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Aim: This Study Aimed to Assess the Intention to Have a Third Child among Millennial Parents (25–40 years old) with Two Children in a City in Eastern China and to Explore the Influencing Factors Related to Fertility Intention. Design: A cross‐sectional design study. Methods: A convenience sampling method was used to enrol participants of childbearing age who visited two tertiary hospitals in Hang zhou, a city in eastern China, from June 2021 to March 2022. We conducted a face‐to‐face questionnaire survey with 520 participants and calculated the prevalence of intention‐related factors. Multivariate logistic regression was used to analyse the independent influencing factors of fertility intention. Results: In total, 105 (20.2%) participants had the intention to have a third child. The results showed that 'employment status', 'age', 'reasons for wanting a third child', the considered 'biggest barrier to having a third child', 'views on the three‐child policy', 'desired free services', 'supporting work policies' and 'assistance policies' were significant independent influencing factors of intention to have a third child (p‐value < 0.05). The intention of the participants 'over 30 years old' was 2.466 times that of those '30 years old and under', and 'older age/personal health status' was considered the 'biggest barrier to having a third child'. Regarding policy and social reasons, the participants who need 'medical assistance' policy negatively affect the intention to have a third child (OR = 0.453, 95% CI = 0.247–0.830). Implications for Healthcare/Nursing: Nursing plays an important role in health promotion. Nurses can help couples make wise decisions about fertility by providing professional consultation, education, evaluation and support. They can also provide corresponding nursing and guidance to improve couples' health quality and overall reproductive success. Conclusions: The general level of intention to have a third child of Millennial parents with two children is still low. The participants who are 'housewives/househusbands', 'over 30 years old', and satisfied with the state of 'medical assistance' have higher fertility intentions. Patient or Public Contribution: It is particularly meaningful for the policymakers to improve the social support system and raise universal awareness to encourage childbirth. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about male nurses not only exacerbate the gender imbalance in the nursing profession but also negatively impact male nurses embarking on their careers. Currently, no tool exists to measure the gender biases toward males in nursing among nursing students in China. Consequently, the primary objective of this study is to assess the validity and reliability of the Chinese translation of the Gender Misconceptions of Men in Nursing (GEMINI) scale among nursing students. Methods: This cross-sectional study involved 1,102 nursing students from China who participated online. We utilized the Brislin translation technique with a forward-backward approach. To determine the factor structure within the Men in Nursing Gender Misconceptions Scale's Chinese version, both exploratory (EFA) and confirmatory factor analysis (CFA) were applied. The scale's internal consistency was measured through the Cronbach's alpha coefficient, corrected item-total correlation, and a retest reliability assessment. Results: The scale showed a content validity index of 0.938 and a retest reliability of 0.844. EFA indicated a two-factor structure for the translated instrument. CFA revealed a chi-square/degree of freedom of 3.837, an incremental fit index (IFI) of 0.952, a goodness-of-fit index (GFI) of 0.910, a comparative fit index (CFI) of 0.952, and an RMSEA of 0.073, all of which were within acceptable limits. The scale's Cronbach's α was 0.953, and the corrected item-total correlations ranged between 0.539 and 0.838. Gender-based misconceptions about men in nursing among students appeared to be influenced by their gender and whether they considered a nursing program as their first choice when applying for a major. Misconceptions about male nurses are greater among men and those who do not consider nursing programs as their first choice when applying for a major. Conclusions: The Chinese adaptation of the GEMINI scale showcased high reliability and validity. It stands as a potential instrument to gauge gender misconceptions concerning male nurses among Chinese nursing students. [ABSTRACT FROM AUTHOR]

Existing research concerning the effects of the sitting birth position during the second stage of labour on maternal and neonatal outcomes remains controversial, and there is a lack of studies to explore its effect on the childbirth experience. The objective of this study is to explore whether the sitting birth position would influence maternal and neonatal outcomes, as well as the childbirth experience. The prospective cohort design was conducted in the study from February to June 2023, a total of 222 women (including primiparous women and multiparous women) were enrolled in our study, and they were divided into the sitting position cohort (n = 106) or the lithotomy position cohort (n = 116). The pre-designed questionnaire and Childbirth Experience Questionnaire (CEQ) were used for data collection during hospitalisation. Chi-square, Fisher's exact test, t-tests, or the Mann–Whitney U test were utilised to assess differences between groups. Multivariate linear regression and logistic regression were employed to control possible confounders. The study found that primiparous women in the sitting position cohort had a shorter duration of the second stage of labour, higher spontaneous vaginal birth rates, lower episiotomy rates, and a better childbirth experience (p < 0.01). After adjusting for confounding factors through multiple linear and logistic regression analyses, the results remained consistent with those reported above. No neonate in each cohort had Apgar scores at 1 min and 5 min postpartum less than 7 or a Cord artery pH less than 7.00, regardless of parity. Based on the findings, we recommend that women could take the sitting birth position into account when giving birth for a positive childbirth experience, especially for primiparous women. The study could also serve as a reference for healthcare providers in the management of childbirth positions and the development of high-quality maternal care. [ABSTRACT FROM AUTHOR]

The Qilian Mountains (QMs) act as the "water tower" of the Hexi Corridors, playing an important role in the regional ecosystem security and economic development. Therefore, it is of great significance to understand the spatiotemporal characteristics of precipitation in the QMs. This study evaluated the performance of 21 models of phase 6 of the Coupled Model Intercomparison Project (CMIP6) from 1959 to 1988 based on ERA5 and in situ datasets. In addition, the precipitation changing trend from 2015 to 2100 was projected according to four shared socioeconomic pathways (SSPs): namely, SSP126, SSP245, SSP370, and SSP585. The results have shown the following: (1) all CMIP6 models could reflect the same precipitation changing trend, based on the observed datasets (−2.01 mm·10a−1), which was slightly lower than that of ERA5 (2.82 mm·10a−1). Multi-mode ensemble averaging (MME) showed that the projected precipitation-change trend of the four scenarios was 5.73, 9.15, 12.23, and 16.14 mm·10a−1, respectively. (2) The MME and ERA5 showed the same precipitation spatial pattern. Also, during the period 1959–1988, the MME in spring, summer, autumn and winter was 130.07, 224.62, 95.96, and 29.07 mm, respectively, and that of ERA5 was 98.57, 280.77, 96.85, and 22.64 mm, respectively. The largest precipitation difference in summer was because of strong convection and variable circulation. (3) From 2015 to 2100, the snow-to-rain ratio was between 0.1 and 1.1, and the snow-to-rain ratio climate tendency rate was concentrated in the range of −10~0.1 mm·10a−1. Both of these passed the significance test (p < 0.05). The projected rainfall of all four SSPs all showed an increasing trend with values of 6.20, 11.31, 5.64, and 20.41 mm·10a−1, respectively. The snowfall of the four SSPs all showed a decreasing trend with values of 0.42, 2.18, 3.34, and 4.17 mm·10a−1, respectively. [ABSTRACT FROM AUTHOR]

Based on monthly precipitation (P), temperature (T) data, and remote sensing images collected from March 2000 to February 2019, this article was constructed to reveal the synergistic effect between P and T for the NDVI in northern China qualitatively and quantitatively by using a one-variable linear regression, the coefficient of variation, multivariate correlation coefficients, and a geodetector. The results show that the NDVI in the study area decreased from 2000 to 2012, increased from 2013 to 2018, decreased in the west, and increased in the east of Northern China. Overall, the NDVI, P, and the average maximum temperature (Tmax) had the strongest multivariate correlations (approximately 43.4% of the total study area passed the 95% confidence level significance test), followed by the average temperature (Tave) and average minimum temperature (Tmin). The explanatory power of the synergistic effect between P and Tmax for the NDVI was the strongest, with the value of explanatory power varying from 0.41 to 0.81, followed by Tave and Tmin. Spatially, the explanatory power of the synergistic effect between P and T for the NDVI was strengthened overall in the study area from northwest to southeast. The annual change rate of the explanatory power showed that the overall explanatory power between P and T for the NDVI in the study area was weakened in the central area and strengthened in the east and the west. Specifically, the synergistic effect between P and T on the NDVI was weakened in both Shaanxi and Ningxia Huizu Zizhiqu, while the opposite occurred in Xinjiang Uygul Zizhiqu, Qinghai, and another five provinces in the eastern part of the study area. [ABSTRACT FROM AUTHOR]

Background: Programmed cell death-1 (PD-1) blockade has been shown to confer clinical benefit in cancer patients. Here, we assessed the level of serum interleukin 14α (IL14α) in patients receiving anti-PD-1 treatment. Methods: This prospective study recruited 30 patients with advanced solid cancer who received pembrolizumab treatment in Northern Jiangsu People's Hospital between April 2016 and June 2018. The western blot analysis was used to assess the expression level of serum IL14α in patients at baseline and after 2 cycles of treatment. Interleukin 14α was performed using the unpaired 2-tailed Student test. The progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method and compared by the log-rank test. Results: The early change of IL14α after 2 cycles of anti-PD-1 therapy was calculated as delta IL14α % change = (IL14α level after 2 cycles − IL14α level before treatment)/IL14α level before treatment × 100%. Receiver operating characteristic (ROC) was analyzed to get a cutoff point of delta IL14α % change as 2.46% (sensitivity = 85.71%, specificity = 62.5%; area under the ROC curve [AUC] = 0.7277, P =.034). Using this cutoff to subgroup the patients, an improved objective response rate was observed in patients with a delta IL14α change higher than 2.46% (P =.0072). A delta IL14α change over 2.46% was associated with a superior PFS (P =.0039). Conclusions: Early changes of serum IL14α levels may be a promising biomarker to predict outcomes in patients with solid cancer following anti-PD-1 treatment. [ABSTRACT FROM AUTHOR]

