Hydrophobic sponge structure‐based triboelectric nanogenerators using an inverse opal structured film for sustainable energy harvesting over a wide range of humid atmosphere have been successfully ...demonstrated. The output voltage and current density reach a record value of 130 V and 0.10 mA cm−2, respectively, giving over 10‐fold power enhancement, compared with the flat film‐based triboelectric nanogenerator.
Strong concerns have been raised about whether the risk of ischemic stroke differs between conventional antipsychotics (CAPs) and atypical antipsychotics (AAPs). This study compared the risk of ...ischemic stroke in elderly patients taking CAPs and AAPs.
We conducted a retrospective cohort study of 71,584 elderly patients who were newly prescribed the CAPs (haloperidol or chlorpromazine) and those prescribed the AAPs (risperidone, quetiapine, or olanzapine). We used the National Claims Database from the Health Insurance Review and Assessment Service (HIRA) from January 1, 2006 to December 31, 2009. Incident cases for ischemic stroke (ICD-10, I63) were identified. The hazard ratios (HR) for AAPs, CAPs, and for each antipsychotic were calculated using multivariable Cox regression models, with risperidone as a reference.
Among a total of 71,584 patients, 24,668 patients were on risperidone, 15,860 patients on quetiapine, 3,888 patients on olanzapine, 19,564 patients on haloperidol, and 7,604 patients on chlorpromazine. A substantially higher risk was observed with chlorpromazine (HR = 3.47, 95% CI, 1.97-5.38), which was followed by haloperidol (HR = 2.43, 95% CI, 1.18-3.14), quetiapine (HR = 1.23, 95% CI, 0.78-2.12), and olanzapine (HR = 1.12, 95% CI, 0.59-2.75). Patients who were prescribed chlorpromazine for longer than 150 days showed a higher risk (HR = 3.60, 95% CI, 1.83-6.02) than those who took it for a shorter period of time.
A much greater risk of ischemic stroke was observed in patients who used chlorpromazine and haloperidol compared to risperidone. The evidence suggested that there is a strong need to exercise caution while prescribing these agents to the elderly in light of severe adverse events with atypical antipsychotics.
Data on the comparative effectiveness of oral antidiabetics on cardiovascular outcomes in a clinical practice setting are limited. This study sought to determine whether a differential risk of ...cardiovascular disease (CVD) exists for the combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor plus metformin versus a sulfonylurea derivative plus metformin or pioglitazone plus metformin.
We conducted a cohort study of 349,476 patients who received treatment with a DPP-4 inhibitor, sulfonylurea, or pioglitazone plus metformin for type 2 diabetes using the Korean national health insurance claims database. The incidence of total CVD and individual outcomes of myocardial infarction (MI), heart failure (HF), and ischemic stroke (IS) were assessed using the hazard ratios (HRs) estimated from a Cox proportional-hazards model weighted for a propensity score.
During follow-up, 3,881 patients developed a CVD, including 428 MIs, 212 HFs, and 1,487 ISs. The adjusted HR with 95% confidence interval (CI) for a sulfonylurea derivative plus metformin compared with a DPP-4 inhibitor plus metformin was 1.20 (1.09-1.32) for total CVD; 1.14 (1.04-1.91) for MI; 1.07 (0.71-1.62) for HF; and 1.51 (1.28-1.79) for IS. The HRs with 95% CI for total CVD, MI, HF, and IS for pioglitazone plus metformin were 0.89 (0.81-0.99), 1.05 (0.76-1.46), 4.81 (3.53-6.56), and 0.81 (0.67-0.99), respectively.
Compared with a DPP-4 inhibitor plus metformin, treatment with a sulfonylurea drug plus metformin was associated with increased risks of total CVD, MI, and IS, whereas the use of pioglitazone plus metformin was associated with decreased total CVD and IS risks.
Aims
To determine the potential association between the use of either glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) or dipeptidyl peptidase‐4 (DPP‐4) inhibitors, and the risk of thyroid cancer ...in individuals with type 2 diabetes.
Materials and Methods
This population‐based cohort study used claims data from the Korean National Health Insurance Database, 2014‐2020. Two distinct cohorts were established to compare each incretin‐based drug with sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, chosen as active comparators because of their previous non‐association with thyroid cancer, and their common usage as add‐on therapy to metformin along with GLP‐1RAs and DPP‐4 inhibitors. The first cohort included 21 722 new users of GLP‐1RAs and 326 993 new users of SGLT2 inhibitors, whereas the second cohort included 904 300 DPP‐4 inhibitor new users and 112 017 SGLT2 inhibitor new users. The outcome was the time to incident thyroid cancer. Weighted Cox proportional models were used to estimate hazard ratios of thyroid cancer incidence associated with incretin‐based drugs of interest.
