Spatiotemporal impact of COVID-19 on Taiwan air quality in the absence of a lockdown: Influence of urban public transportation use and meteorological conditions

The unprecedented outbreak of COVID-19 significantly improved the atmospheric environment for lockdown-imposed regions; however, scant evidence exists on its impacts on regions without lockdown. A novel research framework is proposed to evaluate the long-term monthly spatiotemporal impact of COVID-19 on Taiwan air quality through different statistical analyses, including geostatistical analysis, change detection analysis and identification of nonattainment pollutant occurrence between the average mean air pollutant concentrations from 2018–2019 and 2020, considering both meteorological and public transportation impacts. Contrary to lockdown-imposed regions, insignificant or worsened air quality conditions were observed at the beginning of COVID-19, but a delayed improvement occurred after April in Taiwan. The annual mean concentrations of PM10, PM2.5, SO2, NO2, CO and O3 in 2020 were reduced by 24%, 18%, 15%, 9.6%, 7.4% and 1.3%, respectively (relative to 2018–2019), and the overall occurrence frequency of nonattainment air pollutants declined by over 30%. Backward stepwise regression models for each air pollutant were successfully constructed utilizing 12 meteorological parameters (R2 > 0.8 except for SO2) to simulate the meteorological normalized business-as-usual concentration. The hybrid single-particle Lagrangian integrated trajectory (HYSPLIT) model simulated the fate of air pollutants (e.g., local emissions or transboundary pollution) for anomalous months. The changes in different public transportation usage volumes (e.g., roadway, railway, air, and waterway) moderately reduced air pollution, particularly CO and NO2. Reduced public transportation use had a more significant impact than meteorology on air quality improvement in Taiwan, highlighting the importance of proper public transportation management for air pollution control and paving a new path for sustainable air quality management even in the absence of a lockdown

Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo