Effect of sarcopenia on short-term outcomes of gastric endoscopic submucosal dissection.

BACKGROUND: Sarcopenia has been reported to be associated with short-term outcomes after gastric endoscopic submucosal dissection (ESD). The "strength, assistance with walking, rising from a chair, climbing stairs, and falls" (SARC-F) questionnaire has been widely used as a screening tool for sarcopenia; however, SARC-F combined with body mass index and age (SARC-F+EBM) has recently been reported to be more useful than SARC-F alone. This study aimed to investigate the association between sarcopenia, measured using SARC-F+EBM, and short-term outcomes after gastric ESD. METHODS: Patients who underwent gastric ESD at our institution between May 2020 and June 2023 were included, and their medical records were reviewed retrospectively. A SARC-F+EBM score ≥ 12 indicated sarcopenia. We evaluated the incidence of adverse events and the length of hospital stay in the sarcopenia and non-sarcopenia groups. RESULTS: Overall, 263 patients (64 and 199 in the sarcopenia and non-sarcopenia groups, respectively) were investigated. The incidence of adverse events with a Common Terminology Criteria for Adverse Events grade ≥ 3 was not significantly different between the sarcopenia and non-sarcopenia groups (6.2% vs. 8.5%, p = 0.791). The proportion of patients with an extended hospital stay (≥ 10 days) was significantly higher in the sarcopenia group than that in the non-sarcopenia group (12.5% [8/64] vs. 3.5% [7/199], p = 0.012). Multivariate analysis showed that sarcopenia and lesions that present technical difficulty in ESD were independent risk factors for extended hospital stays (≥ 10 days). Of the eight cases having extended hospital stays in the sarcopenia group, four were due to the management after gastric ESD, three were due to family circumstances, and one was due to decreased activities of daily living. CONCLUSIONS: Sarcopenia is not a predictor of adverse events associated with gastric ESD. However, patients with sarcopenia may be hospitalized for longer owing to non-ESD-related factors.

The Effects of Hot Isostatic Pressing (HIP) and Heat Treatment on the Microstructure and Mechanical Behavior of Electron Beam-Melted (EBM) Ti-6Al-4V Alloy and Its Susceptibility to Hydrogen.

The effects of the secondary processes of Hot Isostatic Pressing (HIP) at 920 °C and Heat Treatment (HT) at 1000 °C of Electron Beam-Melted (EBM) Ti-6Al-4V alloy on the microstructure and hydrogen embrittlement (HE) after electrochemical hydrogen charging (EC) were investigated. Comprehensive characterization, including microstructural analysis, X-ray diffraction (XRD), thermal desorption analysis, and mechanical testing, was conducted. After HIP, the ß-phase morphology changed from discontinuous Widmanstätten to a more continuous structure, 10 times and ~1.5 times larger in length and width, respectively. Following HT, the ß-phase morphology changed to a continuous "web-like" structure, ~4.5 times larger in width. Despite similar mechanical behavior in their non-hydrogenated state, the post-treated alloys exhibit increased susceptibility to HE due to enhanced hydrogen penetration into the bulk. It is shown that hydrogen content in the samples' bulk is inversely dependent on surface hydride content. It is therefore concluded that the formed hydride surface layer is crucial for inhibiting further hydrogen penetration and adsorption into the bulk and thus for reducing HE susceptibility. The lack of a hydride surface layer in the samples subject to HIP and HT highlights the importance of choosing secondary treatment process parameters that will not increase the continuous ß-phase morphology of EBM Ti-6Al-4V alloys in applications that involve electrochemical hydrogen environments.

On Defect Evolution in EBM Additively Manufactured Ti-6Al-4V via In Situ Investigations.

