One and the same or different? An empirical comparison of aged care recipient and non-aged care recipient preferences for quality of aged care amongst older Australians.

The Quality of Care Experience Aged Care Consumers (QCE-ACC) is a new preference-based instrument recently adopted by the Australian government nationally as a new quality indicator for aged care. This study employed a discrete choice experiment (DCE) approach to develop an aged care user-specific value set for the QCE-ACC instrument. This is crucial for establishing the relative importance of key QCE-ACC dimensions for informing quality assessment and economic evaluation in aged care. We further empirically compared the preferences of aged care recipients and non-aged care recipients amongst the older Australian population (65 years and above) for quality of care experience using the QCE-ACC. A total of 201 older people (age 74.2 ± 6.2; 59.7% female) receiving aged care services completed the DCE survey between August and September 2022. The comparison of relative importance indicated some divergence in the preferences between the aged care recipients and non-aged care recipients. Amongst aged care recipients, being treated with "Respect & Dignity" was the most important quality of care experience defining dimension, with "Health & Wellbeing" ranked second and "Skills & Training" (of staff) ranked third. However, within non-aged care recipients, "Skills Training" (of staff) was considered the most important quality of care dimension. Distinction in the QCE-ACC utility weights distributions and mean values were also observed, suggesting that aged care recipients may have different opinions about the quality of aged care compared to those who have not accessed aged care services. The findings shed light on the unique preferences of aged care recipients, indicating that aged care recipients and non-aged care recipients' preferences for quality of aged care are not interchangeable. The value set developed in this study is specifically tailored for assessing the quality of aged care using the QCE-ACC instrument from the perspective of aged care users in Australia.

Does international trade improve carbon productivity? Evidence from countries along the Belt and Road.

The Belt and Road Initiative proposed by China has significantly increased trade in countries along the Belt and Road (B&R). Since most of these countries are developing and emerging economies, the pressure to reduce carbon emissions poses a leading challenge for them. Carbon productivity has become a key indicator for assessing the degree of low-carbon development, as it can link economic development with CO2 emission reduction. However, few studies have investigated how international trade affects carbon productivity. Based on panel data from 43 countries along the B&R during 2001-2019, this paper uses a system GMM model to explore the impact of international trade on carbon productivity. Then, we divide the 43 countries in the sample into two groups according to their income levels to compare the different effects of international trade on carbon productivity. The results show that, first, the carbon productivity of the examined B&R countries has an overall increasing trend, and there is a significant heterogeneity of carbon productivity among countries with different income levels. Second, the effects of international trade, export, and import on carbon productivity are all significantly positive, and export's effect is higher than import. In the high-income group, carbon productivity is more likely to be improved by trade than in the middle (low)-income group. Third, economic development level, urbanization, and energy productivity are positively associated with carbon productivity, while CO2 per capita and government size inhibit carbon productivity improvement. Insight into the impact of international trade on carbon productivity provides theoretical support for B&R countries to better leverage foreign trade activities to achieve a green economy.

Health state utility values in patients with Ankylosing Spondylitis: a systematic review and meta-analysis.

INTRODUCTION: Ankylosing spondylitis (AS) is a chronic condition that requires lifelong treatment and results in a serious disease burden. Health state utility values (HSUVs) are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE: We conducted a systematic review and meta-analysis to obtain estimates of HSUVs in patients with AS, explored potential sources of heterogeneity, and compared pooled patient HSUVs with population norms. METHOD: We searched PubMed, Embase, Web of science, Cochrane database and Scopus until July, 2023 to obtain eligible studies. The methodological quality of the included studies was assessed using the ROBINS-I checklist. RESULTS: Forty-two publications involving 11,354 participants were included in this systematic review. The most commonly used instrument is the EQ-5D (38 studies). The estimated HSUVs for patients with AS from all available studies was pooled as 0.62 (95% CI 0.59 to 0.65). The pooled mean utility estimates from the random effects meta-analysis for SF-6D, EQ-5D-3L, EQ-5D-5L, and HUI3 were 0.65 (95% CI 0.62,0.68), 0.63 (95% CI 0.59,0.66), 0.60 (95% CI 0.42,0.79), and 0.48 (95% CI 0.43,0.53), respectively. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression based on key subgroups. The pooled estimates of EQ-5D-3L were lower for patients published before 2010, with high disease activity, long duration of disease, and in developed countries. CONCLUSION: Pooled estimates of HSUVs for people with AS were substantially lower than population norms. These estimates provide robust evidence that can inform the economic evaluation of new therapies for individuals with AS.

Rationale, conceptual issues, and resultant protocol for a mixed methods Person Trade Off (PTO) and qualitative study to estimate and understand the relative value of gains in health for children and young people compared to adults.

BACKGROUND: Economic evaluation of healthcare typically assumes that an identical health gain to different patients has the same social value. There is some evidence that the public may give greater value to gains for children and young people, although this evidence is not always consistent. We present a mixed methods study protocol where we aim to explore public preferences regarding health gains to children and young people relative to adults, in an Australian setting. METHODS: This study is a Person Trade Off (PTO) choice experiment that incorporates qualitative components. Within the PTO questions, respondents will be asked to choose between treating different groups of patients that may differ in terms of patient characteristics and group size. PTO questions will be included in an online survey to explore respondent views on the relative value of health gains to different age groups in terms of extending life and improving different aspects of quality of life. The survey will also contain attitudinal questions to help understand the impact of question style upon reported preferences. Additionally, the study will test the impact of forcing respondents to express a preference between two groups compared with allowing them to report that the two groups are equivalent. One-to-one 'think aloud', semi-structured interviews will be conducted to explore a sub-sample of respondents' motivations and views in more detail. Focus groups will be conducted with members of the public to discuss the study findings and explore their views on the role of public preferences in health care prioritisation based on patient age. DISCUSSION: Our planned study will provide valuable information to healthcare decision makers in Australia who may need to decide whether to pay more for health gains for children and young people compared with adults. Additionally, the methodological test of forcing respondent choice or allowing them to express equivalence will contribute towards developing best practice methods in PTO studies. The rationale for and advantages of the study approach and potential limitations are discussed in the protocol.

Selective Lattice Doping Enables a Low-Cost, High-Capacity and Long-Lasting Potassium Layered Oxide Cathode for Potassium and Sodium Storage.

Layered transition metal oxides are highly promising host materials for K ions, owing to their high theoretical capacities and appropriate operational potentials. To address the intrinsic issues of KxMnO2 cathodes and optimize their electrochemical properties, a novel P3-type oxide doped with carefully chosen cost-effective, electrochemically active and multi-functional elements is proposed, namely K0.57Cu0.1Fe0.1Mn0.8O2. Compared to the pristine K0.56MnO2, its reversible specific is increased from 104 to 135 mAh g-1. In addition, the Cu and Fe co-doping triples the capacity under high current densities, and contributes to long-term stability over 500 cycles with a capacity retention of 68 %. Such endeavor holds the potential to make potassium-ion batteries particularly competitive for application in sustainable, low-cost, and large-scale energy storage devices. In addition, the cathode is also extended for sodium storage. Facilitated by the interlayer K ions that protect the layered structure from collapsing and expand the diffusion pathway for sodium ions, the cathode shows a high reversible capacity of 144 mAh g-1, fast kinetics and a long lifespan over 1000 cycles. The findings offer a novel pathway for the development of high-performance and cost-effective sodium-ion batteries.

The Relative Importance and Performance of Key Life Domains on Global Life Satisfaction in Early Adolescents.

OBJECTIVE: This study aimed to investigate the relative importance of key life domains of early adolescents and to explore the heterogeneities across age cohorts and countries at different levels of economic development. METHODS: The repeated cross-sectional survey data for 10 countries (England, Israel, Romania, Norway, Malta, Nepal, Estonia, Ethiopia, South Korea, and Germany) from the second (2013-2014) and third (2016-2019) waves of the International Survey of Children's Well-Being study were used. Early adolescents from the 10- and 12-year age groups were included. A total of 14 key life domains were investigated on their influence to the global life satisfaction. Partial least squares structural equation modeling was used and an importance-performance map analysis was conducted. RESULTS: A total of 23 732 respondents in wave 2 (49% from 10-year-old group) and 22 265 respondents in wave 3 (50% from 10-year-old group) were studied. On average, possessions and safety are the top 2 most important domains within the second wave for 10-year-olds. However, when split based on country-income groups, health comes out on top for low-to-middle-income countries followed by possessions, with safety domain ranking much lower at seventh. For the 12-year-old group, possessions and safety rank highest on average irrespective of the country's level of income. Although areas of priority varied across countries, future came out as one of the most important areas adolescents considered needing improvement across age groups and over time. CONCLUSION: Findings from this study revealed substantial heterogeneity across nations and provide important information for prioritizing policy implementation to improve subjective well-being among early adolescents.

The impact of digital empowerment on the economic openness of the textile industry in Keqiao based on a sustainable environment.

Based on the framework theory of industrial digitization, digital industrialization, digital governance and digital value-added in a sustainable environment, this paper systematically studies the relevant elements of governance and value distribution in the sustainable environment of global trade, and its impact on the development path of human beings. This paper explores the way to embed digital technology into the global value chain to realize digital empowerment, measures the competitiveness index of Keqiao's textile industry in the global value chain, analyzes the technical and environmental challenges faced by China's textile industry in the digital age, and proposes the corresponding countermeasures to deal with the impact of global value chain participation and to improve the international competitiveness of China's textile industry.

[Exposure Level and Risk Impact Assessment of Pesticides and Veterinary Drugs in Aquaculture Environment].

To explore the exposure level of pesticides and veterinary drugs in an aquaculture environment and its impact on the ecological environment, this study took the aquaculture environment in Shanghai as an example, and samples of water, sediment, and inputs from 40 major aquaculture farms were collected from July to September 2022. The types and contents of pesticides and veterinary drugs were screened using high-performance liquid chromatography-electrostatic field orbital ion trap mass spectrometry, and the risk quotient (RQ) method was used to assess the ecological risk of pesticide contamination in water and sediment. The results showed that 13 drugs were screened out from 204 samples (72 samples of water, 72 samples of mud, and 60 samples of input), namely, chlorpromazine, carbendazim, thiophanate, diazepam, florfenicol, simazine, amantidine, diazepam, trimethoprim, ciprofloxacin, ofloxacin, mebendazole, and enrofloxacin. Among them, 12 species were found in water samples with concentrations ranging from 0.016 µg·L-1 to 2.084 µg·L-1. The concentrations of seven species in the mud samples ranged from 0.018 µg·kg-1 to 23.101 µg·kg-1. The results showed that there were four types of inputs, ranging from 1.979 µg·kg-1 to 101.940 µg·kg-1. Seven drugs were found in both water and sediment. The risk quotient (RQ) results showed that there were some high and middle risks in both water and sediment samples of aquaculture farms, and the ecological risks of carbendazim were the highest in both water and sediment samples of aquaculture farms; the RQ values were 3.848 and 1.580, respectively, indicating high risk. It is suggested to strengthen the control and management of exogenous pesticides and veterinary drugs in aquaculture environments to protect the ecosystem health of the aquaculture environment.

Mapping the 12-item World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) onto the assessment of quality of life (AQoL)-4D utilities.

PURPOSE: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widely used disability-specific outcome measure. This study develops mapping algorithms to estimate Assessment of Quality of Life (AQoL)-4D utilities based on the WHODAS 2.0 responses to facilitate economic evaluation. METHODS: The study sample comprises people with disability or long-term conditions (n = 3376) from the 2007 Australian National Survey of Mental Health and Wellbeing. Traditional regression techniques (i.e., Ordinary Least Square regression, Robust MM regression, Generalised Linear Model and Betamix Regression) and machine learning techniques (i.e., Lasso regression, Boosted regression, Supported vector regression) were used. Five-fold internal cross-validation was performed. Model performance was assessed using a series of goodness-of-fit measures. RESULTS: The robust MM estimator produced the preferred mapping algorithm for the overall sample with the smallest mean absolute error in cross-validation (MAE = 0.1325). Different methods performed differently for different disability subgroups, with the subgroup with profound or severe restrictions having the highest MAE across all methods and models. CONCLUSION: The developed mapping algorithm enables cost-utility analyses of interventions for people with disability where the WHODAS 2.0 has been collected. Mapping algorithms developed from different methods should be considered in sensitivity analyses in economic evaluations.

Diagnostic Delay and Disease Burden in Primary Aldosteronism: An International Patient Survey.

BACKGROUND: Primary aldosteronism (PA) is a common but underdiagnosed cause of hypertension. Many patients experience preventable end-organ injury due to delayed or missed diagnosis but data on the experience of patients are limited. METHODS: We evaluated the lived experience of PA and determines factors associated with diagnostic delay through an international anonymous online cross-sectional survey, codesigned by researchers and PA consumers. We distributed the survey through academic medical centers, Amazon Mechanical Turk, Twitter, PA patient advocacy groups, and hypertension support groups on Facebook between March 21 and June 5, 2022. RESULTS: Of 684 eligible respondents, 66.5% were women. Diagnostic delay (defined as ≥5 years between the diagnosis of hypertension and PA) was reported in 35.6%. Delay was more likely in women than in men (odds ratio, 1.55 [95% CI, 1.10-2.20]) and respondents with ≥3 comorbidities versus none (odds ratio, 1.77 [95% CI, 1.05-3.02]), ≥10 symptoms versus none (odds ratio, 2.73 [95% CI, 1.74-4.44]), and on ≥4 antihypertensive medications versus none (odds ratio, 18.23 [95% CI, 6.24-77.72]). Three-quarters of patients (74.4%) experienced reduced symptom burden following targeted PA treatment. Quality of life improved in 62.3% of patients, and greater improvement was associated with being a woman (odds ratio, 1.42, [95% CI, 1.02-1.97]), receiving adrenalectomy (odds ratio, 2.36 [95% CI, 1.67-3.35]), and taking fewer antihypertensive medications following diagnosis (odds ratio, 5.28 [95% CI, 3.55-7.90]). CONCLUSIONS: One-third of patients with PA experienced prolonged diagnostic delays. Targeted treatment led to reduced symptom burden and improved quality of life. Gender differences in diagnostic delay and symptom burden are prominent. These findings suggest that routine screening for PA at the onset of hypertension may reduce diagnostic delay and facilitate timely diagnosis.

Systematic Review of the Relative Social Value of Child and Adult Health.

OBJECTIVES: We aimed to synthesise knowledge on the relative social value of child and adult health. METHODS: Quantitative and qualitative studies that evaluated the willingness of the public to prioritise treatments for children over adults were included. A search to September 2023 was undertaken. Completeness of reporting was assessed using a checklist derived from Johnston et al. Findings were tabulated by study type (matching/person trade-off, discrete choice experiment, willingness to pay, opinion survey or qualitative). Evidence in favour of children was considered in total, by length or quality of life, methodology and respondent characteristics. RESULTS: Eighty-eight studies were included; willingness to pay (n = 9), matching/person trade-off (n = 12), discrete choice experiments (n = 29), opinion surveys (n = 22) and qualitative (n = 16), with one study simultaneously included as an opinion survey. From 88 studies, 81 results could be ascertained. Across all studies irrespective of method or other characteristics, 42 findings supported prioritising children, while 12 provided evidence favouring adults in preference to children. The remainder supported equal prioritisation or found diverse or unclear views. Of those studies considering prioritisation within the under 18 years of age group, nine findings favoured older children over younger children (including for life saving interventions), six favoured younger children and five found diverse views. CONCLUSIONS: The balance of evidence suggests the general public favours prioritising children over adults, but this view was not found across all studies. There are research gaps in understanding the public's views on the value of health gains to very young children and the motivation behind the public's views on the value of child relative to adult health gains. CLINICAL TRIAL REGISTRATION: The review is registered at PROSPERO number: CRD42021244593. There were two amendments to the protocol: (1) some additional search terms were added to the search strategy prior to screening to ensure coverage and (2) a more formal quality assessment was added to the process at the data extraction stage. This assessment had not been identified at the protocol writing stage.

A new Monte Carlo sampling method based on Gaussian Mixture Model for imbalanced data classification.

Imbalanced data classification has been a major topic in the machine learning community. Different approaches can be taken to solve the issue in recent years, and researchers have given a lot of attention to data level techniques and algorithm level. However, existing methods often generate samples in specific regions without considering the complexity of imbalanced distributions. This can lead to learning models overemphasizing certain difficult factors in the minority data. In this paper, a Monte Carlo sampling algorithm based on Gaussian Mixture Model (MCS-GMM) is proposed. In MCS-GMM, we utilize the Gaussian mixed model to fit the distribution of the imbalanced data and apply the Monte Carlo algorithm to generate new data. Then, in order to reduce the impact of data overlap, the three sigma rule is used to divide data into four types, and the weight of each minority class instance based on its neighbor and probability density function. Based on experiments conducted on Knowledge Extraction based on Evolutionary Learning datasets, our method has been proven to be effective and outperforms existing approaches such as Synthetic Minority Over-sampling TEchnique.

Educational patterns of health behaviors and body mass index: A longitudinal multiple correspondence analysis of a middle-aged general population, 2007-2016.

Social differences in body mass index and health behaviors are a major public health challenge. The uneven distribution of unhealthy body mass index and of unhealthy behaviors such as smoking, physical inactivity, and harmful alcohol consumption has been shown to mediate social inequalities in chronic diseases. While differential exposures to these health variables have been investigated, the extent to which they vary over the lifetime in the same population and their relationship with level of education is not well understood. This study examines patterns of body mass index and multiple health behaviors (smoking, physical activity and alcohol consumption), and investigates their association with education level among adults living in Northern Norway. It presents findings from a longitudinal multiple correspondence analysis of the Tromsø Study. Longitudinal data from 8,906 adults aged 32-87 in 2007-2008, with repeated measurements in 2015-2016 were retrieved from the survey's sixth and seventh waves. The findings suggest that most in the study population remained in the same categories of body mass index and the three health behaviors at the follow-up, with a clear educational gradient in healthy patterns. That is, both healthy changes and maintained healthy categories were associated with the highest education levels. Estimating differential exposures to mediators of health inequalities could benefit policy priority setting for tackling inequalities in health.

Techno-economic analysis of an HRES with fuel cells, solar panels, and wind turbines using an improved Al-Biruni algorithm.

This research demonstrates the application of novel optimization methods in the realm of renewable energy and contributes to the development of environmentally friendly electricity generation and consumption. In this study, an improved version of the Al-Biruni algorithm has been proposed for Hybrid Renewable Energy Systems (HRES) optimization, which includes fuel cells, photovoltaic cells, and windmills. The algorithm considers supply, demand, and energy storage constraints and seeks the best combination of energy sources to meet load demand while reducing total system cost. Inspired by ancient Iranian philosopher Abu Biruni, the proposed method includes modifications to explore solution space efficiently and improve answer value. The proposed HRES model is applied to a case study from Dunhuang City, China, and its findings are validated by comparing it with other optimization approaches. The Modified Al-Biruni Earth Radius (MBER) algorithm is found to be the most efficient and reliable system, costing 4.23 million units of currency. Compared to other optimization approaches, MBER exhibited a total cost of 4.1 million US dollars, 0.009, 3.7, 3.7, LPSP, and 356 h per year. The overall cost is 5.26 million units of currency with a 0.5% Loss of Power Supply Probability (LPSP), which directly impacts system performance and dependability. The improved Al-Biruni algorithm can efficiently optimize the system, reduce costs, and increase load supply, contributing to the growth of renewable energy sources and the application of advanced meta-heuristic techniques in complex energy systems.

Multi-stakeholder preferences for the use of artificial intelligence in healthcare: A systematic review and thematic analysis.

