| 1. |
- Liang, Hua, et al.
(författare)
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Recognition of maturity-onset diabetes of the young in China
- 2021
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Ingår i: Journal of Diabetes Investigation. - : Wiley. - 2040-1116 .- 2040-1124. ; 12:4, s. 501-509
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Tidskriftsartikel (refereegranskat)abstract
- Aims/Introduction: Given that mutations related to maturity-onset diabetes of the young (MODY) are rarely found in Chinese populations, we aim to characterize the mutation spectrum of MODY pedigrees. Materials and Methods: Maturity-onset diabetes of the young candidate gene- or exome-targeted capture sequencing was carried out in 76 probands from unrelated families fulfilling the clinical diagnostic criteria for MODY. MAF <0.01 in the GnomAD or ExAC database was used to filter significant variants. Sanger sequencing was then carried out to validate findings. Function prediction by SIFT, PolyPhen-2 and PROVEAN or CADD was carried out in missense mutations. Results: A total of 32 mutations in six genes were identified in 31 families, accounting for 40.79% of the potential MODY families. The MODY subtype detection rate was 18.42% for GCK, 15.79% for HNF1A, 2.63% for HNF4A, and 1.32% for KLF11, PAX4 and NEUROG3. Seven nonsense/frameshift mutations and four missense mutations with damaging prediction were newly identified novel mutations. The clinical features of MODY2, MODY3/1 and MODYX are similar to previous reports. Clinical phenotype of NEUROG3 p.Arg55Glufs*23 is characterized by hyperglycemia and mild intermittent abdominal pain. Conclusions: This study adds to the emerging pattern of MODY epidemiology that the proportion of MODY explained by known pathogenic genes is higher than that previously reported, and found NEUROG3 as a new causative gene for MODY.
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| 2. |
- Sampson, Joshua N., et al.
(författare)
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Analysis of Heritability and Shared Heritability Based on Genome-Wide Association Studies for 13 Cancer Types
- 2015
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Ingår i: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 0027-8874 .- 1460-2105. ; 107:12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies of related individuals have consistently demonstrated notable familial aggregation of cancer. We aim to estimate the heritability and genetic correlation attributable to the additive effects of common single-nucleotide polymorphisms (SNPs) for cancer at 13 anatomical sites. Methods: Between 2007 and 2014, the US National Cancer Institute has generated data from genome-wide association studies (GWAS) for 49 492 cancer case patients and 34 131 control patients. We apply novel mixed model methodology (GCTA) to this GWAS data to estimate the heritability of individual cancers, as well as the proportion of heritability attributable to cigarette smoking in smoking-related cancers, and the genetic correlation between pairs of cancers. Results: GWAS heritability was statistically significant at nearly all sites, with the estimates of array-based heritability, h(l)(2), on the liability threshold (LT) scale ranging from 0.05 to 0.38. Estimating the combined heritability of multiple smoking characteristics, we calculate that at least 24% (95% confidence interval [CI] = 14% to 37%) and 7% (95% CI = 4% to 11%) of the heritability for lung and bladder cancer, respectively, can be attributed to genetic determinants of smoking. Most pairs of cancers studied did not show evidence of strong genetic correlation. We found only four pairs of cancers with marginally statistically significant correlations, specifically kidney and testes (rho = 0.73, SE = 0.28), diffuse large B-cell lymphoma (DLBCL) and pediatric osteosarcoma (rho = 0.53, SE = 0.21), DLBCL and chronic lymphocytic leukemia (CLL) (rho = 0.51, SE = 0.18), and bladder and lung (rho = 0.35, SE = 0.14). Correlation analysis also indicates that the genetic architecture of lung cancer differs between a smoking population of European ancestry and a nonsmoking Asian population, allowing for the possibility that the genetic etiology for the same disease can vary by population and environmental exposures. Conclusion: Our results provide important insights into the genetic architecture of cancers and suggest new avenues for investigation.
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| 3. |
- Zheng, Xueying, et al.
(författare)
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Association of Implementation of a Comprehensive Preconception-to-Pregnancy Management Plan With Pregnancy Outcomes Among Chinese Pregnant Women With Type 1 Diabetes : The CARNATION Study
- 2021
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 44:4, s. 883-892
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the effect on pregnancy outcome of integrating a comprehensive management plan for patients with type 1 diabetes (T1D) into the World Health Organization universal maternal care infrastructure. RESEARCH DESIGN AND METHODS: A comprehensive preconception-to-pregnancy management plan for women with T1D was implemented in 11 centers from 8 Chinese cities from 2015 to 2017. Sequential eligible pregnant women (n = 133 out of 137 initially enrolled) with T1D and singleton pregnancies attending these management centers formed the prospective cohort. The main outcome was severe adverse pregnancy outcome comprising maternal mortality, neonatal death, congenital malformations, miscarriage in the second trimester, and stillbirth. We compared pregnancy outcomes in this prospective cohort with two control groups with the same inclusion and exclusion criteria: a retrospective cohort (n = 153) of all eligible pregnant women with T1D attending the same management centers from 2012 to 2014 and a comparison cohort (n = 116) of all eligible pregnant women with T1D receiving routine care from 2015 to 2017 in 11 different centers from 7 cities. RESULTS: The rate of severe adverse pregnancy outcome was lower in the prospective cohort (6.02%) than in either the retrospective cohort (18.30%; adjusted odds ratio [aOR] 0.31 [95% CI 0.13-0.74]) or the contemporaneous comparison cohort (25.00%; aOR 0.22 [95% CI 0.09-0.52]). CONCLUSIONS: The substantial improvements in the prospective cohort are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational T1D. This supports the development of similar approaches in other countries.
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| 4. |
- Deng, Wenjun, et al.
(författare)
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Difference between Supine and Upright Blood Pressure Associates to the Efficacy of Midodrine on Postural Orthostatic Tachycardia Syndrome (POTS) in Children
- 2014
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Ingår i: Pediatric Cardiology. - : Springer Verlag (Germany). - 0172-0643 .- 1432-1971. ; 35:4, s. 719-725
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Tidskriftsartikel (refereegranskat)abstract
- Postural orthostatic tachycardia syndrome (POTS) is common, and has a serious impact on childrens quality of life. Midodrine hydrochloride, an alpha 1-adrenoreceptor agonist, is an effective treatment. The study was designed to examine the therapeutic efficacy of midodrine hydrochloride by quantifying changes in blood pressure during the head-up test (HUT), in children with POTS. Overall, 104 out of 110 children with POTS were treated with midodrine hydrochloride and successfully followed-up. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes were analyzed during the HUT. In a retrospective analysis, a receiver operating characteristic (ROC) curve was used to analyze the therapeutic predictive value of pre-treatment changes in SBP, DBP, and a combination of both, from the supine position to standing, in the subjects. The increase of SBP and DBP from the supine position to standing in responders were significantly lower than that of the non-responders. The ROC curve showed that midodrine hydrochloride for children with POTS would be predicted to be effective when the pre-treatment increase of SBP was a parts per thousand currency sign0 mmHg, or when the pre-treatment increase of DBP was a parts per thousand currency sign6.5 mmHg (from the supine position to standing), yielding a sensitivity of 72 % and specificity of 88 %. The area under the curve was 0.744 and 0.809, respectively. Hence, the results suggested that looking at the changes in blood pressure during the HUT was useful in predicting the response to midodrine hydrochloride in children with POTS.
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| 5. |
- Hou, Xueying, et al.
(författare)
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Cell-Grouping Based Distributed Beamforming and Scheduling for Multi-cell Cooperative Transmission
- 2011
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Ingår i: Proceedings 22nd IEEE Symposium on Personal, Indoor, Mobile and Radio Communications (PIMRC). - : IEEE conference proceedings. - 9781457713477 - 9781457713460 ; , s. 1929-1933
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Konferensbidrag (refereegranskat)abstract
- Base station cooperative transmission is an effective strategy to mitigate inter-cell interference. Centralized multicell transmission provides considerable performance gains but is impractical in large cellular systems, due to its prohibitive complexity and large amount of overhead. Dividing cells into small clusters enables practical channel acquisition and coordination within each cluster but still suffers from out-of-cluster interference. In this paper, we propose a dynamic cooperative framework for large cellular systems, which divides cells into groups such that neighboring cells belong to different groups. Based on the cell-grouping, a distributed scheduling strategy is proposed which can effectively coordinate the interference between cell-groups. With limited signalling among BSs and lower complexity, the cell-grouping based distributed scheduling and beamforming shows performance advantages over the fixed clustering based centralized scheduling and beamforming.
