Use of a risk assessment tool to determine the origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is contentious. Most studies have focused on a zoonotic origin, but definitive evidence such as an intermediary animal host is lacking. We used an established risk analysis tool for differentiating natural and unnatural epidemics, the modified Grunow-Finke assessment tool (mGFT) to study the origin of SARS-COV-2. The mGFT scores 11 criteria to provide a likelihood of natural or unnatural origin. Using published literature and publicly available sources of information, we applied the mGFT to the origin of SARS-CoV-2. The mGFT scored 41/60 points (68%), with high inter-rater reliability (100%), indicating a greater likelihood of an unnatural than natural origin of SARS-CoV-2. This risk assessment cannot prove the origin of SARS-CoV-2 but shows that the possibility of a laboratory origin cannot be easily dismissed.

Subjective and objective financial toxicity among colorectal cancer patients: a systematic review.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer type worldwide. Colorectal cancer treatment costs vary between countries as it depends on policy factors such as treatment algorithms, availability of treatments and whether the treatment is government-funded. Hence, the objective of this systematic review is to determine the prevalence and measurements of financial toxicity (FT), including the cost of treatment, among colorectal cancer patients. METHODS: Medline via PubMed platform, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined CRC FT. There was no limit on the design or setting of the study. RESULTS: Out of 819 papers identified through an online search, only 15 papers were included in this review. The majority (n = 12, 80%) were from high-income countries, and none from low-income countries. Few studies (n = 2) reported objective FT denoted by the prevalence of catastrophic health expenditure (CHE), 60% (9 out of 15) reported prevalence of subjective FT, which ranges from 7 to 80%, 40% (6 out of 15) included studies reported cost of CRC management- annual direct medical cost ranges from USD 2045 to 10,772 and indirect medical cost ranges from USD 551 to 795. CONCLUSIONS: There is a lack of consensus in defining and quantifying financial toxicity hindered the comparability of the results to yield the mean cost of managing CRC. Over and beyond that, information from some low-income countries is missing, limiting global representativeness.

Healthcare costs for patients with rare diseases: Evidence from China.

OBJECTIVE: Rare diseases cause a huge financial burden to countless patients and families. It is an important public health issue that requires widespread attention. This study analyzes medical expenses composition and the change in trends of out-of-pocket (OOP) expenses for patients with Amyotrophic lateral sclerosis (ALS) and explores the factors influencing these changes. METHODS: Data were obtained from the Chinese Medical Insurance Department database from 2018 to 2020, including 857 patients with ALS in 60 cities across 30 provinces. We used descriptive methods to analyse the baseline characteristics and medical expenses of outpatients and inpatients with ALS. And we used quantile regression to analyse the differences in patient OOP ratio and the factors influencing them. RESULTS: In China, 80.3% of ALS patients chose tertiary hospitals, with an annual direct medical cost of 11,339.7 RMB per patient and an OOP ratio of 41.6%. The annual medical cost for outpatients was 345.1 RMB per patient, with an OOP ratio of 36.7%. The annual medical cost for inpatients was 28,139.8 RMB per patient, with an OOP ratio of 41.7%. Compared to outpatients, inpatients had higher medical costs but lower actual reimbursement rates. The OOP ratio of ALS patients decreased, then increased over time. And the OOP ratio was influenced by medical institution, medical insurance, and age (p < 0.05). Patients who chose tertiary hospitals, those who were covered by the urban resident basic medical insurance and younger patients had relatively higher OOP ratio. CONCLUSION: In recent years, although China has begun to pay attention to the rights and interests of patients with rare diseases, the government has provided some healthcare security to patients with rare diseases. However, the level of medical insurance coverage was still low, the equity of protection was still insufficient and the financial burden on patients was high. Therefore, the government should further improve the healthcare system to provide full life-cycle and affordable healthcare services to patients with rare diseases.

Subjective economic inequality is associated with lower well-being through more upward comparison and lower trust.

