Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014

BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity in many countries but few recent large-scale studies have examined trends in its incidence. METHODS: Incidence of CAP leading to hospitalisation in one UK region (Oxfordshire) was calculated over calendar time using routinely collected diagnostic codes, and modelled using piecewise-linear Poisson regression. Further models considered other related diagnoses, typical administrative outcomes, and blood and microbiology test results at admission to determine whether CAP trends could be explained by changes in case-mix, coding practices or admission procedures. RESULTS: CAP increased by 4.2%/year (95% CI 3.6 to 4.8) from 1998 to 2008, and subsequently much faster at 8.8%/year (95% CI 7.8 to 9.7) from 2009 to 2014. Pneumonia-related conditions also increased significantly over this period. Length of stay and 30-day mortality decreased slightly in later years, but the proportions with abnormal neutrophils, urea and C reactive protein (CRP) did not change (p>0.2). The proportion with severely abnormal CRP (>100 mg/L) decreased slightly in later years. Trends were similar in all age groups. Streptococcus pneumoniae was the most common causative organism found; however other organisms, particularly Enterobacteriaceae, increased in incidence over the study period (p<0.001). CONCLUSIONS: Hospitalisations for CAP have been increasing rapidly in Oxfordshire, particularly since 2008. There is little evidence that this is due only to changes in pneumonia coding, an ageing population or patients with substantially less severe disease being admitted more frequently. Healthcare planning to address potential further increases in admissions and consequent antibiotic prescribing should be a priority

The Mitochondrial Ca(2+) Uniporter: Structure, Function, and Pharmacology.

Mitochondrial Ca(2+) uptake is crucial for an array of cellular functions while an imbalance can elicit cell death. In this chapter, we briefly reviewed the various modes of mitochondrial Ca(2+) uptake and our current understanding of mitochondrial Ca(2+) homeostasis in regards to cell physiology and pathophysiology. Further, this chapter focuses on the molecular identities, intracellular regulators as well as the pharmacology of mitochondrial Ca(2+) uniporter complex

Employment Tactics and Strategies of Technical-Vocational Education Students for Career and Professional Development in the Labour Market of Vietnam

Many policies and strategies have been implemented to improve both the quality and quantity of Vietnam's technical and vocational education (TVE) system, and the results indicated innovative reform of the TVE system in both ways in Vietnam. Many aspects of TVE in Vietnam have been explored by a series of reports of the National Institute for Vocational Education and Training (NIVET); however, there exists a shortage of studies attempting to focus on the process of TVE graduates’ employment experience in the Vietnamese labour market. This study attempts to explore the employment of TVE graduates from technical colleges in Vietnam, with a focus on their employment tactics. To base this study on a qualitative approach, the primary data sources were obtained through semi-structure interviews and self-diary on employment tactics and strategies of TVE graduates in the labour market within two years. The obtained data were subjected to thematic analysis. Based on this, results revealed difficulty in obtaining desirable and high-paying jobs even though it was not difficult to obtain jobs to earn a living. Also, low satisfaction and resilience due to poor working conditions were revealed. Three key strategies: maintaining low pay jobs to earn a living, updating their skills to get better jobs, and changing to suitable jobs were figured out by TVE graduates. These strategies gradually assisted TVE graduates to obtain sustainable goals of career promotion and professional development

Substrate protein folds while it is bound to the ATP-independent chaperone Spy

Chaperones assist the folding of many proteins in the cell. While the most well studied chaperones use cycles of ATP binding and hydrolysis to assist protein folding, a number of chaperones have been identified that promote protein folding in the absence of highenergy cofactors. Precisely how ATP-independent chaperones accomplish this feat is unclear. Here we have characterized the kinetic mechanism of substrate folding by the small, ATP-independent chaperone, Spy. Spy rapidly associates with its substrate, Immunity protein 7 (Im7), eliminating its potential for aggregation. Remarkably, Spy then allows Im7 to fully fold into its native state while remaining bound to the surface of the chaperone. These results establish a potentially widespread mechanism whereby ATP-independent chaperones can assist in protein refolding. They also provide compelling evidence that substrate proteins can fold while continuously bound to a chaperone

