Modification and comparison of CT criteria in the preoperative assessment of hepatic arterial invasion by hilar cholangiocarcinoma.

OBJECTIVE: To compare the diagnostic performance of three CT criteria and two signs in evaluating hepatic arterial invasion by hilar cholangiocarcinoma. METHODS: In this study, we retrospectively reviewed the CT images of 85 patients with hilar cholangiocarcinoma. Modified Loyer's, Lu's, and Li's standards were used to evaluate hepatic arterial invasion by hilar cholangiocarcinoma with the reference of intraoperative findings and/or the postoperative pathological diagnosis. Arterial tortuosity and contact length were also evaluated. RESULTS: Loyer's, Lu's, and Li's standards showed sensitivities of 91.7%, 90.3%, and 72.2%, specificities of 94.0%, 94.5%, and 95.6%, and accuracies of 93.3%, 93.3%, and 89.0%, respectively, in evaluating hepatic arterial invasion by hilar cholangiocarcinoma. Loyer's and Lu's standards and contact length performed better than Li's standard (P < 0.001). Arterial tortuosity performed worse than other criteria (P < 0.001). The CT criteria performed best in evaluating proper hepatic arterial invasion compared with the left and right hepatic artery. When the cut-off contact length of 6.73 mm was combined with Loyer's standard, 4 false-negative cases could be avoided. CONCLUSIONS: Loyer's and Lu's standards and the contact length performed best in evaluating hepatic arterial invasion by hilar cholangiocarcinoma on preoperative CT images, particularly in assessing the proper hepatic artery. Arterial tortuosity could serve as an important supplement. The combination of the contact length and Loyer's standard could improve the diagnostic performance.

Can greater reliance on test scores ameliorate the association between family background and access to post-collegiate education? Survey evidence from the Beijing College Students Panel survey.

We evaluate whether greater reliance on test scores may reduce the extent of educational inequality by family origin as college graduates seek entrance to graduate school. In this article, we present a case study using survey data of colleges in Beijing, China, where students' performance in standardized graduate school entrance examination (the GSEE) is the primary determinant for the entrance to graduate school. Using multiple waves of the Beijing College Students Panel Survey (BCSPS), we fit a series of models to capture the correlations of family socio-economic status (SES) with the probabilities of seeking entrance to post-collegiate education, registering for and taking the GSEE, and finally obtaining admission to graduate school. After balancing the differential probabilities of seeking graduate level education, we find that family SES is not significantly associated with the likelihood of taking the GSEE, but significantly predicts the probability of applying a foreign graduate program. Although family SES can be marginally correlated with the odds of being admitted by a domestic graduate program, the strength of such an association is significantly weaker than for overseas programs. It is also shown that, for the elite graduate programs, family origin is independent from both GSEE registration and subsequent admission. These findings suggest that the test-oriented evaluations could ameliorate the extent of inequality at the post-collegiate level.

Relative deprivation in context: How contextual status homogeneity shapes the relationship between disadvantaged social status and health.

We examine the relationship between disadvantaged social status and adverse health outcomes within a context-contingent thesis of relative deprivation. We argue that the health effect of low relative status depends on contextual status homogeneity, which is measured as income inequality and group diversity. Applying mixed-effect modeling to the pooled 2011-2013 Chinese General Social Survey and exploring the cross-level interactions, we found that 1) people in the bottom socioeconomic quartile report significantly better health when contextual income inequality is lower; 2) racial-ethnic minorities report significantly better health when contextual ethnic diversity is higher; and 3) religious minorities also report significantly better health when contextual religious diversity is higher. Ethnic minorities and Muslims even report better health than the majorities in highly diverse contexts. Thus, contextual status homogeneity can modify or even eliminate the health disparities caused by relative deprivation. The context-level moderation of relative deprivation may be explained by the processes of social comparison, institutional resources, and social capital formation. Our findings suggest that health disparities are an interactive product of contextual homogeneity and individual's relative deprivation, and underscore the importance of the nature of the social environment where relative deprivation occurs. In this way, we contribute to knowledge about reducing health disparities along the social gradient.

Is college education an equalizer for social disparities in health literacy? A case study in Shanghai, China.

OBJECTIVES: The aim of the study was to illustrate the immediate effect of the college education process (across college grades) on the strength of association between parental education and college attendees' health literacy. METHODS: Cross-sectional analysis was conducted based on data from a random sample of students in one university in Shanghai, China (N = 574). Exploratory factor analysis was used to generate factors of different dimensions of health literacy. Ordinary least square regression models were estimated to investigate how college education process alters the family-based disparity in health literacy. RESULTS: The link between parental education and health-related skills did not vary significantly across grades of participants, but participants in their third (p < 0.05) and fourth year (p < 0.001) revealed a significantly weaker association between health-promoting proactivity and parental education, relative to the first-year counterparts. Also, the impact of parental education on health-related attitudes significantly declined among the fourth-year seniors, compared with first-year students (p < 0.05). CONCLUSIONS: Higher education experience is an important mechanism to alleviate the socioeconomic gap in health literacy. Such an equalizer effect, nevertheless, is contingent on the particular dimensions of health literacy.

Science or liberal arts? Cultural capital and college major choice in China.

Previous studies on major East Asian societies such as Japan and Korea generally fail to find a strong effect of cultural capital in educational inequality, partly due to the characteristic extreme focus on standardized test and curriculum. This study shifts attention to the horizontal stratification of education by investigating the association between family background, cultural capital, and college major choice in contemporary China. Based on analysis of data from the Beijing College Students Panel Survey (BCSPS), we found that, on average, cultural capital significantly mediates the relationship between family background and college major preference. Those with greater endowment of cultural capital are more likely to come from socio-economically advantaged families, and, at the same time, demonstrate a stronger propensity to major in liberal arts fields rather than science, technology, engineering and mathematics (STEM) fields. Further analyses reveal that the association between cultural capital and academic field choice comes into being by way of performance in the Chinese test in the national college entrance examination and of the non-cognitive dispositions, such as self-efficacy and self-esteem. Our findings better our understanding of formation of the horizontal stratification of higher education.

Which Child Is Parents' Preferred Caregiver/Listener in China?

Adult children are an important source of care providers for parents in a rapidly aging Chinese society, but we know little of which particular child is preferred by parents in time of need. Using the China Longitudinal Aging Social Survey, we investigate the factors associated with parental preference of caregivers and listeners among all his or her children. With children nested within each parent, we fit the conditional (family) fixed-effect fractional logit model. The main results for both caregivers and listeners suggest a preference for the unmarried, the oldest or the youngest, and children who have provided them with support before. Coresident children are favored in rural but not urban China. We did not find preference for sons over daughters. Neither did we find any effect of prior transfers from parents to children. Our findings shed light on the changing norms of eldercare provision in a transitioning society.

Improved image quality of low-dose CT combining with iterative model reconstruction algorithm for response assessment in patients after treatment of malignant tumor.

BACKGROUND: To evaluate the image quality and radiation dose of low-dose (LD) computed tomography (LD-CT) combining with iterative model reconstruction (IMR) algorithm for response assessment in patients after treatment of malignant tumor compared with routine-dose CT (RD-CT). METHODS: Forty-seven patients [mean age 57.8±10.9 years, 30 males, body mass index (BMI) 22.09±2.35 kg/m2] after treatment of malignant tumor underwent contrast-enhanced chest and abdomen CT twice for response assessment with an interval of 6 months according to clinical routine. The first CT scans were performed with RD protocol at 120 kVp and images were reconstructed with filtered back projection (FBP) algorithm; while the second scans were performed with LD protocol at 100 kVp and images were reconstructed with FBP and IMR algorithm respectively. All scans were performed using an automatic tube current modulation technique with 150 mAs as reference. Objective image quality including CT attenuation, image noise, and contrast to noise ratio (CNR), and subjective image quality including artifacts, noise, visualization of small structures and confidence of targeted lesions, as well as lesion detection were assessed and compared. RESULTS: Effective radiation dose of LD-CT scans was reduced 54.8% compared to RD-CT scans (26.89±3.35 vs. 12.14±2.09 mSv). Higher CT attenuation was found in both LD-IMR and LD-FBP images compared to RD-FBP images. Better subjective image quality and CNR as well as lower objective noise were found in LD-IMR images (all, P<0.05). Two small lesions with the diameter less than 1 cm were missed in LD-FBP images, which were able to be observed in LD-IMR images. CONCLUSIONS: IMR is able to help more than half of reduction of radiation dose without compromising the quality of diagnostic information in patients after treatment of malignant tumors to chest and abdomen CT for response assessment.

Changes in college attainment and the economic returns to a college degree in urban China, 2003-2010: implications for social equality.

Expansion of higher education is expected to reduce social inequality under the conditions that (1) higher education should become increasingly egalitarian; (2) educational attainment should be the main determinant of class destinations; and (3) individuals from different social backgrounds should benefit from higher education homogeneously. Using representative data collected in mainland China from 2003 to 2010, we find (1) social background factors, especially parents' education, are significantly associated with the opportunity of completing college across periods; (2) the economic returns to a college degree have been longitudinally increasing; and (3) for both 2003 and 2010, people from different social origins benefit from higher education attainment in a homogeneous way. An overall assessment of the findings suggests that changes in college attainment and the returns to higher education in urban China are not in favor of the promotion of general social equality, but maintain the existing extent of inequality.

Public sector employment, relative deprivation and happiness in adult urban Chinese employees.

The decline in perceived happiness within economic prosperity in Chinese society calls for further examination. In this research, we investigate the effect of employment in public sector work units on perceived happiness through the mediation of economic and social status relative deprivations. In the reform era of China, work unit is still an important mechanism maintaining social inequality, and those working in government/Communist Party agencies and public institutions have advantages of getting access to high wage, comprehensive welfare and the manipulation of administrative public power. Such economic and social status advantages are expected to reduce their relative deprivation and further promote their perceived happiness. Using a nationwide survey data conducted in 2006, we find working in public sector can significantly reduce the odds of experiencing economic relative deprivation, which is further contributive to the improvement of subjective wellbeing.