[Health Risk Assessment and Priority Control Factors Analysis of Heavy Metals in Agricultural Soils Based on Source-oriented].

To analyze the source apportionment and health risk of heavy metals in agricultural soils of major producing areas of agricultural products in Chongqing, a positive matrix factorization (PMF) model and health risk assessment (HRA) model based on Monte Carlo simulation were used. Meanwhile, both the PMF and HRA model were combined to explore health risks of heavy metals in agricultural soils by different pollution sources in order to determine the priority control factors. The results showed that the average values of Cd concentration were higher than its corresponding background value; the average values of Cr concentration were lower than its corresponding background value; and the average values of As, Pb, Cu, Ni, and Zn concentration were basically consistent with their corresponding background values. Using PMF model analysis, natural sources, industrial sources, and agricultural sources were identified as the determinants for the accumulation of heavy metals in agricultural soils, with the contribution rates of 35%, 24%, and 41%, respectively. Using the HRA model based on Monte Carlo simulation analysis, carcinogenic risks of adult and children were tolerable (1.00E-6 < TCR ≤ 1.00E-4), whereas non-carcinogenic risks were acceptable (HI ≤ 1). Oral ingestion was the main exposure pathway. The analysis results of the relationship among heavy metals, pollution sources, and health risks showed that industrial pollution and As were identified as priority control factors, and agricultural pollution and Cd were identified as secondary control factors. Our findings provide scientific support for decision makers to control soil pollution and reduce the management costs of soil pollution.

[Health Risk Assessment of Heavy Metals in Agricultural Soils Around the Gangue Heap of Coal Mine Based on Monte Carlo Simulation].

To analyze the pollution characteristics of heavy metals in the soil of farmland surrounding the gangue heap of a coal mine in Chongqing, the Nemerow, Muller, and Hakanson indices were used. Meanwhile, to investigate the health risks of heavy metals in soil, a health risk assessment model was employed using Monte Carlo simulation. The results revealed that the average contents of Cd, Hg, As, Pb, Cr, Cu, Ni, and Zn were higher than their soil background values, and the Muller index (Igeo) from high to low was as follows:Cd>Hg>Cu>As>Ni>Zn>Cr>Pb. The Nemerow index (PN) demonstrated that the results of the assessment indicated mainly light pollution (1Cu>Ni>Cr>Zn>As>Pb>Hg. The Hakanson index (RI) demonstrated that the results of the assessment indicated mainly moderate ecological risk (150 ≤ RI<300). The single ecological risk index (Eri) from high to low was as follows:Cd>Hg>As>Cu>Ni>Pb>Cr>Zn. The health risk assessment of heavy metals revealed that the non-carcinogenic health risks of children and adults could be ignored, but carcinogenic health risks existed, with an average total carcinogenic risk index (TCR) of 1.04E-5 and 3.94E-6, respectively. The major carcinogenic factors were As and Cd. Sensitivity analysis of non-carcinogenic health risks revealed that the ingestion rate of soil (Ringest) was the most sensitive, followed by the contents of As. Meanwhile, sensitivity analysis of carcinogenic health risks indicated that the content of As was the most sensitive, followed by the ingestion rate of soil (Ringest). In general, the health risks of children, including non-carcinogenic and carcinogenic risks, were higher than those of adults.

Smoking cessation prevalence by menthol cigarette use and select demographics among adults in the United States, TUS-CPS, 2003-2019.

