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PURPOSE: This article provided a comprehensive scoping review, synthesizing existing literature on the financial distress faced by breast cancer patients. It examined the factors contributing to financial distress, the impact on patients, coping mechanisms employed, and potential alleviation methods. The goal was to organize existing evidence and highlight possible directions for future research. METHODS: We followed the scoping review framework proposed by the Joanna Briggs Institute (JBI) to synthesize and report evidence. We searched electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, for relevant literature. We included English articles that met the following criteria: (a) the research topic was financial distress or financial toxicity, (b) the research subjects were adult breast cancer patients, and (c) the article type was quantitative, qualitative, or mixed-methods research. We then extracted and integrated relevant information for reporting. RESULTS: After removing duplicates, 5459 articles were retrieved, and 43 articles were included based on the inclusion and exclusion criteria. The articles addressed four main themes related to financial distress: factors associated with financial distress, impact on breast cancer patients, coping mechanisms, and potential methods for alleviation. The impact of financial distress on patients was observed in six dimensions: financial expenses, financial resources, social-psychological reactions, support seeking, coping care, and coping lifestyle. While some studies reported potential methods for alleviation, few discussed the feasibility of these solutions. CONCLUSIONS: Breast cancer patients experience significant financial distress with multidimensional impacts. Comprehensive consideration of possible confounding factors is essential when measuring financial distress. Future research should focus on exploring and validating methods to alleviate or resolve this issue.
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Adaptação Psicológica , Neoplasias da Mama , Estresse Financeiro , Humanos , Neoplasias da Mama/psicologia , Neoplasias da Mama/economia , Estresse Financeiro/psicologia , Feminino , Efeitos Psicossociais da DoençaRESUMO
Vegetation is vital to the ecosystem, contributing to the global carbon balance, but susceptible to the impacts of climate change. Monitoring vegetation drought remains challenging due to the lack of widely accepted drought indices. This study focused on vegetation, and simulated the vegetation suitable water demand and soil available water supply (calculated by Remote-sensing-based Water Balance Assessment Tool model). The standardized Vegetation Water deficit Index (SVWDI) was established by calculating the vegetation water deficit, which reflects the response of vegetation to drought. We examined the spatiotemporal evolution of vegetation drought on the Loess Plateau and evaluated the applicability of standardized vegetation water deficit index. Our findings revealed that the standardized vegetation water deficit index demonstrated an overall upward trend across different time scales from 1991 to 2020. Drought conditions were concentrated in the first 20 years of the study period, but vegetation drought on the Loess Plateau has been alleviated in the past decade. Moreover, as the time scale extended, the trend of SVWDI generally decreased, with approximately 49.50 % (1-month scale), 46.66 % (3-month scale), 47.08 % (12-month scale), and 32.16 % (24-month scale) of the grid areas experiencing increased SVWDI. The correlation between SVWDI and tree-ring width index (TRWI) performed well under all precipitation gradients, but the Palmer drought severity index (PDSI) was only highly correlated with TRWI in regions with low precipitation. In terms of the relationship with vegetation health, SVWDI demonstrated the highest correlation with the normalized difference vegetation index (NDVI) across different time scales, followed by PDSI and standardized precipitation evapotranspiration index (SPEI). This study provides insights into the evolution of vegetation drought in response to climate change. The findings can guide initiatives such as returning farmland to forest and grassland on the Loess Plateau to aid climate change adaptation strategies.
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Secas , Ecossistema , Água , Solo , Florestas , Plantas , Árvores , Mudança Climática , ChinaRESUMO
Rockbursts have important influences on construction safety, so the risk assessment of rockburst intensity has great significance. Firstly, the depth of the rockburst, the uniaxial compressive strength, the stress concentration coefficients, the brittleness coefficients, and the elastic energy index are selected as the evaluation index. Secondly, an assessment model is developed based on the fuzzy variable theory. And the model is proposed to assess the rockburst intensity in the highway tunnel. Finally, the results demonstrate that the results derived from the proposed model are consistent with the current specifications; the accurate rate comes to 100%. The method can determine the risk level of rockburst intensity and provide an alternative scheme. Hence, the study can accurately present a new approach to assess the rockburst intensity in the future.
