Evaluating Losses from Water Scarcity and Benefits of Water Conservation Measures to Intercity Supply Chains in China.

The severe water scarcity in China poses significant economic risks to its agriculture, energy, and manufacturing sectors, which can have a cascading effect through the supply chains. Current research has assessed water scarcity losses for global countries and Chinese provinces by using the water scarcity risk (WSR) method. However, this method involves subjective functions and parameter settings, and it fails to capture the adaptive behaviors of economies to water scarcity, compromising the reliability of quantified water scarcity loss. There is a pressing need for a new method to assess losses related to water scarcity. Here, we develop an agent-based complex network model to estimate the inter-regional and intersectoral impacts of water scarcity on both cities and basins. Subsequently, we evaluate the supply chain-wide economic benefits of four different water conservation measures as stipulated by the 14th Five-Year Plan for the Construction of a Water-Saving Society. These measures include increasing the utilization rate of recycled water in water-scarce cities, reducing the national water consumption per industrial value-added, and implementing agricultural and residential water conservation measures. Results show that direct losses constitute only 9% of the total losses from water scarcity. Approximately 37% of the losses can be attributed to interregional impacts. Among the water-scarce cities, Qingdao, Lanzhou, Jinan, and Zhengzhou pose a significant threat to China's supply chains. Agricultural water conservation yields the highest amount of water savings and economic benefits, while residential water conservation provides the highest economic benefit per unit of water saved. The results provide insights into managing water scarcity, promoting cross-regional cooperation, and mitigating economic impacts.

Benefits evaluation of ecological restoration projects based on value realization of ecological products.

Ecological restoration project is the premise to realize the value of ecological products. The current ecological product value accounting and ecological restoration project benefit evaluation methods are interlinked. The benefit evaluation of ecological restoration projects can not only analyze the completion of ecological restoration projects, but also quantify the impact of externalities on regional development. This study proposes a hypothesis that the benefit evaluation results of ecological restoration projects can affect the realization of urban ecological product value. In order to verify the above hypothesis, this study designed a benefit evaluation framework to evaluate the economic benefits, ecological benefits and project costs of ecological restoration projects. In this study, the benefit evaluation results are divided into three cases to calculate the benefit-cost ratio under different conditions. The three cases are only considering the direct economic benefits (DEB), considering the indirect economic benefits (TEB) and considering the comprehensive benefits (AEB). Taking Jiangyin City of Jiangsu Province as an example, the benefit evaluation of water source protection project in Jiangyin City is carried out. The results show that the benefit-cost ratios in the three cases are 6.68,7.60 and 9.36, respectively. The results show that the benefit-cost ratio is different in different benefit situations. Therefore, when discussing the realization path of ecological product value in ecological restoration areas, it is also necessary to discuss the situation. The evaluation system can provide reference for the benefit evaluation of ecological restoration projects, and also provide data and theoretical support for the realization of regional ecological product value.

Developing China's roadmap for air quality improvement: A review on technology development and future prospects.

Air pollution control policies in China have been experiencing profound changes, highlighting a strategic transformation from total pollutant emission control to air quality improvement, along with the shifting targets starting from acid rain and NOx emissions to PM2.5 pollution, and then the emerging O3 challenges. The marvelous achievements have been made with the dramatic decrease of SO2 emission and fundamental improvement of PM2.5 concentration. Despite these achievements, China has proposed Beautiful China target through 2035 and the goal of 2030 carbon peak and 2060 carbon neutrality, which impose stricter requirements on air quality and synergistic mitigation with Greenhouse Gas (GHG) emissions. Against this background, an integrated multi-objective and multi-benefit roadmap is required to provide decision support for China's long-term air quality improvement strategy. This paper systematically reviews the technical system for developing the air quality improvement roadmap, which was integrated from the research output of China's National Key R&D Program for Research on Atmospheric Pollution Factors and Control Technologies (hereafter Special NKP), covering mid- and long-term air quality target setting techniques, quantitative analysis techniques for emission reduction targets corresponding to air quality targets, and pathway optimization techniques for realizing reduction targets. The experience and lessons derived from the reviews have implications for the reformation of China's air quality improvement roadmap in facing challenges of synergistic mitigation of PM2.5 and O3, and the coupling with climate change mitigation.

The regionalized ecological, economic and social benefit of China's sloping cropland erosion control during the 12th five-year plan (2011-2015).

With Kriging interpolation, analytic hierarchy process and grey relational analysis, this paper evaluates the regionalized benefit of China's sloping cropland erosion control (SCEC) during 2011-2015, including the ecological, economic, social benefit and the comprehensive benefit. The results show that, in the ecological benefits, the distribution of soil erosion control degree presents patchy characteristics. The reduction of runoff modulus gradually decreases from southeast to northwest. The reduction of soil erosion modulus is the largest in the Northwest Loess Plateau and the smallest in the Northeast Black Soil Zone. In the economic benefits, the increase in the annual output value per unit land area is characterized by "high in the south and low in the north", but there are patchy high-value areas in central Loess Plateau and the Northern Earthy-Rocky Mountain Zone. The increase in the agricultural population's per capita income is higher in the western area than that in the eastern area. In the social benefits, the per capita grain increase in most of the northern China is larger than that in the south, while the characteristic agricultural development in the south is more advantageous than that in the north. The comprehensive benefit is "high in the south and low in the north; highest in the southwest and lowest in the northeast". The spatial heterogeneity implies the necessity to specify the influencing factors for the SCEC benefit in different areas and take pointed measures to improve the benefit.

Assessing restoration benefit of grassland ecosystem incorporating preference heterogeneity empirical data from Inner Mongolia Autonomous Region.

The evaluation of grassland ecosystem restoration benefit considering herdsmen's preference is an important reference for the formulation of grassland protection policy. This study aims to evaluate the marginal benefits of grassland ecosystem services by using choice experiment and mixed logit (ML) model, and a latent class model (LCM) is estimated to identify and explain the heterogeneity of herdsmen's preference for the various functions of the grassland ecosystem, so as to estimate the benefits of grassland ecosystem restoration in Siziwang Banner and Damao Banner of Inner Mongolia Autonomous Region. The results reveal that the restoration benefit of the grassland ecosystem in the two banners is nearly 341.1 million RMB per year. The application of latent class model highlights three potential segments of the herdsmen with different preferences. The social, economic and environmental attitudinal characteristics of herdsmen have significant impacts on their preferences. Thus, to improve the universality of grassland ecological restoration policy, herdsmen's preferences should be thoroughly investigated before policy formulation and implementation. Meanwhile, it is important to publicize the grassland ecosystem services, to popularize the role of wildlife in the ecosystem, and to realize the benign interaction between wildlife protection and animal husbandry development.

Who May Benefit From On-Demand Control of Deep Brain Stimulation? Noninvasive Evaluation of Parkinson Patients.

BACKGROUND: In closed-loop on-demand control (ODC) of deep brain stimulation (DBS), stimulation is applied only when symptoms appear. Following stimulation of a fixed duration, DBS is switched off until the symptoms reappear. By repeating these demand-driven cycles, the amount of stimulation delivered can be decreased, thereby reducing DBS side-effects and improving battery-life of the pulse-generator. This article introduces Ro metric for quantification of degree of benefit of ODC and explores candidate selection in tremor-dominant Parkinson's disease (PD). METHOD: The study was performed on nine PD patients previously implanted with Medtronic DBS systems. Accelerometer sensor was placed on the tremor-dominant hand to detect onset of tremor. Fixed duration of stimulation (DS) of 20-80 sec was applied. Once the tremor was observed, stimulation was switched on. These trials were repeated during resting, postural, and kinetic conditions. Ro metric was calculated as the ratio of stimulation-off tremor-free period to the DS. Ro calculated at different DS were compared for each patient. RESULTS: We found that for each patient, Ro varied with DS and an optimal DS* gave a higher percentage of stimulation-off time. Average Ro at DS* varied from 0.554 to 4.24 for eight patients giving 35%-80% stimulation-off time. CONCLUSIONS: Ro values can be used for selection of optimal DS* in ODC. Three of nine patients were found to be tremor-free without stimulation for >50% of total time with even up to 80% in one patient. Patients with low Ro may not benefit from ODC in DBS, where the trade-off between having side-effects and using ODC system will need to be assessed.

Public health benefits of hair-mercury analysis and dietary advice in lowering methylmercury exposure in pregnant women.

AIMS: To evaluate whether a public health intervention using focused dietary advice combined with a hair-mercury analysis can lower neurotoxic methylmercury exposure among pregnant women without decreasing their overall intake of seafood. METHODS: A total of 146 pregnant women were consecutively recruited from the antenatal clinic at a Danish university hospital at their initial ultrasound scan. Dietary advice was provided on avoiding methylmercury exposure from large predatory fish and a hair sample from each participant was analysed for mercury, with the results being communicated shortly thereafter to the women. A dietary questionnaire was filled in. Follow-up three months later included a dietary questionnaire and a repeat hair-mercury analysis. RESULTS: In the follow-up group, 22% of the women had hair-mercury concentrations above a safe limit of 0.58 µg/g at enrolment, decreasing to 8% three months later. Average hair-mercury concentrations decreased by 21%. However, the total seafood intake remained at the same level after three months. CONCLUSIONS: Increased exposure to methylmercury among pregnant women is an important public health concern in Denmark. The observed lowering of hair-mercury concentrations associated with dietary advice corresponds to a substantial public health benefit that probably makes such an intervention highly profitable.

How Chinese clinicians face ethical and social challenges in fecal microbiota transplantation: a questionnaire study.

BACKGROUND: Fecal microbiota transplantation (FMT) is reportedly the most effective therapy for relapsing Clostridium Difficile infection (CDI) and a potential therapeutic option for many diseases. It also poses important ethical concerns. This study is an attempt to assess clinicians' perception and attitudes towards ethical and social challenges raised by fecal microbiota transplantation. METHODS: A questionnaire was developed which consisted of 20 items: four items covered general aspects, nine were about ethical aspects such as informed consent and privacy issues, four concerned social and regulatory issues, and three were about an FMT bank. This was distributed to participants at the Second China gastroenterology and FMT conference in May 2015. Basic descriptive statistical analyses and simple comparative statistical tests were performed. RESULTS: Nearly three quarters of the 100 respondents were gastro-enterologist physicians. 89% of all respondents believed FMT is a promising treatment modality for some diseases and 88% of whom chose clinical efficacy as the primary reason for recommending FMT. High expectation from patients and pressure on clinicians (33%) was reported as the most frequent reasons for not recommending FMT. The clinicians who had less familiarity with FMT reported significantly more worry related to the dignity and psychological impact of FMT compared to those who have high familiarity with FMT (51.6% vs 27.8%, p = 0.021).More than half of the respondents (56.1%) were concerned about the commercialization of FMT, although almost one in five respondents did not see this as a problem. CONCLUSIONS: We found most respondents have positive attitudes towards FMT but low awareness of published evidence. Informed consent for vulnerable patients, privacy and protection of donors were perceived as the most challenging ethical aspects of FMT. This study identified areas of limited knowledge and ways of addressing ethical issues and indicates the need to devise the education and training for clinicians on FMT.

Study on the Environmental Impact and Benefits of Incorporating Humus Composites in Anaerobic Co-Digestion Treatment.

This study evaluated the environmental impact and overall benefits of incorporating humus composites in the anaerobic co-digestion of kitchen waste and residual sludge. The life cycle assessment method was used to quantitatively analyze the environmental impact of the entire anaerobic co-digestion treatment process of waste, including garbage collection, transportation, and final product utilization. Moreover, the comprehensive assessment of the environmental impact, energy-saving and emission-reduction abilities, and economic cost of using humus composites in the anaerobic co-digestion treatment process was conducted using a benefit analysis method. The results showed that the anaerobic co-digestion of kitchen waste and residual sludge significantly contributed to the mitigation of global warming potential (GWP), reaching -19.76 kgCO2-eq, but had the least impact on the mitigation of acidification potential (AP), reaching -0.10 kgSO2-eq. In addition, the addition of humus composites significantly increased the production of biogas. At a concentration of 5 g/L, the biogas yield of the anaerobic co-digestion process was 70.76 m3, which increased by 50.62% compared with the blank group. This amount of biogas replaces ~50.52 kg of standard coal, reducing CO2 emissions by 13.74 kg compared with burning the same amount of standard coal. Therefore, the anaerobic co-digestion treatment of kitchen waste and residual sludge brings considerable environmental benefits.

Comprehensive evaluation of integrated applications of photovoltaics: case study of three projects in Tianjin, China.

Solar energy has gradually become one of the priorities to sustainable energy supply, driven by the urgent need for energy security and the imminent threats of climate change. Diverse photovoltaic (PV) technologies can be applied and integrated with various industries to significantly increase the usage and output value of different assets, such as land appreciation within limited space. In order to quantitatively evaluate the overall performance of various integrated applications of PV, a comprehensive benefit evaluation index system, involving economy, environment, society, and land use, was proposed and applied to three selected PV projects, PV-JWZ, PV-NHPZ, and PV-DPBD, namely, in Tianjin, China. The results indicated that these projects all have great development potential due to their remarkable benefits of energy saving and emission reduction. Therein, the total income of PV-JWZ within 25 years is equal to 1441.9 million CNY, which is dominated by extra income from industrial convergence; PV-NHPZ can offset 231.8 t/(a·hm2) CO2, attributed to its larger installed capacity; while PV-DPBD would acquire strong policy support for distributed PV to further promote the zero-carbon buildings, owing to lower land consumption of 1.4 hm2/MW. By revealing the effectiveness and feasibility of various PV projects, this study could provide a theoretical reference for the promoting and planning various integrated applications of PV in different areas, according to local conditions.

Measuring the impact of monoclonal antibody therapies.

Objective: Monoclonal antibody (Mab) treatments have significantly improved the quality and quantity of life, but they are some of the most expensive treatments, resulting in a degree of hesitancy to introduce new Mab agents. A system for estimating the effect of Mab drugs, in general, would optimally inform health strategy and fully realize how a single scientific discovery can deliver health benefits. We evaluated such a method with several well-established Mab regimens. Methods: We selected five different Mab regimens in oncology and rheumatology in England. We carried out two systematic literature reviews and meta-analyses to assess health outcomes (Health Assessment Questionnaire-Disability Index for rheumatoid arthritis; overall mortality for melanoma) from real-world data and compared them to the outcomes from randomized control trials (RCTs). We applied economic modeling to estimate the net monetary benefits for health outcomes for the estimated patient population size for each Mab regimen. Results: Meta-analyses of 27 eligible real-world data (RWD) sets and 26 randomized controlled trial (RCT) sets found close agreement between the observed and expected health outcomes. A Markov model showed the net positive monetary benefit in three Mab regimens and the negative benefit in two regimens. However, because of limited access to NHS data, the economic model made several assumptions about the number of treated patients and the cost of treatment to the NHS, the accuracy of which may affect the estimation of the net monetary benefit. Conclusion: RCT results reliably inform the real-world experience of Mab treatments. Calculation of the net monetary benefit by the algorithm described provides a valuable overall measure of the health impact, subject to the accuracy of data inputs. This study provides a compelling case for building a comprehensive, systematized, and accessible database and related analytics, on all Mab treatments within health services.

Does it reasonable to include grid-side energy storage costs in transmission and distribution tariffs? Benefit evaluation based on economic externality.

Grid-side energy storage has become a crucial part of contemporary power systems as a result of the rapid expansion of renewable energy sources and the rising demand for grid stability. This study aims to investigate the rationality of incorporating grid-side energy storage costs into transmission and distribution (T&D) tariffs, evaluating this approach using economic externality theory. We first develop a comprehensive benefit evaluation framework based on economic externality theory considering system stability, renewable energy integration, end-user, and environmental impacts. Then, using the CPLEX solver, an operating model of grid-side energy storage is constructed with the goal of reducing substation load variations. Through a case study, it is found that grid-side energy storage has significant positive externality benefits, validating the rationale for including grid-side energy storage costs in T&D tariffs. Sensitivity analysis suggests that with cost reduction and market development, the proportion of grid-side energy storage included in the T&D tariff should gradually recede. As a result, this study offers important information about whether it is reasonable to include grid-side energy storage costs in T&D tariffs in China.

Evaluating the Comprehensive Benefit of Urban Renewal Projects on the Area Scale: An Integrated Method.

Globally, the challenges facing cities regarding urban decay, insufficient urban function, and fragmented urban development are enormous. Under this context, urban renewal provides opportunities to address these challenges and enhance urban sustainability. Thus, promoting urban renewal projects and improving their performance is a global topic. In many circumstances, urban renewal is planned and initiated on the project scale, but on the area scale, overall coordination of the projects can bring about comprehensive benefits to urban areas on a macro view. In practice, it still lacks a systematic evaluation approach to obtain a clear picture of such comprehensive benefits. In academia, the existing research studies are mainly focused on single-project evaluation. An integrated framework that provides a holistic assessment of area-scale project benefits is missing. Few fully consider the coupling coordination benefits between several urban renewal projects from an area-scale perspective. Thus, this paper aims to propose a framework for integrating an indicator evaluation system through a hybrid entropy weight method with Back Propagation (BP) neural network methods to evaluate the comprehensive benefit of urban renewal projects on the area scale, which is the level at which most development area-scale renewal projects take place in a city. The feasibility and effectiveness of this proposed framework are then verified in a case study of Chongqing, China. The results indicate that the proposed method that integrated multi-project characteristics can contribute to a bigger picture of benefit evaluation of urban renewal based on an area scale perspective. This therefore provides not only guidance for urban planners and policymakers to make better decisions, but also new insight for benefit evaluation in the field of urban development.

[Concepts and application of cost-benefit evaluation in an international overview]. / Grundkonzepte und Einsatz von Kosten-Nutzen-Bewertungen im internationalen Überblick.

Due to market access of high-priced new drugs, the financial burden on the health care system and the appropriateness of drug prices are often doubted. Is it time for a broader perspective of health technology assessment in Germany, which has so far focused on clinical value? Should cost and benefit aspects of new technologies be given equal weight in future assessments of market access for new technologies? The experiences of European neighbors and the Standing Committee on Vaccination with cost-benefit analyses are encouraging. Introducing cost-benefit analyses as a further decision criterion in the pricing of new technologies naturally creates additional work for the players involved but also offers the opportunity to provide transparent and understandable answers to the question of what a health improvement is worth. In view of the increasing funding challenges facing the statutory health insurance system in Germany, this question will continue to gain importance.

An Integrated Care Platform System (C3-Cloud) for Care Planning, Decision Support, and Empowerment of Patients With Multimorbidity: Protocol for a Technology Trial.

BACKGROUND: There is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support. OBJECTIVE: The Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems. METHODS: This paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 "testing and evaluation" phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening. RESULTS: The technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product. CONCLUSIONS: Patients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT03834207; https://clinicaltrials.gov/ct2/show/NCT03834207. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/21994.

Assessment of monitoring and online payment system (Asha Soft) in Rajasthan using benefit evaluation (BE) framework.

CONTEXT: e-Health programs are implemented assuming that e-health/digital health can prove beneficial but pieces of evidence for assessing the actual benefits of e-health programs are lacking. AIMS: To utilize the benefit evaluation (BE) framework to assess Asha Soft, which is an online payment and performance monitoring system initiative taken by Rajasthan. SETTINGS AND DESIGN: BE of Asha Soft in Rajasthan. METHODS AND MATERIALS: BE of ASHA Soft was done using scoping review with consultation exercise. The rationale behind using this methodological framework is to contextualize knowledge of the current state of understanding within BE framework practice contexts. The themes used for data compilation and analysis were based on three broad dimensions of BE framework namely, health information technology quality, use, and net benefits. RESULTS: The state of Rajasthan has been the first in the country to start an online system of payment and monitoring of ASHA workers, through Asha Soft. It has administrative and supportive functions. Its simple and easy to use graphical user interference helps users to make accurate data entries and obtain desired monitoring and analytical reports. It has attributed to the availability of data on various parameters which help decision-maker to decide about the performance of ASHA worker and has brought a positive impact on the work performance of ASHAs. This online payment and monitoring mechanism has argumented motivational level and intention of use. The program has optimally utilized available human resources and no apparent monetary cost was involved in developing this software. CONCLUSIONS: This scoping study using the BE framework has provided evidence on the potential benefits of Asha Soft adoption in Rajasthan. It is recommended that future in-depth assessment of other e-health initiatives could be undertaken to guide the decision making.

Regulation of Clinical Xenotransplantation: A Reappraisal of the Legal, Ethical, and Social Aspects Involved.

Clinical trials of encapsulated pig islet transplantation are underway and are showing promising results. In addition, better immunosuppressant drug regimens and a wealth of new gene-edited pig varieties are raising new hopes in this field. Thus, consideration is also being given to the selection of patients for initial clinical trials of pig solid organ xenotransplantation. It seems likely that clinical trials of pig organ will be initiated within the next couple of years. For the moment, transplanting porcine islets to treat type 1 diabetes is generally viewed as the most likely to reach the clinical first. Further advances will hopefully make this approach a treatment choice for patients with this condition. Regulatory framework for this type of xenotransplantation is now available in several countries, and there is also a wider awareness of the importance of developing an internationally harmonized regulatory framework. For now, xenotransplantation is mainly conceived and regulated as a pharmaceutical product. The reframing of this emerging technology as cell therapy has redefined the normative landscape. Countries should be cautious about allowing xenotransplantation clinical trials to develop. But the original meaning of precaution, referred to safety measures in order to control risks of infection, is no longer seen as requiring restrictive limitations on fundamental rights. As with any new medicinal product, safety is certainly a crucial topic in research. Specific to xenotransplantation is the safety of porcine product. In this regard, regulatory frameworks should contain specific conditions about the safety of the source animals, of the xenotransplantation product, and of the manufacturing process. In turn, these frameworks should ensure that preclinical studies indicate safety and efficacy of the procedure and that risk management protocols are in place to identify, contain, and combat any outbreak of infection in a timely manner. The fragile balance between individual and collective rights and the tensions of globalization make necessary a coordinated international action to harmonize global practices in this field. Xenotransplantation clinical trials should be carried out in a context in which specific safety and ethical issues are addressed and in an environment in which specific practices that facilitate public engagement as a form of shared responsibility for regulatory decision-making are promoted as well.

Benefit-risk review of different drug classes used in chronic heart failure.

INTRODUCTION: Heart failure (HF) is an important public health problem with an increasing prevalence across the globe. The mortality rates from this complex clinical problem have stabilized in the recent years with the use of pharmacotherapeutics which demonstrated survival benefits in patients with HF with reduced ejection fraction (HFrEF). AREAS COVERED: We reviewed the seven classes of medications which constitute the guideline-directed medical therapy (GDMT) in chronic HF patients. We discussed clinical trials which support or contradict their use, potential adverse events, and available real-world data on utilization and safety. EXPERT OPINION: Loop diuretics form a major component of baseline therapy in HF patients to maintain euvolemia. As diastolic HF is more volume sensitive then systolic HF, diuretic use should be judiciously monitored to prevent states of volume depletion and associated complications. Neurohormonal modulation with pharmacotherapies are efficacious in reducing morbidity and mortality in the chronic HFrEF population. However, registry data showed that treatment intolerance and adverse events result in lower prescription rates of GDMT. Sacubitril/valsartan represents a major therapeutic advance in the treatment of HFrEF patients and can be safely used in addition to other GDMTs. Therapies to improve outcomes in diastolic HF  patients are needed.

Development and benefit evaluation of fermentation strategies for poly(malic acid) production from malt syrup by Aureobasidium melanogenum GXZ-6.

Malt syrup, as a low-cost substrate without any pretreatment, was proved to be able to replace maltose for ploymalic acid (PMA) production by Aureobasidium melanogenum GXZ-6. The PMA titer of 55.53 ±â€¯1.72 g/L was obtained by batch fermentation in a 10-L fermentor with addition of malate, citrate and sodium malonate. Then, a higher PMA titer of 124.07 ±â€¯2.28 g/L was obtained in fed-batch fermentation, which increased by 123.43% than that from batch fermentation. Moreover, repeated-batch fermentation with three batches gave a PMA titer of 64.06 g/L on average with a higher yield of 0.81 g/g and productivity of 0.56 g/L·h. Fermentation process and economics analysis were performed by SuperPro Designer for a 2000 metric tons plant. Results showed that PMA production cost was as low as $ 1.716/kg by fed-batch fermentation, which provides an economical strategy for large-scale PMA production.

Comprehensive evaluation on energy-water saving effects in iron and steel industry.

The production of iron and steel is energy-intensive that motivated the emergence of various energy-saving technologies to reduce energy consumption. However, the effects of water-saving brought by these energy-saving technologies are rarely examined which can lead to misevaluation of their economic feasibility. In this regard, material flow analysis (MFA) was used in this study to establish the water-energy nexus and examine the potential of water-saving and energy-saving effects in the condition of applying various mixes of the 16 technologies (Ministry of Industry and Information Technology, 2015-2016) in iron and steel industry. Meanwhile, this study classified the selected 16 energy-saving technologies into three groups: direct water-saving technology, indirect water-saving technology, and water consumption technology. The low-temperature steel rolling technology is the only water-consuming energy-saving technology in this study; its indirect specific water computation reaches 0.06 m3/t. The remaining 15 energy-saving technologies have the potential of saving water indirectly, with averaged indirect specific water-saving amounting to 0.28 m3/t. This study also built an evaluation scheme of cost-benefit analysis for energy-saving technologies. With consideration of benefits brought by water saving, eleven technologies have the potential to achieve economic feasibility compared to nine in which mere energy-saving effects being considered. The results show that if the studied 16 technologies are implemented simultaneously, the comprehensive specific energy consumption will be reduced by 4.28 MJ, and the specific fresh water consumption will be reduced by 0.68 m3. Meanwhile, this research found that the cost of most energy-saving technologies will be decreased by an average of 5.52 CNY/GJ, despite the cost of low-temperature steel rolling technology increased by 0.68 CNY/GJ. This study evaluated the cost-effectiveness of energy-saving technologies taking the benefits of water conservation into consideration. It could provide references for decision-makers to develop commercialization strategies on energy saving technologies in the steel industry.