Preliminary study on the enhanced bioremediation of PAH-contaminated soil in Beijing and assessment of remediation effects based on toxicity tests.

In this study, we focused on soil contaminated by polycyclic aromatic hydrocarbons (PAHs) at typical coking-polluted sites in Beijing, conducted research on enhanced PAH bioremediation and methods to evaluate remediation effects based on toxicity testing, and examined changes in pollutant concentrations during ozone preoxidation coupled with biodegradation in test soil samples. The toxicity of mixed PAHs in soil was directly evaluated using the Ames test, and the correlation between mixed PAH mutagenicity and benzo(a)pyrene (BaP) toxicity was investigated in an effort to establish a carcinogenic risk assessment model based on biological toxicity tests to evaluate remediation effects on PAH-contaminated soil. This study provides a theoretical and methodological foundation for evaluating the effect of bioremediation on PAH-contaminated soil at industrially contaminated sites. The results revealed that the removal rate of PAHs after 5 min of O3 preoxidation and 4 weeks of soil reaction with saponin surfactants and medium was 83.22%. The soil PAH extract obtained after remediation had a positive effect on the TA98 strain at a dose of 2000 µg·dish-1, and the carcinogenic risk based on the Ames toxicity test was 8.98 times greater than that calculated by conventional carcinogenic PAH toxicity parameters. The total carcinogenic risk of the remediated soil samples was approximately one order of magnitude less than that of the original soil samples.

Global Trends in the Incidence of Anxiety Disorders From 1990 to 2019: Joinpoint and Age-Period-Cohort Analysis Study.

BACKGROUND: Anxiety disorders (ADs) are the most common mental illness with high prevalence, chronicity, and comorbidity. Despite rapid economic and cultural development, the global incidence of ADs continues to increase, with predominance in male individuals. OBJECTIVE: To address the above issues, we analyzed the dynamic trends of the global incidence and disease burden of ADs from 1990 to 2019 and their different effects on age, period, and birth cohort and predicted the future trend of AD incidence. METHODS: The data were obtained from the Global Burden of Disease study in 2019. A joinpoint regression model was used to calculate the annual percent change in AD incidence, and age-period-cohort analysis was used to estimate the independent effects of age, period, and cohort. Nordpred age-period-cohort analysis was used to predict the incidence of ADs from 2020 to 2044. RESULTS: The age-standardized incidence rate of ADs increased by 1.06% for both sexes, and the age-standardized disability-adjusted life-year (DALY) rate (ASDR) decreased by 0.12%. Joinpoint regression indicated that increments in average annual percent changes in the age-standardized incidence rate (0.068 vs 0.012) and ASDR (0.035 vs -0.015) for ADs globally were higher among male individuals than female individuals. The age-period-cohort analyses revealed that the relative risk (RR) of the incidence and DALYs of ADs among people of different sexes increased with age in adolescence and middle age and then decreased. For the period effect, the RR of incidence decreased, whereas the RR of DALYs increased in both sexes. Moreover, the RR of the incidence gradually increased and DALYs slowly decreased with birth year for both male and female individuals. New cases of ADs in male individuals are predicted to increase in the coming 25 years. CONCLUSIONS: This study provided the changing trend of the global incidence and disease burden of ADs in the past 3 decades, indicating that early prevention and effective control cannot be ignored. We analyzed the age-period-cohort effect of potential trends in ADs and predicted future incidence trends. The results suggest that we should take active intervention measures, focusing on high-risk groups and developing effective management and control policies to reduce the global burden of disease.

A unified approach to demographic data collection for research with young children across diverse cultures.