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BACKGROUND: The number of HIV-positive pregnant women accounted for about 10% of China's total over the past few years in Liangshan Prefecture, Sichuan province in China. Although cost-effectiveness of the PMTCT of HIV have been evaluated in other previous studies, no specific study has been conducted in Liangshan prefecture, nor has the expenses paid individually by HIV-positive pregnant women been included. The purpose of this study was to evaluate both the short-term and long-term cost-effectiveness of PMTCT of HIV in Liangshan Prefecture from the social perspective. METHODS: From December 2018 to January 2019, individual expenses and the other costs were collected: individual expenses of 133 recruited HIV-positive pregnant women registered in the National Information System of Prevention of Mother-to-Child Transmission of HIV, Syphilis, and HBV, and the other costs from local maternal and child healthcare hospitals, Centers for Disease Control and Prevention, and general hospitals. The costs, the number of pediatric infections averted from being HIV infected were analyzed. And, Life years gained by pediatric infections averted were calculated by using a life table. Besides, Direct benefit was calculated through a Markov mode. Furthermore, One-way sensitivity analysis was conducted for key variables affecting the benefit-cost ratio. RESULTS: The estimated number of pediatric infections averted was 164.The total cost was USD 114.1 million, including direct medical costs, direct non-medical costs, and indirect costs, which were USD 54.2 million, USD 53.4 million, and USD 6.5 million, respectively. 630.6 person-years discounted to 2017 were gained at a 3% annual rate, and cost per life year gained was USD 1809.50. Direct benefits were USD 198.4 million, indirect benefits USD 82.5 million, and the benefit-cost ratio was 1.5. The sensitivity analysis showed that if PMTCT costs hypothetically ranged from USD 85.6 million to USD 142.6 million, benefit-cost ratio would vary from 1.0 to 2.3. CONCLUSIONS: PMTCT of HIV in Liangshan Prefecture was very cost-effective. It was a great economic burden of PMTCT on HIV-positive pregnant women and their families to take individual expenses. Therefore, it could be suggested that individual expenses should be covered as much as possible by different types of financing.
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Infecções por HIV , Complicações Infecciosas na Gravidez , Sífilis , Criança , Análise Custo-Benefício , Feminino , Infecções por HIV/prevenção & controle , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controleRESUMO
Although the competitive advantages brought by intelligent manufacturing technology for enterprises have been preliminarily shown, a lack of matched management capacity still greatly limits its effect. This paper focuses on the cost management capacity problem of intelligent manufacturing enterprises. The multiscale cost data model is established on the basis of the three-dimensional cost system model, which contains actual cost, standard cost, and testing cost. According to the scale transformation theory, we propose the dynamic updating mechanism of standard cost. The key cost center identification methods, respectively, for the production performance assessment scenario (KCCI_PPA) and the business decision-making scenario (KCCI_BDM) are also put forward, which could overcome the subjective determination limitation of initial observation scale in the traditional variable-scale data analysis method. Experiments with both industrial statistical and enterprise real datasets verify the efficiency and accuracy of the proposed KCCI_PPA and KCCI_BDM method.
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Comércio , Análise de Dados , Indústrias , Inteligência , TecnologiaRESUMO
This study explores the relationship between China's reproductive health policy and the rate of return on urban education by using fixed-effect, mediating-effect, and breakpoint regression models. The authors study the impact of China's reproductive health policy on individual years of education, income, return on education, the impact of reproductive health policy on population health, and overall human development. The empirical results show that the implementation of China's reproductive health policy can improve the rate of return on urban education and increase the average length of education of urban residents by 0.29 years. Under the breakpoint regression model, the educational return rate of urban residents is approximately 12.2% higher than the ordinary least squares (OLS) estimate. China's reproductive health policy has significantly promoted the return rate of residents' education and simultaneously effectively promoted the income of urban residents. With the development of the economy, the government should properly adjust reproductive health policies and improve the population health rate so that the adjustment of reproductive health policies can comprehensively promote the health of residents of all ages. The overall relaxation of family restrictions on children's human capital investment will likely reduce the negative impact of the overall relaxation of family planning, not only improving the health of the population but also contributing to sustainable economic development.
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Política Pública , Saúde Reprodutiva , Criança , China , Humanos , Renda , Dinâmica PopulacionalRESUMO
BACKGROUND: Visual impairment (VI) seriously affects the quality of life of the older adults. It is important to formulate appropriate health management strategies for the older adults with VI to help delay the disease development and progression, and improve life quality. The aim of this study was to understand the demand preference for health management services of the older adults with VI, and to provide a reference for the development of future health management strategies in this population. METHODS: The conjoint analysis method was used to analyze demand preferences for health management services of the older adults with VI. 11 keywords were extracted after literature analyzed, 6 keywords were selected as the attributes of health management strategy after expert discussion and the level of each attribute was determined. Then 18 representative virtual health management strategies were formed by combination of different attribute levels through orthogonal design, and older adults with VI were asked to score. A total of 334 older adults with VI who attended the ophthalmology department of the First Affiliated Hospital of China Medical University and the Fourth People's Hospital of Shenyang from February 27, 2021 to June 30, 2021were enrolled in this study by stratified sampling. Of the 334 included people, 80 had grade 1 VI, 80 had grade 2 VI, 84 had grade 3 VI, and 90 had grade 4 VI. RESULTS: The relative importance of health management services ranked by older adults with VI was continuing care (24.033%), visual aid application (19.61%), health education (16.241%), preventive healthcare (15.667%), safety management (12.757%), and rehabilitation training (11.392%). The utility values of each level of continuing care, safety management and preventive healthcare were positive, whereas the utility values of each level of visual aid application, health education and rehabilitation training were negative. The relative importance and utility values of health management services were different for the older adults with different grades of VI. CONCLUSIONS: From the whole group, the older adults with VI have a higher preference for continuing care and a lower preference for rehabilitation training. The preference of the older adults with different grades of VI is different, so medical workers can formulate corresponding health management strategies according to their different demand preferences, and carry out hierarchical health management. Services that they preferred should be satisfied as much as possible in the health management strategy, while the reasons for the services with lower preference can be explored and make targeted improvement to meet the demand preferences of them.
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Qualidade de Vida , Baixa Visão , Idoso , China/epidemiologia , Serviços de Saúde , Humanos , Baixa Visão/epidemiologiaRESUMO
Sulfur autotrophic denitrification (SAD) process, as an alternative to heterotrophic denitrification (HD) filter, receives growing interest in polishing the effluent from secondary sewage treatment. Although individual studies have indicated several advantages of SAD over HD, rare study has compared these two systems under identical condition and by using real secondary effluent. In this study, two small pilot scale filters (SAD and HD) were designed with identical configuration and operated parallelly by feeding the real secondary effluent from a WWTP. The results showed SAD filter can be started up without the addition of soluble electron donor, although the time (14 days) was about 3 times longer than that of HD filter. The nitrate removal rate of SAD filter at HRT of 1.4 h was measured as 0.268 ± 0.047 kg N/(m3âd). Similar value was observed in HD filter with supplementing 90 mg/L COD. The COD concentration of effluent always kept lower than that of influent in SAD filter but not in HD filter. In addition, SAD filter could maintain a stable denitrification performance without backwash for 15 days, while decline of nitrate removal rate was observed in HD filter just 2 days after stopping the backwash. This different behavior was further confirmed as the SAD filter had a better hydraulic flow pattern. Analysis according to high-throughput 16S rRNA gene-based Illumina MiSeq sequencing clearly showed the microbial community evolution and differentiation among the samples of seed sludge, SAD and HD filters. Finally, the economic assessment was carried out, showing the operation cost of SAD filter was over 50% lower than that of HD filter.
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Desnitrificação , Hidrodinâmica , Reatores Biológicos , Nitratos , Nitrogênio , RNA Ribossômico 16S/genética , EnxofreRESUMO
OBJECTIVE: to investigate the birth experiences of women of advanced age having a second child in urban China after introduction of the universal two-child policy in 2016. DESIGN: data were collected using semi-structured in-depth interviews, and were processed and analysed using a qualitative phenomenological method. SETTING: obstetric department of a class 1, level 3 hospital in Henan Province, China. PARTICIPANTS: purposive sampling was undertaken, and 11 hospitalized women from urban backgrounds were selected as the participants. They were all aged >35 years and were having their second child. The interviews were conducted 2-4 days post partum. FINDINGS: the findings were divided into four themes: motives for the birth of a second child; anticipations for the child's gender; difficulty in conceiving; and conflicts after birth. The main reason for having a second child was no longer in accordance with the traditional Chinese mindset to 'raise sons to secure a happy life when one gets old'; instead, it was to secure family balance and harmony to respond to the new policy. Educated women from urban backgrounds were able to accept the gender of the second child 'as it came', without the old mindset that 'men are superior to women' and 'only boys can carry on family lines'. Advanced maternal age and gestational complications were the major difficulties facing these women. Chinese medicine and regimens were recognised as effective and conducive. Following the birth of their second child, the women experienced both positive feelings (joy due to the arrival of the new baby) and negative feelings (pressures and challenges on family finances, demands for more living space, and balancing their affections between two children). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: women of advanced age who choose to have a second child have sensible motives and, for the most part, their experience is positive. That said, the participants faced and overcame many difficulties before, during and after the birth of their second child. They were in need of help from the government and their employers in terms of policy, and proper education on care-taking and recuperation from medical professionals. Families who have a second child should treat the second child calmly and with common sense, make quick adjustments to family structural changes, and strike a proper balance in an effort to divide love and care equally between the two children.
