Characteristics of real-world ship energy consumption and emissions based on onboard testing.

The Yangtze River ships are generally overpowered and less energy efficient. In this study, a Yangtze ship was selected as the test ship, and its characteristics were investigated through energy consumption and emission testing under multiple operating conditions. The results show that the ship operates at 25-50 % engine load for 72.2 % of the time, and at this partial load, 9.72 % more CO2 and 9.81 % more NOX can be emitted than at the rated power. The concentrations of exhaust vary under different operating conditions. The emission factor of CO was the highest under departure conditions; CO2 and SO2 were the highest under anchoring conditions; and NOx was the highest under cruising conditions. The accuracy of the emission factors obtained by the direct calculation method was improved by 30 % compared to the concentration estimation method. This study can help understand the real level of energy consumption and emissions from in-service ships.

Time-Resolved Extensional Rheo-NMR Spectroscopy for Investigating Polymer Nanocomposites under Deformation.

Understanding the microstructure change of polymer nanocomposites (PNCs) under elongation deformation at the molecular level is the key to coupling structure-property relationships of PNCs. In this study, we developed our recently proposed in situ extensional rheology NMR device, Rheo-spin NMR, which can simultaneously obtain both the macroscopic stress-strain curves and the microscopic molecular information with the total sample weight of ∼6 mg. This enables us to conduct a detailed investigation of the evolution of the interfacial layer and polymer matrix in nonlinear elongational strain softening behaviors. A quantitative method is established for in situ analysis of (1) the fraction of the interfacial layer and (2) the network strand orientation distribution of the polymer matrix based on the molecular stress function model under active deformation. The results show that for the current highly filled silicone nanocomposite system, the influence of the interfacial layer fraction on mechanical property change during small amplitude deformation is quite minor, while the main role is reflected in rubber network strand reorientation. The Rheo-spin NMR device and the established analysis method are expected to facilitate the understanding of the reinforcement mechanism of PNC, which can be further applied to understand the deformation mechanism of other systems, i.e., glassy and semicrystalline polymers and the vascular tissues.

Studying Complex Evolution of Hyperelastic Materials under External Field Stimuli using Artificial Neural Networks with Spatiotemporal Features in a Small-Scale Dataset.

Deep-learning (DL) methods, in consideration of their excellence in dealing with highly complex structure-performance relationships for materials, are expected to become a new design paradigm for breakthroughs in material performance. However, in most cases, it is impractical to collect massive-scale experimental data or open-source theoretical databases to support training DL models with sufficient prediction accuracy. In a dataset consisting of 483 porous silicone rubber observations generated via ink-writing additive manufacturing, this work demonstrates that constructing low-dimensional, accurate descriptors is the prerequisite for obtaining high-precision DL models based on small experimental datasets. On this basis, a unique convolutional bidirectional long short-term memory model with spatiotemporal features extraction capability is designed, whose hierarchical learning mechanism further reduces the requirement for the amount of data by taking full advantage of data information. The proposed approach can be expected as a powerful tool for innovative material design on small experimental datasets, which can also be used to explore the evolutionary mechanisms of the structures and properties of materials under complex working conditions.

Theoretical model and measurement of shared decision making in web-based pharmaceutical care consultation.

Objectives: We aimed to construct a theoretical model and an observer-based measurement of shared decision making (SDM) in web-based pharmaceutical care consultation. Methods: We first constructed a theoretical model through analysis of SDM models and interviews with 24 key informants. Then, the initial measurement was formulated, and the content was evaluated by 16 key informants alone. A cross-sectional study was executed, where 300 provider-patient encounters were collected at the online platform 'Good Doctor Website', for reliability and validity assessment. Content validity was evaluated by appropriateness score, that is the median of 7-9 and without disagreement. Interrater reliability was evaluated by Spearman correlation coefficient using 30 out of 300 samples. Single indicator validity was tested by Pearson correlation analysis, and convergent validity was evaluated by the Multiple Indicators Multiple Causes (MIMIC) model using 300 samples. Results: Theoretical model constructed included four elements: 'comprehensive understanding of the patient's condition', 'exchanging ideas on medication options', 'achieving a medication plan', and 'providing decision support'. Measurement constructed included four dimensions and 19 items, and four dimensions were in accordance with four elements of the theoretical model. We found median scores of these dimensions and items were 7-9 and without disagreement, indicating good content validity. Spearman correlation coefficients of 19 items were greater than 0.750, suggesting good interrater reliability. Pearson coefficients between 19 items and their external variables were significant (p < 0.001), and MIMIC model results showed that the R 2 values of dimensions 1-4 were over 0.5, indicating good single indicator validity and convergent validity. Conclusions: Characteristics of web-based pharmaceutical care consultation, highlighting the importance of medication history, medication regimen, and detailed medication plan, were observed in the theoretical model. Measurement constructed had good reliability and validity and may be used by health policymakers to improve the quality of pharmaceutical care consultation online.

