[Real-world research on cervical cancer screening program and effect evaluation for Chinese population]

Objective: To evaluate the actual efficacy of cervical cancer and precancerous lesions screening approaches in real-world regions with different economic levels in China. Methods: The demonstrative application and effect evaluation of cervical cancer screening program were conducted in 21 hospitals nationwide from 2015 to 2018. Multi-stage sampling method was adopted to divide the country into 7 large areas according to geographical location. Two to four screening sites of two types of cancer (cervical cancer and breast cancer) were selected in each area, and the grassroots screening sites were implemented under the guidance of superior hospitals. In rural areas, women were initially screened using cytology, human papillomavirus (HPV) testing and visual inspection. The women with positive cytology or visual inspection were referred for colposcopy, and the women with positive HPV infection were randomly referred for reflex cytology or visual inspection, or direct colposcopy examination. In urban areas, women were primarily randomized into cytology or HPV testing groups. The women with abnormal cytology or positive HPV 16/18 infection were directly referred for colposcopy examination, whereas the women with positive infection of the other 12 high-risk subtypes of HPV were referred for reflex cytology or colposcopy. All of recruited women would be follow-up and screened by the baseline screening techniques in the third year while the positive women underwent colposcopy examination. The positive rates, referral rates, the detection rates of grade 2 and above of cervical intraepithelial neoplasia (CIN 2+ ) were compared. Results: A total of 63 931 women were recruited at the baseline. Among them, 11 rural sites included 33 823 women: 15 577, 11 157 and 7 089 women were screened by HPV testing, visual inspection via acetic acid or Lugol's iodine (VIA/VILI) and cytology, respectively. Additionally, 30 108 women were from 10 urban sites: 9 907 and 20 201 women were screened by cytology and HPV subtyping, respectively. The HPV positive rate for urban women was 9.34%, whereas that for rural women was 12.53%. The abnormal rate of cytology for urban women was 5.63%, and that for rural women was 4.24%. The positive rate of VIA/VILI in the rural women was 12.25% Furthermore, the detection rate of CIN2+ at the baseline was 0.56%, and that was statistically higher in HPV-positive group than cytology-positive group (P<0.05). Conclusions: All of screening sites completed the baseline screening tasks as expected. The prevalence of HPV infection is higher in rural women than urban women. The performance of HPV testing is better than cytology for detecting CIN2+ cases. This real-world demonstration study provides evidences for cervical cancer prevention and control in different regions.

Clinicoradiological features associated with epidermal growth factor receptor exon 19 and 21 mutation in lung adenocarcinoma

AIM

To retrospectively identify clinicopathological and radiological characteristics that could be independent predictors of epidermal growth factor receptor (EGFR) exon 19 and 21 mutation in surgically resected lung adenocarcinomas in a cohort of Asian patients.

MATERIALS AND METHODS

Demographics, histopathology data, and preoperative chest computed tomography (CT) images were evaluated retrospectively in 471 surgically resected lung adenocarcinomas. A total of 24 CT descriptors were assessed. Univariate analyses and multivariate logistic regression analyses were performed to identify independent predicted factors of harbouring EGFR mutations.

RESULTS

EGFR mutations were existed in 252 (53.5%) of 471 patients, and associated with 11 clinicoradiological features. For the model with both clinical and radiological features, the independent predictors of harbouring EGFR mutation were small maximum diameter (≤3.9 cm), non-smokers, micropapillary pattern, pleural retraction, vascular convergence, and absence of solid pattern. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.784. Multivariable logistic regression analysis indicated that non-smokers, vascular convergence, and absence of solid pattern were important independent predictors of EGFR exon 19 mutation, while non-smokers and vascular convergence were independent predictors of EGFR exon 21 mutation. The AUCs were 0.807 and 0.794, respectively. A lepidic growth pattern appeared more frequently in exon 21 mutant tumours than in exon 19 mutant group (p<0.001).

CONCLUSION

CT imaging features of lung adenocarcinomas in combination with clinical variables could be used to prognosticate EGFR mutation status. The separate analysis of EGFR exon 19 or 21 mutation could further improve diagnostic performance.

