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BackgroundAsthma and chronic obstructive pulmonary disease (COPD) impose a heavy burden on health care. Approximately one-fourth of patients with asthma and patients with COPD are prone to exacerbations, which can be greatly reduced by preventive care via integrated disease management that has a limited service capacity. To do this well, a predictive model for proneness to exacerbation is required, but no such model exists. It would be suboptimal to build such models using the current model building approach for asthma and COPD, which has 2 gaps due to rarely factoring in temporal features showing early health changes and general directions. First, existing models for other asthma and COPD outcomes rarely use more advanced temporal features, such as the slope of the number of days to albuterol refill, and are inaccurate. Second, existing models seldom show the reason a patient is deemed high risk and the potential interventions to reduce the risk, making already occupied clinicians expend more time on chart review and overlook suitable interventions. Regular automatic explanation methods cannot deal with temporal data and address this issue well. ObjectiveTo enable more patients with asthma and patients with COPD to obtain suitable and timely care to avoid exacerbations, we aim to implement comprehensible computational methods to accurately predict proneness to exacerbation and recommend customized interventions. MethodsWe will use temporal features to accurately predict proneness to exacerbation, automatically find modifiable temporal risk factors for every high-risk patient, and assess the impact of actionable warnings on clinicians’ decisions to use integrated disease management to prevent proneness to exacerbation. ResultsWe have obtained most of the clinical and administrative data of patients with asthma from 3 prominent American health care systems. We are retrieving other clinical and administrative data, mostly of patients with COPD, needed for the study. We intend to complete the study in 6 years. ConclusionsOur results will help make asthma and COPD care more proactive, effective, and efficient, improving outcomes and saving resources. International Registered Report Identifier (IRRID)PRR1-10.2196/27065

There is little literature which provides any analysis regarding the relationship between cultural order and home education. Research reported here found that home education has grown steadily in recent decades and that parents' motivation for home education was closely associated with cultural order. It was noticeable that Christian and Confucian values seemed to provide philosophical support for Chinese middle-class families who have chosen to educate their children at home. The parents reported that they preferred to cultivate in their children their favourite culture and beliefs, rather than to merely facilitate their achievement of excellent academic outcomes.

IntroductionPelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes.Methods and analysisUsing quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims.Ethics and disseminationThe University of Utah and Intermountain Healthcare Institutional Review Boards approved this study. Data are stored in a secure password-protected database. Papers summarising the primary results and ancillary analyses will be published in peer-reviewed journals.

The literature focusing on Christian home schooling has been entirely ignored in the educational context of China, because practising home schooling is illegal and such families have strong religious beliefs. In particular, in China, studies grounded in empirical research and dealing with the development of Christian home schooling are negligible. The findings of this study were generated by an analysis of qualitative data: they provided in-depth information about the motivation of those who practice Christian home schooling, types of existing Christian home schooling, teaching content, and teaching methods and outcomes. It was found that Christian beliefs and values philosophically support Chinese Christian families in the process of their practice of home schooling.

Home education, in particular Confucian home education, has been increasing steadily in China over the past decades. However, research relating to home-schooling families has largely been ignored. In particular, the literature grounded in empirical study and focusing on the development of Confucian home education is negligible in the educational context of China. This study places a focus on the influence of Confucian culture and beliefs on the development of home education in China, which is now attracting scholarly interest and public attention. It provides in-depth information regarding the status of Confucian home education, the motivation to undertake Confucian home education, teaching content, teaching methods and its outcomes. It is found that Confucian values and beliefs fit well with the model of home education in China in terms of the relationship between family, education, moral development and society.

Background: Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions. Objective: Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV. Methods: We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results. Results: Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP. Conclusion: These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare. [ABSTRACT FROM AUTHOR]

Home education is at an early stage for the public, researchers, media and educational authorities in China. Yet the research relating to the development of home education has been entirely ignored. In particular, the literature focusing on the legal status of home education is negligible in the educational context of China. There is no literature that has systematically explored the relationship between Compulsory Education Law and home education. The public, parents, and researchers have many questions as to whether home education is legal or not. This article provides comprehensive firsthand legal data and an in-depth analysis of the relationship between home education and law in the Chinese context. This article aims to contribute to the literature and reveal the legal status of home education in China.

This article employs Bourdieu's conceptual tools to unpack family influences on students' subject and university choices in China. This empirical study employed mixed research approaches, using both quantitative and qualitative methods, to examine students' choices of subjects and universities in a sample of secondary school students from the age of 16 to 18 in China. This study reveals that while there are few class differences in subject choice, students' choices of a selected university is significantly associated with higher family income level. The data show that the probability of entering a top university for students from high-income families is greater than that of students from low-income families.

The induction of autophagy in the mammalian heart during the perinatal period is an essential adaptation required to survive early neonatal starvation; however, the mechanisms that mediate autophagy suppression once feeding is established are not known. Insulin signaling in the heart is transduced via insulin and IGF-1 receptors (IGF-1Rs). We disrupted insulin and IGF-1R signaling by generating mice with combined cardiomyocyte-specific deletion of Irs1 and Irs2. Here we show that loss of IRS signaling prevented the physiological suppression of autophagy that normally parallels the postnatal increase in circulating insulin. This resulted in unrestrained autophagy in cardiomyocytes, which contributed to myocyte loss, heart failure, and premature death. This process was ameliorated either by activation of mTOR with aa supplementation or by genetic suppression of autophagic activation. Loss of IRS1 and IRS2 signaling also increased apoptosis and precipitated mitochondrial dysfunction, which were not reduced when autophagic flux was normalized. Together, these data indicate that in addition to prosurvival signaling, insulin action in early life mediates the physiological postnatal suppression of autophagy, thereby linking nutrient sensing to postnatal cardiac development.