Individuals often misconstrue the actual degree of economic inequality, which might account for the ambiguity in the literature about the role that inequality plays in well-being. Instead of focusing on objective inequality, we propose a subjective inequality approach by investigating the long-term association between subjective economic inequality and well-being (N = 613). We found that subjective inequality predicted lower life satisfaction and higher depression one year later, which were accounted for by more upward socioeconomic comparison and lower trust. Furthermore, the negative association between subjective inequality and well-being remained constant, regardless of individuals' objective socioeconomic status (SES), subjective SES, and mindset of SES. The long-term association between subjective inequality and well-being remained robust after controlling for prior levels of well-being and multiple covariates. Our findings revealed that subjective inequality is detrimental to well-being and opens a new window into psychological research on economic inequality.

Health state utility values for children and adolescents with type 1 diabetes: A systematic review and meta-analysis.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is one of the most burdensome chronic diseases in the world. Health utility values are an important tool for quantifying this disease burden and conducting cost-utility analyses. This review aimed to derive a reference set of health utility values for children and adolescents with T1DM. METHODS: We searched MEDLINE and Embase from inception to March 2023 for health utility values of T1DM children and adolescents (aged ≤18 years) measured using direct and indirect preference elicitation approaches. Utility estimates were pooled by meta-analyses with subgroup analyses to evaluate differences by populations and elicitation approaches. RESULTS: Six studies involving 1276 participants were included in this study. Meta-analysis showed the overall utility value of children and adolescents with T1DM was 0.91 (95% CI 0.89-0.93). The utility value of T1DM children and adolescents with complications was 0.90 (95% CI 0.88-0.92), which was lower than those without complications (0.96, 95% CI 0.95-0.97). The utility value of children (aged <13 years) was higher than adolescents (aged 13-18 years) (0.90 vs. 0.85). The utility value measured by the EQ-5D-3L (0.91) was higher than the HUI3 (0.89), the SF-6Dv1 (0.83), and the time trade-off (0.81). The parent proxy-reported was similar to the patient self-reported (0.91 vs. 0.91). CONCLUSIONS: This study developed a reference set of pooled utility estimates for children and adolescents with T1DM, which is helpful for understanding the overall health status of T1DM and conducting economic evaluations. Further studies are needed to explore the utilities of T1DM with different types of complications.

Revealing disparities in different types of park visits based on cellphone signaling data in Guangzhou, China.

Urban parks play a crucial role in promoting the urban ecological environment and the health and well-being of dwellers. However, existing research on park visits and drivers has largely ignored the classification of parks. Using the four-level park system in Guangzhou as a case, this study first measured park visits based on cellphone signaling data. Then, the independent and interactive influences of driving factors on the visits of four types of parks were investigated and compared comprehensively based on the geographical detector model. The factor detector model preliminarily distinguished the functional and role differences of various park types. Nature and urban parks are more functional, and community and pocket parks mainly provide nearby residents with convenient relaxation spaces. The interaction detector further revealed the disparities in park visit drivers between four types of parks. The most significant finding is that nearby recreational facility is the key to the use of natural and urban parks, while the determining factor for the visits of community and pocket parks is the surrounding population. Based on these findings, the study recommends tailored strategies for each type of park, to promote effective management and increased utilization. In particular, the study highlights the importance of understanding the differences between park types and developing customized strategies to maximize the benefits of urban parks and foster a healthy and sustainable urban environment.

The impacts of economic policy uncertainty on firm cash holding in China.

Cash holding is an important strategic decision of enterprises. As a macro-level factor, economic policy uncertainty causes risks, affecting enterprises' cash holdings. Taking the quarterly financial data of China's A-share non-financial listed firms for 2010-2020 as a sample, this study adopts the OLS and fixed effect models to investigate how corporate cash holdings are affected by economic policy uncertainty. The findings indicate that economic policy uncertainty is directly proportional to the level of cash that listed corporations hold. The higher the uncertainty, the more cash the company holds. Among them, state-owned enterprises and the manufacturing industry are more significantly affected by economic policy uncertainty. Finally, considering the regional marketization level and the differences in financing constraints enterprises face, it is concluded through grouping empirical studies that enterprises located in regions with lower marketization levels are more susceptible to policy uncertainty, while financially constrained enterprises are more susceptible to economic policy uncertainty. The study of economic policy uncertainty is helpful to guide enterprises to realize the importance of coping strategies in advance under the background of intensifying economic policy uncertainty. Therefore, this paper proposes to introduce policies on the premise of fully considering the smoothness of the economy and the differences in the conditions of firms of different natures, as well as some proposals to alleviate financing constraints, reduce the adverse effects of uncertainty on firms, and bolster the marketization process.

Optimal allocation of agricultural water and land resources integrated with virtual water trade: A perspective on spatial virtual water coordination.

Agricultural production consumes the majority of global freshwater resources. The worsening water scarcity has imposed significant stress on agricultural production when regions seek food self-sufficiency. To seek optimal allocation of spatial agricultural water and land resources in each water function zone of the objective region, a multi-objective optimization model was developed to tackle the trade-offs between the water-saving objective and the economic benefit objective considering virtual water trade (VWT). The cultivated area of each crop in each water function zone was taken into account as the decision variable, while a set of strong constraints were used to restrict land resources and water availability. Then, a decomposition-simplex method aggregation algorithm (DSMA) was proposed to solve this nonlinear, bounding-constrained, and multi-objective optimization model. Based on the quantitative analysis of the spatial blue and green virtual water in each agricultural product, the proposed methodology was applied to a real-world, provincial-scale region in China (i.e., Jiangsu Province). The optimized results provided 18 Pareto solutions to reallocate the land resources in the 21 IV-level water function zones of Jiangsu Province, considering four major rainy-season crops and two dry-season crops. Compared to the actual scenario, the superior scheme increased by 7.95% (5.6 × 109 RMB) for economic trade and decreased by 1.77% (2.0 × 109 m3) for agricultural water consumption. It was mainly because the potential of spatial blue and green virtual water in Jiangsu was fully exploited by improving spatial land resource allocation. The food security of Jiangsu could be guaranteed by achieving self-sufficiency in the superior scheme, and the total VWT in the optimal scheme was 2.2 times more than the actual scenario. The results provided a systematic decision-support methodology from the perspective of spatial virtual water coordination, yet, the methodology is widely applicable.

Evaluation of the operation status of the residential land market in Beijing-Tianjin-Hebei region of China and its spatiotemporal pattern characteristics.

Exploring the operation status and patterns of urban land markets is an important theoretical and practical topic for promoting coordinated socio-economic development. In this study, the operation status of the residential land market in the Beijing-Tianjin-Hebei region and the characteristics of its pattern were analyzed using the composite index method and the 3σ rule of the normal distribution and taking the 174 counties in Beijing, Tianjin, and Hebei, China, as the research objects. The results show that ① Beijing, Tianjin, Langfang, Zhangjiakou, and Baoding residential land market state composite indexes are all in the middle to upper levels in the Beijing-Tianjin-Hebei city cluster, while Qinhuangdao, Handan, and Chengde residential land market state composite indexes are generally low. The harmony between the residential land price and national economy, the market supply and demand balance, and the structural balance may become the main factors affecting the healthy development of the residential land market in Beijing and Tianjin. ② The proportion of counties with "healthy" residential land market in all dimensions and overall market status reached over 64%, and the residential land market in the Beijing-Tianjin-Hebei region is running well. The rapid increase in residential land prices from 2016 to 2020 was an important driver of the increased heat in the residential land market across the region. ③ The residential land market in the counties around Beijing and Tianjin is significantly hotter than in other regions, and there is an obvious polarization effect in the operation state of the residential land market in the Beijing-Tianjin region. The residential land market is generally cold in the counties in the southern and northeastern parts of the region and other peripheral areas, and there is a risk of marginalization in the development of the residential land market in the counties in the peripheral areas. ④ Both the hot and cold residential land market states exhibit spatial clustering characteristics. Most of the clusters are not consistent with the municipal administrative boundaries, and the states of the residential land market in neighboring counties are very similar.

Epidemic monitoring in real-time based on dynamic grid search and Monte Carlo numerical simulation algorithm.

