Fiscal decentralization, leader localization, and reduction of pollution and carbon emissions -empirical evidence from China's fiscal "province-managing-county" reform.

The fiscal system plays an important role in the government's environmental governance efforts. There is currently no consensus on how fiscal structure adjustments impact pollution and carbon reduction. This paper uses China's fiscal "province-managing-county" reform (FPMCR) implemented in 2004 as a quasi-natural experiment, utilizing panel data from 1670 counties in China from 2000 to 2020 to investigate the impact of fiscal decentralization on reduction pollution and carbon emissions (RPCE), as well as its underlying mechanisms. The results show that (1) from 2000 to 2020, China's RPCE shows an overall trend of fluctuating increase, with its value turning positive after 2013. China's RPCE exhibits a spatial pattern characterized by "lower in the north, higher in the south; higher in the east, lower in the west". (2) After implementing FPMCR, the RPCE levels in reformed counties decreased by -1.44%, showing that reformed county-level governments prioritize economic development over environmental protection. (3) The mechanism analysis found that after implementing FPMCR, reformed counties experienced a 9.16% increase in nighttime light intensity (NLI), and a 3.99% and 4.34% increase in the number of large-scale industrial enterprises (NLIE) and industrial agglomeration (IA), respectively. This suggests that FPMCR leads to radical urbanization and rapid industrialization in counties, which is detrimental to the improvement of RPCE levels. (4) The spatial heterogeneity analysis found that FPMCR's impact coefficient on RPCE levels in the eastern regions is -1.96%, while in the western regions it is -1.16%. This indicates that reformed counties in the eastern regions are more likely to invest expanded fiscal resources in economic development projects, leading to a decrease in RPCE levels. (5) The temporal heterogeneity analysis found that after the promulgation of the "Three-Year Action Plan to Win the Blue Sky Defense Battle" in 2018, the adverse impact of FPMCR on RPCE is completely reversed, leading to a 1.76% increase in RPCE levels. (6) Further analysis reveals that localizing leaders can slow down the promotion of county-level urbanization and industrialization by the FPMCR, benefiting the improvement of RPCE levels. In other words, "the outsider monk will not recite scriptures as well as a local one". This study has clarified the causal relationship and underlying mechanisms between fiscal decentralization and environmental governance, providing reliable theoretical support for optimizing grassroots fiscal systems and reducing environmental pollution in other transitional economies. It enriches the field of environmental economics related to fiscal decentralization.

Promoting or inhibiting: the impact of China's urban-rural digital divide on regional environmental development.

Based on the panel data of 30 provinces in China from 2013 to 2020, this paper uses the panel fixed effect model and threshold regression method to systematically examine the impact of the urban-rural digital divide on regional environmental development from the perspective of technological innovation and human capital. The study found that the urban-rural digital divide significantly inhibited regional environmental development; however, this inhibitory effect will be substantially reduced in technological innovation and human capital adjustment. Furthermore, technological innovation and human capital have played a significant single threshold effect in the impact of the urban-rural digital divide on regional environmental development. When technological innovation and human capital cross the corresponding threshold value, the adverse effects of the urban-rural digital divide on the regional environment will be alleviated. Therefore, it is suggested to strengthen the construction of rural information infrastructure; research and develop key technologies for ecological protection and environmental governance; build an ecological environment science and technology innovation system; and promote the sharing of human resources in the region and the ability of rural residents to apply digital resources and digital technology.

Assessment of vibration modulated regional cerebral blood flow with MRI.

