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Background: In 2010, China launched a rural-oriented tuition-waived medical education (RTME) programme to train more general practitioners (GPs) to meet the needs of the rural health workforce. Motivating and maintaining GPs is an important consideration for the shortage in the rural health workforce. This study aimed to investigate job satisfaction and turnover among the first group of rural-oriented tuition-waived medical students (RTMSs) who had completed a three-year compulsory service in Guangxi, as well as the factors affecting RTMSs turnover. Methods: This study adopted a mixed-method approach. A quantitative survey of 129 RTMSs was analysed (81.6% response rate), and qualitative interviews were conducted with 30 stakeholders, including 18 RTMSs, six administrators of the County Health Bureau, and six administrators of township health centers (THCs). A t-test, chi-square test, Fisher's exact test, and logistic regression analysis were used to examine the quantitative data, and thematic analysis was used to analyse the qualitative data. Results: Among the 129 participants, the turnover rate was high, with 103 RTMSs reporting turnover (79.84%). Interpersonal relationships scored the highest in job satisfaction (3.63 ± 0.64) among RTMSs, while working conditions were rated the lowest (2.61 ± 0.85). Marital status (odds ratio [OR] = 0.236, 95% confidence interval [95%CI] = 0.059–0.953, P = 0.043), only child status (OR = 8.660, 95%CI = 1.714–43.762, P = 0.009), and job return satisfaction (OR = 0.290, 95%CI = 0.090–0.942, P = 0.039) were significantly associated with turnover. Univariate analyses showed that income had a significant influence on turnover, but the relationship gone by multivariable; however it was deemed important in the qualitative study. Qualitative analysis revealed that turnover was influenced by the working atmosphere, effort-reward imbalance, professional competence, and opportunities for training and promotion. Conclusions: This study provides insights for the policymakers about the priority areas for retaining GPs in rural locations and provides reference values for the retention of GPs in other regions with a shortage of rural health workers. For RTMSs to continue providing services to rural areas, the government should improve their salaries, balance their income and workload, provide more opportunities for training and career promotion, and managers should recognise their efforts and create an optimistic working atmosphere. [ABSTRACT FROM AUTHOR]

Background: Frequent repairs of pediatric flexible bronchoscopes can lead to a huge financial burden for the hospital. This study aimed to investigate the common causes of the failures in pediatric flexible bronchoscopes and propose the measures to prevent the failures. Methods: This was a retrospective study. We collected repair information of the pediatric flexible bronchoscopes reprocessed in the Department of Sterile Processing at a hospital between September 1, 2018 and September 1, 2022 in order to investigate the causes and possible factors associated with the failures in pediatric flexible bronchoscopes. Results: The Department of Sterile Processing staff reprocessed the pediatric flexible bronchoscopes 4280 times. A total of 29 failures were identified. The failure rate was 0.678%. The average repair cost was USD7246.60. The common failures in the pediatric flexible bronchoscopes included dim video image, black dots, improper video image display or no image during angulation adjustment, and pressure marks in the insertion tube. The failure rates in flexible electronic bronchoscopes and small-diameter flexible bronchoscopes were 65.5% and 93.1%, respectively. The failure rate in the pediatric flexible bronchoscopes reprocessed by the staff members with less work experience was 75.9%. Conclusion: The failure rate in the pediatric flexible bronchoscopes was not high but the repair costs were extremely high. The types and size of the flexible bronchoscopes and work experience of the staff members responsible for bronchoscope reprocessing were the possible factors associated with the failure rate in the pediatric flexible bronchoscopes. It is advisable to further optimize the central workflow and management mode for reprocessing the pediatric flexible bronchoscopes, thereby extending their useful life and reducing costs. [ABSTRACT FROM AUTHOR]

Voriconazole is widely used in the treatment and prevention of invasive fungal diseases. Common drug-induced liver injuries increase the economic burdens and the risks of premature drug withdrawal and disease recurrence. This study estimated the disposal cost of voriconazole-related liver injury, explored the risk factors of voriconazole-related liver injury in hospitalized patients, and established a predictive model of liver injury to assist clinicians and pharmacists in estimating the probability or risk of liver injury after voriconazole administration to allow for early identification and intervention in patients at high risk of liver injury. A retrospective study was conducted on the selected inpatients whose blood concentration of voriconazole was measured in the West China Hospital of Sichuan University from September 2016 to June 2020. The incidence and disposal cost of voriconazole-related liver injuries were calculated. The incidence of voriconazole-related liver injury was 15.82% (217/1372). The disposal cost has been converted to 2023 at a discount rate of 5%. The median (P25, P75) disposal cost of severe liver injury (n = 42), general liver injury (n = 175), and non-liver injury (n = 1155) was 993.59 (361.70, 1451.76) Chinese yuan, 0.00 (0.00, 410.48) yuan, and 0.00 (0.00, 0.00) yuan, respectively, with a statistically significant difference (p < 0.001). Single factor analysis and multiple factor logistic regression were used to analyze the risk factors of voriconazole-related liver injury. The voriconazole-related liver injury was related to the trough concentration (Cmin, OR 1.099, 95% CI 1.058–1.140), hypoproteinemia (OR 1.723, 95% CI 1.126–2.636), and transplantation status (OR 0.555, 95% CI 0.325–0.948). The prediction model of liver injury was Logit (P)= −2.219 + 0.094 × Cmin + 0.544 × Hydroproteinemia − 0.589 × Transplantation, and the prediction model nomogram was established. The model validation results showed that the C-index of the derivation set and validation set was 0.706 and 0.733, respectively. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.705 and 0.733, respectively, indicating that the model had good prediction ability. The prediction model will be helpful to develop clinical individualized medication of voriconazole and to identify and intervene in the cases of patients at high risk of voriconazole-related liver injury early on, in order to reduce the incidence of voriconazole-related liver injuries and the cost of treatment. [ABSTRACT FROM AUTHOR]

Introduction: It has been acknowledged in China that actions should be taken immediately to ease the critical shortage of psychiatric nurses. However, with national data lacking, little is known about nurses' mental health status. Aim: To evaluate psychiatric nurses' mental health status by measuring their burnout, depression, anxiety and stress. Methods: All psychiatric nurses in the 41 selected hospitals in China were invited to participate in the survey. The Maslach Burnout Inventory‐Human Service Survey and Depression Anxiety Stress Scale were used to assess variables of interest. Results: 38.6% of psychiatric nurses met the criteria for burnout. The rates of depression, anxiety and stress were 26.3%, 36.4% and 12.5%, respectively. It was found that workplace region, educational level, working years, longer working hours and night shifts were associated with risk of burnout and DASS. Conclusions: More than a quarter of psychiatric nurses are suffering from burnout, depression or anxiety in China. Policymakers and hospital administrators should design a flexible schedule and restrict working hours for psychiatric nurses to achieve work‐life balance. Implications for Practice: The study informs policymakers and administrators on addressing the nursing shortage by identifying nurses immersed in negative emotions and preventing mental health problems. [ABSTRACT FROM AUTHOR]

Understanding the transformation of accumulated phosphorus (P) is vital for P management. However, previous studies are limited to a few sites in Chinese agroecosystems. In this study, to investigate the temporal-spatial differences of transformation from accumulated P to available P (determined by the Olsen method), a dataset was assembled based on 91 national long-term experimental sites across China in the recent 31 years (1988–2018). A boosted regression tree (BRT) and a structural equation model (SEM) were used to analyze the factors influencing the transformation. The results showed that the transformation from accumulated P to available P in South China (1.97 mg kg−1) was significantly higher than that in other regions (0.69–1.22 mg kg−1). Soil properties were the main driving factors with a relative contribution of 81.8%, while climate and management practices explained 7.8% and 10.4% of the variations, respectively. Furthermore, SEM analysis revealed that the soil organic matter (SOM) could positively and directly affect the transformation, whereas the soil pH, soil silt content, and P fertilizer had negative and direct effects on it. For the first time, this study analyzed the transformation from soil accumulated P to available P at a national scale and at multiple sites and quantified the contribution of the main influencing factors. These results help to predict the soil available P content across different agroecosystems based on the input amount of P fertilizer, contributing to the regional precise management of P fertilizer application. [ABSTRACT FROM AUTHOR]

