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In China, porcine reproductive and respiratory syndrome virus (PRRSV) vaccines are widely used. These vaccines, which contain inactivated and live attenuated vaccines (LAVs), are produced by MARC-145 cells derived from the monkey kidney cell line. However, some PRRSV strains in MARC-145 cells have a low yield. Here, we used two type 2 PRRSV strains (CH-1R and HuN4) to identify the genes responsible for virus yield in MARC-145 cells. Our findings indicate that the two viruses have different spread patterns, which ultimately determine their yield. By replacing the viral envelope genes with a reverse genetics system, we discovered that the minor envelope proteins, from GP2a to GP4, play a crucial role in determining the spread pattern and yield of type 2 PRRSV in MARC-145 cells. The cell-free transmission pattern of type 2 PRRSV appears to be more efficient than the cell-to-cell transmission pattern. Overall, these findings suggest that GP2a to GP4 contributes to the spread pattern and yield of type 2 PRRSV. [ABSTRACT FROM AUTHOR]

Background: The advancement of communication technology and the impact of the COVID-19 pandemic have led to an increased reliance on online education. However, the effects of the long-term use of smart devices for online learning on students' social anxiety and problematic smartphone use (PSU) and the role of fear of missing out (FoMO) in this process have yet to be fully explored. Methods: This study analysed longitudinal data from 2,356 high school students (female 5 1,137 (48.26%), mean age 5 13.84, SD age 5 1.37) in China, divided into high- and low-FoMO groups based on their scores on the FoMO scale, to examine the impact of four months of online learning on social anxiety and PSU. The Social Anxiety Scale (SAS) and Mobile Phone Addiction Index (MPAI) were used to assess social anxiety and PSU symptoms. Results: The undirected symptom networks revealed more bridge symptoms among the students in the high-FoMO group, although their overall symptom scores decreased. The results of the directed cross-lagged panel networks showed that "productivity loss" predicted other symptoms in the low-FoMO group but that "afraid of negative evaluation" was the predictor in the high-FoMO group. Meanwhile, "withdrawal/escape" and "productivity loss" were the symptoms that were most affected by other symptoms in the high-FoMO and low-FoMO groups, respectively. Conclusions: The current study therefore sheds light on the changes in social anxiety and PSU symptoms among secondary school students during long-term online learning, as well as the moderating role of FoMO. [ABSTRACT FROM AUTHOR]

Gerstmann-Sträussler-Scheinker syndrome (GSS) is a rare genetic prion disease caused by a mutation in the prion protein (PRNP) gene. It is typically characterized by progressive cerebellar ataxia and slowly progressive dementia. We present a case study of the GSS from China in which a 45-year-old male with a progressive gait and balance disorder developed cerebellar ataxia onset but was misdiagnosed as spinocerebellar ataxia (SCA) for 2 years. The patient's clinical, electrophysiological, and radiological data were retrospectively analyzed. Examination revealed ataxia, dysarthria,muscle weakness, areflexia in lower limbs, including a pyramidal sign, whereas cognitive decline was insignificant. His late mother had a similar unsteady gait. An electroencephalogram (EEG) showed normal findings, and 14-3-3 protein was negative. A brain MRI was performed for global brain atrophy and ventricular enlargement. Positron emission tomography-- computed tomography (PET--CT) (18F-fluoro-2-deoxy-d-glucose, FDG) images showed mild to moderate decreased glucose metabolism in the left superior parietal lobe and left middle temporal lobe. According to genetic testing, his younger brother also had the P102L variant in the PRNP gene. This single case adds to the clinical and genetic phenotypes of GSS. [ABSTRACT FROM AUTHOR]

The integration of quality management in physical education has changed the traditional approach to teaching. The information overload and an enormous amount of irrelevant data available to qualified specialists may lead to professional stress. Quality management offers educators tips on how to avoid information overload while still staying updated with the necessary information, knowledge and skills. The research aimed to examine the main characteristics of quality management in teaching. The sample consisted of 296 students: 73% - male subjects, 27% - females subjects. The average age is 19.37±0.31. The research analyzed the factors affecting the quality of education using the quality competency and student satisfaction questionnaire. The findings revealed that Chinese students were satisfied with the physical and environmental conditions (8.1±0.23 points) and it was 22% higher than the results of Ukrainian students. The education programs, technological opportunities and student scientific work have the greatest influence on the quality of education in China (8.38±0.32). The least influence has the adequacy of management and staff (7.21±0.27). Career support, tours and practices related to physical education have the greatest influence on the education quality in Ukraine (8.43±0.32). The parameters identified by the research can be integrated into the system of higher physical education to improve the quality and academic achievements. [ABSTRACT FROM AUTHOR]

Background: Self-rated health among old adults (SHOA) indicates individuals' subjective assessments and evaluations of their overall health based on objective physical circumstances. The purpose of this study was to analyze the current state and influencing factors of the subjective perception-based self-rated health (SH) by qualifying selected older adults with similar objective physical conditions, as well as to explore the equality and changing trends of SHOA based on influencing factors. Methods: This study designed a cross-sectional study, conducted in three provinces in east, central and west China, and included 1,153 older adults (> = 60 years) with intact physical condition (IPC). The current state of SHOA and its influencing factors were analyzed using mean comparisons and Logistic regression (LR) models. The equality level and trend of SHOA's effect on health literacy, health habits, and access to health care were determined using the Lorenz curve, Gini coefficient, and Vector Autoregression (VAR) model. Results: The mean SHOA with IPC was 74.37 ± 13.22. Findings from LR modeling indicated that SHOA with IPC was mainly influenced by age and communication methods (P < 0.05). It was also observed that the total Gini coefficient of the allocation of SHOA with IPC based on communication methods was equal to 0.0188, and the VAR results showed that the total effect of change in SHOA on health literacy among older adults was negative and its duration of the effect exceeded 50. Conclusions: The SHOA with IPC was shown to be better and was primarily influenced by age and communication methods. The observed effect of SHOA on health literacy was negative and lasting. To improve SHOA with IPC even further, policymakers could consider promoting the use of modern and convenient communication methods (such as smartphones) through training and purchasing subsidies, as well as focusing on increasing sustained attention and promoting health literacy and behavior among older adults with improved SH. [ABSTRACT FROM AUTHOR]

Buildings near direct current transmission lines are sensitive to the electromagnetic environment, and the measurement of the electric field above them is important in engineering design and environmental assessment in China. The models of buildings and probes in the ion flow field were established to explore the accurate measurement method of the electric field above the building. Based on the upstream finite element method and the predictor–corrector method, the influence of whether the probe was grounded or not above the building was studied. On this basis, simulation experiments and real‐type experiments were carried out. The results show that when the electrical conductivity of the building was greater than 10−10 S/m, being grounded or not would not change the results. When the building conductivity was between 10−11 and 10−12 S/m, the electric field measurement results would be increased by 30% to 120% after grounding. In the real‐type experiments on the platform with a plywood roof, the relative error in the electric field when grounded or not was only 2.6%. This proved the reliability of the calculated results. In this paper, the measuring method of the DC space charge‐modified electric field above buildings was analyzed first, and the conclusion that ground wire can be cancelled above buildings with general materials was presented. The research results can provide a technical basis for the accurate measurement of the electric field above the buildings near DC transmission lines. [ABSTRACT FROM AUTHOR]

A new species of spikemoss, Selaginella densiciliata in S. subg. Heterostachys sect. Tetragonostachyae, China, is described from southeastern Xizang, based on morphological and molecular phylogenetic data. Morphologically, S. densiciliata is similar to S. repanda, S. subvaginata and S. vaginata, but the new species can be easily distinguished from them by having sterile leaves margins densely ciliate, symmetrical axillary leaves oblong ovate to ovate-triangular, and ovate dorsal leaves obviously carinate. Molecular phylogenetic analysis resolves S. densiciliata as sister to the clade comprised with S. vaginata and S. xipholepis, which confirms the recognition of the new species. [ABSTRACT FROM AUTHOR]

