Regional Variability in Survival for Patients Diagnosed with Selected Central Nervous System Tumours in Canada.

Canada's decentralized healthcare system may lead to regional disparities in survival among Canadians diagnosed with central nervous system (CNS) tumours. We identified 50,670 patients diagnosed with a first-ever primary CNS tumour between 2008 and 2017 with follow-up until 31 December 2017. We selected the four highest incidence histologies and used proportional hazard regression to estimate hazard ratios (HRs) for five regions (British Columbia, Prairie Provinces, Ontario, Atlantic Provinces and the Territories), adjusting for sex, tumour behaviour and patient age. Ontario had the best survival profile for all histologies investigated. The Atlantic Provinces had the highest HR for glioblastoma (HR = 1.26, 95% CI: 1.18-1.35) and malignant glioma not otherwise specified (NOS) (Overall: HR = 1.87, 95% CI:1.43-2.43; Pediatric population: HR = 2.86, 95% CI: 1.28-6.39). For meningioma, the Territories had the highest HR (HR = 2.44, 95% CI: 1.09-5.45) followed by the Prairie Provinces (HR = 1.52, 95% CI: 1.38-1.67). For malignant unclassified tumours, the highest HRs were in British Columbia (HR = 1.45, 95% CI: 1.22-1.71) and the Atlantic Provinces (HR = 1.40, 95% CI: 1.13-1.74). There are regional differences in the survival of CNS patients at the population level for all four specific histological types of CNS tumours investigated. Factors contributing to these observed regional survival differences are unknown and warrant further investigation.

Exploring age-standardized cancer incidence rates and regional disparities: A retrospective cohort study of 8 major cancers in South Korea.

BACKGROUND: We analyzed trends in cancer incidence and regional disparities of eight major types of cancer in Korea. METHODS: This retrospective cohort study used the data of 17 cities/provinces from the Korea Central Cancer Registry (1999-2020) in South Korea. Age-standardized incidence rates (per 100,000 person-years), between-group variance (per 100,000 person-years)2, and annual percentage changes ( %) were calculated for the eight most common malignancies. Joinpoint regression was utilized to identify the points at which significant changes occur in cancer incidence or regional disparity trends over time to characterize these trends. RESULTS: The incidence of stomach cancer decreased as regional disparity decreased and that of colorectal cancer initially increased but recently declined, showing fluctuations in regional disparity. The incidence and regional disparity in liver cancer decreased. The incidence of lung cancer remained stable, with reduced regional disparities. The incidence of breast cancer rose with increasing regional disparity, whereas the incidence of cervical cancer decreased, accompanied by decreased regional disparity. A significant increase in prostate cancer was found, with initially reduced regional disparities but later showed a resurgence. The incidence of thyroid cancer fluctuated alongside variations in regional disparities. CONCLUSION: This study revealed cancer incidence and regional variations in each cancer type in Korea. More studies are needed to understand the underlying factors and potential interventions for reducing cancer incidence and addressing regional disparity.

Inter-prefectural and urban-rural regional disparities in lung cancer surgery: a Japanese nationwide population-based cohort study from 2017 to 2019.

PURPOSE: To investigate regional disparities in lung cancer surgery in Japan. METHODS: The annual incidence of lung cancer, lung cancer surgery, and the number of board-certified thoracic surgeons in Japan during 2014-2019 were investigated using a national open database. Lung cancer surgeries were categorized by procedure (wedge resection, segmentectomy, lobectomy, pneumonectomy) and approach (open, thoracoscopic). Disparities in 47 prefectures and urban-rural disparities during 2017-2019 were evaluated using the Gini coefficient and an unpaired t-test. Correlation was assessed using Pearson's correlation method. RESULTS: The national annual average incidences of lung cancer and lung cancer surgery were 121,106 and 50,959, respectively, in 2014-2019. The use of the thoracoscopic approach increased over time in all procedures, except pneumonectomies. The Gini coefficients of lung cancer, thoracoscopic surgery, and board-certified thoracic surgeons indicated low inequality across prefectures; however, those of open surgery indicated high inequality. Open surgery was more common in urban areas than in rural areas. The number of thoracoscopic surgeries and board-certified thoracic surgeons by prefecture were moderately correlated. CONCLUSION: The thoracoscopic approach is becoming more common in lung cancer surgery, with little inter-prefectural regional disparity in the incidence of lung cancer, thoracoscopic surgeries, or the number of board-certified thoracic surgeons.

