Multiple scenario land use simulation based on a coupled MOGA-PLUS model: a case of the Yellow River Basin.

Land use changes have profoundly influenced global environmental dynamics. The Yellow River (YR), as the world's fifth-longest river, significantly contributes to regional social and economic growth due to its extensive drainage area, making it a key global player. To ensure ecological stability and coordinate land use demand, modeling the future land allocation patterns of the Yellow River Basin (YRB) will assist in striking a balance between land use functions and the optimization of its spatial design, particularly in water and sand management. In this research, we used a multi-objective genetic algorithm (MOGA) with the PLUS model to simulate several different futures for the YRB's land use between 1990 and 2020 and predict its spatial pattern in 2030. An analysis of the spatiotemporal evolution of land use changes in the YRB indicated that construction land expansion is the primary driver of landscape pattern and structure changes and ecological degradation, with climate change also contributing to the expansion of the watershed area. On the other hand, the multi-scenario simulation, constrained by specific targets, revealed that economic development was mainly reflected in land expansion for construction. At the same time, grassland and woodland were essential pillars to support the region's ecological health, and increasing the development of unused land emerged as a potential pathway towards sustainable development in the region. This study could be used as a template for the long-term growth of other large river basins by elucidating the impacts of human activities on land use and rationalizing land resource allocation under various policy constraints.

Engineering Low-Cost Organic Cathode for Aqueous Rechargeable Battery and Demonstrating the Proton Intercalation Mechanism for Pyrazine Energy Storage Unit.

Seeking organic cathode materials with low cost and long cycle life that can be employed for large-scale energy storage remains a significant challenge. This work has synthesized an organic compound, triphenazino[2,3-b](1,4,5,8,9,12-hexaazatriphenylene) (TPHATP), with as high as 87.16% yield. This compound has a highly π-conjugated and rigid molecular structure, which is synthesized by capping hexaketocyclohexane with three molecules of 2,3-diaminophenazine derived from low-cost o-phenylenediamine, and is used as a cathode material for assembling aqueous rechargeable zinc ion batteries. Both experiments and DFT calculations demonstrate that the redox mechanism of TPHATP is predominantly governed by H+ storage. The Zn-intercalation product of nitride-type compound, is too unstable to form in water. Moreover, the TPHATP cathode exhibits a capacity of as high as 318.3 mAh g-1 at 0.1 A g-1 , and maintained a stable capacity of 111.9 mAh g-1 at a large current density of 10 A g-1 for 5000 cycles with only a decay of 0.000512% per cycle. This study provides new insights into understanding pyrazine as an active redox group and offers a potential affordable aqueous battery system for grid-scale energy storage.

A Bayesian approach to pilot-pivotal trials for bioequivalence assessment.

BACKGROUND: To demonstrate bioequivalence between two drug formulations, a pilot trial is often conducted prior to a pivotal trial to assess feasibility and gain preliminary information about the treatment effect. Due to the limited sample size, it is not recommended to perform significance tests at the conventional 5% level using pilot data to determine if a pivotal trial should take place. Whilst some authors suggest to relax the significance level, a Bayesian framework provides an alternative for informing the decision-making. Moreover, a Bayesian approach also readily permits possible incorporation of pilot data in priors for the parameters that underpin the pivotal trial. METHODS: We consider two-sequence, two-period crossover designs that compare test (T) and reference (R) treatments. We propose a robust Bayesian hierarchical model, embedded with a scaling factor, to elicit a Go/No-Go decision using predictive probabilities. Following a Go decision, the final analysis to formally establish bioequivalence can leverage both the pilot and pivotal trial data jointly. A simulation study is performed to evaluate trial operating characteristics. RESULTS: Compared with conventional procedures, our proposed method improves the decision-making to correctly allocate a Go decision in scenarios of bioequivalence. By choosing an appropriate threshold, the probability of correctly (incorrectly) making a No-Go (Go) decision can be ensured at a desired target level. Using both pilot and pivotal trial data in the final analysis can result in a higher chance of declaring bioequivalence. The false positive rate can be maintained in situations when T and R are not bioequivalent. CONCLUSIONS: The proposed methodology is novel and effective in different stages of bioequivalence assessment. It can greatly enhance the decision-making process in bioequivalence trials, particularly in situations with a small sample size.

Cost-effectiveness analysis of once-daily oral semaglutide versus placebo and subcutaneous glucagon-like peptide-1 receptor agonists added to insulin in patients with type 2 diabetes in China.

