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Background Effective self-management behaviors offer a promising pathway to address the health challenges faced by patients with chronic diseases. As a key factor influencing self-management behaviors, multidimensional health literacy has yet to be systematically studied in relation to its impact on patients with chronic diseases across different socioeconomic statuses. Objective To systematically investigate the influence of functional, communicative, critical, and distributed health literacy on self-management behaviors among patients with chronic diseases from different socioeconomic statuses. Methods A modified multidimensional health literacy and self-management behavior questionnaire was used to assess the health literacy and self-management behaviors of patients with chronic diseases. A total of 590 valid samples were obtained, and participants were divided into high and low socioeconomic status groups based on their socioeconomic background. Correlation analysis and multiple linear regression were conducted to explore the influence of various dimensions of health literacy on self-management behaviors across different socioeconomic statuses. Results After controlling for confounding variables, the communicative (β = 0.262, P  < 0.01) and distributed (β = 0.343, P  < 0.01) health literacy dimensions showed a significant positive impact on self-management behaviors in the low socioeconomic status group. In the high socioeconomic status group, critical (β = 0.253, P  < 0.05) and distributed (β = 0.267, P  < 0.01) health literacy demonstrated a significant positive effect on self-management behaviors. No significant impact was observed for functional health literacy in either group. Conclusions The study comprehensively reveals the distinct effects of different dimensions of health literacy on self-management behaviors among patients with chronic diseases from varying socioeconomic statuses. These findings provide a theoretical basis for developing strategies aimed at improving self-management behaviors through health literacy enhancement, particularly tailored to patients from different socioeconomic backgrounds.

PurposeInulin is a type of fermentable dietary fiber, which is non-digestible, and can improve metabolic function by modulating intestinal microbiota. This study aimed to evaluate the role of inulin in hyperuricemia and microbial composition of the gut microbiota in a mouse model of hyperuricemia established through knockout of Uox (urate oxidase) gene.MethodsKO (Uox-knockout) and WT (wild-type) mice were given inulin or saline by gavage for 7 weeks. The effect of inulin to combat hyperuricemia was determined by assessing the changes in serum UA (uric acid) levels, inflammatory parameters, epithelial barrier integrity, fecal microbiota alterations, and SCFA (short-chain fatty acid) concentrations in KO mice.ResultsInulin supplementation can effectively alleviate hyperuricemia, increase the expressions of ABCG2 in intestine, and downregulate expression and activity of hepatic XOD (xanthine oxidase) in KO mice. It was revealed that the levels of inflammatory cytokines and the LPS (lipopolysaccharide) were remarkably higher in the KO group than those in the WT group, indicating systemic inflammation of hyperuricemic mice, but inulin treatment ameliorated inflammation in KO mice. Besides, inulin treatment repaired the intestinal epithelial barrier as evidenced by increased levels of intestinal TJ (tight junction) proteins [ZO-1 (zonula occludens-1) and occluding] in KO mice. Moreover, serum levels of uremic toxins, including IS (indoxyl sulfate) and PCS (p-cresol sulfate), were reduced in inulin-treated KO mice. Further investigation unveiled that inulin supplementation enhanced microbial diversity and raised the relative abundance of beneficial bacteria, involving SCFAs-producing bacteria (e.g., Akkermansia and Ruminococcus). Additionally, inulin treatment increased the production of gut microbiota-derived SCFAs (acetate, propionate and butyrate concentrations) in KO mice, which was positively correlated with the effectiveness of hyperuricemia relief.ConclusionsOur findings showed that inulin may be a promising therapeutic candidate for the treatment of hyperuricemia. Moreover, alleviation of hyperuricemia by inulin supplementation was, at least, partially conciliated by modulation of gut microbiota and its metabolites.

The Varian Ethos system allows for online adaptive treatments through the utilization of artificial intelligence (AI) and deformable image registration which automates large parts of the anatomical contouring and plan optimization process. In this study, treatments of intact prostate and prostate bed, with and without nodes, were simulated for 182 online adaptive fractions, and then a further 184 clinical fractions were delivered on the Ethos system. Frequency and magnitude of contour edits were recorded, as well as a range of plan quality metrics. From the fractions analyzed, 11% of AI generated contours, known as influencer contours, required no change, and 81% required minor edits in any given fraction. The frequency of target and noninfluencer organs at risk (OAR) contour editing varied substantially between different targets and noninfluencer OARs, although across all targets 72% of cases required no edits. The adaptive plan was the preference in 95% of fractions. The adaptive plan met more goals than the scheduled plan in 78% of fractions, while in 15% of fractions the number of goals met was the same. The online adaptive recontouring and replanning process was carried out in 19 min on average. Significant improvements in dosimetry are possible with the Ethos online adaptive system in prostate radiotherapy.

