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This study examines the learning experience of Chinese international undergraduate students taking a large core first-year anthropological science course (ANT101) by distance learning during the Winter of 2021 at the University of Toronto Mississauga (UTM). We review the general learning experiences of Chinese international students (n=30) compared to domestic students and other international students through analysis of qualitative and quantitative data collected from self-report pre- and post-course surveys distributed in the course. Our study challenges some prevailing notions about Chinese international student experiences of studying in Western universities. Our data suggests that while many Chinese international students may feel a lack of English language proficiency is a barrier to their learning, it does not significantly impact their performance when compared with domestic students. The results presented here suggest that educational research and policy makers should move beyond an emphasis on language proficiency and further examine the role of other factors when developing strategies to facilitate supportive learning environments for English Language learners (ELL) and international students in a university setting.

This study examined the extent to which perceived organisational support (POS) predicts career exploration via the mediation effect of career adaptability. Grounded in career construction theory, the study employed an online survey with 611 Chinese undergraduate students. The survey employed POS, career adaptability and career-related exploration scales. Multi-group comparisons explored gender, discipline and place of origin (rural or urban). Although gender and major were moderating variables, there was no significant difference among rural and urban subgroups. There was a direct relationship between POS and career-related exploration via the mediation effect of career adaptability. Male students had higher and statistically significant path coefficients when it came to the relationship between POS and career-related exploration. The effects of POS on career adaptability and career-related exploration differed according to discipline. Humanities and social sciences (HASS) students reported significantly less organisational support than those in science and engineering. POS had negligible influence on career-related exploration among HASS students. The results suggest that assessing students' POS is an important preliminary step within career development learning. Recommendations include early assessment and discussion of students' POS and incorporating the concern, control, curiosity and confidence dimensions of career adaptability into career-related interventions.

This article explores critical ways that migrant groups engage in diverse forms of resistance. In this comparative case study, we draw on our longitudinal ethnographic research on migrant groups, particularly those that are characterized as undocumented, with a focus on the ways in which they engage in activism and resistance in China and the United States, respectively. We aim to expand the literature about comparison by asking: how is comparison understood differently through the lens of crisscrossing, and what productive insights can be uncovered through this theoretically informed approach? What implications might crisscrossing have for studying grassroots level resistance from migrants across borders?

Purpose: With a focus on Chinese higher education students, the purpose of this study was to explore the relationship between students' perceived employability and their levels of academic engagement and stress. Design/methodology/approach: The study engaged 1,155 students from three universities in China. Students responded to an online survey, reporting their confidence in relation to their perceived employability, academic engagement and stress in life. The authors employed structural equation modelling to explore students' confidence in each employability attribute and to assess perceived employability relation to academic engagement and perceived stress. Findings: The results suggest that self-perceptions of employability are positively associated with students' academic engagement and negatively associated with perceived stress. Perceived employability mediated the majority paths. Originality/value: This is one of the few studies to examine perceived employability in line with academic engagement or stress and the first study to do so in China.

Background: Alcohol use and abuse remain prevalent in China, though mounting evidence shows that even drinking in moderation is detrimental to health. While many countries' intake is on the decline, China's alcohol consumption is rising fast and is on the path to overtaking countries like the United States, even on a per capita level. Objectives: This paper aims to analyze the danger of lax enforcement of laws and regulations against alcohol use and abuse and underscores the imperative for effective health interventions to curb problematic alcohol consumption in China. Results: Different from their Western counterparts, Chinese drinkers often consume more spirit with a high percentage of alcohol in social settings that encourage the "ganbei culture"—making toasts with alcohol filled to the brim and downed in one go to show respect—which perpetuates excessive drinking at a fast pace. Though the country has various laws and regulations in place to curb problematic alcohol consumption, like workplace drinking, their impacts are dismal. Considering that China has 1.4 billion people, the country's uncurbed alcohol consumption trend could have a detrimental effect on national strategic objectives like "Healthy China 2030" and international ones like the Sustainable Development Goals. To further compound the situation, prevalent campaigns promoted by liquor companies—like alcohol-infused coffee, chocolate, and ice cream—may groom young people to develop alcohol consumption habits, if not addictions, for generations to come. Conclusions: We developed the Framework of 5Vs of China's "Ganbei Culture to shed light on the issue, with the hope that it, along with the overarching insights of this paper, can assist health professionals and policymakers in better guarding and improving public health against the harms of alcohol use and abuse in China and beyond. [ABSTRACT FROM AUTHOR]

This article proposes a global environmentality framework to critique efforts to "green" the Belt and Road Initiative (or Green BRI) by examining the Chinese state's environmental governance of extraterritorial spaces. The article transcends a focus within governmentality studies on domestic processes to reveal the relations between governance techniques and environmental subjects, including state and nonstate actors, beyond sovereign borders. Drawing on interviews, observations, and analysis of policies and reports, we identify three ways in which global environmentalities operate and are negotiated through the Green BRI. First, the Chinese state is embracing international sustainable development criteria to gain global legitimacy while seeking to export its domestic environmental governance model, making the Green BRI a dialectic policy. Second, the state is targeting and disciplining BRI participants, including Chinese financial institutions, construction companies, the renewable industry, and foreign state actors in BRI countries. Third, Chinese and BRI partner country participants' variegated subjectivities arise out of the negotiation of their own interests, Chinese state interests, and BRI host country concerns. Our analysis contributes to understanding of how China, as a rising power, engages in global environmental governance and produces extraterritorial environmental subjects. [ABSTRACT FROM AUTHOR]