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| 6. |
- Hou, Xueying, et al.
(författare)
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Impact of Channel Asymmetry on Base Station Cooperative Transmission with Limited Feedback
- 2011
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Ingår i: 2011 IEEE Vehicular Technology Conference (VTC Fall). - 9781424483273
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Konferensbidrag (refereegranskat)abstract
- To exploit the full benefit of base station (BS) cooperative transmission, also known as coordinated multi-point (CoMP) transmission, large amount of feedback is required to gather the channel information. In this paper, we analyze the impact of channel asymmetry, which is inherent in CoMP systems, on downlink coherent BS cooperative transmission using zero-forcing beamforming with limited feedback. Per-cell quantization of multicell channels is considered, which quantizes the local channel and cross channels separately and is more feasible in practice. We analyze the per-user rate of limited feedback multi-user CoMP systems, and provide approximate expressions for both the inter-cell and intra-cell residual multi-user interference introduced by the quantization errors. When the desired user is at the cell center, the former is weak, but the latter is strong and depends not only on the signal to noise ratio but also on the location of its co-scheduled users. Simulation results validate our theoretical analysis.
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| 7. |
- Hou, Xueying, et al.
(författare)
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Impact of non-orthogonal training on performance of downlink base station cooperative transmission
- 2011
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Ingår i: IEEE Transactions on Vehicular Technology. - 1939-9359. ; 60:9, s. 4633-4639
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Tidskriftsartikel (refereegranskat)abstract
- Base station (BS) cooperative transmission is a promising technique to improve spectral efficiency of cellular systems, using which the channels become asymmetric in average gain. In this paper, we study the impact of the asymmetric channel gains on the performance of coherent cooperative transmission systems, when minimum mean square error (MMSE) and least square (LS) channel estimators are applied for jointly estimating the channel state information (CSI) under non-orthogonal training. We first derive an upper bound of rate loss caused by both channel estimation errors and CSI delay. We then analyze the mean square errors of the MMSE and LS estimators under both orthogonal and non-orthogonal training, which finally reveals the impact of different kinds of training on the precoding performance. It is shown that non-orthogonal training for the users in different cells leads to minor performance degradation for the MMSE channel estimator assisted downlink precoding. The performance degradation induced by channel estimation errors is almost independent of the user’s location. By contrast, the performance loss caused by CSI delay is more severe for users located at the cell center than that for users located at the cell edge. Our analysis is verified via simulation results.
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| 8. |
- Hou, Xueying, et al.
(författare)
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On channel quantization for multi-cell cooperative systems with limited feedback
- 2013
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Ingår i: Science in China, Series F: Information Sciences. - : Springer Science and Business Media LLC. - 1009-2757. ; 56:2, s. 168-022308
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Tidskriftsartikel (refereegranskat)abstract
- Coherent multi-cell cooperative transmission, also referred to as coordinated multi-point transmission (CoMP), is a promising strategy to provide high spectral efficiency for universal frequency reuse cellular systems. To report the required channel information to the transmitter in frequency division duplexing systems, limited feedback techniques are often applied. Considering that the average channel gains from multiple base stations (BSs) to one mobile station are different and the number of cooperative BSs may be dynamic, it is neither flexible nor compatible to employ a large codebook to directly quantize the CoMP channel. In this paper, we employ per-cell codebooks for quantizing local and cross channels. We first propose a codeword selection criterion, aiming at maximizing an estimated data rate for each user. The proposed criterion can be applied for an arbitrary number of receive antennas at each user and also for an arbitrary number of data streams transmitted to each user. Considering that the resulting optimal per-cell codeword selection for CoMP channel is of high complexity, we propose a serial codeword selection method that has low complexity but yields comparable performance to that of the optimal codeword selection. We evaluate the proposed codeword selection criterion and method using measured CoMP channels from an urban environment as well as simulations. The results demonstrate significant performance gain as compared to an existing low-complexity method.
