Background:Male breast cancer(MBC)is a rare but significant health concern,accounting for less than 1%of all breast cancer cases.Despite its low incidence,it presents unique clinical,genetic,and psychosocial challenge...Background:Male breast cancer(MBC)is a rare but significant health concern,accounting for less than 1%of all breast cancer cases.Despite its low incidence,it presents unique clinical,genetic,and psychosocial challenges.Genetic predispositions,including BRCA2 mutations and hormonal imbalances,are key factors influencing the development of MBC.However,the rarity of the condition has led to limited research and fewer treatment guidelines specifically for male patients.Methods:A comprehensive literature review was conducted using PubMed,MEDLINE,and Embase databases to identify studies focusing on the epidemiology,risk factors,clinical presentation,diagnosis,treatment,and psychosocial impacts of male breast cancer.Articles were selected based on relevance,peer-review status,and focus on MBC in male patients.Data were synthesized narratively,and findings were contextualized based on the methodology and design of included studies.Results:The review identified several significant risk factors for MBC,including BRCA2 mutations,hormonal imbalances(particularly estrogen and testosterone levels),and family history of breast cancer.MBC is often diagnosed at later stages due to the absence of routine screening in men,resulting in poorer survival outcomes compared to female breast cancer.Treatment strategies for MBC largely mirror those for women,including surgery,radiation,chemotherapy,and hormonal therapies.However,the psychosocial impacts of MBC are unique to men,with issues such as stigma,body image concerns,and societal perceptions of masculinity.Conclusions:Male breast cancer remains an understudied area of oncology,with significant gaps in research related to early detection,targeted therapies,and long-term care.Collaborative international research efforts,such as the MERGE consortium and the International Male Breast Cancer Program,are essential for improving understanding and treatment outcomes.Genetic counseling,early screening,and personalized treatment approaches are crucial in managing the disease.Further research focusing on the molecular basis of MBC,along with the psychosocial needs of affected men,is necessary to enhance both survival rates and quality of life for male breast cancer patients.展开更多
The advent of point-of-care testing(POCT)has revolutionized the approach to patient management,especially for pediatric care.POCT provides rapid,on-the-spot biochemical and microbiological evaluations,bypassing delays...The advent of point-of-care testing(POCT)has revolutionized the approach to patient management,especially for pediatric care.POCT provides rapid,on-the-spot biochemical and microbiological evaluations,bypassing delays typically associated with central laboratory testing,enabling swift clinical decision-making.Additionally,POCT has proven to be a valuable prognostic tool for monitoring electrolyte,lactate,creatinine levels,often a marker of severe illness and poor outcomes.POCT enables its faster identification,allowing for prompt inter-ventions.This capability is essential in managing conditions like sepsis,where timely treatment can significantly impact survival rates.However,the implementation of POCT is not without its challenges.Variability in sample handling,particularly with heparinized syringes,can affect the accuracy of certain measurements,such as potassium levels.The absence of comprehensive follow-up data and cost-effectiveness analyses in some studies indicate the need for continued research to optimize the use of POCT.In conclusion,POCT is a trans-formative tool in critical care,offering prompt and reliable assessments that significantly enhance patient management.As technology advances,the inte-gration of POCT into emergency departments and intensive critical care units holds great promise for improving the quality of healthcare and patient survival rates.展开更多
BACKGROUND There is a lack of study on vitamin D and calcium levels in epileptic patients receiving therapy,despite the growing recognition of the importance of bone health in individuals with epilepsy.Associations on...BACKGROUND There is a lack of study on vitamin D and calcium levels in epileptic patients receiving therapy,despite the growing recognition of the importance of bone health in individuals with epilepsy.Associations one statistical method for finding correlations between variables in big datasets is called association rule mining(ARM).This technique finds patterns of common items or events in the data set,including associations.Through the analysis of patient data,including demographics,genetic information,and reactions with previous treatments,ARM can identify harmful drug reactions,possible novel combinations of medicines,and trends which connect particular individual features to treatment outcomes.AIM To investigate the evidence on the effects of anti-epileptic drugs(AEDs)on calcium metabolism and supplementing with vitamin D to help lower the likelihood of bone-related issues using ARM technique.METHODS ARM technique was used to analyze patients’behavior on calcium metabolism,vitamin D and anti-epileptic medicines.Epileptic sufferers of both sexes who attended neurological outpatient and in patient department clinics were recruited for the study.There were three patient groups:Group 1 received one AED,group 2 received two AEDs,and group 3 received more than two AEDs.The researchers analyzed the alkaline phosphatase,ionized calcium,total calcium,phosphorus,vitamin D levels,or parathyroid hormone values.RESULTS A total of 150 patients,aged 12 years to 60 years,were studied,with 50 in each group(1,2,and 3).60%were men,this gender imbalance may affect the study’s findings,as women have different bone metabolism dynamics influenced by hormonal variations,including menopause.The results may not fully capture the distinct effects of AEDs on female patients.A greater equal distribution of women should be the goal of future studies in order to offer a complete comprehension of the metabolic alterations brought on by AEDs.86 patients had generalized epilepsy,64 partial.42%of patients had AEDs for>5 years.Polytherapy reduced calcium and vitamin D levels compared to mono and dual therapy.Polytherapy elevated alkaline phosphatase and phosphorus levels.CONCLUSION ARM revealed the possible effects of variables like age,gender,and polytherapy on parathyroid hormone levels in individuals taking antiepileptic medication.展开更多
Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the inc...Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. Methods We used the China Health Insurance Research Data （the CHIRA Data） 2011 which comprises all inpatient hospital records （300,886） during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries （1,718,500 men and 1,616,500 women） from 25 cities and counties in different economic-geographic regions of China's Mainland. Patients with acute aortic dissection were identified according to International Classification of Disease 10m Revision （ICD-10） of I71.0, The estimated incidence of AAD was calculated using the equation： estimated incidence = 2.0 × （40% × hospital admission rate） ＋ 60% × hospital admission rate. Results The hospital admission rate was 2.0/100,000 （65/3,325,000, 95% CI： 1.2-2.8）. The estimated annual incidence of AAD was 2.8/100,000 （95% CI： 1.9-3.6） and was higher in male than in female （3.7 vs. 1.5, P 〈 0.001）. The mean age was 58.9 ± 13.4 years. During the mean hospital stay of 23 ±6 days, the overall in-hospital mortality was 13.9% （9/65）. Conclusions Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.展开更多
Over the past two decades,our understanding of Lauraceae,a large family of woody plants,has undergone significant advances in phylogeny,taxonomy,and biogeography.Molecular systematic studies have elucidated the basic ...Over the past two decades,our understanding of Lauraceae,a large family of woody plants,has undergone significant advances in phylogeny,taxonomy,and biogeography.Molecular systematic studies have elucidated the basic relationships within the family with plastid phylogenomic analyses providing robust support for deep-level relationships between Lauraceae lineages,leading to the recognition of nine tribes:Hypodaphnideae,Cryptocaryeae,Cassytheae,Neocinnamomeae,Caryodaphnopsideae,Mezilaureae,Perseeae,Laureae,and Cinnamomeae,with Mezilaureae validated here.Nuclear genomes and comparative genomics studies have also clarified aspects of the family’s evolutionary history and metabolic diversity.Taxonomic studies have focused mainly on the most diverse regions,e.g.,tropical Asia,tropical America,and Africa(Madagascar),with six new genera described and five reinstated since the last major overview of the family.The extensive fossil record suggests that Lauraceae diversified globally during the Late Cretaceous and Early Cenozoic.Biogeographic studies indicate that different lineages of the family are sorted into Gondwanan and Laurasian lineages,with patterns resulting from the disruption of boreotropical flora and multiple long-distance dispersal events.Phylogeographic studies,predominantly from East Asia,have shown patterns of in situ survival and demographic stability or expansion during the Quaternary.Nevertheless,many systematic relationships within the family remain unresolved and further research is needed into the complex biogeographic history and ecological roles of Lauraceae.A multifaceted approach integrating genomic studies,field work,morphological and ecological investigations is therefore needed to understand the evolution and diversity of this ecologically and economically significant plant family.展开更多
Using the Hill estimator, general multifractal characteristics of events in the New Zealand area have been dis-cussed. Results show that the spatial distribution of shallow events has apparent clustering characteristi...Using the Hill estimator, general multifractal characteristics of events in the New Zealand area have been dis-cussed. Results show that the spatial distribution of shallow events has apparent clustering characteristics, inde-pendent of the threshold magnitude; but for deep events these characteristics are not clear. While the time interval distribution has obvious clustering characteristics both for deep and shallow events, although with a different scal-ing range, the Hill estimates tend to indicate that the time interval distribution has a unifractal rather than a multifractal nature. All above reveal that the seismicity nature for shallow and deep events is apparently different.展开更多
BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical...BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies.METHODS: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction <2 units on the 0–10 pain scale between triage and ED departure.RESULTS: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood of refractory pain.CONCLUSIONS: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.展开更多
This article aims to explore the current status of creative protection for artists in the field of art.With the further development of modern society,the development of the art market,and the continuous growth of the ...This article aims to explore the current status of creative protection for artists in the field of art.With the further development of modern society,the development of the art market,and the continuous growth of the market value of artist works,the protection of artistic creativity has also attracted increasing attention and become a focus.Firstly,the article will introduce the connotation and extension of artistic creativity,as well as the importance and significance of protection.Secondly,this article will explore the challenges faced by the protection of artistic creativity,including issues such as piracy and infringement,and propose corresponding tentative solutions.Finally,through specific analysis,the current status of artistic and creative protection will be summarized,and future development directions will be looked forward to.展开更多
A large number of communities are impacted annually by the increasing frequency of tornado hazards resulting in damage to the infrastructure as well as disruption of community functions.The effect of the hazard geomet...A large number of communities are impacted annually by the increasing frequency of tornado hazards resulting in damage to the infrastructure as well as disruption of community functions.The effect of the hazard geometry(center and angle of tornado path as well as the tornado width)is studied herein on how it influences the recovery of physical and social systems within the community.Given that pre-disaster preparedness including mitigation strategies(e.g.,retrofits)and policies(e.g.,insurance)is crucial for increasing the resilience of the community and facilitating a faster recovery process,in this study,the impact of various mitigation strategies and policies on the recovery trajectory and resilience of a typical US community subjected to a tornado is investigated considering different sources of uncertainties.The virtual testbed of Centerville is selected in this paper and is modeled by adopting the Agent-based modeling(ABM)approach which is a powerful tool for conducting community resilience analysis that simulates the behavior of different types of agents and their interactions to capture their interdependencies.The results are presented in the form of recovery time series as well as calculated resilience indices for various community systems(lifeline networks,schools,healthcare,businesses,and households).The results of this study can help deepen our understanding of how to efficiently expedite the recovery process of a community.展开更多
This study explores the perspectives and challenges faced by family members providing mental support to cancer patients in Beijing,China.The primary objective is to understand the emotional and practical roles family ...This study explores the perspectives and challenges faced by family members providing mental support to cancer patients in Beijing,China.The primary objective is to understand the emotional and practical roles family members undertake and the difficulties they encounter.Utilizing a qualitative research design,data were collected through semi-structured interviews with family caregivers of cancer patients.Thematic analysis revealed several key themes:the dual burden of emotional support and caregiving responsibilities,the impact on daily life and personal well-being,the role and effectiveness of external support systems,perceptions of medical staff support,and the common challenges and conflicts faced in caregiving.The findings highlight the critical need for comprehensive support systems that address both the emotional and practical needs of family caregivers.Recommendations for enhancing family-centered support programs in oncology settings are discussed.展开更多
Circular design encompasses the use of inventive construction methodologies that possess the capability to be readily dismantled,repurposed,or recycled upon reaching the conclusion of their functional lifespan.This wo...Circular design encompasses the use of inventive construction methodologies that possess the capability to be readily dismantled,repurposed,or recycled upon reaching the conclusion of their functional lifespan.This work specifically examines the creation of a reusable design case-study idea for seismic frame design,which is commonly employed in steel-frame constructions in New Zealand.A reusable optimized design for the full seismic frame was proposed in the research.Optimizing the dimensions of welded structures,whether in terms of weight or cost,leads to a decrease in the weight of the steel utilized.The decrease in weight is directly associated with a decrease in environ-mental impact,as the environmental impact is directly proportional to the mass of the construction.The environmental consequences associated with welding technique are contingent upon the dimensions of the weld,hence exerting an indirect influence on the overall mass of the structure.Given the presence of mass dependence in all three areas,albeit in distinct manners,this work employed a multi-objective function optimization strategy to simultaneously address these areas while also partially evaluating them separately.On this way substantial reductions can be achieved both at structural mass and environmental effects.展开更多
The introduction of machine learning (ML) in the research domain is a new era technique. The machine learning algorithm is developed for frequency predication of patterns that are formed on the Chladni plate and focus...The introduction of machine learning (ML) in the research domain is a new era technique. The machine learning algorithm is developed for frequency predication of patterns that are formed on the Chladni plate and focused on the application of machine learning algorithms in image processing. In the Chladni plate, nodes and antinodes are demonstrated at various excited frequencies. Sand on the plate creates specific patterns when it is excited by vibrations from a mechanical oscillator. In the experimental setup, a rectangular aluminum plate of 16 cm x 16 cm and 0.61 mm thickness was placed over the mechanical oscillator, which was driven by a sine wave signal generator. 14 Chladni patterns are obtained on a Chladni plate and validation is done with modal analysis in Ansys. For machine learning, a large number of data sets are required, as captured around 200 photos of each modal frequency and around 3000 photos with a camera of all 14 Chladni patterns for supervised learning. The current model is written in Python language and model has one convolution layer. The main modules used in this are Tensor Flow Keras, NumPy, CV2 and Maxpooling. The fed reference data is taken for 14 frequencies between 330 Hz to 3910 Hz. In the model, all the images are converted to grayscale and canny edge detected. All patterns of frequencies have an almost 80% - 99% correlation with test sample experimental data. This approach is to form a directory of Chladni patterns for future reference purpose in real-life application. A machine learning algorithm can predict the resonant frequency based on the patterns formed on the Chladni plate.展开更多
In child psychiatry, the use of play, a habitual activity in children, is used as a means of communication and therapy. The psychodynamic reading of a sequence of games played by a three-year-old child with dolls, who...In child psychiatry, the use of play, a habitual activity in children, is used as a means of communication and therapy. The psychodynamic reading of a sequence of games played by a three-year-old child with dolls, who had been treated for anorexia for a year at the Children’s Guidance Center of Abidjan, shed new light on the child’s problems. The clinical history of M (3 years old) revealed, in addition to the eating disorder, a disturbance in the attachment bond and parental imagos in distress. This doll game, set up as a copy of reality, enabled the therapist to redirect his treatment and work on the mother-child bond.展开更多
Attracting foreign capital is a key pillar of China’s reform and opening up policy,and foreign-funded enterprises are an important component of China’s economy.Currently,China is taking steps to further boost its at...Attracting foreign capital is a key pillar of China’s reform and opening up policy,and foreign-funded enterprises are an important component of China’s economy.Currently,China is taking steps to further boost its attractiveness as a foreign direct investment(FDI)destination in order to seek more foreign capital.展开更多
An accurate estimation of wind loads on telecommunication towers is crucial for design,as well as for perform-ing reliability,resilience,and risk assessments.In particular,drag coefficient and interference factor are ...An accurate estimation of wind loads on telecommunication towers is crucial for design,as well as for perform-ing reliability,resilience,and risk assessments.In particular,drag coefficient and interference factor are the most significant factors for wind load computations.Wind tunnel tests and computational fluid dynamics(CFD)are the most appropriate methods to estimate these parameters.While wind tunnel tests are generally preferred in practice,they require dedicated facilities and personnel,and can be expensive if multiple configurations of tower panels and antennas need to be tested under various wind directions(e.g.,fragility curve development for system resilience analysis).This paper provides a simple,robust,and easily accessible CFD protocol with widespread applicability,offering a practical solution in situations where wind tunnel testing is not feasible,such as complex tower configurations or cases where the cost of running experiments for all the tower-antennas configurations is prohibitively high.Different turbulence models,structural and fluid boundary conditions and mesh types are tested to provide a streamlined CFD modeling strategy that shows good convergence and balances accuracy,computational time,and robustness.The protocol is calibrated and validated with experimental studies available in the literature.To demonstrate the capabilities of the protocol,three lattice tower panels and antennas with different configurations are analyzed as examples.The protocol successfully estimates the drag and lateral wind loads and their coefficients under different wind directions.Noticeable differences are observed between the esti-mated wind loads with this protocol and those computed by a simple linear superposition used in most practical applications,indicating the importance of tower-antenna interaction.Also,as expected,the wind loads recom-mended by design codes overestimate the simulated results.More importantly,the telecommunication design codes inadequately identify the most favorable wind directions that are associated with the lowest wind loads,while the results of the proposed protocol align with observations from experimental studies.This information may be used to select the tower orientation before construction.The findings of this study are of importance for the telecommunication industry,which seeks reliable results with minimal computational efforts.In addition,it enhances the fragility analysis of telecommunication towers under strong winds,and the portfolio risk and resilience assessment of telecommunication systems.展开更多
Many advances in genetic selection, nutrition, housing and disease control have been incorporated into modern pork production since the 1950s resulting in highly prolific females and practices and technologies, which ...Many advances in genetic selection, nutrition, housing and disease control have been incorporated into modern pork production since the 1950s resulting in highly prolific females and practices and technologies, which significantly increased efficiency of reproduction in the breeding herd. The objective of this manuscript is to review the literature and current industry practices employed for reproductive management. In particular the authors focus on assisted reproduction technologies and their application for enhanced productivity. Modern maternal line genotypes have lower appetites and exceptional lean growth potential compared to females of 20 yr ago. Thus, nutrient requirements and management techniques and technologies, which affect gilt development and sow longevity, require continuous updating. Failure to detect estrus accurately has the greatest impact on farrowing rate and litter size. Yet, even accurate estrus detection will not compensate for the variability in the interval between onset of estrus and actual time of ovulation. However, administration of GnRH analogs in weaned sows and in gilts after withdrawal of altrenogest do overcome this variability and thereby synchronize ovulation, which makes fixed-time AI practical. Seasonal infertility, mediated by temperature and photoperiod, is a persistent problem. Training workers in the art of stockmanship is of increasing importance as consumers become more interested in humane animal care. Altrenogest, is used to synchronize the estrous cycle of gilts, to prolong gestation for 2-3 d to synchronize farrowing and to postpone post-weaning estrus. P.G. 600~ is used for induction of estrus in pre-pubertal gilts and as a treatment to overcome seasonal anestrous. Sperm cell numbers/dose of semen is significantly less for post cervical AI than for cervical AI. Real-time ultrasonography is used to determine pregnancy during wk 3-5. PGF2a effectively induces farrowing when administered within two d of normal gestation length. Ovulation synchronization, single fixed-time AI and induced parturition may lead to farrowing synchronization, which facilitates supervision and reduces stillbirths and piglet mortality. Attendance and assistance at farrowing is important especially to ensure adequate colostrum consumption by piglets immediately after birth. New performance terminologies are presented.展开更多
Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current...Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods： We searched the China Health Insurance Research Association （CHIRA） Database to identify patients with cancer who were 〉 18 years old and received either moderately or highly emetogenie chemotherapy （MEC and HEC, respectively） between 2008 and 2012. Patients＇ characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results： Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC （59.4% vs. 81.3 %; P〈0.001）. The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group （P〈0.012）; however, a higher proportion received a mixed regimen containing eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group （both P〈0.001）. Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions： These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.展开更多
The objective of this research is to determine the effect earthquakes have on the performance of transportation network systems.To do this,bridge fragility curves,expressed as a function of peak ground acceleration(PG...The objective of this research is to determine the effect earthquakes have on the performance of transportation network systems.To do this,bridge fragility curves,expressed as a function of peak ground acceleration(PGA)and peak ground velocity(PGV),were developed.Network damage was evaluated under the 1994 Northridge earthquake and scenario earthquakes.A probabilistic model was developed to determine the effect of repair of bridge damage on the improvement of the network performance as days passed after the event.As an example,the system performance degradation measured in terms of an index,'Drivers Delay,'is calculated for the Los Angeles area transportation system,and losses due to Drivers Delay with and without retrofit were estimated.展开更多
文摘Background:Male breast cancer(MBC)is a rare but significant health concern,accounting for less than 1%of all breast cancer cases.Despite its low incidence,it presents unique clinical,genetic,and psychosocial challenges.Genetic predispositions,including BRCA2 mutations and hormonal imbalances,are key factors influencing the development of MBC.However,the rarity of the condition has led to limited research and fewer treatment guidelines specifically for male patients.Methods:A comprehensive literature review was conducted using PubMed,MEDLINE,and Embase databases to identify studies focusing on the epidemiology,risk factors,clinical presentation,diagnosis,treatment,and psychosocial impacts of male breast cancer.Articles were selected based on relevance,peer-review status,and focus on MBC in male patients.Data were synthesized narratively,and findings were contextualized based on the methodology and design of included studies.Results:The review identified several significant risk factors for MBC,including BRCA2 mutations,hormonal imbalances(particularly estrogen and testosterone levels),and family history of breast cancer.MBC is often diagnosed at later stages due to the absence of routine screening in men,resulting in poorer survival outcomes compared to female breast cancer.Treatment strategies for MBC largely mirror those for women,including surgery,radiation,chemotherapy,and hormonal therapies.However,the psychosocial impacts of MBC are unique to men,with issues such as stigma,body image concerns,and societal perceptions of masculinity.Conclusions:Male breast cancer remains an understudied area of oncology,with significant gaps in research related to early detection,targeted therapies,and long-term care.Collaborative international research efforts,such as the MERGE consortium and the International Male Breast Cancer Program,are essential for improving understanding and treatment outcomes.Genetic counseling,early screening,and personalized treatment approaches are crucial in managing the disease.Further research focusing on the molecular basis of MBC,along with the psychosocial needs of affected men,is necessary to enhance both survival rates and quality of life for male breast cancer patients.
文摘The advent of point-of-care testing(POCT)has revolutionized the approach to patient management,especially for pediatric care.POCT provides rapid,on-the-spot biochemical and microbiological evaluations,bypassing delays typically associated with central laboratory testing,enabling swift clinical decision-making.Additionally,POCT has proven to be a valuable prognostic tool for monitoring electrolyte,lactate,creatinine levels,often a marker of severe illness and poor outcomes.POCT enables its faster identification,allowing for prompt inter-ventions.This capability is essential in managing conditions like sepsis,where timely treatment can significantly impact survival rates.However,the implementation of POCT is not without its challenges.Variability in sample handling,particularly with heparinized syringes,can affect the accuracy of certain measurements,such as potassium levels.The absence of comprehensive follow-up data and cost-effectiveness analyses in some studies indicate the need for continued research to optimize the use of POCT.In conclusion,POCT is a trans-formative tool in critical care,offering prompt and reliable assessments that significantly enhance patient management.As technology advances,the inte-gration of POCT into emergency departments and intensive critical care units holds great promise for improving the quality of healthcare and patient survival rates.
文摘BACKGROUND There is a lack of study on vitamin D and calcium levels in epileptic patients receiving therapy,despite the growing recognition of the importance of bone health in individuals with epilepsy.Associations one statistical method for finding correlations between variables in big datasets is called association rule mining(ARM).This technique finds patterns of common items or events in the data set,including associations.Through the analysis of patient data,including demographics,genetic information,and reactions with previous treatments,ARM can identify harmful drug reactions,possible novel combinations of medicines,and trends which connect particular individual features to treatment outcomes.AIM To investigate the evidence on the effects of anti-epileptic drugs(AEDs)on calcium metabolism and supplementing with vitamin D to help lower the likelihood of bone-related issues using ARM technique.METHODS ARM technique was used to analyze patients’behavior on calcium metabolism,vitamin D and anti-epileptic medicines.Epileptic sufferers of both sexes who attended neurological outpatient and in patient department clinics were recruited for the study.There were three patient groups:Group 1 received one AED,group 2 received two AEDs,and group 3 received more than two AEDs.The researchers analyzed the alkaline phosphatase,ionized calcium,total calcium,phosphorus,vitamin D levels,or parathyroid hormone values.RESULTS A total of 150 patients,aged 12 years to 60 years,were studied,with 50 in each group(1,2,and 3).60%were men,this gender imbalance may affect the study’s findings,as women have different bone metabolism dynamics influenced by hormonal variations,including menopause.The results may not fully capture the distinct effects of AEDs on female patients.A greater equal distribution of women should be the goal of future studies in order to offer a complete comprehension of the metabolic alterations brought on by AEDs.86 patients had generalized epilepsy,64 partial.42%of patients had AEDs for>5 years.Polytherapy reduced calcium and vitamin D levels compared to mono and dual therapy.Polytherapy elevated alkaline phosphatase and phosphorus levels.CONCLUSION ARM revealed the possible effects of variables like age,gender,and polytherapy on parathyroid hormone levels in individuals taking antiepileptic medication.
