Comparative prognosis and risk assessment in gallbladder neuroendocrine neoplasms versus adenocarcinomas.

Background: Gallbladder neuroendocrine neoplasms (GB-NENs) are a rare malignant disease, with most cases diagnosed at advanced stages, often resulting in poor prognosis. However, studies regarding the prognosis of this condition and its comparison with gallbladder adenocarcinomas (GB-ADCs) have yet to yield convincing conclusions. Methods: We extracted cases of GB-NENs and GB-ADCs from the Surveillance, Epidemiology, and End Results (SEER) database in the United States. Firstly, we corrected differences in clinical characteristics between the two groups using propensity score matching (PSM). Subsequently, we visualized and compared the survival outcomes of the two groups using the Kaplan-Meier method. Next, we employed the least absolute shrinkage and selection operator (LASSO) regression and Cox regression to identify prognostic factors for GB-NENs and constructed two nomograms for predicting prognosis. These nomograms were validated with an internal validation dataset from the SEER database and an external validation dataset from a hospital. Finally, we categorized patients into high-risk and low-risk groups based on their overall survival (OS) scores. Results: A total of 7,105 patients were enrolled in the study, comprising 287 GB-NENs patients and, 6,818 GB-ADCs patients. There were substantial differences in clinical characteristics between patients, and GB-NENs exhibited a significantly better prognosis. Even after balancing these differences using PSM, the superior prognosis of GB-NENs remained evident. Independent prognostic factors selected through LASSO and Cox regression were age, histology type, first primary malignancy, tumor size, and surgery. Two nomograms for prognosis were developed based on these factors, and their performance was verified from three perspectives: discrimination, calibration, and clinical applicability using training, internal validation, and external validation datasets, all of which exhibited excellent validation results. Using a cutoff value of 166.5 for the OS nomogram score, patient mortality risk can be identified effectively. Conclusion: Patients with GB-NENs have a better overall prognosis compared to those with GB-ADCs. Nomograms for GB-NENs prognosis have been effectively established and validated, making them a valuable tool for assessing the risk of mortality in clinical practice.

Projecting the response of ecological risk to land use/land cover change in ecologically fragile regions.

Anthropogenic activities have dramatically altered land use/land cover (LULC), leading to ecosystem service (ES) degradation and further ecological risks. Ecological risks are particularly serious in ecologically fragile regions because trade-offs between economic development and ecological protection are prominent. Thus, ways in which to assess the response of ecological risks to LULC change under each development scenario in ecologically fragile regions remain challenging. In this study, future LUCC and its impact on ESs under four development scenarios in 2040 in western Jilin Province were predicted using a patch-generating land use simulation model and the Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) model. Ecological risk was assessed based on future LUCC possibilities, and potential ES degradation and potential drivers of ecological risks were explored using a geographic detector. The results showed that the cropland development scenario (CDS) would experience large-scale urbanization and cropland expansion. Carbon storage (CS), habitat quality (HQ), and water purification (WP) degraded the most under the CDS, and grain yield (GY) and water yield (WY) degraded the most under the ecological protection scenario (EPS). The LUCC probability under the CDS (14.37 %) was the highest, while the LUCC probability under the comprehensive development scenario (CPDS) (8.68 %) was the lowest. The risk of WP degradation was greatest under the CDS, but the risk of soil retention (SR) degradation was greatest under the natural development scenario (NDS), EPS, and CPDS. Ecological risk coverage was the largest (98.04 %), and ecological risks were the highest (0.21) under the CDS, while those under the EPS were the opposite. Distance to roads and population density had a higher impact on ecological risks than other drivers. Further attention should be given to the ecological networks and pattern establishment in urbanized regions. This study will contribute to risk prevention and sustainable urban and agricultural development.

Adolescents' Online Connections with Friends during COVID-19: An Assessment of the Forms of Communication and Their Association with Emotional Adjustment.