Culture is a key determinant of children's development both in its own right and as a measure of generalizability of developmental phenomena. Studying the role of culture in development requires information about participants' demographic backgrounds. However, both reporting and treatment of demographic data are limited and inconsistent in child development research. A barrier to reporting demographic data in a consistent fashion is that no standardized tool currently exists to collect these data. Variation in cultural expectations, family structures, and life circumstances across communities make the creation of a unifying instrument challenging. Here, we present a framework to standardize demographic reporting for early child development (birth to 3 years of age), focusing on six core sociodemographic construct categories: biological information, gestational status, health status, community of descent, caregiving environment, and socioeconomic status. For each category, we discuss potential constructs and measurement items and provide guidance for their use and adaptation to diverse contexts. These items are stored in an open repository of context-adapted questionnaires that provide a consistent approach to obtaining and reporting demographic information so that these data can be archived and shared in a more standardized format. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Wastewater treatment plant effluents exert different impacts on antibiotic resistome in water and sediment of the receiving river: Metagenomic analysis and risk assessment.

Wastewater treatment plants (WWTPs) are considered as hotspots for the spread of antibiotic resistome into the environment. However, the differential contributions of WWTPs to the antibiotic resistome in the receiving river water and sediment are poorly understood. Here, based on metagenomic analysis, we found that the WWTP effluents significantly elevated the diversities and abundances of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) in the receiving river water from the Qinghai-Tibet Plateau, but showed less interference with the antibiotic resistome in sediment. Estimated by SourceTracker, WWTPs contributed 60.691.8% of ARGs in downstream river water, much higher than those for sediment (7.7568.0%). A holistic comparison of ARG risks based on analysis of ARG combination, mobility risk, ARG hosts and ARG-carrying pathogens further revealed the great impacts of WWTP effluents on downstream river water rather than sediment. Among various MGEs, tnpA exhibited the greatest potential for the dissemination of ARGs, and displayed highest co-occurrence frequency with multiple ARGs. P. aeruginosa, E. cloacae, and E. coli were identified as the critical-priority pathogens of ARG hosts. This study demonstrated the much greater impacts of WWTP effluents on the downstream water compared with sediment, which is significant for developing effective strategies to mitigate ARG risks.

Spatial-temporal trends in global childhood overweight and obesity from 1975 to 2030: a weight mean center and projection analysis of 191 countries.

BACKGROUND: The geographic information science-based interactive map provided good prospects for the public health to study disease prevalence. The purpose of this study is to understand global spatial-temporal trends of childhood overweight and obesity and underlying causes help formulating intervention strategies. METHODS: This multiple cross-sectional study included data on childhood overweight and obesity prevalence, gross national income per capita, and urbanization rate for 191 countries from 1975-2016. Autoregressive integrated moving average model, standard deviational ellipse model and mixed-effects models were used to explore spatial-temporal trends of childhood overweight and obesity and associations with gross national income per capita and urbanization rate. RESULTS: Globally, childhood overweight and obesity rate would reach 30.0% in 2030 (boys: 34.2%, girls: 27.4%). By 2030, it would reach 58.3% in middle- and high-income countries and 68.1% in Western Pacific region. Spatial-temporal trendline for childhood overweight and obesity in 1975-2030 exhibited a "C" shape, migrating from 1975 (15.6。E, 24.6。N) to 2005 (10.6。E, 21.7。N), then to 2030 (14.8。E, 17.4。N). The trendline for urbanization rate was also an irregular "C", and the turning point appeared five years earlier than childhood overweight and obesity. CONCLUSIONS: Globally, childhood overweight and obesity prevalence will continue to increase. Its weight mean center migrated from western countries to Asia and Africa following economic development.

Ultrasound-based radiomics for the evaluation of fetal rat lung maturity: A noninvasive assessment method (Ultrasound-based radiomics in fetal rat lung).

