[Distribution Characteristics, Source Analysis and Ecological Risk Assessment of Heavy Metals in the Typical Industry Reclaimed Soil].

To further explore the characteristics of heavy metal pollution and the ecological risk of typical industries in reclaimed soil, based on data from 315 different depth profiles of soil samples collected from 49 plots in Jiading District, Shanghai, the geo-accumulation index and potential ecological risk index were used to evaluate the contents and potential ecological risk of seven heavy metals, namely Cd, Pb, Cu, Zn, Ni, Hg, and As. The APCS-MLR receptor model and PMF positive matrix factorization model were employed to analyze the pollution sources. The results showed that:① except for As, the contents of other heavy metals in the soil of the study area exceeded the Shanghai soil background values to varying degrees. The contents of Cd, Pb, Cu, Zn, Ni, and Hg in the surface soil were 3.54, 2.34, 2.91, 1.20, 3.75, and 4.40 times the background values, respectively. The contents of heavy metals in the soil decreased with the increase in depth, and heavy metals were enriched to a certain extent in the surface soil, indicating that human activities had an impact on the distribution of heavy metals in the soil. ② The APCS-MLR and PMF receptor models identified four main sources of soil heavy metals in the study area. Source 1 (Cu, Zn, and Pb) was a mixture of metal products and automobile manufacturing, source 2 (Ni and Cd) was electroplating enterprises, source 3 (Hg) was mainly from chemical enterprises, and source 4 (As) was natural. The combined use of the two receptor models further improved the accuracy and credibility of source identification. ③ The geo-accumulation index in descending order was Hg(1.54)>Ni(1.32)>Cd(1.21)>Cu(0.96)>Pb(0.64)>Zn(-0.33)>As(-1.02). The potential ecological risk index showed that the comprehensive potential ecological risk index RI value in the study area ranged from 32.50 to 4 910.97, with a mean of 321.40, indicating a strong potential ecological risk. The pollution values of heavy metals Hg, Ni, and Cd in industrial site soil deserve further attention for re-development and utilization purposes.

Predictive model for identifying mild cognitive impairment in patients with type 2 diabetes mellitus: A CHAID decision tree analysis.

BACKGROUND: As the population ages, mild cognitive impairment (MCI) and type 2 diabetes mellitus (T2DM) become common conditions that often coexist. Evidence has shown that MCI could lead to reduced treatment compliance, medication management, and self-care ability in T2DM patients. Therefore, early identification of those with increased risk of MCI is crucial from a preventive perspective. Given the growing utilization of decision trees in prediction of health-related outcomes, this study aimed to identify MCI in T2DM patients using the decision tree approach. METHODS: This hospital-based case-control study was performed in the Endocrinology Department of Xiangya Hospital affiliated to Central South University between March 2021 and December 2022. MCI was defined based on the Petersen criteria. Demographic characteristics, lifestyle factors, and T2DM-related information were collected. The study sample was randomly divided into the training and validation sets in a 7:3 ratio. Univariate and multivariate analyses were performed, and a decision tree model was established using the chi-square automatic interaction detection (CHAID) algorithm to identify key predictor variables associated with MCI. The area under the curve (AUC) value was used to evaluate the performance of the established decision tree model, and the performance of multivariate regression model was also evaluated for comparison. RESULTS: A total of 1001 participants (705 in the training set and 296 in the validation set) were included in this study. The mean age of participants in the training and validation sets was 60.2  ±  10.3 and 60.4  ±  9.5 years, respectively. There were no significant differences in the characteristics between the training and validation sets (p > .05). The CHAID decision tree analysis identified six key predictor variables associated with MCI, including age, educational level, household income, regular physical activity, diabetic nephropathy, and diabetic retinopathy. The established decision tree model had 15 nodes composed of 4 layers, and age is the most significant predictor variable. It performed well (AUC = .75 [95% confidence interval (CI): .71-.78] and .67 [95% CI: .61-.74] in the training and validation sets, respectively), was internally validated, and had comparable predictive value compared to the multivariate logistic regression model (AUC = .76 [95% CI: .72-.80] and .69 [95% CI: .62-.75] in the training and validation sets, respectively). CONCLUSION: The established decision tree model based on age, educational level, household income, regular physical activity, diabetic nephropathy, and diabetic retinopathy performed well with comparable predictive value compared to the multivariate logistic regression model and was internally validated. Due to its superior classification accuracy and simple presentation as well as interpretation of collected data, the decision tree model is more recommended for the prediction of MCI in T2DM patients in clinical practice.