To investigate the regularity and characteristics of adverse drug reaction (ADR) of reactive cutaneous capillary endothelial proliferation caused by Camrelizumab, so as to provide reference for clinical rational use of drugs. Searching for case reports of Camrelizumab-induced reactive cutaneous capillary endothelial proliferation (RCCEP) in databases such as China Biology Medicine disc, VIP Database, CNKI, Wanfang Medical, PubMed, Wiley online library, Embase with "Carritzumab/Ericab," "SHR-1210," "Reactive cutaneous capillary endothelial proliferation," "Reactive capillary hemangiomas," and "Capillary proliferation" as search terms. The retrieval time is from the establishment of the database to February 2022. After eliminating clinical trials and incomplete literature, information of patients included in the literature was analyzed, which included gender, age, reason for medication, usage and dosage, time of ADR, concomitant medication, clinical manifestations, intervention measures, outcomes of patients, etc. A total of 11 articles involving 16 patients were included, including 11 males and five females, with an average age of 60.5 years. Reasons for medication included nine cases of non-small cell lung cancer (NSCLC), four cases of liver cancer, one case of small cell lung cancer (SCLC), one case of synovial sarcoma, and one case of Hodgkin lymphoma. Thirteen patients recorded in detail that the dosage of Camrelizumab was 200 mg, and the frequency of medication was q2w~q4w. Eight patients were treated with Camrelizumab alone, and eight patients were treated with combined medication. RCCEP occurred in nine patients after the first medication, and in seven patients after two-four cycles of medication, the average medication cycle was two cycles, and the average occurrence time was 12.5 days after the last medication. The main clinical manifestations were that several different sizes of growths such as red nevus-like, pearl-like, and mulberry-like growths appear on the head, face, neck, torso, limbs, and other parts of the body, all of which were grade 1-2. The RCCEP of all patients was controlled after treatment. During the treatment, 11 patients were stable and five patients were local remission. RCCEP is caused by Camrelizumabis a special skin immune response, which will not cause life-threatening to patients. However, clinicians and pharmacists should be familiar with the characteristics and regularities of the adverse reaction, to do a good job in medication monitoring and management, as for ensuring the safety of patients with medication. [ABSTRACT FROM AUTHOR]

During floristic surveys of Taxaceae in Hekou County, Yunnan Province, China, a putative natural hybrid between A. yunnanensis H.L. Li and A. hekouensis L.M. Gao was collected. Morphological and molecular evidence confirms its status as a natural hybrid. Amentotaxus × hybridia L.M. Gao has linear or linear-lanceolate leaves 6-13 cm × 1.0-1.5 cm, white stomatal bands with 34-40 rows on abaxial side, 2.5-3.5 mm, slightly wider than leaf margins; 3-6 seeds borne at the base of the branchlet, peduncle 1.3-1.6 cm long with 3-4 rows of persistent basal bracts. [ABSTRACT FROM AUTHOR]

Background: The self-rated health of older adults (SHOA) plays an important role in enhancing their medical service utilization and quality of life. However, the determinants and magnitude variations in SHOA at the family level (SHOAFL) remain unknown. The purpose of this study was to assess the status and equitable level of SHOAFL in China, as well as to analyze the influencing factors and the precise nature and scope of their impacts. Methods: This study analyzed the data from the "Chinese residents' health service needs survey in the New Era", and included a total of 1413 families with older adults. The status and influencing factors of SHOAFL were analyzed using mean comparison and Logistic regression (LR) models. The Concentration Index method was used to explore the equity of the distribution of SHOAFL. The relationship between differences in personal characteristics among family members and differences in SHOA was determined by the method of Coupling Coordination Degree (CCD). Results: The total score of SHOAFL was 66.36 ± 15.47, and LR results revealed that the factors with a significant impact on SHOAFL were number of people living in family, distance to the nearest medical service institution, travel time to the nearest medical service institution, annual family income, yearly family medical and health expenditures, average age, and residence (all P < 0.05). The Concentration index of SHOAFL ranged from -0.0315 to 0.0560. CCD of the differences between SHOA and medical insurance and smoking status were 0.9534 and 0.7132, respectively. Conclusion: The SHOAFL was found to be generally but more inclined towards urban families with high incomes and a short time to medical service institution. The observed disparities in SHOA among family members were mostly attributable to differences in health insurance and pre-retirement occupations. The status and equality of SHOAFL may be improved if policymakers prioritize making services more accessible to older rural residents with low incomes. Concurrently, reducing the existing discrepancy in health insurance coverage between older couples may also enhance their health. [ABSTRACT FROM AUTHOR]

Background: Meeting the demands of older adults for health promotion services (DOAHPS) is essential for maintaining their health and enhancing their quality of life. The purpose of this study was to construct a model for evaluating DOAHPS to quantitatively evaluate the current state and equity level of DOAHPS in China, as well as to explore the main factors affecting DOAHPS' current state and equity level. Methods: This study analyzed the DOAHPS data from the "Survey on Chinese Residents' Health Service Demands in the New Era", which included 1542 older adults aged 65 and older. Relationships between evaluation indicators of DOAHPS were explored using Structural Equation Modeling (SEM). The Weighted TOPSIS method and Logistic regression (LR) were used to analyze the current state and factors impacting DOAHPS. The equity level of DOAHPS' allocation among different older adult groups and its influencing factors were determined using the Rank Sum Ratio (RSR) method and T Theil index. Results: The evaluation score for DOAHPS was 42.57 ± 1.51. Health status, health literacy and behavior were positively correlated with DOAHPS (r = 0.40, 0.38; P < 0.05). The LR results revealed that the most significant determinants of DOAHPS were sex, residence, education level and pre-retirement occupation (all P < 0.05). The number of older adults with very poor, poor, general, high and very high level health promotion service demands accounted for 2.27%, 28.60%, 53.05%, 15.43% and 0.65%, respectively. The total T Theil index of DOAHPS was 2.7433*10–4, and the intra-group difference contribution rate exceeded 72%. Conclusions: Compared to the maximum level, the total DOAHPS level was found to be moderate, although the demands of urban seniors with higher levels of education may be substantially greater. The observed inequities in the allocation of DOAHPS were primarily related to differences in education level and pre-retirement occupation within group. To better address health promotion services for older adults, policymakers could target older males with low education who reside in rural regions. [ABSTRACT FROM AUTHOR]

The ontogenetic sequence of an early Cambrian redlichiid trilobite Bathynotus kueichouensis is presented on the basis of numerous articulated specimens from Guizhou, China. The body regionalization of B. kueichouensis witnessed a wide variation in the morphology of trunk segments between different thoracic regions, referred to as the ‘thoracic region 1-4’. A greater size variation of these long pleural spines is recognized from the earlier meraspid degrees in a gradual appearance or disappearance until the holaspid period. The thoroughly inverse variation of these pleural spines in size and form is seen for the first time during the process of trilobite segment formation, which offers an opportunity to trace the evolutionary path of trilobite body structures, associated with their functional morphology and behavior. The ontogenetic strategy of B. kueichouensis is broadly similar to those of other redlichioid representatives where the full ontogenetic sequence exhibited a balanced rate in segment expression and liberation. Such a developmental mode may be the reason why most redlichiids possess a micropygous body patterning during ontogeny and provides insights into the controls of early arthropod developmental segmentation during evolutionary process. [ABSTRACT FROM AUTHOR]

Introduction: Owing to an increasing demand for a continuous and coordinated health service, integrated care is being promoted worldwide. Chinese research on integrated care has rapidly increased over the last 20 years. However, popular topics, paths and trends of integrated care research in China have not been systematically summarised. The study aimed to examine the evolution of integrated care research in China and predict future research trends. Methods: We searched for integrated care research in China published 2000-2020 in Chinese (China National Knowledge Infrastructure) and English (Web of Science). Research articles that met the inclusion criteria were selected. CiteSpace 5.7.R3 was used to perform keyword clustering, timeline view and burst detection analyses. Results: We included 786 Chinese articles and 124 English articles. Chinese articles formed 10 clusters with 1814 keywords. English articles formed 5 clusters with 487 keywords. From 2000 to 2020, integrated care research in China comprised three stages: (1) In the start-up stage (2000-2007), keywords mainly focus on medical resource integration and two-way referral; (2) In the emergence stage (2008-2015), keywords primarily include integrated model, benefits of integration, paths to integration and incentive mechanisms; (3) In the maturation stage (2016-2020), the main keywords are patient preferences, shared management mechanisms, symbiosis theory, valuebased care, payment methods and people-oriented care. Discussion: With increasing health care system reform, popular integrated care research topics in the next stage will likely focus on people-oriented integrated care, service value and payment method reform. Academic research on integrated care in China will help to shape and lead policymaking. Conclusions: Integrated care research in China has gone through three stages over the last two decades. In the future, integrated care theory in China will be informed by concepts from other fields, such as value co-creation in public management, to address the current problem of lack of synthesis in integrated care in China. [ABSTRACT FROM AUTHOR]

The surface evapotranspiration (ET) process is the key link in the interaction between land and atmosphere. However, the influence of different environmental factors on ET over transitional climate zones and the physical pattern of the interaction between multiple factors remain unclear. Therefore, based on the continuous observation data during the vegetation growing season of a typical grassland in the Semi-Arid Climate and Environment Observation of Lanzhou University (SACOL) station from 2007 to 2012, the influence pattern of multiple environmental factors on ET over China's transitional climate zone was analysed. Each environmental factor exhibited significant seasonal and interannual variations. The mean value of ET was 1.67 mm day-1. Although the maximum values of sensible heat flux and vapour pressure deficit occurred in April and June, respectively, the maximum values of other environmental factors appeared from July to August. Net radiation, soil moisture, and normalized difference vegetation index (NDVI) were the main controlling factors of ET over the grassland, with correlation coefficients of 0.54, 0.52, and 0.46, respectively. The analysis of multiple environmental factors showed that when soil moisture, wind speed, net radiation, and NDVI reached 0.2 m³ m-3, 2 m s-1, 100 W m-2, and 0.2, respectively, ET varied in contrast with vapour pressure, vapour pressure deficit, and air temperature under the influences of weather processes, land–atmosphere coupling, and drought stress. These findings deepen our understanding of the role of ET in the land–atmosphere coupling process over the transitional climate zone in China. [ABSTRACT FROM AUTHOR]

Two sections of the Xintiangou Formation were examined in the Yunyang area, Northeastern Sichuan Basin, China. One of them was systematically sampled from bottom to top. Palynology and geochemistry analyses were performed on 20 samples, and Paleoclimatic indicators were extracted. The sporopollen assemblage indicates arid and hot paleoclimate as a whole, and the geochemical index shows hot and humid paleoclimate. Combined with the analysis of sedimentary characteristics, it shows that the sedimentary period of the Xintiangou Formation in the study area is characterized by arid and hot paleoclimate as a whole, and there were fluctuations of relative moist and arid. The humid climate recorded by geochemical indicators may be the illusion that the unconsolidated sediments transported to the shore shallow lake zone experienced strong weathering. When studying the palaeoclimate characteristics of continental basins, it is necessary to analyze all kinds of palaeoclimate proxy indexes in combination with sedimentary facies, and there may be a deviation in using a single palaeoclimate proxy index to invert the palaeoclimate of continental basins. [ABSTRACT FROM AUTHOR]

Background: Maedi/Visna virus (MVV) is a contagious viral pathogen that causes considerable economic losses to the sheep industry worldwide. Objectives: In China, MVV has been detected in several regions, but its molecular characteristics and genetic variations were not thoroughly investigated. Methods: Therefore, in this study, we conducted next-generation sequencing on an MVV strain obtained from northwest China to reveal its genetic evolution via phylogenetic analysis. Results: A MVV strain obtained from Inner Mongolia (NM) of China was identified. Sequence analysis indicated that its whole-genome length is 9193 bp. Homology comparison of nucleotides between the NM strain and reference strains showed that the sequence homology of gag and env were 77.1%-86.8% and 67.7%-75.5%, respectively. Phylogenetic analysis revealed that the NM strain was closely related to the reference strains isolated from America, which belong to the A2 type. Notably, there were 5 amino acid insertions in variable region 4 and a highly variable motif at the C-terminal of the surface glycoprotein (SU5). Conclusions: The present study is the first to show the whole-genome sequence of an MVV obtained from China. The detailed analyses provide essential information for understanding the genetic characteristics of MVV, and the results enrich the MVV library. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of WeChat-based telehealth services on the postoperative follow-up of children who underwent congenital heart surgery during the COVID-19 epidemic. Methods: This study retrospectively analyzed the clinical and family data of 108 children who underwent congenital heart surgery and underwent remote follow-up via the WeChat platform from December 2019 to March 2020 in our hospital. Results: During the follow-up period, the WeChat platform was used to refer 8 children with respiratory infection symptoms to local hospitals for treatment. Two children with poor incision healing were healed after we used the WeChat platform to guide the parents in dressing the wounds on a regular basis at home. Nutritional guidance was given via the WeChat platform to 13 patients with poor growth and development. The psychological evaluation results of the parents showed that the median (range) SDS score was 43 (34-59), and 7 parents (6.5%) were classified as depressed; the median (range) SAS score was 41 (32-58), and 12 parents (11.1%) were classified as having mild anxiety. Conclusion: The use of WeChat-based telehealth services was effective for the remote postoperative follow-up of children who underwent congenital cardiac surgery during the COVID-19 epidemic. Providing WeChat-based telehealth services can reduce the amount of travel required for these children and their families, which is helpful for controlling and preventing the spread of COVID-19. [ABSTRACT FROM AUTHOR]

Giardia lamblia is a common enteric pathogen associated with diarrheal diseases. There are some reports of G. lamblia infection among different breeds of cattle in recent years worldwide. However, it is yet to know whether cattle in Jiangxi province, southeastern China is infected with G. lamblia. The objectives of the present study were to investigate the prevalence and examine the multilocus genotypes of G. lamblia in cattle in Jiangxi province. A total of 556 fecal samples were collected from 3 cattle breeds (dairy cattle, beef cattle, and buffalo) in Jiangxi province, and the prevalence and genotypes of G. lamblia were determined by the nested PCR amplification of the beta-giardin (bg) gene. A total of 52 samples (9.2%) were positive for G. lamblia. The highest prevalence of G. lamblia was detected in dairy cattle (20.0%), followed by that in beef cattle (6.4%), and meat buffalo (0.9%). Multilocus sequence typing of G. lamblia was performed based on sequences of the bg, triose phosphate isomerase and glutamate dehydrogenase loci, and 22, 42, and 52 samples were amplifiable, respectively, forming 15 MLGs. Moreover, one mixed G. lamblia infection (assemblages A and E) was found in the present study. Altogether, 6 novel assemblage E subtypes (E41*-E46*) were identified for the first time. These results not only provided baseline data for the control of G. lamblia infection in cattle in this southeastern province of China, but also enriched the molecular epidemiological data and genetic diversity of G. lamblia in cattle. [ABSTRACT FROM AUTHOR]

Background. The distribution and use of camphor (Cinnamomum camphora L.) trees are constrained by increasing soil salinity in south-eastern China along the Yangtze River. However, the response mechanism of this species to salinity, especially in team of photosynthesis, are unknown. Methods. Here, we analysed themorphological, physiological, ultrastructural, and proteomic traits of camphor seedlings under NaCl (103.45 mM) treatment in pot experiments for 80 days. Results. The growth was limited because of photosynthetic inhibition, with the most significant disturbance occurring within 50 days. Salinity caused severe reductions in the leaf photosynthetic rate (An), stomatal conductance (gs), maximal chlorophyll fluorescence (Fm), maximum quantum yield of PSII (Fv/Fm), non-photochemical quenching (NPQ), relative quantum efficiency of PSII photochemistry (ΦPSII), photochemical quenching coefficient (qP) and photo-pigment contents (chlorophyll a (Cha), chlorophyll b (Chb), total chlorophyll (Chl)); weakened the antioxidant effects, including those of malondialdehyde (MDA), superoxide dismutase (SOD) and peroxidase (POD); and injured chloroplasts. The physiologicalresults indicated that the main reason for photo-inhibition was oxidative factors induced by NaCl. The proteomic results based on isobaric tags for relative and absolute quantitation (iTRAQ) further confirmedthat photosynthesis was the most significant disrupted process by salinity (P <0:01) and there were 30 downregulated differentially expression proteins (DEPs) and one upregulated DEP related to restraint of the photosynthetic system, which affected photosystem I, photosystem II, the Cytochrome b6/f complex, ATP synthase and the light-harvesting chlorophyll protein complex. In addition, 57 DEPs were related to photo-inhibition by redox effect and 6 downregulated DEPs, including O2 evolving complex 33kD family protein (gi|224094610) and five other predicted proteins (gi|743921083, gi|743840443, gi|743885735, gi|743810316 and gi|743881832) were directly affected. This study provides new proteomic information and explains the possible mechanisms of photo-inhibition caused by salinity on C. camphor. [ABSTRACT FROM AUTHOR]

A new species Amentotaxus hekouensis L.M. Gao is described as new to science from Hekou, Yunnan of China, Lao Cai of Vietnam and Xiang Khouang of Laos. The new species is similar to A. argotaenia (Hance) Pilg. in linear or linear-lanceolate leaves, stomatal bands white and microsporophylls 6-8, each with 4-6 pollen sacs, but differs from the latter by its larger leaf size with 8-12.5 cm × 0.9-1.4 cm (vs. 2-11 cm × 0.5-1.1 cm in A. argotaenia), long acuminate leaf apex (vs. rounded to sharply triangular in A. argotaenia), stomatal bands with 25-30 rows (vs. 15-25 rows in A. argotaenia), stomatal bands equal to or slightly narrower than marginal bands (vs. narrower than marginal bands in A. argotaenia); pollen-cone racemes borne 1-2 (vs. 2-4 (10) in A. argotaenia), cones in 12-16 pairs (vs. ca. 12 pairs in A. argotaenia). Its distinctive nature has also been confirmed through DNA barcoding analysis of this genus. The new species is provisionally assessed as endangered (EN) due to its restricted distribution, small population size and the prevalence of habitat destruction within its range. [ABSTRACT FROM AUTHOR]

Oxygen (δ18O) and hydrogen (δD) stable isotopes in the surface waters of the Huai River basin were analyzed in this study. Results indicated the northern waters had higher δ18O and δD than the southern waters, the water δ18O and δD increased along the water flow directions. These variations mostly resulted from the spatial differences of precipitation and evaporation. Comparing with published different continents' river water δ18O data, this study suggests that evaporation effect is a more plausible interpretation than altitude effect as the cause of δ18O increasing from upriver to downriver waters. This region's local surface water line (LSWL, δD= 5.36δ18O - 18.39; r2= 0.84) represents one of the first presented LSWLs in eastern China. The correlation between d-excess and δ18O demonstrates this region is dominated by the Pacific oceanic moisture masses in summer. Comparing the various LSWLs from eastern China and eastern United States river waters, this study proposes a hypothesis that the water LSWLs slopes of lower latitude regions may be less than those of higher latitude regions within similar topographic areas. This hypothesis may be tested in other geographically comparable coupled areas in the world if corresponding large-scale data can be found. [ABSTRACT FROM AUTHOR]

Land surface models (LSMs) have been widely used to provide objective monitoring of soil moisture during drought, but large uncertainties exist because of the different parameterizations in LSMs. This study aims to evaluate the ability to monitor soil moisture drought over three key regions in China by using the Noah LSM from the Global Land Data Assimilation System, version 2 (GLDASv2), and the Community Atmosphere Biosphere Land Exchange (CABLE) model that is currently used at the China Meteorological Administration. The modeled soil moisture drought indices were verified against the standardized precipitation evapotranspiration index (SPEI), which served as a reference drought indicator over northern China (NC), northwestern China (NWC), and southwestern China (SWC) from 1961 to 2010. The results show that the precipitation forcing data that drive both LSMs have high accuracy when compared with local observational data. GLDASv2/Noah outperforms CABLE in capturing soil moisture anomalies and variability, especially in SWC, but both show good correlations with the 3-month SPEI (SPEI3) in NC, NWC, and SWC. The autumn drought of 2002 and spring drought of 2010 were selected for the comparison of the modeled drought categories with the SPEI3 drought category, where GLDASv2/Noah performed slightly better than CABLE. This work demonstrates that the choice of LSM is crucial for monitoring soil moisture drought and that the GLDASv2/Noah LSM can be a good candidate for the development of a new operational drought-monitoring system in China. [ABSTRACT FROM AUTHOR]

Introduction: Within China's multi-tiered medical system, many patients seek care in higher-tiered hospitals without a referral by a primary-care provider. This trend, generally referred to as patient self-referral behavior, may reduce the efficiency of the health care system. This study seeks to test the hypothesis that having a usual primary care provider could reduce patients' self-referral behavior.Methods: We obtained medical records of 832 patients who were hospitalized for common respiratory diseases from township hospitals in Qianjiang District of Chongqing City during 2012-2014. Logit regressions were performed to examine the association between having a township hospital as a usual provider and self-referring to a county hospital after being discharged from a township hospital, while controlling for patients' gender, age, income, education, severity of disease, distance to the nearest county hospital and the general quality of the township hospitals in their community. A propensity score weighting approach was applied.Results: We found that having a usual primary care provider was associated with a lower likelihood of self-referral (odds ratio = 0.58, 95% confidence interval [CI] =0.41-0.82), and a 9% (95% CI: -14%, - 3%) reduction in the probability of patients' self-referral behavior.Discussion/conclusion: The results suggest that establishing a long-term relationship between patients and primary care providers may enhance the patient-physician relationship and reduce patients' tendency for unnecessary use of medical resources. [ABSTRACT FROM AUTHOR]

Purpose - This chapter provides a thorough historical overview of policies that have governed and guided scientific research in China since 1949 and illustrates changes in scientific publications that accompanied these policy reforms and programs. Design - We divide this historical period into four stages, each with distinct R&D policies: (1) 1949-1955, a period of socialist transformation; (2) 1956-1965, a period of struggle for higher education and research development in a rapidly changing political environment; (3) 1966-1976, the lost decade of the Cultural Revolution; and (4) 1976-present, a period when major national policies have significantly promoted scientific research in China. We use the SPHERE project's comprehensive historical dataset based on Thomson Reuters' Web of Science and data from a set of research universities in China to analyze changes in scientific publication rates concurrent with these policy reforms and programs. Findings - The analysis suggests a tight connection between national policy and scientific research productivity in higher education. The central government controlled scientific research through direct administration in early periods and has guided research activities through funding specific programs in recent decades. Due to their resource dependency on the central government, higher education institutions have been quite responsive to the common goals set by the central government. As a result, what is measured tends to be accomplished. Originality/value - The chapter provides an in-depth description about the rise of higher education and science in China and produces recommendations for future development. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a common and frequently occurring chronic disease of the cardiovascular system. Besides the pathological factors, the occurrence and exacerbation of hypertension are also associated with many factors of lifestyle and behaviors. Thus hypertensive patients' Health-related quality of life (HRQL) is not only influenced by the disease itself but also by many subjective factors such as health literacy and self-management efficacy, especially in the deeper part of southwestern China and thus is less developed compared to the other places. The purpose of this study was to examine the association between the HRQL of hypertensive patients and health literacy and self-management efficacy as well as how they affect the HRQL, so as to provide a theoretical reference for improving the HRQL of patients with hypertension in less developed areas. Methods: This was a cross-sectional study of baseline data from a clustered randomized controlled trial. The study design had passed a cross-national peer review and accepted grants by the China Medical Board. It was also registered in the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563). A standardized questionnaire adapted from a previous validated WHO questionnaire was used for the survey which included detailed questions about patient's socio-demographic characteristics and self-reported information. Patients' HRQL was measured by the Mandarin version of the 36-item Short Form. We used the validated Mandarin version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale to assess patients' self-management efficacy. The validated three-item Brief Health Literacy Screening (BHLS) was used to measure the patients' health literacy. A structural equation model was constructed, and p ≤ 0.05 was taken as significant. Results: Demographic characteristics, health literacy and self-management efficacy have all significant effects on HRQL. Age, education level, self-management efficacy and health literacy were significantly related to the HRQL. The constructed model had a good fit for the data according to the model fit indices. Based on the model, health literacy (r = 0.604, p = 0.029) and Self-management efficacy (r = 0.714, p = 0.018) have a significant impact on HRQL. Demographic characteristics were inversely related to HRQL (r = -0.419, p = 0.007), but have a significant impact on health literacy (r = 0.675, p = 0.029) and self-management efficacy (r = 0.379, p = 0.029). At the same time, self-management efficacy was positively correlated to health literacy (r = 0.413, p <0.01). Conclusions: Age, education level, self-management efficacy and health literacy were all related to the HRQL of patient with hypertension, which means that patients who are more elderly and have lower education level, low self-management efficacy and poor health literacy get worse HRQL. This may imply the necessary to introduce routine assessment of health literacy and self-management efficacy into assessment procedures for hypertensive patients' health management. Such assessment can help professionals to identify the population at greatest risk for poor health outcomes and low well-being in the future. In clinical practice, effective interventions such as direct guidance and education to raise the self-management efficacy and enhance health literacy might improve the HRQL of patients with hypertension. Trial registration: Retrospectively registered Chinese Clinical Trial Registry (ChiCTR-OOR-14005563). Name of registry: Effects of the integrated delivery system and payment system of community-based intervention on rural patients of chronic diseases in Qianjiang District, China Date of registration: Retrospectively registered 23 November 2014. Date of enrolment of the first participant to the trial: 5 July 2012 [ABSTRACT FROM AUTHOR]

Introduction: China's organised health system has remained outdated for decades. Current health systems in many less market-oriented countries still adhere to traditional administrative-based directives and linear planning. Furthermore, they neglect the responsiveness and feedback of institutions and professionals, which often results in reform failure in integrated care. Complex adaptive system theory (CAS) provides a new perspective and methodology for analysing the health system and policy implementation. Methods: We observed the typical case of Qianjiang's Integrated Health Organization Reform (IHO) for 2 years to analyse integrated care reforms using CAS theory. Via questionnaires and interviews, we observed 32 medical institutions and 344 professionals. We compared their cooperative behaviours from both organisational and inter-professional levels between 2013 and 2015, and further investigated potential reasons for why medical institutions and professionals did not form an effective IHO. We discovered how interested parties in the policy implementation process influenced reform outcome, and by theoretical induction, proposed a new semi-organised system and corresponding policy analysis flowchart that potentially suits the actual realisation of CAS. Results: The reform did not achieve its desired effect. The Qianjiang IHO was loosely integrated rather than closely integrated, and the cooperation levels between organisations and professionals were low. This disappointing result was due to low mutual trust among IHO members, with the main contributing factors being insufficient financial incentives and the lack of a common vision. Discussion and Conclusions: The traditional organised health system is old-fashioned. Rather than being completely organised or adaptive, the health system is currently more similar to a semi-organised system. Medical institutions and professionals operate in a middle ground between complete adherence to administrative orders from state-run health systems and completely adapting to the market. Thus, decision-making, implementation and analysis of health policies should also be updated according to this current standing. The simplest way to manage this new system is to abandon linear top-down orders and patiently wait for an explicit picture of IHO mechanisms to be revealed after complete and spontaneous negotiation between IHO allies is reached. In the meantime, bottom-up feedback from members should be paid attention to, and common benefits and fluid information flow should be prioritised in building a successful IHO. [ABSTRACT FROM AUTHOR]

Background: Hypertension affects one billion people globally and is one of the leading risk factors for cardiovascular and renal diseases. However, hypertension management remains poor, especially in rural China.Methods: A clustered randomized controlled trial was conducted in six towns in China's Qianjiang county between 7/2012 and 6/2014, including 5462 hypertension patients above 35 years old. Six towns were randomly assigned to three groups: Group 1 had the integrated care model including a multidisciplinary team and continuous care coordination, Group 2 had both the integrated care model and provider-level financial incentives, and the control group had the usual care. Primary outcomes were systolic blood pressure and health-related quality of life measured by SF36; secondary outcomes included hypertension-related hospitalization rate and inpatient spending. Blood pressure was measured sixteen times bimonthly between 12/1/2011 and 6/30/2014, and quality of life was measured on 7/1/2012 and 6/30/2014. Inpatient data between 7/1/2010 and 8/31/2014 were used. This trial is registered at the World Health Organization's International Clinical Trials Registry, number ChiCTR-OOR-14005563.Results: We found that the integrated care model effectively lowered blood pressure by 1.93 mmHg (95% CI 0.063-3.8), improved self-assessed health-related quality of life, and reduced the rate of hypertension-related hospitalization by 0.17 percentage points (95% CI 0.094-0.24). We also found that the provider-level financial contract further lowered blood pressure by 1.76 mmHg (95% CI 0.73-2.79) and reduced rates of hospitalization and inpatient spending, but it also reduced patients' self-assessed health-related quality of life.Conclusions: Integrated care and financial incentives are effective in lowering blood pressure and reducing hospitalization rate, but financial contracts may hurt patient quality of life. This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563) on November 23, 2014. It was a retrospective registration. [ABSTRACT FROM AUTHOR]

Background: Continuity of care is widely considered a principle of primary care that decreases healthcare utilization and mortality. However, the effect of continuity of care on health-related quality of life (HRQoL) for adult patients with hypertension remains unclear. Methods: To further evaluate the effect of continuity of care, we implemented a cohort study among hypertensive patients aged over 35 years (n = 1200) in six townships in Qianjiang District, Chongqing, China, between 2012 and 2014. The study ultimately included 1079 participants. The continuity of care index was calculated using claim-based longitudinal data obtained from hypertension follow-up service records. The baseline and endline survey-based data, tested by the SF-36 scale, were used to assess HRQoL. To control selection bias and examine the effect of continuity of care, a kernel-based propensity score matching difference-in-differences (DID) method was used. Additionally, descriptive statistics, chi-squared test, and Mann-Whitney nonparametric test were used to summarize characteristics, evaluate proportional differences, and analyze statistical differences, respectively. Results: Our results showed that patients in the high continuity of care group presented greater improvement in both Physical Component Summary (PCS, DID = 5.192 ± 1.970, p < 0.001) and Mental Component Summary (MCS, DID = 7. 900 ± 1.815, p = 0.008) than those in the low continuity of care group. Moreover, patients in the high continuity of care group showed significant improvement in physical functioning, role-physical, general health, role-emotional, and mental health. Conclusions: Our findings indicate that a long-term physician-patient relationship may improve HRQoL in patients with hypertension. However, more unified measurement tools are needed to evaluate continuity of care. Further studies should include more study settings. [ABSTRACT FROM AUTHOR]

Background: Integrative strategy of health services delivery has been proven to be effective in economically developed countries, where the healthcare systems have enough qualified primary care providers. However rural China lacks such providers to act as gatekeeper, besides, Chinese rural hypertensive patients are usually of old age, more likely to be exposed to health risk factors and they experience a greater socio-economic burden. All these Chinese rural setting specific features make the effectiveness of integrative strategy of health services in improving health related quality of life among Chinese rural hypertensive patients uncertain. Methods: In order to assess the impact of integrative strategy of health services delivery on health related quality of life among Chinese rural hypertensive patients, a two-year quasi-experimental trial was conducted in Chongqing, China. At baseline the sample enrolled 1006 hypertensive patients into intervention group and 420 hypertensive patients into control group. Physicians from village clinics, town hospitals and county hospitals worked collaboratively to deliver multidisciplinary health services for the intervention group, while physicians in the control group provided services without cooperation. The quality of life was studied by SF-36 Scale. Blood pressures were reported by town hospitals. The Difference-in-Differences model was used to estimate the differences in SF-36 score and blood pressure of both groups to assess the impact. Results: The study showed that at baseline there was no statistical difference in SF-36 scores between both groups. While at follow-up the intervention group scored higher in overall SF-36, Role Physical, Body Pain, Social Functioning and Role Emotional than the control group. The Difference-in-Differences result demonstrated that there were statistical differences in SF-36 total score (p = 0.011), Role Physical (p = 0.027), Social Functioning (p = 0.000), Role Emotional (p = 0.002) between both groups. Integrative services delivery improved the score of SF-36 by 4.591 ± 1.794, and also improved the score in domains of Role Physical, Social Functioning and Role Emotional by 8.289 ± 3.753, 9. 762 ± 2.019 and 12.534 ± 4.083, respectively. Conclusion: Patients in the intervention group obtained lower systolic blood pressure and diastolic blood pressure. Integrative strategy of health services delivery improved health related quality of life and blood pressure control among rural Chinese hypertensive patients. [ABSTRACT FROM AUTHOR]

Background: Orphan drugs are intended to treat, prevent or diagnose rare diseases. In recent years, China healthcare policy makers and patients have become increasingly concerned about orphan drug issues. However, very few studies have assessed the availability and affordability of orphan drugs for rare diseases in China. The aim of this study was to provide an overview of the availability and affordability of orphan drugs in China and to make suggestions to improve patient access to orphan drugs.Methods: Two components of the availability of orphan drugs were examined. Market availability was assessed by the extent to which orphan drugs were marketed in China with a comparison to orphan drugs in international markets, such as the U.S., EU and Japan. We conducted surveys and collected data from 24 tertiary public hospitals in China to measure hospital-level availability of orphan drugs. The affordability of orphan drugs was calculated using hospital dispensary prices and was expressed as days of average daily income required for the cost of a course of treatment. Affordability was also analyzed under the Chinese basic medical insurance system.Results: Orphan drugs approved in the U.S., EU and Japan had 37.8%, 24.6% and 52.4% market availability in China, respectively. Median availability of 31 orphan drugs surveyed at the 24 tertiary public hospitals was 20.8% (very low). Within a periodic treatment course, the average treatment cost of 23 orphan drugs is approximately 4, 843. 5 USD, which equates to 505.6 days of per capita net income for an urban resident with a middle income (187.4 days for a high-income urban resident) or 1,582.8 days's income for a rural resident with a middle income (657.2 days for a high-income rural resident). Except for homoharringtonine, 22 orphan drugs for 14 rare diseases were unaffordable for the most of residents in China. With 5% out-of-pocket expenses, only three generics could be afforded by middle-income residents, whereas seven drugs for high-income urban residents.Conclusions: The Chinese government can take more responsibility for improving the availability and affordability of orphan drugs through setting up incentive policies and public platforms for sharing of orphan drug information. Control of the high price of orphan drugs, combined with a joint funding model from both government and private enterprise can efficiently reduce the economic burden of affected patients in China. [ABSTRACT FROM AUTHOR]

As an international legal instrument, the International Health Regulations (IHR) is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO). The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC). In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety), radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China. [ABSTRACT FROM AUTHOR]

Structural health monitoring (SHM) has gained in popularity in recent years since it can assess the performance and condition of instrumented structures in real time and provide valuable information to the asset's manager and owner. Operational modal analysis plays an important role in SHM and it involves the determination of natural frequencies, damping ratios and mode shapes of a constructed structure based on measured dynamic data. This paper presents the operational modal analysis and seismic response characterization of the Tsing Ma Suspension Bridge of 2,160 m long subjected to different earthquake events. Three kinds of events, i.e., short-distance, middle-distance and long-distance earthquakes are taken into account. A fast Bayesian modal identification method is used to carry out the operational modal analysis. The modal properties of the bridge are identified and compared by use of the field monitoring data acquired before and after the earthquake for each type of the events. Research emphasis is given on identifying the predominant modes of the seismic responses in the deck during short-distance, middledistance and long-distance earthquakes, respectively, and characterizing the response pattern of various structural portions (deck, towers, main cables, etc.) under different types of earthquakes. Since the bridge is over 2,000 m long, the seismic wave would arrive at the tower/anchorage basements of the two side spans at different time instants. The behaviors of structural dynamic responses on the Tsing Yi side span and on the Ma Wan side span under each type of the earthquake events are compared. The results obtained from this study would be beneficial to the seismic design of future long-span bridges to be built around Hong Kong (e.g., the Hong Kong-Zhuhai-Macau Bridge). [ABSTRACT FROM AUTHOR]

Although a number of studies have been conducted on the association between the GSTM1 null genotype and gastric cancer in People's Republic of China, this association remains elusive and controversial. To clarify the effects of the GSTM1 null genotype on the risk of gastric cancer, an updated meta-analysis was performed in the Chinese population. Related studies were identified from PubMed, Springer Link, Ovid, Chinese Wanfang Data Knowledge Service Platform, Chinese National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) up to November 5, 2014. A total of 25 studies including 3,491 cases and 5,921 controls were included in this meta-analysis. Overall, a significant association (odds ratio [OR] =1.47, 95% CI: 1.28-1.69) was found between the null GSTM1 and gastric cancer risk when all studies in Chinese population were pooled into the meta-analysis. In subgroup analyses stratified by quality score, geographic area, and source of controls, the same results were observed. Additionally, a significant association was found both in smokers and non-smokers. This meta-analysis showed that the null GSTM1 may be a potential biomarker for gastric cancer risk in Chinese, and further studies with gene-gene and gene-environment interactions are required for definite conclusions. [ABSTRACT FROM AUTHOR]

Background: Human Borna disease virus (BDV) infections have recently been reported in China. BDV causes cognitive and behavioural disturbances in animals. The impact on human mental disorders is subject to debate, but previous studies worldwide have found neuropsychiatric patients more frequently infected than healthy controls. A few isolates were recovered from severely depressed patients, but contagiousness of BDV strain remains unknown. Method: We addressed the risk of infection in health care settings at the first affiliated hospital of Chongqing Medical University (CQMU), located in downtown Chongqing, a megacity in Southwest China. Between February 2012 and March 2013, we enrolled 1529 participants, of whom 534 were outpatients with major depressive disorder (MDD), 615 were hospital personnel, and 380 were healthy controls who underwent a health check. Infection was determined through BDV-specific circulating immune complexes (CIC), RNA, and selective antibodies (blood). Results: One-fifth of the hospital staff (21.8%) were found to be infected (CIC positive), with the highest prevalence among psychiatry and oncology personnel, which is twice as many as were detected in the healthy control group (11.1%), and exceeds the prevalence detected in MDD patients (18.2%). Conclusion: BDV circulates unnoticed in hospital settings in China, putting medical staff at risk and warranting clarification of infection modes and introduction of prevention measures. [ABSTRACT FROM AUTHOR]

Remanufacturing is one of the prioritized sectors that pushes sustainability forward and has been vigorously promoted by two rounds of experimental programs in China. A survey of 7 Chinese remanufacturing enterprises involving 190 respondents is used to empirically identify the current situation and explore influential factors of the remanufacturing industry in China. The results of principal component factor analysis indicate that enterprise strategy factors as well as policy and technical factors are the major drivers of the remanufacturing industry with the largest contribution rate of 21.424% and 20.486% respectively. The policy, economic factors and industry environmental factors are major barriers with the largest contribution rate of 29.361% and 19.690% respectively. This is the first empirical study to explore the influencing factors of the remanufacturing industry in China. The results provide preliminary reference for government and industry to further develop mechanism to promote remanufacturing practice in China. [ABSTRACT FROM AUTHOR]

