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Green finance is attracting a substantial amount of attention as an essential way to achieve green development. Through a sample of Chinese non-financial A-share listed companies from 2012 to 2020, we use the implementation of the green finance reform and innovation (GFRI) pilot zone policy that was introduced by the Chinese government in 2017 as a quasi-natural experiment and constructs a difference-in-differences-in-differences (DDD) model. The empirical evidence shows that the implementation of green finance reduces the total factor productivity (TFP) of heavily polluting enterprises in pilot zones. Our mechanism analysis shows that the GFRI pilot policy affects the TFP of enterprises through financing constraints and environmental protection investment rather than technological innovation. The heterogeneity analysis finds that the inhibitory effect of the GFRI pilot policy is more prominent in private enterprises, large enterprises, capital intensive enterprises, and small environmental responsibility enterprises. Further, the mechanism heterogeneity of the financing constraints analyses show that the GFRI pilot policy exerts greater levels of pressure on the financing constraints of private enterprises, large enterprises, and small environmental responsibility enterprises. The mechanism heterogeneity of the environmental investment analyses show that the GFRI pilot policy encourages environmental investment in private enterprises, small and medium enterprises, and small environmental responsibility enterprises. Our study provides evidence to support the expansion and promotion of GFRI and useful guidance on ways to implement green transformation in enterprises. [ABSTRACT FROM AUTHOR]

Background Context Purpose: Evaluate the safety and efficacy of a single intradiscal injection of STRO-3+ adult allogeneic mesenchymal precursor cells (MPCs) combined with hyaluronic acid (HA) in subjects with chronic low back pain (CLBP) associated with degenerative disc disease (DDD) through 36-month follow-up.Study Design/setting: A multicenter, randomized, controlled study conducted at 13 clinical sites (12 in the United States and 1 in Australia).Subject Sample: A total of 100 subjects with chronic low back pain associated with moderate DDD (modified Pfirrmann score of 3-6) at one level from L1 to S1 for at least 6 months and failing 3 months of conservative treatment, including physical therapy were randomized in a 3:3:2:2 ratio to receive 6 million MPCs with HA, 18 million MPCs with HA, HA vehicle control, or saline control (placebo) treatment.Outcome Measures: Subjects were clinically and radiographically evaluated at 1, 3, 6, 12, 24, and 36 months postinjection. Subject-reported outcomes including adverse events, LBP on a Visual Analog Scale (VAS), Oswestry Disability Index (ODI), SF-36 and Work Productivity and Activity Index were collected.Methods: Clinical and radiographic measures were collected at each visit. All randomized subjects were included in the safety assessments and analyzed based on the treatment received. Safety assessments included assessments of AEs, physical and radiographic examinations and laboratory testing. Efficacy assessments evaluated changes in VAS, ODI, and modified Pfirrmann (MP) scores between all active and control groups, respectively. Assessments included least squares mean (Mean), LS mean change from baseline (Mean Change) and responder analyses in order to assess the clinical significance of observed changes from baseline. The population for efficacy assessments was adjusted for the confounding effects of post-treatment interventions (PTIs). This study was conducted under an FDA Investigational New Drug application sponsored and funded by Mesoblast.Results: There were significant differences between the control and MPC groups for improvement in VAS and ODI. The PTI-corrected VAS and ODI Means and Mean Change analyses; the proportion of subjects with VAS ≥30% and ≥50% improvement from baseline; absolute VAS score ≤20; and ODI reduction ≥10 and ≥15 points from baseline showed MPC therapy superior to controls at various time points through 36 months. Additionally, the proportion of subjects achieving the minimally important change and clinically significant change composite endpoints for the MPC groups was also superior compared with controls at various time points from baseline to 36 months. There were no significant differences in change in MP score from baseline across the groups. There were also no statistically significant differences in change in modified MP score at the level above or below the level treated between study arms. Both the procedure and treatment were well tolerated and there were no clinical symptoms of immune reaction to allogeneic MPCs. There was a low rate of Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events, and the rates of these events in the MPC groups were not significantly different from the control groups. One TEAE of severe back pain was possibly related to study agent and one TEAE of implantation site infection was considered to be related to the study procedure.Conclusions: Results provide evidence that intradiscal injection of MPCs could be a safe, effective, durable, and minimally invasive therapy for subjects who have CLBP associated with moderate DDD. [ABSTRACT FROM AUTHOR]

The trend towards the development of small satellites, or smallsats, has been increasing over the last few years. However, the harsh space radiation environment in which these smallsats operate provides a challenge to their survivability as their desired mission lengths increase from a few months to several years also. Smallsats typically use commercial off the shelf components (COTS) that are built for ground operations, not space use. Therefore, they may be more susceptible to the hazards of space radiation than traditional spacecraft which are typically designed to withstand the high radiation levels of space. The present paper provides a targeted assessment of representative COTS components using up to date models of the space radiation environment and its effects on smallsats in a polar Low Earth Orbit (LEO). This orbit will be assumed to be sun synchronous (98.5° inclination) and at an altitude of 800 km. We employed the new Solar Accumulated and Peak Proton and Heavy Ion Radiation Environment (SAPPHIRE) model which has been released recently in 2018, ISO-15390 GCR model, and AP8/AE8 models to estimate the space radiation environment for solar particles, galactic cosmic rays (GCRs), and trapped protons and electrons respectively. The basic damage effects that can be produced in materials and electronics in this orbit due to their exposure to the space radiation are evaluated. These effects are the Total Ionizing Dose (TID), Displacement Damage Dose (DDD), and Single Event Effects (SEE) as represented by Single Event Upsets (SEUs). SEU is evaluated for different COTS components which are believed to be representative of an optimum blend of capability and cost-effectiveness for the next generation of smallsats, including 20 nm Xilinx Kintex Ultra Scale FPGA Configuration RAM (XCKU040), 90-nm SRAM, and MLC NAND flash memory (MT29F128G08CBECBH6). For comparative purposes, the analyses are performed for both maximum and minimum solar activity. Based on these comparisons, we find as expected that the space radiation environment parameters vary with solar activity. The fluence of trapped electrons and solar protons at solar maximum are higher than those at solar minimum in contrast to the trapped protons and galactic cosmic rays at low altitudes. On the other hand, TID, DDD, and SEE all show higher values during maximum solar activity than during minimum solar activity. The use of shielding material for small satellites is mandatory for this orbit as observed TID, DDD, and SEES levels that can be reached are potentially of concern to designers. However, using Al shielding thickness of at least 1.5 mm can reduce the radiation effects to acceptable levels, for both maximum and minimum solar activity for missions of moderate (∼3 years) duration. [ABSTRACT FROM AUTHOR]

