Combined short-term and long-term emission controls improve air quality sustainably in China.

The effectiveness of national policies for air pollution control has been demonstrated, but the relative effectiveness of short-term emission reduction measures in comparison with national policies has not. Here we show that short-term abatement measures during important international events substantially reduced PM2.5 concentrations, but air quality rebounded to pre-event levels after the measures ceased. Long-term adherence to strict emission reduction policies led to successful decreases of 54% in PM2.5 concentrations in Beijing, and 23% in atmospheric nitrogen deposition in China from 2012 to 2020. Incentivized by "blue skies" type campaigns, economic development and reactive nitrogen pollution are quickly decoupled, showing that a combination of inspiring but aggressive short-term measures and effective but durable long-term policies delivers sustainable air quality improvement. However, increased ammonia concentrations, transboundary pollutant flows, and the complexity to achieving reduction targets under climate change scenarios, underscore the need for the synergistic control of multiple pollutants and inter-regional action.

Challenges and support needs in psychological and physical health among pilots: a qualitative study.

Introduction: Physical and mental health problems among pilots affect their working state and impact flight safety. Although pilots' physical and mental health problems have become increasingly prominent, their health has not been taken seriously. This study aimed to clarify challenges and support needs related to psychological and physical health among pilots to inform development of a more scientific and comprehensive physical and mental health system for civil aviation pilots. Methods: This qualitative study recruited pilots from nine civil aviation companies. Focus group interviews via an online conference platform were conducted in August 2022. Colaizzi analysis was used to derive themes from the data and explore pilots' experiences, challenges, and support needs. Results: The main sub-themes capturing pilots' psychological and physical health challenges were: (1) imbalance between family life and work; (2) pressure from assessment and physical examination eligibility requirements; (3) pressure from worries about being infected with COVID-19; (4) nutrition deficiency during working hours; (5) changes in eating habits because of the COVID-19 pandemic; (6) sleep deprivation; (7) occupational diseases; (8) lack of support from the company in coping with stress; (9) pilots' yearly examination standards; (10) support with sports equipment; (11) respecting planned rest time; and (12) isolation periods. Discussion: The interviewed pilots experienced major psychological pressure from various sources, and their physical health condition was concerning. We offer several suggestions that could be addressed to improve pilots' physical and mental health. However, more research is needed to compare standard health measures for pilots around the world in order to improve their physical and mental health and contribute to overall aviation safety.

Role of automated functional imaging and myocardial work in assessment of cardiac function in children with obstructive sleep apnea.

BACKGROUND: Early identification of abnormal left ventricular function in children with obstructive sleep apnea (OSA) is difficult using conventional echocardiographic indices and commonly used clinical markers of myocardial damage. We sought to investigate the value of automatic function imaging and myocardial work parameters in predicting early cardiac impairment in children having OSA with preserved left heart function and thereby identifying an optimal index for assessment. PATIENTS AND METHODS: Fifty-two children who presented with symptoms of nocturnal sleep snoring and open-mouth breathing and 34 healthy controls were enrolled in this study. Clinical characteristics and conventional echocardiographic data were collected, and image analysis was performed using two-dimensional speckle-tracking echocardiography to obtain left ventricular global longitudinal strain (GLS), post-systolic index, peak strain dispersion, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. RESULTS: Children with OSA had significantly lower GLS, GWI, and GCW than those without (P < 0.05). Additionally, GWI (ß = -32.87, 95% CI: -53.47 to -12.27), and GCW (ß = -35.09, 95% CI: -55.35 to -14.84) were found to correlate with the disease severity in the multiple linear regression mode, with worsening values observed as the severity of the disease increased. ROC curve analysis revealed that GCW was the best predictor of myocardial dysfunction, with an AUC of 0.809 (P < 0.001), and the best cutoff point for diagnosing myocardial damage in children with OSA was 1965.5 mmHg%, with a sensitivity of 92.5% and a specificity of 58.7%. CONCLUSIONS: GLS, GWI, and GCW were identified as predictors of myocardial dysfunction in children with OSA, with GCW being the best predictor.

Risk assessment of pesticide compounds: IPT and TCZ cause hepatotoxicity, activate stress pathway and affect the composition of intestinal flora in red swamp crayfish (Procambarusclarkii).

