Risk of Vertebral Fracture in Patients Diagnosed with a Depressive Disorder: A Nationwide Population-Based Cohort Study

OBJECTIVE: Previous studies have reported that depression may play a crucial role in the occurrence of vertebral fractures. However, a clear correlation between depressive disorders and osteoporotic fractures has not been established. We explored the association between depressive disorders and subsequent new-onset vertebral fractures. Additionally, we aimed to identify the potential risk factors for vertebral fracture in patients with a depressive disorder. METHODS: We studied patients listed in the Taiwan National Health Insurance Research Database who were diagnosed with a depressive disorder by a psychiatrist. The comparison cohort consisted of age- and sex-matched patients without a depressive disorder. The incidence rate and hazard ratios of subsequent vertebral fracture were evaluated. We used Cox regression analysis to evaluate the risk of vertebral fracture among patients with a depressive disorder. RESULTS: The total number of patients with and without a depressive disorder was 44,812. The incidence risk ratio (IRR) between these 2 cohorts indicated that depressive disorder patients had a higher risk of developing a subsequent vertebral fracture (IRR=1.41, 95% confidence interval [CI]=1.26-1.57,

MiniZero: Comparative Analysis of AlphaZero and MuZero on Go, Othello, and Atari Games

This paper presents MiniZero, a zero-knowledge learning framework that supports four state-of-the-art algorithms, including AlphaZero, MuZero, Gumbel AlphaZero, and Gumbel MuZero. While these algorithms have demonstrated super-human performance in many games, it remains unclear which among them is most suitable or efficient for specific tasks. Through MiniZero, we systematically evaluate the performance of each algorithm in two board games, 9x9 Go and 8x8 Othello, as well as 57 Atari games. For two board games, using more simulations generally results in higher performance. However, the choice of AlphaZero and MuZero may differ based on game properties. For Atari games, both MuZero and Gumbel MuZero are worth considering. Since each game has unique characteristics, different algorithms and simulations yield varying results. In addition, we introduce an approach, called progressive simulation, which progressively increases the simulation budget during training to allocate computation more efficiently. Our empirical results demonstrate that progressive simulation achieves significantly superior performance in two board games. By making our framework and trained models publicly available, this paper contributes a benchmark for future research on zero-knowledge learning algorithms, assisting researchers in algorithm selection and comparison against these zero-knowledge learning baselines. Our code and data are available at https://rlg.iis.sinica.edu.tw/papers/minizero.Comment: Submitted to IEEE Transactions on Games, under revie

Timeframe for return to driving for patients with minimally invasive knee arthroplasty is associated with knee performance on functional tests

BACKGROUND: This study hopes to establish the timeframe for a safe return to driving under different speed conditions for patients after minimally invasive total knee arthroplasty and further explores how well various kinds of functional tests on knee performance can predict the patients’ braking ability. METHODS: 14 patients with right knee osteoarthritis were included in the present study and instructed to perform three simulated driving tasks at preoperative, 2 weeks postoperative and 4 weeks postoperative. RESULTS: The results showed that the total braking time at 4 week postoperative has attained the preoperative level at the driving speed 50 and 70 km/hr but not at the driving speed 90 km/hr. It had significantly improving in knee reaction time and maximum isometric force at 4 weeks postoperative. Besides, there was a moderate to high correlation between the scores of the step counts and the total braking time. CONCLUSIONS: Summary, it is recommended that driving may be resumed 4 weeks after a right knee replacement but had to drive at low or moderate speed and the best predictor of safety driving is step counts

Modification and validation of the COVID-19 stigma instrument in nurses: A cross-sectional survey

BackgroundNurses taking care of patients with infectious diseases have suffered from noticeable societal stigma, however currently, there is no validated scale to measure such stigma. This study aimed to revise and validate the COVID-19 Stigma Instrument-Nurse-Version 3 (CSI-N-3) by using item response theory (IRT) as well as classical test theory analysis.MethodsIn phase I, the Chinese CSI-N-3 was modified from the English version of HIV/AIDS Stigma Instrument-Nurse based on standard cross-cultural procedures, including modifications, translation/back translations, pilot testing, and psychometric testing with classical test theory and Rasch analysis. In phase II, a cross-sectional study using cluster sampling was conducted among 249 eligible nurses who worked in a COVID-19-designed hospital in Shanghai, China. The influencing factors of COVID-19-associated stigma were analyzed through regression analysis.ResultsIn phase I, the two-factor structure was verified by confirmatory factor analysis, which indicated a good model fit. The 15-item CSI-N-3 achieved Cronbach’s α of 0.71–0.84, and composite reliability of 0.83–0.91. The concurrent validity was established by significant association with self-reported physical, psychological, and social support levels (r = −0.18, −0.20, and −0.21, p < 0.01). In IRT analysis, the CSI-N-3 has ordered response thresholds, with the Item Reliability and Separation Index of 0.95 and 4.15, respectively, and the Person Reliability and Separation Index of 0.20 and 0.50, respectively. The infit and outfit mean squares for each item ranged from 0.39 to 1.57. In phase II, the mean score for the CSI-N-3 in Chinese nurses was 2.80 ± 3.73. Regression analysis showed that social support was the only factor affecting nurses’ COVID-19-associated stigma (standardized coefficients β = −0.21, 95% confidence interval: −0.73 ~ −0.19).ConclusionThe instrument CSI-N-3 is equipped with rigorous psychometric properties that can be used to measure COVID-19-associated stigma during and after the COVID-19 pandemic among nurses. The use of this instrument may facilitate the evaluation of tailored stigma-reduction interventions

Identification of Heat-Tolerant Genes in Non-Reference Sequences in Rice by Integrating Pan-Genome, Transcriptomics, and QTLs.

The availability of large-scale genomic data resources makes it very convenient to mine and analyze genes that are related to important agricultural traits in rice. Pan-genomes have been constructed to provide insight into the genome diversity and functionality of different plants, which can be used in genome-assisted crop improvement. Thus, a pan-genome comprising all genetic elements is crucial for comprehensive variation study among the heat-resistant and -susceptible rice varieties. In this study, a rice pan-genome was firstly constructed by using 45 heat-tolerant and 15 heat-sensitive rice varieties. A total of 38,998 pan-genome genes were identified, including 37,859 genes in the reference and 1141 in the non-reference contigs. Genomic variation analysis demonstrated that a total of 76,435 SNPs were detected and identified as the heat-tolerance-related SNPs, which were specifically present in the highly heat-resistant rice cultivars and located in the genic regions or within 2 kbp upstream and downstream of the genes. Meanwhile, 3214 upregulated and 2212 downregulated genes with heat stress tolerance-related SNPs were detected in one or multiple RNA-seq datasets of rice under heat stress, among which 24 were located in the non-reference contigs of the rice pan-genome. We then mapped the DEGs with heat stress tolerance-related SNPs to the heat stress-resistant QTL regions. A total of 1677 DEGs, including 990 upregulated and 687 downregulated genes, were mapped to the 46 heat stress-resistant QTL regions, in which 2 upregulated genes with heat stress tolerance-related SNPs were identified in the non-reference sequences. This pan-genome resource is an important step towards the effective and efficient genetic improvement of heat stress resistance in rice to help meet the rapidly growing needs for improved rice productivity under different environmental stresses. These findings provide further insight into the functional validation of a number of non-reference genes and, especially, the two genes identified in the heat stress-resistant QTLs in rice

Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens

<p>Abstract</p> <p>Background</p> <p>Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen.</p> <p>Methods</p> <p>Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1) and 35 patients with a gram-negative pathogen (Group 2).</p> <p>Results</p> <p>Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors.</p> <p>Conclusions</p> <p>Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.</p

The Association Between the Sedative Loads and Clinical Severity Indicators in the First-Onset Major Depressive Disorder

Background: High sedative use in a major depressive episode may imply specific clinical features. This study aims to examine the correlation between sedative use and clinical severity indicators in the initial treatment phase of first-onset major depressive disorder.Methods: A study cohort in the first episode of major depressive disorder was used to conduct pharmacological dissection. All participants had at least a 2-year follow-up period with a complete treatment record. The defined daily dose of antidepressants and augmentation agents were calculated as the antidepressant load and augmentation load, respectively. Sedative use, which was calculated as the equivalent dosage of lorazepam, were defined as the sedative load. These psychotropic loads were measured monthly and the averaged psychotropic loads for each day were obtained.Results: A total of 106 individuals (75.5% female) were included. The mean duration of disease course in participants was 5.5 ± 3.5 years. In the multiple regression analysis, after controlling for other classes of psychotropics and comorbid anxiety disorders, the sedative load independently correlated with higher number of antidepressants used, higher number of antidepressant used with an adequate dose and duration, more psychiatric emergency and outpatient visits within 2 years of disease onset.Conclusion: High loading of sedatives correlated with several indicators of clinical severity in major depressive disorder. The sedative load may be used as a specifier to identify subgroups in patients with major depressive disorder

Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America

Background Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. Methods We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. Results Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. Conclusions Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations