Assessment of respiratory support decision and the outcome of invasive mechanical ventilation in severe COVID-19 with ARDS.

Background: The coronavirus disease 2019 (COVID-19) is an ongoing pandemic. Invasive mechanical ventilation (IMV) is essential for the management of COVID-19 with acute respiratory distress syndrome (ARDS). We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV. Methods: In this retrospective, single-center, case series study, patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University, China, from January 8th, 2020, to March 24th, 2020, with the final follow-up date of April 20th, 2020, were included. Demographic, clinical, laboratory, imaging, and management information were collected and analyzed. Compliance with the respiratory support decision system was documented, and its relationship with 28-day mortality was evaluated. Results: The study included 46 COVID-19-associated ARDS patients who required IMV. The median age of the 46 patients was 68.5 years, and 31 were men. The partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at intensive care unit (ICU) admission was 104 mmHg. The median total length of IMV was 12.0 (interquartile range [IQR]: 6.0-27.3) days, and the median respiratory support decision score was 11.0 (IQR: 7.8-16.0). To 28 days after ICU admission, 18 (39.1%) patients died. Survivors had a significantly higher respiratory support decision score than non-survivors (15.0 [10.3-17.0] vs. 8.5 (6.0-10.3), P = 0.001). Using receiver operating characteristic (ROC) curve to assess the discrimination of respiratory support decision score to 28-day mortality, the area under the curve (AUC) was 0.796 (95% confidence interval [CI]: 0.657-0.934, P = 0.001) and the cut-off was 11.5 (sensitivity = 0.679, specificity = 0.889). Patients with a higher score (>11.5) were more likely to survive at 28 days after ICU admission (log-rank test, P < 0.001). Conclusions: For severe COVID-19-associated ARDS with IMV, following the respiratory support decision and assessing completion would improve the progress of ventilation. With a decision score of >11.5, the mortality at 28 days after ICU admission showed an obvious decrease.

Multi-Objective Optimal Allocation of River Basin Water Resources under Full Probability Scenarios Considering Wet-Dry Encounters: A Case Study of Yellow River Basin.

Wet-dry encounters between basins and regions have an important impact on the allocation of water resources. This study proposes a multi-objective allocation model for basin water resources under full probability scenarios considering wet-dry encounters (FPS-MOWAM) to solve the problem of basin water resource allocation. In the FPS-MOWAM model, the sub-regions were merged by precipitation correlation analysis. Next, the joint probability distribution of basin runoff and region precipitation was constructed using copula functions. The possible wet-dry encounter scenarios and their probabilities were then acquired. Finally, the multi-objective allocation model of water resources was constructed using the full probability scenario for wet-dry encounters in each region. The FPS-MOWAM is calculated by the NSGA-II algorithm and the optimal water resource allocation scheme was selected using the fuzzy comprehensive evaluation method. Using the Yellow River Basin as an example, the following conclusions were obtained: (1) the Yellow River Basin can be divided into four sub-regions based on precipitation correlations: Qh-Sc (Qinghai, Sichuan), Sg-Nx-Nmg (Gansu, Ningxia, Inner Mongolia), Sxq-Sxj (Shaanxi, Shanxi), and Hn-Sd (Henan, Shandong), (2) the inconsistencies in synchronous-asynchronous encounter probabilities in the Yellow River Basin were significant (the asynchronous probabilities were 0.763), whereas the asynchronous probabilities among the four regions were 0.632, 0.932, and 0.763 under the high, medium, and low flow conditions in the Yellow River Basin respectively, and (3) the allocation of water resources tends to increase with time, allocating the most during dry years. In 2035, the expected economic benefits are between 11,982.7 billion CNY and 12,499.6 billion CNY, while the expected water shortage rate is between 2.02% and 3.43%. In 2050, the expected economic benefits are between 21,291.4 billion CNY and 21,781.3 billion CNY, while the expected water shortage rate is between 1.28% and 6.05%.

The inward FDI - Energy intensity nexus in OECD countries: A sectoral R&D threshold analysis.

Over recent years, concerns about the need to reduce energy intensity have intensified due to the increasing volume of greenhouse gas emissions that has amplified problems related to global climate change and environmental pollution. At the same time, foreign direct investment (FDI) has been found to have a prominent effect on energy intensity. This study empirically examines the relationship between sectoral FDI inflows and energy intensity by investigating the possibility of a threshold effect of research and development (R&D) technological absorptive capacity. Our sample covers 34 OECD countries over 1987-2013, with FDI and R&D data disaggregated at three sectoral levels (primary, secondary and tertiary sectors), an analysis that is absent in existing literature. We uncover a significant R&D input threshold in the relationship between FDI inflows to non-primary sectors and energy intensity. FDI inflows to non-primary sectors increase the level of energy intensity when the level of sectoral R&D is below the threshold, but such effect decreases when the sectoral R&D level is above the threshold point. Important implications flow from our findings with respect to the type of FDI and the level of indigenous R&D to be encouraged (or discouraged) by policymakers to effectively reduce energy intensity.

Longitudinal and quantitative assessment platform for concurrent analysis of anti-tumor efficacy and cardiotoxicity of nano-formulated medication in vivo.

Increasing nanomedicinal approaches have been developed to effectively inhibit tumor growth; however, critical questions such as whether a nanomedicinal approach can mitigate latent side effects are barely addressed. To this end, we established a zebrafish xenograft tumor model, combining pseudodynamic three-dimensional cardiac imaging and image analysis to enable simultaneous and quantitative determination of the change of tumor volume and cardiac function of zebrafish upon specific nanoformulation treatment. Doxorubicin (DOX), a well-known chemotherapeutic agent with cardiotoxicity, and a recently developed DOX-loaded nanocomposite were employed as two model drugs to demonstrate the effectiveness to utilize the proposed evaluation platform for rapid validation. The nanoformulation significantly mitigated DOX-associated cardiotoxicity, while retaining the efficacy of DOX in inhibiting tumor growth compared to administration of carrier-free DOX at the same dose. We anticipate that this platform possesses the potential as an efficient assessment system for nanoformulated cancer therapeutics with suspected toxicity and side effects to vital organs such as the heart.

Study on Spatial and Temporal Distribution Characteristics of Coordinated Development Degree among Regional Water Resources, Social Economy, and Ecological Environment Systems.

Water resources utilization, social economy development, and ecological environment protection are key factors in regional sustainable development. Scientific evaluation of regional coordinated development status and diagnosis of regional uncoordinated development constraints will improve the management level of decision-makers. At present, most developing countries have the problem of unbalanced regional development caused by the one-sided pursuit of a certain system. Taking 14 prefecture-level cities in Hunan Province as cases, this paper analyzed the spatial and temporal distribution characteristics of the carrying capacity level of the water resources system, the development level of the social economy system and the protection level of the ecological environment system in each evaluation unit based on entropy weight method and order parameter analysis. Based on the theory of coordinated development, a calculation model of a coordinated development degree was constructed, and the corresponding evaluation criteria were formulated. The spatial and temporal distribution characteristics of a coordinated development degree in each research unit were analyzed and evaluated. The results showed that the average coordinated development degree of Hunan Province from 2004 to 2016 evolved from "Light disorder recession" to "Nearly disorder recession", then to "Reluctance coordinated development". Restricted by different systems, the coordinated development degree in each research unit presented spatial and temporal differences. According to different development stages and the characteristics of different regions, corresponding development strategies can be formulated to provide the guidance for coordinated the development of regions.

Interface engineered in situ anchoring of Co9S8 nanoparticles into a multiple doped carbon matrix: highly efficient zinc-air batteries.

Interface modification is an effective and promising route for developing functional electrocatalysts. However, researchers have not created a reliable method to optimize the interfaces of components existing in electrocatalysts, although it is very crucial for the technological development of high-performance electrodes. Here, we develop a strategy aiming at the in situ anchorage of Co9S8 nanoparticles into a nitrogen (N), sulfur (S) co-implanted three-dimensional carbon matrix (Co9S8@NSCM) as a highly active and durable nonprecious metal electrocatalyst for the oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) in alkaline medium. This strategy offers an opportunity to optimize the interface interaction and affords high activity for the ORR and OER in terms of low overpotentials and high current intensities. In addition, by confining Co9S8 nanoparticles into a N,S-doped carbon matrix, corrosion and aggregation can be effectively prevented, and thus the catalyst exhibits nearly unfading ORR catalytic performance after 100 000 s testing, a low discharge-charge voltage gap (0.81 V) and a long cycle life (up to 840 cycles) in Zn-air batteries. The present work highlights potentially powerful interface engineering for designing multi-component heterostructures with advanced performances in oxygen electrochemistry and related energy conversion.

