The Effect of Different Doses of Ropivacaine for Caudal Block in School-aged Children Undergoing Shang Ring Circumcision.

PURPOSE: The present study aimed to evaluate the effects of three different doses of ropivacaine in Shang Ring circumcision in school-aged children. DESIGN: This is a prospective, randomized, controlled study. METHODS: A total of 148 American Society of Anesthesiologists I to II children were enrolled and randomly assigned into the R0.2%, R0.25%, and R0.3% groups. These groups received 0.2%, 0.25%, and 0.3% of ropivacaine (0.5 mL/kg) for caudal block, respectively. The perioperative data on anesthesia quality (including adequate analgesia rate, analgesic duration, lower extremity numbness duration, and postoperative first urination time), and adverse events were collected. Hemodynamic variables were also measured perioperatively. FINDINGS: The adequate analgesia rate of caudal block in the R0.2% group (75.5%) was significantly lower than that in the R0.25% (94.0%) and R0.3% groups (98.0%) (P = .001). The analgesic duration of the R0.2% and R0.25% groups was significantly less than that of the R0.3% group (P < .001). The duration of lower extremity numbness in R0.2% group was significantly shorter than that in R0.25% (P < .05) and R0.3% groups (P < .01), and there was no significant difference between the R0.25% and R0.3% groups. The first urination time of R0.2% was significantly shorter than the R0.3% group (P < .05). There was no significant difference between the R0.2% and R0.25% or the R0.25% and R0.3% groups. No significant difference was found in adverse effects among groups (P > .05). CONCLUSIONS: Caudal block with 0.3% ropivacaine can provide more satisfactory intraoperative analgesia quality for school-aged children receiving Shang Ring circumcision, without increasing the risk of adverse effects.

Spatial-temporal variation and driving factors decomposition of agricultural grey water footprint in China.

The management of agricultural water pollution is crucial to alleviate the water crisis and promote regional sustainable development. Therefore, it is necessary to clarify the spatial-temporal variation characteristics of the agricultural grey water footprint (GWF) and accurately identify its main influencing factors, aiming at formulating differentiated regional management strategies. Based on this, the agricultural GWFs of 31 provincial regions in China from 2011 to 2019 were firstly calculated, and then the spatial-temporal variation characteristics of agricultural GWF were analyzed using the ArcGIS software and Standard Deviational Ellipse (SDE) method. Finally, the Generalized Divisia Index Method (GDIM) was creatively introduced to decompose the factors of agricultural GWF change and their respective contributions at the national and provincial levels. The main results are as follow: (1) Agricultural GWF in China decreased on the whole and showed significant provincial differences. Among them, the agricultural GWF of Henan Province was the largest while that of Shanghai City was the smallest. Compared with 2011, most provinces saw a decrease in agricultural GWF in 2019 while Yunnan, Tibet, Qinghai, Ningxia and Xinjiang Provinces achieved growth. (2) Areas with higher agricultural GDP generally had higher agricultural GWF. The spatial distribution of agricultural GWF and breeding GWF generally tended to be consistent, with the lower value in northwest and southeast of China and higher value in the northeast and southwest of China. Meanwhile, the mean center of SDE of agricultural GWF was located in Henan Province from 2011 to 2018, and shifted to Shaanxi Province in 2019, showing a slight northwest shift. (3) Agricultural GWF intensity and agricultural GDP had the largest restraining effect and driving effect on agricultural GWF growth, respectively. Additionally, China has achieved decoupling between agricultural GWF and agricultural GDP, reflecting that the patterns of agricultural production and consumption have become more sustainable. The findings of this study can provide important decision-making insights for agricultural water pollution management and industry adjustment.

Application Effect of Medical Care Integration Combined with Family Intervention under the Evidence-Based Nursing Mode on Child Patients with Severe Hand-Foot-Mouth Disease and Its Influence on Intestinal Function.

