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Background The purpose of the present study was to obtain information on the use of PD-1/PD-L1 inhibitors by oncologists in China through a national questionnaire survey. Methods Between the 7th and 25th of July in 2019, a questionnaire designed by the Chinese Society of Clinical Oncology Immuno-Oncology (CSCO IO) Committee on the current status of the use of PD-1/PD-L1 inhibitors was distributed online and offline to cancer-related medical departments in thirty different provinces and autonomous regions of China. The national questionnaire consisted of three sections as follows: general information, current status of the application of PD-1/PD-L1 inhibitors in the clinic, and oncologists’ concerns regarding utilization. Results The valid response rate of the current status survey was 76.3%. The proportion of senior doctors (physician-in-charge or a more superior position for more than 3 years) among the respondents was relatively high (67.0% in 588). Of the respondents, 59.2% had prescribed PD-1/PD-L1 inhibitors during clinical treatment, and the most frequent reason for not prescribing these inhibitors was the choice “do not understand the mechanism and the efficacy of PD-1/PD-L1 inhibitors”. In addition, 77.9% of the prescribers used the medications in an off-label situation, and the most important motivation for this use was the fact that “there were indications abroad but not domestically”. In addition, 77.9% of the prescribers believed that “immunotherapy-related adverse effects could be controlled or intervened through follow-up management”. The prescribers were mostly concerned about “how to identify pseudoprogression and hyperprogression” and “immunity-related adverse effects management”. Conclusion The present study highlights the current status of PD-1/PD-L1 inhibitors in China. Increasing numbers of medical oncologists are interested in PD-1/PD-L1 inhibitors, and they are in need of immunotherapy education.

Objective Through the investigation of the current situation of bladder cancer secondary electrotomy performed by urologists in China, it provides reference for further improvement and improvement of diagnosis and treatment norms. Methods From September 3, 2023 to October 7, 2023, questionnaires compiled by researchers were distributed and collected from urologists across the country in the form of electronic questionnaires through the questionnaire Star platform; The questionnaire data were exported online using SPSS 26.0 software (SPSS Inc, Chicago, IL, USA) and R language (R Foundation for Statistical Computing, Vienna, Austria, Austria). Version 4.2.1) for data analysis. Count data were described by percentages, and comparisons between groups were made by chi-square test or Fisher’s exact test. Logistic regression was used to screen out the influencing factors related to the status of secondary electrotomy for bladder cancer performed by Chinese urologists and to construct a predictive model for the column-line diagram. ROC curves, calibration curves, and DCA curves were plotted to evaluate the model and validate its efficacy. Results A total of 514 valid questionnaires were returned. 77.2% (397/514) of the physicians interviewed were from tertiary care hospitals. 21.2% (109/514) were from secondary care hospitals. The acceptance rate of secondary electrosurgical resection of bladder cancer among Chinese urologists was 87.74%, with 12.26% still opposed to the procedure.The majority of respondents believed that secondary electroresection could be performed if the indications recommended by the guidelines were met (75%), while a significant number felt that the initial electroresection was complete and did not require a second (37.74%), or they decided whether to perform a secondary electroresection based on their clinical experience (40.27%). Conclusion Survey results indicate that secondary transurethral resection enhances staging accuracy, eliminates residual lesions, and decreases recurrence and progression rates. However, it serves as a means to compensate for shortcomings in the initial resection. Advances in NMIBC treatment techniques assist in reducing or avoiding the need for secondary transurethral resection in bladder cancer cases. This study is the first to develop a predictive model for Chinese urologists’ acceptance of secondary transurethral resection for bladder cancer and analyzes their perspectives on the procedure, offering a reference for future research.

在现有褐马鸡（Crossoptilon mantchuricum）谱系调查基础上，2019年发放问卷，对我国褐马鸡种群和饲养现状进行研究。结果表明：截至2020年6月30日，中国圈养褐马鸡种群共有存活个体121只，饲养在全国7个单位。种群统计学和遗传学分析结果显示，圈养种群建立者11只，潜在建立者12只，835%的个体处于繁殖年龄，种群未来发展具有较大潜力；圈养个体存活率随年龄增长而下降；在存活时间和繁殖间隔方面，雄性均比雌性长；种群中28%个体的祖先得到确定，人工种群存在一定程度的近亲繁殖。从饲养管理、食物、繁殖、疾病与预防方面，对饲养现状的调查分析显示，91%以上的个体饲养在太原动物园、山西庞泉沟国家级自然保护区、河北小五台山国家级自然保护区管理中心；不同饲养单位在人员配置、饲养笼舍面积和设施、食物供给、疾病预防等方面各有优势。根据种群和饲养现状调查结果建议，今后加强各饲养单位间的合作，扩大圈养种群的数量；进一步明确种群中个体关系，鼓励潜在建立者参与繁殖，避免近亲繁殖，提高种群遗传多样性。在个体标识、食物种类、饲养面积、个体存活率方面做进一步完善；鼓励亲鸟养育，筛选行为丰富、适应力强、遗传多样性高的优良个体，为再引入研究创造条件。