Regional Disparities in Hyperacute Treatment and Functional Outcomes after Acute Ischemic Stroke in Japan.

AIM: This study investigated the impact of rurality on acute ischemic stroke (AIS) outcomes, emphasizing the hyperacute phase, in which immediate care is crucial. METHODS: This retrospective cohort study analyzed data from a large Japanese hospital network covering AIS patients from 2013-2021, was analyzed. The focus was on patients admitted within 4.5 h of the onset, using the Rurality Index for Japan (RIJ) to categorize patients into rural or urban groups. This study examined treatment methods (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) and functional outcomes measured using the modified Rankin Scale (mRS), where scores of 3-6 indicated poor outcomes. Multilevel logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for poor outcomes baSed on rurality. The study also evaluated the population-attributable fraction (PAF) to estimate potential outcome improvements in urban settings. RESULTS: Of 27,691 patients, 17,516 were included in the total cohort and 4,954 in the hyperacute cohort. Urban patients constituted 73.7% (12,902), with higher IVT (5.2%) and MT (3.6%) rates than rural patients (4.1% IVT, 2.0% MT). Poor mRS outcomes were more common in rural areas than in urban areas, with adjusted ORs of 1.30 (1.18-1.43) in the total cohort and 1.43 (1.19-1.70) in the hyperacute cohort. The PAF for poor outcomes due to rural residency was 14.8% (0.5%-31.0%). CONCLUSION: This study demonstrated a notable association between rurality and poorer AIS outcomes in Japan, particularly in the hyperacute phase.

What is the relationship between the local population change and cancer incidence in patients with dyslipidemia: Evidence of the impact of local extinction in Korea.

BACKGROUND: Changes in the local population are intricately linked to healthcare infrastructure, which subsequently impacts the healthcare sector. A decreasing local population can result in lagging health infrastructure, potentially leading to adverse health outcomes as patients may be at risk of not receiving optimal care and treatment. While some studies have explored the relationship between chronic diseases and local population decline, evidence regarding cancer is insufficient. In this study, we focused on how deteriorating management of chronic diseases such as dyslipidemia could influence the risk of cancer. We investigated the relationship between changes in the local population and cancer incidence among patients with dyslipidemia. METHODS: This cohort study was conducted using claims data. Data from adult patients with dyslipidemia from the National Health Insurance Service-National Sample Cohort conducted between 2002 and 2015 were included. Population changes in each region were obtained from the Korean Statistical Information Service and were used to link each individual's regional code. Cancer risk was the dependent variable, and Cox proportional hazards regression was used to estimate the target associations. RESULTS: Data from 336,883 patients with dyslipidemia were analyzed. Individuals who resided in areas with a decreasing population had a higher risk of cancer than those living in areas with an increasing population (decrease: hazard ratio (HR) = 1.06, 95% CI = 1.03-1.10; normal: HR = 1.05, 95% CI = 1.02-1.09). Participants living in regions with a low number of hospitals had a higher risk of cancer than those in regions with a higher number of hospitals (HR = 1.20, 95% CI = 1.12-1.29). CONCLUSION: Patients in regions where the population has declined are at a higher risk of cancer, highlighting the importance of managing medical problems caused by regional extinction. This could provide evidence for and useful insights into official policies on population decline and cancer risk.

Towards synergy: network facility development, whole process carbon reduction and pollution reduction, and regional disparities.

The in-depth implementation of the "Broadband China Strategy" is of great significance in promoting the synergistic governance of urban carbon reduction and pollution reduction. In this paper, based on the "Broadband China" pilot program implemented in China in 2014 as a quasi-natural experiment, the coupled synergy model is used to measure the carbon and pollution reduction synergy index based on the balanced panel data of 277 prefectural-level cities and above in China from 2006 to 2020, and the staggered and synthetic DID methods are applied to investigate the impact of the Broadband China strategy on carbon and pollution reduction synergy and its mechanism. strategy on carbon and pollution reduction synergy and its mechanism. The conclusions of the study show that (1) the Broadband China strategy significantly improves the synergistic governance of carbon reduction and pollution reduction. (2) The mechanism results show that Broadband China mainly realizes carbon and pollution synergistic governance by promoting source control and process innovation but does not have an effective mediating role in end-of-pipe treatment. (3) The results of heterogeneity analysis show that Broadband China weakens the traditional geographic advantage, narrows the carbon pollution synergistic governance gap at the national and regional levels, and significantly improves the regional carbon reduction and pollution reduction governance level. This paper examines the micro-mechanism of the Broadband China strategy on carbon pollution synergistic governance from the whole process of production activities, which provides a new perspective for the study of carbon pollution synergistic governance, and provides an empirical basis for carbon pollution synergistic governance in China.