Cost-effectiveness of tirofiban for acute ischemic stroke without large or medium-sized vessel occlusion: A Markov modelling analysis from the Chinese and United States perspectives.

BACKGROUND: The RESCUE BT2 trial recently showcased the efficacy of tirofiban in treating acute ischemic stroke (AIS) without large or medium-sized vessel occlusion. To further assess the value of tirofiban from the perspectives of Chinese and US healthcare system, a study was conducted to evaluate its cost-effectiveness. METHODS: A hybrid model, integrating a short-term decision tree with a long-term Markov model, was developed to assess cost-effectiveness between tirofiban and aspirin for stroke patients without large or medium-sized vessel occlusion. Efficacy data for tirofiban was sourced from the RESCUE BT2 trial, while cost information was derived from published papers. Outcomes measured included respective cost, effectiveness, and incremental cost-effectiveness ratio (ICER). We conducted a one-way sensitivity analysis to assess the robustness of the results. Additionally, we performed probabilistic sensitivity analysis (PSA) through 10,000 Monte Carlo simulations to evaluate the uncertainties associated with the results. RESULTS: The study revealed that tirofiban treatment in AIS patients without large or medium-sized vessel occlusion led to a considerable reduction of 2141 Chinese Yuan (CNY) in total cost, along with a lifetime gain of 0.14 quality-adjusted life years (QALYs). In the US settings, tirofiban also exhibited a lower cost ($197,055 versus $201,984) and higher effectiveness (4.15 QALYs versus 4.06 QALYs) compared to aspirin. One-way sensitivity analysis revealed that post-stroke care costs and stroke utility had the greatest impact on ICER fluctuation in both Chinese and US settings. However, these variations did not exceed the willingness-to-pay threshold. PSA demonstrated tirofiban's superior acceptability over aspirin in over 95% of potential scenarios. CONCLUSION: Tirofiban treatment for AIS without large or medium-sized vessel occlusion appeared dominant compared to aspirin in both China and the US.

Dynamic disparities in clean energy use across rural-urban, regional, and ethnic boundaries in China.

The consequences of relying on solid fuels are disproportionately borne by minorities, the marginalized, and rural communities. However, the social disparities in transitioning from polluting energy to clean energy are not well understood. We track changes in the main energy source used for cooking among Chinese households between 2010 and 2018. We find that the proportion of households who rely on clean energy increased from 53.7% in 2010 to 80.1% in 2018. We detect substantial disparities in clean energy use between rural and urban areas, across regions, and between ethnic minorities and the Han majority. Urban status, regional variations, and household characteristics entirely accounted for the observed ethnic differences in clean energy use. Over time, disparities across rural-urban, regional, and ethnic boundaries declined, and household characteristics became irrelevant to the ethnic differences. Therefore, China's efforts to mitigate the imbalance in socioeconomic development also reduced ethnic inequalities in clean energy use.

Endovascular treatment for basilar artery occlusion: a cost-effectiveness analysis based on a meta-analysis.

