Prognosis of patients with advanced bile tract carcinoma: assessment using the modified-Gustave Roussy Immune Score (mGRIm-s) as a clinico-immunological tool.

BACKGROUND: The emergence of immune checkpoint inhibitors (ICIs) has enhanced survival outcomes for certain patients with advanced biliary tract carcinoma (BTC). Pinpointing those who would benefit most from immunotherapy remains elusive. We investigated the predictive value of the modified Gustave Roussy Immune Score (mGRIm-s) in BTC patients treated with ICIs. METHODS: Data from 110 patients at Chinese People's Liberation Army General Hospital, spanning September 2015 to April 2021, were analyzed. The median follow-up duration was 38.7 months as of December 2023. Risk factors included low albumin, high lactate dehydrogenase, and an elevated neutrophil-lymphocyte ratio. Patients were stratified into low (patients with no risk factors) and high (patients with at least one risk factor) mGRIm-s groups based on these factors. RESULTS: Survival outcomes post-immunotherapy favored the low mGRIm-s group, with significantly improved progression-free survival (PFS) and overall survival (OS) (8.50 months vs. 3.70 months and 21.60 months vs. 8.00 months). COX regression confirmed an elevated risk in the high mGRIm-s group. Subgroup analysis highlighted a notable survival advantage for low mGRIm-s patients receiving first-line immunotherapy. CONCLUSIONS: This study underscores mGRIm-s's potential in predicting immunotherapy response in BTC, paving the way for more targeted approaches.

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.

A framework for selecting and assessing soil quality indicators for sustainable soil management in waste dumps.

The primary objective of this study was to develop soil quality indexes (SQIs) to reveal the changes in SQ during the restoration of vegetation in the reclaimed waste dumps of the Hequ open-pit coal mine. The study built an SQI evaluation model for waste dumps based on the soil management assessment framework. The total data set (TDS) consisted of nine physicochemical property indicators. The selection of the minimum data set (MDS) involved the utilization of principal component analysis (PCA) and Norm values. The SQ was comprehensively evaluated for nine indicators, taking into account the non-linear membership function and the improved Nemerow index. The findings suggested a notable disparity in the SQ between the reclaimed area and the unreclaimed area, yet the overall SQ fell short. In the TDS index system, the organic matter has the highest weight and a greater contribution to the soil quality of the waste dumps. In the MDS indicator system, the weights of organic matter and total nitrogen are both 0.5. According to Nemerow index method, the average SQIN of 5 plots is calculated to be 0.4352 ± 0.194. The average value obtained from TDS is 0.581 ± 0.236, and the average value obtained from MDS is 0.602 ± 0.351. The weighted additive method was employed to compute three SQIs, all of which yielded satisfactory outcomes. And the above evaluation methods indicate that the overall soil quality level of the waste dumps is at a moderate level. The sequence of SQ in various waste dumps was as follows: No.4lower > No.1 > No.2 > No.3 > No.4upper. Specifically, the non-linear membership function indicated that pH, available nitrogen (AN), available phosphorus (AP), surface moisture content (SMC), and bulk density (BD) were crucial in limiting SQIs in total waste dumps. The crucial limiting SQIs in unreclaimed areas were total phosphorus (TP) and total nitrogen (TN). This analysis demonstrates its efficacy in formulating strategies for the SQ evaluation and targeted soil reclamation plans of waste dumps.

Epitaxial Growth of Large-Scale 2D CrTe2 Films on Amorphous Silicon Wafers With Low Thermal Budget.