Regional inequality in China's educational development: An urban-rural comparison.

In the past two decades, regional inequality in China's educational development, especially between urban and rural areas, has continued to narrow. An in-depth discussion of this phenomenon and the mechanisms behind it will not only help China build a high-quality educational system, but also draw lessons from Chinese practices to guide the reduction of global educational inequality. The comprehensive evaluation results show that China's rural EDL surpassed urban EDL in 2013; in 2003-2019, the urban/rural EDL increased from 0.29 to 0.22 to 0.50 and 0.54, respectively, and the urban-rural EII decreased from 1.31 to 0.92. Spatially, urban/rural EDL in the eastern and northeastern regions is higher than that in the central and western regions, the urban-rural EII in the eastern and northeastern regions is lower than that in the central and western regions. The CV and Theil index show that regional disparity in national urban/rural EDL has been narrowing, and regional inequality in urban-rural EII has also been declining; the decomposition of the Theil index indicates that these decreases in inequality are mainly from the reduction of the urban/rural educational development gap within the regions. The large-scale population migration driven by rapid industrialization and urbanization, and the adjustment of urban-rural and regional relationship promoted by the transformation of national policies such as regional coordinated development strategy and hukou system reform, are the main reasons for the evolution of regional inequality in China's urban and rural educational development.

Relationship between the Number of Pharmacists per Pharmacy and the Provision of Home Healthcare Services in Japan.

Home healthcare services provided by community pharmacists are essential for maintaining community care, especially in Japan's aging population. Personnel shortage in pharmacies is occasionally cited as the reason why pharmacies are unable to provide home healthcare services. This study examined the relationship between the number of pharmacists in each pharmacy and the provision of home healthcare services. The number of full-time and part-time pharmacists per pharmacy has a positive impact on the provision of home healthcare services. Moreover, the larger the number of pharmacists per pharmacy, the easier it is for the pharmacy to provide home healthcare services. With regard to pharmacies with one full-time pharmacist, there are more pharmacies that provide home healthcare services when the population density of municipalities where the pharmacy is located is high. However, the impact of the number of pharmacists on population density became obscure when the number of full-time pharmacists per pharmacy was three or more. Taken together, these findings indicate that the provision of home healthcare services by pharmacies is related to the number of pharmacists per pharmacy and the population density of the area. This could have implications for widening regional disparities in home healthcare services.

Spatiotemporal distribution and dynamics evolution of artificial intelligence development in China.

The quantified measurement and comprehensive analysis of artificial intelligence development (AIDEV) are vital for countries to form AI industrial ecology and promote the long-term development of regional AI technology. Based on the innovation ecosystems (IE) theory, this paper constructs an evaluation system to measure and analyze the spatiotemporal distribution and dynamic evolution of the AIDEV in China from 2011 to 2020. The results show that the AIDEV of China presents an overall upward trend and an obvious unbalance in the spatial distribution which is "eastern > central > western". Meanwhile, the provinces of low-level AIDEV are catching up with the high-level provinces, which leads to the regional difference of AIDEV narrowing. Moreover, the concentration and polarization phenomenon of AIDEV in China has been weakening and the AIDEV will continue to increase in the next three years. Further, there is a significantly positive spatial autocorrelation of AIDEV. Finally, high AIDEV provinces will increase the probability of surrounding provinces' AIDEV to develop. This paper expands the research stream in the field of AI research, extends the application scenarios of IE theory, and puts forward some relevant policy recommendations.

High phenotypic plasticity at the dawn of the eosauropterygian radiation.

