Analysis of affordability differences for rare diseases in China: a comparison across disease types and regions.

BACKGROUND: China has implemented policies to make rare diseases more affordable. While previous studies evaluated overall affordability, few have examined affordability differences across regions and disease types. Given the vastness of China and varying medical policies across cities, this study assesses the affordability of rare diseases based on China's First List of Rare Diseases (CFLRD), National Reimbursement Drug List (NRDL), and outpatient chronic and special disease policies in each prefecture. METHOD: Six rare diseases were selected and the average annual treatment cost of all relevant drugs in NRDL was calculated for each disease. Based on the WHO/HAI standardized approach, the study analyzed 289 cities with outpatient chronic and special disease policies, measured the security levels by the actual reimbursement ratio of Basic Medical Insurance (BMI) and affordability by the ratio of individual expenses after reimbursement to the annual disposable income of urban residents in the province. The security levels and affordability differences across disease types and provinces were analyzed using the Mann-Whitney U test and the K-W test. RESULT: The affordability of rare diseases varied significantly on the disease types and annual treatment cost. Diseases with an annual treatment cost below 100 000 yuan are affordable to all prefectures even with low reimbursement rates, while those with a higher treatment cost were not affordable in at least 80% of prefectures even though the reimbursement ratio is high. The affordability of the same disease varies significantly across provinces and municipalities. Outpatient chronic and special diseases insurance and critical illness insurance, and the inconsistencies between them, result in regional differences. CONCLUSION: Although China has made progress in improving the affordability of rare diseases, significant differences persist between cities and diseases. The study suggests the optimization of the BMI system and explores independent funds and innovative insurance models to enhance the affordability of rare diseases, particularly those with extremely high treatment costs.

Study on the trade-off/synergy between ecosystem services and human well-being based on land use in Weinan City, China.

Change of land use have important impacts on ecosystem services (ESs) and human well-being (HWB), yet the trade-off/synergy among land use, ESs, and HWB has still not received sufficient attention at city regional scales level. Weinan City in the southern of the Loess Plateau of China was taken as the study area. Based on ArcGIS, InVEST model, and RUSLE model, the characteristics of spatial and temporal variations of land use and ESs from 2000 to 2020 were analyzed, and the trade-off/synergy relationship between land use, ESs, and HWB was quantified using correlation analysis. The results indicated that the area of cultivated land decreased significantly and the area of built-up land increased significantly from 2000 to 2020 in Weinan City. The grain production, soil conservation, and water yield functions showed an increasing trend, which was a synergistic relationship with HWB. Carbon storage and habitat quality functions showed a decreasing trend, which was a trade-off relationship with HWB. The index value of HWB has increased significantly, mainly in the added value of agricultural and rural per capita income. Land use intensity has a trade-off relationship with GP, WY functions, and HWB. There are many factors that affect this trade-off/synergy relationship, such as land use patterns, economic development, and population growth. The study can provide a theoretical basis for the sustainable development of regional economy and nature.

Alzheimer's disease with frailty: Prevalence, screening, assessment, intervention strategies and challenges.

Alzheimer's disease (AD) is a neurodegenerative disorder that affects millions worldwide and is expected to surge in prevalence due to aging populations. Frailty, characterized by muscle function decline, becomes more prevalent with age, imposing substantial burdens on patients and caregivers. This paper aimed to comprehensively review the current literature on AD coupled with frailty, encompassing prevalence, screening, assessment, and treatment while delving into the field's challenges and future trajectories. Frailty and AD coexist in more than 30% of cases, with hazard ratios above 120% indicating a mutually detrimental association.Various screening tools have emerged for both frailty and AD, including the Fried Frailty Phenotype (FP), FRAIL scale, Edmonton Frailty Scale (EFS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT), and General Practitioner Assessment of Cognition (GPCOG). However, none has solidified its role as the definitive gold standard. The convergence of electronic health records and brain aging biomarkers heralds a new era in AD with frailty screening and assessment. In terms of intervention, non-pharmacological strategies spanning nutrition, horticulture, exercise, and social interaction, along with pharmacological approaches involving acetylcholinesterase inhibitors (AChEIs), N-methyl-D-aspartate (NMDA) receptor antagonists, and anti-amyloid beta-protein medications, constituted cornerstones for treating AD coupled with frailty. Technological interventions like repetitive transcranial magnetic stimulation (rTMS) also entered the fold. Notably, multi-domain non-pharmacological interventions wield considerable potential in enhancing cognition and mitigating disability. However, the long-term efficacy and safety of pharmacological interventions necessitate further validation. Diagnosing and managing AD with frailty present several daunting challenges, encompassing low rates of early co-diagnosis, limited clinical trial evidence, and scarce integrated, pioneering service delivery models. These challenges demand heightened attention through robust research and pragmatic implementation.

