Turning inward in difficulties: R&D human resource slack, technological diversification, and independent innovation.

Independent innovation emphasizes the self-reliance and control of all key links. Slack resources within an organization, especially for innovation, are the critical resources that are controllable for independent innovation. However, existing research still lacks evidence on the areas of slack innovation resources and independent innovation for deeper exploration. This research addresses this gap by providing an empirical analysis of the relationship between R&D human resource slack and firms' independent innovation. Based on the unbalanced panel data of China's listed manufacturing firms for eleven years, this research explores the effects of R&D human resource slack on firms' independent innovation, the mediating mechanism of technological diversification, and the boundary effects of top management team functional heterogeneity. The results reveal that R&D human resource slack positively affects firms' independent innovation; R&D human resource slack can promote firms' independent innovation through related technological diversification, while the mediating effect of unrelated technological diversification is not statistically significant; the top management team functional heterogeneity strengthens the positive impact of R&D human resource slack on firm independent innovation.

Cost-Effectiveness of Salt Substitute and Salt Supply Restriction in Eldercare Facilities: The DECIDE-Salt Cluster Randomized Clinical Trial.

Importance: Salt substitution has been reported to be a cost-saving sodium reduction strategy that has not yet been replicated in different contexts. Objective: To estimate the cost-effectiveness of sodium reduction strategies within the DECIDE-Salt trial. Design, Setting, and Participants: The DECIDE-Salt trial cluster randomized in a 1:1:1:1 ratio 48 eldercare facilities in China into 4 groups for evaluation of 2 sodium reduction strategies for 2 years: 1 with both strategies, 2 with either strategy, and 1 with neither strategy. The trial was conducted from September 25, 2017, through October 24, 2020. Interventions: The 2 intervention strategies were replacing regular salt with salt substitute and progressively restricting salt supply to kitchens. Main Outcomes and Measures: The main outcomes included per-participant costs of intervention implementation and medical treatments for hypertension and major adverse cardiovascular events (MACEs) against mean reductions in systolic blood pressure, hypertension prevalence, MACE incidence, and mortality. The incremental cost-utility ratio was then assessed as the additional mean cost per quality-adjusted life-year gained. Analyses were conducted separately for each strategy, comparing groups assigned and not assigned the test strategy. Disease outcomes followed the intention-to-treat principle and adopted different models as appropriate. One-way and probabilistic sensitivity analyses were conducted to explore uncertainty, and data analyses were performed between August 13, 2022, and April 5, 2023. Results: A total of 1612 participants (1230 males [76.3%]) with a mean (SD) age of 71.0 (9.5) years were enrolled. Replacing regular salt with salt substitute reduced mean systolic blood pressure by 7.14 (95% CI, 3.79-10.48) mm Hg, hypertension prevalence by 5.09 (95% CI, 0.37-9.80) percentage points, and cumulative MACEs by 2.27 (95% CI, 0.09-4.45) percentage points. At the end of the 2-year intervention, the mean cost was $25.95 less for the salt substitute group than the regular salt group due to substantial savings in health care costs for MACEs (mean [SD], $72.88 [$9.11] vs $111.18 [$13.90], respectively). Sensitivity analysis showed robust cost savings. By contrast, the salt restriction strategy did not show significant results. If the salt substitution strategy were rolled out to all eldercare facilities in China, 48 101 MACEs and 107 857 hypertension cases were estimated to be averted and $54 982 278 saved in the first 2 years. Conclusions and Relevance: The findings of this cluster randomized clinical trial indicate that salt substitution may be a cost-saving strategy for hypertension control and cardiovascular disease prevention for residents of eldercare facilities in China. The substantial health benefit savings in preventing MACEs and moderate operating costs offer strong evidence to support the Chinese government and other countries in planning or implementing sodium intake reduction and salt substitute campaigns. Trial Registration: ClinicalTrials.gov Identifier: NCT03290716.

Cost-effectiveness analysis of first-line serplulimab combined with chemotherapy for extensive-stage small cell lung cancer.