The initial radiation of Eosauropterygia during the Triassic biotic recovery represents a key event in the dominance of reptiles secondarily adapted to marine environments. Recent studies on Mesozoic marine reptile disparity highlighted that eosauropterygians had their greatest morphological diversity during the Middle Triassic, with the co-occurrence of Pachypleurosauroidea, Nothosauroidea and Pistosauroidea, mostly along the margins of the Tethys Ocean. However, these previous studies quantitatively analysed the disparity of Eosauropterygia as a whole without focussing on Triassic taxa, thus limiting our understanding of their diversification and morphospace occupation during the Middle Triassic. Our multivariate morphometric analyses highlight a clearly distinct colonization of the ecomorphospace by the three clades, with no evidence of whole-body convergent evolution with the exception of the peculiar pistosauroid Wangosaurus brevirostris, which appears phenotypically much more similar to nothosauroids. This global pattern is mostly driven by craniodental differences and inferred feeding specializations. We also reveal noticeable regional differences among nothosauroids and pachypleurosauroids of which the latter likely experienced a remarkable diversification in the eastern Tethys during the Pelsonian. Our results demonstrate that the high phenotypic plasticity characterizing the evolution of the pelagic plesiosaurians was already present in their Triassic ancestors, casting eosauropterygians as particularly adaptable animals.

Diversity Differences Among Cardiovascular Fellowships Across Five Geographic Regions in the United States.

Introduction Diversity and inclusion in cardiovascular fellowships are necessary for addressing the healthcare needs of diverse patient populations. However, regional disparities in the diversity of these programs persist, diminishing efforts to create a representative workforce. We observe the regional differences in the diversity of cardiovascular fellowship programs, focusing on gender, doctorate designation, and graduation within the United States (US) or other. We hypothesized that males, medical doctors (MD), and US graduates would be in majority across all regions. Methods Data for cardiovascular fellowships from the Fellowship and Residency Electronic Database Access (FREIDA) system for the matriculation year 2022-2023 was obtained to assess the representation of male vs female gender, MD vs osteopathic doctor (DO) designation, and US vs non-US graduate. We then compared these backgrounds to five defined regions (Midwest, Northeast, Southeast, Southwest, and West) in the United States to define representation for backgrounds across geographic areas. Statistical significance was determined by p<0.05 with the use of SAS Studio 3.8, version 9.4 (Cary, NC: SAS Institute, Inc.), and Wilson score for confidence intervals. Results We found significant disparities across all background factors for all regions. This includes that females, DOs, and non-US graduates were underrepresented among Midwest, Northeast, Southeast, Southwest, and West regions, and the p-value was <0.001 for all variations. Specifically for Midwest, the female frequency was 155 (23.81%; CI: 21, 27; p<0.001), DO frequency was 101 (15.51%; CI: 13, 19; p<0.001), and non-US graduate frequency was 206 (31.84%; CI: 28, 36; p<0.001). For Northeast, the female frequency was 231 (29.62; CI: 27, 33; p<0.001), DO frequency was 72 (9.22; CI: 7, 11; p<0.001), and non-US graduate frequency was 239 (30.68; CI 28, 34; p<0.001). For Southeast, the female frequency was 178 (25.99; CI: 23, 29; p<0.001), DO frequency was 67 (9.78; CI: 8, 12; p<0.001), and non-US graduate frequency 279 (41.46; CI: 38, 45; p<0.001). For Southwest, the female frequency was 74 (26.71; CI: 22, 32; p<0.001), DO frequency was 21 (7.58; CI 5, 11; p<0.001), and non-US graduate frequency was 110 (39.71; CI: 34,46; p<0.001). For West, the female frequency was 107 (31.75; CI 27, 37; p<0.001), DO frequency was 15 (4.45; CI: 3, 7; p<0.001), and non-US graduate frequency was 54 (16.07; CI: 13, 20; p<0.001). Conclusion We emphasize the regional disparities for females, DOs, and non-US graduates within cardiovascular fellowships in the past matriculation year. Understanding that we have not reached diversity goals allows for further reflection and implementation of targeted interventions and initiatives aimed at promoting equal opportunities for applicants. This is true for all regions of the United States. By addressing these disparities, fellowship programs can more effectively mirror the diverse patient populations they serve and foster a healthcare environment that is inclusive and accommodating. This, in turn, contributes to the overall enhancement of healthcare outcomes.

The impact of the COVID-19 pandemic on life expectancy by the level of area deprivation in South Korea.

