Quality Improvement Strategies Research Articles

Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria

Introduction: In 2021, the Intersocietal Accreditation Commission (IAC) introduced modified criteria for carotid duplex interpretation based on peak systolic velocity (PSV) and PSV ratio. The most significant change compared to the 2003 Society of Radiologists in Ultrasound (SRU) criteria involved re-defining the thresholds for <50 and 50% to 69% stenosis ranges. Patients identified in <50% vs 50% to 69% ranges may face different disease severity assignments, variable surveillance protocols, medical management approaches, and recommendations for intervention. Facilities may experience altered payment coverage, issues of staff re-training, and questions from referring physicians regarding patient treatment and disease management expectations. The objective of this study was to assess the impact of re-defining these stenosis ranges using the 2021 IAC criteria vs the SRU criteria. Methods: Anonymized patient data from carotid duplex examinations were collected as part of an internal laboratory quality improvement strategy. These data were analyzed in an electronic database using the IAC and SRU threshold criteria to determine the degree of carotid stenosis. Patients with normal arteries, unilateral studies, or complete occlusions were excluded. Results: Of the 1000 patients considered, 850 met the eligibility criteria. Using PSV: for the right carotid, 242 (28.5%) showed a change and 608 (71.5%) showed no change in stenosis classification; for the left carotid, 228 (27%) showed a change and 622 (73%) showed no change. All changes were a downgrading of disease to <50% stenosis. Using PSV ratio: for the right carotid, re-assignment of 53 (22% of changed, 6% of total cohort); for the left carotid, re-assignment of 48 (21% of changed, 5.6% of total cohort). All changes resulted in re-assignment to the 50% to 69% stenosis category. Conclusions: Implementation of the IAC criteria resulted in patients being re-assigned to lower stenosis categories (27% for PSV and 21% for PSV ratio). The impact of these changes on patient care and facility logistics needs careful consideration.

Analyzing Priority Management for Water Quality Improvement Strategies with Regional Characteristics

As the management areas for NPS pollution continue to increase, it is essential to conduct a situation analysis considering the regional characteristics and the scope of pollution reduction. In this study, the focus is on differentiating regional (urban, agricultural) characteristics to enhance water quality and reduce pollution loads in the increasing management areas for NPSs. Furthermore, priority management areas are identified based on urgency and vulnerability, and management strategies are proposed. The assessment involved evaluating both streamflow and water quality (T-P) using long-term monitoring data and watershed models (SWAT and HSPF) that take into account regional characteristics. The results indicated notable regional improvements, with T-P pollution reductions ranging from 20.7% to 26.8% and T-P concentration reductions ranging from 16.4% to 24.7% compared to baseline conditions in unmanaged areas. Based on these research findings, it is anticipated that the efficient and effective management of NPS pollution can be implemented on a regional basis. Moreover, the results of this study will not only contribute to the establishment of pollution standards, but also significantly impact the evaluation and proposal of management objectives, thereby making a substantial contribution to national water quality policies.

Case Study in Using Value Stream Mapping in Online Graduate Education

Given the rise in demand for online, graduate degree programs there is a need to guide program planning and evaluation professionals within institutions of higher education to utilize continuous quality improvement (CQI) strategies. Using principles of design thinking and CQI, the purpose of this case study was to describe a CQI project that sought to develop a better understanding of adult students’ experience progressing through their plan of study in an online doctoral program. As part of the CQI project, value stream mapping (VSM) was used to gain visibility and perspective on the actions required by faculty and staff to guide students through their plan of study. The VSM process provided information that led to conversations that furthered the CQI efforts and led to changes in the adult education program that would benefit all students. Improvement processes that lead to better quality and more positive experiences for users are valuable. This case study demonstrates the processes, challenges, lessons, and future directions in the use of VSM to better understand online graduate programs designed for adult learners.

