Urban-Rural Disparities in the Association Between Home- and Community-Based Service Utilization and Levels of Disability Among Chinese Older Adults With Disabilities.

Home- and community-based services (HCBS) are optimal ways to deal with disability problems among older adults. This study aims to analyze urban-rural disparities in the relationship between HCBS utilization and levels of disability among Chinese older adults with disabilities, so as to meet the long-term care needs of them. In applying the Andersen Behavioral Model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey (CLASS). After adjusting covariates, disability levels among Chinese older adults with disabilities were significantly correlated with HCBS utilization in urban areas but not in rural areas. The urban-rural disparities may be due to the low utilization of HCBS in rural areas (only 11.2%) among older adults with disabilities compared with their urban counterparts (22.7%).

Pathways to Improve Provision of Home and Community-Based Services-A Configurational Approach Based on a Fuzzy-Set Qualitative Comparative Analysis From China.

Providing home and community-based services (HCBS) is critical for active and healthy aging. However, in China, the positive factors for improving HCBS provision are unclear, limiting its contribution to improving older adults' quality of life and promoting active and healthy aging. Therefore, this study examines the configurations that produce differences in HCBS and identifies multiple pathways for improving them and narrowing regional disparities. Using data from multiple datasets comprising 23 cases, we performed configuration analysis using fuzzy-set qualitative comparative analysis. Four pathways producing high HCBS provision and three pathways producing low HCBS provision were found. Different combinations of the aging population, economic development, institutional support, financial support, and development of multiple stakeholders influence HCBS provision. Thus, measures based on the main factor characteristics should be implemented to improve the HCBS provision level.

Infrared Raman spectroscopy enables noninvasive biochemical assessment of skin tissue and the thermal stability.

Raman-active modes of human skin and pork belly have been studied systematically by a near-infrared Raman spectrometer with an exciting laser of 1064 nm. The main components and quantitative determination of pork belly are extracted by fitting the Raman spectra with the normalized Raman spectra of biochemical reagents such as collagen, elastin, triolein, fibronectin, fibrin, and hyaluronic acid. It demonstrates that the main components and quantity are various at different locations of pork belly, while the main components of human skin are similar to those of pig skin. In a further step, the evolution of the heating time-dependent Raman modes of isolated pig skin has been investigated for the mechanism of burnt skin. One can find that the spatial structure and main components of skin have an excellent thermal stability in the temperature range from -120 to 200 ∘C, which is confirmed by the temperature dependent Raman spectra of isolated pig skin, microporous acellular dermal matrix (MADM) as well as their corresponding biochemical reagents (collagen, elastin, triolein, etc.). These results help understand the mechanism of the living skin burnt by fire or hot water, and supplies an alternative technology for surgeons to diagnose the depth of a burn injury in time.

Achieving green tourism through environmental perspectives of green digital technologies, green innovation, and green HR practices.

This study investigates tourism growth with the role of green digital technologies and green human resource management (GHRM) in China. We applied a fuzzy analysis technique using the 130 Chinese tourism SMEs that use digital technology. The study results declared that digitalization in tourism increases automation in both the process and the final product, raising demand and quality. Moreover, green digital technologies are significant in agile innovation and tourism growth. The study's results extended that green HRM practices have a significant role in Chinese SMEs developing agile innovation, tourism growth, and green digital innovation. These findings were confirmed by using fuzzy robustness tools. The study proposes to achieve SDGs in China's tourism industry using primitive measures to enhance tourism growth and agile innovation based on green HRM practices and green digital technologies. Such prudent measures suggested improving green digital technologies in the Chinese tourism industry for tourism growth and agile innovation maximization.

Developing a Capsule Clinic-A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China.

Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients' usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process-from diagnosis to prescription services-can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations' PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity.

Risk Assessment of the Worldwide Expansion and Outbreak of Massicus raddei (Blessig) (Coleoptera: Cerambycidae) Based on Host Plant and Climatic Factors.

Massicus raddei (Blessig) is a serious trunk borer of oak species, currently widespread only in eastern Asia. A better understanding of the invasive potential of this borer across other distribution-free areas is further needed to prevent its invasion and outbreaks. In this study, we mapped the current distribution of M. raddei, two susceptible hosts (Quercus mongolia and Q. liaotungensis) and all 11 host species of this borer, and then modeled their potential distributions. We comprehensively compared the current distributions and potential invasion ranges among M. raddei, susceptible hosts and all hosts to select areas at risk for the establishment of this borer. MaxEnt model predictions revealed that (1) the central and eastern US, a small area of central and western Europe, western Georgia, and central Argentina had suitable climates for M. raddei. Such highly suitable areas for this borer overlapped considerably with the current plantation and potential distributions of its hosts. Consequently, susceptible hosts and climate suitability together create the highest risk for M. raddei establishment and outbreaks, throughout central and eastern America, a small area of central Europe, western Norway and western Georgia, and (2) the broad host suitability across six continents creates a situation favorable for the colonization of this borer, further extending the spatial scale of possible infestation by M. raddei worldwide.