[Policy Analysis in Plastic Pollution Governance and Recommendations in China].

Plastic pollution is a global concern and an issue in environmental governance. Based on the updated "Plastic Prohibition/Restriction Order" issued recently in China, the present study systematically reviewed the implementation effectiveness of the "Plastic Prohibition/Restriction Order" since 2007. Furthermore, we summarized plastics in China and plastic waste management progress policies. Additionally, three deficiencies of the updated "Plastic Prohibition/Restriction Order" were discussed:policy formulation, implementation, and supervision. Some positive recommendations were provided based on the available reports, such as integrating plastic pollution into national basic laws and regulation systems, building a network platform for public attendance, and coordinating the publicity of the "Plastic prohibition/Restriction Order" with the public interest. Besides these measurements, some points about plastic waste management in the future were also highlighted, such as the "blind area" in small retail stores, the rational sharing of environmental protection responsibility, new materials and processes, and recycling and disposal systems for plastic wastes. Most importantly, the present study could provide ideas for policy-makers to address plastic pollution at its sources.

Reliability and Validity of the Repeatable Battery for Assessment of Neuropsychological Status Scale in Evaluation of Vascular Cognitive Impairment in Elderly Han Population.

Introduction: Vascular cognitive impairment (VCI) and Alzheimer's disease are the most common cognitive impairment diseases in the elderly. This study aimed to apply the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) scale to evaluate VCI in elderly patients and analyze its reliability and validity. Methods: We enrolled 278 VCI patients admitted to our hospital, from June 2017 to June 2018. The basic clinical information of each patient was documented, and the Mini-Mental State Examination (MMSE) and the RBANS scales were suggested to complete. Results: We found significant correlations between the RBANS total score and age, diabetes, hypertension, coronary heart disease and years of education. The internal consistency of the RBANS scale Cronbach αsuggested a good agreement with the total score and the single score at two time points. Moreover, the RBANS total score and the score of each dimension in the RBANS scale were positively correlated with the MMSE immediate memory, calculation ability, delayed memory, commanding ability, reading comprehension ability, command execution, sentence making, and pattern duplicating ability. Conclusion: In conclusion, the RBANS has good reliability and validity for the assessment of cognitive dysfunction in elderly VCI patients. It can be used as a routine clinical and research tool, for the simplicity in operation and superior acceptance.

[Distribution Characteristics and Ecological and Health Risk Assessment of Phthalic Acid Esters in Surface Water of Qiandao Lake, China].