People who smoke menthol cigarettes, particularly those who are non-Hispanic Black/African American, are less likely to achieve successful smoking cessation compared with people who smoke non-menthol cigarettes. This study examined the 2003-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) harmonized data to estimate cross-sectional trends in cigarette smoking cessation among U.S. adults, stratified by menthol cigarette use, race/ethnicity, sex, and age. The analytic sample included respondents who smoked for ≥ 2 years (current users and former users who reported quitting during the past year). We tested cessation trends using orthogonal polynomial contrasts for overall, menthol, and non-menthol smoking cessation prevalence and stratified by race/ethnicity, sex, and age in logistic regression models. We also analyzed the 2018-2019 non-harmonized TUS-CPS data among recent quitters to examine differences in characteristics (e.g., demographic characteristics, smoking frequency, use of smoking cessation aids, switching to other tobacco products) by menthol cigarette use. We observed significant linear changes in prevalence trends for overall cigarette smoking cessation, menthol smoking cessation, and non-menthol smoking cessation (p < 0.0001 for all linear trends), and changes in menthol cessation among non-Hispanic White and non-Hispanic Other race/ethnicity categories during 2003-2019. In the 2018-2019 wave, we observed differences in menthol status for sex, race/ethnicity, age, and educational attainment. We did not observe differences for other characteristics. We observed changes in overall cigarette smoking cessation, menthol, and non-menthol smoking cessation prevalence during the study period; however, gains in cigarette smoking cessation were not experienced among non-Hispanic Black/African American adults who smoke.

[Health Risk Assessment and Environmental Benchmark of Cadmium in Farmland Soils around the Gangue Heap of Coal Mine, Chongqing].

To analyze the health risk assessment and environmental benchmark of cadmium in farmland soils surrounding the gangue heap of a coal mine in Chongqing, Hakanson, the ecological risk index and health risk assessment were used. Meanwhile, the soil environmental reference value of the regional cultivated land was inverted based on the species sensitive distribution model (SSD). The results showed that the dryland soil was polluted by Cd, with an over-standard rate of 55.8%, and the paddy field soil was polluted by Cd, with an over-standard rate of 31.6%. The corn was polluted by Cd, with an over-standard rate of 4.4%, and the rice was not polluted by Cd. The Hakanson ecological risk index showed that Cd was mainly characterized in soils by high ecological risk and considerable ecological risk. The health risk assessment indicated that Cd presented low non-carcinogenic risk by corn and rice; however, it showed acceptable carcinogenic risk by corn and unacceptable carcinogenic risk by rice in this study. The sensitivity analysis of health risks showed that the content of Cd was the most sensitive. The SSD inversion showed that the reference values for Cd in dryland soil of pH ≤ 5.5, 5.57.5 had HC5 values of 0.491, 0.382, 0.376, and 0.588 mg·kg-1, respectively, and that for Cd in paddy soil had an HC5 value of 0.807 mg·kg-1. The reverse analysis showed that the HC5 of Cd in dryland soil (pH ≤ 7.5) and paddy soil was relatively relaxed and was higher than the soil risk screening values, which showed that the current standard was relatively loose. However, the HC5 of Cd in dryland soil (pH>7.5) was lower than the soil risk screening values, which showed that the current standard was relatively strict. It is suggested that the current soil standard could be adjusted in this area.

Photochemical and Atom-Economical Sulfonylimination of Alkenes with Bifunctional N-Sulfonyl Ketimine.

An organo-photocatalytic sulfonylimination of alkenes was developed by employing readily available N-sulfonyl ketimines as bifunctional reagents. This transformation, featuring prominent functional group tolerance, provides a direct and atom-economic approach for the synthesis of valuable ß-amino sulfone derivatives as a single regioisomer. In addition to terminal alkenes, internal alkenes participate in this reaction with high diastereoselectivity. N-Sulfonyl ketimines with aryl or alkyl substituents were found to be compatible with this reaction condition. This method could be applied in the late-stage modifications of drugs. Additionally, a formal insertion of alkene into cyclic sulfonyl imine was observed, affording a ring expansion product.

The spatial analysis, risk assessment and source identification for mercury in a typical area with multiple pollution sources in southern China.

Mercury (Hg) has always been a research hot spot because of its high toxicity. This study conducted in farmland near rare earth mining area and traffic facilities, which considered multiple pollution sources innovatively. It not only analyzed Hg spatial characteristics using inverse distance weighting and self-organizing map (SOM), but also assessed its pollution risk by potential ecological risk index (Er) as well as geoaccumulation index (Igeo), and identified the pollution sources with positive matrix factorization. The results showed that there was no heavy Hg pollution in most farmland, while a few sampling sites with Hg pollution were close to highway, railway station and petrol station in Xinfeng or in the farmland of Anyuan, which were divided into the cluster with highest Hg concentration in SOM. The vehicle exhaust emission and pesticide as well as fertilizer additions significantly contributed to the local Hg pollution. Besides, there was moderate pollution and high ecological risk in Anyuan assessed by Igeo and Er, respectively. In contrast, Xinfeng had the moderate and considerable ecological risks in a larger scale. The enriched Hg might harmed not only the nearby ecological environment, but also the human health when it entered human body through food chain. The three factors that contributed to mercury concentration in this area according to positive matrix factorization were natural source, traffic source and agricultural source, respectively. This study about Hg pollution in the typical area would provide scientific evidence for the particular treatment of Hg pollution from various pollution sources like traffic source, agricultural source, etc.

