Health economics study of paliperidone palmitate in the treatment of schizophrenia: a 12-month cohort study.

BACKGROUND: To analyze the economic benefits of paliperidone palmitate in the treatment of schizophrenia. METHODS: We collected 546 patients who met the diagnostic criteria for schizophrenia according to the 《International Statistical Classification of Diseases and Related Health Problems,10th》(ICD-10). We gathered general population data such as gender, age, marital status, and education level, then initiated treatment with paliperidone palmitate. Then Follow-up evaluations were conducted at 1, 3, 6, 9, and 12 months after the start of treatment to assess clinical efficacy, adverse reactions, and injection doses. We also collected information on the economic burden before and after 12 months of treatment, as well as the number of outpatient visits and hospitalizations in the past year to analyze economic benefits. RESULTS: The baseline patients totaled 546, with 239 still receiving treatment with paliperidone palmitate 12 months later. After 12 months of treatment, the number of outpatient visits per year increased compared to before (4 (2,10) vs. 12 (4,12), Z=-5.949, P < 0.001), while the number of hospitalizations decreased (1 (1,3) vs. 1 (1,2), Z = 5.625, P < 0.001). The inpatient costs in the direct medical expenses of patients after 12 months of treatment decreased compared to before (5000(2000,12000) vs. 3000 (1000,8050), P < 0.05), while there was no significant change in outpatient expenses and direct non-medical expenses (transportation, accommodation, meal, and family accompanying expenses, etc.) (P > 0.05); the indirect costs of patients after 12 months of treatment (lost productivity costs for patients and families, economic costs due to destructive behavior, costs of seeking non-medical assistance) decreased compared to before (300(150,600) vs. 150(100,200), P < 0.05). CONCLUSION: Palmatine palmitate reduces the number of hospitalizations for patients, as well as their direct and indirect economic burdens, and has good economic benefits.

Assessment of Key Factors Impacting Variability in AAV Vector Genome Titration by Digital PCR.

Recombinant adeno-associated virus (rAAV) has emerged as a prominent vector for in vivo gene therapy, owing to its distinct advantages. Accurate determination of the rAAV genome titer is crucial for ensuring the safe and effective administration of clinical doses. The evolution of the rAAV genome titer assay from quantitative PCR (qPCR) to digital PCR (dPCR) has enhanced accuracy and precision, yet practical challenges persist. This study systematically investigated the impact of various operational factors on genome titration in a single-factor manner, aiming to address potential sources of variability in the quantitative determination process. Our findings revealed that a pretreatment procedure without genome extraction exhibits superior precision compared with titration with genome extraction. Additionally, notable variations in titration results across different brands of dPCR instruments were documented, with relative standard deviation (RSD) reaching 23.47% for AAV5 and 11.57% for AAV8. Notably, optimal operations about DNase I digestion were identified; we thought treatment time exceeding 30 min was necessary, and there was no need for thermal inactivation after digestion. And we highlighted that thermal capsid disruption before serial dilution substantially affected AAV genome titers, causing a greater than ten-fold decrease. Conversely, this study found that additive components of dilution buffer are not significant contributors to titration variations. Furthermore, we found that repeated freeze-thaw cycles significantly compromised AAV genome titers. In conclusion, a comprehensive dPCR titration protocol, incorporating insights from these impact factors, was proposed and successfully tested across multiple serotypes of AAV. The results demonstrate acceptable variations, with the RSD consistently below 5.00% for all tested AAV samples. This study provides valuable insights to reduce variability and improve the reproducibility of AAV genome titration using dPCR.

Assessment of causal association between the socio-economic status and osteoporosis and fractures: a bidirectional Mendelian randomization study in European population.