Abstract DDT remains in use for malaria control in South Africa. We quantified DDTs in aquatic bird eggs from the highly biodiverse northern KwaZulu-Natal, a province of South Africa where DDT has been used for more than 80 years for malaria control. Pelican eggs had the highest ΣDDT concentration (7200 ng/g lipid mass; lm), Little Egret eggs had 6900 ΣDDT lm, African Openbill eggs had 3400 ng/g lm ΣDDT, and White-breasted Cormorant had 2400 ng/g lm. All species had non-significantly different mean concentrations of o,p' -DDT, p,p' -DDT, and ΣDDT, but with significant differences for p,p -DDE, o,p' -DDD, p,p' -DDD, %DDT, %DDD, and %lipid. The thinnest pelican eggshell (0.40 mm) had a ΣDDT concentration of 3300 ng/g lm.; the thickest shell (0.96 mm) had the lowest ΣDDT concentration at 29 ng/g lm; a 58% difference. Linear regressions of concentrations with shell thickness for the pelican eggs were significant for p,p' -DDE and p,p' -DDD, indicating risk of reproductive impairment. Compositional profiles indicate different food webs for the different species. DDT concentrations were lower than from another DDT-sprayed locality in South Africa, possible linked to differences in hydrology and rainfall. We conclude that significant ecotoxic threats associated with DDT remain in this area, and possibly threatens birds from less polluted areas. Our findings suggest continued negative human health and environmental impacts from DDT. There is an urgency to move away from DDT as quickly as possible; alternatively, to implement practices that prevent emissions of DDT to the environment while protecting human life. Graphical abstract Image 1 Highlights • Eggs of four predatory aquatic bird species from KwaZulu-Natal analysed for DDTs. • Concentrations were similar or lower in KwaZulu-Natal than in Limpopo province. • DDT composition suggest pelicans feeding from different food web than other species. • Strong evidence of eggshell thinning associated with DDT for pelican eggs. • Urgent efforts to reduce or eliminate DDT for malaria control needed. [ABSTRACT FROM AUTHOR]

• COVID-19 pandemic has brought challenges and opportunities for firm's digital innovation in China. • We use the DDD model to examine the impact of the COVID-19 pandemic on firms' digital innovation. • The COVID-19 pandemic can promote the digital innovation of firms, especially increase the digital innovation of low leverage, non decline period and tertiary industry firms. This study uses text analysis and machine learning methods to construct an index of firms' digital innovation, and employs the triple difference method (DDD) to empirically examine the impact of the COVID-19 on digital innovation of Chinese listed companies. We find that firms' digital innovation, particularly in terms of digital product innovation, has increased after the COVID-19 outbreak, and the promotion of COVID-19 on digital innovation is more pronounced among low-leverage, non-declining periods, and tertiary industry firms. Our results imply that despite the adverse effects brought about by the COVID-19, such as cash flows constrains and revenues reductions, the opportunities it presents for firms' digital innovation cannot be ignored. [ABSTRACT FROM AUTHOR]

Objective This study aimed to analyze radiologic and clinical results with a minimum 5 years follow-up (FUP) of lateral lumbar total disc replacement for the treatment of symptomatic lumbar degenerative disc disease. Methods We performed a prospective, single-center, clinical, and radiologic study. Patients were treated with lumbar total disc replacement (extreme lateral total disc replacement) by a lateral transpsoas approach. From 2005 to 2012, 60 patients were enrolled (31 male, 29 female; total, 66 levels; average age, 42.8 years [standard deviation (SD), 9.7 years, range, 22–64 years]; mean body mass index, 26.0 [SD, 3.4]). Clinical end points included visual analog scale and Oswestry Disability Index questionnaires, complications, and reoperation. Radiographic end points included heterotopic ossification (McAfee classification), adjacent level disease, and prosthesis migration or subluxation. Results The mean surgical duration was 122 minutes (SD, 45 minutes) with mean 58 mL (SD, 21 mL) of estimated blood loss. No intraoperative complication occurred. The exceptions were 1 patient with postanesthesia apnea and 2 patients with quadriceps motor deficit (resolved within 4 months with physiotherapy). Of 60 patients, 9 were missed to FUP and 51 (85%) were enrolled in the study, with mean FUP of 92 months (range, 60–122 months). In total, 5 levels (9%; 5 of 55) required to be fused. Both removal of the prostheses and interbody fusion were performed by the lateral transpsoas approach. One patient experienced CrCo allergy (at 2 months); 4 experienced persistent pain from different causes (at 7, 9, 24, and 88 months). Five patients (10%) presented with progression at adjacent levels and 2 (4%) required surgery. One patient required sacroiliac fusion at 63 months. There were no complications during the retrieval surgeries. One partial disc migration occurred but the patient refused retrieval. There was no bone bridging in 9% of the discs (grade 0 heterotopic ossification): grade I, 22%; grade II, 31%; grade III, 20%; grade IV (fusion), 18%. Most heterotopic ossification cases (93%) occurred in the lateral aspect of the disc space, and mostly at the contralateral side of the surgical approach. Patient-reported outcomes significantly improved (P < 0.01) at the last FUP. Visual analog scale back pain score was preoperatively 8.5, early postoperatively 2.5, and at last FUP 3.1. Oswestry Disability Index was preoperatively 55%, early postoperatively 31%, and at last FUP 21%. Conclusions This study presents mid-term to long-term results of extreme lateral total disc replacement artificial disc for the treatment of lumbar degenerative disease, with fast mobilization, sustained pain relief, and improved physical function. Despite the low rate of ALDis, some discs evolved to ankyloses and others were retrieved. Lumbar artificial disc replacement by the lateral approach seems to be a safe and effective treatment. [ABSTRACT FROM AUTHOR]

Objective This study critically evaluates the long-term results of standalone anterior lumbar interbody fusion (ALIF), without use of rhBMP-2, as a therapeutic option for symptomatic patients with degenerative disc disease (DDD). Furthermore, this study intends to identify predictive parameters for anterior lumbar interbody fusion outcome. Methods A retrospective cohort study with additional telephone interview to obtain missing data was performed. All patients who underwent an L4–L5 or L5–S1 ALIF-procedure, or both, in the period between 2006 and 2011 were identified. The medical files of 123 patients with 154 fusion levels were reviewed. All patients were contacted by telephone to gather supplementary and missing information. Pain and functionality scores (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), radiologic (intervertebral disc height, Modic and Pfirrmann classifications), and different clinical parameters were gathered. Results The mean age of the population at surgery was 46.2 years. Overall, 59 female and 64 male patients were included in the study. The mean VAS score for back and leg pain improved significantly ( P < 0.001) with 5 and 4.4 points respectively at 3-year follow-up. Modic-type I changes are associated with a better improvement in VAS score for back pain ( P = 0.026), Pfirrmann-grades IV and V and an intervertebral disc height of less than 5 mm are associated with a better improvement in leg pain (respective P -values: 0.045 and 0.033). Overall, 89% of patients would reconsider the surgical intervention. Conclusions The ALIF technique is a durable treatment option for patients with DDD. This study suggests different predictive parameters for treatment outcome. [ABSTRACT FROM AUTHOR]

Introduction: We have recently demonstrated evidence of nigro-striatal denervation, disease progression and response to levodopa in a subgroup of patients with schizophrenia who developed parkinsonism.Objective: In the present study, we investigated whether axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia not necessarily related to chronic administration of antipsychotic drugs (AP) drugs.Methods: From a baseline cohort of 299 schizophrenic patients who did not satisfy the diagnostic criteria for parkinsonism (presence of at least two of the following appendicular signs: bradykinesia, tremor, rigidity), we identified a group of patients who manifested two out of three axial parkinsonian signs (abnormality of trunk posture, hypomimia and short-step gait). Accordingly, we obtained two sub-groups of patients with schizophrenia, with (Schiz-Axial, N = 26), and without parkinsonian axial signs (Schiz-NO-Axial, N = 273). Clinical and demographical variables were compared between groups. The motor section of the Unified Parkinson's disease rating scale (UPDRS) was employed to measure motor disability.Results: Schiz-Axial patients were significantly older (p = 0.007) and had longer disease duration (p = 0.04) compared to Schiz-NO-Axial. The two groups did not differ for variables related to AP treatment. Total UPDRS motor score (p < 0.0001) as well as limb (p < 0.0001) and axial (p < 0.0001) UPDRS sub-scores were increased in Schiz-Axial patients compared to Schiz-NO-Axial.Conclusions: Our findings provide evidence that axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia associated to older age and longer disease duration. [ABSTRACT FROM AUTHOR]

We analyzed dated sediment cores for evidence of Rhothane (dichlorodiphenyldichloroethane; DDD) applications to the Saint Lawrence River at Montreal, QC, Canada for the World Exposition of 1967 (Expo 67). More than 16,000 kg of this pesticide were applied between 1965 and 1967 to abate nuisance shadflies that threatened visitor enjoyment. Concentrations of DDD and DDE in Lake Saint-François, 70 km upstream of Expo 67, reached 12.2 and 11.5 μg/kg dry weight (dw), respectively, with clear peaks between 1945 and 1970, consistent with historical use patterns; DDT was not detected. In Lake Saint-Pierre, ~ 100 km downstream, DDD and DDE concentrations were 2 to 5 times higher, exceeding sediment quality guidelines, and DDT concentrations were as high as 3.8 μg/kg. Once normalized for grain size and organic carbon, peaks of DDD, DDE and DDT were observed between 1945 and 1990 in the sediment record. Ratios of DDD to DDE were 1.0 or less in Lake Saint-François, consistent with their formation as degradation products of DDT. In contrast, ratios exceeded 1.0 in Lake Saint Pierre between 1965 and 1970, coinciding with Rhothane applications at Expo 67. Downstream, subfossil diatom assemblages showed little response to DDD inputs, but the abundance of some chironomid taxa increased while others decreased in tandem with elevated DDD concentrations. Overall, contamination of river sediments and impacts on insect communities by DDD applications at Expo 67 were still evident in sediment records 100 km downstream of Montreal. [ABSTRACT FROM AUTHOR]

Although approximately 123 million people may be exposed to high levels of insecticides through the use of indoor residual spraying (IRS) for malaria control, few studies exist on indoor insecticide contamination due to IRS and its relationship with human exposure. In the present study, we developed a sampling method to collect undisturbed dust from 50 homes in Limpopo, South Africa, a region where dichlorodiphenyltrichloroethane (DDT) has been used in IRS programs to prevent malaria for ~ 70 years. We quantified DDT and its degradation products, dichlorodiphenyldichloroethylene (DDE), and dichlorodiphenyldichloroethane (DDD) in dust samples to determine dust loading levels and compared these levels to paired serum concentrations of p , p′ -DDT and p , p′ -DDE in women residents. p , p′ -DDT and p , p′ -DDE had the highest detection frequencies in both dust (58% and 34% detection, respectively) and serum samples (98% and 100% detection, respectively). Significantly higher detection frequencies for o , p′ -DDT, p , p′ -DDE, and p , p′ -DDD were observed in dust samples collected in buildings that had been previously sprayed for malaria control. We also observed a significant, positive association between dust loading and serum concentrations of p , p′ -DDT and p , p′ -DDE (Spearman's rho = 0.68 and 0.54, respectively). Despite the low detection frequency in dust, our results indicate that undisturbed dust may be a good metric to quantify long-term home exposure to DDT-related compounds and that contamination of the home environment may be an important determinant/source of DDT and DDE exposure. [ABSTRACT FROM AUTHOR]

Magnet resonance imaging (MRI) is the most commonly used imaging modality for diagnosis of degenerative disc disease (DDD). Lack of precise observations and documentation of aspects within the complex entity of DDD might partially be the cause of poor correlation of radiographic findings to clinical symptoms. This literature review summarizes the current knowledge on MRI in DDD and outlines the diagnostic limitations. The review further sensitizes the reader toward awareness of potentially untended aspects of DDD and the interaction of DDD and endplate changes. A summary of the available classifications for DDD is provided. [ABSTRACT FROM AUTHOR]

The objective of the article was to: a) present results from a case cohort pilot study comparing stand-alone ALIF and TLIF and, b) review the literature on studies comparing the clinical outcome of stand-alone ALIF with posterior instrumentation including TLIF or PLIF, in patients with disabling low back pain resulting from degenerative disc disease. ALIF surgery has previously been linked with certain high risk complications and unfavorable long term fusion results. Newer studies suggest that stand-alone ALIF can possibly be advantageous compared to other types of posterior instrumented interbody fusion for a selected group of DDD patients. The methods and material consisted of a cohort pilot study of patients, with DDD treated with stand-alone ALIF or TLIF followed by a literature review conducted through a comprehensive PubMed database search of the English literature. Studies comparing stand-alone ALIF with posterior instrumented interbody fusion were selected and reviewed. Results from the pilot study, n = 21, showed a reduced perioperative blood loss, shorter operative time and a trend towards better pain reduction and decreased use of opioid analgesics in patients undergoing stand-alone ALIF compared to posterior instrumented fusion with TLIF. The literature review included three studies, n = 630. All three studies were retrospective cohort studies. The average patient follow-up was 2-years but with heterogeneous selected outcomes. Two of three articles documented significant advantages when using stand-alone ALIF on outcomes such as ODI, VAS, surgical time, blood loss and patient satisfaction. No study found standalone ALIF inferior in chosen outcomes including fusion. In conclusion the pilot study and the literature review, finds similar clinical outcomes and fusion rates after stand-alone ALIF and posterior interbody fusion. Stand-alone ALIF was associated with a shorter duration of surgery, less perioperative blood loss and a faster improvement post-operatively. Therefore stand-alone ALIF is a viable and important surgical option, which could be considered first choice as surgical treatment. [ABSTRACT FROM AUTHOR]

