Unleashing the power of emergency response: controlling natural disasters by addressing environmental risk.

The primary focus of the analysis is to investigate the impact of emergency response management and environmental risk on natural disasters by controlling the variables of national income and financial development. To investigate the model empirically, we have employed the quantile autoregressive distributed lag model that estimates the short- and long-run estimates across various quantiles. The long-run estimates of emergency response management are negative and significant only at higher quantiles, i.e., from 60 to 95th quantiles. In the short run, emergency response management's estimated coefficients are negative and significant from 70 to 95th quantiles. Environmental risk shows a significant positive correlation with natural disasters across quantiles, while national income and financial development decrease natural disasters in the long run. Furthermore, we observed the asymmetric impact of emergency response management on natural disasters in both the short and long run.

Urinary 1-hydroxypyrene in pregnant women in a Northeastern U.S. city: socioeconomic disparity and contributions from air pollution sources.

BACKGROUND: Maternal exposure to polycyclic aromatic hydrocarbons (PAHs), ubiquitous constituents of air pollution, has been associated with adverse birth outcomes. Yet it remains unclear whether and how socioeconomic status (SES) affects gestational PAH exposure. OBJECTIVE: To examine whether there are socioeconomic disparities in PAHs exposure among pregnant women from Rochester, NY, and if so, to what extent disproportionate proximity to air pollution sources, measured by residential distance to transportation-related sources, contributed to the exposure disparity. METHODS: We measured 1-hydroxypyrene concentrations in 726 urine samples collected from 305 pregnant women up to three samples throughout pregnancy. Residential distances to transportation-related sources were calculated based on participants' home addresses. We used linear mixed-effects models with random intercepts of participants to examine associations between 1-hydroxypyrene, SES indicators, and distance to transportation-related sources. We used structural equation modelling to assess to what extent distance to transportation-related sources contributes to the socioeconomic disparity in 1-hydroxypyrene concentrations. RESULTS: Reduced household income and maternal education level were both significant SES predictors of 1-hydroxypyrene concentrations, after the adjustment for other maternal demographic characteristics. Each interquartile range (IQR) increases in residential proximity to the airport (from 14.3 to 6.0 km), the railroad yard (from 22.3 to 6.0 km), and annual average daily traffic within 300 m (from 3796 to 99,933 vehicles/year) were associated with 15.0% (95%CI: 7.0-22.2%), 15.4% (95%CI: 6.5-23.5%), and 13.6% (95%CI: 4.7-23.3%) increases in 1-hydroxypyrene concentrations, respectively. Proximity to these sources jointly explained 10% (95%CI: 1.6-18.4%) of the 1-hydroxypyrene concentration change associated with decreases in SES as a latent variable defined by both household income and education level. IMPACT STATEMENT: Our findings suggest that efforts to address disproportionate residential proximity to transportation-related sources may reduce the socioeconomic disparity in PAH exposure.

Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study.

PURPOSE: Central venous catheter (CVC)-related thrombosis (CRT) is a known complication in critically ill patients. However, its clinical significance remains unclear. The objective of the study was to evaluate the occurrence and evolution of CRT from CVC insertion to removal. METHODS: A prospective multicenter study was conducted in 28 intensive care units (ICUs). Duplex ultrasound was performed daily from CVC insertion until at least 3 days after CVC removal or before patient discharge from the ICU to detect CRT and to follow its progression. CRT diameter and length were measured and diameter > 7 mm was considered extensive. RESULTS: The study included 1262 patients. The incidence of CRT was 16.9% (95% confidence interval 14.8-18.9%). CRT was most commonly found in the internal jugular vein. The median time from CVC insertion to CRT onset was 4 (2-7) days, and 12% of CRTs occurred on the first day and 82% within 7 days of CVC insertion. CRT diameters > 5 mm and > 7 mm were found in 48% and 30% of thromboses. Over a 7-day follow-up, CRT diameter remained stable when the CVC was in place, whereas it gradually decreased after CVC removal. The ICU length of stay was longer in patients with CRT than in those without CRT, and the mortality was not different. CONCLUSION: CRT is a frequent complication. It can occur as soon as the CVC is placed and mostly during the first week following catheterization. Half of the thromboses are small but one-third are extensive. They are often non-progressive and may be resolved after CVC removal.