The COVID-19 pandemic and subsequent stay-at-home orders limited adolescents' ability to connect with friends in person, leading adolescents to rely on digital forms of communication to interact with friends. The present study (N = 168 adolescents ages 11-20, 51.40% female) examined the types of digital communication adolescents used to connect with friends during the pandemic stay-at-home orders and how each form of digital communication related to adolescents' emotional adjustment. The results showed texting to be the most common way adolescents connected with friends. Boys were more likely than girls to talk with friends through social gaming. Synchronous forms of communication (i.e., texting, video calls, and social gaming) were associated with reduced loneliness and depressive symptoms and higher flourishing. Connecting with friends by posting or responding on social media was not associated with adolescent well-being. These results suggest that forms of digital communication that allowed adolescents to talk with friends in real time were particularly important for adolescents' emotional well-being during the COVID-19 pandemic.

Factorial structure and measurement invariance of the Chinese version of the Oral Health Impact Profile-14 among clinical populations and non-clinical populations: an evidence for public oral investigations.

OBJECTIVE: Oral health-related quality of life (OHRQoL) is a multidimensional concept that is commonly used to examine the impact of oral health status on quality of life. The purpose of this study was to examine the optimal factor model of the Chinese version of the Oral Health Impact Profile (OHIP-14) questionnaire in clinical populations, measurement invariance across clinical status and gender cohorts. This would ensure equal validity of the Chinese version of OHIP-14 in different populations and further support public oral investigations. METHODS: The Chinese version of OHIP-14 was used to investigate 490 dental patients and 919 college students. Confirmatory factor analysis (CFA), item analysis and reliability, measurement invariance, and the t-test were used for data analyses. RESULTS: We found that the 7-factor structure had the best-fit index in the sample (CFI = 0.970, TLI = 0.952; SRMR = 0.029, RMSEA = 0.052(0.040,0.063)). The reliability of the scales was satisfactory (Cronbach's α = 0.942). The error variance invariance fitted the data adequately in measurement invariance, indicating that measurement invariance is acceptable both across the clinical and non-clinical populations (∆CFI=-0.017, ∆RMSEA = 0.010) and across genders in the clinical population (∆CFI = 0.000, ∆RMSEA=-0.003). T-test for scores showed that the clinical populations scored significantly higher than the non-clinical populations, as did the overall score (t = 7.046, p < 0.001, d = 0.396), in terms of functional limitation (t = 2.178, p = 0.030, d = 0.125), physical pain (t = 7.880, p < 0.001,d = 0.436), psychological discomfort (t = 8.993, p < 0.001, d = 0.514), physical disability (t = 6.343, p < 0.001, d = 0.358), psychological disability (t = 5.592, p < 0.001, d = 0.315), social disability (t = 5.301, p < 0.001,d = 0.304), social handicap (t = 4.452, p < 0.001, d = 0.253), and that in the non-clinical populations, females scored significantly higher than males, as did in terms of physical pain (t = 3.055, p = 0.002, d = 0.280), psychological discomfort (t = 2.478, p = 0.014, d = 0.222), and psychological disability (t = 2.067, p = 0.039, d = 0.188). CONCLUSION: This study found that the Chinese version of OHIP-14 has measurement invariance between the clinical and non-clinical populations and across genders in the clinical populations, and can be widely used in OHRQoL assessment for public oral investigations.

Burden of cardiovascular disease attributable to long-term exposure to ambient PM2.5 concentration and the cost-benefit analysis for the optimal control level.

