Life cycle assessment of carbonaceous pellets used in blast furnaces in the context of "double carbon".

As the sole carbonaceous renewable energy source, biomass is distinguished by its abundant yield, widespread distribution, and carbon neutrality. It is integral to the achievement of zero and negative carbon production via conventional carbonaceous pellet technology. This study introduces a cradle-to-gate life cycle assessment methodology for biomass preparation in carbonaceous pellets. We prepare high-quality biochar through a process combining hydrothermal carbonization and pyrolytic carbonization. Biomass high molecular weight extracts are obtained via organic pyrolytic extraction, while biomass high-temperature binders result from the modification and treatment of biochar. Biomass carbonaceous pellets are then formed using hot press technology. The ReCiPe model facilitates a comprehensive life cycle assessment of biomass carbonaceous pellets used in blast furnace production. The study leverages two comprehensive evaluation indicators - renewability, and environmental performance - to enhance the environmental performance of the process system and to maximize energy-saving and emission reduction potential.

Quantitative Assessment of Myocardial Edema by MR T2 Mapping in Children With Kawasaki Disease.

BACKGROUND: Few studies assessed myocardial inflammation using Cardiovascular Magnetic Resonance Imaging in Kawasaki disease (KD) patients. PURPOSE: To quantify myocardial edema in KD patients using T2 mapping and explore the independent predictors of T2 values. STUDY TYPE: Prospective. SUBJECTS: Ninety KD patients including 40 in acute phase (26 males, 65.0%) and 50 in chronic phase (34 males, 68.0%). Thirty-one healthy volunteers (21 males, 70.0%). FIELD STRENGTH/SEQUENCE: 3.0 T T2-weighted Turbo Spin Echo-Short Time of Inversion Recovery sequence, True fast imaging with steady precession flash sequence and fast low-angle shot 3D spoiled gradient echo sequence. ASSESSMENT: T2 values were compared among KD groups and controls. STATISTICAL TEST: Student's t test and Fisher's exact test; One-way analysis of variance; Pearson correlation analysis; Receiver operating curve analysis; Multivariable linear regression. RESULTS: Global T2 value of KD patients in acute phase was the highest, followed by those of chronic-phase patients and controls (38.83 ± 2.41 msec vs. 37.55 ± 2.28 msec vs. 36.05 ± 1.64 msec). Regional T2 values showed a same trend. There were no significant differences in global and regional T2 values between KD patients with and without coronary artery (CA) dilation, no matter in acute or chronic phase (all KD patients: P = 0.51, 0.51, 0.53, 0.72; acute KD: P = 0.61, 0.37, 0.33, 0.83; chronic KD: P = 0.65, 0.79, 0.62, 0.79). No significant difference was observed in global T2 values between KD patients with Z score > 5.0 and 2.0 < Z score ≤ 5.0 (P = 0.65). Multivariate analysis demonstrated that stage of disease (ß = -0.123) and heart rate (ß = 0.280) were independently associated with global T2 values. DATA CONCLUSION: The degree of myocardial edema was more severe in acute-phase than in chronic-phase KD patients. Myocardial edema persists in patients regardless of the existence or degree of CA dilation. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

Heavy metals in fish, rice, and human hair and health risk assessment in Wuhan city, central China.

The current study investigated the concentration of heavy metals (HMs) in human hair associated with fish and rice consumption in Wuhan City, central China. The mean values of As in 8/10 fish species exceeded the food safety standard of 0.015 mg/kg. The mean values (mg/kg) of HMs in rice followed a descending order of Zn (13.7)> Cu (1.9)>Cr (0.51)>As (0.11) >Cd (0.08) >Pb (0.04). The ascending order of HMs for male hair was Cd < As < Cr < Pb < Cu < Zn, while As < Cd < Cr < Pb < Cu < Zn for female. 30% of hair Cr and 22% of hair Zn contents exceeded the recommended values. The middle age (19-44) and adult (45-59) groups were the most vulnerable group, as the concentration for most elements was high in these age groups. A significant correlation was found between fish-eating frequency and hair Zn (r = 0.213; p < 0.05), and As (r = 0.204; p < 0.05). High odd ratios were found in a population with high fish-eating frequency, especially for Pb (7.19), As (3.1), Zn (3.83), and Cd (3.7). A significant non-carcinogenic risk was associated with Cr exposure through consuming herbivores, filter feeders, and omnivorous fish. The cancer risk values of Cd exposure (1.54E-04) via rice consumption and As exposure (1.25E-04) via consumption of omnivores fish indicate precautionary measures.

[Heavy Metal Pollution Characteristics and Risk Assessment of Golden Snub-nosed Monkey (Rhinopithecus roxellana) Habitat in Shennongjia Mountains].

The golden snub-nosed monkey is one of the most endangered animal species endemic to China. In order to explore the characteristics and health risks of golden snub-nosed monkeys exposed to heavy metals, we collected the plant food sources, soil, and water samples from the golden snub-nosed monkey habitat in the Shennongjia Mountains; examined the contents of seven heavy metals (Cu, Zn, Pb, Cd, Cr, Ni, and As); and adopted the comprehensive pollution index, potential ecological risk index, and Nemerow index to evaluate pollutants in the water, soil, and food plants. At the same time, the Target Hazard Quotient method was used to assess heavy metals in the food plants. The results showed that the heavy metal concentration of the habitat water was 0.004-1.220 µg·L-1. The water comprehensive pollution index showed that the habitat water was safe. In addition, the ω(Cd)(0.162-0.822 mg·kg-1) in the soil was 2.71 times the background value of the soil in Hubei province, indicating a moderate risk of ecological harm. The over-standard rates of Pb, Cd, Cr, and Ni in food plants were 29%, 29%, 18%, and 35%, respectively; the pollution indexes of lichen and bark were 6.038 and 7.709, which were at a heavy pollution level; and the pollution indexes of Abies fragesii and Vicia cracca were 2.716 and 2.034, which indicated a moderately polluted level. The rest of the plants were at a safe level. Our health risk analysis showed that the risk of lichen and bark were higher than that of leaves, followed by fruits. Among the seven metals, As most threatened the health of the golden snub-nosed monkeys (THQ>1). In general, heavy metals had polluted the habitats of the golden snub-nosed monkeys in the Shennongjia Mountains, and we are certain that the heavy metal pollution was associated with human activities. Thus, human activities in the Shennongjia Mountains should be reasonably restricted in the future. Our results can provide scientific support for the population conservation of golden snub-nosed monkeys in China and provide research samples in the health risk valuation of heavy metals in endangered animals through food plants.

A Low-Cost Na-Ion and K-Ion Batteries Using a Common Organic Cathode and Bismuth Anode.

Molecule-aggregation organic electrodes in principle have the capability for "single-molecule-energy-storage" in metal-ion rechargeable batteries, which indicates that the same organic electrode can be simultaneously applied to multiple metal-ion rechargeable batteries. In this study, the polyanionic organic compound 9,10-anthraquinone-2,6-disulfonate (Na2 AQ26DS, 130 mAh g-1 ) is used as a common cathode and metal bismuth (Bi) as a common anode to simultaneously assemble low-cost Na-ion and K-ion full cells. The Na-ion full cells can deliver the peak discharge capacity of 139 mAh g-1 cathode at 0.5-3.0 V, and the K-ion full cells can show the peak discharge capacity of 130 mAh g-1 cathode at 0.5-3.0 V. These results are comparable to the best organic-based Na-ion and K-ion full cells reported to date.

The impact of rotavirus vaccination in the prevalence of gastroenteritis and comorbidities among children after suboptimal rotavirus vaccines implementation in Taiwan: A population-based study.