2D van der Waals (vdW) magnets open landmark horizons in the development of innovative spintronic device architectures. However, their fabrication with large scale poses challenges due to high synthesis temperatures (>500 °C) and difficulties in integrating them with standard complementary metal-oxide semiconductor (CMOS) technology on amorphous substrates such as silicon oxide (SiO2 ) and silicon nitride (SiNx ). Here, a seeded growth technique for crystallizing CrTe2 films on amorphous SiNx /Si and SiO2 /Si substrates with a low thermal budget is presented. This fabrication process optimizes large-scale, granular atomic layers on amorphous substrates, yielding a substantial coercivity of 11.5 kilo-oersted, attributed to weak intergranular exchange coupling. Field-driven Néel-type stripe domain dynamics explain the amplified coercivity. Moreover, the granular CrTe2 devices on Si wafers display significantly enhanced magnetoresistance, more than doubling that of single-crystalline counterparts. Current-assisted magnetization switching, enabled by a substantial spin-orbit torque with a large spin Hall angle (85) and spin Hall conductivity (1.02 × 107 ℏ/2e Ω⁻¹ m⁻¹), is also demonstrated. These observations underscore the proficiency in manipulating crystallinity within integrated 2D magnetic films on Si wafers, paving the way for large-scale batch manufacturing of practical magnetoelectronic and spintronic devices, heralding a new era of technological innovation.

[Spatio-temporal Evolution and Multi-scenario Simulation of Carbon Storage in Karst Regions of Central Guizhou Province：Taking Puding County as An Example].

Regional land use change is the main cause for the change in karst carbon storage. It is important to analyze the spatial and temporal evolution and future spatial distribution trends of carbon storage in typical counties in central Guizhou's karst region， such as Puding County， to improve regional carbon storage， optimize land ecological security patterns， and promote low-carbon sustainable urban development. The PLUS-InVEST model was coupled， based on the interpreted land use data and future land prediction， the spatial and temporal evolution characteristics of land use change and carbon storage in Puding County from 1973 to 2020 were inverted， and the spatial pattern evolution of land use and carbon storage change under different scenarios in 2060 were simulated and predicted. The results showed： ① from 1973 to 2020， the overall carbon storage in Puding County increased by 6.61×105 t， showing an upward trend. The spatial distribution showed a significant increase in the northeastern and southwestern parts of Puding County and a significant decrease in the south-central parts. The change was due to the increase in carbon storage in dryland to shrubland and forest land and the decrease in carbon storage in areas where paddy fields are converted to construction land. ② The land use change in Puding County in the historical period was mainly reflected in the continuous expansion of construction land and the increased fluctuation of the proportion of forest land and shrub forest land， and the change in land use in different scenarios projected in 2060 retained the change characteristics of the historical period. ③ In 2060， the carbon storage in Puding County under the scenarios of natural evolution， ecological protection， and economic development increased by 2.93×105， 5.40×105， and 1.11×105 t， respectively， compared with that in 2020. Of these， the increase in ecological protection scenarios was the most significant， with the transfer of dryland to shrubland being the main reason for the increase in regional carbon sequestration capacity. These results can serve as a scientific reference for land use management decisions and the formulation of emission reduction and sink increase policies in Puding County. The future land use planning of karst areas should be guided by the goal of "carbon neutrality" in 2060， take appropriate ecological protection measures， strictly control the rapid expansion of construction land to paddy fields， optimize the land use structure， and effectively improve the level of regional carbon storage.

Availability, price, and affordability of anti-hepatitis B virus drugs: a cross-sectional study in China.

BACKGROUND: The global prevalence of hepatitis B virus (HBV) has presented a persistent challenge for public health prevention and treatment. However, studies that assess the public's access to anti-HBV drugs are absent. AIM: To examine the availability, pricing, and affordability of anti-HBV drugs in Jiangsu province, China and provide recommendations for improvement. METHOD: An enhanced methodology developed by the World Health Organization (WHO) and Health Action International was applied in a cross-sectional study that included 1026 healthcare facilities distributed in 13 prefectural-level cities in Jiangsu province. RESULTS: Since almost all drugs had an availability of less than 30%, the accessibility of anti-HBV drugs was notably low. Primary healthcare facilities had the lowest availability, reporting 1.4% for Original Brands (OBs) and 1.7% for lowest-priced generics (LPGs). Furthermore, the northern Jiangsu region recorded the lowest availability at 0.7%. LPGs demonstrated higher availability than OBs, with median availability probabilities of 2.6% and 1.4%, respectively. The drugs listed on the WHO Essential Medicines List exhibited higher availability than those on other lists. The median price ratios for OBs, LPGs, and volume-based purchasing drugs were 0.83, 0.50, and 0.27, respectively, less than 1.5 times the international reference price. Despite favorable pricing, affordability rate was 23% for urban residents and 0% for rural residents, which was discouraging. CONCLUSION: Low availability and affordability of anti-HBV drugs were observed. Policy recommendations should emphasize the improvement of LPG availability by incentivizing priority prescribing. Healthcare subsidies should be provided more effectively and equitably.

