Assessment of different classification systems for predicting the risk of superior laryngeal nerve injury during thyroid surgery: a prospective cohort study.

Background: A multitude of anatomical variations have been noted in the external branch of the superior laryngeal nerve (EBSLN). In this study, intraoperative neuromonitoring (IONM) was used to assess the potential value of the different classical EBSLN classifications for predicting the risk of EBSLN injury. Methods: In total, 136 patients with thyroid nodules were included in this prospective cohort study, covering 242 nerves at risk (NAR). The EBSLN was identified by observing the cricothyroid muscle twitch and/or typical electromyography (EMG) biphasic waveform. The EBSLNs were classified by Cernea classification, Kierner classification, and Friedman classification, respectively. The EMG parameters and outcomes of vocal acoustic assessment were recorded. Results: The distribution of Cernea, Kiernea, and Friedman subtypes were, respectively, Cernea 1 (40.9%), Cernea 2A (45.5%), Cernea 2B (10.7%), Kierner 1 (40.9%), Kierner 2 (45.5%), Kierner 3 (10.7%), Kierner 4 (2.9%) and Friedman 1 (15.7%), Friedman 2 (33.9%), Friedman 3 (50.4%). The amplitudes of EBSLN decreased significantly after superior thyroid pole operation, respectively, in Cernea 2A (193.7 vs. 226.6µV, P=0.019), Cernea 2B (185.8 vs. 221.3µV, P=0.039), Kierner 2 (193.7vs. 226.6µV, P=0.019), Kierner 3 (185.8 vs. 221.3µV, P=0.039), Kierner 4 (126.8vs. 226.0µV, P=0.015) and Friedman type 2 (184.8 vs. 221.6µV, P=0.030). There were significant differences in Fmax and Frange for Cernea 2A (P=0.001, P=0.001), 2B (P=0.001, P=0.038), Kierner 2 (P=0.001), Kierner 3 (P=0.001, P=0.038), and Friedman 2 (P=0.004, P=0.014). In the predictive efficacy of EBSLN injury, the Friedman classification showed higher accuracy (69.8% vs. 44.3% vs. 45.0%), sensitivity (19.5% vs. 11.0% vs. 14.0%), and specificity (95.6% vs. 89.9% vs. 89.9%) than the Cernea and Kierner classifications. However, the false negative rate of Friedman classification was significantly higher than other subtypes (19.5% vs. 11.0% vs. 14.0%). Conclusion: Cernea 2A and 2B; Kierner 2, 3, and 4; and Friedman 2 were defined as the high-risk subtypes of EBSLN. The risk prediction ability of the Friedman classification was found to be superior compared to other classifications.

Convergent relationships between flower economics and hydraulic traits across aquatic and terrestrial herbaceous plants.

Maintaining open flowers is critical for successful pollination and depends on long-term water and carbon balance. Yet the relationship between how flower hydraulic traits are coordinated in different habitats is poorly understood. Here, we hypothesize that the coordination and trade-offs between floral hydraulics and economics traits are independent of environmental conditions. To test this hypothesis, we investigated a total of 27 flower economics and hydraulic traits in six aquatic and six terrestrial herbaceous species grown in a tropical botanical garden. We found that although there were a few significant differences, most flower hydraulics and economics traits did not differ significantly between aquatic and terrestrial herbaceous plants. Both flower mass per area and floral longevity were significantly positively correlated with the time required for drying full-hydrated flowers to 70% relative water content. Flower dry matter content was strongly and positively related to drought tolerance of the flowers as indicated by flower water potential at the turgor loss point. In addition, there was a trade-off between hydraulic efficiency and the construction cost of a flower across species. Our results show that flowers of aquatic and terrestrial plants follow the same economics spectrum pattern. These results suggest a convergent flower economics design across terrestrial and aquatic plants, providing new insights into the mechanisms by which floral organs adapt to aquatic and terrestrial habitats.

Spectrally efficient multi-service fiber-wireless access in low-cost direct-detection THz system at 300†GHz.