OBJECTIVE: To explore the application effect of medical care integration combined with family intervention under the evidence-based nursing mode on child patients with severe hand-foot-mouth disease (HFMD) and its influence on intestinal function. METHODS: 120 child patients with severe HFMD admitted to Qilu Children's Hospital of Shandong University from January 2019 to January 2020 were selected as the research object and randomly divided into group A and group B, with 60 cases each. Conventional nursing was performed on patients in group B, and medical care integration combined with family intervention under the evidence-based nursing mode was performed on patients in group A. Patients were assessed after the intervention using the hospital-made treatment adherence scale, PedsQLTM 4.0 (Pediatric Quality of Life Inventory Version 4.0) scale, and the faces pain scale-revised (FPS-R). The levels of gastrointestinal function indicators such as serum endotoxin (ET), diamine oxidase (DAO), and d-lactic acid (D-LA) were measured before and after the intervention, and recovery such as time to clear fever and time to relief of oral pain were recorded in both groups. RESULTS: Children in group A had significantly higher compliance in diet, behaviour, exercise, and medication than group B (P < 0.05); the time to clear fever, time to relief of oral pain, time to healing of oral ulcers, time to relief of skin herpes, time to hospitalization, and time to eating were shorter in group A than those in group B (P < 0.001); all scores on the PedsQLTM 4.0 scale were higher in group A than those in group B after the intervention (P < 0.001); ET, DAO, and D-LA levels decreased in both groups after the intervention, with group A having lower levels than group B (P < 0.001), in addition, group A had lower eating pain scores after the intervention (P < 0.05). CONCLUSION: Medical care integration combined with family intervention under the evidence-based nursing mode can effectively improve the treatment compliance of child patients with severe HFMD, accelerate their recovery progress, ensure a better prognostic quality of life and gastrointestinal tract function, and reduce the eating pain, indicating that such comprehensive nursing intervention mode should be promoted in practice.

Standardization of Exchanged Water with Different Properties in China's Water Rights Trading.

Water rights trading is an effective way to optimize the allocation of water resources. However, the existing practice of water rights trading in China lacks any consideration of the practical value of the exchanged water. This deficiency may lead to disputes between transferor and transferee during the implementation of the water rights trading contract. This paper puts forward the concept of Standard Water (SW). First, getting the original value of exchanged water by the shadow price model based on input-output table; Second, based on the original value, building the economic profits or costs model to obtain the practical value of exchanged water; Third, establishing SW quantity measurement model according to the principle of rewarding excellence and punishing inferiority, so as to convert the water quantity of exchanged water into SW quantity. With the standardization method, this paper takes the water rights transaction between Dongyang City and Yiwu City in 2000 as an example to carry out case study, and provides policy recommendations. The results show that when the contract requires the provision of 49.999 million m3 water of Class I the quality, if the exchanged water quality provided is in Class II-V, the corresponding SW will be decreased to 48.699-37.399 million m3. The application of this research will be conducive to ensuring the fairness and durability of the water rights trading processes.

Decoupling Analysis of Water Footprint and Economic Growth: A Case Study of Beijing-Tianjin-Hebei Region from 2004 to 2017.

The Beijing-Tianji-Hebei region (BTHR) is economically developed and densely populated, but its water resources are extremely scarce. A clear understanding of the decoupling relationship between water footprint and economic growth is conducive to facilitating and realizing the coordinated development of water resources and economic growth in this region. This study calculated the water footprint and other related indicators of BTHR from 2004 to 2017, and objectively evaluated the utilization of water resources in the region. Then, logarithmic mean divisia index (LMDI) method was applied to study the driving factors that resulted in the change of water footprint and their respective effects. Finally, Tapio decoupling model was used to research the decoupling relationships between water footprint and economic growth, and between the driving factors of water footprint and economic growth. There are three main results in this research. (1) The water utilization efficiency in BTHR continues to improve, and the water footprint shows a gradually increasing trend during the research period, among which the agricultural water footprint accounts for a relatively high proportion. (2) The change of water footprint can be attributed to efficiency effect, economic effect, and population effect. Furthermore, efficiency effect is the decisive factor of water footprint reduction and economic effect is the main factor of water footprint increase, while population effect plays a weak role in promoting the increase in water footprint. (3) The decoupling status between water footprint and economic growth show a weak decoupling in most years, while the status between water footprint intensity and economic growth always remains strong decoupling. Moreover, population size and economic growth always show an expansive coupling state. In sum, it is advisable for policy makers to improve water utilization efficiency, especially agricultural irrigation efficiency, to raise residents' awareness of water conservation, and increase the import of water-intensive products, so as to alleviate water shortage and realize the coordinated development of water resources and economic growth in BTHR.

An evolutionary game analysis of governments' decision-making behaviors and factors influencing watershed ecological compensation in China.

As a way to coordinate the interests of multi-government and solve the problem of transboundary water pollution, watershed ecological compensation system has been promoted in China. It is necessary to understand the influencing factors of watershed ecological compensation from the perspective of how interactions occur between different governments. This paper analyses the interaction among upstream governments, downstream governments and the central government in the Eastern Route of South-to-North Water Transfer Project, using evolutionary game theory. In particular, how ecological benefits are distributed between upstream and downstream governments is analyzed. Simultaneously, numerical simulation is used to analyze the effects of influencing factors on governments' behaviors. The results show that: (1) the initial willingness of governments to corporate affect their final behaviors; (2) upstream and downstream governments cannot spontaneously cooperate to implement watershed ecological compensation system without supervision of the central government; (3) opportunity costs only have a significant impact on upstream governments; (4) punishment on downstream governments can effectively influence the behaviors of governments at all levels; (5) high ecological compensation fee improve downstream governments' willness not to pay; (6) upstream governments get about 78% of ecological benefits due to the implementation of watershed ecological compensation system.

