Charting a sustainable tomorrow: Advancing urban low-carbon economies through comprehensive evaluation and promotion.

With the world population growth, energy consumption and the rapid development of industrial economy, a large amount of carbon emissions has brought destruction and threats to the earth's environment on which human beings depend. The development of low-carbon economy has become the consensus of governments all over the world and has been vigorously advocated & promoted. This paper focuses on the top five global GDP nations in 2022: The United States, China, Japan, Germany, and Britain. A comprehensive evaluation index system of urban low-carbon economic development level is constructed from four dimensions: economic development level, environmental quality, energy consumption emission intensity and social development speed by using literature review and field interview. The evaluation measures are determined using the TOPSIS evaluation method with entropy weight and the grey relational model, providing a comprehensive assessment of the low-carbon economy's development level in these five countries." Judging from the comprehensive evaluation score, the overall development of low-carbon economy in American cities is in good condition and has reached the development standard of low-carbon economy; Germany and Japan rank second and third, and they are low-carbon economies. Britain ranks fourth in comprehensive evaluation, although it belongs to a low-carbon economy country, but there is still a certain gap with Germany and Japan; There is still a big gap between China and the other four countries. Based on the measurement and evaluation outcomes, it presents recommendations and strategies to foster the growth of low-carbon economies, offering valuable insights for the advancement of such economies across different nations. The research results guide countries all over the world to reduce carbon emissions in the process of economic development, protect the earth environment on which human beings depend, and make a better tomorrow for sustainable development.

Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China.

BACKGROUND: The construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called "Diagnostic Intervention Package" (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities. METHODS: This study takes Tai'an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels. RESULTS: The results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: ß3 = 0.197, P < 0.001; secondary hospitals: ß3 = 0.132, P = 0.020) and the case mix index (tertiary hospitals: ß3 = 0.022, P < 0.001; secondary hospitals: ß3 = 0.008, P < 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: ß3 = -0.290, P < 0.001; secondary hospitals: ß3 = -1.200, P < 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (ß3 = 0.186, P = 0.002) and the case mix index (ß3 = 0.002, P < 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (ß3 = -0.515, P = 0.005) and primary-DIP-groups coverage (ß3 = -2.011, P < 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity. CONCLUSION: The DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions.

Formation mechanism of α particles in glycogen: Testing the budding hypothesis by Monte-Carlo simulation.

Glycogen, a complex branched glucose polymer and a blood-sugar reservoir in animals, comprises small ß particles joined together into composite α particles. In diabetic animals, α particles fragment more easily than those in healthy animals. Finding evidence for or against postulated mechanisms for α-particle formation is thus important for diabetes research. Insight into this is obtained here using Monte-Carlo simulations, including addition and loss of glucose monomer, branching and debranching, based on earlier simulations which were in acceptable agreement with experiment [Zhang et al., Int J Biol Macromolecules 2018, 116, 264]. One postulated mechanism for α-particle formation is "budding": occasionally a glucan chain temporarily protrudes from the particle, and if its growing end is sufficiently far from its parent particle, it propagates to a new linked particle. We tested this by simulations in which an "artificial" bud (a chain extending well outside the average particle radius) is added to a glycogen molecule in a dynamic steady state, and the system allowed to evolve. In some simulations, the particle reached a new steady state having an irregular dumbbell shape: a rudimentary α particle. Thus 'budding' is a possible mechanism for α particles to form. If no simulations had shown this behaviour, it would have refuted the postulate.

The price behavior characteristics of China and Europe carbon emission trading market based on the perspective of time scaling and expected returns.

