Influenza vaccine uptake among children and older adults in China: a secondary analysis of a quasi-experimental study.

BACKGROUND: Influenza vaccination is the key to prevent influenza-related disease, especially among high-risk populations. However, influenza vaccine uptake in China is low. This secondary analysis of a quasi-experimental trial aimed to understand factors associated with influenza vaccine uptake among children and older people stratified by funding context. METHODS: A total of 225 children (aged 0.5-8 years) and 225 older people (aged 60 years or above) were recruited from three clinics (rural, suburban and urban) in Guangdong Province. Participants were allocated into two groups based on funding contexts: a self-paid group (N = 150, 75 children and 75 older adults) in which participants paid full price for their vaccination; and a subsidized group (N = 300, 150 children and 150 older adults) in which varying levels of financial support was provided. Univariate and multivariable logistic regressions were conducted stratified by funding contexts. RESULTS: Overall, 75.0% (225/300) of participants in the subsidized group and 36.7% (55/150) in the self-paid group got vaccinated. Older adults had lower vaccination rates than children in both funding groups, while both age groups showed much higher uptake in the subsidized group than in the self-paid group (aOR = 5.96, 95% CI: 3.77-9.42, p = 0.001). In the self-paid group, having prior influenza vaccination history of children (aOR:2.61, 95%CI: 1.06-6.42) or older people (aOR:4.76, 95%CI: 1.08-20.90) was associated with increased influenza vaccine uptake compared to those who had no prior vaccination experiences in the family. While in the subsidized group, participants who got married or lived with partners (aOR = 0.32, 0.10-0.98) had lower vaccination uptake than single ones. Trust in providers' advice (aOR = 4.95, 95%CI:1.99, 12.43), perceived effectiveness of the vaccine (aOR: 12.18, 95%CI: 5.21-28.50), and experienced influenza-like illnesses in the family in the past year (aOR = 46.52, 4.10, 533.78) were associated with higher vaccine uptake. CONCLUSIONS: Older people had suboptimal vaccine uptake compared to children in both contexts and need more attention to enhance influenza vaccination. Tailoring interventions to different vaccine funding contexts may help improve influenza vaccination: In self-paid context, motivating people to accept their first ever influenza vaccination may be a promising strategy. In subsidized context, improving public confidence in vaccine effectiveness and providers' advice would be useful

Ectopic tissue engineered ligament with silk collagen scaffold for ACL regeneration: A preliminary study

Anterior cruciate ligament (ACL) reconstruction remains a formidable clinical challenge because of the lack of vascularization and adequate cell numbers in the joint cavity. In this study, we developed a novel strategy to mimic the early stage of repair in vivo, which recapitulated extra-articular inflammatory response to facilitate the early ingrowth of blood vessels and cells. A vascularized ectopic tissue engineered ligament (ETEL) with silk collagen scaffold was developed and then transferred to reconstruct the ACL in rabbits without interruption of perfusion. At 2 weeks after ACL reconstruction, more well-perfused cells and vessels were found in the regenerated ACL with ETEL, which decreased dramatically at the 4 and 12 week time points with collagen deposition and maturation. ACL treated with ETEL exhibited more mature ligament structure and enhanced ligament-bone healing post-reconstructive surgery at 4 and 12 weeks, as compared with the control group. In addition, the ETEL group was demonstrated to have higher modulus and stiffness than the control group significantly at 12 weeks post-reconstructive surgery. In conclusion, our results demonstrated that the ETEL can provide sufficient vascularity and cellularity during the early stages of healing, and subsequently promote ACL regeneration and ligament-bone healing, suggesting its clinic use as a promising therapeutic modality. Statement of Significance Early inflammatory cell infiltration, tissue and vessels ingrowth were significantly higher in the extra articular implanted scaffolds than theses in the joint cavity. By mimicking the early stages of wound repair, which provided extra-articular inflammatory stimulation to facilitate the early ingrowth of blood vessels and cells, a vascularized ectopic tissue engineered ligament (ETEL) with silk collagen scaffold was constructed by subcutaneous implantation for 2 weeks. The fully vascularized TE ligament was then transferred to rebuild ACL without blood perfusion interruption, and was demonstrated to exhibit improved ACL regeneration, bone tunnel healing and mechanical properties. (C) 2017 Published by Elsevier Ltd on behalf of Acta Materialia Inc

Four-Objective Optimizations for an Improved Irreversible Closed Modified Simple Brayton Cycle

An improved irreversible closed modified simple Brayton cycle model with one isothermal heating process is established in this paper by using finite time thermodynamics. The heat reservoirs are variable-temperature ones. The irreversible losses in the compressor, turbine, and heat exchangers are considered. Firstly, the cycle performance is optimized by taking four performance indicators, including the dimensionless power output, thermal efficiency, dimensionless power density, and dimensionless ecological function, as the optimization objectives. The impacts of the irreversible losses on the optimization results are analyzed. The results indicate that four objective functions increase as the compressor and turbine efficiencies increase. The influences of the latter efficiency on the cycle performances are more significant than those of the former efficiency. Then, the NSGA-II algorithm is applied for multi-objective optimization, and three different decision methods are used to select the optimal solution from the Pareto frontier. The results show that the dimensionless power density and dimensionless ecological function compromise dimensionless power output and thermal efficiency. The corresponding deviation index of the Shannon Entropy method is equal to the corresponding deviation index of the maximum ecological function

