Transformation of 6PPDQ during disinfection: Kinetics, products, and eco-toxicity assessment.

N-phenyl-N'-(1,3-dimethyl butyl)-p-phenylenediamine-quinone (6PPDQ) currently arouses broad concerns because of its acute lethality to coho salmon and rainbow trout at environmentally relevant concentrations and the wide occurrence in runoff-impacted water. Investigation on the fate and transformation of 6PPDQ in various treatment processes is necessary for its risk assessment and control. Here, we explored the transformation of 6PPDQ during disinfection with its precursor 6PPD as a reference, focusing on kinetics, products, and toxicity variation. 6PPDQ readily reacted with hypochlorite and chlorine dioxide with second-order rate constants of 2580 ± 143 M-1 s-1 and 614 ± 52 M-1 s-1 (pH 7.0 and 25 °C), which are slightly lower than the reactions of 6PPD. We tentatively identified thirteen transformation products for 6PPDQ and eight for 6PPD in reaction with the two disinfectants. It seems that the quinone ring of 6PPDQ and the p-phenylenediamine moiety of 6PPD are reactive sites. The transformation of these compounds probably proceeds through Cl-substitution, ring cleavage, hydroxylation, and amine oxidation and hydrolysis. Tests with zebrafish embryos revealed that the transformation products of 6PPDQ could have higher eco-toxicity than the parent compound, while the toxicity of the 6PPD products remained nearly unchanged. The increased toxicity of 6PPDQ during disinfection highlights the necessity to substantially reduce its content before the disinfection of runoff-impacted water.

A simple APACHE IV risk dynamic nomogram that incorporates early admitted lactate for the initial assessment of 28-day mortality in critically ill patients with acute myocardial infarction.

BACKGROUND: Early risk stratification is important for patients with acute myocardial infarction (AMI). We aimed to develop a simple APACHE IV dynamic nomogram, combined with easily available clinical parameters within 24 h of admission, thus improving its predictive power to assess the risk of mortality at 28 days. METHODS: Clinical information on AMI patients was extracted from the eICU database v2.0. A preliminary XGBoost examination of the degree of association between all variables in the database and 28-day mortality was conducted. Univariate and multivariate logistic regression analysis were used to perform screening of variables. Based on the multifactorial analysis, a dynamic nomogram predicting 28-day mortality in these patients was developed. To cope with missing data in records with missing variables, we applied the multiple imputation method. Predictive models are evaluated in three main areas, namely discrimination, calibration, and clinical validity. The discrimination is mainly represented by the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Calibration is represented by the calibration plot. Clinical validity is represented by the decision curve analysis (DCA) curve. RESULTS: A total of 504 people were included in the study. All 504 people were used to build the predictive model, and the internal validation model used a 500-bootstrap method. Multivariate analysis showed that four variables, APACHE IV, the first sample of admission lactate, prior atrial fibrillation (AF), and gender, were included in the nomogram as independent predictors of 28-day mortality in AMI. The prediction model had an AUC of 0.819 (95%CI 0.770-0.868) whereas the internal validation model had an AUC of 0.814 (95%CI 0.765-0.860). Calibration and DCA curves indicated that the dynamic nomogram in this study were reflective of real-world conditions and could be applied clinically. The predictive model composed of these four variables outperformed a single APACHE IV in terms of NRI and IDI. The NRI was 16.4% (95% CI: 6.1-26.8%; p = 0.0019) and the IDI was 16.4% (95% CI: 6.0-26.8%; p = 0.0020). Lactate accounted for nearly half of the total NRI, which showed that lactate was the most important of the other three variables. CONCLUSION: The prediction model constructed by APACHE IV in combination with the first sample of admission lactate, prior AF, and gender outperformed the APACHE IV scoring system alone in predicting 28-day mortality in AMI. The prediction dynamic nomogram model was published via a website app, allowing clinicians to improve the predictive efficacy of the APACHE IV score by 16.4% in less than 1 min.

