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Dignity therapy (DT) is well-established in adults, and it might potentially benefit the younger population. This study aims to develop a pediatric family-based dignity therapy (P-FBDT) protocol for terminally ill children and their families.
Methods
A parallel mixed-methods design was used. The P-FBDT protocol was developed based on the adult DT, and meanwhile by taking children-specific dignity characteristics and Chinese family-oriented culture into consideration. The protocol was then evaluated and modified based on the quantitative and qualitative feedback from 2-round surveys of 14 pediatric oncology or pediatric palliative care experts.
Results
The P-FBDT involves terminally ill children and their families in meaningful interactions including a series of conversations and creative activities, which will be recorded and then edited into a document-based generativity entity. The P-FBDT protocol was recognized as highly reasonable and the P-FBDT interview guide was endorsed as important, acceptable, clear, comprehensive, and suitable to be used in pediatric palliative care practice in Chinese culture (>90%). Potential benefits, possible challenges, and practical considerations of the P-FBDT were also proposed.
Significance of results
The P-FBDT was perceived to be potentially beneficial to terminally ill children and their families by engaging in a series of meaningful family interactions and creating a lasting memento to be preserved. The protocol needs to be pilot tested among terminally ill children and families for feasibility and potential efficacy in practice.
Aphis spiraecola Patch is one of the most economically important tree fruit pests worldwide. The pyrethroid insecticide lambda-cyhalothrin is commonly used to control A. spiraecola. In this 2-year study, we quantified the resistance level of A. spiraecola to lambda-cyhalothrin in different regions of the Shaanxi province, China. The results showed that A. spiraecola had reached extremely high resistance levels with a 174-fold resistance ratio (RR) found in the Xunyi region. In addition, we compared the enzymatic activity and expression level of P450 genes among eight A. spiraecola populations. The P450 activity of A. spiraecola was significantly increased in five regions (Xunyi, Liquan, Fengxiang, Luochuan, and Xinping) compared to susceptible strain (SS). The expression levels of CYP6CY7, CYP6CY14, CYP6CY22, P4504C1-like, P4506a13, CYP4CZ1, CYP380C47, and CYP4CJ2 genes were significantly increased under lambda-cyhalothrin treatment and in the resistant field populations. A L1014F mutation in the sodium channel gene was found and the mutation rate was positively correlated with the LC50 of lambda-cyhalothrin. In conclusion, the levels of lambda-cyhalothrin resistance of A. spiraecola field populations were associated with P450s and L1014F mutations. Our combined findings provide evidence on the resistance mechanism of A. spiraecola to lambda-cyhalothrin and give a theoretical basis for rational and effective control of this pest species.
Childhood maltreatment is an established risk factor for psychopathology. However, it remains unclear how childhood traumatic events relate to mental health problems and how the brain is involved. This study examined the serial mediation effect of brain morphological alterations and emotion-/reward-related functions on linking the relationship from maltreatment to depression. We recruited 156 healthy adolescents and young adults and an additional sample of 31 adolescents with major depressive disorder for assessment of childhood maltreatment, depressive symptoms, cognitive reappraisal and anticipatory/consummatory pleasure. Structural MRI data were acquired to identify maltreatment-related cortical and subcortical morphological differences. The mediation models suggested that emotional maltreatment of abuse and neglect, was respectively associated with increased gray matter volume in the ventral striatum and greater thickness in the middle cingulate cortex. These structural alterations were further related to reduced anticipatory pleasure and disrupted cognitive reappraisal, which contributed to more severe depressive symptoms among healthy individuals. The above mediating effects were not replicated in our clinical group partly due to the small sample size. Preventative interventions can target emotional and reward systems to foster resilience and reduce the likelihood of future psychiatric disorders among individuals with a history of maltreatment.
Modification of the surfaces of montmorillonite (Mnt) by organic molecules is an effective method for improving their affinity toward non-aqueous substances, and has resulted in extensive industrial applications as rheological control agents, drilling fluids, and other functional materials used in applications ranging from environmental remediation to coatings. The present study reviewed recent progress in organo-modification of Mnt, and provides state-of-the-art insights into proposed modification mechanisms and the peculiar functionalities of the resulting organo-montmorillonite (OMnt). Several routes have been employed to modify Mnt, including ion exchange with organic ions, surface adsorption, and grafting of organics. Commonly used organic modifiers include cationic, anionic, zwitterionic, non-ionic, and polymeric species. Organo-modification is driven by multiple interactions: van der Waals forces, cation exchange, electrostatic interaction, hydrogen bonds, and ion–dipole interaction. OMnt, in general, exhibits synergistic and/or antagonistic effects when used in oil-based drilling fluids, environmental remediation, or layered silicate/polymer nanocomposites. The detailed mechanisms of non-ionic and zwitterionic modification of Mnt remain unclear. This literature survey suggests that future work should emphasize deeper understanding of interactions between the Mnt and the organic modifiers, and meanwhile expand the applications of OMnt into catalysis, drug carriers, and the biomedical field.
This study aimed to investigate the characteristics and prognosis of patients with alcoholic Marchiafava–Bignami disease (MBD), a rare neurological disorder commonly associated with chronic alcoholism, in Chongqing, China.
Methods:
We conducted a retrospective analysis of clinical data from 21 alcoholic MBD patients treated at the First Affiliated Hospital of Chongqing University between 2012 and 2022.
Results:
The study included 21 patients with alcoholic MBD who had a mean age of 59 ± 9.86 years and an average drinking history of 35.48 ± 8.65 years. Acute onset was observed in 14 (66.7%) patients. The primary clinical signs observed were psychiatric disorders (66.7%), altered consciousness (61.9%), cognitive disorders (61.9%), and seizures (42.9%). Magnetic resonance imaging revealed long T1 and long T2 signal changes in the corpus callosum, with lesions predominantly found in the genu (76.2%) and splenium (71.4%) of the corpus callosum. The poor prognosis group demonstrated an increased incidence of altered consciousness (100% vs 50%, P = 0.044), pyramidal signs (80% vs 18.8%, P = 0.011), and pneumonia (100% vs 31.3%, P = 0.007). Patients with a longer drinking history (45.0 ± 10.0 years vs 32.69 ± 5.99 years, p = 0.008) and a lower thiamine dose (p = 0.035) had a poorer prognosis at 1 year.
Conclusions:
This study identified altered consciousness, pyramidal signs, and pneumonia as predictors of a poor prognosis in patients with alcoholic MBD. A longer duration of alcohol consumption and inadequate thiamine supplementation were associated with a poorer prognosis.
The age-related heterogeneity in major depressive disorder (MDD) has received significant attention. However, the neural mechanisms underlying such heterogeneity still need further investigation. This study aimed to explore the common and distinct functional brain abnormalities across different age groups of MDD patients from a large-sample, multicenter analysis.
Methods
The analyzed sample consisted of a total of 1238 individuals including 617 MDD patients (108 adolescents, 12–17 years old; 411 early-middle adults, 18–54 years old; and 98 late adults, > = 55 years old) and 621 demographically matched healthy controls (60 adolescents, 449 early-middle adults, and 112 late adults). MDD-related abnormalities in brain functional connectivity (FC) patterns were investigated in each age group separately and using the whole pooled sample, respectively.
Results
We found shared FC reductions among the sensorimotor, visual, and auditory networks across all three age groups of MDD patients. Furthermore, adolescent patients uniquely exhibited increased sensorimotor-subcortical FC; early-middle adult patients uniquely exhibited decreased visual-subcortical FC; and late adult patients uniquely exhibited wide FC reductions within the subcortical, default-mode, cingulo-opercular, and attention networks. Analysis of covariance models using the whole pooled sample further revealed: (1) significant main effects of age group on FCs within most brain networks, suggesting that they are decreased with aging; and (2) a significant age group × MDD diagnosis interaction on FC within the default-mode network, which may be reflective of an accelerated aging-related decline in default-mode FCs.
Conclusions
To summarize, these findings may deepen our understanding of the age-related biological and clinical heterogeneity in MDD.
The question of whether narcissists are more creative than peers has attracted much scholarly attention in both psychology and organizational management sciences. Drawing from social cognitive theory, we theorized that the relationship between narcissism and creativity could be explained by individual creative self-efficacy, which depends on one's direct and vicarious experiences of creativity. Drawing from trait activation theory, we further proposed organizational valuing of creativity as a key contextual moderator that determines whether narcissism facilitates or inhibits creative self-efficacy and, in turn, creativity. We suggest that high organizational valuing of creativity will energize narcissists to put their attention and effort into both direct and vicarious experiences of creativity, enhancing their creative self-efficacy and creativity. We tested our conceptual model through a field study with data collected from 269 full-time employees working in 86 work teams. The empirical results provided support for the social cognitive explanation for the positive relationship between narcissism and creativity in the context of high organizational valuing of creativity. Our study not only resolved prior debates on the relationship between narcissism and creativity but also provided direct empirical support for social cognitive theory and the person-in-context interactionist perspective of creativity research.
This study aims to explore clinicians’ practices and attitudes regarding advance care planning (ACP) in mainland China.
Methods
This study was a multicenter cross-sectional survey. Clinicians from tertiary hospitals in Beijing, Guangxi, and Inner Mongolia were invited to participate in the study. A questionnaire was formulated based on related literature to obtain information including demographic characteristics, and practices and attitudes toward ACP.
Results
The total number of participants included 285 clinicians. The data response rate was 84.57%. Most of the clinicians had an inadequate understanding of ACP. Only a few clinicians had experience in participating or witnessing an ACP or related end-of-life discussions. Among 285 clinicians, 69.82% of clinicians were willing to introduce ACP to patients. Two hundred and thirty-eight (83.51%) clinicians wanted more education on ACP. Almost all clinicians believed that patients had the right to know about their diagnosis, prognosis, and available care options. Most clinicians (82.11%) regarded that ACP was partially feasible in mainland China. If clinicians had a serious illness, almost everyone was willing to find out their true health status and decide for themselves, and 81.40% wanted to institute an ACP for themselves. The biggest barriers to the use of ACP in mainland China were cultural factors. Statistical analysis revealed that some or good understanding level (P = 0.0052) and practical experience (P = 0.0127) of ACP were associated with the positive willingness.
Significance of results
ACP is still in its infancy in mainland China. Clinicians had inadequate understanding and minimal exposure to ACP. Most clinicians recognized the value and significance of ACP and had a positive attitude toward ACP. Clinicians need to be provided with education and training to promote their ACP practices. Culturally appropriate ACP processes and documents need to be developed based on Chinese culture and Chinese needs.
The ongoing global pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and significantly impacts the world economy and daily life. Symptoms of COVID-19 range from asymptomatic to fever, dyspnoea, acute respiratory distress and multiple organ failure. Critical cases often occur in the elderly and patients with pre-existing conditions. By binding to the angiotensin-converting enzyme 2 receptor, SARS-CoV-2 can enter and replicate in the host cell, exerting a cytotoxic effect and causing local and systemic inflammation. Currently, there is no specific treatment for COVID-19, and immunotherapy has consistently attracted attention because of its essential role in boosting host immunity to the virus and reducing overwhelming inflammation. In this review, we summarise the immunopathogenic features of COVID-19 and highlight recent advances in immunotherapy to illuminate ideas for the development of new potential therapies.
To explore the changes in quality of life from the acute hospitalization period to 6 months after discharge in patients with first-ever ischemic stroke and to identify the association between resilience and the course of quality of life.
Design:
A prospective longitudinal cohort study.
Setting:
This study was conducted in Shanghai, China.
Participants:
Two hundred and seventeen stroke patients were recruited for an initial questionnaire survey from two tertiary hospitals from February 2017 to January 2018.
Intervention:
None.
Measurements:
Quality of life was measured using the Stroke Scale Quality of Life. Resilience was assessed using the Connor–Davidson Resilience Scale. Other validated measurement instruments included the modified Rankin Scale and Hospital Anxiety and Depression Scale. A multilevel model was used for the analysis of repeated measurements and to determine the association between resilience and quality of life.
Results:
Quality of life scores significantly improved over the 6 months after discharge (B = 7.31, p < .0001). The multilevel model indicated that resilience was positively correlated with the course of quality of life (B = .133, p < .0001), independent of stroke severity (B = −.051, p = .0006), neurological function (B = −.577, p < .0001), hospitalization days (B = .023, p = .0099), anxiety (B = −.100, p =< .0001), depression (B = −.149, p < .0001), time (B = .360, p < .0001), and the interactions of time with hospitalization days (B = −.008, p = .0002), neurological function (B = .021, p < .0024), depression (B = −.014, p = .0273), and time (B = −.031, p < .0001).
Conclusions:
Resilience played an important role in predicting the self-reported course of quality of life in stroke patients. Our findings emphasized the reasonableness and importance of developing suitable resilience-targeted clinical strategies for improving prognosis in stroke patients.
The time to positivity (TTP) of blood cultures has been considered a predictor of clinical outcomes for bacteremia. This retrospective study aimed to determine the clinical value of TTP for the prognostic assessment of patients with Escherichia coli bacteremia. A total of 167 adult patients with E.coli bacteremia identified over a 22-month period in a 3500-bed university teaching hospital in China were studied. The standard cut-off TTP was 11 h in the patient cohort. The septic shock occurred in 27.9% of patients with early TTP (⩽11 h) and in 7.1% of those with a prolonged TTP (>11 h) (P = 0.003). The mortality rate was significantly higher for patients in the early than in the late group (17.7% vs. 4.0%, P < 0.001). Multivariate analysis showed that an early TTP (OR 4.50, 95% CI 1.70–11.93), intensive care unit admission (OR 8.39, 95% CI 2.01–35.14) and neutropenia (OR 4.20, 95% CI 1.55–11.40) were independently associated with septic shock. Likewise, the independent risk factors for mortality of patients were an early TTP (OR 3.80, 95% CI 1.04–12.90), intensive care unit admission (OR 6.45; 95% CI 1.14–36.53), a Pittsburgh bacteremia score ⩾2 (OR 4.34, 95% CI 1.22–15.47) and a Charlson Comorbidity Index ⩾3 (OR 11.29, 95% CI 2.81–45.39). Overall, a TTP for blood cultures within 11 h appears to be associated with worse outcomes for patients with E.coli bacteremia.
Since the first report of the 2019 novel coronavirus disease (COVID-19) in December 2019 in Wuhan, China, the outbreak of the disease has been continuously evolving. Until March 17, 2020, 185, 178 cases had been confirmed, including 81,134 cases in China and 104,044 cases outside of China. In this comment, we report the unexpected beneficial effect of a deployable rapid-assembly shelter hospital on the prevention and treatment of COVID-19. We describe the shelter hospital maintenance, treatment mode and primary treatment methods, which will provide a valuable experience in dealing with public health emergencies, such as COVID-19, for other countries and areas.
Compared with traditional stainless steels, high nitrogen stainless steels (HNSS), have been widely used due to their high strength, toughness along with excellent corrosion resistance and low cost, formed by partial replacement of Ni (austenite-forming element) by N. The evolution of the microstructure of a Cr19Mn19Mo2N0.7 stainless steel is investigated after solution treatment at 1010, 1060, 1200 or 1250°C for 30min. A complex multilayer structure has been found under a negative pressure vacuum. A white ferritic layer at the surface is formed, and a subsurface layer with full austenitic structure and a bulk microstructure comprising of austenite and ferrite are detected. With increasing solution temperature, the surface layer thickness increases. The formation of the multilayer structure is attributed to an outward diffusion, a diffusive retardation and an abnormal accumulation of nitrogen during solution treatment.
For a multiplier Hopf algebra pairing 〈A,B〉, we construct a class of group-cograded multiplier Hopf algebras D(A,B), generalizing the classical construction of finite dimensional Hopf algebras introduced by Panaite and Staic Mihai [Isr. J. Math. 158 (2007), 349–365]. Furthermore, if the multiplier Hopf algebra pairing admits a canonical multiplier in M(B⊗A) we show the existence of quasitriangular structure on D(A,B). As an application, some special cases and examples are provided.
This study was designed to explore the association between undernutrition in the growth period and cardiovascular risk factors in a middle-aged Chinese population. A total of 1756 subjects, aged 45–60 years, were invited to participate in the Hefei Nutrition and Health Study and divided into three groups according to their self-reported animal food intake in the growth period. Group 1, Group 2 and Group 3 were defined as undernutrition, nutritional improvement and the good nutrition group, respectively. In the three groups, the subjects in Groups 1 and 2 had more oil and salt intake (P<0.001), and less eggs and milk intake (P<0.001), when compared with the subjects in Group 3. After adjusting for age, education, smoking status and other confounding factors, it was found that male participants who experienced nutritional improvement before age 18 had higher risk of hypertension [odds ratio (OR)=1.68; 95% confidence intervals (CI): 1.05, 2.69] than those with good nutrition, and female participants with undernutrition (OR=1.52; 95% CI: 1.01, 2.29) and nutritional improvement (OR=1.68; 95% CI: 1.04, 2.69) before age 18 had a higher risk of hypertension than those with good nutrition. For diabetes, obesity, hypercholesterolemia and hypertriglyceridemia, our results did not found difference among the three groups both in male and female. Our findings indicated that nutritional deficiency in childhood was associated with bad dietary behaviors and a significantly increased risk of hypertension in middle age. Therefore, early adequate nutrition is very important for the prevention of non-communicable diseases later.
