Uneven consequences of global climate mitigation pathways on regional water quality in the 21st century.

Future socioeconomic climate pathways have regional water-quality consequences whose severity and equity have not yet been fully understood across geographic and economic spectra. We use a process-based, terrestrial-freshwater ecosystem model to project 21st-century river nitrogen loads under these pathways. We find that fertilizer usage is the primary determinant of future river nitrogen loads, changing precipitation and warming have limited impacts, and CO2 fertilization-induced vegetation growth enhancement leads to modest load reductions. Fertilizer applications to produce bioenergy in climate mitigation scenarios cause larger load increases than in the highest emission scenario. Loads generally increase in low-income regions, yet remain stable or decrease in high-income regions where agricultural advances, low food and feed production and waste, and/or well-enforced air pollution policies balance biofuel-associated fertilizer burdens. Consideration of biofuel production options with low fertilizer demand and rapid transfer of agricultural advances from high- to low-income regions may help avoid inequitable water-quality outcomes from climate mitigation.

Effectiveness of a healthy lifestyle program based on a mobile serious game for childhood cancer survivors: A quasi-randomized trial.

PURPOSE: This study aimed to develop and evaluate the effectiveness of a healthy lifestyle program based on a mobile serious game (HLP-MSG) to enhance the lifestyles of childhood cancer survivors (CCSs). METHODS: This program proceeded in two stages: development and evaluation, using a non-synchronized design with a quasi-randomized trial. The participants were CCSs aged 6-13 years whose treatment was terminated at least 12 months prior. Data were collected at baseline, and post-intervention, with a follow-up after four weeks using the Child Healthy Lifestyle Profile (CHLP). The experimental (n = 26) and control groups (n = 25) were compared. Data were analyzed using descriptive statistics, chi-squared tests, t-tests, and repeated-measures ANOVA. RESULTS: The HLP-MSG promoted a healthy lifestyle by solving 26 quests, including seven sub-elements (nutrition, exercise, hygiene, interpersonal relationships, stress management, meaning of life, and health responsibility). This study revealed significant differences in the interaction between measurement time and group assignment in the CHLP (p = .006) and physical activity (p = .013), one of the seven sub-dimensions. CONCLUSIONS: A healthy lifestyle program based on a mobile serious game is a feasible health education modality to enhance the physical, psychological, social, and spiritual health of CCSs. IMPLICATIONS TO PRACTICE: The findings add to scientific evidence on a mobile serious game for health education among CCSs. The HLP-MSG provides an evolutionary educational modality that can be delivered non-face-to-face to promote CCSs' continuous healthy behavior maintenance. Moreover, the HLP-MSG is adolescent-friendly and can be utilized as a healthcare tool for parents and children to cooperate.

Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial.

Background and Objectives: Local infiltration analgesia (LIA) represents a potential approach to reducing pain in patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block also provides adequate analgesia for fractures and THA. As most hip surgeries use a lateral incision, affecting the cutaneous supply by branches of the lateral femoral cutaneous nerve (LFCN), the LFCN block can contribute to postoperative analgesia. However, no studies have investigated the effectiveness of supplemental PENG block combined with LFCN block in patients undergoing LIA after hip fracture surgery. Our study aimed to assess the effectiveness of PENG combined with LFCN block following hip fracture surgery in patients who underwent LIA. Materials and Methods: Forty-six patients were randomly assigned to LIA or PENG + LFCN + LIA groups. The primary outcome was the pain score at rest and during movement at 2, 6, 12, 24, and 48 h postoperatively. The total opioid dose for postoperative analgesia was also measured at the same time points. Secondary outcomes included postoperative cognitive function assessment. Results: The median pain scores at rest and during movement were lower in the PENG + LFCN + LIA group throughout the study periods compared to the LIA group, except at 2 h (at rest) and 48 h (during movement) after surgery. The total fentanyl dose was lower in the PENG + LFCN + LIA group at all time points after surgery when compared to the LIA group. Postoperative delirium incidence and the median abbreviated mental test scores were not significantly different between the two groups. Conclusions: The combination of PENG and LFCN blocks may contribute to enhanced recovery for patients undergoing LIA after hip fracture surgery. However, further well-controlled research is necessary to determine the effectiveness of supplemental PENG combined with LFCN block in addressing cognitive deficits in these patients.

