Systematic review of disparities in continuous glucose monitoring and insulin pump utilization in the United States: Key themes and evidentiary gaps.

AIM: This study aims to provide a comprehensive overview of real-world evidence pertaining to disparities in the utilization of continuous glucose monitors (CGMs)/insulin pumps to highlight potential evidentiary gaps and discern emerging themes from the literature. MATERIALS AND METHODS: A systematic review of published manuscripts and abstracts was conducted from: MEDLINE, EMBASE, Nursing and Allied Health, Web of Science and CINHAL. Attributes related to patients, outcomes, interventions (CGMs/pumps/both) and study type were captured. In addition, factors associated with disparities in device utilization were examined. RESULTS: Thirty-six studies were included in the final analysis; the studies predominantly focused on people living with type 1 diabetes. Only two studies included individuals with type 2 diabetes. Almost two-thirds of the studies reported outcomes associated with disparities (e.g. glycated haemoglobin, diabetic ketoacidosis, resource utilization). Most studies highlighted disparities across race, ethnicity and insurance type. Evidentiary gaps were identified, particularly in the evidence for people with type 2 diabetes, the continuation of CGM/pump use and limited studies addressing disparities among Native Americans/American Indians. CONCLUSION: This study reveals critical disparities in diabetes technology use across race, ethnicity and insurance type, particularly among people with type 1 diabetes. Evidentiary gaps assessing disparities in diabetes technology use persist, particularly concerning people with type 2 diabetes, Native American/American Indian and LGBTQ+ populations, and in outcomes related to continuation of use. Social and digital determinants of health, such as income, transportation, residential location and technological literacy, are crucial to achieving equitable access. Future research should focus on the patient journey to identify opportunities for equitable access to diabetes technology as its use grows.

Effects of contact tracing and nucleic acid testing on the COVID-19 outbreak in Zunyi, China: data-driven study using a branching process model.

BACKGROUND: During October 2021, China experienced localized outbreaks of COVID-19 in many cities. We analyzed the small local outbreak in Zunyi (Guizhou Province), a major city in southwestern China, and modeled the effects of different interventions on this outbreak. METHODS: Data on infections and contacts, provided by the Health Commission of Guizhou Province, were used to analyze the epidemiological characteristics of the outbreak and calculate the effectiveness of vaccination. A branching process model was used to simulate the outbreak. This model considered the time interval from exposure of the initial case to confirmation, the number of potential infections caused by the initial case, and the effects of the different interventions. RESULTS: From 18 to 25 October 2021, there were 12 patients with COVID-19 in Zunyi. Overall, the average age was 67.17 years-old, 8 patients were females, and 1 patient had an asymptomatic infection. The effectiveness of two-dose inactivated vaccine against SARS-CoV-2 infection was 16.7% (95% CI: 2.8% to 99.7%). The initial case was infected on 11 or 12 October 2021, 6.40 (95% CI: 6.37, 6.42; IQR: 4.92, 7.63) days before confirmation while the travelling in Lanzhou (Gansu Province). There were 10.07 (95% CI: 10.04, 10.09; IQR: 7.86, 11.93) potential secondary cases. When the effective vaccine coverage reached 60%, the probability of cumulative cases exceeding 20 was less than 8.77%, even if contact tracing was relaxed or eliminated. However, if the probability of tracing contacts decreased, earlier initiation of nucleic acid testing was necessary to control the outbreak. CONCLUSIONS: The COVID-19 outbreak in Zunyi was controlled quickly due to moderately effective vaccine coverage and rapid contact tracing. For controlling localized outbreaks, vaccination and contact tracing seemed to be more effective than massive nucleic acid testing in the initial phase of transmission. However, if there is low effective vaccine coverage or insufficient contact tracing, nucleic acid testing should start earlier.

ARIMA and ARIMA-ERNN models for prediction of pertussis incidence in mainland China from 2004 to 2021.