Association of Pneumococcal Conjugate Vaccine Use With Hospitalized Pneumonia in Medicare Beneficiaries 65 Years or Older With and Without Medical Conditions, 2014 to 2017.

Importance: The association of 13-valent pneumococcal conjugate vaccine (PCV13) use with pneumonia hospitalization in older adults, especially those with underlying medical conditions, is not well described. Objective: To evaluate the association of PCV13 use with pneumonia, non-health care-associated (non-HA) pneumonia, and lobar pneumonia (LP) hospitalization among US Medicare beneficiaries 65 years or older. Design, Setting, and Participants: This cohort study with time-varying exposure assignment analyzed claims data from US Medicare beneficiaries 65 years or older enrolled in Parts A/B with a residence in the 50 US states or the District of Columbia by September 1, 2014. New Medicare Parts A/B beneficiaries within 6 months after their 65th birthday were continuously included in the cohort after September 1, 2014, and followed through December 31, 2017. Participants were censored if they died, changed enrollment status, or developed a study outcome. Most of the analyses were conducted from 2018 to 2019, and additional analyses were performed from 2021 to 2022. Exposures: Use of PCV13 vaccination 14 days or more before pneumonia hospitalization. Main Outcomes and Measures: Discrete-time survival models were used to estimate the incidence rate ratio (IRR) and number of pneumonia hospitalizations averted through PCV13 use. The adjusted IRR for the association of PCV13 vaccination with pneumonia hospitalization was used to estimate vaccine effectiveness (VE). Results: At the end of follow-up (December 2017), 24 121 625 beneficiaries (13 593 975 women [56.4%]; 418 005 [1.7%] Asian, 1 750 807 [4.8%] Black, 338 044 [1.4%] Hispanic, 111 508 [0.5%] Native American, and 20 700 948 [85.8%] White individuals) were in the cohort; 4 936 185 (20.5%) had received PCV13 only, and 10 646 220 (79.5%) had not received any pneumococcal vaccines. More than half of the beneficiaries in the cohort were younger than 75 years, White, and had either immunocompromising or chronic medical conditions. Coverage with PCV13 increased from 0.8% (September 2014) to 41.5% (December 2017). The VE for PCV13 was estimated at 6.7% (95% CI, 5.9%-7.5%) for pneumonia, 4.7% (95% CI, 3.9%-5.6%) for non-HA pneumonia, and 5.8% (95% CI, 2.6%-8.9%) for LP. From September 2014 through December 2017, an estimated 35 127 pneumonia (95% CI, 33 011-37 270), 24 643 non-HA pneumonia (95% CI, 22 761-26 552), and 1294 LP (95% CI, 797-1819) hospitalizations were averted through PCV13 use. Conclusions and Relevance: The study results suggest that PCV13 use was associated with reduced pneumonia hospitalization among Medicare beneficiaries 65 years or older, many of whom had underlying medical conditions. Increased PCV13 coverage and use of recently approved higher-valent pneumococcal conjugate vaccines may avert additional pneumonia hospitalizations in adults.

Contamination, Source Identification, Ecological and Human Health Risks Assessment of Potentially Toxic-Elements in Soils of Typical Rare-Earth Mining Areas.