Aims: To investigate the effect of a transition programme including cognitive‐behaviour‐based preceptorship intervention on ICU new graduate nurses' (NGNs)' professional identity and their intention to remain employed. Design: One‐arm pre‐ and post‐test design followed the TREND Statement. Methods: NGNs' professional identity and intention to remain employed were measured at baseline (T1), postintervention (1 month, T2) and 6‐month follow‐up (T3). Results: Fifty‐three NGNs completed the programme, and their professional identity score significantly increased postintervention [from 111.5 (SD = 16.72) at T1 to 114.2 (SD = 9.12) at T2, p < 0.05], but decreased at T3 [105.8 (SD = 9.44) compared with T1 and T2, p < 0.05]. There was no significant difference in ICU NGNs' intention of remain employed outcomes at three time points (p > 0.05). The transition programme was effective to improve ICU NGNs' professional identity immediately after the intervention, but the increment did not maintain at the 6‐month follow‐up. [ABSTRACT FROM AUTHOR]

This study uses a panel data regression model to investigate how internal and external factors affect the profitability of city commercial banks in China. The research sample consists of 16 listed city commercial banks with an unbalanced dataset covering the time period within the period of 2008–2020. A panel data regression method is utilized to investigate the factors that influence the profitability of city commercial banks in China. There are several estimation methods in panel data, and the most commonly employed models are the fixed effects and random effects models. The pooled OLS model is often used for comparison for panel data regression, and the appropriate model will be determined by statistical hypothesis testing. The results show that internal explanatory variables such as bank size, capital adequacy, credit quality, and operating efficiency and external explanatory variables such as province GDP and inflation have a significant impact on the profitability of city commercial banks, while liquidity has no significant effect on the bank's profitability. The paper contributes to the relevant literature by identifying the determinants of city commercial banks' profitability considering the latest situation of the banking sector in China and provides practical implications from the perspective of improving bank profitability, which are important for both banking management and regulators and for the municipal and state. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recurrence of atrial fibrillation (AF) is common in patients with persistent AF even after multiple ablation procedures. His-Purkinje conduction system pacing (HPCSP) combined with atrioventricular node ablation (AVNA) is effective in managing patients with AF and heart failure. This study aimed to determine whether HPCSP combined with AVNA can improve quality of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures, as well as evaluate the feasibility and safety of this therapy. METHODS: Older patients (≥ 65 years) with symptomatic persistent AF refractory to at least two ablation procedures were treated with combined HPCSP and AVNA. The success rates and complications were recorded. Pacing parameters, European Heart Rhythm Association (EHRA) scores, and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores obtained perioperatively were compared with those recorded at the 6-month follow-up examination. RESULTS: Thirty-one patients were enrolled; of those, only thirty patients were eventually treated with AVNA because one patient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead. The success rates were 100% for HPCSP (22 cases with His bundle pacing, and 9 cases with left bundle branch pacing) and 93.3% (28/30) for AVNA, respectively. By the 6-month follow-up examination, EHRA scores improved significantly (3.00 ± 0.73 vs. 2.44 ± 0.63, P = 0.014) and AFEQT scores increased markedly (49.6 ± 20.6 vs. 70.9 ± 14.0, P = 0.001). No severe complications developed. CONCLUSIONS: When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures, HPCSP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up. This therapy was proved to be safe and effective in this patient population. [ABSTRACT FROM AUTHOR]

Background To identify the prevalence of sleep disorders in China through a large sample study. To explore the relevant social determinants affecting residents' sleep status at both individual and provincial levels based on the theoretical framework of the Dahlgren-Whitehead model. Methods A nationwide cross-sectional web-based survey was conducted from January 20 to February 28, 2019 across 31 provinces of China. The Pittsburgh Sleep Quality Index was used to evaluate residents' sleep quality. Multilevel linear regression analysis was used to analyse the influencing factors of sleep disorder. Results A sample of 107 650 residents completed the survey, and 94 454 questionnaires were included in the final analysis. The crude incidence rate and the age-adjusted rate of sleep disorder in Chinese residents were 19.16% and 21.25%, respectively. Those who were older, female, smokers, drinkers, married, divorced, or widowed, retired, more educated (regression coefficient (b) = 0.172, P < 0.05), had worse self-perceived economic status, and lived far away from community health services (b = 0.758, P < 0.05) were more likely to have sleep problems. Physical exercise, social support (b = -1.705, P < 0.05), and greening coverage of residential areas (b = -1.769, P < 0.05) were protective factors for residents' sleep quality. Conclusions Sleep disorders are prevalent in the Chinese population, with varying incidence rates across provinces. To improve sleep quality, the Chinese government and health management departments should pay more attention to vulnerable groups and promote healthy lifestyles through education. Additionally, the social network can be utilized to provide social support. Improving the ecological environment and daily living environment is also essential. [ABSTRACT FROM AUTHOR]

Background: Effective team leadership and good activation criteria can effectively initiate rapid response system (RRS) to reduce hospital mortality and improve quality of life. The first reaction time of nurses plays an important role in the rescue process. To construct a nurse-led (nurse-led RRS) and activation criteria and then to conduct a pragmatic evaluation of the nurse-led RRS. Methods: We used literature review and the Delphi method to construct a nurse-led RRS and activation criteria based on the theory of "rapid response system planning." Then, we conducted a quasi-experimental study to verify the nurse-led RRS. The control group patients were admitted from August to October 2020 and performed traditional rescue procedures. The intervention group patients were admitted from August to October 2021 and implemented nurse-led RRS. The primary outcome was success rate of rescue. Setting: Emergency department, Gansu Province, China. Results: The nurse-led RRS and activation criteria include 4 level 1 indicators, 14 level 2 indicators, and 88 level 3 indicators. There were 203 patients who met the inclusion criteria to verify the nurse-led RRS. The results showed that success rate of rescue in intervention group (86.55%) was significantly higher than that in control group (66.5%), the rate of cardiac arrest in intervention group (33.61%) was significantly lower than that in control group (72.62%), the effective rescue time of intervention group (46.98 ± 12.01 min) was shorter than that of control group (58.67 ± 13.73 min), and the difference was statistically significant (P < 0.05). The rate of unplanned ICU admissions in intervention group (42.85%) was lower than that in control group (44.04%), but the difference was not statistically significant (P > 0.05). Conclusions: The nurse-led RRS and activation criteria can improve the success rate of rescue, reduce the rate of cardiac arrest, shorten the effective time of rescue, effectively improve the rescue efficiency of patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Multiple myeloma (MM) is characterized by the presence of systemic clinical manifestations. Among them, pneumonia accounts for a significant cause of morbidity and mortality, highlighting an urgent need to explore possible susceptibility and potential mechanisms of pneumonia in MM. Recently, the gut–lung axis has emphasized the relevance of gut microbiota and pneumonia, indicating that the compromised function of gut microbiota may be susceptible to pneumonia. It has been previously shown that intestinal Klebsiella pneumonia enriches in MM patients and promotes MM progression in our previous work. In addition, host metabolism has been identified as a key regulator of MM. However, what role the altered gut microbiota plays in MM with pneumonia remains unknown. In this study, we explored the association between gut microbiota and MM with pneumonia. This is the first study to identify and elucidate the function of gut microbiota involved in MM with pneumonia. Pneumonia accounts for a significant cause of morbidity and mortality in multiple myeloma (MM) patients. It has been previously shown that intestinal Klebsiella pneumonia (K. pneumonia) enriches in MM and promotes MM progression. However, what role the altered gut microbiota plays in MM with pneumonia remains unknown. Here, we show that intestinal K. pneumonia is significantly enriched in MM with pneumonia. This enriched intestinal K. pneumonia links to the incidence of pneumonia in MM, and intestinal colonization of K. pneumonia contributes to pneumonia in a 5TGM1 MM mice model. Further targeted metabolomic assays reveal the elevated level of glutamine, which is consistently increased with the enrichment of K. pneumonia in MM mice and patients, is synthesized by K. pneumonia, and leads to the elevated secretion of TNF-α in the lung normal fibroblast cells for the higher incidence of pneumonia. Inhibiting glutamine synthesis by establishing glnA-mutated K. pneumonia alleviates the incidence of pneumonia in the 5TGM1 MM mice model. Overall, our work proposes that intestinal K. pneumonia indirectly contributes to pneumonia in MM by synthesizing glutamine. Altogether, we unveil a gut–lung axis in MM with pneumonia and establish a novel mechanism and a possible intervention strategy for MM with pneumonia. [ABSTRACT FROM AUTHOR]