OBJECTIVE: To compare an autoregressive integrated moving average (ARIMA) model with a model that combines ARIMA with the Elman recurrent neural network (ARIMA-ERNN) in predicting the incidence of pertussis in mainland China. BACKGROUND: The incidence of pertussis has increased rapidly in mainland China since 2016, making the disease an increasing public health threat. There is a pressing need for models capable of accurately predicting the incidence of pertussis in order to guide prevention and control measures. We developed and compared two models for predicting pertussis incidence in mainland China. METHODS: Data on the incidence of pertussis in mainland China from 2004 to 2019 were obtained from the official website of the Chinese Center for Disease Control and Prevention. An ARIMA model was established using SAS (ver. 9.4) software and an ARIMA-ERNN model was established using MATLAB (ver. R2019a) software. The performances of these models were compared. RESULTS: From 2004 to 2019, there were 104,837 reported cases of pertussis in mainland China, with an increasing incidence over time. The incidence of pertussis showed obvious seasonal characteristics, with the peak lasting from March to September every year. Compared with the mean squared error (MSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) of the ARIMA model, those of the ARIMA-ERNN model were 81.43%, 95.97% and 80.86% lower, respectively, in fitting performance. In terms of prediction performance, the MAE, MSE and MAPE were 37.75%, 56.88% and 43.75% lower, respectively. CONCLUSION: The fitting and prediction performances of the ARIMA-ERNN model were better than those of the ARIMA model. This provides theoretical support for the prediction of infectious diseases and should be beneficial to public health decision making.

The burden of hand, foot, and mouth disease among children under different vaccination scenarios in China: a dynamic modelling study.

BACKGROUND: Hand, foot, and mouth disease (HFMD) is a common illness in young children. A monovalent vaccine has been developed in China protecting against enterovirus-71, bivalent vaccines preventing HFMD caused by two viruses are under development. OBJECTIVE: To predict and compare the incidence of HFMD under different vaccination scenarios in China. METHODS: We developed a compartmental model to capture enterovirus transmission and the natural history of HFMD in children aged 0-5, and calibrated to reported cases in the same age-group from 2015 to 2018. We compared the following vaccination scenarios: different combinations of monovalent and bivalent vaccine; a program of constant vaccination to that of pulse vaccination prior to seasonal outbreaks. RESULTS: We estimate 1,982,819, 2,258,846, 1,948,522 and 2,398,566 cases from 2015 to 2018. Increased coverage of monovalent vaccine from 0 to 80% is predicted to decrease the cases by 797,262 (49.1%). Use of bivalent vaccine at an 80% coverage level would decrease the cases by 828,560. Use of a 2.0× pulse vaccination for the bivalent vaccine in addition to 80% coverage would reduce cases by over one million. The estimated R0 for HFMD in 2015-2018 was 1.08, 1.10, 1.35 and 1.17. CONCLUSIONS: Our results point to the benefit of bivalent vaccine and using a pulse vaccination in specific months over routine vaccination. Other ways to control HFMD include isolation of patients in the early stage of dissemination, more frequent hand-washing and ventilation, and better treatment options for patients.

Ambient nitrogen dioxide pollution and spreadability of COVID-19 in Chinese cities.

This study aims to explore the relationship between ambient NO2 levels and the transmission ability (basic reproductive number, R0) of COVID-19 in 63 Chinese cities. After adjustment for temperature and relative humidity, R0 was positively associated with NO2 concentration at city level. The temporal analysis within Hubei province indicated that all the 11 Hubei cities (except Xianning City) had significant positive correlations between NO2 concentration (with 12-day time lag) and R0 (r > 0.51, p < 0.005). Since the association between ambient NO2 and R0 indicated NO2 may increase underlying risk of infection in the transmission process of COVID-19. In addition, NO2 is also an indicator of traffic-related air pollution, the association between NO2 and COVID-19's spreadability suggest that reduced population movement may have reduced the spread of the SARS-CoV-2.

Simple Non-Fused Electron Acceptors Leading to Efficient Organic Photovoltaics.

Despite the remarkable progress achieved in recent years, organic photovoltaics (OPVs) still need work to approach the delicate balance between efficiency, stability, and cost. Herein, two fully non-fused electron acceptors, PTB4F and PTB4Cl, are developed via a two-step synthesis from single aromatic units. The introduction of a two-dimensional chain and halogenated terminals for these non-fused acceptors plays a synergistic role in optimizing their solid stacking and orientation, thus promoting an elongated exciton lifetime and fast charge-transfer rate in bulk heterojunction blends. As a result, PTB4Cl, upon blending with PBDB-TF polymer, has enabled single-junction OPVs with power conversion efficiencies of 12.76 %, representing the highest values among the reported fully unfused electron acceptors so far.

