Yuan RMB Research Articles

Composition and influencing factors of hospitalization expenses for epilepsy patients based on path analysis

ObjectiveThis study aimed to understand the composition and influencing factors of epilepsy patients’ hospitalization expenses, thus providing a reference for reducing the disease burden of epilepsy patients in low- and middle-income developing countries.MethodsA total of 4206 hospitalized cases of epilepsy from 2018 to 2020 were collected. Descriptive statistics were used to understand the patient cost composition, path analysis was used to understand the direct and indirect factors of hospitalization expenses.ResultsFrom 2018 to 2020, the average hospitalization expenses for epilepsy patients was 4,299.93 RMB yuan, and the average length of stay was 2.47 days. The highest proportion of hospitalization expenses was diagnosis costs (> 50%), followed by comprehensive medical service costs and drug costs. In terms of the total effect coefficient, the major factors affecting the hospitalization expenses were length of stay (0.880), emergency admission(0.463), and the comorbidities and complications(> 0.250). Hospital length of stay, discharge mode(death) and number of hospitalizations(2 times) affect hospitalization expenses through direct effect. Long-term hospitalization (> 30 days), admission routes(emergency), the comorbidities and complications, presence of drug allergy, and age also affect hospitalization expenses through indirect effects.ConclusionDiagnosis costs and length of stay are important factors affecting the medical expenses of epilepsy inpatients. In general, the quality control of the hospital is good, but it still needs to standardize the diagnosis and treatment behavior of medical staff through the clinical path.

Comparison of robotic-assisted single-incision-plus-one-port laparoscopic pyeloplasty and single-incision laparoscopic pyeloplasty in the treatment of pediatric ureteropelvic junction obstruction

Objective: To compare the efficacy of robotic-assisted single-incision-plus- one-port laparoscopic pyeloplasty (R-SILP+1) with single-incision laparoscopic pyeloplasty (SILP) in pediatric ureteropelvic junction obstruction (UPJO). Methods: The clinical data of 47 children with UPJO who underwent surgery from October 2020 to September 2022 in the Department of Pediatric Surgery of Fujian Provincial Hospital were retrospectively analyzed. According to the surgical method chosen by parents, the children were divided into R-SILP+1 group and SILP group. Baseline data, operative time, intraoperative anastomosis time, volume of blood loss, postoperative hospitalization time, complications, total costs, preoperative and postoperative renal parenchymal thickness (PT), anterior posterior diameter of renal pelvis (APD), and differential renal function (DRF) before and after operation were compared between the two groups, and the clinical efficacy of the two kinds of operation was evaluated. Results: Among the 47 children, 27 were in R-SILP+1 group, including 16 males and 11 females, aged (6.6±3.5) years; 20 were in SILP group, including 12 males and 8 females, aged (6.5±3.5) years. The operations were successful in both groups without conversion to open operation. There were no significant differences between the two groups in baseline data, volume of blood loss, complications, APD and PT at postoperative 6 months, APD, PT and DRF at postoperative 12 months (all P>0.05). Compared with the SILP group, the operative time [(153.0±14.4) vs (189.9±32.6) minutes, P<0.001], intraoperative anastomosis time [(68.8±16.8) vs (97.5±12.0) minutes, P<0.001], postoperative hospitalization time [(6.0±1.3) vs (9.0±1.3) d, P<0.001] were shorter, but the total cost was higher[(57 390±7 664) vs (30 183±4 219) yuan RMB, P<0.001]. Conclusions: Compared with the SILP group, R-SILP+1 can achieve considerable efficacy in treating pediatric UPJO, and has certain advantages in shortening operative time, intraoperative anastomosis time, and postoperative hospitalization time. However, the cost is high.

