Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Determination of correlation of Adjusted Blood Requirement Index with outcome in patients presenting with acute variceal bleeding

AIM： To determine the correlation of Adjusted Blood Requirement Index （ABRI） with the 7th day outcome in patients presenting with acute variceal bleeding.METHODS： All patients presenting with acute variceal hemorrhage （AVH） were included. Patients with previous band ligation, sclerotherapy, gastrointestinal or hepatic malignancies were excluded. Patients were managed as per standard protocol for AVH with terlipressin and band ligation. ABRI scores were calculated using the formula outcome of alive or expired up to the 7th day after treatment. The correlation between ABRI and mortality was estimated and a receiver operative characteristic （ROC） curve was plotted.RESULTS： A total of 113 patients （76 male; 37 female） were included. On assessment, 18 were in Child＇s Pugh Class A, 82 in Class B and 13 were in Class C. The median number of blood units transfused ± inter-quartile range was 3.0 ± 2.0. The median ± inter-quartile range for ABRI was 1.3 ± 1.1. The ROC curve of ABRI for expiry showed a significantly large area of 0.848 （P 〈 0.0001; 95% CI： 0.75-0.95）. A significant correlation of log transformation of ABRI with an outcome of mortality was present （P 〈 0.0001）.

An adjusted energy-saving quantity calculation method for building energy-efficient retrofit

Aiming at a comprehensive assessment of energy-saving retrofitting effect on existing buildings,a calculation method is developed to adjust energy-saving quantity in standard condition for comparison under the same conditions. A mathematical model,method theory and calculation steps are given. Error analysis results show that this method can be applied accurately to practical engineering projects. In a case study of energy-saving quantity assessment before and after retrofitting on a certain hospital in Shanghai,with energy simulation software TRNSYS,detailed application of this method is introduced and analyzed. The method is applied to the case of energy-saving quantity assessment to a hospital in Shanghai before and after retrofitting with the energy simulation software TRNSYS.

Hydraulic impactor with impact energy and frequency adjusted independently and steplessly

Based on analysis of the present hydraulic impactor, a new hydraulic impactor with pressure feedback control was developed, whose structure and operation principle were introduced. The results show that the pressure of the impact system can be adjusted steplessly to change the impact energy of the impactor steplessly. By adjusting the oil flow of supply pump steplessly, the impact frequency will also be changed steplessly. So the impact energy and frequency of the new impactor can be adjusted independently and steplessly. In order to decrease the energy loss, a new kind of sleeve valve has been designed, which has features of little leakage, little pressure loss and low energy cost. The new type hydraulic impactor can be operated under various conditions with decreased energy consumption and improved operation efficiency.

IN 1997 SOME IMPORT AND EXPORT TARIFF RATES ADJUSTED

The General Customs Administration issued a circular statingthat,based upon a decision of the State Council,in 1997 someimport and export tariff rates would be adjusted.The major con-tents of the circular are the adjustment of the import tariff rates of 4tariff lines of commodities and items under 124 tariff lines;theelimination of the export tariffs for 14 tariff lines of commodities,addition of export tariff rates for 2 kinds of precious metals andimposition of provisional export tariff rates for 4 kinds of corn-

DFIG Voltage Control Based on Dynamically Adjusted Control Gains

The increasing penetration of wind power presents many technical challenges to power system operations. An important challenge is the need of voltage control to maintain the terminal voltage of a wind plant to make it a PV bus like conventional generators with excitation control. In the previous work for controlling wind plant, especially the Doubly Fed Induction Generator (DFIG) system, the proportional-integral (PI) controllers are popularly applied. These approaches usually need to tune the PI controllers to obtain control gains as a tradeoff or compromise among various operating conditions. In this paper, a new voltage control approach based on a different philosophy is presented. In the proposed approach, the PI control gains for the DFIG system are dynamically adjusted based on the dynamic, continuous sensitivity which essentially indicates the dynamic relationship between the change of control gains and the desired output voltage. Hence, this control approach does not require any good estimation of fixed control gains because it has the self-learning mechanism via the dynamic sensitivity. This also gives the plug-and-play feature of DFIG controllers to make it promising in utility practices. Simulation results verify that the proposed approach performs as expected under various operating conditions.

Improvement of the Algorithm for Computing Adjusted Structure Number for Determination of Backlog Maintenance

The pavement strength is very important for the evaluation of backlog maintenance. The current trend in many developing countries used pavement conditions index-PCI in estimating maintenance costs. The PCI can only justify periodic and routine recurrent maintenance. The condition strength is rarely determined in a flexible pavement creating an opportunity for back long maintenance. This paper reports the study conducted to develop and improve the algorithm for estimating the adjusted structure number to estimate the remaining thickness of the flexible pavement. The analysis of eight ways of computing structure numbers from FWD data ware analyzed and found that the improvement of the HDM 3 - 4 models can influence the usefulness of data collected from road asset management in Tanzania. The algorithm for estimating structural numbers from CBR was improved to compute adjusted structural numbers finally used to estimate the remaining life of the flexible pavement. The analysis of the network of about 6900 km including ST and AM was found that 64.72% were very good, 12% were Good, 10% were fair and 7.84% were poor and 5.4% were very poor.

