Anaerobic membrane bioreactor coupled with polyaluminum chloride for high-strength phenolic wastewater treatment: Robust performance and potential mechanisms.

Anaerobic digestion of phenolic wastewater by anaerobic membrane bioreactor (AnMBR) has revealed increasing attractiveness, but the application of AnMBRs for treating high-strength phenolic wastewater faces challenges related to elevated phenol stress and membrane fouling. In this study, the coupling of AnMBR and polyaluminum chloride (PAC) was developed for efficient treatment of high-strength phenolic wastewater. The system achieved robust removal efficiencies of phenol (99%) and quinoline (98%) at a gradual increase of phenol concentration from 1000 to 5000 mg/L and a constant quinoline concentration of 100 mg/L. The dosing of PAC could effectively control the membrane fouling rate with the transmembrane pressure (TMP) increasing rate as low as 0.17 kPa/d. The robust performances were mainly attributed to the favorable retention of functional microbes through membrane interception, while pulse cross flow buffered against phenol stress and facilitated cake layer removal. Meanwhile, the enriched core functional microbes, such as Syntrophorhabdus, Syntrophus, Mesotoga and Methanolinea, played a crucial role in further reduction of phenol stress. Notably, the significant presence of biomacromolecule degrader, such as Levilinea, contributed to membrane fouling mitigation through extracellular polymer degradation. Moreover, the enlargement of particle size distribution (PSD) by PAC was expected to mitigate membrane fouling. This study provided a promising avenue for sustainable treatment of high-strength phenolic wastewater.

Combined Effects of Tetracycline and Copper Ion on Microorganisms During the Biological Phosphorus Removal.

Tetracycline and copper ion are common pollutants in wastewater, and the effects of mixed pollutants on microorganisms in wastewater biological treatment have been less studied. In order to reveal the effects of mixed pollutants of tetracycline and copper ion on the microorganisms during the biological phosphorus removal, three ratios of tetracycline and copper ions were designed by the direct equipartition ray method. The relative abundance and diversity of microbial community were investigated, and the microbial interactions were revealed through microbiological methods. The results demonstrated that, for three different ratios, the inhibitory effect of specific phosphorus uptake rate became more significant with the increase of the tetracycline-copper ions concentration and the reaction time. The microbial community decreased with the increase of the proportion of tetracycline in different ratios. The relative abundance of Acinetobacter decreased with the increase of the proportion of tetracycline, while the relative abundance of Ca.Competibacter was higher under the conditions of low mixtures concentrations. Positive interactions and symbiotic relationships among microorganisms were predominant for three different ratios. However, as the proportion of tetracycline increased, the community structure of microorganisms shifted from phosphate-accumulating organisms to glycogen accumulating organisms and denitrifying bacteria. This study can provide a reference for the effect of mixed pollutants on microorganisms and the mechanism of wastewater treatment.

Effects of zinc ion concentrations on the performance of SBR treating livestock wastewater and analysis of microbial community.

Zinc ion (Zn2+) is a frequently occurring heavy metal in livestock wastewater. The effects of Zn2+ on the physicochemical properties and the microbial distribution of activated sludge are essential to controlling nitrogen removal performance. Nevertheless, there are raw studies on the effects of Zn2+ on nitrogen removal. This study investigated the effect of Zn2+ on the treatment performance of livestock wastewater in a sequencing batch reactor (SBR). The results indicated the low Zn2+ concentrations could improve nitrogen removal performance. However, as the Zn2+ concentration increased, the total nitrogen (TN) removal performance of the reactor gradually deteriorated. When the Zn2+ concentration was 90.00 mg/L, the TN removal efficiency was the lowest, only 2.40%. The contents of the Extracellular polymeric substance (EPS) presented a trend of first increasing and then decreasing with the increase of Zn2+ concentration, and the main reason was the decrease of protein-like and tryptophan-like. The 16SrRNA analysis indicated that Zn2+ within a specific concentration could increase the operational taxonomic units (OTUs) number, microbial richness, and diversity of microorganisms in the SBR. However, with Zn2+ concentration exceeding 10.00 mg/L, the relative abundance of denitrification functional bacteria (Dechloromonas, Nitrospira, and Thauera) decreased.

