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While ChatGPT has recently become very popular, AI has a long history and philosophy. This paper intends to explore the promises and pitfalls of the Generative Pre-trained Transformer (GPT) AI and potentially future technologies by adopting a speculative methodology. Speculative future narratives with a specific focus on educational contexts are provided in an attempt to identify emerging themes and discuss their implications for education in the 21st century. Affordances of (using) AI in Education (AIEd) and possible adverse effects are identified and discussed which emerge from the narratives. It is argued that now is the best of times to define human vs AI contribution to education because AI can accomplish more and more educational activities that used to be the prerogative of human educators. Therefore, it is imperative to rethink the respective roles of technology and human educators in education with a future-oriented mindset.

Teachers' conceptions of assessment are a significant indicator of teacher assessment literacy. This study contextualized pre-service teachers' conceptions of assessment in Chinese second language education. An exploratory factor analysis generated eight first-order factors and the following confirmatory factor analysis found a hierarchical model, reflecting a noticeable influence of prior learning experiences and official assessment regimes on conceptions. A follow-up latent profile analysis showed three profiles. Improvement-oriented was the most prevalent profile, but more than 40% of the participants were categorized as negative. The study substantiated the need to develop an integrative and balanced understanding of assessment in teacher education to prepare pre-service teachers for teaching in international contexts.

While phonetic training in laboratory settings has been shown to be helpful for second language (L2) sounds learning in prior studies , it is still open to debate whether a perception- or a production-based approach can better help adults learn L2 sounds in classroom settings. This study aimed to fill this knowledge gap. The participants were three groups of adult Chinese college students who had difficulties in perceiving and producing English/?/-/s/and/ð/-/z/. Group 1 and Group 2 were exposed to a perception-based and a production-based training approach respectively. Group 3 was the control group (no training). The training materials were "minimal pairs" embedding the target contrasts in various phonetic environments. Each session included explicit articulatory instructions and perception- or production-based practice activities. Individual participants' perception and production of the target contrasts were tested before (pretest), after (posttest), and one month after the training programme (delayed posttest). According to the results, (1) in comparison with the pretest, both the perception- and production-based groups showed significant perception and production improvement in the posttest, which remained in the delayed posttest; the control group had no significant perception or production changes across the three tests; (2) the production-based group had significantly better perception and production performance than the perception-based group both in the posttest and the delayed posttest. The overall results suggest that a production-based approach may be optimal for L2 sounds learning.

Abstract Background Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China. Methods We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs’ characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation. Results This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs’ heavy workload, and 12 enablers such as HCWs’ passion towards TCP planning. Conclusions With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed. Graphical Abstract

Abstract Objective This study aims to examine the impact of PE/PPE gene mutations on the transmission of Mycobacterium tuberculosis (M. tuberculosis) in China. Methods We collected the whole genome sequencing (WGS) data of 3202 M. tuberculosis isolates in China from 2007 to 2018 and investigated the clustering of strains from different lineages. To evaluate the potential role of PE/PPE gene mutations in the dissemination of the pathogen, we employed homoplastic analysis to detect homoplastic single nucleotide polymorphisms (SNPs) within these gene regions. Subsequently, logistic regression analysis was conducted to analyze the statistical association. Results Based on nationwide M. tuberculosis WGS data, it has been observed that the majority of the M. tuberculosis burden in China is caused by lineage 2 strains, followed by lineage 4. Lineage 2 exhibited a higher number of transmission clusters, totaling 446 clusters, of which 77 were cross-regional clusters. Conversely, there were only 52 transmission clusters in lineage 4, of which 9 were cross-regional clusters. In the analysis of lineage 2 isolates, regression results showed that 4 specific gene mutations, PE4 (position 190,394; c.46G > A), PE_PGRS10 (839,194; c.744 A > G), PE16 (1,607,005; c.620T > G) and PE_PGRS44 (2,921,883; c.333 C > A), were significantly associated with the transmission of M. tuberculosis. Mutations of PE_PGRS10 (839,334; c.884 A > G), PE_PGRS11 (847,613; c.1455G > C), PE_PGRS47 (3,054,724; c.811 A > G) and PPE66 (4,189,930; c.303G > C) exhibited significant associations with the cross-regional clusters. A total of 13 mutation positions showed a positive correlation with clustering size, indicating a positive association. For lineage 4 strains, no mutations were found to enhance transmission, but 2 mutation sites were identified as risk factors for cross-regional clusters. These included PE_PGRS4 (338,100; c.974 A > G) and PPE13 (976,897; c.1307 A > C). Conclusion Our results indicate that some PE/PPE gene mutations can increase the risk of M. tuberculosis transmission, which might provide a basis for controlling the spread of tuberculosis.

Objectives: This study aimed to describe the lineage-specific transmissibility and epidemiological migration of Mycobacterium tuberculosis in China. Methods: We curated a large set of whole-genome sequences from 3204 M. tuberculosis isolates, including thousands of newly sequenced genomes, and applied a series of metrics to compare the transmissibility of M. tuberculosis strains between lineages and sublineages. The countrywide transmission patterns of major lineages were explored. Results: We found that lineage 2 (L2) was the most prevalent lineage in China (85.7%), with the major sublineage 2.2.1 (80.9%), followed by lineage 4 (L4) (13.8%), which comprises major sublineages 4.2 (1.5%), 4.4 (6.2%) and 4.5 (5.8%). We showed evidence for frequent cross-regional spread and large cluster formation of L2.2.1 strains, whereas L4 strains were relatively geographically restricted in China. Next, we applied a series of genomic indices to evaluate M. tuberculosis strain transmissibility and uncovered higher transmissibility of L2.2.1 compared with the L2.2.2 and L4 sublineages. Phylogeographic analysis showed that southern, eastern, and northern China were highly connected regions for countrywide L2.2.1 strain spread. Conclusions: The present study provides insights into the different transmission and migration patterns of the major M. tuberculosis lineages in China and highlights that transmissible L2.2.1 is a threat to tuberculosis control.

With a view to facilitating good practice and enhancing further exchanges and collaboration with the Open University UK, the Open University of China initiated a joint programme of training to offer online tutors and academic management staff three courses: Student Support, Tutoring On-line, and Course Design. The programme brought in not only a new learning mode and a new learning management system, but also new ideas and new assessment mechanisms, which created a positive impact on the reform of teaching and learning in the Open University of China. This paper will reflect on the implementation of the programme to explore the value of international collaboration and to look at changes that have taken place in both tutors and trainees. Through analysing feedback from both tutors and trainees, we can appreciate the potential significance of the joint programme and reflect on our own practice. The paper will also indicate some of the defects of the programme--our students expected more relevant content--and more involvement on the part of the UK experts, so that we can further explore improvements and join hands for meaningful collaboration. (Contains 3 tables.)

IntroductionThe construction of digital villages is widely acknowledged as a way to achieve the “dual goals” of high quality of the agricultural and rural economy and common prosperity under the digital China strategy. Studies have explored the socio-economic benefits of different aspects of rural digitization, but few have focused on the productivity role of rural broadband development in the context of the urban-rural broadband divide. The purpose of this paper is to explore the relationship between rural broadband development and agricultural total factor productivity (TFP) and the intrinsic mechanism of action, and to provide empirical evidence on the productivity effect of promoting digital transformation in rural agriculture.MethodsUsing panel data from 31 provinces in China from 2011 to 2020, this paper investigates the impact and mechanism of rural broadband development on agricultural TFP from the perspective of agriculture-related loans by setting up a two-way fixed effects model, a mechanism effects model and a threshold effects model.ResultsThe results find that rural broadband development has a significant role in enhancing agricultural TFP. Heterogeneity analysis indicates that the productivity-enhancing effect of rural broadband development is remarkable only in the central region and the region with higher rural disposable income. Mechanism analysis points out that rural broadband development can increase agricultural TFP by influencing the share of farm-related loans. Threshold analysis further reveals that the role of increasing the share of farm-related loans on agricultural TFP is marked only after rural broadband development reaches a certain level.DiscussionThese findings can provide practical guidance for other developing countries in accelerating the digital transformation of villages and optimizing factor allocation to achieve high-quality agricultural development.

Abstract Background Leeches are an integral component of aquatic biocenosis and can be found in a wide range of ecosystems such as freshwater, saltwater, flowing, and still-water ecosystems. It especially plays an important role in the freshwater benthic community and is an important part of the food web. In this study, a leech species was found in the mantle cavity of wild freshwater mussels in Zigong City, Sichuan Province, China, and its identity was determined through morphological analysis and molecular biological analysis. Results The leech is Hemiclepsis khankiana, a new species of Hemiclepsis that has been discovered in Russia in recent years. Through morphological analysis, the current survey observed that the morphological characteristics of Hemiclepsis khankiana eyespots were significantly different from the first reported description. The first pair of eyespots on the leech were separated and clear, while it had been reduced to unclear shadows in the previous report. The phylogenetic tree based on the COI gene showed that the COI gene sequence obtained in this study was in the same evolutionary branch as Hemiclepsis khankiana (MN295420, MN295421). Genetically, it was most closely related to Hemiclepsis kasmiana (mean COI p-distance = 3.98%). Conclusions The current study reported on the new distribution range of Hemiclepsis khankiana, which was initially discovered in China. This study indicates that the distribution range of the leech species has expanded, laying a foundation for further studies in China.

Abstract Early and accurate prediction and simulation of grain crop yield can help maximize the revision and development of regional food policy, which is crucial for ensuring national food security. The development of unmanned aerial vehicle (UAV) technology is gradually gaining an advantage over satellite remote sensing at the field scale. In this study, we predicted maize yield using canopy vegetation indices (VIs) and crop phenology metrics obtained through UAV with ordinary least squares (OLS), stepwise multiple linear regression (SMLR) and gradient‐boosted regression tree (GBRT). The results reveal that the VIs extracted from UAV imagery had a high correlation with yield (R = 0.92), facilitating crop yield estimation. Additionally, coupling crop phenology significantly improved the prediction accuracy of SMLR, with the highest R2 and lowest RMSE of 0.894, 1.238 × 103 kg ha−1, respectively. But, the enhancement of GBRT by this method was slender. Its simulation outperformed OLS and SMLR with dramatic R2, RMSE, and MAE of 0.892, 1.189 × 103 kg ha−1, and 9.150 × 102 kg ha−1, respectively. Moreover, the blister stage was deemed the optimal stage for maize yield prediction with an accuracy rate exceeding 81%. These demonstrated the feasibility of using UAV images to predict crop yields, providing an important reference at the field scale.

Abstract Background Population aging has become an escalating issue in China resulting in increasing healthcare demand. Smart senior care has the potential to help older adults live independently and relieve the pressure of healthcare including home-based care. This study aimed to explore Chinese older adults’ preferred access models and service content of smart senior care and factors affecting their willingness to choose smart senior care. Methods This was a cross-sectional study. A total of 760 community-dwelling older adults from Xuzhou, China were included in this study. Their demographics, family support, health status, smart senior care use, and willingness to choose smart senior care were collected. The Chi-square test was used for single factor analysis of each variable. The statistically significant variables were included in the logistics regression model to analyze factors influencing older adults’ willingness to choose smart senior care. The chi-square goodness of fit test was used to analyze the preferred content and access models of smart senior care; the Bonferroni method was used to correct the results. Results The finding indicated that participants’ age, number of children, frequency of children visiting parents, adequate senior care, self-reported health, chronic diseases, smartphone use, and attitude toward smart senior care were significantly associated with their willingness to choose the smart senior care (p 0.005). Regarding service content, participants desired medical care service the most (p’