Isoprothiolane (IPT) and tricyclazole (TCZ) are widely used in rice farming and recently in combined rice-fish farming. However, co-cultured animals are affected by these pesticides. To investigate the organismal effects and toxicity of pesticides, crayfish were exposed to 0, 1, 10, or 100 ppt TCZ or IPT for 7 days. Pesticide bioaccumulation, survival rate, metabolic parameters, structure of intestinal flora, and antioxidant-, apoptosis-, and HSP-related gene expression were determined. Pesticide exposure caused bioaccumulation of IPT or TCZ in the hepatopancreas and muscles of crayfish; however, IPT bioaccumulation was higher than that of TCZ. Both groups showed significant changes in hepatopancreatic serum biochemical parameters. Mitochondrial damage and chromosomal agglutination were observed in hepatopancreatic cells exposed to 100 ppt IPT or TCZ. IPT induced more significant changes in serum biochemical parameters than TCZ. The results of intestinal flora showed that Vibro, Flavobacterium, Anaerorhabdus and Shewanella may have potential for use as a bacterial marker of TCZ and IPT. Antioxidant-, apoptosis-, and HSP-related gene expression was disrupted by pesticide exposure, and was more seriously affected by IPT. The results suggest that IPT or TCZ induce hepatopancreatic cell toxicity; however, IPT or TCZ content in dietary crayfish exposed to 1 ppt was below the food safety residue standard. The data indicated that IPT exposure may be more toxic than TCZ exposure in hepatopancreas and intestines and toxicity of organism are alleviated by activating the pathway of stress-response, providing an understanding of pesticide compounds in rice-fish farming and food safety.

Casting Simulation of Large-Volume Fluid Cementitious Materials: Effect of Material Properties and Casting Parameters.

The increasing pressure of traffic congestion on socio-economic development has made the construction of cross-water transportation ever more crucial. The immersed tunnel method is among the most extensively employed. However, a critical challenge of the immersed tunnel technique is to ensure the compactness and stability of concrete during the casting process. Conventional laboratory methods face challenges in achieving large-volume concrete casting, resulting in the notable waste of human and material resources. Hence, this study employs a simulation approach to investigate the casting parameters and the fresh properties of concrete, exploring their impacts on concrete stability and compactness. The results indicate that when the surface tension of concrete exceeds 0.03 N/m, and the yield stress and plastic viscosity are 50 Pa and 50 Pa·s, respectively, the concrete exhibits excellent casting compactness. A design incorporating three large and six small outlets, paired with a casting speed of 3 cm/s, achieves superior compactness. Additionally, when the yield stress of concrete exceeds 3 Pa, there is no segregation of aggregates. In cases where segregation occurs, the thixotropic property of the cement paste contributes to a significant reduction in the velocity of aggregate segregation.

A tailored approach to horizon scanning for cancer medicines.

BACKGROUND: Horizon scanning (HS) is the systematic identification of emerging therapies to inform policy and decision-makers. We developed an agile and tailored HS methodology that combined multi-criteria decision analysis weighting and Delphi rounds. As secondary objectives, we aimed to identify new medicines in melanoma, non-small cell lung cancer and colorectal cancer most likely to impact the Australian government's pharmaceutical budget by 2025 and to compare clinician and consumer priorities in cancer medicine reimbursement. METHOD: Three cancer-specific clinician panels (total n = 27) and a consumer panel (n = 7) were formed. Six prioritisation criteria were developed with consumer input. Criteria weightings were elicited using the Analytic Hierarchy Process (AHP). Candidate medicines were identified and filtered from a primary database and validated against secondary and tertiary sources. Clinician panels participated in a three-round Delphi survey to identify and score the top five medicines in each cancer type. RESULTS: The AHP and Delphi process was completed in eight weeks. Prioritisation criteria focused on toxicity, quality of life (QoL), cost savings, strength of evidence, survival, and unmet need. In both curative and non-curative settings, consumers prioritised toxicity and QoL over survival gains, whereas clinicians prioritised survival. HS results project the ongoing prevalence of high-cost medicines. Since completion in October 2021, the HS has identified 70 % of relevant medicines submitted for Pharmaceutical Benefit Advisory Committee assessment and 60% of the medicines that received a positive recommendation. CONCLUSION: Tested in the Australian context, our method appears to be an efficient and flexible approach to HS that can be tailored to address specific disease types by using elicited weights to prioritise according to incremental value from both a consumer and clinical perspective. POLICY SUMMARY: Since HS is of global interest, our example provides a reproducible blueprint for adaptation to other healthcare settings that integrates consumer input and priorities.