Automated lung tumor segmentation robust to various tumor sizes using a consistency learning-based multi-scale dual-attention network.

BACKGROUND: It is often difficult to automatically segment lung tumors due to the large tumor size variation ranging from less than 1 cm to greater than 7 cm depending on the T-stage. OBJECTIVE: This study aims to accurately segment lung tumors of various sizes using a consistency learning-based multi-scale dual-attention network (CL-MSDA-Net). METHODS: To avoid under- and over-segmentation caused by different ratios of lung tumors and surrounding structures in the input patch according to the size of the lung tumor, a size-invariant patch is generated by normalizing the ratio to the average size of the lung tumors used for the training. Two input patches, a size-invariant patch and size-variant patch are trained on a consistency learning-based network consisting of dual branches that share weights to generate a similar output for each branch with consistency loss. The network of each branch has a multi-scale dual-attention module that learns image features of different scales and uses channel and spatial attention to enhance the scale-attention ability to segment lung tumors of different sizes. RESULTS: In experiments with hospital datasets, CL-MSDA-Net showed an F1-score of 80.49%, recall of 79.06%, and precision of 86.78%. This resulted in 3.91%, 3.38%, and 2.95% higher F1-scores than the results of U-Net, U-Net with a multi-scale module, and U-Net with a multi-scale dual-attention module, respectively. In experiments with the NSCLC-Radiomics datasets, CL-MSDA-Net showed an F1-score of 71.7%, recall of 68.24%, and precision of 79.33%. This resulted in 3.66%, 3.38%, and 3.13% higher F1-scores than the results of U-Net, U-Net with a multi-scale module, and U-Net with a multi-scale dual-attention module, respectively. CONCLUSIONS: CL-MSDA-Net improves the segmentation performance on average for tumors of all sizes with significant improvements especially for small sized tumors.

Comparative Efficacy of Commercial Liquid and Mat-Type Electric Vaporizer Insecticides Against Asian Tiger Mosquito (Diptera: Culicidae).

Mat and liquid-type electric insecticide vaporizers continuously emit insecticides into the surrounding air. Because both the target insects, mostly mosquitoes, and humans are exposed to those insecticides, it is crucial to understand and monitor their deposition and spatial distribution in treated areas. In the current study, we examined the evaporation of insecticides from seven commercial liquid and mat vaporizers and measured their knock-down and insecticidal activity against the adult females of the Asian tiger mosquito, Aedes albopictus (Skuse). Electric vaporizers from three manufactures had differences in their heaters and active ingredients. Most had continued evaporation during hourly and daily monitoring; however, some liquid vaporizers failed to continue emission to their designated end periods. Overall, mosquitoes located at the upper position in a Peet-Grady chamber and in a field-simulation room exhibited faster knock-down activity than did mosquitoes in other areas, indicating that the insecticides accumulated on the ceiling area. Although most of mat and liquid vaporizers had <60 min of average KT90 values when tested in the Peet-Grady chamber (1.8 × 1.8 × 1.8 m), they failed to have any knock-down in 2 h of observation in the field-simulation room (6.8 × 3.4 × 2.7 m) but showed 72. 8 ± 11.7% and 56. 7 ± 7.3% knock-down in the mat and liquid vaporizers, respectively, in 3 h of operation. Further study will be required to examine whether this relatively limited efficacy can be compensated by other physiological and behavioral effects, including disruption in host-seeking or blood-sucking activities.

Fabrication of Durable Ni-YSZ Hydrogen Electrode for High-Temperature Solid Electrolyzer Cells.

Solid oxide electrolyzer cells with an Ni-Fe-yttria-stabilized zirconia (Ni-Fe-YSZ) hydrogen electrode as the cathode, lanthanum strontium ferrite (LSCF)-gadolinia-doped ceria (GDC) air electrode as the anode, and YSZ as the electrolyte were fabricated, and the oxidation protection effect of sacrificial Fe particles was investigated. X-ray diffraction analysis indicated that Ni was protected from oxidation under a water vapor atmosphere by sacrificial Fe. Scanning electron microscopy observations suggested that the Ni particles accumulated in the Ni-YSZ hydrogen electrode, which might have been associated with the partial oxidation of Ni during cell operation at 700 °C in 50% H2O/15% H2/35% Ar atmosphere. No appreciable microstructural changes were observed for the Ni-Fe-YSZ hydrogen electrode. Furthermore, the presence of the sacrificial Fe particles could be responsible for the superior durability of the cell, compared with that of the cell featuring the conventional Ni-YSZ hydrogen electrode.

Cut-off points between pain intensities of the postoperative pain using receiver operating characteristic (ROC) curves.

BACKGROUND: Pain assessment and management are important in postoperative circumstances as overdosing of opioids can induce respiratory depression and critical consequences. We aimed this study to check the reliability of commonly used pain scales in a postoperative setting among Korean adults. We also intended to determine cut-off points of pain scores between mild and moderate pain and between moderate and severe pain by which can help to decide to use pain medication. METHODS: A total of 180 adult patients undergoing elective non-cardiac surgery were included. Postoperative pain intensity was rated with a visual analog scale (VAS), numeric rating scale (NRS), faces pain scale revised (FPS-R), and verbal rating scale (VRS). The VRS rated pain according to four grades: none, mild, moderate, and severe. Pain assessments were performed twice: when the patients were alert enough to communicate after arrival at the postoperative care unit (PACU) and 30 min after arrival at the PACU. The levels of agreement among the scores were evaluated using intraclass correlation coefficients (ICCs). The cut-off points were determined by receiver operating characteristic curves. RESULTS: The ICCs among the VAS, NRS, and FPS-R were consistently high (0.839-0.945). The pain categories were as follow: mild ≦ 5.3 / moderate 5.4 ~ 7.1 /severe ≧ 7.2 in VAS, mild ≦ 5 / moderate 6 ~ 7 / severe ≧ 8 in NRS, mild ≦ 4 / moderate 6 / severe 8 and 10 in FPS-R. The cut-off points for analgesics request were VAS ≧ 5.5, NRS ≧ 6, FPS-R ≧ 6, and VRS ≧ 2 (moderate or severe pain). CONCLUSIONS: During the immediate postoperative period, VAS, NRS, and FPS-R were well correlated. The boundary between mild and moderate pain was around five on 10-point scales, and it corresponded to the cut-off point of analgesic request. Healthcare providers should consider VRS and other patient-specific signs to avoid undertreatment of pain or overdosing of pain medication.

Role of tenofovir disoproxil fumarate in prevention of perinatal transmission of hepatitis B virus from mother to child: a systematic review and meta-analysis.

BACKGROUND/AIMS: To prevent the perinatal transmission of hepatitis B virus (HBV) from mother to child, administration of an antiviral agent during pregnancy has been attempted in women who are either hepatitis B e antigen positive or have a high viral load. In this systematic review and meta-analysis with randomized controlled trials, we analyzed the efficacy and safety of tenofovir disoproxil fumarate (TDF) in preventing the perinatal transmission of HBV in pregnant women who have high HBV DNA titers. METHODS: Multiple comprehensive databases (PubMed, EMBASE, and Cochrane databases) were searched for studies evaluating the efficacy of TDF for the prevention of perinatal transmission of HBV. RESULTS: Two studies (one open label study and one double blind study) were included and analyzed. Intention-to-treat analysis (527 pregnancies) showed that the preventive effect of TDF was not significant (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.13 to 2.17; p = 0.38, I2 = 81%). However, the per-protocol analysis showed that TDF significantly reduced perinatal transmission (OR, 0.10; 95% CI, 0.01 to 0.77; p = 0.03, I2 = 0%). There was no significant difference between the TDF group and the control group with respect to maternal and fetal safety outcomes. CONCLUSION: In pregnant women who have high HBV DNA titers, TDF can reduce the perinatal transmission from mother to child without significant adverse events.

Patient hiPSCs Identify Vascular Smooth Muscle Arylacetamide Deacetylase as Protective against Atherosclerosis.

Although susceptibility to cardiovascular disease (CVD) is different for every patient, why some patients with type 2 diabetes mellitus (T2DM) develop CVD while others are protected has not yet been clarified. Using T2DM-patient-derived human induced pluripotent stem cells (hiPSCs), we found that in patients protected from CVD, there was significantly elevated expression of an esterase, arylacetamide deacetylase (AADAC), in vascular smooth muscle cells (VSMCs). We overexpressed this esterase in human primary VSMCs and VSMCs differentiated from hiPSCs and observed that the number of lipid droplets was significantly diminished. Further metabolomic analyses revealed a marked reduction in storage lipids and an increase in membrane phospholipids, suggesting changes in the Kennedy pathway of lipid bioassembly. Cell migration and proliferation were also significantly decreased in AADAC-overexpressing VSMCs. Moreover, apolipoprotein E (Apoe)-knockout mice overexpressing VSMC-specific Aadac showed amelioration of atherosclerotic lesions. Our findings suggest that higher AADAC expression in VSMCs protects T2DM patients from CVD.

Fabrication of Ce-Promoted Ni/Al2O3 Methane Steam Reforming Catalysts by Impregnation.

CeO2-promoted Ni/Al2O3 catalysts were fabricated by impregnation. The effects of the CeO2 promotion and impregnation order on the microstructural evolution and catalytic durability were investigated for methane steam reforming. The CeO2-promoter nanoparticles resulted in good dispersion and reduced particle size of Ni catalysts. The enhanced durability of CeO2-promoted Ni/Al2O3 catalysts might be associated with the depression of carbon deposition by the presence of CeO2-promoter nanoparticles.

Publisher Correction: Prominence of the tropics in the recent rise of global nitrogen pollution.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Prominence of the tropics in the recent rise of global nitrogen pollution.

Nitrogen (N) pollution is shaped by multiple processes, the combined effects of which remain uncertain, particularly in the tropics. We use a global land biosphere model to analyze historical terrestrial-freshwater N budgets, considering the effects of anthropogenic N inputs, atmospheric CO2, land use, and climate. We estimate that globally, land currently sequesters 11 (10-13)% of annual N inputs. Some river basins, however, sequester >50% of their N inputs, buffering coastal waters against eutrophication and society against greenhouse gas-induced warming. Other basins, releasing >25% more than they receive, are mostly located in the tropics, where recent deforestation, agricultural intensification, and/or exports of land N storage can create large N pollution sources. The tropics produce 56 ± 6% of global land N pollution despite covering only 34% of global land area and receiving far lower amounts of fertilizers than the extratropics. Tropical land use should thus be thoroughly considered in managing global N pollution.

Utility after robot-assisted radical prostatectomy compared to conventional approaches for localized prostate cancer [socioeconomic perspective study].

BACKGROUND: This study presented the utility across approaches (robotic-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP)), across disease states after surgery, and also across functional outcomes for localized prostate cancers. The utility was measured using the time trade-off method. METHODS: This survey was based on a scenario that describes the state of health in detail and considers surgical methods, short-term adverse effects following RP, disease-specific conditions, and additional treatments 1 year following RP. RESULTS: This study analyzed 393 men; the utility values are as follows: first, health status postoperatively showed that the utility value decreased in patients who underwent ORP versus those who underwent LRP. The utility value for ORP and LRP versus RARP was reduced by ~0.028 (10 days per year) and 0.008 (3 days per year), respectively. Second, the utility value based on adverse effects after RP indicated that erectile dysfunction caused a greater reduction in efficacy than urinary incontinence. Regarding erectile dysfunction and urinary incontinence, the efficacy was reduced to ~0.137 (50 days per year) and 0.111 (41 days per year), respectively, as compared to a health state without adverse effects based on no evidence of disease status. CONCLUSIONS: In conclusion, the disutility was much greater due to the side effects than the disutility due to the difference in the surgical method. In particular, the disutility of erectile dysfunction was bigger than that of the urinary incontinence.

Adverse events of conscious sedation using midazolam for gastrointestinal endoscopy.

BACKGROUND: This study was conducted to identify the types and incidence of adverse events associated with midazolam, which is the most widely used drug to induce conscious sedation during gastrointestinal endoscopy, and to analyze the factors associated with hypoxemia and sedation failure. METHODS: Of 87,740 patients who underwent gastrointestinal endoscopy between February 2015 and May 2017, the electronic medical records of 335 who reportedly developed adverse events were retrospectively reviewed, and analysis was performed to determine the risk factors for hypoxemia and sedation failure, the two most frequent adverse events among those manifested during gastrointestinal endoscopy. RESULTS: The overall adverse event rate was 0.38% (n = 335); hypoxemia was most frequent, accounting for 40.7% (n = 90), followed by sedation failure (34.8%, n = 77), delayed discharge from the recovery room (22.1%, n = 49), and hypotension (2.2%, n = 5). Compared with the control group, the hypoxemia group did not show any significant differences in sex and body weight, but mean age was significantly older (P < 0.001) and a significantly lower dose of midazolam was administered (P < 0.001). In the group with sedation failure, the mean rate was higher in men (P < 0.001) and a significantly higher dose of midazolam was administered (P < 0.001), but no age difference was found. CONCLUSIONS: Midazolam-based conscious sedation during gastrointestinal endoscopy can lead to various adverse events. In particular, as elderly patients are at higher risk of developing hypoxemia, midazolam dose adjustment and careful monitoring are required in this group.

