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Little is known about parents' perspectives on school-based bullying victimization of children with autism spectrum disorder (ASD) in China. This study began by interviewing 16 parents about their experiences with their children (7 to 15 years old) at school in China under the inclusive education policy. Most of the parents' responses indicated the existence and the severity of school-based bullying victimization of their children with ASD. Our findings indicated that bullying victimization at school was a concern for children with ASD and their parents were frequently victimized. Parents reported that they dealt with bullying victims at school independently and tended to hold a pessimistic view about their bullying victimization. The study highlights the importance of incorporating parents' voices in understanding bullying victimization of students with ASD and proposing potential implications in bullying prevention and advocacy with this group of students in mainstream schools in China.

Guided by the social-ecological model, the present study used hierarchical linear modeling to examine the multilevel associations between teacher victimization (TV), teacher burnout, and school climate. Participants were 1,711 teachers from 58 middle and high schools in mainland China. Using hierarchical linear modeling, the study found that upon controlling for teacher and school demographic factors, TV at the individual level had a significant and positive association with all three dimensions of teacher burnout (i.e., emotional exhaustion, depersonalization, and reduced personal accomplishment). School climate at the teacher level, but not at the school level, was negatively associated with all three types of burnout. Moreover, school climate at the school level, but not at the teacher level, significantly moderated the association between TV and two dimensions of teacher burnout (i.e., depersonalization and reduced personal accomplishment). More specifically, a positive school-level climate buffered the positive association between TV and depersonalization but magnified the positive association between TV and reduced personal accomplishment. The current findings highlight the importance of reducing teacher victimization and promoting a positive school climate for preventing teacher burnout and teacher retention. It also indicates that teacher's adjustment in responding to teacher-targeted violence varies depending on school climate context and across the different dimensions of teacher burnout.

To advance cross-country understanding of parental perceptions of school climate, this study examined the psychometric properties of the Delaware School Climate Survey--Home version (DSCS-H) and also compared the parental perception of school climate among Chinese (n = 999) and American (n = 1,251) parents. Confirmatory factor analyses revealed that the DSCS-H was best supported by a second-order factor model in both samples and full measurement invariance across countries was evident. Comparison of overall school climate latent means revealed that American parents from elementary schools perceived a more positive overall school climate than did Chinese parents. Conversely, Chinese parents of students in high school perceived a more positive overall school climate than the American parents. The latent-mean difference of parental perception of the overall school climate in middle schools across the United States and China was not significantly different. Finally, the latent mean differences in school climate subfactors varied across grade levels. Implications for using the DSCS-H for assessing and understanding the perception of school climate among parents from diverse cultural and linguistic backgrounds are discussed.

Objective: This study aimed to examine the relationship between food insecurity (FI) and eating disorder psychopathology in a large sample of rural Chinese adolescents. Methods: Analyses included 1654 adolescents (55.4% girls; Mage = 16.54 years, SD = 1.45) from a rural high school in southwestern China. FI, eating disorder psychopathology, and psychological distress (i.e., symptoms of depression, anxiety, and stress) were assessed. Data were analyzed by sex. Pearson correlation analysis was performed to investigate the zero‐order association between FI and eating disorder psychopathology. Hierarchical linear regressions were used to explore whether FI could explain meaningful variance in eating disorder psychopathology beyond psychological distress and demographic covariates (e.g., socioeconomic status). Results: FI was significantly associated with higher eating disorder psychopathology for boys (r = 0.44, p < 0.001) and girls (r = 0.43, p < 0.001), with medium‐to‐large effect sizes. FI accounted for significant unique variance in eating disorder psychopathology beyond psychological distress and demographic covariates for boys (ΔR2 = 0.14, p < 0.001) and girls (ΔR2 = 0.10, p < 0.001). Discussion: Using a large sample of rural Chinese adolescents, this study extends the connection between FI and eating disorder pathology in adolescents beyond the Western context. Future investigations on the mechanisms underlying FI and eating disorder psychopathology are warranted for developing prevention strategies for eating disorders among rural Chinese adolescents. Public Significance: This is the first investigation that examined the link between FI and eating disorder psychopathology among rural Chinese adolescents. Our findings highlight the importance of incorporating FI as a potential risk factor to screen for the prevention and intervention of eating disorders among rural Chinese adolescents. [ABSTRACT FROM AUTHOR]

To advance our scientific understanding about school climate and bullying victimization from the perspectives of both parents and cross-country comparisons, the present study examined the cross-country similarities and differences of the associations between overall school climate and 3 forms of bullying victimization between United States (U.S.; N = 1,251) and Chinese (N = 999) parents across elementary, middle, and high schools. Confirmatory factor analyses and measurement invariance tests were first conducted to examine the cross-country validity of the Delaware Bullying Victimization Survey--Home (DBVS-H) between U.S. and Chinese parents. Comparison of latent means of bullying victimization revealed that U.S. parents reported higher frequencies of social/relational and verbal bullying victimization compared with Chinese parents. Structural equation modeling (SEM) was then used to examine the cross-country differences of the relationship between school climate and bullying victimization. For parents in both China and the U.S., school climate was found to be significantly associated with 3 types of bullying victimization (i.e., physical, verbal, and social/relational). The negative associations between school climate and all 3 types of bullying victimization reported by U.S. parents were significantly stronger than those found in Chinese parents. Implications for bullying prevention efforts involving parents from diverse cultural and linguistic backgrounds were discussed.

The oxidative potential (OP) of ambient particulate matter (PM) is a common metric for estimating PM toxicity and linking PM exposure to adverse health effects. Organic aerosol (OA), a dominant fraction of ambient PM worldwide, may significantly contribute to PM toxicity. Here, we investigated the source‐based OA components contributing to the OP of PM in the urban (Beijing, summer and winter) and rural (Gucheng, winter) environments of the North China Plain (NCP). Various OA components as identified by the aerosol mass spectrometer/aerosol chemical speciation monitor (AMS/ACSM), transition metals, and black carbon were compared with the OP of PM measured by dithiothreitol assays. The results consistently demonstrate the importance of OA as a contributor to PM's OP in both urban and rural NCP environments. Higher intrinsic OP was observed in winter Beijing than in summer, possibly due to OA being predominantly from anthropogenic sources in winter. Furthermore, different OA components were found to drive the response of OP in the two environments. More‐oxidized oxygenated OA (MO‐OOA), cooking OA, and oxidized primary OA (during winter) are the OA contributors to OP in the urban environment, with a dominant contribution from MO‐OOA. In contrast, biomass burning OA (BBOA) and OOA play a major role in the OP in the rural environment, with BBOA making the largest contribution. Overall, this work highlights the significance of OA in determining PM's OP and calls for more work to reveal the sources and characteristics of OA components contributing to OP across different regions. Plain Language Summary: Ambient fine particulate matter (PM2.5) is a top risk factor for human health. The oxidative potential (OP) of PM2.5 is widely used to estimate PM2.5 toxicity and link PM2.5 exposure with its adverse health effects. Organic aerosol (OA) constitutes a major fraction of PM2.5 and can contribute substantially to the OP of PM2.5. But OA is also a complex mixture comprised of thousands of compounds each with widely different health effects. Here, we reveal the key OA components driving the OP in the urban and rural environments of the NCP. We find that more‐oxidized oxygenated OA, which is highly oxidized and can be formed from multiple atmospheric processes, is a dominant contributor to the OP in the urban environment. In contrast, biomass burning OA makes the largest contribution to the OP in the rural environment. In sum, different OA components are found to be the main drivers of the OP in the two environments. More studies are warranted to further our understanding of the causes, sources, and characteristics of the PM2.5 OP over a wide range of geographical regions. Key Points: Seasonal and spatial variations of oxidative potential (OP) of ambient particulate matter are foundOrganic aerosol (OA) is an important contributor to the oxidative potential in both urban and rural environmentsMore‐oxidized oxygenated OA and biomass burning OA have a dominant contribution to the OP in urban and rural environments, respectively [ABSTRACT FROM AUTHOR]

