Geodetector analysis of individual and joint impacts of natural and human factors on maternal and child health at the provincial scale.

This ecological study examined the individual and joint impacts of natural-human factors on the spatial patterns of maternal and child health status in China at the provincial scale in 2020. We considered natural factors (forest coverage, average temperature, and total sulfur dioxide and particulate matter emissions) and human factors (economic development, urbanization, healthcare access, and education level). We combined maternal, infant, and under-five mortality rates into a composite maternal and child health index using the entropy method. The spatial autocorrelation analysis of this index highlighted distinct health patterns across provinces, whereas the geodetector method assessed the effects of natural-human factors on the patterns. A notable east-central-west stepwise decline in health status was observed. Global Moran's I showed positive spatial clustering, with high-high clustering areas in the Yangtze River Delta and low-low clustering areas in western regions. Factor detection identified eight significant natural-human factors impacting maternal and child health, with total sulfur dioxide emission density having the greatest impact. The interaction between average schooling years and total sulfur dioxide emission notably affected maternal and child health patterns. The study concludes that natural-human factors critically affect the spatial distribution of maternal and child health.

Predicting Survival of Patients with Nonmetastatic Breast Cancer Based on Fibrinogen-to-Albumin Ratio and Lymphocyte-to-Monocyte Ratio: A Nomogram-Based Assessment.

Background: Parameters of systemic inflammation have received attention as prognostic surrogates in various malignant tumors. Fibrinogen-to-albumin ratio (FAR) and lymphocyte-to-monocyte ratio (LMR) correlate with tumor growth and dissemination. We aimed to bring the combination of FAR and LMR (FAR-LMR) together to establish novel nomograms for survival and recurrence in nonmetastatic breast cancer patients. Methods: We retrospectively recruited 461 female patients with nonmetastatic breast cancer from January 2011 to December 2013 in our hospital and randomly assigned them into the training cohort (N = 318) and the validation cohort (N = 143). The potential predictive factors for overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were assessed by Cox proportional hazards models and log-rank test. Results: Elevated FAR was associated with poor OS (p < 0.001) and DMFS (p = 0.02), whereas increased LMR was associated with satisfactory OS (p = 0.01) and LRFS (p = 0.01). High FAR combined with low LMR was associated with less favorable OS (p = 0.001), LRFS (p = 0.005), and DMFS (p = 0.003) Based on multivariate analysis, FAR-LMR, tumor size, lymph node metastasis, age, and pathologic status contributed to prognostic nomograms of OS, DMFS, and LRFS. Nomograms presented exceptional performance for 3-, 5-, and 8-year OS, DMFS, and LRFS prediction compared with clinical TNM stage. The C-index was significantly higher than that of TNM stage, either of FAR or LMR (3-year: 0.709 vs. 0.621 vs. 0.544 vs. 0.641, 5-year: 0.761 vs. 0.597 vs. 0.605 vs. 0.677, 8-year: 0.84 vs. 0.62 vs. 0.539 vs. 0.623). Conclusions: We developed and validated a convenient predictive model for the survival outcomes of patients with nonmetastatic breast cancer. The nomograms can be utilized as auxiliary tools to provide prognostic information.

Expenditure projections for community home-based care services for older adults with functional decline in China.

INTRODUCTION: Difficulty in identifying the functional status of older adults creates an imbalance between the supply and demand for community home-based care. Using a multi-level functional classification system to guide care cost measurement may optimize care resources and meet diverse eldercare demands. METHODS: The Markov model was used to project the older population size in different functional decline (FD) statuses. The project cost and the man-hour costing method were combined to forecast the cost of community home-based care for older adults with FD. RESULTS: The projected cost of eldercare increased from 1668.623 billion yuan in 2020 to 2836.754 billion yuan in 2035. By 2035, the total cost for community-based home care for those in pathological development of FD statuses such as "viability disorder," "acute disease," "somatic functional disorder," and "sub-disorder" was projected to be 1094.591 billion, 433.855 billion, 1256.236 billion, and 52.072 billion yuan, respectively, which is 1.24, 1.58, 1.78, and 0.49 times higher than the results by the man-hour costing method. Family caregiving costs are about three times those of professional caregivers. CONCLUSION: The escalating cost of providing graded care for older adults, particularly by family caregivers, presenting a significant evidence for the need to optimize resource allocation and develop a robust human resources plan for community home-based care.

Non-human and human service efficiency of long-term care facilities in China.

Introduction: Care services provided by long-term care facilities (LTCFs) are currently plagued by care resource shortages and insufficient utilization. The analysis on the temporal and spatial distribution of human resources and non-human resources in LTCFs, could provide a basis to optimize resource allocation and efficient use of limited resources. Methods: This study used data envelopment analysis to comprehensively evaluate the efficiency of human and non-human resources in different time spans and regions. The spatial Markov chain and spatial correlation were also applied to explore the heterogeneity of and correlation between the service efficiency of LTCFs in different regions and then analyzes the influencing factors of efficiency using Tobit regression model. Results: The quantitative changes in the service efficiency of LTCFs in various provinces showed a "W" shape in two periods, ranging from 0.8 to 1.6. The overall efficiency of LTCFs in different regions had a lower probability to achieve short-term cross-stage development. Non-human resource efficiency presented a "cluster" distribution mode, demonstrating a great probability to achieve cross-stage development, which might be due to the regional disparities of economic development and land resource. Tobit regression analysis results also showed that the comprehensive efficiency of LTCFs decreases by 0.210 for every square increase in construction space variation. However, human resource efficiency had a significant spatial polarization, making it difficult to develop area linkages. The reason for this might be the nursing staff have relatively stable regional characteristics, weakening the inter-provincial spatial connection. We also found that female workers, aged between 35 and 45 can positively affect the efficiency of LTCFs. Those staff stay focused and improve their skills, which might improve the efficiency of LTCFs. So improving technology and service quality changes by increasing female workers, aged between 35 and 45, and avoiding excessive construction space changes can enhance the growth of service quality and personnel stability of LTCFs. Conclusion: There is an urgent trade-off among staff quality improvement, resource reduction, construction excessive and substantial regional variation in efficiency. Therefore, strengthening policy support to encourage inter-regional initiatives, particularly highlighting the development of human resources interaction and common development is urgent.

Assessment of genetic variants in D2 dopamine receptor (DRD2) gene as risk factors for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD): A systematic review and meta-analysis.

BACKGROUND: Many studies have performed assessments of genetic variants in the D2 dopamine receptor (DRD2) gene as risk factors for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). However, the results are inconsistent. This meta-analysis aimed to systematically summarize published data to evaluate the reliable association between the DRD2 genetic variants and the risk of PTSD and MDD. METHODS: A systematic literature search was conducted using the Web of Science, PubMed, Google Scholar, Excerpta Medica Database (EMBASE), Springer, ScienceDirect, Wiley Online Library, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database (CBM), WANFANG Data, CQVIP, and Chinese National Knowledge Infrastructure (CNKI) databases before January 1st, 2022. RESULTS: A total of 27 genetic variants in the DRD2 gene were retrieved, and 7 of them met the inclusion criteria for meta-analysis. Our meta-analysis results indicated that the rs1800497 (TaqIA) polymorphism was significantly associated with the increased risk of PTSD (Dominant model (A1A1 + A1A2 vs. A2A2): OR = 1.49, 95 % CI, 1.08-2.04 Z = 2.46, P = 0.014). Subgroup analysis for ethnicity suggested that a significantly increased risk of PTSD was observed in Asians (Dominant model (A1A1 + A1A2 vs. A2A2): OR = 1.39, 95 % CI, 1.08-1.79, Z = 2.60, P = 0.009) and Caucasians (Dominant model (A1A1 + A1A2 vs. A2A2): OR = 1.87, 95 % CI 1.02-3.41, Z = 2.04, P = 0.042). Meanwhile, we detected significant association strengths between the rs1799978 and rs2075652 polymorphisms in the DRD2 gene and MDD (for rs1799978, Homozygote comparison (GG vs. AA): OR = 0.60, 95 % CI = 0.37-0.97, Z = 2.08, P = 0.038; for rs2075652, Homozygote comparison (AA vs. GG): OR = 1.82, 95 % CI = 1.32-2.50, Z = 3.67, P < 0.001). Our cumulative meta-analyses indicated a continuous trend toward association strength with PTSD and MDD. CONCLUSIONS: This meta-analysis indicated that genetic variants in the DRD2 gene might potentially contribute to genetic susceptibility for PTSD and MDD. The utilization of DRD2 genetic variants as risk factors for PTSD and MDD requires further validation by large well-designed case-control studies.