Abstract Background Maternal mortality has always been a major medical concern. Recently, the successful application of extracorporeal membrane oxygenation (ECMO) technology in the rescue of near-death patients has been reported. Case presentation This study retrospectively analyzed 5 cases of critically ill pregnant women/parturients treated with ECMO for respiratory and circulatory failure in the Wuxi People’s Hospital from 2018 to 2020. The mean age of the 5 cases was 30.2 years. Among them, Cases 1 and 5 were treated with Venoarterial (VA) ECMO. Case 1 was diagnosed with congenital heart disease, atrial septal defect, and severe pulmonary hypertension. VA ECMO was applied before cesarean section and was successfully removed after double lung transplantation, but the patient died 10 months after delivery from lung infection. While Case 5 was diagnosed with systemic lupus erythematosus, lupus nephritis, thrombotic vascular disease, HELLP syndrome, and cerebral hemorrhage. VA ECMO was applied 39 days after cesarean section, and the patient died 40 days after delivery due to multiple organ failure. Cases 3 and 4 were treated with Venovenous (VV) ECMO. Case 3 was diagnosed with refractory postpartum hemorrhage, and Case 4 was diagnosed with postpartum hypoglycemic coma, aspiration pneumonia, and shock. They were treated with VV ECMO after delivery, and all survived after successful evacuation. Another Case (Case 2) was diagnosed with postpartum pelvic infection, sepsis and septic shock, and was treated with VA ECMO at 15 days after delivery. The patient changed to VV ECMO at 30 days after delivery due to significant improvement in heart function and poor lung function, but eventually died of multiple organ failure. For the 5 cases, the mean duration of ECMO was 8.7 days, the mean duration of intensive care was 22.0 days, and the mean length of hospital stay was 57.6 days. As a result, 3 patients gradually returned to normal with significant improvement in ventilation and oxygenation after ECMO treatment. Conclusions ECMO technology can be used to treat some of the critical obstetric patients with respiratory and circulatory failure that is ineffective to conventional treatment, but it has no therapeutic effect on the primary disease.

ObjectiveFrailty increases poor clinical outcomes in older adults, the aim of this study was to investigate the prevalence and factors associated with frailty and pre-frailty in older adults in China.Research design and methodsData were obtained from the Sample Survey of the Aged Population in Urban and Rural China in 2015, which was a cross-sectional study involving a nationally representative sample of older adults aged 60 years or older from 31 provinces/autonomous regions/municipalities in mainland China. The frailty index (FI) based on 33 potential deficits was used to classify individuals as robust (FI < 0.12), pre-frail (FI ≧0.12 and

ObjectiveFrailty increases adverse clinical outcomes in older patients with cardio-cerebral vascular disease (CCVD). The aim of this study was to investigate the prevalence of frailty and pre-frailty in older adults with CCVD in China and the factors associated with it.Research design and methodsIn this cross-sectional study, we used data from the fourth Sample Survey of Aged Population in Urban and Rural China. We used the frailty index for frailty and pre-frailty assessment, and the diagnosis of CCVD in older adults was self-reported.ResultsA total of 53,668 older patients with CCVD were enrolled in the study. The age-standardized prevalence of frailty and pre-frailty in older patients with CCVD was 22.6% (95% CI 22.3–23.0%) and 60.1% (95% CI 59.7–60.5%). Multinomial logistic regression analyses showed that being female, increasing age, rural residence, illiteracy, widowhood, ethnic minority, living alone, no health screening during the last year, hospitalization during the last year, difficult financial status, comorbid chronic conditions, and disability in activities of daily living were associated with frailty and pre-frailty in older patients with CCVD.ConclusionCCVD is strongly associated with frailty and pre-frailty in older Chinese people, and assessment of frailty should become routine in the management of older CCVD patients. Appropriate public health prevention strategies should be developed based on identified risk factors for frailty in older CCVD patients, which can help prevent, ameliorate or reverse the development of frailty in CCVD in the older population.

Abstract Background Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by predominant impairment of upper and lower motor neurons. Over 50 TARDBP mutations have been reported in both familial (FALS) and sporadic ALS (SALS). Some mutations in TARDBP, e.g. A382T and G294V, have genetic founder effects in certain geographic regions. However, such prevalence and founder effect have not been reported in Chinese. Methods Whole-exome sequencing (WES) was performed in 16 Chinese FALS patients, followed by Sanger sequencing for the TARDBP p.Gly298Ser mutation (G298S) in 798 SALS patients and 1,325 controls. Haplotype analysis using microsatellites flanking TARDBP was conducted in the G298S-carrying patients and noncarriers. The geographic distribution and phenotypic correlation of the TARDBP mutations reported worldwide were reviewed. Results WES detected the TARDBP G298S mutation in 8 FALS patients, and Sanger sequencing found additional 8 SALS cases, but no controls, carrying this mutation. All the 16 cases came from Southern China, and 7 of these patients shared the 117-286-257-145-246-270 allele for the D1S2736-D1S1151-D1S2667-D1S489-D1S434-D1S2697 markers, which was not found in the 92 non-carrier patients (0/92) (p

Abstract Background Primary ciliary dyskinesia (PCD) is a rare, inherited disorder of the motile cilia that exhibits genetic and clinical heterogeneity among different populations. PCD diagnosis remains challenging owing to the heterogeneity of associated clinical features and lack of a gold standard diagnostic test. Objective The aim of this study was to analyze the clinical and genetic characteristics of a group of children with clinically suspected PCD in one region of China, with the goal of providing a more robust knowledge base regarding the genetic stratification underlying this disease in Chinese populations. Methods We retrospectively analyzed the data from 38 patients with clinically suspected PCD who had undergone next-generation sequencing (NGS) between November 2016 and March 2021 in the respiratory department of a tertiary Children‘s hospital in Western China. The genetic features of the confirmed cases were summarized by reviewing data associated with other cohorts of Chinese children. Results Overall, 16 patients were ultimately diagnosed with PCD with a median age of 8.5 years. All patients presented with a chronic wet cough, 93.75% exhibited chronic or recurrent sinusitis/rhinitis, 43.75% experienced recurrent wheezing, 56.25% reported respiratory symptoms present since infancy, 31.25% had a history of neonatal respiratory distress (NRD), and 25% exhibited otitis media. Only 18.75% of these patients exhibited laterality defects. High frequencies of DNAH11 mutations were detected by integrating data from PCD patient cohorts in China. Conclusion The high frequency of DNAH11 mutations may limit the utility of transmission electron microscopy (TEM) as a first-line approach to diagnosing PCD in China in the absence of other indicators.