BACKGROUND Uninterrupted use of oral anticoagulants before atrial fibrillation (AF) ablation can reduce the incidence of perioperative thromboembolic events. However, the effect of new oral anticoagulants on activated clotting time (ACT) in response to heparin during AF ablation in Chinese populations remains unknown. The aim of the present retrospective study was to investigate the value of ACTs in response to intraoperative heparin administration in patients using dabigatran or rivaroxaban. METHODS From January 2018 to December 2021, a total of 173 patients undergoing AF ablation were included in the study, in which 101 patients were treated with dabigatran, 72 patients were treated with rivaroxaban. The intraoperative ACT values were examined in both groups. The incidence of periprocedural complications was evaluated. RESULTS Initial heparin dosage (88 ± 19 U/kg vs. 78 ± 27 U/kg, P < 0.05), total heparin dosage (137 ± 41 U/kg vs. 106 ± 52 U/kg, P < 0.05) during the ablation procedure were higher in the dabigatran group than those in the rivaroxaban group. Mean ACT (280 ± 36 s vs. 265 ± 30 s, P < 0.05), and the percentage of ACTs within the therapeutic range (250-350 s) (74% ± 26% vs. 60% ± 29%, P < 0.05) were significantly lower in the dabigatran group than those in the rivaroxaban group, particularly in male patients. Furthermore, the average time of achieving the target ACT (250-350 s) was also found longer in the dabigatran group (P < 0.05) as compared with the rivaroxaban group. No significant difference was found in the incidence of periprocedural complications between the two groups. CONCLUSIONS The anticoagulant effect of uninterrupted rivaroxaban therapy appears to be more stable and efficient than dabigatran administration during catheter ablation in patients with AF. [ABSTRACT FROM AUTHOR]

This paper aims at identifying the causal relationship between the reform of the cultural system and the upgrading of industrial structure, revealing the causal relationship between the reform of the cultural system and the upgrading of industrial structure, which is of great significance for promoting the reform of the cultural system and the upgrading of industrial structure. The impact of cultural administrative reform on industrial structure upgrading is empirically tested using panel data from 261 prefecture-level cities in China from 2001 to 2017. The double difference model and PSM-DID method are used. This includes conducting placebo tests and examining the robustness of empirical findings using other methods. The findings indicated that (1) the influence coefficient of the cultural administrative system reform on industrial structure upgrading is positive and passed the significance level test, indicating that the cultural administrative system reform significantly promoted industrial structure upgrading, and on average, it can improve the level of the urban industrial structure by 11.81 percent. (2) Theoretical analysis of the mechanism demonstrates that the innovation level acts as a link between cultural administrative system reform and industrial structure upgrading, implying that cultural administrative system reform promotes industrial structure upgrading by stimulating the innovation level of cultural enterprises. (3) The results of the heterogeneity analysis indicate that the influence of cultural administrative reform on industrial structure upgrading is highly regionally and economically differentiated. The higher the economic level of the local community, the more effective the promotion effect on industrial structure upgrading. The reform of the cultural administrative system has a greater impact on industrial structure upgrading in the eastern region than in the central and western regions. On the basis of the foregoing research findings, this paper makes some policy recommendations for releasing the overall system reform dividend based on the cultural system and promoting regional industrial structure upgrading. [ABSTRACT FROM AUTHOR]

Background: To investigate retinal neurovascular structural changes in patients with ischemic stroke (IS) using optical coherence tomography angiography (OCTA). Materials and Methods: The cross-sectional study was conducted in Guangdong Provincial People’s Hospital, China, consisting of 159 eyes from IS patients and 109 eyes from age-matched control subjects. Retinal microvascular parameters including the vessel density (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and neural parameters such as ganglion cell complex thickness (GCCt) and retinal nerve fibre layer thickness (RNFLt) were measured by OCTA. Results: The VD of SCP and DCP in the macular area were significantly reduced in IS patients compared to the control group (all p < 0.001). The VD of RPC at the optic disc was also significantly reduced in IS patients (all p < 0.05). IS patients showed reduced GCCt and RNFLt and increased GCC focal loss volume and global loss volume compared with the controls (all p < 0.05). Among patients with IS, the parafovea SCP VD was positively correlated with GCCt (r = 0.346–0.408, all p < 0.001) but not with DCP VD (all p > 0.1). In the optic disc region, the whole image RPC VD was positively correlated with mean RNFLt (r = 0. 467–0.548, all p < 0.001). Conclusion: Reduction of retinal VD, GCCt and RNFLt was observed in patients with IS. The parafovea SCP VD and RPC VD were positively correlated with GCCt and RNFLt, respectively. [ABSTRACT FROM AUTHOR]

Based on the daily temperature and precipitation data from 1961 to 2021 obtained from 2019 national meteorological stations of China, and by means of Meteorological Drought Comprehensive Index (MCI) and some improved identification methods, we identified all drought event processes in all the seven regions of China in this paper. We also carefully analyzed these regional droughts and made following conclusions: drought was spreading towards southern China with an increasing frequency; consecutive drought year group occurred in all the seven regions of China with an increasing frequency under the background of global warming; both drought duration and comprehensive intensity consistently changed with the area affected by drought, with a correlation coefficient of 0.52–0.67 and 0.88–0.99 respectively, and passed the significance test of 0.05. The method used in this paper could be employed to effectively monitor and evaluate drought processes from multiple dimensions including duration, comprehensive intensity and area affected by drought. Thus, it actually provided a helpful decision-making basis for governments to prevent the risk of drought. [ABSTRACT FROM AUTHOR]

Landfalling tropical cyclones (TCs) in Northeast China are rare because of the region's high latitude (>40°N). In 2020, Northeast China was affected by three TCs within half a month—the first time on record. We used the Global Precipitation Measurement orbital dataset to study the precipitation microphysics during the TC period in Northeast China in 2020 (2020-TC), and during September in this region from 2014 to 2019 (hereafter September 2014–September 2019). FY-4A was used to provide cloud top height (CTH). The results show that, compared with September 2014–September 2019, the 2020-TC precipitation has stronger precipitation ice productivity, weaker deposition efficiency, stronger riming, and stronger coalescence processes. The storm top height (STH), CTH, and the difference between the two (CTH-STH) are indicative of the near-surface droplet size distribution (DSD), but there are differences: STH and CTH-STH both correlate significantly with mean mass-weighted drop diameter, whereas only the positive correlation between CTH and normalized drop concentration parameter passes the significance test. These results reveal for the first time the precipitation microphysics of landfalling TCs in Northeast China, and allow discussion of the validity of convective intensity indicators from the perspective of DSD. [ABSTRACT FROM AUTHOR]

This study mainly presents the spatiotemporal characteristics and changes of near-surface wind speed with observations from 679 stations over China for 1979–2019. Furthermore, mechanisms of the wind speed changes are also investigated. Major results show that the larger near-surface wind speed mainly occur in northern and eastern regions, Tibetan Plateau and the coastal zones in China. The wind speed in spring is larger than the other seasons with mean value of 2.57 m s−1. Significantly decreased near-surface wind speed trend in China is detected during 1979–2019, particularly in 1979–1996. The mean rates of decrease in 1979–2019 and 1979–1996 are − 0.06 m s−1 (10a)−1 and − 0.19 m s−1 (10a)−1, respectively. The decreased trends of the high wind speed percentiles are more significant than the low, especially in 1979–1996. The change rate of the 95th wind speed percentile in 1979–1996 even reaches to − 0.48 m s−1 (10a)−1 and passes the significance test at p < 0.05. However, the wind speed trend reversed after 1997. The lowest 5th wind speed percentile has the most significant reversal trend. Therefore, the decreased wind speed trend before 1997 is mainly caused by the significant reduction of strong wind, while the reversal trend after 1997 results from weak wind. The variations of the wind speed over China attributed to both the U and V wind components. The significantly declined trend of the surface wind speed is closely related to the weakened upper westerly wind field. In addition, the uneven warming between high and low latitudes may also contribute to the surface wind speed changes through thermal adaption. [ABSTRACT FROM AUTHOR]

Correlation-coefficient fields are widely used in short-term climate prediction research. The most frequently used significance test method for the correlation-coefficient field was proposed by Livezey, in which the number of significant-correlation lattice (station) points on the correlation coherence map is used as the statistic. However, the method is based on two assumptions: (1) the spatial distribution of the lattice (station) points is uniform; and (2) there is no correlation between the physical quantities in the correlation-coefficient field. However, in reality, the above two assumptions are not valid. Therefore, we designed a more reasonable method for significance testing of the correlation-coefficient field. Specifically, a new statistic, the significant-correlation area, is introduced to eliminate the inhomogeneity of the grid (station)-point distribution, and an empirical Monte Carlo method is employed to eliminate the spatial correlation of the matrix. Subsequently, the new significance test was used for simultaneous correlation-coefficient fields between intensities of the atmospheric activity center in the Northern Hemisphere and temperature/precipitation in China. The results show that the new method is more reasonable than the Livezey method. [ABSTRACT FROM AUTHOR]

