Mathematical models and analysis tools for risk assessment of unnatural epidemics: a scoping review.

Predicting, issuing early warnings, and assessing risks associated with unnatural epidemics (UEs) present significant challenges. These tasks also represent key areas of focus within the field of prevention and control research for UEs. A scoping review was conducted using databases such as PubMed, Web of Science, Scopus, and Embase, from inception to 31 December 2023. Sixty-six studies met the inclusion criteria. Two types of models (data-driven and mechanistic-based models) and a class of analysis tools for risk assessment of UEs were identified. The validation part of models involved calibration, improvement, and comparison. Three surveillance systems (event-based, indicator-based, and hybrid) were reported for monitoring UEs. In the current study, mathematical models and analysis tools suggest a distinction between natural epidemics and UEs in selecting model parameters and warning thresholds. Future research should consider combining a mechanistic-based model with a data-driven model and learning to pursue time-varying, high-precision risk assessment capabilities.

Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol.

BACKGROUND: Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. METHODS: This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. CONCLUSION: Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food. CLINICAL TRIAL REGISTRATION: NCT04876053.

Derivation of aquatic predicted no-effect concentration and ecological risk assessment for triphenyl phosphate and tris(1,3-dichloro-2-propyl) phosphate.

Triphenyl phosphate (TPhP) and tris(1,3-dichloro-2-propyl) phosphate (TDCIPP) are common organophosphate esters (OPEs), which are used as additives in various industries. These compounds have been widely detected in aquatic environment, raising concerns about their adverse effects on aquatic organisms. In order to protect aquatic ecosystems, a total of 7 species were selected for acute and chronic toxicity tests in this study. The results indicated that TPhP and TDCIPP exhibited varying degrees of toxicity to aquatic organisms. The 96-h LC50 values ranged from 1.088 mg/L to 1.574 mg/L for TPhP and from 2.027 mg/L to 17.855 mg/L for TDCIPP. The 28-d LC10 values ranged from 0.023 mg/L to 0.177 mg/L for TPhP and from 0.300 mg/L to 1.102 mg/L for TDCIPP. The tested toxicity data, combined with collected toxicity data, were used to investigate the predicted no-effect concentration in water (PNECwater) of TPhP and TDCIPP by species sensitivity distribution (SSD) method. The results revealed PNECwater values of 6.35 and 38.0 µg/L for TPhP and TDCIPP, respectively. Furthermore, the predicted no-effect concentrations in sediment (PNECsed) were derived as 110 µg/kg dry weight (dw) for TPhP and 424 µg/kg dw for TDCIPP using the equilibrium partitioning (EqP) approach. Based on the toxicity data and PNECs, the ecological risk of these two chemicals in surface waters and sediments worldwide over the last decade were evaluated. The results indicated that TDCIPP posed negligible risk in aquatic ecosystems. However, TPhP showed potential risk in sediments, as indicated by the hazard quotients (HQs) exceeding 0.1. The results of joint probability curves (JPC) indicated that the probabilities of exceeding hazardous concentration for 1 % of species for TPhP in water and sediment were 0.33 % and 5.2 %, respectively. Overall, these findings highlight the need for continued monitoring and assessment of the presence and potential impacts of TPhP and TDCIPP in aquatic ecosystems.

Bioavailability (BA)-based risk assessment of soil heavy metals in provinces of China through the predictive BA-models.

The real biological effect is not generated by the total content of heavy metals (HMs), but rather by bioavailable content. A new bioavailability-based ecological risk assessment (BA-based ERA) framework was developed for deriving bioavailability-based soil quality criteria (BA-based SQC) and accurately assessing the ecological risk of soil HMs at a multi-regional scale in this study. Through the random forest (RF) models and BA-based ERA framework, the 217 BA-based SQC for HMs in 31 Chinese provinces were derived and the BA-based ERA was comprehensively assessed. This study found that bioavailable HMs extraction methods (BHEMs) and total HMs content play the predominant role in affecting HMs (As, Cd, Cr, Cu, Ni, Pb, and Zn) bioavailability by explaining 27.55-56.11% and 9.20-62.09% of the variation, respectively. The RF model had accurate and stable prediction ability for the bioavailability of soil HMs with the mean R2 and RMSE of 0.83 and 0.43 for the test set, respectively. The results of BA-based ERA showed that bioavailability could avoid the overestimation of ecological risks to some extent after reducing the uncertainty of soil differences. This study confirmed the feasibility of using bioavailability for ERA and will utilised to revise the soil environmental standards based on bioavailability for HMs.

