Search

Background Esophagogastroduodenoscopy is very useful in diagnosing and treating upper gastrointestinal mucosal disorders, but too much foam and water in stomach decrease its diagnostic efficiency. Simethicone administration can help remove excessive foam. Aims To determine the optimal simethicone administration strategies in a comparative randomized controlled clinical trial. Methods Adult outpatients with indications for esophagogastroduodenoscopy were enrolled and randomly divided into group 1 (simethicone solution intake 20–30 min before procedure, n = 110), group 2 (simethicone solution intake 31–60 min before procedure, n = 92), and group 3 (simethicone solution intake > 60 min before procedure). Primary and secondary outcomes were procedure time and the patients’ satisfaction after the examination. All symptoms like abdominal pain and distension were recorded. Results No statistically significant differences were found on the patients’ demographic and clinical features and mean examination time (all P values > 0.05). The distribution of patients with different endoscopic and pathological diagnosis was comparable among three groups, respectively (P = 0.607; P = 0.289). However, the proportion of patients with Gastric Cleanness Grade A was most in group 2 (n = 73, 79.3%), and patient proportion with Gastric Cleanness Grade C was most found in group 1 (n = 72, 65.5%), which was greatly different (P < 0.001). There was no statistically significant difference on the satisfaction scores [immediately 6 (3–8) vs. 6 (1–10) vs. 6 (1-9), P = 0.533; 2 h after 10 (8–10) vs. 10 (10–10) vs. 10 (8-10), P = 0.463]. Conclusion Simethicone solution intake 31–60 min before esophagogastroduodenoscopy can help obtain the best gastric cleanness, which is recommended in clinical practice (registered at ClinicalTrials.gov, NCT03776916 on December 13, 2018).

Effective governance is crucial for developing various renewable energies, especially in their early stages. After the spectacular growth of onshore wind in the past decade, offshore wind is attracting an increasing amount of attention globally. As an archipelago and facing electricity shortage after the 2011 Fukushima nuclear accident, Japan has been accelerating its pace of developing offshore wind. However, the Japanese government encounters the challenge of adapting its old institution to the new governance demand. This research analyzes the evolution of offshore wind policies and evaluates the progress of inter-ministerial collaboration in Japan. It is found that from the initial potential surveys to the final setting of offshore wind feed-in tariff, the relations between relevant agencies were more characterized by inter-ministerial competitions than collaborations. The deeply rooted traditional sectionalism continues to affect the development of offshore wind and may slow down the progress of energy transition in Japan.

To tackle transboundary air pollution in East Asia, international schemes for environmental cooperation have been introduced, including the Acid Deposition Monitoring Network in East Asia (EANET), Long‐Range Transboundary Pollution of China, Japan and Korea (LTP), and the North‐East Asian Subregional Programme for Environmental Cooperation (NEASPEC). These programs, however, have not been successful in establishing robust regimes for effectively reducing transboundary air pollution in the region. This paper aims to examine the process of forming epistemic communities through these programs in East Asia. A bibliometric data on the scientific articles and reports produced were analyzed to examine the network structure of the scientific activities through EANET. The fragmentation of expert groups within EANET and among the major international schemes on air pollution in East Asia contributed to discouraging solid formation of an epistemic community covering air pollution comprehensively in the region. That makes it difficult to reach a consensus based on the current state of scientific knowledge on air pollution for providing effective advice and recommendations for the development of policies and regulations.

Background: Esophagogastroduodenoscopy is very useful in diagnosing and treating upper gastrointestinal mucosal disorders, but too much foam and water in stomach decrease its diagnostic efficiency. Simethicone administration can help remove excessive foam. Aims: To determine the optimal simethicone administration strategies in a comparative randomized controlled clinical trial.Methods: Adult outpatients with indications for esophagogastroduodenoscopy were enrolled and randomly divided into Group 1 (simethicone solution intake 20-30 min before procedure, n=110), Group 2 (simethicone solution intake 31-60 min before procedure, n=92) and Group 3 (simethicone solution intake >60 min before procedure). Primary and secondary outcome were procedure time and the patients' satisfaction after the examination. All symptoms like abdominal pain, distension were recorded.Results: No statistically significant differences were found on the patients’ demographic and clinical features, and mean examination time (all P values >0.05). The distribution of patients with different endoscopic and pathological diagnosis was comparable among three groups, respectively (P=0.607; P=0.289). However, the proportion of patients with Gastric Cleanness Grade A was most in Group 2 (n=73, 79.3%), and patient proportion with Gastric Cleanness Grade C was most found in Group 1 (n=72, 65.5%), which was greatly different (P

Black carbon mitigation has received increasing attention for its potential contribution to both climate change mitigation and air pollution control. Although different bottom-up models concerned with unit mitigation costs of various technologies allow the assessment of alternative policies for optimized cost-effectiveness, the lack of adequate data often forced many reluctant explicit and implicit assumptions that deviate away from actual situations of rural residential energy consumption in developing countries, where most black carbon emissions occur. To gauge the theory-practice gap in black carbon mitigation – the unit cost differences that lie between what is estimated in the theory and what is practically achieved on the ground – this study conducted an extensive field survey and analysis of nine mitigation technologies in rural China, covering both northern and southern regions with different residential energy consumption patterns. With a special focus on two temporal characteristics of those technologies – lifetimes and annual utilization rates, this study quantitatively measured the unit cost gaps and explain the technical as well as sociopolitical mechanisms behind. Structural and behavioral barriers, which have affected the technologies’ performance, are discussed together with policy implications to narrow those gaps.

Previous studies on the science–policy interface concentrate mostly on institutional arrangements that facilitate the information exchange between scientists and policymakers, but few address the internal structure of the scientist community and its impact on policy-making. Considering that science emerges from academic competition, the examination of the power balance within the scientist community is crucial for understanding political outcomes in the science–policy interface. This study applies social network analysis to the scientist community of grassland management in China and demonstrates that the structure of the scientist community exerts a significant influence on the formation of environmental policies. The dominance of ecologists inside the community led to the prevalence of the overgrazing-causes-degradation narrative. Though anthropologists later questioned the narrative, their capacity to challenge the authority of ecologists was circumscribed by their small group size, weak intra-group connection, and limited political affiliation. This resulted in the persistence of biased policies that continue to blame local communities for environmental problems.

Due to significant cost advantages, wind energy penetrated the energy mix of most large countries much faster than solar PV did until the recent decade. However, Japan has been almost one-sidedly leaning toward the more expensive solar PV. For using solar PV electricity, the Japanese consumers are also paying sizably higher tariffs than those in other countries, especially after the Fukushima nuclear accident in 2011 that led to the sudden suspension of all nuclear power plants. Japan's energy transition towards renewables is accordingly largely single legged, rather than more balanced to take advantage of both wind turbines and solar PV. This article explains the puzzle on why renewable energy development in Japan has created such a wide distance from more economically optimal situations. We focus on the initiation, formation and impacts of the solar lobby that comprises bureaucracies, politicians, solar PV manufacturers, and independent power producers. Policy implications are drawn for Japan and other countries on the importance of controlling political lobby to achieve less costly energy transition.

Propofol sedation has been applied during esophagogastroduodenoscopy procedures, but whether topical pharyngeal anesthesia should be administered at the same time has rarely been reported. Our study examined the role of topical pharyngeal anesthesia in sedated endoscopies in a randomized controlled double-blinded clinical trial. A total of 626 patients who underwent sedated esophagogastroduodenoscopy were randomized into the experimental group (n = 313) or the control group (n = 313). The discomfort score, immediately and one day after the procedure, was not statistically significant [7.2 (5–9) vs. 7.5 (6–9), P = 0.210; 2.3 (0–3) vs. 2.6 (0–4), P = 0.095, respectively]. Two patients in the experimental group and three patients in the control group needed oral medication for pharyngeal discomfort (P = 0.354). The satisfaction score was 9.2 (8–10) in the experimental group and 8.9 (7–10) in the control group (P = 0.778). Lidocaine topical pharyngeal anesthesia in propofol-sedated esophagogastroduodenoscopy did not further reduce the pharyngeal discomfort or improve the satisfaction. This clinical trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT03070379).

Environmental problems are usually framed by a repertoire of arguments articulated by a network of individuals (scientists and policymakers) and their affiliated institutions. Given the complexity of this network, it is important to conduct network analyses on both individual and organizational levels to achieve a better understanding of the underlying political structure that influences science-policy communication. Through an empirical study of a policy network related to grassland management in China, our study examines the underlying political structure of the network as well as its political impact on the problem-framing processes. The analysis reveals that political polarization and power imbalances in the network, the product of existing institutional arrangements, have confined the framing of environmental problems to specific areas and impeded the development of comprehensive policies.