Economic Evaluation of the Comprehensive AIDS Prevention and Control Program - Tianjin Municipality, China, 2011-2022.

What is already known about this topic?: Acquired immunodeficiency syndrome (AIDS) represents a significant public health challenge globally, not only inflicting harm on the health of individuals but also placing a considerable economic strain on society. What is added by this report?: This study represents the inaugural report on the potential reduction in economic burden attributable to human immunodeficiency virus (HIV) prevention strategies in Tianjin. Between 2011 and 2022, it is estimated that effective measures could prevent 2,965 new HIV infections and avert 658 deaths, resulting in an economic benefit of approximately 14.437 billion Chinese Yuan. What are the implications for public health practice?: The findings of this study offer valuable evidence to inform the development of localized HIV prevention and control strategies, as well as to guide public health policymaking.

An Active Dose Measurement Device for Ultra-short, Ultra-intense Laser Facilities.

ABSTRACT: Ultra-short, ultra-intense laser facilities could produce ultra-intense pulsed radiation fields. Currently, only passive detectors are fit for dose measurement in this circumstance. Since the laser device could generate a dose up to tens of mSv outside the chamber in tens of picoseconds, resulting in a high instantaneous dose rate of ~107 Sv s-1, it is necessary to perform real-time dose measurement to ensure the safety of nearby workers. Due to fast response and excellent radiation resistance, a diamond-based dose measurement device was designed and developed, and its dose-rate response and its feasibility for such occasions were characterized. The measurement results showed that the detector had a good dose-rate linearity in the range of 3.39 mGy h-1 to 10.58 Gy h-1 for an x-ray source with energy of 39 keV to 208 keV. No saturation phenomenon was observed, and the experimental results were consistent with the results obtained from Monte Carlo simulation. The charge collection efficiency was about 80%. Experimental measurements and simulations with this dose measurement device were carried out based on the "SG-II" laser device. The experimental and simulation results preliminarily verified the feasibility of using the diamond detector to measure the dose generated by ultra-short, ultra-intense laser devices. The results provided valuable information for the follow-up real-time dose measurement work of ultra-short, ultra-intense laser devices.

Benchtop and bedside validation of a low-cost programmable cortical stimulator in a testbed for bi-directional brain-computer-interface research.

Introduction: Bi-directional brain-computer interfaces (BD-BCI) to restore movement and sensation must achieve concurrent operation of recording and decoding of motor commands from the brain and stimulating the brain with somatosensory feedback. Methods: A custom programmable direct cortical stimulator (DCS) capable of eliciting artificial sensorimotor response was integrated into an embedded BCI system to form a safe, independent, wireless, and battery powered testbed to explore BD-BCI concepts at a low cost. The BD-BCI stimulator output was tested in phantom brain tissue by assessing its ability to deliver electrical stimulation equivalent to an FDA-approved commercial electrical cortical stimulator. Subsequently, the stimulator was tested in an epilepsy patient with subcortical electrocorticographic (ECoG) implants covering the sensorimotor cortex to assess its ability to elicit equivalent responses as the FDA-approved counterpart. Additional safety features (impedance monitoring, artifact mitigation, and passive and active charge balancing mechanisms) were also implemeneted and tested in phantom brain tissue. Finally, concurrent operation with interleaved stimulation and BCI decoding was tested in a phantom brain as a proof-of-concept operation of BD-BCI system. Results: The benchtop prototype BD-BCI stimulator's basic output features (current amplitude, pulse frequency, pulse width, train duration) were validated by demonstrating the output-equivalency to an FDA-approved commercial cortical electrical stimulator (R 2 > 0.99). Charge-neutral stimulation was demonstrated with pulse-width modulation-based correction algorithm preventing steady state voltage deviation. Artifact mitigation achieved a 64.5% peak voltage reduction. Highly accurate impedance monitoring was achieved with R 2 > 0.99 between measured and actual impedance, which in-turn enabled accurate charge density monitoring. An online BCI decoding accuracy of 93.2% between instructional cues and decoded states was achieved while delivering interleaved stimulation. The brain stimulation mapping via ECoG grids in an epilepsy patient showed that the two stimulators elicit equivalent responses. Significance: This study demonstrates clinical validation of a fully-programmable electrical stimulator, integrated into an embedded BCI system. This low-cost BD-BCI system is safe and readily applicable as a testbed for BD-BCI research. In particular, it provides an all-inclusive hardware platform that approximates the limitations in a near-future implantable BD-BCI. This successful benchtop/human validation of the programmable electrical stimulator in a BD-BCI system is a critical milestone toward fully-implantable BD-BCI systems.

