Efficient magnetic solid-phase extraction, UPLC-MS/MS detection, and consumption assessment of five trace psychoactive substances.

Wastewater-based epidemiology (WBE) has become an objective and updated surveillance strategy for monitoring and estimating consumption trends of psychoactive substances (PSs) in the population. Firstly, magnetic shrimp shell biochar-based adsorbent (DZMBC) was synthesized and employed for extraction trace PSs from municipal wastewater. Proper pyrolysis temperature and increased KOH activator content favored the pore structure and surface area, thus facilitating extraction. DZMBC delivered exceptional extraction performance such as pH stability, anti-interference property, fast magnetic separation ability, reusability, and reproducibility. Then, a method based on magnetic solid-phase extraction (MSPE) followed by ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was developed, validated, and utilized for the quantitative determination of five PSs in real wastewater samples. Methodological validation results indicated a favorable linearity, low method limits of detection (1.00-4.75 ng/L), and good precisions (intra-day and inter-day relative standard deviations < 4.8%). Finally, an objective snapshot of Chongqing drug use and consumption pattern was obtained. Methamphetamine (MAMP) and 3,4-methylenedioxymethamphetamine (MDMA) were the prevalent illegal drugs in local. Both concentrations and per capita consumption of MDMA displayed a change (P < 0.05) between July and September, while no statistical differences were observed for each week.

The Impact of the Long-Term Care Insurance on the Medical Expenses and Health Status in China.

Based on the panel data of China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2015, and 2018, this paper used the difference-in-difference (DID) method to evaluate the implementation effect how the Long-Term Care Insurance (LTCI) policy impacted on the medical expenses and the health status of the middle-aged and elder population. The empirical results show that LTCI has reduced the outpatient and inpatient quantity by 0.1689 and 0.1093 per year, and cut the outpatient and inpatient expenses by 23.9% and 19.8% per year. Moreover, the implementation of LTCI has improved the self-rated health, the activity of daily living (ADL), as well as the mental health. These conclusions verify the implementation value of LTCI system and provide policy implications for the medical reform and the further LTCI implementation in a larger scale.

iCVM: An Interpretable Deep Learning Model for CVM Assessment Under Label Uncertainty.

The Cervical Vertebral Maturation (CVM) method aims to determine the craniofacial skeletal maturational stage, which is crucial for orthodontic and orthopedic treatment. In this paper, we explore the potential of deep learning for automatic CVM assessment. In particular, we propose a convolutional neural network named iCVM. Based on the residual network, it is specialized for the challenges unique to the task of CVM assessment. 1) To combat overfitting due to limited data size, multiple dropout layers are utilized. 2) To address the inevitable label ambiguity between adjacent maturational stages, we introduce the concept of label distribution learning in the loss function. Besides, we attempt to analyze the regions important for the prediction of the model by using the Grad-CAM technique. The learned strategy shows surprisingly high consistency with the clinical criteria. This indicates that the decisions made by our model are well interpretable, which is critical in evaluation of growth and development in orthodontics. Moreover, to drive future research in the field, we release a new dataset named CVM-900 along with the paper. It contains the cervical part of 900 lateral cephalograms collected from orthodontic patients of different ages and genders. Experimental results show that the proposed approach achieves superior performance on CVM-900 in terms of various evaluation metrics.

The Health Status Transition and Medical Expenditure Evaluation of Elderly Population in China.

(1) Background: Because of the rapid expansion of the aging population in China, their health status transition and future medical expenditure have received increasing attention. This paper analyzes the health transition of the elderly and how their health transition impacts medical expenditures. At the same time, feasible policy suggestions are provided to respond to the rising medical expenditure and the demand for social care. (2) Methods: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 and analyzed using the Markov model and the Two-Part model (TPM) to forecast the size of the elderly population and their medical expenditures for the period 2020-2060. (3) Results: The study indicates that: (1) for the elderly with a mild disability, the probability of their health improvement is high; in contrast, for the elderly with a moderate or severe disability, their health deterioration is almost certain; (2) the frequency of the diagnosis and treatments of the elderly is closely related to their health status and medical expenditure; alternatively, as the health status deteriorates, the intensity of the elderly individuals' acceptance of their diagnosis and treatment increases, and so does the medical expense; (3) the population of the elderly with mild and moderate disability demonstrates an inverted "U"-shape, which reaches a peak around 2048, whereas the elderly with severe disability show linear growth, being the target group for health care; (4) with the population increase of the elderly who have severe disability, the medical expenditure increases significantly and poses a huge threat to medical service supply. Conclusions: It is necessary to provide classified and targeted health care according to the health status of the elderly. In addition, improving the level of medical insurance, establishing a mechanism for sharing medical expenditure, and adjusting the basic demographic structure are all important policy choices.

Residual and ecological risk assessment of heavy metals in fly ash from co-combustion of excess sludge and coal.

