Value function assessment to different RL algorithms for heparin treatment policy of patients with sepsis in ICU.

Heparin is a critical aspect of managing sepsis after abdominal surgery, which can improve microcirculation, protect organ function, and reduce mortality. However, there is no clinical evidence to support decision-making for heparin dosage. This paper proposes a model called SOFA-MDP, which utilizes SOFA scores as states of MDP, to investigate clinic policies. Different algorithms provide different value functions, making it challenging to determine which value function is more reliable. Due to ethical restrictions, we cannot test all policies on patients. To address this issue, we proposed two value function assessment methods: action similarity rate and relative gain. We experimented with heparin treatment policies for sepsis patients after abdominal surgery using MIMIC-IV. In the experiments, TD(0) shows the most reliable performance. Using the action similarity rate and relative gain to assess AI policy from TD(0), the agreement rates between AI policy and "good" physician's actual treatment are 64.6% and 73.2%, while the agreement rates between AI policy and "bad" physician's actual treatment are 44.1% and 35.8%, the gaps are 20.5% and 37.4%, respectively. External validation using action similarity rate and relative gain based on eICU resulted in agreement rates of 61.5% and 69.1% with the "good" physician's treatment, and 45.2% and 38.3% with the "bad" physician's treatment, with gaps of 16.3% and 30.8%, respectively. In conclusion, the model provides instructive support for clinical decisions, and the evaluation methods accurately distinguish reliable and unreasonable outcomes.

A three-stage eccDNA based molecular profiling significantly improves the identification, prognosis assessment and recurrence prediction accuracy in patients with glioma.

Glioblastoma (GBM) progression is influenced by intratumoral heterogeneity. Emerging evidence has emphasized the pivotal role of extrachromosomal circular DNA (eccDNA) in accelerating tumor heterogeneity, particularly in GBM. However, the eccDNA landscape of GBM has not yet been elucidated. In this study, we first identified the eccDNA profiles in GBM and adjacent tissues using circle- and RNA-sequencing data from the same samples. A three-stage model was established based on eccDNA-carried genes that exhibited consistent upregulation and downregulation trends at the mRNA level. Combinations of machine learning algorithms and stacked ensemble models were used to improve the performance and robustness of the three-stage model. In stage 1, a total of 113 combinations of machine learning algorithms were constructed and validated in multiple external cohorts to accurately distinguish between low-grade glioma (LGG) and GBM in patients with glioma. The model with the highest area under the curve (AUC) across all cohorts was selected for interpretability analysis. In stage 2, a total of 101 combinations of machine learning algorithms were established and validated for prognostic prediction in patients with glioma. This prognostic model performed well in multiple glioma cohorts. Recurrent GBM is invariably associated with aggressive and refractory disease. Therefore, accurate prediction of recurrence risk is crucial for developing individualized treatment strategies, monitoring patient status, and improving clinical management. In stage 3, a large-scale GBM cohort (including primary and recurrent GBM samples) was used to fit the GBM recurrence prediction model. Multiple machine learning and stacked ensemble models were fitted to select the model with the best performance. Finally, a web tool was developed to facilitate the clinical application of the three-stage model.

Coupling life cycle assessment and global sensitivity analysis to evaluate the uncertainty and key processes associated with carbon footprint of rice production in Eastern China.

