High-Energy Laser Protection Performance of Fibrous Felt-Reinforced Aerogels with Hierarchical Porous Architectures.

Continuous-wave lasers can cause irreversible damage to structured materials in a very short time. Modern high-energy laser protection materials are mainly constructed from ceramic, polymer, and metal constitutions. However, these materials are protected by sacrificing their structural integrity under the irradiation of high-energy lasers. In this contribution, we reported multilayer fibrous felt-reinforced aerogels that can sustain the continuous irradiation of a laser at a power density of 120 MW·m-2 without structural damage. It is found that the exceptional high-energy laser protection performance and the comparable mechanical properties of aerogel nanocomposites are attributed to the unique characteristics of hierarchical porous architectures. In comparison with various preparation methods and other aerogel materials, multilayer fibrous felt-reinforced aerogels exhibit the best performance in high-energy laser protection, arising from the gradual interception and the Raman-Rayleigh scattering cycles of a high-energy laser in the porous aerogels. Furthermore, a near-zero thermal expansion coefficient and extremely low thermal conductivity at high temperature allow the lightweight felt-reinforced aerogels to be applied in extreme conditions. The felt-reinforced aerogels reported herein offer an attractive material that can withstand complex thermomechanical stress and retain excellent insulation properties at extremely high temperature.

PICK1 inhibits the malignancy of nasopharyngeal carcinoma and serves as a novel prognostic marker.

Although many important advances have been made in the treatment of nasopharyngeal carcinoma (NPC) in recent years, local recurrence and distant metastasis remain the main factors affecting NPC prognosis. Biomarkers for predicting the prognosis of NPC need to be urgently identified. Here, we used whole-exon sequencing (WES) to determine whether PICK1 mutations are associated with the prognosis of NPC. Functionally, PICK1 inhibits the proliferation and metastasis of NPC cells both in vivo and in vitro. Mechanistically, PICK1 inhibited the expression of proteins related to the Wnt/ß-catenin signaling pathway. PICK1 restrained the nuclear accumulation of ß-catenin and accelerated the degradation of ß-catenin through the ubiquitin-proteasome pathway. The reduced PICK1 levels were significantly associated with poor patient prognosis. Hence, our study findings reveal the mechanism by which PICK1 inactivates the Wnt/ß-catenin signaling pathway, thereby inhibiting the progression of NPC. They support PICK1 as a potential tumor suppressor and prognostic marker for NPC.

Joint effects of heat-humidity compound events on drowning mortality in Southern China.

BACKGROUND: Several previous studies have examined the association of ambient temperature with drowning. However, no study has investigated the effects of heat-humidity compound events on drowning mortality. METHODS: The drowning mortality data and meteorological data during the five hottest months (May to September) were collected from 46 cities in Southern China (2013-2018 in Guangdong, Hunan and Zhejiang provinces). Distributed lag non-linear model was first conducted to examine the association between heat-humidity compound events and drowning mortality at city level. Then, meta-analysis was employed to pool the city-specific exposure-response associations. Finally, we analysed the additive interaction of heat and humidity on drowning mortality. RESULTS: Compared with wet-non-hot days, dry-hot days had greater effects (excess rate (ER)=32.34%, 95% CI: 24.64 to 40.50) on drowning mortality than wet-hot days (ER=14.38%, 95%CI: 6.80 to 22.50). During dry-hot days, males (ER=42.40%, 95% CI: 31.92 to 53.72), adolescents aged 0-14 years (ER=45.00%, 95% CI: 21.98 to 72.35) and urban city (ER=36.91%, 95% CI: 23.87 to 51.32) showed higher drowning mortality risk than their counterparts. For wet-hot days, males, adolescents and urban city had higher ERs than their counterparts. Attributable fraction (AF) of drowning attributed to dry-hot days was 23.83% (95% CI: 21.67 to 26.99) which was significantly higher than that for wet-hot days (11.32%, 95% CI: 9.64 to 13.48%). We also observed that high temperature and low humidity had an additive interaction on drowning mortality. CONCLUSION: We found that dry-hot days had greater drowning mortality risk and burden than wet-hot days, and high temperature and low humidity might have synergy on drowning mortality.

Circ_0098823 binding with IGF2BP3 regulates DNM1L stability to promote metastasis of hepatocellular carcinoma via mitochondrial fission.

Hepatocellular carcinoma (HCC) is highly metastatic and invasive. CircRNA participates in gene regulation of multiple tumor metastases, but little is known whether it is a bystander or an actual player in HCC metastasis. We aim to explore the molecular mechanisms of novel circRNAs in HCC metastasis. RT-qPCR was used to detect the expression of 13 circRNAs derived by the ERBB3 gene. The function of circ_0098823 and DNM1L in HCC cells were estimated by CCK-8, transwell assays, flow cytometry, electron microscope, and in vivo experiments. RNA binding protein of circ_0098823 was confirmed by RNA pull-down, mass spectrometry, and RNA immunoprecipitation. The expression of DNM1L after IGF2BP3 knockdown was detected by RT-qPCR and western blot. Circ_0098823 was significantly up-regulated both in HCC tissues and HGF induced cell lines. Circ_0098823 overexpression significantly enhanced proliferation, migration, and invasion but decreased apoptosis of HCC cells, particularly promoted mitochondrial fission. Compared with the control group, the tumors in the circ_0098823 knockdown mice were significantly smaller and lighter. Circ_0098823 silencing suppressed DNM1L expression, a key molecule for fission, which enhanced proliferation, migration and invasion, and inhibited apoptosis of HCC cell. IGF2BP3 was a binding protein of circ_0098823. The expression and mRNA stability of DNM1L were down-regulated by IGF2BP3 knockdown. IGF2BP3 knockdown significantly alleviated the excessive migration, invasion and apoptosis of HCC cells caused by circ_0098823 overexpression. This study uncovered a novel circ_0098823 with tumor-promoting effect, and the mechanism by which circ_0098823 participates in HCC progression through IGF2BP3-guided DNM1L. Our study broadens molecular understanding of HCC progression.

Differences in Chemical Composition, Polyphenol Compounds, Antioxidant Activity, and In Vitro Rumen Fermentation among Sorghum Stalks.

The aim of the study was to examine the differences in the chemical composition, polyphenol compounds, antioxidant activity, and in vitro rumen fermentation among six varieties of sorghum stalks. The results show that maoliangnuo 1 (M1) contained a higher (p < 0.05) level of dry matter, and jinzhong 405 (J4) contained a higher (p < 0.05) level of crude protein content. The concentrations of neutral detergent fiber, acid detergent fiber, and cellulose were significantly higher (p < 0.05) in stalk jinliangnuo (JN). The levels of chlorogenic acid, homoorientin, isovitexin, vitexin, rhoifolin, genistin, quercetin, apigenin, aloe emodin, emodin, and total polyphenols were all significantly (p < 0.05) higher in maohongnuo 6 (M6) than in the other stalks. Moreover, stalk M6 contained higher (p < 0.05) levels of total antioxidant capacity (TAC), glutathione peroxidase (GPX), catalase (CAT), and 2,2-diphenyl-1-picrylhydrazyl (DPPH) free-radical scavenging capacity. There were significant (p < 0.05) positive correlations between total polyphenols and TAC, superoxide dismutase, GPX, CAT, and DPPH free-radical scavenging capacity. The total gas production was significantly (p < 0.05) influenced by the sorghum stalk variety and incubation time. Stalk J4 displayed higher values for the (p < 0.05) immediately soluble fraction and the potential extent of gas production, while stalk M6 exhibited a significantly lower (p < 0.05) insoluble fraction level. Furthermore, stalk M6 exhibited a significantly higher level of (p < 0.05) ruminal fluid propionic acid, but its level of butyric acid and its ratio of acetic acid to propionic acid were both significantly lower (p < 0.05). Taken together, the results reported in this paper indicate that the chemical composition, polyphenol compounds, antioxidant activity, and in vitro rumen fermentation all vary greatly among different varieties of sorghum stalks.

Attitudes of the public and medical professionals toward nurse prescribing: A text-mining study based on social medias.

Objectives: This study aimed to explore the public and medical professionals' concerns and attitudes toward nurse prescribing using text-mining method to analyze social media data. Methods: Python was used to automatically mine data related to the keywords "nurse prescribing" and "prescription" that were posted on four Chinese internet platforms between January 1, 2017, and November 1, 2022. The four Chinese internet platforms included social media sites such as Zhihu and Weibo, as well as medical forums like Aiaiyi Medical Hotspot and Dingxiangyuan Medicine. We conducted personnel, topic, and sentiment analysis techniques using SnowNLP, Bayesian Latent Dirichlet Allocation (LDA), and BosonNLP. Finally, we conducted content analysis using Nvivo 11 based on the results of the topic and sentiment analysis to obtain comprehensive and insightful results. Results: We acquired 2,823 comments totaling 92,859 words on the four Internet platforms to conduct analysis. The analyze result showed that many public and medical professionals held a negative attitude toward nurse prescribing, and few had a prudent positive attitude. The public is concerned about the impact of nurse prescribing on medical professionals and the competency requirements for nurses. Medical professionals are concerned about the current and future status of nurse prescribing in China and the difficulties in implementing nurse prescribing. Conclusion: Nurses should gradually gain recognition for their expertise and win the acceptance of the public and medical professionals on their ability of nursing prescribing by striving to enhance their professional capacity and self-authorization capabilities. Nurse administrators and educators need to recognize the advantages of nurse prescribing and address the challenges and issues in its implementation through promoting legislation, education, and heightening public awareness of its benefits.

Realization of a circularly transformed Airyprime beam with powerful autofocusing ability.

The reported autofocusing ability of a ring Airyprime beam array reaches up to 8632.40, while the strongest autofocusing ability of a circular Airyprime beam (CAPB) is only 1822.49. How can the autofocusing ability of a single beam reach the autofocusing ability of a beam array? To achieve this goal, a circularly transformed Airyprime beam (CTAPB) is introduced by following two steps. First, a circular equation transformation on the two transverse coordinates in the electric field expression of a propagating Airyprime beam is performed. Then, the electric field expression of a propagating Airyprime beam is integrated over the angle. The intensity profile of a CTAPB on the initial plane changes significantly with varying the primary ring radius r0. With increasing r0, therefore, the autofocusing ability of a CTAPB undergoes a process of first increasing and then decreasing, while the focal length always increases. A CTAPB exhibits more powerful autofocusing ability than a CAPB. The maximum autofocusing ability of a CTAPB can reach up to 8634.76, which is 4.74 times that of a CAPB, while the corresponding focal length is 95.11% of a CAPB. A CTAPB on the initial plane can be approximately characterized by a ring Airyprime beam array with sufficient number of Airyprime beams. Due to the better symmetry, a CTAPB has a slightly stronger autofocusing ability than a ring Airyprime beam array and almost the same focal length as a ring Airyprime beam array. The CTAPB is also experimentally generated, and the experimental results indicate that the CTAPB has powerful autofocusing ability. As a replacement of a CAPB and a ring Airyprime beam array, this introduced CTAPB can be applied to the scenes which involve abruptly autofocusing effect.

The roles of stress mindset and personality in the impact of life stress on emotional well-being in the context of Covid-19 confinement: A diary study.

Previous studies indicate that COVID-19 confinement has led to an increase in psychological distress and a decrease in overall well-being. This longitudinal study aims to investigate how stress mindset and personality traits moderate the impact of life stress on the development of emotional well-being during the COVID-19 pandemic confinement. Our study collected daily life stress and emotions data from 134 participants over 14 consecutive days using the diary method. We used hierarchical linear modeling (HLM) to analyze the data, examining within-person and between-person effects. Life stress predicted moderate increases in positive emotions and strong increases in negative emotions over time. A stress-is-enhancing stress mindset was associated with greater positive emotions at baseline and mitigated the link between life stress and negative emotions. Among the Big Five personality traits, extraversion, openness, agreeableness, and conscientiousness were associated with higher baseline levels of positive emotions. Agreeableness and conscientiousness mitigated the link between life stress and negative emotions. Neuroticism was associated with higher baseline levels of negative emotions and moderately mitigated the link between life stress and positive emotions. The interaction between neuroticism and stress-is-enhancing mindset predicted greater negative emotions and mitigated the link between life stress and positive emotions. In contrast, the interaction between stress-is-enhancing mindset and the other four personality traits mitigated the positive link between life stress and negative emotions. Overall, these findings suggest that life stress from confinement leads to a decrease in daily emotional well-being as the confinement prolongs. Personality traits-agreeableness, conscientiousness, and a stress-is-enhancing stress mindset-act as protective roles in mitigating life stress' effect on reduced emotional well-being over time. The findings advance our knowledge in understanding the roles of personality traits and stress-is-enhancing mindset in explaining the heterogeneity in the impact of life stress on emotional well-being.

Effects of Rosa roxburghii Tratt seed on the growth performance, meat quality, and sensory evaluation characteristics in growing rabbits.

The objective of this study was to observe the effects of Rosa roxburghii Tratt seed (RRTS) on growth performance, meat quality, and sensory characteristic parameters in rabbits. Ninety-six New Zealand White rabbits were allotted to four dietary treatments containing 0 (CON), 120 (LR), 240 (MR), and 360 mg/kg (HR) RRTS. The experimental period lasted for 11 weeks. Thirty-two fattened rabbits were slaughtered, and the Longissimus thoracis et lumborum (LTL) muscle was used for analyses. The feeding of RRTS was significantly (P < 0.05) decreased the feed conversion ratio (FCR). pH45min, pH24h, lightness, redness, drip loss, and percentage of water loss were unaffected (P > 0.05) by dietary treatments, whereas MR and HR treatments resulted in lower (P < 0.05) levels of yellowness and higher (P < 0.05) levels of shear force. LR showed significantly higher (P < 0.05) meat polyphenol compounds and vitamin E relative to the CON. Moreover, compared to the CON, HR treatment showed significantly higher (P < 0.05) vitamin C and glutathione peroxidase, and LR and MR displayed lower (P < 0.05) superoxide anion radicals, and all treatments had higher levels catalase (CAT). C18:2n-6 t, C20:2, C20:3n-6, C20:4n-6, C20:5n-3, C22:5n-3, and C22:6n-3 in LTL meat were higher (P < 0.05) in MR than CON rabbits. Moreover, the LTL muscle sensory evaluation parameters of appearance and fibrousness were improved (P < 0.05). Overall, dietary supplementation with RRTS is a valid strategy for decreasing FCR, and improving meat CAT concentration, C20:5n-3 and C22:5n-3 profiles, and sensory characteristics parameters of rabbits.

Serum albumin mediates the associations between heavy metals and two novel systemic inflammation indexes among U.S. adults.

