Whole-orbit-based multiparametric assessment of disease activity of thyroid eye disease on Dixon MRI.

PURPOSE: This study aimed to explore the diagnostic value of whole-orbit-based multiparametric assessment on Dixon MRI for the evaluation of the thyroid eye disease (TED) activity. METHODS: The retrospective study enrolled patients diagnosed as TED and obtained their axial and coronal Dixon MRI scans. Multiparameters were assessed, including water fraction (WF), fat fraction (FF) of extraocular muscles (EOMs), orbital fat (OF), and lacrimal gland (LG). The thickness of OF and herniation of LG were also measured. Univariable and multivariable logistic regression was applied to construct prediction models based on single or multiple structures. Receiver operating characteristic (ROC) curve analysis was also implemented. RESULTS: Univariable logistic analysis revealed significant differences in water fraction (WF) of the superior rectus (P = 0.018), fat fraction (FF) of the medial rectus (P = 0.029), WF of OF (P = 0.004), and herniation of LG (P = 0.012) between the active and inactive TED phases. Multivariable logistic analysis and corresponding receiver operating characteristic curve (ROC) analysis of each structure attained the area under the curve (AUC) values of 0.774, 0.771, and 0.729 for EOMs, OF, and LG, respectively, while the combination of the four imaging parameters generated a final AUC of 0.909. CONCLUSIONS: Dixon MRI may be used for fine multiparametric assessment of multiple orbital structures. The whole-orbit-based model improves the diagnostic performance of TED activity evaluation.

Characteristics and economic burden of hospitalized patients with herpes zoster in China, before vaccination.

Herpes zoster (HZ) brings a significant economic burden. The HZ vaccine was introduced in China for the first time in 2020, and there is a lack of up-to-date information on the hospitalization costs and characteristics prior to vaccination. This study aimed to describe the characteristics and economic burden of HZ inpatients in Hunan Province, China, and analyze the factors influencing the length of stay (LOS) and costs. This was a retrospective study and we extracted information from the Chinese National Health Statistics Network Reporting System on HZ inpatients in Hunan Province, China from 2017 to 2019. Spatial join tools and Global or Local Moran's Index were used for the geographic analysis of hospitalized HZ incidence. Multivariate linear regression models were used to analyze the factors influencing LOS and costs. There were 44,311 HZ inpatients included in this study, incurring a total of $31,857,734 medical costs. These patients had a median LOS of 8 days and a median expenditure of $573.47. Older age, more comorbidities, and the presence of complications with nervous system involved were all significantly associated with longer LOS and higher costs. HZ infection resulted in a large direct medical cost and heavy disease burden, especially in patients with advanced age or underlying medical conditions. The HZ vaccine has the potential to effectively reduce the disease burden and should be widely popularized especially among high-risk groups.

Participation in a Medicare advanced primary care model and the delivery of high-value services.

OBJECTIVE: To evaluate whether primary care providers' participation in the Comprehensive Primary Care Plus Initiative (CPC+) was associated with changes in their delivery of high-value services. DATA SOURCES: Medicare Physician & Other Practitioners public use files from 2013 to 2019, 2017 to 2019 Medicare Part B claims for a 5% random sample of Medicare Fee-for-Service (FFS) beneficiaries, the Area Health Resources File, the National Plan & Provider Enumeration System files, and public use datasets from the Centers for Medicare & Medicaid Services Physician Compare. STUDY DESIGN: We used a difference-in-difference approach with a propensity score-matched comparison group to estimate the association of CPC+ participation with the delivery of annual wellness visits (AWVs), advance care planning (ACP), flu shots, counseling to prevent tobacco use, and depression screening. These services are prominent examples of high-value services, providing benefits to patients at a reasonable cost. We examined both the likelihood of delivering these services within a year and the count of services delivered per 1000 Medicare FFS beneficiaries per year. DATA COLLECTION/EXTRACTION METHODS: Secondary data are linked at the provider level. PRINCIPAL FINDINGS: We find that CPC+ participation was associated with increases in the likelihood of delivering AWVs (13.03 percentage points by CPC+'s third year, p < 0.001) and the number of AWVs per 1000 Medicare FFS beneficiaries (44 more AWVs by CPC+'s third year, p < 0.001). We also find that CPC+ participation was associated with more flu shots per 1000 beneficiaries (52 more shots by CPC+'s third year, p < 0.001) but not with the likelihood of delivering flu shots. We did not find consistent evidence for the association between CPC+ participation and ACP services, counseling to prevent tobacco use, or depression screening. CONCLUSIONS: CPC+ participation was associated with increases in the delivery of AWVs and flu shots, but not other high-value services.

