The role of physical activity on healthcare utilization in China.

BACKGROUND: Evidence on the role of physical activity (PA) on healthcare utilization and expenditure is limited in China. We aimed to examine the association between the total physical activity (TPA) per week, healthcare service use and expenditure. METHODS: We extracted the data from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, and 2015. Participants more than 50 years old who completed the follow-up for the three waves were enrolled. We converted the volume of vigorous physical activity (VPA) into an equivalent volume of moderate physical activity (MPA) and calculated the TPA per week for each participant. 12,927 of the 17,708 participants in CHARLS were included in our analysis. More than one-third of participants over 50 years old never participate in any moderate or intensity activity, and the median of self-reported moderate or intensity PA was about 525 (IQR 0-1680) MET-minutes per week in 2015. RESULTS: Compared to inactive subjects, the highest level of TPA was significantly related to the decreased risk number of inpatient visits (IRR: 0.58; 95% CI:0.50-0.67, p < 0.001), inpatient hospital days (IRR: 0.60; 95% CI: 0.42-0.84, p < 0.01), healthcare expenditure (IRR: 0.71; 95% CI: 0.65-0.79, p < 0.001) and catastrophic health expenditures (OR: 0.57; 95% CI: 0.45-0.72, p < 0.001) after adjusting for covariates. CONCLUSIONS: Engaging in moderate-to-vigorous PA may drive a potential decrease in healthcare utilization, healthcare expenditure and household financial risk with a dose-response relationship in China, and some possible policy implications in public health may be considered to promote exercise in the middle-aged and elderly to reduce the medical burden on individuals and healthcare systems.

Safety assessment of slope on in-service dump under severe dry-wet cycles at high-altitude.

This study aimed to evaluate the safety of dump slopes in high-altitude areas subjected to severe dry-wet cycles. The slope of No. 1 and No. 2 in-service dumps in limestone mining areas for cement in high-altitude mining areas is taken as the research object. The unsaturated soil shear strength and matrix suction distribution equations were imported based on the unsaturated-saturated seepage theory. Therefore, the evolution characteristics of the unsaturated-saturated seepage field in the dump are analyzed by numerical calculation, and the safety state of the dump slope is evaluated. The results indicated the following rules: under the action of four dry-wet cycles, the surface soil of the dump slope changes from an unsaturated state to a saturated state. Furthermore, with the increase in the times of the dry-wet cycle, the maximum vertical displacement of the No. 1 and No. 2 dump slopes increased. The numerical calculations of the maximum cumulative vertical displacement of the slope were consistent with the actual monitoring data. The factor of safety of the dump slope decreased continuously with the increase in the times of dry-wet cycles. Nevertheless, it still met the safety and stability standards. It was concluded that the slope of the in-service dump remains stable after enduring four severe cycles of dry-wet.

Does green credit promote firm environmental performance? A new perspective of economic growth target constraints.

Green credit encompasses financial instruments and services utilized to mitigate greenhouse gas emissions and facilitate adaptation to global climate change. Establishing a long-term stable green credit institution is crucial to promoting carbon abatement goals. This study uses the difference-in-difference (DID) model to discuss the impact of green credit policy (GCP) on environmental performance based on the China industrial enterprise data. Our results show that GCP inhibits the pollution emissions and improve firm environmental performance. This improvement effect is attributed to a reduction in production scale, and financing constraints. Moreover, GCP increases the firms' exit risk from market and promotes the technological innovation of incumbent firms. Economic growth target constraints trigger a positive moderation role in the implementation of GCP. Heterogeneity results show that such improvement effect is more pronounced in state-owned firm, large-scale firms, and high R&D intensity firms. Importantly, our findings also suggest the environmental monitoring effect of green credit is dependent on the institutional quality. Only in a sound market environment can GCP effectively improve firm environmental performance. Finally, we propose to build a systematic incentives and constraints mechanism to achieve the sustainable development. The conclusions of this paper provide empirical evidence and policy implications for the implementation of GCP.

A nexus between green digital finance and green innovation under asymmetric effects on renewable energy markets: a study on Chinese green cities.

This article examines the innovation in the green sector frequently facing a financial conundrum. Production of renewable energy is the eighth sustainable development, based on the data from the 30 Chinese provinces (2000-2017). This study presents an analysis of the effects of green digital finance on green innovation on protection of environment using influence mechanism analysis. Digital finance, which has become a major driver of green innovations in China, may first increase the number and quality of green technical innovation. The results show that the promotion effect of digital finance on the efficiency of renewable energy markets is greater than the inhibitory effect, making the total effect less obviously favorable. In other results, the elasticity of lnGFDI is significant at the 5% level and is 0.1545% and 0.1880% in the present and 1-year delayed periods, respectively. Further, the average total effect of FDI on the effectiveness of green innovation is 0.008, with an average encouraging effect of 0.0051 and an average inhibiting effect of 0.0039. We conclude that diverse behavior for that policy support increases the impact of green digital finance, promote green innovation, and generate emission free environment for sustainable energy markets.

Assessing the nexus between fiscal policy, COVID-19, and economic growth.

The COVID-19 issue deteriorated South Africa's already dire economic situation, exacerbated by years of considerable debt increase. The COVID-19 pandemic has disrupted trade to such an extent that some enterprises are barely working at a quarter of their potential. Furthermore, economic agents delay economic decisions while waiting to see how the crisis develops. According to some economists, increased government expenditure will raise GDP enough to keep the country's debt-to-GDP ratio steady and restore fiscal sustainability. We use a panel data model to estimate a fiscal reaction function, which we then apply to historical data to assess the government's prior efforts to maintain or restore budgetary sustainability. We calculate the impact fiscal balance, government expenditure, interest rate, and revenue changes that the government will have to make to restore the country's fiscal stability due to the financial impact of the COVID-19 issue.The findings show that fiscal balance and tax revinue have a significant impact on the economics growth, while government expenditure and corruption reduce the growth of the country.

Simultaneously Enhanced Efficiency and Mechanical Durability in Ternary Solar Cells Enabled by Low-Cost Incompletely Separated Fullerenes.

All-polymer solar cells (all-PSCs) are one of the most promising application-oriented organic photovoltaic technologies due to their excellent operational and mechanical stability. However, the power conversion efficiencies (PCEs) are mostly lower than 16%, restricting their core competitiveness. Furthermore, the improvement of mechanical durability is rarely paid attention to cutting-edge all-PSCs. This work deploys a low-cost "technical grade" PCBM (incompletely separated but pure mixtures containing ≥90% [70]PCBM or [60]PCBM), into the efficient PM6:PY-IT all-polymer blend, successfully yielding a high-performance ternary device with 16.16% PCE, among the highest PCE values for all-PSCs. Meanwhile, an excellent mechanical property (i.e., crack onset strain = 11.1%) promoted from 9.5% for the ternary system is also demonstrated. The "technical grade" PCBM slightly disrupts the crystallization of polymers, and disperses well into the amorphous polymer regions of the all-PSC blends, thus facilitating charge transport and improving film ductility simultaneously. All these results confirm introducing low-cost "technical grade" PCBM with high electron mobility into all-polymer blends can improve carrier mobility, reduce charge recombination, and optimize morphology of the amorphous polymer regions, thus yielding more efficient and mechanically durable all-PSCs.

Assessment of passenger long-term vibration discomfort: a field study in high-speed train environments.

This study revealed the mechanism of long-term passenger vibration discomfort in high-speed trains and proposed a novel evaluation model to assess it, while the most popular international standard ISO 2631-1 is unsuitable. Here, a field test was conducted to investigate the long-term passenger vibration comfort in high-speed trains under different operation environments by the measurement of the whole-body vibration (WBV) and the subjective ratings of passenger comfort. During the whole sitting period of high-speed train passengers, the phenomena 'compensatory degradation' and 'discomfort accumulation' were found, which meant that the brief termination of vibration cannot fundamentally alleviate passenger vibration comfort. And the vibration comfort can be evaluated by the product of exposure time and the novel vibration acceleration index we proposed. Meanwhile, high-speed trains with higher velocities or running in tunnel environments have higher frequency-weighted WBV amplitude than open-air and lower velocities, which caused more vibration discomfort of passengers. Practitioner Summary: This field study provided data support for ensuring the occupational health of train drivers whose work routes involve a large number of tunnels and improving passenger vibration comfort. Meanwhile, a novel idea was provided for evaluating the vibration comfort of passengers who prolonged exposure to low-amplitude environments.

Cardiometabolic diseases, frailty, and healthcare utilization and expenditure in community-dwelling Chinese older adults.

This study investigated associations between cardiometabolic diseases, frailty, and healthcare utilization and expenditure among Chinese older adults. The participants were 5204 community-dwelling adults aged at least 60 years from the China Health and Retirement Longitudinal Study. Five cardiometabolic diseases were assessed including hypertension, dyslipidemia, diabetes, cardiac diseases and stroke. Frailty status was based on five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. Participants were deemed frailty if they met at least three criteria. As the number of cardiometabolic diseases increased, so did the prevalence of frailty, and the proportion of healthcare utilization, including outpatient visit and inpatient visit. Moreover, the total healthcare expenditure and the odds of catastrophic health expenditure were increased with the number of cardiometabolic disorders. After adjusting for covariates, cardiometabolic diseases were positively associated with higher odds of frailty, incurring outpatient and inpatient visit. And individuals with 2 or more cardiometabolic diseases had a higher odds of catastrophic health expenditure than persons with non-cardiometabolic disease. Participants who were frailty were more likely to report higher odds of healthcare utilization. These findings suggest that both cardiometabolic diseases and frailty assessment may improve identification of older adults likely to require costly, extensive healthcare.

Duplexed on-microbead binding assay for competitive inhibitor of epidermal growth factor receptor by quantitative flow cytometry.

Upon binding agonist, the epidermal growth factor receptor (EGFR) is dimerized and auto-phosphorylated to activate downstream pathway that induces diverse physiology and pathology processes. Conventional methods for evaluation of EGFR inhibitors are limited. This study describes a duplexed on-microbead binding assay allowing competitive EGFR inhibitors to be quantificationally evaluated in vitro. Polystyrene microbeads barcoded by fluoresceine isothiocyanate fluorescence as high brightness and low brightness microspheres were coated with receptor tyrosine kinase (RTK) ligand-epidermal growth factor (EGF)/stem cell factor (SCF) and ATP/GTP, respectively. High and low brightness microbeads were mixed and incubated with EGFR and its competitive inhibitor in binding assay buffer. Phycoerythrin (PE) fluorescence-labelled antibody was employed to report the level of EGFR binding to EGF/SCF and ATP/GTP. Values were numbered via PE molecules assessed by quantitative flow cytometry. Results from this study demonstrated that incubation with EGFR identified by PE-labelled antibody can make EGF- and ATP-coated microbeads luminous. And EGF or ATP-competitive EGFR inhibitors, respectively, alleviated this in a concentration-dependent manner. Coating microbeads with SCF or GTP as a negative control cannot capture EGFR. The duplexed on-microbead binding assay in this study might be useful for discovering ligand- and ATP-competitive EGFR inhibitors in a rapid and quantificational approach.

Increased N-terminal pro-brain natriuretic peptide level predicts atrial fibrillation after surgery for esophageal carcinoma.

AIM: To evaluate the value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level for predicting postoperative atrial fibrillation (AF) in patients undergoing surgery for esophageal carcinoma. METHODS: NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma. All patients having a preoperative cardiac diagnosis by electrocardiogram (ECG), remained under continuous monitoring for at least 48 h after surgery, and then underwent clinical cardiac evaluation until discharge. RESULTS: Postoperative AF occurred in 11 patients (7.7%). AF patients were significantly older (69.6 +/- 12.2 years vs 63.4 +/- 13.3 years, P = 0.031) than non-AF patients. There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach, anastomosis site, intraoperative hypotension and postoperative fever. The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF (121.3 +/- 18.3 pg/mL vs 396.1 +/- 42.6 pg/mL, P = 0.016). After adjustment for age, gender, chronic obstructive pulmonary disease (COPD), history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF (odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008). CONCLUSION: An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma. This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.