Environmental exposure to fine particulate matter PM2.5 is known to be associated with many hazardous health effects, including cardiovascular diseases (CVDs). To reduce the related health burden, it is crucial that policy-makers throughout the world set regulation levels according to their own evidence-based study outcomes. However, there appears to be a lack of decision-making methods for the control level of PM2.5 based on the burden of disease. In this study, 117,882 CVD-free participants (≥30-years-old) of the MJ Health Database were followed-up (for a median of 9 years) between 2007 and 2017. Each participant's residential address was matched to the 3× 3 km grid PM2.5 concentration estimates with a 5-year average for long-term exposure. We used a time-dependent nonlinear weight-transformation Cox regression model for the concentration-response function (CRF) between exposure to PM2.5 and CVD incidence. Town/district-specific PM2.5-attributable years of life in disability (YLDs) in CVD incidence were calculated by using the relative risk (RR) of the PM2.5 concentration level relative to the reference level. A cost-benefit analysis was proposed by assessing the trade-off between the gain in avoidable YLDs (given a reference level at u and considering mitigation cost) versus the loss in unavoidable YLDs by not setting at the lowest observed health effect level u0. The CRF varied across different areas with dissimilar PM2.5 exposure ranges. Areas with low PM2.5 concentrations and population sizes provided crucial information for the CVD health effect at the lower end. Additionally, women and older participants were more susceptible. The avoided town/district-specific YLDs in CVD incidence due to lower RRs ranged from 0 to 3000 person-years comparing the PM2.5 concentration levels in 2019 with the levels in 2011. Based on the cost-benefit analysis, an annual PM2.5 concentration of 13 µg/m3 would be optimal, which provides a guideline for the updated regulation level (currently at 15 µg/m3). The proposed cost-benefit analysis method may be applied to other countries/regions for regulation levels that are most suitable for their air pollution status and population health.

Pollution levels and health risk assessment of potentially toxic metals of size-segregated particulate matter in rural residential areas of high lung cancer incidence in Fuyuan, China.

The highest incidence and mortality rate of lung cancer in rural area of Fuyuan has been a research hotspot, and the pathogenesis is still unclear. Therefore, atmospheric particulate matters (APMs) samples were collected between 18 February and 01 March 2017, exploring water-soluble potentially toxic metals (WSPTMs) and water-soluble inorganic ionic species (WSIIs) levels, size distribution, sources, acidity and alkalinity, and potential carcinogenic and non-carcinogenic risks, hoping to provide scientific basic data to solve this problem. In our study, the average ratio of nitrate ion (NO3-)/sulfate ion (SO42-) within PM1.1, PM1.1-2.0, PM2.0-3.3, PM3.3-7.0, and PM>7.0 were 0.22, 0.18, 0.15, 0.34 and 0.36, respectively, that revealed that combustion sources contributed to PM were more significant. The anions in equilibrium (ANE) / cations in equilibrium (CAE) < 1 for all samples within PM1.1, PM2.0-3.3, PM3.3-7.0 indicate that the APMs were alkaline, but PM1.1-2.0 particulate matter shows weak acidity. SO42- prefers to combine with NH4+ to form (NH4)2SO4, which hinders the formation of NH4NO3, the remaining SO42- and NO3- to neutralize the K+, KNO3 was formed at all particulate, however, K2SO4 can only be formed in PM<3.3. Arsenic (As) and Selenium (Se) were identified as the most enriched WSPTMs in all PM sizes, predominantly from anthropogenic emissions, were suggested that coal combustion is a significant source of PM-bound WSPTMs. Total WSPTMs exhibited high total carcinogenic risks (TCR) values (9.98 × 10-6, 1.06 × 10-5, and 1.19 × 10-5 for girls, boys and adults, respectively) in the smaller particles (< 1.1 µm). Se was considered as the major contributor (63.60%) to carcinogenic risk (CR) in PM2.0 and had an inverse relationship with PM size that should be of prime concern.

Hospital Occupational Health Service Network and Reporting Systems in Taiwan From 2008 to 2021.

OBJECTIVE: To evaluate the provision of occupational health services at hospitals following the establishment of the Network of Occupational Disease and Injury Service in 2007. METHODS: A review of occupational health services during 2008 to 2021 was conducted. The medical practice-based reporting system was compared with the database of compensated occupational diseases (ODs) from Taiwan's Labor Insurance. RESULTS: First-time outpatient visits for occupational evaluation and total visits to Network of Occupational Disease and Injury Service health care institutions increased from 1777 and 9435 to 12,092 and 23,210, respectively. Reported ODs increased from 1626 to 2043 with a peak of 2791. Up to 1380 workers evaluated for work resumption in 2021. Similar to the increasing trend in reported ODs, the number of compensated ODs increased over years. CONCLUSION: The health service needs of Taiwanese workers from OD evaluation to vocational rehabilitation are increasing.

Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study.

BACKGROUND: Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting. METHODS: We collected daily ambient temperature and mortality data for 452 locations in 24 countries and used Enhanced Vegetation Index (EVI) as the greenspace measurement. We used distributed lag non-linear model to estimate the heat-mortality relationship in each city and the estimates were pooled adjusting for city-specific average temperature, city-specific temperature range, city-specific population density, and gross domestic product (GDP). The effect modification of greenspace was evaluated by comparing the heat-related mortality risk for different greenspace groups (low, medium, and high), which were divided into terciles among 452 locations. FINDINGS: Cities with high greenspace value had the lowest heat-mortality relative risk of 1·19 (95% CI: 1·13, 1·25), while the heat-related relative risk was 1·46 (95% CI: 1·31, 1·62) for cities with low greenspace when comparing the 99th temperature and the minimum mortality temperature. A 20% increase of greenspace is associated with a 9·02% (95% CI: 8·88, 9·16) decrease in the heat-related attributable fraction, and if this association is causal (which is not within the scope of this study to assess), such a reduction could save approximately 933 excess deaths per year in 24 countries. INTERPRETATION: Our findings can inform communities on the potential health benefits of greenspaces in the urban environment and mitigation measures regarding the impacts of climate change. FUNDING: This publication was developed under Assistance Agreement No. RD83587101 awarded by the U.S. Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Research reported in this publication was also supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD012769. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Also, this work has been supported by the National Research Foundation of Korea (2021R1A6A3A03038675), Medical Research Council-UK (MR/V034162/1 and MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/R009384/1), Academy of Finland (Grant ID: 310372), European Union's Horizon 2020 Project Exhaustion (Grant ID: 820655 and 874990), Czech Science Foundation (22-24920S), Emory University's NIEHS-funded HERCULES Center (Grant ID: P30ES019776), and Grant CEX2018-000794-S funded by MCIN/AEI/ 10.13039/501100011033 The funders had no role in the design, data collection, analysis, interpretation of results, manuscript writing, or decision to publication.

How do China's lockdown and post-COVID-19 stimuli impact carbon emissions and economic output? Retrospective estimates and prospective trajectories.

This paper develops a multi-sector and multi-factor structural gravity model that allows an analytical and quantitative decomposition of the emission and output changes into composition and technique effects. We find that the negative production shock of China's containment policy propagates globally via supply chains, with the carbon-intensive sectors experiencing the greatest carbon emission shocks. We further reveal that China's current stimulus package in 2021-2025 is consistent with China's emission intensity-reduction goals for 2025, but further efforts are required to meet China's carbon emissions-peaking target in 2030 and Cancun 2°C goal. Short-term changes in carbon emissions resulting from lockdowns and initial fiscal stimuli in "economic rescue" period have minor long-term effects, whereas the transitional direction of future fiscal stimulus exerts more predominant impact on long-term carbon emissions. The efficiency improvement effects are more important than the sectoral structure effects of the fiscal stimulus in achieving greener economic growth.

Potential evaluation of different intercropping remediation modes based on remediation efficiency and economic benefits - a case study of arsenic-contaminated soil.

Hyperaccumulator-cash crop intercropping remediation is a research hotspot for heavy metal contaminated farmland, but few studies evaluated its feasibility based on practice. Field experiments and survey statistics were conducted to obtain parameters of Pteris vittata-Citrus reticulata/Zea mays intercropping, and potential of intercropping remediation was evaluated based on remediation efficiency and economic benefits. The results showed that intercropping hyperaccumulator with cash crop (especially herbs) had a certain negative effect on remediation efficiency because of the influence on planting density and harvest times of hyperaccumulator; while trees could partly alleviate this effect. Until achieving the predetermined target, the net remediation cost of P. vittata-Z. mays was 18.2 $/g As, followed by P. vittata monoculture (13.3 $/g) and P. vittata-C. reticulata (8.6 $/g). Based on the proposed evaluation model, nealy half of the P. vittata intercropping modes had low economic benefits, insufficient to compensate the cost of sacrificing remediation efficiency. Based on the data from two soil remediation projects, when net income of cash crops intercropped with As-hyperaccumulators exceeded 5865/1607 $/hm2 (herbs/trees), the economic benefit of intercropping will be relatively obvious. Therefore, cash crops should be considered from three aspects: planting conditions, spatial allocation and economic benefits. Novelty statement: This work analyzed remediation efficiency and economic benefits of intercropping remediation. An economic benefit evaluation model was established to evaluate intercropping remediation modes. The selection principle and net income threshold of cash crops in intercropping was put forward for the first time.[Figure: see text]HighlightsThe selection principle of cash crops in intercropping remediation was put forward.An evaluation model of P. vittata intercropping remediation was established.The net cost of extracting 1.0 g of soil As in each remediation mode was proposed.Net income of herb/tree intercropped with P. vittata should exceed 5865/1607 $/hm2.

Health Benefits and Costs of Clean Heating Renovation: An Integrated Assessment in a Major Chinese City.

China has been promoting one of the world's largest campaigns for clean heating renovation since 2017. Here, we present an integrated cost-benefit analysis in a major prefecture-level city by combining a large-scale household energy survey and PM2.5 exposure measurement, high-resolution chemical transport simulation, and health impact assessment. We find that the completed renovation decreases the share of solid fuels in the heating energy mix from 96 to 6% and achieves a concomitant reduction of cooking solid-fuel use by 70%. The completed renovation decreases the ambient PM2.5 concentration in Linfen by 0.5-5 µg m-3 (2.4 µg m-3 on average) and decreases the integrated PM2.5 exposure by 4.2 (3.5-5.0) µg m-3. The renovation is estimated to avoid 162 (125-225) and 328 (254-457) premature deaths annually based on two health impact assessment methods. The ratios of monetized health benefits to cost are 1.51 (0.73-2.59) and 3.06 (1.49-5.23) based on the above two methods. The benefit-to-cost ratio is projected to remain high if the renovation is further expanded. More polluted and less wealthy households enjoy larger health benefits but also experience a higher expense increase, suggesting that a more carefully designed subsidy policy is needed to protect low-income households.

Impact of the VAT reduction policy on local fiscal pressure in China in light of the COVID-19 pandemic: A measurement based on a computable general equilibrium model.

Value added tax (VAT) reduction is an important tool for cultivating new driving forces for economic development, and it has had a notable impact on local fiscal pressure. Taking the 2018-2019 VAT rate reduction in China as an example, this paper uses a CGE model to estimate the impact of the VAT reduction policy on local fiscal pressure in China in light of the COVID-19 pandemic. The results show that local fiscal pressure increased from 0.342 to 0.435, an increase of 27.08%. The study provides policy implications on optimizing tax structure and alleviating local fiscal pressure.

Regional carbon imbalance within China: An application of the Kaya-Zenga index.

Considering the enlarging inter-provincial disparities in China as regards carbon emissions and carbon intensity (carbon emissions per unit gross domestic product), this paper is the first study to investigate the inter-provincial carbon imbalance by constructing and employing the Kaya-Zenga index. We use China's panel data of provincial-level carbon emissions over 1995-2016 to quantitatively measure the levels of inter-provincial imbalance and polarization in carbon emissions and carbon intensity. Further, we decompose the Kaya-Zenga index into different contributing factors both regionally and structurally and perform a scenario analysis to identify the corresponding regionally differentiated countermeasures regarding carbon emission reduction. The results show that the imbalance in carbon emissions is mainly caused by imbalances in population scale and income level, while the imbalance in carbon intensity predominantly results from imbalances in energy efficiency and energy mix. In addition, for heavy manufacturing provinces, the respective emission-reduction strategy should aim at lowering energy intensity through local technology improvement and inter-regional technology transfer. For light manufacturing and high technology provinces, carbon emission reduction is harder to be achieved; however, a mix of policies of improving energy efficiency, optimizing energy mix, and industrial upgrading should be implemented. The results of the scenario analysis indicate that reducing imbalance in carbon intensity under different scenarios can lead to a substantial reduction in carbon emissions (up to 10%).

Physicochemical properties and health risk assessment of polycyclic aromatic hydrocarbons of fragrant rapeseed oils in China.

BACKGROUND: Fragrant rapeseed oil is a type of hot-pressed oil in China. In this study, physicochemical properties, oxidative stability index (OSI), tocopherols, sterols, and polycyclic aromatic hydrocarbons (PAHs) in fragrant rapeseed oils were evaluated. Additionally, the cancer risk assessment pertaining to PAHs in fragrant rapeseed oil was investigated. RESULTS: Acid values (0.64-2.68 mg potassium hydroxide per gram), peroxide values (1.58-4.86 mmol kg-1 ), and color values (R = 2.6-5.8, Y = 35) of fragrant rapeseed oils were all within codex limits. Tocopherols and sterols ranged from 559.5 to 783.7 mg kg-1 and 4412.6 to 7859.8 mg kg-1 respectively. The OSI (110 °C) was between 4.8 and 15.9 h, with an average value of 10.8 h. Mean values of benzo[a]pyrene and PAH4 (chrysene, benz[a]anthracene, benzo[b]fluroranthene, and benzo[a]pyrene) were 2.32 µg kg-1 and 8.21 µg kg-1 respectively. The 95% dietary exposure of benzo[a]pyrene equivalent (BaPeq) contents from PAH4 were 0.3474 ng kg-1 day-1 , 0.3942 ng kg-1 day-1 , 1.8293 ng kg-1 day-1 , and 0.4294 ng kg-1 day-1 for male children, adolescents, adults, and seniors respectively. For females, these values were 0.3443 ng kg-1 day-1 , 0.3228 ng kg-1 day-1 , 1.8697 ng kg-1 day-1 , and 0.4084 ng kg-1 day-1 , respectively. Moreover, incremental lifetime cancer risk values at the cumulative probabilities of 91.3% and 91.6% for male adults and female adults respectively were higher than 1 × 10-5 . CONCLUSION: The results imply that the potential risk of cancer with PAHs in fragrant rapeseed oil should be a concern, especially for the health of adults. Fragrant rapeseed oil is still a product subject to contamination by PAHs. Limits for PAH4 of fragrant rapeseed oil should be included in Chinese regulations to improve safety. © 2020 Society of Chemical Industry.

Characterization of PM2.5-Bound Polycyclic Aromatic Hydrocarbons at Two Central China Cities: Seasonal Variation, Sources, and Health Risk Assessment.

In this study, ambient PM2.5 samples were collected from October 2014 to August 2015 in urban area of Luoyang (LY) and Pingdingshan (PDS), two medium-size industrial cities in central China. Sixteen priority polycyclic aromatic hydrocarbons (PAHs) were analyzed to investigate the seasonal variation, potential pollution sources, and health risk of PAHs bound to PM2.5 (PM2.5-bound PAHs). The diagnostic ratios analysis and positive matrix fraction (PMF) model were used to identify potential sources of PM2.5-bound PAHs. The annual average concentrations of PM2.5 and PM2.5-bound PAHs were 128 µg m-3 and 73 ng m-3 for LY, and 119 µg m-3 and 182 ng m-3 for PDS, respectively, both displaying seasonal trends with higher concentrations in winter and autumn than in spring and summer. BaP equivalent concentrations were 14.4 and 16.5 ng m-3 in LY and PDS, respectively. The predominant PAHs were 4-6 ring PAHs, with contribution of more than 80% at both sampling sites. PMF analysis revealed that coal combustion was the most important source of PM2.5-bound PAHs in LY and PDS, accounting for 37% and 39%, respectively, followed by traffic emissions (34% and 33% in LY and PDS, respectively). The average inhalation cancer risk (ICR) for a lifetime of 70 years were 12.5 × 10-4 and 14.3 × 10-4 in LY and PDS, respectively, which were much higher than US EPA guideline limit of 10-6. The traffic source and coal combustion source contributed the highest ICR values in LY and PDS, respectively.

The Observation of Ligand-Binding-Relevant Open States of Fatty Acid Binding Protein by Molecular Dynamics Simulations and a Markov State Model.

As a member of the fatty acids transporter family, the heart fatty acid binding proteins (HFABPs) are responsible for many important biological activities. The binding mechanism of fatty acid with FABP is critical to the understanding of FABP functions. The uncovering of binding-relevant intermediate states and interactions would greatly increase our knowledge of the binding process. In this work, all-atom molecular dynamics (MD) simulations were performed to characterize the structural properties of nativelike intermediate states. Based on multiple 6 µs MD simulations and Markov state model (MSM) analysis, several "open" intermediate states were observed. The transition rates between these states and the native closed state are in good agreement with the experimental measurements, which indicates that these intermediate states are binding relevant. As a common property in the open states, the partially unfolded α2 helix generates a larger portal and provides the driving force to facilitate ligand binding. On the other side, there are two kinds of open states for the ligand-binding HFABP: one has the partially unfolded α2 helix, and the other has the looser ß-barrel with disjointing ßD-ßE strands. Our results provide atomic-level descriptions of the binding-relevant intermediate states and could improve our understanding of the binding mechanism.

How urban characteristics affect vulnerability to heat and cold: a multi-country analysis.

BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators. METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities. RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat. CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.

Workplace justice and intention to leave the nursing profession.

BACKGROUND:: Poor psychosocial work environments are considered critical factors of nurses' intention to leave their profession. Workplace injustice has been proven to increase the incidence of psychiatric morbidity among workers. However, few studies have directly investigated the effect of workplace justice on nurses' intention to leave their profession and the population attributable risk among nurses. OBJECTIVE:: This study identified factors associated with workplace justice and nurses' intention to leave the profession. METHOD:: A cross-sectional survey was conducted using a self-administered structured questionnaire. Approximately 10% of all secondary referral centers in Taiwan were stratified and randomly sampled. Multiple logistic regression and population attributable risks were preformed to assess the effect of workplace justice on nurses' intention to leave the nursing profession. ETHICAL CONSIDERATIONS:: This study was approved by the Research and Ethical Committee of National Taiwan University Hospital. Only nurses who consented to the study participated in the survey. RESULT:: A total of 2268 nurses were recruited, of whom 1417 (62.5%) satisfactorily completed the questionnaire. The participants were classified and 342 (24.1%) of them were placed into the low workplace justice group. Nurses with low workplace justice had a higher intention of leaving the profession (adjusted odds ratio = 1.34, 95% confidence interval = 1.02-1.77). "Employees' opinions are influential in hospital's decision making" and "employees' performance is evaluated fairly" were the most influential factors of the participants' intention to quit. The adjusted population attributable risk was 3.7% for low workplace justice. CONCLUSION:: This study has identified that workplace justice is a protective factor of nurses' leaving their current profession. A fair performance appraisal system and increased autonomy at work are warranted to dissuade nurses from leaving the nursing profession.