Temporal association between particulate matter pollution and case fatality rate of COVID-19 in Wuhan.

The coronavirus (COVID-19) epidemic reported for the first time in Wuhan, China at the end of 2019, which has caused 4648 deaths in China as of July 10, 2020. This study explored the temporal correlation between the case fatality rate (CFR) of COVID-19 and particulate matter (PM) in Wuhan. We conducted a time series analysis to examine the temporal day-by-day associations. We observed a higher CFR of COVID-19 with increasing concentrations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 µm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 µm or less (PM2.5) in the temporal scale. This association may affect patients with mild to severe disease progression and affect their prognosis.

Effect of true triaxial principal stress unloading rate on strain energy density of sandstone.

Deep rock are often in a true triaxial stress state. Studying the impacts of varying unloading speeds on their strain energy (SE) density is highly significant for predicting rock stability. Through true triaxial unloading principal stress experiments and true triaxial stress equilibrium unloading experiments on sandstone, this paper proposes a method to compute the SE density in a true triaxial compressive unloading principal stress test. This method aims to analyze the SE variation in rocks under the action of true triaxial unloading principal stresses. Acoustic emission is used to verify the correctness of the SE density calculation method in this paper. This study found that: (1) Unloading in one principal stress direction causes the SE density to rise in the other principal stress directions. This rise in SE, depending on its reversibility, can be categorized into elastic and dissipated SE. (2)When unloading principal stresses, the released elastic SE density in the unloading direction is influence by the stress path and rate. (3) The higher the unloading speed will leads to greater increases in the input SE density, elastic SE density, and dissipative SE density in the other principal stress directions. (4) The dissipated SE generated under true triaxial compression by unloading the principal stress is positively correlated with the damage to the rock; with an increase in unloading rate, there is a corresponding increase in the formation of cracks after unloading. (5) Utilizing the stress balance unloading test, we propose a calculation method for SE density in true triaxial unloading principal stress tests.

Selectively Modulating Componential Morphologies of Bulk Heterojunction Organic Solar Cells.

Achieving precise control over the nanoscale morphology of bulk heterojunction films presents a significant challenge for the conventional post-treatments employed in organic solar cells (OSCs). In this study, a near-infrared photon-assisted annealing (NPA) strategy is developed for fabricating high-performance OSCs under mild processing conditions. It is revealed a top NIR light illumination, together with the bottom heating, enables the selective tuning of the molecular arrangement and assembly of narrow bandgap acceptors in polymer networks to achieve optimal morphologies, as well as the acceptor-rich top surface of active layers. The derived OSCs exhibit a remarkable power conversion efficiency (PCE) of 19.25%, representing one of the highest PCEs for the reported binary OSCs so far. Moreover, via the NPA strategy, it has succeeded in accessing top-illuminated flexible OSCs using thermolabile polyethylene terephthalate from mineral water bottles, displaying excellent mechanical stabilities. Overall, this work will hold the potential to develop organic solar cells under mild processing with various substrates.

Ultrasound Imaging of Macrophages Intracellularly Labelled with Biosynthetic Gas Vesicles.

PURPOSE: This study aimed to develop a novel method for real-time imaging to track macrophages and to make it possible to visually track their dynamic features. PROCEDURES: The archaeon Halobacterium NRC-1 was cultured in an ATCC medium. Buoyant cells were allowed to produce biosynthetic gas vesicles (GVs), and isolated GVs were collected after lysis. Gas vesicle-labelled macrophages (GV@RAWs) were obtained by incubating macrophage (RAW 264.7) cells with GVs. The ability of GV@RAWs to track macrophages in real-time for a long term was assessed using a high-frequency ultrasound imaging system. RESULTS: We successfully synthesised and isolated GV@RAWs by co-incubating them with RAW 264.7. The results showed that GV@RAW produced significant ultrasound signals without affecting cell survival and could achieve real-time imaging for up to 3 days in vitro. CONCLUSION: This research provides a new way to achieve long-term real-time imaging of macrophages, opening up new possibilities for immune response research, clinical diagnosis and therapeutic strategies for inflammatory diseases.

