Evolution of black carbon and brown carbon during summertime in Southwestern China: An assessment of control measures during the 2023 Chengdu Summer World University Games.

The 31st FISU Summer World University Games (SWUG) was held in Chengdu, southwestern China, from July 22 to August 8, 2023. A series of control measures were carried out to ensure good air quality during the SWUG, providing an opportunity to investigate the atmospheric behaviors of light-absorbing aerosols under such a substantial disturbance caused by the control measures. To assess the impacts of emission controls on primary pollutants, a field campaign was conducted at a rural site in Chengdu to investigate the characterization of equivalent black carbon (eBC). The changes of eBC concentrations before, during, and after the SWUG were characterized. The sources of eBC were resolved, and the impacts of atmospheric processes on the absorption capacity were also investigated. During the SWUG, the eBC concentration decreased by 12.1 % and 25.3 % compared with those before and after the SWUG. A fossil fuel combustion (eBCff) and a biomass burning (eBCbb) originated eBC were resolved using the aethalometer model. Both eBCff and eBCbb decreased during the SWUG, indicating the effectiveness of control measures. After the SWUG, the influence of biomass burning emissions became more and more significant, and the contribution of brown carbon (BrC) to light absorption at 370-660 nm increased by 52, 19, 7, 6, and 17 % compared to those during the SWUG. As the biomass burning emitted aerosols aged, the absorption Ångström exponent and babs(BrC370nm) decreased gradually, which was mainly due to the photobleaching of the chromophores during the daytime. eBCff was mainly affected by strong wind, while high eBCbb concentration was mainly attributed to the gradual accumulation of biomass-burning emissions near the observation site. The results show the significant reduction of eBC with the implementation of the air pollution mitigation campaign, and provide insights on the impacts of atmospheric processes on BC optical properties during summertime.

The effects of dietary macronutrient composition on resting energy expenditure following active weight loss: A systematic review and meta-analysis.

A systematic review and meta-analysis was conducted to evaluate the relative effectiveness of different dietary macronutrient patterns on changes in resting energy expenditure (REE) in relation to weight loss, categorized as minimal (<5%) and moderate to high (>5%). Changes in REE were assessed using a DerSimonian and Laird random-effects meta-analysis. A diet lower in carbohydrates (CHO) or higher in fat and protein was associated with smaller reductions in REE, with these trends being more pronounced among participants who experienced moderate to high weight loss. Adjusted meta-regression analysis indicated that, within the participants who experienced moderate to high weight loss, each 1% increase in CHO intake was associated with a reduction of 2.30 kcal/day in REE (95% CI: -4.11 to -0.47, p = 0.013). In contrast, a 1% increase in protein and fat intake was correlated with an increase in REE by 3.00 (95% confidence interval [CI] [1.02, 5.07], p = 0.003) and 0.5 (95% CI [-2.43, 3.41], p = 0.740) kcal/day, respectively. No significant associations were found among participants who experienced minimal weight loss. These findings indicate that, under a caloric deficit, the impact of dietary macronutrient composition on REE may vary depending on the degree of weight loss and individual metabolic responses.

An Expert-Knowledge-Based Graph Convolutional Network for Skeleton- Based Physical Rehabilitation Exercises Assessment.

Physical therapists play a crucial role in guiding patients through effective and safe rehabilitation processes according to medical guidelines. However, due to the therapist-patient imbalance, it is neither economical nor feasible for therapists to provide guidance to every patient during recovery sessions. Automated assessment of physical rehabilitation can help with this problem, but accurately quantifying patients' training movements and providing meaningful feedback poses a challenge. In this paper, an Expert-knowledge-based Graph Convolutional approach is proposed to automate the assessment of the quality of physical rehabilitation exercises. This approach utilizes experts' knowledge to improve the spatial feature extraction ability of the Graph Convolutional module and a Gated pooling module for feature aggregation. Additionally, a Transformer module is employed to capture long-range temporal dependencies in the movements. The attention scores and weight matrix obtained through this approach can serve as interpretability tools to help therapists understand the assessment model and assist patients in improving their exercises. The effectiveness of the proposed method is verified on the KIMORE dataset, achieving state-of-the-art performance compared to existing models. Experimental results also illustrate the interpretability of the method in both spatial and temporal dimensions.

Cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy for metastatic triple-negative breast cancer: a trial-based analysis.

BACKGROUND: Sacituzumab govitecan (SG) has recently been approved in China for the post-line treatment of metastatic triple-negative breast cancer (mTNBC). SG substantially improves progression-free survival and overall survival compared with single-agent chemotherapy for pretreated mTNBC. However, in view of the high price of SG, it is necessary to consider its value in terms of costs and outcomes. This study aimed to estimate the cost-effectiveness of SG versus single-agent treatment of physician's choice (TPC) in the post-line setting for patients with mTNBC from a Chinese healthcare system perspective. METHODS: The cohort characteristics were sourced from the ASCENT randomized clinical trial, which enrolled 468 heavily pretreated patients with mTNBC between November 2017 and September 2019. A partitioned survival model was constructed to assess the long-term costs and effectiveness of SG versus TPC in the post-line treatment of mTNBC. Quality-adjusted life-months (QALMs) and total costs in 2022 US dollars were used to derive incremental cost effectiveness ratio (ICER). QALMs and costs were discounted at 5% annually. The willingness-to-pay (WTP) threshold was defined as $3188 per QALM, three times China's average monthly per capita gross domestic product in 2022. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed to estimate the robustness of the results. RESULTS: Treatment with SG yielded an incremental 5.17 QALMs at a cost of $44,792 per QALM, much above the WTP threshold of $3188/QALM in China. One-way sensitivity analysis showed that SG price was a crucial factor in the ICER. Probabilistic sensitivity analysis revealed that the cost-effective acceptability of SG was 0% in the current setting. Scenario analyses indicated that the result was robust in all subgroups in ASCENT or under different time horizons. Furthermore, SG must reduce the price to enter the Chinese mainland market. When the monthly cost of SG reduce to $2298, SG has about 50% probability to be a preferred choice than TPC. CONCLUSIONS: SG was estimated to be not cost-effective compared with TPC for post-line treatment for mTNBC in China by the current price in HK under a WTP threshold of $3188 per QALM. A drastic price reduction is necessary to improve its cost-effectiveness.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China.

Objectives: China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China. Methods: An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform. Results: After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (ß3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (ß3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (ß3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (ß3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (ß3 = -1220.72, p = 0.22) and number of inpatients (ß3 = 75.42, p = 0.09). Conclusion: The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Cancer burden and risk in the Chinese population aged 55 years and above: A systematic analysis and comparison with the USA and Western Europe.

