A single-center, retrospective study of hospitalized patients with lower respiratory tract infections: clinical assessment of metagenomic next-generation sequencing and identification of risk factors in patients.

INTRODUCTION: Lower respiratory tract infections(LRTIs) in adults are complicated by diverse pathogens that challenge traditional detection methods, which are often slow and insensitive. Metagenomic next-generation sequencing (mNGS) offers a comprehensive, high-throughput, and unbiased approach to pathogen identification. This retrospective study evaluates the diagnostic efficacy of mNGS compared to conventional microbiological testing (CMT) in LRTIs, aiming to enhance detection accuracy and enable early clinical prediction. METHODS: In our retrospective single-center analysis, 451 patients with suspected LRTIs underwent mNGS testing from July 2020 to July 2023. We assessed the pathogen spectrum and compared the diagnostic efficacy of mNGS to CMT, with clinical comprehensive diagnosis serving as the reference standard. The study analyzed mNGS performance in lung tissue biopsies and bronchoalveolar lavage fluid (BALF) from cases suspected of lung infection. Patients were stratified into two groups based on clinical outcomes (improvement or mortality), and we compared clinical data and conventional laboratory indices between groups. A predictive model and nomogram for the prognosis of LRTIs were constructed using univariate followed by multivariate logistic regression, with model predictive accuracy evaluated by the area under the ROC curve (AUC). RESULTS: (1) Comparative Analysis of mNGS versus CMT: In a comprehensive analysis of 510 specimens, where 59 cases were concurrently collected from lung tissue biopsies and BALF, the study highlights the diagnostic superiority of mNGS over CMT. Specifically, mNGS demonstrated significantly higher sensitivity and specificity in BALF samples (82.86% vs. 44.42% and 52.00% vs. 21.05%, respectively, p < 0.001) alongside greater positive and negative predictive values (96.71% vs. 79.55% and 15.12% vs. 5.19%, respectively, p < 0.01). Additionally, when comparing simultaneous testing of lung tissue biopsies and BALF, mNGS showed enhanced sensitivity in BALF (84.21% vs. 57.41%), whereas lung tissues offered higher specificity (80.00% vs. 50.00%). (2) Analysis of Infectious Species in Patients from This Study: The study also notes a concerning incidence of lung abscesses and identifies Epstein-Barr virus (EBV), Fusobacterium nucleatum, Mycoplasma pneumoniae, Chlamydia psittaci, and Haemophilus influenzae as the most common pathogens, with Klebsiella pneumoniae emerging as the predominant bacterial culprit. Among herpes viruses, EBV and herpes virus 7 (HHV-7) were most frequently detected, with HHV-7 more prevalent in immunocompromised individuals. (3) Risk Factors for Adverse Prognosis and a Mortality Risk Prediction Model in Patients with LRTIs: We identified key risk factors for poor prognosis in lower respiratory tract infection patients, with significant findings including delayed time to mNGS testing, low lymphocyte percentage, presence of chronic lung disease, multiple comorbidities, false-negative CMT results, and positive herpesvirus affecting patient outcomes. We also developed a nomogram model with good consistency and high accuracy (AUC of 0.825) for predicting mortality risk in these patients, offering a valuable clinical tool for assessing prognosis. CONCLUSION: The study underscores mNGS as a superior tool for lower respiratory tract infection diagnosis, exhibiting higher sensitivity and specificity than traditional methods.

Geographical traceability of flavor compounds in Chinese mitten crab (Eriocheir sinensis): Implications for quality differentiation, authenticity assessment, and mechanism research.

