Spatiotemporal Correlations between Water Footprint and Agricultural Inputs: A Case Study of Maize Production in Northeast China

To effectively manage water resources in agricultural production, it is necessary to understand the spatiotemporal variation of the water footprint (WF) and the influences of agricultural inputs. Employing spatial autocorrelation analysis and a geographically weighted regression (GWR) model, we explored the spatial variations of the WF and their relationships with agricultural inputs from 1998 to 2012 in Northeast China. The results indicated that: (1) the spatial distribution of WFs for the 36 major maize production prefectures was heterogeneous in Northeast China; (2) a cluster of high WFs was found in southeast Liaoning Province, while a cluster of low WFs was found in central Jilin Province, and (3) spatial and temporal differentiation in the correlations between the WF of maize production and agricultural inputs existed according to the GWR model. These correlations increased over time. Our results suggested that localized strategies for reducing the WF should be formulated based on specific relationships between the WF and agricultural inputs

Financing institutional long-term care for the elderly in China: a policy evaluation of new models

A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao and a means-tested model in Nanjing. A focused systematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers

Frailty index based on laboratory tests improves prediction of short-and long-term mortality in patients with critical acute myocardial infarction

BackgroundPrevious studies have shown that the frailty index based on laboratory tests (FI-Lab) can identify older adults at increased risk of adverse health outcomes. This study aimed to determine whether the FI-Lab is associated with mortality risk and can provide incremental improvements in risk stratification of patients with critical acute myocardial infarction (AMI).Materials and methodsWe conducted a secondary analysis of data from the Medical Information Mart for Intensive Care (MIMIC)-IV database. A 33-item FI-Lab was constructed. Outcomes of interest were in-hospital and 1-year mortality. Logistic regression models were used to investigate the association between the FI-Lab and outcomes. For the assessment of the incremental predictive value, the FI-Lab was added to several risk stratification scoring systems for critically ill patients, and the following indices were calculated: Δ C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI).ResultsOut of 2,159 patients, 477 died in hospital (22.1%), and 898 died during the 1-year follow-up period. After adjustment for confounders, the FI-Lab was associated with increased in-hospital mortality [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.05–1.07] and 1-year mortality (OR = 1.05, 95% CI: 1.04–1.06) when assessed as a continuous variable (per 0.01-score increase). When assessed as a categorical variable, the FI-Lab was associated with in-hospital mortality (2nd Quartile: OR = 1.89, 95% CI: 1.18–3.03; 3rd Quartile: OR = 3.46, 95% CI: 2.20–5.46; and 4th Quartile: OR = 5.79, 95% CI: 3.61–9.28 compared to 1st Quartile) as well as 1-year mortality (2nd Quartile: OR = 1.66, 95% CI: 1.23–2.24; 3rd Quartile: OR = 2.40, 95% CI: 1.76–3.26; and 4th Quartile: OR = 3.76, 95% CI: 2.66–5.30 compared to 1st Quartile) after adjustment for confounders. The addition of the FI-Lab to all disease severity scores improved discrimination and significantly reclassified in-hospital and 1-year mortality risk.ConclusionThe FI-Lab was a strong predictor of short- and long-term mortality in patients with critical AMI. The FI-Lab improved the ability to predict mortality in patients with critical AMI and therefore might be useful in the clinical decision-making process

Comprehensive assessment of emergency departments in county-level public hospitals: a multicenter descriptive cross-sectional study in Henan province, China

BackgroundEmergency Departments (EDs) play a crucial role in providing immediate medical care, particularly in densely populated countries like China. While previous research has predominantly focused on well-funded urban hospitals, this study offers a comprehensive evaluation of EDs in county-level public hospitals in Henan province, China, aiming to identify disparities and challenges.MethodsA descriptive cross-sectional survey was conducted in 382 public hospitals across Henan province, China, from July 1, 2023, to August 1, 2023. Data were collected using an electronic questionnaire covering hospital information, human resources, infrastructure, clinical capabilities, and operational capacities. The data collection period for this survey spanned from January 1 to December 31, 2022.ResultsWith a remarkable 94.0% response rate, our study reveals significant disparities in county-level public hospitals compared to their provincial or municipal counterparts in Henan Province, China. County-level hospitals, which constitute 266 of the total 342 surveyed facilities, exhibit notable differences, including fewer doctors (median: 11 vs. 23, p < 0.0001) and nurses (median: 18 vs. 37, p < 0.0001). Additionally, a higher proportion of junior doctors is observed in these hospitals, while senior medical staff are more prevalent in provincial or municipal hospitals (p < 0.001). County-level hospitals also face resource challenges, with fewer beds in the emergency room (median: 4 vs. 7, p = 0.0003) and limited proficiency in advanced clinical procedures such as POCT, fiberoptic bronchoscopy, CRRT, ECMO, ultrasound equipment operation, and intraosseous infusion, with significant differences noted in most of these capabilities (p < 0.05). Operational capabilities show distinctions as well, with county-level hospitals managing a lower patient volume (median: 14,516 vs. 34,703, p < 0.0001) and handling fewer pre-hospital CPR cases (median: 33 vs. 89, p < 0.0001). In-hospital CPR success rates are also lower in county-level hospitals (median ROSC: 25.0% vs. 42.8%, p = 0.0068).ConclusionWhile provincial or municipal hospitals enjoy better resources, county-level hospitals, especially crucial in less urbanized regions, face substantial challenges. Addressing these disparities is imperative, necessitating targeted investments, improved infrastructure, enhanced clinical training, and the adoption of innovations like telemedicine to enhance the quality of emergency care

