Organic and Elemental Carbon in Atmospheric Fine Particulate Matter in an Animal Agriculture Intensive Area in North Carolina: Estimation of Secondary Organic Carbon Concentrations

Carbonaceous components contribute significant fraction of fine particulate matter (PM2.5). Study of organic carbon (OC) and elemental carbon (EC) in PM2.5 may lead to better understanding of secondary organic carbon (SOC) formation. This year-long (December 2008 to December 2009) field study was conducted in an animal agriculture intensive area in North Carolina of United States. Samples of PM2.5 were collected from five stations located in an egg production facility and its vicinities. Concentrations of OC/EC and thermograms were obtained using a thermal-optical carbon analyzer. Average levels of OC in the egg production house and at ambient stations were 42.7 μg/m3 and 3.26 - 3.47 μg/m3, respectively. Average levels of EC in the house and at ambient stations were 1.14 μg/m3 and 0.36 - 0.42 μg/m3, respectively. The OC to total carbon (TC) ratios at ambient stations exceeded 0.67, indicating a significant fraction of SOC presented in PM2.5. Principal factor analysis results suggested that possible major source of in-house PM2.5 was from poultry feed and possible major sources of ambient PM2.5 was from contributions of secondary inorganic and organic PM. Using the OC/EC primary ratio analysis method, ambient stations SOC fractions ranged from 68% to 87%. These findings suggested that SOC could appreciably contribute to total PM2.5 mass concentrations in this agriculture intensive area.

Are Participants in a Behavior Change Communication Campaign More Likely to Seek Care for Childhood Diarrhea? A Study of Caregivers of Children under 2 in Tanzania

Stunting remains a particular challenge in Sub-Saharan Africa. Despite encouraging declines in Tanzania over the past 25 years, one-third of Tanzanian children under the age of five years are stunted. Diarrhea remains one of the greatest causes of childhood stunting worldwide. Mass media has been used to improve the uptake of behaviors associated with reductions in diarrhea. This study evaluates the effectiveness of a mass media campaign in the Lake Zone region of Tanzania from 2015-2020 and positive changes in caregiver health-seeking behaviors related to diarrhea in children. Approximately 5000 households participated in a cross-sectional survey after a communications campaign. Exposure variables included hearing and seeing radio and TV spots and participating in a variety of interpersonal communication approaches. Study results indicated primary caregivers (mothers) exposed to media messages only (OR 1.66, CI 1.05 - 2.62), and to media messages and interpersonal communication (OR 2.51, CI 1.48 - 4.26), were more likely to seek advice or treatment for diarrhea from a health facility. Primary caregivers exposed to both media messages and interpersonal communication were more likely to give oral rehydration salts (OR 2.56, CI 1.72 - 3.79), zinc tablets/syrup (OR 1.74, CI 1.18 - 2.57), and homemade fluids (OR 2.02, CI 1.15 - 3.55) when their children had diarrhea. Male heads of household (fathers) exposure to mass media was not associated with care-seeking for diarrhea treatment.

Elemental Compositions and Chemical Mass Closure of Fine Particulate in an Animal Feeding Operation Facility and Its Vicinity

Particulate matter (PM) emissions from animal feeding operations (AFOs) have been considered as an important contributor to ambient PM in rural areas. Investigation of the chemical compositions of PM2.5 inside and in the vicinity of AFOs can enhance our understanding of the AFO emissions impact on ambient PM characteristics. This year-long field study was conducted on a commercial egg production farm to investigate ambient PM chemical compositions as impacted by the air emissions from the production houses. The PM2.5 samples were collected from five sampling stations (one in-house station and four ambient locations in four wind directions). The trace elements, major ions, organic carbon (OC) and element carbon (EC) were analyzed by X-ray florescence (XRF), ion chromatography (IC), and thermo-optical analyzer, respectively. There were significant differences in elemental compositions between PM samples from in-house station (ST1) and ambient stations (ST2-ST5). The chemical mass balance analysis revealed that OC accounted for above 50% of PM2.5 mass at in-house and ambient stations;NH4+, SO42-, and NO3- accounted for about 40.0% of the total PM2.5 mass in ambient locations and for only 12% of the total PM2.5 mass in house. The measured PM2.5 masses agreed with the sums of the masses of chemical compositions at all stations except for the in-house station. Knowledge gained from this study, with additional consideration of NH3 concentrations and emissions, will lead to better understanding of PM2.5 source and formation, fate and transport, and their atmospheric dynamics.

中国5所医院红细胞输注情况病例对照研究

目的调查参加研究的5所医院红细胞输注指征,输血前后血红蛋白（Hb）水平变化以及与红细胞输注相关的其他临床因素,对临床红细胞输注提供科学依据。方法对5家医院的血库信息系统查询2013年全年住院患者中首次红细胞输注病例,并从中随机选择1000例收集相关数据,病例不满1 000例的医院的全部病例纳入研究;将所有数据按照人口统计学特征、并发症、是否手术、红细胞特征以及Hb水平进行区分。根据主要疾病诊断将病例属于6大诊断组的病例分出,选择在同一时间段入院且在相同诊断组的未输血病例为作为对照,进行临床队列研究,对输注前Hb水平及其他红细胞输注相关临床因素进行统计学分析。结果从约5 000例红细胞输注患者中选择出属于6个诊断组的病例1 356例,对照病例1 201例,外科患者（病例数/对照数）包括骨科手术组（312/216）;普外科手术组（367/332）;内科患者包括实体瘤（230/232）;消化道出血（212/221）;心血管疾病（87/77）;血液系统恶性肿瘤（100/101）。Hb水平与手术患者和内科患者的红细胞输注均具有相关性。手术患者中,Hb为（70—90） g/L患者组相对于Hb〉100 g/L患者组,输注红细胞的OR值（95%可信区间）为27. 0（13. 9—52. 7）,内科患者中该OR值为71. 5（37. 8—135. 4）。外科患者红细胞输注只与红细胞输注前Hb水平相关;内科患者中主要诊断、不同医院以及年龄〉75岁等均是进行红细胞输注的独立因素。心血管疾病患者组相对于实体瘤患者组进行红细胞输注的OR值为2. 5（1. 2—4. 9）,血液系统恶性肿瘤患者组与消化道出血患者组相对于实体瘤患者组进行红细胞输注的OR值分别为0. 4（0. 2—0. 6）和0. 5（0. 3—0. 8）。其中46%的血液系统恶性肿瘤患者红细胞输注前的Hb〈60 g/L。结论红细胞输注前Hb水平是与红细胞输注最相关的因素。其他相关临床因素包括年龄、心血管疾病、主要诊断等仅与内科患者的红细胞输注相关,与外科患者红细胞输注无关。比较西方国家红细胞输注标准[输血前Hb：（70—80） g/L]与中国红细胞输注标准（输血前Hb：60 g/L）的临床研究将为科学合理的红细胞输注标准的制定提供依据。

Trends in outpatient breast cancer surgery among Medicare fee-for-service patients in the United States from 1993 to 2002

The practice of outpatient breast cancer surgery has been controversial in the United States. This study aimed to update time trends and geographic variation in outpatient breast cancer surgery among elderly Medicare fee-for-service women in the United States. Using the 1993-2002 linked Surveillance, Epidemiology and End Results (SEER)-Medicare claims data and the Area Resource Files, we identified 2 study samples, including the women whose breast cancers were the first-ever-diagnosed cancer at age 65 years or older from 9 regions continuously covered by the SEER registries since 1993. The first sample included the women receiving unilateral mastectomy for stage 0-IV cancer; the second included the women receiving the breast-conserving surgery with lymph node dissection (BCS/LND) for stage 0-II cancer. The proportions of patients receiving outpatient surgery increased from 3.2% to 19.4% for mastectomy and from 48.9% to 77.8% for BCS/LND from 1993 to 2002. We observed substantial geographic variation in the average proportion of the patients receiving outpatient surgery in the studied areas across the 10-year period, ranging from 3.9% in Connecticut to 27.2% in Utah for mastectomy and from 54.7% in Hawaii to 78.1% in Seattle, Washington, for BCS/LND. As the popularity of outpatient breast cancer surgery continues to grow, more evidence-based analyses related to quality and outcomes of outpatient breast cancer surgery among various populations are needed in order to facilitate the public debates about state and federal mandated health benefit legislations.

Modeling Climate Change Impacts on the US Agricultural Exports

Climate change is expected to have substantial effects on agricultural productivity worldwide. However, these impacts will differ across commodities, locations and time periods. As a result, landowners will see changes in relative returns that are likely to induce modifications in production practices and land allocation. In addition, regional variations in impacts can alter relative competitiveness across countries and lead to adjustments in international trade patterns. Thus in climate change impact studies it is likely useful to account for worldwide productivity effects. In this study, we investigate the implications of considering rest of world climate impacts on projections of the US agricultural exports. We chose to focus on the US because it is one of the largest agricultural exporters. To conduct our analyses, we consider four alternative climate scenarios, both with and without rest of world climate change impacts. Our results show that considering/ignoring rest of world climate impacts causes significant changes in the US production and exports projections. Thus we feel climate change impact studies should account not only for climate impacts in the country of focus but also on productivity in the rest of the world in order to capture effects on commodity markets and trade potential.

Maximizing Sampling Efficiency

Background and Goals: Although health care quality improvement has traditionally involved extensive work with paper records, the adoption of health information technology has increased the use of electronic record and administrative systems. Despite these advances, quality improvement practitioners now and for the foreseeable future need guidance in defining populations of individuals for study and in selecting and analyzing sample data from such populations. Statistical data analysis in health care research often involves using samples to make inferences about populations. The investigator needs to consider the goals of the study, whether sampling is to be used, and the type of population being studied. While there are numerous sampling strategies designed to conserve resources and yield accurate results, one of these techniques—use of the finite population correction (FPC)—has received relatively little attention in health care sampling contexts. It is important for health care quality practitioners to be aware of sampling options that may increase accuracy and conserve resources. This article describes common sampling situations in which the issue of the finite population correction decision often arises. Methods: This article describes 3 relevant sampling situations that influence the design and analysis phases of a study and offers guidance for choosing the most effective and efficient design. Situation 1: The study or activity involves taking a sample from a large finite target population for which enumerative inferences are needed. Situation 2: The population is finite and the study is enumerative. A complete enumerative count of “defects” in the process is needed so that remediation can occur. Here, statistical inference is unnecessary. Situation 3: The target population is viewed as infinite;such populations are “conceptual populations” [1] or “processes”. Results: The article shows how savings in resources can be achieved by choosing the correct analytic framework at the conceptualization phase of study design. Choosing the right sampling approach can produce accurate results at lower costs. Several examples are presented and the implications for health services research are discussed. Conclusion: By clearly specifying the objectives of a study and considering explicitly whether the data are a sample or a population, the practitioner may be able to design a more efficient study and thereby conserve resources. This article provides a conceptual framework in the form of three situations, several examples, and an algorithm (Figure 1) to help the intervention planner determine how to classify the study and when to apply the FPC.

Enhanced Methane Sorption in Densified Forms of a Porous Polymer Network

Multi-gram synthesis and densification is presented for a porous polymer network (PPN-4) examined as a possible vehicular methane storage material. Compaction at 17,000 psi doubled the bulk density of the material and unexpectedly increased microporosity within the material. As a result, the densified material exhibits higher excess gravimetric methane uptake and improved total volumetric methane uptake relative to the powder.

卫生经济学评价报告标准共识2022(CHEERS 2022):卫生经济学评价报告指导意见更新版

卫生经济学评价是对备选行动方案的成本和结果的比较分析。2013年发表的《卫生经济学评价报告标准共识》(CHEERS)提出了卫生经济学评价的特点,确保结果正确阐释,以支持决策制订。2013版CHEERS旨在指导研究报告撰写者准确报告卫生干预和对照措施、背景、过程、结果等评价细节,使审稿人理解文章内容,帮助读者使用研究结果。本版共识将取代2013版共识,其更加适用于各类卫生经济学评价,结合学科发展和方法更新的需要,更注重患者、公众等相关利益方的参与。本共识适用多种个体或人群健康干预措施(简单或复杂)在不同政策场景的应用分析,包括医疗服务、公共卫生、教育、社会服务等。本文概要介绍了CHEERS 2022共识中包含的28个检查项及每一个检查项的相关建议。CHEERS 2022共识主要用于指导研究人员撰写拟投递同行评议学术期刊的卫生经济学评价文章,亦可用于期刊编辑和审稿专家对待发表文章的评价。熟悉了解本共识要求,还有助于研究人员规划评价研究。随着决策透明度要求提高,本共识可支持卫生技术评估机构建立评价报告标准。

How elimination of lymphatic filariasis as a public health problem in the Kingdom of Cambodia was achieved

Background:Endemicity of lymphatic filariasis(LF)in Cambodia was proven in 1956 when microfilariae were detected in mosquitos in the Kratiéprovince.In 2001,an extensive study confirmed the presence of both Brugia malayi and Wuchereria bancrofti microfilariae.In 2003,the Ministry of Health established a national task force to develop policies and strategies for controlling and eliminating neglected tropical diseases(NTDs),with the goal of eliminating LF by 2015.This article summarizes the work accomplished to eliminate LF as a public health problem in Cambodia.Methods:The National Program to Eliminate Lymphatic Filariasis made excellent progress in the goal towards elimination due to strong collaboration between ministries,intensive supervision by national staff,and advocacy for mobilization of internal and external resources.Mass drug administration(MDA)with diethylcarbamazine citrate and albendazole was conducted in six implementation units,achieving>70%epidemiological coverage for five consecutive rounds,from 2005 to 2009.In 2006,in 14 provinces,healthcare workers developed a line list of lymphedema and hydrocele patients,many of whom were>40 years old and had been affected by LF for many years.The national program also trained healthcare workers and provincial and district staff in morbidity management and disability prevention,and designated health centers to provide care for lymphedema and acute attack.Two reference hospitals were designated to administer hydrocele surgery.Results:Effectiveness of MDA was proven with transmission assessment surveys.These found that less than 1%of school children had antigenemia in 2010,which fell to 0%in both 2013 and 2015.A separate survey in one province in 2015 using Brugia Rapid tests to test for LF antibody found one child positive among 1677 children.The list of chronic LF patients was most recently updated and confirmed in 2011-2012,with 32 lymphoedema patients and 17 hydrocele patients listed.All lymphedema patients had been trained on self-management and all hydrocele patients had been offered free surgery.Conclusions:Due to the success of the MDA and the development of health center capacity for patient care,along with benefits gained from socioeconomic improvements and other interventions against vector-borne diseases and NTDs,Cambodia was validated by the World Health Organization as achieving LF elimination as a public health problem in 2016.

仿制药的利与弊

对于许多大型制药公司来说，现在是最艰难的时期。因为新的重磅炸弹药物的产品线逐渐减少，而且这些药物正陆续达到专利保护期，面临仿制药的竞争。目前，几乎每一种主要疾病，如感染、糖尿病、高血压、心脏衰竭、脂质紊乱、胃酸反流等，都有便宜又有效的仿制药。

Building a global schistosomiasis alliance:an opportunity to join forces to fight inequality and rural poverty

Schistosomiasis,one of the 17 neglected tropical diseases listed by the World Health Organization,presents a substantial public health and economic burden.Of the 261 million people requiring preventive chemotherapy for schistosomiasis in 2013,92%of them lived in sub-Saharan Africa and only 12.7%received preventive chemotherapy.Moreover,in 2010,the WHO reported that schistosomiasis mortality could be as high as 280000 per year in Africa alone.In May 2012 delegates to the sixty-fifth World Health Assembly adopted resolution WHA65.21 that called for the elimination of schistosomiasis,and foresees the regular treatment of at least 75%of school age children in at-risk areas.The resolution urged member states to intensify schistosomiasis control programmes and to initiate elimination campaigns where possible.Despite this,in June 2015,schistosomiasis was indicated to have the lowest level of preventive chemotherapy implementation in the spectrum of neglected tropical diseases.It was also highlighted as the disease most lacking in progress.This is perhaps unsurprising,given that it was also the only NTD with access to drug donations but without a coalition of stakeholders that collaborates to boost commitment and implementation.As a consequence,and to ensure that the WHO NTDs Roadmap Targets of 2012 and World Health Assembly Resolution WHA65.21 are met,the Global Schistosomiasis Alliance(GSA)has been set up.Diverse and representative,the GSA aims to be a partnership of endemic countries,academic and research institutions,international development agencies and foundations,international organizations,non-governmental development organizations,private sector companies and advocacy and resource mobilisation partners.Ultimately,the GSA calls for a partnership to work for the benefit of endemic countries by addressing health inequity and rural poverty.

如何治疗多重慢性疾病？

近来有两件事引起我的思考。第一件事和一位老年女性患者有关，我从她的家庭医生那里听说了她的情况。这位女性身上有很多老年人常见的疾病：糖尿病、高血压、充血性心力衰竭、抑郁症以及轻度肾功能不全。由于协调这些疾病间的治疗十分困难，最终她不得不通过每年几次的住院来进行“调养”。她的家庭医生向我咨询治疗建议，于是我们便开始寻找相关的循证治疗指南。

从母亲学到的 初探老人所面对的医疗体系问题

我的母亲于2010年5月22日去世，86岁。她患有阿尔茨海默病、充血性心力衰竭，最后可能还发生了一次轻度的脑卒中。在生命中的最后一年，她摔过两次，两次都骨折了，致使病情一度恶化。

Impacts of timing,length,and intensity of behavioral interventions to COVID-19 dynamics:North Carolina countylevel examples

We sought to examine how the impact of revocable behavioral interventions,e.g.,shelterin-place,varies throughout an epidemic,as well as the role that the proportion of susceptible individuals had on an intervention's impact.We estimated the theoretical impacts of start day,length,and intensity of interventions on disease transmission and illustrated them on COVID-19 dynamics inWake County,North Carolina,to inform how interventions can be most effective.We used a Susceptible,Exposed,Infectious,and Recovered(SEIR)model to estimate epidemic curves with modifications to the disease transmission parameter(β).We designed modifications to simulate events likely to increase transmission(e.g.,long weekends,holiday seasons)or behavioral interventions likely to decrease it(e.g.,shelter-in-place,masking).We compared the resultant curves'shape,timing,and cumulative case count to baseline and across other modified curves.Interventions led to changes in COVID-19 dynamics,including moving the peak's location,height,and width.The proportion susceptible,at the start day,strongly influenced their impact.Early interventions shifted the curve,while interventions near the peak modified shape and case count.For some scenarios,in which the transmission parameter was decreased,the final cumulative count increased over baseline.We showed that the timing of revocable interventions has a strong impact on their effect.The same intervention applied at different time points,corresponding to different proportions of susceptibility,resulted in qualitatively differential effects.Accurate estimation of the proportion susceptible is critical for understanding an intervention's impact.The findings presented here provide evidence of the importance of estimating the proportion of the population that is susceptible when predicting the impact of behavioral infection control interventions.Greater emphasis should be placed on the estimation of this epidemic component in intervention design and decision-making.Our results are generic and are applicable to other infectious disease epidemics,as well as to future waves of the current COVID-19 epidemic.Developed into a publicly available tool that allows users to modify the parameters to estimate impacts of different interventions,these models could aid in evaluating behavioral intervention options prior to their use and in predicting case increases from specific events.

The natural analgesic conolidine targets the newly identified opioid scavenger ACKR3/CXCR7

Dear Editor,The atypical chemokine receptor ACKR3 has recently been reported to act as an opioid scavenger with unique negative regulatory properties towards different families of opioid peptides.Here,we show that conolidine,a natural analgesic alkaloid used in traditional Chinese medicine,targets ACKR3,thereby providing additional proof of a correlation between ACKR3 and pain modulation and opening alternative therapeutic avenues for the treatment of chronic pain.

Incorporation of near-real-time hospital occupancy data to improve hospitalization forecast accuracy during the COVID19 pandemic

Public health decision makers rely on hospitalization forecasts to inform COVID-19 pandemic planning and resource allocation.Hospitalization forecasts are most relevant when they are accurate,made available quickly,and updated frequently.We rapidly adapted an agent-based model(ABM)to provide weekly 30-day hospitalization forecasts(i.e.,demand for intensive care unit[ICU]beds and non-ICU beds)by state and region in North Carolina for public health decision makers.The ABM was based on a synthetic population of North Carolina residents and included movement of agents(i.e.,patients)among North Carolina hospitals,nursing homes,and the community.We assigned SARSCoV-2 infection to agents using county-level compartmental models and determined agents’COVID-19 severity and probability of hospitalization using synthetic population characteristics(e.g.,age,comorbidities).We generated weekly 30-day hospitalization forecasts during MayeDecember 2020 and evaluated the impact of major model updates on statewide forecast accuracy under a SARS-CoV-2 effective reproduction number range of 1.0e1.2.Of the 21 forecasts included in the assessment,the average mean absolute percentage error(MAPE)was 7.8%for non-ICU beds and 23.6%for ICU beds.Among the major model updates,integration of near-real-time hospital occupancy data into the model had the largest impact on improving forecast accuracy,reducing the average MAPE for non-ICU beds from 6.6%to 3.9%and for ICU beds from 33.4%to 6.5%.Our results suggest that future pandemic hospitalization forecasting efforts should prioritize early inclusion of hospital occupancy data to maximize accuracy.

Resilience indicators support valuation of estuarine ecosystem restoration under climate change

Economic valuation of ecological restoration most often encompasses only the most tangible ecosystem service benefits,thereby omitting many difficult-to measure benefits,including those derived from enhanced reliability of ecosystem services.Because climate change is likely to impose novel ecosystem stressors,a typical approach to valuing benefits may fail to capture the contribution of ecosystem resilience to sustaining long-term benefits.Unfortunately,we generally lack predictive probabilistic models that would enable measurement and valuation of resilience.Therefore,alternative measures are needed to complement monetary values and broaden understanding of restoration benefits.We use a case study of Chesapeake Bay restoration(total maximum daily load)to show that ecosystem service benefits that are typically monetized leave critical information gaps.To address these gaps,we review evidence for ecosystem services that can be quantified or described,including changes in harmful algal bloom risks.We further propose two integrative indicators of estuarine resilience-the extent of submerged aquatic vegetation and spatial distribution of fish.Submerged aquatic vegetation extent is indicative of qualities of ecosystems that promote positive feedbacks to water quality.Broadly distributed fish populations reduce risk by promoting diverse responses to spatially heterogeneous stresses.Our synthesis and new analyses for the Chesapeake Bay suggest that resilience metrics improve understanding of restoration benefits by demonstrating how nutrient and sediment load reductions will alleviate multiple sources of stress,thereby enhancing the system’s capacity to absorb or adapt to extreme events or novel stresses.

The Shifting Landscape of Latent Print Testimony:An American Perspective

Friction ridge comparison testimony in the United States has long been characterized by speaking in absolutes:fingerprints are unique,the Analysis,Comparison,Evaluation,and Verification methodology has a zero-error rate,and the testimony presented by the expert should be regarded as an incontrovertible fact.Once the National Research Council released their watershed report in 2009,questioning and criticizing these clear overstatements of the strength of the evidence,many commentators and professional organizations recommended that the friction ridge community rethink the way their evidence was presented in reports and in court.Yet,change has been slow to come.While some agencies have begun a shift in the way they present their findings,many others still testify the same way they always have.This paper presents the historical context of where American friction ridge testimony has been,lays out the arguments for why it needs to change,describes some recent efforts to improve,and highlights some likely directions for the future of friction ridge reporting and testimony in the United States.