The terms health, health-related quality of life (HRQoL), and quality of life (QoL) are used interchangeably. Given that these are three key terms in the literature, their appropriate and clear use is important. This paper reviews the history and definitions of the terms and considers how they have been used. It is argued that the definitions of HRQoL in the literature are problematic because some definitions fail to distinguish between HRQoL and health or between HRQoL and QoL. Many so-called HRQoL questionnaires actually measure self-perceived health status and the use of the phrase QoL is unjustified. It is concluded that the concept of HRQoL as used now is confusing. A potential solution is to define HRQoL as the way health is empirically estimated to affect QoL or use the term to only signify the utility associated with a health state.

Background Pharmaceutical care is the responsible provision of medication therapy with the motive of improving patients’ quality of life. This study aimed to evaluate the current status, barriers and facilitators of pharmaceutical care provision in tertiary healthcare settings of six major metropolitan cities of Punjab, Pakistan. Methods A cross-sectional survey using convenience sampling method was conducted by administering validated questionnaire. The study was based on pharmacists’ self-reported practices gathered through either in-person interviews or Google Forms. Data was analyzed using SPSS version 25. Simple descriptive statistics and Chi-square test were used to assess the associations between demographic variables and study outcomes ( P < 0.05 considered significant). Results Overall, 127 participants were included in the final analysis. There were 121 (95.3%) respondents who reported adherence to rules while purchasing medications, 70 (55.1%) of respondents acknowledged the presence of a clinical pharmacist, 94 (74.0%) affirmed their commitment to provide counselling at the time of discharge. Significant associations were found between the qualification of pharmacists and the presence of a clinical pharmacist system ( P = 0.018 ). Working experience was associated with inadequate staffing ( P = 0.016 ), patient counseling at discharge (P = 0.018) and lack of trust from physicians ( P = 0.002 ). Lack of administrative support 70 (55.1%), shortage of clinical pharmacists 98 (77.1%), lack of physician’s trust 64 (50.4%), inadequate staffing 78 (61.6%), and patient unawareness of pharmacist’s role 98 (77.1%) were identified as key barriers to pharmaceutical care provision. Among facilitators, private consultation areas for pharmacist 116 (91%), strong physician-pharmacist collaboration 121 (95.2%) and pharmacist participation in medical rounds 80 (63.0%) were found to be associated with pharmaceutical care provision. Conclusions This study highlights the growing emphasis on pharmaceutical care, along with identifying areas that require improvement in tertiary healthcare settings in Pakistan.

Sea otter populations in Southeast Alaska, USA, have increased dramatically from just over 400 translocated animals in the late 1960s to >8,000 by 2003. The recovery of sea otters to ecosystems from which they had been absent has affected coastal food webs, including commercially important fisheries, and thus information on expected growth and equilibrium abundances can help inform resource management. We compile available survey data for Southeast Alaska and fit a Bayesian state-space model to estimate past trends and current abundance. Our model improves upon previous analyses by partitioning and quantifying sources of estimation error, accounting for over-dispersion of aerial count data, and providing realistic measurements of uncertainty around point estimates of abundance at multiple spatial scales. We also provide estimates of carrying capacity (K) for Southeast Alaska, at regional and sub-regional scales, and analyze growth rates, current population status and expected future trends. At the regional scale, the population increased from 13,221 otters in 2003 to 25,584 otters in 2011. The average annual growth rate in southern Southeast Alaska (7.8%) was higher than northern Southeast Alaska (2.7%); however, growth varied at the sub-regional scale and there was a negative relationship between growth rates and the number of years sea otters were present in an area. Local populations vary in terms of current densities and expected future growth; the mean estimated density at K was 4.2 ± 1.58 sea otters/km² of habitat (i.e., the sub-tidal benthos between 0 m and 40 m depth) and current densities correspond on average to 50% of projected equilibrium values (range = 1–97%) with the earliest-colonized sub-regions tending to be closer to K. Assuming a similar range of equilibrium densities for currently un-occupied habitats, the projected value of K for all of Southeast Alaska is 74,650 sea otters. Future analyses can improve upon the precision of K estimates by employing more frequent surveys at index sites and incorporating environmental covariates into the process model to generate more accurate, location-specific estimates of equilibrium density.