Characteristics and economic burden of hospitalized patients with herpes zoster in China, before vaccination.

Herpes zoster (HZ) brings a significant economic burden. The HZ vaccine was introduced in China for the first time in 2020, and there is a lack of up-to-date information on the hospitalization costs and characteristics prior to vaccination. This study aimed to describe the characteristics and economic burden of HZ inpatients in Hunan Province, China, and analyze the factors influencing the length of stay (LOS) and costs. This was a retrospective study and we extracted information from the Chinese National Health Statistics Network Reporting System on HZ inpatients in Hunan Province, China from 2017 to 2019. Spatial join tools and Global or Local Moran's Index were used for the geographic analysis of hospitalized HZ incidence. Multivariate linear regression models were used to analyze the factors influencing LOS and costs. There were 44,311 HZ inpatients included in this study, incurring a total of $31,857,734 medical costs. These patients had a median LOS of 8 days and a median expenditure of $573.47. Older age, more comorbidities, and the presence of complications with nervous system involved were all significantly associated with longer LOS and higher costs. HZ infection resulted in a large direct medical cost and heavy disease burden, especially in patients with advanced age or underlying medical conditions. The HZ vaccine has the potential to effectively reduce the disease burden and should be widely popularized especially among high-risk groups.

Bisphenol A degradation by chlorine dioxide (ClO2) and S(IV)/ClO2 process: Mechanism, degradation pathways and toxicity assessment.

Recently, it has been reported that chlorine dioxide (ClO2) and (bi)sulfite/ClO2 showed excellent performance in micropollutant removal from water; however, the degradation mechanisms and application boundaries of the two system have not been identified. In this study, bisphenol A (BPA) was chosen as the target contaminant to give multiple comparisons of ClO2 and S(IV)/ClO2 process regarding the degradation performance of contaminant, generation of reactive species, transformation of products and toxicity variation. Both ClO2 and S(IV)/ClO2 can degrade BPA within 3 min. The BPA degradation mechanism was mainly based on direct oxidation in ClO2 process while it was attributed to radicals (especially SO4·-) generation in S(IV)/ClO2 process. Meanwhile, the effect of pH and coexisting substances (Cl-, Br-, HCO3- and HA) were evaluated. It was found that ClO2 preferred the neutral and alkaline condition and S(IV)/ClO2 preferred the acidic condition for BPA degradation. An unexpected speed-up of BPA degradation was observed in ClO2 process in the presence of Br-, HCO3- and HA. In addition, the intermediate products in BPA degradation were identified. Three exclusive products were found in ClO2 process, in which p-benzoquinone was considered to be the reason of the acute toxicity increase in ClO2 process.

Life Cycle Assessment of a large commercial kelp farm in Shandong, China.

The environmental benefits of seaweed cultivation have gained a lot of attention, both in policy strategies and by private companies. Sustainability evaluations of seaweed farming have however focused on a very small part of global production of seaweed - on European cultivations at research and pilot-scales although Asia stands for 99 % of global production with China alone producing 60 %. In this study, we use Life Cycle Assessment (LCA) to evaluate the environmental performance of a 400-hectare Chinese kelp farm with a yearly harvest of 60,000 tons. Primary data from the farm was used to assess impacts up until harvest for the functional unit of 1 ton of fresh-weight kelp. Included in the LCA were impact on climate change, acidification terrestrial and marine eutrophication, and use of land water and energy. In addition, we calculated nutrient uptake. Further, we extracted inventory data of four published LCA studies of farmed kelp and recalculated environmental impacts, applying the same background data and method choices with the aim to compare the effects of scale and cultivation system. The results of the hotspot analysis showed that the plastic ropes and buoys dominated impacts on climate change, freshwater and marine eutrophication, and energy consumption. Consequently, the most effective improvement action was recycling after use. The yearly harvest of the Chinese farm was 1000-4000 times larger than previously evaluated farms compared. Results suggest that streamlined and mature production in the large-scale Chinese kelp farm led to lower electricity and fuel consumption compared to small-scale production, thus placing the Chinese farm with a climate impact of 57.5 kg CO2 eq. per ton fresh-weight kelp on the lower end when comparing the carbon footprint. There was a large variation in carbon footprints, which implies that the kelp cultivation sector has considerable room for optimization.

High-value utilization of Cr-containing sludge: Eco-friendly and ultra-low-cost electrocatalyst for efficient OER in alkaline media from Cr-containing sludge.

Economically sustainable development requires more viable waste recycling solutions. In this context, we address the problem of utilizing chromium-containing sludge, a prevalent and environmentally hazardous waste. Meanwhile, sustainable energy development must develop ecology-friendly and low-cost electrocatalysts for the oxygen evolution reaction (OER) in alkaline media. Herein, we report an ultra-low-cost electrocatalyst from chromium-containing sludge. The optimum preparation conditions are determined by optimizing the calcination temperature and the loading of nickel acetylacetonate. The optimized catalyst delivers excellent stability and outstanding OER activity with overpotentials of 320 mV at 10 mA cm-2 in alkaline media. Density functional theory calculations reveal that the energy barrier of OER is decreased because of the catalyst's heterogeneous structure arrangement and confirm the influence of chromium on performance improvement. The concept of "turning waste into treasure" stimulates the search for methods to process Cr-containing waste and produce low-cost, high-performance electrocatalysts.

[Effects of Source Depletion on Vapor Intrusion Risk Assessment].

The current regulatory site investigation employs the J&E model to predict vapor intrusion risk. However, the J&E model assumes that the source concentration is constant for a given exposure period, which is not consistent with the actual site source under depletion. In this study, we compared the differences between the J&E model (constant source), SD source depletion model, and RBCA source depletion model for predicting indoor concentration variation as well as the risk levels during the exposure period with a case study in Beijing. The results showed that the source and indoor air concentrations predicted by the SD and RBCA models showed exponential decreases, whereas those predicted by the J&E model maintained high concentrations throughout the exposure period, which greatly overestimated the risk. The RBCA predicted source depletion at the fastest rate, but the predicted indoor air concentrations were still lower than those of the SD model, which was related to the fact that the RBCA did not consider the effect of buildings on source depletion and did not follow mass conservation. Further, the sensitivity analysis showed that the pressure difference (dP) had the greatest influence on the source concentration in the SD model. For the calculated carcinogenic risk and hazard quotients, the J&E constant source model, the SD source depletion model, and the RBCA source depletion model were ranked in descending order. The results indicated that in general the J&E model was too conservative, the RBCA model may have underestimated risk, and the SD model was more suitable for quantifying vapor intrusion risk in reality.

[Analysis on Change in Soil Organic Carbon Content of Farmland in Yangtze River Economic Belt Under Different Fertilizing Measures].

