Effect of two different doses of nalbuphine for postoperative analgesia in children with cleft palate: a randomized controlled trial.

BACKGROUND: Cleft palate repair surgery may result in severe pain in the immediate postoperative period. The aim of this study is to compare the effects of different doses of nalbuphine for postoperative analgesia in children with cleft palate. METHODS: From November 2019 to June 2021, 90 children (45 males and 45 females, age 9-20 months old, ASA class I-II) were selected for palatoplasty. They were randomly divided into three groups: the control group (Group C), the N1 group (postoperative analgesia with 0.05 mg/kg/h nalbuphine) and the N2 group (postoperative analgesia with 0.075 mg/kg/h nalbuphine). Each group had 30 cases. Nalbuphine was not continuously infused in Group C but was continuously infused in Groups N1 and N2 at rates of 0.05 mg/kg/h and 0.075 mg/kg/h, respectively, for 24 h for postoperative analgesia. The FLACC analgesia score and Ramsay Sedation score were recorded at 10 min (T1), 30 min (T2), 2 h (T3), 12 h (T4) and 24 h (T5) after the operation. Adverse reactions such as nausea, vomiting and respiratory depression were observed and recorded. RESULTS: Compared with those in Group C, the FLACC scores in the N1 and N2 groups decreased significantly at T1-T5 (p < 0.05); the Ramsay Sedation score in the N1 group was significantly higher at T3 and T4 (p < 0.05), and that in the N2 group was significantly higher at T1-T5 (p < 0.05). Compared with that in the N1 group, the FLACC score in the N2 group was not significantly different, and the Ramsay Sedation score increased significantly at T5 (p < 0.05). CONCLUSION: Using 0.05 mg/kg/h Nalbuphine continuously for 24 h for postoperative analgesia in children with cleft palate has a better effect and fewer adverse reactions. TRIAL REGISTRATION: This study was registered at ChiCTR1900027385 (11/11/2019).

Global Embodied Energy Flow and Stock Analysis with Endogeneous Fixed Capital.

Fixed capital stock functions as an embodied energy storage system that connects economic activities which do not happen simultaneously. This paper constructs a dynamic energy input-output model to analyze embodied energy flows and stocks along both temporal and spatial dimensions from 2000 to 2014. The results show that 2043 exajoule of embodied energy was stored in the global fixed capital stock in 2014, which was about three times the world's direct energy use. Compared with those in developed countries, the gaps between the dynamic energy footprints and the traditional ones were larger in fast-developing countries. Net embodied energy usually flowed from high-intensity economies to lower-intensity economies, and around 10% of the energy embodied in trade came from depreciation. The dynamic embodied energy indicators provide information for improving energy efficiency and mitigating corresponding problems from the perspective of consumption.

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.

Consumption-based greenhouse gas emissions accounting with capital stock change highlights dynamics of fast-developing countries.

Traditional consumption-based greenhouse gas emissions accounting attributed the gap between consumption-based and production-based emissions to international trade. Yet few attempts have analyzed the temporal deviation between current emissions and future consumption, which can be explained through changes in capital stock. Here we develop a dynamic model to incorporate capital stock change in consumption-based accounting. The new model is applied using global data for 1995-2009. Our results show that global emissions embodied in consumption determined by the new model are smaller than those obtained from the traditional model. The emissions embodied in global capital stock increased steadily during the period. However, capital plays very different roles in shaping consumption-based emissions for economies with different development characteristics. As a result, the dynamic model yields similar consumption-based emissions estimation for many developed countries comparing with the traditional model, but it highlights the dynamics of fast-developing countries.

China and the global uranium market: prospects for peaceful coexistence.

China's recent reemergence has resulted in a significant increase in the global demand of commodities and is already having major impacts on the dynamics of global commodity markets. In the case of the global uranium market, we stand at the very beginning of a period of change. However, interesting trends are already emerging. Whereas China has had many policy reversals, and some difficulties in taking control of its procurement strategy in other commodity markets, it is seemingly more successful in managing its uranium procurement strategy. Why? The argument presented here is that a mixture of domestic and international level variables has allowed China more room for maneuver in fulfilling its uranium procurement strategy. On the domestic level, a centralized industry, and, on the international level, a geographically dispersed and uncoordinated market have allowed China to forge ahead with an ambitious civilian nuclear power plan and triple its total uranium imports, all within the span of a few years. Many challenges remain, not the least that of negative public opinion, which has surged since the Fukushima disaster in 2011. Nevertheless, should uranium demand continue to grow, this paper will consider the potential for continued peaceful coexistence among uranium market participants worldwide.