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Hand, foot, and mouth disease (HFMD) shows spatiotemporal heterogeneity in China. A spatiotemporal filtering model was constructed and applied to HFMD data to explore the underlying spatiotemporal structure of the disease and determine the impact of different spatiotemporal weight matrices on the results. HFMD cases and covariate data in East China were collected between 2009 and 2015. The different spatiotemporal weight matrices formed by Rook, K-nearest neighbour (KNN; K = 1), distance, and second-order spatial weight matrices (SO-SWM) with first-order temporal weight matrices in contemporaneous and lagged forms were decomposed, and spatiotemporal filtering model was constructed by selecting eigenvectors according to MC and the AIC. We used MI, standard deviation of the regression coefficients, and five indices (AIC, BIC, DIC, R2, and MSE) to compare the spatiotemporal filtering model with a Bayesian spatiotemporal model. The eigenvectors effectively removed spatial correlation in the model residuals (Moran’s I < 0.2, p > 0.05). The Bayesian spatiotemporal model’s Rook weight matrix outperformed others. The spatiotemporal filtering model with SO-SWM was superior, as shown by lower AIC (92,029.60), BIC (92,681.20), and MSE (418,022.7) values, and higher R2 (0.56) value. All spatiotemporal contemporaneous structures outperformed the lagged structures. Additionally, eigenvector maps from the Rook and SO-SWM closely resembled incidence patterns of HFMD.
The study aimed to determine the patterns of the vestibular and ocular motor findings in cerebellar infarction (CI).
Methods:
We retrospectively analyzed vestibular and ocular motor test results in 23 CI patients and 32 acute unilateral vestibulopathy (AUVP) patients.
Results:
Among CI cases, the posterior inferior cerebellar artery (PICA) was the most commonly affected territory. Vertigo is predominantly observed in patients with infarctions affecting PICA or anterior inferior cerebellar artery (AICA). Lesions involving the superior cerebellar artery (SCA) mainly result in dizziness. Saccadic intrusion and oscillation, abnormal bilateral smooth pursuit (SP) and abnormal saccades were more prevalent in the CI group than in the AUVP group (all p < 0.05). Horizontal saccades were abnormal in 11 patients (47.8%) with CI. All AUVP patients had normal horizontal saccades. Horizontal SP was impaired in 13 patients (56.5%) with CI, with decreased gain toward both sides in 10 and toward 1 side in 3. Impaired horizontal SP was noted in nine patients (28.1%) with AUVP, with decreased gain toward the contralesional side in all cases. A total of 26.3% (5/19) of patients with CI exhibited subjective visual vertical (SVV) deviation toward the affected side and 31.6% (6/19) toward the unaffected side. In patients with AUVP, 70.0% (21/30) showed SVV deviation toward the affected side.
Conclusions:
Vertigo is mainly seen in PICA or AICA infarctions. SCA lesions mostly cause dizziness. Saccadic intrusion and oscillation, abnormal bilateral SP and abnormal saccades contribute to the diagnosis of CI. Moreover, SVV deviation varies depending on the cerebellar structures involved.
While environmental concerns are increasingly driving firms’ strategic decisions, insights into why firms make heterogeneous environmental investments are limited. Taking an institutional view, we explore the effect of institutional complexity resulting from multiple but incongruent institutional logics within an organization on firms’ environmental investments. Using China's mixed-ownership reform as a research context, we identify a unique condition in which institutional complexity arises as the privatization process results in two coexisting but incongruent institutional logics – namely, state and financial logic. We further propose that privatization plays both enabling and constraining roles in state-owned enterprises’ (SOEs’) strategic decisions about environmental investments, depending on the relative dominance of each institutional logic, resulting in an inverted U-shaped relationship between privatization and environmental investments. Moreover, we examine the moderating effects of CEO background characteristics and firms’ external environmental context to uncover how these factors influence the relative dominance of state or financial logic in privatized SOEs, thereby reshaping SOEs’ environmental investments. Analyses of multisource panel data from Chinese listed SOEs from 2013 to 2020 support our theoretical propositions. The findings contribute to the literature on how institutional factors affect firm environmental practices and provide new insights to better understand the influence of institutional complexity on firm strategic actions.
