A Double-Edged-Sword Effect of Overplacement: Social Comparison Bias Predicts Gambling Motivations and Behaviors in Chinese Casino Gamblers.

Overconfidence, a widely observed cognitive bias, has been linked to increased gambling motivations and behaviors. However, previous studies have largely overlooked overconfidence under a social comparison context, known as overplacement, i.e., the tendency of individuals to believe that they are better than their similar peers. In the present study, we tested the effect of overplacement on gambling motivations and behaviors though a Pilot Survey of Chinese college students (N = 129) and a Field Survey of Chinese Macao casino gamblers (N = 733). Our results revealed a double-edged sword effect of overplacement: Serving as a risk factor, evaluating one self's earning ability as higher than others was linked to more gambling motivations (ß = 0.18, p = .005) and frequency (ß = 0.18, p = .004); Serving as a protective factor, evaluating oneself as happier than others was linked to less gambling motivations (ß = - 0.32, p < .001) and problem behaviors (ß = - 0.26, p < .001). These findings expand the relationship between overconfidence and gambling from a cognitive bias perspective to a social comparison perspective. Our study not only revealed a typical profile of gambling motivations and behaviors among different demographic groups in Chinese casino gamblers, but also highlighted the importance of considering social factors in the study of the psychological mechanisms of gambling.

Hypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records.

BACKGROUND: The digital transformation of medical data enables health systems to leverage real-world data from electronic health records to gain actionable insights for improving hypertension care. METHODS AND RESULTS: We performed a serial cross-sectional analysis of outpatients of a large regional health system from 2010 to 2021. Hypertension was defined by systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or recorded treatment with antihypertension medications. We evaluated 4 methods of using blood pressure measurements in the electronic health record to define hypertension. The primary outcomes were age-adjusted prevalence rates and age-adjusted control rates. Hypertension prevalence varied depending on the definition used, ranging from 36.5% to 50.9% initially and increasing over time by ≈5%, regardless of the definition used. Control rates ranged from 61.2% to 71.3% initially, increased during 2018 to 2019, and decreased during 2020 to 2021. The proportion of patients with a hypertension diagnosis ranged from 45.5% to 60.2% initially and improved during the study period. Non-Hispanic Black patients represented 25% of our regional population and consistently had higher prevalence rates, higher mean systolic and diastolic blood pressure, and lower control rates compared with other racial and ethnic groups. CONCLUSIONS: In a large regional health system, we leveraged the electronic health record to provide real-world insights. The findings largely reflected national trends but showed distinctive regional demographics and findings, with prevalence increasing, one-quarter of the patients not controlled, and marked disparities. This approach could be emulated by regional health systems seeking to improve hypertension care.

[Fire resistance of 15 main economic tree species in Liangshan Prefecture, Sichuan, China.] / 凉山州15ç§ä¸»è¦ç»æµŽæ ‘ç§çš„é˜²ç«æ€§èƒ½.

Liangshan Prefecture is one of the three major forest areas in Sichuan Province and one of the three major disaster areas of forest fire. We measured the physicochemical properties and combustion performances of different organs (leaves and branches) of 15 main economic tree species in Liangshan, and analyzed the bioecology characteristics, silviculture characteristics and value characteristics of different tree species. We investigated the fire resistance of different tree species to screen out fire-resistant species suitable for economic forest development in Liangshan Prefecture, and improve the biological fire prevention ability. The seven physicochemical properties and combustion performances indices of 15 tree species showed significant differences. Except for crude ash and lignin, the weights of moisture content, caloric value, ignition point, crude fat, and crude fibre of leaves were higher than those of branches. Crude fibre index of leaves (9.6%) and the crude ash index of branches (9.9%) were the highest weight indices of the two organs, respectively. Based on the fire resistance, we divided all the species into three classes, i.e., class Ⅰ (excellent fire-resistance trees) Juglans regia and Morus alba; class Ⅱ (better fire-resistant trees) Sapium sebiferum, Mangifera indica, Phyllanthus emblica, Eriobotrya japonica, Ligustrum lucidum, Castanea mollissima, and Punica granatum; class Ⅲ (poor fire-resistant trees) Pinus armandii, Illicium simonsii, Morella rubra, Sapindus mukorossi, Olea europaea and Camellia oleifera. J. regia and M. alba had fireproof solid performance and could be used as the preferred species for fireproof economic forest in Liangshan region. It was suggested that to use class Ⅰ to Ⅱ fire-resistant tree species built the main fireproof isolated forest belt, and pay attention to fire prevention after planting class Ⅲ tree species in a large area.

