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Objectives: To explore the status of reproductive health and related factors in female patients with systemic sclerosis (SSc)., Methods: A cross-sectional study was conducted among female patients from the Chinese Organization for Scleroderma through a questionnaire. Data on the status of reproductive health including fertility condition and menstrual status were obtained. The clinical and laboratory data of SSc were collected. For patients with pregnancies after disease onset, each pregnancy was matched with a healthy control. Associations between clinical characteristics and the status of reproductive health were analysed., Results: A total of 342 female patients with SSc were included, and 31.8% (108/342, 95% CI 26.9%-36.7%) of them presented problems with reproductive health. Compared with the national data, the menopausal age of patients with disease onset before menopause was earlier (45.2 ± 6.1 vs 48.2 ± 4.4, P < 0.001). Age of disease onset (P = 0.018) and digital ulcer (P = 0.020) had statistically significant effects on menopausal age. Although the infertility rate of patients was not increased, the rate of spontaneous abortions was higher compared with the national data (9/74, 12.2% vs 4.3%, P < 0.001). Compared with the healthy control group, the rate of premature infants (12/55, 21.8% vs 7/110, 6.4%, P = 0.003), low birth weight infants (15/55, 27.3% vs 6/110, 5.5%, P < 0.001), and cesarean section (27/55, 49.1% vs 21/110, 19.1%, P < 0.001) increased significantly., Conclusion: The impairment of reproductive health is common and in many quarters in patients with SSc. Further action should be taken to improve reproductive health in patients with SSc, especially in maternal care., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Recycling of aqueous phase (AP) as a by-product after hydrothermal carbonization (HTC) of sewage sludge (SS) has been of interest. The combination of magnesium ammonium phosphate (MAP) or the so-called struvite crystallization and aqueous phase (AP) recirculation has great potential for resource recovery and hydrochar enhancement. In this study, both the aqueous phase of HTC after MAP recovery of NH 4 + -N (AP-MAP) and the untreated aqueous phase of HTC (AP-HTC) were reused for HTC of fresh SS, and both aqueous phases were recycled four times. The effects of the two AP cycles on the properties of AP and hydrochar at 200, 230, and 260 °C were studied, and the effect of temperature on the two AP cycles was similar. The hydrochar produced by the AP-MAP cycle had lower nitrogen content than that of the AP-HTC cycle due to the low ammonia nitrogen (NH 4 + -N) content, and the combustion performance was improved. MAP recovery reduces the accumulation of NH 4 + -N in the AP cycle and MAP is also a high-quality fertilizer. Therefore, the combination of MAP recovery and AP recycling provides a feasible technical approach for resource utilization, eutrophic AP treatment, and production of high-quality hydrochar in the HTC process of SS., Competing Interests: Declaration of competing interest We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2024. Published by Elsevier B.V.)

In this work, polyethylene terephthalate (PET) and sewage sludge (SS) were co-hydrothermally carbonized to produce low-nitrogen solid fuels. To minimize the effect of nitrogen, this work introduces a co-hydrothermal carbonization method involving alkali (A), ultrasonic cell disruptor (UCC), and sodium dodecyl sulfate (SDS) for both individual and combined pretreatment of SS and PET. Comparative analysis of the products shows that the combined pretreatment with sodium dodecyl sulfate (SDS) and alkali (A) effectively disrupts the SS cell structure, leading to the loosening of stable extracellular polymeric substances (EPS). This condition is conducive to the release and hydrolysis of proteins during hydrothermal carbonization. Moreover, under conditions where PET serves both as an acid producer and a carbon source, and through parameter optimization at a temperature of 240 °C, reaction time of 2 h, PET addition of 20 wt%, and water addition of 0.6 g cm -3 , a high-quality, low-nitrogen clean solid fuel was produced (N: 0.51 wt%, C: 19.10 wt%)., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Objective: Rare diseases cause a huge financial burden to countless patients and families. It is an important public health issue that requires widespread attention. This study analyzes medical expenses composition and the change in trends of out-of-pocket (OOP) expenses for patients with Amyotrophic lateral sclerosis (ALS) and explores the factors influencing these changes., Methods: Data were obtained from the Chinese Medical Insurance Department database from 2018 to 2020, including 857 patients with ALS in 60 cities across 30 provinces. We used descriptive methods to analyse the baseline characteristics and medical expenses of outpatients and inpatients with ALS. And we used quantile regression to analyse the differences in patient OOP ratio and the factors influencing them., Results: In China, 80.3% of ALS patients chose tertiary hospitals, with an annual direct medical cost of 11,339.7 RMB per patient and an OOP ratio of 41.6%. The annual medical cost for outpatients was 345.1 RMB per patient, with an OOP ratio of 36.7%. The annual medical cost for inpatients was 28,139.8 RMB per patient, with an OOP ratio of 41.7%. Compared to outpatients, inpatients had higher medical costs but lower actual reimbursement rates. The OOP ratio of ALS patients decreased, then increased over time. And the OOP ratio was influenced by medical institution, medical insurance, and age (p < 0.05). Patients who chose tertiary hospitals, those who were covered by the urban resident basic medical insurance and younger patients had relatively higher OOP ratio., Conclusion: In recent years, although China has begun to pay attention to the rights and interests of patients with rare diseases, the government has provided some healthcare security to patients with rare diseases. However, the level of medical insurance coverage was still low, the equity of protection was still insufficient and the financial burden on patients was high. Therefore, the government should further improve the healthcare system to provide full life-cycle and affordable healthcare services to patients with rare diseases., (© 2023 John Wiley & Sons Ltd.)

Sewage sludge (SS), a hazardous solid waste with a high water and pollutant content, should be disposed of correctly. Hydrothermal liquefaction (HTL) shows tremendous potential to treat organic matter with substantial water content like SS. In this paper, we examined the impact of key factors on the characteristics and yield of bio-oil during HTL of SS. We clarified the impacts of each component on the yield through model compounds based on that and constructed a component additivity model for forecasting the bio-oil yield from biomass with complex component composition. In the reactions of the model compounds, cellulose showed synergistic interaction with protein and alkali lignin in the bio-oil yield but lipids showed antagonistic effects with protein and alkaline lignin. The co-HTL results of these binary mixtures improved our model and further clarified the reaction mechanism of HTL of SS., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Objective: To explore describe the mechanism between work stress, job satisfaction, perceived organizational support and turnover intention amongst family doctors in China, and to provide reference for improving the brain drain of family doctors., Method: Using convenience sampling, a questionnaire survey was conducted among 2358 family doctors in 13 provinces in eastern, central and western China. Pearson correlation analysis and hierarchical regression analysis were used to explore the effects of job stress, job satisfaction and perceived organizational support on family doctors' turnover intention., Results: Family doctors' work stress was positively correlated with turnover intention (β = 0.631, p＜0.001), job satisfaction played a partial mediating role in the influence path of work stress on turnover intention (β = 0.9175, p＜0.001), perceived organizational support played a moderating role in the relationship between work stress, job satisfaction, and turnover intention (β = 0.124, p＜0.05; β = -0.022, p＜0.05)., Conclusion: Hospital managers should take corresponding measures to reduce the work stress of family doctors, improve their job satisfaction, and provide more support and attention to family doctors to ensure the stable development of family doctors in China., (© 2023 John Wiley & Sons Ltd.)

Producing "green urea" using renewable energy, N 2 , and CO 2 is a long-considered challenge. Herein, an electrocatalyst, Bi 2 S 3 /N-reduced graphene oxide (RGO), was synthesized by loading the Bi 2 S 3 nanorods onto the N-RGO via a hydrothermal method. The Bi 2 S 3 /N-RGO composites exhibit the highest yield of urea (4.4 mmol g -1 h -1 ), which is 12.6 and 3.1 times higher than that of Bi 2 S 3 (0.35 mmol g -1 h -1 ) and that of N-RGO (1.4 mmol g -1 h -1 ), respectively. N-RGO, because of its porous and open-layer structure, improves the mass transfer efficiency and stability, while the basic groups (-OH and -NH 2 ) promote the adsorption and activation of CO 2 . Bi 2 S 3 promotes the absorption and activation of inert N 2 . Finally, the defect sites and the synergistic effect on the Bi 2 S 3 /N-RGO composites work simultaneously to form urea from N 2 and CO 2 . This study provides new insights into urea synthesis under ambient conditions and a strategy for the design and development of a new material for green urea synthesis.

The development of cost-effective non-noble metal electrocatalysts is critical for the research of renewable energy. Transition metal cobalt metaphosphate-based materials have the potential to replace the noble metal Pt. Hence, in this work, we synthesize three-dimensional graphene-supported cobalt metaphosphate (Co(PO 3 ) 2 -3D RGO) for the first time through the one-step hydrothermal synthesis method at low temperature with the aid of PH 3 phosphating. In a 0.5 mol L -1 H 2 SO 4 solution, the obtained electrocatalyst exhibits excellent electrochemical activity for the hydrogen evolution reaction (HER) with a small overpotential of 176 mV at a current density of 10 mA cm -2 and a Tafel slope of 63 mV dec -1 . Additionally, in a 1 mol L -1 KOH solution, the electrocatalyst also shows outstanding HER activity with a small overpotential of 158 mV at a current density of 10 mA cm -2 and a Tafel slope of 88 mV dec -1 . Co(PO 3 ) 2 -3D RGO can maintain its catalytic activity for at least ten hours whether in acid or alkali. This work not only demonstrates an excellent electrocatalyst for the hydrogen evolution reaction, but also provides an extremely convenient preparation technology, which provides a new strategy for the development and utilization of high-performance electrocatalysts., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Protecting soil from Pb contamination has been a programme for a long time in China. However, research on lead pollution in wetlands remains rare. To understand the characteristics of Pb pollution in Beijing and the sources of contamination of different soil samples in wetlands, we collected samples during all four seasons from two soil horizons and analyzed their Pb concentrations and Pb isotope ratios. The average concentrations of Pb varied from 65.44 mg/kg in spring to 106.11 mg/kg in winter. Concentrations in autumn were significantly lower than those in spring and summer and were notably different between A and B Horizons (59.42 and 71.47 mg/kg, respectively). The Pb isotopic compositions show that Pb pollution results from a mixing of geogenic and anthropogenic materials. The ratios of 206 Pb/ 207 Pb and 206 Pb/ 208 Pb evidenced that coal combustion and vehicle exhaust are the main sources of lead contamination in the two horizons. These results will help in reducing lead contamination in soil by knowing the temporal and spatial variations and sources of lead in Beijing.

To examine how two dominant species coexist within a tidal wetland in the Yellow River Delta, we studied the spatial distribution patterns and ecological relationships of Tamarix chinensis and Suaeda salsa. We also analyzed the relationship between these two plant species and soil chemical properties. Nine quadrats were established, and aerial photography was carried out in July 2018 in the study area to investigate plants and soil. Results showed that T. chinensis showed an aggregation distribution at scales of 0-10 m, 0-30 m, and 0-50 m from the sea to inland. Unlike T. chinensis, S. salsa showed an aggregation distribution at approximately 0-50 m in the study area, which meant the aggregation distributions of T. chinensis and S. salsa were found at different scales and S. salsa tended to aggregate distribution compared with T. chinensis. Meanwhile, T. chinensis and S. salsa had negative correlations far from the sea at a scale of 0-20 m and at the offshore area at a scale of 0-30 m. However, in the intermediate area, S. salsa and T. chinensis showed a positive correlation at a scale of 0-30 m. In general, the relationship between the two groups tends to be negatively correlated in a small range. Given that the tidal action decreased from the sea to inland, the driving factors of population aggregation gradually changed from tidal flooding to an interspecific relationship. The different characteristics of the different species may also have had an effect. And the aggregation of adult plant species had a beneficial impact on the establishment and growth of seedlings and plants. Furthermore, soil properties comprised complex actions including environmental conditions and ecological processes. The soil chemical properties such as soil salinity and nutrients were also influenced by the species' canopy.