Analysis and optimization of an axial-radial hybrid ventilation generator's cooling structure

This study focuses on investigating an axial-radial hybrid ventilation generator. The stator and rotor of the generator experience high losses. They are mitigated through simultaneous cooling air blown in from both sides of the generator. The stator is cooled radially and the rotor is designed with small tooth ventilation grooves. A three-dimensional simulation model is created using the cooling structure as a basis. The analysis covers the flow distribution characteristics and velocity variations of the generator, as well as the temperature distribution of major components. To verify the reliability of the simulation, the results are compared with experimental data. An orthogonal design experiment is utilized in conjunction with a numerical simulation method to optimize the generator's structure. The optimization objectives include the highest temperature of the stator and rotor windings, air friction loss, and pressure difference between the inlet and outlet. In comparison to the original scheme, the highest temperature of the stator windings decreases by 1.17% and the highest temperature of the rotor windings decreases by 3.16% in the optimized scheme. Additionally, the pressure difference between the inlet and outlet decreases by 5.56%. However, there is an increase of 9.82% in air friction loss in the optimized scheme. After conducting a thorough comparison, it has been determined that the optimized scheme outperforms the original scheme. The findings of this research hold significant guidance toward enhancing the cooling structure of the generator in the future

Minimum Entropy Generation Rate and Maximum Yield Optimization of Sulfuric Acid Decomposition Process Using NSGA-II

Based on the theory of finite-time thermodynamics (FTT), the effects of three design parameters, that is, inlet temperature, inlet pressure, and inlet total mole flow rate, of a tubular plug-flow sulfuric acid decomposition reactor on the total entropy generation rate (EGR) and SO2 yield are analyzed firstly. One can find that when the three design parameters are taken as optimization variables, the minimum total EGR and the maximum SO2 yield of the reference reactor restrict each other, i.e., the two different performance objectives cannot achieve the corresponding extremum values at the same time. Then, the second-generation non-dominated solution sequencing genetic algorithm (NSGA-II) is further used to pursue the minimum total EGR and the maximum SO2 yield of the reference reactor by taking the three parameters as optimization design variables. After the multi-objective optimization, the reference reactor can be Pareto improved, and the total EGR can be reduced by 9% and the SO2 yield can be increased by 14% compared to those of the reference reactor. The obtained results could provide certain theoretical guidance for the optimal design of actual sulfuric acid decomposition reactors

Power Optimization of a Modified Closed Binary Brayton Cycle with Two Isothermal Heating Processes and Coupled to Variable-Temperature Reservoirs

A modified closed binary Brayton cycle model with variable isothermal pressure drop ratios is established by using finite time thermodynamics in this paper. A topping cycle, a bottoming cycle, two isothermal heating processes and variable-temperature reservoirs are included in the new model. The topping cycle is composed of a compressor, a regular combustion chamber, a converging combustion chamber, a turbine and a precooler. The bottoming cycle is composed of a compressor, an ordinary regenerator, an isothermal regenerator, a turbine and a precooler. The heat conductance distributions among the six heat exchangers are optimized with dimensionless power output as optimization objective. The results show that the double maximum dimensionless power output increases first and then tends to be unchanged while the inlet temperature ratios of the regular combustion chamber and the converging combustion chamber increase. There also exist optimal thermal capacitance rate matchings among the working fluid and heat reservoirs, leading to the optimal maximum dimensionless power output

The significance of changes in platelet concentration during the early phase after severe burn injury in a Chinese mass casualty

Abstract Background Changes in platelet concentration are common in severe burn patients. Platelets play a key role in the course of disease. This study aims to explore the significance of platelet concentration during the course of the disease in victims of a mass burn casualty. Methods A total of 180 patients were involved in the “8.2” Kunshan explosion accident in China. The examined data included age, gender, total burn area (% TBSA), third-degree burn area (% TBSA), and platelet concentration within the first 5 days after the burn injury. The patients were divided into two groups according to four indicators (resuscitation, acute respiratory distress syndrome, acute kidney injury, septic shock). We collected several types of data for the patients and divided the patients into a complication group and non-complication group according to the diagnostic criteria. We analyzed the platelet concentration of the two groups using t tests to determine whether significant differences were present. P values < 0.05 were considered statistically significant. Results The group with successful resuscitation had higher platelet concentration than the failure group on day 3 and day 5. The patients who suffered from acute kidney injury (AKI) and septic shock had a lower platelet concentration than non-sufferers on day 3 and day 5. Conclusions The platelet concentration of burn patients can dynamically reflect the pathophysiological changes of the body. It can be used as an early objective indicator of prognosis in mass burn casualty cases

