Substantial Regional Differences Research Articles

Regionalization of environmental and economic performances of rainwater harvesting systems

Study regionBeijing Region Study focusLimited studies have yet been done on regionalization of multi-performances of rainwater harvesting systems (RHS). In this study, the daily rainfall records from 77 stations are used, and a hydro-economic model is adopted to examine regional water saving, stormwater control and economic performances of RHS by proposing a regionalization approach. New hydrological insights for the regionHigher water saving efficiency (WSE) and reliability (R) of RHS are linked with lower water demand, larger tank size and greater rainfall conditions. Differently, higher stormwater capture efficiency (SCE) is related to higher water demand, larger tank size and lower rainfall. The WSE and R of RHS demonstrate substantial regional differences; their maximized obtainable values closely depend on water demand scenarios and range from 9% to 99%, with smaller values in western mountain area but larger values in northeast suburban and central urban areas. The maximum obtainable values of SCE range from 61% to 100%, with higher values in western mountain area, but lower values in northeast suburban and central urban areas. A 10 m3 tank size can provide the highest benefit-cost ratio of RHS across the Beijing region. The regionalization approach proposed is a useful guidance for the implementation of RHS and sustainable urban water management, and thus it has the potential for wide uses in other regions with high rainfall gradients.

Regional practice variation in hysterectomy and the implementation of less invasive surgical procedures: A register-based study in the Netherlands.

Many women experience bleeding disorders that may have an anatomical or unexplained origin. Although hysterectomy is the most definitive and common treatment, it is highly invasive and resource-intensive. Less invasive therapies are therefore advised before hysterectomy for women with fibroids or bleeding disorders. This study has two aims related to treating bleeding disorders and uterine fibroids in the Netherlands: (1) to evaluate the regional variations in prevalence and surgical approaches; and (2) to assess the associations between regional rates of hysterectomies and less invasive surgical techniques to analyze whether hysterectomy can be replaced in routine practice. We completed a register-based study of claims data for bleeding disorders and fibroids in women between 2016 and 2020 using data from Statistics Netherlands for case-mix adjustment. Crude and case-mix adjusted regional hysterectomy rates were examined overall and by surgical approach. Coefficients of variation were used to measure regional variation and regression analyses were used to evaluate the association between hysterectomy and less invasive procedure rates across regions. Overall, 14 186 and 8821 hysterectomies were performed for bleeding disorders and fibroids, respectively. Laparoscopic approaches predominated (bleeding disorders 65%, fibroids 49%), followed by vaginal (bleeding disorders 24%, fibroids 5%) and abdominal (bleeding disorders 11%, fibroids 46%) approaches. Substantial regional differences were noted in both hysterectomy rates and the surgical approaches. For bleeding disorders, regional hysterectomy rates were positively associated with endometrial ablation rates (β = 0.11; P = 0.21) and therapeutic hysteroscopy rates (β = 0.14; P = 0.31). For fibroids, regional hysterectomy rates were positively associated with therapeutic hysteroscopy rates (β = 0.10; P = 0.34) and negatively associated with both embolization rates (β = -0.08; P = 0.08) and myomectomy rates (β = -0.03; P = 0.82). Regional variation exists in the rates of hysterectomy and minimally invasive techniques. The absence of a significant substitution effect provides no clear evidence that minimally invasive techniques have replaced hysterectomy in clinical practice. However, although the result was not significant, embolization could be an exception based on its stronger negative association.

A lost land of opportunity? The geography of intergenerational educational mobility in China

AbstractDespite the significant political, economic and geographical diversity in China, there is limited research on spatial differences in intergenerational mobility in China. This research aims to fill this gap by exploring the spatial and temporal dimensions of intergenerational educational mobility in China. The data used for the analysis is the 2010–2018 China Family Panel Studies (CFPS), a nationally representative longitudinal general social survey. The analysis incorporates both relative and absolute mobility measures to provide a comprehensive description of intergenerational educational mobility. The results reveal substantial regional differences in intergenerational educational mobility across various economic zones in China, with a rising geographic inequality over time. The southwest and northeast regions stand out as the areas where the educational prospects of the young generation have become not only bleaker but dependent more on their parents. Additionally, this study presents the first education Great Gatsby Curve for China, highlighting the strong relationship between intergenerational mobility and education inequality at the regional level, particularly after China's market reform. The findings highlight the need for regionally targeted policies and levelling up agendas to promote educational opportunities in low‐mobility regions.