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| 9. |
- Jiang, Ziyu, et al.
(författare)
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HLA class I genes modulate disease risk and age at onset together with DR-DQ in Chinese patients with insulin-requiring type 1 diabetes
- 2021
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 64:9, s. 2026-2036
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: The study aimed to investigate the effects of HLA class I genes on susceptibility to type 1 diabetes with different onset ages, in addition to the well-established effects of HLA class II genes. Methods: A total of 361 patients with type 1 diabetes (192 patients with onset <18 years and 169 patients with onset ≥18 years) and 500 healthy control participants from China were enrolled and genotyped for the HLA-A, -B, -C, -DQA1, -DQB1 and -DRB1 genes using next-generation sequencing. Results: The susceptible DR3 (β = −0.09, p = 0.0009) and DR4-DQ8 (β = −0.13, p = 0.0059) haplotypes were negatively associated with onset age, while the protective DR11 (β = 0.21, p = 0.0314) and DR12 (β = 0.27, p < 0.0001) haplotypes were positively associated with onset age. After adjustment for linkage disequilibrium with DR-DQ haplotypes, A*11:01:01 was positively associated with onset age (β = 0.06, p = 0.0370), while the susceptible C*15:02:01 was negatively associated with onset age (β = −0.21, p = 0.0050). The unit for β was double square-root (fourth root) transformed years of change in onset age associated with per copy of the HLA haplotype/allele. In addition, B*46:01:01 was protective (OR 0.41, 0.46; pc [corrected for multiple comparisons] = 0.0044, 0.0040), whereas A*24:02:01 (OR 2.71, 2.25; pc = 0.0003, 0.0002) and B*54:01:01 (OR 3.96, 3.79; pc = 0.0018, 0.0004) were predisposing in both the <18 group and the ≥18 group compared with healthy control participants. In the context of DR4-DQ4, A*11:01:01 (61.29% vs 28.26%, pc = 0.0144) was increased while the predisposing A*24:02:01 (19.35% vs 47.83%, pc = 0.0403) was decreased in patients with onset ≥18 years when compared with patients with onset <18 years. Conclusions/interpretation: In addition to DR-DQ haplotypes, novel HLA class I alleles were detected to play a role in susceptibility to type 1 diabetes with different onset ages, which could improve the understanding of disease heterogeneity and has implications for the design of future studies. Graphical abstract: [Figure not available: see fulltext.].
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| 10. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 11. |
- Ren, Wenqian, et al.
(författare)
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Adult-onset type 1 diabetic patients with less severe clinical manifestation have less risk DR-DQ genotypes than childhood-onset patients
- 2021
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Ingår i: Diabetes/Metabolism Research and Reviews. - : Wiley. - 1520-7552 .- 1520-7560. ; 37:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to investigate differences in clinical features and HLA genotypes between adult-onset and childhood-onset patients with type 1 diabetes in a Chinese population. Materials and Methods: This study enrolled 716 Han Chinese patients with type 1 diabetes from Guangdong (258 childhood-onset and 458 adult-onset) to compare their clinical features. Of them 214 patients with classical type 1 diabetes (100 childhood-onset and 114 adult-onset) were selected for HLA DR and DQ genotyping by next-generation sequencing. Results: Adult-onset patients were characterized by longer duration of symptoms before diagnosis, lower frequency of DKA at disease onset, less frequent autoantibody positivity, higher serum C-peptide concentrations, and better glycemic control. These findings were replicated in the restricted cohort of 214 patients with classical type 1 diabetes. Compared with childhood-onset patients, adult-onset patients had a lower frequency of the DR9 haplotype, as well as lower frequency of high-risk DR3/DR4 and DR3/DR9 genotypes, but higher frequency of DR3/DR3 genotype and DR3/X, DR4/X or DR9/X (X, non-risk) genotypes. Conclusions: Adult-onset type 1 diabetic patients with susceptible haplotypes (DR3, DR4 or DR9) were more likely to carry protective DR-DQ haplotypes than childhood-onset patients, which suggested the association between less risk DR-DQ genotypes and the less severe clinical manifestation in adult-onset patients.