OBJECTIVE: To establish a classification model for the evaluation of rat fetal lung maturity (FLM) using radiomics technology. METHOD: A total of 430 high-throughput features were extracted per fetal lung image from 134 fetal lung ultrasound images (four-cardiac-chamber views) of 67 Sprague-Dawley (SD) fetal rats with a gestational age of 16-21 days. The detection of fetal lung tissues included histopathological staining and the expression of surface proteins SP-A, SP-B, and SP-C. A machine learning classification model was established using a support vector machine based on histopathological results to analyze the relationship between fetal lung texture characteristics and FLM. RESULTS: The rat fetal lungs were divided into two groups: terminal sac period (SD1) and canalicular period (SD2). The mRNA transcription and protein expression level of SP-C protein were significantly higher in the SD1 group than in the SD2 group (p < 0.05). The diagnostic performance of the rat FLM classification model was measured as follows: area under the receiver operating characteristic curve (AUC), 0.93 (training set) and 0.89 (validation set); sensitivity, 89.26% (training set) and 87.10% (validation set); specificity, 85.87% (training set) and 79.17% (validation set); and accuracy, 87.79% (training set) and 83.64% (validation set). CONCLUSION: Ultrasound-based radiomics technology can be used to evaluate the FLM of rats, which lays a foundation for further research on this technology in human fetal lungs.

Potential Toxicity Risk Assessment and Priority Control Strategy for PAHs Metabolism and Transformation Behaviors in the Environment.

In this study, 16 PAHs were selected as the priority control pollutants to summarize their environmental metabolism and transformation processes, including photolysis, plant degradation, bacterial degradation, fungal degradation, microalgae degradation, and human metabolic transformation. Meanwhile, a total of 473 PAHs by-products generated during their transformation and degradation in different environmental media were considered. Then, a comprehensive system was established for evaluating the PAHs by-products' neurotoxicity, immunotoxicity, phytotoxicity, developmental toxicity, genotoxicity, carcinogenicity, and endocrine-disrupting effect through molecular docking, molecular dynamics simulation, 3D-QSAR model, TOPKAT method, and VEGA platform. Finally, the potential environmental risk (phytotoxicity) and human health risks (neurotoxicity, immunotoxicity, genotoxicity, carcinogenicity, developmental toxicity, and endocrine-disrupting toxicity) during PAHs metabolism and transformation were comprehensively evaluated. Among the 473 PAH's metabolized and transformed products, all PAHs by-products excluding ACY, CHR, and DahA had higher neurotoxicity, 152 PAHs by-products had higher immunotoxicity, and 222 PAHs by-products had higher phytotoxicity than their precursors during biological metabolism and environmental transformation. Based on the TOPKAT model, 152 PAH by-products possessed potential developmental toxicity, and 138 PAH by-products had higher genotoxicity than their precursors. VEGA predicted that 247 kinds of PAH derivatives had carcinogenic activity, and only the natural transformation products of ACY did not have carcinogenicity. In addition to ACY, 15 PAHs produced 123 endocrine-disrupting substances during metabolism and transformation. Finally, the potential environmental and human health risks of PAHs metabolism and transformation products were evaluated using metabolic and transformation pathway probability and degree of toxic risk as indicators. Accordingly, the priority control strategy for PAHs was constructed based on the risk entropy method by screening the priority control pathways. This paper assesses the potential human health and environmental risks of PAHs in different environmental media with the help of models and toxicological modules for the toxicity prediction of PAHs by-products, and thus designs a risk priority control evaluation system for PAHs.

Characterization of Gut Microbiome in the Mud Snail Cipangopaludina cathayensis in Response to High-Temperature Stress.

The mud snail Cipangopaludina cathayensis is a widely distributed species in China. Particularly in Guangxi province, mud snail farming contributes significantly to the economic development. However, global warming in recent decades poses a serious threat to global aquaculture production. The rising water temperature is harmful to aquatic animals. The present study explored the effects of high temperature on the intestinal microbiota of C. cathayensis. Snail intestinal samples were collected from the control and high-temperature groups on days 3 and 7 to determine the gut microbiota composition and diversity. Gut bacterial community composition was investigated using high-throughput sequencing of the V3-V4 region of bacterial 16S rRNA genes. Our results suggested that thermal stress altered the gut microbiome structure of C. cathayensis. At the phylum level, Proteobacteria, Bacteroidetes, and Firmicutes were dominant in C. cathayensis gut microbiota. The T2 treatment (32 ± 1 °C, day 7) significantly decreased the relative abundance of Firmicutes, Actinobacteria, and Deinococcus-Thermus. In T2, the abundance of several genera of putatively beneficial bacteria (Pseudomonas, Aeromonas, Rhodobacter, and Bacteroides) decreased, whereas the abundance of Halomonas-a pathogenic bacterial genus-increased. The functional prediction results indicated that T2 treatment inhibited some carbohydrate metabolism pathways and induced certain disease-related pathways (e.g., those related to systemic lupus erythematosus, Vibrio cholerae infection, hypertrophic cardiomyopathy, and shigellosis). Thus, high temperature profoundly affected the community structure and function of C. cathayensis gut microbiota. The results provide insights into the mechanisms associated with response of C. cathayensis intestinal microbiota to global warming.