Munro Pressure Ulcer Risk Assessment Scale in Adult Patients Undergoing General Anesthesia in the Operating Room.

Pressure ulcers are a common complication of immobility and frequently occur in surgical patients. The occurrence of pressure ulcers is affected by many factors, such as operation time and position, anesthesia method, and postoperative nursing. The aim of this study was to investigate the Munro Pressure Ulcer Risk Assessment Scale's value in predicting acute pressure ulcers in general anesthesia patients. This case-control study included patients who underwent more than 2 hours of general anesthesia in our hospital from January 2018 to December 2020. The case group comprised 42 patients who had pressure sores in surgical compression sites within 3 days after surgery. The control group consisted of 84 patients without acute pressure sores after surgery. Baseline patient data were compared between the two groups, and a logistic multivariate model was used to analyze potential risk factors for acute pressure ulcers. The Munro Pressure Ulcer Risk Assessment Scale scores and Braden scale scores were compared between the two groups during and after surgery. A receiver operating characteristic curve was used to evaluate the clinical value of the two scales (administered at the two time points) in predicting the occurrence of acute pressure ulcers after surgery. The operation and anesthesia times of patients in the case group were longer than those in the control group (P < 0.05). The proportion of comatose patients and patients with diabetes were significantly higher in the case group. While the case group had higher Munro scores during and after surgery compared to the control group (P < 0.05), Braden scores at the corresponding time points were lower (P < 0.05). The following variables were identified as independent risk factors of acute pressure ulcers: prolonged operation time and anesthesia time, increase in Munro scores during and after operation, decrease in Braden scores during and after operation, and comatose status (P < 0.05). The area under the receiver operating characteristic curve (AUC) of the postoperative Munro score for predicting postoperative pressure ulcer risk was 0.774; the sensitivity and specificity were 67.73% and 80.58%, respectively. The AUC of the intraoperative Braden score for predicting postoperative pressure ulcer risk was 0.836, with a sensitivity of 78.95% and specificity of 78.00%. The AUC of the postoperative Braden score for predicting postoperative pressure ulcer risk was 0.809, with a sensitivity of 73.58% and specificity of 64.26% (P < 0.05). Our results indicate that the intraoperative Munro Pressure Ulcer Risk Assessment Scale is highly effective for predicting the risk of postoperative pressure ulcers in surgical patients who require general anesthesia.

The Awareness and Attitude of Contracted Service Among General Medical Practitioners in Community Health Service Centers in Urban China: A Cross-Sectional Study.

This study aims to explore the attitude, willingness, and satisfaction with contracted service (CS) among staff in community health service (CHS) centers in urban China and to explore the associated factors of satisfaction with CS. From August 2016 to July 2017, five CHS centers in three provinces of China were selected. Setting-level information was collected by official document review; and personal information on demographic characteristics, awareness, willingness, and attitude of CS among staff was collected by questionnaire survey. Univariate and multivariable logistic regression models were fitted to explore the associated factors of satisfaction with CS. Multiple correspondence analysis (MCA) was used to visually demonstrate the correlations among category data related with satisfaction with CS. The CS signing rates were 30.78, 12.72, 22.20, 14.32, and 21.19% in the five CHS centers. A total of 286 staff included family doctors (40.91%), nurses (31.12%), and others (27.97%) completed the survey. For the sense of self-worth, 86.01% (246/286) participants hold a positive attitude. The predominant barrier of CS signing was caused by the work pressure due to CS performance assessment (48.60%, 139/286). About 30% of family doctors and nurses reported a heavy work pressure, and more than 30% of doctors had great feeling of fatigue. Notably, 51.69% family doctors would like to change their job in the future. Compared with other staff, family doctors were more likely to be unsatisfied with CS (OR: 2.793, 95% CI: 1.155-6.754, p = 0.022). Participants in Sichuan province have lower satisfaction than other places. The MCA yielded similar factors consistent with multivariable results of clustering with different levels of CS satisfaction. Our study revealed that the CS coverage and satisfaction among staff from the primary healthcare system varied geographically and are associated with professional field, workload, and pressure. Measures that aim to promote the stability of primary care human resource should be considered in the future.

A Semi-Quantitative Risk Assessment and Management Strategies on COVID-19 Infection to Outpatient Health Care Workers in the Post-Pandemic Period.

BACKGROUND: In the pandemic of COVID-19, due to asymptomatic patients and high personnel fluidity in outpatient clinics, health care workers (HCWs) in outpatients were facing severe threat from infection. There is an urgent need for a risk assessment to recognize and prevent infection risks. PURPOSE: To establish a semi-quantitative risk assessment model on COVID-19 infections for HCWs in outpatient departments, and apply it to practices. Further to provide infection risk management strategies to reduce infection threats in the post-pandemic of COVID-19. METHODS: We used the method of Brainstorm, Literature study and Analytic Hierarchy Process (AHP) for risk factors selection and model construction, we also created corresponding indicators for each risk factors, in order to collect data in assessment practice. RESULTS: Eighteen risk factors were recognized and selected for model construction, by scatter plot, these risk factors had been classified into four parts, spanned the scopes of diagnosis and treatment, environment, personal protection and emergency handling, with specific management suggestions provided. In the practice, outpatient clinics were divided into three risk levels, 5 clinics in high risk level, 9 in medium risk level and 11 in low risk level. CONCLUSION: A proper comprehensive risk assessment model for COVID-19 infections has been successfully established. With the model, the ability to COVID-19 prevention in outpatients can be easily evaluated. The strategies on disinfection, surveillance and personal protection were also valuable references in the post-pandemic of COVID-19.

In vitro oral bioaccessibility investigation and human health risk assessment of heavy metals in wheat grains grown near the mines in North China.

There is limited research on the effects of gut microbiota on bioaccessibility of heavy metals in wheat grains. In this study, bioaccessibility of heavy metals (Cu, Cd, Pb, and Zn) in wheat was determined to elucidate transfer characteristics in the soil-grain-human systems near two large-scale mining areas in Shandong Province, North China using the physiologically-based extraction test (PBET) in combination with a simulator of human intestinal microbial ecosystems (SHIME). The results showed the bioconcentration factors (BCFs) of Cu, Cd, Pb, and Zn were 0.123-0.327, 0.188-0.478, 0.019-0.099, and 0.262-0.825, respectively. Significant and positive correlations were observed between heavy metals in soils and wheat grains. In the simulated colon phase, bioaccessibility of Cd and Zn significantly decreased to 7.81% and 8.81%, respectively, being 53% and 64% of that in the simulated small intestinal phase. However, bioaccessibility of Pb showed an obvious escalating trend, being 2.4 times higher than that of intestinal incubation. Based on the estimated daily intakes and contribution, the relative high contribution of Cu to the benchmark dose in both phases, Cu metabolism by human gut microbiota should be considered in human health risk assessment regarding wheat consumption.

Unblocking Barriers of Access to Hepatitis C Treatment in China: Lessons Learned from Tianjin.

Background: The high price is a critical barrier of access to new direct-anting-antiviral (DAA) therapies for hepatitis C for both the patients and the society. Many countries continue to face the challenge of financing such expensive medicines. Such examples include both high-income and middle-income countries. Existing evidence about the efforts of China to address this challenge is limited. To our knowledge, this is the first detailed description of a novel financing model and comprehensive analysis of its impact on patient financial burden of hepatitis C treatment in China. Objective: To examine the evolution of approaches to navigating patients' barriers of access to DAA-based treatment of hepatitis C in Tianjin City, China. Methods: Review of publicly available literature, including published and grey literature. Conduct on-site data extraction and key informant interview. The patient financial burden of hepatitis C treatment was analyzed. The financial burden of hepatitis C patients with different treatment models and health insurance financing models was measured by calculating the number of annual income to cover patient out-of-pocket (OOP) expenditure for the standard treatment course accordingly. Findings: Tianjin is the first area to pilot a capitated provider payment program for the treatment of hepatitis C. Through which, the retirees and employees spend 0.7 and 1.0 months of their salary, and residents spend 5.6-6.8 months of their salary for the treatment, the financial burden of patients were much relieved. By the end of March 2019, the first-year pilot program had 876 hepatitis C patients registered the new insurance coverage and treated in Tianjin. Conclusions: The study showed that the financial barriers of access to new hepatitis C treatment for patients could be unblocked with government commitment and novel financing models. International experiences demonstrated that centralized bulk procurement is a good leverage for price negotiation, primarily when using innovative payment approaches. To replicate the initial success of Tianjin, continued efforts are needed for stronger strategic price negotiation, preferably at central level. The case of Tianjin brings implications to the other areas of China and even other developing countries that government commitment, novel financing model and pooled procurement are critical elements of stronger purchasing power and a better secure of treatment.

[Pathological Features, Treatment Options and Prognosis Assessment of Patients with Bone Lymphoma in Real-World].

OBJECTIVE: To investigate the clinical manifestations pathologic features, treatment options and prognosis of patients with bone lymphoma. METHODS: The clinical characteristics, pathologic features, treatment and prognosis of 34 BL patients diagnosed by histopathologic method or/and PET-CT and treated in first hospital of peking university from January 2004 to April 2018 were analyzed retrospectively. RESULTS: The median age of 34 BL patients was 56 years old, the male and female ratio was 1.43∶1 (24 /10). Among 34 patients, the patients with primary bone lymphoma(PBL) were 8 cases, the patients with secondary bone lymphoma(SBL) was 26 cases, the PBL and SBL ratio was 0.31∶1. Bone lymphoma lacks typical systemic symptoms, and its onset began mostly from bone pain and pathologic bone fracture. The most frequent pathological type of bone lymphoma in our study was diffuse large B-cell lymphoma (DLBCL), accounting for 55.88%. At present, the conventional treatment for bone lymphoma includes chemotherapy, or chemotherapy combined with radiotherapy and surgery, as well as hematopoietic stem cell transplantation. The average and median OS time of BL patients were 349 years and 3 years respectively, meanwhile the OS rate for three years and two years were 56.25% and 78.16%, respectively. Factors that affect survival of BL patients were PBL and SBL classification, pathological type, blood LDH level, and treatment methods. CONCLUSION: Bone lymphoma is usually concealed onset，an adequate and adequate combination therapy can improve the survival rate and transplantation therapy plays an important role. Primary bone lymphoma is rare, the prognosis of patients with primary bone lymphoma is good, whereas the prognosis of patients with secondary bone lymphoma is poor.

Socioeconomic status moderates the association between patient satisfaction with community health service and self-management behaviors in patients with type 2 diabetes: A cross-sectional survey in China.

The objective of this study was to examine the association between patient satisfaction with community health service (CHS) and self-management behaviors in patients with type 2 diabetes mellitus (T2DM).In all, 1691 patients with T2DM from 8 community health centers in 5 provinces in China participated in the present study. The dependent variables included 4 measures of self-management behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication adherence, recommended dietary changes, and regular exercise. The independent variable was patient satisfaction with CHS. Multivariable logistic regression models were performed to examine the association between patient satisfaction with CHS and self-management behaviors.The mean satisfaction score in the participants was 3.14 (out of a maximum of 5). After adjusting for covariates including demographic factors, health status, health knowledge, and socioeconomic status (SES), diabetic patients with high CHS satisfaction had better medication adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02-1.55), increased exercise management (OR 1.19, 95% CI 1.06-1.35), and more SMBG (OR 1.16, 95% CI 1.03-1.32); all these associations varied across SES groups. The association between satisfaction and medication adherence was significant among participants younger than 65 years with lower education (OR 2.15, 95% CI 1.37-3.37), income (OR 1.62, 95% CI 1.13-2.32), and lower-status occupations (OR 1.69, 95% CI 1.16-2.47). Among participants younger than 65 years and had lower education attainment, the association between satisfaction and diet management was observed. There were positive associations between satisfaction and regular exercise among subgroups of participants younger than 65 years, except for lower education group. A significant association between satisfaction and SMBG among participants ≥65 years old, who also had lower SES and higher-status occupations, was also observed.The study findings suggested that T2DM patient satisfaction with CHS was moderate. High satisfaction with CHS indicated better medication adherence, exercise management, and SMBG, and these associations varied by SES.

