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Background: To identify the clustering characteristics of individual-, family-, and school-level factors, and examine their associations with health-related physical fitness. Methods: A total of 145,893 Chinese children and adolescents aged 9–18 years participated in this cross-sectional study. The 2-step cluster analysis was conducted to identify clusters among individual-, family-, and school-level factors. Physical fitness indicator was calculated through sex- and age-specific z scores of forced vital capacity, standing long jump, sit-and-reach flexibility, body muscle strength, endurance running, and body mass index. Results: Three, 3, and 5 clusters were automatically identified at individual, family, and school levels, respectively. Students with low physical fitness indicator were more likely to be in the "longest sedentary time and skipping breakfast" cluster (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.12–1.24), and "physical inactivity and insufficient protein consumption" cluster (OR = 1.07; 95% CI, 1.02–1.12) at individual level, the "single children and high parental education level" cluster (OR = 1.15; 95% CI, 1.10–1.21), and "no physical activity support and preference" cluster (OR = 1.30; 95% CI, 1.25–1.36) at family level, and the "physical education occupied" cluster (OR = 1.06; 95% CI, 1.01–1.11), and "insufficient physical education frequency" cluster (OR = 1.16; 95% CI, 1.08–1.24) at school level. Girls were more vulnerable to individual- and school-level clusters, while boys were more susceptible to family clusters; the younger students were more sensitive to school clusters, and the older students were more susceptible to family clusters (P-interaction <.05). Conclusions: This study confirmed different clusters at multilevel factors and proved their associations with health-related physical fitness, thus providing new perspective for developing targeted interventions. [ABSTRACT FROM AUTHOR]

A complete understanding of groundwater dynamics and its interaction with surface water under the impact of agricultural activities is vital for local agriculture, ecology, and residents of dry regions, which is not commonly recognized in arid areas. This research outlines the geochemical characteristics, recharge sources, and potential factors impacting groundwater quality in a new land reclamation located in the small basin of Abu Mina, which is part of the Western Nile Delta region.1 Thirty-one groundwater samples and two surface water samples were collected in 2021 to represent the Pleistocene aquifer and were subjected to multivariate statistical, hydrochemical, and stable isotope analyses. Data analysis demonstrates that Na+ > Ca2+ > Mg2+ > K+ and SO42– > Cl– > HCO3– > NO3– are the predominant cations and anions, respectively. Groundwater salinity ranged from 465.60 to 6455.18 mg/l, with slightly alkaline. Most of the water samples fall into one of three types of facies: Ca–Cl, Na–Cl, and Mixed Ca–Mg–Cl, in decreasing order. The meteoric genesis index (r2) indicates that deep meteoric water percolation dominates the Pleistocene aquifer. The aquiline diagrams, correlation matrix, and different ionic ratios indicate that evaporation, reverse ion exchange reactions, and the dissolution of carbonate and silicate minerals are the main processes governing groundwater chemistry. Factor analysis (FA) indicated that three factors explain groundwater hydrochemistry, accounting for 71.98% of the total variance. According to the rotating components matrix (F1–F3), the chemistry of the Quaternary aquifer is principally affected by evaporation, ion exchange reactions, and anthropogenic influences. Additionally, salinity increases due to the return flow of irrigation activities and mixing between old and recent water. The stable isotopes (δ18O and δ2H) indicate that the Quaternary aquifer receives groundwater recharge through the return flow of excess irrigation and canal seepage. Under desert reclamation conditions, groundwater salinization processes should be given special consideration. All groundwater samples are appropriate for agricultural irrigation based on the Sodium Adsorption Ratio (SAR), Permeability Index (PI), Percent Sodium (%Na), and Residual Sodium Carbonate (RSC). [ABSTRACT FROM AUTHOR]

Background: Premature infants have less physiologic reserve and often delayed vaccination compared to full-term infants. The birth dose of hepatitis B vaccine (HepB-BD) is an essential measure to achieve the goal of "zero infections" of hepatitis B virus in all newborns. However, there are few investigations of hepatitis B vaccination of preterm infants, leading to uncertainty of coverage and insufficient knowledge of factors influencing timely vaccination of this important population. Methods: We obtained hepatitis B vaccine (HepB) vaccination histories of premature infants born during 2019–2021 in three provinces from the respective provincial immunization information systems. Extracted data included date of birth, sex, region, and dates of HepB administration. We conducted descriptive analyses that included basic characteristics of the study subjects, HepB-BD administration, and full-series HepB vaccination. Factors potentially influencing HepB-BD and full series vaccination were analyzed by logistic regression. Results: There were 1623 premature infants included in the analytic data set. Overall HepB-BD coverage was 71.41%; coverage among premature infants born to mothers with unknown hepatitis B surface antigen (HBsAg) status was 69.57%; coverage was higher at county-level-and-above hospitals (72.02%) than hospitals below county level (61.11%). Full-series HepB coverage was 94.15%; full-series coverage among preterm infants weighing less than 2000 g at birth was 76.92%. Logistic regression showed that the HepB-BD vaccination rate was positively associated with being born to an HBsAg-positive mother and being preterm with high birth weight. Regression analysis for factors influencing full-series HepB coverage showed that being born prematurely was positively associated with full-series coverage and being premature with a very low birth weight was negatively associated with full-series coverage. Conclusions: HepB-BD coverage levels in three provinces of China were less than the target of 90%, especially among premature infants born to mothers with unknown HBsAg status and at hospitals below the county level. Screening of pregnant women should be a universal normal standard. Hepatitis B vaccination training should be strengthened in hospitals to improve the HepB-BD vaccination rate of premature infants and to effectively prevent mother-to-child transmission of hepatitis B virus. [ABSTRACT FROM AUTHOR]

Objectives. How to promote the safety citizenship behavior (SCB) of construction workers has been studied in academic circles. However, most current research methods focus on the ‘net effect' between the independent variable and SCB. Methods and Results. Based on the fuzzy set qualitative comparative analysis (fsQCA) method and from the perspective of ‘configuration’, this article proposes that the emergence of SCB not only depends on a single condition, but also depends on the interaction of safety leadership behavior (SLB), organizational safety climate (OSC), organizational safety support (OSS), safety attitude (SA), safety motivation (SM), safety risk perception (SRP) and psychological belonging (PB). Conclusion. The research shows that the emergence of construction workers’ SCB can be realized through different combinations of variables, and both ‘external environment-driven' and ‘interpersonal relationship-driven' paths can promote the generation of SCB. This research provides a more systematic and practical explanation for how to promote the generation of SCB of construction workers, expand the research scope of safety management and play a positive role in reducing the incidence of safety accidents in the construction industry. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Excessive weight gain, obesity, or insufficient weight gain during pregnancy can adversely affect both the mother and her offspring. This study aims to investigate the relationship between pregnant women's self‐perception and beliefs and their body weight management during pregnancy.A cross‐sectional survey involving 350 pregnant women in Changsha City was conducted from July to September 2023. Instruments included a sociodemographic data sheet, protective motivation questionnaire for pregnancy body quality management, and scales measuring body image, anxiety, self‐efficacy, and social support. Univariate analysis and multiple linear regression were employed to identify factors influencing protective motivation for body quality management during pregnancy.The average score of the protective motivation questionnaire was 124 (SD = 13.07), suggesting a need for enhanced weight management. Key factors influencing protective motivation included household income, cooperation with healthcare workers, sources of pregnancy information, midnight snacking habits, prepregnancy exercise, body image, and self‐efficacy (P < 0.05).The study highlights significant factors influencing pregnant women's motivation for body quality management. These include economic status, healthcare collaboration, information accessibility, lifestyle habits, and psychological factors. The findings underscore the need for healthcare professionals to integrate these factors into pregnancy care programs to improve body quality management. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influencing factors of postoperative thrombocytopenia in critically ill patients with heart disease and construct a nomogram prediction model. Methods: From October 2022 to October 2023, 319 critically ill patients with heart disease who visited our hospital were collected and separated into postoperative thrombocytopenia group (n = 142) and no postoperative thrombocytopenia group (n = 177) based on their postoperative thrombocytopenia, Logistic regression analysis was applied to screen risk factors for postoperative thrombocytopenia in critically ill patients with heart disease; R software was applied to construct a nomogram for predicting postoperative thrombocytopenia in critically ill patients with heart disease, and ROC curves, calibration curves, and Hosmer-Lemeshow goodness of fit tests were applied to evaluate nomogram. Results: A total of 142 out of 319 critically ill patients had postoperative thrombocytopenia, accounting for 44.51%. Logistic regression analysis showed that gender (95% CI 1.607–4.402, P = 0.000), age ≥ 60 years (95% CI 1.380–3.697, P = 0.001), preoperative antiplatelet therapy (95% CI 1.254–3.420, P = 0.004), and extracorporeal circulation time > 120 min (95% CI 1.681–4.652, P = 0.000) were independent risk factors for postoperative thrombocytopenia in critically ill patients with heart disease. The area under the ROC curve was 0.719 (95% CI: 0.663–0.774). The slope of the calibration curve was close to 1, and the Hosmer-Lemeshow goodness of fit test was χ2 = 6.422, P = 0.491. Conclusion: Postoperative thrombocytopenia in critically ill patients with heart disease is influenced by gender, age ≥ 60 years, preoperative antiplatelet therapy, and extracorporeal circulation time > 120 min. A nomogram established based on above multiple independent risk factors provides a method for clinical prediction of the risk of postoperative thrombocytopenia in critically ill patients with heart disease. [ABSTRACT FROM AUTHOR]

ABSTRACT Hexavalent chromium (Cr(VI)) has attracted great considerations due to their high toxicity, teratogenicity, and carcinogenicity. In this study, four Zr‐MOFs were synthesized and used to comparative study their catalytic performances of oxalic acid (OA) for Cr(VI) removal. Results showed that the removal efficiency for Cr(VI) was reached 65.91%, 78.64%, 53.58%, and 96.32% by MOF‐525, MOF‐525(Co), MOF‐525(Zn), and MOF‐525(Fe) in the presence of OA when the initial Cr(VI) concentration was 100 mg·L−1, respectively. The single‐factor experiments for further improving the Cr(VI) removal by MOF‐525(Fe)/OA demonstrated that the optimal conditions were OA dosage of 790 mg·L−1, and MOF‐525(Fe) dosage of 500 mg·L−1 and pH of 2.0, and the MOF‐525(Fe)/OA system could be used to treat Cr(VI)‐containing wastewater at concentrations below 50 mg·L−1. Ionic strength studies indicated that Na+, K+, Mg2+, Cl−, and SO42− had little effect on the catalytic reduction of Cr(VI), while high concentrations of Ca2+ (0.10 and 0.25 mol·L−1), NO3− (0.25 mol·L−1), and PO43− (0.25 mol·L−1) had significant inhibition effects. The reusability experiments showed that the stability of MOF‐525(Fe) was excellent, and it could be used for potential applications. Based on the results of Fourier transform infrared spectroscopy (FTIR), X‐ray photoelectron spectroscopy (XPS), and Electron Paramagnetic Resonance spectrometer (EPR), the possible reduction mechanism of Cr(VI) by MOF‐525(Fe)/OA system was proposed as follows: The complexation of OA with Fe3+ was first complexed to produce Fe2+ and CO2•−, then Cr(VI) was combined with Zr–O and Fe–O clusters in MOF‐525(Fe) to obtain activation energy, and the reduction ability was enhanced at the same time; finally, Cr(VI) obtained electrons from CO2•− and was sequentially reduced as Cr(V) and Cr(III). [ABSTRACT FROM AUTHOR]

Background: Researchers have paid little attention to the safety of drug use among community residents (CRs). Irrational use of drugs can lead to health risks. We investigated the situation of knowledge–attitude–practices (KAP) of CRs in Shenzhen (China) for safe use of drugs, and analyzed the main factors influencing drug use. Methods: A multi-stage, random sampling method was used. We used a validated questionnaire to conduct an online questionnaire survey on the demographic characteristics and KAP of safe use of drugs of CRs in 10 administrative districts of Shenzhen City. The KAP score of safe use of drugs of CRs was analyzed. Influencing factors were identified using a single-factor chi-squared test and binary logistic regression analysis. Results: A total of 7269 valid questionnaires were collected. The average scores of knowledge, attitude, and behavior were (9.08 ± 1.49) (possible range: 0–10), (37.82 ± 3.96) (possible range: 8–40), and (35.82 ± 4.56) (possible range: 8–40), respectively, indicating that they had a better grasp of safe use of drugs. Logistic regression analysis showed that sex, age, education level, occupation, monthly household income per capita, marital status, health status, and different sources of information were the main factors affecting the knowledge and behavior of safe use of drugs of CRs. In addition to the marital status variable, other variables also have a significant impact on attitude towards safe use of drugs of CRs. Conclusions: Male sex, lower education level, lower income level, average/poor self-rated health status, and single source of drug-use information were the main factors affecting safe use of drugs based on KAP theory. The government and medical workers should carry out various forms of drug-education activities for people with different needs, encourage CRs to learn safe use of drugs, and promote safe use of drugs by CRs through diverse information sources. [ABSTRACT FROM AUTHOR]

In order to explore the influencing factors of spatial and temporal evolution of production-living-ecological space in Beijing Tianjin sandstorm source area, the remote sensing images, natural environment and socio-economic data of Duolun County in Inner Mongolia from 2000 to 2020 were selected, and the spatial auto-correlation model and principal component analysis model were used to analyze the spatial pattern evolution and influencing factors of production-living-ecological space. The results show that: (1) the function of production space decreases slightly, and the degree of spatial agglomeration decreases; (2) The function of living space rose slightly, and its spatial agglomeration degree showed an upward trend; (3) The ecological spatial function showed a slow upward trend, and its spatial agglomeration degree increased; (4) The spatial pattern of production-living-ecological space is characterized by "high in the southwest and low in the northeast"; (5) Precipitation has the greatest impact on the spatial evolution of the production-living-ecological space. The distance from the main residential areas, per capita GDP, the distance from the main roads and the distance from the main waters have strong explanatory power on the spatial evolution of the production-living-ecological space. [ABSTRACT FROM AUTHOR]

This study examines tuberculosis (TB) incidence among students in Jilin Province, China, focusing on spatial, temporal, and demographic dynamics in areas of social inequality. Variation in incidence rate of TB was analyzed using the joinpoint regression method. Spatial analyses techniques included the global and local Moran indices and Getis-Ord Gi* analysis. Demographic changes in new cases were analyzed descriptively, and the Geodetector method measured the influence of risk factors on student TB incidence. The analysis revealed a declining trend in TB cases, particularly among male students. TB incidence showed geographical heterogeneity, with lower rates in underdeveloped rural areas compared to urban regions. Significant spatial correlations were observed, with high-high clusters forming in central Jilin Province. Hotspots of student TB transmission were primarily concentrated in the southwestern and central regions from 2008 to 2018. Socio-economic factors exhibited nonlinear enhancement effects on incidence rates, with a dominant bifactor effect. High-risk zones were predominantly located in urban centers, with university and high school students showing higher incidences than other educational stages. The study revealed economic determinants as being especially important in affecting TB incidence among students, with these factors having nonlinear interacting effects on student TB incidence. [ABSTRACT FROM AUTHOR]

Paper is a kind of renewable material that exists widely and has important application prospects. However, previous studies have mostly focused on the macromechanical properties of paper but lack micro theory based on paper fiber networks. We present a comprehensive experimental and computational study on the mechanical properties of fibers and fiber networks under the influence of microstructure. A beam-spring model was established based on a beam-fiber network to simulate the behavior of fiber networks. Simulations were performed to demonstrate the influence of fiber microstructural parameters such as fiber bond strength, stiffness, failure strength, size, and network density on mechanical features. Mechanical experiments verified that the fiber bond strength had a greater influence on the paper properties than did the fiber strength. This result is highly consistent with that of the model. All the simulations were validated by experimental measurements. Finally, we provided computational insights into the interfiber bond damage pattern with respect to different fiber microlevels and demonstrated that the proposed beam-spring model can be used to predict the response of fiber networks of paper materials. The above research can be used to optimize the formulation, process, and treatment of paper to meet specific application needs. [ABSTRACT FROM AUTHOR]

Background: Pediatrics is one of the most important medical specialties in the Kingdom of Saudi Arabia) KSA) since it serves a large population. Therefore, the pediatrics residency program is considered one of the most important and competitive programs. Obtaining acceptance in Saudi programs depends mainly on the Saudi Commission for Health Specialties (SCFHS) score, then the applicant enrolls to do the interviews with the training centers in the accepted region. This study aimed to evaluate the factors used by pediatric program directors (PD) in accepting applicants in their pediatric residency program in KSA. Methods: In this cross-sectional study, an online questionnaire consisting of 49 items was distributed among 76 current and former pediatric PDs in KSA. Participants were selected via non-probability convenience sampling. Data were collected and analyzed using the Social Sciences Statistical Package (SPSS version 26). Results: Of the sample of PD studied, males represented 77.6%, while females represented 22.4%. Most of the PDs were over 50 years old. Most of them were former pediatric PDs (71.1%). The current study found that the Saudi Medical Licensing Exam was the most important factor [3.87 (0.89)] followed by services and electives [3.86 (0.65)], research [3.84 (0.83)], interview [3.77 (0.89)], GPA [3.50 (0.62)], and letter of recommendation [3.39 (0.76)]. Conclusions: For those interested in pediatrics residency programs in KSA, this study recommends that seeking a high Saudi Medical Licensing Exam (SMLE) score, taking pediatric elective rotations during internship, and acquiring excellent basic knowledge in research were the most important aspects of pediatrics residency selection from the pediatrics PD's perspective. [ABSTRACT FROM AUTHOR]