BACKGROUND: The effects of heavy metal exposure on immunological function have sparked widespread concern, but unequivocal evidence on the association between mixed metal exposure and novel systemic inflammatory indexes remains scarce. OBJECTIVES: This study aimed to analyze the associations of heavy metals with two novel systemic inflammation indexes and the mediated effects of serum albumin. METHODS: Nineteen metals were detected among 4082 U.S. adults based on the NHANES. A linear regression, restricted cubic splines (RCS) regression, weighted quantile sum (WQS), Quantile-based Gcomputation (qgcomp), and Bayesian kernel machine regression (BKMR) were conducted to evaluate the associations of single metal and mixed metals with systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) levels, respectively. A series of subgroup analyses were used to identify potentially vulnerable populations. Furthermore, we conducted mediation analyses to investigate the mediated effects of serum albumin on the associations of metals with SII and SIRI. RESULTS: In the single-exposure model, exposure to various metals such as urinary Co, As, and serum Zn, Cu was associated with SII and SIRI (PFDR<0.05). Simultaneously, the above metals were linear positively correlated with SII and SIRI. Mixed-exposure analyses consistently showed that overall mixed urinary metal levels were positively pertinent for SII and SIRI levels, and the metal Co played a significant role in the urinary metal mixtures. Subgroup analyses showed that exposure to urinary Cd in men and elderly people increased SII and SIRI levels. The results of mediation analyses suggested the association of urinary metal mixture with SII and SIRI was mediated by albumin, and the proportion of mediation was 14.45% and 9.49%, respectively. CONCLUSIONS: Our findings suggested that metal exposure is strongly associated with the levels of system inflammation indexes and that serum albumin is, in part, a mediator of this association.

Incoherently pumped event horizons in optical fibers.

Optical event horizons in fibers, driven by coherent pumps, have been a prominent subject of study within the field of nonlinear optics. Previously, optical event horizons involving a potent pump and a linear-wave were interpreted as phase-matching processes wherein new spectral components are derived from the linear-wave due to the influence of the strong pump. This nonlinear interaction, coupled with the wave mixing mechanism, has been elaborated upon in the spectral domain. It's portrayed as a cascaded four-wave mixing process, achieving quasi-phase-matching through intermediate spectral components. Until now, research focused on event horizons or soliton linear-wave interactions has predominantly relied on coherent laser pump sources. However, there has been a recent resurgence in the exploration of incoherently pumped nonlinear optics. While the specific dynamics of incoherent light fields and their subsequent nonlinear processes might be elusive due to their inherent random field fluctuations, their incoherent nature unveils a multitude of statistical dynamics for nonlinear phenomena. In this work, we delve into optical event horizons encountered by linear-waves propelled by an incoherent light field within nonlinear optical fibers. Our numerical analysis scrutinizes the dynamics of linear-waves during optical event horizons under incoherent pumping. We further dissect the temporal statistics of the newly birthed idler-waves emerging from these event horizon processes.

The comparison of mortality burden between exposure to dry-cold events and wet-cold events: A nationwide study in China.

BACKGROUND: Most previous studies have focused on the health effect of temperature or humidity, and few studies have explored the combined health effects of exposure to temperature and humidity. This study aims to estimate the relationship between humidity-cold events and mortality, and then to compare the mortality burden between exposure to dry-cold events and wet-cold events, and finally to explore whether there was an additive interaction of temperature and humidity on mortality. METHODS: In the study, Daily mortality data during 2006-2017 were collected from Centers for Disease Control and Prevention in China, and daily mean temperature and daily mean relative humidity data from 698 weather stations in China were obtained from the China Meteorological Data Sharing Service system. We first employed time-series design with a distributed lag nonlinear model and a multivariate meta-analysis model to examine the association between humidity-cold events with mortality. RESULTS: We found that humidity-cold events significantly increased mortality risk, and the effect of wet-cold events (RR:1.24, 95%CI:1.20,1.29) was higher than that of dry-cold events (RR:1.14, 95%CI:1.10,1.18). Dry-cold events and wet-cold events accounted for 2.41 % and 2.99 % excess deaths, respectively with higher burden for the elderly ≥85 years old, Central China and CVD. In addition, there is a synergistic additive interaction between low temperature and high humidity in winter. CONCLUSION: This study showed that humidity-cold events significantly increased mortality risk, and the effect of wet-cold events was higher than that of dry-cold events.

Temporal characteristics of stationary switching waves in a normal dispersion pulsed-pump fiber cavity.

Kerr cavities driven in the normal dispersion regime are known to host switching waves. These consist of a traveling wavefront that connects separate regions associated with high- and low-intensity steady states of the cavity. In this Letter, we drive a 230-m custom built fiber ring cavity with strong normal dispersion using nanosecond pulses, allowing us to directly resolve the fine structure of individual switching waves, including resonant oscillations occurring over periods of the order of ∼10 ps. We demonstrate the intimate connection between the temporal and spectral features of the dispersive waves associated with switching waves, while also investigating how these dispersive waves evolve with cavity parameters, namely the frequency detuning and pump desynchronization. Furthermore, by applying a localized and temporary perturbation to our driving field in the presence of a phase modulation trapping potential, we are able to generate a stable and persistent dark pulse, allowing us to directly observe and model the interlocking of two stationary switching waves under quasi-CW pumping conditions. These results further verify the accuracy of the dispersive wave formalism used, and show that their temporal modulation frequency and decay rate in a pulsed-pumped cavity are accurately captured from theory previously applied to CW-pumped systems.

Antibody-Drug Conjugates: A Review of Approved Drugs and Their Clinical Level of Evidence.

Antibody-drug conjugates (ADCs) are an innovative family of agents assembled through linking cytotoxic drugs (payloads) covalently to monoclonal antibodies (mAbs) to be delivered to tumor tissue that express their particular antigen, with the theoretical advantage of an augmented therapeutic ratio. As of June 2023, eleven ADCs have been approved by the Food and Drug Administration (FDA) and are on the market. These drugs have been added to the therapeutic armamentarium of acute myeloblastic and lymphoblastic leukemias, various types of lymphoma, breast, gastric or gastroesophageal junction, lung, urothelial, cervical, and ovarian cancers. They have proven to deliver more potent and effective anti-tumor activities than standard practice in a wide variety of indications. In addition to targeting antigen-expressing tumor cells, bystander effects have been engineered to extend cytotoxic killing to low-antigen-expressing or negative tumor cells in the heterogenous tumor milieu. Inevitably, myelosuppression is a common side effect with most of the ADCs due to the effects of the cytotoxic payload. Also, other unique side effects are specific to the tissue antigen that is targeted for, such as the cardiac toxicity with Her-2 targeting ADCs, and the hemorrhagic side effects with the tissue factor (TF) targeting Tisotumab vedotin. Further exciting developments are centered in the strategies to improve the tolerability and efficacy of the ADCs to improve the therapeutic window; as well as the development of novel payloads including (1) peptide-drug conjugates (PDCs), with the peptide replacing the monoclonal antibody, rendering greater tumor penetration; (2) immune-stimulating antibody conjugates (ISACs), which upon conjugation of the antigen, cause an influx of pro-inflammatory cytokines to activate dendritic cells and harness an anti-tumor T-cell response; and (3) the use of radioactive isotopes as a payload to enhance cytotoxic activity.

The association of heatwave with drowning mortality in five provinces of China.

Drowning is a serious public health problem in the world. Several studies have found that ambient temperature is associated with drowning, but few have investigated the effect of heatwave on drowning. This study aimed to explore the associations between heatwave and drowning mortality, and further estimate the mortality burden of drowning attributed to heatwave in China. Drowning mortality data were collected in 71 prefectures in China during 2013-2018 from provincial vital register system. Meteorological data at the same period were collected from European Centre for Medium-Range Weather Forecasts (ECMWF). A distributed lag non-linear model (DLNM) was first to explore the association between heatwave and drowning mortality in each prefecture. Secondly, the prefecture-specific associations were pooled using meta-analysis. Finally, attributable fractions (AFs) of drowning deaths caused by heatwave were estimated. Compared to normal day, the mortality risk of drowning significantly increased during heatwave (RR = 1.20, 95%CI: 1.18-1.23). Higher risks were observed in males (RR = 1.23, 95%CI: 1.20-1.27) than females (RR = 1.18, 95%CI: 1.13-1.23), in children aged 5-14 years old (RR = 1.24, 95%CI: 1.15-1.33) than other age groups, in urban city (RR = 1.32, 95%CI: 1.28-1.36) than rural area (RR = 1.09, 95%CI: 1.07-1.12) and in Jilin province (RR = 2.85, 95%CI: 1.61-5.06) than other provinces. The AF of drowning deaths due to heatwave was 11.4 % (95%CI: 10.0 %-12.9 %) during heatwave and 1.0 % (95%CI: 0.9 %-1.1 %) during study period, respectively. Moreover, the AFs during study period were higher for male (1.2 %, 95%CI: 1.0 %-1.3 %), children 5-14 years (1.1 %, 95%CI: 0.7 %-1.6 %), urban city (1.6 %, 95%CI: 1.4 %-1.8 %) than their correspondents. These differences were also observed in AFs during heatwave. We found that heatwave may significantly increase the mortality risk of drowning mortality, and its mortality burden attributable to heatwave was noteworthy. Targeted intervention should be carried out to decrease drowning mortality during heatwave.