Introduction: Oral semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that improves glycated hemoglobin levels and body weight in patients with type 2 diabetes (T2DM). We aim to evaluate the cost-effectiveness of once-daily oral semaglutide in comparison to placebo and injectable GLP-1 RAs in Chinese patients with T2DM inadequately controlled on basal insulin. Methods: The United Kingdom Prospective Diabetes Study Outcomes Model (UKPDS OM2.1) was used to estimate the cost-effectiveness by calculating the incremental cost-effectiveness ratio (ICER). Baseline characteristics of the simulation cohort were obtained from the PIONEER 8 trial. Utility and safety inputs were derived from a network meta-analysis of 12 trials. Direct medical costs were retrieved from published literature and discounted at an annual rate of 5%. We used a willingness-to-pay (WTP) threshold of $36,528.3 per quality-adjusted life-year (QALY) gained. Scenario analysis, and one-way and probabilistic sensitivity analysis were performed. Results: The effectiveness of oral semaglutide was 10.39 QALYs with a total cost of $30,223.10, while placebo provided 10.13 QALYs at a lower total cost of $20,039.19. Oral semaglutide was not cost-effective at an ICER of $39,853.22 and $88,776.61 per QALY compared to placebo and exenatide at the WTP. However, at an annual price of $1,871.9, it was cost-effective compared with dulaglutide, liraglutide, and lixisenatide. The model was most sensitive to the discount rate and annual cost of oral semaglutide. The price of oral semaglutide needed to be reduced to $1,711.03 per year to be cost-effective compared to placebo and other injectable GLP-1 RAs except for exenatide and semaglutide injection. Conclusion: We found that once-daily oral semaglutide, at a comparable price of semaglutide injection, proves to be a cost-effective add-on therapy to insulin for Chinese patients with T2DM, especially when compared to subcutaneous GLP-1 RAs other than injectable semaglutide and exenatide. However, to achieve cost-effectiveness in comparison to placebo, further cost reduction of oral semaglutide is necessary. The estimated annual cost of $1,711.03 for oral semaglutide demonstrates a more cost-effective option than placebo, highlighting its potential value in the management of T2DM.

Challenges facing mental health systems arising from the COVID-19 pandemic: Evidence from 14 European and North American countries.

We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All countries in our sample implemented new policies or initiatives to strengthen mental health service delivery - with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America.

Detection of meteorological influence on bread wheat quality in Hebei province, China based on the gradient boosting decision tree.

Wheat grain quality is equivalent to grain yield in terms of ensuring food security under climate change but has received less attention. Identifying critical meteorological conditions in key phenological periods to account for the variability in grain protein content (GPC) can provide insight into linkages between climate change and wheat quality. The wheat GPC data from different counties of Hebei Province, China during 2006-2018 and corresponding observational meteorological data were used in our study. Through a fitted gradient boosting decision tree model, latitude of the study area, accumulated sunlight hours during the growth season, accumulated temperature and averaged relative humidity from filling to maturity were suggested as the most relevant influencing variables. The relationship between GPC and latitude was distinguished between areas north and south of 38.0° N. GPC decreased with the increasing latitude in areas south of 38.0° N, where at least accumulated temperatures of 515°C from filling to maturity were preferred to maintain high GPC. Besides, averaged relative humidity during the same phenological period exceeding 59% could generate an extra benefit to GPC here. However, GPC increased with increasing latitude in areas north of 38.0° N and was mainly attributed to more than 1500 sunlight hours during the growth season. Our findings that different meteorological factors played a major role in deciding regional wheat quality provided a scientific basis for adopting better regional planning and developing adaptive strategies to minimize climate impacts.

Dynamic changes in provincial exhaust emissions in China in the carbon peak and neutrality setting: based on the effects of energy consumption and economic growth.

Reducing exhaust emissions, promoting economic development, and realizing clean energy utilization have always been concerns in China. To measure the relationship between them, this study selects the data related to energy consumption, economic growth, and exhaust emissions from 2000 to 2019 in 30 Chinese provinces. By constructing a panel vector autoregressive (PVAR) model, the dynamic relationship between them in China is quantitatively analyzed. The results show that there is a long-term interaction between energy consumption, economic growth, and exhaust emissions. Among them, economic growth is highly dependent on energy consumption, but it can promote the reduction of exhaust emissions. However, energy consumption will produce a large amount of industrial waste, such as sulfur dioxide and carbon dioxide emissions. Specifically, the industrial structure and energy structure have the most obvious impact on reducing industrial sulfur dioxide emissions and carbon emissions, with the proportion between 0.071-0.090 and 0.031-0.032, respectively. Therefore, the adjustment of industrial structure and energy structure is the key to exhaust emission reduction.

Understanding Relationships between Cultivated Land Pressure and Economic Development Level across Spatiotemporal Characteristics: Implications for Supporting Land-Use Management Decisions.

Food security is crucial to world peace. Economic development has posed a great threat to the protection of cultivated land. Considering 20 cities in the lower Yellow River (AALYR) as the study area, this study explored the spatial evolution of cultivated land pressure (CLP) and economic development from 1998 to 2018, revealing the spatiotemporal coupling characteristics of the CLP index and economic development. The main results are as follows: we discerned that CLP and economic development have an obvious spatiotemporal consistency during 1998-2018. The CLP showed a spatial pattern of overall stability, as well as local changes. Most prefecture-level cities experienced decreased significantly in CLP and improvements in food security. Overall, there were regional differences in the coupling relationships between CLP and economic development in the study area. The explanatory power of the proportion of secondary and tertiary industries were significantly higher than other driving factors. Therefore, while developing the economy rapidly, we should also protect cultivated land resources and improve the coordination level between them, which is essential to guarantee food security and a steady economic development.

Precision environmental health monitoring by longitudinal exposome and multi-omics profiling.

Conventional environmental health studies have primarily focused on limited environmental stressors at the population level, which lacks the power to dissect the complexity and heterogeneity of individualized environmental exposures. Here, as a pilot case study, we integrated deep-profiled longitudinal personal exposome and internal multi-omics to systematically investigate how the exposome shapes a single individual's phenome. We annotated thousands of chemical and biological components in the personal exposome cloud and found they were significantly correlated with thousands of internal biomolecules, which was further cross-validated using corresponding clinical data. Our results showed that agrochemicals and fungi predominated in the highly diverse and dynamic personal exposome, and the biomolecules and pathways related to the individual's immune system, kidney, and liver were highly associated with the personal external exposome. Overall, this data-driven longitudinal monitoring study shows the potential dynamic interactions between the personal exposome and internal multi-omics, as well as the impact of the exposome on precision health by producing abundant testable hypotheses.

Impact of Electronic Health Record Interoperability on Telehealth Service Outcomes.

This paper aims to develop a telehealth success model and discusses three critical components: (1) health information quality, (2) electronic health record system quality, and (3) telehealth service quality to ensure effective telehealth service delivery, reduce professional burnout, and enhance access to care. The paper applied a policy analysis method and discussed telehealth applications in rural health, mental health, and veterans health services. The results pointed out the fact that, although telehealth paired with semantic/organizational interoperability facilitates value-based and team-based care, challenges remain to enhance user (both patients and clinicians) experience and satisfaction. The conclusion indicates that approaches at systemic and physician levels are needed to reduce disparities in health technology adoption and improve access to telehealth care.

A study of factors impacting disease based on the Charlson Comorbidity Index in UK Biobank.

Objective: With advances in medical diagnosis, more people are diagnosed with more than one disease. The damage caused by different diseases varies, so relying solely on the number of diseases to represent multimorbidity is limited. The Charlson comorbidity index (CCI) is widely used to measure multimorbidity and has been validated in various studies. However, CCI's demographic and behavioral risk factors still need more exploration. Methods: We conduct multivariate logistic regression analysis and restricted cubic splines to examine the influence factors of CCI and the relationship between covariates and risk of CCI, respectively. Our research employs the Multivariate Imputation by Chained Equations method to interpolate missing values. In addition, the CCI score for each participant is calculated based on the inpatient's condition using the International Classification of Diseases, edition 10 (ICD10). Considering the differences in the disease burden between males and females, the research was finally subgroup analyzed by sex. Results: This study includes 5,02,411 participants (2,29,086 female) with CCI scores ranging from 0 to 98. All covariates differed between CCI groups. High waist-hip ratio (WHR) increases the risk of CCI in both males [OR = 19.439, 95% CI = (16.261, 23.241)] and females [OR = 12.575, 95% CI = (11.005, 14.370)], and the effect of WHR on CCI is more significant in males. Associations between age, Body Mass Index (BMI) and WHR, and CCI risk are J-shaped for all participants, males, and females. Concerning the association between Townsend deprivation index (TDI) and CCI risk, the U-shape was found in all participants and males and varied to a greater extent in males, but it is a J-shape in females. Conclusions: Increased WHR, BMI, and TDI are significant predictors of poor health, and WHR showed a greater role. The impact of deprivation indices on health showed differences by sex. Socio-economic factors, such as income and TDI, are associated with CCI. The association of social status differences caused by these socioeconomic factors with health conditions should be considered. Factors might interact with each other; therefore, a comprehensive, rational, and robust intervention will be necessary for health.

Effect of Disparity in Self Dispersion Interactions on Phase Behaviors of Molten A-b-B Diblock Copolymers.

Phase behaviors of molten A-b-B diblock copolymers with disparity in self dispersion interactions are revisited here. A free energy functional is obtained for the corresponding Gaussian copolymers under the influence of effective interactions originating in the localized excess equation of state. The Landau free energy expansion is then formulated as a series in powers of A and B density fluctuations up to 4th order. An alternative and equivalent Landau energy is also provided through the transformation of the order parameters to the fluctuations in block density difference and free volume fraction. The effective Flory χ is elicited from its quadratic term as the sum of the conventional enthalpic χH and the entropic χS that is related to energetic asymmetry mediated by copolymer bulk modulus. It is shown that the cubic term is balanced with Gaussian cubic vertex coefficients in corporation with energetics to yield a critical point at a composition rich in a component with stronger self interactions. The full phase diagrams with classical mesophases are given for the copolymers exhibiting ordering upon cooling and also for others revealing ordering reversely upon heating. These contrasting temperature responses, along with the skewness of phase boundaries, are discussed in relation to χH and χS. The pressure dependence of their ordering transitions is either barotropic or baroplastic; or anomalously exhibits anomalously both at different stages. These actions are all explained by the opposite responses of χH and χS to pressure.

Assessment of Prognostic Value of Aspartate Aminotransferase-to-Platelet Ratio Index in Patients With Hepatocellular Carcinoma: Meta-Analysis of 28 Cohort Studies.

Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors globally; it is valuable to predict its prognosis after treatment. Aspartate aminotransferase-to-platelet index (APRI), a non-invasive biomarker consists of two routine test parameters easily available in all the patients. Our study aimed to investigate whether APRI can serve as an independent prognostic marker in the patients with HCC. Methods: We extensively searched PubMed, Embase, and Web of Science databases on June 20, 2021 to determine all relevant literature. The studies that explored the association between the APRI levels and prognosis of patients with HCC and reported risk estimate data were included. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Results: A total of 1,097 articles were initially identified, of which 28 studies involving 11,041 patients met the eligibility criteria for the meta-analysis. The pooled hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS) were 1.77 (95% CI: 1.53-2.05, P < 0.001) and 1.59 (95% CI: 1.47-1.71, P < 0.001), respectively, suggesting a significant correlation between the increased APRI levels and poor prognosis in the patients with HCC. In the subgroup analyses, statistical significance of the correlation disappeared in the Korean and Japanese population and in the patients undergoing transarterial chemoembolization (TACE). Of note, the current results may be overestimated due to publication bias, but the conclusion remained unchanged when the bias was adjusted. Conclusion: High APRI levels are associated with poor OS and DFS in the patients with HCC. In most cases, pretreatment APRI can be used as an independent prognostic factor, but it is necessary to incorporate other predictive prognostic systems to ensure accuracy. Further studies are needed to determine the specific beneficiary population and the optimal cutoff value.

Human exposome assessment platform.

The Human Exposome Assessment Platform (HEAP) is a research resource for the integrated and efficient management and analysis of human exposome data. The project will provide the complete workflow for obtaining exposome actionable knowledge from population-based cohorts. HEAP is a state-of-the-science service composed of computational resources from partner institutions, accessed through a software framework that provides the world's fastest Hadoop platform for data warehousing and applied artificial intelligence (AI). The software, will provide a decision support system for researchers and policymakers. All the data managed and processed by HEAP, together with the analysis pipelines, will be available for future research. In addition, the platform enables adding new data and analysis pipelines. HEAP's final product can be deployed in multiple instances to create a network of shareable and reusable knowledge on the impact of exposures on public health.

Nexus among economic growth, carbon emissions, and renewable and non-renewable energy in China.

Due to the significant changes of economic growth rate, energy structure, and energy efficiency in China, whether energy policies should be adjusted is worthy of attention. This paper employs ARDL-ECM and Toda-Yamamoto causality to investigate the relationship between renewable energy, non-renewable energy, carbon emissions, economic growth, gross fixed capital formation, and urban population spanning the period 1960-2019 in China. The examined results of ARDL-ECM indicate that renewable energy both have positive impact on GDP in the short term and long term but non-renewable energy only have positive impact on GDP in the short term. Additionally, based on Toda-Yamamoto causality, this paper finds a unidirectional Granger causality running from economic growth to energy consumption and from energy consumption to carbon emissions. And there is a unidirectional Granger causality running from GDP to non-renewable energy consumption. It is worth noting that renewable energy consumption and economic growth have positive bidirectional influence on each other. The study findings suggest that stricter energy conservation and pollution emission reduction policy should be implemented and renewable energy should be applied on a larger scale in order to achieve the goal of sustainable economic development.

Evaluation of the value of diabetes risk scores in screening for undiagnosed diabetes and prediabetes: a community-based study in southwestern China.

OBJECTIVES: To evaluate the performance and cost-effectiveness of existing diabetes risk scores (DRSs) to screen for undiagnosed diabetes mellitus (UDM) and prediabetes (PD) in a community-based southwestern Chinese population. METHODS: Participants in TIDE-Chengdu survey with requisite data and without known diabetes were included. Five Chinese-derived DRSs and six non-Chinese-derived DRSs were included for evaluation. Their performance in detecting UDM and UMD or PD (UDM/PD) was assessed using the C-statistic. The cost-effectiveness of the optimal DRS was compared with that of capillary fasting blood glucose (CFBG). RESULTS: Of the 1,692 TIDE-Chengdu survey participants included, 177 (10.5%) had UDM and 339 (20.0%) had PD. The rural participants (N = 737) were more likely to have UDM (13.4% vs. 8.2%) and PD (24.8% vs. 16.3%) than their urban counterparts (N = 955) (P < 0.0001). In the full population, the included DRSs all showed good discrimination in detecting UDM (C-statistic: 0.699 to 0.762) and UDM/PD (C-statistic: 0.717 to 0.769), but the New Chinese DRS (NCDRS) performed best for both UDM and UDM/PD. The DRSs evaluated all showed better performance in urban participants than rural participants for both UDM (C-statistic: 0.718 to 0.795 vs. 0.642 to 0.720) and UDM/PD (C-statistic: 0.729 to 0.793 vs. 0.682 to 0.726) (all P < 0.05). The mean cost per UDM/PD case identified was lower with NCDRS at score 25 (¥503.3($71.9)) and 27 (¥490.5 ($70.1)) than CFBG at 5.0, 5.1, 5.2, or 5.3 mmol/L (¥631.7 ($90.2), ¥611.8 ($87.4), ¥579.2 ($82.7) and ¥551.9 ($78.8)), whereas the mean costs per UDM case identified was higher with NCDRS at score 25 (¥1379.3 ($197.0)) and 27 (¥1315.1 ($187.9)) than CFBG at 5.3, 5.4, or 5.5 mmol/L (¥1301.7 ($186.0), ¥1247.7 ($178.2) and ¥1173.3 ($167.6)). CONCLUSION: The NCDRS represents a valid and cost-effective tool for use in southwestern China to identify high-risk patients with UDM or PD who need a diagnostic test.

Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study.

BACKGROUND: The high prevalence of early childhood caries (ECC) is widespread around the world, and oral health education (OHE) plays a vital role in preventing ECC. Numerous studies on ECC risk factor assessment have assisted us in enriching the content of OHE. The objective of this study was to further assess independent risk factors for ECC at different ages to provide evidence and insights for OHE. METHODS: Children aged 3-5 years old (N = 1301) in Shandong Province were enrolled in this cross-sectional study. Data about oral health status and caregivers' oral health knowledge, attitude, and practice (KAP) were extracted from the 4th National Oral Health Survey of China. The associations between ECC prevalence and various KAP variables were tested with chi-square tests, bivariate analysis and multivariable logistic regression analyses. RESULTS: The ECC prevalence in Shandong Province was 64.6%, and the dmft mean was 3.15. The independent variables with an increased risk for ECC were age, feeding method within 6 months of birth, bedtime sugar frequency, experience of toothache over the past year and dental visits (P < 0.05, chi-square tests). Complete breastfeeding within 6 months of birth primarily contributed to the high ECC risk of the 3-year-old group (OR: 3.39, 95% CI: 1.41-8.17), while high frequency bedtime sweet consumption mainly contributed to that of the 5-year-old group (OR: 3.22, 95% CI: 1.03-10.06; logistic regression analysis). Tooth brushing was not associated with ECC in this study, and some positive knowledge and attitude variables were positively correlated with a high risk of ECC. CONCLUSION: These data provide evidence to suggest that the ECC-related risk factors at different ages are inconsistent, which provides some insights for OHE. We should highlight the effects of feeding methods in the early stages of deciduous dentition and sugar habits in the late stages of deciduous dentition on ECC, as well as encourage preventive dental visit and supplemental training for oral health practices.