Home care needs assessment among caregivers of children and adolescents with osteogenesis imperfecta: a cross-sectional study.

BACKGROUND: Children and adolescents with complex medical issues need home care services; however, few studies have provided insight into the unmet home care needs of the families of patients with osteogenesis imperfecta (OI). In this study, we aimed to assess the home care needs of caregivers of children and adolescents with OI and the associated factors. METHODS: A self-administered questionnaire was administered online to 142 caregivers of patients with OI aged 3-17 years between May and October 2022 from 25 provinces in China. The questionnaire comprised 15 questions on demographic variables and 14 questions on home care needs. Chi-square analysis was used to compare group differences for categorical variables. Multivariate binary logistic regression analysis was conducted to examine predictors of caregivers' home care needs. RESULTS: The study findings indicated that 81.5% of caregivers had high home care needs. The three leading types of home care needs were helping the child carry out physical fitness recovery exercises at home (72.5%), understanding precautions regarding treatment drugs (72.5%), and relieving the child's pain (70.4%). OI patients' poor self-care ability (adjusted odds ratio = 5.9, 95% confidence interval = 1.8-19.0) was related to caregivers' high level of home care needs. CONCLUSIONS: The findings of this study suggest that future scientific research and nursing guidance should focus on OI patients' physical training, medication management, pain relief, fracture prevention, and treatment. In addition, caregivers of patients with poor self-care ability should receive special attention in the development of interventions. This study can help with addressing the unmet home care needs of caregivers of children and adolescents with OI. It is vital to develop a personalized intervention plan based on patients' self-care ability.

Residue Degradation and Risk Assessment of Difenoconazole and Its Metabolite during Tea Growing, Processing and Brewing by Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry Determination.

Residue dissipation and risk assessment of difenoconazole and its metabolite difenoconazole-alcohol during tea growing, processing, and brewing was first investigated by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The limits of quantification for both difenoconazole and difenoconazole-alcohol were 0.001 mg/kg in fresh tea leaves and tea, and 0.0002 mg/L in tea infusion. In field trials, the dissipation half-lives of difenoconazole in fresh tea leaves was 1.77 days. After spraying, the residues of difenoconazole-alcohol increased and then gradually dissipated like difenoconazole. After 14 days, the dissipation rates of difenoconazole and difenoconazole-alcohol reached 99%. When fresh tea leaves were harvested on different days, the total processing factors (PFs) of difenoconazole and difenoconazole-alcohol for green tea were 0.86-1.05 and 0.78-0.85, respectively, while the total PFs for black tea were 0.83-1.13 and 0.82-1.66, respectively. Metabolism of difenoconazole was accelerated during tea processing. When brewing black tea, the leaching rates (LRs) of difenoconazole and difenoconazole-alcohol were 8.4-17.9% and 31.8-38.9%, respectively, while when brewing green tea, the LRs were 15.4-23.5% and 30.4-50.6%, respectively. The LRs of difenoconazole and difenoconazole-alcohol in black tea were higher than those in green tea. The potential threat to human health for dietary intake of difenoconazole and difenoconazole-alcohol residues from tea consumption is negligible. However, the dietary risk of difenoconazole in fruits and vegetables that are essential for daily diets is concerning, with a risk probability of 158%.

Identifying the spatial heterogeneity of housing financialization in China: Insights from a multiscale geographically weighted regression.

With the deepening linkage between housing and finance, the financial attributes of housing have been increasing. Thus, housing financialization has become a worldwide phenomenon that is gradually emerging in China's real estate market and thus cannot be ignored. The amount of urban capital is an important manifestation of financialization, but only a few studies have considered the spatial heterogeneity of impact of urban capital amount-represented by loan balances (LOAN) on housing prices. To fill this gap, this study builds a dataset of housing prices and influencing factors for county-level units using 2109 counties in China and analyzes the spatial scope and heterogeneity of housing financialization. Results show that globally, LOAN has a significant positive effect on housing prices, and the impact direction is in line with theoretical expectations. Locally, spatial heterogeneity exists for the impact of LOAN on housing prices, and the phenomenon of housing financialization is mainly observed in China's eastern coastal area. This study can help enhance the understanding of the spatial constraints on the impact of LOAN on housing prices and the spatial heterogeneity of housing financialization in China. Moreover, it provides a theoretical basis for policymakers to formulate spatially differentiated housing policies.

