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The process of rapid urbanization has intensified the conversion of different land use types, resulting in a substantial loss of ecological land and ecological security being threatened. In the context of China's vigorous advocacy of an ecological civilization, it is important to explore future land use patterns under ecological security constraints to promote sustainable development. The insufficient consideration of land ecological security in existing land use pattern simulation studies makes it difficult to effectively promote improvement in the ecological security level. Therefore, we developed a land use simulation framework that integrates land ecological security. Taking the sustainable development of land ecosystems as the core, the land ecological security index (LESI) and ecological zoning (EZ) were determined by the pressure-state-response (PSR) model and the catastrophe progression method (CPM). Natural development (ND) and ecological protection (EP) scenarios were then constructed taking the LESI and EZ into consideration. The CA-Markov model was used to simulate the land use pattern of Guangzhou for 2030 under the two scenarios. The results showed that (1) the study area was divided into four categories: ecological core zone, ecological buffer zone, ecological optimization zone, and urban development zone, with area shares of 37.53%, 31.14%, 16.96%, and 14.37%, respectively. (2) In both scenarios, the construction land around the towns showed outward expansion; compared with the ND scenario, the construction land in the EP scenario decreased by 369.10 km 2 , and the woodland, grassland, and farmland areas increased by 337.04, 20.80, and 10.51 km 2 , respectively, which significantly improved the ecological security level. (3) In the EP scenario, the construction land in the ecological core zone, ecological buffer zone, and ecological optimization zone decreased by 85.49, 114.78, and 178.81 km 2 , respectively, and no new construction land was added in the ecological core zone, making the land use pattern of the EP scenario more reasonable. The results of the study have confirmed that the land use pattern simulation framework integrating land ecological security can effectively predict land use patterns in different future scenarios. This study can provide suggestions and guidance for managers to use in formulating ecological protection policies and preparing territorial spatial planning.

BACKGROUND SARS-CoV-2 has caused a pandemic. Control measures differ among countries. It is necessary to assess the effectiveness of these control measures. MATERIAL AND METHODS We collected the data of COVID-19 patients and control measures between January 18, 2020 and September 18, 2020 from the Changshou District and analyzed the clinical characteristics, epidemiological data, and the adjustment of policies to assess the effectiveness of control measures. The control of COVID-19 was divided into 2 stages, with the lifting of lockdown in Hubei province (March 25, 2020) as a dividing line. RESULTS We identified 32 patients through different means in the first stage. All the imported patients entered this area before the lockdown. In 93.1% of patients, the last exposure occurred before the implementation of the stay-at-home order and centralized isolation. Tracing of high-risk people and RT-PCR screening identified 56.3% of cases. In the second stage, all the high-risk people were under centralized isolation. Nine asymptomatic patients were identified. City lockdown and stay-at-home orders were not issued again, and no second-generation patients were found. CONCLUSIONS We have provided a successful model to control the transmission of COVID-19 in a short period.

Exposure to polycyclic aromatic hydrocarbons (PAHs) during pregnancy is a risk factor for adverse neurobehavioral development outcomes. Mitochondrial DNA are sensitive to environmental toxicants due to the limited ability of repairing. The change of mitochondrial DNA copy number (mtDNAcn) might be a biologically mechanism linking PAH exposure and children's neurobehavioral impairment. Our aims are to explore whether PAH metabolites in maternal urine were associated with children's neurobehavioral development at 2 years old and umbilical cord blood mtDNAcn, and whether mtDNAcn was a mediator of PAH-related neurobehavioral development. We included 158 non-smoking pregnant women from Taiyuan City, Shanxi Province. Maternal urinary eleven PAH metabolites were detected by high performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS). MtDNAcn in cord blood was detected by real time quantitative polymerase chain reaction (RT-PCR). Children's neurodevelopment was measured by Gesell Developmental Schedules (GDS) when children were two years age. Generalized linear models and restricted cubic spline models were applied to assess the relationships between PAH metabolites in maternal urine and GDS scores and mtDNAcn. A mediation analysis was also conducted. Generalized linear models showed the relationships of sum of PAH metabolites (Σ-OHPAHs) in maternal urine with decreased motor score, and Σ-OHPAHs with increased mtDNAcn (p for trend < 0.05). Urinary levels of Ln (Σ-OHPAHs) increased one unit was related to a 2.08 decreased in motor scores, and Ln (Σ-OHPAHs) increased one unit was related to 0.15 increased in mtDNAcn. Mediation analysis did not find mtDNAcn can be a mediator between PAH metabolites and neurobehavioral development. Our results suggest that prenatal exposure to PAH decreased children's neurobehavioral development scores and increased mtDNAcn. And reducing exposure to PAH during pregnancy will benefit to improving neurobehavioral development in children. In our present cohort study, sum of PAH metabolites in urine of pregnant women were related with motor score and were positively associated with umbilical cord blood mtDNA copy number., 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 © 2020 Elsevier Ltd. All rights reserved.)

Background: Syphilis self-testing may help expand syphilis testing among men who have sex with men (MSM). China has rapidly scaled up human immunodeficiency virus (HIV) self-testing, creating an opportunity for integrated syphilis self-testing. However, there is a limited literature on implementing syphilis self-testing., Methods: A cross-sectional online survey was conducted among Chinese MSM in 2018. Participants completed a survey instrument including sociodemographic characteristics, sexual behaviors, syphilis self-testing, and HIV self-testing history. Multivariable logistic regression was conducted to identify correlates of syphilis self-testing. We also recorded potential harms associated with syphilis self-testing., Results: Six hundred ninety-nine MSM from 89 cities in 21 provinces in China completed the study. A total of 361/699 (51.7%) men tested for syphilis, of whom 174/699 (24.9%) men used syphilis self-testing. Among 174 who had self-tested, 90 (51.7%) reported that the self-test was their first syphilis test and 161 (92.5%) reported that they undertook syphilis self-testing together with HIV self-testing. After adjusting for covariates, syphilis self-testing was correlated with disclosure of sexual orientation to family or friends (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.32-2.73), reporting 2-5 male sexual partners (aOR, 1.81; 95% CI, 1.04-3.16), HIV self-testing (aOR, 39.90; 95% CI, 17.00-93.61), and never tested for syphilis in the hospital (aOR, 2.96; 95% CI, 1.86-4.72). Self-reported harms associated with syphilis self-testing were minimal., Conclusions: Scaling up syphilis self-testing could complement facility-based testing in China among MSM. Self-testing may increase first-time testing and has limited harms. Our findings suggest that syphilis self-testing could be integrated into HIV self-testing services., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

As a country with the highest CO 2 emissions and at the turning point of socio-economic transition, China's effort to reduce CO 2 emissions will be crucial for climate change mitigation. Yet, due to geospatial variations of CO 2 emissions in different cities, it is important to develop city-specific policies and tools to help control and reduce CO 2 emissions. The key question is how to identify and quantify these variations so as to provide reference for the formulation of the corresponding mitigation policies. This paper attempts to answer this question through a case study of 26 cities in the Yangtze River Delta. The CO 2 emissions pattern of each city is measured by two statistics: Gini coefficient to describe its quantitative pattern and Global Moran's I index to capture its spatial pattern. It is found that Gini coefficients in all these cities are all greater than 0.94, implying a highly polarized pattern in terms of quantity; and the maximum value for Global Moran's I index is 0.071 with a standard deviation of 0.021, indicating a weak spatial clustering trend but strong difference among these cities. So, it would be more efficient for these cities at current stage to reduce CO 2 emissions by focusing on the large emission sources at certain small localities, particularly the very built-up areas rather than covering all the emission sources on every plot of the urban prefectures. And by a combination of these two metrics, the 26 cities are regrouped into nine types with most of them are subject to type HL and ML. These reclassification results then can serve as reference for customizing mitigation policies accordingly and positioning these policies in a more accurate way in each city., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Prenatal exposure to polycyclic aromatic hydrocarbon (PAH) is a potential risk factor for child neurobehavioral development. Telomere length (TL) has important implications for health over the life course., Objective: In this study, we aimed to investigate whether prenatal urinary PAH metabolites were associated with adverse neonatal neurobehavioral development and altered cord blood TL and to explore whether the change of TL was a predictor of neonatal neurobehavioral development., Method: We enrolled 283 nonsmoking pregnant women in Taiyuan city. Eleven PAH metabolites were measured in maternal urine samples. TL in cord blood was measured by real time quantitative polymerase chain reaction. Neonatal behavioral neurological assessment (NBNA) tests were conducted when the infants were three days old. Multiple linear regression models were used to analyze the associations of maternal urinary PAH metabolites with NBNA scores and cord blood TL, and restricted cubic spline models were further used to examine the shapes of dose-response relationships. A mediation analysis was also conducted., Result: We observed dose-response associations of maternal urinary 2-hydroxyfluorene (2-OHFlu) and 2-hydroxyphenanthrene (2-OH Phe) with decreased active tone scores, sum of NBNA scores, and cord blood TL (P for trend<0.05). Each 1 unit increase in urinary levels of Ln (2-OH Flu) or Ln (2-OH Phe) was associated with a 0.092 or 0.135 decrease in the active tone scores and a 0.174 or 0.199 decrease in the sum of NBNA scores. Mediation analysis showed TL could explained 21.74% of the effect of sum of NBNA scores change related to prenatal exposure to 2-OH Phe (P for mediator = 0.047)., Conclusion: Our data indicates maternal urinary specific PAH metabolites are inversely associated with neonatal neurobehavioral development and cord blood TL. TL mediates the associations of 2-OH Phe with neonatal neurobehavioral development and partly explains the effect of 2-OH Phe on neonatal neurobehavioral development., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Large and increasing numbers of rural-to-urban migrants provided new challenges for tuberculosis control in large cities in China and increased the need for high quality tuberculosis care delivered by clinics in urban migrant communities. Based on a household survey in migrant communities, we selected and separated clinics into those that mainly serve migrants and those that mainly serve local residents. Using standardized patients, this study provided an objective comparison of the quality of tuberculosis care delivered by both types of clinics and examined factors related to quality care. Only 27% (95% confidence interval (CI) 14⁻46) of cases were correctly managed in migrant clinics, which is significantly worse than it in local clinics (50%, 95% CI 28⁻72). Clinicians with a base salary were 41 percentage points more likely to demonstrate better case management. Furthermore, clinicians with upper secondary or higher education level charged 20 RMB lower out of pocket fees than less-educated clinicians. In conclusion, the quality of tuberculosis care accessed by migrants was very poor and policies to improve the quality should be prioritized in current health reforms. Providing a base salary was a possible way to improve quality of care and increasing the education attainment of urban community clinicians might reduce the heavy barrier of medical expenses for migrants.