Fitness cost of tet(A) type I variant-mediated tigecycline resistance in Klebsiella pneumoniae.

OBJECTIVE: The aim of the present study is to explore the impact of the tet(A) type I variant (tetA-v1) on its fitness effect in Klebsiella pneumoniae. METHODS: Clinical K. pneumoniae strains were utilized as parental strains to generate strains carrying only the plasmid vector (pBBR1MCS-5) or the tetA-v1 recombinant plasmid (ptetA-v1). Antimicrobial susceptibility testing was conducted to estimate the contribution of tetA-v1 to drug resistance. Plasmid stability was evaluated by serial passage over 10 consecutive days in the absence of tigecycline. Biological fitness was examined through growth curve analysis, in vitro competition assays and a neutropenic mouse thigh infection model. RESULTS: A 2-4-fold increase in tigecycline MIC was observed following the acquisition of tetA-v1. Without tigecycline treatment, the stability of ptetA-v1 plasmids has been decreasing since day 1. The ptetA-v1 plasmid in Kp89, Kp91, and Kp93 exhibited a decrease of about 20% compared to the pBBR1MCS-5 plasmid. The acquisition of the tetA-v1 gene could inhibit the growth ability of K. pneumoniae strains both in vitro and in vivo. tetA-v1 gene imposed a fitness cost in K. pneumoniae, particularly in the CRKP strain Kp51, with a W value of approximately 0.56. CONCLUSION: The presence of tetA-v1 is associated with a significant fitness cost in K. pneumoniae in the absence of tigecycline, both in vitro and in vivo.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China.

BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status. METHODS: A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses. RESULTS: Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01). CONCLUSIONS: The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

Magnetic leakage behavior assessment in pipeline stress-concentrated areas using improved force-magnetic coupling model.

Magnetic flux leakage (MFL) technology is remarkable for its capability to detect pipeline geometric deformation and general corrosion defects. However, it cannot characterize the MFL behavior in stress-concentrated areas, thereby greatly challenging the subsequent pipeline maintenance. This study suggests that the MFL characteristics of pipeline in stress-concentrated areas are caused by the combined effect of the face magnetic charge on the deformed end-face and the body magnetic charge of the dislocation stack. In addition, an improved force-magnetic coupling model of the pipeline in stress-concentrated areas is established based on the magnetic dipole model and Jiles-Atherton (J-A) theory. In the verification experiment, the Q235 steel plate is magnetized along the extension direction (axis of the pipeline) through the solenoid coil to obtain the distribution law of the MFL signal in the stress-concentrated area under different excitation intensities. The results show that with the increase in excitation intensity, the deformation of the MFL field signal caused by the end-face of the stress-concentrated area gradually increases to a stable state. Moreover, the internal stress of the MFL field signal generated by the pipe dislocation rapidly increases to a peak value and then decays exponentially to a certain base value. The overall change trend is in good agreement with the calculation results of the established force-magnetic coupling model. Meanwhile, the differentiation research between deformation and internal stress MFL field signals under different magnetic field intensities can provide a reliable theoretical basis for the subsequent accurate identification and quantification of pipeline stress-concentrated areas.

Trihalomethanes in global drinking water: Distributions, risk assessments, and attributable disease burden of bladder cancer.

This study aimed to assess the global spatiotemporal variations of trihalomethanes (THMs) in drinking water, evaluate their cancer and non-cancer risks, and THM-attributable bladder cancer burden. THM concentrations in drinking water around fifty years on a global scale were integrated. Health risks were assessed using Monte Carlo simulations and attributable bladder cancer burden was estimated by comparative risk assessment methodology. The results showed that global mean THM concentrations in drinking water significantly decreased from 78.37 µg/L (1973-1983) to 51.99 µg/L (1984-2004) and to 21.90 µg/L (after 2004). The lifestage-integrative cancer risk and hazard index of THMs through all exposure pathways were acceptable with the average level of 6.45 × 10-5 and 7.63 × 10-2, respectively. The global attributable disability adjusted of life years (DALYs) and the age-standardized DALYs rate (ASDR) dropped by 16% and 56% from 1990-1994 to 2015-2019, respectively. A big decline in the attributable ASDR was observed in the United Kingdom (62%) and the United States (27%), while China experienced a nearly 3-fold increase due to the expanded water supply coverage and increased life expectancy. However, China also benefited from the spread of chlorination, which helped reduce nearly 90% of unsafe-water-caused mortality from 1998 to 2018.

