Assessment of bidirectional relationships between brain imaging-derived phenotypes and stroke: a Mendelian randomization study.

BACKGROUND: Stroke is a major cause of mortality and long-term disability worldwide. Whether the associations between brain imaging-derived phenotypes (IDPs) and stroke are causal is uncertain. METHODS: We performed two-sample bidirectional Mendelian randomization (MR) analyses to explore the causal associations between IDPs and stroke. Summary data of 587 brain IDPs (up to 33,224 individuals) from the UK Biobank and five stroke types (sample size range from 301,663 to 446,696, case number range from 5,386 to 40,585) from the MEGASTROKE consortium were used. RESULTS: Forward MR indicated 14 IDPs belong to projection fibers or association fibers were associated with stroke. For example, higher genetically determined mean diffusivity (MD) in the right external capsule was causally associated with an increased risk of small vessel stroke (IVW OR = 2.76, 95% CI 2.07 to 3.68, P = 5.87 × 10-12). Reverse MR indicated that genetically determined higher risk of any ischemic stroke was associated with increased isotropic or free water volume fraction (ISOVF) in body of corpus callosum (IVW ß = 0.23, 95% CI 0.14 to 0.33, P = 3.22 × 10-7). This IDP is a commissural fiber and it is not included in the IDPs identified by forward MR. CONCLUSIONS: We identified 14 IDPs with statistically significant evidence of causal effects on stroke or stroke subtypes. We also identified potential causal effects of stroke on one IDP of commissural fiber. These findings might guide further work toward identifying preventative strategies at the brain imaging levels.

Cost-Effectiveness Analysis of Personalized Hypertension Prevention.

BACKGROUND: While a population-wide strategy involving lifestyle changes and a high-risk strategy involving pharmacological interventions have been described, the recently proposed personalized medicine approach combining both strategies for the prevention of hypertension has increasingly gained attention. However, a cost-effectiveness analysis has been hardly addressed. This study was set out to build a Markov analytical decision model with a variety of prevention strategies in order to conduct an economic analysis for tailored preventative methods. METHODS: The Markov decision model was used to perform an economic analysis of four preventative strategies: usual care, a population-based universal approach, a population-based high-risk approach, and a personalized strategy. In all decisions, the cohort in each prevention method was tracked throughout time to clarify the four-state model-based natural history of hypertension. Utilizing the Monte Carlo simulation, a probabilistic cost-effectiveness analysis was carried out. The incremental cost-effectiveness ratio was calculated to estimate the additional cost to save an additional life year. RESULTS: The incremental cost-effectiveness ratios (ICER) for the personalized preventive strategy versus those for standard care were -USD 3317 per QALY gained, whereas they were, respectively, USD 120,781 and USD 53,223 per Quality-Adjusted Life Year (QALY) gained for the population-wide universal approach and the population-based high-risk approach. When the ceiling ratio of willingness to pay was USD 300,000, the probability of being cost-effective reached 74% for the universal approach and was almost certain for the personalized preventive strategy. The equivalent analysis for the personalized strategy against a general plan showed that the former was still cost-effective. CONCLUSIONS: To support a health economic decision model for the financial evaluation of hypertension preventative measures, a personalized four-state natural history of hypertension model was created. The personalized preventive treatment appeared more cost-effective than population-based conventional care. These findings are extremely valuable for making hypertension-based health decisions based on precise preventive medication.

The impact of echinococcosis interventions on economic outcomes in Qinghai Province of China: Evidence from county-level panel data.