The literature from a long-term fertilization experiment in the Yangtze River Economic Belt from January 1992 to May 2022 was collected, and the data of farmland soil organic carbon were extracted and integrated. Using the normalization treatment and the analysis method of relative annual variation, the overall change in soil organic carbon content in farmland in the Yangtze River Economic Belt under different long-term fertilization measures was studied, and the change differences of soil organic carbon content under three tillage modes were compared so as to judge and analyze the influence of the duration of the experiment on soil organic carbon dynamics. The results showed that under different long-term fertilization measures, the organic carbon content of farmland soil in the Yangtze River Economic Belt in China showed an overall upward trend. The NP, NPK, O, and NPKO treatments all increased the organic carbon content of agricultural soils, with that of the NPKO treatment being the largest. The sole application of inorganic nitrogen fertilizer reduced the organic carbon content of the soil. The rates of change in soil organic carbon content were 0.22 g·(kg·a)-1, 0.24 g·(kg·a)-1, and 0.16 g·(kg·a)-1for dryland, paddy, and water-dry rotation farmland, respectively. Additionally, the relatively rapid increase effect of organic carbon brought by the O and NPKO treatments could last for no more than 28 years in dryland soil but could still last for more than 28 years in paddy field and paddy-upland rotation soil. There was some variation in the rate of change of soil organic carbon content between soil types. The average rate of change of organic carbon was 0.25 g·(kg·a)-1for red soils, 0.14 g·(kg·a)-1 for brown soils, 0.19 g·(kg·a)-1 for tidal soils, and 0.15 g·(kg·a)-1 for rice soils. The trend of NPKO>O>NPK>NPK>NP>N was basically maintained for the rate of change in soil organic carbon content. The NPKO treatments were all significantly higher than the chemical fertilizer (N, NP, and NPK) treatments alone. The N treatment showed a reduction in organic carbon content in both red soil and rice soils. Considering the carbon fixation of farmland soil, the combined application of organic and inorganic fertilizers is a more suitable fertilization method in this area.

Footprints of total coliforms, faecal coliforms and E. coli in a wastewater treatment plant and the probabilistic assessment and reduction of E. coli infection risks.

Wastewater contains various pathogenic microorganisms, and the disease of workers caused by exposure to wastewater at the wastewater treatment plants (WWTPs) is a growing concern. The footprints of total coliforms (TC), faecal coliforms (FC) and Escherichia coli (E. coli) in a conventional activated sludge WWTP during 12 consecutive months were clarified. It was found that TC, FC and E.coli in influent were significantly removed (log 4.71, log 4.43 and log 4.62, respectively) by WWTP with sand filtration playing a key role, and excess sludge was a major potential pathway for them flowing to the environment. Through quantitative microbial risk assessment (QMRA), hand-to-mouth ingestion of untreated wastewater and wastewater in secondary/efficient sedimentation tanks, as well as accidental ingestion of sludge in dewatering workshop presented the highest infection risks of pathogenic E.coli in the WWTP, considerably exceeded the U.S. EPA benchmark (≤1 × 10-4 pppy). PPE application and E.coli concentration reduction in wastewater or sludge were recommended to reduce the infection risks at these stages. Further, partial ozonation and dissolved ozone flotation thickening were investigated able to reduce the infection risks at the stages of secondary and tertiary treatment of wastewater or sludge treatment by 90- 98 %. The findings of this study would assist in selecting appropriate processes for the further sanitation of WWTPs.

Species richness disparity in tropical terrestrial herbaceous floras: Evolutionary insight from Collabieae (Orchidaceae).

Species richness is spatially heterogeneous even in the hyperdiverse tropical floras. The main cause of uneven species richness among the four tropical regions are hot debated. To date, higher net diversification rates and/or longer colonization time have been usually proposed to contribute to this pattern. However, there are few studies to clarify the species richness patterns in tropical terrestrial floras. The terrestrial tribe Collabieae (Orchidaceae) unevenly distributes in the tropical regions with a diverse and endemic center in Asia. Twenty-one genera 127 species of Collabieae and 26 DNA regions were used to reconstruct the phylogeny and infer the biogeographical processes. We compared the topologies, diversification rates and niche evolutionary rates of Collabieae and regional lineages on empirical samplings and different simulated samplings fractions respectively. Our results suggested that the Collabieae originated in Asia at the earliest Oligocene, and then independently spread to Africa, Central America, and Oceania since the Miocene via long-distance dispersal. These results based on empirical data and simulated data were similar. BAMM, GeoSSE and niche analyses inferred that the Asian lineages had higher net diversification and niche evolutionary rates than those of Oceanian and African lineages on the empirical and simulated analyses. Precipitation is the most important factor for Collabieae, and the Asian lineage has experienced more stable and humid climate, which may promote the higher net diversification rate. Besides, the longer colonization time may also be associated with the Asian lineages' diversity. These findings provided a better understanding of the regional diversity heterogeneity in tropical terrestrial herbaceous floras.

