Mapping 18F-FDG Kinetics Together with Patient-Specific Bootstrap Assessment of Uncertainties: An Illustration with Data from a PET/CT Scanner with a Long Axial Field of View.

The purpose of this study was to examine a nonparametric approach to mapping kinetic parameters and their uncertainties with data from the emerging generation of dynamic whole-body PET/CT scanners. Methods: Dynamic PET 18F-FDG data from a set of 24 cancer patients studied on a long-axial-field-of-view PET/CT scanner were considered. Kinetics were mapped using a nonparametric residue mapping (NPRM) technique. Uncertainties were evaluated using an image-based bootstrapping methodology. Kinetics and bootstrap-derived uncertainties are reported for voxels, maximum-intensity projections, and volumes of interest (VOIs) corresponding to several key organs and lesions. Comparisons between NPRM and standard 2-compartment (2C) modeling of VOI kinetics are carefully examined. Results: NPRM-generated kinetic maps were of good quality and well aligned with vascular and metabolic 18F-FDG patterns, reasonable for the range of VOIs considered. On a single 3.2-GHz processor, the specification of the bootstrapping model took 140 min; individual bootstrap replicates required 80 min each. VOI time-course data were much more accurately represented, particularly in the early time course, by NPRM than by 2C modeling constructs, and improvements in fit were statistically highly significant. Although 18F-FDG flux values evaluated by NPRM and 2C modeling were generally similar, significant deviations between vascular blood and distribution volume estimates were found. The bootstrap enables the assessment of quite complex summaries of mapped kinetics. This is illustrated with maximum-intensity maps of kinetics and their uncertainties. Conclusion: NPRM kinetics combined with image-domain bootstrapping is practical with large whole-body dynamic 18F-FDG datasets. The information provided by bootstrapping could support more sophisticated uses of PET biomarkers used in clinical decision-making for the individual patient.

Inequalities in non-communicable disease management in China and progress toward universal health coverage: an analysis of nationwide household survey data from 2004 to 2018.

Background: Prevention and control of non-communicable diseases (NCDs) become a policy priority in Universal Health Coverage (UHC) in China, while NCD management has never been comprehensively estimated at national and subnational levels. We aimed to assess NCD management in China nationally and in key subpopulations, investigate inequalities from multidimensions, and further examine its association with health financing and resources. Methods: Data included were from China Chronic Disease and Risk Factors Surveillance (CCDRFS) and China Health and Nutrition Survey (CHNS). Following the WHO recommended frameworks, we selected eight NCD health service and risk management indicators and used meta-analysis to construct the composite NCD index. We explored the trends in and projections of NCD management index and indicators at national and subnational levels by using Bayesian regression models with average annual percentage change (AAPC) from 2004 to 2018 and probability of reaching the UHC target by 2030. We further conducted comprehensive inequality analyses of NCD indicators from multidimensions with patterns of changes over time using absolute difference and relative ratio. Finally, we quantified the associations between NCD management performance with health financing and resources using stochastic frontier analysis. Findings: In China, the NCD management index increased slowly from 62.0% (95% CI 36.0 to 84.0) in 2004 to 64.3% (95% CI 44.0 to 82.2) in 2018, with lagging performance being observed in prevention domain (AAPC -0.1%, 95% CrI -1.0 to 0.8). And all management indicators presented low probabilities of accomplishing 2030 targets in China. Notably, based on subnational analysis, diverse tendency and magnitude of inequalities in multiple NCD indicators were identified with widening gaps between genders (non-overweight, diabetes treatment), age groups (non-use of tobacco), urban-rural areas (non-use of alcohol, non-use of tobacco), regions (sufficient physical activity), and wealth quintiles (non-overweight, sufficient physical activity). Additionally, it was observed that compared with urban area, rural area had constantly lower health resources and presented 2.2% lower NCD management performance in 2018. Importantly, we found that health financing and resources especially distributed in primary health care (PHC) facilities were closely and positively associated with NCD management performance. A 1000 yuan increase of government health expenditure (GHE) per capita and a 10 increase of medical beds per 1000 capita in PHC facilities were associated with a 4.0% (95% CI 2.0 to 6.0) and 6.8% (95% CI 0.2 to 13.5) increase of NCD management index, respectively. Interpretation: The progress towards NCD management is slow at national level and in key subpopulations in China, with great challenges of existing and widening inequalities between genders, age groups, urban-rural areas, regions and socioeconomic groups. Rural and old people were still vulnerable populations who were lagging behind in NCD prevention and control. Optimising resource allocation by strengthening PHC especially in rural area, developing tailor-made programmes targeting specific populations such as old individuals, simultaneously integrating gender, education, and economic interventions to reduce inequalities should be prioritised to help China tackle NCDs during the progress towards UHC. Funding: National Natural Science Foundation of China.

The impact of digital economy on high-quality economic development: Research based on the consumption expansion.

Studies have found that the digital economy plays a positive role in promoting high-quality economic development. Meanwhile, the digital industrialization and industrial digitalization have given rise to new demands and supply modes of consumption. It is necessary to analyze the role of consumption expansion in the impact of digital economy on high-quality economic development. Based on Chinese provincial panel data, we first applied the entropy weight method to construct the digital economy index and the high-quality economic development index. And on this basis, it was verified that the digital economy can positively promote the high-quality development of the inverted U-shaped structural economy. Then we separately used the mediation and the threshold effect models to analyze the role of consumption expansion in empowering high-quality development in the digital economy. Regional heterogeneity was further taken into account. The results dedicate that consumer demand and the digital economy have a partial or complete mediating effect. The promotion of high-quality development by the digital economy can be affected by the threshold of consumption expansion, which is manifested in the marginal incremental effect due to the growth of consumption supply. On the contrary, the growth of consumer demand has led to the inverted U-shape of the digital economy to promote high-quality economic development. In the heterogeneity analysis, the threshold effect also varied greatly. This research enriches the theoretical achievements and reveals the impact of consumption expansion on the digital economy affecting the high-quality development, which may provide certain reference for other countries and regions.

Synthesis of Low-Cost and High-Performance Dual-Atom Doped Carbon-Based Materials with a Simple Green Route as Anodes for Sodium-Ion Batteries.

Sodium-ion batteries (SIBs) are promising alternatives to replace lithium-ion batteries as future energy storage batteries because of their abundant sodium resources, low cost, and high charging efficiency. In order to match the high energy capacity and density, designing an atomically doped carbonous material as the anode is presently one of the important strategies to commercialize SIBs. In this work, we report the preparation of high-performance dual-atom-doped carbon (C) materials using low-cost corn starch and thiourea (CH4N2S) as the precursors. The electronegativity and radii of the doped atoms and C are different, which can vary the embedding properties of sodium ions (Na+) into/on C. As sulfur (S) can effectively expand the layer spacing, it provides more channels for embedding and de-embedding Na+. The synergistic effect of N and S co-doping can remarkably boost the performance of SIBs. The capacity is preserved at 400 mAh g -1 after 200 cycles at 500 mA g-1; more notably, the initial Coulombic efficiency is 81%. Even at a high rate of high current of 10 A g-1, the cell capacity can still reach 170 mAh g-1. More importantly, after 3000 cycles at 1 A g-1, the capacity decay is less than 0.003% per cycle, which demonstrates its excellent electrochemical performance. These results indicate that high-performance carbon materials can be prepared using low-cost corn starch and thiourea.

Bisphenol analogues in water and sediment from the Beibu Gulf, South China Sea: Occurrence, partitioning and risk assessment.

