Influence of different baking temperatures of red kojic rice on the physicochemical properties, antioxidant capacity, and functional components of red starter wine.

BACKGROUND: To improve the quality of red starter wine, this study explored the effects of baking red kojic rice at varying temperatures on the physicochemical characteristics of red starter wine. Baking was predicated on understanding crucial enzyme activities and starch granule structure of red kojic rice at 75, 95, and 105 °C, leading to the production of three red starter wine variants (BHQW1, BHQW2, and BHQW3). RESULTS: The results revealed an increased alcohol (increase 0.50%), total sugar (increase 0.14 g L-1 ), and total acid (increase 0.54 g L-1 ) content in red starter wine fermented using baked red kojic rice compared with the control group (wine fermented with unbaked rice, HQW). Furthermore, both the 105 °C baked red kojic rice and its resulting BHQW3 demonstrated significantly higher red color values than HQW (increase 2.03 U g-1 and 0.15 U mL-1 respectively). The highest lovastatin content was presented in red kojic rice baked at 105 °C and its corresponding fermented wine (1420.63 ± 507.9 µg g-1 and 3368.87 ± 228.16 µg L-1 respectively). Additionally, BHQW groups displayed higher total flavonoids and phenols content than HQW. Regarding antioxidant capacity, all BHQW groups showed stronger overall antioxidant capacity than HQW. The determination of volatile components revealed the highest content of volatile compounds in BHQW2 (2621.19 ± 548.24 µg L-1 ) and significantly higher volatile esters in BHQW1 (254.46 ± 16.63 µg L-1 ). Moreover, 16 volatile compounds were identified only in BHQW groups, including isoamyl caprylate, 2-ethylhexyl alcohol, and benzaldehyde. CONCLUSION: Our findings suggested that the baking technique of red kojic rice could enhance the quality of red starter wine through enhancing antioxidant properties, increasing functional components, and enriching volatile flavor compounds, thus providing a foundation for new techniques in red starter wine production. © 2023 Society of Chemical Industry.

Tissue Proteogenomic Landscape Reveals the Role of Uncharacterized SEL1L3 in Progression and Immunotherapy Response in Lung Adenocarcinoma.

The fundamental pursuit to complete the human proteome atlas and the unmet clinical needs in lung adenocarcinoma have prompted us to study the functional role of uncharacterized proteins and explore their implications in cancer biology. In this study, we characterized SEL1L3, a previously uncharacterized protein encoded from chromosome 4 as a dysregulated protein in lung adenocarcinoma from the large-scale tissue proteogenomics data set established using the cohort of Taiwan Cancer Moonshot. SEL1L3 was expressed in abundance in the tumor parts compared with paired adjacent normal tissues in 90% of the lung adenocarcinoma patients in our cohorts. Moreover, survival analysis revealed the association of SEL1L3 with better clinical outcomes. Intriguingly, silencing of SEL1L3 imposed a reduction in cell viability and activation of ER stress response pathways, indicating a role of SEL1L3 in the regulation of cell stress. Furthermore, the immune profiles of patients with higher SEL1L3 expression were corroborated with its active role in immunophenotype and favorable clinical outcomes in lung adenocarcinoma. Taken together, our study revealed that SEL1L3 might play a vital role in the regulation of cell stress, interaction with cancer cells and the immune microenvironment. Our research findings provide promising insights for further investigation of its molecular signaling network and also suggest SEL1L3 as a potential emerging adjuvant for immunotherapy in lung adenocarcinoma.