Source Contribution Analysis and Collaborative Assessment of Heavy Metals in Vegetable-Growing Soils.

Source quantification of heavy metals in farmland is essential for developing and implementing restoration strategies. We used various data analyses to identify and quantify sources of arsenic, cadmium, chromium, copper, mercury, nickel, lead, and zinc in vegetable-growing soils. A new method of collaborative assessment, combining soil environmental quality and agricultural product safety, showed that approximately 5.20% of cultivation systems were multi-contaminated by heavy metals. The nonlinear relationship between pollution sources and the comprehensive contamination situation was established, deriving from a fitted bivariate model. The model revealed that anthropogenic sources and natural origins accounted for 65.8-86.0 and 34.2-14.0% of the comprehensive pollution, respectively. These results suggested that both human activities and natural factors contributed to the decline of local soil quality and the influence of the former was more substantial than that of the latter.

Dehiscence method: a seed-saving, quick and simple viability assessment in rice.

BACKGROUND: Seed viability monitoring is very important in ex situ germplasm preservation to detect germplasm deterioration. This requires seed-, time- and labor- saving methods with high precision to assess seed germination as viability. Although the current non-invasive, rapid, sensing methods (NRSs) are time- and labor-saving, they lack the precision and simplicity which are the virtues of traditional germination. Moreover, they consume a considerable amount of seeds to adjust sensed signals to germination percentage, which disregards the seed-saving objective. This becomes particularly severe for rare or endangered species whose seeds are already scarce. Here we propose a new method that is precise, low-invasive, simple, and quick, which involves analyzing the pattern of dehiscence (seed coat rupture), followed by embryonic protrusion. RESULTS: Dehiscence proved simple to identify. After the trial of 20 treatments from 3 rice varieties, we recognized that dehiscence percentage at the 48th hour of germination (D(48)) correlates significantly with germination rate for tested seed lots. In addition, we found that the final germination percentage corresponded to D(48) plus 5. More than 70% of the seeds survived post-dehiscence desiccation for storage. Hydrogen peroxide (1 mM) as the solution for imbibition could further improve the survival. The method also worked quicker than tetrazolium which is honored as a fast, traditional method, in detecting less vigorous but viable seeds. CONCLUSION: We demonstrated the comprehensive virtues of dehiscence method in assessing rice seed: it is more precise and easier to use than NRSs and is faster and more seed-saving than traditional methods. We anticipate modifications including artificial intelligence to extend our method to increasingly diverse circumstances and species.

A New Grey Relational Analysis Model Based on the Characteristic of Inscribed Core (IC-GRA) and Its Application on Seven-Pilot Carbon Trading Markets of China.

In recent years, the study of the factors affecting the carbon trading price plays an important role in promoting the carbon trading markets and the sustainable development of green economy. However, due to the short establishment time of China's carbon trading market, the carbon trading price data of the pilot markets were not complete and have the typical characteristics of poor information. The traditional grey correlation model cannot effectively identify the volatility and the grey correlation coefficient of trading data. In this paper, an inscribed cored grey relational analysis model (IC-GRA) is constructed by extracting the values of the triangle inscribed center of the time series sample. Through numerical examples and empirical analysis, it is verified that IC-GRA not only satisfies the four axioms of traditional grey correlation but also avoids the influence of outliers of time series fluctuation and improves the discriminability of the grey correlation coefficient. The empirical results of the IC-GRA model in China's seven pilot carbon trading markets show that: 1. among international carbon trade factor, the biggest influence factor carbon trade price is different in pilot markets. The price of natural gas has a greater correlation with the carbon price of carbon trading markets in Shenzhen, Guangzhou, and Chongqing. The futures price of Certified Emission Reduction (CER) has a strong correlation with the carbon price of Shanghai and Beijing carbon trading markets; the price of Hubei carbon trading market is the largest related to crude oil future price in the New York Mercantile Exchange ( NYMEX). 2. Air Quality Index (AQI) is most relevant to the market carbon price of carbon trading, followed by the trading turnover and trading volume of the carbon trading market. Therefore, studying the carbon trading price of the carbon trading market plays a positive role in improving the sustainable development in those areas.