[Thoracic paravertebral block in the PACU for immediate postoperative pain relief after video-assisted thoracoscopic surgery]

Objective: To investigate the effectiveness and safety of the thoracic paravertebral block(TPVB) in the post postanesthesia care unit(PACU) for patients suffered moderate to severe pain after Video-Assisted Thoracoscopic Surgery(VATS). Methods: 78 atients who complained moderate to severe pain on arrival to PACU after VATS were randomly assigned into two groups: thoracic paravertebral block treatment group(P group) and sufentanil treatment group(S group). The VAS Pain score at rest and movement, heart rate, blood pressure, and pulse oximetry 1 hour after treatment and duration of patients staying in the PACU after treatment were recorded. VAS Pain score at rest and on coughing at 8, 24 and 48 hours after treatment were closely monitored. Sufentanil comsumption, patient satisfaction and related complications were also recorded. Results: A successful TPVB was achieved in all patients in P group without puncture related complications. The VAS pain scores at rest and on coughing 1 hour, 8 hours, 24 hours and 48 hours after treatment in P group were significantly lower than the patients in S group. Systolic blood pressure 1 hour after treatment in P group was also lower than the patients in S group(118mmHg±14mmHg vs 128 mmHg±14 mmHg, P=0.021). SPO2 1 hour after treatment in P group was much higher than the patients in S group(95%±3% vs 92%±4%, P=0.015). The duration of patients staying in the PACU after treatment in both groups were similar. Sufentanil comsumption, rate of vomiting and nausea was significantly less and satisfaction was better in P group than thoses in S group. Conclusion: In the postanesthesia care unit, TPVB could provide effective and safe analgesia therapy for patients suffered from moderate to severe pain after VATS.

In vitro corrosion behavior and biocompatibility of nanostructured Ti6Al4V

Ti6Al4V (TC4) alloy has long been used as a bone interfacing implant material in dentistry and orthopedics due to its excellent biocompatibility and mechanical properties. The performance of TC4 can be further tailored by altering its grain structures. In this study, by means of sliding friction treatment (SFT), a nano-grained (NG) surface layer with an average grain size of ≤100 nm on the topmost surface was successfully generated on coarse-grained (CG) TC4 alloy sheet. It was shown that the NG surface possessed notably enhanced corrosion resistance in physiological solution compared to the CG surface, due to the formation of thicker and denser passive film facilitated by surface nanocrystallization. Additionally, the NG surface with stronger hydrophilicity favorably altered the absorption of anchoring proteins such as fibronectin (Fn) and vitronectin (Vn) that can mediate subsequent osteoblast functions. The in vitro results indicated that the NG surface exhibited remarkable enhancement in osteoblast adherence, spreading and proliferation, and obviously accelerated the osteoblast differentiation as compared to CG surface. Moreover, the NG surface also demonstrated good hemocompatibility. These findings suggest that SFT can endure bio-metals with advanced multifunctional properties for biomedical applications.

[The clinical significance of EBV DNA analysis in nasopharyngeal carcinoma screening]

Objective:The aim of this study is to explore the value of EBV DNA monitor in high risk population of nasopharyngeal carcinoma (NPC). Method:A total of 366 cases of NPC at high risk were screened for 15 864 cases by ELISA, and 262 cases were randomly selected from low-risk groups. Fifty-eight nasopharyngeal carcinoma patients were also involved. EBV DNA was detected by PCR in 366 NPC high risk patients and followed up for 1 year. The clinical significance of EBV-DNA in screening NPC was compared. Result:The positive rate of EBV-DNA test was 12.0% in primary screening, EBV-DNA test in primary screening was 3.4% in low-risk population, and EBV-DNA in nasopharyngeal carcinoma was 91.4%, The positive rate of the three groups was statistically significant (P<0.01); After one year follow-up, a total of 267 cases returned visit. Positive rate of group A with continuous high risk was significantly higher than group B who was high risk at the first time of visit and non high risk at returned visit (P＜0.05). Conclusion:Quantitative analysis of plasma EBV DNA in high risk population can supply serological risk assessment. It can elevate the efficiency of screening and has significant application value for NPC high risk population.

Preparation, Foaming and Characterization of Poly(l-lactic acid))/Poly(d-lactic acid)-Grafted Graphite Oxide Blends

Commercial poly(l-lactic acid) (PLLA) was blended with different contents of graphene oxide-graft-poly(d-lactic acid) (GO-g-PDLA), which was synthesized via ring-opening polymerization using modified GO as initiator. PLLA and PLLA/GO-g-PDLA blend foams were prepared in a batch process via varying-temperature mode using supercritical carbon dioxide as physical foaming agent. The results showed that the addition of GO-g-PDLA in PLLA leads to the formation of stereocomplex (sc)-crystallites. Increase in the GO-g-PDLA content enhances the IR absorption, diffraction peak and melting peak corresponding to the sc-crystallites. The addition of GO-g-PDLA to PLLA leads to the decrease of the cell diameter, increase of the cell density and to a little change in expansion ratio, which is attributed to the fact that the enhancement of PLLA crystallization restricts cell growth and GO-g-PDLA acts as nucleation point.