BACKGROUND: The relationship between socio-economic status and bone-related diseases is attracting increasing attention. Therefore, a bidirectional Mendelian randomization (MR) analysis was performed in this study. METHODS: Genetic data on factors associated with socio-economic status (average total household income before tax, years of schooling completed and Townsend Deprivation Index at recruitment), femoral neck bone mineral density (FN-BMD), heel bone mineral density (eBMD), osteoporosis, and five different sites of fracture (spine, femur, lower leg-ankle, foot, and wrist-hand fractures) were derived from genome-wide association summary statistics of European ancestry. The inverse variance weighted method was employed to obtain the causal estimates, complemented by alternative MR techniques, including MR-Egger, weighted median, and MR-pleiotropy residual sum and outlier (MR-PRESSO). Furthermore, sensitivity analyses, and multivariable MR was performed to enhance the robustness of our findings. RESULTS: A higher educational attainment was associated with an increased level of eBMD (beta:0.06, 95% CI:0.01-0.10, P = 7.24 × 10-3), and decreased risk of osteoporosis (OR:0.78, 95% CI:0.65-0.94, P = 8.49 × 10-3), spine fracture (OR:0.76, 95% CI:0.66-0.88, P = 2.94 × 10-4), femur fracture (OR:0.78, 95% CI:0.67-0.91, P = 1.33 × 10-3), lower leg-ankle fracture (OR:0.79, 95% CI:0.70-0.88, P = 2.05 × 10-5), foot fracture (OR:0.78, 95% CI:0.66-0.93, P = 5.92 × 10-3) and wrist-hand fracture (OR:0.83, 95% CI:0.73-0.95, P = 7.15 × 10-3). Further, material deprivation seemed to harm the spine fracture (OR:2.63, 95% CI:1.43-4.85, P = 1.91 × 10-3). A higher level of FN-BMD positively affected increased household income (beta:0.03, 95% CI:0.01-0.04, P = 6.78 × 10-3). All these estimates were adjusted for body mass index (BMI), type 2 diabetes, smoking initiation, and frequency of alcohol intake. CONCLUSIONS: The Mendelian randomization analyses show that higher educational levels is associated with higher eBMD, reduced risk of osteoporosis and fractures, while material deprivation is positively related to spine fracture. Enhanced FN-BMD correlates with increased household income. These findings offer valuable insights into the formulation of health guidelines and policy development.

We conducted stratified analyses to explore the causal links between socio-economic status and osteoporosis and various fractures and observed that education significantly reduced risk of osteoporosis and lower eBMD. It also lowered the risks of fractures of spine, femur, lower leg-ankle, foot, and wrist-hand, while material deprivation exhibited positive associations with spine fracture risk. Bidirectional MR analysis showed that an elevated score of FN-BMD was associated with a higher income level. Our study shows the importance of conducting routine BMD estimations and osteoporosis screening, to enhance knowledge and awareness among individuals to promote bone health and prevent fractures.

Neutrophil-to-lymphocyte ratio at admission for early diagnosis, severity assessment, and prognosis of acute traumatic spinal cord injury.

STUDY DESIGN: A retrospective study. OBJECTIVE: This study examined the value of neutrophil-to-lymphocyte ratio at admission for early diagnosis, severity assessment, and prognosis of acute traumatic SCI. SETTING: The First People's Hospital of Neijiang, China. METHODS: This was a single-center, retrospective, cohort study of patients treated within 12 h of acute SCI between January 2018 and October 2022. Ninety-four SCI patients were selected as the Observation group, including 26 with complete injury (AIS grade A) and 68 with incomplete injury (AIS grade B-D), while 94 patients with simple spinal fracture were randomly selected as the Control group. Eighty-one observation group patients underwent surgical treatment, of which 33 had a higher AIS grade (Good prognosis subgroup) and 48 a lower or equal grade post-surgery (Poor prognosis subgroup). Univariate and multivariate analyses were performed to assess predictors of early diagnosis, severity, and 6-month outcome. RESULTS: Initial white blood cell count, neutrophil count, monocyte count, and NLR were higher in the Observation group than the Control group, while lymphocyte count was lower in the Observation group. Multivariate logistic regression analysis identified NLR as an independent predictor of early diagnosis. Spinal canal encroachment ≥50%, neutrophil count, and NLR were higher in the complete injury subgroup, and spinal canal encroachment ≥50% was an independent predictor of complete injury, while NLR was not. The NLR was higher in the poor prognosis subgroup and was an independent risk factor. CONCLUSIONS: Peripheral blood NLR is useful for early diagnosis of acute SCI and is predictive of clinical outcome.

Dynamic tear meniscus parameters in complete blinking: insights into dry eye assessment.

AIM: To investigate the relationship between dynamic tear meniscus parameters and dry eye using an automated tear meniscus segmentation method. METHODS: The analysis of tear meniscus videos captured within 5s after a complete blink includes data from 38 participates. By processing video data, several key parameters including the average height of the tear meniscus at different lengths, the curvature of the tear meniscus's upper boundary, and the total area of the tear meniscus in each frame were calculated. The effective values of these dynamic parameters were then linearly fitted to explore the relationship between their changing trends and dry eye disease. RESULTS: In 94.74% of the samples, the average height of central tear meniscus increased over time. Moreover, 97.37% of the samples exhibited an increase in the overall tear meniscus height (TMH) and area from the nasal to temporal side. Notably, the central TMH increased at a faster rate compared to the nasal side with the temporal side showing the slowest ascent. Statistical analysis indicates that the upper boundary curvature of the whole tear meniscus as well as the tear meniscus of the nasal side (2, 3, and 4 mm) aid in identifying the presence of dry eye and assessing its severity. CONCLUSION: This study contributes to the understanding of tear meniscus dynamics as potential markers for dry eye, utilizing an automated and non-invasive approach that has implications for clinical assessment.

The Financial Risk Measurement EVaR Based on DTARCH Models.

The value at risk based on expectile (EVaR) is a very useful method to measure financial risk, especially in measuring extreme financial risk. The double-threshold autoregressive conditional heteroscedastic (DTARCH) model is a valuable tool in assessing the volatility of a financial asset's return. A significant characteristic of DTARCH models is that their conditional mean and conditional variance functions are both piecewise linear, involving double thresholds. This paper proposes the weighted composite expectile regression (WCER) estimation of the DTARCH model based on expectile regression theory. Therefore, we can use EVaR to predict extreme financial risk, especially when the conditional mean and the conditional variance of asset returns are nonlinear. Unlike the existing papers on DTARCH models, we do not assume that the threshold and delay parameters are known. Using simulation studies, it has been demonstrated that the proposed WCER estimation exhibits adequate and promising performance in finite samples. Finally, the proposed approach is used to analyze the daily Hang Seng Index (HSI) and the Standard & Poor's 500 Index (SPI).

Multifunctional trade-off and compensation mechanism of arable land under the background of rural revitalization: a case study in the West Mountain Regions of Hubei Province.

Exploring the spatial relationship and ecological compensation mechanism of each function of arable land in poor mountainous areas is important to promote rural revitalization and enhance arable land protection. Taking the mountainous region of Western Hubei (MRWH) as an example, this study quantified the "three living" functions of arable land and its secondary functions. Using the root mean square deviation method to calculate the trade-off index, a quantitative method can more scientifically reflect the trade-off relationship between arable land functions and measure the overall ecological compensation. Studies have shown that (1) the value of the production function exhibits a growing and subsequently a falling trend, whereas the value of living function and ecological function exhibits an increasing trend over time, with an average functional value of 5310, 220 and 6496 million yuan, respectively. The spatial pattern of the "three living" functional values decreases from west to east. Among them, water conservation and soil conservation function values show a high distribution in the south and low in the north, gas purification and agricultural pollution functional values show a scattered spatial pattern, and the value of other functions shows an increasing trend from southeast to northwest; (2) among the primary functions, the trade-off between production and ecological functions is the strongest, decreasing, and then increasing over time, with an average trade-off index of 0.89. Among the secondary functions, there is the most obvious trade-off between the food supply function and the five ecological functions, which requires coordination; (3) overall, the total amount of ecological compensation has shown an upward trend, with priority areas for level I ecological compensation increasing year by year. Optimized compensation zones and potential compensation zones are concentrated in the northwest, ecological balance zones are located in the central part, and optimized development compensation zones and key development compensation zones are located in the southeast. According to the research, MRWH is oriented to ecological function, followed by the production function, supplemented by the living function. Green agriculture should be vigorously developed and ecological function space should be compressed by strictly limiting the excessive expansion of production activities. Promoting the improvement of production function through ecological function, while exploring the potential value of living function. Ecological compensation in strict accordance with the priority of ecological compensation, zoning. Realizing cross-regional cooperation, low compensation areas drive high compensation areas to achieve sustainable development of arable land.

An Ultra-Low Power Reconfigurable Biomedical AI Processor With Adaptive Learning for Versatile Wearable Intelligent Health Monitoring.