Changes in Ecosystem Services Value and Establishment of Watershed Ecological Compensation Standards.

Ecological compensation standards and the allocation of compensation funds have always been the core issues of watershed ecological compensation. Due to the construction of the Eastern Route of the South-to-North Water Transfer Project (SNWTP), Jiangsu Province has paid a huge cost for the protection of water resources, and local economic development has been greatly affected. Therefore, this paper takes Jiangsu Province, the water source area of the Eastern Route of the SNWTP as an example, and combines a geographic information system (GIS) and remote sensing technology, using the ecosystem services value method to calculate the ecosystem services value of Jiangsu Province from 2005 to 2018. Then the change of this ecosystem services value in Jiangsu Province from 2015 to 2018 is taken as the basis for watershed ecological compensation standards of the Eastern Route. Through a compensation fund allocation model, watershed ecological compensation funds are allocated to four cities, Yangzhou, Huai'an, Suqian and Xuzhou, which are located along the Eastern Route of this SNWTP in Jiangsu Province. The results show that: (1) The ecosystem services value of Jiangsu Province has changed greatly. Urbanization and market environment of grain crops are the main reasons for this change; (2) the relationship between ecosystem services in Jiangsu Province is mainly synergistic; (3) Suqian receives US$24.73 million; Huai'an receives US$16.49 million; Yangzhou receives US$54.88 million and Xuzhou receives US$0.95 million in watershed ecological compensation, respectively. Watershed ecological compensation standards based upon the value of ecosystem services, and the allocation of compensation funds at the municipal level, are conducive to the improvement in efficiency of watershed ecological compensation in mainland China.

The Driving Forces of Point Source Wastewater Emission: Case Study of COD and NH4-N Discharges in Mainland China.

Excess consumption of water resources and environmental pollution have become major challenges restricting sustainable development in China. In order to prevent the pollution of water resources, policymakers should have reliable emission reduction strategies. This paper aims to contribute new knowledge by analyzing the spatial-temporal characteristics and driving forces of point source emission. The chemical oxygen demand (COD) and ammonia nitrogen (NH4-N) emission variations in 31 provinces and municipalities of mainland China during the years 2004-2017 are analyzed. The results obtained using the logarithmic mean Divisia index (LMDI) method indicate that: (1) the COD and NH4-N emission effects have similar temporal characteristics. Technology improvement and pollutant emission intensity are the main factors inhibiting the incremental COD and NH4-N emission effects, while economic development is the main driving factor of COD and NH4-N emission effects. Population increases play a relatively less important role in COD and NH4-N emission effects. (2) The spatial features of COD and NH4-N emission effects show differences among provinces and municipalities. The reduction of COD emission effects in each province and municipality is obviously better than that of NH4-N emissions. (3) In the eastern, central, and the western regions of China, the total COD emission effect shows a downward trend, while apart from the central region, the NH4-N emission effect appears to be rising in the east and west of China. Therefore, increasing investment into pollution treatment, promoting awareness of water conservation, strengthening technological and financial support from the more developed eastern to the less developed central and western regions, can help to reduce the COD and NH4-N emissions in China.

A Pricing Model for Groundwater Rights in Ningxia, China Based on the Fuzzy Mathematical Model.

To reduce groundwater overexploitation and alleviate water shortages, market mechanisms are introduced to allocate water rights. Scientific and reasonable pricing of groundwater rights is key to ensuring the effectiveness of the groundwater market. Because of the complexity and uncertainty of water resources, this study calculates the price of groundwater rights based on the value of water resources with an evaluation indicator system. The system includes 14 indicators developed with a fuzzy mathematics model addressing three dimensions: environment, society, and economy. The weights of the indicators are determined through the analytic network process (ANP) and the entropy method. The results show that the price of groundwater rights in Ningxia, China increased from 5.11 yuan/m3 to 5.73 yuan/m3 between 2013 and 2017; this means the price was basically stable, with a slight increase. The ratio of residents' water fee expenditures to real disposable income also remained essentially stable, fluctuating around 0.37%, far below the normal level. These data demonstrated that the current regional water price policy does not reflect the true value of groundwater resources; there is room to increase urban water prices. Local governments need speed up water price system reforms and adopt water rights systems to optimize water resource allocations.

Assessment of Water Footprints of Consumption and Production in Transboundary River Basins at Country-Basin Mesh-Based Spatial Resolution.