Liquid Crystal-Based Organosilicone Elastomers with Supreme Mechanical Adaptability.

Elastomers with supreme mechanical adaptability where the increasing stress under continuous deformation is significantly inhibited within a large deformation zone, are highly desired in many areas, such as artificial muscles, flexible and wearable electronics, and soft artificial-intelligence robots. Such system comprises the advantages of recoverable elasticity and internal compensation to external mechanical work. To obtain elastomer with supreme mechanical adaptability, a novel liquid crystal-based organosilicon elastomer (LCMQ) is developed in this work, which takes the advantages of reversible strain-induced phase transition of liquid crystal units in polymer matrix and the recoverable nano-sized fillers. The former is responsible for the inhibition of stress increasing during deformation, where the external work is mostly compensated by internal phase transition, and the latter provides tunable and sufficient high tensile strength. Such LCMQs were synthesized with 4-methoxyphenyl 4-(but-3-en-1-yloxy)benzoate (MBB) grafted thiol silicone oil (crosslinker-g-MBB) as crosslinking agent, vinyl terminated polydimethylsiloxane as base adhesive, and fumed silica as reinforcing filler by two-step thiol-ene "click" reaction. The obtained tensile strength and the elongation at break are better than previously reported values. Moreover, the resulting liquid crystal elastomers exhibit different mechanical behavior from conventional silicone rubbers. When the liquid crystal content increases from 1% (w/w) to 4% (w/w), the stress plateau for mechanical adaptability becomes clearer. Moreover, the liquid crystal elastomer has no obvious deformation from 25 °C to 120 °C and is expected to be used in industrial applications. It also provides a new template for the modification of organosilicon elastomers.

Pharmaceutical expenditure and total health-care expenditure in OECD countries and China: bidirectional Granger causality on the basis of health level.

Background: Previous studies have ignored the bidirectional causality and the heterogeneity of health level. This study explored the bidirectional causality between pharmaceutical expenditure (PE) and total health-care expenditure (Total HCE) considering the health level for effective health investment and national health improvement.Methods: Based on the panel data on PE and Total HCE in 32 OECD countries and China, the Granger causality test was applied. Countries were divided into low- and high-health-level (LH and HH) groups according to their life expectancies.Results: A 1% increase in the growth rate of per capita PE boosted a 0.11% increase in that of per capita Total HCE of the following year in HH group, whereas no such causality existed in LH group. A 1% increase in the growth rate of per capita Total HCE boosted a 0.46% increase in that of the per capita PE of the following year in LH group, whereas no such causality existed in HH group.Conclusion: High-health-level countries should continue to increase the health investment by promoting rational PE growth such as expanding insurance coverage for innovative medicine for health improvement. Low-health-level countries should take optimizing policy to increase health investment in pharmaceutical for medicine accessibility and national health.

Procedural fairness predicts cooperative behaviour for high-self-esteem individuals but not for low-self-esteem individuals.

Cooperation is vital for modern society. Previous studies showed that procedural fairness promotes cooperation; however, they mainly focused on cooperation intention, which may fail to reveal actual cooperative behaviour. Moreover, little is known regarding the personality boundary of the effect of procedural fairness on cooperation. Guided by previous findings that self-esteem increases sensitivity to procedural unfairness, we attempted to explore the moderating effect of self-esteem on the association between procedural fairness and cooperative behaviour. In Experiment 1, 160 participants' self-esteem was measured using the Rosenberg Self-Esteem Scale; procedural fairness was manipulated in two conditions, depending on whether money was allocated in an economic game by rolling the dice twice or an allocator's arbitrary choice. Cooperative behaviour was assessed using the chicken game paradigm. Experiment 2 (148 participants) aimed to replicate and extend the results of Experiment 1 using a more rigorous experimental design, in which the possible effect of outcome favourability was excluded. The results of both experiments consistently showed that procedural fairness positively predicted cooperative behaviour, and this association was significant in high-self-esteem individuals, but not in low-self-esteem individuals. These findings shed light on the vital role of self-esteem in understanding the relationship between procedural fairness and cooperative behaviour.