Population ageing and deaths attributable to ambient PM2·5 pollution: a global analysis of economic cost.

BACKGROUND: The health impacts of ambient air pollution impose large costs on society. Although all people are exposed to air pollution, the older population (ie, those aged ≥60 years) tends to be disproportionally affected. As a result, there is growing concern about the health impacts of air pollution as many countries undergo rapid population ageing. We investigated the spatial and temporal variation in the economic cost of deaths attributable to ambient air pollution and its interaction with population ageing from 2000 to 2016 at global and regional levels. METHODS: In this global analysis, we developed an age-adjusted measure of the value of a statistical life-year (VSLY) to estimate the economic cost of deaths attributable to ambient PM2·5 pollution using Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data and country-level socioeconomic information. First, we estimated the global age-specific and cause-specific mortality and years of life lost (YLLs) attributable to PM2·5 pollution using the global exposure mortality model and global estimates of exposure at 0·1°â€ˆ× 0·1° (about 11 km × 11 km at the equator) resolution. Second, for each year between 2000 and 2016, we translated the YLLs within each age group into a health-related cost using a country-specific, age-adjusted measure of VSLY. Third, we decomposed the major driving factors that contributed to the temporal change in health costs related to PM2·5. Finally, we did a sensitivity test to analyse the variability of the estimated health costs to four alternative valuation measures. We identified the uncertainty intervals (UIs) from 1000 draws of the parameters and concentration-response functions by age, cause, country, and year. All economic values are reported in 2011 purchasing power parity-adjusted US dollars. All simulations were done with R, version 3.6.0. FINDINGS: Globally, in 2016, PM2·5 was estimated to have caused 8·42 million (95% UI 6·50-10·52) attributable deaths, which was associated with 163·68 million (116·03-219·44) YLLs. In 2016, the global economic cost of deaths attributable to ambient PM2·5 pollution for the older population was US$2·40 trillion (1·89-2·93) accounting for 59% (59-60) of the cost for the total population ($4·09 trillion [3·19-5·05]). The economic cost per capita for the older population was $2739 (2160-3345) in 2016, which was 10 times that of the younger population (ie, those aged <60 years). By assessing the factors that contributed to economic costs, we found that increases in these factors changed the total economic cost by 77% for gross domestic product (GDP) per capita, 21% for population ageing, 16% for population growth, -41% for age-specific mortality, and -0·4% for PM2·5 exposure. INTERPRETATION: The economic cost of ambient PM2·5 borne by the older population almost doubled between 2000 and 2016, driven primarily by GDP growth, population ageing, and population growth. Compared with younger people, air pollution leads to disproportionately higher health costs among older people, even after accounting for their relatively shorter life expectancy and increased disability. As the world's population is ageing, the disproportionate health cost attributable to ambient PM2·5 pollution potentially widens the health inequities for older people. Countries with severe air pollution and rapid ageing rates need to take immediate actions to improve air quality. In addition, strategies aimed at enhancing health-care services, especially targeting the older population, could be beneficial for reducing the health costs of ambient air pollution. FUNDING: National Natural Science Foundation of China, China Postdoctoral Science Foundation, and Qiushi Foundation.

Impacts of implementing Healthy Building guidelines for daily PM2.5 limit on premature deaths and economic losses in urban China: A population-based modeling study.