Water is unevenly distributed globally. This uneven distribution is the reason behind the differences among geographical areas in terms of their water footprint of consumption and production. This gives the global trade of goods a unique feature. This characteristic of the water footprint might be used to address water scarcity and conflicts because water availability also has the same trend. Transboundary river basins are freshwater resources with a high probability of water scarcity and conflict because the water is claimed by multiple sovereign countries. In order to design sharing mechanisms for transboundary river basins that incorporate virtual water concept, it is key to identify the virtual water balance of country-basin units. A study addressing this research gap is not yet available. This article identified and discussed net virtual water importer and exporter sub-basins of transboundary rivers at a country-basin mesh based spatial resolution. The results of our study show that out of the 565 country-basin units surveyed in this article 391, 369, and 461 are net gray, green, and blue virtual water importers respectively. These sub-basins covers 58.37%, 47.52% and 57.52% of the total area covered by transboundary river basins and includes 0.65, 1.9, and around 2 billion people, respectively. The results depict that not only the water endowment of sub-basins is a determining factor for their water footprint of consumption and production, but also their social, economic, and demographic profiles. Furthermore, the water footprint of consumption and production within most of the country-basin units have a global feature. Hence, sustainable water management schemes within border-crossing basins should take into account not only the local but also the global water footprints of consumption and production. This can offer more options for sharing transboundary river basins water capital, thereby minimizing the probability of water scarcity and water conflicts.

The Impact of Upstream Sub-basins' Water Use on Middle Stream and Downstream Sub-basins' Water Security at Country-Basin Unit Spatial Scale and Monthly Temporal Resolution.

Water, in most of the transboundary river basins, is a bone of contention among their riparian states. Taking this into account, this article assessed the monthly impact of upstream water withdrawal on the water security of middle stream and downstream sub-basins at a country-basin mesh spatial resolution. Roughly 2.18 billion people in 442 sub-basin areas experience water stress intensification by less than 1% throughout the year. In addition, 2.12 billion people in 336 sub-basin areas experience water stress level change, from no water stress to one of the water stress categories, for at least one month as the result of upstream withdrawal. Even though there is a clear upstream impact in many of the basins, water disputes with severe social, economic, political, and environmental consequences are nonexistent. This might be an indication that grave water disputes are the result of complex socio-economic and political interactions, not merely because of water deficits due to upstream water withdrawal. Therefore, understanding this relationship is crucial in identifying inflection points for water conflicts within transboundary river basins.

Spatial Patterns of Urban Wastewater Discharge and Treatment Plants Efficiency in China.

With the rapid economic development, water pollution has become a major concern in China. Understanding the spatial variation of urban wastewater discharge and measuring the efficiency of wastewater treatment plants are prerequisites for rationally designing schemes and infrastructures to control water pollution. Based on the input and output urban wastewater treatment data of the 31 provinces of mainland China for the period 2011⁻2015, the spatial variation of urban water pollution and the efficiency of wastewater treatment plants were measured and mapped. The exploratory spatial data analysis (ESDA) model and super-efficiency data envelopment analysis (DEA) combined Malmquist index were used to achieve this goal. The following insight was obtained from the results. (1) The intensity of urban wastewater discharge increased, and the urban wastewater discharge showed a spatial agglomeration trend for the period 2011 to 2015. (2) The average inefficiency of wastewater treatment plants (WWTPs) for the study period was 39.2%. The plants' efficiencies worsened from the eastern to western parts of the country. (3) The main reasons for the low efficiency were the lack of technological upgrade and scale-up. The technological upgrade rate was -4.8%, while the scale efficiency increases as a result of scaling up was -0.2%. Therefore, to improve the wastewater treatment efficiency of the country, the provinces should work together to increase capital investment and technological advancement.

Association of Enterovirus 71 encephalitis with the interleukin-8 gene region in Chinese children.

The study was performed in 36 Chinese patients with Enterovirus 71 (EV71) encephalitis and 141 patients with EV71-related hand, foot and mouth disease (HFMD) without encephalitis. Genotyping was determined by polymerase chain reaction- restriction fragment length polymorphism. Patients with EV71 encephalitis had a significantly higher frequency of interleukin-8 (IL-8)-251TT genotype than patients with EV71-related HFMD without encephalitis (55.6% vs 31.2%, p = 0.023). The frequency of IL-8-251T alleles was significantly higher among patients with EV71 encephalitis than in patients with EV71-related HFMD without encephalitis (72.2% vs 58.9%, odds ratio 1.8, 95% confidence interval 1.0-3.2, p = 0.038). There were significant differences in gender, age, fever days, white blood cell count, C-reactive protein and blood glucose concentration and IL-8 levels among genotypes of IL-8-251A/T in EV71-infected patients, but no significant differences in alanine or aspartate aminotransferase, creatine kinase-myocardial isozyme and cerebrospinal fluid in patients with EV71 encephalitis. These findings suggest that the IL-8-251T allele is associated with susceptibility to EV71 encephalitis in Chinese patients.