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Highly active, stable, and cut-price (photo-)electrocatalysts are desired to overwhelm high energy barriers for anodic oxygen evolution reaction processes. Herein, a heterostructure of cobalt-iron oxide/black phosphorus nanosheets is in-situ synthesized via a facile and novel three-electrode electrolysis method. Bulky black phosphorus is exfoliated into its nanosheets at the cathode while the CoFe oxide is derived directly from the metal wire anode during the electrolysis process. This heterostructure exhibits excellent electrocatalytic oxygen evolution reaction (OER) performance, and the overpotential at 10 mA·cm−2 is 51 mV lower than that of the commercial RuO2 catalyst. Its superior OER performance stems from the favorable adsorption behavior and an enlarged electrochemical active surface area of the catalyst. To reveal the origin of excellent OER performance from the point of adsorption strength of OH*, methanol oxidation reaction (MOR) test is applied under the identified OER operating conditions. Further introduction of light illumination enhances the OER activity of this heterostructure. The overpotential drops down to 280 mV, benefiting from pronounced photochemical response of black phosphorus nanosheets and iron oxide inside the heterostructure. This work develops a new electrochemical method to construct high performance and light-sensitive heterostructures from black phosphorus nanosheets for the OER.

Electrosynthesized cobalt–iron oxide/graphene heterostructure by a three-electrode electrolysis system for efficient oxygen evolution reaction.

OBJECTIVE To investigate the associations of sodium excretion with blood pressure, mortality and cardiovascular diseases in Chinese population. METHODS We studied 39 366 individuals aged 35-70 years from 115 urban and rural communities in 12 centers across mainland China. Trained research staff conducted face-to-face interview to record baseline information of all participants based on questionnaires, and collected their morning fasting urine samples to estimate 24-h sodium excretion (24hUNaE). Multivariable frailty Cox regression accounting for clustering by centre was performed to examine the association between estimated 24hUNaE and the primary composite outcome of death and major cardiovascular events in a Chinese population. RESULTS Mean 24hUNaE was 5.68 (SD 1.69) g/day. After a median follow-up of 8.8 years, the composite outcome occurred in 3080 (7.8%) participants, of which 1426 (3.5%) died and 2192 (5.4%) suffered from cardiovascular events. 24hUNaE was positively associated with increased SBP and DBP. Using the 24hUNaE level of 4-4.99 g/day as the reference group, a 24hUNaE of either lower (

Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements.To examine associations between household and personal fine particulate matter (PMAs part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PMThe median (interquartile range) of household and personal PMWe used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.