Predictors of Prolonged Length of Stay after Elective Carotid Revascularization

Postoperative day-one discharge is used as a quality-of-care indicator after carotid revascularization. This study identifies predictors of prolonged length of stay (pLOS), defined as a postprocedural LOS of > 1 day, after elective carotid revascularization. Patients undergoing carotid endarterectomy (CEA), Transcarotid artery revascularization (TCAR) and Transfemoral carotid artery stenting (TFCAS) in the Vascular Quality Initiative between 2016 and 2022 were included in this analysis. Multivariable logistic regression analysis was used to identify predictors of pLOS, defined as a postprocedural LOS of > 1 day, after each procedure. A total of 118,625 elective cases were included. pLOS was observed in nearly 23.2% of patients undergoing carotid revascularization. Major adverse events, including neurological, cardiac, infectious, and bleeding complications, occurred in 5.2% of patients and were the most significant contributor to pLOS after the 3 procedures. Age, female sex, nonwhite race, insurance status, high comorbidity index, prior ipsilateral CEA, non-ambulatory status, symptomatic presentation, surgeries occurring on Friday and postoperative hypo- or hypertension were significantly associated with pLOS across all 3 procedures. For CEA, additional predictors included contralateral carotid artery occlusion, preoperative use of dual antiplatelets and anticoagulation, low physician volume (< 11 cases/year) and drain use. For TCAR, preoperative anticoagulation use, low physician case volume (<6 cases/year), no protamine use, and post-stent dilatation intraoperatively were associated with pLOS. One-year analysis showed a significant association between pLOS and increased mortality for all 3 procedures; CEA (HR,1.64; 95%CI, 1.49-1.82), TCAR (HR,1.56; 95%CI, 1.35-1.80), and TFCAS (HR,1.33; 95%CI,1.08-1.64) (all P<0.05). A postoperative LOS of more than 1 day is not uncommon after carotid revascularization. Procedure-related complications are the most common drivers of pLOS. Identifying patients are risk for pLOS highlight quality improvement strategies that can optimize short and 1-year outcomes of patients undergoing carotid revascularization.

Service quality improvement strategies of online car-hailing based on SPC-PCN method

Online car-hailing service is practicing the concept of sharing, bringing new energy and convenience to the transportation market. However, with its rapid development, service issues have become increasingly prominent, and improving service quality is the key to the sustainable growth of the online ride-hailing industry. Microblog, as a major online platform for gathering public views, have become one of the significant media for publishing and disseminating information nowadays, which also contains numerous views of online taxi users on online taxi services. Aiming at the deficiency of online car-hailing service under microblog public opinion, this paper integrates Service Profit Chain (SPC) and Process Chain Network (PCN) from the perspective of service management. Firstly, a crawler program is used to collect the Internet Word of Mouth data related to online taxi. Then, a BERT text classification model is constructed to roughly classify the data, and the accuracy of this model is tested to 94.54 %. Afterwards, layer segmentation is implemented based on SPC and CatBoost. Besides, a series of problems in the current online taxi service, such as poor attitude of drivers, unsafe driving, and inefficient communication with the customer service staff, have been identified by using sentiment analysis and frequent mining methods. Finally, PCN analysis is used to optimize the online taxi service, proposing strategies such as setting a reservation reminder function, building a dynamic feedback mechanism, and establishing a contact point for lost and found items. The new SPC-PCN online taxi service system constructed in this paper is vital for service quality optimization, and can also promote the sustainable growth of the online taxi market.

Does the Porter hypothesis hold in China? evidence from the “2+26” regional air pollution treatment policy

Abstract This study analyzed the impact of environmental regulation, specifically the “2+26” regional strategy for air quality improvement, on corporate research and development (R&amp;D) investment in China. We developed a theoretical model based on the argument that R&amp;D investment rises with regulation intensity. Using 2010–2019 data from China's listed companies located in the Beijing-Tianjin-Hebei region and its surrounding areas, we treated the $2+26$ policy as a quasi-natural experiment and adopted a difference-in-differences approach to explore its effect on firm R&amp;D input. A positive association was observed between firm R&amp;D intensity and the $2+26$ strategy's implementation in major polluting industries. Our results provide in-depth insights into the $2+26$ strategy's economic consequences, which are potentially of interest to both scholars and policymakers.

Retrospective analysis of the adverse events during intra-operative and post-operative period in patients who received anesthesia at a tertiary care center in India

Background: Anesthesia is a critical component of modern surgical procedures ensuring patient comfort and safety during surgery. With the increase in life expectancy, more and more geriatric population with various systemic comorbidities have been coming for surgeries. Along with the newer advances in surgical fields, there is increasing demand on the anesthetists to handle complicated cases with innovative solutions. Despite all efforts by a skillful anesthetist, adverse events are bound to occur which needs to be analysed to prevent such adverse events in the future. Hence, this study aims to analyse the adverse events occurring in intra-operative and post-operative period who received anesthesia in our tertiary care centre. Methods: This study is a retrospective cross-sectional study of 5-year duration from January 2018 to January 2023 done at Bhaktivedanta hospital and research institute post obtaining approval from the institutional ethics committee. A total of 163 patients who developed perioperative adverse events were included in the study and their nature of adverse events were analysed. The data was obtained from the registers of the anesthesia department and descriptive statistical analysis of the data was done accordingly. Results: Most common adverse events were of cardiovascular and respiratory origin, followed by miscellaneous and regional anesthesia adverse events and then, very few drug-related adverse events. The patients who developed these adverse events were evidently of ASA grade I and II, implying no direct correlation between adverse events and grading. Conclusions: Reporting and analysis of the adverse events will help better understanding of the lacunae of the reporting system as well as in the development of quality improvement strategies in the future.

Prioritising Actions for Improving Classroom Air Quality Based on the Analytic Hierarchy Process: Case Studies in China and the UK

The air quality in classrooms significantly impacts school children’s health and learning performance. It has been reported worldwide that classroom air quality does not meet the required standard and actions are pledged for improvement. However, it poses a challenge for decision-making in terms of prioritising taking-up measures. The aim of this study is to propose a method of identifying the action measures for improving classroom air quality and prioritising them. Case studies in the UK and China were conducted, and the key measures were identified through literature studies, open-ended questionnaire surveys, and workshop discussions, which are classified into three categories: B1, policy; B2, technology; and B3, information sharing. The analytical hierarchy process (AHP) is applied in the prioritisation of the action measures. A total of 138 teachers and parents from China and the UK participated in this case study. The genetic algorithm-optimised Hadamard product (GAOHP) method is applied to justify the consistency ratio (CR) within the required threshold value in order to ensure the consistency of the subjective perception and the accuracy of comparative weights. The results show that item B2, technology, is the most desired measure by both Chinese and British parents and teachers, despite the deviation from the optimal choice in China and the UK. Among the proposed action measures, the UK respondents strongly expected air purifiers with natural ventilation as opposed to their Chinese counterparts preferring to share the real-time status of classroom air quality. Our work will provide strong support for the subsequent selection of indoor air quality improvement strategies for schools.

Practitioner research as a pathway to educational leadership

ABSTRACT ‘Educational Leadership’ is embedded in [country] early childhood policy. What the role is, who should do it and why educators are hesitant about becoming leaders however, remains ambiguous. According to the national curriculum framework and teacher standards, more research about the work of educators is needed. The reported research aimed to investigate whether long-term, enquiry-based professional learning, utilizing practitioner research, could lead to quality improvement. Practitioner Research engaged educators in investigating and improving practice in a continuous process of quality improvement. Research topics were pedagogical in nature, designed to be enabling of ‘educational leadership’ for quality improvement. Action Research was used by practitioner researchers to investigate ways to improve pedagogical quality. University researchers also used meta-research to investigate the action research processes. Focus groups and mentor statements revealed unexpectedly that the Educational Leader role was pivotal in the relationship between professional learning, practitioner research and quality. Strengthened Educational Leader identities emerged as participants gained research skills and evidence for designing and implementing pedagogical change. Knowledge building facilitated strengthened engagement of educator teams. This was transformational, informing the case for change and further exploration of practitioner research as a workforce strategy for quality improvement and staff retention.

Benchmarking the quality improvement strategies of wire arc additive manufacturing process using fuzzy QFD approach

PurposeThe purpose of this paper is to improve the productivity and quality of the wire arc additive manufacturing process by benchmarking the strategies from the selected six strategies, namely, heat treatment process, inter pass cooling process, inter pass cold rolling process, peening process, friction stir processing and oscillation process.Design/methodology/approachTo overcome the lack of certainty associated with correlations and relationships in quality functional deployment, fuzzy numbers have been integrated with the quality functional deployment framework. Twenty performance measures have been identified from the literature under five groups, namely, mechanical properties, physical properties, geometrical properties, cost and material properties. Using house of quality weights are allocated to performance measures and groups, relationships are established between performance measures and strategies, and correlations are assigned between strategies. Finally, for each strategy, relative importance, score and crisp values are calculated.FindingsInter pass cold rolling process strategy is computed with the highest crisp value of 15.80 which is followed by peening process, heat treatment process, friction stir processing, inter pass cooling process,] and oscillation process strategy.Originality/valueTo the best of the authors’ knowledge, there has been no research in the literature that analyzes the strategies to improve the quality and productivity of the wire arc additive manufacturing process.

Implementing Quality Improvement Initiatives to Improve the Use of Adolescent- and Youth-Friendly Health Services in Zou, Benin.

In Benin, the unmet need for family planning services is especially high for adolescent girls and youth aged 15-24 years. The Challenge Initiative (TCI) supported the health system to assess and improve the quality of adolescent and youth sexual reproductive health services and enhance contraceptive uptake in 65 service delivery points (SDPs) of the Zou department. Between June 2019 and March 2021, TCI supported the health districts in Zou to train an assessment team to complete 3 cycles of quality assessments (QAs) using a QA checklist adapted to the local context. Based on assessment scores, the SDPs were categorized into poor, moderate, or good to excellent quality. The SDP managers developed remedial action plans after each cycle and for each SDP and followed up with supportive supervision. The first QA cycle showed that 52% of assessed SDPs achieved a good to excellent classification; by the second QA cycle, this reached 74%. However, the quality of adolescent- and youth-friendly health services regressed during the third QA cycle (during COVID-19 pandemic disruptions), when only 40% of SDPs achieved the good to excellent category. Between the first and second QA cycles, contraceptive uptake for adolescents and youth improved in the SDPs that had good or excellent quality of services, compared to the ones that were of lower quality (established significance level of 5% with a P value of .031). Further assessments could deepen our understanding of the internal and external factors that can affect service quality. The findings reinforce the importance of investing in quality improvement strategies to maximize the use of sexual and reproductive health services among adolescents and youth. They also underscore the need for a contextual and nuanced approach to ensure enduring results.

A Student Teaching Assistant Program for Diversity, Equity, Inclusion, and Antiracism Curricular Enhancement.

