PLoS ONE最新文献

Background: Dementia poses an increasingly serious public health challenge worldwide, particularly in China, where home-based care remains the primary form of management. Family caregivers of older adults with moderate-to-severe dementia often experience a substantial caregiving burden, which can adversely affect both their own well-being and that of the patients.

Objective: This study aimed to examine the level of caregiver burden among family caregivers of older adults with moderate-to-severe dementia and to explore the relationships between patient activities of daily living (ADL), quality of life (QoL), depression severity, caregiver QoL, depression severity, and caregiver burden.

Methods: A cross-sectional study in 22 tertiary general hospitals in Shanxi Province, China, involved 529 dyads of older adults with moderate-to-severe dementia and their family caregivers. Caregivers completed the Zarit Burden Interview, the Patient Health Questionnaire-9, and the World Health Organization Quality of Life-Brief Version. Older adults completed the Patient Health Questionnaire-9, the Activity of Daily Living Scale, and the Quality of Life in Alzheimer's Disease scale. Structural equation modeling evaluated relationships among patient ADL, QoL, depression severity, caregiver QoL, depression severity, and caregiver burden.

Results: Patient QoL, ADL, and caregiver QoL had direct negative effects on caregiver burden, whereas patient and caregiver depression severity had direct positive effects on caregiver burden. Meanwhile, caregiver QoL partially mediated the relationships between patient QoL, depression severity, ADL, caregiver depression severity, and caregiver burden.

Conclusion: The results indicate that higher patient QoL, better patient ability in ADL, higher caregiver QoL, and lower levels of depressive severity in both patients and caregivers are associated with reduced caregiver burden. Healthcare professionals should implement family-centered, comprehensive interventions to alleviate caregiver burden.

Athletic training is characterized by physiological systems responding to repeated exercise-induced stress, resulting in gradual alterations in the functional properties of these systems. The adaptive response leading to improved performance follows a remarkably predictable pattern that may be described by a systems model provided that training load can be accurately quantified and that the constants defining the training-performance relationship are known. While various impulse-response models have been proposed, they are inherently limited in reducing training stress (the impulse) into a single metric, assuming that the adaptive responses are independent of the type of training performed. This is despite ample evidence of markedly diverse acute and chronic responses to exercise of different intensities and durations. Herein, we propose an alternative, three-dimensional impulse-response model that uses three training load metrics as inputs and three performance metrics as outputs. These metrics, represented by a three-parameter critical power model, reflect the stress imposed on each of the three energy systems: the alactic (phosphocreatine/immediate) system; the lactic (glycolytic) system; and the aerobic (oxidative) system. The purpose of this article is to outline the scientific rationale and the practical implementation of the three-dimensional impulse-response model.

Identifying drivers of deforestation is crucial for developing targeted conservation and land management strategies, and satellite data provide a long time series of data to understand deforestation dynamics. However, the timing of imagery after forest loss may affect classification accuracy, and optimal timing may be different for different drivers. Studies of broad-scale drivers across large and pan-tropical regions have shown that using time series can improve driver classification from satellite imagery, but requiring multi-year information means waiting longer after forest loss to classify what drives it. Our previously introduced model, Cam-ForestNet, was developed to use single-date imagery to classify fifteen direct detailed deforestation and degradation drivers for Cameroon. Here, we test whether the overall and per-class classification performance of Cam-ForestNet can be improved by either using imagery taken longer after a forest loss event or by incorporating a greater number of images, with performance evaluated using macro-average and per-class F1 scores to enable broad comparability across different contexts. Combining data up to four years after forest loss leads to improved model performance overall (macro-average F1 score) and for nearly all individual classes (per-class F1 scores). The classification of degradation drivers and slow-growing plantation benefitted most by incorporating time series data. However, when comparing approaches using only a single image from different years after a forest loss event, images from the first year following an event performed best, both overall (macro-average F1 score) and for most classes (per-class F1 scores), offering a promising strategy for relatively fast analysis of deforestation and degradation drivers following forest loss. We conclude that whilst multi-year imagery is beneficial, relying on a single image from the first year after forest loss still provides valuable and timely insights into the nature of drivers of forest loss.