Background: We analysed the cancer burden among elderly Chinese people over the age of 55 years and compared them to USA and Western Europe to explore the cancer model in China. Methods: We retrieved data on 29 cancers with 34 risk factors from the 2019 Global Burden of Disease database to evaluate the cancer burden in Chinese elderly individuals aged 55 years and older. We then used the age-standardised incidence rate (ASIR), age-standardised death rate (ASDR), age-standardised disability-adjusted life year (DALY) rate, and average annual percentage change (AAPC) to compare the characteristics and change trend of cancers among China, USA, and Western Europe. Results: In 2019, the number of incident cases of 29 cancers among people aged 55 years and above in China increased more than 3-fold compared to 1990, while the number of deaths and DALYs approximately doubled. We also found that the cancer population in China was ageing; meanwhile, the cancer burden became significantly higher for men than for women, and the gap between men and women had widened. Cancers with the highest cancer DALYs were lung cancer (13 444 500; 95% uncertainty interval (UI) = 11 307 100, 15 853 700), stomach cancer (7 303 900; 95% UI = 6 094 600, 8 586 500), oesophageal cancer (4 633 500; 95% UI = 3 642 500, 5 601 200), colon and rectum cancer (4 386 500; 95% UI = 3 769 500, 5 067 200), liver cancer (2 915 100, 95% UI = 2 456 300, 3 463 900), and pancreatic cancer (2 028 400; 95% UI = 1 725 000, 2 354 900). Compared with 1990, the DALY rate and incidence rate of stomach cancer, oesophageal cancer, and liver cancer had markedly decreased. The DALY rate and incidence rate of lung, colon, rectum, and pancreatic cancer had increased significantly, as did the incidence rate of breast cancer in women. Smoking and diet were the top two cancer risk factors, and the impact of ambient particulate matter pollution on cancer increased each year. The overall 29 cancers age-standardised DALY rate and ASDR in China, USA, and Western Europe were similar, and all showed downward trend in the past 30 years. Compared with the USA and Western Europe, the age-standardised DALY rate of liver, nasopharyngeal, oesophageal, stomach, and cervical cancers in China was more prominent. The age-standardised DALY rate of lung cancer and colon and rectum cancer decreased annually in Western Europe and the USA, but increased in China. Conclusions: Over the past 30 years, China had made progress in controlling stomach, oesophageal, and liver cancer. However, lung, colon, rectum, pancreatic, and breast cancers had become more prevalent, having risen alongside economic development. The risks of smoking and dietary were major issues that need to be addressed urgently. The cancer situation in China remains serious; future cancer prevention efforts need to balance economic development with people's physical health, identify key groups, improve the health environment of residents and guide them to live a healthy life, and expand the scope of cancer screening.

Risk assessment of pesticide compounds: IPT and TCZ cause hepatotoxicity, activate stress pathway and affect the composition of intestinal flora in red swamp crayfish (Procambarusclarkii).

Isoprothiolane (IPT) and tricyclazole (TCZ) are widely used in rice farming and recently in combined rice-fish farming. However, co-cultured animals are affected by these pesticides. To investigate the organismal effects and toxicity of pesticides, crayfish were exposed to 0, 1, 10, or 100 ppt TCZ or IPT for 7 days. Pesticide bioaccumulation, survival rate, metabolic parameters, structure of intestinal flora, and antioxidant-, apoptosis-, and HSP-related gene expression were determined. Pesticide exposure caused bioaccumulation of IPT or TCZ in the hepatopancreas and muscles of crayfish; however, IPT bioaccumulation was higher than that of TCZ. Both groups showed significant changes in hepatopancreatic serum biochemical parameters. Mitochondrial damage and chromosomal agglutination were observed in hepatopancreatic cells exposed to 100 ppt IPT or TCZ. IPT induced more significant changes in serum biochemical parameters than TCZ. The results of intestinal flora showed that Vibro, Flavobacterium, Anaerorhabdus and Shewanella may have potential for use as a bacterial marker of TCZ and IPT. Antioxidant-, apoptosis-, and HSP-related gene expression was disrupted by pesticide exposure, and was more seriously affected by IPT. The results suggest that IPT or TCZ induce hepatopancreatic cell toxicity; however, IPT or TCZ content in dietary crayfish exposed to 1 ppt was below the food safety residue standard. The data indicated that IPT exposure may be more toxic than TCZ exposure in hepatopancreas and intestines and toxicity of organism are alleviated by activating the pathway of stress-response, providing an understanding of pesticide compounds in rice-fish farming and food safety.

Response of soil respiration and carbon budget to irrigation quantity/quality and biochar addition in a mulched maize field under drip irrigation.