China has the world's largest carbon market in terms of greenhouse gas emissions, but its system needs to be improved and enhanced. In comparison, the European carbon market stands as the most mature and well-developed carbon market globally. Carbon trading prices, serving as a barometer for the carbon market, are significantly influenced by investor behavior. Therefore, it is necessary to analyze the characteristics of carbon trading prices in both China and Europe, considering the impact of investor trading intervals and psychological expected returns. This study utilizes the Zipf method to characterize the dynamic behavior of carbon trading prices between China and Europe, conducting a comparative analysis. The results show distinctive asymmetry in the behavior of carbon trading prices in both markets. In the Chinese market, when τ < 277, the absolute deviation da(τ, ε) value gradually changes but consistently indicates a bullish trend. However, when τ ≥ 277, the da(τ, ε) value surges rapidly, reflecting a pronounced bullish sentiment among investors toward carbon trading prices in China. In the European market, within the sample period, regardless of variations in τ and ε, the da(τ, ε) value shows a linear upward trend, indicating a significant overall bullishness in prices. This suggests a higher probability of long-term bullishness in carbon trading prices. Investors' investment time scale (τ) and expected returns (ε) both influence the behavior of carbon trading prices in both China and Europe. Generally, a longer τ implies a higher probability of bullishness. As for ε, higher values lead to more extreme judgments on price movements, resulting in greater distortion in carbon trading prices. Short-term investors (τ<1 month) anticipate extreme fluctuations, exhibiting random behavior when ε < 0.15 and converging rapidly to extreme values of 1 or 0 when ε ≥ 0.15. Long-term investors (τ>quarter) are less biased, expressing a bullish outlook on both Chinese and European carbon prices. With increasing ε, the probability of bullishness either increases or decreases rapidly until reaching the saturation point. Once saturated, there is no further distortion in carbon price behavior. Furthermore, the Chinese carbon market displays a positive trend in carbon trading prices and a higher probability of long-term bullishness. For the European market, lower expected returns contribute to considerable carbon trading price fluctuations, exacerbating risk and uncertainty. The results of this study contribute to understanding the diverse trading behaviors in Chinese and European carbon markets and provide guidance for avoiding extreme volatility in carbon trading prices.

Can institutional pressures serve as an efficacious catalyst for mitigating corporate carbon emissions?

Driving enterprises to implement carbon emission reduction actions and reduce carbon emissions is a crucial research topic in achieving the carbon peaking and carbon neutrality goals. As a significant external environment factor influencing corporate behavior, can institutional pressures effectively promote enterprises to reduce carbon emissions? This study aims to probe into the impact and mechanism of three institutional pressures, namely coercive, mimetic, and normative, on corporate carbon emissions, taking Chinese-listed companies as the research object. The results indicate that coercive pressure is positively associated with corporate carbon reduction, while normative pressure has no significant impact. Furthermore, mimetic pressure impedes corporate carbon emissions. The mechanism test shows that carbon reduction is a mediator in the influence exerted by three institutional pressures on corporate carbon emissions. In response to coercive pressure and mimetic pressure, enterprises tend to reduce their carbon emissions by cultivating concepts related to carbon emission reduction. Concepts related to carbon reduction play a more dominant role than carbon reduction actions when both are mediators, with the former even replacing the latter. This research provides a new perspective for improving corporate environmental performance and corporate sustainability.

Clay minerals/sodium alginate/polyethylene hydrogel adsorbents control the selective adsorption and reduction of uranium: Experimental optimization and Monte Carlo simulation study.

Clay minerals formations are potential geological barrier (host rocks) for the long-rerm storage of uranium tailing in deep geological repositories. However, there are still obstacles to the efficient retardation of uranium because of the competition between negatively charged regions at the clay minerals end face, surface and between layers, as well as low mineralization capacity. Herein, employing a simple method, we used sodium alginate (SA), an inexpensive natural polymer material, polyethylene (PE), and the natural clay minerals montmorillonite (Mt), nontronite (Nt), and beidellite (Bd) to prepare three hydrogel adsorbents, (denoted as Mt/PE-@SA, Nt/PE-@SA, and Bd/PE-@SA), respectively. The application of obtained hydrogel adsorbents further extends to uranium(VI) removal from aqueous. Due to the synergistic action of SA group and PE group, hydrogel adsorbents showed select adsorption and mineralization effect on uranium(VI), among which the maximum uranium(VI) adsorption capacity of Nt/PE-@SA was 133.3 mg·g-1 and Mt/PE-@SA exhibited strong selectivity for uranium(VI) in the presence of coexisting metal ions. Cyclic voltammetry studies indicated the mitigation and immobilization of uranium species onto adsorbents by both reduction and mineralization. Besides, the synergistic adsorption of SA and PE on clay minerals was hypothesized, and the idea was supported by structure optimizations results from Monte Carlo dynamics simulation (MCD). Three obtained hydrogel adsorbents structural model was constructed based on its physicochemical characterization, the low energy adsorption sites and adsorption energies are investigated using MCD simulation. The simulation results show that obtained hydrogel adsorbents have a strong interaction with uranium(VI), which ensures the high adsorption capacity of those materials. Most importantly, this work demonstrates a new strategy for preparing mineral-based hydrogel adsorbents with enough stability and provides a new perspective for uranium(VI) removal in complex environment.