Assessment of soil heavy metal pollution in provinces of China based on different soil types: From normalization to soil quality criteria and ecological risk assessment.

Ecological risks can vary dramatically depending on abiotic factors, such as soil properties and the background values of elements. This study developed a framework for an integrated risk assessment system to derive soil quality criteria (SQC) for heavy metals (HMs) applicable to different soil types and to assess ecological risks at a multi-regional scale. Through the construction of normalization and species sensitivity distribution models, 248 SQC values for Cd, Pb, Zn, As, Cu, Cr, Sb, and Ni in 31 Chinese provinces were derived. These SQC considered the soil types and background values of the elements and effectively reduced the uncertainty caused by spatial heterogeneity. Using the derived SQC values, the qualitative and quantitative ecological risks of HMs in the terrestrial environment of China were comprehensively assessed using a three-level ecological risk assessment (ERA) approach. Compared to traditional ERA methods, the new methodology reached a more quantitative conclusion. The mean overall probabilities of ecological risk in China were 2.42 % (Cd), 2.82 % (Pb), 12.17 % (Zn), 14.89 % (As), 10.42 % (Cu), 32.20 %(Cr), and 8.88 % (Ni). The new framework could be useful for the ERA of various soil types.

Human health ambient water quality criteria and risk assessment of pentachlorophenol in Poyang Lake Basin, China.

Pentachlorophenol (PCP) has been widely used as an insecticide for killing oncomelania (the intermediate host of schistosome) in China and leads to severe environmental contamination. Poyang Lake, as the largest freshwater lake and bird habitat in China, was once a schistosomiasis epidemic area. In this study, the concentrations of PCP in water and aquatic products from Poyang Lake were determined and analyzed, and then the human health ambient water quality criteria (AWQC) was derived based on native parameters of Poyang Lake basin. Finally, a comprehensive analysis of the health risks of drinking water and different types of aquatic products consumption was carried out. The results showed that PCP concentrations were ranged from 0.01 to 0.43 µg/L in surface water and 3.90 to 85.95 µg/kg in aquatic products. Due to the carcinogenicity of PCP, the human health AWQC for PCP are 0.02 µg/L for consumption of water and organisms and 0.03 µg/L for consumption of organisms only. Deterministic and probabilistic risk analysis indicated that the non-carcinogenic risk of PCP were acceptable in Poyang Lake, while the carcinogenic risk cannot be ignored. The health risks of PCP caused by aquatic products consumption were higher than that by drinking water. The percentages of acceptable risk for the population in Poyang Lake Basin were 99.95% at acceptable level of 10-4. Based on the sensitivity analysis, the impact of PCP concentrations on health risk values ranged from 53 to 82%. The study provided valuable information for regional water quality criteria development and water quality assessment.

Single and combined toxicity assessment of primary or UV-aged microplastics and adsorbed organic pollutants on microalga Chlorella pyrenoidosa.

Microplastics (MPs), an emerging pollutant, have been increasingly raising concern due to the potential impacts on aquatic organisms. Moreover, the environmental aged MPs always exhibit different environmental behavior and interaction effect with organic pollutants from virgin MPs. In this work, the single and combined toxicity impact on Chlorella pyrenoidosa, a symbiont representative, has been investigated between MPs (e.g., polyamide microplastic (PA6), 75 µm) and organic pollutants (e.g., sulfamethoxazole (SMX) and dicamba (DCB)). Growth inhibition, chlorophyll accumulation, superoxide dismutase (SOD), malondialdehyde (MDA), and catalase (CAT) were investigated with the primary or UV-aged PA6. Above 0.5 g/L PA6 (primary or UV-aged) inhibited cell growth and chlorophyll accumulation after 96 h cultivation as compared with the control. Besides, the inhibition impacts have enhanced as the UV-aging time extending in the single PA6 systems. The algae growth inhibition rate after 96 h cultivation in both the system i.e., single (PA6: 6.9%) and combined (PA6-SMX: 14.2%, PA6-DCB: 14.9%) was slightly lower than that of exposing in organic pollutants alone (SMX: 23.9%, DCB: 25.0%), while the chl. b concentration in 60 days UV-aged PA6 combined with SMX (1.19 mg/L) or DCB (1.40 mg/L) systems were higher than in single SMX (1.04 mg/L) or DCB (1.33 mg/L) system. In addition, there were several differences of the cellular oxidative stress in the combined system of SMX and DCB. Specially, it was not noticeable of three enzymatic activities for SMX exposing in the presence of primary or UV-aged PA6. While SOD, CAT, and MDA activities was obviously increasing after exposing in PA6 and DCB combined system, indicating the significant synergistic effect on algae cells damage. This research verified the remarkable combined toxicity between UV-aged MPs and organic pollutants on microalgae.