Given a large fraction of people's exposure to urban PM2.5 occur indoors, reducing indoor PM2.5 levels may offer a more feasible and immediate way to save substantial lives and economic losses attributable to PM2.5 exposure. We aimed to estimate the premature mortality and economic loss reductions associated with achieving the newly established Chinese indoor air guideline and a few hypothetical indoor PM2.5 guideline values. We used outdoor PM2.5 concentrations from 1497 monitoring sites in 339 Chinese cities in 2015, coupled with a steady-state mass balance model, to estimate indoor concentrations of outdoor-infiltrated PM2.5. Using province-specific time-activity patterns for urban residents, we estimated outdoor and indoor exposures to PM2.5 of outdoor origin. We then proceeded to use localized census-based concentration-response models and the value of statistical life estimates to calculate premature deaths and economic losses attributable to PM2.5 exposure across urban China. Finally, we estimated potentially avoidable mortality and corresponding economic losses by meeting the current 24-hour based guideline and various hypothetical indoor limits for PM2.5. In 2015 in urban areas of mainland China, the city-specific annual mean outdoor and indoor PM2.5 concentrations ranged 9-108 µg/m3 and 5-56 µg/m3, respectively. Indoor exposures contributed 62%-91% daily and 68%-83% annually to the total time-weighted exposures. The potential reductions in total deaths and economic losses for the scenario in which daily indoor concentrations met the current guideline of 75 µg/m3, 37.5 µg/m3, and 25 µg/m3 were 16.9 (95% CI: 0.7-62.1) thousand, 87.7 (95% CI: 9.7-197.7) thousand, and 165.5 (95% CI: 30.8-304.0) thousand, respectively. The corresponding reductions in economic losses were 5.7 (95% CI: 0.2-34.8) billion, 29.4 (95% CI: 2.4-109.6) billion, and 55.2 (95% CI: 7.7-168.0) billion US Dollars, respectively. Deaths and economic losses would be reduced exponentially within the range of 0-75 µg/m3 for hypothetical indoor PM2.5 limits. The findings demonstrate the effectiveness of reducing indoor concentrations of outdoor-originated PM2.5 in saving substantial lives and economic losses in China. The analysis provides quantitative evidence to support the implementation of an indoor air quality guideline or standard for PM2.5.

Synergistic learning of lung lobe segmentation and hierarchical multi-instance classification for automated severity assessment of COVID-19 in CT images.

Understanding chest CT imaging of the coronavirus disease 2019 (COVID-19) will help detect infections early and assess the disease progression. Especially, automated severity assessment of COVID-19 in CT images plays an essential role in identifying cases that are in great need of intensive clinical care. However, it is often challenging to accurately assess the severity of this disease in CT images, due to variable infection regions in the lungs, similar imaging biomarkers, and large inter-case variations. To this end, we propose a synergistic learning framework for automated severity assessment of COVID-19 in 3D CT images, by jointly performing lung lobe segmentation and multi-instance classification. Considering that only a few infection regions in a CT image are related to the severity assessment, we first represent each input image by a bag that contains a set of 2D image patches (with each cropped from a specific slice). A multi-task multi-instance deep network (called M 2 UNet) is then developed to assess the severity of COVID-19 patients and also segment the lung lobe simultaneously. Our M 2 UNet consists of a patch-level encoder, a segmentation sub-network for lung lobe segmentation, and a classification sub-network for severity assessment (with a unique hierarchical multi-instance learning strategy). Here, the context information provided by segmentation can be implicitly employed to improve the performance of severity assessment. Extensive experiments were performed on a real COVID-19 CT image dataset consisting of 666 chest CT images, with results suggesting the effectiveness of our proposed method compared to several state-of-the-art methods.

Changes in children's respiratory morbidity and residential exposure factors over 25 years in Chongqing, China.