Background: While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. Methods: To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. Discussion: This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients. Conclusion: The integrated care system needs collaborative work from different levels of caregivers. So it is extremely important to consider the supplier cooperative behaviour. In this trial, we introduced payment system to help the delivery system integration through providing financial incentives to motivate people to play their roles. Also, the multidisciplinary team, the multi-institutional pathway and system global budget and pay-for-performance payment system could afford as a solution. [ABSTRACT FROM AUTHOR]

Background The increased funding and reimbursement for the New Rural Cooperative Medical System (NRCMS) have provided residents in rural China with better access to inpatient services. This research aims to examine the level of inappropriate admissions to township hospitals under NRCMS, and the determinants that influence inappropriate admissions. Methods A total of 2,044 medical records in 10 township hospitals were collected from five counties in Midwestern China by stratified cluster sampling and evaluated using the Appropriateness Evaluation Protocol (AEP), which was developed by a Delphi expert consultation of 32 experts. A two-level logistic regression model by MLwiN 2.30 was used to examine the determinants of inappropriate admissions. Results Township hospitals had an average inappropriate admission rate of 26.5%. The highest rate of inappropriate admission was among patients aged more than 59 years old (35.71%). Inappropriate admissions mostly occurred for respiratory, cardiovascular, and circulatory diseases. Township hospital similarity and clustering were observed. Two-level logistic regression analysis showed that age, treating department, and disease were determinants of inappropriate admission. Conclusions Township hospitals have a high rate of inappropriate admissions. Explicit diagnostic criteria and a standardized supervision system should be developed to reduce this. [ABSTRACT FROM AUTHOR]

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• A census of the fungal microbiomes of 13 regional Hong Qu varieties was completed. • Fungal community composition and diversity is different in Hong Qu varieties. • 14 biomarker taxa were identified to distinguish regional varieties. • Correlations of fungal abundances and fermentation characteristics were explored. • 10 key fungal genera were found to be responsible for fermentation characteristics. Hong Qu glutinous rice wine (HQ wine) is a traditional alcoholic beverage produced in China by fermenting cooked rice using a fermentation starter prepared with the fungus Monascus purpureus. This starter (Hong Qu , HQ) is made empirically by open spontaneous fermentation that is hard to control and standardize, resulting in inconsistent wine quality. This study investigates representative HQ samples from a large geographic region. It explores fungal microbiome compositions, identifies characteristic differences important for the production of various HQ wine styles, and reveals the key fungi responsible for HQ wine fermentation characteristics. The source of the HQ inoculum was found to be the main factor influencing fungal community composition and diversity, followed by processing technology and geographical distribution. Linear discriminant analysis effect size (LEfSe) uncovered 14 genera as potential biomarkers to distinguish regional varieties of HQ. Significant differences were also found in fermentation characteristics such as liquefying power (LP), saccharifying power (SP), fermenting power (FP), total acid content (TA) and liquor-producing power (LPP). The key fungi responsible for LP (5 genera), SP (3 genera), FP (1 genera), LPP (4 genera), and TA (4 genera) were determined using redundancy correlation analysis. Finally, Spearman's correlation analysis indicated that LPP shows a strong positive correlation with FP and LP, while TA displays a strong negative correlation with FP. The results of this study may be utilized to prepare consistently high quality, next-generation HQ by better controlling fungal community structures, and to design fermentation processes for HQ wines with desirable oenological characteristics. [ABSTRACT FROM AUTHOR]

Background: Telehealth devices are considered with potential to foster improved health outcome for patients with hypertension. However, the longitudinal use trajectories of telehealth devices have not been identified yet, nor has the connection between developmental trajectories of telehealth devices use and health outcome over time. Objective: To identify the longitudinal trajectories of use of telehealth devices among patients with hypertension, characterize features for each trajectory, and to unravel the correlation between longitudinal trajectories of telehealth devices use patterns and BP control outcome. Methods: A total of 122 patients with hypertension were enrolled, portable telehealth device were given to them to monitor blood pressure. Socio-demographics (e.g. name, age, sex, marital status) were collected at baseline. The real-time measured data, including time and both systolic and diastolic blood pressure data, were sent up to cloud platform through the portable device. The latent class growth analysis modeling approach was used to determine the latent trajectory of telehealth use. And the joint trajectory method was used to identify the correlation between the longitudinal trajectories of telehealth use and BP control status. Results: 5 distinct trajectories were finally identified: Persistently low (47.1%), Moderate with decreasing (23.9%), Sharply decreasing (11.2%), High with decreasing (11.3%), Persistently high with increasing (6.6%). However, no statistical significant differences in age, marital status, BP (both SBP and DBP) and BP control status in the first period between the 5 trajectories were found. It provided evidence that strong correlation existed between the longitudinal telehealth devices use patterns and individuals' longitudinal BP control status. Conclusions: The latent trajectories of telehealth use were identified; yet, no predictors of trajectory membership have been found. Although more prove of the causal relationship needs to be revealed in further studies, this study demonstrated that regular monitor has some positive correlation with improved BP control. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, many countries have established their own gatekeeper system. Tertiary hospitals in China have experienced explosive growth both in the quantity and quality since 2009. However, the healthcare delivery system in China is fragmented for its weak coordination between different faculties. And it was not well prepared for the tremendous and complex needs, especially the grassroots healthcare faculties whittled by the tertiary hospitals. Moreover, it has caused the increasing of total health expenditure and occurrence of catastrophic health expenditure. Policy context and objective: To deal the unreasonable resources distribution among the tertiary-grassroots faculties and urban-rural areas, and establish a high-value healthcare delivery system. In January 2013, the tiered healthcare service delivery was first implemented among Qinghai and Hubei province. Given emerging problems might influence the current policy analysis from different perspective may achieve contrasting results, it is necessary to evaluate the secular effects of the previous pilots and synthesis its experience for the following programs with the similar contextual settings. Targeted population: The New Rural Cooperative Medical System enrollee in the Dangyang. Highlights: A quasi-natural experiment was designed in Dangyang, Hubei province. And the policy were piloted in October 2014, policies related to this reform and claim data from January 2011 to December 2015 were collected from the New Cooperative Medical Scheme (NCMS) enrollees. First, the patients are motivated to take the grassroots faculties for the initial treatment-seeking, with different reimbursement ratio settings varied with the delivery system levels. Second, all the county-level hospitals have to establish the integrated delivery system with more than township faculties. Third, all community healthcare centers should carry out the family doctors system and the grassroots faculties in rural areas should be equipped with a physician good at the Traditional Chinese Medicine. The outcomes indicated the changes in cost and patients flow were included to evaluate its effects and calculated monthly based on the claim data. Policy analysis and interrupted time series analysis model were designed to estimate the before-after changes in the indicators with Stata version 13.0. All the cost data was adjusted according the 2016 China Health Statistics Yearbook. The actual reimburstment ratio and the proportion of total medical expenses in township hospitals increased significantly in the first month of the implementation of the tired medical system policies, and has reversed the orginal downward trend. Meanwhile, the upward trend and level of out-of-pocket has significantly declined. However, the level and trend of proportion of health expenditure and patient visits in health care facilities outside Dangyang did not decreased significantly, so does the average length of stay and average total cost. The proportion of total patient visits in township hospitals increased at first, but not reversed significantly in the long term. Conclusions: Although this policy has not achieved all its expected outcomes temporarily, it has reduce the out-of-pocket cost for patients and improve the effectiveness of the grassroots facilities. Further studies should focus on the more comprehensive evaluation of health system and an appropriate control group should be found. [ABSTRACT FROM AUTHOR]

Background: In China, the increases in caesarean section (CS) rates and in delivery costs have posed questions about the reform of the medical insurance payment system. Case payment is useful in regulating the behavior of health providers and in controlling CS rates and the unreasonable increase in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aim to observe the change in CS rates, compare the changes in delivery-related variables, and find variables related to delivery cost before and after the CPR in Xi County. Methods: A total of 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. The one-way ANOVA and chi-squared test were adopted to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationship between medical expenses and variables. Results: The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), the total medical cost, and the proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups and total samples was significantly influenced by patient age, LOS, and hospital type and had a significant correlation with the CPR in the VD group and total samples. Conclusion: The CPR might fail to control the unreasonable medical expense growth and regulate the behavior of providers, possibly resulting from the unreasonable compensation standard of case payment, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit the motivation of providers to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals. [ABSTRACT FROM AUTHOR]