The trend of unintentional injury-related mortality among children aged under-five years in China, 2010-2020: a retrospective analysis from a national surveillance system.

BACKGROUND: In this study, we estimated the trend of unintentional injury mortality among children aged under-five years in China during 2010-2020. METHODS: Data were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS). The total unintentional injury mortality and all specific-causes unintentional injury mortality was calculated, annual numbers of deaths and live births were adjusted by a 3-year moving average under-reporting rate. The Poisson regression model and the Cochran-Mantel-Haenszel method were used to calculate the average annual decline rate (AADR) and the adjusted relative risk (aRR) of the unintentional injury mortality. RESULTS: In 2010-2020, a total of 7,925 unintentional injury-related deaths were reported in U5CMSS, accounting for 18.7% of all reported deaths. The overall proportion of unintentional injury-related deaths to total under-five children deaths has increased from 15.2% to 2010 to 23.8% in 2020 (χ2 = 227.0, p < 0.001), the unintentional injury mortality significantly decreased from 249.3 deaths per 100,000 live births in 2010 to 178.8 deaths per 100,000 live births in 2020, with an AADR 3.7% (95%CI 3.1-4.4). The unintentional injury mortality rate decreased from 2010 to 2020 in both urban (from 68.1 to 59.7 per 100,000 live births) and rural (from 323.1 to 230.0 per 100,000 live births) areas (urban: χ2 = 3.1, p < 0.08; rural: χ2 = 113.5, p < 0.001). The annual rates of decline in rural areas and urban areas were 4.2% (95%CI 3.4-4.9) and 1.5% (95%CI 0.1-3.3), respectively. The leading causes of unintentional injury mortality were suffocation (2,611, 32.9%), drowning (2,398, 30.3%), and traffic injury (1,428, 12.8%) in 2010-2020. The cause-specific of unintentional injury mortality rates decreased with varying AADRs in 2010-2020, except for traffic injury. The composition of unintentional injury-related deaths also varied by age group. Suffocation was the leading cause in infants, drowning and traffic injury were the leading causes in children aged 1-4 years. Suffocation and poisoning has high incidence in October to March and drowning has high in June to August. CONCLUSION: The unintentional injury mortality rate of children aged under-five years decreased significantly from 2010 to 2020 in China, but great inequity exists in unintentional injury mortality in urban and rural areas. Unintentional injuries are still an important public health problem affecting the health of Chinese children. Effective strategies should be strengthened to reduce unintentional injury in children and these policies and programmes should be targeted to more specific populations, such as rural areas and males.

Geographical disparities in infant mortality in the rural areas of China: a descriptive study, 2010-2018.

BACKGROUND: The infant mortality rate (IMR) is considered a basic measure of public health for countries around the world. The specific aim of our study was to provide an updated description of infant mortality rate among different regions in rural China, and assess the trends and causes of the IMR geographical disparities. METHODS: Data were collected from China's Under-5 Child Mortality Surveillance System(U5CMSS). The annual number of deaths and causes of death were adjusted using a 3-year moving average underreporting rate based on annual national data quality control results. The average annual decline rate (AADR) and the relative risk (RR) of the IMR and cause-specific infant mortality were calculated by Poisson regression and the Cochran-Mantel-Haenszel method. Data analysis was completed by SAS software. RESULTS: There was an apparent decrease in infant mortality in rural China from 2010 to 2018, at the AADR of 11.0% (95%CI 9.6-12.4), 11.2% (95%CI 10.3-12.1) and 6.6% (95%CI 6.0-7.3) in the eastern, central and western rural areas, respectively. The IMR was highest in the western rural area, followed by the central and eastern rural areas. Compared with the eastern rural area, the RR of infant mortality in the central rural area remained at 1.4-1.6 and increased from 2.4 (95%CI 2.3-2.6) in 2010-2012 to 3.1 (95% CI 2.9-3.4) in 2016-2018 in the western rural area. Pneumonia, preterm birth /LBW and birth asphyxia were the leading causes of infant deaths in the western rural area. Mortality rates of these three causes fell significantly in 2010-2018 but contributed to a higher proportion of deaths in the western rural area than in the central and western rural ares. CONCLUSIONS: Our study indicated that the infant mortality rate dropped significantly from 2010 to 2018, however, geographical disparities of IMR in rural China are still persist. Therefore, there is an urgent need for public health programmes and policy interventions for infants in western rural China.

Experimental Study of Ghost Imaging in Underwater Environment.

Underwater imaging technique is a crucial tool for humans to develop, utilize, and protect the ocean. We comprehensively compare the imaging performance of twenty-four ghost imaging (GI) methods in the underwater environment. The GI methods are divided into two types according to the illumination patterns, the random and orthogonal patterns. Three-group simulations were designed to show the imaging performance of the twenty-four GI methods. Moreover, an experimental system was built, and three-group experiments were implemented. The numerical and experimental results demonstrate that the orthogonal pattern-based compressed sensing GI methods have strong antinoise capability and can restore clear images for underwater objects with a low measurement number. The investigation results are helpful for the practical applications of the underwater GI.

Breastfeeding practice in China from 2013 to 2018: a study from a national dynamic follow-up surveillance.

BACKGROUND: Breastfeeding is important for the physical and psychological health of the mother and child. Basic data on breastfeeding practice in China are out-of-date and vary widely. This study aimed to evaluate the progress of breastfeeding practice in China, as well as to explore the bottlenecks in driving better practice. METHODS: This was an observational study. We used data from the Under-5 Child Nutrition and Health Surveillance System in China for the period 2013-2018. The prevalence of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) were calculated for each year for subgroups of China. The Cochran-Armitage test was used to explore the time trends. The annual percent of change (APC) were calculated by log-linear regression followed by exp transformation. RESULTS: The prevalence of EIBF increased significantly from 44.57% (95% CI: 44.07, 45.07) in 2013 to 55.84% (95% CI: 55.29, 56.38) in 2018 (Ptrend < 0.001), with an APC of 4.67% (95% CI: 3.51, 5.85). And the prevalence of EBF increased rapidly from 16.14% (95% CI: 15.10, 17.18) to 34.90% (95% CI: 33.54, 36.26) (Ptrend < 0.001), with an APC of 14.90% (95% CI: 9.97, 20.04). Increases were observed in both urban and rural areas, with urban areas showing greater APCs for EIBF (6.05%; 95% CI: 4.22, 7.92 v.s. 2.26%; 95% CI: 1.40, 3.12) and EBF (18.21%; 95% CI: 11.53, 25.29 v.s. 9.43%; 95% CI: 5.52, 13.49). The highest EBF prevalence was observed in the East, but the Central area showed the highest APC. The prevalence of EBF decreased with increasing age within the first 6 months, especially after 3 months. CONCLUSION: The prevalence of both EIBF and EBF in China are improving in recent years. The rural and West China could be the key areas in the future actions. More efforts should be made to protect and promote breastfeeding to achieve near- and long-term goals for child health.

Social and environmental risk factors for unintentional suffocation among infants in China: a descriptive analysis.

BACKGROUND: This retrospective study aimed to determine the epidemiological features of deaths caused by unintentional suffocation among infants in China. METHODS: The data used in this study were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS) from October 1, 2015, to September 30, 2016. A total of 377 children under 1 year of age who died from unintentional suffocation were included in the survey. Primary caregivers were interviewed individually using the Unintentional Suffocation Mortality among Children under 5 Questionnaire. EpiData was used to establish the database, and the results were analysed using SPSS 22.0. RESULTS: Most (85.9%) unintentional infant suffocations occurred in rural areas, and 67.5% occurred in infants 0 to 3 months old. Among the primary caregivers of the infants, most (82.7%) had a junior middle school education or below, and 83.1% of them lacked unintentional suffocation first aid skills. Of the 377 unintentional suffocated-infant deaths, the causes of death were accidental suffocation and strangulation in bed (ASSB) (193, 51.2%), inhalation suffocation (154, 40.8%), other unintentional suffocation (6, 1.6%), and unknown (24, 6.4%). Among the infant deaths due to ASSB, overlaying (88.6%) was the most frequently reported circumstance. A total of 93.8% of cases reported occurred during co-sleeping/bed sharing with parents, and in 72.8% of the cases, the infants were covered with the same quilt as their parents. In our study, most inhalation suffocation deaths (88.3%) involved liquid food (such as breast milk and formula milk). A total of 80.5% of infant deaths reportedly occurred after eating; in 28.2% of those cases, the infants were held upright and patted by their caregivers, and 57.2% of them were laid down to sleep immediately after eating. CONCLUSIONS: To reduce the occurrence of unintentional suffocation, local government should strengthen knowledge and awareness of unintentional suffocation prevention and safety among parents and caregivers. Additionally, health care providers should educate parents and caregivers about safety issues of unintentional suffocation, and relevant policies should be introduced to provide environments and activities that reduce the risk of suffocation, such as promoting the Safe to Sleep Campaign. It is important to enhance the focus on infant unintentional suffocation as a health issue.