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Parto Obstétrico/normas , Política de Saúde , População Urbana/estatística & dados numéricos , Adulto , China , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Apoio SocialAssuntos
Árvores de Decisões , Infecções por HIV/economia , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/economia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adolescente , Adulto , Criança , Feminino , Humanos , Quênia , Pessoa de Meia-Idade , Mães , África do Sul , Vietnã , Adulto JovemRESUMO
To understand the source-to-sink of pollutants in the Kelantan River estuary and the adjacent shelf area in Malaysia, a total of 42 surface sediment samples were collected in the Kelantan River-estuary-shelf system to analyze for grain size, total organic carbon (TOC) content, Al and heavy metals (Cr, Ni, Cu, Zn, Cd and Pb). The surficial sediments were mainly composed of clayey silt and the TOC content in sediments decreased from the river to the shelf. The surficial sediments experienced Pb pollution; Cr only showed a certain level of pollution in the coastal area of the estuary but not in other areas, and Ni, Cu, Zn, and Cd showed no pollution. The heavy metals mainly originated from natural weathering and erosion of rocks and soils in the catchment and enriched near the river mouth. Total organic carbon can promote the enrichment of heavy metals in sediments.
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Sedimentos Geológicos/análise , Metais Pesados/análise , Poluentes Químicos da Água/análise , Monitoramento Ambiental , Poluição Ambiental/análise , Estuários , Malásia , RiosRESUMO
The application of bio-electrochemical system (BESs) is strongly depended on the development of the engineering applicable electrode. Here we described an economical and readily processable electrode module with three-dimensional structure, the corrugated stainless-steel mesh electrode module (c-SMEM). This novel developed electrode module was demonstrated to provide a good hydrodynamic characteristic and significantly enhanced the decolorization performance of the BES when serving for treating azo dye (acid orange 7, AO7) containing wastewater. Compared to the conventional planar electrodes module (p-SMEM), c-SMEM was found to prolong the mean residence time (MRTθ) of AO7 and change the flow pattern closer to the plug flow. As a result, the maximum enhancement of the volumetric decolorization rate (vDR) can reach to 255%, even when the c-SMEM and p-SMEM have the same electrode surface area. In addition, a techno-economic analysis model was established to elucidated the effects of the decolorization performance and the material cost on the initial capital cost, which revealed the BES with c-SMEM could be economically comparable to or even better than the traditional bio-decolorization technologies. These results suggest c-SMEM holds great potential for engineering application, which may help paving the way of applying BES at large-scale.
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Reatores Biológicos , Cor , Técnicas Eletroquímicas/métodos , Eletrodos , Hidrodinâmica , Aço Inoxidável/química , Análise Custo-Benefício , Técnicas Eletroquímicas/economia , Microscopia Eletrônica de Varredura , Águas ResiduáriasRESUMO
A major challenge of employing bioelectrochemical system (BES) for reductively degrading recalcitrant contaminants in industrial wastewater is lacking sufficient electron donors. In this work, domestic wastewater (DW) was demonstrated to efficiently drive BES for implementing the decolorization of azo dye, acid orange 7 (AO7). Side benefit was the simultaneous treatment of DW. Decolorization efficiency in BES fed with DW (RDW) was found to be comparable with that either fed with glucose (RGlu) or acetate (RAc). Much lower reductant usage ratio was observed in RDW. As a result, when the ratio of electron donors to azo dye decreased to 4.4 mol COD mol-1 AO7, DE of RDW kept over 90% while DEs of RAc and RGlu were significantly dropped due to the insufficient electrons donation. Besides serving as electron donor, DW was proved to also provide some conductivity and buffer capacity. Accordingly, DE of RDW was less deteriorated when fully removing the external buffer slats. This study comprehensively revealed the feasibility and superiority of DW as a cost-effective electron donor source in BES and brings this technology closer to the practice.
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Elétrons , Águas Residuárias , Compostos Azo , Reatores Biológicos , CorantesRESUMO
To understand the distribution of phytoplankton and the water quality in the middle and lower reaches of Fenhe River, 18 sampling sites were selected for specimen collection, species identification and data analysis. The results showed that: (1) There were 298 species of phytoplankton under the membership of 8 divisions and 96 genera, among which, Bacillariophyta was the dominant division, with a total of 127 species of 27 genera, followed by Chlorophyta, with 104 species of 41 genera, and Cyanophyta, with 45 species of 20 genera. Only 22 species of 8 genera belonged to Euglenophyta, Cryptophyta, Pyrrophyta, Chrysophyta and Xanthophyta. The number of species in wet season was higher than that in dry season at all sites. Dominant species included Cyclotella meneghiniana, Synedra acus, Navicula cryptocephala, Nitzschia palea of Bacillariophyta, Chlorella vulgaris of Chlorophyta, Oscillatoria tenuis, O. amphibia of Cyanophyta, most of which were indicator species of alpha- and beta-mesosaprobic type. Cell density was higher in wet season and lower in dry season. (2) Shannon-Wieaver species diversity index ranged from 1 to 3 basically. Margalef species richness index ranged from 0.5 to 2. Pielou evenness index ranged 0.3-0.8. (3) During the wet season, most dominant species of Chlorophyta and Euglenophyta had higher correlation with chemical oxygen demand (COD), conductivity and ammonia nitrogen. The dominant species of Cyanophyta were greatly influenced by the contents of water temperature and chromium (Cr). The distribution of dominant species of Bacillariophyta was complicatedly related with environmental factors. During the dry season, there was a higher correlation between the members of Cyanophyta and ammonia nitrogen, total phosphorus, COD. The species of Chlorophyta and Euglenophyta were mainly influenced by the dissolved oxygen and total phosphorus. The bacillariophytes were mainly related with total phosphorus, dissolved oxygen, pH and cadmium (Cd). In conclusion, the water was moderately to heavily contaminated in middle and lower reaches of Fenhe River and the water quality was eutrophic.
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Monitoramento Ambiental , Fitoplâncton/classificação , Rios/química , Qualidade da Água , China , Clorófitas/classificação , Cianobactérias/classificação , Diatomáceas/classificação , Eutrofização , Oxigênio/análise , Fósforo/análise , Estações do AnoRESUMO
OBJECTIVE: To establish and evaluate a molecular diagnostic method for routine monitoring of four types of diarrheagenic Escherichia (E.) coli (DEC)and to study the distribution of four types of DEC isolated from diarrheal patients in Shanghai. METHODS: DEC-PCR standard operation procedure(SOP)had been developed for DEC detection and isolation, using the Statens Serum Institute (SSI) DEC PCR kits with multiplex PCR technique after verification tests on reference strains. Diarrhea specimens from 3 clinical hospitals in Shanghai were tested from June to September, 2012. RESULTS: Specificity of the PCR kit was 100% by verification on the 26 DEC reference strains. A total number of 218 DEC isolates, including 181 fermented lactose and 37 unfermented lactose were identified from the 1887 stool specimens of diarrhea patients, with positive rate as 11.6%. The most common pathogen(54.1%, 118/218)was enteropathogenic E. coli(EPEC), followed by enterotoxigenic E. coli(ETEC, 41.3%, 90/218), enteroinvasive E. coli (EIEC, 4.1%, 9/ 218) and Shigatoxin-producing E. coli(STEC, 0.5%, 1/218)in addition to 18 Shigella isolates. ETEC dominated in diarrhea patients with foreign residency, as well as 1/3 were perinatal stage of neonatal ETEC of all diarrhea cases under the age of 5, while EPEC dominated in the Chinese diarrhea patients especially among young kids under the age of 2. CONCLUSION: Data was reliable after assessment on this molecular diagnostics and seperation procedures used for the routine monitoring on four types of DEC, while the diagnosis and reference ability of DEC regarding the laboratories net-working on food-borne pathogens need to be built up and improved.
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Diarreia/diagnóstico , Infecções por Escherichia coli/diagnóstico , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Adolescente , Adulto , China/epidemiologia , Diarreia/epidemiologia , Diarreia/microbiologia , Infecções por Escherichia coli/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Patologia Molecular , Vigilância de Evento SentinelaRESUMO
OBJECTIVE: To estimate the status of coincidence of high-risk HPV (HR-HPV) test and thinprep cytology test(TCT) with biopsy histopathological diagnosis. And explore the diagnostic value in the cervical cancer and precancerous lesions by combination of these two methods. METHODS: Retrospective analysis cases with the positive cytological diagnosis. Acrodding to the principle of voluntariness and informed consent, 3197 cases were selected and further investigated by high-risk human papillomavirus testing and biopsy histopathological diagnosis. We had a comparative analysis to the coincidence of TCT, high-risk HPV-DNA test and biopsy histopathological diagnosis. RESULTS: Among 3197 cases, 58.6% cases with chronic inflammation, 26.1% cases with condyloma or CIN I, 14.1% cases with CIN II-III, and 1.2% cases with invasive cervical carcinoma. Compared with pathological biopsy, the coincident rate of the diagnosis of TCT cytology and histopathology were 21.2% (ASC-US), 28.6% (ASC-H), 39.6% (LSIL), 56.2% (HSIL) and 72.4% (cervical carcinoma), respectively. Among cases of positive TCT diagnosis, Compared HR-HPV test and histopathological diagnosis, infection rate of HR-HPV increases significantly with increasing pathological grade (chi2 = 292.354, P = 0.000 < 0.05). As the TCT diagnostic level increases, the positive rate of HR-HPV marked grows (chi2 = 144.113, P = 0.000 < 0.05). CONCLUSION: TCT can reduce the incidence of cancer effectively. But lower sensitivity in the low-grade cervical lesions may cause missed diagnosis. Combined TCT and HR-HPV test will improve the detection rate of cervical lesions; it is an ideal method to screening cervical cancer.
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Alphapapillomavirus/isolamento & purificação , Carcinoma/diagnóstico , Técnicas Citológicas/métodos , Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Adulto , Idoso , Carcinoma/patologia , Carcinoma/virologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Adulto JovemRESUMO
OBJECTIVE: To explore the clinical characteristics, medical costs and its influencing factors in diabetics with amputation. METHODS: The data of diabetic amputation for the whole year of 2010 at 39 central municipal Class 3A hospitals all across China were retrospectively analyzed according to a unified protocol, including demographic characteristics, diabetic complications, classification of diabetic foot disease, level and prognosis of amputation and medical costs at hospitals. RESULTS: Among them, 28.2% of all amputated patients or 39.5% of non-traumatic patients were diabetics. There were 313 males and 162 females. The average age and duration of diabetes were (66 ± 12) years and (130 ± 94) months. The level of HbA1c was 8.9% ± 2.4%. Among all amputated diabetics, the concurrent conditions included neuropathy (50.1%), peripheral artery disease (74.8%), nephropathy (28.4%) and retinopathy (25.9%). The patients with foot ulcer at Wagner 4 (50.3%) were more common. Among them, 67.5% had minor amputation with a median hospitalization stay of 33.0 (24.0 - 45.0) days and a medical cost of 26 138 (16 155 - 46 021) yuan RMB. The duration of diabetes, diabetic complications, severity and location of ulcers and amputation level influenced their hospitalization durations and medical costs. CONCLUSION: The patients with diabetes and amputation are elder with more chronic diabetic complications and uncontrolled hyperglycemia. Most of them have complications of local gangrene and require minor amputation at admission. Their hospital stays are longer and medical costs higher significantly correlated with diabetic complications, severity and location of foot ulcers and level of amputations.
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Amputação Cirúrgica/economia , Amputação Cirúrgica/estatística & dados numéricos , Diabetes Mellitus/economia , Custos de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , China , Diabetes Mellitus/cirurgia , Pé Diabético/economia , Pé Diabético/cirurgia , Neuropatias Diabéticas/economia , Neuropatias Diabéticas/cirurgia , Feminino , Hospitais Urbanos/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Woody hemiepiphytic species (Hs) are important components of tropical rain forests, and they have been hypothesized to differ from non-hemiepiphytic tree species (NHs) in adaptations relating to water relations and carbon economy; but few studies have been conducted comparing ecophysiological traits between the two growth forms especially in an evolutionary context. Using common-garden plants of the genus Ficus, functional traits related to plant hydraulics and carbon economy were compared for seven NHs and seven Hs in their adult terrestrial "tree-like" growth phase. We used phylogenetically independent contrasts to test the hypothesis that differences in water availability selected for contrasting suites of traits in Hs and NHs, driving evolutionary correlations among functional traits including hydraulic conductivity and photosynthetic traits. Species of the two growth forms differed in functional traits; Hs had substantially lower xylem hydraulic conductivity and stomatal conductance, and higher instantaneous photosynthetic water use efficiency. Leaf morphological and structural traits also differed strikingly between the two growth forms. The Hs had significantly smaller leaves, higher leaf mass per area (LMA), and smaller xylem vessel lumen diameters. Across all the species, hydraulic conductivity was positively correlated with leaf gas exchange indicating high degrees of hydraulic-photosynthetic coordination. More importantly, these correlations were supported by correlations implemented on phylogenetic independent contrasts, suggesting that most trait correlations arose through repeated convergent evolution rather than as a result of chance events in the deep nodes of the lineage. Vatiation in xylem hydraulic conductivity was also centrally associated with a suite of other functional traits related to carbon economy and growth, such as LMA, water use efficiency, leaf nutrient concentration, and photosynthetic nutrient use efficiency, indicating important physiological constraints or trade-offs among functional traits. Shifts in this trait cluster apparently related to the adaptation to drought-prone canopy growth during the early life cycle of Hs and clearly affected ecophysiology of the later terrestrial stage of these species. Evolutionary flexibility in hydraulics and associated traits might be one basis for the hyper-diversification of Ficus species in tropical rain forests.
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Evolução Biológica , Carbono/metabolismo , Ficus/genética , Ficus/fisiologia , Água/metabolismo , Animais , Ecossistema , Fotossíntese , Análise de Componente PrincipalRESUMO
The processes of fine sediment transport and deposition can record some relative anthropogenic information in estuarine environments. Grain size analysis of the sediment core collected from coastal wetland of Qi'ao Island in the Pearl River Estuary of China show that the sediment is mainly composed by clayey silt, and the mean grain size, contents of clay and silt increase upward gradually. Chronology analysis show that the sedimentation rate above 59 cm is about 4.15 cm x a(-1), and 0.97 cm x a(-1) beneath 59 cm. Heavy metal analysis indicate that the contents of the each heavy metal increased slowly with a slight intensity of potential ecological risk; however, from 1966 to 1992, the heavy metal contents increased obviously because of the quick social-economy development around the Pearl River Estuary area, and the order of polluting degree of these heavy metals in core sediment is Cd > Ni > Pb > Cu > Cr > Zn. The potential ecological risk intensity of Cd increased from slight risk before 1966 to strong risk since 1992, and the potential ecological risk intensities other heavy metal are slight risk; the potential ecological risk index is weak level. The variations of core sediment heavy metal contents and its ecological risk assessments along the vertical profile reveal the interaction processes and intent of anthropogenic influences from the areas around the Pearl River Estuary and the catchments.
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Monitoramento Ambiental/métodos , Poluentes Ambientais/análise , Metais Pesados/análise , Poluentes Químicos da Água/análise , Áreas Alagadas , China , Ecologia , Oceanos e Mares , Medição de Risco , RiosRESUMO
The concentrations of 7 heavy metals were determined in 48 surface sediments in the Quanzhou Bay by an inductively coupled plasma mass spectroscopy (ICP-MS). The average contents of Cr, Ni, Cu, Zn, As, Cd and Pb are 47.66, 52.2, 30.86, 111.6, 5.29, 0.399 and 50.3 microg x g(-1), respectively. The Cd, Pb, Zn and As were mainly discharged into the Quanzhou Bay by Jinjiang River, while the materials near the Bay might supply a considerable amount of Cr, Ni and Cu. The result of the multi-analysis ecological risk index analyses revealed that Cr, Ni, Cu, Zn, Pb and As were moderately contaminated and presented low potential ecological risk, while Cd was heavily contaminated and raised high potential ecological risk. In general, moderately contaminated and potential ecological risk were occurred in whole Quanzhou Bay with the dominated polluted metals were Ni and Cd. The heavily contaminated area was corresponded to the high potential ecological risk area, which located at the confluent area of Jinjiang River and Luoyangjiang River. From the results of this study, we conclude that the Quanzhou Bay has been heavily polluted by heavy metals, therefore much environmental control should be continued and strengthen to Quanzhou Bay and its adjacent areas.