Economic cost and burden of dengue during epidemics and non-epidemic years in Taiwan.

BACKGROUND: Determining the disease and economic burden of dengue is critical for the allocation of public health resources. Several studies have used disability-adjusted life-years (DALYs) to estimate the disease burden of dengue in different regions. However, there are no published studies discussing the estimates of dengue-related economic and disease burden specifically in Taiwan. OBJECTIVES: We assessed the economic cost and disease burden of dengue infections in Taiwan for the period 1998-2014, and compared these during epidemic and non-epidemic years. METHODS: We estimated the annual DALYs per million population using the disability weights for dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and death cases. Economic costs were estimated and divided into direct (medical costs) and indirect costs (lost work days and caregiver fees). RESULTS: For the period 1998-2014, a mean of 115.3 (range: 6.3-934.3) DALYs per million population annually were lost to dengue. In epidemic years, direct costs associated with dengue resulted mostly from hospitalization (86.09%), emergency (7.77%), outpatient (6.10%), and drug costs (0.03%). For indirect costs, lost productivity due to death (70.76%) was the dominant contributor. Overall, the costs were 12.3 times higher in epidemic years than in non-epidemic years (Wilcoxon rank sum test, p<0.05). CONCLUSIONS: This study is the first to evaluate the economic costs and disease burden of dengue infections for this period in Taiwan, and reveals significant differences in economic impact between epidemic and non-epidemic years.

Features of the Asynchronous Correlation between the China Coal Price Index and Coal Mining Accidental Deaths.

The features of the asynchronous correlation between accident indices and the factors that influence accidents can provide an effective reference for warnings of coal mining accidents. However, what are the features of this correlation? To answer this question, data from the China coal price index and the number of deaths from coal mining accidents were selected as the sample data. The fluctuation modes of the asynchronous correlation between the two data sets were defined according to the asynchronous correlation coefficients, symbolization, and sliding windows. We then built several directed and weighted network models, within which the fluctuation modes and the transformations between modes were represented by nodes and edges. Then, the features of the asynchronous correlation between these two variables could be studied from a perspective of network topology. We found that the correlation between the price index and the accidental deaths was asynchronous and fluctuating. Certain aspects, such as the key fluctuation modes, the subgroups characteristics, the transmission medium, the periodicity and transmission path length in the network, were analyzed by using complex network theory, analytical methods and spectral analysis method. These results provide a scientific reference for generating warnings for coal mining accidents based on economic indices.

Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China.

BACKGROUND: In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. METHODS: This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. RESULTS: We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. CONCLUSIONS: We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.

Challenges faced in the clinical application of artificial anal sphincters.

Fecal incontinence is an unresolved problem, which has a serious effect on patients, both physically and psychologically. For patients with severe symptoms, treatment with an artificial anal sphincter could be a potential option to restore continence. Currently, the Acticon Neosphincter is the only device certified by the US Food and Drug Administration. In this paper, the clinical safety and efficacy of the Acticon Neosphincter are evaluated and discussed. Furthermore, some other key studies on artificial anal sphincters are presented and summarized. In particular, this paper highlights that the crucial problem in this technology is to maintain long-term biomechanical compatibility between implants and surrounding tissues. Compatibility is affected by changes in both the morphology and mechanical properties of the tissues surrounding the implants. A new approach for enhancing the long-term biomechanical compatibility of implantable artificial sphincters is proposed based on the use of smart materials.

Myocardial Iron Loading Assessment by Automatic Left Ventricle Segmentation with Morphological Operations and Geodesic Active Contour on T2* images.

Myocardial iron loading thalassemia patients could be identified using T2* magnetic resonance images (MRI). To quantitatively assess cardiac iron loading, we proposed an effective algorithm to segment aligned free induction decay sequential myocardium images based on morphological operations and geodesic active contour (GAC). Nine patients with thalassemia major were recruited (10 male and 16 female) to undergo a thoracic MRI scan in the short axis view. Free induction decay images were registered for T2* mapping. The GAC were utilized to segment aligned MR images with a robust initialization. Segmented myocardium regions were divided into sectors for a region-based quantification of cardiac iron loading. Our proposed automatic segmentation approach achieve a true positive rate at 84.6% and false positive rate at 53.8%. The area difference between manual and automatic segmentation was 25.5% after 1000 iterations. Results from T2* analysis indicated that regions with intensity lower than 20 ms were suffered from heavy iron loading in thalassemia major patients. The proposed method benefited from abundant edge information of the free induction decay sequential MRI. Experiment results demonstrated that the proposed method is feasible in myocardium segmentation and was clinically applicable to measure myocardium iron loading.