In the United States, physician bias is exhibited early in medical training and contributes to systemic inequities within the field of medicine. A lack of diversity, equity, inclusion, and antiracism (DEI-AR) content within medical curricula drives critical gaps in knowledge and deficiencies when preparing medical students to serve patients of diverse backgrounds. At the Mayo Clinic Alix School of Medicine (MCASOM), student-led curricular reviews between 2017 to 2018 and 2020 to 2021 revealed opportunities to improve DEI-AR content within preclinical courses. Course directors expressed concern of limited expertise and time to enact effective changes. The MCASOM DEI-AR teaching assistant (TA) program aims to curate a collaborative partnership between course directors and compensated student TAs to facilitate course enhancements responsive to the prior preclinical course review while centering standardized DEI-AR best practices. As of January 2024, the program has engaged 14 TAs and partnered with 24 preclinical courses. Postcourse student evaluation responses were collected from 8 courses for 2021 to 2022 (before enhancements) and 2022 to 2023 (after enhancements). Student satisfaction with DEI-AR content is tracked through postcourse evaluations, with preliminary data demonstrating improvement after DEI-AR curricular integration (improvement of mean preenhancement and postenhancement scores of 3.81 to 4.05; t12 = 1.79, P = .21). Qualitative student comments were sorted into general categories of positive, negative, or neutral, showing a 6.25% median increase in positive perception of DEI. Plans for the MCASOM DEI-AR TA program include application of quality improvement strategies to improve program processes and outcomes. Development of a centralized dashboard that integrates course enhancement progress and ongoing feedback from evaluations is anticipated to facilitate this effort. The program additionally aims to develop partnerships with clinical clerkships, which would allow for a more comprehensive enhancement of the overall medical education experience related to DEI-AR.

What are the roles of positive psychological construct in blended learning contexts? Integrating academic buoyancy into the Community of Inquiry framework.

In the post-epidemic era, blended learning has become a social trend for the future of higher education, and scholars have endeavored to understand the factors that influence student learning in these blended communities. Communities of Inquiry is a conceptual framework that describes the components of blended learning environments, indicating teaching presence, social presence, and cognitive presence. However, the framework fails to adequately explore how individual learning motivational factors influence student learning. Therefore, this study extends the Community of Inquiry framework by drawing on a positive psychological construct-academic buoyancy to reveal the relationship between academic buoyancy and the three presences through empirical research. The theoretical model was validated by SPSS 26.0 and smartPLS4.0. To evaluate the measurement and structural models, structural equation modeling (SEM) was carried out using the partial least squares (PLS) method. (a) Teaching presence positively predicts academic buoyancy, and academic buoyancy positively predicts social presence and cognitive presence; (b) academic buoyancy mediates teaching presence and social presence, as well as teaching presence and cognitive presence; and (c) academic buoyancy acts as a chain mediator between teaching presence and cognitive presence through social presence. The results of this study fill a gap in the multiple roles of individual positive psychological construct-academic buoyancy in blended learning communities, extend the Community of Inquiry theoretical framework, and provide empirical evidence for blended learning quality and practical improvement strategies.

Implementation of a quality improvement strategy to optimise the management of community acquired pneumonia in a rural health setting.

In Australia, inappropriate prescribing of antimicrobials is higher in rural and regional areas than in major city hospitals. Inappropriate prescribing is defined as the prescription of antimicrobial agents that do not adhere to guidelines in terms of type of antimicrobial chosen, dose and/or duration or are deemed unnecessary. A review of antimicrobial prescribing in a Queensland rural Hospital and Health Service (HHS) identified that respiratory infections were an area for potential improvement. The study was performed in a rural HHS in Queensland. Appropriateness of antimicrobial prescribing for baseline and post-implementation phases of the study was evaluated according to Therapeutic Guidelines: antibiotic recommendations for community acquired pneumonia (CAP). Quality improvement strategy to implement a multifaceted package of interventions for CAP. Post-implementation, overall appropriateness of antimicrobial prescribing improved and there was a decrease in duration of antimicrobial therapy. A quality improvement strategy to implement a multifaceted package of interventions for CAP has shown to be acceptable and effective in improving the antimicrobial prescribing in a rural setting. Our findings highlight the importance of utilising a multifaceted package of interventions which can be tailored to the prescribers and the patients at hand. It is also valuable to engage with local clinicians to promote the optimal management of common infections in the rural setting.

Research progress in laser additive manufacturing of aluminum alloys: Microstructure, defect, and properties

Laser additive manufacturing (LAM) has attracted significant interest in developing Al alloys due to its potential to fabricate structural components at low cost and high efficiency. Nevertheless, LAM Al alloys still suffer many issues, including heterogeneous microstructure, various defects, and poor mechanical properties, significantly hindering the advancement of LAM Al alloys. This article seeks to provide a comprehensive overview of the current advancements made in the field of LAM Al alloys and attempts to establish an in-depth relationship between microstructural characteristics, defects, and performances. Development status and limitations of LAM technologies are described, microstructural characteristics of Al alloys in LAM are introduced, mechanisms of formed defects and corresponding mitigation measures are discussed, and current quality improvement strategies are summarized. Following the research of previous work, this review will provide an outlook on overcoming the existing challenges and provide a helpful resource and reference for the development of LAM Al alloys.

School Committees' Effectiveness in the Context of School-based Management Policy

The background of this research is the granting of broad educational autonomy to schools, which is a big concern for the government of Indonesia. School-based Management (SBM) appears as an alternative to the new paradigm of education management offered. One of the characteristics of SBM is inseparable from the participation of the community. School Committee is a forum for parents, communities, stakeholders, and entrepreneurs in school development and can bridge the interests of all the parties. To date, not many School Committees have been able to play an effective role in supporting the implementation of education in schools. One of the contributing factors is that the institutional design is not seriously empowered into an independent and professional institution. This study aimed to examine the effectiveness of school committees in school-based quality improvement management. The study method is qualitative descriptive. Data were collected through interviews, observation, and documentation. Validation of the collected data was done through triangulation techniques. The results showed that thematically the author underlined four important things, namely: first, the school committee has effectiveness as a consideration partner, material support, financial, thought and energy, and learning mediator; second, quality improvement strategies can be achieved through efforts to improve school subject competence and involvement in competitions; third, to measure the results of achievements, an education quality management audit is carried out, and; fourth, the budget as one of the determining factors in achieving school goals and objectives must be optimized by utilizing the flexibility of implementing Law No. 23 of 2014 and optimizing available resources. This research has implications for considerations in the preparation of internal school strategies to prioritize school needs and recommendations related to budget policies and inventory of school components.&#x0D; Keywords: effectiveness, School Based Management, School Committee

Partisipasi Komite Sekolah di SDN Ajung 3 Jember Jawa Timur

This research aims to discover the school committee's involvement in fundraising activities, their participation in policy and program development, and their role in facilitating the aspirations of parents and the community at State Elementary School (SDN) Ajung 3 Jember. This study used a qualitative approach to understand the phenomenon of implementing educational quality improvement strategies through the engagement of the school committee at SDN Ajung 3 Jember. Data collection techniques included interviews, observations, and document analysis. Data analysis followed an interactive process involving reduction, presentation, and verification. The research findings indicate that the school committee's participation in fundraising enhances educational quality by providing physical, financial, and conceptual support. These funds also assist in activities that enhance school quality beyond the budget and aid in formulating and establishing the School Operational Plan and Budget (RAPBS) based on principles of transparency, accountability, and democracy. The school committee plays a role in overseeing school policy implementation for sustainability. Acting as a mediator, the committee effectively facilitates the aspirations of parents and the community, receiving input that is subsequently conveyed to the school principal and discussed in meetings involving stakeholders.

Strategies to improve delivery of equitable and evidence-informed care for pregnant and birthing people with a substance use disorder in acute care settings: A scoping review protocol.

This protocol outlines a proposed scoping review to characterize evidence on implementation and quality improvement (QI) strategies that aim to improve equitable, evidence-informed care delivery for pregnant and birthing people with substance use disorder (SUD) in acute care. Untreated SUD during pregnancy is associated with an increased risk of overdose and severe maternal morbidity. Acute care settings are one important place to deliver equitable, evidence-informed clinical care. While clinical practice guidelines for substance use treatment and care of pregnant and birthing people with SUD exist, there are gaps in implementation. Our population of interest is pregnant and birthing people with SUD in an acute care setting. We will include US-based studies that describe or evaluate implementation or QI strategies, including experimental, observational, and descriptive studies published from 2016 to 2023. The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews and registered at OSF (registration number: BC4VZ). We will search MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsychInfo (Ovid) for published studies. Conference proceedings and Perinatal Quality Collaborative websites will be searched for grey literature. Two reviewers will independently screen then extract studies that meet inclusion criteria using a data extraction tool. The completion of this scoping review will help illuminate strengths and gaps in research and practice that aim to inform substance use treatment and care in acute care settings for pregnant and birthing people with SUD.

Deep optimization of water quality index and positive matrix factorization models for water quality evaluation and pollution source apportionment using a random forest model

Effective evaluation of water quality and accurate quantification of pollution sources are essential for the sustainable use of water resources. Although water quality index (WQI) and positive matrix factorization (PMF) models have been proven to be applicable for surface water quality assessments and pollution source apportionments, these models still have potential for further development in today's data-driven, rapidly evolving technological era. This study coupled a machine learning technique, the random forest model, with WQI and PMF models to enhance their ability to analyze water pollution issues. Monitoring data of 12 water quality indicators from six sites along the Minjiang River from 2015 to 2020 were used to build a WQI model for determining the spatiotemporal water quality characteristics. Then, coupled with the random forest model, the importance of 12 indicators relative to the WQI was assessed. The total phosphorus (TP), total nitrogen (TN), chemical oxygen demand (CODCr), dissolved oxygen (DO), and five-day biochemical oxygen demand (BOD5) were identified as the top five significant parameters influencing water quality in the region. The improved WQI model constructed based on key parameters enabled high-precision (R2 = 0.9696) water quality prediction. Furthermore, the feature importance of the indicators was used as weights to adjust the results of the PMF model, allowing for a more reasonable pollutant source apportionment and revealing potential driving factors of variations in water quality. The final contributions of pollution sources in descending order were agricultural activities (30.26%), domestic sewage (29.07%), industrial wastewater (26.25%), seasonal factors (6.45%), soil erosion (6.19%), and unidentified sources (1.78%). This study provides a new perspective for a comprehensive understanding of the water pollution characteristics of rivers, and offers valuable references for the development of targeted strategies for water quality improvement.

CO2 synergistic emission reduction and health benefits of PM2.5 reaching WHO-III level in Pearl River Delta

Protecting human health is one of the fundamental goals of continuous air quality improvement. Considering the same sources of CO2 and air pollutants emissions, their emission control measures often have a certain degree of synergistic emission reduction effects To balance the costs and policy efficiency, policy makers should assess the synergistic benefits of CO2 emission reduction when formulating air quality improvement strategies. Aimed at the air quality improvement strategy targeting WHO-III level (i.e. 15 μg/m3) for PM2.5 in the Pearl River Delta (PRD) region, this study evaluates the synergistic CO2 reduction effects and the associated health benefits from this strategy which includes a range of air pollution prevention and control measures. The results of the study show that promoting the attainment of WHO-III for PM2.5 in the PRD region can bring about 74 Mt of synergistic CO2 emission reduction, resulting in an 18% reduction of CO2 emissions in the PRD compared to 2017. Among various measures considered, industrial restructuring, power supply transition and industrial energy consumption transformation exhibit the most pronounced synergistic effects. Therefore, these measures are recommended to be prioritized and promoted in the next stage of air pollution prevention and CO2 emission reduction. Furthermore, when the PM2.5 concentration in the PRD region reaches the WHO-III level, the number of PM2.5-related deaths will be estimated to reduce approximately 5.5 thousand compared to that in the current policy scenario. Through continuous structural transformation and emission reduction efforts, it not only facilitates the decline in regional PM2.5 concentration but also helps more regional residents to live in an environment with a relatively low PM2.5 concentration. In addition, in order to reduce the health impacts of PM2.5, it is recommended that the government should guide people to change their production and living styles in order to reduce pollutant emissions from anthropogenic activities.