BACKGROUND: Biochar addition strongly alters net carbon (C) balance in agroecosystems. However, the effects of biochar addition on net C balance of maize field under various irrigation water quantities and qualities remains unclear. Thus, a field experiment combining two irrigation levels of full (W1) and deficit irrigation (W2 = 1/2 W1), two water salinity levels of fresh (S0, 0.71 g L-1 ) and brackish water (S1, 4 g L-1 ), and two biochar addition rates of 0 t ha-1 (B0) and 60 t ha-1 (B1) was conducted to investigate soil carbon dioxide (CO2 ) emissions, maize C sequestration and C budget. RESULTS: Compared with W1, W2 reduced average cumulative CO2 emissions by 6.5% and 19.9% for 2020 and 2021, respectively. The average cumulative CO2 emissions under W1S1 treatments were 5.4% and 22.3% lower than W1S0 for 2020 and 2021, respectively, whereas W2S0 and W2S1 had similar cumulative CO2 emissions in both years. Biochar addition significantly increased cumulative CO2 emissions by 17.8-23.5% for all water and salt treatments in 2020, and reduced average cumulative CO2 emissions by 11.9% for W1 but enhanced it by 8.0% for W2 in 2021. Except for W2S1, biochar addition effectively increased total maize C sequestration by 6.9-14.8% for the other three treatments through ameliorating water and salt stress over the 2 years. Compared with W1S0, W1S1 did not affect net C sequestration, but W2 treatments significantly decreased it. Biochar addition increased net C sequestration by 39.47-43.65 t C ha-1 for four water and salt treatments for the 2 years. CONCLUSION: These findings demonstrate that biochar addition is an effective strategy to increase both crop C sequestration and soil C storage under suitable water-saving irrigation methods in arid regions with limited freshwater resources. © 2023 Society of Chemical Industry.

The reimbursement decision speed for oncology new drugs in China and its determinant factors.

Introduction: China has initiated national price negotiations to improve access to innovative drugs. Learning the factors that contributed to the time gap from marketing authorization to reimbursement leads to more clarity to decision-making, which remains under-researched in China. Methods: We collected new oncology drug approvals that were marketed before 30 Jun 2022, using the Listed Drug Database of the Chinese drug agency. Major information of each approval was obtained from the published review report, including the first approval region (China or the US) and the receipt of expedited review pathways (priority review and conditional approval). The reimbursement lists issued by China National Healthcare Security Administration from 2015 to 2023 were used to determine the reimbursement status of drugs. The duration from marketing authorization to reimbursement was defined as the reimbursement decision speed, and the Cox regression was performed to explore the underlying factors. Results: A total of 186 oncology approvals were included. More than half of the approvals qualified for reimbursement (110[59.14%]), and the median reimbursement decision speed was accelerated from 540.5 days in the third-round negotiation to 448 days in the seventh-round. Domestic new drugs had a higher probability of being adopted by the Chinese payer than drugs developed by foreign companies (adjusted HR = 3.73, 95% CI 2.42 to 5.75; P < 0.001). Furthermore, new drug applications receiving the regular review pathway were more likely to be reimbursed (adjusted HR = 2.15, 95% CI 1.13 to 4.08; P = 0.020) compared to those approved under the conditional approval pathway. Discussion: These findings indicate that the Chinese government is actively working toward improving access to new oncology drugs. The faster reimbursement decision speed for domestic drugs might be attributed to their pricing advantages and the regulator's efforts to stimulate innovation in the domestic pharmaceutical industry. However, concerns about the uncertainty in drug benefits can affect the reimbursement decision-making, which suggests the delicate tradeoff between drug accessibility and risk involved in the reimbursement process.

Precise fermentation coupling with simultaneous separation strategy enables highly efficient and economical sophorolipids production.