Maize/peanut rotation intercropping improves ecosystem carbon budget and economic benefits in the dry farming regions of China.

Monoculture is widely practiced to increase crop productivity, but long-term adaptation has drawbacks as it increases the depletion of soil nutrients and reduces soil quality, especially in dryland areas. Conversion from traditional maize monoculture to intercropping improves sustainable production. However, maize/peanut intercropping, especially rotation of planting strips impacts of maize/peanut intercropping in dryland on carbon (C) budgets and economic benefits remain unclear. In this study, a 5-year field experiment was conducted to evaluate the influence of maize/peanut intercropping with rotation of planting strips on soil health, indirect CO2-eq greenhouse gas emissions, and ecosystem C inputs. Four intercropping treatments viz. maize monoculture, peanut monoculture, maize/peanut intercropping, and maize/peanut rotation-intercropping were tested from 2018 to 2022. Maize/peanut rotation intercropping significantly improved the land equivalent ratio followed by intercropping and monoculture. Rotation-intercropping also improved economic benefits over intercropping and monoculture which were mainly associated with increased peanut yield where the border rows contributed the maximum, followed by the middle rows. Moreover, rotation-intercropping significantly increased the soil organic C and nitrogen (N) content. Rotation-intercropping decreased indirect CO2-eq greenhouse gas emissions and ecosystem C inputs by 3.11% and 18.04%, whereas increased ecosystem C outputs and net ecosystem C budget by 10.38% and 29.14%, respectively, over the average of monoculture. On average for intercropping and monoculture, rotation-intercropping increased ecosystem C emission efficiency for economic benefits by 51.94% and 227.27% in 2021 and 2022, respectively, showing the highest C utilization efficiency than other treatments. In the long run, maize/peanut rotation-intercropping can be practiced in dryland agriculture to achieve sustainable agriculture goals.

Further study on particle size, stability, and complexation of silver nanoparticles under the composite effect of bovine serum protein and humic acid.

Silver nanoparticles (AgNPs) are widely used due to their unique antibacterial properties and excellent photoelectric properties. Wastewater treatment plants form a pool of AgNPs due to the social cycle of wastewater. During biological treatment processes, the particle size and stability of AgNPs change. We studied the particle size changes and stability of silver nanoparticles in the presence of bovine serum albumin (BSA) and humic acid (HA). The experimental results indicated that silver nanoparticles can complex with the functional groups in BSA. For AgNP-BSA composites, as the BSA concentration increases, the size of the silver nanoparticles first decreases and then increases. AgNPs can combine with the amide, amino, and carboxyl groups in HA. As the concentration of HA increases, the particle size and large particle size distribution of AgNPs increase. This increasing trend is more obvious when the HA concentration is lower than 20 mg L-1. When HA and BSA exist at the same time, HA will occupy the adsorption sites of BSA on the surface of AgNPs, and the AgNP-HA complex will dominate the system. This study aims to provide key operational control strategies for the process operation of wastewater treatment plants containing AgNPs and theoretical support for promoting water environment improvement and economic development such as tourism.

Unveiling the greenhouse gas emissions of drinking water treatment plant throughout the construction and operation stages based on life cycle assessment.

