The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis.

Background: Subdural empyema is one of the more serious complications of bacterial meningitis and therapeutic challenges to clinicians. We aimed to evaluate the clinical characteristics, treatment, and outcome of subdural empyema in neonates with bacterial meningitis. Methods: A retrospective cohort study was conducted in two medical centers in Taiwan that enrolled all cases of neonates with subdural empyema after bacterial meningitis between 2003 and 2020. Results: Subdural empyema was diagnosed in 27 of 153 (17.6%) neonates with acute bacterial meningitis compared with cases of meningitis without subdural empyema. The demographics and pathogen distributions were comparable between the study group and the controls, but neonates with subdural empyema were significantly more likely to have clinical manifestations of fever (85.2%) and seizure (81.5%) (both p values < 0.05). The cerebrospinal fluid results of neonates with subdural empyema showed significantly higher white blood cell counts, lower glucose levels and higher protein levels (p = 0.011, 0.003 and 0.006, respectively). Neonates with subdural empyema had a significantly higher rate of neurological complications, especially subdural effusions and periventricular leukomalacia. Although the final mortality rate was not increased in neonates with subdural empyema when compared with the controls, they were often treated much longer and had a high rate of long-term neurological sequelae. Conclusions: Subdural empyema is not uncommon in neonates with acute bacterial meningitis and was associated with a high risk of neurological complications, although it does not significantly increase the final mortality rate. Close monitoring of the occurrence of subdural empyema is required, and appropriate long-term antibiotic treatment after surgical intervention may lead to optimized outcomes.

A low-cost process for complete utilization of bauxite residue.

Cost-effective treatment or even valorization of the bauxite residue (red mud) from the alumina industry is in demand to improve their environmental and economic liabilities. This study proposes a strategy that provides a near-complete conversion of bauxite residue to valuable products. The first step involves dilute acid leaching, which allowed the fractionation of raw residues into (1) an aqueous fraction rich in silica and aluminium and (2) a solid residue rich in iron, titanium and rare earth elements. For the proposed process, 91% of the original silicon, 67% of the aluminium, 78% of the scandium and 69% of the cerium were recovered. The initial cost evaluation suggested that this approach is profitable with a gross margin of 167 $US per tonne. This "Residue2Product" approach should be considered for large-scale practices as one of the most economical and sustainable solutions to this environmental and economic liability for the alumina industry.

On the coordination in diversity between water environmental capacity and regional development in the Three Gorges Reservoir area.

Water environment capacity has drew the attention of policymakers and stakeholders to sustainable development, and its dynamic changes are ultimately impacted by population, capital, and industrial clusters under regional development. Previous research, however, has not been able to completely comprehend it. In this paper, the authors use the Coupling Coordination Degree model and the Geodetector model to study the temporal and spatial evolution of water environment capacity and its driving mechanism based on regional development represented by regional function including urbanization function, ecological function, and agricultural function using the Three Gorges Reservoir area on county scale as a case study from 2000 to 2015. The results showed that (1) compared with 2000, 2005, and 2010, the water environment capacity of the whole reservoir area in 2015 was significantly improved. (2) The urban functions of each district and county are increasing in different years, and the dynamic changes of ecological and agricultural functions are obviously different. (3) The water environment capacity of districts and counties in the head area. There are significant disparities in the relationship between water environment capacity and regional function in various regions. Differences in water environment capacity are largely influenced by ecological function and the interaction driver of the proportion of agricultural function and urban function, which are typically the biggest of all the components. This suggests that regional development is a top priority in order to improve the operability of the water environmental capacity through more regulation, rules, and planning.

Spatial characteristics of nutrient budget on town scale in the Three Gorges Reservoir area, China.

