Could an optimally fitted categorization of difference between multi-disease score and multi-symptom score be a practical indicator aiding in improving the cost-effectiveness of healthcare delivery for older adults in developing countries?

BACKGROUND: Physio-psycho-socioeconomical health comprehensively declines during aging, the complexity of which is challenging to measure. Among the complexity, multiple chronic disorders continuously cumulated during aging, further aggravating the challenge. METHODS: A population-based survey on Comprehensive Ageing Health Assessment was conducted in older adults (age > = 60) enrolled from hospital settings and community settings in 13 working centers in six subnational regions in China. Cross-sectional datasets of 8,093 older participants with approximately complete assessment results were collected for the present analysis. Individual's multi-disease or multi-symptom was respectively scored by summing coexistent multiple diseases or multiple symptoms by respective weighting efficient for Self-Rated Health (SRH). Individual's age-dependent health decline was further summed of four SRH-weighted scores for daily function (activity of daily life, ADL), physical mobility (an average of three metrics), cognitive function (mini mental state examination, MMSE) and mental being (geriatric depression scale, GDS) plus multi-disease score (MDS) and multi-symptom score (MSS).Multi-disease patten among 18 diseases or multi-symptom pattern among 15 symptoms was latent-clustered in the older adults, the optimal outcome of which was categorized into high, moderate or low aging-associated clusters, respectively. Percentage distribution was compared between overall health decline score and multi-disease pattern cluster or multi-symptom patten cluster. A new variable of difference between MDS and MSS (hereinafter terming DMM) that displayed linear variation with socioeconomic factors was further fitted using multilevel regression analyses by substantial adjustments on individual confounders (level-1) and subnational region variation (level-2). RESULTS: Consistent gradient distribution was shown between health decline and multimorbidity pattern cluster in the older adults. DMM was found linearly varied with personal education attainment and regional socioeconomic status. Using optimally fitted stratification of DMM (DMM interval = 0.02), an independent U-shaped interrelated tendency was shown between health decline, multi-disease and multi-symptom, which could be well explained by regional disparities in socioeconomic status. CONCLUSION: Newly developed metrics for age-dependent health decline and aging-associated multimorbidity patten were preliminarily validated from within. The new variable of optimally fitted categorization of DMM might function as a practical indicator aiding in improving the cost-effectiveness and reduce inequity of healthcare delivery for older adults in developing countries.

Tumor response assessment by measuring the single largest lesion per organ in advanced non-small cell lung cancer patients treated with PD-1/PD-L1 inhibitor.

Background: For Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST1.1), measuring up to two target lesions per organ is an arbitrary criterion. Objectives: We sought to compare response assessment using RECIST1.1 and modified RECIST1.1 (mRECIST1.1, measuring the single largest lesion per organ) in advanced non-small cell lung cancer (aNSCLC) patients undergoing anti-PD-1/PD-L1 monotherapy. Methods: Concordance of radiologic response categorization between RECIST1.1 and mRECIST1.1 was compared using the Kappa statistics. C-index was calculated to evaluate prognostic accuracy of radiologic response by the two criteria. The Kaplan-Meier method and Cox regression analysis were conducted for progression-free survival (PFS) and overall survival (OS). Results: Eighty-seven patients who had at least two target lesions in any organ per the RECIST1.1 were eligible for comparison analysis. Tumor response showed excellent concordance when measured using the RECIST1.1 and mRECIST1.1 (Kappa = 0.961). C-index by these two criteria was similar for PFS (0.784 versus 0.785) and OS (0.649 versus 0.652). Responders had significantly longer PFS and OS versus non-responders (p < 0.05), whichever criterion adopted. Radiologic response remained a significant predictor of PFS and OS in multivariate analysis (p < 0.05). Conclusion: The mRECIST1.1 was comparable to RECIST1.1 in response assessment among aNSCLC patients who received single-agent PD-1/PD-L1 inhibitor. The mRECIST1.1, with reduced number of lesions to be measured, may be sufficient and more convenient to assess antitumor activity in clinical practice.

Dynamically attentive viewport sequence for no-reference quality assessment of omnidirectional images.