Two-dimensional germanium islands with Dirac signature on Ag2Ge surface alloy

Two-dimensional (2D) Dirac materials have attracted intense research efforts due to their promise for applications ranging from field-effect transistors and low-power electronics to fault-tolerant quantum computation. One key challenge is to fabricate 2D Dirac materials hosting Dirac electrons. Here, monolayer germanene is successfully fabricated on a Ag2Ge surface alloy. Scanning tunneling spectroscopy measurements revealed a linear energy dispersion relation. The latter was supported by density functional theory calculations. These results demonstrate that monolayer germanene can be realistically fabricated on a Ag2Ge surface alloy. The finding opens the door to exploration and study of 2D Dirac material physics and device applications

Nanopore-patterned CuSe drives the realization of PbSe-CuSe lateral heterostructure

Monolayer PbSe has been predicted to be a two-dimensional (2D) topological crystalline insulator (TCI) with crystalline symmetry-protected Dirac-cone-like edge states. Recently, few-layered epitaxial PbSe has been grown on the SrTiO3 substrate successfully, but the corresponding signature of the TCI was only observed for films not thinner than seven monolayers, largely due to interfacial strain. Here, we demonstrate a two-step method based on molecular beam epitaxy for the growth of the PbSe-CuSe lateral heterostructure on the Cu(111) substrate, in which we observe a nanopore patterned CuSe layer that acts as the template for lateral epitaxial growth of PbSe. This further results in a monolayer PbSe-CuSe lateral heterostructure with an atomically sharp interface. Scanning tunneling microscopy and spectroscopy measurements reveal a four-fold symmetric square lattice of such monolayer PbSe with a quasi-particle band gap of 1.8 eV, a value highly comparable with the theoretical value of freestanding PbSe. The weak monolayer-substrate interaction is further supported by both density functional theory (DFT) and projected crystal orbital Hamilton population, with the former predicting the monolayer's anti-bond state to reside below the Fermi level. Our work demonstrates a practical strategy to fabricate a high-quality in-plane heterostructure, involving a monolayer TCI, which is viable for further exploration of the topology-derived quantum physics and phenomena in the monolayer limit.Comment: 26 pagres, 6 Figure

Molecular Characteristics of Staphylococcus aureus From Food Samples and Food Poisoning Outbreaks in Shijiazhuang, China

As an opportunistic pathogen worldwide, Staphylococcus aureus can cause food poisoning and human infections. This study investigated the sequence typing, the penicillin (blaZ) and methicillin (mec) resistance profiles of S. aureus from food samples and food poisoning outbreaks in Shijiazhuang City, and the staphylococcal enterotoxin (SE) types of the S. aureus isolates from food poisoning. A total of 138 foodborne S. aureus isolates were distributed into 8 clonal complexes (CCs) and 12 singletons. CC1, CC5, CC8, CC15, CC97, CC59, CC398, CC88, and CC7 were the predominant CCs of foodborne S. aureus isolates. Moreover, CC59, CC15, and CC5 were the most prevalent CCs in food poisoning outbreaks. SEE was the most commonly detected SE in food poisoning isolates. One hundred thirty-three S. aureus isolates harbored the penicillin-resistant gene blaZ, and nine isolates carried the mec gene. The present study further explained the relationship between S. aureus and foods and food poisoning and indicated the potential risk of S. aureus infection

Assessment of disaster preparedness and related impact factors among emergency nurses in tertiary hospitals: descriptive cross-sectional study from Henan Province of China

BackgroundThe aim of this study was to investigate the current state of disaster preparedness and to determine associated factors among emergency nurses from tertiary hospitals in Henan Province of China.MethodsThis multicenter descriptive cross-sectional study was conducted with emergency nurses from 48 tertiary hospitals in Henan Province of China between September 7, 2022–September 27, 2022. Data were collected through a self-designeds online questionnaire using the mainland China version of the Disaster Preparedness Evaluation Tool (DPET-MC). Descriptive analysis and multiple linear regression analysis were used to evaluate disaster preparedness and to determine factors affecting disaster preparedness, respectively.ResultsA total of 265 emergency nurses in this study displayed a moderate level of disaster preparedness with a mean item score of 4.24 out 6.0 on the DPET-MC questionnaire. Among the five dimensions of the DPET-MC, the mean item score for pre-disaster awareness was highest (5.17 ± 0.77), while that for disaster management (3.68 ± 1.36) was the lowest. Female gender (B = −9.638, p = 0.046) and married status (B = −8.618, p = 0.038) were negatively correlated with the levels of disaster preparedness. Five factors positively correlated with the levels of disaster preparedness included having attended in the theoretical knowledge training of disaster nursing since work (B = 8.937, p = 0.043), having experienced the disaster response (B = 8.280, p = 0.036), having participated in the disaster rescue simulation exercise (B = 8.929, p = 0.039), having participated in the disaster relief training (B = 11.515, p = 0.025), as well as having participated in the training of disaster nursing specialist nurse (B = 16.101, p = 0.002). The explanatory power of these factors was 26.5%.ConclusionEmergency nurses in Henan Province of China need more education in all areas of disaster preparedness, especially disaster management, which needs to be incorporated into nursing education, including formal and ongoing education. Besides, blended learning approach with simulation-based training and disaster nursing specialist nurse training should be considered as novel ways to improve disaster preparedness for emergency nurses in mainland China

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead