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Much of the research in educational technology with a primary concern over how technology enhances learning has been criticized as privileging the immediate learning settings over the other dimensions of learners' social life and the wider social and economic contexts in which learning and technology are located. The ability to develop a rich understanding of learning and technology in various contexts requires careful use of theory that might enable "looking beyond learning". To meet this need, this paper proposes the use of a critical realistic account of learning and technology, in particular Margaret Archer's "three orders of reality" and "personal Identity". Drawing on an empirical case study for illustration, the paper argues that such an approach offers a "way out" to unpack the relationship between learning and technology through a deep exploration of the interrelationship between individual practices of learning, with or without technology, and the bigger picture of how learning intervenes in other dimensions of social life and how other contexts come into play in learning settings. (Contains 1 table and 1 figure.)

Jiechu Wang,1– 3,&ast; Yao Yu,1,&ast; Ya Gao,1– 3,&ast; Tingting Wan,1– 3 Zhukai Cong,1– 3 Zhengqian Li,1– 3 Yang Zhou,1– 3 Xiaoxiao Wang,4 Luyang Feng,1– 3 Yongzheng Han,1– 3 Jing Zhang,1– 3 Yinyin Qu,1– 3 Xiangyang Guo1– 3 1Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 2Beijing Center of Quality Control and Improvement on Clinical Anesthesia, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 3Anesthesia and Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care (CPAM), Beijing, 100191, People’s Republic of China; 4Research Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangyang Guo; Yinyin Qu, Department of Anesthesiology, Peking University Third Hospital, North Garden Road 49, Haidian District, Beijing, 100191, People’s Republic of China, Email puthmzk@hsc.pku.edu.cn; quyinyin@bjmu.edu.cnBackground: Malignant hyperthermia (MH) is a hypermetabolic syndrome with high mortality rates. Early detection and prompt intravenous administration of dantrolene are crucial for effective management of MH. However, there is currently a lack of comprehensive nationwide surveys on the availability of dantrolene and anesthesiologists’ understanding of MH in China.Methods: A nationwide survey was conducted between January 2022 and June 2022. Online questionnaires on the cognition of MH among anesthesiologists in China were sent through social platforms to anesthesiologists in mainland China. Data regarding participants’ perception of MH-related knowledge, availability of domestic dantrolene, and reported MH cases were collected in this study.Results: Responses were collected from a total of 11,354 anesthesiologists representing 31 provinces across the Chinese mainland. Among the 11 scoring questions, the highest accuracy rates were observed for the question regarding therapeutic drugs for MH (99.3%) and the characteristics of MH (98.0%). Conversely, the question pertaining to the earliest clinical signs of MH had the lowest accuracy rate (23.5%). Significant variations were observed in the scores among different professional titles (P=0.003), academic degree (P< 0.001), hospital classification (P< 0.001), and urban hierarchy (P< 0.001). Of the respondents, 919 (8.1%) anesthesiologists reported dantrolene availability in their hospitals, and 631 (5.6%) indicated unclear. A total of 136 hospitals in this survey reported at least one previous case of MH.Conclusion: Mainland China faces challenges such as insufficient experience in diagnosing and treating MH, as well as difficulty in obtaining dantrolene. To improve the public awareness of MH, it is imperative to establish and promote a refined MH training system. Additionally, a streamlined and rapid dantrolene linkage emergency system should be implemented to ensure prompt access to the drug.Keywords: malignant hyperthermia, dantrolene, China, anesthesiologists, survey