Objective: Comparative evidence suggests that the impact of COVID-19 on life expectancy has been relatively milder in South Korea. This study aims to examine whether the pandemic has universal or unequal impacts on life expectancy across 250 districts with varying levels of deprivation. Methods: Using mortality data from 2012 to 2021 obtained from the Microdata Integrated Service of Statistics Korea, we calculated life expectancy at birth and age 65 for both sexes, by deprivation quintiles, before and during the pandemic. We summarized life expectancy gaps using the slope of the inequality index (SII) and further decomposed the gaps by the contribution of age and cause of death using Arriaga's method. Results: Both men and women experienced consistent improvements in life expectancy from 2012 to 2019, but the trend was disrupted during 2020 and 2021, primarily driven by older people. While men in more deprived areas were initially hit harder by the pandemic, the life expectancy gap across deprivation quintiles remained relatively constant and persistent across the study period [SII: -2.48 (CI: -2.70 from -2.27) for 2019 and - 2.84 (CI: -3.06 from -2.63) for 2020]. Middle-aged men from the most deprived areas were the most significant contributors to the life expectancy gap, with liver disease, liver cancer, transport accidents, and intentional injuries being the leading causes, both in the pre and during the pandemic. While these contributors remained largely similar before and during the pandemic, the contribution of transport accidents and liver cancer to the male life expectancy gap slightly decreased during the pandemic, while that of ischemic heart disease and pneumonia slightly increased. A similar increase was also observed for the female life expectancy gap. Conclusion: This study found no clear evidence of an increased life expectancy gap during the pandemic in South Korea, unlike in other countries, although access to emergency healthcare services may have been slightly more disturbed in deprived areas. This achievement can provide lessons for other countries. However, the persistent regional gaps in life expectancy observed over the past decade indicate the need for more targeted public health policies to address this issue.

Long-term satellite observations show continuous increase of vegetation growth enhancement in urban environment.

Urbanization shows continuous expansion and development, ushering in the co-evolution of urban environments and vegetation over time. Recent remote sensing-based studies have discovered prevalent vegetation growth enhancement in urban environments. However, whether there is a temporal evolution of the growth enhancement remains unknown and unexplored. Here we expanded the existing framework for assessing the long-term impact of urbanization on vegetation greenness (enhanced vegetation index, EVI) using long time series of remote sensing images and applied it in Changsha, the capital city of Hunan province in China. Results showed that vegetation growth experienced widespread enhancement from 2000 to 2017, and increased 1.8 times from 2000 to 2017, suggesting strong continuous adaptive capability of vegetation to urban conditions. Although the overall impact of urbanization was negative due to the replacement of vegetated surfaces, the growth enhancement nevertheless offset or compensated the direct loss of vegetated cover during urbanization in the magnitude of 28 % in 2000 to 44 % in 2017. Our study also revealed large spatial heterogeneity in vegetation growth response among various districts at different urbanization levels and found an emergent trend under the observed spatial heterogeneity toward an asymptotic maximum with urbanization, showing EVI converges to 0.22 in highly urbanized areas. We further found that the positive effect of urbanization on vegetation growth is a function of urbanization intensity and time, which implies that the effect of the urban environment on vegetation can be simulated and predicted, and can be verified in more cities in the future. Our study is the first to successfully quantify long-term spatial patterns on the co-evolution of urbanization and vegetation, providing a new understanding of the continuous adaptive responses of vegetation growth to urbanization and shedding light on predicting biological responses to future environmental change.

Regional disparity in continuously measured time-domain cerebrovascular reactivity indices: a scoping review of human literature.

Objective: Cerebral blood vessels maintaining relatively constant cerebral blood flow (CBF) over wide range of systemic arterial blood pressure (ABP) is referred to as cerebral autoregulation (CA). Impairments in CA expose the brain to pressure-passive flow states leading to hypoperfusion and hyperperfusion. Cerebrovascular reactivity (CVR) metrics refer to surrogate metrics of pressure-based CA that evaluate the relationship between slow vasogenic fluctuations in cerebral perfusion pressure/ABP and a surrogate for pulsatile CBF/cerebral blood volume.Approach: We performed a systematically conducted scoping review of all available human literature examining the association between continuous CVR between more than one brain region/channel using the same CVR index.Main Results: In all the included 22 articles, only handful of transcranial doppler (TCD) and near-infrared spectroscopy (NIRS) based metrics were calculated for only two brain regions/channels. These metrics found no difference between left and right sides in healthy volunteer, cardiac surgery, and intracranial hemorrhage patient studies. In contrast, significant differences were reported in endarterectomy, and subarachnoid hemorrhage studies, while varying results were found regarding regional disparity in stroke, traumatic brain injury, and multiple population studies.Significance: Further research is required to evaluate regional disparity using NIRS-based indices and to understand if NIRS-based indices provide better regional disparity information than TCD-based indices.