The mining and leaching processes of rare-earth mines can include the entry of potentially toxic elements (PTEs) into the environment, causing ecological risks and endangering human health. However, the identification of ecological risks and sources of PTEs in rare-earth mining areas is less comprehensive. Hence, we determine the PTE (Co, Cr, Cu, Mn, Ni, Pb, Zn, V) content in soils around rare-earth mining areas in the south and analyze the ecological health risks, distribution characteristics, and sources of PTEs in the study area using various indices and models. The results showed that the average concentrations of Co, Mn, Ni, Pb and Zn were higher than the soil background values, with a maximum of 1.62 times. The spatial distribution of PTEs was not homogeneous and the hot spots were mostly located near roads and mining areas. The ecological risk index and the non-carcinogenic index showed that the contribution was mainly from Co, Pb, and Cr, which accounted for more than 90%. Correlation analysis and PMF models indicated that eight PTEs were positively correlated, and rare-earth mining operations (concentration of 22.85%) may have caused Pb and Cu enrichment in soils in the area, while other anthropogenic sources of pollution were industrial emissions and agricultural pollution. The results of the study can provide a scientific basis for environmental-pollution assessment and prevention in rare-earth mining cities.

Pooled Sampling is an Efficient and Economical Strategy for SARS-CoV-2 Detection in Low-Prevalence Areas.

BACKGROUND: Corona virus disease 2019 (COVID-19) is a severe acute respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Different pooling testing strategies have been applied for the detection of SARS-CoV-2. However, the discrepancies among different pooling strategies are still to be explored. METHODS: The aim of this study was to evaluate the two pooling strategies of collecting respiratory specimens for the detection of SARS-CoV-2 RNA. Two groups of five-sample pools were prepared to evaluate the impact of sample pooling and pooled sampling on test sensitivity, respectively. Viral RNA of coronavirus was extracted with the automation system. The N and ORF1ab genes of SARS-CoV-2 RNA were detected with real-time reverse-transcription PCR. The turnaround time of SARS-CoV-2 testing was analyzed before and after the implement of pooled sampling. RESULTS: The pooled sampling displayed advantages in assay sensitivity over the sample pooling. The implementation of pooled sampling significantly shortened the turnaround time of SARS-CoV-2 testing. CONCLUSIONS: The pooled sampling is an efficient and economical strategy for SARS-CoV-2 detection during the periods of high screening demand in low-prevalence areas.

De novo Creation and Assessment of a Prognostic Fat-Age-Inflammation Index "FAIN" in Patients With Cancer: A Multicenter Cohort Study.

Background and Aims: Malnutrition is highly prevalent and is related to multiple impaired clinical outcomes in cancer patients. This study aimed to de novo create an objective, nutrition-related index specially for prognostic purposes in oncology populations. Methods: We performed a multicenter cohort study including 14,134 cancer patients. The prognostic impact for each baseline characteristic was estimated by calculating Harrell's C-index. The optimal parameters reflecting the nutritional and inflammatory impact on patients' overall survival were selected to develop the fat-age-inflammation (FAIN) index. The associations of the FAIN with the nutritional status, physical performance, quality of life, short-term outcomes and mortality of patients were comprehensively evaluated. Independent external validation was performed to further assess the prognostic value of the FAIN. Results: The study enrolled 7,468 men and 6,666 women with a median age of 57 years and a median follow-up of 42 months. The FAIN index was defined as: (triceps skinfold thickness + albumin) / [age + 5 × (neutrophil count/lymphocyte count)]. There were significant associations of the FAIN with the nutritional status, physical performance, quality of life and short-term outcomes. The FAIN also showed better discrimination performance than the Nutritional Risk Index, the Prognostic Nutritional Index and the Controlling Nutritional Status index (all P < 0.05). In multivariable-adjusted models, the FAIN was independently associated with a reduced death hazard both as a continuous variable (HR = 0.57, 95%CI = 0.47-0.68) and per one standard deviation (HR = 0.83, 95%CI = 0.78-0.88). External validation in a multicenter lung cancer cohort (n = 227) further confirmed the prognostic value of the FAIN. Conclusions: This study created and assessed the prognostic FAIN index, which might act as a feasible option to monitor the nutritional status and help develop intervention strategies to optimize the survival outcomes of cancer patients.

The patient-generated subjective global assessment is a promising screening tool for cancer cachexia.

