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An accurate emission inventory is a crucial part of air pollution management and is essential for air quality modelling. One source in an emission inventory, an industrial source, has been known with high uncertainty in both location and magnitude in China. In this study, a new reallocation method based on blue-roof industrial buildings was developed to replace the conventional method of using population density for the Chinese emission development. The new method utilized the zoom level 14 satellite imagery (i.e. Google®) and processed it based on hue, saturation, and value (HSV) colour classification to derive new spatial surrogates for province-level reallocation, providing more realistic spatial patterns of industrial PM2.5 and NO2 emissions in China. The WRF-CMAQ-based PATH-2016 model system was then applied with the new processed industrial emission input in the MIX inventory to simulate air quality in the Greater Bay Area (GBA) area (formerly called Pearl River Delta, PRD). In the study, significant root mean square error (RMSE) improvement was observed in both summer and winter scenarios in 2015 when compared with the population-based approach. The average RMSE reductions (i.e. 75 stations) of PM2.5 and NO2 were found to be 11 µg m−3 and 3 ppb, respectively. Although the new method for allocating industrial sources did not perform as well as the point- and area-based industrial emissions obtained from the local bottom-up dataset, it still showed a large improvement over the existing population-based method. In conclusion, this research demonstrates that the blue-roof industrial allocation method can effectively identify scattered industrial sources in China and is capable of downscaling the industrial emissions from regional to local levels (i.e. 27 to 3 km resolution), overcoming the technical hurdle of ∼ 10 km resolution from the top-down or bottom-up emission approach under the unified framework of emission calculation.

Asia has attracted research attention because it has the highest anthropogenic emissions in the world, and the Model Inter-Comparison Study for Asia (MICS-Asia) phase III was carried out to foster our understanding of the status of air quality over Asia. This study analyzed wet deposition in southeast Asian countries (Myanmar, Thailand, Lao People's Democratic Republic (PDR), Cambodia, Vietnam, the Philippines, Malaysia, and Indonesia) with the aim of providing insights into the seasonal variation of wet deposition. Southeast Asia was not fully considered in MICS-Asia phase II due to a lack of observational data; however, the analysis period of MICS-Asia III, namely the year 2010, is covered by ground observations of the Acid Deposition Monitoring Network in East Asia (EANET), and the coordinated simulation domain was extended to cover these observation sites. The analyzed species are wet depositions of S (sulfate aerosol, sulfur dioxide (SO2), and sulfuric acid (H2SO4)), N (nitrate aerosol, nitrogen monoxide (NO), nitrogen dioxide (NO2), and nitric acid (HNO3)), and A (ammonium aerosol and ammonia (NH3)). The wet deposition simulated with seven models driven by a unified meteorological model in MICS-Asia III was used with the ensemble approach, which effectively modulates the differences in performance among models. By comparison with EANET observations, although the seven models generally captured the wet depositions of S, N, and A, there were difficulties capturing these in some cases. Considering the model performance for ambient aerosol concentrations over southeast Asia, this failure of models is considered to be related to the difficulty in capturing the precipitation in southeast Asia, especially during the dry and wet seasons. Generally, meteorological fields overestimate the precipitation during the dry season, which leads to the overestimation of wet deposition during this season. To overcome this, a precipitation-adjusted approach that scaled the modeled precipitation to the observed value was applied, and it was demonstrated that the model performance was improved. Satellite measurements were also used to adjust for precipitation data, which adequately accounted for the spatiotemporal precipitation patterns, especially in the dry season. As the statistical scores were mostly improved by this adjustment, the estimation of wet deposition with precipitation adjustment was considered to be superior. To utilize satellite measurements, the spatial distribution of wet deposition was revised. Based on this revision, it was found that Vietnam, Malaysia, and Indonesia were upward corrected, and Myanmar, Thailand, Lao PDR, Cambodia, and the Philippines were downward-corrected; these corrections were up to ±40 %. The improved accuracy of precipitation amount was key to estimating wet deposition in this study. These results suggest that the precipitation-adjusted approach has the potential to obtain accurate estimates of wet deposition through the fusion of models and observations.

Black carbon (BC) emissions play an important role in regional climate change in the Arctic. It is necessary to pay attention to the impact of long-range transport from regions outside the Arctic as BC emissions from local sources in the Arctic were relatively small. The task force Hemispheric Transport of Air Pollution Phase 2 (HTAP2) set up a series of simulation scenarios to investigate the response of BC in a given region to different source regions. This study investigated the responses of Arctic BC concentrations and surface temperature to 20 % anthropogenic emission reductions from six regions in 2010 within the framework of HTAP2 based on ensemble modeling results. Emission reductions from East Asia (EAS) had the most (monthly contributions: 0.2–1.5 ng m−3) significant impact on the Arctic near-surface BC concentrations, while the monthly contributions from Europe (EUR), Middle East (MDE), North America (NAM), Russia–Belarus–Ukraine (RBU), and South Asia (SAS) were 0.2–1.0, 0.001–0.01, 0.1–0.3, 0.1–0.7, and 0.0–0.2 ng m−3, respectively. The responses of the vertical profiles of the Arctic BC to the six regions were found to be different due to multiple transport pathways. Emission reductions from NAM, RBU, EUR, and EAS mainly influenced the BC concentrations in the low troposphere of the Arctic, while most of the BC in the upper troposphere of the Arctic derived from SAS. The response of the Arctic BC to emission reductions in six source regions became less significant with the increase in the latitude. The benefit of BC emission reductions in terms of slowing down surface warming in the Arctic was evaluated by using absolute regional temperature change potential (ARTP). Compared to the response of global temperature to BC emission reductions, the response of Arctic temperature was substantially more sensitive, highlighting the need for curbing global BC emissions.

Background The cost utility of image-guided surveillance using computed tomography (CT) and positron emission tomography (PET)-CT to planned postradiation neck dissection (PRND) was compared for the management of advanced nodal human papillomavirus-positive oropharyngeal cancer following chemoradiation. Methods A universal payer perspective was adopted. A Markov model was designed to simulate four treatment approaches with 3-month cycles over a lifetime horizon: 1) CT surveillance, 2) standard PET-CT surveillance, 3) a novel PET-CT approach with repeat PET at 6 months postchemoradiation for equivocal responders, and 4) PRND. Parameters including probabilities of CT nodal progression/resolution, PET avidity, recurrence, and survival were obtained from the literature. Costs were reported in 2019 Canadian dollars and utilities were expressed in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were performed to evaluate model uncertainty. Results PET-CT surveillance dominated CT surveillance and PRND in the base case scenario, and the novel PET-CT approach was the most cost-effective strategy across a wide range of variables tested in one-way sensitivity analysis. On probabilistic sensitivity analysis, novel PET-CT surveillance was the most cost-effective strategy in 78.1% of model iterations at a willingness-to-pay of $50,000/QALYs. Novel PET-CT surveillance resulted in a 49% lower rate of neck dissection compared with traditional PET-CT, and yielded an incremental benefit of 0.14 QALYs with average cost savings of $1309. Conclusions Image-guided surveillance including PET-CT and CT are more cost effective than PRND. The novel PET-CT approach with repeat PET for equivocal responders was the dominant strategy and yielded both higher benefit and lower costs compared with standard PET-CT surveillance.

ObjectiveTo prospectively examine associations between smoking and nicotine abstinence and pain trajectory over 12 months among smokers with low, moderate, and severe pain and to assess whether these associations differ over time.DesignA secondary analysis of the “Proactive Outreach for Smokers in VA Mental Health” study, a randomized controlled trial of proactive outreach for veteran smokers engaged in U.S. Department of Veterans Affairs (VA) mental health care.MethodsParticipants were categorized into “low” (n = 616), “moderate” (n = 479), and “severe” pain (n = 656) groups according to baseline pain score. Associations between self-reported abstinence from smoking and nicotine at 6 and 12 months and pain trajectory, measured via the PEG scale (Pain intensity, Enjoyment of life, General activity) composite score, were assessed through the use of general linear mixed models. Interaction tests assessed whether these associations differed at 6 and 12 months. Analyses were conducted within the overall sample and within the separate pain groups.ResultsThere were significant interactions in the overall sample and the low and moderate pain groups, such that 7-day point prevalence smoking abstinence was associated with lower pain scores at 6 but not 12 months. In the severe pain group, 7-day abstinence from both smoking and nicotine was associated with lower pain scores across both time points. Six-month prolonged abstinence was not associated with pain scores.ConclusionsIn this prospective analysis conducted among veteran smokers engaged in mental health services, 7-day abstinence from smoking and nicotine was associated with significantly lower levels of pain. Education efforts could help better inform smokers on the relationship between smoking and pain.