Bisphenol analogues (BPs) have gained increasing attention in recent years due to their ubiquitousness in the environment, potential endocrine disrupting properties and ecological impacts. However, very little information is available on the occurrence, partitioning and ecological risks of BPs in marine environments. In the present study, six BPs were investigated in surface water and sediment samples from the Beibu Gulf, South China Sea. Results showed that bisphenol A (BPA) was the predominant BP in both water and sediment samples with levels ranging from 5.26 to 12.04 ng/L in water and 0.56 to 5.22 ng/g dw in sediment samples, followed by bisphenol AF (BPAF: 0.44-0.60 ng/L in water and 0.08-0.66 ng/g dw in sediment samples, respectively) and bisphenol S (BPS: 0.07-0.63 ng/L in water and not detected (ND) to 0.19 ng/g dw in sediment samples, respectively). There is no significant spatial difference of BPs levels between riverine sediment samples and coastal sediment samples. Compared with other studies, the concentrations of BPs from the Beibu Gulf were relatively low. The mean log-transformed sediment-seawater partitioning coefficients (log Koc) ranged from 4.4 (DHBP) to 5.2 (BPAF) and the log Koc values for all the target BPs were generally higher than those reported in freshwater environments. The present study firstly reported the field-based log Koc values for BPB (mean: 4.5) and DHBP (mean: 4.4). The estimated risk quotient (RQ) and 17ß-estradiol (E2) equivalent quotient (EEQ) values indicated that the ecological and human health impacts were negligible associated with target BPs. The present study provided reliable and detailed data for completely evaluating contamination level and environmental behaviors of BPs in the Beibu Gulf.

A neural basis of rational inattention models: consistency of cognitive cost with the mutual information criterion.

The rational inattention model has recently attracted much attention as a promising candidate to model bounded rationality in the research field of decision-making and game theory. However, in contrast to this energetic promotion of the theoretical works, empirical verification of the validity of the RI model has not progressed much. Furthermore, to our knowledge, the central assumption of the RI model, that the amount of mutual information obtained from signals adequately represents the cognitive cost of information, has not been tested from a neuroscientific perspective. The purpose of the present study was to test whether the amount of mutual information adequately represents the cognitive cost of information from a neuroscientific perspective. We proposed a sequential investment task, in which the two main models of RI can be treated simultaneously in a more realistic experimental environment. We used a model-fitting approach to analyze the subjective information cost, and compared the model parameters representing the information cost with the concentration of oxidized hemoglobin in the brain blood. Our results showed that the cost parameter λ of the stochastic choice type model, which fits the behavioral data of the present experiment better than the Kalman filter type model, was significantly positively correlated with the activation status of the rostral prefrontal cortex and dorsolateral prefrontal cortex. The cognitive cost represented by the amount of mutual information employed in the RI model is consistent with the activation of brain regions associated with cognitive cost, and, thus, indirectly supports the assumption of the RI model.

An Intelligent Health Monitoring Model Based on Fuzzy Deep Neural Network.

An intelligent health detection model is a new technology developed under an artificial intelligence environment, which is of great significance to the care of the elderly and other people who cannot take care of themselves. This paper comprehensively reviews the structural health monitoring method based on an intelligent algorithm, introduces the application model of neural networks in structural health monitoring in detail, and points out the shortcomings of using neural network technology alone. On the basis of previous work, the genetic algorithm and fuzzy theory were introduced as optimization tools, and a new neural network training algorithm was constructed by combining genetic algorithm, fuzzy theory, and neural network technology for structural health monitoring research. Aimed at the shortcoming of insufficient samples for training neural networks based on experimental data, this paper proposes to use the finite element method to construct a genetic fuzzy RBF neural network after corresponding processing of the first six-order bending modal frequencies of the structure, so as to realize the localization and detection of delamination damage of composite beams. Injury Assessment. The experimental results of this paper show that the finite element method proposed in this paper can effectively carry out damage localization and damage assessment; compared with the traditional algorithm, the localization accuracy of this algorithm is improved by 20%, and the damage assessment performance is improved by 10%.

[Research on artificial substitutes of rare and endangered animal medicinal materials and industrialization].

Rare and endangered animal medicine, a kind of important Chinese medicine, plays an irreplaceable role in the prevention and treatment of serious acute and chronic diseases and major diseases. Due to resource limitation and depletion and the increasing demand, rare and endangered medicinal animal resources have been drastically reduced or even extinct, which threatens the inheritance of traditional Chinese medicine, the integrity of clinical medicine, and the development of the traditional Chinese medicine industry. For the protection and sustainable utilization of Chinese medicinal resources, artificial substitutes came into being. However, there is still a lack of systematic research on the pharmacological effects and clinical applications of artificial substitutes and whether they can completely replace the original medicinal materials in clinical practice. Therefore, this study focuses on the status quo of rare and endangered animal medicinal materials and their artificial substitutes that have been marketed. To be specific, the two were compared and whether the artificial substitutes can completely replace the original medicinal materials was analyzed. In addition, constructive suggestions on the industrialization of artificial substitutes were put forward, which was expected to promote the sustainable development of Chinese medicinal resources.