Accurately quantifying nutrient budget is an essential step toward sustainable nutrient management in large watersheds increasingly disturbed by human activity. A town-scale nutrient budget framework based on the Soil and Water Assessment Tool was developed for 2010-2012 in the Three Gorges Reservoir area in China (TGRA). Moran's I spatial correlation test and Geodetector spatial heterogeneity test were employed to systematically analyze the spatial characteristics of the resulting nutrient budget. The Moran's I value of total nitrogen (TN) and total phosphorus (TP) gradually increased from input to output in the range of 0.091-0.232 and 0.102-0.484, respectively. Towns with higher TN and TP inputs were largely concentrated in the main urban area of Chongqing because of its high population density. By contrast, towns with higher TN and TP outputs were concentrated in the head of the TGRA. The Moran's I values of the TN and TP retention coefficients (R) were 0.433 and 0.524, respectively, demonstrating clear spatial consistency. Towns with a "High-high" spatial consistency pattern and positive R value were concentrated in the tail and hinterland, while those with a "Low-low" spatial consistency pattern and negative coefficient value were located mainly in the head of the TGRA. This phenomenon was mostly caused by differences in regional elevation, the normalized difference vegetation index, and soil erosion factor. The interaction effect between any two of these three factors on nutrient retention (Geodetector q-value) was greater than 60%. Therefore, future nutrient management should be based on a full understanding of regional biophysical conditions, especially in large areas. These findings provide a new perspective on fine nutrient management.

[Source Analysis and Health Risk Assessment of Heavy Metals in Groundwater of Leizhou Peninsula].

Source identification and health risk assessment of heavy metals in groundwater is one of the key issues in China's new era of environmental management. In order to reveal the status, sources, and health risk of pollutants in groundwater of the Leizhou Peninsula, 44 groundwater samples were collected, and the concentrations and spatial distribution of Cr, Mn, Cu, Zn, As, Cd, Hg, and Pb were measured and analyzed. The sources of heavy metals in groundwater were then determined through correlation coefficient and principal component analysis. Finally, the health risk model was used to evaluate the different health risks associated with these heavy metals. The results showed that the average value of heavy metal elements in groundwater of the Leizhou Peninsula does not inferior to the class Ⅱ water quality standard(GB/T 14848-2017). However, As, Mn, and Cd do not meet the standard. The overall spatial distribution indicated obvious spatial differences, with higher values in the south than in the north. Heavy metal sources can be identified as three principal components (PCs). PC1 (Cu, Zn, Cd, and Pb) metals mainly originate from industrial, agricultural, and traffic sources. PC2 (Cr, Mn, and As) sources can be both natural and man-made, and PC3 (Hg) sources are primarily man-made. For the groundwater of the Leizhou Peninsula, the health risks of 8 metals are with the acceptable range, the carcinogenic risk of adults is higher than that of children, and the risk of drinking exposure is higher than that of skin exposure. The study shows that the environmental protection department should encourage the rational exploitation of groundwater resources and control the sources of pollution to reduce health risks.

Spatial differentiation and driving mechanism of rural water security in typical "engineering water depletion" of karst mountainous area-A lesson of Guizhou, China.

Southwest China gets abundant rainfall, but in its rural areas, there is a severe shortage of water resources for irrigation and drinking. A case study was conducted in the Guizhou Province, which has the most concentrated karst distribution worldwide. The rural water security index was constructed, and Geodetector and ArcGIS were employed to systematically analyze the status quo, spatial differentiation, and driving mechanism of water security in rural areas of Guizhou in 2016. The results showed that (1) there was obvious spatial variation in the rural water security index in the study area, with only 3.85% of areas being maximally safe, and 20.51%, 35.89%, 15.38%, and 24.36% being sub-optimally safe, moderately safe, unsafe, and extremely unsafe, respectively. The spatial distribution of the rural water security index, it generally coincides with a gradual decay from the economically developed areas to the periphery. The water security of the geographical environment is inferior to those of domestic water and water for agricultural production. (2) For Guizhou Province, economic and social factors, such as the disposable income of rural residents and the incidence of impoverishment, were critical factors influencing rural water security. The critical influencing factors vary greatly among prefectures; however, there are some common factors that affect rural water security, such as the incidence of impoverishment, the penetration rate of rural piped water, the percentage of primary industry, and the percentage of karst area. The maximum value of the interactive driver of the percentage of groundwater and the disposable income of rural residents was 0.812, indicating that the interaction between the high percentage of groundwater caused by karst development and the low disposable income of rural residents was the primary reason for the low rural water security. (3) Rural water security was largely influenced by poor socioeconomic development, resulting in a low level of security and the availability of public water facilities and domestic water in rural areas. Significant improvements in rural water security depend on ameliorating the water security of agricultural production and domestic water, rather than improving the geo-environmental conditions of water resources at extremely high costs.