This study concerned the in situ investigation of the defect evolution and fracture mechanism of additively manufactured (AM) Ti-6Al-4V under uniaxial tensile tests. In order to achieve this, microstructure characterization was initially carried out in order to identify the defects within the matrix of the candidate material. In situ testing was then performed, focusing on the spherical defect to observe its evolution under tensile loading. It was found that, before the fracture stage, the geometric evolution of the spherical defect towards an ellipse shape was dominated by the load in the tensile direction. In addition, the slip band density was found to be aggravated near the spherical defect due to the geometric discontinuity-induced stress concentration. During the fracture process, the defect geometry evolved as an irregular shape, which was mainly attributed to the micro-void-induced localized multi-axial stress state. The fracture analysis indicated that defects play a key role in crack initiation, leading to the fracture of LPBF materials.

Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study.

Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. Methods: This nationwide cross-sectional study included postgraduate year-1 and -2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001). Conclusions: The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes.

Effectiveness of artificial intelligence in detecting and managing depressive disorders: Systematic review.

OBJECTIVES: This study underscores the importance of exploring AI's creative applications in treating depressive disorders to revolutionize mental health care. Through innovative integration of AI technologies, the research confirms their positive effects on preventing, diagnosing, and treating depression. The systematic review establishes an evidence base for AI in depression management, offering directions for effective interventions. METHODS: This systematic literature review investigates the effectiveness of AI in depression management by analyzing studies from January 1, 2017, to May 31, 2022. Utilizing search engines like IEEE Xplore, PubMed, and Web of Science, the review focused on keywords such as Depression/Mental Health, Machine Learning/Artificial Intelligence, and Prediction/Diagnosis. The analysis of 95 documents involved classification based on use, data type, and algorithm type. RESULTS: The study revealed that AI in depression management excelled in accuracy, particularly in monitoring and prediction. Biomarker-derived data demonstrated the highest accuracy, with the CNN algorithm proving most effective. The findings affirm the therapeutic benefits of AI, including treatment, detection, and disease prediction, highlighting its potential in analyzing monitored data for depression management. LIMITATIONS: This study exclusively examined the application of AI in individuals with depressive disorders. Interpretation should be cautious due to the limited scope of subjects to this specific population. CONCLUSIONS: To introduce digital healthcare and therapies for ongoing depression management, it's crucial to present empirical evidence on the medical fee payment system, safety, and efficacy. These findings support enhanced medical accessibility through digital healthcare, offering personalized disease management for patients seeking non-face-to-face treatment.

Application of in vitro bioassays to monitor pharmaceuticals in water: A synthesis of chronological analysis, mode of action, and practical insights.

Pharmaceutical compounds in wastewater have emerged as a significant concern for the aquatic environment. The use of in vitro bioassays represents a sustainable and cost-effective approach for assessing the potential toxicological risks of these biologically active compounds in wastewater and aligns with ethical considerations in research. It facilitates high-throughput analysis, captures mixture effects, integrates impacts of both known and unknown chemicals, and reduces reliance on animal testing. The core aim of the current review was to explore the practical application of in vitro bioassays in evaluating the environmental impacts of pharmaceuticals in wastewater. This comprehensive review strives to achieve several key objectives. First, it provides a summary categorisation of pharmaceuticals based on their mode of action, providing a structured framework for understanding their ecological significance. Second, a chronological analysis of pharmaceutical research aims to document their prevalence and trends over time, shedding light on evolving environmental challenges. Third, the review critically analyses existing bioassay applications in wastewater, while also examining bioassay coverage of representative compounds within major pharmaceutical classes. Finally, it explores the potential for developing innovative bioassays tailored for water quality monitoring of pharmaceuticals, paving the way for more robust environmental monitoring and risk assessment. Overall, adopting effect-based methods for pharmaceutical monitoring in water holds significant promise. It encompasses a broad spectrum of biological impacts, promotes standardized protocols, and supports a bioassay test battery approach indicative of different endpoints, thereby enhancing the effectiveness of environmental risk assessment.

Progress and Challenges of Additive Manufacturing of Tungsten and Alloys as Plasma-Facing Materials.

Tungsten (W) and W alloys are considered as primary candidates for plasma-facing components (PFCs) that must perform in severe environments in terms of temperature, neutron fluxes, plasma effects, and irradiation bombardment. These materials are notoriously difficult to produce using additive manufacturing (AM) methods due to issues inherent to these techniques. The progress on applying AM techniques to W-based PFC applications is reviewed and the technical issues in selected manufacturing methods are discussed in this review. Specifically, we focus on the recent development and applications of laser powder bed fusion (LPBF), electron beam melting (EBM), and direct energy deposition (DED) in W materials due to their abilities to preserve the properties of W as potential PFCs. Additionally, the existing literature on irradiation effects on W and W alloys is surveyed, with possible solutions to those issues therein addressed. Finally, the gaps in possible future research on additively manufactured W are identified and outlined.

Psychiatrists' Illustration of Awe in Empathic Listening Assessments: A Pilot Study.

Background "Awe" is typically an inspiring emotional response to perceptually vast stimuli signifying the transcendence beyond all cognitive frames of reference when we encounter the unexpected. Physicians' experience of awe in clinical care interactions has not been studied in an empirical, evidence-based way. We aim to present a focused study of awe in a psychiatrist's empathic listening (EL) assessments and propose an evidence-based framework to study it. Methodology This is an exploratory case series of a psychiatrist's EL interactions (mean duration/x̄ of 46.17 minutes) with six patients (two males and four females) aged 32-72 years (x̄ =54.67, σ = 16.64). Using the method of autoethnography, the verbal and nonverbal aspects of the EL assessments were analyzed and open-coded to generate qualitative data. Results The study revealed that the data in all the case studies could be classed into two thematic groups, namely, mindfulness and transpersonal mindfulness. The emotions of "awe" and "non-agency" were ubiquitous in all six case studies both for the psychiatrist and patients. Conclusions Recognizing the awe and non-agency in EL interaction is essential in conceptualizing the "mindfulness-to-transcendence" framework and the first step toward the evidence-based study of transcendence/metaphysics in phenomenological psychiatry.

Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study.

BACKGROUND: Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention. OBJECTIVE: This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians. METHODS: We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter. RESULTS: In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively. CONCLUSIONS: Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially "filling the vacuum" and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects.

Results of an international interlaboratory study on dioxin-like activities in drinking-, river surface- and wastewater using DR CALUX bioassay.

Aquatic animals and consumers of aquatic animals are exposed to increasingly complex mixtures of known and as-yet-unknown chemicals with dioxin-like toxicities in the water cycle. Effect- and cell-based bioanalysis can cover known and yet unknown dioxin and dioxin-like compounds as well as complex mixtures thereof but need to be standardized and integrated into international guidelines for environmental testing. In an international laboratory testing (ILT) following ISO/CD 24295 as standard procedure for rat cell-based DR CALUX un-spiked and spiked extracts of drinking-, surface-, and wastewater were validated to generate precision data for the development of the full ISO-standard. We found acceptable repeatability and reproducibility ranges below 36 % by DR CALUX bioassay for the tested un-spiked and spiked water of different origins. The presence of 17 PCDD/Fs and 12 dioxin-like PCBs was also confirmed by congener-specific GC-HRMS analysis. We compared the sum of dioxin-like activity levels measured by DR CALUX bioassay (expressed in 2,3,7,8-TCDD Bioanalytical Equivalents, BEQ; ISO 23196, 2022) with the obtained GC-HRMS chemical analysis results converted to toxic equivalents (TEQ; van den Berg et al., 2013).

Can digitalization effectively promote green energy efficiency? The linear and nonlinear relationship analysis.