Emphasis should be placed on identifying and reporting research priorities to increase research value: An empirical analysis.

OBJECTIVES: To compared the presentation of research priorities in the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) clinical practice guidelines (CPGs) developed under the guidance of the GRADE working group or its two co-chair, and the Chinese CPGs. METHODS: This was a methodological empirical analysis. We searched PubMed, Embase, and four Chinese databases (Wanfang, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure and Chinese Biomedical Literature Database) and retrieved nine Chinese guideline databases or Society websites as well as GRADE Pro websites. We included all eligible GRADE CPGs and a random sample of double number of Chinese CPGs, published 2018 to 2022. The reviewers independently screened and extracted the data, and we summarized and analyzed the reporting on the research priorities in the CPGs. RESULTS: Of the 135 eligible CPGs (45 GRADE CPGs and 90 Chinese CPGs), 668, 138 research priorities were identified respectively. More than 70% of the research priorities in GRADE CPGs and Chinese CPGs had population and intervention (PI) structure. 99 (14.8%) of GRADE CPG research priorities had PIC structures, compared with only 4(2.9%) in Chinese. And 28.4% (190) GRADE CPG research priorities reflected comparisons between PICO elements, approximately double those in Chinese. The types of research priorities among GRADE CPGs and Chinese CPGs were mostly focused on the efficacy of interventions, and the type of comparative effectiveness in the GRADE research priorities was double those in Chinese. CONCLUSIONS: There was still considerable room for improvement in the developing and reporting of research priorities in Chinese CPGs. Key PICO elements were inadequately presented, with more attention on intervention efficacy and insufficient consideration given to values, preferences, health equity, and feasibility. Identifying and reporting of research priorities deserves greater effort in the future.

Hexabromocyclododecane-induced reproductive toxicity in Brachionus plicatilis: Impacts and assessment.

Hexabromocyclododecane (HBCD), third-generation brominated flame retardants (BRFs), has aroused worldwide concern because of its wide application and potentially negative impacts on marine ecosystems, but an information gap still exists regarding marine low-trophic organisms. Brachionus plicatilis, the model marine zooplankton, was used in the present study, and its reproductive responses were used as the endpoint to indicate HBCD-induced toxicity. HBCD was suggested to be extremely highly toxic compounds regarding the 96 h-LC50 of 0.58 mg L-1. The sublethal exposure of HBCD injured the reproduction of B. plicatilis: The total number of offspring per female and the key population index calculated from the life table, including the intrinsic rate of population increase (rm) and net reproductive rate (R0), were significantly influenced in a concentration-dependent manner. The reproductive process was also altered, as indicated by the first spawning time, first hatching time and oocyst development time. At the same time, individual survival and growth (body length) were also negatively affected by HBCD. Reactive oxygen species (ROS) were suggested to be responsible for reproductive toxicity mainly because the total ROS contents as well as the main components of •OH and H2O2 greatly increased and resulted in the oxidative imbalance that presented as malondialdehyde (MDA) elevation. Simultaneous activation of the glutathione antioxidant system was accompanied by the apoptosis marker enzymes Caspase-3 and 9, as well as the correlation between ROS content, physiological alteration and cell apoptosis, providing further evidence for this. The integrated biomarker response (IBR) and adverse outcome pathway (AOP) showed that HBCD had a significant toxic effect on B. plicatilis near the concentration range of 96 h-LC50. The establishment of this concentration range will provide a reliable reference for future environmental concentration warning of HBCD in marine.

Carbon emission change based on land use in Gansu Province.

Carbon emissions from land use change have become one of the main sources of regional carbon emissions. In order to explore the changes, 87 districts and counties in Gansu Province are taken as research objects. Based on the remote sensing data and statistical data of land use, the carbon emission coefficient method was used to investigate the spatial characteristics of land use carbon emission of each district and county in Gansu Province in recent 20 years from the perspective of carbon ecological support coefficient and per capita carbon footprint. The main results are as follows: (1) the growth of land use carbon emissions in Gansu Province from 2000 to 2020 was significant, but the growth of carbon emissions after 2010 was fast, and the growth of carbon sinks was relatively slow. (2) The ecological support coefficient of carbon emissions at county level in Gansu Province showed a trend of high in the south and low in the north, high in the east and low in the west, and this trend became more and more obvious with the passage of time. (3) Based on carbon emission, county population, and carbon ecological support capacity, the per capita carbon footprint of each county in Gansu Province was analyzed. The results showed that the per capita carbon footprint in Gansu Province was increasing, indicating that the gap between carbon emission and carbon absorption in each county was widening. By the above result, the author divides the counties of Gansu Province into three regions, low-carbon maintenance area, green development area, and ecological optimization area, and puts forward development suggestions for different regions, respectively. Therefore, this paper can also provide a theoretical reference for the formulation of carbon neutral planning measures in inland northwest China.

Investigation on the budget of peroxyacetyl nitrate (PAN) in the Yangtze River Delta: Unravelling local photochemistry and regional impact.

Peroxyacetyl nitrate (PAN) is a significant indicator of atmospheric photochemical pollution, which can influence the regional distribution of ozone (O3) and hydroxyl radical (OH) through long-range transport. However, investigations of PAN incorporating comprehensive measurement and explicit modeling analysis are limited, hindering complete understandings of its temporal behavior, sources, and impacts on photochemistry. Here we conducted a 1-year continuous observation of PAN and relative atmospheric species in Nanjing located in Yangtze River Delta (YRD). The annual mean concentration of PAN was 0.62 ± 0.49 ppbv and showed a bimodal monthly variation, peaking in April-June and November-January, respectively. This pattern is different from the typical pattern of photochemistry, suggesting important contributions of other non-photochemical processes. We further analyzed the PAN budget using an observation-based model, by which, PAN from local photochemical production and regional source could be decoupled. Our results revealed that local photochemical production of PAN is the sole contributor to PAN in summer, whereas about half of the total PAN concentration is attributed to regional source in winter. Although the formation of PAN can suppress the atmospheric oxidation capacity by consuming the peroxyacetyl radical and nitrogen dioxide (NO2), our analyses suggested this effect is minor at our station (-3.2 ± 1.1 % in summer and - 7.2 ± 2.8 % in winter for O3 formation). However, it has the potential to enhance O3 and OH formation by 14.16 % and 5.93 %, if transported to cleaner environments with air pollutants halved. Overall, our study highlights the importance of both local photochemistry and regional process in PAN budget and provides a useful evaluation on the impact of PAN on atmospheric oxidation capacity.

Assessment of nonylphenol exposure based on global urinary concentration data and its risk analysis.

Nonylphenol (NP) has been recognized as a priority hazardous substance because of its estrogenic activity and ubiquity in the environment. Therefore, it is important to understand the daily intake of NP in humans and evaluate the potential health risks of NP. The median or average estimated daily intake (EDI) of NP was estimated based on urinary NP or alkyl-chain-oxidized NP metabolites concentration data from published epidemiological studies. In brief, we acquired 34 peer-reviewed publications, which contained 14235 samples from twelve countries or regions. The global average estimated daily intake of NP was 1.003 µg/(kg bw·day), which was lower than the tolerable daily intake recommended by the Danish Veterinary and Food Authority [5 µg/(kg bw·day)]. Korea had the highest exposure level [3.471 µg/(kg bw·day)] among different countries or regions. Compared with the adult [0.743 µg/(kg bw·day)] and pregnant women [0.806 µg/(kg bw·day)] groups, the children group had the highest estimated daily intake of NP at 2.368 µg/(kg bw·day). Besides, the global NP risk hazard quotient was 0.201, and the risk hazard quotients of all countries or regions were less than 1. However, the global HQ value of the 95th quantile population was 2.299, which was much higher than 1, the potential health risk cannot be ignored and needs to be confirmed by more research. To our knowledge, this is the first study to assess the overall NP exposure levels based on published biomonitoring data, and has important implications for assessing the potential effects of NP exposure on human health. In addition, OH-NP is a robust and sensitive novel biomarker for NP, there are fewer studies on the application of this biomarker, and more studies are needed in the future for quantitative exposure and risk assessment of NP.

The allometric relationship between carbon emission and economic development in Yangtze River Delta: fusion of multi-source remote sensing nighttime light data.

