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Improving diabetes self-management (DSM) is facing real-world challenges among people with type 2 diabetes mellitus (T2DM) who have a low education level in resource-limited areas. This study aimed to investigate whether diabetes knowledge could predict glycemic levels in people with T2DM in rural China. This analytical cross-sectional study recruited 321 people with T2DM from eight villages by purposive sampling at baseline. After 10 months, 206 patients completed the follow-up survey and HbA1c tests, with a response rate of 64.17% (206/321). Multiple regression analysis was employed to explore the correlation between diabetes knowledge and HbA1c levels. The patient's diabetes knowledge was significantly negatively correlated with HbA1c levels before and after controlling for covariates in both hierarchical multiple regression and multiple logistic regression (p < 0.01). In addition, other influencing factors, including sex, age, marital status, employment status, income, and HbA1c levels at baseline, were also identified. Diabetes knowledge could predict HbA1c levels significantly among patients with low education levels in rural China. Therefore, interventions on improving diabetes knowledge need to be strengthened for patients in rural China so that they can improve their health outcomes and reduce the disease burden. [ABSTRACT FROM AUTHOR]

Peroxy radicals (RO2* = HO2 + RO2) play key roles in forming secondary air pollutants such as ozone, yet model underprediction of RO2* is a challenging radical closure problem. In this study, RO2* were measured by a dual‐channel peroxy radical chemical amplification system during an ozone episode in October 2018 at an urban site in the Pearl River Delta region, China. The box model based on the Master Chemical Mechanism severely underpredicted RO2* levels, particularly at night and under high nitric oxide (NO) conditions. The observed‐to‐modeled ratio of RO2* increased from ∼3 under 1 ppbv NO to ∼46 under >10 ppbv NO with a missing RO2* source up to 5.8 ppbv hr−1. Observation data were used to constrain model predictions, and the results reveal that constraining nitrous acid (HONO) or glyoxal/methylglyoxal could not improve predictions, while constraining nitrate radicals (NO3) or other oxygenated volatile organic compounds (OVOCs), particularly phenolic compounds and improvements in their gas‐phase mechanisms, could more effectively increase model‐simulated RO2* concentrations. When OVOCs, NO3, and HONO were constrained, the simulated RO2* concentrations increased to the greatest extent with an observed‐to‐modeled RO2* ratio of 1.9 during the day and 1.3 at night, mainly due to the interaction between OVOCs and NO3 radicals. As the underestimated NO3 levels and the unmeasured reactive organic gases, as well as their unknown oxidation mechanisms, are among the major reasons for the underestimation of RO2*, upgraded atmospheric chemistry involving more OVOC species and more accurate NO3 would improve model‐simulated RO2* concentrations, especially during nighttime. Plain Language Summary: Peroxy radicals (RO2* = HO2 + RO2), including hydroperoxy radicals (HO2) and organic peroxy radicals (RO2), are mainly formed by atmospheric oxidative degradation of trace gases, such as formaldehyde, carbon monoxide (CO) and volatile organic compounds (VOCs). They are important intermediates for the tropospheric forming secondary air pollutants, yet model underprediction of RO2* is a challenging radical closure problem. Here, we conducted a field campaign during an ozone episode in October 2018 at an urban site in the Pearl River Delta region and revealed that RO2* concentrations simulated by the AtChem2‐MCM were much lower than those observed, particularly at nighttime and under high nitric oxide conditions. We found that using the observations of oxygenated volatile organic compounds (OVOCs) and nitrate radicals to constrain the model could more effectively reduce the gap between the simulated and observed RO2* radicals. Our results highlight that, more attention should be given to OVOCs that have not been measured or whose oxidation mechanisms are not well understood, but can be photolyzed or oxidized to form RO2*, such as phenolic compounds, for the in‐depth understanding of tropospheric RO2* chemistry. Key Points: Peroxy radical levels were severely underpredicted by the MCM model, especially at night and under high‐NO conditionsIncorporating an extra HONO source could slightly improve model's prediction of peroxy radical levelsConstraining both oxygenated volatile organic compounds and nitrate radicals can minimize the gap between modeled and measured peroxy radical levels [ABSTRACT FROM AUTHOR]

Baiyangdian Lake is a typical and largest multi-habitat lake in the North plain of China. To understand the generation and transmission of antibiotics resistance genes (ARGs) in multi-habitat lakes, the contents of nutrients (TC, TOC, TN, TP and TS), heavy metals (Zn, Cr, Ni, Cu, Pb, As, Cd and Hg), 22 antibiotics, 16S-rRNA(16S), Class I integron (intI1) and 20 ARGs were determined. Samples were taken from the Fuhe river, river estuaries, reed marshes, living area, fish ponds and open water of Baiyangdian Lake. The results showed that quinolones were the main pollutants in six habitats, and the content range was ND-104.94 ng/g. Thereinto, aac (6') -IB, blaTEM-1, ermF, qnrA, qnrD, tetG, sul1, sul2 and tetM were detected in all the analyzed samples. The absolute abundance of sul1 was the highest (5.25 × 105 copies/g-6.21 × 107 copies/g) in most of the samples. In these different habitats, the abundance of antibiotics and ARGs in river estuary was the highest, and that in reed marshes was the lowest. There was a significant positive correlation between the abundance of heavy metals (Cu, Pb, Zn, Ni, Cd, Hg) and the absolute abundance of 11 ARGs (P < 0.01). Redundancy analysis showed that Cu, Zn, intI1, TP and macrolides were the important factors affecting the distribution of ARGs. Our finding provides a more likely driving and influencing factor for the transmission of ARGs in lakes with complex and diverse habitats. [ABSTRACT FROM AUTHOR]

Ground surface ozone (O3) is an emerging concern in China due to its complex formation process. In August 2020, field measurements of O3, NOx, and volatile organic compounds (VOCs) were carried out in Hefei's western suburbs. The pollution features of VOCs and O3 formation were thoroughly analyzed. The total VOC concentration was 42.26 ppb, with the dominant contributor being oxygenated VOCs (OVOCs). Seven emission sources were recognized using the positive matrix factorization (PMF) model, including aged air masses, combustion sources, fuel evaporation, industrial emissions, vehicular emission, solvent utilization, and biogenic emission. Ozone generation mainly occurred under an NOx-limited regime based on the zero-dimensional box model analysis. According to the scenario analysis, the 13% cut in O3 might be achieved by the 10% and 30% reduction in NOx and VOCs, respectively. The O3 budget analysis demonstrates its high ozone production rate during the pollution period. The influence of regional transport cannot be ignored for high O3 pollution. This paper provides scientific evidence for O3 production and the strategies of reducing O3 by controlling its precursors. [ABSTRACT FROM AUTHOR]

