Displaying publications 1 - 20 of 370 in total

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  1. Li Y, Lee F
    Front Chem, 2023;11:1286318.
    PMID: 37920413 DOI: 10.3389/fchem.2023.1286318
    In music performances, instruments made of traditional materials often cannot accurately express specific emotions through means such as tone, pitch, and timbre, and it is difficult to adjust the sound effects according to specific emotions. This article studies the impact of conjugated materials on the timbre, frequency response, etc. of musical instruments, hoping to achieve sound effects that better convey specific emotions. This article analyzes the acoustic properties of conjugated materials and applies them to musical performances. It is found that conjugated materials can provide a wider selection of tones, pitches and timbres, performers can choose appropriate tone, pitch, and timbre from conjugated materials to express emotions according to specific emotional needs, or adjust and transform the tone, pitch, and timbre for specific emotions, thereby arousing emotional resonance from the audience, so that specific emotions can be conveyed to the audience more accurately and powerfully. At the same time, this research also found that compared with an environment with poor sound insulation, the average sound absorption coefficient of metal materials in a room with good sound insulation increased by 6.5%, and the average sound absorption coefficient of conjugate materials increased by 25.4%, which shows that the increase in the average sound absorption coefficient of conjugate materials is much greater than that of metallic materials. The research shows that studying the sound effects of musical performances based on the acoustic properties of conjugated materials will help explore and develop more immersive and emotionally rich musical experiences.
  2. Dinglasan JL, Tang LY, Chong MC, Al Raimi AM
    Saudi Med J, 2022 Jan;43(1):113-116.
    PMID: 35022293 DOI: 10.15537/smj.2022.43.1.20210211
    OBJECTIVES: To examine asthma prevalence and the relationship between the level of knowledge and quality of life (QoL) among asthmatic secondary school children aged 13-14 years old in Malaysia.

    METHODS: A cross-sectional design was employed. Data was collected through a self-administered questionnaire containing demographic characteristics, asthma symptoms, knowledge on asthma, and QoL.

    RESULTS: Data from 2891 asthmatic schoolchildren aged 13-14 years old from secondary schools in Petaling Jaya, Malaysia, were analyzed. According to the International Study of Asthma and Allergies in Childhood (ISAAC) scoring for asthma prevalence, the number of children who exhibited signs and symptoms of asthma was 9% (n=260). The mean score for total knowledge indicated a low knowledge level (82.7%). No significant relationship was found between knowledge level and QoL. Only the race factor was associated with asthma knowledge.

    CONCLUSION: This study has provided valuable information on asthma prevalence among Malaysian adolescents and their knowledge on asthma condition. Further research should explore the correlation factors of asthma knowledge and QoL.

  3. Li Y, Lin Y, Li S
    Zookeys, 2020;988:63-128.
    PMID: 33223891 DOI: 10.3897/zookeys.988.56188
    Crassignatha Wunderlich, 1995 is redefined to include species with six eyes in three diads, chelicerae fused only near the base, sculpturing on the carapace, one or two clasping spurs on tibia II, a bilateral scutum of the male abdomen, and globular spermathecae and adjacent copulatory openings in the female. A key and distribution map are provided for 24 Crassignatha species in this paper. Diagnoses and illustrated photographs are provided for 22 species from China, Malaysia, Thailand, and Vietnam. Thirteen species are described and documented as new to science: C. baihua Y. Lin & S. Li, sp. nov. (♂♀), C. bangbie Y. Lin & S. Li, sp. nov. (♀), C. changyan Y. Lin & S. Li, sp. nov. (♀), C. dongnai Y. Lin & S. Li, sp. nov. (♀), C. gucheng Y. Lin & S. Li, sp. nov. (♂♀), C. mengla Y. Lin & S. Li, sp. nov. (♂♀), C. nantou Y. Lin & S. Li, sp. nov. (♂♀), C. nasalis Y. Lin & S. Li, sp. nov. (♂♀), C. rostriformis Y. Lin & S. Li, sp. nov. (♂♀), C. shunani Y. Lin & S. Li, sp. nov. (♂♀), C. si Y. Lin & S. Li, sp. nov. (♂♀), C. thamphra Y. Lin & S. Li, sp. nov. (♀), and C. xichou Y. Lin & S. Li, sp. nov. (♀). Three new combinations are proposed: C. bicorniventris (Lin & Li, 2009), comb. nov., C. quadriventris (Lin & Li, 2009), comb. nov., and C. shiluensis (Lin & Li, 2009), comb. nov. are transferred from Patu Marples, 1951. DNA barcodes and genetic distances of seventeen species are obtained to confirm correct identification. Types of seven known Chinese Crassignatha species are re-examined, and the taxonomic placement of C. longtou Miller, Griswold & Yin, 2009 may be incorrect based on morphological and molecular data.
  4. Li Y, Li S, Wang Y, Zhou J, Yang J, Ma J
    J Fr Ophtalmol, 2021 Dec;44(10):1596-1604.
    PMID: 34454773 DOI: 10.1016/j.jfo.2021.05.005
    BACKGROUND: The main risks for glaucoma are increased intraocular pressure (IOP) and decreased ocular perfusion pressure (OPP). This review aims to examine the potential impact of lower limb isometric resistance exercise on intraocular pressure and ocular perfusion pressure.