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Cowpea is an important leguminous crop in arid and semi-arid tropical regions. However, it is sensitive to the temperature and photoperiod. In this study, 41 new lines of cowpea were evaluated in sowing seasons of spring (SpS), summer (SuS), and autumn (AuS) at Wuming, Guangxi province, China. Nine agronomic and yield-related traits were investigated and analyzed. The results showed that the pod width (0.8 cm) was similar among sowing seasons. For all other traits, the values were lowest at SuS, except the number of branches per plant, which was lowest (2.5) at AuS. Strong correlations were detected for the growth period, plant height, pod length, pod width, and 100-seed weight (p < 0.01) across the sowing seasons. A principal component analysis revealed that the first three components could explain 72.47% of the total variations. On the basis of the possible yield, growth period, and growth habit, we identified nine new lines suitable for different sowing seasons in Guangxi. The results of this study suggest these new cowpea lines may be useful for increasing crop production and for breeding new varieties. [ABSTRACT FROM AUTHOR]

Open vegetable fields in China are a major anthropogenic source of nitrous oxide (N2O) emissions due to excessive nitrogen (N) fertilization. A 4 yr lettuce experiment was conducted to determine the impacts of controlled-release fertilizers (CRFs) and nitrification inhibitors (NIs) on lettuce yield, N2O emissions and net economic benefits. Five treatments included (i) no N fertilizer (CK), (ii) conventional urea at 255 kg N ha–1 based on farmers' practice (FP), (iii) conventional urea at 204 kg N ha–1 (OPT), (iv) CRF at 204 kg N ha–1 (CU) and (v) CRF (204 kg N ha–1) added with NI (CUNI). No significant differences were found in the lettuce yields among different N fertilization treatments. Compared with FP, the cumulative N2O emissions were significantly decreased by 8.1%, 38.0% and 42.6% under OPT, CU and CUNI, respectively. Meanwhile, the net benefits of OPT, CU and CUNI were improved by USD 281, USD 871 and USD 1024 ha–1 compared to CN, respectively. This study recommends the combined application of CRF and NI at a reduced N rate as the optimal N fertilizer management for the sustainable production of vegetables in China with the lowest environmental risks and the greatest economic benefits. [ABSTRACT FROM AUTHOR]

Background: National data on the satisfaction of radiology residents enrolled in standardized residency training (SRT) are rather scarce in China. This study identified a set of potential factors concerning SRT satisfaction among radiology residents as well as the association between SRT satisfaction and post-competency and well-being. Methods: A total of 3666 radiology residents who were receiving SRT during 2020 in China were recruited across all 31 provinces. The cumulative odds logistic regression was used to examine the potential factors associated with SRT satisfaction as well as associations between satisfaction and well-being, burnout, professional identity and competency. Results: The prevalence of satisfaction with SRT was 68.6%. Participants who were male, worked in central China, aged more than 28 years old, had long working hours and claimed increased workload during the COVID-19 pandemic were more likely to be unsatisfied with the SRT program. Participants who were more satisfied with the radiation protection were more likely to report higher degree of SRT satisfaction (OR = 3.00, 95% CI 2.58–3.50). In addition, SRT satisfaction was positively associated with well-being, professional identity, competency and lower burnout. Conclusions: Perceived satisfaction can be introduced into hospital management, as it may reflect the overall situation of the residents during residency training and influence radiologists' well-being, professional identification and competency. Appropriate measures should be taken to reduce the risk of radiation exposure, ensure employee safety (such as risk assessment system and paid time off), provide radiology residents with fair treatment and guarantee the time out of working for optimizing their professional ability. Key points: The radiology residents at all levels in China were systematically landscaped. 68.6% of the 3666 residents reported satisfaction with the residency training. Radiation protection was significantly associated with residency satisfaction. Satisfaction significantly impacts radiology residents' well-being, professional identity and self-reported competency. The findings provide new insights into sustaining and improving the radiology residency. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral therapy (ART) is one of the most effective ways for HIV-infected to treat AIDS. However, it is difficult to start ART among young people those newly diagnosed HIV-infection in China, and their adherence to ART is poor. We have designed an AIDS educational game called AIDS Fighter · Health Defense, which could improve the AIDS-related knowledge and has the potential to improve AIDS prevention ability of young students. In this study, AIDS Fighter · Health Defense will be used with newly diagnosed young people with HIV to evaluate the education effect of the game in improving ART adherence.Design: A stepped-wedge design randomized controlled trial will be conducted to confirm the education effect of AIDS Fighter · Health Defense on improving ART adherence of newly diagnosed young people with HIV, and to verify when to start game-based health education could be more effective for newly diagnosed young people with HIV.Methods: Participants will receive AIDS education from health workers and start ART when diagnosed with HIV and assigned into four groups randomly. The first step group to the fourth step group will receive AIDS Fighter · Health Defense in turn at the star of ART, one week, one month and three months after the start of ART. The primary outcomes are medication adherence, CD4( +) T cell count, and HIV viral load. The secondary outcomes are ART-related knowledge, ART-related skills, psychological resilience, and self-discrimination. Assessments will be completed before the intervention and one week, first month, and third month of the intervention, and then a one-year follow-up evaluation will be conducted after the intervention.Discussion: AIDS Fighter · Health Defense may be an effective approach to help newly diagnosed young people with HIV to improve ART adherence. A stepped-wedge design randomized controlled trial of this study may find the optimal time of AIDS education to improve ART adherence of newly diagnosed young people with HIV.Registration Number: Chinese Clinical Trial Registry: ChiCTR2200059766, registered 11 May 2022. http://www.chictr.org.cn/showproj.aspx?proj=169420. [ABSTRACT FROM AUTHOR]

Introduction: Mental health symptoms are common among health professionals and the influence of lifestyle behaviors on psychiatrists' mental health is insufficiently understood. Based on a nationwide sample, we aimed to survey the lifestyle behaviors and mental health status among psychiatrists, and to identify the co-occurrence and gender differences in lifestyle behaviors.Methods: Data were collected through an anonymous questionnaire among psychiatrists in China. Depression, Anxiety and Stress Scale - 21 (DASS-21) was used to evaluate mental health symptoms. Latent class analysis (LCA) was used to explore the co-occurrence of lifestyle behaviors. The multivariate logistic regression model was used to examine the effects of demographic and lifestyle factors.Results: 4520 psychiatrists were included in the analysis with 11.5 % of them reporting smoking, 10 % reporting alcohol misuse, 35.2 % reporting physical inactivity, and 23.1 % reporting insomnia. The prevalence of depression, anxiety and stress symptoms were 29.2 %, 34.5 %, and 12.2 %, respectively. Significant gender differences were found in smoking (P < 0.001), alcohol misuse (P < 0.001), and physical inactivity (P < 0.001), but not in insomnia. Based on these four high-risk health behaviors above, three lifestyle behavior clusters with huge gender differences were identified through the LCA. Accordingly, the unhealthy lifestyle classes, though defined differently for males and females, were significantly associated with depression, anxiety, and stress.Conclusions: The co-occurrence and significant gender differences in multiple lifestyle behaviors exist in this group, highlighting the need for gender-specific comprehensive interventions against mental health symptoms and the urgency of promoting their well-being. [ABSTRACT FROM AUTHOR]

Rice bean (Vigna umbellata) is an underexploited domesticated legume crop consumed for dietary protein in Asia, yet little is known about the genetic diversity of this species. Here, we present a high-quality reference genome for a rice bean landrace (FF25) built using PacBio long-read data and a Hi-C chromatin interaction map, and assess the phylogenetic position and speciation time of rice bean within the Vigna genus. We sequence 440 landraces (two core collections), and GWAS based on data for growth sites at three widely divergent latitudes reveal loci associated with flowering and yield. Loci harboring orthologs of FUL (FRUITFULL), FT (FLOWERING LOCUS T), and PRR3 (PSEUDO-RESPONSE REGULATOR 3) contribute to the adaptation of rice bean from its low latitude center of origin towards higher latitudes, and the landraces which pyramid early-flowering alleles for these loci display maximally short flowering times. We also demonstrate that copy-number-variation for VumCYP78A6 can regulate seed-yield traits. Intriguingly, 32 landraces collected from a mountainous region in South-Central China harbor a recently acquired InDel in TFL1 (TERMINAL FLOWER1) affecting stem determinacy; these materials also have exceptionally high values for multiple human-desired traits and could therefore substantially advance breeding efforts to improve rice bean. Rice bean is an underexploited legume crop that has many desirable properties against bio and abiotic stresses. Here, the authors report the genome assembly of this species, conduct population genetics studies and reveal the genetic variations associated with adaptation and yield traits. [ABSTRACT FROM AUTHOR]

Significant efforts have been made to characterize viral diversity in bats from China. Many of these studies were prospective and focused mainly on Rhinolophus bats that could be related to zoonotic events. However, other species of bats that are part of ecosystems identified as virus diversity hotspots have not been studied in-depth. We analyzed the virome of a group of Myotis fimbriatus bats collected from the Yunnan Province during 2020. The virome of M. fimbriatus revealed the presence of families of pathogenic viruses such as Coronavirus, Astrovirus, Mastadenovirus, and Picornavirus, among others. The viral sequences identified in M. fimbriatus were characterized by significant divergence from other known viral sequences of bat origin. Complex phylogenetic landscapes implying a tendency of co-specificity and relationships with viruses from other mammals characterize these groups. The most prevalent and abundant virus in M. fimbriatus individuals was an alphacoronavirus. The genome of this virus shows evidence of recombination and is likely the product of ancestral host-switch. The close phylogenetic and ecological relationship of some species of the Myotis genus in China may have played an important role in the emergence of this alphacoronavirus. [ABSTRACT FROM AUTHOR]

Background: Although progress has been made in the prevention and treatment of HIV in China, there are still a considerable number of new infections annually, especially in older men. HIV health education for older men is urgently needed. Evidence-based, acceptable, and scalable interventions are urgently needed to increase their capacity to prevent HIV. We describe a trial protocol to evaluate the effectiveness of a brief video-based intervention targeting older men's knowledge of HIV prevention.Design: This study is a randomized controlled trial. The trial will be held in the residents' activity centers of three communities.Methods: A total of 450 older men will be randomly divided into three groups (Sunset Without AIDS intervention group and two control groups) for 2 weeks. We will assess the feasibility and acceptability of intervention through interviews. The primary outcome includes changes in participants' knowledge related to AIDS after 2 weeks intervention and 1, 3, and 6 months of follow-up. The secondary outcomes, e.g., changes in participants' stigma attitude, risk behaviors attitude, and risk behaviors related to AIDS, will be respectively assessed 2 weeks, 1 month, 3 months, and 6 months after the second intervention.Discussion: Sunset Without AIDS may be an innovative way to help older men improve HIV prevention knowledge, fill the gap in video-based HIV prevention education for the older men in China, and gain experience of HIV education. This project will innovate the HIV education ideas of older men and enrich the theoretical research content of AIDS-related education of older men. The findings may also provide the basis for the research and formulation of more reasonable AIDS education strategies, prevention, and control policies for the elderly.Trial Registration: Chinese Clinical Trial Registry ChiCTR2100045708 . Registered on 23 April 2021. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to explore the use of the Questionnaire Appraisal System with a combination of qualitative and quantitative methods in cognitive interviewing for cross‐cultural adaptation. Design: This is a descriptive methodological study. Methods: Using the Mandarin version of the Post‐Stroke Checklist as an example, cognitive interviews were conducted with 27 stroke survivors in Guangzhou between November 2020 and February 2021. The Questionnaire Appraisal System was applied as a codebook in focus group discussions to perform quantitative data collections and quantitative content analysis. Results: Thirty‐eight problems were proposed in focus group discussions and identified all but four of the 30 questions that emerged in the cognitive interviews. A new item was added to the Questionnaire Appraisal System for better categorization. Four categories and six subcategories of problems in the checklist were revealed. [ABSTRACT FROM AUTHOR]

Background: Despite a significant shortage of psychiatrists in China, an ever-increasing number of psychiatrists in China are experiencing burnout and job dissatisfaction and considering leaving their jobs. Yet, to our knowledge, there have been no nationwide studies to date that examined both burnout and job dissatisfaction of psychiatrists in China. Therefore, this study evaluated burnout and job dissatisfaction of psychiatrists in China, and identified relevant characteristics. Methods: We conducted a nationwide, cross-sectional survey in March 2019. Psychiatrists from all tertiary psychiatric hospitals in China were invited to participate. The Maslach Burnout Inventory-Human Service Survey and the short version of the Minnesota Satisfaction Questionnaire were used to measure burnout and job satisfaction. Data on socio-demographic and occupational characteristics were collected. Multivariate logistic regression was conducted to identify socio-demographic and occupational characteristics associated with burnout and job satisfaction. Results: In total, 4520 psychiatrists from tertiary psychiatric hospitals in China completed the questionnaire. Overall, 38.4% of respondents met the criteria for burnout and 35.6% were dissatisfied with their jobs. Being male, more years of practice, having no leadership role, and longer working hours per week were significantly associated with burnout and job dissatisfaction. Lower monthly pay was significantly associated with job dissatisfaction but not burnout. Moreover, burnout was significantly associated with job dissatisfaction. Conclusions: Our data suggest a high rate of burnout and job dissatisfaction among psychiatrists in China. In order to preserve and strengthen the mental health workforce, proactive measures are urgently needed to mitigate burnout and job dissatisfaction among psychiatrists in China. [ABSTRACT FROM AUTHOR]

AIDS has had physical, psychological and social consequences on People living with HIV (PLWH) with the result that the challenges and adversity they face have significantly increased. Resilience helps individuals cope with these adversities and difficulties. For PLWH to face increased challenges and setbacks created by AIDS, they are required to have resilience. This paper presents research carried out in China aiming to examine the relationships among resilience, self-esteem, self-efficacy, social support, depression and antiretroviral therapy (ART) adherence in PLWH. A cross-sectional study using a convenience sample was conducted and 223 PLWH were recruited from 2 hospitals and 1 Center of Disease Control in Sichuan, China, from May to August 2018. The present research found that resilience was positively affected by self-esteem, self-efficacy and social support, and negatively predicted depression and positively predicted ART adherence. Resilience plays a mediating role between influential factors (self-esteem, self-efficacy and social support) and adaptive outcomes (depression and ART adherence). It suggests that resilience should be considered as a factor in intervention designed to reduce PLWH's depression and improve ART adherence. Improving self-esteem, self-efficacy and social support could enhance resilience. [ABSTRACT FROM AUTHOR]

Background: Although great progress has been made in the prevention and treatment of AIDS, there are still a considerable number of new infections annually, especially in adolescents. With the advance of technology, game-based education has gradually become an important tool for changing healthy behaviors among youth.Methods: A protocol for conducting a randomized controlled trial to evaluate the "AIDS Fighter · Health Defense", a game-based AIDS education project aimed at improving the ability of adolescents to prevent AIDS. During the four-week intervention, participants will receive: 1) A virus combat game; 2) Goal setting to eliminate HIV; 3) Questions to be answered to be resurrected in the game; 4) Points ranking; 5) Recognition and Rewards. The primary outcomes include changes in participants' knowledge, stigma attitude, and risk behaviors attitude related to AIDS after four weeks of intervention. The secondary outcomes are the participants' AIDS-related risk behaviors three and six months after the intervention.Discussion: AIDS Fighter· Health Defense may be an innovative approach to help adolescents improve AIDS prevention capabilities, fill the gap in game-based AIDS prevention education in China, and gain experience of AIDS management.Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000040195 . Registered 25 November 2020. [ABSTRACT FROM AUTHOR]

Ground surface settlement induced by shallow tunnel construction is inevitable, and it is more complicated at the intersection area since the rock behavior is a complex, three-dimensional problem. This paper presented a case study of controlling the surface settlement during the tunneling of an urban shallow intersection between a double-arched tunnel and a connection tunnel in China. Various construction measures, including the sequence excavation, presupport, and primary support systems, were used to control the settlement. Furthermore, a three-dimensional analysis was conducted to investigate the settlement characteristics in different stages, the optimum excavation spacing among pilots, and the support effect of the presupport. The results showed that the settlement was mainly caused by the excavation of the upper steps. The deformation induced by transverse guide tunnel T3 was much larger than that of the others because the surrounding rock at the vault was plain fill. The three-pilot excavation methods can effectively control the surface settlement for a double-arched tunnel, and the optimum spacing values between the different steps were obtained. The reduced proportions of the advanced small pipes supporting construction tunnels T2 and T3 were approximately 27.0% and 17.2%, respectively, while the reduced proportion of the pipe roof supporting T4 was approximately 42.4%. The monitoring results showed that this project was successfully completed. [ABSTRACT FROM AUTHOR]

The industry sector is not only an important driving force for economic growth but also the largest sector of resource consumption and pollution emission. In this study, we first constructed a super-slack-based measure (Super-SBM) model including the resource consumption and undesirable outputs, and estimated the industrial environmental efficiency (IEE) in China from 2007 to 2016. Afterwards, based on the spatial autocorrelation test and the spatial Durbin model, the spatio-temporal evolution and the influencing factors of IEE were analyzed. The empirical results are obtained as follows: the average IEE from 2007 to 2016 was 0.5176. IEE in the east of China was the highest, whereas it was the lowest in the west. The spatial autocorrelation test showed that the regions with similar levels of IEE in China had significant spatial agglomeration, whereas the local spatial distribution of IEE was unbalanced. The high-high IEE agglomeration areas were located in Liaoning, Jilin, and Inner Mongolia. The low-low IEE agglomeration areas were concentrated in Gansu, Ningxia, and Sichuan. Finally, according to the spatial Durbin panel model and spillover effect decomposition, GDP, FDI, human capital, environmental governance investment, research and development investment, and urbanization have a positive impact on IEE. The industrial and energy consumption structures have a negative impact on IEE. Therefore, the central government should focus on balancing IEE of different provinces and regions, increasing investment in industrial pollution treatment, and encouraging FDI to improve IEE. [ABSTRACT FROM AUTHOR]

Evaluating changes in the accumulation of grain minerals, including nitrogen (N), copper (Cu), iron (Fe), potassium (K), magnesium (Mg), manganese (Mn), phosphorus (P), and zinc (Zn), across different genotypes can provide valuable information for the development of nutrient-enriched maize varieties. Meanwhile, N rates can affect maize yield and quality, but their effects on element accumulation remain to be elucidated. Here, field experiments were conducted at two locations in China over 2 years (2010 and 2011). Under a normal N application rate (240 kg N ha−1), 24 maize cultivars that had been bred and released between 1930 and 2010 were evaluated for the elemental concentrations in the grains. Cultivars Yedan 13 and Zhengdan 958, representing old- and new-era cultivars respectively, were selected to investigate grain element accumulation in response to different levels of N (0, 60, 120, 180, and 240 kg N ha−1). The results showed that element concentrations were significantly affected by year, genotype (G), N rates, and N × G interaction. Grain yield tended to increase with the year of cultivar released, while the concentrations of N, Cu, Mn, and Zn in the grain significantly declined in the new-era. The element concentrations of grains were mainly influenced by N rate or N × G interactions. As N levels increased, N, Cu, Fe, Mg, and Mn concentrations rose, while K, P, and Zn concentrations decreased. Compared with old-era cultivars, new-era cultivars showed an increase in grain yield of 25.39%; however, they demonstrated decreases in N, Cu, Fe, K, Mg, P, and Zn concentrations. In the new-era varieties, the reduction in Cu, Fe, K, and P concentrations were significantly exacerbated by high N rates, but this was not the case in the old-era varieties. The concentration of grain Cu, K, Mg, P, and Zn were higher under N-limited condition (N0), but grain yield was also lower. However, the optimal N rate (120–180 kg N ha−1) could increase N, Fe, Mg, and Mn concentrations without affecting grain yield in new-era varieties. It is concluded that maize breeding processes have improved grain yield, but reduced grain nutrient element concentrations. Enhanced concentrations of certain elements in maize grain could be achieved with optimal rates of N fertilizer being applied. [ABSTRACT FROM AUTHOR]

The study aimed to validate the Health Care Provider HIV/AIDS Stigma Scale among medical staff in China. The validation was conducted in four steps from March to December 2017: translation and back-translation; content validity test with six experts; test–retest reliability testing with 63 medical staff with 2 weeks interval; and structural validation with 349 medical staff from 52 hospitals with a convenience sample,using exploratory factor analysis,including principal component analysis and varimax rotation. The scale content validity index average was 0.88, while for test–retest reliability, the ICC was 0.87. Three factors of "discrimination", "prejudice" and "stereotype" with 16 items were extracted and explained 59.61% variance. The Cronbach's alpha value for the total scale was of 0.88, and for the three factors, the values were 0.89, 0.86 and 0.74, respectively. The discrimination factor showed identical means between Canadian medical students and Chinese medical staff, while the prejudice and stereotype factors had higher mean scores in the Chinese sample. The three-factor structure of Health Care Provider HIV/AIDS Stigma Scale was confirmed in Chinese medical staff with a simpler solution. This could provide a basis for trans-cultural application and comparison. [ABSTRACT FROM AUTHOR]

Schistosomiasis is one of the most important zoonoses, threatening approximately 800 million people in 78 countries with a loss of 70 million disability-adjusted life years. Over the past six decades, China has made remarkable achievements in morbidity control, but disability and mortality control remains much to desire; thus, advanced schistosomiasis is a growing problem when on the road to schistosomiasis elimination. Since 2005, China has initiated a national treatment and assistance program to advanced patients, aiming to improve patients' symptoms and quality of life. Here, we conducted a two-phase study to evaluate the program's implementation and effect on advanced patients from 2009 to 2014 in Jiangxi Province, China. A total of 6425 advanced schistosomiasis cases were included in this study. For those having been treated and assisted (90.7 %), the cure or improvement rate was over 99.9 %, with 668 (11.5 %) cases having reached clinical cure and 5152 (88.4 %) cases' condition having improved, which can be partially reflected in the significant decline of the proportion of hepatomegaly (splenomegaly), the degree of liver fibrosis, ascites-related indicators (abdominal girth and frequency of shifting dullness), and portal hypertension-related indices (inner diameter of portal vein and frequency of subcutaneous varicose vein of abdominal wall). Besides, it was estimated to have saved 2004 years of life lost at total. Therefore, the government should continue support and increase input of treatment and assistance program so that this project can reach more patients, leading to consolidation of achievements of schistosomiasis control and contribution to schistosomiasis elimination. [ABSTRACT FROM AUTHOR]

High yields, high stress resistance, and wide adaptability are important cultivar traits, especially for crops sensitive to the photoperiod and temperature. Mung bean (Vigna radiata) is a typical short-day plant, traditionally cultivated in Asian countries, and consumed all over the world. However, there has long been relatively little research regarding its genetic improvement until in recent decades. Zhonglv 5 is a mung bean cultivar that was developed via crossbreeding in China in the early part of this century. It has since played an important role in improving mung bean production in the country because of its high yields, high stress tolerance, and wide adaptability. We herein describe the development of Zhonglv 5, summarize its yield performance and adaptability in diverse eco-regions within China, and predict its potential future uses to provide information relevant for mung bean breeding, production, trade, and related industries. [ABSTRACT FROM AUTHOR]

Wind energy is crucial renewable and sustainable resource, which plays a major role in the energy mix in many countries around the world. Accurately forecasting the wind energy is not only important but also challenging in order to schedule the wind power generation and to ensure the security of wind-power integration. In this paper, four kinds of hybrid models based on cyclic exponential adjustment, adaptive coefficient methods and the cuckoo search algorithm are proposed to forecast the wind speed on large-scale wind farms in China. To verify the developed hybrid models' effectiveness, wind-speed data from four sites of Xinjiang Uygur Autonomous Region located in northwest China are collected and analyzed. Multiple criteria are used to quantitatively evaluate the forecasting results. Simulation results indicate that (1) the proposed four hybrid models achieve desirable forecasting accuracy and outperform traditional back-propagating neural network, autoregressive integrated moving average as well as single adaptive coefficient methods, and (2) the parameters of hybrid models optimized by artificial intelligence contribute to higher forecasting accuracy compared with predetermined parameters. [ABSTRACT FROM AUTHOR]

• Recovery years increased soil enzyme activity in the steppe and forest-steppe zone. • Recovery years decreased SOC stability in the steppe and forest-steppe zone. • The forest zone might have the most stable soil enzyme activity and SOC stability. • Key factors regulating these changes are different among the three vegetation zones. The effects of cropland abandonment on soil enzyme activity and soil organic carbon (SOC) stability, along with the driving factors, are poorly understood. Here, we aimed to systematically and comprehensively evaluate soil enzyme activity, SOC stability, and the associated driving factors in different vegetation zones after cropland abandonment on the Loess Plateau, China. We selected grasslands with different recovery times along a rainfall gradient encompassing the steppe zone (SZ), forest-steppe zone (FSZ), and forest zone (FZ). We measured and compared the changes in soil enzyme activity (saccharase, polyphenol oxidase, urease, phosphatase, and catalase) and SOC stability as a function of recovery time; we also evaluated the relationships between these two parameters. In SZ and FSZ, soil enzyme activity, fractions of oxidizable carbon (including very labile [C1], labile [C2], and less labile [C3]), and the carbon management index (CMI) increased with recovery time, whereas the SOC stability index (SI) decreased. Conversely, in FZ, polyphenol oxidase activity increased linearly, urease and catalase activities decreased linearly, and the change in saccharase activity was represented by a cubic equation regression. SI showed no obvious changes with recovery time, whereas C1, C2, and C3 initially decreased and then increased. Redundancy analysis showed that, in FSZ and FZ, soil enzyme activity, C1, C2, C3, and SI were influenced by vegetation diversity, coverage, and soil nutrient levels. In comparison, in SZ, these parameters were mainly influenced by soil nutrient levels. Soil enzyme activity was strongly correlated with C1 and C3 in SZ and FSZ, but not in FZ. Overall, in SZ and FSZ, soil enzyme activity increased with recovery time, whereas SOC stability decreased. In contrast, both parameters were relatively stable in FZ, which had higher mean annual precipitation and mean annual temperature. [ABSTRACT FROM AUTHOR]

