Economic and Sustainability Impacts of Yield and Composition Variation in Bioenergy Crops: Switchgrass (Panicum virgatum L.).

Economically viable production of biobased products and fuels requires high-yielding, high-quality, sustainable process-advantaged crops, developed using bioengineering or advanced breeding approaches. Understanding which crop phenotypic traits have the largest impact on biofuel economics and sustainability outcomes is important for the targeted feedstock crop development. Here, we evaluated biomass yield and cell-wall composition traits across a large natural variant population of switchgrass (Panicum virgatum L.) grown across three common garden sites. Samples from 331 switchgrass genotypes were collected and analyzed for carbohydrate and lignin components. Considering plant survival and biomass after multiple years of growth, we found that 84 of the genotypes analyzed may be suited for commercial production in the southeastern U.S. These genotypes show a range of growth and compositional traits across the population that are apparently independent of each other. We used these data to conduct techno-economic analyses and life cycle assessments evaluating the performance of each switchgrass genotype under a standard cellulosic ethanol process model with pretreatment, added enzymes, and fermentation. We find that switchgrass yield per area is the largest economic driver of the minimum fuel selling price (MSFP), ethanol yield per hectare, global warming potential (GWP), and cumulative energy demand (CED). At any yield, the carbohydrate content is significant but of secondary importance. Water use follows similar trends but has more variability due to an increased dependence on the biorefinery model. Analyses presented here highlight the primary importance of plant yield and the secondary importance of carbohydrate content when selecting a feedstock that is both economical and sustainable.

Ecological risk assessment of potentially toxic elements in selenium-rich soil with different land-use types.

Dashan Village area is one of the representative areas in China with high selenium concentration in the natural environment. A total of 133 topsoil samples have been collected in the Dashan Village area to explore the potential toxic elements (PTEs) background concentrations in soils under different land-use types for a comprehensive PTEs risk assessment (arsenic, cadmium, chromium, copper, mercury, nickel, lead, selenium and zinc). The results show that the geometric mean concentrations of As, Cr, Cu, Hg, Ni, Pb, Se and Zn found in the soil of the Dashan Village area were lower than the control standard for soil contamination risk in agricultural land. However, the geometric mean concentrations of Cd exceeded their corresponding standard values. For different land-use types, geometric mean concentrations of As, Cd, Cu, Hg, Ni and Pb in the arable soils were higher than in woodland soils and tea garden soils. Based on the potential ecological risk assessment, the woodland, arable and tea garden were at low-risk levels. Cadmium posed the highest ecological risk, while the other PTEs were of low risk in soils. Multiple statistical analyses and geostatistical analysis indicated that the concentrations of Cr, Ni, Pb, Cu, Zn and Se originated mainly from natural sources, while the concentrations of Cd, As and Hg could be influenced by anthropogenic activities. These results provide scientific support for the safe utilization and ecological sustainability of selenium-rich land resources.

Assessment of the Effect on Thromboprophylaxis with Multifaceted Quality Improvement Intervention based on Clinical Decision Support System in Hospitalized Patients: A Pilot Study.

Background: To explore the feasibility and effectiveness of multifaceted quality improvement intervention based on the clinical decision support system (CDSS) in VTE prophylaxis in hospitalized patients. Methods: A randomized, department-based clinical trial was conducted in the department of respiratory and critical care medicine, orthopedic, and general surgery wards. Patients aged ≥18 years, without VTE in admission, were allocated to the intervention group and received regular care combined with multifaceted quality improvement intervention based on CDSS during hospitalization. VTE prophylaxis rate and the occurrence of hospital-associated VTE events were analyzed as primary and secondary outcomes. Results: A total of 3644 eligible residents were enrolled in this trial. With the implementation of the multifaceted quality improvement intervention based on the CDSS, the VTE prophylaxis rate of the intervention group increased from 22.93% to 34.56% (p < 0.001), and the incidence of HA-VTE events increased from 0.49% to 1.00% (p = 0.366). In the nonintervention group, the VTE prophylaxis rate increased from 24.49% to 27.90% (p = 0.091), and the incidence of HA-VTE events increased from 0.47% to 2.02% (p = 0.001). Conclusions: Multifaceted quality improvement intervention based on the CDSS strategy is feasible and expected to facilitate implementation of the recommended VTE prophylaxis strategies and reduce the incidence of HA-VTE in hospital. However, it is necessary to conduct more multicenter clinical trials in the future to provide more reliable real-world evidence.