Summary Background Cascade and restrictive reporting are useful strategies to enhance antibiotic stewardship programs. Methods We combined both strategies to improve the prescribing of antibiotics aimed at Gram-negative infections. Results For Enterobacter aerogenes , the susceptibility rates to amikacin increased from 10% to 100%; for third generation cephalosporins, these rates increased from 55% to 89%. The susceptibility rates of E. aerogenes to cefepime and piperacillin–tazobactam changed little, and the ampicillin susceptibility decreased from 30% in 2009 to 11% in 2010. For Proteus mirabilis , the susceptibility rates increased for third-generation cephalosporins (48% vs. 92%) and piperacillin–tazobactam (10% vs. 98%), with minimal changes for cefepime (96% vs. 93%), ampicillin (69% vs. 73%) and amikacin (96% vs. 84%). For Pseudomonas aeruginosa , the susceptibility rates improved slightly for third-generation cephalosporins (81% vs. 91%) but reduced for piperacillin–tazobactam (99% vs. 59%). Hospital-acquired Clostridium difficile infections decreased from 0.11 to 0.07 per 1000 patient days. Conclusions Selective reporting helps physicians choose the most appropriate antibiotics for their patients within a stewardship program, with reduced C. difficile infection. [ABSTRACT FROM AUTHOR]

In the 1950s and 60s, discharges from a DDT manufacturing plant contaminated a tributary system of the Tennessee River near Huntsville, Alabama, USA. Regulatory action resulted in declaring the area a Superfund site which required remediation and extensive monitoring. Monitoring data collected from 1988, after remediation, through 2011 showed annual decreases approximating first-order decay in concentrations of total DDT and its six principal congeners (p,p'-DDT, o,p'-DDT, p,p'-DDD, o,p'-DDD, p,p'-DDE and o,p'-DDE) in filets from three species of fish. As of 2013, these concentrations met the regulatory requirements of 5 mg/kg or less total DDT for each fish tested. The enantiomer fractions (EF) of chiral o,p'-DDD in smallmouth buffalo and channel catfish were always below 0.5, indicating preferential decay of the (+)-enantiomer of this congener; this EF did not change significantly over 15 years. The often-neglected DDT metabolite p,p'-DDA was found at a concentration of about 20 μg/l in the ecosystem water. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: An antibiotic stewardship program was implemented in our teaching hospital in 1999, and strengthened in 2005. We report its organization and impact on antibiotic use. Methods: This observational study was conducted during a 10-year period (2002–2011). Results: Many interventions were implemented: Infectious Diseases Specialists (IDS) led systematic ward rounds in several departments (1999); nominative antibiotic order form (2005); documentation of IDS advice in the patient''s electronic medical record (2007); IDS advice triggered by the pharmacist (formulary restriction, 2007) or because of positive blood cultures (2009); automated weekly extraction of advice given into a database (2011). Seven thousand two hundred and five pieces of advice were recorded between 2007 and 2011: 63% following physician request, 26% triggered by the pharmacist and 9% because of positive blood cultures. Advice was provided by IDS in 95% of cases (63% by phone). The number of antibiotic prescriptions remained stable since 2005 at around 400 defined daily doses (DDD)/1000 patient-days. Documenting, sharing, and choice of action were improved due to the database. Conclusions: Our antibiotic stewardship program is well accepted by physicians and allows controlling antibiotic use in our hospital. [Copyright &y& Elsevier]

Abstract: Background context: A reduced frequency of discographies might be the result of increasing concern with long-term effects of discography such as disc degeneration. More knowledge is needed in what patient discography is most likely to influence the surgical decision. Purpose: This study was aimed at highlighting how discography affects surgical decisions when performed on one of four different indications in a complicated subgroup of patients with chronic low back pain assumed to be associated with degenerative disc disease (DDD). Study design: Prospective before-after study to analyze how frequently a prediscography preliminary decision was changed and in what direction by adding information from discography in a subgroup of patients with DDD. Patient sample: One hundred thirty-eight patients admitted to a spine clinic more than 4 years with the DDD diagnosis (15% of all) were referred for discography because it was considered that medical history, clinical findings, and magnetic resonance imaging (MRI) were insufficient to make a final assessment on whether to propose surgery/recommend against surgery or what segments to operate on. Outcome measures: These were the recorded changes to prediscography preliminary decisions after information was added from discography. Methods: Before these patients were referred to provocative discography, the surgeon had to select one of four alternative questions/indications being the reason for the discography and choose what decision would have been made if discography would not have been available. The questions/indications were as follows: surgery decided discography to establish whether to treat adjacent segment as well (n=17); several segments degenerated on MRI, pain likely to be discogenic, discography to evaluate what segments to treat (n=56); uncertainty whether pain is discogenic but one suspected segment on MRI (n=38); uncertainty whether pain is discogenic and several segments degenerated in MRI (n=27); the decision after discography was then compared with the prediscography decision and the changes affected by the result of the discography were analyzed. Results: Changes were made to the prediscography decision in 71% of the patients in total. When the surgeon was assured that the pain was discogenic, one segment was added or subtracted in 58% of the patients compared with original prediscography decision. When the surgeon was uncertain if pain was discogenic, the final decision changed from surgery to no surgery in 8%, from no surgery to surgery in 42%, and in cases that were planned for surgery prediscography, one segment was added or subtracted in 17% of the patients. The more certain the surgeon was before discography that the patient''s pain was indeed discogenic, the fewer changes between surgical treatment and no surgical treatment took place. The more uncertain the surgeon was before discography that the patient''s pain was discogenic, the fewer changes in segments to treat took place in patients who went on to surgery. Changes of involved segments were made to all the 27 patients with a preliminary decision for surgical treatment of the L5–S1 segment solely. The corresponding figure for L4–L5 and L4–L5–S1 was 70% and 53%, respectively. Conclusions: A high frequency of decisions was altered in this group of surgeons when using discography as an additional examination in patients where uncertainty remains in how to treat after clinical examination, questioning, and MRI. [Copyright &y& Elsevier]

