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Background: The Acarbose Cardiovascular Evaluation (ACE) trial (ISRCTN91899513) evaluated the alpha‐glucosidase inhibitor acarbose, compared with placebo, in 6522 patients with coronary heart disease and impaired glucose tolerance in China and showed a reduced incidence of diabetes. We assessed the within‐trial medical resource use and costs, and quality‐adjusted life years (QALYs). Methods: Resource use data were collected prospectively within the ACE trial. Hospitalizations, medications, and outpatient visits were valued using Chinese unit costs. Medication use was measured in drug days, with cardiovascular and diabetes drugs summed across the trial by participant. Health‐related quality of life was captured using the EuroQol‐5 Dimension‐3 Level questionnaire. Regression analyses were used to compare resource use, costs, and QALYs, accounting for regional variation. Costs and QALYs were discounted at 3% yearly. Results: Hospitalizations were 6% higher in the acarbose arm during the trial (rate ratio 1.06, p =.009), but there were no significant differences in total inpatient days (rate ratio 1.04, p =.30). Total costs per participant, including study drug, were significantly higher for acarbose (¥ [Yuan] 56 480, £6213), compared with placebo (¥48 079, £5289; mean ratio 1.18, p < 0.001). QALYs reported by participants in the acarbose arm (3.96 QALYs) were marginally higher than in the placebo arm (3.95 QALYs), but the difference was not statistically significant (0.01 QALYs; p =.58). Conclusions: Acarbose, compared with placebo, participants cost more due to study drug costs and reported no statistically significant difference in QALYs. These higher within‐trial costs could potentially be offset in future by savings from the acarbose‐related lower incidence of diabetes. [ABSTRACT FROM AUTHOR]

Meeting the increasing food demand in a manner that ensures both resources and environmental sustainability poses a global challenge. The conceptual framework of planetary boundaries (PBs) has emerged as a crucial reference in the study of sustainable food system, with specific focuses on key dimensions such as land use change, freshwater use, nitrogen (N) and phosphorus (P) cycles, and greenhouse gas (GHG) emissions. In this study, we summarized the threshold applications of PBs in sustainable food system research at both the global and national (China) scales. Based on these thresholds, we evaluated the sustainability conditions of the food system, considering resources such as cropland, freshwater, N and P applications, as well as environmental impacts including N and P losses, and GHG emissions. In addition, we explored the impacts of single or combined management strategies on sustainable food systems. These strategies included dietary changes, improvements in technologies and management, reductions in food loss and waste, and optimization in agricultural production distribution. Finally, we outlined future research directions in sustainable food system, including enhancing research on the interaction mechanisms among PBs elements within food systems, conducting downscaling studies of PBs elements at national and regional levels, and ensuring the rationality of policy-making for sustainable food systems in China. This study can provide a theoretical foundation and strategies guidance for sustainable food system and agricultural land use management in the future both globally and in China. [ABSTRACT FROM AUTHOR]

The process of industrialization often causes resource depletion and environmental pollution. To shed light on China's resource use and pollution trends in the context of the country's rapid industrial growth, this study analyzes the eco-efficiency of China's industry from 2000 to 2015. We quantify industrial eco-efficiency (IEE) for China and its provinces using data envelopment analysis (DEA) and analyze potential influencing factors at national and regional levels using Tobit regression. IEE in China and in most provinces shows a clear upward trend with some fluctuations, with national scores increasing from 0.394 to 0.704. There is strong regional disparity, with average IEE scores in eastern provinces (0.840) higher than those in central provinces (0.625), which are in turn higher than those in the northeast (0.537) and west (0.438). We next consider potential drivers. Economic development and foreign direct investment (FDI) are positively associated with IEE but appear to show diminishing returns. Environmental enforcement and market for technology are also positively associated with IEE, as expected. The impact of economic development, industrial sector structure, and investment in research and development (R&D) are modified by the stage of industrialization in each region. Targeted measures that can adjust industry structure, enhance environmental enforcement, attract FDI, and increase R&D investment may help further improve IEE in China. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in China. However, identifying patients has proved challenging, resulting in widespread under-diagnosis of the condition. We examined the prevalence of COPD diagnosis and COPD risk among adults in urban mainland China, the factors associated with having a COPD diagnosis or COPD risk, and the healthcare resource use and health outcomes of these groups compared with controls.Methods: Respondents to the 2017 National Health and Wellness Survey in China (n = 19,994) were classified into three groups: 'COPD Diagnosed', 'COPD Risk (undiagnosed)', and Control (unaffected), based on their self-reported diagnosis and Lung Function Questionnaire (LFQ) score. The groups were characterised by sociodemographic, health-related quality of life (HRQoL), productivity impairment, and healthcare resource use. Pairwise comparisons (t tests and chi-squared tests) and multivariable regression analyses were used to investigate factors associated with being at risk of, or diagnosed with, COPD.Results: 3320 (16.6%) respondents had a suspected risk of COPD but did not report receiving a diagnosis. This was projected to 105.3 million people, or 16.9% of adult urban Chinese. Of these respondents with an identified risk, only 554 (16.7%) were aware of COPD by name. Relative to those without COPD, those with a risk of COPD (undiagnosed) had significantly greater healthcare resource use, lower productivity and lower HRQoL not only compared to those without COPD, but also compared to people with a COPD diagnosis. Factors associated with increased odds of being at risk of COPD were older age, smoking, alcohol consumption, overweight BMI, occasional exercise, higher comorbidities, asthma diagnosis, being female, lower education, not being employed, and living in a high pollution province (p < 0.05).Conclusions: There is a substantial group of individuals, undiagnosed, but living with a risk of COPD, who have impaired HRQoL, lower productivity and elevated healthcare resource use patterns. Case-detection tools such as the LFQ may prove a quick and cost-effective approach for identifying these at-risk individuals for further definitive testing and appropriate treatment in China. [ABSTRACT FROM AUTHOR]

Resource input is the prerequisite to maintain the operation of socio-economic systems. Exergy analysis provides a wide and clear vision of the use and degradation of natural resources, with essential implications to sustainability. This paper aims to perform an exergy-based system account of the resource utilization in China, one of the most complex societies around the world. An overall systems diagram with seven independent and complimentary social departments is designed to illustrate the clear-cut processes of resource use and exergy destruction and loss. The national total input of resource exergy in 2012 reached 158.11 EJ, with the net input of 155.87 EJ. Its per capita resource consumption increased to 111.95 GJ, compared with 51.5 GJ in 2003. Industry accounted for 26.3% of the total resource exergy consumption, followed by Conversion 23.2%, Household 18.3%, Agriculture 10.2%, Tertiary 10.0%, Exaction 6.7% and Transportation 5.3%. The sectoral conversion coefficients of resource exergy were estimated as 91.92% for Extraction , 34.58% for Conversion , 29.75% for Agriculture , 32.18% for Industry , 18.46% for Transportation , 34.28% for Tertiary and only 1.28% for Household . The structure and efficiencies of resource exergy use of the Chinese society haven’t witnessed a prominent improvement in the recent decade, and its resource utilization performance was still inferior to those of some industrialized societies. Exergy-based unified accounting for a benchmark year provides solid foundation for resource policy formation and can serve as the tool for identifying resource footprint and sustainable development mode. [ABSTRACT FROM AUTHOR]

Economic growth cannot completely explain water use patterns as many other factors also affect the amount of water use. Using province level panel data, this research explores the relationship between water use and economic growth in China by analyzing multiple factors. IPAT identity, which conventionally includes three factors, is expanded to elucidate five driving factors of water use: population, affluence, technology, urbanization, and industrial structure. A quadratic model, a cubic model, and a piecewise regression model are tested and analyzed. Full-sample and region-sample over the period from 2003 to 2014 are investigated. Results show that, first, all the five factors studied have positive effects on water use at both national and regional scales. Population is the most influential factor at the national scale as well as in the eastern region, and technology plays the most important role in the central and the western regions. Second, there is a clear inverted U-shape relationship between water consumption and economic growth, and the inflection point of water consumption occurs at 35,477 RMB per capita GDP as measured in 2000 constant price. In this regard, water use has not reached the inflection point at either national or any of the regional scales.It is concluded that water use in China will rise in the coming years and is expected to reach the inflection point in 2021. [ABSTRACT FROM AUTHOR]

