Assessment of the Implementation of Pakistan's National Action Plan on Antimicrobial Resistance in the Agriculture and Food Sectors.

The agriculture and food (agrifood) sectors play key roles in the emergence, spread, and containment of antimicrobial resistance (AMR). Pakistan's first National Action Plan (NAP) on AMR was developed to guide One Health interventions to combat AMR through 2017-2022. To improve subsequent iterations, we assessed the implementation of Pakistan's NAP in the agrifood sectors (NAPag) in October 2022, using the Progressive Management Pathway on AMR tool developed by the Food and Agriculture Organization of the United Nations (FAO). The assessment tool addressed four crucial focus areas of the NAPag: governance, awareness, evidence, and practices. Each focus area contains multiple topics, which involve four sequential stages of activities to progressively achieve systematic management of AMR risk in the agrifood sectors. High-level representatives of the NAPag stakeholders provided information for the assessment through pre-event documentary review and workshop discussions. The assessment results showed that Pakistan's NAPag had an overall moderate coverage (59%) of the anticipated activities. Gaps were particularly notable in strengthening governance, good practices, and interventions in non-livestock sectors. Furthermore, only 12% of the evaluated activities were fully executed and documented, consistently remaining at the planning and piloting stages in the livestock sector across all the examined topics. Insufficient attention to non-livestock sectors, inadequate regulation and enforcement capacity, and resource constraints have hindered scalable and sustainable interventions under the current plan. This assessment provides valuable insights to strengthen the inclusiveness and contribution of the agrifood sectors in the next NAP iteration. In the short-to-medium term, strategic prioritization is necessary to optimize the use of limited resources and target the most critical gaps, such as improving awareness among key stakeholders and fortifying regulations for prudent antimicrobial use. In the long term, integration of AMR into the country's broader health, development, and agricultural transformation agendas will be needed to generate sustainable benefits.

A cellular automata model coupled with partitioning CNN-LSTM and PLUS models for urban land change simulation.

Urbanisation is a key aspect of land use change (LUC), and accurately modelling of urban LUC is crucial for sustainable development. Cellular automata (CA) are widely used in LUC research. However, previous studies have overlooked the significant temporal dependence and spatial heterogeneity associated with LUC. To address these gaps, this study proposes a novel model called KCLP-CA, which integrates k-means, a convolutional neural network (CNN), a long and short-term memory neural network (LSTM), and the popular patch-generation land use model (PLUS). Initially, k-means and CNN are utilised to address spatial heterogeneity, while LSTM tackles temporal dependence. The LSTM and land expansion analysis strategy (LEAS) models of PLUS are employed to obtain land use conversion probability maps. Finally, a simulation of land use dynamic change was conducted using a linear weighted fusion conversion probability map that accounts for random factors. To validate the KCLP-CA model, land use data collected from Hangzhou between 1995 and 2000 were employed. The results showed that the KCLP-CA model outperformed traditional methods, including artificial neural networks and random forest model, with the figure of merit (FoM) index increasing from 2.12% to 4.19%. Random forest analysis of drivers impacting LUC revealed that distance to water and road network density exerted the greatest influence on urban land development in Hangzhou. Incorporation of various policy planning factors affecting urban development yielded simulation results aligning more closely with reality, resulting in a FoM index increase of 1.64-1.76%. In summary, the model developed in this study combines the strengths of two sub models to deliver an accurate and effective simulation of future land use.

[Occurrence Characteristics and Risk Assessment of Microplastics in Water and Sediments of Anhui Section of Huaihe River Basin].

The occurrence characteristics and ecological risk level of microplastics in the water and sediments of the Anhui section of Huaihe River Basin were analyzed via field sampling, stereomicroscopy, scanning electron microscopy, Fourier transform infrared spectroscopy (FTIR), risk index (H), and pollution load index (PLI) model. The current situation of microplastics in the water and sediments of the basin was analyzed, and the ecological risk assessment of microplastics was conducted. The results showed that the detection rate of microplastics at each site in the basin was 100%. The average abundance of microplastics in surface water and sediments was (39800±3367) n·m-3 and (5078±447) n·kg-1, respectively. The average abundance of microplastics in the downstream was higher than that in the upstream and midstream. The particle size of microplastics in water and sediments was primarily 20-150 µm, accounting for 82.96% and 80.77%, respectively. The microplastics were primarily fiber (water 76.05%, sediment 84.53%), film (water 21.83%, sediment 15.43%), and debris (water 2.12%, sediment 0.04%). The microplastics in water and sediments were primarily transparent, accounting for 63.31% and 83.69%, respectively. Polyethylene (65.74% in water and 80.62% in sediment) and polypropylene (18.43% in water and 9.71% in sediment) were the major components of water and sediments. Microplastics were primarily derived from agricultural films, abandoned fishing gear and nets, and artificially abandoned plastic bags in ports. The microplastic risk index (H) model assessment revealed that the risk index of some sites was high, and the risk level of microplastics in the Anhui section of Huaihe River Basin was grade II. The pollution load index (PLI) model assessment revealed that the ecological risk of surface water and sediments in the basin was generally low.

Global prioritization of endemic zoonotic diseases for conducting surveillance in domestic animals to protect public health.

Zoonotic diseases (zoonoses) originating from domestic animals pose a significant risk to people's health and livelihoods, in addition to jeopardizing animal health and production. Effective surveillance of endemic zoonoses at the animal level is crucial to assessing the disease burden and risk, and providing early warning to prevent epidemics in animals and spillover to humans. Here we aimed to prioritize and characterize zoonoses for which surveillance in domestic animals is important to prevent human infections at a global scale. A multi-criteria qualitative approach was used, where disease-specific information was obtained across literature of the leading international health organizations. Thirty-two zoonoses were prioritized, all of which have multi-regional spread, cause unexceptional human infections and have domestic animal hosts as important sources or sentinels of zoonotic infections. Most diseases involve multiple animal hosts and/or modes of zoonotic transmission, where a lack of specific clinical signs in animals further complicates surveillance. We discuss the challenges of animal health surveillance in endemic and resource-limited settings, as well as potential avenues for improvement such as the multi-disease, multi-sectoral and digital surveillance approaches. Our study will support global capacity-building efforts to strengthen the surveillance and control of endemic zoonoses at their animal sources. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Current status and temporal trend of disease burden of thyroid cancer in China from 1990 to 2019.

OBJECTIVE: Thyroid cancer has been an increasingly high-profile public health issue. Comprehensive assessment for its disease burden seems particularly important for understanding health priorities and hinting high-risk populations. METHODS: We estimated the age-sex-specific thyroid cancer burden and its temporal trend in China from 1990 to 2019 by following the general methods from the global burden of disease (GBDs) 2019 Study. And Joinpoint regression model, the Cox-Stuart trend test, and Cochran-Armitage test were applied for the analysis of temporal and age trend. The Mantel-Haenszel statistical method was used to compare the gender difference. RESULTS: From 1990 to 2019, the age-standardized incidence rate of thyroid cancer in China has almost doubled to 2.05 per 100,000. Although the mortality rate and DALY rate kept leveling off, they presented a downtrend among females, while an upward trend in males. While the average annual percentage changes of those metrics all became deline since 2010 than the previous years. With age advancing, the rates of incidence, mortality, and DALYs for both sexes all presented linear fashion increases, which was particularly typical among males. CONCLUSION: Given the serious trend and gender-age heterogeneity of Chinese thyroid cancer burden, male gender and advanced age may be related to poor prognosis of thyroid cancer, and strengthening primary prevention and exploring the underlying risk factors should be among the top priorities.

Optimal Allocation of Water Resources and Eco-Compensation Mechanism Model Based on the Interval-Fuzzy Two-Stage Stochastic Programming Method for Tingjiang River.

In this work, based on the upper line of water resources utilization and the bottom line of water environmental quality of "Three Lines, Single Project", a fuzzy optimization method was introduced into the Tingjiang River water resources optimal allocation and eco-compensation mechanism model, which is based on the interval two-stage (ITS) stochastic programming method. In addition, a Tingjiang River water resources allocation and eco-compensation mechanism model based on the interval fuzzy two-stage (IFTS) optimization method was also constructed. The objective functions of both models were to maximize the economic benefits of the Tingjiang River. The available water resources in the basin, the water environmental quality requirements, and regional development requirements were used as constraints, and under the five hydrological scenarios of extreme dryness, dryness, normal flow, abundance, and extreme abundance, the water resources allocation plan of various sectors (industry, municipal, agriculture, and ecology) in the Tingjiang River was optimized, and an eco-compensation mechanism was developed. In this work, the uncertainty of the maximum available water resources in each region and the whole basin was considered. If the maximum available water resources were too high, it would lead to a large waste of water resources, whereas if the maximum available water resources were too low, regional economic development would be limited. Therefore, the above two parameters were set as fuzzy parameters in the optimization model construction in this work. The simulation results from the IFTS model showed that the amount of water available in the river basin directly affects the water usage by various departments, thereby affecting the economic benefits of the river basin and the amount of eco-compensation paid by the downstream areas. The average economic benefit of the Tingjiang River after the optimization of the IFTS model simulation was [3868.51, 5748.99] × 108 CNY, which is an increase of [1.67%, 51.9%] compared to the economic benefit of the basin announced by the government in 2018. Compared to the ITS model, the economic benefit interval of the five hydrological scenarios of extreme dryness, dryness, normal flow, abundance, and extreme abundance was reduced by 28.54%, 44.9%, 31.49%, 40.37%, and 36.43%, respectively, which can improve the economic benefits of the basin and provide more accurate decision-making schemes. In addition, the IFTS simulation showed that the eco-compensation quota paid by downstream Guangdong Province to upstream Fujian Province is [28,116.4, 30,738.6] × 104 CNY, which is a reduction of [8461.404, 110,836] × 104 CNY compared to the 2018 compensation scheme of the government. Compared to the ITS model, the range of eco-compensation values was observed to increase by 9.94%, 54.81%, 15.85%, 50.31%, and 82.90%, respectively, under the five hydrological scenarios, which reduces the burden of ecological expenditure downstream and provides a broader decision-making space for decision-makers and thus enables improved decision-making efficiency. At the same time, after the optimization of the IFTS model, the additional water consumption of the second stage of the Tingjiang River during the extremely dry year decreased by 62.11% compared to the results of the ITS model. The additional water consumption of the industrial sector decreased by 68.39%, the municipal sector decreased by 59.27%, and in the first phase of water resources allocation for 14 districts and counties in the Tingjiang River, industrial and municipal sectors are the main two sectors. After introducing the fuzzy method into the IFTS model, the difference in the water consumption by these two sectors in the basin under different hydrological scenarios can be alleviated, and the waste of water resources caused by too low water allocation or excessive water allocation can be avoided. The national and local (the downstream region) eco-compensation quotas can be indirectly reduced, and the risk of water resources allocation and eco-compensation decision-making in the basin can be effectively reduced.

Spatial, temporal variability and carcinogenic health risk assessment of nitrosamines in a drinking water system in China.

Nitrosamines, as a class of emerging frequently detected nitrogenous disinfection byproducts (N-DBPs) in drinking water, have gained increasing attention due to their potentially high health risk. Few studies focus on the occurrence variation and carcinogenic health risk of nitrosamines in drinking water systems. Our study aimed to investigate the spatial and temporal variability of nitrosamines in a drinking water system and to conduct a carcinogenic health risk assessment. Three types of water samples, including influent water, treated water and tap water, were collected monthly during an entire year in a drinking water system utilizing a combination of chlorine dioxide and chlorine in central China, and 9 nitrosamines were measured. The nitrosamine formation potentials (FPs) in influent water were also determined. N-nitrosodimethylamine (NDMA) was the most prevalent compound and was dominant in the water samples with average concentrations ranging from 2.5 to 67.4 ng/L, followed by N-nitrosodiethylamine (NDEA) and N-nitrosopiperidine (NPIP). Nitrosamine occurrence varied monthly, and significant seasonal differences were observed in tap water (p < .05). There were decreasing mean NDMA, NDEA and NPIP concentrations from influent water to treated water to tap water, but no significant spatial variability was observed within the water distribution system (p > .05). The average and 95th percentile total lifetime cancer risks for the three main nitrosamines were 4.83 × 10-5 and 4.48 × 10-4, respectively, exceeding the negligible risk level (10-6) proposed by the USEPA. Exposure to nitrosamines in drinking water posed a higher cancer risk for children than for adults, and children aged 0.75 to 1 years suffered the highest cancer risk. These results suggest that nitrosamine occurrence in tap water varied temporally but not spatially. Exposure to drinking water nitrosamines may pose a carcinogenic risk to human health, especially to children.

Nutritional assessment and prognosis of oral cancer patients: a large-scale prospective study.

BACKGROUND: To evaluate and compare the prognostic performance of four nutritional indicators body mass index (BMI), serum albumin (ALB), prognostic nutritional index (PNI) and nutritional risk index (NRI) in oral cancer patients, and to predict the response to chemotherapy in patients with different nutritional status. METHODS: This prospective study which involved 1395 oral cancer patients was conducted in Fujian, China from September 2007 to November 2018. The BMI, PNI and NRI were calculated according to the following formulas: BMI = weight / height2 (kg/m2), PNI = albumin (g/l) + 0.005 × lymphocyte (count/µl) and NRI = (1.519 × albumin, g/l) + (41.7× present/ideal body weight), respectively. The univariate and multivariate Cox proportional hazards models were used to compare the prognostic value of BMI, ALB, PNI and NRI in overall survival (OS) in oral cancer. RESULTS: Patients with BMI < 18.5 kg/m2 (VS 18.5 kg/m2 ≤ BMI < 24 kg/m2) had a poor survival outcome (HR = 1.585; 95% CI: 1.207-2.082 ). ALB, PNI, NRI were inversely correlated with OS of oral cancer (HR = 0.716; 95% CI: 0.575-0.891; HR = 0.793; 95% CI: 0.633-0.992; HR = 0.588; 95% CI: 0.469-0.738, respectively). In addition, the prognostic predictive performance of NRI was superior to BMI or ALB or PNI. Interestingly, compared with patients with better nutritional status, chemotherapy was significantly associated with poorer OS in malnourished oral cancer patients. CONCLUSIONS: BMI, ALB, PNI and NRI are of prognostic value in patients with oral cancer and the prognostic performance of NRI was superior to BMI or ALB or PNI. Malnutrition (BMI < 18.5 kg/m2 or ALB< 40 g/l or PNI < 49.3 or NRI < 97.5) could predict an unfavorable response to chemotherapy in oral cancer patients.

Exploration of the critical factors influencing the water quality in two contrasting climatic regions.

Over the past few decades, rivers have become severely polluted as a result of receiving vast quantities of domestic and industrial wastewater. The identification of the major factors that influence water quality is crucial to understand the interactions of anthropogenic and natural factors and develop river restoration projects. In this study, the QUAL2Kw water quality model was used to quantitatively evaluate the most critical factors for water quality at two sites with different meteorological conditions and urban scales. The genetic algorithm (GA) was used to optimize the parameters in the model. The Monte Carlo simulation (MCS) method was used to assess the model uncertainty and sensitivity in all reaches for five water quality outputs (temperature, CBOD, DO, TP, and TN) in two seasons. The K-means clustering method associated with the sensitivity results was used to identify the major factors influencing the water quality in all reaches from the input data and the model parameters. The results showed that CBOD, TN, and TP were most sensitive to headwater and tributary quality. DO tended to be affected by more natural reactions than the other water quality indicators. In the cold and dry seasons and the more urbanized areas, river pollution was more severe, and the impact of natural reactions was reduced. The simulation results revealed the reliability of QUAL2Kw in modeling the quantity and quality of all river reaches. The method applied in this study is beneficial for the improvement and management of the water environment.

[Contribution Assessment of Meteorology Conditions and Emission Change for Air Quality Improvement in Beijing During 2014-2017].

During 2014-2017, the number of haze days and air pollution days declined year by year obviously in Beijing. The average mass concentrations of PM2.5, PM10, SO2, and NO2 also decreased with the alleviated pollution level. These decreases were more obvious during the heating period, especially in November and December. In order to analyze the reasons for the improvement of air quality, changes of the meteorological factors and emission-reduction have been discussed and quantified in this study. This work was based on the numerical simulation model WRF-CHEM and the large data mining technologies of k-nearest neighbor (KNN) and support vector machines (SVM). Meteorological observations indicated that the mean wind speed of 2017 increased by 7.9% compared with the last three years. The frequency of hourly wind speed higher than 3.4 m·s-1 was the highest (10.6%), and frequency of daily relative humidity higher than 70% was lowest (25.1%), in 2017. Meanwhile, the number of low wind days (daily wind speed lower than 2 m·s-1), environmental capacity, ventilation index, and height of the boundary layer showed that the diffusion conditions were better in the heating period of 2017 than those of 2014~2016, especially in November and December. The accumulated precipitation during the non-heating period was 558.3 mm in 2017, which is conducive to pollutant removal and wet deposition. Inter-annual changes of meteorological conditions are important to the air quality. A simulation for December 1~19 by WRF-CHEM during 2014-2017 was performed, and the results demonstrated that changes of meteorological conditions led to a reduction of the PM2.5 concentration of 2017 by 5%, 38%, and 25% compared with that of 2014-2016, respectively. However, it was not possible to quantify the specific contributions of meteorology conditions because of the lack of real emission reduction options. The KNN and SVM models are applied in this study based on the observed meteorology factors, haze days, and pollution days, and it was found that for the reduced haze days and heavy pollution days in 2017, 65.0% could be attributed to emission reduction and 35.0% was caused by improvement of the meteorological conditions.

An Interval Two-Stage Stochastic Programming Model for Flood Resources Allocation under Ecological Benefits as a Constraint Combined with Ecological Compensation Concept.

The Momoge National Nature Reserve (MNNR) is located at the intersection of Nenjiang and Taoer Rivers in Baicheng City, Jilin Province, where the Taoer River is the main source of water for the nature reserve. However, due to the construction of the water control project in the upper reaches of the Taoer River, the MNNR has been in a state of water shortage for a long time. To guarantee the wetland function of the nature reserve, the government planned to carry out normal and flood water supply from Nenjiang River through the West Water Supply Project of Jilin Province. Therefore, how to improve the utilization of flood resources effectively has become one of the key issues of ecological compensation for the MNNR. In this paper, a flood resources optimal allocation model that is based on the interval two-stage stochastic programming method was constructed, and the corresponding flood resource availability in different flow scenarios of Nenjiang River were included in the total water resources to improve their utilization. The results showed that the proportion of flood resources that were used in the MNNR after optimization was more than 70% under different flow scenarios, among which the proportion of flood resources under a low-flow scenario reached 77%, which was 23% higher than the proposed increase. In addition, the ecological benefits of low, medium, and high flow levels reached the range of 26.30 (106 CNY) to 32.14(106 CNY), 28.21(106 CNY) to 34.49(106 CNY) and 29.41(106 CNY) to 35.94(106 CNY), respectively. According to the results, flood resources significantly reduce the utilization of normal water resources, which can be an effective supplement to the ecological compensation of nature reserves and provide a basis for the distribution of transit flood resources in other regions.

[Distribution Characteristics and Risk Assessment of Heavy Metals in the Sediments of the Estuary of the Tributaries in the Three Gorges Reservoir, SW China].

To investigate the pollution status of sediments at the junction of the Three Gorges Reservoir area, sediment samples were collected over four seasons from the junction of the estuary located at a tributary of the Ruxi River and the Yangtze River. The content of eight heavy metals (HMs), including Cr, Zn, Mn, Ni, Cu, As, Cd, and Pb, in sediments was determined by ICP-MS. The results showed the average levels of investigated HMs (in mg·kg-1) were Cr (45.24), Zn (46.46), Mn (406.14), Ni (20.885), Cu (12.49), As (7.02), Cd (0.253), and Pb (11.042). The distribution analysis indicated that the levels of HMs at the river mouth were higher than that of the tributaries of the middle reaches and the two sections nearby. The seasonal distribution shows that the heavy metal content in the spring sediment is higher than in summer, autumn and winter. In addition, the correlation analysis indicated that the eight HMs possessed similar homologous characteristics and had common exogenous inputs. The assessment of the Geo Accumulation Index showed slight Cd pollution in the estuary of Ruxi River, and the Potential Ecological Risk index showed that Cd presented moderate ecological risks. The toxic effect of benthonic organisms was possibly correlated to Ni contamination at the intersection of the tributary and main stream, which was supported by the evidence from the sediment quality criteria. In conclusion, the rating of ecological risk at the mouth of the Ruxi River tributary is slight.

Percutaneous US-guided Cholecystocholangiography with Microbubbles for Assessment of Infants with US Findings Equivocal for Biliary Atresia and Gallbladder Longer than 1.5 cm: A Pilot Study.

Purpose To evaluate the feasibility of ultrasonographically (US) guided percutaneous cholecystocholangiography (PCC) for early exclusion of biliary atresia (BA) in infants suspected of having BA with equivocal US findings or indeterminate type of BA and a gallbladder longer than 1.5 cm at US. Materials and Methods This study was approved by the ethics committee; written informed parental consent was obtained. From February 2016 to December 2016, nine infants (four boys, five girls; mean age, 60.2 days; median age, 57 days; age range, 23-117 days) with conjugated hyperbilirubinemia and gallbladder longer than 1.5 cm at US were referred for US-guided PCC after US findings were equivocal for BA (n = 7) or the type of BA was unclear (n = 2). PCC was performed with a US machine with incorporated contrast pulse sequencing, contrast-specific software, and a linear transducer by injecting diluted contrast material via an 18-gauge needle. Images from US and US-guided PCC were evaluated in consensus by two radiologists. US criteria for BA were fibrotic cord sign (>2 mm) and gallbladder length-to-width ratio greater than 5.2. BA was excluded at PCC when contrast material was visualized in the gallbladder, common hepatic ducts, and common bile duct and during passage to the duodenum. Patients in whom BA was diagnosed after PCC underwent surgery or liver biopsy as the reference standard. Nonparametric and Fisher exact tests were used. Results US-guided PCC was successful in all patients. There were no procedural-related complications. BA was excluded in five of the nine patients. The median serum direct bilirubin level in these patients slightly decreased 1 week after PCC, from 91.1 µmol/L (interquartile range [IQR], 81.6-113.8 µmol/L) to 65.3 µmol/L (IQR, 57.8-74.7 µmol/L); however, this difference was not statistically significant (P = .062). BA was diagnosed in four patients, with the diagnosis confirmed at surgery (n = 2) or liver biopsy (n = 2). BA in two patients with unclear type of BA was defined as type III without patency of the common bile duct in one patient and as type III with patency of the common bile duct in the other. Conclusion In this highly selected group of infants with indeterminate type of BA or inconclusive US findings, US-guided PCC enabled the diagnosis of BA in four infants and the exclusion of BA in five. US-guided PCC may be a safe and effective tool to exclude BA early in infants with equivocal US findings. © RSNA, 2017.

Optimizing prescription of chinese herbal medicine for unstable angina based on partially observable markov decision process.

Objective. Initial optimized prescription of Chinese herb medicine for unstable angina (UA). Methods. Based on partially observable Markov decision process model (POMDP), we choose hospitalized patients of 3 syndrome elements, such as qi deficiency, blood stasis, and turbid phlegm for the data mining, analysis, and objective evaluation of the diagnosis and treatment of UA at a deep level in order to optimize the prescription of Chinese herb medicine for UA. Results. The recommended treatment options of UA for qi deficiency, blood stasis, and phlegm syndrome patients were as follows: Milkvetch Root + Tangshen + Indian Bread + Largehead Atractylodes Rhizome (ADR = 0.96630); Danshen Root + Chinese Angelica + Safflower + Red Peony Root + Szechwan Lovage Rhizome Orange Fruit (ADR = 0.76); Snakegourd Fruit + Longstamen Onion Bulb + Pinellia Tuber + Dried Tangerine peel + Largehead Atractylodes Rhizome + Platycodon Root (ADR = 0.658568). Conclusion. This study initially optimized prescriptions for UA based on POMDP, which can be used as a reference for further development of UA prescription in Chinese herb medicine.