Yangyang Han,1 Reidar K Lie,2 Zhenlin Li,3 Rui Guo3 1Department of Outpatient, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China; 2Department of Philosophy, University of Bergen, Bergen, Norway; 3School of Public Health, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Rui Guo, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, People’s Republic of China, Tel +86-10-83911573, Email guorui@ccmu.edu.cnPurpose: Trust is an essential component in a successful health care relationship. Doctor–patient trust involves the subjects of both sides, including the direction of patients’ trust in physicians (patients’ perception) and physicians’ trust in patients (physicians’ perception). This study aims to assess the status quo and explore suggestions for improving trust between doctors and patients.Patients and Methods: In May 2018, we collected data from six representative hospitals in Beijing, China, including 610 questionnaires (310 physicians and 300 patients). Participants were Chinese-speaking, age 14 and older, who expressed their opinions clearly. Kruskal–Wallis H-test and Wilcoxon rank sum test were used to analyze the difference in the trust scores of the responses.Results: Based on the doctor and patient characteristics, the data show that inpatients are trusted more than outpatients, and patients who often visit the clinic are more doubtful of doctors. The family trust is the highest, and social trust is the lowest. In general, the degree of trust between doctors and patients is good, but the score of physicians (Mean=3.87; SD=0.79) is lower than that of patients (Mean=4.05; SD=0.76). Physicians’ evaluation of the degree of trust tends to be more negative than patients’.Conclusion: In spite of recent negative press reports, there remains a high degree of trust between patients and doctors in Beijing. Despite this, one should not be complacent. We need to explore the root cause of the trust between doctors and patients from a deeper perspective to promote better medical services to meet the health needs of patients.Keywords: China, doctor–patient relationship, trust, public hospitals

Summary: From June to July 2017, six Seneca Valley virus (SVV) strains were isolated from swine herds exhibiting SVV‐associated porcine idiopathic vesicular disease (PIVD) in Guangdong province, China. Complete genomic sequences of these six newly identified strains were genetically and phylogenetically analysed. The results revealed that these six SVV strains were genetically closely related to USA/GBI29/2015 and notably distinct from all previous Chinese strains, indicating the reemergence of new SVV strains in Guangdong province. [ABSTRACT FROM AUTHOR]

Prunus necrotic ringspot virus (PNRSV) is an important virus that infects stone fruit trees. In this study, we determined the complete genomic sequence of a PNRSV Chinese sweet cherry isolate designed as PNRSV-ChrYL (GenBank accession numbers KT444701-KT444703). The RNA1, RNA2 and RNA3 of PNRSV-ChrYL are 3,321 nt, 2,592 nt and 1,954 nt in size, respectively. The RNA1 and RNA2 encode the putative replicase protein P1 and P2, respectively. The movement protein (MP) and coat protein (CP) are encoded by RNA3. Phylogenetic analyses based on the MP and CP genes revealed that PNRSV-ChrYL clustered with the PV32 group. This is the first report of complete genome sequence of PNRSV in China. [ABSTRACT FROM AUTHOR]

The future of wild tigers is dire, and the Global Tiger Initiative's ( GTI) goal of doubling tiger population size by the next year of the tiger in 2022 will be challenging. The GTI has identified 20 tiger conservation landscapes ( TCL) within which recovery actions will be needed to achieve these goals. The Amur tiger conservation landscape offers the best hope for tiger recovery in China where all other subspecies have most likely become extirpated. To prioritize recovery planning within this TCL, we used tiger occurrence data from adjacent areas of the Russian Far East to develop two empirical models of potential habitat that were then averaged with an expert-based habitat suitability model to identify potential tiger habitat in the Changbaishan ecosystem in Northeast China. We assessed the connectivity of tiger habitat patches using least-cost path analysis calibrated against known tiger movements in the Russian Far East to identify priority tiger conservation areas ( TCAs). Using a habitat-based population estimation approach, we predicted that a potential of 98 (83-112) adult tigers could occupy all TCAs in the Changbaishan ecosystem. By combining information about habitat quality, connectivity and potential population size, we identified the three best TCAs totaling over 25 000 km2 of potential habitat that could hold 79 (63-82) adult tigers. Strong recovery actions are needed to restore potential tiger habitat to promote recovery of Amur tigers in China, including restoring ungulate populations, increasing tiger survival through improved anti-poaching activities, land-use planning that reduces human access and agricultural lands in and adjacent to key TCAs, and maintaining connectivity both within and across international boundaries. Our approach will be useful in other TCLs to prioritize recovery actions to restore worldwide tiger populations. [ABSTRACT FROM AUTHOR]

