Assessment and clinical utility of metagenomic next-generation sequencing for suspected lower respiratory tract infections.

OBJECTIVES: This study aims to compare the diagnostic efficacy of metagenomic next-generation sequencing (mNGS) to traditional diagnostic methods in patients with lower respiratory tract infections (LRTIs), elucidate the etiological spectrum of these infections, and explore the impact of mNGS on guiding antimicrobial therapy. METHODS: We retrospectively analyzed data from 128 patients admitted to the Respiratory Department of Anqing 116 Hospital between July 2022 and July 2023. All patients had undergone both mNGS and conventional microbiological techniques (CMT) for LRTI diagnosis. We assessed the diagnostic performance of these methods and examined the influence of mNGS on antimicrobial decision-making. RESULTS: Overall, mNGS demonstrated superior sensitivity (96.8%) and accuracy (96.8%) compared to CMT. For Mycobacterium tuberculosis detection, the accuracy and sensitivity of mNGS was 88.8% and 77.6%, which was lower than the 94.7% sensitivity of the T-spot test and the 79.6% sensitivity of CMT. In fungal pathogen detection, mNGS showed excellent sensitivity (90.5%), specificity (86.7%), and accuracy (88.0%). Bacteria were the predominant pathogens detected (75.34%), with Mycobacterium tuberculosis (41.74%), Streptococcus pneumoniae (21.74%), and Haemophilus influenzae (16.52%) being most prevalent. Bacterial infections were most common (62.10%), followed by fungal and mixed infections (17.74%). Of the 118 patients whose treatment regimens were adjusted based on mNGS results, 102 (86.5%) improved, 7 (5.9%) did not respond favorably, and follow-up was lost for 9 patients (7.6%). CONCLUSIONS: mNGS offers rapid and precise pathogen detection for patients with suspected LRTIs and shows considerable promise in diagnosing Mycobacterium tuberculosis and fungal infections. By broadening the pathogen spectrum and identifying polymicrobial infections, mNGS can significantly inform and refine antibiotic therapy.

Integrated and effective management of muck waste under the platform governance mode for a circular economy.

As an inevitable part of construction and demolition (C&D) waste, muck has a dreadful environmental impact due its inadequate management by the traditional governance process. This paper therefore focuses on the management of muck generated from C&D waste by utilizing platform governance as an alternative process, which should more effectively contribute to China's circular economy. The study explores the feasibility of providing such a platform governance mode by using Petri net to compare the traditional governance process and platform governance process for the management of muck trucks, and by using Nanjing's muck smart supervision platform as a case study to assess the effectiveness of the platform governance mode. Results from Petri net simulation modeling reveal that the platform governance mode is more effective than the traditional mode, and from the case study it is found that the success of Nanjing's muck waste management can be attributed to the platform governance mode. The platform management approach can therefore contribute to the sustainability of muck waste governance, and is suitable as an integrated and effective management mode for current practices of muck waste management and resource recovery in China. The main finding from the study is that the platform governance mode significantly improves the efficiency of muck waste management as compared with the traditional governance mode and can therefore provide greater economic and environmental benefits as part of a circular economy.

Smart Wearable Systems for Health Monitoring.

Smart wearable systems for health monitoring are highly desired in personal wisdom medicine and telemedicine. These systems make the detecting, monitoring, and recording of biosignals portable, long-term, and comfortable. The development and optimization of wearable health-monitoring systems have focused on advanced materials and system integration, and the number of high-performance wearable systems has been gradually increasing in recent years. However, there are still many challenges in these fields, such as balancing the trade-off between flexibility/stretchability, sensing performance, and the robustness of systems. For this reason, more evolution is required to promote the development of wearable health-monitoring systems. In this regard, this review summarizes some representative achievements and recent progress of wearable systems for health monitoring. Meanwhile, a strategy overview is presented about selecting materials, integrating systems, and monitoring biosignals. The next generation of wearable systems for accurate, portable, continuous, and long-term health monitoring will offer more opportunities for disease diagnosis and treatment.

Digital economy and environmental governance performance: empirical evidence from 275 cities in China.

Along with the steady worsening of environmental contamination, improving environmental governance performance (EGP) is an urgent issue that needs to be addressed. This study adopts panel data from 275 Chinese cities to examine the holistic relationship between the digital economy (DE) and urban EGP in multiple dimensions. The relationship is tested using fixed-effects models, mediated effects models, panel threshold models, and the spatial Durbin models. Results indicated that (1) the DE can effectively improve urban EGP. The findings still hold after robustness tests using instrumental variable estimation and the introduction of exogenous policy shocks. (2) The analysis of mediating effects shows that green technology innovation and industrial structure optimization are critical transmissions. (3) The panel threshold regression results indicate a nonlinear incremental phenomenon of the significant impact of the DE on urban EGP when nighttime lighting data is used as the threshold. (4) Spatial spillover analysis shows a positive spatial spillover effect of DE development on EGP in the surrounding cities. (5) Spatial heterogeneity analysis states that the enhancement effect of DE development on EGP is more significant in eastern China. Furthermore, areas located within urban agglomerations are more influenced by the DE. These findings provide a policy reference for fully exploiting the environmental enhancement effects of the DE.

Semi-Reliability Probability Damage Assessment of GFRP Bars Embedded in Steam-Curing Concrete Beams Based on the Multiple Factors Related Moisture Absorption Model.

GFRP bars will be damaged due to a series of irreversible hygroscopic chemical reactions under humid and hot curing environmental conditions. The multiple factors related to the moisture absorption model were established through the moisture absorption test of GFRP bars embedded in steam-curing concrete, which considered different curing temperatures, different thicknesses of the protective layer, and different diameters of GFRP bars. Semi-reliability probability damage assessment of GFRP bars embedded in steam-curing concrete was described by introducing the reliability and stochastic theory. Subsequently, the tensile test of GFRP bars was carried out to verify the feasibility of the damage assessment. The results showed that the moisture absorption curves of GFRP bars were basically in line with Fick's law. In addition, the influences of the curing temperature, the thickness of the protective layer, and the diameter on moisture absorption performance were presented. The semi-reliability probability damage assessment model of GFRP bars embedded in steam-curing concrete beams adequately considered the multiple factors related to moisture absorption and the uncertainty and randomness of the influencing factors during the process of moisture absorption.

Hepatic steatosis assessment using ultrasound homodyned-K parametric imaging: the effects of estimators.