Objective Individuals with posttraumatic stress disorder (PTSD) smoke at higher rates compared to the general population and experience significant barriers to initiating cessation treatment. Proactive outreach addresses these barriers by directly engaging with smokers and facilitating access to treatment. The objective of the present study was to evaluate a proactive outreach intervention for increasing rates of treatment utilization and abstinence among veteran smokers with and without PTSD. Method This is a secondary analysis of a randomized controlled trial conducted from 2013 to 2017 that demonstrated the effectiveness of proactive outreach among veterans using Veterans Affairs mental health care services. Electronic medical record data were used to identify participants with (n = 355) and without (n = 1,583) a diagnosis of PTSD. Logistic regressions modeled cessation treatment utilization (counseling, nicotine replacement therapy [NRT], and combination treatment) and abstinence (7-day point prevalence and 6-month prolonged at 6- and 12-month follow-ups) among participants randomized to proactive outreach versus usual care in the PTSD and non-PTSD subgroups, respectively. Results Compared to usual care, proactive outreach increased combined counseling and NRT utilization among participants with PTSD (odds ratio [OR] = 26.25, 95% confidence interval [3.43, 201.17]) and without PTSD (OR = 10.20, [5.21, 19.98]). Proactive outreach also increased 7-day point prevalence abstinence at 12 months among participants with PTSD (OR = 2.62, [1.16, 5.91]) and without PTSD (OR = 1.61, [1.11, 2.34]). Conclusions Proactive outreach increased treatment utilization and abstinence among smokers with and without PTSD. Smokers with PTSD may need additional facilitation to initiate cessation treatment but are receptive when it is offered proactively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background Endoscopic endonasal approaches (EEAs) have been adopted as an alternative to standard transcranial approaches for olfactory groove meningiomas (OGMs). However, the relative cost-effectiveness remains controversial. Methods Cost-utility analysis from a societal perspective comparing EEA vs transcranial approaches for OGM was used in this study. Surgical treatment was modeled using decision analysis, and a Markov model was adopted over a 20-year horizon. Parameters were obtained from literature review. Costs were expressed in 2017 Canadian dollars. Results In the base case, EEA was cost-effective compared with transcranial surgery with an incremental cost-effectiveness ratio of $33 523 ($30 475 USD)/QALY. There was a 55% likelihood that EEA was cost-effective at a willingness-to-pay of $50 000/QALY. EEA remained cost-effective at a cerebrospinal fluid leak rate below 60%, gross total resection rate above 25%, and base cost less than $66 174 ($60 158 USD). Conclusion EEA may be a cost-effective alternative to transcranial approaches for selected OGM.

OBJECTIVE To review insights gained from a 21-year experience with gentamicin-induced vestibulotoxicity including differences in vestibulotoxicity between single daily dosing (SDD) and multiple daily dosing (MDD) regimens. STUDY DESIGN Retrospective case series. SETTING Tertiary care center. PATIENTS Patients with gentamicin vestibulotoxicity referred to the Hertz Multidisciplinary Neurotology Clinic between January 1993 and September 2014. INTERVENTION None. MAIN OUTCOME MEASURES Spectrum of vestibular dysfunction measured using videonystagmography, vestibular evoked myogenic potentials, video head impulse testing, and magnetic scleral search coil testing. RESULTS Of 53 patients with gentamicin-induced vestibulotoxicity, 24 received SDD and 29 received MDD treatment. The most common indications for treatment were sepsis, endocarditis, and osteomyelitis. Angular acceleration receptor function (semicircular canals) was more commonly affected than linear acceleration receptor function (otolithic organ of the saccule; 100% vs. 62%). A significant proportion of patients (53%) developed vestibulotoxicity in the absence of nephrotoxicity and 40% experienced vestibulotoxicity in a delayed fashion up to 10 days posttreatment cessation (mean 3.9 ± 0.7). Therapeutic monitoring did not necessarily prevent delayed vestibulotoxicity. Nephrotoxicity was less common for SDD compared with MDD (60% vs. 35%, p = 0.01). However, the SDD group experienced vestibulotoxicity at a lower cumulative dose (6.3 vs. 7.0 g, p = 0.04) and shorter duration of therapy (20.7 vs 29.4 d, p = 0.02). CONCLUSIONS Our study further highlights important insights regarding gentamicin-induced vestibulotoxicity. While SDD is associated with decreased risk for nephrotoxicity compared with MDD, it confers a higher risk for vestibulotoxicity.

This work analyzes the relationship between short-term exposure to fine particulate matter and its incidence of respiratory and cardiorespiratory diseases. It involved the socioeconomic status of the population distributed in representative areas of Santiago de Chile, the capital city of Chile. The data used were collected from monitoring stations of fine particulate matter concentrations, classification of cardio-respiratory diseases, and the annual age distribution of the population in the representative areas of this megacity. Also, morbidity and mortality data and the distribution of the forecast of health by geographic zones within the Metropolitan Region were variables of input. The relative risk results showed that the level of risk from exposure to air pollution is not defined solely by the level of exposure to the pollutant when crossing the information considered. Therefore, the age distribution or quality of life of the population will define the susceptibility of this, being able to increase the risk of becoming ill or dying by being exposed to air pollution. This work showed that the exposed results serve as input data for the realization of studies in this area, regarding the cost-benefit that would be obtained by reducing pollutant emissions to the atmosphere, as well as valuable information to develop better air quality management policies.

SUMMARYBrain regeneration requires a precise coordination of complex responses in a time- and region-specific manner. Identifying key cell types and molecules that direct brain regeneration would provide potential targets for the advance of regenerative medicine. However, progress in the field has been hampered largely due to limited regeneration capacity of the mammalian brain and understanding of the regeneration process at both cellular and molecular level. Here, using axolotl brain with extrodinary regeneration ability upon injury, and the SpaTial Enhanced REsolution Omics-sequencing (Stereo-seq), we reconstructed the first architecture of axolotl telencephalon with gene expression profiling at single-cell resolution, and fine cell dynamics maps throughout development and regeneration. Intriguingly, we discovered a marked heterogeneity of radial glial cell (RGC) types with distinct behaviors. Of note, one subtype of RGCs is activated since early regeneration stages and proliferates while other RGCs remain dormant. Such RGC subtype appears to be the major cell population involved in early wound healing response and gradually covers the injured area before presumably transformed into the lost neurons. Altogether, our work systematically decoded the complex cellular and molecular dynamics of axolotl telencephalon in development and regeneration, laying the foundation for studying the regulatory mechanism of brain regeneration in the future.

Introduction/Background* No biomarkers have been established yet to predict response to anti-angiogenic treatment. To test whether the Xerna™ TME Panel, a novel biomarker, is predictive of anti-angiogenic treatment outcome, an exploratory, retrospective analysis of the Phase 1b study of navicixizumab in combination with paclitaxel in platinum resistant ovarian cancer was performed. Navicixizumab is a bispecific anti-angiogenic antibody to vascular endothelial growth factor (VEGF) and delta-like ligand 4. The Xerna™ TME Panel evaluates RNA gene expression data of ~100 genes defining the immune and angiogenic biologies that dominate the tumor microenvironment (TME). This novel diagnostic employs a machine learning model to classify a patient’s TME along immune and angiogenic axes, resulting in classification into one of four TME subtypes—Angiogenic (A), Immune Suppressed (IS), Immune Active (IA) and Immune Desert (ID). We hypothesized that patient TME subtypes classified with angiogenic dominant biology (A/IS) are more likely to benefit from treatment with navicixizimab relative to those in the biomarker negative subgroup (IA/ID). Methodology The Phase 1b study of navicixizumab (3 mg/kg or 4 mg/k, IV, q2w) in combination with paclitaxel (80 mg/m2 IV on D0, D7, and D14 of 28-day cycle) was an open-label, non-randomized study that included 44 patients with platinum-resistant, grade 2/3 ovarian cancer. Patients received a median of 4 prior treatments (63% prior bevacizumab, 45% prior PARP). Pre-treatment tumor tissue was analyzed retrospectively using the Xerna™ TME Panel. Result(s)* The objective response rate per RECIST 1.1 was 43.2% in the overall patient population (n=44). Responses were durable (median 6 months [95% CI, 5.4 months, not estimable]). Pre-treatment tumor tissue was available for 33 patients. In the B-positive subgroup (A/IS, n=13), 62% of patients had an objective response, compared to 25%, in the B-negative subgroup (IA/ID, n=20). PFS was 9.2 months in the B-positive subgroup vs. 3.9 months in the B-negative subgroup, HR = 0.43 [95% CI 0.188 to 0.999]). Conclusion* Navicixizumab plus paclitaxel demonstrated promising clinical activity in this heavily pretreated patient population. The Xerna™ TME Panel may identify patients more likely to benefit from treatment with navicixizumab and should be prospectively evaluated in a future study.

