Spatial, temporal and demographic patterns in asthma mortality in China: A systematic analysis from 2014 to 2020.

Background: Asthma is an important contributor to the burden of non-communicable diseases in China. Understanding spatial, temporal, and demographic patterns in asthma mortality is relevant to the design and implementation of targeted interventions. Methods: This study collected information on asthma deaths occurring across 605 disease surveillance points (DSPs) as recorded in the population-based national mortality surveillance system (NMSS) of China. Asthma was defined according to the International Classification of Diseases, 10th Revision code J45-J46. Estimates of age-standardized mortality rates and total national asthma deaths were calculated based on yearly population data. Statistical analysis was performed to investigate the influence of various factors on asthma mortality. Results: Between 2014 and 2020, a total of 40 116 asthma deaths occurred in DSPs. Standardized asthma mortality per 100 000 people decreased from 1.79 (95% CI: 1.74-1.83) in 2014 to 1.07 (95% CI: 1.03-1.10) in 2020 in China. In 2020, the overall asthma mortality rate was higher for male patients than for female patients, and asthma mortality rates increased substantially with age. Age-standardized asthma mortality per 100,000 people exhibited significant geographic variation, ranging from 0.93 (95% CI: 0.89-0.98) in Eastern China to 1.04 (95% CI: 0.98-1.10) in Central China and 1.37 (95% CI: 1.29-1.45) in Western China in 2020. Asthma mortality in urban areas appeared to be higher than in rural areas. Socioeconomic factors, including gross domestic product per capita and density of hospital beds per 10,000 population, may be related to asthma mortality. Male asthma patients who lived in rural areas and were aged 65 years and above were generally at high risk of asthma-related mortality. Conclusions: This study found a spatial and temporal trend for a reduction in asthma deaths over seven years in China; however, there remain important sociodemographic groups that have not secured the same decrease in mortality rates. Trial registration: This was a purely observational study and thus registration was not required.

Anaerobic digestion of agricultural wastes from liquid to solid state: Performance and environ-economic comparison.

Performance and environ-economic impacts were compared for anaerobic digestion (AD) of dairy manure and cucumber residues from liquid to solid state. Environ-economic evaluation of the overall AD process at different total solids (TS) was performed with the estimated treatment capacity of 9600 tons/year and service life of 20 years. Results showed that TS increase from 6% to 22% enhanced both cumulative and volumetric methane (CH4) production. Further TS increase to 25%, however, reduced CH4 yield. Environ-economic assessment indicated that TS increase enhanced volumetric waste treatment capacity and thus AD environmental footprints. Environmental credits from digestate and biogas utilization could compensate the adverse environmental impacts of other processes in AD plants. Furthermore, biogas and nutrients in digestate determined AD net-present value. As a result, solid state AD was more profitable with higher CH4 yield and more nutrients in both biosolids and digested effluent of digestate than its liquid and hemi-solid counterparts.

Assessment of gaseous ozone treatment on Salmonella Typhimurium and Escherichia coli O157:H7 reductions in poultry litter.