ABSTRACT: In Taiwan, rotavirus vaccination was implemented in 2006 in the private sector. The population-based impact of rotavirus vaccination on gastroenteritis and comorbidities of children remains under-investigated.We analyzed the annual prevalence of rotavirus-related disease, including gastroenteritis, convulsions, epilepsy, type I diabetes mellitus, intussusception, and biliary atresia among children under 5 years of age. Data were collected from Taiwan's National Health Insurance Research Database, a nationwide population-based database. A 16-year retrospective cohort study was conducted between 2000 and 2015.Among children <5 years of age, the prevalence of gastroenteritis decreased after 2012 (44,259.69 per 100 thousands) and remained lower through 2015 (39,931.11per 100 thousands, P < .001). The prevalence of convulsions rose steadily and significantly from 2007 (775.90 per 100 thousands) to 2015 (962.17 per 100 thousands, P < .001). The prevalence of epilepsy decreased significantly until reaching a nadir in 2013 (from 501.56 to 293.53 per 100 thousands, P < .001). The prevalence of biliary atresia tended upward, and surged suddenly in 2007 with a peak in 2013 (18.74 per 100 thousands). Among infants (<1 year of age) from 2000 to 2015, the prevalence of gastroenteritis declined steadily, and more rapidly after 2007 (22,513 to 17,285 per 100 thousands).In Taiwan, after introducing rotavirus vaccination, gastroenteritis in young children decreased, especially in infancy. However, gastroenteritis is still common in children, given other emerging pathogens. Our results highlight the impact of rotavirus vaccines on children's health in Taiwan and provide indications for future preventive medicine and healthcare strategies in children.

Assessment of CPS + EG, Neo-Bioscore and Modified Neo-Bioscore in Breast Cancer Patients Treated With Preoperative Systemic Therapy: A Multicenter Cohort Study.

This study was to assess the prognosis stratification of the clinical-pathologic staging system incorporating estrogen receptor (ER)-negative disease, the nuclear grade 3 tumor pathology (CPS + EG), Neo-Bioscore, and a modified Neo-Bioscore system in breast cancer patients after preoperative systemic therapy (PST). A retrospective multicenter cohort study was conducted from 12 participating hospitals' databases from 2006 to 2015. Five-year disease free survival (DFS), disease specific survival (DSS), and overall survival (OS) were calculated using Kaplan-Meier Method. Area under the curve (AUC) of the three staging systems was compared. Wald test and maximum likelihood estimates in Cox proportional hazards model were used for multivariate analysis. A total of 1,077 patients were enrolled. The CPS + EG, Neo-Bioscore, and modified Neo-Bioscore could all stratify the DFS, DSS, and OS (all P < 0.001). While in the same stratum of Neo-Bioscore scores 2 and 3, the HER2-positive patients without trastuzumab therapy had much poorer DSS (P = 0.013 and P values < 0.01, respectively) as compared to HER2-positive patients with trastuzumab therapy and HER2-negative patients. Only the modified Neo-Bioscore had a significantly higher stratification of 5-year DSS than PS (AUC 0.79 vs. 0.65, P = 0.03). So, the modified Neo-Bioscore could circumvent the limitation of CPS + EG or Neo-Bioscore. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT03437837.

An Inkjet-Printed PEDOT:PSS-Based Stretchable Conductor for Wearable Health Monitoring Device Applications.

A stretchable conductor is one of the key components in soft electronics that allows the seamless integration of electronic devices and sensors on elastic substrates. Its unique advantages of mechanical flexibility and stretchability have enabled a variety of wearable bioelectronic devices that can conformably adapt to curved skin surfaces for long-term health monitoring applications. Here, we report a poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS)-based stretchable polymer blend that can be patterned using an inkjet printing process while exhibiting low sheet resistance and accommodating large mechanical deformations. We have systematically studied the effect of various types of polar solvent additives that can help induce phase separation of PEDOT and PSS grains and change the conformation of a PEDOT chain, thereby improving the electrical property of the film by facilitating charge hopping along the percolating PEDOT network. The optimal ink formulation is achieved by adding 5 wt % ethylene glycol into a pristine PEDOT:PSS aqueous solution, which results in a sheet resistance of as low as 58 Ω/□. Elasticity can also be achieved by blending the above solution with the soft polymer poly(ethylene oxide) (PEO). Thin films of PEDOT:PSS/PEO polymer blends patterned by inkjet printing exhibits a low sheet resistance of 84 Ω/□ and can resist up to 50% tensile strain with minimal changes in electrical performance. With its good conductivity and elasticity, we have further demonstrated the use of the polymer blend as stretchable interconnects and stretchable dry electrodes on a thin polydimethylsiloxane (PDMS) substrate for photoplethysmography (PPG) and electrocardiography (ECG) recording applications. This work shows the potential of using a printed stretchable conducting polymer in low-cost wearable sensor patches for smart health applications.

