[Potential Ecological Risk Characteristics and Source Apportionment of Heavy Metals in Farmland Soils around Typical Factories in Hunan Province Based on Monte-Carlo Simulation].

In order to explore the pollution characteristics， ecological risks， and pollution sources of heavy metals in farmland soils around typical factories in Hunan Province， the content characteristics of eight heavy metals in farmland soils around fluoride factories， leather factories， and plating plants were analyzed. The geo-accumulation index and potential ecological risk index were used to evaluate the pollution and environmental risk of heavy metals. The correlation analysis， hierarchical cluster analysis， and principal component analysis were used to analyze the sources of heavy metals. The Monte-Carlo model was used to evaluate the probability risk of regional ecological risk. The results showed that the main pollution elements in the soil were Cd and Zn， and their mean values were 4.46 and 2.73 times the background values， respectively. Zn was at a mild pollution level in the soil of the three typical factories， and Cd was at a moderate pollution level in the whole fluoride factory. The pollution sources of heavy metals in the typical factories were mainly natural sources， industrial activity sources （industrial waste discharge， mineral mining， and smelting activities）， traffic sources， etc. The results of potential ecological risk assessment showed that the ecological risk of the fluoride factory was at a high risk level， and the ecological risk of the leather factory and plating plants was at a high risk level. Cd was the main contributing element. The results of Monte-Carlo probabilistic ecological risk assessment reduced the uncertainty of deterministic assessment， which could provide scientific basis for accurate risk management and control in the regions.

Impacts of unifying urban and rural residents' medical insurance on the hospitalisation expenses of rural patients in eastern China: an interrupted time series analysis.

OBJECTIVES: This study evaluated the impact of the Urban and Rural Residents' Basic Medical Insurance scheme on hospitalisation expenses of rural patients in eastern China, which unified separate healthcare systems for urban and rural residents. DESIGN: Monthly hospitalisation data from municipal and county hospitals were collected from the local Medicare Fund Database, covering the period from January 2018 to December 2021. The unification of insurance between urban and rural patients was implemented at different times for county and municipal hospitals. An interrupted time series analysis was used to assess the immediate and gradual effects of the integrated policy on the total medical expenses, out-of-pocket (OOP) expenses and effective reimbursement rate (ERR) among rural patients. SETTING AND PARTICIPANTS: This study included 636 155 rural inpatients over 4 years in Xuzhou City, Jiangsu Province, China. RESULTS: In January 2020, the policy of urban and rural medical insurance was initially integrated in county hospitals, after which the ERR decreased at a monthly rate of 0.23% (p=0.002, 95% CI -0.37% to -0.09%) compared with the preintervention period. After the insurance systems were unified in municipal hospitals in January 2021, OOP expenses decreased by ¥63.54 (p=0.002, 95% CI -102.48 to -24.61) and the ERR increased at a monthly rate of 0.24% (p=0.029, 95% CI 0.03% to 0.045%). CONCLUSIONS: Our results suggest that the unification of urban and rural medical insurance systems was an effective intervention to reduce the financial burden of illness for rural inpatients, especially OOP expenses for hospitalisation in municipal hospitals.

Invisible economy, performance assessment of local governments, and environmental regulation in China.

Currently, environmental regulation in China is characterized by partial improvement and overall deterioration of the environment. To investigate the impact of China's environmental regulation on the country's environment, we consider the invisible economy by constructing a Stackelberg game model between local governments and polluting enterprises based on the Chinese institutional structure. We derive the following findings: (1) Increasing the invisible economic production scale causes the enterprise to reduce the pollution control level, resulting in increasing total pollutant emissions. Increasing the invisible economy production scale increases the enterprise's profit but undermines the utility of the local government. (2) The higher the proportion of environmental performance in the performance assessment of the local government is, the greater is the incentive for the local government to regulate the environment, which can force the enterprise to improve the pollution control level. However, there is an inefficient range for the proportion of environmental performance. (3) The lenient the pollutant emissions limit is, the weaker is the local government's environmental regulation intensity and the enterprise's pollution control level. (4) The higher the unit fine levied on the enterprise for excessive emissions is, the lower is the environmental regulation intensity of the local government, which can bring about improvement in the enterprise's pollution control level and reduction in total pollutant emissions. The results of the study have positive effects on sustainable environmental regulation in China under the invisible economy.

Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore.

Introduction: Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients. Methods: This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore. Results: 560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required. Conclusion: Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.

Coronary functional assessment in non-obstructive coronary artery disease: Present situation and future direction.

Non-obstructive coronary artery disease (CAD), which is defined as coronary stenosis <50%, has been increasingly recognized as an emerging entity in clinical practice. Vasomotion abnormality and coronary microvascular dysfunction are two major mechanisms contributing to the occur of angina with non-obstructive CAD. Although routine coronary functional assessment is limited due to several disadvantages, functional evaluation can help to understand the pathophysiological mechanism and/or to exclude specific etiologies. In this review, we summarized the potential mechanisms involved in ischemia with non-obstructive coronary arteries (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA), the two major form of non-obstructive CAD. Additionally, we reviewed currently available functional assessment indices and their use in non-obstructive CAD. Furthermore, we speculated that novel technique combined anatomic and physiologic parameters might provide more individualized therapeutic choice for patients with non-obstructive CAD.

Low-Carbon Transition Models of High Carbon Supply Chains under the Mixed Carbon Cap-and-Trade and Carbon Tax Policy in the Carbon Neutrality Era.

To achieve the goals of carbon peak and carbon neutrality, the low-carbon transformation (LCT) of high-carbon firms is inevitable. We construct game models of a supply chain with different dominant types under a mixed carbon policy that embraces carbon cap-and-trade and carbon tax. Solving each dominant model, we derive the effective area and optimal threshold of the mixed carbon policy to guide LCT. We find that the selling price, market demand, and profit of the supply chain system are equal in different dominant models due to the mixed carbon policy, but when a company dominates the supply chain, its profit is higher than when it is a subordinate. In addition, the high-carbon manufacturers (HCM) will pursue LCT only when the sum of the carbon tax rates and carbon trading prices is within a certain threshold, and the subordinate HCM are more likely to be driven to pursue LCT. Therefore, the government should adopt a differentiated hybrid carbon policy, setting a high (low) carbon tax rate for the HCM in a dominant (subordinate) position.

Impacts of Environmental Regulation on the Green Transformation and Upgrading of Manufacturing Enterprises.

Since environmental problems are becoming increasingly prominent, macro policies and social development have placed higher requirements on manufacturing enterprises to promote green transformation and upgrading (GTU) in China. Considering that different manufacturing enterprises choose different green technology innovation levels for GTU under environmental regulation, a game model between manufacturing enterprises and the government is constructed. The relationship between the green technology innovation level (GTIL) and the environmental regulation intensity is analyzed. Through numerical examples, the influences of environmental regulation and consumer preference on system decisions are further examined. Moreover, an econometric model is constructed to explore the influence that the environmental regulation exerts on the GTIL using panel data from the Chinese manufacturing industry. Our results show that the increase in environmental regulation intensity contributes to improving GTIL and promoting the GTU of manufacturing enterprises. Furthermore, as the environmental regulation is enhanced, the sales price decreases, benefiting consumers. Consumers' preference for high-GTIL products is conducive to GTU under environmental regulation. Empirical analysis shows that there is a U-shaped relationship between environmental regulation and the GTIL. Only when the intensity reaches a threshold can the environmental regulation be beneficial to improve the GTIL and promote the GTU of Chinese manufacturing enterprises.

Impact of infection on risk of Parkinson's disease: a quantitative assessment of case-control and cohort studies.

Identifying modifiable risk factors for Parkinson's disease (PD) to help prevent this disease has attracted increasing interest in recent years for the limited effective drugs at present. Despite many studies indicated that infection acts as a risk factor for PD, there is no quantitative assessment of the impact of viral and bacterial infections on the risk of developing PD. The present study performed a meta-analysis on the basis of 38 datasets from 13 studies covering 287,773 PD cases and 7,102,901 controls to ascertain the association between PD and infection and the differences in the strength of the viral and bacterial infections. The overall meta-analytic results indicated that individuals with infection had a 20% increased risk of PD compared with controls (OR 1.20, 95%CI 1.07-1.32). The subgroup analysis according to the type of infection found that bacterial infection had a significant impact on increased risk of PD (OR 1.40, 95%CI 1.32-1.48). The present analysis indicated that infection could increase the risk of developing PD, and physician should be aware of the risk of developing PD in subjects with infection.

Assessment upon heterotrophic microalgae screened from wastewater microbiota for concurrent pollutants removal and biofuel production.

Heterotrophic microalgae, capable of converting organic carbons to biofuel, as well as assimilating nutrients, have a great prospective in wastewater treatment. Meanwhile, the knowledge about heterotrophic microalgae is still far less than the autotrophic conterpart. Hence, in this study, 20 heterotrophic microalgal strains were isolated from a domestic wastewater treatment plant, and identified according to morphology and partial 18S and 23S rRNA gene sequences. Further, their biological traits were assessed in terms of N, P, TOC removal efficiencies, growth parameters, self-settleability and lipids production, expressed through a comprehensive selection index. By such, the optimal strains were chosen and applied back to treat the real wastewater, with or without pretreatment of sterilization. An organic-adaptable strain, i.e., Botryococcus sp. NJD-1, was ultimately recommended to achieve the concurrent biofuel production (up to 61.7% lipid content) and pollutants removal (up to 64.5%, 89.8% and 67.9% for N, P and TOC) in pristine wastewater.

Discovery and Assessment of Atropisomers of (±)-Lesinurad.

(+)- and (-)-Lesinurad were isolated as atropisomers from racemic lesinurad for the first time. No interconversion was observed between the two atropisomers under various conditions tested. The two atropisomers showed significant differences in hURAT1 highly expressed HEK293 cell-based inhibition assays, monkey pharmacokinetic studies, and in vitro human recombinant CYP2C9 stability studies. It was speculated that (+)-lesinurad might offer a better hyperuricemia/gout therapy than (-)-lesinurad or the racemate.

Quantitative assessment of the bidirectional relationships between diabetes and depression.

Diabetes and depression impose an enormous public health burden and the present study aimed to assess quantitatively the bidirectional relationships between the two disorders. We searched databases for eligible articles published until October 2016. A total of 51 studies were finally included in the present bidirectional meta-analysis, among which, 32 studies were about the direction of depression leading to diabetes, and 24 studies about the direction of diabetes leading to depression. Pooled results of the 32 eligible studies covering 1274337 subjects showed that depression patients were at higher risk for diabetes (odds ratio (OR) = 1.34, 95% confidence intervals (CI) = [1.23, 1.46]) than non-depressive subjects. Further gender-subgroup analysis found that the strength of this relationship was stronger in men (OR = 1.63, 95%CI = [1.48, 1.78]) than in women (OR = 1.29, 95%CI = [1.07, 1.51]). For the direction of diabetes leading to depression, pooled data of 24 articles containing 329658 subjects showed that patients with diabetes were at higher risk for diabetes (OR = 1.28, 95%CI = [1.15, 1.42]) than non-diabetic subjects. The available data supports that the relationships between diabetes and depression are bidirectional and the overall strengths are similar in both directions. More mechanistic studies are encouraged to explore the molecular mechanisms underlying the relationships between the two diseases.

MCQ-construction improves Quality of Essay Assessment among undergraduate dental students.

A well-constructed essay is indicative of deep strategic understanding and is considered a valid assessment tool in many dental schools. It has been suggested that constructing MCQs could be an effective learning tool for students while at the same time contribute towards a pool of well-constructed MCQs that could stand up to scrutiny at high-stakes examinations. This study aimed to compare the quality of essays written by students trained and untrained in MCQ construction. The null hypothesis was that construction of MCQs did not result in higher grades achieved in "closed-book" time-limited assessment conditions. A Test cohort (n=48) of undergraduate dental students were taught and constructed MCQs during their preclinical prosthodontics course. The Control cohort (n=48) consisted of students who underwent the same course 1 year prior. The same question was administered to both cohorts without the students׳ knowledge. Answers were de-identified and randomized for grading by a blinded expert prosthodontic examiner not involved in the teaching of the students. Based on a passing grade of 50 and a maximum grade of 100, the Test cohort exhibited significantly improved essay quality, scoring a mean grade of 73.0±8.0, compared to a mean grade of 63.6±11.8 achieved by the control cohort (p<0.001). The null hypothesis was rejected. Under the conditions of this double-blind study, MCQ-construction resulted in better essays written by students under examination conditions.

Assessment of vitamin D levels in type 1 and type 2 diabetes patients: Results from metaanalysis.

SCOPE: Accumulating evidence indicates that vitamin D deficiency is prevalent in patients with type 1 (T1D) and type 2 diabetes (T2D). The present study aims to assess 25-hydroxyvitamin D [25(OH)D] levels in T1D and T2D patients compared with controls through a metaanalysis. METHODS AND RESULTS: We searched databases for articles published until January 2015. A total of 12 studies covering 2003 patients and 1882 controls and 11 studies covering 2236 patients and 2438 controls were included to metaanalyze 25(OH)D levels in patients with T1D and T2D, respectively. Pooled data showed that T1D patients had lower levels of 25(OH)D than controls (summary standardized mean difference (SMD) -0.70, 95% confidence interval (CI) -1.02 to -0.37). Further age-subgroup analysis found that 25(OH)D levels in T1D patients was also significantly lower than controls in subgroup aged ≤ 14 years (summary SMD -1.04, 95% CI -1.55 to -0.53), while the association is not statistically significant in the subgroup aged > 14 years. Similarly, T2D patients had lower 25(OH)D levels compared with controls (summary SMD -0.58, 95%CI -1.16 to -0.00). CONCLUSION: Available data indicated that both T1D and T2D patients had lower levels of 25(OH)D than controls overall. The mechanistic underpinnings of this association warrant further elucidation.

Physical Activity and Sedentary Behavior Patterns Before and During Pregnancy in a Multi-ethnic Sample of Asian Women in Singapore.

OBJECTIVES: To describe physical activity (PA) and sedentary behavior (SB) patterns before and during pregnancy among Chinese, Malay and Indian women. In addition, to investigate determinants of change in PA and SB during pregnancy. METHODS: The Growing Up in Singapore Towards healthy Outcomes cohort recruited first trimester pregnant women. PA and SB (sitting time and television time) before and during pregnancy were assessed as a part of an interview questionnaire at weeks 26-28 gestational clinic visit. Total energy expenditure (TEE) on PA and time in SB were calculated. Determinants of change in PA and SB were investigated using multiple logistic regression analysis. RESULTS: PA and SB questions were answered by 94 % (n = 1171) of total recruited subjects. A significant reduction in TEE was observed from before to during pregnancy [median 1746.0-1039.5 metabolic equivalent task (MET) min/week, p < 0.001]. The proportion of women insufficiently active (<600 MET-min/week) increased from 19.0 to 34.1 % (p <0.001). Similarly, sitting time (median 56.0-63.0 h/week, p < 0.001) and television time (mean 16.1-16.7 h/week, p = 0.01) increased. Women with higher household income, lower level of perceived health, nausea/vomiting during pregnancy and higher level of pre-pregnancy PA were more likely to reduce PA. Women with children were less likely to reduce PA. Women reporting nausea/vomiting and lower level of pre-pregnancy sitting time were more likely to increase sitting time. CONCLUSIONS FOR PRACTICE: Participants substantially reduced PA and increased SB by 26-28 weeks of pregnancy. Further research is needed to better understand determinants of change in PA and SB and develop effective health promotion strategies.

Associations between Vitamin D Status, Supplementation, Outdoor Work and Risk of Parkinson's Disease: A Meta-Analysis Assessment.

The present study aimed to quantitatively assess the associations between vitamin D and Parkinson's Disease (PD) risks, which include: (i) risk of PD in subjects with deficient and insufficient vitamin D levels; (ii) association between vitamin D supplementation and risk of PD; and (iii) association between outdoor work and PD risk, through meta-analyzing available data. An electronic literature search supplemented by hand searching up to March 2015 identified seven eligible studies comprising 5690 PD patients and 21251 matched controls. Odds ratio (OR) and 95% confidence interval (CI) of PD risk were assessed through pooling the collected data from eligible studies using Stata software. Pooled data showed that subjects with deficient and insufficient vitamin D levels had increased PD risks compared with matched-controls according to the corresponding OR: 2.08, 95% CI: 1.63 to 2.65, and 1.29, 95% CI: 1.10 to 1.51. Vitamin D supplementation was associated with significantly reduced risk of PD (OR: 0.62, 95% CI: 0.35 to 0.90). Outdoor work was also related to reduced risk of PD (OR: 0.72, 95% CI: 0.63 to 0.81). The findings may stimulate larger, well-designed studies to further verify the associations between vitamin D and PD risk.

Cost-effectiveness of different regimens of anesthesia for day surgery in China.

OBJECTIVES: To compare the cost-effectiveness of inhalation of sevoflurane, target-controlled infusion (TCI) of propofol, intravenous (IV) propofol for induction-inhalation of sevoflurane, and IV propofol for induction-inhalation of desoflurane for anesthesia maintenance in day surgery. METHODS: 240 patients, scheduled for elective day surgery, were randomly divided into 4 groups (n = 60 each): inhalation of sevoflurane anesthesia group (group S); TCI of propofol anesthesia (group P); and intravenous propofol for induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia group (group PS); and intravenous propofol for induction of anesthesia-inhalation of desoflurane for maintenance of anesthesia group (group PD). RESULTS: Group S was associated with less time to loss of consciousness, as well as the other three groups were associated with less time to recovery (P < 0.05). Group P was associated with a higher anesthetic agents cost than other 3 groups (P < 0.05), and group S was associated with a higher anesthetic agents costs than group PS and PD (P < 0.05). CONCLUSION: Induction with intravenous injection of propofol and maintenance with inhalation of desoflurane is the most cost-effective method of anesthesia for day surgery.

Cost of dry eye treatment in an Asian clinic setting.

OBJECTIVES: To estimate the cost and patterns of expenditure of dry eye treatment. METHODOLOGY: We retrieved data on the type and cost of dry eye treatment in Singapore National Eye Centre from pharmacy and clinic inventory databases over a 2 year period (2008-2009) retrospectively. According to the type of treatment, data were sorted into 7 groups; meibomien gland disease (MGD) treatment, preservative free lubricant eye drops, preserved lubricant eye drops, lubricant ointments and gels, cyclosporine eye drops, oral supplements and non-pharmacological treatments/procedures. Each recorded entry was considered as one patient episode (PE). Comparisons in each group between two years were carried out using Pearson Chi-Square test. Significance level was set at alpha  =  0.05. RESULTS: Cost data from 54,052 patients were available for analysis. Total number of recorded PEs was 132,758. Total annual expenditure on dry eye treatment for year 2008 and 2009 were US$1,509,372.20 and US$1,520,797.80 respectively. Total expenditure per PE in year 2008 and 2009 were US$22.11 and US$23.59 respectively. From 2008 to 2009, there was a 0.8% increase in total annual expenditure and 6.69% increase in expenditure per PE. Pharmacological treatment attributes to 99.2% of the total expenditure with lubricants accounting for 79.3% of the total pharmacological treatment expenditure. Total number of units purchased in preservative free lubricants, cyclosporine eye drops and MGD therapy have increased significantly (p<0.001) whereas number of units purchased in preserved lubricants and ointments/gels have reduced significantly (p<0.001) from 2008 to 2009. CONCLUSION: Dry eye imposes a significant direct burden to health care expenditure even without considering indirect costs. Health care planners should be aware that these direct costs appear to increase over the time and more so for particular types of medications. Given the limitations of socio-economic data, true societal costs of Dry eye syndrome are likely to be much higher than estimated.