Background The relevance of folic acid for stroke prevention in low-folate populations such as in China is uncertain. Genetic studies of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, which increases plasma homocysteine (tHcy) levels, could clarify the causal relevance of elevated tHcy levels for stroke, ischaemic heart disease (IHD) and other diseases in populations without folic acid fortification. Methods In the prospective China Kadoorie Biobank, 156 253 participants were genotyped for MTHFR and 12 240 developed a stroke during the 12-year follow-up. Logistic regression was used to estimate region-specific odds ratios (ORs) for total stroke and stroke types, IHD and other diseases comparing TT genotype for MTHFR C677T (two thymine alleles at position 677 of MTHFR C677T polymorphism) vs CC (two cytosine alleles) after adjustment for age and sex, and these were combined using inverse-variance weighting. Results Overall, 21% of participants had TT genotypes, but this varied from 5% to 41% across the 10 study regions. Individuals with TT genotypes had 13% (adjusted OR 1.13, 95% CI 1.09–1.17) higher risks of any stroke [with a 2-fold stronger association with intracerebral haemorrhage (1.24, 1.17–1.32) than for ischaemic stroke (1.11, 1.07–1.15)] than the reference CC genotype. In contrast, MTHFR C677T was unrelated to risk of IHD or any other non-vascular diseases, including cancer, diabetes and chronic obstructive lung disease. Conclusions In Chinese adults, the MTHFR C677T polymorphism was associated with higher risks of stroke. The findings warrant corroboration by further trials of folic acid and implementation of mandatory folic acid fortification programmes for stroke prevention in low-folate populations. [ABSTRACT FROM AUTHOR]

Background: Movement behaviours, including physical activity, sedentary behaviour, and sleep have been shown to be associated with several chronic diseases. However, they have not been objectively measured in large-scale prospective cohort studies in low-and middle-income countries. We aim to describe the patterns of device-measured movement behaviours collected in the China Kadoorie Biobank (CKB) study. Methods: During 2020 and 2021, a random subset of 25,087 surviving CKB individuals participated in the 3rd resurvey of the CKB. Among them, 22,511 (89.7%) agreed to wear an Axivity AX3 wrist-worn triaxial accelerometer for seven consecutive days to assess their habitual movement behaviours. We developed a machine-learning model to infer time spent in four movement behaviours [i.e. sleep, sedentary behaviour, light intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA)]. Descriptive analyses were performed for wear-time compliance and patterns of movement behaviours by different participant characteristics. Results: Data from 21,897 participants (aged 65.4 ± 9.1 years; 35.4% men) were received for demographic and wear-time analysis, with a median wear-time of 6.9 days (IQR: 6.1–7.0). Among them, 20,370 eligible participants were included in movement behavior analyses. On average, they had 31.1 mg/day (total acceleration) overall activity level, accumulated 7.7 h/day (32.3%) of sleep time, 8.8 h/day (36.6%) sedentary, 5.7 h/day (23.9%) in light physical activity, and 104.4 min/day (7.2%) in moderate-to-vigorous physical activity. There was an inverse relationship between age and overall acceleration with an observed decline of 5.4 mg/day (17.4%) per additional decade. Women showed a higher activity level than men (32.3 vs 28.8 mg/day) and there was a marked geographical disparity in the overall activity level and time allocation. Conclusions: This is the first large-scale accelerometer data collected among Chinese adults, which provides rich and comprehensive information about device-measured movement behaviour patterns. This resource will enhance our knowledge about the potential relevance of different movement behaviours for chronic disease in Chinese adults. [ABSTRACT FROM AUTHOR]

China is expanding its Arctic presence by developing infrastructure in the global commons that intersect with the region. Operations in outer space, the deep sea and cyberspace minimise the need for terrestrial footholds and generate data, a virtual resource. To analyse the epistemic and geopolitical consequences of developing the Arctic global commons as a vertically and digitally integrated volume, we examine a critical form of Chinese 'remote infrastructure': optical, synthetic aperture radar, and navigation satellites. We argue that first, by generating data about the Arctic, these instruments turn China into a regional knowledge producer. Second, as remote observations outnumber field observations, Chinese polar science may shift the regional balance of knowledge towards spaceborne and marine observations. Third, China's emergence as an Arctic knowledge producer may motivate the state to contribute to regional governance as remote sensing and large‐scale, computationally intensive techniques become privileged decision‐making tools. To transcend the terrestrial and maritime fixes that predominate research on China and the Arctic, we call for greater attention to the influence of epistemic capacities on geopolitics. China is expanding its Arctic presence by developing infrastructure in the global commons intersecting with the region. Operations in outer space, the deep sea, and cyberspace minimise the need for terrestrial footholds and generate data, a virtual resource. To analyse the epistemic and geopolitical consequences of developing the Arctic commons as a vertically and digitally integrated volume, we examine a critical form of Chinese 'remote infrastructure': optical, synthetic aperture radar, and navigation satellites. [ABSTRACT FROM AUTHOR]

We have introduced a real-time polling system to support student engagement and feedback in four large Level 1 and 2 modules in Biological Sciences. The audience response system makes use of a technology that is ubiquitous and familiar to the students. To participate, students send text messages using their mobile phones or send a message via their smartphone, and poll results are immediately displayed within a "Powerpoint" presentation during the lecture. In this case study, student evaluations indicate that mobile polling has been very well received and been of real value to students in helping them to gain increased awareness of their strengths and weaknesses. Students also report increased engagement during lectures that has provided an additional incentive to attend classes. Importantly, this innovative approach has the potential to be widely disseminated with minimal training and technological requirements.

This paper analyzes the collapse of the Qing dynasty (1644–1912) through the lens of the Structural Demographic Theory (SDT), a general framework for understanding the drivers of socio-political instability in state-level societies. Although a number of competing ideas for the collapse have been proposed, none provide a comprehensive explanation that incorporates the interaction of all the multiple drivers involved. We argue that the four-fold population explosion peaking in the 19th century, the growing competition for a stagnant number of elite positions, and increasing state fiscal stress combined to produce an increasingly disgruntled populace and elite, leading to significant internal rebellions. We find that while neither the ecological disasters nor the foreign incursions during the 19th century were sufficient on their own to bring down the Qing, when coupled with the rising internal socio-political stresses, they produced a rapid succession of triggering events that culminated in the Qing collapse. [ABSTRACT FROM AUTHOR]