Effects of Sludge Retention Time on the Performance of Anaerobic Ceramic Membrane Bioreactor Treating High-Strength Phenol Wastewater.

Anaerobic ceramic membrane bioreactor (AnCMBR) is an attractive alternative for the treatment of high-strength phenol wastewater, but the effects of sludge retention time (SRT) on the performance and membrane fouling are still unclear. The results indicated that the AnCMBR was successfully employed to treat high-strength wastewater containing 5 g phenol L-1. The removal efficiencies of phenol and chemical oxygen demand (COD) reached over 99.5% and 99%, respectively, with long SRT and short SRT. SRT had no obvious effect on the performance of the AnCMBR treating high-strength phenol wastewater with long time operation. The strong performance robustness of AnCMBR benefited from the enrichment of hydrogenotrophic methanogens and syntrophic phenol-degrading bacteria. However, the decline of SRT led to a more severe membrane fouling in the AnCMBR, which was caused by the small size of sludge flocs and high concentration of protein in the biopolymers. Therefore, this work presented a comprehensive insight to the feasibility and robustness of the AnCMBR for treating high-strength phenol wastewater.

Communicable disease mortality trends and characteristics of infants in rural China, 1996-2015.

BACKGROUND: More attention should be paid to communicable disease-specific infant mortality rate (CD-IMR) in rural China. However, few studies have examined specific geographic patterns and trends in CD-IMR in these areas. Our aims were to assess the epidemiological distribution and trends in CD-IMR in rural China for the period 1996-2015. METHODS: We used data from China's Under-5 Child Mortality Surveillance System (U5CMSS). The time trends in communicable disease-specific IMR (CD-IMR) were assessed by Poisson regression model, and the proportion of total infant deaths due to communicable disease was assessed by the Cochran Armitage trend test. Differences in CD-IMR among and within geographic regions were assessed for significance using the Cochran-Mantel-Haenszel test. RESULTS: The overall CD-IMR fell by 86.0% from 1444.3 to 201.5 per 100,000 live births in rural mainland China from 1996 to 2015. The proportion of total infant deaths related to communicable disease fell from 33.4 to 19.7%. Using eastern rural areas as the reference, rate ratios (RRs) of IMR due to all communicable diseases ranged between 1.7 and 3.1 in central rural areas and between 4.4 and 9.8 in western areas during the four study intervals. Acute respiratory infection (ARI) accounted for 71% of deaths, followed by diarrhea and septicemia. CONCLUSIONS: IMR due to communicable disease remains a major public health issue. ARI is the leading cause of mortality, followed by diarrhea. A regional gap remains in the risk of infant exposure to communicable disease in rural China. More attention should be paid to western rural areas.

Social and environmental risk factors for the accidental drowning of children under five in China.

BACKGROUND: Accidental drowning of children under five is a serious problem in China. The present study analyzed data on environmental and sociodemographic factors and on primary caregivers of drowned children to understand factors that may contribute to this problem. METHODS: The present study collected information on 563 cases of drowning in children under five from October 1, 2015, to September 30, 2016, in 334 sampling districts in China. Primary caregivers were interviewed individually using the Drowning Mortality among Children under 5 Questionnaire. RESULTS: Most drowned children under 5 years old were boys, and 71.6% lived within 100 m of a body of water. The drownings primarily occurred in ponds, canals, rivers, and wells, and over 90% of these water bodies had no safety measures. There were 28.1% of primary caregivers who did not provide full-time care for the children, and 83.1% of them had no knowledge of first aid skills for drowning. CONCLUSION: Encouraging kindergarten enrollment and providing safety education for children may reduce drowning in children under 5 years of age. Public water body protection measures should be strengthened to prevent children from drowning. Encouraging primary caregivers to care full-time for the children and learning first aid skills for drowning may also help reduce fatalities.

Injury-related mortality among children younger than 5 years in China during 2009-2016: an analysis from national surveillance system.

BACKGROUND: Epidemiology in injury-related mortality among children younger than 5 years was unreported in China recently. METHODS: Data were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS) in 2009-2016. Injury-related mortality rates were calculated by residence, age-group, gender and major injury type (drowning, traffic injuries, suffocation, poisoning, falls). The average annual decline rate (AADR) was calculated based on the annual mortality rates by Poisson regression and the relative risk (RR) between urban and rural residence was examined based on the rates of two years for each time point by Cochran-Mantel-Haenszel method. RESULTS: U5CMSS contained 6503 injury-related deaths of children younger than 5 years during the study period, of which 58.6% were male, 86.0% occurred in rural areas, 65.7% were children aged 12-59 months. Deaths were mainly attributed to suffocation (34.3%), drowning (29.6%), traffic injuries (17.7%), falls (7.2%) or poisoning (4.7%). The injury-related mortality rate dropped from 274.7 to 189.2 per 100 000 live births from 2009 to 2016, giving an AADR of 4.53% (95% CI 3.50% to 5.55%). During 2009-2016, the injury-related mortality rate in rural area was higher than that in urban area, the adjusted RRs (aRRs) in infants and children aged 12-59 months were 3.32-6.04 and 4.31-5.49, respectively. CONCLUSION: The rate of injury-related deaths in children younger than 5 years has decreased in China, but it remains high and strong urban-rural disparities still exist. Public health programmes and policy interventions should focus particularly on suffocation among infants and on drowning and traffic injuries among children aged 12-59 months, especially in rural areas.

Under-5 mortality in 2851 Chinese counties, 1996-2012: a subnational assessment of achieving MDG 4 goals in China.

BACKGROUND: In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. METHODS: We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. FINDINGS: In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4.4%. INTERPRETATION: The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8.8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates. FUNDING: National "Twelfth Five-Year" Plan for Science and Technology Support, National Health and Family Planning Commission of The People's Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation.

Water-Soluble Cationic Polyphosphazenes Grafted with Cyclic Polyamine and Imidazole as an Effective Gene Delivery Vector.

Gene therapy holds immense potential as a future therapeutic strategy for the treatment of numerous genetic diseases which are incurable to date. Nevertheless, safe and efficient gene delivery remains the most challenging aspects of gene therapy. In this study, a series of polyphosphazenes (PPZ) bearing cyclic polyamine and imidazole groups were synthesized and investigated for gene delivery. Agarose gel electrophoresis assays showed that poly(imidazole/1,4,7,10-tetraazyclodocane)phosphazene (Im-PPZ-cyclen) had good binding ability with plasmid DNA (pDNA), yielding positively charged particles with a size around 120-140 nm from a ratio of 10:1 to 5:1 (Im-PPZ-cyclen/pDNA, w/w). The cytotoxicity of Im-PPZ-cyclen assayed by MTT was lower than that of PEI 25 kDa, and was similar to that reported for poly(di-2-dimethylaminoethylamine)phosphazene (poly(di-DMAEA)phosphazene) to some degree. The maximum transfection efficiency of Im-PPZ-cyclen/pDNA complexes against 293 T cells at the ratio of 5:1 (Im-PPZ-cyclen/pDNA, w/w) is close to that of Lipofectamine 2000. The present work may provide a strategy for the design of new cationic polymers with reduced cytotoxicity and be applied to gene delivery as an efficient nonviral vector.

Neonatal mortality in the urban and rural China between 1996 and 2013: a retrospective study.