In order to reveal the pollution and risk level of phthalic acid esters (PAEs) in Qiandao Lake, six types of PAEs in 17 sampling points (in Qiandao Lake and its inflowing rivers) in dry and wet seasons were detected. The results showed that six types of PAEs were detected in both dry and wet seasons, with the concentrations of 0.98-5.33 µg·L-1 (average concentration 2.63 µg·L-1) in the dry season and 3.22-17.88 µg·L-1 (average concentration 7.99 µg·L-1) in the wet season. In terms of the detection rate and concentration of each monomer PAEs, DiBP, DBP, and DEHP were the main PAEs components in the water body. The measured value of DBP at 10 sampling points and its average mass concentration in the wet season were higher than the national standard (3 µg·L-1). Principal component analysis indicated that the main sources of PAEs were personal care products, plastics, and domestic waste. The pollution level of PAEs in Qiandao Lake was at a high level at home and abroad. The health risk assessment results in Qiandao Lake showed that the non-carcinogenic risk index of PAEs in the study area was less than 1, which would not produce non-carcinogenic risks to the human body. The carcinogenic risk index of children exceeded 10-6 at some points, indicating that it may pose carcinogenic risks to children, to which more attention should be paid.

A multi-proxy assessment of the impact of environmental instability on Late Holocene (4500-3800 BP) Native American villages of the Georgia coast.

Circular shell rings along the South Atlantic Coast of North America are the remnants of some of the earliest villages that emerged during the Late Archaic (5000-3000 BP). Many of these villages, however, were abandoned during the Terminal Late Archaic (ca 3800-3000 BP). We combine Bayesian chronological modeling with mollusk shell geochemistry and oyster paleobiology to understand the nature and timing of environmental change associated with the emergence and abandonment of circular shell ring villages on Sapelo Island, Georgia. Our Bayesian models indicate that Native Americans occupied the three Sapelo shell rings at varying times with some generational overlap. By the end of the complex's occupation, only Ring III was occupied before abandonment ca. 3845 BP. Ring III also consists of statistically smaller oysters harvested from less saline estuaries compared to earlier occupations. Integrating shell biochemical and paleobiological data with recent tree ring analyses shows a clear pattern of environmental fluctuations throughout the period in which the rings were occupied. We argue that as the environment became unstable around 4300 BP, aggregation at villages provided a way to effectively manage fisheries that are highly sensitive to environmental change. However, with the eventual collapse of oyster fisheries and subsequent rebound in environmental conditions ca. post-3800 BP, people dispersed from shell rings, and shifted to non-marine subsistence economies and other types of settlements. This study provides the most comprehensive evidence for correlations between large-scale environmental change and societal transformations on the Georgia coast during the Late Archaic period.

The 2018 annual cost burden for children under five years of age hospitalised with respiratory syncytial virus in Australia.

ABSTRACT: Respiratory syncytial virus (RSV) is one of the principal causes of acute bronchiolitis and respiratory tract infections in young children. Routine RSV surveillance in Australian children is limited; vaccines are in late stage development; prophylactic monoclonal antibody (mAb) treatment is available but expensive; and there has been uncertainty around the cost burden. The objective of this study was to determine the annual cost burden for children under five years of age hospitalised with RSV in a single health service in 2018, with national extrapolation based on published Australian prevalence data. The methods utilised individual patient-level cost data prospectively collected for hospitalised children under five years of age in a tertiary Melbourne paediatric hospital. Results were extrapolated to all Australian children under five years of age to determine the national annual health cost burden, from a healthcare sector perspective over a 12 month time horizon. The results included 363 children with a mean age of 9.2 months (standard deviation, SD: 8.5 months). The mean cost per child was $17,120 (SD: $37,562), with a combined health service cost of $6,214,439. The reported Australian hospitalisation rate for RSV in the target age group ranged from 2.2 to 4.5 per 1,000 children under five years of age, resulting in a 2018 extrapolated cost range of $59,218,844-$121,129,453 for the estimated 3,459-7,075 children affected (combined index and all-cause six-month readmissions). This study concluded that RSV represents a significant cost burden to Australia's health care system. These data are important for future health economic assessments of preventative therapies, such as new RSV mAb treatments and maternal/childhood RSV vaccines, and provides valuable insights to inform health care planning and health policy.

Assessment of Combined Karyotype Analysis and Chromosome Microarray Analysis in Prenatal Diagnosis: A Cohort Study of 3710 Pregnancies.

