Cost-effectiveness and cost-utility of a digital technology-driven hierarchical healthcare screening pattern in China.

Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and unequally distributed resources. Here, we propose a digital technology-driven hierarchical screening (DH screening) pattern implemented in China to promote the equity and accessibility of healthcare. It consists of home-based mobile artificial intelligence (AI) screening, community-based AI diagnosis, and referral to hospitals. We utilize decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different cataract screening strategies (no screening, telescreening, AI screening and DH screening). A simulated cohort of 100,000 individuals from age 50 is built through a total of 30 1-year Markov cycles. The primary outcomes are incremental cost-effectiveness ratio and incremental cost-utility ratio. The results show that DH screening dominates no screening, telescreening and AI screening in urban and rural China. Annual DH screening emerges as the most economically effective strategy with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided compared with telescreening, and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remain robust across all sensitivity analyses conducted. Here, we report that DH screening is cost-effective in urban and rural China, and the annual screening proves to be the most cost-effective option, providing an economic rationale for policymakers promoting public eye health in low- and middle-income countries.

Evaluation of blood lead measurements by the 6-year external quality assessment program in China.

BACKGROUND: Blood lead is an important clinical indicator. A typical tool for promoting standardisation or harmonisation is external quality assessment (EQA). Therefore, the National Centre for Clinical Laboratories (NCCL) in China launched the EQA Program for blood lead measurement in 2006 to assess its standardisation process. METHODS: Blood lead EQA samples tested for homogeneity and stability were sent to participating laboratories. The return data were grouped according to the detection method. The robust mean value, robust coefficient of variation (CV) and standard uncertainty were calculated according to ISO 13528. The evaluation criteria were determined based on a thorough analysis of the previous pass rate and the current detection level. Overall trends in the blood lead EQA program over 6 years were investigated by calculating the pass rates of participating laboratories. We compared the pass rates and current issues of different detection methods and analysed the target values, bias and CV results of mainstream detection methods. RESULTS: A total of 4,283 laboratories participated in EQA programs from 2017 to 2022. The pass rates were generally increasing while the inter-laboratory mean CVs were decreasing. For samples with varying concentrations, the higher the concentration, the smaller the CV. According to the evaluation criteria, the most used measurement methods, Graphite Furnace Atomic Absorption Spectrometry (GFAAS) and Tungsten Ship Atomic Absorption Spectrometry (TSAAS) demonstrated better performances than Differential Potentiometric Stripping (DPS), Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and Flame Atomic Absorption Spectrometry (FAAS). Furthermore, DPS, ICP-MS and FAAS outperformed Anodic Stripping Voltammetry (ASV). CONCLUSION: Our study provides reliable information on the standardisation of blood lead measurement procedures for manufacturers and clinical laboratories. Further improvements for standardisation are still required to make laboratories more patient-centred.

Food Fraud Vulnerability Assessment in the Chinese Baijiu Supply Chain.

As a representative of Chinese alcoholic drinks, baijiu has developed into a mass-consumption commodity. Its simple industrial chain makes it a suitable target for fraudsters. In order to understand the differences and potential factors of fraud vulnerability among groups at various levels, this study constructed a food fraud vulnerability assessment system for the Chinese baijiu supply chain based on routine activities theory. We examined the fraud vulnerability in the baijiu supply chain with data from 243 producers and 45 retailers by using the safe supply of affordable food everywhere (SSAFE) food fraud vulnerability assessment (FFVA) tool. The results indicate that fraud factors related to opportunities have an overall medium vulnerability, while those related to motivations and control measures have an overall medium-low vulnerability. In addition, there are significant differences in the perceived vulnerability of fraud factors across the supply chain. Moreover, retailers have overall higher fraud vulnerability in terms of opportunities and control measures than producers. The main reasons for the frequent occurrence of fraud in the baijiu industry are numerous technical opportunities, strong economic drivers, and insufficient control measures.

Carbon emission reduction policy with privatization in an oligopoly model.

This study constructs a mixed oligopoly model that includes a public enterprise and two private enterprises. Game theory was adopted to explore the effects of carbon emission reduction policies. In addition, this study analyzes the optimal carbon emission trading prices and privatization decisions. The results show that the proportion of state-owned shares and the equity efficiency gap affect the equilibrium results for different carbon emission policies. Privatization increases the profits of public firms but does not necessarily increase social welfare. Different carbon emission reduction policies have different effects on the equilibrium results. Moreover, the emission reduction target is not completely consistent with the maximum social welfare target and should be comprehensively considered. The government can intervene by setting carbon emission trading prices and making privatization decisions. Full and partial privatization may be optimal decisions.

Long-term trends in the burden of inflammatory bowel disease in China over three decades: A joinpoint regression and age-period-cohort analysis based on GBD 2019.

Background: To study the corresponding strategies to control inflammatory bowel disease (IBD), a comprehensive assessment of the disease burden is required. Herein, we present long-term trends in the burden of IBD in China over the last three decades, as well as its epidemiological features. Methods: We characterized the burden of IBD in China using the GBD 2019 methods and results, based on prevalence, incidence, mortality, years lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) estimated using the DisMod-MR 2-1. We also used joinpoint and age-period-cohort (apc) analysis methods to interpret IBD epidemiological characteristics and compare them to global prevalence trends. Results: The age-standardized incidence and mortality rates in both sexes changed from 1.47 (95% CI: 1.24, 1.74) to 3.01 (95% CI: 2.59, 3.50) and from 0.86 (95% CI: 0.59, 1.16) to 0.30 (95% CI: 0.24, 0.35) per 100,000 people in China from 1990 to 2019. The age-standardized DALY rate in China decreased from 24.47 (95% CI: 17.88, 30.19) per 100,000 people in 1990 to 13.10 (95% CI: 10.29, 16.31) per 100,000 people in 2019. The average annual percentage change (AAPC) in age-standardized incidence, prevalence, and mortality rates for IBD in China were 2.51 (95% CI: 2.44, 2.57), 2.53 (95% CI: 2.41, 2.66), and -3.62 (95% CI: -3.85, -3.39). The effects of age, period, and cohort on incidence and mortality rates differed. Conclusions: The increasing age-standardized prevalence rates are contributed to by the reduction in age-standardized mortality rates and DALYs, compounded by the rise in the age-standardized incidence rates between 1990 and 2019 in China. The burden of IBD in China will be a major public health challenge, given the country's large population base and aging population.

Post-farmgate food value chains make up most of consumer food expenditures globally.

Progress towards many United Nations Sustainable Development Goals depends on interventions in food value chains, yet data and methods have thus far limited the production of cross-nationally comparable estimates of food value chains' magnitudes. Here we develop a standardized method and data series to estimate the distribution of consumer food expenditures between value-added activities on farms and in the post-farmgate value chain. Using data from 61 countries over 2005-2015, representing 90% of the global economy, we show that farmers receive, on average, 27% of consumer expenditure on foods consumed at home and a far lower percentage of food consumed away from home. That figure consistently falls in the 16-38% range for middle- and high-income countries and falls significantly as incomes rise. The large and growing post-farmgate food value chain merits greater attention as the world grapples with the economic, environmental and social impacts of food systems.

Target-responsive subcellular catabolism analysis for early-stage antibody-drug conjugates screening and assessment.

Events including antibody‒antigen affinity, internalization, trafficking and lysosomal proteolysis combinatorially determine the efficiency of antibody-drug conjugate (ADC) catabolism and hence the toxicity. Nevertheless, an approach that conveniently identifies proteins requisite for payload release and the ensuing toxicity for mechanistic studies and quality assessment is lacking. Considering the plethora of ADC candidates under development, we developed a target-responsive subcellular catabolism (TARSC) approach that examines ADC catabolism and probes changes in response to targeted interferences of proteins of interest. We firstly applied TARSC to study the commercial T-DM1 and the biosimilar. We recorded unequivocal catabolic behaviors regardless of the absence and presence of the targeted interferences. Their negligible differences in TARSC profiles agreed with their undifferentiated anti-tumoral efficacy according to further in vitro viability and in vivo tumor growth assays, highlighting TARSC analysis as a useful tool for biosimilarity assessment and functional dissection of proteins requisite for ADC catabolism. Additionally, we employed TARSC to investigate the catabolic behavior of a new trastuzumab-toxin conjugate. Collectively, TARSC can not only characterize ADC catabolism at (sub)cellular level but also comprehensively determine which protein targets affect payload release and therapeutic outcomes. Future use of TARSC is thus anticipated in early-stage screening, quality assessment and mechanistic investigations of ADCs.

Systematic assessment of environmental factors for gastroesophageal reflux disease: An umbrella review of systematic reviews and meta-analyses.

BACKGROUND: Side effects of long-term acid suppression have increased the scholars' interest in nonpharmacologic intervention. AIMS: We summarized an umbrella review of the association between environmental factors and gastroesophageal reflux disease (GERD) and assessed their credibility. METHODS: We appraised systematic reviews and meta-analyses. For each meta-analysis, we considered the effect size, 95% confidence interval, the heterogeneity, small-study effects, P-value for excess significance and largest study significant, then we graded the evidence according to Assessment of Multiple Systematic Reviews and the GRADE assessment. RESULTS: 23 publications met the inclusion criteria (13 meta-analyses and 10 systematic reviews), which evaluated 24 environmental factors. Among observational studies, we identified 7 risk factors: overweight/obesity [GERD/erosive esophagitis (EE)/GERD symptom], central adiposity [EE], smoking [GERD], alcohol [GERD/EE/non-erosive reflux disease (NERD)], NSAID [GERD], coffee [EE], Helicobacter pylori eradication [EE], and 1 protective factor: physical activity [GERD], this was based on a suggestive evidence of credibility. Across intervention studies, we identified 1 risk factor-Helicobacter pylori eradication [GERD] and 1 protective factor-breathing exercises [GERD], evidence for both was low grade. CONCLUSIONS: We found varying levels of evidence for different environmental factors of GERD. None of them was proven to be convincing or highly recommended.

National Program for External Quality Assessment of Chinese Newborn Screening Laboratories.

OBJECTIVES: To analyze the coefficient of variation (CV) of external quality assessment (EQA) in Chinese newborn screening (NBS) laboratories. METHOD: EQA's robust CV was analyzed by the Clinet-EQA evaluation system. RESULTS: Participating laboratories of the EQA program increased annually. There was more than a 11-fold increase in phenylalanine (Phe) and thyroid stimulating hormone (TSH). It has shown a declining robust CV, which has tended to level off in recent years. The interquartile range (IQR) of Phe and TSH's robust CV has decreased from 15.5% to 1.5% and from 22.8% to 1.8%, respectively. Compared to bacterial inhibition assay (BIA), the robust CV of Phe has been shown to be relatively reduced in the fluorescence assay and quantitative enzymatic assay (QEA). The robust CV by ELISA was relatively unstable compared to DELFIA and FEIA. In addition, the robust CVs of glucose-6-phosphate dehydrogenase (G6PD) and 17-alpha-hydroxy progesterone (17-OHP) by Genetic Screening Processor (GSP) were lower than other systems. The median of robust CV by non-derivatized MS/MS (Fenghua) in Phe and free carnitine were around 2.2-4.7% and 2.6-5.2%. CONCLUSION: Neonatal screening has developed rapidly in China and the majority of participant laboratories had satisfactory performance for the quantitative results.

[Quality Assessment of Euglycemic Glucose Clamp Test].

OBJECTIVE: To explorethe quality of euglycemic glucose clamptest performed in the West China Hospital from 2014 to 2017 and to evaluate whether the quality control indexes are suitable for the quality assessment of the clamp test. METHODS: The data collected from 80 euglycemic glucose clamp tests performed between 2014 and2017 were divided into 4 groups according to the coefficient of variation of the blood glucose concentrations (CVBG): group A (CVBG≤4.5%), group B (4.5% < CVBG≤5.0%), group C (5.0% < CVBG≤5.5%) and group D(CVBG > 5.5%).The differences in percentage of glucose excursion from target range (GEFTR), the duration of GEFTR, the area under curve (AUC) of GEFTR, the mean value of excursion from target glucose (GEFT) and the AUC of GEFT were calculated and compared. RESULTS: In group A, the mean value of CVBG was 3.75%. In group B, the mean value of CVBG was 4.76%. In group C, the mean value of CVBG was 5.28%. The median value of CVBG in group D was 6.07%. The percentage of GEFTR, the duration of GEFTR, the AUC of GEFTR, the mean value of GEFT and the AUC of GEFT in group A were all less than those of other groups (P < 0.05).For the same indexes, there were no significant differences between group B and C, while they were higher in group D compared with the other three groups. CVBG was positively correlated with other quality control indexes (correlation coefficient r was 0.770-0.805). Based on the cut-off point 5% of CVBG, the cut-off points of the percentage of GEFTR, the duration of GEFTR, the AUC of GEFTR, the mean value of GEFT and the AUC of GEFT were 5.8%, 14.6 min, 22.82 mg/dL×min, 3.23 mg/dL, 216.25 mg/dL×min/h respectively, with the sensitivity range from 79.3% to 100% and the specificity range from 74.5% to 89.7%.Combined with these indexes, 8.11% of euglycemic clamps were found to havepoor quality in group A, while 66.67% of euglycemic clamps showed acceptable quality in group C. CONCLUSIONS: The investigators should provide an estimation of the quality of the clamps when reporting the results of the insulin analogues' PK/PD characteristics using euglycemic clamps. CVBG less than 4.5% indicates a good quality, and the above-mentioned quality control indexes especially the AUC of GEFT(cut-off point: 216.25 mg·/dL×min/h) should be evaluated when CVBG is more than 4.5%.False high quality and false low quality euglycemic clamps will be detected and a more precise estimation of quality assessment should be made by the combination of these indexes.

Quality assessment of interpretative commenting and competency comparison of comment providers in China.

Background This study aimed to evaluate the ability of comment providers who were responsible for interpreting results in clinical laboratories in China and to improve the quality of interpretative comments. Methods Basic information and interpretative comments for five cases of 1912 routine chemistry External Quality Assessment (EQA) participant laboratories were collected by web-based EQA system in May 2018. EQA organizers assigned scores to each key phrase of comments based on predetermined marking scale and calculated total scores for each participant's answer. Final scores and ranking were calculated according to scores of cases. Finally, we comprehensively analyzed the type of hospital and the professional title of participants. Results In total, 772 clinical laboratories, 1472 participants, from different Chinese provinces submitted interpretative comments. Median scores, interquartile ranges and score ranges of the five cases were 13 (11-15, 1-20), 13 (10-16, 0-20), 15 (12-17, 0-21), 7 (5-9, -2 to 14) and 12 (10-13, -2 to 18). The final scores and ranking of participants that came from tertiary hospitals were higher than those from secondary and other hospitals; however, there were no significant differences (0.774). When grouped by professional title, we found that although no significant variability existed among senior, intermediate, junior and others (0.699), it existed between laboratory physicians and technicians, as the median final scores of the former were higher than the latter. Conclusions Practice and quality of interpretative comments are indeed different among different laboratories and participants in China. Laboratories should train and assess the interpretative ability of personnel. EQA organizers should also improve the scoring method and establish peer assessors team through this survey.

Biosafety assessment of GFP transplastomic tobacco to rhizosphere microbial community.

Green fluorescent protein (GFP) is one of the most widely studied and exploited proteins in biochemistry, and has many applications as a marker, especially in plant transformation system. Although a number of studies have been conducted to assess the toxify of this protein to specific organisms, little is known about GFP on rhizosphere microbial community, which is regarded as good indicator for environmental risk assessment. Chloroplast genetic engineering has shown superiority over traditional nuclear genetic engineering, and has been used in many aspects of plant genetic engineering. High levels of chloroplast-based protein accumulation make this technology as an ideal strategy to evaluate biosafety of transgenes. In the present study, the effects of field-released GFP transplastomic tobacco (Nicotiana tabacum) on rhizosphere microbes over a whole growth cycle were investigated by using both culture-dependent and culture-independent methods. Compared to wild-type control, transplastomic tobacco had no significant influence on the microbial population at the seedling, vegetative, flowering and senescing stages. However, developmental stages had more influence than ecotypes (GFP-transformed and wild-type). This was confirmed by colony forming unit, Biolog Eco(TM) and PCR-DGGE analysis. Thus, these results suggest chloroplast transformation with a GFP reporter gene has no significant influence on rhizosphere microbial community, and will be potential platform for plant biotechnology in future.

[Comprehensive assessment on management measures of rice insect pests].

Based on the investigation of arthropods biodiversity and insect pests controlling effect in the paddy fields of demonstration area of organic rice production in Guangzhou, a comprehensive assessment on the economic, social, and ecological profits and costs of organic rice production in study area was conducted by using analytic hierarchy process (AHP). The results indicated that among all insect pests controlling measures, organic rice planting had the best comprehensive benefits, with a weight value of 0.5355. Ecological cost played a dominant role in comprehensive costs, and that of traditional pesticide-based insect pests control was most cruel, with a weight value of comprehensive costs being 0.6252. From the viewpoint of the ratio of comprehensive profits to comprehensive costs (RPC), organic rice planting was better than any other insect pests controlling modes, whose RPC was 2.4776, being accorded with the requirement of sustainable development of agriculture.