Establishment and validation of a risk score model based on EUS: assessment of lymph node metastasis in early gastric cancer.

BACKGROUND AND AIMS: Lymph node metastasis significantly affects the prognosis of early gastric cancer patients. EUS plays a crucial role in the preoperative assessment of early gastric cancer. This study evaluated the efficacy of EUS in identifying lymph node metastasis in early gastric cancer patients and developed a risk score model to aid in choosing the best treatment options. METHODS: We retrospectively analyzed the effectiveness of EUS for detecting lymph node metastasis in early gastric cancer patients. A risk score model for predicting lymph node metastasis preoperatively was created using independent risk factors identified through binary logistic regression analysis and subsequently validated. Receiver operating characteristic curves were generated for both the development and validation cohorts. RESULTS: The overall accuracy of EUS in identifying lymph node metastasis was 85.3%, although its sensitivity (29.2%) and positive predictive value (38.7%) were relatively low. Patients were categorized based on preoperative risk factors for lymph node metastasis, including tumor size of ≥20 mm, lymph nodes of ≥10 mm, body mass index of ≥24 kg/m2, and lymph node metastasis on CT scans. A 7-point risk score model was developed to assess the likelihood of lymph node metastasis. The areas under the receiver operating characteristic curve for the development and validation sets were 0.842 and 0.837, respectively, with sensitivities of 64% and 79%, respectively. CONCLUSIONS: We developed a practical risk score model based on preoperative factors to help EUS predict lymph node metastasis in early gastric cancer patients, guiding the selection of optimal treatment approaches for these patients.

Modeling assessment of air pollution control measures and COVID-19 pandemic on air quality improvements over Greater Bay Area of China.

A remarkable progress has been made toward the air quality improvements over the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) of China from 2017 to 2020. In this study, for the first time, the emission reductions of regional control measures together with the COVID-19 pandemic were considered simultaneously into the development of the GBA's emission inventories for the years of 2017 and 2020. Based on these collective emission inventories, the impacts of control measures, meteorological variations together with temporary COVID-19 lockdowns on the five major air quality index pollutants (SO2, NO2, PM2.5, PM10, and O3, excluding CO) were evaluated using the WRF-CMAQ and SMAT-CE model attainment assessment tool over the GBA region. Our results revealed that control measures in the Pearl River Delta (PRD) region affected significantly the GBA, resulting in pollutant reductions ranging from 48 % to 64 %. In contrast, control measures in Hong Kong and Macao contributed to pollutant reductions up to 10 %. In PRD emission sectors, stationary combustion, on-road, industrial processes and dust sectors stand out as the primary contributors to overall air quality improvements. Moreover, the COVID-19 pandemic during period I (Jan 23-Feb 23) led to a reduction of NO2 concentration by 7.4 %, resulting in a negative contribution (disbenefit) for O3 with an increase by 2.4 %. Our findings highlight the significance of PRD control measures for the air quality improvements over the GBA, emphasizing the necessity of implementing more refined and feasible manageable joint prevention and control policies.

Scoring the Value Assessment Framework for China: A Factorial Survey.

OBJECTIVES: This study aimed to develop the scoring functions for the recently developed value assessment framework (VAF) for China, which comprises 12 attributes. METHODS: We implemented a factorial survey among Chinese healthcare stakeholders from July to September 2022. A total of 240 hypothetical drug value profiles described by the VAF were grouped into 60 blocks and randomly assigned to respondents. Each respondent was assigned with 1 block, each presented in 3 disease scenarios of different levels of severity. For each profile, respondents were asked to assess the drug's value on a scale from 0 (lowest) to 10 (highest) and make 1 of the 3 insurance recommendations: cover, to be negotiated for coverage, or reject. Linear and logistic mixed-effects models were used to develop scoring functions for aggregating the value attributes. RESULTS: A total of 365 respondents participated in the survey. 3968 responses from 331 respondents were included in the analysis. Most of the included respondents were under 45 (n = 256, 77.3%), females (n = 208, 62.8%), living in urban areas (n = 296, 89.4%), and with a bachelor's degree or higher (n = 303, 91.5%). Health benefits and safety carried more weights than other attributes in the scoring functions across disease scenarios. The value and probability of entering negotiation or receiving insurance coverage for the attribute profiles for severe/critical disease were higher than for mild/moderate disease. CONCLUSIONS: The scoring functions of the VAF can be used to assess the value of a drug and its probability of entering negotiation or receiving insurance coverage in China.