Quantitative multicomponent analysis of a single marker-based simultaneous determination and quality assessment of nucleoside analogs from Qi Zhi capsules.

Qi Zhi capsule (QZC) is approved by the State Drug Administration of China. The QZC consists of nine crude drugs, including astragalus, leeches, ground beetles, curcuma zedoary, hawthorn, semen cassiae, rhizoma sparganii, polygonum multiflorum, and peach kernel, of which leeches and ground beetles are Traditional Chinese Medicine of animal origin. Nucleosides are animal substances with pharmacological effects that are easy to extract and quantify. Different nucleoside analogs in distinct animal-based formulations can be used to characterize animal-based medicines. However, the quality control of a single indicator does not reflect the overall quality of Chinese medicine. Here, we developed a method to simultaneously determine the nucleoside analogs uracil, xanthine, hypoxanthine, uridine, guanine, and uric acid in QZCs using high-performance liquid chromatography. Hypoxanthine was used as an internal reference to determine relative correction factors for the other five components. The six components were determined in ten different batches of QZCs. There was no significant difference between the quantitative multicomponent analysis of a single marker and the external standard method. The relative standard deviation of total nucleosides analogs of 10 batches of samples was 7%. This method can be applied to simultaneously determine multiple active components in QZCs and other nucleoside analog drugs, enabling multi-indicator quality control.

Bibliometric assessment of world scholars' international publications related to conceptual metaphor.

Research on metaphor has gained increasing attention of world's scholars since the publication of Lakoff and Johnson's collaborated book Metaphors We Live By in 1980. The present study comprises a pioneering review of publications on Conceptual Metaphor Theory (CMT). It aimed to use the CiteSpace software to provide a clear overview of international research in relation to CMT. In total, 4,458 bibliometric recordings ranging from 1980 to 2022 were collected from the Web of Science (WOS) Core Collection. The descriptive analysis presents the trend of annual publications, the top 10 most prolific journals and the top 10 most productive authors. A document co-citation analysis was conducted via CiteSpace to navigate the key documents in this field. A visualization of keywords and its cluster analysis were conducted to show the research fields and dominant topics. The top 5 keywords with high frequency were language, comprehension, conceptual metaphor, discourse, and figurative language. The most prominent 5 clusters are labeled as right hemisphere, self, time, teacher education, and corpus linguistics. The present review through CiteSpace flags the need for more investigations of CMT from more aspects or interdisciplinary studies, such as metaphor translation, metaphor in literature, metaphor and corpus linguistics, etc.

Systems assessment of statins hazard: Integrating in silico prediction, developmental toxicity profile and transcriptomics in zebrafish.

Statins are prescribed widely as lipid-lowering agents. However, statins are associated with an increased harmful risk on public health and the ecosystem. Little is known about statins' toxicity on biological development and the underlying molecular mechanisms. We exposed zebrafish embryos to a series of statins to evaluate their development toxicity. Statins-induced embryonic developmental defects in a concentration-dependent manner. 72 h LC50 values for lovastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin, and pravastatin were 0.01 µM, 0.04 µM, 1.93 µM, 37.28 µM, 79.29 µM, and 2170 µM, respectively. Moreover, the expression of genes involved in heart contraction, calcium ion binding, transcription factors, nucleus, and G protein-coupled receptor signaling pathway was altered by statins. The early growth response gene (egr4) and transcription factor genes (fosab and fosb) were screened as potential toxicity targets due to their significant upregulation based on protein-protein interaction (PPI) and drug-gene interaction network analysis. Finally, the ecotoxicity profile of statins was predicted by in silico method, and statins were high or moderate risk to aquatic organisms. We provide a systems toxicology strategy to explore the toxicity of statins and illustrate the potential mechanisms of action.

The Coordinated Development and Regulation Research on Public Health, Ecological Environment and Economic Development: Evidence from the Yellow River Basin of China.