Health risk assessment of soil heavy metals in a typical mining town in north China based on Monte Carlo simulation coupled with Positive matrix factorization model.

The accumulation of heavy metals (HMs) in soil caused by mineral resource exploitation and its ancillary industrial processes poses a threat to ecology and public health. Effective risk control measures require a quantification of the impacts and contributions to health risks from individual sources of soil HMs. Based on high-density sampling, soil contamination risk indexes, positive matrix factorization (PMF) model, Monte Carlo simulation and human health risk analysis model were applied to investigate the risk of HMs in a typical mining town in North China. The results showed that As was the most dominant soil pollutant factor, Cd and Hg were the most dominant soil ecological risk factors, and Cr and Ni were the most dominant health risk factors in the study area. Overall, both pollution and ecological risks were at low levels, while there were still some higher hazard areas located in the central and south-central part of the region. According to the probabilistic health risk assessment (HRA), children suffered greater health risks than adults, with 21.63% of non-carcinogenic risks and 53.24% of carcinogenic risks exceeding the prescribed thresholds (HI > 1 and TCR>1E-4). The PMF model identified five potential sources: fuel combustion (FC), processing of building materials with limestone as raw materials (PBML), industry source (IS), iron ore mining combined with garbage (IOG), and agriculture source (AS). PBML is the primary source of soil HM contamination, as well as the major anthropogenic source of carcinogenic risk for all populations. Agricultural inputs associated with As are the major source of non-carcinogenic risk. This study offers a good example of probabilistic HRA using specific sources, which can provide a valuable reference for strategy establishment of pollution remediation and risk prevention and control.

[Distribution Characteristics, Source Analysis and Ecological Risk Assessment of Heavy Metals in the Typical Industry Reclaimed Soil].

To further explore the characteristics of heavy metal pollution and the ecological risk of typical industries in reclaimed soil, based on data from 315 different depth profiles of soil samples collected from 49 plots in Jiading District, Shanghai, the geo-accumulation index and potential ecological risk index were used to evaluate the contents and potential ecological risk of seven heavy metals, namely Cd, Pb, Cu, Zn, Ni, Hg, and As. The APCS-MLR receptor model and PMF positive matrix factorization model were employed to analyze the pollution sources. The results showed that:① except for As, the contents of other heavy metals in the soil of the study area exceeded the Shanghai soil background values to varying degrees. The contents of Cd, Pb, Cu, Zn, Ni, and Hg in the surface soil were 3.54, 2.34, 2.91, 1.20, 3.75, and 4.40 times the background values, respectively. The contents of heavy metals in the soil decreased with the increase in depth, and heavy metals were enriched to a certain extent in the surface soil, indicating that human activities had an impact on the distribution of heavy metals in the soil. ② The APCS-MLR and PMF receptor models identified four main sources of soil heavy metals in the study area. Source 1 (Cu, Zn, and Pb) was a mixture of metal products and automobile manufacturing, source 2 (Ni and Cd) was electroplating enterprises, source 3 (Hg) was mainly from chemical enterprises, and source 4 (As) was natural. The combined use of the two receptor models further improved the accuracy and credibility of source identification. ③ The geo-accumulation index in descending order was Hg(1.54)>Ni(1.32)>Cd(1.21)>Cu(0.96)>Pb(0.64)>Zn(-0.33)>As(-1.02). The potential ecological risk index showed that the comprehensive potential ecological risk index RI value in the study area ranged from 32.50 to 4 910.97, with a mean of 321.40, indicating a strong potential ecological risk. The pollution values of heavy metals Hg, Ni, and Cd in industrial site soil deserve further attention for re-development and utilization purposes.

Ecological assessment of stream water polluted by phosphorus chemical plant: Physiological, biochemical, and molecular effects on zebrafish (Danio rerio) embryos.

The rapid development of the phosphorus chemical industry has caused serious pollution problems in the regional eco-environment. However, understanding of their ecotoxic effects remains limited. This study aimed to investigate the developmental toxicity of a stream polluted by a phosphorus chemical plant (PCP) on zebrafish embryos. For this, zebrafish embryos were exposed to stream water (0, 25, 50, and 100% v/v) for 96 h, and developmental toxicity, oxidative stress, apoptosis, and DNA damage were assessed. Stream water-treated embryos exhibited decreased hatching rates, heart rates, and body lengths, as well as increased mortality and malformation rates. The general morphology score system indicated that the swim bladder and pigmentation were the main abnormal morphological endpoints. Stream water promoted antioxidant enzymes (superoxide dismutase (SOD), peroxidase (POD), and glutathione peroxidase (GPx)), lipid peroxidation, and DNA damage. It also triggered apoptosis in the embryos' heads, hearts, and spines by activating apoptotic enzymes (Caspase-3 and Caspase-9). Additionally, stream water influenced growth, oxidative stress, and apoptosis-related 19 gene expression. Notably, tyr, sod (Mn), and caspase9 were the most sensitive indicators of growth, oxidative stress, and apoptosis, respectively. The current trial concluded that PCP-polluted stream water exhibited significant developmental toxicity to zebrafish embryos, which was regulated by the oxidative stress-mediated activation of endogenous apoptotic signaling pathways.

Spatial heterogeneity and management challenges of ecosystem service trade-offs: a case study in Guangdong Province, China.

Ecosystem services (ESs) play a crucial connecting role between human well-being and natural ecosystems. Investigating ESs and their interrelationships can aid in the rational distribution of resources and benefits and inform planning decisions that align with the principles of ecological civilization. Nonetheless, our current understanding of these relationships remains limited; thus, further theoretical exploration is required. This study employs the InVEST model to assess the key ESs in Guangdong Province for 2000 and 2018 and applies the multi-scale geographically weighted regression (MGWR) method to identify the primary drivers of ES changes and capture trends in spatial variations. The results showed that (1) from 2000 to 2018, the total carbon storage (CS) and habitat quality (HQ) decreased while the water yield (WY) and net primary productivity (NPP) increased. These ESs also showed spatial differences, with higher values observed in the hilly and mountainous areas of the north compared with the coastal and plain areas of the south. (2) Although the spatial distribution of ES trade-off strength varied, the overall pattern remained consistent from 2000 to 2018. The pairwise trade-off strength of CS-WY and WY-HQ decreased significantly in the northern region of Guangdong due to low rainfall, while that of CS-HQ decreased significantly in the Pearl River delta as a result of urbanization. Cultivated and forested land displayed higher and lower levels of NPP and WY, respectively, with forested land exhibiting greater trade-off strength than the other land use types. (3) Evident spatial heterogeneity was observed in the properties and intensity of the correlations between driving factors and changes in ES trade-offs. Natural factors were the primary determinants of trade-offs among ESs. However, at a regional scale, the landscape index and socioeconomic factors tended to represent stronger drivers. Based on these findings, we suggest that ecological management should be adjusted based on the geographic scale. This study offers a valuable approach to understanding the relationship between ES trade-offs and their drivers in geographic space and serves as a reference for the sustainable provisioning of ESs both locally and globally.

Digital inclusive finance, government intervention, and urban green technology innovation.

Digital inclusive finance eases credit constraints on innovative small and medium-sized enterprises which contributes to urban green technology innovation in China. Government intervention plays an essential role in the development of digital inclusive finance. Based on the panel data of 243 cities in China from 2011 to 2019, this paper empirically examines the relationship between digital inclusive finance and urban green technology innovation as well as the intrinsic mechanism of government intervention. The findings show that, even after a series of robustness tests, digital inclusive finance can promote the quantity and quality of green technology innovation. In terms of its mechanism, digital inclusive finance can empower green technology innovation by complementing traditional financial development and stimulating green consumption, both in terms of supply and demand. At the same time, in the dynamic process of digital financial inclusion from low to high, the development of traditional finance and green consumption level on the marginal promotion of green technology innovation continues to strengthen. The nonlinear relationship test reveals that there is a significant double threshold effect on the positive impact of digital inclusive finance on urban green technology innovation with the evolution of government intervention. The innovation incentive effect of digital financial inclusion will be marginal decreasing with the increase of government intervention. Further considering the heterogeneity of urban geographic location and environmental regulation, it is found that digital financial inclusion promotes green technology innovation more in eastern and high-environmental regulation cities. Based on the above research conclusions, this paper argues that while developing digital inclusion finance, government support policies should be adjusted promptly to constantly stimulate the "Metcalfe's law" effect of digital inclusive finance enabling green technology innovation.

Molecular basis and evolutionary cost of a novel macrolides/lincosamides resistance phenotype in Staphylococcus haemolyticus.

Staphylococcus haemolyticus (S. haemolyticus) is a coagulase-negative Staphylococcus that has become one of the primary causes of nosocomial infection. After a long period of antibiotic use, S. haemolyticus has developed multiple resistance phenotypes for macrolides and lincosamides. Herein, we evaluated four S. haemolyticus clinical isolates, of which three had antibiotic resistance patterns reported previously. The fourth isolate was resistant to both erythromycin and clindamycin in the absence of erythromycin induction. This novel phenotype, known as constitutive macrolides-lincosamides-streptogramins resistance, has been reported in other bacteria but has not been previously reported in S. haemolyticus. Investigation of the isolate demonstrated a deletion in the methyltransferase gene ermC, upstream leader peptide. This deletion resulted in constitutive MLS resistance based on whole-genome sequencing and experimental verification. Continuous expression of ermC was shown to inhibit the growth of S. haemolyticus, which turned out to be the fitness cost with no MLS pressure. In summary, this study is the first to report constitutive MLS resistance in S. haemolyticus, which provides a better understanding of MLS resistance in clinical medicine. IMPORTANCE This study identified a novel phenotype of macrolides/lincosamides resistance in Staphylococcus haemolyticus which improved a better guidance for clinical treatment. It also clarified the mechanistic basis for this form of antibiotic resistance that supplemented the drug resistance mechanism of Staphylococcus. In addition, this study elaborated on a possibility that continuous expression of some resistance genes was shown to inhibit the growth of bacteria themselves, which turned out to be the fitness cost in the absence of antibiotic pressure.

Assessment of the water quality and toxicity effects on zebrafish (Danio rerio) of a stream near a phosphorus chemical plant in Guizhou Province, southwestern China.

To reveal the influence of the phosphorus chemical industry (PCI) on regional water environmental quality and safety, the water quality and ecotoxicological effects of a stream near a phosphorus chemical plant (PCP) in Guizhou Province, southwestern China, were investigated based on water samples collected from the stream. The results showed that the average concentrations of NH3-N, TN, P, F-, Hg, Mn, and Ni were 3.14 mg/L, 30.09 mg/L, 3.34 mg/L, 1.18 mg/L, 1.06 µg/L, 45.82 µg/L, and 11.30 µg/L, respectively. The overall water quality of the stream was in the heavily polluted category, and NH3-N, TN, P, F-, and Hg were the main pollution factors. The degree of pollution was in the order of rainy period > transitional period > dry period, and the most polluted sample site was 1100 m from the PCP. After 28 days of exposure to stream water, there was no significant change in the growth parameters of zebrafish. The gills of zebrafish showed a small amount of epithelial cell detachment and a small amount of inflammatory cell infiltration, and the liver tissue displayed a large amount of hepatocyte degeneration with loose and lightly stained cytoplasm. Compared with the control group, the %DNA in tail, tail length, tail moment, and olive tail moment were significantly increased (p < 0.05), indicating that the water sample caused DNA damage in the peripheral blood erythrocytes of zebrafish. The stream water in the PCI area was found to be polluted and exhibited significant toxicity to zebrafish, which could pose a threat to regional ecological security.

Indicator-based assessments of the coupling coordination degree and correlations of water-energy-food-ecology nexus in Uzbekistan.

Grappling with the global ecological concern of the Aral Sea disaster, Uzbekistan exemplifies the urgent necessity of unravelling and addressing the complex Water-Energy-Food-Ecology (WEFE) nexus conflicts in arid regions, a critical task yet largely uncharted. Through the strategic process of 'Indicator Articulation - Weight Calibration - Nexus Coordination Quantification - Correlational Analysis', this work has developed a tailored framework that integrates a novel, context-specific indicator system, enabling an illumination of the intricate dynamics within the WEFE nexus in arid regions. During 2000-2018, the WEFE Nexus in Uzbekistan showed low-level coordination, indicating systemic imbalances. The Aral Sea crisis was the central disruptor, resulting in a moderately disordered ecological subsystem. Concurrently, disorder was observed in water resources, signaling inadequate management and potential overutilization. Furthermore, Coordination for energy and food were barely coordinated and under primary coordination respectively, underlining critical challenges in energy efficiency and food security. Over the last two decades, the WEFE Nexus has evolved towards a tighter interlinkage, yet the stability of this coupling coordination has experienced increased fluctuations, indicating that Uzbekistan's policies in the WEFE subsystems have been less stable in the last two decades and are in need of further adjustment and improvement. To address the challenges, we recommend a comprehensive approach that integrates technological, infrastructure, and policy solutions is needed. Specifically, promoting water-saving irrigation technology, renewing and maintaining outdated energy facilities, and raising public awareness of ecological protection are part of the essential measures. Furthermore, alleviating the contradiction between economic growth and ecological conservation remains a major challenge. Collectively, our constructed WEFE Nexus framework, with its extendable and context-specific indicators, holds significant potential for broad application in the analysis of multi-sectoral sustainability, particularly within arid regions globally, and forms a solid foundation for the formulation of effective, targeted policies and sustainable development strategies.

Diffusion-weighted imaging in the assessment of cervical cancer: comparison of reduced field-of-view diffusion-weighted imaging and conventional techniques.

BACKGROUND: Cervical cancer (CC) is the second most common cancer in women worldwide. Diffusion-weighted imaging (DWI) plays an important role in the diagnosis of CC, but the conventional techniques are affected by many factors. PURPOSE: To compare reduced-field-of-view (r-FOV) and full-field-of-view (f-FOV) DWI in the diagnosis of CC. MATERIAL AND METHODS: Preoperative magnetic resonance imaging (MRI) with r-FOV and f-FOV DWI images were collected. Two radiologists reviewed the images using a subjective 4-point scale for anatomical features, magnetic susceptibility artifacts, visual distortion, and overall diagnostic confidence for r-FOV and f-FOV DWI. The objective features included the region of interest (ROI) signal intensity of the cervical lesion (SIlesion) and gluteus maximus muscle (SIgluteus), standard deviation of the background noise (SDbackground), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The differences of measured apparent diffusion coefficient (ADC) values between the two examinations in pathological grades and FIGO tumor stages were compared. RESULTS: A total of 200 patients were included (170 with squamous cell carcinoma and 30 with adenocarcinoma). The scores of anatomical features, magnetic susceptibility artifacts, visual distortion, and overall diagnostic confidence for r-FOV DWI were significantly higher than those for f-FOV DWI. There was no difference in SNR and CNR between r-FOV DWI and f-FOV DWI. There were significant differences in ADC values between the two groups in all comparisons (P < 0.05). CONCLUSION: Compared with f-FOV DWI, r-FOV DWI might provide clearer imaging, fewer artifacts, less distortion, and higher image quality for the diagnosis of CC and might assist in the detection of CC.

Safety risk assessment for autonomous vehicle road testing.

OBJECTIVE: Road testing can accelerate the development and validation of autonomous vehicles (AVs). AV road testing can come with high safety risks, particularly in a complex road traffic environment, due to the immaturity of AV technology. A priori safety risk assessments of the road traffic environment before AV road testing are of great importance, allow the quantifying of risk levels in different road scenarios, and provide guidelines for AV road testing in low to high-risk environments. METHODS: This study proposes a framework, namely Safety Risk Assessment for AV road testing (SRAAV), based on the probability and severity of five categories of potential AV accidents. Four groups of influencing factors are considered comprehensively in assessing AV safety risk, and their impacts are quantified using impact coefficients derived from a Bayesian network and empirical AV road testing data. The safety risk is assessed on a road section level, based on which an overall risk level is defined for a corridor and a region. Afterwards, the quantified safety risk is classified into four levels according to expert experience and knowledge, through a questionnaire survey. RESULTS: Applications of the proposed SRAAV framework are conducted for urban roads in Shanghai, and expressways in Shanghai and Gothenburg. The assessment results are validated using disengagement data from AV road testing. The results show that the SRAAV framework and its models could estimate the safety risk levels of road traffic environments for AV road testing in a sound way and have the flexibility for further extensions to be made. CONCLUSIONS: The framework and assessment results can provide technical support for determining where and when to grant permission for public roads to be used for AV road testing, and how to choose public roads from a low to a high risk level, guaranteeing the safety of AV public road testing.

Spatial distribution and influencing factors of high-quality tourist attractions in Shandong Province, China.

Optimizing the spatial layout of high-quality tourist attractions is of great significance in the sustainable development of the tourism industry. This work employs the ArcGIS spatial analysis tool to study the form, equality, and density of the spatial distribution of the 892 3A+ tourist attractions (high-quality tourist attractions hereafter) in Shandong Province, China. It also examines the factors influencing the spatial distribution of tourist attractions from the perspectives of geographic features and landscapes, culture and heritage, socioeconomic development, and transportation. We therefore find the following: 1) High-quality tourist attractions in Shandong Province have obvious clustering in spatial distribution with the high-density areas mainly concentrated in Qingdao, Jining, Jinan, Tai'an and other cities. Influenced by resource endowment and economic development, the two major geographical areas in Central Shandong and Jiaodong Peninsula have the most concentrated distribution of high-quality tourist attractions. 2) The distribution of high-quality tourist attractions shows a southwest‒northeast clustering direction; Qingdao is a high-high clustering area, and Heze is a low-high clustering area with low uniformity of spatial distribution and obvious spatial divergence. 3) Tourist attractions show an obvious "N" type high-density distribution belt and nuclear density distribution across the three existing agglomeration centers in the Jining-Tai'an intersection, Binzhou-Dongying intersection, and Qingdao Jiaozhou Bay coast. 4) Topography, climate conditions, history and culture are intrinsic factors affecting the spatial distribution of tourist attractions, while socioeconomic and transportation conditions are external requirements for the development thereof; collectively, they constrain the spatial distribution of high-quality tourist attractions.

Health Care Costs With Sustained Oral Corticosteroid Use in Systemic Lupus Erythematosus.

PURPOSE: The goal of this study was to compare health care costs, health care resource utilization, and adverse events associated with sustained oral corticosteroid (OCS) use versus no OCS use in systemic lupus erythematosus. METHODS: This retrospective cohort study used claims data (January 1, 2006-July 31, 2019) from patients with systemic lupus erythematosus aged ≥5 years with ≥24 months of continuous enrollment. Health care costs, health care resource utilization, and OCS-related adverse events were assessed. The sustained OCS cohort (defined as ≥12 months of continuous OCS use) was divided into exposure categories based on the number of 6-month classification periods with >5 mg/d OCS (0, 1-2, or 3-4). FINDINGS: Of the 6234 patients in the sustained OCS use cohort, there were 1587 (25.5%) patients with 0 periods of >5 mg/d OCS use, 2087 (33.5%) patients with 1 to 2 periods of >5 mg/d OCS use, and 2560 (41.1%) patients with 3 to 4 periods of >5 mg/d OCS use; the no OCS use cohort included 7828 patients. Adjusted health care cost differences (95% CIs) were significantly greater for patients with 0, 1 to 2, and 3 to 4 periods of OCS use >5 mg/d versus the no OCS use cohort ($7774 [5426-10,223], $21,738 [18,898-25,321], and $30,119 [26,492-33,774], respectively). A higher proportion of patients in all OCS exposure categories required health care resource utilization (≥99.7% vs 93.4%) and experienced OCS-related adverse events (94.3%-96.8% vs 82.6%) versus the no OCS use cohort, with more periods of OCS use >5 mg/d associated with increased health care resource utilization and adverse events. IMPLICATIONS: Sustained OCS use in systemic lupus erythematosus was associated with high economic burden, health care resource utilization, and OCS-related adverse events. These data highlight the need for health care providers to carefully consider OCS use in systemic lupus erythematosus.

Spatial-temporal differentiation of coupling coordination degree for green finance and green innovation efficiency: a case study in China.

Continued investment in finance and innovation is beneficial to economic development, and the joining of green system can accelerate the process of economic recovery from environmental distress. To better enhance the relationship of green finance and green innovation, it is vital to demonstrate the synergy between the two thoroughly. Thirty provinces in China are selected to examine the coupling coordination relationship between the two, specifically testing the spatial aggregation and evolutionary differences in the coupling coordination by adopting the coupling coordination degree (CCD) model, spatial autocorrelation, and kernel density estimation. Conclusions of the paper show that green finance is calculated by the EW-TOPSIS method, and the overall score of provinces is low. Using super-SBM model to evaluate green innovation, the uneven distribution of efficiency is obvious, although it is gradually increasing. The CCD in most provinces is in low-level or basic coordination, with significant regional heterogeneity. The global Moran's index becomes gradually evident with time. The local Moran scatter diagram presents a downward trend from east to west, but with more L-L aggregation provinces emerging in 2020. The center of the national kernel density curve gradually shifts to the right, indicating that the national overall synergy level is improving. Deepening the understanding of the empirical results facilitates the formulation of reasonable policies that fit the four major regions.

Policy analysis in the field of rare diseases in China: a combined study of content analysis and Bibliometrics analysis.

Introduction: The Chinese government has made significant strides in addressing the needs of individuals affected by rare diseases in recent years. This paper aims to provide a comprehensive analysis of national rare disease policies in China from 2009 to 2022, using a mixed-methods approach. Methods: A two-dimensional analytical framework, which includes policy tools and policy themes, is introduced to analyze the rare disease policies comprehensively. Drawing on the policy tools theory proposed by Rothwell and Zegveld, this paper evaluates the tools used in rare disease policies. Co-word analyses and network analyses are employed to identify key themes in rare disease policies and collaboration among government departments. Results: The rare disease policy landscape in China is undergoing rapid growth, with an increasing number of government departments involved in policy formulation. However, further collaboration between departments is needed to strengthen these policies. Environment-based and supply-based tools are preferred in rare disease policies. The policy themes can be grouped into four categories: (1) Registration, Approval and Supply of Rare Disease Drugs, (2) Construction of Diagnosis and Treatment System for Rare Diseases, (3) Development and Genericization of Rare Disease Drugs, and (4) Social Security for Patients with Rare Diseases. Discussion: The study provides valuable insights into the current state of rare disease policies in China and offers suggestions for policy improvement. The results show that the Chinese government has made efforts to address the needs of individuals affected by rare diseases, but there is still room for improvement. The collaboration between government departments needs to be strengthened to achieve better rare disease policies. The findings of this study have implications for other countries with similar healthcare systems and can contribute to a better understanding of the impact of rare disease policies on public health.

Clinical and Economic Burden in Patients With Systemic Lupus Erythematosus During the First Year After Initiating Oral Corticosteroids: A Retrospective US Database Study.