Assessment on China's urbanization after the implementation of main functional areas planning.

China has implemented main functional areas planning (MFAP) since 2010, which is essential for improving the efficiency of land space utilization and achieving sustainable urban development. Quantitative assessments of the urban development levels (UDLs) at the county level across China after the implementation of MFAP have not been well-documented. In this study, a unified indicator system was developed, and the UDLs of 2850 counties in China after MFAP implementation were evaluated. The results showed that MFAP played a positive role in urban development in China. The UDLs in China generally increased but showed obvious spatial differences. The higher UDLs were mostly found in the counties in the five urban belts, which reflects the overall urban layout of China. The UDLs were generally low in the western counties in comparison with those in the eastern part of China. The differences in the UDLs from east to west were greater than those from north to south. Moreover, the differences in the UDLs presented a spatial agglomeration effect. This study could offer insight into the refinement of MFAP in China and sustainable urban development in developing countries.

Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme.

Throughout the duration of the New Cooperative Medical Scheme (NCMS), it was found that an increasing number of rural patients were seeking out-of-county medical treatment, which posed a great burden on the NCMS fund. Our study was conducted to examine the prevalence of out-of-county hospitalizations and its related factors, and to provide a scientific basis for follow-up health insurance policies. A total of 215 counties in central and western China from 2008 to 2016 were selected. The total out-of-county hospitalization rate in nine years was 16.95%, which increased from 12.37% in 2008 to 19.21% in 2016 with an average annual growth rate of 5.66%. Its related expenses and compensations were shown to increase each year, with those in the central region being higher than those in the western region. Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region (X1), rural population (X2), per capita per year net income (X3), per capita gross domestic product (GDP) (X4), per capita funding amount of NCMS (X5), compensation ratio of out-of-county hospitalization cost (X6), per time average in-county (X7) and out-of-county hospitalization cost (X8). According to Bayesian network (BN), the marginal probability of high out-of-county hospitalization rate was as high as 81.7%. Out-of-county hospitalizations were directly related to X8, X3, X4 and X6. The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors, economy factors, regional characteristics and NCMS policy factors was 95.7%, 91.1%, 93.0% and 88.8%, respectively. And how these factors affect out-of-county hospitalization and their interrelationships were found out. Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations, and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.

Understanding Clinical Mammographic Breast Density Assessment: a Deep Learning Perspective.

Mammographic breast density has been established as an independent risk marker for developing breast cancer. Breast density assessment is a routine clinical need in breast cancer screening and current standard is using the Breast Imaging and Reporting Data System (BI-RADS) criteria including four qualitative categories (i.e., fatty, scattered density, heterogeneously dense, or extremely dense). In each mammogram examination, a breast is typically imaged with two different views, i.e., the mediolateral oblique (MLO) view and cranial caudal (CC) view. The BI-RADS-based breast density assessment is a qualitative process made by visual observation of both the MLO and CC views by radiologists, where there is a notable inter- and intra-reader variability. In order to maintain consistency and accuracy in BI-RADS-based breast density assessment, gaining understanding on radiologists' reading behaviors will be educational. In this study, we proposed to leverage the newly emerged deep learning approach to investigate how the MLO and CC view images of a mammogram examination may have been clinically used by radiologists in coming up with a BI-RADS density category. We implemented a convolutional neural network (CNN)-based deep learning model, aimed at distinguishing the breast density categories using a large (15,415 images) set of real-world clinical mammogram images. Our results showed that the classification of density categories (in terms of area under the receiver operating characteristic curve) using MLO view images is significantly higher than that using the CC view. This indicates that most likely it is the MLO view that the radiologists have predominately used to determine the breast density BI-RADS categories. Our study holds a potential to further interpret radiologists' reading characteristics, enhance personalized clinical training to radiologists, and ultimately reduce reader variations in breast density assessment.

