Preservation or removal of the lateral nasal wall in endoscopic management of maxillary sinus neoplasia: A comparison of approach related morbidity.

BACKGROUND: The endoscopic modified medial maxillectomy (MMM) and prelacrimal approach (PLA) are two routinely performed endoscopic approaches to the maxillary sinus when access via a middle meatal antrostomy is insufficient. However, there is no data in the literature that has compared outcomes and complication profile between the two procedures to determine which approach is superior. OBJECTIVE: To compare the approach related morbidity of PLA and MMM. METHODS: A retrospective cohort study of all consecutive adult patients undergoing either MMM or PLA from 2009 to 2023 were identified. The primary outcome was development of epistaxis, paraesthesia, lacrimal injury, iatrogenic sinus dysfunction within a minimum of 3 months post-operative follow up. RESULTS: 39 patients (44 sides) underwent PLA and 96 (96 sides) underwent MMM. There were no statistically significant differences between the rates of paraesthesia (9.1 % vs 14.6 %, p = 0.367) or prolonged paraesthesia (2.3 % vs 5.2 %, p = 0.426), iatrogenic maxillary sinus dysfunction (2.3 % vs 5.2 %, p = 0.426) or adhesions requiring removal (4.5 % vs 4.2 %, p = 0.918). No cases of epiphora or nasal cavity stenosis occurred in either arm in our study. CONCLUSIONS: According to our data, the endoscopic modified medial maxillectomy and prelacrimal approach are both equally safe approaches with their own benefits to access.

Global supply chains amplify economic costs of future extreme heat risk.

Evidence shows a continuing increase in the frequency and severity of global heatwaves1,2, raising concerns about the future impacts of climate change and the associated socioeconomic costs3,4. Here we develop a disaster footprint analytical framework by integrating climate, epidemiological and hybrid input-output and computable general equilibrium global trade models to estimate the midcentury socioeconomic impacts of heat stress. We consider health costs related to heat exposure, the value of heat-induced labour productivity loss and indirect losses due to economic disruptions cascading through supply chains. Here we show that the global annual incremental gross domestic product loss increases exponentially from 0.03 ± 0.01 (SSP 245)-0.05 ± 0.03 (SSP 585) percentage points during 2030-2040 to 0.05 ± 0.01-0.15 ± 0.04 percentage points during 2050-2060. By 2060, the expected global economic losses reach a total of 0.6-4.6% with losses attributed to health loss (37-45%), labour productivity loss (18-37%) and indirect loss (12-43%) under different shared socioeconomic pathways. Small- and medium-sized developing countries suffer disproportionately from higher health loss in South-Central Africa (2.1 to 4.0 times above global average) and labour productivity loss in West Africa and Southeast Asia (2.0-3.3 times above global average). The supply-chain disruption effects are much more widespread with strong hit to those manufacturing-heavy countries such as China and the USA, leading to soaring economic losses of 2.7 ± 0.7% and 1.8 ± 0.5%, respectively.

Automating General Movements Assessment with quantitative deep learning to facilitate early screening of cerebral palsy.

The Prechtl General Movements Assessment (GMA) is increasingly recognized for its role in evaluating the integrity of the developing nervous system and predicting motor dysfunctions, particularly in conditions such as cerebral palsy (CP). However, the necessity for highly trained professionals has hindered the adoption of GMA as an early screening tool in some countries. In this study, we propose a deep learning-based motor assessment model (MAM) that combines infant videos and basic characteristics, with the aim of automating GMA at the fidgety movements (FMs) stage. MAM demonstrates strong performance, achieving an Area Under the Curve (AUC) of 0.967 during external validation. Importantly, it adheres closely to the principles of GMA and exhibits robust interpretability, as it can accurately identify FMs within videos, showing substantial agreement with expert assessments. Leveraging the predicted FMs frequency, a quantitative GMA method is introduced, which achieves an AUC of 0.956 and enhances the diagnostic accuracy of GMA beginners by 11.0%. The development of MAM holds the potential to significantly streamline early CP screening and revolutionize the field of video-based quantitative medical diagnostics.

Research on the dynamic changes of China's agro-processing industry agglomeration and spatial impact of production factors on agglomeration.

Agglomeration is an important phenomenon that accompanies with a large concentration of various production factors. Since the agro-processing industry has become a vital bridge connecting the primary and secondary industries, agglomeration and distribution within this industry are arousing wide concern. Based on provincial panel data of China from 2001 to 2020, this study described the dynamic changes of China's agro-processing industry agglomeration using spatial Gini coefficient and average concentration ratio. A theoretical analysis framework was established and a dynamic spatial Durbin model was used to quantitatively explore the spatial effects of production factors on the agro-processing industry agglomeration, results showed that: first, the agglomerations of agro-processing industry and its sub-industries all have exhibited a fluctuating trend of "up-down-up-down", meanwhile the agro-processing industry shifted from the Eastern coastal region to the central and western regions. Second, in the short term, the capital, labor, and technology factors respectively have remarkably promoted the agro-processing industries agglomeration both in local and neighboring areas. Third, in the long term, these three production factors all had a crowding effect on industrial agglomeration. Therefore, it is necessary to continue optimizing the agro-processing industry spatial layout through adjusting production factor inputs to promote high-quality development of the agro-processing industry.

Correction to: Improved dynamic functional connectivity estimation with an alternating hidden Markov model.

[This corrects the article DOI: 10.1007/s11571-022-09874-3.].

Improved dynamic functional connectivity estimation with an alternating hidden Markov model.

Dynamic functional connectivity (DFC) analysis has been widely applied to functional magnetic resonance imaging (fMRI) data to reveal the time-varying functional interactions between brain regions. Although the sliding window (SW) method is popular for DFC analysis, the selection of window length is hard, and the temporal resolution is limited by the window length. The hidden Markov model (HMM) without the limitation of window length has been proven to be able to estimate time-varying brain states from fMRI data. However, HMM tends to be overfitted in DFC analysis of fMRI data because of the high spatial dimension and the limited sample size of fMRI data. In this study, we proposed an alternating HMM (aHMM) method that used the functional connectivity estimation of SW to initialize the covariance matrix of HMM and adopted an alternating HMM procedure to reduce the number of parameters during each optimization. The simulated and real fMRI resting data from the Human Connectome Projects showed that aHMM produced better robustness to noise, parameter number and sample size in DFC estimation than SW and HMM. For the real fMRI resting data of cerebral small vessel disease (CSVD), results of aHMM revealed that amnesia and mild cognitive impairment (aMCI) caused the CSVD with aMCI (CSVD-aMCI) group tended to spend more time on the brain state with overall weak connections and less time on the state with overall strong connections than the CSVD-controls. Moreover, CSVD-aMCI showed significantly lower connectivity amplitude and higher connectivity fluctuation than CSVD-control. In contrast, HMM did not detect intergroup differences of the connectivity amplitude and fluctuations and SW did not detect intergroup differences of connectivity fluctuations and fraction of time. The results further indicated that aHMM outperformed HMM and SW in detecting inter-group differences of temporal properties of DFC and connectivity fluctuations. Supplementary Information: The online version contains supplementary material available at 10.1007/s11571-022-09874-3.

Comprehensive assessment of toxicity and environmental risk associated with sulfamethoxazole biodegradation in sulfur-mediated biological wastewater treatment.

Incomplete mineralization of sulfamethoxazole (SMX) in wastewater treatment systems poses a threat to ecological health. The toxicity and environmental risk associated with SMX biodegradation in the sulfur-mediated biological process were examined for the first time through a long-term (180 days) bioreactor study and a series of bioassays. The results indicated that the sulfur-mediated biological system was highly resistant and tolerant to SMX toxicity, as evidenced by the enrichment of sulfate-reducing bacteria (SRB), the improved microbial metabolic activity, and the excellent performance on pollutants removal under long-term SMX exposure. SMX can be effectively biodegraded by the cleavage and rearrangement of the isoxazole ring, hydrogenation and hydroxylation reactions in sulfur-mediated biological wastewater system. These biodegradation pathways effectively reduced the acute toxicity, antibacterial activity, and ecotoxicities of SMX and its biotransformation products (TPs) in the effluent of the sulfur-mediated biological system. The TPs produced via hydrogenation (TP1), hydroxylation, and isoxazole ring cleavage (TP3, TP4, TP5, TP8, and TP9) exhibited lower toxicity than SMX. Under SMX stress, although the abundance of sulfonamide resistance genes increased, the total abundance of ARGs decreased due to the extrusion of some intracellular SMX by the efflux pump genes and the inactivation of some SMX through the biodegradation process. Efflux pump and inactivation, as the main resistance mechanisms of antibiotics in the sulfur-mediated biological system, play a crucial role in microbial self-defense. The findings of this study demonstrate the great potential of the sulfur-mediated biological system in SMX removal, detoxication, and ARGs environmental risk reduction.

Bitterness-masking assessment of luteolin encapsulated in whey protein isolate-coated liposomes.

An unacceptable bitter taste limits the application of luteolin in healthier food systems. In this study, a bitterness-masking assessment was performed on whey protein isolate-coated liposomes loaded with luteolin (WPI-coated liposomes) using an electronic tongue and human sensory test. The physical properties of the WPI-coated colloidal nanocarrier were characterized by zeta potential, average diameter, distribution, and morphology analyses. The results indicated that WPI-coated nanocarrier systems exhibited a uniformly dispersed distribution and spherical morphology. After the comparison of the bitterness value, the bitterness-reducing effect of 5% WPI-coated liposomes was the most significant and reduced the bitterness of luteolin by 75%. Raman spectroscopy and X-ray diffraction analysis demonstrated that the decoration of WPI on the liposomes reduced the free motion of lipid molecules. This promoted the ordering at the polar headgroup area and hydrophobic core of the lipid bilayer, which explained why luteolin-loaded liposomes (uncoated liposomes) and WPI-coated liposomes could reduce the bitterness of luteolin from the perspective of bitter molecular groups. Combined with the Raman spectral data, the bilayer rigidity of 5% WPI-coated liposomes was positively responsive to the stabilization of uncoated liposomes against storage and resistance ability against surfactants. It was proven that the emergence of the surface modification of the WPI coating enhanced the stability of uncoated liposomes. These results may contribute to the use of WPI-coated liposomes as prospective candidates for effective delivery of the bioactive bitter substance in nutraceuticals and functional foods.

Global trends and age-specific incidence and mortality of cervical cancer from 1990 to 2019: an international comparative study based on the Global Burden of Disease.

OBJECTIVE: To describe the trends of incidence and mortality of cervical cancer in different age groups and regions from 1990 to 2019. DESIGN: An international comparative study based on the Global Burden of Disease (GBD) study estimates. PARTICIPANTS: Data were publicly available and individuals were not involved. METHODS: We collected detailed information on cervical cancer from the GBD study between 1990 and 2019. Average annual percentage changes (AAPCs) of age-standardised incidence and mortality rate (ASIR and ASMR) in cervical cancer, by age group and region, were calculated to quantify the temporal trends. RESULTS: Globally, the absolute numbers of incident cases and deaths were increasing, with the most cervical cancer cases and deaths being reported in China, India and Brazil. Although the ASIR and ASMR have declined overall from 1990 to 2019, an increasing or stable trend was also observed in East Asia and Southern sub-Saharan Africa. Particularly, we found that the age-specific AAPC of incidence showed an increasing trend in the age group of 15-49 years globally, and the high Sociodemographic Index region increased the most. CONCLUSIONS: Cervical cancer remains a concerning disease that affects women all over the world, although the ASIR and ASMR are decreasing. Efforts to control the younger trend and to reduce the disparity between regions are imminent.

Hemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography.

BACKGROUND: Whether there are sex differences in hemodynamic profiles among people with elevated blood pressure is not well understood and could guide personalization of treatment. METHODS AND RESULTS: We described the clinical and hemodynamic characteristics of adults with elevated blood pressure in China using impedance cardiography. We included 45,082 individuals with elevated blood pressure (defined as systolic blood pressure of ≥130 mmHg or a diastolic blood pressure of ≥80 mmHg), of which 35.2% were women. Overall, women had a higher mean systolic blood pressure than men (139.0 [±15.7] mmHg vs 136.8 [±13.8] mmHg, P<0.001), but a lower mean diastolic blood pressure (82.6 [±9.0] mmHg vs 85.6 [±8.9] mmHg, P<0.001). After adjusting for age, region, and body mass index, women <50 years old had lower systemic vascular resistance index (beta-coefficient [ß] -31.7; 95% CI: -51.2, -12.2) and higher cardiac index (ß 0.07; 95% CI: 0.04, 0.09) than men of their same age group, whereas among those ≥50 years old women had higher systemic vascular resistance index (ß 120.4; 95% CI: 102.4, 138.5) but lower cardiac index (ß -0.15; 95% CI: -0.16, -0.13). Results were consistent with a propensity score matching sensitivity analysis, although the magnitude of the SVRI difference was lower and non-significant. However, there was substantial overlap between women and men in the distribution plots of these variables, with overlapping areas ranging from 78% to 88%. CONCLUSIONS: Our findings indicate that there are sex differences in hypertension phenotype, but that sex alone is insufficient to infer an individual's profile.

An assessment of morphological and pathological changes in paravertebral muscle degeneration using imaging and histological analysis: a cross-sectional study.

BACKGROUND: The high signal of paravertebral muscle (PVM) on T2-weighted image (T2WI) is usually considered to be fatty degeneration. However, it is difficult to distinguish inflammatory edema from fatty degeneration on T2WI. The purpose of this study was to identify different types of PVM high signal in patients with low back pain (LBP) through magnetic resonance imaging (MRI) and histology. METHODS: Seventy patients with LBP underwent MRI. The signal change of multifidus both on T2WI and fat suppression image (FSI) was quantified by Image J. Furthermore, 25 of the 70 patients underwent surgery for degenerative lumbar disease and their multifidus were obtained during the operation. Histological analysis of the samples was performed by HE staining. RESULT: Three types of PVM signal changes were identified from the MRI. Type 1 (n = 36) indicated fatty degeneration characterized by a high signal on T2WI and low signal on FSI. High signal on both T2WI and FSI, signifying type 2 meant inflammatory edema (n = 9). Type 3 (n = 25) showed high signal on T2WI and partial signal suppression on FSI, which meant a combination of fatty degeneration and inflammatory edema. Histological results were consistent with MRI. Among the 25 patients who underwent surgery, type 1 (n = 14) showed adipocytes infiltration, type 2 (n = 3) showed inflammatory cells infiltration and type 3 (n = 8) showed adipocytes and inflammatory cells infiltration. CONCLUSION: From our results, there are three types of pathological changes in patients with PVM degeneration, which may help to decide on targeted treatments for LBP.

Assessment of causal effects of physical activity on neurodegenerative diseases: A Mendelian randomization study.

BACKGROUND: Physical activity has been hypothesized to play a protective role in neurodegenerative diseases. However, effect estimates previously derived from observational studies were prone to confounding or reverse causation. METHODS: We performed a two-sample Mendelian randomization (MR) analysis to explore the causal association of accelerometer-measured physical activity with 3 common neurodegenerative diseases: Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS). We selected genetic instrumental variants reaching genome-wide significance (p < 5 × 10-8) from 2 largest meta-analyses of about 91,100 UK Biobank participants. Summary statistics for AD, PD, and ALS were retrieved from the up-to-date studies in European ancestry led by the international consortia. The random-effect, inverse-variance weighted MR was employed as the primary method, while MR pleiotropy residual sum and outlier (MR-PRESSO), weighted median, and MR-Egger were implemented as sensitivity tests. All statistical analyses were performed using the R programming language (Version 3.6.1; R Foundation for Statistical Computing, Vienna, Austria). RESULTS: Primary MR analysis and replication analysis utilized 5 and 8 instrumental variables, which explained 0.2% and 0.4% variance in physical activity, respectively. In each set, one variant at 17q21 was significantly associated with PD, and MR sensitivity analyses indicated them it as an outlier and source of heterogeneity and pleiotropy. Primary results with the removal of outlier variants suggested odds ratios (ORs) of neurodegenerative diseases per unit increase in objectively measured physical activity were 1.52 for AD (95% confidence interval (95%CI): 0.88-2.63, p = 0.13) and 3.35 for PD (95%CI: 1.32-8.48, p = 0.01), while inconsistent results were shown in the replication set for AD (OR = 1.06, 95%CI: 1.01-1.12, p = 0.02) and PD (OR = 0.99, 95%CI: 0.88-0.12, p = 0.97). Similarly, the beneficial effect of physical activity on ALS (OR = 0.51, 95%CI: 0.29-0.91, p = 0.02) was not confirmed in the replication analysis (OR = 0.96, 95%CI: 0.91-1.02, p = 0.22). CONCLUSION: Genetically predicted physical activity was not robustly associated with risk of neurodegenerative disorders. Triangulating evidence across other studies is necessary in order to elucidate whether enhancing physical activity is an effective approach in preventing the onset of AD, PD, or ALS.

Advances in the Development of Anti-Adhesive Biomaterials for Tendon Repair Treatment.

BACKGROUND: Peritendinous adhesion that simultaneous with tendon healing link the healing tendon to the surrounding tissue. It results in functional disability, and has a significant adverse impact on health as well as social and economic development. METHODS: Based on a search in the PubMed and Web of Science database, the research articles were screened by their time, main idea, impact factor index, while the ones with no credibility were excluded. Afterwards, we go through the analysis of the reliability and characteristics of the results were further screened from selected articles. RESULTS: A total of 17 biomaterials used to evaluate the adhesion mechanism and the properties of the material were found. All of these biomaterials contained randomized controlled studies and detailed descriptions of surgical treatment that support the reliability of their results which indicates that biomaterials act as barriers to prevent the formation of adhesion, and most of them exhibit satisfactory biocompatibility, biodegradability or selective permeability. Moreover, a few had certain mechanical strength, anti-inflammatory, or carrier capacities. However, there still existed some defects, such as time, technology, clinical trials, material targeting and different measurement standards which also lowered the reliability of their results. CONCLUSION: In future, anti-adhesion biomaterials should focus on affordable raw materials with wide sources, and the production process should be simplified, in this way, the versatility and targeting of materials will be improved.

Evaluation of the diffusion MRI white matter tract integrity model using myelin histology and Monte-Carlo simulations.

Quantitative evaluation of brain myelination has drawn considerable attention. Conventional diffusion-based magnetic resonance imaging models, including diffusion tensor imaging and diffusion kurtosis imaging (DKI),1 have been used to infer the microstructure and its changes in neurological diseases. White matter tract integrity (WMTI) was proposed as a biophysical model to relate the DKI-derived metrics to the underlying microstructure. Although the model has been validated on ex vivo animal brains, it was not well evaluated with ex vivo human brains. In this study, histological samples (namely corpus callosum) from postmortem human brains have been investigated based on WMTI analyses on a clinical 3T scanner and comparisons with gold standard myelin staining in proteolipid protein and Luxol fast blue. In addition, Monte Carlo simulations were conducted to link changes from ex vivo to in vivo conditions based on the microscale parameters of water diffusivity and permeability. The results show that WMTI metrics, including axonal water fraction AWF, radial extra-axonal diffusivity De⊥, and intra-axonal diffusivity Dawere needed to characterize myelin content alterations. Thus, WMTI model metrics are shown to be promising candidates as sensitive biomarkers of demyelination.

Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis.

OBJECTIVE: To determine the predictive factors of postoperative hospital stay and total hospital medical cost among patients who underwent total laryngectomy. METHODS: A total of 213 patients who underwent total laryngectomy in a tertiary referral center for tumor ablation were enrolled retrospectively between January 2009 and May 2018. Statistical analyses including Pearson's chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and outcomes. The outcomes of interest including postoperative length of hospital stay and inpatient total medical cost. Logistic regression analyses were performed to reveal the relationship between clinical factors and postoperative length of hospital stay or total inpatient medical cost. RESULTS: Preoperative radiotherapy (p = 0.007), method of wound closure (p < 0.001), postoperative serum albumin level (p = 0.025), and postoperative serum hemoglobin level (p = 0.04) were significantly associated with postoperative hospital stay in univariate analysis. Postoperative hypoalbuminemia (odds ratio [OR]: 2.477; 95% confidence interval [CI]: 1.189-5.163; p = 0.015) and previous radiotherapy history (OR 2.194; 95% CI: 1.228-3.917; p = 0.008) are independent predictors of a longer postoperative hospital stay in multiple regression analysis. With respect to total inpatient medical cost, method of wound closure (p < 0.001), preoperative serum albumin level (p = 0.04), postoperative serum albumin level (p < 0.001), and history of liver cirrhosis (p = 0.037) were significantly associated with total inpatient medical cost in univariate analysis. Postoperative hypoalbuminemia (OR: 6.671; 95% CI: 1.927-23.093; p = 0.003) and microvascular free flap reconstruction (OR: 5.011; 95% CI: 1.657-15.156; p = 0.004) were independent predictors of a higher total inpatient medical cost in multiple regression analysis. CONCLUSIONS: Postoperative albumin status is a significant factor in predicting prolonged postoperative hospital stay and higher inpatient medical cost among patients who undergo total laryngectomy. In this cohort, the inpatient medical cost was 48% higher and length of stay after surgery was 35% longer among hypoalbuminemia patients.

Exploring synergies in the water-food-energy nexus by using an integrated hydro-economic optimization model for the Lancang-Mekong River basin.

The Water-Food-Energy nexus study identifies developmental challenges and trade-offs present along the transboundary river basins. Intensive reservoir development for hydropower production impacts existing actors in the Lancang-Mekong River Basin. Concerns from these stakeholders highlight three major trade-offs that occur between hydropower and irrigation (HP-AG), hydropower and fisheries (HP-F), and irrigation and fisheries (AG-F). Dam construction has an impact not only on power production but also on ecosystems and ultimately the livelihood of people. In this study, we quantify the effects of reservoir operation on hydropower generation, irrigated crop production and fisheries yield in the Tonle Sap lake through a novel hydro-economic model at the whole basin scale. Our main finding is that trade-offs can be turned into synergetic opportunities. First, the dam operation can increase water availability for irrigation without severely harming hydropower production, raising irrigated crop revenue by 49% and reducing crop losses during droughts by 30%. Second, eco-friendly management increases fisheries yield by up to 75%, but decreases both irrigated crop production (-48%) and power production (-17%). Reservoirs can, therefore, benefit the whole basin by releasing more water in months with high irrigation demand (April and December) and by minimizing the adverse effects of flow fluctuations on the livelihood of farmers and fishers living downstream. Our results also reveal the overlooked trade-off between irrigated agriculture and fisheries. Cross-sectoral and transboundary partnerships should strengthen stakeholder participation in decision-making. Local solutions such as enhanced reservoir operation can respond to the broader global issue of natural resource trade-offs and sharing. Our alternative narrative enhances the dialogue about fair and efficient water use among Mekong riparian countries.

The Evaluation Method of Low-Carbon Scenic Spots by Combining IBWM with B-DST and VIKOR in Fuzzy Environment.

With the concept of sustainability gaining popularity, low-carbon tourism has been widely considered. In this paper, a multicriteria group decision making (MCGDM) process based on an uncertain environment is proposed to study the evaluation problem of low-carbon scenic spots (LSSs). In order to minimize the influence of subjective and objective factors, the traditional Vlse Kriterjumska Optimizacija I Kompromisno Resenje (VIKOR) method is expanded, using the improved best and worst method (IBWM) and Bayes approximation method, based on Dempster-Shafer Theory (B-DST). First, in order to make the evaluation process more professional, a number of evaluation criteria are established as effective systems, followed by the use of triangular intuitionistic fuzzy numbers (TIFNs) to evaluate alternatives of LSSs. Next, according to the evaluation results, the weights of the criteria are determined by the IBWM method, and the weights of the expert panels (Eps) are determined by B-DST. Finally, a weighted averaging algorithm of TIFN is used to integrate the above results to expand the traditional VIKOR and obtain the optimal LSS. The applicability of this method is proven by example calculation. The main conclusions are as follows: tourist facilities and the eco-environment are the two most important factors influencing the choice of LSSs. Meanwhile, the roles of management and participant attitudes in LSS evaluations cannot be ignored.

Carer Social Care-Related Quality of Life Outcomes: Estimating English Preference Weights for the Adult Social Care Outcomes Toolkit for Carers.

BACKGROUND: There is increasing interest in assessing the effects of interventions on older people, people with long-term conditions and their informal carers for use in economic evaluation. The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) is a measure that specifically assesses the impact of social care services on informal carers. To date, the ASCOT-Carer has not been preference-weighted. OBJECTIVES: To estimate preference-based index values for the English version of the ASCOT-Carer from the general population in England. METHODS: The ASCOT-Carer consists of 7 domains, each reflecting aspects of social care-related quality of life in informal carers. Preferences for the ASCOT-Carer social care-related quality of life states were estimated using a best-worst scaling exercise in an online survey. The survey was administered to a sample of the general adult population in England (n = 1000). Participants were asked to put themselves into the hypothetical state of being an informal carer and indicate which attribute they thought was the best (first and second) and worst (first and second) from a profile list of 7 attributes reflecting the 7 domains, each ranging at a different level (1-4). Multinomial logit regression was used to analyze the data and estimate preference weights for the ASCOT-Carer measure. RESULTS: The most valued aspect by English participants was the 'occupation' attribute at its highest level. Results further showed participants rated having no control over their daily life as the lowest attribute-level of all those presented. The position of the 7 attributes influenced participants' best and worst choices, and there was evidence of both scale and taste heterogeneity on preferences. CONCLUSION: This study has established a set of preference-based index values for the ASCOT-Carer in England derived from the best-worst scaling exercise that can be used for economic evaluation of interventions on older individuals and their informal carers.