Income loss and subsequent poor psychological well-being among the Chinese population during the early COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has had major ramifications for health and the economy at both the individual and collective levels. This study examined exogenous negative changes in household income and their implications on psychological well-being (PWB) among the Chinese population during the COVID-19 pandemic. METHODS: Data were drawn from the early China COVID-19 Survey, a cross-sectional anonymous online survey administered to the general population in China. Self-reported PWB was measured using a 5-point Likert scale with five questions related to the participants' recent psychological state. Hierarchical multiple linear regression was employed to examine whether income loss during the COVID-19 pandemic was associated with poor psychological health. RESULTS: This study included 8,428 adults, of which 90% had suffered from a moderate or severe loss of household income due to the early COVID-19 pandemic. Those who had experienced moderate or severe loss of income scored significantly lower on psychological well-being than those who did not experience income loss (19.96 or 18.07 vs. 21.46; P < 0.001); after controlling for confounders, income loss was negatively associated with PWB scores (moderate income loss: B = - 0.603, P < 0.001; severe income loss: B = - 1.261, P < 0.001). An interaction effect existed between the degree of income loss and pre-pandemic income groups. Specifically, participants in the middle-income group who had suffered severe income loss scored the lowest on PWB (B = - 1.529, P < 0.001). There was also a main effect on income loss, such that participants with varying degrees of income loss differed across five dimensions, including anhedonia, sleep problems, irritability or anger, difficulty with concentration, and repeated disturbing dreams related to COVID-19. CONCLUSIONS: Income loss during the pandemic has had detrimental consequences on psychological well-being, and the magnitude of the impact of income loss on psychological well-being varied according to previous income levels. Future policy efforts should be directed toward improving the psychological well-being of the economically vulnerable and helping them recover from lost income in the shortest time possible.

Exogenous ABA promotes aroma biosynthesis of postharvest kiwifruit after low-temperature storage.

MAIN CONCLUSION: Exogenous ABA played a positive role in the accumulation and biosynthesis of aroma components of postharvest kiwifruit after low-temperature storage, especially the esters production during ripening. Low-temperature storage (LTS) generally affects the aroma formation associated with the decrease in aroma quality in kiwifruit. In this work, abscisic acid (ABA) treatment after LTS increased the production of aroma components in postharvest kiwifruit and enhanced the related enzyme activity, especially alcohol acyltransferase (AAT), branched amino acid transaminase (BCAT) and hydroperoxide lyase (HPL). Corresponding to the enzyme activity, the gene expression of AchnAAT, AchnADH, AchnBCAT and AchnHPL was significantly up-regulated by ABA. The principal component analysis further illustrated the differences in aroma components between ABA and the control. The positive correlation of aroma accumulation with the expression levels of AchnPDC and AchnLOX and the enzyme activities of BCAT and pyruvate decarboxylase (PDC) was also revealed by correlation analysis. In addition, the promoter sequences of the key genes involved in aroma biosynthesis contained multiple cis-elements (ABRE and G-box) of ABA-responsive proteins. Combining the transcriptome sequencing data, the promoting role of ABA signaling in the regulation of aroma biosynthesis of postharvest kiwifruit after LTS was discussed. This study would provide a reference for improving aroma quality of postharvest kiwifruit after LTS, as well the molecular mechanism of kiwifruit aroma fading after LTS.

Did the Integrated Urban and Rural Resident Basic Medical Insurance Improve Benefit Equity in China?

OBJECTIVES: The reform of merging 2 major health insurance schemes into Urban and Rural Resident Basic Medical Insurance (URRBMI) is recognized as a vital step to safeguard equal healthcare and benefit to each enrollee in China. Against this backdrop, this article aims to evaluate the impact of URRBMI integration on benefit and its contribution to benefit equity. METHODS: The data of this study were derived from the China Health and Retirement Longitudinal Study 2011 and 2015. A total of 11 383 individuals were included in the final sample. Coarsened exact matching with difference-in-difference approach was firstly adopted to investigate the treatment effects of URRBMI on benefits. Next, the decomposition of concentration index (CI) was conducted to explore the contribution of URRBMI to benefit equity. RESULTS: The coarsened exact matching with difference-in-difference results revealed that the consolidation of URRBMI has significantly improved outpatient benefit. The decomposition results showed that the contribution rates of URRBMI scheme to outpatient benefit rate (CI -0.0114), benefit probability (CI 0.0673), compensation fee (CI 0.0076), and reimbursement ratio (CI 0.0483) were 11.26%, -3.38%, -7.67%, and -0.81%, suggesting that this reform makes contribution to the propoor inequity in the outpatient benefit rate and relieves the prorich inequity in outpatient benefit probability and the degree of benefits. CONCLUSIONS: The findings of this study provide novel evidence of enhanced benefits and benefit equity for outpatient care with the integration of URRBMI. Further efforts should be made to the expansion of URRBMI coverage and the elimination of income disparities that affecting benefit equity.