BACKGROUND: Cancer cachexia is a complex metabolic syndrome characterised by a loss of muscle with or without loss of fat mass, and is associated with high morbidity and mortality. Despite its clinical importance, there is a lack of simple tools to screen patients for cancer cachexia. The aim of this study was to evaluate and validate the patient-generated subjective global assessment (PG-SGA) as a screening tool for cancer cachexia. METHODS: This is a secondary analysis of a multicentre, cross-sectional, observational study. Cancer cachexia was diagnosed when there was weight loss ≥5% during the past 12 months and at least three of the five following conditions were present: decreased muscle strength, fatigue, anorexia, low Fat-Free Mass Index (FFMI) and abnormal laboratory findings. A quadratic discriminant analysis was conducted for the ability of PG-SGA to predict cachexia. RESULTS: A total of 4231 patients with cancer were included in this analysis, and 351 patients (8.3%) were diagnosed as having cachexia. The highest incidence of cachexia was found among patients with pancreatic cancer (32.5%), oesophageal cancer (21.5%) and gastric cancer (17.9%). Compared with patients without cachexia, patients with cachexia had a lower body mass index, FFMI, hand grip strength, total protein, prealbumin, albumin, haemoglobin and Karnofsky performance status (p<0.05), while they had a higher C reactive protein level and PG-SGA Score (4.71±3.71 vs 10.87±4.84, p<0.05). The best cut-off value for PG-SGA was 6.5, with 79.8% of sensitivity and 72.3% specificity for cachexia, and the area under the receiver operating characteristic curve was 0.846 (95% CI 0.826 to 0.866, p<0.001). CONCLUSIONS: PG-SGA is a highly specific tool that can be used to screen patients for cancer cachexia.

Fat mass assessment using the triceps skinfold thickness enhances the prognostic value of the Global Leadership Initiative on Malnutrition criteria in patients with lung cancer.

The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the Global Leadership Initiative on Malnutrition (GLIM) framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HR). Malnutrition was identified in 808 (30·2 %) patients, and the best TSF thresholds were 9·5 mm in men and 12 mm in women. Accordingly, 496 (18·6 %) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54 % (HR = 1·54, 95 % CI = 1·25, 1·88) greater death hazard compared with well-nourished individuals, which was also greater compared with malnourished patients with a normal TSF (HR = 1·23, 95 % CI = 1·06, 1·43) or malnourished patients without TSF assessment (HR = 1·31, 95 % CI = 1·14, 1·50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimise the long-term outcomes in patients with LC.

Cost-effectiveness of Anbainuo plus methotrexate compared to conventional disease-modifying antirheumatic drugs for rheumatoid arthritis patients in China.

BACKGROUND: This study aimed to evaluate the cost-effectiveness of Anbainuo (ABN) plus methotrexate (MTX) vs. conventional disease-modifying antirheumatic drugs (cDMARDs) in Chinese rheumatoid arthritis (RA) patients. METHODS: A total of 90 RA patients who underwent ABN + MTX [assigned as ABN + MTX group (n=47)] or cDMARDs [assigned as control group (n=43)] treatment were analyzed. Disease activity was assessed at baseline (M0), 3rd month (M3), 6th month (M6), and 12th month (M12) after treatment. Drug, other medical, indirect, and total costs were calculated. Then, pharmacoeconomic analyses were performed with the threshold of cost-effectiveness set as 3 times of the mean gross domestic product (GDP) per capita in China during the study period. RESULTS: Treatment response rate was similar between the 2 groups, while disease remission and low disease activity (LDA) rates were increased in the ABN + MTX group compared to control group. Drug cost, other medical costs, and total cost were higher in the ABN + MTX group than control group, while indirect cost was similar between the 2 groups. Meanwhile, the quality-adjusted life-years (QALY) in ABN + MTX group and control group were 0.72 and 0.48 years, respectively. The incremental cost-effectiveness ratios (ICER) of ABN + MTX group compared to control group among the entire participant cohort, moderate-disease-activity participants, and severe-disease-activity participants were ¥135,486.7, ¥146,450.4, and ¥124,987.2/QALY, respectively, which were all below the cost-effectiveness threshold. Further sensitivity analyses revealed that the cost-effectiveness of ABN + MTX vs. cDMARDs was relatively robust, while among all the indexes, ABN price and Health Assessment Questionnaire Disability Index (HAQ-DI) score change for the ABN + MTX group affected ICER most. CONCLUSIONS: Treatment with ABN + MTX offers acceptable cost-effectiveness compared to cDMARDs treatment in Chinese RA patients.

