A Multilayer and Multimodal-Fusion Architecture for Simultaneous Recognition of Endovascular Manipulations and Assessment of Technical Skills.

The clinical success of the percutaneous coronary intervention (PCI) is highly dependent on endovascular manipulation skills and dexterous manipulation strategies of interventionalists. However, the analysis of endovascular manipulations and related discussion for technical skill assessment are limited. In this study, a multilayer and multimodal-fusion architecture is proposed to recognize six typical endovascular manipulations. The synchronously acquired multimodal motion signals from ten subjects are used as the inputs of the architecture independently. Six classification-based and two rule-based fusion algorithms are evaluated for performance comparisons. The recognition metrics under the determined architecture are further used to assess technical skills. The experimental results indicate that the proposed architecture can achieve the overall accuracy of 96.41%, much higher than that of a single-layer recognition architecture (92.85%). In addition, the multimodal fusion brings significant performance improvement in comparison with single-modal schemes. Furthermore, the K -means-based skill assessment can obtain an accuracy of 95% to cluster the attempts made by different skill-level groups. These hopeful results indicate the great possibility of the architecture to facilitate clinical skill assessment and skill learning.

The health and economic impact of constructing temporary field hospitals to meet the COVID-19 pandemic surge: Wuhan Leishenshan Hospital in China as a case study.

BACKGROUND: In response to the COVID-19 pandemic, two new temporary hospitals were constructed in record time in Wuhan, China, to help combat the fast-spreading virus in February 2020. Using the experience of one of the hospitals as a case study, we discuss the health and economic implications of this response strategy and its potential application in other countries. METHODS: This retrospective observational study analyzed health resource utilization and clinical outcomes data for 2011 inpatients diagnosed with COVID-19 and admitted to Leishenshan Hospital during its 67 days of operation from February 8th to April 14th, 2020. We used a top-down costing approach to estimate the total cost of treating patients at the Leishenshan Hospital, including capital cost for hospital construction, health personnel costs, and direct health care costs. We used a multivariate generalized linear model to examine risk factors associated with in-hospital deaths. RESULTS: During the 67 days of hospital operation, 19 medical teams comprising of 933 doctors and 2312 nurses were gradually transferred to Leishenshan Hospital from across China. Of the 2011 admissions, 4.5% used intensive care and 2.0% used ventilators. Overall median length of stay was 19 days, and 21 days for patients in the intensive care unit (ICU). The case fatality rate (CFR) was 2.3% overall, 41.8% in the ICU, and 0.4% in general ward (GW). CFRs were 55% and 50% among patients using non-invasive and invasive ventilators, respectively. The mean total cost and direct health care cost were CNY806 997 (US$114 793) and CNY16 087 (US$2288), respectively. Patients admitted to the ICU had much higher direct health care costs, on average, compared to those in the GW (CNY150 415 vs CNY9720, or US$21 396 vs US$1383). The mean direct health care cost per patient with severe or critical diseases was more than five times higher than those with mild or moderate diseases (CNY45 191 vs CNY8838, or US$6428 vs US$1257). Older age, having comorbidities, and critical disease were associated with higher risks of death from COVID-19. Lower health worker to patient ratio (<2.6) was not associated with in-hospital death. CONCLUSION: An adequate health workforce were mobilized and deployed to a new temporary hospital. The Leishenshan Hospital increased access to care during the surge in COVID-19 infections, facilitated timely treatment, and transferred COVID-19 patients between GWs and ICUs within the hospital, all of which are potential contributors to lowering the CFR. Patients in the ICU experienced a much higher CFR and a greater burden of health care cost than those in GW. Our results have important implications for other countries interested in constructing temporary emergency hospitals, such as the need for adequate infrastructure capacities and financial support, centralized strategies to mobilize health workforce and to provide respiratory protective devices, and improvement in access to health care.

The Assessment of Upper-Limb Spasticity Based on a Multi-Layer Process Using a Portable Measurement System.