This paper first discusses the relationship between Kullback–Leibler information (KL) and Fisher information in the context of multi-dimensional item response theory and is further interpreted for the two-dimensional case, from a geometric perspective. This explication should allow for a better understanding of the various item selection methods in multi-dimensional adaptive tests (MAT) which are based on these two information measures. The KL information index (KI) method is then discussed and two theorems are derived to quantify the relationship between KI and item parameters. Due to the fact that most of the existing item selection algorithms for MAT bear severe computational complexity, which substantially lowers the applicability of MAT, two versions of simplified KL index (SKI), built from the analytical results, are proposed to mimic the behavior of KI, while reducing the overall computational intensity.
Item replenishing is essential for item bank maintenance in cognitive diagnostic computerized adaptive testing (CD-CAT). In regular CAT, online calibration is commonly used to calibrate the new items continuously. However, until now no reference has publicly become available about online calibration for CD-CAT. Thus, this study investigates the possibility to extend some current strategies used in CAT to CD-CAT. Three representative online calibration methods were investigated: Method A (Stocking in Scale drift in on-line calibration. Research Rep. 88-28, 1988), marginal maximum likelihood estimate with one EM cycle (OEM) (Wainer & Mislevy In H. Wainer (ed.) Computerized adaptive testing: A primer, pp. 65–102, 1990) and marginal maximum likelihood estimate with multiple EM cycles (MEM) (Ban, Hanson, Wang, Yi, & Harris in J. Educ. Meas. 38:191–212, 2001). The objective of the current paper is to generalize these methods to the CD-CAT context under certain theoretical justifications, and the new methods are denoted as CD-Method A, CD-OEM and CD-MEM, respectively. Simulation studies are conducted to compare the performance of the three methods in terms of item-parameter recovery, and the results show that all three methods are able to recover item parameters accurately and CD-Method A performs best when the items have smaller slipping and guessing parameters. This research is a starting point of introducing online calibration in CD-CAT, and further studies are proposed for investigations such as different sample sizes, cognitive diagnostic models, and attribute-hierarchical structures.
The compatibility of computerized adaptive testing (CAT) with response revision has been a topic of debate in psychometrics for many years. The problem is to provide test takers opportunities to change their answers during the test, while discouraging deceptive strategies from their side and preserving the statistical efficiency of the traditional CAT. The estimating approach proposed in Wang et al. (Stat Sin 27(4):1987–2010, 2017), based on the nominal response model, allows test takers to provide more than one answer to each item during the test, which they all contribute to the interim and final ability estimation. This approach is here reformulated, extended to incorporate a larger class of polytomous and dichotomous item response theory models, and investigated with simulation studies under different test-taking strategies.
Over the past thirty years, obtaining diagnostic information from examinees’ item responses has become an increasingly important feature of educational and psychological testing. The objective can be achieved by sequentially selecting multidimensional items to fit the class of latent traits being assessed, and therefore Multidimensional Computerized Adaptive Testing (MCAT) is one reasonable approach to such task. This study conducts a rigorous investigation on the relationships among four promising item selection methods: D-optimality, KL information index, continuous entropy, and mutual information. Some theoretical connections among the methods are demonstrated to show how information about the unknown vector θ can be gained from different perspectives. Two simulation studies were carried out to compare the performance of the four methods. The simulation results showed that mutual information not only improved the overall estimation accuracy but also yielded the smallest conditional mean squared error in most region of θ. In the end, the overlap rates were calculated to empirically show the similarity and difference among the four methods.
