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It has been confirmed that tamoxifen (TAM) use is associated with thromboembolic risks; however, it remains uncertain which specific thromboembolic events warrant prioritized surveillance beyond those already listed in the prescribing information. This study was conducted to assess the relationship between TAM use and reported thromboembolic events using the latest FDA Adverse Event Reporting System (FAERS) data. Tamoxifen-related AEs reported in FAERS between January 2004 and December 2024 were extracted, screened for thromboembolic cases, and subjected to disproportionality analysis to identify significant signals. A clinical prioritization scoring system was then applied to rank signal relevance, and multivariate regression analyses were performed to identify factors associated with thromboembolic outcomes. Among 385 TAM-associated thromboembolic events, 28 significant signals were detected. Newly detected signals comprised unilateral paralysis, retinal artery occlusion, and atrial thrombosis. Male sex, older age, and elevated body mass were identified as risk indicators for thromboembolism. These findings may inform enhanced clinical surveillance and TAM risk stratification; however, further validation is warranted.

The aerosol–planetary boundary layer (PBL) interaction was proposed as an important mechanism to stabilize the atmosphere and exacerbate surface air pollution. Despite the tremendous progress made in understanding this process, its magnitude and significance still have large uncertainties and vary largely with aerosol distribution and meteorological conditions. In this study, we focus on the role of aerosol vertical distribution in thermodynamic stability and PBL development by jointly using micropulse lidar, sun photometer, and radiosonde measurements taken in Beijing. Despite the complexity of aerosol vertical distributions, cloud-free aerosol structures can be largely classified into three types: well-mixed, decreasing with height, and inverse structures. The aerosol–PBL relationship and diurnal cycles of the PBL height and PM2.5 associated with these different aerosol vertical structures show distinct characteristics. The vertical distribution of aerosol radiative forcing differs drastically among the three types, with strong heating in the lower, middle, and upper PBL, respectively. Such a discrepancy in the heating rate affects the atmospheric buoyancy and stability differently in the three distinct aerosol structures. Absorbing aerosols have a weaker effect of stabilizing the lower atmosphere under the decreasing structure than under the inverse structure. As a result, the aerosol–PBL interaction can be strengthened by the inverse aerosol structure and can be potentially neutralized by the decreasing structure. Moreover, aerosols can both enhance and suppress PBL stability, leading to both positive and negative feedback loops. This study attempts to improve our understanding of the aerosol–PBL interaction, showing the importance of the observational constraint of aerosol vertical distribution for simulating this interaction and consequent feedbacks.

The hierarchical healthcare system is widely considered to be a desirable mode of the delivery of healthcare services. It is expected that the establishment of a hierarchical healthcare system can help provide better and more equal healthcare accessibility. However, limited evidence has been provided on the impacts of a hierarchical healthcare system on healthcare accessibility. This study develops an improved Hierarchical two-step floating catchment area (2SFCA) method, which incorporates variable catchment area sizes, distance friction effects and utilization efficiency for facilities at different levels. Leveraging the Hierarchical 2SFCA method, various scenarios are set up to assess the accessibility impacts of a hierarchical healthcare system. The methods are applied in a case study of Shenzhen. The results reveal significant disparity and inequality in healthcare accessibility and also differences between various facility levels in Shenzhen. The overall healthcare accessibility and its equality can be significantly improved by fully utilizing existing facilities. It is also demonstrated that allocating additional supply to lower-level facilities can generate larger accessibility gains. Furthermore, allocating new supply to primary facilities would mitigate the inequality in healthcare accessibility, whereas inequality tends to be aggravated with new supply allocated to tertiary facilities. These impacts cannot be captured by traditional accessibility measures. This study demonstrates the pivotal role of primary facilities in the hierarchical healthcare system. It can contribute to the literature by providing transferable methods and procedures for measuring hierarchical healthcare accessibility and assessing accessibility impacts of a hierarchical healthcare system in developing countries.

