The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data.

BACKGROUND: The National Drug Price Negotiation (NDPN) policy has entered a normalisation stage, aiming to alleviate, to some extent, the disease-related and economic burdens experienced by cancer patients. This study analysed the use and subsequent burden of anticancer medicines among cancer patients in a first-tier city in northeast China. METHODS: We assessed the usage of 64 negotiated anticancer medicines using the data on the actual drug deployment situation, the frequency of medical insurance claims and actual medication costs. The affordability of these medicines was measured using the catastrophic health expenditure (CHE) incidence and intensity of occurrence. Finally, we used the defined daily doses (DDDs) and defined daily doses cost (DDDc) as indicators to evaluate the actual use of these medicines in the region. RESULTS: During the study period, 63 of the 64 medicines were readily available. From the perspective of drug usage, the frequency of medical insurance claims for negotiated anticancer medicines and medication costs showed an increasing trend from 2018 to 2021. Cancer patients typically sought medical treatment at tertiary hospitals and purchased medicines at community pharmacies. The overall quantity and cost of medications for patients covered by the Urban Employee Basic Medical Insurance (UEBMI) were five times higher than those covered by the Urban and Rural Resident Medical Insurance (URRMI). The frequency of medical insurance claims and medication costs were highest for lung and breast cancer patients. Furthermore, from 2018 to 2021, CHE incidence showed a decreasing trend (2.85-1.60%) under urban patients' payment capability level, but an increasing trend (11.94%-18.42) under rural patients' payment capability level. The average occurrence intensities for urban (0.55-1.26 times) and rural (1.27-1.74 times) patients showed an increasing trend. From the perspective of drug utilisation, the overall DDD of negotiated anticancer medicines showed an increasing trend, while the DDDc exhibited a decreasing trend. CONCLUSION: This study demonstrates that access to drugs for urban cancer patients has improved. However, patients' medical behaviours are affected by some factors such as hospital level and type of medical insurance. In the future, the Chinese Department of Health Insurance Management should further improve its work in promoting the fairness of medical resource distribution and strengthen its supervision of the nation's health insurance funds.

Economic evaluation of camrelizumab plus rivoceranib versus sorafenib as first-line therapy for unresectable hepatocellular carcinoma in the United States and China.

BACKGROUND: Camrelizumab combined with rivoceranib has been proven effective for treating unresectable hepatocellular carcinoma (uHCC). However, their higher prices than sorafenib could impose a substantial economic burden on patients. AIM: This study aimed to evaluate the relative cost-effectiveness of the combination of camrelizumab and rivoceranib versus sorafenib as first-line therapy for patients with uHCC from the perspective of the US and Chinese payers. METHOD: Using data from the CARES-310 trial, a partitioned survival model (PSM) was developed, considering the perspectives of the US and Chinese payers. The model employed a 15-year time horizon and a biweekly cycle. Direct medical costs and utility data were collected from previous studies and open-access databases. Primary outcomes included quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Price simulations, sensitivity analyses, and subgroup analyses were conducted. RESULTS: The ICER for the US and China was $122,388.62/QALY and $30,410.56/QALY, respectively, falling below the willingness-to-pay (WTP) thresholds of $150,000/QALY for the US and $35,898.87/QALY for China. Price simulations indicated the cost-effectiveness of camrelizumab plus rivoceranib when the price of camrelizumab (200 mg) remained below $6275.19 in the US and $558.09 in China. The primary determinant of cost-effectiveness in both regions was the cost of camrelizumab. CONCLUSION: The combination of camrelizumab and rivoceranib is a cost-effective first-line therapy for uHCC in both the US and China. Lowering their prices could significantly influence their cost-effectiveness and accessibility to patients. These findings will guide clinicians in treating uHCC and help decision-makers formulate value-based drug pricing strategies.

Win-win or lose-lose: Children prefer the form of equality.

In middle childhood, children's sense of fairness further develops, they are willing to pay a cost to maintain equality. Win-win and lose-lose are two forms of equality. Win-win equality refers to both parties maximizing benefits, while lose-lose equality means both parties incurring the maximum loss. Win-win equality allows third party upholding fairness to gain more reputational benefits without the violator being punished, embodying the principle of "benefiting oneself without harming others". On the other hand, lose-lose equality is a more deterrent form of fairness with the violator getting punished, and the third-party might experience a situation of "effort without appreciation." However, the specific form of equality which school-aged children prefer still requires further exploration. Therefore, adopting the dictator game paradigm of third-party punishment, we design two experiments to investigate the fairness preference of first to fourth-grade children when acting as a third party and to clarify patterns of age-related changes. Study 1 (N = 111) explored children's preferred form of fairness under advantageous inequity conditions. Study 2 (N = 122) further examined children's fairness preferences in disadvantageous inequity situations. The findings suggest that when confronted with inequitable distributions, whether rooted in disadvantageous or advantageous inequity, children display a notable tendency to utilize third-party punishment to achieve an equal allocation. Meanwhile, this tendency strengthens as they progress in grade levels. Notably, children consistently manifest a preference for win-win equality, highlighting their inclination towards mutually beneficial outcomes.

Effect of Consultation Number on the Assessment and Treatment of Polycystic Ovary Syndrome.

Background: The basic medical education stage is not enough to support physicians to fully diagnose and evaluate polycystic ovary syndrome (PCOS). The study aims to discover the difference in treatment choice between participants with different annual consultation number of PCOS, to promote lifelong learning, and drive balanced development within healthcare. Methods: This is a multicenter cross-sectional survey. Participants' basic information, knowledge of PCOS and treatment options were collected online. According to the annual consultation number of patients with PCOS, physicians were divided into three groups: 0-50 people/yr, 50-200 people/yr, and >200 people/yr, and the results were derived from χ2 test, Fisher exact test, and multivariate logistic regression analysis. Results: The study analyzed 1689 questionnaires, and 1206 physicians (71.4%) received less than 50 women per year, 388 physicians (30.0%) with an annual number of 50-200 women, and 95 physicians (5.6%) with patient turnover for more than 200 people. Reproductive endocrinologists generally have higher access to the clinic. As the number of visits increases, more and more physicians would perceive patients as more likely to have abnormal blood glucose and heavy weight. Physicians with large numbers of consultations are more likely to use Asian or Chinese standards to assess obesity. The multivariate analysis involved variables such as age, hospital level, specialty, and patient turnover annually, and more young doctors actively assessed lipid profile (odds ratio (OR) 1.56, 95% confidence interval (CI) (1.16, 2.16)), and primary hospitals (OR 0.65 CI (0.44, 0.89)) chose OGTT for blood glucose assessment less than tertiary hospitals. Physicians in secondary hospitals are more aggressive in evaluating androgens. Conclusion: Our survey found differences in endocrine assessment, metabolic screening, and treatment in PCOS women in terms of the number of obstetrician-gynecologists who received different patient consultation numbers. The importance of continuing education for physicians is emphasized, to promote lifelong learning.

Analyst optimism, information disclosure, and stock price collapse risk: Empirical insights from China's A-share market.

This study selects stock data of listed companies in China's A-share stock market from 2011 to 2020 as research samples. Using a fixed-effects model, it examines the impact of analyst optimism on stock price collapses and the moderating effect of information disclosure quality. Simultaneously, it conducts additional research to explore the potential transmission mechanisms involved. The main findings are as follows: Firstly, a positive correlation exists between analyst optimism and the risk of stock price collapse. Secondly, improving information disclosure quality of listed companies can enhance the positive impact of analyst optimism on the risk of stock price collapses and expedite the market's adjustment of overly optimistic valuations of listed companies. Additionally, analyst optimism can increase the risk of stock price collapses by affecting institutional ownership. These findings provide theoretical support for regulatory authorities to revise and improve the "information disclosure evaluation" system, regulate the analyst industry, guide analyst behavior, and encourage listed companies to enhance internal governance and improve information disclosure practices.

Scientometric analysis of electrocatalysis in wastewater treatment: today and tomorrow.

Electrocatalytic methods are valuable tools for addressing water pollution and scarcity, offering effective pollutant removal and resource recovery. To investigate the current status and future trends of electrocatalysis in wastewater treatment, a detailed analysis of 9417 papers and 4061 patents was conducted using scientometric methods. China emerged as the leading contributor to publications, and collaborations between China and the USA have emerged as the most frequent partnerships. Primary article co-citation clusters focused on oxygen evolution reaction and electrochemical oxidation, transitioning towards advanced oxidation processes ("persulfate activation"), and electrocatalytic reduction processes ("nitrate reduction"). Bifunctional catalysts, theoretical calculations, electrocatalytic combination technologies, and emerging contaminants were identified as current research hotspots. Patent analysis revealed seven types of electrochemical technologies, which were compared using SWOT analysis, highlighting electrochemical oxidation as prominent. The technological evolution presented the pathway of electro-Fenton to combined electrocatalytic technologies with biochemical processes, and finally to coupling with electrocoagulation. Standardized evaluation systems, waste resource utilization, and energy conservation were important directions of innovation in electrocatalytic technologies. Overall, this study provided a reference for researchers to understand the framework of electrocatalysis in wastewater treatment and also shed light on potential avenues for further innovation in the field.

Surface-Patterned DNA Origami Rulers Reveal Nanoscale Distance Dependency of the Epidermal Growth Factor Receptor Activation.

The nanoscale arrangement of ligands can have a major effect on the activation of membrane receptor proteins and thus cellular communication mechanisms. Here we report on the technological development and use of tailored DNA origami-based molecular rulers to fabricate "Multiscale Origami Structures As Interface for Cells" (MOSAIC), to enable the systematic investigation of the effect of the nanoscale spacing of epidermal growth factor (EGF) ligands on the activation of the EGF receptor (EGFR). MOSAIC-based analyses revealed that EGF distances of about 30-40 nm led to the highest response in EGFR activation of adherent MCF7 and Hela cells. Our study emphasizes the significance of DNA-based platforms for the detailed investigation of the molecular mechanisms of cellular signaling cascades.

The correlation between the costs and clinical benefits of national price-negotiated anticancer drugs for specific cancers in China.

Background: The high costs of novel anticancer drugs have caused concern among healthcare stakeholders. To address the knowledge gap on the proportion of survival benefit with the related economic expenditure, we aimed to assess the correlation between the costs and value of innovative drugs targeted to specific tumours, before and after price negotiation policy implementation. Methods: We identified new drugs for lung and breast cancer that entered the National Reimbursement Drug List (NRDL) through price negotiation from 2016 to 2023. Therapeutic value consisted of traditional clinical endpoints, like the percentage improvement of overall survival (ΔOS%) and progression-free survival (ΔPFS%), and the quantified gains of the American Society of Clinical Oncology Value Framework (ASCO-VF) and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). We calculated monthly drug costs and used Spearman's correlation coefficient and Cohen's kappa statistics for statistical analysis. Results: Twenty-nine innovative price-negotiated drugs were collected between 2016 and 2023. The median monthly costs were US$3381.31 out of NRDL and US$1095.88 within NRDL, with an ΔOS% of 22.24% (IQR = 6.45-29.48) and a ΔPFS% of 83.82% (IQR = 50.41-104.05). The median ASCO-VF score was 40.98, and 17 drugs scored the meaningful benefit of ESMO-MCBS. We found no association between clinical benefits and their costs before and after NRDL, either overall or for specific cancers. The agreement between the two frameworks was stable. Conclusions: The negotiation policy decreased medication costs, but did not generate the expected correlation between the value and costs of anticancer drugs. Comprehensive value assessments need to be performed in the future to explore more in-depth findings and promote the affordability and availability of effective anticancer drugs.

From crisis to resilience: strengthening climate action in OECD countries through environmental policy and energy transition.

Climate change represents a grave challenge to the global economy, environment, and societal well-being, jeopardizing their long-term sustainability. In response to this urgent issue, the study emphasizes the significance of environmental policy and energy transitions as fundamental factors in addressing the climate change crisis. The research draws upon data from OECD countries spanning the period between 1990 and 2020, utilizing robust econometric techniques to assess data properties. The study utilizes a comprehensive CS-ARDL model, incorporating multiple control variables like non-renewable energy GDP, foreign direct investment (FDI), and research and development (R&D). The results show that environmental policy and energy transitions are effective in reducing climate change impacts in the form of CO2 emissions. The non-environmental factors like GDP and FDI are positively associated and thereby accelerate climate change processes, whereas R&D promotes environmental protection by reducing CO2 emissions. Based on these findings, the study advocates for the implementation of rigorous policy measures by OECD economies to strengthen and enforce environmental policies to ensure compliance and foster sustainable practices across sectors. The study also suggests that OECD must promote energy transitions by investing in renewable energy sources at the mass level (micro and macro) and phasing out reliance on non-renewable energy.

The impact of the national volume-based procurement policy on the use of policy-related drugs in Nanjing: an interrupted time-series analysis.

BACKGROUND: In September 2019, the "4 + 7" centralized procurement pilot program was expanded nationwide aiming at reducing drug prices by means of volume-based procurement and using accredited generic drugs for branded drug substitutes. Given the current uncertain effect of the policy outside pilot areas, this study was conducted to evaluate the impact of the National Volume-based Procurement policy on the use of policy-related drugs after expansion. METHOD: A single-group interrupted time series was applied using drug purchase data, covering 25 months from December 2018 to December 2020. Drugs related to the centralized procurement policy were selected as samples, including 25 first-batch policy-related drugs and 56 alternative drugs. Centralized procured drugs can be divided into bid-winning and non-winning products, where non-winning products were sorted into generic and branded drugs, and alternative products were classified according to different degrees of substitution. Purchase volume, expenditures, and daily costs were measured. RESULTS: After the implementation of the policy, a significant increase was associated with the volume of bid-winning drugs (p < 0.001) and the volume of generic and branded drugs decreased immediately. The DDDc of drugs under the same generic name significantly reduced (an instantaneous drop of bid-winning drugs by approximately 25%, 7.62 CNY for generics and 3.07 CNY for branded drugs), saving 48.2 million CNY of drug expenditures. The policy has a significant effect on the drug for the treatment of cardiovascular diseases and exerted little influence on the drug for the treatment of nervous diseases, and the substitution of generics for antitumor-branded drugs was not obvious. In addition, the procurement volume of alternative drugs appeared to be a "carry-over". CONCLUSIONS: These findings indicated that the policy demonstrated positive effects in terms of price reductions and cost savings and accelerated the substitution of generics against branded drugs. The "patent cliff" for branded drugs has gradually emerged. Besides, a short-term "spillover effect" of the volume of alternative drugs was observed, requiring special attention and vigilance.

Diagnostic accuracy of the 3-minute diagnostic interview for confusion assessment method-defined delirium in delirium detection: a systematic review and meta-analysis.

BACKGROUND: Delirium is a common complication clinically and is associated with the poor outcomes, yet it is frequently unrecognised and readily disregarded. Although the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM) has been used in a variety of care settings, a comprehensive evaluation of its accuracy in all available care settings has not been performed. OBJECTIVE: This study aimed to evaluate the diagnostic test accuracy of the 3D-CAM in delirium detection through a systematic review and meta-analysis. METHODS: We systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL (EBSCO) and ClinicalTrials.gov published from inception to 10 July 2022. The quality assessment of the diagnostic accuracy studies-2 tool was applied to evaluate methodological quality. A bivariate random effects model was used to pool sensitivity and specificity. RESULTS: Seven studies with 1,350 participants and 2,499 assessments were included, which were carried out in general medical wards, intensive care units, internal medical wards, surgical wards, recovery rooms and post-anaesthesia care units. The prevalence of delirium ranged from 9.1% to 25%. The pooled sensitivity and specificity were 0.92 (95% confidence interval [CI] 0.87-0.95) and 0.95 (95% CI 0.92-0.97), respectively. The pooled positive likelihood ratio was 18.6 (95% CI 12.2-28.2), the negative likelihood ratio was 0.09 (95% CI 0.06-0.14) and the diagnostic odds ratio was 211 (95% CI 128-349). Moreover, the area under the curve was 0.97 (95% CI 0.95-0.98). CONCLUSIONS: The 3D-CAM has good diagnostic accuracy for delirium detection in different care settings. Further analyses illustrated that it had comparable diagnostic accuracy in older adults and patients with dementia or known baseline cognitive impairment. In conclusion, the 3D-CAM is recommended for clinical delirium detection.

A GBD 2019 study of health and Sustainable Development Goal gains and forecasts to 2030 in Spain.

This study aimed to report mortality, risk factors, and burden of diseases in Spain. The Global Burden of Disease, Injuries, and Risk Factors 2019 estimates the burden due to 369 diseases, injuries, and impairments and 87 risk factors and risk factor combinations. Here, we detail the updated Spain 1990-2019 burden of disease estimates and project certain metrics up to 2030. In 2019, leading causes of death were ischaemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer's disease, and lung cancer. Main causes of disability adjusted life years (DALYs) were ischaemic heart disease, diabetes, lung cancer, low back pain, and stroke. Leading DALYs risk factors included smoking, high body mass index, and high fasting plasma glucose. Spain scored 74/100 among all health-related Sustainable Development Goals (SDGs) indicators, ranking 20 of 195 countries and territories. We forecasted that by 2030, Spain would outpace Japan, the United States, and the European Union. Behavioural risk factors, such as smoking and poor diet, and environmental factors added a significant burden to the Spanish population's health in 2019. Monitoring these trends, particularly in light of COVID-19, is essential to prioritise interventions that will reduce the future burden of disease to meet population health and SDG commitments.

Risk assessment and dose-effect of co-exposure to benzene, toluene, ethylbenzene, xylene, and styrene (BTEXS) on pulmonary function: A cross-sectional study.

Inhalation is the most frequent route and the lung is the primary damaged organ for human exposure to benzene, toluene, ethylbenzene, xylene, and styrene (BTEXS). However, there is limited information on the risk and dose-effect of the BTEXS mixture on pulmonary function, particularly the overall effect. We conducted a cross-sectional study in a petrochemical plant in southern China. Spirometry and cumulative exposure dose (CED) of BTEXS were used to measure lung function and exposure levels for 635 workers in 2020, respectively. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were tested and interpreted as percentages to predicted values [FVC or FEV1% predicted], and FEV1 to FVC ratio [FEV1/FVC (%)]. We found the reduction in FVC% predicted and the risk of lung ventilation dysfunction (LVD) and its two subtypes (mixed and restrictive ventilation dysfunction, MVD, and MVD) were significantly associated with BTEXS individuals. In addition, pulmonary function damage associated with BTEXS was modified by the smoking status and age. Generalized weighted quantile sum (gWQS) regressions were used to estimate the overall dose-effect on lung function damage induced by the BTEXS mixture. Our results show wqs, an index of weighted quartiles for BTEXS, was potentially associated with the reduction in FVC and FEV1% predicted with the coefficients [95% confidence intervals (CI)] between -1.136 (-2.202, -0.070) and -1.230 (-2.265, -0.195). Odds ratios (ORs) and 95% CIs for the wqs index of LVD, MVD, and RVD were 1.362 (1.129, 1.594), 1.323 (1.084, 1.562), and 1.394 (1.096, 1.692), respectively. Furthermore, xylene, benzene, and toluene in the BTEXS mixture potentially contribute to the development of lung function impairment. Our novel findings demonstrated the dose-response relationships between pulmonary function impairment and the BTEXS mixture and disclosed the potential key pollutants in the BTEXS mixture.

Synergistic optimization of syngas quality and heavy metal immobilization during continuous microwave pyrolysis of sludge: Competitive relationships, reaction mechanisms, and energy efficiency assessment.

To realize the efficient resource utilization of sewage sludge, this work explored the competitive relationship and reaction mechanisms between syngas quality optimization and heavy metals (HMs) immobilization. The results showed that continuous microwave pyrolysis (CMP) technology with an instantaneous temperature increase could shorten the pyrolysis time, and the biogas yield and syngas concentration reached 51.68 wt% and 83.6 vol%, respectively. Although a higher pyrolysis (750 °C) temperature could optimize the syngas quality, the HMs immobilization efficiency was reduced due to the deep pyrolysis of the biochar. The moderate pyrolysis temperature (650 °C) facilitated the rapid formation of biochar with abundant surface functional groups and pore structure, thus enhancing HMs immobilization. Furthermore, the HMs could also form more stable crystalline compounds with inorganic components (SiO2, Al2O3, inorganic sulfur). By optimizing the process parameters, the risk factor of HMs in the sludge decreased from 117.36 to 62.5 while obtaining high-quality syngas. The energy utilization efficiency of microwave pyrolysis also increased significantly from 11.20% to 82.01%. This work provided new insight into the efficient resource utilization and environmentally friendly treatment of sludge, and demonstrated that CMP technology has significant potential for future industrial applications as an alternative to traditional pyrolysis.