Introduction: Echinococcosis can incur substantial economic losses for the livestock industry by causing organ condemnation, delayed growth, and reduced meat and wool output and quality in sheep and cattle, as well as increased surgery costs, hospital care, and decreased productivity in humans. Yet echinococcosis could be prevented and controlled by interventions, such as dog management and deworming, lamb vaccination, slaughter management, and training and public education. Methods: Exploiting temporal and spatial variations in the number of intervention measures implemented in 39 counties in Qinghai province of China in 2015-2020, this study assesses the economic impact of echinococcosis interventions using a dynamic difference-in-differences model. Results: The results suggest that echinococcosis interventions brought about substantial economic gains measured by per capita net income of rural residents and per capita gross output of animal husbandry. These economic gains are greater in non-pastoral counties (with a gain in per capita net income of rural residents of 3,308 yuan and a gain per capita gross output of animal husbandry of 1,035 yuan) than in pastoral counties (with a gain in per capita net income of rural residents of 1,372 yuan and a gain per capita gross output of animal husbandry of 913 yuan). They are also greater in counties with echinococcosis infection level-2 (with a human infection rate of 0.1-1% or a dog infection rate of 1-5%) than infection level-1 counties (with a human prevalence rate ≥1% or a dog infection rate ≥5%). Discussion: Not only will these economic gains encourage livestock farmers to strengthen their echinococcosis prevention and control practices, but they will also inform public policy on zoonotic disease prevention and control in China and other countries alike.

[Spatial-temporal Evolution and Heterogeneity of Carbon Emissions at County-level in China].

Counties are the key spatial units in achieving the reduction and control of carbon emissions. It is of great significance to study and reveal the spatial-temporal evolution characteristics and influencing mechanism of carbon emissions for realizing the "carbon peak and carbon neutral" goal. In this study, the spatial-temporal evolution and heterogeneity of carbon emissions at the county level in China from 2000 to 2017 were analyzed by using mathematical statistics and panel data regression modeling, and the influencing mechanism was explored. The results showed that: ① from 2000 to 2017, the annual growth rate of carbon emissions was 7.12%, which experienced the three stages of "sharp rise, slow rise, and high fluctuation" and finally stabilized at approximately 90×108 t. At the county scale, there was a significant positive spatial autocorrelation. ② The general panel regression model showed that GDP, construction land area, population, per capita GDP, and per capita deposit balance of financial institutions were significantly correlated with carbon emissions, and the former three had the strongest promoting effect on carbon emissions. ③ The goodness of fit of the geographically and temporally weighted regression model was high, and the direction and intensity of the other impact factors changed greatly in spatial-temporal characteristics, except that GDP showed a stable promoting effect globally. The results showed that carbon emission levels and main influencing factors varied among counties in China. This study revealed the heterogeneity of carbon emissions at the county level, which is helpful to optimize the spatial-temporal implementation path of the "dual carbon" target.

New Surveillance Metrics for Alerting Community-Acquired Outbreaks of Emerging SARS-CoV-2 Variants Using Imported Case Data: Bayesian Markov Chain Monte Carlo Approach.

BACKGROUND: Global transmission from imported cases to domestic cluster infections is often the origin of local community-acquired outbreaks when facing emerging SARS-CoV-2 variants. OBJECTIVE: We aimed to develop new surveillance metrics for alerting emerging community-acquired outbreaks arising from new strains by monitoring the risk of small domestic cluster infections originating from few imported cases of emerging variants. METHODS: We used Taiwanese COVID-19 weekly data on imported cases, domestic cluster infections, and community-acquired outbreaks. The study period included the D614G strain in February 2020, the Alpha and Delta variants of concern (VOCs) in 2021, and the Omicron BA.1 and BA.2 VOCs in April 2022. The number of cases arising from domestic cluster infection caused by imported cases (Dci/Imc) per week was used as the SARS-CoV-2 strain-dependent surveillance metric for alerting local community-acquired outbreaks. Its upper 95% credible interval was used as the alert threshold for guiding the rapid preparedness of containment measures, including nonpharmaceutical interventions (NPIs), testing, and vaccination. The 2 metrics were estimated by using the Bayesian Monte Carlo Markov Chain method underpinning the directed acyclic graphic diagram constructed by the extra-Poisson (random-effect) regression model. The proposed model was also used to assess the most likely week lag of imported cases prior to the current week of domestic cluster infections. RESULTS: A 1-week lag of imported cases prior to the current week of domestic cluster infections was considered optimal. Both metrics of Dci/Imc and the alert threshold varied with SARS-CoV-2 variants and available containment measures. The estimates were 9.54% and 12.59%, respectively, for D614G and increased to 14.14% and 25.10%, respectively, for the Alpha VOC when only NPIs and testing were available. The corresponding figures were 10.01% and 13.32% for the Delta VOC, but reduced to 4.29% and 5.19% for the Omicron VOC when NPIs, testing, and vaccination were available. The rapid preparedness of containment measures guided by the estimated metrics accounted for the lack of community-acquired outbreaks during the D614G period, the early Alpha VOC period, the Delta VOC period, and the Omicron VOC period between BA.1 and BA.2. In contrast, community-acquired outbreaks of the Alpha VOC in mid-May 2021, Omicron BA.1 VOC in January 2022, and Omicron BA.2 VOC from April 2022 onwards, were indicative of the failure to prepare containment measures guided by the alert threshold. CONCLUSIONS: We developed new surveillance metrics for estimating the risk of domestic cluster infections with increasing imported cases and its alert threshold for community-acquired infections varying with emerging SARS-CoV-2 strains and the availability of containment measures. The use of new surveillance metrics is important in the rapid preparedness of containment measures for averting large-scale community-acquired outbreaks arising from emerging imported SARS-CoV-2 variants.

The inhibitory effects of Ulva prolifera extracts on early growth of Spartina alterniflora and the underlying mechanisms.

Spartina alterniflora, a highly invasive plant, has caused a serious threat to ecosystem biodiversity and economic development in coastal areas of many countries. In this study, the allelopathic effect of Ulva prolifera extracts on seed germination and seedling growth of S. alterniflora was studied. The results showed that three different treatments (water, methanol and ethyl acetate extract) could inhibit the seed germination and seedling growth of S. alterniflora by reducing the germination proportion and germination index of seeds, decreasing the seedling length and root length of seedlings, and affecting the lipid peroxidation and enzyme activity. The higher the concentration of the extracts, the higher the inhibition effect. When the aqueous extract concentration reached 0.20 g/mL, the germination proportion of S. alterniflora decreased to 49.53% of the control. RNA-seq analysis showed that the expression of genes related to amino acid metabolism and photosynthesis were both upregulated, and genes related to energy generation and metabolism were both downregulated after adding the extracts. GC-MS analysis indicated that the U. prolifera extract was rich in organic acids, alcohols and esters, among which butanoic acid, butyl ester, Valine and Hexanedioic acid, bis (2-ethylhexyl) ester might be the dominant allelochemicals. In order to facilitate field dosing, prolong action time and control release effect, PVA/SA hydrogel embedded U. prolifera extract was used to obtain a sustained-release agent. In addition, the survival rate of S. alterniflora was significantly reduced, which was only 21.67% at the salinity of 30 ppt. The results of this study provide a feasible method for controlling the invasion of S. alterniflora and achieving the waste utilization of U. prolifera.

Prediction of diagnosis results of rheumatoid arthritis patients based on autoantibodies and cost-sensitive neural network.

OBJECTIVES: To analyze and evaluate the effectiveness of the detection of single autoantibody and combined autoantibodies in patients with rheumatoid arthritis (RA) and related autoimmune diseases and establish a machine learning model to predict the disease of RA. METHODS: A total of 309 patients with joint pain as the first symptom were retrieved from the database. The effectiveness of single and combined antibodies tests was analyzed and evaluated in patients with RA, a cost-sensitive neural network (CSNN) model was used to integrate multiple autoantibodies and patient symptoms to predict the diagnosis of RA, and the ROC curve was used to analyze the diagnosis performance and calculate the optimal cutoff value. RESULTS: There are differences in the seropositive rate of autoimmune diseases, the sensitivity and specificity of single or multiple autoantibody tests were insufficient, and anti-CCP performed best in RA diagnosis and had high diagnostic value. The cost-sensitive neural network prediction model had a sensitivity of up to 0.90 and specificity of up to 0.86, which was better than a single antibody and combined multiple antibody detection. CONCLUSION: In-depth analysis of autoantibodies and reliable early diagnosis based on the neural network could guide specialized physicians to develop different treatment plans to prevent deterioration and enable early treatment with antirheumatic drugs for remission. Key Points • There are differences in the seropositive rate of autoimmune diseases. • This is the first study to use a cost-sensitive neural network model to diagnose RA disease in patients. • The diagnosis effect of the cost-sensitive neural network model is better than a single antibody and combined multiple antibody detection.