[Industry of traditional Chinese patent medicine science and technology development and review].

"Fifteen" since, our country Chinese traditional medicine industry science and technology has made remarkable achievements. In this paper, the development of science and technology policy, Chinese medicine industry, platform construction and other aspects were analyzed, showing 10 years of Chinese traditional medicine industry development of science and technology innovation achievement and development, and on the current development of traditional Chinese medicine industry facing the main tasks and guarantee measures are analyzed.

[The cost-efficiency and safety of bedside forceps dilatational tracheostomy in the intensive care unit].

OBJECTIVE: To study the cost-efficiency and safety of bedside forceps dilatational tracheostomy (FDT) in the intensive care unit (ICU). METHODS: FDT was performed in 83 patients who needed prolonged artificial airway. The time interval between the decision and actual time of operation, time for completing the procedure, operation cost, perioperative and postoperative complications were recorded and analyzed. The operation cost was compared between 83 FDT cases and other 102 surgical tracheostomy (ST) cases which were performed in the operation room during the same period. RESULTS: FDT was successfully performed for 83 patients. The average time interval between the decision and undertaking FDT was (11.5±8.5) hours, the average operating time was (14.5±5.5) minutes, the operation cost of FDT [(1 560±340) yuan] was lower than that of ST [(2 600±450) yuan, P <0.05]. The incidence of the perioperative and postoperative complication of the 83 patients was 15.66% and 2.41% respectively. Nine patients died within 28 days after FDT. CONCLUSION: FDT performed by intensivists for critically ill patients in ICU is safe and cost-effective.

Ion selectivity of alpha-hemolysin with beta-cyclodextrin adapter. II. Multi-ion effects studied with grand canonical Monte Carlo/Brownian dynamics simulations.

In a previous study of ion selectivity of alpha-hemolysin (alphaHL) in complex with beta-cyclodextrin (betaCD) adapter, we calculated the potential of mean force (PMF) and characterized the self-diffusion coefficients of isolated K(+) and Cl(-) ions using molecular dynamics simulations (Y. Luo et al., "Ion Selectivity of alpha-Hemolysin with beta-Cyclodextrin Adapter: I. Single Ion Potential of Mean Force and Diffusion Coefficient"). In the present effort, these results pertaining to single isolated ions in the wide aqueous pore are extended to take into account multi-ion effects. The grand canonical Monte Carlo/Brownian dynamics (GCMC/BD) algorithm is used to simulate ion currents through the wild-type alphaHL ion channel, as well as two engineered alphaHL mutants, with and without the cyclic oligosaccaride betaCD lodged in the lumen of the pore. The GCMC/BD current-voltage curves agree well with experimental results and show that betaCD increases the anion selectivity of alphaHL. Comparisons between multi-ion PMFs from GCMC/BD simulations and single-ion PMFs demonstrate that multi-ion effects and pore shape are crucial for explaining this behavior. It is concluded that the narrow betaCD adapter increases the anion selectivity of alphaHL because it reduces the pore radius locally, which decreases the ionic screening and the dielectric shielding of the strong electrostatic field induced by a nearby ring of positively charged alphaHL side chains.

[Application of near-infrared diffuse reflectance spectroscopy to the detection and identification of transgenic corn].

With the rapid development of the GMO, more and more GMO food has been pouring into the market. Much attention has been paid to GMO labeling under the controversy of GMO safety. Transgenic corns and their parents were scanned by continuous wave of near infrared diffuse reflectance spectroscopy range of 12000-4000 cm(-1); the resolution was 4 cm(-1); scanning was carried out for 64 times; BP algorithm was applied for data processing. The GMO food was easily resolved. Near-infrared diffuse reflectance spectroscopy is unpolluted and inexpensive compared with PCR and ELISA, so it is a very promising detection method for GMO food.