Occurrence, source apportionment and risk assessment of antibiotics in water and sediment from the subtropical Beibu Gulf, South China.

The widespread use of antibiotics has raised global concerns, but scarce information on antibiotics in the subtropical marine environment is available. In the present study, seawater and sediment samples were collected to investigate the occurrence, spatial distribution, source, and ecological risks of 22 antibiotics in the Beibu Gulf. The total concentrations of target antibiotics (∑antibiotics) were in the range of 1.74 ng/L to 23.83 ng/L for seawater and 1.33 ng/g to 8.55 ng/g dry weight (dw) for sediment. Spatially, a decreasing trend of antibiotic levels from coast to offshore area was observed, with relatively high levels at the sites close to the Qinzhou Bay and Qiongzhou Strait. Sulfamethoxazole (SMX), trimethoprim (TMP), and norfloxacin (NOX) were predominant in seawater, while NOX, enoxacin (ENX), and enrofloxacin (ENR) were the most abundant antibiotics in sediment. In general, the sediment-water partitioning coefficients (Kd) were positively correlated with log molecular weight (MW). Salinity, particle size, and pH of water were predicted to be vital factors influencing the partition of sulfadiazine (SDZ), CIX, and ENR (p < 0.05). Livestock and aquaculture were identified as dominant sources of antibiotics in the Beibu Gulf based on PCA-MLR and Unmix model. Risk assessment revealed that SMX, CIX could pose medium risks to algae in the Beibu Gulf. Overall, our results provided paramount insights into understanding the fate and transport behaviors of antibiotics in the subtropical marine environment.

Material flow cost accounting (MFCA) for the circular economy: An empirical study of the triadic relationship between MFCA, environmental performance, and the economic performance of Japanese companies.

The purpose of this study is to address the question of whether material flow cost accounting (MFCA) can contribute to the circular economy. Because MFCA is an environmental management accounting tool that simultaneously assesses company material and financial flows, it is expected to contribute to the circular economy by assisting companies to achieve both environmental and economic goals through resource efficiency. In short, the expected linkages between MFCA, company environmental and economic goals, and the circular economy are inputs, outputs, and outcomes. However, there is a lack of consensus regarding its potential, perhaps because of the scarcity of studies, with most being models and case studies without readily generalizable results. To address this gap, we analyze the triadic relationship between MFCA, environmental performance, and economic performance using a two-stage regression of data from Japanese listed companies. The main findings are as follows. Companies that implement MFCA more proactively are more likely to improve their environmental performance in terms of energy consumption, CO2 emissions, and waste produced. In turn, those that improve their environmental performance are also more likely to improve their productivity, while those that specifically improve environmental performance in terms of waste produced are also more likely to increase in profitability. Consequently, because MFCA can improve several aspects of environmental performance by saving resources, it can improve productivity by improving a range of environmental performance indicators. In particular, MFCA can improve company productivity and thereby profit, at least by reducing the amount of waste produced. This supports the view that MFCA is an effective tool to contribute to the circular economy.

Subjective and objective quality assessment of gastrointestinal endoscopy images: From manual operation to artificial intelligence.

Gastrointestinal endoscopy has been identified as an important tool for cancer diagnosis and therapy, particularly for treating patients with early gastric cancer (EGC). It is well known that the quality of gastroscope images is a prerequisite for achieving a high detection rate of gastrointestinal lesions. Owing to manual operation of gastroscope detection, in practice, it possibly introduces motion blur and produces low-quality gastroscope images during the imaging process. Hence, the quality assessment of gastroscope images is the key process in the detection of gastrointestinal endoscopy. In this study, we first present a novel gastroscope image motion blur (GIMB) database that includes 1,050 images generated by imposing 15 distortion levels of motion blur on 70 lossless images and the associated subjective scores produced with the manual operation of 15 viewers. Then, we design a new artificial intelligence (AI)-based gastroscope image quality evaluator (GIQE) that leverages the newly proposed semi-full combination subspace to learn multiple kinds of human visual system (HVS) inspired features for providing objective quality scores. The results of experiments conducted on the GIMB database confirm that the proposed GIQE showed more effective performance compared with its state-of-the-art peers.