The dual problems of the public crisis from the global epidemic and the deterioration of the ecological environment constrain the economic development in the Yellow River Basin. To promote the sustainable and balanced development in the Yellow River Basin, this paper takes public health, ecological environment, and economic development, as a whole, to study the coordinated development of the Yellow River Basin. Based on coupling coordinated theory, we use the SMI-P method to evaluate the coordinated development index of public health, the ecological environment, and economic development in the Yellow River Basin. Moreover, we use the coordinated regulation and obstacle factor diagnosis to identify the main influencing factors and design regulation methods to optimize the coordinated development index. The results found that (1), during the research period, there is spatiotemporal heterogeneity in the coordinated development level in the Yellow River Basin. From 2009 to 2019, the overall development index increased steadily, while the regional disparity in the coordinated development level was obvious. (2) The ecological environment indicators contribute more to the relevance and obstacle factors, such as the average concentration of fine particulate matter, per capita arable land area, afforestation area, etc. (3) After regulating the overall development level of the Yellow River Basin, we prove that Path 4, which comprehensively considers the relevance and obstacle factors, performs better.

Disease burden in patients with severe hand, foot, and mouth disease in Jiangsu Province: a cross-sectional study.

This study aimed to estimate the disease burden and health-related quality of life (HRQOL) among patients with severe hand, foot, and mouth disease (HFMD) in Jiangsu Province, China. We analyzed the surveillance data of HFMD cases in Jiangsu Province from 2009 to 2020. Moreover, a cross-sectional study was conducted in Nanjing and Suzhou, China, between January 2017 and May 2018. Patients with severe HFMD and their parents were recruited from selected hospitals. Questionnaires and hospital management systems were used to collect data on direct economic burden. The HRQOL of children was assessed using the TNO-AZL Preschool Quality of Life (TAPQOL) scale. A total of 1,348,737 confirmed cases of HFMD were reported to the NNDRS in Jiangsu province during 2009-2020. Of these, 9,622 were severe cases, with 62 (.64%) of these being fatal. From January 2017 to May 2018, data was collected from 362 severe HFMD cases using a structured questionnaire. The median per capita direct economic burden was RMB 16142.88, and was associated with the region and length of hospital stay (P < .05). The direct economic burden for all cases of severe HFMD in Jiangsu province between 2017 and 2018 was approximately RMB 16.64 million. Finally, the median (IQR) of the TAPQOL scale for children with severe HFMD was 69.23 (56.20, 82.27). Severe HFMD infection is a relatively large burden for individuals, and the burden of EV-A71 infection was seen to be even greater for the population. Prevention of severe HFMD should strengthen hygiene habits and targeted measures for EV-A71 vaccination.

Magnetically Controlled Capsule Endoscopy for Assessment of Antiplatelet Therapy-Induced Gastrointestinal Injury.

BACKGROUND: Gastrointestinal bleeding is the most frequent major complication of antiplatelet therapy. In patients at low bleeding risk, however, clinically overt gastrointestinal bleeding is relatively uncommon. OBJECTIVES: The authors sought to assess the effects of different antiplatelet regimens on gastrointestinal mucosal injury by means of a novel magnetically controlled capsule endoscopy system in patients at low bleeding risk. METHODS: Patients (n = 505) undergoing percutaneous coronary intervention in whom capsule endoscopy demonstrated no ulcerations or bleeding (although erosions were permitted) after 6 months of dual antiplatelet therapy (DAPT) were randomly assigned to aspirin plus placebo (n = 168), clopidogrel plus placebo (n = 169), or aspirin plus clopidogrel (n = 168) for an additional 6 months. The primary endpoint was the incidence of gastrointestinal mucosal injury (erosions, ulceration, or bleeding) at 6-month or 12-month capsule endoscopy. RESULTS: Gastrointestinal mucosal injury through 12 months was less with single antiplatelet therapy (SAPT) than with DAPT (94.3% vs 99.2%; P = 0.02). Aspirin and clopidogrel monotherapy had similar effects. Among 68 patients without any gastrointestinal injury at randomization (including no erosions), SAPT compared with DAPT caused less gastrointestinal injury (68.1% vs 95.2%; P = 0.006), including fewer new ulcers (8.5% vs 38.1%; P = 0.009). Clinical gastrointestinal bleeding from 6 to 12 months was less with SAPT than with DAPT (0.6% vs 5.4%; P = 0.001). CONCLUSIONS: Despite being at low risk of bleeding, nearly all patients receiving antiplatelet therapy developed gastrointestinal injury, although overt bleeding was infrequent. DAPT for 6 months followed by SAPT with aspirin or clopidogrel from 6 to 12 months resulted in less gastrointestinal mucosal injury and clinical bleeding compared with DAPT through 12 months. (OPT-PEACE [Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by Ankon Magnetically Controlled Capsule Endoscopy]; NCT03198741).

Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management (2021 Edition).

OBJECTIVE: Helicobacter pylori infection is mostly a family-based infectious disease. To facilitate its prevention and management, a national consensus meeting was held to review current evidence and propose strategies for population-wide and family-based H. pylori infection control and management to reduce the related disease burden. METHODS: Fifty-seven experts from 41 major universities and institutions in 20 provinces/regions of mainland China were invited to review evidence and modify statements using Delphi process and grading of recommendations assessment, development and evaluation system. The consensus level was defined as ≥80% for agreement on the proposed statements. RESULTS: Experts discussed and modified the original 23 statements on family-based H. pylori infection transmission, control and management, and reached consensus on 16 statements. The final report consists of three parts: (1) H. pylori infection and transmission among family members, (2) prevention and management of H. pylori infection in children and elderly people within households, and (3) strategies for prevention and management of H. pylori infection for family members. In addition to the 'test-and-treat' and 'screen-and-treat' strategies, this consensus also introduced a novel third 'family-based H. pylori infection control and management' strategy to prevent its intrafamilial transmission and development of related diseases. CONCLUSION: H. pylori is transmissible from person to person, and among family members. A family-based H. pylori prevention and eradication strategy would be a suitable approach to prevent its intra-familial transmission and related diseases. The notion and practice would be beneficial not only for Chinese residents but also valuable as a reference for other highly infected areas.

Hazard assessment of beta-lactams: Integrating in silico and QSTR approaches with in vivo zebrafish embryo toxicity testing.

Antibiotics have emerged as a well-known representative of pharmaceuticals and personal care products (PPCPs) by causing public health and environmental problems due to their potential toxicity. ß-lactams are the most commonly used antibiotics in the world. This study used zebrafish embryos to evaluate the toxicity of ß-lactams. The results showed that 23 ß-lactam compounds induced malformation and death in a concentration-response manner. Moreover, this study established and validated quantitative structure-toxicity relationship (QSTR) models for the toxicity of ß-lactams in zebrafish. These models performed well and fast in the prediction of the acute toxicity of ß-lactams. Structural interpretation indicated that the ß-lactam ring, the thiazolidine/dihydrothiazine rings, the side chains, and spatial configuration are the main factors responsible for the toxicity of ß-lactams. The results from our previous studies and this study also revealed that the potential biological risks caused by ß-lactams and their degradation products could not be ignored. This study provided important data for further environmental risk assessment of ß-lactams and regulatory purposes.

Influencing factors and decoupling analysis of carbon emissions in China's manufacturing industry.

The manufacturing industry directly reflects national productivity, and it is also an industry with high energy consumption and severe carbon emissions. This study decomposes the influential factors on carbon emissions in China's manufacturing industry from 1995 to 2018 into industry value added, energy consumption, fixed asset investment, carbon productivity, energy structure, energy intensity, investment carbon intensity, and investment efficiency by Generalized Divisia Index Model. The decoupling analysis of carbon emissions and industry value added is carried out to investigate the states of the manufacturing industry under the pressure of "low carbon" and "economy." Results show that first, fixed asset investment is the driving force of carbon emissions, followed by industry value added; investment carbon intensity, carbon productivity, investment efficiency, and energy intensity are the mitigating factors; simultaneously, the impacts of energy consumption and energy structure are fluctuating. Second, the decoupling of manufacturing has improved, especially in the light industry. Third, the decoupling of carbon emissions and economic development is mainly dominated by the decoupling of energy consumption and industry added value. Therefore, reducing the proportion of coal consumption and optimizing the energy structure are significant ways to promote the low-carbon development of the manufacturing industry.