Background: Bullying victimization has been associated with depressive symptoms in Chinese university students. This study examined the moderating effect of possible avoidant personality disorder (APD) on association between bullying victimization and depressive symptoms in university freshmen. Methods: A total of 1,453 freshmen were recruited from a comprehensive university in Wuhan, China, and administered a self-report questionnaire. The APD subscale of Personality Diagnostic Questionnaire–Version 4 and Beck Depression Inventory were used to measure the presence of possible APD and depressive symptoms, respectively. The moderating effect of possible APD was examined by testing the statistical significance of the interaction between victimization and possible APD in multiple logistic regression analysis. Results: The prevalence of depressive symptoms was 24.8%. In multiple logistic regression analysis, the interaction between bullying victimization and possible APD was significantly associated with depressive symptoms (OR: 1.80, P = 0.029). Subsequent subgroup analyses according to the status of possible APD showed that, the victimization-depression association was stronger among freshmen with possible APD (OR: 3.23, P < 0.001) than those without possible APD (OR: 1.82, P = 0.001). Conclusion: In Chinese university freshmen, bullying victimization is significantly associated with depressive symptoms, and possible APD magnifies the victimization-depression association. Bullied freshmen, particularly freshmen with possible APD, could be considered as the target group of campus-based depression intervention programs. [ABSTRACT FROM AUTHOR]

Background Interactions between genetic and nutritional factors can contribute to the risk of gestational diabetes mellitus (GDM). Objectives We aimed to explore the associations of cyclin-dependent kinase 5 regulatory subunit associated protein 1-like 1 (CDKAL1) single-nucleotide polymorphism (SNP) rs7747752 and serum concentrations of SFAs with the risk of GDM in Chinese women. Methods We conducted a 1:1 case–control study in a prospective cohort of pregnant women in Tianjin, China. Serum SFA data were collected from a total of 243 women with GDM and their controls matched by maternal age (±1 y). Among them, 207 case–control pairs had high-quality sequencing data. P/L and S/P ratios were defined as palmitic acid (16:0)/lauric acid (12:0) and stearic acid (18:0)/palmitic acid, respectively. Conditional logistic regression analysis was performed to estimate associations of CDKAL1 SNP rs7747752 and serum concentrations of SFAs with the risk of GDM. An additive interaction between rs7747752 and palmitic acid was analyzed to test the contribution of their interaction to the risk of GDM. Results Among the 5 tested SFAs, palmitic acid was positively whereas lauric acid was negatively associated with the risk of GDM. A P/L ratio ≥12.2 and an S/P ratio ≤0.71 were independently and synergistically associated with an increased risk of GDM. The CDKAL1 rs7747752 G > C variant was significantly associated with an increased risk of GDM (P  < 0.05). Furthermore, the presence of the rs7747752 G > C variant increased the OR (95% CI) of high palmitic acid concentration from 1.55 (0.61, 3.97) to 4.34 (2.04, 9.23), with a significant additive interaction. Conclusions The interaction between high serum palmitic acid concentration and the CDKAL1 rs7747752 G > C variant played a critical role in GDM. Given that a hypocaloric low-carbohydrate diet can lower palmitic acid concentrations, it is worthwhile to test whether such a diet is effective in reducing the risk of GDM, especially among women who have both risk factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence concerning the effects of greenness on childhood visual impairment is scarce. OBJECTIVES: We aimed to assess whether greenness surrounding schools was associated with visual impairment prevalence and visual acuity levels in Chinese schoolchildren and whether the associations might be explained by reduced air pollution. METHODS: In September 2013, we recruited 61,995 children and adolescents 6–18 years of age from 94 schools in seven provinces/municipalities in China. Greenness exposure was assessed using the normalized difference vegetation index (NDVI) and the soil-adjusted vegetation index (SAVI) from July to August 2013. Visual impairment was defined as at least one visual acuity level (dimensionless) lower than 4.9 (Snellen 5/6 equivalent). Three-year annual averages of particulate matter (PM) with an aerodynamic diameter of =1 lm (PM1) and nitrogen dioxide (NO2) at each school were assessed using machine learning methods. We used generalized linear mixed models to estimate the associations between greenness and prevalent visual impairment and visual acuity levels and used mediation analyses to explore the potential mediating role of air pollution. RESULTS: In the adjusted model, an interquartile range increase in NDVI500m was associated with lower odds of prevalent visual impairment [odds ratio (OR)=0.95; 95% confidence interval (CI): 0.93, 0.97]. The same increase in NDVI500m was also associated with 0.012 (95% CI: 0.008, 0.015) and 0.011 (95% CI: 0.007, 0.015) increases in visual acuity levels for left- and right-eye, respectively. Our results also suggested that PM1 and NO2 significantly mediated the association between NDVI500m and visual impairment. Similar effect estimates were observed for SAVI500m, and our estimates were generally robust in several sensitivity analyses. DISCUSSION: These findings suggest higher greenness surrounding schools might reduce the risk of visual impairment, possibly owing in part to lower PM1 and NO2 in vegetated areas. Further longitudinal studies with more precise greenness assessment are warranted to confirm these findings. https://doi.org/10.1289/EHP8429 [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has become a long-term crisis that calls for long-term solutions. We combined an augmented SEIR simulation model with real-time human mobility data to decompose the effects of lockdown, travel bans and effective testing measures in the curtailment of COVID-19 spread in China over different time horizons. Our analysis reveals that the significant growth in the detection rate of infectious cases, thanks to the expansion in testing efficiency, were as effective as city lockdowns in explaining the reduction in new infections up to mid-March. However, as we extended the analysis to July, increasing the detection rate to at least 50% is the only reliable way to bring the spread under control. [ABSTRACT FROM AUTHOR]

Field significance tests have been widely used to detect climate change. In most cases, a local test is used to identify significant changes at individual locations, which is then followed by a field significance test that considers the number of locations in a region with locally significant changes. The choice of local test can affect the result, potentially leading to conflicting assessments of the impact of climate change on a region. We demonstrate that when considering changes in the annual extremes of daily precipitation, the simple Mann‐Kendall trend test is preferred as the local test over more complex likelihood ratio tests that compare the fits of stationary and nonstationary generalized extreme value distributions. This lesson allows us to report, with enhanced confidence, that the intensification of annual extremes of daily precipitation in China since 1961 became field significant much earlier than previously reported. Plain Language Summary: Changes to weather and climate extremes at individual locations can be highly uncertain due to natural variability. Much of the natural variability in precipitation extremes occurs on small spatial scales, and thus analyzing changes at different locations in a region with a field significance test can help extract information about changes in the region that is less affected by natural variability. An important component of doing so is the local test that is used to identify significant changes at individual locations and a field significance test that evaluates whether such changes are found at more locations than would be expected from natural variability in an unchanged climate. By contrasting several common local test methods with varying complexity, we find that the simple Mann‐Kendall test tends to yield a field significance test with high power of detection. Based on these lessons, we find that the intensification of extreme precipitation in China became field significant much earlier than previously reported, thereby resolving uncertainty about whether intensification is in fact discernable in China. Key Points: Field significance is generally determined by summarizing the results of individual tests conducted at different locations in a domainInconsistent field significance conclusions can be drawn when using different local test methodsFor extreme precipitation, field significance determined from the simple Mann‐Kendall test performs better than other commonly used ones [ABSTRACT FROM AUTHOR]

Building on Leydesdorff, Bornmann, and Mingers (2019), we elaborate the differences between Tsinghua and Zhejiang University as an empirical example. We address the question of whether differences are statistically significant in the rankings of Chinese universities. We propose methods for measuring statistical significance among different universities within or among countries. Based on z-testing and overlapping confidence intervals, and using data about 205 Chinese universities included in the Leiden Rankings 2020, we argue that three main groups of Chinese research universities can be distinguished (low, middle, and high). When the sample of 205 Chinese universities is merged with the 197 US universities included in Leiden Rankings 2020, the results similarly indicate three main groups: low, middle, and high. Using this data (Leiden Rankings and Web of Science), the z-scores of the Chinese universities are significantly below those of the US universities albeit with some overlap. We show empirically that differences in ranking may be due to changes in the data, the models, or the modeling effects on the data. The scientometric groupings are not always stable when we use different methods. Differences among universities can be tested for their statistical significance. The statistics relativize the values of decimals in the rankings. One can operate with a scheme of low/middle/high in policy debates and leave the more fine-grained rankings of individual universities to operational management and local settings. In the discussion about the rankings of universities, the question of whether differences are statistically significant, has, in our opinion, insufficiently been addressed in research evaluations. [ABSTRACT FROM AUTHOR]

When the least square approach is used to solve regression coefficients during the back analysis of a virgin stress field, the multicollinearity among independent variables may cause negative, too large, or non-significant regression coefficients, which can lead to an unreasonable virgin stress field. To make the virgin stress field obtained by a back analysis more reasonable, it is proposed that the ridge regression can be used to solve regression coefficients if multicollinearity exists. In the ridge regression, a small constant term was added to all diagonal elements of the correlation matrix to eliminate multicollinearity. Then this constant term was determined by ridge traces, the residual sum of squares, variance inflation factors, and statistical significance tests. To show the feasibility of determining a virgin stress field by the ridge regression, it was applied to the Heai tunnel located in Huili County, Sichuan Province, China. Results show that the ridge regression can avoid negative, too large, or non-significant regression coefficients effectively, and the virgin stress field obtained by the ridge regression is more reasonable and reliable than that obtained by the least square approach. [ABSTRACT FROM AUTHOR]