Health Risk Assessment on Hazardous Ingredients in Household Deodorizing Products.

The inhalation of a water aerosol from a humidifier containing disinfectants has led to serious lung injuries in Korea. To promote the safe use of products, the Korean government enacted regulations on the chemicals in various consumer products that could have adverse health effects. Given the concern over the potential health risks associated with the hazardous ingredients in deodorizing consumer products, 17 ingredients were analyzed and assessed according to their health risk on 3 groups by the application type in 47 deodorizing products. The risk assessment study followed a stepwise procedure (e.g., collecting toxicological information, hazard identification/exposure assessment, and screening and detailed assessment for inhalation and dermal routes). The worst-case scenario and maximum concentration determined by the product purpose and application type were used as the screening assessment. In a detailed assessment, the 75th exposure factor values were used to estimate the assumed reasonable exposure to ingredients. The exposed concentrations of seven ingredients were calculated. Due to limitation of toxicity information, butylated hydroxyl toluene for a consumer’s exposure via the dermal route only was conducted for a detailed assessment. This study showed that the assessed ingredients have no health risks at their maximum concentrations in deodorizing products. This approach can be used to establish guidelines for ingredients that may pose inhalation and dermal hazards.

Morphology of travel routes and the organization of cities.

The city is a complex system that evolves through its inherent social and economic interactions. Mediating the movements of people and resources, urban street networks offer a spatial footprint of these activities. Of particular interest is the interplay between street structure and its functional usage. Here, we study the shape of 472,040 spatiotemporally optimized travel routes in the 92 most populated cities in the world, finding that their collective morphology exhibits a directional bias influenced by the attractive (or repulsive) forces resulting from congestion, accessibility, and travel demand. To capture this, we develop a simple geometric measure, inness, that maps this force field. In particular, cities with common inness patterns cluster together in groups that are correlated with their putative stage of urban development as measured by a series of socio-economic and infrastructural indicators, suggesting a strong connection between urban development, increasing physical connectivity, and diversity of road hierarchies.

Rapid Quantification of N-Methyl-2-pyrrolidone in Polymer Matrices by Thermal Desorption-GC/MS.

Analysis of a residual solvent in polymeric materials has become an important issue due to the increased regulations and standards for its use. N-Methyl-2-pyrrolidone (NMP) is a solvent widely used in many industries and restricted as one of the chemicals under EU REACH regulations due to its potential harmful effects. In this study, thermal desorption-gas chromatography/mass spectrometry (TD-GC/MS) is applied for the quantitative analysis of NMP with the use of a polymer-coated sample cup. By using the polymer-coated sample cup, the vaporization of NMP was prevented during waiting time before TD-GC/MS analysis. The calibration curve for the TD method showed good linearity (correlation coefficient, r2 = 0.9998) and precision values (below 5.3% RSD). NMP recovery rates in different polymer matrices (PS, PMMA and PVC) were in the range of 98.8 to 106.6% with RSD values below 5.0%. The quantification result (600 mg NMP/kg PVC) for the blind NMP carrying sample in a PVC matrix by TD-GC/MS was higher than that (532 mg NMP/kg PVC) by solvent extraction-GC/MS method.

Relating Land Use and Human Intra-City Mobility.

Understanding human mobility patterns­how people move in their everyday lives­is an interdisciplinary research field. It is a question with roots back to the 19th century that has been dramatically revitalized with the recent increase in data availability. Models of human mobility often take the population distribution as a starting point. Another, sometimes more accurate, data source is land-use maps. In this paper, we discuss how the intra-city movement patterns, and consequently population distribution, can be predicted from such data sources. As a link between land use and mobility, we show that the purposes of people's trips are strongly correlated with the land use of the trip's origin and destination. We calibrate, validate and discuss our model using survey data.