Optimization of the vancomycin administration regimen by clinical pharmacists based on a population pharmacokinetics model: a prospective interventional study

In vancomycin treatment, the rates of correct blood sampling and initial trough concentrations within the target range are very low. Studies of interventions by clinical pharmacists based on population pharmacokinetics (PPK) models are limited. This study aimed to evaluate the intervention effect of clinical pharmacist-mediated optimization of the vancomycin administration regimen based on a PPK model. Retrospectively enrolled patients constituted the control group, and prospectively enrolled patients constituted the intervention group. The vancomycin administration regimen, trough concentration, pharmacokinetic parameters, and clinical outcomes of the two groups were compared. The control and intervention groups comprised 236 and 138 patients, respectively. Compared with those in the control group, the therapeutic drug monitoring (TDM) and correct TDM sampling time rates in the intervention group were significantly higher (76.92% vs. 43.59%; 63.9% vs. 39.0%, both p \u3c 0.001). The rates of an initial trough concentration within 10–20 mg/L and an adjusted regimen were also significantly higher in the intervention group (55.80% vs. 30.51%, 71.95% vs. 39.18%, both p \u3c 0.001). The rate of an area under the curve (AUC) within 400–650 mg·h/L was higher in the intervention group than in the control group (52.7% vs. 36.6%, p \u3c 0.001). The eradication rates of Gram-positive bacteria were 91.4% in the intervention group and 81.3% in the control group (p = 0.049). Eight patients developed acute kidney injury (AKI) in the control group; however, no AKI occurred in the intervention group (p = 0.029). Intervention by clinical pharmacists can increase the rate of correct sampling time. Using the PPK model combined with Bayesian estimation, clinical pharmacists can greatly increase the trough concentration and AUCs within the target range, especially for adjusted regimens. Higher PK/PD target rates resulted in better Gram-positive bacterial eradication and reduced renal toxicity of vancomycin

Stem cell-based therapeutic strategies for rotator cuff tendinopathy

Rotator cuff tendinopathy is a common musculoskeletal disorder that imposes significant health and economic burden. Stem cell therapy has brought hope for tendon healing in patients with final stage rotator cuff tendinopathy. Some clinical trials have confirmed the effectiveness of stem cell therapy for rotator cuff tendinopathy, but its application has not been promoted and approved. There are still many issues that should be solved prior to using stem cell therapy in clinical applications. The optimal source and dose of stem cells for rotator cuff tendinopathy should be determined. We also proposed novel prospective approaches that can overcome cell population heterogeneity and standardize patient types for stem cell applications. The translational potential of this article: This review explores the optimal sources of stem cells for rotator cuff tendinopathy and the principles for selecting stem cell dosages. Key strategies are provided for stem cell population standardization and recipient selection

Animal model for tendinopathy

Background: Tendinopathy is a common motor system disease that leads to pain and reduced function. Despite its prevalence, our mechanistic understanding is incomplete, leading to limited efficacy of treatment options. Animal models contribute significantly to our understanding of tendinopathy and some therapeutic options. However, the inadequacies of animal models are also evident, largely due to differences in anatomical structure and the complexity of human tendinopathy. Different animal models reproduce different aspects of human tendinopathy and are therefore suitable for different scenarios. This review aims to summarize the existing animal models of tendinopathy and to determine the situations in which each model is appropriate for use, including exploring disease mechanisms and evaluating therapeutic effects. Methods: We reviewed relevant literature in the PubMed database from January 2000 to December 2022 using the specific terms ((tendinopathy) OR (tendinitis)) AND (model) AND ((mice) OR (rat) OR (rabbit) OR (lapin) OR (dog) OR (canine) OR (sheep) OR (goat) OR (horse) OR (equine) OR (pig) OR (swine) OR (primate)). This review summarized different methods for establishing animal models of tendinopathy and classified them according to the pathogenesis they simulate. We then discussed the advantages and disadvantages of each model, and based on this, identified the situations in which each model was suitable for application. Results: For studies that aim to study the pathophysiology of tendinopathy, naturally occurring models, treadmill models, subacromial impingement models and metabolic models are ideal. They are closest to the natural process of tendinopathy in humans. For studies that aim to evaluate the efficacy of possible treatments, the selection should be made according to the pathogenesis simulated by the modeling method. Existing tendinopathy models can be classified into six types according to the pathogenesis they simulate: extracellular matrix synthesis-decomposition imbalance, inflammation, oxidative stress, metabolic disorder, traumatism and mechanical load. Conclusions: The critical factor affecting the translational value of research results is whether the selected model is matched with the research purpose. There is no single optimal model for inducing tendinopathy, and researchers must select the model that is most appropriate for the study they are conducting. The translational potential of this article: The critical factor affecting the translational value of research results is whether the animal model used is compatible with the research purpose. This paper provides a rationale and practical guide for the establishment and selection of animal models of tendinopathy, which is helpful to improve the clinical transformation ability of existing models and develop new models