Highlights • Four meaningful neighborhood resource groups were identified by clustering. • Living in alcohol-permissive/tobacco-restrictive neighborhoods had negative impacts. • Place of residence and distance to the closest VA care facility were not significant., Neighborhood-level social determinants are increasingly recognized as factors shaping mental health in adults. Data-driven informatics methods and geographic information systems (GIS) offer innovative approaches for quantifying neighborhood attributes and studying their influence on mental health. Guided by a modification of Andersen’s Behavioral Model of Health Service Use framework, this cross-sectional study examined associations of neighborhood resource groups with psychological distress and depressive symptoms in 1,528 U.S. Veterans. Data came from the Veteran Affairs (VA) Health Services Research and Development Proactive Mental Health trial and publicly available sources. Hierarchical clustering based on the proportions of neighborhood resources within walkable distance was used to identify neighborhood resource groups and generalized estimating equations analyzed the association of identified neighborhood resource groups with mental health outcomes. Few resources were found in walkable areas except alcohol and/or tobacco outlets. In clustering analysis, four meaningful neighborhood groups were identified characterized by alcohol and tobacco outlets. Living in an alcohol-permissive and tobacco-restrictive neighborhood was associated with increased psychological distress but not depressive symptoms. Living in urban or rural areas and access to VA care facilities were not associated with either outcome. These findings can be used in developing community-based mental health-promoting interventions and public health policies such as zoning policies to regulate alcohol outlets in neighborhoods. Augmenting community-based services with Veteran-specialized services in neighborhoods where Veterans live provides opportunities for improving their mental health.

Introduction People with serious mental illness (SMI) have a high smoking prevalence and low quit rates. Few cessation treatments are tested in smokers with SMI. Mental health (MH) providers are reluctant to address smoking. Proactive tobacco cessation treatment strategies reach out directly to smokers to offer counseling and medication and improve treatment utilization and quit rates. The current study is a secondary analysis of a randomized controlled trial of proactive outreach for tobacco cessation treatment in VA MH patients. Aims and Methods Participants (N = 1938, 83% male, mean age 55.7) across four recruitment sites, who were current smokers and had a MH visit in the past 12 months, were identified using the electronic medical record. Participants were randomized to Intervention (telephone outreach call plus invitation to engage in MH tailored telephone counseling and assistance obtaining nicotine replacement therapy) or Control (usual care). The current study assessed outcomes in participants with SMI (N = 982). Results Compared to the Control group, participants assigned to the Intervention group were more likely to engage in telephone counseling (22% vs. 3%) and use nicotine replacement therapy (51% vs. 41%). Participants in the Intervention group were more likely to be abstinent (7-day point prevalence; 18%) at 12 months than participants in the Control group (11%) but equally likely to make quit attempts. Conclusions Proactive tobacco cessation treatment is an effective strategy for tobacco users with SMI. Proactive outreach had a particularly strong effect on counseling utilization. Future randomized clinical trials examining proactive tobacco treatment approaches in SMI treatment settings are needed. Implications Few effective treatment models exist for smokers with SMI. Proactive tobacco cessation outreach with connections to MH tailored telephone counseling and medication promotes tobacco abstinence among smokers with SMI and is an effective treatment strategy for this underserved population.

We projected incident surface solar radiation (SSR) over China in the middle (2040–2059) and end (2080–2099) of the 21st century in the Representative Concentration Pathway (RCP) 8.5 scenario using a multi-model ensemble derived from the weighted average of seven global climate models (GCMs). The multi-model ensemble captured the contemporary (1979–2005) spatial and temporal characteristics of SSR and reproduced the long-term temporal evolution of the mean annual SSR in China. However, it tended to overestimate values compared to observations due to the absence of aerosol effects in the simulations. The future changes in SSR showed increases over eastern and southern China, and decreases over the Tibetan Plateau (TP) and northwest China relative to the present day. At the end of the 21st century, there were SSR increases of 9–21 W m−2 over northwest, central, and south China, and decreases of 18–30 W m−2 over the TP in June–July–August (JJA). In northeast China, SSR showed seasonal variation with increases in JJA and decreases in December–January–February. The time series of annual SSR had a decreased linear trend for the TP, and a slightly increased trend for China during 2006–2099. The results of our study suggest that solar energy resources will likely decrease in the TP under future climate change scenarios.

Tobacco use is rarely addressed in community mental healthcare despite high patient smoking prevalence. Community mental health centers have systems in place that could be used to comprehensively address tobacco use. This study tested feasibility of, satisfaction with, and safety of proactive tobacco treatment (tobacco outreach to offer connection to tobacco cessation treatment). Behavioral health home patients who smoke were randomly assigned to usual care (UC; N = 11) or proactive care (PC; N = 9). All participants were called 3-months post-randomization for follow-up. PC patients reported high satisfaction with the program and experienced no adverse events or mental health symptom exacerbation during treatment. PC patients reported greater reductions in cigarettes per day, more quit attempts, and more cessation medication utilization than UC patients. Proactive outreach for tobacco cessation is feasible in a behavioral health home, acceptable to patients, and may reduce smoking heaviness and promote quit attempts.

IntroductionThe use of electronic cigarettes (e-cigarettes) in smokers with mental health conditions (MHC) is not well understood.AimsThis study aims to compare e-cigarette users and non-users among veteran smokers with MHC to characterize differences in smoking behavior, motivation to quit, psychological distress, primary psychiatric diagnosis, and other factors.MethodsBaseline survey data were used from a randomized smoking cessation trial enrolling smokers with MHC from four Veterans Health Administration hospitals. Participants were categorized as current, former (having ever tried an e-cigarette), or never e-cigarette users. Pearson's χ2 and ANOVA Type-3 F-tests were used to test the bivariate associations between e-cigarette use and variables measured.ResultsAmong 1,836 participants, mean age was 58 years (STD ± 12.5), 87% were male, 15% were current e-cigarette users (n = 275), and 27% were former users (n = 503). Sixty-five percent of e-cigarette users reported ‘wanting to quit smoking’ as a primary reason. Mean readiness to quit smoking (1–10) was 7.2, 6.8, and 6.4 for current, former, and never e-cigarette users, respectively (P = 0.0002). Sixty-three percent of current and former users and 55% of never-users reported some mental distress on Kessler-6 scale (P = 0.0003, OR = 1.4, 95% CI 1.1–1.7). A primary psychiatric diagnosis of alcohol or substance use disorder was recorded for 50% of current or former users and 60% of never-users (P = 0.0003, OR = 0.69, 95% CI 0.56–0.84).ConclusionsE-cigarette users were more ready to quit and most often reported using e-cigarettes to assist with quitting. E-cigarette users had more psychological distress and were less likely to have substance use disorders as their primary psychiatric diagnosis.

