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Background: Understanding how medical students respond to financial and non-financial incentives is crucial for recruiting health workers and attracting health talents in medical education. However, both incentives are integrated in working practice, and existing theoretical studies have suggested that various income levels may influence the substitution effect of both incentives, while the empirical evidence is lacking. Furthermore, little attention has been paid to the intrinsic motivation. This study aimed to explore the substitution effect of extrinsic incentives at different income levels, also taking intrinsic altruism into account. Methods: We used the behavioral data from Zhang et al.'s experiments, which involved discrete choice experiments (DCEs) to assess the job preferences of medical students from six teaching hospitals in Beijing, China. The incentive factors included monthly income, work location, work environment, training and career development opportunities, work load, and professional recognition. Additionally, a lab-like experiment in the medical decision-making context was conducted to quantify altruism based on utility function. Furthermore, we separated the choice sets based on the actual income and distinguished the medical students on altruism. The willingness to pay (WTP) was used to estimate the substitution effect of incentives through conditional logit model. Results: There was a significant substitution effect between non-financial and financial incentives. As income increased, non-financial incentives such as an excellent work environment, and sufficient career development became relatively more important. The impact of the increase in income on the substitution effect was more pronounced among individuals with higher altruism. Concerning the non-financial incentive work environment, in contrast to the growth of 546 CNY (84 USD) observed in the low-altruism group, the high-altruism group experienced a growth of 1040 CNY (160 USD) in the substitution effect. Conclusions: The increase in the income level exerted an influence on the substitution effect of non-financial incentives and financial incentives, especially in high-altruism medical students. Policymakers should attach importance to a favorable environment and promising career prospects on the basis of ensuring a higher income level. Medical school administrations should focus on promoting altruistic values in medical education, enhancing talent incentives and teaching strategies to encourage medical students to devote themselves to the medical professions. [ABSTRACT FROM AUTHOR]

Background: Rational allocation of human resources for health is crucial for ensuring public welfare and equitable access to health services. Understanding medical students' job preferences could help develop effective strategies for the recruitment and retention of the health workforce. Most studies explore the relationship between extrinsic incentives and job choices through discrete choice experiments (DCEs). Little attention has been paid to the influence of intrinsic altruism on job choice. This study aimed to explore the heterogeneous preferences of medical students with different levels of altruism regarding extrinsic job attributes. Methods: We conducted an online survey with 925 medical students from six hospitals in Beijing from July to September 2021. The survey combined job-choice scenarios through DCEs and a simulation of a laboratory experiment on medical decision-making behavior. Behavioral data were used to quantify altruism levels by estimating altruistic parameters based on a utility function. We fit mixed logit models to estimate the effects of altruism on job preference. Results: All attribute levels had the expected effect on job preferences, among which monthly income (importance weight was 30.46%, 95% CI 29.25%-31.67%) and work location (importance weight was 22.39%, 95% CI 21.14%–23.64%) were the most salient factors. The mean altruistic parameter was 0.84 (s.d. 0.19), indicating that medical students' altruism was generally high. The subgroup analysis showed that individuals with higher altruism levels had a greater preference for non-financial incentives such as an excellent work environment, sufficient training and career development opportunities, and a light workload. The change in the rate of the uptake of a rural position by individuals with lower levels of altruism is sensitive to changes in financial incentives. Conclusions: Medical students' altruism was generally high, and those with higher altruism paid more attention to non-financial incentives. This suggests that policymakers and hospital managers should further focus on nonfinancial incentives to better motivate altruistic physicians, in addition to appropriate economic incentive when designing recruitment and retention interventions. Medical school administrations could attach importance to the promotion of altruistic values in medical education. [ABSTRACT FROM AUTHOR]

