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Triceps skinfold thickness (TSF) is a surrogate marker of subcutaneous fat. Evidence is limited about the association of sex-specific TSF with the risk of all-cause mortality among maintenance hemodialysis (MHD) patients. We aimed to investigate the longitudinal relationship of TSF with all-cause mortality among MHD patients. A multicenter prospective cohort study was performed in 1034 patients undergoing MHD. The primary outcome was all-cause mortality. Multivariable Cox proportional hazards models were used to evaluate the association of TSF with the risk of mortality. The mean (standard deviation) age of the study population was 54.1 (15.1) years. 599 (57.9%) of the participants were male. The median (interquartile range) of TSF was 9.7 (6.3–13.3 mm) in males and 12.7 (10.0–18.0 mm) in females. Over a median follow up of 4.4 years (interquartile range, 2.4-7.9 years), there were 548 (53.0%) deaths. When TSF was assessed as sex-specific quartiles, compared with those in quartile 1, the adjusted HRs (95%CIs) of all-cause mortality in quartile 2, quartile 3 and quartile 4 were 0.93 (0.73, 1.19), 0.75 (0.58, 0.97) and 0.69 (0.52, 0.92), respectively (P for trend =0.005). Moreover, when analyzed by sex, increased TSF (≥9.7 mm for males and ≥18mm for females) was significantly associated with a reduced risk of all-cause mortality (quartile 3-4 vs. quartile 1-2; HR, 0.70; 95%CI: 0.55, 0.90 in males; quartile 4 vs. Quartile 1-3; HR, 0.69; 95%CI: 0.48, 1.00 in females). In conclusion, high TSF was significantly associated with lower risk of all-cause mortality in MHD patients.
China formally pledged to peak its carbon emissions within 10 years and achieve carbon neutrality within 30 years thereafter. Considering the numerous challenges and difficulties ahead, it is essential for China to strengthen the building of climate governance systems toward carbon neutrality. This paper examines the interactions between elements of China's climate governance system, and develops a theoretical framework for China's climate governance toward carbon neutrality, with a view to providing more comprehensive information for decision-making.
Technical Summary
China's high ambitions to peak carbon emissions by 2030 and to achieve carbon neutrality by 2060 make climate governance an urgent issue. Against this background, this paper develops a TAM (‘Target, Actor, Mechanism’) theoretical framework for China's climate governance toward carbon neutrality, intending to provide information for decision-making. This framework, centering on governance actors, is based on two key assumptions: First, the stance of each actor toward a climate action depends on the impact of this action on the actor's objectives and the weight of these objectives to this actor; Second, the most feasible governance mechanism is the solution that can best satisfy actors' objective with the greatest decision-making influence. Applying this framework in case studies involves three major steps: (1) Identifying China's climate governance actions according to transition pathways toward carbon neutrality; (2) Assessing the effects of climate actions on the objective of relevant actors; (3) Obtaining feasible governance mechanisms based on historical institutionalism analysis. By linking different climate governance research methodologies, this theoretical framework can provide decision-makers with more comprehensive information on climate governance.
Social media summary
Integrating quantitative models with institutionalism can bridge the gap between policy formulation and implementation.
To meet the demands of laser-ion acceleration at a high repetition rate, we have developed a comprehensive diagnostic system for real-time and in situ monitoring of liquid sheet targets (LSTs). The spatially resolved rapid characterizations of an LST’s thickness, flatness, tilt angle and position are fulfilled by different subsystems with high accuracy. With the help of the diagnostic system, we reveal the dependence of thickness distribution on collision parameters and report the 238-nm liquid sheet generated by the collision of two liquid jets. Control methods for the flatness and tilt angle of LSTs have also been provided, which are essential for applications of laser-driven ion acceleration and others.