In the new generation of Global Navigation Satellite Systems (GNSS), dual-frequency constant envelope multiplexing is widely desired and is becoming an important subject in signal design. Considerable work has been devoted to multiplexing for the Alternative Binary Offset Carrier (AltBOC)-like signal model, for which each sideband consists of two or fewer signal components. In this paper, a phase-aligned dual-frequency constant envelope multiplexing technique is proposed for a general dual-frequency signal model. This multiplexing technique can be used to combine two constant-envelope-modulated signals in two sidebands into a composite signal with a constant envelope, where the constant-envelope-modulated signal in each sideband consists of an arbitrary number of signal components with an arbitrary power ratio and phase relationship among the signal components. A Lookup Table (LUT)-based signal generation method is also proposed, for which the required driving clock rate of the signal generator can be flexibly adjusted to meet the requirements of the satellite payload. Applications for the AltBOC-like signal model and a general dual-frequency signal model in the Beidou B1 band validate the flexibility and high multiplexing efficiency of our method. Specifically, AltBOC is a special case of the proposed method.
The Palaeolithic sequence of East Asia differs from that of western Eurasia in that it is characterised by core-and-flake tools. Blade industries only appear late in the sequence, long after the first appearance of modern humans; bone tools and personal ornaments may therefore function as a better marker of modern human presence. Longquan Cave provides vital new evidence to this effect, with dated hearths indicating an initial occupation around 40 kya cal BP, followed by a second period of activity around 35–31 kya cal BP. They are associated with a polished bone awl and a structured division of settlement space, features typically associated with modern humans.
Alternative Binary Offset Carrier (AltBOC) modulation signal has the constraint of an equal power allocation scheme. Thus, it is not flexible enough to meet different requirements. To solve this problem, we propose a General AltBOC (GAltBOC) modulation. The proposed technique can achieve the same function as AltBOC. Meanwhile, its power allocation ratio can be adjusted when required. The detailed derivation of the GAltBOC modulation is presented, and three representative cases as well as the signal properties are discussed. To further improve the combination efficiency, we develop the Interlacing GAltBOC (IGAltBOC) modulation based on the GAltBOC modulation. The Power Spectrum Density (PSD) and correlation functions of the proposed signals are verified by simulation. The code tracking error and implementation complexities are analysed and compared with existing methods. Results show the proposed signals indeed enhance the flexibility of power allocation ratio with the same level code tracking accuracy. Compared with AltBOC modulation, the proposed signal can reach a higher combination efficiency at the expense of relatively higher implementation complexity. Compared with Asymmetric Constant Envelope Double-sideband (ACED) modulation, the proposed signals have significantly lower complexity of signal generation, which is helpful in simplifying the signal generation in the payload transmitter.
Surface properties affect the attachment of micro- and macroscopic marine organisms. The current study examined the settlement response of the mussel Mytilus coruscus plantigrades to natural biofilms formed on surfaces of different wettability. The percentages of plantigrade settlement were not influenced by the biofilms formed on variously wettable surfaces in the short term, but after 10 days, the plantigrade settlement rates decreased on biofilms formed on lower wettability surfaces. In general, lower wettability of the surfaces resulted in the decrease of the dry weight, bacterial and diatom density and the thickness of natural biofilms when compared to high wettability surfaces. In contrast, chlorophyll-a concentration in biofilms was independent of the initial wettability of the surfaces. Comparative cluster analysis of bacterial denaturing gradient gel electrophoresis patterns revealed that high variability existed between the bacterial community on high wettability surfaces and that on low wettability surfaces. Thus, surface wettability affects the formation of natural biofilms, and this variation in biofilms developed on different wettability surfaces may explain the discrepancy in their corresponding inducing activities on M. coruscus plantigrade settlement. This finding provides new insight into interactions between mussel settlement, biofilm characteristics and surface properties.
Flexible surface acoustic wave (SAW) based temperature and humidity sensors were fabricated and characterized. ZnO piezoelectric films were deposited on polyimide substrates by DC magnetron sputtering. ZnO films possess (0002) crystal orientation with large grain sizes of 50∼70 nm. SAW devices showed two wave modes, namely the Rayleigh and Lamb modes, with the frequencies at fR ∼132MHz and fL∼427MHz respectively for a wavelength of 12 μm device. The two resonant frequencies have a temperature coefficient of frequency (TCF) of −423ppm/K and −258ppm/K for the Rayleigh and Lamb waves, respectively. The SAW sensors exhibited a good repeatability in responding to cyclic change of humidity. The responses of the sensors increase with the increase in humidity, and the sensitivity increases with the decrease in wavelength. A high sensitivity of 34.7 kHz/10%RH has been obtained from a SAW device without any surface treatment, demonstrated that the flexible SAW humidity sensors are very promising for application in flexible sensors and microsystems.