Pre-COVID-19 hospital quality and hospital response to COVID-19: examining associations between risk-adjusted mortality for patients hospitalised with COVID-19 and pre-COVID-19 hospital quality.

OBJECTIVES: The extent to which care quality influenced outcomes for patients hospitalised with COVID-19 is unknown. Our objective was to determine if prepandemic hospital quality is associated with mortality among Medicare patients hospitalised with COVID-19. DESIGN: This is a retrospective observational study. We calculated hospital-level risk-standardised in-hospital and 30-day mortality rates (risk-standardised mortality rates, RSMRs) for patients hospitalised with COVID-19, and correlation coefficients between RSMRs and pre-COVID-19 hospital quality, overall and stratified by hospital characteristics. SETTING: Short-term acute care hospitals and critical access hospitals in the USA. PARTICIPANTS: Hospitalised Medicare beneficiaries (Fee-For-Service and Medicare Advantage) age 65 and older hospitalised with COVID-19, discharged between 1 April 2020 and 30 September 2021. INTERVENTION/EXPOSURE: Pre-COVID-19 hospital quality. OUTCOMES: Risk-standardised COVID-19 in-hospital and 30-day mortality rates (RSMRs). RESULTS: In-hospital (n=4256) RSMRs for Medicare patients hospitalised with COVID-19 (April 2020-September 2021) ranged from 4.5% to 59.9% (median 18.2%; IQR 14.7%-23.7%); 30-day RSMRs ranged from 12.9% to 56.2% (IQR 24.6%-30.6%). COVID-19 RSMRs were negatively correlated with star rating summary scores (in-hospital correlation coefficient -0.41, p<0.0001; 30 days -0.38, p<0.0001). Correlations with in-hospital RSMRs were strongest for patient experience (-0.39, p<0.0001) and timely and effective care (-0.30, p<0.0001) group scores; 30-day RSMRs were strongest for patient experience (-0.34, p<0.0001) and mortality (-0.33, p<0.0001) groups. Patients admitted to 1-star hospitals had higher odds of mortality (in-hospital OR 1.87, 95% CI 1.83 to 1.91; 30-day OR 1.46, 95% CI 1.43 to 1.48) compared with 5-star hospitals. If all hospitals performed like an average 5-star hospital, we estimate 38 000 fewer COVID-19-related deaths would have occurred between April 2020 and September 2021. CONCLUSIONS: Hospitals with better prepandemic quality may have care structures and processes that allowed for better care delivery and outcomes during the COVID-19 pandemic. Understanding the relationship between pre-COVID-19 hospital quality and COVID-19 outcomes will allow policy-makers and hospitals better prepare for future public health emergencies.

Unraveling the Interplay of Extracellular Domain Conformational Changes and Parathyroid Hormone Type 1 Receptor Activation in Class B1 G Protein-Coupled Receptors: Integrating Enhanced Sampling Molecular Dynamics Simulations and Markov State Models.

Parathyroid hormone (PTH) type 1 receptor (PTH1R), as a typical class B1 G protein-coupled receptor (GPCR), is responsible for regulating bone turnover and maintaining calcium homeostasis, and its dysregulation has been implicated in the development of several diseases. The extracellular domain (ECD) of PTH1R is crucial for the recognition and binding of ligands, and the receptor may exhibit an autoinhibited state with the closure of the ECD in the absence of ligands. However, the correlation between ECD conformations and PTH1R activation remains unclear. Thus, this study combines enhanced sampling molecular dynamics (MD) simulations and Markov state models (MSMs) to reveal the possible relevance between the ECD conformations and the activation of PTH1R. First, 22 intermediate structures are generated from the autoinhibited state to the active state and conducted for 10 independent 200 ns simulations each. Then, the MSM is constructed based on the cumulative 44 µs simulations with six identified microstates. Finally, the potential interplay between ECD conformational changes and PTH1R activation as well as cryptic allosteric pockets in the intermediate states during receptor activation is revealed. Overall, our findings reveal that the activation of PTH1R has a specific correlation with ECD conformational changes and provide essential insights for GPCR biology and developing novel allosteric modulators targeting cryptic sites.