Barriers to green human resources management (GHRM) implementation in developing countries: evidence from China.

Because of the current climate adaptation and long-term viability advancements, campaigners both locally and globally are pressuring businesses to embrace green practices. But there are challenges to putting green policies into action. The goal of this research was to analyze the most significant challenges encountered by Chinese businesses when attempting to implement environmentally responsible HR practices (GHRM). There were seventeen setbacks found, and these were sorted into five main groups. In order to pilot test the survey questions, we spoke with twenty experts in the fields of human resources and environmental management. One hundred and ninety-nine questionnaires were subsequently distributed to a random sample of company CEOs (19), HR managers (30), CFOs (30), and HR directors (40). The PSI approach was used to establish a hierarchy of the most significant obstacles and their subobstacles. Twenty-three percent of GHRM barriers in the research area were attributable to economic factors. The absence of financial resources emerged as the most crucial obstacle overall (with a score of 0.99) and among the subbarriers. The second most common barrier was found to be political and regulatory (20.1%), while the least common was found to be cultural and educational (18.2%). Government and financial institutions can help businesses overcome the most significant obstacles by offering low-interest loans for the development and implementation of sustainable business strategies and initiatives. As such, this study complements the current body of literature on green HR. Examining the challenges faced when trying to put GHRM into practice in a poor country context, this helps policymakers and practitioners in China and other similar economies understand environmental innovation barriers and develop policies to overcome them.

Robust and Sustainable Indium Anode Leading to Efficient and Stable Organic Solar Cells.

The fast degradation of the charge-extraction interface at indium tin oxide (ITO) poses a significant obstacle to achieving long-term stability for organic solar cells (OSCs). Herein, a sustainable approach for recycling non-sustainable indium to construct efficient and stable OSCs and scale-up modules is developed. It is revealed that the recovered indium chloride (InCl3 ) from indium oxide waste can be applied as an effective hole-selective interfacial layer for the ITO electrode (noted as InCl3 -ITO anode) through simple aqueous fabrication, facilitating not only energy level alignment to photoactive blends but also mitigating parasitic absorption and charge recombination losses of the corresponding OSCs. As a result, OSCs and modules consisting of InCl3 -ITO anodes achieve remarkable power conversion efficiencies (PCEs) of 18.92% and 15.20% (active area of 18.73 cm2 ), respectively. More importantly, the InCl3 -ITO anode can significantly extend the thermal stability of derived OSCs, with an extrapolated T80 lifetime of ≈10 000 h.

Characteristics, Recombination Methods, and Applications Progresses of Split-Cas9 System.

CRISPR technology has been used to revolutionize various facets of life sciences because of its potent gene editing capabilities. In particular, CRISPR technology is anticipated to be used to cure congenital disorders, and malignant cancers brought on by gene mutation. In this article, we introduce a Split-Cas9 system, in which Cas9 protein is split into two or more parts and recombined in cells to function specific induction circumstances. Split-Cas9 system can improve the therapeutic index of CRISPR technology by splitting Cas9 proteins into small fragments, thus enhancing their compatibility with virus vectors and precise temporal and spatial control. This article examined the combination mode of Split-Cas9 system, contrasted the differences in its split sites and activity efficiency, and discussed the use and clinical transformation in vivo and in vitro.

Genome-Wide Association Study of Arsenic Accumulation in Polished Rice.

The accumulation of arsenic (As) in rice poses a significant threat to food safety and human health. Breeding rice varieties with low As accumulation is an effective strategy for mitigating the health risks associated with arsenic-contaminated rice. However, the genetic mechanisms underlying As accumulation in rice grains remain incompletely understood. We evaluated the As accumulation capacity of 313 diverse rice accessions grown in As-contaminated soils with varying As concentrations. Six rice lines with low As accumulation were identified. Additionally, a genome-wide association studies (GWAS) analysis identified 5 QTLs significantly associated with As accumulation, with qAs4 being detected in both of the experimental years. Expression analysis demonstrated that the expression of LOC_Os04g50680, which encodes an MYB transcription factor, was up-regulated in the low-As-accumulation accessions compared to the high-As-accumulation accessions after As treatment. Therefore, LOC_Os04g50680 was selected as a candidate gene for qAs4. These findings provide insights for exploiting new functional genes associated with As accumulation and facilitating the development of low-As-accumulation rice varieties through marker-assisted breeding.