An accurate and objective evaluation of the carbon footprint of rice production is crucial for mitigating greenhouse gas (GHG) emissions from global food production. Sensitivity and uncertainty analysis of the carbon footprint evaluation model can help improve the efficiency and credibility of the evaluation. In this study, we combined a farm-scaled model consisting of widely used carbon footprint evaluation methods with a typical East Asian rice production system comprising two fertilization strategies. Furthermore, we used Morris and Sobol' global sensitivity analysis methods to evaluate the sensitivity and uncertainty of the carbon footprint model. Results showed that the carbon footprint evaluation model exhibits a certain nonlinearity, and it is the most sensitive to model parameters related to CH4 emission estimation, including EFc (baseline emission factor for continuously flooded fields without organic amendments), SFw (scaling factor to account for the differences in water regime during the cultivation period), and t (cultivation period of rice), but is not sensitive to activity data and its emission factors. The main sensitivity parameters of the model obtained using the two global sensitivity methods were essentially identical. Uncertainty analysis showed that the carbon footprint of organic rice production was 1271.7 ± 388.5 kg CO2eq t-1 year-1 (95% confidence interval was 663.9-2175.8 kg CO2eq t-1 year-1), which was significantly higher than that of conventional rice production (926.0 ± 213.6 kg CO2eq t-1 year-1, 95% confidence interval 582.5-1429.7 kg CO2eq t-1 year-1) (p<0.0001). The carbon footprint for organic rice had a wider range and greater uncertainty, mainly due to the greater impact of CH4 emissions (79.8% for organic rice versus 53.8% for conventional rice). EFc , t, Y, and SFw contributed the most to the uncertainty of carbon footprint of the two rice production modes, wherein their correlation coefficients were between 0.34 and 0.55 (p<0.01). The analytical framework presented in this study provides insights into future on-farm advice related to GHG mitigation of rice production.

Performance-Based Assessment of Bridges with Novel SMA-Washer-Based Self-Centering Rocking Piers.

This study discussed a novel self-centering rocking (SCR) bridge system equipped with shape memory alloy (SMA)-based piers, with a particular focus on the benefit of the SCR bridge system in a life-cycle context. The study commences with an introduction of the SCR bridge system; subsequently, a life-cycle loss and resilience assessment framework for the SCR bridge system is presented. Specifically, the seismic fragility, resilience, and life-cycle loss associated with the SCR and conventional bridge systems were addressed. The proposed life-cycle assessment framework was finally applied to two highway bridges with and without SMA washer-based rocking piers, considering the representative hazard scenarios that could happen within the investigated regions. The results revealed that the novel SCR pier bridge system slightly increased the bearing displacement but extensively reduced the pier curvature ductility due to the rocking mechanism. The SCR bridge system kept a lower life-cycle loss level and exhibited more resilient performance than the conventional bridge, especially in the region with higher seismic intensities. Indirect loss can be significantly larger than the direct loss, specifically for the earthquakes with a relatively low probability of occurrence. The SCR bridge system outperformed the conventional system in terms of recovery time, where a quick recovery after an earthquake and drastically decreased the social and economic losses.

Global Status in Chronic Pancreatitis Research.

OBJECTIVE: The aim of the study was to investigate the global research levels in chronic pancreatitis (CP) fields. METHODS: The term "chronic pancreatitis" was used to retrieve articles published between 2009 and 2018 from the Web of Science database. The 15 highest-output countries' gross domestic product was retrieved to analyze the correlation between output and economic development. The 5 top-ranking countries were compared in quantity and quality. The frequently used terms of all articles were retrieved to conduct co-occurrence analysis to reveal research highlights for CP. RESULTS: There were 6094 articles included and 6007 articles were from 15 highest-output countries. There was a positive correlation between output and gross domestic product (r = 0.928, P < 0.001). The United States, China, and Japan had increasing trends in total output (P = 0.022, P < 0.001, and P = 0.021, respectively). China and Japan had increasing trends in output per capita (P < 0.001 and P = 0.023). However, in average impact factor, all 5 countries did not show increasing trends (all P > 0.05). For research highlights, mass lesion and autoimmune pancreatitis were the notable aspects. CONCLUSIONS: The global output for CP will continue increasing and research quality will be stable.

Distributed Economic Dispatch in Microgrids Based on Cooperative Reinforcement Learning.

Microgrids incorporated with distributed generation (DG) units and energy storage (ES) devices are expected to play more and more important roles in the future power systems. Yet, achieving efficient distributed economic dispatch in microgrids is a challenging issue due to the randomness and nonlinear characteristics of DG units and loads. This paper proposes a cooperative reinforcement learning algorithm for distributed economic dispatch in microgrids. Utilizing the learning algorithm can avoid the difficulty of stochastic modeling and high computational complexity. In the cooperative reinforcement learning algorithm, the function approximation is leveraged to deal with the large and continuous state spaces. And a diffusion strategy is incorporated to coordinate the actions of DG units and ES devices. Based on the proposed algorithm, each node in microgrids only needs to communicate with its local neighbors, without relying on any centralized controllers. Algorithm convergence is analyzed, and simulations based on real-world meteorological and load data are conducted to validate the performance of the proposed algorithm.

Implementation of a "County-Township-Village" Allied HIV Prevention and Control Intervention in Rural China.

In China, rural areas are a weak link of HIV/AIDS prevention and control. From September 2011, an innovative "county-township-village" allied intervention was implemented in Longzhou County, Guangxi, which assigned the tasks of HIV/AIDS prevention and control to the county Centers for Disease Control and Prevention (CDC), township hospitals, and village clinics, respectively, instead of traditional intervention in which the county CDC undertook the entire work. A 6-year consecutive cross-sectional survey, including 3-year traditional intervention (2009-2011) and 3-year innovative intervention (2012-2014), was conducted to evaluate the effects of the new intervention. Compared to traditional intervention, the innovative intervention achieved positive effects in decreasing risky behaviors. Among female sex workers, condom use rate in the last month increased from 72.06% to 96.82% (p < 0.01). Among drug users, having commercial sex rate in the last year reduced from 17.20% to 5.94% and condom use rate increased from 14.06% to 76.09% (p < 0.01). The risk ratio of HIV infection during innovative intervention was 0.631 (95% confidence interval 0.549-0.726) compared with traditional one. Cost-effectiveness analysis indicates that innovative intervention restores each disability-adjusted life year costing an average of $124.26. Taken together, Longzhou's innovative intervention has achieved good effects on HIV/AIDS prevention and control and provides a good reference for rural China.

Rapid determination of nine barbiturates in human whole blood by liquid chromatography-tandem mass spectrometry.

A rapid, simple and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the qualitative and quantitative analysis of nine barbiturates (barbital, phenobarbital, pentobarbital, amobarbital, secobarbital, thiopental, butalbital, butabarbital, and hexobarbital) in human whole blood. Barbiturates were extracted from 100 µL of human whole blood samples using a simple liquid-liquid extraction (LLE) procedure, and detected by LC-MS/MS. An UPLC C18 (2.1 mm × 100 mm, 1.7 µm) column was used at 40 °C for the separation and acetonitrile/water system was used as the mobile phase with gradient elution. This method showed excellent accuracy (86-111%) and precision (relative standard deviation <15%). The limits of detection (LODs) were 0.2 ng/mL for barbital and secobarbital and 0.5 ng/mL for the other barbiturates. The linearity ranged from 2 ng/mL to 2000 ng/mL, with r2 > 0.99 over the range. This method achieved the separation and detection of pentobarbital and amobarbital at the same time in a convenient way. Moreover, it was both simple and sensitive for the determination of nine most commonly used barbiturate drugs, which was meaningful in the field of clinical and forensic toxicology. Copyright © 2016 John Wiley & Sons, Ltd.

Assessment of Different Intervention Models of Male Circumcision and Their Preliminary Effectiveness in Reducing HIV Incidence Among Drug Users in Western China.

World Health Organization (WHO) and Joint United Nations Program on AIDS (UNAIDS) recommend male circumcision (MC) as an additional HIV prevention measure. This study aimed to assess three models of promoting MC and their effects on preventing HIV infection among drug users in western China. We carried out a cohort study in three provinces of western China. HIV seronegative male drug users were recruited from methadone maintenance therapy clinics and cluster randomized into three intervention models. At baseline, 6, and 9 months of follow-up, changes in MC knowledge, the acceptability of MC, MC surgery uptake, and the costs of model implementation were analyzed. Of 1,304 male drug users who were screened, 1,218 were enrolled in the study. The participants' knowledge about MC was significantly increased after interventions by all three models. The one-stage model led to the highest increase in MC acceptability and the greatest increase in MC uptake. Multivariable Cox regression analysis showed that the one-stage model was also the most effective method to promote MC uptake, compared with the two-stage model [rate ratio (RR) = 0.602; 95% confidence interval (CI), 0.420-0.862] and three-stage model (RR = 0.555; 95% CI, 0.382-0.807). The HIV incidence rate in the MC group was lower than that in the non-MC group (RR = 0.234; 95% CI, 0.056-0.974). Moreover, the one-stage model required the lowest cost per circumcision. The one-stage model is the most effective and the most cost-effective intervention to increase MC uptake among male drug users in western China and could decrease the HIV incidence rate, based on a short follow-up investigation.

Assessment of the Role Played by N-propanol Found in Postmortem Blood in the Discrimination Between Antemortem Consumption and Postmortem Formation of Ethanol Using Rats.

This study disproves the reliability of n-propanol as a biomarker to establish whether the ethanol found in postmortem blood is derived from antemortem ingestion or postmortem putrefactive processes. Two groups of rats were given ethanol or normal saline solution, respectively, and sacrificed 1.5 h later. After putrefaction, blood and, in a few cases, urine samples from the rats were analyzed for ethanol and n-propanol by head-space gas chromatography equipped with flame ionization detection. Although the concentration ratios of ethanol/n-propanol in the postmortem blood collected from the bodies without prior alcohol consumption were expected to be <20 (as per limited case reports and previous in vitro studies), in samples from several rats that were on saline solution, this ratio was found to exceed 20. In conclusion, the concentration ratio of ethanol/n-propanol in postmortem blood does not allow for the discernment between antemortem ingestion and the postmortem synthesis of ethanol.

Comparison of three intervention models for promoting circumcision among migrant workers in western China to reduce local sexual transmission of HIV.

OBJECTIVE: Three models for promoting male circumcision (MC) as a preventative intervention against HIV infection were compared among migrant worker populations in western China. METHODS: A cohort study was performed after an initial cross-sectional survey among migrant workers in three provincial level districts with high HIV prevalence in western China. A total of 1,670 HIV seronegative male migrants were cluster-randomized into three intervention models, in which the dissemination of promotional materials and expert- and volunteer-led discussions are conducted in one, two, and three stage interventions. Changes in knowledge of MC, acceptability of MC, MC surgery uptake, and the costs of implementation were analyzed at 6-month and 9-month follow-up visits. RESULTS: All three models significantly increased the participants' knowledge about MC. The three-stage model significantly increased the acceptability of MC among participants and led to greatest increase in MC uptake. At the end of follow-up, 9.2% (153/1,670) of participants underwent MC surgery; uptake among the one-, two-, and three-stage models were 4.9%, 9.3%, and 14.6%, respectively. Multivariable Cox regression analysis showed that three-stage model was the most effective method to scale up MC, with RR = 2.0 (95% CI, 1.3-3.1, P=0.002) compared to the on-site session model. The two-stage intervention model showed no significant difference with either the on-site session model (RR=1.5, 95% CI, 0.92-2.4, P=0.12) or three-stage model (P=0.10). CONCLUSIONS: A three-stage intervention with gradual introduction of knowledge led to the significantly increase in MC uptake among migrant workers in western China, and was also the most cost-effective method among the three models.

ERCP service in China: results from a national survey.