Technology-Based Compensation Assessment and Detection of Upper Extremity Activities of Stroke Survivors: Systematic Review.

BACKGROUND: Upper extremity (UE) impairment affects up to 80% of stroke survivors and accounts for most of the rehabilitation after discharge from the hospital release. Compensation, commonly used by stroke survivors during UE rehabilitation, is applied to adapt to the loss of motor function and may impede the rehabilitation process in the long term and lead to new orthopedic problems. Intensive monitoring of compensatory movements is critical for improving the functional outcomes during rehabilitation. OBJECTIVE: This review analyzes how technology-based methods have been applied to assess and detect compensation during stroke UE rehabilitation. METHODS: We conducted a wide database search. All studies were independently screened by 2 reviewers (XW and YF), with a third reviewer (BY) involved in resolving discrepancies. The final included studies were rated according to their level of clinical evidence based on their correlation with clinical scales (with the same tasks or the same evaluation criteria). One reviewer (XW) extracted data on publication, demographic information, compensation types, sensors used for compensation assessment, compensation measurements, and statistical or artificial intelligence methods. Accuracy was checked by another reviewer (YF). Four research questions were presented. For each question, the data were synthesized and tabulated, and a descriptive summary of the findings was provided. The data were synthesized and tabulated based on each research question. RESULTS: A total of 72 studies were included in this review. In all, 2 types of compensation were identified: disuse of the affected upper limb and awkward use of the affected upper limb to adjust for limited strength, mobility, and motor control. Various models and quantitative measurements have been proposed to characterize compensation. Body-worn technology (25/72, 35% studies) was the most used sensor technology to assess compensation, followed by marker-based motion capture system (24/72, 33% studies) and marker-free vision sensor technology (16/72, 22% studies). Most studies (56/72, 78% studies) used statistical methods for compensation assessment, whereas heterogeneous machine learning algorithms (15/72, 21% studies) were also applied for automatic detection of compensatory movements and postures. CONCLUSIONS: This systematic review provides insights for future research on technology-based compensation assessment and detection in stroke UE rehabilitation. Technology-based compensation assessment and detection have the capacity to augment rehabilitation independent of the constant care of therapists. The drawbacks of each sensor in compensation assessment and detection are discussed, and future research could focus on methods to overcome these disadvantages. It is advised that open data together with multilabel classification algorithms or deep learning algorithms could benefit from automatic real time compensation detection. It is also recommended that technology-based compensation predictions be explored.

Clinical effectiveness of DNA methyltransferase inhibitors and lenalidomide in older patients with refractory anemia with ring sideroblasts: a population-based study in the United States.

Existing studies regarding the role of DNA methyltransferase inhibitors (DNMTi) and lenalidomide in refractory anemia with ring sideroblasts (RARS) are limited. Using the surveillance, epidemiology, and end results-medicare database, we assembled a population-based cohort of older adults diagnosed with non-del(5q) lower-risk myelodysplastic syndromes during 2007-2015. Of 2167 patients, 30% had RARS. About 16% of RARS and non- ring sideroblasts (RS) patients received DNMTi. RARS patients were more likely to receive lenalidomide (11.1% vs. 7.1%, p < 0.01). Among patients who were transfusion-dependent at treatment initiation, 55.6% of those treated with DNMTi only and 42.5% treated with lenalidomide only achieved red blood cell transfusion independence (RBC-TI) for a median duration of 21 and 12 weeks, respectively. RS status did not impact rate of RBC-TI. RARS patients had a significantly better survival, and the median survival of RARS patients varied by treatment group. In this population-based study of older RARS patients, DNMTi and lenalidomide were clinically active.

Clinical outcomes of older patients with AML receiving hypomethylating agents: a large population-based study in the United States.

The hypomethylating agents (HMAs) azacitidine and decitabine have been the de facto standard of care for patients with acute myeloid leukemia (AML) who are unfit for intensive therapy. Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 2263 older adults (age ≥66 years) diagnosed with AML during 2005-2015 who received a first-line HMA; 1154 (51%) received azacitidine, and 1109 (49%) received decitabine. Median survival from diagnosis was 7.1 and 8.2 months (P < .01) for azacitidine- and decitabine-treated patients, respectively. Mortality risk was higher with azacitidine vs decitabine (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.01-1.21; P = .02). The findings were similar when evaluating only patients completing ≥4 cycles (42% of patients treated with either azacitidine or decitabine). These findings lost significance when evaluating those completing a standard 7-day schedule of azacitidine (34%) vs 5-day schedule for decitabine (66%) (HR, 0.95; 95% CI, 0.83-1.08; P = .43). Red blood cell (RBC) transfusion independence (TI) was achieved in one-third of patients with no difference between the 2 HMAs. In conclusion, the majority of older AML patients did not receive the minimum of 4 cycles of HMA often needed to elicit clinical benefit. We observed no clinically meaningful differences between azacitidine- and decitabine-treated patients in their achievement of RBC TI or survival.

Removal of heavy metals using a novel sulfidogenic AMD treatment system with sulfur reduction: Configuration, performance, critical parameters and economic analysis.

A novel sulfidogenic acid mine drainage (AMD) treatment system with a sulfur reduction process was developed. During the 220-d operation, >99.9% of 380-mg/L ferric, 150-mg/L aluminum, 110-mg/L zinc, 20-mg/L copper and 2.5-mg/L lead ions, and 42.6-44.4% of 100-mg/L manganese ions in the synthetic AMD were step-by-step removed in the developed system with three pre-posed metal precipitators and a sulfur reduction reactor. Among them, zinc, copper and lead ions were removed by the biogenic hydrogen sulfide that produced through elemental sulfur reduction; while ferric, aluminum and manganese ions were removed by the alkali precipitation. Compared with the reported sulfate reduction reactors, the sulfur reduction reactor significantly reduced the chemical cost by 25.6-78.9% for sulfide production, and maintained a high sulfide production rate (1.12 g S2-/L-d). The pH level in the sulfidogenic reactor driven by sulfur-reducing bacteria posed a significant effect on the sulfide production rate. Under a nearly neutral condition (pH 7.0-7.5), elemental sulfur dissolved into polysulfide to increase the bioavailability of S0. At acidic conditions (pH < 6.0), polysulfide formation was limited and sulfate reduction became dominant. Therefore, maintaining the sulfidogenic reactor driven by sulfur-reducing bacteria at neutral condition is essential to realize high-rate and low-cost AMD treatment. Moreover, the escape of residual hydrogen sulfide from the system was eliminated by employing a 17% recirculation from effluent to the sulfidogenic reactor.

Hospital Readmissions to Nonindex Hospitals: Patterns and Determinants Following the Medicare Readmission Reduction Penalty Program.

OBJECTIVE: To examine patterns and determinants of nonindex readmissions for Medicare as well as non-Medicare patients both before and immediately after the adoption of Medicare's Hospital Readmission Reduction Program (HRRP) in 2012. Nonindex readmissions are readmissions to hospitals that are different from the one from which the patient was discharged. METHODS: Observational analysis of statewide database from California comprising patient-level discharge reports. Mixed-effects logistic regression models examined the association between nonindex readmissions and both hospital- and patient-level characteristics. RESULTS: Nonindex readmissions for the population studied were approximately 25%, but the percentage of such readmissions was significantly higher for non-Medicare patients than those enrolled in Medicare. Nonindex readmissions were associated with several patient- and hospital-level characteristics from which patients were discharged. The adoption of the HRRP did not have any appreciable impact on the general pattern of nonindex readmissions. CONCLUSIONS: A substantial percentage of hospital readmissions are to nonindex hospitals, but the general pattern and determinants of these events have not changed following the adoption of the HRRP. As preventable readmissions continue to gain attention as a key quality indicator for hospital care, further investigations are needed to understand the potential value of nonindex readmissions as a quality indicator for hospital care.

The predictive value of polysomnography combined with quality of life for treatment decision of children with habitual snoring related to adenotonsillar hypertrophy.

PURPOSE: Both surgical treatment and non-surgical treatment are suggested by clinicians for children with habitual snoring related to adenotonsillar hypertrophy; However, how should the decision be made remains unclear. The objective of this study was to investigate potential predictors for the treatment decision, i.e., surgical treatment vs wait and see in children with habitual snoring related to adenoidal and/or tonsillar hypertrophy. METHODS: Children with complaints of snoring and/or apnea associated with adenotonsillar hypertrophy who received polysomnography (PSG) monitoring at our Hospital were recruited. After at least 6 months, the subjects were followed up and grouped according to whether or not they had received adenoidectomy and/or tonsillectomy (AT) execution. The heights, weights, as well as the quality of life (assessed using the obstructive sleep apnea-18 (OSA-18) quality of life questionnaire) and baseline PSG of the subjects were recorded and compared. Two logistic regressions were performed to reveal the factors influencing decision-making on conducting AT. RESULTS: A total of 509 children were finally included (345 males and 164 females). Among these children, 287 eventually received AT. Significant differences in age, scores for item 1 and 5 of the OSA-18, apnea-hypopnea index, obstructive apnea index, obstructive apnea-hypopnea index (OAHI), and Lowest arterial oxygen saturation (P < 0.05) were observed between groups. By multivariate logistic regression, the factors that influenced the surgical decision were identified as follows: age < 7 years (P = 0.008: odds ratio [OR] = 1.667, 95% confidence interval [CI] 1.140-2.438), score for item 5 of OSA-18 > 4 points (P = 0.042: OR = 1.489, 95% CI 1.014-2.212) and OAHI > 1/h (P = 0.044: OR = 1.579, 95% CI 1.013-2.463). CONCLUSION: School-age children aged < 7 years, with OAHI > 1/h and mouth breathing scored > 4 points were more likely to receive AT during the disease process and thus require increased attention.

Using Support Vector Machine on EEG for Advertisement Impact Assessment.

The advertising industry depends on an effective assessment of the impact of advertising as a key performance metric for their products. However, current assessment methods have relied on either indirect inference from observing changes in consumer behavior after the launch of an advertising campaign, which has long cycle times and requires an ad campaign to have already have been launched (often meaning costs having been sunk). Or through surveys or focus groups, which have a potential for experimental biases, peer pressure, and other psychological and sociological phenomena that can reduce the effectiveness of the study. In this paper, we investigate a new approach to assess the impact of advertisement by utilizing low-cost EEG headbands to record and assess the measurable impact of advertising on the brain. Our evaluation shows the desired performance of our method based on user experiment with 30 recruited subjects after watching 220 different advertisements. We believe the proposed SVM method can be further developed to a general and scalable methodology that can enable advertising agencies to assess impact rapidly, quantitatively, and without bias.

[Quantitative assessment of vasculature with DCE-MRI in nasopharyngeal carcinomas following radiotherapy and its value for efficacy evaluation].

OBJECTIVE: To study the changes in quantitative kinetic parameters in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) during radiotherapy and their value for efficacy evaluation in patients with nasopharyngeal carcinoma (NPC). METHODS: Twenty-four patients with NPC that had been pathologically confirmed as poorly differentiated squamous cell carcinoma underwent conventional MRI and DCE-MRI scans 1-2 days before radiotherapy (Pre-RT), during radiotherapy (RT 50 Gy), and upon completion of radiotherapy (RT 70 Gy). Based on the two-compartment model and using the arterial input function deconvolution technique, we calculated the quantitative kinetic parameters of DCE-MRI (K(trans), kep, and Ve) of the tumor tissues, examined the correlation between the tumor regression rate (RS0-50) and the parameters on Pre-RT and RT 50 Gy, and compared the parameters for RT 70 Gy among the groups with different prognosis. RESULTS: The K(trans) value of the tumor tissue decreased after radiotherapy and showed a significant difference between Pre-RT and RT 70 Gy, but not between Pre-RT and RT 50 Gy. The kep value decreased and Ve value increased after radiotherapy. The tumor regression rate was found to be positively correlated with the K(trans) value for Pre-RT (P=0.005) but negatively with the K(trans) value for RT 50 Gy (P=0.001). During the follow-up for 3 years, 5 patients died and 3 patients had distant metastases. No statistical differences in K(trans), kep, or Ve were found between the groups with different prognosis. CONCLUSIONS: The kinetic parameters in DCE-MRI, which vary significantly during radiotherapy, allow monitoring of tumor angiogenesis and vascular permeability and quantitative assessment of treatment efficacy for NPC. K(trans) value for Pre-RT and RT 50 Gy can serve as an indicator for early efficacy assessment of radiotherapy and for treatment adjustment, but its relation with the long-term outcomes awaits further study.

DCE-MRI assessment of the effect of Epstein-Barr virus-encoded latent membrane protein-1 targeted DNAzyme on tumor vasculature in patients with nasopharyngeal carcinomas.