Sophorolipids (SLs) represent highly promising biosurfactants. However, its widespread production and application encounter obstacles due to the significant costs involved. Here, an intelligent and precise regulation strategy was elucidated for the fermentation process coupled with in-situ separation production mode, to achieve cost-effective SLs production. Firstly, a mechanism-assisted data-driven model was constructed for "on-demand feeding of cells". Moreover, a strategy of step-wise oxygen supply regulation based on the demand for cell metabolic capacity was developed, which accomplished "on-demand oxygen supply of cells", to optimize the control of energy consumption. Finally, a systematic approach was implemented by integrating a semi-continuous fermentation mode with in-situ separation technology for SLs production. This strategy enhanced SLs productivity and yield, reaching 2.30 g/L/h and 0.57 g/g, respectively. These values represented a 40.2% and 18.7% increase compared to fed-batch fermentation. Moreover, the concentration of crude SLs after separation reached 793.12 g/L, facilitating downstream separation and purification processes.

A cost-effectiveness analysis of hypertrophic cardiomyopathy sudden cardiac death risk algorithms for implantable cardioverter defibrillator decision-making.

AIMS: To conduct a contemporary cost-effectiveness analysis examining the use of implantable cardioverter defibrillators (ICD) for primary prevention in patients with hypertrophic cardiomyopathy (HCM). METHODS: A discrete-time Markov model was used to determine the cost-effectiveness of different ICD decision-making rules for implantation. Several scenarios were investigated including the reference scenario of implantation rates according to observed real world practice. A 12-year time horizon with an annual cycle length was used. Transition probabilities used in the model were obtained using Bayesian analysis. The study has been reported according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: Using a 5-year SCD risk threshold of 6% was cheaper than current practice and has marginally better total quality adjusted life years (QALYs). This is the most cost-effective of the options considered, with an incremental cost effectiveness ratio of £834 per QALY. Sensitivity analyses highlighted that this decision is largely driven by what health related quality of life (HRQL) is attributed to ICD patients and time horizon. CONCLUSION: We present a timely new perspective on HCM ICD cost-effectiveness, using methods reflecting real-world practice. While we have shown that a 6% 5-year SCD risk cut-off provides the best cohort stratification to aid ICD decision-making, this will also be influenced by the particular values of costs and HRQL for subgroups or at a local level. The process of explicitly demonstrating the main factors which drive conclusions from such an analysis will help to inform shared decision-making in this complex area for all stakeholders concerned.

Development and validation of a deep learning-based fully automated algorithm for pre-TAVR CT assessment of the aortic valvular complex and detection of anatomical risk factors: a retrospective, multicentre study.

BACKGROUND: Pre-procedural computed tomography (CT) imaging assessment of the aortic valvular complex (AVC) is essential for the success of transcatheter aortic valve replacement (TAVR). However, pre-TAVR assessment is a time-intensive process, and the visual assessment of anatomical structures at the AVC shows interobserver variability. This study aimed to develop and validate a deep learning-based algorithm for pre-TAVR CT assessment and anatomical risk factor detection. METHODS: This retrospective, multicentre study used AVC CT scans to develop a deep learning-based, fully automated algorithm, which was then internally and externally validated. After loading CT scans into the algorithm, it automatically assessed the essential anatomical structure data required for TAVR planning. CT scans of 1252 TAVR candidates continuously enrolled from Fuwai Hospital were used to establish training and internal validation datasets, while CT scans of 100 patients with aortic valve disease across 19 Chinese hospitals served as an external validation dataset. The validation focused on segmentation performance, localisation and measurement accuracy of key anatomical structures, detection ability of specific anatomical risk factors, and improvement in assessment efficiency. FINDINGS: Relative to senior observers, our algorithm achieved significant consistent performance with remarkable accuracy, efficiency and ease in segmentation, localisation, and the assessment of the aortic annulus perimeter-derived diameter, and other basic planes, coronary ostia height, calcification volume, and aortic angle. The intraclass correlation coefficient values for the algorithm in the internal and external validation datasets were up to 0.998 (95% confidence interval 0.998-0.998), respectively. Furthermore, the algorithm demonstrated high alignment in detecting specific anatomical risk factors, with accuracy, sensitivity, and specificity up to 0.989 (95% CI 0.973-0.996), 0.979 (95% CI 0.936-0.995), 0.986 (95% CI 0.945-0.998), respectively. INTERPRETATION: Our algorithm efficiently performs pre-TAVR assessments by using AVC CT imaging with accuracy comparable to senior observers, potentially improving TAVR planning in clinical practice. FUNDING: National Key R&D Program of China (2020YFC2008100), CAMS Innovation Fund for Medical Sciences (2022-I2M-C&T-B-044).

