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Background: Dengue fever has been a significant public health challenge in China. This will be particularly important in the context of global warming, frequent international travels, and urbanization with increasing city size and population movement. In order to design relevant prevention and control strategies and allocate health resources reasonably, this study evaluated the economic burden of dengue fever in China in 2019. Methods: The economic burden of dengue fever patients was calculated from both family and the organisation perspectives. A survey was conducted among 1,027 dengue fever patients in Zhejiang, Chongqing, and Yunnan Provinces. Treatment expenses, lost working days, and insurance reimbursement expenses information were collected to estimate the total economic burden of dengue fever patients in 2019. The expenditures related to dengue fever prevention and control from government, Center for Disease Control and Prevention (CDC), communities and subdistrict offices of 30 counties (or districts) in Zhejiang Province and Chongqing City were also collected. Results: The direct, indirect and total economic burden for dengue fever patients in 2019 in the three Provinces were about 36,927,380.00 Chinese Yuan (CNY), 10,579,572.00 CNY and 46,805,064.00 CNY, respectively. The costs for prevention and control of dengue fever for the counties (or districts) without cases, counties (or districts) with imported cases, and counties (or districts) with local cases are 205,800.00 CNY, 731,180.00 CNY and 6,934,378.00 CNY, respectively. The total investment of dengue fever prevention and control in the 30 counties in China in 2019 was approximately 3,166,660,240.00 CNY. Conclusion: The economic burden of dengue fever patients is relatively high, and medical insurance coverage should be increased to lighten patients' direct medical economic burden. At the same time, the results suggests that China should increase funding for primary health service institutions to prevent dengue fever transmission. Author summary: Dengue fever is one of the most important arbovirus diseases in the world. The distribution of cases has also increased significantly with the number of affected areas the highest in history. Dengue fever mainly occurs in southern provinces in China and its epidemic showed a trend of high incidence in 2019. This study estimated the economic burden of dengue fever in China in 2019 from the perspectives of both family and organisation. We recruited 1,027 dengue fever patients from Zhejiang Province, Chongqing City and Yunnan Province. At the same time, the costs related to dengue fever prevention and control from governments, CDCs, communities and subdistrict offices of 30 counties located in Zhejiang Province and Chongqing City were also collected. The results showed that in family perspective, the total economic burden of dengue in 2019 is estimated to be 46,805,064.00 CNY. In terms of organization expenditures, the regions with a higher incidence had higher costs. [ABSTRACT FROM AUTHOR]

Background: SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among individuals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention.Methods: A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models.Results: Mean follow-up of the 20 995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77-0.96]; P=0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs (¥1538 for the intervention group and ¥1649 for the control group) were lower in the salt substitute group (¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a >99.9% probability of being cost-effective.Conclusions: Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants. [ABSTRACT FROM AUTHOR]

Pancreatic fistula is a life-threatening complication of pancreaticoduodenectomy. Omega-like duct-to-mucosa pancreatojejunostomy is a novel technique which helps reduce the risk of fistulation. This study aimed to compare early postoperative outcomes of omega-like and conventional pancreatojejunostomy. A retrospective single-centre cohort study comparing outcomes of adult patients who underwent open pancreatoduodenectomy with conventional (CDMP) or omega-like duct-to-mucosa pancreatojejunostomy (ODMP) between 1 January 2015 and 31 December 2019. The primary outcome measure was the pancreatic fistula rate. 440 patients were included in this study of whom 233 underwent CDMP and 207 ODMP. The rate of clinically relevant pancreatic fistula (grade B/C) was significantly higher after CDMP than ODMP (18.5% vs. 10.6%, P = 0.021). 153 patients in CDMP group and 99 patients in ODMP group developed one or more complications (65.7% vs. 47.8%, P = 0.004). The average hospitalization expenses were numerically decreased in ODMP group, although this was not statistically significant (120,000 ± 42,000 [Chinese Yuan] vs. 100,000 ± 40,000 [Chinese Yuan] or 18,581 ± 6503 [United States Dollar] vs. 15,484 ± 6194 [United States Dollar], P = 0.402). ODMP may reduce the incidence of pancreatic fistula and other early postoperative complications after pancreatoduodenectomy. [ABSTRACT FROM AUTHOR]

The recent surge in protectionist sentiment in countries around the world has rekindled the long-standing debate over the determinants of citizens' trade policy preferences. We examine the influence of two understudied but increasingly relevant factors – misinformation and economic threat – on support for international trade in the United States. We first show that more than 6–in–10 Americans endorse a salient misperception about Chinese currency manipulation despite extensive evidence to the contrary. Then, based on a preregistered survey experiment, we show that misinformation can be corrected, regardless of whether the threatening frame is present or not. In contrast to these results on factual beliefs, however, we find that trade policy preferences are considerably stable: neither anti-trade misinformation nor an economically threatening frame significantly reduces support for international trade. These findings suggest that political elites' strategy of 'playing the China card' by using misleading and threatening rhetoric is not so effective in mobilizing opposition to trade. [ABSTRACT FROM AUTHOR]

The phase III STELLAR (NCT02533271) trial demonstrated that four cycles of chemotherapy after short-course radiotherapy (SCRT-TNT) were not inferior to the standard care of long-course concurrent radiotherapy (LCRT) in patients with locally advanced rectal cancer (LARC). This study assessed the cost-effectiveness of SCRT-TNT versus LCRT in locally advanced rectal cancer in China on the basis of the STELLAR trial. A Markov model was used to synthesize the healthcare costs and benefits of LARC patients based on results from the STELLAR trial. The model assumes that LARC who meet the inclusion criteria of the STELLAR trial experience four possible states: No Evidence of Disease (NED), locally recurrence, distant metastases, or any death from rectal cancer or other unrelated causes, where local recurrence continues to be classified as resectable and unresectable. The transition status period is 3 month, and 5 years is used to calculate direct medical costs and health benefits. The probabilities of states transition after SCRT-TNT or LCRT were derived from the results of the STELLAR trial and previous published article (Table.1). Costs were evaluated from the Chinese payer's perspective reported in early 2022 US dollars (US$1 = 6.78 Chinese Yuan). Sensitivity analyses were performed for key variables. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Willingness-to-pay (WTP) threshold was set at $43500/QALY. Data were collected from October 3, 2020, to September 20, 2021, and analyzed from November 15, 2020, to October 25, 2021. During the 5-year horizon, for the base case scenario, SCRT-TNT incurred a lower total cost and higher QALYs compared with LCCRT. The total cost was $65767 and QALYs were 1.77 for SCRT-TNT; for LCCRT, the total cost was $72802 and QALYs were 1.64. This resulted in an ICER of -$ 55470.69 per QALY. Therefore, SCRT-TNT was a cost-saving and dominating treatment strategy compared with LCRT. Sensitivity analysis showed that ICERs were most sensitive to the parameters of distant metastases risk after treatment. SCRT-TNT in locally advanced rectal cancer can be a cost-effective alternative to LCRT in China, and should be considered in appropriately selected patients. [ABSTRACT FROM AUTHOR]

The existence of an uncovered liability has historically benefited foreign banks and lead currencies. Using the case of China's efforts to fund its foreign exchange needs by exploiting loopholes in the international financial architecture, the paper examines whether using state-owned settlement banks as a means of intermediating a specialised 'non-deliverable' financial asset in offshore markets can substitute the institutional and technical prerequisites that developing economies typically lack. The findings show that while offshore money markets can reduce US dollar dependency in areas such as trade invoicing that do not depend on currency delivery, increasing the offshore holdings of RMB is more challenging. The reasons for this are to be found in the way the governance, geographic and credit generating limitations of state settlement banks reinforce the constraints imposed by the uncovered liability problem. The findings distinguish the historical evolution of the RMB's offshore use from other offshore markets and reinforce the impossibility of separating issues related to trade infrastructures from those related to the structure of the international financial system. [ABSTRACT FROM AUTHOR]