The expansion of illicit lottery activities has caused significant harm to both agricultural production and the livelihood of rural residents. An analysis of the factors that influence rural residents' participation in underground lotteries can provide crucial insight for regulating the lottery industry's development. This study examines the present state of rural residents' participation in underground lotteries, investigates the factors that impact their participation using the Double-Hurdle model, and further employs the ISM model to evaluate the correlations and hierarchical structure among the factors, using field survey data collected from 603 rural residents in S Province, China. The findings reveal that 53.07% of the respondents have participated in underground lotteries. Risk preference, information acquisition, social networks, age, education, family burden, percentage of agricultural labor, agricultural business scale, and household income significantly affect whether residents purchase lotteries (WPL). All factors, except the percentage of agricultural labor and agricultural business scale, also significantly impact underground lottery spending (LS). Among the significant influencing factors, rural residents' risk preference is the direct surface factor, whereas agricultural business scale, household income, information acquisition, and social networks are the middle indirect factors, and residents' age, education, family burden, and percentage of agricultural labor are the deep-rooted factors. It is recommended to regulate the lottery industry's development can be achieved by enhancing entertainment and cultural activities, expanding economic opportunities, enhancing rural education, increasing law awareness, and improving the public welfare lottery business model. The conclusions offer a valuable reference point for the standardized development of the lottery industry and the promotion of social stability in rural areas. [ABSTRACT FROM AUTHOR]

Objective: To analyze the characteristics of deliberate drug ingestion in adolescents and its related influencing factors. Method: This was a retrospective study. A total of 158 cases of deliberate drug ingestion as observation group and 160 cases of other diseases in adolescents as control group were treated in the Emergency Department of Baoding Hospital of Beijing Children’s Hospital Affiliated to Capital Medical University from January 2020 to December 2022. The clinical characteristics of adolescents who engaged in deliberate drug ingestion were analyzed, and various factors that could potentially influence deliberate drug ingestion in adolescents were subjected to both univariate and multivariate analysis. Result: There was a progressive increase in the number of patients presenting with mental health issues year by year. Univariate analysis showed that family type, guardian’s education level, place of residence, whether they were only children, parents’ knowledge of medication, awareness of medication safety, depression/anxiety, negative life events, and social support were risk factors for deliberate drug ingestion in adolescents (all p<0.05). Logistic regression analysis showed that family type, parents’ knowledge of medication, awareness of medication safety, whether they were depressed/anxious, negative life events, and social support were independent risk factors for deliberate drug ingestion in adolescents (p<0.05). Conclusion: The incidence of deliberate drug ingestion in adolescents is increasing year by year, and their behavior is influenced by multiple factors. Interventions should be targeted at controllable influencing factors to prevent or reduce deliberate drug ingestion in adolescents. [ABSTRACT FROM AUTHOR]

Aims: To offer a holistic view of the personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery. Methods: This systematic synthesis of mixed methods research involved a comprehensive search for articles in English databases, including PubMed, Cochrane Library, Web of Science, EBSCO, Scopus, and Embase, as well as Chinese databases. The search encompassed articles published from the inception of the database up to June 2023. Following the evaluation of literature quality and extraction of relevant information from the selected studies, data from both quantitative and qualitative studies were integrated. The extracted data were analyzed separately, and themes were identified and summarized to elucidate the factors influencing adherence to nutritional and dietary guidelines. The methodology adhered to the guidelines recommended by the Joanna Briggs Institute (JBI) for mixed methods systematic evaluations. Results: Three themes and their corresponding descriptive elements were identified, including: (1) Personal factors: subjective factors (attitude, capability, awareness, behaviors), objective factors (age, sex, work status, economic level, physical activity, dietary habits, weight change); (2) External factors: medication (quantity of pills, complexity of intake times, side effects, unpleasant smell or taste), surgery factor, social influences (family members, dietitians, and peers); (3) Psychological factors: self-efficacy, attachment anxiety, and mental health problems. Conclusions: The synthesis provided a comprehensive overview of the factors influencing postoperative compliance of nutrition and diet among patients undergoing metabolic and bariatric surgery. It emphasizes the necessity for clinical staff to tailor interventions based on these diverse factors, as well as to attach importance to patients' mental health, giving multidimensional dietary guidance and health care. [ABSTRACT FROM AUTHOR]

The inheritance of traditional handicraft of intangible cultural heritage is facing an unprecedented crisis. The essence of inheritance is the process of imparting and inheriting from master to apprentice, but there is acute shortage of research about the parties, the relationship and the behavior of inheritance. Therefore, choosing inherited behavior as a starting point to explore the inner formation mechanism of master and apprentice inheritance in traditional handicraft, as well as determining the influencing factors of the inheritance, have important theoretical value and practical significance for the inheritance of intangible cultural heritage. Using 4 traditional handicraft inheritance institutions in China as case objects, 37 inheritance parties and 21 mentoring matching groups were interviewed. Through standard case analysis and three-step coding method of grounded theory, it is found that skill generation involves the stages of inquiry, interaction and feedback, as well as the following steps:cognition of skill generation, coupling of skill generation, automation of skill generation, etc. Through coding, 12 categories and 33 specific influencing factors are identified. Among them, individual factors influence interaction relation, and the interaction relation has a concrete influence on the process of inheritance, affecting the ultimate effect of inheritance. This study is of reference value for improving the relationship between masters and apprentices and promoting the effective inheritance of traditional handicraft. [ABSTRACT FROM AUTHOR]

As the global economy, society, and environment are undergoing profound changes and the realization of sustainable development has become the common aspiration of the international community, ecological civilization construction has become an increasingly important issue for China to formulate its long-term development strategies and promote modernization. This study analyzes the characterization of 655 established pilot zones of ecological civilization construction and 'clear waters and green mountains are as valuable as mountains of gold and silver' innovative practices from 2017 to 2022. The spatial distribution of ecological civilization areas in China follows a pattern where more regions are in the southeast than in the northwest (Hu Line). The focus of China's comprehensive ecological civilization construction has been towards the southwest in the first year and has subsequently shifted towards the northwest. The overall Gini coefficient decreased from 0.494 to 0.299, and regional ecological civilization disparities gradually narrowed. Currently, regional construction disparities between the eastern and western regions are a major obstacle to balanced development; therefore, promoting coordinated regional development is necessary. Various factors affecting the pattern of ecological civilization construction, including natural resources, economic development, social progress, policies, and culture, were identified. The availability of natural resources and economic development cause regional differences in construction levels. This research will help promote the coordinated development of Chinese ecological civilization, while the development experiences of different regions can also provide guidance for sustainable development in developing countries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to quantitatively compare the efficacy and safety of CDK4/6 inhibitors and PI3K/AKT/mTOR inhibitors for ER+/HER2− metastatic breast cancer. Methods: A parametric survival function was used to analyze the time course of overall survival (OS) and progression-free survival (PFS). The objective response rate (ORR) and the incidence of any grade and grade 3–4 adverse events were summarized using the random-effects model of a single-arm meta-analysis. Results: This study included 44 arms from 48 publications, with a total sample size of 7881 patients. Our study revealed that CDK4/6 inhibitors had a median OS of 40.7 months, a median PFS of 14.8 months, and an ORR of 40%, whereas PI3K/AKT/mTOR inhibitors had a median OS of 29.8 months, a median PFS of 8.3 months, and an ORR of 20%. Additionally, this study also found that the proportion of patients with visceral metastases and specific endocrine therapy used in combination significantly impact OS and PFS. In terms of adverse events, CDK4/6 inhibitors exhibited a relatively high incidence of hematological adverse events. Conclusion: Our study provides solid quantitative evidence for the first-line recommendation of CDK4/6 inhibitors combined with endocrine therapy for ER+/HER2− metastatic breast cancer in clinical guidelines. [ABSTRACT FROM AUTHOR]