Evolutionary dynamics in financial markets with heterogeneities in investment strategies and reference points.

In nature and human societies, the effects of homogeneous and heterogeneous characteristics on the evolution of collective behaviors are quite different from each other. By incorporating pair pattern strategies and reference point strategies into an agent-based model, we have investigated the effects of homogeneous and heterogeneous investment strategies and reference points on price movement. In the market flooded with the investors with homogeneous investment strategies or homogeneous reference points, large price fluctuations occur. In the market flooded with the investors with heterogeneous investment strategies or heterogeneous reference points, moderate price fluctuations occur. The coexistence of different kinds of investment strategies can not only refrain from the occurrence of large price fluctuations but also the occurrence of no-trading states. The present model reveals that the coexistence of heterogeneous populations, whether they are the individuals with heterogeneous investment strategies or heterogeneous reference points of stock prices, is an important factor for the stability of the stock market.

Ecological risk assessment of pesticides on soil biota: An integrated field-modelling approach.

Pesticide residues in soils can cause negative impacts on soil health as well as soil biota. However, research related to the toxicity and exposure risks of pesticides to soil biota are scarce, especially in the North China Plain (NCP) where pesticides are intensively applied. In this study, the occurrence and distribution of 15 commonly used pesticides in 41 fields in Quzhou county in the NCP were determined during the growing season in 2020. The ecological risks of pesticides to the soil biota, including earthworms, enchytraeids, springtails, mites and nitrogen mineralization microorganisms, were assessed using toxicity exposure ratios (TERs) and risk quotient (RQ) methods. Based on pesticide detection rates and RQs, pesticide hazards were ranked using the Hasse diagram. The results showed that pesticides were concentrated in the 0-2 cm soil depth. Chlorantraniliprole was the most frequently detected pesticide with a detection rate of 37%, while the highest concentration of 1.85 mg kg-1 was found for carbendazim in apple orchards. Chlorpyrifos, carbendazim and imidacloprid posed a chronic exposure risk to E. fetida, F. candida and E. crypticus with the TERs exceeding the trigger value. Pesticide mixtures posed ecological risks to soil biota in 70% of the investigated sites. 47.5% of samples were ranked as high-risk, with the maximum RQ exceeding 490. According to the Hasse diagram, abamectin, tebuconazole, chlorantraniliprole and chlorpyrifos were ranked as the most hazardous pesticides for soil biota in the study region, indicating that alternative methods of pest management need to be considered. Therefore, practical risk mitigation solutions are recommended, in which the use of hazardous pesticides would be replaced with low-risk pesticides with similar functions from the Hasse diagram, or with biopesticides.

Assessment of community efforts to advance network-based prediction of protein-protein interactions.

Comprehensive understanding of the human protein-protein interaction (PPI) network, aka the human interactome, can provide important insights into the molecular mechanisms of complex biological processes and diseases. Despite the remarkable experimental efforts undertaken to date to determine the structure of the human interactome, many PPIs remain unmapped. Computational approaches, especially network-based methods, can facilitate the identification of previously uncharacterized PPIs. Many such methods have been proposed. Yet, a systematic evaluation of existing network-based methods in predicting PPIs is still lacking. Here, we report community efforts initiated by the International Network Medicine Consortium to benchmark the ability of 26 representative network-based methods to predict PPIs across six different interactomes of four different organisms: A. thaliana, C. elegans, S. cerevisiae, and H. sapiens. Through extensive computational and experimental validations, we found that advanced similarity-based methods, which leverage the underlying network characteristics of PPIs, show superior performance over other general link prediction methods in the interactomes we considered.

Clinical expert consensus on the assessment and protection of pancreatic islet ß-cell function in type 2 diabetes mellitus.