Trends in forgone medical care and unmet needs among Medicare beneficiaries with a history of depression during the COVID-19 pandemic: a national, repeated cross-sectional study.

OBJECTIVES: To investigate trends in forgone medical care, basic needs disruption, financial and mental health disruption, engagement of preventive behaviours guidelines, and perceived severity of COVID-19 among community-living Medicare beneficiaries in the USA with and without a self-reported history of depression from Summer 2020 to Winter 2021. DESIGN/SETTING: A repeated cross-sectional study using a nationally representative sample of Medicare beneficiaries of three rounds of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement Public Use Files: Summer 2020, Fall 2020 and Winter 2021. PARTICIPANTS: A total of 28 480 community-dwelling Medicare beneficiaries. MAIN OUTCOME MEASURES: Forgone medical care, basic needs disruption, financial and mental health disruption, engagement of preventive behaviours guidelines, and perceived severity of COVID-19. RESULTS: In the study sample, 7629 (27%) had a history of depression. After adjusting for potential confounders, weighted multivariable logistic regression models showed that Medicare beneficiaries with a history of depression had higher odds of foregone medical care (OR: 1.29, 95% CI 1.16 to 1.42, p<0.001), of basic need disruption (OR: 1.49, 95% CI 1.33 to 1.67, p<0.001), and of financial and mental health disruption (OR: 1.75, 95% CI 1.60 to 1.91, p<0.001) during the COVID-19 pandemic when compared with those without a history of depression. No statistically significant differences were observed in engagement of essential preventive behaviours or perception of COVID-19 severity. CONCLUSIONS: COVID-19 pandemic may exacerbate existing barriers to healthcare access and financial and social needs, possibly leading to persistent unmet needs among Medicare beneficiaries with a history of depression beyond the pandemic.

Higher levels of state funding for Home- and Community-Based Services linked to better state performances in Long-Term Services and Supports.

OBJECTIVE: To examine the relationship between the level of state funding for Home- and Community-Based Services (HCBS) and state overall and dimension-specific performances in Long-Term Services and Supports (LTSS). DATA SOURCES AND STUDY SETTING: We employed state-level secondary data from the Medicaid LTSS Annual Expenditures Reports, the American Association of Retired Persons (AARP) State Scorecards, the U.S. Census, and Federal Reserve Economic data, spanning the timeframe of 2010-2020. STUDY DESIGN: Overall state LTSS rankings, along with dimension-specific rankings, were modeled separately against state Medicaid spending on HCBS relative to total Medicaid spending on LTSS. All models were adjusted for state covariates, secular trend, and state fixed effects. DATA COLLECTION/EXTRACTION METHODS: The study sample included all 50 states and the District of Columbia. However, California, Delaware, Illinois, and Virginia were excluded from FY2019 due to missing data on Medicaid HCBS expenditures. PRINCIPAL FINDINGS: Every 10 percentage-point increase in the proportion of Medicaid LTSS spending to HCBS demonstrated 2.05 points improvement (95% confidence interval [CI]: -3.88 to 0.22, p = 0.03) in rankings for state overall LTSS system performance, 2.92 points improvement (95% CI: -4.87 to 0.98, p < 0.01) in rankings for the Choice of Setting and Provider dimension, as well as 1.73 points (95% CI: -3.14 to 0.32, p = 0.02) ranking improvement in the dimension of Effective Transitions. CONCLUSIONS: Our study suggested promising effects of increased state funding for HCBS on LTSS performance.

Coupling coordination analysis and key factors between urbanization and water resources in ecologically fragile areas: a case study of the Yellow River Basin, China.