Spasticity is a common disabling complication caused by the upper motor neurons dysfunction following neurological diseases such as stroke. Currently, the assessment of the spastic hypertonia triggered by stretch reflexes is manually performed by clinicians using perception-based clinical scales, however, their reliability is still questionable due to the inter-rater and intra-rater variability. In order to objectively quantify the complex spasticity phenomenon in post-stroke patients, this study proposed a multi-layer assessment system based on a novel measurement device. The exoskeletal device was developed to synchronously record the kinematic, biomechanical and electrophysiological information in sixteen spastic patients and ten age-matched healthy subjects, while the spastic limb was stretched at low, moderate and high velocities. The mechanical impedance of the elbow joint was identified using a modified genetic algorithm to quantify the alterations in viscoelastic properties underlying pathological resistance. Simultaneously, the time-frequency features were extracted from the surface electromyography (sEMG) signals to reveal the neurophysiological mechanisms of the spastic muscles. By concatenating these single-layer decisions, a support vector regression (SVR)-based fusion model was developed to generate a more comprehensive quantification of spasticity severity. Experimental results demonstrated that the stiffness and damping components of the spastic arm significantly deviated from the nonspastic baseline, and strong correlations were observed between the proposed spasticity assessment and the severity level measured by clinical scales ( R = 0.86, P = 1.67e - 5 ), as well as the tonic stretch reflex threshold (TSRT) value ( R = - 0.89, P = 3.54e - 6 ). These promising results suggest that the proposed assessment system holds great potential to support the clinical diagnosis of motor abnormalities in spastic patients, and ultimately enables optimal adjustment of treatment protocols.

Design of a Low-Cost Miniature Robot to Assist the COVID-19 Nasopharyngeal Swab Sampling.

Nasopharyngeal (NP) swab sampling is an effective approach for the diagnosis of coronavirus disease 2019 (COVID-19). Medical staffs carrying out the task of collecting NP specimens are in close contact with the suspected patient, thereby posing a high risk of cross-infection. We propose a low-cost miniature robot that can be easily assembled and remotely controlled. The system includes an active end-effector, a passive positioning arm, and a detachable swab gripper with integrated force sensing capability. The cost of the materials for building this robot is 55 USD and the total weight of the functional part is 0.23kg. The design of the force sensing swab gripper was justified using Finite Element (FE) modeling and the performances of the robot were validated with a simulation phantom and three pig noses. FE analysis indicated a 0.5mm magnitude displacement of the gripper's sensing beam, which meets the ideal detecting range of the optoelectronic sensor. Studies on both the phantom and the pig nose demonstrated the successful operation of the robot during the collection task. The average forces were found to be 0.35N and 0.68N, respectively. It is concluded that the proposed robot is promising and could be further developed to be used in vivo.

Quantitative Assessment of Upper-Limb Motor Function for Post-Stroke Rehabilitation Based on Motor Synergy Analysis and Multi-Modality Fusion.

Functional assessment is an essential part of rehabilitation protocols after stroke. Conventionally, the assessment process relies heavily on clinical experience and lacks quantitative analysis. In order to objectively quantify the upper-limb motor impairments in patients with post-stroke hemiparesis, this study proposes a novel assessment approach based on motor synergy quantification and multi-modality fusion. Fifteen post-stroke hemiparetic patients and fifteen age-matched healthy persons participated in this study. During different goal-directed tasks, kinematic data and surface electromyography(sEMG) signals were synchronously collected from these participants, and then motor features extracted from each modal data could be fed into the respective local classifiers. In addition, kinematic synergies and muscle synergies were quantified by principal component analysis (PCA) and k weighted angular similarity ( k WAS) algorithm to provide in-depth analysis of the coactivated features responsible for observable movement impairments. By integrating the outputs of local classifiers and the quantification results of motor synergies, ensemble classifiers can be created to generate quantitative assessment for different modalities separately. In order to further exploit the complementarity between the evaluation results at kinematic and muscular levels, a multi-modal fusion scheme was developed to comprehensively analyze the upper-limb motor function and generate a probability-based function score. Under the proposed assessment framework, three types of machine learning methods were employed to search the optimal performance of each classifier. Experimental results demonstrated that the classification accuracy was respectively improved by 4.86% and 2.78% when the analysis of kinematic and muscle synergies was embedded in the assessment system, and could be further enhanced to 96.06% by fusing the characteristics derived from different modalities. Furthermore, the assessment result of multi-modality fusion framework exhibited a significant correlation with the score of standard clinical tests ( R = - 0.87, P = 1.98e - 5 ). These promising results show the feasibility of applying the proposed method to clinical assessments for post-stroke hemiparetic patients.

Qualitative and Quantitative Assessment of Technical Skills in Percutaneous Coronary Intervention: In Vivo Porcine Studies.

OBJECTIVE: Technical skill assessment plays an important role in the professional development of an interventionalist in percutaneous coronary intervention (PCI). However, most of the traditional assessment methods are time consuming and subjective. This paper aims to develop objective assessment techniques. METHODS: In this study, a natural-behavior-based assessment framework is proposed to qualitatively and quantitatively assess technical skills in PCI. In vivo porcine studies were conducted to deliver a medical guidewire to two target coronaries of left circumflex arteries by six novice and four expert interventionalists. Simultaneously, four types of natural behaviors (i.e., hand motion, proximal force, muscle activity, and finger motion) were acquired from the subjects' dominant hand and arm. The features extracted from the behaviors of different skill-level groups were compared using the Mann-Whitney U-test for effective behavior selection. The effective ones were further applied in the Gaussian-mixture-model-based qualitative assessment and Mahalanobis-distance-based quantitative assessment. RESULTS: The qualitative assessment achieves an accuracy of 92% to distinguish the novice and expert attempts, which is significantly higher than that of using single guidewire motions. Furthermore, the quantitative assessment can assign objective and effective scores for all attempts, indicating high correlation ( R = 0.9225) to those obtained by traditional methods. CONCLUSION: The objective, effective, and comprehensive assessment of technical skills can be provided by qualitatively and quantitatively analyzing interventionalists' natural behaviors in PCI. SIGNIFICANCE: This paper suggests a novel approach for the technical skill assessment and the promising results demonstrate the great importance and effectiveness of the proposed method for promoting the development of objective assessment techniques.

Temporal Pattern of Co-Development of Internalizing and Externalizing Problem Behaviors: An Application of Bivariate Mixed-Effects Models.

BACKGROUND: Although previous research has shown that internalizing and externalizing behavior problems often co-occur, the relationship between the developmental trajectories of these two types of behavior problems is understudied. The co-occurring evolutions of developmental trajectories of two behaviors has two components: 1) the correlation between the slopes of two behavior profiles (termed the association of the evolutions); and 2) the marginal correlation of two development trajectory profiles, which is the development of correlation between internalizing and externalizing behavior over time (termed the evolution of the association). The association of the evolutions and the evolution of the association have not been fully explored in the context of the development of internalizing and externalizing behavior problems among kindergarteners in the United States. METHODS: The random-effects approach for joint modeling of multivariate longitudinal profiles was used to evaluate the co-development and its temporal pattern of internalizing and externalizing behavior problems on a nationally representative sample of 9791 kindergarteners from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-99 (ECLS-K). RESULTS: There was a moderate positive association between the evolutions of the two behavior problems with correlation coefficient of 0.319. The evolution of association between the two behaviors was increasing over time with the correlation coefficient from 0.195 at the Fall of kindergarten to 0.291 by the time of fifth grade in general. Race and age groups act differently on the evolution of association. The associations were getting stronger for the Asian group and older groups than their peer groups. CONCLUSION: This investigation of the association of evolutions and the evolution of association between the internalizing and externalizing behaviors show that the two problem behaviors reciprocally reinforce each other and lead to increases in the other in a moderate strength and the strength is increasing over time.

Analysis of Interventionalists' Natural Behaviors for Recognizing Motion Patterns of Endovascular Tools During Percutaneous Coronary Interventions.

Many robotic platforms can indeed reduce radiation exposure to clinicians during percutaneous coronary intervention (PCI), however, interventionalists' natural manipulations are rarely involved in robot-assisted PCI. This requires more attention to analyze interventionalists' natural behaviors during conventional PCI. In this study, four types of natural behavior (i.e., muscle activity, hand motion, proximal force, and finger motion) were synchronously acquired from ten subjects while performing six typical types of guidewire manipulation. These behaviors are evaluated by a hidden Markov model (HMM) based analysis framework for relevant behavior selection. Relevant behaviors are further used as the input of two HMM-based classification frameworks to recognize guidewire motion patterns. Experimental results show that under the basic classification framework (BCF), 91.01% and 93.32% recognition accuracies can be achieved by using all behaviors and relevant behaviors, respectively. Furthermore, the hierarchical classification framework can significantly enhance the recognition ability of relevant behaviors with an accuracy of 96.39%. These promising results demonstrate great potential of proposed methods for promoting the future design of human-robot interfaces in robot-assisted PCI.

A new exploration of health risk assessment quantification from sources of soil heavy metals under different land use.