Background: Most of the integration-related policies are facing implementation problems. During 2012/07-2014/12, we implemented an trial-based intervention in Qianjing, a rural district in southwestern China, to test the effects of an innovative integrated care delivery model targeted for rural patients (RICDM) with hypertension. Using the difference-indifferences analysis, we found that the blood pressure did decrease in treatment group compared to the control group however the health-related quality of life did not, which violated our assumptions. To explore whether the provider performance interfered with the outcomes, we did a process evaluation mainly to compare their behaviors during trial implementation. Methods: All the doctors' behaviors were bimonthly-recorded using diaries, and their attitudes were evaluated using questionnaires adapted from D'Amour's inter-professional collaboration model. We firstly observed the referral amounts and provider communication frequency on four inter-professional cooperation types (village to town, town to county, county to town, and town to village - the former indicated the initiated party). Then we conducted interviews with the doctors, investigating the following aspects that potentially affected the collaboration: willing to cooperate, actual motivation, mutual trust, personal relations and ability to cooperate. All variables were compared between groups before and after intervention. After then we did a regression analysis examining the relations between the cooperation level and the identities of doctors. The implementation degree was also estimated by multiplying the percentage of reach scope for each step of trial process. Results: 120 doctors were included. There were no significant differences between treatment group and control group either on the referral amounts or the communication frequency (all P >0.05). Most of the cooperation aspects showed a low- and middle-level performance (>90%). The collaboration ability in treatment group was significantly higher than control group (P <0.001) after intervention, except for that, there were no differences compared to control group in willingness, motives, mutual trust or personal relationship improvement (all P >0.05). And the doctors from county hospitals showed a lower performance in each of the aspect compared to doctors from town hospitals and village clinics. Associated with the professional identity, the medical staff showed relatively low interests in collaboration compared to primary care professionals. By observing and analyzing the processes of exposure, enrollment, reach and follow-ups, we had found out the implementation degree to be only 61%. For each part, the patient were reached out by 100%, the supplier 72%, and the hospitals 85%. Lessons Learned: The RICDM improved patient health, but did not fully achieve desired effects. We inferred that one possible reason might lied in the providers' reluctance to cooperate. By furtherly investigating into the provider behaviors and implementing process, we had proved our guess and the actual model effect might therefore be underestimated. However the study did not successfully connect the health-related outcomes with the provider behaviors through statistical analysis, so we could not reach a direct conclusion that the incomplete implementation was the exact reason for imperfect model effects. Further studies need to be proposed and also potential bias from provider side should be properly dealt with in the stage of study design. [ABSTRACT FROM AUTHOR]

Background: Cost is a great concern for integrated care. China has been trying to build a hierarchical medical system to integrate services between different medical institutions, so that mild patients can be referred to primary institutions and cost can be cut. Our aim is to explore how much inpatient cost could be saved by the hierarchical medical system. Methods: This study was carried out in Xi County, China, based on the rural inpatient database in 2015. We firstly screen out the inpatient record in county hospitals which could have been in township hospitals based on self-evaluation capability and practical capability of township hospitals and then calculate the difference in cost between township and county hospitals which could have been saved. Self-evaluation capability referred to all the disease that township hospitals thought they could handle by inpatient service and practical capability referred to all the disease that township hospitals actually handled by inpatient service. Results: Under the self-evaluation capacity, 14.90% of the inpatient records in county hospitals could have been in township hospitals and 11.84 million? (5.20% of the total inpatient expenditure within county) could have been saved. Under the practical capability, 6.95% of the inpatient records in county hospitals could have been in township hospitals and 7.15 million? (3.14% of the total inpatient expenditure within county) could have been saved. Discussion: Cost reduction by service integration was limited by the capability of township hospitals. Conclusion: Cost reduction by the hierarchical medical system was small. Lessons learned: Capability improvement of primary medical institutions is a key task for service integration and effectiveness raise. Limitations: We did not compare the inpatient quality and take the patient's willingness into account. Suggestions for future research: Comparison of quality and patient willingness need to be considered in further studies. [ABSTRACT FROM AUTHOR]

Introduction: China has been trying to enhance service collaboration between different levels of medical institutions to lower patient flow and cut down medical expenditure. However, the outcome was poor. Township-County Readmission (TCR) means a patient is firstly admitted to a township hospital and then a county hospital within 30 days for the same disease. Our aim is to explore whether TCR can lower patients' costs in county hospitals. Method: This study was carried out in Qianjiang District, China. Firstly, we selected out TCR patients from the database. Then, we picked out patients who was admitted to county hospitals less than 30 days before TCR (CTCR patients) or after TCR (TCRC patients) for respiratory system disease as our objects. Finally, we compare the former expenditure in county hospital with the latter for TCRC patients and CTCR patients by paired-t test. Result: 74 TCRC patients and 40 CTCR patients of respiratory system disease were screened out. The average of former expenditure in county hospital for TCRC patients was 651.6$, and the latter was 564.0$ (t=-0.467, P=0.643). The average of former expenditure in county hospital for CTCR patients was 594.4$, and the latter was 653.8$ (t=-0.963P=0.339). Discussion: The difference between costs of single county inpatient and costs of county inpatient in TCR is not significant, which means that service provided by township hospitals during TCR is ineffective. Conclusion: Service collaboration between township hospitals and county hospitals didn't achieve the real continuity as wanted, which had enlarged waste and the inefficiency of supply system. Lessons learned: Cutting down the inefficiency during referral is a key task for service collaboration. At least, the patients should not pay for this. Limitation: The sample size was too small and disease severity was not included into the study. Suggestions for future research: More samples should be included. Disease severity needs to be better controlled. [ABSTRACT FROM AUTHOR]

We designed 3 social behavior experiments involving compensation for real estate expropriation. We recruited 88 students at a university in China as our participants, and investigated the impact of third-party punishment on bilateral cooperation in a laboratory setting. The results showed the heterogeneity of human behavior in the different experiment types. In addition, results showed that the potential impact of punishment became more powerful by adding a third party. Finally, a third party had low punishment costs and a significantly higher probability of actually imposing punishment than did a second party. Results showed that, compared with second-party punishment, third-party punishment is more conducive to the maintenance of bilateral cooperation. [ABSTRACT FROM AUTHOR]

Porcine reproductive and respiratory syndrome virus (PRRSV), an important pathogen that affects the pig industry, is a highly genetically diverse RNA virus. However, the phylogenetic and genomic recombination properties of this virus have not been completely elucidated. In this study, comparative analyses of all available genomic sequences of North American (NA)-type PRRSVs (n = 355, including 138 PRRSV genomes sequenced in this study) in China and the United States during 2014–2018 revealed a high frequency of interlineage recombination hot spots in nonstructural protein 9 (NSP9) and the GP2 to GP3 regions. Lineage 1 (L1) PRRSV was found to be susceptible to recombination among PRRSVs both in China and the United States. The recombinant major parent between the 1991–2013 data and the 2014–2018 data showed a trend from complex to simple. The major recombination pattern changed from an L8 to L1 backbone during 2014–2018 for Chinese PRRSVs, whereas L1 was always the major backbone for US PRRSVs. Intralineage recombination hot spots were not as concentrated as interlineage recombination hot spots. In the two main clades with differential diversity in L1, NADC30-like PRRSVs are undergoing a decrease in population genetic diversity, NADC34-like PRRSVs have been relatively stable in population genetic diversity for years. Systematic analyses of insertion and deletion (indel) polymorphisms of NSP2 divided PRRSVs into 25 patterns, which could generate novel references for the classification of PRRSVs. The results of this study contribute to a deeper understanding of the recombination of PRRSVs and indicate the need for coordinated epidemiological investigations among countries. [ABSTRACT FROM AUTHOR]