Does social capital buffer or exacerbate mental health inequality? Evidence from the China Family Panel Study (CFPS).

BACKGROUND: Health inequality, including physical and mental health inequality, is an important issue. What role social capital plays in mental health inequality is still ambiguous, especially in developing countries. The aim of this study is to explore the relationship between social capital and mental health inequality in China. METHOD: Both family-level and community-/village-level social capitals are included in our analysis. Data is mainly extracted from the China Family Panel Studies in 2018, and lagged term of social capital in CFPS 2016 was used to link with other variables in 2018. Depressive symptoms and subjective well-being are set as indicators of mental health. A series of OLS regression models were conducted to estimate the effects of social capital on mental health and mental health inequality. RESULTS: Higher levels of social capital and income are related to a lower level of depressive symptoms and a higher level of subjective well-being. The positive coefficient of interaction term of family-level social capital and income level in the urban area indicates that the inhibiting effect of social capital on depressive symptoms is pro-poor. The negative coefficient of interaction term of village-level social capital and income level in the rural area suggests that the promoting effect of social capital on subjective well-being is pro-poor, too. CONCLUSION: The results show that severe mental health inequality exists in China; family-level social capital can buffer depressive symptom inequality, and village-level social capital can buffer SWB inequality. Although the amount of social capital of the poor is less than the rich, the poor can better use social capital to improve their mental health. Our study advocates enhancing social participation and communication for the poor to reduce mental health inequality.

A Room-Temperature Surface Acoustic Wave Ammonia Sensor Based on rGO/DPP2T-TT Composite Films.

Surface acoustic wave (SAW) sensors based on reduced graphene oxide/poly (diketopyrrolopyrrolethiophene-thieno [3,2-b]thiophene-thiophene) (rGO/DPP2T-TT) composite sensing films for the detection of ammonia were investigated at room temperature in this study. The rGO/DPP2T-TT composite films were deposited onto ST-X quartz SAW resonators by a drop-casting method. FESEM, EDS, and XRD characterizations showed that the rGO/DPP2T-TT composite film was successfully synthesized and exhibited numerous wrinkles and a rough structure, which are crucial for gas adsorption. The frequency response to 500-1400 ppb ammonia shown by the prepared SAW sensor coated with rGO/DPP2T-TT composite film increased linearly as the ammonia concentration increased. The sensor based on a rGO/DPP2T-TT composite film exhibited a positive frequency shift of 55 Hz/ppm, and its frequency response to 500 ppb ammonia was 35 Hz. The sensors thus show promising potential in detecting sub-ppm concentration levels of NH3 at room temperature, which opens up possibilities for applications in the noninvasive detection of NH3 in the breath. As a result, the rGO/DPP2T-TT composite sensor can be a good candidate for in situ medical diagnosis and indoor/outdoor environment monitoring.

Effect of baking technique for rice wine production and the characteristics of baked rice wine.

BACKGROUND: Driven by the requirement to reduce the emission of wastewater in the brewing process, it is necessary to improve and innovate the fermentation technology of Chinese rice wine. In this study, the baking technique used to brew rice wine was explored. RESULTS: Rice wine was brewed based on baked glutinous rice undergoing different high-temperature stages, designated as baked rice wine (BRW1, BRW2 and BRW3). X-ray diffraction and Fourier transform infrared analysis revealed that baking treatment under 110 °C 0.5 h + 170 °C 30 min relatively changed the crystal properties and short-range molecular order of starch. Compared with the traditional rice wine (RW) from steamed rice, the alcohol content in BRWs was nearly twice that of RW, especially in BRW3. The contents of protein, ascorbic acid and total phenols in BRWs were significantly higher than that in RW. Besides, BRWs presented more abundance in the contents of volatile compounds, free amino acids and certain organic acids, including volatile esters and alcohols and 17 amino acids, which would give rice wine a pleasant aroma and a more comprehensive taste. Furthermore, analysis of the antioxidant capacity indicated a functional difference between RW and BRWs. CONCLUSION: It was feasible to produce rice wine using baked rice. The baking method allowed for several advantages, including the improvement of alcohol yield, fermentation efficiency, new typicality and stronger antioxidant capacity. This work is expected to provide a foundation for related research. © 2021 Society of Chemical Industry.