Assessment of debris inputs from land into the river in the Three Gorges Reservoir Area, China.

Riverine debris in the Three Gorges Reservoir Area (TGRA) poses a threat to electricity generation, ship navigation, and water environment. Quantifying riverine debris inputs from land into the river is a foundation for modeling of the transport and accumulation of floating debris on the water surface in the TGRA. However, this has not been researched to date. In this study, debris inputs from land into the river in the TGRA were assessed according to the response relationship between debris inputs and surface runoff. The land-based debris inputs in the TGRA were estimated using simulated surface runoff which was simulated by the Soil and Water Assessment Tool (SWAT) model. Results showed that 15.32 × 106 kg of land-based debris was inputted into the main channel of the TGRA in 2015 which accounted for 9.74% of total debris inputs (the monitoring data of river-sourced and land-sourced debris inputs was 157.27 × 106 kg). Debris inputs varied seasonally and peaked in the summer season (July to September). Compared with monthly measured data, the average relative errors in 2015 were below 30%. In addition, areas with higher debris pollution inputs were mainly located in the upper section of the TGRA, between the Tang River Basin and the Long River Basin. The proposed method was tested and determined to be reliable; thus, it can be used to quickly estimate debris inputs from land into the river by surface runoff of the outlets in a river basin. Moreover, this method provides new insight into the estimation of land-based debris inputs into rivers.

Development of Monte Carlo based real-time treatment planning system with fast calculation algorithm for boron neutron capture therapy.

PURPOSE: We simulated the effect of patient displacement on organ doses in boron neutron capture therapy (BNCT). In addition, we developed a faster calculation algorithm (NCT high-speed) to simulate irradiation more efficiently. METHODS: We simulated dose evaluation for the standard irradiation position (reference position) using a head phantom. Cases were assumed where the patient body is shifted in lateral directions compared to the reference position, as well as in the direction away from the irradiation aperture. For three groups of neutron (thermal, epithermal, and fast), flux distribution using NCT high-speed with a voxelized homogeneous phantom was calculated. The three groups of neutron fluxes were calculated for the same conditions with Monte Carlo code. These calculated results were compared. RESULTS: In the evaluations of body movements, there were no significant differences even with shifting up to 9mm in the lateral directions. However, the dose decreased by about 10% with shifts of 9mm in a direction away from the irradiation aperture. When comparing both calculations in the phantom surface up to 3cm, the maximum differences between the fluxes calculated by NCT high-speed with those calculated by Monte Carlo code for thermal neutrons and epithermal neutrons were 10% and 18%, respectively. The time required for NCT high-speed code was about 1/10th compared to Monte Carlo calculation. CONCLUSIONS: In the evaluation, the longitudinal displacement has a considerable effect on the organ doses. We also achieved faster calculation of depth distribution of thermal neutron flux using NCT high-speed calculation code.

Signal Quality Assessment Model for Wearable EEG Sensor on Prediction of Mental Stress.

Electroencephalogram (EEG) plays an important role in E-healthcare systems, especially in the mental healthcare area, where constant and unobtrusive monitoring is desirable. In the context of OPTIMI project, a novel, low cost, and light weight wearable EEG sensor has been designed and produced. In order to improve the performance and reliability of EEG sensors in real-life settings, we propose a method to evaluate the quality of EEG signals, based on which users can easily adjust the connection between electrodes and their skin. Our method helps to filter invalid EEG data from personal trials in both domestic and office settings. We then apply an algorithm based on Discrete Wavelet Transformation (DWT) and Adaptive Noise Cancellation (ANC) which has been designed to remove ocular artifacts (OA) from the EEG signal. DWT is applied to obtain a reconstructed OA signal as a reference while ANC, based on recursive least squares, is used to remove the OA from the original EEG data. The newly produced sensors were tested and deployed within the OPTIMI framework for chronic stress detection. EEG nonlinear dynamics features and frontal asymmetry of theta, alpha, and beta bands have been selected as biological indicators for chronic stress, showing relative greater right anterior EEG data activity in stressful individuals. Evaluation results demonstrate that our EEG sensor and data processing algorithms have successfully addressed the requirements and challenges of a portable system for patient monitoring, as envisioned by the EU OPTIMI project.