The excessive and inappropriate application of nitrogen (N) fertilizer in open vegetable fields is a major anthropogenic source of gaseous N losses including nitrous oxide (N 2 O) and ammonia (NH 3) emissions in China. A 2-yr Chinese cabbage (Brassica pekinensis L.) experiment was carried out to explore the impacts of optimized N management (reduced N application rate, controlled-release urea [CRF] and nitrification inhibitor [NI]) on cabbage yield, soil inorganic N, and N 2 O and NH 3 emissions, and to assess their economic benefits by a cost-benefit analysis. Six treatments including i) no N fertilizer (CK), ii) conventional urea fertilizer at 400 kg N ha−1 based on farmers' practices (CN), iii) conventional urea at 320 kg N ha−1 (RN), iv) conventional urea (320 kg N ha−1) with the addition of NI (RN + NI), v) CRF at 320 kg N ha−1 (CR) and vi) CRF (320 kg N ha−1) with the addition of NI (CR + NI) were implemented in an open Chinese cabbage field. No significant differences were found in the cabbage yields and soil NH 4 +–N contents under different N fertilization treatments. Only CR + NI treatment had significantly lower soil NO 3 −–N contents than CN by 17.6%–34.6% at the early growing stages of cabbage in both years. Compared with CN, the N 2 O emissions were significantly decreased by 8.61%, 34.4%, 37.8% and 46.6% under RN, RN + NI, CR and CR + NI, respectively, indicating that CR + NI favors N 2 O abatement especially when NH 3 has been suppressed by other 4 R practices. Meanwhile, the NH 3 volatilization was 20.6% higher under RN + NI and 30.8% and 17.3% lower under CR and CR + NI compared to CN, respectively, which implied that CR was the most effective treatment in reducing the NH 3 volatilization and total gaseous N loss in high NH 3 –N loss scenarios. Moreover, the net benefit of RN decreased by $945 USD ha−1 and those of RN + NI, CR and CR + NI treatments increased by $855, $930 and $1004 USD ha−1 compared to CN, respectively. This study recommends CR + NI as the optimal N fertilizer management for the sustainable production of vegetables with the lowest environmental risks and the greatest economic benefits. • Optimizing nitrogen (N) rate and source decreased N 2 O and NH 3 without yield loss. • Controlled-release N fertilizer (CRF) was optimal for reducing NH 3 loss by 30.8%. • N 2 O emission was mitigated by 46.6% under CRF with nitrification inhibitor (NI). • The net economic benefit of cabbage was increased by $1004 USD ha−1 under CRF + NI. • CRF + NI was cost-effective in achieving agronomical and environmental sustainability. [ABSTRACT FROM AUTHOR]

Based on the annual GDP (Gross Domestic Product) in 27 Chinese provinces and autonomous regions, the asymmetric economic information flows between different regions are calculated by the symbolic transfer entropy method and corresponding economic information flow networks are built over two periods, one is before the reform and opening up policy, the other is after that. By analyzing such networks, the obtained results are as follows. First, before the policy, balanced development strategy weakens or cuts off the ties between adjacent areas, resulting in a slow regional economic development, does not conform to the law of scientific development. Second, with introducing market mechanisms and promoting the reform and opening up policy, increasing economic activities have gradually shifted from coast to inland of China over Period II. Last but not least, there has a dramatic alternation of the influential centers that Jilin, Beijing and Jiangsu become new influential centers. Especially, at Beijing–Tianjin–Hebei metropolis circle Beijing becomes an influential center after the policy. [ABSTRACT FROM AUTHOR]

It is currently uncertain whether process-based models are capable of assessing crop yield and nitrogen (N) losses while helping to investigate best management practices from vegetable cropping systems. The objectives of this study were to (1) calibrate and evaluate the Denitrification-Decomposition (DNDC) model in simulating crop growth and nitrate leaching in a typical field radish system; (2) optimize management practices to improve radish yield and mitigate nitrate leaching under 20-year climate variability. A five-season in-situ field experiment of spring and autumn radish in northern China was established in the autumn of 2017 and measurements of radish yield, N uptake, soil temperature, soil moisture, drainage, and nitrate leaching were obtained under different N usage. DNDC overall demonstrated "good" to "excellent" performance in simulating radish yield, total biomass, N uptake, and soil temperature across all treatments (6.4% ≤ normalized root mean square error (nRMSE) ≤ 15.5%; 0.12 ≤ Nash-Sutcliffe efficiency (NSE) ≤ 0.88; 0.80 ≤ index of agreement (d) ≤ 0.97). DNDC generally exhibited "fair" performance in estimating soil moisture and drainage (10.9% ≤ nRMSE ≤ 27.2%; −0.18 ≤ NSE ≤ 0.37; 0.69 ≤ d ≤ 0.82) and "good" performance when predicting nitrate leaching (12.4% ≤ nRMSE ≤ 26.7%; −0.59 ≤ NSE ≤ 0.51; 0.68 ≤ d ≤ 0.90). Sensitivity analyses demonstrated that optimized management practices (planting dates, irrigation amount, fertilization rate and timing) could substantially reduce N usage by 40%–50%, irrigation amount by 33%–50%, and nitrate leaching by 86%–95% compared to farmers' practice in radish planting system. This study indicated that a modelling method is helpful for evaluating the biogeochemical effects of management alternatives and identifying optimal management practices in radish production systems of China. [Display omitted] • Denitrification-Decomposition (DNDC) was applied to simulate field radish systems. • DNDC well simulated radish yield, nitrogen (N) uptake, and nitrate leaching. • DNDC showed acceptable performance in simulating soil moisture and drainage. • Modelled critical agronomic and environmental N rates were 150–180 kg N ha−1. • Optimized planting dates and irrigation rates improved yields and reduced N losses. [ABSTRACT FROM AUTHOR]

Microplastic (MP) pollution in terrestrial ecosystems has aroused great concern. However, little is known regarding the distribution of MPs in Sand Land soils and their associated destinies. We investigated the MPs pollution in different areas, different vegetation cover and restoration years in Mu Us Sand Land soils. The results clearly showed that the soils of Mu Us Sand Land contain a relatively higher MPs abundance. The significant differences of MPs abundance were demonstrated among soil from sand, grassland and woodland, which the total MP abundance of sand soil was higher than that of grassland and woodland. The distribution of MP size in the woodland area primarily from 0 to 0.50 mm, which is significantly higher than that other areas. In addition, the highest concentration of MP collected was found at Salix tree (ST), followed by Poplar tree (PT) and Chinese pine (CP), while the lowest concentration was at Pinus sylvestris (PSs) and Jujube tree (JT). It is worth noting that the abundance of MPs decreases with restoration years increased, whether it is PT or PSs. We speculate that the tree disturbance in the sampling area might affect the distribution of microplastics and then be conducive to plastic fragmentation. ga1 • The abundance of microplastics exhibited exceptionally high level of MPs. • The microplastic abundance of sand was higher than that of grassland and woodland. • Microplastics size decreased gradually with the enhancement of repair degree. • Different types of cover vegetation may influence the distribution of microplastic. • Microplastics disturbance may be related to the history of restoration years. [ABSTRACT FROM AUTHOR]

