Development and validation of an assessment index for quantifying cognitive task load in pilots under simulated flight conditions using heart rate variability and principal component analysis.

To investigate whether high cognitive task load (CTL) for aircraft pilots can be identified by analysing heart-rate variability, electrocardiograms were recorded while cadet pilots (n = 68) performed the plane tracking, anti-gravity pedalling, and reaction tasks during simulated flight missions. Data for standard electrocardiogram parameters were extracted from the R-R-interval series. In the research phase, low frequency power (LF), high frequency power (HF), normalised HF, and LF/HF differed significantly between high and low CTL conditions (p < .05 for all). A principal component analysis identified three components contributing 90.62% of cumulative heart-rate variance. These principal components were incorporated into a composite index. Validation in a separate group of cadet pilots (n = 139) under similar conditions showed that the index value significantly increased with increasing CTL (p < .05). The heart-rate variability index can be used to objectively identify high CTL flight conditions.Practitioner summary: We used principal component analysis of electrocardiogram data to construct a composite index for identifying high cognitive task load in pilots during simulated flight. We validated the index in a separate group of pilots under similar conditions. The index can be used to improve cadet training and flight safety.Abbreviations: ANOVA: a one-way analysis of variance; AP: anti-gravity pedaling task; CTL: cognitive task load; ECG: electrocardiograms; HR: heart rate; HRV: heart-rate variability; HRVI: heart-rate variability index; PT: plane-tracking task; RMSSD: root-mean square of differences between consecutive R-R intervals; RT: reaction task; SDNN: standard deviation of R-R intervals; HF: high frequency power; HFnu: normalized HF; LF: low frequency power; LFnu: normalized LF; PCA: principal component analysis.

Progress, Challenge, and Prospect of LiMnO2 : An Adventure toward High-Energy and Low-Cost Li-Ion Batteries.

Lithium manganese oxides are considered as promising cathodes for lithium-ion batteries due to their low cost and available resources. Layered LiMnO2 with orthorhombic or monoclinic structure has attracted tremendous interest thanks to its ultrahigh theoretical capacity (285 mAh g-1 ) that almost doubles that of commercialized spinel LiMn2 O4 (148 mAh g-1 ). However, LiMnO2 undergoes phase transition to spinel upon cycling cause by the Jahn-Teller effect of the high-spin Mn3+ . In addition, soluble Mn2+ generates from the disproportionation of Mn3+ and oxygen release during electrochemical processes may cause poor cycle performance. To address the critical issues, tremendous efforts have been made. This paper provides a general review of layered LiMnO2 materials including their crystal structures, synthesis methods, structural/elemental modifications, and electrochemical performance. In brief, first the crystal structures of LiMnO2 and synthetic methods have been summarized. Subsequently, modification strategies for improving electrochemical performance are comprehensively reviewed, including element doping to suppress its phase transition, surface coating to resist manganese dissolution into the electrolyte and impede surface reactions, designing LiMnO2 composites to improve electronic conductivity and Li+ diffusion, and finding compatible electrolytes to enhance safety. At last, future efforts on the research frontier and practical application of LiMnO2 have been discussed.

Risk-prediction models for intravenous immunoglobulin resistance in Kawasaki disease: Risk-of-Bias Assessment using PROBAST.

BACKGROUND: The prediction model of intravenous immunoglobulin (IVIG) resistance in Kawasaki disease can calculate the probability of IVIG resistance and provide a basis for clinical decision-making. We aim to assess the quality of these models developed in the children with Kawasaki disease. METHODS: Studies of prediction models for IVIG-resistant Kawasaki disease were identified through searches in the PubMed, Web of Science, and Embase databases. Two investigators independently performed literature screening, data extraction, quality evaluation, and discrepancies were settled by a statistician. The checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS) was used for data extraction, and the prediction models were evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS: Seventeen studies meeting the selection criteria were included in the qualitative analysis. The top three predictors were neutrophil measurements (peripheral neutrophil count and neutrophil %), serum albumin level, and C-reactive protein (CRP) level. The reported area under the curve (AUC) values for the developed models ranged from 0.672 (95% confidence interval [CI]: 0.631-0.712) to 0.891 (95% CI: 0.837-0.945); The studies showed a high risk of bias (ROB) for modeling techniques, yielding a high overall ROB. CONCLUSION: IVIG resistance models for Kawasaki disease showed high ROB. An emphasis on improving their quality can provide high-quality evidence for clinical practice. IMPACT STATEMENT: This study systematically evaluated the risk of bias (ROB) of existing prediction models for intravenous immunoglobulin (IVIG) resistance in Kawasaki disease to provide guidance for future model development meeting clinical expectations. This is the first study to systematically evaluate the ROB of IVIG resistance in Kawasaki disease by using PROBAST. ROB may reduce model performance in different populations. Future prediction models should account for this problem, and PROBAST can help improve the methodological quality and applicability of prediction model development.

[Risk Assessment and Sources of Heavy Metals in Farmland Soils of Yellow River Irrigation Area of Ningxia].

The farmland environment is directly related to the quality and safety of agricultural products. In order to understand the characteristics and main influencing factors of heavy metals in farmland soil in the Yellow River irrigation area of Ningxia, sampling and monitoring were conducted for five consecutive years from 2017 to 2021, and the distribution characteristics and correlation of heavy metals were analyzed. The pollution status and potential ecological risks of heavy metals were evaluated, and the main sources of heavy metals in farmland were analyzed. The results showed that the average values of Pb, As, Zn, Ni, Cu, Hg, Cr, and Cd in the soil of the Ningxia Yellow River irrigation area were 19.74, 11.67, 66.88, 29.09, 22.55, 0.03, 62.27, and 0.19 mg·kg-1, respectively, which were enriched to some extent compared with the background values of the soil environment in Ningxia. Among them, Hg and Cd had middle- and high-grade ecological risk points; however, none of them exceeded the control value of agricultural land soil pollution risk, and all sampling sites had no high-risk or extremely high-risk levels. The results of source analysis based on positive matrix factorization (PMF) and correlation analysis showed that there were five main sources of heavy metals in farmland soil in the study area: natural sources, mixed sources of industrial and mining activities and the production and life of residents, transportation sources, agricultural production activities sources, and industrial sources, with contribution rates of 26.54%, 25.59%, 22.52%, 15.63%, and 9.72%, respectively. On the whole, the heavy metals in farmland soil in the Ningxia Yellow River irrigation area did not exceed the standard, and there was no high-level ecological risk. The production environment of the farmland soil was good, but the contribution rate of human activities to soil heavy metals was large.

Clinical Value of Cytokine Assay in Diagnosis and Severity Assessment of Lung Cancer.

Purpose: To investigate the clinical value of interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor α (TNF-α), and interferon-γ (IFN-γ) in diagnosis and severity assessment of lung cancer. Methods: In this observational study, 50 physical examination healthy subjects were included in the control group and 100 lung cancer patients were included in the study group. In the study group, 53 cases with pleural effusion were subgrouped to the pleural effusion group (n = 53), while 47 patients were assigned to the nonpleural effusion group (n = 47). Plasma cytokines IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of all eligible subjects were collected and compared. Results: The study group showed significantly higher levels of plasma cytokines IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ versus healthy subjects (P < 0.05). Deterioration of lung cancer was associated with increased plasma cytokine levels and APACHE II scores. The combination assay of the above plasma cytokines showed significantly better diagnostic efficacy for lung cancer versus the single assay of the cytokines. Dead patients had higher plasma cytokine levels versus survived patients. The accuracy of plasma IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ levels in the severity assessment of lung cancer was comparable with that of the APACHE II scale. Conclusion: The plasma cytokines IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ are effective markers for the diagnosis of lung cancer. The combined assay contributes to the early diagnosis of lung cancer patients, and the persistent elevation of cytokines suggests an increased risk of death in lung cancer patients, so the detection of cytokine levels facilitates the severity assessment of lung cancer.

Bioaccessibility of microplastic-associated heavy metals using an in vitro digestion model and its implications for human health risk assessment.

Microplastics can act as carriers of heavy metals and may enter humans through ingestion and threaten human health. However, the bioaccessibility of heavy metals associated with microplastics and its implications for human health risk assessments are poorly understood. Therefore, in this study, four typical heavy metals (As(V), Cr(VI), Cd(II), and Pb(II)) and one typical microplastic (polyvinyl chloride, PVC) were chosen to estimate the human health risk of microplastic-associated heavy metals by incorporating bioaccessibility. Significant adsorption of heavy metals was observed with the following order for adsorption capacity: Pb(II) > Cr(VI) > Cd(II) > As(V); the efficiencies for desorption of these four heavy metals from PVC microplastics were all below 10%. The Fourier transform infrared spectroscopy results indicated that the functional groups on the surface of the virgin PVC microplastics did not play an important role in the capture process. Heavy metals in both gastric and small intestinal phases were prone to release from PVC microplastics when bioaccessibility was evaluated with the in vitro SBRC (Soluble Bioavailability Research Consortium) digestion model. In addition, Pb(II) bioaccessibility in the gastric phase was significantly higher than those in the other phases, while As(V), Cr(VI), and Cd(II) bioaccessibilities showed the opposite trend. After incorporating bioaccessibility adjustments, the noncarcinogenic hazards and carcinogenic risks determined were lower than those based on total metal contents. The individual hazard quotients (HQ) and carcinogenic risks (CR) for ingestion of these four heavy metals from PVC microplastics were all lower than the threshold values for adults and children. In summary, this study will provide a new view of the human health risks of heavy metals associated with microplastics.

Several major issues concerning the environmental transmission and risk prevention of SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) is the most serious infectious disease pandemic in the world in a century, and has had a serious impact on the health, safety, and social and economic development of all mankind. Since the earth entered the "Anthropocene", human activities have become the most important driving force of the evolution of the earth system. At the same time, the epidemic frequency of major human infectious diseases worldwide has been increasing, with more than 70% of novel diseases having zoonotic origins. The review of several major epidemics in human history shows that there is a common rule, i.e., changes in the natural environment have an important and profound impact on the occurrence and development of epidemics. Therefore, the impact of the natural environment on the current COVID-19 pandemic and its mechanisms have become scientific issues that need to be resolved urgently. From the perspective of the natural environment, this study systematically investigated several major issues concerning the environmental transmission and risk prevention of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). From a macroscopic temporal and spatial scale, the research focus on understand the impact of the destruction of the natural environment and global changes on the outbreak of infectious diseases; the threat of zoonotic diseases to human health; the regularity for virus diffusion, migration and mutation in environmental media; the mechanisms of virus transmission from animals and environmental media to humans; and environmental safety, secondary risk prevention and control of major epidemics. Suggestions were made for future key research directions and issues that need attention, with a view to providing a reference for the prevention and control of the global coronavirus disease 2019, and to improving the ability of response to major public health emergencies.

Long-Term Continuous Assessment of Internal Limiting Membrane Filling Induced Super-Large Macular Hole Healing.

PURPOSE: To assess the long-term continuous anatomical and functional healing process of a super-large full-thickness macular hole (FTMH) after internal limiting membrane (ILM) filling and air tamponade. DESIGN: Prospective, interventional case series. METHODS: Pars plana vitrectomy with ILM filling and air tamponade was performed in eyes with idiopathic super-large FTMH (> 900 µm). Patients were divided into 3 groups according to the macular hole (MH) diameter: group A, < 1000 µm; group B, 1000 to 1100 µm; and group C, > 1100 µm. The MH closure pattern was analyzed using optical coherence tomography. The preoperative and postoperative macular hole sensitivity, parafoveal sensitivity, and fixation status were assessed using a Microperimeter-3. The preoperative and postoperative best corrected visual acuity were measured. A monthly follow-up was conducted for 15 months postoperatively. RESULTS: Ninety-seven eyes from 96 consecutive patients with super-large FTMH were included in the study. Primary closure was seen in 93 of 97 eyes (95.88%), in which 88 of 97 eyes (90.72%) had a closed MH 1 week after surgery. The MH closure pattern continuously improved and significantly differed in the 3 groups (P < .05). Significant improvements in best corrected visual acuity (P < .01), parafoveal sensitivity (P < .05), and fixation stability (P < .01) were observed in all groups. CONCLUSIONS: Super-large FTMH (> 900 µm) closed promptly within 1 week postoperatively after ILM filling and air tamponade. The morphological and functional improvement lasted over an extended period postoperatively. No central scotoma enlargement was found regardless of the closure patterns, and there was significant retinal sensitivity and fixation status improvement.

Human health risk-based Generic Assessment Criteria for agricultural soil in Jiangsu and Zhejiang provinces, China.

Agricultural soil pollution in China poses a major threat to human health and food safety. There are no agricultural soil environmental standards based on human health in China, which prevents effective screening and assessment of risks. Jiangsu (JS) and Zhejiang (ZJ) provinces, located in the Yangtze River Delta (YRD) core region, have obvious differences in agricultural land conditions, which will result in differences in Generic Assessment Criteria (GAC). In this study, we derived and compared human health risk-based GAC using the Contaminated Land Exposure Assessment (CLEA) model for agricultural land scenarios in these two provinces. We found differences in the GAC between JS and ZJ due to differences in parameters. These differences are greatest for benzene, and cadmium (Cd). For Cd, the contribution of oral intake exceeds 90 %, and the vegetable consumption rate and mean daily intake (MDI) may be key parameters affecting GAC. For the volatile organic compound benzene, the inhalation of indoor vapor accounts for about 30 %, and the key parameters affecting the GAC for benzene may be the attenuation factor and soil organic matte (SOM). The derived GAC are generally lager (i.e., less stringent) than the GB15618-2018 and UK Suitable 4 Use Levels (S4ULs); however, the derived GAC for JS and ZJ were lower than the soil screening values (SSV) for residential land in China. This may be related to methods, land use types, and critical receptors. This work will contribute to the development of regional soil environmental standards in China.

Incorporating bioaccessibility and source apportionment into human health risk assessment of heavy metals in urban dust of Xiamen, China.

Heavy metals in urban dust could pose noticeable human health risks, but there are few studies focusing on comprehensive human health risk assessment with the incorporation of both bioaccessibility and source apportionment in urban dust. Thus, fifty-eight urban dust samples were collected from kindergartens in Xiamen to analyze the bioaccessibility-based, source-specific health risk of heavy metals (V, Co, Ni, As, Mo, Cr, Mn, Cu, Zn, and Pb). Most heavy metals, except for V and Mn, were significantly enriched in urban dust based on their values of geoaccumulation index (Igeo) and may be influenced by human activities. The oral bioaccessibility values of heavy metals, which were estimated by the Solubility/Bioaccessibility Research Consortium (SBRC) in vitro model, ranged from 1.563% to 76.51%. The source apportionment determined by applying the absolute principal component analysis-multiple linear regression (APCS-MLR) model indicated five main potential sources, coal combustion, traffic and industrial, natural, construction and furniture sources, and unidentified sources, with contributions of 34.09%, 20.72%, 18.72%, 7.597% and 18.87%, respectively, to the accumulation of heavy metals in urban dust. After incorporating bioaccessibility adjustments, lower non-carcinogenic and carcinogenic risks of heavy metals were observed than those based on total metal content, with the mean hazard index (HI) values being less than the threshold value (1) and the mean total carcinogenic risk (TCR) values exceeding the precautionary criterion (10-6) for both adults and children. By combining bioaccessibility-based health risk assessment and source apportionment, traffic and industrial emissions and coal combustion dominated the noncarcinogenic and carcinogenic risks induced by heavy metals in urban dust, respectively. This study is expected to promote the systematic integration of source apportionment and bioaccessibility into health risk estimation for heavy metal contamination in urban dust, thus providing useful implications for better human health protection.

Levels of polycyclic aromatic hydrocarbons in edible and fried vegetable oil: a health risk assessment study.

Polycyclic aromatic hydrocarbons (PAHs) are environmental chemicals that are formed due to incomplete combustion of the organic matters, or during heat treatment of the food. The objectives of the present study were first to estimate levels of the 15-priority PAHs in the edible vegetable oil (corn oil, sunflower oil, olive oil, and canola oil) collected from Egypt. Furthermore, the effect of heat treatment on the formation of PAHs in the canola oil was further examined. In addition, dietary intakes and cancer risk among Egyptian consumers were additionally calculated. The achieved results indicated presence of 15-priority PAHs in all examined oil samples. Canola oil had the highest residual concentrations of PAHs compared with the other tested oil species. Heat treatment of canola oil led to a drastic increase in the formed B[a]P (316.55%), total 2-PAHs (322.47%), total 4-PAHs (297.42%), total 8-PAHs (285.26%), and total 15-PAHs (443.32%), respectively. The incremental lifetime cancer risk among the Egyptian population is considered safe when was calculated for all examined oil samples.

TGF-ß-mediated Endothelial to Mesenchymal Transition (EndMT) and the Functional Assessment of EndMT Effectors using CRISPR/Cas9 Gene Editing.

In response to specific external cues and the activation of certain transcription factors, endothelial cells can differentiate into a mesenchymal-like phenotype, a process that is termed endothelial to mesenchymal transition (EndMT). Emerging results have suggested that EndMT is causally linked to multiple human diseases, such as fibrosis and cancer. In addition, endothelial-derived mesenchymal cells may be applied in tissue regeneration procedures, as they can be further differentiated into various cell types (e.g., osteoblasts and chondrocytes). Thus, the selective manipulation of EndMT may have clinical potential. Like epithelial-mesenchymal transition (EMT), EndMT can be strongly induced by the secreted cytokine transforming growth factor-beta (TGF-ß), which stimulates the expression of so-called EndMT transcription factors (EndMT-TFs), including Snail and Slug. These EndMT-TFs then up- and downregulate the levels of mesenchymal and endothelial proteins, respectively. Here, we describe methods to investigate TGF-ß-induced EndMT in vitro, including a protocol to study the role of particular TFs in TGF-ß-induced EndMT. Using these techniques, we provide evidence that TGF-ß2 stimulates EndMT in murine pancreatic microvascular endothelial cells (MS-1 cells), and that the genetic depletion of Snail using clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9)-mediated gene editing, abrogates this phenomenon. This approach may serve as a model to interrogate potential modulators of endothelial biology, and can be used to perform genetic or pharmacological screens in order to identify novel regulators of EndMT, with potential application in human disease.

Levels of biogenic amines in cheese: correlation to microbial status, dietary intakes, and their health risk assessment.

Biogenic amines (BAs) are natural toxicants produced during the metabolism of their precursor amino acids or due to the proteolytic activities of some microorganisms. The objective of this study was to estimate the formed BAs in five types of the most commonly consumed and retailed cheese in Egypt. The examined cheese types included Feta, Karish, Mozzarella, Rumy, and Mish. Besides, the total mesophilic (TMC) and total psychrophilic (TPsC) bacterial counts were investigated. Furthermore, the estimated daily intakes (EDI) of BAs via the ingestion of various types of cheese were calculated, and their potential health risks were discussed. The achieved results indicated the formation of histamine (HIS), tyramine (TYR), cadaverine (CAD), putrescine, spermine, and spermidine at different concentrations. Except for Feta cheese, all samples (100%) of other cheese types had HIS concentrations higher than the established maximum permissible limits. Mish cheese contained the highest concentrations of total BAs, particularly, HIS, TYR, and CAD. TBA content showed significant positive correlations with TMC in the examined cheese types. The recorded EDI values of the different BAs in the current study would not have adverse effects. However, excessive consumption of cheese contaminated with BA might have serious health implications such as symptoms of histamine poisoning. Therefore, the adoption of strict hygienic measures during the production, storage, and distribution of cheese is highly recommended to reduce the formation of BAs in cheese.

Heavy metal(loid)s in the topsoil of urban parks in Beijing, China: Concentrations, potential sources, and risk assessment.

Urban parks play an important role in the urban ecosystem and are also used by residents for recreation. The environmental quality of urban park soils might influence human health following long-term exposure. To assess potential sources and pollution risks of heavy metal(loid)s in the topsoil of urban parks, we subjected metal concentrations in soil samples from 121 parks in the Beijing urban area to geostatistical analyses, conditional inference tree (CIT) analyses, ecological risk and human health risk assessment. CIT effectively explained the influence of human activity on the spatial variation and accumulation of soil metal(loid)s and identified the contributions of natural and anthropogenic inputs. The main factors influencing the accumulation of heavy metal(loid)s, including urbanization duration, park age, per capita GDP, industrial output, and coal consumption, were evaluated by CIT. Except for Cr and Ni, the average concentrations of the metal(loid)s tested (Cu, Pb, Zn, Hg, As, and Cd) were higher than the background values. In the urban parks, Ni and Cr derived mostly from soil parent materials. Concentrations of Cu, Zn, Pb, Cd, As, and Hg were strongly associated with human influences, including industrial, agricultural, and traffic activity. After assessing health and ecological risks, we conclude that heavy metal(loid)s in the soil of Beijing urban parks pose no obvious health risk to humans, and the ecological risk is also low.

Developing a fatigue questionnaire for Chinese civil aviation pilots.

Objective. To assess the fatigue risk is an important challenge in improving flight safety in the aviation industry. The aim of this study was to develop a comprehensive fatigue risk management indicators system and a fatigue questionnaire for Chinese civil aviation pilots. Methods. Participants included 74 civil aviation pilots (all males). They finished the questionnaire in 20 min before a flight mission. Estimation of internal consistency with Cronbach's α and Student's t test as well as Pearson's correlation analysis were the main statistical methods. Results. The results revealed that the fatigue questionnaire had acceptable internal consistency reliability and construct validity; there were significant differences in fatigue scores between international and domestic flight pilots. Also, some international flight pilots, who had taken medications as a sleep aid, had worse sleep quality than those who had not. Long-endurance flights across time zones caused significant differences in circadian rhythm. Conclusions. The fatigue questionnaire can be used to measure Chinese civil aviation pilots' fatigue, which provides a reference for a fatigue risk management system for civil aviation pilots.

Impacts of Hospital Payment Based on Diagnosis Related Groups (DRGs) with Global Budget on Resource Use and Quality of Care: A Case Study in China.

BACKGROUND: China has implemented numerous pilots to shift its hospital payment mechanism from the traditional retrospective cost-based system to prospective diagnosis-related-group (DRG) -based system. This study investigated the impact of the DRG payment reform with global budget in Zhongshan, China. METHODS: A total of 2895 patients diagnosed with acute myocardial infarction (AMI) were selected from local two largest tertiary hospitals, among which 727 were discharged prior to the payment reform and 2168 afterwards. Difference-in-difference (DID) regression models were used to evaluate the policy effects on patients' percutaneous coronary intervention (PCI) use, hospital expenditures, in-hospital mortality, and readmission rates within 30 days after discharge. RESULTS: Patients' PCI use and hospital expenditures increased quickly after the payment reform. With patients with no local insurance scheme as reference, PCI use for local insured patients decreased significantly by 4.55 percent (95 percent confidence interval [CI]: 0.23, 0.72), meanwhile the total hospital expenses decreased significantly by US$986.10 (b=-0.15, P=0.0037) after reform. No changes were observed with patients' hospital mortality and readmission rates in our study. CONCLUSION: The innovative DRG-based payment reform in Zhongshan suggested a positive effect on AMI patient's cost containment but negative effect on encouraging resource use. It had no impacts on patients' care quality. Cost shifting consequence from the insured to the uninsured was observed. More evidence of the impacts of the DRG-based payment in China's health scenario is needed before it is generalized nationwide.

Status of lead accumulation in agricultural soils across China (1979-2016).

The first national-scale assessment of lead (Pb) contamination in agricultural soils across China was conducted based on >1900 articles published between 1979 and 2016. Pb concentrations, temporal and spatial variations, and influencing factors were analyzed. Children's blood lead levels (BLLs) were also estimated using the integrated exposure uptake biokinetic (IEUBK) model. Pb concentrations in different areas of China varied greatly, which was closely associated with the distribution of Pb-related industries, especially Pb-zinc mine smelting, non-ferrous polymetallic mine smelting, e-waste recycling, and leaded gasoline consumption. The year 2000 was a significant transition year for Pb concentrations, with a rapid increase pre-2000 and a subsequent slow upward trend. Pb concentrations were found to be strongly associated with indicators of economic and social development including gross domestic product (GDP), population size, and vehicle ownership. Leaded gasoline, coal combustion, and non-ferrous smelting were the main sources of atmospheric Pb during the different periods. Predicted BLLs were higher in South China than those in the north. This study details the overall Pb contamination status of agricultural soils in China, and thus provides insights for policymakers with respect to pollution prevention measures.

Status of cadmium accumulation in agricultural soils across China (1975-2016): From temporal and spatial variations to risk assessment.

Based on 1186 published studies, the first national-scale assessment of cadmium (Cd) contamination in agricultural soils across China was conducted. Cd concentrations, temporal and spatial variations, and ecological and health risks resulted from Cd exposure were analyzed. A small part of sampling sites with Cd concentration surpass the screening value and the control value (GB15618-2018), respectively. Soil Cd concentrations in South China were higher than other regions. Ecological risks resulting from Cd contamination were low. Soil Cd concentrations accumulated gradually from 1981 to 2016. Cd mainly came from anthropogenic activities, such as mining, smelting, sewage irrigation, and fertilization. Linear correlations were observed between application amounts of fertilizers and Cd concentrations in soil, indicating that the application of nitrogen, phosphorus, potassium, and compound fertilizers is an important contributor of Cd in soils. This study details the overall Cd contamination status of agricultural soils in China, thus can provide insights for policymakers regarding contamination prevention measures.

Assessment of the static upright balance index and brain blood oxygen levels as parameters to evaluate pilot workload.

OBJECTIVE: To investigate the potential for static upright balance function and brain-blood oxygen parameters to evaluate pilot workload. METHODS: Phase 1: The NASA Task Load Index (NASA-TLX) was used to compare the workloads of real flights with flight simulator simulated flight tasks in 15 pilots (Cohort 1). Phase 2: To determine the effects of workload, 50 cadets were divided equally into simulated flight task load (experimental) and control groups (Cohort 2). The experimental group underwent 2 h of simulated flight tasks, while the control group rested for 2 h. Their static upright balance function was evaluated using balance index-1 (BI-1), before and after the tasks, with balance system posturography equipment and cerebral blood oxygen parameters monitored with near infrared spectroscopy (NIRS) in real time. Sternberg dual-task and reaction time tests were performed in the experimental and control groups before and after the simulated flight tasks. RESULTS: (Phase1) There was a significant correlation between the workload caused by real flight and simulated flight tasks (P<0.01), indicating that NASA-TLX scales were also a tool for measuring workloads of the stimulated flight tasks. (Phase 2) For the simulated flight task experiments, the NASA-TLX total scores were significantly different between the two groups (P<0.001) and (pre-to-post) changes of the BI-1 index were greater in the experimental group than in controls (P<0.001). The cerebral blood oxygen saturation levels (rsO2) (P<0.01) and ΔHb reductions (P<0.05) were significantly higher in the experimental, compared to the control group, during the simulated flight task. In contrast to the control group the error rates (P = 0.002) and accuracy (P<0.001) changed significantly in the experimental group after the simulated flight tasks. CONCLUSIONS: The simulated flight task model could simulate the real flight task load and static balance and NIRS were useful for evaluating pilots' workload/fatigue.

Cost-Effectiveness of Primary Prevention with Statin Treatment for Chinese Patients with Type 2 Diabetes.

INTRODUCTION: Statins can reduce the risk of cardiovascular events in patients with diabetes. The objective of this analysis was to evaluate whether primary prevention with statin treatment is cost-effective for newly diagnosed type 2 diabetes mellitus (T2DM) patients in the Chinese context. METHODS: An economic analysis of primary prevention with statin treatment was conducted using the Chinese Outcomes Model for T2DM with a time horizon of a lifetime, which was developed and validated based on the Chinese population. Clinical costs and utility inputs were gathered from published sources. Lifetime discounted quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER) were measured. The uncertainty was evaluated by one-way and probabilistic sensitivity analyses. RESULTS: Statin treatment with atorvastatin 10 mg could add 0.08 QALYs with an additional $1676 compared with that of no statin management (control strategy) over a lifetime horizon, which led to an ICER of $21,924 per QALY gained. At a willingness-to-pay threshold of $27,351 per QALY gained, there was an approximately 80% probability of statin treatment being cost-effective compared with the control strategy. The model outcomes were most sensitive to the length of the expected life and age at the T2DM diagnosis. CONCLUSIONS: Statin treatment with atorvastatin is most likely cost-effective for primary prevention in Chinese patients newly diagnosed with type 2 diabetes. FUNDING: Partially funded by Pfizer Inc.