Objective: The current study aimed to compare the characteristics of chromosome abnormalities detected by conventional G-banding karyotyping, chromosome microarray analysis (CMA), or fluorescence in situ hybridization (FISH)/CNVplex analysis and further explore the application value of combined karyotype analysis and CMA in prenatal diagnosis with a larger sample size. Methods: From March 2019 to March 2021, 3710 amniocentesis samples were retrospectively collected from women who accepted prenatal diagnosis at 16 to 22 + 6 weeks of pregnancy. The pregnant women underwent karyotype analysis and CMA. In the case of fetal chromosomal mosaicism, FISH or CNVplex analysis was utilized for validation. Results: In total, 3710 G-banding karyotype results and CMA results from invasive prenatal diagnosis were collected. Of these, 201 (5.41%) fetuses with an abnormal karyotype were observed. The CMA analysis showed that the abnormality rate was 9.14% (340/3710). The detection rate of CMA combined with karyotype analysis was 0.35% higher than that of CMA alone and 4.08% higher than that of karyotyping alone. Additionally, 12 cases had abnormal karyotype analysis, despite normal CMA results. To further detect the chromosome mosaicism, we used FISH analysis to correct the karyotype results of case 1. Correspondingly, a total of 157 cases showed abnormal CMA results but normal karyotype analysis. We also found chromosomal mosaicism in 4 cases using CMA. Moreover, CNVplex and CMA demonstrated that representative case 15 was mosaicism for trisomy 2. Conclusions: Conventional G-banding karyotyping and CMA have their own advantages and limitations. A combination of karyotype analysis and CMA can increase the detection rate of chromosome abnormalities and make up for the limitation of signal detection.

The Assessment of Prostate Cancer Aggressiveness Using a Combination of Quantitative Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

OBJECTIVE: To explore the value of combining dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters with apparent diffusion coefficient (ADC) values in the diagnosis of prostate cancer. METHODS: The clinical data of 146 patients with prostate lesions, including 87 patients with prostate cancer (PCa) and 59 with benign prostatic hyperplasia (BPH), were collected. After DCE-MRI and diffusion-weighted imaging (DWI) prostate scans, the magnitude of the DCE-MRI transfer constant (Ktrans ), rate constant (kep ), the volume of the extravascular extracellular space (ve ), and the ADC between the groups were compared, and the correlations between the DCE-MRI parameters and Gleason scores were analyzed. The diagnostic efficacy of these quantitative parameters was assessed by the area under the receiver operating characteristic (ROC) curve. RESULTS: The DCE-MRI parameters Ktrans and kep were significantly greater in the PCa group than in the BPH group (p < 0.05). The ROC curve showed the area under the Ktrans, kep , and ADC curves to be 0.665, 0.658, and 0.782, respectively. When all three quantitative indicators were combined, the area under the ROC curve was 0.904, with sensitivity and specificity rates of 83.6% and 93.7%, respectively. The Gleason scores were positively correlated with the Ktrans, kep , and ve (r = 0.39, 0.572, 0.30, respectively; p < 0.05) and negatively correlated with the ADC (r = -0.525; p < 0.05). CONCLUSION: The DCE-MRI quantitative parameters Ktrans and kep , as well as the ADC value, provided effective references for the differential diagnosis of PCa and BPH, as well as more precise and reliable quantitative parameters for grading the aggressiveness of PCa.

A second external quality assessment of isolation and identification of influenza viruses in cell culture in the Asia Pacific region highlights improved performance by participating laboratories.