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| 12. |
- Shen, Erxia, et al.
(författare)
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Control of Germinal Center Localization and Lineage Stability of Follicular Regulatory T Cells by the Blimp1 Transcription Factor
- 2019
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Ingår i: Cell Reports. - : Elsevier BV. - 2211-1247. ; 29:7
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Tidskriftsartikel (refereegranskat)abstract
- © 2019 The Author(s) Follicular regulatory T (TFR) cells are a specialized suppressive subset that controls the germinal center (GC) response and maintains humoral self-tolerance. The mechanisms that maintain TFR lineage identity and suppressive activity remain largely unknown. Here, we show that expression of Blimp1 by FoxP3+ TFR cells is essential for TFR lineage stability, entry into the GC, and expression of regulatory activity. Deletion of Blimp1 in TFR cells reduced FoxP3 and CTLA-4 expression and increased pro-inflammatory cytokines and spontaneous production of autoantibodies, including elevated IgE. Maintenance of TFR stability reflected Blimp1-dependent repression of the IL-23R-STAT3 axis and activation of the CD25-STAT5 pathway, while silenced IL-23R-STAT3 or increased STAT5 activation rescued the Blimp1-deficient TFR phenotype. Blimp1-dependent control of CXCR5/CCR7 expression also regulated TFR homing into the GC. These findings uncover a Blimp1-dependent TFR checkpoint that enforces suppressive activity and acts as a gatekeeper of GC entry.
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| 13. |
- Yang, Xiaoliu, et al.
(författare)
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Institutional Arrangement for Integrated River Basin Management
- 2016
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- This study concerns the management functions, institutional and legal frameworks to foster IRBM in the Yangtze River Basin. It is implemented as part of the EU China River Basin Management Programme funded by the EU.The overall objective of the study is to contribute to an enabling framework of policies, legislation and institutions that will promote IRBM in China and assist the government to harmonise social and economic development and water and environmental protection within the Yangtze River Basin. Specifically, the study will provide the CWRC with a better basis for informed decisions on adjustment of its organization, responsibilities and management functions to be incorporated in the Yangtze River Master Plan. Based on stakeholder mapping an assessment has been made to characterise the present situation of water resources management in China and provide direction for future changes. The assessment found that 1) China has established a legal framework supporting water management in a river basin context, 2) plans embodying IRBM are drafted at national, river basin and provincial levels, and 3) the existing funding of water management is dominated by government investment. A diagnosis and evaluation of the management functions of the CWRC is presented with focus on gaps and overlaps providing recommendations for a more effective governance structure in accordance with internationally accepted principles that have emerged during the past 10 years. The diagnosis is based on key informant interviews and questionnaires and indicated that 1) Chinese legislation enables decentralized river basin management, 2) river basin, regional and provincial management functions are not clearly defined, 3) some management functions of the CWRC are difficult to implement due to discrepancies between authority and responsibilities 4) there are no efficient consultation and coordination mechanisms among stakeholders within the river basin, 5) the implementation of IRBM lacks support of provincial and local authorities, and 6) the CWRC sees stakeholder participation as the key to better river basin governance. Water management in the Yangtze River Basin has been analysed with the Rhine River, Danube River, France and the European Union as reference. The comparisons indicate that 1) legislation or formal agreements between different administrative units, nations or provinces, are required for efficient cooperation, 2) an inter-provincial river basin organization is an ideal platform to promote IRBM and resolve conflicts between nations or provinces within a river basin, 3) political governance and technical support should be separated, 4) stakeholder participation is imperative for efficient IRBM, and 5) pollution of the Yangtze River is at risk of increasing while the Rhine River and to some extent the Danube River have passed a turning point (top of Kuznet’s curve), where pollution is effectively managed and declining.Strategically institutional arrangements for IRBM will be conditional on central government initiative. At the national level four initiatives are proposed as umbrella for basin level action, 1) a national water framework plan to be inspired by the EU Water Framework Directive (WFD), 2) an assessment of basin institutional arrangements inspired by the Rhine and Danube rivers, 3) an assessment of provincial institutions inspired by France and 4) an assessment of legal efficiency taking the EU WFD as benchmark.In close consultation with the CWRC an action plan to foster IRBM in the Yangtze River Basin has been formulated in terms of legislation, institutions, capacity building, financing, information disclosure and stakeholder participation.The principal recommendations of the study are:1) Water Law to be amended or supplemented with legislation, which clearly defines the division of responsibilities between the national, river basin and provincial level authorities.2) A National Water Resource Commission to be established to strengthen cross-sectorial coordination and cooperation and mitigate the current fragmentation of responsibilities, especially the overlapping responsibilities of the Ministry of Water Resources (MWR) and Ministry of Environmental Protection (MEP) in water pollution management and of the Ministry of Water Resources and Ministry of Land and Resources in groundwater management.3) Reform of the CWRC may take one of three basic models: Unified management as branch of central government, essentially the current structure; Coordinated management governed by stakeholders, including central government; Autonomous enterprise authorised by central government.4) Institutions and responsibilities for water resources management and water service delivery to be separated and clearly defined.5) River basin commissions to be assigned responsibility for coordination of water resources management at basin scale and provinces for implementation in accordance with overall management objectives.6) River basin commissions to be responsible for operation of multipurpose infrastructure and bulk water supply.7) Provinces and municipalities to be the responsible for management and delivery of water supply and sanitation services in both rural and urban areas.8) Cost recovery for water resources management, bulk water supply, water supply and sanitation services to be scaled up and serve as water demand management tool as well as a significant source of funding for infrastructure development.9) National Water Resources Council to be set up at national level to supervise and regulate water resources management and services delivery by benchmarking of river basin commissions, provincial administrations and water utility companies using clear and well defined performance indicators.
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| 14. |
- Zhao, Juan, et al.
(författare)
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A cross-sectional study on upright heart rate and BP changing characteristics: basic data for establishing diagnosis of postural orthostatic tachycardia syndrome and orthostatic hypertension
- 2015
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Ingår i: BMJ Open. - : BMJ Publishing Group: Open Access / BMJ Journals. - 2044-6055. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We aimed to determine upright heart rate and blood pressure (BP) changes to suggest diagnostic criteria for postural orthostatic tachycardia syndrome (POTS) and orthostatic hypertension (OHT) in Chinese children. Methods: In this cross-sectional study, 1449 children and adolescents aged 6-18 years were randomly recruited from two cities in China, Kaifeng in Henan province and Anguo in Hebei province. They were divided into two groups: 844 children aged 6-12 years (group I) and 605 adolescents aged 13-18 years (group II). Heart rate and BP were recorded during an active standing test. Results: 95th percentile (P-95) of delta heart rate from supine to upright was 38 bpm, with a maximum upright heart rate of 130 and 124 bpm in group I and group II, respectively. P-95 of delta systolic blood pressure (SBP) increase was 18 mm Hg and P-95 of upright SBP was 132 mm Hg in group I and 138 mm Hg in group II. P-95 of delta diastolic blood pressure (DBP) increase was 24 mm Hg in group I and 21 mm Hg in group II, and P-95 of upright DBP was 89 mm Hg in group I and 91 mm Hg in group II. Conclusions: POTS is suggested when delta heart rate is greater than= 38 bpm (for easy memory, greater than= 40 bpm) from supine to upright, or maximum heart rate greater than= 130 bpm (children aged 6-12 years) and greater than= 125 bpm (adolescents aged 13-18 years), associated with orthostatic symptoms. OHT is suggested when delta SBP (increase) is greater than= 20 mm Hg, and/or delta DBP (increase) greater than= 25 mm Hg (in children aged 6-12 years) or greater than= 20 mm Hg (in adolescents aged 13-18 years) from supine to upright; or upright BP greater than= 130/90 mm Hg (in children aged 6-12 years) or greater than= 140/90 mm Hg (in adolescents aged 13-18 years).
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