Summary Background & aims Although fruits and vegetable consumption has been shown to be associated with lower risks of mortality, cancers, and cardiovascular disease (CVD), there are limited data from China on the shape of the association. This study aimed to quantify the relationship between levels of fruit, vegetable, and legume consumption with the risk of major CVD, CVD mortality, cancer incidence, cancer mortality, and all-cause mortality. Methods In the baseline survey, participants attended 1 of 115 (45 urban and 70 rural) communities from 12 provinces to complete a standardized questionnaire, and undergo a physical examination between 2005 and 2009, and were followed up till 2017 (for the current analysis). Diet was assessed through in-person interviews by using validated food-frequency questionnaires. The clinical outcomes were adjudicated centrally by trained physicians using standardized definitions. Cox frailty models were used to explore the associations between fruit, vegetable, and legume consumption with the risk of all-cause, CVD, and cancer mortality. Results A total of 41 243 participants were eligible for inclusion in the analyses. The average combined average daily intake of fruit, vegetable, and legume was 2.97 [standard deviation (SD) 1.22] servings per day. During a median follow-up of 8.9 years [interquartile range (IQR) 6.7–9.9 years], we recorded 1893 major CVDs, 794 cancer events, and 1324 deaths, with 411 CVD deaths and 429 cancer deaths. In the models adjusted for age, sex, and center (random effect), a higher total intake of fruit, vegetable, and legume was inversely associated with CVD mortality, cancer incidence, cancer mortality, and all-cause mortality. After adjusting for additional covariates, the associations were evidently attenuated and only the association with all-cause mortality (hazard ratio [HR] trend 0.92, 95% CI 0.86–0.98, p trend = 0.021) remained significant, with a non-significant trend for major CVD (HR trend 1.02, 95% CI 0.97–1.08, p trend = 0.449), CVD mortality (HR trend 0.94, 95% CI 0.84–1.06, p trend = 0.301), cancer incidence (HR trend 0.97, 95% CI 0.89–1.06, p trend = 0.540), or cancer mortality (HR trend 0.92, 95% CI 0.82–1.04, p trend = 0.174). Compared with the reference group, the risk of all-cause mortality was the lowest for four to five servings of total daily intake of fruit, vegetable, and legume (HR 0.73, 95% CI 0.55–0.97), and did not show a further decrease for the higher intake group. Separately, fruit intake was associated with a lower risk of all-cause mortality (HR trend 0.92, 95% CI 0.86–0.99, p trend = 0.020) and legume intake was associated with a lower risk of major CVD (HR trend 0.95, 95% CI 0.90–0.99, p trend = 0.028) and all-cause mortality (HR trend 0.94, 95% CI 0.89–0.99, p trend = 0.020) in the fully adjusted models. Conclusions This prospective study suggests that Chinese people with daily consumption of four to five servings (equivalent to 500–625 g/day) of fruit, vegetable, and legume demonstrated the lowest mortality, which conveys an encouraging message to the public that lifestyle modification to increase fruit, vegetable, and legume intakes may have greater beneficial effects on reducing all-cause mortality.

Background Context Previous studies have reported conflicting results for the relationships between anthropometric adiposity indexes and bone mineral density, based on dual-energy X-ray absorptiometry (DXA). However, few studies were published based on quantitative computed tomography (QCT), especially for Chinese population. Purpose To evaluate the associations of spine bone mineral density (BMD) with body mass index (BMI), waist circumstance (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index (ABSI) using QCT. Study Design/Setting A Cross-sectional study. Patient Sample Around 3,457 participants in multiple communities across 7 administrative regions of China. Outcome Measures Spine BMD was measured using QCT, and the classification of osteoporosis was defined as follows: 1) osteoporosis if BMD Methods This study was conducted using convenient sampling between 2013 and 2017. Multivariable linear regression model and logistic regression models were used for the associations of continuous and categorical BMD, respectively. Results Around 3,405 participants were included in the final analyses, including 1,272 males and 2,133 females, with spine BMD of 111.00±35.47 mg/cm3 and 99.38±40.60 mg/cm3, respectively. Spine BMD decreased significantly with the increase of ABSI in females (adjusted β, −5.74; 95% confidence interval [CI], −8.50 to −2.98), and this trend also was kept in females aged at less than 60 years (adjusted β, −14.54; 95% CI, −20.40 to −8.68), and females with age ≥60 years (adjusted β, −7.59; 95% CI, −10.91 to −4.28). However, this inverse association was observed only in males with age ≥ 60 years (adjusted β, −5.19; 95% CI, −10.08 to −0.29). Except ABSI, negative associations of Spine BMD with WC (adjusted β, −0.46; 95% CI, −0.77 to −0.15), WHR (adjusted β, −6.25; 95% CI, −10.63 to −1.86), WHtR (adjusted β, −6.80; 95% CI, −11.63 to −1.97) were shown in females aged at Conclusions ABSI had more remarkable association with spine BMD, compared with the other four indexes.