Evaluation and spatial convergence of carbon emission reduction efficiency in China's power industry: Based on a three-stage DEA model with game cross-efficiency

Reducing carbon emissions is essential for achieving sustainable development in China. In this study, we developed a framework for measuring carbon emission reduction considering both thermal power and clean energy generation perspectives. Subsequently, we constructed a three-stage data envelopment analysis (DEA) model with game cross-efficiency to eliminate the influence of external environmental factors, random factors, and regional competition. Thereafter, we calculated the carbon emission reduction efficiencies (CEREs) of the power industries of 30 provinces in China from 2010 to 2020. Based on this, we conducted temporal and spatial analyses of the carbon emission reduction amount (CERA), evaluated CERE, compared different DEA models, and assessed spatial convergence effects. The evaluation results of CERE across 30 provinces, cities, and autonomous regions in China showed that: (1) although China's CERA increased, substantial regional differences exist in the carbon emission reduction structure. (2) The overall average CERE ranged from 0.485 to 0.737. Since 2016, the highest CERE values have been observed in southwest China, followed by the eastern coastal and central regions, while the northwestern region experienced notable fluctuations. (3) The three-stage DEA model with game cross-efficiency, which eliminates the influence of competition and external environmental factors, can be used to accurately measure CERE. (4) CERE has a spatial convergence effect on China's power industry and is promoted by energy structure, upgrading of industrial structure and government interventions. These findings provide important insights for optimizing the carbon emissions reduction structure and improving CERE.

Incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infection in European hospitals: the COMBACTE-NET ARTHR-IS multi-centre study

The aim of this study was to estimate the incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infections (SA-PJI) after primary hip and knee arthroplasty in European centres. This study was conducted in patients who underwent primary hip and knee arthroplasty in 19 European hospitals between 2014 and 2016. The global incidence of PJI and SA-PJI was calculated. The associated disease burden was measured indirectly as infection-related mortality plus loss of function. For healthcare utilization, number and duration of hospitalizations, number and type of surgical procedures, duration of antibiotic treatments, and number of outpatient visits were collected. Subgroup and regression analyses were used to evaluate the impact of SA-PJI on healthcare utilization, controlling for confounding variables. The incidence of PJI caused by any micro-organism was 1.41%, and 0.40% for SA-PJI. Among SA-PJI, 20.7% were due to MRSA with substantial regional differences, and were more frequent in partial hip arthroplasty (PHA). Related deaths and loss of function occurred in 7.0% and 10.2% of SA-PJI cases, respectively, and were higher in patients with PHA. Compared with patients without PJI, patients with SA-PJI had a mean of 1.4 more readmissions, 25.1 more days of hospitalization, underwent 1.8 more surgical procedures, and had 5.4 more outpatient visits, controlling for confounding variables. Healthcare utilization was higher in patients who failed surgical treatment of SA-PJI. This study confirmed that the SA-PJI burden is high, especially in PHA, and provided a solid basis for planning interventions to prevent SA-PJI.

When the available blood supply mismatches the needs of the patient.

Substantial regional differences in the genetic patterns related to blood group have been observed across different continents. This diversity means that the blood supply, as an essential part of patient care, is increasingly impacted by global migration. Consequently, the Austrian blood donor population does not match the immigrant patient population. This mismatch is likely to result in the formation of alloantibodies to red cell antigens in the chronically transfused. Subsequently, major difficulties in providing compatible blood emerge. The study included patients of African origin (n=290) and Caucasians who represent the Austrian donor population (n=1,017). Genetic typing was performed for up to 69 blood group polymorphisms with a multiplex sequence specific primer-PCR including high frequency antigens and antigens for which antisera are not commercially available. By assessing differences in antigen frequencies between the two populations, and using these data for prophylactic matching, we aim to develop tools to increase the quality of patient care. Results indicate various and significant differences (p<0.0001) in antigen frequencies between African patients and the European donor population, especially in the MNS, Duffy, Knops and Rhesus systems. Our data highlight the importance of matching the donor population to the demographics of the patient population. In addition, it underlines the need to recruit donors of African origin and to focus on the upcoming challenges, such as malaria semi-immunity and a significantly higher rate of infectious disease in this population. It is also recommended to apply extended genetic typing to detect rare blood types, and (cryo)storage of rare blood in national and international rare blood banks. Co-operation with regional blood banks should also be encouraged.

Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts

Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17-49 ml/min) and 3 pediatric cohorts (median eGFR range of 26-45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7-6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%-44% across cohorts). There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations.

Trends in arts education in United States public schools from 1988–2018

There is scant evidence on the level of arts education available in U.S. public schools and how this has changed over time. In this paper, I present new evidence on broad trends in arts education in U.S. public schools from 1988 through 2018 using nationally representative data from the Schools and Staffing Survey (SASS) and the National Teachers and Principals Survey (NTPS) and administrative data from North Carolina. Both the SASS/NTPS and North Carolina data cover several school years after the Every Student Succeeds Act was passed in 2015, which may have impacted arts education. I first calculate the percentage of full-time teachers whose main teaching assignment is in the arts. In the aggregate, about 5.5% of public school teachers are arts teachers, and this has been stable for decades. There are substantial regional differences that have also changed little. I also find substantial and persistent differences by school characteristics: Schools with higher percentages of both Black, Indigenous, and people of color (BIPOC) and low-income students consistently have a lower percentage of full-time arts teachers than other schools. I also examine of school-level and student-level trends in arts access using administrative data from North Carolina from 1998–2013. I find narrowing gaps in the presence of licensed art teachers between low-performing schools and other schools, and high-BIPOC schools and other schools. I also assess access to the arts at the student level from 2007–2018. I find narrowing gaps in arts enrollment between White students and Black and Hispanic students, consistent with the school-level trends I report. This descriptive evidence from both national and North Carolina data improves our understanding of how arts have been prioritized by schools in recent decades and highlights gaps in access students have had to the arts over time.

Standard practice in the treatment of unstable pelvic ring injuries: an international survey

PurposeUnstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe.MethodsA standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents).ResultsThe Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization).ConclusionThe Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences’ impact on outcomes needs to be further explored.

Trends in mortality rates from chronic forms of coronary heart disease in the regions of the Russian Federation in 2017–2021

Objective. To assess the trend and variability of standardized mortality ratios (SMRs) from chronic forms of coronary heart disease (CHD) in the regions of the Russian Federation (RF) in 2017–2021. Material and methods. The investigation used the 2017–21 Russian Federal State Statistics Service (RFSS) data on the average annual population and the number of deaths in the one-year age groups in 82 RF regions on the basis of the RFSS “Brief Death Cause Nomenclature” (BDCN). The SMRs were calculated on the basis of the European standard per 100,000 population for each region; then the average regional SMRs related to the chronic forms of CHD were determined using 4 BDCN accounting lines. Results. For the period from 2017 to 2019, a decrease was noted in the average regional SMRs from all forms of CHD (from 183.9±68.5 to 176.8±65.3 cases per 100,000 population), but in 2020 and 2021, an increase was recorded in SMRs from CHD (204.3±75.4 and 207.4±76.9 cases per 100,000 population, respectively) as the proportion of these causes decreased in the structure of all-cause mortality in the COVID-19 pandemic period (18.4±7.1% in 2017 and 15.8±5.4% in 2021). there was a decrease in the average regional SMRs from all forms of chronic heart diseases (CHD) (from 183.9±68.5 to 176.8±65.3 cases per 100,000 population), but in 2020 and 2021, an increase in the SMRs from CCHD (204.3±75.4 and 207.4±76.9 cases per 100,000 population, respectively) hand in hand with a reduction in the proportion of these causes in the COVID-19 pandemic period (18.4±7.1% in 2017 and 15.8±5.4% in 2021). Results. For the period from 2017 to 2019, over a 5-year period, an annual consistent decrease was recorded in the SMR from CHD in none Russia’s regions; their annual rise was seen in 4 regions; whereas an unstable trend was noted with a decrease and a rise in SMRs in the others. There was a considerable interregional variability of SMRs from all forms of CHD (in 2017, the maximal SMR differed from the minimal one by 60 times) and from individual forms of CHD (in 2020, the regional minimum and maximum SMRs from I25.1 differed by 500 times). The paper presents hypotheses about the causes of the revealed differences and proposals to modify the accounting of deaths from CHD. Conclusion. There were substantial regional differences with an unstable 5-year trend in SMRs from CHD in the entire and individual accounting forms included in this group in accordance with the ICD. The fact that there are no unified criteria for and approaches to identifying the individual forms of CHD as the main cause of death, including that in the presence of multimorbid pathology complicates understanding the causes of death.

Revisiting metropolitan house price-income relationships

We explore long-term patterns of the house price-income relationship across the 70 largest U.S. metropolitan areas. In line with a standard spatial equilibrium model, our empirical findings indicate that regional house price-income ratios are typically not stable, even over the long run. In contrast, panel regression models that relate house prices to aggregate personal income and allow for regional heterogeneity yield stationary long-term relationships in most areas. The house price-income relationship varies significantly across locations, underscoring the importance of using estimation techniques that allow for spatial heterogeneity. The substantial regional differences are closely related to the elasticity of housing supply.

Geographic differences in patients with acute myocardial infarction in the PARADISE-MI trial.

The globalization of clinical trials has highlighted geographic differences in patient characteristics, treatments, and outcomes. We examined these differences in PARADISE-MI. Overall, 23.0% were randomized in Eastern Europe/Russia, 17.5% in Western Europe, 12.2% in Southern Europe, 10.1% in Northern Europe, 12.0% in Latin America (LA), 9.3% in North America (NA), 10.0% in East/South-East Asia and 5.8% in South Asia (SA). Those from Asia, particularly SA, were different from patients enrolled in the other regions, being younger and thinner. They also differed in terms of comorbidities (high prevalence of diabetes and low prevalence of atrial fibrillation), type of myocardial infarction (more often ST-elevation myocardial infarction), and treatment (low rate of primary percutaneous coronary intervention). By contrast, patients from LA did not differ meaningfully from those randomized in Europe or NA. Use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (34.8%) and beta-blockers (65.5%) was low in SA, whereas mineralocorticoid receptor antagonist use was lowest in NA (22%) and highest in Eastern Europe/Russia (53%). Rates of the primary composite outcome of cardiovascular death or incident heart failure varied two-fold among regions, with the lowest rate in SA (4.6/100 person-years) and the highest in LA (9.2/100 person-years). Rates of incident heart failure varied almost six-fold among regions, with the lowest rate in SA (1.0/100 person-years) and the highest in Northern Europe (5.9/100 person-years). The effect of sacubitril/valsartan was not modified by region. In PARADISE-MI, there were substantial regional differences in patient characteristics, treatments and outcomes. Although the generalizability of these findings to a 'real-world' unselected population may be limited, these findings underscore the importance of considering both regional and within-region differences when designing global clinical trials.

Joint modelling of systolic and diastolic blood pressure and its associated factors among women in Ghana: Multivariate response multilevel modelling methods.

