Treatment Preference for Alzheimer's Disease: A Multicriteria Decision Analysis with Caregivers, Neurologists, and Payors.

INTRODUCTION: Alzheimer's disease (AD) is a chronic neurodegenerative disorder associated with a high burden of illness. New therapies under development include agents that target amyloid-beta (Aß), a key component in AD pathogenesis. Understanding the decision-making process for new AD drugs would help determine if such therapies should be adopted by society. Multicriteria decision analysis (MCDA) was applied to three key stakeholder groups to assess treatment alternatives for AD based on a multitude of decision trade-offs covering main components of care. METHODS: AD caregivers (n = 117), neurologists (n = 90), and payors (n = 90) from the USA received an online survey. The decision problem was broken down into four decision criterion and 12 subcriteria for two treatment scenarios: an Aß-targeted therapy vs. the standard of care (SOC). Respondents were asked to indicate how much they preferred one option over another on a scale from 1 (equal preference) to 9 (high preference) based on each criterion and subcriterion. The decision criteria and subcriteria were weighted and presented as partial utility scores (pUS), with higher scores suggesting an increased preference for that decision-making component. RESULTS: Caregivers and payors applied the highest value to need for intervention (mean pUS = 0.303 and 0.259) and clinical outcomes (mean pUS = 0.286 and 0.377). In contrast, neurologists placed the highest value on clinical outcomes and types of benefits (mean pUS = 0.436 and 0.248). When decision subcriteria were examined, efficacy (mean pUS = 0.115, 0.219, and 0.166) and the type of patient benefits (mean pUS = 0.135, 0.178, and 0.126) were among the most valued by caregivers, neurologists, and payors. CONCLUSION: All groups placed the highest value on drug efficacy and types of benefit derived by patients. In contrast, cost implications were among the least important aspects in their decision-making.

Can Inbound Tourism Improve Regional Ecological Efficiency? An Empirical Analysis from China.

Inbound tourism has an important impact on regional eco-efficiency. This paper uses the panel data of 31 provincial administrative units in China from 2005 to 2019; uses the improved DEA model to measure the regional ecological efficiency; and uses the panel threshold model to investigate input, output, and efficiency from the perspective of green technology innovation. Then, it explores the heterogeneous effects of inbound tourism on ecological efficiency. This paper finds that cross-border tourism has a positive impact on the ecological efficiency of tourist destinations. However, the degree of influence varies and will be changed with the level of regional green innovation. The main conclusions are as follows: (1) From an overall perspective, inbound tourism has a significant positive effect on ecological efficiency. (2) With the increase in green innovation investment and output, the promotion effect of inbound tourism on regional ecological efficiency first increases and then decreases. (3) The higher the green innovation efficiency, the greater the promotion effect of inbound tourism on ecological efficiency. Therefore, the Chinese government should encourage the development of inbound tourism, adopt greener innovative technologies that are cleaner and more environmentally friendly, and enhance the welfare effect of tourism on green economy.

Spatial-Temporal Characteristics and Driving Factors of the Eco-Efficiency of Tourist Hotels in China.

At present, COVID-19 is seriously affecting the economic development of the hotel industry, and at the same time, the world is vigorously calling for "carbon emission mitigation". Under these two factors, tourist hotels are in urgent need of effective tools to balance economic and social contributions with ecological and environmental impacts. Therefore, this paper takes Chinese tourist hotels as the research object and constructs a research framework for Chinese tourist hotels by constructing a Super-SBM Non-Oriented model. We measured the economic efficiency and eco-efficiency of Chinese tourist hotels from 2000 to 2019; explored spatial-temporal evolution patterns of their income, carbon emissions, eco-efficiency, and economic efficiency through spatial hotspot analysis and center of gravity analysis; and identified the spatial agglomeration characteristics of such hotels through the econometric panel Tobit model to identify the different driving factors inside and outside the tourist hotel system. The following results were obtained: (1) the eco-efficiency of China's tourist hotels is higher than the economic efficiency, which is in line with the overall Kuznets curve theory, but the income and carbon emissions have not yet been decoupled; (2) most of China's tourist hotels are crudely developed with much room for improving the economic efficiency, and most of the provincial and regional tourist hotels are at a low-income level, but the carbon emissions are still on the increase; and (3) income, labor, carbon emissions, waste emissions, and water consumption are the internal drivers of China's tourist hotels, while industrial structure, urbanization rate, energy efficiency, and information technology are the external drivers of China's tourist hotels. The research results provide a clear path for the reduction in carbon emissions and the improvement of the eco-efficiency of Chinese tourist hotels. Under the backdrop of global climate change and the post-COVID-19 era, the research framework and conclusions provide references for countries with new economies similar to China and countries that need to quickly restore the hotel industry.