Cardiotocography signal abnormality classification using time-frequency features and Ensemble Cost-sensitive SVM classifier.

BACKGROUND: Cardiotocography (CTG) signal abnormality classification plays an important role in the diagnosis of abnormal fetuses. This classification problem is made difficult by the non-stationary nature of CTG and the dataset imbalance. This paper introduces a novel application of Time-frequency (TF) features and Ensemble Cost-sensitive Support Vector Machine (ECSVM) classifier to tackle these problems. METHODS: Firstly, CTG signals are converted into TF-domain representations by Continuous Wavelet Transform (CWT), Wavelet Coherence (WTC), and Cross-wavelet Transform (XWT). From these representations, a novel image descriptor is used to extract the TF features. Then, the linear feature is derived from the time-domain representation of the CTG signal. The linear and TF features are fed to the ECSVM classifier for prediction and classification of fetal outcome. RESULTS: The TF features show the significant difference (p-value<0.05) in distinguishing abnormal CTG signals, but not for traditional nonlinear features. In ECSVM abnormality classification, using only linear features, the sensitivity, specificity, and quality index are 59.3%, 78.3%, and 68.1%, respectively, whereas more effective results (sensitivity: 85.2%, specificity: 66.1%, and quality index: 75.0%) are obtained using a combination of linear and TF features, with a performance improvement index of 10.1%. Especially, the area under the receiver operating characteristic curve (0.77 vs. 0.64) is significantly increased with the ECSVM vs. SVM. CONCLUSION: Our method can greatly improve the classification results, especially for sensitivity. It improves the true positive rate of CTG abnormality classification and reduces the false positive rate, which may help detect and treat abnormal fetuses during labor.

[Carbon budget estimation based on different methods of CO2 storage flux in forest ecosystems]. / CO2储存通量估算方法对森林生态系统碳收支估测的影响.

Accurate measurement of CO2 storage flux (Fs) in forest ecosystems is of great significance for estimating ecosystem carbon budget by eddy covariance (EC). The errors in the estimation of ecosystem carbon budget caused by different methods for calculating Fs has yet not been comprehensively assessed. Using data from an open-path EC system and an eight-level CO2/H2O profile system (AP100, Campbell Scientific Inc., USA) in a broadleaved deciduous forest at the Maoer-shan in 2018, we evaluated the methodological effect of Fs[2-min mean profile (P2 min), 30-min mean profile (P30 min) and 30-min mean EC single point (Ps)] on the estimation of net ecosystem exchange (NEE), ecosystem respiration (Re), and gross primary productivity (GPP). The results showed that the impact of Fs methods on forest carbon flux generally increased with the increases of time scale, indicating that gap-filling of flux data would further amplify the impacts of Fs estimation methods. At the annual scale, NEE based on P2 min and Ps methods were 36.3% and 29.4% lower than that based on P30 min, while Re based on P2 min was higher than that based on P30 min and Ps by 8.7%. The GPP based on P2 min was 5.4% higher, while that based on Ps was 2.1% lower than that based on P30 min. The traditional P30 min ignored the instantaneous changes in CO2 concentration, Ps missed the changes of CO2 concentration within canopy, and thus both underestimated the actual Re. The approximately instantaneous profile (2-min mean profile) had higher temporal and spatial resolution and could more accurately estimate forest carbon budget with non-flat terrain and complex canopy structure. Our findings had great implications for solving the underestimation of forest Re and GPP as well as the overestimation of net carbon sink on complex conditions with the EC method.

The effect of increased family finance and dual-parental absence since infancy on Children's cognitive Abilities.