Hierarchical Self-Assembly of Nanowires on the Surface by Metallo-Supramolecular Truncated Cuboctahedra.

Parastichy, the spiral arrangement of plant organs, is an example of the long-range apparent order seen in biological systems. These ordered arrangements provide scientists with both an aesthetic challenge and a mathematical inspiration. Synthetic efforts to replicate the regularity of parastichy may allow for molecular-scale control over particle arrangement processes. Here we report the packing of a supramolecular truncated cuboctahedron (TCO) into double-helical (DH) nanowires on a graphite surface with a non-natural parastichy pattern ascribed to the symmetry of the TCOs and interactions between TCOs. Such a study is expected to advance our understanding of the design inputs needed to create complex, but precisely controlled, hierarchical materials. It is also one of the few reported helical packing structures based on Platonic or Archimedean solids since the discovery of the Boerdijk-Coxeter helix. As such, it may provide experimental support for studies of packing theory at the molecular level.

Glyphosate, aminomethylphosphonic acid, and glufosinate ammonium in agricultural groundwater and surface water in China from 2017 to 2018: Occurrence, main drivers, and environmental risk assessment.

Glyphosate and glufosinate ammonium are the main herbicides used to control weeds in no-tillage agricultural fields in China. However, their leaching risk to groundwater and ecological risk to aquatic organisms remain unclear. From the agricultural basins among 10 provinces of China, glyphosate, its main metabolite aminomethylphosphonic acid (AMPA), and glufosinate ammonium were detected in 1.01%, 0.86%, 0% of 694 groundwater samples with the maximum concentrations of 2.09, 5.13, and <0.05 µg/L, and were detected in 14.3%, 15.8%, and 2.6% of 196 surface water samples with the maximum levels of 32.49, 10.31 and 13.15 µg/L. Furthermore, to evaluate the main drivers of exposure to the targets in water bodies, the fate models were used. The model simulation indicated that spray drift and overflow runoff were the key factors affecting the exposure to targets in surface water adjacent to rice field, whereas the spray drift deposition, runoff, and erosion induced the exposure to the targets in pond water close to dry land crop fields under different meteorological conditions and soil characteristics. The targets in groundwater posed a low risk to water consumption, while fish embryos might be at unacceptable risk due to glufosinate ammonium exposure in surface water with median risk quotient (RQ) equal to 55.6. The results highlight the spatial and seasonal distribution of glyphosate, AMPA, and glufosinate ammonium in groundwater and surface water in agricultural basins of China, providing the first evidence to the environmental risk of the targets to drinking water consumption and aquatic organism safety in China agriculture system.

Systematic Analysis of Metabolic Pathway Distributions of Bacterial Energy Reserves.

Previous bioinformatics studies have linked gain or loss of energy reserves with host-pathogen interactions and bacterial virulence based on a comparatively small number of bacterial genomes or proteomes. Thus, understanding the theoretical distribution patterns of energy reserves across bacterial species could provide a shortcut route to look into bacterial lifestyle and physiology. So far, five major energy reserves have been identified in bacteria due to their capacity to support bacterial persistence under nutrient deprivation conditions. These include polyphosphate (polyP), glycogen, wax ester (WE), triacylglycerol (TAG), and polyhydroxyalkanoates (PHAs). Although the enzymes related with metabolism of energy reserves are well understood, there is a lack of systematic investigations into the distribution of bacterial energy reserves from an evolutionary point of view. In this study, we sourced 8282 manually reviewed bacterial reference proteomes and combined a set of hidden Markov sequence models (HMMs) to search homologs of key enzymes related with the metabolism of energy reserves. Our results revealed that specific pathways like trehalose-related glycogen metabolism and enzymes such as wax ester synthase/acyl-CoA:diacylglycerol acyltransferase (WS/DGAT) are mainly restricted within specific types of bacterial groups, which provides evolutionary insights into the understanding of their origins and functions. In addition, the study also confirms that loss of energy reserves like polyP metabolism absence in Mollicutes is correlated with bacterial genome reduction. Through this analysis, a clearer picture about the metabolism of energy reserves in bacteria is presented, which could serve as a guide for further theoretical and experimental analyses of bacterial energy metabolism.