Who should be prioritized for COVID-19 vaccination in China? A descriptive study.

BACKGROUND: All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. METHODS: On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. RESULTS: Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. CONCLUSIONS: The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.

An overview of removing heavy metals from sewage sludge: Achievements and perspectives.

The removal of heavy metals from sewage sludge (SS) is attracting increasing attention because the presence of toxic heavy metals in SS restricts its reuse or disposal, especially on land. This review presents an overview of research on the origin and chemical speciation of heavy metals in SS and describes methods for their removal. SS primarily absorbs heavy metals from wastewater via passive sorption and active uptake of biomass, resulting in the different chemical speciation. The advantages and disadvantages of the current methods for the removal of heavy metals from SS are analysed. The current methods focus on the removal efficiencies of heavy metals, which are high enough to meet the standard of land application, but the treatment cost, the change and retention of nutrients, and the effects on SS properties resulting from heavy metal removal are usually ignored. In this review, the main knowledge gaps are identified and proposals for future research are made. These should comprise determining the underlying mechanisms of current removal methods, optimising and integrating the removal methods, and establishing systematic evaluation standards for these methods. This review will help researchers develop new environmentally and economically friendly methods for the removal of heavy metals from SS.

Automated Brain Region Segmentation for Single Cell Resolution Histological Images Based on Markov Random Field.

The brain consists of massive regions with different functions and the precise delineation of brain region boundaries is important for brain region identification and atlas illustration. In this paper we propose a hierarchical Markov random field (MRF) model for brain region segmentation, where a MRF is applied to the downsampled low-resolution images and the result is used to initialize another MRF for the original high-resolution images. A fractional differential feature and a gray level co-occurrence matrix are extracted as the observed vector for the MRF and a new potential energy function, which can capture the spatial characteristic of brain regions, is proposed as well. A fuzzy entropy criterion is used to fine-tune the boundary from the hierarchical MRF model. We test the model both on synthetic images and real histological mouse brain images. The result suggests that the model can accurately identify target regions and even the whole mouse brain outline as a special case. An interesting observation is that the model cannot only segment regions with different cell density but also can segment regions with similar cell density and different cell morphology texture. Thus this model shows great potential for building the high-resolution 3D brain atlas.

Not-in-My-Backyard: Legislation Requirements and Economic Analysis for Developing Underground Wastewater Treatment Plant in China.

Underground wastewater treatment plants (WWTPs) have achieved fast development in China in recent years. Due to the remarkable differences between underground and conventional aboveground construction mode, legislation including technical specifications and regulations for underground WWTPs, which was revealed in vacancy, should be issued in time to promote its development. It is also expected to avoid not-in-my-backyard sentiment by decreasing negative effects of WWTPs via construction in sealed underground space. This research took Beijing city as case study to investigate the impacts of WWTPs on nearby community from the perspective of housing price quantitatively. Differences-in-Difference (DID) model result indicates that WWTPs inhibited nearby housing price increases, leading to huge financial losses. The closer are the houses and WWTPs, the severer were the inhibition effects, indicating the relationship between environmental quality and property price. During 2016⁻2017, the deteriorated estate value surrounding the investigated WWTPs in Beijing was estimated as high as 32.53 billion RMB, much higher than their construction cost of about 4.38 billion RMB. Transformation from grey to green by underground construction was expected to avoid these huge value distortions, while providing alternative to enhance WWTPs with various social functions for public services. This research demonstrates the high social requirements in highly developed cities to promote fast development of underground WWTPs in China.