INTRODUCTION: Despite the proliferation of Artificial Intelligence (AI) technology over the last decade, clinician, patient, and public perceptions of its use in healthcare raise a number of ethical, legal and social questions. We systematically review the literature on attitudes towards the use of AI in healthcare from patients, the general public and health professionals' perspectives to understand these issues from multiple perspectives. METHODOLOGY: A search for original research articles using qualitative, quantitative, and mixed methods published between 1 Jan 2001 to 24 Aug 2021 was conducted on six bibliographic databases. Data were extracted and classified into different themes representing views on: (i) knowledge and familiarity of AI, (ii) AI benefits, risks, and challenges, (iii) AI acceptability, (iv) AI development, (v) AI implementation, (vi) AI regulations, and (vii) Human - AI relationship. RESULTS: The final search identified 7,490 different records of which 105 publications were selected based on predefined inclusion/exclusion criteria. While the majority of patients, the general public and health professionals generally had a positive attitude towards the use of AI in healthcare, all groups indicated some perceived risks and challenges. Commonly perceived risks included data privacy; reduced professional autonomy; algorithmic bias; healthcare inequities; and greater burnout to acquire AI-related skills. While patients had mixed opinions on whether healthcare workers suffer from job loss due to the use of AI, health professionals strongly indicated that AI would not be able to completely replace them in their professions. Both groups shared similar doubts about AI's ability to deliver empathic care. The need for AI validation, transparency, explainability, and patient and clinical involvement in the development of AI was emphasised. To help successfully implement AI in health care, most participants envisioned that an investment in training and education campaigns was necessary, especially for health professionals. Lack of familiarity, lack of trust, and regulatory uncertainties were identified as factors hindering AI implementation. Regarding AI regulations, key themes included data access and data privacy. While the general public and patients exhibited a willingness to share anonymised data for AI development, there remained concerns about sharing data with insurance or technology companies. One key domain under this theme was the question of who should be held accountable in the case of adverse events arising from using AI. CONCLUSIONS: While overall positivity persists in attitudes and preferences toward AI use in healthcare, some prevalent problems require more attention. There is a need to go beyond addressing algorithm-related issues to look at the translation of legislation and guidelines into practice to ensure fairness, accountability, transparency, and ethics in AI.

The relative importance of education and health behaviour for health and wellbeing.

BACKGROUND: Indicators of socioeconomic position (SEP) and health behaviours (HB) are widely used predictors of health variations. Their relative importance is hard to establish, because HB takes a mediating role in the link between SEP and health. We aim to provide new knowledge on how SEP and HB are related to health and wellbeing. METHODS: The analysis considered 14,713 Norwegians aged 40-63. Separate regressions were performed using two outcomes for health-related quality of life (EQ-5D-5 L; EQ-VAS), and one for subjective wellbeing (Satisfaction with Life Scale). As predictors, we used educational attainment and a composite measure of HB - both categorized into four levels. We adjusted for differences in childhood financial circumstances, sex and age. We estimated the percentage share of each predictor in total explained variation, and the relative contributions of HB in the education-health association. RESULTS: The reference case model, excluding HB, suggests consistent stepwise education gradients in health-related quality of life. The gap between the lowest and highest education was 0.042 on the EQ-5D-5 L, and 0.062 on the EQ-VAS. When including HB, the education effects were much attenuated, making HB take the lion share of the explained health variance. HB contributes 29% of the education-health gradient when health is measured by EQ-5D-5 L, and 40% when measured by EQ-VAS. For subjective wellbeing, we observed a strong HB-gradient, but no education gradient. CONCLUSION: In the institutional context of a rich egalitarian country, variations in health and wellbeing are to a larger extent explained by health behaviours than educational attainment.

The Impact of Physician-Patient Gender Match on Healthcare Quality: An Experiment in China.

Despite growing evidence of gender disparities in healthcare utilization and health outcomes, there is a lack of understanding of what may drive such differences. Designing and implementing an experiment using the standardized patients' approach, we present novel evidence on the impact of physician-patient gender match on healthcare quality in a primary care setting in China. We find that, compared with female physicians treating female patients, the combination of female physicians treating male patients resulted in a 23.0 percentage-point increase in correct diagnosis and a 19.4 percentage-point increase in correct drug prescriptions. Despite these substantial gains in healthcare quality, there was no significant increase in medical costs and time investment. Our analyses suggest that the gains in healthcare quality were mainly attributed to better physician-patient communications, but not the presence of more clinical information. This paper has policy implications in that improving patient centeredness and incentivizing physicians' efforts in consultation (as opposed to treatment) can lead to significant gains in the quality of healthcare with modest costs, while reducing gender differences in care.