Fluorescent whitening agents in Baiyangdian Lake in North China: Analysis, occurrence, distribution and ecological risk assessment.

Fluorescent whitening agents (FWAs) are very important chemical additives that are widely applied in the industrial production field. The history of global FWA production and use spans more than 60 years, but the environmental fate of FWAs has been less reported in the public literature and most studies predate 2000; in addition, the studied FWAs were still limited to FWA71 and FWA351. In this study, the occurrence and distribution of 9 commonly used FWAs in a lake in North China were reported for the first time. We found that 6 target FWAs were prevalent in the lake, and the concentration levels were usually at the ng L-1 level. Decreasing FWA levels with increasing distance from the estuary area were observed in summer. FWA135, FWA185, and FWA367, the most detected 3 FWAs, with the ecological risk at high levels, and ΣRQ >10 were obtained from all the investigated samples, suggesting that all the sampling sites could be considered with certain ecological risk for aquatic life. As a category of heavily and widely used dyes, FWAs in environmental media have been ignored for a long time. Substantial additional research needs to be conducted to determine the environmental behavior and ecological toxicology of FWAs.

Material hardship and child neglect risk amidst COVID-19 in grandparent-headed kinship families: The role of financial assistance.

BACKGROUND: COVID-19 has exacerbated material hardship among grandparent-headed kinship families. Grandparent-headed kinship families receive financial assistance, which may mitigate material hardship and reduce child neglect risk. OBJECTIVE: This study aims to examine (1) the association between material hardship and child neglect risk; and (2) whether financial assistance moderates this association in a sample of kinship grandparent-headed families during COVID-19. PARTICIPANTS AND SETTING: Cross-sectional survey data were collected from a convenience sample of grandparent-headed kinship families (not necessarily child welfare involved) (N = 362) in the United States via Qualtrics Panels online survey. METHODS: Descriptive, bivariate, and negative binomial regression were conducted using STATA 15.0. RESULTS: Experiencing material hardship was found to be associated with an increased risk of child neglect, and receiving financial assistance was associated with a decreased risk of child neglect in the full sample and a subsample with household income > $30,000. Receiving financial assistance buffered the negative effect of material hardship on child neglect risk across analytic samples, and receiving SNAP was a significant moderator in the full sample. Among families with a household income ≤ $30,000, receiving SNAP and foster care payments was associated with a decreased risk of child neglect, while receiving TANF and unemployment insurance was associated with an increased risk of child neglect. Among families with household income > $30,000, only receiving SNAP was associated with a decreased risk of child neglect. CONCLUSIONS: This study suggests the potential importance of providing concrete financial assistance, particularly SNAP and foster care payments, to grandparent-headed kinship families in efforts to decrease child neglect risk during COVID-19.

Long-Term Cost-Effectiveness of Smoking Cessation Interventions in People With Mental Disorders: A Dynamic Decision Analytical Model.

OBJECTIVES: People with mental disorders are more likely to smoke than the general population. The objective of this study is to develop a decision analytical model that estimates long-term cost-effectiveness of smoking cessation interventions in this population. METHODS: A series of Markov models were constructed to estimate average lifetime smoking-attributable inpatient cost and expected quality-adjusted life-years. The model parameters were estimated using a variety of data sources. The model incorporated uncertainty through probabilistic sensitivity analysis using Monte Carlo simulations. It also generated tables presenting incremental cost-effectiveness ratios of the proposed interventions with varying incremental costs and incremental quit rates. We used data from 2 published trials to demonstrate the model's ability to make projections beyond the observational time frame. RESULTS: The average smoker's smoking-attributable inpatient cost was 3 times higher and health utility was 5% lower than ex-smokers. The intervention in the trial with a statistically insignificant difference in quit rate (19% vs 25%; P=.2) showed a 45% to 49% chance of being cost-effective compared with the control at willingness-to-pay thresholds of £20 000 to £30 000/quality-adjusted life-years. The second trial had a significant outcome (quit rate 35.9% vs 15.6%; P<.001), and the corresponding probability of the intervention being cost-effective was 65%. CONCLUSIONS: This model provides a consistent platform for clinical trials to estimate the potential lifetime cost-effectiveness of smoking cessation interventions for people with mental disorders and could help commissioners direct resources to the most cost-effective programs. However, direct comparisons of results between trials must be interpreted with caution owing to their different designs and settings.