Abstract: Objectives: The authors report the results of a 15-year antibiotic stewardship policy in the Nancy Teaching Hospital and assess the impact of reinforcing this policy on antibiotic consumption. Methods: Antibiotic stewardship policy was initiated in the mid 90s and then reinforced from 2006 onwards. It was completed by prescription guidelines, nominative prescription of antibiotics, and an operational infectious diseases team (OIDT). The objectives were to promote antibiotic stewardship and decrease the use of extended broad spectrum or costly molecules and intravenous administration. Antibiotics consumption, as defined daily dose per 1000 patient days (DDD/1000PD) and in euros, was monitored from 2005 onwards. Results: Between 2005 and 2008, overall yearly cost of antibiotics dropped by 34% (−€1,308,902) and consumption in DDD/1000PD by 10%. This drop in consumption concerned all antibiotic classes. Teicoplanin prescription dropped by more than 50% and use of fluoroquinolone IV decreased by 15% in 3years. The operational team''s interventions were effective since nearly 80% of suggested prescription amendments were accepted by prescribers. Conclusions: This experiment shows that it is possible to implement antibiotic stewardship policy. Our results prove a significant decrease in overall consumption of antibiotic, a change in prescribing patterns, with a shift towards the use of cheaper antibiotics. [Copyright &y& Elsevier]

Abstract: Persistent organic pollutants (POPs) impact upon human and animal health and the wider environment. It is important to determine where POPs are found and the spatial pattern of POP variation. The concentrations of 90 molecules which are members of four families of POPs and two families of herbicides were measured within a region of Northern France as part of the French National Soil Monitoring Network (RMQS: Réseau de Mesures de la Qualité des Sols). We also gather information on five covariates (elevation, soil organic carbon content, road density, land cover and population density) which might influence POP concentrations. The study region contains 105 RMQS observation sites arranged on a regular square grid with spacing of 16km. The observations include hot-spots at sites of POP application, smaller concentrations where POPs have been dispersed and observations less than the limit of quantification (LOQ) where the soil has not been impacted by POPs. Fifty nine of the molecules were detected at less than 50 sites and hence the data were unsuitable for spatial analyses. We represent the variation of the remaining 31 molecules by various linear mixed models which can include fixed effects (i.e. linear relationships between the molecule concentrations and covariates) and spatially correlated random effects. The best model for each molecule is selected by the Akaike Information Criterion. For nine of the molecules, spatial correlation is evident and hence they can potentially be mapped. For four of these molecules, the spatial correlation cannot be wholly explained by fixed effects. It appears that these molecules have been transported away from their application sites and are now dispersed across the study region with the largest concentrations found in a heavily populated depression. More complicated statistical models and sampling designs are required to explain the distribution of the less dispersed molecules. [Copyright &y& Elsevier]

Abstract: Background context: Advancements in the philosophy of “motion preservation” have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the “equal efficacy” results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. Purpose: To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one- and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. Study design: Prospective, randomized, FDA IDE trials. Patient sample: Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. Outcome measures: Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. Method: Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. Results: At median follow-up of 37 months (range, 24–49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome than pain score (p<.05). Sixteen percent of TDA patients and 18% ACDF patients developed adjacent segment degeneration and were treated actively (p=.3). Concurrent lumbar DDD significantly increased the risk of adjacent segment degeneration (p=.01). Age, gender, smoking habits, and number of levels at index surgery had no predictive value. Conclusion: Total disc arthroplasty is equivalent to ACDF for providing relief from symptoms in the treatment of one- and two-level DDD of cervical spine. The risk of developing adjacent segment degeneration is equivalent after both procedures but is significantly higher in patients with concurrent DDD in lumbar spine. [Copyright &y& Elsevier]

Objective: To establish the effect of chlorinated organic compounds on fertility. Design: We analyzed the influence of polychlorinated biphenyls (PCBs) and pesticides in follicular fluid on the number of fertilized oocytes, the quality of oocytes and embryos, pregnancy rate, and number of embryos cryoconserved in IVF-ET program. Setting: Department of Gynecology and Obstetrics, Charles University, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic. Patient(s): Patients from the Center of Assisted Reproduction. Intervention(s): We collected the follicular fluid of 99 infertile women. Main Outcome Measure(s): The levels of xenobiotics in follicular fluid were examined by high-resolution mass spectrometry and gas chromatography. Correlations between the levels of xenobiotics and IVF-ET program results were statistically analyzed. Result(s): The PCB levels varied from 0.1 to 254.6 ng/g of fat. Levels of DDT and its metabolites varied from 0.3 to 35 228.8 ng/g of fat. A correlation was found between the number of diploid oocytes and the level of DDT, the fertilization of oocytes and level of PCB 158, and the pregnancy rate and the number of embryos cryoconserved and levels of PCB 47. Conclusion(s): Xenobiotics can be detected in the fat compartment of the follicular fluid. Some correlation to the IVF-ET program results was established, to a degree that might be considered of concern, although it was not statistically significant at the 5% level. [Copyright &y& Elsevier]

High levels of p,p′-DDT were detected in Hong Kong breast milk sampled in 1976 and 1985. Monitoring DDT levels in human breast milk in this region is important to identify trends in exposure. As part of the 2002–03 WHO/EURO coordinated exposure study, the concentrations of DDT and its metabolites were determined in 10 pooled milk samples classified by geographic origin and dietary history, comprising milk samples from 238 primiparous mothers giving birth in Hong Kong. Analysis was performed by Gas Chromatography (GC) with electron capture detector and confirmed by GC/Mass Spectrometry. The sum-DDT concentration (range: 0.92–2.05mg/kg fat) was age-dependent and indicated a decreasing trend since the 1970s. Mothers who recently came from mainland China had higher p,p′-DDT to p,p′-DDE ratios, suggesting a more recent exposure compared to women mainly residing in Hong Kong. The average Hong Kong sum-DDT level (1.50mg/kg fat) was among the highest of the contemporary levels (range: 0.12–1.97mg/kg fat; median: 0.40mg/kg fat) in the 16 countries/regions participating in the 2002–03 WHO/EURO exposure study. This is probably due to the previous extensive DDT exposure and continuing use of DDT in agriculture in mainland China. Despite the apparent decrease of DDT body load over 30 years, the environmental health hazard from DDT contamination in the Pearl River Delta region remains a concern. Measures to eradicate illegal use of DDT in mainland China and regular food monitoring programs are needed in the region. Despite the presence of DDT and other persistent organic pollutants in human breast milk, breastfeeding should continue to be strongly supported for its life-long benefits to infants. [Copyright &y& Elsevier]

Abstract: The Chemcatcher passive sampler was primarily developed for the detection and quantification of priority organic pollutants (e.g., polycyclic aromatic hydrocarbons) in water. In the present study, this prototype was evaluated for highly hydrophobic compounds such as the tetrabrominated diphenyl ether BDE-47, the hexabrominated diphenyl ether BDE-153, and the historic pesticide DDT with its main metabolites (DDE and DDD). The sampling device consists basically of a receiving phase with high affinity for organic chemicals which is separated from the environment by a diffusion limiting membrane, both placed in a rigid PTFE body. C18 Empore® disks were evaluated as receiving phase, obtaining a better accumulation when impregnated until saturation with n-octanol. As diffusion membrane, low density polyethylene was chosen over polyethersulphone. Once optimized its accumulation capacity for the target compounds, the linear behaviour of this accumulation was investigated and shown to be satisfactory in a period of 15 days. Preliminary uptake rates calculated from that accumulation anticipate the utility of this device for the detection of DDXs and the PBDEs, as calculated limits of detection are lower than usually reported environmental concentrations. [Copyright &y& Elsevier]

Abstract: DDT (1,1-bis(4-chlorophenyl)-2,2,2-trichloroethane) was dechlorinated in 2-propanol/methanol (99:1v/v) by means of stoichiometric reaction with NaOH and subsequent catalytic dechlorination over Pd/C catalyst. When DDT was treated with a molar excess of NaOH ([NaOH]/[DDT]=9) in the alcohol mixture at room temperature, DDT disappeared within 15min. The reaction of DDT produced an equimolar amount of HCl to yield DDE (1,1-bis(4-chlorophenyl)-2,2-dichloroethylene). The produced DDE was successfully dechlorinated to a chlorine-free product (1,1-diphenylethane, 97% yield) by addition of Pd/C to the alkaline solution and heating at 40°C for 4h. DDD (1,1-bis(4-chlorophenyl)-2,2-dichloroethane) was also dechlorinated to 1,1-diphenylethane in a similar manner. Possible dechlorination pathways for DDT, DDE, and DDD were investigated by observation of the partially dechlorinated intermediates by means of gas chromatography/mass spectrometry (GC/MS). [Copyright &y& Elsevier]

Abstract: An analytical methodology was proposed and validated to be applied to the determination of p,p′-DDT and its metabolites p,p′-DDE and p,p′-DDD in fish oil. The analytical procedure presented in this paper involves a single-step clean up process prior to the analysis. A solution of 1,2,3,4-tetrachloronaphtalene was used as internal standard. The analytical technique used was gas chromatography coupled to an electron capture detector. Details on the validation process are provided. The limits of detection ranged from 2.6 to 4.7 pg μL−1. The BCR 598 standard reference material (cod liver oil) was used to evaluate the performance of the methodology with satisfactory recoveries for all the compounds. The analytes were determined in three different fish oil pills sold in Spain as a supplementary vitamin support. The sum of p,p′-DDT and metabolites was from 13.2 to 51.3 ng g−1, the dominant compound being p,p′-DDE. [Copyright &y& Elsevier]

Summary: Objectives: In 2003 Turkish government released a new budget application instruction for regulating the usage of parenteral antibiotics inside and outside of the hospitals. In this study it was aimed to evaluate the effect of this instruction on the overall usage of restricted antibiotics, their cost, overall mortality, bacterial resistance patterns and nosocomial infection rates in intensive care units (ICUs) of our setting for March–October 2002 and March–October 2003 periods. Methods and results: Overall daily defined dose/1000 patients/day of restricted drugs decreased, whereas unrestricted drugs increased significantly after the instruction. The cost of all analysed drugs in 2003 period was 540,303USD (−19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased significantly (p <0.05). When all microbiologically confirmed nosocomial bacteremia cases during the study period were analysed, amoxycilline/clavulanate, ciprofloxacin, cefuroxime, cefotaxime, piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae decreased significantly (p <0.05). Amikacin resistance in Escherichia coli and Acinetobacter baumannii increased significantly (p <0.05). Conclusion: Antibiotic control is one of the most important and significant ways to save money, and to prevent antibacterial resistance. [Copyright &y& Elsevier]

Abstract: Three piperidine derivatives of 2,9-dimethyl-4,7-diazadecane-2,9-dithiol (DDD), NEPDDD, NEMPDDD, and NEMMPDDD, were synthesized and used as catalysts in DNA cleavage. Under physiological conditions, a series of experiments have been done. The effects of DNA cleavage with three ligands were studied under different concentrations, cleavage time, and pH values. The results strongly suggested that the plasmid DNA (pUC 19) can be cleaved efficiently by these ligands. For the cleavage reaction catalyzed by NEMPDDD, Form I DNA could convert to Form II completely, and the DNA-cleavage mechanism involved an oxidative pathway. [Copyright &y& Elsevier]

We measured the enantiomeric fractions (EF) of various organochlorine pesticides in air samples from Indiana, Arkansas, and Louisiana collected in 2002–2003. Enantiomeric fractions for o,p′-DDD are reported here for the first time, and they suggest preferential depletion of one enantiomer over the other, with a mean value of 0. 44. For the chlordanes, the EFs followed the same trends as reported in previous studies. EF values for trans-chlordane (TC) were slightly below 0. 5, and values for cis-chlordane (CC) were slightly above 0. 5. For cis-heptachlor epoxide (HEPX), the EF values averaged 0. 65, indicating a clear preferential depletion of the (−)-enantiomer. For TC and CC, no clear distinction could be made between the values measured among the three sites, suggesting that it is not possible to use these EF values as “source signatures”. For HEPX, the Indiana site had significantly higher EF values than did the Arkansas site; this difference may reflect differences in the historic use of heptachlor in these two regions. [Copyright &y& Elsevier]

Abstract: Significant concentrations of chlorinated pesticides such as 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT) and its two main transformation products, 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (DDD) and 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (DDE) are still present in soil and sediment systems more than 30 years after DDT use was banned in the United States. DDT enters waterways via the runoff from industrial point sources, agricultural lands and atmospheric deposition. We evaluated zero-valent iron (Fe0), ferrous sulfide (FeS), as well as combining them with hydrogen peroxide (H2O2) as viable treatment technologies for degrading DDT in an aqueous solution. Treatment of DDT with Fe0 and FeS resulted in approximately 88% and 56% transformation of DDT within 150h, respectively. DDE production was insignificant in all systems. The DDT removal was slower with FeS than with Fe0, but the amounts of DDD and DDE produced did not exceed baseline. Treatment with a 1:1 mixture of Fe0–FeS removed about 95% of the added mass of DDT within 4days and generated significant amounts of DDD and minor amounts of DDMU. When small amounts of H2O2 were introduced halfway through the Fe0 and FeS treatment times, the mass of DDT decreased by 87% and 96%, respectively, within 2days. Our results demonstrate that mixtures of Fe0–FeS in combination with H2O2 can be used for rapid and efficient removal of DDT from aqueous solutions. [Copyright &y& Elsevier]