Environmental sustainability analysis of dairy bedding regeneration system based on emergy evaluation and life cycle assessment methods.

Dairy farm bedding can be produced by composting technology using dairy manure, which offers advantages in terms of cost, availability, and economic value. However, few information is available on the environmental sustainability and impacts for manure recycling systems based on different composting methods. The resource-environmental impact and eco-economic sustainability of two manure bedding regeneration systems: forced-ventilation static-stack aerobic fermentation (FVSSAF) system (Scenario A) and bedding recovery unit (BRU) system (Scenario B) were evaluated in this study. The life cycle assessment yielded a combined environmental impact potential of 0.01032 for scenario B, much lower than the 0.02656 for scenario A. The emergy evaluation showed that scenario B can handle more dairy manure than scenario A due to 57% increase of emergy input. Form the emergy indices of the two systems, scenario B had lighter environmental pressure and higher sustainability. Therefore, the BRU system had economic advantages and ecological sustainability, which was more suitable for large dairy farms. The trade-offs between environmental consequences, resource efficiency, and economic benefits were analyzed from several perspectives in this study, which would help stakeholders to have a new understanding when choosing a bedding recycling system.

Nitrogen dioxide and hospital length of stay and cost for systemic lupus erythematosus in Hunan, China.

BACKGROUND: Evidence of both epidemiological and clinical studies exploring the impact of nitrogen dioxide (NO2) on the systemic lupus erythematosus (SLE) disease activity have been contradictory. OBJECTIVES: To evaluate the association between short-term NO2 exposure and length of hospital stay (LOS) and hospital cost of SLE and estimate the burden of disease attributable to NO2 exposure. METHODS: We collected health data of SLE inpatients who were hospitalized at secondary and tertiary hospitals in Hunan province of China during 2017-2019. Daily ambient concentrations of air pollutants (O3, CO, NO2, SO2, PM2.5 and PM10) and other environmental factors were obtained from public repositories by linking to individual addresses and date of hospitalization. Mixed effect models were employed to assess the associations between LOS and hospital cost for SLE inpatients and NO2 exposures during the previous 1 to 21 days (lag1-lag21) before hospitalization. We further estimated excess LOS and hospital cost attributable to NO2 exposure according to China's and World Health Organization's air quality guideline (AQG) respectively. RESULTS: A total of 11,447 records from 221 hospitals were finally included in our study. After full adjustments, 1 µg/m3 increment of NO2 was significantly associated with 0.038 day increase in LOS (95%CI: 0.0159-0.0601, P = 0.0008) and 0.0384 thousand yuan increase in hospital cost (95%CI: 0.0017-0.0679, P = 0.0395) with a lagged effect of 7 days prior to admission. Based on the adjusted effects of lag7, controlling for short-term NO2 exposure according to AQG could avoid up to 1.47 thousand days of hospitalization and 1.35 million yuan of cost for SLE in Hunan province during 2017 to 2019. CONCLUSIONS: Excess LOS and substantial economic burden among SLE inpatients attributable to NO2 could be avoid if policies were implemented to reduce the exposure.

Occurrence and risk assessment of typical PPCPs and biodegradation pathway of ribavirin in wastewater treatment plants.