Dataset-based assessment of heavy metal contamination in freshwater fishes and their health risks.

The ecological risks and health hazards of heavy metals pollution in Taihu Lake have received widespread concern. This study has developed a species-pollution dataset which includes a large amount of data on heavy metal pollution in Taihu fish. The heavy metal contamination poses a significant threat to human consumption, but no studies have been conducted to assess the risk of exposure to consumption of these fish and to make recommendations for their consumption. In this study, we systematically integrated the relevant data in the dataset, analyzed its contamination level using PI (single pollution index) and MPI (metal pollution index) models, and assessed health hazards of fish consumption using THQ (target hazard quotient) and ILCR (incremental lifetime cancer risk) models. Results showed that the contamination levels of heavy metals in fish varied in a feeding habit and living habit dependent manner. The risk of non-cancer health is the highest from consuming omnivorous fish, then from carnivorous and herbivorous fish. The ILCR model predicted that the long-term Taihu consumption of omnivorous fish may pose a potential carcinogenic risk, especially for children. In all, our study provided a comprehensive understanding on the risk of heavy metals in Taihu. Accordingly, it is recommended that children should try to choose herbivorous fish when consuming fish from Taihu Lake while avoiding long-term consumption of omnivorous fish.

Pandemic Risk Management for Public Health Care Schemes.

The coronavirus disease 2019 (COVID-19) caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2, has caused a large death, a range of serious health problems, and significant economic costs in many countries around the world. This study analyzes statistical characteristics of pandemic disasters using historical records since the Middle Ages. Compared to literature which studies the effect of the COVID- 19 pandemic on the financial market, this paper attempts to find two financial instruments in the financial market to hedge pandemic risks. Two instruments could be useful for public health care schemes to increase their assets or decrease their liabilities during the pandemic period, namely, assets in the form of a biotechnology investment portfolio and liabilities in the form of pandemic bonds. Empirical results show the feasibility of such instruments and the informational efficiency of the U.S. stock market.

Impact of deltamethrin-resistance in Aedes albopictus on its fitness cost and vector competence.