Wearable intelligent health monitoring devices with on-device biomedical AI processor can be used to detect the abnormity in users' biomedical signals (e.g., ECG arrythmia classification, EEG-based seizure detection). This requires ultra-low power and reconfigurable biomedical AI processor to support battery-supplied wearable devices and versatile intelligent health monitoring applications while achieving high classification accuracy. However, existing designs have issues in meeting one or more of the above requirements. In this work, a reconfigurable biomedical AI processor (named BioAIP) is proposed, mainly featuring: 1) a reconfigurable biomedical AI processing architecture to support versatile biomedical AI processing. 2) an event-driven biomedical AI processing architecture with approximate data compression to reduce the power consumption. 3) an AI-based adaptive-learning architecture to address patient-to-patient variation and improve the classification accuracy. The design has been implemented and fabricated using a 65nm CMOS process technology. It has been demonstrated with three typical biomedical AI applications, including ECG arrythmia classification, EEG-based seizure detection and EMG-based hand gesture recognition. Compared with the state-of-the-art designs optimized for single biomedical AI tasks, the BioAIP achieves the lowest energy per classification among the designs with similar accuracy, while supporting various biomedical AI tasks.

A rapid, accurate, and low-cost method for detecting Mycobacterium tuberculosis and its drug-resistant genes in pulmonary tuberculosis: Applications of MassARRAY DNA mass spectrometry.

Introduction: Mycobacterium tuberculosis (MTB) identification and drug resistance diagnosis are very important for treatment of drug-resistant tuberculosis (DR-TB). Therefore, high throughput, accurate and low-cost molecular detection techniques are urgently needed. This study aimed to evaluate the clinical application value of MassARRAY in tuberculosis diagnosis and drug resistance screening. Methods: The limit of detection (LOD) and clinical application value of MassARRAY were evaluated using reference strains and clinical isolates. MTB in bronchoalveolar lavage fluid (BALF) and sputum samples were detected using MassARRAY, quantitative real-time polymerase chain reaction (qPCR) and MGIT960 liquid culture (culture). Using culture as the standard, the efficacy of MassARRAY and qPCR for the detection of TB was analyzed. Mutation of drug resistance genes in MTB clinical isolates was tested using MassARRAY, high-resolution melting curve (HRM), and Sanger sequencing. Using sequencing as the standard, the efficacy of MassARRAY, and HRM for the detection of each drug resistance site of MTB was analyzed. Simultaneously, the mutation of drug resistance genes by the MassARRAY method was compared with the results of drug susceptibility testing (DST), and the genotype-phenotype relationship was analyzed. The ability of MassARRAY to discriminate mixed infections was detected using mixtures of standard strains (M. tuberculosis H37Rv) and drug-resistant clinical isolates and mixtures of wild-type and mutant plasmids. Results: In MassARRAY, 20 related gene mutations could be detected by two PCR systems. All genes could be accurately detected when the bacterial load was 104 CFU/mL. When the load of wild-type and drug-resistant MTB mixture was 105 CFU/mL (respectively reached 104 CFU/mL), variants and wild-type genes could be detected simultaneously. The sensitivity of MassARRAY (96.9%) for identification was higher than that of qPCR (87.5%) (p < 0.001). The sensitivity and specificity of MassARRAY for all drug resistance gene mutations were 100.0%, with higher accuracy and consistency than HRM (sensitivity = 89.3% and specificity = 96.9%, p = 0.001). Analyzing the relationship between MassARRAY genotype and DST phenotype, the accuracy of katG_315, rpoB_531, rpsL_43, rpsL_88, and rrs_513 sites was 100.0%, and embB_306 and rpoB_526 were inconsistent with the DST results when the base changes were different. Discussion: MassARRAY can obtain base mutation information and identify heteroresistance infections simultaneously when the mutant proportion was at least 5-25%. It has good application prospects in the diagnosis of DR-TB with high throughput, accurate and low-cost.

Spatiotemporal Differentiation of the Coupling and Coordination of Production-Living-Ecology Functions in Hubei Province Based on the Global Entropy Value Method.