A large number of pharmaceuticals and personal care products (PPCPs) persist in wastewater, and the consumption of PPCPs for COVID-19 control and prevention has sharply increased during the pandemic. This study investigated the occurrence, removal efficiency, and risk assessment of six typical PPCPs commonly used in China in two wastewater treatment plants (WWTPs). Ribavirin (RBV) is an effective pharmaceutical for severely ill patients with COVID-19, and the possible biodegradation pathway of RBV by activated sludge was discovered. The experimental results showed that PPCPs were detected in two WWTPs with a detection rate of 100% and concentrations ranging between 612 and 2323 ng L-1. The detection frequency and concentrations of RBV were substantially higher, with a maximum concentration of 314 ng L-1. Relatively high pollution loads were found for the following PPCPs from influent: ibuprofen > ranitidine hydrochloride > RBV > ampicillin sodium > clozapine > sulfamethoxazole. The removal efficiency of PPCPs was closely related to adsorption and biodegradation in activated sludge, and the moving bed biofilm reactor (MBBR) had a higher removal capacity than the anoxic-anaerobic-anoxic-oxic (AAAO) process. The removal efficiencies of sulfamethoxazole, ampicillin sodium, ibuprofen, and clozapine ranged from 92.21% to 97.86% in MBBR process and were relatively low, from 61.82% to 97.62% in AAAO process, and the removal of RBV and ranitidine hydrochloride were lower than 42.96% in both MBBR and AAAO processes. The discrepancy in removal efficiency is caused by temperature, hydrophilicity, and hydrophobicity of the compound, and acidity and alkalinity. The transformation products of RBV in activated sludge were detected and identified, and the biodegradation process of RBV could be speculated as follows: first breaks into TCONH2 and an oxygen-containing five-membered heterocyclic ring under the nucleosidase reaction, and then TCONH2 is finally formed into TCOOH through amide hydrolysis. Aquatic ecological risks based on risk quotient (RQ) assessment showed that PPCPs had high and medium risks in the influent, and the RQ values were all reduced after MBBR and AAAO treatment. Ranitidine hydrochloride and clozapine still showed high and medium risks in the effluent, respectively, and thus presented potential risks to the aquatic ecosystem.

A cost-effectiveness analysis of capecitabine maintenance therapy versus routine follow-up for early-stage triple-negative breast cancer patients after standard treatment from a perspective of Chinese society.

BACKGROUND: Capecitabine maintenance therapy is safe and efficacious for early-stage triple-negative breast cancer (TNBC) patients, but the cost-effectiveness of its long-term use has not been investigated. Here, we evaluated the cost-effectiveness of capecitabine maintenance therapy, compared with routine follow-up, in early-stage TNBC patients after standard treatment from a perspective of Chinese society. METHODS: A three-state Markov model based on the data from the SYSUCC-001 trial was constructed to estimate the cost-effectiveness of capecitabine maintenance therapy in a month cycle over a period of 30-year time horizon. A 5% annual discount rate was set for all costs and benefits. One-way and probabilistic sensitivity analyses were performed to explore the model uncertainties. The main outcomes include quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and the number needed to treat (NNT) to prevent one additional event. RESULTS: Compared with routine follow-up, 1-year capecitabine maintenance therapy yielded an additional 1.29 quality-adjusted life years (QALYs) at an additional cost of $3391.70, with an ICER of $2630.53 (95% CI: $1159.81-$5090.12) per QALY gained. The ICER was considerably lower than the recommended willingness-to-pay (WTP) threshold (i.e., $28,130.00 per QALY). The results were sensitive to the discount rate, drug cost, and treatment cost after relapse. Further, the NNT to prevent one additional relapse case was 29.2 (95% CI: 13.2-196.6), 16.7 (95% CI: 8.4-111.6), and 12.0 (95% CI: 5.7-82.6) at 1, 2, and 5 years, respectively. CONCLUSIONS: One-year capecitabine maintenance therapy for early-stage TNBC after standard treatment, compared with routine follow-up, was found to be highly cost-effective with promising clinical benefits and acceptable increased costs. Real-world studies are warranted to validate our findings in the future.