Background: For patients with extensive-stage small cell lung cancer (ES-SCLC), serplulimab plus chemotherapy is beneficial as the first-line treatment. It is uncertain whether serplulimab plus chemotherapy will be more cost-effective. The aim of this study was to evaluate from the perspective of the Chinese healthcare system to assess the cost-effectiveness of serplulimab plus chemotherapy for patients with ES-SCLC. Materials and methods: This study employed a partitioned survival model. Patients in the model were selected from ASTRUM-005 for their clinical characteristics and outcomes. In order to assess the robustness of the model, we conducted deterministic one-way sensitivity analyzes as well as probabilistic sensitivity analyzes. Subgroup analyzes were also conducted. Costs, quality-adjusted life-years (QALYs), life-years, incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB) were analyzed. Results: Based on the base-case analysis, serplulimab plus chemotherapy contributed to an increase in 0.826 life-years and 0.436 QALYs; an incremental cost of $52,331, yielded ICER of $120,149/QALY. Based on the willingness to pay (WTP) threshold of $37,669/QALY and $86,569/QALY, the INHB was -0.954 QALYs and - 0.169 QALYs and the INMB was -$35,924 and -$14,626, respectively. Based on the probabilistic sensitivity analysis results, serplulimab plus chemotherapy was unlikely to be cost-effective at a WTP threshold of $37,669/QALY and $86,569/QALY. One-way sensitivity analysis indicated that cost of serplulimab and body weight had the greatest impact on the model. Serplulimab plus chemotherapy could be cost-effective at a WTP threshold of $86,569/QALY when the cost of serplulimab was less than $5.24/mg or when the weight of the patient was less than 40.96 kg. Regardless of the WTP threshold at $37,669/QALY or $86,569. Serplulimab plus chemotherapy was not cost-effective in all subgroups. Conclusion: Serplulimab plus chemotherapy was not cost-effective, despite having a prior clinical benefical and a relative safety profile compared with chemotherapy. With the reduction in the price of serplulimab, ES-SCLC patients treated with serplulimab plus chemotherapy may be able to achieve a favorable cost-effectiveness rate.

Cost-effectiveness of camrelizumab plus chemotherapy in advanced squamous non-small-cell lung cancer.

Objectives: A cost-effectiveness study of camrelizumab plus chemotherapy for advanced squamous non-small-cell lung cancer in China was conducted versus chemotherapy alone. Methods: Survival data were derived from CameL-Sq. Cost-effectiveness is indicated by an incremental cost-effectiveness ratio (ICER) less than the willingness-to-pay threshold. The partitioned survival model stability was assessed by sensitivity analyses. Results: With camrelizumab plus chemotherapy, quality-adjusted life years increased by 0.83, and cost increased by $21,259/patient versus chemotherapy. The ICER was $25,674/quality-adjusted life year. The probability of cost-effectiveness was >90% regardless of PD-L1 expression level. Regardless of the variation in each parameter across a wide range, the ICER never transcended the willingness to pay. Conclusion: Camrelizumab plus chemotherapy is a cost-effective first-line treatment for advanced squamous non-small cell lung cancer in China.

Camrelizumab is a drug, and this drug can be used for advanced squamous non-small-cell lung cancer. Our study showed that patients with non-small-cell lung cancer treated with camrelizumab plus chemotherapy are related to an acceptable price and better clinical outcomes compared with chemotherapy in China. Benefit groups include patients under 65 years of age or over 65, male patients, patients who were current or former smokers and those with or without liver or brain metastases.

Cost-effectiveness of cemiplimab plus chemotherapy versus chemotherapy for the treatment of advanced non-small cell lung cancer.

Background: In patients with advanced non-small cell lung cancer (aNSCLC), cemiplimab plus chemotherapy prolonged overall survival (OS) and progression-free survival (PFS) significantly compared to chemotherapy alone. The cost-effectiveness of these drugs is still uncertain. The aim of this study is to assess the cost-effectiveness of cemiplimab plus chemotherapy compared with chemotherapy for the treatment of aNSCLC from the third-party payer perspective in the United States. Materials and methods: The cost-effectiveness of cemiplimab with chemotherapy versus chemotherapy for the treatment of aNSCLC was evaluated using a partitioned survival model containing three mutually incompatible health states. The clinical characteristics and outcomes used in the model were gathered from EMPOWER-Lung 3 trial. We have conducted deterministic one-way sensitivity analysis and probabilistic sensitivity analysis in order to evaluate the robustness of the model. The primary outcomes considered were the costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB). Results: Treatment of aNSCLC with cemiplimab plus chemotherapy increased efficacy by 0.237 QALYs and was associated with an increased total cost of $50,796 compared to chemotherapy alone, resulting in an ICER of $214,256/QALY gained. At a WTP threshold of $150,000/QALY, the INHB of cemiplimab plus chemotherapy was 0.203 QALYs and the INMB was $304,704 compared to chemotherapy alone. The probabilistic sensitivity analysis revealed that there was only a 0.04% chance that cemiplimab with chemotherapy would be cost-effective at a WTP threshold of $150,000/QALY. The performance of model was mainly determined by the price of cemiplimab, according to a one-way sensitivity analysis. Conclusions: From the third-party payer perspective, cemiplimab combined chemotherapy is unlikely to be a cost-effective option for the treatment of aNSCLC at the WTP threshold of $150,000/QALY in the United States.

Sugemalimab plus chemotherapy vs. chemotherapy for metastatic non-small-cell lung cancer: A cost-effectiveness analysis.

Background: Sugemalimab is a newly developed inhibitor of programmed death ligand 1 (PD-L1). As a first-line treatment for metastatic non-small-cell lung cancer (NSCLC), sugemalimab plus chemotherapy (Sugema-Chemo) has been proven effective. Still, its cost-effectiveness has not yet been determined. The objective of this study was to assess the cost-effectiveness of Sugema-Chemo from a health care perspective in China. Methods: A partitioned survival model was used. According to the GEMSTONE-302 trial, the clinical characteristics and outcomes of the patients were obtained. The outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB) and incremental net monetary benefits (INMB). The robustness of the model was further evaluated, as well as subgroup analyses. When the ICER was lower than the willingness to pay (WTP) threshold ($38,017/QALY or $86,376/QALY, defined as three times the per capita gross domestic product value of the general region and Beijing), the cost-effectiveness of Sugema-Chemo was assumed for general regions or Beijing. Results: Compared with chemotherapy alone, Sugema-Chemo resulted in an incremental gain of 0.82 QALYs, an incremental gain of 1.26 life-years, as well as an average increase cost of $72,472. The ICER was $88,744/QALY. Model outcomes were susceptible to average body weight and cost of sugemalimab. Sugema-Chemo was cost-effective at a WTP threshold of 86,376/QALY if the average body weight was <62.44 kg or if the price of sugemalimab was <$2.996/mg. As well, Sugema-Chemo was also cost-effective when the cost of sugemalimab was <$1.839/mg for a WTP threshold of $38,017/QALY. Sugema-Chemo had a probability of > 50% being considered cost-effective in most subgroups at the $86,376/QALY threshold. However, Sugema-Chemo did not achieve cost-effectiveness (0%) in any of the subgroups when WTP was set at $38,017/QALY. Conclusion: Sugema-Chemo might not be cost-effective in patients with metastatic NSCLC in China. In deciding between Sugema-Chemo and chemotherapy alone, it is essential to consider both the body weight of patients and the price of sugemalimab. A price reduction of sugemalimab under the National Healthcare Security Administration may be an effective measure to improve the cost-effectiveness of the drug.

Tislelizumab plus chemotherapy is more cost-effective than chemotherapy alone as first-line therapy for advanced non-squamous non-small cell lung cancer.

Background and objective: Tislelizumab is a programmed cell death protein-1 (PD-1) inhibitor. Tislelizumab plus chemotherapy as first-line option for advanced non-squamous non-small cell lung cancer (NSCLC), compared with chemotherapy alone, resulted in significantly prolonged survival outcomes; however, evidence regarding its relative efficacy and cost is lacking. We aimed to evaluate the cost-effectiveness of tislelizumab plus chemotherapy compared with that of chemotherapy alone, from the health care perspective in China. Methods: A partitioned survival model (PSM) was used for this study. The survival data were obtained from the RATIONALE 304 trial. Cost-effectiveness was defined as incremental cost-effectiveness ratio (ICER) less than the willingness to pay (WTP) threshold. Incremental net health benefits (INHB), incremental net monetary benefits (INMB), and subgroup analyses were also assessed. Sensitivity analyses were further established to assess the model stability. Results: Compared with chemotherapy alone, tislelizumab plus chemotherapy increased by 0.64 quality-adjusted life-years (QALYs) and 1.48 life-years, and yielded an increase of $16,631 in cost per patient. The INMB and INHB were $7,510 and 0.20 QALYs at a WTP threshold of $38,017/QALY, respectively. The ICER was $26,162/QALY. The outcomes were most sensitive to the HR of OS for tislelizumab plus chemotherapy arm. The probability of tislelizumab plus chemotherapy being considered cost-effective was 87.66% and >50% in most of the subgroups at the WTP threshold of $38,017/QALY. At the WTP threshold of $86,376/QALY, the probability achieved 99.81%. Furthermore, the probability of tislelizumab plus chemotherapy being considered cost-effective in subgroups of patients with liver metastases and PD-L1 expression ≥50% were 90.61 and 94.35%, respectively. Conclusion: Tislelizumab plus chemotherapy is likely to be cost-effective as a first-line treatment for advanced non-squamous NSCLC in China.

