Government subsidy and benefit distribution mechanisms for transportation PPP projects: An evolutionary game perspective.

Public-private partnerships (PPP), as an important model for collaboration between the public and private sectors, is an urgent and critical topic due to the serious financial losses of governments involved in transportation PPP projects in recent years. Current research focuses on the government subsidy model, in which the effective implementation of government subsidies relies on the design of incentives for stakeholder behavior. Although the positive externalities are strong, they are prone to the problem of "free riding," which leads to low project performance and challenges in compensating for the government's financial losses. Therefore, this study proposes a novel dynamic subsidy mechanism that can be adjusted based on actual changes in transportation demand and that is linked to project performance. We use evolutionary game theory to construct a two-party evolutionary game model of the government and social capital, focusing on the stability and influencing factors of these interactions. Our research unveils that reaching specific thresholds in both the incentive coefficient and benefit distribution ratio induces an "positive management-negative management" shift in the behavior of involved parties, leading to enhanced project outcomes. Notably, fluctuations in operational quality substantially enhance the efficiency of the active management of private sector, with no discernible impact on the subsidy efficiency of the government. Therefore, our study provides a theoretical framework for improving the revenue allocation and government subsidy mechanism, which has theoretical and practical implications for enhancing the effect of government incentives and improving the quality of operational social capital.

Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study.

OBJECTIVES: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.

Reverse genetics systems for SARS-CoV-2: Development and applications.

The recent emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused serious harm to human health and struck a blow to global economic development. Research on SARS-CoV-2 has greatly benefited from the use of reverse genetics systems, which have been established to artificially manipulate the viral genome, generating recombinant and reporter infectious viruses or biosafety level 2 (BSL-2)-adapted non-infectious replicons with desired modifications. These tools have been instrumental in studying the molecular biological characteristics of the virus, investigating antiviral therapeutics, and facilitating the development of attenuated vaccine candidates. Here, we review the construction strategies, development, and applications of reverse genetics systems for SARS-CoV-2, which may be applied to other CoVs as well.

Effect of China's long-term care insurance on health outcomes of older disabled people: role of institutional care.

Since the public long-term care insurance (LTCI) system was piloted in Chengdu, China, in October 2017, there has been considerable growth of LTC institutions in China. This study aimed to evaluate the health value effect of LTCI in older patients with severe disabilities in an LTC institution. This prospective study was based on data from 985 severe disability patients with or without LTCI from October 2017 to May 2021 in the Eighth People's Hospital, Chengdu, China. The Cox proportional hazard model estimated LTCI's health value, including survival probability and risk of pneumonia/pressure ulcers. Subgroup analysis was performed for sex, age, Charlson Comorbidity Index (CCI), and the number of drugs. In the analysis, 519 and 466 patients in LTCI and non-LTCI groups were included, respectively. In adjusted Cox analyses, the LTCI group had a significantly elevated survival rate compared with the non-LTCI groups at 12 months (P < .001, hazard ratio (HR) = 1.758, 95% confidence interval (CI) 1.300-2.376). At 40 months, the adjusted survival rate was 62.6% in the LTCI group, which was significantly higher (53.7%; P = .003, HR = 1.438, 95% CI 1.131-1.831). The subgroups of patients aged 60 to 79 years (interaction P = .007) and with CCI ≥ 3 (interaction P = .026) were more significantly associated with survival improvement than those aged >80 years and with CCI< 3. The LTCI group was also at lower risk for hospital-acquired pneumonia (P = .016, HR 0.622, 95% CI 0.422-0.917) and pressure ulcers (P = .008, HR 0.695, 95% CI 0.376-0.862). The improved survival of LTCI remained stable in sensitivity analyses. For older patients with severe disabilities, in a LTC institution, LTCI significantly improved their health profile and longevity after a year, suggesting the large role and development potentiality of institution care in the LTCI system of China.

On-demand plerixafor added to high-dose cyclophosphamide and pegylated recombinant human granulocyte colony-stimulating factor in the mobilization of patients with multiple myeloma: a treatment with high effectiveness, convenient, and affordable cost.