    METHOD: A meta-analysis was conducted to determine the potential impact of isometric exercise on IOP and OPP. The literature on the relationship between isometric resistance exercise and IOP was systematically searched according to the "Cochrane Handbook" in the databases of Pubmed, Web of Science, EBSCO, and Scopus through December 31, 2020. The search terms used were "exercise," "train," "isometric," "intraocular pressure," and "ocular perfusion pressure," and the mean differences of the data were analyzed using the Stata 16.0 software, with a 95% confidence interval.

    RESULTS: A total of 13 studies, which included 268 adult participants consisting of 162 men and 106 women, were selected. All the exercise programs that were included were isometric resistance exercises of the lower limbs with intervention times of 1min, 2min, or 6min. The increase in IOP after intervention was as follows: I2=87.1%, P=0.001 using random-effects model combined statistics, SMD=1.03 (0.48, 1.59), and the increase in OPP was as follows: I2=94.5%, P=0.001 using random-effects model combined statistics, SMD=2.94 (1.65, 4.22), with both results showing high heterogeneity.

    CONCLUSION: As isometric exercise may cause an increase in IOP and OPP, therefore, people with glaucoma and related high risk should perform isometric exercise with caution.

  5. Li Y, Wen H, Chen L, Yin T
    PLoS One, 2014;9(12):e115024.
    PMID: 25502754 DOI: 10.1371/journal.pone.0115024
    The growing concern about the effectiveness of reclamation strategies has motivated the evaluation of soil properties following reclamation. Recovery of belowground microbial community is important for reclamation success, however, the response of soil bacterial communities to reclamation has not been well understood. In this study, PCR-based 454 pyrosequencing was applied to compare bacterial communities in undisturbed soils with those in reclaimed soils using chronosequences ranging in time following reclamation from 1 to 20 year. Bacteria from the Proteobacteria, Chloroflexi, Actinobacteria, Acidobacteria, Planctomycetes and Bacteroidetes were abundant in all soils, while the composition of predominant phyla differed greatly across all sites. Long-term reclamation strongly affected microbial community structure and diversity. Initial effects of reclamation resulted in significant declines in bacterial diversity indices in younger reclaimed sites (1, 8-year-old) compared to the undisturbed site. However, bacterial diversity indices tended to be higher in older reclaimed sites (15, 20-year-old) as recovery time increased, and were more similar to predisturbance levels nearly 20 years after reclamation. Bacterial communities are highly responsive to soil physicochemical properties (pH, soil organic matter, Total N and P), in terms of both their diversity and community composition. Our results suggest that the response of soil microorganisms to reclamation is likely governed by soil characteristics and, indirectly, by the effects of vegetation restoration. Mixture sowing of gramineae and leguminosae herbage largely promoted soil geochemical conditions and bacterial diversity that recovered to those of undisturbed soil, representing an adequate solution for soil remediation and sustainable utilization for agriculture. These results confirm the positive impacts of reclamation and vegetation restoration on soil microbial diversity and suggest that the most important phase of microbial community recovery occurs between 15 and 20 years after reclamation.
  6. He C, Ding N, Li J, Li Y
    Wei Sheng Wu Xue Bao, 2002 Aug;42(4):436-41.
    PMID: 12557549
    A Chicken anemia virus has been isolated from a chicken flock in Harbin of China. The genome of the ivrus was cloned through polymerase chain reaction(PCR) and sequence of the genome was analyzed. The cycle genome is made of 2298 base pairs including three overlapping open reading frames(vp1, vp2, vp3) and a regulative region. Comparing sequence of the genome through BLAST in GenBank, this sequence exhibits 96.9% identity with other genome of CA Vs and least. Multiple alignment of this genome of this virus, 26p4, strain isolated in Germany, strain isolated in Malaysia and Cux-1 found that this sequence exhibits 98.2% (42/2298), 98.2% (42/2298), 96.9% (72/2298) and 97.5% (60/2319) identify with them, respectively. A new CAV strain was isolated and it has better identify with CAV isolated in Europe countries than is Asia country Malaysia. Multiple alignment of VP1, VP2, VP3 of 26p4, strain isolated in Germany, strain isolated in Malaysia, Cux-1 and strain isolated in Harbin of China found the VP2 the most conservative.
  7. Zhu C, Li Y, Zhang L, Wang Y
    PLoS One, 2020;15(11):e0241618.
    PMID: 33156886 DOI: 10.1371/journal.pone.0241618
    To provide a theoretical basis for sustainable land resource utilization and a reference for areas with similar natural conditions, an evaluation index for land-based ecological security was constructed based on the Driving force-Pressure-State-Impact-Response (DPSIR) model and the improved analytic hierarchy process (IAHP) and entropy methods, and the land-based ecological security status of Xingtai city from 2006 to 2017 was evaluated. Then, the obstacles to land-based ecological security were diagnosed. The results show that the values of the comprehensive evaluation index of land-based ecological security were 0.28-0.66 in the period from 2006 to 2017. The value of the index of land-based ecological security was low in the first seven years and gradually improved in the last five years of the study period. However, the overall situation was grave, and the ecological security conditions were poor. The main obstacles to land-based ecological security were the usage of pesticides, investment in environmental pollution treatments, the degree of machine cultivation, the rate of cultivation and the usage of fertilizer in Xingtai city. Based on the results of the land-based ecological security evaluation and the main obstacles identified in Xingtai city, this paper proposes management strategies and suggestions for improving land-based ecological security in Xingtai city. The specific proposals are as follows: vigorously develop green agriculture, increase investment in environmental pollution control, increase input in science and technology, and strengthen supervision and management of land use.
  8. Li Y, Cao K, Jenatabadi HS
    Front Psychol, 2023;14:1240910.
    PMID: 37786481 DOI: 10.3389/fpsyg.2023.1240910
    Entrepreneurship in higher education is increasingly valuing entrepreneurial creativity as a significant driver for improving university students' innovative abilities. The purpose of this study was to examine the direct influence of entrepreneurial education and creativity on entrepreneurial intention, as well as the indirect role of entrepreneurial inspiration, mindset, and self-efficiency. This study gathered survey responses from 448 university business students from three Chinese provinces of Shandong, Jiangsu and Zhejiang. The results indicated that entrepreneurial education and creativity have a positive and significant effect on entrepreneurial intent. In addition, the results demonstrated that the combination of entrepreneurial mindset, inspiration, and self-efficacy partially mediates the relationship between entrepreneurial education and entrepreneurial creativity. In addition, additional implications and restrictions are discussed in this article.
  9. Luo J, Tang L, Kong X, Li Y
    Asian J Psychiatr, 2024 Feb;92:103905.
    PMID: 38262303 DOI: 10.1016/j.ajp.2023.103905
    BACKGROUND: Depressive disorders (DD) including dysthymia and major depressive disorder (MDD) are common among adolescents and young adults. However, global trends in DD burden remain unclear.

    METHODS: We analysed data from the Global Burden of Disease 2019 study on incidence, prevalence, disability-adjusted life years (DALYs), and mortality due to DD from 1990 to 2019 at global, regional and national levels.

    RESULTS: Globally, dysthymia incidence increased notably in females, older age groups, and lower-middle income countries from 1990 to 2019. In contrast, MDD incidence decreased slightly over this period except in high-income North America. Females and middle-income countries had the highest dysthymia burden while North America had the highest MDD incidence and DALYs. Oman and Malaysia experienced largest increases in dysthymia and MDD burden respectively.

    CONCLUSION: Despite certain global indicators suggesting a leveling off or decrease, it's clear that depressive disorders continue to be a significant and increasing issue, particularly among women, teenagers, and young adults. Differences between regions and countries indicate that specific interventions aimed at addressing economic inequalities, improving healthcare systems, and taking cultural factors into account could make a real difference in lessening the burden of depressive disorders. More research is needed to understand what's driving these trends so that we can develop better strategies for preventing and managing these conditions.

  10. Li Y, Kumar S, Zhang L
    Infect Drug Resist, 2024;17:1107-1119.
    PMID: 38525477 DOI: 10.2147/IDR.S453025
    Infections with drug-resistant bacteria have become one of the greatest public health challenges, and K. pneumoniae is among the top six drug-resistant bacteria. K. pneumoniae often causes nosocomial infections, leading to illnesses such as pneumonia, liver abscesses, soft tissue infections, urinary tract infections, bacteremia, and in some cases death. As the pathogen continues to evolve and its multidrug resistance increases, K. pneumoniae poses a direct threat to humans. Drug resistance in K. pneumoniae may occur due to the formation of biofilms, efflux pumps, and the production of β-lactamases. In many cases, resistance is further enhanced by enzymatic modification and loss of porins. Drug resistance to K. pneumoniae has led to a decline in the effectiveness of conventional therapies against this pathogen. Therefore, there is an urgent need to accelerate the development of new antibiotics and explore new therapeutic approaches such as antimicrobial peptides, phages, traditional Chinese medicine, immunotherapy, Antimicrobial nanoparticle technology, antisense oligonucleotides and gene editing technologies. In this review, we discuss the mechanisms of drug resistance in K. pneumoniae and compare several new potential therapeutic strategies to overcome drug resistance in the treatment of K. pneumoniae infections.
  11. Chiang C, Li Y, Ng SK
    Front Immunol, 2020;11:625504.
    PMID: 33613567 DOI: 10.3389/fimmu.2020.625504
    Both DNA and RNA can maintain left-handed double helical Z-conformation under physiological condition, but only when stabilized by Z-DNA binding domain (ZDBD). After initial discovery in RNA editing enzyme ADAR1, ZDBD has also been described in pathogen-sensing proteins ZBP1 and PKZ in host, as well as virulence proteins E3L and ORF112 in viruses. The host-virus antagonism immediately highlights the importance of ZDBD in antiviral innate immunity. Furthermore, Z-RNA binding has been shown to be responsible for the localization of these ZDBD-containing proteins to cytoplasmic stress granules that play central role in coordinating cellular response to stresses. This review sought to consolidate current understanding of Z-RNA sensing in innate immunity and implore possible roles of Z-RNA binding within cytoplasmic stress granules.
  12. Bai D, Hasnimy Mohd Hashim A, Li Y
    Prev Med Rep, 2024 May;41:102718.
    PMID: 38623582 DOI: 10.1016/j.pmedr.2024.102718
    Objectives: This study explored the relationship between physical activity (PA), body mass index (BMI), and physical fitness among junior high school students in Shanghai. Methods: A nationwide offline survey was conducted in Shanghai between August and December 2023, using a purposive sampling design. A total of 403 questionnaires were administered to 10 ninth-grade classes in 10 schools in Shanghai and 372 responses were included in the final analysis. Smart-PLS 4.0, structural equation modeling techniques were employed to analyze the collected data. Results: Light physical activity (LPA) had no influence on BMI, 800/1000 m (800/1000 M), sitting forward bend (FB), standing long jump (SLJ), 50 m (50 M), or vital capacity (VC). The results of part hypothesis supported the hypothetical model and explained that BMI had a negatively influence on 50 M, 800/1000 M and SLJ, BMI had a positively influence on VC. Moderate physical activity (MPA) had a negatively influence on BMI, but vigorous physical activity (VPA) had a positively influence on BMI, they both had influence on 50 M and FB, but had no influence on 800/1000 M, SLJ, and VC. Conclusions: BMI, MPA and VPA were found as pivotal factors influencing physical fitness, MPA and VPA were found to have divergent effects on BMI. This study highlighted the multifaceted nature of the relationship between PA, BMI, and physical fitness in junior high school students in Shanghai.
  13. Li Y, Guo L, Zhang D, Ma J
    Lipids, 2024 Nov 07.
    PMID: 39508270 DOI: 10.1002/lipd.12422