Double Pressure on Power Grids——The demand for electricity is dropping while the electricity price is not adjusted properly

Since October 2008,China's social consumption of electricity had,for the first time,grown negatively compared to the same period of the previous year,and in November the negative growth range further expanded. The major pressure faced by the electricity industry has now turned from the contradiction between coal and electricity to electricity quantity. This is undoubtedly a true and new test to electricity enterprises which get used to high growth but are now suffering great losses. The reform of electricity system has already been in great difficulties and now is getting into a more serious situation. In order to help readers improve their knowledge and understanding of the current tough situation faced by the electricity industry and discuss how to alleviate and get through the difficulty resulted from the economic crisis "encountered once every one hundred years" by joint efforts of all parties concerned,a Seminar on Crisis and Countermeasures for Electricity Industry was held on November 20,2008. Here are some extracts from the speeches of four experts.

Tax Adjusted for Imported Equipment

Ministry of Finance,Central Administration of Customs,and State Administration of Taxation of P.R.of China jointly issued a"Notice on

Tentative tariff rate for partial import and export products adjusted

The tentative tariff rate for partial import and export products was adjusted since November 1^(st) of 2006.Total 58 imported commodities will be imposed lower tentative

Photoluminescence in fluorescent 4H-SiC single crystal adjusted by B,Al,and N ternary dopants

This paper reports the sensitive effect of photoluminescence peak intensity and transmittance affected by B, Al, and N dopants in fluorescent 4H-SiC single crystals. The crystalline type, doping concentration, photoluminescence spectra,and transmission spectra were characterized at room temperature. It is found that the doped 4H-SiC single crystal emits a warm white light covering a wide range from 460 nm to 720 nm, and the transmittance increases from ~10% to ~60%with the fluctuation of B, Al, and N ternary dopants. With a parameter of C_(D-A), defined by B, Al, and N concentration, the photoluminescence and transmittance properties can be adjusted by optimal doping regulation.

Phosphorous Enrichment in Molten Adjusted Converter Slag: Part I Effect of Adjusting Technological Conditions

The effects of adjusting technological conditions on the phosphorous enrichment of adjusted converter slag were investigated. The results showed that the phosphorus could he effectively enriched to 2CaO · SiO2 and 2CaO · SiO2-3CaO· P2O5 solid solution （SS, namely phosphorus-rich phase） to be formed with the decreasing of basicity and cooling rate. Moreover, the morphology of the phosphorus-rich phase changed from granular for the original converter slag with higher basicity to the coexistence of granular shape and rod-like for the adjusted slag with lower basicity. P2 05 content in phosphorus-rich phase exceeded 30° while the hasicity was 1.3 at the cooling rate of 1.0 ℃/min.

New model of PIRADS and adjusted prostatespecific antigen density of peripheral zone improves the detection rate of initial prostate biopsy:a diagnostic study

This study explored a new model of Prostate Imaging Reporting and Data System(PIRADS)and adjusted prostate-specific antigen density of peripheral zone(aPSADPZ)for predicting the occurrence of prostate cancer(PCa)and clinically significant prostate cancer(csPCa).The demographic and clinical characteristics of 853 patients were recorded.Prostate-specific antigen(PSA),PSA density(PSAD),PSAD of peripheral zone(PSADPZ),aPSADPZ,and peripheral zone volume ratio(PZ-ratio)were calculated and subjected to receiver operating characteristic(ROC)curve analysis.The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve(AUC).The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves.The AUCs of PSA,PSAD,PSADPZ,aPSADPZ,and PZ-ratio were 0.669,0.762,0.659,0.812,and 0.748 for PCa diagnosis,while 0.713,0.788,0.694,0.828,and 0.735 for csPCa diagnosis,respectively.All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa.The new model significantly improved the diagnostic accuracy of PCa(0.945 vs 0.830,P<0.01)and csPCa(0.937 vs 0.845,P<0.01)compared with the base model.In addition,the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold.This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators.Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.