文摘Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. Methods We used the China Health Insurance Research Data （the CHIRA Data） 2011 which comprises all inpatient hospital records （300,886） during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries （1,718,500 men and 1,616,500 women） from 25 cities and counties in different economic-geographic regions of China's Mainland. Patients with acute aortic dissection were identified according to International Classification of Disease 10m Revision （ICD-10） of I71.0, The estimated incidence of AAD was calculated using the equation： estimated incidence = 2.0 × （40% × hospital admission rate） ＋ 60% × hospital admission rate. Results The hospital admission rate was 2.0/100,000 （65/3,325,000, 95% CI： 1.2-2.8）. The estimated annual incidence of AAD was 2.8/100,000 （95% CI： 1.9-3.6） and was higher in male than in female （3.7 vs. 1.5, P 〈 0.001）. The mean age was 58.9 ± 13.4 years. During the mean hospital stay of 23 ±6 days, the overall in-hospital mortality was 13.9% （9/65）. Conclusions Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.
基金supported by the National Natural Science Foundation of China(31970222,31770569,31500454,31500165,32260060,32270217,32260056,31970223,32400180)the Science and Technology Basic Resources Investigation Program of China(2017FY100100,2017FY100102)+7 种基金Biodiversity Conservation Program of Chinese Academy of Sciences(ZSSD-013)National Key Research and Development Program of China(2022YFC2601200,2023YFF0805800)Yunnan Fundamental Research Projects(202201AS070055,202301AU070224)the 14th Five-Year Plan of Xishuangbanna Tropical Botanical Garden,Chinese Academy of Sciences(XTBG-1450101)Australian Research Council grant(DP130104314)RSNZ Marsden grant(11-UOO-043)Xingdian Talent Support Program(XDRC-QNRC-2022-0323)Shandong Provincial Natural Science Foundation(ZR2022QC214).
文摘Over the past two decades,our understanding of Lauraceae,a large family of woody plants,has undergone significant advances in phylogeny,taxonomy,and biogeography.Molecular systematic studies have elucidated the basic relationships within the family with plastid phylogenomic analyses providing robust support for deep-level relationships between Lauraceae lineages,leading to the recognition of nine tribes:Hypodaphnideae,Cryptocaryeae,Cassytheae,Neocinnamomeae,Caryodaphnopsideae,Mezilaureae,Perseeae,Laureae,and Cinnamomeae,with Mezilaureae validated here.Nuclear genomes and comparative genomics studies have also clarified aspects of the family’s evolutionary history and metabolic diversity.Taxonomic studies have focused mainly on the most diverse regions,e.g.,tropical Asia,tropical America,and Africa(Madagascar),with six new genera described and five reinstated since the last major overview of the family.The extensive fossil record suggests that Lauraceae diversified globally during the Late Cretaceous and Early Cenozoic.Biogeographic studies indicate that different lineages of the family are sorted into Gondwanan and Laurasian lineages,with patterns resulting from the disruption of boreotropical flora and multiple long-distance dispersal events.Phylogeographic studies,predominantly from East Asia,have shown patterns of in situ survival and demographic stability or expansion during the Quaternary.Nevertheless,many systematic relationships within the family remain unresolved and further research is needed into the complex biogeographic history and ecological roles of Lauraceae.A multifaceted approach integrating genomic studies,field work,morphological and ecological investigations is therefore needed to understand the evolution and diversity of this ecologically and economically significant plant family.
基金State Natural Science Foundation of China (40074013 and 40134010) New Zealand Marsden Foundation (00-SRA-002-MIS).
文摘Using the Hill estimator, general multifractal characteristics of events in the New Zealand area have been dis-cussed. Results show that the spatial distribution of shallow events has apparent clustering characteristics, inde-pendent of the threshold magnitude; but for deep events these characteristics are not clear. While the time interval distribution has obvious clustering characteristics both for deep and shallow events, although with a different scal-ing range, the Hill estimates tend to indicate that the time interval distribution has a unifractal rather than a multifractal nature. All above reveal that the seismicity nature for shallow and deep events is apparently different.
文摘BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies.METHODS: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction <2 units on the 0–10 pain scale between triage and ED departure.RESULTS: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood of refractory pain.CONCLUSIONS: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.
文摘This article aims to explore the current status of creative protection for artists in the field of art.With the further development of modern society,the development of the art market,and the continuous growth of the market value of artist works,the protection of artistic creativity has also attracted increasing attention and become a focus.Firstly,the article will introduce the connotation and extension of artistic creativity,as well as the importance and significance of protection.Secondly,this article will explore the challenges faced by the protection of artistic creativity,including issues such as piracy and infringement,and propose corresponding tentative solutions.Finally,through specific analysis,the current status of artistic and creative protection will be summarized,and future development directions will be looked forward to.
基金Financial support for this work was provided by the US Department of Commerce,National Institute of Standards and Technology(NIST)under the Financial Assistance Award Number(FAIN)#70NANB20H008.
文摘A large number of communities are impacted annually by the increasing frequency of tornado hazards resulting in damage to the infrastructure as well as disruption of community functions.The effect of the hazard geometry(center and angle of tornado path as well as the tornado width)is studied herein on how it influences the recovery of physical and social systems within the community.Given that pre-disaster preparedness including mitigation strategies(e.g.,retrofits)and policies(e.g.,insurance)is crucial for increasing the resilience of the community and facilitating a faster recovery process,in this study,the impact of various mitigation strategies and policies on the recovery trajectory and resilience of a typical US community subjected to a tornado is investigated considering different sources of uncertainties.The virtual testbed of Centerville is selected in this paper and is modeled by adopting the Agent-based modeling(ABM)approach which is a powerful tool for conducting community resilience analysis that simulates the behavior of different types of agents and their interactions to capture their interdependencies.The results are presented in the form of recovery time series as well as calculated resilience indices for various community systems(lifeline networks,schools,healthcare,businesses,and households).The results of this study can help deepen our understanding of how to efficiently expedite the recovery process of a community.
文摘This study explores the perspectives and challenges faced by family members providing mental support to cancer patients in Beijing,China.The primary objective is to understand the emotional and practical roles family members undertake and the difficulties they encounter.Utilizing a qualitative research design,data were collected through semi-structured interviews with family caregivers of cancer patients.Thematic analysis revealed several key themes:the dual burden of emotional support and caregiving responsibilities,the impact on daily life and personal well-being,the role and effectiveness of external support systems,perceptions of medical staff support,and the common challenges and conflicts faced in caregiving.The findings highlight the critical need for comprehensive support systems that address both the emotional and practical needs of family caregivers.Recommendations for enhancing family-centered support programs in oncology settings are discussed.
基金supported by Endeavour funding from the New Zealand Ministry of Business,Innovation and Employment(MBIE)awarded to HERA for the project titled“Developing a Construction 4.0 transformation of Aotearoa New Zealand’s construction sector”coordinated by New Zealand Heavy Engineering Research Association,HERA.
文摘Circular design encompasses the use of inventive construction methodologies that possess the capability to be readily dismantled,repurposed,or recycled upon reaching the conclusion of their functional lifespan.This work specifically examines the creation of a reusable design case-study idea for seismic frame design,which is commonly employed in steel-frame constructions in New Zealand.A reusable optimized design for the full seismic frame was proposed in the research.Optimizing the dimensions of welded structures,whether in terms of weight or cost,leads to a decrease in the weight of the steel utilized.The decrease in weight is directly associated with a decrease in environ-mental impact,as the environmental impact is directly proportional to the mass of the construction.The environmental consequences associated with welding technique are contingent upon the dimensions of the weld,hence exerting an indirect influence on the overall mass of the structure.Given the presence of mass dependence in all three areas,albeit in distinct manners,this work employed a multi-objective function optimization strategy to simultaneously address these areas while also partially evaluating them separately.On this way substantial reductions can be achieved both at structural mass and environmental effects.
文摘The introduction of machine learning (ML) in the research domain is a new era technique. The machine learning algorithm is developed for frequency predication of patterns that are formed on the Chladni plate and focused on the application of machine learning algorithms in image processing. In the Chladni plate, nodes and antinodes are demonstrated at various excited frequencies. Sand on the plate creates specific patterns when it is excited by vibrations from a mechanical oscillator. In the experimental setup, a rectangular aluminum plate of 16 cm x 16 cm and 0.61 mm thickness was placed over the mechanical oscillator, which was driven by a sine wave signal generator. 14 Chladni patterns are obtained on a Chladni plate and validation is done with modal analysis in Ansys. For machine learning, a large number of data sets are required, as captured around 200 photos of each modal frequency and around 3000 photos with a camera of all 14 Chladni patterns for supervised learning. The current model is written in Python language and model has one convolution layer. The main modules used in this are Tensor Flow Keras, NumPy, CV2 and Maxpooling. The fed reference data is taken for 14 frequencies between 330 Hz to 3910 Hz. In the model, all the images are converted to grayscale and canny edge detected. All patterns of frequencies have an almost 80% - 99% correlation with test sample experimental data. This approach is to form a directory of Chladni patterns for future reference purpose in real-life application. A machine learning algorithm can predict the resonant frequency based on the patterns formed on the Chladni plate.
文摘In child psychiatry, the use of play, a habitual activity in children, is used as a means of communication and therapy. The psychodynamic reading of a sequence of games played by a three-year-old child with dolls, who had been treated for anorexia for a year at the Children’s Guidance Center of Abidjan, shed new light on the child’s problems. The clinical history of M (3 years old) revealed, in addition to the eating disorder, a disturbance in the attachment bond and parental imagos in distress. This doll game, set up as a copy of reality, enabled the therapist to redirect his treatment and work on the mother-child bond.
文摘Attracting foreign capital is a key pillar of China’s reform and opening up policy,and foreign-funded enterprises are an important component of China’s economy.Currently,China is taking steps to further boost its attractiveness as a foreign direct investment(FDI)destination in order to seek more foreign capital.
基金support from the Pennsylvania Department of Community&Economic Development(DCED)through grant PIT-19-02 and of Lehigh University through the“Research Futures:Major Program Development”the“Research Fu-tures:Special Seed Funding Opportunity”grants are gratefully acknowl-edged.
文摘An accurate estimation of wind loads on telecommunication towers is crucial for design,as well as for perform-ing reliability,resilience,and risk assessments.In particular,drag coefficient and interference factor are the most significant factors for wind load computations.Wind tunnel tests and computational fluid dynamics(CFD)are the most appropriate methods to estimate these parameters.While wind tunnel tests are generally preferred in practice,they require dedicated facilities and personnel,and can be expensive if multiple configurations of tower panels and antennas need to be tested under various wind directions(e.g.,fragility curve development for system resilience analysis).This paper provides a simple,robust,and easily accessible CFD protocol with widespread applicability,offering a practical solution in situations where wind tunnel testing is not feasible,such as complex tower configurations or cases where the cost of running experiments for all the tower-antennas configurations is prohibitively high.Different turbulence models,structural and fluid boundary conditions and mesh types are tested to provide a streamlined CFD modeling strategy that shows good convergence and balances accuracy,computational time,and robustness.The protocol is calibrated and validated with experimental studies available in the literature.To demonstrate the capabilities of the protocol,three lattice tower panels and antennas with different configurations are analyzed as examples.The protocol successfully estimates the drag and lateral wind loads and their coefficients under different wind directions.Noticeable differences are observed between the esti-mated wind loads with this protocol and those computed by a simple linear superposition used in most practical applications,indicating the importance of tower-antenna interaction.Also,as expected,the wind loads recom-mended by design codes overestimate the simulated results.More importantly,the telecommunication design codes inadequately identify the most favorable wind directions that are associated with the lowest wind loads,while the results of the proposed protocol align with observations from experimental studies.This information may be used to select the tower orientation before construction.The findings of this study are of importance for the telecommunication industry,which seeks reliable results with minimal computational efforts.In addition,it enhances the fragility analysis of telecommunication towers under strong winds,and the portfolio risk and resilience assessment of telecommunication systems.
文摘Many advances in genetic selection, nutrition, housing and disease control have been incorporated into modern pork production since the 1950s resulting in highly prolific females and practices and technologies, which significantly increased efficiency of reproduction in the breeding herd. The objective of this manuscript is to review the literature and current industry practices employed for reproductive management. In particular the authors focus on assisted reproduction technologies and their application for enhanced productivity. Modern maternal line genotypes have lower appetites and exceptional lean growth potential compared to females of 20 yr ago. Thus, nutrient requirements and management techniques and technologies, which affect gilt development and sow longevity, require continuous updating. Failure to detect estrus accurately has the greatest impact on farrowing rate and litter size. Yet, even accurate estrus detection will not compensate for the variability in the interval between onset of estrus and actual time of ovulation. However, administration of GnRH analogs in weaned sows and in gilts after withdrawal of altrenogest do overcome this variability and thereby synchronize ovulation, which makes fixed-time AI practical. Seasonal infertility, mediated by temperature and photoperiod, is a persistent problem. Training workers in the art of stockmanship is of increasing importance as consumers become more interested in humane animal care. Altrenogest, is used to synchronize the estrous cycle of gilts, to prolong gestation for 2-3 d to synchronize farrowing and to postpone post-weaning estrus. P.G. 600~ is used for induction of estrus in pre-pubertal gilts and as a treatment to overcome seasonal anestrous. Sperm cell numbers/dose of semen is significantly less for post cervical AI than for cervical AI. Real-time ultrasonography is used to determine pregnancy during wk 3-5. PGF2a effectively induces farrowing when administered within two d of normal gestation length. Ovulation synchronization, single fixed-time AI and induced parturition may lead to farrowing synchronization, which facilitates supervision and reduces stillbirths and piglet mortality. Attendance and assistance at farrowing is important especially to ensure adequate colostrum consumption by piglets immediately after birth. New performance terminologies are presented.
基金supported by MSD Holding Co.,Ltd.The funding was only for the payment of using CHIRA database
文摘Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods： We searched the China Health Insurance Research Association （CHIRA） Database to identify patients with cancer who were 〉 18 years old and received either moderately or highly emetogenie chemotherapy （MEC and HEC, respectively） between 2008 and 2012. Patients＇ characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results： Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC （59.4% vs. 81.3 %; P〈0.001）. The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group （P〈0.012）; however, a higher proportion received a mixed regimen containing eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group （both P〈0.001）. Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions： These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.
基金The Federal Highway Administration(FHWA)under Contract No.DTFH61-98-C-00094the California Department of Transportation(CALTRANS)
文摘The objective of this research is to determine the effect earthquakes have on the performance of transportation network systems.To do this,bridge fragility curves,expressed as a function of peak ground acceleration(PGA)and peak ground velocity(PGV),were developed.Network damage was evaluated under the 1994 Northridge earthquake and scenario earthquakes.A probabilistic model was developed to determine the effect of repair of bridge damage on the improvement of the network performance as days passed after the event.As an example,the system performance degradation measured in terms of an index,'Drivers Delay,'is calculated for the Los Angeles area transportation system,and losses due to Drivers Delay with and without retrofit were estimated.
