Assessment of Helicobacter pylori infection by deep learning based on endoscopic videos in real time.

BACKGROUND AND AIMS: Endoscopic assessment of Helicobacter pylori infection is a simple and effective method. Here, we aimed to develop a deep learning-based system named Intelligent Detection Endoscopic Assistant-Helicobacter pylori (IDEA-HP) to assess H. pylori infection by using endoscopic videos in real time. METHODS: Endoscopic data were retrospectively obtained from Zhejiang Cancer Hospital (ZJCH) for the development, validation, and testing of the system. Stored videos from ZJCH were used for assessing and comparing the performance of IDEA-HP with that of endoscopists. Prospective consecutive patients undergoing esophagogastroduodenoscopy were enrolled to assess the applicability of clinical practice. The urea breath test was used as the gold standard for diagnosing H. pylori infection. RESULTS: In 100 videos, IDEA-HP achieved a similar overall accuracy of assessing H. pylori infection to that of experts (84.0% vs. 83.6% [P = 0.729]). Nevertheless, the diagnostic accuracy (84.0% vs. 74.0% [P<0.001]) and sensitivity (82.0% vs. 67.2% [P<0.001]) of IDEA-HP were significantly higher than those of the beginners. In 191 prospective consecutive patients, IDEA-HP achieved accuracy, sensitivity, and specificity of 85.3% (95% CI: 79.0%-89.3%), 83.3% (95% CI: 72.8%-90.5%), and 85.8% (95% CI: 77.7%-91.4%), respectively. CONCLUSIONS: Our results show that IDEA-HP has great potential for assisting endoscopists in assessing H. pylori infection status during actual clinical work.

Lifestyle and Social Factors Exacerbated on the Prevalence of Mood Disorders and Functional Dyspepsia Among Neonatal Nurses in China.

Background: Nursing is a high-stress occupation that can have an impact on mental health, particularly for neonatal nurses. Job-related stress factors and work-related behaviors have played a critical role in nurses' mental health. This study aimed to explore the prevalence of mood disorders and the impact of social factors, lifestyle on mood disorders among neonatal nurses. Methods: A total of 260 participants comprising neonatal nurses and nurses who work in neonatal intensive care units (NICU) were recruited. Data were collected using a validated generalized anxiety disorder questionnaire, patient health questionnaire-9, Pittsburgh sleep quality index, and social factors and lifestyle assessments. Results: In total, 49.23% of neonatal nurses exhibited mood disorders, particularly a combination of depression and anxiety. Female, poor interpersonal relationships and unhappy marital status, preference for smoking, alcohol, irregular diet, and poor sleep were common in neonatology nurses who exhibited mood disorders; preference for coffee and tea were lower in neonatology nurses without mood disorders (all P < 0.05). Interpersonal relationships, marital status, irregular diet, and poor sleep were independent factors associated with mood disorders among neonatal nurses (all P < 0.05). Mood disorders presented as functional dyspepsia (FD) among 50.78% of the participants (P < 0.05). Poor sleep and preference for smoking were common among neonatal nurses who had FD with mood disorders (all P < 0.05). Furthermore, the preference for sugary beverages was lower in participants with FD and mood disorders (P < 0.05). Poor sleep was independently associated with FD with mood disorders in neonatology nurses (P < 0.05). Conclusion: Prevalence of anxiety and depression was higher among neonatal nurses. Furthermore, most cases of mood disorders presented as FD. Thus, social factors and lifestyle have an impact on mood disorders which can manifest through somatic symptoms.

Study on the Co-Benefits of Air Pollution Control and Carbon Reduction in the Yellow River Basin: An Assessment Based on a Spatial Econometric Model.

To assess the green and low-carbon development of the Yellow River Basin (YRB) in China, this study utilizes an evaluation index system based on the framework of driving force, pressure, state, impacts, response, and management, and it measured the comprehensive scores of the co-benefits of carbon reduction and air pollution control in the YRB. The global Moran index was used to analyze the spatial correlation characteristics of co-benefits, and a generalized spatial measurement model was constructed to demonstrate their spatial spillover effects. The results show that the co-benefits steadily increased every year. The co-benefits had a significant positive spatial correlation and showed a development trend of "up-down-up". According to the spillover effect test, the economic development level, education level, and intensity of environmental regulations had significant positive effects, while the level of urbanization and foreign investment had significant negative effects. Considering these results and the aim of promoting green and low-carbon development, clear detection of the spatial spillover characteristics of the co-benefits should be prioritized, followed by an understanding of the spatial transmission mechanism of carbon and air pollutant emission and transfer. Policy recommendations are also proposed including upgrading industrial structure, focusing on the development of modern services and high-tech industry, and strictly implementing the industrial environment access system.

Probabilistic assessment of vegetation vulnerability to drought stress in Central Asia.

The increasing frequency and intensity of droughts in a warming climate are likely to exacerbate adverse impacts on ecosystems, especially for water-limited regions such as Central Asia. A quantitative understanding of the impacts of drought on vegetation is required for drought preparedness and mitigation. Using the Global Inventory Modeling and Mapping Studies NDVI3g data and Standardized Precipitation Evapotranspiration Index (SPEI) from 1982 to 2015, we evaluate the vegetation vulnerability to drought in Central Asia based on a copula-based probabilistic framework and identify the critical regions and periods. Furthermore, a boosted regression trees (BRT) model was also used to explore the relative importance of environmental factors and plant traits on vegetation response to drought. Additionally, we also investigated to what extent irrigation could alleviate the impacts of drought. Results revealed that months from June to September was the critical period when vegetated areas were most vulnerable to drought stress. The probabilities of vegetation loss below 20th quantile under extremely dry in these months were 68.7%, 69.4%, 71.0%, and 67.0%, respectively. Regarding vegetation-vulnerable regions, they shifted with different growth stages. During the middle of the growing season, semi-arid areas were the most vulnerable regions, whereas the highest drought-vulnerable regions were observed in arid areas during other periods. The BRT results showed that plant traits accounted for a large fraction (58.9%) of vegetation response to drought, which was more important than ambient soil environment (20.8%). The analysis also showed that mitigations from irrigation during July to September were smaller than in other months. The results of this paper provide insight into the influences of drought on vegetation and may contribute to drought mitigation and land degradation measures in Central Asia under accelerating global warming.

Halogenated flame retardants in wild, prey-sized mud carp from an e-waste recycling site in South China, 2006-2016: Residue dynamics and ecological risk assessment.

The crude e-waste recycling has been regulated in China since the late 2000s; however, information on the recent levels and the ecological risks of e-waste derived contaminants such as halogenated flame retardants (HFRs) in the e-waste sites are limited. We therefore examined the concentrations of several HFRs in wild, prey-sized mud carps collected from a typical e-waste site in 2006, 2011 and 2016, to understand the exposure dynamics and ecological risk of these chemicals. Several ecological and biological parameters including δ15N, δ13C, body size and lipid content of the fish were also examined, to ensure an overall uniformity of the sample set among the sampling years. Among the HFRs measured, polybrominated diphenyl ethers (PBDEs) were detected at the highest concentrations (contributing >90% to ∑HFRs), followed by Dechlorane Plus (DPs), polybrominated biphenyls (PBBs), and alternative brominated flame retardants (ABFRs). The fish concentrations of ∑PBDEs, ∑PBBs and ∑DPs significantly dropped by 65%, 57% and 53% from 2006 to 2011, and 12%, 74% and 51% from 2011 to 2016, respectively; likely reflecting the positive impact of the environmental regulations on crude e-waste recycling. The ∑ABFRs concentrations were also decreased by 80% from 2006 to 2011, but increased by 127% from 2011 to 2016; suggesting possible fresh input of these novel HFRs in recent years. In addition to the changes in the HFR concentrations, contaminant profiles in the fish were also changed, possibly due to environmental degradation of the HFRs. Despite our conservative method of risk assessment, we found that PBDEs posed an important risk both for the mud carp and for piscivorous wildlife that inhabit the e-waste site.

Structured oral examination as an effective assessment tool in lab-based physiology learning sessions.

Traditional oral examination (TOE) is criticized for the shortage of objectivity, standardization, and reliability. These perceived limitations can be mitigated by the introduction of structured oral examination (SOE). There is little evidence of the implementation of SOE in physiology laboratory courses. The purpose of this study was to investigate the effect of SOE in laboratory-based learning sessions. Second-year medical students (n = 114) attended a 16-wk physiology laboratory course. They were initially assessed by TOE in the middle of the academic term. The students' perspectives on this assessment were measured by a modified three-point Likert-type scale questionnaire. Following this, faculty members prepared topics for SOE; nine topics were included from each laboratory course. The correct answers and scoring criteria were discussed among the faculty before the SOE event. One week after the last laboratory course, SOE was carried out for each student. As with the TOE process, student feedback was collected via a modified three-point Likert-type scale questionnaire. The mean laboratory homework score from the first four and last four laboratory courses was also calculated. Paper exams were also conducted after TOE and SOE. The results show that SOE is more acceptable to students than TOE. Significant differences (P < 0.05) were observed in terms of uniformity of questions asked, syllabus coverage, and anxiety levels. In addition, SOE improved students' performance in the laboratory course explored here. We contend that SOE shows promise as an effective assessment tool in laboratory-based physiology learning sessions.

Does financial development and foreign direct investment improve environmental quality? Evidence from belt and road countries.

This study examines the effect of financial development (FD) and foreign direct investment (FDI) on the environmental quality for the panel of 90 belt and road countries from 1990 to 2017. This study advances the knowledge of financial development by using the new comprehensive index, which is based on access, depth, and efficiency of financial markets and financial institutions and incorporated foreign direct investment as an important determinant of environmental quality. By applying the Driscoll-Kraay standard error pooled ordinary least square method, the empirical findings reveal that FD deteriorates the environmental quality by increasing the CO2 emissions, while FDI improves environmental quality and the relationship between economic growth (EG) and CO2 emissions is inverted U-shaped, i.e., presence of EKC hypothesis. The energy consumption and urbanization pollute the environment, while trade openness enhances the quality of the environment. Furthermore, the Dumitrescu-Hurlin (DH) panel causality test result confirms that the bidirectional causality exists among FD, trade openness, energy consumption, and urbanization with CO2 emissions. The empirical results provide new insights for policymakers and also have several implications for the betterment of environmental quality.

Cost-effective approaches for reducing carbon and air pollution emissions in the power industry in China.

The power industry of China plays an important role in reducing the carbon dioxide (CO2) and air pollutant emissions. This paper focuses on synergistic CO2 and air pollution emission reduction by implementing technical and structural measures, and explores the processes aimed at achieving the co-benefits of carbon reduction and air pollution control effectively in the power industry at a local level. The results of the analysis show that the structural measures achieve overall co-benefits, and the technical measures have a good effect in reducing the air pollution, but simultaneously increase CO2 emissions because of the additional electricity used for running air pollution control devices (APCDs). Based on the analysis of the power generation incremental cost and pollutant emission reduction cost, cost-effective approaches to attain different emission reduction targets are proposed to the power industry in four case regions. These approaches can provide policy makers and stakeholders useful and relevant policy and operation recommendations to reduce CO2 and air pollution emissions cost-effectively and promote low carbon sustainability in the power industry of China.

Magnetic fields are causing small, but significant changes of the radiochromic EBT3 film response to 6 MV photons.

The optical density (OD) of EBT3 radiochromic films (Ashland Specialty Ingredients, Bridgewater, NJ, USA) exposed to absorbed doses to water up to D = 20 Gy in magnetic fields of B = 0.35 and 1.42 T was measured in the three colour channels of an Epson Expression 10000XL flatbed scanner. A 7 cm wide water phantom with fixed film holder was placed between the pole shoes of a constant-current electromagnet with variable field strength and was irradiated by a 6 MV photon beam whose axis was directed at right angles with the field lines. The doses at the film position at water depth 5 cm were measured with a calibrated ionization chamber when the magnet was switched off and were converted to the doses in presence of the magnetic field via the monitor units and by a Monte Carlo-calculated correction accounting for the slight change of the depth dose curves in magnetic fields. In the presence of the 0.35 and 1.42 T fields small negative changes of the OD values at given absorbed doses to water occurred and just significantly exceeded the uncertainty margin given by the stochastic and the uncorrected systematic deviations. This change can be described by a +2.1% change of the dose values needed to produce a given optical density in the presence of a 1.42 T field. The thereby modified OD versus D function remained unchanged irrespective of whether the original short film side-the preference direction of the monomer crystals of the film-was directed parallel or orthogonal to the magnetic field. The 'orientation effect', the difference between the optical densities measured in the 'portrait' or 'landscape' film positions on the scanner bed caused by the reflection of polarised light in the scanner's mirror system, remained unaltered after EBT3 film exposure in magnetic fields. An independent optical bench investigation of EBT3 films exposed to doses of 10 and 20 Gy at 0.35 and 1.42 T showed that the direction of the electric vector of polarised light experiencing the largest transmission through EBT3 films remained unaltered after film exposure in the magnetic fields. The observed small modification of the OD versus D curve of the radiochromic film EBT3 in the range up to 20 Gy and 1.42 T, hardly exceeding the experimental uncertainty margin, numerically confirms other recent studies on EBT3 film. A stronger magnetic field effect had been observed with the previous product EBT2 exposed to 60Co gamma radiation at 0.35 T.

The 'cutting away' of potential secondary electron tracks explains the effects of beam size and detector wall density in small-field photon dosimetry.

The well-known field-size dependent overresponse in small-field photon-beam dosimetry of solid-state detectors equipped with very thin sensitive volumes, such as the PTW microDiamond, cannot be caused by the photon and electron interactions within these sensitive layers because they are only a few micrometers thick. The alternative explanation is that their overresponse is caused by the combination of two effects, the modification of the secondary electron fluence profile (i) by a field size too small to warrant lateral secondary electron equilibrium and (ii) by the density-dependent electron ranges in the structural detector materials placed in front of or backing the sensitive layer. The present study aims at the numerical demonstration and visualization of this combined mechanism. The lateral fluence profiles of the secondary electrons hitting a 1 µm thick scoring layer were Monte-Carlo simulated by modelling their generation and transport in the upstream or downstream adjacent layers of thickness 0.6 mm and densities from 0.0012 to 3 g cm-3, whose atomic composition was constantly kept water-like. The scoring layer/adjacent layer sandwich was placed in an infinite water phantom irradiated by circular 60Co, 6 MV and 15 MV photon beams with diameters from 3 to 40 mm. The interpretation starts from the ideal case of lateral secondary electron equilibrium, where the Fano theorem excludes any density effect. If the field size is then reduced, electron tracks potentially originating from source points outside the field border will then be numerically 'cut away'. This geometrical effect reduces the secondary electron fluence at the field center, but the magnitude of this reduction also varies with the density-dependent electron ranges in the adjacent layers. This combined mechanism, which strongly depends on the photon spectrum, explains the field size and material density effect on the response of detectors with very thin sensitive layers used in small-field photon-beam dosimetry.

Assessment of effect of CYP3A inhibition, CYP induction, OATP1B inhibition, and high-fat meal on pharmacokinetics of the JAK1 inhibitor upadacitinib.

AIMS: Upadacitinib (ABT-494) is a selective Janus kinase 1 inhibitor being developed for treatment of auto-immune inflammatory disorders. This work evaluated effects of high-fat meal, cytochrome P450 (CYP) 3A inhibition, CYP induction, and organic anion transporting polypeptide (OATP) 1B inhibition on upadacitinib pharmacokinetics. METHODS: Two Phase 1 evaluations were conducted, each in 12 healthy subjects. In Study 1, using a randomized, two-sequence crossover design, a 3 mg dose of upadacitinib (immediate-release capsules) was administered alone under fasting conditions, after high-fat meal, or on Day 4 of a 6-day regimen of 400 mg once-daily ketoconazole. In Study 2, a 12 mg upadacitinib dose was administered alone, with the first, and with the eighth dose of a 9-day regimen of rifampin 600 mg once daily. Upadacitinib plasma concentrations were characterized. RESULTS: Administration of upadacitinib immediate-release capsules after a high-fat meal decreased upadacitinib Cmax by 23% and had no impact on upadacitinib AUC relative to the fasting conditions. Ketoconazole (strong CYP3A inhibitor) increased upadacitinib Cmax and AUC by 70% and 75%, respectively. Multiple doses of rifampin (broad CYP inducer) decreased upadacitinib Cmax and AUC by approximately 50% and 60%, respectively. A single dose of rifampin (also an OATP1B inhibitor) had no effect on upadacitinib AUC. Upadacitinib was well tolerated when co-administered with ketoconazole, rifampin, or after a high-fat meal. CONCLUSIONS: Strong CYP3A inhibition and broad CYP induction result in a weak and moderate effect, respectively, on upadacitinib exposures. OATP1B inhibition and administration of upadacitinib immediate-release formulation with food does not impact upadacitinib exposure.

In vitro Dosimetric Study of Biliary Stent Loaded with Radioactive 125I Seeds.

BACKGROUND: A novel radioactive 125I seed-loaded biliary stent has been used for patients with malignant biliary obstruction. However, the dosimetric characteristics of the stents remain unclear. Therefore, we aimed to describe the dosimetry of the stents of different lengths - with different number as well as activities of 125I seeds. METHODS: The radiation dosimetry of three representative radioactive stent models was evaluated using a treatment planning system (TPS), thermoluminescent dosimeter (TLD) measurements, and Monte Carlo (MC) simulations. In the process of TPS calculation and TLD measurement, two different water-equivalent phantoms were designed to obtain cumulative radial dose distribution. Calibration procedures using TLD in the designed phantom were also conducted. MC simulations were performed using the Monte Carlo N-Particle eXtended version 2.5 general purpose code to calculate the radioactive stent's three-dimensional dose rate distribution in liquid water. Analysis of covariance was used to examine the factors influencing radial dose distribution of the radioactive stent. RESULTS: The maximum reduction in cumulative radial dose was 26% when the seed activity changed from 0.5 mCi to 0.4 mCi for the same length of radioactive stents. The TLD's dose response in the range of 0-10 mGy irradiation by 137Cs γ-ray was linear: y = 182225x - 6651.9 (R2=0.99152; y is the irradiation dose in mGy, x is the TLDs' reading in nC). When TLDs were irradiated by different energy radiation sources to a dose of 1 mGy, reading of TLDs was different. Doses at a distance of 0.1 cm from the three stents' surface simulated by MC were 79, 93, and 97 Gy. CONCLUSIONS: TPS calculation, TLD measurement, and MC simulation were performed and were found to be in good agreement. Although the whole experiment was conducted in water-equivalent phantom, data in our evaluation may provide a theoretical basis for dosimetry for the clinical application.

A Cross-sectional Study on the Symptom Burden of Patients With Spinal Tumor: Validation of the Chinese Version of the M.D. Anderson Symptom Inventory-Spine Tumor Module.

CONTEXT: Tumors involving the spine are associated with unique symptoms affecting both patient survival and health-related quality of life. Currently, there is no disease-specific instrument in Chinese to assess the symptom burden of these patients. OBJECTIVES: The objective of this study was to translate and validate a Chinese version of the M.D. Anderson Symptom Inventory-Spine Tumor Module (MDASI-SP-C) to assess the symptom burden of Chinese-speaking patients with spinal tumors. METHODS: MDASI-SP-C was forward-and-backward translated according to standard protocols and administered to patients fulfilling study criteria at a major referral center of spine tumor between November 2014 and September 2015. The generic instruments of Short Form 36 Quality of Life Questionnaire (SF-36), Functional Assessment of Cancer Therapy-General Version (FACT-G), and Karnofsky Performance Scale were used along with MDASI-SP-C. Prevalence and severity distribution of each item were analyzed. Psychometric assessment and hierarchical cluster analysis were performed for the translated instrument. RESULTS: One hundred forty-two patients were enrolled. High interdependency and relatively low intra-cluster distances were identified. Cronbach's alpha of the entire instrument, the symptom severity subscale, and the interference subscale was 0.93, 0.91, and 0.92, respectively. Principal axis factoring resulted in a four-factor solution, which was reduced to a three-factor (general symptoms, spine-specific symptoms, and gastrointestinal symptoms) solution on account of clinical interpretation. Correlation coefficients between MDASI-SP-C items and their corresponding domains in SF-36 and/or FACT-G were all greater than 0.3. MDASI-SP-C was able to distinguish patients with different Karnofsky Performance Scale levels. CONCLUSION: MDASI-SP-C demonstrated satisfactory psychometric properties and could be used to better assess the symptom burden of Chinese-speaking patients with spine tumors for improved management of their medical needs.

Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China: a retrospective pre/post-reform case study.

Aiming to control rising medical expenditures and help improve China's healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals' C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004-2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme's implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme's effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healthcare providers' behaviors in a more cost-effective direction.

A cost-effective 3D hydrogen evolution cathode with high catalytic activity: FeP nanowire array as the active phase.

Iron is the cheapest and one of the most abundant transition metals. Natural [FeFe]-hydrogenases exhibit remarkably high activity in hydrogen evolution, but they suffer from high oxygen sensitivity and difficulty in scale-up. Herein, an FeP nanowire array was developed on Ti plate (FeP NA/Ti) from its ß-FeOOH NA/Ti precursor through a low-temperature phosphidation reaction. When applied as self-supported 3D hydrogen evolution cathode, the FeP NA/Ti electrode shows exceptionally high catalytic activity and good durability, and it only requires overpotentials of 55 and 127 mV to afford current densities of 10 and 100 mA cm(2) , respectively. The excellent electrocatalytic performance is promising for applications as non-noble-metal HER catalyst with a high performance-price ratio in electrochemical water splitting for large-scale hydrogen fuel production.

[Comprehensive evaluation of AIDS spending in Dehong prefecture of Yunnan province in 2010].

OBJECTIVE: To comprehensive evaluate the rationality of Acquired Immune Deficiency Syndrome (AIDS) expenditure through the analysis of AIDS expenditure circumstances based on the application of National AIDS Spending Assessment in Dehong prefecture in 2010. METHODS: Demographic and economic indicators of Mang City, Yingjiang, Longchuan, Ruili City, Lianghe and Wanting zone in Dehong prefecture of Yunnan province were collected from the reports issued by Dehong Statistical Bureau of 2010, and HIV/AIDS epidemic indicators were collected from the annual report of national AIDS prevention and control data.NASA method was used to analyze the actual spending and demand index was used to calculate the demand of AIDS funding in these counties (cities). The correlations between HIV/AIDS expenditures and demographic, economic and HIV/AIDS epidemic index were analyzed, respectively, as well as the correlation between the expenditures of AIDS prevention and control and proportion of major transmission approaches. RESULTS: In 2010, the actual expenditures on HIV/AIDS in the 5 counties (cities) of Dehong prefecture was ¥28 752 772, the population was 1 211 400, and Gross Domestic Product (GDP) was ¥11 693. The intervention expenditures in injection drug users, sexually transmitted people, and prevention of mother to child transmission in Ruili county were ¥130 345, ¥71 484 and ¥164 100, the proportions of HIV transmission in these groups were 23.9% (49/205), 73.7% (151/205), and 0.5% (1/205), respectively; and in Lianghe county was ¥141 665, ¥257 142, and ¥99 961, and the proportions of HIV transmission were 17.1% (6/35), 80.0% (28/35) and 0.0% (0/35), respectively. The intervention expenditures in Ruili and Lianghe counties were positive related to the proportion of corresponding people with HIV infection (both r values were 0.99, all P values < 0.05). In the other 4 counties (cities) and the development zone, no correlations. The expenditures of government departments, international projects, domestic research programs and personal and family pays (r value were 0.94, 0.83, 0.99 and 0.88, respectively, all P values < 0.05) were positive related to the number.Except the personal and family pays, other sources of expenditures were all positive related to the number of reported HIV/AIDS cases (r values were 0.94, 0.89 and 0.81, respectively, all P values < 0.05). CONCLUSION: Population and HIV/AIDS epidemic index were considered as factors in AIDS spending. The expenditures corresponded with the demand of different areas basically.

[Health economic evaluation for the extension clinics of methadone maintenance treatment].

OBJECTIVE: To discuss the cost, cost-effectiveness, and cost-utility of the extension methadone maintenance treatment (MMT) clinics and provide the evidences of the strategy of scaling up the extension MMT clinics. METHODS: A study was conducted in Dehong prefecture, Yunnan province, including Mang, Ruili city, Longchuan, Yingjiang, Lianghe county. 117 newly enrolling heroin addict patients in 17 extension MMT clinics were recruited as subjects from December 2010 to February 2011. An interview was conducted by the trained interviewers for the quality of life score of patients, and the cost of drug use was calculated. Table of outpatient costs of methadone maintenance treatment clinic of Dehong prefecture in Yunnan was used for collecting and calculating the fixed cost, operating cost of the clinics, and the unit cost and incremental cost of the patients from 2008 to 2010. Cost-effectiveness and cost-utility of the extension clinics were analyzed by using the Markov model. RESULTS: The total spending of extension clinics for 2008, 2009, and 2010 on average was ¥57 294, ¥80 752 and ¥74 739 respectively, or about ¥4379 annually per patient. The cost of averting one HIV infection was ¥316 509; the cost of averting one acquired immune deficiency syndrome (AIDS) patients was ¥508 676; and the cost of averting one death was ¥152 330. The cost of obtaining one life year (LY) was ¥3696 and the cost of obtaining one quality adjusted life year (QALY) was ¥9014. Comparing with drug users, the incremental cost utility ratio (ICUR) of the patients of the extension MMT clinics were -7074 yuan/QALY and -7162 yuan/LY. CONCLUSION: The extension MMT clinic service is lower in cost, and better in cost-effectiveness and cost-utility.

Halogenated flame retardants in home-produced eggs from an electronic waste recycling region in South China: levels, composition profiles, and human dietary exposure assessment.

Three regulated halogenated flame retardants (HFRs), i.e., polybrominated diphenyl ethers (PBDEs), polybrominated biphenyls (PBBs) and hexabromocyclododecanes (HBCDs), and several alternative HFRs (AHFRs) including Dechlorane Plus (DP), decabromodiphenyl ethane (DBDPE), and 1,2-bis(2,4,6-tribromophenoxy) ethane (BTBPE), were investigated in the home-produced eggs from three recycling sites and a reference site in an electronic waste (e-waste) recycling region, South China. Mean levels of HFRs in eggs from the recycling sites ranged 2640-14100, 700-1620, 44-350, and 720-3920 ng/g lipid weight for ∑PBDEs, ∑PBBs, ∑HBCDs, and ∑AHFRs, respectively, which were one to two orders of magnitude higher than those examined in the reference site. PBDEs were the predominant HFR in those eggs, with contributions >50% to the total HFRs; followed by PBBs and the AHFRs (contributing 14-22% in average). The α-HBCD was the predominant diastereoisomers of HBCDs, with preferential enrichment of the (-)-enantiomer in most of the eggs; but no significant stereoselective enrichment of the DP isomers was observed in these eggs. The average estimated daily intakes (EDIs) of PBDEs, PBBs, HBCDs, and the AHFRs via eggs from the recycling sites ranged 4200-20000, 1120-2440, 80-490, and 970-4530 ng/day, respectively, which were one to two orders of magnitude higher than those reported from other parts of the world. The potential adverse effects of these HFRs to human health in the e-waste sites should be further investigated. This is the first report on the isomer compositions of DP and the chiral signatures of HBCDs in hen eggs.

[The application of National AIDS spending assessment in a county of Dehong prefecture, Yunnan province, China].

OBJECTIVE: To calculate the actual expenditures in a county of Dehong prefecture, Yunnan province, China by using the method of National AIDS Spending Assessment (NASA) in 2010. METHODS: Data were collected through NASA data collection form based on adapted NASA classification in the county of Dehong prefecture from October to December, 2011, and complemented by semi-structured interview with 16 well trained programmatic and financial representatives in 8 spending units. Data were entered in Resource Tracking Software (RTS) V 2009.3.0, and SPSS 13.0 was used for data processing and analysis. RESULTS: The NASA estimations showed that the county spent a total of ¥16 235 954 on HIV/AIDS in 2010. Public funds constituted 96.3% of the total expenditure (¥15 630 937), followed by Global Fund which accounted for 3.0% (¥484 585) and private sources which accounted for 0.7% (¥120 432). Findings based on NASA categories showed that AIDS spendings were mainly on 4 areas, and expenditure on Care & Treatment was ¥12 401 382 (76.4% of total expenditure), followed by Prevention which accounted for 14.3% (¥2 325 707), Program Management & Administration which accounted for 7.8% (¥1 268 523) and human resources which accounted for 1.5% (¥240 342). The most beneficial population group was People Living with HIV (PLHIV), accounting for 84.7% of total expenditure. (¥13 753 428), followed by 4.8% for high risk population, including female sex workers and their partners (¥297 333), injection drug users and their partners (¥293 143), men having sex with men and their partners (¥185 136) and 1.5% (¥241 429) for the general population. CONCLUSION: The local funds for HIV/AIDS in this county was insufficient. The local government should increase corresponding funds based on central government funding. Care and treatment was the first spending priority in the county and the investment of prevention services needs to be increased. Prevention and treatment and care should be combined to ensure the effectiveness of comprehensive prevention and treatment of AIDS.

[Analysis of expenditure cost of intervention among men who have sex with men in certain city].

OBJECTIVES: To learn the use of fund investment and actual expenditure cost among men who have sex with man (MSM) intervention in the city, in order to provide related evidences for carrying out the intervention effectively MSM. METHODS: Financial records were used to collect the information about the fund source and allocation of the resource invested for the MSM intervention between 2006 and 2009. Key staff was interviewed to get related information. The activity-based costing method was adopted to analyze the actual expenditure of MSM intervention in different sites, and the allocation of the total cost to each activity, the intervention times in different sites and the unit cost in actual HIV testing person-times promoted by MSM intervention was then calculated. RESULTS: Interventions through internet and in bar and bathhouse were conducted in the certain city. Total funds for MSM intervention between 2006 and 2009 were 4.441 million, 56.7% (¥2.530 million) of which were from international cooperation programs, whose direct cost covered 50.5% (¥2.243 million) of the total cost. The actual expenditure in interventions through Internet was ¥750 656 (16.9%), including direct expenditure ¥317 088 and indirect expenditure ¥433 568. The actual expenditure in interventions in bar was ¥2 061 846 (46.4%), including direct expenditure ¥1 114 423 and indirect expenditure ¥947 423. The actual expenditure in interventions in bathhouse was ¥1 628 751 (36.7%), including direct expenditure ¥811 474 and indirect expenditure ¥817 277. The person-times of receiving MSM intervention and the unit cost for promoting HIV test through the above 3 access all decreased. The average cost for one person-time intervention through internet and in bar and bathhouse decreased from ¥68.7 (1011 person-times), ¥67.3 (3282 person-times), ¥67.9 (3140 person-times) in 2006 to ¥40.9 (25 523 person-times), ¥30.2 (28 121 person-times), ¥17.5 (28 381 person-times) in 2009 respectively, and the cost for promoting one person-time HIV test decreased from ¥1789.2 (58 person-times), ¥1175.6 (188 person-times), ¥574.2 (312 person-times)per person time to ¥676.9 (394 person-times), ¥556.5 (1637 person-times), ¥316.5 (2237 person-times) respectively. CONCLUSION: The unit cost of MSM intervention through internet and in bar and bathhouse decreased, as well as the cost for HIV test promotion per person-time in the city. Meanwhile, the intervention covered more and more people annually.