Factors associated with eating rate: a systematic review and narrative synthesis informed by socio-ecological model.

Accumulating evidence shows associations between rapid eating and overweight. Modifying eating rate might be a potential weight management strategy without imposing additional dietary restrictions. A comprehensive understanding of factors associated with eating speed will help with designing effective interventions. The aim of this review was to synthesise the current state of knowledge on the factors associated with eating rate. The socio-ecological model (SEM) was utilised to scaffold the identified factors. A comprehensive literature search of eleven databases was conducted to identify factors associated with eating rate. The 104 studies that met the inclusion criteria were heterogeneous in design and methods of eating rate measurement. We identified thirty-nine factors that were independently linked to eating speed and mapped them onto the individual, social and environmental levels of the SEM. The majority of the reported factors pertained to the individual characteristics (n = 20) including demographics, cognitive/psychological factors and habitual food oral processing behaviours. Social factors (n = 11) included eating companions, social and cultural norms, and family structure. Environmental factors (n = 8) included food texture and presentation, methods of consumption or background sounds. Measures of body weight, food form and characteristics, food oral processing behaviours and gender, age and ethnicity were the most researched and consistent factors associated with eating rate. A number of other novel and underresearched factors emerged, but these require replication and further research. We highlight directions for further research in this space and potential evidence-based candidates for interventions targeting eating rate.

Study on the equity of urban green space: Origin, progress, and enlightenment.

Urban green space equity focuses on whether different social groups can equally share the well-being from green space, which is an important issue in the realm of environmental justice. We systematically introduced the origin and development of green space equity, explored its multidimensional progress in conceptual connotation, measurement methodology, phenomenon, mechanism, and regulation, and proposed the enlightenment for deepening the related studies. The green space equity originated from environmental social movement and environmental justice studies, and experienced multilevel evolution in topic constriction and theoretical interpretation. Although the connotation of green space equity was interpreted from various perspectives, its core idea was distributional equality. There was a frequently-used framework for measurement methodology of green space equity, whose spatial scale issue was critical. Due to the differences of characteristics, developmental stages, and institutional backgrounds between Chinese and Western cities, the phenomena and driving mechanisms of green space equity were different. The regulation strategies of green space equity could be summarized into three types, including green distributional equitable strategy, social recognitional justice strategy, and procedural justice orientated strategy. Future studies should deepen the research from the hierarchical logics for practice management, the fine-scale measurement methodology, the interpretation of mechanism for green space inequity in Chinese context, and simulation of differentiated regulation strategies. Social development endows green space equity with more practical tasks and theoretical logics, which is urgent to clarify the research progress to support the future research.

Comprehensive assessment of pretreatment sarcopenia impacts on patients with EGFR-mutated NSCLC treated with afatinib.