In light of the integration of digitalization and the energy revolution, digitalization can be integrated into the energy industry to develop energy-saving technologies and improve resource allocation efficiency. On the basis of 2013-2019 Chinese provincial panel data, this paper measures the level of green energy efficiency based on the super-EBM-DEA model and analyzes the linear relationship, nonlinear relationship, and potential mechanism between digitalization and green energy efficiency. The findings indicate that (1) overall, both China's digitalization and green energy efficiency formed a steady upward trajectory during the sample period. Digitalization showed a spatial characteristic of extending and spreading from the eastern region to the central and western regions. Green energy efficiency was characterized by obvious regional heterogeneity. (2) Progress in digitalization has a significant driving effect on green energy efficiency. Subdimensional analysis shows that this driving effect mainly comes from digital development and digital transactions. (3) The impact of digitalization on green energy efficiency presents a threshold effect of economic agglomeration (with a threshold of 0.0257 and a marginally increasing, positive driving trend) and population agglomeration (with a threshold of 4.2750 and a marginally decreasing, positive driving trend). (4) Decomposing changes in green energy efficiency into scale efficiency and pure technical efficiency, this study shows that pure technical efficiency gains due to digitalization are the main driver of green energy efficiency improvements. Finally, some specific policy recommendations are proposed.

The dilemma of the split between theory and reality as experienced by primary healthcare professionals: a mixed methods study of evidence-based practice in a primary care context.

BACKGROUND: Primary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals' experiences of and attitudes towards working in accordance with EBP in primary care. METHODS: The study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors). RESULTS: The EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: "The dilemma of the split between theory and reality". Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development. CONCLUSIONS: Although the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

Effect-based monitoring of two rivers under urban and agricultural influence reveals a range of biological activities in sediment and water extracts.

Chemical contaminants, such as pesticides, pharmaceuticals and industrial compounds are ubiquitous in surface water and sediment in areas subject to human activity. While targeted chemical analysis is typically used for water and sediment quality monitoring, there is growing interest in applying effect-based methods with in vitro bioassays to capture the effects of all active contaminants in a sample. The current study evaluated the biological effects in surface water and sediment from two contrasting catchments in Aotearoa New Zealand, the highly urbanised Whau River catchment in Tamaki Makaurau (Auckland) and the urban and mixed agricultural Koreti (New River) Estuary catchment. Two complementary passive sampling devices, Chemcatcher for polar chemicals and polyethylene (PED) for non-polar chemicals, were applied to capture a wide range of contaminants in water, while composite sediment samples were collected at each sampling site. Bioassays indicative of induction of xenobiotic metabolism, receptor-mediated effects, genotoxicity, cytotoxicity and apical effects were applied to the water and sediment extracts. Most sediment extracts induced moderate to strong estrogenic and aryl hydrocarbon (AhR) activity, along with moderate toxicity to bacteria. The water extracts showed similar patterns to the sediment extracts, but with lower activity. Generally, the polar Chemcatcher extracts showed greater estrogenic activity, photosynthesis inhibition and algal growth inhibition than the non-polar PED extracts, though the PED extracts showed greater AhR activity. The observed effects in the water extracts were compared to available ecological effect-based trigger values (EBT) to evaluate the potential risk. For the polar extracts, most sites in both catchments exceeded the EBT for estrogenicity, with many sites exceeding the EBTs for AhR activity and photosynthesis inhibition. Of the wide range of endpoints considered, estrogenic activity, AhR activity and herbicidal activity appear to be the primary risk drivers in both the Whau and Koreti Estuary catchments.

Development and validation of the clinical information literacy questionnaire.

BACKGROUND: Clinical Information Literacy (CIL) seems to be a prerequisite for physicians to implement Evidence-Based Medicine (EBM) effectively. This study endeavors to develop and validate a CIL questionnaire for medical residents of Isfahan University of Medical Sciences. MATERIALS AND METHODS: This study employs sequential-exploratory mixed methods in 2019. The participants were 200 medical residents in different specialties; they are selected through the convenience sampling method. In the first (qualitative) phase, an early CIL questionnaire was designed by reviewing literature and performing complementary interviews with health professionals. In the second (validation) phase, the questionnaire's face validity and content validity were confirmed. In the third (quantitative) phase, the construct validity was examined via Item-Response Theory (IRT) model, and the factor loading was computed. The gathered data were analyzed using descriptive statistics, t-test, two-way ANOVA, as well as two-parameter IRT model in R software. RESULTS: In the qualitative phase, the concept of CIL is initially described in seven main categories and 22 subcategories, and the items were formulated. An initial 125-item questionnaire was analyzed by the research team, leading to a 43-item. Through the content validity and face validity examination, we removed 11 and 4 items in the Content Validity Ratio (CVR) and Content Validity Index (CVI), respectively. Throughout the face validity analysis, none of the items were removed. According to the construct validity results, difficulty coefficient, discriminant coefficient, and factor loading were confirmed, most of the other questions achieved a proper factor loading value that is higher than 0.30, and a value of 0.66 was achieved for the reliability via the Kuder-Richardson method. Ultimately, the real-assessment 28-item CIL questionnaire was developed with four components. CONCLUSIONS: The CIL questionnaire could be employed to examine the actual CIL basic knowledge. Because of using the real-assessment approach rather than self-assessment in the design, it can be claimed that this instrument can provide a more accurate assessment of the information literacy status of medical residents. This valid questionnaire is used to measure and train the skills needed by healthcare professionals in the effective implementation of EBM.

Financial Conflicts of Interest Among the Authors of the Clinical Practice Guidelines for Rheumatoid Arthritis in Japan.

Objective To assess the financial relationships between pharmaceutical companies and authors of the 2020 Japan College of Rheumatology Clinical Practice Guidelines (CPG) for the Management of Rheumatoid Arthritis and to evaluate the quality of evidence supporting the guideline recommendations. Methods This retrospective study evaluated financial relationships between all 27 authors of the CPG and pharmaceutical companies in Japan. Personal payments from pharmaceutical companies to these authors between 2016 and 2020 were extracted from publicly disclosed databases for each pharmaceutical company. The quality of the evidence supporting the CPG recommendations was also assessed. Results All 27 authors received personal payments from pharmaceutical companies, totaling $3,683,048 over five years. The median and mean payments per author were $101,624 and $136,409, respectively. Speaking compensations accounted for more than 80% of all personal payments. More than 77.8% (21 authors), 66.7% (18 authors), and 51.9% (14 authors) received more than $10,000, $50,000, and $100,000 in total payments over the five years, respectively. Nevertheless, these financial relationships between the CPG authors and pharmaceutical companies were not disclosed. More than 81.8% of the CPG recommendations were supported by low- or very-low-quality evidence. Of the strong recommendations, 66.7% were supported by low- or very-low-quality evidence. Conclusion Even though all CPG authors received substantial amounts of personal payments from pharmaceutical companies, these conflicts of interest (COIs) were not disclosed in the CPG. These findings underscore the urgent need for policy interventions to enhance transparency, integrity, and reliability in the development of CPGs in Japan.

Pathways to improve energy efficiency under carbon emission constraints in iron and steel industry: Using EBM, NCA and QCA approaches.

Improving environmental performance of energy- and carbon-intensive sectors represented by the iron and steel (IS) industry is of utmost importance to address the challenges of resource depletion and climate change worldwide. This article adopts a global-super-Epsilon-Based Measure (EBM) model with undesirable output for IS energy efficiency estimation, identifies efficiency determinants based on Technology-Organization-Environment (TOE) framework, and analyzes various pathways for efficiency improvement by grouping Necessary Condition Analysis (NCA) and fuzzy-set Qualitative Comparative Analysis (fsQCA). Empirical testing using statistical data of the G20 economies during 2010-2020 demonstrates that: 1) energy efficiency in the IS industry in G20 countries has risen amidst fluctuations, with developed countries performing more efficiently than developing countries; 2) individual factors do not constitute a compulsory condition to achieve high energy efficiency in the IS industry; 3) three different paths to achieve high energy performance are found, that is, technology-structure driven, regulation-economy-technology driven, and regulation-technology-production driven. Heterogenous policy recommendations for efficiency gains in the IS sector of different countries with divergent features are proposed accordingly.

Research on the spatial spillover effect of China's carbon emission trading on total-factor carbon emission efficiency of the power industry.

Improving the carbon emission efficiency in the power industry is a crucial step to achieve China's "double carbon" goal. Carbon emission trading (CET) is an important tool for carbon emission reduction in the power industry. This paper collects data on the power industry of 30 provinces in China from 2005 to 2020 and applies an undesirable super-efficiency epsilon-based measure (EBM) model to measure the total-factor carbon emission efficiency of the power industry (CEEP). A spatial difference-in-differences (SDID) model is constructed to analyze the spatial spillover effects of China's CET on CEEP. Then, a spatial mediating effect model is employed to explore the influence mechanism of CET. The results show that (1) during the sample period, CEEP shows a trend of fluctuating growth, and the overall level of CEEP is still relatively low; (2) CET has a significant promotion effect on CEEP, resulting in an average increase of 6.02% in the efficiency value of the pilot areas; (3) the spatial spillover effect test proves that CET not only improves the CEEP in the pilot areas, but also promotes the improvement of CEEP in the adjacent areas; and (4) the influence mechanism test shows that CET can improve CEEP by reducing energy intensity, promoting technological progress, and upgrading industrial structure. This study provides a new perspective for the measurement of CEEP and expands the research on the emission reduction effect of CET in the power industry. Finally, based on the research results, this study proposes targeted suggestions to provide reference for the government to formulate emission reduction policies.

Environmental quality assessment and spatial spillover effects of three urban agglomerations in China: A Meta-EBM approach.

The new development form of urban agglomeration has greatly promoted economic and social progress in recent years, but it is also facing severe environmental pollution problems. Understanding the status quo of environmental efficiency in urban agglomerations and its leading driving forces is an important prerequisite for formulating energy conservation and emission reduction policies. This research uses the Meta Epsilon Based Measure (Meta-EBM) model to measure the environmental emission efficiency of the Beijing-Tianjin-Hebei（BTH）, Yangtze River Delta (YRD) and Pearl River Delta (PRD) urban agglomerations in China from 2014 to 2018 so as to improve on the inability of traditional Data Envelopment Analysis (DEA) to combine linear and non-linear characteristics, and employs Moran's I index and spatial econometric methods to analyze their spatial dependence and main driving factors. The results demonstrate that the overall environmental efficiency of the three major urban agglomerations in the five years from 2014 to 2018 presents a wave-like development and then tends to be flat. The itemized efficiency of economic outputs has maintained a relatively high level with the environmental output index exhibiting the best efficiency for industrial wastewater, followed by industrial sulfur dioxide (SO2). The scores of the two indicators for inhalable fine particle emissions (PM2.5) and industrial smoke and dust in each urban agglomeration are not ideal, and there are obvious differences between regions. Among them, YRD and PRD are relatively inferior. From the perspective of spatial spillover effects, various indicators show diverse characteristics at different development stages of the regions. Population and Normalized Difference Vegetation Index (NDVI) have a positive effect on environmental efficiency, while both Gross Domestic Product (GDP) per capita and transportation tend to show greater negative effects on regional environmental optimization. This study proposes countermeasures as follows. Each urban agglomeration should set up measures suitable to local conditions and give full play to their location advantages. They can also use space radiation to promote sector economic development and optimize urban environmental benefits.

How to Conduct a Randomized Controlled Trial.

Randomized controlled trials (RCTs) are considered to produce the highest level of evidence in the original studies that informs the practice of evidence-based medicine (EBM). By manipulating an independent variable to study its impact on the outcome, RCTs establish causal relationships and provide valuable insights into clinical treatment. To improve patient outcomes and optimize the use of clinical resources, the practice of EBM plays a crucial role in designing and conducting RCTs to evaluate the effectiveness of clinical interventions. This review aims to explore the essential steps involved in conducting a rigorous and reliable RCT, ensuring the generation of high-quality evidence.