• We created a reservoir water bloom risk index (RWBRI) to assess water bloom risk. • TSI (trophic state index) or FAI (floating algae index) alone can't reliably assess water bloom risk. • The average value of water bloom risk for all three reservoirs is less than 50% • Reservoirs must still remain vigilant against water bloom outbreaks. The occurrence of water blooms in reservoirs poses a serious threat to water safety, so the assessment of water bloom risk is crucial. In this study, we constructed a reservoir water bloom risk index (RWBRI) using the trophic state index (TSI), floating algae index (FAI), temperature, precipitation, and wind speed datasets, and estimated and validated the water bloom risk levels of three large-scale eutrophication reservoirs in Fujian Province, China, from 2019 to 2023 based on the Sentinel-2 MSI dataset at the pixel scale. The results showed that there is no positive correlation between the TSI and FAI parameters of the three reservoirs (the significance test coefficients for Shanzai Reservoir, Dongzhen Reservoir, and Shanmei Reservoir were −0.455**, −0.371**, and −0.049, respectively, and ** indicates that the reservoir passed the statistical significance test at the 0.01 significance level). The TSI of Shanmei Reservoir was less fluctuating and more stable than that of Shanzai Reservoir and Dongzhen Reservoir, but the average value of FAI was higher. The average value of water bloom risk in Shanzai Reservoir and Dongzhen Reservoirs is higher than Shanmei Reservoir (0.47, 0.46, and 0.41, respectively), but the trend of annual average changes indicates that the overall risk of Dongzhen Reservoir is decreasing, while the risk of Shanzai Reservoir and Shanmei Reservoir is increasing. Due to the influence of weather, the water bloom risk in spring and summer is higher than that in fall and winter in the three reservoirs, and the highest risk value usually occurs in summer. The high values in Shanzai Reservoir were mainly distributed in the two inlet channels in the northern and southwestern parts of the reservoir, the bank risk was higher than in the other areas of Dongzhen Reservoir, and the high value of the risk in Shanmei Reservoir was mainly distributed in the center of the reservoir. The RWBRI method can be used for water bloom risk identification in reservoirs with eutrophication trends by comparing it with four-hourly and monthly water quality level data. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate trends in body mass index (BMI)-for-age z-scores among children and adolescents in Xinjiang. Methods Data were obtained for children and adolescents aged 7–18 years in Xinjiang from the Chinese National Survey on Students' Constitution and Health (CNSSCH) in 1985 (n  = 14 683), 1995 (n  = 7198), 2005 (n  = 10 253) and 2014 (n  = 18 521). Results The BMI-for-age z-score distribution of children and adolescents in Xinjiang showed an increased mean BMI-for-age z-score, dispersion and right-skewed of BMI-values, with a rapid increase in BMI with increasing BMI percentiles. The sex-based disparity in BMI-for-age z-scores became wider in the past 30 years. Conclusions Sex-based targeted public health measures and policies are urgently needed in Xinjiang. The rapid increases in the upper percentiles also implicated further efforts to prevent weight gain in those living already with overweight or obesity. [ABSTRACT FROM AUTHOR]

Objective To describe the diverse upper reference limits of serum thyroid stimulating hormone on the same platform for pregnant women in China. Methods The trimester-specific and population-specific TSH reference intervals for pregnant women were established, and then 5 reference intervals on the same platform in China were compared with the reference intervals derived from the present study and the manufacturer. Results The most striking difference in the upper reference limits of TSH among 5 reference intervals on the same platform was shown at the first trimester of pregnancy. The calculated regional prevalence rates of subclinical thyroid diseases varied using the data derived from 30,771 pregnant women who visited the largest obstetric center in our district from 2008 to 2018. Conclusion We reported differences among 7 reference intervals of TSH on the same platform and showed the changing population factors significantly affected them. [ABSTRACT FROM AUTHOR]

To assess the vitamin D status in healthy 6‐month‐old infants, as well as vitamin D supplementation and feeding patterns in Guangzhou, China, serum 25‐hydroxyvitamin D (25OHD) concentrations of 202 infants were measured at birth (cord blood) and at 6 months of age in Guangzhou, China. Questionnaires acquiring demographic characteristics, maternal and infantile vitamin D supplementation during pregnancy and first 6 months after birth, and feeding patterns during the first 6 months were completed by participating mothers. Physical examinations and blood sampling were carried out among infants at 6 months of age. The majority of infants (93.6%) were supplemented with vitamin D during the first 6 months of life on a voluntary basis. The M ± SD of cord serum 25OHD concentration was 46.2 ± 16.4 nmol/L, whereas the M ± SD of 25OHD concentration at 6 months was 82.9 ± 24.9 nmol/L. Serum 25OHD concentrations <30 nmol/L were seen in 34 (16.8%) infants at birth but only one (0.5%) at 6 months. Only 11 (5.4%) infants had concentrations >75 nmol/L at birth, whereas the majority of infants (n = 131, 64.9%) had concentrations >75 nmol/L at 6 months. The main predictors of 25OHD levels at 6 months included season, vitamin D supplementation, parental education level, and feeding patterns. To conclude, serum 25OHD concentrations were low at birth in a southern Chinese population, and infantile supplementation is an effective way to improve 25OHD status. Exclusively breastfed infants might need greater vitamin D supplementation, and individualized vitamin D supplementation plans might be needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bisphenol A (BPA) is an endocrine disruptor that affects fetal growth in experimental studies. Bisphenol F (BPF) and bisphenol S (BPS), which have been substituted for BPA in some consumer products, have also shown endocrine-disrupting effects in experimental models. However, the effects of BPF and BPS on fetal growth in humans are unknown OBJECTIVES: Our goal was to investigate trimester-specific associations of urinary concentrations of BPA, BPF, and BPS with size at birth METHODS: The present study included 845 pregnant women from Wuhan, China (2013–2015), who provided one urine sample in each of the first, second, and third trimesters. Linear regressions with generalized estimating equations were applied to estimate trimester-specific associations of urinary bisphenol concentrations with birth weight, birth length, and ponderal index. Linear mixed-effects models were used to identify potential critical windows of susceptibility to bisphenols by comparing the exposure patterns of newborns in the 10th percentile of each birth anthropometric measurement to that of those in the 90th percentile. RESULTS: Medians (25th–75th percentiles) of urinary concentrations of BPA, BPF, and BPS were 1.40 (0.19–3.85), 0.65 (0.34–1.39), and 0.38 (0.13– 1.11) ng/mL, respectively. Urinary BPA concentrations in different trimesters were inversely, but not significantly, associated with birth weight and ponderal index. Urinary concentrations of BPF and BPS during some trimesters were associated with significantly lower birth weight, birth length, or ponderal index, with significant trend p-values (p,trend < 0.05) across quartiles of BPF and BPS concentrations. The observed associations were unchanged after additionally adjusting for other bisphenols. In addition, newborns in the 10th percentile of each birth anthropometry measure had higher BPF and BPS exposures during pregnancy than newborns in the 90th percentile of each outcome. CONCLUSIONS: Prenatal exposure to BPF and BPS was inversely associated with size at birth in this cohort. Replication in other populations is needed. [ABSTRACT FROM AUTHOR]

Owing to uncertainty in the stock market, stock price prediction has always been a challenging research hotspot. In recent years, many stock prediction methods have used stock price series and technical indicators as inputs and the time series algorithm to predict, but they often ignore the influence of deeper factors such as the situation of the stock company and current situation of the stock industry. In addition, most of them predict based on small-scale stock datasets with limited characteristics and have certain defects such as bias, poor stability of prediction results, and lack of statistical significance tests on experimental results. To solve these problems, we propose a new method for stock price prediction based on knowledge graph (KG) and graph convolution neural network (GCN) models. First, stock KG is constructed, and the semantic relationships between stocks are described in the form of triples. Second, the correlations between stocks are quantified by fully utilizing their explicit/implicit relationships in the KG. Third, K-means, community detection (CD), and GCNs are merged to obtain accurate clustering results for similar stocks. Finally, the historical prices of similar stocks are used as the input characteristics of the time series models to predict stock price trends. We collect 4684 A-share market stocks in China from 2013 to 2019 and predicted the stock price trends for 762 of them. The experimental results and significance test show that the proposed method achieve the best accuracy, precision, and F1-measure on large-scale stock datasets and have the best stability, proving that the overall prediction effect outperforms that by state-of-the-art methods. • A stock knowledge graph is constructed based on the shareholder, concept stock and industry of stocks. • The concept of contribution to quantify the distance between stocks is introduced, and a distance adjacency matrix is constructed. • A new method that combines community detection with graph convolution neural network is proposed. • A small dataset can lead to biased, unstable, or fluctuating predictions. Our model addresses this problem and achieves optimal accuracy, precision, and F1 on a large-scale stock dataset. [ABSTRACT FROM AUTHOR]