Objectives To investigate the critical period for overweight development during early childhood by examining growth trajectory and related sex differences. Methods Using piecewise linear mixed models and logistic regression, we examined the effect of growth trajectory at different periods on overweight at age 4-5 by sex among 136 971 regularly followed children (mean: 12.2 times) during 2000-2005 in south China. Results The high-body mass index ( BMI) group (>top tertile of BMI Z score at age of 4-5 years) had faster growth rates of BMI, BMI Z score, weight and height than the low- BMI group in the first 3 months of life. Boys were more likely to be overweight [odds ratio ( OR) = 2.0, 95% confidence interval: 1.5-2.7] than girls; the male high- BMI group had higher growth rates during the first 3 months than girls with high- BMI, independently of environmental factors. Those fast grown (in the upper tertile of growth rates in BMI and BMI Z score) in periods 0-3 months had relatively higher OR of at risk of overweight at age of 4-5 years than those in other periods. Conclusions Overweight risk develops during the first 3 months of life. Boys have an earlier peak in growth than girls, which may help explain why overweight is more prevalent in boys in China. [ABSTRACT FROM AUTHOR]

China is one of the largest grain producing and consuming nations in the world and the importance of grain security to the Chinese can never be overemphasized. In this paper, we present a comprehensive early-warning model for evaluating the status of grain security in China. The model is based on the analytic hierarchy process (AHP) method and the Dempster-Shafer theory (DST). We divided the risk assessment into four stages. First, we seek risk sources and identify the indices to be used in the model. Then, we preprocess the index data to obtain the index directions and risk bounds. After that, we assign index weights via AHP method. Finally, we evaluate risk of grain security via DST method and determine the overall risk degree. An empirical analysis is conducted to demonstrate the use of the model for evaluating the status of grain security in China. The result shows that the model which conforms to the reality of China is effective and can be used as a grain security pre-warning monitoring tool. [ABSTRACT FROM AUTHOR]

Abstract: Wind power is considered as one of the most promising renewable energy sources in China. Presented in this study is a life cycle analysis of energy performance and greenhouse gas emission for a typical wind farm in Guangxi, with different stages of manufacturing, transportation, and installation of mechanical components, operation and maintenance, and disassemble and disposal taken into account. Results show that the nonrenewable energy cost and greenhouse gas emission to generate 1 MJ of electricity for the grid are 0.046 MJ and 0.002 kg CO2 equivalent, respectively. In consideration of the dominant power generation technology of coal combustion in China, the nonrenewable energy saving brought about by the concerned wind farm is estimated at 1.22E+7GJ during its twenty year operating period, while the reduced greenhouse gas emissions are as much as 1.03E+06 ton CO2 equivalent. It is believed that this successful example can lend solid support to a future wide use of wind power in China. [Copyright &y& Elsevier]

In 2007, China firmly established itself as the driver of the global methanol industry. The country became the world's largest methanol producer and consumer. The development of the methanol industry and methanol fuel in China is reviewed in this article. China is rich in coal but is short on oil and natural gas; unfortunately, transportation development will need more and more oil to provide the fuel. Methanol is becoming a dominant alternative fuel. China is showing the rest of the world how cleaner transportation fuels can be made from coal. [ABSTRACT FROM AUTHOR]

Oryza rufipogon Griff. (common wild rice; CWR) is the ancestor of Asian cultivated rice (Oryza sativa L.). Investigation of the genetic structure and diversity of CWR in China will provide information about the origin of cultivated rice and the grain quality and yield. In this study, we used 36 simple sequence repeat (SSR) markers to assay 889 accessions, which were highly representative of whole germplasm in China. The analysis revealed a hierarchical genetic structure within CWR. First, CWR has diverged into two ecotypic populations, a south subtropical population (SSP) and a middle subtropical population (MSP), probably owing to natural selection by the different climates. The distribution of specific alleles and haplotypes indicated that Chinese CWR had both indica-like and japonica-like variations; the SSP was an indica-like type, whereas the MSP was more japonica-like. The SSP and MSP further diverged into five (HN, GD-GX1, GX2, FJ and YN) and two (JX-HuN1 and HuN2) geographical populations, respectively. The genetic data suggest the isolation by distance, although water systems also appear to play an important role in the formation of homogenous populations, and occasionally landscape was also involved. The population GD-GX1, which grew widely in Guangdong and Guangxi provinces, was the largest geographical population in China. It had a high level of genetic diversity (GD) and the closest genetic relationship with other inferred populations. The population HN, with the smallest SSR molecular weights and the highest level of GD, may be the most ancestral population.Heredity (2008) 101, 527–535; doi:10.1038/hdy.2008.61; published online 1 October 2008 [ABSTRACT FROM AUTHOR]

Objective:To investigate the association between macrosomia and high weight-for-length/height in 1–3 years old Chinese infants.Design:A retrospective longitudinal study.Subjects:918 children aged 1–3 years in Shanghai, China.Measurements:Body weight and length/height, illness status and feeding modalities were obtained during follow-up. Macrosomia was defined as birth weight 90th percentile of sex specific birth weight distribution. High weight-for-length/height was defined as a weight-for-length/height z-score 1.68 using the WHO growth reference.Results:The odds ratios (ORs) for high weight-for-length/height were 3.60 (95% confidence interval (CI), 1.74–7.42) for boys and 1.39 (95% CI, 0.51–3.81) for girls who were macrosomic compared with the nonmacrosomic counterparts after adjustment for age. The ORs were attenuated to 3.48 (95% CI, 1.63–7.43) for boys and were still nonsignificant for girls (OR, 1.38; 95% CI, 0.49–3.91) after further controlling for illness status, the age of breast-feeding cessation and the age at introduction of complementary foods. From the analysis of boys and girls combined, the ORs were 2.48 (95% CI, 1.40–4.40) with adjustment for age and sex and 2.33 (95% CI, 1.29–4.22) with all covariates.Conclusion:Macrosomia is an important predictor for high weight-for-length/height in Chinese children aged 1–3 years.International Journal of Obesity (2008) 32, 55–60; doi:10.1038/sj.ijo.0803765; published online 27 November 2007 [ABSTRACT FROM AUTHOR]

The Shawan River will be the focal point in the development of the Panyu District, the southernmost district of Guangzhou City in the Guangdong Province of South China. In this research, through the use of two scenarios, the future water quality of the Shawan River was predicted with relation to changes in the water quantity utilized to fuel industrial and domestic development. The worst-case scenario used, simulated the situation if no wastewater treatment was employed, and the best-case scenario simulated the situation if 90% of the pollution load was removed. The period of simulation was for the years 2020 and 2050. Three flowrates were used in the evaluation, those of: the 90% probability of the month of lowest flow (37.2 m³/s); and the range of flowrates within the low flow period, that is, the dry season from November to February (307 and 432 m³/s). Subsequently, two countermeasures (industrial and domestic water savings) -- sustainable initiatives -- were nested within the two scenarios to ascertain improvements in water quality as a direct result of reduction in water quantity used. The industrial water saving countermeasure showed the greatest improvement in water quality. For the 90% probability of lowest flow for the worst-case scenario, this countermeasure equated to a 63% decrease in BOD. For the low flow period flowrates the background concentration of pollutants was more influential than improvements imparted by the countermeasures to the future predicted water quality. It was recommended that industrial countermeasures be used that take into account water saving, water recycling, the use of brackish water for cooling, and the implementation of economic pricing initiatives. Also that inter-district governmental policy initiatives be introduced to prevent upstream pollution from influencing downstream proposals, further enhancing sustainable water management of the Shawan River. [ABSTRACT FROM AUTHOR]

Abstract China's soils tend to be phosphate deficient. Application of phosphorus fertilisers to the soil is yield and cost ineffective as much of the phosphate applied is rapidly locked-in and is inaccessible to the crop. Chinese Institutes have established intensive wheat breeding programmes to generate wheat varieties that produce adequate yields and grain quality in such soils. Three such wheat cultivars have been identified with good performance characteristics in the field. These three cultivars are thought to harbour chromosome translocations that may confer enhanced phosphate scavenging abilities to the plants. The isolation and study of the expression of high-affinity phosphate transporters in tissues of these wheats, in two of the donor wheatgrasses and in another widely planted Chinese wheat variety is presented and the first full-length sequence of a wheat phosphate transporter and partial clones of several other putative phosphate transporters are reported. Relative quantitative reverse-transcription – polymerase chain-reaction was used to demonstrate that different phosphate transporters have different expression patterns within a given variety and respond differently to phosphate deprivation. The significance of the genetic background for these findings and for the different phosphate acquisition properties of the wheats under study is discussed. [ABSTRACT FROM AUTHOR]

Background Hepatocellular carcinoma (HCC) is one of the most common malignancies in China with poor prognosis. Recently, personalized neoantigen-based immunotherapy has been reported to induce robust anti-tumor immune responses to facilitate tumor rejection in several solid tumors. However, whether it possess therapeutic potential in HCC still remain unclear. Thus, a systemic understanding of neoantigen burden (TNB) in HCC microenvironment is in need. Methods HCC and matched peritumor tissue collected from 59 HCC patients were subjected to DNA and RNA sequencing for identifying tumor associated neoantigens. Then the association between neoantigens and clinical features, immune signatures, as well as clonal evolution patterns in HCC were evaluated. Results In enrolled HCC patients, a median of 106 somatic mutations and 15 neoantigens were identified in each patient. TNB was significantly correlated with tumor somatic mutation burden (R2 = 0.893, P = 3.0 × 10^-24). Furthermore, the clinicopathological analysis revealed that patients with higher TNB was characterized with older age (p = 0.006), decreased tumor size (p = 0.020) and lower recurrence rate (p = 0.019). Additionally, TNB was also significantly associated with relapse free survival (P = 0.033) and overall survival (P = 0.022) in HCC patients. Surprisingly, HCC tumor with high immune cell infiltration were more likely to have no tumor envelope (P = 0.027) and resulted in shorter overall survival time after surgery (P = 0.025); the patients with lower immune cell signatures related to antigen-processing have relatively higher TNB in HCC. Meanwhile, clonal evolution analysis revealed that the clonal mutations were more likely to be neoantigens (P = 9.2 × 10^-5) than subclonal mutations, suggesting higher immunogenicity for clonal mutations. And tumors with higher proportion of neoantigens in clonal mutations were more likely to involved in clonal evolution, which may due to the immunoediting of neoantigens (P = 0.002). Conclusions Our results demonstrated that neoantigens play an important role in tumor clonal evolution and immune response in HCC, which could provide insights for future HCC immunotherapy. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Abstract Objectives We carried out a randomized multicentre study in China to investigate whether the clofazimine would improve the efficacy of the standardized regimen in patients with multidrug-resistant tuberculosis (MDR-TB). Methods Patients with MDR-TB managed in 17 TB specialist hospitals in China between September 2009 and September 2011 were randomly assigned to the treatment groups at enrolment. In the intervention group, 100 mg clofazimine per day was added to the standardized regimen. The primary outcome was the proportion of patients with successful outcomes. Results From the 156 patients that were screened, 74 were assigned to the control group and 66 to the clofazimine group. Of the 66 cases analysed for clinical outcome in the clofazimine group, 36 patients were cured, and seven completed treatment, yielding a favourable outcome rate of 65.1%. The proportion of patients with favourable outcomes receiving the control regimen was 47.3% (35/74), which was significantly lower than that in the clofazimine group (p 0.034, relative risk 0.661, 95% CI 0.243–0.949). Conclusions The addition of clofazimine to the standard regimen improved the treatment of MDR-TB. [ABSTRACT FROM AUTHOR]

Gehendra Mahara,1,* Zhihong Wu,2,* Qi Ge,1 Zhiwei Li,1 Jinxin Zhang1 1Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China; 2Research Center, Baiyunshan Hejigong Pharmaceutical Factory, Guangzhou Baiyunshan Pharmaceutical Holdings Co., Ltd, Guangzhou, 510080, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinxin ZhangSchool of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of ChinaTel +86-20-87332453Email zhjinx@mail.sysu.edu.cnBackground: The household expired drugs disposal has been a huge public issue in many countries, including China, which may affect various side and toxic effects on human health and environment, water resources, and soil too. This paper explores the knowledge, attitude, and practice of Guangzhou city residents regarding household expired drugs and their effect on human health and provided the scientific pieces of evidence to carry out the long-term recovery mechanism for expired medicines.Methods: An observational, cross-sectional study was conducted using a self-structured questionnaire. Descriptive analysis, including univariate and unconditional logistic regression models, was carried out to analyze the data.Results: A total of 613 community residents with a 99.4% response rate enrolled for the study. More than half 60.2% of residents stated that expired drugs pollute the environment, soil, and water resources, where 81.2% of respondents knew that it would produce side effects or toxic effects. However, still, 71.6% of respondents disposed of directly into the trash bin or sink, and, only 24.8% had good practice that they use a designed recycling bin. Likewise, only 8.3% of respondents placed expired drugs into collection points nearly 3– 5 times in a year, while 65.1% of participants never disposed of in the collection point, which found a worse practice.Conclusion: Overall, the knowledge, attitude, and practice of Guangzhou residents regarding household expired drugs disposal were not ideal. To improve the resident’s awareness about family expired drugs disposal, ensure the financial support for the recycling process, establish an accessible and acceptable recycling point, and introduce relevant laws and regulations for the long-term mechanism.Keywords: household, expired drugs, knowledge, attitude, practice, collection point, Guangzhou, China