Cost-effectiveness of endovascular thrombectomy with alteplase versus endovascular thrombectomy alone for acute ischemic stroke secondary to large vessel occlusion.

BACKGROUND: Recent randomized trials have suggested that endovascular thrombectomy (EVT) alone may provide similar functional outcomes as the current standard of care, EVT combined with intravenous alteplase treatment, for acute ischemic stroke secondary to large vessel occlusion. We conducted an economic evaluation of these 2 therapeutic options. METHODS: We constructed a decision analytic model with a hypothetical cohort of 1000 patients to assess the cost-effectiveness of EVT with intravenous alteplase treatment versus EVT alone for acute ischemic stroke secondary to large vessel occlusion from both the societal and public health care payer perspectives. We used studies and data published in 2009-2021 for model inputs, and acquired cost data for Canada and China, representing high- and middle-income countries, respectively. We calculated incremental cost-effectiveness ratios (ICERs) using a lifetime horizon and accounted for uncertainty using 1-way and probabilistic sensitivity analyses. All costs are reported in 2021 Canadian dollars. RESULTS: In Canada, the difference in quality-adjusted life-years (QALYs) gained between EVT with alteplase and EVT alone was 0.10 from both the societal and health care payer perspectives. The difference in cost was $2847 from a societal perspective and $2767 from the payer perspective. In China, the difference in QALYs gained was 0.07 from both perspectives, and the difference in cost was $1550 from the societal perspective and $1607 from the payer perspective. One-way sensitivity analyses showed that the distributions of modified Rankin Scale scores at 90 days after stroke were the most influential factor on ICERs. For Canada, compared to EVT alone, the probability that EVT with alteplase would be cost-effective at a willingness-to-pay threshold of $50 000 per QALY gained was 58.7% from a societal perspective and 58.4% from a payer perspective. The corresponding values for at a willingness-to-pay threshold of $47 185 (3 times the Chinese gross domestic product per capita in 2021) were 65.2% and 67.4%. INTERPRETATION: For patients with acute ischemic stroke due to large vessel occlusion eligible for immediate treatment with both EVT alone and EVT with intravenous alteplase treatment, it is uncertain whether EVT with alteplase is cost-effective compared to EVT alone in Canada and China.

Identifying Attributes for a Value Assessment Framework in China: A Qualitative Study.

BACKGROUND: Value assessment frameworks (VAFs) are promising tools for measuring the value of health technologies and informing coverage policymaking; however, most published VAFs were developed for high-income countries. This study aimed to identify value attributes as part of the development of a VAF in China. METHODS: We used the qualitative description approach. Specifically, we conducted open-ended semi-structured interviews with Chinese stakeholders, as well as a review and analysis of publicly available government documents related to health technology assessment (HTA) and coverage policies in China. Conventional content analysis and the constant comparison technique were used to generate value attributes. Multiple criteria were used to determine the inclusion of a value attribute, with response levels of included attributes finalized via consensus meetings among the research team. RESULTS: Thirty-four stakeholders living or working in China completed the semi-structured interview. These stakeholders included policymakers (n = 4), healthcare providers (n = 8), HTA researchers (n = 6), patients and members of the general public (n = 9), and industry representatives (n = 7). In addition, 16 government documents were included for analysis. Twelve value attributes grouped in eight categories are included in the VAF: (1) severity of disease; (2) health benefit, including survival, clinical outcomes, and patient-reported outcomes; (3) safety; (4) economic impact, including budget impact to payer and patients, and cost effectiveness; (5) innovation; (6) organizational impact; (7) health equity; and (8) quality of evidence. CONCLUSION: These 12 value attributes were identified for the development of a VAF to support health technologies' value assessment and coverage policymaking in China.

Identifying factors associated with high use of acute care in Canada: a population-based retrospective study.

OBJECTIVES: To determine demographic, socioeconomic, and clinical factors associated with being high-cost users (HCUs) in adult patients (≥ 18 years) who received acute care in Canada. RESEARCH DESIGN: We conducted a retrospective study among adults who had at least one encounter with acute care facilities each year from 2011 to 2014 using national linked data sets. We defined HCUs as patients on the top 10% of the highest acute care cost users in the province, where the care was provided. Risk factors associated with being HCUs were identified using multilevel logistic regression. Provincial variations of identified risk factors were examined using logistic regression. Sensitivity analyses were also performed to investigate the influences of using different metrics and different thresholds to define high system users, missing data, and the inclusion of interaction terms on the study results. RESULTS: Between 2011 and 2014, a total of 3,891,410 patients with 6,017,430 hospitalizations were included. Patients who were male [odds ratio (OR), 1.60; 95% confidence interval (CI) 1.59-1.61], with low incomes [OR 1.42; 95% CI 1.41-1.43), with higher comorbidity score (OR 1.41; 95% CI 1.40-1.41] and older [OR 1.18; 95% CI 1.17-1.18] were more likely to be acute care HCUs. Significant interactions existed between comorbidity score and age/sex/income status. Across provinces, the associations between socioeconomic factors and being HCUs has the largest variation. When using various high system users (HSUs) definitions, the impacts of living in rural area and being visible minority on the odds of being HSUs differ. CONCLUSIONS: A few demographic, socioeconomic, and clinical factors was associated with high acute care expenditures. The associations between included risk factors and being acute care HCUs vary across provinces and different definitions of high system users (HSUs).

Assessment of microplastics using microfluidic approach.

Microplastics are plastic particles smaller than 5 mm, and microplastics have gradually become a severe environmental pollution source that exists in the atmosphere. The identification and quantification of microplastic particles are challenging, current approaches require expensive instruments and are usually time-consuming. In this study, a microfluidic method was introduced to detect and count microplastics using a polymer-based microfluidic chip. Microplastic particles were stained with Nile red, dispersed in the carrier fluid and passed through the microchannel. A fluorescence microscope filmed the whole process as microplastic particles passed through the microchannel. Finally, the software automatically analyzed the video footage for the microplastic particle counting and size analysis. The entire process is fully automated for microplastic particle counting and is much more efficient than the current manual counting method. The proposed study may have broad application potentials in the environmental field.

N, S Co-Doped Carbons Derived from Enteromorpha prolifera by a Molten Salt Approach: Antibiotics Removal Performance and Techno-Economic Analysis.

N, S co-doped bio-carbons with a hierarchical porous structure and high surface area were prepared using a molten salt method and by adopting Entermorpha prolifera (EP) as a precursor. The structure and composition of the bio-carbons could be manipulated by the salt types adopted in the molten salt assisted pyrolysis. When the carbons were used as an activating agent for peroxydisulfate (PDS) in SMX degradation in the advanced oxidation process (AOP), the removal performance in the case of KCl derived bio-carbon (EPB-K) was significantly enhanced compared with that derived from NaCl (EPB-Na). In addition, the optimized EPB-K also demonstrated a high removal rate of 99.6% in the system that used local running water in the background, which proved its excellent application potential in real water treatment. The degradation mechanism study indicated that the N, S doping sites could enhance the surface affinity with the PDS, which could then facilitate 1O2 generation and the oxidation of the SMX. Moreover, a detailed techno-economic assessment suggested that the price of the salt reaction medium was of great significance as it influenced the cost of the bio-carbons. In addition, although the cost of EPB-K was higher (USD 2.34 kg-1) compared with that of EPB-Na (USD 1.72 kg-1), it was still economically competitive with the commercial active carbons for AOP water treatment.

Dual structure engineering of SiOx-acrylic yarn derived carbon nanofiber based foldable Si anodes for low-cost lithium-ion batteries.

Silicon (Si) is attracted much attention due to its outstanding theoretical capacity (4200 mAh/g) as the anode of lithium-ion batteries (LIBs). However, the large volume change and low electron/ion conductivity during the charge and discharge process limit the electrochemical performance of Si-based anodes. Here we demonstrate a foldable acrylic yarn-based composite carbon nanofiber embedded by Si@SiOx particles (Si@SiOx-CACNFs) as the anode material. Since the amorphous SiOx and carbon (C) coating on the outside of the Si particles can provide a double buffer for volume expansion while reducing the contact between the Si core and the electrolyte to form a thin and stable solid electrolyte interface (SEI) film. Simultaneous in-situ electrochemical impedance spectroscopy (in-situ EIS) and galvanostatic intermittent titration technique (GITT) tests show that SiOx and C have higher ion/electron transport rates, and in addition, using acrylic fiber yarn and Zn(Ac)2 as raw materials reduces the manufacturing cost and enhanced mechanical properties. Therefore, the half-cell can achieve a high initial Coulombic efficiency (ICE) of 82.3% and a reversible capacity of 1358.2 mAh/g after 180 cycles. It can return to its original shape and remain intact after four consecutive folds, and the soft-pack full battery can also light up LED lights under different bending conditions.

What Is Value in Health and Healthcare? A Systematic Literature Review of Value Assessment Frameworks.

OBJECTIVES: This study aimed to investigate how value is defined and measured in existing value assessment frameworks (VAFs) in healthcare. METHODS: We searched PubMed, Embase, the Cochrane Library, and Centre for Reviews and Dissemination from 2008 to 2019. We also performed backward citation chaining of included studies and previously published systematic reviews. Studies reporting the development of a VAF in healthcare were included. For each included framework, we extracted and compared the context, target users, intended use, methods used to identify value attributes, description of the attributes, and attribute scoring approaches. RESULTS: Of the 8151 articles screened, 57 VAFs were included. The value attributes included in 55 VAFs were grouped into 9 categories: health benefits (n = 53, 96%), affordability (n = 45, 82%), societal impact (n = 42, 76%), burden of disease (n = 36, 65%), quality of evidence (n = 32, 58%), cost-effectiveness (n = 31, 56%), ethics and equity (n = 27, 49%), unmet needs (n = 21, 38%), and innovation (n = 15, 27%). The remaining 2 VAFs used broad attributes or user-defined attributes. Literature review was the main approach to identify value attributes in 36 VAFs. Patient or public was engaged through the development of only 11 VAFs. Weighting has been used to score 29 VAFs, of which 19 used the methods of multicriteria decision analysis. CONCLUSIONS: There are substantial variations in defining and measuring value. A noticeable weakness of existing VAFs is that patient or public engagement was generally very limited or missing in framework development process. Existing VAFs tend to aggregate multiple value attributes into a single index for decision making.

Leveraging User Comments for the Construction of Recycled Water Infrastructure-Evidence from an Eye-Tracking Experiment.

Building sufficient recycled water infrastructure is an effective way to solve problems related to water shortages and environmental degradation, and is of great strategic significance for saving resources, protecting the ecological environment, and promoting sustainable social and economic development. Although recycled water is environmentally friendly, the public is still skeptical about its use, which has led to the failure of a large number of recycled water infrastructure investments; therefore, increasing the public's willingness to re-use is critical for the construction of recycled water infrastructure. To identify the influence mechanism of user comments on public re-use behaviors, we conducted an eye-tracking experiment in China. The results demonstrated that (1) perceived usefulness, perceived quality, and perceived risk have significant impacts on the public's willingness to buy; (2) user reviews can enhance the public's perceived usefulness of recycled products and increase their willingness to buy; and (3) in the process of consumption, the public tends to pay attention to negative reviews, where user reviews alter the perceived risks and perceived prices of recycled products, thereby affecting the willingness to buy of consumers. This study provides a scientific reference for the construction of recycled water infrastructure and the further promotion of recycled water.

Identifying factors associated with high use of acute care in Canada: protocol of a population-based retrospective cohort study.

INTRODUCTION: High-cost users (HCUs) account for a small proportion of the population but use a disproportionately large share of healthcare resources. Although HCUs exist in all healthcare types, acute care is the most expensive type of service and the most significant contributor to expenditures among HCUs. This study aims to determine demographic, socioeconomic and clinical factors associated with being HCUs in adult patients (≥18 years) receiving acute care in Canada. METHODS AND ANALYSIS: This is a population-based analysis using a national linked dataset. Adult patients who had at least one interaction with acute care facilities each year from 2011 to 2014 were captured in the dataset, and those living in institutions or other collective residences were not covered. The primary outcome is HCU of acute care (yes/no), which is defined as whether a patient is within the top 10% of the highest acute care cost users in his/her province. Multilevel logistic regression will be used to identify factors associated with HCU and to examine the provincial variations of these identified risk factors. Sensitivity analyses investigating the influences of different high user definitions and missing data on the study results will also be performed. ETHICS AND DISSEMINATION: All researchers will follow the codes and rules set by Statistics Canada and the Research Data Centre and give priority to the confidentiality of the data during and after this study. The study findings will be published in peer-review journals and disseminated at academic conferences.

Measurement properties of family resilience assessment questionnaires: a systematic review.

BACKGROUND: There have been numerous measurement questionnaires to estimate the level of family resilience. However, we lack published evidence regarding the most appropriate family resilience questionnaire in different adversity domains. OBJECTIVE: This study critically assesses and contrasts the measurement properties of questionnaires measuring family resilience in two domains: health care domain and social domain. METHODS: Ten electronic databases were searched for studies concerning the establishment, adaptation or evaluation of the measurement properties of a family resilience assessment questionnaire. The methodological quality of included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. On the basis of methodological quality and scoring criteria for the quality of questionnaires, the overall evidence of each questionnaire was rated. RESULTS: A total of 4084 initial studies were obtained, 23 of which met our inclusion criteria assessing 12 different questionnaires. The structural validity (23 studies) and internal consistency (22 studies) were the most frequently used measurement properties. Only two studies tested responsiveness, and the measurement error was not examined in any studies. The Family Resilience Assessment Scale (FRAS) and Italian version of the Walsh Family Resilience Questionnaire (Walsh-IT) showed positive evidence in health care domain. The FRAS performed well in social domain with specific adversity, and the Family Resilience Questionnaire (FRQ) received a good score in social domain without specific adversity. CONCLUSION: For health care domain, we recommend the FRAS and Walsh-IT. For social domain with specific adversity, we recommend the FRAS questionnaire. For social domain without specific adversity, the FRQ is recommended.

Ecological effects and potential risks of the water diversion project in the Heihe River Basin.

To curb the severe ecological deterioration in the lower Heihe River Basin (HRB) in northwest China, a water diversion project was initiated in 2000. A comprehensive analysis of the ecological effects and potential risks associated with the project is needed. We assessed the hydrological and ecological achievements, and also analyzed the potential problems after the project was completed. We found that since the project began the hydrological regime has changed, with more than 57.82% of the upstream water being discharged to the lower reaches on average. As a result, the groundwater level in the lower reaches has risen; the terminal lake has gradually expanded to a maximum area in excess of 50km2 since 2010, and there has been a significant recovery of vegetation in the riparian zone and the Ejin core oases, which represents the initial rehabilitation of the degraded downstream environment. Additionally, the economy of Ejin has developed spectacularly, with an annual growth rate of 28.06%. However, in the middle reaches, the average groundwater level has continuously declined by a total of 5.8m and significant degradation of the vegetation has occurred along the river course. The discrepancy in the water allocation between the middle and lower reaches has intensified. This highlights the inability of the current water diversion scheme to realize further ecological restoration and achieve sustainable development throughout the whole basin. In future water management programs, we recommend that water allocation is coordinated by considering the basin as an integrated entity and to scientifically determine the size of the midstream farmland and downstream oasis; restrict non-ecological water use in the lower reaches, and jointly dispatch the surface water and groundwater.

Assessment upon azo dye decolorization and bioelectricity generation by Proteus hauseri.

This study explored dye decolorization and bioelectricity generation of indigenous Proteus hauseri ZMd44 for dye-bearing wastewater treatment. Chemical structures of azo dyes apparently affected the performance of dye biodecolorization. Additions of diazo dye C.I. reactive blue 160 (RBu160) stimulated simultaneous dye decolorization and bioelectricity generation of ZMd44 in single chamber microbial fuel cells (MFCs). However, high-level additions of RBu160 repressed capabilities of power production in MFC due to competition of electrons used for reductive decolorization. Decolorized intermediates of RBu160-phenyl methadiamine and 5-sulfoanthranilic acid as electron shuttles might mediate electron transport for current generation in MFC.