This Letter demonstrates a novel, to the best of knowledge, overlapping single-sideband (OSSB) transmission scheme for spectrally efficient multi-service fiber-wireless (FiWi) access in a low-cost direct-detection (DD) THz system. Utilizing the proposed OSSB scheme, user data from different services can share the same spectrum resource yet can be successfully demodulated via one cost-effective DD THz receiver in conjunction with the Kramers-Kronig (KK) based SSB field reconstruction and look-up table (LUT) enabled signal separation algorithms. A proof-of-principle experiment is conducted. Based on an IQ modulator and a single THz zero-bias diode (ZBD), two independent 10-GBd quadrature phase shift keying (QPSK) signals with an overlapped spectrum are successfully demodulated after 20-km fiber and up to 3-m wireless transmission at the 300-GHz band. To the best of our knowledge, this is the first demonstration of multi-service FiWi access with an OSSB format in a 300-GHz DD THz system.

[Application of behavioral audiometry in subjective hearing assessment of children].

Objective:To explore the value and influencing factors of behavioral audiometry in subjective hearing assessment of children. Methods:The results of behavioral audiometry（visual reinforcement audiometry or play audiometry） of 1944 children（3888 ears） in the outpatient department from January 2012 to December 2015 were retrospectively analyzed. The subjective performance（" good ", "moderate", "poor", " unfinished "） was compared according to age and hearing level. SPSS 27.0 software was used for statistical analysis. Results:The subjective performance of children was "good" in 2791 ears（71.8%）, "moderate" in 411 ears（10.6%）, "poor" in 309 ears（7.9%） and " unfinished " in 377 ears（9.7%）. In visual reinforcement audiometry, the proportion of children who subjectively performed as "good" gradually increased with age, reaching the peak at 2 years old, and decreased with age after 2 years old. In play audiometry, the proportion of children who subjectively performed as "good" gradually increased with age, peaking at 4-5 years of age. The children who did not finish the test were mainly 1-3 years old. The reasons included uncooperation for 148 ears, crying for 95 ears, refusing to wear headphones for 57 ears, fatigue for 42 ears, lack of interest for 20 ears, not understanding for 14 ears, and distraction for 1 ear. Conclusion:Behavioral audiometry was helpful to assess children's subjective hearing, and children's subjective performance was good. In clinical work, more novel and attractive test materials and methods should be adopted or developed according to the physical and mental characteristics of young children.

Leaf trait association in relation to herbivore defense, drought resistance, and economics in a tropical invasive plant.

PREMISE: Exploring how functional traits vary and covary is important to understand plant responses to environmental change. However, we have limited understanding of the ways multiple functional traits vary and covary within invasive species. METHODS: We measured 12 leaf traits of an invasive plant Chromolaena odorata, associated with plant or leaf economics, herbivore defense, and drought resistance on 10 introduced populations from Asia and 12 native populations from South and Central America, selected across a broad range of climatic conditions, and grown in a common garden. RESULTS: Species' range and climatic conditions influenced leaf traits, but trait variation across climate space differed between the introduced and native ranges. Traits that confer defense against herbivores and drought resistance were associated with economic strategy, but the patterns differed by range. Plants from introduced populations that were at the fast-return end of the spectrum (high photosynthetic capacity) had high physical defense traits (high trichome density), whereas plants from native populations that were at the fast-return end of the spectrum had high drought escape traits (early leaf senescence and high percentage of withered shoots). CONCLUSIONS: Our results indicate that invasive plants can rapidly adapt to novel environmental conditions. Chromolaena odorata showed multiple different functional trait covariation patterns and clines in the native and introduced ranges. Our results emphasize that interaction between multiple traits or functions should be considered when investigating the adaptive evolution of invasive plants.

Do Residents and Healthcare Providers Differ in Preference for Family Doctor Contract Service? Evidence From a Discrete Choice Experiment.