Apart from northern and central China, the fossil record of the latest Miocene and Early Pliocene of Asia is not well documented and the record of South China during this interval is especially poor. Shuitangba, a site in Yunnan Province, offers a rare window into the paleoenvironment of the latest Miocene in southwestern China. Over 2400 vertebrate and macrobotanical specimens have been recovered from the site. The faunal assemblage is dominated by aquatic avian taxa and many of the mammalian taxa are those that indicate densely vegetated, water-margin habitats. Pollen and carpological remains indicate a temperate to subtropical, broad-leaved/coniferous forest around standing water, with more open areas containing grasses and herbs. Analyses of clay minerals, chemical weathering, and enamel stable isotopes suggest that Shuitangba was warmer and more humid than today, possibly with more pronounced seasonality. Results of community structure analysis indicate that the Shuitangba mammalian community was different from those of other Late Miocene Chinese sites in the high proportions of aquatic-dependent mammalian taxa. While Shuitangba shared mammalian faunal elements with other Late Miocene sites in Yunnan, it was still faunally distinct. Further, Shuitangba was depauperate in its mammalian fauna, which may have been a result of the depositional setting rather than a true reflection of regional faunal diversity. • Shuitangba is a unique window into the Late Miocene. • Shuitangba sampled a densely vegetated water-margin habitat. • Shuitangba mammal community differed from those of other Late Miocene Chinese sites. [ABSTRACT FROM AUTHOR]

Objectives: To develop and evaluate an applicable model for a community health service (CHS) in an underdeveloped area of China that ensures efficient, convenient and affordable primary healthcare access for all residents. Study design: The current study was carried out in Puyang, a typical medium-sized city in central-eastern China. Based on the healthcare requirements of the residents in Puyang, a CHS network was set up and its operation was evaluated from 1999 to 2006. The system is characterized by its focus on community health education (CHE). Methods: Firstly, 8231 residents, selected at random, were surveyed to investigate the healthcare requirements of the local residents. Meanwhile, the operation of the pre-existing healthcare resources was investigated in Puyang. Based on the information gained, a network-based CHS system was proposed and established, with CHE as the major focus. This study compared CHS operation prior to and after establishment of the network. Finally, an analytic hierarchy process based evaluation model was applied to evaluate the operation of the CHS network. Results: There was a high prevalence (86.98‰) of chronic diseases among the residents who participated in this investigation. The majority (84.39%) of the residents who had healthcare requirements resorted to professional health care; the other residents did not have access to health services. Among those residents who sought professional treatment, 71.3% visited primary healthcare institutions. This information reflects the enormous requirement for a CHS in primary health care but the lack of accessibility among the residents; this motivated the authors to establish a system to solve the problem. The improvement in CHS operation after the network was established suggests the importance of a network for optimizing the primary healthcare system. The improvement was indicated by better understanding of the residents regarding the CHS, and enhanced capability of self-monitoring for chronic diseases such as hypertension after the network was established. Moreover, the residents' knowledge of health care was significantly increased and, accordingly, the incidence of health risk behaviour was reduced after the network was established. Furthermore, the CHE index between 1999 and 2006 showed good correlation (r = 0.988, p<0.005) with the CHS index, suggesting the important role of CHE in CHS development. Conclusions: A network-characterized CHS system was established in Puyang, and improved the primary healthcare situation. This study provides a feasible model for the development of a CHS in medium and small cities in underdeveloped parts of China. [ABSTRACT FROM AUTHOR]