Smokers with serious mental illness (SMI) face individual, interpersonal, and healthcare provider barriers to cessation treatment utilization and smoking abstinence. Proactive outreach strategies are designed to address these barriers by promoting heightened contact with smokers and facilitating access to evidence-based treatments. The present study examined the effect of proactive outreach among smokers with SMI (n = 939) who were enrolled in the publicly subsidized Minnesota Health Care Programs (MHCP) and compared this effect to that observed among MHCP smokers without SMI (n = 1382). Relative to usual care, the intervention increased treatment utilization among those with SMI (52.1% vs 40.0%, p = 0.002) and without SMI (39.3% vs 25.4%, p < 0.001). The intervention also increased prolonged smoking abstinence among those with SMI (14.9% vs 9.4%, p = 0.010) and without SMI (17.7% vs 13.6%, p = 0.09). Findings suggest that implementation of proactive outreach within publicly subsidized healthcare systems may alleviate the burden of smoking in this vulnerable population. Trial Registration ClinicalTrials.gov identifier: NCT01123967.

Heavy haze usually occurs in winter in eastern China. To control the severe air pollution during the season, comprehensive regional joint-control strategies were implemented throughout a campaign. To evaluate the effectiveness of these strategies and to provide some insights into strengthening the regional joint-control mechanism, the influence of control measures on levels of air pollution was estimated with an integrated measurement-emission-modeling method. To determine the influence of meteorological conditions, and the control measures on the air quality, in a comprehensive study, the 2nd World Internet Conference was held during 16–18 December 2015 in Jiaxing City, Zhejiang province, in the Yangtze River Delta (YRD) region. We first analyzed the air quality changes during four meteorological regimes and then compared the air pollutant concentrations before, during, and after the regulation under static meteorological conditions. Next, we conducted modeling scenarios to quantify the effects caused due to the air pollution control measures. We found that total emissions of SO2, NOx, PM2.5, and volatile organic compounds (VOCs) in Jiaxing were reduced by 56 %, 58 %, 64 %, and 80 %, respectively, while total emission reductions of SO2, NOx, PM2.5, and VOCs over the YRD region are estimated to be 10 %, 9 %, 10 %, and 11 %, respectively. Modeling results suggest that during the campaign from 8 to 18 December, PM2.5 daily average concentrations decreased by 10 µg m−3 with an average decrease of 14.6 %. Our implemented optimization analysis compared with previous studies also reveals that local emission reductions play a key role in air quality improvement, although it shall be supplemented by regional linkage. In terms of regional joint control, implementing pollution channel control 48 h before the event is of most benefit in getting similar results. Therefore, it is recommended that a synergistic emission reduction plan between adjacent areas with local pollution emission reductions as the core part should be established and strengthened, and emission reduction plans for different types of pollution through a stronger regional linkage should be reserved.

Surgical trays contain unused instruments which generate wasted resources from unnecessary reprocessing/replacement costs. We implemented a quality improvement initiative to optimize surgical trays for common otolaryngology procedures, and examined the impact on costs, operating room (OR) efficiency, and patient safety. We studied five common otolaryngology procedures over a 10-month period at a single community hospital. We compared pre- and post-intervention outcome measures including instrument utilization, tray set up time, tray rebuilding time, and balancing measures (operative time, instrument recall, patient safety). We estimated cost-savings from an institutional perspective over 1- and 10-year time horizons. Costs were expressed in 2017 Canadian dollars and modeled as a function of surgical volume, labor costs, instrument depreciation, and indirect costs. A total of 238 procedures by six surgeons were observed. At baseline, only 35% of instruments were utilized. We achieved an average instrument reduction of 26%, yielding 1-year cost savings of $9,010 CDN and 10-year cost savings of $69,576 CDN. Tray optimization reduced average OR tray setup time by 2.5 ± 0.4 min (p = 0.03) and average tray rebuilding time by 1.4 ± 0.2 min (p = 0.06). There was minimal impact on balancing measures such as OR time, stakeholder perception of patient safety and trainee education, and only a single case of instrument recall. Surgical tray optimization is a simple, effective, and scalable strategy for reducing costs and improving OR efficiency without compromising patient safety.

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

PURPOSE/OBJECTIVE(S) Radiation induced heart damage (RIHD) is an important late toxicity of thoracic radiotherapy, which is closely relating with the fractional dose of radiotherapy. With the wide application of stereotactic body radiotherapy and hyperfractionated radiotherapy, the single dose and biological equivalent dose (BED) of the heart of exposure have increased when comparing with conventionally fractionated radiotherapy. However, the mean cardiac dose (MHD), which is frequently used clinically to ensure the control of cardiac damage, is continuously decreased to 26 Gy, 20 Gy, etc. There is still controversy about how much dose could control heart radiation damage better. In this study, 15 Gy/3f low-dose irradiation of the whole heart of rats, which BED is similar with 24 Gy/12f irradiation, is selected to explore the possibility and characteristics of RIHD occurrence, and explore the effect of combined recombinant human endostatin on myocardial damage. MATERIALS/METHODS 75 SD adult male rats were randomly divided into control (C group, E group, MHD25 group) and experimental group (MHD15 group, MHD15+E group). The irradiation method was single dose 5 Gy/f, once per day, continuous irradiation 3d or 5d. After the irradiation, the E group and MHD15+E group were given recombinant human endostatin 6mg/kg intraperitoneal injection, once per day, for 14 consecutive days. At 1, 3, and 6 months after intervention, 5 rats in each group were randomly selected for HE, Masson, and immunohistochemical CD34 microvessel staining, and Western Blot detected mitochondrial Complex II protein expression. Two-way ANOVA statistics. RESULTS Compared with C group, edema and disorder of myocardial cells, infiltration of inflammatory cells and decrease of microvessel density was observed at 1 month after intervention in HE staining in MHD15 and MHD15+E group. The expression of complex II protein decreased at 6 months, and the degree of decrease was less than that in MHD25 group (positive control group) (P < 0.05). The microvessel density was further decreased compared with 1 month. Myocardial fibrosis induced by 15 Gy/3f low-dose irradiation of SD rat heart mainly occurred at 6 months, which observed myocardial cord or reticular fibrosis and collagen deposition. Semi-quantitative analysis of myocardial collagen volume fraction CVF significantly increased (P < 0.001) in HE and Masson staining. Details is shown in the table below. Compared with C group, E group observed myocardial edema and decreased microvessel density. There was no significant difference between MHD15 and MHD15+E group. CONCLUSION Low dose irradiation of 15 Gy/3f (BED = 40 Gy) still cause myocardial fibrosis and damage of cardiac function in SD rats. RIHD were observed after 6 months, which was equal to about 1/5 of the rat's life span, and the time was delayed when compared with the time of RIHD caused by high dose irradiation. Cardiotoxicity was not increased significantly combining recombinant human endostatin on the basis of low-dose cardiac.

Purpose/Objective(s) Recombinant human endostatin (rh-ES) has been found to cause heart damage in clinical use. The heart tissue can be irradiated inevitably while radiation therapy for chest tumors and may result in radiation damage. The regulation of myocardial fibrosis may be related to TGF-β1, Smad2/3, and CTGF signaling pathways. At present, whether targeted drug therapy combined with radiotherapy will increase the damage of the heart is a subject worth studying. Materials/Methods The experimental animals were randomly divided into 25 Gy irradiation group (5 Gy/ time × 5 days), rh-ES 6mg/kg group, rh-ES 12mg/kg group, 25 Gy irradiation + rh-ES 6mg/kg group, 25 Gy irradiation + rh-ES 12mg/kg group and blank control group, with 15 in each group. rh-ES was injected intraperitoneally for 14 consecutive days. Five rats in each group were sacrificed and the cardiac tissues were extracted for HE staining, Masson staining and transmission electron microscopy at 1, 3 and 6 months after irradiation and rh-ES rejection. MTT was used to detect the value of the IC50 rh-ES to cardiomyocytes with different concentrations of rh-ES. The cardiomyocytes with stable knockdown of TGF-β1 is grouped, the irradiation dose is 10 Gy. According to cardiomyocytes trial were divided into four group, the blank control group (without any treatment), the irradiation group (irradiation + TGF-β1 gene knockdown), the rh-ES group (rh-ES + TGF-β1 gene knockdown), the combined group (irradiation, rh-ES and TGF-β1 gene knockdown), flow cytometry was used to detect cardiomyocytes apoptosis, qPCR and Western Blot were used to detect the expression of TGF-β1/Smad2. Smad3/CTGF gene and protein. Results In vivo experiments on the heart of rats showed that a little inflammatory cell infiltration was observed under light microscope at 1 month after radiation and rh-ES treatment, and the inflammatory cell infiltration was obvious with fibrosis changes at 3 months, and the fibrosis changes were aggravated 6 months later. rh-ES alone caused slight injury to rats (no change under light microscope, but some mitochondria swelling and cristae missing under electron microscope). rh-ES and radiation treatment increased the damage of myocardial tissues in rats to some extent, and the process of radiation-induced myocardial fibrosis lasted at least 6 months after radiotherapy. rh-ES can aggravate the process of myocardial fibrosis after radiation injury, but has no toxic effect on normal myocardial tissue. The IC50 value of rh-ES on rat cardiomyocytes was 529μg/ mL in vitro experiment. qPCR and Western Blot results showed that TGF-β1, Smad2/Smad3, CTGF gene and protein expressions were up-regulated in rat cardiomyocytes after rh-ES and irradiation treatment. Conclusion The TGF-β1, Smad2/Smad3 and CTGF signaling pathways may be the common signaling pathways of myocardial fibrosis injury induced by rh-ES combined with radiation, which may be the target for the treatment of myocardial fibrosis by radiation.

