China, like other countries, is facing a growing burden of chronic disease but the prevalence of multimorbidity and implications for the healthcare system have been little researched. We examined the ...epidemiology of multimorbidity in southern China in a large representative sample. The effects of multimorbidity and other factors on usual source of healthcare were also examined.
We conducted a large cross-sectional survey among approximately 5% (N = 162,464) of the resident population in three prefectures in Guangdong province, southern China in 2011. A multistage, stratified random sampling was adopted. The study population had many similar characteristics to the national census population. Interviewer-administered questionnaires were used to collect self-report data on demographics, socio-economics, lifestyles, healthcare use, and health characteristics from paper-based medical reports.
More than one in ten of the total study population (11.1%, 95% confidence interval (CI) 10.6 to 11.6) had two or more chronic conditions from a selection of 40 morbidities. The prevalence of multimorbidity increased with age (adjusted odds ratio (aOR) = 1.36, 95% CI 1.35 to 1.38 per five years). Female gender (aOR = 1.70, 95% CI 1.64 to 1.76), low education (aOR = 1.26, 95% CI 1.23 to 1.29), lack of medical insurance (aOR = 1.79, 95% CI 1.71 to 1.89), and unhealthy lifestyle behaviours were independent predictors of multimorbidity. Multimorbidity was associated with the regular use of secondary outpatient care in preference to primary care.
Multimorbidity is now common in China. The reported preferential use of secondary care over primary care by patients with multimorbidity has many major implications. There is an urgent need to further develop a strong and equitable primary care system.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PM
2.5 and PM
10 samples were collected at two sampling sites in Hong Kong in wintertime from November 2000 to March 2001 and in summertime from June to August 2001. The concentrations of 16 selected ...polycyclic aromatic hydrocarbons (PAHs) in aerosols were quantified. Spatial and seasonal variations of PAHs were characterized. The dominated PAHs in PM
2.5 and PM
10 included benzobfluoranthene, pyrene, fluoranthene, indeno1,2,3-cdpyrene and chrysene, accounting for 50–82% of total PAHs. The sum of 16 PAHs in PM
2.5 at roadside ranged from 3 to 330
ng/m
3, and in PM
10 between 5 and 297
ng/m
3, whereas at a residential/industrial/commercial site, the total PAHs in PM
2.5 was from 0.5 to 122
ng/m
3, and 2–269
ng/m
3 in PM
10. Results indicated that most of the PAHs were in the PM
2.5 fraction. Spatial variations were predominantly due to the difference of source strength. For both PM
2.5 and PM
10, the total PAHs at PU site was higher than that at KT site. The average concentrations of individual PAHs in aerosols at PU site were also higher than that at KT site. Higher winter PAHs concentrations and lower summer concentrations were observed at the two sites. Higher winter PAHs concentrations were mainly caused by local emission sources superimposed by highly polluted air masses from Mainland China. The lower summer PAHs concentrations were likely due to easier dispersion of air pollutants, washout effects and to a lesser extent, photo-degradation and higher percentage in the air in vapor phase. Potential sources of PAHs in aerosols were identified using the diagnostic ratios between PAHs and PCA analysis. At PU site, vehicular emissions were the main contributors of particle-associated PAHs, and stationary combustion sources may also contribute to the particulate PAHs. On the contrary, at the KT site, PAHs in aerosols were predominantly from gasoline and diesel engines.
Anti-interferon- γ (IFN-γ) autoantibodies (anti-IFN-γ Abs) have been increasingly recognized as an important cause of disseminated nontuberculous mycobacterial (DNTM) infection, and identification of ...this immunodeficiency impacts clinical management. However, the protean disease manifestations and inaccessibility to diagnostic tests in clinical settings hamper its early diagnosis. Here, we sought to determine whether QuantiFERON-TB Gold In-tube (QFT-GIT), a commercialized IFN-γ release assay, could be used to screen for neutralizing anti-IFN-γ Abs among previously healthy adults with DNTM infection.
Non-HIV patients with DNTM infection were prospectively enrolled for the QFT-GIT assays. We measured their plasma concentration of anti-IFN-γ Abs and their neutralizing capacity through enzyme-linked immunosorbent assay and flow cytometry. We then analysed the correlation between QFT-GIT results and the presence of neutralizing anti-IFN-γ Abs among patients with and without previously recognized immunosuppression, respectively.
Irrespective of the autoantibody concentration or disease activity, all patients with neutralizing anti-IFN-γ Abs (100%, 30/30) had indeterminate QFT-GIT results because of extremely low or undetectable IFN-γ levels in the mitogen tubes. None of the four DNTM patients who were previously healthy and tested negative of anti-IFN-γ Abs had an indeterminate QFT-GIT result, and their IFN-γ levels in the mitogen tube were significantly higher than those of the patients with anti-IFN-γ Abs (8.28 IU/mL vs. 0.05 IU/mL, p 0.001).
An indeterminate QFT-GIT result because of undetectable or extremely low IFN-γ level in the mitogen tube suggests the presence of neutralizing anti-IFN-γ Abs in a previously healthy patient with DNTM infection.
We present sensitive 850 m imaging of the Cosmological Evolution Survey (COSMOS) field using 640 hr of new and archival observations taken with SCUBA-2 at the East Asian Observatory's James Clerk ...Maxwell Telescope. The SCUBA-2 COSMOS survey (S2COSMOS) achieves a median noise level of 850 m = 1.2 mJy beam−1 over an area of 1.6 sq. degree (main; Hubble Space Telescope/Advanced Camera for Surveys footprint), and 850 m = 1.7 mJy beam−1 over an additional 1 sq. degree of supplementary (supp) coverage. We present a catalog of 1020 and 127 sources detected at a significance level of >4 and >4.3 in the main and supp regions, respectively, corresponding to a uniform 2% false-detection rate. We construct the single-dish 850 m number counts at S850 > 2 mJy and show that these S2COSMOS counts are in agreement with previous single-dish surveys, demonstrating that degree-scale fields are sufficient to overcome the effects of cosmic variance in the S850 = 2-10 mJy population. To investigate the properties of the galaxies identified by S2COSMOS sources we measure the surface density of near-infrared-selected galaxies around their positions and identify an average excess of 2.0 0.2 galaxies within a 13″ radius (∼100 kpc at z ∼ 2). The bulk of these galaxies represent near-infrared-selected submillimeter galaxies and/or spatially correlated sources and lie at a median photometric redshift of z = 2.0 0.1. Finally, we perform a stacking analysis at submillimeter and far-infrared wavelengths of stellar-mass-selected galaxies (M = 1010-1012 M ) from z = 0-4, obtaining high-significance detections at 850 m in all subsets (signal-to-noise ratio, S/N = 4-30), and investigate the relation between far-infrared luminosity, stellar mass, and the peak wavelength of the dust spectral energy distribution. The publication of this survey adds a new deep, uniform submillimeter layer to the wavelength coverage of this well-studied COSMOS field.
Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. ...However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients.
A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8). Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points).
From 1114 patients, 725 (65.1%) had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence.
This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Development of advanced high energy density lithium ion batteries is important for promoting electromobility. Making electric vehicles attractive and competitive compared to conventional automobiles ...depends on the availability of reliable, safe, high power, and highly energetic batteries whose components are abundant and cost effective. Nickel rich LiNi x Co y Mn 1−x−y O 2 layered cathode materials ( x > 0.5) are of interest because they can provide very high specific capacity without pushing charging potentials to levels that oxidize the electrolyte solutions. However, these cathode materials suffer from stability problems. We discovered that doping these materials with tungsten (1 mol%) remarkably increases their stability due to a partial layered to cubic (rock salt) phase transition. We demonstrate herein highly stable Li ion battery prototypes consisting of tungsten-stabilized Ni rich cathode materials ( x > 0.9) with specific capacities >220 mA h g -1 . This development can increase the energy density of Li ion batteries more than 30% above the state of the art without compromising durability.
In this paper, triaxial tests and numerical simulations using the discrete element method (DEM) are combined to explore the underlying mechanisms of the unique behavior of artificially cemented ...sands. The experimental results show that strength enhancement, volumetric dilation, and the shear banding associated failure mode are observed in Portland cement sand;; these features become more pronounced with increasing cement content. Different responses are found in gypsum-cemented sand even though both types of cemented sand specimens were prepared under very similar void ratios before shearing. The DEM simulations on the Portland cement sand were carried out under two particular arrangements (i.e., the use of small cementing particles and flexible membrane boundaries). The simulation results reveal that particles in the bonding network jointly share the loading and many micro force-chains associated with cementation are created. Compared with uncemented sand, a more stable and stronger force-chain complex subjected to smaller force concentration is formed in cemented sand, which gives rise to higher strength. Intensive bond breakage, concentrated relative particle movement, column-like force chains, great particle rotation, and high local porosity are found inside the shear band. The bonded clusters remain at large strains to help stabilize the particle arch and therefore to maintain the volumetric dilation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
While some previous studies examined the contribution of Eastern Pacific (EP) hurricanes toward precipitation in the arid Southwest US (SWUS), their potential to influence wildfires in that region ...has not been explored. Here we show, using observations and simulations from the Energy Exascale Earth System Model (E3SM), that recurving EP hurricanes modulate the wildfire environment in the SWUS by increasing precipitation and soil moisture, and reducing the vapor pressure deficit. This is especially the case during late season months of September–October when the likelihood of storms to recurve and make landfall increases. Further, analysis of burnt area observations reveals that for the months of September–October, recurving EP hurricanes may significantly reduce the prevalence of wildfires in the SWUS. Finally, E3SM simulations indicate that late season EP hurricanes have been on the decline, with important implications for wildfires in the SWUS.
Plain Language Summary
A majority of Eastern Pacific (EP) hurricanes form and traverse westwards away from the North American coastline. Therefore, compared to tropical cyclones in some other basins, EP hurricanes have historically received less attention. However, some previous studies have shown that recurving EP hurricanes can contribute significantly to precipitation in the arid Southwest US (SWUS) region. Here, we build on these studies and demonstrate that recurving EP hurricanes significantly modulate the SWUS wildfire environment. During years with recurving EP hurricanes, the precipitation and soil moisture are enhanced, and the vapor pressure deficit is reduced, over the SWUS region. Therefore, during late season months of September–October, when recurving EP hurricanes occur, they make the environment less favorable for wildfires in the SWUS region. With climate models showing a long‐term decline in recurving EP hurricanes and the precipitation associated with them over the SWUS region, our study has substantial implications for autumn wildfires of that region.
Key Points
Eastern Pacific (EP) hurricanes that recurve tend to enhance precipitation and reduce vapor pressure deficit in the Southwest US region
During September–October, recurving EP hurricanes may make the environment less favorable for wildfires in the Southwest US
Climate model simulations suggest that Southwest US precipitation associated with recurving EP hurricanes has decreased
Abstract Finite element (FE) model studies have made important contributions to our understanding of functional biomechanics of the lumbar spine. However, if a model is used to answer clinical and ...biomechanical questions over a certain population, their inherently large inter-subject variability has to be considered. Current FE model studies, however, generally account only for a single distinct spinal geometry with one set of material properties. This raises questions concerning their predictive power, their range of results and on their agreement with in vitro and in vivo values. Eight well-established FE models of the lumbar spine (L1-5) of different research centers around the globe were subjected to pure and combined loading modes and compared to in vitro and in vivo measurements for intervertebral rotations, disc pressures and facet joint forces. Under pure moment loading, the predicted L1-5 rotations of almost all models fell within the reported in vitro ranges, and their median values differed on average by only 2° for flexion-extension, 1° for lateral bending and 5° for axial rotation. Predicted median facet joint forces and disc pressures were also in good agreement with published median in vitro values. However, the ranges of predictions were larger and exceeded those reported in vitro , especially for the facet joint forces. For all combined loading modes, except for flexion, predicted median segmental intervertebral rotations and disc pressures were in good agreement with measured in vivo values. In light of high inter-subject variability, the generalization of results of a single model to a population remains a concern. This study demonstrated that the pooled median of individual model results, similar to a probabilistic approach, can be used as an improved predictive tool in order to estimate the response of the lumbar spine.
Abstract Background With advances in immunosuppressive therapy, heart transplantation is currently recommended as the only established surgical treatment for refractory heart failure. However, ...chronic immunosuppression increases the risk for malignancy. Everolimus (EVR) is a potent mammalian target of rapamycin inhibitor that is used after transplantation and to treat advanced malignancies, as we have done in Taiwan after heart transplantation since 2004. Mycophenolate mofetil (MMF) and EVR are frequently used as cell-cycle inhibitors to optimize post-transplantation outcomes. Methods We retrospectively analyzed the characteristics and outcomes of 454 patients who received either MMF (n = 232) or EVR (n = 222) after heart transplantation at the National Taiwan University Hospital from March 1, 1990, to March 1, 2015. Patient characteristics and Kaplan-Meier survival curves were compared between groups. Results During a median follow-up of 69.2 months, malignancy was diagnosed in 27 patients receiving MMF (n = 23) or EVR (n = 4). There was a significant difference in malignancy risk between groups (9.91% vs 1.80%, P = .001). The most common malignancies were non-Hodgkin lymphoma, skin cancers, and lung squamous cell carcinoma. The 2-year overall survival after malignancy was 50% in the EVR group and 47% in the MMF group ( P = .745). Conclusions EVR treatment after heart transplant is associated with a lower risk of malignancy than is MMF treatment. The 2-year survival rate after malignancy was similar between EVR and MMF groups.
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