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Background: The use of suboptimal controls in randomized trials of new cancer drugs can produce potentially unreliable clinical efficacy results over the current standard of care and expose patients to substandard therapy. We aim to investigate the proportion of randomized trials of investigational cancer drugs that used a suboptimal control arm and the number of trial participants at risk of exposure to suboptimal treatments in China. The association between the use of a suboptimal control and concluding statistical significance on the primary endpoint was also examined. Methods and findings: This observational study included randomized controlled trials (RCTs) of cancer drugs that were authorized by specific Chinese institutional review boards between 2016 and 2021, supporting investigational new drug applications of these drugs in China. The proportion of trials that used a suboptimal control arm and the total number of trial participants at risk of exposure to suboptimal treatments were calculated. In a randomized trial for a specific condition, a comparator was deemed suboptimal if it was not recommended by clinical guidelines published in priori or if there existed a regimen with a higher level of recommendation for the indication. The final sample included 453 Phase II/III and Phase III randomized oncology trials. Overall, 60 trials (13.2%) adopted a suboptimal control arm. Among them, 58.3% (35/60) used comparators that were not recommended by a prior guideline for the indication. The cumulative number of trial participants at risk of exposure to suboptimal treatments totaled 18,610 by the end of 2021, contributing 15.1% to the total number of enrollees of all sampled RCTs in this study. After adjusting for the year of ethical approval, region of participant recruitment, line of therapy, and cancer site, second-line therapies (adjusted odds ratio [aOR] = 2.7, 95%CI [1.2, 5.9]), adjuvant therapies (aOR = 8.9, 95% CI [3.4, 23.1]), maintenance therapies (aOR = 5.2, 95% CI [1.6, 17.0]), and trials recruiting participants in China only (aOR = 4.1, 95% CI [2.1, 8.0]) were more likely to adopt a suboptimal control. For the 105 trials with publicly available results, no statistically significant difference was observed between the use of a suboptimal control and concluding positive on the primary endpoint (100.0% [12/12] versus 83.9% [78/93], p = 0.208). The main limitation of this study is its reliance on clinical guidelines that could vary across cancer types and time in assessing the quality of the control groups. Conclusions: In this study, over one-eighth of randomized trials of cancer drugs registered to apply for regulatory approval in China used a suboptimal comparator. Our results highlight the necessity to refine the design of randomized trials to generate optimal clinical evidence for new cancer therapies. In this observational study, Yichen Zhang and colleagues explore how comparator arms are used in randomized oncology trials registered in China. Author summary: Why was this study done?: ■ Using inappropriate controls in randomized trials of new cancer drugs can expose patients to harm and produce potentially unreliable results of clinical efficacy. ■ In November 2021, China's Center for Drug Evaluation issued the Guidance on Clinical Value-Oriented Oncology Drug Research and Development. It stated that an active control arm should be selected with consideration of whether it reflects the optimal treatment in current clinical practices. ■ Previous descriptive analysis showed that oncology trials are expanding in China; however, no literature evaluated the quality of their control arms. What did the researchers do and find?: ■ This observational study reports the annual trend and proportion of 453 Phase II/III and Phase III randomized oncology trials registered in China between 2016 and 2021 that adopted a suboptimal control arm. We also calculated the cumulative number of trial participants at risk of exposure to suboptimal treatments. ■ We observed a fluctuating yet overall upward trend in the number of trials and participants that used a suboptimal comparator during our observation period. Overall, 60 trials adopted a suboptimal control arm and the cumulative number of trial participants at risk of exposure to suboptimal treatments totaled 18,610 by the end of 2021. ■ Trials with a suboptimal control reported higher but statistically non-significant proportions of positive results than those using an optimal control. What do these findings mean?: ■ Trial sponsors, ethical review boards, and oncologists should make collaborative efforts to protect patients from unnecessary harm and drugs with uncertain clinical benefits over the existing standard of care. ■ Regulatory agencies should be cautious when reviewing investigational new drug applications whose supporting trial used a suboptimal control and when making subsequent market authorization decisions. ■ A limitation of this study is the reliance on clinical guidelines that could vary across cancer types and time in assessing the quality of the control groups. Hence, though oncologists and clinical pharmacists were consulted when assessing the sample trials, our results may have inherent subjectivity. [ABSTRACT FROM AUTHOR]

In recent years, the volcanic activity of Changbai Mountain has been accompanied by several earthquakes, and the frequent human engineering activities have led to a gradual increase in the number of collapses in the region, which severely impacts residents' lives and property safety. In northeastern China, the Changbai Mountain area in the southeastern Jilin Province is a typical mountain environment. This paper selects 12 evaluation indicators to build a hazard assessment system, including slope, aspect, elevation, curvature, lithology, NDVI, land use type, distance from the fault, the river from the road, volcanic earthquake, and annual average precipitation. Using emotional weight (G1 method) and objective weight (WOE-CV method), the hazard due to collapses in the study area is evaluated too. Among them, the transcendence probability of volcanic earthquakes greater than VI degree represents the relationship between Changbai Mountain volcanic earthquakes and the assessment of geological collapse hazard. The results show that high- and very high-hazard areas are mainly distributed in densely populated areas and national and provincial trunk lines, with apparent spatial agglomeration characteristics. The low-hazard area, medium-hazard area, high-hazard area and very high-hazard area accounted for 19.33%, 44.19%, 33.85% and 2.63% of the total area of the study area, respectively. By comparing the previous geological hazard survey reports in the area with the collapse hazard zoning map in this paper, 87.72% of the known collapse hazard areas are distributed within high and very high hazard zones, indicating that the conclusions of the article are more accurate and in line with the actual situation. Results from collapse-related hazards can provide relevant guidance for preventing and controlling geological risks posed by volcanic earthquakes affecting Changbai Mountain. [ABSTRACT FROM AUTHOR]