Here, we report the generation of MeV alpha-particles from H-11B fusion initiated by laser-accelerated boron ions. Boron ions with maximum energy of 6 MeV and fluence of 109/MeV/sr@5 MeV were generated from 60 nm-thick self-supporting boron nanofoils irradiated by 1 J femtosecond pulses at an intensity of 1019 W/cm2. By bombarding secondary hydrogenous targets with the boron ions, 3 × 105/sr alpha-particles from H-11B fusion were registered, which is consistent with the theoretical yield calculated from the measured boron energy spectra. Our results demonstrated an alternative way toward ultrashort MeV alpha-particle sources employing compact femtosecond lasers. The ion acceleration and product measurement scheme are referential for the studies on the ion stopping power and cross section of the H-11B reaction in solid or plasma.
In the soils of western Jilin Province in northeastern China, some significant gaps have been observed between the fraction of the soil existing as clay-size particles (<0.002 mm) and the amount attributable to crystalline clay minerals, and that the relative proportions of crystalline clay minerals to the total clay-size fraction (CP) apparently varies with latitude. The purpose of the present study was to identify the reason for this discrepancy and to explain the dependence on latitude. The grain sizes and mineral compositions of the whole soils from western Jilin Province, China, were analyzed by laser particle-size analysis (LPSA) and X-ray diffraction (XRD), and the <0.002 mm particle-size fraction was analyzed by XRD and X-ray fluorescence (XRF). The results confirmed that the percentage gaps between the clay fraction and clay minerals increased with increasing latitude. The theoretical illite percentage calculated from K2O content was compared with the illite percentage measured by XRD, and the results suggested that the measured illite accounted for only a small proportion of the theoretical illite. Structures of some special minerals below the identification threshold of XRD was suggested to be the reason for the percent gaps. The grain size and mineral crystallization both changed with latitude: the soil particle size and the CP decreased. In addition, clay minerals were more sensitive to climate than particle sizes were, and the CP of clay minerals in the soils within 0~180 cm depth all decreased with increasing latitude; however, the grain size showed patterns with latitude only in relatively shallow soil layers. The present study provides a reference and error analysis for the testing of clay minerals in alpine regions, and more suitable methods may be considered for development of clay-mineral testing in future studies.
In order to develop high-performance adsorbents to remove toxic methylene blue (MB) from wastewater, palygorskite (Plg) was utilized as a template to prepare palygorskite/carbon (Plg/C) composites by using a hydrothermal reaction in the presence of glucose. The porous Plg/C composites were then activated with ZnCl2. The effects of the dose of the activator and the activation temperature on the crystal structure, micro-morphology, specific surface area, and adsorption performance of the porous Plg/C composites were studied systematically here. X-ray diffraction (XRD) and scanning electron microscopy (SEM) results indicated that the crystal structure of Plg was destroyed during the activation process and irregular porous carbon was closely attached to the residual aluminosilicate skeleton. The activation was optimized at 400°C with a ZnCl2:Plg/C impregnation ratio of 2:1. The sample had a specific surface area of 1497.88 m2/g, together with a total pore volume and micropore volume of 1.0355 and 0.5464 cm3/g, respectively. The MB adsorption capacity was 381.04 mg/g. Such inexpensive, high-performance, porous Plg/C composites could find potential applications in wastewater treatment.
Post-acceleration of protons in helical coil targets driven by intense, ultrashort laser pulses can enhance ion energy by utilizing the transient current from the targets’ self-discharge. The acceleration length of protons can exceed a few millimeters, and the acceleration gradient is of the order of GeV/m. How to ensure the synchronization between the accelerating electric field and the protons is a crucial problem for efficient post-acceleration. In this paper, we study how the electric field mismatch induced by current dispersion affects the synchronous acceleration of protons. We propose a scheme using a two-stage helical coil to control the current dispersion. With optimized parameters, the energy gain of protons is increased by four times. Proton energy is expected to reach 45 MeV using a hundreds-of-terawatts laser, or more than 100 MeV using a petawatt laser, by controlling the current dispersion.
This paper presents a gait optimization method to generate the locomotion pattern for biped and discuss its stability. The main contribution of this paper is a newly proposed energy-based stability criterion, which permits the dynamic stable walking and could be straight-forwardly generalized to different locomotion scenarios and biped robots. The gait optimization problem is formulated subject to the constraints of the whole-body dynamics and kinematics. The constraints are established based on the modelling of bipedal hybrid dynamical systems. Following the whole-body modelling, the system energy is acquired and then applied to create the stability criterion. The optimization objective is also established on the system energy. The gait optimization is solved by being converted to a large-scale programming problem, where the transcription accuracy is improved via the spectral method. To further reduce the dimensionality of the large-scale problem, the whole-body dynamics is re-constructed. The generalization of the optimized gait is improved by the design of feedback control. The optimization examples demonstrate that the stability criterion naturally leads to a cyclic biped locomotion, though the periodicity was not previously imposed. Two simulation cases, level ground walking and slope walking, verify the generalization of the stability criterion and feedback control. The stability analyses are carried out by investigating the motions of centre of gravity and centre of pressure. It is revealed that if the tracked speed is above 0.3 m/s or the biped accelerates/climbs the slope, the stability criterion accomplishes the dynamic stable walking, where zero moment point criterion is not strictly complied.
Schizophrenia is a complex mental disorder with a chronic course. The atypical antipsychotics represented by lurasidone are commonly used in chronic schizophrenia, and its mechanism of action determines the superiority of efficacy and safety. However so far, there are still some adverse reactions, of which the more significant are lethargy, nausea, and sedentary inability. In view of these situations, we will combine nutrition intervention with the use of lurasidone to eliminate adverse reactions and provide help for the formulation of treatment plans.
Subjects and Methods
The study will be based on whether to add nutrition intervention as a difference set up control experiment, the experimental group using lurasidone combined nutrition intervention, the control group using lurasidone single factor intervention. The patients who received treatment in the psychiatric department of our hospital from March 2021 to March 2022 were selected as the research objects, and the efficacy and adverse reactions of the patients were monitored during the treatment. The efficacy will be judged by the medical scale of symptom severity of patients with schizophrenia (Positive and Negative Syndrome Scale, PANSS) and the monitoring data will be statistically analyzed by SPSS.
Results
With the treatment, the results of the Experimental group and the control group are shown in Table 1. The PANSS scores of the two groups finally reached a range of 30-40, with a difference of 4. The incidence of nausea, lethargy and sedentary disorder in adverse symptoms was higher in the control group, and the difference was statistically significant (P < 0.05). It shows that nutritional intervention cannot affect the efficacy of psychosis itself, yet can alleviate the adverse symptoms after medication.Table 1.
Efficacy and adverse reactions of the two groups
Group
PANSS
Nausea
Somnolence
Sedentary disorder
Experimental group (n=46)
32.3±4.1
3(6.5%)
4(8.7%)
2(4.3%)
Control group (n=41)
36.3±5.2
8(19.5%)
6(14.6%)
5(12.2%)
P
>0.05
<0.05
<0.05
<0.05
Conclusions
The group of schizophrenics is not limited to a certain age. Therefore, adverse symptoms caused by psychotropic drugs need to be considered in the practice. Symptoms in the course of the patient’s disease can be used as a treatment optimization path. Although the nutrition intervention strategy has no direct impact on the indicators of mental illness, the prevention of adverse symptoms during treatment can improve the actual experience of patients. In the future, the nutrition strategy will be adaptively optimized to improve the rehabilitation effect of chronic schizophrenia.
Acknowledgements
The research is supported by: Key Discipline of Nutrition and Food Hygiene of Changsha Medical university Quality Engineering Construction Project+2016; Study on Intervention Effect of Mindfulness Acceptance Stress Project on Nurses Aid to COVID-19+Outstanding Youth Project of Scientific Research of Hunan Education Department +2020(264)20B070.
Discourse analysis is one of the clinical methods commonly used to assess the language ability of individuals with traumatic brain injury (TBI). However, the majority of published analytic frameworks are not geared for highlighting the pragmatic aspect of discourse deficits in acquired language disorders, except for those designed for quantifying conversational samples. This study aimed to examine how pragmatic competence is impaired and reflected in spoken monologues in Chinese speakers with TBI.