To achieve high power conversion efficiency in perovskite/silicon tandem solar cells, it is necessary to develop a promising wide-bandgap perovskite absorber and processing techniques in relevance. To date, the performance of devices based on wide-bandgap perovskite is still limited mainly by carrier recombination at their electron extraction interface. Here, we demonstrate assembling a binary two-dimensional perovskite by both alternating-cation-interlayer phase and Ruddlesden−Popper phase to passivate perovskite/C 60 interface. The binary two-dimensional strategy takes effects not only at the interface but also in the bulk, which enables efficient charge transport in a wide-bandgap perovskite solar cell with a stabilized efficiency of 20.79% (1 cm 2 ). Based on this absorber, a monolithic perovskite/silicon tandem solar cell is fabricated with a steady-state efficiency of 30.65% assessed by a third party. Moreover, the tandem devices retain 96% of their initial efficiency after 527 h of operation under full spectral continuous illumination, and 98% after 1000 h of damp-heat testing (85 °C with 85% relative humidity). The performance of wide bandgap perovskite solar cells is limited by the carrier recombination at their electron extraction interface. Here, the authors assemble binary 2D perovskites for efficient charge transport and realizing stable perovskite/silicon tandems with device efficiency over 30%.

Objective This study explored the relationship between smokers’ health literacy, knowledge of smoking hazards, and their intention to quit. Methods Based on data from the 2019 Health Literacy and Tobacco Use Surveillance among residents of a city in Zhejiang Province, 1120 male smokers were screened. Differential tests were used to analyze whether smokers with varying levels of health literacy and knowledge about smoking hazards differed in their intention to quit smoking and the intensity of their intention. A multi-factor logistic regression model was constructed to explore the extent of these differences. Results Only 24.8% of smokers had higher health literacy. Among smokers, those with an intention to quit had a higher health literacy level compared to those without such intention (32.7% vs. 17.0%, p  < 0.001). Health literacy levels did not differ significantly between groups with different intensity of intention to quit (34.2% vs. 31.9% vs. 30.1%, p  = 0.435). About 48.7% of the smokers a higher level of knowledge about smoking hazards. It was more prevalent in the intent to quit group compared to the no intent to quit group (54.0% vs. 43.4%, p  < 0.001), and the low intent to quit group had lower knowledge compared to the moderate and high intent to quit groups (49.1% vs. 56.6% vs. 63.4%, p  = 0.011). After adjusting for other influences, smokers with lower health literacy were less likely to have intention to quit (OR = 0.659, p  = 0.016). And the association between knowledge about smoking hazards and whether smokers have the intention to quit is no longer significant, but it significantly affects the intensity of the intention to quit among smokers who already have the intention (OR = 0.623, p  = 0.005). Conclusion General health literacy may play a role in facilitating smokers’ progression from the stage of no intent to quit to one of intent to quit, but a more specific understanding of the harms of smoking may be needed to increase the strength of intent to quit.

The sustainable development goals of the United Nations, as well as the era of pandemics have introduced serious challenges for agricultural production and management. Precise management of agricultural practices based on satellite-borne remote sensing has been considered an effective means for monitoring cropping patterns and crop-farming patterns. Therefore, we proposed a simple and generic approach to identify multi-year cotton-cropping patterns based on time series of Landsat and Sentinel-2 images, with few ground samples that covered many years, a simple classification algorithm, and had a high classification accuracy. In this approach, we extended the size of training samples using active learning, and we employed a random forest algorithm to extract multi-year cotton planting patterns based on dense time series of Landsat and Sentinel-2 data from 2014 to 2018. We created annual crop cultivation maps based on training samples with an accuracy greater than 95.69%. The accuracy of multi-year cotton cropping patterns was 96.93%. The proposed approach was effective and robust in identifying multi-year cropping patterns, and it could be applied in other regions.