Blindness, low vision and cataract surgery outcome among adults in Hohhot of Inner Mongolia: a Rapid Assessment of Avoidable Blindness (RAAB) study.

BACKGROUND: To determine the prevalence and causes of visual impairment (VI), and to describe the characteristics of cataract surgery coverage and related barriers among adults aged ≥50 years residing in Hohhot, Inner Mongolia. METHODS: A population-based cross-sectional study was performed. Presenting visual acuity (PVA) was measured using the Rapid Assessment of Avoidable Blindness (RAAB) methodology. All VI cases were defined using the WHO definition, based on the PVA of the better-seeing eye. Details on history of cataract surgery and barriers to cataract surgery were also obtained using a standardised questionnaire. RESULTS: Of 4500 eligible individuals, 3985 (88.6% response rate) were examined. The age-standardised prevalence of moderate VI (PVA <6/18 to ≥6/60) was 5.4% (95% CI 4.6% to 6.3%), and severe VI (PVA <6/60 to ≥3/60) was 0.9% (95% CI 0.6% to 1.3%). The age-standardised prevalence of blindness (PVA <3/60) was 1.2% (95% CI 0.8% to 1.6%). Uncorrected refractive error (40.1%) and cataract (37.9%) were the leading causes of overall VI. Cataract (34.9%) was the leading cause of blindness. Among individuals with blindness, cataract surgical coverage was 80.7%. Among individuals with blindness due to cataract, the main barriers to cataract surgery were lack of awareness (38.1%). CONCLUSIONS: The age-standardised prevalence rate of blindness in Hohhot was lower compared with other RAAB studies in China. Cataract was the leading cause of blindness. These findings provide useful information for the planning of public healthcare services in Inner Mongolia.

Population Pharmacokinetic and Covariate Analysis of Apatinib, an Oral Tyrosine Kinase Inhibitor, in Healthy Volunteers and Patients with Solid Tumors.

BACKGROUND AND OBJECTIVES: Apatinib is an oral tyrosine kinase inhibitor approved in China for the treatment of patients with advanced metastatic gastric cancer. The approved dosing schedule is 850 mg once daily. The objective of this study was to develop a population pharmacokinetic (popPK) model of apatinib and determine factors that affect its pharmacokinetics. METHODS: A popPK model for apatinib was developed using data from 106 individuals, including healthy volunteers and patients with malignant solid tumors. The potential influence of demographic, patient, and laboratory characteristics on oral apatinib pharmacokinetics were investigated in a covariate analysis. The extent of the impact of significant covariates on the exposure of apatinib was evaluated using simulations. RESULTS: The final popPK model was a two-compartment model with mixed first- and zero-order absorption and first-order elimination. The population estimates of apparent clearance (CL/F) and apparent volume at steady-state were 57.8 L/h and 112.5 L, respectively. The non-linear dose proportionality in apatinib relative bioavailability was characterized by a sigmoidal maximum effect (E max) equation wherein the midpoint dose for the decrease in bioavailability was 766 mg. Patients with advanced gastric cancer exhibited lower bioavailability. Cancer patients in general had lower CL/F than healthy volunteers. Simulation results indicated that apatinib exposure in various population groups were impacted by disease and laboratory characteristics. CONCLUSIONS: The increase in apatinib exposure was less than proportional to dose. The pharmacokinetics of apatinib in gastric cancer patients were significantly different from those in patients with other cancer types. Dosing of apatinib in various cancer subpopulations may require adjustments to optimize efficacy and benefits to patients.

An economic evaluation for prevention of diabetes mellitus in a developing country: a modelling study.

