Safe disposal of deactivated commercial selective catalytic reduction catalyst (V2O5-MoO3/TiO2) as a low-cost and regenerable sorbent to recover gaseous elemental mercury in smelting flue gas.

The reduction of Hg emissions from non-ferrous metal smelting was proposed in the Minamata Convention. Regenerable sulfureted MoO3/TiO2, which displayed excellent performance in capturing gaseous Hg0, was once developed by us to recover gaseous Hg0 in smelting flue gas (SFG) for centralized control. Recently, a large amount of spent commercial selective catalytic reduction catalysts (for example V2O5-MoO3/TiO2) mostly deactivated by CaSO4 was formed, creating a need for their safe disposal. As the main constituent of deactivated V2O5-MoO3/TiO2 is MoO3/TiO2, deactivated V2O5-MoO3/TiO2 was sulfureted to capture gaseous Hg0 from SFG for its safe disposal and the effects of V2O5 and CaSO4 on Hg0 adsorption onto sulfureted MoO3/TiO2 were investigated. Although the capturing capacity of sulfureted MoO3/TiO2 moderately decreased after the impregnation of V2O5 and CaSO4, sulfureted deactivated V2O5-MoO3/TiO2 still displayed excellent performance and reproducibility in gaseous Hg0 capture. Meanwhile, the cost performance of sulfureted deactivated V2O5-MoO3/TiO2 for Hg0 capture was outstanding as deactivated V2O5-MoO3/TiO2 needs to be safely disposed. Therefore, deactivated V2O5-MoO3/TiO2 can be sulfureted as a regenerable and low-cost sorbent that is effective in recovering gaseous Hg0 from SFG, as well as being a cost-effective and environmentally friendly method for the safe disposal of spent V2O5-MoO3/TiO2.

Cost-Efficient Graphitic Carbon Nitride as an Effective Photocatalyst for Antibiotic Degradation: An Insight into the Effects of Different Precursors and Coexisting Ions, and Photocatalytic Mechanism.

In this study, the photocatalytic activity of graphitic carbon nitride (g-C3 N4 ) synthesized via different precursors (urea, thiourea, and dicyandiamide) is investigated in the degradation process of tetracycline. Owing to the efficient charge separation and transfer, prolonged radiative lifetime of charge, large surface area, and nanosheet morphology, the urea-derived g-C3 N4 exhibits superior photocatalytic activity for tetracycline degradation under visible-light irradiation. This performance can compare with that of most reported g-C3 N4 -based composite photocatalysts. Through the time-circle degradation experiment, the urea-derived g-C3 N4 is found to have an excellent photocatalytic stability. The presence of NO3 - , CH3 COO- , Cl- and SO4 2- ions with the concentration of 10 mm inhibits the photocatalytic activity of urea-derived g-C3 N4 , where this inhibitory effect is more obvious for Cl- and SO4 2- ions. For the coexisting Cu2+ , Ca2+ , and Zn2+ ions, the Cu2+ ion exhibits a significantly higher inhibitory effect than Ca2+ and Zn2+ ions for tetracycline degradation. However, both the inhibitory and facilitating effects are observed in the presence of Fe3+ ion with different concentration. The h+ , . OH and . O2 - radicals are confirmed as major oxidation species and a possible photocatalytic mechanism is proposed in a urea-derived g-C3 N4 reaction system. This study is of important significance to promote the large-scale application of g-C3 N4 photocatalysts in antibiotic wastewater purification.

[The Development of Huaxi Intelligent Endoscopic Skill Training and Assessment System].

OBJECTIVE: To develop a novel objective standardized endoscopic skill training and assessment system based on artificial intelligence technology. METHODS: By designing five basic skill parts of endoscopic operation including vision location, clamping, delivering, shearing and suturing, we achieved objective standardized indexes which gained automatically with image recognition and refined perception. RESULTS: With Huaxi intelligent endoscopic skill training system, the accurate rates of vision location, clamping, delivering, shearing and suturing were 90%, 95%, 99%, 90%, and 89%, respectively. The response and performance time were 8-10 s, <1 s, <1 s, 1-3 s, and <1 s, respectively. CONCLUSION: Huaxi intelligent endoscopic skill training and assessment system has preliminarily possessed the capability to assess the endoscopic skills of surgeons objectively.

[Cost-Effectiveness Analysis of Different Chemotherapy Regimens in the Treatment of Patients with Multiple Myeloma].

OBJECTIVE: To compare the pharmaco-economic effect of 3 chemotherapeutic regimens in the treatment of patients with multiple myeloma(MM). METHODS: One hundred and thirty-eight newly diagnosed cases of MM in our hospital were analyzed retrospectively, and then MM patients were divided into group A, B and C group according to therapeutic regimen. Group A was treated with VCD therapeutic regimen (bortezomib + cyclophosphamide + dexamethasone, 63 cases), The patients in group B was treated with BiCTD therapeutic regimen (clarithromycin+cyclophosphamide+thalidomide+dexamethasone, 44 cases), The patients in group C was treated with CTD therapeutic regimen (cyclophosphamide+ thalidomide+dexamethasone, 33 cases). The clinical efficacy, adverse reaction, cost-effectiveness were observed and analysed after 4 courses of treatment among 3 groups. RESULTS: The overall response rates of group A, B and C were 96.83%, 81.82% and 64.52% with statistical significant difference (P<0.01). The high efficiency response rates of 3 groups were 82.5%, 59.09%, 32.26% with very significant statistical difference (P<0.01). The infection rate of group A was statistically and significantly higher than other 2 groups (P=0.048), and the constipation rate in group A was statistically and significantly higer than that in group B and C (P<0.05). The cost-effectiveness ratios of 3 groups were 69567.44, 20765.12 and 21475.48, respectively. The incremental cost-effectiveness ratio of group A and B were 183933.21 and 22259.09, as compared with group C. The result was in accordance with sensitivity test. CONCLUSION: Clinicial efficacy of group A is the best,but group B has advantages on cost-effectiveness ratio as compared with other groups, otherwise, group B has low incidence of adverse reaction. In the view of safety, therapeutic efficacy and pharmacoeconomics for treatment of patients with MM, the BiCTD regimen has been confirmed to be superior to the other 2 groups.

Do transportation subsidies and living allowances improve tuberculosis control outcomes among internal migrants in urban Shanghai, China?

INTRODUCTION: Tuberculosis (TB) in internal migrants is one of three threats for TB control in China. To address this threat, a project was launched in eight of the 19 districts of Shanghai in 2007 to provide transportation subsidies and living allowances for all migrant TB cases. This study aims to determine if this project contributed to improved TB control outcomes among migrants in urban Shanghai. METHODS: This was a community intervention study. The data were derived from the TB Management Information System in three project districts and three non-project districts in Shanghai between 2006 and 2010. The impact of the project was estimated in a difference-in-difference (DID) analysis framework, and a multivariable binary logistic regression analysis. RESULTS: A total of 1872 pulmonary TB (PTB) cases in internal migrants were included in the study. The treatment success rate (TSR) for migrant smear-positive cases in project districts increased from 59.9% in 2006 to 87.6% in 2010 (P < 0.001). The crude DID improvement of TSR was 18.9%. There was an increased probability of TSR in the project group before and after the project intervention period (coefficient = 1.156, odds ratio = 3.178, 95% confidence interval: 1.305-7.736, P = 0.011). CONCLUSION: The study showed the project could improve treatment success in migrant PTB cases. This was a short-term programme using special financial subsidies for all migrant PTB cases. It is recommended that project funds be continuously invested by governments with particular focus on the more vulnerable PTB cases among migrants.

Factors associated with delayed tuberculosis diagnosis in China.

BACKGROUND: Delays in the diagnosis of tuberculosis reflect a lack of access to care, and contribute to ongoing tuberculosis transmission in the community. The objective of this study was to evaluate the delay in tuberculosis testing and the associated risk factors in Shanghai, Shandong and Sichuan provinces in China. METHODS: A prospective cohort study of 765 culture-positive pulmonary tuberculosis patients registered between December 2006 and December 2008. The delay between the onset of symptoms and tuberculosis diagnosis testing and patient information were recorded in a questionnaire and analysed. RESULTS: The median delay was 36 days and was significantly shorter in patients from Shanghai compared with other places (30 vs. 42 days, P < 0.001). Multivariate analysis revealed that cough in Shanghai patients, lowest income level, being married and presenting expectoration in Shandong and Sichuan patients, were associated with a delay in the diagnosis testing of tuberculosis of >30 days. The only factor associated with a delay of >90 days was, in Shandong and Sichuan provinces only, female gender. The presence of other pulmonary symptoms like haemoptysis and loss of weight, fever and chills could shorten these delays. CONCLUSION: Efforts to shorten delays in the diagnosis of tuberculosis must target vulnerable populations. The non-specific symptom of cough is a risk factor associated with longer delays. Training for healthcare workers in areas with a high incidence of tuberculosis, where a delayed diagnosis in coughers may enhance tuberculosis transmission in the community, is of paramount importance.