The impact of China's high-speed rail investment on regional economy and air pollution emissions.

The high-speed rail (HSR) network in China has experienced rapid development since the 2000s. In 2016, the State Council of the People's Republic of China issued a revised version of the "Mid- and Long-term Railway Network Plan", detailing the expansion of the railway network and construction of an HSR system. In the future, the HSR construction efforts in China will further increase, which is considered to impact regional development and air pollutant emissions. Therefore, in this paper, we apply a transportation network-multiregional computable general equilibrium (CGE) model to estimate the dynamic effects of HSR projects on economic growth, regional disparities, and air pollutant emissions in China. The results indicate that HSR system improvement could generate a positive economic impact but could also increase emissions. The gross domestic product (GDP) growth per unit investment cost stimulated by HSR investment is found to be the largest in eastern China but the smallest in the northwest regions. Conversely, HSR investment in Northwest China contributes to a substantial reduction in regional disparities in terms of the GDP per capita. In regard to air pollution emissions, HSR construction in South-Central China results in the largest increase in CO2 and NOX emissions, while for CO, SO2, and fine particulate matter (PM2.5) emissions, the largest increase occurs due to HSR construction in Northwest China. At the regional level, the provinces with large changes in accessibility also experience large changes in their air pollutant emissions.

Number of computed tomography scanners and regional disparities based on population and medical resources in Japan.

This study aimed to discover the associations between the number of computed tomography (CT) scanners and the population, as well as number of medical resources to identify regional disparities in Japan. The number of CT scanners was tabulated for each detector row of CT scanners for hospitals and clinics in each prefecture. The number of CT scanners, patients, medical doctors, radiological technologists, facilities, and beds per 100,000 population was compared. Additionally, the number of hospitals with ≥ 200 beds and multidetector-row CT scanners with ≥ 64 rows were tabulated, and their ratios were calculated. Medical institutions in Japan have installed 14,595 scanners. CT scanners per 100,000 population were the highest in Kochi Prefecture, although the number of CT scanners in hospitals was the highest in Tokyo Prefecture. Multivariate analysis revealed the number of radiological technologists (ß coefficient: 0.49; P = 0.03), facilities (ß coefficient: 0.12; P < 0.01) and beds (ß coefficient: 0.46; P < 0.01) as independent factors for the number of CT scanners. Prefectures with a high proportion of hospitals with ≥ 200 beds also had a relatively high proportion of CT scanners with ≥ 64 rows (P < 0.01). Our survey revealed an association between regional disparities in the number of CT scanners in Japan, the population, and number of medical resources. A positive correlation was found between hospital size and number of CT scanners with ≥ 64 rows.

How does green credit reduce carbon emissions? Dynamic spatial interactions and regional disparities.

Green credit is an important green financial policy tool to promote green development. However, research is needed to explore how green credit reduces carbon emissions, especially with respect to its dynamic spatial interactions and regional disparities. Based on a theoretical analysis, this paper empirically tests the carbon emission reduction effect of green credit and its three mechanisms by combining a Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model, dynamic spatial Durbin model (SDM), and the mediation model, including their dynamic spatial interactions and regional disparities. The study concludes that green credit can reduce carbon emission intensity based on strong spatio-temporal interactions in China. Green credit mainly reduces carbon emission intensity through scale and technology mechanisms with different spatio-temporal interactions. The tertiary industry in China does not currently have completely clean production; as such, the upgrading of the industrial structure as stimulated by green credit in the long term cannot yet effectively reduce carbon emissions. In addition, the carbon emission reduction effect of green credit and its three mechanisms have different levels of performance and dynamic spatial interactions in different regions of China. Finally, targeted policy recommendations are proposed to apply green credit to effectively reduce the carbon emission intensity.

Divergent Energy-Climate Nexus in the Global Fuel Combustion Processes.