Black carbon (BC) emissions play an important role in regional climate change of the Arctic. It is necessary to pay attention to the impact of long-range transport from regions outside the Arctic as BC emissions from local sources in the Arctic were relatively small. The Task Force Hemispheric Transport of Air Pollution Phase2 (HTAP2) set up a series of simulation scenarios to investigate the response of BC in a given region to different source regions. This study investigated the responses of Arctic BC concentrations and surface temperature to 20 % anthropogenic emission reductions from six regions in 2010 within the framework of HTAP2 based on ensemble modeling results. It was found that the emissions from East Asia (EAS) had most (18.1 %–51.4 %) significant impact on the Arctic while the monthly contributions from Europe, Middle East, North America, Russia Belarus Ukraine, and South Asia were 20.1 %–49.9 %, 0.02 %–0.9 %, 8.3 %–19.3 %, 5.4 %–18.1 %, and 3.1 %–7.7 %, respectively. The responses of the vertical profiles of the Arctic BC to the six regions were found to be different due to multiple transport pathways. The response of the Arctic BC to emission reductions of six source regions became less significant with the increase of the latitude. The benefit of BC emission reductions in terms of slowing down surface warming in the Arctic was evaluated by using Absolute Regional Temperature-change Potential (ARTP). Compared to the response of global temperature to BC emission reductions, the response of Arctic temperature was substantially more sensitive, highlighting the need for curbing global BC emissions.

Background Chest CT is widely used in clinical diagnosis and efficacy evaluation of CAP. While repeated chest CT examinations to evaluate dynamic changes in chest CT images in a short period of time is a common phenomenon, it causes a lot of waste of medical resources, and due to the large dose of CT radiation, it can cause some harm to the human body. The purpose of this study is to establish a new model to predict the dynamic chest CT image changes of CAP patients by analyzing the age, smoking history, and serum inflammatory markers. Methods This is a retrospective study. All patients had received chest CT scan and serum inflammatory indexes were measured, including procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR). The second chest CT examination was performed after a week of treatment. General information on the medical record was also recorded (including age, smoking history, drinking history, and others). Main outcome measures were the changes of chest CT images, including absorption and non-absorption (including patients with progressive inflammation). Single factor analysis and two-dimensional logistic regression analysis were used to explore the independent risk factors of the new CT image change prediction model for CAP patients. ROC was used to evaluate the sensitivity and specificity of the new model. Results Among 220 patients with CAP, 150 patients had absorption in chest CT after a week of treatment (150/220), the remaining 70 patients had no absorption or even progression (70/220). Age, PCT, and smoking history were independent risk factors for inflammatory absorption. The AUC of ROC curve was 0.89 (95% CI 0.83 - 0.94), the sensitivity was 88.70%, and the specificity was 80.00%. Conclusions A new prediction model consists of serum PCT, age, and smoking history has high specificity and sensitivity in predicting dynamic CT changes in adult CAP patients.

Introduction Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early stage cervical cancer. The objective of this study was to compare the 4-year disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy. Methods Multicenter, retrospective cohort study of patients diagnosed with cervical cancer stage IA1 with lymph-vascular invasion, IA2 and IB1(FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from 6 countries. In the main patient-level analysis we used inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women who differed only with respect to surgical approach. We estimated the hazard ratio (HR) for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models. Results 1379 patients were included in the analysis, 681 (49.4%) patients operated by laparoscopy, and 698 (50.6%) by laparotomy. Median age was 46 (22–88) years. Median follow-up was 52.1(0.8–201.2) months for laparoscopy, and 52.6 (0.4–166.6) for laparotomy group. Women who underwent laparoscopic radical hysterectomy had inferior 4-year disease-free survival compared with laparotomy group (HR 1.64; 95% Confidence Interval 1.09–2.46). When the outcomes were compared according to preoperative tumor size, there was a higher risk of recurrence only in patients with a tumor size >2 cm operated by laparoscopy (HR= 2.26; 95% CI 1.17–4.37). Conclusions In this retrospective multicenter study, the laparoscopic approach for early stage cervical cancer was associated with a higher risk of recurrence, compared to laparotomy.

Although proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to improve cardiovascular outcomes, their effects on brain stroke risk are unclear. The present meta-analysis aimed to evaluate the effects of PCSK9 inhibitors on brain stroke prevention.We searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov for research published until December 30, 2020, to find randomized controlled trials (RCTs) of PCSK9 inhibitors for brain stroke prevention. Relative risk (RR) and 95% confidence intervals (CIs) were used to represent the outcomes. Seven RCTs with 57,440 participants, including 29,850 patients treated with PCSK9 inhibitors and 27,590 control participants, were included. PCSK9 inhibitors were associated with significant reductions in total brain stroke risk (RR, 0.77; 95% CI, 0.67-0.88; P 0.001) and ischemic brain stroke risk (RR, 0.76; 95% CI, 0.66, 0.89; P 0.001) in comparison with the control group. There was no significant difference in cardiovascular mortality (RR, 0.95; 95% CI, 0.84-1.07; P = 0.382) and the risk of hemorrhagic brain stroke (RR, 1.00; 95% CI, 0.66-1.51; P = 0.999) between patients treated with PCSK9 inhibitors and controls. PCSK9 inhibitors did not significantly increase the incidence of neurocognitive adverse events (RR, 1.02; 95% CI, 0.81-1.29; P = 0.85). Moreover, subgroup analysis showed no difference in cognitive function disorder risks among different PCSK9 inhibitors and treatment times.PCSK9 inhibitors significantly reduced the risk of total brain stroke and ischemic brain stroke without increasing the risk of brain hemorrhage and neurocognitive impairment.

Background Serum prealbumin (PAB) is an effective tool to evaluate patients with malnutrition. In recent years, studies have shown that PAB is statistically reduced during the course of disease infection. The pneumonia severity index (PSI) scoring system is one of the most widely used scoring tools to evaluate the condition and prognosis of community acquired pneumonia (CAP) patients. However, few studies have reported on PSI combined with blood indicators to predict the prognosis of pneumonia. The aim of this study was to investigate the prognostic value of PAB combined with PSI in patients with CAP. Methods We retrospectively analyzed the data of 400 patients who met the inclusion criteria. Death and survival were selected as prognostic indicators of pneumonia. On the first day after admission, venous blood samples were taken to test PAB and PSI scores. Subject operating characteristic curve (ROC) was used to evaluate PSI, PAB, and PSI combined with PAB to predict 30-day mortality of CAP patients. Results The 30-day mortality rate of CAP patients was 10.5% (42/400). PAB and PSI score were independent risk factors for 30-day mortality in CAP patients. The sensitivity, specificity, positive predictive value, and negative predictive value of PAB predicting the death of CAP patients were 86.3%, 79%, 50.74%, and 95.83%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of PSI predicting the death of CAP patients were 74.80%, 63%, 33.71%, and 90.99%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the combined index predicting the death of CAP patients were 95.20%, 77.80%, 51.70% and 98.41%, respectively. Conclusions Serum prealbumin is a relatively simple acquired index and an independent risk factor for death in CAP patients. Serum prealbumin improves the sensitivity of pneumonia severity index in predicting 30-day mortality of CAP patients.