Are corporate environmental activities to meet sustainable development goals (SDGs) simply greenwashing? An empirical study of environmental management control systems in Vietnamese companies from the stakeholder management perspective.

The purpose of this study is to address the criticism that corporate environmental activities to meet the UN sustainable development goals (SDGs) are simply greenwashing. To this end, we clarify whether and why corporate environmental activities are effective in achieving SDGs from the stakeholder management perspective. Using data on Vietnamese companies, we first empirically clarify the influence of stakeholder pressure on a company's environmental management control system (EMCS) implementation as a comprehensive approach to environmental activities and maintaining a proactive attitude toward the SDGs. Second, we examine the influence of EMCS implementation on environmental performance with or without proactive attitudes. The main findings are as follows. Companies implementing EMCSs normally improve their environmental performance, and pressure from final consumers and the government is a precondition for this accomplishment. However, if these companies incorporate the SDGs into their business targets, they can actually improve their environmental performance somewhat further, and government pressure plays an important role in this additional accomplishment. Therefore, corporate environmental activities to meet the SDGs work better than existing activities in Vietnam, refuting the criticism of greenwashing. Importantly, the Vietnamese government as a powerful stakeholder has proactively promoted domestic structural change to achieve the SDGs and has enacted many policies to encourage companies to be proactive in their environmental activities.

Autophagic flux assessment by immunoblot.

Autophagy is one of the main adaptive mechanisms to maintain cellular homeostasis in response to multiple stresses. During autophagy diverse cellular components such as damaged organelles or superfluous proteins are targeted for lysosomal degradation. Importantly, during the initiation of autophagy MAP1LC3B (better known as LC3) lipidates into the membrane of the forming phagophore, which facilitates the formation and lengthening of autophagosomes. In addition, the autophagy receptor SQSTM1 (better known as p62) selectively recruits various cargos to autophagosomes for lysosomal degradation. Both, the conversion of LC3 as well as the degradation of p62 can be assessed as means of monitoring autophagy. Here we detail a protocol for assessing these key events of the autophagic flux via immunoblot.

Large-Scale Proteomic Assessment of Urinary Extracellular Vesicles Highlights Their Reliability in Reflecting Protein Changes in the Kidney.

BACKGROUND: Urinary extracellular vesicles (uEVs) are secreted into urine by cells from the kidneys and urinary tract. Although changes in uEV proteins are used for quantitative assessment of protein levels in the kidney or biomarker discovery, whether they faithfully reflect (patho)physiologic changes in the kidney is a matter of debate. METHODS: Mass spectrometry was used to compare in an unbiased manner the correlations between protein levels in uEVs and kidney tissue from the same animal. Studies were performed on rats fed a normal or high K+ diet. RESULTS: Absolute quantification determined a positive correlation (Pearson R=0.46 or 0.45, control or high K+ respectively, P<0.0001) between the approximately 1000 proteins identified in uEVs and corresponding kidney tissue. Transmembrane proteins had greater positive correlations relative to cytoplasmic proteins. Proteins with high correlations (R>0.9), included exosome markers Tsg101 and Alix. Relative quantification highlighted a monotonic relationship between altered transporter/channel abundances in uEVs and the kidney after dietary K+ manipulation. Analysis of genetic mouse models also revealed correlations between uEVs and kidney. CONCLUSION: This large-scale unbiased analysis identifies uEV proteins that track the abundance of the parent proteins in the kidney. The data form a novel resource for the kidney community and support the reliability of using uEV protein changes to monitor specific physiologic responses and disease mechanisms.

Assessment of EGFP-Q74 degradation for the measurement of autophagic flux.