To what extent are decisions regarding Chinese investment in Africa motivated by environmental factors? A considerable body of work has examined the determinants of foreign aid among traditional donors, producing useful debates about the relative significance of recipient need or merit and donor interest. But far less scholarly effort has focused on the motivations of emerging donors and the role of environmental factors in influencing aid allocation. In an attempt to fill these gaps, this article uses statistical techniques to test the hypothesis that China deliberately invests in African countries with poor environmental performance for reasons related to recipient need or donor interest. Drawing upon project-level data regarding investments made by China in Africa from 2002 to 2012, the analysis suggests that Chinese development assistance grows commensurate with a country's environmental performance, but only to a point. After a state achieves a certain level of environmental quality, Chinese investments decline. [ABSTRACT FROM AUTHOR]

This study analyzes the relationship between industrial ownership and environmental performance by investigating whether foreign direct investment (FDI) harms the environment. We investigate the potential differences in pollution costs among foreign-owned firms (FOEs), state-owned firms (SOEs), and privately owned firms (POEs) by using firm-level data in China. Results from the Tobit model indicate that FOEs tend to have relatively low pollution costs in most industries, whereas POEs have relatively high pollution costs in all industries. Moreover, the estimated impact of labor skill on pollution cost varies among different ownerships, with FOEs exhibiting a higher skill level than SOEs and POEs, implying that FOEs are more skill efficient and pollute less than SOEs and POEs. The result indicates that perceived advanced technology from FDI reduces environmental pollution in China, thereby supporting the pollution halo hypothesis. [ABSTRACT FROM AUTHOR]

Abstract This paper examines the how new manufacturing firms choose locations in response to the environmental regulations in Jiangsu, China. In particular, we utilize three representative measures of the environmental regulations to test the consistence of the Pollution Haven Hypothesis (PHH). The dramatic results indicate that different measures of environmental regulation lead to different conclusions of the PHH. However, firms' relocation patterns are common and consistent, i.e., new polluting firms are more likely to be driven by the government environmental mandates to northern Jiangsu, where the pollution abatement cost is high. This pattern is consistent with the industrial planning of the province, suggesting that local government may use environmental regulations to achieve economic objectives. More comprehensive and equitable policy design is thus recommended to address the problems of environmental equity in China. Highlights • We examined firms' location choice in response to the environmental regulations. • We utilized three representative measures of the environmental regulations. • We find different measures of environmental regulation lead to different conclusions. [ABSTRACT FROM AUTHOR]

Predicting and analyzing behaviors of investors is of great value to financial institutions. This paper uses survey data from about 9,000 individual investors across China to explore the predictability of decision behaviors by studying demographic characteristics that are relatively easy to obtain. After applying Pearson’s chi-squared test, Spearman rank correlation test, and several data mining methods, we verified that demographic characteristics are closely linked to decision behaviors, and it would be an economical and feasible solution for financial organizations to build initial behavioral prediction models especially when investors’ behavioral data are insufficient. [ABSTRACT FROM AUTHOR]

Background and aims Consecutive climatic extremes have more intense impacts on natural ecosystems and human activities than occasional events. There were many studies about the frequency or intensity of extreme weather events, but few focused on the consecutiveness or continuousness of climatic extremes. We analyzed the temporal and spatial distributions and tendencies in the consecutive temperature and precipitation extremes in China during 1961–2015. Methods Daily temperature and precipitation data at 1867 meteorological stations over China was used and four consecutive indices of climate extremes, i.e. cold spell duration indicator (CSDI), warm spell duration indicator (WSDI), consecutive dry days (CDD) and consecutive wet days (CWD), were calculated by RClimDex 1.0. Linear trends in the time series of consecutive days of temperature and precipitation extremes were examined and their statistical significance was evaluated using Mann–Kendall test. Results and discussion There were obvious differences in the spatial distributions of consecutive days of climate extremes in China. During 1961–2015, CSDI and CWD decreased significantly at rates of 0.9 and 0.1 days per decade respectively, while WSDI increased significantly at rate of 0.8 days per decade in China. Spatially, CSDI decreased at rates of 0–3.0 days per decade in almost all parts of China, and WSDI increased at rates of 0–2.0 days per decade in most parts of China. The spatial trends of CDD and CWD were significant only in several regions of China. CSDI and WSDI had higher percent changes than those of CDD and CWD. Changes in the CSDI and WSDI were associated with large-scale oceanic and atmospheric circulation oscillations, such as Atlantic Multidecadal Oscillation (AMO), El Niño/Southern Oscillation (ENSO) and Pacific Decadal Oscillation (PDO). With global warming, there will be fewer cold extremes, more frequent hot extremes and precipitation extremes. Conclusions Given the increases in the frequency and intensity of some consecutive climatic extremes and an increasing physical exposure and socio-economic vulnerability to such extremes in China, more strategies and capacities of mitigation and adaptation to consecutive climatic extremes are essential for the local government and climate-sensitive sectors. [ABSTRACT FROM AUTHOR]

Based on cohort data obtained from 13,085 college freshmen’s (2005 to 2011) SCL-90 (the Symptom Check-List-90) reports and their subsequent 4-year psychological counseling help-seeking records, this study examined the association between college students’ mental health problems and help-seeking behaviors across four college years. Female students’ mental health problems and help-seeking behaviors increased from the 2005 to the 2011 cohorts and no changes emerged for male students across cohorts. Overall, male students reported higher levels of mental health problems than did female students in the first college year, whereas female students reported more help-seeking behaviors than did male students in the following four college years. College students’ mental health problems was associated positively with help-seeking behaviors. College students were more likely to seek help from the college psychological counselling center when they experienced relatively few or quite a lot of mental health issues (i.e., an inversed U shape). Implications for future studies and practices are discussed. [ABSTRACT FROM AUTHOR]

[Display omitted] • The QBMs area is becoming sustainably wetter, and the NPP is increasing significantly. • The NPP of QBMs has the strongest correlation with SPEI at the four-month time scale. • The carbon sink capacity of the vegetation of QBMs is most dependent on the water balance at July and October. • The vegetation carbon sink capacity is most sensitive to the cumulative effect of hydrothermal equilibrium at the seasonal scale. Drought can significantly affect the carbon cycle of ecosystems. The Qinba Mountains region has a high potential for developing carbon sink forestry due to its strong carbon fixation capacity. This study applied the Carnegie-Ames-Stanford approach (CASA) model calculate monthly net primary productivity (NPP) in the region from 2001 to 2018. The standardized precipitation evapotranspiration indices (SPEI1-12) at various time scales were also analyzed by the Thornthwaite method, along with the test of significance and sustainability (Sen-MK-Hurst) model, to examine the persistent characteristics of dry and wet changes in the Qinba Mountains. The results of the correlation analysis between NPP and SPEI at multiple time scales showed that regional vegetation NPP is significantly impacted by drought, with the most sensitive months being July and October. On average, there is a four-month cumulative effect of drought on NPP. About 45.49% and 19.99% of NPP in the Qinba Mountains region are extremely or heavily sensitive to drought, with grasses being the most sensitive, followed by cultivated plants, deciduous broadleaved forests, mixed forests, sparse forests, and shrublands. The study also found that 40.99% of the region is expected to become wetter and 14.9% is expected to become drier in the future. Understanding the response of NPP to drought in this region can help with the management of regional climate change for environmental regulation. [ABSTRACT FROM AUTHOR]

Background Diverse sources of syndromic surveillance including over-the-counter (OTC) drug sales, hospital and school-based influenza-like illness (ILI) and Baidu search queries estimate influenza activity in Tianjin, China. The purpose of this study was to determine which syndromic surveillance systems had the strongest correlation with laboratory-confirmed influenza activity. Methods Data were obtained from sentinel hospitals and laboratories; sentinel hospitals also reported percentage of ILI. OTC sales and school- based ILI absentee data were provided by public pharmacies and schools. Baidu search queries for influenza surveillance were analyzed. Spearman correlation analysis examined correlations of syndromic systems with laboratory-confirmed data. Results Syndromic data for hospital ILI%, OTC sales and school-based ILI correlated well with laboratory data (r = 0.732, 0.490 and 0.693, respectively; P < 0.05). Baidu, the predominant Chinese Internet service, searches for 'influenza', 'cough' and 'fever' correlated best with laboratory-confirmed activity; queries for 'fever' were strongest (r = 0.924, P < 0.001). Correlations between school-based ILI and laboratory-confirmed influenza increased from 0.693 to 0.795 after a 1-week lag (P < 0.05). Conclusions A Baidu query of 'fever' provided the strongest correlation to laboratory surveillance. School-based ILI absence reporting detected influenza virus activity 1 week earlier than laboratory confirmation. Use of diverse syndromic surveillance systems in conjunction with traditional surveillance systems can improve influenza surveillance. [ABSTRACT FROM AUTHOR]

