Cities occupy a central position in addressing climate change and promoting sustainable regional development. Synergistic control of urban gas emissions at the city level is one of the main issues typically explored. The confounding effect and the interactions between the urban indicators of population and area have been ignored in previous studies. In this study, we examined the spatial distribution characteristics and synergy between greenhouse gases (CO2) and air pollutants (SO2 and NOX) using spatial population and gas emission data. By upgrading the city clustering algorithm (CCA), we established a method for defining active areas of gas emissions (spatial element-coupled clustering, SECC) and identified active areas of gas emissions in China. In this study, we created a research framework that can simultaneously consider the effects of population and area, as well as the possible interactions between these indicators in active areas. The superlinear scaling relationship between the above three gases was revealed at the active zone level, and the existence of synergy between the emission patterns of the three gases was confirmed. Via further model application, we measured the synergistic efficiency of the three gases. It was found that for every 1% increase in SO2 and NOX in an active zone, CO2 increases by 0.86%. In this study, we explored a new perspective and approach to explain the synergy between greenhouse gases and air pollutants. This is essential to promote national competition among cities to achieve synergistic control of CO2 and local air pollutants.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia can be persistent and refractory; however, the optimal approach for its treatment has not been determined. Although fosfomycin (FOM) has been shown to have synergistic effects with anti-MRSA agents in vitro, clinical experience with FOM combination therapy is limited. Thus, we present cases of persistent MRSA bacteremia that improved with the addition of FOM. In case 1, a 48-year-old man with prosthetic vascular graft infection developed persistent MRSA bacteremia despite vancomycin (VCM) and daptomycin (DAP) administration. On day 46, after the first positive blood culture, we added FOM to DAP. The blood culture became negative on day 53. In case 2, an 85-year-old woman presented with pacemaker-related MRSA bacteremia. She was treated with VCM, followed by DAP and DAP plus rifampicin. However, the bacteremia persisted for 32 days because of difficulties in immediate pacemaker removal. After adding FOM to DAP, the blood culture became negative on day 38. In case 3, a 57-year-old woman developed persistent MRSA bacteremia due to pulmonary valve endocarditis and pulmonary artery thrombosis after total esophagectomy for esophageal cancer. The bacteremia continued for 50 days despite treatment with DAP, followed by VCM, VCM plus minocycline, DAP plus linezolid (LZD), and VCM plus LZD. She was managed conservatively because of surgical complications. After adding FOM to VCM on day 51, the blood culture became negative on day 58. FOM combination therapy may be effective in eliminating bacteria and can serve as salvage therapy for refractory MRSA bacteremia.

Ecosystem services (ESs) are the largest benefits that humans derive directly or indirectly from ecosystems. Inland river basins in arid zones have a variety of key ecosystem functions. At present, inland river basins are experiencing a decline in ESs, such as shrinking lakes, land degradation, and rapid biodiversity loss. In order to address these problems, several ecological restoration projects (ERPs) have been implemented. Therefore, this study selected the Tarim River Basin (TRB), which is highly affected by the ecological water transfer project (EWTP), as the study area, and quantified the differences in ESs caused by the implementation of the EWTP through different scenarios of simulation, and discussed the impact of the EWTP in changing the ESs of the basin. Compared to the pre-EWTP period (1990-1999), the major ESs within the basin showed varying degrees of improvement. Water yield increased by 18 %, carbon sequestration increased by 2 %, wind prevention and sand fixation increased by 13 %, habitat quality increased by 8 %, and food production increased by 35 %. EWTP has shown positive impacts by directly or indirectly affecting runoff, vegetation, evapotranspiration, and landscape patterns, which in turn improves the comprehensive benefits of ESs in the TRB. The implementation of EWTP plays an important role in restoring ESs in inland river basins, and this study provides a key reference for the restoration of ESs in inland river basins in arid zones.

This study aims to investigate the activity of the remdesivir-nirmatrelvir combination against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and to report a case of Coronavirus Disease 2019 (COVID-19) cured with this combination.
A Vero E6 cell-based infection assay was used to investigate the in vitro activity of the remdesivir-nirmatrelvir combination. The SARS-CoV-2 strains tested were 20A.EU1, BA.1 and BA.5. After incubation, a viability assay was performed. The supernatants were collected and used for viral titration. The Highest Single Agent (HSA) reference model was calculated. An HSA score >10 is considered synergic.
Remdesivir and nirmatrelvir showed synergistic activity at 48 and 72 h, with an HSA score of 52.8 and 28.6, respectively (p < 0.0001). These data were confirmed by performing supernatant titration and against the omicron variants: the combination reduced the viral titer better than the more active compound alone. An immunocompromised patient with prolonged and critical COVID-19 was successfully treated with remdesivir, nirmatrelvir/ritonavir, tixagevimab/cilgavimab and dexamethasone, with an excellent clinical-radiological response. However, she required further off-label prolonged therapy with nirmatrelvir/ritonavir until she tested negative.
Remdesivir-nirmatrelvir combination has synergic activity in vitro. This combination may have a role in immunosuppressed patients with severe COVID-19 and prolonged viral shedding.