BACKGROUND: This study aimed to comprehensively evaluate the efficacy and toxicity of afatinib in patients with sarcopenia, an important prognostic factor for treatment efficacy and toxicity in patients with cancer. METHODS: The clinical features of patients with advanced NSCLC treated with frontline afatinib between 2014 and 2018 at a medical center in Taiwan were retrospectively reviewed. Sarcopenia was evaluated based on the total cross-sectional area of skeletal muscles assessed by computed tomography (CT) imaging at the L3 level. Baseline characteristics, response rates, survival rates, and adverse events (AEs) were compared between sarcopenic and nonsarcopenic patients. RESULTS: A total of 176 patients evaluated for sarcopenia by CT and treated with afatinib were enrolled in the current study. Sarcopenia was significantly associated with good performance status, low body mass index (BMI), low body surface area (BSA), and low total mass area (TMA). Sarcopenia did not influence the response rate (69.2% vs. 72.0%, p = 0.299), progression-free survival (median 15.9 vs. 14.9 months, p = 0.791), or overall survival (median 26.5 vs. 27.2 months, p = 0.441). However, BSA ≤ 1.7 and the 40 mg afatinib dose were associated with dose reduction. TMA was the only independent factor for afatinib discontinuation due to AEs. CONCLUSION: Sarcopenia was not associated with treatment efficacy or toxicity among patients with NSCLC harboring common mutations treated with afatinib, indicating sarcopenic patients should not be excluded from afatinib treatment. Other factors, such as BSA and TMA, were associated with dose reduction and afatinib discontinuation, respectively, which may require additional evaluations in future studies.

A multidisciplinary study on the social customs of the Tang Empire in the Medieval Ages.

Multidisciplinary research on human remains can provide important information about population dynamics, culture diffusion, as well as social organization and customs in history. In this study, multidisciplinary analyses were undertaken on a joint burial (M56) in the Shuangzhao cemetery of the Tang Dynasty (618-907 AD), one of the most prosperous dynasties in Chinese history, to shed light on the genetic profile and sociocultural aspects of this dynasty. The archaeological investigation suggested that this burial belonged to the Mid-Tang period and was used by common civilians. The osteological analysis identified the sex, age, and health status of the three individuals excavated from M56, who shared a similar diet inferred from the stable isotopic data. Genomic evidence revealed that these co-buried individuals had no genetic kinship but all belonged to the gene pool of the ancient populations in the Central Plains, represented by Yangshao and Longshan individuals, etc. Multiple lines of evidence, including archaeology, historic records, as well as chemical and genetic analyses, have indicated a very probable familial joint burial of husband and wives. Our study provides insights into the burial customs and social organization of the Tang Dynasty and reconstructs a scenario of civilian life in historic China.

Evolutionary dynamics in financial markets with heterogeneities in investment strategies and reference points.

In nature and human societies, the effects of homogeneous and heterogeneous characteristics on the evolution of collective behaviors are quite different from each other. By incorporating pair pattern strategies and reference point strategies into an agent-based model, we have investigated the effects of homogeneous and heterogeneous investment strategies and reference points on price movement. In the market flooded with the investors with homogeneous investment strategies or homogeneous reference points, large price fluctuations occur. In the market flooded with the investors with heterogeneous investment strategies or heterogeneous reference points, moderate price fluctuations occur. The coexistence of different kinds of investment strategies can not only refrain from the occurrence of large price fluctuations but also the occurrence of no-trading states. The present model reveals that the coexistence of heterogeneous populations, whether they are the individuals with heterogeneous investment strategies or heterogeneous reference points of stock prices, is an important factor for the stability of the stock market.

Experimental assessment of robust reference genes for qRT-PCR in lung cancer studies.

Stable internal reference genes are crucial for quantitative real-time PCR (qRT-PCR) analyses in lung cancer studies. Widely used reference genes are mostly chosen by intuition or from pan-cancer transcriptome data and lack experimental validation by qRT-PCR in the context of lung cancer. This study evaluated the stability of candidate reference genes in lung cancer cell lines under normal homeostasis, hypoxia, and serum deprivation to screen for robust reference genes for qRT-PCR in lung cancer studies. The stability of reference gene combinations was also assessed. We found that most of the stably expressed genes from pan-cancer transcriptome analyses were not sufficiently stable under some of the tested conditions. CIAO1, CNOT4, and SNW1 were found to be the most stable reference genes under various conditions. Greater stability was achieved by combining more reference genes. We further used the hypoxia biomarker hypoxia-inducible factor (HIF)-2α to demonstrate that choosing inappropriate reference genes can lead to incorrect qRT-PCR results. We also found that the stable reference genes were irrelevant to malignancy, which may explain their stability under various conditions that cancer cells often encounter. This study provides a list of validated and stable qRT-PCR reference genes and reference gene combinations for lung cancer that may standardize qRT-PCR experiments in future lung cancer studies.

Using the H2O Automatic Machine Learning Algorithms to Identify Predictors of Web-Based Medical Record Nonuse Among Patients in a Data-Rich Environment: Mixed Methods Study.

BACKGROUND: With the advent of electronic storage of medical records and the internet, patients can access web-based medical records. This has facilitated doctor-patient communication and built trust between them. However, many patients avoid using web-based medical records despite their greater availability and readability. OBJECTIVE: On the basis of demographic and individual behavioral characteristics, this study explores the predictors of web-based medical record nonuse among patients. METHODS: Data were collected from the National Cancer Institute 2019 to 2020 Health Information National Trends Survey. First, based on the data-rich environment, the chi-square test (categorical variables) and 2-tailed t tests (continuous variables) were performed on the response variables and the variables in the questionnaire. According to the test results, the variables were initially screened, and those that passed the test were selected for subsequent analysis. Second, participants were excluded from the study if any of the initially screened variables were missing. Third, the data obtained were modeled using 5 machine learning algorithms, namely, logistic regression, automatic generalized linear model, automatic random forest, automatic deep neural network, and automatic gradient boosting machine, to identify and investigate factors affecting web-based medical record nonuse. The aforementioned automatic machine learning algorithms were based on the R interface (R Foundation for Statistical Computing) of the H2O (H2O.ai) scalable machine learning platform. Finally, 5-fold cross-validation was adopted for 80% of the data set, which was used as the training data to determine hyperparameters of 5 algorithms, and 20% of the data set was used as the test data for model comparison. RESULTS: Among the 9072 respondents, 5409 (59.62%) had no experience using web-based medical records. Using the 5 algorithms, 29 variables were identified as crucial predictors of nonuse of web-based medical records. These 29 variables comprised 6 (21%) sociodemographic variables (age, BMI, race, marital status, education, and income) and 23 (79%) variables related to individual lifestyles and behavioral habits (such as electronic and internet use, individuals' health status and their level of health concern, etc). H2O's automatic machine learning methods have a high model accuracy. On the basis of the performance of the validation data set, the optimal model was the automatic random forest with the highest area under the curve in the validation set (88.52%) and the test set (82.87%). CONCLUSIONS: When monitoring web-based medical record use trends, research should focus on social factors such as age, education, BMI, and marital status, as well as personal lifestyle and behavioral habits, including smoking, use of electronic devices and the internet, patients' personal health status, and their level of health concern. The use of electronic medical records can be targeted to specific patient groups, allowing more people to benefit from their usefulness.

Innovative approach to medical leadership and management development: clinician secondment to a management consulting firm.

BACKGROUND AND AIM: Opportunities to participate in leadership and management with protected time can be limited for clinical trainees. The aim of this fellowship was to gain experience of gold standard healthcare management by becoming part of multidisciplinary teams working to deliver transformational change in the National Health Service (NHS). METHODS: A 6-month pilot fellowship, structured as an Out of Programme Experience was created for two registrars to be seconded to the healthcare division of Deloitte, a leading professional services firm. Competitive selection was jointly administered by the Director of Medical Education at St Bartholomew's Hospital and Deloitte. RESULTS: The successful candidates worked on service-led and digital transformation projects, interfacing with senior NHS executives and directors. Trainees gained direct experience and understanding of high-level decision making in the NHS, tackling complex service delivery problems and the practical realities of delivering change within a constrained budget. One impact of this pilot has been completion of a business case to scale up the fellowship into an established programme that can allow other trainees to apply. CONCLUSION: This innovative fellowship has allowed interested trainees an opportunity to broaden the relevant skills and experience in leadership and management required in specialty training curriculum with real-life application in the NHS.