Influenza viruses must be amplified in cell culture for detailed antigenic analysis and for phenotypic assays assessing susceptibility to antiviral drugs or for other assays. Following on from the first external quality assessment (EQA) for isolation and identification of influenza viruses using cell culture techniques in 2016, a follow up EQA was performed in 2019 for National Influenza Centres (NICs) in the World Health Organization (WHO) South East Asia and Western Pacific Regions. Nineteen WHO NICs performed influenza virus isolation and identification techniques on an EQA panel comprising 16 samples, containing influenza A or B viruses and negative control samples. One sample was used exclusively to assess capacity to measure a hemagglutination titer and the other 15 samples were used for virus isolation and subsequent identification. Virus isolation from EQA samples was generally detected by assessment of cytopathic effect and/or hemagglutination assay while virus identification was determined by real time RT-PCR, hemagglutination inhibition and/or immunofluorescence assays. For virus isolation from EQA samples, 6/19 participating laboratories obtained 15/15 correct results in the first EQA (2016) compared to 11/19 in the follow up (2019). For virus identification in isolates derived from EQA samples, 6/19 laboratories obtained 15/15 correct results in 2016 compared to 13/19 in 2019. Overall, NIC laboratories in the Asia Pacific Region showed a significant improvement between 2016 and 2019 in terms of the correct results reported for isolation from EQA samples and identification of virus in isolates derived from EQA samples (p=0.01 and p=0.02, respectively).

[Changes in Water Chemistry and Driving Factors in the Middle and Lower Reaches of the Beijing-Hangzhou Grand Canal].

To reveal the Beijing-Hangzhou Grand Canal natural water chemistry characteristics and the influence of human activities, river samples from Xuzhou to Jiaxing were collected in 2019-2020. Simultaneously, the water chemistry data of the canal from 1959 to 1962 and 1975 to 1977 in the Suzhou, Wuxi, and Changzhou sections and the recent social and economic data of the major cities along the canal were collected and analyzed. The results showed that the type of hydrochemistry in the study area was mainly influenced by the weathering of carbonate rocks in the basin, but K++Na+ accounted for 40.39% of the cation equivalent concentration, which was higher than that in ordinary surface water, thereby indicating that the natural hydrochemistry of the canal had been significantly affected by human factors. Spatially, the major ion mass concentrations, total hardness, and total alkalinity of the Grand Canal from Xuzhou station to the downstream area tended to decrease overall, but the parameters at Wuxi and Suzhou stations increased significantly. It was found that Na+ and SO42- were increased by approximately 16 and 12 times and total dissolved solids was increased by nearly 3 times by analyzing the 60 years of water chemistry of the Suzhou, Wuxi, and Changzhou sections. The current (Ca2++Mg2+)/HCO3- ratio in the Suzhou, Wuxi, and Changzhou sections is generally greater than 1, which is significantly higher than that from 1959 to 1962, thereby reflecting the results of human activities. According to the analysis of the social and economic development of the Grand Canal, this change was the result of the accelerated weathering of carbonate rocks in the basin caused by the sulfur oxides discharged by human activities. Further statistical analysis showed that urban domestic sewage and industrial wastewater discharge were the main driving factors causing chemical salinization of natural water in the Grand Canal. This study can provide a scientific basis for coordinating urban development and protecting the water ecological environment of the Grand Canal Basin.

Impact of energy structure on carbon emission and economy of China in the scenario of carbon taxation.

As the largest CO2 emitter in the world, China intends to achieve the peak of carbon emissions in around 2030. Unlike many other countries' targets of reducing the amount the carbon emissions, China has engaged in achieving the goal of carbon emission intensity regulation including economic development and carbon emission reduction. In recent years, carbon tax policy has been implemented by about 30 national and sub-national jurisdictions in controlling carbon emissions and has shown promising results. In this context, this research evaluates whether the carbon tax is an effective way for China to accomplish the win-win target of carbon reduction and GDP growth. Specifically, a model is established based on the energy substitution theory and input-output theory to evaluate the effectiveness of carbon tax on the eight economic sectors of China. The carbon emission reduction and economic performance before and after carbon taxation are compared. Moreover, the effects of different carbon tax rates on economic development are analyzed. The results are as follows: (1) The total amount of carbon emission decreases while the carbon tax is levied, and a positive correlation is found between the tax rate and the emission reduction amount. (2) The carbon tax has a significant impact on economic development, and a negative correlation is found between the tax rate and economic development. However, the loss of the economic output caused by the carbon tax gradually reduces over time. (3) Carbon tax policy would be effective for China to accomplish the win-win goal of carbon reduction and GDP growth. Moreover, the carbon tax rate should be set at a low level to achieve the target by the lowest economic cost. On this basis, several policy recommendations are proposed by this research.