Omnidirectional images (ODIs) have drawn great attention in virtual reality (VR) due to the capability of providing an immersive experience to users. However, ODIs are usually subject to various quality degradations during different processing stages. Thus, the quality assessment of ODIs is of critical importance to the community of VR. The quality assessment of ODIs is quite different from that of traditional 2D images. Existing IQA methods focus on extracting features from spherical scenes while ignoring the characteristics of actual viewing behavior of humans in continuously browsing an ODI through HMD and failing to characterize the temporal dynamics of the browsing process in terms of the temporal order of viewports. In this article, we resort to the law of gravity to detect the dynamically attentive regions of humans when viewing ODIs. In this article, we propose a novel no-reference (NR) ODI quality evaluation method by making efforts on two aspects including the construction of Dynamically Attentive Viewport Sequence (DAVS) from ODIs and the extraction of Quality-Aware Features (QAFs) from DAVS. The construction of DAVS aims to build a sequence of viewports that are likely to be explored by viewers based on the prediction of visual scanpath when viewers are freely exploring the ODI within the exploration time via HMD. A DAVS that contains only global motion can then be obtained by sampling a series of viewports from the ODI along the predicted visual scanpath. The subsequent quality evaluation of ODIs is performed merely based on the DAVS. The extraction of QAFs aims to obtain effective feature representations that are highly discriminative in terms of perceived distortion and visual quality. Finally, we can adopt a regression model to map the extracted QAFs to a single predicted quality score. Experimental results on two datasets demonstrate that the proposed method is able to deliver state-of-the-art performance.

Sustainable design of pavement systems in highly urbanized context: A lifecycle assessment.

Substantial amount of resources is consumed by pavement systems, which have resulted considerable environmental impacts. Understanding the environmental impacts would provide opportunity for reducing resource consumption and informing decision-makers in the process of designing sustainable pavement. There is a lacking of comprehensive and comparative sustainability assessment of pavement systems in highly urbanized context currently. Therefore, this study aims to design and comprehensively evaluate the environmental performance of the commonly adopted pavement systems in highly urbanized context using lifecycle assessment (LCA) technique through a case in Hong Kong. According to the codes and practices of Hong Kong, two pavement systems including flexible and rigid pavements were designed based on the same road section. After that interviews with structured questionnaire were conducted to collect relevant practical information of pavement construction and maintenance from the relevant professional bodies and experts for the subsequent LCA of such designs. The LCA results reveal that the two mid-point impacts of global warming potential and mineral extraction are 21% and 54% higher for rigid pavement than for flexible pavement. Yet, the end-point results indicate that flexible pavement is associated with 64%, 65%, and 69% higher human health impact, ecosystem quality damage, and resource damage, respectively. Material production and transportation contribute significantly to the total impact in the two pavement systems. For instance, it is about 57% and 97% of the total global warming potential for flexible and rigid pavements, respectively. The overall results demonstrated that 49% higher total impact was found for flexible pavement than rigid pavement. Therefore, the use of more recycled and environmentally friendly materials can potentially enhance the environmental sustainability of both pavement systems. The findings should provide useful information to the design and selection of sustainable pavement structures in resource-scarce highly-urbanized cities.

Annual direct economic burden and influencing factors of dry eye disease in Central China.

PURPOSE: To study the direct economic burden of dry eye diseases (DED) on Chinese residents and analyze the influencing factors of the direct economic burden of patients with DED. METHODS: Two hundred and twenty-one Chinese adults with DED who underwent treatment in Wuhan Aier Hankou Eye Hospital were enrolled in this health economics research from January 2018 to August 2018 and followed for at least 1 year. Examination, pharmacological therapy, and nonpharmacological therapy costs were collected to calculate the annual direct economic burden of DED on patients through the outpatient medical record system. RESULTS: Annual direct economic burden caused by DED on each patient was $465.54 ± 303.08. The direct economic burden of female patients in the 40-49 years group was significantly higher than that of male patients (P < .05). Age, number of hospital visits and severity of DED were showed a significant influence on the direct economic burden both in univariate linear regression analysis and multiple linear regression analysis. Subtype of DED was showed a significant influence on the direct economic burden in multiple linear regression analysis after eliminating confounding factors. CONCLUSION: This study preliminarily analyzed the direct economic burden of Chinese DED patients. Age, number of hospital visits, severity of DED, mixed and evaporative dry eye (EDE) subtypes are shown to be the significant influencing factors of the direct economic burden and sex is a potential influencing factor.

In-depth assessment of the PAM compatibility and editing activities of Cas9 variants.

A series of Cas9 variants have been developed to improve the editing fidelity or targeting range of CRISPR-Cas9. Here, we employ a high-throughput sequencing approach primer-extension-mediated sequencing to analyze the editing efficiency, specificity and protospacer adjacent motif (PAM) compatibility of a dozen of SpCas9 variants at multiple target sites in depth, and our findings validate the high fidelity or broad editing range of these SpCas9 variants. With regard to the PAM-flexible SpCas9 variants, we detect significantly increased levels of off-target activity and propose a trade-off between targeting range and editing specificity for them, especially for the near-PAM-less SpRY. Moreover, we use a deep learning model to verify the consistency and predictability of SpRY off-target sites. Furthermore, we combine high-fidelity SpCas9 variants with SpRY to generate three new SpCas9 variants with both high fidelity and broad editing range. Finally, we also find that the existing SpCas9 variants are not effective in suppressing genome instability elicited by CRISPR-Cas9 editing, raising an urgent issue to be addressed.

How public environmental concern affects the sustainable development of Chinese cities: An empirical study using extended DEA models.

China is now facing the formidable tasks of saving energy and reducing emissions, so it is very important to analyze China's energy and environmental efficiency. However, previous studies have rarely paid attention to the cross-impacts that different forms of public environmental concern (PEC) have simultaneously on energy and environmental efficiency. To investigate how these two types of efficiency change along with PEC variations, this paper employs six extended programming models which are developed based upon the theory of Data Envelopment Analysis (DEA) and the directional distance function (DDF). An empirical analysis of data from 239 Chinese prefecture-level cities demonstrates the techniques. The empirical results show that PEC variations can significantly affect the environmental efficiency only if the city is experiencing unsustainable development. This work also shows that PEC about input resources may exaggerate the environmental efficiency, implying that the public may be more tolerant of resource over-consumption than of pollutant over-emission.

Construction of a comprehensive observer-based scale assessing aging-related health and functioning in captive rhesus macaques.

Aging-related health and functioning are difficult to quantify in humans and nonhuman primates. We constructed an observer-based scale for daily application in assessing the aging-related health and functioning of rhesus macaques. Ten items referring to an aging appearance, musculoskeletal aging and aging-related eating behavior were selected through a panel consensus. The Aging-related Health and Functioning Scale (AHFS) was constructed based on these scored items form 57 healthy rhesus macaques. High reliability of the AHFS was shown based on Cronbach's alpha coefficient (0.877). The structure of the AHFS was validated by three exploratory factors. The largest factor, whose four components were dietary uptake, iliac muscle mass, hair condition and fragility, and sex, explained 50.5% of the variation in aging-related health and functioning scores. The second factor, involving age, tooth loss and tooth wear, explained 15.5% of the variation. The lowest-ranking factor comprised only facial redness and accounted for 10% of the variation. A hierarchical cluster analysis validated the good applicability of the scale in distinct samples. From these scale-scored results, complicated aging phenomena observed in humans, including the sex-survival paradox and the calorie-related health-survival paradox, were both demonstrated in rhesus macaques. Therefore, the AHFS provides a valuable approach for aging-related research.

Study on Benefit Coordination of Supply Chain Network Based on Green Development.

Based on Stackelberg's master-slave game theory and green index decision-making conditions, this paper studies the benefit coordination of a supply chain network composed of a business flow network and logistics network, discusses the decision-making behavior of the main body of the supply chain network under the performance of green contracts or speculative behavior, respectively, and further constructs the supply chain network collaborative benefit coordination model under the guidance of a manufacturer considering a green development index. The supply chain network interest coordination model analyzes the relationship between the dominant manufacturer behavior and the supply chain network green index and network profit. The results show that fulfilling green contracts helps improve the profitability and sustainability of supply chain networks. A counter-intuitive but interesting result is that the dominant manufacturers increase the cost-sharing ratio or penalties of the logistics network, which will reduce the profit level and green index of the logistics network, and increase the cost-sharing ratio or punishment of the suppliers. Strength will increase the profitability and green index of the logistics network. Finally, we validate the relevant conclusions of the model through numerical simulation analysis.

Assessment of heavy metal contamination from penguins and anthropogenic activities on Fildes Peninsula and Ardley Island, Antarctic.

Fildes Peninsula, with a high density of scientific stations, has been significantly impacted by anthropogenic activities. However, the contamination from penguins, a biovector that transports pollutants from ocean to land, has seldom been assessed. In this study, 32 lacustrine surface sediment samples on Fildes Peninsula and 8 lacustrine surface sediment samples on Ardley Island were collected to determine Cu, Zn, Pb, Ni, Cr, Cd, Co, Sb, Hg and P levels. The results showed that the heavy metal contents of lacustrine sediments on Ardley Island are significantly higher than those on Fildes Peninsula. The contaminants on Fildes Peninsula are mainly derived from anthropogenic activities, while the contaminants on Ardley Island are transported to the lacustrine sediments in the form of penguin guanos after a series of biomagnification in the food chain. The results indicated that the impact of penguin-transported contamination on Antarctic environment outweighs human activities near scientific stations in some areas. Therefore, more attention should be paid to the impacts of Antarctic animals on the Antarctic environment.

