Towards carbon neutrality and China's 14th Five-Year Plan: Clean energy transition, sustainable urban development, and investment priorities.

China's 14th Five-Year Plan, for the period 2021-25, presents a real opportunity for China to link its long-term climate goals with its short-to medium-term social and economic development plans. China's recent commitment to achieving carbon neutrality by 2060 has set a clear direction for its economy, but requires ratcheting up ambition on its near-term climate policy. Against this background, this paper discusses major action areas for China's 14th Five-Year Plan after COVID-19, especially focusing on three aspects: the energy transition, a new type of sustainable urban development, and investment priorities. China's role in the world is now of a magnitude that makes its actions in the immediate future critical to how the world goes forward. This decade, 2021-2030, is of fundamental importance to human history. If society locks in dirty and high-carbon capital, it raises profound risks of irreversible damage to the world's climate. It is crucial for China to peak its emissions in the 14th Five-Year Plan (by 2025), making the transition earlier and cheaper, enhancing its international competitiveness in growing new markets and setting a strong example for the world. The benefits for China and the world as a whole could be immense.

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Routine peri-operative pediatric tracheotomy care.

OBJECTIVES: To develop consensus recommendations for peri-operative tracheotomy care in pediatric patients. METHODS: Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. RESULTS: Consensus recommendations including pre-operative, intra-operative, and post-operative considerations, as well as sedation and nutrition management are described. These recommendations are based on the collective opinion of the IPOG members and are targeted to (i) otolaryngologists who perform tracheotomies on pediatric patients, (ii) intensivists who are involved in the shared-care of these patients, and (iii) allied health professionals. CONCLUSION: Pediatric peri-operative tracheotomy care consensus recommendations are aimed at improving patient-centered care in this patient population.

The components of the female athlete triad do not identify all physically active females at risk.

The purpose of the present study was to assess the effectiveness of the triad components (amenorrhoea, disordered eating, and osteoporosis) in identifying physically active women at risk of long-term health problems. Eighty-two females (mean age 31.1 years, s = 6.7; body mass 58.4 kg, s = 6.6; stature 1.65 m, s = 0.06) completed training, menstrual, and dietary questionnaires. Bone mineral density and size-adjusted bone mineral density were assessed at the femoral neck and lumbar spine using dual energy X-ray absorptiometry. Seventy-eight percent of participants were eumenorrhoeic, 20% were oligomenorrhoeic, and 2% were amenorrhoeic. Thirty-six percent and 55% reported disordered eating practices in the present and past respectively. Eighty-one percent, 17%, and 2% were classified as normal, osteopaenic, and osteoporotic at the femoral neck respectively; 92% were normal, 7% osteopaenic, and 1% osteoporotic at the lumbar spine. No significant differences in femoral neck size-adjusted bone mineral density were observed between eumenorrhoeic and oligo/amenorrhoeic participants (F(2,80) = 0.119, P = 0.73); eumenorrhoeic participants had significantly greater lumbar spine size-adjusted bone mineral density (F(2,80) = 9.79, P = 0.003). Disordered eating participants had significantly lower femoral neck size-adjusted bone mineral density than those reporting no disordered eating (F(2,80) = 13.816, P = 0.000). Twenty-two percent of participants fulfilled triad criteria, while 55% were "at risk" of long-term health problems. An accumulation of conditions resulted in lower lumbar spine size-adjusted bone mineral density (F(1,80) = 6.074, P = 0.004). The current triad components do not identify all women "at risk" and more appropriate criteria such as exercise-related menstrual alterations, disordered eating, and osteopaenia are suggested.

In vivo biostability of polyether polyurethanes with fluoropolymer surface modifying endgroups: resistance to biologic oxidation and stress cracking.

A series of Shore 80A polyether polyurethanes were synthesized with from 0 to 6% fluoropolymer surface modifying endgroups (SME) to provide the bulk properties of the polyurethane with the surface properties of the fluoropolymer. It was theorized that the fluoropolymer would migrate to the surface, forming a monolayer barrier to the oxidants and crack-driving agents released by macrophages and foreign body giant cells in vivo. In a 12-week biostability screening test, samples strained to 400% elongation appeared to be highly stable. In a longer-term study, the fluoropolymer SME significantly delayed, but did not completely prevent the onset of microcracking and the development of environmental stress cracking in strained samples. Even so, the 4 and 6% SME polymers explanted at 2 years performed significantly better than the control. FTIR analysis did not correlate with SME concentration, but increased hydrogen-bonding index and loss of aliphatic ether (autoxidation) did correlate with the visual appearance and density of microcracks. Significant molecular weight reductions were seen for the SME-free control, but were small (within instrumental error) for the polymers with SME. The use of fluoropolymer as a SME does appear to be warranted as a means to improve polyether polyurethane biostability.

In vivo biostability of polysiloxane polyether polyurethanes: resistance to metal ion oxidation.

Polyether polyurethanes are subject to oxidation catalyzed by and through direct (redox) reaction with transition metal ions (cobalt), released by corrosion of metallic parts in an implanted device. Replacing part of the polyether with polysiloxane appears to reduce susceptibility to metal ion oxidation (MIO). In vitro studies indicated that polyurethanes containing 20-35% polysiloxane (PS-20 and PS-35) are about optimum. We implanted tubing samples containing cobalt mandrels in the subcutis of rabbits for periods up to 2 years. After 2 years, only traces of microscopic cracks were seen on half the PS-35 samples, PS-20 significantly delayed MIO, while the polysiloxane-free control was very severely degraded. Infrared spectroscopy established that polyether soft segment oxidation was occurring in PS-20. We could not directly evaluate oxidation in PS-35 because siloxane bands mask the aliphatic ether. Indirect FTIR evidence suggests that there is very slight polyether oxidation that develops early, and then seems to stabilize. The molecular weight of degraded PS-20 decreased. That of microcracked PS-35 decreased negligibly while that of undamaged PS-35 increased slightly after 2-year in vivo. The polysiloxane-free control was profoundly degraded. PS-20 has much improved MIO resistance, while that for PS-35 is highly MIO resistant compared with its polysiloxane-free control.

In vivo biostability of polyether polyurethanes with polyethylene oxide surface-modifying end groups; resistance to biologic oxidation and stress cracking.

Polyethylene oxide (PEO) on polymer surfaces has been reported to reduce cellular adhesion, a very desirable property for cardiac pacing leads. A Shore 80A polyether polyurethane with up to 6% PEO surface-modifying end groups (SME) was evaluated for its chronic in vivo biostability. In a short-term (12 week) screening test, strained samples appeared to develop the same surface oxidation as unmodified polymer, but did not produce visible cracking > or =500x, prompting a longer-term study. By the time the longer-term study was initiated, most of the PEO SME had disappeared from the starting material's surface. After 1 year in vivo, surface oxidation, shallow surface cracking, and environmental stress cracking (ESC) developed on highly strained samples to the point of failure, so that there was no significant difference between the SME polymer and its control (the same polymer without SME). No further change was seen for up to 2 years of implantation. Unstrained PEO SME polymer developed shallow surface cracking, but no ESC up to 2 years of implantation. Thus, PEO SME slightly delayed, but did not stop biodegradation, and under unstrained conditions, has no adverse effect on biostability.