BACKGROUND: The homodyned-K (HK) distribution is an important statistical model for describing ultrasound backscatter envelope statistics. HK parametric imaging has shown potential for characterizing hepatic steatosis. However, the feasibility of HK parametric imaging in assessing human hepatic steatosis in vivo remains unclear. METHODS: In this paper, ultrasound HK µ parametric imaging was proposed for assessing human hepatic steatosis in vivo. Two recent estimators for the HK model, RSK (the level-curve method that uses the signal-to-noise ratio (SNR), skewness, and kurtosis based on the fractional moments of the envelope) and XU (the estimation method based on the first moment of the intensity and two log-moments, namely X- and U-statistics), were investigated. Liver donors (n=72) and patients (n=204) were recruited to evaluate hepatic fat fractions (HFFs) using magnetic resonance spectroscopy and to evaluate the stages of fatty liver disease (normal, mild, moderate, and severe) using liver biopsy with histopathology. Livers were scanned using a 3-MHz ultrasound to construct µ RSK and µ XU images to correlate with HFF analyses and fatty liver stages. The µ RSK and µ XU parametric images were constructed using the sliding window technique with the window side length (WSL) =1-9 pulse lengths (PLs). The diagnostic values of the µ RSK and µ XU parametric imaging methods were evaluated using receiver operating characteristic (ROC) curves. RESULTS: For the 72 participants in Group A, the µ RSK parametric imaging with WSL =2-9 PLs exhibited similar correlation with log10(HFF), and the µ RSK parametric imaging with WSL = 3 PLs had the highest correlation with log10(HFF) (r=0.592); the µ XU parametric imaging with WSL =1-9 PLs exhibited similar correlation with log10(HFF), and the µ XU parametric imaging with WSL =1 PL had the highest correlation with log10(HFF) (r=0.628). For the 204 patients in Group B, the areas under the ROC (AUROCs) obtained using µ RSK for fatty stages ≥ mild (AUROC1), ≥ moderate (AUROC2), and ≥ severe (AUROC3) were (AUROC1, AUROC2, AUROC3) = (0.56, 0.57, 0.53), (0.68, 0.72, 0.75), (0.73, 0.78, 0.80), (0.74, 0.77, 0.79), (0.74, 0.78, 0.79), (0.75, 0.80, 0.82), (0.74, 0.77, 0.83), (0.74, 0.78, 0.84) and (0.73, 0.76, 0.83) for WSL =1, 2, 3, 4, 5, 6, 7, 8 and 9 PLs, respectively. The AUROCs obtained using µ XU for fatty stages ≥ mild, ≥ moderate, and ≥ severe were (AUROC1, AUROC2, AUROC3) = (0.75, 0.83, 0.81), (0.74, 0.80, 0.80), (0.76, 0.82, 0.82), (0.74, 0.80, 0.84), (0.76, 0.80, 0.83), (0.75, 0.80, 0.84), (0.75, 0.79, 0.85), (0.75, 0.80, 0.85) and (0.73, 0.77, 0.83) for WSL = 1, 2, 3, 4, 5, 6, 7, 8 and 9 PLs, respectively. CONCLUSIONS: Both the µ RSK and µ XU parametric images are feasible for evaluating human hepatic steatosis. The WSL exhibits little impact on the diagnosing performance of the µ RSK and µ XU parametric imaging. The µ XU parametric imaging provided improved performance compared to the µ RSK parametric imaging in characterizing human hepatic steatosis in vivo.

Improving the maternal mortality ratio in Zhejiang Province, China, 1988-2008.

OBJECTIVE: maternal mortality remains a major public health problem in many countries. The aim of this paper is to describe the progress made in maternal health care in Zhejiang Province, China over 20 years in reducing the maternal mortality ratio (MMR). SETTING: Zhejiang Province is located on the mid-east coast of China, approximately 180km south of Shanghai, and has a population of 49 million. Almost all mothers give birth in hospitals or maternal and infant health institutes. METHOD: the annual maternal death audit reports from 1988 to 2008 were analysed. These reports were prepared annually by the Zhejiang Prenatal Health Committee after auditing each individual case. MEASUREMENTS AND FINDINGS: China has made considerable progress in reducing the MMR. Zhejiang has one of fastest developing economies in China, and since the 86 economic reforms of 1978, health care has improved rapidly and the MMR has declined. During the 1988-2008 period, 2258 maternal deaths were reported from 8,880,457 live births. During these two decades, the MMR decreased dramatically from 48.50 in 1988 to 6.57 per 100,000 in 2008. The MMR in migrant women dropped from 66.87 in 2003 to 21.67 per 100,000 in 2008. The rate of decline was more rapid in rural areas than in the city. There has been a decline in the proportion of deaths with direct obstetric causes and a corresponding increase in the proportion of indirect causes. The proportion of deaths classified as preventable has declined in the past two decades. Social factors are important in maternal safety, and on average 26.8% of maternal deaths were influenced by these factors. CONCLUSION: as the economy was developing, maternal safety was made a priority health issue by the Government and health workers. The provincial MMR has dropped rapidly and is now similar to the rates in developed countries and lower than that in the USA. However, more work is still needed to ensure that all mothers, including migrant workers, continue to have these low rates.