The rapid urbanization (UR) and industrialization in the Yellow River Basin (YRB) have resulted in a significant scarcity of water resources (WRs), highlighting the need to investigate the complex and dynamic relationship between UR and WR for sustainable urban development in ecologically fragile areas. This study utilizes the coupling coordination degree model (CCDM), spatial correlation analysis, and Tobit model to examine the coupling coordination relationship, spatial effects, and key factors between UR and WR in sixty prefecture-level cities within the YRB. The empirical findings reveal that the development of the WR subsystem lags behind the UR subsystem and that there is a significant spatial disequilibrium in the CCD between UR and WR. Specifically, the high-high clusters are located in the northwest and east, while the low-low clusters are spread in the southwest. Furthermore, investment in science and technology and economic development have a positive impact on the CCD, while government capacity, urban construction, and industrial structure have a negative impact. These results can provide valuable guidance for decision-making in urban planning for ecologically fragile areas facing water supply constraints.

Development and validation of multivariable predictive models for recurrence and mortality following nonoperative management of sigmoid volvulus.

AIM: Sigmoid volvulus is a challenging condition, and deciding between elective surgery or expectant management can be complex. The aim of this study was to develop a tool for predicting the risk of recurrent sigmoid volvulus and all-cause mortality within 1 year following initial nonoperative management. METHOD: This is a retrospective cohort study using Medicare claims data from 2016 to 2018 of beneficiaries admitted urgently/emergently for volvulus, undergoing colonic decompression and discharged alive without surgery (excluding those discharged to hospice). The primary outcomes were recurrent sigmoid volvulus and all-cause mortality within 1 year. Proportional hazards models and logistic regression were employed to identify risk factors and develop prediction equations, which were subsequently validated. RESULTS: Among the 2078 patients managed nonoperatively, 36.1% experienced recurrent sigmoid volvulus and 28.6% died within 1 year. The prediction model for recurrence integrated age, sex, race, palliative care consultations and four comorbidities, achieving area under the curve values of 0.63 in both the training and testing samples. The model for mortality incorporated age, palliative care consultations and nine comorbidities, with area under the curve values of 0.76 in the training and 0.70 in the testing sample. CONCLUSION: This study provides a straightforward predictive tool that utilizes easily accessible data to estimate individualized risks of recurrent sigmoid volvulus and all-cause mortality for older adults initially managed nonoperatively. The tool can assist clinicians and patients in making informed decisions about such risks. While the accuracy of the calculator was validated, further confirmation through external validation and prospective studies would enhance its clinical utility.

Assessment tools for stigma in breast cancer patients based on COSMIN guidelines: a systematic review.

OBJECTIVE: The objective of this study was to conduct a systematic review of the measurement properties and methodological quality of stigma assessment tools designed for breast cancer patients. The aim was to provide clinical medical staff with a foundation for selecting high-quality assessment tools. METHODS: A comprehensive computer search was carried out across various databases, including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database(VIP), Embase, PubMed, Web of Science, The Cochrane Library, and Scopus, which were searched from the inception of the databases until March 20, 2023. Literature screening and data extraction were performed independently by two researchers, adhering to predefined inclusion and exclusion criteria. The assessment tools were evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic evaluation guidelines. RESULTS: In the final analysis, a total of 9 assessment tools were included. However, none of these tools addressed measurement error, cross-cultural validity, criterion validity, and responsiveness. Following the COSMIN guidelines, BCSS and CSPDS were assigned to Class A recommendations, while the remaining tools received Class B recommendations. CONCLUSION: The BCSS and CSPDS scales demonstrated comprehensive assessment in terms of their measurement characteristics, exhibiting good methodological quality, measurement attribute quality, and supporting evidence. Therefore, it is recommended to utilize these scales for evaluating breast cancer stigma. However, further validation is required for the remaining assessment tools.

Corneal characteristics of Mongolian population with type 2 diabetic peripheral neuropathy in inner Mongolia, China: an assessment using corneal confocal microscopy.

