Identifying Service, Research and Policy priorities for preventing the impacts of family adversity on children's mental health: An Australian national resource allocation study with professional and lived experience experts.

OBJECTIVES: The objective of this study was to develop Service, Research and Policy priorities to prevent the impact of family adversity on child mental health and determine comparative priorities of diverse stakeholders to those with lived experience of adversity. METHODS: Value-weighting approach conducted in a staged process: (i) professionals and experts with lived experience from health, education, justice and social care sectors attended a national symposium to identify priorities for family adversity and mental health and (ii) a subsequent resource allocation survey gathered views from participants and external experts on symposium priorities. RESULTS: Consensus was reached on priorities. Service priorities included establishing intersectoral hubs for children and families and early childhood nurse home-visiting programs. Research priorities included scaling up evidence-based interventions and evaluating cross-sector, flexible funding models for services addressing childhood adversity. Policy priorities included developing evidence-based policies with evaluation and implementation plans and flexible funding models to support integrated care. CONCLUSIONS: Our results provide detailed and actionable clarity on next steps to address family adversities. IMPLICATIONS FOR PUBLIC HEALTH: The priorities call for a focus on cross-sectoral approaches to preventing or mitigating the effects of family adversity. The current Australian policy environment provides a timely opportunity to action the proposed interventions.

Spatial effects of township health centers' health resource allocation efficiency in China.

Introduction: China is a large agricultural nation with the majority of the population residing in rural areas. The allocation of health resources in rural areas significantly affects the basic rights to life and health for rural residents. Despite the progress made by the Chinese government in improving rural healthcare, there is still room for improvement. This study aims to assess the spatial spillover effects of rural health resource allocation efficiency in China, particularly focusing on township health centers (THCs), and examine the factors influencing this efficiency to provide recommendations to optimize the allocation of health resources in rural China. Methods: This study analyzed health resource allocation efficiency in Chinese rural areas from 2012 to 2021 by using the super-efficiency SBM model and the global Malmquist model. Additionally, the spatial auto-correlation of THC health resource allocation efficiency was verified through Moran test, and three spatial econometric models were constructed to further analyze the factors influencing efficiency. Results: The key findings are: firstly, the average efficiency of health resource allocation in THCs was 0.676, suggesting a generally inefficient allocation of health resources over the decade. Secondly, the average Malmquist productivity index of THCs was 0.968, indicating a downward trend in efficiency with both non-scale and non-technical efficient features. Thirdly, Moran's Index analysis revealed that efficiency has a significant spatial auto-correlation and most provinces' values are located in the spatial agglomeration quadrant. Fourthly, the SDM model identified several factors that impact THC health resource allocation efficiency to varying degrees, including the efficiency of total health resource allocation, population density, PGDP, urban unemployment rate, per capita disposable income, per capita healthcare expenditure ratio, public health budget, and passenger traffic volume. Discussion: To enhance the efficiency of THC healthcare resource allocation in China, the government should not only manage the investment of health resources to align with the actual demand for health services but also make use of the spatial spillover effect of efficiency. This involves focusing on factors such as total healthcare resource allocation efficiency, population density, etc. to effectively enhance the efficiency of health resource allocation and ensure the health of rural residents.

Spying with a pilot's eye: Using eye tracking to investigate pilots' attention allocation and workload during helicopter autorotative gliding.

Flight safety in helicopters is a critical aspect of overall aircraft operational safety management, particularly during engine failures requiring autorotative glide, which makes it extremely challenging for the pilot to land the helicopter successfully. In this study, we evaluated the workload and attention allocation of helicopter pilots under such circumstances. In the experiment, a helicopter flight simulator was used to simulate level flight followed by autorotative glide, with the two phases divided into time segments for data collection. First, the data were visualized using heat maps and saccade sequence diagrams, while changes in eye movement metrics (such as peak value and standard deviation) were statistically analyzed. Finally, the criteria through the inter-criteria correlation (CRITIC) method was used to calculate the weight coefficient for each area of interest. This evaluation system was further applied to analyze and compare the changes in eye-movement data and attention to areas of interest during the two phases. The results revealed a shorter fixation duration, but a greater fixation number during the autorotative glide phase. Further, the mean pupil diameter changed over a larger range than during level flight (in level flight, the mean was 5.229 mm, while the standard deviation was 0.059 mm; in autorotative glide the corresponding values were 5.326 mm and 0.126 mm, respectively). For the tachometer, the weight coefficient matched the color of the heat map (2.7 % and colorless during level flight, but 23.8 % and red during autorotative glide), while those for the airspeed indicator and forward view differed significantly between the two phases. This discrepancy stemmed from the fact that during autorotative glide, the pilots prioritized monitoring aircraft rotation speed and attitude, with a particular focus on the forward view, rotor speed, and airspeed, resulting in a more concentrated attention distribution compared to that achieved during level flight. These results confirmed a significant increase in pilot workload during autorotative glide landing, while a shift was observed from low-frequency long gaze time during level flight to high-frequency short gaze time during autorotative glide. Furthermore, the pilots allocated 81 % of their attention to the tachometer, airspeed indicator, and forward views. Adopting this strategy can improve pilots' landing success and provide flight students with valuable training advice to prevent landing failures when helicopters lose power.