A Range Adjusted Measure of Super-Efficiency in Integer-Valued Data Envelopment Analysis with Undesirable Outputs

DEA(data envelopment analysis) models can be divided into two groups: Radial DEA and non-radial DEA, and the latter has higher discriminatory power than the former. The range adjusted measure(RAM) is an effective and widely used non-radial DEA approach. However, to the best of our knowledge, there is no literature on the integer-valued super-efficiency RAM-DEA model,especially when undesirable outputs are included. We first propose an integer-valued RAM-DEA mode with undesirable outputs and then extend this model to an integer-valued super-efficiency RAM-DEA model with undesirable outputs. Compared with other DEA models, the two novel models have many advantages: 1) They are non-oriented and non-radial DEA models, which enable decision makers to simultaneously and non-proportionally improve inputs and outputs;2) They can handle integer-valued variables and undesirable outputs, so the results obtained are more reliable;3) The results can be easily obtained as it is based on linear programming;4) The integer-valued super-efficiency RAM-DEA model with undesirable outputs can be used to accurately rank efficient DMUs. The proposed models are applied to evaluate the efficiency of China’s regional transportation systems(RTSs) considering the number of transport accidents(an undesirable output). The results help decision makers improve the performance of inefficient RTSs and analyze the strengths of efficient RTSs.

Comprehensive evaluation of surface air temperature reanalysis over China against urbanization-bias-adjusted observations

The reanalysis datasets (CRA40) have now been developed in China Meteorological Administration. We aim to compare the differences in surface air temperature (SAT) between observational that has been adjusted for urbanization bias and reanalysis data (NCEPV1, NCEPV2, ERA5, CFSR, MERRA, JRA55, 20CRV3 and CRA40) over China's Mainland during 1961–2015. The main results are presented as follows. The correlation and standard deviation between the reanalysis data and observations exhibit highly consistent interannual variability and dispersion, with the interannual SAT variability in JRA55 being closest to the observations for 1961–2015 and that of ERA5 for 1979–2015;the dispersions of 20CRV3 is most consistent with the observations for 1961–2015 and that of NCEPV1 for 1979–2015. Although annual mean SAT of the reanalysis is generally 0–2.0 ℃ lower than the observations, the bias in the SAT climatology of 20CRV3 is the least for 1961–2015 in all reanalysis datasets and that of CRA40 is the least for 1979–2015. The trends of NCEPV1 is closer to the observations than other reanalysis for 1961–2015 and that of 20CRV3 for 1979–2015. The biases in terms of interannual variability, dispersion, climatology, and linear trend are increase with altitude. Overall, in terms of the similarity of multiple measures to the urbanization bias-adjusted observations, JRA55 and CRA40 show the best performances for the periods 1961–2015 and 1979–2015 respectively in reproducing various aspects of climatological and climate change features in China's Mainland.

VARIABLE SELECTION FOR COVARIATE ADJUSTED REGRESSION MODEL

This paper employs the SCAD-penalized least squares method to simultaneously select variables and estimate the coefficients for high-dimensional covariate adjusted linear regression models.The distorted variables are assumed to be contaminated with a multiplicative factor that is determined by the value of an unknown function of an observable covariate.The authors show that under some appropriate conditions,the SCAD-penalized least squares estimator has the so called "oracle property".In addition,the authors also suggest a BIC criterion to select the tuning parameter,and show that BIC criterion is able to identify the true model consistently for the covariate adjusted linear regression models.Simulation studies and a real data are used to illustrate the efficiency of the proposed estimation algorithm.

Adjusted Log-rank Test with Double Inverse Weighting under Dependent Censoring

It is a common issue to compare treatment-specific survival and the weighted log-rank test is the most popular method for group comparison. However, in observational studies, treatments and censoring times are usually not independent, which invalidates the weighted log-rank tests. In this paper, we propose adjusted weighted log-rank tests in the presence of non-random treatment assignment and dependent censoring. A double-inverse weighted technique is developed to adjust the weighted log-rank tests. Specifically, inverse probabilities of treatment and censoring weighting are involved to balance the baseline treatment assignment and to overcome dependent censoring, respectively. We derive the asymptotic distribution of the proposed adjusted tests under the null hypothesis, and propose a method to obtain the critical values. Simulation studies show that the adjusted log-rank tests have correct sizes whereas the traditional weighted log-rank tests may fail in the presence of non-random treatment assignment and dependent censoring. An application to oropharyngeal carcinoma data from the Radiation Therapy Oncology Group is provided for illustration.

Adjusted Empirical Likelihood Estimation of Distribution Function and Quantile with Nonignorable Missing Data

This paper considers the estimation problem of distribution functions and quantiles with nonignorable missing response data. Three approaches are developed to estimate distribution functions and quantiles, i.e., the Horvtiz-Thompson-type method, regression imputation method and augmented inverse probability weighted approach. The propensity score is specified by a semiparametric expo- nential tilting model. To estimate the tilting parameter in the propensity score, the authors propose an adjusted empirical likelihood method to deal with the over-identified system. Under some regular conditions, the authors investigate the asymptotic properties of the proposed three estimators for distri- bution functions and quantiles, and find that these estimators have the same asymptotic variance. The jackknife method is employed to consistently estimate the asymptotic variances. Simulation studies are conducted to investigate the finite sample performance of the proposed methodologies.