Co-combustion of municipal excess sludge (ES) and coal provides an alternative method for disposing ES. The present study aims to investigate the residual and ecological risk of heavy metals in fly ash from co-combustion of ES and coal. The total concentration and speciation distribution of heavy metals, characterization of SEM, EDX, XRD and leaching test were carried out to assess the fly ash in this study. The results showed that the total concentrations of Cu, Zn and Mn were higher than others in fly ash, and most heavy metals were concentrated in fine particles. For Cd, Cr and Pb, the percentages of speciation of F4 and F5 were all over 90%, suggesting the relatively lower leaching toxicity. The leaching percent of all heavy metals was lower than 5% by two diluted HNO3 solutions for fly ash. The potential ecological risks increased with the decrease of particle size of fly ash, and Cd accounted for the main fraction for ecological risk despite of lower concentration in comparison to other measured heavy metals.

The multi-user evolutionary game simulation in water quality-based water source system.

Water is a crucial factor for human living and maintaining ecological system health. Water resource conflict has become an important factor which restricts regional economic development and affects the harmony and stability of society. This paper, on the one hand, builds a trilateral evolution game model of water intaking in the upper, middle, and lower reaches in terms of water-quality conflict, and makes an analysis of the evolutionary stable strategy of the model on the foundation of a cross-border water resource conflict warning system and based on the view of evolution game. The paper verifies related conclusions by using numerical simulation calculation examples and makes sensitivity analysis of the change of the parameters of the model. The result of the research indicates that (1) there are three groups of system local gradual stable points [Formula: see text] and [Formula: see text] in the trilateral game of water quality-based cross-border conflicts. This means that there are three groups of evolutionary stable strategies: (non-cooperation, non-cooperation, cooperation), (cooperation, non-cooperation, cooperation), and (non-cooperation, cooperation, cooperation). The conclusion obtained via verification by using numerical simulation is that upper and middle reaches are the sections which most likely lead to conflicts, so the strategy selected therefor is (non-cooperation, non-cooperation, cooperation); (2) in water quality-based cross-border conflict, the factor [Formula: see text] of compensation cost increased because excessive transfer of pollutants has a significant effect on water-intaking group strategy evolution path. It is of great theoretical and practical significance to the scientific operation of cross-border water quality and water amount conflicts and the realization of the goal of water resources management.

Clinical assessment and polysomnographic study of sleep apnea in a Chinese population of snorers.

BACKGROUND AND OBJECTIVES: While an increasing number of people who snore are seeking medical consultations, the clinical characteristics of snorers are rarely reported. The aim of this study is to characterize the clinical and polysomnographic features in a population of snorers. METHODS: A total of 490 subjects were examined retrospectively. The clinical history, Epworth Sleepiness Scale (ESS) scores, physical examination, and full-night polysomnography (PSG) data were obtained for all the subjects. The correlations between the neck circumference, waist circumference, ESS scores, body mass index (BMI), and apnea-hypopnea index (AHI) of obstructive sleep apnea (OSA) patients were explored. The gender and age differences in OSA patients were analyzed. RESULTS: OSA was diagnosed in 84.7% of the sample, with 21.2% of the patients having a mild form, 15.4% having a moderate form, and 63.4% having a severe form of OSA. The ESS scores, neck circumference, waist circumference, and BMI were positively correlated with AHI in OSA patients. The ESS scores and BMI were negatively correlated with nadir oxygen saturation (SaO2). A greater number of men than women exhibited moderate to severe forms of the disease. OSA affects the work of males more commonly compared with females. Nocturia was a more common complaint in elderly OSA patients. Heart diseases coexisted more frequently with OSA in elderly patients. CONCLUSIONS: In a population of snorers, OSA is the most common condition identified. The ESS scores and BMI were well correlated with the severity of the disease. Men had a more severe form of OSA than women. Nocturia frequently occurred in elderly OSA patients, as did the coexistence of heart disease.

[Long-term outcome and health-related quality of life in survivors of severe acute pancreatitis].

OBJECTIVE: To evaluate the health-related quality of life and postdischarge long-term outcome after severe acute pancreatitis. METHODS: The hospital records of patients with SAP discharged healthy from January 2003 to December 2003 were reviewed. The Rand 36-item Health Survey with accessory question was mailed to each patient. The means and deviations for each of eight scales scores of SF-36 were calculated, the study population scores were compared with general Chinese population; Univariate analysis was applied to determining the effects of variables such as age, sex, causes of disease, mode of treatment, frequency of surgery, financial burden, length of stay, chronic complications. Accessory questions were analyzed separately. RESULTS: The means and deviations for each of eight scales (PF, RP, RE, BP, VT, MH, SF, GH) scores of SF-36 in SAP patients were 83 +/- 15, 62 +/- 42, 69 +/- 36, 80 +/- 15, 69 +/- 19, 72 +/- 15, 75 +/- 18, 65 +/- 18, compared with general people. Except RP and SF, the others were similar. In the ANOVA of Physical Component Summary, the three variables mode of treatment, financial burden and length of stay were included (P < 0.05), while in that of Mental Component Summary, the two variables of gender and financial burden were included (P < 0.05). CONCLUSIONS: The health-related quality of life in SAP patients is similar to that of general people. Greater attention should be given to mode of treatment, length of stay and financial burden to improve quality of life.