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Objectives: Tigecycline is a last-resort antibiotic used to treat lethal infections caused by carbapenem-resistant Enterobacterales; however, plasmid-borne tigecycline resistance tmexCD-toprJ gene clusters can confer tigecycline resistance. The aim of the study was to identify novel subtypes and the spread of tmexCD-toprJ.Methods: Five non-duplicate isolates of different species, carrying tmexCD-toprJ gene clusters or novel subtypes, were isolated from patients across China between November 2018 and June 2019. WGS was performed using Illumina and Nanopore platforms. A phylogenetic tree was constructed using a dataset of 77 sequences carrying the tmexCD-toprJ gene clusters, 72 of which were downloaded from NCBI with a blastn identity cut-off of 95%.Results: We detected six different transfer units and two novel subtypes (tmexC1D1.2-toprJ1 and tmexC2D2.2-toprJ2) of the tmexCD-toprJ gene clusters. Among the six transfer units, three were mediated by IS26, while the rest were presumably mediated by Tn5393, hypothetical integrases (xerD-hp clusters-umuC-integrases-tnfxB2-tmexC2D2-toprJ2-umuC) and hypothetical units (hp-hp-hp-tnfxB2-tmexC2D2.2-toprJ2-ΔTn5393-Tn6292). Moreover, two tmexCD-toprJ-like gene clusters co-located on the same plasmid with blaNDM in five isolates. Phylogenetic analysis revealed that tmexCD-toprJ gene clusters may have originated in Pseudomonas spp., being mainly distributed in Pseudomonas spp. and Klebsiella spp. (64/77). Most tmexCD-toprJ gene clusters in Enterobacterales were located on plasmids, indicating that the gene clusters have a high inter-species transfer risk after transfer to Enterobacterales.Conclusions: In summary, to the best of our knowledge, this is the first report of tmexCD-toprJ gene clusters being isolated from Enterobacter cloacae and Klebsiella oxytoca, revealing that these multiple transfer units should be further studied because of their clinical significance. [ABSTRACT FROM AUTHOR]

Long-range transport of anthropogenic air pollutants from East Asia can affect the downwind marine air quality during spring and winter. Long-range transport of continental air pollutants and their interaction with sea salt aerosol (SSA) significantly modify the radiative forcing of marine aerosols and influence ocean biogeochemical cycling. Previous studies poorly characterize variations of aerosol particles along with air mass transport from the continental edge to the remote ocean. Here, the research ship R/V Dongfanghong 2 traveled from the eastern China seas (ECS) to the northwestern Pacific Ocean (NWPO) to understand what and how air pollutants were transported from the highly polluted continental air to clean marine air in spring. A transmission electron microscope (TEM) was used to find the long-range transported anthropogenic particles and the possible Cl-depletion phenomenon of SSA in marine air. Anthropogenic aerosols (e.g., sulfur (S)-rich, S-soot, S-metal/fly ash, organic matter (OM)-S, and OM coating particles) were identified and dramatically declined from 87 % to 8 % by number from the ECS to remote NWPO. For the SSA aging, 87 % of SSA particles in the ECS were identified as fully aged, while the proportion of fully aged SSA particles in the NWPO decreased to 29 %. Our results highlight that anthropogenic acidic gases in the troposphere (e.g., SO 2 , NO x , and volatile organic compounds) could be transported to remote marine air and exert a significant impact on aging of SSA particles in the NWPO. The study shows that anthropogenic particles and gases from East Asia significantly perturb different aerosol chemistry from coastal to remote marine air. More attention should be given to the modification of SSA particles in remote marine areas due to the influence of anthropogenic gaseous pollutants. [ABSTRACT FROM AUTHOR]

The source to sink process of terrigenous sediment from East Asia continent to the marginal seas is crucial for the understanding of land–ocean interaction and marine sedimentary process in the West Pacific continental margin. This paper presents element geochemical and Sr–Nd isotopic records of core CM97 in the Changjiang (Yangtze River) Estuary and core MD06–3040 on the inner shelf of East China Sea, aiming to reconstruct the Changjiang sediment source–to–sink transport process and its major controlling mechanism during the Holocene. Driven by the asynchronous evolution of the Indian and East Asian summer monsoon, the provenance of sediments accumulated in the Changjiang Estuary gradually changed from the upper catchment during the late glacial period to the mid–lower valley in the early–mid Holocene. With the intensive agricultural cultivation and urbanization development in the catchment during the late Holocene, the major source of Changjiang sediment into the sea shifted back to the upper catchment, again. The high–frequency ENSO activity may superimpose the effect of human disturbances on sediment source–to–sink process in the late Holocene. Therefore, the Holocene provenance evolution of Changjiang sediments in the East China Sea witnessed the changes of governing sediment erosion process within a large catchment from monsoon climate–dominated to anthropogenic driving. Our study also suggests the strong effect of hydrodynamics in coastal and shelf environments on sedimentary geochemical compositions, which deserves more attention in further sediment provenance study. [ABSTRACT FROM AUTHOR]

Construction duration and schedule robustness are of great importance to ensure efficient construction. However, the current literature has neglected the importance of schedule robustness. Relatively little attention has been paid to schedule robustness via deviation of an activity's starting time, which does not consider schedule robustness via structural deviation caused by the logical relationships among activities. This leads to a possibility of deviation between the planned schedule and the actual situation. Thus, an optimization model of construction duration and schedule robustness is proposed to solve this problem. Firstly, duration and two robustness criteria including starting time deviation and structural deviation were selected as the optimization objectives. Secondly, critical chain method and starting time criticality (STC) method were adopted to allocate buffers to the schedule in order to generate alternative schedules for optimization. Thirdly, hybrid grey wolf optimizer with sine cosine algorithm (HGWOSCA) was proposed to solve the optimization model. The movement directions and speed of grey wolf optimizer (GWO) was improved by sine cosine algorithm (SCA) so that the algorithm's performance of convergence, diversity, accuracy, and distribution improved. Finally, an underground power station in China was used for a case study, by which the applicability and advantages of the proposed model were proved. [ABSTRACT FROM AUTHOR]

Harmful algal blooms (HABs), eutrophication, and internal pollutant sources from sediment, represent serious problems for public health, water quality, and ecological restoration worldwide. Previous studies have indicated that Modified Local Soil (MLS) technology is an efficient and cost-effective method to flocculate the HABs from water and settle them onto sediment. Additionally, MLS capping treatment can reduce the resuspension of algae flocs from the sediment, and convert the algal cells, along with any excessive nutrients in-situ into fertilisers for the restoration of submerged macrophytes in shallow water systems. Furthermore, the capping treatment using oxygen nanobubble-MLS materials can also mitigate sediment anoxia, causing a reduction in the release of internal pollutants, such as nutrients and greenhouse gases. This paper reviews and quantifies the main features of MLS by investigating the effect of MLS treatment in five pilot-scale whole-pond field experiments carried out in Lake Tai, South China, and in Cetian Reservoir in Datong city, North China. Data obtained from field monitoring showed that the algae-dominated waters transform into a macrophyte-dominated state within four months of MLS treatment in shallow water systems. The sediment-water nutrient fluxes were substantially reduced, whilst water quality (TN, TP, and transparency) and biodiversity were significantly improved in the treatment ponds, compared to the control ponds within a duration ranging from one day to three years. The sediment anoxia remediation effect by oxygen nanobubble-MLS treatment may further contribute to deep water hypoxia remediation and eutrophication control. Combined with the integrated management of external loads control, MLS technology can provide an environmentally friendly geo-engineering method to accelerate ecological restoration and control eutrophication. [ABSTRACT FROM AUTHOR]

• Impacts of cloud scattering properties on FY-3D HIRAS simulations are assessed in ARMS and CRTM. • ARMS and CRTM simulated brightness temperatures are compared with HIRAS observations to provide quantitative evaluation. • Spherical ice cloud approximation has been found to be not appropriate for ARMS model simulations. Cloudy sky spectral radiance at the top of the atmosphere has always been an important while difficult variable to simulate for fast radiative transfer models. In this paper, we focus on examining the impacts of cloud scattering properties on the spectral radiance signature of the High-spectral Resolution Infrared Atmospheric Sounder (HIRAS) onboard the Fengyun-3D (FY-3D) satellite by using the Advanced Radiative transfer Modeling System (ARMS) and the Community Radiative Transfer Model (CRTM). Cloud scattering properties used in the radiative transfer models are critical for modeling the spectral radiance under cloudy sky, which involves choices of appropriate cloud particle models and particle size distributions, etc. Multiple FY-3D HIRAS observations over Southern China and Southeast Asia with ice or liquid water cloud cover on 6 May 2018 are examined, respectively. Vertical atmospheric profiles are derived from the Modern-Era Retrospective analysis for Research and Applications, Version 2 reanalysis product. Cloud property retrievals from the Moderate Resolution Imaging Spectroradiometer are used. Cloud scattering property parameterization schemes based on spherical and nonspherical cloud particle shapes are implemented for liquid water and ice clouds in ARMS and CRTM, respectively. Results show that both ARMS and CRTM can well simulate the radiance at the HIRAS spectral ranges under liquid water cloud condition as compared with the HIRAS observation with mean absolute error (MAE) of brightness temperature of less than 1 K. However, for ice cloud conditions, ARMS model using assumed spherical ice properties exhibits large biases between simulation and observation. CRTM with nonspherical ice properties using 16-stream approximation shows MAE less than 1 K and MAE of about 1 K using 2-stream approximation. [ABSTRACT FROM AUTHOR]

Aerosol loading and trace gas emissions from agriculture crop residue burning has been one of the main factors leading to the deterioration of air quality especially during the harvest time in China. Here, we evaluate the contribution of atmospheric aerosol loading from biomass burning and its relationship to the air pollution control policy. We focused on Shandong province, China because it has the highest level of agriculture burning pollution in October. Satellite-based data related to biomass burning including aerosol optical depth (AOD) and fire pixel counts from Moderate Resolution Imaging Spectroradiometer (MODIS), carbon monoxide (CO) from Measurements Of Pollution In The Troposphere (MOPITT), aerosol index (AI) and tropospheric NO 2 from Ozone Monitoring Instrument (OMI), and aerosol layer depths from Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO). These metrics were synthetically utilized to evaluate spatial and temporal variation of atmospheric aerosols during the agriculture crop residue burning month from 2006 to 2017. Carbonaceous aerosol emission reduction and the impact of the air pollution control policy can be found in the CALIPSO aerosol types and MODIS fire pixel counts data. The AOD, NO 2 , CO, and AI over three different land covers (cropland, forest and impervious surfaces) were further obtained according to the land cover data set. The results indicated that there was an obvious decrease in all carbonaceous aerosol-related quantities after year 2012 when the local government began to enact and implement strict air pollution control policies, although a period (2–3 years) of transition after the policy implementation time was identified. We also found that CO is stable and low over the cropland versus forest and impervious surfaces; NO 2 exhibits a continuously high value in the northern areas of the oil field. The impact of industry activity rather than straw burning should be also considered for NO 2 and CO in certain areas. • Biomass burning is the main factor inducing high AOD in Shandong province in October. • Banning biomass burning policy after 2012 led to efficient control of aerosols. • Impact of industry activity should be considered in understanding NO 2 and CO. [ABSTRACT FROM AUTHOR]

Continental weathering plays a key role in earth surface processes by linking Earth's spheres and producing material for cycling. Previous studies have proposed numerous weathering indices for the evaluation of chemical weathering intensity. However, few research efforts are devoted to the changes of sediment physical properties during weathering processes and on the correlations between weathering and mineralogical/chemical alteration. This study investigates mineral transformation and magnetic properties of two weathering profiles developed on granodiorite and basalt in China. The notable differences in magnetic properties between the two profiles, i.e., magnetic susceptibility ( χ ), percentage frequency-dependent susceptibility ( χ fd %), anhysteretic remanent magnetization ( χ ARM ) and saturation isothermal remnant magnetization (SIRM), are ascribed to the combined effects of parent rock lithology and climate conditions on the formation and alteration of magnetic components during weathering/pedogenesis. Parent rock lithology (e.g., Fe-bearing basalts and relatively Fe-poor granites) determines the initial magnetic susceptibilities. Warm and humid climate favors rock weathering and thus enhances the magnetic intensity, whereas changes in redox conditions lead to inhomogeneous degree of chemical weathering, and thus alter the spatial distribution of magnetic minerals. This study further suggests that the weathering intensity in geologic profiles can be evaluated by magnetic indicators such as χ fd % and χ ARM /SIRM based on their positive correlations with the chemical index of alteration (CIA). The research findings may shed new light on the constraints on continental weathering and detrital sediment cycling in the East Asian continental margin. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a clinical decision support system (CDSS) in improving the use of guideline accordant antihypertensive treatment in primary care settings in China., Design: Pragmatic, open label, cluster randomised trial., Setting: 94 primary care practices in four urban regions of China between August 2019 and July 2022: Luoyang (central China), Jining (east China), and Shenzhen (south China, including two regions)., Participants: 94 practices were randomised (46 to CDSS, 48 to usual care). 12 137 participants with hypertension who used up to two classes of antihypertensives and had a systolic blood pressure <180 mm Hg and diastolic blood pressure <110 mm Hg were included., Interventions: Primary care practices were randomised to use an electronic health record based CDSS, which recommended a specific guideline accordant regimen for initiation, titration, or switching of antihypertensive (the intervention), or to use the same electronic health record without CDSS and provide treatment as usual (control)., Main Outcome Measures: The primary outcome was the proportion of hypertension related visits during which an appropriate (guideline accordant) treatment was provided. Secondary outcomes were the average reduction in systolic blood pressure and proportion of participants with controlled blood pressure (<140/90 mm Hg) at the last scheduled follow-up. Safety outcomes were patient reported antihypertensive treatment related events, including syncope, injurious fall, symptomatic hypotension or systolic blood pressure <90 mm Hg, and bradycardia., Results: 5755 participants with 23 113 visits in the intervention group and 6382 participants with 27 868 visits in the control group were included. Mean age was 61 (standard deviation 13) years and 42.5% were women. During a median 11.6 months of follow-up, the proportion of visits at which appropriate treatment was given was higher in the intervention group than in the control group (77.8% (17 975/23 113) v 62.2% (17 328/27 868); absolute difference 15.2 percentage points (95% confidence interval (CI) 10.7 to 19.8); P<0.001; odds ratio 2.17 (95% CI 1.75 to 2.69); P<0.001). Compared with participants in the control group, those in the intervention group had a 1.6 mm Hg (95% CI -2.7 to -0.5) greater reduction in systolic blood pressure (-1.5 mm Hg v 0.3 mm Hg; P=0.006) and a 4.4 percentage point (95% CI -0.7 to 9.5) improvement in blood pressure control rate (69.0% (3415/4952) v 64.6% (3778/5845); P=0.07). Patient reported antihypertensive treatment related adverse effects were rare in both groups., Conclusions: Use of a CDSS in primary care in China improved the provision of guideline accordant antihypertensive treatment and led to a modest reduction in blood pressure. The CDSS offers a promising approach to delivering better care for hypertension, both safely and efficiently., Trial Registration: ClinicalTrials.gov NCT03636334., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the Chinese Academy of Medical Sciences and the Sanming Project of Medicine in Shenzhen; in the past three years, HMK received options for Element Science and Identifeye and payments from F-Prime for advisory roles, and he is a cofounder of, and holds equity in, Hugo Health, Refactor Health, and Ensight-AI, and he is associated with research contracts through Yale University from Janssen, Kenvue, and Pfizer; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Cefiderocol has been approved in the United States and Europe but not in China. We aim to evaluate carbapenem-resistant Enterobacterales (CRE) susceptibility to cefiderocol to provide baseline data and investigate the resistance mechanism. From 2018 to 2019, 1,158 CRE isolates were collected from 23 provinces and municipalities across China. The MICs of antimicrobials were determined via the agar dilution and broth microdilution methods. Whole-genome sequencing was performed for 26 cefiderocol-resistant Escherichia coli isolates to investigate the resistance mechanism. Clone transformations were used to explore the function of cirA , pbp3 , and bla NDM-5 in resistance. Among the 21 antimicrobials tested, aztreonam-avibactam had the highest antibacterial activity (98.3%), followed by cefiderocol (97.3%) and colistin (95.3%). A total of 26 E. coli isolates harboring New Delhi metallo-beta-lactamase 5 (NDM-5) showed high levels of cefiderocol resistance, of which sequence type 167 (ST167) accounted for 76.9% (20/26). We found 4 amino-acid insertions (YRIN/YRIK) at position 333 of penicillin-binding protein 3 (PBP3) in the 26 E. coli isolates, and 22 isolates had a siderophore receptor cirA premature stop codon. After obtaining the wild-type cirA supplementation, the MIC of the transformants decreased by 8 to 16 times in two cefiderocol-resistant isolates. A cefiderocol-susceptible isolate harboring NDM-5 has an MIC increased from 1 μg/mL to 64 μg/mL after cirA deletion, and the MIC decreased from 64 μg/mL to 0.5 μg/mL after bla mutant was obtained, increased from 0.064 μg/mL to 0.25 μg/mL. Cefiderocol showed activity against most CRE in China. The resistance of ST167 E. coli to cefiderocol is a combination of the premature stop codon of NDM-5 deletion. The MIC of the E. coli DH5α, from which the pbp3 mutant was obtained, increased from 0.064 μg/mL to 0.25 μg/mL. Cefiderocol showed activity against most CRE in China. The resistance of ST167 E. coli to cefiderocol is a combination of the premature stop codon of cirA , pbp3 Cefiderocol, a new siderophore cephalosporin, has been approved in the United States and Europe but not in China. At present, there are almost no antimicrobial susceptibility evaluation data on cefiderocol in China. We evaluated the bla NDM-5 existence. IMPORTANCE Cefiderocol, a new siderophore cephalosporin, has been approved in the United States and Europe but not in China. At present, there are almost no antimicrobial susceptibility evaluation data on cefiderocol in China. We evaluated the in vitro susceptibility of 1,158 strains of carbapenem-resistant Enterobacterales to cefiderocol and other antibiotics. We found that a high proportion of Escherichia coli showed high-level resistance to cefiderocol. Whole-genome sequencing (WGS) and molecular cloning experiments confirmed that the synergistic effect of the cirA gene premature stop codon, bla NDM-5 existence, and the pbp3 mutation is associated with high levels of cefiderocol resistance.

Objective: To understand the antimicrobial resistance, virulence factors, and molecular characterization of MRSA isolates cultured from ready-to-eat(RTE) foods from several provinces in China., Methods: Totally, 397 S. aureus isolates were collected from RTE foods from several provinces in China, in 2017. The mecA gene was amplified to detect the MRSA strains among all 397 isolates by a polymerase chain reaction(PCR) method. Furthermore, the antimicrobial susceptibility and virulence factors of the MRSA isolates were detected by broth microdilution method and PCR, respectively, while the molecular characterization of all MRSA isolates were analyzed by pulsed-field gel electrophoresis(PFGE)., Results: In total, 32 MRSA isolates were identified from 397 isolates. All 32 MRSA isolates were resistant to penicillin, oxacillin and cefoxitin. Meanwhile, 78. 1%, 65. 6%, 53. 1, 28. 1% and 12. 5% of the 32 MRSA isolates showed resistant to erythromycin, clindamycin, tetracycline, chloramphenicol, and ciprofloxacin, respectively. Resistance rates to gentamicin and trimethoprim-sulfamethoxazole of all MRSA isolates were less than 10%. Eleven drug resistant spectrums were identified and 29 out of 32 MRSA isolates were identified as multi-drug resistant(MDR) isolates and two isolates were found to resistant to 9 antimicrobial agents tested in this study. Of all, 27 MRSA isolates were detected to harboring 13 virulence genes with sel-q(56. 3%), sel-k(43. 8%), seb(28. 1%) and sec(18. 8%) genes being the top four frequently detected. Besides, the result also showed that two or more virulence genes could be detected in one MRSA isolate. Finally, all 32 MRSA were identified to have 26 PFGE patterns and no dominant PFGE patterns were found in this study., Conclusion: An overall high level antimicrobial resistance was found among RTE associated MRSA in China in 2017, so was the MDR condition. Virulence genes could be frequently detected in RTE associated MRSA isolates. The PFGE patterns of RTE associated MRSA showed wide distribution characteristics.