Targetable phosphorescent oxygen nanosensors for the assessment of tumor mitochondrial dysfunction by monitoring the respiratory activity.

Cellular respiration is a worthwhile criterion to evaluate mitochondrial dysfunction by measuring the dissolved oxygen. However, most of the existing sensing strategies merely report extracellular (ec-) or intracellular (ic-) O2 rather than intramitochondrial (im-) O2 . Herein we present a method to assess tumor mitochondrial dysfunction with three phosphorescent nanosensors, which respond to ec-, ic-, and im-O2 . Time-resolved luminescence is applied to determine the respective oxygen consumption rates (OCRs) under varying respiratory conditions. Data obtained for the OCRs and on (intra)cellular O2 gradients demonstrate that mitochondria in tumor cells are distinctly less active than those of healthy cells, resulting from restrained glucose utilization of and physical injury to the mitochondria. We believe that such a site-resolved sensing strategy can be applied to numerous other situations, for example to evaluate the adverse effects of drug candidates.

Current status and challenge of Human Parasitology teaching in China.

Parasitic infection profile in China has been changed greatly with the rapid economic development in China since the 1980s, such as the tremendous decreased infection rate of the soil-borne helminthiasis, the elimination of filariasis, the control of malaria, and the initiation to eradicate malaria in 2020. Some food-borne parasitic infections have increased such as Clonorchiasis, Cysticercosis, and Echinococcosis, probably because of the increased chances of eating out. This trend directly affected the status of Human Parasitology teaching in medical universities, such as the shorten length of this course, re-adjusted contents structure and teaching manners, even the change of the name of this course. In this paper, we analyzed the current status and challenges of Human Parasitology teaching in medical universities, and discussed the requisite contents and manners in course delivery and measures to improve the quality of Human Parasitology teaching in China.

Weight of the CURB-65 criteria for community-acquired pneumonia in a very low-mortality-rate setting.

OBJECTIVE: The CURB-65 score is a simple well validated tool for the assessment of severity in community-acquired pneumonia (CAP). The weight of each criterion in very low-mortality-rate settings is unclear. The purpose of this study was to determine the weight in such setting. METHODS: This study retrospectively reviewed 1,230 adult patients admitted for CAP from 2005 to 2009. RESULTS: The 30-day mortality rose sharply from 0%, 1.0%, 8.2% and 16.7%, respectively, for patients with CURB-65 scores of 0, 1, 2 and 3 to 100.0% for patients with the scores of 4 (x(2) = 219.494, p<0.001). Confusion had the strongest association with mortality (odds ratio, 22.148). The presence of low blood pressure was not associated with mortality. Confusion, urea >7 mmol.L(-1) and age ≥ 65 yrs showed independent relationships with mortality (Odds ratio, 11.537, 5.988 and 10.462; respectively). Urea >7 mmol.L(-1) was most strongly associated with the sequential organ failure assessment (SOFA) scores [rank correlation coefficient (r(s)), 0.352]. Confusion had the closest relationship with hospital length of stay (r(s), 0.114). Age ≥ 65 yrs had the strongest association with costs (r(s), 0.223). Conclusion The individual CURB-65 criteria were of unequal weight for predicting the 30-day mortality, SOFA scores, hospital length of stay and costs in a very low-mortality-rate setting, and a low blood pressure was not associated with mortality.

A fiber-optic evanescent wave O2 sensor based on Ru(II)-doped fluorinated ORMOSILs.