Objective: This study aimed to investigate the efficacy and economic effect of endovascular treatment (EVT) combined with standard medical treatment (SMT) vs. SMT alone in Chinese patients with basilar artery occlusion (BAO) from the perspective of the Chinese healthcare system. Methods: We conducted a cost-effectiveness analysis using the results from a meta-analysis comparing EVT and SMT efficacy in Chinese patients with BAO-induced stroke using direct medical costs from the China National Stroke Registry. The meta-analysis's primary outcome was excellent functional outcome (mRS scores of 0-2), with secondary outcomes being poor functional outcome (mRS scores of 3-5) and death (mRS score of 6). To compare EVT plus SMT's cost-effectiveness with that of SMT alone, we constructed a combined decision tree and Markov model with a lifetime duration and a 3-month cycle length. The primary cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost per incremental quality-adjusted life year (QALY). EVT was considered cost-effective if the ICER was lower than the willingness-to-pay (WTP) threshold of three times the per capita gross domestic product (GDP) in 2021 in China; otherwise, it would not be cost-effective. Results: The meta-analysis results indicated that EVT could increase the incidence of excellent functional outcomes, with a risk ratio (RR) of 2.23 (95% confidence interval, CI, 1.18-4.21), p = 0.01. Simultaneously, EVT reduced the risk of poor functional outcome and mortality in the EVT group, with RRs of 0.83 (95% CI, 0.67-1.03), p = 0.09, and 0.71 (95% CI, 0.59-0.85), p = 0.0002, respectively. The study also found that EVT plus SMT resulted in a lifetime effectiveness of 2.15 QALY (3.88 life years) for 32,213 international dollars (Intl.$) per patient with BAO. In contrast, SMT alone achieved an effectiveness of 1.46 QALY (3.03 life years) with a total cost of Intl.$ 13,592 per patient. The ICER was Intl.$ 27,265 per QALY (Intl.$ 22,098 per life-year), which fell below the WTP threshold. Conclusion: Compared to SMT, EVT improves the prognosis of BAO-induced stroke. Considering the Chinese healthcare system, adding EVT to SMT proves to be cost-effective for patients with BAO compared to SMT alone.

Impacts of adjustment of National Reimbursement Drug List on orphan drugs volume and spending in China: an interrupted time series analysis.

OBJECTIVE: To evaluate the impacts of the 2017 adjustment of National Reimbursement Drug List (NRDL) on orphan drugs hospital procurement volumes and spending in China. DESIGN: We used an interrupted time series design covering the period from 2016 to 2018 to analyse changes in hospital procurement volumes and spending of orphan drugs for which were included in the 2017 NRDL. SETTING AND DATA: The study was conducted in China. Orphan drug procurement data of 789 public hospitals (594 tertiary hospitals and 195 secondary hospitals) were derived from the Chinese Medical Economic Information (CMEI). OUTCOME MEASURES: Monthly orphan drugs hospital procurement volumes and spending. RESULTS: Nine orphan drugs were included in the 2017 NRDL (seven were directly included, and two were included after price negotiation). Comparing to orphan drugs not included in the NRDL, hospital procurement volumes ([Formula: see text] =43 312, p<0.001) and spending ([Formula: see text] =6 48 927, p<0.001) of the nine included drugs showed significant upward trends after implementation of the 2017 NRDL adjustment. CONCLUSIONS: Our results suggest that the 2017 adjustment of NRDL significantly changed the usage and spending on certain orphan drugs. The increase in orphan drug hospital procurement volumes should improve rare disease patients' access to these orphan drugs.

Assessment of key parameters of normal uterus in women of reproductive age.

Currently, the precise and detailed anatomical data of the normal uterus, especially the myometrium thickness in various parts of the uterus, are lacking. This study aims to provide normal references for uterine size in healthy reproductive-aged Chinese women to facilitate the application of hysteroscopic surgery. A total of 298 women of reproductive age with normal uterine were included. Parity was significantly correlated with uterine measurements (P < 0.05), and age impacted several measurements (P < 0.05). At each uterine site examined, the myometrium was thinner in nulliparous women than in parous or primiparous women (P < 0.001). Similarly, the extrauterine measurements for parous or primiparous women were larger than those for nulliparous women. Weight affected some external measurements but not myometrial thicknesses, while height did not affect uterine measurements (P > 0.05). There was a positive correlation between body mass index (BMI) and extrauterine measurements as well as myometrial thickness (P < 0.05). The mathematical model of the uterine size for women of reproductive age was constructed stratified by parity. The study is the first to provide a detailed statistical description of the accurate anatomical parameters of the uterus in Chinese reproductive-aged women and has great significance for improving the safety and effectiveness of hysteroscopic surgery for patients.