Islet ß-cell dysfunction is a basic pathophysiological characteristic of type 2 diabetes mellitus (T2DM). Appropriate assessment of islet ß-cell function is beneficial to better management of T2DM. Protecting islet ß-cell function is vital to delay the progress of type 2 diabetes mellitus. Therefore, the Pancreatic Islet ß-cell Expert Panel of the Chinese Diabetes Society and Endocrinology Society of Jiangsu Medical Association organized experts to draft the "Clinical expert consensus on the assessment and protection of pancreatic islet ß-cell function in type 2 diabetes mellitus." This consensus suggests that ß-cell function can be clinically assessed using blood glucose-based methods or methods that combine blood glucose and endogenous insulin or C-peptide levels. Some measures, including weight loss and early and sustained euglycemia control, could effectively protect islet ß-cell function, and some newly developed drugs, such as Sodium-glucose cotransporter-2 inhibitor and Glucagon-like peptide-1 receptor agonists, could improve islet ß-cell function, independent of glycemic control.

Effects of Medical Masks on Voice Assessment During the COVID-19 Pandemic.

OBJECTIVE: Voice assessment is of great significance to the evaluation of voice quality. Our study aims to explore the effects of medical masks on healthy people in acoustic, aerodynamic and formant parameters during the COVID-19 pandemic. In addition, we also attempted to verify the differences between different sexes and ages. METHODS: Fifty-three healthy participants (25 males and 28 females) were involved in our study. The acoustic parameters, including fundamental frequency (F0), sound pressure level (SPL), percentage of jitter (%), percentage of shimmer (%), noise to harmonic ratio (NHR) and cepstral peak prominence (CPP), aerodynamic parameter (maximum phonation time, MPT) and formant parameters (formant frequency, F1, F2, F3) without and with wearing medical masks were included. We further investigated the potential differences in the impact on different sexes and ages (≤45 years old and >45 years old). RESULTS: While wearing medical masks, the SPL significantly increased (71.22±4.25 dB, 72.42±3.96 dB, P = 0.021). Jitter and shimmer significantly decreased (jitter 1.19±0.83, 0.87±0.67 P = 0.005; shimmer 4.49±2.20, 3.66±2.02 P = 0.002), as did F3 (2855±323.34 Hz, 2781.89±353.42 Hz P = 0.004). F0, MPT, F1 and F2 showed increasing trends without statistical significance, and NHR as well as CPP showed little change without and with wearing medical masks. There were no significant differences seen between males and females. Regarding to age, a significant difference in MPT was seen (>45-year-old 16.15±6.98 s, 15.38±7.02 s; ≤45-year-old 20.26±6.47 s, 21.44±6.98 s, P = 0.032). CONCLUSION: Healthy participants showed a significantly higher SPL, a smaller perturbation and an evident decrease in F3 after wearing medical masks. These changes may result from the adjustment of the vocal tract and the filtration function of medical masks, leading to the stability of voices we recorded being overstated. The impacts of medical masks on sex were not evident, while the MPT in the >45-year-old group was influenced more than that in the ≤45-year-old group.

Pesticide screening and health risk assessment of residential dust in a rural region of the North China Plain.

Pesticides that have accumulated in arable soil could be easily transported by wind erosion, thereby potentially threating air quality and human health in surrounding areas. The risks this poses to farmers exposed to pesticide-associated dust is still unknown, especially in rural areas of China. In this study, we screened pesticide residues in dust (indoor and outdoor) collected from the homes and yards of pesticide sprayers (21 participants) and farm workers (14 participants) living in Quzhou County located in the North China Plain to assess health risks by exposed to pesticide-contaminated dust. The results showed that multiple pesticide residues were detected in the dust samples and more than 90% of the samples contained over 10 pesticide residues. The maximum detected number of residues was 23, out of the 25 pesticides currently used in the farming area. There was a wide range of pesticide concentrations with the geometric mean values measuring between 0.03 and 0.86 mg kg-1. More residues and higher concentrations of pesticides were detected in indoor dust compared to outdoor dust. Over the monitoring period, the pesticide application has not caused significant pesticide accumulation in dust. The measured concentrations of carbendazim, dimethomorph, dimethomorph and pendimethalin paired indoor-outdoor dust samples were significantly correlated (p < 0.05). The health risks were assessed using the hazard index (HI) and highest HI was found for children under indoor exposure (HI = 0.82). In addition, based on the survey and statistics, pesticide preparation in the home was significantly correlated with the pesticide indoor exposure level. Therefore, farmers should take measures, such as preparing pesticides outside of the house or in the open fields with protection, in order to avoid the exposure risk of pesticides associated with dust.