Background: The incidence of stroke is a challenge in China, as stroke imposes a heavy burden on families, national health services, social services, and the economy. The length of hospital stay (LOS) is an essential indicator of utilization of medical services and is usually used to assess the efficiency of hospital management and patient quality of care. This study established a prediction model based on a machine learning algorithm to predict ischemic stroke patients' LOS. Methods: A total of 18,195 ischemic stroke patients' electronic medical records and 28 attributes were extracted from electronic medical records in a large comprehensive hospital in China. The prediction of LOS was regarded as a multi classification problem, and LOS was divided into three categories: 1–7 days, 8–14 days and more than 14 days. After preprocessing the data and feature selection, the XGBoost algorithm was used to build a machine learning model. Ten fold cross-validation was used for model validation. The accuracy (ACC), recall rate (RE) and F1 measure were used to evaluate the performance of the prediction model of LOS of ischemic stroke patients. Finally, the XGBoost algorithm was used to identify and remove irrelevant features by ranking all attributes based on feature importance. Results: Compared with the naive Bayesian algorithm, logistic region algorithm, decision tree classifier algorithm and ADaBoost classifier algorithm, the XGBoot algorithm has higher ACC, RE and F1 measure. The average ACC, RE and F1 measure were 0.89, 0.89 and 0.89 under the 10-fold cross-validation. According to the analysis of the importance of features, the LOS of ischemic stroke patients was affected by demographic characteristics, past medical history, admission examination features, and operation characteristics. Finally, the features in terms of hemiplegia aphasia, MRS, NIHSS, TIA, Operation or not, coma index etc. were found to be the top features in importance in predicting the LOS of ischemic stroke patients. Conclusions: The XGBoost algorithm was an appropriate machine learning method for predicting the LOS of patients with ischemic stroke. Based on the prediction model, an intelligent medical management prediction system could be developed to predict the LOS based on ischemic stroke patients' electronic medical records. [ABSTRACT FROM AUTHOR]

Illustrating three instances he encountered here in the United States, the Chinese counselor argues that American counseling is deeply rooted in rugged individualism, and often at the expense of the family and community. The suitability of American counseling for other cultures is thus questioned. (Author/NB)

• The sustainability of sludge treatment and disposal routes in different regions of China were evaluated. • Co-incineration and thermal hydrolysis-anaerobic digestion were preferred sludge treatment processes in China. • A framework integrates carbon emissions, economic cost and environmental risk to assess sustainability was created. • Technical selection was proposed based on sludge characteristics and economic/environmental level for each region. • Developing high-value resource utilization technologies for sludge will be the core of future sludge treatment. In various regions of China, the sludge characteristics, available sludge treatment and disposal routes, and economic and environmental concerns exhibit significant variations. This makes it challenging for regions to select appropriate technologies for sustainable sludge management. This study proposed a universal framework that integrates carbon emissions, economic cost, and environmental risk potential to assess sustainability of diverse sludge treatment and disposal routes in different regions of China. An up-to-date database of sludge characteristics in different regions of China has also been created. Depending on sludge characteristics, co-incineration in coal-fired plants or cement kilns and thermal hydrolysis-anaerobic digestion routes demonstrate outstanding sustainability for most regions in China. Moreover, the current carbon trading price in China is low and does not significantly influence the technical selection. The created sludge characteristics database and the sustainability assessment framework could help sludge managers make better in process selection, technological improvement, and future policy formulation. [Display omitted] [ABSTRACT FROM AUTHOR]

Baiyangdian Lake (BYD), a large shallow lake in North China, has complex water landscape patterns that are underlies spatial variations in water quality. In this study, we collected 61 water samples from three water landscapes (reed littoral zones, fish ponds, and open water) and analyzed them for water quality parameters, such as dissolved organic carbon (DOC), total nitrogen (TN), and total phosphorus (TP). Water landscape distribution (determined using remote sensing imagery) was then used to assess correlations between water quality parameters and water landscape proportion in differently scaled buffer zones. There was substantial variation across all subareas, with TN and TP concentrations ranging from 0.90 to 4.10 mg/L and 0.06 to 0.18 mg/L, respectively, in class IV of water quality as a whole. Spatial variations in water quality were mainly caused by water landscape distribution and external nutrient inputs. There were negative correlations between DOC, TN, and TP concentrations and the area proportion of reed littoral zones in the 300 and 500 m buffers. In contrast, DOC, TN, and TP concentrations were significantly positively correlated with the area proportion of fish ponds in the 100 m buffer. Furthermore, compared with reed littoral zones, a lower ratio of nitrogen to phosphorus and a higher proportion of dissolved organic nitrogen and tyrosine-like proteins were found in fish ponds. These effects were mainly attributed to the development of internal sediment loadings due to nutrient exchange across the sediment–water interface. Therefore, dredging-based sediment removal from fish ponds should be considered to suppress internal phosphorus loading and accelerate recovery of the BYD ecosystem. [ABSTRACT FROM AUTHOR]

Purpose: Baiyangdian Lake is located in the core of Xiongan New Area and is the largest freshwater lake in the North China Plain with a variety of habitats. Microorganisms are important drivers of material cycle and energy transport in freshwater ecosystems. To understand the biogeochemical circulations in Baiyangdian Lake, the bacterial community structures and influencing factors of surface sediments among the different habitats were investigated. Materials and methods: Samples were taken from five areas of Baiyangdian Lake. The concentration of nutrient elements and bacterial community structures was measured. Results and discussion: The bacterial community structures of different habitats were different and were influenced by the nutrients in surface sediment. Open water areas had the richest abundance of ecological functions, such as phototrophy, sulfur oxidation, sulfite respiration, nitrification, and nitrite respiration. The bacterial community structures among the different habitats were decided by different elements in sediment; sulfur was the key influencing factor of the bacterial community structure in open water; C/N ratio was the key influencing factor of reed marshes; nitrogen and organic carbon were the key influencing factors of river estuary habitat. Conclusions: The bacterial community structures and ecological functions of surface sediments among habitats were different, and the dominant bacteria played an important role in biogeochemical circulations, especially in the carbon and sulfur cycles of Baiyangdian Lake. [ABSTRACT FROM AUTHOR]

Purpose: Subsoil has great potential for increasing soil organic carbon (SOC) stock. Soil compaction decreases the content of SOC in the topsoil layer and leads to the formation of a plow pan in subsoil. However, measures for improving poor soil structure mainly concentrate on topsoil. This study aims to understand the effect of subsoiling management practices on soil aggregation and accumulation of SOC in both topsoil (0–20 cm) and subsoil (20–35 cm). Materials and methods: A field experiment was carried out in a Mollisol in northeastern China. The treatments included conventional tillage (CT), subsoiling tillage (ST), and subsoiling with residue incorporation tillage (SST). Results and discussion: The results showed that in comparison to CT, ST and SST not only had lower subsoil bulk densities (reduced by 9.42% and 13.61%, respectively) but also promoted the formation of macroaggregates (> 250 μm) in both soil layers; thus, soil structure stability increased. In the topsoil layer, the content of the > 53 μm aggregate-associated carbon (C) under ST and SST was greater than that under CT. In the subsoil layer, compared with CT, SST increased the organic C content (increased by 0.73–12.32%) in all the aggregate classes, but ST decreased the content of the < 2000 μm aggregate-associated C (6.09–18.96%) on day 150. The soil structure stability decreased by 13.06% and 22.21% under ST and SST after day 150, respectively, which was probably due to the clayey characteristics of the subsoil. Conclusions: We concluded that subsoiling would only improve the soil structure while increasing the loss of organic C. However, the effect of subsoiling on structure improvement was enhanced by residue incorporation, not only promoting soil aggregation but also increasing SOC accumulation. [ABSTRACT FROM AUTHOR]

Controlled laboratory combustion experiments were conducted in the fire test room to mimic freshly emitted smoldering smoke of biomass burning in China. The biomass components were determined by ultimate analysis and proximate analysis before experiments. The particle number size distribution (PNSD) between 5 and 1000 nm of smoke was measured by a high sampling frequency size spectrometer. A cavity-enhanced aerosol albedometer with wavelength of 532 nm was used to measure scattering coefficients, extinction coefficients, and single scattering albedo (SSA) of smoldering smoke. The PNSDs of smoldering smoke from the burning of agricultural straw could be fitted with a bimodal lognormal distribution as modes around 10 nm (nucleation mode) and 60 nm (Aitken mode). The PNSDs of wood sawdust could be fitted with a trimodal lognormal distribution, while the two modes were in nucleation mode, and one was in Aitken mode. The bulk optical properties (scattering and extinction coefficients) of smoldering smoke had strong correlations with particle number concentrations of sizes bigger than 100 nm. The correlation between SSA and fixed carbon (FC) was strong (the correlation coefficient is 0.89), while the correlation between SSA and volatile matter (VM) or ash was weak. The relationship between SSA and N (or S) showed a positive correlation, while that of SSA and C showed a negative correlation. The relationship between SSA and VM/FC (or N) showed a strong linear relationship (r2 > 0.8). This paper could improve understanding of the relationship between the optical and particle size distribution properties of smoke from biomass burning and the components of biomass materials under similar combustion conditions. [ABSTRACT FROM AUTHOR]

Malodor is becoming the main secondary pollution in the municipal sewage sludge-composting process. Ammonia and volatile sulfide compounds (VSCs) are the representative odorants that generated and emitted during the composting process. The emission characteristics of ammonia and VSCs were studied at different workshops in a full-scale municipal sludge-composting plant in North People's Republic of China. Results show that ammonia was the most dominant odorant of all the workshops and relative high concentrations of VSCs were detected at sludge stacking yard and composting workshop. The odor pattern of VSCs at the composting workshop and stacking yard were different. The odor pollution occurred mainly in the first 15 days of the composting process, in which the odor contribution of ammonia increased with time and the VSCs contributed largely in the first 5 days. The cumulative release concentration of VSCs from compost materials was in the order of DMDS (dimethyl disulfide) > DMS (dimethyl sulfide) > CS2 > MT (methyl mercaptan), and the total VSCs release concentration was in the range of 50–3200 μg·m−3. The production of ammonia correlated to the temperature and nitrogen content and state changes, however, the production of VSCs was more complicated due to the reaction and transformation of VSCs. Optimization of aerobic composting conditions and process parameters should be further studied to reduce the emission of odor gas from compost. Implications: Along with the widespread use of sludge aerobic composting in People's Republic of China, the malodor pollution during the composting treatment is becoming a serious environmental issue. The odor pollution occurred mainly in the first 15 days, and ammonia was the main odorant of all the workshops and need to be controlled. Relative high concentrations of VSCs were detected at sludge stacking yard and composting workshop, however, the odor impact of VSCs were different. The generation of VSCs is more complicated than ammonia due to the reaction and transformation of VSCs. [ABSTRACT FROM AUTHOR]

Background: Effective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years.Methods: 4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses.Results: The mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77.Limitations: A clinical interview was not used to validated diagnostic findings.Conclusions: The reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results. [ABSTRACT FROM AUTHOR]

Background: Existing studies in developed countries show that social participation has beneficial effects on the functional ability of older adults, but research on Chinese older people is limited. This study examined the effects of participating in different types of social activities on the onset of functional disability and the underlying behavioral and psychosocial mechanisms among older adults aged 65 and older in China.Methods: The 2005, 2008, and 2011 waves of the Chinese Longitudinal Health Longevity Study were used. Life table analysis and discrete time hazard models were adopted to examine the relationship between social participation and functional disability. Social participation was defined as the frequencies of engaging in group leisure-time activities (i.e., playing cards/mahjong) and organized social activities, involving in informal social interactions (i.e., number of siblings frequently visited), and participating in paid jobs. Extensive social participation was measured by a composite index by adding up the four types of social activities that an older person was engaged in.Results: After controlling for the effect of socio-demographic characteristics, health status, and health behavioral factors, extensive social participation is associated with a significant reduced risk for the onset of functional disability (hazard ratio [HR] = 0.92, p < 0.001). Different types of social participation affect the risk of functional decline through different mechanisms. Frequent playing of cards/mahjong is a protective factor for functional decline (HR = 0.78, p < 0.001), and the relationship is partially mediated by cognitive ability and positive emotions (accounting for 18.9% and 7.0% of the association, respectively). Frequent participation in organized social activities is significantly related to a reduced risk of functional decline (HR = 0.78, p < 0.001), and the association is mediated by physical exercises and cognitive ability (accounting for 25.7% and 17.7% of the association, respectively). Frequent visits from siblings has a strong inverse relationship with functional decline (HR = 0.75, p < 0.001). However, no significant association between paid job and functional decline is observed.Conclusion: Extensive social participation, regular engagement in group leisure-time activities, organized social activities, and informal social interactions in particular may have beneficial effects on the functional health of older adults through behavioral and psychosocial pathways. The findings shed light for the importance of promoting social participation among older adults. [ABSTRACT FROM AUTHOR]

• Subsoiling managements improved soil microstructure in the whole soil profile. • Subsoiling with straw favored microbial growth and SOC sequestration in the whole soil profile. • Bacteria and macropore porosity mainly drive the variation in topsoil C within aggregates. • Bacteria and micropore porosity mainly drive the variation in subsoil C within aggregates. • Microbe contributed more to regulate SOC than soil microstructure did. Soil organic carbon (SOC) accumulation is easily susceptible to tillage managements, which strongly affect soil structure and microbial community structure. Subsoiling is developed for mitigating soil compaction and thus improving soil structure. Coupled with straw residue incorporation, it is expected not only to enhance this improvement but also to promote organic carbon (C) storage in soil. However, how subsoiling tillage managements change soil aggregate microstructure, microbial community structure and SOC fractions, and how soil aggregate microstructure and microbial community structure affect SOC in the topsoil and subsoil layers are equally unknown. An in-situ incubation field experiment was conducted in a Mollisol in northeastern China and included conventional tillage (CT), subsoiling tillage (ST) and subsoiling tillage with straw residue incorporation (ST + S). The methods of synchrotron-based X-ray micro-computed tomography scanning, phospholipid fatty acid and SOC density fractionation were used to analyze aggregate pore characteristics, microbial community structure and SOC fractions, respectively. The results showed that both ST and especially ST + S not only improved soil aggregate microstructure but also enhanced microbial biomass and then favored SOC accrual in the topsoil (0–20 cm). In the subsoil (20–35 cm), ST + S exerted similar positive effects as those in the topsoil. However, ST only improved soil aggregate microstructure but decreased microbial community biomass and SOC in the subsoil. Moreover, soil aggregate structure characteristics explained (solely explained 6 % in the topsoil and 12 % in the subsoil, respectively) a smaller part of the variation in SOC within aggregates than soil microbial characteristics did (solely explained 15 % in the topsoil and 25 % in the subsoil, respectively). Specifically, bacteria explained 26 % and 66 % of the variation in SOC within aggregates in the topsoil and subsoil, respectively. The porosity of macropores (>100 μm) also explained 25 % of the variation in SOC within aggregates in the topsoil, whereas the porosity of micropores (<30 μm) explained more variation (12 %) than that of macropores (3 %) in the subsoil. Notably, the substantially different interaction mechanism-processed of pore characteristics, microbial structure and SOC between topsoil and subsoil was probably traceable for the variation in the influx of organic C, pore size distribution and microbial adaptability in soil layers. These results would provide new insights on tillage managements strategies for improving soil conditions in terms of optimizing soil aggregate microstructure–microbes–SOC interactions in the topsoil and subsoil layers. [ABSTRACT FROM AUTHOR]