Rapid urbanization and industrialization have brought about regional prosperity and pressure on the ecological environment, and the disorder of development has led to competition among the production-living-ecology functions. How to build livable cities, optimize the spatial layout of land, and promote the coordinated development of the production-living-ecology functions in various regions has become an important issue in the sustainable development and utilization of land space. In order to study the spatiotemporal conflict and coordination of the production-living-ecology functions with respect to the dramatic developments associated with the 21st century, this study took Hubei Province, which is the top-ranking economic region in China in recent years, as the study area and adopted the global entropy value method, triangle model, and coupled evaluation model to delineate an index system to measure the degree of conflict and coordination of the production-living-ecology functions in Hubei Province from 2000 to 2020, and also delineate zoning management based on statistical yearbook data. The results showed the following: (1) With respect to the time scale, the indices of the production-living-ecology functions in Hubei Province increased year by year, and the degree of coordination also increased yearly, from the stage of disorder with certain conflict to the stage of coordination with a high level of coupling. (2) On the spatial scale, the development of production-living-ecology functions in Hubei Province was unbalanced, which may be related to the overall development strategy of "two circles and one belt" in Hubei Province, with the eastern part of the province having a higher degree of coordination of the production-living-ecology functions and the western part having a lower degree of coordination. (3) Among the production-living-ecology functions, the ecological function of Hubei Province as a whole exhibited minimal change and maintained stable development, while the living and production functions underwent considerable development, indicating that Hubei Province has protected the orderly development of the ecological environment in the process of urbanization and new industrialization. (4) According to the development and coordination of the production-living-ecology functions in each region of Hubei Province, four development management zones were created: high-quality development zone, secondary development zone, balanced development zone, and development potential zone. Finally, policy suggestions are given for each zone.

Application of near-infrared fluorescence imaging in the accurate assessment of surgical margins during breast-conserving surgery.

OBJECTIVE: To evaluate the feasibility and accuracy of near-infrared fluorescence imaging technology for assessing margins during breast-conserving surgery for breast cancer. METHODS: Forty-three breast cancer patients who received surgical treatment at Yijishan Hospital of Wannan Medical College were selected. Before the operation, the patients were administered with an indocyanine green injection of 0.5 mg/kg intravenously 2 h before operation. During and after the operation, all patients underwent surgical margin monitoring with the near-infrared fluorescence imaging system for fluorescence imaging and acquisition of images and quantitative fluorescence intensity. During the operation, the patients' tissue specimens were collected on the upper, lower, inner, outer, apical, and basal sides of the fluorescence boundary of the isolated lesions for pathological examination. RESULTS: Fluorescence was detected in the primary tumor in all patients. The average fluorescence intensities of tumor tissue, peritumoral tissue, and normal tissue were 219.41 ± 32.81, 143.35 ± 17.37, and 105.77 ± 17.79 arbitrary units, respectively (P < 0.05, t test). The signal-to-background ratio of tumor to peritumor tissue and normal tissue was 1.54 ± 0.20 and 2.14 ± 0.60, respectively (P < 0.05, t test). Abnormal indocyanine green fluorescence was detected in 11.6% patients (5/43), including 3 patients with residual infiltrating carcinoma and 2 patients with adenosis with ductal dilatation. CONCLUSION: This study confirms the high sensitivity and specificity of near-infrared fluorescence imaging technology for breast-conserving surgery margin assessment. Near-infrared fluorescence imaging technology can be used as an intraoperative diagnosis and treatment tool to accurately determine the surgical margin and is of important guiding value in breast-conserving surgery for breast cancer.

Geographical Pattern Evolution of Health Resources in China: Spatio-Temporal Dynamics and Spatial Mismatch.

(1) Background: The rational allocation of limited medical resources is the premise of safeguarding the public health. Especially since the outbreak of COVID-19, the evolution dynamics and spatial mismatch of medical resources have been a focal and frontier issue in academic discussions. (2) Methods: Based on the competitive state model and spatial mismatch index, this paper uses GIS and Geodetector spatial analysis methods and three typical indicators of hospitals, doctors, and beds to conduct an empirical study on the evolutionary characteristics and degree of mismatch in the geographic pattern of health resources in China from 2010 to 2020 (the data are from official publications issued by the National Bureau of statistics in China), in two dimensions of resource supply (economic carrying capacity) and demand (potential demand or need of residents). (3) Results: The spatial pattern of health resources at the provincial level in China has been firmly established for a long time, and the children and elderly population, health care government investment, and service industry added value are the key factors influencing the geographical distribution of health resources. The interaction between the different influence factors is dominated by bifactor enhancement, and about 30-40% of the factor pairs are in a nonlinear enhancement relationship. Hospital, doctor, and bed evolution trends and the magnitude and speed of their changes vary widely in spatial differentiation, but all are characterized by a high level of geographic agglomeration, heterogeneity, and gradient. Dynamic matching is the mainstream of development, while the geographical distribution of negative and positive mismatch shows strong spatial agglomeration and weak spatial autocorrelation. The cold and hot spots with evolution trend and space mismatch are highly clustered, shaping a center-periphery or gradient-varying spatial structure. (4) Conclusions: Despite the variability in the results of the analyses by different dimensions and indicators, the mismatch of health resources in China should not be ignored. According to the mismatch types and change trend, and following the geographic differentiation and spatial agglomeration patterns, this paper constructs a policy design framework of "regionalized governance-classified management", in line with the concept of spatial adaptation and spatial justice, in order to provide a decision making basis for the government to optimize the allocation of health resources and carry out health spatial planning.

