Variation of cataract surgery costs in four different graded providers of China

<p>Abstract</p> <p>Background</p> <p>China has the largest population of cataract patients in the world. However, the cataract surgery rate per million remains low in China. We carried out a survey on costs of cataract surgery from four different graded providers in China and analyzed differences in cost among these clinics.</p> <p>Methods</p> <p>1,189 patients were recruited for the study in four eye clinics, located in two provinces, Guangdong province in southern China and Hubei province in central China. The average cost of each cataract surgery episode was calculated including cost of intraocular lens, cost of drugs and facility cost. We also collected information on reimbursement and disposable annual income of local residents.</p> <p>Results</p> <p>Mean total cost per cataract intervention of four different providers varied considerably, ranging from US$1,293 in Union Hospital to US$ 536 in Jingshan County Hospital. In all providers, except for Jingshan County Hospital, the cost exceeded annual disposable income of local rural residents. As to the proportion of patients with reimbursement, the figure for Union Hospital was only 36%, while for other three clinics it was more than 60%. There was a significant difference between mean reimbursement ratios, with the highest ratio in Zhongshan Ophthalmic Center being 71%.</p> <p>Conclusions</p> <p>Significant differences in costs of cataract surgery were found among the 4 different graded providers. A part of the cost was borne by patients. Proportion of patients with reimbursement and mean reimbursement ratios were higher in economically developed regions than in economically developing regions. Much more financial support should be directed into the rural New Cooperative Medical Scheme to raise the reimbursement ratio in rural China.</p

Safe vs. Fair: A formidable trade-off in tackling climate change

Global warming requires a response characterized by forward-looking management of atmospheric carbon and respect for ethical principles. Both safety and fairness must be pursued, and there are severe trade-offs as these are intertwined by the limited headroom for additional atmospheric CO2 emissions. This paper provides a simple numerical mapping at the aggregated level of developed vs. developing countries in which safety and fairness are formulated in terms of cumulative emissions and cumulative per capita emissions respectively. It becomes evident that safety and fairness cannot be achieved simultaneously for strict definitions of both. The paper further posits potential global trading in future cumulative emissions budgets in a world where financial transactions compensate for physical emissions: the safe vs. fair tradeoff is less severe but remains formidable. Finally, we explore very large deployment of engineered carbon sinks and show that roughly 1,000 Gt CO2 of cumulative negative emissions over the century are required to have a significant effect, a remarkable scale of deployment. We also identify the unexplored issue of how such sinks might be treated in sub-global carbon accounting

Glutamic Acid Decarboxylase-Derived Epitopes with Specific Domains Expand CD4+CD25+ Regulatory T Cells

BACKGROUND:CD4(+)CD25(+) regulatory T cell (Treg)-based immunotherapy is considered a promising regimen for controlling the progression of autoimmune diabetes. In this study, we tested the hypothesis that the therapeutic effects of Tregs in response to the antigenic epitope stimulation depend on the structural properties of the epitopes used. METHODOLOGY/PRINCIPAL FINDINGS:Splenic lymphocytes from nonobese diabetic (NOD) mice were stimulated with different glutamic acid decarboxylase (GAD)-derived epitopes for 7-10 days and the frequency and function of Tregs was analyzed. We found that, although all expanded Tregs showed suppressive functions in vitro, only p524 (GAD524-538)-expanded CD4(+)CD25(+) T cells inhibited diabetes development in the co-transfer models, while p509 (GAD509-528)- or p530 (GAD530-543)-expanded CD4(+)CD25(+) T cells had no such effects. Using computer-guided molecular modeling and docking methods, the differences in structural characteristics of these epitopes and the interaction mode (including binding energy and identified domains in the epitopes) between the above-mentioned epitopes and MHC class II I-A(g7) were analyzed. The theoretical results showed that the epitope p524, which induced protective Tregs, possessed negative surface-electrostatic potential and bound two chains of MHC class II I-A(g7), while the epitopes p509 and p530 which had no such ability exhibited positive surface-electrostatic potential and bound one chain of I-A(g7). Furthermore, p524 bound to I-A(g7) more stably than p509 and p530. Of importance, we hypothesized and subsequently confirmed experimentally that the epitope (GAD570-585, p570), which displayed similar characteristics to p524, was a protective epitope by showing that p570-expanded CD4(+)CD25(+) T cells suppressed the onset of diabetes in NOD mice. CONCLUSIONS/SIGNIFICANCE:These data suggest that molecular modeling-based structural analysis of epitopes may be an instrumental tool for prediction of protective epitopes to expand functional Tregs

Drying shrinkage of alkali-activated slag and fly ash concrete; A comparative study with ordinary Portland cement concrete

This study investigates the drying shrinkage and the shrinkage-induced stress of alkali-activated blast furnace slag and fly ash concrete (AC) in comparison with ordinary Portland cement concrete (OC). For samples that were dried from 1 day after casting, the drying shrinkage of AC was much higher than that of OC. For samples that were stored in a sealed condition for 28 days before drying, the subsequent drying shrinkage amplitudes of AC and OC were comparable. In both conditions, the stresses generated in AC were higher than in OC at the beginning, but experienced great reductions after certain ages, reaching less than one-fourth of the stresses in OC in the end. The stresses decrease, i.e. relaxation in AC was attributed to the pronounced non-elastic deformability of CASH gels. The non-elastic deformability of AC reduced the risk of thorough cracking, but maybe at the expense of the development of local microcracks. It is recommended to protect AC from drying at an early age to avoid micro and macrocracking.</p

Comparative Genomics Reveals Evidence of Genome Reduction and High Extracellular Protein Degradation Potential in Kangiella

The genus Kangiella has recently been proposed within the family Kangiellaceae, belonging to order Oceanospirillales. Here, we report the complete genome sequence of a novel strain, Kangiella profundi FT102, which is the only Kangiella species isolated from a deep sea sediment sample. Furthermore, gaps in the publicly available genome scaffold of K. aquimarina DSM 16071 (NCBI Reference Sequence: NZ_ARFE00000000.1) were also filled using polymerase chain reaction (PCR) and Sanger sequencing. A comparative genomic analysis of five Kangiella and 18 non-Kangiella strains revealed insights into their metabolic potential. It was shown that low genomic redundancy and Kangiella-lineage-specific gene loss are the key reasons behind the genome reduction in Kangiella compared to that in any other free-living Oceanospirillales strain. The occurrence of relatively diverse and more frequent extracellular protease-coding genes along with the incomplete carbohydrate metabolic pathways in the genome suggests that Kangiella has high extracellular protein degradation potential. Growth of Kangiella strains has been observed using amino acids as the only carbon and nitrogen source and tends to increase with additional tryptone. Here, we propose that extracellular protein degradation and amino acid utilization are significant and prominent features of Kangiella. Our study provides more insight into the genomic traits and proteolytic metabolic capabilities of Kangiella

Where and How to Transfer: Knowledge Aggregation-Induced Transferability Perception for Unsupervised Domain Adaptation

Unsupervised domain adaptation without accessing expensive annotation processes of target data has achieved remarkable successes in semantic segmentation. However, most existing state-of-the-art methods cannot explore whether semantic representations across domains are transferable or not, which may result in the negative transfer brought by irrelevant knowledge. To tackle this challenge, in this paper, we develop a novel Knowledge Aggregation-induced Transferability Perception (KATP) module for unsupervised domain adaptation, which is a pioneering attempt to distinguish transferable or untransferable knowledge across domains. Specifically, the KATP module is designed to quantify which semantic knowledge across domains is transferable, by incorporating the transferability information propagation from constructed global category-wise prototypes. Based on KATP, we design a novel KATP Adaptation Network (KATPAN) to determine where and how to transfer. The KATPAN contains a transferable appearance translation module TA(·) and a transferable representation augmentation module TR(·), where both modules construct a virtuous circle of performance promotion. TA(·) develops a transferability-aware information bottleneck to highlight where to adapt transferable visual characterizations and modality information; TR(·) explores how to augment transferable representations while abandoning untransferable information, and promotes the translation performance of TA(·) in return. Comprehensive experiments on several representative benchmark datasets and a medical dataset support the state-of-the-art performance of our model

Drying shrinkage of alkali-activated slag and fly ash concrete; A comparative study with ordinary Portland cement concrete

This study investigates the drying shrinkage and the shrinkage-induced stress of alkali-activated blast furnace slag and fly ash concrete (AC) in comparison with ordinary Portland cement concrete (OC). For samples that were dried from 1 day after casting, the drying shrinkage of AC was much higher than that of OC. For samples that were stored in a sealed condition for 28 days before drying, the subsequent drying shrinkage amplitudes of AC and OC were comparable. In both conditions, the stresses generated in AC were higher than in OC at the beginning, but experienced great reductions after certain ages, reaching less than one-fourth of the stresses in OC in the end. The stresses decrease, i.e. relaxation in AC was attributed to the pronounced non-elastic deformability of CASH gels. The non-elastic deformability of AC reduced the risk of thorough cracking, but maybe at the expense of the development of local microcracks. It is recommended to protect AC from drying at an early age to avoid micro and macrocracking.Materials and Environmen

Image_3_Comparative Genomics Reveals Evidence of Genome Reduction and High Extracellular Protein Degradation Potential in Kangiella.TIF

<p>The genus Kangiella has recently been proposed within the family Kangiellaceae, belonging to order Oceanospirillales. Here, we report the complete genome sequence of a novel strain, Kangiella profundi FT102, which is the only Kangiella species isolated from a deep sea sediment sample. Furthermore, gaps in the publicly available genome scaffold of K. aquimarina DSM 16071 (NCBI Reference Sequence: NZ_ARFE00000000.1) were also filled using polymerase chain reaction (PCR) and Sanger sequencing. A comparative genomic analysis of five Kangiella and 18 non-Kangiella strains revealed insights into their metabolic potential. It was shown that low genomic redundancy and Kangiella-lineage-specific gene loss are the key reasons behind the genome reduction in Kangiella compared to that in any other free-living Oceanospirillales strain. The occurrence of relatively diverse and more frequent extracellular protease-coding genes along with the incomplete carbohydrate metabolic pathways in the genome suggests that Kangiella has high extracellular protein degradation potential. Growth of Kangiella strains has been observed using amino acids as the only carbon and nitrogen source and tends to increase with additional tryptone. Here, we propose that extracellular protein degradation and amino acid utilization are significant and prominent features of Kangiella. Our study provides more insight into the genomic traits and proteolytic metabolic capabilities of Kangiella.</p