Analysis of the phytochemical components of Prunella vulgaris using high-performance liquid chromatography quadrupole time-of-flight mass spectrometry combined with molecular networking and assessment of their antioxidant and anti-α-glucosidase activities.

Prunella vulgaris has long been used in traditional medicine and is consumed as a tea in China. Here, the total phenolic and flavonoid concentrations of plants from different geographical regions were measured. It was found that the total phenolic acid concentration ranged from 4.15 to 8.82 g of gallic acid equivalent per 100 g of dry weight (DW), and the total flavonoid concentration was 4.67-7.33 g of rutin equivalent per 100 g DW. Antioxidant activities were measured using 2,2-diphenyl-1-picrylhydrazyl and 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt, and the results ranged from 73.47% to 94.43% and 74.54% to 93.39%, respectively, whereas α-glucosidase inhibition was between 75.31% and 95.49%. Correlation analysis showed that the total flavonoids in P. vulgaris had superior antioxidant and anti-α-glucosidase activities compared to the total phenolic compounds. The active components of P. vulgaris were analyzed using high-performance liquid chromatography quadrupole time-of-flight mass spectrometry combined with both classical molecular networking and feature-based molecular networking on the Global Natural Products Social platform, identifying 32 compounds, namely 14 flavonoids, 12 phenolic compounds, and 6 other chemical components. These results could provide useful information on the use of P. vulgaris as a functional tea.

Global burden of burns and its association with socio-economic development status, 1990-2019.

BACKGROUND: Burns represent important global health problems. Whereas many studies are limited by the difficulties in estimating the burden of burns and instead focus on the causes of burns, such as fire, heat, and hot substances. Therefore, a complete assessment of the burden of all injuries leading to burns is essential to developing reasonable global intervention strategies. METHODS: Data on three classes of burns, including "< 20 % total burned surface area without lower airway burns" (Moderate injury), "> =20 % total burned surface area or > = 10 % burned surface area if head/neck or hands/wrist involved w/o lower airway burns" (Major injury), "Lower airway burns" (Inhalation injury) were collected from the Global Burden of Disease 2019 database. Age-standardized incidence rates (ASR-I) and Years Lived with Disability (ASR-YLDs) for burns has been standardized by removing the influence of population size and age structure. They were extracted and stratified by cause, year, sex, age, socio-demographic index, country, and territory. RESULTS: In terms of ASR-I and ASR-YLDs, burns showed a significant decrease from 1990 to 2019, especially for moderate and major injury. In 2019, the burden of moderate injury was positively correlated with socio-demographic index while major injury was negatively correlated (P < 0.05). We found no correlation between socio-demographic index and the burden for inhalation injury (P > 0.05). Fire, heat, and hot substances were the most important cause of burns except for inhalation injury. The most common association with inhalation injury was falls, which were also a major cause of moderate and major injury. CONCLUSIONS: The Global Burden of Disease 2019 database data can be used to guide the allocation of resources to reduce ASR-I and ASR-YLDs of different burn classes.

Association between type D personality and supportive care needs in elderly patients with breast cancer: a prospective longitudinal observational study.

BACKGROUND: Elderly patients with breast cancer often have more unmet needs after receiving common treatments such as surgery and chemotherapy. Type D personality has been related to supportive care needs in the general population. However, its association with supportive care needs in elderly breast cancer patients has not been prospectively explored. This study aimed to address this gap. OBJECTIVES: The aim was to understand the impact of Type D personality on the supportive care needs of elderly breast cancer patients at diagnosis, 2 weeks postoperatively, 3 months postoperatively, and 6 months postoperatively and to analyse the impact of Type D personality on the changing trajectory of supportive care needs after controlling for confounding factors such as demographics, symptom distress and social support. METHODS: A total of 122 elderly patients (≥ 65 years) with breast cancer in Ruijin Hospital, Shanghai, China, were included from September 2021 until August 2022. Supportive care needs were measured by the Supportive Care Needs Survey Short Form and tracked at diagnosis, 2 weeks postoperatively, 3 months postoperatively, and 6 months postoperatively. To investigate changes in the supportive care needs of elderly breast cancer patients and the effect of Type D personality on these needs, a linear mixed model was applied. RESULTS: A total of 122 elderly patients participated. There was an overall decreasing trend in supportive care needs, with Type D personality patients having significantly higher levels of supportive care needs than the non-Type D personality patients at all stages. Through linear mixed models, it was found that the Type D personality group had a lower overall downward trend than the non-Type D personality group, with need levels remaining consistently higher. This difference persisted after controlling for demographic information, symptom burden, social support. CONCLUSIONS: Elderly breast cancer patients with Type D personality had higher levels of supportive care needs and a slower rate of decline that was maintained over a longer period than those with non-Type D personality.

Budget impact of increasing uptake of denosumab for the treatment of postmenopausal osteoporosis in Malaysia.

This study evaluated the financial impact of increasing denosumab usage for managing postmenopausal osteoporosis over a 5-year period from the Malaysian healthcare provider's perspective. A gradual moderate increase in denosumab uptake would have a minimal budget impact, with potential savings in fracture treatment expenses. Optimizing denosumab usage could be a cost-effective and potentially affordable strategy to alleviate the economic burden of osteoporosis in Malaysia. PURPOSE: The study aimed to evaluate the budget impact of increasing the uptake of denosumab for the management of postmenopausal osteoporosis in Malaysia. METHODS: A Markov budget impact model was developed to estimate the financial impact of osteoporosis treatment. We modelled a scenario in which the uptake of denosumab would increase each year compared with a static scenario. A 5-year time horizon from the perspective of a Malaysian MOH healthcare provider was used. Model inputs were based on Malaysian sources where available. Sensitivity analyses were performed to examine the robustness of the modelled results. RESULTS: An increase in denosumab uptake of 8% per year over a 5-year time horizon would result in an additional budget impact, from MYR 0.26 million (USD 0.06 million) in the first year to MYR 3.25 million (USD 0.78 million) in the fifth year. When expressed as cost per-member-per-month (PMPM), these were less than MYR 0.01 across all five years of treatment. In sensitivity analyses, the acquisition cost of denosumab and medication persistence had the largest impact on the budget. CONCLUSION: From the perspective of a Malaysian MOH healthcare provider, moderately increasing uptake of denosumab would have a minimal additional budget impact, partially offset by savings in fracture treatment costs. Increasing the use of denosumab appears affordable to reduce the economic burden of osteoporosis in Malaysia.

Economic burden of advanced lung cancer patients treated by gefitinib alone and combined with chemotherapy in two regions of China.

AIM: To assess the economic burden of different chemotherapies for lung cancer patients and influencing factors in China. MATERIALS AND METHODS: The economic burden of lung cancer, including direct, indirect and intangible costs was measured within three months after diagnosis and treatment. Direct cost included the cost of hospitalization, outpatient visits, out-of-pocket drug purchases, costs of transportation, accommodation and meal expenses while seeking treatments in hospitals. Cost information was attained from questionnaire and patients' medical record. Indirect cost was measured by the patients' and their caregivers' productive days lost due to outpatient visits and hospitalization for lung cancer treatment. Intangible cost was obtained through the willingness-to-pay method from a questionnaire completed by the patient. RESULTS: Among the total cost of CNY71,401.92, direct cost, indirect cost and intangible cost constituted 89.02%, 4.29%, and 6.69% respectively. Educational level, occupation, family income, lung cancer classification, and the city of residence significantly influenced the total cost. LIMITATIONS: Limitations in our study included: First, our follow-up period of three months was relatively short compared to the whole survival period of lung cancer patients. Second, the sample size of the chemotherapy combined with targeted therapy group was not large enough, and the cost data obtained would need confirmation in future studies. Third, participants came from only two localities, which may somewhat limit the representativeness of the study results for the whole of China. CONCLUSIONS: The economic burden of lung cancer treatment mainly came from the cost of the drugs. Patients taking chemotherapy had significantly higher cost compared to patients using targeted therapy. The cost was generally higher for those with higher educational level, those with higher family income, and those living in an economically more developed city. Patients with NSCLC had higher cost compared to patients with SCLC.

In China, lung cancer is the leading cause of cancer-related deaths and imparts a heavy economic burden. Most lung cancer patients are treated with chemotherapeutic and/of targeted agents because they are usually diagnosed at an advanced stage (IIIB or IV). The use of targeted therapy has achieved high response rates, longer overall survival, and longer progression-free survival compared with conventional chemotherapies. Adverse reactions with targeted therapeutic agents are usually mild compared with conventional chemotherapy. However, targeted drugs for lung cancer are usually more expensive than conventional chemotherapeutic drugs. It should be noted that the adverse effects and toxicities caused by chemotherapeutic drugs are generally more serious compared to targeted drugs; therefore, a number of measures are needed to prevent or relieve these reactions clinically. This can increase the financial burden of lung cancer treatment. Does these two treatments have a different cost? Our results showed that educational level, occupation, family income, classification of lung cancer, and the city of residence significantly influenced the total cost. Patients taking chemotherapy had significantly higher cost compared to patients using targeted therapy. This result suggests that targeted therapy for lung cancer is a better choice than chemotherapy.

NN-Based Reinforcement Learning Optimal Control for Inequality-Constrained Nonlinear Discrete-Time Systems With Disturbances.

Based on actor-critic neural networks (NNs), an optimal controller is proposed for solving the constrained control problem of an affine nonlinear discrete-time system with disturbances. The actor NNs provide the control signals and the critic NNs work as the performance indicators of the controller. By converting the original state constraints into new input constraints and state constraints, the penalty functions are introduced into the cost function, and then the constrained optimal control problem is transformed into an unconstrained one. Further, the relationship between the optimal control input and worst-case disturbance is obtained using the Game theory. With Lyapunov stability theory, the control signals are ensured to be uniformly ultimately bounded (UUB). Finally, the effectiveness of the control algorithms is tested through a numeral simulation using a third-order dynamic system.

[Establishment of Decision Tree Prediction Model for Risk Factors of Placenta Accreta Spectrum Disorders].

Objective: To analyze the risk factors for placenta accreta spectrum (PAS) disorders and to construct preliminarily a decision tree prediction model for PAS, to help identify high-risk populations, and to provide reference for clinical prevention and treatment. Methods: By accessing the electronic medical record system, we retrospectively analyzed the relevant data of 2022 women who gave birth between January 2020 and September 2020 in a hospital in Chengdu. Univariate logistic regression and multivariate logistic regression were conducted to analyze the risk factors of PAS. SPSS Clementine12.0 was used to make preliminary exploration for the decision tree prediction model of PAS risk factors. Results: Results of logistic regression suggested that the top three risk factors for PAS included the following, the risk of PAS in pregnant women with placenta previa was 8.00 times that in pregnant women without placenta previa (95% CI: 5.24-12.22), the risk of PAS in multiple pregnancies was 2.52 times that in singleton pregnancies (95% CI: 1.72-3.69), and the risk of PAS in pregnant women who have had three or more abortions was 1.89 times that in those who have not had abortion (95% CI: 1.11-3.20). Results of the decision tree prediction model based on C5.0 algorithm were as follows, placenta previa was the most important risk factor, with as high as 93.33% (140/150) patients developed PAS when they had placenta previa; when in vitro fertilization-embryo transfer (IVF-ET) was the only factor the subjects had, the incidence of PAS was 59.91% (133/222); the incidence of PAS was as high as 75.96% (79/104) when the subjects had both IVF-ET and a history of uterine surgery; the probability of PAS in women who had induced abortion in the past was 48.46% (205/423); the probability of PAS in women who had undergone uterine surgery previously was 10.54% (37/351); the incidence of PAS was as high as 100.00% (163/163) when the subjects had induced abortion previously and uterine surgery history. The model showed a prediction accuracy of 85.41% for the training set and a prediction accuracy of 83.36% for the testing set, both being high rates of accuracy. Conclusion: The decision tree prediction model can be used for rapid and easy screening of patients at high risk for PAS, so that the likelihood of PAS can be actively and dynamically assessed and individualized preventive measures can be taken to avoid adverse outcomes.

Digitally embodied lifespan neurocognitive development and Tactile Internet: Transdisciplinary challenges and opportunities.

Mechanisms underlying perceptual processing and inference undergo substantial changes across the lifespan. If utilized properly, technologies could support and buffer the relatively more limited neurocognitive functions in the still developing or aging brains. Over the past decade, a new type of digital communication infrastructure, known as the "Tactile Internet (TI)," is emerging in the fields of telecommunication, sensor and actuator technologies and machine learning. A key aim of the TI is to enable humans to experience and interact with remote and virtual environments through digitalized multimodal sensory signals that also include the haptic (tactile and kinesthetic) sense. Besides their applied focus, such technologies may offer new opportunities for the research tapping into mechanisms of digitally embodied perception and cognition as well as how they may differ across age cohorts. However, there are challenges in translating empirical findings and theories about neurocognitive mechanisms of perception and lifespan development into the day-to-day practices of engineering research and technological development. On the one hand, the capacity and efficiency of digital communication are affected by signal transmission noise according to Shannon's (1949) Information Theory. On the other hand, neurotransmitters, which have been postulated as means that regulate the signal-to-noise ratio of neural information processing (e.g., Servan-Schreiber et al., 1990), decline substantially during aging. Thus, here we highlight neuronal gain control of perceptual processing and perceptual inference to illustrate potential interfaces for developing age-adjusted technologies to enable plausible multisensory digital embodiments for perceptual and cognitive interactions in remote or virtual environments.

Patient Access to Orphan Drugs Covered by Medical Insurance in China: Real-World Evidence From Patient Survey.

BACKGROUND: After the inclusion of more high-cost orphan drugs in China's National Reimbursement Drugs List, this study investigated issues relating to patient access to the 7 medicines for 4 rare diseases after listing. METHODS: This study collected data from a national survey conducted in China. Three aspects associated with the accessibility of medicines, namely, approachability, availability, and affordability, were analyzed using descriptive statistics. In addition, multilevel logistic regression models were used to investigate the associations between patient characteristics and the accessibility of surveyed orphan drugs. RESULTS: Of the 999 completed responses included in the study, 15% of the patients (n = 150) did not use the medicines because of non-medicine-related issues. Among the 849 patients using the surveyed medications, 64.4% (n = 547) encountered the problem of unavailability, whereas 51.2% (n = 435) reported affordability as an issue, and 49.6% (n = 320) had health expenditure beyond the catastrophic threshold. The data also indicated that Commercial Medical Insurance helped patients to relieve the cost burden on orphan drugs, but the payout of Commercial Medical Insurance failed to influence patients' decisions to continue the treatments. CONCLUSION: Accessibility of orphan drugs has improved in China after their inclusion in the National Reimbursement Drugs List. Nevertheless, the availability and affordability of medicines remained the barriers for patients to access the desired treatments. It is recommended that further policy refinement in conjunction with the collaboration among healthcare stakeholders is required to deliver better care for patients with rare disease.

Characteristic pollutants risk assessment of modified manganese residue utilization in sintered product.

The resource disposal of electrolytic manganese residue can effectively solve the problem of environmental pollution caused by it, among which the problem of heavy metal pollution is the most prominent. In this study, a new type of eco-friendly brick mixed with electrolytic manganese residue was designed. The influence of the content of electrolytic manganese residue on its macroscopic properties, microscopic properties, and leaching characteristics was analyzed by test methods such as compressive strength test, radioactivity test, XRF, XRD, FTIR, and ICP test of bricks. The results showed that the manganese content in the EMR leachate was 8120 mg/L, which exceeded the Chinese standard. The leaching experiment of ordinary aqueous solution of sintered bricks mixed with 20% EMR showed that the content of heavy metals was far lower than the Chinese national standard. There was no non-carcinogenic risk of heavy metals in the strong acid leaching solution of sintered bricks mixed with 20% EMR. Only the carcinogenic risk values of Cr for adults and children were 4.21 × 10-4 and 9.82 × 10-4 respectively, both exceeding the USEPA limit, but the application scene of sintered bricks was difficult to achieve strong acidity, so it was judged that it had no carcinogenic risk to the human body. Characteristic heavy metals such as Mn, Cr, and As existed stably in sintered bricks through substitution and encapsulation. In addition, the compressive strength and radioactivity of EMR sintered bricks met the requirements of the Chinese national standard "Fired Ordinary Bricks." This product can be used as national standard MU20 grade brick. This study provided an efficient method for the safe and environmentally friendly disposal of EMR in a sustainable control system.

An Assessment of the Predictive Performance of Current Machine Learning-Based Breast Cancer Risk Prediction Models: Systematic Review.