"Closed-Loop" O2-Economizer Induced In Situ Therapeutic Vaccine against Hypoxic Tumors.

Therapeutic tumor vaccines, which use tumor antigens to stimulate a cancer patient's immune system to eventually kill the tumor tissues, have emerged as one of the most attractive strategies in anticancer research. Especially, exploring in situ vaccines has become a potential field in cancer immunotherapy. However, due to the hypoxic tumor microenvironment, the generation of tumor antigens is always mild and not sufficient. Hence, in this study, we designed a closed-loop mitochondrial oxygen-economizer (TPCA) to induce enhanced phototherapy-driven in situ vaccines. The O2-economizer was developed by the integration of the photosensitizer CyI and the mitochondrial inhibitor atovaquone into the PAMAM dendrimer. In vitro and in vivo studies showed that TPCA could enter the mitochondria through (3-propylcarboxyl) triphenylphosphine bromide (TPP) and effectively restrict the respiration of tumor cells to reduce tumor hypoxia, thus providing continuous oxygen for enhanced iodinated cyanine dye mediated photodynamic therapy, which could further induce in situ vaccines for ablating the primary tumor directly and inhibiting the tumor metastasis and recurrence. Furthermore, the antitumor mechanism revealed that O2-economizer-based oxygen-boosted PDT elicited immunogenic cancer cell death with enhanced exposure and release of DAMPs and altered the immunosuppressive tumor microenvironment with increased recruitment of T cells in tumors, thereby inducing in situ vaccines and provoking the systematic antitumor responses against CT26 tumors. This study will provide innovative approaches for local, abscopal, and metastatic tumor treatment.

Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway.

Introduction: Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway. Methods: Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up. Results: Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity. Conclusion: Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.

Psychometric properties and comparison of four health utility approaches among myopia patients in China.

BACKGROUND: The increased prevalence of myopia creates and earlier age of onset has created public health concerns for the long-term eye health, vision impairment and carries with it a significant economic burden. The quality of the economic evaluation is dependent on the sensitivity and validity of the approaches. Nowadays, there are many approaches to measure patients' health state utility (HSU). However, little is known regarding the performance of direct approach and indirect approach in people with myopia. This study is aimed to compare the psychometric properties of four HSU approaches among patients with myopia in mainland China, including two direct approaches (TTO and SG), the generic preference-based measures (PBM) (AQoL-7D) and the disease-specific PBM (VFQ-UI). METHODS: A convenience sampling framework was used to recruit patients with myopia who attended a large ophthalmic hospital in Jinan, China. Spearman's rank correlations coefficient was used to assess concurrent validity. Known-group validity was analyzed by: (1) whether the patients wear corrective devices; (2) severity of myopia as low or moderate to high of the better eye; (3) duration of myopia as ≤ 10 years or > 10 years. Effect size (ES), relative efficiency (RE) statistic and the largest area under the receiver operating characteristic curve (AUC) were used to assess sensitivity. The intra-class correlation coefficient (ICC) and Bland-Altman plots were used to assess agreement. RESULTS: A valid sample size of 477 myopia patients was analyzed (median duration: 10 years). The mean HSU scores between TTO and SG were similar (0.95) and higher than AQoL-7D (0.89) and VFQ-UI (0.83). Overall, the VFQ-UI had the best performance based on the psychometric analysis. The agreement indicated that there was no pair of approaches that could be used interchangeably. CONCLUSIONS: The VFQ-UI showed better psychometric properties than other three approaches for providing health state utility in Chinese myopia patients. Given the widespread use and its generic nature of the AQoL-7D, it could be used alongside with VFQ-UI to provide complementary health state utility from a generic and disease-specific perspective for economic evaluation. More evidence on the responsiveness of four health utility approaches in myopia patients is required.