With the advent of web-based technology, online testing is becoming a mainstream mode in large-scale educational assessments. Most online tests are administered continuously in a testing window, which may post test security problems because examinees who take the test earlier may share information with those who take the test later. Researchers have proposed various statistical indices to assess the test security, and one most often used index is the average test-overlap rate, which was further generalized to the item pooling index (Chang & Zhang, 2002, 2003). These indices, however, are all defined as the means (that is, the expected proportion of common items among examinees) and they were originally proposed for computerized adaptive testing (CAT). Recently, multistage testing (MST) has become a popular alternative to CAT. The unique features of MST make it important to report not only the mean, but also the standard deviation (SD) of test overlap rate, as we advocate in this paper. The standard deviation of test overlap rate adds important information to the test security profile, because for the same mean, a large SD reflects that certain groups of examinees share more common items than other groups. In this study, we analytically derived the lower bounds of the SD under MST, with the results under CAT as a benchmark. It is shown that when the mean overlap rate is the same between MST and CAT, the SD of test overlap tends to be larger in MST. A simulation study was conducted to provide empirical evidence. We also compared the security of MST under the single-pool versus the multiple-pool designs; both analytical and simulation studies show that the non-overlapping multiple-pool design will slightly increase the security risk.
Research examining (MCI) criteria in diverse and/or health-disparate populations is limited. There is a critical need to investigate the predictive validity for incident dementia of widely used MCI definitions in diverse populations.
Method:
Eligible participants were non-Hispanic White or Black Bronx community residents, free of dementia at enrollment, with at least one annual follow-up visit after baseline. Participants completed annual neurological and neuropsychological evaluations to determine cognitive status. Dementia was defined based on DSM-IV criteria using case conferences. Cox proportional hazard models assessed predictive validity for incident dementia of four specific MCI definitions (Petersen, Jak/Bondi, number of impaired tests, Global Clinical Ratings) at baseline, controlling for age, sex, education, and race/ethnicity. Time-dependent sensitivity and specificity at 2–7 years for each definition, and Youden’s index were calculated as accuracy measures.
Results:
Participants (N = 1073) ranged in age from 70 to 100 (mean = 78.4 ± 5.3) years at baseline. The sample was 62.5% female, and educational achievement averaged 13.9 ± 3.5 years. Most participants identified as White (70.0%), though Black participants were well-represented (30.0%). In general, MCI definitions differed in sensitivity and specificity for incident dementia. However, there were no significant differences in Youden’s index for any definition, across all years of follow-up.
Conclusions:
This work provides an important step toward improving the generalizability of the MCI diagnosis to underrepresented/health-disparate populations. While our findings suggest the studied MCI classifications are comparable, researchers and clinicians may choose to consider one method over another depending on the rationale for evaluation or question of interest.
Fibrosis is a pathological condition that affects various organs by increasing fibrous connective tissue while reducing parenchymal cells. This imbalance can lead to compromised organ function and potential failure, posing significant health risks. The condition’s complexity necessitates the exploration of effective treatments to mitigate its progression and adverse outcomes.
Aims
This study aims to investigate the role of ghrelin, a peptide hormone known for its anti-inflammatory and anti-fibrotic properties, in modulating fibrosis across different organs. By binding to the growth hormone secretagogue receptor type 1a (GHSR-1a), ghrelin has shown potential in attenuating the fibrotic process, particularly through its interaction with the TGF-β signalling pathway.
Methods
An extensive review of clinical and animal model studies focusing on liver, kidney, lung, and myocardial fibrosis was conducted. The primary focus was on examining how ghrelin influences the TGF-β signalling pathway, with an emphasis on the regulation of TGF-β expression and the suppression of Smad signalling molecules. The methodology involved analysing data from various studies to understand ghrelin’s molecular mechanisms in combating fibrosis.
Results
The findings from the reviewed studies indicate that ghrelin exerts significant anti-fibrotic effects across multiple organ systems. Specifically, ghrelin was found to downregulate TGF-β expression and suppress Smad signalling molecules, leading to a marked reduction in fibrous tissue accumulation and preservation of organ function. In liver fibrosis models, ghrelin reduced TGF-β1 levels and Smad3 phosphorylation, while in kidney and cardiac fibrosis, similar protective effects were observed. The data also suggest that ghrelin’s effects are mediated through both canonical and non-canonical TGF-β pathways.
Conclusions
Ghrelin presents a promising therapeutic agent in the management of fibrosis due to its potent anti-inflammatory and anti-fibrotic actions. Its ability to modulate the TGF-β signalling pathway underscores a vital molecular mechanism through which ghrelin can mitigate fibrotic progression in various organs. Future research should focus on further elucidating ghrelin’s molecular interactions and potential clinical applications in fibrosis treatment, offering new avenues for developing effective anti-fibrotic therapies.
Drawing on resource-based and agency theories, this study examines the effects of business concentration and ownership structure on business group performance. On the basis of panel data (2004–2018) from the top 100 Taiwanese business groups investing globally, this study finds an S-shaped relationship between business concentration and business group performance with the interaction of advantages and costs at different levels. Performance increases when there is little business concentration, decreases when there is a moderate amount and increases again when there is a high level of business concentration. In addition, this study hypothesizes that ownership structure has a different moderating effect on this relationship. The family business group has a positive moderating effect; however, outsider direct and manager ownership have no significant moderating role. These findings have important theoretical and managerial implications for business groups.
The aim of this 4-year follow-up study was to examine the predictive effects of demographics, three types of sexual stigma, three types of self-identity confusion, anxiety, depression, family support and problematic Internet use before the coronavirus disease 2019 (COVID-19) pandemic on new-onset suicide risk and persistent suicide risk in young adult lesbian, gay and bisexual individuals who experienced the COVID-19 pandemic in Taiwan.
Methods
Baseline data were collected from 1,000 lesbian, gay and bisexual individuals in 2018 and 2019. Outcome data on suicide risk were collected again in 2023. The suicide module of the Mini International Neuropsychiatric Interview was used to assess suicide risk in terms of thoughts of death, desire to self-harm, thoughts of suicide, plans for suicide and suicide attempts in the preceding month at the initial and follow-up assessments. Baseline three types of sexual stigma, self-identity disturbance, depression, anxiety and problematic Internet use were used to examine their prediction of new-onset suicide risk and persistent suicide risk at follow-up.
Results
In total, 673 individuals participated in the follow-up survey. Notably, 16.5% of the participants who had no suicide risk at baseline had new-onset suicide risk at follow-up; 46.4% of the participants who had suicide risk at baseline also had suicide risk at follow-up. Participants who were transgender (p = .003), who perceived greater levels of microaggression (p < .001), and who had greater levels of problematic Internet use at baseline (p = .024) were more likely to have new-onset suicide risk at follow-up. Participants who had greater levels of self-identity confusion were more likely to have persistent suicide risk at follow-up (p = .023).
Conclusion
Intervention strategies for reducing suicide risk in lesbian, gay and bisexual individuals should be developed with consideration of the predictors identified in this study.
The Indo-Pacific Warm Pool (IPWP) significantly influences the global hydrological cycle through its impact on atmospheric-oceanic circulation. However, gaining a comprehensive understanding of the hydrologic climate dynamics within the IPWP and its broader effects on the global climate have been hindered by spatial and temporal limitations in paleoclimate records on orbital timescales. In this study, we reconstructed precipitation records (approximated from δ18Osw-ivc) over the past 450 kyr, based on planktonic foraminiferal Mg/Ca and δ18O data obtained from International Ocean Discovery Program Site U1486 in the western tropical Pacific. The δ18Osw-ivc record revealed a generally consistent pattern with precession variations over the past 450 kyr, closely corresponding to changes in boreal summer insolation at the equator. The δ18Osw-ivc record displayed an anti-phased relationship with Chinese speleothem δ18O records on the precession band, with lower precipitation in the western tropical Pacific and higher precipitation in the East Asia summer monsoon region during periods of high Northern Hemisphere summer insolation. This anti-phased correlation primarily resulted from the north-south migration of the Intertropical Convergence Zone (ITCZ), influenced by the interhemispheric insolation contrast. By considering additional δ18Osw-ivc records from various locations within the IPWP region, we identified synchronous precipitation changes within the IPWP on the precession band. The synchronization of precipitation on both margins of the ITCZ’s seasonal range and differences between central and marginal regions of the ITCZ within the IPWP revealed the expansion and contraction of the ITCZ on precession band.