BACKGROUND: Aedes albopictus is one of the most invasive species in the world as well as the important vector for mosquito-borne diseases such as dengue fever, chikungunya fever and zika virus disease. Chemical control of mosquitoes is an effective method to control mosquito-borne diseases, however, the wide and improper application of insecticides for vector control has led to serious resistance problems. At present, there have been many reports on the resistance to pyrethroid insecticides in vector mosquitoes including deltamethrin to Aedes albopictus. However, the fitness cost and vector competence of deltamethrin resistant Aedes albopictus remain unknown. To understand the impact of insecticide resistant mosquito is of great significance for the prevention and control mosquitoes and mosquito-borne diseases. METHODOLOGY/PRINCIPAL FINDINGS: A laboratory resistant strain (Lab-R) of Aedes albopictus was established by deltamethrin insecticide selecting from the laboratory susceptible strain (Lab-S). The life table between the two strains were comparatively analyzed. The average development time of Lab-R and Lab-S in larvae was 9.7 days and 8.2 days (P < 0.005), and in pupae was 2.0 days and 1.8 days respectively (P > 0.05), indicating that deltamethrin resistance prolongs the larval development time of resistant mosquitoes. The average survival time of resistant adults was significantly shorter than that of susceptible adults, while the body weight of resistant female adults was significantly higher than that of the susceptible females. We also compared the vector competence for dengue virus type-2 (DENV-2) between the two strains via RT-qPCR. Considering the results of infection rate (IR) and virus load, there was no difference between the two strains during the early period of infection (4, 7, 10 day post infection (dpi)). However, in the later period of infection (14 dpi), IR and virus load in heads, salivary glands and ovaries of the resistant mosquitoes were significantly lower than those of the susceptible strain (IR of heads, salivary glands and ovaries: P < 0.05; virus load in heads and salivary glands: P < 0.05; virus load in ovaries: P < 0.001). And then, fourteen days after the DENV-2-infectious blood meal, females of the susceptible and resistant strains were allow to bite 5-day-old suckling mice. Both stains of mosquito can transmit DENV-2 to mice, but the onset of viremia was later in the mice biting by resistant group as well as lower virus copies in serum and brains, suggesting that the horizontal transmission of the resistant strain is lower than the susceptible strain. Meanwhile, we also detected IR of egg pools of the two strains on 14 dpi and found that the resistant strain were less capable of vertical transmission than susceptible mosquitoes. In addition, the average survival time of the resistant females infected with DENV-2 was 16 days, which was the shortest among the four groups of female mosquitoes, suggesting that deltamethrin resistance would shorten the life span of female Aedes albopictus infected with DENV-2. CONCLUSIONS/SIGNIFICANCE: As Aedes albopictus developing high resistance to deltamethrin, the resistance prolonged the growth and development of larvae, shorten the life span of adults, as well as reduced the vector competence of resistant Aedes albopictus for DENV-2. It can be concluded that the resistance to deltamethrin in Aedes albopictus is a double-edged sword, which not only endow the mosquito survive under the pressure of insecticide, but also increase the fitness cost and decrease its vector competence. However, Aedes albopictus resistant to deltamethrin can still complete the external incubation period and transmit dengue virus, which remains a potential vector for dengue virus transmission and becomes a threat to public health. Therefore, we should pay high attention for the problem of insecticide resistance so that to better prevent and control mosquito-borne diseases.

Few-Shot Learning by a Cascaded Framework With Shape-Constrained Pseudo Label Assessment for Whole Heart Segmentation.

Automatic and accurate 3D cardiac image segmentation plays a crucial role in cardiac disease diagnosis and treatment. Even though CNN based techniques have achieved great success in medical image segmentation, the expensive annotation, large memory consumption, and insufficient generalization ability still pose challenges to their application in clinical practice, especially in the case of 3D segmentation from high-resolution and large-dimension volumetric imaging. In this paper, we propose a few-shot learning framework by combining ideas of semi-supervised learning and self-training for whole heart segmentation and achieve promising accuracy with a Dice score of 0.890 and a Hausdorff distance of 18.539 mm with only four labeled data for training. When more labeled data provided, the model can generalize better across institutions. The key to success lies in the selection and evolution of high-quality pseudo labels in cascaded learning. A shape-constrained network is built to assess the quality of pseudo labels, and the self-training stages with alternative global-local perspectives are employed to improve the pseudo labels. We evaluate our method on the CTA dataset of the MM-WHS 2017 Challenge and a larger multi-center dataset. In the experiments, our method outperforms the state-of-the-art methods significantly and has great generalization ability on the unseen data. We also demonstrate, by a study of two 4D (3D+T) CTA data, the potential of our method to be applied in clinical practice.

Therapeutic drug monitoring in inflammatory bowel disease reduces unnecessary use of infliximab with substantial associated cost-savings.