Background: The first local outbreak of Delta Variant B.1.617.2 COVID-19 of China occurred in Guangzhou city, south China, in May 2021. This study analyzed the transmission chains and local cluster characteristics of this outbreak, intended to provide information support for the development and adjustment of local prevention and control strategies. Methods: The transmission chains and local cluster characteristics of 161 local cases in the outbreak were described and analyzed. Incubation period, serial interval and generation time were calculated using the exact time of exposure and symptom onset date of the cases. The daily number of reported cases and the estimated generation time were used to estimate the effective reproduction number (Rt). Results: We identified 7 superspreading events who had more than 5 next generation cases and their infected cases infected 70.81%(114/161) of all the cases transmission. Dining and family exposure were the main transmission routes in the outbreak, with 29.19% exposed through dining and 32.30% exposed through family places. Through further analysis of the outbreak, the estimated mean incubation period was 4.22 (95%CI: 3.66–4.94) days, the estimated mean generation time was 2.60 (95%CI: 1.96–3.11) days, and the estimated Rt was 3.29 (95%CI: 2.25–5.07). Conclusions: Classification and dynamically adjusted prevention and control measures had been carried out according to analysis of transmission chains and epidemical risk levels, including promoting nucleic acid screening at different regions and different risk levels, dividing closed-off area, controlled area according to the risk of infection, raising the requirements of leaving Guangzhou. By the above control measures, Guangzhou effectively control the outbreak within 28 days without implementing a large-scale lockdown policy. [ABSTRACT FROM AUTHOR]

Problem definition: Personalized medicine (PM) seeks the best treatment for each patient among a set of available treatment methods. Because a specific treatment does not work well on all patients, traditionally, the best treatment was selected based on the doctor's personal experience and expertise, which is subject to human errors. In the meantime, stochastic models have been well developed in the literature for a lot of major diseases. This gives rise to a simulation-based solution for PM, which uses the simulation tool to evaluate the performance for pairs of treatment and patient biometric characteristics and, based on that, selects the best treatment for each patient characteristic. Methodology/results: In this research, we extend the ranking and selection (R&S) model in simulation-based decision making to solving PM. The biometric characteristics of a patient are treated as a context for R&S, and we call it contextual ranking and selection (CR&S). We consider two formulations of CR&S with small and large context spaces, respectively, and develop new techniques for solving them and identifying the rate-optimal budget allocation rules. Based on them, two selection algorithms are proposed, which can be shown to be numerically superior via a set of tests on abstract and real-world examples. Managerial implications: This research provides a systematic way of conducting simulation-based decision-making for PM. To improve the overall decision quality for the possible contexts, more simulation efforts should be devoted to contexts in which it is difficult to distinguish between the best treatment and non-best treatments, and our results quantify the optimal trade-off of the simulation efforts between the pairs of contexts and treatments. Funding: J. Du is partially supported by the National Natural Science Foundation of China [Grant 72091211]. C.-H. Chen is partially supported by the National Science Foundation under Awards FAIN212368. Supplemental Material: The e-companion is available at https://doi.org/10.1287/msom.2022.0232. [ABSTRACT FROM AUTHOR]

Based on the data from the 2018 China Family Panel Studies data, this paper examines the effect of non-cognitive abilities on gender wages gap in the Chinese labor market. First, use the least squares regression (OLS) method to estimate and analyze the income effect of gender differences. On this basis, the non-conditional quantile (RIF) model is used to analyze the impact of non-cognitive abilities on the gender wage gap. The study found that non-cognitive abilities promote the increase of gender wages. It can be seen from the regression of RIF that non-cognitive abilities has a greater effect on women's wages than men. According to the decomposition of RIF, in the gender wage gap, non-cognitive abilities helps to alleviate the degree of gender discrimination. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of multiple primary lung cancer (MPLC) has increased in recent years. The risk factors of MPLC are not well studied, especially in the Asian population. This case-control study investigated the association between a family history of cancer and MPLC risk. Methods: We used data from people who surgically confirmed MPLC with at least 2 nodes of Fujian Medical University Union Hospital and matched 1:2 normal individuals as controls between 2016 and 2017. Information on age, sex, lifestyle, personal history, and family history of cancer was collected using a self-administered questionnaire, and odds ratios (OR) were estimated using unconditional logistic regression. Results: We included 2 104 patients. In total, 321 patients with histologically confirmed MPLC and 642 healthy controls were studied. The significantly higher ratio of current smokers was observed for the cases than the controls (54.1% vs. 30.0%). A family history of LC in first-degree relatives of the cases reported a significantly higher proportion than in the controls (15.3% vs. 8.6%). Family history of all cancers and LC significantly increased the risk of MPLC (OR = 1.64, P = 0.009 and OR = 2.59, P = 0.000, respectively). The multivariate analysis identified a significantly increased risk of MPLC (OR = 2.45, P = 0.000) associated with parents and siblings influenced by LC history. The younger age (aged < 55 years) of LC cases at diagnosis exhibited a significantly increased risk of MPLC (OR = 2.39, P = 0.000). A significant association with a family history of LC was found for male squamous carcinoma and male adenocarcinoma (OR = 1.59, p = 0.037 and OR = 1.64, p = 0.032, respectively). A positive association with LC history was only observed for female adenocarcinoma (OR = 2.23, p = 0.028). The risk of MPLC was not significantly associated with A family history of cancers in non-smokers (OR = 0.91, P = 0.236). Ever-smokers with a positive family history of cancer or LC had a significantly elevated risk of MPLC (OR = 4.01, P = 0.000 and OR = 6.49, P = 0.000, respectively). We also observed a very elevated risk for smokers with no family history (OR = 3.49, P = 0.000). Such a positive association was also observed in ever-smokers with no family history of LC (OR = 3.55, P = 0.000). Adenocarcinoma in females was prevalent and significantly associated with a family history of LC in risk of MPLC compared with other histologic subtypes. Conclusions: Our findings suggest an association between a family history of LC and MPLC risk among an Asian population. Smoking status and family history of LC have a synergistic effect on MPLC. These findings indicate that MPLC exhibits familiar aggregation and that inherited genetic susceptibility may contribute to the development of MPLC. [ABSTRACT FROM AUTHOR]

Based on the data of listed small and medium‐sized enterprises (SMEs) from 2011 to 2020, this paper studies the effects of fintech on the financing constraints of SMEs in China. The results denote that fintech can significantly ease financing constraints of SMEs; with a 1% increase in fintech, the financing constraints of SMEs decrease by 0.0767%. The intermediary mechanism analysis illustrates that fintech can ease the financing constraints of SMEs by alleviating financial industry concentration and information asymmetry. Besides, regions with a higher degree of marketization and industries with relatively free competition are both more conducive to fintech alleviating the financing constraints of SMEs. [ABSTRACT FROM AUTHOR]

Esophageal carcinoma (EC) is a common malignant tumor of the upper digestive tract worldwide. An analysis of the latest data from cancer centers in China showed that the incidence of EC and the number of deaths due to EC in China in 2015 were 266,000 and 188,000, respectively, ranking sixth (6.3%) and fourth (8.0%) among all malignant tumors. The early diagnosis and treatment of EC and standardized diagnosis and treatment are important tasks for EC healthcare professionals in various centers across the country. At present, the 8th edition of the EC staging system jointly released by Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) is the most recent, authoritative and widely used EC staging standard. The EC professional committee of the Chinese Anti-Cancer Association also organizes the "EC Standardization Campaign in China" every year to promote the development of EC diagnostic and treatment norms throughout the country. Since 2011, the EC Committee of the Chinese Anti-Cancer Association has published the Guidelines for Standardized Diagnosis and Treatment of EC. Considering the increasing number of EC clinical studies and the continuous progress in diagnostic and treatment technologies in recent years, the updated Guidelines will include the latest progress in the diagnosis and treatment of EC, with a goal of promoting the forward development of EC diagnosis and treatment in clinical practice. [ABSTRACT FROM AUTHOR]

The WHO recently included Gaming Disorder as a psychiatric diagnosis. Whether there are distinct groups of adolescents who differ based on severity of gaming disorder and their relationships with other mental health and addictive behavior outcomes, including problematic smartphone use (PSU), remains unclear. The current study explored and identified subtypes of Internet Gaming Disorder (IGD) severity and estimated the association between these subtypes and other disorders. Participants completed online questionnaires assessing the severity of IGD, PSU, depression, and anxiety during COVID-19. We conducted a latent class analysis of IGD symptoms among 1,305 Chinese adolescents (mean age = 15.2; male = 58.5%) from 11 secondary schools in Macao (SAR), China. Multinomial logistic regression estimated correlates of latent class membership and PSU. A 4-class model adequately described the sample subgroups. Classes were labeled as normative gamers (30.9%), occasional gamers (42.4%), problematic gamers (22.7%), and addictive gamers (4.1%). Relative to normative gamers, PSU severity, depression, and being male were significantly higher among problematic gamers, addictive gamers, and occasional gamers. Only problematic gamers showed significant positive associations with anxiety severity compared to the other groups. The study revealed the differences in severity of gaming disorder and its association with psychopathology outcomes. Application in screening for IGD and comorbidity is discussed. [ABSTRACT FROM AUTHOR]