County-Level COVID-19 Vaccination Coverage and Social Vulnerability - United States, December 14, 2020-March 1, 2021.

The U.S. COVID-19 vaccination program began in December 2020, and ensuring equitable COVID-19 vaccine access remains a national priority.* COVID-19 has disproportionately affected racial/ethnic minority groups and those who are economically and socially disadvantaged (1,2). Thus, achieving not just vaccine equality (i.e., similar allocation of vaccine supply proportional to its population across jurisdictions) but equity (i.e., preferential access and administra-tion to those who have been most affected by COVID-19 disease) is an important goal. The CDC social vulnerability index (SVI) uses 15 indicators grouped into four themes that comprise an overall SVI measure, resulting in 20 metrics, each of which has national and state-specific county rankings. The 20 metric-specific rankings were each divided into lowest to highest tertiles to categorize counties as low, moderate, or high social vulnerability counties. These tertiles were combined with vaccine administration data for 49,264,338 U.S. residents in 49 states and the District of Columbia (DC) who received at least one COVID-19 vaccine dose during December 14, 2020-March 1, 2021. Nationally, for the overall SVI measure, vaccination coverage was higher (15.8%) in low social vulnerability counties than in high social vulnerability counties (13.9%), with the largest coverage disparity in the socioeconomic status theme (2.5 percentage points higher coverage in low than in high vulnerability counties). Wide state variations in equity across SVI metrics were found. Whereas in the majority of states, vaccination coverage was higher in low vulnerability counties, some states had equitable coverage at the county level. CDC, state, and local jurisdictions should continue to monitor vaccination coverage by SVI metrics to focus public health interventions to achieve equitable coverage with COVID-19 vaccine.

Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREE II instrument.

PURPOSE: To evaluate the quality of published clinical practice guidelines (CPGs) regarding the nutritional risk screening and assessment of cancer patients and to identify high-quality CPGs for clinical healthcare professionals. METHODS: Guidelines for the nutritional risk screening and assessment of cancer patients were comprehensively searched in eight electronic databases, including The Lancet, PubMed, Cochrane Library, Excerpta Medica dataBASE (EMBASE), Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), and Wan Fang Data, through August 2020. Six relevant guideline databases, including the National Comprehensive Cancer Network (NCCN), the National Guideline Clearinghouse (NGC), the Guideline International Network (GIN), the New Zealand Guidelines Group (NZGG), the China Guideline Clearinghouse (CGC), and Medlive, and relevant nutrition society websites, were also searched through August 2020. The methodological quality of the included CPGs was appraised independently by three assessors using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II) tool. RESULTS: Seven CPGs were located, and the domain with the highest percentage was "clarity of presentation" (85.44%), while the domain with the lowest percentage was "applicability" (40.26%). From the AGREE II results, two guidelines were rated as "strongly recommended," three were assessed as "recommended with modifications," and two were deemed as "not recommended." CONCLUSION: Considering that the two "strongly recommended" guidelines were developed within the American and European contexts, translation, validation, and cultural adaptation are recommended prior to implementing these guidelines in other countries or healthcare contexts to improve their effectiveness and sensitivity for local cancer patients. TRIAL REGISTRATION: PROSPERO registration of the study protocol: CRD42020177390 (July 5, 2020).

Spatiotemporal variations, sources, water quality and health risk assessment of trace elements in the Fen River.