Existing research suggests that parental absence per se does not have a main effect on children's cognitive development. However, this body of research is confounded by decreased family finance resulted from parental absence. Further insights on children's cognitive development can be gained by studying situations where parental absence actually leads to higher family finance. China's rural left-behind children (LBC) are uniquely suited for this purpose because of their extended separation from parents who migrated to work for better family finance. The participants were 74 LBC (M = 9.99 years, SD = 2.66) whose parents both migrated away for work within six months of their births and 74 non-left-behind children (NLBC) (M = 10.03 years, SD = 2.58) of similar backgrounds but whose parents never migrated. We used the 4th Edition of the Wechsler Intelligence Scale for Children (WISC-IV) to individually collected data on the children's Verbal Comprehension (which includes Similarities, Vocabulary, and Comprehension subtests), Perceptual Reasoning (which includes Block Design, Picture Concepts and Matric Reasoning subtests), Working Memory (which includes Digit Span and Letter-Number Sequencing subtests), and Processing Speed (which includes Coding and Symbol Search subtests). We found that the LBC scored lower than the NLBC on the language Comprehension and Vocabulary subtests of the Verbal Comprehension Index (Cohen's d = 0.41; p = .01). Subsequent General Linear Modeling analyses revealed that for the Comprehension subtest: (1) dual-parental absence significantly and negatively predicted Comprehension scores and (2) monthly family income significantly and positively predicted Comprehension scores for the LBC but not for the NLBC. For Vocabulary subtest, only dual-parental absence was significant. Overall, these results offer a deeper understanding on the effect of dual parental absence and changes in family finance on different domains of children's cognitive development.

An overview of bromate formation in chemical oxidation processes: Occurrence, mechanism, influencing factors, risk assessment, and control strategies.

Chemical oxidation processes have been extensively utilized in disinfection and removal of emerging organic contaminants in recent decades. Some undesired byproducts, however, are produced in these processes. Of them, bromate has attracted the most intensive attention. It was previously regarded as a byproduct that typically occurred in ozone-based oxidation processes. However, for the past decade, bromate formation has been detected in other oxidation processes such as CuO-catalyzed chlorination, SO4--based oxidation, and ferrate oxidation processes. This review summarizes the occurrences, mechanisms, influencing factors, risk assessment, and control strategies of bromate formation in the four oxidation processes, i.e., ozone-based oxidation, chlorine-based oxidation, SO4--based oxidation, and ferrate oxidation. Besides, some unresolved issues for future studies are provided: (1) Clarification of the relative contributions of SO4- and Br to the oxidation of bromine for bromate formation in SO4--based oxidation processes; (2) evaluation of the role of different reactive species in the bromate formation in the process of UV/HOCl; (3) quantification of the dual role of alkalinity in bromate formation during ozonation; (4) assessment of the risks of bromate formation in SO4--based oxidation processes for practical applications; and (5) exploration of strategies for inhibiting bromate formation in SO4--based oxidation, UV/chlorine, and metal oxide-catalyzed chlorination processes.

Pharmacokinetic, metabolic stability, plasma protein binding and CYP450s inhibition/induction assessment studies of N-(2-pyridylmethyl)-2-hydroxiymethyl-1-pyrrolidinyl-4-(3-chloro-4-methoxy-benzylamino)-5-pyrimidine-carboxamide as potential type 5 phosphodiesterase inhibitors.

N-(2-pyridylmethyl)-2-hydroxiymethyl-1-pyrrolidinyl-4-(3-chloro-4-methoxy-benzylamino)-5-pyrimidine-carboxamide (NHPPC) is a new potential of type 5 phosphodiesterase (PDE5) inhibitors, synthesized from the avanafil analogue for the treatment of erectile dysfunction. The targets of this article were to assess plasma protein binding, liver microsomal metabolic stability, inhibition and induction on cytochrome P450 isozymes and the pharmacokinetics of NHPPC. Equilibrium dialysis technique was applied to determine Plasma protein binding (PPB) and NHPPC was evaluated in male Sprague-Dawley rats and Beagle dogs in vivo pharmacokinetic. The NHPPC was highly bound to plasma proteins in rats, dogs and human tested and the mean values for PPB rate were 96.2%, 99.6% and 99.4%, respectively. After in vitro liver microsomes incubated for 60 min, the percent remaining of NHPPC was 42.8%, 0.8% and 42.0% in rats, dogs and human, respectively. In vitro intrinsic clearance was found to be 0.0233, 0.1204 and 0.0214 mL/min/mg protein in rat, dog and human liver microsomes of NHPPC, respectively. NHPPC showed no significant inhibitory effects on major CYP450 enzymes, and had no significant induction potential on CYP1A2 and CYP3A4. Following oral administration in rats and dogs, t max was 6 and 0.5 h, respectively. The clearance for NHPPC was 1.19 and 1.46 L/h/kg in rats and dogs, respectively. And absolute bioavailability in rat and dog were approximately 34.5% and 53.1%, respectively. These results showed that NHPPC has a good development prospect.