Background: Suicide is an urgent public health challenge for China. This study aims to examine the prevalence, influence factors, and gender differences of suicidal ideation among general population in Northwestern Urban China.Methods: Data used in this study were derived from the third wave of a cohort study of a randomized community sample with 4291 participants (≥ 20 years) in 2008 in Lanzhou City and Baiyin City, Gansu Province. Data were collected via face-to-face interview by the trained interviewers. Descriptive analyses, chi-square tests and multivariate logistic regressions were performed by using Stata 12.0, as needed.Results: The prevalence of 12-month suicidal ideation was 4.29%, there was no significant difference between males and females [5.04% vs 3.62%, Adjusted Odds Ratio (AOR) = 0.83, p = 0.351]. Several risk factors for suicidal ideation were confirmed, including being unmarried (AOR = 1.55, p = 0.030), having depression symptoms (AOR = 2.33, p < 0.001), having other insurance (AOR = 1.83, p = 0.01) or no insurance (AOR = 1.73, p = 0.024). In addition, several influence factors were significantly different in males and females, such as being currently married (unmarried vs married, AOR = 1.84, p = 0.027, for females; no difference for males), feeling hopeless (hopless vs hopeful, AOR = 1.92, p = 0.06, for females; no difference for males), having other insurances (having other insurances vs having basic employee medical insurance, AOR = 1.92, p = 0.044, for males; no difference for females), having debts (having debts vs no debts, AOR = 2.69, p = 0.001, for males; no difference for females), currently smoking (smoking vs nonsmoking, AOR = 3.01, p = 0.019 for females, no difference for males), and currently drinking (drinking vs nondrinking, AOR =2.01, p = 0.022, for males; no difference for females).Discussion and Conclusion: These findings suggested that comprehensive suicide prevention strategies should be developed or strengthened in order to prevent suicide ideation in China, and the gender-specific differences need to be explored through further researches. [ABSTRACT FROM AUTHOR]

Aim. This study identifies existing definitions and approaches among China’s integrative medicine (IM) experts and examines relationships with key characteristics distinguishing individual experts. Methods. Snowball sampling was used to select 73 IM experts for semistructured interviews. In this mixed methods study, we first identified definitions and approaches through analyzing core statements. Four key factors, including age, education, practice type, and working environment, were then chosen to evaluate the associations with the definitions. Results. Four unique definitions were identified, including IM as a “new medicine” (D1), as a combination of western medicine (WM) and Chinese medicine (CM) (D2), as a modernization of CM (D3), and as a westernization of CM (D4). D4 was mostly supported by those working in WM organizations, while D3 was more prominent from individuals working in CM organizations (P=0.00004). More than 64% clinicians had D2 while only 1 (5.9%) nonclinician had D2. Only 1 clinician (1.8%) had D4 while almost 30% nonclinicians had D4 (P=0.0001). Among nonclinicians working in WM organizations, 83.3% of them had D4 (P=0.001). Conclusion. Findings indicate that institutional structure and practice type are factors affecting IM approaches. These results carry implications for the ways in which western countries move forward with the definition and implementation of IM. [ABSTRACT FROM AUTHOR]

Background: With the rapid development of economy, depression disorder is not only a public health issue but also a socioeconomic problem and attracting more and more attention in China. Aims: The target of this study is to examine the prevalence of depression and the related risk factors in the Dibao population in northwestern China. Method: A cross-sectional analysis in a random sample survey conducted in three northwestern Chinese cities in 2007. The data from 4459 respondents with completed Center for Epidemiological Studies–Depression (CES-D) scales were evaluated to explore the key risk factors for depression. Using depression as a binary variable according to the cutoff of the CES-D score and then as a continuous variable, multiple logistic and line regression analysis were performed to compare the odds ratio and the weight of different risk factors for depression. Results: The prevalence of depression in non-Dibao population was 34.7% but that in the Dibao population was 50.0% (p < .001). After adjusting for important confounders, Dibao population had an odds ratio (OR) of 1.38 (95% confidence interval (CI): 1.16-1.63) to have possible depression compared to those non-Dibao people. Furthermore, depression was associated with a higher OR of indebtedness (OR: 1.59, 95% CI: 1.31-1.93), and a small amount of debt would increase the possibility of depression for Dibao people (OR: 1.69, 95% CI: 1.28-2.23). In addition, gender, body mass index (BMI), tobacco use and social network were also important risk factors for depression in the Dibao population. Using depression as a continuous variable, being a member of the Dibao population and being indebted will add 2.06 and 1.83 to the CES-D score, respectively, compared with the non-Dibao population and not being indebted. A comparison of the odds ratios of depression between the Dibao and the non-Dibao population showed that factors such as gender, BMI, tobacco use, social network and indebtedness were statistically significant in the Dibao population but were not statistically significant in the non-Dibao population. Additionally, having a savings account was statistically significant in the non-Dibao population but not in the Dibao population. Conclusions: It was not surprising, as proved by other studies, that gender, obesity and social network were risk factors associated with depression in the Dibao population. Our findings indicated that a small amount of indebtedness was also closely related to depression in the Dibao population. [ABSTRACT FROM AUTHOR]

The article discusses a study regarding the characteristics of the help-seeking behaviors and pathways of people with physical and mental illness from rural regions of China. Topics discussed include documentation of 203 patients with mental disorders using the World Health Organization (WHO)'s pathway encounter form, the use of Mann-Whitney U test, and lack of awareness about treatment services with mental disorders.

(NH)SO, CaCl, NaSiO and NaNO were selected as surrogates of inorganic seed aerosols of ambient atmosphere of Chinese urban areas, respectively, to study their effects on the formation of secondary organic aerosol (SOA) in the toluene/CHONO/NO photooxidation system. The SMPS and aerosol laser time-of-flight mass spectrometer (ALTOFMS) was used to measure the aerodynamic size and chemical composition of individual SOA particles in real-time. Experimental results indicate that either the growth or products of SOA is affected by the presence of inorganic seed aerosol. Inorganic seed aerosols would promote growth rates of SOA formation at the start of the reaction and inhibits its formation rate with prolonging the reaction time. In the case of about 100 μg m seed aerosol load, the addition of NaSiO induced a same growth rate of SOA formation as NaNO. The influence of four individual seed aerosols on the generation of SOA decreased in the order of CaCl > (NH)SO > NaNO, NaSiO. The presence of NaSiO or NaNO has no obvious effect on the growth rates of SOA formation, but it does increase the yield of organic acid and nitrogen-containing organic compounds, respectively. Besides the significantly effect on the growth rate of SOA formation, the presence of CaCl or (NH)SO can lead to the formation of high-molecular weight species which is found to be positively correlated with the hygroscopic behavior of seed aerosols. The CaCl shows the strongest hygroscopic behavior among the four individual seed aerosols, and the most significant promotion effect on the formation of the high-molecular weight species. It is proposed that the SOA generation enhancement and high-molecular weight products are achieved by particle-phase heterogeneous reactions induced and catalyzed by the acidity of CaCl and (NH)SO seed aerosols. [ABSTRACT FROM AUTHOR]