OBJECTIVE: To quantify corneal nerve fiber parameters in a Mongolian population with diabetic peripheral neuropathy (DPN) by corneal confocal microscopy. METHODS: This study conducted a comprehensive evaluation of 114 participants from Hulunbuir between January 2020 and December 2021. The participants included healthy controls, Mongolian and Han patients with type 2 diabetes mellitus. Demographic, medical, and laboratory data were collected, and neuropathy was evaluated by confocal corneal microscopy. And compare various parameters between Han and Mongolian were performed using SPSS software. RESULTS: The average waist circumference of Mongolian diabetic patients was larger than that of Han diabetic patients (P < 0.05). The mean HbA1c of Mongolian was 9.30 (8.15, 10.30) %, and that of Han was 8.30 (7.20, 9.40) % (P = 0.023). The average values of Corneal Nerve Fiber Density (CNFD), Corneal Nerve Fiber Length (CNFL) and corneal nerve branch density (CNBD) in Mongolian diabetic patients were significantly lower than those in Han diabetic patients (P < 0.05). The correlation coefficient between CNFL and age was - 0.368. ROC results show that CNBD has a certain diagnostic value for DPN in Mongolian patients with type 2 diabetes and the optimal cut-off point value is 24.99(no./mm2), the sensitivity is 80.0%, and the specificity is 77.8%. CONCLUSION: The corneal confocal microscopy could possibly represent a promising adjuvant technique for the early diagnosis and assessment of PDN in Mongolian T2DM patients.

Unleashing the power of emergency response: controlling natural disasters by addressing environmental risk.

The primary focus of the analysis is to investigate the impact of emergency response management and environmental risk on natural disasters by controlling the variables of national income and financial development. To investigate the model empirically, we have employed the quantile autoregressive distributed lag model that estimates the short- and long-run estimates across various quantiles. The long-run estimates of emergency response management are negative and significant only at higher quantiles, i.e., from 60 to 95th quantiles. In the short run, emergency response management's estimated coefficients are negative and significant from 70 to 95th quantiles. Environmental risk shows a significant positive correlation with natural disasters across quantiles, while national income and financial development decrease natural disasters in the long run. Furthermore, we observed the asymmetric impact of emergency response management on natural disasters in both the short and long run.

Association of carbohydrate intake from different sources with all-cause and cardiovascular mortality among chronic kidney disease populations: assessment of 1999-2018 National Health and Nutrition Examination Survey participation.

This study analysed the data from the NHANES (1999-2018) to examine how different sources of carbohydrate intake affected the all-cause and cardiovascular mortality of 11,302 chronic kidney disease (CKD) patients. The data were adjusted for other factors using various methods. The results showed that CKD patients (stages 1-2 and 3-5) who consumed more carbohydrates from whole grains, fruits, vegetables and less carbohydrates from fruit juice or sauces had lower mortality rates. Replacing fat intake with carbohydrates from whole grains (HR = 0.86[0.78-0.95]), fruits (raw) (HR = 0.79[0.70-0.88]) and non-starchy vegetables (HR = 0.82[0.70-0.96]), but not protein intake, was linked to lower all-cause mortality. The fibre content in carbohydrates might partly account for the benefits of selected carbohydrate intake. This study provided practical recommendations for optimising the carbohydrate sources in CKD patients.

Antipsychotic use among older patients with dementia receiving home health care services: Prevalence, predictors, and outcomes.

BACKGROUND: Antipsychotic use is a safety concern among older patients in home health care (HHC), particularly for those with Alzheimer's disease and related dementias (ADRD). The objective of this study was to examine the prevalence and predictors of antipsychotic use among older adults with and without ADRD who received HHC, and the association of antipsychotic use with outcomes among patients living with ADRD. METHODS: In this secondary analysis of adults ≥65 years receiving care from an HHC agency in New York in 2019 (N = 6684), we used data from the Outcome and Assessment Information Set, Medicare HHC claims, and home medication review results in the electronic HHC records during a 60-day HHC episode. ADRD was identified by diagnostic codes. Functional outcome was the change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (measured in 5833 patients), where a positive score means improvement and a negative score means decline. Data were analyzed using logistic (predictors) and linear regression (association with outcome) analyses. RESULTS: The point prevalence of antipsychotic use was 17.2% and 6.6% among patients with and without ADRD, respectively. Among patients living with ADRD, predictors of antipsychotic use included having greater ADL limitations (odds ratio [OR] = 1.30, p = 0.01), taking more medications (OR = 1.04, p = 0.02), having behavioral and psychological symptoms (OR = 5.26, p = 0.002), and living alone (OR = 0.52, p = 0.06). Among patients living with ADRD, antipsychotic use was associated with having less ADL improvement at HHC discharge (ß = -0.70, p < 0.001). CONCLUSIONS: HHC patients living with ADRD were more likely to use antipsychotics and to experience worse functional outcomes when using antipsychotics. Antipsychotics should be systematically reviewed and, if contraindicated or unnecessary, deprescribed. Efforts are needed to improve HHC patients' access to nonpharmacological interventions and to provide education for caregivers regarding behavioral approaches to manage symptoms in ADRD.

Distribution, Site-Specific Water Quality Criteria, and Ecological Risk Assessment of Heavy Metals in Surface Water in Fen River, China.

Due to a lack of toxicity reference values that match the regional environmental characteristics, the ecological risk of metals in water bodies cannot be accurately assessed. The Fen River is the second-largest tributary of the Yellow River in China, and the sustainability of this area is threatened by heavy metal pollution caused by intensive industrial and agricultural activities. In this study, site-specific water quality criteria (WQCs) for heavy metals in the Fen River were derived considering toxicity data from native aquatic organisms and regional water quality factors (e.g., water hardness). Short-term WQCs for Mn, Cu, Cd, Zn, Cr, Pb, and Ni were 2026.15, 98.62, 10.02, 63.07, 6.06, 166.74, and 132.73 µg/L, respectively, and long-term WQCs were 166.53, 29.71, 2.18, 19.29, 4.15, 6.38, and 14.76 µg/L, respectively. The distribution characteristics of these metals during the wet season in 2020 were explored, and their average concentrations in the river water did not exceed the environmental quality standards for surface water in China but were higher than the world average levels. Cr was the main pollutant in the sampling sites of Yaodu region, Hongdong Shitan, Xiao River, and Duanchun River, as was Pb in Duanchun River. Based on the site-specific WQCs, using hazardous quotient (HQ) and margin of safety (MOS10) approaches, a high risk of Pb was identified in the Duanchun River, and a medium risk of Cr might occur at midstream and downstream of Yaodu and Xiaodian. The results will provide a reference basis for heavy metal pollution control and water quality management in the Fen River.

The Dissipation Behavior and Risk Assessment of Carbendazim Under Individual and Joint Applications on Peach (Amygdalus persica L.).

Dissipation, residue levels, and ingestion risks of carbendazim in peach (Amygdalus persica L.) were investigated with individual and joint applications in the present study. The dissipation kinetics of carbendazim, chlorpyrifos, prochloraz, and imidacloprid were evaluated by the first-order kinetics. When carbendazim was individually applied, the final residual concentration was 2.97 mg kg-1 and the half-life was 17.4 d. In the joint application of carbendazim with chlorpyrifos, prochloraz, and imidacloprid, the residual concentrations at 35 d after spraying were 7.16, 7.50, and 4.26 mg kg-1 and the half-lives were 30.8, 23.7, and 23.2 d, respectively, which showed an increase of 1.3-1.8 times compared with the single application of carbendazim. In addition, the effects of household processing of rinsing and peeling were investigated, and a high removal rate of 54.6% and 76.5% were found. Furthermore, the carbendazim ingestion risk assessment was conducted, which indicated that the acute health risk (aHI) and hazard quotient (HQ) of carbendazim were all within acceptable levels ranging from 21.7% to 40.9%. However, a higher ingestion risk of carbendazim was found under the joint application. This study provides some preliminary guidance for the joint application and risk assessment of carbendazim in peach, which is worth further investigation.

Is solar heating an appropriate choice in rural areas of northern China? Evidence from numerical simulation and life cycle assessment.