A discriminative structured analysis dictionary is proposed for the classification task. A structure of the union of subspaces (UoS) is integrated into the conventional analysis dictionary learning to enhance the capability of discrimination. A simple classifier is also simultaneously included into the formulated function to ensure a more complete consistent classification. The solution of the algorithm is efficiently obtained by the linearized alternating direction method of multipliers. Moreover, a distributed structured analysis dictionary learning is also presented to address large-scale datasets. It can group-(class-) independently train the structured analysis dictionaries by different machines/cores/threads, and therefore avoid a high computational cost. A consensus structured analysis dictionary and a global classifier are jointly learned in the distributed approach to safeguard the discriminative power and the efficiency of classification. Experiments demonstrate that our method achieves a comparable or better performance than the state-of-the-art algorithms in a variety of visual classification tasks. In addition, the training and testing computational complexity are also greatly reduced.

Herein, three-dimensional (3D) nitrogen-doped graphene with large surface areas and abundant porous structures was prepared by a hydrothermal synthesis method, which served as a novel support to enhance the catalytic properties of noble metal catalysts for the solvent-free selective oxidation of benzyl alcohol. The as-prepared samples were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, Fourier transform infrared (FTIR) spectroscopy, and Brunauer-Emmett-Teller (BET) method. The results clearly showed that the introduced N-containing group prevented the aggregation of graphene sheets and provided more structural defects to maximize the number of exposed active sites. The three-dimensional structure can provide a unique porous structure and large specific surface area. Moreover, the three-dimensional structure makes the recycling and reuse of the catalyst easier. The combination of these properties results in the reduction of the average particle size of metal palladium to 3.2 nm; this significantly increases the catalytic activity of the catalyst. The three-dimensional N-doped graphene aerogel-supported Pd nanoparticle (3D Pd/NRGO) composites exhibit excellent catalytic activity for the solvent-free selective oxidation of benzyl alcohol to benzaldehyde by molecular oxygen at 90 °C for 3 hours under atmospheric pressure, resulting in a 72.2% conversion of benzyl alcohol with 94.5% selectivity for benzaldehyde. In addition, the catalytic efficiency shows no obvious loss even after six repeated cycles. Thus, 3D Pd/NRGO can be used as an efficient, easily separable, recyclable, and stable catalyst for the solvent-free selective oxidation of benzyl alcohol under relatively mild conditions., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

This work reports a catalytic decomposition of algae to bio-oil over an isopropanol and water mixture system. The H 2 yield was adjusted by changing the ratio between isopropanol and water. In this system, the introduction of formic acid was helpful to extend the yield range. Five noble metal supported catalysts were applied and Rh/C was proved to give the highest oil yield. A correlation was established between hydrocarbon yield and H 2 yield. It was useful in predicting product distribution and helping to obtain desired products. EA, GC and GC-MS were applied in product analysis., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

In this paper, we report our investigation into a two-step method of transformation of algae to bio-oil. Elemental analysis, gas chromatography-mass spectrometry and Fourier transform infrared spectroscopy were used to analyze bio-oil. First, organic solvent Soxhlet extraction and reflux extraction were used in the algal extraction step. Ethanol was proven to be the best solvent, and the addition of MgSO 4 could transform acids to esters. In MgSO 4 extraction oil, the yield of hexadecanoic acid ethyl ester was as high as 48.40%. Then, the residual algae powders through the catalytic hydrothermal liquefaction process were converted to bio-oil. Commercialized noble metal catalysts Pd/C, Pt/C, Ru/C and Rh/C combined with Pd/HZSM-5 were used in the second step. Rh/C performed the best in the catalytic hydrothermal liquefaction process, and the highest bio-oil yield of 50.98% and HHV of 30.67 MJ kg -1 were achieved. The oil yield through two steps was higher than that by a direct decomposition step. Also, the two-step method could achieve a higher energy conversion ratio of 85.61% and total energy of 81.09 kJ., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)