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While advances in information technology and interconnectivity have improved efficiency for transportation infrastructure, they have also created higher risk associated with cyber systems. The objective of this study is to inform transportation policy and management in the U.S. by identifying barriers to a robust cyber insurance market and improved cyber resilience for transportation infrastructure. This is accomplished through a mixed-methods approach involving analysis of U.S. cyber incident data for transportation systems and a series of interviews with transportation infrastructure managers and insurers. Contributions include new insights into the nature of cyber risk for transportation infrastructure and recommendations on research needs to improve cyber risk management and insurance. Results indicate that the annual number of transport-related companies affected by cyber incidents and the associated costs are on the rise. The most common incidents involve data breaches, while incidents involving privacy violation have the highest average loss per incident. Cyber risk assessment, mitigation and security measures, and insurance are being implemented to varying degrees in transportation infrastructure systems but are generally inadequate. Infrastructure managers do not currently have the tools to rigorously assess and manage cyber risk. Limited data and models also inhibit the accurate modeling of cyber risk for insurance purposes. Even after improved tools and modeling are developed, insurance purchase can be an important risk management strategy to allow transportation infrastructure systems to recover from cyber incidents. • Annual number and cost of cyber incidents are on the rise for transportation systems. • The most common incidents involve data breach. • Unintentional data disclosure incidents have the highest average loss. • Cyber risk assessment, mitigation measures, and insurance are generally lacking. • Further research on cyber risk models, metrics, biases, and insurance is needed. [ABSTRACT FROM AUTHOR]

Background: The epidemiological data on the use of aspirin in diabetic patients is very limited. The main purpose of this study is to examine the current status of aspirin use in the United States (US) and China in large representative populations., Methods: Data came from the National Health and Nutrition Examination Survey (NHANES) and China Hypertension Survey (CHS), two nationally representative cross-sectional studies., Results: The percentage of aspirin use was 73.8% in US diabetic patients with ASCVD, and the percentage of aspirin use in diabetic patients with high ASCVD risk was marginally higher in men ( p = .052), 54.5% in men and 37.1% in women. The percentages of aspirin use in diabetic patients with intermediate and low ASCVD risk were 55.1% and 35.0%, respectively. In China, the percentage of aspirin use in diabetic patients with ASCVD was 53.5%, and were 14.3%, 9.7%, and 3.2% among diabetic patients with high, intermediate, and low ASCVD risk, respectively., Conclusions: In summary, the percentage of aspirin use in primary prevention in US diabetic patients in men was higher than in women, and this percentage for primary and secondary prevention in US patients was higher than that in Chinese patients.

The 2017 guidelines on the diagnosis and treatment of high blood pressure in adults were published by the American College of Cardiology and the American Heart Association. The impact on clinical outcomes and costs needs to be estimated prior to adopting these guidelines in China. Data from a nationally representative sample in China were analyzed. The prevalence and treatment were calculated based on the criteria of the 2017 guidelines and 2018 Chinese guidelines among participants aged ≥35 years old. Direct medical costs, as well as the averted disability adjusted of life years and cost saving from cardiovascular disease events prevented by controlling hypertension, were also estimated. The prevalence and treatment rate of hypertension were 32.0% and 43.4% according to the 2018 Chinese guidelines. Based on the 2017 guidelines, another 24.5% of the adult population (estimated 168.1 million) would be classified as having hypertension; of whom, about 32.1 million would need to be pharmaceutically treated to reach the current treatment rate of 43.4%. As a result, an estimated additional 42.7 billion US dollars  of the direct medical cost would be required for lifetime therapy. By preventing cardiovascular events, the new guidelines would reduce lifetime costs by 3.77 billion US dollars, while preventing 1.41 million disability adjusted of life years lost. Application of the 2017 guidelines in China will substantially increase the prevalence of hypertension and produce a large increase in therapy costs, although it would prevent cardiovascular disease events and save disability adjusted of life years., (©2019 Wiley Periodicals, Inc.)