Human brain experiences vibration of certain magnitude and frequency during various physical activities such as vehicle transportation and machine operation, which may cause traumatic brain injury or other brain diseases. However, the mechanisms of brain pathogenesis due to vibration are not fully elucidated due to the lack of techniques to study brain functions while applying vibration to the brain at a specific magnitude and frequency. Here, this study reported a custom-built head-worn electromagnetic actuator that applied vibration to the brain in vivo at an accurate frequency inside a magnetic resonance imaging scanner while cerebral blood flow (CBF) was acquired. Using this technique, CBF values from 45 healthy volunteers were quantitatively measured immediately following vibration at 20, 30, 40 Hz, respectively. Results showed increasingly reduced CBF with increasing frequency at multiple regions of the brain, while the size of the regions expanded. Importantly, the vibration-induced CBF reduction regions largely fell inside the brain's default mode network (DMN), with about 58 or 46% overlap at 30 or 40 Hz, respectively. These findings demonstrate that vibration as a mechanical stimulus can change strain conditions, which may induce CBF reduction in the brain with regional differences in a frequency-dependent manner. Furthermore, the overlap between vibration-induced CBF reduction regions and DMN suggested a potential relationship between external mechanical stimuli and cognitive functions.

Spatiotemporal pattern of carbon productivity and carbon offset potential in Chinese counties.

This study used panel data for 2166 county-level units in China between 2000 and 2017 to characterize carbon productivity's temporal and spatial evolution in Chinese counties. The "catch-up effect" of carbon offsets between counties was examined, and this was used to measure the carbon offset potential and analyze its spatial differences. The results indicated that: (1) China's carbon productivity increased from 2000 to 2017; carbon productivity in eastern China was the highest, and carbon productivity in northeast China was the lowest. A polarization to unipolarization evolutionary trend was evident. (2) Considering the spatial differences in carbon productivity, the overall difference in carbon productivity in China from 2000 to 2017 first decreased and then increased; the contribution rate of differences between cities and counties to the overall difference was relatively stable, at around 39.88 %. The contribution rate of the differences between zones to the overall difference was the lowest, remaining stable at around 2.49 %. (3) In terms of the spatial distribution of the carbon offset potential, the eastern region exhibited the highest average carbon offset potential. The carbon offset potential of China exhibited a "high in the north and low in the south; low in the west and high in the east" spatial pattern.

Digital Economy, Agricultural Technological Progress, and Agricultural Carbon Intensity: Evidence from China.

China is the largest carbon emitter in the world, with agricultural carbon emissions accounting for 17% of China's total carbon emissions. Agricultural carbon emission reduction has become the key to achieving the "Double Carbon" goal. At the same time, the role of the digital economy in achieving the "dual carbon" goal cannot be ignored as an important engine to boost the high-quality development of China's economy. Therefore, this paper uses the panel data of 30 provinces in mainland China from 2011 to 2019 to construct a spatial Durbin model and a mediation effect model to explore the impact of the digital economy on agricultural carbon intensity and the mediating role of agricultural technological progress. The research results show that: (1) China's agricultural carbon intensity fluctuated and declined during the study period, but the current agricultural carbon intensity is still at a high level; (2) The inhibitory effect of the digital economy on agricultural carbon intensity is achieved by promoting agricultural technological progress, and the intermediary role of agricultural technological progress has been verified; (3) The digital economy can significantly reduce the carbon intensity of agriculture, and this inhibition has a positive spatial spillover effect. According to the research conclusions, the government should speed up the development of internet technology and digital inclusive finance, support agricultural technology research and improve farmers' human capital, and strengthen regional cooperation to release the contribution of digital economy space.

The green paradox puzzle: fiscal decentralisation, environmental regulation, and agricultural carbon intensity in China.

China has the highest carbon dioxide emissions worldwide. Exploring the mechanism of fiscal decentralisation on agricultural carbon intensity can help China reach its carbon peak and become carbon neutral. This study used panel data for 30 provinces in Mainland China from 2000 to 2019 and constructed a spatial Durbin model to investigate the spatial-temporal patterns and internal relationships among fiscal decentralisation, environmental regulation, and agricultural carbon intensity. The results indicated that (1) from 2000 to 2019, the agricultural carbon intensity showed a downward trend and showed a spatial pattern of 'high in the north and low in the south'. The degree of fiscal decentralisation has gradually increased, and the spatial pattern of 'high in the north and low in the south' has also emerged. The intensity of environmental regulation continues to increase, and the intensity of environmental regulation in inland areas is higher than that in coastal areas. (2) From 2000 to 2019, the global Moran index of agricultural carbon intensity showed a development trend of first rising and then falling, and the spatial correlation changed from strong to weak. Agricultural carbon intensity tends to develop from polarisation to balanced development. (3) Both fiscal decentralisation and environmental regulation can reduce agricultural carbon intensity, and environmental regulation has a negative spatial spillover effect. (4) Under the influence of fiscal decentralisation, environmental regulation is not conducive to reducing agricultural carbon intensity due to the characteristics of 'race to the bottom', causing the 'green paradox' effect. (5) Environmental regulation and fiscal decentralisation in main grain producing areas have less impact on agricultural carbon intensity than in non-main grain producing areas. Therefore, the central government should focus on optimising the fiscal decentralisation system, formulating a differentiated agricultural carbon emission control system, regulating competition among local governments, and optimising a political performance evaluation system.