The carbon peaking and carbon neutrality targets proposed by the Chinese government have initiated a green transformation that is full of challenges and opportunities and endowed sustainable development strategy for combating global warming issue. It is essential to execute comprehensive identification and carbon reduction measures across all industries that produce greenhouse gas (GHG) emissions. Water supply system, as an energy-intensive sector, plays a crucial role in GHG reduction. This work conducted a life cycle assessment (LCA) to account the GHG emissions associated with the construction and operation phases of the drinking water treatment plant (DWTP). During the construction phase, the total GHG emissions were 19,525.762 t CO2-eq, with concrete work and rebar project being the dominant contributors (87.712%). The promotion of renewable or recyclable green building materials and low-carbon construction methods, such as the utilization of prefabricated components and on-site assembly, holds significant importance in reducing GHG emissions during the construction phase of DWTP. Regarding the operation stage, the DWTP possessed an average annual GHG emission of 37,660.160 t CO2-eq and an average GHG intensity of 0.202 kg CO2-eq/m3. Most emissions were attributed to electricity consumption (67.388%), chemicals utilization (12.893%), and heat consumption (10.414%). By increasing the use of clean energy and implementing strict control measures in the water supply pumps, energy consumption and GHG emissions can be effectively reduced. This study offers valuable insights into the mapping of GHG emissions in the DWTP, facilitating the identification of key areas for targeted implementation of energy-saving and carbon-reducing measures.

Disease burden of COPD in the Chinese population: a systematic review.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. OBJECTIVES: This systematic review aimed to evaluate the disease burden of COPD in the Chinese population and to determine the factors influencing the economic burden of the disease. DESIGN: This is a systematic review study. DATA SOURCES AND METHODS: We searched PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, WANGFANG Data, and VIP databases for studies regarding the disease burden of COPD in mainland China published before 31 December 2022. The Agency for Healthcare Research and Quality's recommendation rating tool assessed the cross-sectional studies' risk of bias. RESULTS: A total of 45 studies were included. The disability-adjusted life years (DALYs) for COPD have generally decreased in the Chinese population over the past 30 years. The total number of DALYs due to COPD in China decreased from 26.12 million person-years to 19.92 million person-years, with an annual decline rate of 0.9%. Subjects aged 40 years and older make up the majority of those with COPD in the Chinese population, and the condition is more prevalent among males than females, in rural areas than urban places, and in the West than the East. The median direct medical cost of COPD ranges from 150 to 2014 USD per capita per year. Among 23 influencing factors, age, hospitalization days, hospital type, gender, and career were the most significant variables that had an impact on the economic burden of COPD patients. CONCLUSION: The overall burden of COPD in China has been decreasing over the past 30 years. But there is a lack of standardized indicators for the economic burden of COPD patients in China, and it is recommended to establish a unified standard. REGISTRATION: The systematic review protocol was prospectively registered with PROSPERO (No. CRD42023393429).

Disease burden of COPD in the Chinese populationChronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. This systematic review aimed to evaluate the disease burden of COPD in the Chinese population and to determine the factors influencing the economic burden of the disease. We searched PubMed, Web of Science, Embase, CNKI, WANGFANG Data, and VIP databases for studies regarding the disease burden of COPD in mainland China published before December 31, 2022. The Agency for Healthcare Research and Quality's (AHRQ) recommendation rating tool assessed the cross-sectional studies' risk of bias. The overall burden of COPD in China has been decreasing over the past 30 years. But there is a lack of standardized indicators for the economic burden of COPD patients in China, and it is recommended to establish a unified standard.

A research on urban disaster resilience assessment system for rainstorm and flood disasters: A case study of Beijing.

Under the background of global climate change, rainstorm and flood disasters have become the most serious cataclysm. Under the circumstances of an increasingly severe risk situation, it is necessary to enhance urban disaster resilience. Based on the disaster resilience process of prevention, absorption, and enhancement, and considering the safety factors such as personnel, facility, environment and management, this paper forms a dual dimension of the urban disaster resilience assessment model covering the key elements of urban disaster response and the core capacity of urban disaster recovery. Furthermore, if taking into account the characteristics of rainstorm and flood disasters, the paper screens the key indicators to build up an assessment index system of an urban rainstorm and flood disaster. The practical application was implemented in Beijing to have an assessment of the ability to recover from rainstorm and flood disasters in all districts of Beijing. And then, some pertinent suggestions for enhancing the resilience of Beijing to rainstorm and flood disasters were proposed.