Poultry litter is used as soil amendment or organic fertilizer. While poultry litter is enriched with organic matter suitable for land, the presence of pathogens such as Salmonella in poultry litter is a concern. To investigate the effect of gaseous ozone on pathogen reductions in poultry litter, this study conducted a series of experiments that involved understanding of Salmonella Typhimurium and Escherichia coli O157:H7 inactivation at various doses of Ozone (O3) in wet and dry poultry litter conditions. Previously, ozone treatment has been shown to disinfect the surface of foods and plant materials including fruits, juices, and wastewater, however, additional research are needed to better understand the impacts of ozone on treatment of soil amendments. Sanitizing methods capable of eliminating pathogens of soil amendments are crucial to mitigate disease outbreaks related with litter/manure-based fertilizers. In this study, a bench scale continuous ozone treatment system was designed to produce O3 gas, with a range O3 concentrations (7.15-132.46 mg·L-1), monitor ozone concentrations continuously, and control the ozone exposure time (15 to 90 mins) to understand the effectiveness of O3 in eliminating S. Typhimurium and E. coli O157:H7 in poultry litter. Results showed that 7.15 mg·L-1 did not reduce the counts of S. Typhimurium until exposure to O3 for 90 min. The O3 concentrations of 43.26 ~ 132.46 mg·L-1 exposure reduced the bacterial counts. Furthermore, the moisture content of poultry litter was found to be an influencing factor for pathogen reduction. The pathogen reduction rates were reduced when the moisture content was increased. At higher moisture content, high concentrations of O3 (132.46 mg·L-1) were needed for pathogen reductions. The moisture content of 30% or lower was found to be more effective for controlling pathogen levels in poultry litter. Our study demonstrates that gaseous O3 treatment could be used as an additional decontamination technique to ensure the certain degree of microbiological safety of poultry litter based soil amendment.

The profile inter-unit reliability.

To assess the quality of health care, patient outcomes associated with medical providers (eg, dialysis facilities) are routinely monitored in order to identify poor (or excellent) provider performance. Given the high stakes of such evaluations for payment as well as public reporting of quality, it is important to assess the reliability of quality measures. A commonly used metric is the inter-unit reliability (IUR), which is the proportion of variation in the measure that comes from inter-provider differences. Despite its wide use, however, the size of the IUR has little to do with the usefulness of the measure for profiling extreme outcomes. A large IUR can signal the need for further risk adjustment to account for differences between patients treated by different providers, while even measures with an IUR close to zero can be useful for identifying extreme providers. To address these limitations, we propose an alternative measure of reliability, which assesses more directly the value of a quality measure in identifying (or profiling) providers with extreme outcomes. The resulting metric reflects the extent to which the profiling status is consistent over repeated measurements. We use national dialysis data to examine this approach on various measures of dialysis facilities.

Evaluation of limited irrigation strategies to improve water use efficiency and wheat yield in the North China Plain.

The North China Plain is one of the most important grain production regions in China, but is facing serious water shortages. To achieve a balance between water use and the need for food self-sufficiency, new water efficient irrigation strategies need to be developed that balance water use with farmer net return. The Crop Environment Resource Synthesis Wheat (CERES-Wheat model) was calibrated and evaluated with two years of data which consisted of 3-4 irrigation treatments, and the model was used to investigate long-term winter wheat productivity and water use from irrigation management in the North China Plain. The calibrated model simulated accurately above-ground biomass, grain yield and evapotranspiration of winter wheat in response to irrigation management. The calibrated model was then run using weather data from 1994-2016 in order to evaluate different irrigation strategies. The simulated results using historical weather data showed that grain yield and water use was sensitive to different irrigation strategies including amounts and dates of irrigation applications. The model simulated the highest yield when irrigation was applied at jointing (T9) in normal and dry rainfall years, and gave the highest simulated yields for irrigation at double ridge (T8) in wet years. A single simulated irrigation at jointing (T9) produced yields that were 88% compared to using a double irrigation treatment at T1 and T9 in wet years, 86% of that in normal years, and 91% of that in dry years. A single irrigation at jointing or double ridge produced higher water use efficiency because it obtained higher evapotranspiration. The simulated farmer irrigation practices produced the highest yield and net income. When the cost of water was taken into account, limited irrigation was found to be more profitable based on assumptions about future water costs. In order to increase farmer income, a subsidy will likely be needed to compensate farmers for yield reductions due to water savings. These results showed that there is a cost to the farmer for water conservation, but limiting irrigation to a single irrigation at jointing would minimize impact on farmer net return in North China Plain.

Importance of maintaining body weight for prevention of distant metastasis of nasopharyngeal carcinoma: An alternative workflow for cancer-risk assessment.

Purpose: To design an alternative workflow for cancer-risk assessment to predict distant metastasis (DM) of nasopharyngeal carcinoma (NPC). Methods: We enrolled 234 patients with non-disseminated NPC and a family history of cancer who underwent intensity-modulated radiotherapy and concurrent chemo-radiotherapy with/without induction chemotherapy in our primary cohort. We conducted univariate and multivariate analyses of the associated prognostic factors, built a nomogram model for distant-metastasis-free survival (DMFS), and confirmed the prognostic value of weight-loss ratio (WTratio). The secondary cohort included 97 patients with available pre-DNA levels who were treated at our cancer center. We performed internal validation with the primary cohort and external validation with the secondary cohort, and compared the new DMFS model with the current 7th TNM staging system. Results: In the primary cohort, 95.9% patients experienced weight loss. The N group (N2-3 vs. N0-1, P = 0.037) and pre-DNA level (P = 0.02) were independent prognostic factors for DMFS in NPC patients. Smoking (P = 0.051) and WTratio (P = 0.052) showed a significant trend for DMFS. WTratio was an independent prognostic factor for DMFS (P = 0.03). Smoking, WTratio, N group, and pre-DNA level were merged to build a risk-score model for DMFS using a nomogram, which could predict survival after internal and external validation. Conclusions: Maintaining body weight during treatment is essential to prevent DM of NPC. Compared with the current 7th TNM staging system, the new DMFS model might better predict DM of NPC. The alternative workflow designed could be applied for prognostic analysis of other cancers.

Application of 3D rapid prototyping technology in posterior corrective surgery for Lenke 1 adolescent idiopathic scoliosis patients.

A retrospective study to evaluate the effectiveness of 3-dimensional rapid prototyping (3DRP) technology in corrective surgery for Lenke 1 adolescent idiopathic scoliosis (AIS) patients. 3DRP technology has been widely used in medical field; however, no study has been performed on the effectiveness of 3DRP technology in corrective surgery for Lenke 1 AIS patients. Lenke 1 AIS patients who were preparing to undergo posterior corrective surgery from a single center between January 2010 and January 2012 were included in this analysis. Patients were divided into 2 groups. In group A, 3-dimensional (3D) printing technology was used to create subject-specific spine models in the preoperative planning process. Group B underwent posterior corrective surgery as usual (by free hand without image guidance). Perioperative and postoperative clinical outcomes were compared between 2 groups, including operation time, perioperative blood loss, transfusion volume, postoperative hemoglobin (Hb), postoperative complications, and length of hospital stay. Radiological outcomes were also compared, including the assessment of screw placement, postoperative Cobb angle, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis. Subgroup was also performed according to the preoperative Cobb angle: mean Cobb angle <50° and mean Cobb angle >50°. Besides, economic evaluation was also compared between 2 groups. A total of 126 patients were included in this study (group A, 50 and group B, 76). Group A had significantly shorter operation time, significantly less blood loss and transfusion volume, and higher postoperative Hb (all, P < 0.001). However, no significant differences were observed in complication rate, length of hospital stay, and postoperative radiological outcomes between 2 groups (all, P>0.05). There was also no significant difference in misplacement of screws in total populations (16.90% vs 18.82%, P = 0.305), whereas a low misplacement rate of pedicle screws was observed in patients whose mean Cobb angle was >50° (9.15% vs 13.03%, P = 0.02). Besides, using 3DRP increased the economic burden of patients (157,000 ±â€Š9948.85 Ren Min Bi (RMB) vs 152,500 ±â€Š11,445.52 RMB, P = 0.03). Using the 3D printing technology before posterior corrective surgery might reduce the operation time, perioperative blood loss, and transfusion volume. There did not appear to be a benefit to using this technology with respect to complication rate and postoperative radiological outcomes; however, 3D technology could reduce the misplacement rate in patients whose preoperative mean Cobb angle was >50°. Besides, it also increased the patients' hospital cost. Therefore, future prospective studies are needed to elucidate the efficacy of this emerging technology.