[Characteristics and Risk Assessment of Antibiotic Contamination in Chishui River Basin, Guizhou Province, China].

To preliminarily explore the antibiotic concentration distribution characteristics of Guizhou Chishui River basin surface water and potential ecological risks, we used solid phase extraction liquid chromatography tandem mass spectrometry (SPE-HPLC- MS) to analyze 21 types of antibiotics in surface water samples. Twelve types of antibiotics were detected in the Chishui River basin surface water, and the total concentrations of ofloxacin, sulfadiazine, and trimethoprim ranged from ND-1166.97 ng·L-1, with a detection rate of 100%. On average, the highest concentration of the three types of antibiotics detected were ofloxacin (221.59 ng·L-1), tetracycline (13.18 ng·L-1), and sulfadiazine (4.11 ng·L-1), and the antibiotic concentration distribution showed the following order of characteristics:downstream (359.41 ng·L-1) > midstream(224.59 ng·L-1) > upstream (179.72 ng·L-1). The ecological environment risk assessment results indicated the largest risk for downstream W21, tetracycline, doxycycline, enrofloxacin, norfloxacin, and erythromycin. The risk quotient revealed that lincomycin had a medium-risk level, and ofloxacin had a high-risk level. This shows that antibiotics in the waters of the Chishui River basin may cause certain ecological risks.

A novel colorimetric probe with positive correlation between toxicity and the reaction for the assessment of chromium ions.

Different valence states of chromium ions possess huge differences in toxicity. Hence, it is an innovative idea to design a reasonable probe to detect Cr according to the toxicity characteristics of different valence states. We report a novel, rapid, simple and accurate probe for the detection of Cr3+ and Cr6+ ions. As a probe, gold nanoparticles (Au NPs) are successfully modified using tartaric acid (TA) and 2-[4-(2-hydroxyethyl)-1-piperazinyl] ethanesulfonic acid (HEPES) via a two-step modification; the probe shows an increase in the sensitivity towards Cr6+ and decreases towards Cr3+, which is consistent with their toxicity characteristics, benefiting the assessment of total Cr toxicity. The proposed probe achieves considerable two-channel (ultraviolet absorption spectrum and naked eye vision) detection of Cr3+ and Cr6+ providing wide linearity regions and low detection limits. Meanwhile, the results of the interference experiments and analysis of the real samples showed high selectivity and accuracy of the proposed method. With popularization, this method possesses great potential in environmental monitoring and control.

Assessment of dialysis initiation by a fuzzy mathematics equation (ADIFE): a study protocol for a randomised controlled trial.

INTRODUCTION: Starting dialysis early or late both result in a low quality of life and a poor prognosis in patients undergoing haemodialysis. However, there remains no consensus on the optimal timing of dialysis initiation, mainly because of a lack of suitable methods to assess variations in dialysis initiation time. We have established a novel equation named DIFE (Dialysis Initiation based on Fuzzy-mathematics Equation) through a retrospective, multicentre clinical cohort study in China to determine the most suitable timing of dialysis initiation. The predictors of the DIFE include nine biochemical markers and clinical variables that together influence dialysis initiation. To externally validate the clinical accuracy of DIFE, we designed the assessment of DIFE (ADIFE) study as a prospective, open-label, multicentre, randomised controlled trial to assess the clinical outcomes among patients who initiate dialysis in an optimal start dialysis group and a late-start dialysis group, based on DIFE. METHODS AND ANALYSIS: A total of 388 enrolled patients with end-stage renal disease will be randomised 1:1 to the optimal start dialysis group, with a DIFE value between 30 and 35, or the late-start dialysis group, with a DIFE value less than 30, using the Randomization and Trial Supply Management system. Participants will be assessed for changes in signs and symptoms, dialysis mode and parameters, biochemical and inflammatory markers, Subjective Global Assessment, Kidney Disease Quality of Life Short Form, Cognitive Assessment, medical costs, adverse events and concomitant medication at baseline, predialysis visiting stage and postdialysis visiting stage, every 12-24 weeks. The following data will be recorded on standardised online electronic case report forms. The primary endpoint is 3-year all-cause mortality. The secondary endpoints include non-fatal cerebrocardiovascular events, annual hospitalisation rate, quality of life, medical costs and haemodialysis related complications. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Dalian Medical University China (registration no: YJ-KY-2017-119) and the ethics committees of all participating centres. The final results of the ADIFE trial will be presented to the study sponsor, clinical researchers and the patient and public involvement reference group. Findings will be disseminated through peer-reviewed journals, Clinical Practice Guidelines and at scientific meetings. TRIAL REGISTRATION NUMBER: ClinicalTrial.gov. Registry (NCT03385902); pre-results.

The implementation of a pulmonary embolism response team in the management of intermediate- or high-risk pulmonary embolism.

BACKGROUND: Massive and submassive pulmonary embolism (PE) can be life-threatening. Treatment options include anticoagulation, fibrinolysis, catheter-directed or open surgical thrombus removal, and extracorporeal membrane oxygenation. With increasing patient complexity and advanced therapeutic options, the approach to optimal care for patients with intermediate- to high-risk PE is not clearly established. Multidisciplinary, rapid response teams can optimize risk stratification and expedite management. A PE response team (PERT) composed of specialists from cardiology, vascular surgery, emergency medicine, pulmonary and critical care, interventional radiology, cardiac surgery, hospital medicine, and pharmacy was created at our institution. The team is tasked with evaluating and treating patients with massive and submassive PE by use of a risk stratification and treatment algorithm. We describe our initial experience with this approach. METHODS: The records of patients treated by the PERT since inception in October 2015 through May 2017 were reviewed (intervention group). The diagnoses codes of the PERT patients were retrieved from the Vizient database. A retrospective control cohort group was created using these specific diagnoses and a matching set of demographics (age, sex), Medicare Severity Diagnosis Related Group, admission severity of illness, and admission risk of mortality. Statistical analysis was performed using the Fisher exact test, the Pearson χ2 statistic, Student t-test, and Cochran-Cox approximation. P < .05 was considered significant. RESULTS: During the time interval, 77 patients with massive or submassive PE were treated by PERT activation; 992 patients included in the control group were treated at the discretion of an attending physician without use of the algorithm from October 2013 to 2016. Both groups had similar demographics, similar distribution of risk of mortality and severity of illness, and similar average Medicare Severity Diagnosis Related Group weighting. There was no statistically significant difference in the mortality rate between the two groups. The PERT group had significantly lower intensive care unit stay and overall length of stay. No difference was seen in direct cost between the two groups despite higher use of interventional treatment modalities in the PERT group. CONCLUSIONS: In our institution, assembly of a dedicated team to treat patients with massive or submassive PE according to a clinical algorithm resulted in expedited treatment and reduced variation of care. Intensive care unit stay and overall length of stay were reduced by this approach, with no impact on direct cost despite the use of advanced modalities of treatment. We believe that this paradigm can be of potential value in other disease entities, particularly when multiple disciplines are involved.

Spatiotemporal distribution and potential risk assessment of microcystins in the Yulin River, a tributary of the Three Gorges Reservoir, China.

Microcystins (MCs) pose potential threat for both aquatic organisms and humans, whereas their occurrence in response to hydrodynamic alterations are not clearly understood. Here, spatiotemporal variations of dissolved MC-RR and MC-LR were evaluated monthly in 2016 in the Yulin River, a tributary of the Three Gorges Reservoir (TGR). The environmental factors that linked to MCs concentration were discussed. The results revealed that MC-RR maximumly reached 3.55 µg/L, and the maximum MC-LR concentration exceeded the threshold value of 1.0 µg/L recommended by the WHO. MCs concentrations were higher during the flood season and decreased from the estuary to the upstream reach of the Yulin River. Ecological risk assessment confirmed that MC-LR had significant adverse effects on the benthonic invertebrates Potamopyrgus antipodarum. MCs content in the sediment was 1.70- to 20-fold higher than that in suspended particulate matter (SPM). The impacts of environmental factors on the MCs profile differed between flood and dry seasons and the longitudinal differences of MCs were determined by the longitudinal profile of water velocity and SPM content, which were affected by TGR operations. This study suggested that the occurrence of MCs in the Yulin River were influenced by hydrologic regime in TGR.

Assessment of low concentration wastewater treatment operations with dewatered alum sludge-based sequencing batch constructed wetland system.

Competition of volatile fatty acids between anoxic denitrification and anaerobic phosphorus release is prominent. Therefore, low concentration wastewater has restricted effects on nitrogen and phosphorus removal. The purpose of this study is to treat dormitory sewage with a biochemical oxygen demand (BOD) ranging from 50 to 150 mg/L using dewatered alum sludge-based sequencing batch constructed wetland system. Vegetation in the wetland system was chosen to be Phragmites australis. Three parallel cases were carried out to assess impacts due to different hydraulic retention time (HRT) and artificial aeration. The results showed that this system is effective in removing total nitrogen (TN), ammonia nitrogen (NH3-N) and total phosphorus (TP) under different HRT. However, nitrous oxide (N2O) emission poses to be the greatest challenge in the high HRT cases. Artificial aeration could reduce N2O emission but is associated with high operational cost. Results indicate that dewatered alum sludge-based sequencing batch constructed wetland system is a promising bio-measure in the treatment of low concentration wastewater.

Acute kidney injury in China: a cross-sectional survey.

BACKGROUND: Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. METHODS: We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics. FINDINGS: Of 2,223,230 patients admitted to the 44 hospitals screened in 2013, 154,950 (7·0%) were suspected of having AKI by electronic screening, of whom 26,086 patients (from 374,286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374,286) by KDIGO criteria and 2·03% (7604 of 374,286) by expanded criteria, from which we estimate that 1·4-2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality INTERPRETATION: AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI. FUNDING: National 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee.

Health status, perceptions and needs of Hispanics in rural Shelbyville, Kentucky.

This cross-sectional study was completed to characterize the health status, perceptions and needs of Hispanics in Shelbyville, KY, USA. Community Health Workers interviewed 668 Hispanic residents in Shelbyville, KY, USA. Data were collected from 2009 to 2010 and analyzed from 2011 until present. Hispanic immigrants from Mexico and other Central American countries completed the survey. The most common self-reported diseases were allergies, asthma, diabetes, lung disease and cardiovascular disease. High blood pressure and diabetes were the two most common diagnoses among insured, older females. Health education, disease prevention and nutrition were the top health concerns among participants. Deficits in health care infrastructure for this largely transient community may compromise their ability to meet health care needs and concerns. Similar issues may be faced by other disadvantaged Hispanic communities in the continental US and likely to be influenced by anticipated provisions of the Patient Protection and Affordable Care Act.

Economic development and coastal ecosystem change in China.

Despite their value, coastal ecosystems are globally threatened by anthropogenic impacts, yet how these impacts are driven by economic development is not well understood. We compiled a multifaceted dataset to quantify coastal trends and examine the role of economic growth in China's coastal degradation since the 1950s. Although China's coastal population growth did not change following the 1978 economic reforms, its coastal economy increased by orders of magnitude. All 15 coastal human impacts examined increased over time, especially after the reforms. Econometric analysis revealed positive relationships between most impacts and GDP across temporal and spatial scales, often lacking dropping thresholds. These relationships generally held when influences of population growth were addressed by analyzing per capita impacts, and when population density was included as explanatory variables. Historical trends in physical and biotic indicators showed that China's coastal ecosystems changed little or slowly between the 1950s and 1978, but have degraded at accelerated rates since 1978. Thus economic growth has been the cause of accelerating human damage to China's coastal ecosystems. China's GDP per capita remains very low. Without strict conservation efforts, continuing economic growth will further degrade China's coastal ecosystems.