Construction and Optimization Strategy of an Ecological Network in Mountainous Areas: A Case Study in Southwestern Hubei Province, China.

High-intensity urban development and economic exploitation have led to the fragmentation and isolation of regional habitat patches, and biodiversity is under serious threat. Scientific identification and effective optimization of ecological networks are essential for maintaining and restoring regional ecosystem connectivity and guiding sustainable socio-economic development. Taking the mountainous areas of southwest Hubei Province (MASHP) in central China as an example, this study first developed a new integrated approach to identify ecological sources based on a quantitative assessment of ecosystem services and the morphological spatial pattern analysis (MSPA) method; it then used the Linkage Mapper tool to extract ecological corridors, applied the principle of hydrological analysis to identify ecological nodes, evaluated each ecological element to quantify its importance, and finally constructed the ecological network and further proposed some optimization countermeasures. The results show that the ecological network in the MASHP is dominated by ecological resources composed of forestland. Connectivity in the central region is significantly better than in other regions, including 49 ecological sources with an area of 3837.92 km2, 125 ecological corridors with a total length of 2014.61 km, and 46 ecological nodes. According to the spatial distribution of crucial ecological landscape elements, a complete and systematic ecological framework of "two verticals, three belts, three groups, and multiple nodes" was proposed. The internal optimization of the ecological network in mountainous areas should focus on improving ecological flow, and strategies such as enhancing the internal connectivity of ecosystems, unblocking ecological corridors, and dividing ecological functional zones can be adopted. Based on the above analyses, this study also made recommendations for ecological protection and development and construction planning in mountainous areas. This study can provide realistic paths and scientific guidelines for ecological security and high-quality development in the MASHP, and it can also have implications for the construction of ecological networks and comprehensive ecological management in other mountainous areas.

Dissipation and dietary risk assessment of carbendazim and epoxiconazole in citrus fruits in China.

BACKGROUND: Carbendazim and epoxiconazole are widely applied to control anthracnose and sand bark fungal diseases in citrus. The residues of these two fungicides in citrus and their potential risk to consumers have generated much public concern. We therefore sought to investigate the dissipation, residue, and dietary risk assessment of carbendazim and epoxiconazole in citrus. RESULTS: The dissipation kinetics and residue levels of carbendazim and epoxiconazole in citrus under field conditions were measured using dispersive solid-phase extraction and ultra-high-performance liquid chromatography-tandem mass spectrometry. The citrus samples were extracted with acetonitrile and purified by primary secondary amine sorbent. The mean recoveries of carbendazim and epoxiconazole ranged from 86.2 to 105.6% and relative standard deviations were ≤9.8%. The half-lives of carbendazim and epoxiconazole in whole citrus ranged from 2.0 to 18.0 days. Hazard quotient (HQ) and risk quotient (RQ) models were applied to whole citrus for dietary exposure risk assessment based on the terminal residue test. Hazard quotients ranged from 0.066 to 0.134% and RQs from 18.48 to 82.12%. CONCLUSION: Carbendazim and epoxiconazole in citrus degraded rapidly following first-order kinetics models. The dietary risk of exposure to both carbendazim and epoxiconazole through citrus, based on HQ and RQ, was acceptable for human consumption. This study indicates scientifically validated maximum residue limits in citrus, which are currently lacking for epoxiconazole in China. © 2021 Society of Chemical Industry.

Contrasting Chemical Complexity and the Reactive Organic Carbon Budget of Indoor and Outdoor Air.