Background: Reliable classification of ischemic stroke (IS) etiological subtypes is required in research and clinical practice, but the predictive properties of these subtypes in population studies with incomplete investigations are poorly understood. Aims: To compare the prognosis of etiologically classified IS subtypes and use machine learning (ML) to classify incompletely investigated IS cases. Methods: In a 9-year follow-up of a prospective study of 512,726 Chinese adults, 22,216 incident IS cases, confirmed by clinical adjudication of medical records, were assigned subtypes using a modified Causative Classification System for Ischemic Stroke (CCS) (large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioaortic embolism (CE), or undetermined etiology) and classified by CCS as "evident," "probable," or "possible" IS cases. For incompletely investigated IS cases where CCS yielded an undetermined etiology, an ML model was developed to predict IS subtypes from baseline risk factors and screening for cardioaortic sources of embolism. The 5-year risks of subsequent stroke and all-cause mortality (measured using cumulative incidence functions and 1 minus Kaplan–Meier estimates, respectively) for the ML-predicted IS subtypes were compared with etiologically classified IS subtypes. Results: Among 7443 IS subtypes with evident or probable etiology, 66% had SAO, 32% had LAA, and 2% had CE, but proportions of SAO-to-LAA cases varied by regions in China. CE had the highest rates of subsequent stroke and mortality (43.5% and 40.7%), followed by LAA (43.2% and 17.4%) and SAO (38.1% and 11.1%), respectively. ML provided classifications for cases with undetermined etiology and incomplete clinical data (24% of all IS cases; n = 5276), with area under the curves (AUC) of 0.99 (0.99–1.00) for CE, 0.67 (0.64–0.70) for LAA, and 0.70 (0.67–0.73) for SAO for unseen cases. ML-predicted IS subtypes yielded comparable subsequent stroke and all-cause mortality rates to the etiologically classified IS subtypes. Conclusion: This study highlighted substantial heterogeneity in prognosis of IS subtypes and utility of ML approaches for classification of IS cases with incomplete clinical investigations. [ABSTRACT FROM AUTHOR]

International students have become an important part of many universities, both through the income they provide and the diversity they bring to student populations. Studying in a foreign country can be challenging, requiring students to adapt to unfamiliar educational cultures. With the integration of online technologies into higher education, this can raise an additional set of challenges. This paper presents research that explored Chinese international students' experiences of studying online at an Australian university, drawing on qualitative data collected from focus groups and interviews with Chinese students, interviews with their Australian teachers and course documentation. The findings indicate a strong culture clash between these students' educational dispositions, shaped by their previous learning experiences in China, and the online pedagogic practices, which were underpinned by a constructivist approach. This resulted in detrimental educational and psychological consequences, with participants reporting limited development of their knowledge, and feelings of isolation and anomie. The findings suggest that investigating the interplay between learners' prior and current educational experiences is important in understanding how students experience teaching practices.

Research into learning technology has developed a reputation for being driven by rhetoric about the revolutionary nature of new developments, for paying scant attention to theories that might be used to frame and inform research, and for producing shallow analyses that do little to inform the practice of education. Although there is theoretically-informed research in learning technology, this is in the minority, and has been actively marginalised by calls for applied design work. This limits opportunities to advance knowledge in the field. Using three examples, alternative ways to engage with theory are identified. The paper concludes by calling for greater engagement with theory, and the development of a scholarship of learning technology, in order to enrich practice within the field and demonstrate its relevance to other fields of work.

The cross-cultural experiences of Chinese international students in Western countries have been subject to intensive research, but only a very small number of studies have considered how these students adapt to learning in an online flexible delivery environment. Guided by Berry's acculturation framework (1980, 2005), the investigation discussed in this article aimed to address this gap by exploring the adaptation processes of Chinese international students to online learning at an Australian university. This article reports on the challenges perceived by two students from Mainland China, their coping strategies, changes in their opinions of online learning, and their respective patterns of adaptation. By presenting two indicative case studies drawn from a wider study, this article aims to demonstrate the use of Berry's concepts as a means to frame such studies. (Contains 2 figures.)

Esophageal cancer (EC) remains a significant challenge globally, having the 8th highest incidence and 6th highest mortality worldwide. Esophageal squamous cell carcinoma (ESCC) is the most common form of EC in Asia. Crucially, more than 90% of EC cases in China are ESCC. The high mortality rate of EC is likely due to the limited number of effective therapeutic options. To increase patient survival, novel therapeutic strategies for EC patients must be devised. Unfortunately, the development of novel drugs also presents its own significant challenges as most novel drugs do not make it to market due to lack of efficacy or safety concerns. A more time and cost-effective strategy is to identify existing drugs, that have already been approved for treatment of other diseases, which can be repurposed to treat EC patients, with drug repositioning. This can be achieved by comparing the gene expression profiles of disease-states with the effect on gene-expression by a given drug. In our analysis, we used previously published microarray data and identified 167 differentially expressed genes (DEGs). Using weighted key driver analysis, 39 key driver genes were then identified. These driver genes were then used in Overlap Analysis and Network Analysis in Pharmomics. By extracting drugs common to both analyses, 24 drugs are predicted to demonstrate therapeutic effect in EC patients. Several of which have already been shown to demonstrate a therapeutic effect in EC, most notably Doxorubicin, which is commonly used to treat EC patients, and Ixazomib, which was recently shown to induce apoptosis and supress growth of EC cell lines. Additionally, our analysis predicts multiple psychiatric drugs, including Venlafaxine, as repositioned drugs. This is in line with recent research which suggests that psychiatric drugs should be investigated for use in gastrointestinal cancers such as EC. Our study shows that a drug repositioning approach is a feasible strategy for identifying novel ESCC therapies and can also improve the understanding of the mechanisms underlying the drug targets. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Device-measured Movement Behaviours in Over 20,000 China Kadoorie Biobank Participants," which appeared in the 2023 issue of the magazine.

Since the 2010s, foreign direct investment in real estate (FDIRE) by Mainland Chinese firms has emerged as a major force within global real estate markets, challenging Western investors' traditional dominance. It is unclear, however, whether Mainland Chinese FDIRE is fueled by the same motivations as those of investors from advanced economies, which to date have represented both the primary investors and main objects of study. One major difference may be that Mainland Chinese investment originates in an institutional environment comprised of strong state intervention and social networks important for fostering business and ethnic ties. To uncover the potentially unique determinants and heterogeneity of Mainland Chinese corporate real estate investors, we build and analyze a state-level panel dataset of Mainland Chinese FDIRE by state-owned enterprises and private enterprises in the U.S. from 2010 to 2017. Our empirical results reveal the importance of Chinese migrants in promoting Mainland Chinese real estate investment, especially by private enterprises. Our findings also demonstrate that at the state level, Mainland Chinese FDIRE exhibits few agglomerative tendencies. [ABSTRACT FROM AUTHOR]

Background: Little is known about the incidence rates and importance of major modifiable risk factors for hip and major osteoporotic fractures in low‐ and middle‐income countries. We estimated the age‐ and sex‐specific incidence of hip, major osteoporotic, and any fractures and their associated risk factors in Chinese adults. Methods: This was a prospective study of 512,715 adults, aged 30–79 years, recruited from 10 diverse areas in China from 2004 to 2008 and followed up for 10 years. Age‐ and sex‐specific incidence rates were estimated, and Cox regression was used to yield adjusted hazard ratios (HRs) and population attributable fractions for risk factors. Results: The incidence rates of hip fracture in Chinese adults were 5.1 (95% confidence interval [CI] 5.0–5.3) per 10,000 person‐years; they were higher in women than in men and increased by two‐ to threefold per 10‐year older age. Among men, five risk factors for hip fracture, including low education (HR = 1.23; 95% CI 1.04–1.45), regular smoker (1.22, 1.03–1.45), lower weight (1.59, 1.34–1.88), alcohol drinker (1.18, 1.02–1.36), and prior fracture (1.62, 1.33–1.98), accounted for 44.3% of hip fractures. Among women, lower weight (1.30, 1.15–1.46), low physical activity (1.22, 1.10–1.35), diabetes (1.62, 1.41–1.86), prior fracture (1.54, 1.33–1.77), and self‐rated poor health (1.29, 1.13–1.47) accounted for 24.9% of hip fractures. Associations of risk factors with major osteoporotic or any fractures were weaker than those with hip fractures. Conclusions: The age‐ and sex‐specific incidence rates of hip fracture in Chinese adults were comparable with those in Western populations. Five potentially modifiable factors accounted for half of the hip fractures in men and one quarter in women. [ABSTRACT FROM AUTHOR]

Geographers are paying increasing attention to the geopolitics of knowledge production. China has attracted particular interest given the state's professed goal of becoming a scientific power. Little research, however, has attended to the politics of scientific research relating to the Belt and Road Initiative (BRI). Instead, a focus on the discourses and environmental impacts of infrastructure projects is paramount. Understanding the situated nature of research on the BRI, particularly within the environmental sciences, is crucial considering the Chinese state's ambitions to become a global scientific power and a leader in green energy and climate change. We carry out a systematic review of 537 publications in Chinese and English on the Green BRI, an ostensibly more environmentally-friendly version of the initiative. We find four main research themes across the entire corpus: 1) environmental impact assessments; 2) empirical analysis of non-state actors involved in Green BRI governance; 3) identification of overseas commercial opportunities for China's green industries; and 4) detection of policy alignment of the Chinese initiative with the United Nations' Sustainable Development Goals. For each theme, we articulate the main cleavages separating the Chinese and foreign corpuses and critique the geopolitics and subjectivities embedded in environmental studies of the BRI. The two corpuses agree on: 1) the need for a greener BRI; 2) the need for more diversified governance that engages actors beyond the state; and 3) the ability for host country context and capacity to influence the BRI's implementation. The corpuses disagree regarding: 1) the severity of the initiative's potential impacts; 2) investors' and non-profit organizations' intentions and appropriate roles; and 3) whether China should export its norms and standards or instead adopt international ones. We attribute these cleavages to divergent implicit geopolitics embedded within the Chinese and foreign knowledge communities, which reflects broader interstate power competition. This research underscores how knowledge production is geopolitically situated even within environmental studies, which are often viewed as objective. At a time of heightening international tension, this article urges consideration of how emerging geopolitical ideas and narratives affect the practices and policies of science in rising powers. [ABSTRACT FROM AUTHOR]