ObjectiveThere are few studies on the prevalence and factors associated with frailty and pre-frailty in older adults with asthma worldwide. The aim of this study was to examine the epidemiological status and factors associated with frailty and pre-frailty in older adults with asthma in China.Research design and methodsData were obtained from the Sample Survey of Aged Population in Urban and Rural China in 2015, a nationwide cross-sectional survey covering 224,142 older people aged 60 years or older in 31 provinces/autonomous regions/municipalities in mainland China. We performed frailty and pre-frailty assessments using the frailty index, and the diagnosis of asthma in the older adults was self-reported based on the history of the physician's diagnosis.ResultsNine thousand four hundred sixteen older adults with asthma were included in the study. The age-sex standardized prevalence of frailty and pre-frailty in Chinese older adults with asthma was 35.8% (95% CI 34.8%−36.7%) and 54.5% (95% CI 53.5%−55.5%). Multinomial logistic regression analysis showed that increased age, female, illiteracy, living alone, poor economic status, ADL disability, comorbid chronic diseases, previous hospitalization in the past year, and residence in northern China were associated with frailty and pre-frailty in older adults with asthma.ConclusionThe prevalence of frailty and pre-frailty in Chinese older adults with asthma is very high, and assessment of frailty should become routine in the management of older adults with asthma. Appropriate public health prevention strategies based on identified risk factors for frailty in older adults with asthma should be developed to reduce the burden of frailty in Chinese older adults with asthma.

Meteorological hazards pose a significant risk to the operation and safety of the Chinese railway system. As China Railway High-speed (CRH) has become a vital part of the Chinese transportation infrastructure, an improved understanding of the spatial pattern of multiple hazards across the railway network is urgently needed, especially in the context of accelerated climate change. This study provides a spatial analysis of the dominant meteorological hazards affecting the CRH network (i.e., gales, rainfall, and snow), in terms of both intensity and frequency, and identifies hazard zones according to CRH operating standards. Given that meteorological hazards can lead to speed limitation or disruption of CRH trains, a risk matrix model is developed based on hazard intensity and designated railway speed to comprehensively assess the risk level of CRH lines in China. Risk assessment indicates that CRH lines exposed to hazardous levels of gales, rainfall, and snow account for 6.0%, 29.3%, and 20.0% of the total line length, respectively, while 7.3% of CRH lines are exposed to multiple hazards. Meteorological risk maps for CRH operation reveal hotspot lines that require special adaptive or preventative measures, and emergency protocols to reduce potential losses and disruptions.

Shared decision-making (SDM) is a scientific and reasonable decision-making model. However, whether physicians choose SDM is usually influenced by many factors. It is not clear whether the strained doctor–patient relationship will affect physicians' willingness to choose SDM. Through a survey by questionnaire, 304 physicians' evaluations of doctor–patient relationship (DPR) were quantified by the difficult DPR questionnaire-8. Their preferences for SDM and the reasons were also evaluated. The correlation between physicians' evaluations of DPR and their preferences for SDM were analyzed. 84.5% physicians perceived DPR as poor or strained, 53.3% physicians preferred SDM, mainly because of the influences of medical ethics and social desirability bias. Their preferences for SDM were not significantly correlated with their evaluations of DPR (P > 0.05). Physicians with different evaluations of DPR (good, poor, and strained) all had similar preferences for SDM (42.6, 56.4, and 42.9%), with no significant difference (P > 0.05). There was no correlation between physicians' evaluations of DPR and their preferences for SDM. Physicians' evaluations of poor DPR did not affect their preferences for SDM. This may be influenced by the medical ethics and social desirability bias.

BackgroundEarly adulthood is a vulnerable period for improved nutrition at all phases of the life cycle. However, there is limited research on diversity information in young adults from middle-income countries undergoing an apparent nutritional transition. The purpose of this study was to explore dietary diversity and determinants among young adults aged 18–35 years in central China.MethodsFrom January 2015 to December 2020, a cross-sectional survey of 49,021 young adults in a health management center of central China was conducted through report and phone-assisted self-report for information. The outcome variable was the Dietary Diversity Score. Independent variables included age, sex, race, material status, education, BMI, taste preference, regular meals, midnight snacks, sugared beverage/coffee consumption, and smoking/drinking status. Multivariate logistic regression was performed.ResultsOf 49,021 young adults, 38,374 (78.3%) reported insufficient dietary diversity, and 422 (0.9%) reported sufficient dietary diversity. Light taste preference [adjusted odds ratio (aOR) = 2.325; 95% CI: 1.779, 3.039] and those who had meals regularly (aOR = 1.241; 95% CI: 1.018, 1.513) and consumed coffee (aOR = 2.765; 95% CI: 2.257, 3.387) were more likely to be associated with sufficient dietary diversity. Midnight snacks (aOR = 0.728; 95% CI: 0.588, 0.901) and sugary beverages (aOR = 0.666; 95% CI: 0.535, 0.829) were less likely to be associated with sufficient dietary diversity. Higher BMI (aOR = 1.092; 95% CI: 1.061, 1.125) was associated with higher odds of sufficient dietary diversity. Additionally, participants who were 18–30 years old, with master or above degree and away from cigarette/alcohol were more likely to report better dietary diversity.ConclusionOur results painted a less than ideal nutritional condition affecting young adults. High-fat/sugar/salt dietary practices can lead to low dietary diversity, while high dietary diversity might have adverse BMI outcomes in youth. This study highlighted the importance of increasing the diversity of healthy and selective food items before wide recommendation for dietary diversity.

ObjectiveTo determine the prevalence of thyroid nodules in Chinese adult women. To analyze the relationships between lifestyle, metabolic syndrome and thyroid nodules.MethodsWe conducted a retrospective cross-sectional study in the tertiary hospital from 2017 to 2019. Included participants underwent thyroid color Doppler ultrasonography, lipids examination, and dietary evaluation.ResultsTotally 2,784 participants were included, and 933 participants were found to have thyroid nodule(s) by B-ultrasound. The prevalence of thyroid nodules was 33.3%. Women in 50-59 years (OR: 1.746, 95% CI [1.356-2.249]), older than 60 (2.147 [1.540-2.993]) and occupations with mainly manual work (1.780 [1.367-2.317]) were risk factors for thyroid nodules, while moderate dietary diversity (0.624 [0.476-0.817]) and normal triglycerides level (0.739 [0.604-0.905]) were protective factors.ConclusionWomen over 50 and those whose jobs are mainly manual should enhance screening, follow-up and health management of thyroid nodules. Higher dietary diversity is protective measures against thyroid nodules for adult women and should consider dietary balance and the food varieties, not just increased quantities.