BACKGROUND: EBV-encoded latent membrane protein 1 (EBV-LMP1) is an important oncogenic protein for nasopharyngeal carcinoma (NPC) and has been shown to engage a plethora of signaling pathways. Correspondingly, an LMP1-targeted DNAzyme was found to inhibit the growth of NPC cells both in vivo and in vitro by suppressing cell proliferation and inducing apoptosis. However, it remains unknown whether an LMP1-targeted DNAzyme would affect the vasculature of NPC. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been applied in the clinical trials of anti-angiogenic drugs for more than ten years, and Ktrans has been recommended as a primary endpoint. Therefore, the objective of the current study was to use DCE-MRI to longitudinally study the effect of an EBV-LMP1-targeted DNAzyme on the vasculature of patients with NPC. METHODS: Twenty-four patients were randomly divided into two groups: a combined treatment group (radiotherapy + LMP1-targeted DNAzyme) and a radiotherapy alone group (radiotherapy + normal saline). DCE-MRI scans were conducted 1 ~ 2 days before radiotherapy (Pre-RT), during radiotherapy (RT 50 Gy), upon completion of radiotherapy (RT 70 Gy), and three months after radiotherapy (3 months post-RT). Parameters of vascular permeability and intra- and extravascular volumes were subsequently obtained (e.g., Ktrans, kep, ve) using nordicICE software. RESULTS: Both Ktrans and kep values for NPC tumor tissues decreased for both groups after treatment. Moreover, a statistically significant difference in Ktrans values at the pre-therapy and post-therapy timepoints emerged earlier for the combined treatment group (RT 50 Gy, P =0.045) compared to the radiotherapy alone group (3 months post-RT, P = 0.032). For the kep values, the downward trend observed for both the combined treatment group and the radiotherapy alone group were similar. In contrast, ve values for all of the tumor tissues increased following therapy. CONCLUSIONS: The EBV-LMP1-targeted DNAzyme that was tested was found to accelerate the decline of Ktrans values for patients with NPC. Correspondingly, the LMP1-targeted DNAzyme treatments were found to affect the angiogenesis and microvascular permeability of NPC. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01449942. Registered 6 October 2011.

Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer.

Pancreatic cancer is one of the most common gastrointestinal tumors, with its incidence staying at a high level in both the United States and China. However, the overall 5-year survival rate of pancreatic cancer is still extremely low. Surgery remains the only potential chance for long-term survival. Early diagnosis and precise staging are crucial to make proper clinical decision for surgery candidates. Despite advances in diagnostic technology such as computed tomography (CT) and endoscopic ultrasound, diagnosis, staging and monitoring of the metabolic response remain a challenge for this devastating disease. Positron emission tomography/CT (PET/CT), a relatively novel modality, combines metabolic detection with anatomic information. It has been widely used in oncology and achieves good results in breast cancer, lung cancer and lymphoma. Its utilization in pancreatic cancer has also been widely accepted. However, the value of PET/CT in pancreatic disease is still controversial. Will PET/CT change the treatment strategy for potential surgery candidates? What kind of patients benefits most from this exam? In this review, we focus on the utility of PET/CT in diagnosis, staging, and assessment of resectability of pancreatic cancer. In addition, its ability to monitor metabolic response and recurrence after treatment will be emphasis of discussion. We hope to provide answers to the questions above, which clinicians care most about.

Reproductive toxicity assessment of surface water of the Tai section of the Yangtze River, China by in vitro bioassays coupled with chemical analysis.

Reproductive toxicity of organic extracts of the surface water from the Tai section of the Yangtze River was assessed by in vitro cytotoxity assays and selected persistent organic pollutants including PCBs, OCPs and PAHs were quantified by instrumental analysis. Eleven of the US EPA priority PAHs were detected. Individual PAHs were found to range from 0.7 to 20 ng/L. Concentrations of BaP did not exceed the national drinking water source quality standard of China. However, a 286-fold concentrated organic extract induced significant reproductive toxicity in adult male rats. The morphology of cells, MTT assay and LDH release assay were all affected by exposure to the organic extracts of water. The results of the reproductive toxicity indicated that PAHs posed the greatest risk of the chemicals studied. The compounds present in the water could be bioconcentrated and result in adverse effects.

In vitro assessment of reproductive toxicity on rats induced by organic contaminants of source water.

The safety of drinking water attracts more and more attention these years. This study focused on the reproductive toxicity of source water in Jiangsu Province, China. The organic contaminants of source water are capable of bioaccumulating and cause health effects on human beings. The toxicological tests on Spermatogenic cells, Sertoli cells and Leydig cells of male rats showed that source water extracts can reduce testicular cells membrane integrity and depress cell viability significantly. Among these testicular cells, Leydig cells are most sensitive to organic contaminants and the testosterone secretion of Leydig cells is evidently disturbed correspondingly. The phenols in the source water may be chiefly responsible for the reproductive toxicity. These data indicated that chronic reproductive toxicity of source water cannot be overlooked and action should be taken to protect human health from the threat of organic pollution of source water.