Abstract: In 1998, one of the largest determinations of organochlorine pesticides in a representative sample of a Spanish population (682 serum samples from the Canary Islands) was made in the context of the “Canary Islands Nutrition Survey” (ENCA). In the Canary Islands, extensive farming areas have been developed in these last decades, with greenhouses dedicated to intensive cultivation using DDT in huge amounts. In Spain, similarly to other European countries, DDT was banned in the late 1970s. The pesticide residues in human serum are indicative of past and present exposure to them. Our objective is to point out the differences of pesticide contamination between islands; and together with this, if a connection could be established with gender, age, or habitat of subjects. Concentration of selected persistent organochlorine pollutants (p,p′-DDT, o,p′-DDT, p,p′-DDE, o,p′-DDE, p,p′-DDD, and o,p′-DDD) was measured with gas chromatography-electron capture detector. Almost all of the samples (99.3%) presented detectable levels of some DDT-derivatives, being p,p′-DDE the most frequently detected organochlorine. The median concentration of total DDT body burden, expressed in ng/g fat, present in the Canary Islands (370 ng/g fat) was similar to that found in other European countries, although it was noteworthy that a fourth of the population showed a total DDT body burden higher than 715 ng/g. Interestingly, statistical significant differences were found in serum levels of organochlorine pesticides between islands, being these levels higher in people from Tenerife and Gran Canaria (415 and 612 ng/g fat, respectively), the islands that present both highest population and highest surface devoted to intensive agriculture. As expected, serum levels of both total DDT body burden and p,p′-DDE increased with age. Statistically significant differences were also found in relation to gender, women showing higher levels of these organochlorine pesticides than men. One of the most relevant findings of this work is the presence of a very high DDT/DDE ratio in people from the Canary Islands, thus indicating a chronic exposure to DDT that persists nowadays. DDT and its derivatives are considered as xenoestrogens, and they have been linked to breast cancer. Having into account that the Canary Islands present high incidence and mortality for breast cancer, our results point to the possibility that these environmental contaminants may be playing a determining role that must be investigated in detail. The high levels of DDT and its derivatives in serum from people living in this Archipelago should be considered a matter of public health concern. [Copyright &y& Elsevier]

Abstract: A pilot study found that DDT breakdown at the GC inlet was extensive in extracts from some—but not all—samples with high organic carbon contents. However, DDT losses could be prevented with a one-step extraction-cleanup in the Soxflo instrument with dichloromethane and charcoal. This dry-column procedure took 1h at room temperature. It was tested on spiked soil and peat samples and validated with certified soil and sediment reference materials. Spike recoveries from freshly spiked samples ranged from 79 to 111% at 20–4000μg/kg concentrations. Recoveries from the real-world CRMs were 99.7–100.2% of DDT, 89.7–90.4% of DDD and 89.6–107.9% of DDE. It was concluded that charcoal cleanups should be used routinely during surveys for environmental DDX pollution in order to mitigate against unpredictable matrix-enhanced breakdown in the GC. [Copyright &y& Elsevier]

In human medicine, the defined daily dose is used as a technical measure of drug usage, which is independent of the variations in the potency of the active compound and the formulation of the pharmaceutical product—therefore providing a measure of the relative importance of different drugs. A national system of animal defined daily doses (ADD) for each age-group and species has been defined in VetStat (the Danish national system monitoring veterinary therapeutic drug use). The usage is further standardized according to the number of animals in the target population, acquired from production data on the national level or on herd size by species and age in the Danish central husbandry register (CHR). Statistics based on standardized measures of VetStat data can be used for comparison of drug usage between different herds, veterinary practices, or geographic regions (allowing subdivision by animal species and animal production class, route of administration, disease categories, season and geographic location). Individual statistics are available as interactive reports to the control authorities, farmers and veterinary practitioners by a secure access to the database. The ADD also is used in pharmaco-epidemiogical research and to assist in the interpretation of resistance-surveillance data. [Copyright &y& Elsevier]

: ObjectivesA randomized trial was done to compare single-chamber atrial (AAI) and dual-chamber (DDD) pacing in patients with sick sinus syndrome (SSS). Primary end points were changes in left atrial (LA) size and left ventricular (LV) size and function as measured by M-mode echocardiography.: BackgroundIn patients with SSS and normal atrioventricular conduction, it is still not clear whether the optimal pacing mode is AAI or DDD pacing.: MethodsA total of 177 consecutive patients (mean age 74 ± 9 years, 73 men) were randomized to treatment with one of three rate-adaptive (R) pacemakers: AAIR (n = 54), DDDR with a short atrioventricular delay (n = 60) (DDDR-s), or DDDR with a fixed long atrioventricular delay (n = 63) (DDDR-l). Before pacemaker implantation and at each follow-up, M-mode echocardiography was done to measure LA and LV diameters. Left ventricular fractional shortening (LVFS) was calculated. Analysis was on an intention-to-treat basis.: ResultsMean follow-up was 2.9 ± 1.1 years. In the AAIR group, no significant changes were observed in LA or LV diameters or LVFS from baseline to last follow-up. In both DDDR groups, LA diameter increased significantly (p < 0.05), and in the DDDR-s group, LVFS decreased significantly (p < 0.01). Atrial fibrillation was significantly less common in the AAIR group, 7.4% versus 23.3% in the DDDR-s group versus 17.5% in the DDDR-l group (p = 0.03, log-rank test). Mortality, thromboembolism, and congestive heart failure did not differ between groups.: ConclusionsDuring a mean follow-up of 2.9 ± 1.1 years, DDDR pacing causes increased LA diameter, and DDDR pacing with a short atrioventricular delay also causes decreased LVFS. No changes occur in LA or LV diameters or LVFS during AAIR pacing. Atrial fibrillation is significantly less common during AAIR pacing. [Copyright &y& Elsevier]

The potential of performing photochemical studies in solid phase microextraction (SPME) fibers, “photo-SPME”, to study the photodegradation of p,p′-DDT and two of its major degradation products, p,p′-DDE and p,p′-DDD, is shown. Analyses were carried out by gas chromatography mass spectroscopy detection. DDT was extracted from aqueous solutions using five different commercial coatings. The fibers were then exposed to UV light emitted by a low-pressure mercury lamp. After 30 min of irradiation, the degradation of DDT only occurred in polydimethylsiloxane fibers. The on-fiber degradation kinetics of p,p′-DDT was studied from 2 to 60 min. A large number of photoproducts were generated and their kinetic behavior was studied. In order to clarify the possible photoreaction pathways for DDT, individual water solutions containing p,p′-DDD or p,p′-DDE were prepared and photo-SPME was performed for each compound at different irradiation times. On the basis of the photoproducts identified, some photodegradation pathways are proposed. Finally, aqueous photodegradation studies followed by SPME were performed and compared to the photo-SPME. This work will show the enormous potential of photo-SPME to perform photodegradation studies. [Copyright &y& Elsevier]