BACKGROUND: Therapeutic drug monitoring (TDM) of infliximab (IFX) levels in inflammatory bowel disease (IBD) patients can help to guide dose adjustments or changes to therapy for selected patients in remission or with secondary loss of response (LOR). AIMS: To determine how IFX TDM is utilised in a real-life clinical setting and to quantify the potential for TDM to reduce the unnecessary use of IFX. METHODS: Data from all public IBD IFX level testing performed across Australia were prospectively collected from June 2016 to July 2017 to assess physician-reported for testing indications (induction, in remission or LOR) and associated results. The hypothetical influence of IFX TDM was based on an optimal therapeutic range of 6-10 mg/L for mucosal healing. RESULTS: Secondary LOR (reactive TDM) was the most common indication for TDM. These patients have consistently lower median IFX levels: 3.02 mg/L (IQR 1.14-6.67 mg/L) versus 5.22 mg/L (IQR 2.70-8.12 mg/L), P = 0.0001 compared with patients in remission (proactive TDM). TDM helped to identify unnecessary use of IFX in 30.6% of the TDM tests performed in luminal Crohn disease and ulcerative colitis patients, with an associated drug cost saving of $531.38 per IFX TDM test episode. Unnecessary IFX use was identified in 38.9% (96/247) of reactive IFX TDM tests performed and in 19.3% (35/181) of proactive testing. CONCLUSION: Use of both reactive and proactive IFX TDM is cost-effective for IBD management as it informs the clinician where unnecessary use of IFX can be stopped.

Assessment of coronary artery abnormalities and variability of Z-score calculation in the acute episode of Kawasaki disease-A retrospective study from China.

BACKGROUND: Accurate classification of coronary artery abnormalities (CAAs) is essential for clinical decision-making and long-term management in Kawasaki disease (KD) patients. To date, there are several echocardiographic criteria of CAA assessment. MATERIALS AND METHODS: The Japanese Ministry of Health (JMH) criteria and the Z-score criteria from 2004 American Heart Association guidelines were adopted and their detective efficacies for CAAs were compared in 251 Chinese patients with KD Z scores were calculated by 6 published methods. RESULTS: According to the JMH criteria, 19 (7.57%) KD patients were classified as CAAs during the acute KD episode. However, the detective number of CAAs was highest and had a 0.68-fold increase by the Dallaire et al method with a Z-score cut point of ≥2.5 as compared with the JMH criteria; in contrast, more than 78.95% of patients with CAAs identified by the JMH criteria had a coronary artery Z score ≥2.5. All 6 different Z-score methods had satisfactory accuracies with a range from 93.23% to 97.61% in screening CAAs. For the 19 patients with CAAs identified by the JMH criteria, their Z scores presented the widest variation calculated by the McCrindle et al method. CONCLUSIONS: The JMH criteria underestimate the prevalence of CAAs as compared with the Z-score criteria. Quantitative assessment of coronary artery luminal dimensions, normalized as Z scores adjusted for body surface, should be recommended. The larger coronary artery luminal dimensions vary, the more heterogeneous Z scores calculated by different methods have.

A Well-Designed Implement for Promoting Population Health and Property via Insurance.

The frequency and intensity of catastrophes (including natural disasters and pandemics) rise and damage the population's health, life and property more seriously. In order to protect population health and wealth via full insurance indemnity, many countries set up a public catastrophe insurance scheme (PCIS) to maintain the function of catastrophe insurance markets. Little literature discusses the smart payment way of contributions charged by PCIS. This article design a model to describe the upward trend and cyclic frequency and intensity of catastrophic events. Such characteristics also promote the business cycle of the insurance industry. We analyze the changes in catastrophic insurer's capital structures under three cases of that the volume-based charges to the PCIS may come from equity holders or policyholders or both. PCIS may entail a shift of equity capital toward minimum solvency requirements, and then adverse incentives regarding insurer's security level arise. Various numerical experiments illustrate the changes in equity position, default probabilities, or expected policyholder deficits. The results show that the payment way of contributions should be designed carefully, not only with regard to PCIS's finance balance but also the resultant incentives and effects.

Epidemiology of imported infectious diseases, China, 2014-18.