Priority of a Hesitant Fuzzy Linguistic Preference Relation with a Normal Distribution in Meteorological Disaster Risk Assessment.

As meteorological disaster systems are large complex systems, disaster reduction programs must be based on risk analysis. Consequently, judgment by an expert based on his or her experience (also known as qualitative evaluation) is an important link in meteorological disaster risk assessment. In some complex and non-procedural meteorological disaster risk assessments, a hesitant fuzzy linguistic preference relation (HFLPR) is often used to deal with a situation in which experts may be hesitant while providing preference information of a pairwise comparison of alternatives, that is, the degree of preference of one alternative over another. This study explores hesitation from the perspective of statistical distributions, and obtains an optimal ranking of an HFLPR based on chance-restricted programming, which provides a new approach for hesitant fuzzy optimisation of decision-making in meteorological disaster risk assessments.

On Consistency Test Method of Expert Opinion in Ecological Security Assessment.

To reflect the initiative design and initiative of human security management and safety warning, ecological safety assessment is of great value. In the comprehensive evaluation of regional ecological security with the participation of experts, the expert's individual judgment level, ability and the consistency of the expert's overall opinion will have a very important influence on the evaluation result. This paper studies the consistency measure and consensus measure based on the multiplicative and additive consistency property of fuzzy preference relation (FPR). We firstly propose the optimization methods to obtain the optimal multiplicative consistent and additively consistent FPRs of individual and group judgments, respectively. Then, we put forward a consistency measure by computing the distance between the original individual judgment and the optimal individual estimation, along with a consensus measure by computing the distance between the original collective judgment and the optimal collective estimation. In the end, we make a case study on ecological security for five cities. Result shows that the optimal FPRs are helpful in measuring the consistency degree of individual judgment and the consensus degree of collective judgment.

An economic-research-based approach to calculate community health-staffing requirements in Xicheng District, Beijing.

BACKGROUND: A shortage of community health professionals has been a crucial issue hindering the development of CHS. Various methods have been established to calculate health workforce requirements. This study aimed to use an economic-research-based approach to calculate the number of community health professionals required to provide community health services in the Xicheng District of Beijing and then assess current staffing levels against this ideal. METHODS: Using questionnaires, we collected relevant data from 14 community health centers in the Xicheng District, including resident population, number of different health services provided, and service volumes. Through 36 interviews with family doctors, nurses, and public health workers, and six focus groups, we were able to calculate the person-time (equivalent value) required for each community health service. Field observations were conducted to verify the duration. RESULTS: In the 14 community health centers in Xicheng District, 1752 health workers were found in our four categories, serving a population of 1.278 million. Total demand for the community health service outstripped supply for doctors, nurses, and public health workers, but not other professionals. The method suggested that to properly serve the study population an additional 64 family doctors, 40 nurses, and 753 public health workers would be required. CONCLUSIONS: Our calculations indicate that significant numbers of new health professionals are required to deliver community health services. We established time standards in minutes (equivalent value) for each community health service activity, which could be applied elsewhere in China by government planners and civil society advocates.

Determinants of Quality of Life for Breast Cancer Patients in Shanghai, China.