This study investigates the dynamic impact of green energy investment and energy consumption on carbon emissions in China from 1995 to 2020. It employed the Bootstrap Autoregressive Distributed Lag method to examine the short and long-run relationship. The long-run findings indicate that green energy investment and renewable energy consumption decrease carbon emissions, whereas non-renewable energy consumption and economic growth increase carbon emissions in shorter and longer periods. The long-term reduction in carbon emissions may imply the transition toward carbon neutrality. However, the marginal contribution of renewable energy towards carbon neutrality is significantly higher than green energy investment due to investment lag effects. Moreover, the Error Correction Term (ECT) is significantly negative, authorizing the convergence towards steady-state equilibrium in case of any deviation with a 25% adjustment rate. The empirical results suggest that China should encourage green energy investment and increase the share of renewable energy sources to ensure carbon neutrality in the long run.

As the world's biggest carbon dioxide (CO2) emitter and the largest developing country, China faces daunting challenges to peak its emissions before 2030 and achieve carbon neutrality within 40 years. This study fully considered the carbon-neutrality goal and the temperature rise constraints required by the Paris Agreement, by developing six long-term development scenarios, and conducting a quantitative evaluation on the carbon emissions pathways, energy transformation, technology, policy and investment demand for each scenario. This study combined both bottom-up and top-down methodologies, including simulations and analyses of energy consumption of end-use and power sectors (bottom-up), as well as scenario analysis, investment demand and technology evaluation at the macro level (top-down). This study demonstrates that achieving carbon neutrality before 2060 translates to significant efforts and overwhelming challenges for China. To comply with the target, a high rate of an average annual reduction of CO2 emissions by 9.3% from 2030 to 2050 is a necessity, which requires a huge investment demand. For example, in the 1.5 °C scenario, an investment in energy infrastructure alone equivalent to 2.6% of that year's GDP will be necessary. The technological pathway towards carbon neutrality will rely highly on both conventional emission reduction technologies and breakthrough technologies. China needs to balance a long-term development strategy of lower greenhouse gas emissions that meets both the Paris Agreement and the long-term goals for domestic economic and social development, with a phased implementation for both its five-year and long-term plans.

Background: The trends of obesity-associated metabolic status in Chinese are lacking, especially those from different regions.Objectives: To examine the trends of obesity and metabolic status among Chinese population in 2012–2020.Methods: In a series cross-sectional study, data on 256,782 participants surveyed between 2014 and 2020 in Beijing, northern China, and 697,170 participants surveyed between 2012 and 2020 in Hunan, southern China were analyzed. Anthropometrics, blood pressure measurements, and blood tests were performed according to standard protocols. Trends in obesity and metabolic status were evaluated using the Joinpoint software.Results: Based on age- and sex-standardized values, the mean BMI values in northern and southern participants were 23.94 (95% CI: 23.93, 23.95) and 23.68 (95% CI: 23.67, 23.69) kg/m2, respectively. Between 2014 and 2020, the overall obesity prevalence among northern participants increased from 12.70% (95% CI: 12.17, 13.23%) to 14.33% (95% CI: 13.97, 14.70%) (P = 0.009), mainly derived by the 20–39 and 40–59 age groups. Moreover, the prevalence of metabolically healthy obese significantly increased from 2.07% (95% CI: 1.84, 2.30%) to 4.33% (95% CI: 4.13, 4.53%) in Northerners. Between 2012 and 2020, no significant trend in obesity was found among overall southern participants, but the prevalence of metabolically unhealthy obese significantly increased from 5.36% (95% CI: 5.18, 5.54%) to 7.35% (95% CI: 7.11, 7.58%), mainly derived by the 20–39 and 40–59 age groups.Conclusions: The trends in obesity and metabolic status were different between southern and northern Chinese. A national weight control plan is needed in China, focusing on young and middle-aged population.

Abstract Background China has rapidly transformed into an ageing nation and will be one of the countries with the highest percentage of aged people in 2050. Healthcare management for the aged (HMA) in basic public health service (BPHS), which is delivered by lay healthcare workers (LHWs) in primary health care (PHC) sectors, is an important strategy to address the healthcare challenges that have resulted from ageing in China since 2009. This survey aimed to understand the achievements made and challenges faced by HMA in Southwest China. Methods A multilevel stratified random and consecutive sampling method was used to select study places and participants respectively, and mixed research methods were used to collect data from the aged individuals, LHWs and leaders in PHC sectors. SPSS 21.0 was used for data analysis. Results Seven hundred seventy-two surveys with aged people (over 60 years old), 16 focus group discussions (FGDs) with 96 aged people, and 32 in-depth interviews with 16 LHWs and 16 leaders were completed in PHC sectors. More than 85% of aged individuals had knowledge and utilization of HMA, and over 94% of these respondents were satisfied with HMA. Meanwhile, challenges in HMA delivery included weakness (unmet items and lack of appropriate assessment indicators) in HMA design, low capacity of PHC sectors and competency of LHWs to deliver HMA, poor health literacy of aged individuals, insufficient funds and a lack of multi-sector cooperation. Conclusions Though significant achievements in HMA were observed, this study highlighted the challenges in further quality improvement of HMA delivery program in Southwest China. The “older-person-centered and integrated care” model provided a good theory to improve the quality of HMA by reinforcing the needs-based HMA design, building a comprehensive assessment strategy, improving the capacity of PHC sectors and the LHWs’ competency, and strengthening multi-sector cooperation.

Abstract Background Equalizing basic public health services (BPHS) for all has been one goal of the health system reform in China since 2009. At the end of the 12th five-year plan, we conducted a series of surveys to understand BPHS implementation in Southwest China, and firstly reported implementation of health education (HE) and explore the barriers to HE delivery. Methods Mixed research methods were used to investigate achievement in and barriers to HE in Southwest China. SPSS 22.0 was used for data analysis. Results Nine hundred and eighty-nine residents were surveyed by questionnaire. 16 health care workers (HCWs) and 16 directors from 16 PHC sectors were included in the in-depth interviews. Less than 50% of residents who knew or utilized some item of HE. Age, residence, region (Chongqing or Guizhou), marital status, education, occupation, type and quality of primary health care (PHC) sectors to deliver BPHS, self-reported health and status of chronic diseases were associated with knowledge or utilization of HE. Distance to PHC sectors was associated with the knowledge of HE, gender and health insurance were associated with utilization of HE. Age, marital status, occupation region and self-reported health were associated with satisfaction regarding HE. Barriers to HE delivery included defects in HE design, weak capacity in PHC sectors to provide HE, residents’ poor cooperation, lack of multi-sector cooperation, poor equipment and weak health system. Conclusions Southwest China delivered HE in all PHC sectors. However, our study underlined many barriers to equalization of HE. To address those barriers and achieve HE quality improvement, comprehensive measures to improve capacity of PHC sectors, enhance multi-sector cooperation and strengthen health information systems are all urgent needs.

Abstract Background There has been a growing interest in using diagnosis-related groups (DRGs) payment to reimburse inpatient care worldwide. But its effects on healthcare and health outcomes are controversial, and the evidence from low- and middle- income countries (LMICs) is especially scarce. The objective of this study is to evaluate the effects of DRGs payment on healthcare and health outcomes in China. Method A systematic review was conducted. We searched literature databases of PubMed, Cochrane Library, EMBASE, Web of Science, Chinese National Knowledge Infrastructure and SinoMed for empirical studies examining the effects of DRGs payment on healthcare in mainland China. We performed a narrative synthesis of outcomes regarding expenditure, efficiency, quality and equity of healthcare, and assessed the quality of evidence. Results Twenty-three publications representing thirteen DRGs payment studies were included, including six controlled before after studies, two interrupted time series studies and five uncontrolled before-after studies. All studies compared DRGs payment to fee-for-service, with or without an overall budget, in settings of tertiary (7), secondary (7) and primary care (1). The involved participants varied from specific groups to all inpatients. DRGs payment mildly reduced the length of stay. Impairment of equity of healthcare was consistently reported, especially for patients exempted from DRGs payment, including: patient selection, cost-shifting and inferior quality of healthcare. However, findings on total expenditure, out of pocket payment (OOP) and quality of healthcare were inconsistent. The quality of the evidence was generally low or very low due to the study design and potential risk of bias of included studies. Conclusion DRGs payment may mildly improve the efficiency but impair the equity and quality of healthcare, especially for patients exempted from this payment scheme, and may cause up-coding of medical records. However, DRGs payment may or may not contain the total expenditure or OOP, depending on the components design of the payment. Policymakers should very carefully consider each component of DRGs payment design against policy goals. Well-designed randomised trials or comparative studies are warranted to consolidate the evidence of the effects of DRGs payment on healthcare and health outcomes in LMICs to inform policymaking.

Abstract Background In settings such as China, where universal implementation of directly observed therapy (DOT) is not feasible, innovative approaches are needed to support patient adherence to TB treatment. The electronic medication monitor (EMM) is one of the digital technologies recommended by the World Health Organization (WHO), but evidence from implementation studies remains sparse. In this study, we evaluated acceptance of the EMM among health care workers and patients while implementing the device for differential TB patient management at the community level. Methods Zhenjiang City in Jiangsu Province was purposively selected for the study. All participating patients were allowed to select their preferred management approach. If patients declined to use the EMM, DOT was offered. The EMM was designed to hold 1 month of anti-TB drugs for once-daily dosing of fixed-dose combination (FDC) tablets. Patient EMM records were monitored monthly by a physician; if 20 to 50% of doses were missed twice, or more than 50% of doses were missed once, the patient was switched to DOT. The four physicians and five nurses involved in the study at four designated hospitals were surveyed using a structured questionnaire to assess their acceptance of the EMM. Results From October 2017 through January 2018, 316 pulmonary TB patients were notified in the TB information management system, and 231 (73.1%) met the study enrollment criteria. Although 186 patients (80.5%) initially consented to use the EMM, 17 later refused to use it. Among the 169 patients who used the EMM, 15 (8.9%) were switched to DOT due to poor adherence, and the other 154 completed the treatment course. The median adherence rate was 99.3%. Surveyed health care workers from designated hospitals found the EMM acceptable, although eight of nine felt use of the device moderately increased their workload. However, the EMM program significantly reduced the workload of community physicians by reducing patient visits by 87.9%. Conclusions This study demonstrated the acceptability of using an indigenously developed EMM for differential management of TB patients at the community level. However, more operational research should be conducted before introducing and scaling the technology throughout China.

The outbreak of coronavirus disease 2019 (COVID-19) has caused mental problems among the public and medical staff in China, especially for children and adolescents, a vulnerable group that might present with more mental problems. It seems that there is a rapid growth in the mental problems (such as depression or anxiety) of Chinese children and adolescents during the outbreak of COVID-19. Although several studies reported the prevalence of depression or anxiety problems for children and adolescents, the results are different across different age groups and sex groups. Moreover, the sample size of these studies was small. In the present study, we aim to perform a meta-analysis to identify the confirmed prevalence of depression and anxiety problems for Chinese children and adolescents during home confinement. Five databases were searched including PubMed, Web of Science, PsycINFO, Google Scholar, and the China National Knowledge Infrastructure (CNKI), and both inclusion and exclusion criteria were developed. Finally, a total of 12 studies were included in this meta-analysis. The protocol of this systematic review was registered with INPLASY (protocol ID: INPLASY202150032). It found that the pooled prevalence of mental problems was 28% (95% confidence interval, CI: 0.22–0.34), and the depression and anxiety problem for children and adolescents in China was 22% (95% CI: 0.16–0.30) and 25% (95% CI: 0.20–0.32) based on a random effect model, separately. Subgroup analysis was used to identify that there are no differences between different age groups (primary and middle school vs. high school) (p = 0.26). Meta-regression analysis was performed and the results showed that the moderator of boy percentage was a significant factor (p = 0.04). It indicated that there was an increasing number of children and adolescents with mental problems during the home confinement. It suggested that we should pay more attention to this vulnerable population during a public health crisis in the future, especially for the girls groups, and more detailed implements for mental health management were needed and should be prepared.Systematic Review: The protocol of this systematic review was registered with INPLASY. The protocol ID was INPLASY202150032

Background: COVID-19 not only threatened the public's physical health but also brought unbearable psychological pressure, especially for those vulnerable groups like the elderly. However, studies on the psychological status of older adults during this public health emergency remained scant. This study aims to investigate the mental health status among the elderly Chinese population during COVID-19 pandemic and determine the influencing factors of psychological symptoms.Methods: From February 19 to March 19, 2020, an online survey was administered to Chinese older adults using a convenience sampling method. Information on demographic data, health status and other epidemic related factors were collected. Specifically, the study defined the psychological status as five primary disorder–depression, neurasthenia, fear, anxiety, and hypochondria–which were assessed by the Psychological Questionnaire for Emergent Event of Public Health (PQEEPH). Standard descriptive statistics and multiple logistic regression analyses were conducted to analyze the data.Results: Of 1,501 participants recruited from 31 provinces in China, 1,278 were valid for further analysis. Participants' scores on each sub-scale were described in median and interquartile [M(Q)]: depression [0.00 (0.33)], neurasthenia [0.00 (0.40)], fear [1.00 (0.83)], anxiety [0.00 (0.17)], hypochondria [0.00 (0.50)]. Chronic diseases (depression p = 0.001; neurasthenia p < 0.001; fear p = 0.023; anxiety p < 0.001; hypochondria p = 0.001) and the BMI index (depression p = 0.015; neurasthenia p = 0.046; fear p = 0.016; anxiety p = 0.015; hypochondria p = 0.013) had significant impacts on all of the five sub-scales. Specifically, the rural dwellers had a higher level of neurasthenia, fear, and hypochondria. Besides, education level (p = 0.035) and outbreak risk level (p = 0.004) had significant impacts on the depression. Higher household monthly income per capita (p = 0.031), and the community-level entry/exit control (p = 0.011) are factors against anxiety.Conclusions: Most elderly residents reported mild negative emotions during COVID-19 and more attention should be paid to the recognition and alleviation of fear. Our findings also identified factors associated with the mental health status of the elderly, which is of practical significance in the design and implementation of psychological interventions for this vulnerable population during COVID-19 and future emerging diseases.

Abstract Background Solobacterium moorei, the only species in the genus Solobacterium, is a Gram-positive, non-spore-forming, strict anaerobic, short to long bacillus. It has rarely been documented to cause blood stream infections. Here we report the first case of bacteremia caused by S.moorei in China. Case presentation A 61-year-old male presented to Peking Union Medical College Hospital (Beijing) with thrombotic thrombocytopenic purpura (TTP) and several other underlying diseases. He also had persistent coma accompanied by intermittent convulsions, halitosis, and intermittent fever. Blood cultures taken when the patient had a high fever were positive, with the anaerobic bottle yielding an organism identified as S.moorei by 16S rRNA gene sequencing, whilst the aerobic bottle grew Streptococcus mitis. After replacement of venous pipeline, and empirical use of vancomycin and meropenem, the patient’s body temperature and white blood cell count returned to normal. Unfortunately, the patient died of severe TTP. Conclusion This is the first case report of S. moorei isolation from blood stream in China. 16S rRNA gene sequencing is the only method that can identify S. moorei. Blood cultures must be taken before administration of antibiotics, and anaerobic culture should be considered for such rare pathogens in patients with oral diseases and immune deficiency.

Background: Obsessive-compulsive disorder (OCD) and tic disorders (TDs) are closely related and considered to etiologically overlap. Both disorders are characterized by repetitive behaviors. TD and OCD often co-occur. The high comorbidity between OCD and TD individuals suggests that we also need to pay more attention to the homogeneity and heterogeneity between TS and OCD. To date, there has been no systematic nationwide epidemiological survey of the mental health (including tic disorders and obsessive-compulsive disorder) of children and adolescents in China. Methods: A two-stage epidemiological study of psychiatric point prevalence was conducted. We used the multistage cluster stratified random sampling strategy to assess five provinces of China. The Child Behavior Checklist was used to identify behavioral problems among the enrolled students in the first stage. The results from the Mini-International Neuropsychiatric Interview for Children and Adolescents and evaluations from two psychiatrists based on the Diagnostic and Statistical Manual-IV were used to make a diagnosis. Point weighted prevalence for TD and OCD was estimated. We adjusted prevalence estimates with the product of sampling weights and poststratification weights. Standard error values and 95% confidential intervals were generated with Taylor series linearization. Rao–Scott adjusted chi-square (χ2) tests were employed to compare the prevalence estimates of different age and sex groups. Results: In the first stage, 73,992 participants aged 6–16 years old were selected. The prevalence rates of OCD and TDs were 1.37% (95% CI: 1.28–1.45) and 2.46% (95% CI: 2.35–2.57), respectively. The prevalence of OCD was found to be higher in girls (p < 0.001) and higher in boys with transient tic disorder (TTD) (p < 0.001) and Tourette’s syndrome (TS) (p < 0.001). The most common comorbidity of TS was OCD (40.73%), and for OCD, it was TS (11.36%). Conclusions: Our study is the first nationwide survey on the prevalence of TD (2.46%) and OCD (1.37%) in school students aged 6–16 years old in China. The high comorbidity between OCD and TD individuals suggested overlap based on the prevalence dimensions, which might be influenced by age and sex. This result suggested that we also need to pay more attention to the homogeneity and heterogeneity between TS and OCD.

Abstract Background Health care workers are at the frontline in the fight against infectious disease, and as a result are at a high risk of infection. During the 2014–2015 Ebola outbreak in West Africa, many health care workers contracted Ebola, some fatally. However, no members of the Chinese Anti-Ebola medical team, deployed to provide vital medical care in Liberia were infected. This study aims to understand how this zero infection rate was achieved. Methods Data was collected through 15 in-depth interviews with participants from the People’s Liberation Army of China medical team which operated the Chinese Ebola Treatment Center from October 2014 to January 2015 in Liberia. Data were analysed using systematic framework analysis. Results This study found numerous bio-psycho-socio-behavioural risk factors that directly or indirectly threatened the health of the medical team working in the Chinese Ebola Treatment Center. These factors included social and emotional stress caused by: (1) the disruption of family and social networks; (2) adapting to a different culture; (3) and anxiety over social and political unrest in Liberia. Exposure to Ebola from patients and local co-workers, and the incorrect use of personal protective equipment due to fatigue was another major risk factor. Other risk factors identified were: (1) shortage of supplies; (2) lack of trained health personnel; (3) exposure to contaminated food and water; (4) and long working hours. Comprehensive efforts were taken throughout the mission to mitigate these factors. Every measure was taken to prevent the medical team’s exposure to the Ebola virus, and to provide the medical team with safe, comfortable working and living environments. There were many challenges in maintaining the health safety of the team, such as the limited capability of the emergency command system (the standardized approach to the command, control, and coordination of an emergency response), and the lack of comprehensive international protocols for dealing with emerging infectious disease pandemics. Conclusions The comprehensive and multidisciplinary measures employed to protect the health of the medical team proved successful even in Liberia’s resource-limited setting. The global health community can learn valuable lessons from this experience which could improve the safety of health care workers in future emergencies. These lessons include: establishing capable command systems; implementing effective coordination mechanisms; providing adequate equipment; providing training for medical teams; investing in the development of global health professionals; and improving research on ways to protect health care workers.

Background: To investigate fluoroquinolone resistance and associated mechanisms of Shigella sonnei isolates in Jiangsu Province of China between 2002 and 2011. Methods: All 337 unduplicated S. sonnei isolates were collected from hospitals in Jiangsu Province from January 2002 to December 2011. Fluoroquinolone susceptibility was characterized by Kirby-Bauer disk diffusion method, and direct nucleotide sequencing of genes of the quinolone resistance determining regions were conducted. Also, the transferable quinolone resistance determinants, including qnrA, qnrB, qnrC, qnrD, qnrS, aac-(6′)-Ib-cr and qepA were amplified by PCR. Results: Among 950 Shigella isolates, 337 (35.5%) were identified as S. sonnei, of which 76.6% displayed nalidixic acid resistance and norfloxacin-resistant isolates appeared in 2005-2009, with an average resistance rate of 21.8%. Commonly reported point mutations of Ser83Leu and Asp87Asn/Gly in gyrA and Ser80Ile in parC were detected, with mutation rates of 78.0%, 9.5% and 30.3%, respectively, while no alteration in gyrB or parE were detected. Besides, His211Tyr mutation in gyrA was first reported in a S. sonnei strain in 2009 and two novel mutations in parC were found, of which Met86Trp occurred in another strain in 2009 and Ser129Pro appeared every year except 2011 (28.8%). Plasmid-mediated quinolone resistance determinants were found in 23 isolates and 19 of these isolates were resistant to both nalidixic acid and norfloxacin. qnrB, qnrS, aac-(6′)-Ib-cr and qepA were detected in 1, 7, 14 and 2 S. sonnei strains, relatively, and the most abundant PMQR gene found in this work was aac-(6′)-Ib-cr (4.2%). Interpretation & conclusions: S. sonnei became increasingly important as fluoroquinolone-resistant isolates emerged, and further detection on the resistant genes would be useful in the treatment and control of this infection.

Melophagus ovinus (sheep ked) is a hematophagous ectoparasite that mainly parasitizes sheep. In addition to causing inflammation, wool loss, and skin damage to the animal hosts, M. ovinus also serves as a vector for a variety of pathogens and is highly likely to participate in the life and transmission cycle of pathogenic organisms. Herein, we investigated the presence and molecular characterization of vector-borne pathogens in M. ovinus from Qinghai-Tibet Plateau, China. A total of 92 M. ovinus pools collected from the Qinghai province of China were screened for the presence of selected vector-borne pathogens. The overall positive rate of A. ovis, A. bovis, A. phagocytophilum, and T. ovis in M. ovinus was 39.1%, 17.4%, 9.8%, and 89.1%, respectively. All of the samples were negative for Border disease virus (BDV), other Anaplasma species, Babesia spp., Rickettsia spp., and Borrelia spp. Co-infection of different Anaplasma species and T. ovis occurred in 51.2% of all samples with T. ovis. The positive rates of A. ovis, A. bovis, and A. phagocytophilum in different regions and altitudes of the sampling sites were significantly different. Sequence and phylogenetic analysis of target genes confirmed their identity with corresponding pathogens. Our results elucidate the occurrence and molecular characterization of Anaplasma spp. and Theileria spp. in M. ovinus, which could act as potential zoonotic reservoirs. To the best of our knowledge, this is the first report of the detection of A. bovis and A. phagocytophilum DNA in M. ovinus. This study gives the first extensive molecular survey of vector-borne pathogens with veterinary and public health significance in M. ovinus from the Qinghai-Tibet Plateau, China.

In this study, a retrospective analysis of the relationship between the land use/land cover (LULC) change and associated surface urban heat island (SUHI) effect in fast-growing Greater Hefei between 1995 and 2016 was performed. Our results reveal the heterogeneous patterns of LULC change. The concentric buffer-based urban–rural gradient analysis reveals that most of the newly emerging developed land occurred within downtown Hefei. In contrast, in three suburban municipality/county jurisdictions, the overall area change in the non-developed land was much lower, but the net increase in developed land is remarkable. Meanwhile, the spatiotemporal patterns of SUHI are in good agreement with that of the developed land, as evidenced by the notable increase in SUHI intensity (SUHII) levels and SUHI spatial extent (SUHISE) in response to the rapid urban expansion, particularly along transportation corridors. In addition, partial least square regression (PLSR) models indicate that the buffer-based predictors/independent variables are significantly related to the responses (SUHII and SUHISE), explaining approximately 61.3% of the variance in the SUHII and 79.8% of the variance in the SUHISE, respectively. Furthermore, the relative strength of the independent variables in determining the relationship was quantitatively examined. The findings of this study provide clear evidence for decision making for sustainable land development and mitigation of the SUHI effect.