The China-specific currency market framework of 'one currency, two markets' provides us with a unique natural experiment to investigate how the active offshore exchange rate frequently diverges from the onshore exchange rate. From an interdisciplinary perspective, we propose a methodological framework that first establishes four convexity–concavity indicators, and then employ time series clustering/segmentation techniques to explore the evolutionary patterns of the onshore and offshore Renminbi exchange rates from 2 May 2012 to 29 December 2017. The empirical results show that the methodology is able to recognize five scenarios in which the exchange rates behave in an unsupervised manner, arriving at a diagnosis of the evolutionary patterns for these two markets. The estimated inverse covariance matrices and the associated graphical representations highlight the assembled timestamps of clustering assignments and reveal time-invariant structures of the market state, with all the most relevant dependencies directly interconnected in these two markets. It also suggests that intervention operations should take into account investor attention, varying arbitrage opportunities for market participants in both markets. [ABSTRACT FROM AUTHOR]

We analyzed the economic benefits versus safety risks of sharing anti-vascular endothelial growth factor (VEGF) vials during the coronavirus disease (COVID-19) pandemic. This single-center retrospective study analyzed the data of patients with neovascular age-related macular degeneration (nAMD), proliferative diabetic retinopathy (PDR) and retinal vein occlusion (RVO) who received anti-VEGF between January 2016 and July 2021 at Renmin Hospital, Wuhan University, China. Costs were compared of the two protocols of intravitreal injections (IVIs) of ranibizumab, aflibercept and conbercept after (i) splitting the vial content for use in two patients and after (ii) disposal of the remaining vial content after use in a single patient, with the COVID-19 outbreak considered as the demarcation point. The incidence rates of post-injection endophthalmitis (PIE) pre- and post-outbreak were analyzed. The mean cost of a single IVI increased by 33.3%, from 3917.67±71.69 to 5222.67±84.98 Chinese Yuan during the pandemic. The incidences of IVI-related culture-positive PIE were 0.0134% (3 in 22448) and 0.0223% (1 in 4479), respectively, before and after the pandemic (P=0.6532). We conclude that vial sharing of IVIs in a large clinical institution is not associated with increased PIE risk and can significantly reduce the cost of therapy. [ABSTRACT FROM AUTHOR]

Promoting the synergy between carbon mitigation and pollution reduction (SCMPR) is pivotal for global green and sustainable development. Industrial parks, as crucial economic hubs, require effective SCMPR strategies considering land, economy, and the environment, but present research seldom proposes methods that consider multiple factors and stakeholders together and fit for practical application. Given this, this study establishes a multi-factor industrial structural adjustment model for industrial parks incorporating scenario analysis to unveil optimal adjustment schemes and then develops an efficient spreadsheet tool based on the model. The model results convincingly fulfill SCMPR requirement after applying to a typical industrial park: After adjustments, 50 main industries in the park can achieve SCMPR targets, with carbon intensity and total phosphorous intensity predicted to achieve relative decoupling and other regular pollutant emissions anticipated to absolute decoupling by 2030. The proposed optimal scheme indicates that wastewater, waste gas, and solid waste volumes in the park will rise by 39%–54% by 2025 and 76%–113% from 2025 to 2030, and then translate into a 50% increase in waste treatment costs by 2025 and a subsequent 98% increase by 2030. The carbon intensity of the park will decrease from 154 tonnes of CO 2 per million Chinese Yuan in 2020 to 94 in 2030. The results culminate in three strategic recommendations for industrial parks: (1) prioritize reducing total pollutant emissions and carbon intensity, (2) customize carbon mitigation and pollution reduction strategies for each industry, and (3) regulate material and energy flows at multiple levels. This study can provide a pragmatic tool for industrial parks to make science-based decision-making toward dual carbon goals. [Display omitted] • An industrial structural adjustment model is established for industrial parks. • The model aims to realize synergistic carbon mitigation and pollution reduction. • An efficient spreadsheet tool based on the model is developed for application. • The case park can achieve synergistic reduction by model application. • Three strategic recommendations are proposed for synergistic reduction. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the dynamic relationship between Bitcoin and major foreign exchange rates namely Euro, British Pound, Canadian Dollar, Japanese Yen, and Chinese Yuan. In this context, we employ the causalityin- mean and variance test suggested by Hong (2001) to examine the presence of mean and volatility spillover effects between Bitcoin and foreign exchange rates. Also, we use the causality-in-risks test proposed by Hong et al. (2009) to investigate the existence of tail dependence between Bitcoin and foreign exchange rates. By using daily data from August 19, 2011, through August 6, 2021, we find unidirectional Granger causality-in-mean from Euro, Pound, and Dollar to Bitcoin. On the other hand, causality-in-variance test results suggest a bidirectional volatility spillover effect between Bitcoin and Euro and Pound. Also, Yuan and Dollar are found to be Granger cause-in-variance of Bitcoin. Causality-in-risk test results provide evidence in favor of causal link running from Euro and Pound to Bitcoin. In addition, unexpected losses in Bitcoin are the Granger cause of unexpected losses in the Yen. Overall, our empirical analysis results show that the Chinese currency market seems to be less integrated with Bitcoin. [ABSTRACT FROM AUTHOR]

The Chinese government has proposed a new development model called Dual Circulation, which, we argue, is a response to the upsurge of trade protectionism in recent years, as well as an acceleration of China's long-planned restructuring of its economy. Our input-output analysis reveals the inferior global distributional position of China and the dire consequences it faces from a counterfactual US-China trade decoupling. Specifically, China on average transferred out about 9 percent of its abstract labor during 2010–14, and it stands to lose 2.5 percentage points in its growth rate and over 10 million jobs if the United States and China completely transfer their bilateral trade to other partners. JEL classification : B51, O24, D57 [ABSTRACT FROM AUTHOR]

The extreme floods in the Middle/Lower Yangtze River Valley (MLYRV) during June−July 2020 caused more than 170 billion Chinese Yuan direct economic losses. Here, we examine the key features related to this extreme event and explore relative contributions of SST anomalies in different tropical oceans. Our results reveal that the extreme floods over the MLYRV were tightly related to a strong anomalous anticyclone persisting over the western North Pacific, which brought tropical warm moisture northward that converged over the MLYRV. In addition, despite the absence of a strong El Niño in 2019/2020 winter, the mean SST anomaly in the tropical Indian Ocean during June−July 2020 reached its highest value over the last 40 years, and 43% (57%) of it is attributed to the multi-decadal warming trend (interannual variability). Based on the NUIST CFS1.0 model that successfully predicted the wet conditions over the MLYRV in summer 2020 initiated from 1 March 2020 (albeit the magnitude of the predicted precipitation was only about one-seventh of the observed), sensitivity experiment results suggest that the warm SST condition in the Indian Ocean played a dominant role in generating the extreme floods, compared to the contributions of SST anomalies in the Maritime Continent, central and eastern equatorial Pacific, and North Atlantic. Furthermore, both the multi-decadal warming trend and the interannual variability of the Indian Ocean SSTs had positive impacts on the extreme floods. Our results imply that the strong multi-decadal warming trend in the Indian Ocean needs to be taken into consideration for the prediction/projection of summer extreme floods over the MLYRV in the future. [ABSTRACT FROM AUTHOR]

Objective: To 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. Methods: Analyses 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. Results: Molecular 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. Conclusions: Overall, 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. [ABSTRACT FROM AUTHOR]

This study tested whether pandemic-induced fear is a predictor of the exchange rate returns of seven major currencies – Australian dollar, Canadian dollar, Swiss franc, yuan, EURO, pound sterling, and yen. Daily data on US dollar-based exchange rate returns and the global fear index for COVID-19 pandemic for the period 10-02-2020–02-04-2021 were used. Symmetric and asymmetric wild bootstrap likelihood ratio tests were employed in testing the relationship. The symmetric test results showed that pandemic-induced fear is capable of predicting the exchange rate returns of the Swiss franc, yuan, and the EURO. Specifically, negative relationships were recorded between their returns and the global fear index for pandemics. The asymmetric test results however showed that increasing pandemic-induced fear leads to decreases in the returns of the Australian dollar, Canadian dollar, Swiss franc, yuan and EURO. Overall, this study showed that pandemic-induced fear is a predictor of exchange rate returns. It is therefore suggested that the maintenance of stability in the financial system should be treated as an integral part of policy responses designed to mitigate the adverse effects of pandemics. This way, economic agents will not be forced to move their investments to foreign currency-denominated assets due to fear of investment losses. [ABSTRACT FROM AUTHOR]

The internationalization of the renminbi (RMB) raises important questions concerning dynamics of transformation within the post-crisis global monetary order. International political economists have predominantly analysed the currency's cross-border evolution as a consequence of China's macroeconomic conditions, domestic politics, and currency statecraft within a broader framework of international monetary hierarchy. In this article, we draw upon insights from financial geography to rethink the rise of the RMB as a process of transnational market-making involving actors and political agency across distinctive scales. We develop a multi-scalar framework that illuminates the distinctive agency of London and Hong Kong in this process, conceptualizing it as a form of subnational infrastructural power that facilitates financial market-making in concert with (and despite) dynamics of interstate geopolitics. This goes some way in remedying the scalar deficiency of existing theories of political economy of international money, as well as integrating considerations of power and political agency into financial geography perspectives. Empirically, we trace how the unique development of London's offshore RMB market reflects this interplay between private financial actors, municipal-level authorities, and national political priorities. Finally, we discuss how IFC-led market-making relates to system-level dynamics by both facilitating 'tipping points' in global monetary change, as well as diluting national monetary power. [ABSTRACT FROM AUTHOR]

Background: In 2019, Chinese government implemented volume-based procurement of 25 drugs in 4 municipalities and 7 sub-provincial cities, i.e. "4 + 7" policy. Competitive bidding was conducted by the government based on the annual agreed procurement volume submitted by each public medical institution in pilot cities. Pilot cities were required to implement bid winning results in March 2019 and the use volume of bid winning products was examined to ensure the completion of agreed procurement volume. In the policy, an oral antibiotic (cefuroxime) was included. Given the current condition of the irrational use of antibiotics in China, this study aims to evaluate the impact of "4 + 7" policy on the use of policy-related antibiotics.Methods: This study used drug purchase data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Oral antibiotic drugs related to "4 + 7" policy were selected as study samples, including cefuroxime and 12 antibiotic drugs that have an alternative relationship with cefuroxime in clinical use. Purchase volume and expenditures were selected as outcome variables, and were measured using Defined Daily Doses (DDDs) and Chinese yuan, respectively. Segmented linear regression analysis with interrupted time series was adopted to examine the effect of "4 + 7" policy.Results: After the implementation of "4 + 7" policy, the overall volume of cefuroxime and its alternative drugs increased from 9.47 million DDDs to 13.42 million DDDs, with an increase of 41.8 %. The results of segmented linear regression showed that the volume of cefuroxime significantly increased 161.16 thousand DDDs after "4 + 7" policy (95 % CI: 59.43 to 262.90, p-value = 0.004). The volume of alternative drugs significantly increased 273.65 thousand DDDs (95 % CI: 90.17 to 457.12, p-value = 0.006). The overall "4 + 7" policy-related antibiotics significantly increased 436.31 thousand DDDs (95 % CI: 190.81 to 681.81, p-value = 0.001) after "4 + 7" policy.Conclusions: This study provides evidence that the implementation of "4 + 7" volume-based procurement policy was associated with significant increases in the volume of policy-related antibiotic drugs. The increase in antibiotic use after the policy needs special attention and vigilance. [ABSTRACT FROM AUTHOR]

• Imported inputs affects the exchange rate pass-through via two channels. • Marginal cost channel serves by changing the marginal cost of export products. • Quality change channel serves by altering exporters' incentive to change quality. • These two channels generate opposite effects on the exchange rate pass-through. • The marginal cost channel dominates the quality change one for Chinese exporters. This paper examines how the use of imported intermediate inputs affects the exchange rate elasticity of export prices. We first construct a theoretical model to illustrate that a change in imported input cost followed by a change in the exchange rate affects export prices through two distinct channels: directly changing the marginal cost of export products(i.e., the marginal cost channel) and indirectly altering exporters' incentive to upgrade (or downgrade) the quality of products (i.e., the quality change channel). These two channels generate opposite effects on the exchange rate elasticity of export prices. Our empirical analyses find strong evidence of the existence of the marginal cost and quality change channels. Overall, the marginal cost effect dominates the quality change effect. The marginal cost channel is weaker for products with larger scope for quality differentiation and firms with a higher ability to upgrade quality, as predicted by the theoretical model. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited.Methods: Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records.Results: In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan.Conclusions: The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China. [ABSTRACT FROM AUTHOR]

Using firm-level transaction records from the proprietary Chinese Customs data we estimate differential impacts of the Great Recession (GR) of 2008–2009 on exports of private domestic firms (PDFs) and foreign invested firms (FIFs). We exploit the longitudinal nature of the data spanning almost a decade (2003–2011), as well as product level details available in the customs data, to establish the links. We identify processing trade intensity as one possible mechanism behind the change in exports due to the GR, as well as the differentiated recovery across firm types in its aftermath. Prior to the GR, compared to the PDFs, the FIFs not only accounted for the larger share of China's exports but were also relatively more involved with processing trade. Subsequently, it seems that the firms with greater processing trade intensity were affected more due to GR. We argue that in a comparative sense, processing trade of the FIFs captures the transmission of the negative demand shocks of the GR. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis japonica remains an important public health concern due to its potential to cause severe outcomes and long-term sequelae. An integrated control strategy implemented in the Peoples' Republic of China has been shown to be effective to control or interrupt the transmission of schistosomiasis. The objective of this study is to estimate the disease burden of schistosomiasis and assess the cost-effectiveness of the integrated control strategy focused on different major interventions at three stages for schistosomiasis control in a lake setting, to provide reference for policy making or planning. Methods: Annual cost data of schistosomiasis control during 2009–2019 were obtained from the control program implementers in Jiangling County, Hubei Province, China. Economic costs are provided in constant 2009 Chinese Yuan (CNY). Epidemiological data of schistosomiasis were collected from the Jiangling county station for schistosomiasis control. Disease burden of schistosomiasis was assessed by calculating years of life lost (YLLs) owing to premature death, years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs were calculated as the sum of YLLs and YLDs. We then conducted a rudimentary cost-effectiveness analysis by determining the ratio by dividing the difference between the average cost of integrated control strategy at transmission control (2013–2016) or transmission interruption (2017–2019) and the average cost at stage of infection control (2009–2012) with the difference between the DALYs of schistosomiasis at different control stages. Descriptive statistics on the costs and DALYs were used in the analysis. Results: The total economic costs for schistosomiasis control in Jiangling County from 2009 to 2019 were approximately CNY 606.88 million. The average annual economic costs for schistosomiasis prevention and control at stages of infection control (2009–2012), transmission control (2013–2016), and transmission interruption (2017–2019) were approximately CNY 41.98 million, CNY 90.19 million and CNY 26.06 million respectively. The overall disease burden caused by schistosomiasis presented a downward trend. Meanwhile, the disease burden of advanced cases showed an upward trend with the DALY increased from 943.72 to 1031.59 person-years. Most disease burden occurred in the age group over 45 years old (especially the elderly over 60 years old). Taking the infection control stage as the control, the incremental cost-effectiveness ratio of integrated control strategy was CNY 8505.5 per case averted, CNY 60 131.6 per DALY decreased at transmission control stage and CNY −2217.6 per case averted, CNY −18 116.0 per DALY decreased at transmission interruption stage. Conclusions: The disease burden of schistosomiasis decreased significantly with the implementation of the integrated prevention and control strategy. Surveillance and management on elder population should be strengthened to decrease diseases burden. There remains a need for well-conducted studies that examine the long-term cost-effectiveness of the integrated control strategy for schistosomiasis. Graphic Abstarct: [ABSTRACT FROM AUTHOR]

This meta‐analysis was performed to compare the safety, efficacy, and pharmacoeconomic of bivalirudin versus heparin in high‐risk patients for percutaneous coronary interventions (PCI). Earlier meta‐analysis comparing bivalirudin and heparin during PCI demonstrated that bivalirudin caused less bleeding with more stent thrombosis. However, little data were available on the safety of bivalirudin versus heparin in high‐risk patients for PCI. Thus, we performed a meta‐analysis to evaluate the efficacy and safety in the "high‐risk" patients. A systematic search of electronic databases was conducted up to July 30, 2020. The Cochrane Risk of Bias assessment tool was used to assess the quality of included studies. The primary outcomes were all‐cause death and major adverse cardiac events (MACE); secondary outcomes were major and minor bleeding, followed by a cost‐minimization analysis comparing bivalirudin and heparin using a local drug and medical costs reported in China. Subgroup analysis was based on the type of disease of the high‐risk population. Finally, a total of 10 randomized controlled trials involved 42,699 patients were collected. The Cochrane Risk of Bias Tool was employed to appraise the research quality. No significant difference was noted between bivalirudin and heparin regarding all‐cause death and MACE. However, subgroup analysis showed that bivalirudin caused less major bleeding in female (OR:0.65, 95% CI:0.53–0.79), diabetes (OR:0.55, 95%CI:0.42–0.73), and CKD (OR:0.59, 95%CI:0.63–1.65). The scatterers of the included literature were approximately symmetrical, and no research was outside the funnel plot. Additionally, cost‐minimization analysis showed that heparin was likely to represent a cost‐effective option compared with bivalirudin in China, with potential savings of 2129.53 Chinese Yuan (CNY) per patient for one PCI. Overall, the meta‐analysis showed that although bivalirudin appeared to have a lower risk of major bleeding rate, the overall effectiveness and safety between the two groups showed no significant difference in high‐risk patients for PCI. But the results of the cost‐minimization analysis showed that heparin could be a potential cost‐saving drug than bivalirudin in patients for PCI in China. [ABSTRACT FROM AUTHOR]

Objectives: Movement restriction policies (MRPs) are effective in preventing/delaying COVID-19 transmission but are associated with high societal cost. This study aims to estimate the health burden of the first wave of COVID-19 in China and the cost-effectiveness of early versus late implementation of MRPs to inform preparation for future waves.Methods: The SEIR (susceptible, exposed, infectious, and recovered) modeling framework was adapted to simulate the health and cost outcomes of initiating MRPs at different times: rapid implementation (January 23, the real-world scenario), delayed by 1 week, delayed by 2 weeks, and delayed by 4 weeks. The end point was set as the day when newly confirmed cases reached zero. Two costing perspectives were adopted: healthcare and societal. Input data were obtained from official statistics and published literature. The primary outcomes were disability-adjusted life-years, cost, and net monetary benefit. Costs were reported in both Chinese renminbi (RMB) and US dollars (USD) at 2019 values.Results: The first wave of COVID-19 in China resulted in 38 348 disability adjusted life-years lost (95% CI 19 417-64 130) and 2639 billion RMB losses (95% CI 1347-4688). The rapid implementation strategy dominated all other delayed strategies. This conclusion was robust to all scenarios tested. At a willingness-to-pay threshold of 70 892 RMB (the national annual GDP per capita) per disability-adjusted life-year saved, the probability for the rapid implementation to be the optimal strategy was 96%.Conclusions: Early implementation of MRPs in response to COVID-19 reduced both the health burden and societal cost and thus should be used for future waves of COVID-19. [ABSTRACT FROM AUTHOR]

The multi variate mixture dynamics model is a tractable, dynamical, arbitrage-free multivariate model characterized by transparency on the dependence structure, since closed form formulae for terminal correlations, average correlations and copula function are available. It also allows for complete decorrelation between assets and instantaneous variances. Each single asset is modelled according to a lognormal mixture dynamics model, and this univariate version is widely used in the industry due to its flexibility and accuracy. The same property holds for the multivariate process of all assets, whose density is a mixture of multivariate basic densities. This allows for consistency of single asset and index/portfolio smile. In this paper, we generalize the MVMD model by introducing shifted dynamics and we propose a definition of implied correlation under this model. We investigate whether the model is able to consistently reproduce the implied volatility of FX cross rates once the single components are calibrated to univariate shifted lognormal mixture dynamics models. We consider in particular the case of the Chinese Renminbi FX rate, showing that the shifted MVMD model correctly recovers the CNY/EUR smile given the EUR/USD smile and the USD/CNY smile, thus highlighting that the model can also work as an arbitrage free volatility smile extrapolation tool for cross currencies that may not be liquid or fully observable. We compare the performance of the shifted MVMD model in terms of implied correlation with those of the shifted simply correlated mixture dynamics model where the dynamics of the single assets are connected naively by introducing correlation among their Brownian motions. Finally, we introduce a model with uncertain volatilities and correlation. The Markovian projection of this model is a generalization of the shifted MVMD model. [ABSTRACT FROM AUTHOR]

Background: Many studies suggest that patient satisfaction is significantly negatively correlated with the waiting time. A well-designed healthcare system should not keep patients waiting too long for an appointment and consultation. However, in China, patients spend notable time waiting, and the actual time spent on diagnosis and treatment in the consulting room is comparatively less.Methods: We developed an artificial intelligence (AI)-assisted module and name it XIAO YI. It could help outpatients automatically order imaging examinations or laboratory tests based on their chief complaints. Thus, outpatients could get examined or tested before they went to see the doctor. People who saw the doctor in the traditional way were allocated to the conventional group, and those who used XIAO YI were assigned to the AI-assisted group. We conducted a retrospective cohort study from August 1, 2019 to January 31, 2020. Propensity score matching was used to balance the confounding factor between the two groups. And waiting time was defined as the time from registration to preparation for laboratory tests or imaging examinations. The total cost included the registration fee, test fee, examination fee, and drug fee. We used Wilcoxon rank-sum test to compare the differences in time and cost. The statistical significance level was set at 0.05 for two sides.Results: Twelve thousand and three hundred forty-two visits were recruited, consisting of 6171 visits in the conventional group and 6171 visits in the AI-assisted group. The median waiting time was 0.38 (interquartile range: 0.20, 1.33) hours for the AI-assisted group compared with 1.97 (0.76, 3.48) hours for the conventional group (p < 0.05). The total cost was 335.97 (interquartile range: 244.80, 437.60) CNY (Chinese Yuan) for the AI-assisted group and 364.58 (249.70, 497.76) CNY for the conventional group (p < 0.05).Conclusions: Using XIAO YI can significantly reduce the waiting time of patients, and thus, improve the outpatient service process of hospitals. [ABSTRACT FROM AUTHOR]

Background: The paradigm shift in hepatitis C virus (HCV) treatment options in the last five years has raised the prospect of eliminating the disease as a global health threat. This will require a step-change in the number being treated with the new direct-acting antivirals (DAAs). Given constrained budgets and competing priorities, policy makers need information on how to scale-up access to HCV treatment. To inform such decisions, we examined the cost effectiveness of screening and treatment interventions in Yunnan, China. Methods and findings: We simulated the HCV epidemic using a previously published model of HCV transmission and disease progression, calibrated to Yunnan data, and implemented a range of treatment and screening interventions from 2019. We incorporated treatment, diagnosis, and medical costs (expressed in 2019 US Dollars, USD) to estimate the lifetime benefits and costs of interventions. Using this model, we asked: is introducing DAAs cost effective from a healthcare sector perspective; what is the optimal combination of screening interventions; and what is the societal return on investment of intervention? The incremental cost-effectiveness ratio (ICER) of switching to DAAs with a median cost of 7,400 USD (50,000 Chinese Yuan) per course is 500 USD/disability adjusted life year (DALY) averted; at a threshold of 50% of Yunnan gross domestic product (2,600 USD), switching to DAAs is cost effective 94% of the time. At this threshold, the optimal, cost-effective intervention comprises screening people who inject drugs, those in HIV care, men who have sex with men, and ensuring access to DAAs for all those newly diagnosed with HCV. For each USD invested in this intervention, there is an additional 0·80 USD (95% credible interval: 0·17–1·91) returned through reduced costs of disease or increased productivity. Returns on investment are lower (and potentially negative) if a sufficiently long-term horizon, encompassing the full stream of future benefits, is not adopted. The study had two key limitations: costing data were not always specific to Yunnan province but were taken from China-level studies; and modelled interventions may require more operational research to ensure they can be effectively and efficiently rolled-out to the entire province. Conclusions: Introducing DAAs is cost effective, the optimal package of screening measures is focussed on higher risk groups, and there are likely to be positive returns from investing in such HCV interventions. Our analysis shows that targeted investment in HCV interventions will have net benefits to society; these benefits will only increase as DAA costs fall. [ABSTRACT FROM AUTHOR]

Financial bubbles are described as the deviation of the market values of financial assets from their core values. They are one of the main indicators for the financial crises by negatively affecting the markets due to the constant overvaluation of the assets. Therefore, investigating the presence of financial bubbles and determining the reasons are of great importance for investors, market regulators, and portfolio managers in terms of investment risk and price stability. In the study, the presence of bubbles in the foreign exchange market is investigated by considering the most traded currencies such as the US Dollar, Euro, Japanese Yen, British Pound, and Chinese Yuan. For this purpose, the daily price data for the period between 03.01.2005-20.11.2019 for the US Dollar/Turkish Lira, Euro/Turkish Lira, British Pound/Turkish Lira, and Chinese Yuan/Turkish Lira, and the daily price data belonging to 28.08.2013-20.11.2019 period for Japanese Yen/Turkish Lira are used. Supremum Augmented DickeyFuller (SADF) and Generalized Supremum Augmented Dickey-Fuller (GSADF) tests are used to determine the bubbles in aforementioned exchange rates. The results indicate findings regarding the formation of financial bubbles in the foreign exchange market in Turkey. [ABSTRACT FROM AUTHOR]

Extracellular vesicles bear a rich glycome that presents versatile functions in diverse biological processes. Leverage polydopamine modified magnetic particles to serve as nanosized agents for rapid and robust EV capture and manipulation, we here integrated the easy magnetic actuation with specific lectin-glycan binding and enzyme-mediated fluorescence amplification and thus proposed a facile approach to efficiently decipher a broad spectrum of glycans in EVs. Termed magnetic nanoagent assisted extracellular vesicle glycan deciphering (MAEG), the developed assay utilized a magnet as the assistant operation tool and realized fast (∼1 h) and sensitive (a limit of detection of ∼0.7 μg/mL vesicles) EV glycan analysis in a simple low-cost (around 2.27 Chinese Yuan for one test) manner without requirement of any sophisticated platforms. With robust performance for different sample species, the assay achieved to depict the comprehensive glycosylation landscapes for varied EVs derived from eight cell lines focusing on non-small-cell lung cancer. Systematic analyses clearly revealed the high heterogeneity in glycan features of EVs of varied cellular origins. Using an established difference network method, unique glycan features in different EVs were sifted out and further compiled to construct lectin-denoted patterns as dedicated glycosylation fingerprints, potentially expanding EV-based clinical applications. [ABSTRACT FROM AUTHOR]

System-wide, comprehensive, primary health care (PHC)-oriented health reforms are infrequently introduced in low-income and middle-income countries and often poorly studied. China initiated a large-scale reform in 2015 that included multiple policies: partial gatekeeping, a family physician scheme, and increased system integration. These policies aimed to build a PHC-oriented health system and improve primary care utilisation. This study assessed the heterogeneous effects of the reforms on health service utilisation and health outcomes across regions and over time. In this longitudinal quasi-experimental study, we used longitudinal data (2011–18) from a national survey on elderly populations and governmental yearbooks. This study exploits the staggered rollout of the reforms at the city level identified using web-scrapping. We employed an event study design to assess reform effects on (1) visits to PHC facilities, (2) admissions to hospital, (3) out-of-pocket expenditures (OOPEs), and (4) self-reported health. Models were adjusted for city and time fixed effects, along with demographic and socioeconomic characteristics at individual and provincial levels. Analysis was separated into rural and urban populations. 18 988 Chinese individuals aged 45 and older (mean age 60·4 years [SD 10·3], 9990 [52·6%] women, 8998 [47·4%] men) were included in the analysis. The reform was associated with increasing odds of visiting PHC facilities among rural populations, which became stronger in the 2 years after the reform (adjusted odd ratio [aOR] 1·35, 95% CI 1·02–1·84, p=0·0374; absolute effect sizes [probability] 3%) before it faded. Meanwhile, urban populations were unaffected (from aOR 1·22, 0·82–1·81 to 0·89, 0·50–1·57). The reform did not have a significant effect on admission to hospital (rural: from 0·97, 0·72–1·31 to 1·47, 0·85–2·55; urban: from 1·00, 0·69–1·43 to 1·59, 0·76–3·30) or OOPEs (rural: from 260·32 Chinese Yuan, 95% CI –6·34 to 526·97, to 693·07 Chinese Yuan, –102·96 to 1489·09; urban: from 235·37 Chinese Yuan, –405·10 to 875·83, to 859·93 Chinese Yuan, –199·02 to 1918·88). Urban populations reported higher self-reported health after the reforms than the year before the reforms (1·50, 1·12–2·01, p=0·0002; 5%). System-wide PHC-oriented reforms might contribute to short-term increases in primary care utilisation in elderly populations with implications for urban–rural inequalities. Effects on financial protection and health inequality were limited. Efforts in improving the accessibility and quality of primary care in deprived areas are indispensable to addressing the persistent inverse care law and to achieving Universal Health Coverage for all countries. None. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the efficacy and safety of bronchoalveolar lavage (BAL) in the treatment of neonatal severe pneumonia (NSP).Methods: One hundred patients with severe pneumonia were randomly divided into two groups, the BAL and control groups, with 50 patients in each group. In the BAL group, normal saline was instilled into the endotracheal tube for BAL. Before and after lavage, lung ultrasound (LUS) monitoring was performed to observe the lung pathological changes. Conventional treatment was administered in the control group. The need for and duration of invasive mechanical ventilation, the complication rate, the duration and cost of hospitalization and the mortality rate were compared between the two groups.Results: The results of this study showed that there were 35 (70%) patients who meet the indications of the invasive mechanical ventilation (IMV) at admission in the BAL group, while there were only 15 (30%) patients still requiring IMV after BAL therapy. The duration of IMV was 41.7 ± 7.5 vs. 97.7 ± 12.9 h in BAL and controls, the incidence rate of complications was 8.0% vs. 20.0% in both groups, the length of hospital stay was 9.2 ± 1.9 vs. 14.1 ± 2.1 days in both groups, and the expense of hospital cost was 12 557 ± 832 vs. 19 121 ± 929 Chinese Yuan in both groups. All patients had stable vital signs during lavage, and no significant adverse side effects were observed.Conclusion: BAL was significantly beneficial for NSP with no significant adverse side effects; LUS is a useful tool for the timely detection of BAL effects. [ABSTRACT FROM AUTHOR]

The ICL Kokomeren Summer School aims to demonstrate rockslides of the planar, rotational, wedge, and compound types, most of which have converted into flow-like rock avalanches. One of the training course topics is the paleoseismological interpretation of large rockslides and rock avalanches. Rockslides and rock avalanches are among the most hazardous natural phenomena in mountainous regions. [Extracted from the article]

Semantic segmentation with convolutional neural networks under a complex background using the encoder-decoder network increases the overall performance of online machine vision detection and identification. To maximize the accuracy of semantic segmentation under a complex background, it is necessary to consider the semantic response values of objects and components and their mutually exclusive relationship. In this study, we attempt to improve the low accuracy of component segmentation. The basic network of the encoder is selected for the semantic segmentation, and the UPerNet is modified based on the component analysis module. The experimental results show that the accuracy of the proposed method improves from 48.89% to 55.62% and the segmentation time decreases from 721 to 496 ms. The method also shows good performance in vision-based detection of 2019 Chinese Yuan features. [ABSTRACT FROM AUTHOR]

• Biogas generation mechanism and utilization potential in the STASAB was analyzed. • CH 4 high-speed generation was quickly achieved in the STASAB. • Various microbial communities affecting biogas production were detected. • Higher energy potential was obtained in the STASAB compared with SASAB. • Biogas for electricity production in the STASAB is recommended. The biogas generation mechanism and its utilization potential in a novel spatiotemporally anaerobic/semi-aerobic bioreactor (STASAB) system with three activated bioreactors (C1, C2 and C3) was analyzed. Methane generation potential was obtained by measurements and estimation methods with similar values of 23.38 and 27.79 kg CH 4 /t waste, respectively. CH 4 and CO 2 production was quickly achieved in the STASAB, and the total amount of CH 4 and CO 2 was low due to the mixed leachate-recirculation operation process among bioreactors, which were at different stages of operation. The microbial communities in different bioreactors were diverse. The leachate-recirculation operation was a critical parameter to effectively enhance the microbial community structure in the STASAB, which can regulate CH 4 , CO 2 and N 2 O production with global warming potential of 7.479 kg CO 2 e/(t·d). The STASAB had higher energy potential of 1.011 kWh/(t·d) compared with that of conventional landfills and sequentially anaerobic/semi-aerobic bioreactors. Moreover, direct electricity production in the STASAB is recommended for energy utilization with 38.38% GHG emission reduction, and with 131.43 million CNY (Chinese Yuan) benefit per year for national rural waste disposal via utilization of biogas from the STASAB for power generation. Hence, the STASAB shows a notable potential for treating domestic waste in rural areas. [ABSTRACT FROM AUTHOR]

Background: Rural households in developing countries usually have severe medical debt due to high out-of-pocket (OOP) payments, which contributes to bankruptcy. China implemented the critical illness insurance (CII) in 2012 to decrease patients' medical expenditure. This paper aimed to explore the medical debt of rural Chinese patients and its influencing factors.Methods: A questionnaire survey of health expenditures and medical debt was conducted in two counties of Central and Western China in 2017. Patients who received CII were used as the sample on the basis of multi-stage stratified cluster sampling. Descriptive statistics and multivariate analysis of variance were used in all data. A two-part model was used to evaluate the occurrence and extent of medical debt.Results: A total of 826 rural patients with CII were surveyed. The percentages of patients incurring medical debt exceeded 50% and the median debt load was 20,000 Chinese yuan (CNY, 650 CNY = US$100). Financial assistance from kin (P < 0.001) decreased the likelihood of medical debt. High inpatient expenses (IEs, P < 0.01), CII reimbursement ratio (P < 0.001), and non-direct medical costs (P < 0.001) resulted in increased medical debt load.Conclusions: Medical debt is still one of the biggest problems in rural China. High IEs, CII reimbursement ratio, municipal or high-level hospitals were the risk determinants of medical debt load. Financial assistance from kin and household income were the protective factors. Increasing service capability of hospitals in counties could leave more patiemts in county-level and township hospitals. Improving CII with increased reimbursement rate may also be issues of concern. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to estimate the proportion of Chinese cancer survivors experiencing financial hardship and then examine the relationship between material and behavioral financial hardship.Methods: This study surveyed 964 cancer survivors who were 30 to 64 years old and 644 survivors who were 65 years old or older during 2015-2016 (1608 survivors in all). Material financial hardship was measured by whether they had borrowed money because of cancer, its treatment, or the lasting effects of treatment, and behavioral financial hardship was measured by whether they had forgone some cancer-related medical care because of cost. Multivariable logistic regression models were used to examine factors associated with material financial hardship by age group.Results: Approximately 44% of the cancer survivors who were 65 years old or older borrowed money or went into debt because of cancer, and 54% of younger patients (P < .01) reported cancer-related debts. Among these survivors with cancer care debt, survivors aged 65 years old or older had a lower proportion of borrowing more than 50,000 Chinese yuan (CNY; approximately US $7700) than survivors aged 30 to 64 years (14% vs 20%). In both age groups, approximately 10% of cancer survivors reported that they had experienced behavioral financial hardship. After adjustments for covariates, cancer survivors who reported material financial problems were more likely to report behavioral financial hardship (odds ratio [OR] for those aged 30-64 years, 3.72; 95% confidence interval [CI], 2.13-6.50; OR for those aged 65 years or older, 5.48; 95% CI, 2.69-11.15).Conclusions: Older cancer survivors in China experience significant material financial hardship, but it is not as noticeable as younger patients' hardship. The results highlight the importance of identifying cancer survivors who are more likely to experience financial hardship and improving the affordability of cancer care in China. [ABSTRACT FROM AUTHOR]

In the context of the ongoing trade dispute between China and the United States, our study attempts to investigate the sensitivity of global commodity prices to the appreciation and depreciation of renminbi (RMB). Using quarterly data of 1994–2016, we reach three notable findings based on linear and non-linear specifications of autoregressive distributed lag (ARDL) model. First, the global price for selected agricultural commodities is sensitive to the appreciation of RMB, exercising downward pressure on agricultural commodity markets. Second, the global price for crude oil is found to react negatively to real appreciation of RMB. Third, the global price for selected metal commodities is found to respond negatively to changes in RMB. Based on these findings, we suggest China adopts a one-off appreciation instead of tariffs on imported commodities to prevent the fluctuation of commodity prices and realize the self-sufficiency goal. [ABSTRACT FROM AUTHOR]

This paper modified the Diebold & Yilmaz spillover index model by weighting method, and used this model to analyze the information spillover relationship between RMB and seven major developed contries, currency from July 22, 2005 to the end of 2017. The results showed that: The current international influence of the RMB is not high, far lower than the influence levels of other developed countries' currencies, but it shows a rising trend; especially after the "811" exchange reform in 2015, the international influence of the RMB has been greatly improved; from the rolling window analysis and structure change-point test, the improvement of the marketization level of the RMB exchange rate formation mechanism and international status are two main factors that have led to major changes in the international influence of the RMB. Overall, the weighted modified Diebold & Yilmaz spillover index model can more sensitively reflect changes in the international influence of the RMB. To improve the international influence of the RMB, one key is to continuously increase the marketization level of the exchange rate market. [ABSTRACT FROM AUTHOR]

Background: As one of its Millennium Development Goals (MDGs), China has achieved a dramatic reduction in the maternal mortality ratio (MMR), although a distinct spatial heterogeneity still persists. Evidence of the quantitative effects of determinants on MMR in China is limited. A better understanding of the spatiotemporal heterogeneity and quantifying determinants of the MMR would support evidence-based policymaking to sustainably reduce the MMR in China and other developing areas worldwide. Methods and findings: We used data on MMR collected by the National Maternal and Child Health Surveillance System (NMCHSS) at the county level in China from 2010 to 2013. We employed a Bayesian space–time model to investigate the spatiotemporal trends in the MMR from 2010 to 2013. We used Bayesian multivariable regression and GeoDetector models to address 3 main ecological determinants of the MMR, including per capita income (PCI), the proportion of pregnant women who delivered in hospitals (PPWDH), and the proportion of pregnant women who had at least 5 check-ups (PPWFC). Among the 2,205 counties, there were 925 (42.0%) hotspot counties, located mostly in China's western and southwestern regions, with a higher MMR, and 764 (34.6%) coldspot counties with a lower MMR than the national level. China's westernmost regions, including Tibet and western Xinjiang, experienced a weak downward trend over the study period. Nationwide, medical intervention was the major determinant of the change in MMR. The MMR decreased by 1.787 (95% confidence interval [CI]: 1.424–2.142, p < 0.001) per 100,000 live births when PPWDH increased by 1% and decreased by 0.623 (95% CI 0.436–0.798, p < 0.001) per 100,000 live births when PPWFC increased by 1%. The major determinants for the MMR in China's western and southwestern regions were PCI and PPWFC, while that in China's eastern and southern coastlands was PCI. The MMR in western and southwestern regions decreased nonsignificantly by 1.111 (95% CI −1.485–3.655, p = 0.20) per 100,000 live births when PCI in these regions increased by 1,000 Chinese Yuan and decreased by 1.686 (95% CI 1.275–2.090, p < 0.001) when PPWFC increased by 1%. Additionally, the western and southwestern regions showed the strongest interactive effects between different factors, in which the corresponding explanatory power of any 2 interacting factors reached up to greater than 80.0% (p < 0.001) for the MMR. Limitations of this study include a relatively short study period and lack of full coverage of eastern coastlands with especially low MMR. Conclusions: Although China has accomplished a 75% reduction in the MMR, spatial heterogeneity still exists. In this study, we have identified 925 (hotspot) high-risk counties, mostly located in western and southwestern regions, and among which 332 counties are experiencing a slower pace of decrease than the national downward trend. Nationally, medical intervention is the major determinant. The major determinants for the MMR in western and southwestern regions, which are developing areas, are PCI and PPWFC, while that in China's developed areas is PCI. The interactive influence of any two of the three factors, PCI, PPWDH, and PPWFC, in western and southwestern regions was up to and in excess of 80% (p < 0.001). Junming Li and co-workers report on trends in maternal mortality at county level across China. Author summary: Why was this study done?: Information about the spatiotemporal trends of the maternal mortality ratio is helpful in the policymaking response to reducing the maternal mortality ratio (MMR) in developing areas. The study can help the government to preassess the effects of policy if the corresponding magnitudes of influence of the underlying determinants can be quantified. The quantitative statistical results of national and subnational influencing effects and patterns can help the government to create policies with precision. What did the researchers do and find?: We employed a Bayesian space–time model to explore the spatiotemporal trends of the MMR in 2,205 Chinese counties from 2010 to 2013 and used Bayesian multivariable regression and GeoDetector models to address 3 main ecological determinants of MMR. The major determinants of the MMR in China are medical intervention factors. The MMR will decrease by 1.787 (95% CI 1.424–2.142, p < 0.001) and 0.623 (95% CI 0.436–0.798, p < 0.001) per 100,000 live births when the proportion of hospital births and the proportion of 5 or more antenatal care visits increase by 1.0%. The major determinants for the MMR in the western and southwestern regions of China are per capita income and antenatal care, while in the eastern and southern coastal regions, it is per capita income. What do these results mean?: Many countries, and particularly developing countries, may learn from China's dramatic improvement in maternal survival rates. This progress has profited from long-term strategies to enhance delivery care in healthcare facilities and the provision of professional maternity care in large hospitals. There are, however, a variety of policy effects that have occurred in different areas due to regional heterogeneity. We have revealed the dominant factors and their corresponding influencing magnitudes at the national and subnational level, and this evidence may help China or other developing countries to preassess policy effects. [ABSTRACT FROM AUTHOR]

The article offers an analysis of the domestic politics surrounding the internationalization of the Chinese currency, the renminbi (RMB). It describes the primary role played by the People's Bank of China (PBC) in the internationalization of RMB. The impact of the global financial crisis of 2008-2009 and the U.S. monetary policy on the currency is discussed, as well as the buildup of foreign exchange reserves due to the Chinese central bank's foreign exchange market interventions. Also explored is the effort by the PBC to reinforce its monetary policy effectiveness.

China's increasing trade volume and continuous integration with global financial markets have strengthened the influences of the renminbi on the exchange rates of different currencies. Previous studies find closer co-movements between the renminbi and other currencies. This paper is novel to investigate the underlying determinants of the comovement further, using panel data of over thirty-four countries. Our results show that stronger bilateral trade and financial linkages with China have a positive association with the currency co-movement. Moreover, countries with greater flexibility in exchange rate regimes show stronger co-movements. These findings imply that growing co-movements are the consequence of autonomous decisions at the market rather than that of management by governments or central banks. [ABSTRACT FROM AUTHOR]

Despite burgeoning research on the internationalization of the Chinese renminbi, there has been surprisingly little systematic analysis of how the renminbi is actually used in foreign markets. This study provides a crosscountry analysis of renminbi use in offshore foreign exchange markets, with special attention to the effects of the cooperative policy measures adopted by China and foreign states to promote the renminbi's international use. We find that a country's participation in the Renminbi Qualified Foreign Institutional Investor scheme (which expands its renminbi investment opportunities) and its establishment of an offshore renminbi clearing bank (which provides better renminbi payment services), but not its entry into a renminbi--local currency swap agreement, facilitate use of the renminbi in its foreign exchange markets. States have played a significant role in the rise of the renminbi as a newly internationalizing currency. [ABSTRACT FROM AUTHOR]

Background: Renal replacement therapy was a lifesaving yet high-cost treatment for people with end-stage kidney disease (ESKD). This study aimed to estimate the direct medical costs per capita of ESKD by different treatment strategies: haemodialysis (HD); peritoneal dialysis (PD); kidney transplantation (KT) (in the first year); KT (in the second year), and by two urban health insurance schemes.Methods: This was a retrospective observational cohort study. Data were obtained from outpatient and inpatient claims database of two urban health insurance from Guangzhou City, Southern China. Adult patients with HD (n = 3765; mean age 58 years), PD (n = 1237; 51 years), KT (first year) (n = 117; 37 years) and KT (second year) (n = 41; 39 years) were identified between 2010 and 2012. The primary outcome was the annual per patient medical costs in 2013 Chinese Yuan (CNY) incurred in the outpatient and inpatient sectors. Secondary outcomes were annual outpatient visits and inpatient admissions, length of stay per admission. Generalized linear regression and bootstrapping statistical methods were used for analysis.Results: The estimated average annual medical costs for patients on HD were CNY 94,760.5 (US$15,066.0), 95% Confidence Interval (CI): CNY85,166.6-106,972.2, which was higher than those for patients on PD [CNY80,762.9 (US$12,840.5), 95% CI: CNY 76,249.8-85,498.9]. The estimated annual cost ratio of HD versus PD was 1.17 (95% CI: 1.12-1.25). Among the transplanted patients, the estimated average annual medical costs in the first year were CNY132,253.0 (US$21,026.9), 95%CI: CNY114,009.9-153,858.6, and in the second year were CNY93,155.3 (US$14,810.8), 95%CI: CNY61,120.6-101,989.1. The mean annual medical costs for dialysis patients under Urban Employee-based Basic Medical Insurance scheme were significantly higher than those for patients under Urban Resident-based Basic Medical Insurance scheme (P < 0.001).Conclusions: The direct medical costs of ESKD patients were high and different by types of renal replacement therapy and insurance. The findings can be used to conduct cost-effectiveness research on different types of RRT for ESKD patients that provides economic evidence for health policy design in China. [ABSTRACT FROM AUTHOR]

• Location optimization model of recyclable MSW recycling center (RRC) was developed. • The model was based on p-median method and total cost minimization. • The optimal number of RRCs for case of Shanghai China was proved to be 14. • Optimized RRCs were located in rural area but surrounded populated urban area. • Optimal RRCs will change with unit transportation cost and unit scale cost. The establishment of recycling network is critical to improve municipal solid waste (MSW) management. However, how to determine the best locations for the recycling stations and recycling centers remains to be solved. Under such a circumstance, this study aims to forecast the MSW generation and develop a cost-based location optimization model using p-median method so that the optimal scale and location of recycling centers can be identified. Shanghai, with an ambitious plan for promoting MSW recycling at the city level, was selected as a case study city. Results show that Shanghai's MSW generation rate will be about 3% from 2017 to 2020. Regional distribution analysis shows that the downtown areas have higher intensity for MSW generation due to high population density and consumption level. Fourteen regional recycling centers were identified to be the optimal places for establishing recycling centers. The achievement of this scenario can lead to the lowest total cost of 144 million Chinese Yuan. Moreover, the optimal results may change if unit transportation cost and unit scale cost are changed. For instance, the optimal numbers of recycling centers will increase with the increase of unit transportation cost or decrease of unit scale cost. Finally, model limitations and policy recommendations are raised by considering the local realities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prescribing trends of glaucoma drugs in six major cities of China from 2013 to 2017. Methods: A descriptive analysis using pharmacy prescription data was conducted. Outpatient prescription data was extracted from the Hospital Prescription Analysis Cooperative Project. Prescribing patterns, trends of visits, and corresponding expenditures for glaucoma medications were analyzed. Results: A total of 84297 ambulatory prescriptions were included in the current study. Visits by glaucoma patients increased from 13808 in 2013 to 20060 in 2017. Over the same period, the yearly expenditure for glaucoma drugs increased from 2.33 million to 3.95 million Chinese Yuan (CNY). Among all the six classes of glaucoma drugs (prostaglandin analogues, carbonic anhydrase inhibitors, α-receptor agonists, β-receptor antagonists, cholinergic agonists and fixed combinations), β-receptor antagonists were the most commonly prescribed in 2013, accounting for 34.3% of patients, but gradually decreased to 27.1% in 2017. Prostaglandin analogues became the most frequently prescribed drugs in 2017, accounting for 30.2% of the visits. Prostaglandin analogues are the most expensive and yielded a total expenditure of 2.34 million CNY in 2017, followed by carbonic anhydrase inhibitors, α-receptor agonists, β-receptor antagonists, fixed combinations, and cholinergic agonists. Combination therapy became increasingly prescribed in 2017. Conclusion: Glaucoma prescribing practices exhibited substantial changes over the study period. The number of glaucoma prescriptions continuously increased from 2013 to 2017, leading to increased prescription costs. These findings implied a similar trend observed in previous studies, as well as recommendations in the appropriate guidelines. [ABSTRACT FROM AUTHOR]

Background and Objectives: There are a few problems restraining the effective operation of telemedicine in China. On the basis of practices of the Henan Province Telemedicine Center of China (HTCC), the purpose of this study was to design a telemedicine system jointly driven by videoconferencing and data exchange to address the issues limiting the further development and implementation of telemedicine. Methods: Based on service-oriented architecture, the organizational design of the telemedicine system was gradually refined from top to bottom to complete its hierarchical layout. Technologies including multiprotocol stack adaptation, self-adaptive multilink network transmission, information exchange of heterogeneous medical systems, and open application system architecture were also used to construct the system. Results: The telemedicine system realizes the integration of videoconferencing, data acquisition and exchange of heterogeneous medical information systems, and the actual applications and expansion of telemedicine services. The HTCC currently covers more than 500 telemedicine centers, workstations, and service points, forming a five-level "province-city-county-township-village" telemedicine network linkage. The HTCC handles nearly 30,000 teleconsultation cases per year, helping patients save about ¥120 million Chinese Yuan RMB (approximately US $17.5 million). Conclusions: The proposed telemedicine system achieves satisfactory operation effects, along with social and economic benefits. It has the potential to increase the coverage of medical resources in remote regions, and it can play a role in solving other problems facing telemedicine development in China. The findings also inform measures for further improvement in telemedicine's implementation effects, service quality, and application scope in China and globally. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the comparative efficacy and safety of lixisenatide combined with basal insulin (BI) vs intensive premix insulin (premix), BI plus prandial insulin with the main meal (basal‐plus) or progressively covering all meals (basal‐bolus) in patients with type 2 diabetes mellitus (T2DM) inadequately controlled by BI, and the long‐term cost‐effectiveness of lixisenatide from a Chinese healthcare system perspective. Materials and methods: Randomized controlled trials (RCTs) published between 1998 and 2018 were systematically searched. The clinical efficacy and safety of each treatment were compared by network meta‐analysis (NMA). The IQVIA CORE Diabetes Model was used to estimate the lifetime quality‐adjusted life‐years (QALYs) and direct medical costs of patients treated with different strategies. Results: Eight RCTs were finally included. Lixisenatide plus BI showed a similar reduction in HbA1c from baseline compared with premix, basal‐plus and basal‐bolus. There were significant differences in the change of body weight in favour of lixisenatide plus BI compared with the three insulin regimens. The risk of symptomatic hypoglycaemia of lixisenatide plus BI was significantly lower compared with premix and basal‐bolus. Lixisenatide plus BI was cost‐effective compared with premix, basal‐plus and basal‐bolus with incremental cost‐effectiveness ratios of Chinese yuan (CNY) 87 219, 48 173 and 48 670 per QALY gained, respectively, under the threshold of three times the gross domestic product (GDP) per capita in China. Conclusions: Lixisenatide plus BI shows a similar HbA1c reduction compared with insulin regimens, accompanied by lower risk of hypoglycaemia and greater body weight reduction. It is a cost‐effective treatment alternative for patients with T2DM inadequately controlled by BI in China. [ABSTRACT FROM AUTHOR]