Background Overweight and obesity are major public health crises among children and adolescents and contribute to a significant economic burden. We aimed to investigate the relationship between breastfeeding duration and overweight and obesity in children and adolescents in Qingdao, China in 2017. Methods This study conducted a survey with 10,753 students (5370 boys and 5383 girls) aged 6 to 16 years from the Shibei District of Qingdao, China in 2017. Anthropometric measurements were taken by well-trained personnel and self-completed questionnaires were used to collect data from students. A variety of statistical methods were used in this study, including univariate and multivariate analyses, as well as linear and nonlinear regression models. Results The prevalence of overweight and obesity was 15.45% and 19.76%, respectively. There was a significant negative correlation between breastfeeding duration and BMI in children and adolescents (β = -0.025, 95% CI: -0.033, -0.005, P  < 0.01). Among boys, the BMI in children and adolescences of those who have been breastfed for more than 12 months was significantly lower than that of others whose breastfeeding duration was less than 12 months (β = -0.440, 95%CI -0.655, -0.224, P  < 0.01). Breastfeeding has a particularly positive effect on the prevalence of obesity in boys aged 9 to 11 years (OR = 0.978, 95% CI: 0.958,0.999, P  < 0.05). Conclusion Breastfeeding can significantly reduce the prevalence of overweight and obesity among children and adolescents aged 6 to 16 years. Those who were breastfed for more than 12 months had a lower risk of developing overweight and obesity, especially boys between the ages of 9 and 11.

The pumped storage power station (PSPS) is an important measure to achieve the strategic goal of “dual carbon”. As one of the preferred types for the upper reservoir dams of PSPSs, the concrete-faced rockfill dam (CFRD) often has a dam foundation on a steep transverse slop and is prone to produce slip deformation along the slope, resulting in poor anti-sliding stability of the dam slope. It is dangerous for the operation safety of PSPSs. Therefore, the slip deformation of CFRDs on dam foundations with large dip angles is investigated. The mechanism for the initiation of slip deformation is revealed. The design measures of physical mechanic and geometric structure are proposed to reduce slip deformation. The results show that the larger sliding forces and smaller anti-sliding forces are the fundamental reasons that CFRDs on dam foundations with large dip angles are prone to produce slip deformation. The larger the dip angle of the dam foundation, the larger the slip deformation of the dam body and face slab, and the smaller the safety factor of the dam slope. When the dip angle of the dam foundation is greater than 15°, the safety factor of the dam slope is less than the minimum value of 1.5 required by codes. The addition of pressure slopes can effectively reduce the slip deformation of the dam body or face slab and significantly improve the anti-sliding stability of the dam slope. When the height or width of the pressure slope platform is greater and the cohesion or internal friction angle of the pressure slope is larger, the slip deformations of the dam body and face slab are smaller, and the safety factor of the dam slope is greater. It is recommended that the height and width of the pressure slope platform be 1/2 times the maximum height of the main dam, and the density (cohesion and internal friction angle) of the pressure slope be equivalent to that of the main dam’s rockfill material. The research results can provide theoretical and technical support for the design and construction of CFRDs for the upper reservoir of PSPSs.

Cellular profiling with multiplexed immunofluorescence (MxIF) images can contribute to a more accurate patient stratification for immunotherapy. Accurate cell segmentation of the MxIF images is an essential step. We propose a deep learning pipeline to train a Mask R-CNN model (deep network) for cell segmentation using nuclear (DAPI) and membrane (Na + K + ATPase) stained images. We used two-stage domain adaptation by first using a weakly labeled dataset followed by fine-tuning with a manually annotated dataset. We validated our method against manual annotations on three different datasets. Our method yields comparable results to the multi-observer agreement on an ovarian cancer dataset and improves on state-of-the-art performance on a publicly available dataset of mouse pancreatic tissues. Our proposed method, using a weakly labeled dataset for pre-training, showed superior performance in all of our experiments. When using smaller training sample sizes for fine-tuning, the proposed method provided comparable performance to that obtained using much larger training sample sizes. Our results demonstrate that using two-stage domain adaptation with a weakly labeled dataset can effectively boost system performance, especially when using a small training sample size. We deployed the model as a plug-in to CellProfiler, a widely used software platform for cellular image analysis.