Healthcare provider barriers to cessation resources may be undercutting quit rates for smokers with serious mental illness (SMI). The study aim was to examine how providers influence cessation treatment utilization among smokers with SMI. Data were taken from a trial conducted among smokers in Minnesota Health Care Programs. The sample was split into groups of participants with SMI (n = 939) and without SMI (n = 1382). Analyses assessed whether the association between SMI and treatment utilization was mediated by healthcare provider–delivered treatment advice and healthcare provider bias. Results revealed higher rates of treatment utilization among smokers with SMI than those without SMI (45.9% vs 31.7%, p

In order to clarify the causes of variability among the model outputs for surface ozone in the Model Intercomparison Study Asia Phase III (MICS-Asia III), three regional models, CMAQ v.5.0.2, CMAQ v.4.7.1, and NAQPMS (abbreviated as NAQM in this paper), have been selected. Detailed analyses of monthly averaged diurnal variation have been performed for selected grids covering the metropolitan areas of Beijing and Tokyo and at a remote oceanic site, Oki. The chemical reaction mechanism, SAPRC99, used in the CMAQ models tended to give a higher net chemical ozone production than CBM-Z used in NAQM, agreeing with previous studies. Inclusion of the heterogeneous “renoxification” reaction of HNO3 (on soot surface)→NO+NO2 only in NAQM would give a higher NO concentration resulting in a better agreement with observational data for NO and nighttime O3 mixing ratios. In addition to chemical processes, the difference in the vertical transport of O3 was found to affect the simulated results significantly. Particularly, the increase in downward O3 flux from the upper layer to the surface after dawn was found to be substantially different among the models. Larger early morning vertical transport of O3 simulated by CMAQ 5.0.2 is thought to be the reason for higher daytime O3 in July in this model. All three models overestimated the daytime ozone by ca. 20 ppbv at the remote site Oki in July, where in situ photochemical activity is minimal.

Introduction Concerns about the adverse effects of smoking cessation on alcohol use and mental health are a barrier to cessation for smokers with serious mental illness (SMI). The purpose of this study is to examine how incident smoking cessation affects binge drinking and symptoms of depression and anxiety among smokers with SMI. Methods The present study is a secondary analysis of the OPTIN trial, which demonstrated the effectiveness of proactive outreach for smoking cessation among Minnesota Health Care Programs enrollees. Participants with ICD-9 codes indicating schizophrenia spectrum disorders, psychotic disorders, bipolar disorders, or severe/recurrent major depressive disorder were categorized as having SMI (n = 939); remaining smokers were categorized as non-SMI (n = 1382). Multivariable regressions modeled the association between incident smoking cessation and binge drinking, PHQ-2 depression scores, and PROMIS anxiety scores in the two groups. Results Quitting smoking was not associated with binge drinking among those with SMI, but was associated with less binge drinking among those without SMI (p = 0.033). Quitting smoking was not associated with PHQ-2 depression scores among those with or without SMI. However, quitting smoking was associated with lower mean PROMIS anxiety scores for those with SMI (p = 0.031), but not those without SMI. Conclusion Quitting smoking was not associated with heightened binge drinking or symptoms of depression and anxiety among smokers with SMI. These findings suggest that quitting smoking is not detrimental for these patients, and provide evidential support for facilitating access to cessation resources for patients with serious mental illness who smoke.

Introduction Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a proactive outreach intervention. Methods We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing proactive outreach with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to proactive outreach versus UC were compared using logistic regression. Results Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in proactive outreach as compared with UC. At the 1-year follow-up, men in proactive outreach were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28–2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48–3.99). Conclusions Satisfaction with cessation care in VA remains low. Proactive outreach to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.

Human activities and population growth have increased the natural burden of reactive nitrogen (N) in the environment. Excessive N deposition on Earth’s surface leads to adverse feedbacks on ecosystems and humans. Similar to that of air pollution, emission control is recognized as an efficient means to control acid deposition. Control of nitrogen oxides (NO(x) = NO + NO(2)) emissions has led to reduction in deposition of oxidized nitrogen (NO(y), the sum of all oxidized nitrogen species, except nitrous oxide [N(2)O]). Reduced forms of nitrogen (NH(x) = ammonia [NH(3)] + ammonium [NH(4)(+)]) deposition have, otherwise, increased, offsetting the benefit of reduction in NO(y) deposition. Stringent control of NH(3) emissions is being considered. In this study, we assess the response of N deposition to N emission control on continental regions. We show that significant reduction of NH(x) deposition is unlikely to be achieved at the early stages of implementing NH(3) emission abatement. Per-unit NH(3) emission abatement is shown to result in only 60–80% reduction in NH(x) deposition, which is significantly lower than the demonstrated 80–120% benefit of controlling NO(x) emissions on NO(y) deposition. This 60–80% effectiveness of NH(x) deposition reduction per unit NH(3) emission abatement reflects, in part, the effects of simultaneous reductions in NO(x) and SO(2) emissions.

Haze has been severely affecting the densely populated areas in China recently. While many of the efforts have been devoted to investigating the impact of local anthropogenic emission, limited attention has been paid to the contribution from long-range transport. In this study, we apply simulations from six participating models supplied through the Task Force on Hemispheric Transport of Air Pollution phase 2 (HTAP2) exercise to investigate the long-range transport impact of Europe (EUR) and Russia–Belarus–Ukraine (RBU) on the surface air quality in eastern Asia (EAS), with special focus on their contributions during the haze episodes in China. The impact of 20 % anthropogenic emission perturbation from the source region is extrapolated by a factor of 5 to estimate the full impact. We find that the full impacts from EUR and RBU are 0.99 µg m−3 (3.1 %) and 1.32 µg m−3 (4.1 %) during haze episodes, while the annual averaged full impacts are only 0.35 µg m−3 (1.7 %) and 0.53 µg m−3 (2.6 %). By estimating the aerosol response within and above the planetary boundary layer (PBL), we find that long-range transport from EUR within the PBL contributes to 22–38 % of the total column density of aerosol response in EAS. Comparison with the HTAP phase 1 (HTAP1) assessment reveals that from 2000 to 2010, the long-range transport from Europe to eastern Asia has decreased significantly by a factor of 2–10 for surface aerosol mass concentration due to the simultaneous emission reduction in source regions and emission increase in the receptor region. We also find the long-range transport from the Europe and RBU regions increases the number of haze events in China by 0.15 % and 0.11 %, and the North China Plain and southeastern China has 1–3 extra haze days ( %). This study is the first investigation into the contribution of long-range transport to haze in China with multi-model experiments.

Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. This analysis evaluated the role of SES in smokers' response to a population-based proactive smoking-cessation intervention.This study, conducted in 2016 and 2017, was a secondary analysis of the Veterans Victory Over Tobacco Study, a multicenter pragmatic RCT of a proactive smoking-cessation intervention conducted from 2009 to 2011. Logistic regression modeling was used to test the effect of income or education level on 6-month prolonged abstinence at 1-year follow-up.Of the 5,123 eligible, randomized participants, 2,565 (50%) reported their education level and 2,430 (47%) reported their income level. The interactions between education (p=0.07) or income (p=0.74) X treatment arm were not statistically significant at the 0.05 level. The largest effect sizes for the intervention were found among smokers in the lowest education category (≤11th grade), with a quit rate of 17.3% as compared with 5.7% in usual care (OR=3.5, 95% CI=1.4, 8.6) and in the lowest income range ($10,000), with a quit rate of 18.7% as compared with 9.4% in usual care (OR=2.2, 95% CI=1.2, 4.0).In a large, multicenter smoking-cessation trial, proactive outreach was associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting.This study is registered at www.clinicaltrials.gov NCT00608426.