Background Individual patient data from two multicentre, randomised trials comparing atezolizumab with docetaxel in previously treated advanced non-small-cell lung cancer (NSCLC) were analyzed to identify any preferable therapeutic approaches for patient subsets stratified by EGFR mutation status. Methods We pooled 1,137 patients from the phase II POPLAR trial (NCT01903993) and the phase III OAK trial (NCT02008227). Patients were randomly assigned to receive either atezolizumab or docetaxel and were analyzed based on stratification of EGFR mutation status. We built a novel algorithm integrating the blood-based tumor mutation burden and the ctDNA maximum somatic allele frequency (bTMB-MSAF score) and developed a novel clinicopathologic-genomic nomogram to predict individual survival. Results In the whole intention-to-treat population, OS was significantly longer with atezolizumab than with docetaxel (hazard ratio [HR] 0.72, P < 0.001). Among patients without EGFR or ALK mutations, overall survival (OS) was significantly longer with atezolizumab than with docetaxel (HR 0.67; P < 0.001); patients with a bTMB-MSAF score<20 showed improvement in OS (HR 0.56; P < 0.001) and progression-free survival (PFS) (HR 0.74; P = 0.0023), and these patients who concurrently had programmed death ligand 1 (PD-L1) expressing on over 50% tumor cells or over 10% of tumor-infiltrating immune cells (TC3 or IC3) had the greatest OS improvements (HR 0.44; P = 0.007) and promising PFS benefits (HR 0.54; P = 0.019). EGFR mutant patients could not gain significant OS or PFS benefits from atezolizumab over docetaxel, irrespective of PD-L1 expression and bTMB-MSAF score. Patients with low-risk scores had longer OS (HR 0.17; P < 0.001; AUC=0.912 for 3-year OS) than patients with high-risk scores classified by the nomogram. Conclusions Atezolizumab showed better OS and PFS than docetaxel in previously treated EGFR wild-type NSCLC patients with a bTMB-MSAF score < 20, especially in those with PD-L1 expression of TC3 or IC3. Our clinicopathologic-genomic nomogram is effective in predicting survival of NSCLC patients undergoing atezolizumab. Clinical trial identification NCT01903993 and NCT02008227. Legal entity responsible for the study Herui Yao. Funding Herui Yao is funded by the National Science and Technology Major Project under Grant [2020ZX09201021]; National Natural Science Foundation of China under Grant [81372819, 81572596, U1601223]; Natural Science Foundation of Guangdong Province under Grant [2017A030313828]; and Guangzhou Science and Technology Program under Grant [201704020131]. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background KEYNOTE-181 (NCT02564263) was an open-label, randomized, phase 3 trial of pembrolizumab (pembro) vs investigator choice of single-agent paclitaxel/docetaxel/irinotecan (chemo) in advanced/metastatic esophageal AC or SCC. Pts were enrolled in partially overlapping periods, initially globally and then in China with an extension period. We present results from the global and China cohorts. Methods Pts were randomized 1:1 to receive pembro or chemo. Randomization was stratified by histology (SCC vs AC) and region (Asia vs rest of world). Primary end points were OS in the ITT, SCC, and PD-L1 CPS ≥10 populations. Results There were 628 and 123 pts in the global and China cohorts, respectively. In the global cohort, 314 pts were randomized to receive pembro (199 [63%] had SCC; 107 [34%] had CPS ≥10 tumors); 314 pts to chemo (204 [65%] had SCC; 115 [37%] had CPS ≥10 tumors). Median follow-up was 7.1 mo (pembro) vs 6.9 mo (chemo). Median OS with pembro vs chemo was similar in the ITT group (7.1 vs 7.1 mo) and longer in the SCC (8.2 vs 7.1 mo) and CPS ≥10 groups (9.3 vs 6.7 mo). 