Radiologic indicators for prediction of difficult laryngoscopy in patients with cervical spondylosis

BACKGROUND

We identified the most useful variables for prediction of difficult laryngoscopy in patients with cervical spondylosis according to physical indicators and preoperative skeletal X-ray and soft tissue MRI measurements. We hypothesized that there was a closer association between difficult laryngoscopy and radiologic indicators.

METHODS

We randomly enroled 315 patients undergoing elective cervical spine surgery and analysed the radiological and physical data in predicting difficult laryngoscopy.

RESULTS

We identified five variables that were most useful in predicting difficult laryngoscopy: the inter-incisor gap (P = 0.006), modified Mallampati test score (P = 0.004), distance from the highest point of the hyoid bone to the mandibular body (P < 0.001), most antero-inferior point of the upper central incisor tooth (P < 0.001), and length of the epiglottis (P = 0.002). Binary multivariate logistic regression analyses identified three factors that were independently associated with difficult laryngoscopy: the Mallampati score, distance from the hyoid bone to the mandibular body, and the anterior-inferior point of the upper central incisor tooth. The odds ratios and 95% confidence intervals were 1.547 (1.029-2.327), 1.222 (1.139-1.310), and 1.224 (1.133-1.322), respectively. The AUC for hyoid bone distance to mandibular body (0.832) was larger than that of anterior-inferior point of the upper central incisor tooth (0.802, P > 0.05) and that of modified Mallampati test (0.602, P < 0.05).

CONCLUSION

Distance from the highest point of the hyoid bone to the mandibular body appears to be the most accurate indicator for difficult laryngoscopy in patients with cervical spondylosis.

[The effects of closure to live poultry markets on Avian influenza A (H7N9) epidemics in China]

Since March 2013, China had experienced five seasonal epidemics related to Avian influenza A (H7N9). An unprecedented outbreak of H7N9 epidemic started from September 2016, with 730 cases reported till June 30(th) 2017, in mainland China that caused profound influences on both social development and health of the people. As an emerging infectious disease, information on pathogenic characteristics, transmission patterns and other epidemiological features of H7N9 virus somehow remained unclear. Data from previous studies suggested that the live poultry market (LPM) seemed to have served as main places where H7N9 virus got originated, mutated, spread and thus infected the human beings. Hence, closure of LPMs was suggested a major measure to control and prevent H7N9 epidemics in China. However, the effectiveness of different ways of LPM closures on H7N9 epidemics had been controversial. This study systemically summarized the effects of different ways of LPM closures on H7N epidemics from previous studies, aiming to provide references for developing a better program on H7N9 control and prevention in the country.

[Commuting mode specific exposure to PM(2.5) in urban area of Guangzhou]

Objective: To find the differences in PM(2.5) exposure level in the context of four commuting modes (by walk, bicycle, bus and subway) in Guangzhou. Methods: The PM(2.5) exposure assessment was carried out from January to December 2015 in Guangzhou. PM(2.5) was measured by using SidePak individual dust meter (AM510, TSI Inc. USA) with time interval of 1 minute. Our measurement was taken on Monday, Wednesday, Friday and Sunday in the second week of each month and the samples were collected in the morning (07:00-09:00), afternoon (11:00-13:00) and evening (17:00-19:00). Results: A total of 284 air samples during walking, 281 air samples during bicycle riding, 278 air samples in bus, and 280 air samples in subway were collected. The median PM(2.5) concentrations exposed during walking, during bicycle riding, in bus and in subway were 38.4, 38.6, 23.3 and 24.1 μg/m(3), respectively, which were positive correlated with exposure concentration in fixed surveillance sites. The exposure level was lowest in summer, and highest in winter. The median of one-way exposure level to PM(2.5) from high to low were as follows: 21.0 μg for bicycle riding, 20.1 μg for walking, 5.1 μg for taking bus and 2.6 μg for taking subway. The season and time specific one-way exposure levels to PM(2.5) of four commuting modes were consistent. Conclusions: The exposure level to PM(2.5) was obviously higher during walking and bicycle riding than that in bus and subway. The exposure level to PM(2.5) during walking was higher than that during bicycle riding, in bus and in subway.