[Thoughts on and Construction of a Risk Management and Control System for Contaminated Sites in the Guangdong-Hong Kong-Macao Greater Bay Area].

Preventing the environmental risks linked to contaminated sites and guaranteeing the safety of human settlements are some of the challenges and tasks involved in the construction of world-class city clusters in the Guangdong-Hong Kong-Macao Greater Bay Area. Due to differences in the political systems and land property rights between Guangdong, Hong Kong, and Macao, as well as in the levels of urbanization, industrial structures, and environmental management capabilities of the nine cities in the Pearl River Delta, the risk management and control mode of contaminated sites varies considerably within the Greater Bay Area. In this context, an analysis of the features of risk management and control in the contaminated sites of typical cities can help strengthening technical communication and cooperation, optimizing risk management and control systems. This article briefly describes the risk management and control systems adopted for polluted sites in China; in particular it elaborates on the features of these systems in Guangzhou, Shenzhen, Dongguan, Hong Kong, and Macao, which have been subjected to monitoring, contamination assessments, and renovation procedures. During our study, the risk management and control systems adopted in different cities have been analyzed and compared; moreover, we elaborated thoughts and suggestions for land planning, policy feedback, information disclosure, and alliance mechanisms. We conclude that, overall, Hong Kong and several cities of the Pearl River Delta have established effective risk management and control systems for the polluted sites, which take into account certain local characteristics. However, with the further development and reuse of contaminated sites, the building of a world-class urban agglomeration in the Guangdong-Hong Kong-Macao Greater Bay Area will require safer, more refined, and more efficient risk management and control strategies. We highlight the need to exchange information among researchers in order to promote technical exchange and cooperation. This is particularly important for the risk management and control of polluted sites distributed within the two regions and nine cities of the Guangdong-Hong Kong-Macao Greater Bay Area, sine it would allow their safe reuse and efficient development.

Decadal evolution of the surface energy budget during the fast warming and global warming hiatus periods in the ERA-interim.

The global-mean surface temperature has experienced a rapid warming from the 1980s to early-2000s but a muted warming since, referred to as the global warming hiatus in the literature. Decadal changes in deep ocean heat uptake are thought to primarily account for the rapid warming and subsequent slowdown. Here, we examine the role of ocean heat uptake in establishing the fast warming and warming hiatus periods in the ERA-interim through a decomposition of the global-mean surface energy budget. We find the increase of carbon dioxide alone yields a nearly steady increase of the downward longwave radiation at the surface from the 1980s to the present, but neither accounts for the fast warming nor warming hiatus periods. During the global warming hiatus period, the transfer of latent heat energy from the ocean to atmosphere increases and the total downward radiative energy flux to the surface decreases due to a reduction of solar absorption caused primarily by an increase of clouds. The reduction of radiative energy into the ocean and the surface latent heat flux increase cause the ocean heat uptake to decrease and thus contribute to the slowdown of the global-mean surface warming. Our analysis also finds that in addition to a reduction of deep ocean heat uptake, the fast warming period is also driven by enhanced solar absorption due predominantly to a decrease of clouds and by enhanced longwave absorption mainly attributed to the air temperature feedback.

Intraseason decline in influenza vaccine effectiveness during the 2016 southern hemisphere influenza season: A test-negative design study and phylogenetic assessment.

BACKGROUND: We estimated the effectiveness of seasonal inactivated influenza vaccine and the potential influence of timing of immunization on vaccine effectiveness (VE) using data from the 2016 southern hemisphere influenza season. METHODS: Data were pooled from three routine syndromic sentinel surveillance systems in general practices in Australia. Each system routinely collected specimens for influenza testing from patients presenting with influenza-like illness. Next generation sequencing was used to characterize viruses. Using a test-negative design, VE was estimated based on the odds of vaccination among influenza-positive cases as compared to influenza-negative controls. Subgroup analyses were used to estimate VE by type, subtype and lineage, as well as age group and time between vaccination and symptom onset. RESULTS: A total of 1085 patients tested for influenza in 2016 were included in the analysis, of whom 447 (41%) tested positive for influenza. The majority of detections were influenza A/H3N2 (74%). One-third (31%) of patients received the 2016 southern hemisphere formulation influenza vaccine. Overall, VE was estimated at 40% (95% CI: 18-56%). VE estimates were highest for patients immunized within two months prior to symptom onset (VE: 60%; 95% CI: 26-78%) and lowest for patients immunized >4 months prior to symptom onset (VE: 19%; 95% CI: -73-62%). DISCUSSION: Overall, the 2016 influenza vaccine showed good protection against laboratory-confirmed infection among general practice patients. Results by duration of vaccination suggest a significant decline in effectiveness during the 2016 influenza season, indicating immunization close to influenza season offered optimal protection.

The first external quality assessment of isolation and identification of influenza viruses in cell culture in the Asia Pacific region, 2016.

BACKGROUND: The isolation and propagation of influenza viruses from clinical specimens are essential tools for comprehensive virologic surveillance. Influenza viruses must be amplified in cell culture for detailed antigenic analysis and for phenotypic assays assessing susceptibility to antiviral drugs or for other assays. OBJECTIVES: To conduct an external quality assessment (EQA) of proficiency for isolation and identification of influenza viruses using cell culture techniques among National Influenza Centres (NICs) in the World Health Organisation (WHO) South East Asia and Western Pacific Regions. STUDY DESIGN: Twenty-one NICs performed routine influenza virus isolation and identification techniques on a proficiency testing panel comprising 16 samples, containing influenza A or B viruses and negative control samples. One sample was used exclusively to determine their capacity to measure hemagglutination titer and the other 15 samples were used for virus isolation and identification. RESULTS: All NICs performed influenza virus isolation using Madin Darby canine kidney (MDCK) or MDCK-SIAT-1 cells. If virus growth was detected, the type, subtype and/or lineage of virus present in isolates was determined using immunofluorescence, RT-PCR and/or hemagglutination inhibition (HI) assays. Most participating laboratories could detect influenza virus growth and could identify virus amplified from EQA samples. However, some laboratories failed to isolate and identify viruses from EQA samples that contained lower titres of virus, highlighting issues regarding the sensitivity of influenza virus isolation methods between laboratories. CONCLUSION: This first round of EQA was successfully conducted by NICs in the Asia Pacific Region, revealing good proficiency in influenza virus isolation and identification.

Solidification and Biotoxicity Assessment of Thermally Treated Municipal Solid Waste Incineration (MSWI) Fly Ash.

In the present work, thermal treatment was used to stabilize municipal solid waste incineration (MSWI) fly ash, which was considered hazardous waste. Toxicity characteristic leaching procedure (TCLP) results indicated that, after the thermal process, the leaching concentrations of Pb, Cu, and Zn decreased from 8.08 to 0.16 mg/L, 0.12 to 0.017 mg/L and 0.39 to 0.1 mg/L, respectively, which well met the limits in GB5085.3-2007 and GB16689-2008. Thermal treatment showed a negative effect on the leachability of Cr with concentrations increasing from 0.1 to 1.28 mg/L; nevertheless, it was still under the limitations. XRD analysis suggested that, after thermal treatments, CaO was newly generated. CaO was a main contribution to higher Cr leaching concentrations owing to the formation of Cr (VI)-compounds such as CaCrO4. SEM/EDS tests revealed that particle adhesion, agglomeration, and grain growth happened during the thermal process and thus diminished the leachability of Pb, Cu, and Zn, but these processes had no significant influence on the leaching of Cr. A microbial assay demonstrated that all thermally treated samples yet possessed strong bactericidal activity according to optical density (OD) test results. Among all samples, the OD value of raw fly ash (RFA) was lowest followed by FA700-10, FA900-10, and FA1100-10 in an increasing order, which indicated that the sequence of the biotoxicity for these samples was RFA > FA700-10 > FA900-10 > FA1100-10. This preliminary study indicated that, apart from TCLP criteria, the biotoxicity assessment was indispensable for evaluating the effect of thermal treatment for MSWI fly ash.