12-month OS rates were higher with pembro in all groups (ITT 32% vs 24%; SCC 39% vs 25%; CPS ≥10 42% vs 20%). In the China cohort, 62 pts were randomized to pembro (60 had SCC; 25 had CPS ≥10 tumors); and 61 pts to chemo (59 had SCC; 29 had CPS ≥10 tumors). Median follow-up was 8.3 mo (pembro) vs 5.6 mo (chemo). Median OS was higher with pembro in the ITT (8.4 vs 5.6 mo; HR 0.55; 95% CI 0.36-0.82), SCC (8.4 vs 5.6 mo; HR 0.55; 95% CI 0.37-0.83), and CPS ≥10 groups (12.0 vs 5.3 mo; HR 0.34; 95% CI 0.17-0.69). 12-month OS rates were higher with pembro in all groups (ITT 36% vs 17%; SCC 36% vs 16%; CPS ≥10 53% vs 16%). Fewer pts had TRAEs with pembro than chemo (global 64% vs 86%; China 76% vs 83%). TRAE rates resulting in discontinuation with pembro vs chemo were comparable in the global cohort (6% each) and lower with pembro in the China cohort (6% vs 12%). Conclusions Pembro and chemo showed comparable OS as 2L therapy for esophageal AC/SCC in the global ITT cohort. Pembro showed favorable OS in SCC and CPS ≥10 groups in the global cohort and in all groups in the China cohort, in which most patients had SCC. Pembro showed favorable safety in both cohorts. Clinical trial identification NCT02564263. Editorial acknowledgement Medical writing and/or editorial assistance was provided by Traci Stuve, MA, of the ApotheCom pembrolizumab team (Yardley, PA, USA). This assistance was funded by Merck Sharp & Dohme Corp. a subsidiary of Merck & Co. Inc. Kenilworth, NJ, USA. Legal entity responsible for the study Merck Sharp & Dohme Corp. a subsidiary of Merck & Co. Inc. Kenilworth, NJ, USA. Funding Merck Sharp & Dohme Corp. a subsidiary of Merck & Co. Inc. Kenilworth, NJ, USA. Disclosure S-B. Kim: Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Sanofi-Aventis; Research grant / Funding (institution): Kyowa-Kirin; Research grant / Funding (institution): DongKook Pharmaceutical. T. Doi: Advisory / Consultancy: Kyowa Hakko Kirin, MSD, Daiichi Sankyo, Amgen, Sumitomo Dainippon, Taiho Pharmaceutical, Takeda, AbbVie, Novartis, Bayer; Research grant / Funding (institution): Taiho Pharmaceutical, Novartis, Merck Serono, MSD, Boehringer Ingelheim, Pfizer, Lilly Japan, Sumitomo Group, Kyowa Hakko Kirin, Daiichi Sankyo, Bristol-Myers Squibb, AbbVie, Quintiles, Eisai. K. Kato: Research grant / Funding (institution): MSD, ONO Pharmaceutical, Shionogi, Merck Serono. M. Shah: Research grant / Funding (institution): Merck, Roche, Boston Biomedical. A. Adenis: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: MSD; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: BMS; Research grant / Funding (institution), Travel / Accommodation / Expenses: Bayer; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Servier. T. Kojima: Non-remunerated activity/ies, Other- Patents, Royalties, other Intellectual Property: Ono Pharmaceutical, MSD, Shionogi Pharma, Oncolys BioPharma, Astellas Amgen BioPharama; Honoraria (self): Oncolys BioPharma. J-P. Metges: Research grant / Funding (institution): Bristol-Myers Squibb; Research grant / Funding (institution): Merck; Honoraria (self): Bayer-Health; Honoraria (self): Lilly; Advisory / Consultancy: ERYTECH Pharma; Advisory / Consultancy: Sanofi. E. Francois: Research grant / Funding (institution): MSD; Non-remunerated activity/ies, +Personal Fees: Roche; Non-remunerated activity/ies, +Personal Fees: Servier; Non-remunerated activity/ies, +Personal Fees: Merck; Non-remunerated activity/ies, +Personal Fees: Amgen; Non-remunerated activity/ies, +Personal Fees: Sanofi; Non-remunerated activity/ies, +Personal Fees: Novartis; Non-remunerated activity/ies, +Personal Fees: Bayer. K. Muro: Honoraria (self): Takeda, Chugai Pharma, Yakult Honsha, Merck Serono, Taiho Pharmaceutical, Lilly, Ono Pharmaceutical, Bayer; Research grant / Funding (institution): Ono Pharmaceutical, MSD, Daiichi Sankyo, Shionogi, Kyowa Hakko Kirin, Gilead Sciences, Merck Serono, Pfizer, Sanofi. R. Wang: Full / Part-time employment: Merck & Co. Inc. Y. Cui: Full / Part-time employment: MSD China. P. Bhagia: Full / Part-time employment: Merck & Co. Inc. All other authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]