BACKGROUND: One of the proposed United Nations post-2015 sustainable development goals is to eliminate avoidable neonatal deaths by 2030. This study aims to examine changes in neonatal mortality rate (NMR) and cause-specific NMR in urban and rural areas to guide renewed efforts to further reduce NMR in China. METHODS: This retrospective study used 18 y of consecutive data from the National Under-5 Child Mortality Surveillance System. RESULTS: Urban NMR decreased from 11.0 to 4.0 deaths per 1,000 live births, and rural NMR was decreased births from 26.0 to 8.1 deaths per 1,000 live births between the periods of 1996-1998 and 2011-2013. Rural NMR was about two times as much as urban NMR in 2011-2013. Approximately four-fifths of neonatal deaths occurred within less than 7 d after birth. In 2011-2013, the three leading causes of early neonatal death were premature delivery, intrapartum-related conditions, and congenital abnormalities; the three causes of death in late neonates were classification premature delivery, congenital abnormalities, and pneumonia. CONCLUSION: China has made substantive progress in reducing NMR; however, the disparity in NMR between urban and rural areas still exists. More effort should be made to prevent and manage premature delivery and congenital abnormalities, especially in rural areas.

Incorporating comorbidities into latent treatment pattern mining for clinical pathways.

In healthcare organizational settings, the design of a clinical pathway (CP) is challenging since patients following a particular pathway may have not only one single first-diagnosis but also several typical comorbidities, and thus it requires different disciplines involved to put together their partial knowledge about the overall pathway. Although many data mining techniques have been proposed to discover latent treatment information for CP analysis and reconstruction from a large volume of clinical data, they are specific to extract nontrivial information about the therapy and treatment of the first-diagnosis. The influence of comorbidities on adopting essential treatments is crucial for a pathway but has seldom been explored. This study proposes to extract latent treatment patterns that characterize essential treatments for both first-diagnosis and typical comorbidities from the execution data of a pathway. In particular, we propose a generative statistical model to extract underlying treatment patterns, unveil the latent associations between diagnosis labels (including both first-diagnosis and comorbidities) and treatments, and compute the contribution of comorbidities in these patterns. The proposed model extends latent Dirichlet allocation with an additional layer for diagnosis modeling. It first generates a set of latent treatment patterns from diagnosis labels, followed by sampling treatments from each pattern. We verify the effectiveness of the proposed model on a real clinical dataset containing 12,120 patient traces, which pertain to the unstable angina CP. Three treatment patterns are discovered from data, indicating latent correlations between comorbidities and treatments in the pathway. In addition, a possible medical application in terms of treatment recommendation is provided to illustrate the potential of the proposed model. Experimental results indicate that our approach can discover not only meaningful latent treatment patterns exhibiting comorbidity focus, but also implicit changes of treatments of first-diagnosis due to the incorporation of typical comorbidities potentially.

[Trendency analysis of infant mortality rate due to premature birth or low birth weight in China from 1996 to 2013].

OBJECTIVE: To study the secular trend and characteristics of infant mortality rate due to premature birth or low birth weight (IMRPL) in China from 1996 to 2013. METHODS: Data used in this study was collected from the population-based Child's Health Surveillance Network of China. The Cochran-Armitage Trend test and Poisson regression were used to test the trend of IMRPL and explore the differences of the trend among different regions or areas. RESULTS: The nationwide IMRPL was 629.9 per 100 000 live births in 1996 and it decreased to 214.6 per 100 000 live births in 2013. The average annual decline rate was 6.14%, while the proportion of infant mortality due to premature birth or low birth weight in all infant deaths was on the rise with the average annual growth rate of 1.52%. And the proportion increased to 22.6% in 2013. IMRPLin rural and urban areas fell 28.1% and 66.6% respectively during 1996 and 2013. But the differences between urban and rural areas was obvious. During the same period, the average IMRPLin the central region was 1.40 times (95%CI:1.31-1.49) of that in the eastern region. And the average IMRPL in the western region was 2.25 times (95%CI:2.12-2.40) of that in the eastern region. The differences among different regions was obvious. Male infant mortality rate due to premature birth or low birth weight was 1.09 times (95%CI:1.05-1.14) of that in female infant from 1996 to 2013. CONCLUSION: The risk of IMRPL decreased substantially in China from 1996 to 2013. And the risk of IMRPL decreased more in rural areas than that in urban areas. The differences among different regions and areas were obvious. Premature birth or low birth weight as one of main factors has become a serious threat for health of Chinese children.

Nationwide study of injury-related deaths among children aged 1-4 years in China, 2000-2008.

AIMS: The aims of this study are to investigate injury mortality in children aged 1-4 years, to analyse prevalent mortality rates of childhood injury and to identify the leading causes of child injury deaths in China from 2000 to 2008. METHODS: The data were obtained from a nationwide mortality surveillance system for children under 5 years of age in China. The injury mortality rates of children aged 1-4 years were compared between rural and urban areas, boys and girls and among five major injury types between 2000 and 2008. RESULTS: During the 9-year study period, the injury mortality rates for children aged 1-4 years declined significantly by an average of 5.4% each year (P < 0.001; 95% confidence interval (CI): 3.6-7.0%) overall in China, with a decrease of 4.8% (P < 0.001; 95% CI: 2.5-7.1%) and 9.9% (P < 0.001; 95% CI: 4.9-14.7%) in rural and urban areas, respectively. The proportion of injury-related deaths to total mortality rates dropped from 32.9% in 2000 to 18.8% in 2008 in urban areas but increased from 45.6% to 56.9% in rural areas. The injury mortality rates in both boys and girls decreased significantly by an average of 5.4% each year (P < 0.001; 95% CI: 2.6-8.0%) and 6.1% (P < 0.001; 95% CI: 2.7-9.4%), respectively. Drowning and traffic accidents were the most prevalent causes of injury-related deaths in children aged 1-4 years. CONCLUSION: Childhood injury is still the leading cause of death in children aged 1-4 years in China. Drowning and traffic accidents were the most prevalent causes of childhood deaths in this study. Boys living in rural areas are at a higher risk and therefore require increased attention to help control and prevent childhood injury.

Design of a Shock-Protected Structure for MEMS Gyroscopes over a Full Temperature Range.

Impact is the most important factor affecting the reliability of Micro-Electro-Mechanical System (MEMS) gyroscopes, therefore corresponding reliability design is very essential. This paper proposes a shock-protected structure (SPS) capable of withstanding a full temperature range from -40 °C to 80 °C to enhance the shock resistance of MEMS gyroscopes. Firstly, the shock transfer functions of the gyroscope and the SPS are derived using Single Degree-of-Freedom and Two Degree-of-Freedom models. The U-folded beam stiffness and maximum positive stress are deduced to evaluate the shock resistance of the silicon beam. Subsequently, the frequency responses of acceleration of the gyroscope and the SPS are simulated and analyzed in Matlab utilizing the theoretical models. Simulation results demonstrate that when the first-order natural frequency of the SPS is approximately one-fourth of the gyroscope's resonant frequency, the impact protection effect is best, and the SPS does not affect the original performance of the gyroscope. The acceleration peak of the MEMS gyroscope is reduced by approximately 23.5 dB when equipped with the SPS in comparison to its counterpart without the SPS. The anti-shock capability of the gyroscope with the SPS is enhanced by approximately 13 times over the full-temperature range. After the shock tests under the worst case, the gyroscope without the SPS experiences a beam fracture failure, while the performance of the gyroscope with the SPS remains normal, validating the effectiveness of the SPS in improving the shock reliability of MEMS gyroscopes.

Characterization of Sand and Dust Pollution Degradation Based on Sensitive Structure of Microelectromechanical System Flow Sensor.

The effect of sand and dust pollution on the sensitive structures of flow sensors in microelectromechanical systems (MEMS) is a hot issue in current MEMS reliability research. However, previous studies on sand and dust contamination have only searched for sensor accuracy degradation due to heat conduction in sand and dust cover and have yet to search for other failure-inducing factors. This paper aims to discover the other inducing factors for the accuracy failure of MEMS flow sensors under sand and dust pollution by using a combined model simulation and sample test method. The accuracy of a flow sensor is mainly reflected by the size of its thermistor, so in this study, the output value of the thermistor value was chosen as an electrical characterization parameter to verify the change in the sensor's accuracy side by side. The results show that after excluding the influence of heat conduction, when sand particles fall on the device, the mutual friction between the sand particles will produce an electrostatic current; through the principle of electrostatic dissipation into the thermistor, the principle of measurement leads to the resistance value becoming smaller, and when the sand dust is stationary for some time, the resistance value returns to the expected level. This finding provides theoretical guidance for finding failure-inducing factors in MEMS failure modes.