Nitrous oxide (N2O) is a long-lived greenhouse gas that mainly originates from agricultural soils. More and more studies have explored the sources, influencing factors and effective mitigation measures of N2O in recent decades. However, the hierarchy of factors influencing N2O emissions from agricultural soils at the global scale remains unclear. In this study, we carry out correlation and structural equation modeling analysis on a global N2O emission dataset to explore the hierarchy of influencing factors affecting N2O emissions from the nitrogen (N) and non-N fertilized upland farming systems, in terms of climatic factors, soil properties, and agricultural practices. Our results show that the average N2O emission intensity in the N fertilized soils (17.83 g N ha−1 d−1) was significantly greater than that in the non-N fertilized soils (5.34 g N ha−1 d−1) (p< 0.001). Climate factors and agricultural practices are the most important influencing factors on N2O emission in non-N and N fertilized upland soils, respectively. For different climatic zones, without fertilizer, the primary influence factors on soil N2O emissions are soil physical properties in subtropical monsoon zone, whereas climatic factors are key in the temperate zones. With fertilizer, the primary influence factors for subtropical monsoon and temperate continental zones are soil physical properties, while agricultural measures are the main factors in the temperate monsoon zone. Deploying enhanced agricultural practices, such as reduced N fertilizer rate combined with the addition of nitrification and urease inhibitors can potentially mitigate N2O emissions by more than 60% in upland farming systems. [ABSTRACT FROM AUTHOR]

HIV-positive men who have sex with men (MSM) are at high risk of suicide and experience intersectional inequalities. The Social Determinants of Health (SDH) framework provides valuable insights into how inequalities can lead to adverse outcomes. This study aimed to employ the SDH framework to identify factors that contribute to suicidal behaviors among this population. 1410 HIV-positive MSM were recruited using a web-based questionnaire, whose mean age was 30.77 ± 6.92 years old. Participants completed questionnaires including baseline information and psychological measurements, such as Suicidal Behaviors Questionnaire-Revised (SBQ-R). Logistic regression analysis was conducted to screen for risk factors associated with suicidal behaviors. More than half of the participants (53.3 %, 752/1410) had an SBQ score of 7 or higher. Binary logistic regression analysis of structural and intermediary determinants (Model 3) revealed that sexual orientation, stigma (ORs: 1.018, 95 % CI: 1.005–1.032), interpersonal needs (ORs: 1.021, 95 % CI: 1.010–1.031), depression (ORs: 1.037, 95 % CI: 1.001–1.074) and entrapment (ORs: 1.018, 95 % CI: 1.004–1.032) were positively correlated with suicidal behaviors. Individuals with other or unknown sexual orientation had significantly higher rates of suicidal behaviors compared to those with a heterosexual sexual orientation (ORs: 5.021, 95 % CI: 1.529–17.640). Sampling of HIV-positive MSM posed challenges in data collection. It may introduce selection bias and affect generalizability. This study identified that sexual orientation, stigma, interpersonal needs, depression, and entrapment were significantly associated with suicidal behaviors among HIV-positive MSM. Additionally, these factors can be social determinants of health that contribute to suicidal behaviors. • This study is the first to apply the SDH framework in HIV-positive MSM. • SBQ scale rather than one or a few questions was used to measure the suicidal behaviors among HIV-positive MSM. • Sexual orientation, stigma, interpersonal needs, depression, entrapment contribute to suicidal behaviors in HIV-positive MSM. [ABSTRACT FROM AUTHOR]

Glaciers are one of the most active erosional forces sculpting mountainous regions, and understanding the diversity of glacial valleys is a key to advancing knowledge of mountain evolution. 'Inverted trapezoidal' glacial valleys are an important type of glacial erosional landform, and research on their morphologic characteristics and causal mechanisms might contribute to a deeper comprehension of the variety of landforms formed by glacial erosion. In this paper, ALOS 12.5m DEM data and field geomorphologic surveys were used to quantitatively extract 171 transect parameters from 32 valleys in the study area and to quantitatively describe the morphologic characteristics of the inverted trapezoidal glacial valley transects based on the V-index model. The results show that the minimum V-index value for glacial valley cross-sections in the study area is 0.42, the maximum value is 0.86, and the mean value is 0.60. The most important factors influencing the diversity in the morphology of glacial valleys in the study area are the area of glacial action and climatic conditions. The formation of inverted trapezoidal glacial valleys may be attributed to the stable glacial action region of ice caps with gentle topography in Geladandong snow mountain. Research highlights: The minimum value of the V-index for glacial valley cross-sections in the study area was 0.42, the maximum value was 0.86, and the mean value was 0.60. The greatest number of cross-sections were concentrated in the 0.60 ~0.70 interval. The most important factor influencing the diversity in the morphology of glacial valleys in the study area are the area of glacial action and climatic conditions. The formation of inverted trapezoidal glacial valleys may be attributed to the stable glacial action region of ice caps with gentle topography in Geladandong snow mountain. [ABSTRACT FROM AUTHOR]

Based on national agricultural trade panel data of Regional Comprehensive Economic Partnership (RCEP) countries from 2002 to 2020, the structural characteristics of the RCEP national agricultural trade spatial network are reconstructed by the social network analysis method in this paper. Specifically, the characteristics consist of overall characteristics, individual characteristics, core-periphery structure analysis, and block models. Moreover, the influence factors on the agricultural trade network are also examined by the QAP regression model. The conclusions are summarized as follows. Firstly, the agricultural trade in RCEP countries has significant spatial correlation, showing favorable stability and accessibility. Secondly, Australia, China, Thailand, and Vietnam are the central actor's leading position in the correlation network. While Cambodia, Laos, Myanmar, and other countries are in the marginal position. Thirdly, the network can be divided into four blocks, including the net benefit block, the two-way spillover block, the broker block, and the net spillover block. The spillover effect between the blocks is transitive. And finally, geographical distance, economic and social conditions, resource endowment, and language proximity index significantly impact the RCEP agricultural trade network structure. [ABSTRACT FROM AUTHOR]

Aiming at the seismic problem of underground utility tunnel, the three-core arch section underground utility tunnel between Genghe Substation and Bowen Substation in Zhengzhou City was taken as the research object, ANSYS Workbench software was used to establish a three-dimensional solid model, and carries out the first 6 order modal analysis. It was found that the utility tunnel had longitudinal vibration, vertical vibration, lateral vibration and rotation. Based on the modal analysis, the displacement response, acceleration response and principal stress response of the utility tunnel with horizontal and vertical earthquakes were analyzed. The results showed that the maximum horizontal and vertical displacement peaks were -24.222 mm and -8.954 mm, respectively. The maximum acceleration peaks were 3 354.2 mm/s² and 1 646.0 mm/s², respectively. The peak values of the first principal stress were 514.7 kPa and 244.15 kPa, respectively. The peak values of the third principal stress were - 608.15 kPa and -256.71 kPa, respectively. It could be concluded that the horizontal earthquake played a leading role. Based on the transverse seismic dynamic time history analysis of the utility tunnel, the parameters such as spectral characteristics, structural material strength and structural depth were changed to analyze their influence on the seismic performance of the utility tunnel. The utility tunnel structure studied was the most sensitive when the seismic wave spectrum characteristic was about 1.1 Hz; the change of concrete strength had little effect on the dynamic response of the pipe gallery structure. With the increase of the buried depth of the utility tunnel, the surrounding soil pressure increased, and the internal force gradually increased. [ABSTRACT FROM AUTHOR]

With the continuous growth of electric vehicle ownership, energy consumption has become an important factor restricting its development. Real-time and accurate energy consumption estimation is essential to alleviate range anxiety and help with energy-efficient route planning. This study aims to explore the factors affecting energy consumption, and estimate the energy consumption of electric vehicles under different road characteristics. Based on the real-world driving data of electric vehicles in Nanjing over a long period, this study analyzed the influencing factors of energy consumption, including trip conditions, weather, driving behavior, and road characteristics. Based on feature selection and correlation analysis, an energy consumption estimation framework for electric vehicles was proposed to estimate energy consumption under different road characteristics using extreme gradient boosting. The results show that energy consumption is significantly affected by trip conditions, weather, driving behavior, and road characteristics. The modeling of different road characteristics helps improve the accuracy of model estimation. The error of the model proposed in this paper is within the reasonable range (−0.25–0.25 kWh/km), which is better than the random forest and k-nearest neighbor models. [ABSTRACT FROM AUTHOR]

Purpose: Understanding spatial variations in soil nutrients and its drivers is essential for sustainable nutrient management and related environmental assessment in terrestrial ecosystems. Here, we investigated the distribution characteristics and controlling factors of soil total nitrogen (N) and N fractions along an altitude gradient in an alpine meadow of the Qinghai-Tibet Plateau. Materials and methods: Six experimental sites at altitudes 4400, 4500, 4650, 4800, 4950, and 5200 m were established on southern slope of Nyainqentanglha Mountain since 2005. Total N and N fractions were quantified and their relationships with climate, vegetation, and edaphic factors were analyzed by Pearson correlation, redundancy analysis, and structural equation modeling. Results and discussion: With increasing altitude, the contents of total N, alkali-hydrolyzable N, inorganic N fractions (ammonium N and nitrate N), and organic N fractions (acid-hydrolyzable and acid-insoluble organic N) gradually increased, reached their maximums at altitude 4800 or 4950 m, and then decreased. Soil organic carbon explained 90.5% of the variations in TN and N fractions, and soil moisture, pH, mineralogy, texture, and N hydrolyzing enzyme activity explained 8.80% of the variations in TN and N fractions. Mean annual temperature and precipitation exhibited direct and positive impact on soil organic carbon, which had positive effect on inorganic N fractions and plant aboveground biomass in sequence. Conclusions: Soil organic carbon is the most dominant factors driving the variations in TN and N fractions along the altitude gradient. Climate change can impact alpine grassland productivity by regulating soil inorganic N distribution. [ABSTRACT FROM AUTHOR]

Data Pension Explorer (DAPE) introduces an innovative approach to delve into the intricacies of commercial pension insurance adoption within rural communities in China, particularly amid the challenges posed by an aging population. Leveraging advanced Deep Long Short-Term Memory (LSTM) techniques within the domain of big data analysis, this study pioneers the analysis of extensive datasets. It systematically unravels intricate patterns, correlations, and pivotal determinants shaping the landscape of pension insurance adoption in rural areas. Going beyond conventional analyses, this research provides a nuanced understanding of the multifaceted factors influencing both the sustainability and uptake of pension insurance. The culmination of these efforts yields valuable insights that extend beyond the theoretical realm, directly informing strategic decision-making processes. These insights prove instrumental in designing and implementing policies tailored to address the unique challenges faced by rural communities in China. Thus, DAPE not only navigates the complexities of population aging but also serves as a guiding force in fostering widespread adoption and sustainability of pension insurance within rural landscapes in the Chinese context. [ABSTRACT FROM AUTHOR]

While the industry has produced sugar-derived ethanol from the conventional method of fermentation for hundreds of years, other effective routes involving the direct transformation of carbohydrates still remain extremely rare. Very recently, an innovative chemo-catalytic method driven by the aqueous-phase catalysis was created for the synthesis of cellulosic ethanol, making a great breakthrough in the common ways as it can theoretically utilize all of the carbon atoms in sugars with faster kinetics; up to now, results from the relevant studies have been accumulated to a certain extent, but the periodic conclusions in this field are unfortunately absent. For this reason, this work tries to offer an overview of the cellulosic ethanol produced by chemo-catalytic routes, highlighting the present knowledge in relation to the technical efficiency, catalytic mechanisms as well as practical applications. At first, the advanced progress on the increasing efficiency from a varied type of catalytic systems are extensively discussed, which involves the specific functions of hybrid components from different strategies; meanwhile, the general influences of processing conditions, such as the hydrothermal severity and aqueous environments, are also identified. Subsequently, possible mechanisms behind the chemo-catalytic processes are widely elaborated by analyzing a number of experimental cases associated with the reaction network and its kinetic models. After that, the actual effects of this technique on the real biomass are collected to identify the positive/negative interactions between multiple components, together with the potential solutions on the semi-continuous processes of pilot scale application. The techno-economic analysis (TEA) is also calculated and compared with other similar methods, such as fermentation and gasification. Finally, several proposals aimed at upgrading the whole chain of chemo-catalytic processes are clearly provided, which may function as a guideline for future studies on the production of bio-ethanol from lignocellulosic materials. [ABSTRACT FROM AUTHOR]

Relevant studies in the fields of fire safety, occupational health and firefighter clothing were analyzed in this study to address the high injury rate among firefighters during fire rescue and the complexity of factors affecting skin burns. The findings indicate that the degree of skin burns in firefighters is primarily influenced by the heat source (heat flux, type), firefighter clothing (fabric, pattern) and the under-clothing air gap (thickness, characteristics). Since skin burns cannot be directly measured, internal skin heat transfer and burn prediction models are commonly employed to assess the impact of external factors on skin burns. These models can predict the safe working distance or time for firefighters. Investigating the influencing factors and prediction models of skin burns among firefighters holds significant value in enhancing operating procedures, optimizing firefighter clothing design and effectively preventing skin burns. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease. Objective: This study aimed to investigate the self-management ability of patients with MASLD, analyse related factors that may affect self-management ability and evaluate the impact of this ability on readmission. Methods: The study recruited patients with MASLD admitted to the Department of Infectious Diseases, First Affiliated Hospital of Wenzhou Medical University, between February and October 2021 using the random sampling method. The MASLD diagnosis was based on the guidelines for the prevention and treatment of MASLD. An analysis of patients' self-management ability was conducted using the self-management ability scale for patients with MASLD. Multiple linear regression analysis was used to analyse the factors influencing this self-management ability, and the readmission rate within 1 year was tracked. The patients were rediagnosed as having MASLD upon readmission to the hospital. Results: A total of 241 baseline data items and self-management scale scores for patients with MASLD were collected and investigated. In our study, the normal score range for the self-management scale was 31–155 points, and the self-management scale scores for patients with MASLD was 91.24 ± 16.98, with a low level of self-management accounting for 52.7% and a medium level accounting for 44.8%. The results of the multiple linear regression analysis revealed that marital status, smoking history, fatty liver severity and education were the main factors affecting self-management ability (P < 0.05). The readmission rates were 18.25%, 7.48% and 0%, respectively, after 1 year of follow-up; the difference in survival distribution was statistically significant (P < 0.05). Conclusion: The self-management ability of patients with MASLD is relatively low and is primarily influenced by factors such as marital status, smoking history, the severity of fatty liver disease and level of education, which also affect the readmission rate of patients within 1 year. [ABSTRACT FROM AUTHOR]

Background: Pulmonary tuberculosis (PTB) is a prevalent chronic disease associated with a significant economic burden on patients. Using machine learning to predict hospitalization costs can allocate medical resources effectively and optimize the cost structure rationally, so as to control the hospitalization costs of patients better. Methods: This research analyzed data (2020–2022) from a Kashgar pulmonary hospital's information system, involving 9570 eligible PTB patients. SPSS 26.0 was used for multiple regression analysis, while Python 3.7 was used for random forest regression (RFR) and MLP. The training set included data from 2020 and 2021, while the test set included data from 2022. The models predicted seven various costs related to PTB patients, including diagnostic cost, medical service cost, material cost, treatment cost, drug cost, other cost, and total hospitalization cost. The model's predictive performance was evaluated using R-square (R2), Root Mean Squared Error (RMSE), and Mean Absolute Error (MAE) metrics. Results: Among the 9570 PTB patients included in the study, the median and quartile of total hospitalization cost were 13,150.45 (9891.34, 19,648.48) yuan. Nine factors, including age, marital status, admission condition, length of hospital stay, initial treatment, presence of other diseases, transfer, drug resistance, and admission department, significantly influenced hospitalization costs for PTB patients. Overall, MLP demonstrated superior performance in most cost predictions, outperforming RFR and multiple regression; The performance of RFR is between MLP and multiple regression; The predictive performance of multiple regression is the lowest, but it shows the best results for Other costs. Conclusion: The MLP can effectively leverage patient information and accurately predict various hospitalization costs, achieving a rationalized structure of hospitalization costs by adjusting higher-cost inpatient items and balancing different cost categories. The insights of this predictive model also hold relevance for research in other medical conditions. [ABSTRACT FROM AUTHOR]

Background: Many studies have explored the risk factors associated with cognitive impairment in patients with Type 2 diabetes mellitus (T2DM). However, research on determining the optimal threshold for these risk factors and comparative studies on the therapeutic effects of insulin and metformin is limited. This study aims to establish the optimal threshold for cognitive impairment risk factors in T2DM patients and compare the efficacy of insulin and metformin in treating mild cognitive impairment (MCI). Methods: A total of 308 patients with T2DM were included. The optimal threshold for cognitive impairment risk factors was determined using receiver operating characteristic curve and binary logistic regression models. MCI patients were divided into three groups: insulin, metformin, and insulin with metformin. The treatment effect was evaluated after a 6-month follow-up. Results: The study identified several factors that influenced cognitive function in T2DM patients, including female gender, duration of diabetes >13.50  years, years of education >7.50  years, and serum sodium level  >  141.90  mmol/L. Metformin and insulin with metformin showed superior therapeutic effects compared to insulin alone, but no difference was observed between metformin and combination therapy. Conclusion: Special attention should be given to female and those with diabetes duration >13.50  years, as well as to individuals with educational level ≤  7.50  years and serum sodium concentration ≤  141.90  mmol/L. Metformin and insulin with metformin effectively improve MCI in patients with T2DM and outperform insulin monotherapy. The efficacy of metformin and combination therapy was found to be comparable [ABSTRACT FROM AUTHOR]