Background: Exploring factors that may influence general practitioners (GPs)' intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area. However, little is known about how GPs' perception towards the National Compulsory Service Programme (NCSP) and job satisfaction impact their turnover intention. This paper explores GPs' intentions to remain in rural China and how their policy perception and job satisfaction predict the intentions., Methods: We conducted a cross-sectional, online survey from December 2021 to February 2022 to investigate GPs' perception towards NCSP, job satisfaction, and intentions to remain in rural area. Eligible participants were GPs who were required to provide health services as part of NCSP at township health centres of 9 provinces which could represent all NCSP GPs in China. Multinomial logistic regression analyses were performed to explore the associations between policy perceptions, job satisfaction, and intentions to remain., Results: Of 3615 GPs included in the analysis, 442 (12.2%) would like to remain in rural area and 1266 (35.0%) were unsure. Results of the multinomial logistic regression analyses showed that compared with GPs who would leave, GPs with higher perception scores for the restriction on taking postgraduate exam (RRR: 1.93, 95% CI 1.72, 2.16) and the commitment to work for six years (RRR: 1.53, 95% CI 1.31, 1.78) were more likely to remain. In contrast, GPs who had higher perception scores for completing standardised residency training (RRR: 0.75, 95% CI 0.64, 0.88) and passing National Medical Licensing Examinations (RRR: 0.74, 95% CI 0.62, 0.87) were more likely to leave. GPs who were satisfied with the freedom of choosing work methods (RRR: 1.52, 95% CI 1.25, 1.84) and chances of promotion (RRR: 1.60, 95% CI 1.32, 1.94) were more likely to remain., Conclusions: This study highlights the significance of policy perception and job satisfaction on GPs' intentions to remain in rural area. Factors such as career advancement and the empowerment of GPs to build on and use their skills and abilities should be taken into account when designing rural placement programmes., (© 2024. The Author(s).)

BACKGROUND Central sterile supply departments (CSSDs) play a vital role in hospital infection control. We investigate the factors associated with wet pack occurrence after steam sterilization. MATERIAL AND METHODS We designed a log sheet to record information concerning sterilized packs. The data included the type of sterilized pack; outside weather (sunny, overcast, or rainy); the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been laid flat, upright, or leaning at an acute angle; which sterilizer was used for sterilization of the pack; whether the pack had been placed on the top or bottom shelf inside the sterilizer chamber; whether the pack had been loaded in compliance with guidelines; the drying time following sterilization; and cooling time after sterilization. The sterilized packs in our study were selected from all of the packs that were sterilized in the CSSD of the authors' institution during June to December 2021. RESULTS Factors associated with wet pack occurrence after steam sterilization include: outside weather on the day of sterilization; the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been placed on the top or bottom shelf; and cooling time after sterilization. Statistically significant differences (P<0.05) in wet pack incidence were identified for all of these factors. CONCLUSIONS Various factors are associated with wet pack occurrence after steam sterilization. Recommendations for reducing the risk of wet packs include regular maintenance of the steam pipeline, regular replacement of thermal insulation materials for the steam pipeline, and extension of the drying time.

Background: Medical error (ME) is a serious public health problem and a leading cause of death. The reported adverse incidents in China were much less than western countries, and the research on patient safety in rural China's primary care institutions was scarce. This study aims to identify the factors contributing to the under-reporting of ME among general practitioners in township health centres (THCs)., Methods: A qualitative semi-structured interview study was conducted with 31 general practitioners working in 30 THCs across 6 provinces. Thematic analysis was conducted using a grounded theory approach., Results: The understanding of ME was not unified, from only mild consequence to only almost equivalent to medical malpractice. Common coping strategies for THCs after ME occurs included concealing and punishment. None of the participants reported adverse events through the National Clinical Improvement System website since they worked in THCs. Discussions about ME always focused on physicians rather than the system., Conclusions: The low reported incidence of ME could be explained by unclear concept, unawareness and blame culture. It is imperative to provide supportive environment, patient safety training and good examples of error-based improvements to rural primary care institutions so that ME could be fully discussed, and systemic factors of ME could be recognised and improved there in the future., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Rodents represent over 40% of known mammal species and are found in various terrestrial habitats. They are significant reservoirs for zoonotic viruses, including harmful pathogens such as arenaviruses and hantaviruses, yet knowledge of their hosts and distributions is limited. Therefore, characterizing the virome profile in these animals is invaluable for outbreak preparedness, especially in potential hotspots of mammal diversity. This study included 681 organs from 124 rodents and one Chinese tree shrew collected from Yunnan Province, China, during 2020-2021. Metagenomic analysis revealed unique features of mammalian viruses in rodent organs across habitats with varying human disturbances. R. tanezumi in locations with high anthropogenic disturbance exhibited the highest mammal viral diversity, with spleen and lung samples showing the highest diversities for these viruses at the organ level. Mammal viral diversity for both commensal and non-commensal rats was identified to positively correlate with landscape disturbance. Some virus families were associated with particular organs or host species, suggesting tropism for these pathogens. Notably, known and novel viral species that are likely to infect humans were identified. R. tanezumi was identified as a reservoir and carrier for various zoonotic viruses, including porcine bocavirus, hantavirus, cardiovirus, and lyssavirus. These findings highlight the influence of rodent community composition and anthropogenic activities on diverse virome profiles, with R. tanezumi as an important reservoir for zoonotic viruses.

Microplastics (MPs) as new environmental pollutants are receiving increasing attention worldwide. Urban rainwater runoff plays an important role in facilitating the migration of land-based MPs to surface water. Previous research has focused predominantly on aquatic ecosystems, whereas research on this migration pathway and the characteristics of MPs in rainwater pipelines draining from different land-use types is still lacking. This study investigated the abundance and characteristics of MPs in rainfall and pipeline rainwater runoff from main roads, office complexes, an agricultural experiment station, and residential areas during different rainfall periods in Haidian District, Beijing, China. Microplastic abundance in pipeline rainwater runoff ranged from 1.6 to 29.6 items L -1 , of which 0.7 to 6.0 items L -1 were derived from rainfalls, accounting for 24.0 % to 77.4 % of the total. Microplastic abundances in rainfall and pipeline rainwater runoff decreased significantly as rainfall events progressed. The proportions of MPs < 1 mm in rainfall (38.0 %) and rainwater runoff (44.5 %) were the largest. Average MPs abundance was the highest in rainwater runoff from the main road area and lowest in the office area (p < 0.05). The abundance of polyester fibers in rainwater runoff from the residential area was significantly higher than that in other areas, while the main road area had the highest abundance of films (p < 0.05). Overall, 72 % of MPs in rainfall were fibers, and most were composed of polyester, while the MPs in rainwater runoff were mainly fragments (41.2 %) and fibers (35.3 %) composed mainly of polypropylene, polyethylene, and polyester. This study shows that urban pipeline rainwater runoff is one of the main pathways for land-based MPs transport to surface waters, and provides a scientific reference for preventing and controlling MPs entering water bodies through rainwater pipelines., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Microplastics (MPs) pollution in the environment has become a global hotspot, but there is insufficient research on MPs in soils of large cities. This study investigated the pollution status of MPs in soils in different functional areas (commercial, tourist, industrial, and residential areas) of the Xi'an metropolitan area. The average abundances of MPs were 2218 items/kg in Xi'an city, 1329 items/kg in Xianyang city and 1400 items/kg in Yangling city. All MPs presented different shapes and were dominated by fragment and fiber. The 0-0.5 mm MPs accounted for the largest proportion. Polyethylene terephthalate (PET) was the predominant polymer type for MPs. The results showed that the soil in the Xi'an metropolitan area was polluted by MPs, with the pollution of MPs in Xi'an city being more severe than other two cities. This could be related to the advanced urbanization and industrialization process. Moreover, industrial and tourist areas had frequent industrial and human activities, so their MPs pollution was the worst. In addition, residential areas and some commercial areas far away from pollution sources had lower pollution levels and a more uniform distribution of MPs. This study may provide data and valuable reference for the investigation of soil MPs pollution in the Xi'an metropolitan area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Aims: This study aims to investigate the association between stressors, coping strategies and intention to leave the nursing profession among nurses., Background: Job stressors and coping strategies are believed to affect turnover intention among nurses, but no large-scale study has been conducted on these associations in China yet., Method: A cross-sectional secondary analysis was conducted among 51,406 nurses from 1858 hospitals. Univariable and multivariable logistic regression analyses were carried out, and odds ratios were reported., Results: Overall, 49.58% nurses had an intention to leave the profession. It is found that stress from health condition, family, occupational injuries, nurse-patient tension, high job demands, strict leaders and colleague relationships were significantly associated with higher intention to leave. Coping strategies such as talking to family and friends, talking to leaders, doing outdoor activities, engaging in hobbies and attending on-the-job training were significantly associated with lower intention, but social gathering, psychological counselling and suffering in silence had an opposite effect., Conclusions: Our study provides new insights into the association between stressors, coping strategies and turnover intention among nurses in China., Implications for Nursing Management: Evidence from this study indicates that policies promoting a safe and supportive work environment should be developed to help nurses cope with stress., (© 2022 John Wiley & Sons Ltd.)

Background: SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC) is a rare primary lung malignancy. These diseases are not listed separately in the 2021 World Health Organization (WHO) classification of lung neoplasms, but they have special morphological, immunophenotypic and molecular genetic characteristics. This study aims to improve understanding of SMARCA4-dNSCLC by discussing the clinicopathological features, diagonosis and differential diagnosis of the disease., Methods: The clinical and imaging data of 9 cases of SMARCA4-dNSCLC diagnosed in Shanghai Changhai Hospital from January 2020 to March 2022 were collected. The clinicopathological features were analyzed by histological and immunohistochemical staining, and the literature was reviewed., Results: The median age of 9 patients was 65 years old. Six men were smokers. The average maximum diameter of tumor was 3.3 cm. Six cases had been metastasized. The imaging showed that it was an infiltrating mass with unclear boundary and 3 cases invaded the pleura. Nine cases were diagnosed as SMARCA4-dNSCLC, which mainly showed three pathological forms including classic lung adenocarcinoma, mucinous adenocarcinoma and poorly differentiated carcinoma. Poorly differentiated tumor cells are epithelioid, syncytial or rhabdomyoid, the cytoplasm was rich, the cytoplasm could be completely transparent to eosinophilic, eosinophilic globules or small abscesses could be seen, showing solid flakes, with more inflammatory cells and flake necrosis in the stroma. Immunohistochemistry showed that SMARCA4 was negative in all cases and eight cases demonstrated cytokeratin 5.2 (CAM5.2) and cytokeratin 7 (CK7) was diffusely strongly positive, p40 was negative, thyroid transcription factor-1 (TTF-1) was negative in 6 cases, partially positive in 2 cases and diffusely positive in 1 case., Conclusions: SMARCA4-dNSCLC is a rare subtype of lung cancer with complex and diverse pathological morphology. The characteristic of immunohistochemical phenotype can assist in the diagnosis.

BACKGROUND Surgical site infections in patients after abdominal hysterectomy can increase medical expenses and increase the risk of death in patients. This retrospective study from 2 grade A tertiary hospitals in China aimed to evaluate the risk factors for postoperative surgical site infections (SSIs) in 188 patients undergoing abdominal hysterectomy between September 2013 and June 2021. MATERIAL AND METHODS Of the 188 patients, 94 patients with SSIs were classified into the infected group, and 94 patients without SSIs were classified into the control group. Wound drainage was sampled for bacterial isolation and culture. RESULTS The suspected risk factors for SSIs after abdominal hysterectomy were body mass index, whether the patient had comorbidities of diabetes mellitus, cancer, or hypoproteinemia, surgical wound classification, whether preoperative skin preparation was performed, whether the patient had chemotherapy, length of incision, amount of blood loss during surgery, duration of surgery, necessity of a second surgery, whether a wound drainage tube was inserted, and whether delayed suturing was used in wound. Of them, body mass index (OR=1.133; 95% CI: 1.012~1.266; P=0.029), more than 3 hours of surgery (OR=0.261; 95% CI: 0.108~0.631; P=0.003), and wound drainage tube insertion (OR=0.223; 95% CI: 0.094~0.531; P=0.001) were the independent risk factors. CONCLUSIONS The findings support previous studies and showed that risk factors for SSIs after abdominal hysterectomy included increased patient BMI, increased operation duration, and the number of surgical drainage tubes used.

To study the regulatory function of Bombyx mori (B. mori) miRNAs (bmo-miR) on the expression of fibroin light chain gene (BmFib-L), the 3'UTR of BmFib-L mRNA was used as the target for online prediction of miRNAs from miRBase using RNAhybrid Software, and miR-2845 was screened out. First, the expression profiles of miR-2845 and BmFib-L in larvae of the 5th instar were analyzed by Real-time quantitative PCR (RT-qPCR). Then recombinant plasmids (pcDNA3.0-pre-miR-2845 and pGL3.0-BmFib-L) were constructed to use for the expression of miR-2845 and BmFib-L 3'UTR, respectively. Cellular-level functional verification of miR-2845 on BmFib-L was carried out using multiple experimental methods (including dual luciferase reporter vectors, artificially synthesized mimics and inhibitors, and target site mutations). Finally, in vivo functional verification was performed by injecting the recombinant vector in 5th instar larvae. BmFib-L expression levels were detected using RT-qPCR in the posterior silk glands (PSG) of the injected larvae. Results showed that the expression of miR-2845 increased between the 1st and 5th day in 5th instar larvae, but began to decline on the 5th day, while the expression of the target gene BmFib-L increased sharply. This suggests that miR-2845 and BmFib-L expression levels show opposing trends, implying a negative regulatory relationship. In BmN cells, miR-2845 significantly down-regulated the expression of BmFib-L; the inhibitory effect of miR-2845 on BmFib-L was disappeared after mutation of the targeting site on 3'UTR of BmFib-L; in individuals, miR-2845 significantly down-regulated BmFib-L expression levels. Our results provide new experimental data for clarifying the molecular regulation mechanism of silk protein expression., Competing Interests: The authors declare that there is no conflict of interests.

Vaccine hesitancy is an obstacle to COVID-19 vaccination. This study aims to inform the vaccine hesitancy and analyze related factors toward COVID-19 vaccination among medical students in China, so as to provide suggestions for increasing vaccines uptake. An online cross-sectional survey was conducted among medical students in a medical university and a health school. A total of 2,196 valid questionnaires were received. 41.2% vaccine hesitancy was reported among medical students in total. Female (OR = 1.336) and individuals with higher education (OR = 1.724) reported slightly higher vaccine hesitancy. Being in low-risk areas and no need to get vaccinated (OR = 2.285), fear of serious consequences of vaccination (OR = 1.929), being in good health and no need to be vaccinated (OR = 1.891), being concerned about short-term side effects (OR = 1.793) and being concerned that the vaccine was ineffective (OR = 1.694) had higher prevalence of vaccine hesitancy. Those who were believing the specialty of study or work environment made vaccination necessary (OR = 0.378), believing they were susceptible to COVID-19 (OR = 0.411) and the vaccine was free (OR = 0.519) were more willing to get vaccinated. Confidence in vaccines and perceptions of benefits and risk are associated with vaccine hesitancy. It is important to strengthen vaccine health literacy education for medical students and enhance vaccine confidence. Countries need to supervise the public opinions in social media, television broadcasting and other media, so as to ensure the correct orientation of public opinion. Open and transparent evidence-based information is also needed which can help improve the vaccination coverage rate of the public.