Healthcare costs among patients with hemophilia A treated with factor replacement or bypassing agents.

Objective: To assess real-world costs for patients with hemophilia A treated with bypassing agents versus factor VIII (FVIII) replacement. Methods: Claims data from a large US health insurer during 1 January 2006-30 September 2014 were used for analysis. Treated patients with hemophilia A were identified based on ≥1 medical claim with a diagnosis code for hemophilia A (ICD-9-CM 286.0) and ≥1 medical or pharmacy claim for bypassing therapy and/or FVIII replacement during 1 January 2007-31 August 2014. The bypassing therapy cohort comprised patients with ≥1 claim for bypassing therapy; all others were assigned to the factor replacement therapy cohort. Post-index hemophilia-related costs were computed as combined health plan plus patient paid amounts for medical claims with hemophilia A diagnosis code or hemophilia therapy procedure code (bypassing therapy, FVIII replacement therapy, desmopressin, antifibrinolytic therapy), as well as pharmacy claims for hemophilia therapy. Results: The study sample represented 580 patients: 50 (8.6%) in the bypassing therapy cohort (mean age: 38.5 years; mean post-index period: 2.1 years) and 530 (91.4%) in the factor replacement therapy cohort (mean age: 29.3 years; mean post-index period: 2.7 years). Compared with the factor replacement therapy cohort, mean per-patient-per-month hemophilia-related total costs were 4.8-fold higher in the bypassing therapy cohort ($57,232 vs. $11,899), comprising 4.4-fold higher medical costs ($45,911 vs. $10,352) and 7.3-fold higher outpatient pharmacy costs ($11,321 vs. $1547). Conclusions: Patients with hemophilia A treated with bypassing agents between 2007 and 2014 incurred substantially higher monthly hemophilia-related medical and pharmacy costs than patients treated only with FVIII replacement.

Assessment of heavy metals, fungicide quintozene and its hazardous impurity residues in medical Panax notoginseng (Burk) F.H.Chen root.

A quick, easy, cheap, effective, rugged, and safe extraction approach and gas chromatography/tandem mass spectrometry with programmed temperature vaporization sampling technology were used to determine fungicide quintozene and its hazardous impurity hexachlorobenzene (HCB) in Panax notoginseng root, which is commonly used as a rare traditional Chinese medicine worldwide. The mean recoveries were in the ranges of 94-125 and 84-119% for quintozene and HCB with relative standard deviations of 6.2-16.1% at three concentrations: 0.01, 0.1 and 1 mg kg-1 . Heavy metals arsenic, cadmium, copper and lead were simultaneously detected by an inductively coupled plasma-mass spectrometry approach after digestion with nitric acid. The above methods were used to analyze 50 samples of P. notoginseng roots collected at markets and planting bases from the special local producing areas, namely, Honghe, Kunming and Wenshan in Yunnan province, China. Quintozene and HCB in root samples were determined at <0.0015-1.50 and <0.0015-0.125 mg kg-1 . In the 50 samples, 60, 16, 56, 2 and 6% exceeded the maximum permissible levels in medicinal plants (WM/T2-2004) for quintozene, arsenic, cadmium, lead and copper. The results showed that the method is robust and suitable for measuring quintozene, its hazardous impurity and heavy metals in P. notoginseng roots.

Assessment of the dissipation, pre-harvest interval and dietary risk of carbosulfan, dimethoate, and their relevant metabolites in greenhouse cucumber (Cucumis sativus L.).