The coursebook-centered approach adopted by the Hellenic Open University\'s Master\'s program in TEIL/TEFL has lost momentum during the coronavirus lockdown periods. This study addresses synergies between institutional policy and involved participants through the experience of an EFL teacher with a Computer-Mediated Intercultural Communication-based assignment about the online archivability of teaching and learning reflections. Relying on her study journal, the EFL teacher proposed a reflection-based inquiry into the compilation of a student-generated coronavirus memory archive on the e-me digital platform. Three journaling spaces emerged in the context of teacher development: the physical, the digital and the academic archive. The results indicated the transformative effects that archival procedures have on the dominant training practices of a graduate-level TEFL program. This study holds implications for flipping a switch on the educator-educatee relationship, while examining how reflective teaching pedagogy assimilates the learners\' creative response to remoteness.

Analyzing the multi-functional evolution of land use can help solve the confusion in the relationship between land use functions and unreasonable land use structure. From the perspective of ecological security, we integrated multi-source data on the basis of quantitative evaluation of various land use functions, and used the method of combining band set statistical model and bivariate local Moran\'s I to measure the dynamics of trade-off and synergy relationship between land use functions in Huanghua, Hebei from 2000 to 2018, and divided land use functional areas. The results showed that production function (PF) and life function (LF) showed the alternate evolution of the trade-off and synergy relationship, which mostly occured in the central urban areas such as the southern region. The PF and ecological function (EF) was mainly based on the synergistic relationship, which mostly occured in the traditional agricultural areas in the west region. The degree of synergy between LF and water conservation function (WCF) first increased and then decreased, with obvious regional differences in the degree of synergy. LF and soil health function (SHF)/ biological diversity function (BDF) was dominated by trade-off relationship, which mostly occured in western saline-alkali land and coastal areas. The performance of multiple EF was the mutual transformation of trade-offs and synergies. The land space of Huanghua could be divided into six types of areas, agricultural production area, urban development core area, urban and rural optimized development area, renovation and improvement area, nature reserve area, and ecological restoration area. There were differences in the dominant mode of land function and optimization strategies in each area. This research could provide scientific refe-rence for clarifying land function relationship and optimizing land spatial development pattern.
分析土地利用多功能演变有助于解决土地利用功能间关系表征混乱与土地利用结构不合理等问题。本研究以生态安全为视角,在对各项土地利用功能定量评估的基础上融合多源数据,采用波段集统计模型与双变量局部Moran I相结合的方法测度河北省黄骅市2000—2018年土地利用功能间权衡-协同关系演变特征,并划分出土地利用功能区。结果表明: 研究区生产功能-生活功能表现为权衡协同关系交替演变,多发生于南部地区等中心城镇区。生产功能-生态功能以协同关系为主,多发生于西部传统农业区域。生活功能-水源涵养功能协同程度先升后降,协同程度呈现明显区域差异。生活功能-土壤健康功能、生活功能-生物多样性功能以权衡关系为主导,多发生于西部盐碱地以及沿海区域。多项生态功能间表现为权衡、协同关系相互转化。黄骅市国土空间可划分为农业生产区、城镇发展核心区、城乡优化发展区、整治改良区、自然保护区、生态修复区6个类型区,各分区土地功能主导模式及优化对策存在差异。研究结果可为明晰土地功能关系以及优化国土空间开发格局提供科学参考。.

Treatment of Mycobacterium abscessus infections are problematic due to inherent multidrug resistance and lack of response to antibacterials commonly used as therapy for other mycobacterial infections. We report the clinical success of five patients who received definitive-treatment with an omadacycline-containing combination regimen for M. abscessus infection.

Alcohol use disorder (AUD) and anxiety disorders (AnxD) are prevalent health concerns in clinical practice which frequently co-occur (AUD-AnxD) and compound one another. Concurrent AUD-AnxD poses a challenge for clinical management as approaches to treatment of one disorder may be ineffective or potentially counterproductive for the other disorder.
We present the case of a middle-aged man with anxiety disorder, AUD, chronic pain, and gamma-hydroxybutyrate use in context of tapering prescribed benzodiazepines who experienced severe alcohol withdrawal episodes during a complicated course of repeated inpatient withdrawal management. After medical stabilization, the patient found significant improvement in symptoms and no return to alcohol use with a regimen of naltrexone targeting his AUD, gabapentin targeting both his AUD and AnxD, and engagement with integrated psychotherapy, Alcoholics Anonymous, and addictions medicine follow-up.
Proper recognition and interventions for AUD and AnxD, ideally with overlapping efficacy, can benefit individuals with comorbid AUD-AnxD. Gabapentin, tobacco cessation, and integrated psychotherapy have preliminary evidence of synergistic effects in AUD-AnxD. Meta-analysis evidence does not support serotoninergic medications (e.g. selective serotonin reuptake inhibitors) which are commonly prescribed in AnxD and mood disorders as their use has not been associated with improved outcomes for AUD-AnxD. Additionally, several double-blind placebo-controlled randomized trials have suggested that serotonergic medications may worsen alcohol-related outcomes in some individuals with AUD. Areas for future investigation are highlighted.

There is limited evidence regarding the exposure-effect relationship between lung-cancer risk and hexavalent chromium (Cr(VI)) or nickel. We estimated lung-cancer risks in relation to quantitative indices of occupational exposure to Cr(VI) and nickel and their interaction with smoking habits. We pooled 14 case-control studies from Europe and Canada, including 16 901 lung-cancer cases and 20 965 control subjects. A measurement-based job-exposure-matrix estimated job-year-region specific exposure levels to Cr(VI) and nickel, which were linked to the subjects\' occupational histories. Odds ratios (OR) and associated 95% confidence intervals (CI) were calculated by unconditional logistic regression, adjusting for study, age group, smoking habits and exposure to other occupational lung carcinogens. Due to their high correlation, we refrained from mutually adjusting for Cr(VI) and nickel independently. In men, ORs for the highest quartile of cumulative exposure to CR(VI) were 1.32 (95% CI 1.19-1.47) and 1.29 (95% CI 1.15-1.45) in relation to nickel. Analogous results among women were: 1.04 (95% CI 0.48-2.24) and 1.29 (95% CI 0.60-2.86), respectively. In men, excess lung-cancer risks due to occupational Cr(VI) and nickel exposure were also observed in each stratum of never, former and current smokers. Joint effects of Cr(VI) and nickel with smoking were in general greater than additive, but not different from multiplicative. In summary, relatively low cumulative levels of occupational exposure to Cr(VI) and nickel were associated with increased ORs for lung cancer, particularly in men. However, we cannot rule out a combined classical measurement and Berkson-type of error structure, which may cause differential bias of risk estimates.

Partnerships have become increasingly important in addressing complex global health challenges, a reality exemplified by the COVID-19 pandemic and previous infectious disease epidemics. Partnerships offer opportunities to create synergistic outcomes by capitalizing on complimentary skills, knowledge and resources. Despite the importance of understanding partnership functioning, research on collaboration is sparse and fragmented, with few conceptual frameworks applied to evaluate real-life partnerships in global health. In this study, we aimed to adapt and apply the Bergan Model of Collaborative Functioning (BMCF) to analyse partnership functioning in the UK Public Health Rapid Support Team (UK-PHRST), a government-academic partnership, dedicated to outbreak response and research in low- and middle-income countries. We conducted a literature review identifying important elements to adapt the framework, followed by a qualitative case study to characterize how each element, and the dynamics between them, influenced functioning in the UK-PHRST, exploring emerging themes to further refine the framework. Elements of the BMCF that our study reinforced as important included the partnership\'s mission, partner resources (skills, expertise and networks), leadership, the external environment, management systems and communication. Additional elements identified in the literature and critical to partnership functioning of the UK-PHRST included governance and financial structures adopted, trust and power balance, organizational culture, strategy and evaluation and knowledge management. Because of the way the UK-PHRST was structured, fostering team cohesion was an important indicator of synergy, alongside collaborative advantage. Dividing the funding and governance equally between organizations was considered crucial for maintaining institutional balance; however, diverse organizational cultures, weak communication practices and perceived power imbalances compromised team cohesion. Our analysis allowed us to make recommendations to improve partnership functioning at a critical time in the evolution of the UK-PHRST. The analysis approach and framework presented here can be used to evaluate and strengthen the management of global health partnerships to realize synergy.