Cognitive cost of empathizing with mothers and strangers by Chinese college students.

Background: Empathy is a choice and the product of a dynamic decision process based on motivation. The value trade-off in empathy is object-specific and people are more likely to empathize with ingroup, especially empathize with whom we are particularly concerned. The mother is an integral part of the self-concept, but the status of the mother in the self-concept of the eastern and western subjects was different. Previous studies have shown that mother is integrated in self-concept and share the same motivational hierarchy with self in Chinese brain. Objectives: The study's purpose is to investigate the empathic choice for mothers in Chinese culture and its regulatory mechanism. Methods: Three experiments were conducted to investigate whether Chinese college students would choose to empathize with their mothers. Experiment 1 used the Empathy Selection Task to examine the empathic choices between mother-other and stranger-other conditions with two blocks of 50 trials, and used the NASA Task Load Index to evaluate the cognitive costs for each deck option presented; Experiment 2 induced a disagreeable emotional state and replicate the same conditions of the experiment 1; Experiment 3 induced an agreeable emotional state and replicate the same conditions of the experiment one. Results and conclusions: The results showed that: (1) participants tended to avoid empathizing with their mothers and strangers for to the cognitive cost; (2) participants were more likely to choose empathy when the target was their mother rather than when the target was a stranger-other, due to the social reward; and (3) participants were more likely to opt to empathize with their mothers when positive emotions towards their mothers were primed. The results suggested that empathy is a choice and the product of a dynamic decision process based on motivation and the value trade-off in empathy is object-specific.

Initial dietary risk assessment of chlorinated paraffins in edible fungi in Chinese markets.

Dietary intake is one of the main pathways for residents to become exposed to chlorinated paraffins (CPs). In China, due to the popularization of nutritional and medicinal edible fungi, consumption has increased on a yearly basis. Edible fungi have a variety of active substances and are consumed daily by residents. However, there is limited information on the concentration and source of chlorinated paraffins in edible fungi. In this study, the concentrations of short-chain chlorinated paraffins (SCCPs) and medium-chain chlorinated paraffins (MCCPs) in 105 edible fungi samples and 36 culture material samples were detected. The concentration range of SCCPs was 79.8 ng/g dw to 3879.3 ng/g dw, and the MCCPs was ND to 572.3 ng/g dw. Spearman correlation analysis indicated that the sources of SCCPs and MCCPs in edible fungi were similar (r = 0.57, p < 0.01). The preponderant SCCPs and MCCPs congener group profiles were C10 Cl7-8 and C14 Cl6-8 . CPs were detected in culture materials, the concentration range of SCCPs was 320.2 ng/g dw to 4326 ng/g dw, and the MCCPs was 333.4 ng/g dw to 4517.4 ng/g dw. And the preponderant SCCPs and MCCPs homologues in culture materials were C11-12 Cl6 and C14 Cl6 . The linear discriminant analysis results indicated different contamination models of CPs between edible fungi and culture materials. The mean estimated daily intake values of SCCPs and MCCPs were 308.1 ng/kg bw/d and 94.4 ng/kg bw/d, respectively, indicating no potential health risk posed by CP exposure in edible fungi.

Atezolizumab plus bevacizumab versus nivolumab as first-line treatment for advanced or unresectable hepatocellular carcinoma: A cost-effectiveness analysis.

BACKGROUND: The cost effectiveness of atezolizumab plus bevacizumab (atezo-beva) versus nivolumab treatment for advanced or unresectable hepatocellular carcinoma is still uncertain. In this study, the cost effectiveness of these treatments was assessed in the United States. METHODS: A cost-effectiveness analysis integrating a network meta-analysis framework was performed using data from the IMbrave150 (ClinicalTrials.gov identifier NCT03434379) and CheckMate 459 (ClinicalTrials.gov identifier NCT02576509) trials. In total, 1244 patients were enrolled. A partitioned survival model was used to evaluate cost effectiveness. A deterministic one-way sensitivity analysis and probabilistic sensitivity analyses were further performed to evaluate model robustness. Subgroup analyses were also performed. RESULTS: Compared with the outcomes using nivolumab, the hazard ratio (HR) for overall survival with atezo-beva was 0.68 (95% CI, 0.48-0.98), and the HR for progression-free survival was 0.63 (95% CI, 0.47-0.85). Atezo-beva treatment was associated with an increase of 1.13 life-years and an increase of 0.69 quality-adjusted life-years (QALYs), as well as a $78,280 increase in cost per patient. The incremental cost-effectiveness ratio was $113,892 per QALY. The incremental net health benefit and the incremental net monetary benefit were 0.17 QALYs and $24,770, respectively, at a willingness-to-pay (WTP) threshold of $150,000 per QALY. The model was most sensitive to the HR for progression-free survival. The probability of atezo-beva being considered cost effective was 78%, and it was >50% in most of the subgroups at the WTP threshold of $150,000 per QALY. CONCLUSIONS: At a WTP threshold of $150,000 per QALY and under current drug pricing, atezo-beva is likely considered cost-effective as a first-line treatment for advanced or unresectable hepatocellular carcinoma compared with nivolumab.

Nivolumab Versus Sorafenib as First-Line Therapy for Advanced Hepatocellular Carcinoma: A Cost-Effectiveness Analysis.

Objective: Nivolumab improves overall survival (OS) and is associated with fewer adverse events than sorafenib for the treatment of advanced hepatocellular carcinoma (aHCC). However, the cost-effectiveness of nivolumab compared with sorafenib treatment for aHCC remains unclear. This study evaluated the cost-effectiveness of nivolumab and sorafenib in the treatment of aHCC. Materials and methods: A partitioned survival model that included three mutually exclusive health states was used to evaluate the cost-effectiveness of nivolumab and sorafenib for treating aHCC. The clinical characteristics and outcomes of the patients in the model were obtained from the CheckMate 459. We performed deterministic one-way sensitivity and probabilistic sensitivity analyses to evaluate the robustness of the model. Subgroup analyses were also performed. Costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB) were measured. Results: The base case analysis showed that compared with sorafenib, treatment with nivolumab was associated with an increment of 0.50 (2.45 vs. 1.95) life-years and an increment of 0.32 (1.59 vs. 1.27) QALYs, as well as a $69,762 increase in cost per patient. The ICER was $220,864/QALY. The INHB and INMB were -0.15 QALYs and -$22,362 at a willingness-to-pay (WTP) threshold of $150,000/QALY, respectively. The probabilistic sensitivity analysis demonstrated that the probability of nivolumab being cost-effective was only 10.38% at a WTP threshold of $150,000/QALY. The model was most sensitive to the costs of sorafenib and nivolumab according to the one-way sensitivity analysis. When the price of sorafenib exceeded $0.93/mg or nivolumab was less than $24.23/mg, nivolumab was more cost-effective. The subgroup analysis illustrated that the probability of cost-effectiveness was >50% in the Barcelona Clinic Liver Cancer Stage B subgroups for nivolumab at a WTP threshold of $150,000/QALY. This study also showed that the probability of cost-effectiveness was <50% in most subgroups. Conclusion: Nivolumab was not cost-effective, although it was associated with better clinical benefit and a favorable safety profile for the treatment of aHCC compared with sorafenib from the third-party payer perspective in the United States. If the price of nivolumab is substantially reduced, favorable cost-effectiveness can be achieved among patients with aHCC.

Dietary exposure and risk assessment of chlorinated paraffins in roots and rhizomes of traditional Chinese medicine herbs.

Traditional Chinese medicine (TCM) provides therapeutic and health care effects through dietary intake. Owing to the susceptibility of plants to contaminations, a risk assessment system is urgently needed to ensure the safe use of TCMs. In this study, the contamination levels and risks associated with the dietary intake of short-chain chlorinated paraffins (SCCPs) and medium-chain chlorinated paraffins (MCCPs) were investigated in six kinds of frequently-used TCM herbs. The concentrations varied from 144.4 to 1527.8 ng·g-1 dw for SCCPs and non-detect to 1214.1 ng·g-1 dw for MCCPs, with mean values of 551.5 and 259.8 ng·g-1 dw, respectively. A geographic distribution analysis indicated that the concentrations of CPs in TCMs were mainly associated with their levels of contamination in the ambient environment. Carbon atom-chlorine congener profiles of CPs were dominated by C10Cl7-8 and C14Cl7-8 congeners, accounting for 20.1% and 32.4% of the total SCCP and MCCP concentrations, respectively. Principal component analysis indicated that the TCM species might be the main factor influencing the accumulation of SCCPs congeners. Finally, a risk assessment reveals that the estimated daily intake and margin of exposure were far below levels that might pose a health risk, indicating an acceptable dietary intake of SCCPs and MCCPs in the studied TCMs. This is the first report of CPs in the TCM herbs and the obtained results are expected to aid in future evaluation of the quality of TCMs and ensuring diet and drug safety.

Social participation and quality of life among patients with neuromyelitis optica spectrum disorders: The mediating effects of depression.

BACKGROUND: Depression is one of the most common and important symptoms of patients with neuromyelitis optica spectrum disorders. Depression is an important aspect of mental health which would be expected to affect a person's social participation. Studies have shown that depression and social participation are independent predictors of health-related quality of life. Depression especially affects its mental component and social participation especially affects its physical aspects. This study was designed to explore to what extent depression may regulate the relationship between social participation and quality of life. METHODS: A convenience sample of 138 discharged patients with neuromyelitis optica spectrum disorders were surveyed. They were asked about their demographic characteristics and disease-related information. Their ability in the activities of daily living was quantified using the Barthel Index. The 36-item short-form health survey, the Beck Depression Inventory and the Impact on Participation and Autonomy questionnaire were also administered. Univariate analysis and Pearson correlations were used to test for any significant relationships between the variables and quality of life. The mediating effect of depression on the association between social participation and life quality was examined using structural equation modeling. RESULTS: The structural equation models provided an excellent fit for the data. Social participation and the physical aspects of life quality were found to be strongly associated. And depression was of course strongly related to the mental aspects. Depression was not a mediator in the significant relationship between social participation and the physical aspects of life quality, but depression was found to be a strong and significant meditator in the association between social participation and the mental aspects of life quality. CONCLUSION: These findings help to clarify the direct and indirect effects of depression and social participation on the life quality of patients with neuromyelitis optica spectrum disorders. While helping and encouraging patients to actively participate in social life should be supplemented by monitoring them for signs of depression and providing appropriate treatment.

Analysis of dietary exposure and risk assessment of pesticide residues in roots and rhizomes of Chinese herbs.

Medicine food homologous (MFH) plants provide therapeutic and health care effects through diet. Thus, a risk assessment system for hazardous ingredient residues is urgently required to ensure their safe use. In this study, the pesticide contamination of six root and rhizome Chinese herbs, Ginseng Radix et Rhizoma, Panacis Quinquefolii Radix, Pseudostellariae Radix, Salviae Miltiorrhizae Radix et Rhizoma, Codonopsis Radix, and Glehniae Radix, and the risks associated with their intake were investigated. A total of 420 MFH plant samples collected from 22 provinces in China were tested, and 61 pesticides were detected in 413 samples. Multiple pesticide residues were detected in each MFH sample, with contents ranging from 0.0002 to 3.010 mg/kg dry weight. Carbendazim (≥47.14%) and propham (≥40%) were the most frequently detected pesticides. Risk assessment determined by hazard quotients indicated that the risks were acceptable, with no short- or long-term adverse health effects. However, considering the high incidence of residues and the detection of unregistered or even prohibited pesticides, strict supervision of soil quality and pesticide application (particularly cadusafos) in MFH plant cultivation are recommended to aid in monitoring MFH plant quality and ensuring diet and drug safety. PRACTICAL APPLICATION: Ensure the diet and drug safety of Chinese herbs.

A Three-Dimensional Spatial Metaphorical Representation of Generation Implied in Han Kin Terms.

concepts can be represented in the brain by means of metaphors. Generation refers to seniority in the family or clan, implies the implementation of different attitudes required by kinship, and contains profound psychological, emotional, and social factors. Generation as an abstract concept is related to concepts such as power, social status, importance, and time. The conceptual metaphor theory based on the embodied theory proposes that abstract concepts are represented by actual sensorimotor experiences. Generation implied in Han kin terms is often represented by multiple spatial terms. According to conceptual metaphor theory, the current study predicted that generation could be represented by multiple spatial metaphors. We designed six experiments to investigate this issue. The results showed that (1) the up-down and left-right positions in which kinship words were presented affected the processing of the concept of generation; (2) the processing of kinship words also affected up-down and left-right spatial information perception; and (3) the processing of the concept of generation could also automatically activate the front-back spatial operation and induce the embodied simulation of body movement. In sum, the results suggested that generation might be represented by the three-dimensional spatial metaphor of vertical, horizontal, and sagittal axes, which are influenced by the sensorimotor system.

[Dynamic Assessment of PM2.5 Health Damage Value in China from 2015 to 2018].

With the development of industrialization and urbanization in China, there are many environmental problems especially air pollution, which has serious impacts on the sustainable development of economy, ecological environment and public health. Since 2013, a series of environmental protection laws and regulations, and industrial and energy policies have been successively implemented, including Action Plan for Air Pollution Control, and Three-Year Action Plan to Win the Blue Sky Defense War etc. The air quality of the whole country has been improved. In order to evaluate the dynamic changes of environmental health benefits from air pollution control in China, this paper estimates the health effects and health economic losses caused by PM2.5 pollution, and makes a comparative analysis among different regions and cities based on the data of 297 cities at prefecture level and above in China from 2015 to 2018. The results show that, due to sharp decline of ρ(PM2.5), the population exposed to ρ(PM2.5)>35 µg·m-3 decreased year by year, and the proportion of the total population decreased from 80.88% to 62.32%. The total number of all kinds of health endpoints decreased from 33.23 million to 15.91 million, health economic loss decreased from 1579.04 billion yuan to 838.42 billion yuan, the proportion of healthy economic loss in GDP dropped from 2.31% to 0.99%. Among the six regions, the index values of Beijing, Tianjin, Hebei, and surrounding areas, and Chengyu areas have declined year by year. However, Fenwei Plain areas, Yangtze River Delta areas, Pearl River Delta areas, and the middle reaches of the Yangtze River show a complex trend of increasing in some years and decreasing later. However, the situation of Fenwei Plain is still more serious than other areas, and the ρ(PM2.5) is next to Beijing, Tianjin, Hebei and surrounding areas. ρ(PM2.5) of all 11 cities still exceed 35 µg·m-3 in 2018. Compared with 2015, the number of early deaths decreased by 1500, but the total number of all kinds of health endpoints increased by 18900. The health economic loss is 80.711 billion yuan, an increase of 10.714 billion yuan than that in 2015. The proportion of health economic loss in GDP is 3.16%, which is 0.25% lower than that in 2015. The per capita health economic loss is 182.67 yuan higher than that in 2015. In terms of cities, from 2015 to 2018, ρ(PM2.5) in 228 cities decreased with varying degrees. Among which, Dezhou and Baoding dropped the most, only 10 cities saw ρ(PM2.5) rise. 14 cities saw an increase in the number of healthy endpoints, and 11 cities saw an increase in the proportion of healthy economic loss to GDP. Although the index values of Baoding, Xingtai, Handan, and other cities have declined year by year, they still rank top 10 every year. The index value of Xi'an, Xianyang, Linfen, and other cities in 2018 is more than that in 2015. The research shows that the environmental health benefits of air pollution control are significant in China, but it is still necessary to further strengthen regional joint prevention and control, as well as one city one policy.

Dietary exposure and risk assessment of short-chain chlorinated paraffins in supermarket fresh products in Jinan, China.

Dietary intake is the major route for the exposure of residents to short-chain chlorinated paraffins (SCCPs). SCCPs are classified as persistent organic pollutants (POPs) by the Stockholm Convention since May 2017. This study assessed the general population's dietary exposure to SCCPs through supermarket products. Five food categories, which included 40 food species, were collected from five supermarkets in April 2019. The SCCP concentrations in all food matrices varied between 58.6 and 1977 ng g-1 dry weight (dw), with the average and standard deviation (SD) value of 301 ± 379 ng g-1 dw. Generally, the SCCP concentrations in animal-origin food matrices were higher than those in plant-origin food matrices. The C10Cl7 congeners were predominant among the congener groups of SCCPs. The proportion of C10 congeners in the animal-origin food samples (29.8%) was lower than that in the plant-origin food samples (39.7%), and the C13 congeners showed a contrasting result. The estimated daily intake (EDI) of SCCPs through dietary intake for the residents was 3109 ng kg-1 day-1, which is much lower than the standards of European Food Safety Authority (10 mg kg-1 day-1) for SCCPs. Risk assessment based on the supermarket foods indicated that SCCP exposure through dietary intake does not cause adverse effects to human health according to the margin of exposure (MOE).

Assessment of the Quality and Content of Clinical Practice Guidelines on Irritable Bowel Syndrome Using the AGREE II Instrument.

OBJECTIVES: The aim of the study was to assess the quality of guidelines on irritable bowel syndrome (IBS) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and identify concordance of different commendations. MATERIALS AND METHODS: A systematic search was undertaken from inception to May 2018. Two reviewers independently selected the titles and abstracts. The guidelines included were assessed using the AGREE II instrument. The consistency of evaluations was calculated using intra-class correlation coefficients with 95% CI. RESULTS: From 994 records, 7 guidelines were included. Most of guidelines got a moderate score of AGREE II. The highest median scores were achieved for scope and purpose and clarity and presentation (69.4%), while the lowest median scores across guidelines were for applicability (50.0%). Most of the nonpharmacologic management recommendations for IBS were similar. However, there also existed some differences on pharmacologic between different guidelines. CONCLUSIONS: The guidelines on IBS varied in quality and there were discrepancies about recommendations and recommendation grades. There is some space to improvement the quality of methodological rigor in development and reporting within clinical guidelines.

A school-based, multi-faceted health promotion programme to prevent obesity among children: protocol of a cluster-randomised controlled trial (the DECIDE-Children study).

INTRODUCTION: Obesity is a public health concern that is becoming increasingly more serious worldwide. Effective and sustainable childhood obesity prevention strategies may help to reduce the prevalence of obesity and may have an impact on lifelong health. However, few such strategies have been rigorously evaluated for Chinese children in different regions of China. METHODS AND ANALYSIS: The Diet, ExerCIse and CarDiovascular hEalth-Children is a cluster-randomised controlled trial that aims to assess the effectiveness and sustainability of a school-based, multi-faceted intervention to prevent obesity among Grade 4 primary school students (8-10 years old) in China. Twenty-four schools (approximately 1200 students) from above average, average and below average developed regions in China will be randomised to an intervention (12 schools) or usual practice (12 schools) group. The intervention will last for one school year (9 months) and consists of activities towards students, parents and school environment. A smartphone application will be used to assist in providing information on, monitoring and providing feedback on the behaviours and body weight of the students. Data will be collected at baseline, 4 months, 9 months and 21 months. The primary outcome will be the difference between groups in the change in students' body mass index at 9 months after the baseline investigation. The secondary outcomes will include the differences between groups in the changes in anthropometric measures, diet, physical activity levels and other measures at the follow-up visits. A variety of process evaluation methods will be used to evaluate the implementation process of the complex intervention. ETHICS AND DISSEMINATION: This study was approved by the Peking University Institution Review Board (IRB00001052-18021). The results will be disseminated through publication in peer-reviewed journals, presentations at conferences and in lay summaries provided to school staff and participants. TRIAL REGISTRATION NUMBER: NCT03665857.

Quality assessment of kidney cancer clinical practice guidelines using AGREE II instrument: A critical review.

BACKGROUND: Evidence-based guidelines are expected to provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. However, the existing practice guidelines(CPGs) vary in quality. This study aimed to evaluate the quality of CPGs of kidney cancer. METHODS: We systematically searched PubMed, Embase, China Biology Medicine disc, and relevant guideline websites from their inception to April, 2018. We identified CGPs that provided recommendations on kidney cancer; 4 independent reviewers assessed the eligible CGPs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. The consistency of evaluations was calculated using intraclass correlation coefficients (ICC). RESULTS: A total of 13 kidney cancer CGPs were included. The mean scores for each AGREEII domain were as follows: scope and purpose-76.9%; clarity and presentation-76.4%; stakeholder involvement-62.8%; rigor of development-58.7%; editorial independence-53.7%; and applicability-49.4%. Two CPGs were rated as "recommended"; 8 as "recommended with modifications"; and 3 as "not recommended." Seven grading systems were used by kidney cancer CGPs to rate the level of evidence and the strength of recommendation. CONCLUSIONS: Overall, the quality of CPGs of kidney cancer is suboptimal. AGREE II assessment results highlight the need to improve CPG development processes, editorial independence, and applicability in this field. It is necessary to develop a standardized grading system to provide clear information about the level of evidence and the strength of recommendation for future kidney cancer CGPs.