BACKGROUND: The dissipation behavior, pre-harvest interval and dietary risk of carbosulfan, dimethoate, and their relevant metabolites were investigated in greenhouse cucumber in Tianjin, northern China, to ensure raw consumption safety. RESULTS: Carbosulfan was metabolized to carbofuran, dibutylamine, 3-hydroxycarbofuran and 3-ketocarbofuran, and dimethoate was degraded to omethoate in cucumber fruits and leaves. The dissipation of carbosulfan, carbofuran, 3-hydroxycarbofuran and dimethoate fitted first-order kinetics well, with R2 ranging from 0.912 to 0.992, and their half-lives were 2.6, 2.7, 2.4 and 5.2 days in cucumber fruits and 2.8, 3.0, 4.6 and 2.5 days in leaves, respectively. The estimated daily intakes of the active ingredients and their relevant metabolites were 0.1-4% of the corresponding acceptable daily intakes. Acute oral exposure to carbofuran (a metabolite of carbosulfan) represented 367% of the acute reference dose (ARfD) for 1-6-year-old Chinese children and 227% for the general Chinese population. CONCLUSION: A minimum pre-harvest interval of 12 days for carbosulfan is proposed to ensure safe consumption of cucumber. The slow dissipation rate of omethoate in cucumber reveals that a longer pre-harvest interval (≥ 27 days) is necessary to prevent dietary risk when dimethoate is applied to cucumber. © 2018 Society of Chemical Industry.

Patient-centered assessment on disease burden, quality of life, and treatment satisfaction associated with acromegaly.

The study aimed to assess the economic burden, health-related quality of life (HRQoL), and acromegaly treatment satisfaction in the USA. A web-based, cross-sectional survey was distributed to members of Acromegaly Community. Data related to comorbidities, treatment patterns, and treatment satisfaction were collected. The costs over the past 3 months included out-of-pocket cost, sick leave, leave of absence, direct loss of job due to acromegaly, unemployment, assistance to perform household chores, and family member loss of income. The HRQoL was assessed by Acromegaly Quality of Life (AcroQoL) and EQ-5D-3L questionnaires. Among 106 patients who completed the survey (mean age: 46 years, female: 76.4%), 44.3% presented with ≥5 comorbidities, and 90.6% reporting acromegaly-related symptoms. Compared with the low-symptom group 0-3 (n=41), the 4+ symptoms group (n=65) was more likely to have depression (OR=2.3, 95% CI 1.1 to 5.2) and cardiovascular disease (OR=5.8, 95% CI 2.0 to 16.7), and experienced higher costs (loss of job: $8874 vs $1717, P=0.02; unemployment disability: $17,102 vs $429, P=0.003; household chores: $2160 vs $932, P=0.0003; family members' income loss: $692 vs $122, P=0.03). The high-symptom group had lower HRQoL scores, compared with the low-symptom group (EQ-5D-3L: 0.53 vs 0.75, P<0.0001; AcroQoL: 27 vs 56, P<0.0001). Only 55.7% among patients requiring injections for acromegaly were satisfied. Patients with acromegaly who presented with multiple acromegaly-related symptoms were evidenced to have experienced higher economic burden and poorer quality of life than patients with the same diagnosis but fewer symptoms. The low rate of treatment satisfaction warrants need for further studies.

Automatic single-step quick, easy, cheap, effective, rugged and safe sample preparation devices for analysis of pesticide residues in foods.

In this research, the manual two-step QuEChERS approach has been streamlined and automated into a one-step method using a cleanup tube fitted within an extraction tube. A novel automatic QuEChERS combination have been developed to simplify the QuEChERS procedures and improve sample preparation efficiency. This combination integrates QuEChERS procedures into a single run via the use of a vortex vibration-centrifuge device and a centrifuge filtration tube. To validate the efficiency of our automatic QuEChERS device, 270 pesticides were analyzed in plant origined foods including celery, tomatoes, leeks, eggplants, grapes, corn, green tea, and soybean oil using this automatic platform. The results were then compared with those obtained using the manual QuEChERS method. Different parameters were validated and compared including recovery, linearity, repeatability and limits of quantification (LOQ). Satisfactory results, comparable to results obtained using the manual QuEChERS method were obtained. The average recoveries ranged between 70% and 120% for most pesticides with associated relative standard deviations (RSDs) <20% (n=5) indicating satisfactory accuracy and repeatability. An LOQ of 2µg/kg was obtained for most pesticides present in celery and corn matrices, and the correlation coefficients (r2) were >0.990 within a linearity range of 2-500µg/kg. Compared to manual QuEChERS, this novel automatic QuEChERS device and combination could significantly improve the sample preparation efficiency for the multiresidue analysis of pesticides.

Regional disparities in the quality of stroke care.

BACKGROUND AND PURPOSE: There is widespread geographic variation in healthcare quality, but we often lack clear strategies for improving quality in underserved areas. This study characterized geographic disparities in stroke care quality to assess whether improved access to neurological services has the potential to bridge the care quality gap, particularly in terms of alteplase (rt-PA) administration. METHODS: This was a retrospective study using quality performance data from the 2015 Hospital Compare database linked to information on certification status from the Joint Commission and information on local access to neurological services from the Area Health Resources File. We used these data to compare stroke care quality according to geographic area, certification, and neurologist access. RESULTS: Non-metropolitan hospitals performed worse than metropolitan hospitals on all assessed stroke care quality measures. The most prevalent disparity occurred in the use of rt-PA for eligible patients (52.2% versus 82.7%, respectively). Certified stroke centers in every geographic designation provided higher quality of care, whereas large variation was observed among non-certified hospitals. Regression analyses suggested that improvements in hospital certification or access to neurologists were associated with absolute improvements of 44.9% and 21.3%, respectively, in the percentage of patients receiving rt-PA. CONCLUSIONS: The large quality gap in stroke care between metropolitan and non-metropolitan areas could be at least partly addressed through improved procedural efforts by stroke center certification increasing the supply of neurological services, (i.e. through training and hiring new neurologists) or by adopting decision support systems such as telemedicine.

Dependency and health utilities in stroke: Data to inform cost-effectiveness analyses.

INTRODUCTION: Health utilities (HU) assign preference weights to specific health states and are required for cost-effectiveness analyses. Existing HU for stroke inadequately reflect the spectrum of post-stroke disability. Using international stroke trial data, we calculated HU stratified by disability to improve precision in future cost-effectiveness analyses. MATERIALS AND METHODS: We used European Quality of Life Score (EQ-5D-3L) data from the Virtual International Stroke Trials Archive (VISTA) to calculate HU, stratified by modified Rankin Scale scores (mRS) at 3 months. We applied published value sets to generate HU, and validated these using ordinary least squares regression, adjusting for age and baseline National Institutes of Health Stroke Scale (NIHSS) scores. RESULTS: We included 3858 patients with acute ischemic stroke in our analysis (mean age: 67.5 ± 12.5, baseline NIHSS: 12 ± 5). We derived HU using value sets from 13 countries and observed significant international variation in HU distributions (Wilcoxon signed-rank test p < 0.0001, compared with UK values). For mRS = 0, mean HU ranged from 0.88 to 0.95; for mRS = 5, mean HU ranged from -0.48 to 0.22. OLS regression generated comparable HU (for mRS = 0, HU ranged from 0.9 to 0.95; for mRS = 5, HU ranged from -0.33 to 0.15). Patients' mRS scores at 3 months accounted for 65-71% of variation in the generated HU. CONCLUSION: We have generated HU stratified by dependency level, using a common trial endpoint, and describing expected variability when applying diverse value sets to an international population. These will improve future cost-effectiveness analyses. However, care should be taken to select appropriate value sets.

Perfluorinated Compounds in Greenhouse and Open Agricultural Producing Areas of Three Provinces of China: Levels, Sources and Risk Assessment.

Field investigations on perfluoroalkyl acid (PFAA) levels in various environmental matrixes were reported, but there is still a lack of PFAA level data for agricultural environments, especially agricultural producing areas, so we collected soil, irrigation water and agricultural product samples from agricultural producing areas in the provinces of Liaoning, Shandong and Sichuan in China. The background pollution from instruments was removed and C4-C18 PFAAs were detected by LC-MS/MS. The concentrations of PFAAs in the top and deep layers of soil were compared, and the levels of PFAAs in different agricultural environments (greenhouses and open agriculture) were analyzed. We found the order of PFAA levels by province was Shandong > Liaoning > Sichuan. A descending trend of PFAA levels from top to deep soil and open to greenhouse agriculture was shown and perfluorobutanoic acid (PFBA) was considered as a marker for source analysis. Bean vegetables contribute highly to the overall PFAA load in vegetables. A significant correlation was shown between irrigation water and agricultural products. The EDI (estimated daily intake) from vegetables should be of concern in China.

Clinical and Economic Burden of Commercially Insured Patients with Acromegaly in the United States: A Retrospective Analysis.

BACKGROUND: Acromegaly is a chronic disorder characterized by excess growth hormone secretion and elevated insulin-like growth factor-1 levels most often caused by a pituitary adenoma. Clinical presentation of the disease includes coarsening of the facial features, soft-tissue swelling of the hands and feet, and overgrowth of the frontal skull and protrusion of the jaw, as well as joint symptoms. Acromegaly is associated with several comorbidities, including diabetes, cardiovascular disease, and arthropathy, which, if left untreated, can lead to early mortality. Surgery to remove the adenoma is the first-line treatment for many patients, but more than 50% of patients will require additional pharmacologic or radiation therapy. OBJECTIVES: To (a) determine the clinical and economic burden of illness among patients with acromegaly using administrative claims data from a large, commercially insured population in the United States and (b) estimate the most frequent acromegaly-related comorbidities and health care resource utilization and costs among these patients. METHODS: This retrospective, observational cohort study used administrative claims data from the HealthCore Integrated Research Database, containing a geographically diverse spectrum of longitudinal claims data from the largest database of commercially insured patients in the United States. Patients were aged ≥ 20 years and fulfilled ≥ 1 of the following criteria during the intake period (March 31, 2008-July 31, 2012): ≥ 2 independent diagnostic codes for acromegaly, ≥ 1 acromegaly diagnosis code and ≥ 1 acromegaly-related procedure code, or ≥ 1 acromegaly diagnosis code and ≥ 1 medical claim for acromegaly-related therapy. The index date was defined as the date of the first medical claim for acromegaly within the intake period. Assessed outcomes included prevalence of acromegaly diagnosis and incidence of new acromegaly diagnoses during the study period (January 1, 2008-July 31, 2013), acromegaly-related comorbidities, and pharmacotherapy use. Because 2008 and 2012 data were incomplete, incidence rates were only reported for 2009, 2010, and 2011. Total and acromegaly-related health care resource utilization and annual health care costs were analyzed during a 12-month post-index observational period. RESULTS: In total, 757 patients with acromegaly met the selection criteria for this study, with a mean age of 49.3 years (53.6% female). The total prevalence of acromegaly was 41.7 cases per million. Acromegaly incidence was 15.0, 13.3, and 9.5 cases per million in 2009, 2010, and 2011, respectively. The top 5 acromegaly-related comorbidities were hypertension, diabetes, hypothyroidism, arthropathy/arthralgia/synovitis, and sleep apnea. During the study period, 51% of patients (n = 385) used acromegaly-related pharmacologic therapy, with the most common being cabergoline and octreotide (used by 12.4% and 12.2% of patients, respectively). Overall, 18.8% of patients incurred an acromegaly-related inpatient stay; 97.0% used outpatient services other than emergency room (ER) or physician visits; 74.8% had a physician office visit; and 1.8% visited the ER for acromegaly-related reasons. In the 12-month post-index period, 37.0% of patients filed claims for acromegaly-related prescription drugs, and patients with greater than 1 claim had an average of 7.6 prescriptions. The most expensive acromegaly-related costs in this study population were inpatient hospitalizations ($6,754) and prescription drugs ($6,147). CONCLUSIONS: Consistent with previous studies, this study confirms that acromegaly is a rare condition associated with multiple comorbidities. Notably, 18.8% of this study population required an inpatient hospital admission during the 12-month post-index period, possibly because of severe comorbidities. Because acromegaly-related costs were driven by hospitalizations and pharmacotherapy, improved management of the disease may reduce the clinical and economic burden experienced by patients with acromegaly.