Geographical traceability plays a crucial role in ensuring quality assurance, brand establishment, and the sustainable development of the crab industry. In this study, we examined the possibility of using gas chromatography-ion mobility spectrometry with multivariate statistical authenticity analysis to identify the origin of crabs from five sites downstream of the Yangtze River. Significant variations were observed in the levels of alcoholic flavor compounds in the hepatopancreas and muscles of crabs from different geographical locations, and a support vector machine exhibited discriminant ability with 100% accuracy. These flavor variations exhibited significant correlations with the types and concentrations of elements within the crabs, as well as with free amino acids. This study offers a practical approach for determining the geographical traceability of Chinese mitten crabs and elucidates the role of elements in flavor modulation, thereby providing innovative strategies to enhance the efficiency of crab farming.

Environment-Sensitive Fluorescent Probe Enables Assessment of Anaplastic Lymphoma Kinase Activity in Nonsmall Cell Lung Cancer.

Anaplastic lymphoma kinase (ALK) rearrangements have been identified as key oncogenic drivers of a subset of nonsmall cell lung cancer (NSCLC). The final chimeric protein of the fusion gene can be constitutively activated, which accounts for the growth and proliferation of ALK-rearranged tumors and thus strongly associates with cancer invasion and metastasis. Diagnostic tools enabling the visualization of ALK activity in a structure-function-based approach are highly desirable to determine ALK status and guide ALK tyrosine kinase inhibitor (ALK-TKI) treatment making. Here, we describe the design, synthesis, and application of a new environment-sensitive fluorescent probe HX16 by introducing an environment-sensitive fluorophore 4-sulfonamidebenzoxadiazole to visualize ALK activity in living cancer cells and tumor tissue slices (mouse model and human biopsy sample). HX16 is a multifunctional chemical tool based on the pharmacophore of ALK-TKI (ceritinib) and can specifically target the kinase domain of ALK with a high sensitivity. Using flow cytometry and confocal microscopy, HX16 enables visualization of ALK activity in various cancer cells with distinct ALK fusion genes, as well as xenograft mouse models. Importantly, HX16 was also applied to visualize ALK activity in a tumor biopsy from a NSCLC patient with ALK-echinoderm microtubule-associated protein-like-4 fusion gene for prediction of ALK-TKI sensitivity. These results demonstrate that strategically designed ALK-TKI-based probe allows the assessment of ALK activity in tumor tissues and hold promise as a useful diagnostic tool in predicting ALK-TKI therapy response.

Revealing spatiotemporal inequalities, hotspots, and determinants in healthcare resource distribution: insights from hospital beds panel data in 2308 Chinese counties.

BACKGROUND: Ensuring universal health coverage and equitable access to health services requires a comprehensive understanding of spatiotemporal heterogeneity in healthcare resources, especially in small areas. The absence of a structured spatiotemporal evaluation framework in existing studies inspired us to propose a conceptual framework encompassing three perspectives: spatiotemporal inequalities, hotspots, and determinants. METHODS: To demonstrate our three-perspective conceptual framework, we employed three state-of-the-art methods and analyzed 10 years' worth of Chinese county-level hospital bed data. First, we depicted spatial inequalities of hospital beds within provinces and their temporal inequalities through the spatial Gini coefficient. Next, we identified different types of spatiotemporal hotspots and coldspots at the county level using the emerging hot spot analysis (Getis-Ord Gi* statistics). Finally, we explored the spatiotemporally heterogeneous impacts of socioeconomic and environmental factors on hospital beds using the Bayesian spatiotemporally varying coefficients (STVC) model and quantified factors' spatiotemporal explainable percentages with the spatiotemporal variance partitioning index (STVPI). RESULTS: Spatial inequalities map revealed significant disparities in hospital beds, with gradual improvements observed in 21 provinces over time. Seven types of hot and cold spots among 24.78% counties highlighted the persistent presence of the regional Matthew effect in both high- and low-level hospital bed counties. Socioeconomic factors contributed 36.85% (95% credible intervals [CIs]: 31.84-42.50%) of county-level hospital beds, while environmental factors accounted for 59.12% (53.80-63.83%). Factors' space-scale variation explained 75.71% (68.94-81.55%), whereas time-scale variation contributed 20.25% (14.14-27.36%). Additionally, six factors (GDP, first industrial output, local general budget revenue, road, river, and slope) were identified as the spatiotemporal determinants, collectively explaining over 84% of the variations. CONCLUSIONS: Three-perspective framework enables global policymakers and stakeholders to identify health services disparities at the micro-level, pinpoint regions needing targeted interventions, and create differentiated strategies aligned with their unique spatiotemporal determinants, significantly aiding in achieving sustainable healthcare development.

