Moderating effect of urban endowment factors on environmental regulations-productivity relationship in Beijing-Tianjin-Hebei region.

In this paper, six major cities in the Beijing-Tianjin-Hebei region of China are classified into two groups, namely core city (Beijing) and industrial cities. The objective is to analyze the moderating effect of urban endowments in different urban contexts on the environmental regulation-productivity relationship using an econometric model. The results are: As environmental regulation intensifies, production in Beijing's high-polluting industries rises after falling, showing "innovation compensation" and "inefficient exit" effects. In contrast, the high-polluting industries in the industrial cities exhibit a "compliance cost" effect. In Beijing, four urban endowment factors, including economic development, technological innovation, human capital, and government intervention, can provide supportive conditions for business development under environmental regulatory pressure, primarily by reducing the "compliance cost" effect and enhancing the "innovation compensation" effect. In industrial cities, on the other hand, urban endowment factors have not had a positive moderating effect, and government intervention has even had a negative effect. We argue that government intervention may be the more fundamental urban endowment factor, which may affect the moderating outcomes of other endowment factors. Based on these findings, we propose that governments should make greater use of guiding and incentive-based environmental policy instruments, while reducing administrative interventions. Appropriate policy instruments can activate the positive moderating role of urban endowments and thus provide a better supportive environment for firms' technological innovation.

Establishment of a differential diagnosis method and an online prediction platform for AOSD and sepsis based on gradient boosting decision trees algorithm.

OBJECTIVE: The differential diagnosis between adult-onset Still's disease (AOSD) and sepsis has always been a challenge. In this study, a machine learning model for differential diagnosis of AOSD and sepsis was developed and an online platform was developed to facilitate the clinical application of the model. METHODS: All data were collected from 42 AOSD patients and 50 sepsis patients admitted to Affiliated Hospital of Xuzhou Medical University from December 2018 to December 2021. In addition, 5 AOSD patients and 10 sepsis patients diagnosed in our hospital after March 2022 were collected for external validation. All models were built using the scikit-learn library (version 1.0.2) in Python (version 3.9.7), and feature selection was performed using the SHAP (Shapley Additive exPlanation) package developed in Python. RESULTS: The results showed that the gradient boosting decision tree(GBDT) optimization model based on arthralgia, ferritin × lymphocyte count, white blood cell count, ferritin × platelet count, and α1-acid glycoprotein/creatine kinase could well identify AOSD and sepsis. The training set interaction test (AUC: 0.9916, ACC: 0.9457, Sens: 0.9556, Spec: 0.9578) and the external validation also achieved satisfactory results (AUC: 0.9800, ACC: 0.9333, Sens: 0.8000, Spec: 1.000). We named this discrimination method AIADSS (AI-assisted discrimination of Still's disease and Sepsis) and created an online service platform for practical operation, the website is http://cppdd.cn/STILL1/ . CONCLUSION: We created a method for the identification of AOSD and sepsis based on machine learning. This method can provide a reference for clinicians to formulate the next diagnosis and treatment plan.

Influences of long-term care insurance on pulmonary and urinary tract infections among older people with disability.

BACKGROUND: Pulmonary infection (PI) and urinary tract infection (UTI) have been the most common cause of hospitalization and most frequent infection respectively in older people with disability (OPWD). Long-term care insurance (LTCI) policy, intending to provide services to reduce the disease burden of OPWD, it remains unclear whether LTCI could reduce PI-, and UTI-related hospitalizations. This quasi-experimental study aimed to assess the influences of LTCI on all-cause, especially PI- and UTI-related hospitalizations among OPWD and the variation across sociodemographic characteristics. METHODS: 32,120 participants in the Chengdu Long-term Care Insurance cohort were considered the intervention group, and 2,704 not covered by the LTCI were in the control group. A total of 3,134,160 hospitalization records were collected between January 2014 and June 2021. A doubly robust difference-in-differences (DID) method was used to estimate the average treatment effect on the treated (ATT), indicating the average effect of LTCI on intervention group. RESULTS: The average monthly all-cause, PI-, and UTI-related hospitalization rates were 16.3%, 4.0% and 0.5% in the intervention group, respectively, and were 19.3%, 3.9% and 0.5% in the control group, respectively. Under LTCI, all-cause (ATT [95% CI]: 7.15% [6.41%, 7.88%]), PI- (3.25% [2.76%, 3.74%]), and UTI-related hospitalizations (0.46% [0.28%, 0.64%]) were decreased. The influences of LTCI became significant after 5 months since the LTCI implementation and remained stable over time. The impact was more pronounced among those with longer coverage. The overall reduction was stronger in those who were not married, lived alone, and resided in institutions. CONCLUSIONS: LTCI may reduce the occurrence of all-cause, PI-, and UTI-related hospitalizations in OPWD, with stronger influences observed over an extended period of implementation. The implementation of LTCI can play a role in reducing the burden of infectious diseases in OPWD and the care burden of families and society.

Risk assessment and its influencing factors of involuntary admission in patients with mental disorders in Shanghai, China.

BACKGROUND: The 'risk criterion' for involuntary admission (IA) has been adopted by Mental Health Law of the People's Republic of China since 2013. How the new legal regulation influences daily practices in psychiatric institutes are still unclear. AIMS: The present study sought to explore the application of risk criterion in IA cases; especially risk assessed by psychiatrists at admission and its influencing factors. METHOD: Socio-demographic and clinical data including risk assessment for admission of 3,529 involuntary admitted patients from two typical hospitals in Shanghai from 2013 to 2014 were consecutively collected. Personal information of psychiatrists who made admission assessment was collected separately. RESULTS: Among the 3,529 cases, 1,890 (53.6%) were admitted because of actual harmful behaviors to self or others, while 1,639 (46.4%) were admitted with some kinds of risk, but 265 (7.5%) were admitted without any records on risk assessment checklists. Patients who were unemployed, of younger age, single status, diagnosed with schizophrenia were more likely to be admitted without any records on the checklist. Male gender, older age, and lower professional title are influencing factors that psychiatrists made no risk assessment records. CONCLUSIONS: The vast majority (92.5%) of risk assessment in IA patients were qualified in our study. In order to protect the legal rights of patients better, operational and reasonable procedures of risk assessment should be developed, such include more detailed rules to IA, systematic training of psychiatrists on IA assessment, mechanism improving doctor-patient relationship, and alternative mental health services for patients and so on.

Stoichiometric characteristics and economic implications of water-soluble ions in PM2.5 from a resource-dependent city.

The stoichiometric characteristics of water-soluble ions (WSIs) in PM2.5, which can be used as an indicator socioeconomic development level, are mostly depending on the sources and formation mechanism of PM2.5. This work presents the stoichiometric characteristics and socioeconomic linkage of WSIs in PM2.5 from a resource-dependent city. The relationship between NO3-/SO42- and car parc indexes the contribution of mobile emission source. The equivalent ratio of WSIs suggested that aerosol particles were weak acidic due to the deficiency of cations in PM2.5, which was consistent with the average annual pH (6.27) of precipitation in Wuhai in 2015. NH4+ neutralizes PM2.5 acidity in clean and polluted days, while Ca2+ and NH4+ in dust storm days. Furthermore, the PCA analysis indicated the multi-sources pollution characteristics from Spring to Fall, which was related the small build-up area (only 62.30 km2) and the close-set of various industrial enterprises in Wuhai. The ratios of NO2/SO2 may not work effectively to identify the importance of mobile versus stationary pollution emission sources when the heavy emission from the secondary industry, especially the proportion of secondary industry higher than 65% and the ratios of NO2/SO2 lower than 0.4. This work contributes to more effective control strategies for PM2.5 in resource-dependent areas.

Wheat yield response to input and socioeconomic factors under changing climate: Evidence from rainfed environments of Pakistan.

More than three-quarters of the world's total cultivated land is under rainfed farming, producing almost 70% of total food. Most food production comes from developing and least favored nations. Pakistan, a developing country with an agro-based economy, is facing severe threats from climate change. Rainfed agriculture, especially wheat farming, is highly susceptible due to its heavy dependency on precipitation, one of the most important climatic parameters. Wheat is the main food crop, as well as a major source of calorific intake, for millions of people in Pakistan. This study aims to quantify the impacts of climate variability on mean yield levels and yield variability of wheat crop in the rainfed zone of Pakistan. Multistage random sampling technique is used for primary data collection from 400 rainfed wheat farmers during the 2016-17 crop season. The study uses primary data on crop input-output, management, socioeconomic, institutional, and historical climatic data (1980-2017). The data are analyzed employing the Just and Pope (J-P) stochastic production function approach with linear and non-linear functional forms. The results reveal that temperature rise negatively affects observed wheat mean yields, while cumulative precipitation positively affected it. Further, input market access, seed rate, and cumulative precipitation also cause variability in yield levels, leading to yield instability. Further, farm elevation influences wheat mean yield positively while input market access influences it negatively. The findings of the study have important implications for climate resilient wheat farming. Timely and tailor-made adaptations need to be undertaken in the rainfed wheat farming systems of Pakistan. Creating awareness among farmers about the optimal use of agronomic inputs under changing climatic conditions could be an effective adaptation strategy that improves yields and copes with yield instability.

