Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human ...development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.
Summary Background Human infection with avian influenza A H7N9 virus emerged in eastern China in February, 2013, and has been associated with exposure to poultry. We report the clinical and ...microbiological features of patients infected with influenza A H7N9 virus and compare genomic features of the human virus with those of the virus in market poultry in Zhejiang, China. Methods Between March 7 and April 8, 2013, we included hospital inpatients if they had new-onset respiratory symptoms, unexplained radiographic infiltrate, and laboratory-confirmed H7N9 virus infection. We recorded histories and results of haematological, biochemical, radiological, and microbiological investigations. We took throat and sputum samples, used RT-PCR to detect M, H7, and N9 genes, and cultured samples in Madin-Darby canine kidney cells. We tested for co-infections and monitored serum concentrations of six cytokines and chemokines. We collected cloacal swabs from 86 birds from epidemiologically linked wet markets and inoculated embryonated chicken eggs with the samples. We identified and subtyped isolates by RT-PCR sequencing. RNA extraction, complementary DNA synthesis, and PCR sequencing were done for one human and one chicken isolate. We characterised and phylogenetically analysed the eight gene segments of the viruses in the patient's and the chicken's isolates, and constructed phylogenetic trees of H, N, PB2, and NS genes. Findings We identified four patients (mean age 56 years), all of whom had contact with poultry 3–8 days before disease onset. They presented with fever and rapidly progressive pneumonia that did not respond to antibiotics. Patients were leucopenic and lymphopenic, and had impaired liver or renal function, substantially increased serum cytokine or chemokine concentrations, and disseminated intravascular coagulation with disease progression. Two patients died. Sputum specimens were more likely to test positive for the H7N9 virus than were samples from throat swabs. The viral isolate from the patient was closely similar to that from an epidemiologically linked market chicken. All viral gene segments were of avian origin. The H7 of the isolated viruses was closest to that of the H7N3 virus from domestic ducks in Zhejiang, whereas the N9 was closest to that of the wild bird H7N9 virus in South Korea. We noted Gln226Leu and Gly186Val substitutions in human virus H7 (associated with increased affinity for α-2,6-linked sialic acid receptors) and the PB2 Asp701Asn mutation (associated with mammalian adaptation). Ser31Asn mutation, which is associated with adamantane resistance, was noted in viral M2. Interpretation Cross species poultry-to-person transmission of this new reassortant H7N9 virus is associated with severe pneumonia and multiorgan dysfunction in human beings. Monitoring of the viral evolution and further study of disease pathogenesis will improve disease management, epidemic control, and pandemic preparedness. Funding Larry Chi-Kin Yung, National Key Program for Infectious Diseases of China.
Abstract
Earth‐abundant commercial conductive carbon materials are ideal electrocatalyst supports but cannot be directly utilized for single‐atom catalysts owing to the lack of anchoring sites. ...Therefore, we employed crosslink polymerization to modify the conductive carbon surface with Fe−Co dual‐site electrocatalysts for oxygen reduction reaction (ORR). First, metal‐coordinated polyurea (PU) aerogels were prepared using via crosslinked polymerization at ambient temperature. Then, carbon‐supported, atomically dispersed Fe−Co dual‐atom sites (FeCoNC/BP) were formed by high‐temperatures pyrolysis with a nitrogen source. FTIR and
13
C NMR measurements showed PU linkages, while
15
N NMR revealed metal–nitrogen coordination in the PU gels. Asymmetric, N‐coordinated, and isolated Fe−Co active structures were found after pyrolysis using XAS and STEM. In alkaline media, FeCoNC/BP exhibited excellent ORR activity, with a
E
1/2
of 0.93 V vs. RHE, higher than that of Pt/C (20 %) (0.90 V), FeNC/BP (0.88 V), and CoNC/BP (0.85 V). An accelerated durability test (ADT) on FeCoNC/BP indicated good durability over 35000 cycles. FeCoNC/BP also showed moderate ORR and ADT performance in acidic media. The macro/mesoporous N‐doped carbon structures enhanced the mass transport properties of the dual Fe−Co active‐sites. Therefore, modifying carbon supports with nonprecious metal catalysts may be a cost‐effective‐strategy for sustained electrochemical energy conversion.
Summary Background The effect of the addition of adjuvant chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma is unclear. We aimed to assess the ...contribution of adjuvant chemotherapy to concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone. Methods We did an open-label phase 3 multicentre randomised controlled trial at seven institutions in China. Randomisation was by a computer-generated random number code. Patients were stratified by treatment centre and randomly assigned in blocks of four. Treatment allocation was not masked. We randomly assigned patients with non-metastatic stage III or IV (except T3–4N0) nasopharyngeal carcinoma to receive concurrent chemoradiotherapy plus adjuvant chemotherapy or concurrent chemoradiotherapy alone. Patients in both groups received 40 mg/m2 cisplatin weekly up to 7 weeks, concurrently with radiotherapy. Radiotherapy was given as 2·0–2·27 Gy per fraction with five daily fractions per week for 6–7 weeks to a total dose of 66 Gy or greater to the primary tumour and 60–66 Gy to the involved neck area. The concurrent chemoradiotherapy plus adjuvant chemotherapy group subsequently received 80 mg/m2 adjuvant cisplatin and 800 mg/m2 per day fluorouracil for 120 h every 4 weeks for three cycles. Our primary endpoint was failure-free survival. We did efficacy analyses in our intention-to-treat population. Our trial is ongoing; in this report we present the 2 year survival results and acute toxic effects. This trial is registered with ClinicalTrials.gov , number NCT00677118. Findings 251 patients were assigned to the concurrent chemoradiotherapy plus adjuvant chemotherapy group and 257 to the concurrent chemoradiotherapy alone group. After a median follow-up of 37·8 months (range 1·3–61·0), the estimated 2 year failure-free survival rate was 86% (95% CI 81–90) in the concurrent chemoradiotherapy plus adjuvant chemotherapy group and 84% (78–88) in concurrent chemoradiotherapy only group (hazard ratio 0·74, 95% CI 0·49–1·10; p=0·13). Stomatitis was the most commonly reported grade 3 or 4 adverse event during both radiotherapy (76 of 249 patients in the concurrent chemoradiotherapy plus adjuvant chemotherapy group and 82 of 254 in the concurrent chemoradiotherapy alone group) and adjuvant chemotherapy (43 21% of 205 patients treated with adjuvant chemotherapy). Interpretation Adjuvant cisplatin and fluorouracil chemotherapy did not significantly improve failure-free survival after concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma. Longer follow-up is needed to fully assess survival and late toxic effects, but such regimens should not, at present, be used outside well-designed clinical trials. Funding Sun Yat-sen University Clinical Research 5010 Programme (No 2007037), Science Foundation of Key Hospital Clinical Programme of Ministry of Health PR China (No 2010–178), and Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2010).
This paper reexamines the issue of the pricing of discretionary accruals using the approach of mixtures of regressions. In contrast to previously documented contemporaneous results, this study ...retests the issue by addressing the heterogeneous perceptions and behaviors of investors when they encounter various conditions of return and risk. The empirical results of this study indicate that market investors positively value discretionary accruals when the stock they invest in experiences a rise in price and carries a low degree of risk. Conversely, investors negatively value managerial accruals for stock that shows a fall in price and carries a high degree of risk.
AbstractTransmission lines (TLs) are vulnerable to wind actions. Notwithstanding the fact that the behavior of transmission lines under strong winds has been investigated in numerous studies, ...wind-induced failures of TLs are still common worldwide, which are mainly due to the lack of accurate understanding of the tremendous variability in wind speed. The main goal of this paper is to extend the concept of nonlinear dynamic analysis to identify and characterize the dynamic structures hidden in wind speed fluctuation, which are responsible for generating the variability in wind speed. Two well-established nonlinear dynamic analysis techniques, namely, recurrence plot and recurrence quantification analysis, are applied to diagnose the underlying dynamic characteristics. The results indicate that wind speed time series, regardless of the type of wind event, are likely to exhibit chaotic behavior. Often, the dynamics associated with monsoons are more complex than those for tropical cyclone and thunderstorm winds. Moreover, site-to-site variability in wind speed dynamics is also apparent, which is due mainly to the terrain-enhanced effect. The outcomes of this study are expected to provide a new avenue to aid the wind-resistant design of TL systems, and to accelerate the advancement in wind load design codes and climate-adapted decision-making procedures.
Summary Schistosomiasis is a major neglected tropical disease, with more than 200 million people infected and close to 800 million at risk. The disease burden is estimated to exceed 70 million ...disability-adjusted life-years. The anthelmintic drug praziquantel is highly effective in killing adult schistosome worms, but it is unable to kill developing schistosomes and so does not prevent reinfection. As a result, current praziquantel-based control programmes in Asia and sub-Saharan Africa are not effective or sustainable in the long term. The control of neglected tropical diseases, including schistosomiasis, is a funding priority for several donor agencies, with over US$350 million committed until 2013. Here we put forward an argument that donor funds would be more effectively spent on the development of a multi-faceted, integrated control programme, which would have a greater and longer lasting effect on disease transmission than the current chemotherapy-based programmes. The development of a transmission-blocking vaccine is also of great importance. A multi-faceted integrated control programme that incorporates a vaccine, even if only partly effective, has the potential to eliminate schistosomiasis. This integrated-approach model has the potential to improve the health of a billion of the world's poorest people and its effect cannot be underestimated.
Summary Background The ability of circulating microRNAs (miRNAs) to detect preclinical hepatocellular carcinoma has not yet been reported. We aimed to identify and assess a serum miRNA combination ...that could detect the presence of clinical and preclinical hepatocellular carcinoma in at-risk patients. Methods We did a three-stage study that included healthy controls, inactive HBsAg carriers, individuals with chronic hepatitis B, individuals with hepatitis B-induced liver cirrhosis, and patients with diagnosed hepatocellular carcinoma from four hospitals in China. We used array analysis and quantitative PCR to identify 19 candidate serum miRNAs that were increased in six patients with hepatocellular carcinoma compared with eight control patients with chronic hepatitis B. Using a training cohort of patients with hepatocellular carcinoma and controls, we built a serum miRNA classifier to detect hepatocellular carcinoma. We then validated the classifiers' ability in two independent cohorts of patients and controls. We also established the classifiers' ability to predict preclinical hepatocellular carcinoma in a nested case-control study with sera prospectively collected from patients with hepatocellular carcinoma before clinical diagnosis and from matched individuals with hepatitis B who did not develop cancer from the same surveillance programme. We used the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to evaluate diagnostic performance, and compared the miRNA classifier with α-fetoprotein at a cutoff of 20 ng/mL (AFP20). Findings Between Aug 1, 2009, and Aug 31, 2013, we recruited 257 participants to the training cohort, and 352 and 139 participants to the two independent validation cohorts. In the third validation cohort, 27 patients with hepatocellular carcinoma and 135 matched controls were included in the nested case-control study, which ran from Aug 1, 2009, to Aug 31, 2014. We identified a miRNA classifier (Cmi ) containing seven differentially expressed miRNAs (miR-29a, miR-29c, miR-133a, miR-143, miR-145, miR-192, and miR-505) that could detect hepatocellular carcinoma. Cmi showed higher accuracy than AFP20 to distinguish individuals with hepatocellular carcinoma from controls in the validation cohorts, but not in the training cohort (AUC 0·826 95% CI 0·771–0·880 vs 0·814 0·756–0·872, p=0·72 in the training cohort; 0·817 0·769–0·865 vs 0·709 0·653–0·765, p=0·00076 in validation cohort 1; and 0·884 0·818–0·951 vs 0·796 0·706–0·886, p=0·042 for validation cohort 2). In all four cohorts, Cmi had higher sensitivity (range 70·4–85·7%) than did AFP20 (40·7–69·4%) to detect hepatocellular carcinoma at the time of diagnosis, whereas its specificity (80·0–91·1%) was similar to that of AFP20 (84·9–100%). In the nested case-control study, sensitivity of Cmi to detect hepatocellular carcinoma was 29·6% (eight of 27 cases) 12 months before clinical diagnosis, 48·1% (n=13) 9 months before clinical diagnosis, 48·1% (n=13) 6 months before clinical diagnosis, and 55·6% (n=15) 3 months before clinical diagnosis, whereas sensitivity of AFP20 was only 7·4% (n=2), 11·1% (n=3), 18·5% (n=5), and 22·2% (n=6) at the corresponding timepoints (p=0·036, p=0·0030, p=0·021, p=0·012, respectively). Cmi had a larger AUC than did AFP20 to identify small-size (AUC 0·833 0·782–0·883 vs 0·727 0·664–0·792, p=0·0018) and early-stage (AUC 0·824 0·781–0·868 vs 0·754 0·702–0·806, p=0·015) hepatocellular carcinoma and could also detect α-fetoprotein-negative (AUC 0·825 0·779–0·871) hepatocellular carcinoma. Interpretation Cmi is a potential biomarker for hepatocellular carcinoma, and can identify small-size, early-stage, and α-fetoprotein-negative hepatocellular carcinoma in patients at risk. The miRNA classifier could be valuable to detect preclinical hepatocellular carcinoma, providing patients with a chance of curative resection and longer survival. Funding National Key Basic Research Program, National Science and Technology Major Project, National Natural Science Foundation of China.
Line profile analysis was carried out on neutron diffraction patterns collected by the energy-dispersive method for an in situ tensile-deformed AISI-316 stainless steel specimen. The experiments were ...carried out at the VULCAN engineering beam line of the spallation neutron source of the Oak Ridge National Laboratory. Both the dislocation densities and the local stresses in grains oriented with different hkl crystal directions along the tensile axis were determined. The work-hardening equation of Taylor was tested for the hkl-dependent phenomenological constant α. The grain-orientation-dependent α values were directly related to the heterogeneity of dislocation distribution in correlation with previous transmission electron microscopy data.
This collection juxtaposes a variety of approaches about China and Africa, and their interrelations seeking to go beyond early, simplistic formulations. Perspectives informed by Polanyi advance ...nuanced analysis of varieties of capitalisms and double-movements. It seeks to put contemporary China-Africa relations in critical, comparative context and in doing so, it will go beyond descriptions of inter-regional trade and investment, large- and small-scale sectors, to ask whether structural change is underway. Already it is apparent that the growing presence of China in Africa presents the latter with some novel options but whether these will generate a new embeddedness remains problematic. Highlighting the 'varieties of capitalisms' in the new century, given the undeniable difficulties of extreme neo-liberalism in the US and UK by contrast, to the apparent ebullience of the emerging economies in the global South, this book examines such implications for international relations, international political economy, development studies and policies.
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