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Background: Competency-oriented medical education has become a global trend. However, most current studies focus on the independent effects of various competencies and lack an examination of the combined effects. Therefore, the purpose of this study was to explore the competency configurations of excellent pediatric residents and general pediatric residents and to provide a scientific reference for the talent training and career development of pediatric residents. Methods: Behavioral event interviews were conducted with 23 pediatric residents at a children's hospital in Beijing in July and August 2019. Two researchers coded the interview data to summarize the competency of pediatric residents. The research group scored the performance of 23 pediatric residents in various aspects of competency and used the crisp-set qualitative comparative analysis method to explore the competency configurations of excellent pediatric residents and general pediatric residents. Results: This study concludes that pediatric residents should have six core competencies: professional spirit, clinical skills, communication ability, learning ability, mental capacity and research ability. There are 4 combinations of competencies for becoming an excellent pediatric resident: the clinical type, scientific research type, all-around development type and high emotional intelligence type. In addition, there are 3 combinations of competencies for becoming a general pediatric resident: the comprehensive ability deficiency type, lack of professionalism and mental capacity type, lack of communication ability type. Conclusions: There are differences in competence between excellent and general pediatric residents. Excellent pediatric residents do not need to possess all competencies but should specialize in clinical practice, scientific research or communication skills. This study suggests that training in mental capacity, professional spirit and communication ability should be strengthened during pediatric resident training. Pediatric residents should make career development plans according to their actual situation, and hospitals should arrange suitable positions according to the characteristics of pediatric residents. [ABSTRACT FROM AUTHOR]

The green total factor productivity (GTFP) has become an important index of balancing the energy consumptions, economic development, and environmental protections. This study extends the slacks‐based directional distance function (SDDF) of Fare and Grosskopf into the framework of the Malmquist–Luenberger productivity index to estimate the slack‐based GTFP. This SDDF can allow decision‐making units to explore the optimal direction and measure a more precise productivity index. For the empirical study, we employ the new model to measure the slack‐based GTFP for Chinese 30 provinces over the period of 2005–2017. Furthermore, we investigate the effect of the regional differences on the GTFP and the convergence of the Chinese GTFP with β‐converge and σ‐convergence. Our results show that there is a rapid improvement in the GTFP in China, which is attributed to the technical change. However, there exists a significant difference in GTFP for three regions of China. The eastern region performs significantly better than the others. Finally, we find there is a strong convergence in China, and the eastern region has a faster convergence than the other regions. [ABSTRACT FROM AUTHOR]

Objective To investigate the roles of serum Th1 and Th2 cytokines in Kawasaki disease (KD) and determine whether the Th1/Th2 cytokine profiles in children with KD may be involved in intravenous immunoglobulin (IVIG) resistance and development of coronary artery lesions (CALs). Methods Serum Th1 and Th2 cytokines, including interferon-γ (IFNγ), tumor necrosis factor α (TNFα), interleukin-10 (IL-10), IL-6, IL-4, and IL-2, were measured using a cytometric bead array in the serum of 143 patients with KD before and after treatment with IVIG (pre-IVIG, at 3 days after temperature normalization following IVIG treatment [post-IVIG], and 1 month posttreatment). Results Levels of IL-6, IL-10, TNFα, and IFNγ were significantly increased in KD patients pre-IVIG. Post-IVIG, the levels of IL-6, IL-10, and IFNγ quickly decreased. The levels of TNFα decreased significantly after IVIG treatment in KD patients without CALs post-IVIG and in KD patients who were IVIG responders, but increased slightly in KD patients with CALs post-IVIG and in KD patients who were IVIG nonresponders. Before IVIG treatment, the levels of IL-4, IL-6, IL-10, and IFNγ were significantly higher in KD patients with CALs than in those without CALs. The post-IVIG levels of IL-6 and IL-10 were significantly higher in IVIG nonresponders than in IVIG responders. Pre-IVIG, an IL-10 level >8 pg/ml had a sensitivity of 75.0% and a specificity of 64.4% for predicting CALs, while a TNFα level <2 pg/ml had a sensitivity of 66.7% and a specificity of 74.2% for predicting IVIG resistance. Post-IVIG, an IL-6 level >10 pg/ml had a sensitivity of 67.9% and a specificity of 81.7% for predicting CALs, while an IL-10 level >6 pg/ml had a sensitivity of 53.6% and a specificity of 86% for predicting CALs. Conclusion Determination of the serum Th1/Th2 cytokine profile may be helpful for predicting the disease prognosis and targeting treatment strategies in patients with KD. [ABSTRACT FROM AUTHOR]