Optimal Planning of Urban Building-Type Integrated Energy Systems Considering Indoor Somatosensory Comfort and PV Consumption

Building energy consumption is the main urban energy consumption component, which mainly serves people-centered work and living energy demands. Based on the physical requirements of humans in urban buildings and to determine the comfortable body temperature in each season, this paper establishes a sizing optimization model of building-type integrated energy systems (IES) for sustainable development, where the cooling and heating loads required to maintain indoor somatosensory body comfort temperature are calculated. Depending on the external energy price, internal power balance, and other constraints, the model develops an optimal sizing and capacity-planning method of energy conversion and storage unit in a building-type IES with PV generation. The operating principle is described as follows: the PV generation is fully consumed, a gas engine satisfies the electric and thermal base load requirements, and the power system and a heat pump supply the remaining loads. The gas price, peak-valley electricity price gap, and heat-to-power ratio of gas engines are considered important factors for the overall techno-economic analysis. The developed method is applied to optimize the economic performance of building-type IES and verified by practical examples. The results show that using the complementary characteristics of different energy conversion units is important to the overall IES cost. A 300 kW building photovoltaic system can reduce the gas engine capacity from 936.7 kW to 854.7 kW, and the annual cost can be approximately reduced from 7.82 million to 7.50 million RMB yuan.

Analysis of mental health status and related factors in patients with acute cerebral infarction.

Acute cerebral infarction (ACI) is characterized by a high incidence of morbidity, disability, recurrence, death and heavy economic burden, and has become a disease of concern in global researchers. As ACI has serious effects on patients' physical status, life and economy, often causing anxiety, depression and other psychological problems, these problems can lead to the aggravation of physical symptoms; thus, it is very important to understand the factors affecting the mental health of these patients. To understand the elements that affect the mental health of patients who have suffered an ACI. A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals (Quanzhou First Hospital, Fuqing City Hospital Affiliated to Fujian Medical University, and the 900 Hospital of the Joint Service Support Force of the People's Liberation Army of China) in Fujian Province from January 2022 to December 2022 using the convenience sampling method. ACI inpatients who met the inclusion criteria were selected. Informed consent was obtained from the patients before the investigation, and a face-to-face questionnaire survey was conducted using a unified scale. The questionnaire included a general situation questionnaire, Zung's self-rating depression scale and Zung's self-rating anxiety scale. All questionnaires were checked by two researchers and then the data were input and sorted using Excel software. The general situation of patients with ACI was analyzed by descriptive statistics, the influence of variables on mental health by the independent sample t test and variance analysis, and the influencing factors on psychological distress were analyzed by multiple stepwise regression. The average age of the 220 patients with ACI was 68.64 ± 10.74 years, including 142 males and 78 females. Most of the patients were between 60 and 74 years old, the majority had high school or technical secondary school education, most lived with their spouse, and most lived in cities. The majority of patients had a personal income of 3001 to 5000 RMB yuan per month. The new rural cooperative medical insurance system had the largest number of participants. Most stroke patients were cared for by their spouses and of these patients, 52.3% had previously smoked. Univariate analysis showed that gender, age, residence, course of disease, number of previous chronic diseases and smoking history were the main factors affecting the anxiety scores of patients with ACI. Age, living conditions, monthly income, course of disease and knowledge of disease were the primary variables influencing the depression score in patients with ACI. The findings of multivariate analysis revealed that the course of disease and gender were the most important factors influencing patients' anxiety scores, and the course of disease was also the most important factor influencing patients' depression scores. Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders. These groups require more attention and counseling.