Cost-Effectiveness of Testing for NS5A Resistance to Optimize Treatment of Elbasvir/Grazoprevir for Chronic Hepatitis C in China.

Objectives: Baseline presence of nonstructural protein 5A (NS5A) resistance-associated variants can attenuate the efficacy of new direct-acting antivirals. A potential method to attain the higher efficacy would be to screen for NS5A polymorphisms prior to the initiation of therapy and to adjust the treatment length based on the test results. However, baseline testing adds additional costs and it is unclear whether this would represent a high value strategy for chronic hepatitis C in China. Methods: A hybrid model compared 1) standard 12-weeks treatment (no testing), 2) shortened 8-weeks treatment (no testing), and 3) baseline testing with 12-/8-weeks treatment for those with/without NS5A polymorphisms from a lifetime Chinese health care payer perspective. All model inputs were retrieved from clinical trials and publically available literature. And sensitivity analyses were also conducted to assess the impact of uncertainty. Results: Baseline testing was associated with overall increase in total health care cost of USD 13.50 and in QALYs of 0.002 compared with standard 12-weeks treatment (no testing), yielded in an ICER of USD 6750/QALY gained. Scenario analyses suggested that shortened 8-weeks treatment (no testing) was found to be lower costs and great QALYs compared with other two strategies when the sustained virologic response (SVR) rate increased to 95%. Sensitivity analyses indicated that the results were robust. Conclusions: Our results suggest prior assessment of NS5A sensitivity followed by optimizing treatment duration was an economic strategy. In addition, shortened 8-weeks treatment (no testing) was shown to be dominant with the SVR rate increased to 95%.

Biomechanical assessment of two types and two different locations of subtalar arthroereisis implants for flexible flatfoot: A cadaveric study.

BACKGROUND: Subtalar arthroereisis refers to the implantation of a sinus tarsi implant for the treatment of flexible flatfoot. The purpose of this study was to compare the ability to correct the flatfoot deformity and contact pressure of the posterior subtalar joint between two types of self-locking wedge implants and between two different positions for the same device in a cadaveric flatfoot model. METHODS: The flatfoot model was created in ten cadaver feet through ligament sectioning and cyclic loading. Three kinds of arthroereisis procedures were evaluated: Talar-Fit (type I self-locking wedge implant) anchored in the sinus portion of the tarsal sinus (T-sinus group), Talar-Fit in the canalis portion (T-canalis group), and HyProCure (type II) in the canalis portion (H group). Corrective ability in the sagittal and transverse planes were measured with clinometers. Contact pressure was measured with pressure-sensitive films. FINDINGS: T-canalis group provided more sagittal (mean difference for size 10 mm: 1.9°, P = 0.014; mean difference for size 11 mm: 3.1°, P = 0.037) and transverse (mean difference for size 8 mm: 1.8°, P = 0.049; mean difference for size 11 mm: 2.2°, P = 0.049) corrections than T-sinus group. The flattening process shifted the peak pressure of the posterior subtalar joint to the posteromedial side (P < 0.05) and arthroereisis helped the distribution of contact pressure restore uniformity (all P > 0.05). INTERPRETATION: A self-locking wedge implant inserted in the canalis portion of the tarsal sinus achieved better correction than an implant inserted in the sinus portion.

General, Straightforward, and Atom-Economical Synthesis of Vinyl Triflimides.