[Multi-modal synergistic quantitative analysis and rehabilitation assessment of lower limbs for exoskeleton].

In response to the problem that the traditional lower limb rehabilitation scale assessment method is time-consuming and difficult to use in exoskeleton rehabilitation training, this paper proposes a quantitative assessment method for lower limb walking ability based on lower limb exoskeleton robot training with multimodal synergistic information fusion. The method significantly improves the efficiency and reliability of the rehabilitation assessment process by introducing quantitative synergistic indicators fusing electrophysiological and kinematic level information. First, electromyographic and kinematic data of the lower extremity were collected from subjects trained to walk wearing an exoskeleton. Then, based on muscle synergy theory, a synergistic quantification algorithm was used to construct synergistic index features of electromyography and kinematics. Finally, the electrophysiological and kinematic level information was fused to build a modal feature fusion model and output the lower limb motor function score. The experimental results showed that the correlation coefficients of the constructed synergistic features of electromyography and kinematics with the clinical scale were 0.799 and 0.825, respectively. The results of the fused synergistic features in the K-nearest neighbor (KNN) model yielded higher correlation coefficients ( r = 0.921, P < 0.01). This method can modify the rehabilitation training mode of the exoskeleton robot according to the assessment results, which provides a basis for the synchronized assessment-training mode of "human in the loop" and provides a potential method for remote rehabilitation training and assessment of the lower extremity.

Nivolumab plus chemotherapy versus chemotherapy alone as first-line treatment for advanced gastric, gastroesophageal junction, and esophageal adenocarcinoma: a cost-effectiveness analysis.

BACKGROUND: The aim of the study was to evaluate the cost-effectiveness of nivolumab plus chemotherapy as first-line treatment for patients with advanced gastric, gastroesophageal junction (GEJ), or esophageal adenocarcinoma from the perspective of Chinese and US society. METHODS: To conduct the analysis, a state-transitioned Markov model, which included three mutually exclusive health states (progression-free survival (PFS), progressive disease (PD), and death), was developed. Cycle length was set at 3 weeks and lifetime horizon was set at 10 years. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) were calculated in the analysis. Willingness-to-pay (WTP) thresholds in the model were set at $37,653.00/QALY in China and $100,000.00/QALY in the US, respectively. Meanwhile, one-way sensitivity analyses and probabilistic sensitivity analyses were conducted to investigate the robustness of the model. RESULTS: Over a lifetime horizon, the ICERs of nivolumab plus chemotherapy versus chemotherapy alone were $430,185.04/QALY and $944,089.78/QALY in China and the US, respectively. Cost of nivolumab and utility for the PFS state had the most significant impact on ICERs both in the US and China based on the results of the one-way sensitivity analyses. In the probabilistic sensitivity analyses, the proportions of nivolumab plus chemotherapy being cost-effective compared with chemotherapy alone were 0%. CONCLUSIONS: In conclusion, nivolumab plus chemotherapy is unlikely to be a cost-effective treatment option compared with chemotherapy alone in the first-line setting of advanced gastric, GEJ, or esophageal adenocarcinoma.

Mercury budgets in the suspended particulate matters of the Yangtze River.

Riverine processes are crucial for the biogeochemical cycle of mercury (Hg). The Yangtze River, the largest river in East Asia, discharges a substantial amount of Hg into the East China Sea. However, the influencing factors of the Hg budget and its recent trends remain unclear. This study quantitatively analyzed the total Hg concentration (THg) in suspended particulate matter (SPM) in the Yangtze River and calculated the Hg budget in 2018 and 2021. The results showed that the total Hg concentrations varied substantially along the river, with concentrations ranging from 23 to 883 µg/kg in 2018 and 47 to 146 µg/kg in 2021. The average Hg flux to China Sea in 2018 and 2021 were approximately 10 Mg/yr, lower than in 2016 (48 Mg/yr). Over 70% of the SPM was trapped in the Three Gorges Dam (TGD), and 22 Mg/yr of Hg settled in the TGD in 2018 and 10 Mg/yr in 2021. Hg fluxes in the Yangtze River watershed were driven by various factors, including decreased industrial emissions, increased agriculture emissions, and decreased soil erosion flux. We found that in the upper reach of the Yangtze River changed from sink to source of Hg possibly due to the resuspension of sediments, which implies that the settled sediments could be a potential source of Hg for downstream. Overall, emission control policies may have had a positive impact on reducing Hg flux to the East China Sea from 2016 to 2021, but more efforts are needed to further reduce Hg emissions.