[Ecological risk assessment of landslide disasters based on potential loss of ecosystem services]. / 基于生态系统服务潜在损失的滑坡灾害生态风险评价.

Landslides are common geological calamities in mountainous regions, which not only threaten social and economic development and residents' safety but also cause ecosystem damage, with consequences on human welfare. A more comprehensive and systematic reference for disaster prevention and mitigation with ecosystem services loss as an index for the potential damage of ecosystem could aid the progress of landslide ecological risk assessment. Five provinces in Southwest China (Sichuan, Yunnan, Guizhou, Guangxi and Chongqing) have diverse landforms, complex stratum and lithology, and active geological tectonic movements, which are the most landslide prone areas in China. In this study, the ecological risk assessment framework, model and indicator were constructed from three dimensions, including disaster risk, vulnerability and potential loss of the ecosystem. Disaster risk was based on the comprehensive analysis of factors such as geology, topo-graphy, landform, precipitation, and their mutual relationship. The vulnerability of the ecosystem was characterized by landscape patterns indices. The potential loss was measured by ecosystem service to evaluate the ecological risk associated with landslide hazards in the five provinces of Southwest China. The results showed that the areas with high potential loss of ecosystem services were mainly distributed in the south of Ailao Mountain in Yunnan Province, Qionglai Mountain of Sichuan Pro-vince, Hengduan Mountains, Dadu River Basin, Northwest Guangxi Autonomous Region, and eastern area of Dayao Mountain. The high ecological risk of landslide hazard in the study area mainly distributed in the areas of Min Mountain, Qionglai Mountain, Wuliang Mountain, Ailao Mountain, Miao Ridge, Leigong Mountain, and Dadu River basin. With respect to altitude, 500-1500 m was the main high-risk areas, accounting for 37.9% of the high-risk area. In terms of ecosystem types, forests are the high-risk areas, accounting for 66.4% of the high-risk areas. Landslide monitoring and early warning in the high ecological risk areas should be strengthened, through strengthening ecosystem protection in the region and improving the stability and resistance of ecosystems.

Analysis of economic burden and its associated factors of twenty-three rare diseases in Shanghai.

BACKGROUND: It is estimated that at present there are over 10 million rare disease patients in China. Recently an increased focus from policy perspective has been placed on rare diseases management. Improved disease definitions and the releases of local and national rare disease lists are some of the steps taken already. Despite these developments, few Chinese rare disease-related epidemiology and economic studies exist, thus hindering assessment of the true burden of rare diseases. For a rare disease with an effective treatment, this is a particularly important aspect due to the often-high cost associated. OBJECTIVE: The goal of this study is to address the data scarcity on the subject of rare diseases economic impact in China. We aim to address an existing knowledge gap and to provide a timely analysis of the economic burden of 23 rare diseases in Shanghai, China. METHODS: We utilized the data from the Health Information Exchange system of Shanghai and employed statistical modeling to analyze the economic burden of rare diseases with an effective treatment in Shanghai. RESULTS: First, we described the actual direct medical expenditure and analyzed its associated factors. Second, we found age, disease type, number of complications, and payment type were significantly associated with rare disease medical direct costs. Third, a generalized linear model was employed to estimate the annual direct cost. The mean direct medical cost was estimated as ¥9588 (US$1521) for inpatients and ¥1060 (US$168) for outpatients, and was over ¥15 million (~US$2.4 million) per year overall. CONCLUSION: Our study is one of the first quantifying the economic burden of an extensive set of rare diseases in Shanghai and China. Our results can serve to inform healthcare-focused policy making, contribute to the increase of public awareness, and incentivize development of rare-disease strategies and treatments specific to the Chinese context.