Depression among children has been a growing public health concern. It is generally recognized that individuals with depression are likely to have interpersonal malfunctioning. However, there remains a limited scientific understanding of the reciprocal relationship between interpersonal communication and depressive symptoms among rural Chinese children in a longitudinal approach. Therefore, guided by the interpersonal model of depression and the developmental cascade model, the present study conducted a cross-lagged panel analysis study to explore the bidirectional relationship between interpersonal communication and depressive symptoms across three waves among 2188 elementary school students in rural areas of one county of Gansu Province, China. We also examined the mediating effect of resilience and sex differences of the models. Our results showed that depressive symptoms negatively predicted interpersonal communication from T1 to T2 and T2 to T3. Interpersonal communication negatively predicted depressive symptoms from T1 to T2, but not T2 to T3. Furthermore, resilience showed significant partial mediating effects in the reciprocal relationship between interpersonal communication and depressive symptoms. In terms of sex differences, the significant relationship between depressive symptoms at T1 and interpersonal communication at T2 was found to be significant among male students and marginally significant among female students. The full mediating effect of resilience at T1 was found only among male students, whereas resilience at T2 functioned as a full mediator between depressive symptoms at T2 and interpersonal communication at T3 only among female students. First, the present sample consisted of only third and fourth grade (i.e., in T1) students from one county in rural China. Second, the present study examined depressive symptoms instead of depression as a clinical diagnosis. Third, the third wave of the data was collected during COVID-19. The impact of the COVID-19 pandemic could unexpectedly pose on child mental health. The finding underlined the importance of providing comprehensive depression prevention and intervention from fostering children's inner resilience and promoting their ability to navigate interpersonal resources. • Interpersonal communication and depressive symptoms were reciprocal overtime pre- and during COVID. • Resilience showed partial mediating effects in the reciprocal relationship for entire sample. • Sex differences were identified in the bidirectional relationship longitudinally. • Resilience fully mediated depressive symptoms and interpersonal communication across sexes. [ABSTRACT FROM AUTHOR]

Background: As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have been increasingly important in China. However, the association between HCBSs utilization and depressive symptoms in older adults in China is unclear. Consequently, this study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults. Methods: This study included 7,787 older adults (≥ 60 years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, "What kind of HCBSs were being utilized in their community?". Data were analyzed using binary logistic regression models and generalized hierarchical linear models (GHLM). Results: Of the 7,787 participants, 20.0% (n = 1,556) reported that they utilized HCBSs, and 36.7% (n = 2,859) were evaluated that they had depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.180, 95% CI: 1.035–1.346, p < 0.05). Additionally, the depressive symptoms were significantly associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health (SRH), smoking, and provincial Gross Domestic Product (GDP) per capita. Conclusions: This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is of utmost significance for the government to provide targeted HCBSs at the community level to address the unmet care needs of older adults, which can reduce the occurrence of negative emotions, consequently contributing to less severe depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: The Delta variant of SARS-COV-2 has replaced previously circulating strains around the world in 2021. Sporadic outbreaks of the Delta variant in China have posed a concern about how to properly respond to the battle against evolving COVID-19. Here, we analyzed the "hierarchical and classified prevention and control (HCPC)" measures strategy deployed during the recent Guangzhou outbreak. Methods: A modified susceptible–exposed–pre-symptomatic–infectious–recovered (SEPIR) model was developed and applied to study a range of different scenarios to evaluate the effectiveness of policy deployment. We simulated severe different scenarios to understand policy implementation and timing of implementation. Two outcomes were measured: magnitude of transmission and duration of transmission. The outcomes of scenario evaluations were presented relative to the reality case (i.e., 368 cases in 34 days) with 95% confidence interval (CI). Results: Based on our simulation, the outbreak would become out of control with 7 million estimated infections under the assumption of the absence of any interventions than the 153 reported cases in reality in Guangzhou. The simulation on delayed implementation of interventions showed that the total case numbers would also increase by 166.67%–813.07% if the interventions were delayed by 3 days or 7 days. Conclusions: It may be concluded that timely and more precise interventions including mass testing and graded community management are effective measures for Delta variant containment in China. [ABSTRACT FROM AUTHOR]

Background: Studies have shown a close association between home and community-based healthcare services (HCBHS) utilization and depressive symptoms in older adults. However, no studies have explored the underlying mechanism of this relationship in rural China. This study was designed to evaluate the roles of instrumental activities of daily living (IADL) and marital status in the association between HCBHS utilization and depressive symptoms in Chinese rural older adults. Methods: Data were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5,981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Moderated mediation analysis was carried out applying Hayes' PROCESS macro (Model 7). Results: HCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents. Conclusion: The results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization being negatively associated with IADL among single but not married respondents. The government should focus on rural older adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms. [ABSTRACT FROM AUTHOR]

The safe production of food on Cd-polluted land is an urgent problem to be solved in South China. Phytoremediation or cultivation of rice varieties with low Cd are the main strategies to solve this problem. Therefore, it is very important to clarify the regulatory mechanism of Cd accumulation in rice. Here, we identified a rice variety with an unknown genetic background, YSD, with high Cd accumulation in its roots and shoots. The Cd content in the grains and stalks were 4.1 and 2.8 times that of a commonly used japonica rice variety, ZH11, respectively. The Cd accumulation in the shoots and roots of YSD at the seedling stage was higher than that of ZH11, depending on sampling time, and the long-distance transport of Cd in the xylem sap was high. Subcellular component analysis showed that the shoots, the cell wall, organelles, and soluble fractions of YSD, showed higher Cd accumulation than ZH11, while in the roots, only the cell wall pectin showed higher Cd accumulation. Genome-wide resequencing revealed mutations in 22 genes involved in cell wall modification, synthesis, and metabolic pathways. Transcriptome analysis in Cd-treated plants showed that the expression of pectin methylesterase genes was up-regulated and the expression of pectin methylesterase inhibitor genes was down-regulated in YSD roots, but there were no significant changes in the genes related to Cd uptake, translocation, or vacuole sequestration. The yield and tiller number per plant did not differ significantly between YSD and ZH11, but the dry weight and plant height of YSD were significantly higher than that of ZH11. YSD provides an excellent germplasm for the exploration of Cd accumulation genes, and the cell wall modification genes with sequence- and expression-level variations provide potential targets for phytoremediation. [ABSTRACT FROM AUTHOR]

Little is known about parents' perspectives on school-based bullying victimization of children with autism spectrum disorder (ASD) in China. This study began by interviewing 16 parents about their experiences with their children (7 to 15 years old) at school in China under the inclusive education policy. Most of the parents' responses indicated the existence and the severity of school-based bullying victimization of their children with ASD. Our findings indicated that bullying victimization at school was a concern for children with ASD and their parents were frequently victimized. Parents reported that they dealt with bullying victims at school independently and tended to hold a pessimistic view about their bullying victimization. The study highlights the importance of incorporating parents' voices in understanding bullying victimization of students with ASD and proposing potential implications in bullying prevention and advocacy with this group of students in mainstream schools in China. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, combined segmental resection (CSS) can avoid resection of multiple segments to preserve lung function. When two or more distant lung segments or subsegments of the same lobe present with a ground glass opacity (GGO) that meets the indications for sublobar resection, conventional CSS or wedge resection could not remove all the nodules, and lobectomy is performed in most of these patients. For these particular types of nodules, we perform a single lobe noncombined subsegmental resection, or "separated" precise subsegmentectomy, to preserve more lung tissue. This study was designed to initially assess the feasibility and safety of "separated" precise subsegmentectomy. Methods: Selected cases of specific GGO were subjected to "separated" precise subsegmentectomy and the results of general clinical data, perioperative operative time, bleeding, length of stay, computed tomography (CT) review, lung function and its dynamic changes were collected and analyzed in these patients. Results: "Separated" precise subsegmentectomy was performed in 12 patients and successfully completed. The median operation time, bleeding amount, and length of hospital stay were 96 min, 50 ml and 4 days, respectively. There was one case of pulmonary infection and one case of persistent air leakage, no death or pulmonary torsion, bronchopleural fistula and other pulmonary complications occurred. After 3 months, the median percentage of lung function retention was 91.7%, and the CT scan showed that the reserved lung tissue of 12 patients was well inflated and there was no obvious imaging manifestation of atelectasis. Conclusion: "Separated" precise subsegmentectomy is a novel and safe surgical method that provides a more optimized way for patients with specific multiple nodules to preserve lung function. Further prospective large studies are needed to verify this finding. [ABSTRACT FROM AUTHOR]

Background: To compare the diagnostic positive rate and complication rate between the electromagnetic navigation bronchoscopy (ENB) technique and computed tomography (CT)‐guided lung puncture for the biopsy of lung nodules located in the middle of an anatomic lung segment. Methods: Electronic medical records of 114 patients who underwent lung nodule biopsy between June 2021 and June 2022 were retrospectively evaluated. In all patients, the nodules were located in the middle third lung segment. To compare the diagnostic positive and complication rates between the two biopsy modalities performed in this lung region, clinical data, complication rates, nodule pathology, and imaging results were reviewed based on nodule characteristics retrieved from the electronic medical records. Results: Ninety‐three patients underwent CT‐guided lung puncture, while the remaining 21 patients underwent the ENB technique. No significant difference was observed in the diagnostic positive rate between the two groups (73.6 and 76.1%, respectively). In the CT‐guided lung puncture group, pneumothorax incidence, tube placement, postoperative hemorrhage, and symptomatic hemorrhage rates were 16.1, 6.5, 6.5, and 1.1%, respectively. In contrast, no complications occurred in the ENB group. Conclusions: The ENB technique is a safe and effective method for performing biopsies of pulmonary nodules with a diagnostic positive rate comparable to that of CT‐guided lung puncture and with a lower postoperative complication rate. [ABSTRACT FROM AUTHOR]

To understand the pollution characteristics of volatile organic compounds (VOCs) in the glass deep-processing industry, samples were collected using polyvinyl fluoride bags and quickly transferred to summa tanks for GC/MS/FID analysis. The emission characteristics of VOCs, the ozone formation potential and the secondary aerosol formation potential were studied. The results showed that the VOCs emitted by the six enterprises were mainly aromatics and OVOCs, accounting for 35% to 97% of the emissions, with high emission loads of alkanes and halocarbons from individual enterprises. The stack emissions from Enterprise 2 were as high as 38 mg/m3, while the emissions from the remaining five enterprises were all in the range of 1.7~4.1 mg/m3, probably because the terminal treatment facilities were not updated in a timely manner, resulting in excessive stack emissions from Enterprise 2. The characteristic pollutants, including OVOCs, aromatics and alkanes, which are mainly derived from spray painting and gluing, were screened in the six enterprises. Aromatics and OVOCs contributed the most to the ozone formation potential in the six enterprises, with some enterprises having a high contribution from alkanes and alkenes. On the basis of the secondary aerosol formation potential, toluene, benzene, ethylbenzene, o-xylene and m/p-xylene account for 98% of the six enterprises' emissions. Glass enterprises should prioritise the control of benzene and OVOCs emissions. The glass processing industry mainly emits aromatics, OVOCs and alkanes. Through a preliminary study on the emission characteristics of VOCs in the glass deep-processing industry, we provided basic data for the reduction and control of VOCs in the glass deep-processing industry in China. [ABSTRACT FROM AUTHOR]

Purpose: We aim to assess whether osimertinib postoperative adjuvant therapy, compared with placebo, is cost‐effective in China. Methods: We set up the Markov model that contains three health states over a 20‐year period. Data were collected from the ADAURA trial that included transition probabilities and safety data. Through the analysis of literature and local charges, we explore both the cost and utility values. Sensitivity analyses were employed using TreeAge Pro software to access model stability. Findings Patients in the osimertinib group had 1.46 more Quality‐adjusted Life Years (8.45 QALYs vs 6.99 QALYs) than the placebo group at an incremental cost of $14098.51($39962.99 vs $25864.48). Compared with the placebo group, the treatment strategy with osimertinib postoperative adjuvant therapy had an incremental cost‐effectiveness ratio of $9661.97/QALY. The probability of the osimertinib‐assisted therapy strategy being cost‐effective will reach 100% if the threshold of willingness to pay is above $15,000/QALY. Implications: From the perspective of the Chinese Healthcare System, the treatment strategy with osimertinib postoperative adjuvant therapy is more cost‐effective than the placebo strategy. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore the association between dietary acid load and hyperuricemia in Chinese adults. Methods: A case-control study was conducted. Adult participants with hyperuricemia were recruited as the cases and those without hyperuricemia were as the controls. Food consumption was evaluated by food frequency questionnaire (FFQ). Dietary acid load was assessed by potential renal acid load (PRAL) and net endogenous acid production (NEAP). Dietary acid load was divided into four levels: the first quartile (Q1), the second quartile (Q2), the third quartile (Q3) and the fourth quartile (Q4). Logistic regression model was applied for exploring the association between dietary acid load (PRAL and NEAP) and hyperuricemia. Odds ratio (OR) and its correspondence confidence interval (CI) were computed. Results: A total of 290 participants were eligible in this study, in which there were 143 individuals in case group and 147 in control group. A higher level of PRAL was found to be associated with odds of hyperuricemia. ORs of hyperuricemia for Q2, Q3 and Q4 of PRAL were 2.74 (95%CI: 1.94 ~ 3.88, p-value: 0.004), 2.90 (95%CI: 2.05 ~ 4.10, p-value: 0.002) and 3.14 (95%CI: 2.22 ~ 4.45, p-value: 0.001), respectively. There was a positive association between elevated NEAP and hyperuricemia. OR of hyperuricemia for Q2 was not material significance (OR:1.54, 95%CI: 0.93 ~ 2.53, p-value: 0.210), however, ORs of hyperuricemia for Q3 (OR: 2.40, 95%CI: 1.70 ~ 3.38, p-value: 0.011) and Q4 (OR: 3.27, 95%CI: 2.31 ~ 4.62, p-value: 0.001) were statistically significant. Conclusion: Higher level of dietary acid load was found to be associated with hyperuricemia in Chinese adults, indicative of advocation of a well-balanced diet in this population. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICIs) have shown a powerful benefit in the neoadjuvant therapy for esophageal cancer, but evidence for its safety and efficacy is limited and may not reflect real-world practice. We retrospectively reviewed the database of treatment-naive patients from 15 esophageal cancer centers in China who received ICIs as neoadjuvant treatment for locally advanced esophageal cancer from May 2019 to December 2020. The primary endpoints were rate and severity of treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs). Secondary endpoints included pathologically complete response (pCR) rate, R0 resection rate, mortality and morbidity. Among the 370 patients, 311 (84.1%) were male with a median age of 63 (range: 30–81) years and stage III or IVa disease accounted for 84.1% of these patients. A total of 299 (80.8%) patients were treated with ICIs and chemotherapy. TRAEs were observed in 199 (53.8%) patients with low severity (grade 1-2, 39.2%; grade 3-4, 13.2%; grade 5, 1.4%), and irAEs occurred in 24.3% of patients and were mostly of grade 1-2 severity (21.1%). A total of 341 (92.2%) patients had received surgery and R0 resection was achieved in 333 (97.7%) patients. The local pCR rate in primary tumor was 34.6%, including 25.8% of ypT0N0 and 8.8% of ypT0N+. The rate of postoperative complications was 41.4% and grade 3 or higher complications occurred in 35 (10.3%) patients. No death was observed within 30 days after surgery, and three patients (0.9%) died within 90 days postoperatively. This study shows acceptable toxicity of neoadjuvant immunotherapy for locally advanced esophageal cancer in real-world data. Long-term survival results are pending for further investigations. [ABSTRACT FROM AUTHOR]

Azathioprine (AZA) is commonly used for many autoimmune disorders; however, the limitation of its clinical use is due to potential toxicities, including severe leukopenia. Recent studies have identified genetic NUDT15 variants strongly associated with AZA‐induced leukopenia in Asian patients. This study aimed to investigate the strength of above genetic association and evaluate the usefulness of prospective screening of the NUDT15 variants to prevent AZA‐induced leukopenia in Chinese patients. AZA‐induced leukopenia in patients with autoimmune disorders were enrolled from multiple medical centers in Taiwan/China between 2012 and 2017 to determine the strength of genetic association of NUDT15 or TPMT variants by whole exome sequencing (WES). Furthermore, a prospective study was conducted between 2018 and 2021 to investigate the incidence of AZA‐induced leukopenia with and without genetic screening. The WES result showed the genetic variants of NUDT15 R139C (rs116855232) (P = 3.7 × 10−25, odds ratio (OR) = 21.7, 95% confidence interval (95% CI) = 12.1–38.8) and NUDT15 rs746071566 (P = 4.2 × 10−9, OR = 7.1, 95% CI = 3.7–13.7), but not TPMT, were associated with AZA‐induced leukopenia and NUDT15 R139C variant shows the highest sensitivity with 92.5%. Furthermore, the targeted screening of 1,013 participants for NUDT15 R139C enabled those identified as carriers to use alternative immunosuppressants. This strategy resulted in a significant decrease in the incidence of AZA‐induced leukopenia compared with historical incidence (incidence rate = from 7.6% decreased to 0.4%; P = 9.3 × 10−20). In conclusion, the NUDT15 R139C variant was strongly associated with AZA‐induced leukopenia in Chinese patients. The genetic screening of NUDT15 R139C followed by use of alternative immunosuppressants in identified carriers effectively decreased the incidence of AZA leukopenia for patients with autoimmune disorders. [ABSTRACT FROM AUTHOR]