OBJECTIVE: Few are known on how and to what extent residents and healthcare providers have different preferences for family doctor contract service (FDCS). This study aimed to elicit and compare the residents' and healthcare providers' preferences for FDCS through a discrete choice experiment (DCE). METHODS: Residents and healthcare providers recruited for the DCE were asked to choose repeatedly between two hypothetical service plans, which differed in six attributes: cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team. We use mixed logit regression models to determine preferences for potential attributes. RESULTS: A total of 2,159 residents and 729 healthcare providers completed valid DCE questionnaires. The mixed logit model results suggested that cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team all had a significant impact on residents' and healthcare providers' preference. The level of healthcare team was the most important characteristic of FDCS to both residents and healthcare providers, followed by types of service. They have different preferences on the cost and way of service delivery. CONCLUSIONS: This study provides new evidence on how and to what extent residents and healthcare providers have different preferences for FDCS by determining their perception of various service attributes. These findings suggested that the optimal design and improvement of FDCS plans should consider not only residents but also healthcare providers' preferences to maximize contract service uptake.

A Low-Cost and Air-Stable Rechargeable Aluminum-Ion Battery.

Rechargeable aluminum-ion batteries (AIBs) are promising for large-scale energy storage due to the abundant reserves, low cost, and high capacity of the Al anode. However, the development of AIBs is currently hindered by the usage of AlCl3 /1-ethyl-3-methylimidazolium chloride electrolyte, which is expensive, highly corrosive, and extremely air-sensitive. Herein, a new hydrated eutectic electrolyte (HEE) composed of hydrated aluminum perchlorate and succinonitrile for low-cost, noncorrosive, and air-stable AIBs is reported. Crystal water in the hydrated aluminum perchlorate plays a vital role in forming the HEE, in which one H2 O and five succinonitrile molecules coordinate with one Al3+ ion. The optimized ratio of Al(ClO4 )3 ·9H2 O to succinonitrile is 1:12. When combining with the self-doped polyaniline cathode, the associated AIB delivers a high discharge capacity of 185 mAh g-1 over 300 cycles; and the charge/discharge mechanism in the HEE is studied experimentally and theoretically. The HEE is nonflammable, air-stable, and noncorrosive, thus enabling good air tolerance and facile fabrication of AIBs.

Challenges and Strategies of Low-Cost Aluminum Anodes for High-Performance Al-Based Batteries.

The ever-growing market of electric vehicles and the upcoming grid-scale storage systems have stimulated the fast growth of renewable energy storage technologies. Aluminum-based batteries are considered one of the most promising alternatives to complement or possibly replace the current lithium-ion batteries owing to their high specific capacity, good safety, low cost, light weight, and abundant reserves of Al. However, the anode problems in primary and secondary Al batteries, such as, self-corrosion, passive film, and volume expansion, severely limit the batteries' practical performance, thus hindering their commercialization. Herein, an overview of the currently emerged Al-based batteries is provided, that primarily focus on the recent research progress for Al anodes in both primary and rechargeable systems. The anode reaction mechanisms and problems in various Al-based batteries are discussed, and various strategies to overcome the challenges of Al anodes, including surface oxidation, self-corrosion, volume expansion, and dendrite growth, are systematically summarized. Finally, future research perspectives toward advanced Al batteries with higher performance and better safety are presented.

Novel risk factors for craniofacial microsomia and assessment of their utility in clinic diagnosis.

Craniofacial microsomia (CFM, OMIM%164 210) is one of the most common congenital facial abnormalities worldwide, but it's genetic risk factors and environmental threats are poorly investigated, as well as their interaction, making the diagnosis and prenatal screening of CFM impossible. We perform a comprehensive association study on the largest CFM cohort of 6074 samples. We identify 15 significant (P < 5 × 10-8) associated genomic loci (including eight previously reported) and decipher 107 candidates based on multi-omics data. Gene Ontology term enrichment found that these candidates are mainly enriched in neural crest cell (NCC) development and hypoxic environment. Single-cell RNA-seq data of mouse embryo demonstrate that nine of them show dramatic expression change during early cranial NCC development whose dysplasia is involved in pathogeny of CFM. Furthermore, we construct a well-performed CFM risk-predicting model based on polygenic risk score (PRS) method and estimate seven environmental risk factors that interacting with PRS. Single-nucleotide polymorphism-based PRS is significantly associated with CFM [P = 7.22 × 10-58, odds ratio = 3.15, 95% confidence interval (CI) 2.74-3.63], and the top fifth percentile has a 6.8-fold CFM risk comparing with the 10th percentile. Father's smoking increases CFM risk as evidenced by interaction parameter of -0.324 (95% CI -0.578 to -0.070, P = 0.011) with PRS. In conclusion, the newly identified risk loci will significantly improve our understandings of genetics contribution to CFM. The risk prediction model is promising for CFM prediction, and father's smoking is a key environmental risk factor for CFM through interacting with genetic factors.

Rural-urban differences in home-based care willingness among older adults: A cross-sectional study in Shandong, China.

OBJECTIVE: To examine the rural-urban disparities of home-based care willingness among older adults and identify the influencing factors. DESIGN: A cross-sectional study. SETTING: The data used in this cross-sectional study were conducted in Shandong province. STUDY PARTICIPANTS: 7070 older adults (60 years and older) with complete data were included in this analysis from the 2017 Survey of the Shandong Elderly Family Health Service. INTERVENTION: N/A. MAIN OUTCOME MEASURE: The data were analyzed using logistic regression models to examine whether socio-demographic characteristic, physical health, loneliness score and other factors were associated with home-based care willingness in rural and urban older adults. After exploring the factors, we compared the difference. RESULTS: Of 7070 participants, 66.9% were rural older adults and 33.1% were urban. The urban older adults less likely chose home-based care than the rural (OR = 0.667; P < 0.05). Binary logistic regression analysis showed that age (P < 0.05), income (P < 0.05), current employment (P < 0.05) and loneliness (P < 0.05) were significantly associated with the home-based care willingness both in rural and urban residence. Besides, the number of family members (P = 0.010), education years (P = 0.026) and financial support from children (P = 0.017) were associated factors of rural respondents' home-based care willingness. The bad self-reported-health-status-urban-older adults (P = 0.026) were more willing for home-based care. CONCLUSIONS: The research we have done suggests that there is a residence difference toward home-based care willingness among older adults. Targeted policies and an age-friendly environment should be made for different subgroups of older adults.

The Relationship between Self-Rated Economic Status and Falls among the Elderly in Shandong Province, China.

(1) Background: Older people are more vulnerable and likely to have falls and the consequences of these falls place a heavy burden on individuals, families and society. Many factors directly or indirectly affect the prevalence of falls. The aims of this study were to understand the prevalence and risk factors of falls among the elderly in Shandong, China; the relationship between economic level and falls was also preliminary explored. (2) Methods: Using a multi-stage stratified sampling method, 7070 elderly people aged 60 and over were selected in Shandong Province, China. General characteristics and a self-rated economic status were collected through face to face interviews. Chi-square tests, rank sum tests and two logistic regression models were performed as the main statistical methods. (3) Results: 8.59% of participants reported that they had experienced at least one fall in the past half year. There was a significant difference in experienced falls regarding gender, residence, marital status, educational level, smoking, drinking, hypertension, diabetes, coronary disease, and self-reported hearing. The worse the self-rated economic status, the higher the risk of falling, (poor and worried about livelihood, OR = 3.60, 95%; CI = 1.76-7.35). (4) Conclusions: Women, hypertension, diabetes and self-reported hearing loss were identified as the risk factors of falls in the elderly. The difference of economic level affects the falls of the elderly in rural and urban areas. More fall prevention measures should be provided for the elderly in poverty.

Full-scale MBR applications for leachate treatment in China: Practical, technical, and economic features.