Elevated blood pressure is the leading cause of cardiovascular diseases related mortality and a major contributor to non-communicable diseases globally, especially in sub-Saharan Africa where about 74.7 million people live with hypertension. In Ghana, hypertension is epidemic with prevalence of over 30% and experiencing continuing burden with its associated morbidity and mortality. Using the 2014 Ghana Demographic and Health Survey, we analyzed data on 4744 women aged 15-49 years residing in 3722 households. We employed univariate and multivariate response multilevel linear regression models to analyze predictors of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Geospatial maps were produced to show the regional distribution of hypertension prevalence in Ghana. Stata version 17 and R version 4.2.1 were used to analyze the data. Of the 4744 woman, 337 (7.1%) and 484 (10.2%) were found to be hypertensive on SBP and DBP, respectively. A combined prevalence of 12.3% was found. Older ages 25-34 (OR 2.45, 95%CI: 1.27, 3.63), 35-44 (OR 8.72, 95%CI: 7.43, 10.01), 45-49 (OR 15.85, 95%CI: 14.07, 17.64), being obese (OR 5.10, 95%CI: 3.62, 6.58), and having no education (OR -2.05, 95%CI: -3.40, -0.71) were associated with SBP. For DBP, we found the associated factors to be older ages 25-34 (OR 3.29, 95%CI: 2.50, 4.08), 35-44 (OR 6.78, 95%CI: 5.91, 7.64), 45-49 (OR 10.05, 95%CI: 8.85, 11.25), being obese (OR 4.20, 95%CI: 3.21, 5.19), and having no education (OR -1.23, 95%CI: -2.14, -0.33). Substantial residual household level differences in SBP (15%) and DBP (14%) were observed. We found strong residual correlation of SBP and DBP on individual women (r = 0.73) and household-level (r = 0.81). The geospatial maps showed substantial regional differences in the observed and reported hypertension prevalence. Interventions should be targeted at the identified high-risk groups like older age groups and those who are obese, and the high-risk regions.

Resilience of international trade to typhoon-related supply disruptions

Shipping accidents and environmental disasters pose a challenge to the reliability of maritime supply chains. Since international trade intensifies without a significant diversification of the supply routes the risk of transportation perturbations caused by extreme events like tropical cyclones may increase conceivably. In this study we model the regional and global economic repercussions of typhoon-induced short-term transport disruptions of West Pacific trading routes. Using a numerical agent-based shock model with myopic local optimization, we compute the response of more than 7,000 regional economic sectors with more than 1.8 million trade and supply relations. We compute that transportation perturbations, due to West Pacific typhoons between 2000–2020, may cause local oversupply and scarcity situations as well as the associated regional price changes. In our model economic agents respond to these price signals and temporary supply bottlenecks by rescheduling and increasing their demand. As a consequence from our numerical analysis, we find annual median export volume to increase in all trade blocs due to a decrease of export prices, but substantial regional differences emerge. Further we show that resilience of export to typhoon-induced perturbations increase in China, ASEAN, East Asia, and Europe within the first 16 years of this century. We trace this back to a rise of the inter-connectivity of these trade blocs to their foreign trade partners.

Assessment of Top of Atmosphere, Atmospheric and Surface Energy Budgets in CMIP6 Models on Regional Scales

AbstractWe examine top of atmosphere (TOA), atmospheric, and surface energy budget components of 53 CMIP6 models for the period 2000–2009 on regional scales with respect to two reference data sets: the NASA Energy and Water cycle Study (NEWS), from which we adopt the regional decomposition, and the Clouds and the Earth's Radiant Energy System (CERES) Energy Balanced and Filled (EBAF). Focusing on regional scale, CMIP6 models tend to have more energy entering or less energy leaving the climate systems at TOA over the Northern Hemisphere land, Southern Hemisphere ocean and the polar regions compared to CERES EBAF, while the contrary applies in other regions. Atmospheric net shortwave and longwave fluxes both tend to be underestimated in CMIP6 models as compared to EBAF, with substantial regional differences. Regional surface radiative fluxes as reported by NEWS and EBAF can differ substantially. Nevertheless, robust regional biases exist in CMIP6. Surface upward shortwave radiation is overestimated by 43 (81%) models over Eurasia. For almost all surface radiative flux components over the North Atlantic and Indian Ocean, there are at least 21 (40%) models which fall outside the NEWS uncertainty range. Latent heat flux is overestimated over most of the land and ocean regions while firm conclusions for sensible heat flux remain elusive due to discrepancies between different reference data sets. Compared to CMIP5, there is an overall improvement in CMIP6 on regional scale. Still, substantial deficiencies and spreads on regional scale remain, which are potentially translated into an inadequate simulation of atmospheric dynamics or hydrological cycle.

Diagnosis and treatment of meralgia paresthetica between 2005 and 2018: a national cohort study

The prevalence of meralgia paresthetica (MP), which is caused by compression of the lateral femoral cutaneous nerve (LFCN), has been increasing over recent decades. Since guidelines and large-scale studies are lacking, there are substantial regional differences in diagnostics and management in MP care. Our study aims to report on current diagnostic and therapeutic strategies as well as time trends in clinical MP management in Germany. Patients hospitalized in Germany between January 1, 2005, and December 31, 2018, with MP as their primary diagnosis were identified using the International Classification of Disease (ICD-10) code G57.1 and standardized operations and procedures codes (OPS). A total of 5828 patients with MP were included. The rate of imaging studies increased from 44% in 2005 to 79% in 2018 (p < 0.001) and that of non-imaging diagnostic studies from 70 to 93% (p < 0.001). Among non-imaging diagnostics, the rates of evoked potentials and neurography increased from 20%/16% in 2005 to 36%/23% in 2018 (p < 0.001, respectively). Rates of surgical procedures for MP decreased from 53 to 37% (p < 0.001), while rates of non-surgical procedures increased from 23 to 30% (p < 0.001). The most frequent surgical interventions were decompressive procedures at a mean annual rate of 29% (± 5) throughout the study period, compared to a mean annual rate of 5% (± 2) for nerve transection procedures. Between 2005 and 2018, in-hospital MP care in Germany underwent significant changes. The rates of imaging, evoked potentials, neurography, and non-surgical management increased. The decompression of the LFCN was substantially more frequent than that of the LFCN transection, yet both types of intervention showed a substantial decrease in in-hospital prevalence over time.

Aging Industries in the Regional Economy: How to Support an Aging China?

This study investigates the law, distribution characteristics, and changing trend of the coordinated development of China’s aging industry and regional economy, as well as the factors which influence the degree of coordination between the aging industry and economic development on the provincial level. In doing so, we construct a comprehensive evaluation index system of the aging industry and regional economy development, introduce an entropy weight coupling model, and measure the coupling and coordinated development level of the two systems using data of 31 selected Chinese provinces (municipalities) from 2009 to 2019. The spatial Dubin model is then used to empirically analyze the influencing factors and spatial effect decomposition of the coordinated development of the aging industry and regional economy. We reach the following main results: (1) China’s aging industry is developing unevenly, with substantial regional differences, but these differences have narrowed in recent years. (2) China’s regional economic disparities have widened. The eastern regions have the highest level of development, while the northeast region’s growth rate of GDP has declined since 2014. (3) The coordinated development of the aging industry and regional economy in one region of China has a positive impact on its neighboring regions, and all Chinese regions exhibits high–high, low–low agglomeration characteristics in terms of their degree of coordination. (4) A variety of socioeconomic and demographic factors affect the coordinated development of the aging industry and regional economy. An important implication of these findings is that, China should improve population structure, population quality, and economic development quality in order to achieve a high-level coordinated development of the aging industry and regional economy.

Abstract 14610: Geographic Differences Among Patients With Acute Myocardial Infarction in the PARADISE-MI Trial

Introduction: The globalization of clinical trials has highlighted geographic differences in patient characteristics, treatments and outcomes, but there are few data on those with high-risk acute MI. We examined these differences in PARADISE-MI, the most globally representative trial in high-risk MI patients to date Methods: PARADISE-MI enrolled 5661 patients with an acute MI complicated by left ventricular dysfunction and/or pulmonary congestion; 23.0% were randomized in Eastern Europe/Russia (EER), 17.5% Western Europe, 12.2% Southern Europe, 10.1% Northern Europe (NE), 12.0% Latin America (LA), 9.3% North America (NA), 10.0% East/South-East Asia, 5.8% South Asia (SA) Results: Those from Asia, particularly SA, were notably different from patients enrolled in the other regions - they were younger, thinner and had a different pattern of comorbidities (high prevalence of diabetes despite lower BMI, and very low prevalence of AF), type of MI (more often STEMI) and treatment (low rate of primary PCI). By contrast, the characteristics of patients from LA did not differ meaningfully from those in Europe or NA. Use of ACEi/ARB (34.8%) and beta-blockers (65.5%) was remarkably low in SA, whereas MRA use was lowest in NA (21.8%) compared with the highest rate (53.0%) in EER. Rates of the primary composite outcome of cardiovascular death or incident HF varied two-fold among regions with the lowest rate in SA (4.6 / 100 person-years [PY]) and the highest in LA (9.2 / 100 PY). Strikingly, rates of incident HF varied almost six-fold among regions with the lowest rate in SA (1.0 /100 PY) and the highest in NE (5.9 /100 PY). Conversely, the rate of death from any cause varied about two-fold among regions (Figure) with the lowest rate in NA (2.4 /100 PY) and the highest in LA (5.3 / 100 PY) although the rate in the other six regions differed little (range 3.9 to 4.7 / 100 PY) Conclusion: In PARADISE-MI, there were substantial regional differences in patient characteristics, treatments and outcomes

Segmentation-guided Denoising Network for Low-dose CT Imaging

Background: To reduce radiation exposure and improve diagnosis in low-dose computed tomography, several deep learning (DL)-based image denoising methods have been proposed to suppress noise and artifacts over the past few years. However, most of them seek an objective data distribution approximating the gold standard and neglect structural semantic preservation. Moreover, the numerical response in CT images presents substantial regional anatomical differences among tissues in terms of X-ray absorbency. Methods: In this paper, we introduce structural semantic information for low-dose CT imaging. First, the regional segmentation prior to low-dose CT can guide the denoising process. Second the structural semantical results can be considered as evaluation metrics on the estimated normal-dose CT images. Then, a semantic feature transform is engaged to combine the semantic and image features on a semantic fusion module. In addition, the structural semantic loss function is introduced to measure the segmentation difference. Results: Experiments are conducted on clinical abdomen data obtained from a clinical hospital, and the semantic labels consist of subcutaneous fat, muscle and visceral fat associated with body physical evaluation. Compared with other DL-based methods, the proposed method achieves better performance on quantitative metrics and better semantic evaluation. Conclusions: The quantitative experimental results demonstrate the promising performance of the proposed methods in noise reduction and structural semantic preservation. While, the proposed method may suffer from several limitations on abnormalities, unknown noise and different manufacturers. In the future, the proposed method will be further explored, and wider applications in PET/CT and PET/MR will be sought.

Cervical cancer rates in relation to the Roma population distribution in Slovakia in 2013 – 2020

Abstract Background Globally, more than 300 000 women die due to cervical cancer (CC) each year despite its high preventability and treatability in its early stages. This study aimed to analyse CC rates at the regional level in Slovakia from 2013 to 2020 in relation to the distribution of the Roma population. Methods An ecological study was conducted using data obtained from the relevant national and regional authorities in Slovakia. Mortality, incidence, precancerous lesions incidence and the number of colposcopy and oncocytology examinations per 100 000 females 15 years and older were calculated. Linear regression models were performed in the R Project to assess associations between the rates and the estimated percentage of the Roma population at the regional level after adjusting for the unemployment, at-risk-of-poverty rate, and average disposable household income per month. Results CC mortality in Slovakia declined from 10.0 in 2013 to 7.1/100 000 in 2020 (p &amp;lt; 0.05). Average mortality ranged from 5.9 in the Presov region to 10.7 in Kosice. Incidence varied from 108 in 2019 to 160/100 000 in 2017, with the highest average rates in Bratislava and the lowest in Banska Bystrica (194 and 89/100 000). Precancerous lesions incidence rates significantly differed between the regions (400 in Kosice, 984/100 000 in Trnava). The average colposcopy and oncocytology examinations rates were found to be lower in Presov (177 and 226) and Kosice (166 and 223) compared to the other regions (318 and 283/100 000 on average). After adjusting for the selected factors, CC mortality (p &amp;lt; 0.05), incidence (p &amp;lt; 0.05) and both preventive examination rates (p &amp;lt; 0.01) were statistically significantly associated with the percentage of the Roma population. Conclusions Substantial differences in CC rates and preventive examinations were identified at the regional level in Slovakia. To eliminate CC in line with the WHO Global Strategy, suitable approaches to reaching those at the highest risk should be implemented. Key messages • Substantial regional differences in preventive examination and cervical cancer incidence and mortality rates were identified in Slovakia in relation to the distribution of the Roma population. • Strategies to eliminate cervical cancer should be adjusted to the regional differences and seek alternative approaches for implementing screening in hard-to-reach communities at the highest risk.