Background. IgA nephropathy is the most common cause of primary glomerulonephritis in China, and Traditional Chinese Medicine (TCM) is a vital treatment strategy. However, not all doctors prescribing TCM medicine have adequate knowledge to classify the syndrome accurately. Aim. To explore the feasibility of differentiation of TCM syndrome types among IgA nephropathy patients based on clinicopathological parameters. Materials and Methods. The cross-sectional study enrolled 464 biopsy-proven IgA nephropathy adult patients from 2010 to 2016. The demographic data, clinicopathological features, and TCM syndrome types were collected, and the decision tree models based on classification and regression tree were built to differentiate between the syndrome types. Results. 370 patients of training dataset were 32 years old with serum creatinine of 79 μmol/L, estimated glomerular filtration rate (eGFR) of 97.2 mL/min/1.73 m2, and proteinuria of 1.0 g/day. The scores of Oxford classifications were as follows: M1 = 97.6%, E1 = 14.6%, S1 = 50.0%, and T1 = 52.2%/T2 = 18.4%. The decision trees without or with MEST scores achieved equal precision in training data. However, the tree with MEST scores performed better in validation dataset, especially in classifying the syndrome of qi deficiency of spleen and kidney. Conclusion. A feasible method to deduce TCM syndromes of IgA nephropathy patients by common parameters in routine clinical practice was proposed. The MEST scores helped in the differentiation of TCM syndromes with clinical data. [ABSTRACT FROM AUTHOR]

Background: Sophorae Flos (SF) is a composite of flowers and buds of Styphnolobium japonicum (L.) Schott and has been used in traditional Korean and Chinese medicine for the treatment of hemostasis and inflammation. Previous studies reported that SF possesses anti-obesity properties, as well as anti-allergic, anti-proliferative, and anti-inflammatory activities. However, the effect of SF in bone resorption has not been studies. In this study, we examined the potential of SF extract (SFE) to inhibit receptor activator of NF-κB ligand (RANKL) -induced osteoclast differentiation in cultured mouse-derived bone marrow macrophages (BMMs). Methods: BMMs, that act as osteoclast precursors, were cultured with M-CSF (50 ng/ml) and RANKL (100 ng/ml) for 4 days to generate osteoclasts. Osteoclast differentiation was measured by tartrate-resistant acidic phosphatase (TRAP) staining and the TRAP solution assay. Osteoclast differentiation marker genes were analyzed by the quantitative real-time polymerase chain reaction analysis. RANKLs signaling pathways were confirmed through western blotting. Results: SFE significantly decreased osteoclast differentiation in a dose-dependent manner. SFE inhibited RANKL-induced osteoclastogenesis by suppressing NF-κB activation. By contrast, SFE did not affect phospholipase C gamma 2 or subsequent cAMP response element binding activation. SFE inhibited the RANKL-induced expression of nuclear factor of activated T cells c1 (NFATc1). Conclusions: SFE attenuated the RANKL-mediated induction of NF-κB through inhibition of IκBα phosphorylation, which contributed to inhibiting of RANKL-induced osteoclast differentiation through downregulation of NFATc1. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a known risk factor for stroke, but data on its prospective association with first stroke are limited. Folic acid supplementation has been shown to protect against first stroke, but its role in preventing first stroke in diabetes is unknown. Objectives: This post hoc analysis of the China Stroke Primary Prevention Trial tested the hypotheses that the fasting blood glucose (FBG) concentration is positively associated with first stroke risk and that folic acid treatment can reduce stroke risk associated with elevated fasting glucose concentrations. Design: This analysis included 20,327 hypertensive adults without a history of stroke or myocardial infarction, who were randomly assigned to a double-blind daily treatment with 10 mg enalapril and 0.8 mg folic acid (n = 10,160) or 10 mg enalapril alone (n = 10,167). Kaplan-Meier survival analysis and Cox proportionate hazard models were used to test the hypotheses with adjustment for pertinent covariables. Results: During a median treatment duration of 4.5 y, 616 participants developed a first stroke (497 ischemic strokes). A high FBG concentration (≥7.0 mmol/L) or diabetes, compared with a low FBG concentration (<5.0 mmol/L), was associated with an increased risk of first stroke (6.0% compared with 2.6%, respectively; HR: 1.9; 95% CI: 1.3, 2.8; P < 0.001). Folic acid treatment reduced the risk of stroke across a wide range of FBG concentrations ≥5.0 mmol/L, but risk reduction was greatest in subjects with FBG concentrations ≥7.0 mmol/L or with diabetes (HR: 0.66; 95% CI: 0.46, 0.97; P < 0.05). There was a significant interactive effect of FBG and folic acid treatment on first stroke (P = 0.01). Conclusions: In Chinese hypertensive adults, an FBG concentration ≥7.0 mmol/L or diabetes is associated with an increased risk of first stroke; this increased risk is reduced by 34% with folic acid treatment. These findings warrant additional investigation. This trial was registered at clinicaltrials.gov as NCT00794885. [ABSTRACT FROM AUTHOR]

Background: Recent studies have proved metabolic syndrome (MetS) was linked to cancer risks. However, few data has examined the relationship between MetS and epithelial ovarian cancer (EOC). Methods: We conducted a population-based case-control study in Tianjin Medical University Cancer Institute and Hospital, China (2010-2015) that enrolled 573 EOC patients and 1146 matched controls. Data were collected through in-person interviews, anthropometric measurement, and 8-h fasting bloods drawn. MetS was estimated by Chinese Diabetes Society (CDS) definition requiring presence of ≥3 of the following risk factors: 1) body mass index (BMI) ≥25. 0kg/m²,2) fasting plasma glucose ≥6.1 mmol/L or 2-h plasma glucose ≥ 7.8 mmol/L, 3) systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, 4) triglyceride (TG) ≥1.70 mmol/L or high-density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L. Statistics were completed using chi-square tests and logistic regression analysis. The survival analysis was conducted by the Kaplan-Meier method and Cox proportional hazard regression models. Results: MetS was significantly more prevalent among EOC (25.13%) than controls (6.89%). A statistically significant increase risk for EOC was observed for MetS (multivariable-adjusted OR = 3.187; 95% CI: 2.135-4.756). MetS was significantly associated with histological grade (P < 0.001), FIGO stage (P = 0.003), and lymph node (LN) status (P = 0.002) of EOC. In binary logistic regression analysis, the presence of MetS predicts the risk of advanced FIGO stage (OR = 2.155, 95% CI: 1.327-3.498, P = 0.002), lower differentiation (OR = 2.472, 95% CI: 1.164-5.250, P = 0.019), and LN metastasis (OR = 2.590, 95% CI: 1.089-6.160, P = 0.031) of EOC. Moreover, MetS is the independent factor for the evaluation of PFS and OS of EOC patients (both of them P < 0.001) in Cox proportional hazard model. Conclusion: MetS is obviously related to increased EOC risk. EOC patients with MetS in Chinese population were found to have statistically significant tumor advanced stage, low differentiation, LN metastasis and poor prognosis. [ABSTRACT FROM AUTHOR]

Background: Fasting is the most widely prescribed and self-imposed strategy for treating excessive weight gain and obesity, and has been shown to exert a number of beneficial effects. The aim of the present study was to determine the exact role of fasting and subsequent refeeding on fat distribution in mice. Methods: C57/BL6 mice fasted for 24 to 72 h and were then subjected to refeeding for 72 h. At 24, 48 and 72 h of fasting, and 12, 24, 48 and 72 h of refeeding, the mice were sacrificed, and serum and various adipose tissues were collected. Serum biochemical parameters, adipose tissue masses and histomorphological analysis of different depots were detected. MRNA was isolated from various adipose tissues, and the expressions of thermogenesis, visceral signature and lipid metabolism-related genes were examined. The phenotypes of adipose tissues between juvenile and adult mice subjected to fasting and refeeding were also compared. Results: Fasting preferentially consumed mesenteric fat mass and decreased the cell size of mesenteric depots; however, refeeding recovered the mass and morphology of inguinal adipose tissues preferentially compared with visceral depots. Thermogenesis-related gene expression in the inguinal WAT and interscapular BAT were suppressed. Mitochondrial biogenesis was affected by fasting in a depot-specific manner. Furthermore, a short period of fasting led to an increase in visceral signature genes (Wt1, Tcf21) in subcutaneous adipose tissue, while the expression of these genes decreased sharply as the fasting time increased. Additionally, lipogenesis-related markers were enhanced to a greater extent greater in subcutaneous depots compared with those in visceral adipose tissues by refeeding. Although similar phenotypic changes in adipose tissue were observed between juvenile mice and adult mice subjected to fasting and refeeding, the alterations appeared earlier and more sensitively in juvenile mice. Conclusions: Fasting preferentially consumes lipids in visceral adipose tissues, whereas refeeding recovers lipids predominantly in subcutaneous adipose tissues, which indicated the significance of plasticity of adipose organs for fat distribution when subject to food deprivation or refeeding. [ABSTRACT FROM AUTHOR]