BACKGROUND: Respiratory morbidity and mortality during childhood remains a major challenge for global health. Due to the rapid economic development in Chongqing, we expect substantial temporal changes in respiratory health status and environmental risk factors in children. By leveraging a historical dataset, this study aims to assess the changes in prevalence of respiratory symptoms and diseases, residential exposure factors, and their associations in school-age children over a period of 25 years. METHODS: This study involved two cross-sectional surveys conducted in Chongqing with a 25-year interval (2017 vs. 1993). Purpose sampling was used to conduct questionnaire surveys on school-age children in both surveys. Information collected include children's respiratory health outcomes, family residential exposures, demographic information, and parental respiratory disease history. The changes of residential exposures as well as demographics were determined by chi-square test. Odds ratios were calculated to compare the prevalence of children's respiratory symptoms and diseases between the two periods. Associations between children's respiratory outcomes and exposure indicators were assessed using multivariate logistic regressions. RESULTS: The majority of residential exposure indicators improved in 2017, including sleep in shared room, cooking with coal, poor kitchen ventilation, cooking frequency, and parental smoking. Compared to the 1993 study, the adjusted risk for children's wheezing was lower (OR: 0.38, 95% CI: 0.29, 0.49), but the risk for bronchitis was higher (OR: 1.89, 95% CI: 1.54, 2.31) in the 2017 study. Poor kitchen ventilation and parental smoking were linked to an increased risk of children's wheezing (OR: 1.39, 95% CI: 1.02, 1.90) and bronchitis (OR: 1.51, 95% CI: 1.02, 2.21), respectively, while heating in winter was linked to an increased risk of phlegm (OR: 1.40, 95% CI: 1.03, 1.90) and wheezing (OR: 1.47, 95% CI: 1.07, 2.01) in the 1993 study. However, these residential exposure factors were no longer associated with the children's respiratory diseases in the 2017 study. CONCLUSIONS: Our study found improvement of residential exposures in Chongqing, a decline of prevalence of children's wheezing but an increase of that of bronchitis from 1993 to 2017. Poor kitchen ventilation, heating in winter, and parental smoking were significant risk factors in the 1993 survey but, with significantly reduced prevalence in 2017, were not significantly associated with children's respiratory morbidity in the latter survey.

Changes in children's asthma prevalence over two decades in Lanzhou: effects of socioeconomic, parental and household factors.

BACKGROUND: The prevalence of childhood asthma may have changed with rapid economic development. This study aims to ascertain potential changes in asthma prevalence in relation to changes in socioeconomic, parental and household factors, based on a comparison between two periods spanning over 20 years in Lanzhou, a large northwestern city of China. METHODS: Cross-sectional studies using the same protocols were performed in Lanzhou, China in 1994-1995 (Period I) and in 2017 (Period II). Children of 6-12 years old from elementary schools were selected by a multistage sampling method. Information on the presence of asthma and asthma-related symptoms of children, socioeconomic status, feeding methods, parental illness and behavior patterns, as well as household characteristics, were collected through a questionnaire survey. Logistic regression models were used to estimate odds ratios of asthma prevalence with regard to socioeconomic, parental and household factors, respectively. RESULTS: Significant prevalence reductions were observed for paternal smoking, household coal use, and parental asthma, while the prevalence increased significantly for children sleeping in their own rooms or own beds, ventilation use during cooking, and parental occupation and education level after 22 years. In children, the prevalence of ever-diagnosed asthma decreased from 3.2% in period I to 1.5% in Period II (P<0.001); the prevalence of wheeze also decreased from 15.4% to 9.3% (P<0.001). Passive smoking (OR =1.531, 95% CI: 1.032-2.270) and poor household ventilation (OR =1.709, 95% CI: 1.208-2.416) were significantly associated with an increased prevalence of wheeze in Period I, whereas household mold (OR =2.112, 95% CI: 1.203-3.811) was significantly associated with prevalence of wheeze. Parental asthma history was associated with increased prevalence of asthma and asthma-related symptoms. Breastfeeding was significantly associated with reduced risk of asthma in period II children. CONCLUSIONS: The prevalence of asthma and that of asthma-related symptoms were lower in 2017 than in 1994-1995 in school children living in Lanzhou. In 2017 with increased urbanization and industrialization, breastfeeding became a significant protective factor and household mold was a significant risk factor for asthma diagnosis and asthma-related symptoms. Promoting breastfeeding and household mold control is recommended to reduce the risk of childhood asthma in contemporary Lanzhou.