With the rising anthropogenic emissions from human activities, elevated concentrations of air pollutants have been detected in the hemispheric air flows in recent years, aggravating the regional air pollution and deposition issues. However, the regional contributions of hemispheric air flows to deposition have been given little attention in the literature. In this light, we assess the impact of hemispheric transport on sulfur (S) and nitrogen (N) deposition for six world regions: North America (NA), Europe (EU), South Asia (SA), East Asia (EA), Middle East (ME) and Russia (RU) in 2010, by using the multi-model ensemble results from the 2nd phase of the Task Force Hemispheric Transport of Air Pollution (HTAP II) with 20 % emission perturbation experiments. About 27 %–58 %, 26 %–46 % and 12 %–23 % of local S, NOx and NH3 emissions and oxidation products are transported and removed by deposition outside of the source regions annually, with seasonal variation of 5 % more in winter and 5 % less in summer. The 20 % emission reduction in the source regions could affect 1 %–10 % of deposition in foreign continental regions and 1 %–14 % in foreign coastal regions and the open ocean. Significant influences are found from NA to the North Atlantic Ocean (2 %–14 %), and from EA to the North Pacific Ocean (4 %–10 %) and to western NA (4 %–6 %) (20 % emission reduction). The impact on deposition caused by short-distance transport between neighboring regions (i.e., from EU to RU) occurs throughout the whole year (slightly stronger in winter), while the long-range transport (i.e., from EA to NA) mainly takes place in spring and fall, which is consistent with the seasonality found for hemispheric transport of air pollutants. Deposition in the emission-intensive regions such as US, SA and EA is dominated (∼80 %) by own-region emissions, while deposition in the low-emission-intensity regions such as RU is almost equally affected by foreign exported emissions (40 %–60 %) and own-region emissions. We also find that deposition of the coastal regions or the near-coastal open ocean is twice more sensitive to hemispheric transport than the non-coastal continental regions, especially for regions in the downwind direction of emission sources (i.e., west coast of NA). This study highlights the significant impacts of hemispheric transport of air pollution on the deposition in coastal regions, the open ocean and low-emission-intensity regions. Further research is proposed to improve the ecosystem and human health, with regards to the enhanced hemispheric air flows.

This study uses multi-model ensemble results of 11 models from the second phase of Task Force Hemispheric Transport of Air Pollution (HTAP II) to calculate the global sulfur (S) and nitrogen (N) deposition in 2010. Modeled wet deposition is evaluated with observation networks in North America, Europe and East Asia. The modeled results agree well with observations, with 76–83 % of stations being predicted within ±50 % of observations. The models underestimate SO42−, NO3− and NH4+ wet depositions in some European and East Asian stations but overestimate NO3− wet deposition in the eastern United States. Intercomparison with previous projects (PhotoComp, ACCMIP and HTAP I) shows that HTPA II has considerably improved the estimation of deposition at European and East Asian stations. Modeled dry deposition is generally higher than the inferential data calculated by observed concentration and modeled velocity in North America, but the inferential data have high uncertainty, too. The global S deposition is 84 Tg(S) in 2010, with 49 % in continental regions and 51 % in the ocean (19 % of which coastal). The global N deposition consists of 59 Tg(N) oxidized nitrogen (NOy) deposition and 64 Tg(N) reduced nitrogen (NHx) deposition in 2010. About 65 % of N is deposited in continental regions, and 35 % in the ocean (15 % of which coastal). The estimated outflow of pollution from land to ocean is about 4 Tg(S) for S deposition and 18 Tg(N) for N deposition. Comparing our results to the results in 2001 from HTAP I, we find that the global distributions of S and N deposition have changed considerably during the last 10 years. The global S deposition decreases 2 Tg(S) (3 %) from 2001 to 2010, with significant decreases in Europe (5 Tg(S) and 55 %), North America (3 Tg(S) and 29 %) and Russia (2 Tg(S) and 26 %), and increases in South Asia (2 Tg(S) and 42 %) and the Middle East (1 Tg(S) and 44 %). The global N deposition increases by 7 Tg(N) (6 %), mainly contributed by South Asia (5 Tg(N) and 39 %), East Asia (4 Tg(N) and 21 %) and Southeast Asia (2 Tg(N) and 21 %). The NHx deposition increases with no control policy on NH3 emission in North America. On the other hand, NOy deposition has started to dominate in East Asia (especially China) due to boosted NOx emission.

We firstly conducted a long-term in-situ field measurement at a marginal area (Hotan) of the southern Taklimakan Desert covering all four seasons. Detailed chemical characterization of dust aerosol over Hotan showed several unconventional features, including (1) ubiquity of high Na+ and Cl− abundances in the Taklimakan dust aerosol and its Cl−/Na+ ratio close to seawater; (2) high Ca content in the Taklimakan dust (7.4~8.0%) which was about two times of that in the natural crust; (3) high abundance of soluble sulfate concentrations and strong correlations between sulfate and Na+ and Cl− as well as typical mineral tracers such as Al and Ca. Our results collectively indicated that the dust aerosol from the Taklimakan Desert was characterized of evident paelo-oceanic signature as the Taklimakan Desert was found as an ocean in the ancient times from the perspective of paleogeology. It was estimated that primary sources dominated the total abundances of sulfate during the dust seasons while previous climate modeling works had seldom considered the cooling effects of sulfate from the Taklimakan Desert.

The need for cognitive closure describes the extent to which a person, faced with a decision, prefers any answer in lieu of continued uncertainty. This construct may be relevant in lung cancer screening, which can both reduce and increase uncertainty. We examined whether individual differences in need for cognitive closure are associated with Veterans’ completion of lung cancer screening using a self-administered survey ( N = 361). We also assessed whether need for cognitive closure moderates an association between screening completion and lung cancer risk perception. Contrary to our main hypothesis, high need for cognitive closure Veterans were not more likely to complete lung cancer screening and need for cognitive closure did not have a moderating role.

Forests are an important biome that covers about one third of the global land surface and provides important ecosystem services. Since atmospheric deposition of nitrogen (N) can have both beneficial and deleterious effects, it is important to quantify the amount of N deposition to forest ecosystems. Measurements of N deposition to the numerous forest biomes across the globe are scarce, so chemical transport models are often used to provide estimates of atmospheric N inputs to these ecosystems. We provide an overview of approaches used to calculate N deposition in commonly used chemical transport models. The Task Force on Hemispheric Transport of Air Pollution (HTAP2) study intercompared N deposition values from a number of global chemical transport models. Using a multi-model mean calculated from the HTAP2 deposition values, we map N deposition to global forests to examine spatial variations in total, dry and wet deposition. Highest total N deposition occurs in eastern and southern China, Japan, Eastern U.S. and Europe while the highest dry deposition occurs in tropical forests. The European Monitoring and Evaluation Program (EMEP) model predicts grid-average deposition, but also produces deposition by land use type allowing us to compare deposition specifically to forests with the grid-average value. We found that, for this study, differences between the grid-average and forest specific could be as much as a factor of two and up to more than a factor of five in extreme cases. This suggests that consideration should be given to using forest-specific deposition for input to ecosystem assessments such as critical loads determinations. Estimates of nitrogen deposition to global forests by global models may be a factor of 2 or more higher if the forest-specific deposition is used, compared to the grid cell average value and is on average 12% higher for all global forests.

Introduction Individuals with (vs. without) mental illness use tobacco at higher rates and have more difficulty quitting. Treatment models for smokers with mental illness are needed. Methods This secondary analysis of the Victory Over Tobacco study [a pragmatic randomized clinical trial (N = 5123) conducted in 2009–2011 of Proactive Care (proactive outreach plus connection to smoking cessation services) vs. Usual Care] tests the effectiveness of treatment assignment in participants with and without a mental health diagnosis on population-level, 6 month prolonged abstinence at one year follow-up. Results Analyses conducted in 2015–6 found that there was no interaction between treatment group and mental health group on abstinence (F(1,3300 = 1.12, p = 0.29)). Analyses stratified by mental health group showed that those without mental illness, assigned to Proactive Care, had a significantly higher population-level abstinence rate than those assigned to Usual Care (OR = 1.40, 95% CI = 1.17–1.67); in those with mental illness, assignment to Proactive Care produced a non-significant increase in abstinence compared to Usual Care (OR = 1.18, 95% CI = 0.98–1.41). Those with mental illness reported more medical visits, cessation advice and treatment (p 0.05), but lower abstinence self-efficacy (p Conclusions Those with a mental health diagnosis benefitted less from proactive outreach regarding tobacco use. VA primary care patients with mental illness may not need additional outreach because they are connected to cessation resources during medical appointments. This group may also require more intensive cessation interventions targeting self-efficacy to improve cessation rates. Clinicaltrials.gov registration # NCT00608426 .