[Assessment of external methods of traditional Chinese medicine in patients with chronic ulcer of the lower extremities: study protocol of a multicenter, randomized, parallel-group, prospective trial].

BACKGROUND: Chronic ulcer of the lower extremities amounts for a grave and serious problem for public health. Western medicine focuses on controlling infection, improving blood circulation, surgical debridement, skin grafting, etc, but there are bottlenecks in the treatment. Traditional Chinese medicine (TCM) has a long history and a legacy of sound clinical efficacy in this area. TCM has developed a unique, effective external theory, and a large number of topical prescriptions and external technology. Through this research, a safe and effective treatment protocol of TCM for chronic ulcer of the lower extremities can be formed. To this end, during China's "Eleventh Five-Year" Plan, special research committees and projects on TCM external treatments and external technologies were established. This study on ulcer of the lower extremities constitutes one of the major research topics. METHODS AND DESIGN: Clinical information of patients with chronic ulcer of the lower extremities will be first collected in a large, multicenter, epidemiological survey. Concurrently, a large multicenter, randomized, parallel-group, prospective study will be launched based on evidence-based medical principles to evaluate the efficacy and safety of external methods for removing carrion, dissolving stasis, reinforcing deficiency and promoting tissue regeneration. The evaluated indexes will include the wound healing percentage for primary outcome, wound healing time, wound healing rate, time and rate of removal of necrotic tissue, and TCM syndromes for secondary outcomes and routine blood test, routine urine test, liver and kidney function, blood mercury content and finally urine mercury content for adverse events. DISCUSSION: In this trial, the authors will evaluate the efficacy and safety of external methods for removing carrion, dissolving stasis, reinforcing deficiency and promoting tissue regeneration in cases of chronic ulcer of the lower extremities for standardizing external therapy of TCM for treatment of this condition, and establishing the clinical assessment system for TCM. TRIAL REGISTRATION NUMBER: The research program was registered in the Chinese Clinical Trial Registry in both English and Chinese in June 2011. REGISTRATION NUMBER: ChiCTR-TRC-11001365.

Barriers to conceiving sibling donors for sickle cell disease: perspectives from patients and parents.

OBJECTIVES: The lack of matched sibling donors poses a significant barrier to utilizing hematopoietic cell transplantation (HCT), the only proven cure for children with sickle cell disease (SCD). Little is known about current patient and parent perspectives towards HCT for SCD. This study examines the perceived barriers of transplant, and the use of in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD), when there is no pre-existing sibling donor. DESIGN: Semi-structured interviews were conducted with adult patients with SCD and parents of children with SCD in an urban medical center in the US. Transcribed data was analyzed using qualitative methods. RESULTS: Of 23 participants, 17 reported having heard of HCT for SCD. Fewer knew of IVF or PGD as a means for conceiving an unaffected child (n =7) or to select a potential umbilical cord blood donor (n =1). The financial cost of IVF and PGD was perceived as a significant initial barrier to accessing these technologies, with the clinical risks of HCT and the ethical appropriateness of using PGD also identified as barriers. The value of informing families of these options was a recurring theme, even among respondents who personally disagreed with their application. CONCLUSION: The low utilization of curative strategies for SCD appears to be partly attributable to a lack of information about the technologies available to facilitate transplantation. Ethical reservations, while present, were not static and did not preclude patients' and parents' desire to be informed. We discuss the implications of these perceived barriers to the dissemination of advanced medical technologies for SCD.