Methods:
Discourse samples of five tasks (personal narrative, storytelling, procedural, single- and sequential picture description) were elicited from ten TBI survivors and their controls. Each discourse sample was measured using 16 indices (e.g., number of informative words, percentage of local/global coherence errors, repeated words or phrases) that corresponded to the four Gricean maxims. Twenty-five naïve Chinese speakers were also recruited to perform perceptual rating of the quality of all 50 TBI audio files (five discourse samples per TBI participant), in terms of erroneous/inaccurate information, adequacy of amount of information given, as well as degree of organization and clarity.
Results:
The maxim of quantity best predicted TBI’s pragmatic impairments. Naïve listeners’ perception of pragmatics deficits correlated to measures on total and informative words, as well as number and length of terminable units. Clinically, personal narrative and storytelling tasks could better elicit violations in pragmatics.
Conclusion:
Applying Gricean maxims in monologic oral narratives could capture the hallmark underlying pragmatic problems in TBI. This may help provide an additional approach of clinically assessing social communications in and subsequent management of TBI.
High fibre intake is associated with reduced mortality risk in both general and chronic kidney disease populations. However, in dialysis patients, such data are limited. Therefore, the association between dietary fibre intake (DFI) and the risk of all-cause and CVD mortality was examined in this study. A total of 1044 maintenance haemodialysis (MHD) patients from eight outpatient dialysis centres in China were included in this study. Data on DFI were collected using 24-h dietary recalls for 3 d in a week and were normalised to actual dry weight. The study outcomes included all-cause and CVD mortality. Over a median of 46 months of follow-up, 354 deaths were recorded, of which 210 (59 %) were due to CVD. On assessing DFI as tertiles, the CVD mortality risk was significantly lower in patients in tertiles 2–3 (≥0·13 g/kg per d; hazard ratio (HR) 0·71; 95 % CI 0·51, 0·97) compared with those in tertile 1 (<0·13 g/kg per d). A similar but non-significant trend was found for the association between DFI (tertiles 2–3 v. tertile 1; HR 0·83; 95 % CI 0·64, 1·07) and all-cause mortality. In summary, higher DFI was associated with lower CVD mortality risk among Chinese MHD patients. This study emphasises the significance of DFI in MHD patients and provides information that is critical for the improvement of dietary guidelines for dialysis patients.
The razor clam, Sinonovacula constricta, contains high levels of long-chain PUFA (LC-PUFA), which are critical for human health. In addition, S. constricta is the first marine mollusc demonstrated to possess Δ6 fatty acyl desaturase (Fad) and complete LC-PUFA biosynthetic ability, providing a good representative to investigate the molecular mechanism of sterol regulatory element binding proteins (SREBP) in regulating Δ6 Fad for LC-PUFA biosynthesis in marine molluscs. Herein, S. constricta SREBP and Δ6 Fad promoter were cloned and characterised. Subsequently, dual luciferase and electrophoretic mobility shift assays were conducted to explore the SREBP binding elements in the core regulatory region of S. constricta Δ6 Fad promoter. Results showed that S. constricta SREBP had a very conservative basic helix-loop-helix-leucine zipper motif, while S. constricta Δ6 Fad promoter exhibited very poor identity with teleost Fads2 promoters, indicating their differentiation during evolution. A 454 bp region harbouring a core sequence in S. constricta Δ6 Fad promoter was predicted to be essential for the transcriptional activation by SREBP. This was the first report on the regulatory mechanism of LC-PUFA biosynthesis in marine molluscs, which would facilitate optimising the LC-PUFA biosynthetic pathway of bivalves in further studies.