Objective: The combination of high-dose cyclophosphamide (HD-Cy) (3g/m2) plus granulocyte colony-stimulating factor (G-CSF) and on-demand plerixafor (PXF) has been considered an effective mobilization regimen of patients with multiple myeloma(MM). However, the daily multi-injection regimen of G-CSF poses challenges. This study delves into the efficiency and cost implications of a novel approach, using HD-Cy alongside pegylated G-CSF (PEG G-CSF) and on-demand PXF. Unlike G-CSF, which necessitates daily injections, the half-life of PEG G-CSF extended allows for a single injection. Methods: A retrospective analysis was conducted on 350 MM patients, which were categorized based on their mobilization regimens: Cy+PEG G-CSF+/-PXF (n=66), Cy+PEG G-CSF (n=91), Cy+ G-CSF (n=169), and G-CSF+PXF (n=24). Results: Mobilization with Cy+PEG G-CSF+/-PXF(8.79)yielded a notably higher median CD34+ cell count compared to the other regimens: Cy+PEG G-CSF(4.96), Cy+G-CSF (4.65), and G-CSF+PXF (2.99) (P<0.001). The percentage of patients who achieved >6×106/kg CD34+ cells was significantly higher in the Cy+PEG G-CSF+/-PXF group (77.3%) than in the other mobilization regimens: Cy+PEG G-CSF (41.8%), Cy+ G-CSF (37.3%), and G-CSF+PXF (8.3%) (P<0.001). From a cost perspective, the Cy+PEG G-CSF+/-PXF approach was more economical than the G-CSF+PXF strategy but was marginally costlier than the other two methods. A multivariate assessment highlighted that the combination of Cy+PEG G-CSF with on-demand PXF had a superior potential to achieve the desired harvest (6×106/kg) compared to the Cy+PEG G-CSF protocol without PXF. The incremental cost-effectiveness ratio for each 1% increase in the probability of achieving a successful optimal harvest was $ 97.02 per patient. The incidence of neutropenic fever was 3.0% in the Cy+PEG G-CSF+/-PXF group. Conclusion: The combination of on-demand PXF with HD-Cy and PEG G-CSF offers a cost-effective approach with a high mobilization success rate, manageable side effects, and the convenience of fewer injections. It stands as a promising mobilization strategy for MM patients.

Regional Economic Prediction Model Using Backpropagation Integrated with Bayesian Vector Neural Network in Big Data Analytics.

Forecasting economic growth is critical for formulating national economic development policies. Neural Networks are a type of artificial intelligence that may be used to model complex target functions. ANN (Artificial Neural Networks) are one of the most effective learning approaches now available for specific sorts of tasks, such as learning to understand complex real-world sensor data. This paper proposes the regional economic prediction model based on neural networks techniques. Bayesian vector neural network (BVNN) is integrated with backpropagation (BP) model. The database has been collected based on the economics of particular region which has been extracted and classified using knowledge-based computer analysis by neural networks. Discretization, reduction, importance ranking, and prediction rule are attributes considered here. Then, as the input training sample, feed extracted important components into the NN. This strategy enhanced the training speed and prediction accuracy by reducing structure of NN. WEO, APDREO, and AFRREO are the dataset and FWA-SVR and LSTM are the existing method taken for comparison. For the WEO dataset, 97% of GDP and 98% of accuracy are produced. For APDREO dataset, 92% of accuracy and GDP of 97% are obtained. For AFRREO dataset, 98% of accuracy is produced. The neural network can tackle nonlinear problems, according to experimental data, and the technology has been proven to be successful and viable with high accuracy. For practical application, the model has a good reference value. The proposed model reduces error by increasing the convergence rate and accuracy for each dataset.

[Territorially ecological restoration zoning and optimization strategy in Guyuan City of Ningxia, China: Based on the balance of ecosystem service supply and demand]. / 基于生态系统服务供需平衡的宁夏固原生态修复分区与优化策略.

Scientifically identifying the territorially ecological restoration zoning is a vital prerequisite for implementing ecological restoration projects and enhancing environmental quality. Based on remote sensing data, we syste-matically assessed supply and demand for ecosystem service and their relationship in Guyuan City, China by using the InVEST model, coordination degree model, and spatial autocorrelation analysis. We carried out territorially ecological restoration zoning by coupling the ecosystem service supply and demand. Furthermore, the corresponding optimization strategies were put forward according to the regional characteristics of natural resources and socio-economic development. The results showed that the areas with high water yield, carbon storage, soil conservation and habitat quality were mainly located in the southern part of Guyuan City. The areas with high population density, economic development level and high ecological demand were mainly located in the central urban area and the location towns of the county government. The spatial mismatch of supply and demand for ecosystem services in Guyuan City was dominant, as indicated by the fact that the areas with high ecological supply having low ecological demand and low ecological supply having high ecological demand. The average coordination index was 0.5, indicating that the relationship between ecological supply and ecological demand was basically coordinated. Based on the diffe-rences between supply and demand of ecosystem services and regional natural geographical pattern, the administrative township units in Guyuan could be classified into six ecological restoration zonings: key ecological restoration area, potential ecological restoration area, ecological economic reconstruction area, characteristic agricultural development area, ecological core protection area, and ecological industry construction area. Different management strategies were proposed to provide scientific support for ecological restoration.

Effects of calcium dobesilate (CaD) interference on serum creatinine measurements: a national External Quality Assessment (EQA)-based educational survey of drug-laboratory test interactions.

Objectives: Drug-laboratory test interactions (DLTIs) are one of the major sources of laboratory errors. Calcium dobesilate (CaD) interference on serum creatinine testing is a widespread problem that has long been ignored in China. A national EQA-based survey was launched to investigate the current status of CaD interference on creatinine routine methods used in China and enhance the education of CaD interference in clinical laboratories. Methods: A descriptive survey was developed to characterize the status quo of Chinese laboratory professionals' cognition to CaD interference. Four of survey samples which were spiked with/without interference additive were shipped to 175 participant laboratories. The target reference values from a reference measurement procedure were compared against the results from participating laboratories to evaluate the CaD interference on serum creatinine measurements using enzymatic method or Jaffé method. Results: The lack of knowledge of DLTIs and the barriers to collect information from pharmacological and laboratory data systems had become the main problems on implementing DLTIs education in China. A significant negative influence of CaD on enzymatic method was observed regardless of measurement platforms. Jaffé method was generally free from interaction with CaD but showed poor precision and accuracy at low creatinine concentrations. Conclusions: More efforts should be made to enhance the education of DLTIs in clinical laboratories in China.

Assessment of biomass demineralization on gasification: From experimental investigation, mechanism to potential application.

Considering the advantages (e.g. agglomeration mitigation) and disadvantages (e.g. inorganic species catalysis removal) of biomass demineralization, it is valuable to investigate its effects on gasification performance, thus assessing its necessity prior to performing gasification. To accomplish this, corn straw (CS) was demineralized to different degrees with H2O and HCl, respectively. H2O and HCl demineralization behaved different abilities to inorganic species removal. Cellulose and hemicelluloses content decreased, while lignin content increased, especially with HCl demineralization. The experiments were investigated by using a bench-scale downdraft fixed-bed gasifier at 600-800 °C and were further analyzed via thermogravimetric coupled with Fourier transform infrared spectrometry. Demineralization demonstrated a positive effect on gasification at lower temperatures (600-700 °C) for a dominant effect of lignin content and an insignificant effect of inorganic species removal. However, the catalysis of inorganic species increased as the temperature increased, resulting in the highest H2 (11.30 vol%) and CO (16.02 vol%) production of raw CS compared to demineralized CS at 800 °C. Inorganic species had a dual positive effect on CO generation, promoting both CO2 and char generation leading to a higher CO yield following Boundouard reaction, and increasing the formation of active intermediates thus producing more CO. These effects enhanced when the gasification temperature increased. Additionally, inorganic species catalyzed the aromatic rings rearrangement to generate more H2O, thus driving the endothermic Primary water-gas to produce H2. This was also positively correlated with gasification temperature. Therefore, raw CS demonstrated higher H2 and CO production than demineralized CS at a higher gasification temperature. Moreover, the promotion effect of inorganic species on thermal devolatilization of methoxyl groups and Methanation reaction led to the higher CH4 production of raw CS. This research clarifies the effects of biomass demineralization on its gasification and suggests the potential application.

The assessment of xenogeneic bone immunotoxicity and risk management study.

BACKGROUND: Xenogeneic bone has been widely used in a variety of clinical bone-related disease to promote bone healing and restore bone defects. However, the adverse effects of immune system limit its application in the clinic. The aim of this study was to evaluate xenogeneic bone safety of immunotoxicity and explore the methods for immune risk supervision. RESULTS: Xenogeneic bone, which is freeze-dried bovine cancellous bone, was implanted into the muscle of mice. On day 7, 14 and 28, the effects of xenogeneic bone were examined on humoral immunity and cellular immunity, including the levels of IgG, IgM, C3, inflammatory factors (TNF-α, IL-6), alkaline phosphatase (ALP) and the lymphocyte phenotype. The data showed that xenogeneic bone implantation had no potential to induce immune responses not only in humoral immunity but also in cellular immunity. To reveal the risk of immunogenicity, the residual DNA and the clearance of α-gal epitope were analyzed in 2 different bones (bone 1 is deproteinized bone, bone 2 is acellular and defatted bone). It was suggested that DNA of xenogeneic bone can be limited to < 50 ng per mg dry weight for the repair or regeneration with the acceptable immune risk. And α-gal clearance of xenogeneic bone could be an effective risk factor for improving xenograft quality management. CONCLUSIONS: Through the detection of xenogeneic bone immunotoxicity, our findings indicated that the supervisions of risk factors could contribute to reduce the immune risk. And the risk factors under the acceptable limitation could decrease or replace animal experiment. However, it still needs to be studied on the limitation of α-gal epitope to predict rejection of xenogeneic bone more accurately.

Classifying Chinese Questions Related to Health Care Posted by Consumers Via the Internet.

BACKGROUND: In question answering (QA) system development, question classification is crucial for identifying information needs and improving the accuracy of returned answers. Although the questions are domain-specific, they are asked by non-professionals, making the question classification task more challenging. OBJECTIVE: This study aimed to classify health care-related questions posted by the general public (Chinese speakers) on the Internet. METHODS: A topic-based classification schema for health-related questions was built by manually annotating randomly selected questions. The Kappa statistic was used to measure the interrater reliability of multiple annotation results. Using the above corpus, we developed a machine-learning method to automatically classify these questions into one of the following six classes: Condition Management, Healthy Lifestyle, Diagnosis, Health Provider Choice, Treatment, and Epidemiology. RESULTS: The consumer health question schema was developed with a four-hierarchical-level of specificity, comprising 48 quaternary categories and 35 annotation rules. The 2000 sample questions were coded with 2000 major codes and 607 minor codes. Using natural language processing techniques, we expressed the Chinese questions as a set of lexical, grammatical, and semantic features. Furthermore, the effective features were selected to improve the question classification performance. From the 6-category classification results, we achieved an average precision of 91.41%, recall of 89.62%, and F1 score of 90.24%. CONCLUSIONS: In this study, we developed an automatic method to classify questions related to Chinese health care posted by the general public. It enables Artificial Intelligence (AI) agents to understand Internet users' information needs on health care.

[Depressive Symptoms in the Mid- and Old-aged People in China].

OBJECTIVES: To determine the prevalence and determinants of depressive symptoms in the mid- and old-aged people in China. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study (CHARLS),which containthe Center Epidemiologic Studies-Depression scale(CES-D). Binary logistic regression models were developed to identify factors associated with the prevalence of depression symptoms. These included socio-economic status of the respondents (gender, age, education),health-related factors (chronic diseases, disability, accident injury, and fall in recent two years),and family events over the past two years (deaths of a parent, spouse or child). RESULTS: About 31.9% of respondents had depressive symptoms, with a mean CES-D score of 8.0±4.9.Women and those who were younger than 75 years, widowed, resided in a rural area, had low levels of education, and suffered from multiple chronic conditions were more likely to have depressive symptoms than the others. CONCLUSIONS: High prevalence of depressive symptoms in the mid- and old-aged population in China is evident, which is associated with the health and socio-economic status of the population.

Recovery and removal of nutrients from swine wastewater by using a novel integrated reactor for struvite decomposition and recycling.

In the present study, struvite decomposition was performed by air stripping for ammonia release and a novel integrated reactor was designed for the simultaneous removal and recovery of total ammonia-nitrogen (TAN) and total orthophosphate (PT) from swine wastewater by internal struvite recycling. Decomposition of struvite by air stripping was found to be feasible. Without supplementation with additional magnesium and phosphate sources, the removal ratio of TAN from synthetic wastewater was maintained at >80% by recycling of the struvite decomposition product formed under optimal conditions, six times. Continuous operation of the integrated reactor indicated that approximately 91% TAN and 97% PT in the swine wastewater could be removed and recovered by the proposed recycling process with the supplementation of bittern. Economic evaluation of the proposed system showed that struvite precipitation cost can be saved by approximately 54% by adopting the proposed recycling process in comparison with no recycling method.

[Distribution and ecological risk assessment of polycyclic aromatic hydrocarbons in overlying waters and surface sediments from the Yangtze estuarine and coastal areas].

Polluted levels, temporal and spatial distributions of polycyclic aromatic hydrocarbons (PAHs) were studied in overlying water and surface sediments from nine typical sampling sites in the Yangtze estuarine and coastal areas. The results showed that PAHs concentrations in overlying waters and surface sediments in dry season (1988 ng/L and 1154 ng/g) were both higher than those in flood season (1727 ng/L and 605 ng/g). And phenanthrene (Phe) was dominant among PAH compounds. Temperature was the most important factor that controlled PAHs seasonal variation in overlying waters, while organic carbon and soot carbon influenced PAHs accumulation in surface sediments. Complicated hydrodynamic conditions and pollutant inputs caused by various anthropogenic activities not only affected on PAHs spatial distribution, but also led to complicated sources in the Yangtze estuarine and coastal areas. Ecological risk assessment indicated that PAHs in water-sediment system from the Yangtze estuarine and coastal areas might potentially damage the Yangtze estuary ecosystem to some extent. Some of PAH compounds in overlying waters had exceeded the ecotoxicological assessment standard or EPA National Recommended Water Quality Criteria, and BaP also exceeded the normal concentration of Chinese Environmental Quality Standards for surface water. Some of PAH compounds in surface sediments had exceeded the effects range low (ER-L) levels and ISQV-L values.

[Self-assessment characteristics of voice handicap index for voice disorders and its influencing factors].

OBJECTIVE: To investigate the self-assessment characteristics of Voice Handicap Index (VHI) for voice disorders and its influencing factors. METHODS: One thousand seven hundred and sixty six dysphonic patients and 120 control subjects were included in this study. Two hundred twenty seven patients were treated with phonosurgery or Botulinumtoxin injection. VHI was used for self-assessment. RESULTS: Dysphonic patients had worse VHI scores than control (z from 8.039 to 17.043, P = 0.000). There was a significant difference among the VHI scores of different diseases. VHI scores were descending in order among spasmodic dysphonia, vocal fold paralysis, functional dysphonia, sulcus vocalis, benign and malignant tumor of vocal fold, vocal fold cyst, Reinke's edema, vocal fold polyp, vocal fold keratosis and chronic laryngitis, vocal nodule. The emotional scores were the highest in spasmodic dysphonia, and followed by functional dysphonia. In another group, the physical scores were higher than functional scores and emotional scores. Treatment resulted in statistical improvement in VHI scores (P < 0.05). The total scores were different significantly between different educational background and age groups (F from 8.701 to 27.371, P = 0.000). The higher the educational degree, the higher the VHI scores. As to age groups, the juvenile group's scores were the lowest, while the youth's group the highest, then the scores declined when ages increased. CONCLUSION: As a useful supplementary instrument to measure the voice disorder severity and the treatment's effect, VHI can comprehensively assess the voice handicap's affect to the life quality and the difference after the treatment, especially in physical, functional and emotional aspects, but it is somehow subject to the educational degree and age.