Zr61Ti2Cu25Al12 metallic glass for potential use in dental implants: biocompatibility assessment by in vitro cellular responses.

In comparison with titanium and its alloys, Zr61Ti2Cu25Al12 (ZT1) bulk metallic glass (BMG) manifests a good combination of high strength, high fracture toughness and lower Young's modulus. To examine its biocompatibility required for potential use in dental implants, this BMG was used as a cell growth subtract for three types of cell lines, L929 fibroblasts, human umbilical vein endothelial cells (HUVEC), and osteoblast-like MG63 cells. For a comparison, these cell lines were in parallel cultured and grown also on commercially pure titanium (CP-Ti) and Ti6-Al4-V alloy (Ti64). Cellular responses on the three metals, including adhesion, morphology and viability, were characterized using the SEM visualization and CCK-8 assay. Furthermore, real-time RT-PCR was used to measure the activity of integrin ß, alkaline phosphatase (ALP) and type I collagen (COL I) in adherent MG63 cells. As indicated, in all cases of three cell lines, no significant differences in the initial attachment and viability/proliferation were found between ZT1, CP-Ti, and Ti64 until 5d of incubation period. It means that the biocompatibility in cellular response for ZT1 BMG is comparable to Ti and its alloys. For gene expression of integrin ß, ALP and COL I, mRNA level from osteoblast cells grown on ZT1 substrates is significantly higher than that on the CP-Ti and Ti64. It suggests that the adhesion and differentiation of osteoblasts grown on ZT1 are even superior to those on the CP-Ti and Ti64 alloy, then promoting bone formation. The good biocompatibility of ZT1 BMG is associated with the formation of zirconium oxide layer on the surface and good corrosion-resistance in physiological environment.

Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study.

PURPOSE: The aim of this study was to establish enhanced recovery protocols for the management of mild gallstone pancreatitis. METHODS: Sixty consecutive patients were divided into enhanced recovery and traditional recovery (TR) groups in a randomized observational study. The basic enhanced recovery elements included early laparoscopic cholecystectomy, restrictive endoscopic intervention, and early oral nutrition. The incidence of complications, readmission, length of stay, and total medical cost were analyzed during the hospital course. RESULTS: The length of hospital stay and medical cost were significantly lower in the enhanced recovery group in comparison to the TR group: 5.9 days vs. 10.6 days (P < 0.01) and ¥10,023 vs. ¥15,035 (P < 0.01). The complications and readmission rates in the two groups were similar. CONCLUSIONS: The implementation of enhanced recovery protocols is feasible in the management of mild gallstone pancreatitis. The utilization of these protocols can achieve shorter hospital stays and reduced costs, with no increase in either the re-admission or peri-operative complication rates.

[Clinical significance for monitoring of serum ghrelin in acute pancreatitis severity assessment].

OBJECTIVE: To explore the value of altered serum level of Ghrelin for severity assessment in patients with acute pancreatitis (AP). METHODS: Peripheral blood samples were collected from 47 AP patients at admission, 48 hours post-admission and at discharge. According to the criteria of APACHEII score ≥ 8, RANSON ≥ 3, CT ≥ 4, they were divided into mild (n = 17) and severe (n = 30) groups. Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum level of Ghrelin. And correlation analysis was made with the score of APACHEII and the level of C reactive protein (CRP). Also the serum level of Ghrelin was analyzed with receiver operating characteristic (ROC) curve. RESULTS: The serum levels of Ghrelin after 24 h were 358.6 ± 119.3 vs 212.1 ± 42.7 ng/L (P < 0.001); after 48 hours, 253.1 ± 71.2 vs 275.5 ± 73.6 ng/L (P = 0.572); at discharge, 327.8 ± 103.8 vs 319.4 ± 87.1 ng/L respectively (P = 0.816). And serum level of Ghrelin was positively correlated with APACHEII and CRP. ROC area under curve was 0.841 ± 0.057 and 95% confidence interval 0.729-0.952 (P < 0.001). CONCLUSION: The serum level of Ghrelin during early-stage AP has significant differences between two groups. And it may become an early predictor of pancreatic necrosis and a degree marker of clinical severity.

Culturally-Tailored Education Programs to Address Health Literacy Deficits and Pervasive Health Disparities among Hispanics in Rural Shelbyville, Kentucky.

OBJECTIVES: This investigation was conducted to evaluate the impact of culturally-tailored education on health knowledge among Hispanic residents of rural, Shelbyville, KY. DESIGN: The program identified specific pathways to address health literacy deficits and disparities identified through a community-wide health assessment completed in 2010. RESULTS: A total of 43 Hispanic males who shared deficiencies in community-wide health infrastructure were enrolled in the program. The curriculum included an introductory session followed by five, subject-specific, sessions offered on a weekly basis from February to April 2011. Pre/post-test assessments showed marked improvement in knowledge base for all participants after each session, most notably related to cardiovascular disease, diabetes and metabolic syndrome. The group reconvened in January 2012 for follow-up instruction on cardiovascular disease and diabetes, as well as global assessment of knowledge retention over a nine-month period. Comparisons of pre/post testing in cardiovascular disease and diabetes, as well as global health-related knowledge showed significant gains for all parameters. CONCLUSIONS: Health education programs that embrace perceptions of the community of their own health, and that integrate knowledge into culturally-sensitive education, significantly improved health knowledge among Hispanic residents in rural Kentucky. Such gains may translate into sustainable improvements in health literacy and help reduce health disparities.

Prevalence of chronic kidney disease in China: a cross-sectional survey.

BACKGROUND: The prevalence of chronic kidney disease is high in developing countries. However, no national survey of chronic kidney disease has been done incorporating both estimated glomerular filtration rate (eGFR) and albuminuria in a developing country with the economic diversity of China. We aimed to measure the prevalence of chronic kidney disease in China with such a survey. METHODS: We did a cross-sectional survey of a nationally representative sample of Chinese adults. Chronic kidney disease was defined as eGFR less than 60 mL/min per 1·73 m(2) or the presence of albuminuria. Participants completed a lifestyle and medical history questionnaire and had their blood pressure measured, and blood and urine samples taken. Serum creatinine was measured and used to estimate glomerular filtration rate. Urinary albumin and creatinine were tested to assess albuminuria. The crude and adjusted prevalence of indicators of kidney damage were calculated and factors associated with the presence of chronic kidney disease analysed by logistic regression. FINDINGS: 50,550 people were invited to participate, of whom 47,204 agreed. The adjusted prevalence of eGFR less than 60 mL/min per 1·73 m(2) was 1·7% (95% CI 1·5-1·9) and of albuminuria was 9·4% (8·9-10·0). The overall prevalence of chronic kidney disease was 10·8% (10·2-11·3); therefore the number of patients with chronic kidney disease in China is estimated to be about 119·5 million (112·9-125·0 million). In rural areas, economic development was independently associated with the presence of albuminuria. The prevalence of chronic kidney disease was high in north (16·9% [15·1-18·7]) and southwest (18·3% [16·4-20·4]) regions compared with other regions. Other factors independently associated with kidney damage were age, sex, hypertension, diabetes, history of cardiovascular disease, hyperuricaemia, area of residence, and economic status. INTERPRETATION: Chronic kidney disease has become an important public health problem in China. Special attention should be paid to residents in economically improving rural areas and specific geographical regions in China. FUNDING: The Ministry of Science and Technology (China); the Science and Technology Commission of Shanghai; the National Natural Science Foundation of China; the Department of Health, Jiangsu Province; the Sichuan Science and Technology Department; the Ministry of Education (China); the International Society of Nephrology Research Committee; and the China Health and Medical Development Foundation.