Opportunity Costs of Internal Promotions in Plastic Surgery: Are Women Given a Fair Shot?

Background: Academic advancement in plastic surgery necessitates creation of opportunities for rising faculty, which are pivotal for women in their efforts to close prominent gender gaps in higher ranks. We study positions of academic prestige that benefit from internal nomination as surrogates for opportunities afforded to men and women seeking leadership roles. Methods: We collected the following datapoints: authors of invited discussions published in Plastic and Reconstructive Surgery from 2010 to 2019; current editorial board members of representative plastic surgery journals; recipients of society-sponsored traveling fellowships; and directors of the American Board of Plastic Surgery. Public profiles for all authors and surgeons were referenced to confirm gender identification. Results: Seven-hundred ninety-seven plastic and reconstructive surgery discussions were included, 18% of which included female first or senior authorship. Seventy-one (9%) discussions listed a female senior author. Male and female senior authors were equally as likely to collaborate with a female first co-author (25% and 26%, respectively). Only 17% of invited authors contributed to 55% of discussion articles. Women occupied 19% of journal editorial board positions, though none were editors-in-chief. American Society of Reconstructive Microsurgery, American Society of Maxiliofacial Surgeons, American Society for Surgery of the Hand, and Plastic Surgery Foundation traveling fellowships were awarded to one (3%), four (7%), five (13%), and 141 (15%) female plastic surgeons, respectively. Women comprise 26% of directors of American Board of Plastic Surgery. Conclusions: Female representation in plastic surgery is rising, but it is not mirrored across appointed positions in academia. We should strive to support advancements that allow selected prestigious positions to more accurately reflect the gender distribution within the plastic surgery community.

Study on water resources carrying capacity in Zhuanglang River Basin.

With the rapid development of China's social economy, the phenomenon of unbalanced regional economic development is increasingly obvious. The shortage of water resources in northwest China is an important constraint to local development. The study on the water resources carrying capacity of the Zhuanglang River Basin plays an important role in the development of local economy; thus, we evaluate the water resources situation of Zhuanglang River Basin by using hydrology-related calculation method, combining with field investigation, visiting relevant departments, and referring to relevant data. Meanwhile, the water resources carrying capacity of 3 counties and 12 townships in the Zhuanglang River Basin in the current year are studied and analyzed based on methods such as fuzzy comprehensive evaluation model and quantitative calculation. Results indicate that the carrying capacity of water resources in Zhuanglang river basin can mostly meet the needs of township, but it is necessary to further optimize the water resources carrying capacity of the Zhuanglang River Basin from the four systems of water resources, society, economy, and ecology in the future. Besides, the results of quantitative calculation show that the maximum economic scale that water resources can withstand in most areas of the Zhuanglang River Basin is the overall well-off level, that is, the per capita domestic water is 80L/(d· person), and the per capita GDP is 10000 yuan/person. But there is still a certain gap to achieve the level, when the people are well-off in an all-round way, the two indexes are correspondently raised to 120L/(d· person), and the per capita GDP is 30,000 yuan/person.

Cost-Effective Fabrication of Micro-Nanostructured Superhydrophobic Polyethylene/Graphene Foam with Self-Floating, Optical Trapping, Acid-/Alkali Resistance for Efficient Photothermal Deicing and Interfacial Evaporation.