Assessment of superficial retinal microvascular density in healthy myopia.

PURPOSE: To evaluate retinal microvasculature in healthy myopia and investigate the correlation between microvascular density and ocular factors. METHODS: A total of 174 eyes from 174 healthy Korean subjects were included. The eyes were divided into four groups according to refraction: emmetropia [21 eyes, - 1.00 D ≤ mean spherical equivalent (MSE) < + 0.75 D], mild myopia (32 eyes, - 3.00 D ≤ MSE < - 1.00 D), moderate myopia (76 eyes, - 6.00 D ≤ MSE < - 3.00 D), and high myopia (45 eyes, MSE < - 6.00 D). Images of retinal vasculature in parapapillary and parafoveal area were obtained using optical coherence tomography angiography. Superficial retinal microvascular density was measured for correlation analysis with ocular parameters. RESULTS: High myopia was found to have a lower superficial parapapillary microvascular density compared with the other groups in total parapapillary area, and in sectors of nasal and inferonasal (all p ≤ 0.001). The superficial parapapillary microvascular density showed a negative correlation with axial length (AL) and intraocular pressure (IOP) (ß = - 0.479, p = 0.008 and ß = - 0.160, p = 0.048, respectively), and a positive correlation with parapapillary retinal nerve fiber layer (RNFL) thickness (ß = 0.140, p < 0.001). However, there was no significant difference in superficial parafoveal microvascular density among all groups (p > 0.05). CONCLUSIONS: This study reveals that superficial parapapillary microvascular density is lower in high myopia and has correlation with AL, IOP, and parapapillary RNFL thickness. It also indicates that superficial parafoveal microvascular density tends to be unaffected by healthy myopia. These retinal microvascular alterations may facilitate understanding the pathogenesis of glaucomatous optic nerve damage in high myopia.

Suicide and Ambient Temperature in East Asian Countries: A Time-Stratified Case-Crossover Analysis.

BACKGROUND: A limited number of studies suggest that ambient temperature contributes to suicide; these studies typically focus on a single nation and use temporally and spatially aggregated data. OBJECTIVE: We evaluated the association between ambient temperature and suicide in multiple cities in three East Asian countries. METHODS: A time-stratified case-crossover method was used to explore the relationship between temperature and suicide, adjusting for potential time-varying confounders and time-invariant individual characteristics. Sex- and age-specific associations of temperature with suicide were estimated, as were interactions between temperature and these variables. A random-effects meta-analysis was used to estimate country-specific pooled associations of temperature with suicide. RESULTS: An increase in temperature corresponding to half of the city-specific standard deviation was positively associated with suicide in most cities, although average suicide rates varied substantially. Pooled country-level effect estimates were 7.8% (95% CI: 5.0, 10.8%) for a 2.3°C increase in ambient temperature in Taiwan, 6.8% (95% CI: 5.4, 8.2%) for a 4.7°C increase in Korea, and 4.5% (95% CI: 3.3, 5.7%) for a 4.2°C increase in Japan. The association between temperature and suicide was significant even after adjusting for sunshine duration; the association between sunshine and suicide was not significant. The associations were greater among men than women in 12 of the 15 cities although not significantly so. There was little evidence of a consistent pattern of associations with age. In general, associations were strongest with temperature on the same day or the previous day, with little evidence of associations with temperature over longer lags (up to 5 days). CONCLUSIONS: We estimated consistent positive associations between suicide and elevated ambient temperature in three East Asian countries, regardless of country, sex, and age. CITATION: Kim Y, Kim H, Honda Y, Guo YL, Chen BY, Woo JM, Ebi KL. 2016. Suicide and ambient temperature in East Asian countries: a time-stratified case-crossover analysis. Environ Health Perspect 124:75-80; http://dx.doi.org/10.1289/ehp.1409392.