Heavy metals in the topsoil affected adversely human health through inhalation, ingestion and dermal contact. The health risk assessment, which are quantified from soil heavy metals sources under different land use, can provide an important reference basis for preventing and controlling the soil heavy metals pollution from the source. In this study, simple statistical analysis and Positive Matrix Factorization (PMF) were used to quantify sources of soil heavy metals; then a health risk assessment (HRA) model combined with PMF was proposed to assess quantificationally the human health risk (including non-cancer risk and cancer risk) from sources under residential-land, forest-land and farm land. Xiang River New District (XRNQ) was chosen as the example and four significant sources were quantitatively analyzed in the study. For cancer risk, industrial discharge was the largest source and accounted for about 69.6%, 69.7%, 56.5% for adults under residential-land, forest-land and farm-land, respectively. For non-cancer risk, industrial discharge was still the largest significant source under residential-land and forest-land and accounted for about 41.7%, 39.2% for adult, respectively; while agricultural activities accounted for about 51.8% for adult under farm-land. The risk trend of children, including cancer risk and non-cancer risk, was similar with adults. However, the non-cancer risk areas of adults affected by industrial discharge was higher than that of children, while the cancer risk areas of adults were on the contrary. The new exploration was useful to assess health risk quantification from sources under different land use, thus providing certain reference in preventing and controlling the pollution from the source for local authorities effectively.

Simultaneous Recognition and Assessment of Post-Stroke Hemiparetic Gait by Fusing Kinematic, Kinetic, and Electrophysiological Data.

Gait analysis for the patients with lower limb motor dysfunction is a useful tool in assisting clinicians for diagnosis, assessment, and rehabilitation strategy making. Implementing accurate automatic gait analysis for the hemiparetic patients after stroke is a great challenge in clinical practice. This study is to develop a new automatic gait analysis system for qualitatively recognizing and quantitatively assessing the gait abnormality of the post-stroke hemiparetic patients. Twenty-one post-stroke patients and twenty-one healthy volunteers participated in the walking trials. Three of the most representative gait data, i.e., marker trajectory (MT), ground reaction force (GRF), and electromyogram, were simultaneously acquired from these subjects during their walking. A multimodal fusion architecture is established by using these different modal data to qualitatively distinguish the hemiparetic gait from normal gait by different pattern recognition techniques and to quantitatively estimate the patient's lower limb motor function by a novel probability-based gait score. Seven decision fusion algorithms have been tested in this architecture, and extensive data analysis experiments have been conducted. The results indicate that the recognition performance and estimation performance of the system become better when more modal gait data are fused. For the recognition performance, the random forest classifier based on the GRF data achieves an accuracy of 92.26% outperformed other single-modal schemes. When combining two modal data, the accuracy can be enhanced to 95.83% by using the support vector machine (SVM) fusion algorithm to fuse the MT and GRF data. When integrating all the three modal data, the accuracy can be further improved to 98.21% by using the SVM fusion algorithm. For the estimation performance, the absolute values of the correlation coefficients between the estimation results of the above three schemes and the Wisconsin gait scale scores for the post-stroke patients are 0.63, 0.75, and 0.84, respectively, which means the clinical relevance becomes more obvious when using more modalities. These promising results demonstrate that the proposed method has considerable potential to promote the future design of automatic gait analysis systems for clinical practice.

No Robust Evidence of Future Changes in Major Stratospheric Sudden Warmings: A Multi-model Assessment from CCMI.

Major stratospheric sudden warmings (SSWs) are the largest instance of wintertime variability in the Arctic stratosphere. Due to their relevance for the troposphere-stratosphere system, several previous studies have focused on their potential response to anthropogenic forcings. However, a wide range of results have been reported, from a future increase in the frequency of SSWs to a decrease. Several factors might explain these contradictory results, notably the use of different metrics for the identification of SSWs, and the impact of large climatological biases in single-model studies. Here we revisit the question of future SSWs changes, using an identical set of metrics applied consistently across 12 different models participating in the Chemistry Climate Model Initiative. From analyzing future integrations we find no statistically significant change in the frequency of SSWs over the 21st century, irrespective of the metric used for the identification of SSWs. Changes in other SSWs characteristics, such as their duration and the tropospheric forcing, are also assessed: again, we find no evidence of future changes over the 21st century.

Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients.

BACKGROUND: Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS: Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program. RESULTS: Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (P<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPImax [maximal inspiratory pressure] 5.20±0.89 cmH2O vs 1.32±0.91 cmH2O; P<0.05). However, there were no significant differences in the other indices between the two groups (P>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (P>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (P>0.05). CONCLUSION: Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.

An exploration of spatial human health risk assessment of soil toxic metals under different land uses using sequential indicator simulation.