Exploring the allometric relationship between carbon emission and economic development can provide guidance for policy-makers who hope to accelerate carbon emission reduction and achieve high-quality development. First, based on the established DMSP/OLS and NPP/VIIRS nighttime light datasets, this study simulated the carbon emissions of the Yangtze River Delta from 2000 to 2020. Second, our research analyzed the spatiotemporal evolution characteristics of carbon emissions. Third, adopting allometric growth model, we explored the allometric relationship between economic development and carbon emissions in Yangtze River Delta. The main conclusions are as follows. First, four prediction models, namely, linear fitting, support vector machine, random forest, and CNN-BiLSTM deep learning, were compared to simulate the accuracy of carbon emissions. Consequently, the CNN-BiLSTM deep learning estimation model presented the best accuracy. Second, both the carbon emissions in YRD as a whole showed an increasing trend, with the largest growth rate appearing in Shanghai and the smallest growth rate occurring in Lishui. Moreover, the high-carbon emission areas were mainly distributed in the core city cluster, which are enclosed by Shanghai, Nanjing, and Hangzhou. Finally, the allometric relationship between economic development and carbon emissions was dominated by one-level negative during the sample period, and the relative growth rate of carbon emissions is lower than that of the economic development, which made the YRD at a basic coordinate stage of weak expansion of economy.

Influencing factors and spatiotemporal heterogeneity of net carbon sink of conservation tillage: evidence from China.

Conservation tillage is an important reform of traditional tillage, which has significant carbon sequestration and emission reduction effects. It is important to investigate the influencing factors and spatiotemporal heterogeneity of net carbon sink of conservation tillage for realizing the "dual carbon" target, and facilitating agricultural sustainable development. This study used the coefficient accounting method to calculate the carbon sink and carbon emission of conservation tillage in China from 2000 to 2019, respectively. Based on this, the net carbon sink of conservation tillage was measured. Then, the spatiotemporal heterogeneity of influencing factors on net carbon sink of conservation tillage was analyzed by using the geographically and temporally weighted regression model. The results showed that (1) the net carbon sink of conservation tillage in China was significant and had potential to have a constant rise; (2) spatially, the net carbon sink of conservation tillage changed more variably in longitudinal direction. Specifically, the promotion effect of conservation tillage machinery gradually decreased from west to east. The planting structure and conservation tillage promotion intensity played key roles in improving net carbon sink of conservation tillage. (3) Temporally, the effect of conservation tillage machinery showed positive effect of decreasing yearly, while the positive effect of promotion intensity increased year by year. Planting structure and economic development negatively affected improvement on the net carbon sink of conservation tillage and the negative effect increased year by year. Additionally, the effect of education on the net carbon sink shifted from positive to negative over time. The study aims to provide a reference for the government to promote conservation tillage according to local conditions and to achieve the "dual carbon" target.

[Clinical comprehensive evaluation of Xiangju Capsules in treatment of rhinosinusitis].

The articles involving Xiangju Capsules were retrieved, and qualitative research and quantitative research methods were combined to evaluate the evidence of the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine( "6+1" dimensions) of this drug. Multi-criteria decision analysis(MCDA) model and CSC v2.0 software were used to comprehensively evaluate the clinical value of Xiangju Capsules in the treatment of rhinosinusitis and clarify the precise clinical positioning. The dimensions are graded A, B, C, or D. Multi-source safety evidence showed that the main adverse reactions were gastrointestinal reactions, rash, itching, dizziness, and headache. Based on the available studies, the risk is controllable and the safety is grade A. Meta-analysis showed that Xiangju Capsules + conventional western medicine could recover the Lund-Kennedy score, Lund-Mackay score, and CT score, relieve headache, nasal congestion, olfactory disturbance, and facial pain, with the effectiveness is grade B. The incremental cost-effectiveness ratio of Xiangju Capsules + conventional western medicine compared with conventional western medicine alone in the treatment of chronic rhinosinusitis was 263.71 yuan, about 0.82% of the per capita disposable income. The results of sensitivity analysis showed that the research results were relatively robust. Based on the assumption that the per capita disposable income in 2020 will be the threshold of patients' willingness to pay, it is more economical to use Xiangju Capsules + conventional western medicine. The drug belongs to grade A of the national medical insurance, with an average daily cost of 3.06 yuan, and the economy is grade B. This formula is modified from classic formulas and characteristic empirical formulas, be capable of improving immunity and preventing repeated attacks. It can be used for acute and chronic rhinitis-rhinosinusitis. It had a wide range of applicability, especially for the patients with head and face tenderness. Service innovation was reflected in the measures to guarantee supply, capacity, scalability, and coverage of grass-roots sales channels. The industrial innovation was improved through the management of medicinal resources, pharmaceutical industry, production technology, quality control, scientific research and development, and this formula won three national invention patents. Comprehensively, the innovation of Xiangju Capsules is grade B. According to the survey of 188 medical practitioners and 196 patients in 20 provinces, municipalities, and autonomous regions of China, the drug was characterized by easy preparation and administration, individualized medication, simple technology and management, convenient use, storage, and transport, and controllable adverse reactions, with the suitability is grade B. Xiangju Capsules showed the cost of 45.9 and 275.4 yuan for treatment of acute and chronic rhinitis-rhinosinusitis, respectively, being well affordable. It was sold in 35 000 medical institutions in China. The dosage form was suitable for transportation, storage, and grass-root application. With rich, sustainable, and available medicinal resources, the accessibility of Xiangju Capsules is grade A. This drug can be used for both acute and chronic rhinitis-rhinosinusitis, clearing heat and expelling pus, and strengthening the exterior to prevent relapse. After this drug was available on the market, over 4 000 cases were studied, with rich experience in human use accumulated, and characteristics of traditional Chinese medicine is grade B. Overall, the clinical value of Xiangju Capsules is class B. It is suggested that Xiangju Capsules should be used in accordance with the relevant policies of basic clinical drug administration to play its role.

Blood Circulation Assessment by Steadily Fluorescent Near-Infrared-II Aggregation-Induced Emission Nano Contrast Agents.

The dysfunction of the blood circulation system typically induces acute or chronic ischemia in limbs and vital organs, with high disability and mortality. While conventional tomographic imaging modalities have shown good performance in the diagnosis of circulatory diseases, multiple limitations remain for real-time and precise hemodynamic evaluation. Recently, fluorescence imaging in the second region of the near-infrared (NIR-II, 1000-1700 nm) has garnered great attention in monitoring and tracing various biological processes in vivo due to its advantages of high spatial-temporal resolution and real-time feature. Herein, we employed NIR-II imaging to carry out a blood circulation assessment by aggregation-induced emission fluorescent aggregates (AIE nano contrast agent, AIE NPs). Thanks to the longer excited wavelength, enhanced absorptivity, higher brightness in the NIR-II region, and broader optimal imaging window of the AIE NPs, we have realized a multidirectional assessment for blood circulation in mice with a single NIR-II imaging modality. Thus, our work provides a fluorescence contrast agent platform for accurate hemodynamic assessment.

Understanding financial risk protection in China's health system: a descriptive analysis using data from multiple national household surveys.

BACKGROUND: Providing financial risk protection is one of the fundamental goals of health systems. Catastrophic health expenditure (CHE) and medical impoverishment (MI) are two common indicators in evaluating financial risk protection in health. As China continues its health system reform to provide accessible and affordable health care, it is important to have a clear understanding of China's progress in financial risk protection. However, past research showed discrepancies in the incidence of CHE and MI. In this article, using data from four national household surveys, we analyzed levels and characteristics of CHE and MI in China under different definitions. METHODS: We used multiple conventional thresholds for CHE and MI to comprehensively describe the levels of financial risk protection in China. We used data from four national household surveys to measure the incidence of CHE and MI, and their inequalities by urban/rural status and by income quartiles. The Probit regression model was used to explore influencing factors of CHE and MI. RESULTS: We found that the incidences of CHE and MI were largely consistent across four national household surveys, despite different sampling methods and questionnaire designs. At the 40% nonfood expenditure threshold, the incidence of CHE in China was 14.95%-17.73% across four surveys during the period of 2016-2017. Meanwhile, at the 1.9 US dollars poverty line, the incidence of MI was 2.01%-5.63%. Moreover, rural residents, lower-income subgroups, and smaller households were faced with higher financial risks from healthcare expenditures. Although positive progress in financial risk protection has been achieved in recent years, China has disproportionately high incidences of CHE and MI, compared to other countries. CONCLUSION: China has large margins for improvements in risk financial protection, with large inequalities across subgroups. Providing better financial protection for low-income groups in rural areas is the key to improve financial protection in China.

Differences among fathers, mothers, and teachers in symptom assessment of ADHD patients.

Background: The Swanson Nolan, and Pelham scale version IV (SNAP-IV) is the most critical tool for ADHD screening and diagnosis, which has two scoring methods. ADHD requires symptom assessment in multiple scenarios, and parent and teacher reports are indispensable for diagnosing ADHD. But the differences of assessment results from fathers, mothers and teachers, and the consistency of results from different scoring methods are unknown. Therefore, we carried out this study to understand the differences in the scores of fathers, mothers and teachers using SNAP-IV for children with ADHD and to explore the differences in scoring results under different scoring methods. Methods: The SNAP-IV scale and Demographics Questionnaire and Familiarity Index were used to survey fathers, mothers and head teachers. Measurement data are expressed as the mean ± standard deviation (x ± s). The enumeration data were described by frequency and percentage. ANOVA was used to compare group differences in mothers', fathers', and teachers' mean SNAP-IV scores. The Bonferroni method was used for post hoc multiple comparison tests. Cochran's Q test was used to compare the differences in the abnormal rate of SNAP-IV score results of mothers, fathers and teachers. Dunn's test was used for post hoc multiple comparison tests. Results: There were differences in scores among the three groups, and the differences showed inconsistent trends across the different subscales. Differences between groups were calculated again with familiarity as a control variable. The results showed the familiarity of parents and teachers with the patients did not affect the differences in their scores. The evaluation results were different under two assessment methods. Conclusion: Results concluded that fathers did not appear to be an appropriate candidate for evaluation. When using the SNAP-V for assessment, it should be comprehensively considered from both the scorer and symptom dimensions.

Optimal pricing and carbon emission reduction decisions for a prefabricated building closed-loop supply chain under a carbon cap-and-trade regulation and government subsidies.

This paper explores a two-level prefabricated building closed-loop supply chain (CLSC) comprising a retailer and a prefabricated building manufacturer (PBM) under carbon cap-and-trade legislation and the government subsidies of carbon emission reduction (CER). In this CLSC, the PBM and the retailer recycle used products through their independent recycling channels. The optimum pricing and CER strategies within both decentralized and centralized systems, respectively, are analyzed. The Stackelberg game is used in the decentralized system to determine the optimum PBM's CER level and the retailer's pricing. By analysis, it concludes that increasing the carbon trading price can stimulate prefabricated construction corporations to improve their CER level, and that the government subsidy rate has a great effect on the profits of the PBM. Numerical examples with sensitivity analysis are used to further evaluate the roles of important factors in the optimum CER and pricing solutions of the prefabricated building CLSC in two dissimilar systems.

[Changes in Land Use Carbon Emissions and Coordinated Zoning in China].

Carbon emissions from land use changes have become one of the main sources of regional carbon emissions. In order to explore its changes, based on the MCD12Q-LUCC data of MODIS from 2001 to 2019 using the carbon emission coefficient method, clustering, and outlier analysis method, the spatial characteristics of land use carbon emissions in various provinces in China in the past 19 years were discussed from the perspectives of carbon emission economy contributive coefficient, carbon ecological support coefficient, and their coupling and coordination relationship. The results showed that:① from 2000 to 2019, the national land use carbon emissions increased significantly; however, after 2011, the growth rate of carbon emissions became flat, whereas the growth of carbon sinks was relatively slow, and the gap between the two was still large. ② Clustering and outlier analysis showed that during the study period, the high-value agglomeration centers of land use carbon emissions in various provinces and cities across the country shifted from Guangdong, Jiangsu, and other provinces to Hebei, Shanxi, Inner Mongolia, and other provinces, and the agglomeration status became increasingly obvious. ③ The economy contributive coefficient of carbon emissions in all provinces and cities across the country had the spatial characteristics of being high in the south and low in the north, and the ecological support coefficient gradually developed from high in the west to low in the east, followed by that in the north, and the coupling coordination between the two showed a downward trend. ④ Based on the economy contributive of carbon emissions and carbon ecological support, this study divided the provinces into four categories:low-carbon maintenance area, economic development area, carbon sink development area, and comprehensive optimization area. We also put forward our own development suggestions, striving to achieve carbon neutrality and low-carbon sustainable development.

Fipronil and its transformation products in the Yangtze River: Assessment for ecological risk and human exposure.

Fipronil (FP), a phenylpyrazole insecticide, is widely used in agricultural, residential, and veterinary settings. It is toxic to ecosystems and humans; moreover, some of its transformation products are more toxic than FP. A comprehensive profile of the contamination of the Yangtze River by FP and its transformation products (FPs) is not yet available. This study aims to fill this data gap. A total of 144 water samples were collected from 72 sampling locations along the river during the wet (June 2021) and dry (December 2020) seasons. High detection rates (85.4-91.7%) of FPs were found, with ΣFPs' median concentration of 0.49 ng/L. The parent compound FP was the most abundant (median: 0.13 ng/L), followed by FP-desulfinyl (0.08), FP-sulfone (0.07), FP-detrifluoromethylsulfinyl (DTF, 0.07), FP-sulfide (0.06) and FP-amide (0.06). Their concentrations increased significantly from the upper to the lower reaches; for approximately every 100 km toward the lower reaches, the level of FPs increased by 13-15%. The urban region and wet season had the higher FPs contamination. Through water ingestion, the human exposure risk posed by FPs in the river was acceptable; however, the ecological risk assessment showed a moderate to high risk posed by FPs. Follow-up studies are warranted to establish integrated ecological risk assessment models and conduct epidemiological risk assessments among population groups with high exposure levels of FPs. Given the high ecological risk of FPs, regular monitoring of them in the Yangtze River is necessary. FP-DTF was reported in surface water for the first time.

Understanding medical corruption in China: a mixed-methods study.

Medical corruption is a significant obstacle to achieving health-related Sustainable Development Goals. However, the understanding of medical corruption is limited, especially in developing countries. As the largest developing country, China is also plagued by medical corruption. By employing a mixed-methods design and combining data from three resources, this study attempts to examine patterns of medical corruption in China, explore its key drivers and investigate the perceived effectiveness of recent anti-corruption interventions. Using extracted data from 3546 cases on the China Judgments Online website between 2013 and 2019, we found that bribery, embezzlement and insurance fraud accounted for 68.1%, 22.8% and 9.1% of all medical corruption cases, respectively. Bribery was the major form of medical corruption. Approximately 80% of bribe-takers were healthcare providers, and most bribe-givers were suppliers of pharmaceuticals, medical equipment and consumables. Using a nationally representative household survey, we further found that the prevalence of informal payments from patients remained at a low level between 2011 and 2018. In 2018, only 0.4% of outpatients and 1.4% of inpatients reported that they had ever given 'red envelopes' to physicians in the past. Finally, we conducted interviews with 17 key informants to explore drivers of medical corruption and investigated the perceived effectiveness of recent anti-corruption interventions in China. Interview results showed that financial pressure and weak oversight were two main reasons for corrupt behaviours. Interview results also suggested that the anti-corruption campaign since 2012, the national volume-based procurement, and the special campaign against medical insurance fraud had reduced opportunities for medical corruption, implying China's positive progress in combating medical corruption. These findings hold lessons for anti-corruption interventions in China as well as other developing countries.

An aging giant at the center of global warming: Population dynamics and its effect on CO2 emissions in China.

Revealing the complex correlation between population aging and CO2, and projecting their future dynamics are fundamentally necessary to inform effective policies toward a low-carbon and sustainable development in China. Differing from the existing studies, this study highlighted a quantitative investigation on the impact of aging on CO2 emissions across the different stages of regional development in China through a STIRPAT model based on balanced provincial panel data from 1995 to 2019, and projected the demographic change and CO2 emissions till 2050 by employing cohort model and scenario analysis. It is found that CO2 emissions in China has witnessed a significant growth during 1995-2019, and will exhibit an inverted U-shaped growth till 2050 with its peak appears between 2030 and 2040. Statistically, every 1% growth of aging population will cause a 0.62% increase in CO2 emissions in China. However, a big regional difference was also detected as aging contributed to CO2 reduction in the eastern region, but stimulated CO2 emissions in the central and western regions. Policy implications for achieving a low-carbon and aging-oriented sustainable development may include the integration of aging into the decision-making in industrial structure upgrading and CO2 emission reduction at both national and region levels, the promotion of further transition to low-carbon consumption and green products in the eastern region, and strengthening the deep fusion of aging-oriented industries with local resource and environmental endowment in the central and western regions such as the development of eco-agriculture and green pension industries.