The urban heat island (UHI) refers to the land surface temperature (LST) difference between urban areas and their undeveloped or underdeveloped surroundings. It is a measure of the thermal influence of the urban built-up area expansion (UBAE), a topic that has been extensively studied. However, the impact of UBAE on the LST differences between urban areas and rural areas (UHIU−R) and between urban areas and emerging urban areas (UHIU−S) in different seasons has seldom been investigated. Here, the UHIU−S and UHIU−R in 34 major metropolitan regions across China, and their spatiotemporal variations based on long-term space-borne observations during the period 2001–2020 were analyzed. The UBAE quantified by the difference in landscape metrics of built-up areas between 2020 and 2000 and their impact on UHI was further analyzed. The UBAE is impacted by the level of economic development and topography. The UBAE of cities located in more developed regions was more significant than that in less developed regions. Coastal cities experienced the most obvious UBAE, followed by plain and hilly cities. The UBAE in mountainous regions was the weakest. On an annual basis, UHIU−R was larger than UHIU−S, decreasing more slowly with UBAE than UHIU−S. In different seasons, the UHIU−S and UHIU−R were larger, more clearly varying temporally with UBAE in summer than in winter, and their temporal variations were significantly correlated with UBAE in summer but not in winter. The seasonal difference in UHIU−R was larger than that of UHIU−S. Both the UHIU−S and UHIU−R in coastal cities were the lowest in summer, decreasing the fastest with UBAE, while those in mountain cities decreased the slowest. The change in the density of built-up lands was the primary driver affecting the temporal variations in UHIU−S and UHIU−R during UBAE, followed by changes in proportion and shape, while the impact of the speed of expansion was the smallest, all of which were more obvious in summer than in winter. The decreased density of built-up lands can reduce UHI. These findings provide a new perspective for a deeper understanding of the effect of urban expansion on LST in different seasons.

Urbanization and air pollution are major anthropogenic impacts on Earth’s environment, weather, and climate. Each has been studied extensively, but their interactions have not. Urbanization leads to a dramatic variation in the spatial distribution of air pollution (fine particles) by altering surface properties and boundary-layer micrometeorology, but it remains unclear, especially between the centers and suburbs of metropolitan regions. Here, we investigated the spatial variation, or inhomogeneity, of air quality in urban and rural areas of 35 major metropolitan regions across China using four different long-term observational datasets from both ground-based and space-borne observations during the period 2001–2015. In general, air pollution in summer in urban areas is more serious than in rural areas. However, it is more homogeneously polluted, and also more severely polluted in winter than that in summer. Four factors are found to play roles in the spatial inhomogeneity of air pollution between urban and rural areas and their seasonal differences: (1) the urban–rural difference in emissions in summer is slightly larger than in winter; (2) urban structures have a more obvious association with the spatial distribution of aerosols in summer; (3) the wind speed, topography, and different reductions in the planetary boundary layer height from clean to polluted conditions have different effects on the density of pollutants in different seasons; and (4) relative humidity can play an important role in affecting the spatial inhomogeneity of air pollution despite the large uncertainties.

Equal accessibility to healthcare services is essential to the achievement of health equality. Recent studies have made important progresses in leveraging GIS-based location–allocation models to optimize the equality of healthcare accessibility, but have overlooked the hierarchical nature of facilities. This study developed a hierarchical maximal accessibility equality model for optimizing hierarchical healthcare facilities. The model aims to maximize the equality of healthcare facilities, which is quantified as the variance of the accessibility to facilities at each level. It also accounts for different catchment area sizes of, and distance friction effects for hierarchical facilities. To make the optimization more realistic, it can also simultaneously consider both existing and new facilities that can be located anywhere. The model was operationalized in a case study of Shenzhen, China. Empirical results indicate that the optimal healthcare facility allocation based on the model provided more equal accessibility than the status quo. Compared to the current distribution, the accessibility equality of tertiary and secondary healthcare facilities in optimal solutions can be improved by 40% and 38%, respectively. Both newly added facilities and adjustments of existing facilities are needed to achieve equal healthcare accessibility. Furthermore, the optimization results are quite different for facilities at different levels, which highlights the feasibility and value of the proposed hierarchical maximal accessibility equality model. This study provides transferable methods for the equality-oriented optimization and planning of hierarchical facilities.

Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients' mobile app adoption behavior; however, they offer limited insights into doctors' personal preferences among a variety of choices of mobile apps. This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees' perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors' affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. Our findings contribute to a nuanced understanding of doctors' adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns.