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Introduction Most people with schizophrenia in China are supported by their family members in community. The patient’s family is confronted with severe care burden and pressure, which directly affects the caregiver’s own health and social life, and indirectly affects the patient’s rehabilitation. Adequate family resources can reduce the burden and pressure on families. But there is an absence of systematic family resource indicators for people with schizophrenic disorder in China.Objectives This study aimed to develop a set of family resource indicators for people with schizophrenic disorder in China.Design Preliminary family resource indicators were generated and refined by literature review and an expert consultation meeting. Two rounds of email-based Delphi survey were carried out to identify family resource indicators.Setting Two rounds of email-based Delphi survey were performed from July to September 2021 in Beijing, China.Participants There were 15 mental health doctors from community health service centres and four psychiatrists from tertiary hospitals, and two primary care researchers from universities in the first and second rounds Delphi survey.Results All the 21 experts participated in both rounds of Delphi survey. A total of 46 indicators achieved consensus for inclusion in the final set of indicators after two rounds of Delphi survey. The final set of indicators was grouped into 10 domains: financial support (three indicators), psychological and spiritual support (eight indicators), medical treatment (three indicators), information and education (three indicators), structural support (two indicators), external family resources included social resources (five indicators), cultural resources (two indicators), economic resources (seven indicators), environmental resources (four indicators) and medical resources (nine indicators).Conclusions A set of 46 family resource indicators for people with schizophrenic disorder in community was identified by an iterative Delphi process in Beijing, China. However, the indicators still need to be validated by testing in further studies.

Objectives This study aims to understand the caregiving experiences of family caregivers of people with schizophrenia in a community.Design A qualitative study based on phenomenological analysis was conducted through in-depth interviews.Setting This study was carried out from May to June 2023 in two community health service centres in urban Beijing, China.Participants We selected 16 family caregivers for interviews using purposive sampling method.Results Four themes and 10 subthemes were identified: (1) psychosocial distress of family caregivers (feeling unprepared and helpless at the beginning, confronting negative emotions in long-term care and straying away from social life); (2) adverse impacts on the whole family (poor cooperation within the family, insufficient family involvement in professional care); (3) coping with family caregiving (accepting the reality of the patients’ illness, struggling with family life balance and having realistic expectations); (4) concerns about future care (daily living support, physical health management).Conclusion Family caregivers experienced psychosocial distress and family stress in the process of caregiving. They had to cope with caregiving stress and were concerned about the long-term care of people with schizophrenia. These findings provide implications for intervention programmes to strengthen social support, family involvement, and active coping for caregivers and develop long-term care mechanisms for people with schizophrenia.

Abstract Background Workplace violence severely impacts individual nurses. With the three-child opening policy of China and the impact of the COVID-19 epidemic in the recently years, obstetric nurses face the double attack of heavy workload and staffing shortage. This study aimed to evaluate the current situation of workplace violence among Chinese obstetric nurses under the new situation, assess the level of violence prevention knowledge-attitude-practice and climate perception in Chinese obstetric nurses and explore the correlation between workplace violence and the level of violence prevention knowledge-attitude-practice and climate perception. Methods A cross-sectional survey on the workplace violence for Chinese obstetric nurses was conducted from August to February 2023. All the questionnaires came from 10 provinces and 3 autonomous regions in China. The basic characteristics of obstetric nurse’s workplace violence, workplace violence prevention knowledge-attitude-practice scale and workplace violence climate perception scale were collected. Results Totally, 522 Chinese obstetric nurses were included. 55.0% of obstetric nurses (287) had experienced workplace violence in the past 12 months, including verbal assault (40.4%), physical assault (34.1%), and sexual assault (31.0%). The overall level of obstetric nurses’ workplace violence prevention knowledge-attitude-practice and climate perception of workplace violence was low. Multiple linear regression analysis showed that the violence prevention knowledge dimension significantly influenced obstetric nurses’ workplace violence (B = -0.278, P

AbstractEndometrial cancer is one of the most common malignant tumours in women, and cancer stem cells are known to play an important role in its growth, invasion, metastasis, and drug resistance. Immunotherapy for endometrial cancer is still under research. In this study, a total of 547 endometrial cancer cases were randomly divided into training set (351 cases) set and test set (196 cases). The stemness index of patients was calculated using the One-Class Logistic Regression (OCLR) machine learning algorithm to explore the clinicopathological differences between index levels. Stemness subtypes were determined according to the characteristics of cancer stemness and their clinicopathological characteristics, immune features, and therapeutic effects were described. Our study suggests that endometrial cancer is classified into two stemness subtypes. Stemness subtypes, which are associated with its clinical features, may be independent prognostic factors for endometrial cancer. The stemness subtypes differed significantly in immune activity, immune cell infiltration, and the immune microenvironment, including sensitivity to chemotherapeutic drugs and potential therapeutic compounds. Algorithms were utilised to construct a stemness subtype prediction model and predictor. These findings will provide guidance for the clinical diagnosis, treatment, and prognosis of endometrial cancer.

The thermal failure mechanism of sliding composite leaf springs (SCLSs) is examined in this research. Bench fatigue testing is used in the experimental investigation of the thermal failure temperature and mode. The findings demonstrate that after 20 min, when the temperature reaches the glass transition temperature, cracks start to form around the bolt hole of the composite body. The findings from bench experiments indicate that thermal fatigue failure of SCLS can be divided into three main forms: delamination failure of the resin-rich layer, the resin-fiber interface, and fibre pull-out failure. The utilization of finite element simulation has demonstrated that when subjected to thermal load, the leaf spring’s internal defects can lead to localized stress concentration. The structure of the spring end is optimized using the insulating panel scheme and the metal joint scheme. The thermal fatigue issue with SCLS is best addressed by the heat dissipation approach, according to bench tests.

Abstract The cornea is the outmost ocular tissue and plays an important role in protecting the eye from environmental insults. Corneal epithelial wounding provokes pain and fear and contributes to the most ocular trauma emergency assessments worldwide. ZEB1 is an essential transcription factor in development; but its roles in adult tissues are not clear. We identify Zeb1 is an intrinsic factor that facilitates corneal epithelial wound healing. In this study, we demonstrate that monoallelic deletion of Zeb1 significantly expedites corneal cell death and inhibits corneal epithelial EMT-related cell migration upon an epithelial debridement. We provide evidence that Zeb1-regulation of corneal epithelial wound healing is through the repression of genes required for Tnfa-induced epithelial cell death and the induction of genes beneficial for epithelial cell migration. We suggest utilizing TNF-α antagonists would reduce TNF/TNFR1-induced cell death in the corneal epithelium and inflammation in the corneal stroma to help corneal wound healing.

Summary: Most mutations in retinitis pigmentosa (RP) arise in rod photoreceptors, but cone photoreceptors, responsible for high-resolution daylight and color vision, are subsequently affected, causing the most debilitating features of the disease. We used mass spectroscopy to follow 13C metabolites delivered to the outer retina and single-cell RNA sequencing to assess photoreceptor transcriptomes. The S cone metabolic transcriptome suggests engagement of the TCA cycle and ongoing response to ROS characteristic of oxidative phosphorylation, which we link to their histone modification transcriptome. Tumor necrosis factor (TNF) and its downstream effector RIP3, which drive ROS generation via mitochondrial dysfunction, are induced and activated as S cones undergo early apoptosis in RP. The long/medium-wavelength (L/M) cone transcriptome shows enhanced glycolytic capacity, which maintains their function as RP progresses. Then, as extracellular glucose eventually diminishes, L/M cones are sustained in long-term dormancy by lactate metabolism.

Abstract Background Family doctor service (FDS) is a scheme oriented to improving the access and continuity of primary care in China. Type 2 diabetes mellitus (T2DM) management is a core component of FDS. However, evidence on the quality of T2DM care is lacking and the potential association between FDS attributes and T2DM care is largely unknown. This study attempted to assess the process quality of T2DM care in general practice and explore the association between patient perceived FDS attributes and process quality of T2DM care. Methods Total 400 patients were recruited from 5 community health service centers in two urban districts in Beijing. Questionnaire survey and extraction of data from electronic health record (EHR) were conducted to collect patient characteristics, patient perceived FDS attributes (accessibility, continuity and team-based care) and process quality indicators (monitoring and health counseling indicators). Chi-square test and a two-level generalized linear mixed model (GLMM) were used to explore the association between FDS attributes and process quality. Results The utilization rate of all the 12 indicators in monitoring, 6 indicators in health counseling and all the 18 process indicators, was 12.8%, 23.8% and 6.0% respectively. Over half of the patients (56.8%) perceived all the 3 FDS attributes. There were statistically significant associations between accessibility of care and lipid (p = 0.008), electrocardiogram (p = 0.016), retinopathy (p = 0.037) and peripheral neuropathy (p = 0.006) monitoring and each of the 6 health counseling indicators (all the p values

Abstract Background Cervical cancer is the fourth most common cancer in women. N6-dimethyladenosine (m6A) mRNA methylation is closely associated with cervical cancer. Methods Using TCGA database, we studied the expression and mutation of m6A-related genes in cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) and obtained genetic characteristics based on an m6A risk model and prognostic value of m6A. We studied the effects of the m6A risk score on immune features and genomic changes of patients with CESC, evaluated the sensitivity of patients with CESC to different small-molecule drugs based on the m6A risk score, and established a clinical prediction model. Results Ten m6A-related genes were differentially expressed between CESC and normal tissues. High-risk patients had a low overall survival (OS) and significantly low immune scores but showed no significantly altered stromal scores. The tumor mutation burden (TMB) and tumor neoantigen levels significantly differed between the high- and low-risk groups. In the high-risk group, copy number variation (CNV) changes mainly led to gene amplification, while in the low-risk group, CNV changes primarily manifested as gene copy number deletions. ZC3H13 expression was low in CESC tissues. ZC3H13 knockdown promoted CESC cell proliferation, migration, and invasion, reducing the RNA methylation levels. Rapamycin suppressed the CESC cell proliferation, migration, and invasion abilities, increasing the m6A levels. Conclusion m6A mRNA methylation is closely related to the occurrence, development, immune invasion, drug sensitivity, and prognosis of cervical cancer. The prognostic m6A feature model of m6A signature genes can accurately predict the OS of patients with CESC. Drugs targeting factors regulating m6A mRNA methylation might offer a good prospect for treating cervical cancer.

Forecasting wind structure of tropical cyclone (TC) is vital in assessment of impact due to high winds using Numerical Weather Prediction (NWP) model. The usual verification technique on TC wind structure forecasts are based on grid-to-grid comparisons between forecast field and the actual field. However, precision of traditional verification measures is easily affected by small scale errors and thus cannot well discriminate the accuracy or effectiveness of NWP model forecast. In this study, the Method for Object-Based Diagnostic Evaluation (MODE), which has been widely adopted in verifying precipitation fields, is utilized in TC's wind field verification for the first time. The TC wind field forecast of deterministic NWP model and Ensemble Prediction System (EPS) of the European Centre for Medium-Range Weather Forecasts (ECMWF) over the western North Pacific and the South China Sea in 2020 were evaluated. A MODE score of 0.5 is used as a threshold value to represent a skillful (or good) forecast. It is found that the R34 (radius of 34 knots) wind field structure forecasts within 72 h are good regardless of DET or EPS. The performance of R50 and R64 is slightly worse but the R50 forecasts within 48 h remain good, with MODE exceeded 0.5. The R64 forecast within 48 h are worth for reference as well with MODE of around 0.5. This study states that the TC wind field structure forecast by ECMWF is skillful for TCs over the western North Pacific and the South China Sea.

Tropical cyclone (TC) size is an important parameter for estimating TC risks, such as precipitation distribution, gale-force wind damage, and storm surge. This paper uses the TC size dataset compiled by the Shanghai Typhoon Institute of China Meteorological Administration (STI/CMA) to investigate the interannual, monthly variation in TC size, and the relationships between TC size and intensity in the WNP basin from 1981 to 2009. The results show that the annual mean TC size oscillated within the range of 175–210 km from 1981 to 2002, then decreased following 2003. For the monthly average TC size, there are two peaks in September and October. The TC size, overall, becomes larger with increasing intensity; the samples with an unusually large size are mainly concentrated near a 40 m s−1 intensity. After the TC intensity exceeds 40 m s−1, the number of unusually large size samples gradually decreases. About 60% of the TCs reach their maximum size after reaching the peak intensity, and the average lag time is 8.3 h.

Summary: Epithelial-mesenchymal transition (EMT) facilitates cancer invasion and is initiated by mesenchyme-driving transcription factors and actin cytoskeletal assembly. We show a cytoplasmic-to-nuclear transport gradient of the EMT transcription factor Zeb1 toward sites of invasion in lung adenocarcinoma (LUAD), driven by the EMT inducer Tgfb, which is expressed in M2 polarized macrophages. We show that Zeb1 binds free actin monomers and RhoA in the cytoplasm to inhibit actin polymerization, blocking cell migration and Yap1 nuclear transport. Tgfb causes turnover of the scaffold protein Rassf1a, which targets RhoA. Release of this RhoA inhibition in response to Tgfb overcomes Zeb1’s block of cytoskeleton assembly and frees it for nuclear transport. A ZEB1 nuclear transport signature highlights EMT progression, identifies dedifferentiated invasive/metastatic human LUADs, and predicts survival. Blocking Zeb1 nuclear transport with a small molecule identified in this study inhibits cytoskeleton assembly, cell migration, Yap1 nuclear transport, EMT, and precancerous-to-malignant transition.

Abstract Background The “5 + 3” residency training is the main stream general practitioner training program in China. However, a competency model is absent for evaluating the clinical competence attained by general practitioners after training. This study was conducted to develop a consensus set of competencies for general practitioners after standardized residency training in China. Methods A modified Delphi process was deployed to develop the competency model, including two stages: (1) generation of an initial set of competencies derived from literature review, behavioral observation of GP–patient consultations, and critical incidents interview of GPs; (2) a 2-round, web-based Delphi survey of experts in general practice, selected using purposive sampling, to prioritize and gain consensus on the essential competencies of GPs. Results From literature review, behavioral observation, and critical incidents interview, 46 competencies in 7 domains were identified. After two rounds of Delphi survey of 28 participants (the mean age was 47.9 [9.3] years and 64.3% were women) representing a range of health professionals (GPs, managers, and researchers), a consensus was reached on 50 competencies categorized into 7 domains. Conclusion A consensus-based competency model for general practitioners in China has been identified which may be used to evaluate the general practitioners’ clinical competence after standardized training.

Cyanidin-3-glucoside (C3G), which is the widest and richest anthocyanin (ACN) found in the edible fruit and vegetables, has been illustrated to perform a wide range of bioactivities. Nanoliposomes can inhibit C3G degradation and enhance the absorption rate of C3G as tools for conveying materials to particular locations. This experiment aims to study the absorption, transport and anti-inflammatory effects of C3G nanoliposomes in Caco-2/RAW 264.7 co-culture model, which symbolizes an intestinal inflammation system. The results indicated that the uptake and transport of C3G nanoliposomes by Caco-2/RAW 264.7 co-culture model were concentration-dependent as well as affected by temperature (37 and 4°C) and endocytic inhibitors, which revealed C3G nanoliposomes penetrate cells via endocytosis. Moreover, compared with C3G, C3G nanoliposomes significantly decreased pro-inflammatory cytokine expression (tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8), suggesting a stronger anti-inflammatory potential. Conclusively, the uptake of C3G nanoliposomes by Caco-2/RAW 264.7 co-culture model is mainly involved in macropinocytosis and endocytosis mediated by carrier protein (clathrin). C3G nanoliposomes may play a better role in the treatment of LPS-induced intestinal inflammation diseases.

Objectives This study aims to investigate the access to family resources by families living with schizophrenia from the perspective of primary care workers in Beijing, and provide evidence for appropriate and effective family resource coordination in primary care.Design Qualitative research using individual in-depth interviews to identify the access to family resources by families living with schizophrenia from the perspective of primary care workers.Setting This study was conducted from September to December 2021 in six urban community health service centres (CHSCs) in Beijing, China.Participants 3 general practitioners and 10 mental health doctors selected by purposive sampling method from 6 CHSCs in urban Beijing were interviewed.Results Five themes emerged from the insights of the primary care workers: most family resources are non-targeted for families living with schizophrenia, the publicity of family resources is difficult, burdensome application process of family resources, limited available community-based treatment options and stigma hindering effective communication between families and society.Conclusions It is necessary to simplify the application process of family resources and provide primary care workers with systematic training regarding family resources. More family resources and improved public attitudes should be promoted for patients with schizophrenia and their caregivers.

BackgroundDespite the dramatic growth of primary care in China, little evidence showed what general practitioner (GP) do and how GP provided medical service in Beijing.ObjectiveThis study aimed to explore the work content of GPs in primary care in Beijing.MethodsA multi-method study was conducted in five community health service institutions using non-participant observation and critical incident technique interview. Eleven GPs was recruited by purpose sampling, with each GP recording details of 100 patient encounters. Health problems of patients and activities of GPs were observed in consultations. Then, critical incident technique interviews were conducted focusing on GPs' works out of clinics and challenge.ResultsA total of 1, 100 patients encounters and 1,897 reasons for encounter (RFEs) were recorded from 11 GPs. There were 1897 RFEs (1.72 per encounter) and 2,762 health problems (2.51 per encounter) from 1,100 encounters during our observation. GPs' work related to consultation was focus on disease diagnoses and treatment. Physical examination and investigations were performed in only 15.5 and 17.1% consultations, respectively. Procedures for chronic disease management were infrequently provided to patients (0.4–26.6%). Time spent in each work process in consultations ranged from 0.68 ± 0.27 min for reservation to 4.00 ± 2.45 min for surgical treatment. In addition to clinical work, there were tasks about health files, contracted family doctor services, health education, teaching students, and scientific research.ConclusionThis study illustrated the complexity of GPs' work and heavy workload in Beijing, China. More attention and effort are needed to develop GPs performance and release GPs' work workload in primary care.

Summary: The cornea is an avascular tissue for vision clarity. Alkali burn could cause severe traumatic damage on the cornea with inflammation and neovascularization (NV), leading to vision reduction and blindness. Mechanisms underlying corneal inflammation and NV are not as clear. We previously reported that Zeb1 is an important factor in corneal NV, and we sought to clarify whether it is also involved in regulation of corneal inflammation. We analyzed the alkali burn-induced corneal inflammation and wound healing in both Zeb1+/+ and Zeb1−/+ littermates through a multidisciplinary approach. We provide evidence that Zeb1 forms a positive regulatory loop with Tgfb to regulate early corneal inflammation by maintenance of immune cell viability and mobility and later wound healing by activation of both Nf-κb and Tgfb-related Stat3 signaling pathways. We believe that ZEB1 is a potential therapeutic target, and inactivation of ZEB1 could be a strategy to treat severe corneal inflammation condition.

Insects are by far the most abundant and diverse living organisms on earth and are frequently prone to microbial attacks. In other to counteract and overcome microbial invasions, insects have in an evolutionary way conserved and developed immune defense mechanisms such as Toll, immune deficiency (Imd), and JAK/STAT signaling pathways leading to the expression of antimicrobial peptides. These pathways have accessory immune effector mechanisms, such as phagocytosis, encapsulation, melanization, nodulation, RNA interference (RNAi), lysis, autophagy, and apoptosis. However, pathogens evolved strategies that circumvent host immune response following infections, which may have helped insects further sophisticate their immune response mechanisms. The involvement of ncRNAs in insect immunity is undeniable, and several excellent studies or reviews have investigated and described their roles in various insects. However, the functional analyses of ncRNAs in insects upon pathogen attacks are not exhaustive as novel ncRNAs are being increasingly discovered in those organisms. This article gives an overview of the main insect signaling pathways and effector mechanisms activated by pathogen invaders and summarizes the latest findings of the immune modulation role of both insect- and pathogen-encoded ncRNAs, especially miRNAs and lncRNAs during insect–pathogen crosstalk.

Abstract Background Most schizophrenia patients are supported by main informal caregivers at home in China. This study aims to investigate the further needs of social supports for main informal caregivers of schizophrenia patients and to analyze influencing factors on the awareness and utilization of social supports in Beijing. The results of this study could potentially act as reference for health professionals to implement appropriate and effective support programs. Methods A mixed-methods approach was used in this study. Awareness, utilization and influencing factors of social supports for main informal caregivers were investigated using questionnaires in 6 urban districts in Beijing. Meanwhile, individual in-depth interviews with 10 main informal caregivers from the urban districts of Beijing were conducted to identify the caregivers’ perspective on social supports and their further needs. Results Quantitative results showed that although the government provided multi-channel resources for schizophrenia patients and their families, awareness and utilization of the resources such as rehabilitation and relevant subsidies were less than 10.0 and 5.0% respectively. Most caregivers in in-depth interviews expressed that they had negative experiences with respect to obtaining social supports, and they emphasized that more support would be needed in terms of financial support, respect, and rehabilitation institutions. Conclusions The awareness and utilization of social supports are low for main informal caregivers of schizophrenia patients. More services and improved public attitudes are needed for schizophrenia patients and their caregivers.

Abstract Background The service capacity of primary care has improved in China. General practice also takes growing responsibility in the management of type 2 diabetes mellitus, but there are concerns about the paucity of evidence of the quality of care delivered. And there is an absence of systematic quality indicators of type 2 diabetes mellitus in general practice in China. This study aimed to develop a set of type 2 diabetes mellitus quality indicators to facilitate quality measurement in general practice in China. Methods Preliminary quality indicators were generated and refined by literature review and an expert consultation meeting. Two rounds of email-based Delphi survey and a consensus meeting were carried out to identify quality indicators. Delphi questionnaires with 43 indicators were sent to 30 participants in the first round. There were 16 general practitioners and 10 community health service center leaders from primary care, 3 endocrinologists and a primary care researcher in the first round. And 27 out of the 30 participants participated in the second round. The consensus meeting was held among 9 participants to refine the indicators and a last round of rating was carried out in the meeting. The indicators were rated in terms of importance and feasibility. The agreement criteria were defined as median ≥ 7.0 and ≥ 85.0% of ratings in the 7–9 tertile for importance; median ≥ 7.0 and ≥ 65.0, 70.0, 75.0% of ratings in the 7–9 tertile for feasibility respectively in the three rounds of rating. Results After 2 rounds of Delphi survey and the consensus meeting, total 38 indicators achieved consensus for inclusion in the final set of indicators. The final set of indicators were grouped into 7 domains: access (5 indicators), monitoring (12 indicators), health counseling (7 indicators), records (2 indicators), health status (7 indicators), patient satisfaction (2 indicators) and self-management (3 indicators). Conclusions A set of 38 potential quality indicators of type 2 diabetes mellitus in general practice were identified by an iterative Delphi process in Beijing, China. Preliminary approach for measurement and data collection were described. However, the indicators still need to be validated by testing in a further study.

Abstract Background Leukemias are a group of life-threatening malignant disorders of the blood and bone marrow. The incidence of leukemia varies by pathological types and among different populations. Methods We retrieved the incidence data for leukemia by sex, age, location, calendar year, and type from the Global Burden of Disease online database. The estimated average percentage change (EAPC) was used to quantify the trends of the age-standardized incidence rate (ASIR) of leukemia from 1990 to 2017. Results Globally, while the number of newly diagnosed leukemia cases increased from 354.5 thousand in 1990 to 518.5 thousand in 2017, the ASIR decreased by 0.43% per year. The number of acute lymphoblastic leukemia (ALL) cases worldwide increased from 49.1 thousand in 1990 to 64.2 thousand in 2017, whereas the ASIR experienced a decrease (EAPC = − 0.08, 95% CI − 0.15, − 0.02). Between 1990 and 2017, there were 55, 29, and 111 countries or territories that experienced a significant increase, remained stable, and experienced a significant decrease in ASIR of ALL, respectively. The case of chronic lymphocytic leukemia (CLL) has increased more than twice between 1990 and 2017. The ASIR of CLL increased by 0.46% per year from 1990 to 2017. More than 85% of all countries saw an increase in ASIR of CLL. In 1990, acute myeloid leukemia (AML) accounted for 18.0% of the total leukemia cases worldwide. This proportion increased to 23.1% in 2017. The ASIR of AML increased from 1.35/100,000 to 1.54/100,000, with an EAPC of 0.56 (95% CI 0.49, 0.62). A total of 127 countries or territories experienced a significant increase in the ASIR of AML. The number of chronic myeloid leukemia (CML) cases increased from 31.8 thousand in 1990 to 34.2 thousand in 2017. The ASIR of CML decreased from 0.75/100,000 to 0.43/100,000. A total of 141 countries or territories saw a decrease in ASIR of CML. Conclusions A significant decrease in leukemia incidence was observed between 1990 and 2017. However, in the same period, the incidence rates of AML and CLL significantly increased in most countries, suggesting that both types of leukemia might become a major global public health concern.

Abstract Background Retinal degeneration is a leading cause of blindness in the world; its etiology is complex and involves genetic defects and stress-associated aging. In addition to gene therapies for known genetically defective retinal degeneration, cellular therapies have been widely explored for restoring vision in both preclinical animal models and clinical trials. Stem cells of distinct tissue sources and their derived lineages have been tested for treating retinal degeneration; most of them were reported to be effective to some extent in restoring/improving deteriorated vision. Whether this visual improvement is due to a functional integration of grafted cells to substitute for lost retinal neurons in recipients or due to their neuroprotective and neurotrophic effects to retain recipient functional neurons, or both, is still under debate. Methods We compared the results of subretinal transplantation of various somatic cell types, such as stem cells and differentiated cells, into RhoP23H/+ mice, a retinal degeneration model for human retinitis pigmentosa (RP) by evaluating their optokinetic response (OKR) and retinal histology. We identified some paracrine factors in the media that cultured cells secreted by western blotting (WB) and functionally evaluated the vascular endothelial growth factor Vegfa for its potential neurotrophic and neuroprotective effects on the neuroretina of model animals by intravitreal injection of VEGF antibody. Results We found that live cells, regardless of whether they were stem cells or differentiated cell types, had a positive effect on improving degenerating retinas after subretinal transplantation; the efficacy depended on their survival duration in the host tissue. A few paracrine factors were identified in cell culture media; Vegfa was the most relevant neurotrophic and neuroprotective factor identified by our experiments to extend neuron survival duration in vivo. Conclusions Cellular therapy-produced benefits for remediating retinal degeneration are mostly, if not completely, due to a paracrine effect of implanted cells on the remaining host retinal neurons.

Abstract Background Evidence-based medicine (EBM) is gradually being recognized worldwide as an important clinical skill and plays an important role in health care. Although the concept has successfully spread in the health care field, EBM still has not been widely incorporated into clinical decisions in primary care due to potential barriers. This study aimed to explore the views, experiences and obstacles of general practitioners (GPs) regarding the use EBM in their daily clinical practices in Beijing. Methods We performed a qualitative study with GP focus groups. Thirty-two GPs working in 26 community health service centres in 7 districts in Beijing were recruited. Four focus group sessions with 32 GPs were conducted in a meeting room at the Capital Medical University from January to February in 2018 in Beijing. All sessions were audio-recorded, transcribed and analysed for themes using an inductive content analysis approach. Results GPs believed that EBM could help them enhance the quality of their clinical practice. The most common EBM behaviour of GPs was making clinical decisions according to guidelines. The barriers that limited the implementation of EBM were patients’ poor compliance, lack of time, lack of resources, inadequate skills or knowledge, and guideline production problems. The first need for GPs was to participate in training to enhance their skills in practising EBM. Conclusions To practise EBM in general practice, integrated interventions of different levels need to be developed, including enhancing GPs’ communication skill and professional competency, training GPs on the implementation of EBM, employing more staff to reduce GPs’ workloads, providing adequate resource support, and developing evidence-based clinical guidelines for GPs.

Abstract Background General practice clinics are the main primary care institutions providing ambulatory care in the rural areas of Beijing, rational use of medicines is crucial for the rural primary care system. This study investigated the prescribing patterns of general practice clinics in rural Beijing to provide a baseline for monitoring and promoting the rational use of medicines. Methods We performed a cross-sectional study at 14 rural community health service centers in 6 non-central districts of Beijing sampled through a multistage approach, 85 general practitioners were selected from the 14 centers. Total 8500 prescriptions were derived by recording 100 consecutive patients of each the general practitioner. The World Health Organization drug use indicators and an additional indicator were adopted to assess the prescribing patterns. Results The median number of medicines per encounter was 2.0 (1.0, 2.0); the percentage of generics and essential medicines prescribed were 97.0 and 58.2%, respectively; the percentage of encounters with antibiotics prescribed was 15.1%; the percentage of encounters with injections prescribed was 3.7%; the percentage of encounters with traditional Chinese patent medicines prescribed was 52.5%; the median duration of consultation time was 6.0 (4.0, 10.0) minutes. The most frequently prescribed medicine was aspirin (low dose, 4.6%). The prescribing indicators were influenced by different patient characteristics, patients with new cooperative rural medical scheme were less likely to be prescribed with ≥3 medicines (OR 0.865), essential medicines (OR 0.812) and traditional Chinese patent medicines (OR 0.631), but were more likely to be prescribed with injections (OR 1.551) in the encounter. Patients with ≥3 problems were more likely to be prescribed with ≥3 medicines (OR 6.753), antibiotics (OR 2.875) and traditional Chinese patent medicines (OR 2.926) in the encounter. Conclusions Most indicators in this study showed similar or fair performance in comparison with World Health Organization and domestic reports, except the percentage of medicines prescribed from the essential medicine list. Regular monitoring on the prescription quality of general practice clinics in rural Beijing should be maintained.

Adalimumab, as a TNF inhibitor biologic for the treatment of rheumatoid arthritis, is one of the top-selling drugs worldwide. As its various patents have gradually expired, experiments on its biosimilars are constantly being implemented. In this review, we summarized clinical trials of seven biosimilars currently approved by the FDA and/or EMA for the treatment of rheumatoid arthritis, namely: ABP 501 (Amjevita/Amgevita/Solymbic), BI 695501 (Cyltezo), SB5 (Imraldi/Hadlima), GP2017 (Hyrimoz/Hefiya/Halimatoz), MSB11022 (Idacio), FKB327 (Hulio), and PF-06410293 (Abrilada). Overall, these biosimilars showed similar efficacy, safety, and immunogenicity to adalimumab. All biosimilar switching trials indicated that switching from adalimumab to a biosimilar does not have a significant impact on efficacy, safety, and immunogenicity.

Abstract Background Family caregivers play crucial roles in taking care of people experiencing schizophrenia in the community. The burdens on and needs of caregivers of these patients should be emphasized. This study aimed to explore the perspective of family caregivers of people experiencing schizophrenia in the communities of Beijing in terms of the burdens of care and the acquisition and further need for support in order to provide guidance to health care providers regarding how to target therapeutic interventions for families of individuals experiencing schizophrenia and to provide recommendations for policy makers to tailor countermeasures and services. Methods A total of 20 family caregivers of schizophrenia patients were enrolled in our study. A face-to-face and semi-structured in-depth qualitative interview study was conducted to explore the caregivers’ perspective on the burden on caregivers, support and further needs. This study was conducted in the community health service centres where the family caregivers regularly visit. The study was carried out according to good ethical practices, data analysis and reporting guidelines. Results Most participants reported that they were suffering from heavy life burdens and had negative experiences with respect to obtaining social support, and they emphasized that they would require more support. Economic and daily housework burdens, limited social communication, and psychological stresses were the principal burdens. Support including financial, medical and information and educational support did not satisfy the needs of the caregivers and their patients. More financial support, respect, and rehabilitation institutions were reported to be needs of the caregivers. Conclusions Family caregivers of people experiencing schizophrenia suffer from heavy physical and psychological burdens; however, the current support provided is insufficient. More services and better public attitudes should be considered for people experiencing schizophrenia and their caregivers.

Abstract Background The Chinese government offered various types of training programs for strengthening the role of doctors working in community health service institutions (CHSIs). The study intended to investigate the current training programs and training needs of doctors nationally in urban CHSIs in China, and to provide propositions for training more qualified doctors in the future. Methods Total 3098 doctors in 192 urban CHSIs were chosen from 9 provinces (Hebei, Liaoning, Shandong, Zhejiang, Fujian, Hunan, Guangxi, Guizhou, Ningxia) and one municipality (Beijing) among 31 provinces in eastern, central, and western regions by stratified sampling methods in Mainland China. All doctors in the selected CHSIs were investigated in this study. We discharged 3073 questionnaires, and the response rate was 98.0%. Descriptive statistics were used to describe the characteristics, training contents, problems and needs of doctors. Differences in training contents, problems and needs between eastern, central and western regions were analyzed with chi-square tests. Results 49.3% of doctors in CHSIs had Bachelor’s degree and beyond. 12.9% of doctors had senior professional titles. The most frequent training topics for the doctors in eastern, central and western regions were “basic clinical theory knowledge” (52.4%), “community health service competency” (59.6%), “clinical practice skills” (45.9%) respectively. The most serious problem for doctors was “insufficient training time” in eastern (36.8%), central (36.5%) and western (39.6%). The biggest knowledge need for doctors both in eastern (79.8%) and central region (79.1%) was “the updated international medical knowledge”, in western region it was “the updated domestic medical knowledge” (73.2%). The biggest skill-related training need for doctors in eastern region (84.1%) and central region (82.6%) was “communication skills”, and “diagnosis and differential diagnosis” in western region (78.2%). Conclusion Government should design proper training contents according to the knowledge and skill needs of different design. Furthermore, a uniform, rigorous training and evaluation system focus on practicability should be established to promote community health service system in Mainland China.

Ilex crenata Thunb. is a species of Aquifoliaceae with high ornamental and ecological values. In this study, the complete chloroplast (cp) genome of I. crenata was assembled and characterized through Illumina sequencing data. The entire cp genome of I. crenata was 157,988 bp in length with 37.64% overall GC content, containing a large single-copy (LSC) region of 87,414 bp and a small single-copy (SSC) region of 18,422 bp, which were separated by a pair of 26,076 bp inverted repeat (IR) regions. A total of 135 genes were annotated, including 88 protein-coding genes, 39 tRNA genes, and 8 rRNA genes. Phylogenetic analysis based on 78 conserved protein-coding genes demonstrated that I. crenata is closely related to I. viridis and I. szechwanensis.

Background: The retinal pigment epithelium (RPE) has the potential to regenerate the entire neuroretina upon retinal injury in amphibians. In contrast, this regenerative capacity has been lost in mammals. The reprogramming of differentiated somatic cells into induced pluripotent stem cells (iPSCs) by viral transduction of exogenous stem cell factors has triggered a revolution in regenerative medicine. However, the risks of potential mutation(s) caused by random viral vector insertion in host genomes and tumor formation in recipients hamper its clinical application. One alternative is to immortalize adult stem cells with limited potential or to partially reprogram differentiated somatic cells into progenitor-like cells through non-integration protocols. Methods: Sphere-induced RPE stem cells (iRPESCs) were generated from adult mouse RPE cells. Their stem cell functionality was studied in a mouse model of retinal degeneration. The molecular mechanism underlying the sphere-induced reprogramming was investigated using microarray and loss-of-function approaches. Findings: We provide evidence that our sphere-induced reprogramming protocol can immortalize and transform mouse RPE cells into iRPESCs with dual potential to differentiate into cells that express either RPE or photoreceptor markers both in vitro and in vivo. When subretinally transplanted into mice with retinal degeneration, iRPESCs can integrate to the RPE and neuroretina, thereby delaying retinal degeneration in the model animals. Our molecular analyses indicate that the Hippo signaling pathway is important in iRPESC reprogramming. Interpretation: The Hippo factor Yap1 is activated in the nuclei of cells at the borders of spheres. The factors Zeb1 and P300 downstream of the Hippo pathway are shown to bind to the promoters of the stemness genes Oct4, Klf4 and Sox2, thereby likely transactivate them to reprogram RPE cells into iRPESCs. Fund: National Natural Science Foundation of China and the National Institute of Health USA. Keywords: RPE stem cells, Sphere-induced reprogramming, Retina degeneration, Cell transplantation

Transition from premalignant lesion to cancer cell highlights tumor initiation. Here, the authors use a model of K-Ras-initiated lung cancer to document two successive asymmetric divisions, each driven by mitotic polarization of key transcription factors, which lead to generation of initial cancer cells.

Abstract Background Migrants are the unique production of China’s urbanization process. They are often excluded from social welfare and security systems of cities, and often exposed to high health risk related closely to their health problems. This research sought to unveil and explore the influencing factors on health services utilization of migrants in Beijing. Methods A sample of 2014 inter-provincial migrants and 4578 residents with Beijing “Hukou” who were 15 years old and above was chosen by three-stage stratified cluster sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Anderson health service utilization model was used to demonstrate the effects of the explanatory variables on health seeking behavior from predisposing, enabling and need variables. Results The study reveals that the rate of ‘having symptoms’ of migrants was lower than that of residents with “Hukou” only in the group of 25 to 34 years old in the past month. 503 migrants (25.0%) and 1441 (31.5%) residents with “Hukou” reported at least one episode of discomfort in the past month, and the rate of health service seeking behavior among migrants (46.8%) was lower than residents with “Hukou” (62.6%) (P

Abstract Human uveal melanoma (UM) is a major ocular malignant tumor with high risk of metastasis and requires multiple oncogenic factors for progression. ZEB1 is a zinc finger E-box binding transcription factor known for participating epithelial-mesenchymal transition (EMT), a critical cellular event for metastasis of malignant tumors of epithelium origin. ZEB1 is also expressed in UM and high expression of ZEB1 correlates with UM advancement, but has little effect on cell morphology. We show that spindle UM cells can become epithelioid but not vice versa; and ZEB1 exerts its tumorigenic effects by promoting cell dedifferentiation, proliferation, invasiveness, and dissemination. We provide evidence that ZEB1 binds not only to repress critical genes involving in pigment synthesis, mitosis, adherent junctions, but also to transactivate genes involving in matrix degradation and cellular locomotion to propel UM progression towards metastasis. We conclude that ZEB1 is a major oncogenic factor required for UM progression and could be a potential therapeutic target for treating UM in the clinic.

Summary: Retinitis pigmentosa (RP) initiates with diminished rod photoreceptor function, causing peripheral and night-time vision loss. However, subsequent loss of cone function and high-resolution daylight and color vision is most debilitating. Visual pigment-rich photoreceptor outer segments (OS) undergo phagocytosis by the retinal pigment epithelium (RPE), and the RPE also acts as a blood-outer retinal barrier transporting nutrients, including glucose, to photoreceptors. We provide evidence that contact between externalized phosphatidylserine (PS) on OS tips and apical RPE receptors activates Akt, linking phagocytosis with glucose transport to photoreceptors for new OS synthesis. As abundant mutant rod OS tips shorten in RP, Akt activation is lost, and onset of glucose metabolism in the RPE and diminished glucose transport combine to cause photoreceptor starvation and accompanying retinal metabolome changes. Subretinal injection of OS tip mimetics displaying PS restores Akt activation, glucose transport, and cone function in end-stage RP after rods are lost. : Wang et al. show that onset of glucose metabolism in the retinal pigment epithelium (RPE), which acts as the blood-outer retinal barrier, and inhibition of RPE glucose transport to photoreceptors combine to cause photoreceptor starvation and vision loss in retinitis pigmentosa. Keywords: retinitis pigmentosa, retinal pigment epithelium, photoreceptors, vision, metabolism, glucose transport

We used the observations from Atmospheric Infrared Sounder (AIRS) onboard Aqua over the northwest Pacific Ocean from 2006–2015 to study the relationships between (i) tropical cyclone (TC) temperature structure and intensity and (ii) cloud macro-/micro-physical properties and TC intensity. TC intensity had a positive correlation with warm-core strength (correlation coefficient of 0.8556). The warm-core strength increased gradually from 1 K for tropical depression (TD) to >15 K for super typhoon (Super TY). The vertical areas affected by the warm core expanded as TC intensity increased. The positive correlation between TC intensity and warm-core height was slightly weaker. The warm-core heights for TD, tropical storm (TS), and severe tropical storm (STS) were concentrated between 300 and 500 hPa, while those for typhoon (TY), severe typhoon (STY), and Super TY varied from 200 to 350 hPa. Analyses of the cloud macro-/micro-physical properties showed that the top of TC cloud systems mainly consisted of ice clouds. For TCs of all intensities, areas near the TC center showed lower cloud-top pressures and lower cloud-top temperatures, more cloud fractions, and larger ice-cloud effective diameters. With the increase in TC intensity, the levels of ice clouds around the TC center became higher and the spiral cloud-rain bands became larger. When a TC developed into a TY, STY, or Super TY, the convection in the clouds was stronger, releasing more heat, thus forming a much warmer warm core.

Most retinitis pigmentosa (RP) mutations arise in rod photoreceptor genes, leading to diminished peripheral and nighttime vision. Using a pig model of autosomal-dominant RP, we show glucose becomes sequestered in the retinal pigment epithelium (RPE) and, thus, is not transported to photoreceptors. The resulting starvation for glucose metabolites impairs synthesis of cone visual pigment-rich outer segments (OSs), and then their mitochondrial-rich inner segments dissociate. Loss of these functional structures diminishes cone-dependent high-resolution central vision, which is utilized for most daily tasks. By transplanting wild-type rods, to restore glucose transport, or directly replacing glucose in the subretinal space, to bypass its retention in the RPE, we can regenerate cone functional structures, reactivating the dormant cells. Beyond providing metabolic building blocks for cone functional structures, we show glucose induces thioredoxin-interacting protein (Txnip) to regulate Akt signaling, thereby shunting metabolites toward aerobic glucose metabolism and regenerating cone OS synthesis.

This study applied the non-parametric four-stage data envelopment analysis method (Four-Stage DEA) to measure the relative efficiencies of Chinese public hospitals from 2010 to 2016, and to determine how efficiencies were affected by eight factors. A sample of public hospitals (n = 84) was selected from Chongqing, China, including general hospitals and traditional Chinese medicine hospitals graded level 2 or above. The Four-Stage-DEA method was chosen since it enables the control of the impact of environment factors on efficiency evaluation results. Data on the number of staff, government financial subsidies, the number of beds and fixed assets were used as input whereas the number of out-patients and emergency department patients and visits, the number of discharged patients, medical and health service income and hospital bed utilization rate were chosen as study outputs. As relevant environmental variables, we selected GDP per capita, permanent population, population density, number of hospitals and number of available sickbeds in local medical institutions. The relative efficiencies (i.e. technical, pure technical, scale) of sample hospitals were also calculated to analyze the change between the first stage and fourth stage every year. The study found that Four-Stage-DEA can effectively filter the impact of environmental factors on evaluation results, which sets it apart from other models commonly used in existing studies.

The purpose of this study was to describe the patients' reasons for encounter (RFE) and health problems managed by general practitioners (GPs) in the rural areas of Beijing to provide evidences for health services planning and GPs training.This study was conducted at 14 community health service centers (CHSCs) in 6 suburban districts of Beijing, using a multistage sampling method. A total of 100 GPs was selected from the study sites. A self-designed data collection form was developed on the basis of Subjective-Objective-Assessment-Plan (SOAP), including patient characteristics, RFEs, health problems, interventions, and consultation length. Each GP recorded and coded their 100 consecutive patients' RFEs and health problems with the International Classification of Primary Care, 2nd version (ICPC-2). Descriptive statistics were employed to describe the distribution of RFE and health problems. Student t-test and analysis of variance were used to compare the differences of mean number of RFE or health problems per encounter by patient characteristics.A total of 10,000 patient encounters with 13,705 RFEs and 15,460 health problems were recorded. The RFEs and health problems were mainly distributed in respiratory, circulatory, musculoskeletal, endocrine, metabolic and nutritional, and digestive systems. Cough and hypertension were the most common RFE and health problem, respectively. With increased ages, the mean number of RFEs decreased and the mean number of health problems increased. Patients with Beijing medical insurance had less RFEs and more health problems than those in other cities (p

ABSTRACT: A disaster induced by a tropical cyclone (TC) is a complex non-linear process, involving interactions of multiple factors. Assuming that the resilience to TC disasters remains basically unchanged, the disaster-causing risk is usually consistent with intensities of the TC-induced rainstorms and wind. When an area is hit by a low probability TC, the rainstorm and wind intensities are higher, and the likelihood for causing a disaster is greater. Therefore, criteria for the impact of a TC and disaster risk assessments can be established based on the probable intensities of the TC-associated rainstorms and wind. In this study, an AMH Copula-based function is introduced to investigate the joint risk probabilities of TC rainstorms and wind. In line with the equivalence principle of the distribution of a stochastic atmospheric phenomenon in both time and space, and taking the impact on Shanghai of TC Haikui as an example, the Copula-based joint probability distribution model is developed to assess the impacts of TC rainstorms and wind, based on the marginal distributions of the maximum daily rainfall and extreme gust velocity. The joint exceedance probabilities of TC rainstorms and wind derived from the model can be used as criteria to measure the risk levels. As our findings show, this approach captures the TC risks well, especially in high-risk areas. The aim of the study is to provide a practically useful concept for making more accurate assessments of the risk level of an extreme weather event using observational data, and objective criteria for risk avoidance and transfer. Keywords: TC impact, joint distribution, joint exceedance probability, risk assessment, spatial distribution

ABSTRACT: China is frequently affected by tropical cyclones in summer and autumn because its southern and eastern parts border low-latitude oceans. The track forecasting of tropical cyclones is a key issue in weather forecasting. In daily operations, forecasters usually focus on the effects of environmental flow fields on tropical cyclones, such as the subtropical high pressure belt, the basic flow, the troughs and ridges in westerlies, the cross-equatorial flow, the equatorial convergence belt, and the polar front. However, these factors become less significant when the environmental fields are so weak that the steering flow does not play a vital role or we cannot accurately determine the evolution of the environment flow field. Meteorological satellite cloud imagery can fill the data gap of conventional observations and provide important clues for forecasting the status and development of tropical cyclones when they are included in day-to-day weather forecasting operations. In this study, using “Muifa”, “Haikui” and other typhoons as examples, the effects of the cloud pattern and the large-scale environmental vapor fields, on the moving tracks of typhoons were analyzed based on satellite data. The results showed that the change of structures of typhoon spiral cloud bands and the turning of the typhoon path were taking on greater relevance, and at the same time the satellite water vapor images had obvious advantages in terms of indicating the large-scale environmental fields. A combination of satellite cloud imagery, observational data, and weather event analysis remains the most effective approach in the operational forecasting of typhoon moving tracks. Keywords: typhoon, moving track, satellite cloud imagery, environmental field

ABSTRACT: An objective tropical cyclone (TC) intensity estimation model is proposed based on the statistical relationship between TC intensity and its inner-core convection, plus the persistence of TC intensity. In the model, the inner-core convection is described by several parameters retrieved from digital infrared (IR) satellite images, including the number of convective cores (Num), their distance to the TC center, and their blackbody temperature (TBB), among others. The persistence of TC intensity is embodied by the TC intensity six hours previous (V6h). The model was set up by the stepwise regression technique using a five-year dataset (2006-2010) and was tested using an independent dataset covering 2011-2012, with V6h from the best-track dataset. Selected factors of the model included V6h, Num, Lat (TC center latitude), Lon (TC center longitude), DISmin (minimum distance between convective cores and TC center), and TBBdif (difference between the maximum and minimum TBB value of convective cores). Results showed that, for independent samples during 2011-2012, the MAE (mean absolute error) and RMSE (root-mean-square error) of Vmax estimation were 1.8 m s−1 and 2.4 m s−1, respectively. In order to make the model totally independent from the best-track dataset, the model estimation from six hours previous was used as the V6h for a second independent test covering 2011-2012. The results showed that the model had an MAE and RMSE of 5.4 m s−1 and 7.3 m s−1, respectively. Large errors were found for strong TCs (Severe Typhoon or Super Typhoon). The error statistics of the proposed model are comparable to published statistics on the widely used Dvorak technique or its objective versions, implying its potential to be used as an alternative tool for TC intensity estimation in either real-time operation or post-season best-track analyses. Keywords: IR images, convective core, tropical cyclone, intensity estimation

OBJECTIVE:To develop the Chinese (Mainland) version of Chronic Liver Disease Questionnaire (CLDQ) and use it to assess the health-related quality of life (HRQoL) of chronic hepatitis B (CHB) patients in China and identify the determinants of HRQoL. METHODS:The Chinese (Mainland) CLDQ was developed by expert consultation, focus group interviews with patients, and pilot study. The final version of questionnaire was adopted to assess the HRQoL of chronic hepatitis B outpatients enrolled from two largest infectious hospitals in Beijing. Cronbach' s alpha was used to measure the internal consistency reliability. The construct validity was measured by factor analysis. T-test, one-way analysis of variance (ANOVA), and multi-variable linear regression were used to analyze the data. RESULTS:Cronbach's alpha of the overall CLDQ is 0.935, ranging from 0.628 to o.881 among six subscales. Six factors were identified via factor analysis, including a new factor sleeping(SL). A total of 519 patients with CHB were included in the investigation with the final version of questionnaire, 405 of them were only with CHB, 53 with compensated cirrhosis, and 61 with decompensated cirrhosis. The CHB group scored the highest in the overall score of CLDQ (p

Community health service center (CHSC) and community health service station (CHSS) are the main institutions where general practitioners (GPs) deliver primary care in the urban area of China. Motivated by incentive policies, visits to community health service institutions (CHSIs) increased gradually in recent years, but concerns had been raised on the quality of general practice consultation. This is a preliminary study aimed to investigate the existing problems of general practice consultation in Beijing and provide practical evidence for developing relevant policies.Six GPs from 2 CHSCs and 3 CHSSs were selected by purposive sampling. The GPs were observed for 4 or 5 consecutive days during January 2013 to March 2013. The length and content of consultations were recorded in structured observation forms. Quantitative description was applied to describe the median, percentage and frequency of variables.A total of 1135 consultations were observed. The most frequent reason for consultations was specific prescription (61.6%), followed by presenting symptoms (20.7%), check-up (9.1%), counseling (5.4%), transfusion & injection (3.0%) and sickness certificate (0.2%). The median consultation length of all consultations was 2.0 minutes. The GPs prescribed in 81.0% of the consultations, on the other hand, history taking, physical examination, explanation of illness and health education only took place in 27.0%, 28.0%, 21.9% and 17.7% of the consultations respectively.The adequacy of consultation length in CHSIs is in doubt. Most patients visited the CHSIs for prescription renewal. Health promotion e.g. health education are not adequately provided in consultations. The quality of general practice consultations was jeopardized by the large amount of patient flow for medicine renewal. Policies should be adjusted to reduce unnecessary consultations. Further studies are in need to evaluate the outcome and influencing factors of general practice consultation in China.

Thirty-year (1980–2009) tropical cyclone (TC) images from geostationary satellite (GOES, Meteosat, GMS, MTSAT and FY2) infrared sensors covering the Northwestern Pacific were used to build a TC size dataset based on objective models. The models are based on a correlation between the size of TCs, defined as the mean azimuth radius of 34 kt surface winds (R34) and the brightness temperature radial profiles derived from satellite imagery. Using satellite images between 2001 and 2009, we obtained 16,548 matchup samples and found the correlation to be positive in the TC’s inner core region (in the annulus field 64 km from the TC center) and negative in its outer region (in the annulus field 100–250 km from the TC center). Then, we performed a stepwise regression to select the dominant variables and derived the associated coefficients for the objective models. Independent validation against best track archives shows the median estimation error to be between 27 and 65 km, which are not significantly different to other satellite series data. Finally, we applied the models to 721 TCs and made 13,726 measurements of TC size. The difference of mean TC size derived from our models, and also that from the US Joint Typhoon Warning Center (JTWC) best track archives is 19 km. The developed database is valuable in the research fields of TC structure, climatology, and the initialization of forecasting models.

BACKGROUND: We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. METHODS: A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. RESULTS: On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. CONCLUSIONS: This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

BACKGROUND: Among the Chinese population of 1.3 billion, there are an estimated 93 million carriers of hepatitis B virus (HBV). Men who have sex with men (MSM) are at increased risk for HBV infection; however, the prevalence of HBV immunization and infection among Chinese MSM remains undetermined. METHODS: A cross-sectional survey of 1,114 eligible participants was conducted in Beijing, China. Multiple methods were used to recruit study participants. Demographic information and potential correlated factors were collected by questionnaire. Additionally, blood specimens were collected and tested for sexually transmitted infections and serologic markers of hepatitis B immunization and infection. RESULTS: Laboratory data were available for 1,111 participants (99.7%), the prevalence of hepatitis B immunization was 38.9%, and 26.5% had serologic markers of HBV infection. Multivariate analyses indicated that higher education level, smaller number of male sex partners in the past 12 months, reported diagnosis of sexually transmitted disease (STD), and history of blood donation were independently associated with HBV immunization. Absence of steady male sex partner(s) in the past 12 months, and reported diagnosis of STD were shown to be independently associated with HBV infection. MSM positive for HBV infection were more likely to have past or current syphilis infection. CONCLUSIONS: Low prevalence of HBV immunization and high prevalence of HBV infection among Chinese MSM and a correlation between sexual risk factors and hepatitis B infection indicate that comprehensive preventative measures for HBV among MSM, including blood donor and HIV-STD clinic vaccination programs as well as targeted health education campaigns should be developed in China.

Vitamin D is an essential micronutrient; it is necessary for human well-being, including brain and heart health; its deficiency is widespread and can lead to fatal diseases. Daily consumed foods are enriched and fortified with vitamin D; still, adequate bioavailability and safe delivery are significant issues. In the food system, due to unfavorable conditions, vitamin D loses its nature and functionality; likewise, it is fat-soluble and can't be incorporated into juices and soft drinks. Due to the acidic nature of the gastric environment, the timely release and adequate bioavailability of vitamin D is also hampered. Therefore, the most challenging and critical issue is the application of techniques to safeguard vitamin D for its optimum functionality. Recently food researchers and nutritionists are developing innovative methods using nanotechnology to ensure the safety of vitamin D, its timely release and absorbance during digestion. This review reflects valuable data, precisely the effectiveness of recently developed nano-based methods on vitamin D's sustainability, retention, and bioavailability, including nano-encapsulation, nanoemulsion, mixed micelles, complexation, and Conjugation. This manuscript also discusses some of the important clinical trialed based health benefits of vitamin D, summarizes the most recent techniques developed, and demonstrates understanding of novel methods and future developments. [ABSTRACT FROM AUTHOR]