Distributed model predictive control of positive Markov jump systems.

This paper proposes a new distributed model predictive control (DMPC) for positive Markov jump systems subject to uncertainties and constraints. The uncertainties refer to interval and polytopic types, and the constraints are described in the form of 1-norm inequalities. A linear DMPC framework containing a linear performance index, linear robust stability conditions, a stochastic linear co-positive Lyapunov function, a cone invariant set, and a linear programming based DMPC algorithm is introduced. A global positive Markov jump system is decomposed into several subsystems. These subsystems can exchange information with each other and each subsystem has its own controller. Using a matrix decomposition technique, the DMPC controller gain matrix is divided into nonnegative and non-positive components and thus the corresponding stochastic stability conditions are transformed into linear programming. By virtue of a stochastic linear co-positive Lyapunov function, the positivity and stochastic stability of the systems are achieved under the DMPC controller. A lower computation burden DMPC algorithm is presented for solving the min-max optimization problem of performance index. The proposed DMPC design approach is extended for general systems. Finally, an example is given to verify the effectiveness of the DMPC design.

Association between long-term prescription of febuxostat and the progression of heart failure with preserved ejection fraction in patients with hypertension and asymptomatic hyperuricemia.

Both hypertension and hyperuricemia are closely associated with the morbidity and mortality of heart failure. This study was designed to evaluate the influences of long-term xanthine oxidase inhibitor (febuxostat) prescription on left ventricular hypertrophy (LVH), left ventricular (LV) diastolic function, and new-onset heart failure with preserved ejection fraction (HFpEF) in these patients. Using a propensity score matching of 1:2 ratio, this retrospective claims database study compared febuxosatat prescription (n = 96) and non-urate-lowering therapy (n = 192) in patients with hypertensive left ventricular hypertrophy (LVH) and asymptomatic hyperuricemia. With a follow-up of 36 months, febuxostat significantly decreased the level of serum uric acid as well as generated more prominent improvement in LVH and LV diastolic function. Besides, the new-onset symptomatic HFpEF occurred in 2 of 96 patients in febuxostat group and 13 of 192 patients in non-urate-lowering group (P = 0.091). No increased risk for major adverse cardiovascular events in patients prescribed with febuxostat was noted. In conclusion, long-term febuxostat exposure was associated with protective effects in terms of LVH or LV diastolic dysfunction in patients with hypertensive LVH and asymptomatic hyperuricemia. Febuxostat also displayed a trend for reduced risk of new-onset HFpEF in this population.

Using low-cost sensors to monitor indoor, outdoor, and personal ozone concentrations in Beijing, China.

High concentrations of ground-level ozone (O3) have been measured outdoors across China but there are limited measurements of O3 in microenvironments, including in homes, and for personal exposure. This highlights the need for cheaper methods to accurately make these measurements and to better capture fine-scale spatial variability in O3 across cities. With this in mind, we conducted a pilot study at six homes in Beijing, China, over 12 days to evaluate the use of portable, low-cost, time-resolved monitors for measuring O3 indoors and outdoors. We also assessed personal exposure for one adult in each home for two 48 hour periods using backpack-mounted monitors. Prior to and following sampling we collocated all monitors with a reference analyzer; we used data from these colocations to generate linear calibrations which we applied to all monitor data. Calibration slopes did not change significantly over the study although some intercepts differed. The average limit of detection (LOD) was 7.0 ppb, average root mean square error was 16.7 ppb, mean absolute error was 13.3 ppb and normalized root mean square error was 33%. Performance varied substantially between sensors, underscoring the importance of monitor-specific calibrations and determinations of measurement error. Outdoor concentrations varied spatially, with home-specific peak hourly averages of 32-165 ppb; indoor concentrations ranged from below the LOD to 15 ppb. Hour-averaged personal exposure was generally higher than O3 indoors, and at times exceeded ambient O3 indicating contributions to personal exposure from ambient sources of O3 away from the home. This work illustrates the feasibility of using these monitors to characterize distributions of O3 spatially and temporally when differences in concentrations are large, and outlines considerations for using these monitors to measure personal exposure.