A genome-wide association study suggests new candidate genes for milk production traits in Chinese Holstein cattle

A genome-wide association study (GWAS) was conducted on 15 milk production traits in Chinese Holstein. The experimental population consisted of 445 cattle, each genotyped by the GGP (GeneSeek genomic profiling)-BovineLD V3 SNP chip, which had 26 151 public SNPs in its manifest file. After data cleaning, 20 326 SNPs were retained for the GWAS. The phenotypes were estimated breeding values of traits, provided by a public dairy herd improvement program center that had been collected once a month for 3 years. Two statistical models, a fixed-effect linear regression model and a mixed-effect linear model, were used to estimate the association effects of SNPs on each of the phenotypes. Genome-wide significant and suggestive thresholds were set at 2.46E-06 and 4.95E-05 respectively. The two statistical models concurrently identified two genome-wide significant (P < 0.05) SNPs on milk production traits in this Chinese Holstein population. The positional candidate genes, which were the ones closest to these two identified SNPs, were EEF2K (eukaryotic elongation factor 2 kinase) and KLHL1 (kelch like family member 1). These two genes could serve as new candidate genes for milk yield and lactation persistence, yet their roles need to be verified in further function studies.

[A prospective study of the efficacy and safety of maintenance therapy with recombinant human thrombopoietin in patients with primary immune thrombocytopenia: a multicenter study]

Objective: To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO. Methods: Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×10(9)/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×10(9)/L. Results: A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×10(9)/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×10(9)/L) at 4(th) week, 8(th) week and 12(th) week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×10(9)/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild. Conclusion: Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.

[Application of general anesthesia combined with epidural anesthesia/analgesia in rehabilitation after gastric cancer resection]

Objective: To investigate the efficacy of general anesthesia with epidural anesthesia and postoperative epidural analgesia in terms of pain relief and post-operative functional recovery. Methods: Ninety-six patients were randomly assigned to general anesthesia and intravenous analgesia group (GI) or general anesthesia combined with epidural anesthesia and epidural analgesia group (GE). Demographic and operative data, postoperative VAS pain scores, gastrointestinal function, postoperative hospital stays, general complications were assessed prospectively. Results: (1) The postoperative VAS scores of patients in the group GE at 2, 24, 48, and 72 hours were significantly lower than those in the group GI. (2) Compared with the group GI, the patients in group GE had earlier postoperative flatus and a shorter postoperative hospital stay (8.4 ± 2.5 vs 10.0 ± 3.2, P=0.012 8). Conclusion: General anesthesia combined with epidural anesthesia and postoperative epidural analgesia could provide better pain relief, enhance early rehabilitation and reduce the duration of hospital.

[Clinical research about the consecutive pain and flubiprofen axetil analgesia following uvulopalatopharyngoplasty]

Objective:To evaluate the postoperative pain degree on OSAHS patients following UPPP, analyze the pain characteristic during seven consecutive days, and discuss the mechanism. To observe the analgesia effect by using flubiprofen axetil. Finally making a comprehensive understanding about UPPP perioperative period and providing more choices about analgesia treatment.Method:Fifty-five patients who underwent UPPP in the First Hospital of China Medical University were divided into analgesia group（n=30）and control group（n=25）.Normal saline 50 ml+ flubiprofen axetil 100 mg was used bid for pain relief in analgesia group during seven days following operation, and normal saline 50ml was used in control group.A visual analog scale(VAS) was used for measuring mean pain intensity each day during the period from operative day to the post-operative 7th day，scores were recorded. Continuous changes about pharynx pain were observed and VAS pain scores were compared betweenanalgesia groupand control group. Result:VAS pain scores were the highest on the operative day and the post-operative 1st day, median (interquartile range) was 7（5.5-8.25），7（6-8）respectively,then decreased gradually. The most significantly decrease happened on the post-operative 2nd and 5th day(P<0.01). Pain scores in analgesia group were most significantly lower than control group from the operative day to the post-operative 4th day(P<0.01), were lower during the post-operative 5th and 6th day(P<0.05),no difference on the post-operative 7th day. Conclusion:The most painful period following UPPP is from the operative day to the post-operative 1st day, then pain decreases gradually. The pain reduces significantly on the post-operative 2nd and 5,6th day.Surgical trauma, in flammatory reaction and suture pulling may be the reason of pain. Flubiprofen axetil effectively reduces pain and the suggested analgesia period is from the operative day to the post-operative 4th-6th day.