Lichen as a Biomonitor for Vehicular Emission of Metals: A Risk Assessment of Lichen Consumption by the Sichuan Snub-Nosed Monkey (Rhinopithecus roxellana).

Two lichen species, Usnea aciculifera and Usnea luridorufa, were used as biomonitors for the deposition of traffic-related metals in China's Shennongjia National Nature Reserve. The suitability of the two lichen species for use as biomonitors was compared. The health threat to the Sichuan snub-nosed (aka golden) monkey (Rhinopithecus roxellana) from consuming lichen with elevated metal concentrations due to vehicular traffic was then assessed. Lichens, with large surface areas and neither roots nor stomata, efficiently absorb both particulate and gaseous air pollutants. The resulting data was used to assess the effect of heavy metal accumulation on the lichens as well as the health risk imposed on the monkeys as lichen is a primary food source. Lichen samples were collected in the core area of the reserve at three locations of varying traffic intensity. A forth site in the reserve, with no proximate traffic, was used as the control. Results show: (1) lichen from high traffic sites has significantly higher concentrations of Fe, Cd, Pb Zn, and Cr than lichen collected from the control site; (2) vehicular traffic is the primary source of metals in lichen; (3) U. luridorufa collected at high traffic sites displayed decreased photosynthetic efficiency, an indication of stress; (4) intake of Cd and Pb from vehicle emissions in the Shennongjia National Nature Reserve could adversely affect snub-nosed monkey health. This research advances the science of biomonitoring, contributes to environmental protection efforts in China's nature reserves and helps improve food safety for Sichuan snub-nosed monkey, a national treasure of China.

Exploration of sources of OVOCs in various atmospheres in southern China.

Oxygenated volatile organic compounds (OVOCs) are critical atmospheric ozone and secondary organic aerosol (SOA) precursors and radical sources, while understanding of OVOC sources in the atmosphere, especially with large anthropogenic emissions, still has large uncertainties. A high-sensitivity proton transfer reaction mass spectrometer (PTR-MS) was deployed in vastly different atmospheres in southern China, including an urban site (SZ-U), a regional site (NA-R), and a background site (NL-B). Four critical OVOCs, i.e., methanol, acetone, methyl ethyl ketone (MEK) and acetaldehyde, five groups of aromatic hydrocarbons, isoprene and acetonitrile were measured with a high time resolution. The featured relative abundance and diurnal variations of the OVOCs indicated that methanol, acetone and MEK had prominent contributions from urban industrial activities, while acetaldehyde was closely related to the photochemical formation at all three sites. The photochemical age-based parameterization method was improved locally and then applied to quantify different sources of daytime OVOCs: anthropogenic secondary and biogenic sources (together 60-73%) were always the dominant source for acetaldehyde in various atmospheres; in addition to a significant background for methanol, acetone and MEK, anthropogenic primary emissions (mostly industrial) were their dominant source at SZ-U (38-73%), while biogenic sources played the key role for them at NL-B (30-43%); biomass burning contributed a small fraction of 5-17% for the four OVOCs at the three sites.

Integrating traditional Chinese medicine healthcare into dementia care plan by reducing the need for special nursing care and medical expenses.

Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days. We also used ANOVA test to compare the hospital cost, hospital stay, and numbers according to different duration of TCM.We assessed 9438 new diagnosed patients with dementia without advanced nursing care were categorized into 2 groups: 4094 (43.4%) TCM users, and 5344 (56.6%) non-TCM users. In the TCM groups, 894 (21.8%) patients were declared as advanced nursing care, while 1683 (31.5%) patients were in non-TCM group. Cox proportional hazard regression indicated that using TCM may decrease the need for advanced nursing care (adjusted hazard ratio (aHR) = 0.61, 95% confidence interval [95% CI]: 0.56-0.66) compared to non-TCM. The TCM users have lower hospitalization costs and hospitalization time compared to non-TCM users.Integrating TCM healthcare into dementia care was found to be associated with a lower need for advanced nursing care, hospitalization costs, and admission time with more benefits from longer durations of TCM use.

Emergency department overcrowding: Quality improvement in a Taiwan Medical Center.

BACKGROUND/PURPOSE: Overcrowding of hospital emergency departments (ED) is a worldwide health problem. The Taiwan Joint Commission on Hospital Accreditation has stressed the importance of finding solutions to overcrowding, including, reducing the number of patients with >48 h stay in the ED. Moreover, the Ministry of Health and Welfare aims at transferring non-critical patients to district or regional hospitals. We report the results of our Quality Improvement Project (QIP) on ED overcrowding, especially focusing on reducing length of stay (LOS) in ED. METHODS: For QIP, the following 3 action plans were initiated: 1) Changing the choice architecture of patients' willingness to transfer from opt-in to opt-out; 2) increasing the turnover rate of beds and daily monitoring of the number of free beds for boarding ED patients; 3) reevaluation of patients with a LOS of >32 h after the morning shift. RESULTS: Transfer rates increased minimally after implementation of this project, but the sample size was too small to achieve statistical significance. No significant increase was observed in the number of free medical beds, but discharge rates after 12 pm decreased significantly (p < 0.001). The proportion of over 48 h LOSs decreased from 4.9% to 3.7% before and after QIP implementation, respectively (p < 0.001). CONCLUSION: Patients with LOS of >32 h were reevaluated first. After QIP, the proportion of LOSs of >48 h dropped significantly. Changing the choice architecture may require further systemic effort and a longer observation duration. Higher-level administrators will need to formulate a more comprehensive bed management plan to speed up the turnover rate of free inpatient beds.

Prevalence, risk factors, and medical costs of Chlamydia trachomatis infections in Shandong Province, China: a population-based, cross-sectional study.

BACKGROUND: A population-based study of Chlamydia trachomatis (CT) infections is essential in designing a specific control program; however, no large investigation of CT infections among the general population in mainland China has been conducted since 2000. We aimed to determine the prevalence, risk factors, and associated medical costs of CT among residents, 18-49 years of age, in Shandong, China. METHODS: From May to August 2016, a multistage probability sampling survey involving 8074 individuals was distributed. Data were collected via face-to-face interviews, followed by self-administered questionnaire surveys. First-void urines were collected and tested for CT and Neisseria gonorrhoeae (NG) using nucleic acid amplification. RESULTS: The weighted prevalence of CT infection was 2.3% (95% confidence interval [CI], 1.5-3.2) in females and 2.7% (1.6-3.8) in males. Women, 30-34 years of age, had the highest prevalence of CT infections (3.5%, 2.6-4.4), while the highest prevalence of CT infections in males was in those 18-24 years of age (4.3%, 0.0-8.8). Neisseria gonorrhoeae infection had a prevalence of 0.1% (0.0-0.3) in women and 0.03% (0.0-0.1) in men. Risk factors for CT infections among females included being unmarried, divorced, or widowed (odds ratio [OR], 95% CI 3.57, 1.54-8.24) and having two or more lifetime sex partners (3.72, 1.14-12.16). Among males, first intercourse before 20 years of age (1.83, 1.10-3.02) and having two or more lifetime sex partners (1.85, 1.14-3.02) were associated with CT infections. The estimated lifetime cost of CT infections in patients 18-49 years of age in Shandong was 273 million (range, 172-374 million) China Renminbi in 2016. CONCLUSIONS: This study demonstrated a high burden of CT infections among females < 35 years of age and males < 25 years of age in Shandong. Thus, a CT infection control program should focus on this population, as well as others with identified risk factors.