Impact of digital economy on ecological resilience of resource-based cities: spatial spillover and mechanism.

Resource-based cities, which are widely distributed in China, contribute significantly to China's sustainable development. The digital economy and the construction of ecological civilization are central issues in the sustainable development of resource-based cities, and it is necessary to analyze the impact of the digital economy on the ecological resilience of resource-based cities. Thus, this paper measures ecological resilience of 117 resource-based cities from 2011 to 2020 using the entropy weight TOPSIS (technique for order preference by similarity to ideal solution; see Table 1 for a list of acronyms) method and empirically investigates the impact and mechanism of digital economy on ecological resilience using the spatial Durbin model (SDM) and intermediary effect model. The results show that the ecological resilience of resource-based cities has a certain upward trend, with a stepwise distribution pattern from east to west. There is a significant positive correlation between ecological resilience of resource-based cities, showing the phenomenon of club convergence which is primarily dominated by high-high (H-H) and low-low (L-L). The digital economy has a significant spatial spillover effect, which promotes ecological resilience of resource-based cities in the local and adjacent regions. A mechanism analysis reveals that technological innovation and industrial structure are mediators between digital economy and ecological resilience of resource-based cities, with significant heterogeneity in region and growth cycle. Among them, the intermediary role of technological innovation is stronger. Following the above findings, this paper proposes policy suggestions related to digital economy evolution and ecological resilience enhancement. This paper further enriches the literature on the ecological resilience and provides a theoretical basis for government policy-making.

Does access to free medication reduce health system costs? An evaluation of the Dispensary of Hope program.

BACKGROUND: Cost-related medication nonadherence-when patients fail to take medication as prescribed because of the cost of the medication-has numerous consequences: more hospitalizations, avoidable deaths, and greater health care expenditures. Dispensary of Hope is a charitable medication access program that collects and distributes pharmaceuticals to pharmacies to dispense free of charge to patients with no insurance, low incomes, and chronic conditions. OBJECTIVE: To estimate the differences in medical costs and utilization of hospital patients enrolled in the Dispensary of Hope program relative to those who were not enrolled. METHODS: We used administrative claims data from 2 health systems participating in Dispensary of Hope to identify those in the program and a comparison group, respectively. Claims data included emergency department (ED) encounters, inpatient encounters, costs, and prescriptions. Health system 1 (HS1) data began July 1, 2016, and ended December 31, 2019; health system 2 (HS2) data ran from March 10, 2014, to December 31, 2019. Program enrollment dates (index dates) were identified via program registration or prescription fills. We propensity score weighted a comparison population from HS1 and HS2, respectively, to match program patient demographic and comorbidity characteristics. We estimated changes in costs, ED visits, inpatient stays, and primary care sensitive ED visits over time between the 2 groups (difference-indifference) over 18 months preenrollment and postenrollment. RESULTS: HS1 comparison (n = 6,714) and Dispensary of Hope (n = 880) groups were balanced on age, sex, race and ethnicity, and comorbidities; both populations were approximately 46 years old, 43% female, 64% White, with an average of 3.0 comorbidities. The HS2 samples were almost 50 years old and a majority female (56%) and Black (55%). Per-person annual costs at HS1 decreased by $3,161 (P < 0.05) more in the Dispensary of Hope group than in the comparison group from the preenrollment to the postenrollment period. Inpatient stays decreased by 200 stays per 1,000 patients per year (P = 0.02) and ED visits increased by 0.32 (P < 0.01) on a yearly basis relative to the comparison group. Primary care sensitive ED visits increased over the period. No results were statistically significant in HS2. CONCLUSIONS: We found substantial reductions in costs and inpatient stays for Dispensary of Hope HS1 participants, and we did not find significant results at HS2. Differences between the health systems or patient populations could explain these varying results. Our study represents a rigorous, multistate evaluation that highlights the impact of a charitable medication access program on hospital utilization for the medically underserved population. DISCLOSURES: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was funded and supported by Dispensary of Hope.

Prediction of wastewater discharge based on GRA-LSTM: a case study of Beijing.

Water resources, as one of the indispensable resources for urban development, have become an important factor limiting the sustainable development of cities. In order to promote sustainable urban development, Beijing has set the work task of reaching 99% of urban and rural wastewater treatment rate from 2020 to 2035. Accurate prediction of future wastewater discharge is essential to achieve the target. For this reason, this study takes Beijing as the research object and constructs a combined prediction model based on gray relational analysis and long- and short-term memory (GRA-LSTM). Firstly, gray relational analysis (GRA) is used to analyze the correlation of the experimental data indicators affecting the amount of wastewater discharged in order to obtain experimental data indicators with stronger correlation. Secondly, the long short-term memory (LSTM) model was used to learn the characteristics of the key impact indicators and obtain the optimal model parameters. The results showed that the mean absolute percentage error (MAPE) value of the combined GRA-LSTM model constructed in this study was 5.62%, and the prediction accuracy was higher than that of the other seven prediction models. Then, three scenarios with low, medium, and high dimensions were set to predict the wastewater discharge in Beijing from 2020 to 2035, and the prediction result that the wastewater discharge in Beijing will still continue to grow was obtained. Finally, in order to improve the water utilization rate and promote the sustainable development of the city, this study proposes relevant policy recommendations in terms of the unbalanced urban-rural development of Beijing's wastewater treatment capacity and the increase of recycled water usage.

Nitrogen dioxide and hospital length of stay and cost for systemic lupus erythematosus in Hunan, China.

BACKGROUND: Evidence of both epidemiological and clinical studies exploring the impact of nitrogen dioxide (NO2) on the systemic lupus erythematosus (SLE) disease activity have been contradictory. OBJECTIVES: To evaluate the association between short-term NO2 exposure and length of hospital stay (LOS) and hospital cost of SLE and estimate the burden of disease attributable to NO2 exposure. METHODS: We collected health data of SLE inpatients who were hospitalized at secondary and tertiary hospitals in Hunan province of China during 2017-2019. Daily ambient concentrations of air pollutants (O3, CO, NO2, SO2, PM2.5 and PM10) and other environmental factors were obtained from public repositories by linking to individual addresses and date of hospitalization. Mixed effect models were employed to assess the associations between LOS and hospital cost for SLE inpatients and NO2 exposures during the previous 1 to 21 days (lag1-lag21) before hospitalization. We further estimated excess LOS and hospital cost attributable to NO2 exposure according to China's and World Health Organization's air quality guideline (AQG) respectively. RESULTS: A total of 11,447 records from 221 hospitals were finally included in our study. After full adjustments, 1 µg/m3 increment of NO2 was significantly associated with 0.038 day increase in LOS (95%CI: 0.0159-0.0601, P = 0.0008) and 0.0384 thousand yuan increase in hospital cost (95%CI: 0.0017-0.0679, P = 0.0395) with a lagged effect of 7 days prior to admission. Based on the adjusted effects of lag7, controlling for short-term NO2 exposure according to AQG could avoid up to 1.47 thousand days of hospitalization and 1.35 million yuan of cost for SLE in Hunan province during 2017 to 2019. CONCLUSIONS: Excess LOS and substantial economic burden among SLE inpatients attributable to NO2 could be avoid if policies were implemented to reduce the exposure.

Assessment of Long-Term Effects on Pulmonary Functions Between Severe and Non-Severe Convalescent COVID-19 Patients: A Single-Center Study in China.

Objective: To explore the long-term effects of SARS-Cov-2 infection on the pulmonary function in the severe convalescent COVID-19 patients for 6 to 9 months follow-up in Beijing, China. Methods: A total of 64 cases of COVID-19 patients were recruited for the study and discharged from the Beijing Ditan Hospital, Capital Medical University, for 6 to 9 months. COVID-19 patients were divided into non-severe (mild and moderate) and severe groups. The follow-up investigated the lung function tests, the novel coronavirus antibody (IgM and IgG), chest CT and blood tests. Results: About 25.00% (16/64) patients had pulmonary ventilation dysfunction and 35.9% (23/64) had diffusion dysfunction. In the severe group, 56.50% (13/23) individuals showed decreased diffusion function. The diffusion dysfunction of the severe group was significantly decreased than the non-severe group (P = 0.01). Among 56 cases, the positive rate of IgG titers was 73.2% (41/56). The result of chest CT showed 55.36% (31/56) cases in nodules, 44.64% (25/56) in strip-like changes, 37.5% (21/56) in-ground glass shadow, and 5.36% (3/56) in grid shadow, which was significantly different between the severe group and the non-severe group. Patients tended to have ground glass changes in the severe group while nodules in the non-severe group. Conclusion: For the 6 to 9 months in convalescent COVID-19 patients, 56.50% (13/23) of severe patients had pulmonary diffusion dysfunction. Convalescent COVID-19 patients should have their pulmonary function regularly tested, especially those with severe illness.

Partnering with immigrant families to promote language justice and equity in education.

Despite US federal legislation mandates institutions to provide meaningful access and participation to students and families in educational settings, culturally and linguistically diverse (CLD) families and caregivers of children in special education experience cultural and linguistic barriers. A Community Advisory Team (CAT) of parents, advocates, community interpreters and translators, researchers, and teachers explored CLD families' experiences and advocacy efforts. Critical bifocality and circuits of dispossession, privilege, and resistance informed the documentation of inequities and resistance to understand the linkages of structural arrangements of power. Focus groups with families (n = 21) speakers of Spanish, Portuguese, and Cantonese were conducted. Findings indicate perceived discrimination, poor and inadequate interpretation and translation services impact children's access to special education services, hinder family's communication with schools and reduce the perceptions of schools as trustworthy institutions. Families advocate relentlessly for their children and recommend schools listen to families and hire culturally and linguistically competent interpreters and translators. Community psychologists can make significant contributions to promote language justice in education settings through participatory approaches to inquiry that value CLD families' knowledge and expertise.

Analysis of Xinjiang HPV16 L1 gene polymorphisms: a newly developed, low-cost enzyme-linked immunosorbent assay.

BACKGROUND: Xinjiang, China shows the world's highest incidence and mortality rates of cervical cancer. Due to limited conditions available for medical examination, hybrid capture 2 (HC2) and other detection methods are used rarely, and early screening for human papillomavirus (HPV) cannot be carried out. Therefore, we established a double-antibody sandwich (DAS)-enzyme-linked immunosorbent assay (ELISA) based on a polymorphism of the Xinjiang HPV16 L1 strain (KU721788). METHODS: According to the conserved sequence and specific epitope of Xinjiang strain HPV16 L1, we prepared two anti-HPV16 L1 monoclonal antibodies and combined them to construct a DAS-ELISA. Detection conditions for the DAS-ELISA were optimized, and HC2 was used as the control to verify the specificity, repeatability and coincidence detection of the DAS-ELISA. RESULTS: The optimized conditions for the DAS-ELISA were: dilution of the capture antibody was 1:100; the enzyme-labelled antibody was 1:10; the sample reaction time was 45 min; the enzyme-labelled antibody was applied for 40 min, and the substrate color development time was 15 min. The quality of the DAS-ELISA for the detection of HPV 16 was very high, and there was no significant difference when compared with HC2. CONCLUSION: The DAS-ELISA developed on the basis of the Xinjiang strain (KU721788) polymorphism possesses the advantages of a detection rate similar to that for the HC2 assay currently used clinically, but it is more convenient operationally and at lower cost. DAS-ELISA is thus easier to implement for cervical cancer screening in economically depressed areas.

Epidemiology and disease burden of androgenetic alopecia in college freshmen in China: A population-based study.

OBJECTIVE: To evaluate the epidemiology and disease burden of androgenetic alopecia (AGA) in college freshmen in China. METHODS: This population-based cross-sectional survey was carried out among 9227 freshmen of two comprehensive universities in two cities of China (Changsha and Xiamen) from September 2018 to October 2018. Questionnaires covering basic issues, surrounding demographic information, history of diseases, living habits, comorbidities, etc. were completed online in a self-reported manner Dermatological examination was performed by certified dermatologists. The disease burden of AGA, which includes health-related quality of life, symptoms of anxiety, symptoms of depression and quality of sleep, was measured by EQ-5D-3L, PHQ-2, GAD-2 and PSQI, respectively. RESULTS: The prevalence of AGA in college freshmen in China was 5.3/1000. Male was significantly associated with higher prevalence of AGA (7.9/1000, P<0.01) while female with lower risk of AGA (OR = 0.29, P = 0.002). There was no significant association between BMI and AGA, nor predilection of AGA in the Han nationality or the other ethnic minorities. Annual household income or parental highest educational level exerted no significant influence on the prevalence of AGA. Rosacea (OR = 3.22, P = 0.019) was significantly associated with higher prevalence of AGA while acne seemed not to be related to AGA. The scores of EQ-5D, GAD-2, PHQ-2 and PSQI were not significantly different between students with and without AGA. CONCLUSION: The onset of AGA in Chinese college freshmen differ between genders and was significantly associated with rosacea.

Willingness-to-Pay and Benefit-Cost Analysis of Botulinum Toxin for the Treatment of Rosacea in China: Findings from a Web-Based Survey.

PURPOSE: Botulinum toxin (BTX) is a new treatment approach primarily aimed at relieving flushing and erythema for rosacea, but it is expensive and lacks economic benefit evaluation studies.This study aimed to investigate willingness-to-pay (WTP) of BTX treatment and conduct benefit-cost analysis (BCA) to assess if BTX treatment for rosacea is recommendable from a viewpoint of economics in China. METHODS: WTP of BTX treatment in rosacea and information of sociodemographic and clinical characteristics were inquired via an online questionnaire among the Chinese rosacea patients. The WTP was inquired by photos of three cases with different severities of rosacea before and after BTX treatment. The benefit-cost ratio (BCR) was calculated by dividing WTP by cost. Factors associated with WTP were identified using logistic regression models. RESULTS: The average costs of BTX treatment were USD410.09. The mean WTP for Case 1, Case 2, and Case 3 was USD295.53, 307.91, and 311.78, respectively (p<0.05 for Case 1 vs Case 3). 44.31% to 47.52% of Chinese rosacea patients were willing to pay for the BTX treatment. The BCRs were 0.72, 0.75, and 0.76 for Case 1, Case 2, and Case 3, respectively. A positive correlation between WTP and visiting frequency in the past year (OR=1.181-1.200, p=0.015-0.032, for Cases 1 and 2) or Dermatology Life Quality Index (DLQI) score (OR=2.022-2.266, all p<0.01) was observed, but duration (OR=0.521-0.564, p<0.05, for Cases 1 and 2) of rosacea was negatively correlated with WTP. CONCLUSION: For rosacea patients with poor quality of life, and those with high visiting frequency, BTX should be regarded as a recommendable new treatment in China.

Effects of environmental contaminants in water resources on nonalcoholic fatty liver disease.

The global prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing rapidly in recent years, which is now estimated to be over 25%. NAFLD is one of the most common chronic liver diseases in the world. At present, with the rapid development of economy and industrialization, many chemicals are released into the environment. These chemical contaminants in the environment might cause harm to human health and result in lipid metabolism disorder during long-term exposure. Moreover, the incentive of many NAFLD cases is unknown, and the environmental risk factors of NAFLD need to be urgently identified. Hence, we focus on the impacts of several popular environmental contaminants in water environment on the development and progression of NAFLD. These contaminants mainly include microcystins (MCs), disinfection by-products (DBPs), heavy metals (HMs), dioxins and polychlorinated biphenyls (PCBs). Through analyzing a great many epidemiological and toxicological studies, we have found positive associations between NAFLD and chronic exposure to these contaminants at the environmental levels. This review may enhance the understanding of liver damage caused by environmental pollutants, which are considered as tangible environmental risk factors for NAFLD.

Changing The Face Of Health Care Delivery: The Importance Of Youth Participation.

Young people are often the intended audience for health and social programs, yet they rarely participate in the decision-making processes that determine how these programs are designed, implemented, or evaluated. Failing to meaningfully engage young people, well-intended adults may miss opportunities to create relevant and effective programs and policies for youth. This article describes a youth-led health assessment conducted with researchers from an academic medical center accountable care organization and stakeholders from a local community center. We explain the process of recruiting and engaging youth in this project, along with health concerns they identified in their communities via a survey, including mental and sexual health, food access, and community safety, as well as recommendations the youth researchers developed for improving health and tackling inequities. Our findings show that youth participation fosters a deeper sense of empowerment and leadership potential. Policy makers and other health leaders should consider engaging young people as they make decisions about health care delivery.

The assessment of epigenetic diversity, differentiation, and structure in the 'Fuji' mutation line implicates roles of epigenetic modification in the occurrence of different mutant groups as well as spontaneous mutants.