Assessment of Factors Associated With Mental Well-Being Among Chinese Youths at Individual, School, and Province Levels.

Importance: Although rapid urbanization in China provided improved economic prosperity and educational opportunities, it was associated with increased internalizing and externalizing problems among youths, with negative outcomes for mental well-being. Previous studies suggested that factors in individual, school, and regional levels were associated with mental well-being, and comprehensively examining these factors may provide evidence for policies for improving youth mental health. Objective: To investigate factors associated with mental well-being at individual, school, and province levels among Chinese youths. Design, Setting, and Participants: This cross-sectional study analyzed nationally representative data collected December 1, 2021, to January 1, 2022, from schools in China. Among 435 schools, 144 institutions had primary school students, 107 institutions had middle school students, 95 institutions had primary and middle school students, and 89 institutions had high school students. A total of 398 520 students were included. Exposures: Characteristics at individual, school, and province levels. Main outcomes and measures: The main outcome was mental well-being, assessed by the Short Warwick-Edinburgh Mental Well-being Scale. Linear mixed-effects models were used to investigate individual, school, and regional disparities in mental well-being among youths. Results: There were 398 520 participants (194 460 females [48.80%]; mean [SD; range] age, 13.78 [2.40; 9-20] years). At the school level, 352 443 students (88.44%) were in public school and 291 354 students (73.11%) were in urban schools. Drinking (coefficient = -1.08; 95% CI, -1.12 to -1.05; P < .001), smoking (coefficient = -0.89; 95% CI, -0.96 to -0.83; P < .001), and increased age (coefficient per 1-year increase in age = -0.02; 95% CI, -0.03 to -0.01; P < .001) were associated with worse mental well-being. Male sex (coefficient = 1.01; 95% CI, 0.98 to 1.04; P < .001), being in a 1-child family (coefficient = 0.17; 95% CI, 0.13 to 0.20; P < .001), being in the Han group (coefficient vs other ethnic groups = 0.20; 95% CI, 0.14 to 0.26; P < .001), a higher frequency and coverage of psychological courses (eg, ≥2/wk for all students vs none: coefficient = 1.02; 95% CI, 0.36 to 1.69; P = .003), and a higher level of self-rated popularity in school (coefficient per 1-unit increase in score = 0.89; 95% CI, 0.88 to 0.89; P < .001) were associated with improved mental well-being. However, age (eg, age and 1 courses/2 wk for all students: coefficient per 1-year increase in age = -0.047; 95% CI, -0.089 to -0.005; P = .03) and sex (eg, female sex and ≥2 courses/wk for some students: coefficient = -0.184; 95% CI, -0.323 to -0.046; P = .009) had interactions with the association between psychological courses and mental well-being. Conclusions and relevance: This study found that social disparities in mental well-being existed and that various factors at different levels were associated with mental well-being among Chinese youths. These findings suggest that public mental health programs may be recommended for associated improvements in regional disparities in mental health resources.

Assessment of the incremental prognostic value from the modified frailty index-5 in complete traumatic cervical spinal cord injury.

Frailty, as measured by the modified frailty index-5 (mFI-5), and older age are associated with increased mortality in the setting of spinal cord injury (SCI). However, there is limited evidence demonstrating an incremental prognostic value derived from patient mFI-5. We conducted a retrospective cohort study to evaluate in-hospital mortality among adult complete cervical SCI patients at participating centers of the Trauma Quality Improvement Program from 2010 to 2018. Logistic regression was used to model in-hospital mortality, and the area under the receiver operating characteristic curve (AUROC) of regression models with age, mFI-5, or age with mFI-5 was used to compare the prognostic value of each model. 4733 patients were eligible. We found that both age (80 y versus 60 y: OR 3.59 95% CI [2.82 4.56], P < 0.001) and mFI-5 (score ≥ 2 versus < 2: OR 1.53 95% CI [1.19 1.97], P < 0.001) had statistically significant associations with in-hospital mortality. There was no significant difference in the AUROC of a model including age and mFI-5 when compared to a model including age without mFI-5 (95% CI Δ AUROC [- 8.72 × 10-4 0.82], P = 0.199). Both models were superior to a model including mFI-5 without age (95% CI Δ AUROC [0.06 0.09], P < 0.001). Our findings suggest that mFI-5 provides minimal incremental prognostic value over age with respect to in-hospital mortality for patients complete cervical SCI.

Variations and driving mechanisms of desertification in the southeast section of the China-Mongolia-Russia Economic Zone.

Desertification seriously restricts sustainable development in the arid-semiarid areas of the eastern section of the China-Mongolia-Russia Economic Zone, especially in China and Mongolia. In this study, the potential range of desertification was bounded. Spatio-temporal dynamics from 2000 to 2020 were analyzed using best-performing indices (fvc, albedo and LST). Further analysis focused on the driving factors resulting in desertification. The research showed that the potential range of desertification accounted for 50.99 % of the entire region, mainly distributed in central and western parts of Inner Mongolia, and central and southern parts of Mongolia. From 2000 to 2020, desertification in the entire study area improved, with a 2.23 % decrease in the area of severe and extremely severe desertification. Among the studied countries, the grades of desertification in China decreased over the years of study; the area of desertification in Mongolia expanded. The study also indicated that the restoration regions were affected mainly by climatic factor sand human activities, and the degradation area was driven primarily by human activities. Therefore, it is essential to formulate a reasonable land policy for desertification control.

Rethinking the effects of micro/nanoplastics from the global environmental change and systematic perspective: An aquatic environmental system-based comprehensive assessment approach of micro/nanoplastic impacts.

The study on micro/nanoplastic pollution should embrace complexity. Here, we aim to develop an aquatic environmental system-based comprehensive assessment approach of micro/nanoplastic impacts (ACAM) to evaluate the effects of micro/nanoplastics on aquatic ecosystems from the global environmental change (GEC) and systematic perspective. A case study for freshwater systems in Saskatchewan, Canada was conducted to evaluate the comprehensive effects of multiple GEC factors (polystyrene-nanoplastics (PS-NPs), N, P, salinity, dissolved organic matter (DOM), pH, hardness) on Asterococcus superbus based on ten ecologically relevant endpoints. It is found that at the cellular level, PS-NPs and N had an antagonistic interaction on microalgal growth in the Saskatchewan freshwater ecosystem; at the molecular level, the PS-NP-induced changes in lipid composition in microalgae were regulated by P, DOM, and pH. The significance ranking of factor effects suggested that instead of PS-NPs pollution, the fluctuations in pH level, DOM and N concentrations should be paid attention to first in Saskatchewan. Under the combined impact of PS-NPs and other GEC factors, microalgae at station 14 (Qu'Appelle River near highway 56) might have the minimum growth rate with [-0.048, 0.094] d-1 in Saskatchewan. These findings demonstrate the efficacy of the developed ACAM in a more comprehensive and context-specific assessment of MNP risks, providing new insight for the management of MNP pollution.

Patient-reported outcome (PRO)-based symptom assessment in patients with advanced lung cancer receiving first-line combination immunotherapy: a protocol for a multicenter, prospective, observational study.