The effects of family physician-contracted service on health-related quality of life and equity in health in China.

BACKGROUND: Family physician-contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents' health-related quality of life (HRQoL) and equity in health among the Chinese population. METHODS: The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health. RESULTS: Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P <  0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p <  0.001). CONCLUSIONS: This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.

Exploring the relationship between functional limitations of the older adults and the health-related quality of life of their spouse in Shaanxi Province, China.

BACKGROUND: With trends towards longer life expectancy, lifetime with disability has also been prolonged. It is increasingly recognized that not only the person with disability but also those around them are affected. The relationship between functional limitation (FL) of the older adults and health-related quality of life (HRQoL) of their spouse is of interest. So too is the determination of the factors aside from FL that influence HRQoL. METHODS: The sample was derived from the 2013 National Health Service Survey conducted in Shaanxi Province in China. Married couples aged ≥ 60 years were selected (n = 3463). The European quality of life five dimensions (EQ-5D) and visual analogue scale were used to measure HRQoL. RESULTS: Both wife and husband reported lower HRQoL if either the male or female partner had some or serious FLs (P < 0.001). Other factors associated with lower HRQoL of the spouse included age, lower educational level, presence of chronic disease, and lower household economic status. Family size was associated with wife's HRQoL only when the male had no FL and lived with another 1-2 persons, or when the male had some FLs and lived in a larger family (n ≥ 5). Residential status did not relate to the HRQoL of spouses regardless of FL status. CONCLUSIONS: Older adults in Shaanxi province who have partners with FLs tend to report poorer EQ-5D, suggesting that couples amongst whom one has FL may be particularly vulnerable to lower HRQoL.

Gender differences in depressive symptoms of rural Chinese grandparents caring for grandchildren.

BACKGROUND: Caring for grandchildren is regarded as one of the principle roles of middle- and old-aged adults, especially among rural Chinese grandparents. This study aims to examine the gender differences in depressive symptoms of rural Chinese grandparents caring for grandchildren, based on the gender differences in grandparental role engagement and the theories of role strain and role enhancement. METHODS: A total of 4833 rural citizens with one or more grandchildren were selected from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015. Grandchild care was measured by continuous variable (duration) and categorical variable (no care, low intensity, moderate intensity, high intensity). Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). We used coarsened exact matching (CEM) to balance the covariates of caregivers and non-caregivers. Following CEM, 1975 non-caregivers and 2212 caregivers were identified (N = 4187). Multilevel linear regression was employed to examine the gender differences in depressive symptoms. We also tested for the moderating role of gender on the association between grandchild care and depressive symptoms. RESULTS: Grandmothers were more likely to provide grandchild care (54.42% vs 51.43%) at high intensity (61.46% vs 51.01%), with longer duration (39.24 h vs 33.15 h) than that given by grandfathers. Grandmothers suffered more from depressive symptoms than grandfathers, and such gap increased when grandparents were involved in high-intensity care. Grandmothers providing grandchild care, particularly at moderate intensity, were associated with fewer depressive symptoms (Coef. = - 0.087, 95%CI: - 0.163, - 0.010; Coef. = - 0.291, 95%CI: - 0.435, - 0.147), compared with non-caregivers. Grandmothers giving moderate intensity of grandchild care were also associated with fewer depressive symptoms (Coef. = - 0.171, 95% CI: - 0.313, - 0.029), compared with those with low-intensity care. However, such associations were not significant among grandfathers. CONCLUSIONS: Our findings highlight the gender differences in depressive symptoms of rural Chinese grandparents caring for grandchildren. Grandparents should be encouraged to engage in grandchild care, but at moderate intensity. The health status of middle- and old-aged adults, particularly females, should be monitored closely. Humanistic care, preventive care and curative treatment strategies focusing on such populations should be developed and refined.

Comparison of inequity in health-related quality of life among unemployed and employed individuals in China.

BACKGROUND: In China, achieving health equity has been regarded as a key issue for health reform and development in the current context. It is well known that unemployment has a negative effect on health. However, few studies have addressed the association between unemployment and inequity in health-related quality of life (HRQOL). This study aims to compare the inequality and inequity in HRQOL between the unemployed and employed in China. METHODS: The material regarding this study was derived from the Chinese National Health Services Survey of Shaanxi Province for 2013. We controlled for confounding factors by utilizing the coarsened exact matching method. Finally, 7524 employed individuals and 283 unemployed individuals who were 15 to 64 years old in urban areas were included in this study. We used HRQOL as the outcome variable, which was evaluated by using the Chinese version of EQ-5D-3L. The health concentration index, decomposition analysis based on the Tobit model, and the horizontal inequity index were employed to compute the socioeconomic-related equity between the unemployed and employed and the contribution of various factors. RESULTS: After matching, unemployed people tended to have poorer EQ-5D utility scores than employed people. There were statistically pro-rich inequalities in HRQOL among both employed and unemployed people, and the pro-rich health inequity of unemployed people was substantially higher than that of employed people. Economic status, age, education, smoking and health insurance were the factors influencing inequality in HRQOL between employed and unemployed individuals. Education status and basic health insurance have reduced the pro-rich inequity in HRQOL for unemployed people. CONCLUSION: It is suggested that unemployment intensifies inequality and inequity in HRQOL. According to policymakers, basic health insurance is still a critical health policy for improving health equity for the unemployed. Intervention initiatives aiming to tackle long-term unemployment through active labour market programmes, narrow economic gaps, improve educational equity and promote the health status of the unemployed should be considered by the government to achieve health equity.

Whether high government subsidies reduce the healthcare provision of township healthcare centers in rural China.

BACKGROUND: China's government launched a large-scale healthcare reform from 2009. One of the main targets of this round reform was to improve the primary health care system. Major reforms for primary healthcare institutions include increasing government investment. However, there are insufficient empirical studies based on large sample to catch long-term effect of increased government subsidy and lack of sufficient incentives on township healthcare centers (THCs), therefore, this study aims to provide additional empirical evidence on the concern by conducting an empirical analysis of THCs in Shaanxi province in China. METHODS: We collected nine years (2009 to 2017) data of THCs from the Health Finance Annual Report System (HFARS) that was acquired from the Health Commission of Shaanxi Province. We applied two-way fixed effect model and continue difference-in-difference (DID) model to estimate the effect of percentage of government subsidy on medical provision. RESULTS: A clear jump of the average percentage of government subsidy to total revenue of THCs can be found in Shaanxi province in 2011, and the average percentage has been more than 60% after 2011. Continue DID models indicate every 1% percentage of government subsidy to total revenue increase after 2011 resulted in a decrease of 1.1 to 3.5% in THCs healthcare provision (1.9% in medical revenue, 1.2% in outpatient visit, 3.5% in total occupy beds of inpatient, 1.1% in surgery revenue, 2.1% in sickbed utilization rate). The results show that the THCs with high government subsidy reduce the number of medical services after 2011. CONCLUSIONS: We think that it is no doubt that the government should take more responsibility for the financing of primary healthcare institutions, the problem is when government plays a central role in the financing and delivery of primary health care services, more effective incentives should be developed.

Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents.

BACKGROUND: Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China. METHODS: Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression. RESULTS: The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = - 2.897, 95%CI: - 4.434, - 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = - 3.040, 95%CI: - 4.473, - 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience. CONCLUSIONS: Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.

The Effectiveness of Bereavement Support for Adult Family Caregivers in Palliative Care: A Meta-Analysis of Randomized Controlled Trials.

PURPOSE: This meta-analysis aimed to summarize and synthesize the effectiveness of bereavement support for adult family caregivers in palliative care. METHODS: Meta-analysis was conducted. The databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, PubMed, Scopus, and Web of Science were comprehensively searched from inception until January 2020. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and standard methods for conducting a meta-analysis. Data analysis was performed using Comprehensive Meta-analysis version 3.0, and the random-effects model was adopted. FINDINGS: In total, 19 randomized controlled trials with an overall sample size of 2,690 participants met the inclusion criteria. The study showed that bereavement support had a significant effect on reducing grief (Hedges' g score = -0.198; 95% confidence interval [CI] -0.310 to -0.087), depression (Hedges' g score = -0.252; 95% CI -0.406 to -0.098), and anxiety (Hedges' g score = -0.153; 95% CI -0.283 to -0.023); however, high heterogeneity was present. No statistically significant difference was shown for traumatic feelings. Based on moderator analysis, a group format was more effective for grief, a combined individual and group format for depression, and an individual format for anxiety. Bereavement support was more effective when delivered by professionals, when delivered in more than six sessions, and need to be evaluated within 6 months. CONCLUSIONS: Bereavement support was effective in reducing grief, depression, and anxiety. The majority of the included studies had moderate heterogeneity, which limited the comparability of the evidence. Therefore, more robust randomized controlled trials are needed to confirm these study results. CLINICAL RELEVANCE: This meta-analysis provides evidence that bereavement support delivered in the palliative care setting is effective for reducing grief, depression, and anxiety. Nurses and other healthcare professionals can make recommendations for adult family caregivers based on this study in reducing psychological symptoms due to a loss in the palliative care domain.

HISTONE DEACETYLASE6 Acts in Concert with Histone Methyltransferases SUVH4, SUVH5, and SUVH6 to Regulate Transposon Silencing.

Histone deacetylases (HDACs) play important roles in regulating gene expression. In yeast and animals, HDACs act as components of multiprotein complexes that modulate transcription during various biological processes. However, little is known about the interacting proteins of plant HDACs. To identify the plant HDAC complexes and interacting proteins, we developed an optimized workflow using immunopurification coupled to mass spectrometry-based proteomics in Arabidopsis thaliana We found that the histone deacetylase HDA6 can interact with the histone methyltransferases SUVH4, SUVH5, and SUVH6 (SUVH4/5/6). Domain analysis revealed that the C-terminal regions of HDA6 and SUVH5 are important for their interaction. Furthermore, HDA6 interacts with SUVH4/5/6 and coregulates a subset of transposons through histone H3K9 methylation and H3 deacetylation. In addition, two phosphorylated serine residues, S427 and S429, were unambiguously identified in the C-terminal region of HDA6. Phosphomimetics (amino acid substitutions that mimic a phosphorylated protein) of HDA6 resulted in increased enzymatic activity, whereas the mutation of S427 to alanine in HDA6 abolished its interaction with SUVH5 and SUVH6, suggesting that the phosphorylation of HDA6 is important for its activity and function.

Measuring spatial accessibility and within-province disparities in accessibility to county hospitals in Shaanxi Province of Western China based on web mapping navigation data.

BACKGROUND: The Chinese government proposed the "XIAO BING BU CHU CUN, DA BING BU CHU XIAN" initiative in 2016, which states the rate of health care service provided by county hospitals should reach 90% of overall health care service provision. The prerequisite for achieving this goal is that citizens should be able to access county hospitals' services conveniently and impartially. However, little research has been done on the actual levels of the spatial accessibility of citizens to county hospitals in Western China. Therefore, we aimed to measure the spatial accessibility to county hospitals for county residents and to identify any regional disparities in Shaanxi Province in Western China. METHODS: We implemented a novel method - involving utilizing navigation data from the AutoNavi web mapping system (knows as Gaode map in Chinese) - to assess the time and distance from villages and neighborhoods to the county hospitals. The navigation data were collected by request through an application-programming-interface using a web crawler (web data extraction tool) in Python. The shortest driving time and distance were extracted from the navigation data. The travel impedance to the nearest provider (TINP) indicator was used to measure spatial accessibility. RESULTS: The results show that county residents in Western China's Shaanxi Province have poor spatial accessibility to county hospitals. Only 68.8% of villages and neighborhoods are within 60 min travel time (based on driving mode) to a county hospital, while 13.4% of such villages and neighborhoods are beyond 90 min travel time. Moreover, a significant within-province disparity exists, with residents in the central area enjoying the best accessibility to county hospitals, while the northern and southern areas still need improvements in accessibility. CONCLUSIONS: Focused health resource planning is required to improve the spatial accessibility to county hospitals and to eliminate regional disparities. Further studies are called for to integrate the navigation data of web mapping systems with GIS methods to the measure spatial accessibility of health facilities in more complex contexts.

Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China.

BACKGROUND: Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients' access to health care and whether their inpatient care use varies by remoteness. METHODS: Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent's village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient's latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored. RESULTS: The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients. CONCLUSION: Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies.

[Impact of Chest Physical Therapy on Length of Stay and Medical Expenditures for Patients With Pulmonary Infection].

BACKGROUND: Sputum retention increases significantly the risk of repetitive respiratory tract infections, which may result in dyspnea and lung injury. Chest physical therapy is the most commonly used method to assist patients to expel sputum. This intervention promotes sputum clearance and prevents airway obstruction, thereby reducing the risk of lung infection. PURPOSE: The purpose of this study was to investigate the impact of chest physical therapy on the length of hospitalization and the medical expenditures of patients with pulmonary infection. METHODS: A retrospective-correlation study was used. Data were collected from 2013 to 2017 in the medical ward of a medical center located in southern Taiwan. The annual differences in the length of stay, medical expenditures, and readmission rates for patients with pulmonary infection after chest physical therapy were analyzed. RESULTS: A total of 707 patients with pulmonary infection were recruited and enrolled as participants. The mean age of the participants was 75.4 (± 13.8) years. The results showed that length of stay (F = 6.66, p < .001) and medical expenditures (F = 5.34, p < .001) were both significantly lower after chest physical therapy and that the corresponding readmission rates had decreased significantly, from 6.9% in 2013 to 1.7% in 2017 (x2 = 5.84, p = .016). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: After conducting a yearly comparison, the results of this study indicate that administering chest physical therapy may be an effective strategy for reducing the length of stay, readmission rates, and medical expenditures of patients with pulmonary infection. The findings of this study may serve as a reference for the clinical implementation of chest physical therapy in patients with pulmonary infection.

Origination and selection of ABCDE and AGL6 subfamily MADS-box genes in gymnosperms and angiosperms.

BACKGROUND: The morphological diversity of flower organs is closely related to functional divergence within the MADS-box gene family. Bryophytes and seedless vascular plants have MADS-box genes but do not have ABCDE or AGAMOUS-LIKE6 (AGL6) genes. ABCDE and AGL6 genes belong to the subgroup of MADS-box genes. Previous works suggest that the B gene was the first ABCDE and AGL6 genes to emerge in plant but there are no mentions about the probable origin time of ACDE and AGL6 genes. Here, we collected ABCDE and AGL6 gene 381 protein sequences and 361 coding sequences from gymnosperms and angiosperms and reconstructed a complete Bayesian phylogeny of these genes. In this study, we want to clarify the probable origin time of ABCDE and AGL6 genes is a great help for understanding the role of the formation of the flower, which can decipher the forming order of MADS-box genes in the future. RESULTS: These genes appeared to have been under purifying selection and their evolutionary rates are not significantly different from each other. Using the Bayesian evolutionary analysis by sampling trees (BEAST) tool, we estimated that: the mutation rate of the ABCDE and AGL6 genes was 2.617 × 10-3 substitutions/site/million years, and that B genes originated 339 million years ago (MYA), CD genes originated 322 MYA, and A genes shared the most recent common ancestor with E/AGL6 296 MYA, respectively. CONCLUSIONS: The phylogeny of ABCDE and AGL6 genes subfamilies differed. The APETALA1 (AP1 or A gene) subfamily clustered into one group. The APETALA3/PISTILLATA (AP3/PI or B genes) subfamily clustered into two groups: the AP3 and PI clades. The AGAMOUS/SHATTERPROOF/SEEDSTICK (AG/SHP/STK or CD genes) subfamily clustered into a single group. The SEPALLATA (SEP or E gene) subfamily in angiosperms clustered into two groups: the SEP1/2/4 and SEP3 clades. The AGL6 subfamily clustered into a single group. Moreover, ABCDE and AGL6 genes appeared in the following order: AP3/PI → AG/SHP/STK → AGL6/SEP/AP1. In this study, we collected candidate sequences from gymnosperms and angiosperms. This study highlights important events in the evolutionary history of the ABCDE and AGL6 gene families and clarifies their evolutionary path.