Random number generation using spontaneous symmetry breaking in a Kerr resonator.

We demonstrate an all-optical random number generator based on spontaneous symmetry breaking in a coherently driven Kerr resonator. Random bit sequences are generated by repeatedly tuning a control parameter across a symmetry-breaking bifurcation that enacts random selection between two possible steady-states of the system. Experiments are performed in a fiber ring resonator, where the two symmetry-broken steady-states are associated with orthogonal polarization modes. Detrimental biases due to system asymmetries are suppressed by leveraging a recently discovered self-symmetrization phenomenon that ensures the symmetry-breaking dynamics act as an unbiased coin toss, with a genuinely random selection between the two available steady-states. We optically generate bits at a rate of 3 MHz without post-processing and verify their randomness using the National Institute of Standards and Technology and Dieharder statistical test suites.

The Combined Effects of Short-Term Exposure to Multiple Meteorological Factors on Unintentional Drowning Mortality: Large Case-Crossover Study.

BACKGROUND: Drowning is a serious public health problem worldwide. Previous epidemiological studies on the association between meteorological factors and drowning mainly focused on individual weather factors, and the combined effect of mixed exposure to multiple meteorological factors on drowning is unclear. OBJECTIVE: We aimed to investigate the combined effects of multiple meteorological factors on unintentional drowning mortality in China and to identify the important meteorological factors contributing to drowning mortality. METHODS: Unintentional drowning death data (based on International Classification of Diseases, 10th Edition, codes W65-74) from January 1, 2013, to December 31, 2018, were collected from the Disease Surveillance Points System for Guangdong, Hunan, Zhejiang, Yunnan, and Jilin Provinces, China. Daily meteorological data, including daily mean temperature, relative humidity, sunlight duration, and rainfall in the same period were obtained from the Chinese Academy of Meteorological Science Data Center. We constructed a time-stratified case-crossover design and applied a generalized additive model to examine the effect of individual weather factors on drowning mortality, and then used quantile g-computation to estimate the joint effect of the mixed exposure to meteorological factors. RESULTS: A total of 46,179 drowning deaths were reported in the 5 provinces in China from 2013 to 2018. In an effect analysis of individual exposure, we observed a positive effect for sunlight duration, a negative effect for relative humidity, and U-shaped associations for temperature and rainfall with drowning mortality. In a joint effect analysis of the above 4 meteorological factors, a 2.99% (95% CI 0.26%-5.80%) increase in drowning mortality was observed per quartile rise in exposure mixture. For the total population, sunlight duration was the most important weather factor for drowning mortality, with a 93.1% positive contribution to the overall effects, while rainfall was mainly a negative factor for drowning deaths (90.5%) and temperature and relative humidity contributed 6.9% and -9.5% to the overall effects, respectively. CONCLUSIONS: This study found that mixed exposure to temperature, relative humidity, sunlight duration, and rainfall was positively associated with drowning mortality and that sunlight duration, rather than temperature, may be the most important meteorological factor for drowning mortality. These findings imply that it is necessary to incorporate sunshine hours and temperature into early warning systems for drowning prevention in the future.

Complementary and Alternative Medicine Use in Patients With Cancer and Immigration Background.

PURPOSE: Studies have shown that patients with cancer are more likely to use complementary and alternative medicine (CAM) than noncancer patients for symptom relief and hope. We aimed to evaluate factors of race, ethnic groups, and immigration status in attitude of patients with cancer in seeking out CAM. PATIENTS AND METHODS: This is a prospective questionnaire study where information on demographics, cancer information, race/ethnicity, immigration duration, and psychosocial factors was correlated with the CAM use in a community cancer center located in the borough of Brooklyn, at New York City. RESULTS: Among 658 patients, the prevalence of CAM use was 66.11%. CAM use was 71.98% in females and 54.34% in males (P = .113 × 10-4). Patients of African descent had higher CAM use (72.73%) than the White patients (63.53%; P = .0371). There was no difference of CAM use between the US born (68.77%) and the immigrants (63.98%, P = .199) as a whole; however, comparing with the US born (66.50%), Asian-born immigrants had lower CAM use (53.77%, P = .0161), whereas Latin-American born had a numerical trend toward higher CAM use (74.83%, P = .0608). The number of years of living in the United States was not associated with more CAM use. Prayer and spirituality was the most common CAM subtype used (25.91%). There was no difference in CAM use in the respective non-White ethnic groups whether they were US born or non-US born. CONCLUSION: In this cohort of patients with cancer enriched with immigration background, CAM use was the highest in African American patients. The use of CAM in the non-White patients was associated with their ethnic background, regardless whether they were US born or not. Cultural roots appeared to be a strong influencing factor for the usage of CAM.

Mortality burden based on the associations of ambient PM2.5 with cause-specific mortality in China: Evidence from a death-spectrum wide association study (DWAS).

Although studies have estimated the associations of PM2.5 with total mortality or cardiopulmonary mortality, few have comprehensively examined cause-specific mortality risk and burden caused by ambient PM2.5. Thus, this study investigated the association of short-term exposure to PM2.5 with cause-specific mortality using a death-spectrum wide association study (DWAS). Individual information of 5,450,764 deaths during 2013-2018 were collected from six provinces in China. Daily PM2.5 concentration in the case and control days were estimated by a random forest model. A time-stratified case-crossover study design was applied to estimate the associations (access risk, ER) of PM2.5 with cause-specific mortality, which was then used to calculate the population-attributable fraction (PAF) of mortality and the corresponding mortality burden caused by PM2.5. Each 10 µg/m3 increase in PM2.5 concentration (lag03) was associated with a 0.80 % [95 % confidence interval (CI): 0.73 %, 0.86 %] rise in total mortality. We found greater mortality effect at PM2.5 concentrations < 50 µg/m3. Stratified analyses showed greater ERs in females (1.01 %, 95 %CI: 0.91 %, 1.11 %), children ≤ 5 years (2.17 %, 95 %CI: 0.85 %, 3.51 %), and old people ≥ 70 years. We identified 33 specific causes (level 2) of death which had significant associations with PM2.5, including 16 circulatory diseases, 9 respiratory diseases, and 8 other causes. The PAF estimated based on the overall association between PM2.5 and total mortality was 3.16 % (95 %CI: 2.89 %, 3.40 %). However, the PAF was reduced to 2.88 % (95 %CI: 1.88 %, 3.81 %) using the associations of PM2.5 with 33 level 2 causes of death, based on which 250.15 (95 %CI: 163.29, 330.93) thousand deaths were attributable to short-term PM2.5 exposure across China in 2019. Overall, this study provided a comprehensive picture on the death-spectrum wide association between PM2.5 and morality in China. We observed robust positive cause-specific associations of PM2.5 with mortality risk, which may provide more precise basis in assessing the mortality burden of air pollution.