E-commerce platform financing versus trade credit financing: Financing mode selection for online retailer considering live-stream selling in China.

Introduction: The rise of live-stream selling has made the e-commerce platform attractive to many small and medium-sized retailers that are often faced with capital constraints. The choice between the e-commerce platform financing (EPF) and trade credit financing (TCF) for the capital-constrained e-retailers engaging in live-stream selling is particularly important problem. Methods: This paper considers a supply chain made up of a manufacturer, an e-commerce platform that offers live-stream selling service to consumers and an online retailer with capital constraint. We, respectively, investigate the optimal decisions of the supply chain enterprises under EPF and TCF modes based on Stackelberg game models and optimization theories. Results: We compare the profits of supply chain firms under different cases and obtain some important conclusions through theoretical and numerical analysis. Discussion: First, when the e-commerce platform's commission rate is low enough, the retailer's ordering quantity is, under EPF mode, greater than that evidenced without capital constraint. In addition, when the retailer's marginal profit is high and the e-commerce platform's commission rate is low, the online retailer should choose EPF mode; in other instances, TCF is its optimal choice. Second, the e-commerce platform can obtain the highest profit under EPF mode, while TCF mode will bring the highest profit to the manufacturer. Third, when the platform's commission rate is below a certain threshold, the profit of the entire supply chain under EPF mode is larger than that of well-funded supply chain, but TCF mode cannot. Finally, we also find there exists the access threshold about the live-stream selling. Only when the commission rate is relatively high, the e-commerce platform should offers live-stream service to consumers and the live-stream investment is the highest under EPF mode.

Optimization of Vaccination Clinics to Improve Staffing Decisions for COVID-19: A Time-Motion Study.

As the COVID-19 pandemic disturbed people's daily life for more than 2 years, many COVID-19 vaccines have been carried forward systematically to curb the transmission of the virus. However, high vaccination tasks bring great challenges to personnel allocation. We observed nine vaccination clinics in Huzhou and Shanghai and built a discrete-event simulation model to simulate the optimal staffing of vaccination clinics under 10 different scenarios. Based on the result of the simulations, we optimized the allocation of vaccination staff in different stages of epidemic development by province in China. The results showed that optimizing staffing could both boost service utilization and shorten the queuing time for vaccination recipients. Taking Jilin Province as an example, to increase the booster vaccination rate within 3 months, the number of vaccination staff members needed was 2028, with a continuous small-scale breakout and 2,416 under a stable epidemic situation. When there was a shortage of vaccination staff, the total number of vaccination clinic staff members needed could be significantly reduced by combining the preview and registration steps. This study provides theoretical support for the personnel arrangement of COVID-19 vaccinations of a booster dose by province and the assessment of current vaccination staff reserves.

Application and Prospect of CRISPR/Cas9 Technology in Reversing Drug Resistance of Non-Small Cell Lung Cancer.

Cancer drug resistance has always been a major factor affecting the treatment of non-small cell lung cancer, which reduces the quality of life of patients. The clustered regularly interspaced short palindromic repeats/CRISPR associated protein 9 (CRISPR/Cas9) technology, as an efficient and convenient new gene-editing technology, has provided a lot of help to the clinic and accelerated the research of cancer and drug resistance. In this review, we introduce the mechanisms of drug resistance in non-small cell lung cancer (NSCLC), discuss how the CRISPR/Cas9 system can reverse multidrug resistance in NSCLC, and focus on drug resistance gene mutations. To improve the prognosis of NSCLC patients and further improve patients' quality of life, it is necessary to utilize the CRISPR/Cas9 system in systematic research on cancer drug resistance.

Vaccination as an alternative to non-drug interventions to prevent local resurgence of COVID-19.

BACKGROUND: While a COVID-19 vaccine protects people from serious illness and death, it remains a concern when and how to lift the high-cost and strict non-pharmaceutical interventions (NPIs). This study examined the joint effect of vaccine coverage and NPIs on the control of local and sporadic resurgence of COVID-19 cases. METHODS: Between July 2021 and January 2022, we collected the large-scale testing information and case number of imported COVID-19 patients from the website of the National Health Commission of China. A compartment model was developed to identify the level of vaccine coverage that would allow safe relaxation of NPIs, and vaccination strategies that can best achieve this level of coverage. We applied Monte Carlo simulation 50 000 times to remove random fluctuation effects and obtain fitted/predicted epidemic curve based on various parameters with 95% confidence interval at each time point. RESULTS: We found that a vaccination coverage of 50.4% was needed for the safe relaxation of NPIs, if the vaccine effectiveness was 79.3%. The total number of incidence cases under the key groups firstly strategy was 103 times higher than that of accelerated vaccination strategy. It needed 35 months to fully relax NPIs if the key groups firstly strategy was implemented, and 27 months were needed with the accelerated vaccination strategy. If combined the two strategies, only 8 months are needed to achieve the vaccine coverage threshold for the fully relaxation of NPIs. Sensitivity analyses results shown that the higher the transmission rate of the virus and the lower annual vaccine supply, the more difficult the epidemic could be under control. When the transmission rate increased 25% or the vaccination effectiveness rate decreased 20%, 33 months were needed to reduce the number of total incidence cases below 1000. CONCLUSIONS: As vaccine coverage improves, the NPIs can be gradually relaxed. Until that threshold is reached, however, strict NPIs are still needed to control the epidemic. The more transmissible SARS-CoV-2 variant led to higher resurgence probability, which indicates the importance of accelerated vaccination and achieving the vaccine coverage earlier.

Serum total bilirubin and new-onset hypertension in perimenopausal women: a cross-sectional study.

OBJECTIVE: Previous studies have shown negative associations between total bilirubin (TBIL) and hypertension. However, the association of TBIL with new-onset hypertension in perimenopausal women is unknown. METHODS: A total of 196 perimenopausal women were included in this cross-sectional study of which 85 had new-onset hypertension. All participants underwent 24-hour ambulatory blood pressure monitoring and a clinical assessment including anthropometrics. Sociodemographic, lifestyle, and menopausal symptoms (modified Kupperman Index [mKI]) were measured by questionnaire. A fasting blood sample was taken to measure a wide range of biomarkers and hormone levels. Restricted cubic spline regression was used to investigate potential nonlinearity. Multivariable logistic and robust linear regression analyses adjusting for minimal sufficient adjustment sets based on directed acyclic graphs were performed to test the association of TBIL with hypertension/blood pressure. We examined mKI-stratified analyses and a TBIL-mKI interaction term to explore potential effect modification by number of menopausal symptoms. RESULTS: Hypertensive women had significantly lower TBIL levels than did normotensive women (11.15 vs 12.55 µmol/L, P = 0.046). Univariate restricted cubic spline regression showed nonsignificant nonlinearity ( P value for nonlinearity, 0.339). Multivariable regression analyses adjusted for minimal sufficient adjustment sets revealed that higher TBIL level was associated with lower odds of hypertension (odds ratio, 0.91 per µmol/L TBIL; 95% confidence interval [CI], 0.84-0.98; P = 0.019). Total bilirubin showed a significant inverse association with average 24-hour diastolic blood pressure ( ß = -0.36 mm Hg per µmol/L TBIL; 95% CI, -0.62 to -0.10; P = 0.008) but not with 24-hour systolic blood pressure ( ß = -0.37 mm Hg per µmol/L TBIL; 95% CI, -0.79 to 0.06; P = 0.090). Stratified analyses suggested stronger inverse associations of TBIL with hypertension and 24-hour blood pressure in women with fewer menopausal symptoms (mKI ≤10), although the TBIL-mKI interaction was not significant. CONCLUSIONS: In perimenopause, TBIL was inversely associated with diastolic blood pressure and new-onset hypertension, diagnosed using 24-hour ambulatory blood pressure monitoring.