BACKGROUND: The frequent movement of population between countries brings an increasing number of travel-related infections. This study aims to define the spectrum and dynamics of imported infections observed from international travel in the Chinese mainland. METHODS: Sick travellers were screened by inbound sentinel surveillance and post-travel clinic visits from 2014 to 18. The infections were classified as respiratory, gastrointestinal, vector-borne, blood/sexually transmitted and mucocutaneous. The analysed variables included the place of origin of the travellers (Chinese or foreign) and the time when travel-related infection was present (at the time of return, during travel and post-travel visits to the clinic). RESULTS: In total, 58 677 cases were identified amongst 1 409 265 253 travellers, with an incidence of 41.64/million, comprising during-travel incidence of 27.44/million and a post-travel incidence of 14.20/million. Respiratory infections constituted the highest proportion of illnesses during travel (81.19%, 31 393 of 38 667), which mainly came from Asian countries and tourists; with influenza virus and rhinovirus infections being mainly diagnosed. Vector-borne diseases constituted the highest proportion of post-travel illnesses (98.14%, 19 638 of 20 010), which were mainly diagnosed from African countries and labourers; with malaria and dengue fever being mainly diagnosed. The differential infection spectrum varied in terms of the traveller's demography, travel destination and travel purpose. As such, a higher proportion of foreign travellers had blood/sexually transmitted diseases (89.85%, 2832 of 3152), while Chinese citizens had a higher prevalence of vector-borne diseases (85.98%, 19 247 of 22 387) and gastrointestinal diseases (79.36%, 1115 of 1405). The highest incidence rate was observed amongst travellers arriving from Africa, while the lowest was observed amongst travellers arriving from Europe. CONCLUSIONS: The findings might help in preparing recommendations for travellers and also aid in primary care or other clinics that prepare travellers before trips abroad. The findings will also help to identify locations and the associated types of infections that might require attention.

A driver behavior assessment and recommendation system for connected vehicles to produce safer driving environments through a "follow the leader" approach.

As part of the emerging world of intelligent transportation, there is considerable interest in developing connected vehicles that are more capable of identifying and guiding individual drivers' behavior than collecting mileage as a moving cart. The two goals of this study are (a) to build a conceptual framework for driver assessment and (b) develop recommendation systems to evaluate individual driving performance and guide driver behaviors, thus improving the network traffic conditions and individuals' perceived safety. A safety score is defined relatively by comparing a driver's individual pattern to a standard "safe driver" pattern. To elaborate, the proposed system adopts advanced data mining techniques to extract, identify, characterize, and display driving behavior patterns. The scoring system provides a basis of assessing individual drivers, who are then recommended to mimic a nearby "safe" driver in a connected environment. To evaluate and implement the proposed conceptual framework, an anonymous trajectory dataset collected from Pittsburgh urban area is applied to build the scoring system, which is then integrated within a virtually simulated environment. The results show that the proposed behavior assessment and recommendation system framework improves the overall performance of a connected traffic system beyond those attained through baseline connectivity principles.

Guideline implementation and early risk assessment in pulmonary arterial hypertension associated with congenital heart disease: A retrospective cohort study.

INTRODUCTION: Current guidelines emphasize that accurate risk stratification is important for patients with pulmonary arterial hypertension (PAH), however, few suggestions have been specified for PAH associated with congenital heart disease (PAH-CHD). OBJECTIVES: The aim of this study was to propose an accurate and simple system based on current guidelines for risk stratification in PAH-CHD patients during 12-month follow-up. METHODS: We reviewed 288 Chinese PAH-CHD patients between January 2014 and December 2016 in this retrospective cohort study. The low-risk criteria according to 2015 European Society of Cardiology guidelines and the adverse events (AEs) during follow-up were collected. The association between low-risk criteria and AEs was assessed with Cox regression, and a simplified risk stratification system was proposed. RESULTS: There were 105 PAH-CHD patients included in the final analysis. Twenty-nine patients had AEs defined as death, initiation of new or combined medication treatment, or re-hospitalisation because of the PAH worsening. Among the low-risk criteria, WHO/NYHA functional class, 6-minute walking distance (6MWD), NT-proBNP and SvO2 were significantly different between AE and AE-free groups. However, 6MWD (HR = 0.08, 95% CI: 0.03-0.19, P < 0.001) and NT-proBNP (HR = 0.35, 95% CI: 0.16-0.78, P = 0.01) were the only independent predictors of AEs in multivariable model. When taking them into a simplified system for risk stratification, the number of low-risk criteria at diagnosis discriminated the risk of AEs (P < 0.001). CONCLUSIONS: Among the low-risk criteria proposed by current guidelines, 6MWD and NT-proBNP predicted AEs independently for PAH-CHD patients. Simplified risk stratification system by taking these two parameters numerically provides accurate prognostic information in PAH-CHD patients.