As the largest river in Shanxi Province, the Fen River is the main water source for regional economic and ecological development. Water deficiency and industrialization have led to serious water pollution in the Fen River. The major and trace elements of seasonal river waters were measured to determine the spatiotemporal variations and assess the water quality as well as its controlling factors in the Fen River. Trace elements are divided into high abundance elements (B, Ba, Li, and Mn) and low abundance elements (As, Cu, Fe, Ni, Rb, Se, U, and V). The spatial variation of trace elements is obvious, with low values upstream, intermediate values downstream, and very high values midstream. The average values of the trace elements showed different seasonal variations, with high values of As, B, Ba, Mn, and Rb in the wet season, high Cu, V, and Li values in the dry season, and minor seasonal variations of Fe, Ni, Se, and U concentrations. Principal component analysis (PCA) and correlation analysis (CA) showed natural origins of Ba, Mn, Ni, and U, anthropogenic input of As, B, Cu, Li, Rb, Se, and V. According to the results of absolute principal component sore-multivariate linear regression (APCS-MLR), the major pollution sources in the Fen River basin were related to human activities. The land use type significantly influenced the concentrations of trace elements, with high values in the cropland and low values in the forest. The water quality index (WQI) values were higher in the midstream and wet season. In comparison with other rivers in the world, the pollution of the Fen River is at a moderate level. Health risk assessment showed that As, Ba, Mn, Ni, V, and Se were the potential pollutants damaging in the Fen River, especially for children. This study highlights the importance of seasonal sample analysis and can provide vital data for water quality conservation in the Fen River basin.

Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States.

Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million-12.0 million), results in 601,000 ED visits (95% CrI 364,000-866,000), 118,000 hospitalizations (95% CrI 86,800-150,000), and 6,630 deaths (95% CrI 4,520-8,870) and incurring US $3.33 billion (95% CrI 1.37 billion-8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually.

Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer.

INTRODUCTION: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors. METHODS: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status. RESULTS: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition. CONCLUSION: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.

A rigorous assessment and comparison of enumeration methods for environmental viruses.

Determining exact viral titers in a given sample is essential for many environmental and clinical applications, e.g., for studying viral ecology or application of bacteriophages for food safety. However, virus quantification is not a simple task, especially for complex environmental samples. While clonal viral isolates can be quantified with relative high accuracy using virus-specific methods, i.e., plaque assay or quantitative real-time PCR, these methods are not valid for complex and diverse environmental samples. Moreover, it is not yet known how precisely laser-based methods, i.e., epifluorescence microscopy, flow cytometry, and nanoparticle tracking analysis, quantify environmental viruses. In the present study, we compared five state-of-the-art viral quantification methods by enumerating four model viral isolates of different genome and size characteristics as well as four different environmental water samples. Although Nanoparticle tracking analysis combined with gentle staining at 30 °C could be confirmed by this study to be a reliable quantification technique for tested environmental samples, environmental samples still lack an universally applicable and accurate quantification method. Special attention has to be put on optimal sample concentrations as well as optimized sample preparations, which are specific for each method. As our results show the inefficiency when enumerating small, or single-stranded DNA or RNA viruses, the global population of viruses is presumably higher than expected.

Effect of socioeconomic status on the healthcare-seeking behavior of migrant workers in China.

In recent years, China has made great efforts to resolve the health inequality caused by household registration restrictions, and the unequal allotment of health services faced by migrant workers has been effectively alleviated. However, inequality in health services may exist not only between migrant workers and local citizens but also among migrant workers. Thus, the unbalanced utilization of health services among migrant workers deserves attention. Using data from the 2017 China Migrants Dynamic Survey (CMDS), we examined the relationship between socioeconomic status (SES) and healthcare-seeking behavior through multivariate regression analysis. Then, from the perspective of SES, this study divided migrant workers into different groups to explore the characteristics of healthcare-seeking behavior in different groups. The results showed that SES had a significant relationship with healthcare-seeking behavior. Those with high SES were more likely to use high-quality health services. By subdividing the category of migrant workers, we found that the utilization of health services among migrant workers was unbalanced. Education and income had significant gradients in multiple measures of healthcare-seeking behavior, while occupation had no significant difference in the behavior. Migrant workers with higher income and education were more likely to use high-quality health services. Especially for migrant workers who had high incomes (above 15,000 CNY) or whose educational backgrounds were graduate level or above, their utilization of health resources was significantly higher than that of other groups. When designing particular policies to improve the healthcare-seeking behavior of different SES migrant workers, we should pay attention to the low-education groups and low-income groups. Policymakers can reduce the current health inequality of migrant workers by strengthening health education and increasing medical subsidies to achieve health equality among migrant workers and between migrant workers and local citizens.