Background: Clinical learning environment plays a vital role in nursing clinical education. The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts., Objectives: To validate the Chinese version of the CLES+T scale that is in line with the Chinese culture and educational context., Design: A cross-sectional survey., Setting: Data were collected from nursing students in six provinces in different parts of China between September and October 2018., Participants: Six hundred and ninety-four nursing students participated in this study., Methods: Purposeful sampling was used, and students completed online survey to explore the structure of the CLES+T scale. Internal consistency reliability was tested on the total scale and its sub-dimensions using Cronbach's alpha., Results: An exploratory factorial analysis identified a three-component solution, with 11 items, and explained 60.01% of the variance. Confirmatory factor analysis supported the factor structure. Cronbach's alpha coefficient for the scale was 0.82, and those of the three subscales were 0.79, 0.71, and 0.70., Conclusions: The unique, stable and relatively concise Chinese version of CLES+T scale instrument could be a useful instrument for using as an assessment scale in Chinese-speaking countries., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: This phase 1 study aimed to develop a Type 1 diabetes (T1DM) educational resource for adolescents (10-19 years) in China, and to test its validity for improving diabetes knowledge, self-efficacy and adherence., Design and Methods: This phase 1 study was carried out in four phases: preliminary development of the Type 1 diabetes educational resource in English based on the health belief model (HBM) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines 2014; translation of the resource into Chinese; readability testing of the resource; and face and content validity testing for scientific and clinical accuracy., Results: Type 1 diabetes educational resource with 17 "topics" in four sections was developed for 10-19-years old adolescents in China. Cartoon story, images, stories, questions & answers, and quizzes were used to attract adolescents' interest. Furthermore, the educational resource was confirmed to be understandable among adolescents, clinically accurate, and consistent with its purpose., Conclusions: This resource with good readability and content validity is a potential facilitator for diabetes education and self-management in adolescents with T1DM in China., Practical Implications: This type 1 diabetes resource can be used to educate adolescents with T1DM as a validated resource after further testing in an effectiveness study., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Despite the discovery of animal coronaviruses related to SARS-CoV-2, the evolutionary origins of this virus are elusive. We describe a meta-transcriptomic study of 411 bat samples collected from a small geographical region in Yunnan province, China, between May 2019 and November 2020. We identified 24 full-length coronavirus genomes, including four novel SARS-CoV-2-related and three SARS-CoV-related viruses. Rhinolophus pusillus virus RpYN06 was the closest relative of SARS-CoV-2 in most of the genome, although it possessed a more divergent spike gene. The other three SARS-CoV-2-related coronaviruses carried a genetically distinct spike gene that could weakly bind to the hACE2 receptor in vitro. Ecological modeling predicted the co-existence of up to 23 Rhinolophus bat species, with the largest contiguous hotspots extending from South Laos and Vietnam to southern China. Our study highlights the remarkable diversity of bat coronaviruses at the local scale, including close relatives of both SARS-CoV-2 and SARS-CoV., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Moistening of surgical instruments affects the quality of instrument cleaning, thereby affecting the degree of cross-contamination and in-hospital infection among patients. Surgical instruments should be kept moist immediately after use in order to avoid concentrations of contamination remaining on surgical instrument surfaces. Implementation and pass rates of surgical instrument moistening have been rarely studied. We aimed to investigate the factors affecting implementation and pass rates of surgical instrument moistening., Methods: A cross-sectional study was conducted to investigate surgical instrument moistening procedures within 22 clinical departments of the West China Second University Hospital, Sichuan University over 122 days between September and December 2019. We collected data from departmental staff using an interviewer-administrated questionnaire. Data about implementation and pass rates of surgical instrument moistening was analyzed in SPSS20.0., Results: Implementation and pass rates of surgical instrument moistening were 57.25% and 31.98%, respectively. Factor analysis showed that implementation rates of moistening were affected by instrument structure (X 2  = 143.670; P = 0.001), the number of instruments inside the pack (X 2  = 140.135; P = 0.001), and the person responsible for keeping surgical instruments moist (X 2  = 8.052; P = 0.005). Correlation analysis showed that instrument structure and the number of instruments inside the pack were negatively correlated with implementation rates of moistening. The more complex the structure and the greater the number of the instruments inside the pack, the lower implementation rates of moistening., Conclusion: Implementation and pass rates of surgical instrument moistening were low, and failed to meet the central sterile supply department applicable industrial standard, hence the potential risk of hospital-acquired infection was considerable. Staff that manipulate reusable surgical instruments should be trained to properly moisten the instruments and institutional protocols should be established to ensure standardization and respect of guidelines., (© 2021. The Author(s).)

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common X-linked enzymopathies caused by G6PD gene variant. We aimed to provide the characteristics of G6PD deficiency and G6PD gene variant distribution in a large Chinese newborn screening population. We investigated the prevalence of G6PD in China from 2013 to 2017. Then, we examined G6PD activity and G6PD gene in representative Chinese birth cohort to explore the distribution of G6PD gene variant in 2016. We then performed multicolor melting curve analysis to classify G6PD gene variants in 10,357 neonates with activity-confirmed G6PD deficiency, and DNA Sanger sequencing for G6PD coding exons if hot site variants were not found. The screened population, organizations, and provinces of G6PD deficiency were increased from 2013 to 2017 in China. The top five frequency of G6PD gene variants were c.1376G>T, c.1388G>A, c.95A>G, c.1024C>T, and c.871G>A and varied in different provinces, with regional and ethnic features, and four pathogenic variant sites (c.152C>T, c.290A>T, c.697G>C, and c.1285A>G) were first reported. G6PD deficiency mainly occurs in South China, and the frequency of G6PD gene variant varies in different regions and ethnicities., (© 2019 Wiley Periodicals, Inc.)

This study investigated the water resource potential for bioenergy production from sweet sorghum (Sorghum bicolor (L.)) in Northern China according to the distribution of water resources, climate conditions and the total water consumption of bioenergy based on sweet sorghum, which consisted of blue water, green water and grey water. At a case study site in Inner Mongolia, simulation with a plant phenological model was used to determine whether sweet sorghum could reach the harvestable stage for sugar juice production. The blue water in the agricultural phase was estimated according to the potential crop evapotranspiration (ET c ), the drought sensitivity of sweet sorghum in different stages and the precipitation during the growing season. The results showed that the irrigation water was significantly different among the districts, ranging from 730 to 5500 m 3 /ha and 2060 to 6680 m 3 /ha for early-maturing and late-maturing varieties, respectively. To avoid the water pressure level to be exacerbated and the severe reallocation of water resources resulting in negative effects on other sectors, the maximal annual water withdrawal was set to not surpass the upper threshold of water stress level of 40%. That makes the maximum area for the production of sweet sorghum cannot exceed 1.95 × 10 4  ha, representing only 0.24% of the total marginal land area in Inner Mongolia. However, the economic benefits of bioenergy production from sweet sorghum would be negative due to the high labour input. Therefore, not only the availability of marginal land, the climate conditions and local water resources but also the improvement of mechanisation and agricultural production techniques should be considered to attain the sustainable development of bioenergy production and address global energy and environmental crises., (Copyright © 2018. Published by Elsevier B.V.)

Background: The Mentors' Behavior Scale was developed and validated initially among nursing students by assessing the importance of mentors' behavior, showing satisfactory psychometrics and the potential to match mentors with students according to students' expectation., Objectives: This study aims to test the discriminant validity and the structure of the Mentor's Behavior Scale among mentors to assess mentors' performance., Design: A cross-sectional survey was applied in the study., Setting: Data were collected from mentors in seven hospitals in north, south, southwest China in 2016 and 2017., Participant: 871 mentors participated in this study., Methods: Purposeful sampling and online survey was used., Results: Three factors (to guide personal growth, promote professional development, and provide psychosocial support) were identified by exploratory factor analysis. The cumulative contribution of variance was 61.03%. The Cronbach's alpha coefficient of the scale was 0.85, and those of the three subscale's were 0.84, 0.72, and 0.74. The results of discriminant validity showed that mentors who received training and who liked mentoring students scored higher in mentoring behavior., Conclusion: Mentors considered that mentoring behavior were to guide students' personal growth, promote professional development and provide them with psychosocial support. It will be useful to apply The Mentors' Behavior Scale among mentors to guide and evaluate their behaviors., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

As the most common inherited retinal degenerations, retinitis pigmentosa (RP) is clinically and genetically heterogeneous. Some of the RP genes are also associated with other retinal diseases, such as LCA (Leber's congenital amaurosis) and CORD (cone-rod dystrophy). Here, in our molecular diagnosis of 99 Chinese RP patients using targeted gene capture sequencing, three probands were found to carry mutations of RPGRIP1, which was known to be associated with pathogenesis of LCA and CORD. By further clinical analysis, two probands were confirmed to be RP patients and one was confirmed to be LCA patient. These novel mutations were co-segregated with the disease phenotype in their families. Our result not only expands the mutational spectrum of the RPGRIP1 gene but also gives supports to clinical diagnosis and molecular treatment of RP patients.

Congenital cataract is both clinically diverse and genetically heterogeneous. To investigate the underlying genetic defect in three-generations of a Chinese family with autosomal dominant congenital cataracts, we recruited family members who underwent comprehensive ophthalmic examinations. A heterozygous missense mutation c.634G > C (p.G212R) substitution was identified in the MIP gene through target region capture sequencing. The prediction results of PolyPhen-2 and SIFT indicated that this mutation was likely to damage the structure and function of MIP. Confocal microscopy images showed that the intensity of the green fluorescent signal revealed much weaker signal from the mutant compared to the wild-type MIP. The expressed G212R-MIP was diminished and almost exclusively cytoplasmic in the HeLa cells; whereas the WT-MIP was stable dispersed throughout the cytoplasm, and it appeared to be in the membrane structure. Western blot analysis indicated that the protein expression level of the mutant form of MIP was remarkably reduced compared with that of the wild type, however, the mRNA levels of the wild-type and mutant cells were comparable. In conclusion, our study presented genetic and functional evidence for a novel MIP mutation of G212R, which leads to congenital progressive cortical punctate with or without Y suture.