    This study was carried out to systematically review and evaluate the influence of exercise with and without curcumin on body fat composition, glucose, and lipid metabolism in obese adults. Search for eligible studies through four databases, and then proceed with screening. The inclusion criteria are as follows: (1) obese adults; (2) randomized controlled trial (RCT); (3) classified the exercise intervention with curcumin supplementation as the exercise with curcumin (CU) group and without curcumin supplementation as the exercise without curcumin (EX) group; (4) Conducted pre- and post-training assessments, which include body fat composition, glucose and lipid metabolism parameters. Use the Cochrane bias risk assessment tool to evaluate the quality of the selected study. Select standardized mean difference (SMD) as the appropriate effect scale index, and use Revman 5.4 software to analyze the mean difference of the selected article data with a 95% confidence interval (CI). A total of seven studies fulfilled the inclusion criteria and were selected for the meta-analysis. The included studies involved 72 males and 111 females, where 94 belonged to the EX group and 89 from the CU group. The CU group benefited more from the reduced Fat% (SMD, 2.18 [0.12, 4.24], p 
  14. Huang D, Li Y, Cui F, Chen J, Sun J
    Carbohydr Polym, 2016 Feb 10;137:701-708.
    PMID: 26686182 DOI: 10.1016/j.carbpol.2015.10.102
    A novel polysaccharide-peptide complex CNP-1-2 with molecular weight of 9.17 × 10(4) Da was obtained from Clinacanthus nutans Lindau leaves by hot water extraction, ethanol precipitation, and purification with Superdex 200 and DEAE-Sepharose Fast Flow column chromatography. CNP-1-2 exhibited the highest growth inhibitory effect on human gastric cancer cells SGC-7901 with inhibition ratio of 92.34% and stimulated activation of macrophages with NO secretion level of 47.53 μmol/L among the polysaccharide fractions. CNP-1-2 comprised approximately 87.25% carbohydrate and 9.37% protein. Monosaccharide analysis suggested that CNP-1-2 was composed of L-rhamnose, l-arabinose, D-mannose, D-glucose and D-galactose with a molar ratio of 1.30:1.00:2.56:4.95:5.09. Methylation analysis, FT-IR, and (1)H NMR spectroscopy analysis revealed that CNP-1-2 might have a backbone consisting of 1,4-linked Glcp, 1,3-linked Glcp, 1,3-linked Manp, 1,4-linked Galp, 1,2,6-linked Galp and 1,2,6-linked Galp. Its side chain might be composed of 1-linked Araf, 1,6-linked Galp and 1-linked Rhap residues. AFM (atomic force micrograph) analysis revealed that CNP-1-2 had the molecular aggregation along with branched and entangled structure.
  15. Low W, Azmi S, Li Y, Yee SL, Abdat A, Kalita P, et al.
    Value Health, 2014 Nov;17(7):A767.
    PMID: 27202816 DOI: 10.1016/j.jval.2014.08.292
  16. Zhong X, Li Y, Zhang J, Han FS
    Org. Lett., 2015 Feb 6;17(3):720-3.
    PMID: 25602274 DOI: 10.1021/ol503734x
    The synthesis of a pentacyclic indole compound corresponding to the core structure of the misassigned indole alkaloid, tronoharine (1), is presented. The key reactions were a formal [3 + 3] cycloaddition of an indol-2-yl carbinol with an azadiene for the construction of the 6/5/6/6 tetracyclic system containing an all-carbon quaternary center and an intramolecular substitution reaction of an amine and a triflate for the creation of the bridged azepine ring. In addition, some other interesting transformations discovered during the synthetic studies are also discussed.
  17. Hu L, Yu W, Li Y, Prasad N, Tang Z
    Biomed Res Int, 2014;2014:341291.
    PMID: 24719856 DOI: 10.1155/2014/341291
    The antioxidant activities and protective effects of total phenolic extracts (TPE) and their major components from okra seeds on oxidative stress induced by carbon tetrachloride (CCl4) in rat hepatocyte cell line were investigated. The major phenolic compounds were identified as quercetin 3-O-glucosyl (1 → 6) glucoside (QDG) and quercetin 3-O-glucoside (QG). TPE, QG, and QDG from okra seeds exhibited excellent reducing power and free radical scavenging capabilities including α, α-diphenyl-β-picrylhydrazyl (DPPH), superoxide anions, and hydroxyl radical. Overall, DPPH radical scavenging activity and reducing power of QG and QDG were higher than those of TPE while superoxide and hydroxyl radical scavenging activities of QG and TPE were higher than those of QDG. Furthermore, TPE, QG, and QDG pretreatments significantly alleviated the cytotoxicity of CCl4 on rat hepatocytes, with attenuated lipid peroxidation, increased SOD and CAT activities, and decreased GPT and GOT activities. The protective effects of TPE and QG on rat hepatocytes were stronger than those of QDG. However, the cytotoxicity of CCl4 on rat hepatocytes was not affected by TPE, QG, and QDG posttreatments. It was suggested that the protective effects of TPE, QG, and QDG on rat hepatocyte against oxidative stress were related to the direct antioxidant capabilities and the induced antioxidant enzymes activities.
  18. Usman A, Fun HK, Li Y, Xu JH
    Acta Crystallogr C, 2003 Jun;59(Pt 6):o308-10.
    PMID: 12794347