Though having been applied for decades in the leachate treatment, membrane bioreactors (MBRs) have not attracted as much attention as their application in the municipal wastewater treatment. A timely survey for full-scale applications of MBRs treating leachate would be necessary to present a thorough knowledge and implication in this field. In this study, 175 full-scale MBRs treating leachate (with individual treatment capacity of ≥100 m3/d) in China were comprehensively analyzed. The accumulative treatment capacity exceeded 65,000 m3/d in 2018, and such projects were primarily distributed in areas with developed economy and large production of municipal solid waste. Sanitary landfill leachate owned 70 % of the leachate-treating MBRs' capacity, while the proportion for incineration plants increased gradually. Synchronously, leachate from incineration plants was more degradable than that from sanitary landfills. MBRs were advantageous to pollutant removal, fouling control, and successive energy mitigation of the whole treatment processes. The investment and footprint of processes adopting MBRs were medially ∼90,000 CNY/(m3/d) and ∼15 m2/(m3/d) respectively, and the energy consumption was 20-30 kW h/m3. The technical and economical applicability and environmental policy forces would strengthen a predictable increment of market share of MBRs in leachate treatment field in the future.

The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China.

Objectives: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods: The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results: Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor's advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines' reimbursement policy significantly correlated with older adults' willingness for downward referral. Conclusions: The proportion of older adults who self-initiated downward referral was less than one-third. Doctors' advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors' advice.

Not performing an OGTT results in underdiagnosis, inadequate risk assessment and probable cost increases of (pre)diabetes in Han Chinese over 40 years: a population-based prospective cohort study.

OBJECTIVE: To explore the influence by not performing an oral glucose tolerance test (OGTT) in Han Chinese over 40 years. DESIGN: Overall, 6682 participants were included in the prospective cohort study and were followed up for 3 years. METHODS: Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2h-PG), FPG and 2h-PG (OGTT), and HbA1c testing using World Health Organization (WHO) or American Diabetes Association (ADA) criteria were employed for strategy analysis. RESULTS: The prevalence of diabetes is 12.4% (95% CI: 11.6-13.3), while the prevalence of prediabetes is 34.1% (95% CI: 32.9-35.3) and 56.5% (95% CI: 55.2-57.8) using WHO and ADA criteria, respectively. 2h-PG determined more diabetes individuals than FPG and HbA1c. The testing cost per true positive case of OGTT is close to FPG and less than 2h-PG or HbA1c. FPG, 2h-PG and HbA1c strategies would increase costs from complications for false-positive (FP) or false-negative (FN) results compared with OGTT. Moreover, the least individuals identified as normal by OGTT at baseline developed (pre)diabetes, and the most prediabetes individuals identified by HbA1c or FPG using ADA criteria developed diabetes. CONCLUSIONS: The prevalence of isolated impaired glucose tolerance and isolated 2-h post-load diabetes were high, and the majority of individuals with (pre)diabetes were undetected in Chinese Han population. Not performing an OGTT results in underdiagnosis, inadequate developing risk assessment and probable cost increases of (pre)diabetes in Han Chinese over 40 years and great consideration should be given to OGTT in detecting (pre)diabetes in this population. Further population-based prospective cohort study of longer-term effects is necessary to investigate the risk assessment and cost of (pre)diabetes.

Natural Antioxidants in Foods and Medicinal Plants: Extraction, Assessment and Resources.

Natural antioxidants are widely distributed in food and medicinal plants. These natural antioxidants, especially polyphenols and carotenoids, exhibit a wide range of biological effects, including anti-inflammatory, anti-aging, anti-atherosclerosis and anticancer. The effective extraction and proper assessment of antioxidants from food and medicinal plants are crucial to explore the potential antioxidant sources and promote the application in functional foods, pharmaceuticals and food additives. The present paper provides comprehensive information on the green extraction technologies of natural antioxidants, assessment of antioxidant activity at chemical and cellular based levels and their main resources from food and medicinal plants.

Correlation between dual-axis rotational coronary angiography and intravascular ultrasound in a coronary lesion assessment.

The purpose of this study was to evaluate the accuracy of dual-axis rotational coronary angiography (DARCA) for coronary lesion assessment by directly comparing with intravascular ultrasound (IVUS). From October 2014 to December 2015, 40 patients (58 lesions) who had undergone both DARCA and IVUS were included in the image analysis. The minimum lumen diameter (MLD), lesion length, reference vessel diameter (RVD) and percent diameter stenosis at the same lesion, were identified and assessed. Significant correlation with IVUS was found for DARCA in either lesion length (r = 0.90, P < 0.001) or RVD (r = 0.81, P < 0.001) comparison. DARCA had fair correlation with IVUS for both MLD (r = 0.65, P < 0.001) and diameter stenosis (r = 0.48, P < 0.001). From the Bland-Altman plots, there was a good agreement between DARCA and IVUS regarding MLD (mean difference: -0.23 mm, 95 % limits of agreement: -0.96 to 0.50 mm) and RVD (mean difference: -0.15 mm, 95 % limits of agreement: -0.85 to 0.55 mm), while lesser agreement was found on lesion length (mean difference: -3.39 mm, 95 % limits of agreement: -12.63 to 5.85 mm) and diameter stenosis (mean difference: 4.82 %, 95 % limits of agreement: -17.05 to 26.68 %). There is an adequate correlation and agreement between DARCA and IVUS in coronary lesion assessment.

Stent boost subtract imaging for the assessment of optimal stent deployment in coronary ostial lesion intervention: comparison with intravascular ultrasound.

Percutaneous coronary intervention (PCI) of ostial lesions is complex and is technically very demanding. Intravascular ultrasound (IVUS) is considered the gold standard method to guide PCI but has several limitations. Stent boost subtract (SBS) imaging is an enhancement of the radiologic edge of the stent by digital management of regular X-ray images. The purpose of this study was to determine the availability of stent enhancement with SBS during ostial PCI by comparison with IVUS.We investigated SBS and IVUS after stent implantation in 58 ostial lesions in 55 patients. SBS and IVUS were performed in all patients to obtain improved stent location and to detect optimal release and deployment. We defined the SBS and IVUS criteria for accuracy of stent location and adequate stent deployment. IVUS findings showed that stent location was generally good. The location was accurate in 48 (82.8%) and inadequate stent deployment was observed in 10 of 58 (17.2%). Eight SBS images showed inadequate stent expansion. SBS predicted inadequate findings of IVUS with 100% specificity and 80% sensitivity, while a significant positive correlation was observed between SBS-MSA and MSA by IVUS with a regression coefficient of 0.95.Imaging techniques have a primary role during ostial PCI. SBS is a simple and quick method that offers several advantages, enabling improved stent location, adequate stent expansion, and optimal apposition of the struts to the wall. SBS imaging could be conventionally used during ostial PCI, especially in centers where IVUS is not used routinely.

Unit asking: a method to boost donations and beyond.

The solicitation of charitable donations costs billions of dollars annually. Here, we introduce a virtually costless method for boosting charitable donations to a group of needy persons: merely asking donors to indicate a hypothetical amount for helping one of the needy persons before asking donors to decide how much to donate for all of the needy persons. We demonstrated, in both real fund-raisers and scenario-based research, that this simple unit-asking method greatly increases donations for the group of needy persons. Different from phenomena such as the foot-in-the-door and identifiable-victim effects, the unit-asking effect arises because donors are initially scope insensitive and subsequently scope consistent. The method applies to both traditional paper-based fund-raisers and increasingly popular Web-based fund-raisers and has implications for domains other than fund-raisers, such as auctions and budget proposals. Our research suggests that a subtle manipulation based on psychological science can generate a substantial effect in real life.

Overearning.

High productivity and high earning rates brought about by modern technologies make it possible for people to work less and enjoy more, yet many continue to work assiduously to earn more. Do people overearn--forgo leisure to work and earn beyond their needs? This question is understudied, partly because in real life, determining the right amount of earning and defining overearning are difficult. In this research, we introduced a minimalistic paradigm that allows researchers to study overearning in a controlled laboratory setting. Using this paradigm, we found that individuals do overearn, even at the cost of happiness, and that overearning is a result of mindless accumulation--a tendency to work and earn until feeling tired rather than until having enough. Supporting the mindless-accumulation notion, our results show, first, that individuals work about the same amount regardless of earning rates and hence are more likely to overearn when earning rates are high than when they are low, and second, that prompting individuals to consider the consequences of their earnings or denying them excessive earnings can disrupt mindless accumulation and enhance happiness.