Vinyl triflimides were only accessible recently and their chemistry is yet to be discovered. Herein, we describe a general, straightforward and atom-economical synthesis of these materials from alkynes and triflimide. A vast array of terminal and internal alkynes with broad spectrum of functionalities could be employed to generate various di- and trisubstituted vinyl triflimides regiospecifically with high to specific stereoselectivity. Moreover, the protocol could be conducted on gram scale using terminal and internal alkynes. Preliminarily attempts to probe the unprecedented reactivity of vinyl triflimides revealed part of its chemical properties.

Predicting Metabolic Syndrome With Machine Learning Models Using a Decision Tree Algorithm: Retrospective Cohort Study.

BACKGROUND: Metabolic syndrome is a cluster of disorders that significantly influence the development and deterioration of numerous diseases. FibroScan is an ultrasound device that was recently shown to predict metabolic syndrome with moderate accuracy. However, previous research regarding prediction of metabolic syndrome in subjects examined with FibroScan has been mainly based on conventional statistical models. Alternatively, machine learning, whereby a computer algorithm learns from prior experience, has better predictive performance over conventional statistical modeling. OBJECTIVE: We aimed to evaluate the accuracy of different decision tree machine learning algorithms to predict the state of metabolic syndrome in self-paid health examination subjects who were examined with FibroScan. METHODS: Multivariate logistic regression was conducted for every known risk factor of metabolic syndrome. Principal components analysis was used to visualize the distribution of metabolic syndrome patients. We further applied various statistical machine learning techniques to visualize and investigate the pattern and relationship between metabolic syndrome and several risk variables. RESULTS: Obesity, serum glutamic-oxalocetic transaminase, serum glutamic pyruvic transaminase, controlled attenuation parameter score, and glycated hemoglobin emerged as significant risk factors in multivariate logistic regression. The area under the receiver operating characteristic curve values for classification and regression trees and for the random forest were 0.831 and 0.904, respectively. CONCLUSIONS: Machine learning technology facilitates the identification of metabolic syndrome in self-paid health examination subjects with high accuracy.

Systematic review and meta-analysis of the association between dimensions of inequality and a selection of indicators of Reproductive, Maternal, Newborn and Child Health (RMNCH).

BACKGROUND: Globally, progress in Maternal and Child Health (MCH) has been inconsistent, with several evidence showing both between and within country disparities in several RMNCH outcome measures. In this study, we aim to meta-analyse existing literature on association between three major equity stratifiers and a selection of RMNCH indicators. METHODS: We searched PubMed, Embase, Scopus databases and grey literatures from the WHO, UNICEF and World Bank publications. Using the PRISMA guidelines, we identified and reviewed studies from low and middle-income countries, that explored the effects of inequalities on RMNCH, with focus on studies that utilised data from a nationally representative survey. The review protocol was registered at the PROSPERO international prospective register of systematic reviews. RESULTS: A total of 28 studies were included in the meta-analysis. Results revealed the existence of marked inequality based on income levels, education and place of residence. The most significant level of disparity was with regards to unmet need for contraception and antenatal coverage. For both respective indicators, those with secondary or higher education were 6 times more likely to have better coverage, than those with lesser level of education; (odds ratio (OR) = 6.25 (95% confidence interval (CI) = 1.68-23.23; I2 = 98%, P = 0.006) and (OR = 6.17 (95% CI = 3.03-12.56; I2 = 97%, P < 0.00001) respectively. In contrast, the lowest inequality was in the completion of 3 doses of diphtheria, pertussis and tetanus vaccines (DPT3), those with primary or no education, were equally as likely as those with secondary or higher education to have received DPT3; (OR = 1.21, 95% CI = 0.34-4.27; I2 = 96%, P = 0.77). CONCLUSIONS: In developing countries, maternal and child health coverage remains highly inequitable and assess to maternal and child health services are governed by factors such as income, level of education, and place of residence.

Cost-effectiveness of Daratumumab-based Triplet Therapies in Patients With Relapsed or Refractory Multiple Myeloma.