Building upon the foundational principles of the grid search algorithm and Monte Carlo numerical simulation, this article introduces an innovative epidemic monitoring and prevention plan. The plan offers the capability to accurately identify the sources of infectious diseases and predict the final scale and duration of the epidemic. The proposed plan is implemented in schools and society, utilizing computer simulation analysis. Through this analysis, the plan enables precise localization of infection sources for various demographic groups, with an error rate of less than 3%. Additionally, the plan allows for the estimation of the epidemic cycle duration, which typically spans around 14 days. Notably, higher population density enhances fault tolerance and prediction accuracy, resulting in smaller errors and more reliable simulation outcomes. Overall, this study provides highly valuable theoretical guidance for effective epidemic prevention and control efforts.

SMILE: Cost-sensitive multi-task learning for nuclear segmentation and classification with imbalanced annotations.

High throughput nuclear segmentation and classification of whole slide images (WSIs) is crucial to biological analysis, clinical diagnosis and precision medicine. With the advances of CNN algorithms and the continuously growing datasets, considerable progress has been made in nuclear segmentation and classification. However, few works consider how to reasonably deal with nuclear heterogeneity in the following two aspects: imbalanced data distribution and diversified morphology characteristics. The minority classes might be dominated by the majority classes due to the imbalanced data distribution and the diversified morphology characteristics may lead to fragile segmentation results. In this study, a cost-Sensitive MultI-task LEarning (SMILE) framework is conducted to tackle the data heterogeneity problem. Based on the most popular multi-task learning backbone in nuclei segmentation and classification, we propose a multi-task correlation attention (MTCA) to perform feature interaction of multiple high relevant tasks to learn better feature representation. A cost-sensitive learning strategy is proposed to solve the imbalanced data distribution by increasing the penalization for the error classification of the minority classes. Furthermore, we propose a novel post-processing step based on the coarse-to-fine marker-controlled watershed scheme to alleviate fragile segmentation when nuclei are with large size and unclear contour. Extensive experiments show that the proposed method achieves state-of-the-art performances on CoNSeP and MoNuSAC 2020 datasets. The code is available at: https://github.com/panxipeng/nuclear_segandcls.

A Retrospective, Long-term Follow-up of the Clinical Outcomes and Cost-effectiveness of Single-anesthetic Multiple Total Joint Procedures in Hemophilic Arthropathy.

OBJECTIVE: Although total joint replacement (TJR) procedures are efficacious, perioperative high-dose factors replacement therapy (FRT) to avoid catastrophic bleeding represents a significant hurdle, particularly for patients with multiple joint affection. Double simultaneous bilateral TJRs were reported as safe and cost-effective. However, little is known about multiple TJRs. The feasibility and effects remain debatable. Surgeons need to weigh the high cost of FRT against safety. Accordingly, we aimed to evaluate the clinical outcomes and cost-effectiveness of single-anesthetic multiple-joint procedures of lower limbs in end-stage hemophilic arthropathy. METHODS: Our retrospective cohort study retrieved data from an inpatient database of patients with hemophilia who underwent total knee arthroplasty (TKA), total hip arthroplasty (THA), and/or ankle arthrodesis from January 2000 to April 2016. Complications, hospital stays, transfusion, doses of clotting factor, medical costs, range of motion (ROM), Harris hip scores (HHSs) and Hospital for special surgery knee scores (HSSs) were recorded. A P value < 0.05 was considered significant. RESULTS: A total number of 81 patients were included in this study, among which 89 TKAs and 52 THAs were performed. Compared to the single TJR group, the simultaneous multiple TJR group showed a significantly higher rate of blood transfusions (P < 0.05). But no significant differences were found in the length of hospital stays, factor consumption, hospitalization costs excluding prosthesis expenses, and total complication rates. Finally, similar postoperative ROM, HHS, and HSS were witnessed in two groups (P value > 0.05). CONCLUSION: Our data indicated that simultaneous multiple TJRs are a safe and cost-effective choice for treating hemophilic patients with multiple HA-affected lower limb joints.

Optimizing Agronomic, Environmental, Health and Economic Performances in Summer Maize Production through Fertilizer Nitrogen Management Strategies.

Although nitrogen (N) fertilizer application plays an essential role in improving crop productivity, an inappropriate management can result in negative impacts on environment and human health. To break this dilemma, a 12-year field experiment (2008-2019) with five N application rates was conducted on the North China Plain (NCP) to evaluate the integrated impacts of optimizing N management (Opt. N, 160 kg N ha-1 on average) on agronomic, environmental, health, and economic performances of summer maize production. Over the 12-year study, the Opt. N treatment achieved the maximal average grain yield (10.6 Mg ha-1) and grain protein yield (793 kg ha-1) among five N treatments. The life cycle assessment methodology was applied to determine the negative impacts on environmental and human health, and both of them increased with the N rate. Compared with the farmers' conventional N rate (250 kg N ha-1), the Opt. N treatment reduced acidification, eutrophication, global warming, and energy depletion potentials by 29%, 42%, 35%, and 18%, respectively, and reduced the health impact by 32% per Mg of grain yield or grain protein yield produced. Both the Opt. N and Opt. N*50-70% treatments resulted in high private profitability (2038 USD ha-1), ecosystem economic benefit (1811 USD ha-1), and integrated compensation benefit (17,548 USD ha-1). This study demonstrates the potential benefits of long-term optimizing of N management to maintain high maize yields and grain quality, to reduce various environmental impacts and health impacts, and to enhance economic benefits. These benefits can be further enhanced when Opt. N was combined with advanced agronomic management practices. The results also suggest that reducing the optimal N rate from 160 to 145 kg N ha-1 is achievable to further reduce the negative impacts while maintaining high crop productivity. In conclusion, optimizing the N management is essential to promote sustainable summer maize production on the NCP.

Construction and pattern optimization of ecological network in Zhengzhou metropolitan area.

The rapid urbanization process has led to the increasingly prominent problems of ecological environment protection and optimization. The construction of ecological network system, planning to guide ecological values, and efficiently utilizing landscape effects are of great significance for regional regulation of ecological space and promotion of local sustainable development. Taking Zhengzhou metropolitan area as an example, based on land use data at eight time points from 1980 to 2020, using ArcGIS, Guidos Toolbox, Conefor and other tools, we outlined the ecological network with a high structural integrity in the study area. We used future land use simulation to predict future land pattern, morphological spatial pattern analysis to identify landscape elements, minimum cumulative resistance to construct comprehensive resistance surface, gravity model to calculate ecological gravity, hydrologic analysis to create resistance paths, and network structure evaluation, etc. The results showed that, among the nine source sites in the study area, the ecological sources in the Yellow River Basin connected the large-scale centralized source areas in the east and west of the network. The rest sources were located in the northeast, southeast, and southwest of the study area, which were distributed in a semi-circumferential manner around the main urban area of Zhengzhou. There were a total of 163 minimum cost paths and 58 ecological corridors, of which 10, 19 and 29 were primary, secondary and tertiary corridors, respectively, in the form of "three horizontals and three verticals" and "point-axis" along the Yellow River Basin distribution was dominant. A total of 70 ecological nodes were recored in the study area, which were divided into strategic points (10), natural ecological points (27) and artificial environment points (33). Those ecological nodes were distributed in key nodes such as the core of each source area and the intersection of corridors location. The ecological network included all the landscape elements in the study area and connected the main ecological substrates in a horizontal "C" shape. The overall performance was a semi-enclosed network structure of "one horizontal, two verticals and four groups".

Health insurance fraud detection by using an attributed heterogeneous information network with a hierarchical attention mechanism.

BACKGROUND: With the rapid growth of healthcare services, health insurance fraud detection has become an important measure to ensure efficient use of public funds. Traditional fraud detection methods have tended to focus on the attributes of a single visit and have ignored the behavioural relationships of multiple visits by patients. METHODS: We propose a health insurance fraud detection model based on a multilevel attention mechanism that we call MHAMFD. Specifically, we use an attributed heterogeneous information network (AHIN) to model different types of objects and their rich attributes and interactions in a healthcare scenario. MHAMFD selects appropriate neighbour nodes based on the behavioural relationships at different levels of a patient's visit. We also designed a hierarchical attention mechanism to aggregate complex semantic information from the interweaving of different levels of behavioural relationships of patients. This increases the feature representation of objects and makes the model interpretable by identifying the main factors of fraud. RESULTS: Experimental results using real datasets showed that MHAMFD detected health insurance fraud with better accuracy than existing methods. CONCLUSIONS: Experiment suggests that the behavioral relationships between patients' multiple visits can also be of great help to detect health care fraud. Subsequent research fraud detection methods can also take into account the different behavioral relationships between patients.

How finance shared services affect profitability: an IT business value perspective.

Shared services have become an important IT-enabled organizational form for providing support business functions to internal users. The information systems that implement and deliver shared services are part of the organizational IT infrastructure that has a twofold effect on firm financial performance. On the one hand, with the shared services model, the IT infrastructure consolidates so that the costs are lowered for providing the common functions firm-wide. On the other hand, the systems delivering the shared services embody the workflow and business functions so that the value of shared services can be gained from improvements in the function performance at the process level. We perceive finance shared services as IT-enabled services for corporate finance and accounting functions, and propose that finance shared services improve firm profitability via cost savings at firm level and via increased working capital efficiency at the process level. We test our hypotheses with data on Chinese public firms from 2008 to 2019. Data analysis results show both direct effect of finance shared services on profitability and mediating effect of working capital efficiency. This study expands our understandings about impacts of shared services, and contributes to empirical research in IT business value.

Enhanced degradation of tetracycline under natural sunlight through the synergistic effect of Ag3PO4/MIL-101(Fe) photocatalysis and Fenton catalysis: Mechanism, pathway, and toxicity assessment.

Here, we show that the adverse environmental and health effects of tetracycline (TC) can be efficiently reduced by encapsulating Ag3PO4 into MIL-101(Fe) to construct a Ag3PO4/MIL-101(Fe) heterojunction composite through advanced oxidation processes, such as Fenton catalysis, photocatalysis, and photo-Fenton catalysis. Notably, the reaction can be driven by natural sunlight and does not require any artificial energy source. Remarkably, the optimal degradation of TC can be achieved under different compositions of the composite system through photocatalysis and photo-Fenton catalysis. For photo-Fenton catalysis, the maximum degradation rate of TC (2.5730 min-1) is achieved when the mass ratio of MIL-101(Fe) to Ag3PO4 in the composite is 5:1, which is 31.65- and 3.12-fold of that in the Ag3PO4 + PDS + Sunlight and MIL-101(Fe) + PDS+ Sunlight catalyst systems, respectively. Moreover, the internal conversion of matrix during photocatalysis and Fenton catalysis processes inhibits the photocorrosion of Ag3PO4 and improves the reusability of the composite. Furthermore, it is found that both radical and non-radical species participate in the TC degradation. Besides, the degradation products and catalytic mechanism of Ag3PO4 and Ag3PO4/MIL-101(Fe) systems are explored. The toxicity evaluation results suggest that the intermediates produced during Ag3PO4/MIL-101(Fe) catalysis have a lower biotoxicity than those produced during Ag3PO4 catalysis. Overall, this work provides an effective strategy to inhibit the inherent photocorrosion of Ag3PO4 and establishes an efficient catalytic system for the treatment of organic-contaminated wastewater under natural sunlight conditions.

The Malay version of the caregiver assessment of function and upset instrument (Malay-CAFU): a translation and validation study among informal stroke caregivers.

BACKGROUND: Post-stroke complications affect the informal caregivers equally as the stroke survivors, especially those who have a moderate to worst prognosis in functional capacity recovery. Caregiver Assessment of Function and Upset (CAFU) is one of the common tools used in both research and clinical practice to measure the patient's dependency level and the stroke caregivers' upset level. OBJECTIVE: This study aimed to translate and validate the CAFU instrument into the Malay language and test the validity and reliability of the CAFU among informal stroke caregivers in Malaysia. METHODS: A standard forward-backward translation method was employed to translate CAFU. Subsequently, 10 expert panels were included in the validation process, and thereafter reliability testing was conducted among 51 stroke caregivers. The validation of the instrument was determined by computing the content validity indices (CVIs), and we used the Cronbach's alpha method to explore the internal consistency of the overall score and subscales scores of the Malay-CAFU. Finally, the explanatory factor analysis used principal component extraction and a varimax rotation to examine construct validity. RESULTS: All items of the Malay-CAFU had satisfactory item-level CVI (I-CVI), with values greater than 0.80, and the scale-level CVI (S-CVI) was 0.95. These results indicate that the Malay-CAFU had good relevancy. The internal consistency for the reliability test showed a Cronbach's alpha value of 0.95 for the overall score. The eigenvalues and scree plot supported a two-factor structural model of the instrument. From the explanatory factor analysis, the factor loadings ranged from 0.82 to 0.90 and 0.56 to 0.83, respectively. CONCLUSION: The Malay-CAFU questionnaire is a valid and reliable instrument to assess the dependence level of stroke survivors and the upset level of informal stroke caregivers in Malaysia.

Medical capacity investment for epidemic disease: The effects of policymaker's confidence and public trust.

Due to the server bed shortage, which has raised ethical dilemmas in the earliest days of the COVID-19 crisis, medical capacity investment has become a vital decision-making issue in the attempt to contain the epidemic. Furthermore, economic strength has failed to explain the significant performance difference across countries in combatting COVID-19. Unlike common diseases, epidemic diseases add substantial unpredictability, complexity, and uncertainty to decision-making. Knowledge miscalibration on epidemiological uncertainties by policymaker's over- and underconfidence can seriously impact policymaking. Ineffective risk communication may lead to conflicting and incoherent information transmission. As a result, public reactions and attitudes could be influenced by policymakers' confidence due to the level of public trust, which eventually affects the degree to which an epidemic spreads. To uncover the impacts of policymakers' confidence and public trust on the medical capacity investment, we establish epidemic diffusion models to characterize how transmission evolves with (and without) vaccination and frame the capacity investment problem as a newsvendor problem. Our results show that if the public fully trusts the public health experts, the policymaker's behavioral bias is always harmful, but its effect on cost increment is marginal. If a policymaker's behavior induces public reactions due to public trust, both the spread of the epidemic and the overall performance will be significantly affected, but such impacts are not always harmful. Decision bias may be beneficial when policymakers are pessimistic or highly overconfident. Having an opportunity to amend initially biased decisions can debias a particular topic but has a limited cost-saving effect.

[Pollution Characteristics and Ecological Risk Assessment of Antibiotics in Vegetable Field in Kaizhou, Chongqing].

The accumulation of antibiotics in farmland and its ecological risk have become a research hotspot at home and abroad. The objective of this study was to investigate the occurrence and accumulation of antibiotics and their potential environmental and ecological risks in vegetable fields in Kaizhou district of Chongqing country. The occurrence characteristics of antibiotics including tetracyclines, sulfonamides, quinolones, macrolides, and chloramphenicols were detected using experimental analysis. The results showed that there was an accumulation of antibiotics in the vegetable soil, and 18 antibiotics in five categories were detected (0-42.88 µg·kg-1), mainly for tetracyclines and quinolones. The detection rate of quinolone antibiotics was the highest (15.38%-100%), especially for norfloxacin and ofloxacin (100%), whereas the tetracyclines presented the highest concentration (0-42.88 µg·kg-1). The amount of total antibiotics in the vegetable soil was 1.64-233.11 µg·kg-1, whereas different vegetable soils showed the following trend:water spinach soil (89.73 µg·kg-1)>cabbage soil (32.53 µg·kg-1)>pepper soil (32.16 µg·kg-1)>tomato soil (32.13 µg·kg-1)>cucumber soil (26.46 µg·kg-1)>grassland (7.32 µg·kg-1). The correlation results showed that there was a significantly positive correlation between total antibiotic residues and organic fertilizer application (P<0.05) but a significantly negative correlation with soil pH (P<0.05). Quinolones and sulfonamides were negatively correlated with soil water content (P<0.05), whereas quinolones positively correlated with soil available phosphorus and organic matter content (P<0.05). The potential eco-environmental risk assessment results showed that tetracyclines and quinolones in vegetable soil in Kaizhou district had certain ecological risks, of which 62%-92% and 62%-100% of soil samples with quinolones had potential toxicity to soil animals and microorganisms.