Predictors on delay of initial health-seeking in new pulmonary tuberculosis cases among migrants population in East China.

OBJECTIVES: To determine the length of delay in initial health-seeking in new pulmonary tuberculosis (PTB) cases among migrant population in the eastern part of China, and factors associated with it. METHODS: A cross-sectional study was conducted using a structured questionnaire in six counties in Shanghai, Guangdong and Jiangsu from May to October, 2008, to estimate the extent and factors responsible for delayed initial health-seeking of the new PTB cases. The interval between self-reported onset of TB symptoms and date of first attendance at any medical institution was determined. More than the median duration was defined as delayed health-seeking. RESULTS: A total of 323 new migrant PTB patients participated in the study. Only 6.5% had medical insurance. The median and mean durations to initial health-seeking were respectively 10 and 31 days. There was no significant association between socio-demographic factors and delayed initial health-seeking. Average monthly working days >24 (AOR, 1.61; 95% CI, 1.03-2.51), and hemoptysis or bloody sputum (AOR, 0.48; 95% CI, 0.28-0.85) were significantly associated with delayed initial health-seeking. CONCLUSIONS: Interventions to improve health seeking behavior among the migrant population in China must focus on strengthening their labor, medical security and health education.

Providing financial incentives to rural-to-urban tuberculosis migrants in Shanghai: an intervention study.

BACKGROUND: Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis (TB) care in China. This paper discusses the effectiveness of providing financial incentives to migrant TB patients (with a focus on poor migrants in one district of Shanghai using treatment completion and default rates), the effect of financial incentives in terms of reducing the TB patient cost, and the incremental cost-effectiveness ratio of the intervention. RESULTS: Ninety and ninety-three migrant TB patients were registered in the intervention and control districts respectively. TB treatment completion rates significantly improved by 11% (from 78% to 89%) in the intervention district, compared with only a 3% increase (from 73% to 76%) in the control district (P = 0.03). Default rates significantly decreased by 11% (from 22% to 11%) in the intervention district, compared with 1% (from 24% to 23%) in the control district (P = 0.03). In the intervention district, the financial subsidy (RMB 1,080/US$170) accounted for 13% of the average patient direct cost (RMB 8,416/US$1,332). Each percent increase in treatment completion costs required an additional RMB 6,550 (US$1,301) and each percent reduction in defaults costs required an additional RMB 5,240 (US$825) in the intervention district. CONCLUSIONS: Overall, financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai. The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China, and this strategy may be applicable to similar international settings.

Barriers to TB care for rural-to-urban migrant TB patients in Shanghai: a qualitative study.

OBJECTIVE: To understand barriers to tuberculosis (TB) care among migrant TB patients in Shanghai after the introduction of the TB-free treatment policy which has applied to migrants since 2003, and to provide policy recommendations to improve TB control in migrant populations in big cities. METHODS: In-depth interviews were conducted with 34 migrant patients who registered on the Shanghai TB programme as new bacteria positive pulmonary TB cases. Patients were purposively selected across six districts of Shanghai to give a balance of gender and TB treatment phase. RESULTS: Financial constraints were reported as the biggest barriers to TB service among migrant patients. Many migrant patients experienced high medical costs both before and after their TB diagnosis. The government free treatment policy only covered a small fraction of patients' total costs. However, respondents tended to stay in Shanghai for treatment because their families were in Shanghai, they were more confident with the quality of medical care there or they felt they could not earn cash at home. Migrant patients had a limited knowledge of TB and the free TB treatment policy, and reported being laid off from work or avoided after having TB. CONCLUSIONS: Health system problems caused the biggest barrier to migrant patients' access to TB care. The free treatment policy alone has little, if any, effect in reducing migrant patients' financial stress: it is also essential to provide social welfare, including living subsidies, for poor migrant TB patients.