PURPOSE: The prominent efficacy of the addition of daratumumab to lenalidomide and dexamethasone (DRd) or the addition to bortezomib and dexamethasone (DVd) was proven previously for patients with relapsed or refractory multiple myeloma (RRMM). However, the cost-effectiveness of adding daratumumab to traditional doublet regimens versus doublet regimens alone (DRd vs Rd; DVd vs Vd) was unknown. METHODS: We developed a semi-Markov model by using a US payer perspective and 10-year time horizon to estimate the cost and quality-adjusted life years (QALYs) for treatments. Clinical data were obtained from the POLLUX (Phase 3 Study Comparing DRd Versus Rd in Subjects with Relapsed or Refractory Multiple Myeloma [RRMM]) and CASTOR (Phase 3 Study Comparing DVd Versus Vd in Subjects with RRMM) trials. Deterministic and probabilistic sensitivity analyses were conducted to evaluate model uncertainty. FINDINGS: The incremental cost-effectiveness ratio (ICER) for DVd compared with Vd was $284,180 per QALY; the ICER for DRd compared with Rd was $1,369,062 per QALY. Only when the price of daratumumab was reduced to 37% (US $702/vial) of the current price could the addition of daratumumab to Vd be cost-effective under the US willingness-to-pay (WTP) of $50,000/QALY. However, under no discount level of the daratumumab price is the addition of daratumumab to Rd acceptable. When the WTP increased to $300,000/QALY, the addition of DVd had a 56.7% probability of being cost-effective compared with the Vd regimen. IMPLICATIONS: Due to the high price of daratumumab, neither the addition of daratumumab to Rd nor Vd proved to be cost-effective under US WTP. However, if the daratumumab price fell to a certain discount level, the DVd regimen might be cost-effective.

Cost-effectiveness analysis of universal influenza vaccination: Application of the susceptible-infectious-complication-recovery model.

OBJECTIVES: Despite the fact that vaccination is an effective primary prevention strategy for the containment of influenza outbreaks, health policymakers have shown great concern over the enormous costs involved in universal immunization, particularly when resources are limited. METHODS: A two-arm cost-effectiveness analysis (CEA) was conducted that took into account the aspect of herd immunity. The analysis used a study cohort of 100000 residents with a demographic make-up identical to that of the underlying population in Taipei County, Taiwan, during the epidemic influenza season of 2001-2002. The parameters embedded in the dynamic process of infection were estimated through the application of the newly proposed susceptible-infection-complication-recovery (SICR) model to the empirical data, in order to compute the number of deaths and complications averted due to universal vaccination compared to no vaccination. Incremental cost-effectiveness ratios (ICERs) and the cost-effectiveness acceptability curve (CEAC) given maximum amount of willingness-to-pay (WTP) were calculated to delineate the results of the two-arm CEA. RESULTS: The incremental costs involved in the vaccinated group as compared to the unvaccinated group were $1195 to reduce one additional complication and $805 to avert one additional death, allowing for herd immunity. The corresponding figures were higher for the results without considering herd immunity. Given the ceiling ratio of WTP equal to $10000 (approximately two-thirds of GDP), the probability of the vaccination being cost-effective for averting death was 100% and for averting complications was 96.7%. CONCLUSIONS: Universal vaccination against seasonal influenza was found to be very cost-effective, particularly when herd immunity is considered. The probability of being cost-effective was almost certain given the maximum amount of WTP within two-thirds of the GDP.

A Multiview Learning Framework With a Linear Computational Cost.

Learning features from multiple views has attracted much research attention in different machine learning tasks, such as multiclass and multilabel classification problems. In this paper, we propose a multiclass multilabel multiview learning framework with a linear computational cost where an example is associated with at least one label and represented by multiple information sources. We simultaneously analyze all features by learning an integrated projection matrix. We can also automatically select more important views for subsequent classifier to predict each class. As the proposed objective function is nonsmooth and difficult to solve, we apply a novel optimization method that converts the multiview learning problem to a set of linear single-view learning problems by bridging our problem to an easily solvable approach. Compared to the conventional methods which learn the entire projection matrix, our algorithm independently optimizes each column of the projection matrix for each class, which can be easily parallelized. In each column optimization, the most computationally intensive step is pure and simple matrix-by-vector multiplication. As a result, our algorithm is much more applicable to large-scale problems than the multiview learning methods with a nonlinear computational cost. Moreover, rigorous convergence proof of the proposed algorithm is also provided. To evaluate the effectiveness of the proposed approach, experimental comparisons are made with state-of-the-art algorithms in multiclass and multilabel classification tasks on many multiview benchmarks. We also report the efficiency comparison results on different numbers of data samples. The experimental results demonstrate that our algorithm can achieve superior performance to all the compared algorithms.

Assessment of the Biocompatibility and Biological Effects of Biodegradable Pure Zinc Material in the Colorectum.

Little attention has been paid to the biocompatibility and biological effects of zinc as a material. Here, we therefore investigated the biocompatibility and anti-inflammatory and collagen-promoting effects of pure zinc material in the colorectum. Our in vitro results indicated that zinc toxicity and concentration were closely related. Low concentrations of zinc ions and pure zinc material extract had only minor effects on the viability of primary rectal mucosal epithelial cells; however, cytotoxicity was observed at concentrations greater than 0.017 µg/µL and 60%, respectively. In vivo experiments demonstrated that zinc pins degraded slowly in the colorectum (their volume decreasing by approximately 7.79% over 1 month) and did not cause serious adverse reactions. Pure zinc material was found to inhibit acute inflammation through increased expression of ENA-78 and F4/80. Moreover, zinc material heightened expression of collagen and VEGF, factors conducive to wound healing, in surrounding colorectal tissues. These preliminary results suggest that zinc shows great promise as an implant material for medical applications involving colorectal surgery.

Screening and assessment of solidification/stabilization amendments suitable for soils of lead-acid battery contaminated site.

Lead exposure via ingestion of soil and dust generally occurs at lead-acid battery manufacturing and recycling sites. Screening solidification/stabilization (S/S) amendments suitable for lead contaminated soil in an abandoned lead-acid battery factory site was conducted based on its chemical forms and environmental risks. Twelve amendments were used to immobilize the Pb in soil and assess the solidification/stabilization efficiency by toxicity leaching tests. The results indicated that three amendments, KH2PO4 (KP), KH2PO4:oyster shell power=1:1 (by mass ratio; SPP), and KH2PO4:sintered magnesia=1:1 (by mass ratio; KPM) had higher remediation efficiencies that led to a 92% reduction in leachable Pb with the addition of 5% amendments, while the acid soluble fraction of Pb (AS-Pb) decreased by 41-46% and the residual fraction (RS-Pb) increased by 16-25%. The S/S costs of the three selected amendments KP, SPP, and KPM could be controlled to $22.3 per ton of soil when the Pb concentration in soil ranged from 2000 to 3000 mg/kg. The results of this study demonstrated that KP, SPP, and KPM can effectively decrease bioavailability of Pb. These findings could provide basis for decision-making of S/S remediation of lead-acid battery contaminated sites.

Economic evaluation of vaccination against influenza in the elderly: an experience from a population-based influenza vaccination program in Taiwan.

Due to viral strains, influenza season, and consultations and admission rates varying from country to country, the continued economic evaluation of influenza vaccination for the elderly people aged 65 years and above is paramount, particularly in areas with dense population. Efficacy and cost-effective analysis of influenza vaccination in reducing all-cause mortality and hospitalization was therefore elucidated based on a prospective and population-based study targeted to 226,997 elderly people aged 65 years and above residing in Taipei county, Taiwan between 1 October 2000 and 31 March 2001. Vaccination against influenza for the elderly persons can lead to a 29% (95% CI: 23-35%) significant reduction of all-cause deaths. Approximately, 20% (95% CI: 9-30%) significant reduction in hospitalization was observed for average-risk group but 4% (95% CI: -4-11%) non-significant reduction for high-risk group. Community-based influenza vaccination program for elderly people aged 65 years and above was demonstrated to be effective in reducing mortality in all elderly people but not significantly in reducing hospitalization. Universal vaccination program for the elderly people seems cost-effective in averting death or gaining life years.