A modified method was proposed which integrates the spatial patterns of toxic metals simulated by sequential indicator simulation, different exposure models and local current land uses extracted by remote-sensing software into a dose-response model for human health risk assessment of toxic metals. A total of 156 soil samples with a various land uses containing farm land (F1-F25), forest land (W1-W12) and residential land (U1-U15) were collected in a grid pattern throughout Xiandao District (XDD), Hunan Province, China. The total Cr and Pb in topsoil were analyzed. Compared with Hunan soil background values, the elevated concentrations of Cr were mainly located in the east of XDD, and the elevated concentrations of Pb were scattered in the areas around F1, F6, F8, F13, F14, U5, U14, W2 and W11. For non-carcinogenic effects, the hazard index (HI) of Cr and Pb overall the XDD did not exceed the accepted level to adults. While to children, Cr and Pb exhibited HI higher than the accepted level around some areas. The assessment results indicated Cr and Pb should be regarded as the priority pollutants of concern in XDD. The first priority areas of concern were identified in region A with a high probability (>0.95) of risk in excess of the accepted level for Cr and Pb. The areas with probability of risk between 0.85 and 0.95 in region A were identified to be the secondary priority areas for Cr and Pb. The modified method was proved useful due to its improvement on previous studies and calculating a more realistic human health risk, thus reducing the probability of excessive environmental management.

The influence of estimated retail tobacco sale price increase on smokers' smoking habit in Jiangxi province, China: a cross-sectional study.

INTRODUCTION: China is the biggest tobacco producer and consumer in the world. Raising cigarette taxes and increasing tobacco retail prices have been prove as effective strategies to reduce tobacco consumption and the prevalence of smoking in western countries. But in China, it is uncertain how an increase of cigarette retail price will influence the tobacco consumption. METHODS: From April to July, 2012, we selected 4025 residents over 15 years by a three stage random sampling in four cities, Jiangxi Province, China. We conducted interviews of their current smoking habits and how they would change their smoking behavior if tobacco retail prices increase. RESULTS: Overall, the prevalence of smoking is 27 % (47 % for male, 3.1 % for female). 15 % of smokers have tried to quit smoking in the past but all relapsed (168/1088), and over 50 % of current smokers do not want to quit, The average cigarette price per pack is 1.1 USD (range = 0.25-5.0). If retail cigarette prices increases by 50 %, 45 % of smokers say they will smoke fewer cigarettes, 20 % will change to cheaper brands and 5 % will attempt to quit smoking. Smokers who have intention to quit smoking are more sensitive to retail cigarette price increase. With retail cigarette price increases, more smokers will attempt to quit smoking. CONCLUSION: Chinese smokers will change their smoking habits if tobacco retail prices increase. Consequently the Chinese government should enact tobacco laws which increase the retail cigarette price. The implementation of new tobacco laws could result in lowering the prevalence of smoking. Meanwhile, price increase measures need to apply to all cigarette brands to avoid smokers switching cigarettes to cheaper brands.

Socioeconomic status and the incidence of child injuries in China.

Injuries are the major cause of morbidity among children and one of the leading causes of death for children ages 1-17 years in developing countries. Of particular importance is whether child injuries are equally distributed across all socioeconomic groups and the implications of this question for child injury prevention, but there is a lack of research on the relationship between socioeconomic status and risk of child injuries in developing countries, including China. This study used a provincially-representative, population-based sample of 98,385 Chinese children under age 18 to investigate the relationships between socioeconomic status (SES) and child injuries. Despite the lack of a SES gradient in the overall incidence of nonhospitalized injuries, evidence of SES disparity was found for the overall incidence of H/PD injuries (injuries resulting in hospitalization or permanent disability) and fatal injuries. The odds of getting injured in the poorest wealth quintile were about 1.3 and 3.5 times greater than the odds found in the richest wealth quintile for H/PD and fatal injuries respectively. Further analyses showed that the associations between SES and injuries varied by type and severity of injury, and across different life stages. The findings have important implications for identifying at-risk populations and the optimal times for interventions to reduce different types and severity levels of child injuries.

Convergence of non-communicable and infectious diseases in low- and middle-income countries.

The convergence of non-communicable disease (NCD) and infectious disease (ID) in low- and middle-income countries (LMICs) presents new challenges and new opportunities to enact responsive changes in policy and research. Most LMICs have significant dual disease burdens of NCDs such as cardiovascular disease, diabetes and cancer, and IDs including tuberculosis, HIV/AIDS and parasitic diseases. A combined strategy is needed in surveillance and disease control; yet, experts, institutions and policies that support prevention and control of these two overarching disease categories have limited interaction and alignment. NCDs and IDs share common features, such as long-term care needs and overlapping high-risk populations, and there are also notable direct interactions, such as the association between certain IDs and cancers, as well as evidence of increased susceptibility to IDs in individuals with NCDs. Enhanced simultaneous surveillance of NCD and ID comorbidity in LMIC populations would generate the empirical data needed to better understand the dual burden, and to target coordinated care. Where IDs and NCDs are endemic, focusing on vulnerable populations by strengthening social protections and improving access to health services is crucial, as is the re-alignment of efforts to combine NCD and ID screening, treatment programmes, and the assessment of their impact. Integrating public health activities for ID and NCD should extend beyond health care services to prevention, which is widely seen as crucial to successful NCD and ID control campaigns alike. The convergence of NCD and ID in LMICs has the potential to overstretch already strained health systems. With some LMICs now focused on major health system reforms, a unique opportunity is available to address NCD and ID challenges with newfound urgency and novel approaches.

[Assessment model for heavy metal pollution in sediment based on trapezoidal fuzzy numbers and case study].

Due to the practical shortcomings of the classical deterministic pollution assessment model, the theory of trapezoidal fuzzy numbers was introduced to the environmental assessment system. A fuzzy risk assessment model was built based on the geoaccumulation index and biotoxicity coefficients of heavy metals. Using the fuzzy pollution risk assessment model, the risk of heavy metal pollution was evaluated for the surface sediment of Dongting Lake. The results showed that the pollution risk in a descending order was Hg > Cd > Pb > Cu > Cr > Zn > As, with Hg,Cd and Pb being the priority pollutants in Dongting Lake. Both the intervals of possible values for the geoaccumulation indexes of heavy metals and their credible levels were calculated using this model. Compared with the results of the deterministic assessment model, the fuzzy pollution risk assessment model gave a better characetriztaion of the actual pollution status and spatial distribution difference of the heavy metals in the sediment of the studied region which is more objective and comprehensive.

Projected health impact and cost-effectiveness of rotavirus vaccination among children <5 years of age in China.

INTRODUCTION: Two rotavirus vaccines have been licensed globally since 2006. In China, only a lamb rotavirus vaccine is licensed and several new rotavirus vaccines are in development. Data regarding the projected health impact and cost-effectiveness of vaccination of children in China against rotavirus will assist policy makers in developing recommendations for vaccination. METHODS: Using a Microsoft Excel model, we compared the national health and economic burden of rotavirus disease in China with and without a vaccination program. Model inputs included 2007 data on burden and cost of rotavirus outcomes (deaths, hospitalizations, outpatient visits), projected vaccine efficacy, coverage, and cost. Cost-effectiveness was measured in US dollars per disability-adjusted life-year (DALY) and US dollars per life saved. RESULTS: A 2-dose rotavirus vaccination program could annually avert 3013 (62%) deaths, 194,794 (59%) hospitalizations and 1,333,356 (51%) outpatient visits associated with rotavirus disease in China. The medical break-even price of the vaccine is $1.19 per dose. From a societal perspective, a vaccination program would be highly cost-effective in China at the vaccine price of $2.50 to $5 per dose, and be cost-effective at the price of $10 to $20 per dose. CONCLUSIONS: A national rotavirus vaccination program could be a cost-effective measure to effectively reduce deaths, hospitalizations, and outpatient visits due to rotavirus disease in China.

[Study on the relationship between childhood non-intentional injury and socio-economic status in Jiangxi province].

OBJECTIVE: To understand the relationship between childhood non-intentional injury and socio-economic status (SES) in Jiangxi province. METHODS: Nearly 100 000 households were selected by PPS sampling method, in Jiangxi province. All children aged 0 - 17 years in selected households were surveyed using an 'injury questionnaire'. SES was calculated under the World Bank method. RESULTS: 98 335 children were surveyed and the identified number of non-intentional injury cases was 5429 and with 52 fatal cases. The morbidity was 5.52% and mortality was 52.88/100 000. The mortality of children with higher SES was lower than that of other groups but without statistical significance. The morbidity of moderate injury increased with the increasing SES, also without statistical significance. However, the morbidity of severe injury in male children decreased with the increasing SES. Rates of moderate injury morbidities of fall and road traffic injury also increased with the increasing SES. Moderate injury morbidity caused by animals decreased with the increasing SES. Severe injury morbidity of fall decreased with the increasing SES. CONCLUSION: The morbidity of injury in children was affected by the SES and the relationship between injury and SES varied along with the results of different types of injuries.