Effectiveness of seasonal influenza vaccine in Australia, 2015: An epidemiological, antigenic and phylogenetic assessment.

BACKGROUND: A record number of laboratory-confirmed influenza cases were notified in Australia in 2015, during which type A(H3) and type B Victoria and Yamagata lineages co-circulated. We estimated effectiveness of the 2015 inactivated seasonal influenza vaccine against specific virus lineages and clades. METHODS: Three sentinel general practitioner networks conduct surveillance for laboratory-confirmed influenza amongst patients presenting with influenza-like illness in Australia. Data from the networks were pooled to estimate vaccine effectiveness (VE) for seasonal trivalent influenza vaccine in Australia in 2015 using the case test-negative study design. RESULTS: There were 2443 eligible patients included in the study, of which 857 (35%) were influenza-positive. Thirty-three and 19% of controls and cases respectively were reported as vaccinated. Adjusted VE against all influenza was 54% (95% CI: 42, 63). Antigenic characterisation data suggested good match between vaccine and circulating strains of A(H3); however VE for A(H3) was low at 44% (95% CI: 21, 60). Phylogenetic analysis indicated most circulating viruses were from clade 3C.2a, rather than the clade included in the vaccine (3C.3a). VE point estimates were higher against B/Yamagata lineage influenza (71%; 95% CI: 57, 80) than B/Victoria (42%, 95% CI: 13, 61), and in younger people. CONCLUSIONS: Overall seasonal vaccine was protective against influenza infection in Australia in 2015. Higher VE against the B/Yamagata lineage included in the trivalent vaccine suggests that more widespread use of quadrivalent vaccine could have improved overall effectiveness of influenza vaccine. Genetic characterisation suggested lower VE against A(H3) influenza was due to clade mismatch of vaccine and circulating viruses.

Residue behavior and risk assessment of mixed formulation of imidacloprid and chlorfenapyr in chieh-qua under field conditions.

A simple and rapid method based on high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was developed for the simultaneous determination of imidacloprid and chlorfenapyr residues in chieh-qua. Field trials were designed to investigate the dissipation and terminal residue behavior of the mixed formulation of imidacloprid and chlorfenapyr in chieh-qua in Guangzhou and Nanning areas. Risk assessment was performed by calculating the risk quotient (RQ) values. The developed analytical method exhibited recoveries of 89.9-110.3% with relative standard deviations (RSDs) of 2.8-12.5% at the spiked levels of 0.01, 0.10, and 1.00 mg/kg. The limit of detection (LOD) was 0.003 mg/kg, and the limit of quantification (LOQ) was 0.01 mg/kg for both imidacloprid and chlorfenapyr. It was found that the half-lives of imidacloprid in chieh-qua under field conditions were 3.3 and 3.5 days in Guangzhou and Nanning at a dose of 180 g ai/ha, while the half-lives of chlorfenapyr were 3.3 and 2.6 days, respectively. The terminal residues of imidacloprid and chlorfenapyr were from 0.01 to 0.21 mg/kg and from 0.01 to 0.46 mg/kg, respectively. Results of dietary exposure assessment showed that the RQ values were much lower than 1, indicating that the risk of imidacloprid and chlorfenapyr applied in chieh-qua was negligible to human health under recommended dosage and good agricultural practices. The proposed study would provide guidance for safe and reasonable use of imidacloprid and chlorfenapyr in chieh-qua cultivation in China.