PURPOSE: To evaluate the association of social support status, health insurance and clinical factors with the quality of life of Chinese women with breast cancer. METHODS: Information on demographics, clinical characteristics, and social support status was collected from 1,160 women with newly diagnosed breast cancer in Shanghai, China. The Perceived Social Support Scale was used to assess different sources of social support for breast cancer patients. The quality of life was evaluated using the Functional Assessment of Cancer Therapy-Breast Cancer that consisted of five domains: breast cancer-specific, emotional, functional, physical, and social & family well-being. Multivariate linear regression models were used to evaluate the associations of demographic variables, clinical characteristics, and social support status with the quality of life measures. RESULTS: Adequate social support from family members, friends and neighbors, and higher scores of Perceived Social Support Scale were associated with significantly improved quality of life of breast cancer patients. Higher household income, medical insurance plans with low copayment, and treatment with traditional Chinese medicine for breast cancer all were associated with higher (better) scores of quality of life measures whereas patients receiving chemotherapy had significantly lower scores of quality of life. CONCLUSION: Social support and financial aids may significantly improve the quality of life of breast cancer survivors.

A model to estimate the cost of the National Essential Public Health Services Package in Beijing, China.

BACKGROUND: In order to address several health challenges, the Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009. In China's large cities, the lack of funding for community health centers and consequent lack of comprehensive services and high quality care has become a major challenge. However, no study has been carried out to estimate the cost of delivering the services in the package. This project was to develop a cost estimation approach appropriate to the context and use it to calculate the cost of the NEPHSP in Beijing in 2011. METHODS: By adjusting models of cost analysis of primary health care and workload indicators of staffing need developed by the World Health Organization, a model was developed to estimate the cost of the services in the package through an intensive interactive process. A total of 17 community health centers from eight administrative districts in Beijing were selected. Their service volume and expenditure data in 2010 were used to evaluate the costs of providing the NEPHSP in Beijing based on the applied model. RESULTS: The total workload of all types of primary health care in 17 sample centers was equivalent to the workload requirement for 14,056,402 standard clinic visits. The total expenditure of the 17 sample centers was 26,329,357.62 USD in 2010. The cost of the workload requirement of one standard clinic visit was 1.87 USD. The workload of the NEPHSP was equivalent to 5,514,777 standard clinic visits (39.23 % of the total workload). The model suggests that the cost of the package in Beijing was 7.95 USD per capita in 2010. The cost of the NEPHSP in urban areas was lower than suburban areas: 7.31 and 8.65 USD respectively. CONCLUSIONS: The average investment of 3.97 USD per capita in NEPHSP was lower than the amount needed to meet its running costs. NEPHSP in Beijing is therefore underfunded. Additional investment is needed, and a dynamic cost estimate mechanism should be introduced to ensure services remain adequately funded.

HLA disparity is not crucial for the survival rate and severity of chronic health conditions in adult recipients following family donor hematopoietic stem cell transplantation.

The shortage of HLA-identical siblings or unrelated donors has restricted the application of hematopoietic stem cell transplantation (HSCT). Few studies have systematically assessed survival and chronic health conditions (CHCs) in the same cohort of patients after HLA-mismatched/haploidentical (mismatched) family donor transplantation. In the present study, we retrospectively analyzed the survival of 127 adult patients receiving either HLA-matched (71 cases) or HLA-mismatched (56 cases) family donor transplantation. Of 127 patients, 81 patients survived at least 2 years after HSCT and were still alive until the present investigation. We evaluated the CHCs in 76 survivors (41 matched and 35 mismatched). CHC-related information was scored according to the Bone Marrow Transplant Survivor Study questionnaire. There was no significant difference in overall survival or disease-free survival between HLA-matched and -mismatched transplant recipients. The CHCs were less severe in HLA-mismatched recipients than in matched cohorts. Multivariate analysis identified that age over 40 years at transplantation and presence of chronic graft-versus-host disease were independent risk factors for CHCs, while anti-thymocyte globulin-containing conditioning regimens might be protective. However, HLA disparity was not crucial for either the survival rate or CHCs. In conclusion, HLA-mismatched family donor transplantation can achieve comparable therapeutic effects to HLA-identical sibling transplantation.

A policy-driven multifaceted approach for early childhood physical fitness promotion: impacts on body composition and physical fitness in young Chinese children.

BACKGROUND: The prevalence of obesity increased while certain measures of physical fitness deteriorated in preschool children in China over the past decade. This study tested the effectiveness of a multifaceted intervention that integrated childcare center, families, and community to promote healthy growth and physical fitness in preschool Chinese children. METHODS: This 12-month study was conducted using a quasi-experimental pretest/posttest design with comparison group. The participants were 357 children (mean age = 4.5 year) enrolled in three grade levels in two childcare centers in Beijing, China. The intervention included: 1) childcare center intervention (physical activity policy changes, teacher training, physical education curriculum and food services training), 2) family intervention (parent education, internet website for support, and family events), and 3) community intervention (playground renovation and community health promotion events). The study outcome measures included body composition (percent body fat, fat mass, and muscle mass), Body Mass Index (BMI) and BMI z-score and physical fitness scores in 20-meter agility run (20M-AR), broad jump for distance (BJ), timed 10-jumps, tennis ball throwing (TBT), sit and reach (SR), balance beam walk (BBW), 20-meter crawl (20M-C)), 30-meter sprint (30M-S)) from a norm referenced test. Measures of process evaluation included monitoring of children's physical activity (activity time and intensity) and food preparation records, and fidelity of intervention protocol implementation. RESULTS: Children in the intervention center significantly lowered their body fat percent (-1.2%, p < 0.0001), fat mass (-0.55 kg, p <0.0001), and body weight (0.36 kg, p <0.02) and increased muscle mass (0.48 kg, p <0.0001), compared to children in the control center. They also improved all measures of physical fitness except timed 10-jumps (20M-AR: -0.74 seconds, p < 0.0001; BJ: 8.09 cm, p < 0.0001; TBT: 0.52 meters, p < 0.006; SR: 0.88 cm, p < 0.03; BBW: -2.02 seconds, p <0.0001; 30M-S: -0.45 seconds, p < 0.02; 20M-C: -3.36 seconds, p < 0.0001). Process evaluation data showed that the intervention protocol was implemented with high fidelity. CONCLUSIONS: The study demonstrated that a policy-driven multi-faceted intervention can improve preschool children's body composition and physical fitness. Program efficacy should be tested in a randomized trial. TRIAL REGISTRATION: ChiCTR-ONRC-14004143.

A cost-effective sandwich electrochemiluminescence immunosensor for ultrasensitive detection of HIV-1 antibody using magnetic molecularly imprinted polymers as capture probes.

In this report, a rapid and cost-effective sandwich electrochemiluminescence (ECL) immunosensor was constructed for the ultrasensitive detection of human immunodeficiency virus type 1 antibody (anti-HIV-1) using magnetic molecularly imprinted polymers (MMIPs) as capture probes by combining surface and epitope imprinting techniques and antigen conjugated with horseradish peroxidase (HRP-HIV-1) as labels. First, 3-aminobenzeneboronic acid (APBA) was used as the functional monomer and cross-linking reagent, which was polymerized on the surface of silicate-coated magnetic iron oxide nanoparticles (Fe3O4@SiO2 NPs) in the presence of human immunoglobulin G (HIgG), as the template exhibiting the same Fc region but different Fab region to anti-HIV-1 after the addition of the initiator, ammonium persulfate. This process resulted in grafting a hydrophilic molecularly imprinted polymer (MIP) film on the Fe3O4@SiO2 NPs. Thus, MMIPs, which could be reused after eluting the template, were used to recognize and enrich ultra-trace levels of anti-HIV-1. Subsequently, a novel sandwich ECL immunosensor was formed through the immunoreaction between MMIPs conjugated with varied concentrations of anti-HIV-1 and HRP-HIV-1. By the catalysis of HRP immobilized onto HRP-HIV-1 on the ECL system of Luminol-H2O2, a linear response range of the anti-HIV-1 dilution ratio (standard positive serum) was achieved from 1:20,000 to 1:50, with a detection limit of 1:60,000 (S/N=3). The developed method provides a low-cost, simple, and sensitive way for the early diagnosis of HIV infected patients.