Two-Dimensional Negative Thermal Expansion in a Facile and Low-Cost Oxalate-Based Metal-Organic Framework.

Two-dimensional negative thermal expansion (NTE) is achieved in a tetragonal oxalate-based metal-organic framework (MOF), CdZrSr(C2O4)4, within a temperature range from 123 to 398 K [space group I4̅m2, αa = -2.4(7) M K-1, αc = 11.3(3) M K-1, and αV = 6.4(1) M K-1]. By combining variable-temperature X-ray diffraction, a high-resolution synchrotron X-ray pair distribution function, and thermogravimetry-differential scanning calorimetry, we shows that NTE within the ab plane derives from the oriented rotation of an oxalate ligand in zigzag chains (-CdO8-ox-ZrO8-ox-)∞. That is simplified to the Zr atom rotating with an unchanged Zr···Cd distance as the radius, which also gives rise to the deformation of a hingelike connection along the c axis and results in its positive thermal expansion. By virtue of the facile and low-cost oxalate ligand, the present NTE MOF may show application prospects in the future.

Incidence, prevalence and disability associated with neurological disorders in Italy between 1990 and 2019: an analysis based on the Global Burden of Disease Study 2019.

BACKGROUND: Neurological conditions are highly prevalent and disabling, in particular in the elderly. The Italian population has witnessed sharp ageing and we can thus expect a rising trend in the incidence, prevalence and disability of these conditions. METHODS: We relied on the Global Burden of Disease 2019 study to extract Italian data on incidence, prevalence and years lived with a disability (YLDs) referred to a broad set of neurological disorders including, brain and nervous system cancers, stroke, encephalitis, meningitis, tetanus, traumatic brain injury, and spinal cord injury. We assessed changes between 1990 and 2019 in counts and age-standardized rates. RESULTS: The most prevalent conditions were tension-type headache, migraine, and dementias, whereas the most disabling were migraine, dementias and traumatic brain injury. YLDs associated with neurological conditions increased by 22.5%, but decreased by 2.3% in age-standardized rates. The overall increase in prevalence and YLDs counts was stronger for non-communicable diseases with onset in old age compared to young to adult-age onset ones. The same trends were in the opposite direction when age-standardized rates were taken into account. CONCLUSIONS: The increase in YLDs associated with neurological conditions is mostly due to population ageing and growth: nevertheless, lived disability and, as a consequence, impact on health systems has increased. Actions are needed to improve outcome and mitigate disability associated with neurological conditions, spanning among diagnosis, treatment, care pathways and workplace interventions.

Taccachatrones A-G, Highly Oxidized Steroids from the Rhizomes of Tacca chantrierii and Their Cytotoxicity Assessment.

Seven highly oxidized steroids, taccachatrones A-G (1-7), together with four known taccalonolides (8-11), were characterized from the rhizomes of Tacca chantrieri. The structures of 1-7 were established on the basis of spectroscopic data analysis, while the absolute configurations were determined by single-crystal X-ray diffraction. Compounds 1-4 may be derived from taccalonolide derivatives by the degradation of three carbon atoms. Compounds 7, 8, 10, and 11 exhibited cytotoxicity to human cancer cell lines, indicating that the presence of a lactone moiety, as well as a double bond between C-22 and C-23, might play key roles in mediating their cytotoxicity.

Hotspot detection and socio-ecological factor analysis of asthma hospitalization rate in Guangxi, China.

BACKGROUND: Asthma is a major public health concern throughout the world. Numerous researches have shown that the spatial-temporal patterns of asthma are inconsistent, leading to the suggestion that these patterns are determined by multiple factors. This study aims to detect spatial-temporal clusters of asthma and analyze socio-ecological factors associated with the asthma hospitalization rate in Guangxi, China. METHODS: Asthma hospitalization and socio-ecological data for 88 counties/municipal districts in Guangxi, China in 2015 was collected. Space-time scan statistics were applied to identify the high-risk periods and areas of asthma hospital admissions. We further used GeoDetector and Spearman correlation coefficient to investigate the socio-ecological factors associated with the asthma hospitalization rates. RESULTS: There were a total of 7804 asthma admissions in 2015. The high-risk period was from April to June. The age groups of 0-4 and ≥65 years were both at the highest risk, with hospital admission rates of 45.0/105 and 46.5/105, respectively. High-risk areas were found in central and western Guangxi with relative risk (RR) values of asthma hospitalizations greater than 2.0. GDP per capita and altitude were positively associated with asthma hospitalizations, while air pressure and wind speed had a negative association. The explanatory powers of these factors (i.e., GDP per capita, altitude, air pressure, wind speed) were 22%, 20%, 14% and 10%, respectively. CONCLUSIONS: The GDP per capita appears to have the strongest correlation with asthma hospitalization rates. High-risk areas were identified in central and western Guangxi characterized by high GDP per capita. These findings may be helpful for authorities developing targeted asthma prevention policies for high-risk areas and vulnerable populations, especially during high-risk periods.

[Influence of Land Use Change on Ecosystem Service Value Based on GEE in the Beijing-Tianjin-Hebei Region from 1998 to 2018].

In sustainable development assessment of the Beijing-Tianjin-Hebei region, the ability to dynamically estimate the value of ecosystem services is of great significance. This study considers the Beijing-Tianjin-Hebei region as the research area, based on the google earth engine (GEE); the classification and decision tree (CART) classification algorithm was adopted to supervise and classify the Landsat Thematic Mapper/Operational Land Imager (TM/OLI) images in the study area in 1998, 2003, 2008, 2013, and 2018, and land use types in these five periods were obtained. Quantitative analysis of the dynamic changes of land use in the Beijing-Tianjin-Hebei region from 1998 to 2018 was carried out. Then, the ecosystem service value (ESV) equivalent estimation method was used to quantitatively estimate the ESV in the Beijing-Tianjin-Hebei region and combine it with a 15 km×15 km scale grid to detect its temporal and spatial dynamics. The main results were as follows. ① From 1998 to 2018, the area of construction land (increased by 16.67%) and grassland (reduced by 13.73%) in the six land use types in the Beijing-Tianjin-Hebei region was the largest, and the change in the proportion of water bodies (0.2%) was the smallest. ② The total value of ESV in the Beijing-Tianjin-Hebei region experienced a short-term increase from 1998 to 2003 (an increase of 91.97×108 yuan), and continued to decrease from 2003 to 2018 (a decrease of 239.07×108 yuan), mainly related to the expansion of construction land area in the other three time periods excluding 1998 and 2003. Among the six land use types, the forest provides the highest value of ecosystem services, and the construction land and unused land provide the lowest value of ecosystem services. ③ The ESV time-space analysis based on the 15 km×15 km scale grid showed that the ESV medium area in the Beijing-Tianjin-Hebei region gradually decreased from 1998 to 2018, the ESV lower area and the higher area gradually increased, and the ESV lower-area growth rate was higher than for the higher area. ④ The revised value of the Beijing-Tianjin-Hebei region (sensitivity coefficient range 0-0.83) has good significance and reliability. In future economic development, the Beijing-Tianjin-Hebei region should rationally optimize the land use pattern and strengthen the protection of forest land, grassland, water bodies and cultivated land.

A geometric design method for intersections with pre-signal systems using a phase swap sorting strategy.

Conventional geometric design methods for pre-signal systems usually use the expected traffic demand, which may obtain a short sorting area distance and lead to frequent queue spillbacks due to stochastic traffic arrivals. On the other hand, if one selects a longer sorting area distance, the geometric design will suffer from low spatial utilization with higher delay and lower capacity. In this paper, we propose a geometric design method for intersections with pre-signal systems using a phase swap strategy. The geometric design can balance the desire of storing more vehicles to prevent spillbacks and improve the spatial utilization of the road. We model the traffic dynamic within the pre-signal system using queue theory and shockwave theory to determine the furthest point a queue can reach. The length of the pre-signal system should be short enough to improve spatial utilization but longer than the furthest point of the queue to prevent queue spillback. The effectiveness of the pre-signal system is evaluated by the VISSIM Signal Control Application Programming Interfaces (SCAPI). The results indicate that the proposed design plan increases the spatial utilization of the pre-signal system by 7.5% while maintaining a similar delay, queue length and ratio of flow to saturation flow.