Solar evaporation is one of the most attractive and sustainable approaches to address worldwide freshwater scarcity. Unfortunately, it is still a crucial challenge that needs to be confronted when the solar evaporator faces harsh application environments. Herein, a promising polymer molding method that combines melt blending and compression molding, namely micro extrusion compression molding, is proposed for the cost-effective fabrication of lightweight polyethylene/graphene nanosheets (PE/GNs) foam with interconnected vapor escape channels and surface micro-nanostructures. A contact angle of 155 ± 2°, a rolling angle of 5 ± 1° and reflectance of ≈1.6% in the wavelength range of 300-2500 nm appears on the micro-nanostructured PE/GNs foam surface. More interestingly, the micro-nanostructured PE/GNs foam surface can maintain a robust superhydrophobic state under dynamic impacting, high temperature and acid-/alkali solutions. These results mean that the micro-nanostructured PE/GNs foam surface possesses self-cleaning, anti-icing and photothermal deicing properties at the same time. Importantly, the foam exhibits an evaporation rate of 1.83 kg m-2 h-1 under 1 Sun illumination and excellent salt rejecting performance when it is used as a self-floating solar evaporator. The proposed method provides an ideal and industrialized approach for the mass production of solar evaporators suitable for practical application environments.

Integrating life cycle assessment and a farmer survey of management practices to study environmental impacts of peach production in Beijing, China.

While intensive peach production has expanded rapidly in recent years, few studies have explored the environmental impacts associated with specific regional systems or the optimal management strategies to minimize associated environmental risks. Here, data from a survey of 290 native farmers were used to conduct a life cycle assessment to quantify the acidification potential (AP), global warming potential (GWP), eutrophication potential (EP), and reactive nitrogen (Nr) losses in peach production in Pinggu District, Beijing. Total annual Nr losses, and GWP, AP, and EP values for peach production in Pinggu District were respectively 10.7 kg N t-1, 857 kg CO2-eq t-1, 12.9 kg SO2-eq t-1, and 4.1 kg PO4-eq t-1. The principal driving factors were fertilizer production, transportation, and application, which together accounted for 94%, 67%, 75%, and 94% of Nr losses, GWP, AP, and EP, respectively. In the high yield, high nitrogen-use efficiency (HH) group, relative values of Nr losses, GWP, AP, and EP were respectively 33%, 25%, 39%, and 32% lower than the overall averages for 290 orchards. Further analyses indicate that improved farming practices such as decreasing application rates of fertilizers, increasing proportion of base fertilization rate, and proper fertilization frequency in the HH group were the main reasons for these orchards' better performance in peach yields and partial factor productivity of nitrogen fertilizer, and their reduced environmental impacts. These results highlight the need to optimize nutrient management in peach production in order simultaneously to realize both environmental sustainability and high productivity in the peach production system.

Market impact shapes competitive advantage of investment strategies in financial markets.

The formation of an efficient market depends on the competition between different investment strategies, which accelerates all available information into asset prices. By incorporating market impact and two kinds of investment strategies into an agent-based model, we have investigated the coevolutionary mechanism of different investment strategies and the role of market impact in shaping a competitive advantage in financial markets. The coevolution of history-dependent strategies and reference point strategies depends on the levels of market impact and risk tolerance. For low market impact and low risk tolerance, the majority-win effect makes the trend-following strategies become dominant strategies. For high market impact and low risk tolerance, the minority-win effect makes the trend-rejecting strategies coupled with trend-following strategies become dominant strategies. The coupled effects of price fluctuations and strategy distributions have been investigated in depth. A U-shape distribution of history-dependent strategies is beneficial for a stable price, which is destroyed by the existence of reference point strategies with low risk tolerance. A δ-like distribution of history-dependent strategies leads to a large price fluctuation, which is suppressed by the existence of reference point strategies with high risk tolerance. The strategies that earn more in an inefficient market lose more in an efficient market. Such a result gives us another explanation for the principle of risk-profit equilibrium in financial markets: high return in an inefficient market should be coupled with high risk in an efficient market, low return in an inefficient market should be coupled with low risk in an efficient market.

Selection of OSA-specific pronunciations and assessment of disease severity assisted by machine learning.