Artificial sweeteners are generally used and recommended to alternate added sugar for health promotion. However, the health effects of artificial sweeteners remain unclear. In this study, we included 6371 participants from the National Health and Nutrition Examination Survey with artificial sweetener intake records. Logistic regression and Cox regression were applied to explore the associations between artificial sweeteners and risks of cardiometabolic disorders and mortality. Mendelian randomisation was performed to verify the causal associations. We observed that participants with higher consumption of artificial sweeteners were more likely to be female and older and have above medium socio-economic status. After multivariable adjustment, frequent consumers presented the OR (95 % CI) for hypertension (1·52 (1·29, 1·80)), hypercholesterolaemia (1·28 (1·10, 1·50)), diabetes (3·74 (3·06, 4·57)), obesity (1·52 (1·29, 1·80)), congestive heart failure (1·89 (1·35, 2·62)) and heart attack (1·51 (1·10, 2·04)). Mendelian randomisation confirmed the increased risks of hypertension and type 2 diabetes. Moreover, an increased risk of diabetic mortality was identified in participants who had artificial sweeteners ≥ 1 daily (HR = 2·62 (1·46, 4·69), P = 0·001). Higher consumption of artificial sweeteners is associated with increased risks of cardiometabolic disorders and diabetic mortality. These results suggest that using artificial sweeteners as sugar substitutes may not be beneficial.
The discovery that blazars dominate the extra-galactic $\gamma$-ray sky is a triumph in the Fermi era. However, the exact location of $\gamma$-ray emission region still remains in debate. Low-synchrotron-peaked blazars (LSPs) are estimated to produce high-energy radiation through the external Compton process, thus their emission regions are closely related to the external photon fields. We employed the seed factor approach proposed by Georganopoulos et al. It directly matches the observed seed factor of each LSP with the characteristic seed factors of external photon fields to locate the $\gamma$-ray emission region. A sample of 1 138 LSPs with peak frequencies and peak luminosities was adopted to plot a histogram distribution of observed seed factors. We also collected some spectral energy distributions (SEDs) of historical flare states to investigate the variation of $\gamma$-ray emission region. Those SEDs were fitted by both quadratic and cubic functions using the Markov-chain Monte Carlo method. Furthermore, we derived some physical parameters of blazars and compared them with the constraint of internal $\gamma\gamma$-absorption. We find that dusty torus dominates the soft photon fields of LSPs and most $\gamma$-ray emission regions of LSPs are located at 1–10 pc. The soft photon fields could also transition from dusty torus to broad line region and cosmic microwave background in different flare states. Our results suggest that the cubic function is better than the quadratic function to fit the SEDs.
This experiment aimed to investigate the impacts of tributyrin (TB) dietary supplementation on serum biochemical indices and meat quality characteristics of longissimus thoracis et lumborum (LTL) muscle of lambs after weaning. Thirty healthy Small-Tailed Han female lambs (27.5 ± 4.1 kg; mean ± standard deviation) were randomly assigned to five treatments: basal diet (1) without TB, (2) with 0.5 g/kg TB, (3) with 1.0 g/kg TB, (4) with 2.0 g/kg TB or (5) with 4.0 g/kg TB. Each treatment consisted of six lambs, and the lambs were weaned on d 90 and were raised until d 165. Results showed that supplementing TB significantly promoted serum immunoglobulin concentrations of lambs such as immunoglobulins G, A and M. Besides, TB significantly increased muscle ether extract content, intermuscular fat length, pH value and redness but decreased lightness, drip loss and shear force. In addition, TB significantly elevated inosine-5ʹ-phosphate content and upregulated the relative expressions of genes related to lipid metabolism such as SREBP-1C, SCD, PPARγ, FAS and LPL. The mostly important, TB significantly enhanced essential amino acids (EAAs) and conjugated linoleic acids contents of the LTL muscle, despite it decreased total unsaturated fatty acids level. In conclusion, supplementing TB not only could promote the healthy status of weaned lambs via promoting serum immunity but also may improve nutritional quality of LTL muscle by improving EAA and conjugated linoleic acid contents.