Development and Validation of Online Textual Pediatrician-Parent Communication Instrument Based on the SEGUE Framework.

The prevalence and feature of online textual pediatrician-parent communication (OPPC) have been recognized, but evidence on OPPC assessment remains insufficient. This study aimed to develop and validate an OPPC instrument to provide measurement and quality characteristics for quality assessment and management. 490 OPPC exchanges of 61 tertiary hospitals from 9 Chinese provinces were obtained from the Spring Rain Doctor website. The SEGUE framework, OPPC feature, and a pilot study were considered to establish the instrument. An empirical study was conducted to validate it and the incidence of OPPC items was also analyzed. As a result, a four-dimensional, 15-item OPPC instrument was developed. The empirical results are as follows. Cronbach's α values of dimensions were 0.80, 0.62, 0.64, and 0.60; the mean interrater reliability was 0.93; the correlation coefficients between items and their corresponding dimensions' scores ranged from 0.51 to 0.89 (P<0.001). The goodness-of-fit indices were acceptable. The overall incidence rate of parent-dominated/cooperative items (46.9%) was higher than that of pediatrician-dominated items (39.6%). Thus, the instrument is acceptable and OPPC quality is characterized by more parent-dominated and cooperative behaviors.

PD-L1 Expression Promotes Epithelial to Mesenchymal Transition in Human Esophageal Cancer.

BACKGROUND/AIMS: PD-L1 (Programmed cell death 1 ligand 1, PD-L1), an essential immune checkpoint molecule in the tumor microenvironment, is an important target for cancer immunotherapy. We have previously reported that its expression in human gastric and esophageal cancer tissues is significantly associated with cancer progression and patients' postoperative prognoses. Its expression in cancer cells is well known to inhibit the T cell-mediated anti-tumor response, and this mechanism of action has been targeted for cancer immunotherapy. As of now, the autonomous effect of PD-L1 on cancer cells is not well understood, thus our present study aimed to examine the role of PD-L1 intervention in cellular biological functions, especially epithelial to mesenchymal transition (EMT), of the human esophageal cancer cell line, Eca-109 cells. METHODS: Immunohistochemistry assay was used to investigate the correlation between expression of PD-L1 and EMT markers in human esophageal cancer tissues. Intervention of PD-L1 by using RNAi and over-expression methods were used to study the role of PD-L1 in regulation of biological behaviors and EMT in Eca-109 cells. RESULTS: Our clinical and pathological data demonstrated that tumor samples in the EMT positive subgroup had higher PD-L1 expression than those in the EMT negative subgroup. By manipulating PD-L1 expression in Eca-109 cells either through ablation or overexpression of wild type and the cytoplasmic domain-truncated mutant, we demonstrated that PD-L1 expression significantly promoted the cell viability, migration and EMT phenotype. Furthermore, our study also indicated that PD-1 fusion protein mediated stimulation of PD-L1 and the cytoplasmic domain of PD-L1 played a critical role in promoting EMT phenotype of Eca-109 cells, thereby suggesting that PD-1 receptor usually by triggering the reverse signaling can effect PD-L1 mediated regulation of esophageal cancer cell response. CONCLUSION: Our present study reveals a tumor cell-autonomous role of PD-L1 signaling in promoting EMT in human esophageal cancer.

Knockdown of PD-L1 in Human Gastric Cancer Cells Inhibits Tumor Progression and Improves the Cytotoxic Sensitivity to CIK Therapy.

Background/Abstract: PD-L1 has been an important target of cancer immunotherapy. We have showed that in human gastric cancer tissues, over-expression of PD-L1 was significantly associated with cancer progression and patients' postoperative prognoses. However, as of now, how PD-L1 regulates the biological function of gastric cancer cells still remains elusive. METHODS: We constructed the stable PD-L1 knockdown expression gastric cancer cell lines by using RNAi method, and further investigated the changes of biological functions including cell viability, migration, invasion, cell cycle, apoptosis, tumorigenicity in vivo, and the cytotoxic sensitivity to CIK therapy, in contrast to the control cells. RESULTS: In the current study, we demonstrated that the knockdown of PD-L1 expression in human gastric cancer cells could significantly suppress the cell proliferation, migration, invasion, apoptosis, cell cycle, tumorigenicity in vivo and the cytotoxic sensitivity to CIK therapy. CONCLUSION: Our results indicate that PD-L1 contributes towards transformation and progression of human gastric cancer cells, and its intervention could prove to be an important therapeutic strategy against gastric cancer.