Assessment of the Redox Characteristics of Iron Ore by Introducing Biomass Ash in the Chemical Looping Combustion Process: Biomass Ash Type, Constituent, and Operating Parameters.

Chemical looping combustion (CLC) is a potential CO2 capture and sequestration (CCS) technology that can easily separate CO2 and H2O without energy loss and greatly improve the efficiency of carbon capture. Due to the inherent defects of natural iron ore, such as low reactivity and poor oxygen carrying capacity, four kinds of biomass ashes (rape stalk ash, rice stalk ash, platane wood ash, and U. lactuca ash) that have different constituents of K, Na, Ca, and Si were applied to modify the redox performance of natural iron ore. The effects of biomass ash type, constituent, reaction temperature, H2O vapor flow rate, and redox cycle on the CLC process were assessed experimentally in a batch fluidized bed reactor system. Oxygen carrier physicochemical characteristics were determined by several analytical techniques. The results showed that rape stalk ash, platane wood ash, and U. lactuca ash with a high K content and high K/Si ratio significantly improved the reactivity and cycle stability of iron ore, even after 10 redox cycles, while rice straw ash with a low K/Si ratio showed an inhibitory effect due to the formation of bridge eutectics, which enhanced agglomeration. In a range from 800 to 950 °C, higher temperatures led to a much better ability to promote the CLC process than lower temperatures. A higher flow rate of H2O had little effect on the further promotion of the CLC process due to hydrogen inhibition. It is believed that the application of BA-modified iron ore oxygen carriers is an effective strategy to improve the CLC process.

Quantitative risk assessment of storm surge using GIS techniques and open data: A case study of Daya Bay Zone, China.

Storm surge is a natural disaster, often causing economic damage and loss of human life in the coastal communities. In recent decades, with more people attracted to coastal areas, the potential economic losses resulted from storm surges are increasing. Therefore, it is important to make risk assessments to identify areas at risk and design risk reduction strategies. However, the quantitative risk assessment of storm surge for coastal cities in China is often difficult due to the lack of adequate data regarding the building footprint and vulnerability curves. This paper aims to provide a methodology for conducting the quantitative risk assessment of storm surge, estimating direct tangible damage, by using Geographical Information System (GIS) techniques and open data. The proposed methodology was applied to a coastal area with a high concentration of petroleum industries in the Daya Bay zone. At first, five individual typhoon scenarios with different return periods (1000, 100, 50, 20, and 10 years) were defined. Then, the Advanced Circulation model and the Simulating Waves Nearshore model were utilized to simulate storm surge. The model outputs were imported into GIS software, transformed into inundation area and inundation depth. Subsequently, the building footprint data were extracted by the use of GIS techniques, including spatial analysis and image analysis. The layer containing building footprints was superimposed on the inundation area layer to identify and quantify the exposed elements to storm surge hazard. Combining the exposed elements with their related depth-damage functions, the quantitative risk assessment translates the spatial extent and depth of storm surge into the estimation of economic losses. The quantitative risk assessment and zonation maps for sub-zones in the study area can help local decision-makers to prioritize the sub-zones that are more likely to be affected by storm surge, make risk mitigation strategies, and develop long-term urban plans.

The main factors affecting Taiwan's economic growth rate via dynamic grey relational analysis.

Ever since the grey system theory was proposed about 40 years ago, its characteristics such as small samples, few data, and uncertainty have been used for study in the literature with increasingly wider scope. Recent studies on grey relation analysis have included static data analyses, and most of them have adopted initial values with only a relational order. Under the same study conditions, if different data preprocessing methods are used, then the relational order will be ranked differently. This study took Taiwan as the object to explore seven economic indices (birth rate (%), Taiwan's total population (thousand people), unemployment rate (%), income per capita (USD), weighted average interest rate on deposits (%), Consumer Price Index (CPI), and national income (NI)) and how they affect the economic growth rate. The traditional static grey relational analysis treated the collected data with taking consideration of time effect which is irrational under some circumstance. An innovative dynamic grey relational analysis was carried out by shifting the raw data due to the time leading or lagging effect which is a mean to improve the capability of traditional grey relational analysis. The differences in analyses between static grey relational analysis and dynamic grey relational analysis via different data preprocessing methods were further discussed, finding that different data preprocessing methods generated a new set of relational orders through the latter. Finally, the prosperity index was used to identify the effects of all factors on economic growth (leading, synchronization, and lagging indices).

Assessment of the optimal cutoff value of fasting plasma glucose to establish diagnosis of gestational diabetes mellitus in Chinese women.

Our aim is to assess the optimal cutoff value of fasting plasma glucose (FPG) in Chinese women at 24-28 weeks' gestation by performing oral glucose tolerance test (OGTT) to improve diagnostic rate of gestational diabetes mellitus (GDM). Data were derived from the Medical Birth Registry of Xiamen. A FPG cutoff value of 5.1 mmol/L confirmed the diagnosis of GDM in 4,794 (6.10%) pregnant women. However, a FPG cutoff value of 4.5 mmol/L should rule out the diagnosis of GDM in 35,932 (45.73%) pregnant women. If we use this cutoff value, the diagnosis of GDM to about 27.3% of pregnant women will be missed. Additionally, a 75-g OGTT was performed in pregnant women with FPG values between 4.5 and 5.1 mmol/L, avoiding the performance of formal 75-g OGTT in about 50.37% pregnant women. Meanwhile, according to maternal age and pre-pregnancy BMI categories, with FPG values between 4.5 mmol/L and 5.1 mmol/L, which had high sensitivity, to improve the diagnostic rate of GDM in all groups. Further researches are needed to present stronger evidences for the screening value of FPG in establishing the diagnosis of GDM in pregnant women.

Comparison of Physician Visual Assessment With Quantitative Coronary Angiography in Assessment of Stenosis Severity in China.

Importance: Although physician visual assessment (PVA) of stenosis severity is a standard clinical practice to support decisions for coronary revascularization, there are concerns about its accuracy. Objective: To compare PVA with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China. Design, Setting, and Participants: A cross-sectional study (2012-2013) of a random subset of 1295 patients from the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Prospective PCI Study was carried out. The PEACE Prospective PCI study recruited a consecutive sample of patients undergoing PCI at 35 hospitals in 18 provinces of China. The coronary angiograms of this subset of participants were reviewed using QCA by 2 independent core laboratories blinded to PVA readings. Main Outcomes and Measures: Differences between PVA and QCA assessments of stenosis severity for lesions for which PCI was performed and variation of these differences among hospitals and physicians, stratified by the diagnosis of acute myocardial infarction (AMI). Results: In patients without AMI, the mean (SD) age was 62 (10) years, and 217 (31.5%) were women; in patients with AMI, the mean (SD) age was 60 (11) years, and 153 (25.2%) were women. The mean (SD) percent diameter stenosis by PVA was 16.0% (11.5%) greater than that by QCA in patients without AMI and 10.2% (12.3%) in those with AMI (P < .001 for both comparisons). In patients without AMI, of 837 lesions with 70% or more stenosis by PVA, 427 (50.6%) were less than 70% by QCA; in patients with AMI, similar patterns were observed to a lesser extent. Among patients without AMI, only 4 (0.47%) lesions were additionally assessed with fractional flow reserve. Among 30 hospitals, the difference between PVA and QCA readings of stenosis severity varied from 7.6% (95% CI, 0.4%-14.7%) to 21.3% (95% CI, 17.1%-24.9%) among non-AMI patients. Across 57 physicians, this difference varied from 6.9% (95% CI, -1.4%-15.3%) to 26.4% (95% CI, 21.5%-31.4%). Conclusions and Relevance: For coronary lesions treated with PCI in China, PVA reported substantially higher readings of stenosis severity than QCA, with large variation across hospitals and physicians. These findings highlight the need to improve the accuracy of information used to guide treatment decisions in catheterization laboratories.

Treatment Intensification for Hypertension in US Ambulatory Medical Care.

BACKGROUND: Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all-cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care. METHODS AND RESULTS: Using the nationally representative National Ambulatory Medical Care Survey (2005-2012) and National Hospital Ambulatory Medical Care Survey (2005-2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005-2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2-7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time. CONCLUSIONS: US hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension-related morbidity and mortality nationwide.

Physical activity to overcome the adversity of widowhood: Benefits beyond physical health.

Widowhood has been increasingly encountered because of increasing longevity of women, often characterized by social stigmatization and poor physical and mental health. However, applied research to overcome its adversity has been quite limited. The goal of this study is to explore the role of physical activity in improving the health of widows.A cohort of 446,582 adults in Taiwan who successively participated in a comprehensive medical screening program starting in 1994, including 232,788 women, was followed up for mortality until 2008. Each individual provided detailed health history, and extensive lab tests results.The number of widows increased with time trend. Every other woman above age 65 was a widow (44%). Widows were less active, more obese, and smoked and drank more, had sleep problems, were more depressed with taking sedatives or psychoactive drugs, leading to more suicides. In the global development of health policies by World Health Organization (WHO), physical activity is one of the main factors to reverse poor health. The poor health of inactive widow was mitigated when becoming fully active in this study. Exercise not only reduced the observed 18% increase in all-cause mortality, but also gained 4 years and as much as 14% mortality advantage over the married but inactive. More importantly, becoming physically active energized their mental status, improved sleep quality and quantity, reduced depressions and the need for psychoactive drugs, and increased socialization circles.Widows, a rapidly growing and socially stigmatized group, suffered from social and financial inequality and tended to develop poorer health. Sustained physical activity could be one of the ways for them to overcome and reverse some of the physical and mental adversities of widowhood, and improve their quality and quantity of life.

Prompt Oseltamivir Therapy Reduces Medical Care and Mortality for Patients With Influenza Infection: An Asian Population Cohort Study.

There are limited population-based studies on the progress of oseltamivir therapy for influenza infection.Using insurance claims data of 2005, 2009, and 2010, the authors established an "in-time" cohort and a "lag-time" cohort representing influenza patients taking the medicine within and not within 1 week to examine the treatment progress. Incident outpatient visit, emergency care and hospitalization, and fatality were compared between the 2 cohorts in the first week and the second week of follow-up periods, after the oseltamivir therapy.A total of 112,492 subjects diagnosed with influenza on oseltamivir therapy in 2005, 2009, and 2010 were identified. The multivariate logistic regression analysis showed that the in-time treatment was superior to the lag-time treatment with less repeat outpatient visits, hospitalizations, and fatality. The overall corresponding in-time treatment to lag-time treatment odds ratios (OR) were 0.50, 0.54, and 0.71 (all P value < 0.05), respectively. The in-time to lag-time ORs of all events were 0.50 in 2009 and 0.54 in 2010.Our study demonstrates that the in-time oseltamivir therapy leads to significantly better treatment outcomes. Oseltamivir should be administered as early as the onset of influenza symptoms appears.