Background: With the rapidly aging population in China, there is an urgent need to understand and address the community care needs of older adults. This study sought to examine these unmet community care needs of older adults in China and the factors influencing them, with the goal of providing essential groundwork for the development of community care health policies. Methods: This study used data from the 2018 China Longitudinal Healthy Longevity Survey of 8,870 adults aged 65 years and older. Logistic regression analysis was performed to identify factors related to unmet community care needs. Results: The results showed that lower number of children, increased years of schooling, poorer self-perceived economic and health status, residing in an institution rather than living with household members, not having public old-age pensions, and not having activity due to daily living impairments were associated with a higher likelihood of unmet community care needs among older adults. Conclusions: These findings indicate the necessity for crafting policies that consider the factors affecting unmet community care needs of older adults, including their health vulnerabilities and individual needs. Implementing national initiatives aimed at enhancing the quality of services delivered to older adults is crucial, along with establishing programmes to proactively address their vulnerabilities and individual needs. This study can contribute to the formulation of policy measures aimed at enhancing community care services of older adults in China. [ABSTRACT FROM AUTHOR]

Background: Nurses represent China's largest healthcare workforce. Nurse practitioners (NPs) play an essential role in providing cost-effective quality healthcare and bridging the healthcare gaps. However, NPs are relatively new in China, and limited evidence exists on senior nurses' knowledge of and attitudes toward NPs. Aims: This study aimed to describe senior nurses' knowledge, attitudes, and perceived facilitators and barriers of NPs in China using a self-designed, culturally adaptive questionnaire. Methods: A cross-sectional online survey was conducted among 412 senior nurses in Hunan Province from December 2021 to January 2022. The Knowledge and Attitudes towards Nurse Practitioners Questionnaire (KANPQ) was developed based on the Delphi method, which included 30 items under three dimensions: knowledge (22 items), attitude (2 items), and perceived facilitators and barriers (6 items). Multivariate linear regression was conducted to explore factors associated with senior nurses' attitudes toward NPs. Results: The average KANPQ knowledge score was 68.56 ± 22.69, with 55.09%,10.20%, and 34.71% of participants showing good, moderate, and poor levels of knowledge, respectively. The average KANPQ attitude score was 7.79 ± 1.72, with 65.3% thinking NPs were necessary and 69.9% expressing willingness to become NPs. Nurses with higher professional titles and better knowledge of NPs had more positive attitudes toward NPs. The three most frequently mentioned barriers to NP implementation were patient trust, laws, and education. Conclusions: Approximately one-third of senior nurses have poor knowledge and negative attitudes toward NPs, indicating much room for improvement. Strengthening the education and training of NPs, especially among those with lower professional titles and lower knowledge of NPs, may help improve their knowledge and attitudes toward NPs. In addition, continuous political, social, economic, and individual efforts are needed to facilitate the successful development of NPs in China. [ABSTRACT FROM AUTHOR]

Background: Despite readiness for hospital discharge widespread popularity since readiness for hospital discharge introduction in 1979 and extensive study, readiness for hospital discharge among pulmonary tuberculosis (PTB) patients has not yet been investigated. Moreover, the factors influencing this process remain unclear. Objective: The objective of this study was to investigate the factors influencing readiness for hospital discharge in initially treated PTB patients using the capability, opportunity, motivation-behavior (COM-B) model. Methods: This phenomenological study was conducted from December 2023 to March 2024. Face-to-face individual interviews were conducted with 18 initially treated patients with PTB according to a semistructured interview guide developed on the basis of the COM-B model. The interview data were subjected to analysis using NVivo 14 software and Colaizzi's method. Results: As a result, 6 themes and 14 subthemes were identified. Physical capability for readiness for hospital discharge (subthemes included poor health status, early acquisition of adequate knowledge about PTB, inadequate knowledge about readiness for hospital discharge), psychological capability for readiness for hospital discharge(subthemes included false perceptions about readiness for hospital discharge, high treatment adherence), physical opportunity for readiness for hospital discharge (subthemes included high continuity of transition healthcare, insufficient financial support, insufficient informational support), social opportunity for readiness for hospital discharge (subthemes included stigmatization, inadequate emotional support), reflective motivation for readiness for hospital discharge (subthemes included lack of reflection on coping with difficulties, intention to develop a readiness for hospital discharge plan), and automatic motivation for readiness for hospital discharge (subthemes included strong desire to be cured, negative emotions). Conclusion: We established factors related to readiness for hospital discharge in initially treated PTB patients in terms of capability, opportunity and motivation, which can inform the future development of readiness for hospital discharge plans. To improve patients' readiness for hospital discharge, patients need to be motivated to plan and desire readiness for hospital discharge, patients' knowledge and treatment adherence should be improved, and patients' transition healthcare continuity and emotional support should be focused on. Moreover, the quality of readiness for hospital discharge and discharge education should be assessed in a timely manner to identify impeding factors and provide interventions. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Implications The introduction of Small Private Online Courses (SPOCs) in English as a Foreign Language (EFL) instruction at Higher Vocational Colleges (HVCs) signifies a shift in education. Understanding the factors that affect deep learning in this SPOC context is crucial for improving educational outcomes.By employing grounded theory, we seek to explore the key factors that shape deep learning experiences for students in SPOC learning environments at HVCs and clarify the interrelationships among these influencing factors.Semi‐structured interviews were conducted with 18 EFL students and 4 teachers and NVivo 11 software was utilised to aid in the qualitative analysis of the collected data. Through a rigorous three‐tier coding analysis, an “environment‐person‐mediation ‐behaviour” (EPMB) model was constructed, aiming to clarify the mechanisms that influence deep learning among EFL students in HVCs.Our findings reveal that intrinsic motivation and cognitive abilities are crucial for deep learning among EFL students in HVCs. Blended learning settings, English curriculum satisfaction, and English teachers' teaching methods serve as situational influencing factors. These factors are interconnected, mediating positive or negative effects on deep learning through various intermediaries like continuity, attraction, guidance, motivation, and regulation.The findings offer pedagogical insights for HVC stakeholders, enabling them to enhance students' deep learning experiences. [ABSTRACT FROM AUTHOR]

Objective To understand the prognosis of patients with bone metastases from first-treatment non-small cell lung cancer （NSCLC） of different pathological types after different first-line treatment regimens， in order to provide clinical prediction of disease progression， guidance of treatment， and improvement of prognosis. Methods 403 NSCLC patients with bone metastases who received primary treatment with bone metastases from Chaohu Hospital of Anhui Medical University from 1 January 2019 to 31 December 2023 were selected for univariate analysis using survival analysis （Log-rank test） and multifactorial analysis with Cox regression， and it was found that histopathological subtyping was an independent factor affecting the prognosis of patients （P = 0.001， HR = 1.952）， after which the effect of this factor on prognosis was removed， and the total number of patients was divided into two groups according to histopathological classification: adenocarcinoma group （316） and squamous carcinoma group （87）， and then multifactorial analysis was performed again using Cox regression model to analyse the factors affecting survival prognosis. Results In this data analysis， patients with the pathological type of squamous carcinoma had a median overall survival （mOS） of 15 months （95% CI: 12.85 ~ 17.15） and a median progression-free survival （mPFS） of 9 months （95% CI: 7.34 ~ 10.67）， whereas patients in the adenocarcinoma group had a mOS of 25 months （95% CI: 23.26 ~ 26.74） and mPFS was 16 months （95% CI:14.43 ~ 17.57）， a statistically significant difference. The OS of the overall group was affected by multiple factors， including Eastern Cooperative Oncology Group （ECOG） score status （1/> 1） at the time of initial diagnosis， bone metastases to Trunk + limb bones + cranium， number of bone metastases ≥ 4， mutation of ALK target genes， and the use of chemotherapy+targeted therapy as the first line of treatment. therapy； similarly， PFS was also affected by the above factors. In addition， in the adenocarcinoma and squamous carcinoma models based on histopathological classification， chemotherapy + targeted therapy and chemotherapy + immunotherapy were found to be the protective factors for the two groups， and ALK target gene mutation was only a protective factor for the adenocarcinoma group. Conclusion This study further confirmed the prognostic factors influencing the prognosis of patients with bone metastases from primary NSCLC， which provides an important reference for clinical treatment. [ABSTRACT FROM AUTHOR]

Under the wave of Industry 4.0, traditional pharmaceutical manufacturing enterprises are in urgent need of intelligent manufacturing transformation and upgrading, and exploring the optimal realization path of intelligent manufacturing transformation can help accelerate the transformation process of pharmaceutical manufacturing enterprises. This paper uses grounded theory research methods to conduct a multi-case study to summarize six influencing factors of the intelligent manufacturing transformation of Chinese pharmaceutical manufacturing enterprises; and then analyzes the correlation between the intelligent manufacturing influencing factors based on the DEMATEL method and the NK model, and identifies the key influencing factors according to this, and then draws the fitness landscape map of the intelligent manufacturing transformation, and finally arrives at the optimal path selection of the intelligent manufacturing transformation of pharmaceutical manufacturing enterprises. The study enriches and extends the research paradigm of intelligent manufacturing transformation, and provides lessons for pharmaceutical manufacturing enterprises to realize intelligent manufacturing transformation and upgrading. [ABSTRACT FROM AUTHOR]

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Environmental regulation is one of the important factors affecting the development of animal husbandry. Realizing the high-quality development of animal husbandry should focus on both the steady increase of the total output value of animal husbandry and the green transformation in the production process. Based on the elaboration of the mechanism of the role of environmental regulation on the development of the animal husbandry industry, regression analysis is carried out based on the panel data of 14 prefectural and municipal cities and towns in Xinjiang from 2010 to 2020, using the static OLS model and the dynamic differential GMM model. The results showed that the existence of a significant positive impact of environmental regulation on the development of the livestock industry indicates that environmental regulation can directly promote the development of animal husbandry through technological innovation and industrial structure optimization and other paths. Among them, the level of animal husbandry structure, the number of livestock production at the end of the year and the level of financial support all have a significant positive impact on the livestock industry in Xinjiang, while the level of livestock development lagging one period has a significant negative impact on the development of the current period of the livestock industry, in addition, the effect of environmental regulation on the level of development of the livestock industry in Xinjiang is not a simple linear relationship, and there is a double-threshold effect with the level of economic development as the threshold variable. [ABSTRACT FROM AUTHOR]

This article takes Ningxia as the research object, analyzes the current situation of comprehensive grain production capacity in Ningxia, and uses the grey correlation analysis method to explore the problems faced by comprehensive grain production in Ningxia and the factors affecting the comprehensive grain production capacity.The results showed that: ①The overall comprehensive grain production capacity is on the rise, but the problem of regional grain crop structure imbalance is more prominent.There are problems such as reduced arable land planting area, labor loss, and insufficient scientific and technological talents. ②The top three main factors affecting the comprehensive grain production capacity of Ningxia are the net amount of unit fertilizer application, rural electricity consumption, and rural employees, with correlation degrees of 0.897, 0.763, and 0.758, respectively. The results of this study lay a theoretical foundation for future research on the construction of comprehensive grain production capacity in Ningxia, which is conducive to promoting the construction of comprehensive grain production capacity in Ningxia. [ABSTRACT FROM AUTHOR]

Background: The prevalence of oral diseases is subject to change over time. In 2021, Guangdong Province conducted its fourth survey assessing the oral health status of individuals aged 65–74. Materials and methods: Evaluation criteria and potential influencing factors were identified. A sample of residents aged 65–74 from 13 designated monitoring sites in Guangdong Province was randomly selected for the study. Spearman correlation analysis was employed to investigate the clinical correlation between influencing factors and evaluation criteria. Negative binomial and zero-inflated negative binomial regression models were utilized to examine the factors influencing caries prevalence. In contrast, logistic regression was employed to identify the risk factors for caries occurrence. A p-value of ≤0.05 was considered statistically significant. Results: The prevalence of caries rate of crowns, roots, and teeth were 76.36%, 52.25%, and 79.2%, respectively. Individuals with periodontal pockets exhibited a significantly higher risk of root caries. The presence of dental calculus significantly exacerbated the occurrence of crown, root, and dental caries, and increased the risk of crown and dental caries. Consuming sweet foods once or more a week notably increased the average root decayed score (D of roots), the prevalence rate of root caries, and the D score of the Decayed, Missing, and Filled teeth [DMFT] index in individuals already afflicted with this condition. Similarly, the consumption of sweetened drinks significantly elevated the risk of crown and root caries, exacerbating overall caries progression. Frequencies of manual toothbrush and toothpick cleaning showed a negative correlation with average tooth missing score (MT). In contrast, the frequency of manual/electric toothbrush and toothpick cleaning was negatively correlated with the DMFT index. Engaging in dental diagnosis and treatment behaviors significantly increased the number of filled crowns (F), MT, and DMFT scores while reducing the prevalence of dental caries. Conclusions: In Guangdong Province, caries prevalence among older individuals aged 65–74 remains substantial. Relevant professionals and institutions must provide comprehensive guidance and assistance to the older population, emphasizing the importance of reducing the consumption of sweets and sweetened beverages, adopting correct tooth brushing techniques and frequency (at least twice daily), timely treatment of periodontal diseases, conducting regular epidemiological caries surveys, and addressing economic barriers to accessing caries diagnosis and treatment services. [ABSTRACT FROM AUTHOR]

Objective: To explore the main factors affecting early dental caries among preschool children aged 3–6 years in Xingtai City to formulate effective preventive measures. Methods: A cross-sectional study was conducted on 570 preschool children aged 3–6 years in Xingtai City through questionnaire surveys and oral examinations to understand their dental caries situation. Multifactorial logistic regression analysis was used to analyse the main influencing factors for the occurrence of dental caries in preschool children. Results: Univariate analysis showed statistically significant differences in age (χ2 = 2.636, p = 0.008), father's education level (χ2 = 4.207, p < 0.001), mother's education level (χ2 = 4.217, p < 0.001), daily tooth brushing frequency (χ2 = 3.160, p = 0.002), age of starting tooth brushing (χ2 = 8.756, p < 0.001), mouth rinsing after meals (χ2 = 89.401, p < 0.001), Streptococcus mutans positivity (χ2 = 133.503, p < 0.001), non-sweet snack consumption frequency (χ2 = 5.962, p < 0.001), snack flavour preference (χ2 = 116.119, p < 0.001), use of fluoridated toothpaste (χ2 = 75.639, p < 0.001), regular oral examinations (χ2 = 98.711, p < 0.001), sugary drink consumption frequency (χ2 = 10.370, p < 0.001) and sweet food consumption frequency (χ2 = 9.261, p < 0.001) between the caries and non-caries groups. Multifactorial analysis revealed that older age (odds ratio [OR] = 5.342, 95% confidence interval [CI]: 1.434–6.631), later initiation of tooth brushing (OR = 3.244, 95% CI: 2.413–5.424), S. mutans positivity (OR = 5.357, 95% CI: 4.529–8.563), high snack consumption frequency (OR = 3.452, 95% CI: 2.634–5.442), high sugary drink consumption frequency (OR = 4.414, 95% CI: 2.534–6.451) and high sweet food consumption frequency (OR = 4.531, 95% CI: 3.421–6.354) were risk factors for dental caries. Higher father's educational level (OR = 0.724, 95% CI: 0.564–0.891), higher mother's educational level (OR = 0.641, 95% CI: 0.601–0.813), high daily tooth brushing frequency (OR = 0.572, 95% CI: 0.423–0.864), mouth rinsing after meals (OR = 0.743, 95% CI: 0.643–0.813), use of fluoridated toothpaste (OR = 0.657, 95% CI: 0.553–0.931) and regular oral examinations (OR = 0.443, 95% CI: 0.352–0.747) were protective factors against dental caries (all p < 0.05). Conclusion: Multiple factors result in early dental caries in preschool children aged 3–6 years; however, the most influential factors are older age and high snack consumption, as well as high sugary and sweet food/drink consumption. [ABSTRACT FROM AUTHOR]

Objective To explore the status and influencing factors of latent tuberculosis infection among high school students in Chongqing and to provide technical support for the prevention and control of tuberculosis in schools in Chongqing. Methods Stratified cluster sampling method was used to select the students of the first and second years of high school in Chongqing in 2023, as the study subjects to detect latent tuberculosis infection with recombinant Mycobacterium tuberculosis fusion protein skin test, to collect the information related to latent tuberculosis infection, and to analyse the influencing factors using Logistic regression model. Results A total of 9161 students in the first and second years of high school in Chongqing were included, and 543 latent tuberculosis infections were detected, with a latent tuberculosis infection rate of 5. 93%. Multifactorial logistic regression analysis showed that history of previous tuberculosis (0R: 4, 244, 95%Cf: 2. 239 - 8. 044), history of close contact with tuberculosis (OR:2. 096, 95% CI: 1, 123 -3.914), smoking (OR: &819, 95% Cf: 3. 562 - 13. 053), and staying up late (<92,: 1. 665, 95% CI: 1. 154 - 2. 402) were risk factors for latent tuberculosis infection in students. Conclusion The rate of latent tuberculosis infection among students in the first and second years of high school in Chongqing is low. Not smoking, not staying up late, avoiding close contact with tuberculosis patients, taking good personal protective measures, strengthening physical exercise, and improving immunity can reduce the risk of students being infected with Mycobacterium tuberculosis. [ABSTRACT FROM AUTHOR]