Higher Numbers of T-Bet+ Tumor-Infiltrating Lymphocytes Associate with Better Survival in Human Epithelial Ovarian Cancer.

BACKGROUND/AIMS: T-bet, a member of the T-box family of transcription factors, is a key marker of type I immune response within the tumor microenvironment, and has been previously reported by us to serve as an important prognostic indicator for human gastric cancer patients and a potential biomarker for immunotherapy. In the present study, we aimed to assess the clinical significance and prognostic value of T-bet+ tumor-infiltrating lymphocytes in human epithelial ovarian cancer. METHODS: The immunohistochemistry was used to analyze the infiltration density of T-bet+ lymphoid cells in human epithelial ovarian cancer tissues, and the flow cytometry analysis was used to further analyze the presence of T-bet+ tumor-infiltrating lymphocytes subgroups in cancer tissues. RESULTS: Our immunohistochemistry analysis showed increased number of T-bet+ lymphoid cells in the human epithelial ovarian cancer tissues, and the flow cytometry analysis further demonstrated the presence of T-bet+ tumor-infiltrating lymphocytes subgroups including CD4+ , CD8+ T cells and NK cells. In addition, we also observed a significant association of T-bet+ tumor-infiltrating lymphocytes density in the tumor nest of cancer with not only serum CA125 levels but also with distant metastasis. However no association was observed with other characteristics like patients' age, pathological type, FIGO stage, tumor site and tumor size. Furthermore, the survival analysis showed that higher density of T-bet+ tumor-infiltrating lymphocytes both in tumor nest and tumor stroma of cancer tissues was significantly associated with better patient survival. In addition, the density of T-bet+ tumor-infiltrating lymphocytes in tumor nest appeared to be an independent risk factor for predicting patients' postoperative prognoses. CONCLUSIONS: Our data indicated that the key transcription factor T-bet might play an important role in the type I immune cells mediated antitumor response, and the density of T-bet+ lymphocytes in human epithelial ovarian cancer tissues could serve as a prognostic predictor for ovarian cancer patients.

Hierarchical investigating the predictive value of p53, COX2, EGFR, nm23 in the post-operative patients with colorectal carcinoma.

The aim of this study was to evaluate the correlations between p53, COX2, EGFR, nm23 expression and the progression free survival (PFS) of post-operative patients with colorectal carcinoma. Immunohistochemistry was used to detect the expression of p53, COX2, EGFR and nm23 in 459 specimens from colorectal carcinoma patients. Kaplan-Meier estimates, Cox proportional hazard regression analyses and hierarchical analyses were performed on the collected data. Kaplan-Meier estimates analysis suggested that EGFR expression was as a negative predictor, the median PFS of patients with EGFR high expression was 21.73 months, and the median PFS of patients with low EGFR expression was 57.83 months (χ2=20.880, P<0.001); nm23 expression was positive predictive factor for the prognosis of patients with colorectal carcinoma, the median PFS of patients with high nm23 expression was 37.77 months, and the median PFS was 21.47 months in the patients with low nm23 expression (χ2=7.364, P=0.007). Cox regression analysis revealed that comparing with the patients with low expression of EGFR, the patients with high EGFR expression were at higher risk of tumor progression (HR=1.667, P=0.004); Comparing with the patients with high nm23 expression, the patients with nm23 low expression had a higher risk of tumor progression (HR=0.412, P<0.001); and the risk of tumor progression was higher in the patients with high EGFR expression and low nm23 expression (HR=0.245, P<0.001). Hierarchical analysis showed that EGFR expression mainly correlates with the PFS of TNM stage I-II colorectal cancer patients, the median PFS was 33.53 months in the TNM stage I-II colorectal cancer patients with high EGFR expression patients; The median PFS of the TNM stage I-II colorectal cancer patients with low EGFR expression was 70.43 months (χ2=9.530, P=0.002); The median PFS was 19.2 months in the TNM stage III-IV colorectal cancer patients with high expression EGFR, the PFS of the TNM stage III-IV colorectal cancer patients with low EGFR expression was 37.87 months (χ2=7.97, P=0.005). nm23 expression mainly correlates with the PFS of TNM stage III-IV colorecatal cancer patients. The median PFS was 47.27 months in TNM stage I-II colorectal cancer patients with nm23 high expression, the median PFS was 48.85 months in TNM stage I-II colorectal cancer patients with low nm23 expression (χ2=0.101, P=0.750); The median PFS was 28.8 months in TNM stage III-IV colorectal cancer patients with nm23 high expression, the median PFS was 14.7 months in TNM stage III-IV colorectal cancer patients with low nm23 expression (χ2=13.213, P<0.001). EGFR is mainly a predictive factor for the prognosis of post-operative patients with TNM stage I-II colorectal cancer, and nm23 is important for predicting the prognosis of patients with stage III-IV, and EGFR and nm23 could be as predictor of combination.

Association of TIMP-2-418G/C and TIMP-2-303G/A with gastric cancer: a meta-analysis.

BACKGROUND: According to the relevant reports, TIMP-2 polymorphism might be associated with the susceptibility to gastric cancer. Owing to the inconclusive results from the published studies based on the association between TIMP-2 single nucleotide polymorphisms (SNPs) and gastric cancer susceptibility, a meta-analysis was conducted to investigate the correlation between the TIMP-2 SNPs and the risk of gastric cancer. MATERIALS AND METHODS: PubMed, Embase, CNKI and Wanfang databases were systematically searched to cover all the studies based on the association of two SNPs with the susceptibility to gastric cancer published before April 2016. Pooled odds ratios (ORs) and 95% confidence intervals were calculated for all genetic models. RESULTS: A total of six case-control studies on TIMP-2-418G/C and four studies on TIMP-2-303G/A were included. No obvious association was found between TIMP-2-418G/C polymorphism and the risk of gastric cancer in all the genetic models. On the other hand, TIMP-2-303G/A polymorphism had a significant association with increased risk of gastric cancer in homozygote recessive and allele comparisons, and similar results were observed in subgroups of Asian populations, but there were inadequate data to completely verify the association between TIMP-2-303G/A and gastric cancer. CONCLUSION: TIMP-2-418G/C polymorphism is not correlated with the risk of gastric cancer, while TIMP-2-303G/A is a risk factor for gastric cancer, especially in Asian populations. However, owing to the limited cases, the results of TIMP-2-303G/A should be thoroughly examined and validated with large-scale and well-designed studies.

Influence of supplemental parenteral nutrition approach on nosocomial infection in pediatric intensive care unit of Emergency Department: a retrospective study.

BACKGROUND & AIMS: Nutritional support for patients in the intensive-care unit (ICU) is a part of standard care which promotes medical quality and decreases nosocomial infection. Supplemental parenteral nutrition (SPN) approach (enteral nutrition (EN) combined with parenteral nutrition (PN) when EN alone is insufficient) has become one major concern in nutrition research field. This research aims to explore the following relationships: (i) the relationship between SPN and nosocomial infection, (ii) the relationship between early and late SPN initiation and the development of nosocomial infection. METHODS: A retrospective study was conducted in patients who met the inclusion criteria from February 2012 to February 2015 in Pediatric ICU (PICU). Patients were classified into two groups according to nutrition delivery approach-SPN group and EN alone group. Then SPN group were further divided into two subgroups by initiation timing, which were defined as early-initiation SPN and late-initiation SPN group respectively. Age, gender, serum albumin at admission, severity of disease, length of stay in PICU, nutrition delivery approach, amounts of delivered caloric intake and occurence of nosocomial infection were recorded. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors and assess the independent effect of SPN approach on nosocomial infection in PICU of Emergency Department. RESULTS: 204 patients were included in our study. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate (34.0 vs.10.9%, p < 0.001). The late-initiation subgroup of SPN approach was found to be an independent predictor of nosocomial infection in the logistic regression analysis model (OR = 3.40; 95% CI, 1.13 ~ 10.19; p = 0.029). Serum albumin at admission (OR = 0.91; 95% CI, 0.84 ~ 0.97; p = 0.008), mechanical ventilation (OR = 3.85; 95% CI, 1.43 ~ 10.39; p = 0.008), severity of disease (OR = 3.79; 95% CI, 1.03 ~ 13.99; p = 0.045) and PICU length of stay (OR = 1.23; 95% CI, 1.11 ~ 1.35; p < 0.001) were also identified as significant risk factors for nosocomial infection. CONCLUSIONS: Our study shows late-initiation SPN approach increases the incidence of nosocomial infection compared with early-initiation approach in critically ill children in PICU of Emergency Department. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate.

Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China.

BACKGROUND: The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. METHODS: Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China's Health Statistics Yearbook.By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. RESULTS: Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed. CONCLUSION: In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program.