Simple Summary: Bovine viral diarrhea virus (BVDV) is a pathogen that is widespread throughout the world, causing serious economic losses. Most of the current BVDV infection research focuses on genotyping based on the 5′-UTR sequence, neglecting the molecular characteristics of the whole genome of BVDV strains. Cows infected with non-cytopathic (NCP) BVDV in early pregnancy may give birth to persistently infected (PI) cattle, which are the main sources of virus transmission in the herd. The present study isolated and identified nine BVDV strains from PI cattle in China. The complete genome of the new isolates was sequenced for phylogenetic analysis, recombination analysis and sequence analysis in 5′-UTR, E0 and E2. In this study, we reported the isolation, identification, and molecular characteristics of nine BVDV strains that were isolated from the serum of persistently infected cattle. The new strains were designated as BVDV TJ2101, TJ2102, TJ2103, TJ2104, TJ2105, TJ2106, TJ2107, TJ2108 and TJ2109. The TJ2102 and TJ2104 strains were found to be cytopathic BVDV, and the other strains were non-cytopathic BVDV. An alignment and phylogenetic analysis showed that the new isolates share 92.2–96.3% homology with the CP7 strain and, thus, were classified as the BVDV-1b subgenotype. A recombination analysis of the genome sequences showed that the new strains could be recombined by the major parent BVDV-1a NADL strain and the minor parent BVDV-1m SD-15 strain. Some genome variations or unique amino acid mutations were found in 5′-UTR, E0 and E2 of these new isolates. In addition, a potential linear B cell epitopes prediction showed that the potential linear B cell epitope at positions 56–61 is highly variable in BVDV-1b. In conclusion, the present study has identified nine strains of BVDV from persistently infected cattle in China. Further studies on the virulence and pathogenesis of these new strains are recommended. [ABSTRACT FROM AUTHOR]

Exposure to air pollution is one of the greatest environmental risks for human health. Air pollution level is significantly driven by anthropogenic emissions and meteorological conditions. To protect people from air pollutants, China has implemented clean air actions to reduce anthropogenic emissions, which has led to rapid improvement in air quality over China. Here, we evaluated the impact of anthropogenic emissions and meteorological conditions on trends in air pollutants in a coastal city (Lianyungang) in eastern China from 2015 to 2022 based on a random forest model. The annual mean concentration of observed air pollutants, including fine particles, inhalable particles, sulfur dioxide, nitrogen dioxide, and carbon monoxide, presented significant decreasing trends during 2015–2022, with dominant contributions (55–75%) by anthropogenic emission reduction. An increasing trend in ozone was observed with an important contribution (28%) by anthropogenic emissions. The impact of meteorological conditions on air pollution showed significant seasonality. For instance, the negative impact on aerosol pollution occurred during cold months, while the positive impact was in warm months. Health-risk-based air quality decreased by approximately 40% in 8 years, for which anthropogenic emission made a major contribution (93%). [ABSTRACT FROM AUTHOR]

With extreme rainfall events and rapid urbanization, urban flood disaster events are increasing dramatically. As a key flood control city in China, Changchun City suffers casualties and economic losses every year due to floods. The improvement of flood resilience has become an important means for cities to resist flood risks. Therefore, this paper constructs an assessment model of urban flood resilience from four aspects: infrastructure, environment, society and economy. Then, it quantifies infrastructure and environmental vulnerability based on GIS, and uses TOPSIS to quantify social and economic recoverability. Finally, based on k-means clustering of infrastructure and environmental vulnerability and social and economic recoverability, the flood resilience of Changchun City was evaluated. The results show that different factors have different effects on flood resilience, and cities with low infrastructure and environmental vulnerability and high socioeconomic recoverability are more resilient in the face of floods. In addition, cities in the same cluster have the same flood resilience characteristics. The proposed framework can be extended to other regions of China or different countries by simply modifying the indicator system according to different regions, providing experience for regional flood mitigation and improving flood resilience. [ABSTRACT FROM AUTHOR]

China has been suggested to be the country with the largest vegetation greenness over the last four decades. In this study, we investigated the change in the speed of canopy development and senescence as well as its linkage with climate at monthly scale across temperate China, using satellite‐derived Normalized Difference Vegetation Index (NDVI) data from 1982 to 2015. A significant increase in mean monthly NDVI occurred across all growing‐season months except June and November, but this greening trend was mainly contributed by the faster speed of canopy development in April and the slower speed of canopy senescence in October. The average of VNDVI (the difference in NDVI between 2 consecutive months) over temperate China is significantly increased only in April (7.75 × 10−4 year−1, p <.05) and October (4.98 × 10−4 year−1, p <.05). In contrast, VNDVI in November is significantly decreased, indicating an increasing trend in the magnitude of leaf fall in the last month of the growing season due to both increase in season maximum greenness and slower canopy senescence in October. We also found clear seasonal differences in the correlations between VNDVI and climatic factors, especially temperature. In April and October, the correlations between VNDVI and temperature were generally positive, while they were negative in June. VNDVI in spring (early growing season) and summer (middle growing season) was also positively correlated with precipitation in semiarid regions. Such seasonally distinct climatic controls on VNDVI should be considered in modelling vegetation responses to climate change. Overall, our findings can help quantify the contribution of different climatic drivers on the shifts in canopy development and senescence and better elucidate the change in vegetation greenness under future climate change. [ABSTRACT FROM AUTHOR]

As a country with the fastest population aging rate in the world, China's existing elderly care and medical resources are not enough to meet the growing and complex needs of elderly care and health services. The Chinese government is actively promoting the integrated development of medical and elderly care institutions, but it has yet to give full play to the inexpensive and existing advantages of traditional Chinese medicine in the treatment of diseases and rehabilitation of the elderly, by sorting out the advantages of "TCM + intelligent pension" in medical expenses, pension costs, disease prevention, intelligent pension services, and so on. In view of the current problems existing in China's pension, this paper mainly proposes to solve the pension dilemma in China from several aspects: improving the supervision and evaluation system, increasing capital investment, building a unified digital medical and pension service platform, and strengthening the talent training in the field of traditional Chinese medicine integration. The application of the "TCM + smart elderly care" system into the medical and elderly care service system is promoted to effectively improve the operation efficiency of the whole medical and elderly care service system and the satisfaction of elderly families. [ABSTRACT FROM AUTHOR]

Background: High prices of anticancer medicines have increased the economic burden for both patients and health insurance systems. Since 2017, China has implemented national price negotiations for medicines, relying on evidence from health technology assessments. We aim to assess the relation between negotiated price and value of anticancer medicines listed in China's National Reimbursement Drug List (NRDL). Methods: For all price-negotiated anticancer medicines and corresponding indications listed in the latest NRDL between 2017 and 2020, we collected their clinical outcomes data, including overall survival (OS) and progression-free survival (PFS), in supporting trials. Pearson correlation coefficient was calculated to estimate the association between the daily cost and clinical benefit of each indication. Results: In total, 75 indications of 46 branded anticancer medicines were included for analysis. The median daily costs for the anticancer therapies that had gone through negotiation in 2017–2020 were US$87.6, US$71.8, US$58.9, and US$39.7, respectively. For indications supported by randomized trials, no correlation between daily costs and OS and PFS benefit of the price-negotiated cancer therapies was observed (N = 41, r = −0.05, and N = 49, r = 0.04, respectively). For cancer indications newly listed in NRDL in 2020, the association between their daily cost and OS benefit was −0.78 (N = 4, p = 0.221) and 0.01 (N = 8, p = 0.986) before and after the price negotiation. Conclusion: Though the negotiation policy decreased prices of anticancer medicines in China, no statistically significant correlation was observed between their daily costs and clinical benefits. A more transparent and credible pricing approach needs to be established to promote value-based anticancer medicines and healthcare system efficiency. [ABSTRACT FROM AUTHOR]

Different from less developed countries, 80% of children with cancers in the United States are cured. Traditional chemotherapy drugs are the mainstay of therapies; new targeted medications have become available recently. Using publicly available data, we created a database of cancer drugs with paediatric malignancy indications approved by 31 October 2020 in China and the United States. We compared numbers, type, indications and listing on the World Health Organization Model List of Essential Medicines for Children (WHO EMLc) between the two countries, assessed the correlation between paediatric indications and cancer incidences, and described evidence supporting approvals of targeted medications in the two settings. Our study showed that by 31 October 2020, 31 and 39 cancer drugs available in China and the United States were approved for use in children, corresponding to 137 and 102 paediatric cancer indications, respectively. About half of these drugs (17 in China and 18 in the United States) were listed on the WHO EMLc. The correlation between indications and burden of disease was higher in the United States (r = 0.68) than China (r = 0.59). More traditional chemotherapy drugs were approved in China (n = 27) than the United States (n = 19). Of 20 targeted childhood anticancer medicines approved in the United States, mainly on the basis of single arm trials (27/32 indications, 84.4%), only four were approved for paediatric indications in China, at a median of 2.8 years after US Food and Drug Administration approval. A harmonised, evidence‐based regulatory framework is needed to ensure approvals of needed, safe and efficacious childhood cancer drugs across the world. What's new? This comprehensive review of the childhood cancer drugs and their paediatric indications approved in China and the United States suggests that key therapeutics for the treatment of children with cancers are approved in China. But more traditional chemotherapy drugs are approved in China than in the United States, and only a few of the targeted childhood anticancer medications approved in the United States, mainly on the basis of single‐arm clinical trials, are also approved in China. A harmonised, evidence‐based regulatory framework is needed to ensure the development and approval of needed, safe, and efficacious childhood cancer drugs across the world. [ABSTRACT FROM AUTHOR]

Evidence on physician patient-sharing relationships from developing countries is limited. This study aimed to identify patient-sharing networks among physicians in China and explore the effect of attributes of physician networks on healthcare utilization and costs. Retrospective analysis was undertaken based on healthcare claims from Urban Employee Basic Medical Insurance Data spanning the years 2015 to 2018. We identified patients with hypertension and modeled physician patient-sharing networks using social network analysis. Relationships among physicians were further quantified using network measures. We fitted a log-linear model to examine the association between networks and healthcare at the physician level. 29,321 patients, seen by 3,429 physicians from 57 hospitals in one eastern city of China were included. Physicians were connected to 21 other physicians (threshold = 1 shared patients) or 7 other physicians (threshold = 4, 6, or 8 shared patients). Degree and centrality measures of physicians at primary care facilities were significantly lower than those at secondary or tertiary hospitals (p < 0.001). The links between physicians at different hospital grades were weak and patients tended to flow among physicians at the same hospital grade. Compared with a low closeness centrality, a medium level was associated with fewer hospitalization costs and days, and high closeness centrality was accompanied by a sharper decrease (all P < 0.001). Primary care physicians were located in peripheral positions in China, and the links between primary care facilities and higher-grade hospitals were still weak. Characteristics of physicians' networks and the position of physicians in the network were associated with spending and utilization of services, but not all associations were in the same direction. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is highly prevalent in Chinese population. The association of operative approach with economic burden in these patients remains unknown. Objectives: This institution-level cohort study aimed to compare the cost-related clinical outcomes and health care costs among patients undergoing video-assisted thoracoscopic surgery (VATS) and open lobectomy, and to investigate the factors associated with the costs. Methods: This retrospective cohort study included patients who underwent VATS or open lobectomy in a provincial referral cancer center in China in 2018. Propensity score matching (PSM) method was applied to balance the baseline characteristics in VATS lobectomy and open lobectomy group. Clinical effectiveness measures included post-operative blood transfusion, lung infection, and length of stay (LOS). Hospitalization costs were extracted from hospital information system to assess economic burden. Multivariable generalized linear model (GLM) with gamma probability distribution and log-link was used to analyze the factors associated with total costs. Results: After PSM, 376 patients were selected in the analytic sample. Compared to open lobectomy group, the VATS lobectomy group had a lower blood transfusion rate (2.13% vs. 3.19%, P = 0.75), lower lung infection rate (21.28% vs. 39.89%, P < 0.001) and shorter post-operative LOS (9.4 ± 3.22 days vs. 10.86 ± 4.69 days, P < 0.001). Total hospitalization costs of VATS lobectomy group and open lobectomy were similar: Renminbi (RMB) 84398.03 ± 13616.13, RMB 81,964.92 ± 16748.11, respectively (P = 0.12). Total non-surgery costs were significantly lower in the VATS lobectomy group than in the open lobectomy group: RMB 41948.40 ± 7747.54 vs. RMB 45752.36 ± 10346.42 (P < 0.001). VATS approach, lung infection, longer post-operative length of stay, health insurance coverage, and lung cancer diagnosis were associated with higher total hospitalization costs (P < 0.05). Conclusions: VATS lobectomy has a lower lung infection rate, and shorter post-operative LOS than open lobectomy. Future studies are needed to investigate other aspects of clinical effectiveness and the economic burden from a societal perspective. [ABSTRACT FROM AUTHOR]

Introduction: Patients with type 2 diabetes have lower quality of life, which is further impaired by diabetes complications and comorbidities. This study aims to evaluate the impact of diabetes complications and comorbidities on EuroQol Five-Dimension Three-Level (EQ-5D-3L) scores among patients with type 2 diabetes with ongoing oral drug treatments in China. Methods: This retrospective cross-sectional analysis included 9570 patients with type 2 diabetes on oral drug treatments, who were enrolled from 75 hospitals in nine cities in China. Patient characteristics, including demographic data, health conditions, oral treatment history, and health insurance coverage, were collected through self-reported questionnaires. Health utility was measured by the EQ-5D-3L scale in the questionnaire and a Chinese version of the EQ-5D-3L scoring weights was applied in the analysis. The associations between complications and health utility were assessed using linear regression. Results: A total of 7081 patients with complete survey data were included in the analytic sample; 3479 (49.13%) patients were female. The mean age was 59.6 years old, with a standard deviation (SD) of 12.64. The average duration with type 2 diabetes was 7.91 (SD = 6.22) years. A total of 5189 (73.28%) patients reported complications. Hypertension (51.25%) and hyperlipidemia (28.90%) were the most common complications. Other complications reported by patients included cardiovascular disease, stroke, retinopathy, nephropathy, diabetic foot, and hypoglycemia. On average, each patient had 1.54 complications. All complications and comorbidities decreased the EQ-5D-3L score. Among patients with complications, the worst effect on EQ-5D-3L score was caused by diabetic foot, decreasing by 0.118 (p < 0.001), followed by stroke (decreasing by 0.101, p < 0.001) and nephropathy (decreasing by 0.058, p < 0.001). Conclusion: The diabetes complications and comorbidities among patients with type 2 diabetes were associated with poor health utility scores, especially for those with diabetic foot, stroke, and nephropathy. [ABSTRACT FROM AUTHOR]

Landslides pose a constant threat to the lives and property of mountain people and may also cause geomorphological destruction such as soil and water loss, vegetation destruction, and land cover change. Landslide susceptibility assessment (LSA) is a key component of landslide risk evaluation. There are many related studies, but few analyses and comparisons of models for optimization. This paper aims to introduce the Tree-structured Parzen Estimator (TPE) algorithm for hyperparameter optimization of three typical neural network models for LSA in Shuicheng County, China, as an example, and to compare the differences of predictive ability among the models in order to achieve higher application performance. First, 17 influencing factors of landslide multiple data sources were selected for spatial prediction, hybrid ensemble oversampling and undersampling techniques were used to address the imbalanced sample and small sample size problem, and the samples were randomly divided into a training set and validation set. Second, deep neural network (DNN), recurrent neural network (RNN), and convolutional neural network (CNN) models were adopted to predict the regional landslides susceptibility, and the TPE algorithm was used to optimize the hyperparameters respectively to improve the assessment capacity. Finally, to compare the differences and optimization effects of these models, several objective measures were applied for validation. The results show that the high-susceptibility regions mostly distributed in bands along fault zones, where the lithology is mostly claystone, sandstone, and basalt. The DNN, RNN, and CNN models all perform well in LSA, especially the RNN model. The TPE optimization significantly improves the accuracy of the DNN and CNN (3.92% and 1.52%, respectively), but does not improve the performance of the RNN. In summary, our proposed RNN model and TPE-optimized DNN and CNN model have robust predictive capability for landslide susceptibility in the study area and can also be applied to other areas containing similar geological conditions. [ABSTRACT FROM AUTHOR]

Clean groundwater resources are vital to human health. To evaluate groundwater quality in the Songnen Plain (Jilin), a field investigation sampling test, multivariate statistical analysis, and spatial analysis were conducted based on a geographic information system. The main substances exceeding the standard were screened out, and the main controlling factors affecting groundwater quality were discussed. The research result showed that nine components exceeded groundwater standards by approximately 10%: Al, total hardness (TH), total dissolved solids (TDS), Mn, As, NO3−, Fe, F−, and BaP. The over-standard of TDS and TH in groundwater are mainly distributed in the geological environment conditions and unreasonable exploitation and utilization of groundwater in this area. The results of the multi-index evaluation showed that the most important factors affecting groundwater quality were general chemical indices, followed by inorganic toxicology and heavy metals. Controlling the overexploitation of water resources, controlling agricultural activities and sewage discharge, and implementing water conservation systems are the main pathways to improve water quality in the study area. The research results can provide a reference for groundwater pollution control and water resource protection in the Songnen Plain (Jilin). [ABSTRACT FROM AUTHOR]

Among the most frequent and dangerous natural hazards, landslides often result in huge casualties and economic losses. Landslide susceptibility mapping (LSM) is an excellent approach for protecting and reducing the risks by landslides. This study aims to explore the performance of Bayesian optimization (BO) in the random forest (RF) and gradient boosting decision tree (GBDT) model for LSM and applied in Shuicheng County, China. Multiple data sources are used to obtain 17 conditioning factors of landslides, Borderline-SMOTE and Randomundersample methods are combined to solve the imbalanced sample problem. RF and GBDT models before and after BO are adopted to calculate the susceptibility value of landslides and produce LSMs and these models were compared and evaluated using multiple validation approach. The results demonstrated that the models we proposed all have high enough model accuracy to be applied to produce LSM, the performance of the RF is better than the GBDT model without BO, while after adopting the Bayesian optimized hyperparameters, the prediction accuracy of the RF and GBDT models is improved by 1% and 7%, respectively and the Bayesian optimized GBDT model is the best for LSM in this four models. In summary, the Bayesian optimized RF and GBDT models, especially the GBDT model we proposed for landslide susceptibility assessment and LSM construction has a very good application performance and development prospects. [ABSTRACT FROM AUTHOR]