BACKGROUND: The serious consequences of diabetes mellitus, and the subsequent economic burden, call for urgent preventative action in developing countries. This study explores the clinical and economic outcomes of strategies that could potentially prevent diabetes based on Chinese circumstances. It aims to provide indicators for the long-term allocation of healthcare resources for authorities in developing countries. METHODS: A representative sample of Chinese adults was used to create a simulated population of 20,000 people aged 25 years and above. The hybrid decision tree Markov model was developed to compare the long-term clinical and economic outcomes of four simulated diabetes prevention strategies with a control group, where no prevention applied. These preventive strategies were the following: (i) one-off screening for undiagnosed diabetes and impaired glucose tolerance (IGT), with lifestyle interventions on diet, (ii) on exercise, (iii) on diet combined exercise (duo-intervention) respectively in those with IGT, and (iv) one-off screening alone. Independent age-specific models were simulated based on diverse incidences of diabetes, mortalities and health utilities. The reported outcomes were the following: the remaining survival years, the quality-adjusted life years (QALYs) per diabetes or IGT subjects, societal costs per simulated subject and the comparisons between preventions and control over 40 years. Sensitivity analyses were performed based on variations of all assumptions, in addition to the performance and the compliance of screening. RESULTS: Compared with the control group, all simulated screening programmes prolonged life expectancy at the initiation ages of 25 and 40 years, postponed the onset of diabetes and increased QALYs at every initiation age. Along with an assumption of six years intervention, prevention programmes were associated with cost-saving compared with the control group, especially in the population aged 25 years. The savings were at least US$2017 per subject, but no statistically significant difference was observed among the intervention strategies within each age groups. The cost savings were reduced when screening was affected by poor performance and noncompliance. CONCLUSIONS: Developing countries have few effective strategies to manage the prevention of diabetes. One-off screening for undiagnosed diabetes and IGT, with appropriate lifestyle interventions for those with IGT are cost saving in China, especially in young adults.

Micro-computed tomography-guided, non-equal voxel Monte Carlo method for reconstruction of fluorescence molecular tomography.

The study of dual-modality technology which combines microcomputed tomography (micro-CT) and fluorescence molecular tomography (FMT) has become one of the main focuses in FMT. However, because of the diversity of the optical properties and irregular geometry for small animals, a reconstruction method that can effectively utilize the high-resolution structural information of micro-CT for tissue with arbitrary optical properties is still one of the most challenging problems in FMT. We develop a micro-CT-guided non-equal voxel Monte Carlo method for FMT reconstruction. With the guidance of micro-CT, precise voxel binning can be conducted on the irregular boundary or region of interest. A modified Laplacian regularization method is also proposed to accurately reconstruct the distribution of the fluorescent yield for non-equal space voxels. Simulations and phantom experiments show that this method not only effectively reduces the loss of high-resolution structural information of micro-CT in irregular boundaries and increases the accuracy of the FMT algorithm in both forward and inverse problems, but the method also has a small Jacobian matrix and a short reconstruction time. At last, we performed small animal imaging to validate our method.

Data preprocessing method for fluorescence molecular tomography using a priori information provided by CT.

The combined system of micro-CT and fluorescence molecular tomography (FMT) offers a new tool to provide anatomical and functional information of small animals in a single study. To take advantages of the combined system, a data preprocessing method is proposed to extract the valid data for FMT reconstruction algorithms using a priori information provided by CT. The boundary information of the animal and animal holder is extracted from reconstructed CT volume data. A ray tracing method is used to trace the path of the excitation beam, calculate the locations and directions of the optional sources and determine whether the optional sources are valid. To accurately calculate the projections of the detectors on optical images and judge their validity, a combination of perspective projection and inverse ray tracing method are adopted to offer optimal performance. The imaging performance of the combined system with the presented method is validated through experimental rat imaging.

Molecular imaging of small animals with fluorescent proteins: from projection to multimodality.

Fluorescent proteins (FPs) have been widely adopted in cell research for protein trafficking and reporter gene expression studies, as well as to study other biological processes. However, biological tissue has high light scattering and high absorption coefficients of visible light; hence, using FPs in small animal imaging remains a challenge, especially when the FPs are located deep in the tissue. In small animals, fluorescence molecular imaging could potentially address this difficulty. We constructed fluorescence molecular imaging systems that have two modes: a planner mode (projection imaging) and a multimodality mode (fluorescence molecular tomography and micro-CT). The planner mode can provide projection images of a fluorophore in the whole body of a small animal, whereas three-dimensional information can be offered by multimodality mode. The planner imaging system works in the reflection mode and is designed to provide fast imaging. The multimodality imaging system is designed to allow quantification and three-dimensional localization of fluorophores. A nude mouse with a tumour targeted with a far-red FP, which is appropriate for in vivo imaging, was adopted to validate the two systems. The results indicate that the planner imaging system is probably suitable for high throughput molecular imaging, whereas the multimodality imaging system is fit for quantitative research.