BACKGROUND: ERCP had been performed throughout China for decades. OBJECTIVE: To determine the status of ERCP service in China. DESIGN: A national survey. SETTING: All of the hospitals performing ERCP in mainland China in 2006. PATIENTS: All of the patients undergoing ERCP in mainland China in 2006. MAIN OUTCOME MEASUREMENTS: The questionnaire included the (1) type of hospitals involved; (2) ownership of the endoscopy unit; (3) ERCP infrastructure; (4) volume, indication, setting, and anesthesia methods; and (5) training and research. The correlation between economic development and ERCP status in different regions was investigated, and the ERCP rates in China and developed countries were compared. RESULTS: Completed questionnaires were returned by 449 (95.5%) of the 470 hospitals providing ERCP service. Among the 449 hospitals, 186 (41.4%) did not have separate ERCP suites, 379 (84.4%) shared fluoroscopy with their radiology departments, and the average number of duodenoscopes was 1.58. A total of 63,787 ERCP procedures were performed in mainland China in 2006, with an estimated annual ERCP rate of 4.87 per 100,000 inhabitants, much lower than that of developed countries. Ninety-six percent of patients were admitted to undergo ERCP, and 94.4% of hospitals used pharyngeal local anesthesia and conscious sedation, whereas 5.6% used general anesthesia. There was a significant correlation between the ERCP rate and gross domestic product per capita (r = 0.871, P < .001). LIMITATIONS: The survey was retrospective and descriptive. CONCLUSIONS: There is an enormous gap in ERCP service between China and developed countries. The imbalance of ERCP status between different regions is significant, which correlates with economic development. Great effort is needed to develop the technique nationwide.

Factors influencing Chinese male's willingness to undergo circumcision: a cross-sectional study in western China.

BACKGROUND: Male circumcision (MC) has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore the acceptability of MC among the Chinese and to identify factors associated with circumcision preference. METHODS: A cross-sectional survey was conducted between September 2009 and December 2010. We interviewed 2,219 male community participants, from three high HIV prevalence provinces in western China. A structured questionnaire was used to collect data on MC knowledge, willingness to accept MC, reasons to accept or refuse MC, and sexual behaviors and health. For those who refused MC, a health education intervention providing information on the benefits of circumcision was conducted. We used multiple logistic regression models to identify factors associated with the acceptability of MC. RESULTS: Of the respondents (n = 2,219), 44.6% (989/2,219) reported they would accept MC for the following reasons: promotion of female partners' hygiene (60.3%), redundant foreskin (59.4%), prevention of penile cancer (50.2%), enhanced sexual pleasure (41.4%), and protection against HIV and STDs (34.2%). The multivariable logistic regression showed that five factors were associated with MC willingness: long foreskin (OR = 15.98), residing in Xinjiang province (OR = 3.69), being younger than 25 (OR = 1.60), knowing hazards of redundant foreskin (OR = 1.78), and having a friend who underwent circumcision (OR = 1.36). CONCLUSION: The acceptability of male circumcision was high among the general population in China. Our study elucidates the factors associated with circumcision preference and suggests that more health education campaigns about positive health effects are necessary to increase the MC rate in China.

[A nested multiplex PCR assay for rapid subtyping the prevailing HIV-1 strains in Guangxi].

OBJECTIVE: To establish a rapid nested multiplex PCR assay for subtyping HIV-1 CRF01_AE, CRF07_BC, CRF08_BC, B, and C strains prevailing in Guangxi. METHOD: Subtype-specific primers were designed for these subtypes based on their gag sequences. The subtypes of HIV-1 samples from Guangxi were determined by nested multiplex PCR and DNA sequencing and phylogenetic analysis, respectively, and then the sensitivity and the specificity of nested multiplex PCR were calculated. RESULTS: Nested multiplex PCR could correctly classify the 5 known-subtype samples, and were not reactive to all HIV-negative samples. Of the 72 HIV-positive samples, 66 were correctly identified as CRF01_AE, CRF07_BC, CRF08_BC, and B by this assay, giving a sensitivity of 91.7% (66/72), and a specificity of 100%. CONCLUSION: This assay is a simple, fast, and cost-effective subtyping method for HIV-1 CRF01-AE, CRF07_BC, CRF08_BC, and B strains prevailing in Guangxi.