299645 research outputs found
Sort by
Palliative Care Involvement and End-of-Life Care Intensity Among Adolescents and Young Adults with Nonmalignant Illnesses: A Population-Based Cohort Study in Ontario, Canada
No full textBackground: Adolescents and young adults (AYAs) with life-limiting illnesses face unique challenges and often receive late or no palliative care (PC). This study examines the correlation between PC involvement and the intensity of end-of-life care among AYAs with nonmalignant life-limiting illnesses. Design: A retrospective cohort study analyzing population-based health care data from 2010 to 2018. Setting/Subjects: The study population included AYAs aged 15-39 who died in Ontario, Canada, from nonmalignant life-limiting illnesses during the study period (n = 2313). Measurements: PC involvement was defined as at least one encounter with a PC provider. End-of-life (EOL) care intensity was measured using rates of emergency department visits, hospitalizations, intensive care unit admissions, and mechanical ventilation in the last 30 days of life. Results: Of the 2313 AYAs studied, 37.5% had at least one PC encounter during their lifetime. Specialist PC delivered ≥90 days before death was associated with lower intensity of EOL care, including fewer intensive care unit deaths (17% vs. 34% versus 31%, p < 0.0001) and emergency department visits (17% vs. 27% versus 21%, p = 0.0091) when compared to generalist PC and no PC, respectively. Conclusions: AYAs with nonmalignant illnesses received high EOL care intensity and had a high percentage of death in acute care settings. Specialist PC involvement was associated with improved EOL care outcomes compared with generalist and no PC
Long-Term Care Ownership and Operator Factors in Probable Delirium: A Population-Based Study from Ontario, Canada
No full textObjectives: To evaluate the association between long-term care (LTC) home ownership models and operator characteristics and the prevalence of probable delirium. Design: Cross-sectional study using provincial health administrative data. Setting and Participants: All LTC residents aged 65–105 years in Ontario, Canada, who underwent assessment via the Resident Assessment Instrument—Minimum Data Set, version 2.0, between January 1, 2016, and December 31, 2019. Methods: Probable delirium was identified using the delirium Clinical Assessment Protocol on the Resident Assessment Instrument—Minimum Data Set, version 2.0, assessment. LTC home ownership model (for-profit, not-for-profit, and municipal) and operator characteristics (chain status, operator size, and home size) were evaluated in relation to probable delirium using multivariable logistic regression models. Results: Among the 169,762 LTC residents included in this study, 94,014 (55.4%) lived in for-profit homes, 42,051 (24.8%) in not-for-profit homes, and 33,697 (19.8%) in municipal homes. Only 3.6% (n = 6182) had probable delirium. The adjusted odds ratios (aOR) of probable delirium in for-profit and municipal homes were 0.83 (95% CI, 0.66–1.06) and 0.89 (95% CI, 0.64–1.25), respectively, compared with not-for-profit homes. Residents in larger homes had a reduced odds of probable delirium (aOR, 0.49; 95% CI, 0.33–0.72 for 50–99 beds; aOR, 0.68, 95% CI, 0.47–0.99 for 100–149 beds, ≥150 beds vs <50 beds). The adjusted odds of probable delirium did not differ across chain status or operator size. Conclusions and Implications: LTC residents in homes with ≥50 beds had reduced odds of probable delirium. This finding may reflect differences in delirium risk or identification across home ownership models. There was no evidence that the prevalence of probable delirium varied across LTC home ownership models, operator size, or chain status
Ocean oxygenation in the aftermath of the origin of multicellular eukaryotes: Evidences from Ce anomaly and I/Ca of the Yangzhuang Formation at 1.50 Ga
No full textMulti-proxies and decimeter-scale multicellular eukaryotes fossils in the North China Craton indicate a pulsed oxygenation event at 1.56–1.57 Ga. It has been widely proposed that oxygen concentration is the most important control factor governing the evolution of life. However, the subsequent evolution of life and ocean redox condition are less constrained. We here report I/(Ca + Mg) values, carbonate C isotopes (carbon) and cerium (Ce) anomalies across the ca. 1.56–1.52 Ga Gaoyuzhuang-Yangzhuang Formation in the North China Platform, in order to reconstruct the ocean redox conditions and its relationship with the evolution of life. Our geochemistry proxies demonstrate that after the pulsed oxygenation event at 1.57 Ga, the content of oxygen rapidly decreased to lower levels and continued until 1.55 Ga. Negative Ce anomaly (as low as 0.56) and high I/(Ca + Mg) values (up to1.2 μmol/mol) are identified at 1.54 Ga, indicating a possible pulsed oxygenation event. Furthermore, the negative δ13Ccarb excursion from 0.5 ‰ to −2.6 ‰ recorded by the Yangzhuang formation supports oxidation of the dissolved organic carbon (DOC) in the early Mesoproterozoic Ocean. No Ce anomaly and low I/(Ca + Mg) values (＜0.5 μmol/mol) are observed at 1.53 Ga, suggesting that the shallow ocean oxygen levels decreased to lower levels again. Thus, the Yangzhuang Formation may have recorded a transient oxidation event at 1.54 Ga, but the fossil record indicative of eukaryotic evolution is missing until Neoproterozoic. Therefore, we concluded that besides the redox condition of ocean, the limited input of key trace metal elements and higher seawater temperature may have hindered the evolution of eukaryotes in the Mesoproterozoic.</p
A prospective study on the regulation of osteoarthritis risk through inflammatory pathways in clonal hematopoiesis
No full textOsteoarthritis (OA) is a common degenerative joint disease characterized by articular cartilage degeneration, joint inflammation, and bone hyperplasia. Clonal hematopoiesis of indeterminate potential (CHIP) refers to the presence of cancer-related variants in blood cells of individuals without malignancies. However, it is unclear whether the proinflammatory state induced by CHIP affects the onset of OA. Thus, we investigated CHIP as a risk factor for OA. Here, we analyzed whole-exome sequence (WES) data from 45,380 UK Biobank participants without OA at baseline to identify CHIP. Multivariate Cox regression models were used to evaluate the association between CHIP and incident OA as well as different sites of OA onset. Additionally, enrichment and mediation analyses were conducted on 1463 unique protein datasets to identify protein markers and biological pathways related to both CHIP and OA. We found that the incidence of OA was higher in individuals with CHIP than in those without CHIP. Importantly, individuals with CHIP and VAF > 10% had an increased risk of OA (hazard ratio [HR], 1.46; 95% CI, 1.28–1.68; P < 0.001). The results of classification of OA sites showed that polyarticular OA and hip OA were most significantly associated with CHIP. In addition, analysis of OA and CHIP-related expression proteins and pathways revealed that both were mainly involved in extracellular matrix organization, inflammation, and metabolic pathways. Moreover, the proteomic analysis results suggested that CHIP may influence the occurrence of OA by affecting seven proteins: CD5, CD79B, CEACAM1, FOLR2, LILRA5, SIRPB1, and TXNDC15. CHIP is significantly associated with the risk of incident OA and may exacerbate the progression of OA through inflammatory and immune response mechanisms. This research provides new insights into the pathogenesis of OA, offering a theoretical basis for the early prevention of OA, although a causal relationship remains to be investigated.</p
High-efficiency generation of bi-functional holography with metasurfaces
Full text linkHolography is a highly desired technology in modern photonics, yet setups for traditional generating methods suffer from complexity and bulky sizes. While metasurface-based holography exhibits advantages of compactness and easy-fabrication, most meta-holograms realized so far exhibit only single functionality, with a few multifunctional ones suffering from imbalances of efficiency and device-thickness. Here, we propose a generic approach to design ultra-thin metasurfaces for realization of multiple holographic images with high efficiencies, and experimentally verify the concept in the telecom regime. We first design a series of high-efficiency reflective meta-atoms exhibiting incident-spin-delinked reflection phases governed by geometric and resonant mechanisms, and experimentally characterize their optical properties at wavelengths around 1,064 nm. We next experimentally demonstrate a single-functional meta-hologram as a benchmark test. Finally, we employ the designed meta-atoms to construct a metasurface with the thickness ∼1/4λ, and experimentally demonstrate its capability of generating two distinct holographic images under illuminations of circularly polarized light beams with different helicities, possessing generation efficiencies ∼48.08 %. Our work provides a highly-efficient and ultra-compact platform to generate multifunctional holographic images, which may inspire numerous applications in integration optics.published_or_final_versio
Applying a Disaster Justice Lens to LGBTQ+ Refugees in Complex Humanitarian Emergencies