Summary Background Data are scarce on the availability and affordability of essential medicines for diabetes. Our aim was to examine the availability and affordability of metformin, sulfonylureas, and insulin across multiple regions of the world and explore the effect of these on medicine use. Methods In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 35–70 years (n=156 625) were recruited from 110 803 households, in 604 communities and 22 countries; availability (presence of any dose of medication in the pharmacy on the day of audit) and medicine cost data were collected from pharmacies with the Environmental Profile of a Community's Health audit tool. Our primary analysis was to describe the availability and affordability of metformin and insulin and also commonly used and prescribed combinations of two medicines for diabetes management (two oral drugs, metformin plus a sulphonylurea [either glibenclamide (also known as glyburide) or gliclazide] and one oral drug plus insulin [metformin plus insulin]). Medicines were defined as affordable if the cost of medicines was less than 20% of capacity-to-pay (the household income minus food expenditure). Our analyses included data collected in pharmacies and data from representative samples of households. Data on availability were ascertained during the pharmacy audit, as were data on cost of medications. These cost data were used to estimate the cost of a month's supply of essential medicines for diabetes. We estimated affordability of medicines using income data from household surveys. Findings Metformin was available in 113 (100%) of 113 pharmacies from high-income countries, 112 (88·2%) of 127 pharmacies in upper-middle-income countries, 179 (86·1%) of 208 pharmacies in lower-middle-income countries, 44 (64·7%) of 68 pharmacies in low-income countries (excluding India), and 88 (100%) of 88 pharmacies in India. Insulin was available in 106 (93·8%) pharmacies in high-income countries, 51 (40·2%) pharmacies in upper-middle-income countries, 61 (29·3%) pharmacies in lower-middle-income countries, seven (10·3%) pharmacies in lower-income countries, and 67 (76·1%) of 88 pharmacies in India. We estimated 0·7% of households in high-income countries and 26·9% of households in low-income countries could not afford metformin and 2·8% of households in high-income countries and 63·0% of households in low-income countries could not afford insulin. Among the 13 569 (8·6% of PURE participants) that reported a diagnosis of diabetes, 1222 (74·0%) participants reported diabetes medicine use in high-income countries compared with 143 (29·6%) participants in low-income countries. In multilevel models, availability and affordability were significantly associated with use of diabetes medicines. Interpretation Availability and affordability of essential diabetes medicines are poor in low-income and middle-income countries. Awareness of these global differences might importantly drive change in access for patients with diabetes. Funding Full funding sources listed at the end of the paper (see Acknowledgments).

Background The predictive value of adiposity indices and the newly developed index for cardiometabolic risk factors and cardiovascular diseases ( CVD s) remains unclear in the Chinese population. This study aimed to compare the predictive value of A Body Shape Index with other 5 conventional obesity‐related anthropometric indices (body mass index, waist circumference, hip circumference, waist‐to‐hip ratio, waist‐to‐height ratio) in Chinese population. Methods and Results A total of 44 048 participants in the study were derived from the baseline data of the PURE ‐China (Prospective Urban and Rural Epidemiology) study in China. All participants’ anthropometric parameters, CVD s, and risk factors (dyslipidemia, abnormal blood pressure, and hyperglycemia) were collected by standard procedures. Multivariable logistic regression models and receiver operator characteristic curve analysis were used to evaluate the predictive values of obesity‐related anthropometric indices to the cardiometabolic risk factors and CVD s. A positive association was observed between each anthropometric index and cardiometabolic risk factors and CVD s in all models ( P AUC s) for predicting dyslipidemia ( AUC s: 0.646, sensitivity: 65%, specificity: 44%), hyperglycemia ( AUC s: 0.595, sensitivity: 60%, specificity: 45%), and CVD s ( AUC s: 0.619, sensitivity: 59%, specificity: 41%). Waist circumference showed the best prediction for abnormal blood pressure ( AUC s: 0.671, sensitivity: 66%, specificity: 40%) compared with other anthropometric indices. However, the new body shape index did not show a better prediction to either cardiometabolic risk factors or CVD s than that of any other traditional obesity‐related indices. Conclusions Waist‐to‐height ratio appeared to be the best indicator for dyslipidemia, hyperglycemia, and CVD s, while waist circumference had a better prediction for abnormal blood pressure.

Digital, Introduction. Switching from polluting (e.g. wood, crop waste, coal) to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods. We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study. We assessed household-level primary cooking fuel switching during a median of 10 years of follow up (∼2005–2015). We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households (12 369) reported changing their primary cooking fuels between baseline and follow up surveys. Of these, 61% (7582) switched from polluting (wood, dung, agricultural waste, charcoal, coal, kerosene) to clean (gas, electricity) fuels, 26% (3109) switched between different polluting fuels, 10% (1164) switched from clean to polluting fuels and 3% (522) switched between different clean fuels. Among the 17 830 households using polluting cooking fuels at baseline, household-level factors (e.g. larger household size, higher wealth, higher education level) were most strongly associated with switching from polluting to clean fuels in India; in all other countries, community-level factors (e.g. larger population density in 2010, larger increase in population density between 2005 and 2015) were the strongest predictors of polluting-to-clean fuel switching. Conclusions. The importance of community and sub-national factors relative to household characteristics in determining polluting-to-clean fuel switching varied dramatically across the nine countries examined. This highlights the potential importance of national and other contextual factors in shaping large-scale clean cooking transitions among rural communities in low- and middle-income countries., Ciencias Médicas y de la Salud

Biochars converted from agricultural residuals can effectively remove ammonium from water. This work further improved the sorption ability of biochars to aqueous ammonium through alkali modification. Three modified biochars were prepared from agricultural residuals pre-treated with NaOH solution through low-temperature (300 °C) slow pyrolysis. The modified biochars effectively removed ammonium ions from water under various conditions with relatively fast adsorption kinetics (reached equilibrium within 10 h) and extremely high adsorption capacity (>200 mg/g). The Langmuir maximum capacity of the three modified biochars were between 313.9 and 518.9 mg/g, higher than many other ammonium adsorbents. Although the sorption of ammonium onto the modified biochar was affected by pH and temperature, it was high under all of the tested conditions. Findings from this work indicated that alkali-modified biochars can be used as an alternative adsorbent for the removal of ammonium from wastewater.

Background Calcium is widely recognized as an effective intervention for the prevention of osteoporosis. However, some recent studies and meta-analyses indicate that calcium supplements may be ineffective to prevent fracture. The association of dietary calcium intake with vertebral fracture and spinal volumetric bone mineral density (vBMD) in low calcium intake population is unknown. Methods China Action on Spine and Hip Status (CASH) study is a multi-center, community-based cohort study of 3,457 participants from 12 centers across China from March 2013 and August 2017. We documented their baseline dietary calcium intake using validated food frequency questionnaires with a median of 10 years before the spine CT screening of CASH study. Vertebral fracture of CT images was defined as the primary outcome and the main measures included volumetric bone mineral density at participants' median of 10 years visit and dietary calcium intake at baseline. Odds ratio (OR) and 95% confidence interval (CI) were obtained for the associations of vertebral fracture with dietary calcium from ordinal logistic regression models (if outcome defined as three categories) or dichotomous logistic regression models (when mild, moderate, or severe fracture were combined and defined as prevalent fracture and no fracture as reference group). Because only 14.5% reached Chinese Dietary Reference Intakes (CDRI) calcium target of ≥800 mg/day, we selected 500, 600, 700, 800 mg/day of calcium intake from food as cutpoints for modeling, respectively. Findings Of the 3457 CASH participants, 3273 (94.7%) were used for analysis including 2052 women (mean [SD] age, 52.1 [9.0] years) and 1221 men (53.3 [9.1] years). Total vertebral fracture prevalence was 16.5% (n=551). The mean daily calcium intake from the FFQ was calculated as 517.0±266.4 mg. 8% reduction of fracture risk was observed per 100 unit increase of calcium intake from food among females (OR, 0.92; 95% CI, 0.87-0.97), but results among males were not significant (OR, 0.98; 95% CI, 0.92-1.04). No interaction was detected between vBMD and calcium intake from food (P>0.05). When high calcium intake groups had enough sample sizes (i.e. calcium ≥500 or ≥600 mg/day), negative assciations of fracture risk with calcium intake were found among females (≥500 vs.