Background: Facilitating the primary health care (PHC) system and maintaining people's reasonable healthcare-seeking behavior are key to establishing a sustainable healthcare system. China has employed a multitiered copayment system/medical insurance differentiated payment policies to incentivize the public to utilize PHC services through its hierarchical medical care system; however, most people still prefer visiting tertiary care hospitals. We question whether the quality gap in healthcare services reduces the effect of the multitiered copayment system, which is considered an important factor in the lack of reform in the Chinese healthcare system. Thus, we explore the effect and influencing factors of the multitiered copayment system that drives primary healthcare-seeking behavior under the current situation with a large quality gap. We also consider the hypothetical situation of a reduced gap in the future.Methods: This study used the hypothetical quality improvement scenario to elicit people's hypothetical behaviors, and a multistage stratified cluster random sampling method. This preliminary study was conducted in 2016 using 1829 individuals from four regions of Wenzhou in Zhejiang Province: Ouhai, Ruian, Yongjia, and Taishun. A descriptive statistical analysis, chi-square analysis, Fisher's exact test, and multinomial logistic regression model were performed to introduce the effect of the multitiered copayment system, and to explore the factors affecting the selection of PHC institutions at pre- and post-change phases.Result: The results show that compared with the large quality gap phase, the number of respondents who believed the multitiered copayment system had an effect on their selection of PHC institutions after the equalization of healthcare services quality increased threefold (from 14.0% to 50.8%). Moreover, the main determinants in people's selection of PHC institutions changed from age and needs variables (self-rated health status) to age, needs variables (self-rated health status) and enabling variables (distance to a medical care facility).Conclusion: The results indicate limited initial effects of the multitiered copayment system. However, they become more pronounced after the equalization of healthcare services quality. This study confirms that changes in the quality gap in healthcare services influence the effect of the multitiered copayment system. Hence, reducing this gap can help achieve the intended outcome of the tiered healthcare insurance schedule. [ABSTRACT FROM AUTHOR]

The vast rural areas often experience more severe haze pollution than megacities during wintertime in North China Plain (NCP), yet the sources and evolution processes of aerosol particles, particularly organic aerosol (OA) remain poorly understood. Here we conducted real‐time measurements of submicron aerosol (PM1) species using a high‐resolution aerosol mass spectrometer at a representative rural site in NCP in winter 2019. Our results showed the dominance of organics (36%) and nitrate in PM1 (22%) in 2019. Positive matrix factorization analysis illustrated similarly important primary sources from traffic emissions, coal combustion, and biomass burning, yet secondary OA (SOA) from photochemical and aqueous‐phase related processing exceeded primary OA (53% vs. 47%). Substantial decreases in primary species and considerable increases in nitrate and sulphate were observed since winter 2018, demonstrating enhanced secondary formation in winter 2019. OA composition changed significantly from clean period to fog events with the contribution of aqueous phase‐related oxygenated OA increasing from 6% to 44%, while the photochemical SOA decreased correspondingly from 51% to 19%. The size distributions of aerosol species also changed by shifting toward large sizes during fog events. Elemental analysis of OA and the Van Krevelen diagram (H/C vs. O/C) illustrated the different roles of photochemical and aqueous‐phase processing during daytime and nighttime, respectively, and aqueous‐phase processing is subject to the formation of organic compounds with high H/C and O/C ratios. The large differences in fog processing of submicron aerosol species between 2018 and 2019 due to different temperatures were also elucidated. Plain Language Summary: Air quality in megacities in North China Plain (NCP) has been improved significantly during the last decade, however, severe haze pollution events occur frequently in vast rural areas during wintertime. Recent studies have demonstrated stronger health impacts of aerosol particles in rural area than megacities, yet the composition, sources and evolution processes of aerosol particles, particularly organic aerosol (OA) in rural area in NCP remain poorly characterized. Here we have a comprehensive characterization of submicron aerosol species at a rural site in winter in NCP. We observed substantial decreases in primary species and considerable increases in nitrate and sulphate from 2018 to 2019 due to enhanced secondary formation and the decreases in primary emissions. We found similarly important primary sources from traffic emissions, coal combustion, and biomass burning in rural area. However, secondary OA (SOA) from photochemical and aqueous‐phase related processing exceeded primary OA. The aqueous‐phase related SOA increased significantly by up to 44% during fog events, while the photochemical SOA decreased correspondingly from 51% to 19%. The size distributions, elemental composition of OA, and Van Krevelen diagram further illustrated the different roles of photochemical and aqueous‐phase processing in secondary aerosol formation in rural area in NCP. Key Points: Primary organic aerosol (OA) was primarily from coal combustion, biomass burning and traffic emissions in rural North China Plain in winterAqueous phase‐related OA showed large increases during fog events, while photochemical secondary OA was important during non‐fog periodsAerosol composition showed significant changes from 2018 to 2019 due to enhanced secondary formation and changes in primary emissions [ABSTRACT FROM AUTHOR]

Guided by the social-ecological model, the present study used hierarchical linear modeling to examine the multilevel associations between teacher victimization (TV), teacher burnout, and school climate. Participants were 1,711 teachers from 58 middle and high schools in mainland China. Using hierarchical linear modeling, the study found that upon controlling for teacher and school demographic factors, TV at the individual level had a significant and positive association with all three dimensions of teacher burnout (i.e., emotional exhaustion, depersonalization, and reduced personal accomplishment). School climate at the teacher level, but not at the school level, was negatively associated with all three types of burnout. Moreover, school climate at the school level, but not at the teacher level, significantly moderated the association between TV and two dimensions of teacher burnout (i.e., depersonalization and reduced personal accomplishment). More specifically, a positive school-level climate buffered the positive association between TV and depersonalization but magnified the positive association between TV and reduced personal accomplishment. The current findings highlight the importance of reducing teacher victimization and promoting a positive school climate for preventing teacher burnout and teacher retention. It also indicates that teacher's adjustment in responding to teacher-targeted violence varies depending on school climate context and across the different dimensions of teacher burnout. [ABSTRACT FROM AUTHOR]

Green investment, as a socially responsible investment, conforms to the concept of ecological civilization. It is considerable to promote enterprises to make green investment. This article is based on 211 questionnaires for employees of various enterprises in China, using STATA.14 for descriptive statistical analysis, logistical regression analysis, and trend analysis. It aims to explore the impact of government-led institutional environment on enterprises from five aspects. This study examines that the institutional environment has a positive effect on enterprise' green investment from the legal and cultural aspects, but it has no significant impact from the political, economic, and financial aspects. Finally, this paper provides policy advice that can promote the construction of institutional environment to encourage enterprises to make green investment. [ABSTRACT FROM AUTHOR]

The exhalation of radon from waters surrounding active fault zones is at present not well understood. In this work, radon concentrations in urban waters around fault zones in Jiaozuo, China were measured using a RAD7 Electronic Radon Detector. The average values of radon concentration in drinking water were 8.90 ± 1.16 and 0.21 ± 0.14 Bq L−1 in the fault and non-fault zones, respectively. The radon concentration decreased with increasing distance from the active faults. The total annual effective doses for adults, children and infants in the fault and non-fault zones through inhalation and ingestion of radon in water were within an acceptable range. [ABSTRACT FROM AUTHOR]

Few studies have assessed the impact of home and community‐based services (HCBSs) provision on cognitive function among older adults over time. This study examined the longitudinal association between HCBSs provision and cognitive function in Chinese older adults. The study included 5,134 participants aged 65 years and older in the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The Mini‐Mental State Examination (MMSE) was used to evaluate cognitive function over the same time period. Participants were asked what kind of HCBSs were provided in his or her community. However, they were not asked whether services were utilised. The study used the number of HCBSs provided each wave to represent the strength of HCBSs, and used the MMSE score of each wave to represent the older adults' cognitive function status. A latent growth model was used to explore the relationship between HCBSs provision and cognitive function of older adults. The number of HCBSs provided was positively associated with older adults' cognitive function (2008: β = 0.03, p = 0.031; 2011: β = 0.06, p < 0.001; 2014: β = 0.06, p < 0.001) after controlling for gender, age, residence, education, income, medical insurance, activities of daily living disability, instrumental activities of daily living disability, serious illness, living arrangement and marital status. Results provided longitudinal evidence that an increase in HCBSs provision at a national level can result in better cognitive function in Chinese older adults. [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) is a good predictor of morbidity and mortality. Extensive research has shown that females generally report poorer SRH than males but still tend to live longer. Previous studies used cross-sectional or pooled data for their analyses while ignoring the dynamic changes in males' and females' SRH statuses over time. Furthermore, longitudinal studies, especially those that focus on older adults, typically suffer from the incompleteness of data. As such, the effect of dropout data on the trajectories of SRH is still unknown. Our objective is to examine whether there are any gender differences in the trajectories of SRH statuses in Chinese older adults.Methods: The trajectories of SRH were estimated using the pattern-mixture model (PMM), a special latent growth model, under non-ignorable dropout data assumption. We analyzed the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data of 15,613 older adults aged 65 years and above, collected from 2005 to 2014.Results: The results demonstrated the effect of non-ignorable dropout data assumptions in this study. The previous SRH score was negatively associated with the likelihood of dropping out of the study at the next follow-up survey. Our results showed that both males and females in China perceive their SRH as decreasing over time. A significant gender difference was found in the average SRH score (female SRH was lower than male SRH) in this study. Nonetheless, based on the results obtained using the PMM, there are no gender differences in the trajectories of SRH at baseline as well as in the rate of decline among the total sample. The results also show that males and females respond to SRH predictors similarly, except that current drinking has a more pronounced positive effect on males and healthcare accessibility has a more pronounced positive effect on females.Conclusions: Our results suggest that missing data have an impact on the trajectory of SRH among Chinese older adults. Under the non-ignorable dropout data assumptions, no gender differences were found in trajectories of SRH among Chinese older adults. Males and females respond to SRH predictors similarly, except for current drinking habit and healthcare accessibility. [ABSTRACT FROM AUTHOR]

Background: The prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China. Methods: The cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0–5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale–Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices. Results: In the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice. Conclusions: Exclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged. [ABSTRACT FROM AUTHOR]

Icotinib has provided survival benefits for patients with advanced, epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC). We aimed to compare icotinib with chemotherapy in patients with EGFR -mutant stage II–IIIA NSCLC after complete tumour resection. Here, we report the results from the preplanned interim analysis of the study. In this multicentre, randomised, open-label, phase 3 trial done at 29 hospitals in China, eligible patients were aged 18–70 years, had histopathogically confirmed stage II–IIIA NSCLC, had complete resection up to 8 weeks before random assignment, were treatment-naive, and had confirmed activation mutation in exon 19 or exon 21 of the EGFR gene. Participants were randomly assigned (1:1) with an interactive web-based response system to receive either oral icotinib 125 mg thrice daily for 2 years or four 21-day cycles of intravenous chemotherapy (vinorelbine 25 mg/m2 on days 1 and 8 of each cycle plus cisplatin 75 mg/m2 on day 1 of each cycle for adenocarcinoma or squamous carcinoma; or pemetrexed 500 mg/m2 plus cisplatin 75 mg/m2 on day 1 every 3 weeks for non-squamous carcinoma). The primary endpoint was disease-free survival assessed in the full analysis set. Secondary endpoints were overall survival assessed in the full analysis set and safety assessed in all participants who received study drug. This trial is registered with ClinicalTrials.gov , NCT02448797. Between June 8, 2015, and August 2, 2019, 322 patients were randomly assigned to icotinib (n=161) or chemotherapy (n=161); the full analysis set included 151 patients in the icotinib group and 132 in the chemotherapy group. Median follow-up in the full analysis set was 24·9 months (IQR 16·6–36·4). 40 (26%) of 151 patients in the icotinib group and 58 (44%) of 132 patients in the chemotherapy group had disease relapse or death. Median disease-free survival was 47·0 months (95% CI 36·4–not reached) in the icotinib group and 22·1 months (16·8–30·4) in the chemotherapy group (stratified hazard ratio [HR] 0·36 [95% CI 0·24–0·55]; p<0·0001). 3-year disease-free survival was 63·9% (95% CI 51·8–73·7) in the icotinib group and 32·5% (21·3–44·2) in the chemotherapy group. Overall survival data are immature with 14 (9%) deaths in the icotinib group and 14 (11%) deaths in the chemotherapy. The HR for overall survival was 0·91 (95% CI 0·42–1·94) in the full analysis set. Treatment-related serious adverse events occurred in two (1%) of 156 patients in the icotinib group and 19 (14%) of 139 patients in the chemotherapy group. No interstitial pneumonia or treatment-related death was observed in either group. Our results suggest that compared with chemotherapy, icotinib significantly improves disease-free survival and has a better tolerability profile in patients with EGFR -mutant stage II–IIIA NSCLC after complete tumour resection. Betta Pharmaceuticals For the Chinese translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Background: In China, men who have sex with men (MSM) face a high risk of HIV infection. Intimate partner violence (IPV) is common in this population and leads to various adverse consequences, including risky sexual behaviors, substance abuse, and poor mental health, which pose huge challenges to HIV prevention and control.Methods: An anonymous cross-sectional study was conducted to investigate the lifetime prevalence of IPV and prevalence of risky sexual behaviors during the previous 6 months in a convenience sample of 578 MSM from 15 cities covering seven geographical divisions in mainland China. The associations between IPV and risky sexual behaviors and the moderating effect of self-efficacy on these associations were explored through univariate and multivariate regression analyses.Results: The prevalence rates of IPV perpetration and victimization were 32.5% and 32.7%, respectively. The proportions of participants who reported inconsistent condom use with regular or casual partners and multiple regular or casual sexual partners were 25.8%, 8.3%, 22.2%, and 37.4%, respectively. Multiple IPV experiences were positively associated with risky sexual behaviors; for example, any IPV victimization was positively associated with multiple regular partners, adjusted odds ratio (ORa) = 1.54, 95% CI [1.02,2.32], and multiple casual partners, ORa = 1.93, 95% CI [1.33, 2.80]. Any IPV perpetration was positively associated with inconsistent condom use with regular partners, ORa = 1.58, 95% CI [1.04, 2.40], and multiple casual partners, ORa = 2.11, 95% CI [1.45, 3.06]. Self-efficacy was identified as a significant moderator of the association between multiple casual sexual partnership and emotional IPV.Conclusions: In conclusion, given the high prevalence of both IPV and risky sexual behaviors among Chinese MSM in this study, the inclusion of self-efficacy in interventions targeting IPV and risky sexual behaviors should be considered. [ABSTRACT FROM AUTHOR]

The rapidly increasing prevalence of Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing bacteria has become a serious challenge to public health. Currently, the bla KPC– 2 gene is mainly disseminated through plasmids of different sizes and replicon types. However, the plasmids carrying the bla KPC– 2 gene have not been fully characterized. In this study, we report the complete genome sequences of two novel bla KPC– 2-harboring incompatibility group U (IncU) plasmids, pEC2341-KPC and pEC2547-KPC, from international high-risk clones of Escherichia coli isolated from Zhejiang, China. Two KPC-2-producing E. coli isolates (EC2341 and EC2547) were collected from clinical samples. Whole-genome sequencing (WGS) analysis indicated that EC2341 and EC2547 belonged to the ST410 and ST131 clones, respectively. S1-nuclease pulsed-field gel electrophoresis (S1-PFGE), Southern blot and conjugation experiments confirmed the presence of the bla KPC– 2 gene on the pEC2341-KPC plasmid and that this was a conjugative plasmid, while the bla KPC– 2 gene on the pEC2547-KPC plasmid was a non-conjugative plasmid. In addition, plasmid analysis further revealed that the two bla KPC– 2-harboring plasmids have a close evolutionary relationship. To the best of our knowledge, this is the first report of E. coli strains carrying the bla KPC– 2 gene on IncU plasmids. The emergence of the IncU-type bla KPC– 2-positive plasmid highlights further dissemination of bla KPC– 2 in Enterobacteriaceae. Therefore, effective measures should be taken immediately to prevent the spread of these bla KPC– 2–positive plasmids. [ABSTRACT FROM AUTHOR]

In fragmented forests, edge effects can drive intraspecific variation in seedling performance that influences forest regeneration and plant composition. However, few studies have attempted to disentangle the relative biotic and abiotic drivers of intraspecific variation in seedling performance. In this study, we carried out a seedling transplant experiment with a factorial experimental design on three land-bridge islands in the Thousand Island Lake, China, using four common native woody plant species. At different distances from the forest edge (2, 8, 32, 128 m), we transplanted four seedlings of each species into each of three cages: full-cage, for herbivore exclusion; half-cage, that allowed herbivore access but controlled for caging artifacts; and no-cage control. In the 576 cages, we recorded branch architecture, leaf traits, and seedling survival for each seedling before and after the experimental treatment. Overall, after one full growing season, edge-induced abiotic drivers and varied herbivory pressure led to intraspecific variation in seedling performance, including trade-offs in seedling architecture and resource-use strategies. However, responses varied across species with different life-history strategies and depended on the driver in question, such that the abiotic and biotic effects were additive across species, rather than interactive. Edge-induced abiotic variation modified seedling architecture of a shade-tolerant species, leading to more vertical rather than lateral growth at edges. Meanwhile, increased herbivory pressure resulted in a shift toward lower dry matter investment in leaves of a light-demanding species. Our results suggest that edge effects can drive rapid directional shifts in the performance and intraspecific traits of some woody plants from early ontogenetic stages, but most species in this study showed negligible phenotypic responses to edge effects. Moreover, species-specific responses suggest the importance of interspecific differences modulating the degree of trait plasticity, implying the need to incorporate individual-level responses when understanding the impact of forest fragmentation on plant communities. [ABSTRACT FROM AUTHOR]

Cervical cancer is the fourth most common cancer worldwide, but its incidence varies greatly in different countries. Regardless of incidence or mortality, the burden of cervical cancer in China accounts for approximately 18% of the global burden. The Chinese Cervical Cancer Clinical Study is a hospital-based multicenter open cohort. The major aims of this study include (i) to explore the associations of therapeutic strategies with complications as well as mid- and long-term clinical outcomes; (ii) to widely assess the factors which may have an influence on the prognosis of cervical cancer and then guide the treatment options, and to estimate prognosis using a prediction model for precise post-treatment care and follow-up; (iii) to develop a knowledge base of cervical clinical auxiliary diagnosis and prognosis prediction using artificial intelligence and machine learning approaches; and (iv) to roughly map the burden of cervical cancer in different districts and monitoring the trend in incidence of cervical cancer to potentially inform prevention and control strategies. Patients eligible for inclusion were those diagnosed with cervical cancer, whether during an outpatient visit or hospital admission, at 47 different types of medical institutions in 19 cities of 11 provinces across mainland China between 2004 and 2018. In a total, 63 926 patients with cervical cancer were enrolled in the cohort. Since the project inception, a large number of standardized variables have been collected, including epidemiological characteristics, cervical cancer-related symptoms, physical examination results, laboratory testing results, imaging reports, tumor biomarkers, tumor staging, tumor characteristics, comorbidities, co-infections, treatment and short-term complications. Follow-up was performed at least once every 6 months within the first 5 years after receiving treatment and then annually thereafter. At present, we are developing a cervical cancer imaging database containing Dicom files with data of computed tomography/magnetic resonance imaging examination. Additionally, we are also collecting original pathological specimens of patients with cervical cancer. Potential collaborators are welcomed to contact the corresponding authors, and anyone can submit at least one specific study proposal describing the background, objectives and methods of the study. [ABSTRACT FROM AUTHOR]

Stigmatization associated with the coronavirus disease 2019 (COVID-19) is expected to be a complex issue and to extend into the later phases of the pandemic, which impairs social cohesion and relevant individuals' well-being. Identifying contributing factors and learning their roles in the stigmatization process may help tackle the problem. This study quantitatively assessed the severity of stigmatization against three different groups of people: people from major COVID-19 outbreak sites, those who had been quarantined, and healthcare workers; explored the factors associated with stigmatization within the frameworks of self-categorization theory and core social motives; and proposed solutions to resolve stigma. The cross-sectional online survey was carried out between April 21 and May 7, 2020, using a convenience sample, which yielded 1,388 valid responses. Employing data analysis methods like multivariate linear regression and moderation analysis, this study yields some main findings: (1) those from major COVID-19 outbreak sites received the highest level of stigma; (2) factors most closely associated with stigmatization, in descending order, are objectification and epidemic proximity in an autonomic aspect and fear of contracting COVID-19 in a controllable aspect; and (3) superordinate categorization is a buffering moderator in objectification–stigmatization relationship. These findings are important for further understanding COVID-19-related stigma, and they can be utilized to develop strategies to fight against relevant discrimination and bias. Specifically, reinforcing superordinate categorization by cultivating common in-group identity, such as volunteering and donating for containment of the pandemic, could reduce objectification and, thus, alleviate stigma. [ABSTRACT FROM AUTHOR]

Chinese mahogany (Toona sinensis) is a woody plant that is widely cultivated in China and Malaysia. Toona sinensis is important economically, including as a nutritious food source, as material for traditional Chinese medicine and as a high‐quality hardwood. However, the absence of a reference genome has hindered in‐depth molecular and evolutionary studies of this plant. In this study, we report a high‐quality T. sinensis genome assembly, with scaffolds anchored to 28 chromosomes and a total assembled length of 596 Mb (contig N50 = 1.5 Mb and scaffold N50 = 21.5 Mb). A total of 34,345 genes were predicted in the genome after homology‐based and de novo annotation analyses. Evolutionary analysis showed that the genomes of T. sinensis and Populus trichocarpa diverged ~99.1–103.1 million years ago, and the T. sinensis genome underwent a recent genome‐wide duplication event at ~7.8 million years and one more ancient whole genome duplication event at ~71.5 million years. These results provide a high‐quality chromosome‐level reference genome for T. sinensis and confirm its evolutionary position at the genomic level. Such information will offer genomic resources to study the molecular mechanism of terpenoid biosynthesis and the formation of flavour compounds, which will further facilitate its molecular breeding. As the first chromosome‐level genome assembled in the family Meliaceae, it will provide unique insights into the evolution of members of the Meliaceae. [ABSTRACT FROM AUTHOR]

Leisure and tourism constitute important means for migrants to keep in touch with their homeland. This study is the first to investigate the relationship between the leisure and tourism activities of contemporary migrants in a transnational social field. Overseas Chinese residing in North America were surveyed to compare transnational leisure participation and travel behavior across five migrant generations, and examine the effects of transnational leisure on travel behavior and intention. A U-shaped pattern was found in respondents' media-based and event-based transnational leisure, frequency of travel, and intention to visit China, with the second generation being the lowest. Media-based leisure influenced the first and 1.5-generations' number of homeland trips whereas event-based leisure influenced that of the second, third, and fourth-plus generations. Overall, there is a positive relationship between transnational leisure and diaspora tourism, and different types of transnational leisure have varying effects on the travel behavior and intention of different generations. [ABSTRACT FROM AUTHOR]

Despite the large number of people with cancer who need hospice care, utilization rates at community hospice service in Shanghai are low. This study aimed to review the care provided in these hospice wards and examine the difficulties in delivering service. Fourteen hospice care providers were interviewed, and the data analyzed using qualitative content analysis. Three themes emerged from the interviews: (i) characteristics of hospice patients, mostly cancer patients at the end‐of‐life stage (within 3‐months of life expectancy) who were admitted without awareness of their condition; (ii) components of care, from physicians and nurses who focused mainly on physical problems as psycho‐spiritual care stagnated at a superficial level; and (iii) difficulties in care, including a lack of patients as well as inadequacies in service, along with suggestions for the future. Efforts at improvement should be made in both the health care system and society. To address the lack of patients, doctors in secondary/tertiary care hospitals need improved skills in discussing end‐of‐life care, while the general public needs better awareness and acceptance of hospice care. Solutions should respect the perspective of patients and their families, while hospice care providers must also enhance their skills of communication and psycho‐spiritual care. [ABSTRACT FROM AUTHOR]

Land use change is the most prominent feature of Chinese urbanisation. In China, the expansion of land consumed for urban development is inevitable given the rapid increases in the urban economy and urban population, but also in meeting the population's increasing demand for better quality of life. This paper is based on a research study of Wujiang district in Suzhou, which is considered representative of many of the rapid urbanisation areas within the nation. The objective is to develop an in-depth understanding of the characteristics of land use change and how this change contributes to environmental deterioration, as assessed by changes in the ecosystem service value (ESV). In this study, ESV is defined as the environmental products and functions provided for human well-being. Based on local planning documents, Landsat TM remote-sensing images and field surveys, the research analyses the cost to the environment when traditional land uses are transformed into urbanisation. The research demonstrates that conversion to urban land use which ignores the limit and capacity of the environment can generate significant environmental costs, as assessed by ESV, which in turn, can lead to a deterioration of quality of life for inhabitants, the exact opposite of the original intention. The research demonstrates that by mapping the spatial distribution of ecological service values, ESV can be used as a guide to urban sustainable development. [ABSTRACT FROM AUTHOR]