[Lagged effects of diurnal temperature range on mortality in 66 cities in China: a time-series study]

Objective: To estimate the effect of daily diurnal temperature range (DTR) on mortality in different areas in China. Methods: A time series study using the data collected from 66 areas in China was conducted, and Meta-analysis was used to analyze the estimates of associations between DTR and daily mortality. Modifying effects of extremely low and high DTR-mortality relationship by season and socioeconomic status (SES) were also evaluated respectively. Cumulative excess risk (CER) was used as an index to evaluate the effects. Results: The information about 1 260 913 registered deaths were collected between 1 January 2006 and 31 December 2011, we found the relationship between extreme DTR and mortality was non-linear in all regions and the exposure-response curve was J-shaped. In central and south areas of China, the result indicated the obvious acute effect of extremely high DTR, and the mortality effect in central area (CER=5.1%, 95% CI: 2.4%-7.9%) was significant higher than that in south area (CER=4.5%, 95% CI: 1.7%-7.3%). Regarding to the modification of seasons, the cumulative mortality effect of DTR in cold season (CER=5.8%, 95%CI: 2.5%-9.2%) was higher than that in hot season (CER=3.1%, 95%CI: 1.1%-5.1%). Generally, deaths among the elderly (≥75 years) were associated more strongly with extremely high DTR. Conclusions: The mortality effects of extremely DTR in different areas and seasons showed different characteristics, that in central area and in cold season it was significantly stronger. After modified by season and SES, DTRs were the greatest threat to vulnerable population, especially to the elderly (≥75 years). Therefore, more attention should be paid to vulnerable groups and protection measures should be taken according to the local and seasonal conditions.

[A review on the advancement of internet-based public health surveillance program]

Internet data is introduced into public health arena under the features of fast updating and tremendous volume. Mining and analyzing internet data, researchers can model the internet-based surveillance system to assess the distribution of health-related events. There are two main types of internet-based surveillance systems, i.e. active and passive, which are distinguished by the sources of information. Through passive surveillance system, information is collected from search engine and social media while the active system gathers information through provision of the volunteers. Except for serving as a real-time and convenient complementary approach to traditional disease, food safety and adverse drug reaction surveillance program, Internet-based surveillance system can also play a role in health-related behavior surveillance and policy evaluation. Although several techniques have been applied to filter information, the accuracy of internet-based surveillance system is still bothered by the false positive information. In this article, we have summarized the development and application of internet-based surveillance system in public health to provide reference for a better surveillance program in China.

Performance assessment and microbial diversity of two pilot scale multi-stage sub-surface flow constructed wetland systems

This study assessed the performance and diversity of microbial communities in multi-stage sub-surface flow constructed wetland systems (CWs). Our aim was to assess the impact of configuration on treatment performance and microbial diversity in the systems. Results indicate that at loading rates up to 100gBOD5/(m(2)·day), similar treatment performances can be achieved using either a 3 or 4 stage configuration. In the case of phosphorus (P), the impact of configuration was less obvious and a minimum of 80% P removal can be expected for loadings up to 10gP/(m(2)·day) based on the performance results obtained within the first 16months of operation. Microbial analysis showed an increased bacterial diversity in stage four compared to the first stage. These results indicate that the design and configuration of multi-stage constructed wetland systems may have an impact on the treatment performance and the composition of the microbial community in the systems, and such knowledge can be used to improve their design and performance.

Ethylene Methyl Acrylate Copolymer Toughened Poly(lactic acid) Blends: Phase Morphologies, Mechanical and Rheological Properties

The ethylene methyl acrylate copolymer (EMA), for the first time, was melt blended with poly(lactic acid) (PLA) by a twin-screw extruder to toughen PLA. The phase morphologies, mechanical, and rheological properties of the PLA/EMA blends with six weight ratios were investigated. The results showed that the addition of EMA improves the toughness of PLA at the expense of the tensile strength, flexural strength and modulus to a certain degree, and results in the transition from brittle fracture of PLA into ductile fracture. The droplet-matrix morphology is observed in the PLA/EMA blends, in which the mean diameter of EMA droplets increases and its distribution widens gradually with increasing the EMA content. The PLA/EMA blends with three weight ratios (90/10, 80/20, and 70/30) display different characteristic linear viscoelastic properties in the low frequency region, which were investigated in terms of their complex viscosity, storage modulus, and Cole-Cole plots. The interfacial tension between the PLA and EMA is calculated using the Palierne model conducted on the 80/20 PLA/EMA blend, and the calculated result is 3.3 mN/m.

A single-phase heteroatom doped carbon dot phosphor toward white light-emitting diodes

Single-phase heteroatom doped carbon dots were prepared using citric acid monohydrate and ethylenediamine toward white light-emitting diodes.

Effect and mechanism of dihydroartemisinin on proliferation, metastasis and apoptosis of human osteosarcoma cells

Osteosarcoma represents an aggressive type of bone malignancy that poses a significant health threat. The objective of the current study was to analyze the effect and mechanism of dihydroartemisinin (DHA) on the proliferation, metastasis and apoptosis of human osteosarcoma cells. A gradient concentration of DHA (15, 25 and 35 μmol.L-1) was used to stimulate the cells, along with control and Dimethyl sulfoxide (DMSO). The phenotypic outcomes were characterized using MTT assay, clone formation assay, Hoechst 33258 staining assay, luciferase reporter plasmid assay, Western blot and wound healing assay. In addition, IBM SPSS Statistics 18.0 software was applied for statistical analysis and all experimental data were expressed as mean ± s.d. Analysis of variance (ANOVA) was applied to compare the differences among multiple groups. Our results demonstrated that DHA inhibited the proliferation and metastasis of osteosarcoma cells and promoted the apoptosis in the cytomorphosis.

Tree-based methods for individualized treatment regimes

Individualized treatment rules recommend treatments on the basis of individual patient characteristics. A high-quality treatment rule can produce better patient outcomes, lower costs and less treatment burden. If a treatment rule learned from data is to be used to inform clinical practice or provide scientific insight, it is crucial that it be interpretable; clinicians may be unwilling to implement models they do not understand, and black-box models may not be useful for guiding future research. The canonical example of an interpretable prediction model is a decision tree. We propose a method for estimating an optimal individualized treatment rule within the class of rules that are representable as decision trees. The class of rules we consider is interpretable but expressive. A novel feature of this problem is that the learning task is unsupervised, as the optimal treatment for each patient is unknown and must be estimated. The proposed method applies to both categorical and continuous treatments and produces favourable marginal mean outcomes in simulation experiments. We illustrate it using data from a study of major depressive disorder.

Nitrogen dynamics model for a pilot field-scale novel dewatered alum sludge cake-based constructed wetland system

A model simulating the effluent nitrogen (N) concentration of treated animal farm wastewater in a pilot on-site constructed wetland (CW) system, using dewatered alum sludge cake (DASC) as wetland substrate, is presented. The N-model was developed based on the Structural Thinking Experiential Learning Laboratory with Animation software and is considering organic nitrogen, ammonia nitrogen (NH3) and nitrate nitrogen (NO3-N) as the major forms of nitrogen involved in the transformation chains. Ammonification (AMM), ammonia volatilization, nitrification (NIT), denitrification, plant uptake, plant decaying and uptake of inorganic nitrogen by algae and bacteria were considered in this model. pH, dissolved oxygen, temperature, precipitation, solar radiation and nitrogen concentrations were considered as forcing functions in the model. The model was calibrated by observed data with a reasonable agreement prior to its applications. The simulated effluent detritus nitrogen, NH4-N, NO3-N and TN had a considerably good agreement with the observed results. The mass balance analysis shows that NIT accounts for 65.60%, adsorption (ad) (11.90%), AMM (8.90%) followed by NH4-N (Plants) (5.90%) and NO3-N (Plants) (4.40%). The TN removal was found 52% of the total influent TN in the CW. This study suggested an improved overall performance of a DASC-based CW and efficient N removal from wastewater.

Doubly Robust Learning for Estimating Individualized Treatment with Censored Data

Individualized treatment rules recommend treatments based on individual patient characteristics in order to maximize clinical benefit. When the clinical outcome of interest is survival time, estimation is often complicated by censoring. We develop nonparametric methods for estimating an optimal individualized treatment rule in the presence of censored data. To adjust for censoring, we propose a doubly robust estimator which requires correct specification of either the censoring model or survival model, but not both; the method is shown to be Fisher consistent when either model is correct. Furthermore, we establish the convergence rate of the expected survival under the estimated optimal individualized treatment rule to the expected survival under the optimal individualized treatment rule. We illustrate the proposed methods using simulation study and data from a Phase III clinical trial on non-small cell lung cancer.