Landslides are among the most frequent natural hazards in the world. Rainfall is an important triggering factor for landslides and is responsible for topples, slides, and debris flows—three of the most important types of landslides. However, several previous relevant research studies covered general landslides and neglected the rainfall–topples–slides–debris flows disaster chain. Since landslide hazard mapping (LHM) is a critical tool for disaster prevention and mitigation, this study aimed to build a GeoDetector and Bayesian network (BN) model framework for LHM in Shuicheng County, China, to address these geohazards. The GeoDetector model will be used to screen factors, eliminate redundant information, and discuss the interaction between elements, while the BN model will be used for constructing a causality disaster chain network to determine the probability and risk level of the three types of landslides. The practicability of the BN model was confirmed by error rate and scoring rules validation. The prediction accuracy results were tested using overall accuracy, Matthews correlation coefficient, relative operating characteristics curve, and seed cell area index. The proposed framework is demonstrated to be sufficiently accurate to construct the complex LHM. In summary, the combination of the GeoDetector and BN model is very promising for spatial prediction of landslides. [ABSTRACT FROM AUTHOR]

Debris flow events often pose significant damage and are a threat to infrastructure and even livelihoods. Recent studies have mainly focused on determining the susceptibility of debris flow using deterministic or heuristic/probabilistic models. However, each type of model has its own significant advantages with some irreparable disadvantages. The random forest model, which is sensitive to the region where the terrain conditions are suitable for the occurrence of debris flow, was applied along with the steady-state infinite slope method, which is capable of describing the initiation mechanism of debris flow. In this manner, a random-forest-based steady-state infinite slope method was used to conduct susceptibility assessment of debris-flow at Changbai mountain area. Results showed that the assessment accuracy of the proposed random-forest-based steady-state infinite slope method reached 90.88%; however, the accuracy of just the random forest model or steady-state infinite slope method was only 88.48% or 60.45%, respectively. Compared with the single-model assessment results, the assessment accuracy of the proposed method improved by 2.4% and 30.43%, respectively. Meanwhile, the debris-flow-prone area of the proposed method was reduced. The random-forest-based steady-state infinite slope method inherited the excellent diagnostic performance of the random-forest models in the region where the debris flow disaster already occurred; meanwhile, this method further refined the debris-flow-prone area from the suitable terrain area based on physico-mechanical properties; thus, the performance of this method was better than those of the other two models. [ABSTRACT FROM AUTHOR]

The aim of this project was to produce an earthquake–landslide debris flow disaster chain susceptibility map for the Changbai Mountain region, China, by applying data-driven model series and parallel model and Bayesian Networks model. The accuracy of these two models was then compared. Parameters related to the occurrence of landslide and debris flow disasters, including earthquake intensity, rainfall, elevation, slope, slope aspect, lithology, distance to rivers, distance to faults, land use, and the normalized difference vegetation index (NDVI), were chosen and applied in these two models. Disaster chain susceptibility zones created using the two models were then contrasted and verified using the occurrence of past disasters obtained from remote sensing interpretations and field investigations. Both disaster chain susceptibility maps showed that the high susceptibility zones are situated within a 10 km radius around the Tianchi volcano, whereas the northern and southwestern sections of the study area comprise primarily very low or low susceptibility zones. The two models produced similar and compatible results as indicated by the outcomes of basic linear correlation and cross-correlation analyses. The verification results of the ROC curves were found to be 0.7727 and 0.8062 for the series and parallel model and BN model, respectively. These results indicate that the two models can be used as a preliminary base for further research activities aimed at providing hazard management tools, forecasting services, and early warning systems. [ABSTRACT FROM AUTHOR]

Debris flow is one of the most frequently occurring geological disasters in Jilin province, China, and such disasters often result in the loss of human life and property. The objective of this study is to propose and verify an information fusion (IF) method in order to improve the factors controlling debris flow as well as the accuracy of the debris flow susceptibility map. Nine layers of factors controlling debris flow (i.e., topography, elevation, annual precipitation, distance to water system, slope angle, slope aspect, population density, lithology and vegetation coverage) were taken as the predictors. The controlling factors were improved by using the IF method. Based on the original controlling factors and the improved controlling factors, debris flow susceptibility maps were developed while using the statistical index (SI) model, the analytic hierarchy process (AHP) model, the random forest (RF) model, and their four integrated models. The results were compared using receiver operating characteristic (ROC) curve, and the spatial consistency of the debris flow susceptibility maps was analyzed while using Spearman's rank correlation coefficients. The results show that the IF method that was used to improve the controlling factors can effectively enhance the performance of the debris flow susceptibility maps, with the IF-SI-RF model exhibiting the best performance in terms of debris flow susceptibility mapping. [ABSTRACT FROM AUTHOR]

The impacts of earthquakes and secondary disasters on ecosystems and the environment are attracting increasing global attention. Development of uncertainty reasoning models offers a chance to research these complex correlations. The primary aim of this research was to construct a disaster chain hazard assessment model that combines a Bayesian Network model and the ArcGIS program software for Changbai Mountain, China, an active volcano with a spate of reported earthquakes, collapses, and landslide events. Furthermore, the probability obtained by the Bayesian Networks was used to determine the disaster chain probability and hazard intensity of the earthquake events, while ArcGIS was used to produce the disaster chain hazard map. The performance of the Bayesian Network model was measured by error rate and scoring rules. The confirmation of the outcomes of the disaster chain hazard assessment model shows that the model demonstrated good predictive performance on the basis of the area under the curve, which was 0.7929. From visual inspection of the produced earthquake disaster chain hazard map, highly hazardous zones are located within a 15 km radius from the Tianchi center, while the northern and the western parts of the studied area are characterized mainly by "very low" to "low" hazard values. [ABSTRACT FROM AUTHOR]

This study compared the concentrations, types and distributions of sialic acid (SA) in human milk at different stages of the postnatal period with those in a range of infant formulas. Breast milk from mothers of healthy, full-term and exclusively breastfed infants was collected on the 2nd ( n 246), 7th ( n 135), 30th ( n 85) and 90th ( n 48) day after birth. The SA profiles of human milk, including their distribution, were analysed and compared with twenty-four different infant formulas. Outcome of this observational study was the result of natural exposure. Only SA of type Neu5Ac was detected in human milk. Total SA concentrations were highest in colostrum and reduced significantly over the next 3 months. Approximately 68·7–76·1 % of all SA in human milk were bound to oligosaccharides. Two types of SA, Neu5Ac and Neu5Gc, have been detected in infant formulas. Most SA was present in infant formulas combined with protein. Breastfed infants could receive more SA than formula-fed infants with the same energy intake. Overall, human milk is a preferable source of SA than infant formulas in terms of total SA content, dynamics, distribution and type. These SA profiles in the natural state are worth to be considered by the production of formulas because they may have a great effect on infant nutrition and development.

Changchun, China is located in one of the world's three golden corn belts. As a key commodity grain base in China, Changchun plays a vital role in providing food security in the northeast. A total of 16 polycyclic aromatic hydrocarbons (PAHs) was analyzed to determine the influence of anthropogenic activities on the environmental quality of agricultural soils under straw burning conditions. The polycyclic aromatic hydrocarbons soil contamination severity was evaluated using the Maliszewska-Kordybach method. The results indicated that the agricultural soils of Changchun are substantial contaminated with PAHs. Petroleum, biomass, and coal combustion are the primary sources of PAH and have been determined using principal component analysis (PCA) and the isomeric ratio approach. The degree of hazard to human health was assessed using toxicity equivalence and increased lifetime cancer risk (ILCR) factors, except in localized areas during adulthood, the general risk was found to be modest. This study provides important information on PAH exposure in agricultural soils in northeast China, and the findings aid in the exploitation of straw and the mitigation of soil environmental concerns, allowing northeast China to achieve green agricultural development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Key Message: We mapped a new race-specific seedling stripe rust resistance gene on wheat chromosome 5BL and a new APR locus QYr.hazu-2BS from CIMMYT wheat line Kfa/2*Kachu. Breeding resistant wheat (Triticum aestivum) varieties is the most economical and efficient way to manage wheat stripe rust, but requires the prior identification of new resistance genes and development of associated molecular markers for marker-assisted selection. To map stripe rust resistance loci in wheat, we used a recombinant inbred line population generated by crossing the stripe rust-resistant parent 'Kfa/2*Kachu' and the susceptible parent 'Apav#1'. We employed genotyping-by-sequencing and bulked segregant RNA sequencing to map a new race-specific seedling stripe rust resistance gene, which we designated YrK, to wheat chromosome arm 5BL. TraesCS5B02G330700 encodes a receptor-like kinase and is a high-confidence candidate gene for YrK based on virus-induced gene silencing results and the significant induction of its expression 24 h after inoculation with wheat stripe rust. To assist breeding, we developed functional molecular markers based on the polymorphic single nucleotide polymorphisms in the coding sequence region of YrK. We also mapped four adult plant resistance (APR) loci to wheat chromosome arms 1BL, 2AS, 2BS and 4AL. Among these APR loci, we determined that QYr.hazu-1BL and QYr.hazu-2AS are allelic to the known pleiotropic resistance gene Lr46/Yr29/Pm39 and the race-specific gene Yr17, respectively. However, QYr.hazu-2BS is likely a new APR locus, for which we converted closely linked SNP polymorphisms into breeder-friendly Kompetitive allele-specific PCR (KASP) markers. In the present study, we provided new stripe rust resistance locus/gene and molecular markers for wheat breeder to develop rust-resistant wheat variety., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: High prices of targeted anticancer medicines (TAMs) result in financial toxicity for patients and the health insurance system. How national price negotiation and reimbursement policy affect the accessibility of TAMs for cancer patients remains unknown., Methods: In this population-based cohort study, we used national health insurance claims data in 2017 and identified adult patients with cancer diagnoses for which price-negotiated TAMs were indicated. We estimated the half-month prevalence of price-negotiated TAMs use before and after the policy implementation in September 2017. We calculated direct medical costs, out-of-pocket (OOP) costs, and the proportion of OOP cost for each cancer patient to measure their financial burden attributable to TAMs use. We performed segmented linear and multivariable logistic regression to analyse the policy impact., Results: We included 39 391 of a total 118 655 cancer beneficiaries. After September 2017, the prevalence of price-negotiated TAMs use increased from 1.4%-2.1% to 2.9%-3.1% (P = 0.005); TAMs users' daily medical costs increased from US$261.3 to US$292.5 (P < 0.001), while median daily OOP costs (US$68.2 vs US$65.7; P = 0.134) and OOP costs as a proportion of daily medical costs persisted (28.5% vs 28.5%; P = 0.995). Compared with resident beneficiaries, the relative probability of urban employee beneficiaries on TAMs uses decreased after the policy (adjusted odds ratio (aOR) = 2.4 vs aOR = 2.2)., Conclusions: The government price negotiation and reimbursement policy improved patient access to TAMs and narrowed disparities among insurance schemes. China's approach to promoting the affordability of expensive medicines provides valuable experience for health policy decision-makers., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Objectives: In the post-covid-19 era, students face numerous mental health-related effects. Returning to Chinese institutions, international students in China experienced mental health issues (anxiety and stress). These overseas students' psychological issues are obstacles to their academic performance in China. Students' fear restructured their ability to think critically and execute effectively. Consequently, the framework of this study is intended to emphasize the beneficial effects of offline activities, physical activity, and classroom activities on reducing anxiety among international students in China. Methods: This study is predicated on survey data acquired using a five-point Likert scale. 317 responses were received from overseas students enrolled in Hainan universities. Results: The findings show that offline, physical, and classroom activities substantially impact the anxiety reduction of overseas students in China. The study's contribution to the literature is a fresh concept that previous research has not addressed. In addition, this research has significant theoretical and practical consequences for both knowledge and findings. Conclusion: The study has given a paradigm for relieving anxiety among overseas students in China by addressing a research gap. Meanwhile, this study's limitations provide a roadmap for researching further areas of literature in the future.

Global vegetation greening has been widely confirmed in previous studies, yet the changes in the velocity of green-up in each month of green-up period (GUP) remains unclear. Here, we defined the velocity of vegetation green-up as V NDVI (the monthly increase of Normalized Difference Vegetation Index [NDVI] during GUP) and further explored its response to climate change in middle-high-latitude Northern Hemisphere. We found that in early GUP, V NDVI generally showed positive trends from 1982 to 2015, whereas in late GUP, it showed negative trends in most areas. Such contrasting trends were mainly due to a positive temperature effect on V NDVI in early GUP, but this effect turned negative in late GUP. The increase of soil moisture also in part explained the accelerated vegetation green-up, especially in the arid and semi-arid ecosystems of inland areas. Our analyses also indicate that the first month of the GUP was the key stage impacting vegetation greenness in summer. Future warming may continuously speed up the early growth of vegetation, altering the seasonal trajectory of vegetation and its feedbacks to the Earth system., (© 2022 John Wiley & Sons Ltd.)

The spatiotemporal distributions, influential factors, and ecological risks of 15 phthalate acid esters (PAEs) in the sediments of three typical lakes in Inner Mongolia were investigated in this work. PAEs were widespread in all surface sediments ranging from 598.3 to 3873.8 μg/kg dry weight. Average PAE concentrations were highest in the surface sediments of Wuliangsuhai Lake followed by Daihai and Hulun Lakes, which were consistent with population density and intensity of anthropogenic activities. Dibutyl phthalate, di-iso-butyl phthalate (DIBP), and diethyl phthalate (DEP) were the dominant PAEs with similar abundance orders for the three lakes. The cold climate could explain the higher DEP abundance in the sediments of lakes at higher latitudes. The highest Σ PAE and most individual PAE concentrations were located at one of the discharge river estuaries because most PAEs were terrestrial pollutants. Σ PAE concentrations in the core sediments increased with years and fluctuations owing to the increasing PAE usage and input. The second highest PAE concentration peaks were associated with the high gross domestic product growth rates in 2003-2008. Redundancy analysis revealed that butyl benzyl phthalate and diamyl phthalate in the surface sediments of Hulun Lake were principally positively influenced by organic matter (65.6% contribution among geochemical variables), Fe oxides (25.1% contribution among metals), and Mn oxides (23.8% contribution among metals). The DIBP and DEP exhibited high risks to sensitive fish according to a risk quotient assessment. This work presents new insights into PAE status and deposition mechanisms in the lakes within high latitudes or cold climates, and provides important information for future environmental protection and management., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study evaluated the efficacy and safety of 3D printing technology combined with percutaneous nephrolithotomy in the treatment of complex renal calculi. Ninety patients with complex renal calculi were randomly divided into a 3D printing group (45 patients) and a control group (45 patients). In the 3D printing group, a patient-specific 1:1 3D printing model was established based on the patient's thin-layer CT scanning data. A 3D printing model was used for preoperative communication between doctors and patients. Preoperative puncture training, channel design, residual stone prediction, and percutaneous nephrolithotomy were performed under the guidance of a 3D printing model and B-ultrasound. The control group was treated with the conventional B-ultrasound-guided puncture method. Results suggest that there was a statistically significant difference between the two groups (P < 0.05). The overall score of the doctor-patient communication objects in the 3D printing group was 19.32 ± 1.57 points, and in the control group, it was 14.51 ± 2.13 points. The operation time of the 3D printing group was 103.21 ± 13.49 min, and that of the control group was 126.12 ± 25.87 min. The calculi clearance rate of the 3D printing group was 96%, while that of the control group was 80%. The incidence of postoperative complications was 6.67% in the 3D printing group and 22.22% in the control group. Compared with traditional percutaneous nephrolithotomy, 3D printing technology combined with percutaneous nephrolithotomy can significantly enhance the effectiveness of doctor-patient communication, shorten operation time, reduce operation bleeding, improve the stone clearance rate, reduce the incidence of complications and shorten the length of hospital stay. The proposed method is thus a safe and effective method to treat complex renal calculi., (© 2022. The Author(s).)

Background: Studies relating obesity to cognition in older people show conflicting results, which may be explained by the choice of obesity indicators., Objectives: This study aimed to investigate the relationship between obesity-related indicators and cognitive impairment, especially between different age or gender subgroups, and explore whether obesity-related indicators were related to specific cognitive domains., Methods: This was a cross-sectional study on 1753 participants aged ≥ 60 years (41.0% men; aged 71.36 ± 5.96 years). Obesity-related indicators included body mass index (BMI), waist circumference (WC), calf circumference (CC), waist to hip ratio (WHR), waist to calf circumstance ratio (WCR), fat to fat-free mass ratio (FM/FFM). The Mini-Mental State Examination scale (MMSE) was used to assess cognitive function. Cognitive impairment was defined as a score ≤ 17 for illiterates, ≤ 20 for participants with primary school education, and ≤ 24 for those with junior high school degrees or above. Multiple logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic splines were used to analyze and visualize the linear relationships., Results: The prevalence of cognitive impairment was 18.77%. In the fully adjusted model, CC was negatively associated with cognitive impairment (OR = 0.94, 95% CI: 0.90-0.98). Further analysis showed that CC correlated positively with recall and place orientation. A higher FM/FFM was found to be associated with a higher prevalence of cognitive impairment (OR: 1.44, 95%CI: 0.88-2.35, P for trend = 0.029); this association was notable in women (P for trend = 0.002) and the oldest (P for trend = 0.009), and so did the potential effect of BMI on cognitive impairment (70-80 years: P for trend = 0.011; ≥ 80 years: P for trend = 0.013). No statistically significant association was found between cognitive impairment and WC, WHR, or WCR., Conclusion: CC and FM/FFM were associated with cognitive impairment in older people. Future research needs to distinguish the effects of fat and muscle mass on cognitive function, with special attention to different ages and genders., Competing Interests: The authors have declared that no competing interests exist.

Fragaria nilgerrensis is a diploid wild strawberry widely distributed in Southwest China. Its white color and "peach-like" fragrance of fruits are valuable characters for the genetic improvement of cultivated strawberry plants. Its strong biotic and abiotic resistance and tolerance also enable it to survive in different habitats in the field. In this study, we evaluated the level of genetic variation within and between 16 populations with 169 individuals of F. nilgerrensis using 16 newly developed EST-SSR (expressed sequence tag-simple sequence repeats) markers. The results show that the genetic diversity of this species was high, based on Nei's genetic diversity (0.26) and polymorphic loci (0.41), although it is self-compatible and has clonal propagation. Significant genetic differentiation among populations was also detected by AMOVA analysis (Fst = 0.34), which could be indicative of little gene flow (Nm = 0.43) in F. nilgerrensis. The phylogenetic tree indicates that most of individuals from the same population have clustered together. These populations were not grouped based on the geographical distance, consistent with the Mantel test result (R 2  = 0.0063, P > 0.05). All the populations were assigned into two ancestral groups, with some individuals admixed, suggesting ancestral gene flow had occurred between these two groups. Our developed EST-SSR markers as well as the genetic diversity and population structure analysis of F. nilgerrensis are important for genetic improvement in the breeding process. Moreover, the populations that contain high genetic diversity would be a priority for collection and conservation., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: New targeted therapies have changed cancer treatment in the past decades. However, high prices of targeted anticancer medications have increased economic burden for both patients and health insurance systems. In July 2017, China implemented combined medication price negotiation and mandatory reimbursement policies for 15 targeted anticancer medications. This study assesses effects of the policy on hospital procurement prices, volumes and spending., Methods: Using a quasi-experimental interrupted time series design, we analysed procurement data from the Chinese Medical Economic Information of 789 public hospitals in 30 provinces between January 2016 and September 2018. The intervention group consisted of 15 targeted anticancer medications with negotiated prices in 2017. The comparison group consisted of six targeted anticancer medications without negotiated prices by 2018. The effective date of the policy was September 2017., Results: After the implementation of the 2017 medication price negotiation and reimbursement policy, cost per defined daily dose (DDD) of the 15 targeted anticancer medications dropped US$71.21 on average from an average US$169.24/DDD before (p=0.000). Compared with what would have happened without the intervention, cost/DDD of price-negotiated medications decreased by 48.9% (p=0.000), procurement volumes increased by 143.0% (p=0.000) and hospital medication spending decreased by 6.9% (p=0.146)., Conclusions: The 2017 medication price negotiation and reimbursement policy decreased targeted medication procurement costs per DDD, increased volumes procured and at least temporarily contained spending. These changes should result in better access to and affordability of targeted anticancer medications in China., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: We examined the association between obesity and physical performance under different metabolic status., Methods: The sample included 1395 Chinese community-dwelling participants (mean age, 71.88 ± 5.87 years; 40.9% men). Being metabolically healthy was defined as having the presence of < 3 of 5 components of metabolic syndrome (MetS); obesity was defined as having a BMI > 28 kg/m 2 . Participants were divided into four groups based on BMI (non-obese/obese) and metabolic health (healthy/unhealthy). Physical performance was measured by grip strength, 4-m walking speed, and the timed up and go test (TUGT)., Results: After multiple adjustments, compared with metabolically healthy non-obese group, the metabolically unhealthy obese group showed lower relative grip strength, lower 4-m walking speed, and higher TUGT ( P all < 0.05), and only relative grip strength of the metabolically healthy obese group was significantly lower than that of metabolically healthy non-obese ( P < 0.01). Relative grip strength was negatively associated with impaired fasting glucose (β = -0.071), elevated triglycerides (β = -0.062), abdominal obesity (β = -0.230) and general obesity (β = -0.225) ( P all < 0.01). Walking speed and TUGT were only associated with general obesity, rather than other metabolic components. The associations of MetS with physical performance were mainly driven by abdominal obesity., Conclusion: Even in those who are metabolically healthy, obesity (especially general obesity) increases the risk of poor physical performance. Elderly people with general obesity and MetS, whether in combination or alone, have an increased risk of muscle dysfunction, and that combination produces a higher risk of impaired mobility., Competing Interests: The authors declare no conflicts of interest., (© 2021 Ma et al.)

Objective: Access to highly priced anticancer medications usually requires insurance coverage. A first step towards coverage of such medications is their inclusion in reimbursement lists. We assessed listing for reimbursement in China between 2009 and 2018 of anticancer medications on the WHO's Essential Medicines List., Setting and Study Design: Using publicly available data, we assessed which anticancer medications listed in the 20th WHO Model List of Essential Medicines (EML) were included in China's National Reimbursement Drug List (NRDL). For five targeted anticancer medications on the WHO EML, we also assessed inclusion in the 31 Chinese Provincial Reimbursement Drug Lists (PRDLs). Logistic regression was used to test whether inclusion of targeted anticancer medications was associated with provincial economic levels., Primary Outcome Measures: Inclusion of five targeted anticancer medications in the NRDL and PRDLs before and after 2017., Results: The 2017 NRDL included all anticancer medications on the WHO EML (except for one not approved in China at the time), and by 2018, all 31 PRDLs listed the targeted anticancer medications except for nilotinib; four provinces had covered all five targeted medications before the 2017 NRDL coverage mandate. Provincial economic level and regional incidence of specific cancers seemed unrelated to the inclusion of five targeted anticancer medications in PRDLs., Conclusion: Our findings suggest that by including medications in the national and provincial reimbursement lists, China has taken an important first step in promoting access to targeted anticancer medications. Further research is needed to determine whether inclusion in PRDLs improved the availability, appropriate use and affordability of highly priced targeted anticancer medications in China., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Tianchi volcano is a dormant active volcano with a risk of re-eruption. Volcanic soil and volcanic ash samples were collected around the volcano and the concentrations of 21 metals (major and trace elements) were determined. The spatial distribution of the metals was obtained by inverse distance weight (IDW) interpolation. The metals' sources were identified and their pollution levels were assessed to determine their potential ecological and human health risks. The metal concentrations were higher around Tianchi and at the north to the west of the study area. According to the geo-accumulation index ( I geo ), enrichment factor (EF) and contamination factor (CF) calculations, Zn pollution was high in the study area. Pearson's correlation analysis and principal component analysis showed that with the exception of Fe, Mn and As, the metals that were investigated (Al, K, Ca, Na, Mg, Ti, Cu, Pb, Zn, Cr, Ni, Ba, Ga, Li, Co, Cd, Sn, Sr) were mostly naturally derived. A small proportion of Li, Pb and Zn may have come from vehicle traffic. There is no potential ecological risk and non-carcinogenic risk because of the low concentrations of the metals; however, it is necessary to pay attention to the carcinogenic risk of Cr and As in children.