Background: The village doctors have served rural residents for many decades in China, and their role in rural health system has been highly praised in the world; unfortunately, less attention has been paid to the health workforce during the ambitious healthcare reform in recent years. Therefore, we conducted a longitudinal study to explore the current situation and track the future evolution of the rural healthcare workforce.Methods: The self-administered structured Village Clinic Questionnaire and Village Doctor Questionnaire, which were modified from the official questionnaires of the Ministry of Health, were constructed after three focus groups, in-depth interviews in Hebei Province, and a pilot survey in Sichuan Province. Using a stratified multistage cluster sampling process, we gathered baseline data for a longitudinal survey of village doctors, village clinics from Changshu County, Liyang County, Yongchuan District, Mianzhu County, and Jingning County in China in 2011. Well-trained interviewers and strict procedures were employed to ensure the quality of this survey. Descriptive and correlation analyses were performed with Stata 12.0.Results: After four months of surveying, 1,982 Village Doctor Questionnaires were collected, and the response rate was 88.1%. There were 1,507 (76.0%) male and 475 (24.0%) female doctors, with an average age of 51.3 years. The majority of village doctors (58.5%) practiced both western medicine and Traditional Chinese Medicine, and 91.2% of the doctors received their education below college level. Their practice methods were not correlated with education level (P = 0.43), but closely related to the way they obtained their highest degree (that is, prior to starting work or as on-the-job training) (P < 0.01). The mean income of the village doctors was 1,817 (95% CI 1,733 to 1,900) RMB per month in 2011; only 757 (41.3%) doctors had pensions, and the self-reported expected pension was 1,965 RMB per month.Conclusions: Village doctors in rural China are facing critical challenges, including aging, gender imbalance, low education, and a lack of social protection. This study may be beneficial for making better policies for the development of the health workforce and China's healthcare reform. [ABSTRACT FROM AUTHOR]

Background: Trust is regarded as the cornerstone of the doctor-patient relationship in the world of medicine; it determines the decisions patients make when choosing doctors and influences patients' compliance with recommended treatments. In China, patient-doctor trust acts as a thermometer measuring harmony in the doctor-patient relationship. The objective of this study is to explore the relationship between the contract service and patient-doctor trust-building in 25 village clinics of rural China.Method: The research was carried out in village clinics in rural China. A simple random sampling method was used to choose clinics and subjects. Based on feasibility and financial support, we chose three counties as our study settings: Dafeng District, Jiangsu Province; Yinan County, Shandong Province; and Wufeng Tujia Autonomous County, Hubei Province. Twenty-five village clinics and 574 subjects were selected in the three areas from the contract service and patient list. Descriptive statistics, t-tests, MANOVA, SEM, and multiple regression statistical analysis were employed to analyze the data.Result: Statistical analysis showed that contract service directly and indirectly influenced patient-doctor trust-building in village clinics. The patient perception of doctor communication skills was a mediator in the relationship between contract service policy and patient-doctor trust-building.Conclusions: Building patient-doctor trust is important in developing and enhancing rural health. The policy of contract service plays a significant role in building relationships. Well-developed communication skills of doctors contribute to the implementation of the contract service policy and to establishing patient-doctor trust. [ABSTRACT FROM AUTHOR]

The subsoiling tillage managements have been recommended to remediate subsoil compaction and maintain crop production. These practices can improve soil properties and fertility due to soil loosening and straw incorporation, and further affect soil microbial community characteristics. However, the response of soil microbial community structure to subsoiling tillage managements is still poorly understood. The objective of this study was to examine the effects of tillage practices (conventional tillage, CT; subsoiling tillage, ST; subsoiling tillage with straw incorporation, STS) on soil microbial community characteristics. Topsoil (0–20 cm) and subsoil (20–35 cm) samples were taken from a 360–day in−situ field experiment in northeast China. Microbial community characteristics were determined by the phospholipid fatty acid (PLFA) method. The contents of subsoil bacterial PLFAs and fungal PLFAs were lower in the ST treatment than those in the other treatments within 60–360 days, and gram−positive (G+) bacteria were more abundant in the subsoil of ST treatment than those in the subsoil of STS treatment. In contrast to the other treatments, the STS treatment had the larger total PLFAs content and the higher ratio of fungal to bacterial PLFAs (F/B) in the subsoil during the whole incubation period, and fungi played a dominant role in straw degradation of subsoil. Compared with the other treatments, the STS treatment had a lower cyclopropyl to precursors (cy/pre) ratio in the subsoil on the 30th day, suggesting that the STS treatment provided more K 2 SO 4 −extractable organic carbon (EOC) and some available nutrients (nitrogen, potassium and phosphorous) for soil microbes. The STS treatment relative to the other treatments increased the bacterial PLFAs and fungal PLFAs contents in the topsoil, which were associated with the increase in the EOC/SOC ratio. Accordingly, STS practice had a great potential for improving subsoil and topsoil microbial community characteristics. • Subsoiling tillage with straw incorporation (STS) improved subsoil and topsoil microbial community characteristics. • Fungi were enriched in the subsoil and topsoil of STS. • Gram−positive bacteria were more abundant in the subsoil of subsoiling tillage. • Subsoil and topsoil microbial community composition were mainly controlled by the EOC/SOC ratio. [ABSTRACT FROM AUTHOR]

To investigate the association between diabetes knowledge and diabetes self-management (DSM) behaviors and to explore the influence mechanism between them among patients with type 2 diabetes mellitus (T2DM) based on health belief model in rural China. This cross-sectional study included 483 participants with T2DM from 8 villages of 3 townships in Jiangsu Province. All participants completed a structured questionnaire, including demographic information, diabetes knowledge, DSM behaviors, health beliefs, and cognitive function. Multiple linear regression and mediation analysis were performed to analyze the association between diabetes knowledge and DSM behaviors, furthermore the mechanism between them. Diabetes knowledge and self-efficacy positively influenced DSM behaviors. Health beliefs multiply mediated the association between diabetes knowledge and DSM behaviors. Perceived behavioral barriers mediated the relationship between diabetes knowledge and DSM behaviors, where a suppression effect existed. A chain-mediated effect was found: diabetes knowledge affected perceived benefits, followed by self-efficacy, and finally DSM behaviors. Diabetes knowledge acquisition played an important role in improving DSM behaviors, and health beliefs multiply mediated the relationship between them. When designing interventions, health systems and health providers should refocus on diabetes knowledge, emphasize the benefits of self-management, and consider the barriers that patients may encounter. • The more patients know about diabetes, the more benefits they feel of self-care. • The more benefits patients have of self-care, the more confident they are to do it. • The more confident patients are in self-care, the more likely they are to do it. • The more patients know about diabetes, the more barriers they have to self-care. • The more barriers patients feel of self-care, the less likely they are to do it. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Fulvic-like, humic-like acids, C C, and unsaturated aldehyde ketone were fund in dEOM. • Aromatic protein and amidogen were fund in the supernatant liquor and dEOM solution. • Stationary phase achieved the highest particle size and more compact and rough flocs. • Microcystin concentration increased after microalgal cells coagulating treatment. • PAC 2.0 with 50 mg L−1 at the stationary growth phase is a good practical application. Abstract Harmful algal blooms have become critical threats to human health as they have occurred with increasing frequency and intensity in various water bodies. In the People's Republic of China, thousands of people are exposed to water bodies heavily contaminated with microalga Microcystis aeruginosa and thus at grave risk of microcystin poisoning. This study investigated the characteristics of extracellular organic matters (EOMs), floc morphology, and microcystin in each microalgal growth phase for the treatment of microalgae-laden water. The characterization was performed under different alkalinities and dosage treatments of polyaluminum chloride (PAC). Results suggested fulvic-like and humic-like acids, C C, and unsaturated aldehyde ketones were present in the supernatant liquor and dissolved EOM (dEOM) solution under logarithmic and stationary phase treatments for EOM. However, the same components along with aromatic protein and amidogen were detected in the supernatant liquor and dEOM solution under the decline phase treatments. The EOM of the supernatant liquor and dEOM solution nearly resembled willmigerl, which was different from bound extracellular organic matter (bEOM) in the three growth phases. Nonetheless, the highest particle size and most compact and roughest flocs were observed in the stationary phase. Meanwhile, no significant difference (P > 0.05) was observed among the microcystin concentrations of microalgal cells before and after coagulation, although the concentrations increased after the coagulating treatment. Therefore, coagulation pH of 2.0 and 50 mg L−1 dose of PAC was a good practical application to treat microalgae laden water at the stationary growth phase. [ABSTRACT FROM AUTHOR]