PURPOSE/OBJECTIVE(S) Radiation induced heart damage (RIHD) is the leading cause of non-cancer-related deaths in patients receiving thoracic radiotherapy. The mean cardiac dose (MHD) of normal tissue tolerance in NCCN guidelines for radiotherapy has been continuously decreased from 35 Gy in 2017 to 2020 20 Gy, indicating there is controversy of MHD that how much dose could control cardiac radiation damage better. In this study, 15 Gy/3f (BED = 40 Gy) low-dose irradiation of SD rat heart was used to explore the mechanism and functional parameter changes of RIDH caused by low-dose irradiation, and to explore the effect of combining recombinant human endostatin (E). MATERIALS/METHODS 75 SD adult male rats were randomly divided into control group (C, E, MHD25) and experimental group (MHD15, MHD15+E). A single dose 5 Gy/f, once per day, continuous irradiation 3d or 5d. After the irradiation, the E group and MHD15+E group were given recombinant human endostatin 6mg/kg intraperitoneal injection, once per day, for 14 consecutive days. At 24h, 48h and 15d after the intervention, the blood of the rats was taken to measure CK, CK-MB, LDH and CRP. At 1, 3 and 6 months, 5 rats after cardiac echocardiography was performed in each group were randomly killed and myocardial tissues were collected for Masson staining, Western Blot and qPCR. Two-way ANOVA statistics. RESULTS There was no difference in LDH, CK, CK-MB, and CRP in the same time period among the groups at 24h, 48h, and 14d after intervention (P > 0. 05). Compared with group C, the EF and FS of the MHD25, MHD15 and MHD15+E group all decreased at 3 months (P 0.05). The EF and FS of the MHD25, MHD15 and MHD15+E group also decreased at 6 months (P 0.05). Comparing 6 months with 1 month, EF and FS of each group decreased (P 0.05). CONCLUSION SD rat heart 15 Gy/3f (BED = 40 Gy) low-dose irradiation cause cardiac function damage in the early stage and myocardial fibrosis in the late stage, the appearance delayed and degree is lower than that of high-dose irradiation. On the basis of low-dose irradiation, combined with recombinant human endostatin increase the expression of related factors of TGF-β/Smad signaling pathway. Echocardiography may be able to predict the occurrence of RIDH early, but serological predictive indicators have yet to be found.

Overwhelming evidence has shown that, from the Industrial Revolution to the present, human activities influence ground-level ozone (O3) concentrations. Past studies demonstrate links between O3 exposure and health. However, knowledge gaps remain in our understanding concerning the impacts of climate change mitigation policies on O3 concentrations and health. Using a hybrid downscaling approach, we evaluated the separate impact of climate change and emission control policies on O3 levels and associated excess mortality in the US in the 2050s under two Representative Concentration Pathways (RCPs). We show that, by the 2050s, under RCP4.5, increased O3 levels due to combined climate change and emission control policies, could contribute to an increase of approximately 50 premature deaths annually nationwide in the US. The biggest impact, however, is seen under RCP8.5, where rises in O3 concentrations are expected to result in over 2,200 additional premature deaths annually. The largest increases in O3 are seen in RCP8.5 in the Northeast, the Southeast, the Central, and the West regions of the US. Additionally, when O3 increases are examined by climate change and emissions contributions separately, the benefits of emissions mitigation efforts may significantly outweigh the effects of climate change mitigation policies on O3-related mortality. Keywords: Ozone, Climate change, Predictive modeling, Emissions, Pollution, Public health, Mortality

PLUTO will conduct a sequential, multiple assignment, randomized trial to inform the choice and delivery of smoking cessation treatments for smokers in the setting of lung cancer screening, including for smokers who respond both incompletely (any smoking after quit date) and completely to first-line treatment (4 or 8 weeks of counseling with nicotine replacement therapy). Currently, there is little evidence to guide the development of adaptive interventions in tobacco cessation. SMART designs, such as the one we propose, are an ideal experimental design to assess different adaptive intervention strategies. Adaptive interventions for smoking cessation in the context of lung cancer screening have high potential for dissemination and impact. The USPSTF recommends annual low-dose CT screening for patients at high risk Recommendation (Grade B)4; private insurance coverage is mandated for USPSTF Grade A or B recommendations. The Affordable Care Act (ACA) mandates coverage of preventative services including smoking cessation treatment. The ACA requires coverage of at least 2 quit attempts/year, 4 counseling sessions of at least 10 minutes, and all Food and Drug Administration (FDA) approved tobacco cessation meds for a 90 day treatment regimen when prescribed by a health care provider (7 medications: 5 forms of NRT, bupropion, and varenicline).74 Effective smoking cessation treatment, delivered in the context of lung cancer screening programs, may augment the mortality benefit of imaging studies. The novel tobacco treatment system we plan – identification of smokers by using the EMR and proactive invitation to treatment coupled with lung cancer screening – is an opportunity to engage a new cohort of smokers with mechanisms in place to implement delivery of care. Thus, the PLUTO trial takes advantage of a new clinical practice development: recommendation for annual lung cancer screening based on age and smoking history. Strengths are an innovative study design and sequential random assignment of treatment conditions in addition to the main comparative effectiveness outcome that allows more rigorous measurement of effects than a standard randomized controlled trial would afford. The information about timing of assessment, optimal intervention components, and intensity of treatment are ripe for dissemination.

ummary Background Chronic hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States (US) and an emerging cause in China. Aim To compare the clinical characteristics of hepatitis C patients in the US and China, and factors influencing disease stage. Methods Prospective study of 2 cohorts of HCV patients recruited at 1 site in the US and 3 sites in China. Standardised questionnaire on risk factors and medical history were used and diagnosis of cirrhosis and HCC was based on pre-defined criteria. Results One thousand nine hundred and fifty seven patients (1000 US and 957 China) were enrolled. US patients were more likely to be men (61.4% vs 48.5%), older (median age 57 vs 53 years), obese (38.4% vs 16.8%) and diabetic (21.8% vs 10.8%). A significantly higher per cent of US patients had cirrhosis (38.2% vs 16.0%) and HCC (14.1% vs 2.7%). Investigator estimated time at infection in US was 10 years earlier than in Chinese patients but US patients were more likely to have advanced disease even after stratifying for duration of infection. Study site in the US, older age, truncal obesity, diabetes and prior HCV treatment were significant predictors of advanced disease on multivariate analysis. Conclusions HCV patients in the US had more advanced liver disease than those in China. We speculate that underlying fatty liver disease may be a major contributor to this difference, and management of glycometabolic abnormalities should occur in parallel with anti-viral therapy to achieve optimal outcomes.

Objective To compare financial and perioperative outcomes between endoscopic and open surgical approaches in the surgical management of sinonasal malignancies. Design Retrospective chart review. Setting Tertiary care hospital. Participants Patients undergoing surgical resection of a sinonasal malignancy from January 2000 to December 2014. Main Outcome Measures In-hospital costs, complications, and length of stay (LOS). Results Of 106 patients, 91 received open surgery (19 free flap and 72 non-free flap) and 15 were treated with purely endoscopic approaches. Free flaps had a significantly higher average cost, operative time, and LOS compared to both non-free flap (p Conclusion Hospital costs are comparable between endoscopic and open approaches when no free tissue reconstruction is required. Longer operative times, higher CSF leak rates, and our institutional protocol necessitating ICU admission for endoscopic cases may account for the failure to demonstrate cost savings with endoscopic surgery.

Purpose To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. Design Pre-post quasi-experimental trial. Setting General medical units of four US Department of Veterans Affairs hospitals. Subjects 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). Intervention The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. Measures The primary outcome was self-reported 7-day point prevalence abstinence at six months. Analysis Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. Results Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio ( AOR ) and 95% confidence interval ( CI 95 )=0.78 [0.51–1.18]) or six months ( AOR =0.92; CI 95 =0.62–1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect ( p =0.0004) and perceived likelihood of staying off cigarettes following discharge ( p Conclusions Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.