A novel fiber-optic evanescent wave sensor (FOEWS) for O(2) detection based on [Ru(bpy)(3)](2+)-doped hybrid fluorinated ORMOSILs (organically modified silicates) has been developed. The sensing element was fabricated by dip-coating the optical fiber with [Ru(bpy)(3)](2+)-doped hybrid fluorinated ORMOSILs composed of n-propyltrimethoxysilane (n-propyl-TriMOS) and 3, 3, 3-trifluoropropyltrimethoxysilane (TFP-TriMOS). Fluorophores of [Ru(bpy)(3)](2+) were excited by the evanescent wave field produced on the fiber core surface and the emission fluorescence was quenched by O(2). Spectroscopic properties have been characterized by FTIR and UV-VIS absorption measurements. By using the presented hybrid fluorinated ORMOSILs, which enhances the coating surface hydrophobicity, the quenching response is increased. The sensitivity of the sensor is 7.5, which is quantified in terms of the ratio I (N2)/I (O2) (I (N2) and I (O2) represent the fluorescence intensities in pure N(2) and pure O(2) environments, respectively). The limit of detection (L.O.D.) is 0.01% (3sigma) and the response time is about 1 s. Meanwhile, the proposed FOEWS has the advantages of easy fabrication, low cost, fast response and suitable sensitivity for oxygen monitoring using a cheap blue LED as light source and coupling a miniature PMT detector directly to the optical fiber probe.

[An epidemiological study of visual disability and visual rehabilitation in Beijing].

OBJECTIVE: To investigate the status of visual disability and the demands for visual rehabilitation services in Beijing. METHODS: Five hundred and fifty-five persons with visual disability in Beijing from the Second National Survey on Disability of China were involved in this study. Their visual disability and demands for rehabilitation were evaluated. RESULTS: About three fourth of the visual disabled persons were over 60 years of age. Cataract, retinal and choroidal diseases, and glaucoma were the three leading causes of the visual impairment. Medical service was the number one (82.0%) demand for the persons with visual disability, although 89.4% of them had previously received some kinds of medial services. People who had received visual aid devices or rehabilitation training were 26.7% and 5.8%, respectively, while more people showed their demand for these service (36.6% and 11.9%, respectively). The demand for visual rehabilitation varied in different groups of age and severity of disability. CONCLUSION: Accessibility of high quality medical services for preventable blindness diseases should be further promoted. Public health education on visual rehabilitation is also needed.

[Status of demands on rehabilitation among handicapped persons of six categories in Beijing].

OBJECTIVE: To explore the status of rehabilitation demands and services of persons with disability in Beijing and to provide evidence for rehabilitation establishment programmed by government and civil society. METHODS: Using both qualitative and descriptive methodologies to analyze the data of 4852 disabled persons who had been confirmed of requiring rehabilitation services in Beijing. Data was from the Second China National Sample Survey on Disability in conferring the demands for rehabilitation services. RESULTS: The consciousness and demand for rehabilitation was higher among urban disabled residents than those living in the rural areas. Demand on rehabilitation training from children was accounted for 75.23%. Rates of demand on assistant device and medical service among the elderly were 57.05%, 66.86% respectively. Primary rehabilitation format of grade I and II appeared to be community-based and family service while grade III and IV were institutional rehabilitation programs. Rates on needs regarding vision and limb accounted for 85.23% and 59.91% respectively. 76.95% of the disability persons among intelligentsia needed community and family service. The rates on demand of medical treatment of mental, vision, limbs services were 92.80%, 86.77% and 68.24% respectively while the demand for assistant device of hearing disability was 83.09%. Rates of demand on rehabilitative training from mental, dication and mind disabled were 84.36%, 77.42%, 62.82%. Other kinds of demand and services seemed relatively low other than medical treatment. CONCLUSION: The gap between demand and salvation on rehabilitation was relatively great, suggesting the enhancement of disabled rehabilitation programs be strengthened to promote the build-up of a correct concept on rehabilitation among the disabled. Demands from the disabled persons should be extensively met.