OBJECTIVE: To characterize health care resource utilization (HCRU), health care costs, and adverse events (AEs) among patients with systemic lupus erythematosus (SLE) initiating oral corticosteroids (OCS) versus patients without OCS use. METHODS: In this retrospective cohort study (GSK Study 213061), eligible patients (aged ≥5 years at first OCS claim) with SLE from the IQVIA Real-World Data Adjudicated Claims-US database (January 2006 to July 2019) had continuous enrollment during the 6-month preindex (baseline) and 12-month postindex (observation) periods and one or more inpatient or emergency department SLE diagnosis codes or two or more outpatient SLE diagnosis codes during baseline. The "OCS-initiator cohort" comprised patients with one or more OCS pharmacy claims during the study period and no evidence of preindex OCS use and was classified into three exposure categories based on the number of 6-month periods of more than 5 mg/day of OCS use (0, 1, 2). The "no-OCS-use cohort" comprised patients without OCS claims, although patients may have received OCS prior to the study period. Clinical and economic outcomes were reported over the observation period. RESULTS: Adjusted health care costs differed significantly ($6542 [95% confidence interval (CI): $5761-$7368], $19,149 [95% CI: $16,954-$21,471], $28,985 [95% CI: $25,546-$32,885]). HCRU incidence rates were significantly greater for all OCS-initiator exposure categories (n = 16,216) versus the no-OCS-use cohort (n = 11,137; adjusted incidence rate ratios [95% CI]: 1.22 [1.19-1.24], 1.39 [1.34-1.43], 1.66 [1.60-1.73]). OCS-related AEs were experienced by 67.1% to 74.1% of patients with OCS initiation, most commonly affecting the immune system. CONCLUSION: Within 12 months of OCS initiation, patients with SLE experienced substantial clinical and economic burden, which may imply a need to minimize OCS use.

Value of Group Intervention on Prognosis of Quality of Life in Epileptic Patients Treated With Sodium Valproate and Lamotrigine.

Objective: The study intended to analyze the effects of a group nursing intervention on quality of life (QoL) of patients with epilepsy (EP) after treatment with sodium valproate combined with lamotrigine. Design: The research team performed a randomized controlled trial. Setting: The study took place in the Department of Neurology at the Affiliated Brain Hospital of Nanjing Medical University in Nanjing, Jiangsu, China. Participants: Participants were 170 EP patients at the hospital between January 2019 and August 2022. Intervention: The research team randomly assigned participants to one of two groups: (1) 85 to the intervention group, and they took part in a group nursing intervention; and (2) 85 to the control group (n = 85) and they received conventional care. Outcome Measures: To evaluate participants' risk of suicide, psychological state, and QOL, participants completed at baseline and postintervention: (1) the Mini-International Neuropsychiatric Interview (MINI), (2) the Self-Rating Scale for Psychiatric Symptoms 90 (SCL-90), and (3) the Short Form Health Survey (SF-36) To assess participants' management ability, self-efficacy, and social functioning, they also completed at those time points: (1) the EP Self-Management Behavior Scale (ESMS), (2) the General Self-Efficacy Scale (GSES), and (3) the Social Functioning Deficit Screening Scale (SDSS). Finally, the research also investigated participants' satisfaction with the nursing care. Results: The intervention group's risk of suicide decreased between baseline and postintervention, and its SCL-90 scores were significantly lower and SF-36 scores were significantly higher than those of the control group (both P < .05). In addition, the intervention group's ESMS and GSES scores were also significantly higher than those of the control group, while its SDSS score was significantly lower than that of the control group (all P < .05). Finally, the intervention group's nursing satisfaction was also significantly higher than that of the control group (P < .05). Conclusions: The group nursing intervention can effectively improve the psychological states of EP patients, reduce their pain, improve their self-management skills and QoL, provide them with better and more detailed nursing care, and facilitate the treatment and recovery of EP patients, which can have a significant value in clinical practice.