Microbial Ecology and Metabolism of Emerging Adulthood: Gut Microbiome Insights from a College Freshman Cohort.

The human gut microbiome (GM) undergoes dynamic changes throughout life, transitioning from infancy to adulthood. Despite improved understanding over the past years about how genetics, lifestyle, and the external environment impact the GM, limited research has explored the GM's evolution during late-stage adolescence, especially among college students. This study addresses this gap by investigating the longitudinal dynamics of fecal microbial, functional, and metabolomic signatures in a diverse group of first-year, dormitory-housed college students. A total of 485 stool samples from 246 participants were analyzed, identifying four primary GM community types, predominantly led by Bacteroides (66.8% of samples), as well as Blautia and Prevotella. The Prevotella/Bacteroides (P/B) ratio emerged as a robust GM composition indicator, predictively associated with 15 metabolites. Notably, higher P/B ratios correlated negatively with p-cresol sulfate and cholesterol sulfate, implying potential health implications, while positively correlating with kynurenic acid. Distinct GM transition and stability patterns were found from a detailed longitudinal subset of 93 participants over an academic year. Parasutterella and the Ruminococcus gnavus group exhibited positive associations with compositional variability, whereas Faecalibacterium and Eubacterium ventriosum group displayed negative associations, the latter suggesting stabilizing roles in the GM. Most notably, nearly half of the longitudinal cohort experienced GM community shifts, emphasizing long-term GM adaptability. Comparing individuals with stable community types to those undergoing transitions, we observed significant differences in microbial composition and diversity, signifying substantial shifts in the microbiota during transitions. Although diet-related variables contributed to some observed variance, diet did not independently predict the probability of switching between community types within the study's timeframe via multi-state Markov modeling. Furthermore, exploration of stability within dynamic microbiomes among the longitudinal cohort experiencing shifts in community types revealed that microbiome taxa at the genus level exhibited significantly higher total variance than estimated functional and fecal metabolomic features. This suggests tight control of function and metabolism, despite community shifting. Overall, this study highlights the dynamic nature of the late-stage adolescent GM, the role of core taxa, metabolic pathways, the fecal metabolome, and lifestyle and dietary factors, contributing to our understanding of GM assembly and potential health implications during this life phase.

Crossing national borders for transplantation: A focused evaluation of deceased donor lung exports from the United States.

Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the US faces a shortage of available organs. US policies incentivize identifying recipients for all recovered organs. Technological advancements have extended donor organ viability, creating new opportunities for long-distance transport and international sharing. We aimed to assess organ exports from deceased US donors to candidates abroad, a component of allocation policy allowed without suitable domestic candidates. Based on national SRTR data from January 2014-September 2023, 388,342 organs were recovered for transplantation, with 511(0.13%) exported. Most exported organs were lungs(80%). Exported lung donors were older(41 vs. 34 years,p<0.001), more likely Hepatitis-C positive(22% vs. 4%,p<0.001), and more likely donors after circulatory death(20% vs 7%,p<0.001). Lungs that were eventually exported were offered to more US PTRs (median=65) than those kept in the US(median=21 and 41 for lungs recovered by non-exporting and exporting OPOs;p<0.001). Our study highlights the necessity for further research and clear policy initiatives to balance the benefits of cross-border sharing while considering potential opportunities for more aggressive organ allocation within the US.

Effective dynamic energy management algorithm for grid-interactive microgrid with hybrid energy storage system.