The acute or chronic effect of VVI pacing on P wave duration in the same patient with dual chamber pacemaker has not been studied before. Hence, with the purpose of determining whether VVI pacing increases dispersion of atrial refractoriness, we undertook a comparative study with the aid of a simple noninvasive approach, namely P wave dispersion (PWD) determined from surface electrocardiogram in the same patients who were implanted with dual chamber pacemakers. Pmax duration calculated in VVI paced mode was significantly higher than in VDD paced mode (121±21 vs. 111±17 ms, P=0.021). PWD (33±15 vs. 40±23 ms, P=0.062) did not demonstrate any significant difference between VDD and VVI paced modes, respectively. In conclusion, the findings of our study suggest that short-term VVI pacing itself does not have any direct effect on PWD in patients with dual chamber pacemakers. Different pacing modes in the long term might be responsible for altering PWD and the occurrence of atrial fibrillation while affecting the autonomic nervous system. [Copyright &y& Elsevier]

The introduction or renewal of information systems conventionally begins with data modelling. In the domain of land administration, like others, the process is challenging: complex laws and regulations, lengthy process descriptions, shared organisational responsibilities, differing information encodings and formats, and seeking compliance with the LADM ISO 19152 standard, must be considered. Between 2016 and 2018, The Netherlands' Cadastre, Land Registry and Mapping Agency – in short, Kadaster – successfully undertook the renewal of the information system supporting its deeds registration. The previous system dated back to the 1980s. In-house data modelling specialists led the program, the most extensive undertaken in decades. Inspired by action-research principles, the process and resultant lessons are documented using a case study approach. It is shown that beyond Model Driven Architectures, other model-driven methodologies, such as Domain-Driven Design, are entirely useful in the land administration domain. A domain is usually more extensive than a few objects, and to make it more manageable, DDD divides a domain into subdomains. The DDD term 'problem domain' is used to define a functional area within a context such as an organisation or department. The terms domain in DDD and LADM have common characteristics as considering contexts such as a land registry and a cadastre. Evans (2003) and Vernon (2013) articulate how DDD is a set of design practices, techniques and fundamental principles, terms, and implications to facilitate the development of software projects within complex domains, used to guide software developers and domain experts to share and represent models of knowledge from the domain. In DDD, the ubiquitous language is also essential in intersecting the jargons between domain experts and IT experts. The LADM provides a formal language for describing similarities and differences for describing the many aspects of the land administration domain. The approach demands greater participation from domain experts: they lead modelling of the current state and its evolution: the events. The Annex N of ISO 19152 describes that LADM covers both event-based and state-based modelling via LA_Source and VersionedObject. The application of Event-Based Modelling and Event Sourcing is still relatively novel to the LA domain. Event Sourcing ensures that all current state changes are stored as a sequence of events, enabling querying and state reconstruction. The new information system is considered futureproof, delivering improvements for deed registration times, monitoring, traceability/auditing, history management and interoperability. Further research suggestions include undertaken Domain-Driven Design in other contexts, particularly those implementing LADM. • Domain-Driven Design applied to land administration system development. • Event-Driven approach in a deed system for land administration. • Event Sourcing and Command Query Responsibility Segregation novel for implementation land administration. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance is a worldwide issue whereby a more prudent use of medications is needed, especially for those antimicrobials (AM) classified as 'highest priority critically important antimicrobials' (HPCIAs) which are likely contributors to the development of resistance. So far, data on antimicrobial use (AMU) in EU are mainly reported at sales level while information on real use, mostly in beef production, is poor. The most reliable indicator to measure AMU is the treatment incidence (TI100) calculated by using the Defined Daily Dose Animal (DDDA) as stated by the European Medicines Agency (EMA). Although Italy ranks second among EU countries with regard to the AM sales in livestock production, data on AMU of the Italian beef production is still lacking, whereby the aim of this study was to provide information on the current scenario of AMU in Italian beef cattle. Data were collected from January 2016 to April 2019 from specialized beef fattening farms located in the north of Italy yielding a final dataset of 1376 batches. Data on performance and AM agents used in the study were collected and TI100 indexes per batch were calculated according to both Italian and EMA's DDDA. A Kruskal-Wallis test was used to check for differences between years and seasons. Results showed a significant variation between years and seasons with a reduction of TI100 based on Italian DDDA as time progressed (P < 0.05). However, about 40% of the total amount of treatments administered were HPCIAs with macrolides accounting for the 27.7% of the total amount. The most common reasons of administration of AM were respiratory diseases (68.9%) and lameness (17.6%). Penicillins was the class of AM used on the highest proportion of batches (84.4%) showing that broad-spectrum AM were widely exploited among herds. In summary, despite a general reduction of AMU in beef cattle over time, a great use of HPCIAs was still observed suggesting that AM stewardship for Italian beef production should pay particular emphasis on the reduction of HPCIAs use. This shows how overall knowledge on where efforts need to be optimized is important to develop targeted strategies for a more responsible AM stewardship. Results of the current study may also contribute to define national and EU benchmark criteria for AMU, as a comparison with studies carried out in other countries or on other food-producing sectors is still challenging to achieve. [ABSTRACT FROM AUTHOR]

Many developing countries including China have launched command-and-control regulation (CCR) to achieve sustainable development. However, we know little about whether CCR promotes green innovation performance. This study empirically analyses the impact of CCR, which is represented by China's eleventh Five-Year Plan (FYP) environmental regulation, on enterprise green innovation performance and use green innovation efficiency as the measure of innovation. Super-SBM DEA model, difference-in-differences (DID) and difference-in-difference-in-differences (DDD) methods are employed to investigate 496 industrial enterprises in China's A-share market for the 2002–2017 period. Moreover, we distinguish each treat group from the control group by using continuous variables and consider enterprise features in the analysis. The results find that, in general, the eleventh FYP environmental regulation negatively influences enterprise green innovation efficiency in a short-term through reducing cash flows. More specifically, the eleventh FYP CCR generates a detrimental effect on small enterprises, state-owned enterprises, and enterprises in China's western and eastern regions. Overall, this empirical analysis suggests that the government should consider the effect of CCR on economy and focus on the heterogeneity of enterprises during designing environmental policies. Unlabelled Image • Command-and-control regulation's impact on green innovation efficiency is studied. • Super-SBM DEA, DID and DDD methods are used to analyse 496 industrial enterprises. • Command-and-control regulation harms green innovation efficiency in a short-term. • Enterprises' heterogeneity should be considered in designing environmental policy. [ABSTRACT FROM AUTHOR]