[Enrichment and Ecological Risk Assessment of Available Phosphorus in Paddy Soil of Fujian Province Over Past 40 years].

The ecological risks such as water eutrophication caused by soil phosphorus loss have attracted extensive attention, and its dynamic changes and enrichment effects are the basis for formulating reasonable control measures. In this study, based on the paddy soils of 1.8×106 hm2 in Fujian province, the dynamic changes and ecological risks of available phosphorus in paddy soils over the past 40 years were analyzedusing a soil database of 1:50000. The soil database contained 1471, 215534, and 2895 paddy soil samples in different periods, respectively. The paddy soil samples were derived from the 1982 Second National Soil Census, the 2008 Ministry of Agriculture and Rural Areas Soil Testing and Formulated Fertilization Project and the 2018 Ministry of Agriculture, and the Rural Areas Arable Land Quality Monitoring Project, respectively. The results showed that from 1982 to 2018, the content of available phosphorus in paddy soils increased by 47 mg·kg-1, and the enriched area reached 1.65×106 hm2, accounting for 91% of the total paddy soils in Fujian province. From 1982 to 2008, the available phosphorus content of paddy soils in Fujian province increased by 28 mg·kg-1, with the enriched area reaching 1.47×106 hm2, accounting for 82% of the total paddy soils in Fujian province. From 2008 to 2018, the available phosphorus content of paddy soils in Fujian province increased by 19 mg·kg-1, with the enriched area reaching 1.22×106 hm2, accounting for 69% of the total paddy soils in Fujian province. Further ecological risk assessment showed that from 2008 to 2018, the area of paddy soil with ecological phosphorus enrichment risk in the province gradually increased, mainly distributed in percogenic paddy soils and hydromorphic paddy soils with a slope of less than 2°. In the future, effective phosphorus fertilizer management measures should be formulated for different types of paddy soil to prevent the occurrence of environmental problems such as water eutrophication.

Economic inequalities in contemporary rural China: How does political capital matter?

To assess how the transition from state socialism to a market economy has impacted the social stratification order in China, some prior studies have debated whether the economic privileges of the political redistributors have declined relative to the emerging market elites, while others have examined the coevolution between the two in urban institutional contexts. This study provides new insights into how political capital influences economic inequalities in contemporary rural China by revisiting informal social institutions. Drawing upon a unique nationally representative household survey and using surname sharing with the village cadres to infer shared lineage membership, we find that lineage-based political ties help rural Chinese households to materialize income as well as asset advantages over fellow villagers bereft of such ties. Furthermore, the economic privileges of political connections are larger in villages with lineage groups than those without, and larger for villages of more frequent kin interactions than those of less frequent kin interactions. Our results extend prior findings on the coevolution between political and market elites by going beyond formal institutions and examining grassroots-level evidence in contemporary rural communities.

Incidence and disease burden of community-acquired pneumonia in southeastern China: data from integrated medical resources.

Community-acquired pneumonia (CAP) is a lower respiratory tract infection. It is one of the commonest infectious diseases and the third leading cause of death worldwide. However, the epidemiological profiles of CAP in southeastern China are unknown. Data of inpatients and outpatients diagnosed with CAP from January 1, 2015 to December 31, 2020 were obtained from the National Healthcare Big Data in Fuzhou (Fuzhou Database). This database covers medical data from 37 hospitals and 159 community health service stations. The incidence rate, treatment pattern, and direct medical costs of CAP were assessed using clinical data. A total of 8,156,237 patients were enrolled, with a mean age of 33.72 ± 20.88 years. The overall incidence rate of CAP was 3.13 (95% confidence interval [CI]: 3.11-3.15) per 1000 person-years (PY), with 15.97 (95% CI: 15.85-16.08) per 1000 PY in children below 5 years old and 2.62 (95% CI: 2.57-2.66) per 1000 PY in the elderly ≥60 years. The cost per outpatient was $242.83 ± 341.62, and the cost per inpatient was $4,530.4 ± 9,151.68. The three most used therapeutic drugs in patients with CAP are cefotaxime, moxifloxacin, and azithromycin. In addition, despite the ability of both imported and domestic pneumococcal conjugate vaccines to reduce the incidence rate of CAP, the current vaccination coverage rates were relatively low. We suggest that more attention should be paid to the disease burden of CAP, especially due to its great economic burden in China.

Spatial Pattern Change and Ecosystem Service Value Dynamics of Ecological and Non-Ecological Redline Areas in Nanjing, China.

Ecological conservation red line (ECRL) is gaining increasing academic attention as delimiting the minimum space scope of ecological protection and the bottom line of ecological security. Taking Nanjing as a case study, we divided the territory into ecological and non-ecological redline areas (ERAs and NERAs, respectively). This paper highlights two key research issues based on the 2005, 2010, 2015 and 2018 annual remote sensing data: (i) quantitative analysis of the Ecological Redline Policy (ERP) validity by conducting a horizontal comparison of the ERAs and NERAs; and (ii) exploration of the land-use transitions and spatial pattern changes affecting ecosystem service value (ESV). Results showed that delineating ECRL could effectively slow down the decline rate of ESV. The trend of eco-quality deterioration was greater than eco-quality improvement in Nanjing, presenting an ESV that declined slightly in the whole. According to our findings, we suggest that reasonably increasing eco-lands (woodland and water area) and decreasing construction land will enhance the regional ESV. Meanwhile, promoting the transition from production space to ecological space and depressing the encroachment of living space on other space types, will be instrumental in mitigating the ESV decline. The results of this study are expected to provide valuable implications for spatial planning and sustainable development in Nanjing.

Economic growth, income inequality and life expectancy in China.

China had made dramatic health gains before its economic reform that began in 1978 produced rapid economic growth in the ensuing years. Since the economic reform, China's income inequality has substantially increased, and health gains have stagnated. This article investigates the extent to which China's health stagnation may be attributable to the rise in income inequality in China. By simulating the improvement in life expectancy that could have resulted if, ceteris paribus, income inequality had stayed constant at the lowest level after the founding of the People's Republic of China in 1949, we find that the sharply increasing income inequality in China has contributed to life loss in China's population, about 0.6 years for men and 0.4 years for women. These findings suggest that redistribution of income from rich to poor may be one of the most important policy levers for improving population health in China.

Quality assessment and differentiation of Aucklandiae Radix and Vladimiriae Radix based on GC-MS fingerprint and chemometrics analysis: basis for clinical application.

Vladimiriae Radix, a geo-authentic medicinal herb found in Sichuan Province in China, is highly similar in chemical composition and pharmacological activity to Aucklandiae Radix. It is often used in local practice and as a substitute for Aucklandiae Radix in the treatment of gastrointestinal tract diseases. However, Vladimiriae Radix is preferred to Aucklandiae Radix in traditional Chinese medicine in Sichuan. In order to compare the difference in quality between the two species and differentiate them according to their chemical profiles, and further to explain the rationality of using Vladimiriae Radix as a substitute and explore the reason for the medication preference in Sichuan, similarity was evaluated using gas chromatography-mass spectrometry (GC-MS) fingerprinting and chemometric analysis. Volatile compounds were identified by comparing mass spectra with spectral data from the National Institute of Standards and Technology library 14.L (NIST 14.L) and the linear retention indices (RI) with those previously reported. The results showed that the similarity between the samples from Aucklandiae Radix (>96%) was greater than that of Vladimiriae Radix (>80%). In addition, 41 and 38 compounds were identified in 10 batches of Vladimiriae Radix and Aucklandiae Radix, respectively, and 21 compounds were common to both species, of which dehydrocostus lactone and aplotaxene were abundant in both. However, γ-patchoulene, longicyclene, ß-gurjunene, humulene1,2-epoxide, and ß-patchoulene were unique to Vladimiriae Radix, while 4-terpineol, α-ionone, trans-α-bergamotene, γ-selinene, and camphene were characteristic compounds of Aucklandiae Radix. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) suggested that the two species were well differentiated with regard to the level of essential oils. Orthogonal partial least squares discriminant analysis (OPLS-DA) further showed that compounds including costol, aplotaxene, caryophyllene, humulene, and ß-eudesmol, together with the characteristic compounds of the two species, could be regarded as potential markers for differentiation, among which ß-eudesmol, which is richer in Vladimiriae Radix, and ß-patchoulene, which is unique to Vladimiriae Radix, have potential therapeutic effects on gastrointestinal diseases. The results obtained in this study distinguished Vladimiriae Radix and Aucklandiae Radix on a chemical level, and the similarity in chemical constituents may provide a basis for the rationality of Vladimiriae Radix as a substitute, while ß-patchoulene and ß-eudesmol existing in Vladimiriae Radix provide a theoretical basis for its preferential use in Sichuan. The analysis method established here has important implications for the quality control and differentiation of Vladimiriae Radix and Aucklandiae Radix, which can also serve as a reference for the identification of similar species. Graphical abstract.

Long-term decline in intergenerational mobility in the United States since the 1850s.

We make use of newly available data that include roughly 5 million linked household and population records from 1850 to 2015 to document long-term trends in intergenerational social mobility in the United States. Intergenerational mobility declined substantially over the past 150 y, but more slowly than previously thought. Intergenerational occupational rank-rank correlations increased from less than 0.17 to as high as 0.32, but most of this change occurred to Americans born before 1900. After controlling for the relatively high mobility of persons from farm origins, we find that intergenerational social mobility has been remarkably stable. In contrast with relative stability in rank-based measures of mobility, absolute mobility for the nonfarm population-the fraction of offspring whose occupational ranks are higher than those of their parents-increased for birth cohorts born prior to 1900 and has fallen for those born after 1940.

Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma.

BACKGROUND: The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy (IMRT) as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients. Endoscopic nasopharyngectomy (ENPG) was successfully applied in recurrent NPC with radiation free and relatively low medical costs. In this study, we examined whether ENPG could be an effective treatment for localized stage I NPC. METHODS: Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center. Simultaneously, the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort. The survival outcomes, quality of life (QOL), and medical costs between two groups were compared. RESULTS: After a median follow-up of 59.0 months (95% CI 53.4-64.6), no death, locoregional recurrence, or distant metastasis was observed in the 10 patients treated with ENPG. The 5-year overall survival, local relapse-free survival, regional relapse-free survival, and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients (100% vs. 99.1%, 100% vs. 97.7%, 100% vs. 99.0%, 100% vs. 97.4%, respectively, P > 0.05). In addition, compared with IMRT, ENPG was associated with decreased total medical costs ($ 4090.42 ± 1502.65 vs. $ 12620.88 ± 4242.65, P < 0.001) and improved QOL scores including dry mouth (3.3 ± 10.5 vs. 34.4 ± 25.8, P < 0.001) and sticky saliva (3.3 ± 10.5 vs. 32.6 ± 23.3, P < 0.001). CONCLUSIONS: ENPG alone was associated with promising long-term survival outcomes, low medical costs, and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy. However, the application of ENPG should be prudent, and prospective clinical trials were needed to further verify the results.

The long-term impact of the Communist Revolution on social stratification in contemporary China.