    9,10-Diphenyl-9,10-epidioxyanthracene, C(26)H(18)O(2), (I), was accidentally used in a photooxygenation reaction that produced 9,10-dihydro-10,10-dimethoxy-9-phenylanthracen-9-ol, C(22)H(20)O(3), (II). In both compounds, the phenyl rings are approximately orthogonal to the anthracene moiety. The conformation of the anthracene moiety differs as a result of substitution. Intramolecular C-H.O interactions in (I) form two approximately planar S(5) rings in each of the two crystallographically independent molecules. The packing of (I) and (II) consists of molecular dimers stabilized by C-H.O interactions and of molecular chains stabilized by O-H.O interactions, respectively.
  19. Li Y, Liu C, Lin L, Li Y, Xiao J, Loh KH
    Zookeys, 2020;969:137-154.
    PMID: 33013170 DOI: 10.3897/zookeys.969.52069
    The southern lesser pomfret (Pampus minor) is an economically important fish, and its numbers are declining because of overfishing and environmental pollution. In addition, owing to the similarities of its external morphological characteristics to other species in the genus Pampus, it is often mistaken for grey pomfret (P. cinereus) or silver pomfret (P. argenteus) juveniles. In this study, the genetic diversity and structure of 264 P. minor individuals from 11 populations in China and Malaysia coastal waters were evaluated for the first time, to the best of our knowledge, using mitochondrial cytochrome b fragments. The results showed that P. minor had moderate haplotype diversity and low nucleotide diversity. Furthermore, two divergent lineages were detected within the populations, but the phylogenetic structure corresponded imperfectly with geographical location; thus, the populations may have diverged in different glacial refugia during the Pleistocene low sea levels. Analysis of molecular variation (AMOVA) showed that genetic variation originated primarily from individuals within the population. Pairwise FST results showed significant differentiation between the Chinese and Malaysian populations. Except for the Xiamen population, which was classified as a marginal population, the genetic differentiation among the other Chinese populations was not significant. During the Late Pleistocene, P. minor experienced a population expansion event starting from the South China Sea refugium that expanded outward, and derivative populations quickly occupied and adapted to the new habitat. The results of this study will provide genetic information for the scientific conservation and management of P. minor resources.
  20. Jamal A, Babazono A, Li Y, Yoshida S, Fujita T
    Medicine (Baltimore), 2020 May;99(18):e19871.
    PMID: 32358355 DOI: 10.1097/MD.0000000000019871
    The presence of comorbid conditions along with heterogeneity in terms of healthcare practices and service delivery could have a significant impact on the patient's outcomes. With a strong interest in social epidemiology to examine the impact of health services and variations on health outcomes, the current study was conducted to analyse the incidence of hemodialysis-associated infection (HAI) as well as its associated factors, and to quantify the extent to which the contextual effects of the care facility and regional variations influence the risk of HAI.A total of 6111 patients with end-stage renal disease who received hemodialysis treatment between 1 October 2015 and 31 March 2016 were identified from the insurance claim database as a population-based, close-cohort retrospective study. Patients were followed for one year from April 1, 2016 to March 31, 2017. A total of 200 HAI cases were observed during the follow-up and 12 patients died within 90 days of the onset of HAI. Increased risks for HAI were associated with moderate (HR 1.73, 95% confidence interval [CI] 1.00-2.98) and severe (HR 1.87, 95% CI 1.11-3.14) comorbid conditions as well as malignancy (HR 1.36, 95% CI 1.00-1.85). Increased risk was also seen among patients who received hemodialysis treatment from clinics (HR 2.49, 95% CI 1.1-5.33). However, these statistics were no longer significant when variations at the level of care facilities were statistically controlled. In univariate analyses, no statistically significant association was observed between 90-day mortality and baseline patients, and the characteristics of the care facility.The results of the multivariate, multilevel analyses indicated that HAI variations were only significant at the care facility level (σ 2.07, 95% CI 1.3-3.2) and were largely explained by the heterogeneity between care facilities. The results of this study highlight the need to look beyond the influence of patient-level characteristics when developing policies that aim at improving the quality of hemodialysis healthcare and service delivery in Japan.
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