Water contamination by ammonium ions presents huge risks to the ecosystems. This work evaluated the potential of biochar as an alternative adsorbent to remove ammonium from aqueous solutions. Nine types of biochars were converted from three types of agricultural residuals at three pyrolysis temperatures. Batch sorption experiment showed that all the biochars effectively removed ammonium ions from water. The biochars produced at low pyrolysis temperatures, however, showed higher sorption of ammonium. The low-temperature biochars showed relatively fast sorption kinetics of ammonium, which reached equilibrium around 10 h. Sorption isotherms showed that the low-temperature biochars had high sorption capacities to the ammonium, and the Langmuir maximum capacities were all higher than 200 mg/g. Batch sorption experiments also showed the sorption of ammonium onto the biochar was affected by pH and temperature, but not by ionic strength. The biochar showed good sorption ability to ammonium in aqueous solu...

Background Most cardiovascular diseases occur in low‐ and middle‐income regions of the world, but the socioeconomic distribution within China remains unclear. Our study aims to investigate whether the prevalence of cardiovascular diseases differs among high‐, middle‐, and low‐income regions of China and to explore the reasons for the disparities. Methods and Results We enrolled 46 285 individuals from 115 urban and rural communities in 12 provinces across China between 2005 and 2009. We recorded their medical histories of cardiovascular diseases and calculated the INTERHEART Risk Score for the assessment of cardiovascular risk‐factor burden, with higher scores indicating greater burden. The mean INTERHEART Risk Score was higher in high‐ and middle‐income regions than in low‐income regions (9.47, 9.48, and 8.58, respectively, P P trend =0.0064). In high‐ and middle‐income regions, urban communities have higher INTERHEART Risk Score and higher prevalent rate than rural communities. In low‐income regions, however, the prevalence of total cardiovascular disease was similar between urban and rural areas despite the significantly higher INTERHEART Risk Score for urban settings. Conclusions We detected an inverse trend between risk‐factor burden and cardiovascular disease prevalence in urban and rural communities in high‐, middle‐, and low‐income regions of China. Such asymmetry may be attributed to the interregional differences in residents’ awareness, quality of healthcare, and availability and affordability of medical services.

Background: Physical Activity (PA) during leisure time has been inversely associated with Cardiovascular Disease (CVD) risk in Western populations. We aim to evaluate PA at work and leisure time in relation to Acute Myocardial Infarction (AMI) in Chinese. Methods: We conducted a hospital-based case-control study. Cases were first AMI (n=2909). Controls (n=2947) were matched to cases on age and sex. All the participants from 27 regions in China were enrolled between February 1999 and March 2003. Results: After adjustment for age and sex, the OR associated with heavy physical labour, compared with mainly sedentary was 1.44 (95% CI: 1.06 to 1.94), for walking, climbing, and lifting 1.00 (95% CI: 0.77 to 1.30) and for walking at one level 0.90 (95% CI: 0.75 to 1.07) (Global P value for multiple logistic regression, 0.0279, respectively). The ORs of leisure-time PA for strenuous exercise group compared with mainly sedentary group was 0.74 (95% CI: 0.61 to 0.90), and for mild and moderate exercise group 0.96 (95% CI: 0.85 to 1.08). People in the highest level (≥7 hours per week of leisure-time sport activity such as running, swimming) had an OR of 0.67 (95% CI: 0.55 to 0.82; P value=0.0001) compared with those in the lowest level (no leisure-time sport activity). Multivariate adjustment did not substantially alter the association. There was the interaction between leisure-time physical activity and related factors of AMI. People in the highest level of leisure-time physical activity consumed more cigarettes. Conclusions: Moderate work-related PA, such as walking, can reduce the risk of AMI and excessive heavy work-related PA increased the risk of AMI, compared mainly sedentary. Leisure-time physical activity was protective for AMI risk compared to sedentary lifestyles in a population in China.