An evolutionary analysis of corruption in the process of collecting environmental tax in China.

Considering the bargaining power of enterprises, this paper distinguishes between "Offering Bribes Voluntarily" (OBV) and "Offering Bribes under Pressure from Environmental Inspectors" (NOBV). An evolutionary game model between environmental inspectors and enterprises is constructed to study the corruption of environmental inspectors in the process of environmental tax collection under the system of upward accountability. At the same time, numerical simulations are carried out using China's pollution discharge data and pollution discharge fee collection standards in 2017. The results show that when enterprises have different bargaining powers, there are differences in the evolutionary stable strategy (ESS) in the process of environmental tax collection. Enterprises with weak bargaining power may adopt "OBV" strategy. Under the system of upward accountability, it is difficult for the public to form adequate supervision over polluting enterprises and environmental inspectors. Only with the power of the upper-level government can the public's supervisory role be brought into play. High audit costs and environmental tax rates may be objective incentives for environmental inspectors' corruption and enterprises' bribery.

Influential Factors and Spatiotemporal Characteristics of Carbon Intensity on Industrial Sectors in China.

Based on the extended STIRPAT model and panel data from 2005 to 2015 in 20 industrial sectors, this study investigates the influential factors of carbon intensity, including employee, industry added value, fixed-assets investment, coal consumption, and resource tax. Meanwhile, by expanding the spatial weight matrix and using the Spatial Durbin Model, we reveal the spatiotemporal characteristics of carbon intensity. The results indicate that Manufacturing of Oil Processing and Coking Processing (S7), Manufacturing of Non-metal Products (S10), Smelting and Rolling Process of Metal (S11), and Electricity, Gas, Water, Sewage Treatment, Waste and Remediation (S17) contribute most to carbon intensity in China. The carbon intensity of 20 industrial sectors presents a spatial agglomeration characteristic. Meanwhile, industry added value inhibits the carbon intensity; however, employee, coal consumption, and resource tax promote carbon intensity. Finally, coal consumption appears to have spillover effects, and the employee has an insignificant impact on the carbon intensity of industrial sectors.

OCT Angiography for the Diagnosis of Glaucoma: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the current published literature on the use of OCT angiography (OCTA) to help detect changes associated with the diagnosis of primary open-angle glaucoma. METHODS: Searches of the peer-reviewed literature were conducted in March 2018, June 2018, April 2019, December 2019, and June 2020 in the PubMed and Cochrane Library databases. Abstracts of 459 articles were examined to exclude reviews and non-English articles. After inclusion and exclusion criteria were applied, 75 articles were selected and the panel methodologist rated them for strength of evidence. Three articles were rated level I and 57 articles were rated level II. The 15 level III articles were excluded. RESULTS: OCT angiography can detect decreased capillary vessel density within the peripapillary nerve fiber layer (level II) and macula (level I and II) in patients with suspected glaucoma, preperimetric glaucoma, and perimetric glaucoma. The degree of vessel density loss correlates significantly with glaucoma severity both overall and topographically (level II) as well as longitudinally (level I). For differentiating glaucomatous from healthy eyes, some studies found that peripapillary and macular vessel density measurements by OCTA show a diagnostic ability (area under the receiver operating characteristic curve) that is comparable with structural OCT retinal nerve fiber and ganglion cell thickness measurements, whereas other studies found that structural OCT measurements perform better. Choroidal or deep-layer microvasculature dropout as measured by OCTA is also associated with glaucoma damage (level I and II). Lower peripapillary and macular vessel density and choroidal microvasculature dropout are associated with faster rates of disease progression (level I and II). CONCLUSIONS: Vessel density loss associated with glaucoma can be detected by OCTA. Peripapillary, macular, and choroidal vessel density parameters may complement visual field and structural OCT measurements in the diagnosis of glaucoma.

Preoperative Medical Testing and Falls in Medicare Beneficiaries Awaiting Cataract Surgery.