The 'Fuji' line includes many varieties with a similar genetic background and consistent inducement factors with epigenetic occurrence, thus it may be considered an ideal candidate for epigenetic research. In this study, 91 bud mutations of 'Fuji' apple were used as the test materials. Using the genetic variation within 'Fuji' as the control, the characteristics of epigenetic variation at different levels in both varieties and mutant groups were examined. The results showed that: (1) the global genomic DNA methylation level of the 91 bud mutants of 'Fuji' ranged from 29.120%-45.084%, with an average of 35.910%. Internal cytosine methylation was the main DNA methylation pattern. Regarding the variation of methylation patterns of 'Fuji' mutants, the vast majority of loci maintained the original methylation pattern existed in 'Fuji'. CHG methylation variation was the main type of variation; (2) the variation in methylation patterns between the mutant groups was greater than that of methylation levels. Among these patterns, the variation in CHG methylation patterns (including CHG hypermethylation and CHG demethylation) was expected to be dominant. The observed variation in methylation levels was more important in the Color mutant group; however, the variation in methylation patterns was more obvious in both the early maturation and Spur mutant groups. Moreover, the range of variation in the Early-maturation group was much wider than that in the Spur mutant group; (3) epigenetic diversity and genetic diversity were both low between the mutant groups. In the 'Fuji' mutant groups, there was few correlation between genetic and epigenetic variation, and epigenetic differentiation resulted in more loci with moderate or greater differentiation; (4) the purifying selection seemed to play a major role in the differentiation of different groups of 'Fuji' mutants (65.618%), but epigenetic diversity selection still occurred at nearly 35% of loci. Sixteen epigenetic outlier loci were detected.

[Comparison of critical care resources between second-class hospitals and third-class hospitals in Guizhou Province of China].

OBJECTIVE: To know the critical care resources of the different class-hospitals in Guizhou Province, China, and to provide the direction and evidence for quality improvement and discipline construction of critical care medicine in Guizhou Province. METHODS: The resource status of the departments of intensive care unit (ICU) in Guizhou Province was obtained through form filling and/or field investigation. The forms were filled and submitted from May 2017 to February 2018, and the field investigation (some of the hospitals) was carried out in March 2018. The data of hospitals in Guizhou Province in 2018, was obtained from the official website of Health Committee of Guizhou Province, which was released online on November 28th, 2019. The obtained data were summarized and analyzed according to different aspects such asthe status of ICU construction, main equipment configuration and technology implementation. RESULTS: There were 39 third-class hospitals and 77 second-class hospitals included in this study, which accounted for 76.5% (39/51) of third-class public hospitals and 50.0% (77/154) of second-class public hospitals respectively. Among them, there were 86.8% (33/38) of third-class general hospitals and 50.4% (69/137) of second-class general hospitals respectively. In terms of ICU construction, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were established earlier [years: 2011 (2008, 2012) vs. 2013 (2011, 2015), P < 0.01], had more ICU beds, doctors and nurses [15 (11, 20) vs. 8 (6, 10), 9 (8, 11) vs. 6 (5, 7), 25 (20, 41) vs. 15 (12, 19), respectively, all P < 0.01]. However, there were no significant differences regarding the doctor-bed ratio and the nurse-bed ratio in ICUs between second-class hospitals and third-class hospitals. In terms of main equipment configuration, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals had more ventilators, higher ratio of ventilators to beds, more infusion pumps, higher ratio of infusion pumps to beds, more monitor, gastrointestinal nutrition pumps and single rooms, and higher proportion of ICUs equipped with negative pressure rooms [ventilators: 14 (10, 18) vs. 6 (4, 8), ratio of ventilators to beds: 1.0 (0.7, 1.1) vs. 0.8 (0.6, 1.0), infusion pumps: 10 (6, 20) vs. 5 (3, 8), ratio of infusion pumps to beds: 0.8 (0.0, 1.0) vs. 0.0 (0.0, 0.4), monitor: 18 (13, 24) vs. 9 (6, 12), gastrointestinal nutrition pumps: 2 (1, 5) vs. 1 (0, 3), single rooms: 2 (1, 3) vs. 1 (0, 3), proportion of ICUs equipped with negative pressure rooms: 53.8% (21/39) vs. 31.5% (23/73), respectively, all P < 0.05]. Furthermore, there were higher proportions of ICUs equipped with portable ventilator, pulse indicator continuous cardiac output monitoring (PiCCO), intra-aortic balloon pump (IABP), extra-corporeal membrane oxygenation (ECMO), B ultrasound machine, bronchoscope, pressure of end-tidal carbondioxide (PETCO2) monitoring, bispectral index (BIS) monitoring, bedside gastroscopy, the apparatus used for the prevention of deep vein thrombosis of lower extremity in third-class hospitals than in second-class hospitals [portable ventilator: 86.7% (26/30) vs. 59.6% (28/47), 43.3% (13/30) vs. 1.5% (1/66), 14.3% (4/28) vs. 0% (0/65), 10.7% (3/28) vs. 0% (0/65), 62.5% (20/32) vs. 37.3% (25/67), 97.1% (33/34) vs. 63.6% (42/66), 60.6% (20/33) vs. 28.4% (19/67), 17.2% (5/29) vs. 0% (0/65), 27.6% (8/29) vs. 1.5% (1/65), 77.4% (24/31) vs. 52.3% (34/65), respectively, all P < 0.05]. In terms of skills development, there were more ICUs carried out intracranial pressure monitoring, abdominal pressure monitoring, ultrasound diagnosis, bronchoscope examination and treatment and blood purification in third-class hospitals than in second-class hospitals [31.6% (12/38) vs. 14.7% (11/75), 75.7% (28/37) vs. 38.6% (27/70), 61.5% (24/39) vs. 24.3% (18/74), 89.7% (35/39) vs. 45.9% (34/74), 92.3% (36/39) vs. 48.6% (36/74), respectively, all P < 0.05]. CONCLUSIONS: The data were mainly derived from public general hospitals in Guizhou Province. Compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were founded earlier and larger, had better hardware configuration and could carry out more skills. However, the human resource situations were similar between second-class hospitals and third-class hospitals. Both second-class hospitals and third-class hospitals have a need to improve the allocation of manpower and equipment and expand various skills in ICUs, while it is more urgent for second-class hospitals.

The Development of Chinese Assessment and Evaluation of Physical Literacy (CAEPL): A Study Using Delphi Method.

The aim of this study is to introduce the development of the Chinese Assessment and Evaluation of Physical Literacy (CAEPL), to present the theoretical model of the CAEPL, and to quantify the weight of each domain of the CAEPL. 34 experts took part in the Delphi survey, and 23 experts completed all the three rounds of the survey. Experts' opinions are used to develop the theoretical model of the CAEPL. The analytical hierarchy process (AHP) was employed for determining the weights of subdomains and items of the CAEPL. The CAEPL is a comprehensive model, including intention of physical activity (IPA), knowledge of physical activity (KPA), motor/sport skill (MSS), behavior of physical activity (BPA) and physical fitness (PF). Specific weights of IPA, KPA, MSS, BPA and PF are 17.25%, 16.23%, 27.01%, 23.72% and 15.79%, respectively. The CAEPL provides an important and useful instrument to measure and improve physical literacy (PL) among young Chinese people. Studies on the feasibility, reliability, validity and sensitivity of the CAEPL should be conducted to improve it in the future.

Occurrence, Seasonal Variation and Risk Assessment of Antibiotics in the Surface Water of North China.

In this study, the occurrence, seasonal, and spatial variations of four classes antibiotics were investigated in the surface water of North China. Water samples were taken from 24 sampling sites along rivers in May and August and antibiotics in water samples were detected by SPE-UPLC-MS/MS. The occurrence of all antibiotics except for FLO in May were higher than in August. The mean concentrations of four classes antibiotics detected in May and August were in the following order respectively: quinolones (421.23 ng/L) > tetracyclines (28.37 ng/L) > amphenicols (20.38 ng/L) > sulfonamides (5.79 ng/L) and amphenicols (284.36 ng/L) > quinolones (15.74 ng/L) > tetracyclines (3.05 ng/L) > sulfonamides (0.20 ng/L). The results showed that quinolones and amphenicols were dominant antibiotics among four classes antibiotics. To explore the source of antibiotics from the fish ponds nearby, antibiotic concentration data, which was investigated in the sediment, fish feed and fish revealed a direct relationship between the main antibiotics and fish farms along the rivers. Risk assessment data indicated enrofloxacin and florfenicol could cause higher safety risks to aquatic organisms compared to other antibiotics.