The unsuccessful attempt to add a citizenship question to the 2020 US Census has drawn attention to citizenship questions on other surveys. Simultaneously, researchers have noted a secular increase in Current Population Survey (CPS) non-response. We combine these topics, studying the effect of the CPS citizenship question, added in the 1994 CPS redesign, on refusals. Direct panel regressions show states with higher rates of non-citizenship have higher refusal rates. An event-study regression discontinuity shows a 20-40% increase in refusals attributable to the redesign. Moreover, a difference-in-differences research design shows states with larger non-citizen and Hispanic populations were more affected by the redesign. These results imply the question causes non-citizens and Hispanics to refuse to participate in the survey disproportionately. Given the question appears to threaten the representativeness of the survey, we recommend there be a randomized controlled trial to precisely determine the question’s effects.

To assign values to the health states of children, some health economists have suggested relying on the ‘proxy’ preferences among the health states of children expressed by a random sample of the adult population. These preferences have been elicited in several ways, with respondents sometimes asked to express their (adult) preferences among the health states of children, and sometimes asked to imagine themselves as children and to express what they think their preferences would be. This essay discusses three grounds for eliciting the preferences of a random sample of adults that have been suggested as ways to assign values to the health states in the EQ-5D-Y, and criticizes the first two: (1) the evidential ground: the preferences of the population sample are good evidence of how good or bad the health states of children are; (2) the ‘taxpayer’ ground: the adult population has the authority to assign values to health states, therefore their preferences are determinative; and (3) the pragmatic grounds: surveying is straightforward and shifts the responsibility from health economists to the population. I argue that instead of surveying a random sample of the population, health economists should rely on deliberative groups that include older children, experts on children’s health and development, as well as members of the population at large. These groups should engage with the reasons that lie behind preferences among health states.

Among many coastal hazards, rip currents have gradually become one of the most noticeable hazards. Studies have demonstrated that most drowning accidents at beaches around the world are related to rip currents. In this study, online and field questionnaires were combined for the first time to reveal beachgoers’ awareness of rip currents in China from four aspects: demographic characteristics, swimming ability, information about visiting beaches, and knowledge about rip currents. One educational strategy was introduced to the field survey. The results suggest that (i) the proportion of online and field respondents who have heard of “rip currents” and seen warning signs of rip currents is extremely small. This reflects that beachgoers lack awareness of rip current hazards. Thus, China needs to strengthen the safety education of rip current knowledge. (ii) The level of awareness of rip currents can significantly affect the community’s ability to identify the location of rip currents and their choice of escape direction. (iii) In the field survey, we implemented an educational strategy as an intervention for respondents, and the accuracy of identifying rip currents and choosing the correct escape route improved by 34% and 46.7%, respectively. This implies that the intervention of educational strategy can significantly deepen beachgoers’ awareness of rip currents. It is recommended that more educational strategies about rip current knowledge be implemented on Chinese beaches in the future.

Purpose Although the popularity of the Lean Six Sigma (LSS) methodology has illustrated many benefits over the years for those organisations who have implemented it, this strategy has received less attention in developing countries. The purpose of this paper is to critically assess the current status of LSS implementation in Saudi Arabian organisations. Design/methodology/approach This research is based on a descriptive survey questionnaire which has been derived from two systematic literature reviews. The survey was distributed to 400 organisations in Saudi Arabia using Qualtrics online software. In total, 146 responses were received where 102 responses were completed and analysed. Findings The findings of the survey highlighted that the implementation of LSS is still in the early stages in organisations within Saudi Arabia. This was clearly shown by many factors such as years of deploying LSS, LSS infrastructure, level of awareness of LSS, impact of LSS on business functions and so on. Research limitations/implications The primary limitation of this study is that data has been collected from an online survey and therefore no deeper insights could have been captured from the survey. This calls for future research to be undertaken by executing semi-structured interviews in selective organisations within Saudi Arabia. Originality/value This paper contributes to the current status of LSS in Saudi Arabian organisations. It also gives recommendations to guide the future of LSS in Saudi organisations by comparing LSS literature with best practice.