The Chinese Communist Revolution that culminated in the 1949 founding of the People's Republic of China fundamentally transformed class relations in China. With data from a nationally representative, longitudinal survey between 2010 and 2016, this study documents the long-term impact of the Communist Revolution on the social stratification order in today's China, more than 6 decades after the revolution. True to its stated ideological missions, the revolution resulted in promoting the social status of children of the peasant, worker, and revolutionary cadre classes and disadvantaging those who were from privileged classes at the time of the revolution. Although there was a tendency toward "reversion" mitigating the revolution's effects in the third generation toward the grandparents' generation in social status, the overall impact of reversion was small. The revolution effects were most pronounced for the birth cohorts immediately following the revolution, attenuating for recently born cohorts.

Parental divorce is not uniformly disruptive to children's educational attainment.

Children whose parents divorce tend to have worse educational outcomes than children whose parents stay married. However, not all children respond identically to their parents divorcing. We focus on how the impact of parental divorce on children's education varies by how likely or unlikely divorce was for those parents. We find a significant negative effect of parental divorce on educational attainment, particularly college attendance and completion, among children whose parents were unlikely to divorce. Families expecting marital stability, unprepared for disruption, may experience considerable adjustment difficulties when divorce occurs, leading to negative outcomes for children. By contrast, we find no effect of parental divorce among children whose parents were likely to divorce. Children of high-risk marriages, who face many social disadvantages over childhood irrespective of parental marital status, may anticipate or otherwise accommodate to the dissolution of their parents' marriage. Our results suggest that family disruption does not uniformly disrupt children's attainment.

Influences of Material Aspirations on Migration.

In this article, we investigate the influences of material aspirations on migration in Nepal, positing that material aspirations may have important influences on decisions to migrate and where to locate. We discuss a theoretical model explaining how these aspirations might be key influences in the migration decision. Using detailed continuous migration histories from the 2008-2012 Chitwan Valley Family Study, we estimate logistic and alternative-specific conditional logit models to examine how material aspirations in Nepal influence migration rates and destinations. Our empirical analyses provide strong evidence that material aspirations have large effects on overall rates of migration and affect destination-specific migration rates, particularly for relatively wealthy Western and Asian destinations. We also show an interaction effect between material aspirations and destination-specific expected earnings in influencing people's migration choices. It is the people with high aspirations who migrate to destinations with high earning potentials.

Assessment of Liver Fibrosis Using Real-time Shear-wave Elastography for Patients with Hepatitis B e Antigen-negative Chronic Hepatitis B and Alanine Transaminase <2 Times the Upper Limit of Normal.

BACKGROUND: We assessed liver fibrosis using real-time shear-wave elastography (SWE) combined with liver biopsy (LB) for patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) and alanine transaminase < 2 times the upper limit of normal and hepatitis B virus DNA < 2000 IU/ml. METHODS: A total of 107 patients met the inclusion criteria. Real- ime SWE and ultrasoundassisted liver biopsies were consecutively performed. Fibrosis was staged according to the METAVIR scoring system. Analyses of receiver operating characteristic curve were performed to calculate the optimal area under the receiver operating characteristic curve for F0-F1 versus F2-F4, F0-F2 versus F3-F4, and F0-F3 versus F4 for real-time SWE. RESULTS: The most concurrent liver fibrosis degrees were between F1 and F2 for these HBeAg-negative CHB patients. Liver stiffness increased in parallel with the degree of liver fibrosis using SWE measurements. The area under the receiver operating characteristic curves was 0.881 (95% confidence interval [CI]: 0.704-1.000) for SWE (p = 0.004); 0.912 (95% CI: 0.836-0.987) for SWE (p = 0.000); 0.981 (95% CI: 0.956-1.000) for SWE (p = 0.000); 0.974 (95% CI: 0.936-1.000) for SWE (p = 0.000) when comparing F0 versus F1-F4, F0-F1 versus F2-F4, F0-F2 versus F3-F4, and F0-F3 versus F4, respectively. CONCLUSIONS: SWE has the advantage of providing an image of liver stiffness in real-time. As an alternative to LB, the development of all these noninvasive methods for dynamic evaluation of liver fibrosis will decrease the need for LB, making clinical care safer and more convenient for patients with liver diseases.