In order to address population aging and the healthy China strategy, this paper takes three provinces and one city in the Yangtze River Delta urban agglomeration as the empirical target. Firstly, using the 2010 and 2020 census data, and taking the aging coefficient and the density of the elderly population as the basic research indexes, this paper adopts the center of gravity migration model and the standard deviation ellipse to outline the spatial evolution path of the aging coefficient and the density of the elderly population. Second, using the data of recreational tourism sites in each prefecture-level city of the Yangtze River Delta urban agglomeration from 2016 to 2022, the closest neighbor index is used to judge the overall distribution characteristics of recreational tourism sites, and the judgment results are further verified with the help of Tyson polygonal analysis. Finally, based on the cross-section data of the elderly population in 2020, the spatial distribution of recreation and tourism sites and the elderly population are matched by the geographic concentration index, the center of gravity model and the matching coefficient. The results show that (1) the degree of population aging is deepening, and the characteristics of spatial Agglomeration are obvious, but the development speed among regions is inconsistent; (2) the distribution of health tourism destinations is wide and uneven between regions, showing the characteristics of ‘overall dispersion and local concentration’; (3) the spatial distribution of health tourism destinations and the elderly population shows a certain matching relationship, but the matching degree is not high. With the Yangtze River as the boundary, the distribution of health tourism destinations is ‘high in the south and low in the north’ and assumes a ladder shape from south to north, with obvious regional differences. Overall, health tourism lags behind the development process of aging.

Background The influence of different dimensions of intergenerational support on depression in older adults has a configuration effect. Existing researches have only used linear analyses to examine the independent effects of each dimension of intergenerational support on depression in older adults, resulting in the nature of the effects of each dimension of intergenerational support on the presence of depression in older adults remaining highly controversial. Objective To explore the synergy and substitution effects (configurational effects) of dimensions of intergenerational support on depression in older adults. Method Based on data from the 2018 China Health and Retirement Longitudinal Study(CHARLS), depression among older adults was used as the outcome variable, and intergenerational support (including three dimensions of emotional, economic, and caregiving support) was used as the antecedent variable. Qualitative comparative analysis (QCA) was used to analyze the configurational effects of intergenerational support on depression in older adults. Result A single dimension of intergenerational support cannot be a necessary condition for depression in older adults.Factor configurations of different dimensions of intergenerational support as a sufficient condition for depression in older adults. The consistency parameter for all solution configurations in this study is 0.83, with a coverage of 0.61. The research identifies four types of configurational patterns associated with older adults’ depression: “Unidirectional Care Deficiency Type” (consistency mean of 0.84, coverage of 0.49), “Bidirectional Care Deficiency Type” (consistency mean of 0.86, coverage of 0.33), “Bidirectional Economic Deficiency Type” (consistency mean of 0.85, coverage of 0.48), and “Mixed Type” (consistency mean of 0.83, coverage of 0.23). Conclusion Depression in older adults is influenced by the configurational effects of intergenerational support. The complex link between intergenerational support and depression in older adults should be examined from a holistic perspective, paying attention to the dynamic balance of intergenerational support reception and provision.

The wetland landscape patterns of the Yellow River Delta have undergone an extremely significant change due to rapid economic development since 2000. The aim of this paper is to quantitatively analyze spatial and temporal changes of these wetlands in the recent decade. Three sets of wetland maps were acquired using object–oriented classification method based on remotely sensed imageries in 2000, 2005 and 2010. Then landscape indices from class and landscape level using FRAGSTATS 3.3 software were used to quantify the spatial and temporal dynamics of wetlands. The results showed that wetlands coverage decreased by approximately 2.27%. Natural wetlands decreased while constructed wetlands increased, especially prawn pools, which increased by 268.33%. Wetland landscape patches gradually became more complex and decentralized. Wetlands distribution analysis indicated that wetlands were mainly located in the area 45 km from the coastline. The study indicated a relatively high diversity at the estuary of the river and the north of the study area. However, wetlands were highly fragmented in the south of the study area and urban area. Dynamic of wetlands was mainly caused by human–induced factors, especially GDP and urban built–up area.

Nanjing (China) has undergone rapid urbanization since the reform and opening up in 1978. The urban heat environment has been affected significantly by human activities. In this paper, we aim at revealing the influence of land cover types on urban heat retrieved from the thermal infrared band of Landsat-5 Thematic Mapper. The results show that the high-temperature area is mainly located in the urban area of Nanjing, while the low-temperature area is located in the forest and water body areas. The average land surface temperature of Qinhuai District is the highest (29.1 °C), while Pukou District has lower temperatures. Geometrically, the city center has the highest temperature, and the land surface temperature gradually decreases with distance from the city center. The land surface temperature of industrial land is the highest, while rivers reveal the lowest temperature in the region (24.3 °C). The size and number of land cover patches have a positive correlation with the heat contribution. The construction land has the significantly positive correlation with land surface temperature, while arable land, forest, water body and wetland have significantly negative correlations. Land surface temperatures in highly growing urban areas are higher than the associated old town, and this is due to the use of new construction materials, and to lower vegetation coverage.