Evaluating the Efficacy of Government Spending on Air Pollution Control: A Case Study from Beijing.

The reform and opening up of the Chinese economy over the last 40 years has led to rapid economic development. However, with the rapid expansion of the economy, increasingly serious air pollution is apparent. In order to control urban air pollution effectively, Chinese governments at all levels have invested large sums every year. However, it has become a difficult issue which influences public government decisions with respect to how and according to what standard to distribute financial funds so as to improve air quality while saving money at the same time. Taking Beijing as an example, this paper investigates the ten-year change in the annual daily mean of inhalable particulate matter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) from the year of 2006 to 2015, researches the invested funds in environmental protection in Beijing, and establishes a relationship between the atmospheric indexes of the above three parameters and government-invested funds in environmental protection. According to model analysis, government financial input has an obvious influence on the improvement of air quality. However, during the long period of financial input, the degree of air quality improvement will reduce gradually as time goes by. There exists a direct link between the effectiveness of government financial input to promote air quality and the air quality index, which means when the pollutant standards index is poor (i.e., the corresponding pollutant concentration is higher), the effectiveness will be more apparent. On the contrary, when the index is at a good level, the effectiveness of government financial input is very small. To achieve the best air quality conditions, the government should set the detailed financial input at or over the first-grade standard according to urban air quality standards.

Does economic development improve urban greening? Evidence from 289 cities in China using spatial regression models.

Significant differences in urban greening have occurred in Chinese cities, accompanied by China's rapid urbanization. However, there are relatively few studies on the spatial differentiation of urban greening in China at the city level. In addition, there is no unanimous conclusion on the main factors influencing the spatial differentiation of urban greening. Based on 2014 emission inventory data from 289 cities, the spatial differentiation pattern and spatial correlation characteristics of the urban green space ratio, urban green coverage rate, and public green area per capita were calculated and analyzed using global and local Moran's I. We then used ordinary least squares, spatial error model, spatial autoregression, and geographically weighted regression to quantify the impact and spatial variations of China's economy on urban greening. The results showed (1) a significant spatial dependence and heterogeneity existed in urban greening values, and the patterns showed influences of both the stage of economic development and spatial agglomeration; (2) regression models revealed per capita GDP had a positive effect on the urban green space ratio and public green area per capita while the urbanization rate, secondary industry, urban land, and population density had opposite effects on these two greening indexes; and (3) geographically weighted regression revealed per capita GDP had a greater influence on urban greening in the northwestern region than in the southeastern region. The study could constitute a valuable reference for mid-to-long-term green space planning policy in diverse parts of China and could further assist in coordinating the development of urban greening and economic growth.

Study on Spatial Spillover Effects of Logistics Industry Development for Economic Growth in the Yangtze River Delta City Cluster Based on Spatial Durbin Model.

The overall entropy method is used to evaluate the development level of the logistics industry in the city based on a mechanism analysis of the spillover effect of the development of the logistics industry on economic growth, according to the panel data of 26 cities in the Yangtze River delta. On this basis, the paper uses the spatial durbin model to study the direct impact of the development of the logistics industry on economic growth and the spatial spillover effect. The results show that the direct impact coefficient of the development of the logistics industry in the Yangtze River Delta urban agglomeration on local economic growth is 0.092, and the significant spatial spillover effect on the economic growth in the surrounding area is 0.197. Compared with the labor force input, capital investment and the degree of opening to the world, and government functions, the logistics industry's direct impact coefficient is the largest, other than capital investment; the coefficient of the spillover effect is higher than other control variables, making it a "strong engine" of the Yangtze River Delta urban agglomeration economic growth.

Historical change of mercury pollution in remote Yongle archipelago, South China Sea.

We collected three ornithogenic coral sand sedimentary profiles from Jinyin Island, Jinqing Island and Guangjin Island of Yongle archipelago, South China Sea and reconstructed the deposition flux of anthropogenic Hg over the past 700 years in the study area. On the whole, the anthropogenic Hg flux is relatively low; it remained at a low level before the Industrial Revolution with a small peak at about 1450-1550 AD, which may record the enhanced metallurgy activity in Ming Dynasty of China. During the 20th century, the deposition flux of anthropogenic Hg increased rapidly, but two troughs occurred during the periods around 1940s and 1970s, corresponding to the economic depression caused by World War II, Civil War in China (1945-1949), and the Culture Revolution (1966-1976) in China. Since the 1970s the deposition flux of anthropogenic Hg has been persistently increasing, apparently the result of fast economic development in East and Southeast Asia countries around South China Sea.