What Has Caused Desertification in China?

Desertification is the result of complex interactions among various factors, including climate change and human activities. However, previous research generally focused on either meteorological factors associated with climate change or human factors associated with human activities, and lacked quantitative assessments of their interaction combined with long-term monitoring. Thus, the roles of climate change and human factors in desertification remain uncertain. To understand the factors that determine whether mitigation programs can contribute to desertification control and vegetation cover improvements in desertified areas of China, and the complex interactions that affect their success, we used a pooled regression model based on panel data to calculate the relative roles of climate change and human activities on the desertified area and on vegetation cover (using the normalized-difference vegetation index, NDVI, which decreases with increasing desertification) from 1983 to 2012. We found similar effect magnitudes for socioeconomic and environmental factors for NDVI but different results for desertification: socioeconomic factors were the dominant factor that affected desertification, accounting for 79.3% of the effects. Climate change accounted for 46.6 and 20.6% of the effects on NDVI and desertification, respectively. Therefore, desertification control programs must account for the integrated effects of both socioeconomic and natural factors.

Escaping the resource curse in China.

Many societies face an income gap between rich regions with access to advanced technology and regions that are rich in natural resources but poorer in technology. This "resource curse" can lead to a Kuznets trap, in which economic inequalities between the rich and the poor increase during the process of socioeconomic development. This can also lead to depletion of natural resources, environmental degradation, social instability, and declining socioeconomic development. These problems will jeopardize China's achievements if the current path continues to be pursued without intervention by the government to solve the problems. To mitigate the socioeconomic development gap between western and eastern China, the government implemented its Western Development Program in 2000. However, recent data suggest that this program has instead worsened the resource curse. Because each region has its own unique strengths and weaknesses, China must escape the resource curse by accounting for this difference; in western China, this can be done by improving education, promoting high-tech industry, adjusting its economic strategy to balance regional development, and seeking more sustainable approaches to socioeconomic development.

The efficacy and cost-effectiveness of cell saver use in instrumented posterior correction and fusion surgery for scoliosis in school-aged children and adolescents.

Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver was not cost-effective.

Rural households' attitude and economic strategies toward the conversion of cropland to forest and grassland program (CCFG): a case study in Qira, China.

The Conversion of Cropland to Forest and Grassland Program (CCFG), which was initiated by the Chinese government in 1999, is a cropland retirement program with integrated objectives for ecological preservation and local development. The purpose of this article was to study the influencing factors of attitude and economic strategies in rural households toward the CCFG. Rural households' knowledge, attitude and economic strategies toward the CCFG were investigated through a questionnaire survey in Qira, China. Influencing factors of attitude and strategies of households were analyzed using a logit model technique. The analysis indicated that household's income level, environmental knowledge of the program, and program implementation were significant influencing factors in a household's attitude toward the CCFG, while major influencing factors of household strategies were their regional background and availability of income generation sources. Meaningful association was not found between attitude and strategy choices. Rich households had more strategy choices, while poor households were usually confined to low input strategies with uncertain income. To sustain their livelihood, the poor need extra assistances in marketing, loan granting, employment training, information, and technical services.

Multi-indicator assessment of water environment in government environmental auditing.

This study focused on a multi-indicator assessment methodology for governmental environmental auditing of water protection programs. The environmental status of Wuli Lake in China was assessed using the global indicators (driver-status-response) developed by the Commission on Sustainable Development, and four additional indicators proposed by the author: water quality, pollution load, aquatic ecosystem status, and lake sediment deposition. Various hydrological, chemical, biological and environmental parameters were used to estimate the values of the indicators for assessment of environmental status of the lake based on time series data sets for twenty years. The indicators proposed can be customized to meeting the needs for particular assessment of water protection programs. This method can be used to evaluate the performance of national environmental protection programs and provide technical support for environmental auditors.