Background: Genetic testing for breast cancer (BC) patients may shift the paradigm towards more personalized management and treatment strategies. While gene alterations may be ethnic-specific in breast cancer, our understanding of genetic epidemiology of BC remains mainly driven by data from Caucasian populations and further limited to selected handful of genes. Methods: We collected whole blood samples from 356 BC patients at metastatic first line BC and primary stage IV disease at Beijing Cancer Hospital between Jan. 2013 to Dec. 2019. A comprehensive 600-gene cancer panel was used to detect germline variants in the covered genes with a median 300x sequencing depth. Variants were classified into pathogenic, likely pathogenic, variant of uncertain significance, likely benign and benign groups according to the ACMG/AMP Standards and Guidelines. Pathogenic and likely pathogenic variants were considered as deleterious mutations. Results: The median age of 356 BC patients was 49 years (range, 21-87 years) at the first diagnosis of BC. Deleterious germline mutations across 48 cancer-related genes were identified in 21.6% (77/356) of the patients. The most prevalent mutations were BRCA1/2 mutations (7.0%), followed by ATM and RAD50 mutations (1.4% each). In addition, patients with family history were more likely to carry BRCA1 mutations (P=0.04). Moreover, patients with triple-negative breast cancer (TNBC) were more likely to harbor BRCA1 mutations than those with HR+ or HER2+ breast cancer (P=0.006). While there was no significant survival difference observed in BRCA1/2 carriers relative to non-carriers, patients with DNA damage repair (DDR) gene mutations (mostly frequently BRCA, ATM, RAD50) had worse disease-free survival (P=0.02). Conclusions: The most prevalent germline mutations in a large cohort of Chinese patients with advanced BC were BRCA1/2 mutations, followed by ATM and RAD50 mutations. In total, approximately 16.0% (57/356) of patients carry deleterious mutations in DDR pathway. Patients with breast or ovarian cancer family history were more likely to carry BRCA1/2 mutations, and ones with DDR mutations had worse survival. These findings suggest that DDR mutations are prevalent in Chinese BC patients who may potentially benefit from treatment with Poly (ADP-ribose) polymerase inhibitors. [ABSTRACT FROM AUTHOR]

Objective: Our study aims to clarify the role of estradiol and leptin in breast cancer risk and prognostic assessment in postmenopausal Chinese women. Design: The serum circulating estradiol and leptin level was detected by ELISA. Then the correlation between estradiol, leptin level, and clinical characteristics was analyzed using Fisher's exact test. Next, the Kaplan-Meier model was used to analyze the association between estradiol, leptin, and prognosis of postmenopausal breast cancer patients in our cohort and the TCGA dataset. Setting: The study was conducted at the National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College. Patients: A total of 182 postmenopausal breast cancer patients and 111 healthy subjects from January 2010 to August 2010 were included in the analysis. Another 702 cases with breast cancer were retrieved from The Cancer Genome Atlas (TCGA) database for subsequent analysis. Main Outcome Measure: Serum circulating estradiol and leptin level. Results: The level of estradiol was significantly higher (P <0.001) but the level of leptin had no significant difference (P = 0.764) in postmenopausal breast cancer patients compared with healthy subjects. The level of estradiol and leptin was not significantly different between estrogen receptor (ER) positive and ER-negative groups (P >0.05). Estradiol was significantly correlated with tumor T stage (P = 0.002) and leptin was significantly associated with perineural invasion (P = 0.014). In addition, the disease-free survival of patients with a high level of estradiol was significantly shorter (P = 0.025) but leptin tended to be a protective factor for overall survival in TCGA analysis (P = 0.038). Conclusion: Circulating estradiol and leptin played important roles in the risk of postmenopausal breast cancer even in low-estrogen nations with an independent expression of ER status. High circulating estradiol was a poor prognostic factor and leptin may be a protection signal in Chinese postmenopausal patients with breast cancer. [ABSTRACT FROM AUTHOR]

Construction of urban green spaces may effectively mitigate urban heat island effect. Better design of green spaces may improve their thermal performance, and therefore provide better ecosystem services in cities. Aiming at providing empirical evidence and further insights for urban park design, field measurement of air temperature (Ta) and relative humidity (Rh) was conducted in Tiantan Park in Beijing, China. Results show that within Tiantan park, 1.29–2.71 °C air temperature difference and 1.27–5.16% relative humidity difference were observed at different time. Among all parameters, radiation condition (β = 0.872; β = 0.723) and land cover composition (β = 0.601) are dominant influencing factor on daytime and nighttime Ta respectively. Among different vegetation types, deciduous trees have significant cooling and humidifying effects at noon in summer (ρ = −0.65); evergreen trees have little effects in summer, but a humidifying effect in winter (ρ = −0.58); grassland may give rise to daytime Ta in both summer and winter (ρ = 0.48; ρ = 0.52). Effects of the shape of different vegetation types remain unclear, while more compact imperious surfaces may lead to lower daytime Ta (ρ = 0.55; ρ = 0.67). Understanding such microclimate conditions in an urban park may assist designers to create a more thermally friendly environment in future. [ABSTRACT FROM AUTHOR]

China has experienced severe hazes with high concentrations of particulate matter in recent years. The understanding of the size spectrum evolution of submicron particulate matter is critical to making efficient remediation policies to minimize the regional and global environmental impacts from hazes. During a time period of about one month, we monitored five severe haze episodes in Xi'an and four severe haze episodes in Beijing, which were characterized by two distinct kinds of aerosol mass concentration growth processes: accumulative-rise and abrupt-rise. A new method was developed to quantitatively evaluate the physical and chemical contributions to growth processes by analysing the size spectrum evolution data. The results showed that the accumulative-rise processes are governed by primary emissions and the abrupt-rise processes are governed by secondary chemical reactions. The population balance equations (PBE) were used to describe the variation of size spectrum of fine particulate matter, and the respective contributions of the physical aggregation rate and the chemical growth rate. The PBE model is solved using the adjustable direct quadrature method of moments (ADQMOM) to simulate the abrupt-rise process of haze development and to calibrate the contribution of the physical and chemical effects on the size spectrum of aerosol particles. [ABSTRACT FROM AUTHOR]

Background: With the increase of awareness of mycoplasma pneumoniae pneumonia (MPP), we found thrombosis in severe MPP (SMPP) was not rare. The aim of the study was to investigate the clinical characteristics, treatment, and long-term prognosis of MPP-associated thrombosis.Methods: We retrospectively reviewed the medical records of 43 children with MPP-associated thrombosis between January 2013 and June 2019 at Beijing Children's Hospital. The results of blood coagulation studies, autoimmune antibody, thrombophilia screening, contrast-enhanced lung computed tomography, echocardiography, and blood vessel ultrasonography were analyzed, as were treatment outcomes.Results: Forty-two patients were diagnosed with SMPP. D-dimer was higher than 5.0 mg/L in 58.1% (25/43) of patients. The mean D-dimer level was 11.1 ± 12.4 mg/L. Anticardiolipin-IgM was positive in 60.0% of patients, β2-glycoprotein-IgM in 64.0%, and lupus anticoagulant in 42.1%. Chest imaging revealed pulmonary consolidation with lobe distribution in all patients (2/3-1 lobe in 10 patients, > 1 lobe in 29 patients). In our experience, thrombosis can occur in a vessel of any part of the body, and it can be initially detected as late as 31 days after disease onset. Thrombosis in the brain and abdomen can occur early, at 5 days after disease onset. Pulmonary vessels were the most commonly involved sites in the current study, and accordingly chest pain was the most common symptom (32.6%), followed by neurological symptoms (14.0%) and abdominal pain (9.3%). Thirty-five percent of patients were asymptomatic with regard to thrombosis. All patients underwent anticoagulant therapy, and thrombus absorption took > 3 months in most patients. All patients were followed until October 2019, at which time 41 were asymptomatic and 2 had mild recurrent cough.Conclusions: SMPP with pulmonary consolidation (> 2/3 lobe) was the most strongly associated risk factor for thrombosis. Thrombosis-associated symptoms may be subtle, even absent. Elevated D-dimer, specifically > 11.1 mg/L (even > 5.0 mg/L), would assist in the early diagnosis of thrombosis. The long-term prognosis of thrombosis was good after timely administration of anticoagulant therapy. [ABSTRACT FROM AUTHOR]

• Beijing has a rich resources of the potential green roofs (PGRs), accounting for 19.6% of the study area. • More than 10% of the runoff can be reduced by fully implementing of the PGRs in the north central downtown. • 13 of the 20 flooding underpasses would not have happened in the 7.21 Rainstorm, if only 20% of the PGRs had been greened. Although the study of hydrological performance of green roofs is of great significance to urban water security and sustainable development, large-scale roofs greening within a city range has not received sufficient attention. In this study, a typical urban area of 675 km2 within the fifth ring road of Beijing was chosen as a case study. The potential green roofs were defined before being identified from high resolution images. Under three retrofitting scenarios (100%, 50% and 20%) of extensive green roofs, the hydrological behaviour of potential green roofs was investigated at catchment units by employing the Soil Conservation Service Curve Number model. The behaviour was evaluated finally through two aspects of the runoff reduction effect and the flooding mitigation effect. According to this study, a 19.6% of the potential green roofs within the study area indicates a strong potential for the future greening. In the city scale, the average runoff reduction rates decrease from 9.38% to 6.13% with the increasing return period of rainfall events. Catchments in the core of northern city play key roles in reducing runoff, by more than 10% with the 100% implementation scenario. This study also showed that flooding in 13 of the 20 underpasses would have been avoided in the 7.21 Rainstorm if only 20% of the potential green roofs had been implemented. This study demonstrated a potentially positive hydrological behaviour contributed by roof greening in the future Beijing at a city scale, and effective runoff reduction can be achieved if only with a 50% greening of the potential green roofs. However, urban planners should take notice of the predicament that the deposit of high potential green roofs do not match spatially well to the severe flooding sites. [ABSTRACT FROM AUTHOR]

The role of school-based disaster education in mitigating natural disaster has received extensive emphasis across the world. After the Wenchuan earthquake in 2008, the elementary and secondary schools in China have attached more importance to disaster education. However, it is unclear about the outcome up to now. Therefore, we conduct a relatively extensive survey in Beijing, Hunan, Guangdong and Sichuan recently, based on the perspectives of both students and teachers, so as to explore their attitude, gains, and expectations. The findings indicate that, first, it is the consensus that school-based disaster education should be enhanced to raise the awareness and capability of students to address disasters. Second, school-based disaster education has received overall positive outcome in recent years, although there are also 18% students expressing that their schools have not opened disaster curricula or they are unclear about that. Third, almost all the teachers argue that schools should develop disaster-related curricula, incorporate disaster education curricula into the compulsory curricula, and design special textbooks for disaster education. Finally, most teachers insist that the school-based disaster education has limited effect on students to improve their disaster prevention awareness and capability; in particular, the disaster education tends to impart knowledge for the most part but lack attractiveness and local features. [ABSTRACT FROM AUTHOR]

This paper investigates the residents' direct and indirect energy consumption behaviors in Beijing, as well as the impact of age, educational background and income level on the behaviors. The results show that, first, there are a high proportion of residents who may support the policies and activities about consumption behaviors adjustment towards energy-saving and low-carbon pattern, but currently the residents' awareness and behaviors are still not desirable. Second, the promotion of energy-saving appliance is effective to drive the energy conservation and emission reductions, and the current energy prices are higher but not effective to curb energy consumption and carbon emissions. Third, the direct energy consumption behaviors of older respondents and those with higher education background and income level generally tend to be more energy conservative than the younger respondents and other education and income level groups. The survey results may provide significant policy implications for the government and energy-saving product suppliers. [ABSTRACT FROM AUTHOR]

Construction of urban parks has long been proved as an effective way to mitigate urban heat island effect, and better arrangement of green spaces in a city is expected to help regulate urban climate. To provide further empirical evidence and guidance for urban green spaces planning and design, field measurement of summertime air temperature and relative humidity was conducted in and out of 10 large urban parks in Beijing, China. Averaged daytime and nighttime park cool and wet island intensity were 1.09 ℃, 1.48 % and 3.63 ℃, 4.25 % respectively. Parks' influence on local-scale climate extended as far as over 1km during summer nights, and more effective cooling effects were provided within approximately one-park width. Among all influencing factors, park size plays dominant role in regulating nighttime local-scale climate in parks' adjacent area, while vegetation coverage around sampling points out of urban parks also has significant contributions, indicating that large urban parks and their surrounding urban greenery interact to affect neighborhood climate. Park size was the only factor found correlated with nocturnal park cool and wet island intensity. Results of this study provide additional information on large urban parks' local-scale climate effect and give insights to future urban green spaces planning and design practice. [ABSTRACT FROM AUTHOR]

For patients with hypertension, serious complications, such as myocardial infarction, a common cause of heart failure, occurs in the late stage of hypertension. Hypertension outcomes can lead to complications, including death. Hypertension outcomes threaten patients' lives and need to be predicted. In our research, we reviewed the hypertension medical data from a tertiary-grade A class hospital in Beijing, and established a hypertension outcome prediction model with the machine learning theory. We first proposed a gain sequence forward tabu search feature selection (GSFTS-FS) method, which can search the optimal combination of medical variables that affect hypertension outcomes. Based on this, the XGBoost algorithm established a prediction model because of its good stability. We verified the proposed method by comparing other commonly used models in similar works. The proposed GSFTS-FS improved the performance by about 10%. The proposed prediction method has the best performance and its AUC value, accuracy, F1 value, and recall of 10-fold cross-validation were 0.96. 0.95, 0.88, and 0.82, respectively. It also performed well on test datasets with 0.92, 0.94, 0.87, and 0.80 for AUC, accuracy, F1, and recall, respectively. Therefore, the XGBoost with GSFTS-FS can accurately and effectively predict the occurrence of outcomes for patients with hypertension, and can provide guidance for doctors in clinical diagnoses and medical decision-making. [ABSTRACT FROM AUTHOR]

Highlights: [•] VNTR–MIRU typing is a reliable method for analyzing M. tuberculosis transmission in relatively closed populations. [•] VNTR3820 shows having the highest discriminatory power and allelic diversity. [•] Endogenous relapse is main source of TB cases in eastern China. [•] Migration has played an important role in the recent transmission of the W-Beijing family of M. tuberculosis. [Copyright &y& Elsevier]