Reactive organic carbon (ROC) comprises a substantial fraction of the total atmospheric carbon budget. Emissions of ROC fuel atmospheric oxidation chemistry to produce secondary pollutants including ozone, carbon dioxide, and particulate matter. Compared to the outdoor atmosphere, the indoor organic carbon budget is comparatively understudied. We characterized indoor ROC in a test house during unoccupied, cooking, and cleaning scenarios using various online mass spectrometry and gas chromatography measurements of gaseous and particulate organics. Cooking greatly impacted indoor ROC concentrations and bulk physicochemical properties (e.g., volatility and oxidation state), while cleaning yielded relatively insubstantial changes. Additionally, cooking enhanced the reactivities of hydroxyl radicals and ozone toward indoor ROC. We observed consistently higher median ROC concentrations indoors (≥223 µg C m-3) compared to outdoors (54 µg C m-3), demonstrating that buildings can be a net source of reactive carbon to the outdoor atmosphere, following its removal by ventilation. We estimate the unoccupied test house emitted 0.7 g C day-1 from ROC to outdoors. Indoor ROC emissions may thus play an important role in air quality and secondary pollutant formation outdoors, particularly in urban and suburban areas, and indoors during the use of oxidant-generating air purifiers.

Economic burden of measles and its influencing factors in Fujian, China.

BACKGROUND: Measles is a highly-contagious, serious diseases that can lead to potentially fatal illness, disability and death . We conducted an investigation to calculate the economic burden of measles cases from 2018 to 2019 and to analyze factors that influenced the total costs of measles cases in Fujian Province, China. METHODS: We investigated confirmed cases of measles by telephone interview, from 2018 to 2019, including demographic characteristics, therapeutic measures, self-treatment and nutritional supplement expenditure, transportation fees, and lost wages. Medical expenses in the hospitals were obtained from the hospital service charge system. RESULTS: A total of 131 measles cases were investigated, the average direct cost, indirect cost, and total cost were $518, $284, and $802, respectively. The total cost was 15.5% of Annual Per Capita Disposable Income of Households ($5 162) in Fujian. Hospitalization (OR = 98.6, 95%CI: 21.1 ~ 460.6) and complication (OR = 8.7, 95%CI: 1.3 ~ 58.0) significantly influenced the total cost according to binary logistic regression, and an outbreak of measles may pose a significant threat to household finances in a short term. CONCLUSIONS: The economic burden of measles was high when compared with Annual Per Capita Disposable Income of Households. The resurgence of measles and measles outbreaks increased economic burden of household finances.

Exploring the role of green innovation and investment in energy for environmental quality: An empirical appraisal from provincial data of China.

To better analyze China's carbon neutrality target, this study investigates the effect of green innovation and investment in the energy industry on China's provincial and regional data from 1995 to 2017. Using Westerlund and Edgerton's panel cointegration test, the authors found a stable long-run relationship between CO2 emissions and its determinants. We found that under major structural breaks at the local, regional, and global levels, such as the East Asian crises of 1997, the financial crises of 2007-2008, China's RMB exchange rate reform announced on August 11, 2015, and mild recession in 2001, CO2 emissions, income, green innovation, renewable energy use, and energy industry investment are cointegrated. The environmental Kuznets curve hypothesis is valid. In the long run, income, environmental innovation, investment in the energy industry, and renewable energy consumption are key contributors in explaining CO2 emissions. The empirical evidence from augmented mean group (AMG) is consistent with the estimates of CS-ARDL. Concerning practical implications, the findings suggest that there is a need to switch the Chinese economy to more sustainable sources of energy, a viable solution to abate environmental degradation. China should introduce and shift investments to green innovation.

Application of Geostatistical Analysis and Random Forest for Source Analysis and Human Health Risk Assessment of Potentially Toxic Elements (PTEs) in Arable Land Soil.

Arable land soil is one of the most precious natural resources of Earth, it provides the fundamental material and numerous resources essential for the development of human society. To determine the pollution of potential toxic factors in the surface soil of cultivated land and its risks to human health, concentrations of five different potentially toxic elements (PTEs) were detected in 1109 soil samples collected in Xiangzhou, China, in 2019. In this study, health risk assessment was used to judge the degree of pollution in the study area, the result of Geographic Information System (GIS) was as used to research the spatial distribution characteristics of PTEs, and random forest (RF) was used to assess the natural and man-made influencing factors. We investigated the sources of PTEs through quantifying the indicators, which gave further insights. The main results are: (1) In arable land soil, the average content of PTEs is 0.14 mg/kg cadmium (Cd), 0.05 mg/kg mercury (Hg), 12.89 mg/kg arsenic (As), 29.23 mg/kg lead (Pb), and 78.58 mg/kg chromium (Cr), respectively. The content of As and Pb outpaced the background value of Hubei soil. (2) The human health risk assessment in Xiangzhou indicates that the most important exposure pathway is soil ingestion, occupied about 99% to health risks of PTEs; non-carcinogenic risk from exposure to As, Pb and Cr in soil was higher than the limit (overall potential risk index, HI > 1) for both children and adults. Moreover, carcinogenic risk postured by Cd, Cr, and As was higher than the limit (10-4) through soil exposure for both children and adults, indicating that Cd, As, Pb and Cr in soil have significant effect on people's health through exposure. (3) We found that the increased PTEs in the arable land soil mainly originated from potential water sources, air and soil pollution sources, breeding farms, and mining areas.