Musculoskeletal ultrasonography for arthropathy assessment in patients with hemophilia: A single-center cross-sectional study from Shanxi Province, China.

Magnetic resonance imaging (MRI) is currently considered the gold standard for assessing hemophilic arthropathy (HA) severity; however, MRI is often costly, time-consuming, and difficult to perform in children. In the present study, we evaluated the joint status of hemophilic patients from Shanxi Province, China, using musculoskeletal ultrasonography (MSKUS) and identified the factors that most strongly correlated with disease severity.The study included 104 patients with hemophilia, who underwent MSKUS examination. A total of 1248 joints (including the shoulder, elbow, wrist, hip, knee, and ankle joints on both sides) from these patients were evaluated. Effusion, hypertrophy, cartilage modification, and bone erosion were assessed. The chi-square test was used to analyze categorical variables, and multivariate logistic regression was used to analyze the relationship between joint disease and risk factors.MSKUS allowed clear visualization of synovial lesions, effusion, cartilage modification, and bone surface damage; however, it was unable to identify changes deep within bones. The distribution of damaged joints was as follows: shoulder, 2 (1.0%); elbow, 80 (38.5%); wrist, 4 (1.9%); hip, 4 (1.9%); knee, 126 (60.6%); and ankle, 90 (43.3%). Damage was more common in the knee, elbow, and ankle joints than in the shoulder, wrist, and hip joints (P < .001). Among the 1248 joints, 306 showed lesions, which included effusion in 102 (8.2%) joints, synovium hypertrophy in 176 (14.1%), cartilage modification in 193 (15.5%), and bone damage in 176 (14.1%). Many joints had multiple lesions at the same time. The chi-square test and multivariate logistic analysis showed that age and hemophilia severity were significantly associated with joint disease, while type of hemophilia and treatment categories were not associated with joint disease.MSKUS is a convenient and cost-effective examination that can play an important role in the diagnosis and long-term monitoring of HA.

LEARN: Learned Experts' Assessment-Based Reconstruction Network for Sparse-Data CT.

Compressive sensing (CS) has proved effective for tomographic reconstruction from sparsely collected data or under-sampled measurements, which are practically important for few-view computed tomography (CT), tomosynthesis, interior tomography, and so on. To perform sparse-data CT, the iterative reconstruction commonly uses regularizers in the CS framework. Currently, how to choose the parameters adaptively for regularization is a major open problem. In this paper, inspired by the idea of machine learning especially deep learning, we unfold the state-of-the-art "fields of experts"-based iterative reconstruction scheme up to a number of iterations for data-driven training, construct a learned experts' assessment-based reconstruction network (LEARN) for sparse-data CT, and demonstrate the feasibility and merits of our LEARN network. The experimental results with our proposed LEARN network produces a superior performance with the well-known Mayo Clinic low-dose challenge data set relative to the several state-of-the-art methods, in terms of artifact reduction, feature preservation, and computational speed. This is consistent to our insight that because all the regularization terms and parameters used in the iterative reconstruction are now learned from the training data, our LEARN network utilizes application-oriented knowledge more effectively and recovers underlying images more favorably than competing algorithms. Also, the number of layers in the LEARN network is only 50, reducing the computational complexity of typical iterative algorithms by orders of magnitude.

Impact of Smoking Ban on Passive Smoke Exposure in Pregnant Non-Smokers in the Southeastern United States.

