Mushroom Poisoning Outbreaks - China, 2023.

What is already known about this topic?: Mushroom poisoning poses a significant food safety concern in China, with a total of 196 species identified in poisoning incidents by the end of 2022. What is added by this report?: In 2023, the China CDC conducted an investigation into 505 cases of mushroom poisoning spanning 24 provincial-level administrative divisions. This investigation resulted in 1,303 patients and 16 deaths, yielding a case fatality rate of 1.23%. A total of 97 mushrooms were identified as the cause of 6 distinct clinical disease types, with 12 species newly documented as poisonous mushrooms in China. What are the implications for public health practice?: Close collaboration among CDC staff, physicians, and mycologists remains crucial for the control and prevention of mushroom poisoning in the future.

Collagen/functionalized cellulose nanofibril composite aerogels with pH-responsive characteristics for drug delivery system.

In this work, carboxylated and amination modified cellulose nanofibrils (CNFs) were fabricated via the TEMPO catalytic oxidation system and diethylenetriamine, and collagen composite aerogels were fabricated through a simple self-assembly pretreatment and directional freeze-drying technology. Morphology analysis showed that the collagen composite aerogels had distinct layered-oriented double network structures after the self-assembly pretreatment. The intermolecular interactions between the collagen fibrils and functionalized CNFs (fCNFs) on the structures and properties of the composite aerogels were also examined through various characterization techniques. Water contact angle tests demonstrated the pH-responsive characteristics of the collagen/fCNF composite aerogels. Using 5-fluorouracil as the model drug, the pH-response mechanism was revealed. These results indicated that the collagen/fCNF composite aerogels exhibited excellent pH-responsive drug release capacities. Therefore, these pH-responsive collagen composite aerogels might have potential applications in industrial production in the biomedical, drug delivery, and tissue engineering fields.

Nanocellulose based ultra-elastic and durable foams for smart packaging applications.

Foams with advanced sensing properties and excellent mechanical properties are promising candidates for smart packaging materials. However, the fabrication of ultra-elastic and durable foams is still challenging. Herein, we report a universal strategy to obtain ultra-elastic and durable foams by crosslinking cellulose nanofiber and MXene via strong covalent bonds and assembling the composites into anisotropic cellular structures. The obtained composite foam shows an excellent compressive strain of up to 90 % with height retention of 97.1 % and retains around 90.3 % of its original height even after 100,000 compressive cycles at 80 % strain. Their cushioning properties were systematically investigated, which are superior to that of wildly-used petroleum-based expanded polyethylene and expanded polystyrene. By employing the foam in a piezoelectric sensor, a smart cushioning packaging and pressure monitoring system is constructed to protect inner precision cargo and detect endured pressure during transportation for the first time.

Recent insights on the use of modified Zn-based catalysts in eCO2RR.

Converting CO2 into valuable chemicals can provide a new path to mitigate the greenhouse effect, achieving the aim of "carbon neutrality" and "carbon peaking". Among numerous electrocatalysts, Zn-based materials are widely distributed and cheap, making them one of the most promising electrocatalyst materials to replace noble metal catalysts. Moreover, the Zn metal itself has a certain selectivity for CO. After appropriate modification, such as oxide derivatization, structural reorganization, reconstruction of the surfaces, heteroatom doping, and so on, the Zn-based electrocatalysts can expose more active sites and adjust the d-band center or electronic structure, and the FE and stability of them can be effectively improved, and they can even convert CO2 to multi-carbon products. This review aims to systematically describe the latest progresses of modified Zn-based electrocatalyst materials (including organic and inorganic materials) in the electrocatalytic carbon dioxide reduction reaction (eCO2RR). The applications of modified Zn-based catalysts in improving product selectivity, increasing current density and reducing the overpotential of the eCO2RR are reviewed. Moreover, this review describes the reasonable selection and good structural design of Zn-based catalysts, presents the characteristics of various modified zinc-based catalysts, and reveals the related catalytic mechanisms for the first time. Finally, the current status and development prospects of modified Zn-based catalysts in eCO2RR are summarized and discussed.

Piezoelectric Polymer Solid Electrolyte Integrating Electromechanical Coupling and Ferroelectric Polarization Effects.

The unsatisfactory lithium-ion conductivity (σ) and limited mechanical strength of polymer solid electrolytes hinder their wide applications in solid-state lithium metal batteries (SSLMBs). Here, a thin piezoelectric polymer solid electrolyte integrating electromechanical coupling and ferroelectric polarization effects has been designed and prepared to achieve long-term stable cycling of SSLMBs. The ferroelectric Bi4 Ti3 O12 nanoparticle (BIT NPs) loaded poly(vinylidene fluoride-trifluoroethylene) (P(VDF-TrFE)) piezoelectric nanofibers (B-P NFs) membranes are introduced into the poly(ethylene oxide) (PEO) matrix, endowing the composite electrolyte with unique polarization and piezoelectric effects. The piezoelectric nanofiber membrane with a 3D network structure not only promotes the dissociation of lithium (Li) salts through the polarization effect but also cleverly utilizes the coupling effect of a mechanical stress-local electric field to achieve dynamic regulation of the Li electroplating process. Through the corresponding experimental tests and density functional theory calculations, the intrinsic mechanism of piezoelectric electrolytes improving σ and suppressing Li dendrites is fully revealed. The obtained piezoelectric electrolyte has achieved stable cycling of LiFePO4 batteries over 2000 cycles and has also shown good practical application potential in flexible pouch batteries.

Boosting the output performance of triboelectric nanogenerators via surface engineering and structure designing.

Triboelectric nanogenerators (TENGs) have been utilized in a wide range of applications, including smart wearable devices, self-powered sensors, energy harvesting, and high-voltage power sources. The surface morphology and structure of TENGs play a critical role in their output performance. In this review, we analyze the working mechanism of TENGs with the aim to improve their output performance and systematically summarize the morphological engineering and structural design strategies for TENGs. Additionally, we present the emerging applications of TENGs with specific structures and surfaces. Finally, we discuss the potential future development and industrial application of TENGs. By deeply exploring the surface and structural design strategy of high-performance TENGs, it is conducive to further promote the application of TENGs in actual production. We hope that this review provides insights and guidance for the morphological and structural design of TENGs in the future.

MnF2 Surface Modulated Hollow Carbon Nanorods on Porous Carbon Nanofibers as Efficient Bi-Functional Oxygen Catalysis for Rechargeable Zinc-Air Batteries.

Developing highly efficient bi-functional noble-metal-free oxygen electrocatalysts with low-cost and scalable synthesis approach is challenging for zinc-air batteries (ZABs). Due to the flexible valence state of manganese, MnF2 is expected to provide efficient OER. However, its insulating properties may inhibit its OER process to a certain degree. Herein, during the process of converting the manganese source in the precursor of porous carbon nanofibers (PCNFs) to manganese fluoride, the manganese source is changed to manganese acetate, which allows PCNFs to grow a large number of hollow carbon nanorods (HCNRs). Meanwhile, manganese fluoride will transform from the aggregation state into uniformly dispersed MnF2 nanodots, thereby achieving highly efficient OER catalytic activity. Furthermore, the intrinsic ORR catalytic activity of the HCNRs/MnF2 @PCNFs can be enhanced due to the charge modulation effect of MnF2 nanodots inside HCNR. In addition, the HCNRs stretched toward the liquid electrolyte can increase the capture capacity of dissolved oxygen and protect the inner MnF2 , thereby enhancing the stability of HCNRs/MnF2 @PCNFs for the oxygen electrocatalytic process. MnF2 surface-modulated HCNRs can strongly enhance ORR activity, and the uniformly dispersed MnF2 can also provide higher OER activity. Thus, the prepared HCNRs/MnF2 @PCNFs obtain efficient bifunctional oxygen catalytic ability and high-performance rechargeable ZABs.

One-Dimensional Oxide Nanostructures Possessing Reactive Surface Defects Enabled a Lithium-Rich Region and High-Voltage Stability for All-Solid-State Composite Electrolytes.

The development of highly safe and low-cost solid polymer electrolytes for all-solid-state lithium batteries (ASSLBs) has been hindered by low ionic conductivity, poor stability under high-voltage conditions, and severe lithium-dendrite-induced short circuits. In this study, Li-doped MgO nanofibers bearing reactive surface defects of scaled-up production are introduced to the poly(ethylene oxide) (PEO)/lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) system. The characterizations and density functional theory calculations reveal that TFSI- is strongly adsorbed on the nanofibers based on the electrostatic interactions of surface oxygen vacancies and the formation of Li-N and Li-O bonds derived from the exposed Li. Additionally, the introduced Li exposed near oxygen vacancies may be liberated from the lattice and engage in the formation of Li-rich domains. Therefore, a high ionic conductivity of 1.48 × 10-4 S cm-1 for the solid electrolyte at 30 °C and excellent cycling stability for the assembled battery, with a discharge capacity retention of 85.2% after 1500 cycles at 2C, can be achieved. Furthermore, the increased coordination of EO chains in the Li-rich region and chemical interactions with nanofibers substantially improve the antioxidant stability of the solid electrolyte, endowing the LiNi0.8Co0.1Mn0.1O2/Li battery with a long lifespan of more than 700 cycles. The results of this study suggest that the surface defects of 1D oxide nanostructures can substantially improve the Li+ diffusion kinetics. This study provides insight into the construction of Li-rich regions for high-voltage ASSLBs.

Assembled one-dimensional nanowires for flexible electronic devices via printing and coating: Techniques, applications, and perspectives.

The rapid progress in flexible electronic devices has necessitated continual research into nanomaterials, structural design, and fabrication processes. One-dimensional nanowires, characterized by their distinct structures and exceptional properties, are considered essential components for various flexible electronic devices. Considerable attention has been directed toward the assembly of nanowires, which presents significant advantages. Printing and coating techniques can be used to assemble nanowires in a relatively simple, efficient, and cost-competitive manner and exhibit potential for scale-up production in the foreseeable future. This review aims to provide an overview of nanowire assembly using printing and coating techniques, such as bar coating, spray coating, dip coating, blade coating, 3D printing, and so forth. The application of assembled nanowires in flexible electronic devices is subsequently discussed. Finally, further discussion is presented on the potential and challenges of flexible electronic devices based on assembled nanowires via printing and coating.

Multifunctional Ti3C2Tx MXene/Silver Nanowire Membranes with Excellent Catalytic, Antifouling, and Antibacterial Properties for Nitrophenol-Containing Water Purification.

The uncontrolled release of nitrophenol and dye pollutants into water systems is an increasingly serious worldwide concern, and thus efficient wastewater treatment technologies are urgently needed. Herein we report a novel two-dimensional (2D) transition metal carbides and/or nitrides (Ti3C2Tx MXene) membrane modified with silver nanowires (AgNWs) by vacuum assisted filtration technology for the ultrafast nitrophenol catalysis and water purification applications. Regular and controllable membrane transport channels were constructed by stacking Ti3C2Tx MXene nanosheets. Furthermore, the intercalation of AgNWs into the Ti3C2Tx MXene interlayer greatly enlarged the interlayer spacing, resulting in more gaps for fast and selective molecular transport. The optimized Ti3C2Tx MXene@AgNWs (M@A) membrane exhibited a water flux up to ∼191.9 L/(m2 h) while maintaining a high bovine serum albumin (BSA) rejection of ∼95.4%. We emphatically used M@A membranes as efficient catalysts for the reduction of 4-nitrophenol (4-NP), and the results indicated that M@A-12% membrane exhibited the greatest catalytic reduction ability, and recycling utilization. M@A-12% membrane also had an antibacterial rate of more than 99% against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). This work provides a possibility to expand the application of 2D multifunctional M@A membranes in wastewater treatment and pollutant catalytic degradation.

Chitosan/poly (ethylene oxide) nanofiber sponge with dual-responsive drug release and excellent antibacterial property.

An ideal wound dressing can absorb wound exudate in time, and has the advantages of moisture permeability, oxygen permeability, rapid hemostatic performance, antibacterial and low-toxic, which are the key to wound healing. However, traditional wound dressings exist structural and functional defects, especially in controlling bleeding and active wound protection. Herein, a novel three-dimensional chitosan/ poly (ethylene oxide) sponge dressing (3D CS/PEO sponge-ZPC) consists of CS/PEO nanofiber sponge (carrier unit), Zn metal-organic framework grown in-situ (Zn-MOF, drug loading unit and antibacterial unit), curcumin (CUR, antibacterial unit), and poly[(N-isopropylacrylamide)-co-(methacrylic acid)] (P(NIPAM-co-MAA), 'gatekeepers' unit) to promote the wound healing by absorb exudate in time, accelerate hemostasis and inhibit bacteria growth. Due to the unique structure of the as-prepared 3D CS/PEO sponge-ZPC was endowed with smart stimuli-responsive drug release mode, rapid hemostatic performance and strong antibacterial property. The result of CUR release showed smart "ON-OFF" drug release mode. Antibacterial results verified strong antibacterial property up to 99.9 %. Hemolysis test showed that hemolysis ratio of 3D CS/PEO sponge-ZPC met the acceptable standard. The rapid hemostatic property was demonstrated by hemostatic test. High wound healing effect was confirmed in vivo. These results provide an important research basis for the design of new smart dressing.

Macrocycle Self-Assembly Hydrogel for High-Efficient Oil-Water Separation.

Supramolecular hydrogels involved macrocycles have been explored widely in recent years, but it remains challenging to develop hydrogel based on solitary macrocycle with super gelation capability. Here, the construction of lantern[33 ]arene-based hydrogel with low critical gelation concentration (0.05 wt%), which can be used for efficient oil-water separation, is reported. The lantern[33 ]arenes self-assemble into hydrogen-bonded organic nanoribbons, which intertwine into entangled fibers to form hydrogel. This hydrogel which exhibits reversible pH-responsiveness characteristics can be coated on stainless-steel mesh by in situ sol-gel transformation. The resultant mesh exhibits excellent oil-water separation efficiency (>99%) and flux (>6 × 104 L m-2 h-1 ). This lantern[33 ]arene-based hydrogel not only sheds additional light on the gelation mechanisms for supramolecular hydrogels, but also extends the application of macrocycle-based hydrogels as functional interfacial materials.

A voltammetric sensor based on a reduced graphene oxide/ß-cyclodextrin/silver nanoparticle/polyoxometalate nanocomposite for detecting uric acid and tyrosine.

In the present work, an electrochemical sensor based on reduced graphene oxide/ß-cyclodextrin/silver nanoparticle/polyoxometalate (RGO-CD-AgNP-POM) was developed for the simultaneous detection of uric acid (UA) and L-tyrosine (L-Tyr). First, an RGO-CD-AgNP-POM nanocomposite was synthesized via a simple photoreduction method and characterized by transmission electron microscopy (TEM), energy dispersive X-ray imaging (EDS), scanning electron microscopy (SEM), and thermal gravimetric analysis (TGA). As an electrode material, RGO-CD-AgNP-POM showed wide linear ranges (0.5-500 µM for UA, and 1-400 µM for L-Tyr) and relatively low detection limits (0.11 µM for UA, and 0.23 µM for L-Tyr). In addition, the combination of supramolecular recognition from CD and excellent electrochemical performances from RGO, AgNPs and POM was expected to enhance the sensing performances toward UA and L-Tyr in real samples with favorable recovery ranges (99%-104%). This nanocomposite provides a new platform for developing the family of electrode materials.

Copper nanodot-embedded nitrogen and fluorine co-doped porous carbon nanofibers as advanced electrocatalysts for rechargeable zinc-air batteries.

Porous carbon-based electrocatalysts for cathodes in zinc-air batteries (ZABs) are limited by their low catalytic activity and poor electronic conductivity, making it difficult for them to be quickly commercialized. To solve these problems of ZABs, copper nanodot-embedded N, F co-doped porous carbon nanofibers (CuNDs@NFPCNFs) are prepared to enhance the electronic conductivity and catalytic activity in this study. The CuNDs@NFPCNFs exhibit excellent oxygen reduction reaction (ORR) performance based on experimental and density functional theory (DFT) simulation results. The copper nanodots (CuNDs) and N, F co-doped carbon nanofibers (NFPCNFs) synergistically enhance the electrocatalytic activity. The CuNDs in the NFPCNFs also enhance the electronic conductivity to facilitate electron transfer during the ORR. The open porous structure of the NFPCNFs promotes the fast diffusion of dissolved oxygen and the formation of abundant gas-liquid-solid interfaces, leading to enhanced ORR activity. Finally, the CuNDs@NFPCNFs show excellent ORR performance, maintaining 92.5% of the catalytic activity after a long-term ORR test of 20000 s. The CuNDs@NFPCNFs also demonstrate super stable charge-discharge cycling for over 400 h, a high specific capacity of 771.3 mAh g-1 and an excellent power density of 204.9 mW cm-2 as a cathode electrode in ZABs. This work is expected to provide reference and guidance for research on the mechanism of action of metal nanodot-enhanced carbon materials for ORR electrocatalyst design.

Composite Solid Electrolyte with Continuous and Fast Organic-Inorganic Ion Transport Highways Created by 3D Crimped Nanofibers@functional Ceramic Nanowires.

A 3D crimped sulfonated polyethersulfone-polyethylene oxide(C-SPES/PEO) nanofiber membrane and long-range lanthanum cobaltate(LaCoO3 ) nanowires are collectively doped into a PEO matrix to acquire a composite solid electrolyte (C-SPES-PEO-LaCoO3 ) for all-solid-state lithium metal batteries(ASSLMBs). The 3D crimped structure enables the fiber membrane to have a large porosity of 90%. Therefore, under the premise of strongly guaranteeing the mechanical properties of C-SPES-PEO-LaCoO3 , the ceramic nanowires conveniently penetrated into the 3D crimped SPES nanofiber without being blocked, which can facilitate fast ionic conductivity by forming 3D continuous organic-inorganic ion transport pathways. The as-prepared electrolyte delivers an excellent ionic conductivity of 2.5 × 10-4  S cm-1 at 30 °C. Density functional theory calculations indicate that the LaCoO3 nanowires and 3D crimped C-SPES/PEO fibers contribute to Li+ movement. Particularly, the LiFePO4 /C-SPES-PEO-LaCoO3 /Li and NMC811/C-SPES-PEO-LaCoO3 /Li pouch cell have a high initial discharge specific capacity of 156.8 mAh g-1 and a maximum value of 176.7 mAh g-1 , respectively. In addition, the universality of the penetration of C-SPES/PEO nanofibers to functional ceramic nanowires is also reflected by the stable cycling performance of ASSLMBs based on the electrolytes, in which the LaCoO3 nanowires are replaced with Gd-doped CeO2 nanowires. The work will provide a novel approach to high performance solid-state electrolytes.

Aramid nanofibers supported metal-organic framework aerogel for protection of chemical warfare agent.

Protective fabrics containing Zr-Based Metal-Organic Frameworks (Zr-MOFs) show great potential in the detoxification of chemical warfare agents (CWAs). However, the current studies still face the challenges of complicated fabrication processes, limited MOF loading mass, and insufficient protection. Herein, we developed a lightweight, flexible and mechanical robust aerogel by in situ growth of UiO-66-NH2 onto aramid nanofibers (ANFs) and assembly of UiO-66-NH2 loaded ANFs (UiO-66-NH2@ANFs) into 3D hierarchically porous architecture. The UiO-66-NH2@ANF aerogels feature high MOF loading of 261 %, high surface area of 589.349 m2 g-1, open and interconnected cellular structure, which provide efficient transfer channels and promote catalytic degradation of CWAs. As a result, the UiO-66-NH2@ANF aerogels demonstrate high 2-chloroethyl ethyl thioether (CEES) removal rate at 98.9 % and a short half-life of 8.15 min. Moreover, the aerogels present good mechanical stability (recovery rate of 93.3 % after 100 cycles under 30 % strain), low thermal conductivity (λ of 25.66 mW m-1 K-1), high flame resistance (LOI of 32 %) and good wearing comfortableness, indicating promising potential in multifunctional protection against CWAs.

Sodium alginate reinforced polyacrylamide/xanthan gum double network ionic hydrogels for stress sensing and self-powered wearable device applications.

Strong and ductile sodium alginate (SA) reinforced polyacrylamide (PAM)/xanthan gum (XG) double network ionic hydrogels were constructed for stress sensing and self-powered wearable device applications. In the designed network of PXS-Mn+/LiCl (short for PAM/XG/SA-Mn+/LiCl, where Mn+ stands for Fe3+, Cu2+ or Zn2+), PAM acts as a flexible hydrophilic skeleton, and XG functions as a ductile second network. The macromolecule SA interacts with metal ion Mn+ to form a unique complex structure, significantly improving the mechanical strength of the hydrogel. The addition of inorganic salt LiCl endows the hydrogel with high electrical conductivity, and meanwhile reduces the freezing point and prevents water loss of the hydrogel. PXS-Mn+/LiCl exhibits excellent mechanical properties and ultra-high ductility (a fracture tensile strength up to 0.65 MPa and a fracture strain up to 1800%), and high stress-sensing performance (a high GF up to 4.56 and pressure sensitivity of 0.122). Moreover, a self-powered device with a dual-power-supply mode, i.e., PXS-Mn+/LiCl-based primary battery and TENG, and a capacitor as the energy storage component was constructed, which shows promising prospects for self-powered wearable electronics.

Mushroom Poisoning Outbreaks - China, 2022.

What is already known about this topic?: Mushroom poisoning is one of the most serious food safety issues in China. By the end of 2021, over 520 poisonous mushrooms had been discovered in China. The Southwest region of China was the most severely affected. Mushroom poisonings mainly concentrated in the summer and autumn months. What is added by this report?: In 2022, China CDC conducted an investigation of 482 incidents of mushroom poisoning across 21 provincial-level administrative divisions (PLADs). This resulted in 1,332 patients and 28 deaths, with a total case fatality rate of 2.1%. A total of 98 mushrooms were identified, causing 7 different clinical types of diseases. Three provisional new species (Collybia humida nom. prov., Spodocybe venenata nom. prov., and Omphalotus yunnanensis nom. prov.) were newly recorded as poisonous mushrooms in China, in addition to 10 other species. What are the implications for public health practice?: In view of the extensive impact and harm of poisonous mushrooms on public health, it is necessary to promote prevention and improve the ability of professionals to identify, diagnose, and treat mushroom poisoning.

Effects of temperature on incidence of bacillary dysentery in a temperate continental arid climate city in northwest China.

The effect of ambient temperature on health continues to draw more and more attention with the global warming. Bacillary dysentery (BD) is a major global environmental health issue and affected by temperature and other environmental variables. In the current study, we evaluated the effect of temperature on the incidence of BD from January 1st, 2008 to December 31st, 2011 in Jiayuguan, a temperate continental arid climate city in the Hexi Corridor of northwest China. A distributed lag non-linear model (DLNM) was performed to evaluate the lag effect of temperature on BD up to 30 days. Results showed the risk of BD increased with temperature significantly, especially after 8 °C. The maximum risk of BD was observed at extreme high temperature (29 °C). The effect of temperature on BD risk was significantly divided into short-term effect at lag 5 days and long-term effect at lag 30 days. Age ≤ 15 years were most affected by high temperature. The maximum cumulative risk for lag 30 days (25.8, 95% CIs: 11.8-50.1) was observed at 29 °C. Age ≤ 15 years and females showed short-term effect at lag 5 days and long-term effect at lag 30 days, while age > 15 years and males showed acute short-term effect at lag 0 and light long-term effect at lag 16 days.

Air pollution and its associated health risks before and after COVID-19 in Shaanxi Province, China.

Air pollution is a serious environmental problem that damages public health. In the present study, we used the segmentation function to improve the health risk-based air quality index (HAQI) and named it new HAQI (NHAQI). To investigate the spatiotemporal distribution characteristics of air pollutants and the associated health risks in Shaanxi Province before (Period I, 2015-2019) and after (Period II, 2020-2021) COVID-19. The six criteria pollutants were analyzed between January 1, 2015, and December 31, 2021, using the air quality index (AQI), aggregate AQI (AAQI), and NHAQI. The results showed that compared with AAQI and NHAQI, AQI underestimated the combined effects of multiple pollutants. The average concentrations of the six criteria pollutants were lower in Period II than in Period I due to reductions in anthropogenic emissions, with the concentrations of PM2.5 (particulate matter ≤2.5 µm diameter), PM10 (PM ≤ 10 µm diameter) SO2, NO2, O3, and CO decreased by 23.5%, 22.5%, 45.7%, 17.6%, 2.9%, and 41.6%, respectively. In Period II, the excess risk and the number of air pollution-related deaths decreased considerably by 46.5% and 49%, respectively. The cumulative population distribution estimated using the NHAQI revealed that 61% of the total number of individuals in Shaanxi Province were exposed to unhealthy air during Period I, whereas this proportion decreased to 16% during Period II. Although overall air quality exhibited substantial improvements, the associated health risks in winter remained high.