Fuel combustion provides basic energy for the society but also produces CO2 and incomplete combustion products that threaten human survival, climate change, and global sustainability. A variety of fuels burned in different facilities expectedly have distinct impacts on climate, which remains to be quantitatively assessed. This study uses updated emission inventories and an earth system model to evaluate absolute and relative contributions in combustion emission-associated climate forcing by fuels, sectors, and regions. We showed that, from 1970 to 2014, coal burned in the energy sector and oil used in the transportation sector contributed comparable energies consumed (24 and 20% of the total) but had distinct climate forcing (1 and 40%, respectively). Globally, coal burned for energy production had negative impacts on climate forcing but positive effects in the residential sector. In many developing countries, coal combustion in the energy sector had negative radiative forcing (RF) per unit energy consumed due to insufficient controls on sulfur and scattering aerosol levels, but oils in the transportation sector had high positive RF values. These results had important implications on the energy transition and emission reduction actions in response to climate change. Distinct climate efficiencies of energies and the spatial heterogeneity implied differentiated energy utilization strategies and pollution control policies by region and sector.

Survival benefit of younger gastric cancer patients in China and the United States: A comparative study.

BACKGROUND: The impact of racial and regional disparity on younger patients with gastric cancer (GC) remains unclear. AIM: To investigate the clinicopathological characteristics, prognostic nomogram, and biological analysis of younger GC patients in China and the United States. METHODS: From 2000 to 2018, GC patients aged less than 40 years were enrolled from the China National Cancer Center and the Surveillance Epidemiology and End Results database. Biological analysis was performed based on the Gene Expression Omnibus database. Survival analysis was conducted via Kaplan-Meier estimates and Cox proportional hazards models. RESULTS: A total of 6098 younger GC patients were selected from 2000 to 2018, of which 1159 were enrolled in the China National Cancer Center, and 4939 were collected from the Surveillance Epidemiology and End Results database. Compared with the United States group, younger patients in China revealed better survival outcomes (P < 0.01). For race/ethnicity, younger Chinese cases also enjoyed a better prognosis than that in White and Black datasets (P < 0.01). After stratification by pathological Tumor-Node-Metastasis (pTNM) stage, a survival advantage was observed in China with pathological stage I, III, and IV (all P < 0.01), whereas younger GC patients with stage II showed no difference (P = 0.16). In multivariate analysis, predictors in China involved period of diagnosis, linitis plastica, and pTNM stage, while race, diagnostic period, sex, location, differentiation, linitis plastica, signet ring cell, pTNM stage, surgery, and chemotherapy were confirmed in the United States group. Prognostic nomograms for younger patients were established, with the area under the curve of 0.786 in the China group and of 0.842 in the United States group. Moreover, three gene expression profiles (GSE27342, GSE51105, and GSE38749) were enrolled in further biological analysis, and distinctive molecular characteristics were identified in younger GC patients among different regions. CONCLUSION: Except for younger cases with pTNM stage II, a survival advantage was observed in the China group with pathological stage I, III, and IV compared to the United States group, which might be partly due to differences in surgical approaches and the improvement of the cancer screening in China. The nomogram model provided an insightful and applicable tool to evaluate the prognosis of younger patients in China and the United States. Furthermore, biological analysis of younger patients was performed among different regions, which might partly explain the histopathological behavior and survival disparity in the subpopulations.

Spatial and temporal characteristics of rural livability and its influencing factors: implications for the development of rural revitalization strategy.

Building livable rural regions is a key objective of China's rural revitalization, and fostering coordinated and sustainable regional development in China necessitates investigating the geographical and temporal distribution and influencing variables of livability in China's rural areas. This paper compares the concept and connotation of rural livability based on regional economic development theory and sustainable development theory, integrates China's rural revitalization strategy, proposes an index system for evaluating rural livability in China, and conducts an empirical analysis of livable rural areas. Firstly, the level of rural livability development is measured by the entropy method; secondly, the aggregation effect of provinces is demonstrated by using the Moran I index, and finally, the spatial Durbin model is used to explore the influencing factors of rural livability and its spatial spillover effects. Findings of our study reveal that the results of the entropy method indicate that the livability of rural China is in a growing development trend in all provinces, but the livability shows some regional disparities. The Moran index reveals that there are obvious spatial autocorrelations in the livability of Chinese rural areas, and the most typical features are the "high" and "low" clusters. The spatial Durbin model suggests that the influences on the development of rural livability are diverse. Besides, other variables such as environmental pollution and per capita housing area show a negative association with rural livability, and investment in fixed assets, cultural atmosphere and medical health show a positive relationship with rural livability. Based on the study findings, it is proposed that in the rural revitalization strategy process, the formulation of monitoring system should be strengthened and intensify the promotion of coordinated inter-regional development.