Objective To analyze the myopia of middle school students in Heilongjiang Province in 2022, and to provide scientific basis for the development of myopia prevention strategies and measures. Methods 99 114 middle school students in Heilongjiang Province in 2022 were selected to carry out a special survey on health risk behaviors. Their visual acuity and diopter were examined by using a 5 - meter standard logarithmic visual acuity chart and desktop optometer. Binary Logistic regression was used to analyze the factors affecting myopia of students. Results The total myopia rate of middle school students was 72. 44%, including 70.50% junior high school students, 76.91% senior high school students and 64. 47% vocational high school students. The myopia rate of students in urban area was higher than that in suburban county. The myopia rate of girls was higher than that of boys. Binary logistic regression analysis showed that: female students (OR = 1. 38, 95% CI: 1.35 -- 1.43), frequently or always switching seats(OR = 1.20, 95% CI: 1. 15 - 1.25), spending more than 2 hours reading and writing after school every day(OR = 1. 11, 95% CI: 1. 07 - 1, 14), spending more than 2 hours a week attending cultural tutoring classes (0/, = 1. 07, 95% CI: 1. 03 - 1. 11), parents often or always reminding them to pay attention to their reading and writing posture(OR = 1. 14, 95% CI: 1. 10 - 1. 19), and spending more time using the computer every day (h) M 2(OR = 1. 19, 95% CIz 1. 24 - 1. 45), using of mobile electronic devices in the past week (OR = 1. 11, 95% CIt 1. 06 - 1. 16), how often close range eye rest occurs(h) M 1 (OR = 1. 11, 95% CI: 1. 08 -- 1. 15), average daily indoor sitting time (h) M 8 (OR = 1. 15, 95% CI: 1. 12 - 1. 19) are risk factors for myopia; Suburban counties(OR = 0. 95, 95% CI: 0. 92 - 0. 98), frequently adjusting the height of desks and chairs according to one's own height(OR = 0. 94, 95% CI: 0. 91 - 0. 97), engaging in outdoor activities during breaks (OR = 0. 91, 95% CI: 0. 89 - 0. 94), having eyes more than 33 cm away from books while reading and writing (OR = 0. 84, 95% CI: 0. 81 - 0. 88), watching TV for 2 (OR = 0. 84, 95% CI: 0. 80 - 0. 88), and having outdoor activity time during the day(h) M 2(OR = 0. 93, 95% CI: 0. 90 - 0. 97), average daily sleep time (h) M 8 (OR = 0.80, 95% CI: 0. 78 -0.83) are protective factors for myopia. Conclusion Myopia is related to various factors such as residential area, gender, lifestyle, and behavioral habits. [ABSTRACT FROM AUTHOR]

Objective To explore potential classifications and characteristics of mental health literacy among HIV - positive men who have sex with men. Methods From November 2023 to January 2024, 226 HIV - positive MSM in a tertiary hospital in Nanjing were selected by the convenience sampling method and were investigated by general information questionnaire and multicomponent mental health literacy scale. Latent class analysis and multivariate logistic regression analysis were used to explore the categorical characteristics and influencing factors of mental health literacy in this group. Results The mental health literacy characteristics of HIV - positive MSM could be classified into low literacy group (22. 1%), resource deficient group (38. 1%), and high literacy group (39. 8%). Multiple logistic regression analysis showed that patients aged 18 - 34 (OR = 5. 573, 95% CI = 1, 020 -30.449) were more likely to be in the resource deficient group than the low literacy group, and those who had participated in learning mental health skills {OR = 0. 126, 95% CI = 0. 033 - 0. 476) were more likely to be in the high literacy group. Compared with the high literacy group, patients with literacy level of junior high school or below (OR = 15. 992, 95% Cf = 2. 036 -125.591), high school or junior college (OR = 2. 805, 95% G = 1. 098 - 7. 166), length of time to diagnosis of HIV infection < 1 year (OR = 8. 440, 95% CI = 1. 628 - 43. 742), and with comorbidities (OR = 6.619, 95% CI = 1. 077 - 40.663) were more likely to be in the low literacy group; and patients with a monthly per capita family income of < 3000 yuan (OR = 6. 241, 95% CI = 1. 088 - 35. 814) were more likely to be in the resource deprived group. Conclusion There are three potential categories of mental health literacy among HIV - positive MSM. In the future - targeted intervention strategies should be developed to improve the level of their mental health literacy and further improve their mental health according to this group's different category characteristics and influencing factors. [ABSTRACT FROM AUTHOR]

Objective To investigate the knowledge of monkeypox among men who have sex with men (MSM) in Central Jiangsu Province in 2023, and to provide evidence for the prevention and treatment of monkeypox in this population. Methods The monkeypox questionnaire designed by Jiangsu Provincial Center for Disease Control and Prevention was used to investigate HIV Voluntary Counseling & Testing (VCT) clinic and social organizations in central Jiangsu Province. Excel 2010 and SPSS19. 0 software were used to organize and analyze the data. Also, univariate and multivariate Logistic regressions were used to analyze the factors affecting the awareness rate of monkeypox knowledge, χ² test was used to compare the difference of concern degree of monkeypox among people with different characteristics. Results A total of 1 290 valid questionnaires were collected. The majority were aged from 26 to 50 years, accounting for 65.04% (839/1 290). The majority of the students were college students, bachelor students or above, accounting for 64.26% (829/1 290). The awareness rate of monkeypox was 26. 12%, and the complete awareness rate was 15.27%. The results of multivariate Logistic regression analysis showed that the related factors with higher awareness rate of monkeypox included Taizhou (OR = 6. 710, 95% CI: 4. 309 - 10.447), high school/technical school (OR =2.461, 95% CI: L 270 - 4.769), college (OR = 2. 515, 95% CI: L 311 - 4. 825), bachelor, s degree or above (OR = 2.253, 95% CZ: 1. 184 -4.288), concerned about monkeypox epidemic and related situation (OR = 1. 684, 95% Cl: 1, 188 - 2. 387) (all P < 0. 05). The correct rates of monkeypox symptoms, preventive measures and transmission routes were 30. 78%, 42. 25% and 27. 75%, respectively. 1 186 people (91. 94%) paid attention to monkeypox epidemic and prevention knowledge from WeChat, Weibo and other network new media. MSM with different regions (χ² = 65. 348, P < 0. 001), age groups (χ²= 19. 422, P = 0. 001), educational levels (χ² = 31. 447, P < 0. 001), marital status = 11. 162, P = 0. 025), results of the latest HIV test (χ² = 37. 793, P < 0. 001), sexual orientations (χ² = 39. 441, P < 0. 001), whether they had sexual contact with the same sex in the last 6 months = 29. 329, P < 0. 001), and whether they had sexual contact with overseas personnel (χ² = 29. 199, P < 0. 001), paid different attention to monkeypox information, and the differences were statistically significant. Conclusion The awareness rate of MSM monkeypox knowledge in central Jiangsu Province is low, and the accuracy rate of monkeypox symptoms, transmission routes and prevention and control measures are low. Therefore, it is necessary to publicize monkeypox symptoms and transmission routes through new media such as WeChat, Weibo, Douyin and Baidu in the later stage. [ABSTRACT FROM AUTHOR]

Objective To investigate the current status of fertility intentions among married women of childbearing age in Hebei Province under the background of the three - child policy, and to analyze the influencing factors of fertility support on married women of childbearing age's fertility intention. Methods A random cluster sampling method was used to select married women of childbearing age in Hebei Province as the respondents in July 2023, and a self - designed questionnaire was used for the survey. Multinomial logistic regression was used to analyze the influencing factors of fertility intentions among married women of childbearing age. Results A total of 1 200 questionnaires were distributed and 1104 valid questionnaires were collected, with a valid recovery rate of 92%. Among the survey subjects, 222 people (20. 1%) had no intention of fertility/re - fertility, 263 people (23. 8%) intended to have 1 child, 545 people (49. 4%) intended to have 2 children, and 74 people (6.7%) intended to have 3 children or more. The results of multinomial logistic regression analysis showed that age, ethnicity, occupation, and residence area were influencing factors of fertility intentions. In terms of fertility support, time support, monthly childcare expenses, maternal care, and economic support were influencing factors of fertility intentions among married women of childbearing age. Condusion The fertility intentions of married women of childbearing age are relatively low, and the intention of having three children is still at a low level. Actively providing fertility support and policies that encourage the fertility intentions of married women of childbearing age, and creating a good fertility environment, will help to enhance the fertility intentions of married women of childbearing age. [ABSTRACT FROM AUTHOR]