STUDY OBJECTIVES: To screen all of the obstructive sleep apnea (OSA)-characteristic pronunciations, explore the pronunciations which provide a better OSA classification effect than those used previously, and further clarify the correlation between speech signals and OSA. METHODS: A total of 158 adult male Mandarin native speakers who completed polysomnography at the Sleep Medicine Center of Beijing Tongren Hospital from November 15, 2019, to January 19, 2020, were enrolled in this study. All Chinese syllables were collected from each participant in the sitting position. The syllables, vowels, consonants, and tones were screened to identify the pronunciations that were most effective for OSA classification. RESULTS: The linear prediction coefficients of Chinese syllables were extracted as features and mathematically modeled using a decision tree model to dichotomize participants with apnea-hypopnea index thresholds of 10 and 30 events/h, and the leave-one-out method was used to verify the classification performance of Chinese syllables for OSA. Chinese syllables such as [leng] and [jue], consonant pronunciations such as [zh] and [f], and vowel pronunciations such as [ing] and [ai] were the most suitable pronunciations for classification of OSA. An OSA classification model consisting of several syllable combinations was constructed, with areas under curve of 0.83 (threshold of apnea-hypopnea index = 10) and 0.87 (threshold of apnea-hypopnea index = 30), respectively. CONCLUSIONS: This study is the first comprehensive screening of OSA-characteristic pronunciations and can act as a guideline for the construction of OSA speech corpora in other languages. CITATION: Ding Y, Sun Y, Li Y, et al. Selection of OSA-specific pronunciations and assessment of disease severity assisted by machine learning. J Clin Sleep Med. 2022;18(11):2663-2672.

A National Quality Improvement Program on Ultrasound Department in China: A Controlled Cohort Study of 1297 Public Hospitals.

Providing high-quality medical services is of great importance in the imaging department, as there is a growing focus on personal health, and high-quality services can lead to improved patient outcomes. Many quality improvement (QI) programs with good guidance and fine measurement for improvement have been reported to be effective. In order to improve the quality of ultrasound departments in China, we conducted this study of a national quality improvement program. A total of 1297 public hospitals were included in this QI program on ultrasound departments in China from 2017 to 2019. The effect of this QI program was investigated, and potential factors, including hospital level and local economic development, were considered. The outcome indicators, the positive rate and diagnostic accuracy, were improved significantly between the two phases (positive rate, 2017 vs. 2019: 66.21% vs. 73.91%, p < 0.001; diagnostic accuracy, 2017 vs. 2019: 85.37% vs. 89.74%; p < 0.001). Additionally, they were improved in secondary and tertiary hospitals, with the improvement in secondary hospitals being greater. Notably, the enhancement of diagnostic accuracy in low-GDP provinces was almost 20%, which was more significant than the enhancement in high-GDP provinces. However, the important structural indicator, the doctor-to-patient ratio, decreased from 1.05:10,000 to 0.96:10,000 (p = 0.026). This study suggests that the national ultrasound QI program improved the outcome indicators, with secondary-level hospitals improving more than tertiary hospitals and low-GDP provinces improving more than high-GDP regions. Additionally, as there is a growing need for ultrasound examinations, more ultrasound doctors are needed in China.

Multi-pollutant assessment of river pollution from livestock production worldwide.

Livestock production is often a source of multiple pollutants in rivers. However, current assessments of water pollution seldomly take a multi-pollutant perspective, while this is essential for improving water quality. This study quantifies inputs of multiple pollutants to rivers from livestock production worldwide, by animal types and spatially explicit. We focus on nitrogen (N), phosphorus (P), and Cryptosporidium (pathogen). We developed the MARINA-Global-L (Model to Assess River Inputs of pollutaNts to seAs for Livetsock) model for 10,226 sub-basins and eleven livestock species. Global inputs to land from livestock are around 94 Tg N, 19 Tg P, and 2.9 × 1021 oocysts from Cryptosporidium in 2010. Over 57% of these amounts are from grazed animals. Asia, South America, and Africa account for over 68% of these amounts on land. The inputs to rivers are around 22 Tg Total Dissolved Nitrogen (TDN), 1.8 Tg Total Dissolved P (TDP), and 1.3 × 1021 oocysts in 2010. Cattle, pigs, and chickens are responsible for 74-88% of these pollutants in rivers. One-fourth of the global sub-basins can be considered pollution hotspots and contribute 71-95% to the TDN, TDP, and oocysts in rivers. Our study could contribute to effective manure management for individual livestock species in sub-basins to reduce multiple pollutants in rivers.