Influenced by the complex geological conditions in mountainous region, micro-pile foundation for transmission line faces the risk of insufficient bearing performance. It is important to study the risk suppression measures of micro-pile foundation and its assessment method to promote the construction of transmission lines in mountainous regions. Firstly, the mechanical simulation model of pile-soil system for the micro-pile foundation is established in this paper, and the field test is carried out to verify the accuracy of the simulation model, thus the ultimate load of the micro-pile foundation is determined according to the current code requirement for maximum displacement in case of damage to the group pile foundation. Secondly, to address the subjectivity of traditional methods, an improved Likelihood-Exposure-Consequence (LEC) method is proposed. Its novelty lies in constructing a quantitative displacement-risk mathematical mapping, directly linking the physical limit state (maximum displacement) to the risk likelihood factor. Thirdly, structural risk reduction measures for the micro-pile foundation using micro-expanded pile foundation and micro-inclined pile foundation are proposed, and the ultimate load of the traditional micro straight pile foundation is used as an excitation to carry out the simulation of the bearing performance of the two improved micro-pile foundations, and the maximum displacements of the two improved micro-pile foundations are calculated. Finally, based on the proposed improved LEC method, the risk values-defined in the LEC framework as the quantitative product of Likelihood (L), Exposure (E), and Consequence (C)-and risk classes of the two improved micro-pile foundations are calculated and compared with the conventional micro straight pile. The results demonstrate that the proposed strategies significantly reduce the safety risk class, providing a robust, quantifiable basis for optimizing foundation designs in complex mountainous terrain.

Reliability evaluation of park-level integrated energy systems (PIES) requires capturing the complex interactions among electricity, gas, thermal, and building subsystems, which exhibit typical multiscale dynamic behaviors. Although existing studies have partially considered the dynamic characteristics of PIES, the critical transient responses and the long-term impacts of heat supply interruptions on human health are overlooked. To address these gaps, this paper proposes a reliability evaluation method based on quasi-steady-state simulation. The dynamic behaviors of the electricity, gas, and heating systems, as well as buildings, are analyzed to develop simplified quasi-steady-state models for both energy demand under normal conditions and indoor temperature evolution under extreme scenarios. A new reliability index is then formulated by incorporating the thermal inertia of district heating networks and the temperature tolerance of occupants, forming a comprehensive framework for PIES reliability assessment. Case studies verify that the proposed method enhances the accuracy and interpretability of reliability evaluations, bridging the gap in user health considerations under extreme conditions. The results further reveal that building thermal dynamics play a dominant role in determining the overall reliability performance of PIES.

The research is motivated by the strategic integration of moral and value education into China's college English curriculum and the critical role of textbooks as value carriers in EFL education. Despite growing attention to value integration in EFL materials, empirical studies on moral and value representation in oral English textbooks remain sparse, and learners' perspectives on value acquisition through oral instruction are underexplored-this study aims to address these gaps. The study employed a mixed-methods approach: the researcher systematically analyzed 318 pages of New Inside Out Book 1 and Book 2 (first-year college EFL oral English textbooks), screening all module types including vocabulary, grammar, dialogue, listening, reading, writing, and exercise for value-related content, which was then coded and recorded in Excel. Frequency statistics show the sample textbooks include 273 value-laden verbal text samples, with a Chi-Square Test revealing statistically significant differences in dimension emphasis between the two volumes. Within Martin and White's (2005) Language Appraisal Theory, qualitative textual analysis identifies the value significance of linguistic resources as a prominent feature across module types. Additionally, to gather learner feedback on the effectiveness of value education in the oral English course, an online questionnaire survey (via Wen Juan Xing platform) was administered to learners who used the selected EFL oral English textbooks for a whole academic year. The survey showed that values-based EFL instruction positively impacted morality and personal growth.

Background: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune rheumatic disease whose epidemiology and clinical prognosis vary by race and sex. Observed disparities in SLE may be partly attributable to cognitive processes in clinical decision-making, which can influence diagnostic accuracy and clinical management. We aimed to examine variation in primary care physicians' (PCP) diagnosis and management of SLE when all content of a clinical case is identical, apart from race and sex.

Methods: We distributed an online randomized factorial survey from 04/11/2024-06/10/2024 to PCPs across the US. Participants were presented with one of four possible SLE vignettes - Black female, White female, Black male, White male - for which all other clinical content was identical. Block randomization was used to randomly modify the race (Black/White) and sex (female/male) of the SLE "case". Primary outcomes were correct text-based responses for SLE diagnosis at initial case presentation and after reviewing additional lab results. Secondary outcomes were participants' review time and planned next steps (treatment, referral, tests) as a proxy for cognitive bias and certainty, respectively. We calculated descriptive statistics for all outcomes stratified by assigned randomized factor and used chi-square tests to evaluate between-group differences.

Results: 1031 PCPs (42.7% women, mean age 52.1 ± 12.1 years) completed the case. At initial presentation, 63.9% of participants correctly identified SLE as a differential diagnosis. An initial diagnosis of SLE significantly differed by the race and sex of the case (p < 0.001), with the highest proportion of correct diagnoses occurring for Black female cases (72.2%) and lowest for White male cases (55.3%). Median review time for correct initial diagnoses was longest for White male cases (175 s). After participants reviewed lab results, the overall proportion assigning a final diagnosis of SLE (63.9%) remained unchanged from the initial diagnosis.

Conclusion: A patient's race and sex may influence diagnostic accuracy and clinical decision-making for SLE in primary care. The observed variation in diagnostic accuracy, which aligns with the descriptive epidemiology of SLE, highlights the need for targeted interventions to ensure equitable diagnostic processes.

Background: Although cytomegalovirus (CMV) reactivation is implicated in ulcerative colitis (UC) exacerbation, the efficacy of antiviral treatment in hospitalized patients with UC with suspected CMV infection has not been thoroughly investigated. We aimed to investigate the diagnostic accuracies of typical endoscopic findings for CMV reactivation in hospitalized UC patients.

Methods: A total of 143 hospitalized cases due to the exacerbation of UC were retrospectively collected. Sensitivity, specificity and diagnostic accuracy of endoscopic findings (punched-out ulcer, round ulcer, girdle ulcer, longitudinal ulcer, and ulcer with wide mucosal defect)for prediction of CMV colitis (histological CMV positivity) and CMV viremia (antigenemia, serum DNA) was assessed. Endoscopic characteristics were compared between patients who initially received anti-viral treatment and who did not receive.

Results: The diagnostic performance of endoscopic findings for histologically confirmed CMV infection varied by lesion type. Punched-out ulcers demonstrated a sensitivity of 66.7%, specificity of 58.3%, and overall diagnostic accuracy of 59.1%. Longitudinal ulcers showed a sensitivity of 58.3%, specificity of 40.0%, and diagnostic accuracy of 41.7%. In contrast, wide mucosal defects exhibited lower sensitivity (16.6%) but higher specificity (75.0%), with an overall diagnostic accuracy of 69.7%. The same tendencies were found as diagnostic accuracies of endoscopic findings of punched-out ulcers, longitudinal ulcers, and wide mucosal defects for CMV antigenemia positivity was 55.6%, 40.0%, 60.4%, respectively. The specificity of girdle ulcers for positivity of serum DNA test was relatively high (84.8%) while sensitivity was 9.1%. In total, the diagnostic accuracies of endoscopic findings with punched-out, round, girdle, and longitudinal ulcers, and those with wide mucosal defects were 46.9%, 42.9%, 33.7%, 51.0%, and 35.7% for positivity of serum DNA test, respectively. Punched-out ulceration (57% vs.13%; p < 0.001), longitudinal ulceration (70%vs.34%; p < 0.001), and ulceration with wide mucosal defects (31%vs.9%; p < 0.001) were higher with ganciclovir treatment than without.

Conclusion: Endoscopic findings cannot predict CMV antigenemia or CMV colitis. Therefore, antiviral treatment should not be administered without evidence of CMV reactivation using only endoscopic findings.