Microgrids offer an optimistic solution for delivering electricity to remote regions and incorporating renewable energy into existing power systems. However, the energy balance between generation and consumption remains a significant challenge in microgrid setups. This research presents an adaptive energy management approach for grid-interactive microgrids. The DC microgrid is established by combining solar PV with a battery-supercapacitor (SC) hybrid energy storage system (HESS). The proposed approach integrates the frequency separation strategy with a rule-based algorithm to ensure optimal power sharing among sources while maintaining the safe operation of storage units. Specifically, the battery meets steady-state energy demands, the SC addresses transient power requirements, and the grid support is tailored to system needs. The method employs the dq reference frame technique to control the grid inverter (VSC). The key merits include efficient power allocation, fast regulation of the DC link voltage irrespective of load or generation variations, seamless transition between scenarios, and introduction of a straightforward battery state of charge (SOC)-based coefficient for allocating power between the battery and the grid while enhancing the power quality within the grid. Moreover, safety measures prevent the SC from overcharging, the battery from high current, overcharging, and deep discharging, potentially extending their lifespan. Validation and implementation of the method are conducted using MATLAB/Simulink.

Differentially Private Client Selection and Resource Allocation in Federated Learning for Medical Applications Using Graph Neural Networks.

Federated learning (FL) has emerged as a pivotal paradigm for training machine learning models across decentralized devices while maintaining data privacy. In the healthcare domain, FL enables collaborative training among diverse medical devices and institutions, enhancing model robustness and generalizability without compromising patient privacy. In this paper, we propose DPS-GAT, a novel approach integrating graph attention networks (GATs) with differentially private client selection and resource allocation strategies in FL. Our methodology addresses the challenges of data heterogeneity and limited communication resources inherent in medical applications. By employing graph neural networks (GNNs), we effectively capture the relational structures among clients, optimizing the selection process and ensuring efficient resource distribution. Differential privacy mechanisms are incorporated, to safeguard sensitive information throughout the training process. Our extensive experiments, based on the Regensburg pediatric appendicitis open dataset, demonstrated the superiority of our approach, in terms of model accuracy, privacy preservation, and resource efficiency, compared to traditional FL methods. The ability of DPS-GAT to maintain a high and stable number of client selections across various rounds and differential privacy budgets has significant practical implications, indicating that FL systems can achieve strong privacy guarantees without compromising client engagement and model performance. This balance is essential for real-world applications where both privacy and performance are paramount. This study suggests a promising direction for more secure and efficient FL medical applications, which could improve patient care through enhanced predictive models and collaborative data utilization.

Anti-Jamming Resource-Allocation Method in the EH-CIoT Network through LWDDPG Algorithm.

In the Energy-Harvesting (EH) Cognitive Internet of Things (EH-CIoT) network, due to the broadcast nature of wireless communication, the EH-CIoT network is susceptible to jamming attacks, which leads to a serious decrease in throughput. Therefore, this paper investigates an anti-jamming resource-allocation method, aiming to maximize the Long-Term Throughput (LTT) of the EH-CIoT network. Specifically, the resource-allocation problem is modeled as a Markov Decision Process (MDP) without prior knowledge. On this basis, this paper carefully designs a two-dimensional reward function that includes throughput and energy rewards. On the one hand, the Agent Base Station (ABS) intuitively evaluates the effectiveness of its actions through throughput rewards to maximize the LTT. On the other hand, considering the EH characteristics and battery capacity limitations, this paper proposes energy rewards to guide the ABS to reasonably allocate channels for Secondary Users (SUs) with insufficient power to harvest more energy for transmission, which can indirectly improve the LTT. In the case where the activity states of Primary Users (PUs), channel information and the jamming strategies of the jammer are not available in advance, this paper proposes a Linearly Weighted Deep Deterministic Policy Gradient (LWDDPG) algorithm to maximize the LTT. The LWDDPG is extended from DDPG to adapt to the design of the two-dimensional reward function, which enables the ABS to reasonably allocate transmission channels, continuous power and work modes to the SUs, and to let the SUs not only transmit on unjammed channels, but also harvest more RF energy to supplement the battery power. Finally, the simulation results demonstrate the validity and superiority of the proposed method compared with traditional methods under multiple jamming attacks.

Behavioral and Emotional Responding to Punishment in ADHD: Is Increased Emotionality Related to Altered Behavioral Responding?

Children with ADHD are theorized to experience increased negative emotional responses to punishment, compared to typically developing (TD) children, resulting in altered behavioral responding (Amsel, 1992). However, this has not been empirically tested. The current study evaluated the effects of punishment and reward on the behavioral and emotional responding of children with and without ADHD. Fifty-three children with ADHD (64.15% boys) and 46 TD children (47.83% boys), age 6-12, completed a task in which they chose between playing two simultaneously available games. Reward was arranged symmetrically across the games; responses on one game were punished four times as often as responses on the other game. Children's negative and positive emotional expressions were assessed during task completion with facial expression coding. Results indicated both groups showed a preference for playing the less punished game. Children with ADHD took longer to respond after punishment and reward compared to TD children. Negative emotional expressions increased with time on task for those with ADHD, the opposite pattern was seen in TD children. Children with ADHD showed more positive emotional expressions overall. The effect of ADHD on increased response times after reward was statistically fully mediated by increased positive facial expressions. Findings indicate children with ADHD do not show an altered response bias under punishment compared to TD children, but their cumulative negative emotional responding may indicate problems with building frustration tolerance as hypothesized by Amsel (1992). Results are theoretically important as they suggest increased emotional responding in ADHD is associated with slower responding.

Optimum designs for clinical trials in personalized medicine when response variance depends on treatment.

We study optimal designs for clinical trials when the value of the response and its variance depend on treatment and covariates are included in the response model. Such designs are generalizations of Neyman allocation, commonly used in personalized medicine when external factors may have differing effects on the response depending on subgroups of patients. We develop theoretical results for D-, A-, E- and D A-optimal designs and construct semidefinite programming (SDP) formulations that support their numerical computation. D-, A-, and E-optimal designs are appropriate for efficient estimation of distinct properties of the parameters of the response models. Our formulation allows finding optimal allocation schemes for a general number of treatments and of covariates. Finally, we study frequentist sequential clinical trial allocation within contexts where response parameters and their respective variances remain unknown. We illustrate, with a simulated example and with a redesigned clinical trial on the treatment of neuro-degenerative disease, that both theoretical and SDP results, derived under the assumption of known variances, converge asymptotically to allocations obtained through the sequential scheme. Procedures to use static and sequential allocation are proposed.

Does innovative city pilot policy improve carbon reduction? Quasi-experimental evidence from China.

A new direction for China in exploring sustainable development is the Innovative City Pilot Policy (ICPP), which provides policy guidance for accelerating carbon peaking and carbon neutrality by reducing carbon emissions. With data from 282 cities spanning 2006-2018, this paper examines ICPP's effect on carbon intensity (CI) through a multi-period difference-in-differences (DID) model, as well as exploring the mediating effect, moderating effect, heterogeneity, and spatial spillover effects. The results show that ICPP reduces CI significantly by enhancing technology innovation (TI), and when industrial structure (IS) is added, the effect of ICPP is expanded. The ICPP gains additional advantages in reducing CI by optimizing the efficiency of resource allocation (ERA). Compared with the concentration of human capital (HCL), the amount of scientific research institutes (SRI) has a slightly greater moderating effect. ICPP impacts considering location, size, and hierarchy heterogeneity. ICPP has a greater impact on mitigating CI in the western, larger size, and provincial capital cities. There are positive spillover effects of the ICPP on neighboring CI. To support the idea that ICPP can effectively contribute to CI reduction, this paper provides empirical evidence and theoretical guidelines.

Unveiling Hidden Disparities: Evaluating US Multiple Listing Practices in Lung Transplantation.

BACKGROUND: Multiple listing (ML) is a practice utilized to increase the potential for transplant but is controversial due to concerns that it disproportionately benefits patients with greater access to healthcare resources. RESEARCH QUESTION: Is there disparity in ML practices based on social deprivation in the United States and does ML lead to quicker time to transplant? STUDY DESIGN AND METHODS: A retrospective cohort study of adult (>18 years old) lung transplant candidates listed for transplant (2005-2018) was conducted. Exclusion criteria included heart only or heart and lung transplant and patients relisted during the observation period. Data were obtained from the UNOS Standard Transplant Analysis and Research File. The first exposure of interest was social deprivation index (SDI) with a primary outcome of ML status, to assess disparities between ML and SL participants. The second exposure of interest was ML status with a primary outcome of time to transplant, to assess whether implementation of ML leads to quicker time to transplant. RESULTS: 35,890 subjects were included in the final analysis, of whom 791 (2.2%) were ML and 35,099 (97.8%) were SL. ML participants had lower median level of social deprivation (5 units, more often female (60.0% vs 42.3%), and had lower median LAS (35.3 vs 37.3). ML patients were more likely to be transplanted compared to SL patients (OR=1.42, 95%CI [1.17-1.73]), but there was a significantly quicker time to transplant only for whom ML was early (within 6 months of initial listing) (sHR=1.17, 95%CI [1.04-1.32]). INTERPRETATION: ML is an uncommon practice with disparities existing between ML and SL patients on the basis of several factors including social deprivation. ML patients are more likely to be transplanted, but only if they ML early in their transplant candidacy. With changing allocation guidelines, it is yet to be seen how ML will change with the implementation of continuous distribution.