[Transfer Factor and Health Risk Assessment of Heavy Metals in a Soil-Crop System in a High Incidence Area of Nasopharyngeal Carcinoma, Guangdong].

In order to reveal the transfer factor and perform health risk assessments of heavy metals in soil-crop systems in the high incidence area of nasopharyngeal carcinoma (NPC) in Guangdong province of China, the farmland system of Sihui City in the high incidence area of NPC was selected as the research object, and rice, lettuce, and corresponding soil samples were collected. As, Cu, Hg, Mn, Ni, Pb, and Cd in the soil and crop samples were analyzed. Based on the contents and chemical forms of seven heavy metals, the environmental pollution, bioavailability, and transfer factors of heavy metals in the soil-crop system were assessed using statistical analyses, pollution index evaluations, and transfer factor methods, and the health risks of adults and children in the study area were assessed using the health risk assessment model recommended by the U.S. Environmental Protection Agency. The results showed that the farmland soil in the study area was basically clean (P=0.43); Cd and Mn mainly existed in a bioavailable state, Hg mainly existed in a potentially available state, and As Cu, Ni, and Pb mainly existed in a residual state. The lettuce was safe (P=0.48), while the pollution index of rice (P=7.66) was higher than that of lettuce, and the main polluting element was Pb (PI=10.25). The results of soil pollution assessments are not completely consistent with those of crop pollution assessments, so they should be combined with the bioavailability of heavy metals and crop effects for correlation analyses. Cd and Cu are more easily absorbed by lettuce, while Cd, Cu, and As are more easily enriched by rice. Special attention should be paid to Cd and Cu pollution in farmland soils, and As pollution should be of focus in paddy fields. In the study area, the non-carcinogenic risk index (HI) value of edible lettuce for adults and children was less than 1 and the average value of the total carcinogenic risk index (Risk) of edible lettuce was less than 1×10-4. Therefore, the health risk of edible local lettuce was within the acceptable range. The average HI index of rice for adults and children was more than 1 and the main non-carcinogenic factor was Pb; the risk index of rice was more than 1×10-4, and the main carcinogenic factor was As. Rice consumption in the study area will cause certain health risks, and the threat to adults is greater than that to children. Therefore, As in rice may be related to the high incidence of NPC in Sihui City. It is suggested that the remediation of heavy metals in farmland soils be strengthened or that residents be forbidden to plant or eat local rice and other crops with greater health risks.

Finite Element Assessment of the Screw and Cement Technique in Total Knee Arthroplasty.

BACKGROUND: The screw and cement technique is a convenient method used to rebuild medial tibial plateau defects in primary total knee arthroplasty (TKA). The objective of this study was to perform a finite element assessment to determine the effect of different numbers of screws on the stability of TKA and to determine whether differences exist between two different insertion angles. METHOD: Six tibial finite element models with defects filled with screws and cement and one model with defects filled only with cement were generated. Contact stresses on the surface of cancellous bone in different areas were calculated. RESULTS: Compared to the cement-only technique, the stress on the border of cancellous bone and bone cement decreased by 10% using the screw and cement technique. For bone defects with a 12% defect area and a 12-mm defect depth, the use of 1 screw achieved the greatest stability; for those with a 15% defect area and a 20-mm defect depth, 2 screws achieved the greatest stability. CONCLUSIONS: (1) The screw and cement technique is superior to the bone cement-only technique. For tibial defects in which the defect area comprises a large percentage but the depth is less than 5 mm, the screw and cement technique is recommended. (2) Vertical screws can achieve better stability than oblique screws. (3) Screws should be used in moderation for different defects; more is not always better.