Differences between the Vastus Lateralis and Gastrocnemius Lateralis in the Assessment Ability of Breakpoints of Muscle Oxygenation for Aerobic Capacity Indices During an Incremental Cycling Exercise.

In recent years, breakpoints (Bp) of muscle oxygenation have been measured in local muscles using near infrared spectroscopy (NIRS) to assess (predict) systemic aerobic capacity indices [lactate threshold (LT), gas exchange threshold (GET) and maximal oxygen uptake (VO2peak)]. We investigated muscular differences in the assessment (predictive) ability of the Bp of muscle oxygenation for aerobic capacity indices during incremental cycling exercise on the aerobic capacity indices. Thirty-one active college students were recruited for an incremental cycling exercise test, during which NIRS muscle oxygenation in the vastus lateralis (VL) and gastrocnemius lateralis (GL), blood lactate concentration and cardiopulmonary variables were measured simultaneously in a multi-modality approach. A linear regression model was used to analyse the relationship between the Bp of the muscle oxygenation index (OI) and the systemic aerobic capacity indices. The Bp of the muscle OI in both the VL (BpVL) and GL (BpGL) were significantly correlated with the aerobic capacity indices. Additionally, the BpVL had a better goodness-of-fit [higher coefficient of determination (R(2), p < 0.001) and lower root mean squared error (RMSE, p < 0.03)] in the linear regressions and occurred earlier than the BpGL. In conclusion, both the BpVL and the BpGL could be measured by NIRS to assess the systemic aerobic capacity indices; however, there were muscular differences in the assessment ability of the Bp of muscle oxygenation.

Visualization of light propagation in visible Chinese human head for functional near-infrared spectroscopy.

Using the visible Chinese human data set, which faithfully represents human anatomy, we visualize the light propagation in the head in detail based on Monte Carlo simulation. The simulation is verified to agree with published experimental results in terms of a differential path-length factor. The spatial sensitivity profile turns out to seem like a fat tropical fish with strong distortion along the folding cerebral surface. The sensitive brain region covers the gray matter and extends to the superficial white matter, leading to a large penetration depth (>3 cm). Finally, the optimal source-detector separation is suggested to be narrowed down to 3-3.5 cm, while the sensitivity of the detected signal to brain activation reaches the peak of 8%. These results indicate that the cerebral cortex folding geometry actually has substantial effects on light propagation, which should be necessarily considered for applications of functional near-infrared spectroscopy.

Monte Carlo-based fluorescence molecular tomography reconstruction method accelerated by a cluster of graphic processing units.

High-speed fluorescence molecular tomography (FMT) reconstruction for 3-D heterogeneous media is still one of the most challenging problems in diffusive optical fluorescence imaging. In this paper, we propose a fast FMT reconstruction method that is based on Monte Carlo (MC) simulation and accelerated by a cluster of graphics processing units (GPUs). Based on the Message Passing Interface standard, we modified the MC code for fast FMT reconstruction, and different Green's functions representing the flux distribution in media are calculated simultaneously by different GPUs in the cluster. A load-balancing method was also developed to increase the computational efficiency. By applying the Fréchet derivative, a Jacobian matrix is formed to reconstruct the distribution of the fluorochromes using the calculated Green's functions. Phantom experiments have shown that only 10 min are required to get reconstruction results with a cluster of 6 GPUs, rather than 6 h with a cluster of multiple dual opteron CPU nodes. Because of the advantages of high accuracy and suitability for 3-D heterogeneity media with refractive-index-unmatched boundaries from the MC simulation, the GPU cluster-accelerated method provides a reliable approach to high-speed reconstruction for FMT imaging.

Effects of heart rate and anesthetic timing on high-resolution echocardiographic assessment under isoflurane anesthesia in mice.