Material flow analysis on the critical resources from spent power lithium-ion batteries under the framework of China's recycling policies

With the rapid growth of electric vehicles in China, the number of spent power lithium-ion batteries is dramatically increased. Considering the environmental risk, security risk, and potential resource value, China has issued a series of laws and regulations to manage the spent power lithium-ion batteries. This work employs the material flow analysis method to evaluate the material flows of Li, Ni, Co, and Mn during the life cycle of power lithium-ion batteries under the framework of China's recycling policy system. The results show that the demand for primary Li, Ni, Co, and Mn can achieve 26.9, 68.1, 20.4, and 21.9 kt in 2021, and a lot of primary critical resources will inburst the in-use stage. Moreover, the number of secondary Li, Ni, Co, and Mn can achieve 6.1, 15.4, 4.6, and 5 kt in 2021, accounting for 22.7%, 22.6%, 22.5%, and 22.8% of their corresponding demand. Based on the economic evaluation under the framework of China's recycling policy system, it is found that the potential recycling values of Li, Ni, Co, and Mn are approximately 966, 523, 414, and 43 million RMB yuan, which are 66.4%, 71%, 59.6%, and 66.4% higher than those in the absence of China's recycling policy system. It is implied that China's recycling policy system could markedly improve the collection rate by reducing losses and indirectly enhancing the recycling and reuse of spent power lithium-ion batteries. This work is expected to provide guidance for policymakers to improve the management of spent power lithium-ion batteries in China.

Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study

BackgroundChronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally.ObjectiveTo quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients.MethodsDischarged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases.ResultsA total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase.ConclusionThis study characterized CR engagement, and explored demographic, medical, and psychological factors—with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

Health shock, the Green for Grain Program and medical expenses: Empirical Evidence on the well-being of Chinese Farmers

Health shock is an important factor affecting the medical expenditure of farmers. As the largest environmental compensation project in China, the Green for Grain Program plays an important role in increasing the well-being of farmers. Based on the 2017–2019 China Household Finance Survey (CHFS) dataset, this paper constructs two balanced panel data, which adopts the differences-in-differences propensity score matching (PSM-DID) from the perspective of post-hoc. The method identified the effect of health shock on the level of household medical expenditure in peasant household. The findings suggest that health shock have significantly increased the level of medical expenditure in peasant household, and this conclusion remains true after a series of robustness tests. Specifically, the health impact can significantly increase household medical expenditure by 2270 RMB yuan. Further research found that the impact is significantly heterogeneous due to whether farmers participate in the Green for Grain Program. Specifically, under the impact of health shock, the increased amount of medical expenditure of farmers participating in the Green for Grain Program is relatively small, that is, there is a “well-being paradox” phenomenon. Therefore, this paper puts forward suggestions on improving the level of farmers’ health literacy, optimizing the compensation policy for the Green for Grain Program and developing the service industry policy in the areas where the Green for Grain Program is implemented. This study has certain policy guidance and reference value for the Chinese government to continue to consolidate the results of the Green for Grain Program to alleviate poverty and improve the well-being of farmers in developing countries.

Multi-objective optimization methodology for green-gray coupled runoff control infrastructure adapting spatial heterogeneity of natural endowment and urban development

Cost-effective runoff control scheme drafting involves localization, multi-sector coordination, and configuration of multifunctional infrastructures. Numerous independent variables, parameters, weights, and objectives make runoff control optimization quantitatively arduous. This study innovatively proposed a multi-objective optimization methodology for green-gray coupled runoff control infrastructure adapting spatial heterogeneity of natural endowment and urban development. The quantitative methods of multi-objective evaluation, hydrological feature partition, and pressure-adapted multi-objective weight assignment were proposed. Remote sensing inversion of water quality, hydrological model simulation (using SWAT and SWMM software), landscape pattern index calculation, life cycle cost (LCC), life cycle assessment (LCA) on ecological impact, and NSGA-II optimization algorithm were applied. Wuhan, the most water-sensitive city in China, was studied as a case. Runoff control function (RCF), capital investment (CI), and ecological return on investment (EROI) served as optimized objectives. High, medium, and low built-up regions in Wuhan urban development planning district were extracted by topographic factors and landscape patterns, which comprised 28, 34, and 38% of the case area, respectively. Three corresponding hydrological models were then built to illustrate distinct runoff control cost-efficiency in each region. Pressure distributions on runoff control, economic constraints, and ecological resource scarcity were quantitatively evaluated. And four pressure zones were clustered, which occupied 36, 29, 16, and 19% of the case area, respectively. Then the zonal weighted optimization decision-making matrix (with 3 hydrological models and 5 wt) was established by overlaying the pressure zone and built-up zone. In high, medium, and low built-up regions, optimized solutions reduced annual runoff volume by 86, 82%, and 77%The average runoff investments per square meter of impervious underlying surface in high, medium, and low built-up regions were 34.2, 18.7, and 7.9 RMB yuan, respectively. Medium and low built-up regions may only need 55 and 23% of the high built-up region for the unitary impervious underlying surface to balance runoff control and ecological benefits. Runoff control and financial utilization efficiency enhance with hydrological differentiation zones. Thus, the optimization solutions are zonal adaptive, refined, comparable, replicable, and implementable.

Residents’ Health Effect of Environmental Regulations in Coal-Dependent Industries: Empirical Evidence from China’s Cement Industry

Coal-dependent industries are the economic pillar of many countries; however, their contribution to air pollution also restricts long-term economic development. While the negative effects of environmental regulations on coal-dependent industries has attracted much attention, the health effects of such regulations remains barely quantitatively studied. Our study is based on a quasi-natural experiment created by a command-and-control policy in China’s cement industry, whereby cement enterprises are forced to stop production for a specific period of time every year. This paper adopted DID methods and found that direct pollution control measures for coal-dependent industries could significantly improve residents’ health levels and that the resultant reduction in medical expenditures could save 456.8 RMB yuan per capita per year. Additionally, our mechanism analysis found that the COPP is beneficial to residents’ health in that it reduces air pollution and sewage treatment rates. This means that pollution from coal-dependent industries has a large and underestimated impact on residents’ health. Environmental regulation of the coal-dependent industry could greatly improve the health of residents.

Evaluation of ecosystem services from 2000 to 2020 and their trade-offs/synergies in a coalfield: a case study in the Pingshuo mining area of the Loess Plateau, China.

Determining the spatiotemporal dynamics in land use and ecosystem service value (ESV) and understanding the trade-offs/synergy relationships between ecosystem services (ESs) are crucial for ecosystem management and achieving sustainable development in mining areas. However, existing research on ESV and ESs has not paid sufficient attention to the special coalfield in arid/semiarid areas. In this study, we investigated the Pingshuo mining area and used the standard equivalent factor to evaluate ESV variations resulting from the spatiotemporal changes of land use based on remote sensing and land use data (2000, 2010, and 2020). Simultaneously, the trade-offs/synergies between ESs were further explored using the ESs trade-offs/synergies degree (ESTD) model. We found that (1) the land use changed considerably in this area, which was mainly reflected in farmland decrease and built-up land increase by 3580.60 hm2 and by 5103.44 hm2, respectively, from 2000 to 2020. (2) ESV in our study area declined by 7116.53 × 104 RMB yuan over the investigated period. High ESV mainly appeared in the north/south of the study area, while the low ESV was concentrated in the middle and northeast/southeast of the mining area. (3) The interactions between paired ESs were mainly the synergies that generally appeared among eight ESs except soil conservation, while trade-offs mainly existed between soil conservation and other paired ESs in the study region. To achieve socio-economic and ecological benefits, the local government should take effective measures to improve the environment of the coalfield and reverse the falling tendency of ESV.

Influence of in-vehicle crowding on passenger travel time value: Insights from bus transit in Shanghai, China

In-vehicle crowding is an external cost imposed on passengers by public transport. It is necessary to quantify the crowding discomfort to measure its influence on passengers’ travel choice. This study presents a stated preference survey embedded with revealed preference to investigate the influence of in-vehicle crowding on the travel choice behavior. The in-vehicle crowding degree is measured as standing density. Considering the in-vehicle environment and the subjective perception of passengers, the classification criteria for the in-vehicle crowding degree of bus transit are put forward. Then, the mixed logit model is used to establish the utility function of bus passenger travel choice behavior under different in-vehicle crowding degrees, and the value of travel time is calculated. Also, the functional relationship between in-vehicle crowding and travel time value is identified. In addition, by converting in-vehicle crowding into time, the travel impedance model considering in-vehicle crowding and the crowding value of time multipliers are defined. A study of Shanghai bus transit shows that when the standing density is higher than 7.5 passengers per square meter, bus passengers are willing to exchange 12.83 Chinese Yuan RMB for 1-hour travel time saving, and the perceived in-vehicle time is twice as long as the actual in-vehicle time. This study provides a reference for improving the attraction of bus transit and easing the decline in bus rides.

When will China's total water consumption reach the turning point? EKC simulation and influencing factors.

The turning point of China's total water consumption is very important for the understanding of the evolution trend of total water consumption and the formulation of water conservation policies. Based on the environmental Kuznets curve (EKC) model, this paper verifies the shape of water consumption Kuznets curve. Scenario analysis and Monte Carlo simulation are combined for the first time to predict water consumption Kuznets curve. The LMDI model is used to decompose the driving factors of the evolution of total water consumption, and the STIRPAT model is expanded to explore the influence mechanism of total water consumption. The results show the following: (1) The theoretical water consumption Kuznets curve exists, and the turning point is 26,448 yuan RMB (in around 2013). (2) Based on the multiple driving factors (water intensity, per capita GDP, and population) and multiple scenarios (baseline scenario, target scenario, and 2 adjusted scenarios), 32 scenarios are designed in this paper; in the S1-S8, the turning point still appeared near 2013; the curves under the S11-S14, S16, and S25-S32 were inverted U-shaped, and the turning point was 48,728 yuan RMB (in around 2025); and in the S9, S10, and S15, the curve shows an upward trend; in the S17-S24, the curve has a rising-falling-rising characteristic. (3) Domestic effect and ecological effect both play a role in promoting the total water consumption, while the production effect is in an inverted N-shaped. Economic growth has always promoted the increase in industrial and agricultural water consumption, and the role of population size is relatively weak. The intensity of production water consumption has always promoted reduction in industrial and agricultural water consumption. Industrial water intensity and industrial structure are the primary and secondary factors that promote the decline of production intensity. (4) The per capita GDP has the largest contribution to total water consumption, followed by the water intensity, and the industrial structure has the least impact. The population has a negative impact. Based on this, a number of policy implications are obtained.

A Mine Ventilation System Energy Saving Technique Based on an Improved Equilibrium Optimizer

Over the years, the ventilation systems used in coal mines have become more and more complex. Due to a lack of scientific and effective management, the energy consumed by ventilation systems has rapidly increased, resulting in considerable wasted energy. To solve this problem, the authors established a nonlinear optimization model aimed at minimizing the total energy consumption of a mine ventilation network. Furthermore, the authors propose an improved equilibrium optimizer algorithm to solve the model. First, the population is initialized by a chaotic map. Second, the adjustment strategy of a trigonometric function is introduced to improve the index F, which improves the global development ability of the algorithm, avoids falling into local optimum, and can improve the local search ability in the later stages. Then, Gaussian disturbance is introduced to enhance the diversity of particles and avoid falling into the local optimum. Finally, a learning factor was introduced to improve the generation rate G and improve the algorithm’s integrity; it was then compared with other algorithms. The simulation results show that the performance of the improved algorithm is significantly better than other algorithms. It was tested with the ventilation system of Wangjialing mine of Zhongmei Huajin Energy Co., Ltd. The results showed that the energy consumption of the ventilation system was reduced by 17.83%. This method can save the mine about 2 million yuan RMB every year. The economic effect is remarkable, we achieved the purpose of energy conservation and emission reduction, and the effectiveness of the proposed method was verified.

Model-based temporal evolution and spatial equilibrium analysis of green development in China's Yangtze River Economic Belt from 2009 to 2018

Green development is one of the important guidance and core contents of high-quality development of regional economy and society, and its spatial–temporal pattern evolution analysis is helpful to the scientific formulation of relevant policies. However, the green development evaluation is faced with multi attribute decision making difficulties. In view of this, firstly, based on discussing the connotation of green development from ontology, epistemology, axiology and methodology, a new evaluation indicator system from the four dimensions of energy conservation, emission reduction, efficiency increase and harmony was explored. Then, coupling symmetric cross entropy multi attribute decision making and Gini coefficient method, a comprehensive evaluation framework of temporal evolution and spatial equilibrium of green development was constructed and applied in 11 provinces (cities) of China's Yangtze River Economic Belt (YEB) from 2009 to 2018. The results show that during the study period, the green development level of YEB has improved year by year, but there was still a large gap. Among the 120 research samples, only 41.7% had a ranking score of more than 6, and only Chongqing in 2017 had a ranking score of more than 8. The Gini coefficient of green development in 11 provinces (cities) is about 0.2, which is balanced on the whole, but there is a significant difference in the indicators, such as proportion of new energy power generation, sulfur dioxide emission per 104 RMB yuan GDP and proportion of investment in environmental protection; The effect of energy conservation and emission reduction is obvious, while efficiency increase and harmony need to be improved. The complementary role of 11 provinces (cities) in YEB's green development has become increasingly prominent, which made that YEB (as a whole) ranked second in comparison with 11 provinces (cities) in 2018.

Study of Hospitalization Costs in Patients with Cerebral Ischemia Based on E-CHAID Algorithm.

Background The aging of the population has led to a rapid increase in the prevalence of most neurological diseases between 1990 and 2016, with a growth rate of up to 117%, which has put enormous pressure on medical insurance funds. As one of the core diseases of disease diagnosis grouping, the hospitalization cost composition and grouping research of patients with cerebral ischemic disease can help to determine scientific payment standards and reduce the economic burden of patients. Aim We aimed to understand the cost composition and influencing factors of hospitalized patients with cerebral ischemic diseases and to identify a reasonable cost grouping scheme. Methods The data come from the homepage of medical records of inpatients with cerebral ischemia in a tertiary hospital in Sichuan Province from 2018 to 2020. After cleaning the data, a total of 5,204 pieces of data were obtained. Nonparametric tests and gamma regression models were used to explore the influencing factors of hospitalization costs. Taking the influencing factors as the predictor variables and the hospitalization cost as the target variable, the exhaustive Chi-squared automatic interaction detector (E-CHAID) algorithm was used to form the costs grouping, and the payment standard of the hospitalization cost for each group was determined. The rationality of cost grouping was evaluated by coefficient of variation (CV) and Kruskal–Wallis H test. Results From 2018 to 2020, the average hospital stay of 5,204 inpatients with cerebral ischemic disease was 10.70 days, and the average hospitalization cost was 17,206.09 RMB yuan. Among the hospitalization costs, diagnosis costs and drug costs accounted for the highest proportion, accounting for 41.18% and 22.38%, respectively, in 2020. Gender, age, admission route, comorbidities and complications, super length of stay (>30 days), and discharge mode had significant effects on hospitalization costs (P < 0.05). Patients were divided into 10 cost groups, and the grouping nodes included comorbidities and complications, discharge mode, age, gender, and admission route. The CV of 9 of the 10 cost groups is less than or equal to 1. The Kruskal–Wallis H test showed that the difference between groups was statistically significant (P < 0.05). Conclusion The cost grouping of patients with cerebral ischemic diseases based on the E-CHAID algorithm is reasonable. This study examined the effects of super length of stay (>30 days), comorbidities and complications, and age on hospitalization cost in patients with cerebral ischemic disease. This study can provide a theoretical basis for advancing the China Healthcare Security Diagnosis Related Groups (CHS-DRG) grouping program and medical expense payment, thereby reducing the disease burden of patients.

The environmental, nutritional, and economic benefits of rice-aquaculture animal coculture in China

Traditional rice monoculture is often energy-inefficient because of the large amount of non-renewable energy investment, and leads to negative environmental impacts. This study conducted a joint economic, energy, and life-cycle assessment (LCA) to obtain a comprehensive understanding of the economic and environmental sustainability of rice monoculture (RM), rice-crayfish coculture (RC), rice-loach coculture (RL), and rice-catfish coculture (RA). Economic analysis showed that the total profit of RM was 20,496 ¥ ha−1, while this increased by 172.3%–345.5% in coculture modes. Energy analysis showed that RM outperformed the coculture modes in net energy and energy use efficiency. LCA showed that the environmental footprint varied depending on the functional unit. The coculture modes had a larger environmental footprint than RM, on a per hectare basis across at least six of ten impact categories. The higher nutrition and economic profits meant that the coculture modes had a lower impact per nutrient density unit, and lower impact per RMB yuan across all ten impact categories compared with RM. These findings show that although the energy efficiency of the coculture mode was lower than RM, it showed promise due to its diverse foods with higher nutrition, increased economic benefits, and lower environmental impact.

A survey on work status and competencies of Clinical Research Nurses in China.

The clinical trials industry in China has enjoyed robust growth; the demand for qualified personnel to conduct clinical trials with higher quality has increased. The Clinical Research Nurse has emerged as a new workforce in China. This study aimed to examine the current work status of Clinical Research Nurses in China and to investigate their competencies in knowledge and behavior associated with this profession. An online survey was analyzed. The current work status of Clinical Research Nurses in China was characterized. In addition, their competencies were self-assessed across nine competency categories and the "contribution to science" domain, based on the International Association of Clinical Research Nurses Scope and Standards of Practice. A total of 638 eligible questionnaires were included in the final analysis. Of whom, 98.28% (627/638) were females. The mean age was 35 years (range: 22-64 years). Over 80% of whom were working at the largest Chinese cities and the majority (78.2%) held a Bachelor's degree in nursing. The average time of clinical research experience was 5.67 years. Three quarters of the 638 had an annual income of <150,000 Yuan RMB. The average weekly working time was 45.46 h; clinical trial-related work accounted for 62.68% of their workload. There were some gaps between the Clinical Research Nurses' self-assessed competencies in knowledge and behavior, with the widest gaps along the ethical principles, leadership and professional development, protocol compliance, and document management categories. This is the first large-scale survey of Clinical Research Nurses in China. Our results profile this emerging workforce as a population of young, moderately trained/experienced, predominantly female nurses working in the largest Chinese cities. They performed well on most knowledge/behavior parameters; still, gaps exist. Therefore, there is a pressing need to enhance professional education and training for Clinical Research Nurses in China.

Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.

ObjectiveTo determine the cost effectiveness of molecular monitoring in patients with chronic myeloid leukemia in the chronic phase (CML-CP) compared to no molecular monitoring from a Chinese payer perspective.MethodsAnalyses were conducted using a semi-Markov model with a 50-year time horizon. Population data from multicenter registry-based studies of Chinese patients with CML-CP informed the model. Transition probabilities were based on time-to-event data from the literature. Utility values were obtained from published studies and were assumed to be the same for patients with and without molecular monitoring. Costs were based on values commonly used in the Chinese healthcare system, including drug acquisition, drug administration, follow-up, treatment for disease progression, molecular monitoring, and terminal care costs, and were in the local currency (2020 Chinese Yuan RMB [¥]). Outcomes were total life-years (LYs) and quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio.ResultsMolecular monitoring was dominant to no molecular monitoring, with increased LYs (1.52) and QALYs (1.90) and costs savings (¥93,840) over a lifetime compared to no monitoring in discounted analyses. The opportunity of patients that receive molecular monitoring to discontinue treatment during treatment-free remission, an opportunity not afforded to those without molecular monitoring, was the principle driver of this result. Results were similar across multiple clinical scenarios. Particularly, molecular monitoring remained dominant even if the proportion of patients achieving deep molecular response (DMR) was reduced by 10%-30%, or the proportion of patients maintaining DMR for 1 year was reduced by 10%-30% or increased by 10%. Cost savings in these scenarios ranged from ¥62,230 to ¥103,964.ConclusionsOverall, this analysis demonstrates that adherence to guideline recommendations of regular molecular monitoring of patients with CML-CP treated with TKIs provides significant clinical benefit that leads to substantial cost savings compared to no molecular monitoring from the perspective of a Chinese payer. In a time where healthcare systems have limited resources to allocate to optimal patient care, investment in molecular monitoring is an ideal choice for improving patient benefits at a reduced cost.

Cost-benefit analysis of the hepatitis B vaccination to prevent mother-to-child transmission strategies in China, 1992-2019

Objective: To make a cost-benefit analysis of the hepatitis B vaccination (HepB) to prevent mother-to-child transmission (PMTCT) strategies in China, 1992-2019. Methods: We built a decision analytic-Markov model to estimate the birth cohorts of 1992-2019. The parameters in our model were referred from literature, published yearbooks, and data from Chinese Center for Disease Control and Prevention. We conducted a univariate sensitivity analysis to test the robustness of the model. Results: For the 28 birth cohorts, the Chinese government has invested 37.43 billion RMB Yuan in direct costs and 47.61 billion RMB Yuan in societal costs on HepB vaccination and HBV prevention of mother to child transmission (PMTCT). And we estimated that about 50 million chronic HBV infections and 12.5 million premature deaths due to HBV-related diseases would be averted. China would save 2.89 trillion RMB Yuan and 6.92 trillion RMB Yuan for the direct and societal medical burden on HBV-related conditions. The direct and societal net benefit was 2.85 trillion RMB yuan 6.87 trillion RMB yuan, respectively. The direct and societal benefit-cost ratios (BCRs) were 77.21 and 145.29, respectively. Conclusion: The strategies of HepB vaccination for HBV PMTCT prevention were cost-effective in China during 1992-2019.

Epidemiological characteristic of newly reported HIV/AIDS cases with non-martial and non-commercial heterosexual behaviors in Zhejiang province, 2017-2019

Objective: To understand the epidemiological characteristics and transmission routes of newly reported HIV/AIDS cases with non-martial and non-commercial (NMNC) heterosexual behaviors in Zhejiang province. Methods: A retrospective survey was conducted among HIV/AIDS cases that had NMNC heterosexual behavior history and diagnosed with HIV infection in Zhejiang between January 1st, 2017 and September 30th, 2019. The multiple correspondence analysis (MCA) was used to explore the association of social demographic characteristics with NMNC heterosexual partner types in the cases. Results: A total of 406 participants with NMNC heterosexual behaviors before HIV diagnoses were recruited in this study. Most of them were males (67.2%, 273/406), aged 25-49 years at HIV diagnoses (59.1%, 240/406). Prior to HIV infection confirmation, 36.0% (146/406) participants only had casual sexual partners, 52.0% (211/406) only had regular sexual partners, and 12.0% (49/406) had both. Statistical differences in marital status, occupation and income level were found among participants with different types of NMNC heterosexual partners (all P<0.05). Result of MCA indicted that monthly income ≤3 000 yuan RMB, self-employed, being married were only associated with casual NMNC heterosexual partner; working in service industry, education level of junior high school were only associated with regular heterosexual partner; working in enterprise, high school education level or above, monthly income ≥5 000 yuan RMB were associated with both casual and regular sexual partner. Conclusion: The HIV/AIDS cases with NMNC heterosexual behaviors before HIV diagnoses accounted for a large proportion in Zhejiang province during 2017-2019. Active intervention efforts should be made to improve the health awareness of the public to reduce the risk behaviors for HIV transmission.