To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
There is growing interest globally in using real-world data (RWD) and real-world evidence (RWE) for health technology assessment (HTA). Optimal collection, analysis, and use of RWD/RWE to inform HTA requires a conceptual framework to standardize processes and ensure consistency. However, such framework is currently lacking in Asia, a region that is likely to benefit from RWD/RWE for at least two reasons. First, there is often limited Asian representation in clinical trials unless specifically conducted in Asian populations, and RWD may help to fill the evidence gap. Second, in a few Asian health systems, reimbursement decisions are not made at market entry; thus, allowing RWD/RWE to be collected to give more certainty about the effectiveness of technologies in the local setting and inform their appropriate use. Furthermore, an alignment of RWD/RWE policies across Asia would equip decision makers with context-relevant evidence, and improve timely patient access to new technologies. Using data collected from eleven health systems in Asia, this paper provides a review of the current landscape of RWD/RWE in Asia to inform HTA and explores a way forward to align policies within the region. This paper concludes with a proposal to establish an international collaboration among academics and HTA agencies in the region: the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) working group, which seeks to develop a non-binding guidance document on the use of RWD/RWE to inform HTA for decision making in Asia.
Increased intake of vegetables and fruits has been associated with reduced risk of tuberculosis infection. Vegetables and fruits exert immunoregulatory effects and may be beneficial for treating pulmonary tuberculosis. However, it is not clear whether vegetables and fruits have an adjuvant treatment effect on tuberculosis. Furthermore, limited research has been conducted on the effects of colour categories and specific types of vegetables on tuberculosis treatment outcome. Between 2009 and 2013, a hospital-based cohort study was conducted in Linyi, Shandong Province, China. Treatment outcome was ascertained by sputum smear and chest computerized tomography, and dietary intake was assessed by a semi-quantitative food frequency questionnaire. The dietary questionnaire was conducted at the end of month two of treatment initiation. Participants recalled their dietary intake of the previous two months. A total of 2,309 patients were enrolled in this study. After 6 months of treatment, 2,099 patients were successfully treated and 210 were uncured. In multivariate models, higher intake of total vegetables and fruits [OR (95% CI): 0.70 (0.49-0.99)], total vegetables [OR (95% CI): 0.68 (0.48-0.97)], dark-coloured vegetables [OR (95% CI): 0.61 (0.43-0.86)], light-coloured vegetables [OR (95% CI): 0.67 (0.48-0.95)] were associated with reduced failure rate of tuberculosis treatment. No association was found between total fruit intake and reduced failure rate of tuberculosis treatment [OR (95% CI): 0.98 (0.70-1.37)]. High intake of total vegetables and fruits, especially vegetables, is associated with lower risk of failure of tuberculosis treatment in pulmonary tuberculosis patients. The results provide important information for dietary guidelines during tuberculosis treatment.
Having enterprises engaged in environmentally friendly behavior is an important part of reducing negative environmental impacts. This study makes a quantitative analysis against the backdrop of China's transitional economic system. The results show that politically-connected enterprises significantly reduce environmental expenditure, but this only holds for state-owned enterprises; private enterprises with political connections spend significantly more. Analysis of the efficiency of environmental expenditure indicates that, for private enterprises, environmental spending is used as a way to maintain political connections, with rent-seeking as the likely motivation. Politically-connected private enterprises have not reduced their emissions to the same extent as state-owned enterprises, despite increased expenditure. Given the scale of environmental degradation in China during a period of massive economic and social upheaval, the results of this analysis provide a quantitative case for policy change: governments should shift focus to the results that environmental spending produces.
In order to expand the family and improve the bioactivity of oral implant ceramics, the phase structures, mechanical and wetting properties of the hot-pressed yttria-zirconia/multilayer graphene oxide composite (3Y-ZrO2/GO) ceramics were investigated. GO was uniformly distributed in 3Y-ZrO2 powders, forming the C–O–Zr bond during the sintering process. In comparison to raw 3Y-ZrO2 ceramics, the flexural strength and fracture toughness improved up to 200% (1489.96 ± 35.71 MPa) in ZG3 (with 0.15 wt% GO) and 40.9% (8.95 ± 0.59 MPa m1/2) in ZG2 (with 0.1 wt% GO), respectively, while the relative density and Vickers hardness increased slightly. The toughening mechanisms included crack deflection, crack bridging, and GO put-out. Meanwhile, the composite ceramics were transformed into a more hydrophilic direction and indicated a good wetting property. In consideration of mechanical and wetting properties, the ZG3 would be a favorable alternative to the yttria-zirconia ceramic (Y-TZP) in dental implant applications. The results are expected to serve as a technical guidance for the fabrication and evaluation of dental implants.