The surface topology of biomaterial has a definite effect on the growth behavior of nerve cells for peripheral nerve regeneration. In this study, the silk fibroin (SF) film with different anisotropic microgroove/ridge was constructed by micropatterning technology. The effects of topologies width on the directional growth of dorsal root ganglion (DRG) neurons were evaluated. The results showed that the topological structure of the SF film with higher SF concentration was more clear and complete. The microtopography of the SF film with a concentration of 15% and a groove width of around 30 μm could effectively guide the directional growth of the nerve fibers of DRG. And nerve fibers could obviously form nerve fiber bundles which may have a certain pavement effect on the recovery of nerve function. The study indicated that the SF film with a specific width of the topological structure may have potential applications in the field of directional nerve regeneration.
Maintenance haemodialysis (MHD) is the use of a machine to filter wastes, salts and fluid from blood for at least 3 months to prolong the life of patients with advanced kidney failure. Although low dietary energy intake (DEI) has been observed in MHD patients, few studies have related DEI to the risk of mortality. To explore this relationship, a study included 1039 MHD patients from eight centres was conducted. DEI was assessed by three 24-h diet recalls and was normalised to ideal body weight (IBW). All-cause mortality and CVD mortality were the primary and secondary outcomes, respectively. During a median follow-up of 28 months, a U-shaped relationship was observed between DEI and all-cause or CVD mortality. The risk of all-cause mortality decreased significantly with the increase of DEI in participants with DEI <167·4 kJ/kg IBW per d (hazard ratio (HR) 0·98; 95 % CI 0·96, 1·00) and increased significantly with the increase of DEI in those with DEI ≥167·4 kJ/kg IBW per d (HR 1·12; 95 % CI 1·04, 1·20). Similarly, the risk of CVD mortality decreased with the increase of DEI in participants with DEI <152·7 kJ/kg IBW per d (HR 0·96; 95 % CI 0·93, 0·99) and increased with the increase of DEI in participants with DEI ≥152·7 kJ/kg IBW per d (HR 1·11; 95 % CI 1·04, 1·18). In summary, there was a U-shaped association between DEI and all-cause or CVD mortality, with a turning point at about 167·4 and 152·7 kJ/kg IBW per d, respectively, in MHD patients.
North Korea is a unique regime that has not followed the ‘mono-transition’ path (economic reform under modified one-party rule) of other surviving communist regimes (China, Vietnam, Cuba) in the post-Cold War era. Debates over North Korea's unique features (reluctance in economic reform, absence of political modification, international troublemaking) have generated two contending interpretations. The mainstream interpretation attributes North Korea's uniqueness to its regime's highly rigid political system (‘monolithic leadership system’). For the alternative interpretation, structural pressures and political calculus have driven the monolithic regime towards economic reform (‘marketization from above’), making it more convergent with the ‘mono-transition’ regimes, at least in the economic aspect. In support of the latter interpretation, this article will delve further into three contentious issues that represent the most common doubts about the advance of marketization in North Korea. First, how can the regime reconcile marketization with the interests of its ‘core constituencies’? Second, since ‘crony socialism’ exists, how does it influence distribution and productive activity? Third, how does marketization advance in view of the persistence of monolithic rule? In so doing, it will show how the sources of economic reform (structural factors and political calculus) have enabled the marketization constraints to be overcome.
An in-house self-held respiration monitoring device (SHRMD) was developed for providing deep inspiration breath hold (DIBH) radiotherapy. The use of SHRMD is evaluated in terms of reproducibility, stability and heart dose reduction.
Methods and materials:
Sixteen patients receiving radiotherapy of left breast cancer were planned for treatment with both a free breathing (FB) scan and a DIBH scan. Both FB and DIBH plans were generated for comparison of the heart, left anterior descending (LAD) artery and lung dose. All patients received their treatments with DIBH using SHRMD. Megavoltage cine images were acquired during treatments for evaluating the reproducibility and stability of treatment position using SHRMD.
Results:
Compared with FB plans, the maximum dose to the heart by DIBH technique with SHRMD was reduced by 29·9 ± 15·6%; and the maximum dose of the LAD artery was reduced by 41·6 ± 18·3%. The inter-fractional overall mean error was 0·01 cm and the intra-fractional overall mean error was 0·04 cm.
Conclusion:
This study demonstrated the potential benefits of using the SHRMD for DIBH to reduce the heart and LAD dose. The patients were able to perform stable and reproducible DIBHs.