Children's leisure activities in parks have attracted increasing scholarly interest in recent decades. However, relatively little attention has been given to the emotional needs and responses of children to their activities within a park's play spaces. Moreover, what parents perceive, and how they themselves engage within children's playing spaces, is under-studied. Drawing on fieldwork carried out in the Guangzhou Children's Park, China, this paper aims to explore the experiences of both children and parents within this particular playing space. Supplementing participant observations with interviews and analysis of reviews on the Internet, the paper finds that children obtain a sense of family and company from their parents' presence, and parents recall memories of their own childhood and obtain emotional recovery by visiting parks with their children. The findings suggest that play spaces are not only places where children play, but also where family life and childhood are 'built'. The paper contributes to the existing literature by highlighting and examining the 'child–parent' relationship within playing spaces. By conducting a case study of a non-Western society, the paper encourages researchers to examine 'child–parent' relationships in a family leisure context, and to explore the everyday and emotional geographies of family life in contemporary China. [ABSTRACT FROM AUTHOR]

Submicron aerosol (PM1) species measured by aerosol mass spectrometers have been widely used to validate chemical transport models; however, the uncertainties due to chemical differences between PM1 and PM2.5 are poorly constrained. Here we characterized such differences in a highly polluted environment in north China in winter. Our results showed that the changes in PM1/PM2.5 ratios as a function of relative humidity (RH) were largely different for primary and secondary species. Secondary organic and inorganic aerosol (SOA and SIA) presented clear decreases in PM1/PM2.5 ratios at RH > 60% during periods with high SIA contributions (>50%), likely driven by the changes in aerosol hygroscopicity and phase states, while the traffic and coal combustion OA had limited dependence on RH. Thermodynamic modeling showed negligible impacts of PM differences on predictions of particle acidity, yet these impacts can cause a difference in aerosol water content by up to 50–70%. Plain Language Summary: Current air pollution studies rely largely upon aerosol mass spectrometers that provide real‐time measurements of submicron aerosol (PM1) species, and in many studies, PM1 aerosol species are used to validate those of PM2.5 in chemical transport models and estimate particle acidity and aerosol water content which are key parameters in studying heterogeneous reactions. However, the uncertainties in air pollution studies due to the chemical differences of PM1 and PM2.5 are poorly constrained, particularly in highly polluted environment, for example, China and India. We found that the changes in PM1/PM2.5 ratios as a function of relative humidity were largely different for primary and secondary aerosol species in highly polluted environment, which was likely driven by the changes in aerosol hygroscopicity and phase states. The chemical differences of PM1/PM2.5 ratios were also found to have negligible impacts on predictions of particle acidity, yet these impacts can cause a difference in aerosol water content by up to 50–70%. Considering the rapid increases in the deployments of aerosol mass spectrometers worldwide, the results in this study are of great importance for a better understanding of the uncertainties in both modelling and observations. Key Points: We observed large chemical differences between PM1 and PM2.5 under high relative humidity periods in highly polluted environmentThe RH dependence of PM1/PM2.5 ratios of primary and secondary species was largely different due to different hygroscopicityThe chemical differences between PM1 and PM2.5 have negligible influences on particle acidity prediction, yet have a large impact on AWC [ABSTRACT FROM AUTHOR]

The Wulanba granite, consisting of biotite monzogranite and syenogranite, is located in the southern part of the Great Xing'an Range, NE China. Whole-rock major- and trace-element geochemistry suggests the Wulanba granite is a high-K–shoshonitic, slightly peraluminous and highly differentiated I-type granite. The Sr–Nd–Hf isotopes indicate that it originated from partial melting of juvenile crust derived from the depleted mantle with a minor input of old crust. The relatively young T2DM and tDM2 ages indicate it was most likely derived from a Late Neoproterozoic to Early Palaeozoic source. We have demonstrated that the biotite monzogranite is the ore-related intrusion of the Haobugao Zn–Fe mineralization based on the following geological, geochronological and geochemical evidence: (1) the chalcopyrite/pyrite in the biotite monzogranite and the continuous mineralization of drill core ZK2508; (2) the consistence of the emplacement age of the biotite monzogranite (~141–140/138 Ma) with the skarn mineralization age (~142 Ma); and (3) the presence of rich ore-forming elements (Fe–Zn–Cu) in the biotite monzogranite, and the similar Pb compositions of the sulfides from the Haobugao deposit and the biotite monzogranite. Compared to the barren syenogranite, the fertile biotite monzogranite is more oxidized, while the edges of the apatite grains in the biotite monzogranite are more oxidized than the centres. The average F/Cl ratio of the fertile biotite monzogranite (~123.45) is much higher than that of the barren syenogranite (~73.98). We conclude that these differences reflect unique geochemical signatures, and the geochemical composition of the apatite can be used to infer the economic potential of granites. [ABSTRACT FROM AUTHOR]

Background: A large number of students at a school in Guangzhou city developed a sudden onset of symptoms of diarrhea and vomiting. To help control the outbreak, we conducted an epidemiological investigation to determine the causative agent, sources, role of transmission and risk factors of the infections.Methods: The study population consisted of probable and confirmed cases. An active search was conducted for cases among all students, teachers and other school staff members. A case control study was carried out using standardized online questionnaires. Data were obtained regarding demographic characteristics, gastrointestinal symptoms, personal hygiene habits, history of contact with a person who had diarrhea and/or vomiting and dining locations during the past 3 days. Rectal swabs or stool samples of the cases and, food handlers, as well as environmental samples were collected to detect potential intestinal viruses and bacteria. We calculated odds ratios and 95% confidence intervals (CIs).Results: A total of 157 individuals fit the definition of a probable case, including 46 with laboratory-confirmed norovirus infection between March 8 and March 22, 2018. The proportion of students who had eaten delivery food 3 days before the onset of illness in the case group was 2.69 times that in the control group (95%CI: 1.88-3.85). Intake of take-out food 3 days earlier, and exposure to similar cases 72 h before onset and case in the same dormitory were risk factors. A total of 20 rectal swab samples from students, 10 rectal swabs from food handlers and 2 environmental swab samples from the out-campus restauranttested positive for norovirus (GII, genogroup II strain).Conclusions: We investigated an outbreak of norovirus infectious diarrhea. Food handling practices carry potential risk of acute gastroenteritis outbreaks owing to a lack of surveillance and supervision. Greater attention should be paid to the monitoring and supervision of food handlers in off campus restaurant to reduce the incidence of norovirus-related acute gastroenteritis associated with delivery food. [ABSTRACT FROM AUTHOR]

Objective: To evaluate current diagnosis and treatment of patients with nocturnal gastroesophageal reflux (nGER). Methods: This multicenter observational study was conducted in 44 hospitals in China from May 2017 to February 2018. Outpatients with nGER were recruited and their relevant data were collected using a questionnaire, including age, gender, body mass index, history of smoking and alcohol consumption, comorbid diseases, lifestyle, self‐reported health status, medical history, nGER symptoms and severity, Hospital Anxiety Depression Scale, Pittsburgh Sleep Quality Index, diagnosis and treatment choices. The study was registered on the Chinese Clinical Trial Registry (no. ChiCTR1800017525). Results: The study included 4978 individuals, with valid questionnaires collected from 4448 patients (89.4%). The symptoms of heartburn and regurgitation were more severe at night than during the day (P < 0.05). Age and body mass index were positively correlated with reflux severity at night and during the day (P < 0.05). The severity of nGER was positively associated with lifestyle factors such as smoking, a high‐fat diet, carbonated beverage consumption, late supper (later than 9 pm), and snoring (all P < 0.05). Night‐time heartburn and regurgitation were related with sleep disorder. Conclusions: Lifestyle factors are associated with nGER severity, and nGER affects sleep quality. It will be beneficial to popularize and strengthen the diagnosis and treatment of nGER. [ABSTRACT FROM AUTHOR]

The goal of this study is to examine individual-level and school-level predictors of teacher victimization (TV) by students in China based upon the multilevel social-ecological framework. A sample of 1711 teachers (7-12th grade) from 58 schools from eight provinces in mainland China completed measures of teacher victimization (i.e., physical TV, verbal TV, social TV, cyber TV, sexual harassment, and personal property offenses) by students, school-wide bullying and disciplinary practices, and demographics. In the present sample, 25.1% of teachers reported that they experienced at least one of the six forms of victimization from students in the past school year. Prevalence of teacher victimization ranged from 4.0% (physical victimization) to 16.8% (social victimization). Male teachers were more likely to experience all forms of TV and homeroom teachers were more likely than non-homeroom teachers to experience social TV. Schools with fewer students, but higher number of teachers, also had higher levels of TV. Student bullying and punitive disciplinary practices at the teacher level were associated with higher levels of most forms of TV. Implications of these findings are discussed. [ABSTRACT FROM AUTHOR]