No full textThis chapter presents a detailed, critical reflection on the findings of a 2017 study involving LGBTQ+ refugees from the Middle East, North Africa, and South Asia who fled to Austria and the Netherlands. The chapter argues that disaster justice provides an effective framework for understanding and responding to the rapid increase in humanitarian crises and their impacts on diverse populations, including LGBTQ+ refugees. The chapter then applies a disaster justice perspective to develop specific recommendations that policymakers and practitioners can use to ensure disaster-related justice for LGBTQ+ refugees during complex humanitarian emergencies.</p
Discontinuous extreme learning machine for interface and free boundary problems
No full textWe present a machine-learning framework for interface and free-boundary problems, focusing on physics-informed neural networks (PINNs). Two major challenges are addressed: (i) interface-induced discontinuities and (ii) moving boundaries inherent to free-boundary problems. To meet these challenges, we introduce the discontinuous extreme learning machine (DELM), a mesh-free method that leverages an “artificial discontinuity” mechanism, and the local extreme learning machine (locELM) architecture. Our first innovation augments the input of a single-layer neural network with two additional variables: a piecewise-constant indicator that enforces discontinuities in the solution itself, and the absolute value of a signed-distance level-set function that produces the correct gradient jump across the interface. This design captures discontinuities without splitting the network into multiple pieces or inflating the parameter count. For problems with evolving interfaces (e.g., the Stefan problem), we devise a decoupled discrete-DELM strategy that integrates seamlessly with the classical front-tracking and time-discretization technique. At each time step, the front-tracking module updates the interface geometry, and DELM subsequently solves the governing PDE in the updated domain. To further reduce complexity while maintaining accuracy, the computational domain is partitioned, and an independent single-layer ELM is trained within each subdomain. Various numerical experiments validate the proposed framework, demonstrating high accuracy and fast computational speed across a wide range of benchmark problems
An approach for interdisciplinary knowledge discovery: Link prediction between topics
No full textPredicting interdisciplinary links between topics can unveil potential interdisciplinary knowledge relationships and foster innovation. Considering keywords extracted from interdisciplinary research as topics, we propose a topic link prediction method based on graph neural networks. We emphasize the integration of topic semantic content features, author direct-collaboration features, and indirect-collaboration features to improve prediction performance. The interdisciplinary topic link prediction models are constructed using Graph Convolutional Networks (GCN), Graph Attention Networks (GAT), Graph Sample and Aggregate (GraphSAGE), BERT, and Node2Vec. These models are validated by using digital humanities data as a case study. We find that the integration of semantic content, direct-collaboration, and indirect-collaboration features significantly improved the Area Under the Curve (AUC) by 20.68 % and the Average Precision (AP) by 16.52 %, compared to relying solely on the co-occurrence network. For topic reorganization, we find that the features we designed make more sense than GNN algorithms alone, and that weak relationships contribute more to topic link prediction than strong relationships. Our approach provides valuable research insights and references for scholars engaged in interdisciplinary knowledge. Notably, this is an innovative approach to interdisciplinary knowledge discovery through knowledge reorganization. </p
Potentiation of macrophage Piezo1 by atherogenic 7-ketocholesterol
No full textThe mechanosensitive ion channel Piezo1 present in endothelial and smooth muscle cells, as well as in macrophages, is emerging as a novel, important player in the etiology of atherosclerosis. Here, we show that myeloid-specific deficiency of Piezo1 in atherogenic Ldlr−/− mice reduces plaque formation. Moreover, chronic oxLDL, as well as its main oxysterol 7-ketocholesterol (7-KC), promotes Piezo1 opening by pressure stimulation in both mouse macrophages and transfected HEK cells. 7-KC dramatically enhances Piezo1 current amplitude and slows down inactivation and deactivation. This up-modulation involves an increase in Piezo1 expression, as well as a potentiation of mechanical gating that depends on membrane cholesterol depletion and decreased order. By contrast, Piezo1 is inhibited by the athero-protective free docosahexaenoic acid, either without or with 7-KC. Altogether, these findings indicate that macrophage Piezo1 is differentially modulated by pro- and anti-atherogenic lipids, pointing to the role of Piezo1 and its potentiation by oxysterols in atherosclerosis