BACKGROUND: Several studies have explored the predictive performance of machine learning-based breast cancer risk prediction models and have shown controversial conclusions. Thus, the performance of the current machine learning-based breast cancer risk prediction models and their benefits and weakness need to be evaluated for the future development of feasible and efficient risk prediction models. OBJECTIVE: The aim of this review was to assess the performance and the clinical feasibility of the currently available machine learning-based breast cancer risk prediction models. METHODS: We searched for papers published until June 9, 2021, on machine learning-based breast cancer risk prediction models in PubMed, Embase, and Web of Science. Studies describing the development or validation models for predicting future breast cancer risk were included. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias and the clinical applicability of the included studies. The pooled area under the curve (AUC) was calculated using the DerSimonian and Laird random-effects model. RESULTS: A total of 8 studies with 10 data sets were included. Neural network was the most common machine learning method for the development of breast cancer risk prediction models. The pooled AUC of the machine learning-based optimal risk prediction model reported in each study was 0.73 (95% CI 0.66-0.80; approximate 95% prediction interval 0.56-0.96), with a high level of heterogeneity between studies (Q=576.07, I2=98.44%; P<.001). The results of head-to-head comparison of the performance difference between the 2 types of models trained by the same data set showed that machine learning models had a slightly higher advantage than traditional risk factor-based models in predicting future breast cancer risk. The pooled AUC of the neural network-based risk prediction model was higher than that of the nonneural network-based optimal risk prediction model (0.71 vs 0.68, respectively). Subgroup analysis showed that the incorporation of imaging features in risk models resulted in a higher pooled AUC than the nonincorporation of imaging features in risk models (0.73 vs 0.61; Pheterogeneity=.001, respectively). The PROBAST analysis indicated that many machine learning models had high risk of bias and poorly reported calibration analysis. CONCLUSIONS: Our review shows that the current machine learning-based breast cancer risk prediction models have some technical pitfalls and that their clinical feasibility and reliability are unsatisfactory.

Spatial Heterogeneity and Influencing Factors of HFRS Epidemics in Rural and Urban Areas: A Study in Guanzhong Plain of Shaanxi Province, China.

Objective: The Guanzhong Plain of Shaanxi Province is a severely afflicted hemorrhagic fever with renal syndrome (HFRS) epidemic area, while HFRS prevalence has decreased in most epidemic areas in China. Little information is available regarding the leading fine-scale influencing factors in this highly HFRS-concentrated area and the roles of natural environmental and socioeconomic factors. To investigate this, two regions in the Guanzhong Plain, that is, the Chang'an District and Hu County, with similar geographical environments, different levels of economic development, and high epidemic prevalence, were chosen as representative areas of the HFRS epidemic. Methods: Maximum entropy models were constructed based on HFRS cases and fine-scale influencing factors, including meteorological, natural environmental, and socioeconomic factors, from 2014 to 2016. Results: More than 95% of the HFRS cases in the study area were located in the northern plains, which has an altitude of less than 800 m, with topography contributed 84.1% of the impact on the spatial differentiation of the HFRS epidemic. In the northern plains, precipitation and population density jointly affected the spatial differentiation of the HFRS epidemic, with contribution rates of 60.7% and 28.0%, respectively. By comparing the influencing factors of the northern plains of Chang'an District and Hu County, we found that precipitation and the normalized difference vegetation index (NDVI) dominated the HFRS epidemic in the relatively developed Chang'an District, while land-use type, temperature, precipitation and population density dominated the HFRS epidemic in the relatively undeveloped Hu County. Conclusion: Topography was the primary key factor for HFRS prevalence in the Chang'an District and Hu County, and the spatial differentiation of HFRS was dominated by precipitation and population density in the northern plains. Compared with the influencing factors of the relatively developed Chang'an District, the developing Hu County was more affected by socioeconomic factors. When formulating targeted HFRS epidemic prevention and control strategies in the targeted areas, it is crucial to consider the local economic development state and combine natural environmental factors, including the meteorological environment and vegetation coverage.

Global, Regional, and National Burden of Cancer in Children Younger Than 5 Years, 1990-2019: Analysis of the Global Burden of Disease Study 2019.

Objectives: To quantify the burden and variation trends of cancers in children under 5 years at the global, regional, and national levels from 1990 to 2019. Methods: Epidemiological data for children under 5 years who were diagnosed with any one childhood cancer were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2019. The outcomes were the absolute numbers and rates of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for different types of cancer. Results: In 2019, 8,774,979.1 incident cases (95% uncertainty interval [UI]: 6,243,599.2 to11,737,568.5) and 8,956,583.8 (6,446,323.9 to 12,364,520.8) prevalent cases of cancer in children under 5 years were identified worldwide; these cancers resulted in 44,451.6 (36,198.7 to 53,905.9) deaths and 3,918,014.8 (3,196,454.9 to 4,751,304.2) DALYs. From 1990 to 2019, although the numbers of incident and prevalent cases only decreased by -4.6% (-7.0 to -2.2) and -8.3% (-12.6 to -3.4), respectively, the numbers of deaths and DALYs clearly declined by -47.8% (-60.7 to -26.4) and -47.7% (-60.7 to -26.2), respectively. In 2019, the middle sociodemographic index (SDI) regions had the highest incidence and prevalence, whereas the low SDI regions had the most mortality and DALYs. Although all of the SDI regions displayed a steady drop in deaths and DALYs between 1990 and 2019, the low-middle and low SDI regions showed increasing trends of incidence and prevalence. Leukemia remained the most common cancer globally in 2019. From 1990 to 2019, the burdens of leukemia, liver cancer, and Hodgkin's lymphoma declined, whereas the incidence and prevalence of other cancers grew, particularly testicular cancer. Conclusions: The global childhood cancer burden in young children has been steadily decreasing over the past three decades. However, the burdens and other characteristics have varied across different regions and types of cancers. This highlights the need to reorient current treatment strategies and establish effective prevention methods to reduce the global burden of childhood cancer.

Cost-effectiveness of interventions for the prevention and control of COVID-19: Systematic review of 85 modelling studies.

Background: We aimed to quantitatively summarise the health economic evaluation evidence of prevention and control programs addressing COVID-19 globally. Methods: We did a systematic review and meta-analysis to assess the economic and health benefit of interventions for COVID-19. We searched PubMed, Embase, Web of Science, and Cochrane Library of economic evaluation from December 31, 2019, to March 22, 2022, to identify relevant literature. Meta-analyses were done using random-effects models to estimate pooled incremental net benefit (INB). Heterogeneity was assessed using I2 statistics and publication bias was assessed by Egger's test. This study is registered with PROSPERO, CRD42021267475. Results: Of 16 860 studies identified, 85 articles were included in the systematic review, and 25 articles (10 studies about non-pharmacological interventions (NPIs), five studies about vaccinations and 10 studies about treatments) were included in the meta-analysis. The pooled INB of NPIs, vaccinations, and treatments were $1378.10 (95% CI = $1079.62, $1676.59), $254.80 (95% CI = $169.84, $339.77) and $4115.11 (95% CI = $1631.09, $6599.14), respectively. Sensitivity analyses showed similar findings. Conclusions: NPIs, vaccinations, and treatments are all cost-effective in combating the COVID-19 pandemic. However, evidence was mostly from high-income and middle-income countries. Further studies from lower-income countries are needed.

A systematic review of the cost-effectiveness of medicationadherence-enhancing intervention for asthma.

Objective: This systematic review aimed to evaluate the cost-effectiveness of medication adherence-improving interventions in patients with asthma.Data source: Search engines including PubMed, Scopus and EBSCOhost were used to locate relevant studies from the inception of the databases to 19 October 2018. Drummond's checklist was used to appraise the quality of the economic evaluation.Study selection: Economic studies evaluating the cost-effectiveness of medication adherence enhancing interventions for asthmatic patients were selected. Relevant information including study characteristics, quality assessment, health outcomes and costs of intervention were narratively summarized. The primary outcome of interest was cost-effectiveness (CE) values and the secondary outcomes were costs, medication adherence and clinical consequences.Results: Twenty studies including 11 randomized controlled trials, 6 comparative studies and 3 modeled studies using Markov models were included in the review. Among these, 15 studies evaluated an educational intervention with 13 showing cost-effectiveness in improving health outcomes. The CE of an internet-based intervention showed similar results between groups, while 3 studies of simplified drug regimens and adding a technology-based training program achieved the desirable cost-effectiveness outcome.Conclusion: Overall, our results would support that all of the identified medication adherence-enhancing interventions were cost-effective considering the increased adherence rate, improved clinical effectiveness and the reduced costs of asthma care. However, it was not possible to identify the most cost-effective intervention. More economic studies with sound methodological conduct will be needed to provide stronger evidence in deciding the best approach to improve medication adherence.