This research involves a compact wideband circularly-polarized antenna array, which consists of a sequential rotating phase feed network, 2 × 2 mushroom-type metamaterial (MTM) unit, and so on. Each antenna array unit contains a microstrip feedline, an L-shaped slot antenna, and so on. The MTM-based antennas were incorporated with a sequential-phase network of sequentially rotated series-parallel feed to achieve wideband operation. The operational bandwidth and the radiation model in the high-frequency area were improved through the adjustment of spacing between the L-shaped slots while maintaining the size and structure of the MTM. The proposed design had dimensions of 80 mm × 80 mm × 3.5 mm (~1.64 λ0 × 1.64 λ0 × 0.072 λ0 at 6.15 GHz), and it was simulated, fabricated, and tested.
A novel coronavirus disease, designated as COVID-19, has become a pandemic worldwide. This study aims to estimate the incubation period and serial interval of COVID-19. We collected contact tracing data in a municipality in Hubei province during a full outbreak period. The date of infection and infector–infectee pairs were inferred from the history of travel in Wuhan or exposed to confirmed cases. The incubation periods and serial intervals were estimated using parametric accelerated failure time models, accounting for interval censoring of the exposures. Our estimated median incubation period of COVID-19 is 5.4 days (bootstrapped 95% confidence interval (CI) 4.8–6.0), and the 2.5th and 97.5th percentiles are 1 and 15 days, respectively; while the estimated serial interval of COVID-19 falls within the range of −4 to 13 days with 95% confidence and has a median of 4.6 days (95% CI 3.7–5.5). Ninety-five per cent of symptomatic cases showed symptoms by 13.7 days (95% CI 12.5–14.9). The incubation periods and serial intervals were not significantly different between male and female, and among age groups. Our results suggest a considerable proportion of secondary transmission occurred prior to symptom onset. And the current practice of 14-day quarantine period in many regions is reasonable.
Institutional demand for a stock before its earnings announcement is negatively related to subsequent returns. The relation is not attributable to the price pressure of institutional demand and is stronger for stocks with higher information asymmetry and/or greater valuation difficulty. These findings support the notion that overconfident institutions misprice stocks. Following announcements, institutions’ behavior exhibits the outcome-dependent feature of self-attribution bias. Whether they become more overconfident and delay their mispricing correction depends on whether earnings news confirms their preannouncement trades. This behavioral bias also offers a new explanation for the well-known post-earnings-announcement drift.
Primary liver cancer is the third leading cause of cancer-related death worldwide. Most patients are diagnosed at late stages with poor prognosis; thus, identification of modifiable risk factors for primary prevention of liver cancer is urgently needed. The well-established risk factors of liver cancer include chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), heavy alcohol consumption, metabolic diseases such as obesity and diabetes, and aflatoxin exposure. However, a large proportion of cancer cases worldwide cannot be explained by current known risk factors. Dietary factors have been suspected as important, but dietary aetiology of liver cancer remains poorly understood. In this review, we summarised and evaluated the observational studies of diet including single nutrients, food and food groups, as well as dietary patterns with the risk of developing liver cancer. Although there are large knowledge gaps between diet and liver cancer risk, current epidemiological evidence supports an important role of diet in liver cancer development. For example, exposure to aflatoxin, heavy alcohol drinking and possibly dairy product (not including yogurt) intake increase, while intake of coffee, fish and tea, light-to-moderate alcohol drinking and several healthy dietary patterns (e.g. Alternative Healthy Eating Index) may decrease liver cancer risk. Future studies with large sample size and accurate diet measurement are warranted and need to consider issues such as the possible aetiological heterogeneity between liver cancer subtypes, the influence of chronic HBV or HCV infection, the high-risk populations (e.g. cirrhosis) and a potential interplay with host gut microbiota or genetic variations.
Lassa fever (LF) is increasingly recognised as an important rodent-borne viral haemorrhagic fever presenting a severe public health threat to sub-Saharan West Africa. In 2017–18, LF caused an unprecedented epidemic in Nigeria and the situation was worsening in 2018–19. This work aims to study the epidemiological features of epidemics in different Nigerian regions and quantify the association between reproduction number (R) and state rainfall. We quantify the infectivity of LF by the reproduction numbers estimated from four different growth models: the Richards, three-parameter logistic, Gompertz and Weibull growth models. LF surveillance data are used to fit the growth models and estimate the Rs and epidemic turning points (τ) in different regions at different time periods. Cochran's Q test is further applied to test the spatial heterogeneity of the LF epidemics. A linear random-effect regression model is adopted to quantify the association between R and state rainfall with various lag terms. Our estimated Rs for 2017–18 (1.33 with 95% CI 1.29–1.37) was significantly higher than those for 2016–17 (1.23 with 95% CI: (1.22, 1.24)) and 2018–19 (ranged from 1.08 to 1.36). We report spatial heterogeneity in the Rs for epidemics in different Nigerian regions. We find that a one-unit (mm) increase in average monthly rainfall over the past 7 months could cause a 0.62% (95% CI 0.20%–1.05%)) rise in R. There is significant spatial heterogeneity in the LF epidemics in different Nigerian regions. We report clear evidence of rainfall impacts on LF epidemics in Nigeria and quantify the impact.
Autonomous ships are gaining in importance and are expected to shape the future of the global shipping industry. This evolutionary shift raises serious issues about compliance with the International Regulations for Preventing Collisions at Sea 1972 (COLREGs). This paper reviews the literature on autonomous ships from the perspective of the obligations of good seamanship imposed by COLREGs. The authors conclude that to facilitate the introduction of autonomous ships, the application barriers presented by COLREGs need to be analysed. With this goal, this paper presents a perspective from navigational practice. Four nautical scientists and two deck officers were invited to give their opinions. The analysis indicates that COLREGs require further elaboration and amendments to eliminate uncertainty of interpretation. In particular, the paper highlights the need to amend the ‘look-out’ rule (COLREGs Rule 5) to permit look-out by ‘computer vision’ alone while, at the same time, preserving the distinction between vessels navigating in restricted visibility and in sight of one another.
Identifying risk factors and mortality of individuals with Alzheimer’s disease (AD) could have important implications for the clinical management of AD.
This pilot study aimed to examine the overall mortality of AD patients over a 10-year surveillance period in Shanghai, China. This study is an extension of our previous investigation on mortality of neurodegenerative diseases.
One hundred and thirty-two AD patients recruited from the memory clinics of two hospitals in Shanghai in 2007 were followed up until December 31, 2017 or death, representing a follow-up period of up to 10 years. Overall standardized mortality ratios (SMRs) were calculated, and predictors for survival at recruitment were estimated.
Sixty-seven patients had died by December 31, 2017, and the SMR at 10 years of follow-up was 1.225 (95% confidence interval 0.944–1.563). Employing Cox’s proportional hazard modeling, lower Mini-Mental State Examination score, and comorbid diabetes predicted poor survival in this cohort.
This pilot study suggests a similar survival trend of patients with AD compared to the general population in Shanghai urban region. Poor cognitive status and comorbid diabetes had a negative impact on the survival of AD patients.
Malnutrition and acute kidney injury (AKI) are common complications in hospitalised patients, and both increase mortality; however, the relationship between them is unknown. This is a retrospective propensity score matching study enrolling 46 549 inpatients, aimed to investigate the association between Nutritional Risk Screening 2002 (NRS-2002) and AKI and to assess the ability of NRS-2002 and AKI in predicting prognosis. In total, 37 190 (80 %) and 9359 (20 %) patients had NRS-2002 scores <3 and ≥3, respectively. Patients with NRS-2002 scores ≥3 had longer lengths of stay (12·6 (sd 7·8) v. 10·4 (sd 6·2) d, P < 0·05), higher mortality rates (9·6 v. 2·5 %, P < 0·05) and higher incidence of AKI (28 v. 16 %, P < 0·05) than patients with normal nutritional status. The NRS-2002 showed a strong association with AKI, that is, the risk of AKI changed in parallel with the score of the NRS-2002. In short- and long-term survival, patients with a lower NRS-2002 score or who did not have AKI achieved a significantly lower risk of mortality than those with a high NRS-2002 score or AKI. Univariate Cox regression analyses indicated that both the NRS-2002 and AKI were strongly related to long-term survival (AUC 0·79 and 0·71) and that the combination of the two showed better accuracy (AUC 0·80) than the individual variables. In conclusion, malnutrition can increase the risk of AKI and both AKI and malnutrition can worsen the prognosis that the undernourished patients who develop AKI yield far worse prognosis than patients with normal nutritional status.
Human-like motion of robots can improve human–robot interaction and increase the efficiency. In this paper, a novel human-like motion planning strategy is proposed to help anthropomorphic arms generate human-like movements accurately. The strategy consists of three parts: movement primitives, Bayesian network (BN), and a novel coupling neural network (CPNN). The movement primitives are used to decouple the human arm movements. The classification of arm movements improves the accuracy of human-like movements. The motion-decision algorithm based on BN is able to predict occurrence probabilities of the motions and choose appropriate mode of motion. Then, a novel CPNN is proposed to solve the inverse kinematics problems of anthropomorphic arms. The CPNN integrates different models into a single network and reflects the features of these models by changing the network structure. Through the strategy, the anthropomorphic arms can generate various human-like movements with satisfactory accuracy. Finally, the availability of the proposed strategy is verified by simulations for the general motion of humanoid NAO.
A credit default swap (CDS) is an exchange of premium payments for a compensation for the occurrence of a credit event. Counterparty risks refer to defaults of parties holding CDS contracts. In this paper we develop a valuation/pricing model for a CDS subject to counterparty risks. Using the Cox–Ingersoll–Ross (CIR) model for interest rate and first arrival times of Poisson processes with variable intensities for the occurrences of credit default and counterparty defaults, we derive a mathematical formulation and make a full theoretical investigation. In addition, we develop a full theory for the corresponding infinite horizon problem and establish its connection with the asymptotic long expiry behaviour of finite horizon problem. Furthermore, we establish a connection between two major frameworks for default times: the structure model approach and the intensity model approach. We show that a solution of the structure model can be obtained as the limit of a sequence of solutions of intensity models. Regarded as an important theoretical development, we remove a constraint typically imposed on the parameters of the CIR model; that is, the well-posedness (existence, uniqueness and continuous dependence of parameters) of the mathematical model holds for any empirically calibrated parameters for the CIR model.
Existing data on folate status and hepatocellular carcinoma (HCC) prognosis are scarce. We prospectively examined whether serum folate concentrations at diagnosis were associated with liver cancer-specific survival (LCSS) and overall survival (OS) among 982 patients with newly diagnosed, previously untreated HCC, who were enrolled in the Guangdong Liver Cancer Cohort (GLCC) study between September 2013 and February 2017. Serum folate concentrations were measured using chemiluminescent microparticle immunoassay. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95 % CI by sex-specific quartile of serum folate. Compared with patients in the third quartile of serum folate, patients in the lowest quartile had significantly inferior LCSS (HR = 1·48; 95 % CI 1·05, 2·09) and OS (HR = 1·43; 95 % CI 1·03, 1·99) after adjustment for non-clinical and clinical prognostic factors. The associations were not significantly modified by sex, age at diagnosis, alcohol drinking status and Barcelona Clinic Liver Cancer (BCLC) stage. However, there were statistically significant interactions on both multiplicative and additive scale between serum folate and C-reactive protein (CRP) levels or smoking status and the associations of lower serum folate with worse LCSS and OS were only evident among patients with CRP > 3·0 mg/l or current smokers. An inverse association with LCSS were also observed among patients with liver damage score ≥3. These results suggest that lower serum folate concentrations at diagnosis are independently associated with worse HCC survival, most prominently among patients with systemic inflammation and current smokers. A future trial of folate supplementation seems to be promising in HCC patients with lower folate status.