A health economic analysis of an integrated diabetes care program in China: based on real-world evidence

IntroductionAn integrated care program was set up in China to improve the collaboration between primary healthcare centers and hospitals on diabetes management. This study aims to evaluate the economic value of this program with real-world data and to examine whether it can be promoted in primary healthcare settings in China.MethodsThis integrated diabetes care program was implemented in Yuhuan City, China, to coordinate primary care and specialty care, treatment and prevention services, as well as the responsibilities of doctors and nurses. Cost-effectiveness analysis was used to compare the short-term economic value of this program (intervention group) versus usual diabetes management (control group). The cost data were collected from a societal perspective, while the effectiveness indicators pointed to the improvement of control rates of fasting blood glucose (FBG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels after the 1 year intervention. In addition, cost-utility analysis was applied to evaluate the long-term value of the two groups. Patients’ long-term diabetes management costs and quality-adjusted life years (QALYs) were simulated by the United Kingdom Prospective Diabetes Study Outcomes Model 2.ResultsThe results showed that for 1% FBG, SPB, and DBP control rate improvement, the costs for the intervention group were 290.53, 124.39, and 249.15 Chinese Yuan (CNY), respectively, while the corresponding costs for the control group were 655.19, 610.43, and 1460.25 CNY. Thus, the intervention group’s cost-effectiveness ratios were lower than those of the control group. In addition, compared to the control group, the intervention group’s incremental costs per QALY improvement were 102.67 thousand CNY, which means that the intervention was cost-effective according to the World Health Organization’s standards.DiscussionIn conclusion, this study suggested that this integrated diabetes care program created short-term and long-term economic values through patient self-management support, primary care strengthening, and care coordination. As this program followed the principles of integrated care reform, it can be promoted in China. Also, its elements can provide valuable experience for other researchers to build customized integrated care models

Assessment of toxicity reduction in ZnS substituted CdS:P3HT bulk heterojunction solar cells fabricated using a single-source precursor deposition

Utilisation of cadmium sulphide (CdS) for the preparation of hybrid bulk heterojunction (BHJ) solar cells is limited due to its high human, soil and marine toxicity. This work aims to reduce the toxicity of the cadmium based hybrid bulk heterojunctions, by varying the composition of metal sulphide nanoparticles between CdS and zinc sulphide (ZnS). Furthermore, these devices were created using a single-source precursor, which limits potential barriers for scaling up this process to industrial scale. It was found that the chemical composition of fabricated devices varied as expected; however, comparable morphologies were noted by SEM analyses. Toxicity of fabricated photovoltaic devices was estimated according to the life cycle assessment methodology, using the SimaPro software. Although negligible changes between the band gaps of prepared devices were calculated by decreasing the Cd load to 50 wt%, over 50 % reduction to human toxicity could be achieved. As a photovoltaic device, the highest power conversion efficiency (0.018 %) was observed for the device containing 75 wt% Cd and 25 wt% Zn, which also showed significant reductions for human and environmental toxicity (25 % and 19 % reduction, respectively) in comparison to the device containing only CdS, while increasing the power conversion efficiency by roughly 30 %. It was also noted that although the ZnS only device had the lowest efficiency (0.002 %, a decrease of roughly 98 %), however, this allowed for a 99 % reduction in human toxicity and a 73 % reduction in terrestrial ecotoxicity

Characterization of fibroblast growth factor 1 in obese children and adolescents

Background: Fibroblast growth factor 1 (FGF1) can regulate glucose and lipid metabolism in obese mice. Serum FGF1 has increased in type 2 diabetes mellitus adults and correlated with BMI. This study aimed to indicate conventional weight loss effects on FGF1 in obese children and adolescents. Materials and methods: Clinical and metabolic parameters of 88 lean and obese individuals (ages 5–15 years) and 39 obese individuals followed with 6 months of lifestyle intervention were collected. Serum FGF1 levels were detected through enzyme-linked immunosorbent assays. Results: FGF1 levels were increased in obese individuals. Serum FGF1 levels were significantly correlated with BMI and waist circumferences (r = 0.377, P = 0.012; r = 0.301, P = 0.047, respectively). Multivariate stepwise linear regression analyses showed that FGF1 levels were significantly correlated with HbA1c and HOMA-IR (β = 0.371, P = 0.008; β = 0.323, P = 0.021, respectively). Weight loss (2.3 ± 0.1 kg) was accompanied by a significant reduction of circulating FGF1 levels (7.2 ± 0.4 pg/mL). Changes in FGF1 were significantly correlated with changes in fasting glucose, HOMA-IR and low-density lipoprotein cholesterol (β = 0.277, P = 0.020; β = 0.474, P < 0.001; β = 0.320, P = 0.008, respectively). Conclusion: FGF1 was related to increased risk of insulin resistance in obese children and adolescents. Serum FGF1 reduced after weight loss in obese individuals and was associated with the improvement of insulin resistance. Changes in serum FGF1 were more correlated with insulin resistance than changes in obesity per se

A cloud-edge based data security architecture for sharing and analyzing cyber threat information

Cyber-attacks affect every aspect of our lives. These attacks have serious consequences, not only for cyber-security, but also for safety, as the cyber and physical worlds are increasingly linked. Providing effective cyber-security requires cooperation and collaboration among all the entities involved. Increasing the amount of cyber threat information (CTI) available for analysis allows better prediction, prevention and mitigation of cyber-attacks. However, organizations are deterred from sharing their CTI over concerns that sensitive and confidential information may be revealed to others. We address this concern by providing a flexible framework that allows the confidential sharing of CTI for analysis between collaborators. We propose a five-level trust model for a cloud-edge based data sharing infrastructure. The data owner can choose an appropriate trust level and CTI data sanitization approach, ranging from plain text, through anonymization/pseudonymization to homomorphic encryption, in order to manipulate the CTI data prior to sharing it for analysis. Furthermore, this sanitization can be performed by either an edge device or by the cloud service provider, depending upon the level of trust the organization has in the latter. We describe our trust model, our cloud-edge infrastructure, and its deployment model, which are designed to satisfy the broadest range of requirements for confidential CTI data sharing. Finally we briefly describe our implementation and the testing that has been carried out so far by four pilot projects that are validating our infrastructure

Autonomous Overlapping Community Detection in Temporal Networks: A Dynamic Bayesian Nonnegative Matrix Factorization Approach.

A wide variety of natural or artificial systems can be modeled as time-varying or temporal networks. To understand the structural and functional properties of these time-varying networked systems, it is desirable to detect and analyze the evolving community structure. In temporal networks, the identified communities should reflect the current snapshot network, and at the same time be similar to the communities identified in history or say the previous snapshot networks. Most of the existing approaches assume that the number of communities is known or can be obtained by some heuristic methods. This is unsuitable and complicated for most real world networks, especially temporal networks. In this paper, we propose a Bayesian probabilistic model, named Dynamic Bayesian Nonnegative Matrix Factorization (DBNMF), for automatic detection of overlapping communities in temporal networks. Our model can not only give the overlapping community structure based on the probabilistic memberships of nodes in each snapshot network but also automatically determines the number of communities in each snapshot network based on automatic relevance determination. Thereafter, a gradient descent algorithm is proposed to optimize the objective function of our DBNMF model. The experimental results using both synthetic datasets and real-world temporal networks demonstrate that the DBNMF model has superior performance compared with two widely used methods, especially when the number of communities is unknown and when the network is highly sparse

Solenoid-free current drive via ECRH in EXL-50 spherical torus plasmas

As a new spherical tokamak (ST) designed to simplify engineering requirements of a possible future fusion power source, the EXL-50 experiment features a low aspect ratio (A) vacuum vessel (VV), encircling a central post assembly containing the toroidal field coil conductors without a central solenoid. Multiple electron cyclotron resonance heating (ECRH) resonances are located within the VV to improve current drive effectiveness. Copious energetic electrons are produced and measured with hard X-ray detectors, carry the bulk of the plasma current ranging from 50kA to 150kA, which is maintained for more than 1s duration. It is observed that over one Ampere current can be maintained per Watt of ECRH power issued from the 28-GHz gyrotrons. The plasma current reaches Ip>80kA for high density (>5e18me-2) discharge with 150kW ECHR heating. An analysis was carried out combining reconstructed multi-fluid equilibrium, guiding-center orbits of energetic electrons, and resonant heating mechanisms. It is verified that in EXL-50 a broadly distributed current of energetic electrons creates smaller closed magnetic-flux surfaces of low aspect ratio that in turn confine the thermal plasma electrons and ions and participate in maintaining the equilibrium force-balance

Genetic and molecular analysis of the anthocyanin pigmentation pathway in Epimedium

IntroductionFlower color is an ideal trait for studying the molecular basis for phenotypic variations in natural populations of species. Epimedium (Berberidaceae) species exhibit a wide range of flower colors resulting from the varied accumulation of anthocyanins and other pigments in their spur-like petals and petaloid sepals.MethodsIn this work, the anthocyanidins of eight different Epimedium species with different floral pigmentation phenotypes were analyzed using HPLC. Twelve genes involved in anthocyanin biosynthesis were cloned and sequenced, and their expression was quantified.ResultsThe expression levels of the catalytic enzyme genes DFR and ANS were significantly decreased in four species showing loss of floral pigmentation. Complementation of EsF3’H and EsDFR in corresponding Arabidopsis mutants together with overexpression of EsF3’5’H in wild type Arabidopsis analysis revealed that these genes were functional at the protein level, based on the accumulation of anthocyanin pigments.DiscussionThese results strongly suggest that transcriptional regulatory changes determine the loss of anthocyanins to be convergent in the floral tissue of Epimedium species

Ultra-short lifetime isomer studies from photonuclear reactions using laser-driven ultra-intense {\gamma}-ray

Isomers, ubiquitous populations of relatively long-lived nuclear excited states, play a crucial role in nuclear physics. However, isomers with half-life times of several seconds or less barely had experimental cross section data due to the lack of a suitable measuring method. We report a method of online {\gamma} spectroscopy for ultra-short-lived isomers from photonuclear reactions using laser-driven ultra-intense {\gamma}-rays. The fastest time resolution can reach sub-ps level with {\gamma}-ray intensities >10^{19}/s ({\geqslant} 8 MeV). The ^{115}In({\gamma}, n)^{114m2}In reaction (T_{1/2} = 43.1 ms) was first measured in the high-energy region which shed light on the nuclear structure studies of In element. Simulations showed it would be an efficient way to study ^{229m}Th (T_{1/2} = 7 {\mu}s), which is believed to be the next generation of nuclear clock. This work offered a unique way of gaining insight into ultra-short lifetimes and promised an effective way to fill the gap in relevant experimental data

The Metallic State in Neutral Radical Conductors: Dimensionality, Pressure and Multiple Orbital Effects

Pressure-induced changes in the solid-state structures and transport properties of three oxobenzene-bridged bisdithiazolyl radicals 2 (R = H, F, Ph) over the range 0–15 GPa are described. All three materials experience compression of their π-stacked architecture, be it (i) 1D ABABAB π-stack (R = Ph), (ii) quasi-1D slipped π-stack (R = H), or (iii) 2D brick-wall π-stack (R = F). While R = H undergoes two structural phase transitions, neither of R = F, Ph display any phase change. All three radicals order as spin-canted antiferromagnets, but spin-canted ordering is lost at pressures <1.5 GPa. At room temperature, their electrical conductivity increases rapidly with pressure, and the thermal activation energy for conduction Eact is eliminated at pressures ranging from ∼3 GPa for R = F to ∼12 GPa for R = Ph, heralding formation of a highly correlated (or bad) metallic state. For R = F, H the pressure-induced Mott insulator to metal conversion has been tracked by measurements of optical conductivity at ambient temperature and electrical resistivity at low temperature. For R = F compression to 6.2 GPa leads to a quasiquadratic temperature dependence of the resistivity over the range 5–300 K, consistent with formation of a 2D Fermi liquid state. DFT band structure calculations suggest that the ease of metallization of these radicals can be ascribed to their multiorbital character. Mixing and overlap of SOMO- and LUMO-based bands affords an increased kinetic energy stabilization of the metallic state relative to a single SOMO-based band system