Prenatal passive smoke exposure raises risk for negative birth outcomes. Legislation regulating public smoking has been shown to impact exposure levels, though fewer studies involving pregnant women have been conducted within the U.S. where bans are inconsistent across regions. This study examined the effect of a ban enacted in the southeastern U.S. on pregnant women's cotinine levels. Additional analyses compared self-reported exposure to cotinine and identified characteristics associated with passive exposure. Pregnant women (N = 851) were recruited prospectively between 2005 and 2011 in North Carolina. Sociodemographic and health data were collected via surveys; maternal blood samples were assayed for cotinine. Among non-active smokers who provided self-report data regarding passive exposure (N = 503), 20% were inconsistent with corresponding cotinine. Among all non-smokers (N = 668), being unmarried, African American, and less educated were each associated with greater passive exposure. Controlling for covariates, mean cotinine was higher prior to the ban compared to after, F(1, 640) = 24.65, p < 0.001. Results suggest that banning smoking in public spaces may reduce passive smoke exposure for non-smoking pregnant women. These data are some of the first to examine the impact of legislation on passive smoke exposure in pregnant women within the U.S. using a biomarker and can inform policy in regions lacking comprehensive smoke-free legislation.

Evaluation of the three-in-one team-based care model on hierarchical diagnosis and treatment patterns among patients with diabetes: a retrospective cohort study using Xiamen's regional electronic health records.

BACKGROUND: Xiamen is a pilot city in China for hierarchical diagnosis and treatment reform of non-communicable diseases, especially diabetes. Since 2012, Xiamen has implemented a program called the "three-in-one", a team-based care model for the treatment of diabetes, which involves collaboration between diabetes specialists, general practitioners, and health managers. In addition, the program provides financial incentives to improve care, as greater accessibility to medications through community health care centers (CHCs). The aim of this study was to evaluate the effectiveness of these policies in shifting visits from general hospitals to CHCs for the treatment of type 2 diabetes mellitus (T2DM). METHOD AND MATERIALS: A retrospective observational cohort study was conducted using Xiamen's regional electronic health record (EHR) database, which included 90% of all patients registered since 2012. Logistic regression was used to derive the adjusted odds ratio (OR) for patients shifting from general hospitals to CHCs. Among patients treated at hospitals, Kaplan-Meier(KM) curves were constructed to evaluate the time from each policy introduction until the switch to CHCs. A k-means clustering analysis was conducted to identify patterns of patient care-seeking behavior. RESULTS: In total, 89,558 patients and 2,373,524 visits were included. In contrast to increased outpatient visits to general hospitals in China overall, the percentage of visits to CHCs in Xiamen increased from 29.7% in 2012 to 66.5% in 2016. The most significant and rapid shift occurred in later periods after full policy implementation. Three clusters of patients were identified with different levels of complications and health care-seeking frequency. All had similar responses to the policies. CONCLUSIONS: The "three-in-one" team-based care model showed promising results for building a hierarchical health care system in China. These policy reforms effectively increased CHCs utilization among diabetic patients.

Outdoor air pollution and respiratory health in Asia.

With the rapid economic development occurring in the last decade in many countries of Asia, the level of air pollution has increased from both industrial and motor vehicle emissions. Compared with Europe and North America, the potential health effects of this increasing air pollution in Asia remain largely unmeasured. Recent data published by the Health Effects Institute from some major cities in India and China reveal that a 10 µg/m(3) increase in PM(10) was associated with an increase in mortality of 0.6% in daily all-natural cause mortality, with higher risks being found at extremes of high temperatures and in the lowest economically advantaged population. Other Asian studies have confirmed the link between hospital admissions for the worsening of COPD and the increase in asthma prevalence to levels of outdoor air pollutants. Although potential health effects appear to be similar to already-published Western data, it is important that further studies be carried out in Asia that will inform the public and the authorities of the necessity to curb levels of outdoor air pollutants to acceptable levels.