Emergency presentation of cancer and short-term mortality

Background:The short-term survival following a cancer diagnosis in England is lower than that in comparable countries, with the difference in excess mortality primarily occurring in the months immediately after diagnosis. We assess the impact of emergency presentation (EP) on the excess mortality in England over the course of the year following diagnosis. Methods:All colorectal and cervical cancers presenting in England and all breast, lung, and prostate cancers in the East of England in 2006-2008 are included. The variation in the likelihood of EP with age, stage, sex, co-morbidity, and income deprivation is modelled. The excess mortality over 0-1, 1-3, 3-6, and 6-12 months after diagnosis and its dependence on these case-mix factors and presentation route is then examined. Results:More advanced stage and older age are predictive of EP, as to a lesser extent are co-morbidity, higher income deprivation, and female sex. In the first month after diagnosis, we observe case-mix-adjusted excess mortality rate ratios of 7.5 (cervical), 5.9 (colorectal), 11.7 (breast ), 4.0 (lung), and 20.8 (prostate) for EP compared with non-EP. Conclusion:Individuals who present as an emergency experience high short-term mortality in all cancer types examined compared with non-EPs. This is partly a case-mix effect but EP remains predictive of short-term mortality even when age, stage, and co-morbidity are accounted for

Rotating machinery fault diagnosis for imbalanced data based on decision tree and fast clustering algorithm

To diagnose rotating machinery fault for imbalanced data, a kind of method based on fast clustering algorithm and decision tree is proposed. Combined with wavelet packet decomposition and isometric mapping (Isomap), sensitive features of different faults can be obtained so the imbalanced fault sample set is constituted. Then the fast clustering algorithm is applied to search core samples from the majority data of the imbalanced fault sample set. Consequently, the balanced fault sample set consisted of the clustered data and the minority data is built. After that, decision tree is trained with the balanced fault sample set to get the fault diagnosis model. Finally, gearbox fault data set and rolling bearing fault data set are used to test the fault diagnosis model. The experiment results show that proposed fault diagnosis model could accurately diagnose the rotating machinery fault for imbalanced data

Tissue Microenvironments Define and Get Reinforced by Macrophage Phenotypes in Homeostasis or during Inflammation, Repair and Fibrosis

Current macrophage phenotype classifications are based on distinct in vitro culture conditions that do not adequately mirror complex tissue environments. In vivo monocyte progenitors populate all tissues for immune surveillance which supports the maintenance of homeostasis as well as regaining homeostasis after injury. Here we propose to classify macrophage phenotypes according to prototypical tissue environments, e.g. as they occur during homeostasis as well as during the different phases of (dermal) wound healing. In tissue necrosis and/or infection, damage- and/or pathogen-associated molecular patterns induce proinflammatory macrophages by Toll-like receptors or inflammasomes. Such classically activated macrophages contribute to further tissue inflammation and damage. Apoptotic cells and antiinflammatory cytokines dominate in postinflammatory tissues which induce macrophages to produce more antiinflammatory mediators. Similarly, tumor-associated macrophages also confer immunosuppression in tumor stroma. Insufficient parenchymal healing despite abundant growth factors pushes macrophages to gain a profibrotic phenotype and promote fibrocyte recruitment which both enforce tissue scarring. Ischemic scars are largely devoid of cytokines and growth factors so that fibrolytic macrophages that predominantly secrete proteases digest the excess extracellular matrix. Together, macrophages stabilize their surrounding tissue microenvironments by adapting different phenotypes as feed-forward mechanisms to maintain tissue homeostasis or regain it following injury. Furthermore, macrophage heterogeneity in healthy or injured tissues mirrors spatial and temporal differences in microenvironments during the various stages of tissue injury and repair. Copyright (C) 2012 S. Karger AG, Base

Training-free Subject-Enhanced Attention Guidance for Compositional Text-to-image Generation

Existing subject-driven text-to-image generation models suffer from tedious fine-tuning steps and struggle to maintain both text-image alignment and subject fidelity. For generating compositional subjects, it often encounters problems such as object missing and attribute mixing, where some subjects in the input prompt are not generated or their attributes are incorrectly combined. To address these limitations, we propose a subject-driven generation framework and introduce training-free guidance to intervene in the generative process during inference time. This approach strengthens the attention map, allowing for precise attribute binding and feature injection for each subject. Notably, our method exhibits exceptional zero-shot generation ability, especially in the challenging task of compositional generation. Furthermore, we propose a novel metric GroundingScore to evaluate subject alignment thoroughly. The obtained quantitative results serve as compelling evidence showcasing the effectiveness of our proposed method. The code will be released soon.Comment: 26 pages, 13 figure