The development of cooperative relationships among project participants makes relationship norms an important governance mechanism to promote cooperative behavior. However, the research on relationship norms mostly ignored the project network environment established by project participants. A static project network cannot accurately reflect the actual project network state from the perspective of network embeddedness, but the research on the mechanism of cooperative behavior from the perspective of dynamic network embeddedness is limited. Therefore, this study overcame the limitation of static analysis. This paper divided the implementation process of construction projects into early, middle, and late phases. The theoretical model of network embeddedness, relationship norms, and cooperative behavior was tested using sample data from 716 surveys regarding the three phases from China to determine the mechanism of the effect of network embeddedness on cooperative behavior. The research results show that network embeddedness (including structural embeddedness and relational embeddedness) has a direct impact on cooperative behavior. The results also indicate that network embeddedness has an indirect impact on cooperative behavior through relationship norms. Additionally, the results further indicate that the direct and indirect effects of network embeddedness on cooperative behavior are different in different phases of construction projects. With the advance of construction projects, the influence of relational embeddedness increases, whereas the effect of structural embeddedness decreases. The research results deepen the understanding of relationship norms in construction projects and make up for the lack of research on cooperative behavior in construction projects from the perspective of dynamic networks. The research results also provide enlightenment for project participants to fully utilize the network relationships in different phases of construction projects, stimulate the establishment of relationship norms, and promote cooperation. This is helpful to improve the cooperative construction management mode. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the acceptances and associated influences of organ donation in mainland China. Background: The shortage of organ donors has limited the development of organ transplantation in China. It is important to recognise the target population who has high intention to donate their organs may change the status. Design: We conducted a cross‐sectional, multi‐stage sampling study collected demographic data and individuals' willingness to accept organ donation. Methods: A stepwise linear regression analysis was adopted to evaluate the factors related to the attitudes toward organ donation. Results: We collected 11,031 valid samples for the survey. The willingness to donate organs among Chinese residents averaged 56.93 points. To be specific, males (β = −.03), religious believers (β = −.01) and parents with a different number of children (all: β = −.04) are less willing to donate their organs. Respondents who live in an urban area (β =.03), have higher education level (High school or junior college β =.04, Bachelor degree or above β =.09), feel anxious (mild, moderate β =.02), feel pressured (moderate, severe β =.08), have higher scores of the Short‐Form Health Literacy Instrument (HLS‐SF12) (β =.31), The Self‐Management Scale (SHMS) (β =.16), EuroQol Five Dimensions Questionnaire (EQ‐5D) (β =.04) and EuroQol Visual Analogue Scale (EQ‐VAS) (β =.24), are more positive to donate. Conclusions: This study firstly discusses the public acceptance of organ donation through a nationwide sample around China. In this study, we discovered that Chinese residents' acceptance level of organ donation and that gender, house, anxiety, pressure, social support and health literacy were the main influencing factors on residents' attitudes. Relevance to Clinical Practice: To figure out the Chinese public acceptance and its influencing factors of organ donation can help nurse transplant coordinators to recognise the target population and the obstacles of organ donation. Patient or Public Contribution: At the phase of collecting data, participants were recruited to fill the questionnaires. [ABSTRACT FROM AUTHOR]

The Intensive Supervision Mechanism (hereafter referred to as ISM) is one of the most important institutional management innovations for air pollution control in China, but there is currently no consensus on the effects of the ISM on air quality improvement. In this study, a reliable quantitative model based on the Difference-in-Differences (DID) analysis was designed to evaluate the impacts of ISM on air quality (as indicated by good air quality days (hereafter referred to as GAD) and the concentrations of six major air pollutants (i.e. PM2.5, PM10, O3_8H, NO2, SO2, and CO)), in China with focuses on the implementation cities of Henan Province. To optimize the model design, six meteorological factors, five socio-economic indicators, and VIIRS (Visible Infrared Imaging Radiometer Suite) data were also considered as alternative control variables for more comprehensive and effective results. In addition, the redundancy analysis (RDA) and Monte Carlo simulation were conducted to determine the optimal combination of those control variables which can best reflect the changes in explanatory variables. The main findings are as follows: (1) the statistical model applied in this study can well evaluate the impacts of ISM; (2) the implementation of ISM can significantly reduce the concentrations of SO2, CO, and NO2, but the improvements for PM2.5, PM10, GAD and O3_8H were not significant. (3) the potential for air quality improvement due to ISM tends to be reduced over time, and thus the positive effects of ISM at its second stage were not increased significantly compared with those observed during its first stage. In general, those results not only demonstrate the effectiveness of ISM on air quality improvement, but also provide insights into how the ISM can be optimized to gain a sustained improvement of the ambient air quality in the future. Implications: As a policy measure implemented by the Chinese government, the Intensive Supervision Mechanism (ISM) has significantly contributed to the improvement of air quality since its execution. However, the potential for air quality improvement due to ISM tends to be reduced over time, and thus the positive effects of ISM at its second stage were not increased significantly compared with those observed during its first stage. In addition, the implementation of ISM requires a large amount of financial investment, and thus has limited sustainability. Considering the increased difficulty of this policy instrument, whether to insist on the ISM warrants further analyses on its cost and effectiveness. More importantly, more targeted measures of ISM should be applied to decrease the ozone concentration in the future. [ABSTRACT FROM AUTHOR]