Results
The use of GLP‐1RAs was not associated with an increased risk of thyroid cancer (weighted hazard ratio 0.98, 95% confidence interval 0.62‐1.53) compared with that of SGLT2 inhibitors. Using DPP‐4 inhibitors was also not associated with an increased risk of thyroid cancer (0.95, 0.79‐1.14) compared with that of SGLT2 inhibitors. No significant effect modifications were observed across subgroup analyses. Sensitivity analyses, including alternative outcome definition analysis of medullary thyroid cancer, were consistent with the primary analysis results.
Conclusions
GLP‐1RAs and DPP‐4 inhibitors were not associated with an increased risk of thyroid cancer in individuals with type 2 diabetes.
Aim
The aim of the present study was to describe the prescription of medications for attention‐deficit hyperactivity disorder (ADHD) in the UK between 1995 and 2015.
Methods
Using the Clinical ...Practice Research Datalink (CPRD), we defined a cohort of all patients aged 6–45 years, registered with a general practitioner between January 1995 and September 2015. All prescriptions of methylphenidate, dexamphetamine/lisdexamphetamine and atomoxetine were identified and annual prescription rates of ADHD were estimated using Poisson regression.
Results
Within a cohort of 7 432 735 patients, we identified 698 148 prescriptions of ADHD medications during 41 171 528 person‐years of follow‐up. Usage was relatively low until 2000, during which the prescription rate was 42.7 95% confidence interval (CI) 20.9, 87.2 prescriptions per 10 000 persons, increasing to 394.4 (95% CI 296.7, 524.2) in 2015, corresponding to an almost 800% increase (rate ratio 8.87; 95% CI 7.10, 11.09). The increase was seen in all age groups and in both sexes but was steepest in boys aged 10–14 years. The prescription rate in males was almost five times that of females. Methylphenidate remained the most prescribed drug during the 20‐year study period, representing 88.9% of all prescriptions in the 6–24‐year‐old group, and 63.5% of all prescriptions in adults (25–45 years of age).
Conclusions
Prescription rates of ADHD medications have increased dramatically in the past two decades. This may be due, at least in part, to both an increase in the number of patients diagnosed with ADHD over time and a higher percentage of those patients treated with medication.
Recent evidence suggests that gut microbiota dysbiosis adversely affects the efficacy of immune checkpoint inhibitors (ICIs). Our objective was to investigate the association between concomitant use ...of proton pump inhibitors (PPIs) and ICIs, and poor prognosis in patients with nonsmall cell lung cancer (NSCLC). We conducted a cohort study using a completely enumerated lung cancer cohort from a nationwide healthcare database in South Korea. We identified 2963 patients treated with ICIs as second‐line or later therapy for stage ≥IIIB NSCLC. PPI use was ascertained within 30‐days before and on the date of ICI initiation, and nonuse was defined as no prescription of PPIs during this period. Using national vital statistics in South Korea, we assessed the risk of all‐cause mortality associated with concomitant PPI use through a propensity score‐matched Cox proportional hazard model. Among 1646 patients included after 1:1 propensity score‐matching, concomitant PPI use was associated with a 28% increased risk of all‐cause mortality, compared to nonuse (adjusted hazard ratio HR 1.28; 95% confidence intervals CIs, 1.13‐1.46). We observed an increased risk when we restricted the analysis to new users of PPI (adjusted HR = 1.64; 95% CI = 1.25‐2.17). Subgroup analysis showed that PPI use was associated with high mortality risk among patients with viral hepatitis (adjusted HR = 2.72; 95% CI = 1.54‐4.78; Pinteraction = .048). Our study indicates that PPI use is associated with poor prognosis in NSCLC patients treated with ICIs. Further prospective studies are required to determine the risk‐benefit balance of concomitant use of PPIs and ICIs.
What's new?
The efficacy of immune checkpoint inhibitors (ICIs) in the treatment of non‐small cell lung cancer (NSCLC) is potentially affected by imbalances in the human gut microbiota. Such imbalances may be induced by proton pump inhibitors (PPIs), though whether concomitant PPI and ICI use affects ICI efficacy remains unknown. Here, the authors investigated associations between concomitant PPI and ICI therapy and poor prognosis among NSCLC patients in South Korea. Propensity score‐matched cohort study shows that PPI use is associated with elevated risk of early mortality in ICI‐treated NSCLC patients. Increased risk was most evident among patients with viral hepatitis.