Autophagy plays a major role in physiological and pathological processes. The quantitation of the abundance of autophagy-specific substrates constitutes an efficient strategy for assessing autophagic activity. Here, we provide a detailed protocol for quantifying the decay of a fusion protein composed by enhanced green fluorescent protein (EGFP) and glutamine repeats (Q74) using regular or high-throughput fluorescence microscopy. This method provides a direct measurement of autophagic flux in a Huntington's disease model.

Efficacy and cost-effectiveness of a community-based smoke-free-home intervention with or without indoor-air-quality feedback in Bangladesh (MCLASS II): a three-arm, cluster-randomised, controlled trial.

BACKGROUND: Exposure to second-hand smoke from tobacco is a major contributor to global morbidity and mortality. We aimed to evaluate the efficacy and cost-effectiveness of a community-based smoke-free-home intervention, with or without indoor-air-quality feedback, in reducing second-hand-smoke exposure in homes in Bangladesh. METHODS: We did a three-arm, cluster-randomised, controlled trial in Dhaka, Bangladesh, and randomly assigned (1:1:1) mosques and consenting households from their congregations to a smoke-free-home intervention plus indoor-air-quality feedback, smoke-free-home intervention only, or usual services. Households were eligible if they had at least one resident attending one of the participating mosques, at least one adult resident (age 18 years or older) who smoked cigarettes or other forms of smoked tobacco (eg, bidi, waterpipe) regularly (on at least 25 days per month), and at least one non-smoking resident of any age. The smoke-free-home intervention consisted of weekly health messages delivered within an Islamic discourse by religious leaders at mosques over 12 weeks. Indoor-air-quality feedback comprised providing households with feedback on their indoor air quality measured over 24 h. Households in the usual services group received no intervention. Masking of participants and mosque leaders was not possible. The primary outcome was the 24-h mean household airborne fine particulate matter (<2·5 microns in diameter [PM2·5]) concentration (a marker of second-hand smoke) at 12 months after randomisation. Cost-effectiveness was estimated using incremental cost-effectiveness ratios (ICERs). This trial is registered with ISRCTN, 49975452. FINDINGS: Between April 11 and Aug 2, 2018, we enrolled 1801 households from 45 mosques. 640 households (35·5%) were assigned to the smoke-free-home intervention plus indoor-air-quality feedback group, 560 (31·1%) to the smoke-free-home intervention only group, and 601 (33·4%) to the usual services group. At 12 months, the adjusted mean difference in household mean 24-h PM2·5 concentration was -1·0 µg/m3 (95% CI -12·8 to 10·9, p=0·88) for the smoke-free-home intervention plus indoor-air-quality feedback group versus the usual services group, 5·0 µg/m3 (-7·9 to 18·0, p=0·45) for the smoke-free-home intervention only group versus the usual services group, and -6·0 µg/m3 (-18·3 to 6·3, p=0·34) for the smoke-free-home intervention plus indoor-air-quality feedback group versus the smoke-free-home intervention only group. The ICER for the smoke-free-home intervention plus indoor-air-quality feedback versus usual services was US$653 per quality-adjusted life-year (QALY) gained, which was more than the upper limit of the Bangladesh willingness-to-pay threshold of $427 per QALY. INTERPRETATION: The smoke-free-home intervention, with or without indoor-air-quality feedback, was neither effective nor cost-effective in reducing household second-hand-smoke exposure compared with usual services. These interventions are therefore not recommended for Bangladesh. FUNDING: Medical Research Council UK. TRANSLATION: For the Bengali translation of the abstract see Supplementary Materials section.

Custodial Grandparent's Job Loss During the COVID-19 Pandemic and Its Relationship With Parenting Stress and Mental Health.

Involuntary job loss during the COVID-19 pandemic adds challenges, especially for custodial grandparents that are taking care of grandchildren. Grandparents are relatively vulnerable, and they need more attention and support when facing the negative impacts of COVID-19. This study analyzed cross-sectional survey data collected from 234 custodial grandparents via Qualtrics Panels in June 2020 in the United States. After using the propensity score weighting adjustment, results from logistic and ordinary least squares regression showed that compared with grandparents that did not lose their job during the pandemic, grandparents that did had more parenting stress and worse mental health. Moderation analysis also showed that social support was a significant moderator of the relationship between job loss and mental health, but not the relationship between job loss and parenting stress. The findings and implications are discussed.