Stable isotopes reveal sex- and context-dependent amino acid routing in green anole lizards (Anolis carolinensis).

Allocation of acquired resources to phenotypic traits is affected by resource availability and current selective context. While differential investment in traits is well documented, the mechanisms driving investment at lower levels of biological organization, which are not directly related to fitness, remain poorly understood. We supplemented adult male and female Anolis carolinensis lizards with an isotopically labelled essential amino acid (13C-leucine) to track routing in four tissues (muscle, liver, gonads, and spleen) under different combinations of resource availability (high and low-calorie diets) and exercise training (sprint training and endurance capacity). We predicted sprint training should drive routing to muscle, and endurance training to liver and spleen, and that investment in gonads should be of lower priority in each of the cases of energetic stress. We found complex interactions between training regime, diet, and tissue type in females, and between tissue type and training and tissue type and diet in males, suggesting that males and females adjust their 13C-leucine routing strategies differently in response to similar environmental challenges. Importantly, our data show evidence of increased 13C-leucine routing in training contexts not to muscle as we expected, but to the spleen, which turns over blood cells, and to the liver, which supports metabolism under differing energetic scenarios. Our results reveal the context-specific nature of long-term tradeoffs associated with increased chronic activity. They also illustrate the importance of considering the costs of locomotion in studies of life history strategies.

Sustainable flood control strategies under extreme rainfall: Allocation of flood drainage rights in the middle and lower reaches of the yellow river based on a new decision-making framework.

Climate change has exacerbated the frequency and magnitude of extreme rainfall, which has led to the perpetuation of flooding as a hazard to humans and society. China has begun to consider introducing Flood drainage rights (FDR), a sustainable flood control measure, into non-engineering measures as a complement to engineering measures for flood control. FDR represent the right of regions to discharge regional floodwaters caused by extreme rainfall into the river, and are the primary means of controlling the amount of floodwaters from regions when regional flood capacity is exceeded. However, existing studies on quantitative FDR allocation still have limitations, and some previous methods have resulted in allocation schemes that are not entirely reasonable and fair because they do not comprehensively consider the influencing factors of FDR or the allocation method is unreasonable. This paper explores the impact of flooding on rural and agricultural areas. We incorporate the factors of agricultural economy and security and construct a system of the allocation indicators of FDR composed of five principles: Natural Environmental Endowment, General Economic and Social Development, Agricultural Economy and Security, Macro policy regulation, and Respect for Historical Background. Second, considering the influence of expert judgment and data of different time nodes on the allocation of FDR, we introduce the concepts of expert weight and time weight into the allocation model of FDR, and construct a new set of framework for the allocation of FDR, i.e., "[(expert weight + subjective weight)+(time weight + objective weight)]+decision making model ". To reduce the loss of information during the transformation of subjective judgments, we also introduced triangular fuzzy numbers for the transformation between expert judgments and numbers. Finally, we take the five provinces in the middle and lower reaches of the Yellow River as an example. Using the data from 2010 to 2021, we obtain the final allocation scheme (proportion) of FDR as Henan (33.26%) > Shaanxi (23.08%) > Inner Mongolia (21.31%) > Shanxi (14.44%) > Shandong (7.91%). On this basis, this paper utilizes sensitivity analysis and comparative validation to demonstrate the rationality and effectiveness of the method, and identifies several indicators that have a greater impact on the results of the allocation of FDR. FDR can form part of a set of integrated flood management system together with flood control projects, which greatly alleviates the drainage conflicts arising from flooding caused by extreme precipitation. Under extreme rainfall conditions, FDR improves drainage efficiency and minimizes the overall damage caused by flooding in the watershed. This study can contribute to the sustainable development of the watershed and provide a reference for the promotion and utilization of sustainable flood control measures.