Biochar produced from agricultural residues through pyrolysis has the characteristics of large specific surface area and porous structure and thus can be used as an adsorbent for various contaminants. In this study, five types of agricultural residues, peanut shells (PS), mung bean shells (MBS), rice husk (RH), corn cob (CC), and cotton stalks (CS), were selected as feedstocks to prepare biochars. Magnesium chloride (MgCl2; 5 mol L−1 m) solution was used as a modifier to prepare pre-modified and post-modified biochar adsorbents. The modified biochars were used in adsorption experiment to test their sorption ability to phosphate from aqueous solution. Model simulations and analysis were used to determine phosphorus removal mechanisms. Experimental results showed that the phosphate removal efficiency of the pre-modified cotton stalk paralyzed at 600 °C (Pre-CS600) was the best with adsorption capacity of 129.9 mg g−1. The results also showed that the adsorption capacity of the biochar pre-modified by MgCl2 was much better than that of unmodified and post-modified ones, suggesting the pre-modification method can be used to prepare modified biochars for the removal of phosphorus from aqueous solution.

Recently, genome-wide association studies on coronary artery disease (CAD) identified a series of associated single-nucleotide polymorphisms (SNPs) in an intergenic region of chromosome 9p21.3, near the CDKN2A and CDKN2B genes. We investigated the association of this locus with CAD in 12 case-control studies of East Asians and undertook a meta-analysis for effect size, heterogeneity, publication bias, and strength of evidence. English and Chinese language articles were tested for 9p21.3 SNPs with coronary heart/artery disease or myocardial infarction as primary outcomes. Included articles also provided race, numbers of participants, and data to compute an odds ratio (OR). Articles were excluded if reporting other outcomes (e.g., stroke). Thirty-five articles were initially identified and 12 were included. Independent extraction was performed by two reviewers and consensus was reached. SNP rs1333049, rs2383206 and rs10757278 representing the 9p21.3 locus, were genotyped in 12 case-control studies involving a total of 9,813 patients and 10,710 controls. For rs1333049 (8 data sets), using a fixed-effects model, the summary OR was 1.29 (95 % CI, 1.23-1.36, P = 0.001). For rs2383206 (6 data sets), using a fixed-effects model, the summary OR was 1.24 (95 % CI, 1.18-1.31, P = 0.001). For rs10757278 (6 data sets), using a random-effects model, the summary OR was 1.34 (95 % CI, 1.21-1.50, P = 0.001). In addition, we defined the haploblock structure of SNPs within the region of 9p21.3 in China population in one study. This broad replication provides unprecedented evidence for association between genetic variants at chromosome 9p21.3 and risk of CAD in East Asians.

Identification and treatment of hypertension in China remain suboptimal despite high prevalence of hypertension and increasing incidence of stroke and myocardial infarction.This study reported blood pressure levels, prevalence, awareness, treatment, and control rates of hypertension, in addition to drug treatments in China.This is a country-specific analysis of 45 108 individuals, average age 51.4 (standard deviation 9.6) (35-70) years, enrolled between 2005 and 2009, from 70 rural and 45 urban communities in 12 provinces.Among 18 915 (41.9% overall population) hypertensive participants, 7866 (41.6%) were aware, 6503 (34.4%) treated but only 1545 (8.2%) controlled. Prevalence of hypertension was higher, but awareness, treatment, and control were lower in rural than urban residents. Prevalence of hypertension was highest in eastern (44.3%), intermediate in central (39.3%), and lowest in western regions (37.0%). Awareness was higher in central (44.3%) and eastern (42.4%) but lower in western regions (37.0%). Similar patterns were observed in treatment rates, 37.7% central, 35.2% eastern, and 26.7% in western regions with control rates of 8.3% in eastern, 7.6% central, and 5.3% west regions. Of 4744 participants receiving documented treatments, 37.5% received traditional combination drugs alone, 55.4% western drugs alone and 7.1% combination of traditional combination drug in addition to western drugs.In China, hypertension is common, and while recent studies suggest some improvements, more than half of affected individuals were unaware that they had hypertension. Rates of control remain low. National programs effective in preventing and controlling hypertension in China are urgently needed.