PURPOSE: Delaying cataract surgery is associated with an increased risk of falls, but whether routine preoperative testing delays cataract surgery long enough to cause clinical harm is unknown. We sought to determine whether the use of routine preoperative testing leads to harm in the form of delayed surgery and falls in Medicare beneficiaries awaiting cataract surgery. DESIGN: Retrospective, observational cohort study using 2006-2014 Medicare claims. PARTICIPANTS: Medicare beneficiaries 66+ years of age with a Current Procedural Terminology claim for ocular biometry. METHODS: We measured the mean and median number of days between biometry and cataract surgery, calculated the proportion of patients waiting ≥ 30 days or ≥ 90 days for surgery, and determined the odds of sustaining a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥ 75% of their patients) compared with patients of low-testing physicians. We also estimated the number of days of delay attributable to high-testing physicians. MAIN OUTCOME MEASURES: Incidence of falls occurring between biometry and surgery, odds of falling within 90 days of biometry, and estimated delay associated with physician testing behavior. RESULTS: Of 248 345 beneficiaries, 16.4% were patients of high-testing physicians. More patients of high-testing physicians waited ≥ 30 days and ≥ 90 days to undergo surgery (31.4% and 8.2% vs. 25.0% and 5.5%, respectively; P < 0.0001 for both). Falls before surgery in patients of high-testing physicians increased by 43% within the 90 days after ocular biometry (1.0% vs. 0.7%; P < 0.0001). The adjusted odds ratio of falling within 90 days of biometry in patients of high-testing physicians versus low-testing physicians was 1.10 (95% confidence interval [CI], 1.03-1.19; P = 0.008). After adjusting for surgical wait time, the odds ratio decreased to 1.07 (95% CI, 1.00-1.15; P = 0.06). The delay associated with having a high-testing physician was approximately 8 days (estimate, 7.97 days; 95% CI, 6.40-9.55 days; P < 0.0001). Other factors associated with delayed surgery included patient race (non-White), Northeast region, ophthalmologist ≤ 40 years of age, and low surgical volume. CONCLUSIONS: Overuse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.

Rapid iodine capture from radioactive wastewater by green and low-cost biomass waste derived porous silicon-carbon composite.

The effective and safe capture and storage of radioactive iodine (129I or 131I) are of significant importance during nuclear waste storage and nuclear energy generation. Herein, a porous silicon-carbon (pSi-C) composite derived from paper mill sludge (PMS) is synthesized and used for rapid iodine capture. The influences of the activator type, the impregnation ratio of the paper mill sludge to the activator, carbonization temperature, and carbonization time on the properties of the pSi-C composite are investigated. The pSi-C composite produced in the presence of ZnCl2 as the activator and at an impregnation ratio of 1 : 1, a carbonization temperature of 550 °C, and a carbonization time of 90 min has a surface area of 762.13 m2 g-1. The as-synthesized pSi-C composite exhibits promising iodine capture performance in terms of superior iodine adsorption capacity (q t ) of around 250 mg g-1 and rapid equilibrium adsorption with in 15 min. The devised method is environmentally friendly and inexpensive and can easily be employed for the large-scale production of porous silicon-activated carbon composites with excellent iodine capture and storage from iodine-contaminated water.

Causes of vision loss at China's largest blind school during a period of significant economic growth: 2008-2016.

PURPOSE: To investigate the different causes of vision loss and school-based treatment regimens at Quanzhou Blind School (QBS), China's largest blind school, in 2008 and 2016. METHODS: In 2008, 144 students received comprehensive eye examinations along with a complete family and ophthalmic history; in 2016, 125 students were examined. Vision loss was categorized into visual impairment and blindness classifications based on WHO guidelines. The etiologies of impairment and blindness in 2008 were compared to those in 2016 using the Fisher exact test. The prevalence and type of visual aids were also analyzed during this period. RESULTS: The leading cause of visual impairment significantly shifted from corneal scarring in 2008 to retinopathy of prematurity (ROP) in 2016 (P = 0.020). Congenital cataracts remained the leading cause of blindness in 2008 and 2016. In 2016 there was a significant increase in the use of visual aids, with 63.2% of students using them in 2016 compared to 8.3% in 2008 (P = 0.0001). CONCLUSIONS: Between 2008 and 2016, the leading cause of visual impairment shifted from corneal scarring to ROP, while congenital cataracts remained the leading cause of blindness.