Parts of the figure were drawn by using pictures from Servier Medical Art (http://smart.servier.com/), licensed under a Creative Commons Attribution 3.0 Unported License (https://creativecommons.org/licenses/by/3.0/).
Artificial neural networks (ANNs) have been extensively used to forecast monthly precipitation for water resources management over the past few decades. Efforts to produce more accurate and stable ...forecasts face ongoing challenges as the so‐called single‐ANN (S‐ANN) approach has several limitations, particularly regarding uncertainty. Many attempts have been made to deal with different types of uncertainties by applying ensemble approaches. Here, we propose a new ANN ensemble model (ANN‐ENS) dealing with uncertainty in model structure and input variable selection to provide a more accurate and stable forecasting performance. This model is structured by generating various input layers, considering all the candidate input variables (i.e.,large‐scale climate indices and lagged precipitation). We developed a modified backward elimination method to select the preliminary input variables from all the candidate input variables. Then, we tested and validated the proposed ANN‐ENS using observed monthly precipitation from 10 meteorological stations in the Han River basin, South Korea. Our results demonstrated that the ANN‐ENS enhanced the forecasting performance in terms of both accuracy and stability. Although a significant uncertainty was introduced by using all the candidate input variables, the forecasting result outperformed S‐ANNs for all employed stations. Additionally, the ANN‐ENS provided a more stable forecasting performance in comparison with S‐ANNs, which are highly sensitive. Moreover, the generated ensemble members were slightly biased at some stations but were generally reliable.
Key Points
We develop a new artificial neural network (ANN) ensemble model (ANN‐ENS) to deal with uncertainty in model structure and input variable selection
This is based on a modified backward elimination method that improves preliminary input variables for the ANN‐ENS
The resulting ANN‐ENS demonstrated remarkable performance in terms of forecasting accuracy, stability, and ensemble reliability
Abstract
The spatial interpolation of precipitation has been employed in a number of fields, including by spatially downscaling the Global Circulation Model (GCM) to a finer scale. Most precipitation ...events become more sporadic when the coverage area increases (i.e., a portion of the points experience zero precipitation). However, spatial interpolations of precipitation generally ignore these dry areas, and the interpolated grids are filled with certain precipitation amounts. Subsequently, no delineation of dry and wet regions can be made. Therefore, the current study suggested a novel approach to determine dry areas in spatial interpolations of precipitation events by assigning latent negative precipitation (LNP) to points with observed precipitation values of zero. The LNP-assigned points are then employed in a spatial interpolation. After that, the dry region can be determined using the negative region (i.e., points with zero precipitation). The magnitude of LNP can be defined by multiplying the precipitation values of neighboring stations by a tuning parameter. The LNP method and the tuning parameter are tested on weather stations covering South Korea. The results indicate that the proposed LNP method can be suitable for the spatial interpolation of precipitation events by delineating dry and wet regions. Additionally, the tuning parameter plays a special role in that it increases in value with longer precipitation durations and denser networks. A value of 0.5–1.5 can be suggested for the tuning parameter as a rule of thumb when high accuracy for final products of interpolated precipitation is not critical. For future studies, the LNP model derived herein can be tested over much larger areas, such as the United States, and the model can also be easily adopted for other variables with spatially sporadic values.
Water vapour is among the most critical variables that shape the Earth's energy balance and hydrologic cycle. Surface relative humidity (RH) and specific humidity (SH) are the main measures of ...atmospheric moisture. Long‐term changes in these variables in South Korea vary regionally as well as locally, but have not been explored using long‐term observation data. This study analyzes the annual trends of the means and SD of RH, surface air temperature, and SH in South Korea at 55 stations for the period 1973–2018. Three trend detection tests based on the Mann–Kendall test have been performed to detect trends at the 5% significance level for the annual and monthly statistics (means and SD) of these variables. Significant decreasing and increasing trends have been detected in the annual means of RH and air temperature, while the annual mean of SH has remained nearly constant. Overall, the surface air in South Korea has become drier over the study period, particularly in winter. The trend in RH and SH varies widely according to months to result in the increase in the SD over the annual cycle. The monthly SD of RH, SH, and surface air temperature show especially large positive trends for March and September, when the transition from winter to spring and summer to fall, respectively, occurs.
This study analyzes the annual trends of the means and SD of relative humidity, surface air temperature, and specific humidity in South Korea. The surface air in South Korea has become drier over the study period, particularly in winter. The monthly SD of relative humidity, specific humidity, and surface air temperature show especially large positive trends for March and September, when the transition from winter to spring and summer to fall, respectively, occurs.
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