A comprehensive evaluation of private sector investment decisions for sustainable water supply systems using a fuzzy-analytic hierarchy process: A case study of Ha Nam province in Vietnam.

This study examined the factors that affect the private sectors' willingness to invest in rural water supply. The study applied a mixed methods approach, including an overview of relevant studies, expert consultation, exploratory factor analysis using SPSS software, and a fuzzy-analytic hierarchy process to identify and evaluate the factors applicable to Ha Nam province in Vietnam. Some factors were distinguished that are significant to private investors' rural water supply investment decisions, including tax incentive policy, policies to support preferred access to loans and credit, a state risk-sharing mechanism, a mechanism to adjust water price, community support, high community demand for clean water, and input water quality. In addition, the study constructed an investment attractiveness index to evaluate the attractiveness of private sector investment for two typical rural water supply projects in Ha Nam province. This index can be used as a basis for the government to design appropriate incentives to attract investment from private investors and construct an investment attractiveness map.

Establishment and validation of an individualized nomogram to predict distant metastasis in chondrosarcoma patients: a population-based study.

Background: Distant metastasis is a significant factor influencing chondrosarcoma (CHS) patients' treatment and prognosis. We aimed to establish a consistent and effective nomogram to better predict distant metastases of CHS individuals. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to obtain the demographics and clinicopathological characteristics of CHS patients from 2010 to 2018. Independent risk factors were identified via univariate and multivariate logistic regressive analysis. A nomogram that predicts metastasis risk was established based on the training cohort, and its accuracy was validated through the validation cohort. The performance of this predictive model was assessed by the receiver operating characteristic (ROC) curve and Harrell's concordance index (C-index). Finally, decision curve analysis (DCA) was conducted to test its clinical reliability. Results: Data of 1,066 patients were extracted, of these, 66 cases (6.19%) were with distant metastasis at initial diagnosis. The following features were shown to be linked to an increased risk of metastasis: high-grade tumor, T3 stage, and large tumor size; whereas unmarried and use of surgery were independent protective factors. Marital status, tumor grade, T stage, use of cancer-directed surgery and tumor size were incorporated to develop the novel nomogram. The ROC curves showed the effectiveness of the nomogram with the high area under the curves, the C-indices were 0.931 and 0.951 in the internal and external validation, respectively. The calibration plots indicated a good consistency and agreement of the nomogram, while the DCA illustrated that the nomogram had favorable potential clinical applicability due to great positive net benefit with wide ranges of the threshold probabilities. Conclusions: This work developed a novel nomogram for predicting distant metastasis in CHS patients, which might assist clinicians to determine the optimal treatment plan by precisely predicting individualized metastatic risk.

Risk Factors for Incidence and Prognosis in Chondrosarcoma Patients with Pulmonary Metastasis at Initial Diagnosis.

BACKGROUND The incidence and prognostic factors of chondrosarcoma patients have been reported in early studies. However, the association between risk factors and the incidence or prognosis of chondrosarcoma patients with pulmonary metastasis remains unclear. Therefore, we assessed these risk factors among chondrosarcoma patients with pulmonary metastasis. MATERIAL AND METHODS From 1365 chondrosarcoma patients in the Surveillance, Epidemiology, and End Results (SEER) database, we collected the information of 69 patients with pulmonary metastasis at the initial diagnosis of chondrosarcoma from 2010 to 2016. We investigated the incidence, risk factors, and prognostic factors for pulmonary metastasis patients by using multivariate logistic regression and multivariate Cox regression analyses. RESULTS Data from a total of 69 (6.8%) chondrosarcoma patients with pulmonary metastasis at initial diagnosis were extracted. Patients with the following characteristics were positively associated with higher risk of pulmonary metastasis: dedifferentiated subtype, high grade of malignancy, extracompartmental tumor (Enneking B), presence of regional lymph nodes, local recurrence, large tumor size (larger than 15 cm), and being married. Older patients (older than 67 years), and patients with clear cell chondrosarcoma or large tumor size (larger than 15 cm) exhibited the worse prognosis and survival (overall and cancer-specific). Resection of the primary tumor tended to be correlated with a better prognosis. CONCLUSIONS The incidence of pulmonary metastasis in chondrosarcoma was approximately 6.8%, with poor prognosis. Identifying risk factors and their associations with the incidence and prognosis in chondrosarcoma patients with pulmonary metastasis could provide a reference for clinical surveillance and guide the design of personalized treatment plans.

Host Transcription Profile in Nasal Epithelium and Whole Blood of Hospitalized Children Under 2 Years of Age With Respiratory Syncytial Virus Infection.

Background: Most insights into the cascade of immune events after acute respiratory syncytial virus (RSV) infection have been obtained from animal experiments or in vitro models. Methods: In this study, we investigated host gene expression profiles in nasopharyngeal (NP) swabs and whole blood samples during natural RSV and rhinovirus (hRV) infection (acute versus early recovery phase) in 83 hospitalized patients <2 years old with lower respiratory tract infections. Results: Respiratory syncytial virus infection induced strong and persistent innate immune responses including interferon signaling and pathways related to chemokine/cytokine signaling in both compartments. Interferon-α/ß, NOTCH1 signaling pathways and potential biomarkers HIST1H4E, IL7R, ISG15 in NP samples, or BCL6, HIST2H2AC, CCNA1 in blood are leading pathways and hub genes that were associated with both RSV load and severity. The observed RSV-induced gene expression patterns did not differ significantly in NP swab and blood specimens. In contrast, hRV infection did not as strongly induce expression of innate immunity pathways, and significant differences were observed between NP swab and blood specimens. Conclusions: We conclude that RSV induced strong and persistent innate immune responses and that RSV severity may be related to development of T follicular helper cells and antiviral inflammatory sequelae derived from high activation of BCL6.

Respiratory Syncytial Virus and Other Viral Infections among Children under Two Years Old in Southern Vietnam 2009-2010: Clinical Characteristics and Disease Severity.

BACKGROUND: Despite a high burden of respiratory syncytial virus (RSV) infections among children, data on demographic and clinical characteristics of RSV are scarce in low and middle income countries. This study aims to describe the viral etiologies, the demographic, epidemiological, and clinical characteristics of children under two years of age who were hospitalized with a lower respiratory tract infections (LRTI), focusing on RSV (prevalence, seasonality, subgroups, viral load) and its association with disease severity. METHODS: A prospective study among children under two years of age, hospitalized with LRTI was conducted in two referral pediatric hospitals in Ho Chi Minh City, Vietnam, from May 2009 to December 2010. Socio-demographic, clinical data and nasopharyngeal swabs were collected on enrolment and discharge. Multiplex real-time RT-PCR (13 viruses) and quantitative RSV RT-PCR were used to identify viral pathogens, RSV load and subgroups. RESULTS: Among 632 cases, 48% were RSV positive. RSV infections occurred at younger age than three other leading viral infections i.e rhinovirus (RV), metapneumovirus (MPV), parainfluenza virus (PIV-3) and were significantly more frequent in the first 6 months of life. Clinical severity score of RSV infection was significantly higher than PIV-3 but not for RV or MPV. In multivariate analysis, RV infection was significantly associated with severity while RSV infection was not. Among RSV infections, neither viral load nor viral co-infections were significantly associated with severity. Young age and having fever at admission were significantly associated with both RSV and LRTI severity. A shift in RSV subgroup predominance was observed during two consecutive rainy seasons but was not associated with severity. CONCLUSION: We report etiologies, the epidemiological and clinical characteristics of LRTI among hospitalized children under two years of age and risk factors of RSV and LRTI severity.

Direct whole-genome deep-sequencing of human respiratory syncytial virus A and B from Vietnamese children identifies distinct patterns of inter- and intra-host evolution.

Human respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infections in children ,2 years of age. Little is known about RSV intra-host genetic diversity over the course of infection or about the immune pressures that drive RSV molecular evolution. We performed whole-genome deep-sequencing on 53 RSV-positive samples (37 RSV subgroup A and 16 RSV subgroup B) collected from the upper airways of hospitalized children in southern Vietnam over two consecutive seasons. RSV A NA1 and RSV B BA9 were the predominant genotypes found in our samples, consistent with other reports on global RSV circulation during the same period. For both RSV A and B, the M gene was the most conserved, confirming its potential as a target for novel therapeutics. The G gene was the most variable and was the only gene under detectable positive selection. Further, positively selected sites inG were found in close proximity to and in some cases overlapped with predicted glycosylation motifs, suggesting that selection on amino acid glycosylation may drive viral genetic diversity. We further identified hotspots and coldspots of intra-host genetic diversity in the RSV genome, some of which may highlight previously unknown regions of functional importance.