Background: Little is known about the frequency and types of disease clusters involving major chronic diseases that contribute to multimorbidity in China. We examined the frequency of disease clusters involving major chronic diseases and their relationship with age and socioeconomic status in 0.5 million Chinese adults. Methods: Multimorbidity was defined as the presence of at least two or more of five major chronic diseases: stroke, ischaemic heart disease (IHD), diabetes, chronic obstructive pulmonary disease (COPD) and cancer. Multimorbid disease clusters were estimated using both self-reported doctor-diagnosed diseases at enrolment and incident cases during 10-year follow-up. Frequency of multimorbidity was assessed overall and by age, sex, region, education and income. Association rule mining (ARM) and latent class analysis (LCA) were used to assess clusters of the five major diseases. Results: Overall, 11% of Chinese adults had two or more major chronic diseases, and the frequency increased with age (11%, 24% and 33% at age 50–59, 60–69 and 70–79 years, respectively). Multimorbidity was more common in men than women (12% vs 11%) and in those living in urban than in rural areas (12% vs 10%), and was inversely related to levels of education. Stroke and IHD were the most frequent combinations, followed by diabetes and stroke. The patterns of self-reported disease clusters at baseline were similar to those that were recorded during the first 10 years of follow-up. Conclusions: Cardiometabolic and cardiorespiratory diseases were most common disease clusters. Understanding the nature of such clusters could have implications for future prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: There is limited prospective evidence on the association of physical activity with hepatobiliary cancer subtypes and other major hepatobiliary diseases, especially in China. We aimed to quantify the associations with risk of these diseases.Methods: The study population involved 460 937 participants of the prospective China Kadoorie Biobank aged 30-79 years from 10 diverse areas in China without history of cancer or hepatobiliary disease at baseline. Cox regression was used to estimate adjusted hazard ratios (HRs) for each disease associated with self-reported total and domain-specific physical activity (occupational and non-occupational, ie, leisure time, household and commuting).Results: During ~10 years of follow-up, 22 012 incident cases of hepatobiliary diseases were recorded. The overall mean (SD) total physical activity was 21.2 (13.9) metabolic equivalent of task (MET)-hours/day, with 62% from occupational activity. Total physical activity was inversely associated with hospitalised non-alcoholic fatty liver disease (HR comparing top vs bottom quintile: 0.62, 95% confidence interval (CI) 0.53 to 0.72), viral hepatitis (0.73, 95% CI 0.62 to 0.87), cirrhosis (0.76, 95% CI 0.66 to 0.88) and liver cancer (0.81, 95% CI 0.71 to 0.93), as well as gallstone disease (0.86, 95% CI 0.81 to 0.90), gallbladder cancer (0.51, 95% CI 0.32 to 0.80) and biliary tract cancer (0.55, 95% CI 0.38 to 0.78). The associations for occupational physical activity were similar to those for total physical activity, but for non-occupational physical activity they differed by disease subtype. For leisure-time physical activity, there was an inverse association with liver cancer and an inverse trend for gallstone disease (HR comparing ≥7.5 MET-hours/day with none: 0.83, 95% CI 0.75 to 0.91 and 0.82, 95% CI 0.66 to 1.01).Conclusion: Among Chinese adults, high total physical activity, particularly occupational physical activity, was inversely associated with risk of major hepatobiliary cancers and diseases, including non-alcoholic fatty liver disease, cirrhosis and certain types of cancer. [ABSTRACT FROM AUTHOR]

Background: Over 3.5 billion individuals worldwide are exposed to household air pollution from solid fuel use. There is limited evidence from cohort studies on associations of solid fuel use with risks of major eye diseases, which cause substantial disease and economic burden globally.Methods and Findings: The China Kadoorie Biobank recruited 512,715 adults aged 30 to 79 years from 10 areas across China during 2004 to 2008. Cooking frequency and primary fuel types in the 3 most recent residences were assessed by a questionnaire. During median (IQR) 10.1 (9.2 to 11.1) years of follow-up, electronic linkages to national health insurance databases identified 4,877 incident conjunctiva disorders, 13,408 cataracts, 1,583 disorders of sclera, cornea, iris, and ciliary body (DSCIC), and 1,534 cases of glaucoma. Logistic regression yielded odds ratios (ORs) for each disease associated with long-term use of solid fuels (i.e., coal or wood) compared to clean fuels (i.e., gas or electricity) for cooking, with adjustment for age at baseline, birth cohort, sex, study area, education, occupation, alcohol intake, smoking, environmental tobacco smoke, cookstove ventilation, heating fuel exposure, body mass index, prevalent diabetes, self-reported general health, and length of recall period. After excluding participants with missing or unreliable exposure data, 486,532 participants (mean baseline age 52.0 [SD 10.7] years; 59.1% women) were analysed. Overall, 71% of participants cooked regularly throughout the recall period, of whom 48% used solid fuels consistently. Compared with clean fuel users, solid fuel users had adjusted ORs of 1.32 (1.07 to 1.37, p < 0.001) for conjunctiva disorders, 1.17 (1.08 to 1.26, p < 0.001) for cataracts, 1.35 (1.10 to 1.66, p = 0.0046) for DSCIC, and 0.95 (0.76 to 1.18, p = 0.62) for glaucoma. Switching from solid to clean fuels was associated with smaller elevated risks (over long-term clean fuel users) than nonswitching, with adjusted ORs of 1.21 (1.07 to 1.37, p < 0.001), 1.05 (0.98 to 1.12, p = 0.17), and 1.21 (0.97 to 1.50, p = 0.088) for conjunctiva disorders, cataracts, and DSCIC, respectively. The adjusted ORs for the eye diseases were broadly similar in solid fuel users regardless of ventilation status. The main limitations of this study include the lack of baseline eye disease assessment, the use of self-reported cooking frequency and fuel types for exposure assessment, the risk of bias from delayed diagnosis (particularly for cataracts), and potential residual confounding from unmeasured factors (e.g., sunlight exposure).Conclusions: Among Chinese adults, long-term solid fuel use for cooking was associated with higher risks of not only conjunctiva disorders but also cataracts and other more severe eye diseases. Switching to clean fuels appeared to mitigate the risks, underscoring the global health importance of promoting universal access to clean fuels. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly spread all over the globe from China. Pleural involvement is not common; around 5–10% of patients can develop pleural effusion and little is known about the involvement of pleural structures in this new infection. A 61-year-old male kidney transplant patient with a history of multiple biopsy-confirmed acute rejections and chronic allograft rejection was admitted to our COVID-19 Unit with dry cough, exertional dyspnea, oliguria, and abdominal distension. Lung ultrasound imaging, chest X-ray, and CT scan showed left pleural effusion and atelectasis of the neighboring lung parenchyma. RT-PCR was positive for SARS-CoV-2 in the pleural fluid and cytology showed mesothelial cells with large and multiple nuclei, consistent with a cytopathic effect of the virus. This is one of few reports describing detection of SARS-CoV-2 in the pleural fluid and to the best of our knowledge, is the first to document the simultaneous presence of a direct cytopathic effect of the virus on mesothelial cells in a kidney transplant patient with COVID-19 pneumonia. The pleura proved to be a site of viral replication where signs of a direct pathological effect of the virus on cells can be observed, as we report here. RT-PCR for SARS-CoV-2 should be part of routine examination of pleural effusion even in patients with mild respiratory symptoms or with comorbidities that seem to explain the cause of effusion. [ABSTRACT FROM AUTHOR]

Through active involvement in UNESCO's ICH (Intangible Cultural Heritage) programme, China has developed its own framework to support traditional making practices. To examine the 'characteristics' of heritage crafts preservation in China, we undertook empirical research in the Yellow River basin. Our research involved in-depth observations and key informant interviews with a range of highly accomplished craftspeople who have inherited their particular expertise from their family and have been officially designated ICH Inheritors. Through our qualitative research with inheritors, a businessperson and a government official, we identified various support mechanisms employed by the Chinese government that aim to protect traditional culture while also recognising outstanding individuals. We also found that ICH Inheritors play an important role in raising cultural awareness and enhancing cultural confidence through their creative activities and making practices, craft businesses and transfer of expertise. Based on the findings, potential areas where designers may collaborate with inheritors were identified. [ABSTRACT FROM AUTHOR]

Divining the future of development, not least of all of China, from Hong Kong has long been fraught. Taking up Jamie Peck's call for 'conjunctural theorizing' that destabilizes idealizations of the state and market, through examples drawn from the Pearl River Delta, this paper explores how the colonial and contemporary accumulation of political power and financial capital by wealthy individuals, families and their corporations renders divisions between the two institutions superficial. It then considers the local and global geopolitical effects of Hong Kong's transformation into an entrepôt for international trade and, more recently, offshore wealth – increasingly from Mainland China, a dynamic which will again reshape state–market relations. These reflections support Peck's demonstration of the productive possibilities of starting rather than ending theory from cases such as Hong Kong. [ABSTRACT FROM AUTHOR]

Aims: The economic burden of diabetes is driven by the management of vascular complications. Sodium–glucose cotransporter‐2 inhibitors (SGLT2i) have demonstrated reductions in cardiovascular and renal complications, including hospitalization for heart failure (HHF) and renal disease progression, in randomized clinical trials. The objective of this study was to evaluate the cost‐effectiveness of the SGLT2i class versus standard of care in type 2 diabetes mellitus (T2DM), using evidence from both clinical trial and real‐world studies. Methods: An established T2DM model was adapted to use contemporary outcomes evidence from real‐world studies and randomized controlled trial evaluations of SGLT2i, and extrapolated over a lifetime for HHF, myocardial infarction, stroke, end‐stage renal disease and all‐cause mortality. The economic analysis considered adults with T2DM, with and without established cardiovascular disease, and was conducted over a lifetime from the perspective of the health care payer in the United Kingdom, United States and China, discounted at country‐specific rates. Results: SGLT2i were consistently associated with increased treatment costs, reduced complication costs and gains in quality‐adjusted life years driven by differences in projected life expectancy, cardiovascular and microvascular morbidity and weight loss. SGLT2i were estimated to be cost‐saving or cost‐effective at relevant thresholds for the overall population in the United Kingdom, United States and China, with cost‐effectiveness being the greatest in higher risk subgroups. Conclusions: The findings highlight the need to take into account cost savings from reducing common, morbid and preventable T2DM complications when considering the cost of diabetes medications. [ABSTRACT FROM AUTHOR]

Over the last two decades, China's outward foreign direct investment (OFDI) has expanded rapidly. The country is now the world's second‐largest source of OFDI. China is often viewed as a monolithic investor, however, without sufficient attention to the differences between investments by state‐owned enterprises (SOEs) and private enterprises (PEs). To shed light on the internal complexity and heterogeneity of Chinese OFDI, we construct a panel dataset of investments in the U.S. across the 50 states and Washington, D.C. from 2005 to 2017, which we analyze using a spatial autoregressive model. We find clear evidence that the ownership structure of Chinese firms affects investment strategy and entry mode. Statistical analysis indicates that SOEs are more likely to pursue greenfield investment motivated by market‐seeking and resource‐seeking objectives, while PEs pursue mergers and acquisitions in order to obtain strategic assets. We also detect a positive and significant relationship between the presence of Chinese overseas communities and OFDI, with the strength of the correlation depending on ownership structure. Finally, we find that Chinese OFDI is spatially dependent, meaning that investments flow to states where they are already concentrated nearby. [ABSTRACT FROM AUTHOR]

This study considers the phenomenology of 'islandness' by analysing the experiences of tourists, islanders, and migrant tourism workers on two Chinese islands in the South China Sea. Although we begin by presuming place to be a phenomenological concept centring on 'being-in-the-world', we find that people's experiences both on and off the islands of Dong'ao and Wailingding engender a desire to 'be-in-many-worlds' at once. Findings drawn from three months of ethnographic fieldwork suggest that while tourists privilege 'being-at-the-seaside', long-term residents prioritize being both 'on' and 'off' the island. Meanwhile, migrant tourism workers' sense of islandness emerges from 'being-at-theseaside' and 'being-on-the-island'. In all cases, we find that islands challenge people's desires to dwell in just one specific place to which they have an attachment. We argue that this liminal place attachment arises partly because the physical geography of islands, being surrounded by the sea, facilitates movement and may prompt a longing for elsewhere. Our findings have consequences for the phenomenology of place, which assumes that people have an innate desire to be somewhere. Yet thinking through and from islands shows that people equally wish to be somewhere else, too. The manifold human experiences of islandness underscore the need for a more relational phenomenology of place based not just on 'being-in-the-world', but rather 'in-many-worlds' at once. [ABSTRACT FROM AUTHOR]

Summary: This prospective study of Chinese adults demonstrated an inverse J-shaped association of number of children with risk of hip fracture in both men and postmenopausal women aged 50 years or older. Women with 2 or 3 children and men with 4 children had the lowest risk of hip fracture. Introduction: Women have higher absolute risks of fracture than men, which is believed to reflect differences in oestrogen exposure. The aim of this study was to compare the associations of number of children with risk of hip fracture between men and women aged over 50 years. Methods: The China Kadoorie Biobank (CKB) recruited 133,399 women and 110,296 men, aged 50 years or older between 2004 and 2008. During 10-year follow-up, 2068 participants (1394 women and 674 men) suffered a hip fracture. Cox regression analysis was used to estimate sex-specific adjusted hazard ratios (HRs) and 95% CI for incident hip fracture. Results: Over 98% of both subsets of men and women aged 50 or older reported having children. Women who had 2 or 3 children had the lowest risks of hip fracture compared with other groups. Compared with nulliparous women, the adjusted HR for hip fracture were 0.89 (95% CI; 0.72, 1.10) for 1 child, 0.79 (0.70, 0.90) for 2 children, 0.79 (0.72, 0.87) for 3 children, 0.81 (0.72, 0.91) for 4 children, and 0.95 (0.83, 1.10) for those with 5 or more children. The associations of number of children with hip fracture were broadly consistent in men of a similar age. Conclusions: The concordant effects of the number of children with risk of hip fracture between men and women suggest that the lower risks in multiparous women are not due to differences in oestrogen exposure or other biological effects, but may reflect residual confounding by socioeconomic or lifestyle factors. [ABSTRACT FROM AUTHOR]

Pregnancy and pregnancy loss may be associated with increased risk of diabetes in later life. However, the evidence is inconsistent and sparse, especially among East Asians where reproductive patterns differ importantly from those in the West. We examined the associations of pregnancy and pregnancy loss (miscarriage, induced abortion, and still birth) with the risk of incident diabetes in later life among Chinese women. In 2004–2008, the nationwide China Kadoorie Biobank recruited 302 669 women aged 30–79 years from 10 (5 urban, 5 rural) diverse localities. During 9.2 years of follow-up, 7780 incident cases of diabetes were recorded among 273,383 women without prior diabetes and cardiovascular disease at baseline. Cox regression yielded multiple-adjusted hazard ratios (HRs) for the risk of diabetes associated with pregnancy and pregnancy loss. Overall, 99% of women had been pregnant, of whom 10%, 53%, and 6% reported having a history of miscarriage, induced abortion, and stillbirth, respectively. Among ever pregnant women, each additional pregnancy was associated with an adjusted HR of 1.04 (95% CI 1.03; 1.06) for diabetes. Compared with those without pregnancy loss, women with a history of pregnancy loss had an adjusted HR of 1.07 (1.02; 1.13) and the HRs increased with increasing number of pregnancy losses, irrespective of the number of livebirths; the adjusted HR was 1.03 (1.00; 1.05) for each additional pregnancy loss. The strength of the relationships differed marginally by type of pregnancy loss. Among Chinese women, a higher number of pregnancies and pregnancy losses were associated with a greater risk of diabetes. [ABSTRACT FROM AUTHOR]

High body mass index (BMI) has been associated with an increased risk of several cancers. Evidence relating body fatness, especially based on different anthropometric measures, to risk of major cancers in China from prospective cohort studies is lacking. The prospective China Kadoorie Biobank study recruited 0.5 million adults aged 30–79 years from 10 diverse areas across China during 2004–2008, recording 21,474 incident cancers during 8.95 years of follow‐up. BMI, body fat percentage (BFP), waist circumference (WC) and waist‐to‐hip ratio (WHR) were measured at baseline. We assessed the associations of body fatness with 15 major cancers by calculating Cox regression yielded adjusted hazard ratios (HRs). Each 5 kg/m2 increase in BMI was associated with an increased risk of endometrial (HR, 2.01; 95% CI, 1.72–2.35), postmenopausal breast (HR, 1.29; 95% CI, 1.18–1.40), colorectal (HR, 1.17; 95% CI, 1.10–1.25) and cervical (HR, 1.15; 95% CI, 1.03–1.29) cancer, whereas it was associated with a reduced risk of esophageal (HR, 0.73; 95% CI, 0.67–0.79), lung (HR, 0.78; 95% CI, 0.74–0.82), liver (HR, 0.85; 95% CI, 0.79–0.92) and gastric (HR, 0.88; 95% CI, 0.82–0.94) cancer. Significant linear trends of BMI‐cancer associations were observed, excluding for lung, gastric and cervical cancer (both overall and nonlinear p < 0.05). The relation between BFP, WC and WHR and the above cancers was similar to that of BMI. Our study indicates that either high or low body fatness contributes to the incidence of different types of cancer in China. What's new? Obesity and overweight are associated with an increased risk of several cancers. However, most studies have focused only on Caucasian populations. In this large, prospective study of people in China, the authors found that a high BMI was again associated with significantly increased risks, specifically for endometrial, breast, colorectal, and cervical cancers. (Surprisingly, high BMI appeared to reduce the risk of esophageal, lung, liver, and gastric cancers.) These results highlight the importance of encouraging healthy levels of body fat in the Chinese population. [ABSTRACT FROM AUTHOR]

Background: Harmful substances in solid fuel and tobacco smoke are believed to enter the bloodstream via inhalation and to be metabolized in the liver, leading to chronic liver damage. However, little is known about the independent and joint effects of solid fuel use and smoking on risks of chronic liver disease (CLD) mortality.Methods: During 2004-08, ∼0.5 million adults aged 30-79 years were recruited from 10 areas across China. During a 10-year median follow-up, 2461 CLD deaths were recorded. Multivariable Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the individual associations of self-reported long-term cooking fuel and tobacco use with major CLD death.Results: Overall, 49% reported solid fuel use and 26% smoked regularly. Long-term solid fuel use for cooking and current smoking were associated with higher risks of CLD deaths, with adjusted HRs of 1.26 (95% CI, 1.02-1.56) and 1.28 (1.13-1.44), respectively. Compared with never-smoking clean fuel users, the HRs were 1.41 (1.10-1.82) in never-smoking solid fuel users, 1.55 (1.17-2.06) in regular-smoking clean fuel users and 1.71 (1.32-2.20) in regular-smoking solid fuels users. Individuals who had switched from solid to clean fuels (1.07, 0.90-1.29; for median 14 years) and ex-regular smokers who stopped for non-medical reasons (1.16, 0.95-1.43; for median 10 years) had no evidence of excess risk of CLD deaths compared with clean fuel users and never-regular smokers, respectively.Conclusions: Among Chinese adults, long-term solid fuel use for cooking and smoking were each independently associated with higher risks of CLD deaths. Individuals who had stopped using solid fuels or smoking had lower risks. [ABSTRACT FROM AUTHOR]

Provides an overview of China's music education system. Notes that there is in Chinese education a different emphasis upon conformity and the individual. Finds a separation between ideals and action in both the Chinese and United States programs. States that efforts to move the Chinese program away from training are still rudimentary. (KO)

Objective: To examine urban-rural disparity in childhood stunting, wasting and malnutrition at national and subnational levels in Chinese primary-school children in 2010 and 2014.Design: Data were obtained from two nationwide cross-sectional surveys conducted in 2010 and 2014. Malnutrition was classified using the Chinese national 'Screening Standard for Malnutrition of Children'.Setting: All twenty-seven mainland provinces and four municipalities of mainland China.ParticipantsChildren aged 7-12 years (n 215 214; 107 741 in 2010 and 107 473 in 2014) from thirty-one provinces.Results: Stunting, wasting and malnutrition prevalence were 1·9, 12·3 and 13·7 % in 2010, but decreased to 1·0, 9·4 and 10·2 % in 2014, respectively. The prevalence of stunting, wasting and malnutrition in both urban and rural children was higher in western provinces, while lower in eastern provinces. Although the prevalence of wasting and malnutrition was higher in rural children than their urban counterparts, the urban-rural disparity in both wasting and malnutrition decreased from 2010 to 2014 (prevalence OR: wasting, 1·35 to 1·16; malnutrition, 1·50 to 1·27). A reversal occurred in 2014 in several eastern provinces where the prevalence of wasting and malnutrition in urban children surpassed their rural peers. The urban-rural disparity was larger in western provinces than eastern provinces.Conclusions: The shrinking urban-rural disparity and the reversal in wasting and malnutrition suggest that the malnutrition situation has improved during the post-crisis period, especially in the western provinces. Region-specific policies and interventions can be useful to sustainably mitigate malnutrition in Chinese children, especially in rural areas and the western provinces. [ABSTRACT FROM AUTHOR]

The article discusses research which hypothesized that selenium status was associated with coronavirus disease-2019 (COVID-19) disease outcome in China. Topics covered include the results of comparing cure rate and death rate using the Stata prtest, the association found between the reported cure rates for COVID-19 and selenium status, and the limitations of the study.

Relatively little is known about the experiences of Chinese widows, especially those living outside China. This qualitative study examines the experiences of eight Chinese or Hong Kong-born widows living in the UK. Using a semistructured approach to interviewing, participants were asked about their lives before, during, and after their spousal bereavement. Five major themes emerged: (1) complexity of marital lives; (2) experiences around the time of the death including fate; (3) loneliness and isolation; (4) the challenges of practical tasks; and finally, (5) current life. The implications of the findings for social policy and practice are briefly discussed. [ABSTRACT FROM AUTHOR]

Importance: When combusted indoors, solid fuels generate a large amount of pollutants such as fine particulate matter.Objective: To assess the associations of solid fuel use for cooking and heating with cardiovascular and all-cause mortality.Design, Setting, and Participants: This nationwide prospective cohort study recruited participants from 5 rural areas across China between June 2004 and July 2008; mortality follow-up was until January 1, 2014. A total of 271 217 adults without a self-reported history of physician-diagnosed cardiovascular disease at baseline were included, with a random subset (n = 10 892) participating in a resurvey after a mean interval of 2.7 years.Exposures: Self-reported primary cooking and heating fuels (solid: coal, wood, or charcoal; clean: gas, electricity, or central heating), switching of fuel type before baseline, and use of ventilated cookstoves.Main Outcomes and Measures: Death from cardiovascular and all causes, collected through established death registries.Results: Among the 271 217 participants, the mean (SD) age was 51.0 (10.2) years, and 59% (n = 158 914) were women. A total of 66% (n = 179 952) of the participants reported regular cooking (at least weekly) and 60% (n = 163 882) reported winter heating, of whom 84% (n = 150 992) and 90% (n = 147 272) used solid fuels, respectively. There were 15 468 deaths, including 5519 from cardiovascular causes, documented during a mean (SD) of 7.2 (1.4) years of follow-up. Use of solid fuels for cooking was associated with greater risk of cardiovascular mortality (absolute rate difference [ARD] per 100 000 person-years, 135 [95% CI, 77-193]; hazard ratio [HR], 1.20 [95% CI, 1.02-1.41]) and all-cause mortality (ARD, 338 [95% CI, 249-427]; HR, 1.11 [95% CI, 1.03-1.20]). Use of solid fuels for heating was also associated with greater risk of cardiovascular mortality (ARD, 175 [95% CI, 118-231]; HR, 1.29 [95% CI, 1.06-1.55]) and all-cause mortality (ARD, 392 [95% CI, 297-487]; HR, 1.14 [95% CI, 1.03-1.26]). Compared with persistent solid fuel users, participants who reported having previously switched from solid to clean fuels for cooking had a lower risk of cardiovascular mortality (ARD, 138 [95% CI, 71-205]; HR, 0.83 [95% CI, 0.69-0.99]) and all-cause mortality (ARD, 407 [95% CI, 317-497]; HR, 0.87 [95% CI, 0.79-0.95]), while for heating, the ARDs were 193 (95% CI, 128-258) and 492 (95% CI, 383-601), and the HRs were 0.57 (95% CI, 0.42-0.77) and 0.67 (95% CI, 0.57-0.79), respectively. Among solid fuel users, use of ventilated cookstoves was also associated with lower risk of cardiovascular mortality (ARD, 33 [95% CI, -9 to 75]; HR, 0.89 [95% CI, 0.80-0.99]) and all-cause mortality (ARD, 87 [95% CI, 20-153]; HR, 0.91 [95% CI, 0.85-0.96]).Conclusions and Relevance: In rural China, solid fuel use for cooking and heating was associated with higher risks of cardiovascular and all-cause mortality. These risks may be lower among those who had previously switched to clean fuels and those who used ventilation. [ABSTRACT FROM AUTHOR]