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Physics education aims to develop sophisticated thinking abilities and enhance conceptual depth, but student interest has decreased, emphasizing the importance of teacher quality in fostering success and positive attitudes. The aim of the study was to examine the physics teachers' self-efficacy, innovative teaching, and comprehensive teaching approach levels. As data collecting instruments, self-efficacy, innovative physics teaching, and comprehensive teaching approach scores were utilized. In the pilot research group, validity and reliability assessments were conducted on the scales. The primary research involved 241 physics teachers. As the measurement variables were constantly changeable, Latent Profile Analysis was utilized. The present study's results suggest that teachers have high self-perceptions in various dimensions related to teaching effectiveness, including self-efficacy, innovative teaching, and comprehensive teaching approach. These results are consistent with previous research that has shown a positive relationship between teacher self-perceptions and teaching effectiveness. Future research could explore the relationship between teacher self-perceptions and student achievement to better understand the impact of self-perceptions on student outcomes. Overall, the results of this study highlight the importance of supporting teachers' self-efficacy and providing opportunities for innovative teaching and professional development to improve comprehensive teaching approach.

Aim: This study adopted the qualitative research method, aiming to explore the learning experience of nursing graduate professional curricula in China from the perspective of students and provided a basis for the continuous improvement of nursing graduate training. Design: A qualitative study. Methods: A purposive sampling method was employed to conduct semi‐structured in‐depth interviews with 14 nursing master's students enrolled in professional curricula from September 03, 2021, to December 8, 2022. The Colaizzi seven‐step analysis method was utilized for data analysis, summarization and extraction. Results: Four themes emerged from the study findings: (i) The study of professional curricula is the cornerstone of scientific research work, but it is relatively boring; (ii) The teaching methods and assessment methods of postgraduate education need to be diversified; (iii) The postgraduate education needs to increase the study time of specialized courses and highlight the specialty characteristics; (iv) the study of professional curricula can enhance the comprehensive ability of postgraduate students. Conclusion: The study of professional curricula for post‐graduate nursing students plays an important role in the development of post‐graduate research and can statistically significant improve their comprehensive ability, but there are some problems such as boring courses, single teaching assessment methods and insufficient time. In the future teaching reform, it is necessary to highlight the specialty characteristics of nursing scientific research, optimize curriculum education and improve students' scientific research knowledge and thinking. Patient and Public Contributions: We thank all participants for their valuable input throughout the study. [ABSTRACT FROM AUTHOR]

Introduction: Over the past decade, numerous studies have described the types of pathogens and their antibiotic resistance patterns in patients with burn injuries in China; however, the findings have generally been inconsistent. We conducted a literature search and meta-analysis to summarize the infection spectra and antimicrobial resistance patterns in patients with burn injuries. Methods: We searched the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, China Biomedical Literature, Wanfang, and Weipu databases for relevant articles published between January 2010 and December 2023. The DerSimonian–Laird random-effects model was used to estimate the proportions and 95% confidence intervals (CIs) of pathogens among Chinese patients with burn injuries. Meta-regression analyses were performed to explore differences in the proportions of pathogens among different subgroups and their resistance patterns. This study was registered with PROSPERO (CRD42024514386). Results: The database searches yielded 2017 records; after removing duplicates and conducting initial screening, 219 articles underwent full-text screening. Ultimately, 60 studies comprising a total of 62,819 isolated strains reported the proportions of pathogens in patients with burn injuries and were included in this meta-analysis. Meta-analyses were conducted on 18 types of pathogens. The most common pathogens causing infections in Chinese patients with burn injuries were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus epidermidis. Similar results were observed in the subgroup analysis focusing on wound infections. Since 2015, there has been a significant decrease in the proportion of Pseudomonas aeruginosa (R2 = 4.89%) and a significant increase in the proportion of Klebsiella pneumoniae (R2 = 9.60%). In terms of antibiotic resistance, there has been a significant decrease in the resistance of Staphylococcus aureus to multiple antibiotics and an increasing trend in the resistance of Klebsiella pneumoniae. Conclusions: We systematically summarized the epidemiological characteristics and antibiotic resistance patterns of pathogens among individuals suffering from burns in China, thus providing guidance for controlling wound infections and promoting optimal empirical antimicrobial therapy. The observed high levels of antibiotic resistance underscore the need for ongoing monitoring of antibiotic usage trends. [ABSTRACT FROM AUTHOR]

While many studies have examined the role of biochar in carbon (C) accrual in short-term scale, few have explored the decadal scale influences of biochar on non-biochar C, e.g., native soil organic C (SOC) and added substrate. To address this knowledge gap, soils were collected from decade-old biochar field trials located in the United Kingdom (Cambisol) and China (Fluvisol), with each site having had three application rates (25–30, 50–60 and 75–100 Mg ha−1) of biochar plus an unamended Control, applied once in 2009. We assessed physicochemical and microbial properties associated with sucrose (representing the rhizodeposits) mineralization and the priming effect (PE) on native SOC. Here, we showed both soils amended with biochar at the middle application rate (50 Mg ha−1 biochar in Cambisol and 60 Mg ha−1 biochar in Fluvisol) resulted in greater substrate mineralization. The enhanced accessibility and availability of sucrose to microorganisms, particularly fast-growing bacterial genera like Arenimonas, Spingomonas, and Paenibacillus (r-strategists belonging to the Proteobacteria and Firmicutes phyla, respectively), can be attributed to the improved physicochemical properties of the soil, including pH, porosity, and pore connectivity, as revealed by synchrotron-based micro-CT. Random forest analysis also confirmed the contribution of the microbial diversity and physical properties such as porosity on sucrose mineralization. Biochar at the middle application rate, however, resulted in the lowest PE (0.3 and 0.4 mg of CO2-C g soil−1 in Cambisol and Fluvisol, respectively) after 53 days of incubation. This result might be associated with the fact that the biochar promoted large aggregates formation, which enclosed native SOC in soil macro-aggregates (2–0.25 mm). Our study revealed a diverging pattern between substrate mineralization and SOC priming linked to the biochar application rate. This suggests distinct mechanisms, biophysical and physicochemical, driving the mineralization of non-biochar carbon in a field where biochar was applied a decade before. Highlights: The application of biochar at a moderate rate (50–60 Mg ha−1) resulted in increased labile C mineralization and decreased priming of native SOC. Biochar amendments led to the reconfiguration of physicochemical properties, including pH, porosity, and the formation of aggregates. Modified microbial community structure towards more r-strategists caused greater sucrose mineralization. Biochar incorporation rate governed the C dynamics via (biophysical vs physicochemical mechanisms) in long-term biochar amended fields. [ABSTRACT FROM AUTHOR]

Background Pseudomonas aeruginosa is one of the most common pathogens in surgical site infections (SSIs). However, comprehensive epidemiological and antibiotic resistance details for P aeruginosa in Chinese SSIs are lacking. We evaluated the proportions and antimicrobial resistance of P aeruginosa among patients with SSIs in China. Methods Relevant papers from January 2010 to August 2022 were searched in databases including PubMed, Embase, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Weipu. A meta-analysis was performed to analyze the proportions and 95% confidence interval (CIs) of P aeruginosa among patients with SSIs. Meta-regression analysis was used to investigate the proportion difference among different subgroups and antimicrobial resistance. Results A total of 72 studies met inclusion criteria, involving 33 050 isolated strains. The overall proportion of P aeruginosa among patients with SSIs was 16.0% (95% CI, 13.9%–18.2%). Subgroup analysis showed higher proportions in orthopedic (18.3% [95% CI, 15.6%–21.0%]) and abdominal surgery (17.3% [95% CI, 9.9%–26.2%]). The proportion in the central region (18.6% [95% CI, 15.3%–22.1%]) was slightly higher than that in other regions. Antibiotic resistance rates significantly increased after 2015: cefoperazone (36.2%), ceftriaxone (38.9%), levofloxacin (20.5%), and aztreonam (24.0%). Notably, P aeruginosa resistance to ampicillin and cefazolin exceeded 90.0%. Conclusions The proportion of P aeruginosa infection among patients with SSIs was higher than the data reported by the Chinese Antimicrobial Resistance Surveillance System, indicating rising antimicrobial resistance. The existing antimicrobial drug management plan should be strengthened to prevent a hospital epidemic of drug-resistant P aeruginosa strains. [ABSTRACT FROM AUTHOR]

Thalassaemia is a typically monogenic disease caused by mutations or deletions in the globin gene and has a high prevalence in southern China. Prenatal screening for thalassaemia can be effective in reducing the incidence of thalassaemia. Haematologic parameters of pregnant thalassaemia carriers are diverse and potentially valuable for identifying different types of genotypes. By comparing and evaluating haematological parameters, formulas in the literature, we tried to reveal differences between pregnant women carrying different types of thalassaemia genes. The Mentzer formula (MCV/RBC) showed a strong ability to differentiate thalassaemia genotypes in pregnant women. In addition, combined with haemoglobin electrophoresis HbA2 can further distinguish the –α/αα, αTα/αα, –/αα, β+/N and β0/N groups. HbA2 divides them into two groups. Based on the Mentzer formula, we can further decide which type of thalassaemia to screen (α/β and the subgroups) for genotyping. Therefore, this simpler and more cost-effective workflow has great potential for application in screening pregnant women for thalassaemia carriers. What is already known on this subject? Currently, it is known that thalassaemia gene carriers have abnormal blood indicators. Many findings describe their important values in distinguishing thalassaemia and other blood diseases. They combined different metrics as an algorithm to distinguish thalassaemia and iron deficiency anaemia. Prenatal screening is an effective method to reduce the incidence of thalassaemia. The current main method is PCR. Due to technical and financial constraints, many backward places cannot use this technology. The necessity for prenatal screening for thalassaemia has been overlooked. Whatthe results of this study add? Among these algorithms, Mentzer formula revealed differences in haematological parameters during pregnancy between normal individuals and thalassaemia carriers. Combining the HbA2, thalassaemia carriers can be distinguished from normal individuals, including –α/αα, αTα/αα, –/αα, β0/N and β+/N. What are the implications of these findings for clinical practice and/or further research? We provide another tool for these hospitals that donot have Hb electrophoresis test and PCR. Then the clinical doctor can get some evidence and suggest women go to another big hospital for essential tests. It is an excellent suggestion. In the future, we will collect more specific gene types and further investigate their potential relationship using these formulas. [ABSTRACT FROM AUTHOR]

Fostering human–wildlife coexistence necessitates a thorough and nuanced grasp of local attitudes toward wildlife. Attitudes can vary substantially based on the sociodemographic backgrounds of individuals within a society. This study examines Tibetan attitudes toward large carnivores, emphasizing the importance of contextualization in discerning the effects of sociodemographic factors on attitudes. We began by analyzing existing research on Tibetan attitudes toward wildlife in China, identifying previously studied sociodemographic variables. We then executed an online survey to evaluate the affective, behavioral, cognitive, and overall attitudes of ethnic Tibetans in China toward snow leopards (Panthera uncia), gray wolves (Canis lupus), and brown bears (Ursus arctos). Our findings show that while factors such as gender, age, religious identity, and level of education shape these attitudes, their influence differs depending on the specific attitude component and the target animal under examination. Therefore, making broad generalizations about sociodemographic differences in attitudes can be misleading. It is imperative for attitude research to clearly define the attitude component (what type of attitude), object (attitude toward what), and circumstance (attitude in which situation) being studied. Conducting ethnographic fieldwork in collaboration with local cultural experts can deepen our understanding of local perspectives and the ways sociodemographic factors influence attitudes. Such insights are pivotal for developing conservation strategies attuned to local sociocultural contexts. [ABSTRACT FROM AUTHOR]

Dry-wet variations are a hot topic in global climate change research. Climate warming has led to the changes of evapotranspiration and precipitation are unevenly distributed, which have and will undoubtedly affect the dry-wet variations. In this study, based on daily climatic data from 423 meteorological stations in Southwest China (SWC), we analyze the trends and spatial variabilities of dry-wet climatic factors during 1961–2017, such as potential evapotranspiration (ET0), precipitation, and humid index (HI). Also, we investigate the possible influencing factors causing dry-wet variations. The results show that the arid, semi-arid, and humid regions decreased in 1991–2017 compared with those in 1961–1990, but the sub-humid regions increased. During 1961–2017, there was a noticeable decreasing trend in precipitation, while the variation trend in the ET0 was not apparent, which contributed to the dry climate in the SWC. The ET0 was most sensitive to temperature, followed by relative humidity. The contribution to the change of the ET0 was most remarkable for the change of temperature, followed by sunshine hours and wind speed. On the seasonal scale, the climate became drier in summer and autumn during 1961–2017, but there were no obvious wet-dry variations in spring and winter. Temperature and wind speed were the major factors causing the ET0 variation in spring and winter. Temperature, wind speed, and relative humidity were the critical factors contributing to the ET0 variation in autumn. while sunshine hours played a primary role in the ET0 variation in summer. On the monthly scale, the climate tended to be dry in most months, except for January, March, June, and July. Temperature was the most prominent contributor to the ET0 increase in most months. Also, wind speed and sunshine hours were the main factors of the ET0 reduction in October–May and June–September, respectively. This study can provide a specific reference for drought monitoring and early warning in different climate zones of the SWC. [ABSTRACT FROM AUTHOR]

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Background: The job performance of individual employees determines the overall performance of an organization, and organizational support is known as an important resource at the organizational level to enhance job performance. Although nursing scholars have confirmed the crucial role of organizational support in enhancing job performance, there are no studies on whether psychological capital and organizational identification mediate the association between organizational support and job performance. The purpose of this study is to investigate the influence of organizational support, psychological capital, and organizational identification on nurses' job performance. Methods: A cross-sectional survey was conducted among 455 nurses from 21 public hospitals in China. Instruments were perceived organizational support scale, task performance scale, contextual performance scale, Nurse Psychological Capital Questionnaire, and Organizational Identification Questionnaire. Survey data were analyzed using SPSS and AMOS, and hypotheses were tested using path model analysis. Results: Nurses' perceived organizational support, psychological capital, organizational identification, and task/contextual performance were positively correlated in every two variables. Psychological capital played an important mediating role in perceived organizational support and task/contextual performance, as well as organizational identification. The multi-mediating effect of psychological capital and organizational identification on the relationship between organizational support and task/contextual performance were 0.14 and 0.25, respectively. Conclusions: There was a positive correlation between organizational support and job performance among nurses. Psychological support, organizational identification and contextual performance played a chain mediation role in the relationship between organizational support on task performance in nurses. Nursing managers should pay more attention to enhancing nurses' psychological capital and organizational identification through effective interventions to improve nurses' job performance. [ABSTRACT FROM AUTHOR]

Wolfberry (Lycium barbarum) is a traditional cash crop in China and is well-known worldwide for its outstanding nutritional and medicinal value. Lycium ruthenicum is a close relative of Lycium barbarum but differs significantly in size, color, flavor and nutritional composition. To date, the metabolic differences between the fruits of the two wolfberry varieties and the genetic basis behind them are unclear. Here, we compared metabolome and transcriptome data of two kinds of wolfberry fruits at five stages of development. Metabolome results show that amino acids, vitamins and flavonoids had the same accumulation pattern in various developmental stages of fruit but that Lycium ruthenicum accumulated more metabolites than Lycium barbarum during the same developmental stage, including L-glutamate, L-proline, L-serine, abscisic acid (ABA), sucrose, thiamine, naringenin and quercetin. Based on the metabolite and gene networks, many key genes that may be involved in the flavonoid synthesis pathway in wolfberry were identified, including PAL, C4H, 4CL, CHS, CHI, F3H, F3'H and FLS. The expression of these genes was significantly higher in Lycium ruthenicum than in Lycium barbarum, indicating that the difference in the expression of these genes was the main reason for the variation in flavonoid accumulation between Lycium barbarum and Lycium ruthenicum. Taken together, our results reveal the genetic basis of the difference in metabolomics between Lycium barbarum and Lycium ruthenicum and provide new insights into the flavonoid synthesis of wolfberry. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests that fungal communities are key components of biogeochemical cycles in coastal ecosystems. However, at a regional scale, the major drivers of the seasonal and spatial distribution of fungi in areas impacted by mariculture remain largely unknown. Intensive aquaculture takes place in Dongshan Bay of Fujian, China, a typical subtropical marine ecosystem with multiple environmental gradients extensively perturbed by anthropogenic activities. To better understand the consequences of mariculture on fungal community composition and activities, we simultaneously evaluated the temporal (four different seasons) and spatial dynamics in total (DNA) and active (RNA) fungal communities of Dongshan Bay in relation to several major physicochemical properties. Our results revealed that fungal communities in the Bay were highly diverse, but showed the ubiquitous dominance of Dikarya and the occasional predominance of Glomeromycota, Mucoromycota, Mortierellomycota, Chytridiomycota, Olpidiomycota, and Rozellomycota. Fungal diversity varied much more with season than with the degree of aquaculture activity, for both total and active communities. This notion is supported by co‐occurrence networks exhibiting a clear seasonal pattern. Furthermore, fungal community structure in coastal waters showed distinct relationships with environmental factors varying both with season and in space. For both total and active fungal communities, a combination of environmental variables including temperature, dissolved oxygen, and nitrite exhibited the greatest impact on community structure. Our study demonstrates a distinct spatiotemporal dynamics of both total and active fungi and provides a foundation to better understand the ecological roles of marine fungi in coastal ecosystems in relation to mariculture activities. [ABSTRACT FROM AUTHOR]

To evaluate the characteristics of violent injury cases in Sichuan Province, China. Overall, 4866 violent injury cases in Sichuan province, China from 2014 to 2017 were included. The injury evaluation report was used to classify and summarize the injury information, case and injury characteristics, and to describe the characteristics for each risk factor. The majority of cases were males (n = 3851, 79.14%), aged 20–60 (n = 3867, 79.47%), and living in rural areas (n = 3094, 65.55%). Many cases occurred in public areas (n = 3351, 74.19%) and in the evening (n = 1005, 29.49%). Passion was the main motive for the violent injuries (n = 2098, 82.11%) and the main types of injuries were those to the brain, face, and auricula (n = 3075, 63.21%). Blunt instruments (n = 2951, 64.86%) were most commonly used to inflict injury, and the injury evaluation determined that the majority of injuries were simple (n = 2669, 54.85%) and slight (n = 1685, 34.63%). For cases resulting from passion and money, blunt instruments were more commonly used, while sharp instruments were more commonly used for injuries resulting from emotion and revenge (p < 0.05). Compared with grievous injuries, public and entertainment areas and the use of blunt instruments were risk factors for slight injuries. The use of blunt instruments was a risk factor for simple injuries. The cases of violent injury in the Sichuan Province of China have certain characteristics and causes. In order to reduce the frequency of such cases, corresponding intervention measures should be actively conducted at the identified high risk places, times, and populations. [ABSTRACT FROM AUTHOR]

Previous observational studies on the relationship between sleep characteristics and fracture have yielded contradictory results. The goal of this study was to replicate the findings in a large longitudinal cohort and then conduct a Mendelian randomization (MR) analysis to infer the causality between sleep behaviors and fracture risk. Based on data from the China Health and Retirement Longitudinal Study (CHARLS) including 17,708 participants, we found that individuals with short sleep duration (<5 h) (OR [odds ratio] = 1.62, 95% CI: 1.07–2.44) or restless sleep (OR = 1.55, 95% CI: 1.10–2.19) have a higher risk of hip fracture. A U-shaped relationship between nighttime sleep duration and hip fracture risk (p-nonlinear = 0.01) was observed using restricted cubic spline regression analysis. Through joint effect analysis, we found that participants with short sleep duration (<5 h) combined with midday napping could significantly decrease hip fracture incidence. We further inferred the causal relationship between self-reported sleep behaviors and hip fracture using the MR approach. Among four sleep phenotypic parameters (sleep duration, daytime napping, chronotype, and insomnia), we found a modest causal relationship between sleep duration and fracture (OR = 0.69, 95% CI: 0.48 to 0.99, p = 0.04). However, no causal relationship was observed for other sleep traits. In conclusion, our findings suggest that short sleep duration has a potential detrimental effect on hip fracture. Improving sleep patterns is of significance for developing hip fracture preventive strategies in the middle-aged and the elderly populations. [ABSTRACT FROM AUTHOR]

Understanding local encounters with large carnivores is important for promoting sustainable coexistence. The use of smartphones and social media in geographically remote areas offers a novel avenue to study human–wildlife encounters from a local perspective. We conducted a content analysis of mobile videos on social media (n = 207) to characterize human encounters with snow leopards, gray wolves, and brown bears on the Tibetan Plateau in China. We also used ethnographic interviews to understand the backgrounds and motivations of videographers. Results show large carnivore encounters are not necessarily conflictual. Over half of encounters are neutral without observable interference between people and predators. The likelihood of a "negative encounter" is significantly associated with the target species, the distance between the videographer and the animal, the level of human influence in the surroundings, and the presence of other animals (i.e., dogs and livestock). Local Tibetan herders document unusual encounters with carnivores using videos for various reasons, but what is deemed unusual is context‐dependent and fluid. Our study demonstrates that social media videos can provide valuable insights into the diversity and complexity of human–wildlife interactions. We encourage conservationists to develop visual participatory programs to better engage local people in conservation knowledge production. [ABSTRACT FROM AUTHOR]

Background: Continuing professional development (CPD) is essential for career progression and maintaining military nursing competency. A well-designed CPD programme can improve the effectiveness of transforming knowledge and skills in healthcare organisations. This study aimed to develop a competency-based CPD curriculum for military nurses in China and evaluate its effectiveness from a developmental pilot study. Methods: In phase one, a two-round Delphi was conducted to design a competency-based curriculum of CPD based on a clinical ladder model among military nurses. In phase two, the curriculum of one CPD programme was redesigned, and a pilot quasi-experiment was conducted to evaluate the effectiveness of this programme. Results: A competency-based curriculum was developed for primary, intermediate, and senior titles, respectively. The trainees' overall satisfaction with the redesigned CPD programme was 100%. The four themes in the qualitative data were: 1) learning motivation and learning barriers; 2) professional growth; 3) role model promoted career planning; 4) learning environment mattered. Conclusion: This study developed a competency-based curriculum for continuing professional development among military nurses that can be used in designing CPD programmes. Competency-based curriculum can be utilised in the CPD activities to facilitate the improvement of nursing competency. [ABSTRACT FROM AUTHOR]

Objective. A rising trend in electronic use has increased the prevalence of myopia in adolescents, but the optimal approach to controlling myopia remains undetermined. Here, we explored the effects of common single vision (SV) spectacle lenses combined with 0.01% atropine eye drops (SV + A), orthokeratology (OK) lenses, and peripheral defocus (PD) spectacle lenses on myopia control in adolescents. Methods. Totally 150 myopic adolescent patients (300 eyes) receiving treatment at The First People's Hospital of Chenzhou City were enrolled. According to doctors' advice and guardians' wishes, the patients were divided into SV + A group, OK group, and PD group, with each group consisting of 50 cases (100 eyes). The spherical equivalent, axial length, accommodative response index (accommodative sensitivity and accommodative lag), and intraocular pressure were compared before and after 12 months of wearing lenses, and the complications were recorded. Results. Before wearing lenses, there was no statistical significance in baseline characteristics such as age, gender, and spherical equivalent among the three groups (P > 0.05). After wearing lenses, the increase in spherical equivalent and axial length in the SV + A and OK groups were lower than in the PD group (P < 0.05), and the SV + A group had the lowest axial length growth. Compared with the SV + A group, accommodative sensitivity was much higher and accommodative lag was significantly lower in the OK and PD groups (P < 0.01). In addition, there was no significant difference in intraocular pressure before and after wearing lenses among the three groups (P > 0.05). Though the OK group patients had more complications, the difference was not statistically significant (P > 0.05). Conclusion. SV + A, OK, and PD lenses can effectively control the progression of myopia in adolescents, but SV + A and OK lenses exhibited more significant effects. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing longevity of the world's population, with an unprecedented rise in the number of people who need palliative care (PC), there has been sparse research regarding palliative care for older people, especially when it comes to comparison of PC between healthcare systems and cultures. The aim of this systematic scoping review was to identify the characteristics of the body of literature and to examine the knowledge gaps concerning PC research for older people (> 60 years) in two healthcare systems and cultures, mainland China and Sweden. Methods: The guidelines PRISMA (Preferred Reporting Items for Systematic Reviews), and PICOS (Patient/population, Intervention, Comparison/control, and Outcome) were used. Empirical studies on patients 60 years or older, next of kin or staff participating in a palliative care intervention or setting were included. They were conducted in mainland China or in Sweden during 2007–2019, were published in English and were extracted from seven databases: Embase, PubMed, Scopus, Cinahl, PsycInfo, Academic Search Complete and Cochrane Library. Two independent researchers conducted the selection of studies, data extraction and methodological evaluation. Any disagreements were resolved in consultation with a third researcher. The analysis was manifest directed content analysis based on PICOS domains. Results: Of the 15 studies, four were from mainland China and 11 from Sweden. Both countries included older patients with cancer but also other end-stage diseases such as heart failure and dementia. The studies differed in design, method and the content of the interventions. The study in China based on traditional Chinese medicine concerns traditional Chinese folk music. The six qualitative studies from Sweden were evaluations of five interventions. Conclusions: Despite the high age of the participating patients, there was no focus on an ageing perspective concerning palliative care. To adapt to the changes taking place in most societies, future research should have increased focus on older persons' need for palliative care and should take account of issues concerning research ethics, ethnicity and culture. Registered in Prospero: CRD42020078685, available from. [ABSTRACT FROM AUTHOR]

Use of aerobic denitrifying consortia, as a new efficient tool for nitrogen removal, has attracted widespread attention because of their stable and efficient nitrogen removal ability. Yet, little attention has been given to highly efficient aerobic denitrifying consortia from mariculture environments. In this study, a natural aerobic denitrifying consortium, named C3, was obtained by an enrichment technique from a coastal mariculture area of Dongshan Bay of Fujian Province, China. In culture, it exhibited good and stable nitrate removing performance. Nitrogen mass balance indicated that 49.30% of the initial TN was converted into gaseous nitrogen and 49.63% was assimilated to biomass nitrogen. High-throughput sequencing and network analysis revealed that Pseudomonas and Fusarium were putative dominant aerobic denitrifying bacterial and fungal species, respectively, cooperating with Exophiala , Penicillium , Mortierella , Neocamarosporium , Neocosmospora , Sterigmatomyces , Thelebolus , Thermomyces , Cutaneotrichosporon and Gymnopilus to perform aerobic denitrification. In addition, four Pseudomonas strains have been successfully isolated from consortium C3, which supported the inference that Pseudomonas was the dominant contributor in the aerobic denitrifying consortium C3. These results will offer novel insights into aerobic denitrifying consortia in mariculture environments for biotechnological nitrogen pollution removal. • An aerobic denitrifying consortium C3 was screened through sub-cultures. • NO 3 − and TN removal efficiencies of C3 could reach 99.14% and 49.30%, respectively. • NO 3 − removal pathways of C3 were demonstrated by nitrogen mass balance. • Potential microbial cooperative interactions drove the nitrate removal process. • Dominant contribution of Pseudomonas in C3 was supported by the isolation of single strains. [ABSTRACT FROM AUTHOR]

Ketamine, as a non-competitive antagonist of N-methyl-D-aspartate (NMDA) receptors, was originally used in general anesthesia. Epidemiological data show that ketamine has become one of the most commonly abused drugs in China. Ketamine administration might cause cognitive impairment; however, its molecular mechanism remains unclear. The glymphatic system is a lymphoid system that plays a key role in metabolic waste removal and cognitive regulation in the central nervous system. Focusing on the glymphatic system, this study evaluated the behavioral performance and circulatory function of the glymphatic system by building a short-term ketamine administration model in mice, and detected the expression levels of the 5-HT2c receptor, ΔFosb, Pten, Akt, and Aqp4 in the hippocampus. Primary astrocytes were cultured to verify the regulatory relationships among related indexes using a 5-HT2c receptor antagonist, a 5-HT2c receptor short interfering RNA (siRNA), and a ΔFosb siRNA. Ketamine administration induced ΔFosb accumulation by increasing 5-HT2c receptor expression in mouse hippocampal astrocytes and primary astrocytes. ΔFosb acted as a transcription factor to recognize the AATGATTAAT bases in the 5′ regulatory region of the Aqp4 gene (−1096 bp to −1087 bp), which inhibited Aqp4 expression, thus causing the circulatory dysfunction of the glymphatic system, leading to cognitive impairment. Although this regulatory mechanism does not involve the Pten/Akt pathway, this study revealed a new mechanism of ketamine-induced cognitive impairment in non-neuronal systems, and provided a theoretical basis for the safety of clinical treatment and the effectiveness of withdrawal. [Display omitted] • Ketamine administration causes circulatory dysfunction of glymphatic system. • Ketamine administration induces cognitive impairment in mice. • Ketamine induces ΔFosb accumulation by increasing the expression of 5-HT2c receptor. • ΔFosb acts as a transcription factor to recognize and inhibit Aqp4 expression. [ABSTRACT FROM AUTHOR]

The H9N2 subtype of avian influenza virus (H9N2 AIV) has caused significant losses in chicken flocks throughout China. At present, consensus has been reached that field isolates of H9N2 underwent antigenic drift to evolve into distinct groups with significant antigenic divergence from the commercially available vaccines in China. This project continues to monitor the evolution characteristics of H9N2 hemagglutinin (HA) genes in China over the past 3 yr. The results showed that the current circling H9N2 viruses were diversified into h9.4.2.5 subclade, which was genetically distant from commonly used commercial vaccine strains. Compared with vaccine strains or 2014 strains, more than 42.1% of the variable antigenic sites in recent 3 yr' strains have shown significant changes and these stacked changes have caused significant differences in antigenicity. We constructed a recombinant vaccine strain rCQY-GHHA, which uses A/Chicken/China/SichuanCQY/2014 as the framework and A/Chicken/China/SichuanGH/2020 strain, which meets the recent viral antigenic characteristics, as the HA gene donor. The recombinant strain was prepared as an oil-adjuvant inactivated vaccine following an industrial process. The results of the immune protection experiment showed that the rCQY-GHHA vaccine was better than the commercial vaccine strain SS in reducing the morbidity, pathological lesion, virus shedding, and viral load. These results provide a reference for the control of H9N2 AIV in China. [ABSTRACT FROM AUTHOR]

Background: Different degrees of self-transcendence exist in lung cancer patients, which can stimulate patients' self-awareness and promote them to face negative events in life positively, thus improving patients' quality of life and treatment outcomes. However, there are few reports on self-transcendence in lung cancer patients in China, and the related influencing factors have not yet been clarified. This study aims to investigate the current situation of self-transcendence in lung cancer patients and explore its risk factors, so as to provide a theoretical basis for clinical intervention decision-making., Methods: 243 lung cancer patients who were admitted to the Department of Lung Cancer Center of West China Hospital, Sichuan University from September 2023 to February 2024 were enrolled as the study subjects; general information questionnaire, self-transcendence scale, Herth hope scale and social support scale were used for the investigation. The influencing factors related to self-transcendence of lung cancer patients were analyzed., Results: The total mean score of self-transcendence in lung cancer patients was (44.73±8.94); the total mean score of hope level was (37.60±4.98), and the total mean score of social support was (41.31±7.27). Self-transcendence was positively correlated with hope level and social support (P<0.001, P<0.001). Education, hope level and social support were influencing factors of self-transcendence in lung cancer patients (P<0.05, P<0.001, P<0.05)., Conclusions: Self-transcendence in lung cancer patients was at a low level and was influenced by hope level and social support. Healthcare professionals should pay attention to improving the hope level of lung cancer patients, carrying out targeted psychological interventions, and at the same time guiding them to enhance the perception of social support, so as to promote the realization of self-transcendence in patients.

Background: Chronic kidney disease (CKD) is a significant public health concern, and patient self-management is an effective approach to manage the condition. Mobile applications have been used as tools to assist in improving patient self-management, but their effectiveness in long-term outpatient follow-up management of patients with CKD remains to be validated. This study aimed to investigate whether using a mobile application combined with traditional outpatient follow-up can improve health outcomes of patients with CKD ., Methods: This retrospective cohort study recruited CKD patients with stage 1-5 who were not receiving renal replacement therapy from a CKD management center. Two groups were established: the APP + outpatient follow-up group and the traditional outpatient follow-up group. Baseline data was collected from January 2015 to December 2019, followed by a three-year long-term follow-up until December 2022. Laboratory data, all-cause mortality, and renal replacement treatment were then collected and compared between the two groups., Results: 5326 patients were included in the study, including 2492 in the APP + outpatient group and 2834 in the traditional outpatient group. After IPTW virtualization matching, the final matched the APP + outpatient group consisted of 2489 cases (IQR, 33-55) and 2850 (IQR, 33-55) in the traditional outpatient group. By the end of the study, it was observed that the laboratory data of Phosphorus, Sodium, Triglyceride, Hemoglobin showed significant improvements, Furthermore the APP + outpatient group demonstrated superior results compared to the traditional outpatient group (P < .05). And it was observed that there were 34 deaths (1.4%) in the APP + outpatient group and 46 deaths (1.6%) in the traditional outpatient group(P = .49). After matching for renal replacement therapy outcomes, the two groups were found to be comparable (95% CI [0.72-1.08], P = .23), with no significant difference. However, it was noted that the traditional outpatient group had a lower incidence of using temporary catheters during initial hemodialysis (95% CI [8.4-29.8%], P < .001)., Conclusion: The development and application of an app combined with outpatient follow-up management can improve patient health outcomes. However, to ensure optimal preparation for kidney replacement therapy, patients in CKD stages 4-5 may require more frequent traditional outpatient follow-ups, and further develop an information-based decision-making support tool for renal replacement therapy., (© 2024. The Author(s).)

Objective: As an integral part of emergency medical rescue teams during public health events, understanding the core competencies that nursing personnel should possess-including theoretical knowledge, practical skills, comprehensive abilities and personal traits-can provide a practical basis for better preparation and targeted training for future emergency rescue works. Thus, this study aims to provide a scientific and applicable reference for perfecting the routine training strategy of nursing personnel assembled by emergency medical rescue teams and improving the overall guarantee ability level of this group., Design: This is a qualitative study conducted using individual semi-structured interviews. All interviews were recorded and transcribed verbatim for the purpose of thematic analysis and extraction., Setting: Participants were recruited from February to March 2023, from four comprehensive hospitals in Chongqing China with the highest number of emergency relief works., Participants: A sample of experts (N=15) with extensive experience in emergency relief works was recruited in Chongqing, China., Results: 60% of the experts held master's degrees or higher, 73.3% held senior or higher titles, 36.7% had participated in work execution more than five times and 73.3% held leadership positions in their current units and in the execution of emergency relief works. Four main themes and 22 corresponding subthemes were derived for the core competencies required for nursing personnel selected for emergency medical rescue teams in public health events, including theoretical knowledge, practical skills, comprehensive abilities and personal traits., Conclusions: Our study revealed that through interviews with 15 experts with extensive experience in the public health event, the essential elements of core competencies for nursing personnel assigned to emergency medical rescue teams during the public health event were identified. These can serve as a reference standard for the selection of nursing personnel in public health events, and provide a basis for the cultivation and evaluation of competency for nursing personnel assigned to emergency medical rescue teams in the public health event in China and globally., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In the global trend of actively promoting the participation of older adults in the digital age, the relevant negative issues featuring potential Internet Addiction (IA) among them has risen to be a new challenge facing the global public health. However, there is a severe lack of related research. This study aimed to gain a comprehensive understanding of the phenomenon and process of IA among the elderly. The purpose of this paper is to introduce factors that may influence IA in the demographic., Methods: This study employed qualitative descriptive research methods to investigate older adults' perceptions and experiences of IA. Semi-structured in-depth personal interviews were conducted between March and June 2023 with 36 senior citizens from urban communities in Chongqing, Southwest China. Data were analyzed via inductive content analysis methods., Results: Through data analysis, 2 main categories concerning IA in older adults were identified: risk factors and protective factors. The risk factor categories include 5 individual factors (e.g., Internet as the major avenue for pursuing personal hobbies and interests, etc.), 3 family factors (e.g., household WIFI increasing the risk of prolonged Internet use indoors, etc.), 2 peer factors (e.g., peer recommendation and guidance as catalysts for intensified Internet engagement, etc.), 2 socio-environmental factors (e.g., the widespread daily Internet use spurs offline intolerance, etc.), and 3 Internet platform factors (e.g., the plenitude of online content triggers endless viewing/browsing behaviors, etc.). The category of protective factors encompasses 2 individual factors (e.g., a higher level of perceived risk regarding internet health hazards, etc.) and 2 family factors (e.g., more family commitment, etc.)., Conclusions: Older adults' Internet addictive behaviors are shaped by multiple and complex internal and external factors. A higher level of online health risk perception is a key protective factor to effectively avoid the occurrence and deterioration of IA among the aged, a distinct finding from this study. It is believed that the "individual-family-peer-community" synergy strategy is expected to become an essential direction for IA intervention for older adults, in order to promote healthy Internet use among older adults., (© 2024. The Author(s).)

Background: Previous studies have shown that changes in the microbial community of the female urogenital tract are associated with Human papillomavirus (HPV) infection. However, research on this association was mostly focused on a single site, and there are currently few joint studies on HPV infection and multiple sites in the female urogenital tract., Methods: We selected 102 healthy women from Yunnan Province as the research object, collected cervical exfoliation fluid, vaginal, urethral, and rectal swabs for microbial community analysis, and measured bacterial load, and related cytokine content. The link between HPV, microbiota, and inflammation was comprehensively evaluated using bioinformatics methods., Findings: The impact of HPV infection on the microbial composition of different parts varies. We have identified several signature bacterial genera that respond to HPV infection in several detection sites, such as Corynebacterium, Lactobacillus, Campylobacter, and Cutibacterium have been detected in multiple sites, reflecting their potential significance in cross body sites HPV infection responses. There was a solid microbial interaction network between the cervix, vagina, and urethra. The interrelationships between inflammatory factors and different bacterial genera might also affect the immune system's response to HPV infection., Interpretation: It might be an effective strategy to prevent and treat HPV infection by simultaneously understanding the correlation between the microbial changes in multiple parts of the female urogenital tract and rectum and HPV infection, and controlling the microbial network related to HPV infection in different parts., (© 2024. The Author(s).)

Background: Although increasing evidence has revealed the efficacy of acupuncture in obesity/overweight, actual improvement in metabolism in children and adolescents is unclear. Therefore, we conducted a meta-analysis to evaluate this correlation., Methods: A comprehensive search was conducted using multiple databases, including Medline, Cochrane, Embase, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, to identify relevant randomized controlled trials published before February 1, 2023. General information and data for the descriptive and quantitative analyses were extracted., Results: Fifteen randomized controlled trials of 1288 obese/overweight children and teenagers were included. All the trials were conducted in China and South Korea. Regarding quality assessment, no other significant risk of bias was found. The acupuncture groups were more likely to have improved metabolic indicators of obesity/overweight than the control groups, in terms of body mass index (standardized mean difference [SMD] = -0.45, 95% confidence interval [CI]: -0.69 to -0.21, I2 = 71.4%), body weight (SMD = -0.48, 95% CI: -0.92 to -0.05, I2 = 84.9%), and serum leptin (SMD = -0.34, 95% CI: -0.58 to -0.10, I2 = 91.8%). The subgroup analysis showed that for body mass index, the results were consistent regardless of the intervention duration, body acupuncture or auricular acupuncture combined with other interventions., Conclusion: Our results suggest that acupuncture is effective in improving metabolic outcomes of obese/overweight children and adolescents. Owing to the limited number of trials included in this study, the results should be interpreted with caution., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The process of education is mutual. The learning needs of students need to be paid attention to and can affect the learning outcome. In order to make nursing postgraduates' curriculum better, meet the learning needs of students, and help to achieve the learning objectives of students, this study based on Hutchinson's learning needs theory, aims to collect the learning experience of nursing graduates, as well as the gap between learning needs and target needs, and explore the benefits and barriers of nursing graduates in the curriculum learning. It may provide beneficial reference for further optimizing teaching content and improving teaching methods., Methods: This study was designed as a qualitative research. Purposive sampling was used to recruit 17 nursing postgraduates in the only two universities in Chongqing, Southwest China, 2021. Semi-structured, in-depth individual interviews were conducted to explore how they subjectively experience the benefits and demands of the professional curriculum. Data was analyzed using Colaizzi's seven-step analysis., Results: Three main themes "clear learning cognition and goals," "positive learning attitude," and "the gap between learning goals and actual needs" were identified from the original data. Respectively, Subthemes concerning the first theme included "improve scientific research capabilities, enlighten thinking and broaden your horizons, and learn new knowledge and new skills." Subthemes of the second theme were "improve abilities in practice and actively seek diversification of course content and format." Subthemes of the third theme included "the course has a certain depth and breadth, but the course study does not meet the needs of scientific research, the course contents are theoretical, not knowing how to use the research method in certain conditions.", Conclusions: The learning needs of nursing postgraduates in Southwest China could be divided into two parts: benefits and barriers, among which the benefits were participants had clear learning goals and positive learning attitudes. When curriculum could not meet their needs, they actively sought methods (e.g., networks or off-campus resources) to close the gap between those needs and their goals. Follow-up educators should focus on learning needs and build curricula by optimizing the contents and methods of existing teaching resources., (© 2023. The Author(s).)

Background: Older adults who live alone face challenges in daily life and in maintaining their health status quo . Currently, however, their growing demands cannot be satisfied with high quality; therefore, these demands expressed by elders may be settled in the form of smart senior care. Hence, the improvement in smart senior care may produce more positive meanings in promoting the health and sense of happiness among this elderly population. This study aimed to explore the perceptions of demands and satisfaction with regard to the provision of senior care services to the community-dwelling older adults who live alone in Southwest China, thus providing a reference for the popularization of smart senior care., Methods: This study adopted a qualitative descriptive approach on demands and the popularization of smart senior care. Semi-structured and in-depth individual interviews were conducted with 15 community-dwelling older adults who lived alone in Southwest China between March and May 2021. Thematic analysis was applied to analyze the data., Results: Through data analysis, three major themes and subcategories were generated: "necessities" (contradiction: more meticulous daily life care and higher psychological needs vs. the current lower satisfaction status quo ; conflict: higher demands for medical and emergency care against less access at present), "feasibility" (objectively feasible: the popularization of smart devices and applications; subjectively feasible: interests in obtaining health information), and "existing obstacles" (insufficient publicity; technophobia; patterned living habits; and concerns)., Conclusions: Smart senior care may resolve the contradiction that prevails between the shortage of medical resources and the increasing demands for eldercare. Despite several obstacles that stand in the way of the popularization of smart senior care, the necessities and feasibility lay the preliminary foundation for its development and popularization. Decision-makers, communities, developers, and providers should cooperate to make smart senior care more popular and available to seniors living alone, facilitating independence while realizing aging in place by promoting healthy aging., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kong, Liu, Hong, Chen and Luo.)

Background: The provinces in western China have undergone rapid urbanization and industrialization, particularly since the Chinese government launched the Great Western Development Strategy in 2000. We examined the time trends and contributions of age, period, and cohort effects to asthma incidence and mortality in Sichuan Province, a populous province in western China, from 1990 to 2019., Methods: The data of Sichuan Province from 1990 to 2019 were extracted from the Global Burden of Disease study 2019. Trends and average annual percentage change were estimated using joinpoint regression. Age, period, and cohort effects were estimated using an age-period-cohort model with the intrinsic estimator method., Results: In the latest period (2015-2019), the highest incidence of asthma was 2004.49/100,000 in children aged < 5 years, and the highest mortality rate was 22.04/100,000 for elderly people aged > 80 years. Age-standardized rates generally remained stable (95% confidence interval [CI]  - 0.21, 0.11) for incidence and declined by 4.74% (95% CI - 5.09, - 4.39) for mortality over the last 30 years. After controlling for other effects, the age effect on asthma showed that the incidence rate ratio (RR) was highest in the < 5 years age group, and the mortality RR was highest in the > 80 years age group. The period effect on incidence and mortality decreased from 1990 to 2019, respectively. A cohort effect was found the incidence RR increased slowly from the early birth cohorts to the later birth cohorts, especially after the 2005 birth cohort, whereas the mortality RR continued to decline., Conclusions: There was a significant effect of older age on the asthma mortality rate over the last 30 years, and the incidence rate in children aged < 5 years increased. The relative risk of asthma incidence in the later birth cohorts increased. Effective preventive measures and public health policies should be to protect children and elderly people from potentially harmful chronic diseases., (© 2022. The Author(s).)

Background: Considering older adults are getting closer to the end-of-life and face death more directly. Attitudes to death not only affect the physical and mental health of older adults, but also affect their acceptance of hospice care, even the quality of death. This study aims to explore the status, influencing factors of attitudes toward death and demands of death education among the community-dwelling older adults in southwestern China., Methods: A cross-sectional survey was adopted to investigate 683 community-dwelling older adults in Chongqing, China. Non-parametric test and multiple linear regression analysis was used to explore the influencing factors of different attitudes toward death of older adults in community., Results: The multiple linear regression models showed that different dimensions of death attitudes were affected by one or more factors including number of diseases, discussion about life and death, marital status, and average income per month. And community-dwelling older adults have high level demand for death education., Conclusions: Under the taboo culture of death in China, this study is one of the few studies on the attitudes toward death and the demands for death education of the community-dwelling older adults. This study contributes to enrich the global death studies and provide reference for the death education for older adults., (© 2022. The Author(s).)

Background: The rapid development of digital health has reduced the time and cost of medical treatment, bringing efficient and economical benefits. However, older adults all over the world are deficient in digital health knowledge and skills to varying degrees. This study intends to investigate the current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China, so as to provide theoretical reference for global digital health researches and the construction of gerontological digital health service models., Methods: A cross-sectional survey was conducted from September 2020 to April 2021 in Chongqing, China. 572 community-dwelling older adults (≥ 65 years) were surveyed by stratified sampling. Data on sociodemographic characteristics, Internet usage, attitude towards Internet health information and digital health literacy were collected. Wherein, the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test-retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity. The influencing factors were explored by univariate analysis and multiple linear regression analysis., Results: The average score of digital health literacy was 37.10 (SD 18.65). Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables, such as different age and education levels. Multiple linear regression analysis showed that education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy, while age and perceived risk were negatively correlated with digital health literacy., Conclusion: The overall digital health literacy of community-dwelling older adults in Southwest China is relatively low. In the future, health professionals should fully consider the diverse influencing factors of digital health literacy, assess individual differences and provide targeted intervention programs. Meanwhile, global public health authorities should integrate health resources effectively, and seek health service models for older adults in line with the development of the digital age to narrow the digital divide., (© 2022. The Author(s).)

Abstract: Chronic hepatitis B virus (HBV) infection is a serious health issue because of its severe sequelae. Prevention of mother-to-child transmission (MTCT) of HBV is critical to eliminate chronic HBV infection. Here, we reviewed the progress toward the elimination of HBV infection in children in China in the recent decade. A universal hepatitis B vaccination program started from 2002 has been intensified, with the coverage of timely birth dose >95% of all newborn infants from 2012. Since 2011, China has taken a nationwide program to administer hepatitis B immunoglobulin (HBIG) with free of charge in all neonates of HBV-infected mothers, leading to a significant increment of timely use of HBIG. The prevalence of hepatitis B surface antigen (HBsAg) was declined from around 10% among children in 1980s to <0.5% among children born after 2011. Administration of oral antiviral agents in HBV-infected pregnant women with HBV DNA >2 × 105 U/mL during the third trimester is increasing, which will further reduce MTCT of HBV. However, there are some challenges in the elimination of HBV infection in children, which need to overcome by the concerted efforts. Nevertheless, it is anticipated that China will achieve the goal set by the World Health Organization that the prevalence of HBsAg in children aged <5 years is ≤0.1% by 2030., (Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)