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A vivid chronicle of the world's most successful authoritarian state. Pan, who reported from China for seven years, eluded the police and succeeded in going where few Western journalists have dared. From the rusting factories in the industrial northeast to a tabloid newsroom in the booming south, from a small-town courtroom to the plush offices of the nation's wealthiest tycoons, he takes us inside the battle for China's soul and into the lives of individuals struggling to come to terms with their nation's past and to take control of its future. Capitalism has brought prosperity and global respect to China, but the Communist government continues to resist the demands of its people for political freedom. The young people who filled Tiananmen Square in the spring of 1989 saw their hopes for a democratic China crushed, but Pan reveals that as older, more pragmatic adults, many continue to push for justice in different ways.--From publisher description.

Sex is increasingly recognized as an important factor in the epidemiology and outcome of many diseases. This also appears to hold for coronavirus disease 2019 (COVID-19). Evidence from China and Europe has suggested that mortality from COVID-19 infection is higher in men than women, but evidence from US populations is lacking. Utilizing data from a large healthcare provider, we determined if males, as compared to females have a higher likelihood of SARS-CoV-2 susceptibility, and if among the hospitalized COVID-19 patients, male sex is independently associated with COVID-19 severity and poor in-hospital outcomes. Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we conducted a cross-sectional analysis of data from a COVID-19 Surveillance and Outcomes Registry (CURATOR). Data were extracted from Electronic Medical Records (EMR). A total of 96,473 individuals tested for SARS-CoV-2 RNA in nasopharyngeal swab specimens via Polymerized Chain Reaction (PCR) tests were included. For hospital-based analyses, all patients admitted during the same time-period were included. Of the 96,473 patients tested, 14,992 (15.6%) tested positive, of whom 4,785 (31.9%) were hospitalized and 452 (9.5%) died. Among all patients tested, men were significantly older. The overall SARS-CoV-2 positivity among all tested individuals was 15.5%, and was higher in males as compared to females 17.0% vs. 14.6% [OR 1.20]. This sex difference held after adjusting for age, race, ethnicity, marital status, insurance type, median income, BMI, smoking and 17 comorbidities included in Charlson Comorbidity Index (CCI) [aOR 1.39]. A higher proportion of males (vs. females) experienced pulmonary (ARDS, hypoxic respiratory failure) and extra-pulmonary (acute renal injury) complications during their hospital course. After adjustment, length of stay (LOS), need for mechanical ventilation, and in-hospital mortality were significantly higher in males as compared to females. In this analysis of a large US cohort, males were more likely to test positive for COVID-19. In hospitalized patients, males were more likely to have complications, require ICU admission and mechanical ventilation, and had higher mortality than females, independent of age. Sex disparities in COVID-19 vulnerability are present, and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients.

Atmospheric deposition is considered to be a major process that removes pollutants from the atmosphere and an important source of nutrients and contaminants for ecosystems. Trace elements (TEs), especially toxic metals deposited on plants and into soil or water, can cause substantial damage to the environment and human health due to their transfer and accumulation in food chains. Despite public concerns, quantitative knowledge of metal deposition from the atmosphere to ecosystems remains scarce. To advance our understanding of the spatiotemporal variations in the magnitudes, pathways, compositions and impacts of atmospherically deposited TEs, precipitation (rain and snow) and dry-deposited particles were collected simultaneously at 10 sites in Northern China from December 2007 to November 2010. The measurements showed that the wet and dry depositions of TEs in the target areas were orders of magnitude higher than previous observations within and outside China, generating great concern over the potential risks. The spatial distribution of the total (wet plus dry) deposition flux was consistent with that of the dry deposition, with a significant decrease from industrial and urban areas to suburban, agricultural and rural sites, while the wet deposition exhibited less spatial variation. In addition, the seasonal variation of wet deposition was also different from that of dry deposition, although they were both governed by the precipitation and emission patterns. For the majority of TEs that exist as coarse particles, dry deposition dominated the total flux at each site. This was not the case for potassium, nickel, arsenic, lead, zinc, cadmium, selenium, silver and thallium, for which the relative importance between wet and dry deposition fluxes varied by site. Whether wet deposition is the major atmospheric cleansing mechanism for the TEs depends on the size distribution of the particles. We found that atmospheric inputs of copper, lead, zinc, cadmium, arsenic and selenium were of the same magnitude as their increases in the topsoil of agricultural systems. At a background forest site in Northern China, the total deposition flux of lead observed in this study (14.1 mg m−2 yr−1) was twice that of the critical load calculated for temperate forest ecosystems in Europe. These findings provide baseline data needed for future targeting policies to protect various ecosystems from long-term heavy metal input via atmospheric deposition.

Additional size-resolved chemical information is needed before the physicochemical characteristics and sources of airborne particles can be understood; however, this information remains unavailable in most regions of China due to lacking measurement data. In this study, we report observations of various chemical species in size-segregated particle samples that were collected over 1 year in the urban area of Beijing, a megacity that experiences severe haze episodes. In addition to fine particles, high concentrations of coarse particles were measured during the periods of haze. The abundance and chemical compositions of the particles in this study were temporally and spatially variable, with major contributions from organic matter and secondary inorganic aerosols. The contributions of organic matter to the particle mass decreased from 37.9 to 31.2 %, and the total contribution of sulfate, nitrate and ammonium increased from 19.1 to 33.9 % between non-haze and haze days, respectively. Due to heterogeneous reactions and hygroscopic growth, the peak concentrations of the organic carbon, cadmium and sulfate, nitrate, ammonium, chloride and potassium shifted from 0.43 to 0.65 µm on non-haze days to 0.65–1.1 µm on haze days. Although the size distributions of lead and thallium were similar during the observation period, their concentrations increased by a factor of more than 1.5 on haze days compared with non-haze days. We observed that sulfate and ammonium, which have a size range of 0.43–0.65 µm, sulfate and nitrate, which have a size range of 0.65–1.1 µm, calcium, which has a size range of 5.8–9 µm, and the meteorological factors of relative humidity and wind speed were responsible for haze pollution when the visibility was less than 10 km. Source apportionment using Positive Matrix Factorization showed six PM2.1 sources and seven PM2.1–9 common sources: secondary inorganic aerosol (25.1 % for fine particles vs. 9.8 % for coarse particles), coal combustion (17.7 % vs. 7.8 %), biomass burning (11.1 % vs. 11.8 %), industrial pollution (12.1 % vs. 5.1 %), road dust (8.4 % vs. 10.9 %), vehicle emissions (19.6 % for fine particles), mineral dust (22.6 % for coarse particles) and organic aerosol (23.6 % for coarse particles). The contributions of the first four factors and vehicle emissions were higher on haze days than non-haze days, while the reverse is true for road dust and mineral dust. The sources' contribution generally increased as the size decreased, with the exception of mineral dust. However, two peaks were consistently found in the fine and coarse particles. In addition, the sources' contribution varied with the wind direction, with coal and oil combustion products increasing during southern flows. This result suggests that future air pollution control strategies should consider wind patterns, especially during episodes of haze. Furthermore, the findings of this study indicated that the PM2.5-based data set is insufficient for determining source control policies for haze in China and that detailed size-resolved information is needed to characterize the important sources of particulate matter in urban regions and better understand severe haze pollution.

To elucidate the relationship between various sleep-wake-related indicators and nutritional status. Cross-sectional study. Community-based survey between 2017 and 2022 in Yilan City, Taiwan. 1,905 community-dwelling older adults aged ≥65 years. Nutritional status was evaluated using the Mini Nutritional Assessment, and participants were classified into normal nutritional status and undernutrition groups. Regarding sleep-wake-related indicators, specific items or component scores of the Pittsburgh Sleep Quality Index were used to assess sleep-wake schedule, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, presence of sleep disturbances, hypnotic use, and dysfunction in maintaining enthusiasm. The 5-item Athens Insomnia Scale and the Epworth Sleepiness Scale were used to evaluate insomnia and excessive daytime sleepiness, respectively. Of the 1,905 participants, the mean age was 75.6±7.1, with 52.2% being ≥75 years old, 58.9% were women, and 11.4% had undernutrition. After controlling for covariates, short sleepers were less likely to have undernutrition (OR: 0.63; 95% CI: 0.41–0.97); in contrast, long sleepers were more likely to exhibit undernutrition (OR: 1.52; 95% CI: 1.06–2.17). In addition, poor habitual sleep efficiency (OR:1.69; 95% CI:1.15–2.50), taking hypnotics in the past month (OR: 1.58; 95% CI: 1.12–2.24), and dysfunction in maintaining enthusiasm (OR: 1.93; 95% CI: 1.24–2.99) were associated with increased risk of undernutrition. Among older adults, various sleep-wake-related indicators differed in their relationships with nutritional status. Specific sleep-wake disturbances may indicate undernutrition in this population.

Emissions of reactive nitrogen (N) species can affect surrounding ecosystems via atmospheric deposition. However, few long-term and multi-site measurements have focused on both the wet and the dry deposition of individual N species in large areas of Northern China. Thus, the magnitude of atmospheric deposition of various N species in Northern China remains uncertain. In this study, the wet and dry atmospheric deposition of different N species was investigated during a three-year observation campaign at ten selected sites in Northern China. The results indicate that N deposition levels in Northern China were high with a ten-site, three-year average of 60.6 kg N ha−1 yr−1. The deposition levels showed spatial and temporal variation in the range of 28.5–100.4 kg N ha−1 yr−1. Of the annual total deposition, 40% was deposited via precipitation, and the remaining 60% was comprised of dry-deposited forms. Compared with gaseous N species, particulate N species were not the major contributor of dry-deposited N; they contributed approximately 10% to the total flux. On an annual basis, oxidized species accounted for 21% of total N deposition, thereby implying that other forms of gaseous N, such as NH3, comprised a dominant portion of the total flux. The contribution of NO3− to N deposition was enhanced in certain urban and industrial areas, possibly due to the fossil fuse combustion. As expected, the total N deposition in Northern China was significantly larger than the values reported by national scale monitoring networks in Europe, North America and East Asia because of high rates of wet deposition and gaseous NH3 dry deposition. Taken together, these findings show that NH3 emissions should be abated to mitigate high N deposition and associated potential impacts on ecosystems in Northern China. The present results improve our understanding of spatio-temporal variations of magnitudes, pathways and species of deposited N in the target areas, and are important not only to inform conservation and regulatory bodies but also to initiate further detailed studies. Uncertainties among current observations underscore the need to quantify the impact of vegetation on dry deposition and to refine the simulation of dry deposition velocity.

Since the mid-20th century, nitrogen (N) deposition has shown an increasing trend in the Tibetan Plateau (TP), where alpine ecosystems are sensitive to elevated N deposition. However, the quantitative characterization of N deposition in the TP remains unclear, due in most part to the lack of in situ measurement. Using the Tibetan Observation and Research Platform network, we conducted short-term in situ measurements of major ions (NO3−, Cl−, SO42−, NH4+, Na+, K+, Ca2+, and Mg2+) wet deposition at five remote sites in the TP during 2011–2013. At Southeast Tibet Station, Nam Co Station, Qomolangma Station, Ngari Station, and Muztagh Ata Station, the NH4+–N wet deposition was 0.63, 0.68, 0.92, 0.36, and 1.25 kg N ha−1 yr−1, respectively; the NO3−–N wet deposition was 0.28, 0.24, 0.03, 0.08, and 0.30 kg N ha−1 yr−1, respectively; and the inorganic N wet deposition was 0.91, 0.92, 0.94, 0.44, and 1.55 kg N ha−1 yr−1, respectively. The inorganic N wet deposition mainly occurred in the form of NH4+–N during summer at all sites. Results of enrichment factor analysis and principal component analysis demonstrated that both NH4+–N and NO3−–N wet deposition in the TP were mainly influenced by anthropogenic activities. Backward trajectory analysis showed that the inorganic N deposition at Muztagh Ata Station was mainly transported from central Asia and the Middle East through westerlies. At Southeast Tibet Station, Nam Co Station, Qomolangma Station, and Ngari Station, the inorganic N deposition was mainly contributed by anthropogenic sources in south Asia, and was mainly transported by the Indian monsoon. Combining site-scale in situ measurements of inorganic N wet deposition in this and previous studies, the average wet deposition of atmospheric NH4+–N, NO3−–N, and inorganic N in the TP was estimated to be 1.06, 0.51, and 1.58 kg N ha−1 yr−1, respectively. The average NH4+–N : NO3−–N ratio in precipitation in the TP was approximately 2 : 1. Results from the present study suggest that earlier estimations based on chemical transport model simulations and/or limited field measurements likely overestimated substantially the regional inorganic N wet deposition in the TP. To clarify the total N deposition in the TP more clearly, it is essential to conduct long-term monitoring of both wet and dry deposition of atmospheric N in various climate zones in the TP in the future.

Cas9 nucleases permit rapid and efficient generation of gene-edited cell lines. However, in typical protocols, mutations are intentionally introduced into the donor template to avoid the cleavage of donor template or re-cleavage of the successfully edited allele, compromising the fidelity of the isogenic lines generated. In addition, the double-stranded breaks (DSBs) used for editing can introduce undesirable “on-target” indels within the second allele of successfully modified cells via non-homologous end joining (NHEJ). To address these problems, we present an optimized protocol for precise genome editing in human iPSCs that employs (1) single guided Cas9 nickase to generate single-stranded breaks (SSBs), (2) transient overexpression of BCL-XL to enhance survival post electroporation, and (3) the PiggyBac transposon system for seamless removal of dual selection markers. We have used this method to modify the length of the CAG repeat contained in exon 7 of PPP2R2B . When longer than 43 triplets, this repeat causes the neurodegenerative disorder spinocerebellar ataxia type 12 (SCA12); our goal was to seamlessly introduce the SCA12 mutation into a human control iPSC line. With our protocol, ~ 15% of iPSC clones selected had the desired gene editing without “on target” indels or off-target changes, and without the deliberate introduction of mutations via the donor template. This method will allow for the precise and efficient editing of human iPSCs for disease modeling and other purposes.

Sex differences in post-stroke cognitive decline have not been systematically evaluated in a nationally representative cohort. We use a quasi-experimental design to investigate sex differences in rate of post-stroke cognitive decline. Utilizing the event study design, we use the Health and Retirement Study (HRS) data (1996-2016) to evaluate the differences (percentage points [95% Confidence interval]) in the rate of change in cognitive function, measured using the modified version of the Telephone Interview for Cognitive Status (TICS-m) score, before and after incident stroke, and among patients with and without incident stroke. We estimated this event study model for the overall study population and separately fit the same model for male and female participants. Of 25,872 HRS participants included in our study, 14,459 (55.9%) were females with an overall mean age (SD) of 61.2 (9.3) years. Overall, 2,911 (11.3%) participants reported experiencing incident stroke. Participants with incident stroke (vs. no stroke) had lower baseline TICS-m score (15.6 vs. 16.1). Among participants with incident stroke, the mean pre-stroke TICS-m score was higher than the mean post-stroke TICS-m score (14.9 vs. 12.7). Event study revealed a significant short-term acceleration of cognitive decline for the overall population (4.2 [1.7-6.6] percentage points, p value = 0.001) and among female participants (5.0 [1.7-8.3] percentage points, p value = 0.003). We, however, found no evidence of long-term acceleration of cognitive decline after stroke. Moreover, among males, incident stroke was not associated with significant changes in rate of post-stroke cognitive decline. Females, in contrast to males, experience post-stroke cognitive deficits, particularly during early post-stroke period. Identifying the sex-specific stroke characteristics contributing to differences in post stroke cognitive decline may inform future strategies for reducing the burden of post-stroke cognitive impairment and dementia.

Atmospheric reactive nitrogen (N r ) has been a cause of serious environmental pollution in China. Historically, China used too little N r in its agriculture to feed its population. However, with the rapid increase in N fertilizer use for food production and fossil fuel consumption for energy supply over the last four decades, increasing gaseous N r species (e.g. NH 3 and NO x ) have been emitted to the atmosphere and then deposited as wet and dry deposition, with adverse impacts on air, water and soil quality as well as plant biodiversity and human health. This paper reviews the issues associated with this in a holistic way. The emissions, deposition, impacts, actions and regulations for the mitigation of atmospheric N r are discussed systematically. Both NH 3 and NO x make major contributions to environmental pollution but especially to the formation of secondary fine particulate matter (PM 2.5 ), which impacts human health and light scattering (haze). In addition, atmospheric deposition of NH 3 and NO x causes adverse impacts on terrestrial and aquatic ecosystems due to acidification and eutrophication. Regulations and practices introduced by China that meet the urgent need to reduce N r emissions are explained and resulting effects on emissions are discussed. Recommendations for improving future N management for achieving ‘win-win’ outcomes for Chinese agricultural production and food supply, and human and environmental health, are described. This article is part of a discussion meeting issue ‘Air quality, past present and future’.