Solar heating is generally regarded as a clean and low-carbon heating method, while its high initial investment hinders its promotion in economically underdeveloped areas. With the implementation of the clean heating policy and the proposal of the carbon neutralization target, rural bulk coal heating in northern China is restricted. The Chinese government proposes to widely adopt solar heating to meet the heating demands of rural residents. In this research, the application of solar assisted heat pump systems in Beijing, Tianjin, Hebei and its surrounding areas in China is numerically simulated. A new evaluation method under the same initial investment constraint is proposed to verify its benefits throughout the entire life cycle. The results indicate that although solar thermal heating has the lowest environmental impact and carbon emissions among various heating methods, it is not the best solution to rural clean heating. The reason is that equal investment in other projects can bring much more benefits, such as roof solar photovoltaic. In contrast to the air source heat pump and photovoltaic panel scheme with the same initial investment, solar heating has obvious negative environmental impact, 53.3 % higher economic cost, 35.9 tons more carbon emissions, and 105.9 % higher roof area occupation. The sensitivity analysis of solar fraction, geographical coordinates, and energy price also supports the above findings. The recommendation is proposed to promote air source heat pumps or solar photovoltaic, rather than solar thermal collectors, so as to reduce the cost of rural clean heating and carbon emission reduction.

Association of Sources of COVID-19 Information with Vaccine Uptake, Preventive Behaviors, and Perceived Severity of COVID-19.

OBJECTIVE: To investigate the association of using informal sources and reliance on multiple sources of information with actual COVID-19 vaccine uptake, the number of doses of vaccine received, COVID-19 testing, essential preventive measures, and perceived severity of COVID-19. DESIGN: Retrospective cross-sectional study. SETTING AND PARTICIPANTS: Our study sample consisted of 9584 community-dwelling Medicare beneficiaries, representing a weighted 50,029,030 beneficiaries from the Winter 2021 Medicare Current Beneficiary Survey COVID-19 Supplement. METHODS: Two key independent variables were whether a respondent relied on a formal source (ie, traditional news, government guidance, or health care providers) or an informal source (ie, social media, Internet, or friends/family) the most for the COVID-19 information and the total number of information sources a respondent relied on. RESULTS: Compared with beneficiaries relying on formal sources of information, those relying on informal sources of information were less likely to receive COVID-19 vaccine (odds ratio [OR], 0.65; 95% CI, 0.56-0.75) and COVID-19 testing (OR, 0.85; 95% CI, 0.74-0.98), to engage in preventive behaviors (OR, 0.61; 95% CI, 0.50-0.74), to have high perception of COVID-19 severity, and were more likely to be unvaccinated vs 2 doses of vaccine (relative risk ratio [RRR], 1.64; 95% CI, 1.41-1.91). Relying on more information sources was significantly associated with higher odds of actual vaccine uptake (OR, 1.21; 95% CI, 1.17-1.26), COVID-19 testing (OR, 1.11; 95% CI, 1.07-1.15), engagement of essential preventive behaviors (OR, 1.33; 95% CI, 1.25-1.42), having high perception of COVID-19 severity, and with lower likelihood of being unvaccinated vs 2 doses of vaccine (RRR, 0.82; 0.79-0.85). CONCLUSIONS AND IMPLICATIONS: The COVID-19 pandemic has made communicating information about coronavirus more important than ever. Our findings suggest that information from formal sources with expertise and more balanced sources of information were key to effective communication to prevent from COVID-19 infection among older adults.

Collaborative optimal allocation of water resources and sewage discharge rights in watershed cities: considering equity among water sectors.

Water supply systems in watershed cities face challenges due to increasing water demand and arbitrary sewage discharge allocations. Previous studies have primarily focused on water resource allocation and sewage discharge rights, neglecting the intricate interactions between the two. This study introduces a novel approach by integrating sewage discharge rights into the watershed's water resource allocation mechanism. A multi-objective optimization model was developed, employing the Gini coefficient to balance the equitable and economic aspects across various water sectors. This model takes into account the distinct water demands and sewage discharge requirements of different sectors. The findings of this study are as follows: (a) the Gini coefficients for water demand allocation and sewage discharge rights allocation exhibit simultaneous optimization and display consistent trends; (b) when the importance of sewage discharge relative to other water users increases, the return on investment for domestic and industrial water use decreases, but the fairness of water distribution improves; (c) proper allocation of sewage discharge rights can effectively enhance the economic value of agricultural water use. Overall, this strategy has the potential to enhance both the equality and economic benefits of the water supply system while ensuring the sustainable utilization of water and sewage rights in the basin cities.