Quantitative benefit and risk assessment of arsenic and nutrient levels in tilapia products sold on Chinese e-commerce platforms.

E-commerce platforms have become a significant sales channel for processed tilapia products such as frozen tilapia fillets, pickled tilapia, and canned tilapia in China. As food safety issues are worldwide concerned, the imbalance between the nutritional benefits of fish and the risk of contamination has become a major constraint on fish consumption. Therefore, it is necessary to assess the safety of tilapia products sold on e-commerce platforms. We conducted a quantitative benefit-risk assessment of arsenic and nutrient levels for tilapia products sold on Chinese e-commerce platforms using the hazard quotient (HQ). A total of 147 tilapia products were collected from the central Chinese e-commerce platforms Tmall, Taobao, and Jingdong for arsenic determination. Arsenic concentrations in tilapia products ranged from 0.004 to 0.820 mg·kg-1. The inorganic arsenic content of tilapia products was lower than the national limit (0.1 mg·kg-1). One-way analysis of variance revealed that there was no significant difference in arsenic levels in tilapia products among different regions (p > 0.05), while there was a significant difference in product form, with canned tilapia containing significantly higher arsenic levels than frozen tilapia fillets and pickled tilapia fillets (p < 0.05). We conducted an aquaculture experiment to analyze the nutrient levels of tilapia. The mean value of EPA + DHA content of tilapia was 20.634 mg·100 g-1. The HQ values of tilapia products ranged from 0.004 to 0.736. In a word, the nutritional benefits of consuming tilapia products exceed the risk of arsenic exposure. These data can help demonstrate that tilapia products are low-risk, high-yield nutritious food and provide relevant safety recommendations for consumers purchasing processed tilapia products online.

Assessment of the benefits of essential fatty acids and risks associated with antimicrobial residues in aquatic products: A case study of Chinese mitten crab (Eriocheir sinensis).

Much attention has been given to the safety and quality of aquatic products, including consuming Chinese mitten crab (Eriocheir sinensis), which offers both nutritional benefits and toxicological risks. Eighteen sulfonamides, 9 quinolones and 37 fatty acids were analyzed in 92 crab samples from primary aquaculture provinces in China. Enrofloxacin and ciprofloxacin have been mentioned as typical antimicrobials occurring at the greatest concentrations (>100 µg/kg, wm). By use of an in vitro method, the proportions of enrofloxacin, ciprofloxacin and essential fatty acids (EFAs, DHA and EPA) in ingested nutrients were determined to be 12 %, none and 95 %, respectively. The risk-benefit quotient (HQ) between the adverse effects of antimicrobials and nutritional benefits of EFAs in crabs found that HQs based on data after digestion were significantly less (HQ = 0.0086) than that of the control group where no digestion occurred (HQ = 0.055). This result suggested that (1) there was less risk posed by antimicrobials due to the consumption of crab, and (2) ignoring the bioaccessible fraction of antimicrobials in crabs might overestimate risks to the health of humans due to dietary exposure. Meaning bioaccessibility can improve the accuracy of the risk assessment process. Realistic risk evaluation should be recommended to achieve a quantified assessment of the dietary risks and benefits of aquatic products.

Spatial Distribution, Contamination Assessment and Origin of Soil Heavy Metals in the Danjiangkou Reservoir, China.

Soil heavy metal contamination is crucial due to menacing food safety and mortal health. At present, with the fast advancement of urbanization and industrialization, heavy metals are increasingly released into the soil by anthropogenic activities, and the soil ecosystem contamination around the Danjiangkou Reservoir is directly associated with water quality security of the reservoir. In this paper, using 639 soil samples from the Danjiangkou Reservoir, Henan Province, China, we studied a variety of space distribution characteristics of heavy metals in soil. Geographic information system analysis (GIS), geo-accumulation index (Igeo), contamination factor (CF), principal component analysis (PCA) model, and positive matrix factorization (PMF) model were used together to recognize and quantify the distribution, contamination, and origin of heavy metals. We uncovered an exceptional variety of heavy metal concentrations among the tested soils: the mean arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), manganese (Mn), nickel (Ni), zinc (Zn), lead (Pb) and mercury (Hg) concentrations (14.54, 0.21, 18.69, 81.69, 898.42, 39.37, 79.50, 28.11, 0.04 mg/kg, respectively, in the topsoil (0-20 cm depth)), all exceed their background values. The mean Igeo value and CF values of these trace elements are both in descending order: Cd > Co > Mn > Ni > Pb > Zn > Cr > As > Hg. Cd was the highest contributor to the assessment of heavy metal pollution, with an average Igeo value over three, indicating that the study area is modestly contaminated by Cd. The PCA analysis and PMF model revealed three potential sources, including natural sources (PC1) for Cr, Co, Mn and Ni; agricultural sources (PC2) for Cd, Zn and Hg; and industrial emissions and transportation sources (PC3) for Pb. This study displays a map of heavy metal contamination in the eastern area topsoil of the Danjiangkou Reservoir, showing the most severe pollutant is Cd, which poses a threat to the water quality security of Danjiangkou Reservoir and provides a significant source identification for future contamination control.

Electricity price forecast based on the STL-TCN-NBEATS model.

Taking long-term high-frequency electricity price data as the research content, this paper proposes seasonal and trend decomposition using loess-temporal convolutional network-neural basis expansion analysis for an interpretable time series forecasting (STL-TCN-NBEATS) model to solve the problems of low forecast accuracy caused by high volatility, high frequency and nonlinearity and poor interpretability of the deep learning model. By comparing the forecast effects of the temporal convolutional network-long short-term memory (TCN-LSTM), LSTM and other models, the main conclusions are as follows: (1) The hybrid model, STL-TCN-NBEATS, selected in this paper can effectively solve the problem of low forecast accuracy after reasonable selection of model parameters. The evaluation indexes of the root mean square error (RMSE) and the mean absolute percentage error (MAPE) were 3.7441 and 4.5044, respectively, which were 3.1416 and 2.1336 lower than those of the second-best model (TCN-LSTM). Compared with the autoregressive integrated moving average model (ARIMA), the accuracy was improved by approximately 49.18% (RMSE) and 60.35% (MAPE). (2) The STL-TCN-NBEATS model has better feature extraction ability, so it can obtain higher forecast accuracy. Since the construction of the TCN introduces extended causal convolution and residual blocks, the deep learning network model has better processing ability and robustness for large sample time series. Moreover, the NBEATS network structure enables the model to be trained quickly, and the experimental results verify the effectiveness and high accuracy of this method. (3) The model not only has high precision but also has some interpretability. By decomposing time series data into a trend term, period term and remainder term, the NBEATS and the TCN are used to process the trend term, period term and remainder term, respectively, so that the hybrid model can forecast electricity prices according to the traditional time series processing mode.

Social support and prolonged grief disorder symptoms in parents who lost their only child from urban and rural China.

OBJECTIVE: The one-child policy has existed in China for more than 30 years. It brought benefits to the country's economic development and reduced the magnitude of the population within a short period. However, it has led to the emergence of a significant number of parents who have lost their only child, referred to as shiduers (). This study explored the symptoms of prolonged grief disorder (PGD) among shiduers and their relationship with the social support shiduers received after they lost the child, specifically accounting for the disparity between rural and urban areas. METHOD: In total, 405 participants were recruited with a mean age of 60.37 years (SD = 7.78). Around 68.75% were female, and 58.66% were urban shiduers. They were asked to complete a series of self-reported questionnaires, including demographic information, the Social Support Rate Scale, and the Prolonged Grief-13. RESULTS: First, 29.63% of the participants (N = 120) fulfilled the International Classification of Diseases (11th rev.) diagnostic criteria for PGD symptoms; second, PGD symptoms of shiduers were negatively related to social support, including objective support, subjective support, and the availability of support; and third, urban/rural location moderated the effect of objective support on the PGD symptoms of shiduers, but not the effect of subjective support on PGD symptoms. Furthermore, the simple-slope tests indicated that the shiduers in rural areas benefited most from objective support. CONCLUSIONS: The present results revealed high rates of PGD symptoms in Chinese shiduers, and our findings highlight the important role of urban/rural location in the relationship between social support and PGD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Occurrence, distribution and risk assessment of antibiotics at various aquaculture stages in typical aquaculture areas surrounding the Yellow Sea.

The pollution of antibiotics commonly existed throughout the entire aquaculture process, but the residues of antibiotics at different aquaculture stages have rarely been studied. This study investigated the occurrence, distribution and risk assessment of antibiotics at different aquaculture stages (the non-aquaculture stage, the early aquaculture stage, the middle aquaculture stage, and the late aquaculture stage) in two typical marine aquaculture areas (Mahegang River and Dingzi Bay) surrounding the Yellow Sea. Fluoroquinolones and tetracyclines were commonly used antibiotics in the aquaculture of these areas with high detection frequencies (17% to 83%). Compared among four aquaculture stages, the highest concentration of antibiotics (9032.08 ng/L) in aquaculture ponds was detected at the late aquaculture stage. And the antibiotic pollution level of natural water was directly related to the aquaculture stages. Similarly, at the aquaculture stages, the detection frequency of antibiotics in sediments was higher than that at the non-aquaculture stage. Based on the correlation analysis, the concentration of main antibiotics in water showed a positive correlation with total nitrogen (p<0.05) and chlorophyll a (p<0.01), while it showed a negative correlation with salinity (p<0.01) in coastal water of the Dingzi Bay. According to the risk assessment, with the development of aquaculture stages, the selection pressure of fluoroquinolones and tetracyclines on resistant bacteria had increased. And the ecological risks caused by sulfonamides and tetracyclines to aquatic organisms had also increased markedly. Overall, this study may provide a reference for formulating regulatory policies regarding antibiotic use at different aquaculture stages.

Systematic literature review of cost-effectiveness analyses of robotic-assisted radical prostatectomy for localised prostate cancer.

OBJECTIVES: Review and assess cost-effectiveness studies of robotic-assisted radical prostatectomy (RARP) for localised prostate cancer compared with open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). DESIGN: Systematic review. SETTING: PubMed, Embase, Scopus, International HTA database, the Centre for Reviews and Dissemination database and various HTA websites were searched (January 2005 to March 2021) to identify the eligible cost-effectiveness studies. PARTICIPANTS: Cost-effectiveness, cost-utility, or cost-minimization analyses examining RARP versus ORP or LRP were included in this systematic review. INTERVENTIONS: Different surgical approaches to treat localized prostate cancer: RARP compared with ORP and LRP. PRIMARY AND SECONDARY OUTCOME MEASURES: A structured narrative synthesis was developed to summarize results of cost, effectiveness, and cost-effectiveness results (eg, incremental cost-effectiveness ratio [ICER]). Study quality was assessed using the Consensus on Health Economic Criteria Extended checklist. Application of medical device features were evaluated. RESULTS: Twelve studies met inclusion criteria, 11 of which were cost-utility analyses. Higher quality-adjusted life-years and higher costs were observed with RARP compared with ORP or LRP in 11 studies (91%). Among four studies comparing RARP with LRP, three reported RARP was dominant or cost-effective. Among ten studies comparing RARP with ORP, RARP was more cost-effective in five, not cost-effective in two, and inconclusive in three studies. Studies with longer time horizons tended to report favorable cost-effectiveness results for RARP. Nine studies (75%) were rated of moderate or good quality. Recommended medical device features were addressed to varying degrees within the literature as follows: capital investment included in most studies, dynamic pricing considered in about half, and learning curve and incremental innovation were poorly addressed. CONCLUSIONS: Despite study heterogeneity, RARP was more costly and effective compared with ORP and LRP in most studies and likely to be more cost-effective, particularly over a multiple year or lifetime time horizon. Further cost-effectiveness analyses for RARP that more thoroughly consider medical device features and use an appropriate time horizon are needed. PROSPERO REGISTRATION NUMBER: CRD42021246811.

Risk and benefit assessment of potential neurodevelopment effect resulting from consumption of cultured largemouth bass (Micropterus salmoides) in China.

The aim of this study was to evaluate the net effects of dietary consumption on the potential neurodevelopmental effects of largemouth bass (Micropterus Salmoides, simplify as bass) cultured in China, especially when the bait of largemouth bass is changed from iced trash fish to formulated feed. A total of three bait group bass samples were collected from main producing areas during harvest period, including formulated feed group, iced trash fish group, and both group (converting from iced trash fish to formulated feed). Net neurodevelopment value (expressed as intelligence quotient or IQ) was calculated using FAO/WHO deterministic methods and probabilistic assessment model. The results showed net IQ of largemouth bass fed by the three baits groups all showed positive or beneficial neurodevelopmental effects, with the values of 1.55 ± 0.97 (formulated feed group), 3.17 ± 1.76 (iced trash fish group), and 2.65 ± 1.29 (both group) respectively. Bass samples fed with ice trash fish showed the highest neurodevelopmental effect. The present study suggested that more valuable formulated feed should be developed to improve the quality of cultured largemouth bass.

Spatiotemporal disparities in regional public risk perception of COVID-19 using Bayesian Spatiotemporally Varying Coefficients (STVC) series models across Chinese cities.

Regional public attention has been critical during the COVID-19 pandemic, impacting the effectiveness of sub-national non-pharmaceutical interventions. While studies have focused on public attention at the national level, sub-national public attention has not been well investigated. Understanding sub-national public attention can aid local governments in designing regional scientific guidelines, especially in large countries with substantial spatiotemporal disparities in the spread of infections. Here, we evaluated the online public attention to the COVID-19 pandemic using internet search data and developed a regional public risk perception index (PRPI) that depicts heterogeneous associations between local pandemic risk and public attention across 366 Chinese cities. We used the Bayesian Spatiotemporally Varying Coefficients (STVC) model, a full-map local regression for estimating spatiotemporal heterogeneous relationships of variables, and improved it to the Bayesian Spatiotemporally Interacting Varying Coefficients (STIVC) model to incorporate space-time interaction non-stationarity at spatial or temporal stratified scales. COVID-19 daily cases (median contribution 82.6%) was the most critical factor affecting public attention, followed by urban socioeconomic conditions (16.7%) and daily population mobility (0.7%). After adjusting national and provincial impacts, city-level influence factors accounted for 89.4% and 58.6% in spatiotemporal variations of public attention. Spatiotemporal disparities were substantial among cities and provinces, suggesting that observing national-level public dynamics alone was insufficient. Multi-period PRPI maps revealed clusters and outlier cities with potential public panic and low health literacy. Bayesian STVC series models are systematically proposed and provide a multi-level spatiotemporal heterogeneous analytical framework for understanding collective human responses to major public health emergencies and disasters.

An External Patient Healthcare Index (EPHI) for Simulating Spatial Tendencies in Healthcare Seeking Behavior.

Background: Healthcare resources are always more limited compared with demand, but better matching supply with demand can improve overall resource efficiency. In countries like China where patients are free to choose healthcare facilities, over-utilization and under-utilization of healthcare resources co-exist because of unreasonable healthcare seeking behavior. However, scholarship regarding the spatial distribution of utilization for healthcare resources, resulting from unreasonable spatial tendencies in healthcare seeking, is rare. Methods: In this article, we propose a new External Patient Healthcare Index (EPHI) to simulate the spatial distribution of utilization for healthcare resources, based on the Two-Step Floating Catchment Area (2SFCA) method, which is widely used to assess potential spatial accessibility. Instead of using individual-level healthcare utilization data which is difficult to obtain, the EPHI uses institution-level aggregated data, including numbers of inpatient/outpatient visits. By comparing the estimated utilization (based on local healthcare institution services provision) with the expected utilization (based on local population morbidity), guest patients (e.g., patients flowing in for treatment) and bypass patients (patients flowing out) can be identified. To test the applicability of this index, a case study was carried out on China's Hainan Island. The spatial tendencies of patients for inpatient and outpatient services were simulated, then incorporated with spatial access to healthcare resources to evaluate overall resource allocation efficiency, thus guiding future resource allocations and investment for policy makers and healthcare providers. Results: The EPHI revealed that bypass activities widely exist on Hainan Island in both inpatient and outpatient care, with patients tending to travel from less developed regions with fewer healthcare resources to more highly developed regions with more healthcare resources to receive healthcare. Comparison with spatial accessibility demonstrated how bypass activities on Hainan produced an under-utilization of doctors in less developed regions and over-utilization of doctors in more developed coastal regions. Conclusions: This case study on Hainan Island demonstrates that this new index can very clearly identify both the sources and sinks of patient spatial tendencies. Combining these results with spatial accessibility of healthcare resources, how efficiently the available supply matches the utilization can be revealed, indicating wide-ranging applicability for local governments and policymakers.

Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK.

Importance: The cost-effectiveness of different surgical techniques for radical prostatectomy remains a subject of debate. Emergence of recent critical clinical data and changes in surgical equipment costs due to their shared use by different clinical specialties necessitate an updated cost-effectiveness analysis in a centralized, largely government-funded health care system such as the UK National Health Service (NHS). Objective: To compare robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) and laparoscopic-assisted radical prostatectomy (LRP) using contemporary data on clinical outcomes, costs, and surgical volumes in the UK. Design, Setting, and Participants: This economic analysis used a Markov model developed to compare the cost-effectiveness of RARP, LRP, and ORP to treat localized prostate cancer. The model was constructed from the perspective of the UK NHS. The model simulated 65-year-old men who underwent radical prostatectomy for localized prostate cancer and were followed up for a 10-year period. Data were analyzed from May 1, 2020, to July 31, 2021. Exposures: Robotic-assisted radical prostatectomy, LRP, and ORP. Main Outcomes and Measures: Quality-adjusted life-years (QALYs), costs (direct medical costs and costs outside the NHS), and incremental cost-effectiveness ratios (ICERs). Results: Compared with LRP, RARP cost £1785 (US $2350) less and had 0.24 more QALYs gained; thus, RARP was a dominant option compared with LRP. Compared with ORP, RARP had 0.12 more QALYs gained but cost £526 (US $693) more during the 10-year time frame, resulting in an ICER of £4293 (US $5653)/QALY. Because the ICER was below the £30 000 (US $39 503) willingness-to-pay threshold, RARP was more cost-effective than ORP in the UK. The most sensitive variable influencing the cost-effectiveness of RARP was the lower risk of biochemical recurrence (BCR). Scenario analysis indicated RARP would remain more cost-effective than ORP as long as the BCR hazard ratios comparing RARP vs ORP were less than 0.99. Conclusions and Relevance: These findings suggest that in the UK, RARP has an ICER lower than the willingness-to-pay threshold and thus is likely a cost-effective surgical treatment option for patients with localized prostate cancer compared with ORP and LRP. The results were mainly driven by the lower risk of BCR for RARP. These findings may differ in other health care settings where different thresholds and costs may apply.

[Distribution Characteristics and Ecological Risk Assessment of Soil Heavy Metals in the Eastern Mountainous Area of the Nanyang Basin].

The spatial distribution, pollution degree, and ecological risk of heavy metals in the soil were studied by analyzing the contents of As, Hg, Cd, Cr, Pb, Zn, Ni, and Cu and pH values in surface soil samples of the eastern mountainous area of the Nanyang basin. The results showed that the contents of Cd, Cu, Cr, Ni, Pb, Zn, and As in the soil exceeded the screening value of soil pollution risk. The spatial distribution of soil heavy metals displayed regional-and island-shaped. The highest concentration of heavy metals was found in the south of the study area, where a mining area is located. Most of the samples had no pollution levels except some samples with high contents of Cd. For As, Cr, Pb, Zn, Ni, and Cu, the potential ecological risk of most samples were low, while Cd and Hg posed medium risk in most areas. The areas with high and relatively high ecological risk index accounted for 58.93% and 37.66%, respectively. Soil Hg, Cd, and Pb contents were related to anthropogenic activities such mineral mining. As derives from geological processes, while Zn, Ni, Cr, and Cu are both controlled by anthropogenic activities and geological processes. The mining of mineral resources is the main driving factor of soil heavy metal pollution and ecological risk in the study area.

The shift from inpatient to outpatient hysterectomy for endometrial cancer in the United States: trends, enabling factors, cost, and safety.

OBJECTIVE: To evaluate trends in outpatient versus inpatient hysterectomy for endometrial cancer and assess enabling factors, cost and safety. METHODS: In this retrospective cohort study, patients aged 18 years or older who underwent hysterectomy for endometrial cancer between January 2008 and September 2015 were identified in the Premier Healthcare Database. The surgical approach for hysterectomy was classified as open/abdominal, vaginal, laparoscopic or robotic assisted. We described trends in surgical setting, perioperative costs and safety. The impact of patient, provider and hospital characteristics on outpatient migration was assessed using multivariate logistic regression. RESULTS: We identified 41 246 patients who met inclusion criteria. During the time period studied, we observed a 41.3% shift from inpatient to outpatient hysterectomy (p<0.0001), an increase in robotic hysterectomy, and a decrease in abdominal hysterectomy. The robotic hysterectomy approach, more recent procedure (year), and mid-sized hospital were factors that enabled outpatient hysterectomies; while abdominal hysterectomy, older age, Medicare insurance, black ethnicity, higher number of comorbidities, and concomitant procedures were associated with an inpatient setting. The shift towards outpatient hysterectomy led to a $2500 savings per case during the study period, in parallel to the increased robotic hysterectomy rates (p<0.001). The post-discharge 30-day readmission and complications rate after outpatient hysterectomy remained stable at around 2%. CONCLUSIONS: A significant shift from inpatient to outpatient setting was observed for hysterectomies performed for endometrial cancer over time. Minimally invasive surgery, particularly the robotic approach, facilitated this migration, preserving clinical outcomes and leading to reduction in costs.

General Self-Efficacy and Employability Among Financially Underprivileged Chinese College Students: The Mediating Role of Achievement Motivation and Career Aspirations.

Although previous research shows that general self-efficacy is related to employability, the mechanism of them is unclear. Thus, this study aims to explore the relationship between general self-efficacy and employability, examines the mediating role of achievement motivation and career aspirations among financially underprivileged college students in China. The analysis of 651 participants (59% female, 41% male) from six provinces indicates that general self-efficacy positively predicts employability through the mediating chain of achievement motivation and career aspirations. Based on these findings, the researchers propose feasible suggestions for related issues of financially underprivileged college students and future research.