have historically sustained these communities, face restructuring and decline in many places. Regardless of location, young people typically struggle to find good-quality work because of their relative lack of credentials and/or experience, and a shortage of local options can trap some, and force others to look 'away'. Outmigration decisions are based on economics, but also social and emotional factors. Thus, even in places with low unemployment, young adults must consider where to live, and what to do next, and down the road. The reviewed literature suggests that there are commonalities among the choices typically facing those in rural and remote communities, whether on an island or on a mainland. We believe, though, that this dilemma can be exacerbated for those living on islands because of the logistical and psychological complexity of the 'stay or leave' decision. Rather than presenting detailed summaries from the young islanders whom we interviewed, our intended contribution is to present our typology as a way to spur on research towards specific policy remedies. The challenges facing any young rural islander can be complicated and individualized. Nonetheless, after conducting dozens of interviews in many island communities, some clear patterns of Stayers and Leavers emerged across the various jurisdictions. In turn, we argue for the development of social and economic policies tailored to suit each category of rural island youth.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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