BACKGROUND: Immunotherapy is currently applied in the first-line treatment regimens for numerous advanced cancers, especially advanced lung cancer. Immune-related adverse events (irAEs) resulting from immunotherapy can vary in severity and cause a substantial symptom burden to patients. However, there are limited data on symptom burden in patients with advanced lung cancer following immunotherapy. To address this deficit, this study aims to provide insight into the symptom burden and severity through patient-reported outcome measurements and conduct an analysis of temporal trends and clinical consequences of symptom burden in patients with advanced lung cancer receiving combination immunotherapy. METHODS: We will prospectively recruit 168 eligible patients from 14 hospitals in China. Eligible patients will be aged ≥ 18 years, pathologically diagnosed with locally advanced or stage IV primary lung cancer without surgical indications, and agreed to receive immunotherapy in combination with other therapies. The primary outcome of this study is the symptom burden of patients during the immunotherapy course. Longitudinal symptom data will be collected using the MD Anderson Symptom Inventory-Lung Cancer module (MDASI-LC) and the symptomatic irAEs scale at baseline (once before treatment) and weekly after treatment, until 1 month after the last treatment cycle has been completed. The trajectory of symptom burden following combination immunotherapy will be depicted, and by linking it to clinical outcomes (the secondary outcome and exploratory outcome of this study), the consequence of symptom burden in patients with advanced lung cancer receiving combination immunotherapy will be examined further. DISCUSSION: This study intends to establish longitudinal symptom trajectories in patients with lung cancer receiving immunotherapy, and explore its association with clinical outcomes. These findings may serve as an important reference for clinicians in the symptomatic management of patients with lung cancer receiving immunotherapy. TRIAL REGISTRATION NUMBER: ChiCTR2200061540. Registered on June 28, 2022.

Vertebral bone quality score provides preoperative bone density assessment for patients undergoing lumbar spine surgery: a retrospective study.

OBJECTIVE: The novel MRI-based vertebral bone quality (VBQ) score has been described as an opportunistic screening tool for osteoporosis, but the stability and practical value of this score deserve further investigation. The purpose of this study was to assess whether preoperative VBQ scores could assist in identifying reduced bone mineral density (BMD) or osteoporosis and evaluating the consistency between MRI systems with different field strengths. METHODS: The VBQ scores of the patients who underwent surgery for lumbar disc herniation and the single-level VBQ scores of each L1-4 vertebral body were measured and calculated with preoperative lumbar MRI noncontrast T1-weighted phases. The VBQ scores were evaluated for correlation analysis using dual-energy x-ray absorptiometry (DEXA) T-scores. The receiver operating characteristic (ROC) curve was used to evaluate the ability of the VBQ scores to identify patients with reduced BMD and with osteoporosis. Differences in CSF measurements at different levels of L1-4 were compared. Twenty-four patients who had been examined using another MRI machine were used as controls to test the interdevice agreement of the VBQ scores. RESULTS: The study included 100 patients with mean VBQ scores of 2.81 ± 0.28 (normal BMD), 3.06 ± 0.36 (osteopenia), and 3.43 ± 0.37 (osteoporosis). VBQ scores differed significantly between BMD subgroups (p < 0.001). The Pearson correlation coefficient showed a moderate negative linear correlation between novel VBQ scores and the lowest DEXA T-scores (r = -0.524). ROC analysis showed good discrimination of VBQ scores in patients with reduced BMD (area under the curve [AUC] 0.793) and with osteoporosis (AUC 0.810). The diagnostic thresholds of reduced BMD and osteoporosis according to the maximum Youden index were 3.06 (sensitivity 0.636, specificity 0.870, positive predictive value [PPV] 0.942, negative predictive value [NPV] 0.417) and 3.05 (sensitivity 0.875, specificity 0.618, PPV 0.519, NPV 0.913), respectively. CSF measurements at the L2, L3, and L4 levels were essentially identical and did not significantly affect the final VBQ scores (p > 0.05), whereas CSF measurements at the L1 level were found to be heterogeneous (p < 0.001). No significant differences were found in VBQ scores between the same brand of MRI machines at different field strengths (1.5 and 3.0 T, p = 0.107). CONCLUSIONS: The new VBQ score provides an additional screening opportunity for preoperative BMD assessment. A VBQ score < 3.05 essentially excludes osteoporosis, whereas a VBQ score ≥ 3.05 (especially ≥ 3.06) suggests the need for further examination. The VBQ score is comparable between different MRI systems.