[Display omitted] • Environmental impacts and benefits of twelve current sludge treatment and disposal routes in China are evaluated. • Co-incineration has the negative toxicity impacts and carbon emissions due to the offset of energy recovery. • Carbon emissions of co-incineration, anaerobic digestion, and anaerobic digestion with thermal hydrolysis are −27.26, −572.44, and −474.92 kg CO 2 eq/t DS, respectively. • Controlling heavy metals is the priority of digested sludge land application. The management and utilization of sludge in a sustainable approach require a systematic analysis of the environmental impacts generated from diverse sludge treatment and disposal processes. This study systematically assessed 12 common sludge treatment and disposal routes based on the existing operating and construction conditions of representative sludge disposal projects in China. We evaluated their environmental impacts using a life cycle assessment following the International Organization for Standardization (ISO 14040 and ISO 14044), and found that the routes of co-incineration, mono-incineration, and anaerobic digestion with or without thermal hydrolysis may be useful in terms of simultaneously controlling environmental pollution and carbon emissions in China. Therein, the route of co-incineration was recommended as the best one because its human toxicity potential (−152.31 kg dichlorobenzene (1,4-DB) eq/ton dry solid (t DS)), freshwater ecotoxicity potential (FEP, −127.40 kg 1,4-DB eq/t DS), terrestrial ecotoxicity potential (TEP, −0.81 kg 1,4-DB eq/t DS), and global warming potential (−27.26 kg CO 2 eq/t DS) were all negative (environmental benefits). Furthermore, the toxicity impacts of the mono-incineration route were also negative, but it still needed to further enhance energy recovery to reduce carbon emissions. Despite the routes of anaerobic digestion and thermal hydrolysis in combination with anaerobic digestion had the excellent negative carbon emission attributes (-572.44 kg CO 2 eq/t DS, −474.92 kg CO 2 eq/t DS), they showed serious FEP and TEP owing to the heavy metals pollution caused by subsequent land use of anaerobic digested sludge. Overall, this study selected the most suitable sludge treatment and disposal routes to simultaneously satisfy the requirements of carbon emission reduction and pollution control in China and proposed optimizing suggestions for future technical improvement and development. [ABSTRACT FROM AUTHOR]

In China, rapid and continuing infrastructure growth will significantly affect the feasibility of achieving CO 2 emission reduction targets. It is uncertain whether the current infrastructure designs are consistent with the national emission targets of China, consequently posing a threat to the national commitment to reaching carbon neutrality. To illustrate the gap in achieving the emission targets with respect to bridges, we present carbon intensity reduction targets relevant to bridges by 2040. By exploring three policy–economic scenarios that combine with CO 2 emission reduction policy scenarios of the International Energy Agency and shared socioeconomic pathways, we assess the adaptability of the bridge designs to short-, medium- and long-term carbon intensity targets. We propose a new sustainability design approach based on a bridge big data set that integrates reliability, environmental impacts, and cost. We show that, under the current policy–economic scenario, more than 50% of code-based bridges would meet the five-year CO 2 emission target, whereas only one in ten thousand could meet the ten-year target under the new policy–economic scenario. Under the sustainable development policy–economic scenario, none of the bridge designs would meet the carbon reduction targets over the next 20 years. Our findings highlight that the bridges in China need to be duly considered in setting CO 2 reduction targets, and in the national move toward zero carbon, careful consideration should be given to implementing our proposed bridge sustainability design. • Three policy–economic scenarios present reduction targets for bridges to 2040 are designed. • Assess the gap of achieving CO 2 emission reduction targets for China's bridges. • Reliability, environmental impact, cost integrated in sustainability bridge design for the first time. • New sustainability design approach based on a bridge big data set. [ABSTRACT FROM AUTHOR]

• We analyzed the data from 301 mother of preschool children from rural areas of Northwest China to examine the potential mediating role of maternal responsiveness in the relationship between maternal depression and childhood aggression. The results indicated the incidence rate of maternal depression was 39.5% in rural areas of Northwest China, which is relatively high compared with other regions. Moreover, maternal reactivity played a significant mediating role between maternal depression and childhood aggression. The purpose of this study was to examine the potential mediating role of maternal responsiveness in the relationship between maternal depression and childhood aggression in Rural areas of Northwest China. Specifically, we analyzed the data from 301 mother of preschool children from rural areas of Northwest China. The data included maternal depression symptoms, maternal responsiveness, and childhood aggression. Structural equation modeling and regression analysis were conducted. Child's age, child's gender, maternal education and other demographic variables served as control variables. The results indicated the incidence rate of maternal depression was 39.5% in rural areas of Northwest China, which is relatively high compared with other regions. Moreover, maternal reactivity played a significant mediating role between maternal depression and childhood aggression. The implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Biogenic volatile organic compounds (BVOCs) are believed to play a central role in determining atmospheric composition and the oxidizing capacity of the atmosphere. Many studies have found great discrepancy between measured and simulated OH concentration, total OH reactivity and also the production of ozone. In addition to the uncertainty in the understanding of VOCs emissions, the lack of systematic understanding on the reaction process of identified VOCs is also an important reason for this discrepancy. Thus, it is very important to thoroughly study their reaction process, including atmospheric degradation mechanism and kinetic information, for all the VOCs emitted into the atmosphere.As an important group of green leaf volatiles (GLVs), C6 hexenyl esters are found to be widely emitted into the atmosphere by plants and vegetation, especially when they suffer mechanical damage. Although reaction with OH may be the dominant degradation pathway for these esters in the atmosphere, reaction with O3 may also play an important role, especially in polluted areas.In this presentation, the rate constants for reactions of O3 with a series of cis-3-hexenyl esters have been measured using absolute method in a flow tube reactor at 298K and atmospheric pressure. Theoretical calculations were also carried out for the title reactions to better understand their kinetics and mechanism using density functional theory (DFT) and transition state theory (TST). Geometry optimizations, energy and the harmonic vibrational frequency calculations were performed for all of the stationary points at the BHandHLYP/6-311+G(d,p) level of theory. The calculated rate constants were in good agreement with the experimental values. The results showed that the reactivity of the studied compounds towards O3 was obviously dependent on their chemical structure, such as the nature of the substituent, and the relative positions of the double bond and the substituent. The results were also discussed in terms of their atmospheric importance in the degradation of these unsaturated esters by comparing their lifetimes with respect to their reactions with O3 and other main atmospheric oxidants.Acknowledgements. This work was supported by the National Natural Science Foundation of China (41575125, 21876177 and 91544228), and Opening Project of Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3, FDLAP18001). [ABSTRACT FROM AUTHOR]

Objectives: Whether the routine delivery of diabetes-related knowledge can change patients' attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China., Design: A cross-sectional study., Setting: Yuhuan City, Zhejiang Province, China., Participants: A total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below., Primary and Secondary Outcome Measures: A questionnaire based on existing scales and expert consultation was applied to assess patients' socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients' characteristics and KAP., Results: No significant association was found between patients' knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p<0.001; β=0.46, p=0.01). However, patients with a more positive attitude toward diabetic care showed worse foot care practice (β=-0.13, p=0.02), while better knowledge was associated with better foot care practice (β=0.29, p<0.001). In addition, patients with higher SI (β=0.88, p<0.001) and/or disease progression risk (β=0.42, p<0.001) tended to present higher levels of disease knowledge., Conclusions: While successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The Mollisol region of Northeast China has a large soil organic carbon (SOC) storage which is important for maintaining soil fertility. SOC is susceptible to various environmental factors; however, the responses of SOC content to environmental factors in different soil layers of cropland remain unclear, particularly in deep soil layers. In this study, we collected 138 soil samples from the surface, subsurface, and subsoil layers among 46 sample sites with monocropping maize and intensive conventional tillage in this region. We assessed the relative importance and effect paths of 12 environmental factors (including geography, climate, and soil properties) on SOC content in different layers using redundancy analysis (RDA), structural equation model (SEM), and variation partitioning analysis (VPA). The VPA results showed that SOC content was mainly affected by climatic factors that explained 68% and 57% for the surface and subsurface layers, respectively. However, SOC content in the subsoil layer was greatly affected by soil properties that explained 27%. Furthermore, the SEMs results suggested that geographical factors indirectly affected SOC content by influencing the climatic factors. Mean annual temperature was the most important factor affecting SOC content directly or indirectly, and its negative effects significantly diminished with soil depth, as it explained 63%, 52%, and 17% of the variation in SOC content for the surface, subsurface and subsoil layers, respectively. In addition, the effects of soil water-holding capacity on SOC content also decreased with soil depth, whereas pH and clay content showed a contrasting pattern. This implies that pH and clay content play important roles in the sequestration of SOC in deep soil layers. Moreover, the organic C content within >53 μm aggregates was more sensitive to environmental factors. This study can be useful for forecasting SOC dynamics and establishing reasonable C management strategies under climate change conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

This study comprehensively analyzes the environmental risk of heavy metals (HMs) in the dewatering process of dredged sediment. First, the toxicity leaching capacity, total content, and chemical speciation of the HMs (As, Cd, Co, Cr, Cu, Hg, Mo, Pb, Sb, Sr, Tl, Zn) in dewatered sediment were determined using toxicity characteristic leaching procedure and modified Community Bureau of Reference sequential extraction procedure. The ecotoxicity and environmental risk of the HMs were then evaluated based on sediment quality guidelines, geo-accumulation index, enrichment factor, potential ecological risk, and risk assessment code. The results showed that flocculants reduced the ecological risk of Hg and Mo in sediment, and promoted the transformation of Mo, Sb, and Tl from the biologically active fraction to the more stable fraction. The transformation percentages of Mo, Sb, and Ti were 45.15%, 50.59% and 76.44%, respectively, after chitosan (CTS) treatment, and 64.55%, 31.75% and 99.90%, respectively, after cationic polyacrylamide (CPAM) treatment. CTS reduced the potential risks of bioavailable As, Cr, Cu, Mo, Sb, and Hg by (at most) 46.28%, 45.92%, 43.01%, 100.00%, 44.45%, and 39.69%, respectively, whereas CPAM decreased the ecotoxicity of bioavailable Cd, Co, and Zn by (at most) 27.49%, 16.10%, and 20.89%, respectively. According to the result of principal component analysis, the main factors affecting the environmental risk of HMs in sediment dewatering were nitrogenous organic compounds (mainly protein substances), fulvic acid substances, and minerals. The most essential factor was nitrogenous organic compounds, which accounted for 89.52% of the total variance. Chemical speciation was apparently more suitable for environmental risk assessment of sediment dewatering than total content. This study provides an important basis for controlling the environmental risk of HMs caused by sediment dewatering., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The overall genetic distribution and divergence of cloned genes among bread wheat varieties that have occurred during the breeding process over the past few decades in Ningxia Province, China, are poorly understood. Here, we report the genetic diversities of 44 important genes related to grain yield, quality, adaptation and resistance in 121 Ningxia and 86 introduced wheat cultivars and advanced lines., Results: The population structure indicated characteristics of genetic components of Ningxia wheat, including landraces of particular genetic resources, introduced varieties with rich genetic diversities and modern cultivars in different periods. Analysis of allele frequencies showed that the dwarfing alleles Rht-B1b at Rht-B1 and Rht-D1b at Rht-D1, 1BL/1RS translocation, Hap-1 at GW2-6B and Hap-H at Sus2-2B are very frequently present in modern Ningxia cultivars and in introduced varieties from other regions but absent in landraces. This indicates that the introduced wheat germplasm with numerous beneficial genes is vital for broadening the genetic diversity of Ningxia wheat varieties. Large population differentiation between modern cultivars and landraces has occurred in adaptation genes. Founder parents carry excellent allele combinations of important genes, with a higher number of favorable alleles than modern cultivars. Gene flow analysis showed that six founder parents have greatly contributed to breeding improvement in Ningxia Province, particularly Zhou 8425B, for yield-related genes., Conclusions: Varieties introduced from other regions with rich genetic diversity and landraces with well-adapted genetic resources have been applied to improve modern cultivars. Founder parents, particularly Zhou 8425B, for yield-related genes have contributed greatly to wheat breeding improvement in Ningxia Province. These findings will greatly benefit bread wheat breeding in Ningxia Province as well as other areas with similar ecological environments.

Background: Several studies have demonstrated that smoke-free legislation is associated with a reduced risk of mortality from acute myocardial infarction (AMI). This study aimed to examine and quantify the potential effect of smoke-free legislation on AMI mortality rate in different countries., Methods: Studies were identified using a systematic search of the scientific literature from electronic databases, including PubMed, Web of Science, ScienceDirect, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI), from their inception through September 30, 2017. A random effects model was employed to estimate the overall effects of smoke-free legislation on the AMI mortality rate. Subgroup analysis was performed to explore the possible causes of heterogeneity in risk estimates based on sex and age. The results of meta-analysis after excluding the studies with a high risk of bias were reported in this study., Results: A total of 10 eligible studies with 16 estimates of effect size were included in this meta-analysis. Significant heterogeneity in the risk estimates was identified (overall I 2  = 94.6%, p < 0.001). Therefore, a random effects model was utilized to estimate the overall effect of smoke-free legislation. There was an 8% decline in AMI mortality after introducing smoke-free legislation (RR = 0.92, 95% confidence interval (CI): 0.90-0.94). The results of subgroup analyses showed that smoke-free legislation was significantly associated with lower rates of mortality for the following 5 diagnostic subgroups: smoke-free in workplaces, restaurants and bars (RR = 0.92, 95% CI: 0.90-0.95), smaller sample size (RR = 0.92, 95% CI: 0.89-0.95), study location in Europe (RR = 0.90, 95% CI: 0.85-0.94), regional study area (RR = 0.92, 95% CI: 0.89-0.94), and no previous local smoke-free legislation (RR = 0.91, 95% CI: 0.90-0.93). However, there was not much difference in AMI mortality rates after the legislation between the longer (RR = 0.92, 95% CI: 0.86-0.98) and shorter follow-up duration subgroups (RR = 0.92, 95% CI: 0.89-0.94)., Conclusion: Smoke-free legislation could significantly reduce the AMI mortality rate by 8%. The reduction in the AMI mortality rate was more significant in studies with more comprehensive laws, without prior smoke-free bans, with a smaller sample size, at the regional level, and with a location in Europe.

Sludge treatment and disposal have become critical environmental issues in China. Electro-dewatering (ED) is an attractive technology for enhancing dewaterability and improving the sustainability of waste activated sludge (WAS) handling. However, electrically assisted mechanical dewatering processes consume more energy and the extracellular polymeric substance (EPS) dissolution caused by electrochemical reactions can lead to clogging of the filter cloth. Carbon-based materials (CBMs) such as activated carbon and graphite have electrical conductivity and well-developed pore structures which can adsorb the biopolymers. Therefore, addition of CBMs is expected to improve WAS electro-dewatering performance for fuel treatment by enhancing sludge conductivity and filterability. In this study, we evaluated the effects of the three carbon materials (AC-0, AC-5, and graphite) on sludge electro-dewatering behavior and the flammability of sludge cakes. The results showed that CBMs promote the performance of WAS electro-dewatering, and the promoting effect of the carbon materials on the sludge electro-dewatering is proportional to the electrical conductivity of the carbon material, and carbon materials can increase the electrophoretic mobility of sludge flocs and the electro-osmotic effect. Moreover, CBMs can adsorb the dissolved EPS, thus alleviate the plugging and filtration resistance of the filter medium. The addition of CBMs also decreases the energy consumption for water removal during the electro-dewatering process and improves the calorific value and sustainable combustion time of the sludge cake. Our approach can facilitate the resource utilization of the dewatered sludge cake in electro-dewatering processes., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Type D personality and medication nonadherence have been shown to be associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease, myocardial infarction, and heart failure. However, the relationship between type D personality and medication adherence in patients with Type 2 Diabetes Mellitus (T2DM) remains unknown. This study aims to examine whether type D personality was associated with medication adherence in patients with T2DM., Design and Settings: A follow-up study was conducted in general hospital of the People's Liberation Army in Beijing., Methods: 412 T2DM patients (205 females), who were recruited by circular systematic random sampling, provided demographic and baseline data about medical information and completed measures of Type D personality. Then, 330 patients went on to complete a self-report measure of medication adherence at the sixth month after baseline data collection. Chi-square test, t tests, and hierarchical multiple regression analyses were conducted, as needed., Results: Patients with type D personality were significantly more likely to have poor medication adherence (p<0.001). Type D personality predicts poor medication adherence before and after controlling for covariates when it was analyzed as a categorical variable. However, the dimensional construct of type D personality was not associated with medication adherence when analyzed as a continuous variable., Conclusion: Although, as a dimensional construct, type D personality may not reflect the components of the personality associated with poor medication adherence in patients with T2DM, screening for type D personality may help to identify those who are at higher risk of poor medication adherence. Interventions, aiming to improve medication adherence, should be launched for these high-risk patients.

The objective of the study was to examine the relationships between mental health conditions (posttraumatic stress disorder [PTSD] only, depression only, and PTSD and depression) and related factors. A cross-sectional survey was conducted among 1362 adults from two severely affected townships at 6 months after the earthquake. The results of the analyses showed that the prevalence of depression and PTSD were 31.4% and 22.1%, respectively, 6 months after the earthquake. When PTSD and depression were treated as two separate dependent variables, PTSD and depression share almost similar sets of predictive factors. After its four categories (none, PTSD only, depression only, and PTSD and depression) were used as categorical dependent variables, there are different predictive factors. The findings suggest that there are two different groups of individuals, those who develop depression only in response to earthquake exposure and those who develop both depression and PTSD.

Background: Airborne bacterial contamination poses a risk for surgical site infection, and routine surveillance of airborne bacteria is important. Traditional methods for detecting airborne bacteria are time consuming and strenuous. Measurement of biologic particle concentrations using a fluorescent particle counter is a novel method for evaluating air quality. The current study was to determine whether the number of biologic particles detected by the fluorescent particle counter can be used to indicate airborne bacterial counts in operating rooms., Methods: The study was performed in an operating theater at a university hospital in Hefei, China. The number of airborne biologic particles every minute was quantified using a fluorescent particle counter. Microbiologic air sampling was performed every 30 minutes using an Andersen air sampler (Pusong Electronic Instruments, Changzhou, China). Correlations between the 2 different methods were analyzed by Pearson correlation coefficients., Results: A significant correlation was observed between biologic particle and bacterial counts (Pearson correlation coefficient = 0.76), and the counting results from 2 methods both increased substantially between operations, corresponding with human movements in the operating room., Conclusion: Fluorescent particle counters show potential as important tools for monitoring bacterial contamination in operating theatres., (Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

In China, caregivers for family members with schizophrenia play an important role in treatment and recovery but may experience stigma and discrimination simply because of their family relationship. The object of this study was to measure the degrees and correlates of stigma and discrimination experiences among this group. Four hundred twenty-seven caregivers participated in this hospital-based and cross-sectional study in Ningbo and Guangzhou, China. Data were collected by trained interviewers using fixed questionnaires. Stigma and discrimination experiences were measured by the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). Caregivers' social support was measured by the Social Support Rating Scale. Parametric analysis, nonparametric analysis and multivariate linear regression were used. The mean (SD) score of MCESQ was 2.44(0.45), 2.91(0.71) for stigma experiences and 1.97(0.37) for discrimination experiences on a five-point score ("1 = never" and "5 = very often"). Approximately 65% of caregivers reported that they tried to conceal their family members' illness, and 71% lacked the support of friends. The experience of stigma was significantly negatively associated with the perceived social support of caregivers (standard β = -0.2,p<0.001). Caregivers who were children of the patients experienced fewer stigmas than other (standard β = -0.18, p<0.001). Urban residence (standard β = -0.12, p<0.01) and patients did not complete primary school education (standard β = -0.13, p<0.01) were negatively related with stigmas. In addition, stigma and discrimination was more experienced in Zhejiang than in Guangdong (p<0.05). In conclusion, this study performed that caregivers of people with schizophrenia in China experienced general stigmas and rare discrimination and found the relations with social support, kinship, patient's educational level and regional differences. More interventions and supports should been given to caregivers who are lack of social support, who live in rural area and who are the patients' parents, spouses or siblings.