A bimetallic metal–organic frameworks (MOFs)-templated strategy was developed to fabricate mesoporous CdxZn1−xS polyhedrons with improved photocatalytic hydrogen evolution activity, and the formation mechanism of these mesoporous polyhedrons was discussed in detail. Incorporating Cd atoms, the Brunauer–Emmett–Teller surface areas of mesoporous CdxZn1−xS polyhedrons were significantly increased (271 m2/g), providing more exposed active sites compared with ZnS. In addition, suitable conduction band potential (< −0.55 eV) of the mesoporous CdxZn1−xS polyhedrons was also beneficial for the photocatalysis. Impressively, by the co-effects of mesoporous structure and modified conduction band, the mesoporous CdxZn1−xS polyhedrons exhibited better photocatalytic activity for hydrogen evolution than most reported photocatalysts without noble metals. The maximum hydrogen evolution rate of the CSZ3 reached 4.10 mmol/(h g) under visible-light irradiation and without any cocatalyst condition. This facile strategy for the construction of mesoporous CdxZn1−xS polyhedrons provided a deep insight to fabricate other metal sulfides for a variety of photochemical applications.
CrFeNiTix (x = 0.2, 0.3, 0.4, 0.5, and 0.6 molar ratio) compositionally complex alloys were fabricated by vacuum arc melting to investigate the microstructure, hardness, and compressive properties. The results revealed that CrFeNiTix alloys consisted of the principal face-centered cubic (FCC) phase and body-centered cubic (BCC) solid solution, with an amount of (Ni, Ti)-rich hexagonal close-packed phase. CrFeNiTix alloys exhibited the typical dendrite. Ti0.2 and Ti0.3 alloys were composed of FCC and BCC solid solutions in the dendrite, as well as ε (Ni3Ti) and R (Ni2.67Ti1.33) phases in the inter-dendrite, simultaneously. For Ti0.4, Ti0.5, and Ti0.6 alloys, (Fe, Cr)-rich solid solution separated out and ε phase transformed into R phase gradually. Meanwhile, TEM analysis indicated that Ti0.4 alloy matrix consisted of the principal FCC phase containing (Ni, Ti)-rich intragranular nanoprecipitates. The hardness values of CrFeNiTix alloys were increased with the addition of Ti content and the high compressive strength of CrFeNiTix alloys was maintained, which was attributed to the solid solution strengthening and precipitation hardening.
Globally over the last forty years the number of students who leave their home country to study abroad has grown considerably. According to the Organisation for Economic Co-operation and Development (OECD), in 1975, 0.8 million students moved abroad to study; by 2012, this number had grown to 4.5 million (OECD, 2014). The reasons for migrating to study are often described in terms of ‘push’ factors relating to poorer higher education opportunities in the student's home country, and ‘pull’ factors, relating to attractive features of provision in the host country (Altbach, 2004). Traditionally, countries in the English-speaking world, such as the UK, USA and Australia, have been major recipients of international students, but these countries are now facing increasing competition, as universities vie for advantage in a global higher education market (Marginson, 2008; de Wit et al., 2013). International students are considered valuable not only to the host country, but also to individual universities since they boost institutional finance as well as generating jobs in the local economy and creating a more diverse local culture.
Using data from the Higher Education Statistics Agency (HESA) as well as key informant interviews, this chapter examines the relative importance of international students in the four countries of the UK. The issue of migrant students has become intertwined with the hot political topic of immigration more generally, and we examine how this has played out in different contexts. Finally, we present a case study of Chinese students studying mainly at an ancient Scottish university to shed light on their reasons for enrolling at this institution and their experiences of living and studying in Scotland. Gallacher and Raffe (2012) suggested that the internationalisation of higher education was an area of policy convergence across the UK, and in the conclusion we explore the extent to which this is still the case. It should be noted that throughout this chapter the term ‘international student’ or ‘overseas student’ is used to refer to a non-EU student, since those from the EU study under the same terms and conditions as home students.