Environmental lessons from China: finding promising policies in unlikely places.

BACKGROUND: Alongside the major health risks posed by environmental pollution in China are recent achievements on several environmental issues that have affluent Western nations racing to catch up. The country has propelled itself to a position of leadership in clean energy and efficiency, for instance, with important consequences for public health. OBJECTIVES: We comment on China's challenges and recent accomplishments in addressing environmental problems from domestic pollution to global climate change. We compare China's commitment to clean energy technology with that of other leading nations and discuss key achievements in other areas, including vehicle efficiency standards and transportation policy. DISCUSSION: We discuss policy directions that would secure much-needed improvements to environmental quality and health in China, along with actions that could motivate global action on issues of energy conservation and pollution reduction. CONCLUSIONS: A comprehensive regulatory and institutional framework for environmental policy is within reach in China but will require addressing major hurdles such as the lack of an independent monitoring mechanism and the need for greater transparency and enforcement in environmental matters. Meanwhile, China can continue to set important examples by investing in renewable energy, improving energy efficiency, and limiting greenhouse gas emissions.

[A simple method for assessment of RNA integrity in laser capture microdissection samples].

OBJECTIVE: To develop a simple method for assessment of RNA integrity in laser capture microdissection (LCM) samples. METHODS: The total RNA were isolated from the LCM samples and the sections before and after microdissection and examined by agarose gel electrophoresis. Real-time PCR was employed to assess the RNA from LCM samples, and the quantity of RNA was theoretically estimated according to the average total RNA product in mammalian cells (10 ng/1000 cells). RESULTS: When the total RNA from the sections before and after microdissection was intact, the RNA from LCM samples also had good quality, and the 28S and 18S rRNAs were visualized by ethidium bromide staining. Real-time PCR also showed good RNA quality in the LCM samples. CONCLUSION: A simple method for quantitative and qualitative assessment of the RNA from LCM samples is established, which can also be applied to assessment of DNA or proteins in LCM samples.

Selective detection of monohydroxy metabolites of polycyclic aromatic hydrocarbons in urine using liquid chromatography/triple quadrupole tandem mass spectrometry.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitously present in the environment and associated with a variety of adverse health effects. Monohydroxylated PAHs (OH-PAHs), metabolites of PAHs, have been employed as biomarkers for human exposure assessment of PAHs. This manuscript describes new, selective detection methods for OH-PAHs using liquid chromatography and tandem mass spectrometry (LC/MS/MS). Electrospray ionization was operated in the negative ion mode to detect the deprotonated PAH metabolites ([M-H](-)). Hydroxylated metabolites of naphthalene, fluorene, phenanthrene, fluoranthene, pyrene, benzo[c]phenanthrene, chrysene, benzo[a]anthracene, and benzo[a]pyrene were selected for the method development. Based on the collision-induced dissociation MS/MS spectra of the selected OH-PAHs, a characteristic ion fragmentation, loss of 28 Da from the [M--H](-) ion, was identified for all of these OH-PAHs. This characteristic fragmentation was exploited for selective screening for OH-PAHs in human urine by incorporating a constant neutral loss (CNL) scan with data-dependent scanning, using a triple quadruple mass spectrometer. Selected reaction monitoring (SRM) was also used to tentatively identify isomers of the target OH-PAHs in human urine. The excellent linearity (3-4 orders of magnitude) and signal-to-noise performance provided by the SRM method allowed development of a sensitive LC/MS/MS method for measuring OH-PAHs in urine samples. The limits of detection of the SRM method ranged from approximately 0.1-5 pg on column for a suite of OH-PAHs tested in the study. The LC-SRM method was applied, following enzymatic deconjugation and solid-phase extraction of the urine, to preliminarily determine the OH-PAH concentrations in urine specimens from six Chinese non-occupationally exposed workers and seven Chinese coke oven workers.