OBJECTIVE: Anesthesia provides sedation and immobility, facilitating echocardiography in mice, but it influences cardiovascular function and therefore outcomes of measurement. This study aimed to determine the effect of the optimal heart rate (HR) and anesthetic timing on echocardiographic reproducibility under isoflurane anesthesia. METHODS: Male C57BL/6J mice underwent high-resolution echocardiography with relative fixed HRs and anesthetic timing. The same experiment was repeated once again after 1 week. RESULTS: Echocardiography was highly reproducible in repeated measurements under low-HR (350-400 beats per minute [bpm]) and high-HR (475-525 bpm) conditions except some M-mode parameters under low-HR conditions. With similar anesthetic timing, mice with a high HR had decreased preload indices and increased ejection phase and Doppler indices. Inversely, when the HR was similar, the echocardiographic results of mice under short anesthetic timing showed little difference from the ones under long anesthetic timing. CONCLUSIONS: This study shows that echocardiographic assessment is greatly reproducible under a high HR. The HR is more important than anesthetic timing for echocardiographic evaluation in mice.

Possible beneficial effect of olmesartan medoxomil on left atrial function in patients with hypertension : noninvasive assessment by acoustic quantification.

BACKGROUND AND OBJECTIVE: Hypertension alters the diastolic properties of the left ventricle and results in deterioration in the structure and function of the left atrium. We aimed to evaluate whether olmesartan medoxomil has an effect on left atrial function in hypertensive patients. METHODS: Fifty hypertensive patients and 20 controls were included in the study. Hypertensive patients were treated with olmesartan medoxomil for 8 weeks. Before and after treatment, study participants were examined by acoustic quantification and tissue Doppler imaging. Left atrial reservoir function was assessed by end-diastolic volume (EDV), end-systolic volume (ESV), reservoir volume (RV) and peak filling rate (PFR). Left atrial booster pump function was assessed by atrial emptying volume (AEV), atrial emptying fraction (AEF) and peak atrial emptying rate (PAER). Left atrial conduit function was assessed by rapid emptying volume (REV), rapid emptying fraction (REF), REV/AEV ratio, and the ratio of peak rapid emptying rate and PAER (PRER/PAER). RESULTS: Atrial RV and PFR were significantly increased in hypertensive subjects (48.30 +/- 19.28 mL vs 34.35 +/- 14.26 mL, p < 0.001; 267.26 +/- 126.52 mL/s vs 206.81 +/- 107.17 mL/s, p < 0.05) compared with controls, while the REV/AEV ratio was decreased in hypertensive patients compared with controls (2.86 +/- 0.85 vs 3.69 +/- 2.13, p < 0.001). After therapy with olmesartan medoxomil, atrial RV (48.30 +/- 19.28 mL vs 40.50 +/- 17.59 mL) and PFR decreased (267.26 +/- 126.52 mL/s vs 220.40 +/- 108.56 mL/s, p < 0.05) and the REV/AEV ratio increased (2.86 +/- 0.85 vs 3.14 +/- 0.43, p < 0.05) in hypertensive patients. CONCLUSION: Our novel findings indicate that left atrial function is impaired in hypertensive patients, and that olmesartan medoxomil can improve left atrial function in this context. Our study also showed that acoustic quantification is useful for non-invasive evaluation of the benefits of treatment on left atrial function.

Accurate multiplex gene synthesis from programmable DNA microchips.

Testing the many hypotheses from genomics and systems biology experiments demands accurate and cost-effective gene and genome synthesis. Here we describe a microchip-based technology for multiplex gene synthesis. Pools of thousands of 'construction' oligonucleotides and tagged complementary 'selection' oligonucleotides are synthesized on photo-programmable microfluidic chips, released, amplified and selected by hybridization to reduce synthesis errors ninefold. A one-step polymerase assembly multiplexing reaction assembles these into multiple genes. This technology enabled us to synthesize all 21 genes that encode the proteins of the Escherichia coli 30S ribosomal subunit, and to optimize their translation efficiency in vitro through alteration of codon bias. This is a significant step towards the synthesis of ribosomes in vitro and should have utility for synthetic biology in general.