Background: Abraxane® and Taxol® are both effective drugs for the treatment of advanced stage breast cancer. However, each agent possesses unique drug delivery characteristics with the former not requiring premedication and having a considerably shorter recommended infusion time (i.e. 30 min vs. 2-4 h). To measure the overall efficiency and cost-saving potential associated with Abraxane® relative to Taxol®, a time and motion study was undertaken in breast cancer patients treated in China. Methods: Baseline patient data collection included age, disease stage, number and sites of metastatic disease, and performance status. Time and resource use data were then collected from breast patients being treated with Abraxane® (n=12) or Taxol® (n=15) in one of three cancer clinics located in Jiangsu, Shanghai, and Beijing. Resource use and time impact on clinical staff were quantified using unit cost estimates. This included costs for drug preparation, administration, materials and supplies, premedication, patient chair time, labor costs, and all acute adverse drug reactions. Outcomes were presented as a mean total time and cost for delivering a dose of Abraxane® or Taxol® and were compared using parametric and non-parametric statistical tests where appropriate. All costs were reported in US dollars (US$1=6.1 RMB, as of January 2014). Results: Patients were comparable with respect to mean age, number of metastatic sites, and performance status. Approximately 9 of 12 (75%) patients received Abraxane® as on a weekly schedule (vs. every 3 weeks) compared to 6 of 15 (40%) withTaxol®. Therewere 5 (33.3%) acute adverse drug reactions withTaxol®, 3 ofwhich required a physician visit and the initiation of supportive interventions. In contrast, there was only one minor event with Abraxane® (8.3%), which was easily managed with a temporary stoppage of the infusion. Fromthe timeandmotion study, themean total timeforAbraxane® and Taxol® delivery (preparation, administration, premedication, total chair time, and adverse effects management) was 84 and 282 min respectively (p<0.001), with the associated costs being US$59 and US$254 respectively per dose (p<0.001). Conclusion: To our knowledge, this is first such study in breast cancer patients to be undertaken in China. Abraxane® was associated with fewer acute adverse drug reactions and significant reductions in health care resources, physician/ nurse time and overall drug delivery costs compared to Taxol®. [ABSTRACT FROM AUTHOR]

The resource-development trajectory of developed countries after the Industrial Revolution of the eighteenth and nineteenth centuries can be portrayed as an ' environmental mountain' (EM). It is important for developing countries to decouple their resource use from economic growth and tunnel through the EM. In this study, we embedded the decoupling indicators for resource use and waste emissions into EM curves to quantify China's progress in tunneling through the EM over a specific time period. Five case studies regarding the conditions required for decoupling energy consumption, crude steel production, cement production, CO2 emissions, and SO2 emissions from economic growth in China were conducted. The results indicated that during 1985-2010 the trajectories of energy consumption, and CO2 and SO2 emissions in China met the requirements for tunneling through the EM, but the trajectories of cement and steel production did not. Based on these results, suggestions regarding China's environmental policies are provided to enable the country to tunnel through the EM. [ABSTRACT FROM AUTHOR]

Ensuring food security is the foundation of economic development and social stability. China is historically a country that is dominated by agriculture. In the past 60 years, China's total grain output increased by fivefold, from 113 million tons (MT) in 1949 to 571 MT in 2011, a statistic which provides inspiration to producers in other parts of the world. Grain production per capita doubled, from 209 to 425 kg during the same time period. At the national scale, China has succeeded in maintaining a basic self-sufficiency for grain for the past three decades. However, with the increasing population pressure and a growing appetite for animal products, China will need 776 MT grain by 2030 to feed its own people, a net increase of 35.9% from its best year on record. China's drive for future food security is challenged by problems such as low efficiency of resource use and resource limitation, diminishing return in yield response, competition for nonagricultural land uses, and environmental degradation. In this article, we analyze historical, temporal, and spatial variation in total grain production as well as the overall developing trends of current and future grain production, and discussed relevant options to overcome production constraints and further promote agricultural production. [ABSTRACT FROM AUTHOR]

Natural resources provide the basis for our life on Earth. This article presents the accounts of China's direct material input (DMI) during 1998-2008. Using decomposition, we examine factors that have influenced changes in recent resource use in China. China's resource demand in 2011-2015 is projected, based on China's 12th Five-Year Plan. Finally, effective policies to restrain China's resource demand are discussed with the following conclusions: (1) During 1998-2008, China's DMI doubled, from 11 gigatons (Gt) to 22 Gt. Metallic minerals had the strongest growth, quadrupling; nonmetallic minerals and fossil fuels more than doubled, but biomass remained stable. In relative terms, nonmetallic minerals dominated, with more than 60% of total DMI. (2) Factors of affluence ( A) and material use intensity ( T), respectively, contributed most to the increase and decrease of DMI, but the overall decrease effect is much smaller. Factors of population ( P) and recycling ( R) only slightly affected changes in China's DMI. (3) During 2008-2015, China's DMI is expected to increase by 27% to 38%, from 22 Gt to 28 to 31 Gt. The average annual rate of increase of DMI would drop to 3% to 5%, from 7% during 1998-2008. (4) Designing new products and infrastructure that use less energy and materials and changing consumption patterns to be more sustainable are crucial to the future resource strategy of China. More policies are expected to improve China's material use intensity and recycling levels. [ABSTRACT FROM AUTHOR]

The main objective of this study was to assess the economic cost of Alzheimer's disease (AD) in Shanghai, China, as a pilot study for future evaluations. Sixty-seven patients with AD were interviewed, and the information of the AD-related cost and resources used was collected from October 2005 to September 2006. By retrospective analysis, annual costs were calculated and expressed in Chinese renminbi (RMB). Direct cost per patient per year averaged approximately 8,432 RMB (1,058 USD), indirect cost per patient per year was 10,568 RMB (1,326 USD), and annual costs were 19,001 RMB (2,384 USD) per patient per year in this investigation. Total cost was significantly associated with the degree of severity including cognitive function (MMSE) and activity of daily living (ADL). With the increase in the number of persons at risk for developing AD, the economic burden of AD patients in China is significantly heavy. [ABSTRACT FROM AUTHOR]

Variation in leaf traits may represent differences in physiological processes and environmental adaptative strategies. Using multivariate analyses, we investigated 13 leaf traits to quantify the trade-off in these traits and the trait–climate/biome relationships based on the China Plant Trait Database, which contains morphometric and physiological character information on 1215 species for 122 sites, ranging from the north to the tropics, and from deserts and grasslands to woodlands and forests. Leaf traits across the dataset of Chinese plants showed different spatial patterns along longitudinal and latitudinal gradients and high variation. There were significant positive or negative correlations among traits; however, with the exception of the leaf 13C:12C stable isotope ratio, there were no significant correlations between leaf area and other traits. Climate, life form, and family jointly accounted for 68.4% to 95.7% of trait variance. Amongst these forms of variation partitioning, the most important partitioning feature was the family independence of climate and life form (35.6% to 57.2%), while the joint effect of family and climate was 4.5% to 26.2%, and the joint effect of family and life form was 2.4% to 21.6%. The findings of this study will enhance our understanding of the variation in leaf traits in Chinese flora and the environmental adaptative strategies of plants against a background of global climate change, and also may enrich and improve the leaf economics spectrum of China. [ABSTRACT FROM AUTHOR]

Objective: To report the resource use, characteristics and outcomes of patients with prolonged non-invasive ventilation (NIV)., Design: A single-centre observational study., Setting: An intensive care unit of a teaching hospital., Participants: Patients who only received NIV because of acute respiratory failure were enrolled. Prolonged NIV was defined as subjects who received NIV ≥14 days. A total of 1539 subjects were enrolled in this study; 69 (4.5%) underwent prolonged NIV., Main Outcome Measures: Predictors of prolonged NIV and hospital mortality., Results: The rate of do-not-intubate (DNI) orders was 9.1% (140/1539). At the beginning of NIV, a DNI order (OR 3.95, 95% CI 2.25 to 6.95) and pH ≥7.35 (2.20, 1.27 to 3.82) were independently associated with prolonged NIV. At days 1 and 7 of NIV, heart rate (1.01 (1.00 to 1.03) and 1.02 (1.00 to 1.03], respectively) and PaO 2 /FiO 2 <150 (2.19 (1.25 to 3.85) and 2.05 (1.04 to 4.04], respectively) were other independent risk factors for prolonged NIV. When patients who died after starting NIV but prior to 14 days were excluded, the association was strengthened. Regarding resource use, 77.1% of subjects received NIV<7 days and only accounted for 47.0% of NIV-days. However, 18.4% of subjects received NIV 7-13.9 days and accounted for 33.4% of NIV-days, 2.9% of subjects received NIV 14-20.9 days and accounted for 9.5% of NIV-days, and 1.6% of subjects received NIV≥21 days and accounted for 10.1% of NIV-days., Conclusions: Our results indicate the resource use, characteristics and outcomes of a prolonged NIV population with a relatively high proportion of DNI orders. Subjects with prolonged NIV make up a high proportion of NIV-days and are at high risk for in-hospital mortality., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)