Background: There has been increased recognition that prenatal or perinatal nutrition has an effect on the development of type 2 diabetes (T2D) in adulthood, although studies that have directly examined whether the effect could be transmitted to the next generation remain sparse. Objective: We investigated the role of prenatal exposure to the Chinese famine in affecting future T2D risk in adulthood in 2 consecutive generations. Design: A total of 1034 families, including 2068 parents [parental generation (F1)] and 1183 offspring [offspring generation (F2)], were recruited from the Suihua rural area that was affected by the Chinese Famine of 1959-1961. Participants born between 1 October 1959 and 30 September 1961 were defined as famine exposed, and those born between 1 October 1962 and 30 September 1964 were defined as nonexposed. The F2 were classified as having 1) no parent exposed to famine,) only a mother exposed to famine, 3) only a father exposed to famine, or 4) both parents exposed to famine. Classical risk factors for T2D as well as fasting-glucose- and oral-glucosetolerance tests were measured in both the F1 and F2. Results: Prenatal exposure to famine was associated with elevated risks of hyperglycemia (multivariable-adjusted OR: 1.93; 95% CI: 1.51, 2.48) and T2D (OR: 1.75; 95% CI: 1.20, 2.54) in adulthood in F1. Furthermore, compared with the offspring of nonexposed parents, the F2 with exposed parents-- especially both exposed parents--had increased hyperglycemia risk (OR: 2.02; 95% CI: 1.12, 3.66) in adulthood. Conclusion: Prenatal exposure to famine remarkably increases hyperglycemia risk in 2 consecutive generations of Chinese adults independent of known T2D risk factors, which supports the notion that prenatal nutrition plays an important role in the development of T2D across consecutive generations of Chinese adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: Manganese is both an essential element and a known toxicant, and it plays important roles in many mechanisms in relation to type 2 diabetes (T2D). However, epidemiological studies of this relationship are rare. OBJECTIVE: We investigated the association between plasma manganese and newly diagnosed T2D as well as whether the association could be modified by manganese superoxide dismutase (MnSOD) polymorphisms. METHODS: We conducted a case -- control study of 3,228 participants in China: 1,614 T2D patients and 1,614 controls. Concentrations of plasma magnesium were measured, and all participants were genotyped for the MnSOD Vall6Ala polymorphism (rs4880). RESULTS: A U-shaped association was observed between plasma manganese and T2D, with increased odds ratios (ORs) in relation to either low or high plasma manganese levels. Compared with the middle tertile, the multivariate-adjusted ORs [95% confidence intervals (CIs)] of T2D associated with the lowest tertile and the highest tertile of plasma manganese were 1.89 (1-53, 2.33) and 1.56 (1.23, 1-97), respectively. In spline analysis, the U-shaped association was consistently indicated, with the lowest odds of T2D at the plasma manganese concentration of 4.95 ug/L. Minor allele frequencies (C allele) of the MnSOD Vall6Ala polymorphism (rs4880) in the normal glucose tolerance (NGT) and the T2D groups were 13.57% and 14.50%, respectively. The MnSOD rs4880 polymorphism was not associated with T2D, and no interaction was found between plasma manganese and the MnSOD rs4880 polymorphism in relation to T2D. CONCLUSIONS: Our results suggested a U-shaped association between plasma manganese and T2D; both low and high levels of plasma manganese were associated with higher odds of newly diagnosed T2D. The U-shaped association was not modified by the MnSOD rs4880 polymorphism. Citation: Shan Z, Chen S, Sun T, Luo C, Guo Y, Yu X, Yang W, Hu FB, Liu L. 2016. U-shaped association between plasma manganese levels and type 2 diabetes. Environ Health Perspect 124:1876-1881; http://dx.doi.org/10.1289/EHP176 [ABSTRACT FROM AUTHOR]

Background: Epidemiologic evidence on dietary carbohydrates and stroke risk remains controversial. Very few prospective cohort studies have been conducted in Asian populations, who usually consume a high-carbohydrate diet and have a high burden of stroke. Objective: We examined dietary glycemic index (GI), glycemic load (GL), and intakes of refined and total carbohydrates in relation to risks of total, ischemic, and hemorrhagic stroke and stroke mortality. Design: This study included 64,328 Chinese women, aged 40-70 y, with no history of cardiovascular disease, diabetes, or cancer. A validated, interviewer-administered food-frequency questionnaire was used to assess usual dietary intakes at baseline and during follow-up. Incident stroke cases and deaths were identified via follow-up interviews and death registries and were confirmed by review of medical records and death certificates. Results: During mean follow-ups of 10 y for stroke incidence and 12 y for stroke mortality, we ascertained 2991 stroke cases (2750 ischemic and 241 hemorrhagic) and 609 stroke deaths. After potential confounders were controlled for, we observed significant positive associations of dietary GI and GL with total stroke risk; multivariable-adjusted HRs (95% CIs) for high compared with low levels (90th compared with 10th percentile) were 1.19 (1.04, 1.36) for GI and 1.27 (1.04, 1.54) for GL (both P-linearity < 0.05 and P-overall significance < 0.05). Similar linear associations were found for ischemic stroke, but the associations with hemorrhagic stroke appeared to be J-shaped. Similar trends of positive associations with stroke risks were suggested for refined carbohydrates but not for total carbohydrates. No significant associations were found for stroke mortality after multivariable adjustment. Conclusion: Our results suggest that high dietary GI and GL, primarily due to high intakes of refined grains, are associated with increased risks of total, ischemic, and hemorrhagic stroke in middle-aged and older urban Chinese women. [ABSTRACT FROM AUTHOR]

Background: Whether calcium supplementation can reduce body weight and prevent obesity remains unclear because of inconsistent reports. Objective: We performed a meta-analysis to investigate the correlations between calcium supplementation and changes in body weight on the basis of age, sex, body mass index (BMI) of the subjects, and length of calcium intervention. Design: PubMed, EMBASE, Web of Knowledge, and China National Knowledge Infrastructure databases were systematically searched to select relevant studies that were published from January 1994 to March 2016. Both randomized controlled trials and longitudinal studies of calcium supplementation were included, and random- or fixed-effects models in a software program were used for the data analysis. Results: Thirty-three studies involving a total of 4733 participants were included in this meta-analysis. No significant differences in weight changes were shown between calcium intervention and control groups (mean: -0.01 kg; 95% CI -0.02, 0.00 kg; P = 0.12). However, negative correlations between calcium supplementation and weight changes were shown in children and adolescents (mean: -0.26 kg; 95% CI: -0.41, -0.11 kg; P < 0.001) and in adult men and either premenopausal or old (>60 y of age) women (mean: -0.91 kg; 95% CI: -1.38, -0.44 kg; P < 0.001) but not in postmenopausal women (mean: -0.14 kg; 95% CI: -0.54, 0.26 kg; P = 0.50). When BMI was considered, a negative correlation between calcium supplementation and weight changes was observed in subjects with normal BMI (mean: -0.53 kg; 95% CI: -0.89, -0.16 kg; P = 0.005) but not in overweight or obese subjects (mean: -0.35 kg; 95% CI: -0.81, 0.11 kg; P = 0.14). Compared with the control groups, no differences in weight changes were shown in the calcium-intervention groups when the lengths of calcium interventions were <6 mo (mean: -0.09 kg; 95% CI: -0.45, 0.26 kg; P = 0.60) or ≥ 6 mo (mean: -0.01 kg; 95% CI: -0.02, 0.01 kg; P = 0.46). Conclusion: Increasing calcium intake through calcium supplements can reduce body weight in subjects who have a normal BMI or in children and adolescents, adult men, or premenopausal women. [ABSTRACT FROM AUTHOR]

Objectives: Road traffic crashes that involve very high numbers of fatalities and injuries arouse public concern wherever they occur. In China, there are two categories of such crashes: a crash that results in 10–30 fatalities, 50–100 serious injuries or a total cost of 50–100 million RMB ($US8-16m) is a “serious road traffic crash” (SRTC), while a crash that is even more severe or costly is a “particularly serious road traffic crash” (PSRTC). The aim of this study is to identify the main factors affecting different types of these crashes (single-vehicle, head-on, rear-end and side impact) with the ultimate goal of informing prevention activities and policies. Methods: Detailed descriptions of the SRTCs and PSRTCs that occurred from 2007 to 2014 were collected from the database “In-depth Investigation and Analysis System for Major Road Traffic Crashes” (IIASMRTC), which is maintained by the Traffic Management Research Institute of the Ministry of Public Security of China (TMRI). 18 main risk factors, which were categorized into four areas (participant, vehicle, road and environment-related) were chosen as potential independent variables for the multinomial logistic regression analysis. Comparisons were made among the single-vehicle, head-on, rear-end and side impact crashes in terms of factors affecting crash occurrence. Findings: Five risk factors were significant for the six multinomial logistic regression models, which were location, vertical alignment, roadside safety rating, driver distraction and overloading of cargo. It was indicated that intersections were more likely to have side impact SRTCs and PSRTCs, especially with poor visibility at night. Overloaded freight vehicles were more likely to be involved in a rear-end crash than other freight vehicles. Driver distraction is an important risk factor for head-on crashes, while vertical alignment and roadside safety rating are positively associated with single-vehicle crashes. Conclusion: Based on the findings, promising measures were proposed to prevent each type of SRTC and PSRTC, which governmental or regulatory agencies could employ to plan strategies to reduce SRTCs and PSRTCs and support lifesaving policies. [ABSTRACT FROM AUTHOR]