Perceptions of Health Risks from Hot Weather, and Coping Behaviors among Ethnic Minority Groups in Mountain Areas of China: A Case Study in the Tujia and Miao Autonomous Prefecture.

Limited research focuses on risk perceptions of hot weather among ethnic minority groups in remote mountain areas of China. Adopting a multi-stage sampling method, this study received completed questionnaires from 643 participates in Enshi Tujia and Miao Autonomous Prefecture of China in 2017 and 2018. We used multivariate logistic regression models to explore the factors affecting risk perceptions and coping behaviors with regards to hot weather. Results showed that despite a relatively high level of risk perception, the study population in the mountain areas of China had a very low level of preparedness in responding to the risks from heat, and a lack of professional health knowledge in general. In particular, 61.3% (95% CI: 57.1%-5.6%) of the participants felt increasing temperatures in recent years, 73.2% (95% CI: 69.3%-7.0%) thought extreme high temperatures would be a health threat, and 61.3% (95% CI: 57.1%-5.4%) reported physical discomfort during hot weather. However, only 12% (95% CI: 9.5%-4.5%) had the information or knowledge to stay healthy during the extreme high temperatures, and only 24.2% had (95% CI: 20.8%-7.6%) preparation. The logistic regression models suggested that ethnic group, health status, marital status, gender, and employment could affect their perceptions, which could significantly affect the adoption of coping behaviors. In conclusion, our findings have significant implications for developing policies and health education and promotion programs for ethnic minorities in remote regions to maintain good health during hot weather.

Cortical Bone Trajectory Screw Fixation in the Upper and Middle Thoracic Spine (T1-T8): An Anatomic and Radiographic Assessment.

OBJECTIVE: To assess an alternative method of cortical bone trajectory (CBT) screw placement in the thoracic spine from T1 to T8 and to investigate the proper entry point, screw insertion angle, screw length, and diameter. METHODS: Computed tomography images of 80 patients were used to measure all related parameters. Ten cadaveric spines were studied and 4.5-mm screws were inserted into both sides of the vertebrae. Computed tomography of all vertebrae previously inserted with CBT screws was performed and lateral or medial pedicle wall violation was checked. RESULTS: Of the inserted 160 CBT screws, 41.25% (66/160) penetrated the lateral pedicle wall, and the proportion of medial pedicle wall violation accounted for 0.625% (1/160). Maximal screw length tended to gradually increase from T1 to T8 (from 24.54 mm at T1 to 29.53 mm at T8). Compared with T4 and T5, maximal screw diameters of other thoracic levels were wider, ranging from 4.63 mm at T4 to 5.53 mm at T8. The greatest lateral angle was 8.66° in men and 8.39° in women at T8, whereas the smallest lateral angle was 4.97° in men and 4.67° in women at T1. The cephalad angle ranged from 17.23° at T7 to 31.50° at T1 and it was significantly larger in men at T7 (P < 0.05), T6 and T8 (P < 0.01). CONCLUSIONS: Based on the results of this study, we suggest that patients could be placed with 4.5 × 25.0-30.0 mm CBT screws from T1 to T8 through the pedicle or pedicle rib unit.