The phytoplankton community affects the energy metabolism and immunomodulation strategy of oyster during breeding seasons.

The mass mortality of Pacific oyster Crassostrea gigas has become a severe ecological and economic concern to Chinese aquaculture, which is proposed to be linked to the phytoplankton community in the farming waters. In the present study, both field and laboratory experiments were conducted to identify the phytoplankton taxa associated with oyster mortality and explore the molecular mechanism by which they affect the physiological health of oysters. The field experiment showed that more serious mortality of oysters was observed in the North Yellow Sea from July to September in 2018 (average survival rate of 75.11 %) than in 2019 (average survival rate of 85.78 %), with the proportion of Bacillariophyta (diatoms) in the phytoplankton community in 2018 lower than that in 2019. In comparison to 2019, reduced dry weight, lower glycogen and triglyceride contents in hepatopancreas, lower 17ß-estradiol and testosterone concentrations in gonad, as well as a generally weaker immune response against Vibrio splendidus stimulation were detected in the oysters sampled in 2018. The treatment of oysters with either starvation (starvation group) or Nitzschia closterium f. minutissima feeding (N. closterium group) was conducted to verify the field findings, with individuals reared in natural seawater as control. After 40 days of N. closterium feeding, dry weight, glycogen and triglyceride contents in hepatopancreas significantly increased, as well as the biosynthesis of sex hormones and gonadal maturation were promoted compared to the control and starvation groups. Moreover, a much stronger immune response against V. splendidus stimulation was observed in the oysters of N. closterium group, with the fold-changes of norepinephrine content in serum, SOD activity in hepatopancreas, and the mRNA expression level of IL17-5 and HSP70 in haemocytes higher than those in the control and starvation groups. Collectively, these results suggested that lack of diatoms in the farming waters suppressed the energy storage and gonadal maturation of adult oysters, and also resulted in a compromised immune response against bacterial infection, which may be a leading cause of the mass mortality of oysters living in diatom-deficient waters during breeding seasons.

Research on the coupling measurement of medical education and health resource allocation under the background of healthy China.

OBJECTIVE: To analyze the coupling and coordination level of medical education and health resource allocation in China, and to provide scientific basis for promoting the high-quality development of medical education and the efficient allocation of health resources. METHODS: Based on the panel data from 2011 to 2021, the coupling coordination degree model was used to measure the coupling coordination index of medical education and health resources in China. The spatial auto-correlation model was used to analyze the development status and distribution characteristics of the coupling coordination degree of the two systems. The kernel density estimation method was used to analyze the dynamic evolution trend of the coupling coordination of the two systems. The QR quantile regression model was used to explore the key factors affecting the coupling coordination degree of the two systems. RESULTS: During the observation period, the coupling coordination degree of the two systems increased from 0.393 to 0.465, with a growth rate of 18.3%. The coupling coordination degree between regions gradually decreased in the eastern-central and eastern-western regions, and there were still large differences between the central and western regions. The coupling coordination degree of the two systems in the region was significantly different in the eastern and western regions, and the central region was relatively similar. There is a positive spatial correlation between the provinces, and 25.81% of the provinces have transitions. Finally, the number of points in the first and third quadrants is higher than that in the second and fourth quadrants. In the process of dynamic distribution, the degree of polarization of the coupling coordination degree curve of the two systems is gradually weakened. Per capita GDP, residents ' income difference and population size are the positive and significant factors driving the coupling and coordinated development of the two systems. CONCLUSION: The coupling and coordination degree of the two systems of medical education and health resource allocation showed a stable upward trend during the observation period, and the global spatial positive correlation also gradually increased, showing the spatial agglomeration characteristics of ' high-high agglomeration ' and ' low-low agglomeration '. The spatial difference of coupling coordination degree shows a shrinking trend and develops towards equalization. The coupling coordination degree of the two systems is affected by social, economic and demographic factors to varying degrees. Therefore, it is necessary to innovate the coordinated development mechanism of the two systems, promote the two-way flow of medical education and health resource allocation in talents, technology and other elements, and then promote the coupling and coordinated development of the two systems.

Adaptive responses to elevated CO2 in fruit species with different phloem loading mechanisms.

Introduction: It has been suggested that the mechanism of phloem loading, that is apoplastic or symplastic loading, may affect a plant's ability to adapt to elevated CO2 levels. Strawberry (Fragaria × ananassa) and tomato (Solanum lycopersicum) are two fruit crops that use different mechanisms to load sugars into the phloem - the former symplastically and the latter apoplastically - yet both species can increase their yields when grown in a CO2-enriched environment. In this study, we subjected strawberry and tomato plants to long-term CO2 enrichment to determine the morphological and physiological adaptations that enable them to increase their yields in response to higher CO2 levels. Methods: Transplanted tomato and strawberry plants were subjected to ambient (400 ppm) and elevated (800 ppm) CO2 for three months. We examined various parameters associated with growth, yield, photosynthesis, and carbon allocation by means of phenotyping, gas exchange analysis, and 13C labelling combined with isotope ratio mass spectrometry. Results: We found that CO2 enrichment promoted growth and reproductive development in both species, resulting in more flowers per plant (tomato and strawberry), larger crown (strawberry), and, eventually, higher yields. Gas exchange analysis and A/c i curves revealed that elevated CO2 increased carbon assimilation rate in strawberry, but not in tomato - the latter being limited by Rubisco's carboxylation efficiency. Finally, whereas both species prioritized fruit development over the development of other sink organs, they were both limited by carbon export at elevated CO2, since new photoassimilates were equally distributed to various sinks between CO2 treatments. Discussion: The findings suggest that both species will benefit from future increases in CO2 levels and support current glasshouse practices entailing CO2 enrichment. Those benefits probably stem from an enhanced performance of both species at early developmental stages, as differences in carbon assimilation rate (tomato) and carbon allocation between treatments at late developmental stages were absent. Moreover, crop adaptation to elevated CO2 seems to depend on the ability of each species to respond to elevated CO2, rather than on the phloem loading mechanism per se.

Joint computation offloading and resource allocation for end-edge collaboration in internet of vehicles via multi-agent reinforcement learning.

Vehicular edge computing (VEC), a promising paradigm for the development of emerging intelligent transportation systems, can provide lower service latency for vehicular applications. However, it is still a challenge to fulfill the requirements of such applications with stringent latency requirements in the VEC system with limited resources. In addition, existing methods focus on handling the offloading task in a certain time slot with statically allocated resources, but ignore the heterogeneous tasks' different resource requirements, resulting in resource wastage. To solve the real-time task offloading and heterogeneous resource allocation problem in VEC system, we propose a decentralized solution based on the attention mechanism and recurrent neural networks (RNN) with a multi-agent distributed deep deterministic policy gradient (AR-MAD4PG). First, to address the partial observability of agents, we construct a shared agent graph and propose a periodic communication mechanism that enables edge nodes to aggregate information from other edge nodes. Second, to help agents better understand the current system state, we design an RNN-based feature extraction network to capture the historical state and resource allocation information of the VEC system. Thirdly, to tackle the challenges of excessive joint observation-action space and ineffective information interference, we adopt the multi-head attention mechanism to compress the dimension of the observation-action space of agents. Finally, we build a simulation model based on the actual vehicle trajectories, and the experimental results show that our proposed method outperforms the existing approaches.

Temporal evolution of living donor liver transplantation survival - A UNOS registry study.

Living donor liver transplantation (LDLT) is a curative treatment for various liver diseases, reducing waitlist times and associated mortality. We aimed to assess the overall survival (OS), identify predictors for mortality, and analyze differences in risk factors over time. Adult patients undergoing LDLT were selected from the United Network for Organ Sharing database from inception (1987) to 2023. The Kaplan-Meier method was used for analysis, and multivariable Cox proportional hazard models were conducted. 7,257 LDLT recipients with a median age of 54years (IQR:45,61), 54% male, 80% non-Hispanic White, BMI 26.3kg/m2 (IQR:23.2,30.0), and MELD 15 (IQR:11,19) were included. The median cold ischemic time was 1.6hours (IQR:1.0,2.3) with 88% right-lobe-grafts. The follow-up was 4.0years (IQR:1.0,9.2). The contemporary reached median overall survival was 17.0years (95%CI:16.1,18.1) with OS estimates: 1-year 95%, 3-years 89%, 5-years OS 84%, 10-years 72%, 15-years 56% and 20-years 43%. Nine independent factors associated with mortality were identified, with an independent improved OS in the recent time era (aHR 0.53; 95%CI:0.39,0.71). The median center-caseload per year was 5 (IQR:2,10) with observed center-specific improvement of OS. LDLT is a safe procedure with excellent OS. Its efficacy has improved despite an increase of risk parameters, suggesting its limits are yet to be met.